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Research Article | Volume 14 Issue: 4 (Jul-Aug, 2024) | Pages 701 - 710
A Comprehensive Analysis of Patients with Abdominal Symptoms and Associated Risk Factors
 ,
 ,
1
Associate Professor, Department of Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
2
Assistant Professor, Department of Community Medicine, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
3
Assistant Professor, Department of Microbiology, Vydehi Institute of Medical Sciences and Research Centre, Bangalore, Karnataka, India
Under a Creative Commons license
Open Access
Received
June 28, 2024
Revised
July 25, 2024
Accepted
Aug. 6, 2024
Published
Aug. 15, 2024
Abstract

Introduction: Abdominal symptoms are frequently encountered in clinical practice. Mostly patients seek medical attention after attempting various dietary modifications and sometimes even after self-medicating. These patients express dissatisfaction when they receive similar advice in their subsequent hospital visits. Studies suggests that a significant proportion of patients coming to hospital with abdominal symptoms would have already consulted a doctor and would be hoping for alternative treatment or advices in the current visit. Method and Methods: This was an observational cross-sectional study conducted in Vydehi Institute of Medical Sciences and Research Centre, Bangalore over a period of 6 months and was designed to examine the relationship between abdominal symptoms and their potential risk factors. 100 patients who reported abdominal symptoms that were outlined in the structured questionnaire were included in the study. Results: The study population consisted of 100 participants with a mean age of 37.48 years (SD = 12.12), ranging from 19 to 70 years. The prevalence of various abdominal symptoms among the study participants.  61 participants reported symptoms belonging to this category. The most common symptoms were heartburn (42%), water brash (21%), halitosis (20%), and belching (26%). 51 participants reported symptoms belonging to this category. The most frequently reported symptoms were a sense of incomplete evacuation of stools (39%) and straining during defecation (32%). Less common symptoms included mass per rectum (8%), blood in stool (6%), and mucus in stool (3%). Conclusions: The findings emphasize the need to identify specific risk factors associated with particular symptoms while interviewing patients. This will enable healthcare providers to tailor the interventions to address the unique needs of patients. Also, the methodology employed in this study can be extended to study symptoms and risk factors related to different medical conditions. For example, similar studies could be conducted with respiratory or cardiovascular symptoms utilizing statistical tests to find significant associations and co-occurrences of symptoms and risk factors. This can help us in developing models that can improve the overall management of patients in clinical settings

Keywords
INTRODUCTION

Abdominal symptoms are frequently encountered in clinical practice. Mostly patients seek medical attention after attempting various dietary modifications and sometimes even after self-medicating.1 These patients express dissatisfaction when they receive similar advice in their subsequent hospital visits. Studies suggests that a significant proportion of patients coming to hospital with abdominal symptoms would have already consulted a doctor and would be hoping for alternative treatment or advices in the current visit.2

 

This study aims to investigate the relationship between specific abdominal symptoms and their potential risk factors. The goal is to identify possible risk factors that may be contributing to a specific symptom. Understanding these relationships will be useful in improving patient management and outcomes.

MATERIAL AND METHODS

This was an observational cross-sectional study conducted in Vydehi Institute of Medical Sciences and Research Centre, Bangalore over a period of 6 months and was designed to examine the relationship between abdominal symptoms and their potential risk factors. 100 patients who reported abdominal symptoms that were outlined in the structured questionnaire were included in the study.

     The interview collected information on the presence or absence (Yes/No) of various abdominal symptoms that were categorized into four main groups:

 

  1. Gastro-Esophageal Reflux Disease (GERD) or Acid reflux symptoms: heartburn (burning sensation in the chest or upper abdomen), water brash (sour taste in the mouth), halitosis (unpleasant breath odour), belching (expelling air through the mouth)
  2. Acid peptic disease symptoms: abdominal pain (unspecified or dull aching), early satiety, feeling uncomfortably full after food, nausea (vomiting like sensation), vomiting, dark/black stool.
  3. Bowel symptoms: cramps (sudden, painful tightening within abdomen), bloating (sensation of abdomen being full), flatulence (farting), hard/dry stool
  4. Anorectal disease symptoms: straining during defecation, Sense of incomplete evacuation of stools, mass per rectum, blood in stool, mucus in stool

Additionally, data on potential risk factors, such as dietary habits, lifestyle factors, stressors and medication use were collected using standardized questionnaires. The questionnaire was administered in both online and hard copy formats.

