Background Occupational wood dust exposure has been implicated in reduced lung function. Owing to varied estimates from studies, a systematic review was done to evaluate the association between occupational wood dust exposure and decline in lung function. Methods This systematic review has been conducted and reported according to Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines. The PubMed and Google Scholar databases were screened. Data were extracted from eligible studies and were considered for qualitative and quantitative synthesis. Results The qualitative synthesis included 55 studies. Eligible studies were pooled using random-effects meta-analysis, and high heterogeneity was noted between studies with I2>95%. Workers exposed to wood dust showed significant reduction in lung function measures, including forced expiratory volume 1 percentage predicted (pooled mean difference [MD] -8.57; 95% CI -12.07 to -5.08; 16 studies), forced vital capacity (FVC) percentage predicted (pooled MD-7.43; 95% CI -11.35 to -3.51; 14 studies), and peak expiratory flow rate (PEFR) percentage predicted (pooled MD -13.43; 95% CI -25.14 to -1.72; 9 studies). Funnel plot indicated greater chances for publication bias among studies included in the meta-analysis. Sawmill workers were likely to have obstructive lung function patterns compared to furniture industry workers, who present with a restrictive pattern. Conclusion Evidence from this review suggests that wood dust-exposed workers have a reduced FEV1, FVC, and PEFR, indicating obstructive and restrictive patterns. There is a need for workplace dust control measures and personal protective equipment to prevent lung function impairment among wood industry workers.
Wernicke's encephalopathy (WE) is a neurological disorder primarily caused by thiamine deficiency, typically presenting with malnutrition, confusion or delirium, oculomotor abnormalities (such as nystagmus or ophthalmoplegia), and ataxia. Although commonly associated with alcoholism, WE is frequently observed in oncology patients but is often under-recognised, leading to inadequate diagnosis and treatment. Malnutrition and rapid weight loss in cancer patients can increase the risk of this condition. We report two patients with cancer who presented with significant malnutrition and weight loss, leading to a diagnosis of WE. Both patients were diagnosed based on clinical presentation and magnetic resonance imaging, which is crucial for detecting neurological deficits. Immediate treatment with intravenous thiamine led to a positive clinical response. Early recognition and treatment of WE in oncology patients is essential, as the neurological deficits are potentially reversible. Intravenous thiamine supplementation, and supportive care, can prevent long-term complications.
Background We explored the perceptions of community health officers (CHOs) regarding the effectiveness of eSanjeevani, a telemedicine platform used in rural healthcare delivery across India. The increasing use of eSanjeevani highlights its potential to address healthcare accessibility limitations, particularly in remote areas. Methods We included 120 CHOs who completed training between March and August 2020 and had a 2-year experience at the time of this study (September 2022). A structured questionnaire was distributed via Google Forms to assess the CHOs’ perceptions of eSanjeevani. Interviews were also conducted to gather qualitative data on perceived modifications for improvement. Descriptive statistics were analysed for quantitative data. Results A response rate of 88.3% (n=106) was achieved. Over half (53.77%) the CHOs used eSanjeevani daily. CHOs perceived eSanjeevani to be effective in managing non-communicable diseases, with 39.6% reporting it was useful for diabetes and 38.7% for hypertension, skin conditions (50.9%), followed by paediatric (45.3%) and maternal health issues (42.5%). However, limited specialist availability (58.49%), network connectivity issues (22.64%), and extended waiting times (15.1% with wait times exceeding 90 minutes) were identified as the limitations of the platform. Thematic analysis of the open-ended responses revealed recommendations for improvement, with a focus on increasing specialist availability (41.5%) and reducing waiting times (37.7%). Conclusion From the perspective of CHOs, the eSanjeevani platform facilitates improved access to specialists and early diagnosis but challenges related to infrastructure and resource limitations persist. The findings support continued investment in eSanjeevani alongside efforts to address identified limitations to optimize role of telemedicine in enhancing rural healthcare delivery.
