Journal of postgraduate medicine最新文献

Introduction: The alarming increase in the incidence of myocardial infarction in young population has warranted a different approach to its management. Imaging-based study of the culprit lesion has provided a new dimension in understanding this condition. The authors aimed to study the morphological characteristics in young patients (<40 years) as defined by optical coherence tomography (OCT).

Materials and methods: This prospective, single-centre, open-label, observational study was conducted at a tertiary care centre and enrolled all young patients presenting with ST-elevation myocardial infarction (STEMI) who fulfilled the inclusion criteria, between January 2020 and June 2022.

Results: Out of 36 patients who underwent OCT, plaque rupture was observed in 63.89%, followed by plaque erosion in 36.11%. White thrombus was evident in the majority of patients (55.56%). As most of our patients were fibrinolized and the procedure was not a primary PCI but performed within 48 hours as a pharmacoinvasive approach, the native characteristics of the lesion and thrombus might have changed. A total of five patients underwent balloon predilatation due to a critically stenotic lesion that prevented the OCT catheter from passing distally.

Conclusion: Plaque rupture was the most common pathology for STEMI among young patients, with plaque erosion being another important contributor. The study also highlighted an early predilection for atherosclerotic changes in the Indian population.

Introduction: Foreign body ingestion (FBI) is frequently encountered in the pediatric population and sometimes requires emergency removal. This study aimed to investigate the demographical and clinical profile, nature of foreign body (FB), and endoscopic management of FBI in a tertiary care center in India.

Materials and methods: This is a retrospective observational study of 370 patients with FBI who underwent endoscopic removal at our center from May 2019 to April 2024. Descriptive and analytical statistical tests were used to analyze the data.

Results: Out of 370 patients, 61.4% of FBs were blunt, 29.2% were sharp, and 9.5% were corrosive objects. Coin was the most common FB observed (46.5%). Furthermore, 63.78% of patients were asymptomatic. There was a positive correlation between the endoscopic location of FB and symptoms ( P = 0.030). Mucosal injuries were seen in only 34% of patients. There was a positive correlation ( P = 0.012) between the morphological nature of FB and mucosal injury. We found a positive correlation ( P = 0.034) between the size of the FB and its possibility of spontaneous passage in the GI tract. Endoscopic removal of FB was successful in 83.2% of patients.

Conclusions: Sharp and corrosive FBs should be removed on an emergency basis irrespective of their symptoms, location, and time since ingestion to avoid complications. FBs with a diameter of more than 2 cm and a length of more than 5 cm should be removed endoscopically because of their lower chances of spontaneous passage.

Abstract: Power dynamics in medical education, driven by leadership roles, significantly influence patient care, learning, research, and institutional growth. Hierarchies provide essential structure and mentorship, but can also suppress communication and ethical behaviour through intimidation and exclusion. This duality underscores the importance of addressing hierarchical dynamics in academic medicine. This narrative review evaluates the impact of hierarchical dynamics on faculty experiences, focusing on both positive and negative leadership behaviours. A comprehensive literature search was conducted across PubMed, Google Scholar, and ScienceDirect using terms such as "power dynamics," "hierarchical structures," and "faculty development." Articles published within the last 20 years were prioritised, with studies selected based on their empirical contribution and relevance to medical education. A thematic synthesis approach was used to identify key themes and strategies for fostering a supportive and inclusive academic culture. Hierarchies in medical education can positively influence faculty by offering structure, mentorship, and clear role expectations, which are critical for professional development. However, pervasive negative behaviours, including micromanagement, favouritism, and exclusion, were identified as major contributors to stress, burnout, and hindered professional growth among junior faculty and colleagues. Hierarchical dynamics are pivotal in shaping faculty experiences in medical education. Mitigating the adverse impacts of power imbalances requires regular behavioural audits, leadership training, and robust mentorship programs. These initiatives can foster an inclusive academic culture that prioritises open communication and equitable professional development. Future research should develop and evaluate targeted interventions to address power imbalances and improve institutional culture.

Abstract: Type I and Type II errors are inherent in any empirical medical research on an antecedent-outcome relationship when it is based on a dataset of a sample of subjects. Type I error is the incorrect rejection of a true null hypothesis, and its probability in a study is the P value. This error is more serious and is kept under control by specifying a cap called the level of significance. The complement of the probability of Type II error, called power, is the probability of not missing a medically significant effect when present. This article concisely explains P values, power, and medical significance in nontechnical terms for our medical colleagues and their implications for assessing the credibility of medical research.

Introduction: Antimicrobial resistance is a global health threat. Carbapenem-resistant Enterobacterales (CRE) are increasingly becoming an important cause of concern. We aimed to present a comprehensive update on CRE, including their prevalence, antimicrobial susceptibility profile, phenotypic and genotypic characterization. The study also evaluated the activity of ceftazidime-avibactam (CZA) against CRE.

