International Journal of Research in Medical Sciences
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Knowledge and practice among mothers of children with autism spectrum disorder on gluten free casein free diet in a tertiary medical centre of Bangladesh
Get PDFThe gluten-free casein-free (GFCF) diet helps reduce hyperactivity and improve learning, cognitive function, and communication in children with autism spectrum disorder (ASD). Poor adherence and knowledge can lead to improper application, resulting in persistent health issues and hyperactive behavior. This study aimed to address these gaps. A descriptive cross-sectional study was conducted among 50 mothers of children with ASD on GFCF diet from August 2024 to January 2025 by purposive sampling technique. Descriptive statistics and Chi-square test were used to explore the knowledge and practices of the mothers and to identify factors affecting them using the statistical software. During the six-month study with a 100% response, 50 mothers of children with ASD (ages 18–35+) were interviewed. A significant association was found between mothers’ knowledge levels and GFCF diet practices (p<0.001). The study concludes that most mothers had medium knowledge and practice levels, highlighting the need for improved awareness to enhance dietary practices. Mothers' moderate knowledge of the GFCF diet highlights the need for improved practices to address maladaptive behaviors. Future guidelines should consider enablers and barriers, as adherence remains incomplete (only GF or CF). A qualitative approach is recommended
A study of clinical profile and treatment outcome in patients of liver abscess admitted in a tertiary care centre
Get PDFBackground: Liver diseases have a wide range of clinical implications. Commonly found to be pyogenic or amoebic in origin, fungi and parasites account for a small percent of cases. Liver abscesses have been linked to a mortality rate as high as 20%. Underdeveloped nations have greater rates of amoebic liver abscess (ALA). The study was performed to analyse the clinical manifestation and treatment outcome among patients with hepatic abscesses.
Methods: It was a cross-sectional, observational study. The study took place for one year at Indira Gandhi Institute of Medical Sciences (IGIMS), Patna, Bihar, India. Total 100 patients were enrolled into this study. Ethical clearance to conduct this study was obtained from Institutional Ethics Committee (IEC) of IGIMS, Patna, Bihar, India under letter no. 752/IEC/IGIMS/2022 dated 06 October 2022.
Results: Average age in years of included participants was 42.82±11.33. Total 90 male participants were enrolled into the study and 10 female participants were part of the study. Forty-seven individuals with bilirubin levels above normal had clinical jaundice. Hemoglobin levels below 11 gm% were identified in 64 cases (64%), with the lowest recorded hemoglobin in this series being 6.7 gram%. The study determines an important statistically significant correlation (p value =0.000109) between the alcohol consumption and amoebic liver abscess.
Conclusions: The study concluded that substantial statistical association between alcohol use and liver abscess. Single, isolated abscesses were more prevalent than multiple abscesses, and the right lobe of the liver was more frequently afflicted. The medical management therapy has been provided to all the patients
Vitamin D deficiency: a cause of clinical concern
Get PDFIn India, the prevalence of vitamin D deficiency ranges from 35% to 99% despite the fact that India is a tropical country with plenty of sunshine. The prevalence of vitamin D deficiency is high in patients with comorbid conditions such as type 2 diabetes mellitus (T2DM) (84.2%), hypertension (82.6%), and hypothyroidism (76.9%). The effects of vitamin D deficiency are not just restricted to the musculoskeletal system. The presence of vitamin D receptors on the pancreatic beta cells, adipose tissues and skeletal muscle cells indicates the function of vitamin D in the glucose metabolism. Recent literature shows that altered vitamin D and calcium homeostasis may play a role in the development of T2DM. This review delves into recommendation shared by group of expert endocrinologists on skeletal and extra skeletal implications of vitamin D deficiency and the ways to manage patients of vitamin D deficiency. Experts shared that as per guidelines vitamin D deficiency be defined as a 25(OH)D below 20 ng/ml, insufficiency as a 25(OH)D of 21–29 ng/ml, and sufficiency as a 25(OH)D of ≥30 ng/ml. The experts opined that vitamin D levels should be maintained between 40-60 ng/ml for extra skeletal benefits. Vitamin D supplementation has demonstrated potential benefits on glycemic control. Thus, vitamin D supplementation can be added as an effective adjunctive intervention in diabetic and prediabetic patients. Recent advances in technology have enabled delivery of vitamin D through nanoparticle-based Vitamin D which ensure higher absorption and better serum vitamin 25(OH) levels. Experts shared that nano-particle based vitamin D3 appears to be better in achieving higher levels of serum 25(OH)D than that observed with other oral dosage formulations of vitamin D3
Common parlance English in an Indian medical undergraduate institution: current scenario and ranking the improvement
Get PDFBackground: Indian undergraduate medical students fail to differentiate word-inflexions, or look-alike-sound-alike words, and words which are not candid contextually. Baseline English vocabulary assessment followed by a gap analysis and training can motivate an improvement.
