Nevin Manimala

J Assoc Physicians India. 2022 Oct;70(10):11-12. doi: 10.5005/japi-11001-0113.

ABSTRACT

BACKGROUND: Teaching clinical skills is generally done by bedside teaching (BT). Clinical teaching stations (CTSs) are specially designed for the final year medics.

METHODS: The aim was to evaluate and compare the impact of CTS with BT on the final year medical undergraduates. Evaluation of the effectiveness of CTS among the participants was the primary objective with a % change in academic performance. A teaching program was conducted in two phases with each phase having two sessions, covering respiratory system (RS), gastrointestinal tract (GIT), cardiovascular system (CVS), and central nervous system (CNS). In the first phase, RS and GIT and in the second phase CVS and CNS were taught by TS and BT methods. Each session lasted for 2 weeks.

RESULTS: Thirty participants were grouped into two. The total mean ± SD score was 22.57 (±3.86) and 24.4 (±4.32) for BT and TS, respectively. Mean scores were higher in students who were taught by CTS but were statistically not significant (p>0.05) in both phases. There was no significant gender difference in the impact of the two teaching methodologies. The number of students who excelled was more with TS whereas, the scores were moderate with BT. All (100%) participants unanimously agreed that CTS is more effective and interactive and helped in better understanding of the subject.

CONCLUSION: TS as a teaching tool is realistic with repeatable clinical scenarios and objective assessment. BT provides students with the required clinical skills, TS can enhance the knowledge and application. TS can be used as a supplementary tool along with BT.

PMID:37355864 | DOI:10.5005/japi-11001-0113

J Assoc Physicians India. 2022 Oct;70(10):11-12. doi: 10.5005/japi-11001-0107.

ABSTRACT

OBJECTIVES: Coronavirus disease 2019 (COVID-19) has neurologic manifestations associated with the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This study aimed to retrospectively analyze SARS COVID-19 patients with neurological manifestations and identify patterns of presentation including the site of neuroaxis involvement, neuroimaging, and associated systemic involvement.

METHODS AND SUBJECTS: This retrospective observational study was conducted at two tertiary care hospitals in western Rajasthan. Data on age, sex, presenting symptoms, and comorbidities (hypertension, diabetes, cardiac, cerebrovascular disease, and cancer) were collected from 28th February 2020 to 31st December 2020 through medical records, discharge summaries, and radiological studies. Verbal/written patient consent was obtained due to the prevailing COVID-19 norms at the time of the first wave. Major inclusion criteria were as follows: age >18 years, consent from patient/surrogate, positive RT-PCR report in case of active COVID cases, or positive COVID antibody test in case of post-COVID neurological sequelae. All neurological manifestations were reviewed by at least two neurologists and were divided into central nervous system (CNS) and peripheral nervous system (PNS) manifestations. Systemic features and their temporal relationship with neurological features were recorded. Various other specialized assessments and therapeutic interventions were conducted. Statistical analysis was performed using the SPSS software. A Chi-square test was performed to determine the association between variables. Student’s t-test and one-way analysis of variance were used to determine differences in mean values. Statistical significance was set at p < 0.05.

RESULTS: The mean age was 57.32 years for the CNS group and 40 years for the PNS group (p = 0.025). Age was significantly lower in the PNS group than in the CNS group (p = 0.025). Anemia, leucocytosis, and elevated serum creatinine were more commonly seen in the CNS group, although the difference was not statistically significant. The most common CNS manifestations were stroke (41.8%), of which ischemic stroke constituted 83% of cases, followed by seizure (22%), encephalopathy (20.9%), headache (15.1%), and vertigo (3.8%). The most common PNS manifestation was neuropathy (57%), which included Guillain-Barré syndrome (GBS), critical illness neuropathy, and autonomic neuropathy Conclusion: CNS symptoms of COVID-19 are more common than PNS symptoms. Stroke is the most frequent (46%) COVID-CNS symptom, which occurs in people of age above 35 years and is associated with high mortality.

PMID:37355862 | DOI:10.5005/japi-11001-0107

J Assoc Physicians India. 2022 Oct;70(10):11-12. doi: 10.5005/japi-11001-0108.

