Tobacco Abuse Research Articles

Development of a Risk Stratification Scoring System to Predict General Surgical Complications for Patients Undergoing Foot and Ankle Surgery.

Preventing postoperative complications is crucial for patients, surgeons, and health care facilities. We developed a risk stratification scoring system to optimize postoperative outcomes for patients undergoing foot and ankle surgery. A total of 35,580 patients who underwent foot and ankle procedures from 2005 to 2017 were identified as part of the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP). To assess the risk of a postoperative complication, we identified several independent risk factors associated with 30-day postoperative complications, then proceeded to develop a point-based risk scoring system. To validate our scoring system, we used it on a cohort of patients from the database who underwent foot and ankle surgery. Risk factors that correlated with postoperative complications included tobacco abuse, age (≥65 years), diabetes mellitus, hypertension, elevated creatinine level (≥1.3 mg/dL), hypoalbuminemia (<3.5 g/dL), chronic obstructive pulmonary disease (COPD), congestive heart failure (CHF), hyponatremia (<135 mEq/L), and anemia (hematocrit value, men <42%; women <38%). Point scores for each factor were: anemia, +10; hypoalbuminemia, +9; elevated creatinine level, +6; CHF, +4; diabetes mellitus, +3; hyponatremia, +3; COPD, +2; hypertension, +2; age, +1; and tobacco abuse, +1. For the validation cohort, we stratified patients according to risk as low (0-20 points), medium (21-30 points), and high (≥31 points) risk. In terms of having a postoperative complication, compared with low-risk patients, patients who were at medium risk had an odds ratio of 4.7 (95% CI, 2.8-7.9) and those at high risk had an odds ratio of 8.3 (95% CI, 4.8-14.5). [Orthopedics. 2022;45(3):139-144.].

Tobacco Taxation Influences the Smoking Habits of Adult Smokers Attending Smoking Cessation Clinic in Saudi Arabia.

ObjectivesTo determine whether the increased tobacco price due to tax implementation on tobacco products (including cigarettes) has a significant effect on smoking cessation among Saudi Arabian adult smokers.MethodsAn interviewer-administered questionnaire was used to obtain data from adult Saudi smokers and recent quitters attending smoking cessation clinics between January 2018 and September 2019. The responses of the participants were summarized and analyzed.ResultsIn total, 660 participants were interviewed, of which 98% were men who resided in the western region (33%). Taxation had no effect on smoking in 387 participants [58.6%; 95% confidence interval (CI): 54.9, 62.4], some effect in 220 participants (33.3%; 95% CI: 29.7, 36.9), and a substantial effect in 50 participants (7.6%; 95% CI: 5.6, 9.6). Strategies adopted to cope with the tax implementation included cutting down on the number of cigarettes smoked (302; 45.8%), changing to a cheaper brand of cigarette (151; 22.9%), purchasing in bulk (105; 15.9%), attempting to quit (453; 68.6%), and doing nothing (108; 16.4%). The rate of quitting smoking after attending the clinic was 20.7% (95% CI: 17.7, 23.9). Occupation (P = 0.003), education (P = 0.03), and current smoking habit (P = 0.07) were significantly associated with the impact of tobacco taxation. The strategies adopted in response to tax implementation on cigarettes were significantly associated with occupation (χ2 = 30, degrees of freedom = 12, P < 0.001).ConclusionsTobacco taxation influenced 40% of the participants. Their attempts to opt for alternatives should be recognized in evaluating policies to reduce adverse health impacts caused by tobacco abuse.

Stress and substance abuse among workers during the COVID-19 pandemic in an intensive care unit: A cross-sectional study.

