The Journal of the Association of Physicians of India最新文献

Introduction: Human immunodeficiency virus-acquired immunodeficiency syndrome (HIV-AIDS) is an important public health problem with almost 39.9 million people living with HIV (PLHIV) all over the world and 1.3 million new cases being detected every year according to a report by the World Health Organization. Due to an increase in the treatment landscape for HIV-positive patients, a revolutionary transformation has occurred in the life expectancy of these people. HIV is a chronic viral infection that can cause suppression of the body's immune response, leading to inflammatory changes and elevation in markers of inflammation such as C-reactive protein (CRP), interleukin-6 (IL-6). These elevated inflammatory markers are associated with increased risk of atherosclerosis as well as cardiovascular diseases.

Methodology: This was a cross-sectional observational study, which was conducted at LLRM Medical College. Sample size calculation was done, and considering inclusion and exclusion criteria, 100 patients were included for the study, and all the parameters (clinical, biochemical, radiological) were assessed.

Results: Out of 100 patients, almost half (53%) were in the 18-30 years age-group, and 47% were in the 31-40 years age-group. The male-to-female ratio was almost equal (45:55). The maximum patients in our study were graduates (42%), while only 5% were illiterate. The most common occupation in our study was semiskilled persons (38%). The most common electrocardiogram (ECG) finding was sinus tachycardia (27%), the second most common finding was low-voltage complexes, which were present in 10% of patients; diffuse ST-T changes were the third commonest finding (4%), while 54% of patients did not show any ECG abnormality. On echocardiography of the patients, 70% did not show any abnormality, while 12% had pericardial effusion, 7% had dilated cardiomyopathy (DCMP), 5% had concentric left ventricular hypertrophy (LVH) with left ventricular diastolic dysfunction (LVDD), 3% showed pulmonary hypertension, and 3% had grade 1 diastolic dysfunction.

Conclusion: Cardiac abnormality was found in 30% of patients, which must be considered a risk factor for HIV patients. The most common cardiac abnormality was pericardial effusion, the cause of which should be investigated further for proper management of the patients. These results emphasize the importance of regular cardiovascular monitoring in HIV-positive patients.

Background: The National Medical Commission (NMC) of India requires medical postgraduate students to conduct research in the form of a thesis or dissertation. However, students often face challenges throughout the process, including topic selection, protocol approval, data collection, and thesis writing. This study aimed to assess the effectiveness of a 1-day focused thesis writing workshop in improving the knowledge and confidence of medical postgraduate students.

Methods: A cross-sectional mixed-methods study was conducted involving 68 postgraduate students from various medical disciplines who participated in a thesis writing workshop. Participants were administered pre- and post-test questionnaires to assess their knowledge of key thesis writing components, including literature review, results, discussion, and conclusion. The workshop included interactive sessions on each of these topics. Descriptive and inferential statistics were used to analyze the results, and qualitative feedback was gathered to assess participant satisfaction and perceived improvements in confidence.

Results: The pre- and post-test scores showed a significant improvement in knowledge, particularly in the areas of literature review, results, and discussion (p < 0.05). However, the improvement in knowledge regarding thesis conclusions was not statistically significant. Feedback from participants indicated high satisfaction with the workshop, with 85% reporting increased confidence in their thesis writing skills. The majority of students (78%) found the workshop relevant and helpful in enhancing their understanding of thesis writing.

Conclusion: A focused, 1-day workshop significantly improved the knowledge and confidence of medical postgraduate students in thesis writing. This suggests that such workshops can be an effective intervention to support postgraduate students in completing their research. The study advocates for the integration of similar workshops into postgraduate curricula. Further research with larger, multicenter studies is needed to evaluate the long-term impact and feasibility of institutionalizing such programs.

Background: The number of people living with multiple chronic medical conditions has risen, and with it, the number of medications taken by them. In addition to adherence to medications, it is extremely important to correctly identify the medications. Medication errors occur at all steps, with polypharmacy, low literacy, language barriers, old age, and lack of communication as contributing factors. Many of the patients may not be identifying medications themselves or may be doing so incorrectly. Hence, this study is aimed to check the methods used by patients to identify medications.

