National Medical Journal of India
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Item The Status of Liver Transplantation in India(All India Institute of Medical Sciences, 2025-02) Tiwari, P; Nundy, S.Background The passage of the Transplantation of Human Organs Act in 1994 banned the unethical trade in human kidneys and recognized heart beating brain death as a form of death. This enabled liver transplantation to be performed in India. We briefly recount the history of the Act抯 passage and describe, in some detail, the present status of the procedure. Methods We sent a questionnaire regarding liver transplant services via email to 400 members of the Liver Transplant Society of India requesting them to provide details on liver transplantation at their centres up to 2022. We received information on 3069 of 3920 transplants that had been performed in 2022. Results There were 183 registered centres who had performed a total of 3920 liver transplants, placing India in third position behind the USA (n=9528) and China (n=6053) while it performed the largest number of living donor liver transplants (n=3183) in the world. The most common indication for liver transplantation was non-alcoholic steatohepatitis (NASH)-related cirrhosis (20%). Our teams published 2449 PubMed indexed research papers and 384 foreign trainees came from 52 countries for training in liver transplantation. The concerns were the small numbers of deceased organ donation, the dominance of the private sector (96.7%), corruption in the form of kickbacks and false declarations of relationship and gender imbalance with only 22% women recipients receiving organs from men while 68% women donated their livers to men. Conclusion Liver transplantation has saved the lives of many Indians, made a major impact on Indian healthcare overall, and increased its reputation worldwide. There are problems which we hope will be tackled by increasing societal awareness.Item Rapid diagnosis of disseminated Mycobacterium avium complex infection mimicking metastatic malignancy using metagenomic next-generation sequencing(All India Institute of Medical Sciences, 2025-02) Liu, Y; Wang, J; Pu, Y; Tang, S.Disseminated non-tuberculous mycobacteria (NTM) disease, which is mainly found in immunocompromised individuals, is a rare and severe infection whose diagnosis poses a challenge to clinicians. We present a patient with disseminated NTM infection mistaken for metastatic malignancy in an otherwise healthy patient and the tortuous diagnostic process. Metagenomic next-generation sequencing (mNGS) played a critical role in the diagnosis. Further screening for anti-interferon-? antibodies revealed that the patient had a potential immunodeficiency.Item The district residency programme: Perception of postgraduate students at a tertiary care hospital in Jaipur(All India Institute of Medical Sciences, 2025-02) Sharma, K; Jain, M; Sharma, J.Background The district residency programme (DRP) has been made essential for postgraduates by the National Medical Commission. We studied the perception of postgraduate students about this programme. Methods A cross-sectional survey was done using a pre-validated questionnaire developed in Google forms. The link to the questionnaire was circulated through existing social media platforms and had questions about knowledge, attitude and practice. Scores were appropriately assigned to the questions. The data were coded numerically, and themes were identified from the data using inductive content analysis. Results All participants had a negative opinion of the DRP with a mean perception score of 26.6. Two-thirds of the participants believed that the DRP had no positive impact on learning and knowledge of their respective postgraduate subjects. About 55% of them believed that the duration of DRP training should be reduced. Important themes that were obtained from the data were that DRP training was not beneficial for the participants, and perceived barriers in DRP training included lack of accommodation, food, and communication with the parent department during the training. Conclusion Postgraduate students had a negative perception of the DRP. Upgradation of district hospitals with modern and optimal facilities for patient care, facilities to accommodate students, and provision for communication with the parent department during the DRP, could improve students perception.Item An online course to teach clinical reasoning skills: Students� perspectives and short-term outcomes(All India Institute of Medical Sciences, 2025-02) Nithyanandam, S; Stephen, J; Shankar, N; Joseph, M; Umesh, S; Muralidharan, J; Nagarajan, T; Lobo, AC; Anantharaman, L.Background Currently, clinical reasoning (CR) skills are not explicitly taught in the MBBS curriculum. We aimed to