National Medical Journal of India

Permanent URI for this collection

https://imsear.searo.who.int/handle/123456789/118075

Browse

Now showing 1 - 20 of 2765

Motor functions and interventions to improve frailty in patients with heart failure
(All India Institute of Medical Sciences, 2024-12) Umehara, T; Kaneguchi, A; Katayama, N; Kawakami, W; Kuwahara, D; Kito, N; Kakehashi, M.
Background There is limited research on the factors influencing frailty improvement and on whether exercise therapy is effective in the general population with heart failure. We aimed to examine the factors and interventions that affect the improvement of frailty in older patients with heart failure during hospitalization. Methods This multicentre prospective cohort study included patients with heart failure admitted and treated in the participating hospitals. Cox regression analysis was done to determine factors and interventions that affect improvement of frailty. After the Cox regression analysis, the receiver operating characteristic (ROC) curve was calculated for significant predictors to assess the cut-off point. Results The factors that affect improvement of frailty were the high short physical performance battery (SPPB) chair-stand test and hand grip strength values. The results of the ROC analysis revealed that the cut-off values of the SPPB chair-stand test and hand grip strength were 2 points and 13.7 kg, respectively. Interventions that affect frailty improvement were use of dobutamine, low resting heart rate, early days to start until aerobic exercise, and light intensity or higher of aerobic exercise. Moreover, the cut-off values of the resting heart rate, number of days to start until aerobic exercise, and intensity of aerobic exercise were 80 beats per minute, 7 days, and 31.6%, respectively. Conclusions Our results suggest that pharmacotherapy and exercise will be effective to improve frailty in patients with heart failure. In particular, early exercise therapy, including aerobic exercise, started within 7 days, may be effective to improve frailty in older patients with heart failure with low resting heart rate, depending on their condition on admission.
Why DM and MCh seats are lying vacant?
(All India Institute of Medical Sciences, 2024-10) Bhattacharya, S; Bhattacharya, K.
With a large number of the DM and MCh Super specialty seats lying vacant after the National Eligibility cum Entrance Test–Super specialty (NEET-SS), the reason for such a decrease in seeking a super specialty degree needs a careful analysis. To streamline the quality of medical care in India we cannot afford to neglect super specialty training and loose some of them in days to come because of lack of student interest. The reasons were broadly medical treatment replacing the surgical interventions, doctors preferring independent practices instead of hospital dependent ones, super specialties that are physically less demanding and mentally less challenging, avoiding medicolegal or litigation prone high-risk specialties and selecting only those branches which are financially lucrative as well as have plenty of job opportunities with no state bond. The tendency is also to select a super specialty that is an ‘end’ branch with no further fellowship or training.
Assessment of food safety and hygiene practices of street food vending units in urban and semi-urban areas of Puducherry
(All India Institute of Medical Sciences, 2024-12) Loganathan, V; Thirunavukkarasu, P; Muthukrishnan, V; Dhanuskodi, T.
Background We aimed to assess the food safety and hygiene practices at street food vending units (SFVUs) in urban and semi-urban areas of Puducherry. Methods We did an observational assessment in two areas of Puducherry. We did a walk-through mapping and enumeration to identify active SFVUs. Later, through discrete non-participatory observations, we recorded various physical, environmental, food handling, vending and behavioural aspects involved in street food vending using a checklist. This was done at an optimal distance from the SFVUs, without the knowledge of the vendor. Results Of the 115 SFVUs enumerated, 102 units were active during observation visits; 52 in Lawspet (urban) and 50 in Villianur (semi-urban). None of these units displayed the licence or certification required under India’s Food Safety and Standards Act. Only 29 (28.3%) of the units had dedicated handwashing facilities, and 50 (49%) had dustbins. All the units had separated raw foods from cooked foods. Other key characteristics such as maintenance of appropriate temperature to preserve foods, appropriate packaging materials, and cleaning methods, were less than satisfactory. Vendors involved in frequent unhygienic behaviours and practices, including frequent contact with food being served, body parts, cash and utensils, but in relatively fewer healthy behaviours such as handwashing or cleaning. Conclusion Street food vending and consumption were common and of unsatisfactory standards in urban and semi-urban parts of Puducherry.
