Pub Date : 2023-01-01DOI: 10.4103/mgmj.mgmj_128_22
S. Sirajudeen, H. Chidambaram, M. Dominic, Pooja Thiyagarajan, Chanjal Sathyan, V. Jinka
Ratol is a rodenticide (rat killer paste) that contains yellow phosphorus, a dangerous toxin that harms the gastrointestinal, hepatic, cardiovascular, and renal systems both locally and systemically. The liver is one of these that is most frequently injured, and the most terrifying result is acute liver failure with coagulopathy. A 25-year-old male who is a known case of epilepsy and was on medication was brought to the Emergency Department by his mother with an alleged history of consuming approximately 15 g of Ratol paste mixed in water 5 days before presentation to our hospital at around 5 pm at his residence. The patient sustained nausea and vomiting during the following day of consumption and was treated for the same in a nearby hospital. The main element in lowering morbidity and death is the provision of effective and timely supportive care.
{"title":"A case of successfully treated self-ingested yellow phosphorous poisoning in a known case of epilepsy","authors":"S. Sirajudeen, H. Chidambaram, M. Dominic, Pooja Thiyagarajan, Chanjal Sathyan, V. Jinka","doi":"10.4103/mgmj.mgmj_128_22","DOIUrl":"https://doi.org/10.4103/mgmj.mgmj_128_22","url":null,"abstract":"Ratol is a rodenticide (rat killer paste) that contains yellow phosphorus, a dangerous toxin that harms the gastrointestinal, hepatic, cardiovascular, and renal systems both locally and systemically. The liver is one of these that is most frequently injured, and the most terrifying result is acute liver failure with coagulopathy. A 25-year-old male who is a known case of epilepsy and was on medication was brought to the Emergency Department by his mother with an alleged history of consuming approximately 15 g of Ratol paste mixed in water 5 days before presentation to our hospital at around 5 pm at his residence. The patient sustained nausea and vomiting during the following day of consumption and was treated for the same in a nearby hospital. The main element in lowering morbidity and death is the provision of effective and timely supportive care.","PeriodicalId":52587,"journal":{"name":"MGM Journal of Medical Sciences","volume":"10 1","pages":"146 - 148"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"48474056","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}
Abhinav Srivastava, Supriya Gupta, Amit Kumar, Nitesh Mohan
Background: Globally, tuberculosis is a prevalent disease, with an estimated 10.5 million cases. According to the World Health Organization, extrapulmonary tuberculosis, caused by Mycobacterium tuberculosis, affects tissues and organs outside the lungs and constitutes 20%–25% of all tuberculosis cases. The delayed diagnosis of this form of tuberculosis is expected due to challenges in obtaining representative samples and lower bacterial loads in the samples obtained. Despite the availability of various diagnostic tests, the current lack of a proper diagnostic algorithm poses a daily challenge for clinicians in accurately identifying extrapulmonary tuberculosis. Cartridge-based nucleic acid amplification test (CBNAAT) has emerged as a promising and faster option for diagnosis. In light of these issues, a study has been initiated to evaluate the manifestations of otorhinolaryngological tuberculosis and develop a protocol that enables early diagnosis of this specific form of extrapulmonary tuberculosis. The goal is to enhance the timely detection and management of otorhinolaryngological tuberculosis. Materials and Methods: During the study period, 39 samples were collected, and the research received ethical approval from the Institutional Ethics Committee. Results: Of the 39 cases examined, the sensitivity and specificity of CBNAAT were determined to be 78.3% and 100%, respectively. The positive predictive value (PPV) was also 100%, whereas the negative predictive value was 20%. Conclusion: For any suspected neck swelling indicative of tuberculosis, CBNAAT should be the primary investigation. It offers ease of use, delivers faster results within a few hours, and boasts a 100% PPV.
