Journal of postgraduate medicine最新文献

Introduction: This study aimed to determine the bacterial profile and their antibiotic spectrum in patients with ventilator-associated pneumonia (VAP) and investigate the risk factors for VAP and the presence of multidrug-resistant (MDR) pathogens.

Materials and methods: A cross-sectional study was included 105 patients with clinically suspected VAP in intensive care units (ICUs) of two university hospitals from Syria, between January 2023 and February 2024. Culture-positive included 69 samples (65.7%), which were classified based on post-intubation as early-onset (<5 days) or late-onset (≥5 days).

Results: Gram-negative and Gram-positive bacteria were observed in 82.6% and 17.4%; respectively. Early and late-onset VAP was reported in 30 (43.5%) and 39 (56.5%) patients; respectively. The primary cause of early-onset VAP was Acinetobacter and Enterobacter , whereas Klebsiella and Acinetobacter were the main causes of late-onset VAP. Gram-negative showed a high resistance to fluoroquinolones (91.2%), carbapenems (78.9% for imipenem and 86% for meropenem), and amikacin (83.2%), while all were sensitive to colistin. Gram-positive was sensitive to tetracycline, vancomycin, linezolid, tigecycline, and trimethoprim-sulfamethoxazole. MDR was observed in 55 patients (79.7%) and in early (76.9%) and late-onset (83.3%) VAP. There were no risk factors favoring MDR or early compared to late-onset VAP.

Conclusions: The study revealed a high prevalence of Gram-negative among VAP patients. A significant prevalence of MDR pathogens was observed in early and late-onset VAP, along with high resistance to carbapenems. This necessitates a reassessment of the current use of antibiotics and highlights the need for further studies to choose alternative treatments for empirical antibiotic coverage.

Introduction: Non-pharmacological distraction using video games (VG) is still under-explored in pediatric surgical patients.

Materials and methods: We conducted this randomized controlled study of 150 children, aged 4-12 years, scheduled for elective surgery in a tertiary care hospital to estimate the distractive effect of VG on immediate preoperative anxiety in children. In the intervention group (I), playing with VG was encouraged till anesthetic induction. The control group (C) received usual care with verbal reassurance. Modified Yale preoperative anxiety scale (mYPAS) score and presence of anxiety (mYPAS >30) were noted in the preoperative area (T1), at parental separation (T2), and anesthetic induction (T3). Parental separation anxiety score (PSAS) >3 was considered unacceptable parental separation. We used the Mann-Whitney test and t-test to find significance of intergroup mean difference of anxiety and logistic regression to find risk factors for immediate preoperative anxiety.

Results: The mean m-YPAS (±SD) scores at T1 and T2 were 38 (±10.9) and 52.2 (±18.7) in group C and 46.5 (±13.5) and 33 (IQR: 28.3-65.5) in group I, respectively. The incidence of anxiety at T2 was higher in group C (81.3%) than in group I (59%). More children in group I (53/75) had acceptable separation than in group C (32/75) (P = 0.001). VG led to a 2.32 times lower risk of anxiety at T2 (P = 0.036). In children with acceptable separation, the incidence of anxiety was lower in group I (59%) than in group C (87%).

Conclusion: VG-based distraction effectively reduced preoperative anxiety in children undergoing elective surgeries.

Introduction: Pharmacology is one of the most dynamic and evolving branches, not only in the concepts but also in teaching methodologies. Many attempts have been made by various colleges all over the world to make the teaching of pharmacology more interesting and relevant.

Materials and methods: The literature from two databases (Google Scholar and PubMed) published between 2005 and 2020 were searched using terms related to "Teaching Techniques" AND "Pharmacology." The articles with unavailable full-text those published in conference proceedings, duplicate studies, and articles published in languages apart from English were excluded. Teaching techniques were compared using success and popularity ratios, which were calculated on the basis of student's test score and their feedback with an average minimum score of 50%, which was considered the benchmark.

Results: Out of the 1,093 articles reviewed, only 95 studies met the inclusion criteria. The majority of the studies were conducted among medical (64.21%) and pharmacy (28.42%) students. Most common teaching techniques belonged to computer and case-based (21.05% each) types followed by multiple techniques (11.58%) types. Flipped, case-based, multiple methods, modules, and other innovative methods have been well received by students with a popularity ratio ranging between 100 and 81, and improvement in students' test scores further demonstrated their utility with a success ratio between 100 and 88. The effectiveness and popularity of computer-based techniques and student-centered techniques were found to be moderate (73 and 71). Although popular, team-based techniques and simulations seemed to be less effective in improving test scores (50 and 33, respectively).

Conclusion: There is a need for periodic up-gradation in techniques utilized for teaching pharmacology. Every teaching technique has its strengths and weaknesses. They need to be utilized as per the student's requirement.

Abstract: Medical research is costly and requires significant effort. While intracellular research hardly follows a formal design, most data-based studies require a structural approach for optimal utilization of resources. Depending on the study's objectives and available resources, as well as the aim to obtain valid and reliable results, the design may be descriptive, employing specific sampling strategies, or analytical, exploring antecedent-outcome relationships. Analytical studies often involve designs such as randomization and blinding in clinical trials, and may use prospective, retrospective, or cross-sectional designs in observational studies. This first article in the series on biostatistics methods specifies the essential features of each design and describes the contexts in which they are most appropriate.

