Medical Journal Armed Forces India最新文献

{"title":"Neutrophil–lymphocyte ratio as an early predictive biomarker for severity in patients with high altitude pulmonary edema","authors":"Rohit Jain ,&nbsp;Yogendra Mishra ,&nbsp;Amit Sharma ,&nbsp;Samir Samdarshi ,&nbsp;D. Banerjee","doi":"10.1016/j.mjafi.2024.04.021","DOIUrl":"10.1016/j.mjafi.2024.04.021","url":null,"abstract":"<div><h3>Background</h3><div>High altitude pulmonary edema (HAPE) is a serious condition characterized by pulmonary edema occurring at high altitudes, posing a medical emergency. Biomarkers predicting HAPE severity remain elusive, prompting the exploration of accessible indicators such as Neutrophil-to-Lymphocyte Ratio (NLR) and Platelet-toLymphocyte Ratio (PLR). This study aimed to assess the predictive role of NLR and PLR in HAPE severity, alongside analyzing its clinical profile and outcomes.</div></div><div><h3>Methods</h3><div>A single-center cross-sectional comparative study was conducted in a high-altitude hospital in North Sikkim. Participants underwent acclimatization at varying altitudes, with medical history<span><span><span> and examinations recorded. HAPE severity was categorized based on symptoms, pulse, respiratory rate, and </span>chest radiograph findings. NLR and PLR were calculated, and their association with severity, hospitalization duration, and oxygen support days were analyzed. Statistical methods included </span>logistic regression, Receiver Operating Characteristic (ROC) curve analysis, and cutoff determination.</span></div></div><div><h3>Results</h3><div><span>Dyspnea and cough showed significant correlation with HAPE severity. </span>Tachycardia<span>, tachypnea<span>, and adventitious sounds during auscultation were significantly associated with severity. Hematological parameters revealed higher NLR and PLR in severe cases, with NLR demonstrating sensitivity and specificity in distinguishing severe from non-severe cases.</span></span></div></div><div><h3>Conclusion</h3><div>A comprehensive assessment involving clinical symptoms and hematological parameters aids in determining HAPE severity. NLR emerges as a promising, costeffective marker for severity prediction. Further research with larger cohorts and multicenter studies is needed to validate these findings and establish optimal cutoff values. Nevertheless, this study underscores the importance of accessible biomarkers in HAPE, particularly in resource-limited settings, offering valuable insights into disease severity assessment and prognosis.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 2","pages":"Pages 185-192"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141715683","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Shamrock fetus in fetu: An anesthetic enigma","authors":"Amrita Rath ,&nbsp;Abha Singh ,&nbsp;Reena ,&nbsp;Ritwik Mohan ,&nbsp;M. Rajesh ,&nbsp;Rajat Arora ,&nbsp;Ruchira Nandan","doi":"10.1016/j.mjafi.2024.07.009","DOIUrl":"10.1016/j.mjafi.2024.07.009","url":null,"abstract":"<div><div>Fetus in fetu (FIF) is a rare congenital anomaly with an incidence of 1 in 5 lakh live births. Till date, only 200 cases have been reported, with the majority having a single FIF. We report an interesting case of FIF with 3 interlinked fetuses inside giving the appearance of Shamrock leaf. The FIF was causing compression of the common bile duct causing obstructive jaundice as well as was associated with moderate hydronephrosis, presenting unique anesthetic challenges. Our purpose to write this case report was to add to the existing knowledge of this rare entity besides discussing its anesthetic implications.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 2","pages":"Pages 222-225"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535219","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Deviation from conventional anesthetics: MRI sedation with dexmedetomidine for a child with Morquio's syndrome","authors":"Nithisha Roy,&nbsp;Ranganatha Praveen,&nbsp;Manikandan Sethuraman,&nbsp;Ajay Prasad Hrishi","doi":"10.1016/j.mjafi.2024.06.007","DOIUrl":"10.1016/j.mjafi.2024.06.007","url":null,"abstract":"","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 2","pages":"Pages 242-244"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535211","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Diagnostic accuracy of frozen section in ovarian masses: A single centre study","authors":"Priyanka Goel ,&nbsp;Samta Bali Rathore ,&nbsp;Neha Sethi ,&nbsp;Shagun Gupta ,&nbsp;Abhishek Kalani","doi":"10.1016/j.mjafi.2023.08.011","DOIUrl":"10.1016/j.mjafi.2023.08.011","url":null,"abstract":"<div><h3>Background</h3><div>Ovarian mass is not an uncommon imaging finding in women of all age groups. Hence, frozen section plays a very important role in determining the nature of the mass and, thus, deciding the appropriate surgical procedure. In the present study, we aim to analyze the accuracy of frozen sections at our center in diagnosing benign, borderline, and malignant tumors.</div></div><div><h3>Methods</h3><div>A total data on 50 patients were collected who were operated between February 2020 and January 2022, and frozen sections were sent intraoperatively. The results were compared with the final histopathology report, and the accuracy, sensitivity, specificity, positive predictive value, and negative predictive value were analyzed for diagnosing benign, borderline, and malignant masses.