International Journal of Research in Medical Sciences
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A clinico laboratorial study of effect of chronic alcoholism on hematological picture and changes in peripheral smear
Get PDFBackground: Alcohol consumption is a widespread public health concern, significantly impacting immunological functions, increasing vulnerability to infections, and contributing to hematological disorders. Chronic alcoholics often experience notable changes in their blood profile, necessitating further investigation.
Methods: This observational cross-sectional study was conducted over two months at Andhra Medical College, Vishakhapatnam. A total of 45 male subjects, aged 26 to 76 years, consumed alcohol for more than five years and averaged over ten drinks per week. Exclusion criteria included congenital hematologic disorders and ongoing chemotherapy. Blood parameters were assessed against standard values.
Results: Key findings included decreased red blood cell (RBC) counts in 68.9% of subjects, with macrocytosis observed in 82.2%. Lymphocytopenia occurred in 60%, while thrombocytopenia was found in 35.6%. Neutrophil levels were elevated in 62.2% of the cohort. Notably, a significant decrease in mean corpuscular hemoglobin concentration (MCHC) and an increase in mean corpuscular volume (MCV) were documented, reflecting typical consequences of chronic alcohol exposure.
Conclusions: Chronic alcoholism significantly alters the hematological profile, characterized by decreased RBC counts, thrombocytopenia, increased neutrophils, lymphocytopenia, and macrocytosis. These findings underscore the urgent need for tailored interventions and preventive measures to address hematological impacts among chronic alcohol consumers
Diffuse large B-cell lymphoma, multilocalized and extranodal in adult with complete remission: a case report
Get PDFDiffuse large B-cell lymphoma (DLBCL) is a heterogeneous group of lymphomas. The current classification recognizes an expanding group of distinct entities, with this being the most common. Up to one-third of DLBCL cases may originate in nearly any organ, most commonly in the gastrointestinal tract, skin and soft tissues, bones, or genitourinary tract. A 52-year-old woman with no history of chronic degenerative diseases presented with severe abdominal pain, weight loss, and night sweats. As part of her evaluation, an abdominopelvic CT scan was performed, revealing splenomegaly with internal nodular lesions of undetermined origin, inguinal lymphadenopathy, and cutaneous involvement. A lymphoproliferative process was suggested among the differential diagnoses. Immunohistochemical studies confirmed DLBCL. The patient subsequently received treatment with R-CHOP (rituximab, cyclophosphamide, doxorubicin, vincristine, and prednisone), achieving a cure rate of approximately 50% after six cycles with an adequate response to treatment.
Study of the prescription pattern of antidiabetics in hypertension with diabetes patients in geriatric population at tertiary care centre: a retrospective observational study
Get PDFBackground: In India, the elderly population is particularly affected with diabetes and hypertension which is prevalent in this population, leading to complex health challenges, necessitating effective treatment strategies. This study aimed to analyze the prescription patterns of antidiabetic drugs in geriatric patients with type 2 diabetes (T2DM) and hypertension at a tertiary care center.
Methods: A retrospective, cross-sectional study was conducted at the government medical college, Chhatrapati Sambhaji Nagar, from March 2023 to March 2024. Prescriptions of patients aged 60 years and above, diagnosed with both diabetes and hypertension, were analyzed.
Results: A total of 649 prescriptions were reviewed, with 58.71% of patients being male and 41.29% female. The majority (72.73%) were in the 60-70 age group. Metformin was the most prescribed drug (49.10%), followed by sulfonylureas, particularly glimepiride (30.04%). Combination therapy was the most common treatment approach, with 69.65% of patients receiving two-drug regimens, and 12.02% on three-drug regimens. The most frequent combination was metformin + glimepiride (79.42%). A small proportion (0.92%) received more than three drugs. Generic prescriptions dominated (99.22%), and nearly 89.80% drugs were from the WHO-EML 2023. The average number of drugs per prescription was 1.96.
Conclusions: The study highlights metformin as the predominant treatment for elderly patients with diabetes and hypertension, with a strong preference for generic medications and combination therapies. These findings underscore the importance of ongoing evaluation of prescribing patterns to optimize treatment strategies for geriatric patients
Prevalence of fecal carriage of vancomycin resistant Enterococci in a tertiary care centre in South India
Get PDFBackground: The number of VRE infections gradually increases worldwide and ICUs in hospitals which remains to be the major reservoir of antibiotic-resistant organisms. The current study was carried out to determine prevalence of fecal carriers of vancomycin resistant Enterococci in a tertiary care hospital, thereby preventing the spread of vancomycin resistant Enterococci to patients under high risk.
