Medical Journal Armed Forces India最新文献

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Comparison of clinicodemographic characteristics in patients with selective serotonin reuptake inhibitors poisoning: A cross-sectional study

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2025-01-01 DOI: 10.1016/j.mjafi.2024.06.004

Nastaran Eizadi-Mood , Nastaran Miranzade , Shadi Haddad , Maryam Ghasemi Aliabadi , Parastoo Golshiri , Rokhsareh Meamar

Background

Our objective of this study was to evaluate patients of Selective Serotonin Reuptake Inhibitors (SSRIs) overdose and compare the toxicological effects of citalopram overdose with other SSRIs in adult poisoning cases.

Methods

This cross-sectional study focused on acute, known-type SSRI ingestions. Demographic and toxicological data were collected on the patients. The outcomes analyzed were length of hospital stay, coma, seizures, electrocardiographic abnormalities, abnormal heart examination, and the presence of serotonin syndrome.

Results

There were a total of 199 cases, with 165 (82.9%) being women. The majority of cases (n = 76, 38.2%) were attributed to citalopram, followed by sertraline (n = 67, 33.7%), fluoxetine (n = 33, 16.6%), fluvoxamine (n = 10, 5%), escitalopram (n = 6, 3%), paroxetine (n = 1, 0.5%), and mixed (n = 6, 3%). The most common symptoms were nausea and vomiting (n = 96, 48.2%). Most patients (58.3%) were conscious, with only 7 patients (3.5%) experiencing seizures. Among those with seizures, six patients had taken citalopram, with 50% of them ingesting 400 mg of citalopram. Tachycardia was observed in 62 (31.2%) patients, while no QT interval prolongation, PR interval changes, or arrhythmias were reported. Serotonin toxicity was noted in only 6 patients (3%), with 4 of them being poisoned with citalopram. The incidence of seizures with citalopram was significantly higher than with other SSRIs (odds ratio (OR) = 10.457; 1.6–2.88, P = 0.008), while nausea and vomiting were significantly more common in poisoning cases involving other SSRIs (OR = 0.51; 0.2–0.9, P = 0.02). There were no reported deaths.

Conclusion

Ingesting SSRIs results in minimal toxicity. However, seizures are more likely to occur with citalopram compared to other SSRIs.

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引用次数: 0

Specialty preferences of undergraduate medical students: What do they choose and why?

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2025-01-01 DOI: 10.1016/j.mjafi.2024.04.009

Aditya Amit Godbole , Gauri A. Oka , Mrunal N. Ketkar , Rajvardhan Singh Solanki , Dhruvi T. Desai , Sejal V. Bangale , Atharva S. Rele

Background

The choice of choosing a specialty after completing MBBS is influenced by multiple factors. Personality traits like extraversion, agreeableness, conscientiousness, neuroticism, and open-mindedness form the intrinsic factors. Factors like early financial stability and cost of education form the external factors. This study evaluates the association between these factors and the specialty choice.

Methods

This was a cross-sectional study including students from first year to intern doctors in India. An online questionnaire was used for data collection which included questions about demographics, choice of specialty, personality traits, and external factors affecting their choice. The Big Five Inventory-2-S 30-item Scale (BFI-2-S) was used to assess the personality traits.

Results

One thousand nine hundred and twenty-one students participated in this study (57.6% females). Most participants, 1761 (91.7%) opted for clinical branches. Only 13 (0.7%) students wanted to pursue a non-clinical branch. Only 20 (1.0%) participants wanted to pursue a pre-clinical branch. Participants who opted for clinical branches were more extraverted, and more open-minded than those who chose non-clinical branches. Participants who opted for surgical branches were more extraverted, more conscientious, and had fewer negative emotions than their peers who chose medicine-related branches. High income generated per annum (65%), early financial stability (within 2–5 years) (60.7%), cost of postgraduate education (46%), and gender predominance (35.3%) were the most influential external factors.

Conclusion

These findings show that there are distinct personality traits and external factors associated with specialty choices. This will aid counselors to guide undergraduate medical students to choose a specialty for post-graduation.