{"title":"Relevance of CBNAAT in the early diagnosis of suspected tubercular swelling","authors":"Abhinav Srivastava, Supriya Gupta, Amit Kumar, Nitesh Mohan","doi":"10.4103/mgmj.mgmj_87_23","DOIUrl":"https://doi.org/10.4103/mgmj.mgmj_87_23","url":null,"abstract":"Background: Globally, tuberculosis is a prevalent disease, with an estimated 10.5 million cases. According to the World Health Organization, extrapulmonary tuberculosis, caused by Mycobacterium tuberculosis, affects tissues and organs outside the lungs and constitutes 20%–25% of all tuberculosis cases. The delayed diagnosis of this form of tuberculosis is expected due to challenges in obtaining representative samples and lower bacterial loads in the samples obtained. Despite the availability of various diagnostic tests, the current lack of a proper diagnostic algorithm poses a daily challenge for clinicians in accurately identifying extrapulmonary tuberculosis. Cartridge-based nucleic acid amplification test (CBNAAT) has emerged as a promising and faster option for diagnosis. In light of these issues, a study has been initiated to evaluate the manifestations of otorhinolaryngological tuberculosis and develop a protocol that enables early diagnosis of this specific form of extrapulmonary tuberculosis. The goal is to enhance the timely detection and management of otorhinolaryngological tuberculosis. Materials and Methods: During the study period, 39 samples were collected, and the research received ethical approval from the Institutional Ethics Committee. Results: Of the 39 cases examined, the sensitivity and specificity of CBNAAT were determined to be 78.3% and 100%, respectively. The positive predictive value (PPV) was also 100%, whereas the negative predictive value was 20%. Conclusion: For any suspected neck swelling indicative of tuberculosis, CBNAAT should be the primary investigation. It offers ease of use, delivers faster results within a few hours, and boasts a 100% PPV.","PeriodicalId":52587,"journal":{"name":"MGM Journal of Medical Sciences","volume":"52 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136366650","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}
Background: The growing occurrence of antibiotic-resistant bacteria, especially those resistant to multiple drugs found in pyogenic infections, presents considerable challenges in effectively managing and curing these infections. Objective: This current research aimed to determine the prevalence of Gram-negative bacteria with multidrug resistance in cases of pyogenic infections treated at a tertiary care hospital located in Haryana, India. Materials and Methods: An observational cross-sectional investigation was conducted over 8 months, from June 2022 to January 2023, at a tertiary care hospital located in Haryana, India. Throughout the study, 376 samples of pus and wound swabs were gathered from patients visiting the outpatient and inpatient departments. Subsequently, specimens that exhibited noteworthy aerobic bacterial growth were identified following established bacterial testing procedures, and their antibiotic susceptibility profiles were determined using the Kirby-Bauer disc diffusion method. Results: Out of the total 376 collected pus and wound swab specimens (n = 376), significant aerobic bacterial growth was observed in 116 cases (30.9%), with 113 instances (97.4%) showing monomicrobial growth and the remaining three cases (2.6%) exhibiting polymicrobial growth. Consequently, a sum of 119 bacterial isolates was obtained, with 70 (58.8%) being Gram-negative bacilli (GNB) and 49 (41.2%) being Gram-positive cocci. Among the GNB isolates, 37 (52.9%) were identified as Gram-negative fermenters (belonging to the Enterobacteriaceae family), while the remainder were categorized as Gram-negative non-fermenters. The prevalent isolate was Pseudomonas aeruginosa, accounting for 42.9% of the cases, Escherichia coli at 25.7%, and Enterobacter species at 7.1%. Of these isolates, 31 (44.3%) were multidrug-resistant, 24 were Gram-negative fermenters, and seven were Gram-negative non-fermenters. Approximately three-quarters of the Enterobacteriaceae isolates showed potential for producing extended-spectrum β-lactamases, whereas a quarter exhibited potential for producing carbapenemases. Similarly, a quarter of the Gram-negative non-fermenters were identified as potential carbapenemase producers. Conclusion: The present study underscores the prevalence of multidrug-resistant strains within the pathogens, particularly among Enterobacteriaceae isolates responsible for pyogenic infections. Additionally, these findings will play a pivotal role in shaping a community-specific antimicrobial stewardship initiative, which stands as one of the most essential strategies for addressing the challenge of antimicrobial resistance.
{"title":"Prevalence of multidrug-resistant Gram-negative bacteria causing pyogenic infections at a tertiary care hospital in Haryana","authors":"LeimapokpamSumitra Devi, KeithellakpamDibiya Devi, Manisha Khandait, Mukesh Sharma, Moumita Sardar, Ashima Singh, Rituparna Saha","doi":"10.4103/mgmj.mgmj_66_23","DOIUrl":"https://doi.org/10.4103/mgmj.mgmj_66_23","url":null,"abstract":"Background: The growing occurrence of antibiotic-resistant bacteria, especially those resistant to multiple drugs found in pyogenic infections, presents considerable challenges in effectively managing and curing these infections. Objective: This current research aimed to determine the prevalence of Gram-negative bacteria with multidrug resistance in cases of pyogenic infections treated at a tertiary care hospital located in Haryana, India. Materials and Methods: An observational cross-sectional investigation was conducted over 8 months, from June 2022 to January 2023, at a tertiary care hospital located in Haryana, India. Throughout the study, 376 samples of pus and wound swabs were gathered from patients visiting the outpatient and inpatient departments. Subsequently, specimens that exhibited noteworthy aerobic bacterial growth were identified