Feasibility study of a low-cost powered air-purifying respirator (PAPR): A hospital-based simulation study to assess the perception of healthcare professionals
(All India Institute of Medical Sciences, 2024-12) Ajan, A; Von Lieres, JS; Jayan, V; Sai Bala, M; Sasi, DD; Mohandas, R; Rao, BR.
Background There is a need for affordable and effective air-filtering respirators, that provide the user protection against infection and are comfortable to wear. Among the various air-filtering respirators, powered air-purifying respirators (PAPR) that supply the user with filtered air through a powered system provide better protection than the commonly used N-95 masks, that directly filters the air that surrounds the user, with filtration efficiency of these procedures being up to 99.99% and up to 95%, respectively. However, in India, the PAPRs are imported, making them unaffordable. Engineers at our university developed a low-cost PAPR model. We investigated the feasibility of using this low-cost PAPR as a potential air-filtering respirator as part of personal protective equipment. Methods In a simulation study, 20 woman nurses wore an N-95 mask with face shield, or the low-cost PAPR in two separate sessions and performed routine nursing tasks. They then answered questionnaires to assess their perceived comfort and suitability for the tasks. Results The low-cost PAPR provided better breathing comfort and vision. However, the current N-95 mask system was perceived to be more suitable for tasks requiring high mobility. Discussion Our study demonstrated the feasibility of the low-cost PAPR model, particularly for low-mobility tasks.
Evaluation of online active learning strategies in first year medical students
(All India Institute of Medical Sciences, 2024-10) Dara, P; Mopuri, R; Sujatharan, I A.
Background Didactic lectures form a large part of the teaching–learning process in medical education. To impart competency-based medical education (CBME) in the Covid-19 pandemic there was a shift to online learning. This pedagogical change would likely impact the efficacy of student learning outcomes. Several studies have shown that learning outcomes and knowledge retention increase considerably when lectures are interactive. However, the efficacy of online teaching with active learning strategies has not been studied. Methods At the Department of Biochemistry, Osmania Medical College, Hyderabad, we did this study with 203 first year MBBS students. Five sessions were conducted on the topic of ‘Enzymology’ with appropriate active learning methods. Each lecture session was preceded and followed by a test, which included multiple-choice questions (MCQs) and brief note questions (BNQs). Feedback of students, was recorded on the 5-point Likert scale from strongly agree to strongly disagree. Results The majority of students felt that answering questions in the pre-test required substantial effort compared to the post-test. The case scenarios included in the pre-test had a positive impact on the curiosity of students. The activities as part of self-directed learning were interesting, and enhanced understanding and retention. They felt lectures without pre-and post-tests were less efficacious and thus should be continued in all the classes. Conclusion Online lectures without pre-and post-test model were less efficacious. Online teaching, coupled with active learning increased interest and the understanding capacity of students.
Coexistence of BCR–ABL1 reassortment and JAK2 V617F mutation in chronic myeloid leukaemia
(All India Institute of Medical Sciences, 2024-12) Cheeloo, JY; Bi, K; Zhang, Z.
Myeloproliferative neoplasms (MPNs) can be classified into two major categories, namely chronic myeloid leukaemia (CML) and Philadelphia-negative MPNs (PN-MPNs). BCR– ABL1 reassortment is an irreplaceable indicator for the diagnosis of typical CML, while the V617F mutation on the Janus kinase 2 (JAK2) gene is common in PN-MPNs patients. Generally, these two genetic abnormalities are considered unable to coexist. We report a patient with CML who had both genetic changes, suggesting that when tyrosine kinase inhibitors (TKIs) monotherapy cannot obtain satisfactory treatment outcomes in CML patients, another possibility besides disease progression is a mutation on the JAK2 V617F gene.
Thyroid hormone resistance due to a novel mutation in thyroid hormone receptor presenting as attention deficit hyperactivity disorder
(All India Institute of Medical Sciences, 2024-12) Yadav, R; Goyal, M; Aggarwal, A; Kulshreshtha, B.
