International Journal of Research in Medical Sciences
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Approaches to fostering active learning techniques for generation Z in nursing education: concept review article
Get PDFNursing education is undergoing a significant transformation as generation Z enters the field, requiring educators to adapt their pedagogical approaches to effectively engage and prepare these digital natives for the complexities of modern healthcare. Adapting medical curriculum to the needs of the generation Z may bridge the generational divides. Generation Z is the most diverse generation identified. With traits like tech-savviness, flexibility in learning, social relevance, creativity, self-expressiveness, predominant hands-on learners valuing practical skills, driven with immediate feedback, engaging learners, participatory, curious, collaborative, self-directed, preferring autonomy yet a short attention span, they demand comfortable, conducive learning environments that fulfil their learning goals. These tips expressed aimed to sensitize the instructors to merely act as facilitators with the help of the mentioned active strategies, thereby enhancing the satisfaction of both teachers and learners
Distribution of ABO and Rh (D) blood group and allele frequency in North-East India: a systematic review
Get PDFDespite several reviews on ABO and Rh (D) blood group frequencies across different regions of India, a comprehensive analysis from North-Eastern states of India is lacking. This systematic review analysed the distribution and allelic frequencies of ABO and Rh (D) antigens among the states and ethnic groups in North East India. Databases including PubMed, Google Scholar, Web of Science, Science Direct and the library web portal of Sikkim University were searched for articles published between 1958 and 2024. After screening for titles, abstracts, and full texts, 24 original research articles were included for review. The allelic frequency of blood antigens was calculated using Hardy-Weinberg equilibrium model. Studies from seven states of North East India, including a total of 40,513 individuals’ ABO data, were analyzed. Blood group O (36.07%) was found to be most prevalent followed by A (30.72%), B (24.66%), and AB (8.55%). Blood group O was dominant in Arunachal Pradesh, Assam, Manipur, Sikkim and Nagaland; A in Meghalaya; and B in Tripura. The allelic frequencies for IA (p), IB(q) and i(r) were found to be 0.22, 0.18 and 0.60 respectively. A total of 98% individuals were Rh(D) positive, while 2% were Rh(D) negative. A notable variation was observed for ABO frequency among the various ethnic populations of North-East India. Even though variations were observed in blood group frequency among the ethnic groups and states of North East India, overall frequency was found to be in the order: O>A>B>AB
Use of a Fogarty embolectomy catheter as a bronchial blocker through a single-lumen endotracheal tube in a patient with tracheal narrowing
Get PDFTechniques for single lung ventilation include a double-lumen tube, Univent or a bronchial blocker. However, the larger outer diameter of double-lumen or Univent tubes may pose problem in its passage through an area of subglottic stenosis or tracheal narrowing. Here, we report our experience in a case of tracheal narrowing due to extraluminal compression by mediastinal mass in which a Fogarty embolectomy catheter was used as a bronchial blocker through a single lumen endotracheal tube (ETT). Fogarty embolectomy catheter may be a suitable option for one lung ventilation (OLV) in tracheal narrowing, where there is limitation to use double lumen tube or Univent tube
An insight into the adverse drug reactions considering causality, severity, preventability and adherence among patients receiving anticancer drugs at a North Indian rural tertiary care centre
Get PDFBackground: The cytotoxic nature of anticancer drugs and their limited therapeutic index make adverse drug reactions (ADRs) a significant challenge in therapeutics in oncology. These adverse drug reactions have a major effect on quality of life, therapeutic results and patient adherence. An estimated 1,392,179 cancer cases were reported in India in 2020, representing an incidence rate of 98.7 incidences per 100,000 people. With a prevalence of 10-12%, ADRs are more common among hospitalised and elderly patients. It is essential to comprehend the causality, severity and preventability of ADRs in order to optimise cancer treatment and enhance patient safety.
Methods: An observational study was conducted at a tertiary care centre in western Uttar Pradesh. Chemotherapy patients were observed for adverse drug reactions. The Modified Hartwig and Siegel scale was used to assess the severity, the WHO-UMC scale was used to determine causality and the Schumock and Thornton criteria were used to determine preventability. Treatment adherence was also examined using Modified Morisky scale.
Results: The most frequent ADRs were gastrointestinal and haematological. The majority of ADRs were categorised as moderately severe, mostly non-preventable and probable in the causation evaluation. In several instances, treatment adherence was impacted.
