Khandelwal A, Bhattacharjee A, Ahmed KA
… +1 more, Medhi A
Natl Med J India
· 2026 · PMID 42240492
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Buprenorphine transdermal patches (TPs) are used for the management of both acute and chronic pain of varied aetiologies. They offer a convenient and sustained method of drug delivery with a good safety profile. Though n...Buprenorphine transdermal patches (TPs) are used for the management of both acute and chronic pain of varied aetiologies. They offer a convenient and sustained method of drug delivery with a good safety profile. Though nausea and/or vomiting have been reported with buprenorphine TP, intractable vomiting (without spontaneous resolution) has never been reported before. We report a 45-year-old female who presented with acute exacerbation of chronic low back pain with radiculopathy of bilateral lower limbs. We offered her conservative management initially. Buprenorphine TP (10 mcg/hour) was applied along with the prescription of a few oral medications. However, the subsequent day, she visited our clinic again with complaints of 6-7 episodes of vomiting with persistent nausea over the past 24 hours. Buprenorphine TP-induced vomiting was suspected. The patch was removed promptly, and rescue antiemetics were administered. Monitoring of patients on opioids, even with TPs, is warranted.
Ismail M, Al-Zaidy M, Al-Kafaji A
… +8 more, Ahmed F, Albairmani S, Al-Ageely T, Algburi H, Abdulsada A, Altaweel M, Salih H, Hoz S
Natl Med J India
· 2026 · PMID 42240491
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Background Mentorship is a high-quality educational process that provides exposure in clinical subjects to medical students. In the sub-mentorships system, mentees become mentors, directly connected to the senior mentor,...Background Mentorship is a high-quality educational process that provides exposure in clinical subjects to medical students. In the sub-mentorships system, mentees become mentors, directly connected to the senior mentor, and this stimulates early progress for all parties. We document the submentorship concept in neurosurgery and present our experience with this system in low and middle-income countries. Methods Over six years (2016-2022), we conducted 9 medical student mentorship programs covering 1116 mentees. Mentees underwent an integrated course based on 5 parameters: neurosurgery emergency rotation, neurosurgical intensive care unit, hands-on clinical laboratory training, operating room observership, and a research course. Students who showed an interest in neurosurgery were selected and prepared under the senior mentor's supervision to be the program's sub-mentors in future courses. Results A total of 27 medical students in different stages of training at various medical schools were trained to be sub-mentors. Of 149 research papers published, accepted, and submitted by our team, sub-mentor students participated in 73 projects. From around 500 neurosurgical procedures done over the past 4 years, students and sub-mentors attended 275. Conclusion Sub-mentorship can be a conduit for advancing the classical pattern of mentorship in neurosurgery. In addition, it may represent an avenue for capacity building in underserved areas or war-torn countries.
Natl Med J India
· 2026 · PMID 42240488
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Conferences, continuing medical education programs, and scientific forums are part of a medical professional's life. Such programs often generate a lot of waste, mostly nonbiodegradable. Organizers often do not realize t...Conferences, continuing medical education programs, and scientific forums are part of a medical professional's life. Such programs often generate a lot of waste, mostly nonbiodegradable. Organizers often do not realize this or are unaware of its environmental impact. This article details the measures adopted in a workshop on the application of biostatistics for clinical researchers, organized at a medical institute as a zero-waste workshop. The organizers made efforts to reduce the use of paper at all stages of the workshop. Brochures or posters were not used for promotion. It was ensured that this workshop did not use any single-use items like pens, lanyards, water bottles, tea cups, water cups, meal plates, snack plates, dessert bowls, and cutlery. The sustainable measures taken at this workshop can be replicated in any academic program. Academic programs, which are organized very frequently, can easily be made zero-waste events with proper planning and consistent practices.