Materials and methods: A total of 150 patients attending the outpatient department (OPD) of the medicine department were interviewed using a structured questionnaire, which had multiple-choice questions and one open-ended question. Sociodemographic data, level of education, data on type and number of clinical conditions, groups of medications taken, and methods used for identification of medications were collected. Statistical analysis was done using Stata 14.2.

Results: Most (85.33%) of the patients had a chronic medical condition, out of which 37.33% had two or more clinical conditions. Physical attributes of the tablets (60%) and packaging (39.33%) were used most commonly to identify medications. About 10.67% did not identify the medications themselves. Again 45.33% of the patients depended on the doctor's prescription for the dosing of medications. Patients felt that identification of medications would be easier if the content on packaging included indication, was written in the local language, and was in bold font. They also felt that healthcare professionals spending more time explaining would help them.

Conclusion: Irrespective of the level of education, language known, and number of comorbidities, physical attributes and packaging were most commonly used to identify medications.

Background: Falls among the elderly are a significant public health concern, particularly in socioeconomically disadvantaged urban settings. Beyond physical injuries, falls contribute to psychological effects such as fear of falling, which may limit mobility and increase dependency. The concept of fall efficacy, or the confidence in performing daily activities without falling, has emerged as a key psychological indicator in understanding fall risk. However, limited data exist on these aspects among older adults living in urban slums in India.

Objectives: To determine the prevalence of falls among older adults residing in urban slums of Siliguri, West Bengal, and to explore the association between fall efficacy and the occurrence of falls.

Methods: A descriptive cross-sectional study was conducted among 207 adults aged ≥60 years selected via two-stage cluster sampling from 30 urban slum clusters in Siliguri. Data were collected via a pretested, semi-structured questionnaire capturing sociodemographic information, medical history, fall episodes, and fall efficacy, assessed using the Fall Efficacy Scale (FES). Data were analyzed using the Statistical Package for the Social Sciences (SPSS) version 20.0 with multivariable logistic regression to identify predictors of falls.

Results: The prevalence of falls in the past 6 months was 41.1%, and the distribution of falls was nearly equal between indoor and outdoor settings. Significant predictors of falls included advanced age [≥80 years; adjusted odds ratio (AOR) = 4.25], presence of comorbidities (AOR = 8.16), physical disabilities (AOR = 2.50), and residence in pucca houses (AOR = 3.38). Although higher concern about falling (as indicated by higher FES scores) was associated with increased fall risk (AOR = 1.88), the association was not statistically significant.

Conclusion: Falls among the elderly in urban slums are prevalent and influenced by a complex interplay of age, health status, and living conditions. Integrating physical, environmental, and psychological interventions is critical for fall prevention among older adults, especially in underserved urban slums.

Background: Cerebral venous thrombosis (CVT) is a rare but treatable cause of stroke, predominantly affecting younger individuals, particularly women during the puerperal period. Despite increased recognition through advanced imaging, clinical diagnosis remains challenging due to its diverse presentation and varying etiological factors.

Objective: To evaluate the clinical profile, etiological factors, treatment outcomes, and prognosis of CVT patients, with a focus on comparing puerperal and nonpuerperal cases in a tertiary care setting in Northwest India.

Materials and methods: This prospective observational study included 80 adult patients diagnosed with CVT via computed tomography venography (CTV) or magnetic resonance venography (MRV) over a 2-year period. Participants were categorized into male, puerperal female, and nonpuerperal female groups. Detailed clinical, laboratory, and radiological evaluations were performed. Modified Rankin Scale (mRS) was used to assess neurological outcomes. Statistical analyses were conducted using analysis of variance (ANOVA) and Chi-squared tests with significance at p < 0.05.

Results: Puerperal females were younger than other groups. Common symptoms included headache (85%), seizures (45%), and focal deficits (47.5%). Hyperhomocysteinemia (65%) and vitamin B12 deficiency (51.25%) were prevalent, particularly among males and nonpuerperal females. Anemia was significantly more common in females. No significant difference was noted in clinical outcomes across groups. Poor prognosis was associated with Glasgow Coma Scale (GCS) <8, focal deficits, and low vitamin B12 levels. In-hospital mortality was 6.25%; 97% of survivors had favorable outcomes (mRS <3) at 3 months.

