International Journal of Applied and Basic Medical Research最新文献

Background: Empathy stands as a cornerstone of humanistic qualities and is essential in healthcare for understanding and alleviating emotional suffering. Despite its necessity, formal empathy training remains elusive in postgraduate medical education across the globe, contributing to decline of humanistic practice among trainees. This study aims to assess and establish the need for empathy training by evaluating the perspectives of postgraduate trainees and faculty.

Materials and methods: The study was conducted in a medical college of western India in 2023. Three online validated questionnaires were used to assess empathy-related perceptions among faculty and postgraduate trainees across various specialties. The questionnaires focused on demographic data, importance of empathy in patient care, empathy training, perceived levels of empathy, reasons for shortfalls in empathetic behavior and recommendations for nurturing empathy. Data were analyzed quantitatively and thematically.

Results: A total of 150 and 127 responses were gathered and analyzed from faculty and trainees, respectively. Excessive workload, lack of formal training, and technology-dependent fast paced lifestyle were attributed for lack of empathy in clinical care. All the faculty agreed that empathy training is essential and majority (67%) believed that lack of empathetic behavior led to dissatisfaction among patients and caregivers.

Conclusion: Empathetic communication and behaviors are fundamental competencies for health-care professionals. There is need for a structured training for empathy in postgraduate medical curriculum.

Background: Mentoring helps in the personal and professional development of mentees and helps them develop self-confidence in their work. Final-year undergraduate medical students face many challenges but they also have to gain the confidence to start working independently and plan their careers in the near future. In the coronavirus disease scenario, many of these challenges were amplified, and final-year students were in greater need of mentoring. Even though mentoring had been introduced under the new curriculum in 2019, formal online mentoring programs were nonexistent in most Indian medical colleges. Therefore, it was aimed to implement and evaluate an online mentoring program for final-year undergraduate medical students.

Materials and methods: This prospective study was conducted with 16 mentees allotted to the principal researcher. A needs assessment survey was conducted before finalizing the program. A mentoring module was designed, and subsequently, five rounds of individual mentoring sessions were conducted on "Google Meets." Feedback was obtained from the mentees and analyzed.

Results: Most mentees (93.8%) agreed that an online mentoring program should be introduced. The mentees were satisfied with the online mentoring program (5-point Likert Scale; median = 4) and felt that they had received motivation and gained confidence to overcome challenges. The majority of the respondents (80%) felt supported during mentoring, whereas 86.67% agreed that they were able to harness their positive attributes and started working toward their goals.

Conclusions: The online mentorship program was successful in improving the confidence of the medical students in dealing with academic and nonacademic issues.

Introduction: Critical care nurses are crucial in managing critical patients, facing challenges with advanced technology, alarms, ventilators, and multiple laboratory investigations. They must effectively communicate and manage patients on mechanical ventilation (MV), a lifesaving intervention for those needing oxygenation and ventilation support to ensure patient satisfaction.

Materials and methods: The study employed a quasi-experimental design with 80 mechanically ventilated patients selected through purposive sampling. Data were collected using demographic and clinical pro forma and a predesigned four-point Likert satisfaction scale comprised 14 items. The intervention group utilized a communication board, while the conventional group received routine care. The aim was to evaluate satisfaction levels in both groups, followed by a posttest on the 5^th day using the same instrument.

Results: The pretest revealed mean satisfaction scores of 32.47 ± 6.48 and 33.95 ± 6.41 for the intervention and conventional groups, respectively, with a mean difference of 1.47, considered statistically nonsignificant (t ₇₈ = 1.023, P = 0.310). Conversely, posttest scores showed 37.85 ± 8.23 and 34.32 ± 6.18 for the intervention and conventional groups, respectively, with a mean difference of 3.53, indicating statistical significance (t ₇₈ = 2.164, P = 0.034). Hence, the communication board intervention significantly enhanced satisfaction scores among mechanically ventilated patients, underscoring its positive impact on nursing care in terms of patients' satisfaction.

Conclusion: Effective communication is crucial in intensive care unit patient care, especially for those unable to speak due to MV. Utilizing communication boards significantly enhances patient satisfaction, highlighting the need for ongoing innovation in critical care nursing.

Background: Due to lack of formal training, young doctors cannot deliver bad news in a way that is expected by patients and their attendants, thereby jeopardizing doctor-patient relationship.