Background: Assessment is a part of every step of professional growth. Conventional viva examination is subjective, non-transparent, and unstructured; it may be prejudiced. We evaluated the merits and desirability of using structured viva over traditional viva as an assessment tool for formative examinations in Biochemistry, and to obtain students’ and faculty’s perception of it. Methods: The study was conducted in the Department of Biochemistry, J.N. Medical College, Belagavi, during the 2nd internal assessment examinations. Students were briefed about a structured viva. They were divided into 8 batches (25 students in each batch). Half of the batch gave a structured viva and the other half gave a traditional viva. Later, crossing over was followed. After the examination by both methods, students’ performance was compared in both groups. The feedback was collected on a Likert scale from the students and faculty regarding the structured viva. Statistical analysis was done using Microsoft Excel and Statistical Package for the Social Sciences (SPSS) version 21. Results: The overall scores for the structured and traditional vivas were 5.94 and 6.17, respectively. This shows that the scores are almost the same in both methodologies used in the study. More students got average (between 5 and 7) and high marks (7 and above 7) in the traditional viva. In contrast, more students got low marks (below 5) in the structured viva. Conclusion: As the mean scores obtained by students using both methods were the same, we cannot conclude that the structured viva is a better assessment tool than the traditional viva. However, the method was perceived well by both the faculty and students. To support this pattern, a larger sample size than the one utilized would be required.
Background The National Poisons Information Centre, All India Institute of Medical Sciences, New Delhi (NPIC) receives calls related to management of drug overdoses and poisoning. We aimed to identify the nature of drug-related calls (DRC) received by the centre in the period before and during the Covid-19 pandemic. Methods Data on total and DRCs received by the NPIC over a 5-year period (2017 to 2021) were retrieved. Comparisons were made between calls received during equivalent pre-Covid-19 and Covid-19 periods. Results An increasing trend was observed for both total and DRCs during Covid-19 compared to the pre-Covid-19 period. DRCs were 24% of total calls, and 99% of these were made by treating physicians, and the majority were related to unintentional/accidental intake. The DRCs were more for males (57%) as compared to females (41%), and maximum calls were received from the northern and southern regions of India. Calls related to drugs like antidepressants, anti-psychotics, and polypharmaceuticals were higher while for drugs like analgesics, benzodiazepine, thyroxine, and ‘others’ were fewer during the pre-Covid-19 period compared to the Covid-19 period. DRCs for children and adolescents were more compared to other age groups. During the Covid-19 period, there was a decrease in DRCs for infants, while such calls increased for children, adolescents and young adults. Conclusion Both total and DRCs increased during the study period, with a marked increase in calls related to children and adolescents and in the southern region of India during Covid-19 compared to the pre-Covid-19 period.
Background India is among countries with high mortality and morbidity rates from fire-related incidents. Fires at healthcare facilities can be more devastating than any other place at any time as they house more vulnerable people. Knowledge and experience of hospital workers and managers largely determine hospital preparedness. Methods A questionnaire-based interventional study was conducted in the advanced cardiac centre of a tertiary care institute. Ninety healthcare workers from different areas were included. We assessed the knowledge of hospital staff about fire safety practices and the effect of fire safety education on knowledge and practice. Results We observed that most participants reported appropriate practices, which increased significantly after the education. Among 90 participants, baseline awareness of immediate fire response and exit routes was high (100%). Fire safety education led to a significant improvement in knowledge, with correct responses for type B fire increasing from 7.8% to 48.9%, and correct identification of foam extinguisher use rising from 28.9% to 43.3% (p<0.05), alongside a marked reduction in ‘don’t know’ responses (22.2% to 4.4%). Practice-related responses also improved significantly post-intervention, with a higher proportion of participants reporting appropriate fire safety practices across domains. Discussion We found a statistically significant positive moderate correlation between knowledge and practice scores, indicating that knowledge and practice are related to each other affected by significant randomness.
Following the introduction of the competency-based medical education (CBME) curriculum for MBBS in India in 2019, several papers have been published on challenges and opportunities arising from its implementation. We review the key concerns raised in these publications and attempt to explain why they have occurred and to suggest a way forward.
