Journal of postgraduate medicine最新文献

Objective: This cross-sectional study aimed to investigate the emergence of adeno-enterovirus conjunctivitis, with a focus on its clinical manifestations, prevalence, and implications within the context of acute epidemic conjunctivitis.

Methods: Real-time PCR analysis was employed to precisely identify the viral strain in conjunctival swab samples. A total of 80 patients were tested, and specific clinical symptoms were assessed.

Results: The study revealed the first documented case in India and the second worldwide of adeno-enterovirus conjunctivitis. The prevalence among the tested patients was significant, with 15% testing positive. Those infected with adeno-enterovirus exhibited shorter illnesses (≤3 days). Notably, clinical symptoms such as subconjunctival hemorrhage, chemosis, swelling, photophobia, and epiphora were significantly linked to this viral variant. Multivariable logistic regression analysis highlighted swelling and photophobia as robust predictors for identifying adeno-enterovirus conjunctivitis cases.

Conclusion: The findings underscore the urgent need to recognize adeno-enterovirus conjunctivitis as a potential threat, capable of causing significant ocular morbidity. Swelling and photophobia emerged as robust predictors for identifying cases, emphasizing the importance of vigilant monitoring and comprehension of this viral variant. Proactive measures are essential to address its clinical implications and mitigate its impact on affected populations. Ongoing research is crucial to unravel the complete spectrum of adeno-enterovirus conjunctivitis and guide effective management strategies.

Abstract: Cerebral venous thrombosis (CVT) is a rare stroke with multiple risk factors. One rare risk factor is Behçet's disease (BD). Out of around 3000 cases at our center in the past 10 years, two cases of BD with CVT were seen. Herein, we report on their clinical symptoms, course, and management. Case 1 was a 18-year-old girl with a history of recurrent skin lesions presenting with encephalopathy syndrome due to CVT, requiring decompression. Despite our best efforts, she developed complications and expired due to sepsis. Case 2 was a 22-year-old male with raised intracranial pressure syndrome and a history of recurrent orogenital ulcers. His evaluation showed retinal vasculitis, papilledema, and bilateral lateral rectus palsy. Both had CVT on neuroimaging and had positivity for human leukocyte antigen-B51. Case 2 responded to the anticoagulation and immunomodulation. Risk factor identification is essential in managing CVT, and planned evaluation (clinical or investigations) plays an important role in identifying rare causes that need specific treatment.

Objective: To evaluate an in vitro antiplatelet effect of generic ticagrelor 90 mg (ticaspan) alone and in combination with aspirin 75 mg as compared to the innovator formulation of ticagrelor alone and in combination with aspirin among healthy Indian volunteers.

Methods: 18 volunteers were enrolled and platelet viability was tested using lactate dehydrogenase (LDH) assay in six of 18 volunteers. In 12 volunteers, maximum platelet aggregation (MPA) and percentage inhibition of platelet aggregation (PI) were assessed using a platelet aggregometer in six study groups.

Results: There was no significant increase in LDH levels when platelets were incubated with an innovator or generic drug alone and in combination with aspirin as compared to the dimethyl sulfoxide [DMSO] group. All five study groups showed a significant reduction in the MPA values compared to the DMSO group ( P < 0.01). The extent of decrease in MPA observed with the generic drug was not significantly different from the innovator drug ( P = 0.325). Similarly, the MPA observed with the two combination groups did not differ from each other ( P = 1.000), but it was significantly different from the MPA observed with aspirin ( P = 0.039, each). The PI of platelet aggregation was significantly more in four study groups [generic drug alone; innovator alone; generic drug + aspirin; and innovator drug + aspirin] ( P < 0.01) as compared to the aspirin group.

Conclusion: The generic ticagrelor and its combination with aspirin demonstrated an antiplatelet effect equivalent to the innovator drug and its combination with aspirin.

Background: A difficult airway is anticipated with cervical spine injuries (CSIs) as immobilization techniques such as manual in-line stabilization (MILS) are used, which distort the oro-pharyngeal-laryngeal axis. Video laryngoscopes (VLs) make difficult airway management easy, as they do not require axis alignment. The present study aimed to compare the total time taken by Macintosh laryngoscope (ML), conventional blade, and D-blade ™ of C-MAC ® VL in simulated CSI scenarios using MILS.