assess the effectiveness of an online CR course for final-year MBBS students. Methods This was a single-group pre- and post-test study with 57 final-year MBBS students enrolled. Six groups were formed, and one or two faculty facilitators were assigned to each group. A structured format for CR was introduced to the students, and the sessions were designed so that students could sequentially practice the steps using specifically created case scenarios. The students� CR skills were assessed using a rubric before and after the course. Their confidence levels and perceptions about the course were also obtained. Paired T-test and the Wilcoxon signed rank test were used to assess before and after course differences in the CR abilities and confidence levels, respectively. A thematic analysis of the perceived beneficial aspects of the course and suggested improvements were also done. Results The post-course scores were significantly higher than the pre-course scores (p<0.001). The confidence levels of the students for each component of the structured framework for CR showed significant improvement (p<0.001). The structured format used during the course, group activities, case discussions, and the expertise of teachers and course structure were perceived as beneficial. This course could be introduced earlier in the MBBS course with a discussion of more case scenarios. Conclusions The online course improved confidence levels and CR abilities of the participants.Item Challenges during implementation of point-of-care testing in a multispecialty children抯 hospital(All India Institute of Medical Sciences, 2025-02) Sequeira, S; Lone, R; Anjum, S.Point-of-care testing (POCT) has been one of the fastest-growing areas of critical care management. It continues to increase in volume and complexity over the past few years and is now moving to the molecular level. POCT is currently defined as a testing process done near or at the site of patient care by non-laboratory clinical staff. Since these tests are done by clinical staff with minimum technical knowledge, many challenges arise due to a lack of understanding of the process of POCT. The key challenges faced during the successful step-by-step implementation and execution of POCT at our multi-specialty hospital for children in the Middle East included POCT instrumentation, training and competency, quality control issues, proper handling of reagents and consumables, importance of critical call notification, patient identification errors, data management, etc. Many clinical decisions are made based on the results of POCT, hence care should be taken during every step of the POCT process. If implemented appropriately, POCT can have a positive impact on operational efficiency and patient care. Healthcare organizations should innovate rapidly to meet the challenges of POCT.Item Inadequate ventilation in a patient with tracheal stenosis due to previous intubation(All India Institute of Medical Sciences, 2025-02) Kudu, E; Aksan, A; Ince, EO; Aksu, NM.Patients with chronic obstructive pulmonary disease often visit the emergency department due to exacerbation of their disease condition or the development of pneumonia. Tracheal stenosis is a rare but fatal condition if not diagnosed and treated promptly. We report the successful diagnosis and management of tracheal stenosis in a patient with a history of intubation three months prior to her index presentation.Item Satisfaction of stakeholders with the government e-marketplace platform in a tertiary care hospital of northern India(All India Institute of Medical Sciences, 2025-04) Sethi, S; Arora, P; Koushal, V.Background Automation of the procurement process through e-procurement is a key strategy for enhancing industrial operations management. E-procurement in the supply chain allows companies to use the internet to procure materials and handle value-added services. The Government of India, in the year 2016, introduced the government e-marketplace (GeM) for public sector procurement. Any new intervention faces challenges, and stakeholder feedback can help improve the system. Our study uses stakeholder satisfaction to assess the implementation of GeM compared to traditional/other purchase methods. Methods We undertook a prospective study in the procurement division of a tertiary care institute over 1 year. The study tool was a questionnaire containing 28 questions to analyse the stakeholders� satisfaction. Results Of the total participants in the study, 40.6% were secondary buyers, 37.5% were storekeepers and 21.9% were dealing hand/hospital purchase division clerks. The stakeholders opined ease in process, time bound and transparency as the parameters in which GeM is better than the conventional platform. Conclusion A public procurement process should