Pub Date : 2024-06-01DOI: 10.3126/ajms.v15i6.63704
Aditi Aikat
The road to implementation of competency-based medical education (CBME) in the medical curriculum in India has both challenges and windows of opportunities in its folds. The hindrances identified were reluctance to change, capacity building of faculties, lack of infrastructural support, and methods of assessment. Notwithstanding, CBME has the potential to ensure that the Indian medical graduates are equipped with better clinical skills, and learner-centric education, that aligns well with individual competence, and community healthcare needs. Effective navigation through this transition calls for collaborative efforts among academicians, regulatory bodies, and related stakeholders while drawing from relevant successful models of our country itself. It is imperative to address the challenges concerning capacity building of faculties, resource allocation, and assessment methodology for successful implementation. Given appropriate adoption, the CBME-based curriculum can go a long way to deliver quality healthcare.
{"title":"Navigating the transition: Implementing competency-based medical education in medical curriculum in India","authors":"Aditi Aikat","doi":"10.3126/ajms.v15i6.63704","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.63704","url":null,"abstract":"The road to implementation of competency-based medical education (CBME) in the medical curriculum in India has both challenges and windows of opportunities in its folds. The hindrances identified were reluctance to change, capacity building of faculties, lack of infrastructural support, and methods of assessment. Notwithstanding, CBME has the potential to ensure that the Indian medical graduates are equipped with better clinical skills, and learner-centric education, that aligns well with individual competence, and community healthcare needs. Effective navigation through this transition calls for collaborative efforts among academicians, regulatory bodies, and related stakeholders while drawing from relevant successful models of our country itself. It is imperative to address the challenges concerning capacity building of faculties, resource allocation, and assessment methodology for successful implementation. Given appropriate adoption, the CBME-based curriculum can go a long way to deliver quality healthcare.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"31 1","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141279418","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 : 2024-06-01DOI: 10.3126/ajms.v15i6.34644
M. Dar, E. Bhat, Ajay Kotwal, Mir Sadaqat, Hassan Zaffer, Owvass Hamid Dar
Background: Acute febrile encephalopathy (AFE) in spite of being a common clinical condition is less known to the general population thereby resulting in delay in seeking medical attention with detrimental consequences. The causes can range from infectious central nervous system (CNS) and systemic diseases to non-infectious conditions such as neuroleptic malignant syndrome, poisoning, and drug overdose. Early diagnosis and prompt medical management can result in good clinical outcome in terms of morbidity and mortality. Aims and Objectives: The aims and objectives are to study the clinical profile, etiology, seasonal variation, and outcome in patients admitted as case of AFE in a tertiary care hospital. Materials and Methods: All patients of AFE fulfilling the inclusion and exclusion criteria admitted in the departments of neurology and general medicine in Batra Hospital and Medical Research Centre (BHMRC) New Delhi, a tertiary care hospital were subjected to study analysis. The patients underwent detailed history, examination, baseline, and special investigations such as cerebrospinal fluid and magnetic resonance imaging brain whenever needed. Patients of AFE were studied according to the prevalence, etiological diagnosis, and seasonal variations. The final outcome at discharge was based on modified Rankin scale (mRs). Results: About 122 serially admitted patients diagnosed with AFE were found eligible and included in the study. About 47 (45%) patients had acute pyogenic CNS infection while as 36 (35%) had non-pyogenic CNS infection followed by malarial, tubercular, and cryptococcal CNS infection. We found maximum number of cases (n=61, 50%) of AFE during monsoon followed by 36 patients (30%) in post-monsoon, 15 patients (12%) were in summer, and only 10 cases (8%) during winter. We found higher and statistically significant disability in CNS infection group, patients with delayed hospitalization (P=0.001), and lower Glasgow coma scale (0.00001). Conclusion: AFE being a condition with serious consequences, we conclude that clinical suspicion, sensitization, and swift response from the treating physicians are required to avoid worse outcomes associated with the delayed diagnosis and late hospitalization of these patients.