 

Statistical methods:

The data were analyzed using JASP version 0.18.3. Data

was organized using binary coding (1 for present, 0 for absent) for both symptoms and risk factors. Non-parametric Chi-square test with Standardized residuals and Logistic regression were used for performing statistical analysis and to assess the association between risk factors and symptoms. The analysis of the co-occurrence of abdominal symptoms and co-occurrence of risk factors were conducted using the Chi-square test and standardized residuals. Logistic regression analysis was employed to assess the relationship between each symptom and potential risk factors. Statistical significance was assumed with a p-value of < 0.05. Standardized residual values greater or lesser than ±1.96 were considered as significant contributors to the Chi-square test.

RESULTS

Symptom Profile

The study population consisted of 100 participants with a mean age of 37.48 years (SD = 12.12), ranging from 19 to 70 years. The prevalence of various abdominal symptoms among the study participants is presented in Table 1.

 

Table 1: Prevalence of abdominal symptoms

 

GERD or Acid reflux symptoms

61

Acid peptic disease symptoms

67

Bowel symptoms

75

Anorectal disease symptoms

51

Heartburn

42

Feeling uncomfortably full after eating

47

Bloating

54

Incomplete evacuation of stools

39

Water brash

21

Abdominal pain

40

Cramps

31

Straining during defecation

32

Belching

26

Early satiety

34

Flatulence

28

Mass per rectum

8

Halitosis

20

Nausea

22

Hard/dry stool

23

Blood in stool

6

Vomiting

9

Mucus in stool

3

Dark/black stool

9

 

GERD or Acid reflux symptoms:

 61 participants reported symptoms belonging to this category. The most common symptoms were heartburn (42%), water brash (21%), halitosis (20%), and belching (26%).

Acid peptic disease symptoms:

67 participants reported symptoms belonging to this category. The most frequently reported symptoms were abdominal pain (40%), feeling uncomfortably full after eating (47%), and early satiety (34%) followed by nausea (22%), vomiting (9%), and dark/black stool (9%).

Bowel symptoms:

75 participants reported symptoms belonging to this category. Bloating (54%) was the most common symptom, followed by cramps (31%), flatulence (28%), and hard/dry stool (23%).

Anorectal disease symptoms:

51 participants reported symptoms belonging to this category. The most frequently reported symptoms were a sense of incomplete evacuation of stools (39%) and straining during defecation (32%). Less common symptoms included mass per rectum (8%), blood in stool (6%), and mucus in stool (3%).

 The analysis of the co-occurrence of abdominal symptoms revealed the following significant associations among various symptoms and the findings have been summarized in Table 2.

 

Table 2: Symptom co-occurrence with p value and Standardized residuals

 

Symptoms

Co-occur with

P value, Standardized residuals

Acid reflux symptoms

Acid peptic disease symptoms

<0.001, 3.545

Acid reflux symptoms

Abdominal pain

0.006, 2.762

Acid reflux symptoms

Early satiety

0.007, 2.709

Acid reflux symptoms

Feeling uncomfortably full after food

0.003, 3.011

Acid reflux symptoms

Vomiting

0.012, 2.515

Acid reflux symptoms

Black/dark stool

0.012, 2.515

Acid reflux symptoms

Bloating

0.013, 2.493

Acid reflux symptoms

Sense of incomplete evacuation of stools

0.029, 2.190

Heartburn

Waterbrash

<0.001, 3.572

Heartburn

Acid peptic disease symptoms

0.012, 2.525

Heartburn

Early satiety

<0.001, 3.73

Heartburn

Feeling uncomfortably full after food

<0.001, 3.353

Heartburn

Black / dark stool

0.023, 2.280

Heartburn

Mass per rectum

0.049, 1.972

Water brash

Belching

0.048 (1.981)

Water brash

Acid peptic disease symptoms

0.040, 2.052

Water brash

Abdominal pain

0.021, 2.305

Water brash

Early satiety

0.002, 3.037

Water brash

Feeling uncomfortably full after food

0.012, 2.524

Water brash

Nausea

0.001, 3.189

Water brash

Vomiting

0.008, 2.668

Water brash

Anorectal disease

0.009, 2.598

Water brash

Sense of incomplete evacuation of stools

0.015, 2.421

Halitosis

Belching

0.006 (2.736)