ensure efficiency, economy and accountability in the system. Given the findings, the GeM platform is a welcome addition to the public procurement landscape. While the platform has definite advantages, there is a need to strengthen it further to meet the specific needs of the healthcare industry.Item Endobronchial ultrasound guided transbronchial needle aspiration leading to cardiac empyema and tamponade by Prevotella oris(All India Institute of Medical Sciences, 2025-02) Ernur, D; Hanci, V; Kaya, SY.Endobronchial ultrasound guided transbronchial needle aspiration (EBUS-TNBA) is widely recommended for the diagnosis of mediastinal lymphadenopathy of malignant and non-malignant aetiology. EBUS-TBNA is preferred over mediastinoscopy as it has a better diagnostic accuracy and safety, is cost-effective and less invasive. Major complications of EBUS-TBNA include bleeding, mediastinitis, pneumonia, mediastinal abscess, empyema, lung abscess, pericarditis, pneumothorax, and rarely pericardial tamponade. We report a patient who developed pericardial empyema and tamponade due to Prevotella oris following EBUS-TBNA.Item Prevalence and antimicrobial resistance pattern of Burkholderia cepacia at a tertiary care teaching hospital(All India Institute of Medical Sciences, 2025-02) Patel, N; Dabhi, C; Patel, R; Singh, S.Background Burkholderia cepacia (B. cepacia) is the fourth most common pathogenic non-fermenting gram-negative bacilli isolated from clinical samples in hospitalized patients. It is an emerging opportunistic pathogen causing a wide range of infections in immunocompromised and hospitalized patients. Methods We did a retrospective observational study at Shree Krishna Hospital, Karamsad after approval by the Institutional Ethics Committee to determine the prevalence and antimicrobial resistance pattern of B. cepacia from January 2015 to November 2020. Clinical specimens of all the indoor and outdoor patients of all age groups, from whom B. cepacia was isolated, were included in the study. Identification and antimicrobial susceptibility testing of isolates were done by the Vitek 2 Compact system as per the Clinical and Laboratory Standards Institute (CLSI) guidelines. Results Ninety-one (0.54%) B. cepacia were isolated out of 16 840 organisms from 45 743 specimens received during the duration of the study. These were isolated most commonly from patients in the 0� years age group (31%) followed by those 41� years of age (20%). Also it was isolated more often in males than females. Blood and body fluids (57%) were the most common specimens from which B. cepacia was isolated followed by respiratory specimens (18%), urine (14%), and pus (11%). B. cepacia antimicrobial resistance was seen more commonly to ticarcillin朿lavulanate (72%) followed by levofloxacin (34%), trimethoprim� sulphamethoxazole (30%), ceftazidime (30%), minocycline (21%) and meropenem (14%). Conclusion The prevalence of B. cepacia was low. B. cepacia has been identified as an important pathogen in bloodstream infections. It is important to know the antimicrobial resistance pattern of B. cepacia for better management of patients.Item The role of a specific module for motivating medical educators towards self-directed learning in medical education: A qualitative study(All India Institute of Medical Sciences, 2025-04) Chaudhuri, A; Manivasakan, S; Ananthakrishnan, N.Background Medicine is a rapidly evolving field, so medical education aims to instill in students a commitment to ongoing learning and professional development promoting lifelong learning. To determine the role of a specific module in motivating medical educators to promote self-directed learning (SDL) in Medical Education. Methods The present study was conducted after obtaining institutional ethical clearance and informed consent from the participants. One-month mentor-learner web sessions on SDL using Google Group were arranged after administrative approval was obtained. There were 42 participants in the study. The whole module was conducted online. Study materials were provided to the participants using the Google Group and the WhatsApp Group, and for group activities learners were divided into five groups. Results Faculty members were motivated to apply their acquired skills as per feedback responses, reflection writing analysis, responses to motivational scale scores (Mean of importance and effort items were between 4.07-4.48 on a 5-point scale), and program evaluation (Kirkpatrick Level 1) was satisfactory. Conclusion The present faculty development program conducted online focused on SDL providing educators with essential tools and strategies to foster SDL among medical students. The program encompassed various elements, including peer review, hands-on training sessions, and collaborative