The National medical journal of India最新文献

Scrub typhus presenting as infective endocarditis of the mitral valve is rare. There are few reports of infective endocarditis by scrub typhus with just one previous report of involvement of the aortic valve. An 18-year-old woman presented with prolonged fever for 1 month. Her repeated blood cultures were negative. She was finally diagnosed to have scrub typhus with scrub typhus IgM being positive and became afebrile with prolonged oral doxycycline monotherapy. Although atypical organisms such as Legionella, Mycoplasma and Coxiella are described to cause culture-negative endocarditis, vegetations were present on both the anterior and posterior mitral valve leaflets in our patient.

Scrub typhus is still an underdiagnosed disease despite an increase in incidence as the clinical presentation is often different, leading to a low index of suspicion among doctors. Scrub typhus, an acute febrile disease, is a cause of prolonged fever and pyrexia of unknown origin. It can have varied clinical presentations ranging from mild asymptomatic disease to fatal multi-organ dysfunction. Splenomegaly in scrub typhus has been rarely reported. We report a 30-year-old man presenting with fever, hepatomegaly, massive splenomegaly, lymphadenopathy and lobar pneumonia. Tests for malarial parasite and enteric fever were negative. Bone marrow aspiration showed normal haematopoiesis. IgM scrub was positive. Upon serological confirmation, doxycycline therapy was started followed by a rapid and complete resolution of pneumonia (both clinically and radiologically), splenomegaly and lymphadenopathy. This highlights the importance of recognizing rare clinical manifestations of this common tropical disease. An early diagnosis is required as a delay may lead to complications and a poor outcome.

Background We aimed to evaluate the 3-year participation status of tuberculosis (TB) laboratories in public health laboratories (PHL) tuberculosis external quality assessment (EQA) and EQA results. Method During 2018-2020, PHLs participated in the EQA programme organized annually by the National Tuberculosis Reference Laboratory (NTRL). Five kinds of EQA samples were sent to the participating laboratories on three parameters, including microscopy, culture and phenotypic first-line drug susceptibility testing and they were asked to perform according to the standard protocol. The results were taken over by the Tuberculosis Laboratories Surveillance Network (TULSA) web system and analysed. Results A total of 24 PHLs participated in the EQA in 2018; 30 in 2019 and 23 in 2020. In terms of sensitivity, specificity, accuracy and reproducibility in microscopy, respectively, in 2018, 20 of the laboratories were 100%, 4 of them 80%, and in culture 16 of them were 100% and 2 of them 80%; in 2019, 28 of them were 100%, 2 of them 80%, and in culture 11 of them were 100%, 6 of them 80%, 1 of them 60%; in 2020, 20 of them were 100%, 3 of them 80%, and in culture 13 of them were 100% and 3 of them 80%. Conclusion It is beneficial for laboratories working on TB to participate in EQA in terms of evaluating the accuracy and reliability of the method used.

Background About 35% of the global child deaths and 11% of the total disease burden are due to inadequate nutrition. While in India, 1 in 3 children are underweight and stunted, and 1 in 5 children are wasted. Methods Using multivariate and descriptive statistical analysis, we examined the prevalence, determinants of minimum diet diversity failure (MDDF) and trends of MDDF across different regions of India among children aged 6-23 months. Dietary pattern in 8 food groups was also examined using the National Family and Health Survey (NFHS) data from 2005-06 to 2019-21. Results Overall, MDDF in India has decreased from 87.4% (2005-06) to 77.1% (2019-21). The central region (84.6%) reported the highest prevalence of MDDF in 2019-21. Children of illiterate and rural residing mothers with no mass media exposure, children of the first birth order and children not exposed to counselling and health check-ups at Anganwadi/Integrated Child Development Services (ICDS) centres, children with low birth weight and anaemic, and who belonged to a large family had greater likelihood for MDDF. Conclusion To tackle the high prevalence of MDDF, a holistic action is needed from the government, i.e. improved public distribution system (PDS), intensified Integrated Child Development Scheme (ICDS) programme, use of social media, and nutrition counselling through local self-governance.

Apartheid had a devastating impact on medical education in South Africa. Until the development of the University of Natal Medical School in 1951, there were minimal opportunities for blacks (collectively Africans, Indians and so-called coloureds) to undertake undergraduate and postgraduate medical training in South Africa. At the height of apartheid (1968-1977), whites who had constituted 17% of the population, accounted for up to 87% of all medical graduates. The African majority, constituting 70% of the population had less than 5% of all medical graduates in South Africa. The global isolation of South Africa from the late 1940s further impacted negatively on the medical training for blacks in South Africa. During apartheid, the Government of India provided full scholarships to the marginalized in South Africa to study medicine in India. This initiative, coming at a time when India was grappling with its post-colonial challenges, was a remarkable yet seldom appreciated gesture.

To compensate for physician shortage, many countries around the world have introduced a cadre of mid-level healthcare providers (MLHPs) into their health systems to shoulder many of the conventional responsibilities of a physician. Besides backing their clinical competence and service quality, evidence and experience on MLHPs also supports their lower turnover and higher rural retention rates. In India, mainstreaming of MLHPs has time and again been met with resistance from organized medicine. We explore a fresh case for MLHPs in India in view of some recent developments and the probable future contours that Indian healthcare is likely to assume. Aided by global precedents, we broaden the rationale for mainstreaming MLHPs, address some common misunderstandings, and describe the conducive emergent legal and policy landscape. We also explain how a possible reorganization of Indian healthcare, highly likely under expanded publicly financed health insurance and value-based healthcare regimes, can warrant greater health workforce differentiation and an expanded role of MLHPs in mainstream healthcare delivery. We also touch upon important political economy considerations, including the need for navigating organized medical opposition, involving medical stakeholders in the MLHP mainstreaming process, autonomous regulation of MLHP professions, streamlining MLHP competencies, and inclusive health financing systems.

Background The newly introduced 'Elective programme', a voluntary special study module in the final phase of the undergraduate medical curriculum, offers scope for new immersive, self-directed learning opportunities. We describe a programme of study for learning 'medical sociology' through the innovative use of humanities in medicine. Methods Our elective module, called 'Community Health and Rock Music' (CHaRM), was a 2-week programme, merging the curricular subject of community health with 'rock music' as an exposure to the 'counter-culture' outside of the medical world. The half-day sessions consisted of: (i) watching/listening to a rock song-video without reading its lyrics; (ii) listening to the same song again but with lyrics; (iii) undertaking an emotionally stimulating activity (watching a movie, making a site-visit, etc.); and (iv) debriefing, to identify/discuss the underlying social determinants of health and their relevance in the grooming of a socially aware medical student. Formative assessment was intended to gauge levels of expression of the affective domain (attitude/emotions). Results Seven of 143 students volunteered for this programme. Key learnings were a clear appreciation of the societal determinants of health (such as deprivation/discrimination/social structures); multi-level causation of diseases; social issues not addressed in traditional medical curriculum; personal growth; teamwork; and the role of empathy in medical practice. Additional learning was the exposure to the 'counter-culture of arts'. All 7 student assessments 'met expectation', with 4 of them 'exceeding expectation'. Conclusion An 'elective programme' combining humanities with medicine is potentially an innovative, student-centric and replicable model of learning that impacts the affective domain critical for doctors-in-training.