Conclusion: CVT in Northwest India affects a significant number of males and nonpuerperal females. Nutritional deficiencies, particularly vitamin B12 and anemia, play a crucial role. Early diagnosis and appropriate anticoagulation therapy are critical for favorable outcomes.

Introduction: Hemoglobinopathies, a group of inherited disorders characterized by abnormal hemoglobin (Hb) production or structure, pose significant health risks during pregnancy. This study aims to assess the prevalence of hemoglobinopathies among antenatal females and establish guidelines for effective screening and management.

Materials and methods: An observational cross-sectional study was conducted over 18 months at Dr DY Patil Medical College, Hospital and Research Centre, involving 800 antenatal women. Demographic data, medical history, and blood samples were collected for complete blood count (CBC) and Hb electrophoresis. Statistical analysis was performed using SPSS software.

Results: A study evaluated 800 antenatal females aged 20-39 years, with an almost equal distribution between age-groups 20-29 (49.23%) and 30-39 (50.77%) years. Peripheral blood smear analysis revealed 97.69% had microcytic hypochromic anemia, indicating a high prevalence of iron deficiency, while 2.31% exhibited normocytic normochromic anemia. Hb electrophoresis identified hemoglobinopathies in 1.72% of cases, with 1.53% cases identified as beta-thalassemia carriers, and 0.19% with sickle cell trait (SCT). Among the abnormal cases, beta-thalassemia (55.56%) was found to be the most common, followed by HbE heterozygous (11.11%), HbE homozygous (11.11%), and double heterozygous (11.11%), with a single case (11.11%) of sickle cell disease (SCD). Beta-thalassemia was the most prevalent hemoglobinopathy. CBC parameters showed significant variations among hemoglobinopathy types, with analysis of variance (ANOVA) p-values of 0.0001 for Hb, mean corpuscular volume (MCV), and mean corpuscular Hb. These findings underscore the significance of microcytic hypochromic anemia and the relatively low prevalence of hemoglobinopathies in the antenatal population.

Discussion: The low prevalence of hemoglobinopathies in this region contrasts with higher rates reported elsewhere in India, indicating potential regional genetic factors. The predominant finding of microcytic hypochromic anemia underscores the urgent need for targeted interventions addressing iron deficiency in antenatal care.

Conclusion: This study emphasizes the importance of routine screening for hemoglobinopathies in pregnant women, particularly in regions with known genetic predispositions. Increased awareness and follow-up molecular analysis are recommended for accurate diagnosis and management, ultimately improving maternal and fetal health outcomes. Future research should expand to larger, multicentric studies to further validate these findings.

Urinary tract infection (UTI) is the second most common type of infection in the human body. It is one of the most prevalent conditions in medical practice, with approximately 150 million cases occurring globally each year. Approximately 50% of women will experience at least one episode of UTI during their lifetime, and between 20 and 40% will have recurrent episodes. The discovery of a broad-spectrum antibiotic, fosfomycin tromethamine, occurred in Spain in 1969 and is prominently used in the management of uncomplicated UTIs. As a phosphonic acid derivative, fosfomycin acts by disrupting bacterial cell wall synthesis by inhibiting the enzyme MurA, demonstrating effective activity against a wide variety of gram-negative and gram-positive pathogens, comprising multidrug-resistant strains such as Escherichia coli and Klebsiella pneumoniae. Fosfomycin is not metabolized and is predominantly excreted unchanged in the urine through glomerular filtration. Mean peak urinary concentrations of fosfomycin ranging from 1053 to 4415 mg/L occur within 4 hours of administration of a single oral dose of fosfomycin tromethamine correspondent to fosfomycin 3 gm. Urinary concentrations >128 mg/L, which are adequate to inhibit most urinary pathogens, are maintained for 24-48 hours following a single oral dose of fosfomycin tromethamine. This makes it particularly advantageous for uncomplicated UTIs, where it offers a convenient and effective single-dose treatment option. Clinical trials and observational studies have consistently shown high cure rates and patient compliance, attributing this to its minimal side effects and broad-spectrum efficacy. A single oral dose of fosfomycin tromethamine, equivalent to 3 gm of fosfomycin, is indicated for treating acute uncomplicated lower UTIs in adults. It is classified as pregnancy category B. Various clinical guidelines, such as the Infectious Diseases Society of America (IDSA), European Association of Urology (EAU), and National Institute for Health and Care Excellence (NICE), also recommend fosfomycin tromethamine for the treatment of UTI. In conclusion, fosfomycin tromethamine remains a robust and indispensable antibiotic in the management of uncomplicated UTIs, with a distinct pharmacological profile that ensures both efficacy and safety, and patient compliance due to its single-dose regimen.

