Background: Post-operative emergence delirium (ED) has a varied incidence. Methods: In this prospective observational study carried out in 150 children (2-12 years) posted for elective surgeries under general anaesthesia using sevoflurane for induction and isoflurane for maintenance of anaesthesia we assessed the incidence of ED and attempted to identify risk factors for ED. Postoperatively, ED was assessed with paediatric anaesthesia ED (PAED) score at 15-min interval along with face, leg, activity, cry, consolation (FLACC) score for pain, and risk factors were identified. Results: ED occurred in 42/150 (28.1%) children. Among the children who developed ED, 73.8% were in the age group of 2–6 years, 85% were males, 63% had parental presence and 92.8% received no pre-medication. The mean FLACC score was 0.76 ± 2.02 and patients with ED had FLACC score < 4. The mean duration spent in post-anaesthesia care unit (PACU) was 130 min for children with ED and 96 min in children who did not manifest ED (P = 0.0003). Conclusions: The judicious use of sevoflurane, age-appropriate pre-medication, distraction techniques and limiting fasting duration helps in avoiding ED. Using the FLACC scoring system with PAED score can help in differentiating pain from ED and treat accordingly. Clinical Trials Registry of India No. CTRI/2020/02/023660.
Background: Klebsiella species are the second most common uropathogen after Escherichia coli. We attempted to estimate the proportion of Klebsiella species as an uropathogen among inpatients and to determine their antimicrobial susceptibility pattern. Methods: This hospital-based cross-sectional study was conducted among 7057 urine samples received from the patients admitted in different wards of our teaching hospital during May 2022–April 2024. Urine samples were processed aerobically in Cysteine Lactose Electrolyte Deficient media at 37°C. Bacterial colonies were identified by colony morphology, Gram’s staining and conventional biochemical tests. Antimicrobial susceptibility tests were performed for Klebsiella-positive colonies on Mueller–Hinton Agar using the Kirby–Bauer disc diffusion method. Results: Out of 7057 urine samples, 1050 (14.8%) showed significant growth. Klebsiella species constituted 370 (35.2%) of these. Of these, 54.8% showed resistance to nitrofurantoin, 45.7% to ciprofloxacin, 42.1% to levofloxacin, 33.2% to piperacillin and tazobactam combination, 32% to amikacin and 21.6% to meropenem. However, no resistance was observed against colistin and tigecycline. Conclusions: Our observations suggest that, ciprofloxacin and levofloxacin should be recommended as the first-line drugs, keeping amikacin and meropenem as reserve drugs for treating urinary tract infections in this setting.
Background: Clinical biochemistry laboratory plays a critical role in patient management. Hence, the laboratory must report accurate and reliable results through proper implementation of quality control (QC) practices. This study was conducted to evaluate the analytical performance of routine chemistry analytes in our tertiary care hospital laboratory by the application of Sigma metrics to determine the underlying causes of unsatisfactory performance of analytes with a Sigma value of <4 using quality goal index (QGI) and root cause analysis. Methods: This retrospective study was conducted on data between July and December 2023, available with the department from internal QC data for two levels of controls, and external quality assurance data were collected. Sigma metrics were calculated for 16 biochemical analytes using coefficient of variation, %bias and %total allowable error. QGI analysis was done to analyse imprecision and inaccuracies. Results: Total bilirubin, triglycerides for level 1 (L1) and level 2 (L2) of internal QC (IQC), uric acid (L1) and aspartate aminotransferase (AST) (L2) showed a performance of ≥6 sigma. Sigma was between 3 and 6 for glucose, creatinine, total protein (L1, L2), calcium, AST, alkaline phosphatase (L1) and uric acid (L2), alanine aminotransferase (ALT), ALP, and iron (L2). Sigma was less than 3 for urea, cholesterol, sodium, albumin and potassium (L1, L2), and ALT and iron (L1). For analytes with <4, QGI analysis exposed inaccuracy or imprecision issues and identified errors such as the reconstitution of IQC, storage temperature and fluctuations in instrument performance, which are common causes of poor performance. Conclusions: Six Sigma approach is helpful for quality assurance and identifying areas for improvement. Assessing Six Sigma metrics should be a routine practice to decide the frequency of QC run and to detect errors in analysis.
