Medical Journal Armed Forces India最新文献

英文中文

Organic foreign body removal by flexible bronchoscopy in an adult using retrieval basket 使用回收篮通过成人柔性支气管镜去除器质性异物

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2022.08.011

Amit Singh Vasan, Indramani Pandey, Robin Choudhary, Shipra Verma

引用次数: 0

Sirenomelia with alveolar capillary dysplasia: An unusual association Sirenomelia伴肺泡毛细血管发育不良：一种不寻常的关联

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2023.01.004

Shrutiprajna Kar, Pavithra Ayyanar, Tanushree Sahoo, Usha Devi, Tapas Som, Pankaj Kumar Mohanty

引用次数: 0

Transport and successful management of a case of ARDS using VV-ECMO 使用 VV-ECMO 转运并成功处理一例 ARDS 病例

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2024.03.001

Alok Kumar, D Vijay Kumar, Arvind Kumar, Nikhil Tiwari

引用次数: 0

Evaluating cervical mucous inflammatory status as novel predictor for spontaneous onset of labour at term: A prospective observational study 评价宫颈粘液炎症状态作为足月顺产的新预测因素：一项前瞻性观察性研究

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2022.06.006

Priya Tiwari , Shikha Seth , Ritu Sharma , Ruchi Verma , Meher Narain , Rakesh Gupta

Background

The objective of this study was to explore the relationship between cervical inflammatory status at term gestation and spontaneous onset of labour. The aim was to search for a cost-effective, readily available, point of care test as predictor for spontaneous onset of labour (SPOL) at term.

Methods

This prospective observational cohort study was ICMR-STS project. Women who were primigravida with 20–30 years age, term gestation, single-live foetus with cephalic presentation, not in labour, asymptomatic with no evidence of infection and obstetric complications, were included in the study. Cervical mucous samples were subjected to cytological assessment after Giemsa staining and differential count under microscope. Primary outcome measure was the spontaneous onset of labour within 7 days of enrollment; and depending on whether SPOL occurred or not the participants were divided into two groups, Group I and Group II, respectively.

Results

Out of 47 participants, 23 went into SPOL and included in Group I. We observed significantly increased mean levels of polymorphs (71.7 ± 29 vs. 55 ± 28; p-value 0.03), and raised PLR (12.72 ± 6.89 vs. 7.01 ± 3.4; p-value 0.0007) in group I before onset of labour. Polymorphs showed good sensitivity (73.9%) and specificity (83.3%); and on ROC polymorphs curve was on the left of the reference line which indicated that it has good predictive value for SPOL.

Conclusion

Predominance of polymorphs in the cervical mucous prior to the onset of labour has emerged as a novel, cost-effective, point of care predictor for SPOL.

本研究的目的是探讨妊娠期宫颈炎症状态与自然分娩的关系。目的是寻找一种具有成本效益，易于获得的护理点测试作为足月自然分娩（SPOL）的预测因子。方法采用ICMR-STS项目进行前瞻性观察队列研究。研究包括20-30岁的初产妇、足月妊娠、单胎头位胎儿、未分娩、无感染和产科并发症证据的无症状妇女。宫颈粘膜标本经吉氏染色和显微镜下鉴别计数后进行细胞学评估。主要结局指标为入组后7天内的自然分娩；根据是否发生SPOL，将参与者分为两组，分别为组I和组II。结果47名受试者中，23名进入SPOL，被纳入i组。我们观察到多态性的平均水平显著增加(71.7±29比55±28；p值为0.03)，PLR升高(12.72±6.89∶7.01±3.4；p值0.0007)。多态性具有良好的敏感性（73.9%）和特异性（83.3%）；ROC多态曲线位于参考线左侧，对SPOL有较好的预测价值。结论产程前宫颈黏膜多形态的优势已成为SPOL的一种新颖、经济、护理点预测指标。

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引用次数: 0

Study to evaluate effect of oral mini pulse corticosteroid therapy for unstable vitiligo on hypothalamic pituitary adrenal axis suppression 评价口服小脉冲皮质类固醇治疗不稳定型白癜风对下丘脑-垂体-肾上腺轴抑制的影响