Methods: Ninety patients were randomly allocated into three groups: Group M (ML), Group C (conventional blade of C-MAC ® ), and Group D (D-blade ™ of C-MAC ® ) with MILS applied before intubation. Primary outcome was the total time taken for successful intubation, while secondary outcomes were to assess Cormack-Lehane (CL) grade, number of attempts, hemodynamic response, and associated complications.

Results: Total time for intubation in Group C was 23.40 ± 7.06 sec compared to 35.27 ± 6.53 and 47.27 ± 2.53 sec in groups D and M, respectively ( P < 0.001). CL-grade I was observed in 15/30 (50%) in Group M, 25/30 (83.3%) in Group C, and 29/30 (96.7%) in Group D. Group M reported 7/30 (23.3%) failed intubations, while none were observed in other groups. Hemodynamic parameters were significantly higher at 3 and 5 min in Group M. Postoperative sore throat was recorded in 12/30 (40%) in Group M compared to 3/30 (10%) in groups C and D each ( P value 0.037).

Conclusion: C-MAC ® VL requires less time for intubation, provides better glottic view, and has higher success, with better attenuation of hemodynamic response and fewer complications compared to ML.

Abstract: Medullary nephrocalcinosis is an uncommon manifestation of primary hyperaldosteronism (PHA) and the exact etiology of this association is still debated. Here we report three cases of PHA with medullary nephrocalcinosis and how medullary nephrocalcinosis in one patient led to misdiagnosis as renal tubular acidosis (RTA). Although PHA and RTA can share overlapping symptoms, careful evaluation of clinical presentation, biochemical tests, and imaging studies are essential to differentiate between the two conditions and ensure appropriate management. Also, awareness of this uncommon manifestation of PHA is essential to avoid misdiagnosis as tubulopathy, as this may delay the treatment.

Objectives: The primary objective of the study was to assess the factors that influenced the increased failure rate among first-year Indian medical students who appeared for the Maharashtra University of Health Science (MUHS) summative university examination, having experienced the competency-based medical education (CBME) curriculum for the first time amid the coronavirus disease (COVID-19) pandemic.

Methods: A retrospective cross-sectional online questionnaire-based study was undertaken between July 2021 and November 2021, in which first-year Indian medical students who were enrolled in the Bachelor of Medicine, Bachelor of Surgery (MBBS) program in the year 2019 and appeared for the MUHS summative university examination in February 2021 were invited to participate. Analysis was done using JASP (v0.16.0.0), and the odds ratio for failure was calculated at a significance level of P < 0.05.

Results: Responses were obtained from 360 individuals, of whom 74.5% had passed and 25.5% had failed (n = 360). The odds of failure in first-year MBBS summative university examination was higher in students with irregular Internet access, irregular device access, an unsupportive peer environment in college, a National Entrance cum Eligibility Test score below 500, an unsupportive family environment during the lockdown, severe stress, severe depression, testing positive for COVID-19 before the exam, death in the family during the exam, and failing in terms and prelims and students of male gender ( P < 0.01).

Conclusion: The total failure rate of 27% in the MUHS examination was mainly attributed to interplay between the student's mental health, lack of devices or Internet, and the changed assessment part of the CBME curriculum. Surprisingly, lecture frequencies, teaching patterns, and study resources did not influence the failure rate. These results can be used to formulate interventions that will help to improve academic performance and mental health students and thus help them adapt to the new curriculum.

Abstract: Neuroblastomas are the most common extracranial solid tumor in the pediatric age group (~8%-10% of childhood neoplasms). Most cases of intracranial neuroblastomas occur due to metastasis from some primary extracranial sites and are known as secondary neuroblastomas. However, the occurrence of primary central nervous system neuroblastomas (PCN-NB) is very rare, and only a few cases and case series have been reported in the literature. PCN-NB is mainly an intra-axial pathology, and extra-axial involvement is mainly due to metastasis from some extracranial primary site with involvement of the skull bone. Herein we report a case of a 23-year-old female having a large extra-axial space-occupying lesion in the right frontal region that was mimicking a meningioma, and surprisingly the histopathology was suggestive of a supratentorial neuroblastoma. A right frontal craniotomy was made, and Simpson's grade 1 excision of the tumor was done. The excised tissue was sent for histopathological examination. PCN-NB located extra-axially are extremely rare to occur. Due to inconsistent radiological imaging, it becomes very difficult to diagnose these tumors preoperatively, and these should be kept in mind as one of the differential diagnoses of extra-axial intracranial space-occupying lesions. Histopathological examination is crucial in diagnosing the intracranial neuroblastomas.