{"title":"Clinicoetiological profile and outcome of patients of acute febrile encephalopathy in a tertiary care hospital in New Delhi - A prospective observational study","authors":"M. Dar, E. Bhat, Ajay Kotwal, Mir Sadaqat, Hassan Zaffer, Owvass Hamid Dar","doi":"10.3126/ajms.v15i6.34644","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.34644","url":null,"abstract":"Background: Acute febrile encephalopathy (AFE) in spite of being a common clinical condition is less known to the general population thereby resulting in delay in seeking medical attention with detrimental consequences. The causes can range from infectious central nervous system (CNS) and systemic diseases to non-infectious conditions such as neuroleptic malignant syndrome, poisoning, and drug overdose. Early diagnosis and prompt medical management can result in good clinical outcome in terms of morbidity and mortality.\u0000Aims and Objectives: The aims and objectives are to study the clinical profile, etiology, seasonal variation, and outcome in patients admitted as case of AFE in a tertiary care hospital.\u0000 Materials and Methods: All patients of AFE fulfilling the inclusion and exclusion criteria admitted in the departments of neurology and general medicine in Batra Hospital and Medical Research Centre (BHMRC) New Delhi, a tertiary care hospital were subjected to study analysis. The patients underwent detailed history, examination, baseline, and special investigations such as cerebrospinal fluid and magnetic resonance imaging brain whenever needed. Patients of AFE were studied according to the prevalence, etiological diagnosis, and seasonal variations. The final outcome at discharge was based on modified Rankin scale (mRs).\u0000Results: About 122 serially admitted patients diagnosed with AFE were found eligible and included in the study. About 47 (45%) patients had acute pyogenic CNS infection while as 36 (35%) had non-pyogenic CNS infection followed by malarial, tubercular, and cryptococcal CNS infection. We found maximum number of cases (n=61, 50%) of AFE during monsoon followed by 36 patients (30%) in post-monsoon, 15 patients (12%) were in summer, and only 10 cases (8%) during winter. We found higher and statistically significant disability in CNS infection group, patients with delayed hospitalization (P=0.001), and lower Glasgow coma scale (0.00001).\u0000Conclusion: AFE being a condition with serious consequences, we conclude that clinical suspicion, sensitization, and swift response from the treating physicians are required to avoid worse outcomes associated with the delayed diagnosis and late hospitalization of these patients.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"58 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141274935","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 : 2024-06-01DOI: 10.3126/ajms.v15i6.62443
Shobitha Rao, R. Bilagi, Radhe B K, R. Hiregoudar, Vishnu Narayanan
Background: Asthma is a chronic inflammatory disorder arising from heterogenic geneenvironment interactions. Obesity is one of the risk factors for asthma. Evidence shows that several inflammatory markers are active in obese and overweight patients. There is growing evidence that obesity can affect the course and control of asthma. Aims and Objectives: The study was done to compare clinical characteristics, spirometry variables, and quality of life among obese and non-obese asthmatics. Materials and Methods: The study was a crosssectional comparative study conducted in a tertiary care hospital using a semi-structured pre-tested questionnaire. Detailed history and examination, quality of life using AQLQ score, and spirometry severity were assessed. Results: A total of 80 patients, 40 obese asthmatics and 40 non-obese asthmatics were included in the study. The study found that most subjects belonged to the age group of 31–40 years and body mass index of 30.89±1.94 among the obese group and 23.19±3.77 in non-obese, respectively. The majority had symptoms of breathlessness and wheezing in both groups. The mean forced expiratory volume in 1 s was similar in both groups. However, the mean forced vital capacity was lower in the obese group. The asthma control test (ACT) score was poorer in obese group as compared to nonobese group (7 in obese vs. 15 in non-obese). The dosage of inhaled steroids was higher in the obese group. Conclusion: The symptomatology was similar among the two groups. Restrictive abnormalities, higher asthma symptoms with lower ACT scores, and higher dosages of medications were seen in obese asthmatics as compared to non-obese patients.
