Impact of Nasal Symptoms on the Quality of Life of Fresh Inductees in High Altitude

Background

Troops deployed in high altitude areas of Ladakh face nasal problems in the form of obstructive nasal symptoms and recurrent epistaxis. This study analyses the changes in the nasal mucociliary transit times (NMTT) and deterioration in quality of life of troops on first high altitude induction.

Methods

A prospective study on 100 healthy volunteers was done. Mucociliary transit time was measured and a standardized quality of life questionnaire (RQLQ) administered at onset and after a period of three months in high altitude. Thereafter the subjects were divided into two groups and the study group was administered normal saline nasal drops. The observations were taken and results were statistically analysed after a period of three months.

Result

The mucociliary transit time was prolonged after a three month stay in high altitude (p< 0.005). Normal saline nasal drops were successful in improving the nasal mucociliary transit times (p < 0.05). There was a statistically significant derangement in the quality of life which was improved by administering normal saline nasal drops (p<0.05).

Conclusion

An increased muco-cilliary transport time after exposure to high altitude denotes a deranged physiology of the nasal mucosa. This leads to a statistically significant adverse impact on the quality of life of the troops deployed. The use of normal saline nasal drops is a simple and effective method of reversing some of these changes.Key Words: High altitude, Nasal mucosa, Military medicine     

Variation of semen parameters in healthy medical students due to exam stress

Aim

This study was aimed at investigating semen parameters that vary most in samples of healthy donors undergoing stressful examination period.

Methods

Samples were left to liquefy in an incubator at 37°C, 5% CO2 for 30 minutes before volume was measured. Concentration and motility parameters were measured by means of computer assisted semen analysis (CASA) using Sperm Class Analyzer® (Microptic S.L, Madrid, Spain).

Results

Sperm concentration was significantly decreased in samples donated close to the exam period as well as samples donated during the exam period when compared to samples donated at the beginning of the semester.

Conclusion

Stress levels of donors might prove to be clinically relevant and important when designing experiment protocols.     

Objective criteria for diagnosing high altitude pulmonary edema in acclimatized patients at altitudes between 2700?m and 3500?m

Background

The criteria used for diagnosing high altitude illnesses are largely based on Western literature. This study was undertaken to define objective, simple and reliable diagnostic criteria for high altitude pulmonary edema (HAPE) in Indian soldiers at altitudes between 2700 m and 3500 m.

Methods

Clinical data of 235 cases of HAPE that occurred between 2700 m and 3500 m were analysed. Receiver operator characteristic (ROC) curve analysis was used to select simple clinical parameters suitable for the diagnosis of HAPE at peripheral medical facilities. Cut-off values and their reliability for the diagnosis of HAPE were defined.

Results

HAPE occurred 2.8 ± 2.2 days after arrival at altitudes between 2700 m and 3500 m. Breathlessness, cough, chest discomfort and headache were the commonest symptoms. Low pulse oximetry (SPO₂) values than normal for this altitude were seen in 89% of patients. ROC analysis of clinical parameters identified a heart rate more than 95 beats per minute (bpm), respiratory rate more than 21 per minute and SPO₂ less than 86% while breathing ambient air at this altitude as diagnostic of HAPE. The sensitivity and specificity of these cut-offs was 0.66, 0.83 and 0.82 and 0.94, 0.95 and 0.93 respectively.

Conclusion

A heart rate of more than 95 bpm, respiratory rate more than 21 per minute and SPO₂ less than 86% breathing room air in individuals complaining of breathlessness, cough, chest discomfort or headache within the first 5 days of arrival at altitudes between 2700 m and 3500 m is highly suggestive of HAPE.     

D-dimer in the diagnostic workup of suspected pulmonary thrombo-embolism at high altitude

Background

Pulmonary thrombo-embolism (PTE) is relatively common in high altitude areas where radiological diagnostic facilities are usually not available. So this study was undertaken to use the results of D-dimer assay to determine the need for imaging studies in patients suspected of having PTE at high altitude.

Methods

A total of 101 patients at an altitude of > 3,000 m suspected of having PTE were evacuated. D-dimer and imaging studies were carried out to confirm the diagnosis.

Results

A total of 101 patients suspected of having PTE underwent D-dimer level estimation and imaging studies for PTE. Sixty-eight of these had negative findings) on D-dimer assay. All these patients with negative findings on D-dimer assay had negative findings on pulmonary imaging studies also. So this test is very sensitive with very high negative predictive value (NPV). Whereas, 17 out of 33 patients positive for D-dimer, had positive findings on imaging studies, indicating a relatively less specific test.