Resistance to thyroid hormone (RTH) is rare and is characterized by high circulating levels of thyroid hormones in the presence of either normal or elevated thyroid stimulating hormone (TSH) levels. Decreased responsiveness of the peripheral tissues to thyroid hormones owing to defective thyroid receptor function is the underlying cause. RTH is variable in its presentation. We report a 21-year-old man with long-standing attention deficit hyperactivity disorder (ADHD) and learning disabilities. His thyroid function tests showed an increased free T3 and T4 in the presence of a non-suppressed TSH. Other pituitary hormones were normal. Subsequently, a genetic analysis revealed a heterozygous mutation (Pro452Thr) in THR? gene, establishing the diagnosis of RTH. Thus, this was a RTH presenting as ADHD due to a novel mutation in the thyroid hormone receptor gene.
Lamellar cataract in a child with Alagille syndrome
(All India Institute of Medical Sciences, 2024-12) Khokhar, S; Rani, D; Namdev, V; Rathod, A; Kumar, S.
Alagille syndrome is a multisystem disorder inherited in an autosomal dominant manner with a variable phenotypic presentation. Typical features include intrahepatic bile duct paucity, butterfly-shaped vertebrae, typical facies, axenfeld anomaly (posterior embryotoxon) and cardiac abnormalities. Since this syndrome has typical ocular associations, ophthalmologists also have an important role in diagnosing the condition. Ocular features include posterior embryotoxon, corneal pannus, chorioretinal abnormalities and posterior subcapsular cataract. We report a toddler, diagnosed with Alagille syndrome who presented to us with a visually significant lamellar cataract in both eyes. To the best of our knowledge, this is the first case reporting lamellar cataract in a toddler with Alagille syndrome.
Objective structured practical examination (OSPE) for formative assessment of medical undergraduates in Biochemistry
(All India Institute of Medical Sciences, 2024-10) Suneja, S; Kaur, C.
Background Assessment is a process that includes ascertainment of improvement in students’ performance over time, motivation of students to study, evaluation of teaching methods and ranking of students. Despite the new competency-based medical education, assessment remains a largely untouched aspect. Most medical colleges still follow the conventional practical examination (CPE) methods that raise concerns about examiner variability, standardisation, and assessment uniformity. Objective structured practical examination (OSPE) includes objective testing through direct observation, knowledge assessment, comprehension, and skills. We studied the feasibility and acceptability of OSPE as a method of formative assessment of practical skills in biochemistry and to determine faculty and student perception of OSPE as an assessment tool. Methods Phase 1 MBBS students of the 2020–21 batch of Vardhman Mahavir Medical College and Safdarjung Hospital, New Delhi, were divided into two groups of 85 students each. The first group was assessed for Competency-1 through CPE and the second group was assessed for the same competency through OSPE. These students were then crossed over. The first group was now assessed for Competency-2 through OSPE and the second through CPE for the same competency. The process was repeated for the third and fourth competencies. Thus, two crossovers were performed with four OSPEs and their corresponding CPEs. The mean scores of the students were compared using both assessment methods, using an unpaired student ‘t’ test. Bland–Altman analysis was done to compare differences between OSPE and CPE. Student and faculty feedback was collected on a 5-point Likert scale for close-ended questions, and a thematic analysis of open-ended questions was done. Results When assessed with OSPE, students’ mean scores were found to be significantly higher (p<0.001) than CPE. Cronbach alpha of the questions administered had high internal consistency with a score of 0.83 for students and 0.89 for the faculty. Conclusion OSPE can be used for formative assessments in undergraduate medical students in biochemistry as it is feasible and acceptable to both students and faculty and brings a level of objectivity and structure to the assessment process.
The effect of overweight/obesity and FTO gene polymorphism on liver function-related parameters in Chinese adolescents
(All India Institute of Medical Sciences, 2024-10) Ning, M; Xu, A; Zeng, R; Xue, J; Wang, B; Liu, X.
Background Overweight/obesity is an important risk factor for liver disease, affecting changes in liver function-related parameters. The fat mass and obesity associated (FTO) gene has been reported to have a link between overweight/obesity and liver fat metabolism. We studied the association of FTO rs9939609 variants with liver function-related parameters and overweight/obesity in Chinese adolescents aged 16 to 26 as freshmen. Methods We examined rs9939609 polymorphisms in 198 control and 173 overweight/obese people, and the genotypes of the samples were analyzed by Sanger sequencing. We investigated the effects of FTO gene polymorphism on overweight/obesity and liver function-related parameters. Results The values of aspartate transaminase (AST), alanine transaminase (ALT), gamma-glutamyl transferase (GGT) and alkaline phosphatase (ALP) in overweight/obesity group were significantly higher than those in control group. The rs9939609 AA genotype increased the risk of overweight/obesity by 3.45 times independent of body mass index (BMI) compared with TT genotype, the rs9939609 (AA) genotype was significantly associated with AST and ALT. Conclusion FTO rs9939609 variants were associated with overweight/obesity and overweight/obesity has a significant influence on the increased liver function-related parameters. The rs9939609 (AA) positively correlated with AST and ALT levels. Overweight/obese patients should pay more attention to liver function-related parameters.
