Fish in throat: An Unusual Foreign Body.

A 19 year-old man was presented to us in a state of respiratory distress with history of alleged accidentally swallowed the live fish. Flexible nasopharyngolaryngoscope showed a big live fish impacted in the laryngopharynx. Attempts to remove the fish orally were futile as the fish was impacted. We resorted to tracheostomy under local anaesthesia, followed by direct laryngoscopy and removal of the fish under general anaesthesia. The literature review of such rare incidence and approach to such case are discussed.

Submandibular intraductal calculi removal as an office procedure with radiofrequency device.

Salivary duct obstruction secondary to calculi is a common disorder of the submandibular gland and often manifesting as painful episodic swelling of the gland during meals. Complications may arise in unresolved obstruction leading to infections, abscess formation and a hypofunctioning gland. Treatment of this disorder has evolved from the traditional sialadenectomy to organ preserving procedures done under general or local anaesthesia. Our technique using Ellman Surgitron radiofrequency device, is another alternative technique for transoral removal of extraglandular calculi. It is a simple, quick an easy technique to learn that can be done in the office setting under local anaesthesia.

Removal of foreign-bodies under general anaesthesia. A review of rigid endoscopy for foreign-bodies of the hypopharynx and oesophagus.

A total of 36 patients with suspected foreign body (FB) of the oesophagus who underwent rigid endoscopy under general anaesthesia (GA) from January 2005 to March 2007 were reviewed. The majority of the patients were working adults in the 3rd to 5th decade of life. There was no foreign body in 33.3% of the patients. Co-morbidities were present in 33.3%. Morbidity and mortality from the procedure included one aspiration pneumonia, one lateral pharyngeal wall tear and one death (8.3%). X-ray findings were negative or inconclusive in 11(45.8%) patients with a foreign body. The majority of patients, 85.7% required 2 to 3 days of admission of which 52.7% had no foreign bodies. The most common foreign body retrieved was fishbone accounting for 13 of the 24 foreign bodies detected.

Neck pain among undergraduate medical students in a premier institute of central India: A cross-sectional study of prevalence and associated factors.

CONTEXT: Competitive exams conducted for undergraduate and postgraduate medical courses in India are tough. The undergraduate course is additionally taxing to the students' health. Lack of physical activity, the stress of studies, and universal adoption of different gadgets make the undergraduate medical students prone to develop musculoskeletal pain-related issues. AIMS: This study aimed to evaluate the prevalence of neck pain and the associated factors including gadget use among undergraduate medical students of a premier medical college in central India. SETTINGS AND DESIGN: All undergraduate medical students including the interns of our institute were enrolled for this cross-sectional study. METHODS AND MATERIALS: A self-explanatory internet-based questionnaire prepared using Kobo Toolbox was circulated via WhatsApp and email by the class representative of each batch of students. The responses obtained were analyzed using Statistical Package for the Social Sciences (SPSS). STATISTICAL ANALYSIS USED: Proportions and means were calculated. Chi-square test and univariable logistic regression analysis were used. RESULTS: Three hundred thirty-one valid responses out of 423 responses were analyzed. In total, 58.3% of 331 students suffered from neck pain within the last one year. Students in the 3rd and 4th year had 2.9 times higher odds of current neck pain in comparison to 1st-year students. History of neck pain before joining the course was associated with a higher risk of having current neck pain. Self-perceived aggravation of pain from gadget use had significantly higher odds of contributing to the current episode of neck pain. CONCLUSIONS: Neck pain is not uncommon among undergraduate medical students. History of previous neck pain including that during schooling makes a student prone for the current episode of pain. Academic stress, smartphone and laptop use tend to aggravate the pain in those who have neck pain.

Descriptive profile of risk factors for cardiovascular diseases using WHO STEP wise approach in Madhya Pradesh.

BACKGROUND: Periodic information on risk factor distribution is critical for public health response for reduction in non-communicable disease (NCDs). For this purpose, the WHO has developed STEPs wise approach. State representative population-based STEPS survey was last conducted in 2007-08 in seven states of In India. Since then no such work has been reported from low ETL states. This survey was carried out to assess the prevalence of risk factors associated with NCDs and the prevalence of NCDs in the low ETL state of Madhya Pradesh using the WHO STEPs approach. METHODS: A total of 5680 persons aged 18-69 years were selected from the state of Madhya Pradesh using multi-stage cluster random sampling. Using the WHO STEPs approach, details were collected on demographics, STEP 1 variables (tobacco consumption, alcohol consumption, physical activity, diet), STEP 2 variables (weight, height, waist circumference, blood pressure) and STEP 3 variables (fasting blood glucose, blood cholesterol). RESULTS: We found that 9.4% individuals smoked tobacco, 15.3% were overweight/obese, 22.3% had hypertension, and 6.8% have diabetes mellitus. As compared to women, men were less likely to be overweight or obese, but more likely to smoke tobacco, and have diabetes mellitus. Hypertension was also more common in men. Overall, about a fourth of all adults had three or more risk factors for cardiovascular disease. CONCLUSION: The survey shows that a large section of the population from Madhya Pradesh is either suffering from NCDs or have risk factors which predispose them to acquire NCDs. This state representative survey provides benchmarking information for behavioural and biological risk factor distribution for recently scaled up National Programme for the Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases, and Stroke (NPCDCS).

Determinants of behavioural and biological risk factors for cardiovascular diseases from state level STEPS survey (2017-19) in Madhya Pradesh.