Professionals working in intensive care units (ICUs) during the COVID-19 pandemic have been exposed to stressful situations and increased workload. The association between symptoms of traumatic stress disorders, substance abuse and personal/occupational characteristics of Brazilian COVID-19-ICU workers is still to be addressed. Our aim was to evaluate the prevalence of those conditions and to find if those associations exist. In this observational, single-center, cross-sectional study, all professionals working in a COVID-19 ICU were invited to fill an anonymous form containing screening tools for traumatic stress disorders and substance abuse, and a section with questions regarding personal and occupational information. Three hundred seventy-six ICU professionals participated. Direct exposure to patients infected by COVID-19, history of relatives infected by COVID-19, and sex (female) were significantly associated with signs and symptoms of traumatic stress disorders. 76.5% of the participants had scores compatible with a diagnosis of traumatic stress disorders. Moreover, the prevalence of scores suggestive of Tobacco and Alcohol abuse were 11.7% and 24.7%, respectively. ICU workers had significantly elevated scores on both screening forms. Providing psycho-social support to ICU professionals may prevent future problems with traumatic stress disorders or substance abuse.

Pioglitazone and Risk of Chronic Obstructive Pulmonary Disease in Patients with Type 2 Diabetes Mellitus: A Retrospective Cohort Study.

BackgroundPioglitazone’s effect on chronic obstructive pulmonary disease (COPD) has rarely been studied.PurposeThis retrospective observational study investigated whether the use of pioglitazone would affect the risk of COPD in patients with type 2 diabetes mellitus.Patients and MethodsThe Taiwan’s National Health Insurance database was used to enroll 9487 matched pairs of ever users and never users of pioglitazone based on propensity score from a cohort of 350,536 patients. The enrolled patients had a new diagnosis of type 2 diabetes mellitus between 1999 and 2008 and were not having a diagnosis of COPD before January 1, 2009. They were then followed up for COPD, starting from January 1, 2009 until December 31, 2011. Diagnosis of COPD was based on the codes of 491 for chronic bronchitis and 492 for emphysema based on the International Classification of Diseases, Ninth Revision, Clinical Modification. Cox regression was used to estimate hazard ratios. The interactions between pioglitazone and COPD risk factors including pneumonia, pulmonary tuberculosis and tobacco abuse were also investigated.ResultsIn 9487 never users and 9487 ever users of pioglitazone, the case numbers of incident COPD were 359 and 295, respectively. The respective incidence rates of COPD were 1484.73 and 1167.61 per 100,000 person-years. The overall hazard ratio (95% confidence interval) for COPD that compared ever to never users was 0.778 (0.667–0.908). The hazard ratios for the tertiles of cumulative duration of pioglitazone therapy (cutoffs: <11.0, 11.0–19.6 and >19.6 months) to never users were 0.904 (0.729–1.121), 0.727 (0.578–0.914) and 0.715 (0.570–0.896), respectively. No interactions between pioglitazone and COPD risk factors including pneumonia, pulmonary tuberculosis and tobacco abuse were noted.ConclusionPioglitazone use is associated with a significantly lower risk of COPD.

Racial Disparities in Cardiovascular Disease Among Patients with Cancer in the United States: The Elephant in the Room.

Cardiovascular disease (CVD) is common among patients with cancer, potentially due to overlapping risk factors such as diabetes, obesity, tobacco abuse, etc. While underlying systemic inflammation appears to be a common driver for both disease processes, a significant burden of CVD also appears to stem from anti-cancer therapies. As the paradigm of cancer care continues to evolve from purely disease-focused to more patient-centered, there is a growing emphasis on developing strategies for the early diagnosis and treatment of disease and treatment-related complications such as CVD.

Clinical and Biologic Characteristics and Outcomes in Young and Middle-Aged Patients With Laryngeal Cancer: A Retrospective Cohort Analysis.