Pre-eclampsia remains a persistent challenge in obstetric care, not simply as a disorder of hypertension and proteinuria, but as a syndrome rooted in disrupted placental perfusion, endothelial instability and a complex interplay of oxidative and immunological stressors – renal involvement often emerging later, yet critically shaping disease severity. Current management strategies are largely supportive, with delivery still representing the only definitive intervention. In this context, attention has shifted towards biologically active compounds with the potential to modulate upstream mechanisms. Propolis ethanol extract, a resinous bee-derived substance rich in flavonoids and phenolic esters such as caffeic acid phenethyl ester, pinocembrin and artepillin C, has been explored experimentally for such effects. A systematic review was conducted in accordance with Preferred Reporting Items for Systematic Reviews and Meta-Analyses 2020 guidance, with database searches (PubMed, Scopus, Web of Science, Embase and Cochrane Library) performed through May 2025 without language restriction. Eligible studies included in vivo and in vitro investigations examining propolis or its constituents across pathways relevant to pre-eclampsia pathophysiology, whereas reviews and purely computational studies were excluded. From 1245 identified records, 43 studies met the inclusion criteria, of which 20 were classified as low risk of bias using established methodological appraisal tools. Across heterogeneous experimental models, propolis demonstrated consistent antioxidant and vasculoprotective effects, including modulation of nuclear factor erythroid 2-related factor 2/heme oxygenase-1 (Nrf2/HO-1) and nuclear factor kappa B signalling, improved nitric oxide bioavailability and context-dependent regulation of angiogenic mediators. Evidence of renal protection was observed in non-gestational injury models, although direct evaluation of pregnancy-specific renal endpoints remains notably limited. No systemic toxicity was reported in the included studies; however, human data in pregnancy are lacking, and hypersensitivity reactions described in other settings warrant caution. Overall, the findings support biological plausibility while emphasising the need for standardised preparations, targeted renal assessment and carefully designed safety studies before clinical translation.
Background: Exposure to cadaver during the early stages of medical education induces some positive and negative feelings among medical students. However, evidence available from earlier studies shows that most negative feelings are temporary and do not overweigh the big advantage of superior quality learning of anatomy through cadaver dissection. To sensitise students on these aspects, falling line with the National Medical Commission introduced the concept of cadaver as first teacher; it was planned to conduct a sensitising session and study the changes in attitudes of the students. Methods: An interventional cross-sectional study was conducted on the first MBBS students admitted during the year 2023. A questionnaire including 16 questions, validated by a peer group of 20 members, was given for grading by the students using Likert scale before and after a sensitising session on cadaver as the first teacher through general lecture and self-directed learning sessions. The student responses before (pre-test) and after (post-test) the sessions were evaluated for changes in attitude and ethics towards cadaveric dissection. Results: One hundred and thirty-four of the 150 first year MBBS students participated in the study. The mean age of the students was 18 years, and 35% of them were male. After the sensitisation session, the majority of the students showed a positive change in their attitude and perception with regard to cadaver dissection. Conclusions: The present study shows that sensitising sessions for students during the early phase of learning anatomy helps to accept the concept of cadaver as the first teacher.