following established bacterial testing procedures, and their antibiotic susceptibility profiles were determined using the Kirby-Bauer disc diffusion method. Results: Out of the total 376 collected pus and wound swab specimens (n = 376), significant aerobic bacterial growth was observed in 116 cases (30.9%), with 113 instances (97.4%) showing monomicrobial growth and the remaining three cases (2.6%) exhibiting polymicrobial growth. Consequently, a sum of 119 bacterial isolates was obtained, with 70 (58.8%) being Gram-negative bacilli (GNB) and 49 (41.2%) being Gram-positive cocci. Among the GNB isolates, 37 (52.9%) were identified as Gram-negative fermenters (belonging to the Enterobacteriaceae family), while the remainder were categorized as Gram-negative non-fermenters. The prevalent isolate was Pseudomonas aeruginosa, accounting for 42.9% of the cases, Escherichia coli at 25.7%, and Enterobacter species at 7.1%. Of these isolates, 31 (44.3%) were multidrug-resistant, 24 were Gram-negative fermenters, and seven were Gram-negative non-fermenters. Approximately three-quarters of the Enterobacteriaceae isolates showed potential for producing extended-spectrum β-lactamases, whereas a quarter exhibited potential for producing carbapenemases. Similarly, a quarter of the Gram-negative non-fermenters were identified as potential carbapenemase producers. Conclusion: The present study underscores the prevalence of multidrug-resistant strains within the pathogens, particularly among Enterobacteriaceae isolates responsible for pyogenic infections. Additionally, these findings will play a pivotal role in shaping a community-specific antimicrobial stewardship initiative, which stands as one of the most essential strategies for addressing the challenge of antimicrobial resistance.","PeriodicalId":52587,"journal":{"name":"MGM Journal of Medical Sciences","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136368095","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}
This case report outlines the effect of a low-level laser therapy (LLLT) and exercise regimen on a 59-year-old patient with a venous ulcer. The current case examines the impact of a combination of LLLT and exercise on blood flow and healing in a patient with venous leg ulcer (VLU) brought on by ambulatory venous hypertension due to venous incompetence. Above the left lateral malleolus, the patient had a circular, well-defined raw area covered in pale granulation tissue that was not healing. Wound assessment was done using a two-dimensional method using graph paper. The patient received LLLT therapy and an aerobic exercise regimen, reducing wound size and improving healing. It demonstrates the potential advantages of using LLLT and aerobic exercise to treat venous ulcers.
{"title":"Effect of laser and exercises in venous ulcer: A case report","authors":"JeelM Jeevrajani, Dipmala Silajiya, Komal Shah, Megha Sheth","doi":"10.4103/mgmj.mgmj_84_23","DOIUrl":"https://doi.org/10.4103/mgmj.mgmj_84_23","url":null,"abstract":"This case report outlines the effect of a low-level laser therapy (LLLT) and exercise regimen on a 59-year-old patient with a venous ulcer. The current case examines the impact of a combination of LLLT and exercise on blood flow and healing in a patient with venous leg ulcer (VLU) brought on by ambulatory venous hypertension due to venous incompetence. Above the left lateral malleolus, the patient had a circular, well-defined raw area covered in pale granulation tissue that was not healing. Wound assessment was done using a two-dimensional method using graph paper. The patient received LLLT therapy and an aerobic exercise regimen, reducing wound size and improving healing. It demonstrates the potential advantages of using LLLT and aerobic exercise to treat venous ulcers.","PeriodicalId":52587,"journal":{"name":"MGM Journal of Medical Sciences","volume":"68 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136368103","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}
Globally, vaccines against 47 infectious etiologic agents are approved by at least one regulatory authority as of December 2022. The numbers of viral diseases, infections caused by mycoplasma, bacterial and protozoal diseases, mycoses, diseases caused by parasitic worms, and other infectious diseases of unknown etiology run into thousands. Therefore, more vaccines are required to be developed to keep more populations disease free. Climate change and global increase in temperature may promote sea level rises and an increase in the intensity of rains, causing an upsurge in certain infectious diseases in regions of the human population and even causing movement of habitats. In societies where the expenditure on health as a percentage of gross domestic product is higher, people are more capacitated to tackle the treatment and spread of infectious diseases. As several of such conditions are zoonotic, well-planned strategies for controlling the spread would go a long way in the proper direction. Poverty and contagious diseases are infallibly linked. Major infectious diseases of poverty include tuberculosis, human immunodeficiency virus (HIV)/ acquired immuno deficiency syndrome (AIDS), malaria, measles, pneumonia, diarrheal diseases, and several neglected tropical diseases. The world is not yet unified in action to jointly work to contain the global problem of infectious diseases in every human habitat. There was a visible divide between and among the rich countries versus the developing countries regarding accessibility and deployment of vaccines against COVID-19 flu. To contain the spread of infectious diseases in the future, the whole world would have to work together, raising funds, strengthening epidemiological surveys, inventing effective vaccines, and vaccinating the eligible population, as also treating the infected with therapy in time, besides resorting to other preventive measures for overall human progress. The developmental efforts are to be pursued jointly and together to benefit all people, respecting the world as one.
