International Journal of Applied and Basic Medical Research最新文献

The Guillain-Barré syndrome (GBS) outbreak in Pune, India, has raised significant public health concerns, with over 230 reported cases and 12 fatalities in the state of Maharashtra, India. Epidemiological investigations indicate a potential link between the outbreak and contaminated drinking water. This review discusses the outbreak's progression, surveillance efforts, clinical management, and preventive measures implemented. The findings underscore the need for improved water safety measures, enhanced surveillance, and policy interventions to prevent future outbreaks of GBS in India.

Myasthenia gravis (MG) is an autoimmune condition affecting the neuromuscular junction. Juvenile MG (JMG) is a subtype of pediatric MG and is reported to be a rare neurological disorder with variable presentation and difficult diagnosis. MG has been described as a great neurological mimicker having resemblance with a wide spectrum of neurological disorders. The present case is a distinctive and compelling example of JMG that manifested at a young age with a disguised presentation. Bilateral ptosis was the principal presenting symptom with mild facial droop which simulated Bell's palsy initially. The patient was finally diagnosed as JMG based on acetylcholine receptor antibody test along with ophthalmological, electrophysiological, and imaging findings. She was managed for JMG and concurrent hyperthyroidism and is being regularly monitored for the effectiveness of the treatment. This report highlights the relevance of extensive clinical history, meticulous clinical examination, and awareness of similar neurologic disorders with overlapping characteristics in order to facilitate correct diagnosis, appropriate management, and effective treatment of this condition, often described as the "great imitator."

Introduction: Cation exchange high-performance liquid chromatography (HPLC) serves as a rapid, reproducible, and accurate method for diagnosing hemoglobinopathies. This study outlines the diagnostic approach and the challenges faced in the routine diagnosis of hemoglobinopathies through HPLC, particularly in laboratories with limited resources.

Aims and objectives: The aim of the study was to identify the challenges encountered in identifying abnormal hemoglobin (Hb) variants and to determine the significance of HbA2 and/or fetal Hb (HbF) analysis in the HPLC methodology for hemoglobinopathies.

Materials and methods: A total of 1900 samples were analyzed using the ARKRAY ADAMS HA-8180T HPLC automated analyzer for the purpose of hemoglobinopathy testing. The samples were classified into normal or abnormal hemoglobin variants based on the percentage levels of HbA2, HbF, HbA, and the identification of any abnormal peaks. Among these, 113 cases were diagnosed to have thalassemia or hemoglobinopathy. The clinical presentations and red blood cell (RBC) indices were compared with the HPLC findings for each case, thereby contributing to the accuracy of the diagnosis.

Results: The study examined the distribution of Hb variants, revealing that β-thalassemia trait was the most prevalent at 44.2%, followed by sickle cell trait at 13.3% and HbD Punjab trait at 10.6%. There were many challenging cases with elevated HbA2, like HbE thalassemia and Hb Lepore. Furthermore, there was identification of some abnormal peaks which were not exactly in the instrument's predetermined HbA2, HbF, HbA, or sickle windows, like HbJ Meerut. There were a few cases with abnormally elevated HbF, which can be seen in homozygous β-thalassemia, sickle cell disease, compound double heterozygous sickle cell β-thalassemia, δβ-thalassemia, and hereditary persistence of HbF. Carriers of β-thalassemia were generally identified by an HbA2 level of 4% or higher; however, there were nine cases which exhibited borderline HbA2 levels ranging from 3.5% to 3.9%, which might turn out to be β-thalassemia trait, especially in high-prevalence areas like Gujarat.

Conclusion: Any case scenario with abnormally elevated HbA2 is not always β-thalassemia trait. Nor abnormally elevated HbF may always indicate β-thalassemia major. Furthermore, some clinico-pathologically relevant hemoglobinopathies might show an abnormal peak on HPLC at any retention time, which may not be necessarily determined by the machine to be in some specific window. We need to correlate the clinical context, RBC indices, HPLC findings, and family studies to effectively detect most Hb variants.

Background: The prevalent diagnostic tests available for rheumatoid arthritis (RA), i.e. rheumatoid factor, C-reactive protein (CRP), and erythrocyte sedimentation rate (ESR), are nonindicative in the initial stages of disease as well as nonspecific. The latest marker introduced for detection of RA is anticyclic citrullinated peptide (anti-CCP), which can help in early diagnosis and check the progression of severity of RA.

