International Journal of Research in Medical Sciences
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Item analysis of type “A” multiple choice questions of biochemistry in GIM module, year 1 MBBS program
Full text linkBackground: Medical education is continually evolving to meet the demands of healthcare and scientific advancements. The Defence Services Medical Academy (DSMA) in Myanmar implemented an outcome-based curriculum in 2017. The genetics, immunology, and molecular medicine (GIM) module is a critical component of the first-year MBBS program, laying the foundation for knowledge in biochemistry and related sciences.
Methods: This study analyzed the quality of type “A” multiple choice questions (MCQs)- 28 items from the Biochemistry section of the GIM module’s end-module assessment. The evaluation focused on four key indices: difficulty index (P), discrimination index (D), distractor efficiency (DE), and Kuder-Richardson formula 20 (KR-20) for reliability.
Results: Of the 28 items, 21 (75%) were classified as having average difficulty, while 5 (18%) were deemed too difficult. Regarding discrimination, 12 (43%) items displayed very good discrimination, while 8 (29%) had poor discrimination, indicating the need for revision. Nearly 70% of the MCQs had fully functional distractors. Overall, the Biochemistry questions showed moderate reliability (KR-20 score =0.682), with three items (11%) recommended for rejection due to poor performance.
Conclusions: These findings highlight the necessity of regular item analysis and revision to ensure the quality and fairness of assessments. Faculty development and active learning strategies are essential to improving the overall reliability and effectiveness of MCQs in medical education
Haemodynamic stability and incidence of adverse events during tracheal intubation without neuromuscular blockade: comparison of clinical versus bispectral-index monitored depth of anaesthesia
Full text linkBackground: Haemodynamic stability during intubation is influenced by sympathetic response to laryngoscopy and intubation. Furthermore, the incidence of adverse events during intubation without NMB warrants further investigation. BIS-guided anaesthesia has been associated with improved haemodynamic outcomes compared to clinical monitoring alone. Despite these advantages, the utility of BIS monitoring during intubation without NMB remains underexplored.
Methods: This was a randomised, single-blind, controlled clinical study conducted in the Jos university teaching hospital, Jos, Nigeria, among 56 children aged 2 to 6 years with ASA I and II scheduled for adenotonsillectomy. Patients were randomised into two groups, B and C, with patients in group B receiving BIS monitoring while those in group C received clinical monitoring for the depth of anaesthesia with sevoflurane and without a neuromuscular blocking agent. Haemodynamic changes and adverse events associated with laryngoscopy were noted. Data was analysed using SPSS with students’ t test and chi-square test being the statistical tests utilised, and the level of significance set at p=0.05.
Results: Systolic blood pressures were slightly higher in group C than group B. Diastolic blood pressures were slightly higher in group B than group C, while differences in mean arterial pressure between group B and group C were not statistically significant (p=0.10). Adverse events were only found in group C, with 10.7% of patients developing laryngospasm.
Conclusions: The monitoring of inhalational induction using clinical signs is an acceptable alternative to BIS and can be used in the absence of BIS
Characteristics of metastatic lung cancer patients on osimertinib therapy in Bangladesh
Full text linkBackground: Lung cancer is a major cause of mortality worldwide and metastasis plays a vital role in determining treatment and survival rate. Osimertinib showed significant success in the treatment of lung cancer, as evidenced by the literature, however, this outcome varies according to age, site of metastasis, etc. The objective of this study was to obtain demographic information on patients and assess the frequency of metastatic sites based on their age and sex.
Methods: This descriptive cross-sectional study included eighty metastatic lung cancer patients on osimertinib therapy attending a tertiary level health facility in Dhaka, Bangladesh. Data were obtained through reviewing their clinical reports.
Results: According to the findings, the patients' mean (±SD) age was 60.95 ±13.98 years. Patients who were between the ages of 55 and 75 had the highest rate of metastases. Under the age of 55, brain metastases (27%) were more common in both sexes (16.2%). While spinal metastasis was more frequent in female patients (8.1%), skin metastasis was more common in male patients (16.2%). Skin metastases were most frequently observed in patients aged 55 to 65 (10.8%), followed by those aged 25 to 45 (5.4%).
Conclusions: Mid-age male patients have been observed to have more cases of brain metastases and metastatic lung cancer. The findings are not conclusive due to the small sample size but suggest that the site of metastasis varied according to the patient's demographic characteristics. Further research on this topic is recommended to yield evidence for practitioners and policymakers
Clinicopathological features and survival outcomes in bone-only metastatic breast cancer patients stratified by hormone receptor status: a tertiary care study
Full text linkBackground: Bone metastatic disease is common across all breast cancer subtypes. Patients with hormone receptor (HR)-positive breast cancer tend to have the greatest predilection for developing bone metastases and have better survival outcomes; unlike organotypic metastasis to visceral organs in triple-negative breast cancer. In this retrospective study, we compared the features and survival of these bone metastatic breast cancer subgroups and demonstrated that different ER and PR statuses contribute to varied survival outcomes.