{"title":"Infectious human diseases: Regions, habitats, threats, and mitigation strategies: The issues—Part II","authors":"P. Khandekar, P. Ghosh","doi":"10.4103/mgmj.mgmj_16_23","DOIUrl":"https://doi.org/10.4103/mgmj.mgmj_16_23","url":null,"abstract":"Globally, vaccines against 47 infectious etiologic agents are approved by at least one regulatory authority as of December 2022. The numbers of viral diseases, infections caused by mycoplasma, bacterial and protozoal diseases, mycoses, diseases caused by parasitic worms, and other infectious diseases of unknown etiology run into thousands. Therefore, more vaccines are required to be developed to keep more populations disease free. Climate change and global increase in temperature may promote sea level rises and an increase in the intensity of rains, causing an upsurge in certain infectious diseases in regions of the human population and even causing movement of habitats. In societies where the expenditure on health as a percentage of gross domestic product is higher, people are more capacitated to tackle the treatment and spread of infectious diseases. As several of such conditions are zoonotic, well-planned strategies for controlling the spread would go a long way in the proper direction. Poverty and contagious diseases are infallibly linked. Major infectious diseases of poverty include tuberculosis, human immunodeficiency virus (HIV)/ acquired immuno deficiency syndrome (AIDS), malaria, measles, pneumonia, diarrheal diseases, and several neglected tropical diseases. The world is not yet unified in action to jointly work to contain the global problem of infectious diseases in every human habitat. There was a visible divide between and among the rich countries versus the developing countries regarding accessibility and deployment of vaccines against COVID-19 flu. To contain the spread of infectious diseases in the future, the whole world would have to work together, raising funds, strengthening epidemiological surveys, inventing effective vaccines, and vaccinating the eligible population, as also treating the infected with therapy in time, besides resorting to other preventive measures for overall human progress. The developmental efforts are to be pursued jointly and together to benefit all people, respecting the world as one.","PeriodicalId":52587,"journal":{"name":"MGM Journal of Medical Sciences","volume":"10 1","pages":"116 - 125"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"46307010","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}
Pub Date : 2023-01-01DOI: 10.4103/mgmj.mgmj_186_22
M Ramya Sree, Himabindu Kolli, Bagavathiammal Periyasamy, V Praveen
Introduction: Gastro-esophageal reflux disease (GERD) is a condition characterized by the reflux of stomach contents into the esophagus, causing unpleasant symptoms and/or consequences like heartburn and acid regurgitation. GERD in the student stages can hurt their quality of life, college attendance, everyday activities, and overall well-being of the individual. Materials and Methods: This is a cross-sectional study that was conducted among medical students of a tertiary care setting from August 2021 to October 2021 for a three-month duration. A convenient sample of 458 participants from all the years of MBBS was included in this study. Results: A total of 458 medical students were made part of this study of which most of them (58.9%) were females and 41.1% were males. The average age among the study participants was 22 ± 2.3 years (range of 18–27 years). The average BMI of the individuals was 23.48 (range 14.58–32.41), with the majority (54.8%) of them having a normal BMI. Discussion: In our study, we found that the prevalence of GERD in the medical students of a rural Indian tertiary care setting was 24.2%, and was observed that irregular meal timings and consuming coffee and soft drinks are the crucial risk factors for developing GERD in the medical students in comparison to the general population. Conclusion: Medical students should be trained on proper eating habits, maintaining ideal body weight, good sleep hygiene, and avoiding drinking alcohol and smoking to lessen the burden of GERD.
{"title":"A cross-sectional study to evaluate the prevalence and risk factors of gastro-esophageal reflux disease among the undergraduate medical students of a tertiary-care Indian setting","authors":"M Ramya Sree, Himabindu Kolli, Bagavathiammal Periyasamy, V Praveen","doi":"10.4103/mgmj.mgmj_186_22","DOIUrl":"https://doi.org/10.4103/mgmj.mgmj_186_22","url":null,"abstract":"Introduction: Gastro-esophageal reflux disease (GERD) is a condition characterized by the reflux of stomach contents into the esophagus, causing unpleasant symptoms and/or consequences like heartburn and acid regurgitation. GERD in the student stages can hurt their quality of life, college attendance, everyday activities, and overall well-being of the individual. Materials and Methods: This is a cross-sectional study that was conducted among medical students of a tertiary care setting from