Journal of postgraduate medicine最新文献

Abstract: Whether it is the diagnosis, treatment, and prognosis of individual patients or the research results derived from group studies, uncertainties are an integral part of the decision-making process because of the omnipresence of inter- and intra-individual variations. Whereas artificial intelligence methods are poised to steeply reduce the uncertainties at the individual level, they cannot completely eliminate the role of chance. This is especially so with group-based medical research where uncertainties may still confound the decision processes even with the advent of artificial intelligence. Probabilities quantify the uncertainties. Confidence level and the level of significance measure the probability in different contexts in statistical inference and remain the essential features of group-based research. Some researchers mix up these two levels. This article explains the difference between these two levels and offers a new perspective in the era of artificial intelligence.

Introduction: Functional bowel disorders (FBD) are chronic, recurrent, debilitating disorders affecting the mid or lower gastrointestinal tract with no identifiable underlying pathology. There is a dearth of Indian studies focusing on treatment awareness and prescription evaluation in FBD. Due to chronic course, patients tend to self-medicate. The study was planned to evaluate disease and drug treatment awareness, self-medication practices, and prescription patterns in FBD patients.

Materials and methods: A cross-sectional, single-center, questionnaire-based study was carried out on FBD patients after getting clearance from the Institutional Ethics Committee. The patients were administered two questionnaires, i.e. disease/drug awareness and self-medication questionnaire. Prescriptions were analyzed based on World Health Organization prescribing indicators.

Results: A total of 118 FBD patients were enrolled and the common disorder was functional constipation (94/118, 79.7%). Number of males (77/118, 65%) was greater than females (41/118, 34%). In disease awareness (98/118, 83%), patients opined that FBD occurs frequently and agreed that medications can treat FBD. In treatment awareness (106/118, 90%), patients were aware about the importance of drug compliance, but only (10/118, 9%) knew the adverse effects. In prescription patterns, a total of 311 medications were prescribed. A total of 173 medications were primary drugs for FBD. Laxatives were the common class (98/138, 68.9%) prescribed with polyethylene glycol (77/138, 55.7%) as the most common drug prescribed for functional constipation. A total of 28/118 (23.7%) patients' self-medicated prior to visiting the current OPD.

Conclusions: FBD patients were aware of the dosing schedule and consulted their treating doctor but awareness regarding drug name, and adverse effects was poor among the patients. Laxative-polyethylene glycol was the common drug prescribed. Only less than 1/4 th of patients resorted to self-medication commonly with herbal remedies.

Abstract: Pediatric sternal abscess with associated osteomyelitis is an infrequent but challenging clinical entity. Atypical presentations and negative bacterial cultures compound its diagnosis. This report details a case of a 5-year-old boy who presented with a progressively increasing lower sternal swelling for 1 month. Upon examination, the lesion was suggestive of a sternal abscess. Work-up revealed leukocytosis and a raised erythrocyte sedimentation rate. Magnetic resonance imaging depicted a hyperintense collection in the subcutaneous tissue, extending into the retrosternal space, accompanied by osteomyelitic changes in the manubrium. Surgical drainage of the superficial abscess and curetting of the bony edges of the manubrium, including excision of the sinus tract, were performed. The patient was initiated on anti-tubercular therapy, to which he exhibited a favorable response. The follow-up visits showed adequate healing and new bone formation. Anti-tubercular therapy is a cornerstone for a successful treatment modality for pediatric sternal abscess with tubercular osteomyelitis. Timely intervention and interdisciplinary collaboration are essential for achieving optimal outcomes.

Introduction: Antimicrobial resistance (AMR) is a growing concern, particularly in critical care, where patients are more susceptible to infections by multidrug-resistant organisms. Understanding local resistance trends is essential for guiding effective empirical therapy. This study aimed to assess the prevalence and resistance profile of bacterial pathogens isolated from patients admitted in intensive care units (ICUs) in a tertiary care hospital located in northwestern India.

Materials and methods: This was a retrospective observational study conducted for 1 year from January 2024 to December 2024 in the Department of Microbiology at a tertiary care teaching hospital in northwestern India. All clinical specimens (blood, urine, pus, respiratory secretions, etc.) from patients admitted in ICU were processed using standard microbiological protocols. Organism identification and antimicrobial susceptibility testing were performed using a VITEK-2 Compact system and interpreted using Clinical Laboratory Standard Institute guidelines.