Methods: Harrison’s Textbook of Internal Medicine was the reference textbook for vocabulary. All the asked words in MCQ.1 (pre-test) or MCQ.2 (post-test) were ensured in Oxford English Mini Dictionary to verify their common parlance use. Dorland’s Illustrated Medical Dictionary was referred to verify semantic similarity. The chosen words’ usage frequency rank was decided as per COCA corpus. After 7 months, MCQ.2, with word-to-word match of nearly 5000 higher rank (hinted as per internal assessment), was held and students were expected to repeat a similar performance.
Results: In MCQ.1, 89 students got enrolled and 87 participated. In MCQ.2, 104 students were enrolled and 103 participated (an indicator of motivation). On 2-tailed paired t-test, p value was 0.1129, confidence interval at 95% significance was -0.54 to +0.06 and t-value was 1.6017 (MCQ.1 and MCQ.2 performances were essentially similar).
Conclusions: Similar performance at higher rank indicates that the training uplifted the students’ vocabulary by at least 5000 ranks within 7 months
The challenges of managing acute myeloid leukemia in pediatric patients: a review of current treatment strategies
Get PDFAcute myeloid leukemia (AML) in pediatric patients presents with complex pathophysiology but a diverse treatment response and so is a difficult disease to treat. Despite substantial progress in genetic profiling of the diseases and precision medicine as well as targeted therapies, pediatric AML continues to be a significant cause of loss of life to cancer in children. Intensive chemotherapy, hematopoietic stem cell transplantation (HSCT), and FLT3 inhibitor are most of the treatment strategies used so far. However, therapeutic efforts are complicated by the high risk of relapse of certain patient subtypes and disease genetic heterogeneity, as well as continually rising incidence of resistance. Novel insight in the field of immunotherapy such as monoclonal antibodies, CAR-T cell therapy, and conjugation of FLT3 inhibitor in therapy hold promise for improved efficacy and decreased toxicity in the recent past. Nevertheless, conventional therapy of pediatric AML is still not an option for these pediatric AML patients with high risk genetic mutation (TP53), so new paradigms in treatment of pediatric AML are required. Then, the current treatment strategies for high risk pediatric AML are reviewed, the challenges in the management of the disease are discussed, and how emerging treatments may improve survival are discussed. The outcomes of genetic mutations, treatment protocols and reviewed combined advantages of current clinical trials is included and made available as valuable insights in pediatric AML treatment on this paper
Evaluating advanced artificial intelligence in oncology education and clinical knowledge assessment
Get PDFBackground: The rapid advancement of artificial intelligence (AI), particularly multimodal large language models (MLLMs), holds promise for revolutionizing oncology practices. This study evaluates the performance of two MLLMs, GPT-4o and Gemini Advanced, in answering oncology examination questions from the American Society of Clinical Oncology Self-Evaluation Program (ASCO-SEP) question bank.
Methods: A total of 832 multiple-choice questions covering various oncological tasks were extracted from the ASCO-SEP question bank. Both models were independently presented with these questions, and their responses were compared to the official answer key. Statistical analyses were performed to assess accuracy differences between the models.
Results: Gemini advanced outperformed GPT-4o, achieving 74.84% accuracy compared to 60% for GPT-4o (p=0.025). Gemini advanced consistently excelled across all task categories, particularly in making diagnoses, ordering and interpreting test results, and recommending treatment. Both models struggled with questions related to pathophysiology and basic science knowledge.
Conclusions: While both MLLMs demonstrate significant understanding of oncological knowledge, Gemini Advanced shows superior performance, highlighting the influence of model architecture and training data. These findings underscore the potential of AI in augmenting clinical practice and medical education but emphasize the need for further improvements, particularly in handling complex clinical scenarios and integrating foundational science knowledge
Lipoma-induced jejunojejunal intussusception: a novel “bow-tie sign”
Get PDFIntussusception, a condition predominantly observed in infants and young children, is one of the leading causes of acute abdominal emergencies, second only to appendicitis. In contrast, adult intussusception is rare, accounting for less than 5% of all cases and 1% to 5% of bowel obstructions. While pediatric intussusception is often idiopathic, over 90% of adult cases have an identifiable organic cause, including malignancy. Among benign causes, small bowel lipomas are a rare but significant lead point for intussusception. We report a case of jejunojejunal intussusception in an adult patient caused by a small bowel lipoma, which presents with a novel intraoperative finding we describe as the "bow-tie sign." This case emphasizes the importance of imaging and appropriate surgical management
Prevalence, risk factors, and outcomes of acute kidney injury in a cardiac intensive care unit patients: a comprehensive study in a tertiary care setting
Get PDFBackground: Acute kidney injury (AKI) is a frequent and serious complication among critically ill patients in the intensive care unit (ICU), contributing to increased morbidity, mortality, and prolonged hospitalization. This study aimed to assess the prevalence of AKI and identify associated risk factors among ICU patients at Government General Hospital (GGH), Srikakulam.