Background: Glycosyated haemoglobin (HbA1c) is prone to analytical interference by haemoglobin (Hb) variants depending on the method used, which may lead to inaccurate results and improper treatment. We studied effect of common Hb variants on HbA1c obtained by the high-performance liquid chromatography (HPLC) method. Methods: Samples processed for HbA1c by HPLC method (Bio-Rad D-10) and found positive Hb variants (117) such as Hb S trait, Beta-Thal trait, Hb D and Hb E traits were included in the study after confirming their variant state. They were also run by the immunoassay (IA) method (Roche Tinia-quant). Later, the stored samples were analysed by the capillary electrophoresis (CE) method (Mini Cap flex piercing – Sebia) in a batch-wise analysis. Results: Among the variant population, a comparison of mean HbA1c values between the HPLC/CE, HPLC/IA and IA/CE methods showed no statistically significant difference (P = 0.65, 0.18 and 0.41, respectively). A similar observation was found even among the subgroups of variants. Correlation analysis also showed a strong positive correlation between the above-mentioned method pairs (r = 0.984, 0.967 and 0.972, respectively). Bland–Altman analysis between the methods HPLC/CE and HPLC/IA in variant populations, a bias was 0.13% and 0.25%, respectively, was observed and was not clinically significant. A similar observation was found among individual variant subgroups. Conclusions: HbA1c values were not significantly affected by common Hb variants when determined by the HPLC method.
Background: Iron-deficiency anaemia in pregnancy poses significant risks to maternal and foetal health. Methods: The present mixed-methods study was designed to estimate the prevalence of anaemia, to elicit adherence patterns of iron and folic acid (IFA) tablets intake among 158 pregnant mothers in the second and third trimester of pregnancy in a rural setting of West Bengal and also to explore the enabling and challenging factors regarding IFA tablets intake. Results: Prevalence of anaemia among the pregnant women was 52.5%, and overall adherence to IFA tablets was 67.7%. Adherence was higher among pregnant women with higher education levels and those from nuclear families. Forgetfulness followed by side effects due to IFA tablets were common causes for non-adherence to IFA. In qualitative analysis, health education by service providers, peer group and social support and free and regular supply of IFA tablets were identified as enabling factors, whereas unpalatability, side effects, competing priorities in the family and misconceptions were identified as challenging factors. Conclusions: Anaemia in pregnancy is still widely prevalent with missed opportunity to utilise the benefit of IFA supplementation. Addressing various challenges for adherence to IFA tablet intake is the need of an hour for reducing anaemia, thereby improving maternal and foetal health outcomes.
Background: Healthcare-associated infections (HAIs) are a significant global health concern, making effective infection prevention and control (IPC) practices essential for patient safety. This study aimed to assess the knowledge, attitude and practices regarding IPC among undergraduate medical students, who require a strong foundation in these principles as future healthcare providers. Methods: A cross-sectional analytical study was conducted from June to September 2024, involving 171 undergraduate medical students (Phase II to Phase III Part 2). Data were collected using a self-administered online questionnaire based on national IPC guidelines. Results: The study revealed moderate overall knowledge of IPC among participants, with a mean score of 17.08 out of 25. Knowledge scores were highest in ‘biomedical waste management’ (mean – 4.1) and lowest in ‘infection control protocols and antimicrobial stewardship’ (mean – 2.7). Female students demonstrated significantly higher overall knowledge scores (mean 17.7 vs. 15.6, P = 0.005). Most students recognised the importance of IPC and expressed confidence in adhering to guidelines. However, some reported discomfort in addressing IPC lapses with peers or superiors. Self-reported practices indicated good adherence to hand hygiene, but inconsistencies were noted in cleaning and disinfecting medical equipment and adherence to biomedical waste disposal guidelines. Conclusions: The findings highlight areas for improvement in IPC education, specifically concerning infection control protocols, antimicrobial stewardship and addressing gender disparities in knowledge. Incorporating practical training, communication skills development and strategies to enhance confidence in addressing IPC lapses is crucial to ensure competent and confident future healthcare providers.
We report the case of a 23-year-old female who presented with multiple episodes of vomiting and loose stools for 2 days, followed by rapidly progressive quadriparesis for 1 day. Neurological examination revealed hyporeflexia and a power of 2/5 in all 4 limbs, with diminished deep tendon reflexes and a flexor plantar reflex. Laboratory investigations showed severe hypokalaemia with normal anion gap metabolic acidosis and renal loss of potassium secondary to distal renal tubular acidosis (RTA). Antinuclear antibody profiling tested positive for Sjogren syndrome-A/Ro-52 and Sjogren syndrome-B/La. The patient was diagnosed to have Sjogren’s syndrome as per the European League Against Rheumatism and the American College of Rheumatology criteria. This case highlights the importance of considering distal RTA secondary to Sjogren’s syndrome to hypokalaemia quadriparesis.
