The National medical journal of India最新文献

Background The submission of a thesis or dissertation is a requirement stipulated by the National Board of Examinations in Medical Sciences (NBEMS) before a candidate can be awarded a postgraduate degree. Although the thesis is a requirement, its subsequent publication in a journal is not mandatory; if not published, a large amount of potentially valuable research data is lost. Our primary objective was to assess the conversion rate of postgraduate theses into publications in biomedical journals, and the secondary objective was to estimate the frequency of presentations of papers and posters at conferences by postgraduates during their tenure. Methods In this retrospective study, we collected data (between 1991 and 2019) from 434 theses written by the residents of 7 departments of Sir Ganga Ram hospital, New Delhi which were submitted to the NBEMS in partial fulfilment of their final degrees. The 'conversion' rate to publication was calculated using data from the websites PubMed, Google Scholar, and our hospital journal, Current Medicine Research and Practice. Results The conversion rate of the thesis into a publication was 33.2%. The frequency of oral or poster presentations at state, national, or international conferences during the residency period was 47.2%. Conclusion Less than one-third of thesis were published. Almost half were, however, presented at various conferences.

Background Research is important for medical education and evidence-based patient care. Efforts should be made to enhance student engagement in research. Students should be able to appraise the literature to identify credible and high-quality research critically. Hence, it is necessary to understand the reasons that deter students from getting involved in research, which will help institutions and universities initiate effective measures. We identified factors associated with research attitudes among medical students and assessed barriers to research practice among them. Methods A mixed-method study was done at a rural medical college in southern Karnataka from October to December 2021. A quantitative method was used to assess perceptions and practices towards research through a cross-sectional survey. The questionnaire consisted of separate sections to gather information regarding the sociodemographic characteristics of the participants and their perceptions and practices regarding research among medical students. Focus group discussions (FGDs) were conducted to identify barriers to conducting research from the students' perspective. Results Of 575 participants, 40.9% of students had good knowledge, 50.8% had a favourable attitude, and 11.1% had satisfactory research practice. The MBBS phase of study and peer involvement in research were independent factors associated with students' research attitudes (p=0.04 and p=0.002, respectively). FGDs revealed that the lack of awareness and interest (24, 40%), lack of guidance (18, 30%), feasibility issues (12, 20%), and a rigid curriculum (6, 10%) were the barriers to research from the students' perspective. Conclusion Knowledge about research is not translated into practice due to certain barriers. Hence, students need to be equipped with skills to conduct and complete research projects independently. Institutions need to develop and implement effective strategies to promote research among undergraduates.

Background There is a paucity of newer studies focusing on survival patterns in the era of targeted pulmonary vasodilators in Eisenmenger syndrome (ES). We aimed to study the survival pattern, mortality predictors and outcome of targeted pulmonary vasodilator therapy in patients with ES. Methods This was a single-centre retrospective observational study of patients treated between January 2000 and January 2020. Consecutive patients with clinical and echo- cardiographic and/or cardiac catheterization diagnoses of ES were included in the study. Shunt types were classified into pre-tricuspid shunts, post-tricuspid shunts and complex lesions. Clinical outcomes and treatment data of all patients were assessed. Results Of 206 patients, 139 were female with a mean (SD) age of 23.4 (14.3) years. Pre-tricuspid shunts were the most common shunt type, with atrial septal defect being the most common anatomical defect. During a mean (SD) follow-up of 7.1 (6.2) years, a significant decline in mean resting systemic saturation and WHO functional class on follow-up was observed. Atrial arrhythmias and right ventricular dysfunction were the most common in pretricuspid shunt lesions. ES secondary to complex defects had the worst prognosis with early attrition. Survival patterns were equally poor in complex defects and pre-tricuspid defects after the onset of Eisenmenger physiology. Targeted pulmonary vasodilator therapy was associated with better survival, irrespective of monotherapy or dual therapy. Congestive heart failure was the most common cause of death. Survival at 5 and 10 years in the disease modifier treatment group was 84% and 69% while in the treatment naïve group was 66% and 44%. Resting systemic saturation <80% on follow-up, the presence of atrial arrhythmias and the absence of disease-targeted therapy were independently associated with mortality. Conclusion The long-term survival of patients with ES remains poor in the era of targeted pulmonary vasodilator therapy. ES resulting from complex cyanotic congenital heart diseases has the worst survival outcomes. Although pretricuspid shunt ES patients survived longer, they tended to decompensate at lower mean pulmonary artery pressure than all other subgroups with ES. Targeted pulmonary vasodilator therapy may be associated with improved functional class and survival benefits in ES.

Background A joint tuberculosis-tobacco collaborative was launched in India in 2017 to reduce the addictive habit of tobacco use among patients with tuberculosis (TB). We aimed to estimate the prevalence and predictors of smokeless tobacco use and its awareness among patients with pulmonary TB in Bhavnagar city, Gujarat, India. Methods We did a cross-sectional study among 258 randomly selected drug-sensitive pulmonary TB patients registered at the District TB Centre in Bhavnagar from April to October 2019. The Global Adult Tobacco Survey questionnaire was used for data collection. Multivariable logistic regression was used to determine the predictors of smokeless tobacco use. Results Among the 258 patients, 73% were male, 66% were married, 40% traveled for their occupation, 62% had a nuclear family, and 46% were illiterate. More than half (52%) the patients used smokeless tobacco: 44% were daily users and 8% were occasional users. On multivariable logistic regression, male gender (adjusted odds ratio [aOR]: 5 [95% confidence interval (CI) 2-11]), occupation requiring travel (aOR: 4 [95% CI: 2-7]), monthly income of ₹3001-6000 (aOR: 0.2 [95% CI: 0.1-0.6]), ₹9000-12 000 (aOR: 0.3 [95% CI: 0.1-0.9]) and above ₹12 000 (aOR: 0.3 [95% CI: 0.1-0.8]) were significant predictors of smokeless tobacco use. Almost all (98%) of the participants were aware of the harmful effects of smokeless tobacco on health. Conclusion More than half the patients with pulmonary TB used smokeless tobacco. The TB-tobacco collaborative framework needs to be strengthened with brief counselling interventions for patients with TB using smokeless tobacco for collateral benefits in the control of TB in India.