</div></div><div><h3>Results</h3><div>The accuracy of frozen section analysis at our center was 90.0%. The sensitivity for diagnosing malignant tumors was 89.4%, with a specificity of 100%. For benign tumors, the sensitivity and specificity were 96.2% and 86.9%, respectively. Borderline tumors had the lowest sensitivity of 50.0% with specificity of 95.6%.</div></div><div><h3>Conclusion</h3><div>Intraoperative frozen sections are a very good and necessary tool for the identification of ovarian tumors<span>. It helps to prevent unnecessary extensive surgeries in benign tumors<span>, especially in young patients, and complete surgery in one sitting in cases of malignancy.</span></span></div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 2","pages":"Pages 151-156"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135809944","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A treated case of high-grade serous adenocarcinoma of ovary recurring as metastatic carcinosarcoma with rhabdomyosarcomatous differentiation","authors":"Shruti Rao ,&nbsp;Rahul Dnyandev Dhake ,&nbsp;Rashmi Chintan Parikh ,&nbsp;Mihir Mohan Vaidya ,&nbsp;Shona Nag","doi":"10.1016/j.mjafi.2024.08.007","DOIUrl":"10.1016/j.mjafi.2024.08.007","url":null,"abstract":"<div><div>This case report describes a rare case of high-grade serous carcinoma of ovaries recurring as metastatic carcinosarcoma with heterologous rhabdomyosarcomatous differentiation. A 42-year-old pre-menopausal female patient presented with abdominal fullness and distention. Biopsy from the multiloculated pelvic mass confirmed the diagnosis of high-grade serous carcinoma. The patient underwent neoadjuvant chemotherapy, followed by cytoreductive surgery and post-operative chemotherapy. However, her disease progression was suspected in the follow-up with a raised serum CA-125 level and newly developed metastatic masses on radiology. She was ultimately diagnosed with metastatic carcinosarcoma through repeat biopsy from the internal mammary lymph node. Immunohistochemistry analysis confirmed the rhabdomyosarcomatous differentiation. The literature search reported a limited number of such cases, and none of them from India. This report describes the clinical course, histopathological findings, and treatment details of a patient, along with a brief literature review.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 2","pages":"Pages 226-231"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535220","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Bridging the chasm: Addressing mental health awareness and care disparities in India","authors":"V.S. Chauhan ,&nbsp;Prateek Yadav ,&nbsp;S.P. Panda ,&nbsp;Neha Sharma","doi":"10.1016/j.mjafi.2024.06.009","DOIUrl":"10.1016/j.mjafi.2024.06.009","url":null,"abstract":"","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 2","pages":"Pages 123-125"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535212","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"An inflated Foley's balloon inserted for posterior nasal tamponade causing post-extubation airway obstruction","authors":"Shreya B. Shah,&nbsp;Kelika Prakash","doi":"10.1016/j.mjafi.2024.05.004","DOIUrl":"10.1016/j.mjafi.2024.05.004","url":null,"abstract":"","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 2","pages":"Pages 240-241"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535210","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Experiences of Therapeutic Plasma Exchange in geriatric patients at a tertiary care hospital in western Maharashtra: An observational study","authors":"Anurag Gairola ,&nbsp;Ujjwal Dimri ,&nbsp;Rajat Jagani ,&nbsp;Amit Ajay Pawar ,&nbsp;Sudeep Kumar","doi":"10.1016/j.mjafi.2024.08.010","DOIUrl":"10.1016/j.mjafi.2024.08.010","url":null,"abstract":"<div><h3>Background</h3><div>Geriatric patients undergo Therapeutic Plasma Exchange (TPE) for variety of indications that poses its unique challenges and complications. We present our experience with TPE in geriatric patients in terms of diseases encountered and adverse events, if any, witnessed during the procedure.</div></div><div><h3>Methods</h3><div>A prospective analysis of TPE procedures was done for a period of 01 year. Patients above 60 years of age with a range of 01–02 volume exchange per procedure were enrolled in the study. Baseline procedure investigations such as complete blood count, serum electrolytes, coagulation profile, and transfusion-transmitted infection screening were carried out before the TPE procedure. All TPE procedures were performed using a continuous-flow cell separator. All these patients were followed-up, and findings related to patients and procedures were documented.</div></div><div><h3>Results</h3><div>A total of 21 eligible enrolled patients underwent 85 procedures in the present study. Neurological disorders (80.9%, n = 17) were most common indication, with Guillain–Barre syndrome (42.8%, n = 9) being tthe most replaced by second common, followed by myasthenia gravis (23.8%, n = 5). Barring one, all other patients showed significant clinical response. The overall incidence of complications during the study was 80.9% (n = 17), among which majority were patient-related (94.11%, n = 16). However, only one procedure was terminated due to a machine error, and there were no procedure-related deaths.