As the WHO puts it, breastfeeding is the cornerstone of child survival, nutrition, development, and maternal health. According to NFHS data of India, only 71.2% of children under six months are exclusively breastfed in M...As the WHO puts it, breastfeeding is the cornerstone of child survival, nutrition, development, and maternal health. According to NFHS data of India, only 71.2% of children under six months are exclusively breastfed in Maharashtra. The problem may be more prevalent in tribal communities due to their geographical location and strong cultural norms. This community-based cross-sectional observational study was conducted among consenting mothers of the Scheduled Tribe category with children aged six months to one year residing in the area under the Primary Health Center in a tribal village. A list of mothers fulfilling inclusion criteria was obtained from seven subcentres, and participants were selected by random sampling from each. Data was obtained by a structured interview schedule. Descriptive analysis estimated the prevalence of exclusive breastfeeding (EBF), and the association between qualitative variables was assessed by the Chi-square test. Multivariate logistic regression was applied to determine the predictors of EBF, using the software SPSS-28. A P value of ≤ 0.05 was used as the cut-off for statistical significance. Prevalence of EBF was 63.4%. Factors like age, education, occupation of mother, maternal education, place of delivery, practice of colostrum feeding, are statistically significantly associated with the practice of EBF. Multivariate logistic regression revealed that the age of the mother and the education of the father are determinants of EBF. The prevalence of EBF in the study area is lower than the state prevalence, highlighting the need for focused intervention. Furthermore, EBF practices are influenced by a mix of social, cultural, and economic factors.
To explore the potential of virtual reality (VR) as a training tool for basic life support (BLS) and other emergency procedures to achieve higher levels of knowledge in the cognitive, psychomotor, and affective domains....To explore the potential of virtual reality (VR) as a training tool for basic life support (BLS) and other emergency procedures to achieve higher levels of knowledge in the cognitive, psychomotor, and affective domains. Sixty trainees, divided into two groups of thirty each, were trained first using conventional methods, followed by VR devices, and then crossed over in this randomized crossover trial. Data indicators included a pre-validated set of thirty-one mixed response questions administered via Google Forms and a checklist of twelve parameters. Assessment was performed using "Direct observation of procedural skills" at four time periods, at T0 (before training), T1 (post-completion of training with the conventional or immersive technique), T2 (post-completion of training with the immersive or conventional technique), and T3 (post-three months of last training with either the conventional or immersive technique). Inferential statistics were performed using the Chi-square test for categorical variables and analysis of variance (ANOVA) for continuous variables. Intra-group comparison revealed a significant difference from T0 to T3 for all parameters in groups I and II, except for the "compression depth" parameter in group I. Inter-group comparison at T0 and T3 revealed no statistically significant difference between the two techniques. Overall satisfaction levels from T0 to T3 in both groups revealed an increasing learning preference for the VR method (46.6%-73.3% in group I and 50%-80% in group II). Immersive teaching-learning methods using VR provided a scalable and consistent learning experience, highlighting its utility for BLS training in remote or resource-constrained environments. Trainees' preferences and VR's ability to foster a desired teaching-learning environment are promising signs, warranting exploration of its long-term synergistic impact with other immersive teaching-learning methods.
