ACPM Medical College

Abstract Introduction: Integrating digital health like eSanjeevani, India’s national telemedicine, may enhance healthcare delivery and learning outcomes during Family Adoption Program. Therefore, a study was planned to appraise the application of eSanjeevani OPD in the Family Adoption Survey. Subjects and Methods: Multiphasic cohort study was conducted across rural and tribal areas from October 2023 to October 2025. In Phase I, students’ knowledge about telemedicine was assessed. Phase II involved a cross-sectional survey of family members. The manuscript was prepared in accordance with the Strengthening the Reporting of Observational Studies in Epidemiology (STROBE) guidelines. Results: Knowledge of digital health improved significantly post-sensitisation. Of 231 surveyed family members, 29.87% had heard of eSanjeevani and only 20.28% of those who had heard were actually using it. Reported difficulties were login-issues (50%), complex terminology (42.86%) and poor connectivity (21.43%). Despite low utilisation, 68.84% perceived telemedicine as more convenient than physical visits. Around two-thirds, 74.64% expressed willingness to register for Ayushman Bharat Health Account (ABHA ID), while 18% showed willingness to use eSanjeevani OPD. Conclusions: One-third of family members had heard about eSanjeevani, while very few were utilising it for consultations. A higher proportion know about ABHA ID. Most of the participants preferred the mobile app over the website. There is a need to raise awareness about telemedicine services in people.

Objective: The aim of the article is to assess the impact of retrograde intrarenal surgery under central neuraxial blockade in comparison to general anesthesia (GA). Material and Methodology: This systematic review was conducted following the guidelines set out by the preferred reporting items for systematic reviews and meta-analyses. We conducted a comprehensive search across major electronic databases, including various types of studies such as descriptive studies and full-text literature, all of which were incorporated into the current review from 2018 to 2023. We involved those studies, which included the comparative study of spinal anesthesia (SA), epidural anesthesia (EA), and combined spinal epidural anesthesia with GA. Result: In our meta-analysis of 12 studies, it was found that anesthesia technique significantly affected operation time, with neuraxial anesthesia (NA) showing a mean difference of -2.28 (95% confidence interval (CI): -3.5 to -1.04, P = 0.003) compared to GA. However, there were no significant differences in rates of stone clearance, 24-h pain scores and length of hospital stay among patients administered with NA or GA for retrograde intrarenal surgery (RIRS). Conclusion: On the basis of the outcomes of study, NA can serve as a viable alternative to GA for RIRS. Our analysis reveals no significant differences in rates of stone clearance, operation duration, 24-h pain scores, complication rates, and length of hospital stay between NA in addition to GA in the context of RIRS. This suggests that given the potential economic advantages, NA might be a preferable choice over GA, contingent on patient preferences, baseline characteristics, and stone burden.

Prenatal stress is increasingly recognized as a significant factor impacting an individual's life from the beginning. This comprehensive review explores the intricate relationship between prenatal stress and its effects on behaviour, cognition, and psychopathology. Key findings reveal that prenatal stress can lead to a wide range of adverse outcomes in offspring, including neurodevelopmental disorders, emotional dysregulation, cognitive deficits, mood disorders, and an increased risk of psychopathological conditions. These effects' mechanisms involve epigenetic modifications, hypothalamic-pituitary-adrenal (HPA) axis dysregulation, neurodevelopmental alterations, inflammatory processes, and changes in brain structure and function. Moreover, moderating factors such as maternal stress levels, maternal mental health, socioeconomic status, social support, and early-life adversity can significantly influence the impact of prenatal stress. The review also discusses intervention and prevention strategies, emphasizing the importance of prenatal stress reduction programs, maternal mental health support, nutritional interventions, and targeted early interventions for at-risk populations. These findings have substantial implications for public health and clinical practice, highlighting the need for a holistic approach to prenatal care that prioritizes maternal well-being and mitigates the lasting effects of prenatal stress. Addressing this critical issue promises healthier generations and stronger communities in the future.

Background With the advent of COVID-19, mortality rates of end-stage kidney disease (ESKD) rose by 37% which makes its treatment an important part of healthcare. Arteriovenous fistula (AVF) is linked to higher patient survival rates. Cimino-Brescia fistula is the most effective vascular access technique, but it has a high rate of primary failure (PF) and a several-week maturation period before it can be used. The current study aims to verify the preoperative evaluation in improving survival among AVF patients. Methodology The current study is a retrospective analysis of the hospital database from Jan 2022 to July 2023, with patients of a mean age of 60.2 years. The sample size was around 700, including the patients indicated for long-term hemodialysis (HD) with an estimated GFR of less than 20 mm/min/1.73m². Following AVF surgery, post-operative outcomes, PF, and maturation time were considered. Results Among the 757 AVF procedures, 588 (82%) were new cases, and 112 (16%) had prior AVF history on the same side. PF was observed in 126 (18%) AVFs, while 574 (84%) achieved maturation. Age at surgery did not correlate with PF. Male sex and brachiocephalic AVF (BCAVF) had lower PF rates, while female gender, non-BCAVF, and vascular chronic kidney disease (CKD) were independent predictors. Proximal fistulas had a higher failure risk (32%). During surgery, the PF occurred six times more frequently in patients with veins and arteries under 2 mm and without a bruit. Conclusion AVF maturation aims to achieve a functional AVF for easy dialysis, requiring meticulous vein selection, doppler vascular mapping, and a standardized process to reduce PF rates. Factors determining PF include thrill and bruit, flow rates, and comorbidities. These findings can help clinicians make informed decisions and improve outcomes for patients undergoing fistula surgery.

Granulosa cell tumours (GCT) belong to the group of sex cord and stromal tumours of ovary. Adult granulosa cell tumours account for approximately 1% of all ovarian tumours and 95% of all granulosa cell tumours. They are found more often in postmenopausal than premenopausal women, with a peak incidence between 50 and 55 years of age. We present the case of a 35-year female who came with white discharge, irregular menses and excessive bleeding during menses since 5 to 6 months. The complete blood picture with peripheral smear examination, kidney and liver function tests were all within normal limits. CT abdomen was advised which revealed a large solid cystic lesion of left ovarian origin. Surgical intervention was done and histopathology revealed adult granulosa cell tumor of ovary.