learning, aimed at enhancing faculty members� understanding of SDL principles and their practical implementation in medical curricula. The combination of intrinsic and extrinsic motivators, coupled with a well-designed faculty development program, contributed to the success of the initiative in promoting SDL in medical education.Item Two lady doctors, a vicereine, and a princess: The women behind four historic medical colleges in India(All India Institute of Medical Sciences, 2025-04) Mitra, S; George, R.We introduce the stories of the lives of four women founders of four Indian medical colleges: Dr Edith Brown who founded the North Indian Medical School for Christian Women, Ludhiana (present-day Christian Medical College, Ludhiana); Lady Winifred Hardinge, after whom the Lady Hardinge Medical College, Delhi was named; Dr Ida Sophia Scudder who founded the Christian Medical College, Vellore; and Rajkumari Amrit Kaur, the cabinet minister responsible for the creation of the All India Institute of Medical Sciences, New Delhi. We highlight events and people in their lives crucial to the creation of the four institutions that have had a transformative impact on Indian medical education particularly for women. We observed that very diverse backgrounds and early lives prepared these four women for a mission that in its impact was very similar.Item Secondary mania caused by olfactory groove meningioma: A case report(All India Institute of Medical Sciences, 2025-04) Kim, G; Ku, H; Ku, B.The major clinical manifestations of orbitofrontal cortex lesions include disinhibition, perseveration and obsessive朿ompulsive and antisocial behaviours. Some patients with orbitofrontal cortex lesion can show mood elevation. We report a 69-year-old female who presented with manic and inappropriate emotional responses caused by a large olfactory groove meningioma. Magnetic resonance imaging showed a large, extra-axial mass with homogenous enhancement in the olfactory groove, compressing the orbitofrontal cortex. She showed no focal or lateralising neurological signs. We did standardized neuropsychological batteries, including the Young Mania rating scale to evaluate her manic symptoms. After removal of the tumour, her manic symptoms and abnormal behaviours gradually disappeared. These findings suggest that her manic symptoms might have resulted from compression of the orbitofrontal cortex due to the olfactory groove meningioma. Clinicians must have an index of suspicion for organic brain lesion compressing the orbitofrontal area when a patient without a history of psychiatric disease develops progressive manic symptoms.Item Combined hereditary spherocytosis and ?-thalassaemia trait: A rare co-existence(All India Institute of Medical Sciences, 2025-04) Jamal, I; Shuchismita; Choudhary, V.Haemoglobinopathies, the most prevalent haemolytic disease in India, make up the majority of patients in most haematology outpatient clinics. The most prevalent hereditary haemolytic anaemia is beta-thalassaemia trait (?TT). It often remains undiagnosed as it has an asymptomatic clinical course. However, ?TT needs be identified to provide genetic counselling to the affected families and to reduce the number of affected children born, which will lower their overall financial burden. Better screening methods for haemoglobinopathies have increased the detection of mixed haemolytic anaemia. We report a patient with combined ?TT and hereditary spherocytosis.Item Knowledge and attitude of college students towards cannabis use in urban India: A comparative perspective of users and non-users(All India Institute of Medical Sciences, 2025-04) Ali, E; Sachdeva, A; Thakur, A; Khullar, S; Das, P; Abbas, SZ.Background We aimed to assess the knowledge and attitude about cannabis use among college students in India, compare the perspective among users and non-users and lay a framework for development of effective primary prevention strategies in future. Methods This cross-sectional study was done in different colleges of Mumbai. Two hundred and sixty students of both sexes aged between 18 and 25 years were selected by systematic random sampling. Participants had to fill a sociodemographic questionnaire and a self-administered questionnaire that was analysed using the Statistical Package for the Social Sciences software. Results About 11.2% of the participants were users of cannabis and around 15% of them expressed a desire to take cannabis in the future. About 72% users were introduced to cannabis by their friends. The most common reasons for consumption of cannabis were peer pressure (29.6%), followed by stress reduction (23.5%) and experimentation (21.9%). The majority of participants (81%) did not favour legalization of cannabis use. However, more than half the participants