RESUMO
Background and Aims: Spinal anesthesia (SA) is the most widely practiced neuraxial anesthesia. Lumbar puncture (LP) at multiple levels and multiple attempts due to any reason may cause discomfort and even serious complications. Hence the study was conducted to evaluate the patient variables that can predict difficult LP thus allowing for the use of alternate techniques. Material and Methods: We included 200 patients of ASA physical status I-II, scheduled to undergo elective infra-umbilical surgical procedures under spinal anesthesia. During preanesthetic evaluation, difficulty score was assessed using the 5 variables: Age, abdominal circumference, spinal deformity - assessed as axial trunk rotation (ATR) value, anatomical spine assessed by spinous process landmark grading system (SLGS) and patient position, by assigning a score of 0- 3 for each variable, with a total score of 0 - 15. The difficulty of LP was graded as easy, moderate or difficult based on total number of attempts and spinal levels by independent experienced investigator. The scores obtained during preanesthetic evaluation and the data collected after performing LP were analyzed using multivariate analysis and P value noted. Results: Our study showed that above patient variables correlated well with difficult LP scoring (P < 0.001). SLGS was noted to be a strong predictor, while ATR value a weak predictor. The correlation between the total score and grades of SA had a positive association (R = 0.6832, P < 0.00001) and was statistically significant. A median difficulty score of 2, 5 and 8 predicted easy, moderate and difficult LP respectively. Conclusion: The scoring system provides for a useful tool to predict difficult LP and helps both patient and anesthesiologist to choose an alternative technique.
RESUMO
BACKGROUND: Whole-grain consumption is associated with several health benefits. Little is known, however, about whole-grain consumption patterns in medical students in Malaysia. OBJECTIVES: The study was conducted to assess whole-grain intake pattern and factors influencing intake among Malaysian medical students. METHODS: A cross-sectional study investigating whole-grain intake among 151 medical students in a private medical university in Malaysia was conducted from January to June 2018. A self-administered questionnaire was used to assess sociodemographic variables, the whole-grain intake pattern and the knowledge and attitudes toward whole-grain intake. Data were analyzed using IBM SPSS software. Chi-square test and multivariable logistic regression were used. RESULTS: The prevalence of reported whole-grain intake in the past 3 months was 51%. Chinese ethnicity, readiness to adhere to Malaysian food pyramid, and self-preparation of food, and eating at home were significantly associated with whole-grain consumption. However, the primary determinants of food choice such as education, knowledge, and affordability did not seem to influence whole-grain consumption. Whole-grain consumption is relatively low among Malaysian medical students. Cultural background and self-belief influence this practice despite being from the medical fraternity. CONCLUSIONS: Efforts are needed to bridge the knowledge-practice gap by assessing the barriers to whole-grain consumption to design effective initiatives to promote an increase in whole-grain consumption.
