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Background: The prevalence of stress among medical students has been reported to be different. Medical undergraduates especially in MBBS first phase are more likely to develop psychological distress than in later phases. It may affect their physical and mental health leading to anxiety, depression, and poor academic performance. Aim and Objectives: The objectives of this study are as follows: (1) To assess the prevalence of stress and its effects among Medical undergraduates, that is, MBBS 1st Phase students at the time of their joining to the course (baseline) and after about 8 months of their joining (repeat testing). (2) To compare any difference in levels of stress and its physical and psychological effects among male and female students. Materials and Methods: A cross-sectional study was conducted with the help of Hamilton Anxiety Rating Scale (HAM-A) on 141 students of MBBS first Phase in the Department of Physiology. The data were collected only after taking informed consent. Results: Among our male and female students at the time of baseline scoring, mild anxiety was observed in (95% of males and 91% of females) and mild-to-moderate anxiety (4% of males and 8% of females). At the time of repeat scoring mild anxiety (93% of males and 85% of females), mild-to-moderate anxiety (7% of males and 10% of females) was observed. Anxiety was observed to be more in our female students as compared to male students. Comparative analysis of each variable of HAM-A (baseline and repeat score) showed a significant difference (P < 0.0001) in eight HAM-A variables in repeat score as compared to four variables in baseline score. Conclusion: Early screening of MBBS first phase students should be planned for the presence of stress and its negative and lethal health consequences. Academic and psychological counseling should be provided to them.
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Background: The conventional drug regimen of sedation for patients requiring mechanical ventilation in an intensive care unit (ICU) is propofol or midazolam. Dexmedetomidine is a newer drug for sedation with a better clinical profile. We conducted this study to compare the sedative efficacy of dexmedetomidine versus propofol in patients after head and neck cancer surgeries requiring mechanical ventilation. Methods:After ethics committee approval and written informed consent, 80 patients undergoing head and neck onco?surgery were recruited. The patients were randomly allocated to group I[1 mg/kg of bolus propofol over 15minutes followed by infusion of 1 mg/kg/hour titrated by increasing or decreasing the infusion dose to Ramsay Sedation Score (RSS) 2� or group II (a loading dose of dexmedetomidine 1 mcg/kg over 15 minutes followed by a maintenance dose of 0.4 礸/kg/hour titrated to desired sedation level). The RSS, behavioral pain scale (BPS), heart rate, blood pressure, fentanyl consumption, additional sedative agent, extubation time, length of ICU stays, mechanical ventilation duration, side effects, and patient抯 satisfaction were noted. Results: Total fentanyl required was 0.56 � 0.13 礸/kg/hour in group II and 0.58 � 0.18 礸/kg/hour in group I(P = 0.75). Extubation time, RSS, BPS, patient satisfaction, and ICU duration were similar in both the groups. The incidence of hemodynamic?related adverse effects were 41.67% in group II and 11.11% in group I (P = 0.006). Conclusion: The fentanyl requirement was comparable in both the groups in the postoperative period. Dexmedetomidine was associated with an increased incidence of bradycardia and hypotension as compared to the propofol group. Propofol should be the preferred sedative for postoperative mechanical ventilation after head and neck onco?surgeries.
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In October 2022, the launch of first year MBBS books in Hindi language in the state of Madhya Pradesh in India kick started the debate on the introduction of Hindi/local language in medical education, which is currently being imparted in English. Opinions have been divided among the supporters of Hindi and local languages as well as opponents of this move. However, several issues need to be addressed before wider implementation of the policy of imparting medical education in Hindi/local languages. Right from infrastructure, human resource, economic impact, academic impact, international effects to legal issues have to be kept in mind and stakeholders must discuss these before implementation. A subsequent reversal of this policy, either through executive orders or judicial intervention, could lead to irreparable loss to students enrolled and trained in Hindi/local language.
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Background: Every student faces stress after their admission to higher educational institutes. The examination process is one major form of an unpredictable type of academic stressor. Aims and Objectives: The objectives of the study are as follows: (1) To measure the baseline cardiorespiratory parameters: Systolic blood pressure (SBP), diastolic blood pressure (DBP), pulse rate (PR) and respiratory rate (RR), and pre-examination readings to evaluate the effect of stress on all the above and (2) to compare their values among all the students and different gender also. Materials and Methods: In our study, 146 MBBS first phase students, age group of 18–20 years, had participated. After written consent, their anthropometric parameters and cardiorespiratory parameters – baseline and pre-examination readings were measured and data were analyzed statistically. Results: In the male students, the SBP (P < 0.05), DBP and RR both (P < 0.001) were found to increase statistically significantly, while DBP and RR was found to increase significantly in female students (P < 0.001). PR was observed to increase statistically not significantly (P > 0.05). Conclusion: Academic stress affected most of the cardio-respiratory parameters in our students. Thus, we suggest the need of continuous academic and psychological support in the form of counseling sessions to overcome the stress.