August 2021 to October 2021 for a three-month duration. A convenient sample of 458 participants from all the years of MBBS was included in this study. Results: A total of 458 medical students were made part of this study of which most of them (58.9%) were females and 41.1% were males. The average age among the study participants was 22 ± 2.3 years (range of 18–27 years). The average BMI of the individuals was 23.48 (range 14.58–32.41), with the majority (54.8%) of them having a normal BMI. Discussion: In our study, we found that the prevalence of GERD in the medical students of a rural Indian tertiary care setting was 24.2%, and was observed that irregular meal timings and consuming coffee and soft drinks are the crucial risk factors for developing GERD in the medical students in comparison to the general population. Conclusion: Medical students should be trained on proper eating habits, maintaining ideal body weight, good sleep hygiene, and avoiding drinking alcohol and smoking to lessen the burden of GERD.","PeriodicalId":52587,"journal":{"name":"MGM Journal of Medical Sciences","volume":"36 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135585549","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}
Introduction: Alzheimer’s disease (AD) is a neurodegenerative condition that impairs activities of daily living and sharply declines gross cognitive ability. Over 152 million individuals worldwide will live with the dreaded consequence of a longer lifespan by the year 2050, making it a pressing public health issue. Magnetic resonance imaging (MRI) provides excellent soft tissue contrast and helps image the brain in vivo, non-invasively. Aims and Objectives: To summarize AD’s anatomical, physiological, and pathophysiological changes and derivation of quantifiable biomarkers from MRI to develop artificial intelligence (AI) based computer-aided detection (CAD) system to classify subjects among AD, mild cognitive impairment (MCI), and cognitively normal (CN). Materials and Methods: This retrospective study uses clinical and standardized, pre-processed, quality-controlled, and quality-checked—structural MRI imaging (diagnosed/labeled) data of 1069 subjects, age, gender, and class matched, taken from Alzheimer’s disease neuroimaging initiative. A pipeline is developed to get quantified biomarkers from the assessment of (1) cortical thickness, (2) volumetric segmentation for whole brain volumes, and (3) region of interest (ROI) areas most affected in AD. A gradient boosting method is used to predict class labels. The second approach implements a convolution neural network (CNN) model comprising 3D ROI. Results: Implemented CAD system using an ensemble gradient boosting approach has demonstrated good receiver operating characteristics characteristic and yielded balanced accuracy (BA) of 82.31%, 78.52%, and 72.73%, and the CNN approach has given better results 88.44%, 82.96%, and 74.34% for classification task AD versus CN, AD versus MCI, and MCI versus CN, respectively. Conclusion: This study has used a substantially large dataset of 1069 subjects. The deep learning-based efficient and optimal CNN model has used significantly large ROI-based 3-Dimentional volume, resulting in impressive performance improvements over comparable methods. The CNN model had given higher accuracy (6.13% for AD vs. CN, 4.44% for AD vs. MCI and 1.61% for MCI vs. CN) over gradient boosting, as the model uses significantly large ROI-based 3D brain volume and an inherent capability of it in learning most discriminative features automatically. However, quantitative biomarkers derived from brain morphometry, which accesses structural changes, yield reasonable estimates over pathophysiological alterations across the brain and augment a clinician with insightful and a holistic view, resulting in higher confidence over predicated class label by CNN and is a step closer to explainable AI. Accuracy for MCI versus CN drops as these classes share similar features and characteristics and can be improved by integrating biomarkers from other MRI modalities.
简介:阿尔茨海默病(AD)是一种神经退行性疾病，损害日常生活活动并急剧下降总体认知能力。到2050年，全世界将有超过1.52亿人面临寿命延长的可怕后果，使其成为一个紧迫的公共卫生问题。磁共振成像(MRI)提供了出色的软组织对比，并有助于在体内无创地成像大脑。目的和目的:总结AD的解剖、生理和病理生理变化，并从MRI中获得可量化的生物标志物，开发基于人工智能(AI)的计算机辅助检测(CAD)系统，将AD、轻度认知障碍(MCI)和认知正常(CN)的受试者进行分类。材料和方法:本回顾性研究使用1069名受试者的临床和标准化、预处理、质量控制和质量检查的结构MRI成像(诊断/标记)数据，这些数据来自阿尔茨海默病神经影像学倡议，年龄、性别和类别匹配。通过评估(1)皮质厚度，(2)全脑体积分割，以及(3)AD中受影响最大的感兴趣区域(ROI)，开发了一种方法来获得量化的生物标志物。使用梯度增强方法来预测类标签。第二种方法实现了包含三维ROI的卷积神经网络(CNN)模型。结果:采用集成梯度增强方法实现的CAD系统显示出良好的接收机工作特性特征，平衡精度(BA)分别为82.31%、78.52%和72.73%，而CNN方法在分类任务AD vs CN、AD vs MCI和MCI vs CN上分别取得了88.44%、82.96%和74.34%的更好结果。结论:本研究使用了1069名受试者的大量数据集。基于深度学习的高效和最优CNN模型使用了非常大的基于roi的三维体积，与同类方法相比，性能有了令人印象深刻的提高。CNN模型在梯度增强上给出了更高的准确率(AD vs. CN为6.13%，AD vs. MCI为4.44%，MCI vs. CN为1.61%)，因为该模型使用了非常大的基于roi的3D脑容量，并且它具有自动学习大多数判别特征的固有能力。然而，来自大脑形态测量学的定量生物标志物，可以获得结构变化，对整个大脑的病理生理变化产生合理的估计，并增强临床医生的洞察力和整体观点，从而比CNN预测的类别标签具有更高的置信度，并且更接近可解释的人工智能。MCI与CN的准确性下降，因为这些类别具有相似的特征和特征，可以通过整合其他MRI模式的生物标志物来提高。