ABSTRACT

INTRODUCTION: Barrett’s esophagus (BE) is a complication of gastroesophageal reflux disease (GERD). It is seen among 15% of GERD patients as per a population-based study by Ronkainen et  al. Barrett’s has malignant potential and annual progression to carcinoma depends on the presence or absence of dysplasia. There are various risk factors for the development of BE. We compared two symptomatic cohorts of GERD patients from the same geographical area who were evaluated for the presence of Barrett’s and various factors that can contribute to Barrett’s Materials and methods: Cross-sectional study. Two GERD cohorts, one from Kottayam and the other from Trivandrum were taken. The presence of Barrett’s and the factors contributing to the development of Barrett’s were analyzed between the two groups. Since biopsy data of all patients were not available, endoscopically suspected esophageal metaplasia (ESEM) was taken as Barrett’s Results: 415 patients were enrolled for the study (203 from Trivandrum and 212 from Kottayam). 192 females (99 from Trivandrum and 93 from Kottayam), and 223 males (104 from Trivandrum and 119 from Kottayam). Barrett’s esophagus and especially long-segment Barrett’s were significantly more common in Kottayam than Trivandrum (68 vs 22 and 36 vs 9) (p-value <0.001). Among the factors that were traditionally thought to contribute to the development of Barrett’s esophagus, age (>50 years) was not statistically significant among the two cohorts (mean age of Trivandrum was 48 years and Kottayam was 49 years). Duration of GERD symptoms was significantly more in the Trivandrum cohort compared to Kottayam (p-value <0.001). Hiatus hernia and body mass index (BMI) were more common in Kottayam. There were no statistically significant differences in erosive esophagitis and antral gastritis (%age?) between the two cohorts.

CONCLUSION: Both Trivandrum and Kottayam belong to the same geographical area and are separated by a distance of only 150 km. The Kottayam cohort is more prone to develop distal esophageal carcinoma as the BE is more in Kottayam. This data also suggests the need for GERD registries so that high-risk population can be targeted and early intervention can lead to a decrease in the incidence of distal esophageal carcinomas.

PMID:37355861 | DOI:10.5005/japi-11001-0108

J Assoc Physicians India. 2022 Oct;70(10):11-12. doi: 10.5005/japi-11001-0109.

ABSTRACT

BACKGROUND: HIV infection is a global pandemic. The adult HIV prevalence in India is 0.22%. Successful therapy is transforming HIV into a chronic medical condition, and there are many metabolic complications. This study aimed to evaluate the metabolic abnormalities in people living with HIV (PLHIV) who were on antiretroviral therapy (ART) for at least 2 years and compare it with ART-naïve patients as well as the effect of protease inhibitor-based (PI-based) and non-protease inhibitor-based (non-PI-based) ART was assessed.

METHODOLOGY: Adult HIV-positive patients both ART-naïve and on ART for more than 2 years were included. Detailed history and clinical examination, including blood pressure and anthropometric measurements were done. This was followed by investigations like lipid profile including total cholesterol, triglyceride, high-density lipoprotein-cholesterol (HDL-C), low-density lipoprotein-cholesterol (LDL-C), fasting plasma glucose, and hemoglobin A1c (HbA1C) estimation. Standard statistical tools were utilized to assess derangements and association to therapy.

RESULTS: The study was conducted for 1.5 years in a tertiary care hospital. A total of 70% of the study population was male with mean age of participants being 43.2 years, 40% were ART-naïve, 37% received non-PI-based ART, and 23% PI-based ART. The mean total cholesterol level and mean triglyceride value were significantly higher in the PI-based ART group than in the therapy-naïve group. The ART-naïve group was seen to have more subjects with abnormally low HDL-C values. The PI-based ART study subjects were found to have a greater number of cases of glucose intolerance in relation to the rest of the two groups significantly (p-value <0.001). The LDL-C systolic blood pressure (SBP), diastolic blood pressure (DBP), body mass index (BMI), and waist circumference had no association with the different ART regimens or with the HIV infection itself. CD4 T cell count at diagnosis in the three study groups was compared with all the variables of metabolic syndrome and no association was found.

CONCLUSION: Total cholesterol, triglycerides, and glucose levels are the main parameters found to be affected in PLHIV on therapy.

PMID:37355860 | DOI:10.5005/japi-11001-0109

JPEN J Parenter Enteral Nutr. 2023 Jun 25. doi: 10.1002/jpen.2540. Online ahead of print.

ABSTRACT

OBJECTIVES: The objective of the study was to compare body composition of children with intestinal failure measured using bioelectrical impedance analysis (BIA) and skinfolds to dual energy x-ray absorptiometry (DXA). DXA is the reference method for body composition assessment in clinical settings.

METHODS: Children 1-18 years with intestinal failure, having a DXA as part of routine clinical monitoring were eligible. BIA measured total body water on the same day as DXA. Skinfold measurements were taken at four sites: triceps, biceps, subscapular, and suprailiac. Percent fat- and fat-free mass (FFM) were derived from resistance and reactance measured by BIA using age-specific equations. Percent fat-mass (FM) was calculated from skinfold measures using age-specific equations. Data on subject characteristics, intestinal failure related factors and feeding method were collected. Paired T-test examined differences in %FM and %FFM and Bland Altman analysis determined agreement between BIA, skinfolds and DXA. Marginal linear model assessed the effect of age, sex and feeding method on the difference in body composition obtained between DXA and BIA, and DXA and skinfolds.