{"title":"A comparative study of clinical characteristics and quality of life between obese and non-obese asthmatics","authors":"Shobitha Rao, R. Bilagi, Radhe B K, R. Hiregoudar, Vishnu Narayanan","doi":"10.3126/ajms.v15i6.62443","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.62443","url":null,"abstract":"Background: Asthma is a chronic inflammatory disorder arising from heterogenic geneenvironment interactions. Obesity is one of the risk factors for asthma. Evidence shows that several inflammatory markers are active in obese and overweight patients. There is growing evidence that obesity can affect the course and control of asthma.\u0000Aims and Objectives: The study was done to compare clinical characteristics, spirometry variables, and quality of life among obese and non-obese asthmatics.\u0000Materials and Methods: The study was a crosssectional comparative study conducted in a tertiary care hospital using a semi-structured pre-tested questionnaire. Detailed history and examination, quality of life using AQLQ score, and spirometry severity were assessed.\u0000Results: A total of 80 patients, 40 obese asthmatics and 40 non-obese asthmatics were included in the study. The study found that most subjects belonged to the age group of 31–40 years and body mass index of 30.89±1.94 among the obese group and 23.19±3.77 in non-obese, respectively. The majority had symptoms of breathlessness and wheezing in both groups. The mean forced expiratory volume in 1 s was similar in both groups. However, the mean forced vital capacity was lower in the obese group. The asthma control test (ACT) score was poorer in obese group as compared to nonobese group (7 in obese vs. 15 in non-obese). The dosage of inhaled steroids was higher in the obese group.\u0000Conclusion: The symptomatology was similar among the two groups. Restrictive abnormalities, higher asthma symptoms with lower ACT scores, and higher dosages of medications were seen in obese asthmatics as compared to non-obese patients.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"10 7","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141274236","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 : 2024-06-01DOI: 10.3126/ajms.v15i6.63414
Preeti, M. H. Khan, S. Mittal, Vikram Singh Dhapola, Dr. Vikram Singh Dhapola
Background: The internet, computers, smartphones, and other electronic device’s use has increased suddenly over recent decades. Although this increase has benefits to the users, but also excessive use often leads negative health consequences. Aims and Objectives: The objective of this study was to measure the prevalence of internet addiction (IA) and stress among undergraduate medical students. Materials and Methods: A descriptive cross-sectional study was conducted among 299 undergraduate medical students enrolled in the government medical college, Almora. A 20-item Young’s IA test which is a Likert scale-based interview schedule was used to measure the prevalence of IA and the perceived stress scale 14 scale is used to assess stress among them. Results: Among the 299 study subjects, 49.5% were males and 50.5% were females. Males were more addicted to the internet than females. The prevalence of IA among the study subjects in the present study was 45.4% mild, 13.8% moderate, while 40.8% of students reported normal internet usage. Conclusion: IA is a growing health problem among medical students these days, thus necessary preventive and therapeutic interventions are very important to promote healthy and safe usage of the internet.
{"title":"The prevalence of internet addiction and associated factors among undergraduate medical students in government medical college, Almora","authors":"Preeti, M. H. Khan, S. Mittal, Vikram Singh Dhapola, Dr. Vikram Singh Dhapola","doi":"10.3126/ajms.v15i6.63414","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.63414","url":null,"abstract":"Background: The internet, computers, smartphones, and other electronic device’s use has increased suddenly over recent decades. Although this increase has benefits to the users, but also excessive use often leads negative health consequences.\u0000Aims and Objectives: The objective of this study was to measure the prevalence of internet addiction (IA) and stress among undergraduate medical students.\u0000Materials and Methods: A descriptive cross-sectional study was conducted among 299 undergraduate medical students enrolled in the government medical college, Almora. A 20-item Young’s IA test which is a Likert scale-based interview schedule was used to measure the prevalence of IA and the perceived stress scale 14 scale is used to assess stress among them.\u0000 Results: Among the 299 study subjects, 49.5% were males and 50.5% were females. Males were more addicted to the internet than females. The prevalence of IA among the study subjects in the present study was 45.4% mild, 13.8% moderate, while 40.8% of students reported normal internet usage.\u0000Conclusion: IA is a growing health problem among medical students these days, thus necessary preventive and therapeutic interventions are very important to promote healthy and safe usage of the internet.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"54 8","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141279244","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 : 2024-06-01DOI: 10.3126/ajms.v15i6.64125
Gayathri Elango, Varsha AP, Ganga Muruga Bharathi
Background: Statins are widely prescribed for the management of hyperlipidemia and the prevention of cardiovascular diseases. Atorvastatin and rosuvastatin are among the most commonly used statins, with varying impacts on lipid profiles, side effect profiles, patient adherence, and health-care costs. Understanding these differences within specific populations can inform more tailored and cost-effective treatment strategies. Aims and Objectives: This study aimed to evaluate the differences in side effect management, patient outcomes, and health-care costs between atorvastatin and rosuvastatin therapies in a cohort from Coimbatore, Tamil Nadu, India. Materials and Methods: An observational study was conducted with 100 patients at the Karpagam Faculty of Medical Sciences and Research, evenly split between atorvastatin (n=50) and rosuvastatin (n=50) groups. Data on demographic characteristics, side effects, low-density lipoprotein (LDL) cholesterol reduction, medication adherence, and health-care costs were collected and analyzed. Results: The cohort had an average age of 62 years, with a higher prevalence of males (57%). Socioeconomic analysis showed 30% from low-income, 50% from middle-income, and 20% from high-income backgrounds. Side effects were more common in the atorvastatin group (35%) compared to the rosuvastatin group (28%), with muscle pain and gastrointestinal issues being predominant. Rosuvastatin treatment resulted in higher adherence rates (90%) and more significant LDL cholesterol reduction but incurred higher annual health-care costs (INR 28,000) versus atorvastatin (INR 25,000) (P=0.04). Conclusion: Both statins effectively reduced LDL cholesterol; however, rosuvastatin demonstrated higher patient adherence but at an increased cost. These findings underscore the need for individualized statin therapy that considers both clinical outcomes and economic constraints, particularly in settings with limited health-care resources.
