Effectiveness of Medical Student Counseling for Hospitalized Patients Addicted to Tobacco (MS-CHAT): a Randomized Controlled Trial.

BACKGROUND: Low-middle-income countries face an enormous burden of tobacco-related illnesses. Counseling for tobacco cessation increases the chance of achieving quit outcomes, yet it remains underutilized in healthcare settings. OBJECTIVE: We tested the hypothesis that utilizing trained medical students to counsel hospitalized patients who use tobacco will lead to an increase in patient quit rates, while also improving medical student knowledge regarding smoking cessation counseling. DESIGN: Investigator-initiated, two-armed, multicenter randomized controlled trial conducted in three medical schools in India. PARTICIPANTS: Eligibility criteria included age 18-70 years, active admission to the hospital, and current smoking. INTERVENTION: A medical student-guided smoking cessation program, initiated in hospitalized patients and continued for 2 months after discharge. MAIN MEASURES: The primary outcome was self-reported 7-day point prevalence of smoking cessation at 6 months. Changes in medical student knowledge were assessed using a pre- and post-questionnaire delivered prior to and 12 months after training. KEY RESULTS: Among 688 patients randomized across three medical schools, 343 were assigned to the intervention group and 345 to the control group. After 6 months of follow up, the primary outcome occurred in 188 patients (54.8%) in the intervention group, and 145 patients (42.0%) in the control group (absolute difference, 12.8%; relative risk, 1.67; 95% confidence interval, 1.24-2.26; p < 0.001). Among 70 medical students for whom data was available, knowledge increased from a mean score of 14.8 (± 0.8) (out of a maximum score of 25) at baseline to a score of 18.1 (± 0.8) at 12 months, an absolute mean difference of 3.3 (95% CI, 2.3-4.3; p < 0.001). CONCLUSIONS: Medical students can be trained to effectively provide smoking cessation counseling to hospitalized patients. Incorporating this program into the medical curriculum can provide experiential training to medical students while improving patient quit rates. TRIAL REGISTRATION: URL: http://www. CLINICALTRIALS: gov . Unique identifier: NCT03521466.

Multisystem Inflammatory Syndrome in Adults Associated With COVID-19: A Case Series on the Importance of Early Diagnosis and Corticosteroid Therapy in Prognosis.

Multisystem inflammatory syndrome in adults (MIS-A) is a rare condition that can occur after an adult has been infected with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). It can occur anywhere between two and 12 weeks after the beginning of acute coronavirus disease 2019 (COVID-19) infection and is characterized by extrapulmonary multiorgan failure. It is primarily seen in young and previously healthy individuals. The exact prevalence of MIS-A is unclear. It is likely underdiagnosed due to overlapping symptoms with severe COVID-19 and difficulty in identifying the syndrome without a preceding COVID-19 infection. The pathogenesis of MIS-A is also largely unknown but is likely caused by an immune response that is dysregulated or antibody-mediated. Treatment primarily involves corticosteroids, but severe cases may require intravenous immune globulin (IVIG). The timing of starting corticosteroid therapy is crucial, as delays can result in increased complications and a longer hospital stay.

Rationale and Design of a Randomized Controlled Trial to Evaluate the Effectiveness of Medical Student Counseling for Hospitalized Patients Addicted to Tobacco (the MS-CHAT Trial).

Globally, India is the second largest consumer of tobacco. However, Indian medical students do not receive adequate training in smoking cessation counseling. Each patient hospitalization is an opportunity to counsel smokers. Medical Student Counseling for Hospitalized patients Addicted to Tobacco (MS-CHAT) is a 2-arm multicenter randomized controlled trial (RCT) that compares the effectiveness of a medical student-guided smoking cessation program initiated in inpatients and continued for two months after discharge versus standard hospital practice. Current smokers admitted to the hospital are randomized to receive either usual care or the intervention. The intervention group receives inpatient counseling and longitudinal postdischarge telephone follow-up by medical students. The control group receives counseling at the discretion of the treating physician. The primary outcome is biochemically verified 7-day point prevalence of smoking cessation at 6 months after enrollment. Changes in medical student knowledge and attitude will also be studied using a pre- and postquestionnaire delivered prior to and 12 months after training. This trial tests a unique model that seeks to provide hands-on experience in smoking cessation counseling to medical students while simultaneously improving cessation outcomes among hospitalized smokers in India.

Spectrum of cytology of neck lesions: comparative study from two centers.

BACKGROUND: The objective of this descriptive study was to observe the frequency of various pathological conditions detected in FNAC of patients presenting with neck swellings coming from two different regions of southern India. MATERIALS AND METHODS: This study included 100 consecutive patients from each region (Region 1: Wyanad, Region 2: Salem) presenting to the department of Pathology with swelling in the neck region as the chief complaint. All age groups were included. All patients underwent FNAC and results were recorded. Frequency of various pathologies was determined. RESULTS: Thyroid lesions were predominant in both the regions with colloid goiter being the commonest lesion followed by lymphadenitis. Metastasis was more common compared to primary malignancies in Salem due to the elderly population under study. CONCLUSION: Non-neoplastic lesions were commonly encountered in our study which is in accordance with findings in similar studies conducted in other developing countries. FNAC should be the primary investigation of choice as it is inexpensive, safe and has a high degree of diagnostic accuracy.