Aim: The aim of this study was to train interns about "breaking bad news" to the patients using a structured module.

Materials and methods: A workshop comprising interactive lectures and videos followed by debriefing, and discussion was conducted for interns. Pre/posttest, workshop feedback evaluation, and a group activity based on article case were conducted, followed by discussion. An assessment of skills based on a checklist was done after 15 days of workshop in simulated conditions.

Results: There was a significant difference in scores of written tests taken by all 56 participants before and after the session (P < 0.0001). Almost all of them agreed that their ability to break bad news has improved, and they feel confident in breaking bad news after attending this session. During the assessment of the skill of breaking bad news, most of them fell into the category of beginner after attending the workshop with a median of 2.

Conclusions: A structured module is an effective method in improving the skills of the interns in sharing bad news with the patients.

Coronaries arise normally from the aortic sinus which consists of one anterior and two posterior cusps of which the right coronary artery (RCA) arises from the anterior cusp and the left coronary artery arises from the left posterior cusp. Abnormal origin of coronary arteries is very rare and counts for about 2.33% of prevalence and below 1% incidence and are comparatively very difficult to diagnose through routine investigations. Till date, only one case has been reported in the literature where the culprit vessel was the victim as seen in our case. We report a case of a 68-year-old male, who underwent coronary angiography for his anginal chest pain, was diagnosed with coronary artery disease with an "abnormally arising RCA" from the left coronary cusp with a proximal stenotic lesion in the anomalously arising RCA, which was confirmed on multidetector computed tomography three-dimensional reconstruction volume-rendered imaging.

Objective: Ovarian reserve and hence ovarian response has a key role in assisted reproductive technology and predicting response to gonadotrophins in controlled ovarian hyperstimulation. Various tools, namely follicle-stimulating hormone (FSH), anti-Mullerian hormone (AMH), antral follicle count (AFC), estradiol, etc., have been studied to discover the best determinant of ovarian reserve. The aim of our study is to correlate different reproductive hormones with age of women to estimate ovarian reserve and to evaluate reliable marker for aiding infertility treatment.

Materials and methods: It is an observational study performed for 6 months, with 88 women (aged 21-39 years) having a complaint of infertility, enrolled in the infertility clinic of a tertiary care hospital. Baseline scan for AFC was done for every patient and their blood was sent for serum FSH, AMH analysis. Statistical procedures were employed to determine the association between age and reproductive hormones (i.e. FSH and AMH) as independent variables and AFC as a dependent variable.

Results: A strong negative correlation was noted between FSH and AMH and between age and AMH (r = -0.492 and r = -0.498, respectively). A weak negative correlation was seen between AMH and total AFC (r = -0.241). A moderate positive correlation was seen on comparing age and FSH (r = 0.331), whereas no correlation was seen on comparing FSH with AFC and AMH with AFC. The presence of ovarian cyst did not affect AMH or AFC but reduced FSH values significantly.

Conclusion: In the quest to determine a panel test for ovarian reserve testing we conclude, FSH and AFC should perform fairly in poor resource and low socioeconomic setting. The combination of FSH with AMH and AFC might aid in better determination of ovarian reserve in tertiary centers with available resources.

Background: Coronary artery disease (CAD) that encompasses acute myocardial infarction (AMI), chronic stable angina (CSA), and unstable angina (UA) has numerous known risk factors. Genetic predispositions contribute as major risk in the development of CAD and the genes regulating atherosclerosis are important for disease prevention. Nitric oxide synthase 3 (NOS3) gene responsible for nitric oxide (NO) production is of special importance.

Aim: To evaluate the role of three NOS3 polymorphisms (-786C/T, 894G/T, and 4a4b) in patients with CAD, particularly in AMI and CSA and their comparison with healthy controls.

Materials and methods: One hundred patients in each AMI and CSA group and 100 controls were included and were typed for three NOS3 polymorphisms (-786C/T, 894G/T, and 4a4b) by polymerase chain reaction-restriction fragment length polymorphism. Plasma NO metabolites (NOx) were also evaluated.