Critical illness is a catabolic state leading to a loss of lean body mass and malnutrition. Even though there have been insights regarding the role of nutrition in adult patients admitted to the intensive care unit (ICU), there has been no consensus regarding the proper assessment of the nutritional status of the patient or the nutritional risk assessment. The pathophysiology of critical illness and the pivotal role of nutrition in such patients, with its reflection on the duration of MICU stay and overall mortality, suggest that the treating clinician should have an in-depth knowledge and understanding about nutrition in critically ill patients for ensuring better treatment outcomes. Nutrition has to be given with care after calculating the resting energy expenditure of the patient, as both over- and undernutrition result in poorer outcome. In this review, the recent guidelines, recommendations and complications of enteral and parenteral nutrition in patients with critical illness are presented. The challenges that a clinician faces in specific disease conditions pertaining to nutrition, along with the prevailing opinion regarding micronutrient supplementation and the debated mortality benefit of antioxidants, have also been reviewed.
Autoimmune haemolytic anaemia (AIHA) is characterised by pathologic autoantibodies attached to red blood cells (RBCs), leading to their destruction. AIHA is categorised into warm and cold types based on the optimal binding of antibodies to RBC antigens at temperatures of 37 °C and below 37 °C, respectively. Warm AIHA accounts for 70% of all AIHA cases whereas cold AIHA accounts for 20%–30% cases. Epstein–Barr virus (EBV) is frequently associated with cold-type AIHA, and case reports of EBV-induced warm AIHA are scarce. Haemophagocytic lymphohistiocytosis (HLH) is a dreadful hyperinflammatory complication associated with autoimmune cytopenias. Our case report is regarding a 17-year-old female who presented with haemolytic anaemia, and on evaluation, she was diagnosed with warm AIHA after ruling out other causes. EBV was discovered as the cause of AIHA on further investigations. The clinical presentation, cytopenias and hyperferritinaemia directed us to the diagnosis of secondary HLH which was confirmed with haemophagocytosis observed on bone marrow examination. We report the rare occurrence of EBV-induced warm AIHA and HLH.
It is now widely recognised that generative artificial intelligence (AI) is transforming medicine and society worldwide. AI-enhanced health tools are being increasingly adopted by patients in their routine and by medical enterprises in their workflow. This is changing patients’ and physicians’ understanding and expectations about health and the medical profession. A similar transformation is occurring in medical education and research. Currently, there is a lack of well-recognised benchmarks to evaluate these new and diverse AI-health and teaching tools, making their efficacy and compliance with ethical practices difficult to assess. It is feared that the use of advanced AI in workspaces will disrupt and threaten our roles and livelihoods. Educators worry that reliance on AI may diminish our critical faculties over time. In this review how AI augmentation in medicine and medical teaching can enhance learning and research and expand professional opportunities is presented. The need for viewing these transformations through a broad, global lens – while remaining grounded in the core ethical principles that guide teaching and learning methods and meaningful patient-centred care is presented. Further, how approaches to AI implementation may differ by country and highlight the need for broader community involvement and a global collaborative approach to overcome shared challenges are discussed.