To describe the clinical and biologic characteristics and outcomes of young and middle-aged (YMA; <65 years) patients according to the presence or absence of traditional risk factors for laryngeal cancer. Retrospective cohort analysis. Single-institution academic medical center. Patients without a history of clinically significant tobacco use or heavy alcohol use were defined as "nontraditional": ≤5 pack-years, ≤5 years smoked, ≤14 alcoholic drinks per week, and ≥15-year interval from last tobacco abuse use to diagnosis. Remaining patients were categorized as "traditional." Select tumor samples were evaluated for bacterial and viral DNA by multiplex polymerase chain reaction. Seventy-eight YMA patients with primary laryngeal squamous cell carcinoma were identified, 23% (n = 18) of whom were nontraditional. Nontraditional patients were younger than traditional patients (median age, 51 vs 59 years; P < .001). Twenty-eight tumors were prospectively tested for human papillomavirus (HPV), and nontraditional patients were more likely to exhibit high-risk HPV (57% vs 5%, P < .01). Among 17 select tumors (nontraditional, n = 8; traditional, n = 9), 35% exhibited HPV16 (nontraditional, 63%; traditional, 11%; P = .05). Other viruses were identified but did not differ according to risk status: herpesviruses (40%) and Merkel cell polyomavirus (7%). Chlamydia, β-HPV, and γ-HPV DNA was not detected in any samples. Median length of follow-up was 42 months. On adjusted analyses, nontraditional patients exhibited nonsignificantly improved overall survival (hazard ratio, 0.24 [95% CI, 0.03-1.82]; P = .17) and disease-free survival (hazard ratio, 0.34 [95% CI, 0.10-1.23]; P = .08) as compared with traditional patients. Almost one-quarter of YMA patients lacked characteristic risk factors for laryngeal squamous cell carcinoma, and their tumors exhibited a higher prevalence of high-risk HPV. The significance of HPV16 and other tumor viruses with outcomes in nontraditional patients should be evaluated further.

The effect of Caries, Periodontitis and Substance abuse on Salivary Interleukin - 6 levels

Objective: Earlystage diagnosis of oral cancer will help in complete control of the progression of the lesion.Salivary biomarker analysis is a non-invasive and inexpensive method in the early detection of oral cancer. Materials and Methods: The study aimed at the detection of the changes of salivary IL-6 in caries, periodontitis and substance abuse. Sociodemographic details, habits like tobacco and alcohol abuse were recorded. Clinical factors like caries and periodontal status of subjects were assessed using dentition status and treatment need index and modified CPITN index, respectively. Whole unstimulated saliva was collected and IL-6 estimated using ELISA. Mann Whitney U test was used to compare between clinical groups and demographic variables using ANOVA. Result:The median and mean baseline salivary IL-6 value of the 48 samples were 4.13 and 5.998 ±2.76 pg/ml. Subjects with substance abuse had highest median: 6.82 pg/ml (IQR: 4.871-13.110) and mean values:15.073 ±15.47pg/ml. The median of other groups,caries- 3.53, periodontitis- 4.2 and normal- 4.0, pg/ml respectively. ROC analysis showed AUC for the substance abuse and normal was 78 (sensitivity 71% specificity 82%) substance abuse and all groups was 75 (sensitivity 86% specificity 61%). The cut off was 6.41and 4.2 pg/ml respectively. Conclusion: Based on the higher AUC value, salivary IL-6 levels of more than 6.41pg/ml can be taken as cutoff for clinical evaluation with higher potential for malignant change. The fact that cases with periodontitis did not show a statistically significant difference in IL-6 levels when compared to substance abuse, needs further consideration. Key words: Caries, Interleukin-6, Periodontitis, Salivary biomarkers, Substance abuse.

Mitral Regurgitation in Obstructive Hypertrophic Cardiomyopathy: Systolic Anterior Motion or a More Unusual Cause?

A 52-YEAR-OLD, 100-kg, 191-cm transitioned woman, receiving hormonal therapy, with a history of hypertension, hyperlipidemia, tobacco abuse, and known coronary artery disease, presented to a community hospital with recurrent chest pain and dyspnea. An electrocardiogram demonstrated new ST-segment elevation consistent with an anterior wall myocardial infarction. The patient was taken to the cardiac catheterization laboratory where drug-eluting stents were implanted in the left anterior descending and diagonal coronary arteries. Her recovery was complicated by cardiogenic shock, refractory pulmonary edema, and acute respiratory failure that was unresponsive to vasoactive medications and mechanical ventilation. She was transferred to the authors’ institution for definitive care. On admission, the physical examination was notable for sinus tachycardia (110 beats/min) and a grade III of VI holosystolic murmur heard best at the left sternal border. Leukocytosis was present (19.4 103/µL), but blood cultures were negative. Transesophageal echocardiography (TEE) was performed as part of the diagnostic evaluation and revealed the following images (Fig. 1, 2, and 3; Videos 1, 2, and 3). What is the diagnosis? Fig 2Midesophageal five-chamber transesophageal echocardiography view, focus on mitral valve. Single white arrow highlights contact between the anterior mitral leaflet and hypertrophied septum. Double white arrows highlight the perforation in the anterior mitral leaflet. View Large Image Figure Viewer Download Hi-res image Fig 3Midesophageal five-chamber transesophageal echocardiography color Doppler view, focus on mitral valve. Single white arrow highlights regurgitant jet from malcoaptation between mitral leaflets. Double white arrows highlight regurgitant jet from perforation. View Large Image Figure Viewer Download Hi-res image