Natl Med J India
· 2026 · PMID 41729510
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Background We examined the relationship between resilience and professional quality of life (ProQoL) through specifically developed surveys and identified the correlation with sociodemographic characteristics that may af...Background We examined the relationship between resilience and professional quality of life (ProQoL) through specifically developed surveys and identified the correlation with sociodemographic characteristics that may affect both concepts. Methods The study was done among physicians working in different emergency departments. An online questionnaire with 3 parts was used. (i) 10 questions on the demographic characteristics and working conditions of the participating physicians; (ii) The 'Connor-Davidson Resilience Scale' (CDRS), a 10-item scale, which measures the psychological resilience of physicians; and (iii) The 'Professional Quality of Life Scale' (ProQoL scale) a 30-item questionnaire which measures physicians' compassion satisfaction (CS), burnout (BO) and compassion fatigue (CF). Scores for the subscales of ProQoL were categorized as follows: <22 low; 23-41 moderate; and >42 high levels. Results The questionnaire was completed by 290 participants (99.3%). The median age was 30 (26-37) years, and 40.7% (118) of the participants were females. For the BO subscale, the median CDRS score of participants with high BO scores (18 [15-20]) was found to be lower than the median score of participants with low and moderate BO scores (p values 0.013 and 0.009, respectively). For CS subscale, the median scores of all 3 groups were statistically different, and the highest median score belonged to the high group (29 [27-34]) (p<0.001 for all 3 groups). For the CF subscale, the median CDRS score for participants with high CF scores (13 [9-16]) was found to be significantly lower than the CDRS score of participants with low and moderate CF scores (p <0.017 and <0.032, respectively). The median CDRS score of men was significantly higher than that of women (p<0.001). Conclusion The concept of resilience is associated with BO, CS and CF, which constitute ProQoL. Physicians who have high scores for BO and CF, which are negative sub-factors of the ProQoL scale, have lower resilience; on the contrary, those who have high scores for CS, which is a positive indicator of the quality of life, have higher resilience. Female gender can be considered a risk factor for low resilience.
Sharma A, Satija J, Rathee M
… +4 more, Antil P, Sharma A, Walym M, Dahiya R
Natl Med J India
· 2026 · PMID 41729508
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Background India has the highest number of people with diabetes in the world. Health services for people with diabetes in India are varied with regard to quality, access, and affordability. We explored the various facets...Background India has the highest number of people with diabetes in the world. Health services for people with diabetes in India are varied with regard to quality, access, and affordability. We explored the various facets of care being provided for diabetes mellitus. Methods A descriptive phenomenological study (qualitative research) was conducted in Rohtak, Haryana, India, during March-April 2022. Thirty-four participants were recruited via purposive sampling. These included 17 people with diabetes and 17 healthcare workers. In-depth interviews were conducted in a semi-structured format after taking written informed consent. Data were recorded and then transcribed. On analysis, initial codes were grouped into meaningful themes. Results Three themes each were drawn from the qualitative data. The patient interviews yielded diagnosis, management, complications, and emotional burden of the disease. The daily ordeals of people with diabetes were understood better. The healthcare workers' themes were-experiences so far, complications, and policy recommendations. This focused on the healthcare workers' experiences as providers of care. Conclusion Policy decisions, including a structured referral linkage, are needed to improve care for people with diabetes. Accredited social health activists must be incentivized to screen for diabetes at the village level. Newer initiatives under the Ayushman Bharat Digital Mission, Health and Wellness Centres, and the National Programme for Prevention and Control of Cancer, Diabetes, Cardiovascular Diseases and Stroke are steps in the right direction.