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2022.08.010

Preema Sinha , Aradhana Sood , Bhasker Mukherjee , Anwita Sinha , Sukriti Baveja , Vikas Pathania

Background

The treatment of vitiligo is difficult and usually requires prolonged therapy. All exogenous glucocorticoid therapies can lead to the hypothalamic–pituitary–adrenal axis (HPA) suppression. Steroid therapy in the form of an intermittent pulse therapy is a much safer option than daily administration. Very few studies have been carried out to evaluate the effect of oral minipulse prednisolone (OMP) on HPA axis, and there are no concrete guidelines regarding the tapering of steroids after OMP, if needed at all. This study is a pilot study to evaluate the effect of use of OMP on HPA axis suppression in unstable vitiligo.

Methods

It is an observational prospective study approved by the Institutional Ethics Committee (IEC) of institution carried out on 30 patients with unstable vitiligo being initiated on OMP between the ages of 20–50 yrs carried out at a tertiary care hospital of Western Maharashtra for a period of one year. Inclusion criteria was all new cases of unstable vitiligo attending dermatology OPD with patients in the age group 20–50 years. Patients treated with systemic corticosteroids in the last six months, on prolonged topical steroid therapy, patients on any other immunosuppressive therapy, patients having contraindications for exhibiting systemic steroids were excluded from the study.

Results

Thirty steroid-naive patients (11 women, 19 men) with a median duration of vitiligo of 10.67 months duration were evaluated. A total of 19 (63.3%) were males and 11 (36.6%) were females with mean age 29.13 years. Serum cortisol levels at baseline, one week, and the end of therapy were 291.1 nmol/L, 288.7 nmol/L, and 304 nmol/L, respectively. Acton Prolongatum (ACTH) stimulated serum cortisol levels at baseline, one week, and the end of therapy were 658.3 nmol/L, 626.1 nmol/L, and 630.1 nmol/L, respectively. Time taken to achieve stability was a mean of 4.41 months post-initiation of OMP in 22/25(73.3%) patients. In 4/30 (13.3%) patients, no stability was achieved at six months of follow-up.

Conclusions

This pilot study has shown that there is no suppression of serum cortisol levels by OMP prednisolone if taken in a weekly dose. OMP steroid therapy is not very effective to achieve a decent level of repigmentation alone; hence, they should be used in combination with other modalities like topical steroids or phototherapy to achieve better repigmentation. The patients did not develop any systemic or cutaneous side effects due to the drug; hence, prednisolone can be considered a safe drug for pulse therapy.

白癜风的治疗很困难，通常需要长时间的治疗。所有外源性糖皮质激素治疗均可导致下丘脑-垂体-肾上腺轴（HPA）抑制。间歇脉冲治疗形式的类固醇治疗比每日给药安全得多。很少有研究评估口服小脉冲强的松龙（OMP）对HPA轴的影响，并且没有关于OMP后类固醇逐渐减少的具体指南，如果需要的话。本研究是一项评估使用OMP对不稳定白癜风患者HPA轴抑制作用的初步研究。方法：这是一项经机构伦理委员会（IEC）批准的观察性前瞻性研究，研究对象为30例年龄在20-50岁之间的不稳定白癜风患者，在西马哈拉施特拉邦的一家三级医院进行为期一年的OMP治疗。纳入标准是所有在皮肤科门诊就诊的不稳定白癜风新病例，患者年龄在20-50岁之间。在过去6个月内接受全身性皮质类固醇治疗的患者，长期局部类固醇治疗的患者，接受任何其他免疫抑制治疗的患者，有全身性类固醇禁忌症的患者被排除在研究之外。结果30例初治白癜风患者（女性11例，男性19例）中位病程10.67个月。男性19例（63.3%），女性11例（36.6%），平均年龄29.13岁。基线、一周和治疗结束时血清皮质醇水平分别为291.1 nmol/L、288.7 nmol/L和304 nmol/L。在基线、治疗一周和治疗结束时，ACTH刺激血清皮质醇水平分别为658.3 nmol/L、626.1 nmol/L和630.1 nmol/L。22/25例（73.3%）患者在开始使用OMP后达到稳定所需的平均时间为4.41个月。在4/30（13.3%）的患者中，在6个月的随访中没有达到稳定。结论：本初步研究表明，每周服用OMP强的松龙对血清皮质醇水平没有抑制作用。OMP类固醇治疗不是很有效，以达到一个体面的水平的重新着色单独；因此，它们应该与其他方式结合使用，如局部类固醇或光疗，以达到更好的重新着色。患者未因药物产生任何全身或皮肤副作用；因此，强的松龙可以被认为是一种安全的脉冲治疗药物。