Blood safety training: Can virtual training replace in-person training?
(All India Institute of Medical Sciences, 2024-12) Tripathi, PP; Kumawat, V.
Background Healthcare professionals require continuous professional development and training to improve their knowledge and skills to prevent or minimize errors in blood transfusion. The novel Coronavirus-19 (Covid-19) pandemic affected face-to-face medical education and resulted in a shift from traditional education methods to online or virtual methods. We analysed the effect of virtual blood safety training on participant’s knowledge and perception. Methods A prospective analysis of pre-test and post-test responses to a 25-item multiple choice questionnaire and feedback received for the training programme were analysed. The training feedback was obtained using a Google form link. Results The mean pre-test score of 131 analyzed participants was 16.02, which increased to 18.06 after the training. The difference was not statistically significant. The mean pre-test and post-test scores for doctors (n=45) were 17.91 and 19.33, respectively which was statistically significant. There was no statistically significant difference between the mean pre-test (15.03) and post-test (17.39) scores of technical staff (n=86). The majority (54%) preferred in-person physical training during feedback. Conclusion Virtual training can be conducted as a temporary measure. We did not find a difference in participants’ knowledge except for doctors. The majority of participants preferred in-person training.
Antiphospholipid anti-body syndrome presenting with diffuse alveolar haemorrhage and refractory autoimmune haemolytic anaemia
(All India Institute of Medical Sciences, 2024-12) Marwah, V; Hegde, A; Adhikari, S; Choudhary, R.
Antiphospholipid antibody syndrome (APS) is characterized by vascular thrombosis. Somewhat paradoxically, some patients with this disease develop diffuse alveolar haemorrhage. This bleeding is usually a delayed manifestation, occurring a few years after the onset of other manifestations and diagnosis of APS. We encountered a patient with an unusual presentation, i.e. onset with diffuse alveolar haemorrhage as well as vascular thromboses. He also had autoimmune haemolytic anaemia, which is infrequent in APS. The diagnosis of APS was based on elevated levels of IgM and IgG anti-cardiolipin antibody and IgG and IgM beta-2 GP1 antibodies. Treatment with high-dose glucocorticoids, anticoagulants and rituximab led to a decline in levels of these antibodies and was associated with a good and lasting clinical response.
Severe early childhood caries among young children and its association with behavioural factors: A hospital-based cross-sectional study
(All India Institute of Medical Sciences, 2024-10) Singh, B; Bansal, K; Pavithra Devi, K; Mathur, VP; Tewari, N; Sharma, R.
Background Several risk factors have been associated with early childhood caries (ECC). However, conclusive data are not available about the socio-demographic and behavioural factors which are associated with severe ECC (S-ECC). We assessed the severity and pattern of ECC in young children. We also looked for association of S-ECC with various sociobehavioural risk factors in a hospital-based setting. Methods We included 200 children, 1–6 years old, who reported with dental caries to a paediatric dental outpatient in a tertiary care hospital. Information about socio-demographics and various behavioural factors was recorded in a structured proforma using an interview method. The American Academy of Paediatric Dentistry (AAPD) criteria were used for categorizing children into ECC and severe ECC groups (S-ECC). Qualitative variables were analysed by chi-square test. Multiple logistic regression analysis was done to find the predictors of severe S-ECC. All statistical tests were done at a significance level of p<0.05. Results The majority of children (85%) had S-ECC and anterior-posterior (AP) caries pattern (77%). A significant association was found between the age of the child (p<0.001), absence of siblings (p=0.009), continuation of bottle feed or mother’s milk till the age of reporting to the hospital (p=0.007), frequency of night-time feed (p=0.048) and S-ECC. Conclusions A continued habit of milk feed from bottle/mother till the time of dental visit seeking treatment and night time-feeds more than twice had a significant association with S-ECC.