Halitosis

Abdomen pain

0.041, 2.041

Halitosis

Dark/Black stool

0.005, 2.795

Halitosis

Sense of incomplete evacuation of stools

0.001, 3.178

Belching

Acid peptic disease symptoms

0.007, 2.705

Belching

Abdomen pain

0.032, 2.141

Belching

Vomiting

<0.001, 3.712

Belching

Dark/black stools

<0.001, 3.712

Belching

Bowel symptoms

0.018, 2.369

Belching

Bloating

<0.001, 3.641

Belching

Hard/dry stool

 

0.001, 3.261

Belching

Anorectal disease

0.031, 2.162

Belching

Straining during defecation

0.022, 2.287

Belching

Sense of incomplete evacuation of stools

0.023, 2.272

Acid peptic disease symptoms

Cramps

0.016, 2.405

Acid peptic disease symptoms

Bloating

 

0.040, 2.057

Acid peptic disease symptoms

Hard/dry stool

0.020, 2.320

Abdominal pain

Early satiety

0.006, 2.758

Abdominal pain

Nausea

0.010, 2.562

Abdominal pain

Dark/black stool-

0.002, 3.138

Abdominal pain

Bowel symptoms-

<0.001, 3.300

Abdominal pain

Cramps

<0.001, 5.120

Abdominal pain

Hard/dry stool-

0.020, 2.328

Early satiety

Feeling uncomfortably full after food

<0.001, 7.622

Early satiety

Nausea

0.021, 2.303

Early satiety

Dark/black stool

0.030, 2.169

Early satiety

Hard/dry stool

0.036, 2.097

Feeling full after food

Dark/black stool

0.008, 2.639

Feeling full after food

Bloating

0.024, 2.259

Feeling full after food

Hard/dry stool

0.046, 1.995

Feeling full after food

Straining during defecation

0.033, 2.130

Nausea

Vomiting

<0.001, 5.922

Nausea

Hard/dry stool

0.024, 2.260

Vomiting

Hard/dry stool

0.015, 2.433

Dark or black stool

Cramps

0.001, 3.181

Dark or black stool

Bloating

0.028, 2.201

Dark or black stool

Hard/dry stool

0.015, 2.433

Dark or black stool

Anorectal disease

0.017, 2.384

Dark or black stool

Straining during defecation

0.019, 2.337

Dark or black stool

Sense of incomplete evacuation of stool

0.001, 3.217

Dark or black stool

Mass per rectum

0.003, 2.937

Bowel symptoms

Straining during defecation

0.013, 2.475

Bloating

Flatulence

0.029, 2.181

Bloating

Straining during defecation

0.042, 2.030

Bloating

Sense of incomplete evacuation

0.001, 3.266

Flatulence

Anorectal disease

0.035, 2.103

Flatulence

Mass per rectum

0.023, 2.266

Flatulence

Blood in stool

0.030, 2.176

Hard/dry stool

Anorectal disease

<0.001, 3.456

Hard/dry stool

Straining during defecation

<0.001, 4.911

Hard/dry stool

Sense of incomplete evacuation of stool

0.05, 1.963

Straining during defecation

Sense of incomplete evacuation of stool

<0.001, 4.624

 

Straining during defecation

Mass per rectum

0.007, 2.718

Sense of incomplete evacuation of stools

Mass per rectum

0.003, 2.932

Mass per rectum

Blood in stool

<0.001, 3.911

Blood in stool

Mucus in stool-

0.043, 2.024

 

Risk profile

The risk profile of participants in this study was assessed to identify lifestyle factors, dietary dietary habits, stress and medication use. The findings are summarized below in Table 3.

 

Table 3: Prevalence of risk factors

Dietary habits

Number of participants

Lifestyle factors

Number of participants

Stress and Medication Use

Number of participants

Irregular mealtimes

64

Sleeping immediately after food

45

Stress at home or workplace

62

Eating spicy foods

57

Inadequate sleep

44

Stress at home

49

Eating late at night

54

Being overweight

40

Stress at workplace

35

Habit of skipping meals

50

Decreased water intake (less than 1.5 liters per day)

37

Use of over-the-counter painkillers

 

21

Eating high-fat foods

47

Physical inactivity

34

Using Aspirin

 

5

Eating too quickly

46

Sleeping without pillows

14

Eating sweets

44

Exercising after food

11

Eating large meals

43

Eating a diet low in fruits and vegetables

41

Excessive coffee or tea consumption

36

Carbonated drinks/soft drinks

30

Eating leftover food

30

Eating pickled foods

26

Excessive intake of meat

24

Eating very hot foods

23

Consuming alcohol

16

Smoking

8

Consuming peppermints

5

 

The most common dietary risk factors were irregular mealtimes (64%), consumption of spicy foods (57%), and eating late at night (54%). The most common lifestyle factors were sleeping immediately after food (45%), inadequate sleep (44%), and high levels of stress (62% reporting stress either at home or workplace).

