KFibi Ninan, R. Iyadurai, Justin K Varghese, JJonathan Arul Jeevan, Karthik Gunasekaran, R. Karuppusami, B. Chacko, K. Johnson, Amit Mandal, NivinStanley David
Background: COVID-19 acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality. Identification of clinical prognostic factors at admission is crucial in the triage and therapeutic selection of patients in resource-poor settings. The study was done to identify clinical parameters at admission to prognosticate patients who required intensive care unit (ICU) admission. Methods: In this retrospective study, the clinical parameters and outcomes of critically ill patients admitted from a single medical unit during the second wave of COVID-19 were studied. Patients were categorized as survivors and nonsurvivors. Factors associated with mortality were explored using Fisher's exact and t-test as appropriate. Results: The study population included 62 patients with a male: female ratio of 43 (69.3%):19 (30.7%) with a mean (standard deviation [SD]) age of 50.97 (±9.9) years. The mean (SD) O2 saturation was 82% (±10%) and median (interquartile range) PaO2/FiO2 ratio was 161 (89–214) on arrival to the emergency department. Forty-two (66%) required mechanical ventilation and the mean (SD) duration of hospital stay was 20 (±15) days. Thirty-six patients died, and the overall mortality was 58.1%. Increasing age, low SpO2 at presentation to the hospital, and need for mechanical ventilation were noted to be independent predictors of mortality with an odds ratio of 5.1 (95% confidence interval) (1.61–16.2) (P = 0.006) and 25 (3.70–180.19) (P = 0.001), respectively. Admission respiratory rate >36/min (P = 0.009) and SpO2 ≤83% (P = 0.001) were predictive of increased mortality among ICU patients. Conclusion: Low SpO2 at presentation (<83%), high respiratory rate (>36/min), and requirement of mechanical ventilation were strong predictors of mortality in patients admitted to ICU with COVID-19 ARDS.
{"title":"Can clinical parameters at admission predict severity and intensive care unit mortality outcomes in patients with COVID-19?","authors":"KFibi Ninan, R. Iyadurai, Justin K Varghese, JJonathan Arul Jeevan, Karthik Gunasekaran, R. Karuppusami, B. Chacko, K. Johnson, Amit Mandal, NivinStanley David","doi":"10.4103/cmi.cmi_6_23","DOIUrl":"https://doi.org/10.4103/cmi.cmi_6_23","url":null,"abstract":"Background: COVID-19 acute respiratory distress syndrome (ARDS) is associated with high morbidity and mortality. Identification of clinical prognostic factors at admission is crucial in the triage and therapeutic selection of patients in resource-poor settings. The study was done to identify clinical parameters at admission to prognosticate patients who required intensive care unit (ICU) admission. Methods: In this retrospective study, the clinical parameters and outcomes of critically ill patients admitted from a single medical unit during the second wave of COVID-19 were studied. Patients were categorized as survivors and nonsurvivors. Factors associated with mortality were explored using Fisher's exact and t-test as appropriate. Results: The study population included 62 patients with a male: female ratio of 43 (69.3%):19 (30.7%) with a mean (standard deviation [SD]) age of 50.97 (±9.9) years. The mean (SD) O2 saturation was 82% (±10%) and median (interquartile range) PaO2/FiO2 ratio was 161 (89–214) on arrival to the emergency department. Forty-two (66%) required mechanical ventilation and the mean (SD) duration of hospital stay was 20 (±15) days. Thirty-six patients died, and the overall mortality was 58.1%. Increasing age, low SpO2 at presentation to the hospital, and need for mechanical ventilation were noted to be independent predictors of mortality with an odds ratio of 5.1 (95% confidence interval) (1.61–16.2) (P = 0.006) and 25 (3.70–180.19) (P = 0.001), respectively. Admission respiratory rate >36/min (P = 0.009) and SpO2 ≤83% (P = 0.001) were predictive of increased mortality among ICU patients. Conclusion: Low SpO2 at presentation (<83%), high respiratory rate (>36/min), and requirement of mechanical ventilation were strong predictors of mortality in patients admitted to ICU with COVID-19 ARDS.","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"14 1","pages":"168 - 173"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"84919132","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}
Program evaluation is a must for medical education programs and requires the involvement of all the concerned stakeholders. It is important to note that the general aim behind any educational program is to look for a change, and thus, program evaluation should look to identify whether the change has occurred or not. In fact, a systematically performed program evaluation provides the organizers with the desired evidence about the quality of the program, accountability, and its sustainability. In conclusion, the program evaluation in the field of medical education is a vital cog in the entire cycle of development and implementation. Thus, it is extremely important to give due attention to the evaluation component and develop the framework for the same right at the time of the planning phase of the program.