were unaware of cannabis-related legal issues. Non-users considered cannabis to be more harmful and addictive than users who held a more permissive view regarding effects of taking cannabis. Conclusion The knowledge regarding harmful and legal implications of cannabis is relatively low amongst college students. Peer pressure, stress reduction and experimentation remain the commonest reasons for consumption. Imparting knowledge in early adolescence remains crucial in mitigating ignorant attitudes towards harmful cannabis use.Item Reflections from the district residency programme posting in Gadchiroli, Maharashtra(All India Institute of Medical Sciences, 2025-02) Khan, A; Madke, B; Waghmare, TL; Singh, AL; Gedam, M.Working at a rural hospital in India under the National Medical Commission抯 District Residency Programme provided a firsthand encounter with the unique challenges and triumphs of healthcare in resource-limited settings. The experience in Gadchiroli, Maharashtra, highlighted the profound impact of poverty, illiteracy, and geographical barriers on healthcare delivery. Despite facing shortages in equipment and resources, the dedication of healthcare professionals proved the importance of knowledge and adaptability in patient care. The prevalence of diseases such as leprosy and the provision of care to marginalized populations, including inmates and orphaned children, highlighted the critical role of healthcare in addressing societal needs beyond medical treatment. Collaborative efforts with local healthcare providers emphasized the importance of community-driven interventions and culturally sensitive approaches that encompass not just physical health, but also mental, emotional, social, and spiritual dimensions in order to promote holistic well-being. This transformative experience emphasizes the need for flexible, inclusive healthcare solutions to address disparities in resource-constrained settings and establishes the pivotal role of accessible healthcare in improving lives.Item Attitude towards psychiatry and mental illness among medical students: A cohort study(All India Institute of Medical Sciences, 2025-04) Mukhim, D; George, A; Gopalakrishnan, R; Gowri, MS; Kuruvilla, A.Background Medical students� attitude towards psychiatry (ATP) and mental illness will impact their choice of psychiatry as a future specialization and the quality of mental healthcare that they deliver to their patients. There is a paucity of longitudinal research on students� ATP and mental illness at different periods during medical school. We aimed to assess the attitudes of a cohort of medical undergraduates towards psychiatry and mental illness, before and after a clinical psychiatry rotation. Methods Medical students, in their second clinical year, underwent the first assessment on the 1st day of the psychiatry rotation. Socio-demographic information was collected. ATP and mental illness were assessed using the ATP-30 and the attitudes towards mental illness (AMI) scale, respectively. Assessments were repeated on the last day of the rotation and again 1 year later. Results One hundred and three medical students completed the pre- and immediate post-rotation survey questionnaire. One student withdrew consent for the 1-year assessment. There was an increase in ATP-30 and AMI scores after the rotation, and this persisted at the 1-year assessment. However, only the increase in ATP-30 scores was statistically significant. There was a significant reduction in the number of students with an overall negative attitude towards psychiatry and mental illness at 1 year. Conclusion Students generally had positive attitudes towards psychiatry and mental illness before the rotation. This improved further by the end of the rotation and persisted at 1 year of follow-up.Item Candida parapsilosis endocarditis ?n a patient with liver transplantation(All India Institute of Medical Sciences, 2025-04) Kaya, SD; Karaa?a�, AT.Infective endocarditis (IE) is caused by viral, bacterial or fungal pathogens, with high morbidity and mortality. Fungal endocarditis is rare and is associated with severe complications with poor prognosis despite combined medical and surgical treatment. Although Candida albicans is the most common fungal agent of this severe form of endocarditis, Candida parapsilosis is the most common non-albicans causative species. A 17-year-old patient who had had a liver transplant was referred to our paediatric cardiovascular surgery ward with a diagnosis of right heart failure. He had had coronary artery bypass graft and aortic valve replacement in 2021. He came to the outpatient clinic with complaints of fever, weakness, nausea and vomiting. On physical examination, he had pallor, dyspnoea and tachycardia. His fever was 38 癈 and a grade 2/6 