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引用次数: 0

Sports and exercise medicine: Beyond injury management 运动和锻炼医学：超越伤病管理

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2025-01-01 DOI: 10.1016/j.mjafi.2024.03.007

Geetika R. Jadon , J. Muthukrishnan , Karuna Datta

There is a limited awareness about the role of Sports and Exercise Medicine (SEM) among medical as well as nonmedical fraternity beyond just management of sports injuries. SEM professionals play a significant role in healthy general population and illness by designing and implementing specific primordial, primary and secondary preventive activities against the lifestyle disorders through exercise. In amateur and professional sports, they provide scientifically sound advice to enhance performance and prevent injuries through pre- and rehabilitative techniques. In the Armed Forces personnel, SEM has a special role beyond these to assess fitness for battle physical efficiency and also enhance the performance in various physical activities of military nature. Scientifically sound professionals in this field can help build a strong army and a healthier nation.

引用次数: 0

Hiding in plain sight: A rare case of ocular thelaziasis

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2025-01-01 DOI: 10.1016/j.mjafi.2024.06.011

Vikas Sharma , Ritesh Waghray , Samrudhi Samant , Atul K. Singh , Sunil Agrawal

A 65-year-old male patient presented to eye outpatient department of a zonal hospital in North Eastern India with complaints of diminution of vision for 1-year duration. On ocular examination, his unaided visual acuity was 6/36 right eye and 6/12 left eye. He was diagnosed as a case of immature senile cataract with nuclear sclerosis grade 2+ in the right eye and immature senile cataract with nuclear sclerosis grade 1+ in the left eye, with no other ocular or systemic findings. He was taken up for phacoemulsification cataract surgery in the right eye. He underwent uneventful phacoemulsification with posterior chamber intraocular lens implantation in the right eye. On completion of cataract surgery, while removing the wire speculum, a slender, motile, chalky white worm was noticed in the lower fornix. The worm was retrieved and was sent for microbiology examination. The patient was given a thorough antibiotic wash of cul-de-sac of conjunctiva. The eye was patched with antibiotic ointment. The worm was identified as a female Thelazia callipaeda. This condition is rare and may present asymptomatically as in our case or may be a cause of ocular morbidity leading to intraocular as well as extraocular manifestations.

{"title":"Hiding in plain sight: A rare case of ocular thelaziasis","authors":"Vikas Sharma , Ritesh Waghray , Samrudhi Samant , Atul K. Singh , Sunil Agrawal","doi":"10.1016/j.mjafi.2024.06.011","DOIUrl":"10.1016/j.mjafi.2024.06.011","url":null,"abstract":"<div><div>A 65-year-old male patient presented to eye outpatient department of a zonal hospital in North Eastern India with complaints of diminution of vision for 1-year duration. On ocular examination, his unaided visual acuity was 6/36 right eye and 6/12 left eye. He was diagnosed as a case of immature senile cataract with nuclear sclerosis grade 2+ in the right eye and immature senile cataract with nuclear sclerosis grade 1+ in the left eye, with no other ocular or systemic findings. He was taken up for phacoemulsification cataract surgery in the right eye. He underwent uneventful phacoemulsification with posterior chamber intraocular lens implantation in the right eye. On completion of cataract surgery, while removing the wire speculum, a slender, motile, chalky white worm was noticed in the lower fornix. The worm was retrieved and was sent for microbiology examination. The patient was given a thorough antibiotic wash of cul-de-sac of conjunctiva. The eye was patched with antibiotic ointment. The worm was identified as a female <em>Thelazia callipaeda.</em> This condition is rare and may present asymptomatically as in our case or may be a cause of ocular morbidity leading to intraocular as well as extraocular manifestations.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 1","pages":"Pages 109-113"},"PeriodicalIF":0.0,"publicationDate":"2025-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143053891","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

引用次数: 0

A cross-sectional study to estimate the cost of managing patients with acute on chronic liver failure at a tertiary care centre 一项横断面研究，估算一家三级医疗中心管理急性和慢性肝衰竭患者的成本

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2025-01-01 DOI: 10.1016/j.mjafi.2024.02.003

Surender Palakuri , Alok Chandra , Sudeep Prakash , Manish Manrai , J. Muthukrishnan , Sharad Srivastava , Saurabh Dawra

Background

Acute-on-chronic liver failure (ACLF) is a life threatening disease. This study seeks to identify factors that contribute to greater financial burden in ACLF.

