Journal of Postgraduate Medicine, Education and Research

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2022 | July-September | Volume 56 | Issue 3

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EDITORIAL

Venkata Ganesh, Tanvir Samra, B Naveen Naik

Simulation-based Education and Evaluation: Why the Wait?

[Year:2022] [Month:July-September] [Volume:56] [Number:3] [Pages:2] [Pages No:107 - 108]

   DOI: 10.5005/jp-journals-10028-1595  |  Open Access |  How to cite  | 

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RESEARCH ARTICLE

Jasleen Kaur, Sukhpal Kaur, Neena Vir Singh, Aditya K Aggarwal

Effectiveness of Perioperative Patient Education Program on Knowledge and Satisfaction among Patients Undergoing Total Joint Arthroplasty

[Year:2022] [Month:July-September] [Volume:56] [Number:3] [Pages:7] [Pages No:109 - 115]

Keywords: Patient knowledge, Patient satisfaction, Perioperative education, Total joint arthroplasty

   DOI: 10.5005/jp-journals-10028-1586  |  Open Access |  How to cite  | 

Abstract

Total hip arthroplasty (THA) or total knee arthroplasty (TKA) is a major surgical procedure that can provoke physical as well as psychological stress in patients. It is hypothesized that perioperative patient education helps patients to prepare better for surgery and enhance postoperative recovery. Objective: To evaluate the effectiveness of perioperative patient education program on knowledge and satisfaction among patients undergoing total joint arthroplasty. Materials and methods: A total of 100 patients undergoing THA or TKA were enrolled preoperatively and were randomized into control (50) and experiment groups (50) by covariate adaptive randomization. In the experimental group, along with routine care, perioperative education program was implemented. It included a patient information booklet, demonstration, and return demonstration of pre- and postoperative exercises and transfer techniques. The patients in the control group continued with routine care. Assessment of patient's knowledge regarding surgery and postoperative self-care was done preoperatively, before educational intervention, and at the time of discharge. Patient satisfaction with perioperative information was assessed at the time of discharge using a patient satisfaction scale. Results: There was statistically no significant difference between the pre-intervention knowledge scores of both groups. However, there was a significant improvement in knowledge (p < 0.001) regarding surgery and postoperative self-care as well as satisfaction level (p < 0.001) in participants who underwent an education program than in the control group. Conclusion: Educational booklet combined with exercise program was effective in enhancing patient knowledge and satisfaction. This program is recommended as routine care of patients undergoing total joint arthroplasty.

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Original Article

Sunil K Das, Navneet Singla, Sunil K Gupta, Kokkula Praneeth, Parth Jani, Ashish Aggarwal, Ajay Kumar

Aneurysmal Subarachnoid Hemorrhage: Do Changes in Inflammatory Markers Precede or Succeed Symptomatic Vasospasm?

[Year:2022] [Month:July-September] [Volume:56] [Number:3] [Pages:5] [Pages No:116 - 120]

Keywords: C-reactive protein levels, Inflammatory markers, Platelet count, Subarachnoid hemorrhage, Total leukocyte count, Vasospasm

   DOI: 10.5005/jp-journals-10028-1590  |  Open Access |  How to cite  | 

Abstract

Background: Vasospasm remains the most important predictor of outcome after aneurysmal subarachnoid hemorrhage (aSAH), especially in those who have undergone aneurysm occlusion. Vasospasm elicits an inflammatory response. The exact temporal course of levels of inflammatory markers vis-à-vis vasospasm remains a matter of debate, thus limiting its utility to be used as a predictive tool. Materials and methods: A total of 103 patients of aSAH, who underwent clipping/coiling were prospectively studied. Sequential values of total leukocyte count (TLC), platelet count, and C-reactive protein (CRP) were studied over a period of 2 weeks from the date of ictus. The temporal course of clinical vasospasm and inflammatory markers was then evaluated. Results: The mean age of the study group was 49.5 years. Thirty-three (32%) patients developed vasospasm. The mean day of onset of vasospasm was day 6. Age, gender, and site of aneurysm showed no significant bearing on the occurrence of vasospasm. Inflammatory markers-TLC, platelet count, and CRP levels were initially raised in both vasospasm and non-vasospasm groups. However, after day 10 the values became normal in the non-vasospasm group, but these remained persistently high in the vasospasm group. Conclusion: Persistent leukocytosis, thrombocytosis, and raised CRP beyond 7 days were found in vasospasm group. This period was beyond the mean period of onset of vasospasm. Raised CRP on day 3 seems to have a predictive value for the vasospasm.

