JK Science: Journal of Medical Education & Research

Teen Suicide Prevention

Ravinder K Gupta — 2024-04-10

Suicide is "any self-destructive behaviour that has an intent to seriously damage oneself or cause death". It is the second leading cause of death among adolescents. India reported the highest suicide rate in 2021 with 12 suicides for every 100,000 population. Furthermore, this trend, according to Indian National Crime Records Bureau (NCRB) has risen at the rate of 6.2% compared to the year 2020. The interaction between multiple factors like biological, psychological, socio cultural, and family-like factors can cause contribute to suicide in teens. The increase in suicide rates among females could be attributed to gender specific stressors, violence, and discrimination. The rise in male suicide rates could be attributed to financial strain, academic pressure, and substance abuse.

Intellectual Disability Among Disabled Children: Prevalence and Risk Factors in a Rural Area of Jammu, India

Preeti Kumari — 2024-04-10

Background: Disabled Children suffer Intellectual Disability/ies (ID) to a varying extent. Role of environmental and non-genetic factors in Intellectual Disability remains largely unexplored in developing nations. The study aimed to determine Intellectual Disability among disabled rural children and its association of various demographic variables.
Methods: A cross sectional study was conducted in a randomly selected rural health zone. 52 children of ages 1 18 years with various disabilities were assessed for IQ by a clinical psychologist using Developmental Screening Test, Sequin Form Board test, CM Bhatia test and Vineland Social Maturity Scale. Chi-square test was used to find associations, if any.
Results: 16 children out of 52 were suffering from Intellectual Disability thus resulting in a prevalence of 30.7%. Male: Female ratio for Intellectual Disability was 1.3:1. Among the demographic variables, sex of the child and maternal age at child birth were significantly associated with Intellectual Disability (p<0.05).
Conclusions: High prevalence of Intellectual Disability among disabled children is a cause of concern. Healthcare team needs to raise awareness among females of reproductive age about various risk factors and screen children with disabilities for Intelligence Quotient (IQ) for early interventions.

Cutaneous Adverse Drug Reaction Profile in Tertiary Care Teaching institute: A Prospective Study

Sana Bashir — 2024-04-10

Introduction: Cutaneous adverse drug reactions (CADRs) are the most common type of drug sensitivity reactions, with a varied and diverse range of morphologies. Therefore, it is essential to be aware of them for diagnosis and prevention.
Aim: To assess the cutaneous adverse drug reaction (CADR) profile of patients from the tertiary care teaching hospital in North India.
Methods: A prospective, observational study was conducted over 6 months in the Department of Pharmacology & Therapeutics, Jammu in collaboration with the Dermatology department, SMGS Hospital, Jammu after obtaining permission from the institutional ethical committee. Patients with drug rash, of either sex and all age groups were included in the study. The WHO-UMC scale and Naranjo algorithm scale were used to determine the causality assessment. Details regarding drug intake, morphology of eruption, offending drugs, drug rechallenge/ dechallenge history, and treatment given to the patients were assessed.
Results: Out of 100 patients enrolled, 42% had an exanthematous drug eruption, while 21% had fixed drug eruptions. Most reactions were caused by antimicrobials 64% followed by non-steroidal anti-inflammatory drugs (NSAIDs) in 15% of patients, with 9% experiencing severe cutaneous adverse drug reactions (SCADRs), like Stevens- Johnson syndrome (SJS) and toxic epidermal necrolysis (TEN), caused by antituberculous drugs.
Conclusion: The study findings show that reporting adverse drug reactions (ADR) can help identify the drugs most commonly associated with dermatological reactions. This leads to better patient treatment through early identification and management of these reactions.

Pre-Emptive Dexamethasone for Managing Post Operative Pain in Patients Undergoing Laparoscopic Cholecystectomy Under General Anaesthesia: A Prospective Randomized Study

