Journal of Postgraduate Medicine, Education and Research

Register      Login

Table of Content

2023 | July-September | Volume 57 | Issue 3

Total Views

EDITORIAL

Anshika Chauhan, Geeta S Boora, Arnab Pal

Circulating Tumor Cells (CTCs) as a “Liquid Biopsy” Component: Where do We Stand?

[Year:2023] [Month:July-September] [Volume:57] [Number:3] [Pages:3] [Pages No:105 - 107]

   DOI: 10.5005/jp-journals-10028-1631  |  Open Access |  How to cite  | 

297

RESEARCH ARTICLE

Ongkila Bhutia, Harsh Priya, Morankar Rahul, Aditi Nanda, Nitesh Tewari, Dheeraj Koli, Ritu Duggal, Arvind Kumar, Naveet Wig

Assessment of Transmission Dynamics of COVID-19 Infection via Contact Tracing in a Dental Center of a Tertiary Care Hospital

[Year:2023] [Month:July-September] [Volume:57] [Number:3] [Pages:5] [Pages No:108 - 112]

Keywords: Coronavirus disease 2019, Contact tracing, Infection control, Prevention, Tertiary hospital

   DOI: 10.5005/jp-journals-10028-1603  |  Open Access |  How to cite  | 

Abstract

Introduction: Contact tracing is an essential public health tool, which includes prompt and rapid identification of potentially infected individuals before the emergence of severe symptoms. Objective: The objective of this cross-sectional analysis was to highlight a targeted prevention strategy for the spread of disease by monitoring rigorous contact tracing. Study design: A retrospective cross-sectional analysis. Study setting: Tertiary care hospital. Patients/participants: Health care workers of a tertiary care hospital. Methodology: An analysis of information provided in the contact tracing of 30 diagnosed coronavirus disease 2019 (COVID-19) positive patients was done in the present study. The study duration ranged from April to December 2020 and was conducted among the diagnosed COVID-19-positive patients of the Center for Dental Education and Research (CDER), All India Institute of Medical Sciences (AIIMS), New Delhi. Ethical approval was obtained from the Institutional Ethics Committee (IEC-1079/06.11.2020). The retrospective contact tracing was done for a period of 48 hours prior to the time of diagnosis or the time of first reported symptoms, whichever was earlier, by a trained medical professional. Results: Fever (76.7%) was the most common symptom found at the time of diagnosis among the cases. It was found that the high-risk contacts (20%) were more susceptible to developing a COVID-19 infection compared to their low-risk counterparts (2%). Conclusion: Aggressive contact tracing, when done right, is tremendously effective in containing an outbreak. Overstretched contact tracing can clearly diminish the possibility of the creation of a hot spot.

247

RESEARCH ARTICLE

KM Soni, Kusum K Rohilla, C Vasantha Kalyani

Patient Satisfaction among Cancer Patients Receiving Palliative Care Services Provided at Tertiary Care Unit of Uttarakhand

[Year:2023] [Month:July-September] [Volume:57] [Number:3] [Pages:4] [Pages No:113 - 116]

Keywords: Advanced cancer, Cancer, Palliative care, Satisfaction, Terminally ill

   DOI: 10.5005/jp-journals-10028-1617  |  Open Access |  How to cite  | 

Abstract

Introduction: Even though there have been significant advances in our understanding of the advantages of early palliative care integration with disease management, many people with chronic life-threatening illnesses either do not receive any palliative care services at all or only receive them in the final stages of their illness. The aim of the present study was to assess patient satisfaction among terminally ill cancer patients for palliative care services provided at the tertiary care unit. Materials and methods: The current study, which involved 100 palliative patients getting care from a palliative clinic, was an observational study with a cross-sectional design. In this study, purposive sampling was employed and an interview schedule was used to acquire the data. Result: The majority of patients (40%) are between the ages of 41 and 50, live in rural areas (36%), and make <20,000 Rs/month (32%). The majority of patients had their cancer diagnosed between 3 and 6 months (40%), were receiving palliative care (66%), had begun taking morphine 3–6 months earlier (41%), and visited the hospital for palliative care every 15 days (65%). Patients who responded to the survey expressed satisfaction (44%) with the palliative care they received, the technical service level (53%) of the palliative center, and the manner in which doctors and other healthcare workers interacted with them (37%). Patients who discussed their experiences with their doctors were unanimous in saying that their medical professionals attended to their financial needs (66%) and gave them enough time during consultations (50%). Most people agree that the center's palliative care services were accessible and practical (52%). Conclusion: In this research, palliative care clinic for treating medical cancer and to provide supportive/palliative care services at tertiary care facilities have expanded more slowly, and patients feel satisfied with the service.

