Journal of postgraduate medicine最新文献

Abstract: Effective healthcare leadership is essential to ensure high-quality patient care and foster a supportive work environment for healthcare professionals. This review aims to consolidate existing healthcare leadership literature to provide evidence-based insights that can guide leadership development, improve team performance, and enhance patient care outcomes. A systematic search of academic databases such as PubMed, Scopus, Web of Science, CINAHL, Embase, and Google Scholar was performed using keywords related to healthcare leadership. Studies were selected based on their relevance, peer-reviewed status, and focus on healthcare settings. Thematic analysis was employed to synthesize findings from the selected studies. The review explores various leadership theories, including Great Man, trait, behavioral, transactional, transformational, and contingency theories, highlighting their relevance and application in healthcare. Effective healthcare leaders must possess traits such as vision, emotional intelligence, adaptability, and ethical integrity to navigate the complexities of modern healthcare. The review categorizes different leadership styles, including authoritarian, transformational, transactional, servant, and participative, and discusses their application in specific healthcare contexts. Leaders face challenges such as balancing personal and professional responsibilities, adapting to technological advancements, managing financial constraints, and ensuring regulatory compliance. Healthcare leadership requires a dynamic and adaptable approach that integrates various leadership theories and styles to address the unique challenges of the healthcare environment. This review underscores the importance of leadership development programs and calls for further research to explore the practical implementation of leadership strategies in diverse healthcare settings. The findings provide actionable insights for healthcare leaders to tailor their leadership styles to the specific needs of their teams and organizational contexts, ultimately enhancing patient care and operational efficiency.

Background: Diabetic peripheral neuropathy (DPN) is a chronic microvascular complication in diabetic mellitus patients due to chronic hyperglycemia, resulting in platelet hyperactivity and dyslipidemia. Alpha-lipoic acid (ALA) is a potent antioxidant which has antiplatelet activity and lipid-modulating characteristics and plays a major role in the prevention of disease progression.

Aim: To evaluate the effect of ALA on inhibition of platelet aggregation and lipid profile.

Settings and design: This was a prospective, randomized, double-blind, placebo-controlled study conducted at the Department of Clinical Pharmacology and Therapeutics at a tertiary care hospital.

Materials and methods: We recorded efficacy parameters including changes in inhibition of platelet aggregation, lipid profile, blood sugars, and glycated hemoglobin over 12 weeks of ALA (600 mg once daily orally) supplementation in DPN patients on gabapentin (300 mg twice daily [BD]) or pregabalin (75 mg BD) compared to placebo. We used Student's t-test paired and unpaired for within-group and between-group comparisons, respectively.

Results: A total of 52 study participants (males = 22, females = 30) with a mean age 55.63 ± 7.5 years were randomized to receive either ALA or placebo. Between-group analysis at 12 weeks showed that ALA significantly inhibited both collagen-induced platelet aggregation (from 32.61 ± 8.00 to 24.88 ± 5.30; P < 0.001) and adenosine diphosphate-induced platelet aggregation (from 34.00 ± 6.97 to 25.96 ± 6.45; P < 0.001) compared to placebo. Significant reduction in total cholesterol, low-density lipoprotein cholesterol, very low-density lipoprotein cholesterol, and triglycerides was found in the ALA group at 12 weeks compared to baseline. No serious adverse events were reported.

Conclusion: ALA, an antioxidant, demonstrated a protective effect against DPN by the virtue of its inhibitory effect on platelet aggregation and lipid-modulating effects and was found to have good safety.

Introduction: The World Health Organization added methicillin-resistant S aureus (MRSA) to the list of "priority pathogens," given its capacity to cause life-threatening infections. Clindamycin is a preferred treatment for non-complicated S aureus-induced skin and soft tissue infections. Its good tissue penetration and oral absorption make it suitable for outpatient therapy. However, the emergence of inducible and constitutive (MLS B ) resistance led to clinical challenges, primarily due to the potential oversight of inducible resistance in routine antimicrobial sensitivity testing.

Materials and methods: This cross-sectional study was conducted at a tertiary care hospital during 2020-2022. A total of 158 MRSA isolates from various clinical specimens were analyzed. The Kirby-Bauer disk diffusion method using cefoxitin disk and D-test were used to identify MRSA and detect inducible clindamycin resistance (ICR), respectively.

Results: Among the 158 MRSA isolates, 34.17% showed constitutive clindamycin resistance (MLS B c), while 22.15% displayed ICR (MLS B i). In addition, 10.13% of isolates demonstrated the MS phenotype, clindamycin, and erythromycin susceptibility, with 53 (33.54%) isolates susceptible to both antibiotics. The relative risk of clindamycin treatment failure was 7.66 times higher if the D-test was not used.

Conclusion: To prevent clindamycin treatment failures, the D-test must be implemented to detect ICR in MRSA isolate. Neglecting simple and cost-effective tests may lead to inaccurate susceptibility reporting, jeopardizing treatment success.

Introduction: Machine learning (ML) has been tried in predicting outcomes following sepsis. This study aims to identify the utility of stacked ensemble algorithm in predicting mortality.

Methods: The study was a cohort of adults admitted to a medical unit of a tertiary care hospital with sepsis. The data were divided into a training data set (70%) and a test data set (30%). Boruta algorithm was used to identify important features. In the first phase of stacked ensemble model, weak learners such as random forest (RF), support vector machine (SVM), elastic net, and gradient boosting machine were trained. The SVM was used in phase 2 as meta learner to combine the results of all weak learners. All models were validated using test data.

Results: In our cohort of 1,453 patients, the mortality rate was 27% (95% confidence interval [CI]: 25, 29). The Boruta algorithm identified inotrope use and assisted ventilation as the most important variables, which could predict mortality. The random forest outperforms (area under the curve [AUC]: 97.91%) the other algorithms. The AUCs for the other models are SVM (95.21%), GBM (93.67%), and GLM net (91.42%). However, the stacking of all the above models had an AUC of 92.14%. In the test data set, the accuracy of all methods including the RF method accuracy decreased (92.6 to 85.5%).

Conclusions: The random forest showed high accuracy in train and moderate accuracy in the test data. We suggest more regional open-access intensive care databases that can aid making machine learning a bigger support for healthcare personnel.

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.