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Artificial intelligence (AI) in today’s era has been described as “the new electricity” as it continually transforms today’s world by affecting our way of living in many different spheres. Extensive government programs in most countries and enhanced technology investments thereof are set to rapidly advance AI. Consequently, healthcare teams will be majorly affected by intelligent tools and systems to be launched into healthcare and patient homecare settings. AI represents a variety of functions under an umbrella of terms like machine learning (ML), deep learning, computer vision, natural language processing (NLP) and automated speech recognition (ASR) technologies. Each of these when used individually or in combination has the potential to add intelligence to applications. Understanding of AI in medical field is crucial for nurses. Utilization of AI in nursing will accelerate innovation and fasten up decision making for them thus saving their time and improving patient outcome plus satisfaction with nursing care provided. Of utmost importance while partnering with AI is the requirement for AI to be safe and effective. A major concern for AI practitioners in the current scenario is managing bias. To realize the full potential of AI, stakeholders (AI developers and users) need to be confident about two aspects: (1) reliability and validity of the datasets used and (2) transparency of AI based system. Issues encompassing AI are novel yet complex, and there is still much to be learnt about it. Nursing experience, knowledge, and skills will transit into new ways of thinking and processing information. This will give new roles to nurses-like information integrators, data managers, informatics specialists, health coaches and above all deliverers of compassionate caring-not replaced by AI technologies yet supported by them.
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Background: Feedback of client/customer is the key for improvement in any services. It is a precious input for identifying gaps and developing an effective action plan for quality improvement in any organization. Hence, patient feedback on services provided by the health care organization is important quality tool for improvement of services both in public and private hospitals. With the back ground this study was conceptualized with the aim to analyse feedback of inpatients admitted in private wards of a government tertiary care hospital of India, regarding hospital personnel and for basic amenities provided by the hospital. Methods: This was a record-based study where predesigned feedback forms of one year were analysed. Feedback was categorized under three themes and subthemes which were services provided by the hospital, infrastructure of the hospital and feedback with respect to the care provided by the hospital staff. Results: 80% patients were dissatisfied with the delay in conduct of investigations and receipt of reports and cleanliness in ward, housekeeping services and quality of food. As far as clinical care and soft skills of healthcare providers are concerned, 80% of the patients were satisfied by the care provided by doctors and nurses. Suggestions were analysed and implemented to strengthen the service delivery to initiate quality assurance. Conclusions: Major factors for dissatisfaction among patients are the unscientific processes which can be improved with minimum cost.
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Cervical cancer, which is mostly caused by infection with the human papillomavirus (HPV), is the second most common malignancy in women worldwide and the main illness affecting Indian women. It has been demonstrated that many developing countries lack basic information and health-seeking behaviours, necessitating the need for an effective awareness and immunization programme. For public health, the HPV vaccine is essential. For all females who can afford it, the Indian Academy of Paediatrics Committee on Immunization (IAPCOI) suggests administering the HPV vaccine. Females as young as 9 years old and those who have not received all recommended vaccinations between the ages of 13 and 26 can receive vaccinations. Cervical cancer can be prevented in a number of ways, however vaccination is currently the most effective strategy. The most effective means of preventing cervical cancer include HPV vaccination and routine cervical screening. Before beginning this chemoprophylaxis against cervical cancer, parents and caregivers of the child must receive education regarding HPV vaccine. In order to mobilise the scientific, public health, and civil society communities to adopt the vaccination policy, gaps and challenges to HPV vaccination access and delivery must be addressed.