Conclusions: ADRs from anticancer drugs continue to be a major clinical problem. Risks can be mitigated and patient safety can be enhanced with timely intervention and regular monitoring
Rectal prolapse in systemic sclerosis: a rare but demanding surgical scenario
Get PDFRectal prolapse is a relatively common gastrointestinal manifestation in patients with systemic sclerosis. However, its surgical repair in this group of patients requires special consideration due to its association with a high rate of failure and recurrence. We present the case of a 57-year-old woman with systemic sclerosis and grade V Oxford rectal prolapse, successfully resolved through laparoscopic ventral rectopexy. There was follow up for two years with no evidence of recurrence. There are few documented cases of surgical repair in patients with systemic sclerosis, and this is the first reported case of successful repair using this surgical technique. Given the above, the documentation of this case provides a valuable reference for physicians encountering this rare condition associated with a high recurrence rate
Effect of kangaroo mother care on serum bilirubin levels in term neonates undergoing phototherapy for neonatal jaundice: a cross-sectional study in South India
Get PDFBackground: Neonatal jaundice is a common condition affecting nearly 60% of full-term and 80% of preterm infants, characterized by elevated serum bilirubin levels. While most cases resolve without intervention, untreated hyperbilirubinemia can result in serious neurological complications such as kernicterus. Phototherapy is the standard treatment but may lead to adverse effects and prolonged hospitalization. Kangaroo mother care (KMC), involving skin-to-skin contact between infant and caregiver, has emerged as a supportive, cost-effective method that may enhance bilirubin clearance and improve recovery. Objective is to evaluate the effect of KMC on serum bilirubin levels in term neonates with jaundice undergoing phototherapy.
Methods: A cross-sectional observational study was conducted over one year (July 2023 to August 2024) in the Department of Paediatrics at Sree Balaji Medical College and Hospital. A total of 120 term neonates (gestational age 37–42 weeks; birth weight >2500 g) with neonatal hyperbilirubinemia requiring phototherapy were included using purposive sampling. Exclusion criteria were preterm birth, low birth weight, early-onset jaundice, hemolytic disorders, and congenital anomalies. Participants were divided into two groups: phototherapy alone and phototherapy with KMC. Serial bilirubin levels were measured at baseline, 24, 48, and 72 hours, and at the end of treatment. Statistical analysis was performed using SPSS v27 with chi-square tests, correlation analysis, and Bland-Altman plots.
Results: Infants receiving KMC alongside phototherapy showed significantly faster bilirubin reduction (p<0.05) compared to those receiving phototherapy alone. No significant association was found with infant gender or maternal age. However, higher gestational age and maternal education were positively correlated with improved outcomes. The KMC group demonstrated enhanced clinical recovery without adverse effects.
Conclusions: KMC is an effective adjunct to phototherapy in managing neonatal jaundice. It accelerates bilirubin clearance, and may offer added benefits such as improved bonding and lower healthcare costs. KMC should be considered in routine neonatal care, especially in low-resource settings. Further research is needed to explore its long-term outcomes
Multidrug resistance mechanisms and therapeutic strategies in Candida auris
Get PDFIn recent years, Candida auris has emerged as a formidable global health threat due to its multidrug resistance, high transmissibility in healthcare settings, and diagnostic challenges. Unlike most Candida species, C. auris can colonize the skin, persist on surfaces, and resist common antifungal agents including azoles, echinocandins, and polyenes. Its rapid global spread and association with high mortality in immunocompromised patients have drawn intense clinical and scientific attention. This review aims to consolidate current knowledge on the mechanisms underlying antifungal resistance in C. auris, including genetic mutations in target enzymes (e.g., ERG11, FKS1), overexpression of efflux pumps, biofilm formation, and stress response pathways. Additionally, it explores the pathogen’s virulence factors, diagnostic challenges, and environmental resilience. We also provide a critical overview of emerging therapeutic strategies, including novel antifungal agents, combination therapies, and immunotherapeutic interventions. Special emphasis is given to the ongoing clinical trials and pipeline antifungals such as ibrexafungerp, manogepix, and rezafungin. The review concludes with future directions for research, highlighting the need for improved surveillance, molecular diagnostics, and antifungal stewardship to curb the rise of this deadly fungal pathogen
Open common bile duct exploration with primary closure treatment of complicated choledocholithiasis: a case report and literature review
Get PDFCholedocholithiasis, a common complication of cholelithiasis, presents significant challenges in management, particularly in cases involving multiple or large stones. This case report describes a 55-year-old woman with multiple choledocholithiasis complicated by acute biliary pancreatitis, cholangitis, and cholecystitis. Initial management included endoscopic retrograde cholangiopancreatography (ERCP) with biliary stenting due to unsuccessful stone extraction, followed by open common bile duct (CBD) exploration with primary closure. The patient’s postoperative course was notable for a self-limiting grade A biliary leak, which resolved spontaneously. This case highlights the efficacy of primary closure in selected patients with a dilated CBD, despite the inherent risk of bile leakage, and underscores the importance of a multidisciplinary approach tailored to resource availability and surgical expertise. The findings in this case support primary closure as a viable option for complex choledocholithiasis, offering shorter hospital stays and reduced complications when performed in appropriate clinical settings
Clinical severity and patterns of organ involvement in acute systemic lupus erythematosus flares and predictors of disease severity: a retrospective study
Get PDFBackground: Acute, severe flares of systemic lupus erythematosus (SLE) are associated with significant morbidity and mortality, yet robust, accessible predictors for poor outcomes are not fully established. We aimed to identify the clinical and laboratory characteristics associated with in-hospital mortality in patients with severe SLE flares.
