Journal of Postgraduate Medicine, Education and Research

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2023 | January-March | Volume 57 | Issue 1

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EDITORIAL

Arcot J Priyadarsini, Sangeeta Kumari, Karan Kumar, Suchet Sachdev

Voluntary Non-remunerated Blood Donations: The Reasons for Underrepresentation of Female Gender and the Way Forward

[Year:2023] [Month:January-March] [Volume:57] [Number:1] [Pages:2] [Pages No:1 - 2]

   DOI: 10.5005/jp-journals-10028-1622  |  Open Access |  How to cite  | 

409

RESEARCH ARTICLE

Varma A Sindhubhai, Sukhpal Kaur, Pravin Salunke, Sandhya Ghai

Effectiveness of “Coma Stimulation Technique” on Conscious Level and Brain Functioning among Comatose Patients with Traumatic Brain Injury

[Year:2023] [Month:January-March] [Volume:57] [Number:1] [Pages:5] [Pages No:3 - 7]

Keywords: Brain functioning, Coma stimulation technique, Consciousness, Glasgow coma scale, Traumatic brain injury

   DOI: 10.5005/jp-journals-10028-1593  |  Open Access |  How to cite  | 

Abstract

Objective: To assess the effectiveness of the coma stimulation technique (CST) on consciousness and brain functioning among comatose traumatic brain injury (TBI) patients. Materials and methods: The study was conducted amongst admitted patients in neurosurgical units of a tertiary care center in North India. A single group was exposed to the intervention of CST, and its effectiveness was observed on the Glasgow Coma Scale (GCS) and Coma Recovery Scale (CRS). A total of 156 TBI patients were assessed for eligibility. The patients above 18 years with GCS between three and eight and patients with stable vital signs were included in the study. Patients having a past history of head injury, cardiac arrest lasting >4 minutes, and history of brain stem injury was excluded. Finally, 40 patients were analyzed. The intervention constituted CST, which involved promoting awakening, maintaining arousal, and enhancing the rehabilitative potential of comatose patients by stimulating all five senses, that is, visual, olfactory, gustatory, tactile, auditory, and kinesthetic. CST was administered once a day from day 1 to day 14 or till the discharge of the patients. Postintervention GCS and CRS scores were assessed on days 3rd, 7th, 10th, and 14th/at the time of discharge. The main outcome measures were the GCS and CRS scores. Statistical analysis: Continuous variables are presented as the median and interquartile range (IQR). McNemar and Wilcoxon's tests were used to analyze the effectiveness of CST on GCS and CRS scores. Results: Median GCS score of the patients was six at the baseline. After the intervention, it was 10 on day 14th/at the time of discharge. Before the intervention, the median CRS score was five. It increased to 14 on day 14th/at the time of discharge. There was a statistically significant improvement in GCS and CRS scores after the intervention, as per McNemar's test (p < 0.001) and Wilcoxon's test (p < 0.001). Conclusion: Early intervention with CST may help in the improvement of the level of consciousness and brain functioning of the comatose patient with TBI.

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RESEARCH ARTICLE

Nidhi Jaswal, Sonu Goel, Kritika Upadhyay, Arshdeep Singh, Mahendra P Singh, Poonam Khanna

Trans-fat Free Diwali Campaign: Development of “Knowledge, Persuasion, Communication, and Participation” Model to generate Awareness about Trans Fat and its Ill Effects

[Year:2023] [Month:January-March] [Volume:57] [Number:1] [Pages:7] [Pages No:8 - 14]

Keywords: Campaign, Communication, Health promotion, Media, Trans fats

   DOI: 10.5005/jp-journals-10028-1607  |  Open Access |  How to cite  | 

Abstract

Background: The current study highlights the planning and implementation of a 1 month long “Trans-fat Free Diwali” campaign (21st October to 21st November 2020). It was organized in the state of Punjab and the union territory of Chandigarh using a “knowledge, persuasion, communication, and participation” (KPCP) model. Aim and objective: To create awareness among the policymakers, producers, suppliers, and the general public about the negative health impact of trans fats for achieving an overarching “Eat Right India” movement by the Government of India. Materials and methods: The development of the KPCP model underwent three stages: (1) review of literature; (2) Delphi analysis for developing draft model; (3) and piloting of the model. The campaign incorporated multisectoral partnerships, including health, education, entertainment, and media departments. Community participation was enabled to ensure the sustainability of the campaign and develop a sense of ownership among the general public. The relevant use of print, social, and electronic media led to the extensive awareness generation and promotion of the campaign. Results: The ample use of print, electronic, and social media, along with messages from ambassadors, helped in behavioral change and community mobilization. Conclusion: Such campaigns should not be a knee-jerk response but rather a sustainable action to prevent many risky behaviors.