{"title":"Program evaluation in the field of medical education: Need and approaches","authors":"S. Shrivastava, P. Shrivastava","doi":"10.4103/cmi.cmi_31_23","DOIUrl":"https://doi.org/10.4103/cmi.cmi_31_23","url":null,"abstract":"Program evaluation is a must for medical education programs and requires the involvement of all the concerned stakeholders. It is important to note that the general aim behind any educational program is to look for a change, and thus, program evaluation should look to identify whether the change has occurred or not. In fact, a systematically performed program evaluation provides the organizers with the desired evidence about the quality of the program, accountability, and its sustainability. In conclusion, the program evaluation in the field of medical education is a vital cog in the entire cycle of development and implementation. Thus, it is extremely important to give due attention to the evaluation component and develop the framework for the same right at the time of the planning phase of the program.","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"4 1","pages":"181 - 182"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"75514306","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: Diagnostic and management challenges with unpredictable angiographic presentations are encountered in left main coronary artery disease (LMCAD) patients. Therefore, this study was designed to evaluate the prevalence, risk factors, angiographic profile, and outcomes associated with LMCAD at 6-month follow-up. Materials and Methods: This was a prospective observational study where a total of 1474 patients undergoing coronary angiography were enrolled between March 2018 and August 2019. Demographic details, physical examination, and routine biochemical investigations were reported. Obstructive LMCAD patients were managed either with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) according to syntax score, and outcomes were recorded at 6-month follow-up. Results: The mean age of the overall study population (1474 patients) was 59 ± 8.1 years with male 959 (65%) preponderance. Obstructive LMCAD was observed in 103 (6%) patients. Smoking was the prime risk factor associated with obstructive LMCAD observed among 58 (56%) patients followed by hypertension in 45 (43%), dyslipidemia in 42 (40%), obesity in 26 (25%), and diabetes mellitus in 23 (22%) patients. Among 41 (40%) obstructive LMCAD patients, non-ST-elevation myocardial infarction/unstable angina was the major presentation. The majorly affected target vessels were left anterior descending artery (100%) and left circumflex artery (80%) among 103 and 83 patients, respectively. Triple-vessel disease was predominantly observed among 63 (62%) obstructive LMCAD patients. PCI and CABG were performed in 19 (18.4%) and 27 (26.2%) patients with a mean syntax score of 20 and 31, respectively. Conclusion: Smoking, advanced age, diabetes, and dyslipidemia were significantly associated risk factors of LMCAD.
{"title":"Assessment of risk factors and angiographic profile in left main coronary artery disease: An observational study","authors":"R. Singh, A. Kandoria, P. Negi","doi":"10.4103/cmi.cmi_127_22","DOIUrl":"https://doi.org/10.4103/cmi.cmi_127_22","url":null,"abstract":"Background: Diagnostic and management challenges with unpredictable angiographic presentations are encountered in left main coronary artery disease (LMCAD) patients. Therefore, this study was designed to evaluate the prevalence, risk factors, angiographic profile, and outcomes associated with LMCAD at 6-month follow-up. Materials and Methods: This was a prospective observational study where a total of 1474 patients undergoing coronary angiography were enrolled between March 2018 and August 2019. Demographic details, physical examination, and routine biochemical investigations were reported. Obstructive LMCAD patients were managed either with percutaneous coronary intervention (PCI) or coronary artery bypass grafting (CABG) according to syntax score, and outcomes were recorded at 6-month follow-up. Results: The mean age of the overall study population (1474 patients) was 59 ± 8.1 years with male 959 (65%) preponderance. Obstructive LMCAD was observed in 103 (6%) patients. Smoking was the prime risk factor associated with obstructive LMCAD observed among 58 (56%) patients followed by hypertension in 45 (43%), dyslipidemia in 42 (40%), obesity in 26 (25%), and diabetes mellitus in 23 (22%) patients. Among 41 (40%) obstructive LMCAD patients, non-ST-elevation myocardial infarction/unstable angina was the major presentation. The majorly affected target vessels were left anterior descending artery (100%) and left circumflex artery (80%) among 103 and 83 patients, respectively. Triple-vessel disease was predominantly observed among 63 (62%) obstructive LMCAD patients. PCI and CABG were performed in 19 (18.4%) and 27 (26.2%) patients with a mean syntax score of 20 and 31, respectively. Conclusion: Smoking, advanced age, diabetes, and dyslipidemia were significantly associated risk factors of LMCAD.","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"45 