Methods

In total, 55 patients were included. ACLF was defined as per ‘European Association for the Study of the Liver-Chronic liver failure (EASL-CLIF)’ criteria. Patient's sociodemographic profile, comorbidities, clinical features as well as ‘Child–Turcotte–Pugh (CTP)' score, ‘Model for end stage liver disease-Sodium (MELD-Na)’, ‘Acute physiology and chronic health evaluation (APACHE-II)’ and sequential organ failure assessment score (SOFA) scores were recorded. Direct costs (medicines, doctor visits, investigations, procedures, treatment), direct non-medical cost (transportation, food and accommodation), and indirect costs (due to loss of productivity by patient and care giver) were calculated. All charges were as prescribed by central government health scheme (CGHS). Patients were followed till discharge/death.

Results

The mean cost of management of ACLF was Indian Rupee (₹) 178,483 ± 83,460, equivalent to United States Dollars ($) 2174.69 ± 1016.90. The direct medical costs, direct non-medical costs and indirect costs were ₹134,310 ± 62,796 (1639.56 ± 766.5$), 13,809 ± 8455 (168.5 ± 103.2$) and ₹0.30,364 ± 21,142 (370.6 ± 258 $), respectively.

There was no significant correlation between total cost and demographic and clinical variables. Length of intensive care unit (ICU) stay incurred higher cost (p < 0.0001). We found direct positive correlation between total cost of management and ICU stay (R = 0.80) and duration of hospital stay (R = 0.77). A negative correlation was revealed between total cost of managing ACLF and APACHE-II score (R = −0.10), MELD-Na score (R = −0.13).

Conclusion

The current study can serve as a benchmark for future research on ACLF cost management.

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引用次数: 0

Renal limited sarcoidosis presenting with acute kidney injury 肾局限性结节病表现为急性肾损伤

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2025-01-01 DOI: 10.1016/j.mjafi.2023.06.003

Vishal Singh , Pavitra Manu Dogra , Pulkit Singh , Indranil Ghosh , Gaurav Singhal

Sarcoidosis is a multisystem granulomatous disease of unknown etiology, characterized by noncaseating epithelioid granuloma, multinucleate giant cells, and tissue destruction. While lung and lymph node involvement is common, isolated renal involvement is rare. We report the case of a 55-year-old female patient, with renal limited sarcoidosis, who presented with worsening sensorium and acute kidney injury. The investigation showed elevated levels of serum calcium and angiotensinogen converting enzyme; the imaging study of the chest was normal. The kidney biopsy performed for nonresolving acute kidney injury showed noncaseating granulomatous interstitial nephritis and the presence of concurrent Immunoglobulin A (IgA)nephropathy. She responded to a therapy comprising fluid resuscitation, hemodialysis, and oral steroids.

引用次数: 0

The role of cation-exchange resins in hyperkalemia management

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2025-01-01 DOI: 10.1016/j.mjafi.2024.07.001

Angela Kimberly Tjahjadi , Henry Sutanto , Artaria Tjempakasari

Hyperkalemia, characterized by elevated serum potassium levels, poses significant health risks, including life-threatening cardiac arrhythmias. The management of hyperkalemia has evolved, incorporating calcium polystyrene sulfonate (CPS) and newer agents such as sodium zirconium cyclosilicate (SZC) and patiromer alongside traditional treatments. This review provides a comprehensive examination of current management strategies for hyperkalemia, focusing on the comparative effectiveness, safety profiles, and patient preferences concerning CPS, SZC, and patiromer. Through an analysis of clinical trials, safety data, and guidelines, we highlight SZC's rapid action and favorable safety profile compared to CPS, which has been a standard treatment option for years. Additionally, the review explores patiromer, other emerging treatments, and future directions in hyperkalemia management, including the potential benefits of combination therapies and the role of personalized medicine. The findings suggest a shift toward newer potassium-binding agents in clinical practice, underscored by the need for individualized treatment approaches based on patient-specific factors. This article aims to guide clinicians in optimizing hyperkalemia management, ensuring effective, safe, and patient-centered care.