Results: A significant association of 894G/T polymorphism with AMI in dominant model (P = 0.052) and with CSA in dominant and codominant models was detected (P = 0.008 and P = 0.006, respectively). Plasma NO levels were found to be significantly higher (P < 0.0001) in healthy controls (43.80 ± 6.28) compared to AMI and CSA patients (37.05 ± 6.75 and 38.67 ± 5.61). No significant association of -786C/T and 4a4b polymorphism with AMI and CSA risk under recessive, dominant, and codominant models was detected.

Conclusion: Our study revealed a significant association of 894G/T polymorphism with AMI and independent association of NOx levels with CAD, indicating high risk of CAD in the North Indian population. Our findings will be helpful in identifying the genetic risk factors associated with CAD and better management of the diagnostic as well as therapeutic measures.

Background: Hypobaric hypoxia refers to a condition where there is a decreased oxygen partial pressure in the air due to low atmospheric pressure. It is known to affect the metabolism, leading to increased basal metabolic rate, alterations in appetite, and changes in cellular metabolism and energy homeostasis. The effects of hypoxia on metabolism and weight loss are influenced by genetic factors, gender, and the duration and severity of exposure to hypoxia. Currently, there are no reports which elucidate the impact of hypobaric hypoxia on female laboratory rats.

Objective: The aim of this study was to observe the effect of varying degrees and durations of hypobaric hypoxia on the body weight of female rats.

Materials and methods: In this study, the body weight of 36 laboratory rats divided into six groups was taken at day 0, and then, the rats were exposed to hypobaric hypoxia in a specially designed hypoxia chamber and their body weights were recorded after 5 days and 10 days of hypoxia exposure. The change in body weight at 5 days and 10 days was compared to that of their body weight before the exposure to hypoxia. Data analysis was performed using IBM SPSS version 20.

Results: Body weight was reduced in all rats subjected to varying degrees and duration of hypoxia. The percentage change in body weight was higher in moderate and severe hypoxia than in the mild hypoxia group. No significant difference was observed in rats exposed to varying degrees of hypoxia for 5 days as compared to those exposed for 10 days.

Conclusion: Hypoxia may cause a reduction in body weight of female rats proportionate to the increasing severity of hypoxia and this reduction remains independent of the duration of exposure to hypoxia.

Dowling-Degos disease (DDD) is an extremely rare hereditary skin condition characterized by the development of painless, small-sized pigmented patches known as macules or keratotic papules. Typically inherited in an autosomal dominant manner, DDD primarily manifests in adulthood, with onset occurring between the ages of 30 and 40 years, and a higher prevalence among females. Although DDD shares clinical similarities with other reticulated pigmentary disorders such as dyschromatosis symmetrica hereditaria, dyschromatosis universalis hereditaria, and reticulate acropigmentation of Kitamura, its distinctive histopathological features set it apart. A 50-year-old female patient presented with hyperpigmented lesions since infancy, predominantly located in flexural areas, prompting consideration of endogenous eczema or DDD. Despite the absence of a family history and normal laboratory test results, a biopsy confirmed the diagnosis based on characteristic histological findings. The identification of DDD underscores the importance of considering rare dermatological entities in differential diagnosis, especially when clinical presentation aligns with established criteria. Further research and awareness are essential for enhancing our understanding and management of this intriguing skin condition.

Background: TwinRab™ is a novel life-saving biological containing two monoclonal antibodies (docaravimab and miromavimab) essential for all age victims of category III animal exposures. It effectively neutralizes rabies and similar viruses at the exposure site until the body generates vaccine-induced antibodies. This postmarketing surveillance study assesses the safety of TwinRab™ in current postexposure prophylaxis (PEP) use and aims to reinforce its safety data for future applications.

Methods: The prospective, open-label observational study was conducted on patients with the World Health Organization category III animal exposures at a government hospital in a northern region of India, by a suspected rabid animal. The study protocol included administering TwinRab™ (40 IU/kg) and a full course of anti-rabies vaccination as PEP.

Results: Out of 405 participants, 404 completed the study as per the protocol. Adverse events (AEs) occurred in 12.35% of cases, with 9.88% local AEs (primarily pain and tenderness) and 2.47% systemic AEs (fever, malaise, and myalgia). All AEs were mild and resolved without complications. Most participants (88.9%) and investigators (89.1%) rated TwinRab™'s tolerability as excellent.

Conclusion: The present study demonstrates the evidence of a satisfactory safety profile along with better tolerability of TwinRab™ (40 IU/kg) for category III animal exposures and supports its continued usage.