1","pages":"151 - 156"},"PeriodicalIF":0.0,"publicationDate":"2023-07-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"78915852","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: Lymphadenopathy requires differentiation into benign and malignant for appropriate management. The current study was done to find out if diffusion-weighted images and apparent diffusion coefficient (ADC) will be able to differentiate benign from malignant cervical lymphadenopathy. Methods: This cross-sectional study was done in the Department of Radiology at Sri Ramachandra Medical College from April 2016 to August 2018. A total of 54 patients with a history of lymphadenopathy were recruited. Histopathological examination (HPE) and magnetic resonance imaging were done for all patients after a complete history and physical examination. The ADC was correlated with HPE in differentiating benign and malignant lymphadenopathy. Results: Majority (46.30%) were in the age group of 51 years and above. Twenty-eight (51.85%) had benign, whereas 26 (48.15%) had malignant lesions. There was a statistically significant difference between the nature of the lesion in ADC value ([× 10–3 mm2/s] [P < 0.001]). The ADC had good predictive validity in predicting malignancy, as indicated by the area under the curve of 0.904 (95% confidence interval 0.821 to 0.987, P < 0.001). Conclusion: ADC values can be used as a complementary tool in assessing the malignant potential of lymph nodes in various conditions and hence play an essential role in the further course of management.
{"title":"Diffusion-weighted imaging in differentiating benign versus malignant lymphadenopathy: A cross-sectional study","authors":"K. Sumith, T. Vinoth, P. Jenikar, M. Kumar","doi":"10.4103/cmi.cmi_86_22","DOIUrl":"https://doi.org/10.4103/cmi.cmi_86_22","url":null,"abstract":"Background: Lymphadenopathy requires differentiation into benign and malignant for appropriate management. The current study was done to find out if diffusion-weighted images and apparent diffusion coefficient (ADC) will be able to differentiate benign from malignant cervical lymphadenopathy. Methods: This cross-sectional study was done in the Department of Radiology at Sri Ramachandra Medical College from April 2016 to August 2018. A total of 54 patients with a history of lymphadenopathy were recruited. Histopathological examination (HPE) and magnetic resonance imaging were done for all patients after a complete history and physical examination. The ADC was correlated with HPE in differentiating benign and malignant lymphadenopathy. Results: Majority (46.30%) were in the age group of 51 years and above. Twenty-eight (51.85%) had benign, whereas 26 (48.15%) had malignant lesions. There was a statistically significant difference between the nature of the lesion in ADC value ([× 10–3 mm2/s] [P < 0.001]). The ADC had good predictive validity in predicting malignancy, as indicated by the area under the curve of 0.904 (95% confidence interval 0.821 to 0.987, P < 0.001). Conclusion: ADC values can be used as a complementary tool in assessing the malignant potential of lymph nodes in various conditions and hence play an essential role in the further course of management.","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"124 1","pages":"93 - 97"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"79492176","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}
Shovna Dash, G. Mohanty, Soumya Mohanty, N. Mohakud
Background: The pandemic resulted in increased screen hours in children due to virtual education. The rate of progression of myopia was noticed to be remarkable in the past 2 years. This study is an endeavor to study the effect of increased screen hours during COVID home confinement on the degree of progression of myopia in school children and to evaluate the difference in change of refractive errors with a variation in the screen size of the digital device used. Methods: This was prospective observational study with a retrospective comparison arm, wherein 70 school children (140 eyes) aged 4–18 years were subjected to a cycloplegic refraction test. The difference in spherical equivalent refraction from the year 2018 to 19 was compared with that of the difference observed in the pandemic year 2019–2020. A statistical analysis was also made regarding the correlation of variation in refraction between the different genders, age groups, and screen sizes. Results: Of the 70 children, 29 (41.42%) were girls and 41 (58.58%) were boys. The gadgets being used vary from mobiles to laptops, and the range of screens and sizes varies from 100 cm2 to 500 cm2. Similarly, the duration of device use varied from 4 to 8 h. For 2018, the mean value of the spherical equivalent was −1.69 ± 1.42, for 2019 it was −1.92 ± 1.50 and for 2020 the mean value was −2.61 ± 1.47 for the right eye. The mean value of the spherical equivalent for the left eye in 2018 was −1.68 ± 1.51, in 2019 the value was −1.87 ± 1.58, and in 2020, the mean value was −2.73 ± 1.78. Conclusions: Increased exposure to digital devices during the COVID-19 period has a role to play in the progression of myopia in school-aged children.
