Journal of postgraduate medicine最新文献

Abstract: Insulin autoimmune syndrome (IAS) is a rare cause of spontaneous hypoglycemia characterized by the presence of insulin autoantibodies. Alpha-lipoic acid (ALA), a widely used nutraceutical, has been increasingly recognized as a potential trigger for IAS. We report two cases of ALA-induced IAS in Indian patients and review existing literature to highlight its clinical presentation, diagnostic challenges, and management strategies. In the first case, rapid-onset severe hypoglycemia mandated the use of oral steroids with gradual tapering and stoppage over a duration of few months, while in the second case, mild hypoglycemia was essentially managed with dietary modifications alone and the condition remitted on its own. ALA-induced IAS should be considered in the differential diagnosis of hyperinsulinemic hypoglycemia. Early recognition and appropriate management can prevent severe complications and avoid unnecessary investigations to evaluate other causes of hyperinsulinemia.

Abstract: We report a case of an elderly female with subacute submental neck swelling, dry cough, and a history of significant weight loss. Unexpectedly, a left submandibular chronic sialadenitis was noted on ultrasound of the neck, along with a thyroid nodule that, on biopsy, showed lymphocytic infiltration. High-resolution computed tomography of the lungs revealed multifocal irregular consolidations with lymphadenopathy, and possible infective causes, including tuberculosis, were ruled out after a thorough microbiological evaluation. It was only after a positron emission tomography-guided lung biopsy with specialized immunohistochemical staining was performed that the diagnosis of IgG4-related disease (IgG4-RD) was confirmed. Our patient exhibited overlapping features of head and neck-limited and Mikulicz/systemic phenotype of IgG4. In this case report, we highlight the clinical phenotypes of IgG4-RD, their respective differential diagnoses, and discuss our approach to this challenging case.

Introduction: Artificial intelligence (AI) platforms have achieved a noteworthy role in various fields of medical sciences, ranging from medical education to clinical diagnostics and treatment. ChatGPT, Gemini, and Meta AI are some large language models (LLMs) that have gained immense popularity among students for solving questions from different branches of education.

Materials and methods: A cross-sectional study was conducted in the Department of Microbiology to assess the performance of ChatGPT, Gemini, and Meta AI in answering higher-order questions from various competencies of the microbiology curriculum (MI 1 to 8), according to CBME guidelines. Sixty higher-order questions were compiled from university question papers of two universities. Their responses were assessed by three faculty members from the department.

Results: The mean rank scores of ChatGPT, Gemini, and Meta AI were found to be 102.76, 108.5, and 60.23 by Evaluator 1; 106.03, 88.5, and 76.95 by Evaluator 2; and 104.85, 85.6, and 81.04, respectively, indicating lowest overall mean rank score for Meta AI. ChatGPT had the highest mean score in MI 2,3,5,6,7, and 8 competencies, while Gemini had a higher score for MI 1 and 4 competencies. A qualitative assessment of the three platforms was also performed. ChatGPT provided elaborative responses, some responses from Gemini lacked certain significant points, and Meta AI gave answers in bullet points.

Conclusions: Both ChatGPT and Gemini have created vast databases to correctly respond to higher-order queries in medical microbiology in comparison to Meta AI. Our study is the first of its kind to compare these three popular LLM platforms for microbiology.

Introduction: Whether the protective role of optimal cardiovascular health (CVH) exists among individuals with preexisting cardiometabolic comorbidities and to what extent these impacts on longevity are unknown. This study aims to evaluate the protective effect on mortality in individuals with and without cardiometabolic comorbidities.

Materials and methods: This cohort study utilized data from the China Health and Nutrition Survey. CVH was evaluated using the Life's Essential 8 (LE8) metric. Five cardiometabolic comorbidities, namely hypertension, diabetes mellitus (DM), dyslipidemia, chronic kidney disease (CKD), and cardiovascular disease (CVD), were self-reported. The outcome was all-cause mortality.

Results: Maintaining intermediate/ideal CVH attenuated the hazardous impact of hypertension (intermediate/ideal CVH: HR: 1.02; 95% CI: 0.71, 1.47; poor CVH: HR: 1.50; 95% CI: 1.16, 1.95), prediabetes (intermediate/ideal CVH: HR: 1.00; 95% CI: 0.64, 1.55; poor CVH: HR: 1.81; 95% CI: 1.30, 2.52), DM (intermediate/ideal CVH: HR: 2.53; 95% CI: 1.65, 3.87; poor CVH: HR: 5.02; 95% CI: 3.74, 6.76), dyslipidemia (intermediate/ideal CVH: HR: 1.13; 95% CI: 0.76, 1.68; poor CVH: HR: 1.29; 95% CI: 0.89, 1.86), and CKD (intermediate/ideal CVH: HR: 1.36; 95% CI: 1.01, 1.84; poor CVH: HR: 1.84; 95% CI: 1.21, 2.79) on longevity ( P for interaction < 0.05). No significant interaction between CVD and CVH was observed in the association with mortality. CVH status significantly interacted with the associations between cardiometabolic comorbidities and the risk of mortality when the number of comorbidities increased up to 3.