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@#Introduction: The preferred management of medial meniscus tears has notably moved from meniscectomies towards repair. With a higher volume of meniscal repairs being done all across the world with every passing day, the lack of an objective and definitive sign suggesting the adequacy of its repair is daunting. The purpose of our study was to introduce a unique and novel arthroscopic sign formed after adequate repair of the medial meniscus, the AMR (Adequacy of Medial meniscus Repair) sign. We hypothesised that it is not only the objective end point for repair, but can also form the indicator for excellent clinical, functional, and radiological outcome even in the long term. Materials and methods: This was a multicentric, prospective study initiated by the corresponding author, and the findings validated subsequently by the other authors. Overall, it included 804 patients of isolated medial meniscus tear operated with arthroscopic all-inside technique between January 2014 and December 2017. Patients were segregated into three groups based on whether an S-shaped curve in the free, inner edge of the medial meniscus sign was formed post-repair, lost after further tightening, or not formed upon subjective completion of repair. All the patients were followed-up and evaluated based of medial joint line tenderness, McMurray’s test for medial meniscus, IKDC score, WOMET score, and radiologically using an MRI at the terminal follow-up. Results: The mean terminal follow-up was 42.34±4.54 months. There was significant (p<0.01) improvement in all patients at the terminal follow-up post-surgery, irrespective of the group. The group in which AMR sign was formed and maintained showed a significantly better functional outcome on terminal follow-up as well as lower failure rates compared to the other two groups. Conclusion: AMR sign is an S-shaped fold at the inner, free edge of medial meniscus, formed after an adequate repair of isolated medial meniscus tear, as viewed on arthroscopy. It is an objective sign denoting regained integrity of the collagen architecture of the medial meniscus following repair. It is also a reliable indicator of excellent long term functional, clinical, and radiological outcome and also lower failure rates in patients after arthroscopic medial meniscus repair.
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Objectives: Globally, the case fatality ratio is more in males versus females. Some studies have suggested estrogen hormone decreases susceptibility to SARS CoV-2. We have analyzed the observed sex differences in COVID-19 behavior in males and females and the clinical profiles of females of different age groups of COVID-19 patients and discussed their symptoms, laboratory evaluations, and associated comorbidities. Material and Methods: The patients were tested for COVID-19 through real-time RT-PCR (Reverse Transcription Polymerase Chain Reaction) assay. The data obtained were studied for the epidemiological, clinical, and laboratory characteristics from their medical records. Results: The mortality rate in females was 12.33% (36/292) whereas mortality in males was 19.63% (84/428). In between group analysis, 8.7% (14/161) of females died in the <40 years age group versus 16.8% (22/131) in more than 40 years age group whereas in males, the mortality was 13.7% (21/153) in <40 years versus 22.9%(63/275). The mortality rate in women older than 40 years was greater than mortality in younger females emphasizing the protection provided by estrogen hormone in them. The proportion of patients who expired due to COVID-19 significantly differs by age cutoff of 40 years, X2 (1, n = 428). The difference is statistically significant at P < 0.05. Males more than 40 years are more likely to expire. Conclusion: Sex-related differences in coronavirus pandemic have been found pointing toward the protective role of estrogen hormone and other differences in immunological behavior in males and females. Downregulation of ACE2 expression, thereby reducing viral entry, might also be contributory to decreasing mortality in females.
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Background: Targeted therapy using tyrosine kinase inhibitors in cases of non-small-cell lung carcinoma (NSCLC) that harbor epidermal growth factor receptor (EGFR) mutations has drastically improved the overall survival rate. The current study estimated the frequency of EGFR mutations in the Indian population by analyzing the diagnostic parameters of various techniques available for the detection of these mutations. Materials and Methods: A case series of 100 histologically diagnosed and immunohistochemically confirmed NSCLC with the adenocarcinoma phenotype comprises the study sample. EGFR mutations were detected using clone-specific immunohistochemistry (IHC), real-time polymerase chain reaction (PCR), and Sanger sequencing. Results: EGFR mutations were identified in 48% cases with 72.78% mutations involving exon 19. Clone-specific IHC had a low sensitivity of 46.43%, and the specificity was 79.17%. Sanger sequencing yielded interpretable results in 16% cases only, which were in concordance with the results of real-time PCR. Conclusion: EGFR mutations are increasingly being explored for targeted therapy and personalized medicine. Real-time PCR was found to be the best and the most accurate method for the detection of somatic EGFR mutations in adenocarcinoma primarily in the lungs.