{"title":"Progression in refractive error in children during COVID-19 pandemic due to virtual classes: A cohort study","authors":"Shovna Dash, G. Mohanty, Soumya Mohanty, N. Mohakud","doi":"10.4103/cmi.cmi_108_22","DOIUrl":"https://doi.org/10.4103/cmi.cmi_108_22","url":null,"abstract":"Background: The pandemic resulted in increased screen hours in children due to virtual education. The rate of progression of myopia was noticed to be remarkable in the past 2 years. This study is an endeavor to study the effect of increased screen hours during COVID home confinement on the degree of progression of myopia in school children and to evaluate the difference in change of refractive errors with a variation in the screen size of the digital device used. Methods: This was prospective observational study with a retrospective comparison arm, wherein 70 school children (140 eyes) aged 4–18 years were subjected to a cycloplegic refraction test. The difference in spherical equivalent refraction from the year 2018 to 19 was compared with that of the difference observed in the pandemic year 2019–2020. A statistical analysis was also made regarding the correlation of variation in refraction between the different genders, age groups, and screen sizes. Results: Of the 70 children, 29 (41.42%) were girls and 41 (58.58%) were boys. The gadgets being used vary from mobiles to laptops, and the range of screens and sizes varies from 100 cm2 to 500 cm2. Similarly, the duration of device use varied from 4 to 8 h. For 2018, the mean value of the spherical equivalent was −1.69 ± 1.42, for 2019 it was −1.92 ± 1.50 and for 2020 the mean value was −2.61 ± 1.47 for the right eye. The mean value of the spherical equivalent for the left eye in 2018 was −1.68 ± 1.51, in 2019 the value was −1.87 ± 1.58, and in 2020, the mean value was −2.73 ± 1.78. Conclusions: Increased exposure to digital devices during the COVID-19 period has a role to play in the progression of myopia in school-aged children.","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"18 1","pages":"110 - 113"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88481009","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}
Sachin George, R. Deepthi, Georgie Mathew, Jude Prakash, Dona Maria, I. Agarwal
Background: Urinary tract infections (UTIs) are common in children and have the risk of renal scarring. To better identify this at risk group, the following study was carried out to analyze the clinical profile of children below 18 months of age with culture-positive UTI and the outcome of radiological investigations. The primary objective was to assess the clinical profile of culture-positive UTI children and diagnostic yield and correlation between radiological tests. The secondary objectives were to assess the prevalent uropathogens and their antibiogram. Materials and Methods: For this retrospective study, clinical details regarding radiological investigations, prevalent uropathogens and antibiograms, common antibiotics used in treatment, and uroprophylaxis were obtained through electronic medical records in children <18 months of age admitted with culture-positive UTI. Results: In 225 children seen over a period of 36 months, a slight male predominance (56%) was observed. Ultrasonography (USG) was done in nearly all children, micturating cystourethrography (MCU) was performed in only 40% of patients, dimercaptosuccinic acid (DMSA), performed after 6 months of the index UTI, in one-fifths of the patients. All three investigations were performed in one out of six children. USG and MCU used in combination detected the highest number of significant abnormalities (39%) compared to USG and DMSA (32%). Escherichia coli was the predominant uropathogen identified. Significant meropenem resistance (52%) was observed in the community-acquired UTI. Conclusion: The evaluation and follow-up of infants and young children with UTI show inadequate radiological evaluation, which could increase the risk of undetected and untreated renal sequelae.