287

RESEARCH ARTICLE

George Araklitis, Georgina Baines, Ashish Pradhan, Karen Guerrero, Linda Cardozo

Impact of COVID on Training in Urogynecology in the United Kingdom

[Year:2023] [Month:January-March] [Volume:57] [Number:1] [Pages:4] [Pages No:15 - 18]

Keywords: Advanced training skills module, Education, Observational study, Subspecialty, Training, Urogynecology

   DOI: 10.5005/jp-journals-10028-1610  |  Open Access |  How to cite  | 

Abstract

Aim: To assess how training has been impacted in urogynecology by coronavirus disease 2019 (COVID-19) pandemic. Materials and methods: Questionnaire sent to trainees doing urogynecology advanced training skills module (ATSM) and subspecialty trainers in the United Kingdom. Results: Around 83% of doctors felt their training had been negatively impacted by the pandemic, with a reduction in operating time being the significant factor. There has also been a reduction in other clinical activities as well as educational courses. Trainees anticipated an extension to their training. Similar findings were confirmed by trainers, where 73% felt their trainee needed at least 6 months of training extension. Conclusions : The COVID-19 pandemic has had a significant impact on the training of future consultants. The Royal College of Obstetricians and Gynaecologists (RCOG), alongside Health Education England (HEE), has tried to find ways to help with this problem. Training in the future will need to adjust and change with the use of technology and other novel ideas. Clinical significance: Training in the future will need to adjust and change with the use of technology and other novel ideas.

301

REVIEW ARTICLE

Prem Lata Manhas, Upninder Kaur, Jayshree Singh, Rakesh Sehgal, Pankaj Malhotra

Immunopathology of Malaria in Pregnancy: Immune Cells Response to Infection

[Year:2023] [Month:January-March] [Volume:57] [Number:1] [Pages:8] [Pages No:19 - 26]

Keywords: Immunopathogenesis, Malaria, Pregnancy.

   DOI: 10.5005/jp-journals-10028-1608  |  Open Access |  How to cite  | 

Abstract

Malaria during pregnancy is a leading public health problem. Apart from causing maternal illness or death, malaria during pregnancy is also responsible for the occurrence of frequent abortion, stillbirth, premature delivery, and low birth weight. Malaria during pregnancy has a central feature of placental accumulation of infected erythrocytes, which is how the parasite circumvents host immunity. In this review, we have briefly discussed the immunopathogenesis of malaria in nonpregnant women explaining the normal progression of the disease in nonpregnant women. Next, we have explained in the review how it is controlled, discussing the cellular and humoral immune response in malaria. Further, we have focused in detail on the immunopathogenesis of malaria in pregnancy, how it is different from malaria in nonpregnant women, and the risks special to malaria in pregnancy. Challenges of endemicity and cell-mediated immune response [natural killer (NK) cells, macrophages, dendritic cells (DCs), T-cells, and B-cells] to malaria in pregnancy are briefed lastly.

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REVIEW ARTICLE

Sukhpal Kaur, Ajay Singh

Proning for Patients with COVID-19 Related ARDS: A Review of Literature and Recommendations for Practice

[Year:2023] [Month:January-March] [Volume:57] [Number:1] [Pages:5] [Pages No:27 - 31]

Keywords: Acute respiratory distress, Coronavirus disease 2019, Positioning, Proning

   DOI: 10.5005/jp-journals-10028-1596  |  Open Access |  How to cite  | 

Abstract

Aim: To review the existing literature, guidelines and recommendations to inform the best practice of proning among patients with coronavirus disease 2019 (COVID-19) related acute respiratory distress syndrome (ARDS). Background: Proning is one promising therapy for patients with ARDS, but clear guidelines to guide practicing health care workers, especially in low-resource settings, are missing. Review results: Four databases were searched systematically for this review. Search criteria included any type of research papers written in the English language and publications within the last 20 years (1st January 2000 and 31st May 2021). The extracted data from various articles were tabulated to reach conclusions. Conclusion: Turning a patient into a prone position involves multiple sequential steps, and any error may lead to potential complications. The recommendations provided here aim to guide the personnel involved in this procedure so as to ensure patient safety and minimize the risk of complications. Clinical significance: Complications can be reduced if a standard operational protocol for proning a patient is available. This article will provide specific guidelines to health care personnel who have less experience working in critical care areas.