Methods: A total of 219 stool samples and rectal swabs were collected from health care workers and ICU patients and processed in vancomycin resistant Enterococci agar and subjected to certain phenotypic tests for its species identification. Antimicrobial susceptibility testing was done for all the vancomycin resistant enterococcal isolates.
Results: A total of 73 VRE were isolated of which 64 (36%) were from HCW and 9 (22%) were from ICU patients. The prevalence of VRE was 33% and the most common VRE isolated was Enterococcus faecium. All the 73 VRE isolates were susceptible to linezolid and 52% were susceptible to quinpristine/dalfopristine.
Conclusions: Screening of stool samples aids in the prevention of spread of multi-drug resistant VRE isolate from HCW to high risk patients. It’s imperative to step up infection control strategies so as to curtail its spread
Smart skills for a smarter India: the role of simulation in education
Get PDFThe revised curriculum introduced by the national medical commission mandates comprehensive training in communication and procedural skills for medical students. This makes simulation-based education (SBE) an imminent necessity across disciplines. Simulation offers a computer-generated representation of real-world systems, providing learners with an opportunity for practice, feedback, reflection, and immersion without the risks inherent in real-life scenarios. Over the years, the scope of simulation in medical education has expanded significantly, ranging from basic task trainers for fundamental skills to high-fidelity human patient simulators. India has begun recognizing the critical role of SBE in enhancing core clinical skills and teamwork. However, its widespread implementation is fraught with challenges, including resource limitations and the need for trained educators. The dualistic outcomes of simulation-based education necessitate a structured evaluation of its viability and utility in the Indian healthcare education system. This review employs "skills acquisition theory" as a framework, emphasizing the development of clinical skills through deliberate practice
Cutaneous vasculopathy in microscopic colitis: the role of gut-derived endothelial toxins
Get PDFMicroscopic colitis (MC) is a chronic inflammatory bowel disorder marked by persistent diarrhea and colonic mucosal inflammation. Emerging evidence suggests systemic manifestations, including cutaneous vasculopathy such as livedo reticularis and leukocytoclastic vasculitis, potentially driven by gut-derived endothelial toxins. However, the mechanisms linking MC to microvascular disorders remain poorly understood. This review examines the interplay between MC, gut dysbiosis, and systemic endothelial dysfunction, emphasizing the role of gut-derived toxins like lipopolysaccharides and microbial metabolites in vascular injury. A comprehensive literature search was conducted across PubMed, EMBASE, and Web of Science using predefined terms. Studies were appraised with standardized quality tools, and findings were categorized into endothelial toxin profiles, mechanisms of vascular injury, and clinical correlations. Emphasis was placed on studies using advanced techniques, such as metabolomics for toxin analysis, histopathology for vasculitis lesions, and imaging for vascular assessment. Evidence highlights a potential link between gut-derived toxins and systemic vascular effects in MC, though causality remains unproven. Variability in toxin profiles among MC patients and their correlation with cutaneous manifestations were noted. Key knowledge gaps include mechanisms of endothelial dysfunction, variability in toxin-mediated vascular injury, and lack of standardized diagnostic criteria for MC-associated vasculopathy. Further longitudinal and mechanistic studies are needed. Clarifying the role of endothelial toxins in MC-associated vasculopathy could lead to novel diagnostic biomarkers, therapeutic targets, and improved outcomes for patients with MC and its systemic vascular complications
Factors determining acceptance of coronavirus vaccine in diabetics at the endocrinology unit of Joseph Raseta Befelatanana Hospital
Get PDFBackground: Since the advent of the COVID-19 pandemic, diabetics have been categorized as being at risk of severe disease, and should benefit from vaccination to prevent the onset of severe disease and excess mortality. However, various studies reported limited participation of diabetic patients in vaccination. The aim of this study was to assess diabetic’s understanding and practices regarding vaccination against COVID-19 and the determining factors.
Methods: This was a cross-sectional study conducted over a 6-month period. Diabetic outpatients and inpatients who were able to answer our questions and who had given informed consent were invited to participate. Patients unable to complete the survey were excluded from the study.
Results: One hundred patients from the 110 diabetics included were retained, giving a participation rate of 90.9%. The median age of participants was 58.4 years (IQR: 19-85), with a sex ratio of 1.04. The positive determining factors significantly linked to participation in vaccination were the attainment of a university degree (p=0.04), confidence in the vaccine (p=0.02), and the presence of a personal history of infection or of being around COVID-19. Reasons for refusing vaccination included fear of the vaccine (88%) and of its adverse effects (80%).
