Background: Interprofessional education (IPE) enforces the key idea of learning together that enhances future partnerships among learners. IPE fosters a collaborative approach to team-based healthcare that improves the patient outcomes. This study aims to evaluate the interprofessional readiness score among undergraduate students and compare the subscale scores across study groups. Methodology: This quasi-experimental study was conducted among four different groups of medical and allied health students who were introduced to a day-long workshop on IP competencies, including role clarity, ethics communication, and teamwork, through multimodal teaching and learning methods. Postworkshop, their responses were assessed by a validated tool, namely “Readiness for Interprofessional Learning Scale (RIPLS)” questionnaire. The questionnaire comprises 19 components grouped into three subscales: “teamwork and collaboration,” (1–9) “professional identity,” (10–16) and “roles and responsibilities” (17–19). The descriptive data and median scores for the various groups of participants were analyzed using the Kruskal–Wallis test. Results: The total participants were 204, inclusive of 156 females and 48 males, with an age range of 18–23 years. Among them, 74 were medical, 36 BSc Physician Assistants, 57 BSc nursing, and 37 BSc Critical Care. The readiness scores remained high pre- and postintervention (73.81 ± 8.2 and 74.12 ± 9.3), reflecting a strong willingness for participants. Only the roles and responsibilities domain showed significant improvement (<0.05), indicating better role clarity. Conclusion: This study revealed that health professional learners’ readiness for IPE had high perception mean scores in all RIPLS subscales. Postintervention, only “roles and responsibilities” subscale showed a significant change. Students were eager to experience IPE in the real-world settings.
Background: The Competency-based Medical Education (CBME) curriculum allocates instructional time for both Small Group Discussion (SGD) and Self-directed Learning (SDL). However, the comparative effectiveness of these approaches in routine undergraduate teaching remains unclear. This study compared SGD and SDL in teaching clinicopathological concepts with respect to academic performance, baseline academic motivation, and learner perceptions. Methods: This longitudinal crossover study was conducted among second-year MBBS students (n = 83) from May to December 2022. Students participated in three sessions each of SGD and SDL on comparable topics. Academic motivation was assessed at baseline using the Self-Determination Index. The learning outcomes were measured through weekly and final assessments and student involvement and perceptions were collected using a structured questionnaire. Results: Baseline academic motivation was generally positive across all the participants. There was no statistically significant difference in final assessment scores between SGD and SDL (mean final score 4.02 vs. 4.00; P = 0.81). Self-reported involvement and recommendation scores were comparable between the two methods (P > 0.05). SDL was associated with higher self-reported self-confidence and holistic understanding (P < 0.001), whereas SGD was associated with higher perceived correctness of learning (P < 0.001). Conclusion: SGD and SDL resulted in comparable learning outcomes for clinicopathological concepts among Phase II MBBS students. Structured SDL does not compromise academic performance and may complement faculty-led instructional methods within CBME curricula.
Background: Emergency general surgery (EGS) carries substantial morbidity and mortality, particularly in low- and middle-income countries. Despite the burden, prospective data identifying the determinants of adverse outcomes in the Indian context remain limited. With this aim, the study was conducted to identify the independent predictors of 30-day postoperative morbidity and mortality in patients undergoing EGS at a tertiary care teaching hospital in India. Methods: This prospective observational cohort study enrolled consecutive adult patients (t18 years) undergoing emergency general surgical procedures over 12 months (January–December 2025). The primary outcomes were 30-day postoperative morbidity (defined as any Clavien-Dindo grade -II complication) and 30-day mortality. Demographic, clinical, laboratory, and operative variables were collected. Univariate analysis identified the factors associated with outcomes, followed by multivariable logistic regression to determine independent predictors. Results: Of 385 patients enrolled, 372 completed a 30-day follow-up. Mean age was 48.3 ± 16.8 years; 68.5% were male. Common diagnoses included perforation peritonitis (38.2%), intestinal obstruction (24.5%), and acute appendicitis (18.3%). Overall 30-day morbidity was 42.7% (n = 159) and mortality was 8.9% (n = 33). Independent predictors of morbidity were: ASA ditys (adjusted odds ratios [aOR] 3.42, 95% confidence interval [CI] 2.08–5.63), sepsis at admission (aOR 2.89, 95% CI 1.74–4.81), delayed presentation >48 h (aOR 2.34, 95% CI 1.42–3.86), and age >60 years (aOR 1.98, 95% CI 1.15–3.41). Independent predictors of mortality were: ASA lIII (aOR 5.67, 95% CI 2.34–13.72), sepsis at admission (aOR 4.23, 95% CI 1.68–10.65), preoperative hypotension (aOR 3.78, 95% CI 1.52–9.39), and generalized peritonitis (aOR 2.91, 95% CI 1.18–7.16). Conclusion: Modifiable risk factors including delayed presentation, sepsis, and preoperative hypotension significantly predict the adverse outcomes. Early recognition, timely referral, and protocolized resuscitation may improve EGS outcomes in the resource-limited settings.
