J Postgrad Med
· 2026 Jan · PMID 41773763
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Regression, correlation, association, and agreement are commonly used statistical terms in medical research, yet their distinctive meanings are not clear to some researchers. This article explains the precise meaning and...Regression, correlation, association, and agreement are commonly used statistical terms in medical research, yet their distinctive meanings are not clear to some researchers. This article explains the precise meaning and interpretation of these terms and discusses their inappropriate use in some cases. However, the discussion is brief and focused on fundamentals for our medical colleagues.
J Postgrad Med
· 2026 Jan · PMID 41769785
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Artificial intelligence (AI) systems based on Large Language Model (LLM) are becoming an increasingly important aspect of biomedical research, assisting with the tasks ranging from research design to data analysis and pu...Artificial intelligence (AI) systems based on Large Language Model (LLM) are becoming an increasingly important aspect of biomedical research, assisting with the tasks ranging from research design to data analysis and publication. Although AI systems increase productivity by cutting the time taken for individual tasks, they also expose their users to severe risk due to systematic distortion of outputs due to algorithmic sycophancy. The honesty of these AI systems is questionable, and can effortlessly crumble when user prompts are incorrect or when the system is under pressure. This viewpoint emphasizes the fundamental understanding of algorithmic sycophancy and the potential mechanism underlying it, which leads to systematic distortion of biological research. There is an important need to bring this issue to light in order to prevent systematic distortion of biomedical research through the cautious utilization of these LLM-based AI systems. Understanding this threat can also help to minimize the propagation of unreliable findings and literature, which pose a significant safety risk to biomedical research as a whole.
J Postgrad Med
· 2025 Oct · PMID 41370188
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This scoping review aimed to map the landscape of medical education research (MER) in India from 2016 to 2021, focusing on teaching-learning methodologies. The objectives were to identify demographic trends, analyze rese...This scoping review aimed to map the landscape of medical education research (MER) in India from 2016 to 2021, focusing on teaching-learning methodologies. The objectives were to identify demographic trends, analyze research methodologies and their shifts, and inform future research priorities. It was conducted following updated Joanna Briggs Institute (JBI) and Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR) guidelines. A systematic search was performed across MEDLINE, Education Resources Information Center (ERIC), and Google Scholar, supplemented by hand-searched journals to select original English-language research articles that addressed teaching-learning methodologies within Indian medical colleges. Data on pertinent variables were extracted. The methodological quality of these studies was assessed using the Mixed Methods Appraisal Tool. From 348 articles screened, 238 met the inclusion criteria. Publication output showed a peak in 2021 (n = 60). A majority of studies originated from private medical colleges (n = 137, 57.6%). The department of Physiology was the most frequent contributor. Undergraduate students were the main participants (n = 205, 86.1%). Most studies were classroom-based (n = 172, 72.3%) and used quantitative, perception-based methods (n = 208, 87.4%). Only 56 studies (23.5%) were rated as high quality. Ethical approval and informed consent were reported in 79.4% (n = 189) and 66.0% (n = 157) of studies, respectively. MER in India has grown in volume since 2016, but significant improvements are needed in methodological rigor, ethical transparency, and instrument validation. It is dominated by quantitative, perception-based studies focusing on undergraduates. Future progress requires in-depth training in research methodologies, improved reporting standards, and stronger institutional support.
Kuttiatt VS, Anandan M, Elangovan N
… +1 more, Sadhasivam A
J Postgrad Med
· 2026 Jan · PMID 41370187
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Lipedema is a chronic adipose tissue disorder primarily affecting women, marked by abnormal, symmetrical, and disproportionate accumulation of subcutaneous fat in the lower limbs and sometimes in the arms, with hands and...Lipedema is a chronic adipose tissue disorder primarily affecting women, marked by abnormal, symmetrical, and disproportionate accumulation of subcutaneous fat in the lower limbs and sometimes in the arms, with hands and feet typically spared. Frequently misdiagnosed as lymphedema or obesity, lipedema presents with pain, easy bruising, bilateral nonpitting edema, and swelling that worsens throughout the day. We present two cases: Two middle-aged women reported longstanding bilateral lower limb swelling, pain, and varicose veins, without significant comorbidities. Clinical examination revealed characteristic disproportionate fat distribution and negative Stemmer's sign. Laboratory investigations and lymphoscintigraphy excluded other causes of edema. Imaging confirmed subcutaneous thickening, fat stranding, and varicosities. Both patients were advised to have conservative management including compression therapy, limb elevation, physiotherapy and dietary counseling; one patient had significant limb volume reduction. Our report underscores the importance of recognizing lipedema for early diagnosis and effective management to prevent progression and complications.