{"title":"Ensemble method employing quantitative biomarkers and deep learning approach from structural magnetic resonance imaging to diagnose Alzheimer’s disease","authors":"HiteshB Shah, ChintanR Varnagar","doi":"10.4103/mgmj.mgmj_53_23","DOIUrl":"https://doi.org/10.4103/mgmj.mgmj_53_23","url":null,"abstract":"Introduction: Alzheimer’s disease (AD) is a neurodegenerative condition that impairs activities of daily living and sharply declines gross cognitive ability. Over 152 million individuals worldwide will live with the dreaded consequence of a longer lifespan by the year 2050, making it a pressing public health issue. Magnetic resonance imaging (MRI) provides excellent soft tissue contrast and helps image the brain in vivo, non-invasively. Aims and Objectives: To summarize AD’s anatomical, physiological, and pathophysiological changes and derivation of quantifiable biomarkers from MRI to develop artificial intelligence (AI) based computer-aided detection (CAD) system to classify subjects among AD, mild cognitive impairment (MCI), and cognitively normal (CN). Materials and Methods: This retrospective study uses clinical and standardized, pre-processed, quality-controlled, and quality-checked—structural MRI imaging (diagnosed/labeled) data of 1069 subjects, age, gender, and class matched, taken from Alzheimer’s disease neuroimaging initiative. A pipeline is developed to get quantified biomarkers from the assessment of (1) cortical thickness, (2) volumetric segmentation for whole brain volumes, and (3) region of interest (ROI) areas most affected in AD. A gradient boosting method is used to predict class labels. The second approach implements a convolution neural network (CNN) model comprising 3D ROI. Results: Implemented CAD system using an ensemble gradient boosting approach has demonstrated good receiver operating characteristics characteristic and yielded balanced accuracy (BA) of 82.31%, 78.52%, and 72.73%, and the CNN approach has given better results 88.44%, 82.96%, and 74.34% for classification task AD versus CN, AD versus MCI, and MCI versus CN, respectively. Conclusion: This study has used a substantially large dataset of 1069 subjects. The deep learning-based efficient and optimal CNN model has used significantly large ROI-based 3-Dimentional volume, resulting in impressive performance improvements over comparable methods. The CNN model had given higher accuracy (6.13% for AD vs. CN, 4.44% for AD vs. MCI and 1.61% for MCI vs. CN) over gradient boosting, as the model uses significantly large ROI-based 3D brain volume and an inherent capability of it in learning most discriminative features automatically. However, quantitative biomarkers derived from brain morphometry, which accesses structural changes, yield reasonable estimates over pathophysiological alterations across the brain and augment a clinician with insightful and a holistic view, resulting in higher confidence over predicated class label by CNN and is a step closer to explainable AI. Accuracy for MCI versus CN drops as these classes share similar features and characteristics and can be improved by integrating biomarkers from other MRI modalities.","PeriodicalId":52587,"journal":{"name":"MGM Journal of Medical Sciences","volume":"141 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136366371","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}
Background: Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in intensive care units (ICUs), with high mortality and morbidity rates. Multidrug-resistant pathogens such as Klebsiella pneumoniae and Acinetobacter spp. generally cause VAP. Following an outbreak of VAP due to Klebsiella pneumonia in the trauma ICU (TICU), aggressive infection control practices and effective interventions were instituted to reduce the infection. We summarize the timely implementation and changes in infection control practices that helped reduce VAP incidence in an ICU. Materials and Methods: An intervention was done in the form of the implementation of infection control practices, training of healthcare workers (HCWs), and auditing of practices. Data were collected, and VAP rates were calculated pre- and postintervention. Results: Twenty-four VAP cases/1000 ventilator days due to multidrug-resistant Klebsiella pneumoniae were identified in April–May 2019. After the intervention in the form of training and auditing, there was a change in the behavior of healthcare workers. The hand hygiene compliance rate improved from 33% to 74%. Overall bundle adherence rate in the study period was 62.5%, with semirecumbent position (head end elevation) achieved in 95%, administration of deep vein thrombosis prophylaxis in 56%, peptic ulcer prophylaxis in more than 90% of patients, and daily oral care was achieved in 96% patients. Their VAP rate decreased to 8 cases/1000 ventilator days in June and July 2019 from 24/1000 ventilator days in April–May 2019. The difference was statistically significant (P < 0.05). Conclusions: The VAP rates in TICUs were reduced by strengthening basic infection control practices.