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引用次数: 0

Stenotrophomonas maltophilia sepsis in preterm neonates 早产儿嗜麦芽窄食单胞菌败血症

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2023.01.010

Arjun Verma , Suprabha K. Patnaik , Pradeep Suryawanshi

Stenotrophomonas maltophilia, an environmentally ubiquitous microbe, is a challenging opportunistic pathogen in the hospital setting. Neonates are particularly vulnerable to infection with Stenotrophomonas but information on presentation, therapeutic response and outcome of such infection in this population is limited. To expand this knowledge, we report here a series of five cases. All the five neonates having S. maltophilia sepsis, were preterms (27–32 weeks), very low birth weight, with clinical presentation within three weeks of life, with respiratory involvement presenting as respiratory distress due to pulmonary haemorrhage, non-specific features like lethargy, altered blood sugar levels and haemodynamic instability. The microbe was sensitive to amikacin, ceftazidime, cotrimoxazole, gentamycin, levofloxacin and minocycline except in two cases showing levofloxacin resistance. All but one neonate survived with morbidities like retinopathy of prematurity, bronchopulmonary dysplasia and metabolic bone disease.

嗜麦芽窄养单胞菌是一种环境中普遍存在的微生物，是医院环境中具有挑战性的机会性病原体。新生儿特别容易感染窄养单胞菌，但在这一人群中，有关这种感染的表现、治疗反应和结果的信息有限。为了扩展这方面的知识，我们在这里报告一系列的五个案例。所有5例患有嗜麦芽链球菌败血症的新生儿均为早产儿（27-32周），出生体重极低，临床表现为三周内出生，呼吸受累，表现为肺出血引起的呼吸窘迫，非特异性特征，如嗜睡，血糖水平改变和血流动力学不稳定。该菌对阿米卡星、头孢他啶、复方新诺明、庆大霉素、左氧氟沙星和米诺环素均敏感，但有2例对左氧氟沙星耐药。除了一名新生儿外，所有新生儿都患有早产儿视网膜病变、支气管肺发育不良和代谢性骨病等疾病。

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引用次数: 0

A questionnaire-based study on the knowledge, attitude and practice on pharmacovigilance among pharmacists and nursing staff at teaching hospitals 教学医院药师和护理人员药物警戒知识、态度和实践的问卷调查

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2023.03.005

Bhupendra Prakash Solanke , Priyanka Birhare , Sharmila Sinha , Navdeep Dahiya

Background

The present study aimed to evaluate the knowledge, attitude and practices (KAP) about pharmacovigilance (PV) practices among health care professionals, that is, pharmacists and nursing staff before and after educational intervention in a tertiary care hospital.

Methods

This was an observational and questionnaire-based pre- and post-test educational interventional study involving pharmacists and nursing staff. A 15-point prevalidated questionnaire on KAP about PV was distributed to pharmacists and nursing staff before and after educational intervention. Ethical clearance was obtained before the start of the study.

Results

A total of 120 pharmacists and 60 nursing staff participated in pre- and post-KAP questionnaire study. The KAP of PV when compared before (pre-KAP) and after (post-KAP) the educational intervention, the correct response rates were found to be statistically significant (P < 0.001). Encouraging feedback was received from the participants.

Conclusion

This study proves that KAP of PV and adverse drug reaction reporting in routine practice can be improved by imparting knowledge about PV and hands-on training on adverse drug reaction reporting among pharmacists and nursing staff who are the backbone of health care system.