Background: The transition from traditional to competency-based medical curriculum within Indian medical institutions was motivated by regulatory bodies’ recognition of evolving disease patterns, socioeconomic conditions, and healthcare system expectations. Competency-based medical education (CBME) is “an approach to preparing physicians for practice that is fundamentally oriented to graduate outcome abilities and the organization around competencies derived from an analysis of societal and patient needs.” Methods: This cross-sectional study was conducted among 230 2nd year (junior) and 3rd year (senior) medical students. Students pursuing CBME curriculum were included in the study. Questionnaire comprised of three sections which included sociodemographic details, perspectives on the CBME curriculum using Likert-scale items and an open-ended item asking participants to write their own suggestions for improving the current curriculum. Data were entered into Microsoft Excel and analyzed using Jamovi statistical software (version 2.7.9). Results: The mean age of the study participants was 21.7 ± 0.9 years. Regarding different teaching methods, 45 (19.6%) students were not familiar with any methods as such, 44.3% of the students are familiar with self-directed learning, 27.8% of the students are familiar with small group discussion. Juniors show higher odds of agreeing that the foundation course was beneficial. Juniors again have greater odds of agreeing that attitude ethics and communication was useful. Students consistently mentioned that more practical sessions, clinical exposure, and hands-on learning opportunities. Conclusion: Overall, the study indicated that CBME curriculum is widely accepted and perceived as an improvement, but its effectiveness depends on careful calibration of workload, assessment design, clinical exposure, and support for student well-being.
Background: Argyrophilic nucleolar organizer region (AgNOR) staining is a rapid and cost-effective marker of cellular proliferation, useful in differentiating benign from malignant breast lesions. This study evaluated the mean AgNOR count and the subjective AgNOR pattern assessment (SAPA) score in fine needle aspiration cytology (FNAC) samples of breast neoplasms. Materials and Methods: This prospective study included 100 women with palpable breast lumps who underwent FNAC at a tertiary care teaching hospital over 2 years. Smears were stained with hematoxylin and eosin (H and E) for cytology and silver stain for AgNOR analysis. Mean AgNOR count (mAgNOR) and SAPA score were evaluated in 100 neoplastic cells per case. Histopathology was available for 61 cases for correlation. Data were analyzed using SPSS 20.0; descriptive statistics and Chi-square tests were applied, with P < 0.05 considered statistically significant. Results: Among 100 breast lesions, FNAC classified 53% as benign, 36% as malignant, and 11% as premalignant, with fibroadenoma and ductal carcinoma being the most common benign and malignant lesions, respectively. Histopathological follow-up was available for 61 cases. Mean AgNOR counts rose progressively from benign (3.62 ± 0.91) to premalignant (4.92 ± 1.52) and malignant lesions (6.79 ± 2.11; P < 0.001), paralleling histopathology. SAPA scores similarly distinguished benign (6.92 ± 1.49), premalignant (10.27 ± 1.95), and malignant lesions (12.42 ± 2.43; P < 0.001). FNAC-histopathology concordance was high, with all malignant cases confirmed and 75% of premalignant cases upgraded to malignancy. Conclusion: These findings suggest that both AgNOR count and SAPA score are reliable indicators of proliferative activity and can effectively differentiate malignant from benign breast lesions in FNAC smears.