223

RESEARCH ARTICLE

Ram K Saini, Neha Saini, Sant Ram, Ankita Goyal, Shiv Soni, Vikas Suri, Ravjit Jassal, Arnab Pal, Deepy Zohmangaihi

Predictive Model for the Assessment of COVID-19 Severity based on Acute Phase Proteins: An Analysis from a Clinical Laboratory in North India

[Year:2023] [Month:July-September] [Volume:57] [Number:3] [Pages:7] [Pages No:117 - 123]

Keywords: Acute phase proteins, Coronavirus disease 2019, Model, Prediction, Severity

   DOI: 10.5005/jp-journals-10028-1621  |  Open Access |  How to cite  | 

Abstract

Aim: Pestilence owing to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus in recent times and its ongoing resurgence poses an urgent need for the identification of a predictive marker for determining coronavirus disease 2019 (COVID-19) severity. Considering inflammation as the fundamental cause of morbidity following COVID-19 infections, our study targeted acute phase proteins (APPs), potential markers reflecting the inflammatory state of the body. Materials and methods: We retrospectively analyzed the serum levels of seven APPs, namely, α-1 antitrypsin (AAT), α-1 acid glycoprotein (AGP), ceruloplasmin (Cp) and C-reactive protein (CRP), transferrin (Tf), transthyretin (TTR), and human serum albumin (HSA) in 788 COVID-19 patients. Multivariate regression analysis and receiver operating characteristic (ROC) analysis were performed to develop a mathematical model for predicting COVID-19 severity. Results: Out of the seven APPs, levels of CRP (p < 0.0001) and HSA (p < 0.0001) were found to have significant associations with the incidence of intensive care unit (ICU) admission in COVID-19 patients, as analyzed primarily in 219 patients. A mathematical model was designed with ROC displaying sensitivity and specificity of 88.89 and 66.67% with 0.802 [95% confidence of interval (CI), 0.4408–0.6508] area under the curve (AUC). The logistic regression equation thus developed was validated in a different cohort of 569 COVID-19 patients where probabilities for ICU admission calculated on the 1st day of admission were higher (p < 0.0001) in patients actually admitted to ICU at any time point during their hospital stay. Conclusion: The model appears fit for predicting the severity of COVID-19 patients at its early stages. Utilization of this model is feasible and practical as severity is decided based on a few biochemical parameters.

218

RESEARCH ARTICLE

Mohammed Parisa Abdul Arshad, Elezebeth Mathews, Sandeep Gopinathan, Kavumpurathu R Thankappan

Diabetes Health Literacy, Drug Adherence and Factors Associated with Them among Urban Patients in Kerala, India

[Year:2023] [Month:July-September] [Volume:57] [Number:3] [Pages:7] [Pages No:124 - 130]

Keywords: Diabetes health literacy, Diabetes patients, India, Kerala, Medication adherence

