Anwer M, Bagaria D, Choudhary N
… +6 more, Kumar A, Priyadarshini P, Sagar S, Gupta A, Mishra B, Kumar S
Natl Med J India
· 2025 · PMID 40826967
·
Publisher ↗
Background Pelvic fractures are often a result of injuries caused by a major force and lead to considerable morbidity and mortality. Despite advances in acute management protocols involving angioembolization as a prime i...Background Pelvic fractures are often a result of injuries caused by a major force and lead to considerable morbidity and mortality. Despite advances in acute management protocols involving angioembolization as a prime intervention, mortality in complex pelvic fractures remains high. We analysed our experience with the outcomes of a pelvic trauma management protocol using surgical haemostatic techniques over 5 years. Methods We did a retrospective analysis of all patients admitted with pelvic factures from January 2014 to December 2018. Demographic profile, clinical details, imaging findings, operative details and outcomes were analyzed. Logistic regression analysis was used to determine factors predicting poor outcomes in patients with pelvic fractures. Results A total of 501 patients with pelvic fractures were included, predominantly male (376; 75%), with a mean (SD) age of 34 (13.1) years. Road traffic accidents were the most common cause of injury (362; 72.3%). On presentation, 76 (15.2%) patients were haemodynamically unstable. The most common pattern of pelvic fractures was lateral compression in 320 (63.9%). Seventy-nine patients (15.7%) died. Haemorrhagic shock (251; 50%) and sepsis (86; 34.2%) were the predominant causes of death. Multivariate analysis predicted a higher class of haemorrhagic shock and a high injury severity score was associated with poor outcomes of pelvic fractures. Conclusions Management of pelvic trauma is complex due to haemodynamic instability and multiple organ involvement. Our goal-directed, resource-directed approach provided an overall favourable outcome in patients with pelvic fractures.
Kasturi S, Kumar S, Kumar N
… +4 more, Naveen TMU, Sharma S, Narkhede V, Giri S
Natl Med J India
· 2025 · PMID 40826965
·
Publisher ↗
Data on acute mesenteric ischaemia (AMI) in patients with Covid-19 are limited. We studied the clinical profile and outcome of patients presenting and treated for AMI and Covid-19 infection. This retrospective, observati...Data on acute mesenteric ischaemia (AMI) in patients with Covid-19 are limited. We studied the clinical profile and outcome of patients presenting and treated for AMI and Covid-19 infection. This retrospective, observational study was done at a single tertiary care centre in India from May 2021 to April 2022. Ten patients (8 males; median age 57 years) with confirmed Covid-19 and AMI diagnosed on the basis of clinical and radiological criteria were included in the analysis. Associated comorbid conditions were present in 8 of 10 patients. The median interval from diagnosis of Covid-19 to onset of gastrointestinal symptoms was 11 days, with abdominal pain being the most common. Seven patients underwent surgical resection, while 3 patients were managed conservatively. Two patients were on antithrombotics before the development of AMI and had less severe involvement. Four patients died in hospital. AMI in Covid-19 infection is associated with morbidity and mortality. Previous antithrombotic use does not prevent the development of AMI but possibly reduces its severity.