Background: Traumatic small bowel injury is a significant public health issue worldwide at all socioeconomic levels. Our goal is to describe the clinical profile of traumatic gut injury and the factors affecting the outcome. Materials and Methods: This prospective study enrolled 50 patients who had clinic-radiological evidence of small bowel injury following abdominal trauma and had surgery during the study period. Patients’ demographic details, their clinical signs and symptoms, relevant investigations, treatment approach, hospital care records during the perioperative period, and outcomes are collected and analyzed. Results: The mean age was 36.46 years, with the male-female ratio being 6.1:1. Other associated injuries were found in 56% of patients. The injury was found to involve mostly the jejunum (74%), followed by the ileum (24%) and the duodenum (2%). Of these patients, 23 had primary repair, 19 required resection-anastomosis, and 7 required diversions. Seventeen patients developed postoperative complications, with surgical site infection (16%) being the most frequent and sepsis being the most fatal. The mortality rate was 18%, and the death rate was directly related to the shock at the time of admission (P = 0.001). The majority (95.1%) of survivors had a hospital stay of <14 days. Conclusion: Jejunoileal injury is the most common form of traumatic small bowel injury following road traffic accidents. It mostly involves young and physically active populations. Injury severity and associated other injuries determine shock, which also relates to high mortality. The length of the hospital stay depends on the type of surgery, postoperative complications, and associated injuries.
Inflammatory linear verrucous epidermal nevus (ILVEN) is a rare variant of epidermal nevus, typically presenting during infancy or early childhood, and is characterized by unilateral, erythematous, hyperkeratotic, and verrucous plaques that follow the Blaschko lines. ILVEN is classically pruritic, with lesions that are often refractory to standard treatments. We report a 38-year-old woman with congenital, asymptomatic ILVEN confined to the leg. After decades of quiescence, rapid adult progression with bilateral hand lesions occurred. Histology revealed psoriasiform epidermal hyperplasia with alternating vertical tiers of parakeratosis and orthokeratosis. The parakeratotic zones were overlaid by areas of diminished or absent granular layer (hypogranulosis), while the orthokeratotic zones demonstrated retained hypergranulosis. Findings were consistent with ILVEN. Given the widespread lesions and absence of disabling symptoms, conservative management with acitretin was initiated. This case illustrates the clinical variability and mosaic inflammatory nature of ILVEN, highlighting atypical features such as adult onset, bilateral acral distribution, and lack of systemic manifestations. This unusual course expands ILVEN spectrum and supports molecular evaluation in atypical cases. Future studies on the genetic basis of ILVEN may guide targeted therapies and improve management of extensive or refractory cases.
Background and Objectives: Chronic suppurative otitis media (CSOM) is a commonly diagnosed condition in otorhinolaryngology practice which is characterized by persistent inflammation of the middle ear and its adjacent structures. If left untreated, it can lead to serious complications involving both intra- and extracranial regions. Therefore, prompt diagnosis and appropriate treatment should be given to reduce the morbidity due to CSOM. Treatment of CSOM includes aural toilet, antibiotics, and surgery if necessary. Methodology: Ear swabs were collected from patients with CSOM from June 2023 to July 2024, and the samples were processed in the microbiology laboratory by standard microbiological techniques. The isolates were identified by Gram stain, colony morphology, biochemical tests, and by the VITEK 2 system. Antibiotic susceptibility testing was performed by Kirby–Bauer disc diffusion method and the VITEK system. Results: A total of 100 nonrepetitive samples were taken from patients with CSOM, out of which 80 samples had pure microbial growth. The predominant isolates were Pseudomonas aeruginosa (38/100) and Staphylococcus aureus (14/100). Among the isolates of P. aeruginosa, 60% were susceptible to ciprofloxacin, 87% to gentamicin, 82% to ceftazidime, 84% to cefepime and piperacillin–tazobactam, and 95% to amikacin, whereas among S. aureus, 93% of the isolates were susceptible to gentamicin, 28% to ciprofloxacin. Conclusion: The causative organisms of CSOM and their antimicrobial susceptibility profiles exhibit marked geographic variability. Therefore, continuous surveillance and regular updates on the prevailing microbial patterns are required to guide clinicians in selecting appropriate antibiotic therapy, ultimately contributing to the prevention of antimicrobial resistance.