Prevalence and Screening of Tobacco and Substance Abuse among patients visiting Emergency Department

Aim: To prevalence and screening of tobacco and substance abuse among patients visiting emergency. Methods: This is a cross-sectional study conducted in the emergency department of Usman Memorial Hospital, Karachi during the period of Jan, 2020 to June, 2021. In the 18 months of study, we included patients visiting to our emergency department due to any acute complaint who is older than 18 years of age. All the participants were to be asked National Institute of Drug Abuse (NIDA) quick screen and tobacco addiction screening was done by CAGE questionnaire. Data was collected and analyzed using SPSS version 2. Results: During the 18 months’ time, we received 642 patients matching our inclusion criteria for this study. Out of these 371(59.4%) participants agreed to participate in the study whereas the 40.6% refused to enter the study. Out of these there were 242(65.2%) males and 129(34.7%) females in the study sample. All these participants were asked the single screen question for drug use and 178(47.9%) of the participants have used an illegal drug or prescription drugs for non-medical reason. Among the total 194 participants who smoke currently there were 146(75.2%) participants with positive CAGE modified results suggests nicotine dependence. Conclusion: The above study suggests that substance abuse/misuse of prescription drugs and nicotine dependence is common in our population and awareness regarding smoking cessation and drugs use is needed. Screening of individuals at emergency department is an efficient method for identifying severe cases and provide them proper medical help. Keywords: Tobacco, Nicotine, Smoking.

INTERACTION OF TOBACCO ABUSE WITH OTHER CONVENTIONAL RISK FACTORS OF CARDIOVASCULAR RISK - SYNERGISTIC IMPACT OR AN INDEPENDENT MENACE?

Objectives: To determine the prevalence, patterns and behavioural attributes of tobacco abuse in patients of acute coronary syndrome (ACS). Furthermore, to assess the interaction of tobacco abuse with other conventional risk factors of cardiovascular disease (CVD). Methodology: This observational study included 230 consecutive patients with ACS. Data was collected regarding total duration and extent of tobacco consumption, “tobacco addiction” and various behavioural patterns related to it. Risk factors profile was acquired for hypertension, diabetes, obesity, family history of premature CVD and dyslipidemia. Odds ratios (OR) with 95% confidence intervals (CI) for these risk factors were calculated for tobacco abusers compared to non-abusers. Results: Among the study population, 63(27.4%) were active tobacco users. Urban residents had lesser odds of being tobacco abusers compared to non-urban residents (0.49, [0.27 – 0.89]). Tobacco abusers had a lower prevalence of hypertension compared to non-abusers (0.44 [0.24 – 0.81]). A similar trend was observed for diabetes, obesity and dyslipidemia, however, the differences could not reach significance thresholds. Cigarette smoking was the commonest mode of tobacco consumption (90.5%). “Tobacco addiction” could be attributed to 84.1% of abusers. Most (82.5%) were willing to give up tobacco abuse and 63.3% had already made attempts at quitting. Conclusion: About one-third of ACS patients were tobacco abusers with the majority being tobacco addicts. Tobacco abuse was observed to be independently implicated as a risk factor in ACS patients. Furthermore, tobacco abuse was inversely related to hypertension translating into a sub-multiplicative / additive impact of hypertension as a risk factor.