 

The analysis of the co-occurrence of the risk factors showed some significant associations between dietary, lifestyle, and psychosocial factors and are summarized in Table 4 with their respective significance levels.

 

Table 4: Risk factor co-occurrence with p value and Standardized residuals

Risk factors

Co-occur with

P value, Standardized residuals

Eating high-fat foods

Spicy foods

<0.001, 3.727

Very hot food

0.003, 2.947

Eating sweets

0.032, 2.147

Eating pickled foods

0.008, 2.640

Eating large meals

0.006, 2.748

Eating too quickly

0.010, 2.565

Eating late at night

0.008, 2.661

Excessive intake of meat

<0.001, 5.029

Irregular meal times

<0.001, 3.723

Habit of skipping meals

<0.001, 3.406

Carbonated drinks

0.032, 2.142

Consuming alcohol

0.003, 2.995

Smoking

0.002, 3.131

Decreased water intake

0.002, 3.158

Being over weight

0.003, 2.945

Eating spicy foods

Eating very hot foods

0.019, 2.347

Eating pickled foods

0.004, 2.846

Eating large meals-

0.002, 3.056

Eating left over food

0.031, 2.160

Habit of skipping meals

0.026, 2.222

Decreased water intake

0.013, 2.473

Physical inactivity

0.049. 1.970

Sleeping immediately after food

0.010, 2.578

Eating very hot food

Eating sweets

0.005, 2.815

Eating pickled food

0.007, 2.720

Eating large meals

0.049, 1.973

Eating too quickly

0.035, 2.107

Excessive intake of meat

0.013, 2.493

Eating very hot and irregular mealtimes

0.034, 2.119

Eating a diet that is low in fruits and vegetables

Eating too quickly

0.036, 2.097

Carbonated drinks

0.019, -2.352

Smoking

0.041, 2.039

Vegetables and decreased water intake

0.042, 2.034

Eating sweets

Eating pickled food

<0.001, 3.472

Eating large meals

0.039, 2.067

Eating too quickly

0.006, 2.732

Irregular mealtimes

0.042, 2.031

Eating pickled foods

Eating large meals

0.026, 2.220

Carbonated drinks

0.010, 2.587

Consuming alcohol

0.017, 2.388

Sleeping immediately after food

0.049, 1.971

Eating large meals

Eating excessive meat

0.027, 2.213

Habit of skipping meals

0.002, 3.030

Consuming peppermints

0.008, 2.641

Being over weight

0.017, 2.391

Inadequate sleep

0.013, 2.474

Stress at workplace

0.036, 2.096

Eating leftover food

Habit of skipping meals

0.009, 2.619

Consuming alcohol

0.012, 2.500

Inadequate sleep

0.011, 2.550

Eating late at night

Excessive intake of meat

<0.001, 3.307

Irregular meal times

<0.001, 3.528

Habit of skipping meals

0.005, 2.809

Consuming alcohol

0.017, 2.386

Smoking

0.006, 2.722

Sleeping immediately after food

0.022, 2.299

Stress at workplace

0.032, 2.145

Excessive intake of meat

Irregular mealtimes

0.024, 2.263

Consuming alcohol

0.044, 2.018

Smoking

<0.001, 3.521

Decreased water intake

0.013, 2.483

Irregular mealtimes

Habit of skipping meals

<0.001, 5.417

Consuming alcohol

0.033, 2.137

Decreased water intake

0.022, 2.296

Sleeping immediately after food

0.029, 2.178

Stress at home or workplace

0.022, 2.283

Stress at workplace

<0.001, 3.320

Habit of skipping meals

Decreased water intake

0.007, 2.693

Being over weight

0.041, 2.041

Inadequate sleep

0.016, 2.417

Stress at home or workplace

0.004, 2.884

Stress at workplace

0.002, 3.145

Excessive coffee or tea

Peppermints

0.035, 2.103

Decreased water intake

0.014, 2.451

Physical inactivity

0.003, 2,973

Sleeping immediately after food

0.004, 2.848

Consuming peppermint

Smoking

0.007, 2.706

Decreased water intake

0.041, 2.043