Conclusion

Clinical assessment in combination with D-dimer assay can be used for timely differentiation of PTE from other conditions such as high altitude pulmonary oedema (HAPO) especially at isolated high altitude areas/military posts, so that patients could be evacuated as early as possible by fastest means to save the precious lives and in hospital settings this test identifies patients to whom anticoagulant therapy should not be given or patients who should not be subjected to invasive imaging tests.Key Words: D-dimer test, PTE     

A framework for assessing patient crossover and health information exchange value

Objective

To evaluate the benefit of a health information exchange (HIE) between hospitals, we examine the rate of crossover among neurosurgical inpatients treated at Emory University Hospital (EUH) and Grady Memorial Hospital (GMH) in Atlanta, Georgia. To inform decisions regarding investment in HIE, we develop a methodology analyzing crossover behavior for application to larger more general patient populations.

Design

Using neurosurgery inpatient visit data from EUH and GMH, unique patients who visited both hospitals were identified through classification by name and age at time of visit. The frequency of flow patterns, including time between visits, and the statistical significance of crossover rates for patients with particular diagnoses were determined.

Measurements

The time between visits, flow patterns, and proportion of patients exhibiting crossover behavior were calculated for the total population studied as well as subpopulations.

Results

5.25% of patients having multiple visits over the study period visited the neurosurgical departments at both hospitals. 77% of crossover patients visited the level 1 trauma center (GMH) before visiting EUH.

Limitations

The true patient crossover may be under-estimated because the study population only consists of neurosurgical inpatients at EUH and GMH.

Conclusion

We demonstrate that detailed analysis of crossover behavior provides a deeper understanding of the potential value of HIE.     

Performance factors of mobile rich media job aids for community health workers

Objective

To study and analyze the possible benefits on performance of community health workers using point-of-care clinical guidelines implemented as interactive rich media job aids on small-format mobile platforms.

Design

A crossover study with one intervention (rich media job aids) and one control (traditional job aids), two periods, with 50 community health workers, each subject solving a total 15 standardized cases per period per period (30 cases in total per subject).

Measurements

Error rate per case and task, protocol compliance.

Results

A total of 1394 cases were evaluated. Intervention reduces errors by an average of 33.15% (p=0.001) and increases protocol compliance 30.18% (p<0.001).

Limitations

Medical cases were presented on human patient simulators in a laboratory setting, not on real patients.

Conclusion

These results indicate encouraging prospects for mHealth technologies in general, and the use of rich media clinical guidelines on cell phones in particular, for the improvement of community health worker performance in developing countries.     

Sociotechnical challenges to developing technologies for patient access to health information exchange data

Background

Providing patients with access to their medical data is widely expected to help educate and empower them to manage their own health. Health information exchange (HIE) infrastructures could potentially help patients access records across multiple healthcare providers. We studied three HIE organizations as they developed portals to give consumers access to HIE data previously exchanged only among healthcare organizations.

Objective

To follow the development of new consumer portal technologies, and to identify barriers and facilitators to patient access to HIE data.

Methods

Semistructured interviews of 15 key informants over a 2-year period spanning the development and early implementation of three new projects, coded according to a sociotechnical framework.

Results

As the organizations tried to develop functionality that fully served the needs of both providers and patients, plans were altered by technical barriers (primarily related to data standardization) and cultural and legal issues surrounding data access. Organizational changes also played an important role in altering project plans. In all three cases, patient access to data was significantly scaled back from initial plans.

Conclusions

This prospective study revealed how sociotechnical factors previously identified as important in health information technology success and failure helped to shape the evolution of three novel consumer informatics projects. Barriers to providing patients with seamless access to their HIE data were multifactorial. Remedies will have to address technical, organizational, cultural, and other factors.     

Research and applications: The intended and unintended consequences of communication systems on general internal medicine inpatient care delivery: a prospective observational case study of five teaching hospitals

Background

Effective clinical communication is critical to providing high-quality patient care. Hospitals have used different types of interventions to improve communication between care teams, but there have been few studies of their effectiveness.

Objectives

To describe the effects of different communication interventions and their problems.

Design

Prospective observational case study using a mixed methods approach of quantitative and qualitative methods.

Setting

General internal medicine (GIM) inpatient wards at five tertiary care academic teaching hospitals.

Participants

Clinicians consisting of residents, attending physicians, nurses, and allied health (AH) staff working on the GIM wards.

Methods

Ethnographic methods and interviews with clinical staff (doctors, nurses, medical students, and AH professionals) were conducted over a 16-month period from 2009 to 2010.

Results

We identified four categories that described the intended and unintended consequences of communication interventions: impacts on senders, receivers, interprofessional collaboration, and the use of informal communication processes. The use of alphanumeric pagers, smartphones, and web-based communication systems had positive effects for senders and receivers, but unintended consequences were seen with all interventions in all four categories.

Conclusions

Interventions that aimed to improve clinical communications solved some but not all problems, and unintended effects were seen with all systems.     