Manolasya V, Archana MH, Prasanthi P
… +5 more, Reddy AS, Katyarmal DT, Surekha A, Prayaga AK, Mohan A
Natl Med J India
· 2025 · PMID 40826964
·
Publisher ↗
A 61-year-old male presented with a history of fever and burning micturition for 1 week; 3 days after being started on nitrofurantoin 100 mg twice a day by a local practitioner, he developed rash over the body along with...A 61-year-old male presented with a history of fever and burning micturition for 1 week; 3 days after being started on nitrofurantoin 100 mg twice a day by a local practitioner, he developed rash over the body along with scrotal swelling and pain. Following admission to the local government hospital where he developed acute anterolateral myocardial infarction (MI), he was referred to our hospital. At admission, physical examination revealed reticular purpuric plaques with occasional ulceration over both lower limbs, upper limbs and abdomen with extensive scrotal purpura with necrosis. His pulse rate was 110/minute, oxygen saturation by pulse oximetry was 88% on ambient air and temperature was 101 °F. He was started on intravenous antibiotics and treatment for MI. Laboratory investigations revealed leucocytosis, thrombocytopenia, acute kidney injury and hepatic dysfunction. Scrotal ultrasound revealed epididymo-orchitis. The next day, the patient developed altered sensorium. Computed tomography of the brain showed an infarct in the right fronto-parietal region. Possibility of leukocytoclastic vasculitis (LCV) with systemic involvement as an adverse drug reaction to nitrofurantoin was considered; vasculitis-related blood work-up was inconclusive. Punch biopsy of the lesion showed LCV with subepidermal bulla formation. Patient was treated with intravenous corticosteroids (dexamethasone 8 mg thrice-daily), antibiotics and symptomatic management. He was discharged after 2 weeks on decreasing doses of corticosteroids.
Natl Med J India
· 2025 · PMID 40826963
·
Publisher ↗
Background Leave against medical advice (LAMA) is defined as a patient leaving the hospital against the doctor's advice, sometimes avoiding routine and potentially lifesaving procedures. The rate of LAMA can be a reflect...Background Leave against medical advice (LAMA) is defined as a patient leaving the hospital against the doctor's advice, sometimes avoiding routine and potentially lifesaving procedures. The rate of LAMA can be a reflection of the effectiveness of communication, treatment and processes of the hospital. We aimed to identify the reasons for LAMA from an emergency department (ED) of a tertiary care hospital in New Delhi. Methods 400 consecutive patients going LAMA from the ED were enrolled in the study. Demographic data, triage category and reasons for LAMA were collected using questionnaires. Statistical analysis was performed and results analyzed. Results 103 (25.8%) patients went LAMA as they felt better after initial treatment and refused further in-hospital care. Other reasons for LAMA decisions included non-availability of intensive care unit (ICU) beds (82; 20.5%), financial constraints (69; 17.3%) and perceived risk of infection (59; 14.8%). Age, gender or triaging categories had no significant effect (p>0.05). Multiple logistic regression analysis revealed that the lack of health insurance and low family income were independent risk factors for LAMA decision. Conclusion In our study, the leading causes of LAMA were a patient feeling better after initial treatment, a lack of ICU beds, financial constraints and a perceived risk of infection.
Natl Med J India
· 2025 · PMID 40826962
·
Publisher ↗
Background Medical research is the backbone of advances in medical technology. To decrease the deficit in the physician- scientist ratio in developing countries, initiatives are being taken to inspire medical students to...Background Medical research is the backbone of advances in medical technology. To decrease the deficit in the physician- scientist ratio in developing countries, initiatives are being taken to inspire medical students to pursue research careers. Hence, it is necessary to understand the attitudes of undergraduate (UG) medical students towards medical research. Methods This cross-sectional survey included 241 UG medical students of the 2016-17 academic year from the 1st, 2nd and 3rd years of a teaching institute and a tertiary care hospital. A pretested, structured questionnaire containing 25 items was used to capture the various dimensions of attitudes towards medical research, such as the importance of research, the scientific rigour of medical research, perceived personal benefits and difficulties, and motivators for pursuing research as a medical student. Results Of the 241 students, 20 (8.3%) had undertaken research during medical school, and 144 (60%) had a positive attitude with strong agreement on the statement 'Research discovery is essential for clinical care'. In exploratory factor analysis, 5 attitudes towards research were obtained: (i) Instrumental motivated attitude, (ii) externally motivated or forced attitude, (iii) positive attitude, (iv) negative attitude and (v) seriousness towards research. Conclusion UG medical students had a positive attitude towards the idea that 'research is essential for clinical care' and showed interest in attending training in research methodology.