Oral health status of psychoactive substance abusers

Introduction: Among varied substance abuse, tobacco abuse is a common relapsing addiction among youth. The relationship of tobacco abuse in varying grades of dental caries (DC) is worthy of study. This study was planned with a null hypothesis, there is no difference in varying grades of DC in tobacco and related substance abusers to those of nonabusers in the population visiting institute. Materials and Methods: The present study comprised 270 adults, 135 participants in each group, with age ranged from 20 years to 50 years including both gender. Study group formed of smokers, tobacco abusers, smokeless tobacco abusers, gutka, betel nut, and a combination of these two, whereas the healthy, nonhabit group formed control. DC was measured using the decayed, missing, and filled teeth (DMFT) index. Oral hygiene was evaluated by recording a simplified Oral Hygiene Index (OHI). Results: DC was found higher in individuals with habits (mean DMFT: 4.73 ± 4.32) as compared to those of nonhabit group (mean DMFT: 3.17 ± 3.11), and the difference was statistically significant (P = 0.001). OHI was significantly higher in tobacco abusers than those of nonabusers (P = 0.0001). In the case of both moderate and severe caries, the duration and frequency of tobacco abuse was significantly associated with a pattern of DC (P = 0.001). As the frequency of tobacco and related substance abuse increased, caries (DMFT) also increased (r = 0.15 and P = 0.013), and it was statistically highly significant. Conclusion: Psychoactive substance abuse along with poor oral hygiene, in any form of smokeless or smoking form of tobacco habit, is a risk for increased caries activity, and it is higher in smokeless tobacco abusers as compared to smokers.

Tobacco Abuse among Support Staff and Effectiveness of Planned Teaching Programme in Terms of Knowledge, Attitude and Practice of Tobacco Abuse

Tobacco is one of the most widely abused drugs in the world making it leading cause of preventable death. A two-phase study was done to identify the prevalence of tobacco abuse and to develop and evaluate the effectiveness of planned teaching programme in terms of knowledge, attitude and practice among the support staff in a selected hospital in New Delhi. During phase-I of the study, 200 support staff were selected based on total enumeration sampling technique. Structured tools containing socio-demographic variables, prevalence assessment tool, knowledge questionnaire, attitude scale, and practice scale were administered as a pre-test. During phase-II of the study, administration of the planned teaching programme was done for all the 200 support staff. A post-test was conducted for 66 tobacco abusers identifi ed during phase-I of the study based on the prevalence. The study results revealed that the prevalence rate of tobacco abuse among the support staff was 33 percent. Out of this 33 percent of the tobacco abusers, 26.5 percent were smokeless tobacco users and 6 percent were smoking tobacco abusers. The mean difference of pre-test and post-test knowledge, attitude, and practice scores were found out to be 2.95, 1.99, and 0.69 respectively. The planned teaching programme was effective in increasing the knowledge score of the tobacco abusers but there was no effect of PTP on attitude and practice score. The demographic variables such as age, sex, gender, educational qualifi cation, marital status, and monthly income were found to be signifi cantly associated with tobacco abuse among the support staff

Development of A Risk Stratification Scoring System to Predict General Surgical Complications in Foot and Ankle Surgery Patients

Category:Ankle; Ankle Arthritis; Arthroscopy; Basic Sciences/Biologics; Bunion; Diabetes; Hindfoot; Lesser Toes; Midfoot/Forefoot; Sports; TraumaIntroduction/Purpose:Preventing postoperative complications is crucial for patients, surgeons, and healthcare facilities. A risk stratification scoring system was created to help optimize risk factors for general surgical complications in foot and ankle surgery patients.Methods:A total of 85,363 patients that underwent foot and ankle procedures from 2005 to 2017 were identified as part of the American College of Surgeons National Surgical Quality Improvement Program. Independent risk factors associated with postoperative complications within 30 days of surgery were identified and used to develop a point-scoring system to estimate the relative risk for experiencing complications. For validation, the system was tested on a subset of patients from the database who had foot and ankle surgery.Results:The 30-day postoperative complication incidence after foot and ankle surgery was 19.1%. Risk factors associated with postoperative complications were tobacco abuse, age (>64), diabetes mellitus, hypertension, elevated creatinine (>1.3 mg/dL), hypoalbuminemia (<3.5 g/dL), and anemia (male hematocrit <42; female <38). Point scores from each factor were: anemia, +7; hypoalbuminemia, +4; hypertension, +4; elevated creatinine, +3; diabetes mellitus, +3; age over 64, +2; and tobacco abuse, +1. In the validation cohort, patients categorized as low risk (0-5), using the point scoring system had a 2.5% rate of 30-day complications; patients categorized as medium risk (6-10) had a 7.5% complication rate (relative risk = 2.0; 95% CI, 1.7-2.3 compared with low risk) and high risk (>=11), 33.1% (relative risk = 3.7; 95% CI, 3.2-4.3).Conclusion:This point scoring system predicts risk for general postoperative complications after foot and ankle surgery. These data may help foot and ankle surgeons identify areas of clinical concern with patients to reduce the risk of experiencing postoperative complications.

