The National medical journal of India最新文献

Background . Handling a heavy load on a handcart is common in the wholesale and retail trade markets in India and many parts of the globe. These carts transport goods between major markets, warehouses and transporters. We assessed the physiological workload among handcart pullers in terms of cardiovascular load (CVL), energy expenditure (EE), heart rate (HR), physiological cost of work and subjective rating of perceived exertion. Methods . Physiological workload was assessed with the help of HR during resting, working (15 minutes) and recovery state with a smart wearable device to extrapolate percentage of CVL, EE and physiological cost of work among handcart pullers. Subjective assessment of exertion was measured with the Borg 5-point rating scale among 35 cart pullers. Data were analysed using Microsoft Excel version 2010. Results . It was found that in handcart-pulling activity, EE was 11.706 kJ/minute, average working HR was 128 beats/minute and physiological cost of work was 89.09 beats/minute with no loads on handcart. This signifies that the activity falls under heavy physiological workload. The average percentage of CVL was found to be 50.5%, which falls under acceptable category for persons with a healthy cardiovascular system. Thirty-one (88.6%) of the participants reported the activity to be moderately heavy, whereas 4 (11.4%) participants mentioned it to be light. Conclusions . Handcart-pulling operation in this study without load on cart was found to be a heavy physiological workload. In real-time situations, the load, road conditions, long duration and traffic congestion is likely to result in a higher range of physiological workload on cart pullers.

Background . We investigated the demographic, aetiological and clinical characteristics of patients who presented to the emergency department and had severe hyponatraemia. Methods . We retrospectively evaluated 1171 patients who presented to the emergency department and were diagnosed with severe hyponatraemia. Results . Over half the patients studied were women (53.5%). The mean age of women was higher (p<0.0001). The most common complaint was dyspnoea (16.8%) and 42.5% of the patients had an oral intake disorder. In addition, 22.3% of the patients were on loop diuretics. About 76.3% of patients were conscious, and the mean sodium level of these patients was higher than the mean sodium level of those who responded to verbal and painful stimuli (p<0.001). Severe isolated hyponatraemia was observed in 61.8% of the patients. The mortality rate was 12.8%. There was no difference between the mean sodium levels of the deceased and discharged patients (p=1.0). The mortality rate was higher in patients who had a history of cirrhosis and cancer, but was lower in patients with a history of coronary artery disease (p=0.0002, p<0.0001 and p=0.04, respectively). Conclusion . Severe hyponatraemia was more prevalent in women, serum sodium levels were higher in conscious patients, and the mortality rate was higher in patients who had a history of cirrhosis and cancer. We found that the mean serum sodium levels did not help in distinguishing between the deceased and discharged patients.

Background Patients visiting the emergency department (ED) may show variations by certain time periods such as Ramadan. We wished to ascertain whether Ramadan affects the ED presentations, clinical conditions and outcomes of patients aged 65 years or older. Methods . Patients aged 65 years or older who presented to ED in Ramadan and in the following month in 2018 were reviewed retrospectively. Results . A total of 1947 patients were enrolled, of whom 958 presented in Ramadan and 989 in the following month. The patients who presented in Ramadan most commonly (23.8%) presented between 8 p.m. and 11.59 p.m.; patients who presented in the following month most commonly (24%) presented between 8 a.m. and 11.59 a.m. (p=0.26). Complaints concerning the central nervous system (CNS) were more common in the month after Ramadan (p<0.0001). Diagnoses related to the cardiovascular system were more commonly made in Ramadan (p=0.037), whereas those related to CNS, otorhinolaryngology and oncology were more commonly made in the following month (p=0.0005, p=0.024 and p=0.003, respectively). No significant difference was found between the two groups with respect to outcomes (p=0.36). Compared to patients who presented in Ramadan, those that presented in the following month had a significantly longer ED stay (p=0.036). Conclusion . Our study detected no significant difference between the two groups with respect to the time of presentation and ED outcomes. Patients who presented in Ramadan had a lower incidence of CNS complaints; a higher incidence of cardiovascular diagnoses; lower incidences of CNS, oncological and otorhinolaryngological diagnoses and a significantly shorter length of ED stay.

Background . The General Medical Council's publication Tomorrow's Doctors recommends that medical students should attain professional awareness at an early stage of their education. Accordingly, in the University of Nottingham, basic science teaching is integrated with clinical practice, by attaching medical students to hospital specialty teams and general practices in the community, as regular timetabled 'hospital visits' from the beginning of their medical education. We evaluated the feedback forms of the preclinical (1st and 2nd years) medical students retrospectively based on their experience of the hospital-based clinical teaching programme over 2 years. The hospital visit programme was modified based on the student feedback following which the effectiveness of the modified programme was revaluated post-test. Methods . This study was based on a quasi-experimental design in which comparisons of pre-test and post-test feedbacks with 337 feedback forms in each group were analysed in the study period. Quantitative response questions in the feedback were statistically analysed using independent t-test, and free text questions were qualitatively analysed and grouped into themes. Results . Data analyses showed significant difference (p<0.001) between the pre- and post-test groups. The main feedback themes identified were number of the patients examined, organization of the visit, patient selection, introductory talk, and briefing and debriefing before and after the visit. Conclusion . The structure of the hospital visit programme was influenced by the available infrastructure, flexibility of access and delivery of clinical teaching. The programme helped build professional attitudes in both staff and students and encouraged independent learning.

We report a 46-year-old woman with disseminated Mycobacterium abscessus infection who was on maintenance haemodialysis for chronic glomerulonephritis. Prolonged blood cultures yielded growth of a rapid-growing nontubercular Mycobacterium. Diagnosis to a species level guided empirical therapy while we awaited antimicrobial susceptibility results. The patient was treated successfully with a multidrug regimen.