Natl Med J India
· 2026 · PMID 42325025
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Background Severe trauma and injury may be associated with the release of inflammatory cytokines and the presence of circulating cell-free DNA (cfDNA). cfDNA is released by tissue damage, cell death, or dying cells in tr...Background Severe trauma and injury may be associated with the release of inflammatory cytokines and the presence of circulating cell-free DNA (cfDNA). cfDNA is released by tissue damage, cell death, or dying cells in trauma haemorrhagic shock (T/HS) patients. However, the source and mechanism of release of cfDNA in T/HS is not well understood. Neutrophil extra-cellular traps (NETs) are the most common source of cfDNA, released by activated neutrophils during the process of NETosis. We aimed to determine the levels of cfDNA following T/HS at different time points after injury. Methods A prospective cohort study was done at Jai Prakash Narayan Apex Trauma Centre, All India Institute of Medical Sciences, New Delhi, India, with three groups: T/HS patients, trauma victims without haemorrhagic shock (TVWHS), and healthy controls. Peripheral blood samples were collected and analysed for circulating cfDNA, protein C, myeloperoxidase (MPO, a marker of neutrophil activation), citrullinated histone H3 (a marker of NETosis), cyclophilin, and caspase-cleaved CK18 on hospital admission and follow-up days 3 and 7. Results A total of 60 patients were included, 20 each of T/HS, TVWHS patients and controls. The mean age was 32 years; 10% were women, and 90% were men, and mortality was 35% at 15 days. Circulating cfDNA were elevated in T/HS when compared to TVWHS and controls. Moreover, serum levels of MPO, CK18, and H3Cit were significantly elevated in T/HS patients. Conclusion Our study suggests that elevated circulating levels of cfDNA are present in T/HS patients.
Goel A, Goyal M, Mahadule A
… +2 more, Verma N, Tiwari S
Natl Med J India
· 2026 · PMID 42325022
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Background Hypertension is a major global threat associated with adverse cardiovascular events, especially in the Asian population. Ambulatory blood pressure monitoring (ABPM) is a valuable tool in diagnosis and manageme...Background Hypertension is a major global threat associated with adverse cardiovascular events, especially in the Asian population. Ambulatory blood pressure monitoring (ABPM) is a valuable tool in diagnosis and management of hypertension and is predictive of future cardiovascular events. We assessed the feasibility of ABPM and generated preliminary normative data specific to the Indian population. Methods The circadian profile of 24-hour blood pressure (BP) in 53 healthy subjects was studied in their natural settings. Various circadian parameters like midline estimating statistic of rhythms (MESOR), 24-hour average BP, awake hours average BP, sleep hours average BP, % dip in systolic BP, and morning surge in BP were studied. Results BP and heart rate followed a sinusoidal pattern, with almost all the subjects having significant Cosinor rhythm. ABPM was generally well-tolerated, with no major discomfort, limited restrictions on daily activities, and the values of ABPM parameters in this population matched those of other populations. Conclusion ABPM is feasible and acceptable in India and follows a sinusoidal pattern in healthy young adults, similar to other populations.
Vishnu S, Namboodiri N, Prabhu M
… +6 more, Ayyappan A, Valakkada J, Prasad B V S, Mohanan Nair KK, Pushpangadan A, Valaparambil A
Natl Med J India
· 2026 · PMID 42240508
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Background Cardiac sarcoidosis (CS) may present with conduction abnormalities, ventricular arrhythmias, and heart failure. The delay in recognizing cardiac involvement in systemic sarcoidosis leads to disease progression...Background Cardiac sarcoidosis (CS) may present with conduction abnormalities, ventricular arrhythmias, and heart failure. The delay in recognizing cardiac involvement in systemic sarcoidosis leads to disease progression, resulting in major morbidity and mortality. We studied the clinical, electrocardiographic, and imaging features of cardiac sarcoidosis and its mortality predictors. Methods The clinical data of patients with CS who presented to the Sree Chitra Tirunal Institute for Medical Sciences and Technology between 2005 and 2021 were retrospectively analysed. The diagnosis of CS was based on the 2014 Heart Rhythm Society Expert Consensus recommendations and the 2016 Japanese Circulation Society clinical diagnosis criteria. Patients with obstructive coronary artery disease and possible myocarditis were excluded from the study. Results Forty-three patients of CS (31 males), aged 49 (8.8) years, were followed up for a mean duration of 4.3 (range 1.87-6.5) years. The presenting clinical manifestations were ventricular tachycardia (VT) 14/43 (33%), acute heart failure 14/43 (33%), complete heart block 10/43 (23%), and non-sustained VT/symptomatic ventricular premature complexes 2/43 (5%). Systemic manifestations included lymphadenopathy 28/43 (65%), pulmonary parenchymal involvement 26/43 (60%), and neurological involvement 8/43 (19%). The