Ali E, Sachdeva A, Thakur A
… +3 more, Khullar S, Das P, Abbas SZ
Natl Med J India
· 2025 · PMID 40587287
·
Publisher ↗
Background We aimed to assess the knowledge and attitude about cannabis use among college students in India, compare the perspective among users and non-users and lay a framework for development of effective primary prev...Background We aimed to assess the knowledge and attitude about cannabis use among college students in India, compare the perspective among users and non-users and lay a framework for development of effective primary prevention strategies in future. Methods This cross-sectional study was done in different colleges of Mumbai. Two hundred and sixty students of both sexes aged between 18 and 25 years were selected by systematic random sampling. Participants had to fill a sociodemographic questionnaire and a self-administered questionnaire that was analysed using the Statistical Package for the Social Sciences software. Results About 11.2% of the participants were users of cannabis and around 15% of them expressed a desire to take cannabis in the future. About 72% users were introduced to cannabis by their friends. The most common reasons for consumption of cannabis were peer pressure (29.6%), followed by stress reduction (23.5%) and experimentation (21.9%). The majority of participants (81%) did not favour legalization of cannabis use. However, more than half the participants were unaware of cannabis-related legal issues. Non-users considered cannabis to be more harmful and addictive than users who held a more permissive view regarding effects of taking cannabis. Conclusion The knowledge regarding harmful and legal implications of cannabis is relatively low amongst college students. Peer pressure, stress reduction and experimentation remain the commonest reasons for consumption. Imparting knowledge in early adolescence remains crucial in mitigating ignorant attitudes towards harmful cannabis use.
Natl Med J India
· 2025 · PMID 40587286
·
Publisher ↗
Background We evaluated the effect of 6 months of regular training, tele-monitoring and daily text message to remind medication intake on treatment adherence in tuberculosis (TB) patients and their contacts. Methods This...Background We evaluated the effect of 6 months of regular training, tele-monitoring and daily text message to remind medication intake on treatment adherence in tuberculosis (TB) patients and their contacts. Methods This randomized, controlled study with pre- test and post-test design was conducted with the following groups: TB Intervention, TB control, contacted intervention and contacted control group, a total of 66 patients and 87 contacted people. The data of study were collected with 'Patient and Contact Question Form', Tuberculosis Adherence Determination Questionnaire (TADQ) and 'Morisky 8-Item Adherence to Drug Questionnaire' (MMAS-8). Results TADQ scores of the TB intervention group in the beginning, 1st, 3rd and 6th months were 80.4 (7.9), 117.8 (6.3), 137.7 (7.5), 143.2 (4.5), respectively, and TADQ scores of the TB control group in the beginning, 1st, 3rd and 6th months were 88.1 (7.1), 84.5 (9.8), 75.9 (7.9), 65.2 (9.2), respectively. MMAS-8 scores of the contacted intervention group in the beginning, 1st, 3rd and 6th months were 3.6 (1.3), 5.5 (0.7), 7.2 (0.8) and 7.7 (0.7), and those of the control group were 5.7 (1.4), 4.3 (1.4), 1.8 (1.5) and 0.7 (1.4), respectively. Conclusion As a result of 6 months of regular training, tele-monitoring and daily text message, adherence of the patients to TB treatment increased, and the adherence of the contacted people to the medication increased. Nurses should take an active role in the management of TB, determine the patients who do not use drugs correctly in the early period and apply the required interventions as soon as possible to improve treatment adherence of TB patients and contacts.
Natl Med J India
· 2025 · PMID 40587284
·
Publisher ↗
Haemoglobinopathies, the most prevalent haemolytic disease in India, make up the majority of patients in most haematology outpatient clinics. The most prevalent hereditary haemolytic anaemia is beta-thalassaemia trait (β...Haemoglobinopathies, the most prevalent haemolytic disease in India, make up the majority of patients in most haematology outpatient clinics. The most prevalent hereditary haemolytic anaemia is beta-thalassaemia trait (βTT). It often remains undiagnosed as it has an asymptomatic clinical course. However, βTT needs be identified to provide genetic counselling to the affected families and to reduce the number of affected children born, which will lower their overall financial burden. Better screening methods for haemoglobinopathies have increased the detection of mixed haemolytic anaemia. We report a patient with combined βTT and hereditary spherocytosis.