Aim: The present study was designed to evaluate the role of anti-CCP antibody in the diagnosis of RA in early stage of disease as compared to ESR and CRP.

Materials and methods: The study population consisted of 325 participants presenting to the orthopedic department, AIMSR, with suspected clinical features of arthritis. All enrolled participants were subjected to demographic and biochemical analysis after taking a detailed history and following the inclusion and exclusion criteria.

Results: The specificity and sensitivity of anti-CCP antibody for the diagnosis of RA, as compared to ESR and CRP, were observed to be 75.77% and 97.7%, respectively. Further, the negative and positive predictive value was found to be as high as 98% and 75.77%, while the likelihood ratios of a positive and negative test were found to be 3.88 and 0.06, respectively. The diagnostic odds ratio was observed to be 133.44, while the accuracy of anti-CCP antibody in the diagnosis of RA was observed to be 84%.

Conclusions: The diagnostic potential of anti-CCP antibody can be useful for specific and sensitive diagnosis of RA disease in early stage, helping the clinicians in early and timely administration of treatment.

Background: Blood transfusion has an essential role in the resuscitation and management of patients undergoing surgical procedures. However, instances of incongruous blood ordering and usage have been reported worldwide, requiring an assessment of blood ordering patterns and addressing the gaps between requisition and utilization through programs such as Maximum Surgical Blood Ordering Schedule (MSBOS).

Aim: To estimate blood utilization, design a blood ordering schedule as a guide to normal transfusion needs for common elective surgeries and analyze the specialty-wise difference in blood transfusion indices.

Methods: An observational and cross-sectional study was undertaken for 12 months. Fifty-two elective surgeries across eight different surgical specialties were analyzed, including Urology, Cardiothoracic Surgery, Gastrosurgery, Pediatric Surgery, Oncosurgery, Orthopedics, Obstetrics and Gynecology, and Otorhinolaryngology. Blood utilization indices - Cross-match to Transfusion Ratio (CTR), transfusion probability (%T), Transfusion Index, Blood Utilization%, NonUsage Probability, and Blood Ordering Quotient (BOQ) were calculated against standard blood usage to formulate the MSBOS using the Mead's criteria.

Results: For 882 patients, 1160 packed red blood cells units were requested and cross-matched. Five hundred and seventy-four units were transfused. The nonutilization of 586 units (51%) suggested an indiscriminate ordering of blood. The nonusage of units cross-matched ranged from 27% to 100% in different specialties. The overall %T was 48.64%, varying from 13.23% in urological surgeries to 88.89% in cardiothoracic surgeries. The CTR ranged from 1.37 to 7.38, TI from 0 to 2.03, and BOQ from 0.92 to 1.36 in different specialties.

Conclusion: Rationalizing blood usage is essential. Developing an MSBOS based on the findings would enhance the efficiency of blood utilization in elective surgeries.

Background: Ventricular catheter (VC) misplacement is one of the most common causes of ventriculoperitoneal (VP) shunt malfunction and revision surgery. Most of the VC placements are done by freehand method. We evaluated the use of intraoperative fluoroscopy for assessing VC placement.

Materials and methods: A total of 70 patients were enrolled in the study. Patients with hydrocephalus who required cerebrospinal fluid diversion were enrolled in the study. Thirty-five patients were placed in the control group (patients in whom intraoperative fluoroscopy was not done), and 35 patients were placed in the test group (patients in whom intraoperative fluoroscopy was done). Patients with trapped ventricles and multiloculated hydrocephalus were excluded from the study. VP shunt insertion was done through standard Keen's point.

Results: The positioning of VC was optimal in 40 patients, with a significant difference between the test group and the control group. Gross malpositioning was seen in seven patients: four in the test group and three in the control group. All gross malpositioned VCs in the test group were corrected intraoperatively. VC crossing midline was less in the test group as compared to the control group.

Conclusion: Fluoroscopy is an easy and cheap method to assess VC position intraoperatively. It is readily available and helps us in avoiding resurgery due to VC misplacement and subsequent blockage.

Context: Professionalism Mini-Evaluation Exercise (P-MEX) has demonstrated valid evidence in assessing the construct, professionalism, in resident training. As the Indian medical regulatory body has introduced "professional" as one of the seven roles of Indian Medical Graduate and as cultural and social differences affect professionalism of students' cohort across geographical regions, this study was undertaken to establish P-MEX's validity, reliability, and feasibility in assessing the construct, professionalism, in undergraduate medical students (UMSs) in India.