Haematological involvement in infections is a common occurrence, with the potential to affect various blood cell lineages, often resulting in cytopenia. Among these, thrombocytopenia is frequently seen. Mycobacterium tuberculosis (MTB) is a well-known infectious agent associated with anaemia, leucocytosis/leukopenia, and thrombocytosis/thrombocytopenia, though severe thrombocytopenia in the context of tuberculosis is relatively uncommon. An unusual manifestation of MTB, such as severe thrombocytopenia, can pose diagnostic challenges with a high risk of fatality. A 31-year-old female presented with fever associated with symptomatic, severe thrombocytopenia, which, after extensive work-up, was diagnosed as disseminated tuberculosis. This was managed as MTB-induced immune thrombocytopenia (ITP) with intravenous immunoglobulin and steroids. The management of ITP in the presence of an underlying infection remains a complex issue, as the approach to treating thrombocytopenia in the context of MTB is not well-defined. The use of corticosteroids in such infections presents a major challenge, requiring careful consideration of the risks and benefits. Additionally, the role of immunotherapy in treating infection-induced thrombocytopenia remains a topic of debate.
Background There has been an increase in incidents of violence against doctors. We aimed to explore the perceived nature and causes of violence faced or witnessed by doctors and its perceived impact on them and on medical practice in India. Methods A semi-structured validated questionnaire comprising demographic and work-related details, particulars of incidents of violence, perceived reasons and impact of the incidents, was disseminated to doctors practising in India through various email and WhatsApp groups and messages. Participation was voluntary, and responses were anonymized. Results Of the 439 responses received, 80.2% reported having faced or witnessed workplace violence (WPV), of which verbal abuse was the most common, followed by physical and sexual violence. Mental health was affected by the incident, lasting for weeks to a year. Measures to prevent WPV and outcomes of reporting the incidents were inadequate. Mob mentality and unrealistic expectations of a good outcome were considered important contributory factors, and practical skill training of doctors and safety measures at the workplace were considered preventive factors. Conclusion WPV against medical professionals is a matter of concern. Measures at various levels can be introduced to prevent WPV, including an adequate system of reporting and measures to address them in real time, incorporation of various practical communication skills in the medical graduate curriculum, and rigorous implementation of the law.
Background Tetanus, a vaccine-preventable but potentially fatal infection caused by Clostridium tetani, remains a public health concern, particularly in low-resource settings. This scoping review examines the clinical features, treatment strategies, and outcomes of tetanus in the 21st century. Methods A systematic search of PubMed and Embase (2000–2024) identified studies on tetanus epidemiology, clinical presentation, treatment, and outcomes. Data extraction and synthesis followed the Arksey and O’Malley framework and PRISMA for scoping reviews guidelines. Results The inclusion criteria were met by 34 studies. Tetanus primarily affects older adults in developed regions due to waning immunity, while younger populations in developing nations remain at risk due to insufficient immunization practices. Generalized tetanus was the most severe form, often requiring prolonged intensive care unit (ICU) admission and mechanical ventilation. Management includes toxin neutralization, antibiotics, benzodiazepines, magnesium sulphate, and supportive care. Human tetanus immunoglobulin (HTIG) is preferred for neutralizing unbound toxins; however, equine tetanus antitoxin (TAT) is an alternative in resource-limited settings. Intrathecal administration of HTIG has demonstrated greater efficacy compared to the intramuscular route. Siltartoxatug, a recombinant monoclonal antibody targeting tetanus toxin, has shown promise in providing faster and more durable seroprotection. Mortality ranged from 5.26% to 52.8%, with higher rates linked to short incubation periods, severe symptoms, and lack of ICU access. Conclusion Tetanus remains an important preventable global disease. Strengthening immunization programmes, maternal vaccination, and post-exposure prophylaxis is crucial in decreasing its incidence. Expanding ICU access, improving diagnostics, and optimising treatment strategies are key to reducing mortality and improving outcomes.