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Original Article

Naveen Prashar, Amarjeet Singh

Differentials in the Health Nutrition and the academic Performances in Hostellers and dayscholar Students of a University in Chandigarh

[Year:2022] [Month:July-September] [Volume:56] [Number:3] [Pages:5] [Pages No:121 - 125]

Keywords: Academics, Body mass index, Day scholars, Health, Hostellers, Medical history

   DOI: 10.5005/jp-journals-10028-1592  |  Open Access |  How to cite  | 

Abstract

Aim and objective: To ascertain the health-related determinants of differences in the academic performance and health profile of hostellers and day scholars of a North Indian University, Chandigarh. Materials and methods: This cross-sectional study was conducted at North Indian University, Chandigarh. Respondents were 300 students (150 hostellers, 150 day scholars) from three streams, that is, medical, nonmedical, and arts and commerce. Data analysis was done with the help of MS Excel and a statistical package for the social sciences (SPSS). A comparison between hostellers and day scholar students regarding their academics was made. Findings were considered statistically significant if the p-value was less than or equal to 0.05. Results: Overall, 300 students of North Indian University were studied. The mean academic performance score was 4.44 [standard deviation (SD) ± 0.88]. Undergraduate (UG) students had better academic performances than postgraduates (PG). With an increase in age, there was declining order in academic performances seen. Students of nonmedical streams were extremely good in their academics than medical and arts/commerce students. Most of the students had problems related to the ear, eyes, nose, throat, and oral cavity. Day scholar students had better health status profiles than hostellers. Conclusion: The majority of the hostellers had a good academic performance. Only one-third of day scholars were good in academics. Day scholar students had good medical health status than those who stayed at the hostel.

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CASE REPORT

Vijay Kumar, Suresh K Angurana, Sanjeev Naganaur, Sachin Mahajan, Akshay Saxena, Sanjay Verma

Disseminated Staphylococcal Disease with Massive Pyopericardium and Severe Myocardial Dysfunction in a Child

[Year:2022] [Month:July-September] [Volume:56] [Number:3] [Pages:3] [Pages No:126 - 128]

Keywords: Empyema, Pyopericardium, Staphylococcus aureus

   DOI: 10.5005/jp-journals-10028-1575  |  Open Access |  How to cite  | 

Abstract

The disseminated staphylococcal disease can lead to massive pyopericardium, cardiac tamponade, and myocardial dysfunction. The management includes prompt initiation of intravenous antibiotics, assessment by echocardiography, and/or computed tomography of the chest, urgent drainage by pericardial catheter, and inotropic support. The surgical intervention may be needed in cases with nonimprovement in clinical status.

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CASE REPORT

Jasmine Sethi, Tom Kakkanattu, Harsimran Kaur, Harbir Singh Kohli

Disseminated Nocardiosis in a Patient with Steroid-dependent Nephrotic Syndrome

[Year:2022] [Month:July-September] [Volume:56] [Number:3] [Pages:2] [Pages No:129 - 130]

Keywords: Brain abscess, Nephrotic syndrome, Nocardiosis

   DOI: 10.5005/jp-journals-10028-1576  |  Open Access |  How to cite  | 

Abstract

Aim: We aim to describe an unusual case of disseminated nocardiosis in a patient with steroid-dependent nephrotic syndrome and its successful management with medical therapy alone. Background: Nocardia infection is uncommon in clinical practice, with most cases occurring as the result of opportunistic infection in immunocompromised patients. Here, we report a case of disseminated nocardiosis with brain abscesses in a patient with nephrotic syndrome. Case description: We report a middle-aged female with steroid-dependent nephrotic syndrome with disseminated nocardiosis. The patient was managed with imipenem/cilastatin, oral trimethoprim/sulfamethoxazole (TMP/SMX), and amikacin for 4 weeks followed by dual therapy with co-amoxiclav and TMP/SMX for 6 months. The patient had both clinical and radiological recovery. Clinical significance: The present case indicates the risk of life-threatening infection in patients receiving steroids and the need for prophylactic therapy to prevent serious infections during the course of steroid therapy.