INTRODUCTION: Skin, hair, and nail diseases can greatly impact psychosocial well-being, making an accurate diagnosis essential. Skin biopsies are a key diagnostic tool in dermatology, aiding in identifying and distinguis...INTRODUCTION: Skin, hair, and nail diseases can greatly impact psychosocial well-being, making an accurate diagnosis essential. Skin biopsies are a key diagnostic tool in dermatology, aiding in identifying and distinguishing various skin conditions. This study was done to determine the spectrum of diseases requiring skin biopsy and the level of clinicopathological concordance. MATERIALS AND METHODS: We retrospectively reviewed 5000 skin biopsy records at a tertiary care center over 2 years. Data included demographics, biopsy sites, lesion morphology, clinical indications, and histopathological diagnoses. The Chi-square test assessed the concordance between clinical and histopathological findings ( P < 0.05). RESULTS: Of 5000 biopsies, 56.2% were from males, with peak incidence in the 35-40 age group. The most biopsied sites were the lower limb (22%), with plaques being the most common lesion morphology (37.9%). Papulosquamous disorders (24.7%) were the leading indication, particularly Lichenoid dermatitis (9.6%), followed by cutaneous infections (14.7%), mainly mycobacterial (9.2%). Lichen planus (6.2%) and psoriasis (4.5%) were the most frequent histopathological diagnoses. Overall, clinicopathological concordance was 86%, with 50.6% full and 35.4% partial concordance. Variability in concordance rates was seen across disease categories. CONCLUSION: Skin biopsy plays a vital role in diagnosing dermatological conditions, with an 86% concordance rate. Variability across conditions highlights the importance of clinicopathological correlation and careful clinical evaluation.
INTRODUCTION: Adverse drug reactions (ADRs) are an important cause of morbidity, prolonged hospital stay, and increased healthcare costs. Monitoring and reporting ADRs through pharmacovigilance systems help identify drug...INTRODUCTION: Adverse drug reactions (ADRs) are an important cause of morbidity, prolonged hospital stay, and increased healthcare costs. Monitoring and reporting ADRs through pharmacovigilance systems help identify drug-related risks and improve patient safety. This study aimed to describe the pattern, characteristics, and outcomes of ADRs reported at a tertiary care teaching hospital under the Pharmacovigilance Programme of India (PvPI). MATERIALS AND METHODS: A retrospective, observational, cross-sectional study was conducted at the ADR Monitoring Center of a tertiary care teaching hospital. Individual Case Safety Reports submitted to the Vigiflow database between January 2023 and December 2024 were analyzed. This study got approval by ethics committee. Data were evaluated for patient demographics, suspected drugs, system organ class involvement, seriousness, outcomes, and causality using the World Health Organization-Uppsala (WHO-UMC) scale. Descriptive statistics were used to summarize the data. RESULTS: A total of 299 ADRs were described and analyzed. Adults accounted for the majority of cases, with a slight male predominance. Antimicrobials (29%) were the most commonly implicated drug class. Most ADRs were non-serious. On causality assessment, the majority of reactions were classified as "probable (90.63%)". The most common adverse event was headache (8.6%). The ADR outcome was recovered/resolved in 64.6%. CONCLUSION: ADRs are commonly encountered in tertiary care settings, with antimicrobials being the most frequent contributors. Describing and analyzing reported ADR data, increasing awareness among medical students, healthcare professionals, and encouraging regular ADR reporting are essential steps to enhance patient safety and promote rational drug use.
The study aimed to assess clinicians' perceptions regarding therapeutic drug monitoring (TDM), including perceived need, lacunae, extent of utilization, and barriers to TDM services in a tertiary care teaching hospital i...The study aimed to assess clinicians' perceptions regarding therapeutic drug monitoring (TDM), including perceived need, lacunae, extent of utilization, and barriers to TDM services in a tertiary care teaching hospital in Nagpur. We conducted a cross-sectional, questionnaire-based study among clinicians directly involved in patient care after obtaining institutional ethics committee approval. Clinicians were approached to obtain written or electronic consent. The questionnaire consisted of 18 structured, close-ended questions. Responses were collected using a three-point Likert scale, yes/no, or multiple-choice questions. The questionnaire demonstrated good reliability, with a Cohen's kappa index of 0.7, a scale-level content validity index of 0.82, and a Pearson's r value of 0.9 on test-retest reliability. The study included 75 clinicians. Among the total participants, only 36% ( n = 27) reported prior use of TDM services in clinical practice; 93.33% ( n = 70) agreed that TDM can be used to optimize drug exposure, and 96% ( n = 72) agreed that pharmacokinetic parameters are affected by concomitant medications and that TDM may prevent adverse drug reaction (ADR). Overall, 56% ( n = 42/75) reported a moderate level of awareness regarding TDM. Major barriers included limited awareness among clinicians (58.66%, n = 44), lack of practical experience (68%, n = 51), and lack of facilities (60%, n = 45). The findings of the present study highlight the need for the implementation of TDM services. While awareness regarding the role of TDM in optimizing drug exposure and preventing ADRs was high, important gaps were noted in the utilization of services, highlighting the need to facilitate education for healthcare professionals and to develop clear, evidence-based clinical guidelines to overcome the observed gaps.