Esthetics and Biocompatibility of Composite Dental Laminates

Background

Advances in modern dental materials provide patients with a choice of natural looking veneers to provide esthetic restorations. These may be directly fabricated composite resin veneers or indirectly fabricated veneers. This study was carried out to evaluate the clinical effect of new generation indirect veneering composites and to compare them with veneers fabricated from direct composite restorations.

Methods

The present study was carried out in the Prosthodontics department of a medical college. A total of forty patients requiring restoration of the anterior teeth using composite veneers were selected and either of the two materials was used to fabricate the veneers.

Result

Clinical evaluation was done for esthetics and periodontal health. Statistical analysis showed that there were no significant changes to the periodontal health during the period of the study.

Conclusion

The evidence obtained from this study indicates that both direct as well as indirect composite materials had clinically acceptable outcomes in terms of restoration of esthetics. Biocompatibility with the periodontal tissues of both materials was also evident by the improvement in oral health indices used in the study.Key Words: Veneers, Indirect composites, Biocompatibility     

Multidisciplinary assessment of vision in children with neurological disability

Introduction

There is no consensus as to the best method of assessing vision in children with neurological disability. There are a variety of tests and approaches that can be used. It is important to look at models of assessment that identify the visual diagnosis and provide appropriate feedback and explanation to parents, carers and educational professionals.

Methods

This study reports on the results of comprehensive visual assessments of fifty children with neurological disability over a three year period. It focuses on the feedback from families and professionals after the assessment report was disseminated.

Results

The majority of families and professionals strongly agreed that a specialist assessment was needed in this population. Parents and professionals particularly valued the written report which provided guidance on appropriate visual material including advice relevant to education.

Conclusion

This study highlights the importance of specialist teams engaging with local child development services and indicates how partnership working can potentially be emotionally supportive as well as developmentally beneficial.     

HPLC analysis of camptothecin content in various parts of Nothapodytes foetida collected on different periods

Objective

To investigate the content of topoisomerase I-DNA inhibitor alkaloid camptothecin (CPT) from various parts of Nothapodytes foetida (N. foetida) collected from the month of October to February.

Methods

The content of CPT was quantified in the methanolic extract of various parts of N. foetida using high performance liquid chromatography (HPLC). Quantification was performed with the regression analysis and the method was validated as per ICH guidelines.

Results

The results revealed that maximum concentrations of camptothecin were found in root (2.62%) collected in the month of February followed by fruits (January, 1.22%), stem (January, 0.81%) and leaves (February, 0.70%). Roots were found to have 3-fold higher concentration of CPT than the leaves and stem, while the fruits showed 2-fold higher concentration. Maximum concentration of camptothecin in fruits was observed in month of January, when they were not fully mature, which was 2-fold higher than that of young and fully mature fruits.

Conclusions

These findings indicate that the synthesis of CPT differs in different parts of N. foetida and the content varies periodically.     

Trends of Sexually Transmitted Infections : A 33 Year Experience

Background

Sexually Transmitted Infections (STIs) are a major public health problem the world over. This study was aimed at analyzing the trends of STIs in a 33 year period at a tertiary care service hospital.

Methods

A retrospective data analysis was done of all the cases diagnosed as STIs during a 33 year period from 1974 to 2006.

Result

A total of 4532 STIs were seen in 4215 males. The commonest STI was chancroid (37.2%), followed by syphilis (16.2%). The commonest age group involved was the 21-30 year group (57.6 %). STIs declined from a total of 311 cases in 1974 to seven cases in 2006. This trend was mirrored in all major STIs. Multiple STIs were seen in 317 (07.5%) cases.

Conclusion

The frequency of STIs has shown a distinctly decreasing trend from over the last 33 years.Key Words: Sexually transmitted infections, Trends     

Outbreak of Scrub Typhus in Jammu – A Report

Background

Jammu is scrub typhus prone. Scrub typhus is often seen when troops move out of permanent locations.

Methods

In a prospective study cases of fever reporting to the local military hospital from July to October 2002 were examined clinically, investigated and categorised as scrub typhus when Weil Felix readings were above 1:160.

Results

Twelve cases of scrub typhus were diagnosed during the period of study. The clinical features included fever, malaise and conjunctival congestion. However rashes were rare and only one had an eschar. Multisystem complications occurred in one patient. There was a spatial and temporal clustering of cases. Control of outbreak was carried out by 25% benzyl benzoate impregnation of clothing, clearing of scrub, residual spray with malathion and antirodent measures.

Conclusion

Scrub typhus outbreaks have been noted whenever troops move out of permanent locations to scrub areas.Key Words: Scrub typhus, Mites, Eschar     

Antiglycation,antioxidant and toxicological potential of polyphenol extracts of alligator pepper,ginger and nutmeg from Nigeria

Objective

To evaluate the antioxidant and antiglycation potential of polyphenols from three spices; alligator pepper, ginger and nutmeg.