systolic ejection murmur was detected on auscultation. Amphotericin B in a dose of 4 mg/kg/day was started based on the antifungal sensitivity test.Item Rifampicin-associated intravascular haemolysis causing acute kidney injury(All India Institute of Medical Sciences, 2025-04) Aravindhmozhi, P; Lamech, TM; Swamikkannu, C; Kurien, AA; Gopalakrishnan, N.Drug-induced acute kidney injury (AKI) is a rare adverse effect of rifampicin, and is mostly related to acute tubular necrosis and acute interstitial nephritis. We report a sputum- positive, isoniazid mono-resistant, pulmonary tuberculosis patient who had a history of anti-tuberculous therapy (ATT) intake 30 years ago. The patient developed AKI requiring dialysis when he restarted the ATT recently. A renal biopsy was consistent with pigment-cast nephropathy secondary to rifampicin-induced intravascular haemolysis. Rifampicin was stopped, and the patient underwent a total of four dialysis sessions and subsequently recovered.Item The effect of telephone follow-up and training on treatment adherence in tuberculosis patients and contacts: A randomized controlled study(All India Institute of Medical Sciences, 2025-04) Ayta�, S; Ovayolu, �.Background We evaluated the effect of 6 months of regular training, tele-monitoring and daily text message to remind medication intake on treatment adherence in tuberculosis (TB) patients and their contacts. Methods This randomized, controlled study with pre- test and post-test design was conducted with the following groups: TB Intervention, TB control, contacted intervention and contacted control group, a total of 66 patients and 87 contacted people. The data of study were collected with 慞atient and Contact Question Form�, Tuberculosis Adherence Determination Questionnaire (TADQ) and 慚orisky 8-Item Adherence to Drug Questionnaire� (MMAS-8). Results TADQ scores of the TB intervention group in the beginning, 1st, 3rd and 6th months were 80.4 (7.9), 117.8 (6.3), 137.7 (7.5), 143.2 (4.5), respectively, and TADQ scores of the TB control group in the beginning, 1st, 3rd and 6th months were 88.1 (7.1), 84.5 (9.8), 75.9 (7.9), 65.2 (9.2), respectively. MMAS-8 scores of the contacted intervention group in the beginning, 1st, 3rd and 6th months were 3.6 (1.3), 5.5 (0.7), 7.2 (0.8) and 7.7 (0.7), and those of the control group were 5.7 (1.4), 4.3 (1.4), 1.8 (1.5) and 0.7 (1.4), respectively. Conclusion As a result of 6 months of regular training, tele-monitoring and daily text message, adherence of the patients to TB treatment increased, and the adherence of the contacted people to the medication increased. Nurses should take an active role in the management of TB, determine the patients who do not use drugs correctly in the early period and apply the required interventions as soon as possible to improve treatment adherence of TB patients and contacts.Item Prevalence of hepatitis B and C virus infections among Buddhist tribes of Kaza health block, Lahaul and Spiti district of Himachal Pradesh(All India Institute of Medical Sciences, 2025-02) Sharma, R; Gupta, A; Sharma, N; Sachdeva, A; Barall, D; Bodh, V; Sharma, D; Sharma, B.Background. Infection of hepatitis B virus (HBV) and/ or hepatitis C virus (HCV) is a global public health concern. We aimed to estimate the prevalence of viral hepatitis B and C in the Buddhist tribal area of Kaza health block in Lahaul and Spiti district in Himachal Pradesh, India, and to identify the determinants. Methods. The study was conducted by the departments of Gastroenterology, Community Medicine and Microbiology, Indira Gandhi Medical College, Shimla between June 2015 and October 2017. Using a two-stage sampling method, 4231 participants in 40 clusters were enrolled. For each subject, a pre-tested interview schedule was administered, and blood was tested for hepatitis B surface antigen (HBsAg) and antibodies to HCV (anti-HCV). Those samples which tested positive for HBsAg were further tested for hepatitis B core antigen (HBeAg) and antibody to HBeAg (anti-HBe). Results. Among the 4231 participants, HBsAg and anti- HCV were detected in 961 (22.7%) and 33 (0.9%), respectively, including 6 (0.1%) who tested positive for both. HBsAg positivity was not associated with religion (p=0.07), caste (p=0.16), level of education (p=0.58) ormarital status (p=0.73). Of all the participants, 588 (13.9%) reported a history of HBV vaccination. Of those who were HBsAg positive (961), 21.6% were positive for HBeAg and 58.3% were positive for anti-HBe. Conclusion. The prevalence of HBV infection in the Kaza health block was high, and no specific associations were identified. Interventions such as public health education and universal childhood immunization at birth may help reduce the high rate of transmission of HBV in this population.