Savneet Sasan — 2024-04-10

Background: Pain after laparoscopic cholecystectomy arise from multiple sources and so require multimodal approaches to manage it. Dexamethasone is a corticosteroid drug with excellent anti-inflammatory properties. Present study was designed to study the effect of administering an intermediate dose of dexamethasone (8 mg), one hour before the induction of anaesthesia, on post-operative analgesia, time to first analgesia and total number of analgesics used in twenty-four hours.
Material and Methods: A total of 80 patients were randomly allocated into two study groups by computer generated randomization. Group 1 received 8 mg/2 ml of Inj. Dexamethasone intravenously 1 hour prior to induction of General Anaesthesia slowly over a period of 5 minutes. Group 2 received 2 ml of Normal Saline (NS) intravenously 1 hour prior to induction of General Anaesthesia slowly over a period of 5 minutes.
Results: The mean Visual analogue score of group 1 was lower than that of group 2 and the difference was statistically significant at 0, 2, 6 and 12 hours postoperatively (p<0.05). The mean time taken by the patients in group 1 for the first rescue analgesic was (11.65±4.59) hours, which was statistically significant as compared to group 2 (4.01±2.03) hours(p=0.0001). Mean total number of analgesic used in Group I was significantly less as compared to Group 2 (p=0.0001)
Conclusion: Use of dexamethasone 8 mg intravenously one hour before induction of general anaesthesia for post-operative analgesia causes a significant decrease in overall VAS score at 0, 2, 6 and 12 hours post-operatively, increases the duration between the surgery and the need for first rescue analgesia and decreases the total number of analgesics used with minimal adverse effects after laparoscopic cholecystectomy

Serum Cortisol Level as a Biomarker in Predicting the Severity of Stroke

Akhil Konduru — 2024-04-10

Background: A number of clinical and radiological indicators can reliably detect the prognosis of a stroke. Improved biomarkers for predicting prognosis in acute ischemic and hemorrhagic stroke are still elusive.
Aims and Objective: The present study was aimed to observe whether serum cortisol acts a biomarker in predicting the severity of stroke.
Materials and Methods: A prospective study performed among 50 patients with ischemic in Group A and 50 patients with hemorrhagic stroke in Group B. The random serum cortisol of these patients was compared with the NIHHS score.
Results: Incidence of hypertension was significantly higher in group B than group A (72% vs. 38%; P<0.0001). Both systolic and diastolic BP were significantly higher in group B in comparison to group A (P<0.001). Severity of stroke was significantly higher in group B in comparison to group A (P<0.001). Mean cortisol levels were significantly more in group B in comparison to group A (P<0.001). Also, a statistically significant correlation with raised serum cortisol levels and the severity of stroke irrespective of type of stroke was observed.
Conclusion: The study revealed that serum cortisol can be used as a biomarker for the prediction of severity of stroke.

Comparative Evaluation of Perineural Versus Intravenous Dexmedetomidine as an Adjuvant to Ropivacaine for Interscalene Brachial Plexus Block in Shoulder Joint & Lateral Clavicular Surgeries : A Randomised Control Trial

Saima Hassan Tantray — 2024-04-10

Background & Aims: Upper extremity regional anesthesia is the mainstay of an anesthesiologist’s armamentarium. The aim of this study was to evaluate the analgesic efficacy of 50mcg perineural dexmedetomidine versus 50mcg of intravenous dexmedetomidine when given along with USG guided interscalene block using 15 ml of 0.75% ropivacaine and superficial cervical plexus block using 10 ml of 0.5% ropivacaine in patients undergoing shoulder joint and lateral clavicular surgeries.
Materials & Methods: This randomized controlled clinical study included 105 patients of ASA group I & II divided into three groups as Group R received 14.5 ml of 0.75% ropivacaine with 0.5ml normal saline as placebo, Group RDp received 14.5 ml of 0.75% ropivacaine with 50mcg (0.5ml) of perineural dexmedetomidine and Group RDi received 14.5 ml of 0.75% ropivacaine with 0.5ml normal saline with 50mcg (0.5ml) of intravenous dexmedetomidine. In addition, each group was given superficial cervical plexus block with 10 ml of 0.5% ropivacaine.
Results: The duration of analgesia was significantly prolonged in group RDp (704.57+272.90 mins) than group RDi (586.86+283.67 mins) & group R (335.71+35.17 mins) which was statistically significant. No significant adverse effects were noted.
Conclusion: The administration of adjuvant 50 mcg dexmedetomidine via perineural or intravenous route along with 0.75% ropivacaine for interscalene brachial plexus block significantly enhanced the onset of motor and sensory blockade as well as the duration of analgesia without any significant side effects and better patient satisfaction than patients receiving plain ropivacaine.