Background: Gustilo–Anderson Grade IIIB (GA IIIB) open fractures pose major challenges due to extensive soft tissue damage and high infection risks. Vacuum-assisted closure (VAC) therapy, a type of negative pressure wound therapy, is widely used to enhance healing, reduce infections, and promote bone union. This study evaluates its effectiveness in managing GA IIIB fractures by assessing infection rates, wound healing, hospital stay, and bone union outcomes, especially in the context of its application in resource-limited settings where there is delayed access to reconstructive procedures. Materials and Methods: In this prospective observational study, 42 patients with GA IIIB fractures were treated with VAC therapy after a single surgical debridement. We analyzed infection rates, wound healing progress, and fracture union. Statistical tests (t-tests, χ², and logistic regression) were conducted using SPSS, with P ≤ 0.05 considered statistically significant. Results: VAC therapy significantly lowered infection rates (9.52%) compared to historical averages (20%–50%). Granulation tissue was formed in 21.52 ± 6.12 days, with larger wounds taking longer time (P = 0.0029). Complete wound healing occurred in 80.95% of patients, and 71.43% achieved bone union (mean time: 21.86 weeks). Delayed union and nonunion were observed in 11.90% and 16.67% of cases, respectively. Hospital stay averaged 33.1 ± 7.77 days, correlating with wound severity and VAC duration. Conclusion: VAC therapy improves soft tissue healing, reduces infections, and enhances wound readiness for grafting in GA IIIB fractures. Though hospital stays may be prolonged, its benefits in infection control and granulation tissue formation make it a valuable tool in complex fracture management. Our results validate VAC therapy as a vital adjunct in managing GA IIIB fractures, particularly in resource-limited settings. Further research is needed to refine treatment protocols and minimize hospitalization.
Background: Psychological stress has been shown to be associated with the etiopathogenesis of several autoimmune diseases. Uveitis can be a sight-threatening disease if not treated promptly and adequately. There are limited data on the potential association between psychological stress and noninfectious or autoimmune uveitis, particularly from the Indian subcontinent. The aim of our study was to evaluate the role of psychological stress in noninfectious uveitis. Methodology: This was a prospective, single-center, cross-sectional study. Sixty-three patients with noninfectious uveitis (Group 1 – 32 patients with recently active uveitis in Group 1A and 31 patients with inactive uveitis in Group 1B) and 63 age- and gender-matched patients without uveitis (Group 2), who met the eligibility criteria, were enrolled. Psychological stress was assessed in all participants using the 10-item version of Cohen Perceived Stress Scale (PSS-10). The main outcome measure was the comparison of mean stress scores between the groups and subgroups. Results: This study found significantly higher levels of psychological stress in patients with uveitis (13.92 ± 4.48 vs. 12.24 ± 2.79, P = 0.01). This was significantly higher in patients with recently active uveitis compared to both nonuveitis controls (15.81 ± 4.90 vs. 12.24 ± 2.79, P < 0.001) and patients with inactive uveitis (15.81 ± 4.90 vs. 11.97 ± 2.96, P < 0.001). A significantly higher number of patients in the recently active uveitis group reported stressful life events within a 6-month period prior to presentation, compared to both the nonuveitis control group (P = 0.01) and the inactive uveitis group (P = 0.04). Disease-related stress was reported by patients in both the recently active uveitis and inactive uveitis groups. Conclusions: This study highlights the significant association of psychological stress with both the cause and the effect of the disease in patients with noninfectious uveitis. It is important to identify and address psychological stress in patients with uveitis for their holistic care and management.