Das A, Mishra S, Gupta A
… +2 more, Dwivedi S, Singh S
Natl Med J India
· 2026 · PMID 41729505
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Background Healthcare providers need to be aware of stigma and risks that affect lesbian, gay, bisexual and transgender (LGBT) patients but often lack the experience and may hold homophobic attitudes, making it difficult...Background Healthcare providers need to be aware of stigma and risks that affect lesbian, gay, bisexual and transgender (LGBT) patients but often lack the experience and may hold homophobic attitudes, making it difficult to care for such patients. We aimed to study the attitudes of medical and nursing students towards LGBT people. Methods This observational cross-sectional study was done between November and December 2021 among medical and nursing students of Government Bundelkhand Medical College, Sagar, Madhya Pradesh. Data were collected on sociodemographic variables and attitudes towards LGBT using a semi-structured questionnaire. The attitude was measured using a five-point Likert scale, which included a 14-item questionnaire. Statistical analysis was done using Statistical Package for Social Sciences. Results A total of 155 students participated, comprising 91 medical students and 64 nursing students. The mean age of participants was 23.2 (3.6) years, and most participants were female (67.1%). Overall, 96.1% of students believed healthcare providers should care for LGBT patients, and 89.7% believed they deserved equal care. However, 30.3% would prefer not to treat LGBT patients, and 14.8% believed that they should go to LGBT clinics. The gender and sexual orientation of the study participants influenced the responses. Conclusions Our study offers preliminary insight into the attitudes of Indian medical and nursing students towards LGBT individuals and reveals mixed responses.
Natl Med J India
· 2026 · PMID 41729504
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Randomized controlled trials (RCTs) are the gold standard design of studies evaluating novel interventions, pharmaceutical and otherwise. The standard RCT design is a 'superiority' study to assess if the tested intervent...Randomized controlled trials (RCTs) are the gold standard design of studies evaluating novel interventions, pharmaceutical and otherwise. The standard RCT design is a 'superiority' study to assess if the tested intervention is better than existing treatments. However, a new intervention that has additional benefits, such as better adverse effect profile, may be useful even if it is not more effective than existing treatments. In such cases, a non-inferiority (NI) design may be preferable. In NI designs, once NI is demonstrated, sequential analysis for superiority may be done, provided it is pre-specified. This article discusses the utility and principles of an NI design. Examples to illustrate the design are taken from published trials of anticoagulation in atrial fibrillation.
Lenin A, Thomas S, Rajan SJ
… +1 more, Sathyendra S
Natl Med J India
· 2026 · PMID 41729503
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Background Medical education was completely online during the lockdown caused by the Covid-19 pandemic. This introduced new challenges in teaching clinical skills to medical students virtually. We describe the methods us...Background Medical education was completely online during the lockdown caused by the Covid-19 pandemic. This introduced new challenges in teaching clinical skills to medical students virtually. We describe the methods used by a tertiary teaching hospital to teach clinical skills in neurology to final year medical students and present the qualitative analysis of the feedback received from the students. Methods Clinical teaching was broadly divided into background clinical knowledge, history taking, clinical examination, and decision making leading to a diagnosis. To facilitate background clinical knowledge, the students created a virtual class notebook using OneNote. History taking skills were taught by using simulated patients, patients' relatives with consent, faculty and peers to provide mock history. Clinical examination was taught by live streaming of clinical demonstration, home examination videos created by the students, and by pictures and videos of abnormal clinical signs. Clinical decision making and diagnosis were taught by using an online quiz with case scenarios where the students had to localize the lesion. Anonymous feedback was received from the students, and the themes from these were analysed. Results A higher percentage (36.9%, n=38) of students were confident in performing neurological examination and taking history independently compared to the students who were not confident (28.1%, n=29). The need for more clinical teaching was emphasized by the students. The students appreciated the OneNote compilation. The students also stated the difficulty in understanding without a real patient. Conclusion Teaching clinical skills in neurology through an online platform is challenging. The online platform can be used to strengthen the students understanding and background knowledge. It can be used to teach normal examination techniques and standardize teaching. However it is not a replacement for skills learnt by hands-on teaching.