RESULTS: Sixty-eight children with intestinal failure, mean age 8.9±4.2 years, were studied. There was no difference between %FFM and %FM obtained by DXA and BIA (p=0.26), with a mean bias (95% CI) of -0.69(-1.9, 0.5)% for %FFM. Sex and age were individually and jointly associated with the bias observed between DXA and BIA (p<0.05). Skinfold and DXA measurements were significantly different (p<0.05).

CONCLUSIONS: BIA is an acceptable clinical tool for assessing body composition in pediatric intestinal failure. This article is protected by copyright. All rights reserved.

PMID:37355855 | DOI:10.1002/jpen.2540

J Assoc Physicians India. 2023 Jun;71(6):11-12. doi: 10.5005/japi-11001-0261.

ABSTRACT

AIMS: Early identification of at-risk individuals for diabetic nephropathy would help in preventing or delaying end-stage renal failure. We measured the levels of circulating soluble tumor necrosis factor receptor 1 (sTNFR1) in various stages of proteinuria (MAC) to determine the association of this marker with diabetic nephropathy.

MATERIALS AND METHODS: The study was performed on 160 subjects, and a case-control methodology was employed. Type 2 diabetic subjects were recruited based on albuminuria and were grouped as (1) normoalbuminuria (NA); (2) microalbuminuria (MIC); (3) MAC; (4) normal glucose tolerance (NGT) subjects who served as healthy controls. sTNFR1 levels were measured by quantitative enzyme-linked immunosorbent assay (ELISA).

RESULTS: Soluble tumor necrosis factor receptor 1 (sTNFR1) levels were highest in the MAC group, followed by the microMAC group. The sTNFR1 levels were not statistically different between the NGT and NA groups. On regression models, sTNFR1 was associated with MIC [odds ratio (OR)- 6.491, 95% confidence interval (CI)-1.868-22.55] and MAC (OR per standard deviation-15.28; 95% CI-3.76-62.15; p &lt; 0.001) even after controlling for all the possible confounding factors. Receiver operator curve (ROC) analysis revealed sTNFR1 cut-point of 1832 pg/mL had a C-statistic of 0.685 to discriminate MI from NA with 52% sensitivity. Whereas the sTNFR1 cut-point of 2050 pg/mL with a C-statistic of 0.8177 had 77% sensitivity for identifying MAC.

CONCLUSION: Soluble tumor necrosis factor receptor 1 (sTNFR1) is significantly associated with MIC and MAC group in type 2 diabetes, and this suggests a potential early diagnostic biomarker role of sTNFR1 for MAC among Asian Indians.

PMID:37355839 | DOI:10.5005/japi-11001-0261

J Assoc Physicians India. 2023 May;71(5):11-12. doi: 10.5005/japi-11001-0238.

ABSTRACT

INTRODUCTION: Asthma and chronic obstructive pulmonary disease (COPD) are characterized by chronic airway inflammation. Lack of knowledge about the correct inhalation techniques leads to poor control of both diseases. This study aimed to study the effectiveness of inhalation technique training in patients with COPD and asthma.

MATERIALS AND METHODS: A total of 132 patients fulfilling the inclusion criteria were trained with the correct technique of inhalation on day 0 and at the end of 1 and 6 months. Evaluation of technique training was done on these three occasions posttraining. The mean score of devices was obtained, and the mean inhalation technique score of various devices was compared.

RESULTS: Out of 132 patients, 65.1% (86/132) patients were using a dry powdered inhaler (DPIs), 26.5% (35/132) patients used metered dose inhalers (MDIs), and 8.4% (11/132) patients used MDI with spacer. The mean scores of patients using MDI at baseline were 5.68 ± 0.83, and after 1 month, 6.68 ± 0.58 (p &lt; 0.000). The inhalation technique mean score of MDI improved after 6 months, 7.02 ± 0.56 as compared to baseline (p &lt; 0.008) mean score of the patients using DPIs improved after 1 month, 5.53 ± 0.58 as compared to baseline 4.37 ± 5.53 (p &lt; 0.000). There was no statistical improvement in the device mean score of DPIs after 6 months, 5.62 ± 0.55 when compared with 1 month, 5.53 ± 0.58 (p &lt; 0.117). Patients who used pressurized metered-dose inhalers (pMDI) with spacers improved their inhalation score after 1 month by 6.90 ± 0.94 as compared to the baseline score of 6.90 ± 0.94 (p &lt; 0.001). The mean score decreased marginally after 6 months, 7.818 ± 0.60, as compared to the score at the end of 1 month of 8.27 ± 0.64 (p &lt; 0.053).