Introduction: Globally, hepatitis B virus (HBV) is the major cause of hepatitis. Bhutan introduced HBV vaccine in 1997 and maintains high childhood vaccination coverage. HBV vaccine has an efficacy of 80%–100%. Methods: A descriptive cross-sectional study was carried out among healthcare workers (HCWs) in Jigme Dorji Wangchuck National Referral Hospital (JDWNRH) to assess HBV vaccination and antibody status. Participants (n = 440) were selected through a systematic random sampling method from the list of about 1200 HCWs. After obtaining written informed consent, study questionnaire was administered, blood was collected, serum separated and tested for antibody against hepatitis B (HB) surface antigen. Results: Of the 440 HCWs, 92% reported being vaccinated against HB but only 70.7% completed the full course. Females were more likely to opt for vaccination (Odds ratio [OR] 2.93, 95% confidence interval [CI] 1.39, 6.12, P = 0.005) but there was no sex difference in completing the full course (OR 1.28, 95% CI 0.8, 1.99, P = 0.27). Only 52.7% (232/440) had a detectable level (≥10 IU/mL) of protective antibody against HB. Among those vaccinated (n = 406), 53.7% (217/406) were positive for antibody but 44.1% (15/34) of those unvaccinated also had protective antibodies. Only 68% of the participants have undertaken HBV testing and HBV positivity rate was 3.3%. An alarming 44.6% of the participants were accidentally exposed to needle stick injuries at work. Conclusions: This study revealed HBV vaccination gaps and high incidence of accidental needlestick injuries among HCWs in Bhutan’s National Referral Hospital. Relevant public health programs of the Ministry of Health must address this urgently as part of the HCWs work health safety program.
Background: Patients scheduled for elective procedures require appropriate fasting to prevent complications like aspiration. In children, it is important to avoid over-fasting. The primary objective of this study was to determine whether we adhered to the fasting guidelines of the American Society of Anesthesiologists (ASA). The secondary objectives included identifying the reasons for any deviations from these guidelines and assessing the impact of fasting on a child’s preoperative and postoperative behavior. Materials and Methods: We collected data on preoperative fasting in 263 children aged 1 month to 18 years who were scheduled for elective surgeries over a year. We recorded details regarding preoperative fasting hours for solids, breast milk, clear fluids, and water. In addition, we noted any delay in scheduled time, preoperative and postoperative behavior, signs of dehydration, premedication, reasons why parents chose to feed their children during the preoperative period, postoperative analgesia, feeding in recovery, and recovery times. Results: We were able to strictly and partially comply with ASA guidelines on fasting in 65.7%, 84.2%, and 91.2% of cases for water/clear juice, breast milk, and solids, respectively. Even though we prioritized the smallest babies at the top of the list, instances of prolonged fasting still occur due to many reasons. Prolonged fasting can lead to abnormal behavior in children both preoperatively (10.7%) and, possibly, postoperatively (12.3%). Conclusion: With proper planning and communication, we can adhere to standard preoperative fasting guidelines. Avoiding excessive fasting helps keep children comfortable during the preoperative and postoperative periods.
Background: Evans syndrome (ES), a chronic autoimmune disorder, is infrequently diagnosed during pregnancy and the outcomes are underreported. The aim of the study was to examine the incidence, as well as the maternal and perinatal outcomes of ES in pregnancy over a 12-year period. Methodology: A retrospective review of electronic records at a tertiary care institute in southern India was conducted, which identified 17 women with ES during pregnancy, accounting for a total of 24 pregnancies. Maternal characteristics, treatment modalities, and perinatal outcomes were analyzed. Results: The incidence of ES in pregnancy was 0.104 per 1000 births. Secondary ES was more common, primarily associated with systemic lupus erythematosus. Treatment typically involved steroids and/or hydroxychloroquine, often with other immunosuppressants. Obstetric complications occurred in 66.6% of pregnancies, with fetal growth restriction and hypertension being most frequent. Of the 24 pregnancies, 11 had favorable perinatal outcomes, while 13 resulted in adverse outcomes, including intrauterine demise or stillbirths. Among live births, 41.1% were small for gestational age. None of the neonates had anemia, but four neonates developed thrombocytopenia. No significant correlation was found between maternal factors and neonatal outcomes. Conclusion: ES in pregnancy is rare, but is linked to significant maternal and fetal complications. Regular monitoring of these pregnancies, and of the neonate postdelivery, is essential. The relatively smaller numbers make it challenging to draw definitive conclusions regarding the relationship between maternal risk factors and perinatal outcomes. Larger studies looking at maternal clinical characteristics and perinatal outcomes are needed to establish or refute correlations.