Conclusions: CVH significantly attenuated the detrimental impacts of cardiometabolic comorbidities on longevity, highlighting the protective role of CVH even in individuals with preexisting cardiometabolic diseases.

Abstract: Sickle cell disease (SCD) is prevalent in Sub-Saharan Africa, the Middle East, and parts of India, where it is often complicated by iron deficiency anemia (IDA). Untreated IDA exacerbates SCD symptoms, reducing quality of life (QOL) and increasing morbidity and mortality. Diagnosis typically depends on ferritin levels, which can be unreliable due to inflammation associated with SCD's altered red cell morphology and chronic hemolysis. This systematic review and meta-analysis explores the interplay between IDA and SCD, focusing on diagnostic criteria for effective management. We conducted a thorough search of PubMed and EMBASE, leading to the selection of 14 studies following PRISMA guidelines. The review protocol was registered in PROSPERO (CRD42023462914). Data extraction, quality assessments, and heterogeneity checks were rigorously performed. Out of 3188 articles, 14 studies met the inclusion criteria, covering 763 SCD cases with 118 instances of IDA. The meta-analysis found an IDA prevalence of 6% (95% CI: 1%-20%) among SCD patients, with high heterogeneity (I 2 = 88.8%). Sensitivity analysis adjusted for publication bias indicated an 8% prevalence (95% CI: 4%-19%) with reduced heterogeneity (I 2 = 19.5%). Subgroup analysis revealed a lower prevalence of IDA in pregnant women (0.01%; 95% CI: 0.00%-0.92%) compared to non-pregnant individuals (7%; 95% CI: 2%-22%). The study highlights significant regional variability in IDA prevalence among SCD patients, emphasizing the importance of early diagnosis and targeted management to improve patient outcomes and QOL.

Abstract: Data are the soul of most empirical research. Adequate data collection and their proper collation are essential to arrive at right conclusions. These conclusions are mostly drawn from the statistical analysis of properly collated data. Since the methods of statistical analysis are different for different types of data, a clear understanding of various types of data is necessary for their efficient processing. Whereas broad types of data-quantitative and qualitative-are well known, some researchers struggle with the proper collation of ordinal data and quantitative categories. Additionally, some young researchers need guidance on preparing tables to communicate their results effectively. Graphics add muscles to the skeleton of data and need to be judiciously chosen. This article provides details of various types of data, their adequacy, and their proper collation, including a brief on tables and graphics. Almost all medical researchers carry out these activities - thus, this may have wide ramifications. Although this article primarily targets postgraduate students and young researchers, our interaction with a diverse group of researchers suggests that many experienced researchers may also find this article useful in the management of their data for reaching the right conclusions.

Introduction: Urinary tract infections make up a major proportion of infections encountered in outpatient setting in hospitals. Treatment is largely based on the epidemiology of locally prevalent flora. Selection of an appropriate antibiotic is crucial, as inappropriate use could contribute to an alarming rise in antimicrobial resistance.

Materials and methods: This is a retrospective observational study conducted in a tertiary care teaching hospital. The urine samples were inoculated on cysteine lactose electrolyte-deficient (CLED) media and identification, and antimicrobial susceptibility testing of uropathogens was done using VITEK-2 system.

Results: A total of 3893 urine samples were received during the study period, out of which 293 (7.5%) samples were reported positive, including 167 (57%) females and 126 (43%) males. The most common pathogenic isolates were Escherichia coli (191, 65.1%) followed by Klebsiella pneumoniae (42, 14.3%), Enterococcus spp (20, 6.8%), and Pseudomonas aeruginosa (19, 6.4%). Cotrimoxazole resistance was observed in 52.3% Escherichia coli and 47.1% Klebsiella pneumoniae isolates. About, 100% susceptibility was observed for fosfomycin. A total of 58.1% Escherichia coli and 40.7% Klebsiella pneumoniae isolates were found to be multi-drug resistant (MDR).

Conclusion: According to this study, cotrimoxazole, cephalosporins, and fluoroquinolones need to be curtailed for empirical treatment of UTI in OPD because of high resistance. Nitrofurantoin and fosfomycin may be considered as drugs of choice for empirical therapy of lower UTIs.

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.