A prediction model can be considered to have high performance when it gives correct prediction in at least 90% cases for qualitative outcome and at least 90% differences between the observed and predicted values are with...A prediction model can be considered to have high performance when it gives correct prediction in at least 90% cases for qualitative outcome and at least 90% differences between the observed and predicted values are within clinical tolerance in the case of quantitative outcome. A model with an accuracy between 80% and 90% can be possibly tolerated in some situations, but any model with less accuracy implies an unacceptably large error in clinical applications. Most of the models developed so far do not meet these criteria. Moreover, prediction of the unknown is confused with classification of the known. Developing high-performance models requires a lot of extra efforts that are rarely seen in the present endeavors. For this, it is imperative that a large number of known and suspected predictors are considered and complexity in terms of interactions and nonlinearity is accepted. Models with many predictors is not a big limitation now because of wide availability of enormous computing power. More rigorous validation is needed than done now. Artificial intelligence-based models can be linked to the relevant literature so that they continuously update with the new development under the data science paradigm. This article highlights the problems with many of the existing models and describes steps to develop a high-performance model for medical outcomes. Many of the advices we give are rarely available in the literature.
J Postgrad Med
· 2026 Jan · PMID 41848354
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Peripheral artery disease is considered as an extra-cardiac manifestation of atherosclerosis, and its clinical presentation is equated to lower limb ischemia. A similar pathogenetic mechanism plays a role in luminal sten...Peripheral artery disease is considered as an extra-cardiac manifestation of atherosclerosis, and its clinical presentation is equated to lower limb ischemia. A similar pathogenetic mechanism plays a role in luminal stenosis or obliteration of one or more of the aortic arch arteries. This is a presentation of an uncommon case of synchronous athero-thrombotic obliteration of the right brachio-cephalic and left subclavian arteries in a hypertensive male, who had been symptomatic for only 6 hours.
J Postgrad Med
· 2026 Jan · PMID 41834512
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Despite the growing clinical significance of Burkholderia cepacia complex (Bcc), there are lacunae regarding indepth understanding of its epidemiology and management. The present study was conducted to evaluate the clini...Despite the growing clinical significance of Burkholderia cepacia complex (Bcc), there are lacunae regarding indepth understanding of its epidemiology and management. The present study was conducted to evaluate the clinico-epidemiological profile of patients presenting with Bcc infections and antibiotic susceptibility profile of these clinical isolates.This retrospective observational study was conducted in a tertiary care teaching university hospital, from January' 2018 to December' 2024 and included all Bcc isolates recovered during the study period. Identification and antimicrobial susceptibility testing were done using VITEK 2 compact automated system. A total of 224 Bcc isolates were included in the study. The most predominant age group was >60 years, accounting for 29.5%, and male preponderance was observed. A total of 90% isolates were from inpatients, with 56.7% being admitted to ICUs. Maximum isolates were recovered from blood (61.2%), and diabetes was the most common comorbidity observed (44.6%). Respiratory samples amounted to only 9.8% of isolates. The susceptibility rates observed for ceftazidime, meropenem, trimethoprim-sulfamethoxazole, minocycline, and levofloxacin were 93%, 85.7%, 78.1%, 70%, and 60%, respectively. To the best of our knowledge, this is the first record of clinico-epidemiological and microbiological characteristics of Bcc isolates from Rajasthan. This research could significantly inform clinical practice, optimizing treatment strategies for infections caused by this opportunistic pathogen. Since it is a difficult-to-treat emerging pathogen, regular and systematic surveillance is crucial.