Tumour-induced osteomalacia
(All India Institute of Medical Sciences, 2024-10) Ramakrishanan, A; Parekh, A; Gayana, S; Velusamy, S; Sadhoo, A.
Tumour-induced osteomalacia (TIO) is a rare paraneoplastic syndrome caused by increased production of fibroblast growth factor 23 (FGF-23). A 45-year-old man presented to us with progressive weakness over 2 years along with recurrent fractures with minimal trauma. His FGF-23 was found to be above the normal range and DOTATATE positron emission tomography (PET) scan showed a well-defined enhancing soft tissue density involving the left posterior ethmoid with extension to the spheno-ethmoidal recess and sphenoid sinus ostium. He underwent endoscopic sinus surgery and excision of the tumour. Histopathological examination showed features of phosphaturic mesenchymal tumour–mixed connective tissue type. Postoperatively the serum phosphorus level increased from day 1 and reached the normal value of 2.5 mg/dl on day 3. He was discharged and continued on oral calcium and vitamin D3. Gradually his myalgia improved and he started walking independently over the next 1 month. The mean delay from symptom onset to treatment in our patient was 2 years and 5 months. Timely diagnosis and meticulous follow-up are necessary for the management of patients with this rare disorder.
The undergraduate virtual grand teaching ward round: Perceptions from the subcontinent
(All India Institute of Medical Sciences, 2024-01) Gooneratne, T; Wijeyaratne, M.
Background Grand ward rounds are an integral component of undergraduate medical education. Covid-19 prevented the conduct of conventional grand ward rounds (CWRs) prompting a ‘virtual’ grand ward round (VWR). With restrictions lifted should future grand ward rounds remain virtual? Undergraduate perceptions on the two formats were sought to explore the feasibility of the VWR as a teaching ward round for medical students. Methods Our study was done during April 2021 to April 2022. The weekly grand ward round was converted to a VWR during April–November 2021. Following lifting of restrictions, it was reverted to a CWR. All patients provided informed consent. A Zoom-based, secure, online platform was created with the use of smartphones to share audiovisuals and patient discussions. An online anonymised feedback survey was conducted for undergraduates during both VWR and CWR phases. Results The response rate was 71% (182/258). VWR was considered more advantageous than the CWR in terms of time efficiency (p=0.03), space restrictions (p=0.01), improved audibility (p=0.02) and better opportunity to engage in discussions (p=0.1). Most students (80%) felt that the VWR provides a more ‘ideal’ grand ward. Overall preference was towards VWR across safety (92%), efficacy (72%), communication (85%), information availability (84%) and training opportunity (73%). Again 80% of students preferred future ward rounds to be virtual. Conclusions VWR is an innovative approach. While not a substitute for bedside teaching it appears safer, efficient, thought/discussion-provoking and more satisfactory. Successful elements of the VWR can be adopted in future, to develop a more ideal undergraduate grand ward round.
Pseudo-subarachnoid haemorrhage: An unusual presentation of hyperviscosity syndrome
(All India Institute of Medical Sciences, 2024-01) Thomas, A; Jose, H; Jacob, L; Koshy, JM; Sebastian, GM
Hyperviscosity syndrome can present with haematological, neurological or cardiovascular manifestations. The common differential diagnoses for severe headache and altered sensorium in a patient with Eisenmenger syndrome include brain abscess, meningitis, cortical venous thrombosis and subarachnoid haemorrhage (SAH). We report a patient with Eisenmenger syndrome with hyperviscosity, presenting as pseudo-SAH, which was successfully treated with phlebotomy.
Epidemiology and clinical spectrum of melioidosis: Analysis of cases from a tertiary care centre in southern Tamil Nadu
(All India Institute of Medical Sciences, 2024-01) Ganesan, V; Sundaramurthy, R.