Background Medical research is the backbone of advances in medical technology. To decrease the deficit in the physician- scientist ratio in developing countries, initiatives are being taken to inspire medical students to pursue research careers. Hence, it is necessary to understand the attitudes of undergraduate (UG) medical students towards medical research. Methods This cross-sectional survey included 241 UG medical students of the 2016-17 academic year from the 1st, 2nd and 3rd years of a teaching institute and a tertiary care hospital. A pretested, structured questionnaire containing 25 items was used to capture the various dimensions of attitudes towards medical research, such as the importance of research, the scientific rigour of medical research, perceived personal benefits and difficulties, and motivators for pursuing research as a medical student. Results Of the 241 students, 20 (8.3%) had undertaken research during medical school, and 144 (60%) had a positive attitude with strong agreement on the statement 'Research discovery is essential for clinical care'. In exploratory factor analysis, 5 attitudes towards research were obtained: (i) Instrumental motivated attitude, (ii) externally motivated or forced attitude, (iii) positive attitude, (iv) negative attitude and (v) seriousness towards research. Conclusion UG medical students had a positive attitude towards the idea that 'research is essential for clinical care' and showed interest in attending training in research methodology.

Data on acute mesenteric ischaemia (AMI) in patients with Covid-19 are limited. We studied the clinical profile and outcome of patients presenting and treated for AMI and Covid-19 infection. This retrospective, observational study was done at a single tertiary care centre in India from May 2021 to April 2022. Ten patients (8 males; median age 57 years) with confirmed Covid-19 and AMI diagnosed on the basis of clinical and radiological criteria were included in the analysis. Associated comorbid conditions were present in 8 of 10 patients. The median interval from diagnosis of Covid-19 to onset of gastrointestinal symptoms was 11 days, with abdominal pain being the most common. Seven patients underwent surgical resection, while 3 patients were managed conservatively. Two patients were on antithrombotics before the development of AMI and had less severe involvement. Four patients died in hospital. AMI in Covid-19 infection is associated with morbidity and mortality. Previous antithrombotic use does not prevent the development of AMI but possibly reduces its severity.

A 61-year-old male presented with a history of fever and burning micturition for 1 week; 3 days after being started on nitrofurantoin 100 mg twice a day by a local practitioner, he developed rash over the body along with scrotal swelling and pain. Following admission to the local government hospital where he developed acute anterolateral myocardial infarction (MI), he was referred to our hospital. At admission, physical examination revealed reticular purpuric plaques with occasional ulceration over both lower limbs, upper limbs and abdomen with extensive scrotal purpura with necrosis. His pulse rate was 110/minute, oxygen saturation by pulse oximetry was 88% on ambient air and temperature was 101 °F. He was started on intravenous antibiotics and treatment for MI. Laboratory investigations revealed leucocytosis, thrombocytopenia, acute kidney injury and hepatic dysfunction. Scrotal ultrasound revealed epididymo-orchitis. The next day, the patient developed altered sensorium. Computed tomography of the brain showed an infarct in the right fronto-parietal region. Possibility of leukocytoclastic vasculitis (LCV) with systemic involvement as an adverse drug reaction to nitrofurantoin was considered; vasculitis-related blood work-up was inconclusive. Punch biopsy of the lesion showed LCV with subepidermal bulla formation. Patient was treated with intravenous corticosteroids (dexamethasone 8 mg thrice-daily), antibiotics and symptomatic management. He was discharged after 2 weeks on decreasing doses of corticosteroids.

Background Leave against medical advice (LAMA) is defined as a patient leaving the hospital against the doctor's advice, sometimes avoiding routine and potentially lifesaving procedures. The rate of LAMA can be a reflection of the effectiveness of communication, treatment and processes of the hospital. We aimed to identify the reasons for LAMA from an emergency department (ED) of a tertiary care hospital in New Delhi. Methods 400 consecutive patients going LAMA from the ED were enrolled in the study. Demographic data, triage category and reasons for LAMA were collected using questionnaires. Statistical analysis was performed and results analyzed. Results 103 (25.8%) patients went LAMA as they felt better after initial treatment and refused further in-hospital care. Other reasons for LAMA decisions included non-availability of intensive care unit (ICU) beds (82; 20.5%), financial constraints (69; 17.3%) and perceived risk of infection (59; 14.8%). Age, gender or triaging categories had no significant effect (p>0.05). Multiple logistic regression analysis revealed that the lack of health insurance and low family income were independent risk factors for LAMA decision. Conclusion In our study, the leading causes of LAMA were a patient feeling better after initial treatment, a lack of ICU beds, financial constraints and a perceived risk of infection.