{"title":"Clinical, uropathogenic, and radiological profile of culture-positive urinary tract infections in children below 18 months of age","authors":"Sachin George, R. Deepthi, Georgie Mathew, Jude Prakash, Dona Maria, I. Agarwal","doi":"10.4103/cmi.cmi_76_22","DOIUrl":"https://doi.org/10.4103/cmi.cmi_76_22","url":null,"abstract":"Background: Urinary tract infections (UTIs) are common in children and have the risk of renal scarring. To better identify this at risk group, the following study was carried out to analyze the clinical profile of children below 18 months of age with culture-positive UTI and the outcome of radiological investigations. The primary objective was to assess the clinical profile of culture-positive UTI children and diagnostic yield and correlation between radiological tests. The secondary objectives were to assess the prevalent uropathogens and their antibiogram. Materials and Methods: For this retrospective study, clinical details regarding radiological investigations, prevalent uropathogens and antibiograms, common antibiotics used in treatment, and uroprophylaxis were obtained through electronic medical records in children <18 months of age admitted with culture-positive UTI. Results: In 225 children seen over a period of 36 months, a slight male predominance (56%) was observed. Ultrasonography (USG) was done in nearly all children, micturating cystourethrography (MCU) was performed in only 40% of patients, dimercaptosuccinic acid (DMSA), performed after 6 months of the index UTI, in one-fifths of the patients. All three investigations were performed in one out of six children. USG and MCU used in combination detected the highest number of significant abnormalities (39%) compared to USG and DMSA (32%). Escherichia coli was the predominant uropathogen identified. Significant meropenem resistance (52%) was observed in the community-acquired UTI. Conclusion: The evaluation and follow-up of infants and young children with UTI show inadequate radiological evaluation, which could increase the risk of undetected and untreated renal sequelae.","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"21 1","pages":"114 - 119"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"88226416","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}
{"title":"Approach to reducing the burden of pesticide poisoning and improving outcomes in patients with deliberate self-harm","authors":"J. Peter, A. Mampilly","doi":"10.4103/cmi.cmi_13_23","DOIUrl":"https://doi.org/10.4103/cmi.cmi_13_23","url":null,"abstract":"","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"2005 1","pages":"79 - 82"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"89514317","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: Placenta accreta can cause significant morbidity and mortality in pregnant women. Timely diagnosis is essential for management. This study aimed to evaluate the accuracy of ultrasound (USG) and magnetic resonance imaging (MRI) techniques in predicting placenta accreta. Methodology: A retrospective study was conducted at our institute from April 2014 to September 2017. Pregnant women with suspected placenta accrete were recruited for the study. Medical records of pregnant women who have undergone both USG and prenatal MRI were included. The accuracy of USG and MRI was compared. Results: Among the 56 cases evaluated in the study, the diagnosis was accurately obtained with ultrasonography in 75% of cases and with MRI in 68.51% of cases. Sensitivity for placenta accreta was 97.29% for USG and 78.37% for MRI. Specificities were 31.57% for USG and 47.05% for MRI. The positive predictive value was 73.46% for USG and 76.31% for MRI. Conclusion: Although a definite demarcation could not be obtained from the sensitivity, specificity, and positive predictive value of the placenta accrete with ultrasonography and MRI, the diagnostic accuracy may be taken as a definite pointer. Hence, ultrasonography remains the mainstay of diagnosis for placenta accrete; and MRI can be considered complementary in cases with few USG signs.