Role of Wet Laboratory Training for Residents of Ophthalmology

Ashok K Sharma — 2024-04-10

Background: In current residency programs, surgical skill acquisition relies on observation and incremental practice, often due to limited surgical opportunities, potentially lowering learner confidence and impacting patient outcomes. To counter this, mandatory wet lab training has been introduced to enhance surgical exposure.
Aim: To evaluate the role of wet laboratory training for residents of Ophthalmology.
Material and Methods: Thirty-two postgraduate residents participated in three supervised sessions, practicing small incision cataract surgery (SICS) on goat eyes. Faculty evaluated their performance using the SICS Ophthalmic Simulated Surgical Competency Assessment Rubric (Sim-OSSCAR:SICS) scale. Residents provided feedback through a pretested questionnaire.
Results: Significant improvement in mean scores across sessions (16.094 ± 5.449 after exposure 1, 22.188 ± 4.948 after exposure 2, and 29.094 ± 5.384 after exposure 3, p < 0.001) was seen. Qualitative analysis indicated high relevance of wet lab training (71.9%), with residents acknowledging its usefulness (68.7% strongly agreed, 31.3% agreed) and confidence boost (75% strongly agreed, 25% agreed). Most residents found ease in performing different (93.7%) and subsequent (96.9%) steps during wet lab training.
Conclusion: This study emphasized the importance of wet lab training is crucial, as it significantly contributes to enhancing patient care quality by allowing residents to refine surgical skills in a safe environment.

Assessment of High-resolution Computed Tomography Thorax Volumetric Indices in Covid-19 Patients and Correlation with Biochemical Markers

Bikash Parida — 2024-04-10

Background: Years after SARS recovery, residual pulmonary abnormalities may still exist. This raises the question of whether or not Covid-19 could have comparable late consequences. Structural changes in the Lungs after recovery can be better visualized using CT-Thorax.
Objectives: To study the Covid CT changes during hospitalization and after four months follow-up of infection, and to correlate with the volumetric HRCT thorax indices and Biochemical parameters.
Material and Methods: This is a hospital based Cross-sectional study, with a follow-up among 100 Hospitalized clinically moderate to severe Covid- 19 patients who recovered after four months.
Results: The biochemical markers such as d-Dimer and C-Reactive Protein (CRP) were significantly reduced. The values of NL (L) and NL (%) had a significant negative correlation with d-Dimer and C-Reactive Protein (CRP). The individuals’ average ages in years, which ranged from 24 to 80, were 48.56 ± 13.87.
Conclusion: Biochemical indicators, including d-Dimer and CRP, were greatly decreased. The NL (L) and NL% values exhibited a strong negative connection with d-Dimer and C-reactive protein (CRP) both during and after Covid. Hence the different CT indices (NL, NL%) can be used along with Biochemical parameters (CRP and d-Dimer) for structural and functional recovery in Covid-19 patients.

A Rare Case of Pseudoglucagonoma Syndrome Masquerading as Necrolytic Migratory Erythema

Nikita — 2024-04-10

Necrolytic migratory erythema (NME) is pathognomonic of glucagonoma syndrome associated with pancreatic neoplasm. Pseudoglucagonoma syndrome, which is extremely rare, refers to NME without a glucagon-secreting tumor. We describe a rare case of NME in a 45-year-old female who presented with a skin rash associated with scaling, cheilitis, glossitis, hair loss, and weight loss. Serum glucagon and serum zinc levels were normal. Skin biopsy was suggestive of necrolytic erythema migrans. Ultrasonography (USG) and computed tomography (CT) of the abdomen showed chronic pancreatitis. Resolution of lesions was observed with topical steroids, emollients, intravenous (IV) protein infusions, and other supplements.

Malignant Mixed Germ Cell Tumor in a Patient with Swyer Syndrome: A Case Report

Kartik Raina — 2024-04-10

Mixed germ cell tumors are extremely rare tumors, usually malignant with a poor prognosis and made up of at least two different germ cell tumors. These tumors occur most often in the gonads but may also occur at other sites in body. In this case, a 24-year female presented to SMGSH, GMC Jammu with an abdominal lump associated with pain and primary amenorrhea. On examination, a firm mass reaching upto epigastrium was present. Upon investigation, all the tumor markers were raised. Her radiological evaluation showed a complex solid-cystic adnexal mass suggestive of neoplastic etiology. Simultaneously, patient was also evaluated for primary amenorrhea and upon karyotyping, she had an XY chromosome suggestive of Swyer syndrome. Patient underwent laparotomy with bilateral salpingo-gonadectomy and pelvic lymphadenectomy with preservation of the uterus. Histopathology confirmed mass to be a malignant mixed germ cell tumor with elements of teratoma, yolk sac tumor, and embryonal carcinoma.