Risk stratification and in-hospital outcome in patients with acute coronary syndrome

ABSTRACTBackground:Death and morbidity are caused by coronary artery disease (CAD) and acute coronary syndrome (ACS), which include ST-elevation myocardial infarction (STEMI) and unstable angina (UA), are the most common causes of death among those with CAD. The aim of the study was to define the demographic profile of patients with ACS in a tertiary care center, to identify risk factors in the profile of patients with ACS, to learn about the management of ACS in tertiary health care centers, and to estimate in-hospital outcomes in ACS patients at a tertiary health care center.Methods:The study was carried out in the Cardiology Department of Batra hospital and Medical Research Center, New Delhi, India. The Research Ethics Committee of the Hospital reviewed and approved the study protocol.Data Collected Included:Sociodemographic data, anthropometric data, clinical history, significant past medical history, medications, current clinical status of the patient, and investigations including electrocardiogram (ECG), electrocardiogram (ECHO), and coronary artery graft.Results:Age groups and type of ACS were having a statistically significant association (p = 0.04). A majority of patients with ACS were seen in the 55–74 years age group. Tobacco abuse was more common in STEMI patients as compared to other types of ACS. There was significant variation between risk stratification of ACS patients by Thrombolysis in Myocardial Infarction and Global Registry of Acute Cardiac Events scores. Single vessel disease (SVD) patients dominated both the STEMI [26 (50.9%)] and UA [13 (52%)] groups. There was a highly significant association between a specific line of treatment and type of ACS (p < 0.0001). A majority of patients underwent percutaneous intervention (69% of 100). Coronary artery bypass graft (CABG) was done in five (5/100) patients only. Thrombolysis was advocated in three (5.7%) patients with Streptokinase (SK) and two patients with Tenecteplase (TNK).Conclusion:There was a marked preponderance of STEMI in younger patients but it was less marked in older patients, according to the study. All conventional risk factors were represented in all types of ACS but hypertension and tobacco abuse were more consistent risk factors associated with STEMI.

Anxiety and depression among students using tobacco in a selected college of Sonitpur District, Assam: A crosssectional study

Introduction: Tobacco use is one of the major public health concerns around the world, accounting for many deaths and disabilities. The use of tobacco is linked to many physical and mental ailments. A large population of adolescents are enrolled in colleges and universities in India, making them a vulnerable population for the use and abuse of tobacco. Objective: The objective of this study is to assess the level of anxiety and symptoms of depression among college-going students who consume tobacco. Methods: A descriptive cross-sectional approach was selected for the study. The purposive sampling technique was used to select college students aged between 17 and 24 years, enrolled in any degree program at the selected college. General Anxiety Disorder-7 Questionnaire, Patient Health Questionnaire-9 Depression Scale, and a modified version of WHO-Global Youth Tobacco Survey Questionnaire were used to collect data. Results: The study findings show that tobacco use was highest among male students having a family member who uses tobacco. It was also found that the majority of the current tobacco users 43 (40.2%) had symptoms of a mild level of anxiety and 36 (33.6%) had minimal symptoms of depression. Conclusion: The students who are current or past tobacco users have some level of anxiety and depression. Interventions that are tailored to sensitize students about the effects of tobacco might help in reducing tobacco consumption.