J Postgrad Med
· 2025 Oct · PMID 41348503
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INTRODUCTION: Antimicrobial resistance (AMR) represents a global public health crisis. The WHO Global Action Plan and India's National Action Plan on AMR underscore the rational use of antibiotics in healthcare settings...INTRODUCTION: Antimicrobial resistance (AMR) represents a global public health crisis. The WHO Global Action Plan and India's National Action Plan on AMR underscore the rational use of antibiotics in healthcare settings as a critical strategy for mitigating AMR. Intensive Care Units (ICUs) are high-risk environments for development of AMR. This study analyzes baseline antibiotic utilization data in ICUs by applying the defined daily dose (DDD) metrics in the context of the 'Access', 'Watch', 'Reserve' (AWaRe) classification framework. MATERIALS AND METHODS: This prospective observational study was conducted over a 12-month period. Data from patients prescribed antibacterials for systemic use during their stay in the medicine, surgery, and neurosurgery ICUs were included. Antibiotic utilization was analyzed using daily dose metrics and the WHO AWaRe framework. RESULTS: Data from 359 eligible ICU patients were analyzed. The DU75% segment included 'Watch' category antibiotics, ceftriaxone, meropenem, and 'Access' category antibiotics, metronidazole and doxycycline. 'Watch' category antibiotics were used most frequently, with a cumulative DDD/100 patient days of 71.8. This was followed by the 'Access' category with a cumulative DDD/100 patient days of 48. The use of 'Watch' category antibiotics in the NSICU was significantly higher than in other ICUs ( P < 0.005, χ2 = 7.8). Antibiotics were used mostly for prophylaxis (59%), followed by empirical (28.4%) and definitive therapy (13%). CONCLUSIONS: The study demonstrates excessive use of 'Watch' antibiotics and a relative underuse of 'Access' agents in ICUs, emphasizing the scope for implementing robust stewardship measures including culture-guided de-escalation, formulary restriction of broad-spectrum agents, and implementing stringent surgical prophylaxis protocols.
J Postgrad Med
· 2025 Oct · PMID 41277378
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Antimicrobial resistance (AMR) is a growing concern that can compromise clinical outcomes as well as increase the significant economic stress on healthcare systems. Antimicrobial stewardship programs (ASPs) have demonstr...Antimicrobial resistance (AMR) is a growing concern that can compromise clinical outcomes as well as increase the significant economic stress on healthcare systems. Antimicrobial stewardship programs (ASPs) have demonstrated promising results in improving treatment outcomes and reducing costs worldwide. However, the effectiveness of ASP in Indian hospital settings remains underexplored. This systematic review aimed to evaluate the effectiveness of implementing ASP in Indian hospital settings. Literature search was carried out in electronic databases such as PubMed, Clinical Trials Registry-India, Clinicaltrials.gov, and Google Scholar from January 2015 till April 2025 to identify published studies that explored the clinical outcomes in Indian hospital-based settings that implemented ASP. Studies that assessed at least one of the following outcomes-AMR pattern, infection rate, mortality rate, prescription pattern, costs, or barriers/challenges in ASP implementation-were eligible for screening. Two independent reviewers screened the articles for eligibility, with discrepancies resolved through discussion with a third reviewer. Out of the 1732 studies screened, 11 studies were found eligible for inclusion. Those studies were conducted in different Indian states. Each study implemented different ASP practices, including infection control, audit and feedback, and customized training. Most of the studies evaluated demonstrated improvements such as a reduction in inappropriate prescriptions, lower antimicrobial resistance rates, decreased infection and mortality rates, and reduced costs following the implementation of ASP. Despite the benefits, implementation challenges remain. This review highlights the need for strict ASP implementation and monitoring in Indian hospitals to combat AMR.
