The impact of frailty syndrome and risk scores on emergency cholecystectomy patients

Abstract

Purpose

Cholecystectomy, which is one of the most common surgical procedures, is also performed in the emergency setting. A number of risk scores have been introduced in recent studies; moreover, over the last few years literature has focused on surgical patients with frailty syndrome. The aim of the present study is to evaluate whether frailty syndrome and the risk scores are correlated with morbidity, post-operative hospital stay and the ICU admission rate following emergency cholecystectomy.

Methods

Eighty-five consecutive patients of >65 years of age who underwent cholecystectomy were selected from 2306 emergency procedures for inclusion in the present study. The patients were assessed for frailty syndrome and their scores were calculated on the basis of chart review. Univariate analyses were performed to compare severe frailty patients to intermediate frailty and robust patients. ROC and logistic regression analyses were performed with the end-points of morbidity, hospital stay and ICU admission.

Results

In addition to having worse ASA, inflammatory and risk values than robust patients, frailty syndrome patients also had higher rates of morbidity and ICU admission and longer hospitalization periods. A logistic regression analysis showed that the P-Possum was independently correlated with morbidity. Frailty and open surgery were independently correlated with longer hospitalization, whereas ICU admission was correlated with worse ASA and P-Possum values.

Conclusions

Frailty syndrome significantly impacts the length of hospitalization in patients undergoing emergency cholecystectomy. Although the ORs were limited, the P-Possum value was independently associated with the outcome.

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Are family medicine residents physically active? And do they counsel their chronically ill patients about physical activity? A cross-sectional study among residents of the family medicine joint program, eastern province, Saudi Arabia

2016-05-30T09-42-12Z
Source: International Journal of Medical Science and Public Health
Malak Audah Al Shammari.
Background: Physical activity is a major factor in both preventing chronic illness and in controlling it in already diseased patients. It has been established that a physically active physician may be more likely to counsel patients about the benefits of physical activity and patients tend to adhere to exercise regimens when advised by a physician they think of as a role model. Objective: To determine the amount of physical activity the family medicines residents adhere to and to determine if family medicine residents practice what they counsel to their patients regarding physical activity. Materials and Methods: All family medicine residents in all of the training levels were recruited to take part in the International Physical Activity Questionnaire (IPAQ) survey voluntarily. Levels of physical activity were divided into three categories: low, moderate, and high, according to the guidelines of data processing of the IPAQ. Section two of the survey assessed whether residents in fact counseled patients with chronic prevalent diseases (coronary artery disease, diabetes mellitus, obesity, etc.) about physical activity and the ranking of the most important health determinants according to them. Result: The sample size consisted of 80 participants, all residents of the program from R1 to R4. We have found that the majority >70% of them had low level of physical activity. The majority (96%) did counsel their patients about physical activity especially when the patient had diabetes. Conclusion: Although residents of the joint family medicine program of the eastern province of the Kingdom of Saudi Arabia were not, self-reportedly, physically active themselves, they were active in patient counseling regarding the importance of physical activity in achieving global health and well-being.


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Treatment of plantar fasciitis with dexamethasone with lidocaine hydrochloride

2016-05-30T09-42-12Z
Source: International Journal of Medical Science and Public Health
Sumit Kalra.
Background: Plantar heel pain is a commonly occurring foot complaint. Various electrotherapy modalities are frequently utilized as a treatment. Objective: To determine the effects of a combination of dexamethasone with lidocaine hydrochloride for the treatment of patients with plantar fasciitis (PF). Materials and Methods: A total of 40 patients suffering from PF were divided into two groups; Group A received iontophoresis with distilled water along with 4 mg/mL dexamethasone and 2 cm3 of lidocaine hydrochloride (4% lidocaine hydrochloride), and Group B received iontophoresis with distilled water. Both groups received stretching of plantar fascia and calf muscles, followed by ultrasound for 5 min. Treatment for each patient was for a period of 2 weeks with 3 sessions per week. Result: Group A showed significant decrease in symptoms of PF posttreatment. Conclusion: Iontophoresis with lidocaine hydrochloride showed better results in decreasing symptoms of PF as compared to iontophoresis with distilled water only.


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Foreign body inhalation in children: clinical presentations and x-ray chest findings

2016-05-30T09-42-12Z
Source: International Journal of Medical Science and Public Health
Nisar Hussain Dar, Suhail Amin Patigaroo, Tahir Hussain.
Background: Foreign body aspiration (FBA) is a medical emergency in children. Delay in diagnosis and treatment can cause complications and even deaths are reported. Objective: The aim of this study was to find out clinical features and x-ray findings in patients with FBA. Materials and Methods: A retrospective analysis was done on all patients less than 15 years of age with the discharge diagnosis of FBA from 2011 to 2014 at SMHS Hospital in Kashmir province. Results: Out of 140 patients with FBA, 87 (62%) were male. The mean age was 48 months. The most common clinical findings were history of chocking (77%), decreased breath sounds (42%), wheezing (38%), cough (20%), respiratory distress (15.5%), and fever. CXR was normal in 46% of patients. Air trapping (emphysema) was the most common radiological finding (29.5%) followed by atelectasis (14%) and consolidations (9.2%) and opaque foreign bodies (5.7%). Gram seeds (pulses) were the commonest foreign body (40%). Bronchoscopic removal of foreign body was done successfully in 133 patients (95%). Conclusion: Although FBA in children diagnosed by history, physical examination and radiographic findings, but this finding may be misleading. Negative X-ray chest should not exclude the diagnosis of FBA in children especially with a strong history of FBA. Early bronchoscopic examination will be safe and lifesaving.