Background: Haemodialysis therapy poses many challenges including financial strains, dietary constraints, physical limitations and increased reliance on caregivers. This study attempts to evaluate the quality of life (QOL) among haemodialysis patients, using the kidney disease quality of life-short Form 1.3 tool (KDQOL-SF 1.3) and its determinants. Methods: A cross-sectional study was done on haemodialysis patients (n = 74) at a tertiary care centre in Kerala. The KDQOL-SF 1.3 questionnaire assessed the overall QOL and domain wise, which consists of physical component summary (PCS), mental component summary (MCS) and kidney disease component summary (KDCS). The dialysis symptom index (DSI) was used to estimate the proportion and severity of 30 symptoms, while the subjective global assessment (SGA) tool was employed to determine nutritional status. Univariate analysis followed by multiple linear regression was done for factors with P value < 0.05. Results: The overall QOL mean score obtained was 50.8 ± 12.3. The mean PCS score was 33.7 ± 20.5, the mean MCS score was 46.6 ± 16.5 and the mean KDCS score was 60.9 ± 12.2. The mean DSI score was 37.6 ± 17.8. SGA indicated that 4.0% were well-nourished, 90.5% mildly malnourished and 5.4% moderately malnourished. On multivariable analysis, a high DSI score was a determinant for lower PCS and MCS scores. Greater societal support and financial independence were associated with higher KDCS scores. Conclusions: This study highlights the poor QOL among haemodialysis patients, particularly in the physical and mental domains. Undernutrition and higher symptom burden significantly impact QOL.
Background: High-grade spondylolisthesis can cause severe low back pain and reduced functional mobility, significantly impacting quality of life. However, there is no consensus on the specific post-operative changes in clinical and radiological outcomes at the L4–L5 and L5–S1 levels. We attempted to compare the functional and radiological outcomes in high-grade spondylolisthesis patients treated with posterolateral interbody fusion with pedicle screw fixation (PLIBF-PSF) at the L4–L5 and L5–S1 levels. Methods: From August 2022 to February 2024, 30 patients with high-grade spondylolisthesis underwent PLIBF-PSF at the L4–L5 (n = 15) and L5–S1 (n = 15) levels. Clinical outcomes were assessed using the Oswestry severity index (OSI); radiological outcomes were assessed using pelvic tilt, pelvic incidence and sacral slope. Results: Their mean age was 53.4 years; majority (73.3%) were female. Patients treated at L4–L5 level showed significantly greater improvement compared to those at the L5–S1 level as per OSI scores (17.80 ± 5.57 vs. 27.33 ± 6.36; P < 0.001), pelvic tilt (18.80° ±3.88° vs. 23.27° ±3.86°; P = 0.004), pelvic incidence (65.20° ±7.54° vs. 77.60° ±8.90°; P < 0.001) and sacral slope (46.27° ±3.86° vs. 54.33° ±5.30°; P < 0.001). Conclusions: Single-stage PLIBF-PSF at the L4–L5 level demonstrated superior functional outcomes compared to the L5–S1 level. This indicates treatment at the L4–L5 level offers enhanced benefits for managing patients with high-grade spondylolisthesis.
Background: Quality of sleep affects the physical and psychological health of an individual. Medical students are especially prone to sleep problems for a variety of reasons. The present study assessed the sleep quality and to find the related factors for sleep disturbances, if any, amongst the undergraduate medical students at a medical college in Kolkata. Methods: This cross-sectional study was, carried out during December 2022–March 2023. The census method was applied for selecting the study participants. A pre-designed, pretested, structured questionnaire including the Epworth Sleepiness Scale (ESS) and Pittsburgh Sleep Quality Index (PSQI) was used for data collection. Results: About one-third (37%) of the study participants (n = 340) usually sleep <6 h at night, and 62.6% have poor quality of sleep (PSQI score >5). The average of total PSQI of the students was 6.9 ± 3.3. The PSQI score was significantly associated with the year of the study, present residence, average hours of mobile use before sleep, habit of alcohol, tea, coffee or smoking after dinner and daily average hours of sleep. According to ESS, 6.8% of the study participants were excessively sleepy and should consider seeking medical attention. The total ESS score is significantly correlated with the global PSQI score (r = 0.261, P < 0.001). Conclusions: Poor sleep quality is common among medical students, and several modifiable factors are related to this phenomenon which needs urgent attention to prevent adverse health and other academic implications.