Background We studied the clinical features and treatment outcome of patients with melioidosis in our hospital. Methods We did this retrospective observational chart review over a period of 7 years between December 2014 and February 2022. Results There were 59 cases and 23 deaths attributable to melioidosis over the study period. The age range was 5 to 74 years and 48 (81.3%) were men. The comorbid conditions included diabetes mellitus (68%), alcoholism (11.8%), pulmonary tuberculosis (6.7%) and chronic kidney disease (5%). Over three-fourths of patients (78%) presented during the rainy season (June to December) and were acute presentations (44 [75%]). The most common sites were liver and spleen, followed by the musculoskeletal system, skin, soft tissues, lungs and brain. Of the 21 (36%) patients with septic shock, 16 (76%) died. On the contrary, of 38 (64%) patients without septic shock, only 11% died. Of the 27 (47%) admitted to ICU, 11 (41%) died. In ICU, 18 (67%) were ventilated. Of the 23 (39%) deaths overall, median time from admission to death was 4 days. There were no relapses in the 42% patients followed up for 2–6 months. Conclusions The epidemiology of melioidosis is similar to other endemic areas with preponderance of men. There was a temporal association with the monsoon season and a higher number of acute cases. The differences included a higher proportion of deep visceral abscesses and musculo-skeletal involvement compared to lung involvement.
Macrolipasemia variant of macroenzymes: An endocrine laboma
(All India Institute of Medical Sciences, 2024-01) Sharma, LK; Datta, RR; Aggarwal, A; Sharma, N; Dutta, D.
Macroenzymes, formed by polymerization of physiological enzymes with immunoglobulins, have slower renal clearance rates due to their higher molecular mass. They are usually incidentally detected, have no pathophysiological importance, and can potentially lead to over-treatment and iatrogenic morbidity. We present, possibly for the first time, a macro-lipasemia variant of macroenzyme, detected in a 14-year-old girl with type-1 diabetes admitted with severe hyperglycaemia and pain abdomen. Raised lipase levels (414 U/L), initially raised the suspicion of underlying pancreatitis, which was ruled out by the clinical symptoms and normal ultrasound and CT imaging of the pancreas. Upper gastrointestinal endoscopy revealed pangastritis, which could explain the mild upper abdominal pain in the child. She improved with proton pump inhibitor therapy and was discharged after 5 days of hospital admission after good glycaemic control using multiple subcutaneous injections of insulin. Post-polyethylene glycol (PEG) precipitation, the recovery of lipase activity in PEG treated serum sample was 30.6% (127 U/L), which confirmed the presence of macrolipase. An increased clinical suspicion and performing a cheap reliable test (PEG precipitation), whenever there is clinical biochemical discordance can help us in diagnosing more patients with macroenzymes and macrolipasemia.
Regional patterns in minimum diet diversity failure and associated factors among children aged 6–23 months in India
(All India Institute of Medical Sciences, 2024-07) Gunnal, G; Bagaria, D; Roy, S.
Background About 35% of the global child deaths and 11% of the total disease burden are due to inadequate nutrition. While in India, 1 in 3 children are underweight and stunted, and 1 in 5 children are wasted. Methods Using multivariate and descriptive statistical analysis, we examined the prevalence, determinants of minimum diet diversity failure (MDDF) and trends of MDDF across different regions of India among children aged 6–23 months. Dietary pattern in 8 food groups was also examined using the National Family and Health Survey (NFHS) data from 2005–06 to 2019–21. Results Overall, MDDF in India has decreased from 87.4% (2005–06) to 77.1% (2019–21). The central region (84.6%) reported the highest prevalence of MDDF in 2019–21. Children of illiterate and rural residing mothers with no mass media exposure, children of the first birth order and children not exposed to counselling and health check-ups at Anganwadi/Integrated Child Development Services (ICDS) centres, children with low birth weight and anaemic, and who belonged to a large family had greater likelihood for MDDF. Conclusion To tackle the high prevalence of MDDF, a holistic action is needed from the government, i.e. improved public distribution system (PDS), intensified Integrated Child Development Scheme (ICDS) programme, use of social media, and nutrition counselling through local self-governance.
Credit hours and continuing medical education (CME) programmes
(All India Institute of Medical Sciences, 2024-05) Bhattacharya, S; Bhattacharya, K.
Continuing medical education (CME) credits has been mandated by the National Medical Commission for registered medical practitioners in India as a part of continuing professional development and a minimum of 30 credits in 5 years is required for the renewal of the medical license. Undoubtedly, credit hours for CME attendance is an essential yardstick for professional and career growth, the modus operandi adopted to grant these credit hours needs a serious look. Targeted learning with adequate feedback either with a post CME examination or questionnaire should become the norm and every publication in high impact indexed journal deserve a higher credit point than the rest of the publications.

Browse

Recent Submissions