India faces a mounting epidemic of noncommunicable diseases (NCDs), such as hypertension, diabetes, and oral cancer, that demands effective risk communication strategies for prevention and management. This review evaluates a decade of evidence on approaches ranging from community health worker initiatives and mobile health interventions to participatory and culturally-adapted campaigns. Results indicate that multi-channel communication–combining digital tools with interpersonal engagement–yields the best outcomes, especially when adapted to local languages and literacy. Effective risk messaging improves screening rates, treatment adherence, and health behaviors, particularly in underserved communities. Challenges persist, including digital divides, variable health literacy, and inconsistent training among frontline workers. Tobacco cessation and stroke prevention efforts highlight the importance of trusted messengers, tailored content, and community involvement. Embedding risk communication within routine care pathways, ensuring continuous provider-patient dialogue, and co-creating health materials with communities are key to sustaining change. Holistic, context-sensitive communication is essential to curb India’s growing NCD burden.
Tumors with clear cell morphology in histopathology are relatively common. From lipomas to clear cell sarcoma, many tumors share the common feature of clearing of the cytoplasm, which occurs due to their cytoplasmic content of fat, glycogen, or mucins, which are lost during processing in histopathology. This case series describes the various tumors with clear cell morphology at varied sites, along with a detailed review of the clear cell tumors.
Background: Medical research is the cornerstone of healthcare progress, enabling the development of evidence-based clinical practices. The present study set out to assess medical students’ understanding of research, explore their attitudes toward it, measure their participation in research projects, identify challenges to engagement, and evaluate their knowledge of and involvement in the Indian Council of Medical Research’s (ICMR) short-term studentship (STS) program. Methodology: This cross-sectional study involved 160 undergraduate medical students and interns. Information was obtained through a self-completed online questionnaire distributed through a secure digital survey platform. The survey covered demographic details, knowledge and attitudes regarding research, research experience, perceived barriers, and aspects related to the ICMR STS program. Data were analyzed using Jamovi software. Results: The study found that 61.9% of students demonstrated good knowledge of research concepts. While a majority (96.9%) recognized the importance of research, only 55% expressed interest in pursuing it as a career. Most students (90%) had experience in writing research proposals and 85% had collected data but fewer had experience in data analysis (51.9%), presentations (25%), or publications (13.1%). The most commonly reported barriers were time constraints (63.1%) and lack of resources (50%). Only 12.5% of students had participated in the ICMR STS program. Conclusion: The study underscores the need to enhance research opportunities, address time constraints, improve resource accessibility, and strengthen mentorship programs. Addressing these barriers can foster a stronger research culture among medical students, which can ultimately improve the quality of clinical practice and healthcare.
Introduction: The Ottawa charter recognizes responsible self-medication as a component of self-care, particularly in resource-limited settings. However, irresponsible self-medication can lead to adverse drug interactions, polypharmacy, and delayed diagnosis, posing significant public health concerns. Understanding local drivers of self-medication is essential to guide context-specific interventions. Methodology: This mixed-methods study aimed to assess the prevalence, patterns, and determinants of self-medication among adults in suburban Central Kerala. A sequential explanatory design was employed, combining a community-based cross-sectional survey using EpiCollect5 with in-depth interviews of local pharmacists. Multistage sampling was used, and a sample size of 164 was calculated using (1.96)² PQ/R². Quantitative data were analyzed through IBM SPSS 20 and Qualitative data using an inductive thematic approach in Quirkos software. Results: The study included 162 participants; the nonresponse rate was only 1.2%. The prevalence of self-medication was 39.6% (95% confidence interval [CI]: 32–47.5). Antipyretics (49.1%) and nonsteroidal anti-inflammatory drugs (38.6%) were the most commonly used medications, primarily for symptoms such as fever (69.3%). Self-medication was found to be uniformly prevalent across all sociodemographic and health-related variables, including marital status (P = 0.63), education level (P = 0.51), type of healthcare visits (P = 0.18), health insurance status (P = 0.25), distance to hospital (P = 0.90), and chronic disease status (P = 0.45). Qualitative findings revealed that a perceived familiarity with medications, high consultation costs, long waiting times, and the persuasive influence of pharmaceutical marketing were key factors motivating self-medication. Conclusion: These findings emphasize the high and uniform prevalence of self-medication across different population groups in central Kerala. They highlight the urgent need for targeted public health strategies that encourage responsible self-medication practices while simultaneously addressing existing challenges in healthcare access and delivery.