Natl Med J India
· 2026 · PMID 41729502
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Background Ameloblastoma is a common benign, odontogenic tumour with high prevalence in Africans, particularly Nigerians. We describe the epidemiology, clinicopathology, pattern of management and incidence of recurrence...Background Ameloblastoma is a common benign, odontogenic tumour with high prevalence in Africans, particularly Nigerians. We describe the epidemiology, clinicopathology, pattern of management and incidence of recurrence of ameloblastoma and ameloblastic carcinoma, in Lagos, Nigeria. Methods This retrospective study included ameloblastoma cases surgically managed at the Lagos University Teaching Hospital from January 2012 to December 2021. Primary outcome was recurrence; secondary outcomes were length of hospital (LOH) stay and postoperative complications. Results We included 63 patients with a mean (SD) age of 34.2 (14.8) years, peak incidence (31.7%) in the 3rd decade of life, and male-to-female ratio of 1.03. The most common location, radiological feature and histological type were posterior mandible (77.8%), multilocular radiolucency (90.5%) and follicular ameloblastoma (50.8%), respectively. For surgical intervention, majority of patients had nasotracheal intubation (67.3%) and mandibulectomy (88.9%), and the most common surgical approach was extraoral (67.3%). The mean (SD) LOH stay was 9.4 (2.4) days, and the transoral approach was associated with shortened LOH. The mean follow-up was 2.7 years, and recurrence was recorded in 2 patients who had conventional ameloblastoma, and one who had ameloblastic carcinoma at 3 years and 3 months postoperatively, respectively. No significant association was noted for recurrence-free survival based on tumour size, tumour diagnosis, histological type and surgical approach (p>0.05). Conclusion Although the epidemiology, clinicopathology and treatment of ameloblastoma reported were similar to older reports, this study provides more recent information on the persistent public health burden of ameloblastoma, which can be used for comparisons with ameloblastoma in other populations.
Natl Med J India
· 2026 · PMID 41729501
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Anaphylactic acute coronary syndrome (Kounis syndrome) is under-recognized due to its wide spectrum of manifestations, ranging from asymptomatic cardiac biomarker elevation to frank ST-segment elevation myocardial infarc...Anaphylactic acute coronary syndrome (Kounis syndrome) is under-recognized due to its wide spectrum of manifestations, ranging from asymptomatic cardiac biomarker elevation to frank ST-segment elevation myocardial infarction (STEMI). We report a middle-aged female who developed acute onset chest pain with diffuse maculopapular rash after an injection of diclofenac. In the setting of anaphylaxis, she had elevated tryptase and was diagnosed with allergic non-STEMI (NSTEMI). She was managed with epinephrine, steroids, and antihistamines. Prompt recognition of this clinical entity is vital for its successful treatment.
Sethi S, Prakash R, Bhatia P
… +2 more, Saxena A, Singh B
Natl Med J India
· 2026 · PMID 41729497
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Background Medical postgraduate training is stressful and can have a detrimental impact on students' physical, emotional, and mental well-being. This, in turn, can affect their academic performance, as well as their pers...Background Medical postgraduate training is stressful and can have a detrimental impact on students' physical, emotional, and mental well-being. This, in turn, can affect their academic performance, as well as their personal and professional development. The effects of stress are mediated by one's coping skills. The coping strategies can be adaptive or constructive, which reduce stress levels. An insight into the coping styles may be helpful for addressing this stress. Methods This cross-sectional study was carried out after approval from the Institutional Ethics Committee. All postgraduate students from all three years (with a minimum of 6 months into the residency programme) across all specialties constituted the study sample. The study was conducted online using a predesigned, pretested questionnaire (including an informed consent form) as a Google Form. Medical Students' Stressor Questionnaire and Brief COPE were used to measure stress and its sources, and specific coping strategies used by the students. Results Of 456 students from 22 different specialties approached for the study, 384 responded, a response rate of 84%. Their mean (SD) age was 28.2 (3.3) years, age range being 23-44 years, and 53% were females. All students reported some degree of stress. The majority of the students (79%) considered academic-related stressors to be the major source. Female and married students and those in their first year of residency reported significantly higher stress in almost all the domains. Presence of mental illness correlated positively with all the domains of stress. None of the socio-demographic variables showed any correlation with coping styles. However, all 6 domains of stress showed statistically significant positive correlation with all 3 coping styles, though the students used more emotion-focused and avoidant coping than problem-focused. Conclusion A significant number of postgraduate medical students reported stress in more than one domain. Academic stress topped the list of sources of stress. Factors such as age, gender, marital status, year, and type of specialty contribute to the level of stress. Presence of psychiatric illness may further increase the propensity to feel stressed. Use of dysfunctional coping styles may further increase the stress level among students.