Exercising after food

0.033, 2.126

Consuming alcohol

Smoking

<0.001, 6.757

Over the counter pain killers

- 0.015, 2.438

Smoking

Over the counter pain killers

0.036, 2.100

Decreased water intake

Inadequate sleep

0.005, 2,804

Sleeping immediately after food

0.002, 3.060

Stress at workplace

0.028, 2.193

Inadequate sleep

Sleeping without pillows

0.026, 2.229

Stress at home or workplace

0.050, 1.959

Stress at home

0.028, 2.192

Physical inactivity

Sleeping immediately after food

<0.001, 3.692

Sleeping without pillows

0.010, 2.580

Exercising after food

Over the counter pain killers

0.035, 2.111

Sleeping without pillows

Over the counter pain killers

0.030, 2.165

 

Relationship between symptoms and risk factors

The analysis of the relationship between abdominal symptoms and associated risk factors was conducted using logistic regression analysis. This also revealed significant associations between various symptoms and dietary, lifestyle, and medication-related risk factors and the findings are summarized in Table 5.

 

Table 5: Risk factors significantly associated with symptoms with p values

Symptoms

Associated risk factors

P values

Acid reflux symptoms

Eating spicy foods

0.006

Eating large meals

0.034

Eating late at night

0.020

Sleeping without pillows

0.035

Use of over-the-counter painkillers

0.003

Using medications like Aspirin

0.047

Heartburn

Eating spicy foods

0.027

Use of over-the-counter painkillers

0.002

Water brash

Stress at Home or Workplace

0.028

Use of over-the-counter painkillers

0.020

Halitosis

-

 

Belching

Consuming peppermint

0.032

Acid peptic disease symptoms

Eating spicy foods

0.031

Eating pickled foods

0.017

Eating large meals

0.007

Eating too quickly

0.036

Sleeping without pillows

0.002

Stress at workplace

0.030

Use of over-the-counter painkillers

0.003

Using medications like Aspirin

0.047

Abdominal pain

Eating large meals

0.003

Decreased water intake

0.007

Physical inactivity

0.034

Sleeping without pillows

0.013

Early satiety

Eating a diet that is low in fruits and vegetables

0.014

Carbonated drinks / Soft drinks

0.009

Exercising after food

0.022

Stress at Home or Workplace

0.006

Stress at workplace

0.013

Use of over-the-counter painkillers

0.036

Feeling full after food

Eating too quickly

0.012

Stress at Home or Workplace

0.021

Stress at home

0.046

Stress at workplace

0.011

Nausea

Eating spicy foods

0.028

Excessive coffee or tea

0.043

Sleeping immediately after food

0.027

Sleeping without pillows

0.011

Use of over-the-counter painkillers

0.006

Vomiting

-

 

Dark or black stool

-

 

Bowel symptoms

Stress at workplace

0.033

Cramps

Eating large meals

0.050

Use of over-the-counter painkillers

0.042

Bloating

Eating large meals

0.029

Flatulence

Use of over-the-counter painkillers

0.020

Hard/dry stool

Eating sweets

0.262

Eating too quickly

0.036

Stress at workplace

0.006

Anorectal disease symptoms

-

 

Straining during defecation

Eating spicy foods

0.043

Sense of incomplete evacuation of stools

-

 

Mass per rectum

-

 

Blood in stool

-

 

Mass per rectum and blood in stool

-

 

Mucus in stool

-

 

 

DISCUSSION

Prevalence and Co-occurrence of Symptoms and Risk Factors

The prevalence of specific abdominal symptoms and potential risk factors found in the study aligned with the existing literature on abdominal symptoms and their impact on quality of life.