Methods: We conducted a retrospective, cross-sectional study of 30 adult patients admitted for a severe SLE flare (SLE disease activity index 2000 [SLEDAI-2K] score >6) to a tertiary care center in Bhubaneswar, India, between January 2024 and January 2025. We extracted demographic, clinical, and comprehensive laboratory data. Pearson’s correlation was used to assess the relationship between SLEDAI-2K and laboratory parameters. Baseline characteristics were compared between survivors and non-survivors to identify predictors of the primary outcome, in-hospital mortality.
Results: The cohort was predominantly female (80.0%) with a median age of 28 years and high disease activity at admission (median SLEDAI-2K, 17.5). The overall in-hospital mortality rate was 13.3% (4 of 30). Disease activity strongly correlated with red cell distribution width (r=0.892), anti-dsDNA levels (r=0.760), complement C3 (r=–0.846), and mean platelet volume (r=–0.820; all p<0.001). Compared to survivors, non-survivors had significantly higher median SLEDAI-2K scores (29.0 versus 16.0, p<0.001) and a higher frequency of neurological involvement (75.0% versus 15.4%, p=0.025). Severe leukopenia (median WBC 1.8 versus 7.2×103/μl, p<0.001) and thrombocytopenia (median platelets 42.5 versus 172.0×103/μl, p=0.005) were also significantly associated with mortality.
Conclusions: In patients hospitalized for severe SLE flares, high baseline disease activity, neurological involvement, and profound cytopenias are key predictors of in-hospital mortality. Readily available hematological indices, particularly RDW and MPV, correlate strongly with disease activity and may serve as useful adjuncts for risk stratification
Dr. Yellapragada Subba Rao: an Indo-American trailblazer in the field of medicine
Get PDFDr. Yellapragada Subba Rao (1895-1948) was a pioneering biochemist whose contributions have left a profound impact on modern medicine. Born into a Telugu family in India, SubbaRao's educational journey took him from Madras Medical College to prestigious institutions like Harvard Medical School and the School of Tropical Medicine, London. Despite the interruption of his medical education due to his involvement in the Indian independence movement, SubbaRao made ground-breaking advancements in biochemistry. Notably, his collaboration with Cyrus Fiske led to the development of the Fiske-Subbarow Method for phosphorus estimation and elucidated the role of phosphocreatine and ATP in muscle function. His research on vitamin B12 significantly advanced the understanding of anaemia treatment, while his work on folic acid contributed to its synthesis and therapeutic applications. SubbaRao’s contributions extended to oncology and infectious diseases; his work was instrumental in developing methotrexate, an early chemotherapy drug and discovering chlortetracycline, the world’s first tetracycline antibiotic. His innovative biochemical assays and research on metabolic pathways have facilitated the development of various treatments and antibiotics, fundamentally shaping the field of drug discovery and clinical practice. Despite his passing at a young age, SubbaRao's legacy endures through his significant scientific achievements and the recognition of his contributions, including tributes such as a commemorative postal stamp and the naming of species and institutions in his honour. His work remains influential in on-going research and medical applications, underscoring his role as a key figure in the advancement of biochemistry and medicine