背景本研究旨在了解某三级医院卫生专业人员（即药师和护理人员）在教育干预前后对药物警戒（PV）行为的知识、态度和行为（KAP）。方法采用观察性和问卷调查法对药师和护理人员进行测试前和测试后的教育干预研究。在教育干预前后，分别向药师和护理人员发放了一份15点预效性PV认知能力问卷。在研究开始前获得了伦理许可。结果共有120名药师和60名护理人员参与了kap前后的问卷调查。在教育干预前（KAP前）和后（KAP后）比较，发现正确反应率有统计学意义(P <；0.001)。与会者的反馈令人鼓舞。结论通过对医疗卫生系统的骨干药师和护理人员进行PV知识的传授和药物不良反应报告的实践培训，可以提高PV知识和药物不良反应报告的KAP水平。

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引用次数: 0

Diagnostic enigma of pulmonary hypertension: Tale from a series of three patients 肺动脉高压的诊断难题：三个病人的故事

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2023.08.003

Anil Kumar Singhi , Anup Banerji , Nandini Biswas , Soumen Das

Pulmonary hypertension (PH) is a complex condition with multiple etiological factors. The ability to identify a potential underlying cause is crucial for accurate diagnosis, patient management, and prognostication. This article presents a series of three patient cases to illustrate the enigmatic nature of PH diagnosis. Understanding the enigmatic nature of PH and implementing focused clinical evaluation and protocol-driven management are crucial in deciphering this complex condition. By unraveling the mysteries surrounding PH, we can pave the way for effective interventions and better patient care.

肺动脉高压（PH）是一种复杂的疾病，有多种病因。识别潜在病因的能力对于准确诊断、患者管理和预后至关重要。这篇文章提出了一系列的三个病人的情况下，说明谜性质的PH诊断。了解PH的神秘本质，实施有针对性的临床评估和协议驱动的管理是破译这一复杂疾病的关键。通过解开围绕PH的谜团，我们可以为有效的干预和更好的病人护理铺平道路。

引用次数: 0

Descriptive study of sweat dermatitis: A rare dermatoses not so rare in tropics 汗性皮炎的描述性研究:一种罕见的皮肤病，在热带地区并不罕见

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2022.11.004

Deepak Vashisht , Parul Kamboj , Chaudhary Sampoorna Raj , Manoj GM , Preema Sinha , Sukriti Baveja , Aradhana Sood , Rajneesh Joshi

Background

Sweat dermatitis is an irritant inflammatory dermatosis commonly encountered in tropics during summers. Profuse sweating triggered by high heat index, friction, clothing, outdoor activities, military training, overcrowding, prolonged working in ill-ventilated places, etc., are responsible or this dermatitis. Aim was to study the clinical, dermoscopic, vapometric, histopathological, and immunohistochemistry (IHC) findings in sweat dermatitis.

Methods

Twenty-five patients of sweat dermatitis attending out-patient department (OPD) of tertiary care hospital, were recruited over a period of three months (June to August 2022). A detailed history was followed by dermatological examination, dermoscopy, vapometry, histopathology, and IHC studies.

Results

Twenty-five patients were included in the study. There was male preponderance with male: female ratio of 2.1:1. The mean age of patients was 30.36 years. Dermatological examination in all patients revealed brownish “parchment”-like, shiny “crinkled cellophane paper”-like patches over the entire upper back and shoulder region with areas of exfoliation. Dermoscopy revealed increased skin markings, deep brown pigmentary changes with superimposed whitish scales with islands of eroded skin, and prominent eccrine duct openings. Vapometric analysis revealed increased transepidermal water loss (TEWL) in the affected area in 88% of patients. Histopathological examination showed features of spongiotic dermatitis. IHC with CK7 (cytoplasmic) highlighted the normal eccrine coils.

Conclusion

Sweat dermatitis is common seasonal dermatoses in tropics, but it remains undiagnosed due to lack of awareness. This study aims to sensitize medical doctors and dermatologists about sweat dermatitis and prevention strategies that can be helpful in mitigating it. The study also discusses the role of investigative modalities, such as dermoscopy, vapometry, histopathology, and IHC, in sweat dermatitis.