BACKGROUND: National and statewide assessment of cardiovascular risk factors needs to be conducted periodically in order to inform public health policy and prioritise allocation of funds, especially in LMICs. Although there have been studies from India which have explored the determinants of cardiovascular risk factors, they have mostly been from high epidemiological transition states. The present study assessed the determinants of cardiovascular (CVD) risk factors in a low epidemiological transition state (Madhya Pradesh) using the WHO STEPwise approach to surveillance (STEPS). METHODS: A total of 5,680 persons aged 18-69 years were selected from the state of Madhya Pradesh through multi-stage cluster random sampling. Key CVD risk factors we sought to evaluate were from behavioural (tobacco, alcohol, physical activity, diet) and biological domains (overweight or obese, Hypertension, Diabetes, and Raised serum cholesterol). Key socio-demographic factors of interest were the caste and tribe groups, and rural vs urban location, in addition to known influencers of CVD risk such as age, gender and education level. RESULTS: Those belonging to the scheduled tribes were more at risk of consuming tobacco (OR 2.13 (95% CI [1.52-2.98]), and a diet with less than five servings of fruits and vegetables (OR 2.78 (95% CI [1.06-7.24]), but had had the least risk of physical inactivity (OR 0.31 (95% CI [0.02-0.54]). Residence in a rural area also reduced the odds of physical inactivity (OR 0.65 (95% CI [0.46-0.92])). Lack of formal education was a risk factor for both tobacco consumption and alcohol intake (OR 1.40 (95% CI [1.08-1.82]) for tobacco use; 1.68 (95% CI [1.14-2.49]) for alcohol intake). Those belonging to schedules tribes had much lower risk of being obese (OR 0.25; 95% CI [0.17-0.37]), but were at similar risk of all other clinical CVD risk factors as compared to other caste groups. CONCLUSION: In the current study we explored socio-demographic determinants of behavioural and biological CVD risks, and found that in Madhya Pradesh, belonging to a scheduled tribe or living in a rural location, protects against being physically inactive or being overweight or obese. Increasing age confers a greater CVD-risk in all domains. Being a male, and lack of formal education confers a greater risk for behavioural domains, but not for most clinical risk domains. Future efforts at curbing CVDs should be therefore two pronged -a population-based strategy targeting biological risk factors, and a more focussed approach directed at those displaying risky behaviour.

Young, obese, and underweight patients show up inadequately at scheduled appointments: Findings from a record-based study on diabetic, hypertensive diabetic, and hypertensive patients attending a primary care clinic of Puducherry.

BACKGROUND: One key barrier to proper management of common cardio-metabolic conditions such as diabetes and hypertension in primary care is inadequate adherence to treatment, which, in many cases, results from inadequate follow-up at scheduled appointments. In addition to provider and health system level factors, individual patient level factors are also associated with attendance at follow-up appointments. OBJECTIVE: To document the association of diabetic, hypertensive diabetic, and hypertensive patient's demographic and clinical factors with showing up inadequately at scheduled appointments. METHODS: A record-based retrospective follow-up study was conducted in an urban primary health center of Puducherry from January to March 2015. Registered diabetic, hypertensive diabetic, and hypertensive patients who made at least one visit between July and December 2014 were included. Data on demographic factors, clinical factors, and dates of visits to the clinic were collected from case records of patients and were entered in EpiData entry version 3.1. Analysis was performed using R statistical package. RESULTS: Out of 366 patients, 79% were females and 70.2% were aged >50 years. It was found that 183 (50%) were diabetic, 266 (72.7%) were hypertensive, and 115 (31.4%) were hypertensive diabetic. Out of 366 patients, all the five follow-up visits were attended by 185 (50.6%) patients, and "adequate follow-up" was found in 123 (33.6%) patients. Young, underweight, and obese patients were more likely to have inadequate follow-up. CONCLUSION: Family physicians should give special attention to these groups in their routine practice along with providing targeted health education and implementing full proof mechanisms to track them.

Prevalence, patterns, clinico-social, and behavioral factors associated with the consumption of sugar-sweetened beverages among undergraduate medical students of central India

Introduction: Excessive consumption of sugar-sweetened beverages (SSBs) in adolescents has become a global issue. As its link to obesity and noncommunicable diseases is clear, it is imperative to understand SSB consumption behaviors in the future health-care professionals. The objective of this study is to document the prevalence, patterns, and clinico-social and behavioral factors predicting high intake of SSBs among medical students. Material and Methods: This cross-sectional study was conducted using a self-reported, web-based, questionnaire. All the students and interns who were part of a publicly funded premiere teaching hospital between October and November 2019 were included in this study. The semi-structured questionnaire enquired regarding socio-demographic, clinical details, amount, behavioral patterns, and money spent in connection with SSB consumption. Data were analyzed using IBM SPSS version 24. Results: The mean age of participants was 19.3 ± 1.6 years, 71.7% being males. The current prevalence of SSB consumption was 90.5%. Furthermore, 49.9% and 29.1% of participants preferred soft drinks and sweetened fruit juice, respectively. Multivariate analysis showed that male gender (adjusted odds ratio [aOR]: 1.83, (1.03–3.25), current alcohol consumption (aOR: 4.09, 1.25–13.42), and recent (last week) consumption of a SSB predicted high intake of SSBs [aOR: 7.36, (3.41–15.87)] whereas, preference of energy/sports category of drinks predicted low intake of SSBs [aOR 0.10, (0.02–0.47)]. Conclusion: The consumption of SSBs among medical students was high. Targeted health education and behavior change interventions should be provided to males, alcohol users, and frequent consumers