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Toward primordial prevention of childhood obesity—predictors and parameters of childhood obesity

2016-05-30T09-42-12Z
Source: International Journal of Medical Science and Public Health
Anil Kumar Paruchuri, Mohammed Faisal, Samiksha Singh.
Background: Overweight children may become overweight adults, particularly if obesity is present in adolescence. There are very much chances of children to become obese if they have obese parents. Parents can contribute both the genes and eating environment for their children and familial patterns of adiposity because of gene-environment interactions. Objective: To find out associations between parental and child overweight and obesity. Materials and Methods: This was a cross-sectional study done in the schools of a city of South India. Children between the ages of 1215 years were included in the study. During the enrollment, study objectives and methodology were explained to each participant, and written consent was taken. Result: There was a poor but statistically significant correlation between childs BMI and fathers BMI (r = 0.226, p = 0.000). Similarly, the correlation between childs BMI and mothers BMI was poor but statistically significant (r = 0.252, p = 0.000). Poor but statistically significant correlation was also observed between BMI and waist-to-height ratio (r = 0.189, p = 0.000) and waisthip ratio (r = 0.127, p = 0.000) of children. Conclusion: The results of this study may assist to identify those children who have more chances to become overweight and obese in adulthood. Parental overweight or obesity is one of the important factors for the development of obesity in the children. Strategies for prevention of overweight and targeted interventions for prevention of the progression of overweight to obesity are required in school-aged children.


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An assessment of the functioning of the Village Health Sanitation and Nutrition Committee in the rural areas of Kamrup district, Assam

2016-05-30T09-42-12Z
Source: International Journal of Medical Science and Public Health
Manjit Das, Jutika Ojah, Rupali Baruah.
Background: The Village Health Sanitation and Nutrition Committee (VHSNC) is a first step toward decentralized planning and community empowerment approach. Objective: To assess the constitution of the VHSNCs, to assess the activities undertaken by them, and to assess the funding and utilization status of the VHSNCs. Materials and Methods: Study designCommunity-based cross-sectional study. Study placeThree blocks of Kamrup district viz, Boko-Bongaon, Hajo, and Sualkuchi. Study periodJuly 1 to October 31, 2015. Study populationThe functionaries of VHSNCs present during visit and the records maintained. Sample sizeTotal 78 VHSNCs were assessed in this study. Sample collection techniqueOut of the total 12 blocks, 3 blocks were selected. Sub-centers (50%) under these three blocks selected and two villages from each SC selected. All the 78 VHSNCs operating in these villages were included in this study. Data collection toolPredesigned and pretested schedule containing both open- and closed-ended questions. Primary data were collected by interview method and secondary data obtained from various records. Results: 55.12% VHSNCs had 11 or more members. Panchayati Raj Institution (PRI) member, Auxiliary Nurse Midwife (ANM), Accredited Social Health Activist (ASHA), Anganwadi Worker (AWW), and Medical officer were members in all of the committees. Only 16.67% of the VHSNCs conducted 1012 meetings in 1 year. 16.67% VHSNCs had maintained and updated the untied fund register. Formation of new committee and new members (96.15%), ASHAs incentive (94.87%), and Anganwadi Center (AWC) repairing (88.76%) were commonly discussed topics in monthly meetings. A majority of 67.93% VHSNCs utilized more than 90% of the funds allotted to them. Conclusion: It was observed that although VHSNCs have been constituted in all of the revenue villages in the study area, there are several lacunae in their organization.


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Infant feeding beliefs and practices among tribal mothers in Nashik district, Maharashtra

2016-05-30T09-42-12Z
Source: International Journal of Medical Science and Public Health
Reshma R Garje, Sunil Kumar Thitame, Konduri V Somasundaram, Laxmi Gautam, Mahesh S Gite.
Background: Breast milk is the safest and nutritious food for infant. Colostrum feeding provides nutrients and immunity to the newborn. Early initiations of breastfeeding and exclusive breastfeeding practices are essential for both infants and mothers. Even though breastfeeding is almost universal in India, culture and tradition exhibit great impact in breastfeeding practice. Objective: To study the beliefs and practice about breastfeeding and identify the impact of selected sociodemographic factors on the infant feeding practices in rural ethnic mothers. Materials and Methods: A cross-sectional study was conducted from December 2014 to April 2015 among 400 rural ethnic mothers having infants and attending Mobile Medical Unit under NRHM in Nasik, Maharashtra. Interview was done by using predesigned, semi-structured questionnaire. Result: The average age of respondents was 22.47 ± 2.58 years; most of them (67.3%) were from the age group 2125 years. Average age at marriage was 17.5 ± 0.81 years, and average age at first pregnancy was 19.04 ± 0.77 years. Almost half (49.3%) of the respondents got married below the age of 18 years, and 75% of them were pregnant with their first baby when they were still at their teenage. Over 55% of the respondent belonged to scheduled tribes category. Majority of the women (42.3%) revealed less than 4 years of schooling, while 13.8% of them never attended school. Majority (61.3%) of the respondents were daily wage laborers. Colostrum feeding was observed in 88.8% study subjects, prelacteal feeding in 17.5%, early initiation of breastfeeding in 70.1%, and exclusive breastfeeding in 83.8%. Conclusion: Even though knowledge and practice of breastfeeding was better, early marriage and early conception were concerns that require attention.


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