{"title":"Role of basic infection control practices to curtail the outbreak of ventilator-associated pneumonia caused by Klebsiella pneumoniae in a tertiary care hospital’s trauma intensive care unit","authors":"Swati Mudshingkar, Ashwini Dedwal, Rajesh Karyakarte","doi":"10.4103/mgmj.mgmj_51_23","DOIUrl":"https://doi.org/10.4103/mgmj.mgmj_51_23","url":null,"abstract":"Background: Ventilator-associated pneumonia (VAP) is the most common hospital-acquired infection in intensive care units (ICUs), with high mortality and morbidity rates. Multidrug-resistant pathogens such as Klebsiella pneumoniae and Acinetobacter spp. generally cause VAP. Following an outbreak of VAP due to Klebsiella pneumonia in the trauma ICU (TICU), aggressive infection control practices and effective interventions were instituted to reduce the infection. We summarize the timely implementation and changes in infection control practices that helped reduce VAP incidence in an ICU. Materials and Methods: An intervention was done in the form of the implementation of infection control practices, training of healthcare workers (HCWs), and auditing of practices. Data were collected, and VAP rates were calculated pre- and postintervention. Results: Twenty-four VAP cases/1000 ventilator days due to multidrug-resistant Klebsiella pneumoniae were identified in April–May 2019. After the intervention in the form of training and auditing, there was a change in the behavior of healthcare workers. The hand hygiene compliance rate improved from 33% to 74%. Overall bundle adherence rate in the study period was 62.5%, with semirecumbent position (head end elevation) achieved in 95%, administration of deep vein thrombosis prophylaxis in 56%, peptic ulcer prophylaxis in more than 90% of patients, and daily oral care was achieved in 96% patients. Their VAP rate decreased to 8 cases/1000 ventilator days in June and July 2019 from 24/1000 ventilator days in April–May 2019. The difference was statistically significant (P < 0.05). Conclusions: The VAP rates in TICUs were reduced by strengthening basic infection control practices.","PeriodicalId":52587,"journal":{"name":"MGM Journal of Medical Sciences","volume":"71 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136366974","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}
Background: Globally, uterine corpus tumors significantly increase women’s mortality and morbidity. Histopathological examination plays a crucial role in effectively managing patients with these tumors. Aims: This study aims to explore uterine tumors and tumor-like lesions, with a secondary objective specifically focusing on categorizing their histopathological characteristics using the 2020 World Health Organization classification of uterine corpus tumors. Moreover, the study seeks to analyze the clinical parameters of patients afflicted by these tumors and tumor-like lesions to discover possible correlations between histopathological findings and clinical features. Materials and Methods: A study involving a retrospective and prospective analysis over 3.5 years, encompassing 430 cases of histopathologically confirmed uterine corpus tumors and tumor-like lesions. Results: The tumors and tumor-like lesions in our study were classified into three main categories: benign tumors (95.2%), which were the most prevalent; malignant tumors (4.5%); and borderline tumors (0.3%). Among the benign tumors, leiomyoma was the most common, accounting for 91.1% of cases, with intramural leiomyomas being the most prevalent subtype at 60.2%. Most of the patients diagnosed with these tumors were multiparous female patients (95.6%), aged between the fourth and fifth decades of life (80%), and commonly presented with menorrhagia (42.5%). Hyalinization was the most frequently observed secondary change (24.2%), and cellular leiomyoma was the most common histological variant (N = 4). Endometrial carcinoma was the sole type identified in our study for malignant tumors. These patients were mainly in the age group of 60–69 years (47%), multiparous (88.2%), and presented with post-menopausal bleeding (41.2%). Grade I endometrioid carcinoma was the predominant histopathological type, accounting for 88.2% of the malignant cases. Among the other lesions identified in our study, there was one case of STUMP (smooth muscle tumor of uncertain malignant potential) and 15 cases of adenomyoma. Endometrial polyp (N = 57, 95%) was the most common type among the tumor-like lesions. In their fifth decade, these polyps were predominantly found in multiparous female patients (N = 50, 87.7%). Menorrhagia was the most common presentation; most polyps were solitary and sessile. Additionally, we observed a single case of papillary proliferation of the endometrium with mucinous, ciliated, and clear cell metaplasia without any atypia and two instances of Arias-Stella reaction. Conclusion: Benign tumors were more common than malignant tumors in the uterine corpus. Among these, leiomyoma was the most frequently observed benign lesion, whereas endometrial carcinomas were the predominant malignant lesions. It is essential to emphasize that certain specific lesions, such as endometrial polyps, metaplasia, and Arias-Stella reaction, can mimic malignant tumors even upon careful histopathological examinat
{"title":"Uterine corpus tumors and tumor-like lesions: A clinicopathological evaluation of 430 patients","authors":"AshishS Kawthalkar, AmitkumarB Pandav, YasminA Momin","doi":"10.4103/mgmj.mgmj_96_23","DOIUrl":"https://doi.org/10.4103/mgmj.mgmj_96_23","url":null,"abstract":"Background: Globally, uterine corpus tumors significantly increase women’s mortality and morbidity. Histopathological examination plays a crucial role in effectively managing patients with these tumors. Aims: This study aims to explore uterine tumors and tumor-like lesions, with a secondary objective specifically focusing on categorizing their histopathological characteristics using the 2020 World Health Organization classification of uterine corpus tumors. Moreover, the study seeks to analyze the clinical parameters of patients afflicted by these tumors and tumor-like lesions to discover possible correlations between histopathological findings and clinical features. Materials and Methods: A study involving a retrospective and prospective analysis over 3.5 years, encompassing 430 cases of histopathologically confirmed uterine