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CASE REPORT

Rajesh Sharma, Ashish Chauhan, Brij Sharma, Vishal Bodh, Neeti Aggarwal, Ashok Kaundal

Intrathoracic Chronic Gastric Volvulus Secondary to Paraesophageal Hernia in a Young Adult: A Case Report

[Year:2022] [Month:July-September] [Volume:56] [Number:3] [Pages:3] [Pages No:131 - 133]

Keywords: Bochardt's triad, Gastric volvulus, Hiatal hernia, Organoaxial volvulus, Paraesophageal hernia

   DOI: 10.5005/jp-journals-10028-1577  |  Open Access |  How to cite  | 

Abstract

Introduction: Gastric volvulus is a rare disorder seen commonly in elderly individuals with 50% of cases reported in association with hiatal hernia. Gastric volvulus commonly presents acutely as a surgical emergency, but chronic variant is also well documented. Case description: We report a case of 35-year-old gentleman, who presented with epigastric pain, postprandial fullness and weight loss of 13 kg in last 6 months. In gastroduodenoscopy, crossing gastroesophageal junction (GEJ) required maneuvering due to abnormal anatomy of stomach and on retroflexion, possible paraesophageal hernia was seen with torsion around scope. CECT abdomen was suggestive of type 3 paraesophageal hernia with gastric volvulus. Patient underwent open laparotomy with repair of hernia and devolvulization of stomach. Discussion: Gastric volvulus is characterized by abnormal rotation of the stomach around one of its axes leading to foregut obstruction with a risk of strangulation. Treatment involves devolvulization of stomach with correction of underlying pathology. Endoscopic treatment has evolved in recent years with endoscopic devolvulization and percutaneous endoscopic gastrostomy being tried as less invasive approaches, but, most of the patients require surgery either laparoscopic or open. Conclusion: High index of suspicion is needed to diagnose gastric volvulus, especially chronic variant. Any delay can lead to gastric ischemia and necrosis, and can be fatal.

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Correspondence

Chandni Sinha, Amarjeet Kumar, Ajeet Kumar, Poonam Kumari, Veena Singh

COVID Era: Rethinking Postgraduate Education

[Year:2022] [Month:July-September] [Volume:56] [Number:3] [Pages:2] [Pages No:134 - 135]

Keywords: COVID-19, Medical education, Postgraduates

   DOI: 10.5005/jp-journals-10028-1581  |  Open Access |  How to cite  | 

Abstract

With the number of patients suffering from COVID-19 increasing all over our country, many teaching hospitals are getting converted to dedicated COVID hospitals. This would mean admission of only COVID- proven/suspect patients with suspension of elective surgeries, preanesthetic clinics, chronic pain, and palliative clinics. Newly joined junior residents are being harnessed to meet the ever-increasing demand in critical care setups. This is a difficult situation as they not only have to provide optimum care to patients, but also work in stressful real-life scenarios. In 2003, severe acute respiratory syndrome (SARS) outbreak in Hong Kong affected healthcare workers, and 17 medical students got infected. This led to the closure of the university. During this period, there was growth of technology-based learning as a continuum to clinical teaching. The various modalities used were webcasting, videotaped vignettes, audio recordings, problem-based learning tutorials on online chat rooms, and mannequin simulators. Though all these modalities sound impressive, implementing all these requires time, adequate resources, and planning. Implementing all these might not be feasible in the present scenario, but this pandemic has taught us one important lesson. It is time that the institutions and government develop and establish customized technology-based learning and assessment for the postgraduate students, in view of any future pandemics.