Anthropometric and socio-demographic profile of diabetes mellitus patients attending tertiary care teaching hospital of Bankura, West Bengal

Background: Diabetes mellitus (DM), a non-communicable disease is on increasing trend in India as well as in West Bengal. DM develop mainly due to insulin deficiency or insulin resistance associated with deleterious effect of risk factors such as advancing maternal age, family history of diabetes, obesity, and ethnicity. Aims and Objectives: Humungous number of diabetic patient attending the Bankura Sammilani Medical College and Hospital inspires us to study the socio-demographic profile and anthropometric risk factors to create awareness and reduce disease burden. Materials and Methods: This hospital based descriptive cross-sectional study was done after receiving approval from the institute ethical committee. This study enrolled 220 Type 2 diabetic patients, selected based on recent American Diabetes Association guideline. Patients with pregnancy, other endocrinal disorders, and history of drug intake influencing plasma glucose concentration are excluded from the study. The data were collected, extrapolated in Microsoft excel sheet and relevant statistical analysis was done. Results: Among 220 participants, female dominance (62.3%) is noted. Maximum participants are from age group 45–59 years. Majority of them are from rural area (81.3%). Illiteracy is high (43.6%), sedentary physical activity is more (81.8%) among participants. History of stress (80%) is present in larger section of patients. Positive family history of diabetes is absent in (67.3%) of participants. Tobacco abuse is present in (32.7%) of diabetics, (60%) of the patients are pre-obese and obese as per Asian criteria of Body mass index and (57.7%) have high waist-hip ratio (WHR). Conclusion: DM is emerging as a major health issue in West Bengal too. The patients belong to both genders. Larger section of the participants is pre-obese and obese and has higher WHR. There is need to focus on socio-demographic and anthropometric factors to create awareness and to recommend preventive strategies to reduce the burden of the disease.

Burden of tobacco use and control in India- A review

Tobacco is the only legal consumer product that harms every user, killing up to half of those who use it as intended. Tobacco abuse is one of the most harmful habits practiced by the population worldwide. Tobacco use is also a primary etiologic factor for periodontal disease and poor wound healing following oral surgery and gingival recession. In the current times, all tobacco-growing countries find that their efforts to control tobacco products are challenged by the tobacco industry. Despite India being the second largest tobacco producer and a major exporter, tobacco control measures in India have always been equally or more stringent than in many developed countries. However studies have strongly supported the argument that tobacco was of no real economic benefit to the nation, while being a major health hazard. Dental professionals play an active role as a Role model, Clinician, Educator, Scientist, Opinion-builder, Alliance-builder, Leaderand to watch out for the activities in the Tobacco industry while facing various barriers to aid in tobacco cessation for the people. Thus, the dangers of tobacco use, and other lifestyle risk factors needs to be well taught and reinforced in dental undergraduate curricula. A priority need is the education of the dentists and the other health care professionals as to the need for, and methods for, offering smoking cessation in their clinical environment.

Preoperative Opioid Prescription is a Risk Factor for Extended Opioid Filling After Ankle Arthroscopy