Materials and methods: This multicentric study assessed the final phase-2 (5^th year) UMSs for the construct of professionalism using a 24-item P-MEX questionnaire during various clinical encounters. Construct validity was established by performing exploratory factor analysis (EFA) and confirmatory factor analysis (CFA) through structural equation modeling. Cronbach's alpha values defined the reliability of the questionnaire.

Results: The item mean score for the 697 collected P-MEX questionnaires ranged from 2.57 to 3.24 out of 4. EFA conducted using principal component analysis with item-component loading of 0.5 and above with Varimax rotation gave a 5-factor, 21-item solution. However, the CFA suggested a 4-factor, 18-item solution which was then confirmed by a rerun of the CFA.

Conclusion: The CFA suggests that the 18-item, 4-factor questionnaire is a good fit solution for assessing the construct, professionalism, in UMSs in Indian context.

Background: Caregivers of visually impaired individuals often endure significant physical, emotional, and financial challenges, yet their burden and depression remain understudied, particularly in resource-limited settings like India. This study examines the prevalence and associated factors of caregiver burden and depression.

Methodology: A cross-sectional study was conducted at a tertiary care institution in India from July 2022 to December 2023, involving 270 caregivers of 109 patients with permanent visual impairment (Category III or higher). Caregivers were assessed using the Zarit Caregiver Burden Scale (ZCBS) and the Center for Epidemiologic Studies Depression Scale (CES-D). Statistical analyses included Chi-Square tests and Pearson's correlation, with P < 0.05 considered statistically significant.

Results: Caregiver burden was prevalent, with 54.07% experiencing mild-to-moderate burden, 42.60% moderate to severe, and 3.33% severe burden. Depression affected 30% of caregivers (18.15% mild to moderate and 11.85% at risk of major depression). Burden was significantly associated with care duration (P < 0.001), female caregivers (P = 0.016), illiteracy (P = 0.002), patient relationship (P < 0.001), and patient employment status (P = 0.016). Depression was significantly linked to care duration (P < 0.001), female caregivers (P = 0.012), female patients (P = 0.009), married caregivers (P = 0.021), and nuclear families (P = 0.006). A moderate positive correlation between burden and depression was observed (R = 0.648, P < 0.01).

Conclusion: Caregivers of visually impaired individuals experience a substantial burden and depression, influenced by demographic and socioeconomic factors. Targeted interventions, including financial support, coping skills training, and psychiatric referrals, are essential to alleviate caregiver distress and enhance well-being.

Gallbladder carcinoma (GBC) is the most common malignant tumor of the biliary system and presents with frequent locoregional lymphadenopathy and distant metastasis. Gallbladder tuberculosis (GT) is rare abdominal tuberculosis (TB). GBC and GT mimic each other. The clinical examinations and radiographic investigations sometimes fail to exhibit the difference between these two which are confirmed only after postoperative histopathological assessment. Herein, we report a patient of GBC with coexistent GT with pleural metastasis and pleural effusion. We emphasize the importance of differential diagnosis of the two conditions, with similar signs and symptoms. The pleura is an extremely rare site of spread of GBC as seen in our patient.

Background: Patients having nasal polyposis who do not respond to medical management are subjected for functional endoscopic sinus surgery (FESS). One of the most common complications of surgery is bleeding. One of the strategies to reduce bleeding and securing a dry operating field during surgery is the use of preoperative corticosteroids which shrink the polyps and decrease mucosal inflammation.

Aim: The current study is designed to assess whether preoperative single-dose steroids 24 h before surgery can be a substitute for a 5-day regimen.

Methods: The proposed study was conducted on 60 patients of unilateral/bilateral nasal polyposis divided into two random groups. Group A was given a single oral dose of 1 mg/kg/dose of prednisolone on the day before surgery. Group B was given 1 mg/kg/day of oral prednisolone for 5 days before surgery. Side effects of steroids in both groups were assessed. Outcome measures were the amount of blood loss, quality of the surgical field, and time taken for the surgery.

Results: The mean age in both groups was similar with the majority of patients being male in both groups. Patients receiving a single dose of corticosteroid have almost no side effects as compared to patients receiving 5-day course. However, patients receiving single doses of corticosteroid preoperatively had significantly more blood loss during surgery. The surgical field in the single dose group was poor and the time taken for surgery was also significantly more.

Conclusion: Preoperative single dose of oral corticosteroid can reduce side effects but it is not as effective as short course of preoperative corticosteroid 5-day regimen in case of FESS for nasal polyposis.