   DOI: 10.5005/jp-journals-10028-1632  |  Open Access |  How to cite  | 

Abstract

Aims: The study aimed to assess diabetes health literacy, adherence to diabetes medication, and its associated factors in Kerala, India, the most advanced Indian state in epidemiological transition with the highest literacy level in India. Materials and methods: We conducted a community-based cross-sectional study among 280 diabetes patients (mean age 62 years, male 42%) selected by multistage cluster sampling. Information on sociodemographic variables was collected using a pretested structured interview schedule. Diabetes health literacy was assessed using the revised Michigan Diabetes Knowledge test. Adherence to diabetes medication was assessed using the Hill-Bone subscale. Binary logistic regression analysis was done to find out the factors associated with diabetes health literacy and medication adherence. Results: Good diabetes health literacy was reported by 35.7% [95% confidence interval (CI): 30.1–41.6] of the patients. Perfect adherence to diabetes medication was reported by 33.2% of patients (CI: 27.7–39.1). Patients who reported regular newspaper reading [adjusted odds ratio (AOR) 3.16; CI: 1.57–6.30], using the internet (AOR 2.23; CI: 1.11–4.50) and insulin use (AOR 2.60; CI: 1.35–5.00) were more likely to report good diabetes health literacy compared to their counterparts. Patients who reported reading health magazines (AOR 2.75; CI: 1.01–7.60) were more likely to report perfect medication adherence compared to those who did not. Conclusion: Why diabetes health literacy and medication adherence were low among diabetes patients in the most literate state needs further investigation. Interventions to enhance diabetes health literacy and medication adherence may be undertaken among diabetes patients encouraging them to read newspapers and health magazines regularly and use the internet.

537

REVIEW ARTICLE

Ashok Kumar, Rimesh Pal, Manisha Nagi, Maninderdeep Kaur, Sukhpal Kaur

Superiority Trial: Sample Size Calculation and its Interpretation in Health Research

[Year:2023] [Month:July-September] [Volume:57] [Number:3] [Pages:6] [Pages No:131 - 136]

Keywords: Health research, Randomized clinical trial, Sample size calculation, Superiority trial

   DOI: 10.5005/jp-journals-10028-1623  |  Open Access |  How to cite  | 

Abstract

Sample size calculation in any randomized clinical trial is an essential step to avoid over- and underestimation of the outcomes. Health researchers should prior estimate the sample size which helps in the validity and reliability of the superiority trial. This paper highlights the step-by-step calculation of sample size in a superiority trial using appropriate and simple formulas and its interpretation with suitable examples in different conditions so that health researchers can better understand this important part of a clinical trial.

1,549

CASE REPORT

Deepak Thakran, Amit S Nachankar

Refractory Hyponatremia as an Initial Presentation of Panhypopituitarism with Partial Empty Sella

[Year:2023] [Month:July-September] [Volume:57] [Number:3] [Pages:3] [Pages No:137 - 139]

Keywords: Case report, Empty sella, Hyponatremia, Hypopituitarism

   DOI: 10.5005/jp-journals-10028-1628  |  Open Access |  How to cite  | 

Abstract

Introduction: Hyponatremia of varying severity is a fairly common disorder of water homeostasis encountered in the practice of internal medicine and has a variety of etiologies. Here we present a case of refractory hyponatremia secondary to an uncommon endocrine disorder. Case description: Our patient, a 55-year-old woman with a known case of hypothyroidism for 5 years, presented with complaints of moderate, symptomatic, and persistent hyponatremia. An evaluation revealed chronic euvolemic hyponatremia refractory to 3% saline. Further workup to rule out the syndrome of inappropriate antidiuretic hormone (SIADH) revealed panhypopituitarism with partial empty sella (PES). Discussion: Though usually not associated with any hormonal deficiency, rarely PES is associated with a deficiency of one or more pituitary hormones. Equally rare is the syndrome of euvolemic hyponatremia secondary to empty sella syndrome with hypopituitarism. Panhypopituitarism can have life-threatening consequences if left undiagnosed and untreated. Conclusion: In any case of euvolemic hyponatremia, it is important to work up for hypopituitarism as a rare cause before ruling in SIADH.

223

CASE REPORT

Karthick K Vaitheeswaran, Ragu Raja, Prayas Sethi, Neeraj Nischal, Arvind Kumar, Naveet Wig

Frontal Bone Tuberculous Osteomyelitis with Orbital Involvement: A Case Report

[Year:2023] [Month:July-September] [Volume:57] [Number:3] [Pages:4] [Pages No:140 - 143]

Keywords: Calvarial tuberculosis, Case report, Frontal bone tuberculosis, Skull tuberculosis