{"title":"Impact of side effect management, patient outcomes, and health-care costs in atorvastatin and rosuvastatin therapy: An observational study","authors":"Gayathri Elango, Varsha AP, Ganga Muruga Bharathi","doi":"10.3126/ajms.v15i6.64125","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.64125","url":null,"abstract":"Background: Statins are widely prescribed for the management of hyperlipidemia and the prevention of cardiovascular diseases. Atorvastatin and rosuvastatin are among the most commonly used statins, with varying impacts on lipid profiles, side effect profiles, patient adherence, and health-care costs. Understanding these differences within specific populations can inform more tailored and cost-effective treatment strategies.\u0000Aims and Objectives: This study aimed to evaluate the differences in side effect management, patient outcomes, and health-care costs between atorvastatin and rosuvastatin therapies in a cohort from Coimbatore, Tamil Nadu, India.\u0000Materials and Methods: An observational study was conducted with 100 patients at the Karpagam Faculty of Medical Sciences and Research, evenly split between atorvastatin (n=50) and rosuvastatin (n=50) groups. Data on demographic characteristics, side effects, low-density lipoprotein (LDL) cholesterol reduction, medication adherence, and health-care costs were collected and analyzed.\u0000Results: The cohort had an average age of 62 years, with a higher prevalence of males (57%). Socioeconomic analysis showed 30% from low-income, 50% from middle-income, and 20% from high-income backgrounds. Side effects were more common in the atorvastatin group (35%) compared to the rosuvastatin group (28%), with muscle pain and gastrointestinal issues being predominant. Rosuvastatin treatment resulted in higher adherence rates (90%) and more significant LDL cholesterol reduction but incurred higher annual health-care costs (INR 28,000) versus atorvastatin (INR 25,000) (P=0.04).\u0000Conclusion: Both statins effectively reduced LDL cholesterol; however, rosuvastatin demonstrated higher patient adherence but at an increased cost. These findings underscore the need for individualized statin therapy that considers both clinical outcomes and economic constraints, particularly in settings with limited health-care resources.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"101 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141234421","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 : 2024-06-01DOI: 10.3126/ajms.v15i6.63345
M. Prashanthi, Santa Kumari, Abdul Raoof, Omer Siddiqui, Mudassir Mirza
Background: Hypertension (HTN) incidence and progression are monitored by regular blood pressure (BP) measurement; one of the most ignored components of regular check-up is the measurement of inter-arm difference (IAD) in BP. Aims and Objectives: The objective of this study was to estimate the prevalence of IAD in BP among offspring of hypertensive parents compared to normotensive parents. Materials and Methods: This cross-sectional study was conducted on 100 male students at Osmania Medical College, Hyderabad, Telangana for a period of 6 months. After IEC clearance, the subjects were divided into two groups, 50 students in each group: Group I had offspring with hypertensive parents and Group II had offspring with normotensive parents. Age, height, weight, and body mass index (BMI) were recorded. IAD was calculated as the difference between BP (Systolic BP [SBP] and diastolic BP [DBP]) in the right arm and left arm. Subjects with a history of structural, functional cardiovascular disease disorders, endocrine disorders, Diabetes mellitus, and addictions such as smoking and alcohol were excluded from the study. Data were statistically analyzed using Microsoft Excel software. Results: Among 100 subjects, Group I and II IAD in SBP was 8.68±6.02 and 5.00±3.24 (P<0.0002), respectively, and Group I and II IAD in DBP was 5.12±4.48 4.79±3.56 (P<0.7117), respectively. BMI of the two groups is almost within the similar range (23.44±4.04, 22.098±3.15, respectively) and not statistically significant (P=0.0694), a positive correlation of 0.12, 011 was found between BMI, systolic IAD,and diastolic IAD, respectively. Conclusion: The above results show a significant association between IAD in systolic BP and family history of HTN.