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Background: The price of medicine in India has always been a point of discussion in public domain. The price range of the same drug is very large with more than 100% difference between various brands available in different settings. Aims and Objectives: To assess the price of different drugs at Jan Aushasdhi (JA), AMRIT and Private Chemist and to compare the prices of these three outlets so that the issues. Material and Methods: This institution-based cross-sectional study was carried out from May 2019 to June 2019. A pretested proforma was prepared to compare the prices of 284 different medicines in Jan Aushadhi, AMRIT and private chemist shops. The collected data were entered in an Excel spreadsheet and presented in Proportions, percentages, and mean. Results: The price of 284 medicines were compared from JA (Median(IQR)- 15.18(18.75) INR) and Private chemist shop (Median(IQR)-88(111.5) INR) while 249 medicine from AMRIT (Median(IQR)-61.05(78.33) INR). Although the majority of the AMRIT drugs are cheaper than the chemist shop except for 31% of Antipsychotic drugs, 26.6% of antihypertensives, 25% of respiratory drugs, 25% of steroids, 21.9% of antibiotics. Conclusion: We concluded that JA is providing drugs cheaper than AMRIT and Private chemist . The prices of medicines offered at AMRIT are lower than market pricing but they are costlier when compared to JA prices.
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Purpose: To record central corneal thickness and corneal diameter in preterm and term newborns within first week of their birth and in preterm neonates at term age. Methods: Babies born at ?34 weeks of gestation period (n = 100), term babies who have a gestation period of >37 weeks (n = 100) and preterm neonates at term age (38-42 weeks) who were born at ?34 weeks (n = 100) were included in this hospital based observational descriptive study. Corneal diameter was taken by Castroviejo Calipers. Central corneal thickness was measured using portable ultrasonic pachymeter (Pachette 3). Refractive status of the eyes was measured using streak Wellch Allyn retinoscope under cyclopentolate cycloplegia. Results: Measure of central corneal thickness and corneal diameter in preterm newborns was found to be 633.5 ± 2.8 ?m and 8.1 ± 0.6 mm, in full term newborns it was 555.1 ± 2.7 ?m and 9.5 ± 0.6 mm, and in preterm neonates at term age, it was 563.5 ± 2.5 ?m and 9.6 ± 0.5 mm, respectively. Mean central corneal thickness was found to be more in preterm newborns 633.5 um then term newborns 555.1 um and the difference was statistically significant (P =0.001). Mean corneal diameter was found to be maximum (9.6 mm) in preterm neonates at term age. Conclusion: Preterm babies have thick corneas and small corneal diameters. This study is useful with respect to the analysis of glaucoma in children and using preterm corneas as donor corneas in penetrating keratoplasty.
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Background: C-ros oncogene 1, receptor tyrosine kinase (ROS 1) proto-oncogene 1, receptor tyrosine kinase (ROS-1) fusions are potent oncogenic drivers and these re-arrangements promote signal transduction programs leading to uninhibited cell survival and proliferation identified in 1–2% of cases of nonsmall-cell lung cancer. Mesenchymal epithelial transition factor (MET) receptor tyrosine kinase and its ligand are predominantly involved in epithelial mesenchymal transition and tissue regeneration. The MET amplification and overexpression is oncogenic in 3–7% cases. The objectives of this study were to identify the frequency of ROS-1 and c-MET protein expression in adenocarcinoma lung and to correlate it with the clinicopathological parameters and to analyze the histomorphology of cases that harbor the characteristic mutations (c-MET and ROS-1). Materials and Methods: Study group comprised a prospective cases series of 90 cases of adenocarcinoma lung. ROS-1 protein expression was determined by immunohistochemistry using the D4D6 rabbit monoclonal antibody (Cell Signaling, Danvers, MA) and c-MET protein expressed was analyzed using the SP-44 clone (Ventana Medical Systems). Results: c-MET protein expression was identified in 33.33% cases (n = 30/90) with statistically significant thyroid transcription factor-1 (TTF-1) positivity. ROS-1 protein expression was detected in 3.33% cases (n-3/90), in biopsies from the respiratory tree with TTF-1 expression. Conclusion: This is the first study from the Indian subcontinent to identify the frequency of ROS-1 re-arrangements and MET amplification in the Indian population. The availability of targeted therapy that has a significant impact on survival makes it essential to detect these less frequent mutations.