J Postgrad Med
· 2026 Jan · PMID 41834495
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INTRODUCTION: Healthcare demands of Duchenne muscular dystrophy (DMD) impose a significant burden with the possibility of country-specific differences. MATERIAL AND METHODS: Analysis to determine cost-of-illness from a s...INTRODUCTION: Healthcare demands of Duchenne muscular dystrophy (DMD) impose a significant burden with the possibility of country-specific differences. MATERIAL AND METHODS: Analysis to determine cost-of-illness from a societal perspective was performed by prevalence-based, bottom-up microcosting in 60 boys with DMD between July 2022 and January 2024. Direct (medical and nonmedical), indirect (productivity losses of caregivers) and intangible (cost of suffering monetized by willingness to pay method) costs were estimated. National burden was calculated using India-specific prevalence. RESULTS: The cumulative annual cost for 60 patients was ₹ 23,987,323 (USD 290,157). The total median annual cost per patient was ₹ 268,325 (USD 3245). The national economic burden of DMD was ₹ 20,549,902,776 (248,577,510 USD). The highest cost driver of direct costs was expenditure on complementary and alternative medicines and unapproved therapies (₹ 8,549,790 or USD 103,420). Nature of therapy was a significant predictor of total, direct, and intangible costs ( P < 0.001, 0.003, and < 0.001, respectively). Residence in tier X city was a predictor for direct ( P = 0.042) and intangible costs ( P = 0.032). Residence in urban areas ( P = 0.022) and Mumbai ( P = 0.002) were significant predictors of intangible costs. CONCLUSIONS: Despite some limitations, the study provides directions for planning healthcare services for DMD in India by developing standard treatment guidelines, allocation of resources through national health schemes for carrier screening and prenatal diagnosis, promoting evidence-based therapeutic practices, and regulation to curb unscientific therapies. Baseline data are available to decide cost-effectiveness of public expenditure for disease-modifying drugs for DMD.
Panda A, Kumar S, Garg P
… +3 more, Sahu S, Matlani M, Nair D
J Postgrad Med
· 2026 Jan · PMID 41789629
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Epstein-Barr virus (EBV) is an underrecognized cause of pediatric febrile illness due to its clinical overlap with other viral infections such as dengue and cytomegalovirus (CMV). This study aimed to determine the burden...Epstein-Barr virus (EBV) is an underrecognized cause of pediatric febrile illness due to its clinical overlap with other viral infections such as dengue and cytomegalovirus (CMV). This study aimed to determine the burden of primary EBV infection among febrile children and to assess the diagnostic limitations of using viral capsid antigen (VCA)-IgM alone for its detection. We retrospectively analyzed 245 stored pediatric sera submitted for dengue, chikungunya, or toxoplasma, rubella, CMV, and herpes simplex virus (TORCH) IgM testing. EBV-specific antibodies like VCA-IgM, VCA-IgG, and Epstein-Barr nuclear antigen (EBNA)-1 IgG were detected using commercial enzyme-linked immunosorbent assay (ELISA) kits. Primary EBV infection was defined as VCA-IgM positive with EBNA-1 IgG negative. Data were expressed as n (%) and compared using χ2 test. Primary EBV infection was detected in 9.8% (24/245) of cases, second only to dengue (42/245; 17.1%). Approximately one-third of VCA-IgM positive samples (12/36; 33%) represented false positives (FPs) due to cross-reactivity, primarily with dengue and CMV. VCA-IgM alone demonstrated 100% sensitivity but only 93.2% specificity. EBV infection was more common in infants, while dengue predominated in older children, though the difference was not statistically significant ( P = 0.081). Primary EBV infection constitutes a hidden yet significant cause of pediatric febrile illness. Reliance on VCA-IgM alone may lead to diagnostic errors; hence, a complete EBV serologic panel is essential to improve diagnostic accuracy and avoid misclassification.