mean basal left ventricular ejection fraction at presentation was 41.1% (standard deviation 16.1%), and 31/33 (94%) of the patients had late gadolinium enhance-ment in cardiac MRI, with the predominant pattern being sub-epicardial 18/33 (58%) or mid-myocardial 17/33 (54%). Eighteen (42%) patients received implantable cardioverter defibrillator (ICD); nearly half had appropriate ICD shocks. On follow-up, 11 (25%) patients died, 10 (23%) had recurrent heart failure admissions, and 5 (29%) had recurrent ICD shocks. Multivariate analysis revealed higher New York Heart Association (NYHA) class/clinical heart failure at presentation, elevated erythrocyte sedimentation rate at diagnosis, and persistent low ejection fraction during follow-up to be predictors of mortality, not VT. Survival analysis showed that recurrent heart failure admissions predict early mortality. Conclusion Although arrhythmia was the most common manifestation, clinical heart failure was seen in nearly half of the patients with a diagnosis of CS. A high prevalence of heart failure, along with 25% mortality in our study, may indicate a delayed recognition of cardiac involvement in these patients' natural history. Recurrent heart failure admissions predicted early mortality.
Thomas T, Pradeep Raj J, Pinheiro T
… +2 more, Devaraj U, Ramachandran P
Natl Med J India
· 2026 · PMID 42240507
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Background Tobacco cessation interventions are a cost-effective way of reducing ill health due to tobacco, as quitting unaided is difficult. There is limited data from India on the success of these strategies. We assesse...Background Tobacco cessation interventions are a cost-effective way of reducing ill health due to tobacco, as quitting unaided is difficult. There is limited data from India on the success of these strategies. We assessed effectiveness of tobacco cessation strategies in our tobacco cessation clinic (TCC) and the risk factors for smoking relapse. Methods We did an observational study between April 2017 and January 2020 in a tertiary care teaching hospital in Bengaluru, India. All adults who visited the Department of Pulmonary Medicine or TCC were enrolled in the study. A pilot-tested, semi-structured, standardized questionnaire including basic demographics, smoking/tobacco usage, and treatment history, the Fagerström test for nicotine dependence, motivation stage assessment, and a history of adverse drug reactions was administered to the study participants. Results A total of 135 participants were screened, and 127 were recruited. However, only 121 participants were available for the 6-month follow-up. The mean (standard deviation [SD]) age of the participants was 51.7 (14.4) years, and only 2/127 (1.57%) were women. At follow-up, 28/121 (23.14%) participants reported having quit smoking, and 90/121 (74.38%) reported reduced tobacco use. Behavioural counselling (BC) only (65.35%), followed by a combination of BC and nicotine replacement therapy (33.07%), were the commonly used interventions. No significant predictor of relapse/treatment failure was identified. Conclusion Although the quit rate was low, the number of subjects who reduced tobacco usage was high, thereby suggesting the positive role of TCCs in tobacco cessation. BC alone was the most prescribed intervention, although a combination therapy is recommended.
Jacob JA, P T, Jawaharlal GRJ
… +2 more, Kuruvilla A, Gopalakrishnan R
Natl Med J India
· 2026 · PMID 42240506
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Background Advance directives help strike a balance between the ethical concepts of paternalism and patient autonomy in medical practice. It supports end-of-life decisions by the patient within an appropriate legal and e...Background Advance directives help strike a balance between the ethical concepts of paternalism and patient autonomy in medical practice. It supports end-of-life decisions by the patient within an appropriate legal and ethical framework. This concept is still in its infancy in India and is an under-researched area. We aimed to assess the knowledge and attitudes of medical professionals on advance directives in a tertiary care teaching hospital. Methods Medical doctors from all departments were invited to participate in this survey using systematic sampling. The knowledge and attitude questionnaire was administered after obtaining informed consent. Socio-demographic and professional details were also collected. Descriptive, bivariate, and multivariate statistics were obtained using SPSS version 16.0.1. Results Our study included 391 medical doctors; 168 (43%) had good knowledge of advance directives, and 129 (33%) had a positive attitude towards them. Doctors who had completed postgraduate training in their specialty had better knowledge. Positive attitudes to advance directives were associated with greater knowledge and working in a super specialty department, while negative attitudes were associated with being more religious. Conclusion The level of knowledge and attitudes towards advance directives among medical practitioners is inadequate. While training will help improve knowledge and attitudes, other socio-cultural factors may also influence the same.