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Background: Tuberculous meningitis (TBM) is the main form of tuberculosis that affects the central nervous system and is associated with high rates of death and disability. The objective of this study was to study neurological symptoms in TBM patients using clinical diagnosis and MRI of spine and comparing with urodynamic study.Methods: Fifty one patients diagnosed with TBM were studied in Neurology Department of KGM Medical University, Lucknow. Uroflowmetry and urodynamic study were done to divide the patients into normal and abnormal. A detailed history taking, general physical and neurological examination using MRI spinal cord was done and recorded on a predesigned proforma.Results: Visual impairment, hemiparesis, paraparesis, abnormal tone and reflexes in lower limbs showed significant association with abnormality in urodynamic study. MRI spine showed significant relationship of spinal meningeal enhancement, lumbosacral arachnoiditis, with abnormal urodynamic study.Conclusions: We found a significant association between neurological symptoms and abnormal urodynamic
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Epithelioid inflammatory myofibroblastic sarcoma (EIMS) is a rare entity and a novel variant of inflammatory myofibroblastic tumor (IMT), usually seen in children and nonsmoking young adults. Their occurrence in a posttransplant setting is still rare. These tumors are characterized by prominent epithelioid morphology, large histiocytoid “Reed Sternberg”-like cell, unique pattern of ALK immuno-reactivity, and aggressive clinical behavior. Their etiology and metastatic potential is controversial. In a post-transplant setting, many factors such as trauma, infections with EBV, HIV, Hepatitis C, mycobacteria, fungus, and chemotherapy-induced immunosuppression have been implicated in their etiology. We present the case of a 2-year-old female child who developed multiple omental and mesenteric tumor nodules, 8 months post liver transplant for progressive familial intrahepatic cholestasis (PFIC). Following a histopathological diagnosis of “mesenchymal neoplasm of possible malignant nature” on a trucut biopsy and frozen section, tumor debulking was performed. A final histological diagnosis of EMIS was made on the completely resected tumor. The patient remains in remission nearly 7 months after presentation, without any follow-up systemic chemotherapy. IMT after a solid organ transplant is rare, only 5 cases have been reported in the literature until now. Similar phenomenon has also been noted with hematopoietic stem cell transplant. However, to our knowledge, this case of EMIS in a post liver transplant patient is first of its kind.
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Background & objectives: Substance use disorders are a major public health concern in Punjab. However, reliable estimates of prevalence of substance use disorders are not available for the State. The present study reports estimates of prevalence of substance use disorders in Punjab, conducted as part of National Mental Health Survey, India. Methods: Using multistage stratified random cluster sampling, 2895 individuals from 719 households of 60 clusters (from 4 districts of Punjab) were interviewed. Mini International Neuropsychiatric Interview and Fagerstrom nicotine dependence scale were used to assess substance use disorders. Results: The sample comprised almost equal numbers of males and females. Nearly 80 per cent had less than or equal to high school education, and 70 per cent were married. The weighted prevalence of alcohol and other substance use disorders was 7.9 and 2.48 per cent, respectively. The prevalence of tobacco dependence was 5.5 per cent; 35 per cent households had one person with substance use disorder. The prevalence was highest in the productive age group (30-39 yr), urban metro and less educated persons. The prevalence of alcohol and other substance use disorders was much higher in Punjab as compared to other States where survey was done. Tobacco dependence was lowest in Punjab. Majority (87%) of the persons with substance use disorders did not suffer from any other mental disorder. Treatment gap was 80 per cent. Interpretation & conclusions: Punjab has a high burden of substance use disorders. The estimates will help clinicians and policymakers to plan the strategies against the menace of substance use disorders effectively.
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Objective: The objective of the present work was to formulate and evaluate a stable, odour free garlic powder loaded floating matrix tablet for the treatment of peptic ulcers. Methods: A gastro-retentive floating matrix tablet (FMT) formulation of garlic powder (GP) was prepared using various concentrations of hydroxypropyl methylcellulose K4M (HPMC K4 M) and effervescent system (sodium bicarbonate and citric acid in 1:1 % w/w) to achieve desirable floating time (FT), floating lag time (FLT) and drug release. Wet granulation method was selected using ethanol as a binder for preparation of tablet. 32 full factorial designs were used for selection of suitable polymer concentration and effervescent system. Nonenteric film coating was applied to mask GP odour. Results: It was observed that FMT with optimum quantities of HPMC K4M and the effervescent system showed 97 % of drug release in 12 h with FT up to 10 h and minimum FLT of 3 min. There was no significant change in FLT, FT and drug content during the stability study of FMT. Conclusion: A stable, sustained release FMT of GP tablets using HPMC K4M and an effervescent system was successfully prepared. This formulation can overcome problems of taste and odour masking, gastric irritation, and loss of active constituents present in garlic.
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Cryptococcus gattii predominantly causes central nervous system and pulmonary infection in both immunocompromised and immunocompetent patients with substantial morbidity. We report a case of rapidly fatal meningitis by C. gattii in an HIV–non-infected man with CD4 lymphopenia who tested negative for cryptococcal antigen. This case may serve as an alert to its wider occurrence and less explored risk factors.