背景：通过定期测量血压来监测高血压（HTN）的发生和发展；定期体检中最容易被忽视的一项内容是测量血压的臂间差（IAD）：本研究的目的是估算高血压父母的后代与正常血压父母的后代相比，血压臂间差（IAD）的发生率：这项横断面研究在特兰甘纳邦海德拉巴市奥斯曼尼亚医学院的 100 名男生中进行，为期 6 个月。在通过 IEC 审查后，受试者被分为两组，每组 50 人：I 组的后代父母患有高血压，II 组的后代父母血压正常。记录受试者的年龄、身高、体重和体重指数（BMI）。IAD 以右臂和左臂血压（收缩压 [SBP] 和舒张压 [DBP]）之差计算。有结构性、功能性心血管疾病史、内分泌失调、糖尿病以及吸烟和酗酒等不良嗜好的受试者不在研究范围内。数据使用 Microsoft Excel 软件进行统计分析：100名受试者中，I组和II组IAD的SBP分别为（8.68±6.02）和（5.00±3.24）（P<0.0002），DBP分别为（5.12±4.48）和（4.79±3.56）（P<0.7117）。两组的 BMI 值几乎在相似范围内（分别为 23.44±4.04、22.098±3.15），无统计学意义（P=0.0694），BMI 值与收缩压 IAD、舒张压 IAD 之间的正相关性分别为 0.12、011：上述结果表明，收缩压中的 IAD 与高血压家族史之间存在明显关联。
{"title":"Cross-sectional study of the prevalence of inter-arm blood pressure difference in offspring of normotensive and hypertensive parents among students of tertiary care teaching hospital, Hyderabad","authors":"M. Prashanthi, Santa Kumari, Abdul Raoof, Omer Siddiqui, Mudassir Mirza","doi":"10.3126/ajms.v15i6.63345","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.63345","url":null,"abstract":"Background: Hypertension (HTN) incidence and progression are monitored by regular blood pressure (BP) measurement; one of the most ignored components of regular check-up is the measurement of inter-arm difference (IAD) in BP.\u0000Aims and Objectives: The objective of this study was to estimate the prevalence of IAD in BP among offspring of hypertensive parents compared to normotensive parents.\u0000Materials and Methods: This cross-sectional study was conducted on 100 male students at Osmania Medical College, Hyderabad, Telangana for a period of 6 months. After IEC clearance, the subjects were divided into two groups, 50 students in each group: Group I had offspring with hypertensive parents and Group II had offspring with normotensive parents. Age, height, weight, and body mass index (BMI) were recorded. IAD was calculated as the difference between BP (Systolic BP [SBP] and diastolic BP [DBP]) in the right arm and left arm. Subjects with a history of structural, functional cardiovascular disease disorders, endocrine disorders, Diabetes mellitus, and addictions such as smoking and alcohol were excluded from the study. Data were statistically analyzed using Microsoft Excel software.\u0000Results: Among 100 subjects, Group I and II IAD in SBP was 8.68±6.02 and 5.00±3.24 (P<0.0002), respectively, and Group I and II IAD in DBP was 5.12±4.48 4.79±3.56 (P<0.7117), respectively. BMI of the two groups is almost within the similar range (23.44±4.04, 22.098±3.15, respectively) and not statistically significant (P=0.0694), a positive correlation of 0.12, 011 was found between BMI, systolic IAD,and diastolic IAD, respectively.\u0000Conclusion: The above results show a significant association between IAD in systolic BP and family history of HTN.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"54 23","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141277285","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 : 2024-06-01DOI: 10.3126/ajms.v15i6.63106
Sabina Adhikari
Classic polyarteritis nodosa (PAN) is an uncommon form of aggressive systemic vasculitis involving small-to-medium sized arteries usually of renal vasculature and other visceral organs but characteristically sparing the lung vasculature. Cutaneous PAN (c-PAN) is still a rare type of small-to-medium vessel vasculitis with involvement of skin without any systemic or visceral involvement. However, extracutaneous features such as arthritis, arthralgia, myopathy, and myositis can co-exist with the cutaneous features. c-PAN can be confirmed histopathologically by the presence of polymorphonuclear leukocytes around the medium-sized vessels with evidence of fibrinoid necrosis and luminal thrombi at the bifurcations. While c-PAN has a benign but chronic course and can be managed with low doses of short-course oral steroids or anti-inflammatory drugs, systemic involvement has an aggressive course and needs adequate and prompt immunosuppression with high dose oral steroids, cyclophosphamide, rituximab, or other immunosuppressive. We present a case of a 33-year-old male who landed in our OPD with features of c-PAN and on further investigative workup was found to have a renal infarct.