DISCUSSION: Patients showed improvement in the technique of inhalation after educational training, reinstructions, and a standard checklist.

PMID:37355820 | DOI:10.5005/japi-11001-0238

Sci Rep. 2023 Jun 24;13(1):10266. doi: 10.1038/s41598-023-37172-3.

ABSTRACT

Data plots are widely used in science, journalism and politics, since they efficiently allow to depict a large amount of information. Graphicacy, the ability to understand graphs, has thus become a fundamental cultural skill comparable to literacy or numeracy. Here, we introduce a measure of intuitive graphicacy that assesses the perceptual ability to detect a trend in noisy scatterplots (“does this graph go up or down?”). In 3943 educated participants, responses vary as a sigmoid function of the t-value that a statistician would compute to detect a significant trend. We find a minimum level of core intuitive graphicacy even in unschooled participants living in remote Namibian villages (N = 87) and 6-year-old 1st-graders who never read a graph (N = 27). The sigmoid slope that we propose as a proxy of intuitive graphicacy increases with education and tightly correlates with statistical and mathematical knowledge, showing that experience contributes to refining graphical intuitions. Our tool, publicly available online, allows to quickly evaluate and formally quantify a perceptual building block of graphicacy.

PMID:37355745 | DOI:10.1038/s41598-023-37172-3

Sci Rep. 2023 Jun 24;13(1):10257. doi: 10.1038/s41598-023-37333-4.

ABSTRACT

Research on mortality outcomes and non-cancer-related causes of death in patients with cutaneous melanoma (CM) remains limited. This study aimed to identify the prevalence of non-cancer-related deaths following CM diagnosis. The data of 224,624 patients diagnosed with malignant CM in the United States between 2000 and 2019 were extracted from the Surveillance, Epidemiology, and End Results (SEER) database. We stratified our cohort based on their melanoma stage at diagnosis and further calculated standardized mortality ratios (SMRs) for each cause of death, comparing their relative risk to that of the general US population. The total number of fatalities among melanoma patients was 60,110, representing 26.8% of the total cases. The percentage of deaths is directly proportional to the disease stage, reaching 80% in distant melanoma. The highest fatalities among the localized melanoma group (25,332; 60.5%) occurred from non-cancer causes, followed by melanoma-attributable deaths (10,817; 25.8%). Conversely, melanoma is the leading cause of death in regional and distant melanoma cohorts. Cardiovascular and cerebrovascular diseases were the most prevalent non-cancer causes of death among the three disease-stage cohorts. Compared to the general population, we did not observe an increased risk of death due to non-cancer causes in the localized CM cohort, while patients diagnosed with regional and distant CMs had a statistically significant higher risk of death from all the reported major causes of death.

PMID:37355743 | DOI:10.1038/s41598-023-37333-4

ISME Commun. 2023 Jun 24;3(1):63. doi: 10.1038/s43705-023-00268-y.

ABSTRACT

Biological nitrogen fixation, the conversion of N₂ gas into a bioavailable form, is vital to sustaining marine primary production. Studies have shifted beyond traditionally studied tropical diazotrophs. Candidatus Atelocyanobacterium thalassa (or UCYN-A) has emerged as a focal point due to its streamlined metabolism, intimate partnership with a haptophyte host, and broad distribution. Here, we explore the environmental parameters that govern UCYN-A’s presence at the San Pedro Ocean Time-series (SPOT), its host specificity, and statistically significant interactions with non-host eukaryotes from 2008-2018. 16S and 18S rRNA gene sequences were amplified by “universal primers” from monthly samples and resolved into Amplicon Sequence Variants, allowing us to observe multiple UCYN-A symbioses. UCYN-A1 relative abundances increased following the 2015-2016 El Niño event. This “open ocean ecotype” was present when coastal upwelling declined, and Ekman transport brought tropical waters into the region. Network analyses reveal all strains of UCYN-A co-occur with dinoflagellates including Lepidodinium, a potential predator, and parasitic Syndiniales. UCYN-A2 appeared to pair with multiple hosts and was not tightly coupled to its predominant host, while UCYN-A1 maintained a strong host-symbiont relationship. These biological relationships are particularly important to study in the context of climate change, which will alter UCYN-A distribution at regional and global scales.

PMID:37355737 | DOI:10.1038/s43705-023-00268-y