corpus tumors and tumor-like lesions. Results: The tumors and tumor-like lesions in our study were classified into three main categories: benign tumors (95.2%), which were the most prevalent; malignant tumors (4.5%); and borderline tumors (0.3%). Among the benign tumors, leiomyoma was the most common, accounting for 91.1% of cases, with intramural leiomyomas being the most prevalent subtype at 60.2%. Most of the patients diagnosed with these tumors were multiparous female patients (95.6%), aged between the fourth and fifth decades of life (80%), and commonly presented with menorrhagia (42.5%). Hyalinization was the most frequently observed secondary change (24.2%), and cellular leiomyoma was the most common histological variant (N = 4). Endometrial carcinoma was the sole type identified in our study for malignant tumors. These patients were mainly in the age group of 60–69 years (47%), multiparous (88.2%), and presented with post-menopausal bleeding (41.2%). Grade I endometrioid carcinoma was the predominant histopathological type, accounting for 88.2% of the malignant cases. Among the other lesions identified in our study, there was one case of STUMP (smooth muscle tumor of uncertain malignant potential) and 15 cases of adenomyoma. Endometrial polyp (N = 57, 95%) was the most common type among the tumor-like lesions. In their fifth decade, these polyps were predominantly found in multiparous female patients (N = 50, 87.7%). Menorrhagia was the most common presentation; most polyps were solitary and sessile. Additionally, we observed a single case of papillary proliferation of the endometrium with mucinous, ciliated, and clear cell metaplasia without any atypia and two instances of Arias-Stella reaction. Conclusion: Benign tumors were more common than malignant tumors in the uterine corpus. Among these, leiomyoma was the most frequently observed benign lesion, whereas endometrial carcinomas were the predominant malignant lesions. It is essential to emphasize that certain specific lesions, such as endometrial polyps, metaplasia, and Arias-Stella reaction, can mimic malignant tumors even upon careful histopathological examinat","PeriodicalId":52587,"journal":{"name":"MGM Journal of Medical Sciences","volume":"21 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136367221","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}
Introduction: Thyroid fine-needle aspiration cytology (FNAC) has gained significance as a quick, safe, and relatively simple method to differentiate malignant from benign thyroid nodules and is regarded as the gold-standard first-line diagnostic test in the evaluation of thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) established a standardized, category-based reporting system for thyroid FNAC with each category having an implied cancer risk. However, the optimal management of thyroid nodules in the Bethesda III and IV categories is controversial, given the variable malignancy rates. Aims/Objectives: (1) Analysis of the cytomorphological characteristics of patients with categories III and IV of “TBSRTC.” (2) Assessment of risk of malignancy of TBSRTC category III, IV, and substratification of TBSRTC category III. Materials and Methods: A retrospective and prospective study of cases categorized under TBSRTC as category III and IV at a tertiary-care center. Cytological along with their histological results were compared. Results: We identified an overall malignancy rate of 33% for nodules belonging to Bethesda category III and a malignancy rate between 19% and 33% for Bethesda category IV. Also, a significantly higher risk of malignancy in subcategories with nuclear and architectural atypia (66.6%) than only architectural atypia (28.7%). Conclusion: Although surgery is recommended in most of these cases, cytomorphology helps to predict the final histopathological findings with greater accuracy. Substratification of category III into subgroups may help reduce the heterogeneity of the atypia of undetermined significance/follicular lesion of undetermined significance category and more.
{"title":"Risk of malignancy in thyroid nodules classified as Bethesda categories III, III - subcategories and IV: 2.5 years study","authors":"A. Ilyas, Nilam More, L. Naik","doi":"10.4103/mgmj.mgmj_36_23","DOIUrl":"https://doi.org/10.4103/mgmj.mgmj_36_23","url":null,"abstract":"Introduction: Thyroid fine-needle aspiration cytology (FNAC) has gained significance as a quick, safe, and relatively simple method to differentiate malignant from benign thyroid nodules and is regarded as the gold-standard first-line diagnostic test in the evaluation of thyroid nodules. The Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) established a standardized, category-based reporting system for thyroid FNAC with each category having an implied cancer risk. However, the optimal management of thyroid nodules in the Bethesda III and IV categories is controversial, given the variable malignancy rates. Aims/Objectives: (1) Analysis of the cytomorphological characteristics of patients with categories III and IV of “TBSRTC.” (2) Assessment of risk of malignancy of TBSRTC category III, IV, and substratification of TBSRTC category III. Materials and Methods: A retrospective and prospective study of cases categorized under TBSRTC as category III and IV at a tertiary-care center. Cytological along with their histological results were compared. Results: We identified an overall malignancy rate of 33% for nodules belonging to Bethesda category III and a malignancy rate between 19% and 33% for Bethesda category IV. Also, a significantly higher risk of malignancy in subcategories with nuclear and architectural atypia (66.6%) than only architectural atypia (28.7%). Conclusion: Although surgery is recommended in most of these cases, cytomorphology helps to predict the final histopathological findings with greater accuracy. Substratification of category III into subgroups may help reduce the heterogeneity of the atypia of undetermined significance/follicular lesion of undetermined significance category and more.","PeriodicalId":52587,"journal":{"name":"MGM Journal of Medical Sciences","volume":"10 1","pages":"12 - 17"},"PeriodicalIF":0.0,"publicationDate":"2023-01-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"43361259","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}
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