Background and objectives: Tobacco use leads to over 7 million deaths each year worldwide and is expected to rise to over 8 million by 2030. The aim of the present study was to assess the prevalence of current tobacco use in the smoked and smokeless form in Punjab, India.
Methodology: This cross-sectional study was conducted from December 2015 till March 2016. A three-stage sampling technique was used for collecting data from three randomly selected districts representing three major regions of Punjab, India. A sample size of 510 individuals was divided equally into urban and rural area with proportionate sampling on basis of subsets of age groups and gender. The questionnaire based on tobacco questions for the survey (TQS), a subset of key questions from the global adult tobacco survey (GATS) was used.
Results: Overall, the prevalence of current tobacco use was 11.5%. The smoked form was more prevalent (15.2%) as compared to smokeless (7.8%) form. The odds for smoked tobacco users are 4 times more in age group of 45 years and above (OR 4.9, 95% CI 1.4, 16.8). In addition, an antagonistic relationship between education and use of smoked tobacco was observed as the odds ratio decreased with increasing level of education (OR 0.83–0.13, C.I. 0.23–2.97, 0.02–0.74).
Conclusion: Tobacco use was low in Punjab, India especially in females as compared to other states of the country. Despite of low overall prevalence of tobacco use, it is higher among low socio economic underprivileged groups and people with low literacy levels. The focus of government should be on these groups and address the need for active tobacco cessation facilities in the state.
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Sharma M, Parry MA, Mahanta PJ, Doley P, Pegu G, Jeelani H. Drug-induced Acute Kidney Injury/Acute Tubulointerstitial Nephritis: A Clinico-etiological Study from a Single Center in North-east India. J Postgrad Med Edu Res 2019; 53 (1):7-10.
Introduction: Drug-induced acute kidney injury (AKI)/acute tubule-interstitial nephritis (ATIN) is an important cause of AKI. There is little information about drug-induced AKI in our part of the world (north-east India).
Aim: To determine the clinico-etiological profile of drug-induced AKI and their outcome in our part of the world and correlation with the histological pattern.
Materials and methods: This is a retrospective observational study of patients who developed AKI following intake of some medications. AKI was defined as per risk’ injury faiure less and end-stage kidney (RIFLE) criteria. On ultrasonography, kidney size was normal without any evidence of obstruction. Kidney biopsy was done in patients who didn\'t improve or had a history of multiple drugs or unknown drugs. Patients’ clinical data were correlated with offending drug and histopathology findings
Results: A total of 97 patients were included in this study, 60% were males and 40% were females. Mean age of patients was 45 ± 12.09 years. Herbal medication (29%) was the most common cause of drug-induced AKI, followed by nonsteroidal anti-inflammatory drugs (NSAIDs) (26%). Renal biopsy was done in 54 patients, 59.6% had acute tubulointerstitial nephritis (ATIN), 35% of patients had acute on the chronic TIN. Renal replacement therapy was required in 57.7% patients. Full renal recovery occurred in 38% patients while as, partial recovery occurred in 30% patients. Out of 29 patients with herbal medication intake,17% had full recovery compared to 56% in NSAID group.
Conclusion: Drug-induced AKI is an important cause of renal dysfunction and can be under-diagnosed. AKI may occur with many drugs. Herbal medications were the most common cause of drug-induced AKI and had poor renal outcome compared to NSAIDs.
Clinical significance: In our study, herbal medications intake was a common cause of AKI and was associated with poor renal recovery. Early suspicion and withdrawal of the offending drug are needed to prevent renal damage.
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Bindal S, Singla N, Singh P, Modi M, Praneeth K, Mohanty M, Vyas S, Gupta SK. Effect of Extent of Hippocampal and Amygdala Resection on Seizure Outcome in Patients with Refractory Epilepsy Secondary to Medial Temporal Sclerosis. J Postgrad Med Edu Res 2019; 53 (1):11-16.
Introduction: Anterior temporal lobectomy with amygdalohippocampectomy is the most common surgical procedure for refractory epilepsy secondary to mesial temporal sclerosis. There is no consensus on whether the degree of hippocampal or amygdala resection has any influence on determining outcomes after epilepsy surgery. In this study, we assessed the seizure control and neuropsychological outcome and correlated these with the degree of surgical resection as determined on postoperative magnetic resonance imaging (MRI) in patients who had undergone surgery for refractory temporal lobe epilepsy.
Materials and methods: A total of 20 patients of refractory medial temporal lobe epilepsy were taken who underwent anterior temporal lobectomy with hippocampal and amygdala resection. Pre and Post-op clinical and neuropsychological assessment was done. Pre- and post-operative MR scans were compared for degree of hippocampal and amygdala resection. Seizure control was assessed based upon the degree of resection.
Results: Out of 18 patients with complete resection of the hippocampal body, 17 (94.4%) patients had Engels class I outcome and one (5.6%) patient had Engels class II outcome. But in patients with partial body resection, both the patients (100%) had Engel\'s class II outcome. On complete resection of the tail, 12 patients had class I and one patient had class II outcome. When the tail of hippocampus was partially resected, or unresected resection five patients had class I but two patients had class II outcome.
Conclusion: It is required to achieve complete removal of pes hippocampus and hippocampal body for better seizure control and improvement in neuropsychological performance. The degree of the hippocampal tail or amygdala resection does not affect the outcome.
Artificial intelligence (AI) has entered the popular mind for the past few years. Unlike many technical buzzwords, AI has stronger staying power. There has been a spurt in employing AI in many fields like aviation, package delivery to homes, stock trading, media, music, video games, telecom, and many others. However, the field of health has seen limited permeation, especially given its huge size.