Category:Arthroscopy; Ankle; Sports; OtherIntroduction/Purpose:Opioids can be an important tool in the management of postoperative pain, however, increased prescribing of these medications following orthopaedic procedures has significantly contributed to the current opioid crisis. Post- operative opioid utilization and duration varies greatly among surgeons, procedures, and patients. We sought to investigate patterns of opioid prescription following ankle arthroscopy and determine patient factors associated with increased postoperative opioid prescribing.Methods:A national claims-based database was queried for patients undergoing first-time ankle arthroscopy. Only patients with continuous database inclusion for at least one year prior to and one year after index ankle arthroscopy were included. Patients carrying an International Classification of Diseases (ICD)-9 or ICD-10 code(s) for diagnosis of septic ankle joint or a CPT code for total ankle arthroplasty prior to index ankle arthroscopy were excluded from the study. Patients who filled at least 1 opioid prescription between 1 and 4 months prior to surgery were defined as preoperative opioid-use group. Monthly relative risk ratios for filling an opioid prescription were calculated for the first year after surgery. Multiple logistic regression analysis was performed to identify factors associated with opioid prescription refills at 3, 6, 9, and 12 months after ankle arthroscopy. For analysis, P<0.05 was defined as significant.Results:We identified 6,039 patients who underwent primary ankle arthroscopy. The preoperative opioid-use group consisted of 1,514 patients (25.1%), of which 24 (1.6%) filled opioid prescriptions at 6 months postoperatively compared to 39 (0.9%) of opioid-naive patients (relative risk [RR], 1.84 95% confidence interval [CI], 1.11-3.05). Multivariate analysis determined that the preoperative opioid-use group was at increased risk of filling prescriptions at 3 (odds ratio [OR], 2.22; 95% CI 1.42-3.48) and 6 months (OR, 1.74; 95% CI, 1.01-2.95) postoperatively. Patients with Body Mass Index (BMI) > 30 were also at increased risk at 3 months (OR, 1.65; 95% CI, 1.04-2.62) and 6 months (OR, 2.01; 95% CI, 1.17-3.49) postoperatively. Comorbidities such as diabetes, hypertension, fibromyalgia, alcohol, and tobacco abuse were not associated with opioid filling (P>0.05).Conclusion:Preoperative opioid prescription filling and BMI 30 were associated with an increased risk of extended opioid prescription utilization following ankle arthroscopy. Overall, prolonged opioid prescribing was not widespread in either group postoperatively. This may represent the indications and outcomes of ankle arthroscopy. Patients presenting with preoperative opioid-use and increased BMI may benefit from multimodal pain management and additional perioperative education around non- pharmacologic pain-management strategies to decrease risk of prolonged opioid use.

Frequency of Metabolic Syndrome in Type 2 Diabetes Mellitus in a Tertiary Care Hospital of Bangladesh

Background: As a well-established risk factor for coronary heart disease, Metabolic Syndrome was already encountered. But the relationship between Metabolic Syndrome and Type 2 Diabetes Mellitus and the independent contribution of Metabolic Syndrome remained unclear. To evaluate the status of metabolic syndrome in the Type 2 diabetic population and for their ability to predict Type 2 Diabetes Mellitus, in parallel with conventional stroke risk factors, this study was planned. Methods: A hospital-based descriptive observational study was conducted in 100 patients with Type 2 Diabetes Mellitus who were selected by consecutive random sampling techniques. Patients were diagnosed through proper history, clinical examination, and necessary investigations. The outcome values were measured in anthropometric measurements, blood pressure, dyslipidemia, and blood glucose. Results: Among 100 patients with Type 2 Diabetes Mellitus, (64%) were females who were housewives (41%) with significant difference (p &lt; 0.001) and Mean± SD was 58±12.24 yrs ranging from 32-85 years. About 30% had a positive family history of Type 2 Diabetes Mellitus and 28% tobacco abuse. Of the total, 31% of patients had high blood pressure, and 28% had low HDL with a significant difference (p&lt;0.001), but 46% had high triglyceride levels, which was not significant. More than half (53.12%) females showed central obesity, while only 16.67% had central obesity among males, and it showed a significant difference (p=0.04) in both sex. There was a high frequency of Metabolic Syndrome in a patient with Type 2 Diabetes Mellitus (68%) with a significant difference, and 48% were female, and 20 % were male. In patients of Metabolic Syndrome, central obesity was found in 36(52.94%) patients where females were predominantly affected 32(88.89%), hypertension found in 28(4118%) patients where male were predominantly affected 16(57.14%) patients, hypertriglyceridemia found in 44(64.70%) patients where a female was predominantly affected 26(59.09%) patients and low HDL found in 22(32.35%) patients where a female was predominantly affected 16(72.73%). Conclusion: The frequency of Metabolic Syndrome was more than double in women (48%). Central obesity and low HDL were significantly more prevalent in women than men, where hypertension was significant in men. So it would be reasonable to conclude that women are more likely to suffer from Metabolic Syndrome from cardiovascular morbidity and mortality.

Recurrent acute pancreatitis prevention by the elimination of alcohol and cigarette smoking (REAPPEAR): protocol of a randomised controlled trial and a cohort study

Background/objectivesAcute recurrent pancreatitis (ARP) due to alcohol and/or tobacco abuse is a preventable disease which lowers quality of life and can lead to chronic pancreatitis. The REAPPEAR study aims to...