Materials and methods: This was a prospective observational study conducted in a multispecialty tertiary care teaching hospital in Jaipur, western India. All consecutive non-duplicate CRE strains isolated from various clinical samples received in the laboratory during the study period were included in the study. Detection of carbapenemase enzyme production and phenotypic characterization was done using modified carbapenem inactivation method (mCIM) and EDTA-modified carbapenem inactivation method (eCIM), respectively, and genotypic detection was performed by multiplex PCR.

Results: CRE prevalence was 43%, and 91% were found to be carbapenemase producers. In addition, 94%, 91%, 21%, and 20% susceptibility was observed for tigecycline, colistin, amikacin, and trimethoprim/sulfamethoxazole, respectively. Thirty-three percent of CRE were susceptible to CZA alone, and 93% were found to exhibit synergy between CZA and aztreonam. The most prevalent carbapenemase gene detected in the current study was bla OXA-48 , which was found in 61.4% of the isolates tested. More than one carbapenemase gene was detected in 35% of the isolates.

Conclusions: This study highlights the escalating threat of CRE and emphasizes the pressing need for their continuous surveillance for appropriate management.

Abstract: India's healthcare system faces substantial challenges, including a high burden of communicable and non-communicable diseases, limited access to healthcare in rural areas, and a shortage of skilled healthcare professionals. Artificial intelligence (AI) offers promising solutions to address these gaps by enhancing diagnostic accuracy, improving disease prediction, and optimizing treatment management. This scoping review examines AI's role in early detection, treatment, and disease prevention in community health settings. A comprehensive literature search was conducted in PubMed, Embase, Scopus, and Google Scholar from January 2013 to July 2024. Eligible studies focused on the application of AI in public health, emphasizing early detection, disease prevention, and treatment interventions. Data on AI models, health outcomes, and performance metrics were extracted and analyzed in line with PRISMA-ScR guidelines. Forty-eight studies were analyzed and categorized into diagnostic accuracy, disease prediction, treatment management, and clinical validation. AI-based tools, such as AIDMAN for malaria detection, demonstrated high diagnostic accuracy (95%) and AUC (0.96). Predictive models for chronic kidney disease (93% accuracy) and diabetes (91% accuracy) showed substantial promise. TB screening using AI-powered cough analysis achieved 86% accuracy. The studies also emphasized AI's role in managing chronic diseases, facilitating early interventions, and reducing healthcare burdens in resource-limited settings. AI has the potential to revolutionize healthcare delivery in India, particularly in underserved regions, by enhancing early detection and treatment. However, challenges related to data privacy, algorithmic bias, and infrastructure require attention. Continued research and policy development are essential to fully harness AI's capabilities in improving public health outcomes.

Abstract: Tuberculosis as cause of mediastinal mass, is rare in children, and may be seen in immunodeficiencies. Data on the prevalence of mediastinal tuberculosis and on its clinical spectrum and outcome is lacking in children. A 4.5-month-old boy presented with fever and cough since 7 days and increased respiratory activity. He had respiratory distress with hypoxia. Examination revealed decreased breath sounds on the right lung with tracheal shift to the left. Chest radiograph showed homogenous opacity in the right upper zone, with heterogenous opacity in the right middle and lower zones and tracheal shift to left. Computed tomography scan confirmed the presence of mediastinal abscess. Human immunodeficiency virus status of patient's mother and primary immunodeficiency workup of the child were negative. In view of clinical deterioration and non-responsiveness to 10 days of intravenous antibiotics, tuberculosis workup was done. GeneXpert of the abscess aspirate showed Mycobacterium tuberculosis (rifampicin resistant). Patient was labeled as pre-XDR tuberculosis based on the line probe assay. Antitubercular regimen was modified accordingly (linezolid, amikacin, cycloserine, clofazimine, and ethionamide). The child required invasive mechanical ventilation in pediatric intensive care unit (PICU) for 15 days. The patient showed clinical and radiological improvement and was discharged after 6 weeks of inpatient stay. However, the patient was readmitted 16 days later with linezolid-induced lactic acidosis, developed measles, and succumbed to measles complication (pneumonia).

Abstract: Thunderclap headaches and multifocal cerebral artery constrictions characterize reversible cerebral vasoconstrictive syndrome (RCVS). Leucine-rich glioma-inactivated 1 (LGI-1) autoimmune encephalitis (AE) presents as limbic encephalitis, hyponatremia, and faciobrachial dystonic seizures. Their unusual presentation concurrently is unknown. We describe a rare case of LGI-1 AE with RCVS. A 31-year-old lady presented with acute onset visual loss and encephalopathy on the background of sleep behavioral symptoms. Retrospectively, the patient complained of having muscle twitching, and mood changes. Her blood pressure was high (220/120 mm Hg). Blood investigations revealed hyponatremia and positivity for LGI-1+ and anti-amphiphysin 1+ antibodies. Neuroimaging initially showed features of RCVS. The cerebrospinal fluid study was unremarkable. Electromyography showed florid fasciculations with myokymic discharges. She was treated with steroids and responded to immunotherapy (Azathioprine). She maintained well into follow-up. AE is a great mimicker. Knowledge about atypical presentations is important for guiding treatment and further clinical course.