{"title":"Accuracy of ultrasound and magnetic resonance imaging in predicting placenta accreta: A retrospective study","authors":"P. Jaisankar, M. Kumar, R. Gowtham, T. Vinoth","doi":"10.4103/cmi.cmi_85_22","DOIUrl":"https://doi.org/10.4103/cmi.cmi_85_22","url":null,"abstract":"Background: Placenta accreta can cause significant morbidity and mortality in pregnant women. Timely diagnosis is essential for management. This study aimed to evaluate the accuracy of ultrasound (USG) and magnetic resonance imaging (MRI) techniques in predicting placenta accreta. Methodology: A retrospective study was conducted at our institute from April 2014 to September 2017. Pregnant women with suspected placenta accrete were recruited for the study. Medical records of pregnant women who have undergone both USG and prenatal MRI were included. The accuracy of USG and MRI was compared. Results: Among the 56 cases evaluated in the study, the diagnosis was accurately obtained with ultrasonography in 75% of cases and with MRI in 68.51% of cases. Sensitivity for placenta accreta was 97.29% for USG and 78.37% for MRI. Specificities were 31.57% for USG and 47.05% for MRI. The positive predictive value was 73.46% for USG and 76.31% for MRI. Conclusion: Although a definite demarcation could not be obtained from the sensitivity, specificity, and positive predictive value of the placenta accrete with ultrasonography and MRI, the diagnostic accuracy may be taken as a definite pointer. Hence, ultrasonography remains the mainstay of diagnosis for placenta accrete; and MRI can be considered complementary in cases with few USG signs.","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"124 1","pages":"83 - 87"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80108855","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}
The kind and range of attributes that an undergraduate medical student should acquire by the time of completion of their training are extensive. The exposure of undergraduate medical students to the local community during the training period carries immense significance in the learning curve of the students. The exposure to community as a learning resource satisfies multiple principles of adult learning, as medical students can be actively engaged in the learning process, wherein they have to play a specific role and the learning happens across all the learning domains and does not remain restricted to the cognitive domain alone. In conclusion, the use of community as a learning resource for facilitating the training of medical students has been linked with multiple benefits. However, it is quite essential that potential challenges should be identified and accordingly preparation is done by the concerned departments to ensure the attainment of learning objectives and avoid rejection from the community.
{"title":"Utilizing the community as a learning resource in the training of undergraduate medical students","authors":"S. Shrivastava, P. Shrivastava","doi":"10.4103/cmi.cmi_125_22","DOIUrl":"https://doi.org/10.4103/cmi.cmi_125_22","url":null,"abstract":"The kind and range of attributes that an undergraduate medical student should acquire by the time of completion of their training are extensive. The exposure of undergraduate medical students to the local community during the training period carries immense significance in the learning curve of the students. The exposure to community as a learning resource satisfies multiple principles of adult learning, as medical students can be actively engaged in the learning process, wherein they have to play a specific role and the learning happens across all the learning domains and does not remain restricted to the cognitive domain alone. In conclusion, the use of community as a learning resource for facilitating the training of medical students has been linked with multiple benefits. However, it is quite essential that potential challenges should be identified and accordingly preparation is done by the concerned departments to ensure the attainment of learning objectives and avoid rejection from the community.","PeriodicalId":72734,"journal":{"name":"Current medical issues","volume":"8 1","pages":"123 - 125"},"PeriodicalIF":0.0,"publicationDate":"2023-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"80165248","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}
Mansi Agrawal, V. Konduru, A. Tirkey, Riju Jeyashant, Philip George, D. Philip, C. Setty, Kiran Devarkonda
Introduction: Oral cancers recur in a significant proportion of patients, in spite of aggressive treatment strategies. The presence of a clear surgical margin is an important predictor of recurrent disease, among others. Since oral cancers often recur in the absence of compromised margins, there is a need to study the factors affecting recurrence and overall survival outcomes where clear surgical margins have been achieved during upfront surgery. This study attempts to identify the significant predictors of locoregional recurrence in oral squamous cell carcinoma (OSCC) with pathologically clear surgical margins. Methodology: This retrospective study was done to study the clinicopathological parameters associated with recurrence of oral cavity squamous cell carcinoma (SCC) in patients with clear surgical margins operated in our unit between January 2010 and December 2015. A total of 526 cases of oral cavity SCC were analyzed and records of 160 cases with clear surgical margins were reviewed for clinical details, histopathological data, and follow-up status. Age, gender, subsite, T–N clinical and pathological staging, tumor depth of invasion, grade of differentiation, lymphovascular invasion, perineural spread, adjuvant therapy, and recurrence details were analyzed. Results: Lymphovascular Invasion was found to be a significant predictor for local recurrence in OSCC in both univariate and multivariate analysis. Median recurrence-free survival was 53.6 months. Conclusion: Despite the best efforts of the surgeon in obtaining adequate tumor-free margins and the most comprehensive adjuvant treatment, recurrence patterns in oral cancers continue to defy accurate prediction. Lymphovascular invasion could be an important predictor of recurrence for oral cavity cancers in patients with clear surgical margins that require aggressive management.
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