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Clinicopathological Conference Report

Ritambhra Nada, Venkatesh Dhanasekaran, Parminder Sharma, Aravind Sekar, Ashish Sharma

Mycophenolate Mofetil Colitis and Toxic Epidermal Necrosis: Unusual Complications in Renal Allograft Recipient

[Year:2022] [Month:July-September] [Volume:56] [Number:3] [Pages:6] [Pages No:136 - 141]

   DOI: 10.5005/jp-journals-10028-1591  |  Open Access |  How to cite  | 

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Educational Forum

Manpreet Singh, Manjeet Singh

“Oxygen Audit” with a Novel Teaching and Training Tool in COVID Pandemic

[Year:2022] [Month:July-September] [Volume:56] [Number:3] [Pages:3] [Pages No:142 - 144]

Keywords: Oxygen audit, Oxygen crisis, Teaching and training tool

   DOI: 10.5005/jp-journals-10028-1585  |  Open Access |  How to cite  | 

Abstract

In the midst of oxygen shortage across several states in the country, the union territory Chandigarh (India) mapped the oxygen supply chain that brought the lifesaver gas, from oxygen generation manufacturers to the hospitals. Various steps were taken by the administration to identify the key bottlenecks along the way. Oxygen audit and prevention of oxygen wastage in the pandemic with the use of teaching and training education tools was a novel, innovative thought. The purpose of this training was to sensitize the medical staff regarding unintentional oxygen wastage and thus indirectly save oxygen at times of crisis in the pandemic. It was audited that more than 20–25% oxygen requirement and consumption was decreased in a few days after the sensitization program as extracted from the feedback pro forma, number of patients admitted, demand of the number of oxygen cylinders per day, or liquid oxygen required. The hospital staff admitted that the oxygen-saving sensitization programs decreased their consumption and were eye-openers for them. The fixed oxygen quota provided to all the hospitals in the city was efficiently managed by the administration, with oxygen audit as one of the significant measures toward efficiently managing the resources.

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STATISTICS CORNER

Kamal Kishore, Vidushi Jaswal

Statistics Corner: Comparing Two Unpaired Groups

[Year:2022] [Month:July-September] [Volume:56] [Number:3] [Pages:4] [Pages No:145 - 148]

Keywords: Independent t-test, Student's t-test, Unequal variance, t-test Unpaired t-test, Welch's t-test

   DOI: 10.5005/jp-journals-10028-1594  |  Open Access |  How to cite  | 

Abstract

Statistical analysis comparing two groups is most frequently reported in the literature; an unpaired t-test is popular to inform results from two independent groups. The t-test is parametric and makes certain assumptions about the data. Literature, however, has shown that the t-test is robust to statistical assumptions violation. Many researchers, therefore, do not test assumptions to apply t-test. The robustness property of the t-test has certain limitations. A researcher interested in reporting results using a t-test must know the following: • What are the assumptions for an unpaired t-test? • Are assumptions essential and need to be tested? • What is robustness in the context of statistical tests? • Are there any reporting standards to report t-test results?

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LETTER TO THE EDITOR

Raman Sharma, Kusum K Rohilla, Mahendra Kumar

A Word about Infodemic during COVID-19 Pandemic among Healthcare Professionals

[Year:2022] [Month:July-September] [Volume:56] [Number:3] [Pages:2] [Pages No:149 - 150]

Keywords: COVID-19 pandemic, HCWs, Healthcare professionals, Infodemic, SARS-CoV virus

   DOI: 10.5005/jp-journals-10028-1582  |  Open Access |  How to cite  | 

Abstract

In December 2019, the first coronavirus case was detected in Wuhan, China. On 11th March 2020, the World Health Organization (WHO) declared coronavirus a pandemic (COVID-19) due to the rapid spread of the SARS-CoV virus. Common folks using smartphones and social media to access health information create health crisis scenarios. The study's purpose was to see how healthcare workers got information and fake news through social media during the COVID-19 outbreak. In a country like India, receiving an unregulated flood of incorrect information on social media adds to the confusion and turns a pandemic into an infodemic.

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