Abstract: A 76-year-old male patient, who underwent a post-aortic valve replacement with a mechanical valve in 2006, was on oral anticoagulant therapy with warfarin, maintaining a stable therapeutic level of anticoagulation until 2022. He had a new diagnosis of ulcerative colitis in 2022, following which he was started on mesalamine. He had been having a supratherapeutic level of anticoagulation, as evidenced by an international normalized ratio (INR) of 12 to 14 on multiple occasions since 2022, leading to gastrointestinal bleeding, necessitating multiple packed red cell transfusions. He presented to us in August 2024 with severe anemia due to gastrointestinal bleeding. The evaluation revealed severe depletion of vitamin K-dependent coagulation factors. In this report, we discuss the possible drug-drug interactions between mesalamine and vitamin K antagonists, which went unrecognized leading to life-threatening gastrointestinal bleeding.

Introduction: Gender-based violence (GBV), including domestic violence, honor killings, and dowry deaths, represents one of the most extreme forms of violence against women. These deaths are often misclassified as accidents or suicides due to societal biases, leading to underreporting and obscuring the true impact of GBV on women's mortality.

Aims and objectives: This study aimed to evaluate the prevalence of GBV-related deaths, with a focus on cases misreported as accidents or suicides. The objective was to determine the proportion of female deaths attributable to GBV and to highlight the challenges in reporting and investigating these cases.

Materials and methods: A retrospective, cross-sectional study was conducted at a medical teaching institution in Mumbai, analyzing 5 years (May 2017-April 2022) of autopsy data involving unnatural female deaths. Autopsy records, police reports, and victim/relative statements were examined to identify potential GBV cases and discrepancies in death classification.

Results: The study found a significant proportion of female deaths attributed to GBV, primarily within domestic settings. Many cases initially reported as accidents or suicides showed discrepancies in injury patterns and circumstances. The majority of GBV victims were young women aged 15-44 years, with burns being the most common cause of death.

Conclusion: The study emphasizes the need for improved investigation and classification of unnatural female deaths. Domestic violence emerged as the most common factor in these deaths, with intimate partners being primary perpetrators, with most incidents occurring within the home. It also stresses on enhanced protocols to accurately identify and address GBV-related fatalities.

Abstract: Tricuspid valve pathology is a relatively common anomaly. In patients with mechanical tricuspid valve replacement, implantation of a permanent pacemaker can be challenging due to the risk of valve damage, failure, and lead fracture associated with right ventricular endocardial leads. Epicardial leads may be an option, but they require a surgical procedure and are not preferred in patients with prior thoracotomy. This case report aims to demonstrate the safety and feasibility of left ventricular (LV) pacing via the coronary sinus (CS) in a 30-year-old young female with a mechanical tricuspid valve and infected epicardial leads. Due to the complications and contraindications of traditional approaches, Lead implantation via the CS was utilized. This method allowed for successful pacemaker implantation, demonstrating the feasibility and safety of LV pacing in such complex cases. The use of CS-guiding catheters and specialized leads facilitated effective cannulation and stable, reliable pacing, avoiding the need for further invasive surgeries.

Abstract: Prion diseases are rare, incurable, and rapidly progressive. Pathogenic misfolded proteins accumulate in the central nervous system causing fatal neurodegeneration. Fatal familial insomnia (FFI) is an even rarer, hereditary subset of prion disease. The initial clinical course is nonspecific, leading to difficulties with diagnosis. We describe a patient with a family history of prion disease who presented with early symptoms of FFI including disordered sleep, cognitive dysfunction, and autonomic dysregulation. Notably, diagnostic studies including magnetic resonance imaging (MRI), cerebrospinal fluid (CSF) analysis, and electroencephalography (EEG) did not show changes characteristic of prion disease. However, genetic testing showed a pathological, heterozygous mutation c.532G> A (p.Asp178Asn), confirming FFI. His clinical course progressed rapidly, and death occurred several months after the initial hospital presentation. We discuss the pathophysiology and diagnosis of FFI and the emotional care required to treat this fatal disease. General practitioners should be aware of this rare diagnosis to improve patient management.

Abstract: Balantidium coli is the largest, uncommon, and only ciliate parasite that infects humans and is more common in tropics and subtropical regions. It is mostly asymptomatic, but can cause diarrhea and abdominal pain and sometimes leads to perforation of the colon. It is harbored in animals, particularly among pigs in hotter environments and monkeys in the jungles. If not treated on time, it may lead to perforation of the large intestine, peritonitis, appendicle involvement, etc. It is more common in immune-compromised individuals, particularly in those living in poor hygienic conditions. Retrieval of rare parasites was possible only because of prompt stool transport and its early processing. There are only few previous reports regarding the pediatric cases of balantidiasis, and there is a little information about its clinical signs and treatment. Here, we report a case series of B. coli infection presenting as an acute diarrheal disease from Rajasthan.