J Postgrad Med
· 2025 Oct · PMID 41277377
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INTRODUCTION: Artemisinin combination therapy (ACT) is the World Health Organization (WHO) recommended first-line therapy for falciparum malaria. However, recent concern is ACT resistance. Arterolane-piperaquine is a syn...INTRODUCTION: Artemisinin combination therapy (ACT) is the World Health Organization (WHO) recommended first-line therapy for falciparum malaria. However, recent concern is ACT resistance. Arterolane-piperaquine is a synthetic alternative to ACT. Our objective was to determine the safety and efficacy of arterolane-piperaquine in comparison with artemether-lumefantrine for the treatment of falciparum malaria. MATERIAL AND METHODS: We conducted a systematic review and meta-analysis to determine the safety and efficacy of arterolane maleate and piperaquine phosphate for the treatment of uncomplicated falciparum malaria. We searched PubMed/MEDLINE, Cochrane Library, Google Scholar, Clinical Trials.gov and MedRxiv. Search results were screened by title, abstract, and full text before inclusion into the study. Meta-analysis of risk difference between arterolane-piperaquine and artemether-lumefantrine in regard to safety and efficacy was done using a random effects model. RESULTS: Four randomized controlled trials (RCTs) were included. One RCT had a high risk of bias, while the other three studies had a low risk of bias. The 28-day polymerase chain reaction (PCR) corrected risk difference between the artemether-lumefantrine and arterolane-piperaquine was 0 (95% confidence interval -0.02 to 0.02), whereas the PCR uncorrected risk difference was 0.11 (95% confidence interval -0.06 to 0.27). On 42-day follow-up, the PCR uncorrected risk difference was 0.17 (95% confidence interval -0.05 to 0.38), while the PCR-corrected risk difference was 0.01 (95% confidence interval -0.01 to 0.03). Adverse effect profile was similar with risk difference of at least one adverse effect being -0.01 (95% confidence interval -0.02 to 0.00). The commonly reported adverse effects of arterolane-piperaquine were vomiting, anemia, and pain abdomen. CONCLUSIONS: Our study shows that arterolane-piperaquine is non-inferior to artemether-lumefantrine for the treatment of uncomplicated falciparum malaria.
J Postgrad Med
· 2025 Oct · PMID 41263261
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Sample size is among the most common concerns while planning an empirical research study in health and medicine. Its role in rigorous conclusions is well known. The procedure for determining the sample size is different...Sample size is among the most common concerns while planning an empirical research study in health and medicine. Its role in rigorous conclusions is well known. The procedure for determining the sample size is different for the estimation of a population parameter than for testing a hypothesis on a parameter. The former requires specification of the tolerable margin of error, and the latter the minimum clinically important effect to be not missed when present. But all research studies must be subjected to the highest rigor, and several other factors, such as inter-subject variability and the design, need to be considered for determining the adequate sample size. This communication compiles all these considerations together at one place. This also provides a general method for computing sample size for the two types of statistical inferences, which is not generally available in the literature. This may sensitize the reader to the ingredients required for calculating the correct sample size and the intricacies involved. The sources and tools for the calculation of sample size are also presented. This may enable the researchers and statisticians to determine the right sample size for rigorous results in their study.
Su M, Yang X, Li T
… +3 more, Zhang Y, Qiu W, Liu S
J Postgrad Med
· 2025 Oct · PMID 41263260
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INTRODUCTION: The combined impact of type 2 diabetes mellitus (T2DM), sarcopenia, and hypertension on incident cardiovascular disease (CVD) and mortality remains inconclusive. This study aimed to evaluate the additive ef...INTRODUCTION: The combined impact of type 2 diabetes mellitus (T2DM), sarcopenia, and hypertension on incident cardiovascular disease (CVD) and mortality remains inconclusive. This study aimed to evaluate the additive effect of these co-morbidities on CVD and all-cause mortality among Chinese adults aged 45 years and older. MATERIALS AND METHODS: A total of 12,398 participants were enrolled in the China Health and Retirement Longitudinal Study. Participants were categorized based on their T2DM, sarcopenia, and hypertension status. The study outcomes included incident CVD (including heart disease and stroke) and all-cause mortality. Multivariable logistic regression models and population attributable fractions (PAFs) were employed to investigate the associations between the coexistence of T2DM, sarcopenia, and hypertension with CVD incidence and mortality. RESULTS: Compared to those with none of T2DM, sarcopenia, or hypertension, participants with any one, any two, or all three of these conditions exhibited increased risks of incident CVD and higher odds of all-cause mortality. The ORs for CVD and all-cause mortality significantly increased in the groups with none, any one, any two, and all three co-morbidities. (P for trend < 0.001) These three co-morbidities collectively explained 19.1% (95% confidence interval [CI]: 15.7, 22.3) of PAF for CVD and 19.0% (95% CI: 13.5, 24.2) for mortality. The results remained generally consistent in the sensitivity analyses. CONCLUSIONS: Participants with the coexistence of T2DM, sarcopenia, and hypertension faced a more than two-fold increase in the risk of CVD events and mortality. The estimated PAFs indicated that preventing these three co-morbidities could be beneficial in reducing CVD incidence and all-cause mortality.
Prajapati R, Shetty S, Chaudhary A
… +2 more, Khajanchi M, Bhoir R
J Postgrad Med
· 2025 Jul · PMID 40996771
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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 m...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.
Jorwal A, Sharma S, Bairwa K
… +2 more, Sharma R, Rajni E
J Postgrad Med
· 2025 Jul · PMID 40977623
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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...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.
J Postgrad Med
· 2025 Jul · PMID 40977615
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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-y...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.
J Postgrad Med
· 2025 Jul · PMID 40965014
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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 occ...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.