Effects of stage-matched repeated individual behavioural counselling session (RIBCS) as an intervention for decreased and stopping smoking.

We aimed to evaluate the effects of stage-matched repeated individual behavioural counselling (RIBCS) on the basis of the transtheoretical model (TTM) as an intervention to reduce and stop smoking. This study was conducted over a period of one year where all smokers presenting to a chest clinic in a tertiary centre were enrolled, each was classified on the basis of stage of readiness to change and underwent repeated counselling for a period of six months and each session was preceded and succeeded with filling of Fagerstorm test for nicotine dependence. Over the period of a year, 207 patients participated in this study, the mean age was 50.74±14.74 years; mean duration of tobacco use was 29.43±14.72 years; 64.3% were illiterate, 11.6% primary education, 14.1% were matric and while 10.1% were graduate. About 73% of smokers reported high level of nicotine dependence (FTND score >5/10). In the present study mean dependence score was 6.0±1.96; 44 (21.3%) were in pre-contemplation stage, 93 (44.9%) were in contemplation, 57 (27.5%) were in preparation and 13 (6.3%) were in action. The point prevalence excellence rate in follow up-I was 15%, follow up-II was 35.3% and follow up-III was 61.9% which was statistically significant. When we took both abstinence and reduction in smoking behaviour as one, p-value was <0.05. The point prevalence of abstinence rate (questionnaire validated) 1 month to 6 months was almost 4 times. Our intervention (RIBCS) succeeded in increasing the abstinence rates during the study period among smokers with a lower motivation to quit (pre-contemplators and contemplators) as well as those ready to quit (preparators). This is significant because of most existing smoking-cessation interventions target only motivated smokers, with few having a positive effect in smokers with a lower motivation to quit.

Personal Protective Equipment: A Pandora's Box.

Countries all over the world writhing under the wrath of coronavirus face not only the challenge of protecting their population but the tougher challenge of protecting their healthcare workers (HCWs) dealing with the patient population. This pandemic has put unprecedented pressure on global healthcare systems, with personal protective equipment (PPE) being the most notable one. Apart from the challenge of procurement of PPE, the major challenge is rationalizing the use of PPE in this war against corona virus disease 19 (COVID19). Using PPE comes with its own set of problems such as extreme exhaustion, rashes, inability to consume food, or use washroom which can result in clouding of judgment and breach of infection barrier. Making PPE user-friendly and limiting the interaction of HCW with COVID19 patients coupled with the use of robotics, telemedicine, and other innovations is the need of the hour. HOW TO CITE THIS ARTICLE: Chawla G, Abrol N, Kakkar K. Personal Protective Equipment: A Pandora's Box. Indian J Crit Care Med 2020;24(5):371-372.

Comparison of two different doses of hyperbaric bupivacaine for intracavitary radiotherapy in patients with carcinoma cervix - A randomized control trial.

Background: Subarachnoid block has been used for intracavitary radiotherapy (ICRT) for carcinoma cervix, but the literature on the appropriate dose of local anesthetic required to achieve the desired effect is lacking. We compared two different intrathecal doses of 0.5% hyperbaric bupivacaine (1.2 and 1.5 mL) for providing optimal surgical conditions and readiness to discharge in patients undergoing ICRT for carcinoma cervix. Materials and Methods: This prospective double-blind study was done in 80 patients undergoing ICRT. The patients were randomized into two groups (Groups I and II) to receive 1.2 and 1.5 mL of intrathecal hyperbaric bupivacaine, respectively, for ICRT. The level of sensory achieved, the patient satisfaction score, radiation oncologist score, time to L5 regression, and time to motor recovery (walking unaided) were assessed. Statistical Analysis Used: The data were analyzed using SPSS 20 for Windows (IBM, Chicago, IL, USA). Results: The time taken for the block to regress to L5 (Group I: 134.6 ± 32.4 minutes vs. Group II: 143.2 ± 43.0 minutes, P = 0.31) were comparable. However, the mean time for walking unaided (Group I: 220.87 ± 47.12 minutes versus Group II: 247.00 ± 49.83 minutes, P = 0.032) after the subarachnoid block was significantly less in Group I. The patient satisfaction with the procedure and overall satisfaction of the radiation oncologists regarding the operating condition were comparable in both the groups. Conclusions: Hence, a 1.2 mL dose of intrathecal hyperbaric bupivacaine for ICRT provides optimal surgical conditions with hemodynamic stability and ensures the early discharge of the patient.