</div></div><div><h3>Conclusion</h3><div>The current study showed that TPE in geriatric patients gives substantial results in terms of clinical improvement but is fraught with multiple complications. However, in trained and expert hands, these complications can be managed effectively.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 2","pages":"Pages 206-211"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"143535216","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A survey on practices of embalming techniques and usage of soft embalming methods in Indian medical institutes","authors":"Joseph Abraham ,&nbsp;Anne D. Souza ,&nbsp;Anil K. Bhat ,&nbsp;Akhilesh Kumar Pandey ,&nbsp;Minnie Pillay ,&nbsp;Lokandolalu C. Prasanna","doi":"10.1016/j.mjafi.2024.01.003","DOIUrl":"10.1016/j.mjafi.2024.01.003","url":null,"abstract":"<div><h3>Background</h3><div><span><span>Soft cadavers are becoming increasingly popular for surgical skills development in competency-based medical education curricula. However, few studies evaluate this strategy's viability, dependability, and validity, particularly in </span>India. This study intends to investigate </span>embalming procedures and procedural skills practices at medical institutions.</div></div><div><h3>Methods</h3><div>A validated questionnaire gathered information on demographic details, embalming practices, surgical skill training, willingness to adopt modern embalming techniques and awareness and practice of soft embalming methods. A total of 350 Indian medical institutions were forwarded the questionnaire via email. Responses were analyzed using SPSS version 16, and the Chi-square test was used to examine the association between the two categorical variables.</div></div><div><h3>Results</h3><div>A study of 350 Indian medical institutions found a 62% response rate. In the studied population, 53.5% (N = 116) of institutes demonstrated procedural skills in undergraduate education as a part of early clinical experience. A total of 54.4% (N = 118) of institutes conducted hands-on surgical training. For postgraduates in surgical departments, voluntary cadaver dissection was offered at 53.9% (N = 117) of institutes. In 78.3% (N = 170) of the institutes, surgical training was performed on formaldehyde-embalmed cadavers. Institutions used proprietary solutions, fresh frozen approaches, Thiel solution, phenol, and saturated salt solutions for embalming.</div></div><div><h3>Conclusion</h3><div>The study highlights disparities in undergraduate teaching and surgical skill training in medical institutes, emphasizing the need for re-evaluating embalming practices to ensure the safety and educational quality. It also highlights underutilization of soft embalming methods, highlighting need for improved training programs and strategies to enhance medical education quality.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 2","pages":"Pages 170-176"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"140469522","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"How aware are we about doping in sports? : A cross-sectional pilot survey of doctors","authors":"K. Prabhakaran ,&nbsp;Chandra Sekara Guru ,&nbsp;Prafull Mohan ,&nbsp;Karuna Datta","doi":"10.1016/j.mjafi.2024.04.015","DOIUrl":"10.1016/j.mjafi.2024.04.015","url":null,"abstract":"<div><h3>Background</h3><div>Doctors lack the required anti-doping knowledge. The aim of this single-centre pilot study is to survey the awareness level of doctors about anti-doping regulations and their opinion with reasons on inclusion of sports pharmacology/anti-doping aspects in undergraduate medical curriculum.</div></div><div><h3>Methods</h3><div>After ethical clearance, a cross-sectional online pilot survey was done among medical doctors on anti-doping aspects, general awareness, practical applications and opinion on inclusion of doping in sports as a competency under undergraduate medical curriculum. Responses were categorized and analysed. The significance was set at 0.05.</div></div><div><h3>Results</h3><div>80 doctors including 53 medicine and allied residents, 16 surgery and allied residents and 11 medical doctors took part in the study. 94% doctors understood about doping, 53% were aware about anti-doping organisation, 37% on regulations and 64% were right on prohibited list substances. 80% drugs of abuse mentioned clustered under only four categories (S1, S2, S5 and S6) of the World anti-doping agency (WADA) prohibited list. Practical sports specific anti-doping knowledge in weight cutting (97%), retroactive therapeutic use<span> exemption of medical emergency management (0%), anti-asthmatic medication use (59%) and alcohol use (41%) were significant. Internet (67%) and newspaper (20%) were the main source of information. 73% doctors recommended inclusion of doping in sports in MBBS competency-based medical education (CBME) curriculum.</span></div></div><div><h3>Conclusion</h3><div>Anti-doping specific awareness and knowledge was found lacking among doctors. 73% doctors favour inclusion of doping in sport as a competency in the undergraduate medical curriculum to aid in better clinical practice and athlete counselling.</div></div>","PeriodicalId":39387,"journal":{"name":"Medical Journal Armed Forces India","volume":"81 2","pages":"Pages 177-184"},"PeriodicalIF":0.0,"publicationDate":"2025-03-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"141400606","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}