   DOI: 10.5005/jp-journals-10028-1635  |  Open Access |  How to cite  | 

Abstract

Introduction: Tuberculosis (TB) is a significant health problem in developing countries like India. The rising trend of multidrug-resistant (MDR) TB and extrapulmonary TB (EPTB) imposes an additional burden on TB management. Though TB is endemic in India, calvarial TB is very rare, contributes only to 0.2–1.3% of skeletal TB and very limited data is available on calvarial MDR-TB. In this report, we present a rare case of multidrug-resistant tuberculous osteomyelitis affecting the frontal bone and involving the orbit in a young boy. Case description: we present a case of a 14-year-old boy presented with a 3-month history of a gradually progressive, painless swelling in the scalp, located just above the forehead on the left side. additionally, he reported a 1-month history of swelling in the left eyelid. He also had history of fever, evening rise of temperature, loss of appetite and loss of weight of 4 kg over 3 months. On examination, there was a fluctuant swelling of 6 x 7 cm in left side of the forehead, without any signs of inflammation or sinuses. The left eyelid was swollen with yellowish material inside, leading to severe mechanical ptosis. The right eye was normal. Systemic examination was normal. On investigation, CECT revealed focal area of osteolysis and erosion in the left half of the frontal bone with osteolytic extension into the roof and lateral wall of the left orbit along with adjacent interconnecting epidural and subgaleal collection. GeneXpert ULTRA from the aspirated pus detected Mycobacterium tuberculosis and Rifampicin resistance. Later TB culture confirmed the presence of Mycobacterium tuberculosis and the line probe assay detected Rifampicin resistance and high-level Isoniazid resistance. Hence, a definitive diagnosis of multidrug resistant tuberculous osteomyelitis affecting the left frontal bone with orbital involvement was made. The patient showed significant clinical improvement with bedaquiline-based oral longer MDR-TB regimen without any surgical intervention. Discussion: Calvarial tuberculosis is a very rare entitity, but can be managed effectively with proper antituberculous drug regimen. Hence tuberculous osteomyelitis should be considered as a possible diagnosis when encountering lytic lesions of the skull. Maintaining a high index of suspicion, facilitating early diagnosis, and ensuring appropriate treatment is essential for achieving favorable outcomes in patients with calvarial tuberculous osteomyelitis.

214

SHORT COMMUNICATION

Shruti Jha

Potential of Andrology in Providing Male Health Services from Womb to Tomb: PESTEL Analysis

[Year:2023] [Month:July-September] [Volume:57] [Number:3] [Pages:3] [Pages No:144 - 146]

Keywords: Adolescent health, Andrology, Community medicine, Differentiation, Disorder of sex epidemiology, Geriatrics, Male health services, Political, economic, social, technological, environmental, and legal-analysis

   DOI: 10.5005/jp-journals-10028-1634  |  Open Access |  How to cite  | 

Abstract

Andrology studies the physiological, pathological, and psychosocial aspects of male reproduction, with major issues for men including male infertility, contraception, hypogonadism, erectile dysfunction, disorders of sex differentiation, and male senescence. Political, economic, social, technological, environmental, and legal (PESTEL) analysis is essential to understanding the advantages and disadvantages of providing male health services from womb to tomb. Changes in government policy and economic, social, technological, and environmental factors can all affect the accessibility of andrology services. Raising education and knowledge can help reduce social stigma and cultural attitudes, while technological advancements can be costly and require specialized training. The potential of andrology in delivering healthcare to male individuals from the womb to the tomb is great, but a multidisciplinary strategy that overcomes societal stigma and considers environmental variables is needed.

511

CPC CLINICOPATHOLOGICAL CONFERENCE REPORT

Uma Nahar Saikia, Venkatesh Dhanasekaran, Shefali Sharma, Sreedhara B Chaluvashetty

A Rare Case of Massive Gastrointestinal Bleeding as a Cause of Death in a Young Adult with Catastrophic Granulomatosis Polyangiitis

[Year:2023] [Month:July-September] [Volume:57] [Number:3] [Pages:6] [Pages No:147 - 152]

   DOI: 10.5005/jp-journals-10028-1636  |  Open Access |  How to cite  | 

226

© Jaypee Brothers Medical Publishers (P) LTD.