Natl Med J India
· 2025 · PMID 40587280
·
Publisher ↗
We introduce the stories of the lives of four women founders of four Indian medical colleges: Dr Edith Brown who founded the North Indian Medical School for Christian Women, Ludhiana (present-day Christian Medical Colleg...We introduce the stories of the lives of four women founders of four Indian medical colleges: Dr Edith Brown who founded the North Indian Medical School for Christian Women, Ludhiana (present-day Christian Medical College, Ludhiana); Lady Winifred Hardinge, after whom the Lady Hardinge Medical College, Delhi was named; Dr Ida Sophia Scudder who founded the Christian Medical College, Vellore; and Rajkumari Amrit Kaur, the cabinet minister responsible for the creation of the All India Institute of Medical Sciences, New Delhi. We highlight events and people in their lives crucial to the creation of the four institutions that have had a transformative impact on Indian medical education particularly for women. We observed that very diverse backgrounds and early lives prepared these four women for a mission that in its impact was very similar.
Natl Med J India
· 2025 · PMID 40587279
·
Publisher ↗
Background Automation of the procurement process through e-procurement is a key strategy for enhancing industrial operations management. E-procurement in the supply chain allows companies to use the internet to procure m...Background Automation of the procurement process through e-procurement is a key strategy for enhancing industrial operations management. E-procurement in the supply chain allows companies to use the internet to procure materials and handle value-added services. The Government of India, in the year 2016, introduced the government e-marketplace (GeM) for public sector procurement. Any new intervention faces challenges, and stakeholder feedback can help improve the system. Our study uses stakeholder satisfaction to assess the implementation of GeM compared to traditional/other purchase methods. Methods We undertook a prospective study in the procurement division of a tertiary care institute over 1 year. The study tool was a questionnaire containing 28 questions to analyse the stakeholders' satisfaction. Results Of the total participants in the study, 40.6% were secondary buyers, 37.5% were storekeepers and 21.9% were dealing hand/hospital purchase division clerks. The stakeholders opined ease in process, time bound and transparency as the parameters in which GeM is better than the conventional platform. Conclusion A public procurement process should ensure efficiency, economy and accountability in the system. Given the findings, the GeM platform is a welcome addition to the public procurement landscape. While the platform has definite advantages, there is a need to strengthen it further to meet the specific needs of the healthcare industry.
Mukhim D, George A, Gopalakrishnan R
… +2 more, Gowri MS, Kuruvilla A
Natl Med J India
· 2025 · PMID 40587277
·
Publisher ↗
Background Medical students' attitude towards psychiatry (ATP) and mental illness will impact their choice of psychiatry as a future specialization and the quality of mental healthcare that they deliver to their patients...Background Medical students' attitude towards psychiatry (ATP) and mental illness will impact their choice of psychiatry as a future specialization and the quality of mental healthcare that they deliver to their patients. There is a paucity of longitudinal research on students' ATP and mental illness at different periods during medical school. We aimed to assess the attitudes of a cohort of medical undergraduates towards psychiatry and mental illness, before and after a clinical psychiatry rotation. Methods Medical students, in their second clinical year, underwent the first assessment on the 1st day of the psychiatry rotation. Socio-demographic information was collected. ATP and mental illness were assessed using the ATP-30 and the attitudes towards mental illness (AMI) scale, respectively. Assessments were repeated on the last day of the rotation and again 1 year later. Results One hundred and three medical students completed the pre- and immediate post-rotation survey questionnaire. One student withdrew consent for the 1-year assessment. There was an increase in ATP-30 and AMI scores after the rotation, and this persisted at the 1-year assessment. However, only the increase in ATP-30 scores was statistically significant. There was a significant reduction in the number of students with an overall negative attitude towards psychiatry and mental illness at 1 year. Conclusion Students generally had positive attitudes towards psychiatry and mental illness before the rotation. This improved further by the end of the rotation and persisted at 1 year of follow-up.