Conclusions: This study suggests the need to prioritize strategies focused on improving the level of information, education and knowledge of patients regarding the severity of coronavirus disease and the importance of vaccination
A study of treatment modalities in breast cancer patients with help of triple marker test
Get PDFBackground: Breast cancer is a leading cause of cancer-related morbidity and mortality worldwide. Advances in early diagnosis and molecular profiling have significantly improved treatment outcomes. The triple marker test, which assesses estrogen receptor (ER), progesterone receptor (PR), and human epidermal growth factor receptor 2 (HER2) status, plays a crucial role in classifying breast cancer subtypes and guiding treatment decisions. Personalized treatment approaches based on molecular characteristics enhance the effectiveness of hormone therapy, targeted therapy, and chemotherapy.
Methods: This prospective study evaluates the impact of the triple marker test in determining breast cancer treatment modalities. Patients were classified based on their ER, PR, and HER2 status to assess their response to various therapeutic interventions. Data collection included clinical examinations, histopathological analysis, and treatment outcomes following neoadjuvant therapy, surgery, and adjuvant therapies.
Results: Findings indicate that ER/PR-positive patients benefit significantly from hormone therapy, while HER2-positive cases show improved outcomes with targeted agents like trastuzumab. Triple-negative breast cancer (TNBC) remains a therapeutic challenge, often requiring aggressive chemotherapy. The study also highlights the role of neoadjuvant therapy in reducing tumor size, facilitating breast-conserving surgery (BCS), and improving overall prognosis.
Conclusions: Molecular profiling using the triple marker test is instrumental in optimizing breast cancer treatment strategies. Personalized treatment plans based on receptor status enhance survival rates and quality of life (QoL). Integrating biomarker-driven approaches into clinical practice ensures more precise and effective breast cancer management
Development and validation of self-administration medication error tool
Get PDFBackground: Medication errors during self-administration pose significant risks to patient safety. The absence of standardized tools to assess and mitigate self-administration errors necessitates the development of a reliable instrument, to identify patients at risk and enhance patient outcomes by reducing adverse drug events.
Methods: This quantitative study was conducted at Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), Pondicherry, between May 2023 and April 2024. The SAME tool was developed through a literature review, resulting in ten items assessing various aspects of medication self-administration. Content validity was assessed by four experts using a 4-point Likert scale. The Content Validity Index (CVI) was calculated, and the tool was tested on 100 subjects selected by convenience sampling. Internal consistency was measured using Cronbach's alpha, and validity was assessed through Pearson Product Moment Correlation analysis.
Results: The SAME tool included ten items covering confidence in medication administration, understanding instructions, and psychological impact of medication regimens. Validation: All items achieved a CVI of ≥0.88 indicating strong content validity. Cronbach's alpha was 0.815, reflecting good internal consistency. Pearson correlation coefficients for individual items ranged from 0.492 to 0.740, all statistically significant (p<0.05), confirming the tool's validity. The estimated prevalence of self-administration errors among participants was 17%, highlighting significant challenges in managing complex medication regimens.
Conclusions: The SAME tool is a valid, reliable instrument for assessing self-administration medication errors in a clinical setting. It can identify patients at risk of medication errors, enabling targeted interventions to improve patient safety and outcomes
Incidental detection of gallbladder carcinoma in third trimester of pregnancy
Get PDFGall bladder cancer (GBC) represents the most common biliary tract cancer. GBCs are diagnosed more frequently in women. GB cancer represents a progression from dysplasia, to carcinoma in situ, to invasive carcinoma over about 15 years. Severe dysplasia and carcinoma in situ have been found in more than 90% of gallbladders that contain GB cancer. A 35-year-old G2P1L1 @34.4 weeks with previous 1 lower segment caesarean section (LSCS) came to emergency referred from a primary health center in view of pain abdomen. She was worked up and was found out to have deranged liver functions but no visible icterus, ultrasound whole abdomen showed GB mass with multiple heterogenous hypoechoic round to oval targeted lesions largest measuring 3.5×3 cm suggestive of metastasis. Patient was taken up for LSCS at 36 weeks. Post-operative period was uneventful until day 3 when patient started complaining of pain epigastrium with mild abdominal distention. Contrast enhanced computed tomography (CECT) was done which proved it to be a metastatic GB cancer. GB cancer during pregnancy is rare but challenging to manage. Diagnostic imaging, like ultrasound is mostly the safest and first line approach. The prognosis of stage 4 gallbladder cancer in pregnancy depends on various factors, including the extent of metastasis, the patient’s overall health, and the timing of diagnosis and treatment. Generally, stage 4 gallbladder cancer has a poor prognosis, with low survival rates even outside of pregnancy