Thachaparambil A, Vij A, Lathwal A
… +1 more, Mohammad K
Natl Med J India
· 2026 · PMID 42240504
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Background Nurses form the backbone of the healthcare system; their role is vital in healthcare delivery in terms of promotion, prevention, treatment, care, and rehabilitation. Nurse managers play a key role in patient c...Background Nurses form the backbone of the healthcare system; their role is vital in healthcare delivery in terms of promotion, prevention, treatment, care, and rehabilitation. Nurse managers play a key role in patient care coordination and ensure quality nursing care. Apart from this, they also perform staff management, document administrative activities, and supervise hospital store activities. Efficient and effective nursing administration is essential for smooth functioning and safe patient care. Methods In an observational study in two phases, we estimated the time utilized by administrative nurses in different tasks. In the first phase, a questionnaire was developed for self-reporting various activities carried out by administrative nurses. In the second phase, activity sampling with 316 hours of observations and 15 344 nursing activities was recorded across the hospital to estimate actual time distribution and utilization of administrative nurses. Results Administrative nurses spent a major portion of their time in store management (28%), staff management (23%), and documentation (21%), and much less time for patient care supervision and teaching activities, i.e. 4%-8% of the total time available in a day. Conclusion We found that administrative nurses spent most of their time in three major activities: store management, staff management, and documentation. Their roles may need to be reviewed for them to spend more time in supervision of patient care and teaching activities.
Iqbal A, Joshi R, Beniwal N
… +4 more, Sood K, Habib M, Rivera Valentin M, Basta M
Natl Med J India
· 2026 · PMID 42240502
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Background Attention deficit hyperactivity disorder (ADHD) affects 5% of children and adolescents. Diagnostic criteria rely on behavioural observations. YouTube offers easily accessible health information, including that...Background Attention deficit hyperactivity disorder (ADHD) affects 5% of children and adolescents. Diagnostic criteria rely on behavioural observations. YouTube offers easily accessible health information, including that on ADHD. We analyzed ADHD-related YouTube videos covering causes, treatment, medication, patient presentation, and ADHD deficit hyperkinetic disorder to assess the quality of information. Methods YouTube videos related to ADHD were evaluated in a cross-sectional study. Seven different search terms was used by seven authors to review the top 10 videos each. The videos were scored using the modified video power index (VPI), Global Quality Scale (GQS) and DISCERN scores to evaluate the quality and reliability of the information. The quality of videos was compared based on the nature of the source of the videos. The Statistical Package for the Social Sciences software was used to perform statistical analysis. Results This study included 67 videos, mostly by doctors (n = 21, 31.3%), most often describing ADHD symptoms (n = 58, 86.57%). The median GQS for the videos was 4, and the reliability score was also 4. The quality of videos was similar among the source of videos with p values for VPI, GQS, and global reliability being 0.073, 0.922, and 0.617, respectively. Conclusion The quality of videos on ADHD on YouTube are similar irrespective of the source such as doctors, patients, healthcare providers etc.
Gupta Y, Lomi N, Raj N
… +2 more, Kishore A, Tandon R
Natl Med J India
· 2026 · PMID 42240501
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Background Covid-19 disease and the imposed lockdown adversely affected patient care at healthcare facilities worldwide. Children affected with retinoblastoma require uninterrupted care due to systemic immunosuppression...Background Covid-19 disease and the imposed lockdown adversely affected patient care at healthcare facilities worldwide. Children affected with retinoblastoma require uninterrupted care due to systemic immunosuppression and the chances of disease relapse. We evaluated the impact of Covid-19 on patients with retinoblastoma and report a strategy to mitigate this impact. Methods We reviewed records of patients attending the ophthalmic emergency from March 2020 to March 2021. Patients with retinoblastoma were categorized based on their urgency level, and managed as per the treatment protocol. The relevant demographic data, clinical profile, referral details, and management strategy used were recorded and analysed. Results Fifty patients with retinoblastoma were reviewed (males 31 [62%], mean age 3.33 years). After Covid-19 screening, an ophthalmic examination was done, and an ocular diagnosis was established. The categorization was: 1 emergent, 21 urgent, 26 semi-urgent, and 2 non-urgent patients. Of the 47 patients tested for Covid-19, two were positive and the intervention was deferred. An intervention was delivered in 41 patients (1 orbital biopsy, 9 enucleation, 27 focal therapy, 4 systemic chemotherapy), and 9 received no intervention. A 78.7% reduction in new patients was seen in attendance of the retinoblastoma clinic (p=0.02). All healthcare professionals used personal protective equipment. Teleconsultations were encouraged wherever possible. Support of non-governmental organizations was sought for patient mobilization. Conclusion The described model exemplifies a strategy to mitigate the impact of Covid-19 and lockdown on healthcare delivery to patients with retinoblastoma for a year.