Methods: It was a single‑institute retro prospective study. Out of the 200 HPR-proven cases of breast carcinoma, 100 patients were eligible for the study who presented/developed bone metastases. Patients with visceral mets were excluded from the study. Based on ER, PR and HER2 neu, status patients were divided into four groups.
Results: Out of 100 patients taken for this study 45 were ER+ PR+, 20 were Er-,PR-, 18 were ER-, PR +, and 17 were ER+,PR-.and the mean age in the study groups was 49.5±.5. Higher tumour grade and lymph node positivity was observed in ER- PR- and ER- PR+ as compared to hormone-positive groups. In our study group percentage of bone mets was higher in ER +, PR+(31.11 ) and ER+ PR- (52.63%),While as it was similar in Er-,PR- and ER-, PR + patients. The overall survival of ER+ PR- was 94.1% followed by ER +, PR+(86.7%) while patients with ER-, PR- had 30.0% and ER-, PR + 27.8%.
Conclusions: Different ER and PR statuses in breast cancer exert a significant impact on bone metastasis incidence and survival condition of bone metastatic breast cancer. Hormone receptor‑positive tumours show a predilection for bones as the first site of relapse and better overall survival as compared to hormone‑receptor‑negative tumours
Prevalence of HIV/AIDS in antenatal patients in a tertiary health care center
Full text linkBackground: India is way behind in its battle against HIV-AIDS. Human immunodeficiency virus is spreading at an alarming rate; statistics show that India has the third largest number of people living with the virus. According to National AIDS control organisation (NACO), the overall prevalence is 0.29% among the ANC clinic patients in India. HIV still has a stigma in this country, thus exact data and appropriate studies are not available to take relevant steps.
Methods: After taking written consent and explaining the protocols, 5-ml of blood samples are collected in Clot vials and tested for HIV virus by ELISA. Positive samples were again sent to the ICTC center for further testing. The "opt-out" approach to HIV testing is offered to all women as part of routine antenatal tests. Women who are tested positive are also tested for HBV and HCV by ELISA.
Results: Out of 40054 ANC patients tested in the last 5 years, 42 were tested positive for HIV which accounts for 0.12%. The coinfection rate of HBV and HCV was 0.007% and 0.017%. They were further classified based on specific criteria including age, education status, gravida, trimester in which they were detected and if they belonged to rural/urban household and co-infection with HCV and HBV.
Conclusions: HIV-AIDS a disease with less mortality but major morbidity if not controlled well with timely ART. Appropriate management must be instituted to reduce the consequences of HIV in pregnancy with preconception counselling and planning pregnancies when the viral load is minimum
Clinical profile, risk factors and outcomes of ectopic pregnancy in a tertiary care hospital
Full text linkBackground: Extrauterine or ectopic pregnancy occurs when the fertilized ovum becomes implanted in tissue other than the endometrium. Aim of this study is to find the incidence, clinical presentation, risk factors, management of ectopic pregnancy.
Methods: It was an observational study done in the department of obstetrics and gynaecology, Shri Lal Bahadur Shastri medical college Mandi, Himachal Pradesh for period of one year from 1st January 2024 to 31st December 2024.
Results: A total 3628 women delivered in the tertiary care hospital during the study period of one year. The incidence of ectopic pregnancy was 1.87%. The most common age group was 20-30 years. Incidence of ectopic pregnancy was more in multipara (73.53%). Most common clinical presentation was amenorrhoea in 95.58% followed by abdominal pain in 80.88% patients. The failed tubal ligation was the risk factor in 14.74% patients. Unilateral salpingectomy was done in 45.58%, methotrexate treatment in 50%, expectant treatment in 2.94% and laparotomy for one caesarean scar ectopic pregnancy. Anaemia was observed in75.6% patients, blood transfusion in 55.2% and ICU admissions were 5.8%.
