Detailed 2021 batch tentative thesis titles here: http://medicinedepartment.blogspot.com/2022/07/2021-20-allocated-thesis-and-other.html?m=1
Problem statement/background :
"Understanding anemia’s varied and complex etiology is crucial for developing effective interventions that address the context-specific causes of anemia."
"While iron deficiency ID remains a primary cause in many settings, the proportion of anemic individuals with ID varies by contextual factors, and poor iron nutrition cannot be assumed to be the primary cause in all cases.Given the complex etiology of anemia, the extent to which ID accounts for the anemia burden continues to be investigated."
Quoted from :
Chaparro CM, Suchdev PS. 2019. Anemia epidemiology, pathophysiology, and etiology in low-and middle-income countries. Annals of the New York Academy of Sciences 1450: 15. Full text link at:
AIM:
To navigate clinical complexity in patients with anemia and optimize their management toward reducing diagnostic and therapeutic uncertainty along with improvement in their anemia outcomes.
OBJECTIVES:
• To assess various clinical and investigational characteristics of patients with anemia in relation to their clinical complexity and outcomes.
• To analyse patient outcomes based on morbidity (physical, social & psychological limitations)
PATIENTS AND METHODS:
PLACE OF STUDY: Department of General medicine
STUDY PERIOD: November 2022- October 2024
STUDY DESIGN : Non experimental (Observational) qualitative Prospective Study
SAMPLE SIZE: 50 patients
INCLUSION CRITERIA:
• Anemia patients of any gender above or equal to 18yrs of age at the time of presentation.
• Patients presenting with a combination of anemia and complex etiological possibilities where the diagnosis remains uncertain and treatment remains empirical.
For example a typical patient to be included may have low hemoglobin and low serum ferritin with no history of blood loss or dietary indiscretions or a patient with low hemoglobin and high serum ferritin likely to have both iron deficiency as well as chronic inflammation.
EXCLUSION CRITERIA:
1.Patients below 18 yrs of age (minors)
2.Patients not capable of giving consent (mentally-ill patients)
3.Patients not willing to participate in study (non-consenting patients)
PROFORMA (data to be captured)
Demographics
Patient event data reflected in a narrative history of the sequence of events leading to the current presentation and outcomes
Body data from clinical general and systemic examination
Pallor
Lymphadenpathy
Nails
Organomegaly
Skin
Muscle mass
Mid arm circumference
Visceral fat
Body data from laboratory investigation :
- CBP with peripheral smear
- Iron profile with serum ferritin
- Serum albumin
- Serum creatinine
- Special tests on indication :
- Thyroid function tests
- Chest X-ray -PA view
- ECG
- 2D ECHO
- Bone marrow if indicated
Data from treatment instituted :
Data from Patient reported outcomes :
Daily functionality (in terms of routine activities)
Daily diet in the form of meal images captured before consumption
Daily intake output where relevant such as complex anemias with renal failure and nutritional deficiency or anemia and chronic diarrhoea
Sample anemia with Clinical complexities case report forms linked below :
Clinical complexity consists of a few defining characteristics such as uncertainty, non linearity, unpredictability and yet an overall pattern leading to resolution through attractor states over time. (2) As physician attractors we are uniquely privileged to "be" with our patients regardless of the diagnosis and that is the only way we may know our patient's outcomes where our "being" with them is the most significant (and often overlooked) intervention.
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