Results: Out of 8858 samples received, 2507 (28.3%) were culture-positive. Gram-negative bacteria constituted 60.4% of isolates, predominated by Klebsiella pneumoniae (34.4%), 88.4% being carbapenem resistant. Among nonfermenters, Acinetobacter baumannii (23.6%) was most common with carbapenem resistance around 98.4%. For Gram-positive, Enterococcus spp 245 (44.6%) predominated, followed by Coagulase-negative Staphylococcus (39.9%). The prevalence of Methicillin-resistant Staphylococcus aureus (MRSA) and vancomycin-resistant Enterococci (VRE) was 58% and 39.7%, respectively.

Conclusions: Our ICU ecosystem harbors a substantial burden of multidrug-resistant organisms, including alarming levels of carbapenem-resistance, MRSA, and VRE. These data underscore the urgent need for robust antimicrobial stewardship and stringent infection control practices. Continuous surveillance is vital to optimize empirical treatment strategies in critical care settings.

Abstract: Angioedema without urticaria (AEwU) is an uncommon manifestation of autoimmune thyroid disease (AITD), rarely reported in the pediatric population. A 12-year-old boy presented with recurrent episodes of angioedema affecting the lips and eyelids for 6 months, unresponsive to antihistamines. There were no systemic symptoms, wheals, or identifiable allergic triggers. Laboratory evaluation revealed normal C1-inhibitor levels and function, ruling out hereditary angioedema. Notable findings included eosinophilia (14.4%) and elevated serum Immunoglobulin E levels (1617 IU/mL), while bone marrow flow cytometry and serum tryptase levels were normal. Autoimmune screening identified AITD with overt hypothyroidism (thyroid-stimulating hormone: 34 μIU/mL). A diagnosis of AEwU secondary to AITD was considered. Initiation of levothyroxine (62.5 μg/day) led to symptom resolution within 3-4 days, with no recurrence in eight months. AEwU secondary to AITD is a diagnosis of exclusion and should be considered in patients with unexplained angioedema after ruling out hereditary and allergic causes.

Abstract: Cardiac myxomas (CMs) constitute one of the most common benign tumors of the heart, with a characteristic histomorphology of "lepidic cells" in an eosinophilic myxoid material, warranting immediate recognition. However, several, though uncommon, alterations in the classic pathological features hinder straightforward diagnosis. This is a report of one such intriguing entity, in which the myxoma shows the presence of glandular components, with a brief overview of the histogenesis, immunohistochemical characteristics, and differential diagnosis of glandular CMs.

Introduction: Common bile duct (CBD) stones are present in approximately 5-18% of patients undergoing cholecystectomy for gallstones. Nearly half of them suffer from complications of choledocholithiasis. Such cases are managed by endoscopic retrograde cholangio-pancreatography (ERCP) with stone clearance followed by laparoscopic cholecystectomy (LC). Prophylactic CBD stenting post-ERCP stone clearance is practiced in some centers to prevent stone reimpaction, though its necessity remains debated due to potential complications such as adhesions and technical difficulty during subsequent surgery.

Materials and methods: This prospective observational study included 84 patients aged ≥18 years who underwent LC within seven days of successful ERCP with complete CBD clearance, without stenting. Intraoperative parameters and difficulties, postoperative complications, and hospital stay were recorded. Patients were followed up to 14 days postprocedure.

Results: Among 84 patients (61.9% female; mean age 39.8 ± 4.5 years), 79.8% achieved single-session CBD clearance. Intraoperative adhesions were seen in 40.5% of cases. Bile spillage occurred in 17.9%; 15.5% experienced blood loss >100 ml. Conversion to open cholecystectomy was required in 11.9% of patients. The average hospital stay was 3.48 ± 1.65 days. No readmissions or recurrent CBD stones were noted at follow-up.

Conclusions: Omitting prophylactic CBD stenting after ERCP does not increase intraoperative or postoperative complications. Early LC without stenting is a safe, effective, and resource-optimized strategy, suggesting ease of surgery without any stent-in-situ and early discharge as well as the added benefit of no need of stent removal later.

Abstract: Esophageal perforation is a rare but critical emergency that requires early detection and prompt management. Iatrogenic esophageal injury is the most common cause of esophageal perforation in children, and most cases occur during endoscopic dilatation of strictures. There are various options available for the management of iatrogenic esophageal perforation, such as conservative management, endoscopic interventions, or surgical interventions. Surgical interventions for esophageal perforation have a high risk of perioperative morbidity and mortality. Endoscopic metal stenting is one of the minimally invasive treatment options for the management of esophageal perforation. However, this procedure is rarely implemented in the pediatric population due to the unavailability of appropriately size-matched endoscopic accessories. Here, we report a case of a 22-month-old male child born with a tracheoesophageal fistula, who underwent corrective surgery twice and developed anastomotic site esophageal stricture. The patient developed esophageal perforation during endoscopic dilatation of the stricture and was managed successfully with a biliary fully covered self-expandable metal stent.