Cutaneous Rosai-Dorfman Disease - A Rare Non-Langerhans Cell Histiocytosis

Afthab Jameela Wahab — 2024-04-10

Cutaneous Rosai-Dorfman disease is classified as non-Langerhans cell histiocytosis. It is a benign lymphoproliferative disorder involving only skin and subcutaneous tissue, which is rare and not well documented. It manifests as erythematous to brown papules, plaques, or nodules with histiocyte-rich inflammatory infiltrate which constantly exhibit emperipolesis i.e., uptake of intact lymphocytes and plasma cells; they express both Langerhans cell and macrophage markers (S100 and CD68 respectively). We report a case of a 45-year-old female presenting with a plaque on right cheek since 10 months without systemic symptoms. The lesion was excised in-toto and defect covered with rhomboid flap repair.

Congenital Medial Clavicular Pseudoarthrosis - A Rare Presentation in an Adult

Mohd Ilyas — 2024-04-10

We are presenting a rare case of a 29-year-old male patient with congenital pseudoarthrosis of the clavicle who presented in adulthood with a progressively growing lump on medial end of clavicle which after investigations tuned out to be pseudoarthrosis of the medial clavicle.

From Silence to Sound - A Case of Autoimmune Ear Disease

Mahabaleshwar Mamadapur — 2024-04-10

Autoimmune inner ear disease (AIED) is a rare rheumatological cause of sensorineural hearing loss, accounting for less than 1% of worldwide hearing loss. It presents with rapidly progressive, unilateral or bilateral SNHL, often fluctuating. The progression is over weeks to months, along with vestibular symptoms. Diagnosing the condition is challenging because no adopted standardized tests are available. Hence, AIED is a challenging diagnosis based on exclusion. Clinical characteristics and how the patients respond to immunosuppressive agents are used for the diagnoses of AIED. Only a few cases have been reported in India till now. Here, we present a rare case of Autoimmune Ear Disease without any underlying systemic autoimmune disease.

Revolutionizing Diabetes and Obesity Management: A Comprehensive Review of Tirzepatide’s Dual Agonist Approach

Sonam Samal — 2024-04-10

Tirzepatide, an innovative glucagon-like peptide-1 (GLP-1) and glucagon receptor dual agonist, has emerged as a promising therapeutic avenue for type 2 diabetes and obesity management. This review encompasses a comprehensive evaluation of Tirzepatide’s mechanism of action, clinical efficacy, safety profile, and comparative effectiveness against existing treatments. By targeting multiple pathways related to glucose and weight regulation, Tirzepatide exhibits superior glycemic control and substantial weight loss, presenting a novel approach to address the intertwined challenges of diabetes and obesity. An analysis of pivotal clinical trials, potential adverse effects, and future directions in Tirzepatide research further underscores its potential as a transformative treatment strategy.

Congenital Perisylvian Syndrome: Magnetic Resonance Imaging Findings in Six Cases

Sugandhi Malgotra — 2024-04-10

Background: Congenital perisylvian syndrome is an extremely rare congenital neurological disorder associated with distinctive imaging findings. Herein we describe the clinical features and imaging appearance of congenital perisylvian syndrome on Magnetic Resonance Imaging (MRI).
Material and Methods: Six patients with clinical history, neurological examination and MRI findings suggestive of perisylvian syndrome were included in this review.
Results: Six patients were found to have perisylvian syndrome on MRI findings. Five patients presented with pseudobulbar palsy while seizures were present in 3 patients. The most common MRI findings were vertically oriented sylvian fissures that were continuous with the central or post-central gyrus and perisylvian polymicrogyria. The findings were bilateral in 4 cases and unilateral in 2 cases.
Conclusion: Perisylvian syndrome is a rare neurological disorder which can be diagnosed with certainty on MRI findings along with relevant clinical history.

Uncommon skin and soft tissue infections encountered in adults and children caused by different aerobic, anaerobic bacteria and protistan organism: A series of cases from Kolkata, India

Ananda Sanchayeeta Mandal — 2024-04-10

Skin and soft tissue infections (SSTIs) result from microbial invasion and may be mono or polymicrobial in etiology. The present retrospective record-based study described five uncommon SSTIs from a medical college hospital of West Bengal. Clinical samples were collected and processed following standard microbiological procedures and guidelines. Identification and antimicrobial susceptibility testing of etiological agents, wherever applicable, were done by conventional and automated (Vitek-2 Compact) system. We found a case of spontaneous gas gangrene caused by Clostridium septicum, Group-A â-hemolytic Streptococcus mediated necrotizing fasciitis; lesions of Burkholderia pseudomallei and Burkholderia cepacia complex and that of disseminated rhinosporidiosis caused by Rhinosporidium seeberi. We infer that strong clinical suspicion may surface uncommon etiology from unusual presentations of SSTIs making their diagnosis, treatment and relief rapid and uneventful.