Indian tubercular belly: A prospective study of 140 patients of abdominal tuberculosis and their outcomes.

Background: Abdominal tuberculosis is an important yet ignored entity in the spectrum of tuberculosis which has been dominated by pulmonary tuberculosis. Diagnosis and treatment are often delayed due to nonspecific symptoms. In this study, we aimed to highlight the clinical features, diagnostic methods and outcomes of abdominal tuberculosis. Methods: A prospective study was conducted in tertiary referral centre where all patients referred to drug distribution centres (DOTS centre) for abdominal tuberculosis were identified. Their demographic clinical and radiological profile was evaluated. These patients were followed-up for their treatment course for complications and outcomes. Results: A total of 140 patients who were labelled abdominal tuberculosis over a period of 2 years were reviewed at tuberculosis drug distribution centre (DOTS). Mean age of study population was 35.42 ± 12.53 years and majority of the population were males, 58.6% (82). The most common presenting symptom was abdominal pain which was seen in 82.8% (n = 116) of the patients, followed by feverin 65.6% (n = 92); 22.8% (n = 32) were seropositive for HIV and 44.2% (n = 62) had luminal tuberculosis of which ileocecal was the most common site. Peritoneum was second most common site which was involved in 26.4% (n = 37) of the patients followed by mixed tuberculosis involving more than one type. Confirmed diagnosis was achieved in 74 patients (52.8%), while the remaining 66 patients (47.14%) were diagnosed clinically. During follow-up, 12 patients were lost to follow-up; 113 (80.7%) had complete response, while 3 (2.14%) patients died during treatment. Conclusion: Abdominal tuberculosis usually presents with nonspecific complaints which require high index of suspicion. Most patients require only medical therapy which has good results.

Air flow limitation in smokers - A cause of concern.

Introduction: In India smoking is a common habit prevalent in both urban and rural areas irrespective of mode of smoking i.e., cigarettes, bidis, pipes, cigar, hookah etc., Spirometry can be helpful to determine effects of smoking on pulmonary functions. We aimed to study the effect of smoking on the pulmonary function tests. Materials and Methods: This study was conducted on 300 subjects including 150 smokers and 150 non-smokers aged between 25 and 60 years attending a tertiary health care center in northern part of our country. Quantification of tobacco smoking was performed by calculating smoking index. All the study subjects underwent spirometry. Results: All the spirometric variables (FVC, FEV1, PEFR, FEF 25-75%) were lower in smokers as compared to non-smokers and this difference was statistically significant. 76% of the smokers had obstructive, 10.7% had normal, 6.7% had restrictive, and 6.7% had mixed pattern on spirometry. 65.3% of the non-smokers had normal, 28.7% had obstructive and 6% had restrictive pattern on spirometry. Conclusion: Almost all the pulmonary function parameters were significantly reduced in smokers compared to non-smokers and obstructive impairment was common amongst smokers. As early quitting is associated with improved survival, it is important that these asymptomatic smokers are identified early and helped to quit. Primary care physicians being the first point of contact, can play a major role.

Obstructive sleep apnea, intermittent hypoxemia and prothrombotic biomarkers.

OBJECTIVE: To study the serum levels of fibrinogen and d-dimer in patients with obstructive sleep apnea (OSA) and its correlation with apnea hypopnea index (AHI), oxygen desaturation index (ODI), minimal oxygen saturation and arousal index. METHODS: It was a case control study in which 23 cases of OSA and 23 controls were enrolled. Morning fasting serum fibrinogen and d-dimer were measured in cases of OSA and controls. RESULTS: Serum fibrinogen levels among OSA patients (268.47±53.11mg/dl) were elevated as compared to the levels in controls (221.52±65.84mg/dl) (p<0.05). Serum fibrinogen co-related positively with AHI (r=0.6381, p=0.0011) and ODI (r=0.7434, p=0.0000), negatively with minimal oxygen saturation (r=-0.4461, p=0.0329). There was no statistically significant correlation of fibrinogen with arousal index (r=0.2697, p=0.2133). There was no statistically significant difference between mean fasting d-dimer level in cases (0.12mg/L, 0.06±0.18mg/L) and controls (0.12mg/L, 0.02±0.22mg/L) (p=0.8926). CONCLUSIONS: The observation of elevated fibrinogen levels with the increasing severity of OSA and hypoxemic events makes OSA one of the important risk factor for cardiovascular disorders.