{"title":"Classic polyarteritis nodosa presenting initially as a case of cutaneous polyarteritis nodosa: A case report","authors":"Sabina Adhikari","doi":"10.3126/ajms.v15i6.63106","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.63106","url":null,"abstract":"Classic polyarteritis nodosa (PAN) is an uncommon form of aggressive systemic vasculitis involving small-to-medium sized arteries usually of renal vasculature and other visceral organs but characteristically sparing the lung vasculature. Cutaneous PAN (c-PAN) is still a rare type of small-to-medium vessel vasculitis with involvement of skin without any systemic or visceral involvement. However, extracutaneous features such as arthritis, arthralgia, myopathy, and myositis can co-exist with the cutaneous features. c-PAN can be confirmed histopathologically by the presence of polymorphonuclear leukocytes around the medium-sized vessels with evidence of fibrinoid necrosis and luminal thrombi at the bifurcations. While c-PAN has a benign but chronic course and can be managed with low doses of short-course oral steroids or anti-inflammatory drugs, systemic involvement has an aggressive course and needs adequate and prompt immunosuppression with high dose oral steroids, cyclophosphamide, rituximab, or other immunosuppressive. We present a case of a 33-year-old male who landed in our OPD with features of c-PAN and on further investigative workup was found to have a renal infarct.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"45 9","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141278510","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 : 2024-06-01DOI: 10.3126/ajms.v15i6.63670
Zulfiqar Ali, Iqra Nazir, Shahid Ahmad Mir, Zoya Sehar, Aymen Masood, Eman Aftab, Muqtashid Rashid
Background: Agitation is frequently encountered in patients recovering from traumatic brain injury (TBI) in the intensive care unit (ICU). The etiopathology for agitation is multifactorial. Melatonin has been widely used to study the effects of delirium in ICU, however, its effect on agitation is not well studied. Aims and Objectives: The aim of this study was to assess the effect of melatonin administration on the prevalence of agitation and length of stay in patients with severe TBI, managed conservatively, or undergoing decompressive craniectomy. Materials and Methods: A retrospective observational study with 70 patients undergoing various decompressive craniotomy or managed conservatively, and admitted to neurosurgical ICU was included in the study. Thirty-six patients were recruited from the control group and 34 patients received melatonin during their stay in the ICU. In this study, records of 70 patients who had suffered isolated TBI with no associated injuries were analyzed. The patients had a Glasgow coma score of 3–14 on admission to ICU. The patients were managed as per the standard protocols, as per the existing guidelines, and based on TBI guidelines. Results: A non-significant decreasing trend of agitation and reduced duration of ICU stay was noted in patients who received melatonin compared with the control group. The prevalence of agitation observed on modified Ramsay scale (Mean±SD) in patients who received melatonin on Day 3, Day 4, Day 5, Day 6, Day 7, Day 8, and Day 9 were −1.67±3.01; −1.61±2.82; −1.2±2.55; −1.23±2.51; −1.23±2.11; −1.05±2.09; and 0.76±2.03, respectively. These scores were slightly lower than observed in the control group on Day 3, Day 4, Day 5, Day 6, Day 7, Day 8, and Day 9 as −1.58±3.16; −1.33±2.72; −1.08±2.46; −1.13±2.25; −0.94±1.87; −0.52±1.7; and 0.52±1.36, respectively. The mean±SD duration of stay in ICU of patients receiving melatonin (13.14±3.37) and not receiving melatonin (14.52±3.73) was comparable (P=0.1). Conclusion: Although there was a decreased prevalence of agitation and a decrease in the mean duration of the ICU stay in patients who received oral melatonin, these beneficial effects did not show any statistical significance once compared with the control group.
{"title":"Effects of administration of melatonin on agitation and duration of stay in patients of traumatic brain injury admitted to neurosurgical intensive care unit – A retrospective study","authors":"Zulfiqar Ali, Iqra Nazir, Shahid Ahmad Mir, Zoya Sehar, Aymen Masood, Eman Aftab, Muqtashid Rashid","doi":"10.3126/ajms.v15i6.63670","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.63670","url":null,"abstract":"Background: Agitation is frequently encountered in patients recovering from traumatic brain injury (TBI) in the intensive care unit (ICU). The etiopathology for agitation is multifactorial. Melatonin has been widely used to study the effects of delirium in ICU, however, its effect on agitation is not well studied.\u0000Aims and Objectives: The aim of this study was to assess the effect of melatonin administration on the prevalence of agitation and length of stay in patients with severe TBI, managed conservatively, or undergoing decompressive craniectomy.\u0000Materials and Methods: A retrospective observational study with 70 patients undergoing various decompressive craniotomy or managed conservatively, and admitted to neurosurgical ICU was included in the study. Thirty-six patients were recruited from the control group and 34 patients received melatonin during their stay in the ICU. In this study, records of 70 patients who had suffered isolated TBI with no associated injuries were analyzed. The patients had a Glasgow coma score of 3–14 on admission to ICU. The patients were managed as per the standard protocols, as per the existing guidelines, and based on TBI guidelines.