270

CASE REPORT

R Madhusudan, BM Anand, NS Sreedhara, M Nidhi, M Girijapathi, Jason Zachariah, Noyal Sunny

Management of SARS-CoV-2 Multisystem Inflammatory Syndrome in Adult with Intravenous Immunoglobulin

[Year:2023] [Month:January-March] [Volume:57] [Number:1] [Pages:3] [Pages No:32 - 34]

Keywords: Adult, COVID-19, Fever, Intravenous immunoglobulin, Lymphadenopathy, Multisystem inflammatory syndrome in adults, SARS-CoV-2, Skin rash

   DOI: 10.5005/jp-journals-10028-1579  |  Open Access |  How to cite  | 

Abstract

Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) continues to evolve creating management dilemmas as time passes. Multisystem inflammatory syndrome in adults (MIS-A) unlike multisystem inflammatory syndrome in children and adolescents (MIS-C) has not been well characterized. Multisystem inflammatory syndrome in adults is a rare but potentially life-threatening hyperinflammatory syndrome affecting adults of all ages. Multisystem inflammatory syndrome in adults can occur in current or previous SARS-CoV-2 infection. Here we present a case of an elderly male with previous SARS-CoV-2 infection who had an unusual presentation with high fever, neck swelling, and skin rashes and recovered after intravenous immunoglobulin (IVIG) therapy. Clinicians should be aware of this postinfectious multisystem inflammatory illness after COVID-19. Intravenous immunoglobulin has an important role to play in the management of MIS-A.

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CASE REPORT

Akhil K Ravi, Deepu Peter

A Case of Bilateral Facial Nerve Palsy with Bilateral Cavitary Lung Nodules in a Young Adult

[Year:2023] [Month:January-March] [Volume:57] [Number:1] [Pages:3] [Pages No:35 - 37]

Keywords: Bilateral facial nerve palsy, Glomerulonephritis, Granulomatosis with polyangiitis, Vasculitides

   DOI: 10.5005/jp-journals-10028-1583  |  Open Access |  How to cite  | 

Abstract

Granulomatosis with polyangiitis (GPA) mostly involves the upper and lower respiratory tract with renal involvement. It is a rare disease with varied presentation. However, bilateral facial nerve involvement in this disease is an extremely rare entity. We report a case of a young lady who presented with bilateral facial nerve palsy and was diagnosed as a case of GPA with multisystem involvement.

329

CASE REPORT

Hari K Boorugu, Jaydip R Chaudhuri, Pavan Katragadda, Swathi Alluri, Manoj Cheerla, Manusruta Manusrut

Varicella Meningitis Presenting with Neurogenic Dysphagia

[Year:2023] [Month:January-March] [Volume:57] [Number:1] [Pages:2] [Pages No:38 - 39]

Keywords: Aseptic meningitis, Lower cranial nerve involvement, Varicella

   DOI: 10.5005/jp-journals-10028-1584  |  Open Access |  How to cite  | 

Abstract

Varicella zoster virus (VZV) infection is common, but central nervous system involvement is rare. We report a patient with herpes zoster oticus and aseptic meningitis with 8–10th cranial nerve involvement who responded well to treatment with aciclovir.

309

STATISTICS CORNER

Kamal Kishore, Vidushi Jaswal

Statistics Corner: Chi-squared Test

[Year:2023] [Month:January-March] [Volume:57] [Number:1] [Pages:5] [Pages No:40 - 44]

Keywords: Categorical data, Chi-square, Fisher's exact test, Non-parametric, Test of association

   DOI: 10.5005/jp-journals-10028-1618  |  Open Access |  How to cite  | 

Abstract

It is desirable to collect and analyze quantitative data with parametric tests. Researchers, however, also gather categorical variables such as cured vs non-cured and diseased vs non-diseased. And many times, they convert continuous variables such as body mass index (BMI) to high, regular, and low BMI and quality of life to good, average, and poor categories. When both independent and dependent variables are categorical—Chi-square is a standard test. A researcher designed a study and collected data with many categorical outcome variables. The literature search recommends applying the Chi-squared test. The researcher, however, has a few vital questions related to the Chi-squared test: What is Yates’ correction? When to apply Fisher's exact test? What is the post hoc Chi-squared test? How to assess the strength of an association?

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CPC CLINICOPATHOLOGICAL CONFERENCE REPORT

Saikat Mitra, Ritin Mohindra, Vikas Bhatia, Sanjay Jain

Severe Tubercular Meningovasculitis Presenting as Fatal Brainstem Hemorrhage in a Young Female: A Rarity

[Year:2023] [Month:January-March] [Volume:57] [Number:1] [Pages:7] [Pages No:45 - 51]

   DOI: 10.5005/jp-journals-10028-1619  |  Open Access |  How to cite  | 

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