Methods: A descriptive cross-sectional study was conducted over one year in the nephrology ICU at GGH, Srikakulam, Andhra Pradesh. Data from 150 adult ICU patients were retrospectively reviewed. Patients with chronic kidney disease or prior kidney transplantation were excluded. Information on demographics, comorbidities, AKI diagnosis (based on KDIGO criteria), treatment, and outcomes was collected. Statistical analysis was performed to determine significant risk factors for AKI.
Results: AKI was diagnosed in 74 patients (49.3%). The mean age of AKI patients was 65.4 years, significantly higher than non-AKI patients (58.6 years, p=0.001). Hypertension was more common among AKI patients (50% versus 29%, p=0.02), and sepsis was present in 60% of AKI cases compared to 19.4% in non-AKI patients (p=0.001). AKI patients had longer ICU stays (14.8 versus 8.9 days, p=0.001) and higher mortality (46.7% versus 16.1%, p=0.001).
Conclusions: AKI is highly prevalent in ICU patients and is significantly associated with older age, hypertension, and sepsis. It correlates with longer ICU stays and increased mortality. Early recognition and targeted management of risk factors are crucial to improving outcomes in critically ill patients
Comparing the theory of planned behavior and transtheoretical model in limiting screen time before bedtime: a narrative review
Get PDFExcessive screen time before bed is becoming an increasing public health issue, as it’s associated with poor sleep, impaired cognitive functioning, and elevated stress levels. The key to healthier digital habits is understanding behavior change mechanisms. The purpose of this article is to compare the theory of planned behavior (TPB) and the transtheoretical model (TTM) to determine their relative effectiveness for screen use reduction prior to sleep. TPB describes behavior change in regards to attitudes, subjective norms and perceived behavioral control; however, it also faces struggles with the intention-behavior gap, where individuals intend to reduce screen use but fail to act. In contrast, TTM recognizes that behavior change is a multi-stage process, allowing for tailored interventions based on an individual’s readiness for change. This narrative review attempts to synthesize empirical research on TPB and TTM in a systematic literature search in ISI Web of Science, Scopus, PubMed, SID and Magiran. Studies were included if they focused on screen time reduction and applied either TPB or TTM. The review emphasizes that TPB gives insightful understanding of behavioral intentions, while TTM provides a step-by step, structured framework for intervention development. Findings suggest that integrating TPB’s predictive strengths with TTM’s staged framework could enhance intervention effectiveness. Future research should explore hybrid models that bridge the gap between intention formation and sustained behavior change, ultimately supporting better sleep hygiene and long-term digital well-being.
The body mass index and reflex reaction connection: insights into upper limb reflexes in young adults
Get PDFBackground: Reflexes are automatic responses to stimuli, enabling quick reactions through reflex arcs. Body Mass Index (BMI) influences various physical and cognitive functions, and deviations from optimal BMI may impact reflex reactions. This study aimed to investigate the correlation between BMI and upper limb reflex reaction in young adults aged 18-25 years, emphasizing the importance of maintaining a healthy BMI.
Methods: This observational, cross-sectional study involved 51 participants (14 females, 37 males) from an institution in Mangalore. Data such as height, weight, and reflex reaction time were collected. BMI was calculated using the WHO classification (2004), and upper limb reflex time was assessed using the Ruler Drop Test. Each participant underwent three trials, and the average distance was analyzed. Statistical analysis was performed using SPSS 21.0, applying Pearson correlation to evaluate relationships between BMI and reflex reaction (p<0.05).
Results: The study revealed a moderate negative correlation between BMI and upper limb reflex reaction time (r = -0.437). Participants with higher or lower BMI beyond the optimal range showed slower reflex responses. Males exhibited slightly quicker reflexes (28.25±6.18 cm) compared to females (30.25±7.20 cm).
Conclusions: Deviations in BMI negatively impact upper limb reflex response in young adults, highlighting the need for maintaining an optimal BMI for efficient neuromuscular functioning