\u0000Results: A non-significant decreasing trend of agitation and reduced duration of ICU stay was noted in patients who received melatonin compared with the control group. The prevalence of agitation observed on modified Ramsay scale (Mean±SD) in patients who received melatonin on Day 3, Day 4, Day 5, Day 6, Day 7, Day 8, and Day 9 were −1.67±3.01; −1.61±2.82; −1.2±2.55; −1.23±2.51; −1.23±2.11; −1.05±2.09; and 0.76±2.03, respectively. These scores were slightly lower than observed in the control group on Day 3, Day 4, Day 5, Day 6, Day 7, Day 8, and Day 9 as −1.58±3.16; −1.33±2.72; −1.08±2.46; −1.13±2.25; −0.94±1.87; −0.52±1.7; and 0.52±1.36, respectively. The mean±SD duration of stay in ICU of patients receiving melatonin (13.14±3.37) and not receiving melatonin (14.52±3.73) was comparable (P=0.1).\u0000Conclusion: Although there was a decreased prevalence of agitation and a decrease in the mean duration of the ICU stay in patients who received oral melatonin, these beneficial effects did not show any statistical significance once compared with the control group.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"28 10","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141278978","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 : 2024-06-01DOI: 10.3126/ajms.v15i6.62766
A. Rajkonwar, Upam Kumar, S. Sonowal, Arpita Nath, Hiranya Saikia, Gautam Hazarika
Background: Chronic myeloid leukemia (CML) is a hematologic malignancy characterized by excessive growth of myeloid cells and their progenitors. The incidence of CML is approximately 1–2/100,000 population per year. Aims and Objectives: The aims and objectives of the study are to determine the clinicopathological features of patients with CML and their risk stratification by the Sokal score at a tertiary care hospital in North-East India. Materials and Methods: This was a single-center prospective study conducted for 5 years (2018–2022). A total of 109 cases diagnosed with CML by qualitative analysis of BCR-ABL1 transcript reverse transcription-polymerase chain reaction were included in the study. The Sokal score was calculated using previously published formulae to classify the patients into different risk groups. The outcome (dead or alive) of CML patients was compared with their individual risk groups using Fisher’s exact test. Results: Out of 109 CML patients, 73 were males and 36 were females. At the end of the study, 85 patients were alive whereas 24 died. The mean age at presentation was 42.08±15.06 years. The pediatric age group comprises 1.84% of total cases. The percentages of death were higher (79.17%) in patients aged 18–59 years, followed by 20.83% in ≥60 years age group, whereas no death was recorded in the pediatric age group (<18 years). The abdominal hard lump was the most common clinical presentation, followed by abdominal fullness, weakness, and pain abdomen. The Sokal score assigns the majority (66.06%) of patients to the intermediate risk (IR) category, followed by 25.69% and 8.26% in the high-risk (HR) and low-risk (LR) categories, respectively. It was observed that the majority (28.57%) of patients died in the HR group, followed by 20.83% in the IR group and 11.11% in the LR group. Conclusion: The mean age of CML patients is lower than that observed in many Western countries. The Sokal score assigns the majority of patients to IR category and the maximum death were seen in the HR group.
{"title":"Clinicopathological features and risk stratification by the sokal score of patients with chronic myeloid leukemia at a tertiary care hospital in North-East India: A prospective study","authors":"A. Rajkonwar, Upam Kumar, S. Sonowal, Arpita Nath, Hiranya Saikia, Gautam Hazarika","doi":"10.3126/ajms.v15i6.62766","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.62766","url":null,"abstract":"Background: Chronic myeloid leukemia (CML) is a hematologic malignancy characterized by excessive growth of myeloid cells and their progenitors. The incidence of CML is approximately 1–2/100,000 population per year.\u0000Aims and Objectives: The aims and objectives of the study are to determine the clinicopathological features of patients with CML and their risk stratification by the Sokal score at a tertiary care hospital in North-East India.\u0000Materials and Methods: This was a single-center prospective study conducted for 5 years (2018–2022). A total of 109 cases diagnosed with CML by qualitative analysis of BCR-ABL1 transcript reverse transcription-polymerase chain reaction were included in the study. The Sokal score was calculated using previously published formulae to classify the patients into different risk groups. The outcome (dead or alive) of CML patients was compared with their individual risk groups using Fisher’s exact test.