 

GERD or Acid Reflux Symptoms

In the study, 61 participants reported symptoms belonging to this group, with heartburn being the most common (42%). This is consistent with a study that reports heartburn and regurgitation as the most common manifestations of GERD. The presence of water brash (21%) and halitosis (20%) in our study shows that symptoms associated with GERD are diverse and can also include atypical symptoms such as chronic cough and dental erosions.3

 

Risk Factors

The study identified several risk factors associated with acid reflux symptoms, including eating spicy foods (p = 0.006), consuming large meals (p = 0.034), and sleeping without pillows (p = 0.035). These findings are consistent with a study that reported that dietary habits like consumption of spicy and fatty foods, and large meal sizes can significantly increase the risk of acid reflux.4 The study showed that use of over-the-counter painkillers (p = 0.003) and medications like aspirin (p = 0.047) were strong risk factors and therefore these medications should be used judiciously in patients with high risk of developing abdominal symptoms. Reflux symptoms associated with nonsteroidal anti-inflammatory drugs (NSAIDs) could be due to irritation of gastric mucosa leading to increased acid secretion.3, 5

 

Heartburn and Water Brash

Heartburn was associated with consumption of spicy foods (p = 0.027) and the use of over-the-counter painkillers (p = 0.002). This aligns with findings from a study which reported that dietary factors and certain medications can trigger heartburn episodes. Water brash symptoms were associated with stress at home or the workplace (p = 0.028), indicating that stress can exacerbate GERD symptoms through increased gastric acid production as previously reported in other studies.5,6

 

Acid Peptic Disease Symptoms

The study showed that abdominal pain (40%) and a feeling of fullness after eating (47%) were common complaints in this category. These findings are supported by another study that has documented similar complaints in patients with acid-related disorders.7

 

Risk Factors

The study found that acid peptic disease symptoms were linked to dietary habits like eating spicy foods (p = 0.031) and pickled foods (p = 0.017). Studies in the past have highlighted that diet high in salt and preservatives contribute to gastric mucosal damage and increase the risk of peptic ulcer disease.5,8,9

 

Other Contributing Factors

Eating large meals (p = 0.007), eating too quickly (p = 0.036), sleeping without pillows (p = 0.002), stress at workplace (p = 0.030), use of over-the-counter painkillers (p = 0.003), and medications like Aspirin (p = 0.047) were also significant risk factors reflecting findings from previous study.5  Decreased water intake (p = 0.007) and physical inactivity (p = 0.034) were other risk factors for acid peptic disease related symptoms and are substantiated by the evidence that hydration and regular physical activity are crucial for maintaining gastrointestinal health.10,11

 

Bowel Symptoms

Among bowel symptoms, bloating (54%) was the most common symptom, followed by cramps (31%) and flatulence (28%). The high incidence of these symptoms in our study could be suggesting a potential overlap of bowel symptoms in patients with functional gastrointestinal disorders which are also commonly characterized by symptoms like bloating and discomfort.12

 

Risk Factors

Bowel symptoms were associated with stress (at workplace, p = 0.033), eating large meals (p = 0.050 for cramps and p = 0.029 for bloating), and the use of over-the-counter painkillers (p = 0.042 for cramps and p = 0.020 for flatulence). These findings are supported by studies that indicate that large meals can lead to discomfort and NSAIDs can disrupt gut motility and by exacerbating bowel symptoms.5,12

 

Anorectal Disease Symptoms

A sense of incomplete evacuation (39%) and straining during defecation (32%) were the most common anorectal disease symptoms found in the study. 

 

Risk Factors

The study found that straining during defecation was strongly associated with eating spicy foods (p = 0.043). This is consistent with the evidence that dietary irritants can lead to bowel dysmotility and straining.13

 

Overall, the prevalence of gastrointestinal symptoms and associated risk factors reported in this study reflects the trends observed in the existing literature. The statistical approach used in the study provided a framework for identifying patterns of symptoms, risk factors and their relationship with each other. Certain risk factors found to co-occur in the study could be suggesting that these risk factors act synergistically resulting in the development of particular abdominal symptoms. Understanding such co-occurrences of symptoms and risk factors can guide clinicians in anticipating future symptoms and complications as well as help in planning for the required investigations. This can assist in efficient use of healthcare resources.

 

Limitation

Recall bias is inherent to the design of the study as it relies on the details reported by the patients.

CONCLUSION

The findings emphasize the need to identify specific risk factors associated with particular symptoms while interviewing patients. This will enable healthcare providers to tailor the interventions to address the unique needs of patients.

 

Also, the methodology employed in this study can be extended to study symptoms and risk factors related to different medical conditions. For example, similar studies could be conducted with respiratory or cardiovascular symptoms utilizing statistical tests to significant associations and co-occurrences of symptoms and risk factors. This can help us in developing models that can improve the overall find management of patients in clinical settings.

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