It should be noted that some branches in healthcare do have strong AI usage like robotic surgery, computer-aided diagnosis, clinical decision support systems, eye scan analysis, but they are limited to advanced institutions and highly trained doctors. AI can truly revolutionize healthcare when applications employing it can be used at the grassroots level. For medical practitioners, uninitiated in AI technologies, it could be hard to visualize the kind of problems AI can solve in their professional field. Several examples are also provided where healthcare could leverage AI for the benefit of the masses. For a couple of examples, more details to the problem and a corresponding AI based solution are also provided. Several barriers to AI adoption are also presented followed by a conclusion which suggests a simple strategy to boost AI adoption.
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Joseph J, Basu D. Adverse Drug Reactions to Disulfiram Treatment with or without Alcohol Challenge in the Indian Setting: Systematic Review. J Postgrad Med Edu Res 2019; 53 (1):21-30.
Background: Disulfiram has been used for treating alcohol dependence in the Indian population for the last three decades. The safety concerns associated with adverse effectsraise a high index of suspicion for disulfiram therapy in Indian population. Surprisingly few reviews exist on adverse reaction to disulfiram treatment and most of such articles published during the 1990s. Moreover, such systematic investigation relevant to the Indian population is missing in the literature. Thepresent review aims to narrate and discuss disulfiram induced adverse reactionsin the Indian setting.
Materials and methods: We analyzed clinical trials, observational studies and case reports of adverse drug reactions to disulfiram therapy reportedin the Indian setting. Relevant studies published within 2017 in the electronic databases: Medline, Ind MED, Ermed, and Embase were included. The Naranjo adverse drug reaction probability scale (NADRPS) was used for assessing adverse drug reactions to disulfiram treatment.
Results: The present review identified four open-label trials, four observational studies and 24 case reports describing thirtytwo cases of disulfiram-induced adverse reactions in the Indian setting. Psychiatric adverse events and de novo convulsions were the common adverse reactions to disulfiram treatment without alcohol challenge in this setting. The NADRPS score was found to be from 5–9 and the magnitude of the adverse effects associated with disulfiram-ethanol reaction was largely associated with surreptitious use.
Conclusion: The review is a pioneer attempt for an evidence base summary of common adverse reactions and temporal association of dose-dependent adverse effects to disulfiram treatment in the Indian setting. The results of the review open an area of discussion regarding ethnic variations and the adverse effects of disulfiram in clients treated for alcohol dependence in this setting.
A young male patient of 20-year-old came to our hospital for evaluation of hypertension in young. The patient has presented with symptoms of dizziness and heaviness of the head for past 3 months. ECHO was suggestive of coarctation of the aorta and was evaluated for the same with catheter angiography study. Aortograms were taken through both right brachial and femoral routes. Transfemoral catheter failed to pass beyond the proximal descending thoracic aorta, and flush angiograms showing aortic stump are taken. Transbrachial artery catheter angiogram showed abrupt cut off of the arch of aorta distal to the origin of the left subclavian artery. It was interpreted as severe coarctation of aorta and stent dilatation was planned during the same sitting. However even guide wire was not negotiable through the segment and procedure was abandoned. For proper delineation of aortic anatomy, multislice computed tomography (CT) angiography was performed which showed complete discontinuity of lumen of the aorta between the aortic arch and descending thoracic aorta which is separated by an atretic fibrous band of thickness ~3.2 mm suggestive of interruption of the aorta (type A).
Satnam S Jolly,
Vijay K Meena
Oral and maxillofacial defects are both aesthetically and functionally challenging for the surgeon. Autogenous bone grafts seldom fulfill the criteria of three-dimensional replication of the lost hard and soft tissues. Medical grade titanium alloy has recently been used to fabricate three dimensional (3D) customized implants for the reconstruction of various upper and midface bony defects. This paper presents three cases of midface reconstruction with the help of customized 3D titanium patient-specific implants.
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Mangtani N, Pruthi G, Jain V. Post-surgical Extraoral Commissure Stent for Correction of Microstomia in a Child with Chemical Burns: A Clinical Report. J Postgrad Med Edu Res 2019; 53 (1):38-41.
An 8-year-old male child presented with long-standing microstomia due to chemical burns six months before reporting to us. Challenges and limitations were difficult intraoral and extraoral impressions, partially erupted and carious teeth along with financial constraints and unavailability for frequent follow-ups as the patient hailed from a distant place with poor accessibility. Microstomia was treated surgically followed by delivery of removable acrylic extraoral commissure stent to prevent lip adhesions in the post-surgical phase. Fabrication technique of the appliance was innovative, and it involved a new technique for making an impression of the oral commissures. The appliance was effective, economical, easy to fabricate and required minimal follow-up visits and adjustments.
It is well accepted in medical education that assessment drives learning. Authentic assessment involves examining the knowledge, skills or competencies that students are expected to exhibit in their future professional practice. In recent times, transparency and public demand for accountability have gained momentum in the context of undergraduate and postgraduate medical education. By adopting authentic assessment tools, medical institutes are better prepared to justify the grades awarded to students and the outside world. The paper discusses the preference of criterion-referenced tests (CRT) over norm-referenced test (NRT) in medical education to support the development and implementation of authentic assessment activities. The value of laying down clear, standardized criteria for assessment has been emphasized to improve student learning and engagement with the curriculum. The paper has attempted to summarize barriers in implementing competencybased assessment, including educators, students, and institutional factors. It also suggests pragmatic measures to overcome these difficulties and the need to adopt a critical view of existing assessment modes.