Conclusions: Early recognition of ectopic pregnancy is the key to diagnosis and management. It is important to maintain high degree of suspicion of ectopic pregnancy with pregnancies of unknown location
Cardiac myxoma and its growth over 5 years in a patient with a history of multiple cerebrovascular events: a case report
Full text linkCardiac tumors frequently present significant clinical, diagnostic, and therapeutic challenges. In many cases, a cardiac mass is detected incidentally and can represent benign or malignant processes, primary or secondary. Over 90% of primary cardiac tumors are benign (in adults, myxomas are most common, while in children, rhabdomyomas are more frequent). These tumors can be further classified as simple or complex based on the necessary treatment and may affect different chambers of the heart and the pericardium. Secondary or metastatic cardiac tumors are 30 times more common than primary neoplasms, with an incidence in autopsies ranging from 1.4% to 14%. Myxomas constitute approximately 50% of all benign cardiac tumors in adults. Most myxomas (over 80%) are located in the left atrium, with decreasing frequency in the right atrium, right ventricle, and left ventricle. We present the case of a 76-year-old woman who was found to have a left atrial mass identified on echocardiogram in 2019 as part of a cerebrovascular disease evaluation protocol. However, the patient did not attend follow-up. In December 2024, she was hospitalized for a lower respiratory tract infection, and during her admission, a new echocardiographic study showed tumor growth over 5 years
Cholecystoduodenal fistula: a rare cause of gastric outlet obstruction-case report and imaging findings
Full text linkCholecystoduodenal fistula (CDF) is a rare complication of chronic gallstone disease, characterized by an abnormal communication between the gallbladder and duodenum. It is often asymptomatic but may present with complications such as gastric outlet obstruction (GOO), gallstone ileus, or cholangitis. Due to its nonspecific clinical presentation, CDF is often diagnosed incidentally on imaging or during surgery. In rare cases, it can lead to GOO, usually due to chronic inflammation-induced duodenal stenosis. Early recognition is crucial to prevent complications and guide appropriate management. We present the case of a 66-year-old male with a history of gallstone disease who developed progressive nausea, vomiting, and weight loss over two months. Abdominal examination revealed mild epigastric tenderness. Routine blood investigations were unremarkable. Contrast-enhanced CT abdomen showed pneumobilia, a contracted gallbladder with a direct fistulous communication to the duodenum, and significant enhancing thickening of the pyloroduodenal region, suggesting chronic inflammation-induced GOO. Upper gastrointestinal endoscopy confirmed pyloric stenosis without an obstructing gallstone. The patient underwent laparoscopic cholecystectomy with fistula closure and gastrojejunostomy, with significant symptomatic improvement postoperatively. This case highlights the suspicion of CDF in cases of unexplained GOO with pneumobilia
Retrospective analysis of breast cancer subtypes, risk factors, and lump features: outcomes from a tertiary care hospital in Multan, Pakistan
Full text linkBackground: Breast cancer is the most frequently diagnosed malignancy and a leading cause of cancer-related mortality among Pakistani women. Despite its high prevalence, patients in Pakistan are often diagnosed at advanced stages, resulting in poor prognosis. This study aimed to assess the frequency of different breast cancer subtypes, clinical features, staging, grading, and receptor statuses among patients in southern Punjab.
Methods: A retrospective analysis was conducted at Nishtar Cancer Center, Multan, from October 2024 to February 2025, using medical records of 193 female patients diagnosed with breast tumors in 2024. Demographic details, risk factors, tumor characteristics, and receptor status were analyzed using statistical package for the social sciences (SPSS) version 26.0.
Results: Most patients (47.2%) were aged 40–60 years, with 96.9% being married and 17.6% having a history of breastfeeding. Most tumors were invasive ductal carcinoma (90.7%), commonly located in the upper outer quadrant (69.4%). Advanced-stage disease was prevalent, with T4 tumors (38.3%) and N1 lymph node involvement (43.5%). Grade III tumors were frequent (60.1%), and receptor analysis showed luminal B (31.6%) as the most common subtype, followed by luminal A (30.1%) and triple-negative (25.4%).
Conclusions: The findings highlight the late-stage diagnosis and aggressive nature of breast cancer in this region, emphasizing the urgent need for enhanced awareness, early screening programs, and improved healthcare accessibility to facilitate early detection and better treatment outcomes
Neutrophil to lymphocyte ratio and red blood cell distribution width as predictors of microalbuminuria in type 2 diabetes mellitus
Full text linkBackground: Diabetic nephropathy (DN) is a common and feared complication of diabetes mellitus, linked to higher morbidity and mortality rates. Very few studies have assessed the possible clinical value of biomarkers such as neutrophil-to-lymphocyte ratio (NLR) and red blood cell distribution width (RDW) in DN in type 2 diabetes mellitus (T2DM) patients. The present cross-sectional observational study aimed to find the correlation of NLR and RDW with microalbuminuria in T2DM patients.
Methods: One hundred and sixty-nine patients aged ≥40 years of either sex, with duration T2DM >4 years, and diagnosed according to the American Diabetes Association criteria, were included in this cross-sectional observational study. NLR, RDW and urine microalbumin were noted. The primary outcome measures were to find the correlation between NLR and RDW with microalbuminuria, whereas the secondary outcome measures were to study the predictive value of NLR and RDW for microalbuminuria in T2DM patients.
Results: There was a significant positive correlation between NLR and microalbuminuria (r=0.165) and a significant negative correlation between RDW and microalbuminuria (r=-0.159). The mean serum albumin and NLR were significantly higher in patients having microalbuminuria. The sensitivity of NLR and RDW to predict microalbuminuria was 82.4% and 64.7% respectively.
Conclusions: NLR and RDW significantly correlated with microalbuminuria and have good sensitivity for microalbuminuria in T2DM patients. NLR and RDW are cheap and inexpensive methods for detecting DN