\u0000Results: Out of 109 CML patients, 73 were males and 36 were females. At the end of the study, 85 patients were alive whereas 24 died. The mean age at presentation was 42.08±15.06 years. The pediatric age group comprises 1.84% of total cases. The percentages of death were higher (79.17%) in patients aged 18–59 years, followed by 20.83% in ≥60 years age group, whereas no death was recorded in the pediatric age group (<18 years). The abdominal hard lump was the most common clinical presentation, followed by abdominal fullness, weakness, and pain abdomen. The Sokal score assigns the majority (66.06%) of patients to the intermediate risk (IR) category, followed by 25.69% and 8.26% in the high-risk (HR) and low-risk (LR) categories, respectively. It was observed that the majority (28.57%) of patients died in the HR group, followed by 20.83% in the IR group and 11.11% in the LR group.\u0000Conclusion: The mean age of CML patients is lower than that observed in many Western countries. The Sokal score assigns the majority of patients to IR category and the maximum death were seen in the HR group.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"9 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141279611","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 : 2024-06-01DOI: 10.3126/ajms.v15i6.64850
Usha Ramakrishna N, Radhika Potnuri, Raj Kumar Sahu, Hitesh Chavda
Background: Laparoscopic cholecystectomy (LC) is a common surgical procedure, the difficulty of which can vary significantly based on pre-operative factors. Identifying these factors can improve surgical planning, patient counseling, and outcomes. Aims and Objectives: To develop a predictive scoring system for assessing the difficulty of LC preoperatively based on individual patient parameters. To employ operative time and intra-operative events to validate the accuracy of the scoring system in reflecting the technical difficulty of LCs. Materials and Methods: This prospective study enrolled 104 patients scheduled for LC, assessing them with a pre-operative scoring system to predict operative difficulty. Patients were categorized into groups indicating expected levels of difficulty: Easy, difficult, and very difficult. Demographic information, clinical characteristics, and operative outcomes were analyzed to validate the scoring system’s predictive accuracy. Results: Of the patients assessed, 68.3% were predicted to have an easy LC (scores 0–5), whereas 31.7% were anticipated to face a difficult LC (scores 6–10). Key predictors of operative difficulty included age, sex, history of previous hospitalization for acute cholecystitis, body mass index (BMI), the presence of an abdominal scar, palpable gallbladder (GB), thickened GB wall, pericholecystic collection, and impacted stone. The study found that operative outcomes closely aligned with pre-operative predictions, confirming the scoring system’s moderate predictive accuracy (area under the curve of 0.798). Conclusion: The pre-operative scoring system demonstrated moderate effectiveness in predicting LC difficulty, with significant predictors including a history of hospitalization, BMI, palpable GB, and thickened GB wall. These findings can aid in pre-operative planning and optimizing patient outcomes.
{"title":"A prospective study of various pre-operative factors and the development of a scoring system in predicting difficult laparoscopic cholecystectomy","authors":"Usha Ramakrishna N, Radhika Potnuri, Raj Kumar Sahu, Hitesh Chavda","doi":"10.3126/ajms.v15i6.64850","DOIUrl":"https://doi.org/10.3126/ajms.v15i6.64850","url":null,"abstract":"Background: Laparoscopic cholecystectomy (LC) is a common surgical procedure, the difficulty of which can vary significantly based on pre-operative factors. Identifying these factors can improve surgical planning, patient counseling, and outcomes.\u0000Aims and Objectives: To develop a predictive scoring system for assessing the difficulty of LC preoperatively based on individual patient parameters. To employ operative time and intra-operative events to validate the accuracy of the scoring system in reflecting the technical difficulty of LCs.\u0000Materials and Methods: This prospective study enrolled 104 patients scheduled for LC, assessing them with a pre-operative scoring system to predict operative difficulty. Patients were categorized into groups indicating expected levels of difficulty: Easy, difficult, and very difficult. Demographic information, clinical characteristics, and operative outcomes were analyzed to validate the scoring system’s predictive accuracy.\u0000Results: Of the patients assessed, 68.3% were predicted to have an easy LC (scores 0–5), whereas 31.7% were anticipated to face a difficult LC (scores 6–10). Key predictors of operative difficulty included age, sex, history of previous hospitalization for acute cholecystitis, body mass index (BMI), the presence of an abdominal scar, palpable gallbladder (GB), thickened GB wall, pericholecystic collection, and impacted stone. The study found that operative outcomes closely aligned with pre-operative predictions, confirming the scoring system’s moderate predictive accuracy (area under the curve of 0.798).\u0000Conclusion: The pre-operative scoring system demonstrated moderate effectiveness in predicting LC difficulty, with significant predictors including a history of hospitalization, BMI, palpable GB, and thickened GB wall. These findings can aid in pre-operative planning and optimizing patient outcomes.","PeriodicalId":8522,"journal":{"name":"Asian Journal of Medical Sciences","volume":"31 21","pages":""},"PeriodicalIF":0.0,"publicationDate":"2024-06-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141234777","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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