The National medical journal of India最新文献

We describe a 4-year-old girl with a white reflex since birth, who presented with orbital retinoblastoma, complicated with orbital myiasis as a result of lack of compliance to treatment. The patient was managed with orbital exenteration followed by adjuvant radiation therapy. This case highlights the critical need for creating public health awareness and the importance of early medical attention to prevent such devastating conditions.

Background In the Indian context, there is no recent data on substance use among school students. We report on the pattern of substance use and associated factors among school students in a cross-sectional nationwide survey conducted in 10 cities of India. Methods From each city, data from 200 students each from three schools (urban-government, urban-private, rural school) were collected. Within each school, a section from each grade (VIII, IX, and XI/XII) was randomly selected. Finally, 5920 students (boys 52.4%, mean [SD] age 14.7 [1.6] years) self-administered the questionnaire in the classroom setting. Results There were 15.1% students who reported lifetime, 10.3% past year, and 7.2% past month use of any substance, including tobacco, with most being used occasionally. Substances used in the past year were tobacco (4%), alcohol (3.8%), opioids (2.8%), cannabis (2%), inhalants (1.9%), and sedatives (0.6%). Substance use was significantly higher among boys than girls and higher with increasing grades. Past year users had significantly high/very high total difficulties score on the Strengths and Difficulties Questionnaire (15.0 [5.1]) compared to non-users (13.4 [5.7]; p<0.001). There was a significant difference between substance users and non-users in the subscales conduct problem, hyper-activity, emotional problems, and in the impact score (p<0.001). Past year users compared to non-users reported higher 'substance use (any)' by family members (p<0.001) and peers (p<0.001). Conclusions A substantial proportion of school students reported using psychoactive substances, mostly for occasional use. School-based prevention efforts are required on a wide scale in the country. We recommend early identification and intervention for substance use in school settings.

Background Medical humanities encompass an integrated and interdisciplinary approach that spans the literary arts, visual and performing arts, the history of medicine, and bioethics, among many others. Its purpose is to document and understand human encounters with illness, disability and medical procedures, aiming to cultivate empathy, compassion, and a broader perspective in doctors by emphasizing human interaction and creativity, leading to a more holistic view of healthcare. Methods We designed and introduced a 14-hour, choice-based coursework in the fields of literature, photography, painting, film studies, and dramatics to 150 medical undergraduate students during their 1st and 2nd professional years. A "Humanities Mahotsav" was celebrated as a culmination of the work done by the students at the end of the coursework followed by student feedback. Results We received encouraging feedback and majority of the students believed that medical colleges should provide a structured program to demonstrate their work in the field of arts and found the humanities coursework interesting. Most of the students were not in favor of assessment for humanities but perceived that the coursework makes them think more empathetically and help them become better doctors in future. Conclusion We believe that while the humanities too have to work within the parameters of medical education, it is imperative to explore and seek clarity on how to integrate the subject of humanities along with medical training process so that both 'medical' and 'humanities' find equal validity and weightage to actualize the true potential of the field.

Spinal extradural arachnoid cyst is a rare condition, commonly located in the thoracic spine. It can be asymptomatic or present with symptoms of myelopathy due to spinal cord or nerve root compression. MRI is the initial imaging modality to diagnose this condition. CT myelography is the imaging modality of choice for detecting the actual site of communication between the subarachnoid space and arachnoid cysts; hence, it plays a pivotal role in surgical planning. We describe the imaging features of a symptomatic large spinal extradural arachnoid cyst and cord changes in a 12-year-old boy, who presented with paraparesis. CT and MR myelography helped in surgical planning by delineating the cyst morphology and the dural defect. It is an uncommon cause of myelopathy and must be accurately identified through imaging.

Background National surveys report that more than 90% of families in India access iodised salt (IS). Surveys of school children reported that median urinary iodine (UI) excretion was satisfactory in around 80% and high in 20% of the districts. Methods Between 2017 and 2021, based on data from 2 separate studies (A and B), UI was estimated in urban low-middle income families residing in South Delhi who had purchased IS from the market and used it for >1 year, or received IS or iron-fortified IS (DFS) from the research team and used it for >1 year. Spot urine samples were collected in the morning in both these groups; UI excretion was estimated using the microplate method based on the Sandell-Kolthoff reaction. Results Median baseline UI in those who purchased IS in the market was 234 µg/L in 2017 (Study A) and 235 µg/L in 2019 (Study B). In those who received the salt from the research team and used it in Study A, median UI in 2019 was 183 µg/L in IS users and 182 µg/L in DFS users; while in Study B, median UI in 2021 was 139 µg/L in IS users and 125 µg/L in DFS users. In both studies, UI after intervention was significantly different (lower) from baseline but not different between the IS and DFS groups. Conclusion There was a decrease in median UI between 2019 and 2021. This might be due to increasing awareness of the adverse consequences of excess iodine intake, and the salt industry complying with the Food Safety and Standards Authority of India's revised standards, which require the iodine content of salt at the manufacturer level to be between 20 and 30 ppm.

Background Critically ill cardiac patients may decompensate suddenly owing to arrhythmias and worsening haemodynamics, often necessitating emergent endotracheal intubation. Training in airway management is usually neglected for residents in the cardiac intensive care unit (ICU). There is an unmet need to train cardiology residents in the swift management of airways in the acute setting of a cardiac arrest. Methods In this manikin-based cross-over study, we compared King's vision channelled (KVC) and non-channelled video laryngoscopes (King's vision [KV]) with Macintosh direct laryngoscopes (DL) for endotracheal intubation by 89 resident doctors, predominantly cardiology residents. All participants performed endotracheal intubation by all three types of laryngoscopes after a didactic training session. The primary endpoint of the study was time to endotracheal intubation. Other parameters assessed were best glottic view, time to glottic view, ease of use of the device, failed attempts and retention of skills over 6 months. Results Total time to tracheal intubation was least with KVC, 10.0 (interquartile range [IQR] 6.0-10.0) seconds, as compared to KV, 15.0 (IQR 12.0-17.5) or DL, 24.0 (IQR 22.0-30.0) seconds (p<0.001). Both types of video laryngoscopes provided superior glottic view and had lower failure rates (p<0.001). KVC video laryngoscope and Macintosh DL were relatively easier to use (p<0.001). KVC and KV provided better retention of skills at 6 months. Conclusion Cardiology residents who were novices in endotracheal intubation took the least time for intubation on manikin with the KVC video laryngoscope when compared with the KV video laryngoscope and Macintosh DL. Further, real-life studies are needed to assess any difference in clinical situations.