Background: Diabetes mellitus (DM) is a global health concern with rising prevalence, particularly in India, where undiagnosed cases are significant. A common yet often overlooked complication, diabetic gastroparesis impairs gastric motility and significantly reduces quality of life. Current treatments focus on symptom management, but the relationship between gastric motility patterns and therapeutic outcomes remains underexplored. This study evaluates the efficacy of levosulpiride in managing diabetic gastroparesis and its impact on gastric scintigraphy patterns.

Methods: This analytical observational study included 27 adult patients with type 2 DM (T2DM) and gastroparesis, conducted at a tertiary care hospital in North India from April 2021 to 2022. Patients received 25 mg levosulpiride thrice daily for 4 weeks. Gastroparesis symptoms were assessed using the Gastroparesis Cardinal Symptom Index (GCSI). Gastric motility was evaluated via gastric scintigraphy before and after treatment. Changes in GCSI scores and scintigraphy patterns were analyzed using paired t-tests and the Stuart-Maxwell test.

Results: Participants (mean age 56.41 ± 9.48 years) showed significant improvement in GCSI scores (11.48 ± 3.02 to 6.04 ± 2.08, p < 0.001). Gastric scintigraphy revealed significant changes, with 66.7% of patients demonstrating normalized motility patterns posttreatment (χ² = 14.000, p = 0.016). While delayed gastric emptying persisted in some cases, levosulpiride alleviated key symptoms like nausea, vomiting, and early satiety.

Conclusion: Levosulpiride significantly alleviated symptoms of diabetic gastroparesis, as evidenced by reduced GCSI scores and improvements in gastric scintigraphy patterns. Despite minimal changes in delayed gastric emptying, the drug's effect on motility dysfunction highlights its therapeutic potential. This study underscores the importance of focusing on motility patterns in symptom management, suggesting levosulpiride as a promising option for targeted treatment of diabetic gastroparesis.

Aim: To study the perception of nonintensivists of Indian intensive care units (ICUs) about the role of intensivists as leaders of the ICU, their impact on patient outcomes, including length of stay on the ventilator, cost of care, and evidence-driven quality care using a survey questionnaire.

Materials and methods: This study employed an online survey conducted using a Google Form and distributed via WhatsApp to nonintensivists taking care of ICU/high dependency unit (HDU) patients in public and private hospitals all over India. It consisted of 24 questions related to perceptions about the role of an intensivist in the ICU, their impact on patient-driven outcomes, ICU processes, and ICU structure.

Results: There was a statistically significant difference in responses from respondents working in closed and semi-open ICUs vs open ICUs. Overall, the presence of an intensivist was perceived to be associated with improvements in patient outcomes, smoother decision-making for complex cases, reduced costs by avoiding unnecessary tests, and reduced litigation by patient families, especially in closed and semi-open ICUs vs open ICUs.

Conclusion: This is the first-ever survey done to understand the role of an intensivist in the ICU in India in the eyes of a nonintensivist/admitting physician or surgeon. It shows that intensivists are considered to play a significant role in impacting patient outcomes, such as facilitating smoother decision-making in complex cases, improving decision-making efficiency, reducing costs associated with unnecessary tests, and preventing litigation by families. The survey results are very encouraging and should pave the way for conducting large-scale surveys in the developing world.