Natl Med J India
· 2025 · PMID 40587275
·
Publisher ↗
The major clinical manifestations of orbitofrontal cortex lesions include disinhibition, perseveration and obsessive-compulsive and antisocial behaviours. Some patients with orbitofrontal cortex lesion can show mood elev...The major clinical manifestations of orbitofrontal cortex lesions include disinhibition, perseveration and obsessive-compulsive and antisocial behaviours. Some patients with orbitofrontal cortex lesion can show mood elevation. We report a 69-year-old female who presented with manic and inappropriate emotional responses caused by a large olfactory groove meningioma. Magnetic resonance imaging showed a large, extra-axial mass with homogenous enhancement in the olfactory groove, compressing the orbitofrontal cortex. She showed no focal or lateralising neurological signs. We did standardized neuropsychological batteries, including the Young Mania rating scale to evaluate her manic symptoms. After removal of the tumour, her manic symptoms and abnormal behaviours gradually disappeared. These findings suggest that her manic symptoms might have resulted from compression of the orbitofrontal cortex due to the olfactory groove meningioma. Clinicians must have an index of suspicion for organic brain lesion compressing the orbitofrontal area when a patient without a history of psychiatric disease develops progressive manic symptoms.
Natl Med J India
· 2025 · PMID 40587274
·
Publisher ↗
Infective endocarditis (IE) is caused by viral, bacterial or fungal pathogens, with high morbidity and mortality. Fungal endocarditis is rare and is associated with severe complications with poor prognosis despite combin...Infective endocarditis (IE) is caused by viral, bacterial or fungal pathogens, with high morbidity and mortality. Fungal endocarditis is rare and is associated with severe complications with poor prognosis despite combined medical and surgical treatment. Although Candida albicans is the most common fungal agent of this severe form of endocarditis, Candida parapsilosis is the most common non-albicans causative species. A 17-year-old patient who had had a liver transplant was referred to our paediatric cardiovascular surgery ward with a diagnosis of right heart failure. He had had coronary artery bypass graft and aortic valve replacement in 2021. He came to the outpatient clinic with complaints of fever, weakness, nausea and vomiting. On physical examination, he had pallor, dyspnoea and tachycardia. His fever was 38 °C and a grade 2/6 systolic ejection murmur was detected on auscultation. Amphotericin B in a dose of 4 mg/kg/day was started based on the antifungal sensitivity test.
Natl Med J India
· 2025 · PMID 40587273
·
Publisher ↗
Background Medicine is a rapidly evolving field, so medical education aims to instill in students a commitment to ongoing learning and professional development promoting lifelong learning. To determine the role of a spec...Background Medicine is a rapidly evolving field, so medical education aims to instill in students a commitment to ongoing learning and professional development promoting lifelong learning. To determine the role of a specific module in motivating medical educators to promote self-directed learning (SDL) in Medical Education. Methods The present study was conducted after obtaining institutional ethical clearance and informed consent from the participants. One-month mentor-learner web sessions on SDL using Google Group were arranged after administrative approval was obtained. There were 42 participants in the study. The whole module was conducted online. Study materials were provided to the participants using the Google Group and the WhatsApp Group, and for group activities learners were divided into five groups. Results Faculty members were motivated to apply their acquired skills as per feedback responses, reflection writing analysis, responses to motivational scale scores (Mean of importance and effort items were between 4.07-4.48 on a 5-point scale), and program evaluation (Kirkpatrick Level 1) was satisfactory. Conclusion The present faculty development program conducted online focused on SDL providing educators with essential tools and strategies to foster SDL among medical students. The program encompassed various elements, including peer review, hands-on training sessions, and collaborative learning, aimed at enhancing faculty members' understanding of SDL principles and their practical implementation in medical curricula. The combination of intrinsic and extrinsic motivators, coupled with a well-designed faculty development program, contributed to the success of the initiative in promoting SDL in medical education.