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引用次数: 0

Vitamin D deficiency presenting as seizures 维生素 D 缺乏症表现为癫痫发作

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2025-01-01 DOI: 10.1016/j.mjafi.2023.11.010

Amitabh Sagar , Gaurav Datta , Muthukrishnan Jayaraman

Vitamin D deficiency is commonly seen in the general population, likely due to lack of adequate exposure to sunlight as well as lack of sufficient dietary intake. However, severe hypocalcemia secondary to vitamin D deficiency, manifesting as seizures is uncommon. We present a series of such cases encountered by us in the time frame of June 2020 to Dec 2021 (the first wave of the Covid-19 pandemic associated with a lockdown) during which patients of varying age groups presented with seizures. The only abnormality detected was severe hypocalcemia due to vitamin D deficiency and they all responded well to calcium and vitamin D replacement, without recurrence of seizures or hypocalcemia.

引用次数: 0

Meeting an elite controller in a Busy medical OPD!

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2025-01-01 DOI: 10.1016/j.mjafi.2024.04.006

Mukti Nath Sankhi, Nirmal Shrestha, Rohit Vashisht

引用次数: 0

Proof of concept study – alternative pharmacoprophylaxis for high-altitude pulmonary edema: A hospital-based randomized controlled trial 概念证明研究——高原肺水肿的替代药物预防:一项基于医院的随机对照试验

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2025-01-01 DOI: 10.1016/j.mjafi.2023.07.015

Oommen Savina George , Krishan Singh , Binit Kumar , Vineet Kumar Malhotra , Vishal Jha

Background

High-altitude pulmonary edema (HAPE) is noncardiogenic pulmonary edema caused by exaggerated hypoxic pulmonary vasoconstriction and abnormally high pulmonary artery pressure. Some patients who develop HAPE have more chances to develop HAPE again on reinduction to high altitude (HA). This was a pilot project to look for a suitable drug (acetazolamide, nifedipine, or tadalafil) that could be used prophylactically in HAPE patients on reinduction to HA. The study incorporated a randomized, double-blind, placebo-controlled trial.

Method

One hundred and twenty serving personnel/previously healthy lowlanders, inducted to HA, thirty in each group, with history of one episode of clinically and radiologically diagnosed mild-to-moderate HAPE, were randomly distributed in the nifedipine, acetazolamide, tadalafil, and placebo groups. On discharge, all the patients were sent on leave for 4 weeks, after descent, to their homes, and they had to report to transit camp before reascent, where they were given either of the three medications or the placebo, then they were inducted to HA.

Result

HAPE, on reascent, did not develop in patients, given any of the three medications but developed in four patients in the placebo group.

Conclusion

Hence, a fully conscious person with mild-to-moderate HAPE could be effectively managed at altitude if the appropriate expertise and facilities are available and may be reinducted with any of the three drugs, if exigency exists. Trial Registry No.: CTRI/2022/03/041543.

高原肺水肿(HAPE)是由肺血管过度缺氧收缩和肺动脉压异常高引起的非心源性肺水肿。一些发生HAPE的患者在再诱导到高海拔(HA)时更有可能再次发生HAPE。这是一个试点项目，寻找一种合适的药物(乙酰唑胺、硝苯地平或他达拉非)，可以预防HAPE患者再次诱导HA。该研究纳入了一项随机、双盲、安慰剂对照试验。120名服役人员/以前健康的低地居民，诱导HA，每组30人，有一次临床和放射诊断的轻中度HAPE病史，随机分布在硝苯地平组、乙酰唑胺组、他达拉非组和安慰剂组。出院时，所有的病人都被送去休假4周，在下降后，回到他们的家，他们必须在上升前到中转营报告，在那里他们被给予三种药物中的一种或安慰剂，然后他们被诱导到HA。另外，服用三种药物中的任何一种的患者都没有发生HAPE，但在安慰剂组的四名患者中发生了HAPE。因此，如果有适当的专业知识和设施，轻度至中度HAPE的完全清醒的人可以在高海拔地区得到有效管理，如果存在紧急情况，可以重新使用三种药物中的任何一种。

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