汗液性皮炎是夏季热带地区常见的一种刺激性炎症性皮肤病。高热指数引发的大量出汗、摩擦、服装、户外活动、军事训练、过度拥挤、长时间在通风不良的地方工作等，都是造成这种皮炎的原因。目的是研究汗液性皮炎的临床、皮肤镜、蒸发法、组织病理学和免疫组织化学（IHC）的表现。方法于2022年6月至8月在三级医院门诊（OPD）就诊的汗液性皮炎患者25例。详细病史后进行皮肤检查、皮肤镜检查、气相测量、组织病理学和免疫组化研究。结果共纳入25例患者。以男性为主，男女比例为2.1:1。患者平均年龄30.36岁。所有患者的皮肤检查均发现整个上背部和肩部有棕色“羊皮纸”样、闪亮的“皱褶玻璃纸”样斑块，并伴有脱落。皮肤镜检查显示皮肤斑纹增加，深棕色色素改变，白色鳞片叠加，皮肤侵蚀岛状，突出的内分泌管开口。气相分析显示，88%的患者患处经皮失水（TEWL）增加。组织病理学检查表现为海绵性皮炎。CK7（细胞质）的免疫组化突出了正常的内分泌线圈。结论汗液性皮炎是热带地区常见的季节性皮肤病，但由于对该病的认识不足，不易被确诊。这项研究的目的是提高医生和皮肤科医生对汗液性皮炎和预防策略的认识，有助于减轻汗液性皮炎。该研究还讨论了调查方式的作用，如皮肤镜，蒸汽测量，组织病理学和免疫组化，在汗液性皮炎。

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引用次数: 0

External validation of Prediabetes Risk Test in Indian population for screening prediabetes 前驱糖尿病风险测试在印度人群中筛查前驱糖尿病的外部验证

Q2 Medicine

Medical Journal Armed Forces India

Pub Date : 2024-12-01 DOI: 10.1016/j.mjafi.2022.11.001

Radhika Aditya Jadhav , G. Arun Maiya , Shashikiran Umakanth , K.N. Shivashankara

Background

Prediabetes Risk Test (PRT) has been found valid in the Western population for screening prediabetes. However, ethnicity, race, geographical and other biological characteristics have been linked to the development of prediabetes. There is a dearth of literature on the external validity of PRT in the Indian population. So, the objective of this study was to assess the external validity of the PRT in the Indian population for screening prediabetes.

Methods

The study contained 522 participants aged between 18 and 60 years. The medical history, physical activity level and anthropometric measures were assessed. Prediabetes was diagnosed using fasting blood sugar and HbA_1C levels. External validation of PRT was performed using specificity, sensitivity, positive predictive value, negative predictive value, positive likelihood ratio and negative likelihood ratio. The receiver operating curve was plotted to identify the optimum cut-off value for Indians.

Results

The study found that the sensitivity of PRT was 48.1%, specificity 95.5%, positive predictive value 66.1% and negative predictive value 90.9% for screening prediabetes in the Indian population. Receiver operating curve analysis revealed that the optimum cut-off of PRT was around 3 for Indians.

Conclusion

The results showed that PRT might not be useful in the Indian population to identify the true positives of prediabetes as it has a sensitivity of 48.1%. However, it can be helpful to identify the true negatives as the specificity is 95.5%. Further study is required to modify PRT for the Indian context to make it more appropriate for the Indian population.

背景：糖尿病前期风险测试（PRT）在西方人群中用于筛查糖尿病前期是有效的。然而，民族、种族、地理和其他生物学特征与前驱糖尿病的发展有关。关于PRT在印度人口中的外部有效性的文献缺乏。因此，本研究的目的是评估PRT在印度人群中筛查前驱糖尿病的外部有效性。方法研究对象522人，年龄在18 ~ 60岁之间。评估病史、体力活动水平和人体测量指标。通过空腹血糖和HbA1C水平诊断前驱糖尿病。采用特异性、敏感性、阳性预测值、阴性预测值、阳性似然比和阴性似然比对PRT进行外部验证。绘制接受者工作曲线以确定印度人的最佳临界值。结果PRT筛查印度人群糖尿病前期的敏感性为48.1%，特异性为95.5%，阳性预测值为66.1%，阴性预测值为90.9%。接受者工作曲线分析显示，印度人PRT的最佳截止时间在3左右。结论PRT在印度人群中识别糖尿病前期真阳性的敏感性为48.1%，可能不适用。但其特异性为95.5%，有助于鉴别真阴性。需要进一步研究修改PRT以适应印度的情况，使其更适合印度人口。

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