Methods

Polyphenol extracts of these spices were subjected to brine-shrimp lethality assay, phytotoxicity test, DPPH and superoxide anion radical scavenging as well as BSA-glucose antiglycation assay.

Results

Results obtained showed that polyphenol extract of ginger has the highest antioxidant potential with IC₅₀ 0.075 and 0.070 mg/mL for DPPH and superoxide anion radical scavenging assay while alligator pepper displayed highest antiglycation activity with IC₅₀ 0.125 mg/mL. However, nutmeg extract exhibited weakest cytotoxic and phytotoxic potential with LD₅₀ 4359.70 and 1490 µg/mL respectively.

Conclusions

It can be concluded that the polyphenol extracts of alligator pepper, ginger and nutmeg displayed good antioxidant as well as antiglycation potential and are safe for consumption.     

Hypoglycemic effect of Brassica juncea (seeds) on streptozotocin induced diabetic male albino rat

Objective

To evaluate the hypoglycemic effect of Brassica juncea (seeds) on streptozotocin induced diabetic male albino rats.

Methods

Hypoglycemic activity of Brassica juncea (seeds) aqueous extract at a dose of 250, 350 and 450 mg/kg body weight was evaluated. Adult male Swiss albino rats of six numbers in each group was undertaken for study and evaluated.

Results

The serum insulin levels were recorded a significant depletion in all groups, short term as well as long term diabetic animals, when compared to that of normal animals. A significant dosage dependent augmenting effect of the seed extract on the serum insulin was recorded in both short term as well as long term groups.

Conclusions

The aqueous seed extract of Brassica juncea has potent hypoglycemic activity in male albino rat.     

Tear Break-up Time in High Altitude Areas

Background

In high altitude areas, patients report with irritation, redness and foreign body sensation in their eyes suggesting tear film abnormality due to low humidity and windy environmental conditions.

Methods

Tear Break- up Time (TBUT) was studied in 100 subjects consisting of local population and those originally from plains residing in high altitude areas in Ladakh.

Result

There were 24% individuals with TBUT of < 5 seconds, 30% between 6-10 seconds and 46% with TBUT of > 10 seconds. In symptomatic patients with TBUT of <5 seconds, eight cases had irritation of eyes, six foreign body sensation and two cases had pain, watering, irritation and redness of eyes. Pterygium was seen in 12 individuals and inter palpebral congestion in 4 cases. Conclusion: A total of 24% cases showed abnormal (<5 seconds) TBUT. Abnormality of tear film in the presence of low humidity and windy condition with high ultraviolet radiation may lead to ocular discomfort and pterygium in these areas.Key Words: Tear Break-up Time (TBUT), High altitude areas (HAA)     

Governance for clinical decision support: case studies and recommended practices from leading institutions

Objective

Clinical decision support (CDS) is a powerful tool for improving healthcare quality and ensuring patient safety; however, effective implementation of CDS requires effective clinical and technical governance structures. The authors sought to determine the range and variety of these governance structures and identify a set of recommended practices through observational study.

Design

Three site visits were conducted at institutions across the USA to learn about CDS capabilities and processes from clinical, technical, and organizational perspectives. Based on the results of these visits, written questionnaires were sent to the three institutions visited and two additional sites. Together, these five organizations encompass a variety of academic and community hospitals as well as small and large ambulatory practices. These organizations use both commercially available and internally developed clinical information systems.

Measurements

Characteristics of clinical information systems and CDS systems used at each site as well as governance structures and content management approaches were identified through extensive field interviews and follow-up surveys.

Results

Six recommended practices were identified in the area of governance, and four were identified in the area of content management. Key similarities and differences between the organizations studied were also highlighted.

Conclusion

Each of the five sites studied contributed to the recommended practices presented in this paper for CDS governance. Since these strategies appear to be useful at a diverse range of institutions, they should be considered by any future implementers of decision support.     

Enhancement of wound healing with roots of Ficus racemosa L. in albino rats

Objective

To establish the wound healing activity of aqueous and ethanolic extract of roots of Ficus racemosa (F. racemosa).

Methods

Two models were performed to evaluate the wound healing activity i.e. incision and excision models. In incision model the parameter which was carried out was breaking strength of wounded skin. In excision model percentage wound contraction and period of epithelialization were established for both the extracts. Reference standard drug was povidone iodine ointment for comparison with other groups.

Results

From the observation in both two models, aqueous extract of F. racemosa was found to have greater wound healing activity in terms of breaking strength in incision model and percentage wound contraction, period of epithelialization in excision model than that of other groups.

Conclusions

In conclusion, our findings suggest that aqueous extract of F. racemosa possesses better wound healing ability than the ethanolic extract.