Natl Med J India
· 2026 · PMID 42240499
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The dissemination of skills acquired by master surgeons remains an unmet need within the surgical community. Live surgical workshops (LSWs) are envisaged as comprehensive initiatives to foster ongoing learning and skill...The dissemination of skills acquired by master surgeons remains an unmet need within the surgical community. Live surgical workshops (LSWs) are envisaged as comprehensive initiatives to foster ongoing learning and skill enhancement for surgeons across all surgical sub-specialties. With advances in technology, these workshops are now being conducted worldwide and are commonly featured in major scientific meetings. A public interest litigation filed in the Supreme Court of India has sparked controversies, raising questions about the utility of LSW and the ethical considerations surrounding their conduct. We provide a comprehensive review of the existing literature pertaining to LSWs. A body of literature related to LSWs was identified, outlining the perceived benefits and risks associated with such workshops. Overall, LSWs were perceived by surgeons to have immense educational potential. However, concerns regarding the perceived benefits for the audience and anticipated issues related to ethics and safety need to be addressed. These appear to be predominantly rooted in qualitative studies that explore the perspectives of surgeons and attendees, rather than in objective quantitative studies that investigate patient safety and outcomes. Recognizing the potential for underreporting adverse events from LSWs, reliance on published figures of equality between groups is at best subject to further studies. Field experts have proposed several interventions to conduct LSWs safely, based on their experience.
Shekhar V, Kahlon N, Srivastava M
… +4 more, Abbas SZ, Pandey A, DAS A, Deepak KK
Natl Med J India
· 2026 · PMID 42240498
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The use of transcranial Doppler (TCD) ultrasound in acute cerebrovascular events has not been widely adopted although it can help clinicians make informed decisions in the early evaluation of patients. A 74-year-old fema...The use of transcranial Doppler (TCD) ultrasound in acute cerebrovascular events has not been widely adopted although it can help clinicians make informed decisions in the early evaluation of patients. A 74-year-old female presented to the emergency department with an acute onset of weakness of the left upper and lower limbs, along with slurring of speech, for the last 12 hours. Non-contrast CT of the head showed a hypodense area in the right frontotemporal region, suggestive of cerebral oedema. A TCD study through the transtemporal window showed increased pulsatility index (PI) of right internal carotid artery and right middle cerebral artery when compared with a control subject. A contrast-enhanced magnetic resonance angiography showed findings consistent with those obtained with the TCD. The TCD clearly indicated the regional involvement in a patient who presented with stroke-like symptoms and, in resource-limited settings, may help in making early treatment decisions.
Natl Med J India
· 2026 · PMID 42240496
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The announcement of the competency-based medical education (CBME) curriculum for undergraduates by the National Medical Commission (NMC) in India in 2019, and its consequent implementation by all medical colleges has, by...The announcement of the competency-based medical education (CBME) curriculum for undergraduates by the National Medical Commission (NMC) in India in 2019, and its consequent implementation by all medical colleges has, by and large, been unsatisfactory because of many difficulties experienced by colleges in its implementation. The program has over 2800 listed competencies for the students to be trained in, over 800 listed skills, and over 100 skills for mandatory certification before the summative examination. The greatest reason for failure, however, is no major change in the assessment process with CBME. Workplace-based assessment methods on a continuous basis are well known and applied widely in other countries. However, these are yet to be widely accepted and notified by the regulatory agency for the Indian undergraduate medical student. We focus on the reasons for the unsatisfactory state of affairs in CBME assessment that have led to deficiencies in the intended outcome. Major policy changes in assessment such as revision of the list of competencies and skills, along with adoption of a combined formative-summative assessment process based on learning place-based assessment methods could ensure creation of an adequately trained Indian medical graduate.