ABSTRACT Despite its widespread use in qualitative research, saturation is often improperly stated or loosely used in the methods section and cited as a methodological checkbox to persuade editors and peer reviewers that research methodology is robust. This narrative review sheds light on this multifaceted concept, tracing its origin in grounded theory to its current, diluted applications across qualitative methodologies. Four conceptually distinct forms of saturation are synthesized: theoretical saturation, where researchers can no longer develop category properties due to lack of new data; inductive thematic saturation, where more data yield no new codes or themes; a priori thematic saturation, where sufficient examples exist for predefined categories in an existing theory; and data saturation, where new information merely restates what has already been heard, without offering new perspectives. Empirical evidence indicates saturation is often achieved within 9 to 17 In-Depth Interviews and 4 to 8 Focus Group Discussions, yet these are estimates, not fixed rules, and parameters such as study goals, population, and sampling strategy influence when saturation is reached. Most qualitative researchers stop data collection not because saturation is truly achieved but because of budgetary and time constraints. Saturation should not be regarded as a rigid universal rule but must align with the goals of the research, guiding, not dictating, qualitative inquiry. This review emphasizes defining saturation properly, aligning it with analytical and epistemological methods, and reporting it separately in the protocol and publication for transparency rather than retrofitting the label to satisfy editors and peer reviewers.
ABSTRACT:Trichosporon species are emerging opportunistic pathogens capable of causing a spectrum of disease, from superficial skin infections to deep-seated, disseminated, and life-threatening infections. These infections are often challenging to diagnose due to their rarity, frequent misidentification as Candida , and intrinsic resistance to conventional antifungal therapies, resulting in delays in appropriate management. We report a case series of Trichosporon fungemia in six critically ill patients, highlighting varied clinical presentations. Common comorbidities included diabetes mellitus, hypertension, anemia, hypothyroidism, sepsis, multiorgan dysfunction, and complications related to indwelling devices. All cases had blood culture-confirmed Trichosporon fungemia. The overall mortality was 66.7% (4/6 cases). Our findings emphasize the importance of early recognition, prompt antifungal therapy, and strict infection control measures to improve outcomes in high-risk patients.
ABSTRACT Mental health is an under-recognized aspect of HIV care. The psychological wellbeing among people living with HIV (PLHIV) is often neglected in routine antiretroviral therapy (ART) services, especially in resource-limited settings. The study assessed the knowledge, attitude, and practices (KAP) related to psychological wellbeing among PLHIV attending an ART Plus Centre in India and identified service delivery gaps. This cross-sectional study included 301 adult PLHIV attending an ART Plus Centre. A prevalidated, structured questionnaire was administered via in-person interviews. Data were analyzed using descriptive statistics to assess trends in knowledge, attitude, and practices. The study was approved by the Institutional Ethics Committee. The mean age of participants was 35.5 years; 50.5% were male and 49.2% female. While 98.7% were on ART, only 61.8% were aware that HIV can affect mental health. Just 22.4% expressed willingness to access psychological support services if made available. Approximately 51.2% had received some form of psychological counseling, but only 3.3% participated in formal support groups. A significant proportion (41.5%) reported having no one to confide in during emotional distress. Only 34.6% engaged in any coping practices like meditation or prayer. Despite high ART adherence, substantial gaps persist in awareness, attitudes, and utilization of mental health services among PLHIV. Integration of mental health screening, counseling, and psychosocial support into routine HIV care is essential for comprehensive management.
ABSTRACT POEMS is an uncommon paraneoplastic plasma cell disorder known with the expansion of polyneuropathy, organomegaly, endocrine abnormalities, M-band, and skin changes. We report a patient presenting with monoarthritis and weight loss for 5 months, who was treated empirically for tuberculous arthritis and later developed debilitating axonal polyneuropathy due to delayed diagnosis. POEMS/Plasma cell dyscrasias rarely involve joints, and this case highlights this unique presentation of POEMS syndrome. Bone biopsy from the affected joint revealed the diagnosis. Chronic large-joint monoarthritis with systemic symptoms, mimicking tuberculous arthritis, and polyneuropathy is a unique combination—so clinicians should consider an underlying plasma cell dyscrasia/POEMS to avoid delayed diagnosis.
ABSTRACT Pediatric pulmonary cystic/cavitary lesions are uncommon. The spectrum of cystic/cavitary pulmonary lesions in pediatric patients includes congenital and acquired lesions. They have similar clinical presentation and overlapping radiologic features. Histopathology plays an important role in diagnosis. This study was planned to describe the spectrum of surgically resected cystic/cavitary pulmonary lesions in pediatric patients (age <12 years) and correlate clinical features with pathology findings. This is a single-center 10-year retrospective descriptive study. The cases were divided into two categories: congenital and acquired. Demographic details, clinical presentation, and investigational data were correlated with pathology findings.The study included 40 cases of surgically resected cystic/cavitary pulmonary lesions received from pediatric patients. Congenital lesions (22 cases, 55%) predominated over acquired lesions (18 cases, 45%). Cystic pulmonary airway malformation (29.2%, 12 cases) was the most common lesion and the most common cystic lesion overall. Acquired lesions included hydatid cyst (nine cases) and post infectious (post abscess) cavitary lesions (nine cases which included two cases of tuberculosis). Most congenital lesions were found in the neonates and infants and none found in late childhood, while most acquired lesions belonged to late childhood with no case found in neonates. Though radiology plays an important role in the diagnosis of cystic/cavitary lesions, histopathology is the key investigation for confirmation. Very few studies that describe the clinico-pathologic spectrum of these rare lesions in children were found in the literature.
ABSTRACT:Antimicrobial resistance (AMR) poses a major challenge to patient outcomes, particularly in resource-constrained settings with widespread antimicrobial misuse. Structured antimicrobial stewardship programs (AMSPs) are essential to optimize antimicrobial use and reduce resistance. This pre-post interventional observational study evaluated the impact of AMSP implementation on antimicrobial susceptibility patterns, multiple antibiotic resistance (MAR) indices, stewardship performance indicators, clinical outcomes, and antimicrobial expenditure in the medical and surgical intensive care units of a tertiary-care teaching hospital in India over a 12-month period (pre-AMSP: October 2024-March 2025; post-AMSP: April-September 2025). Standard microbiological methods and Clinical and Laboratory Standards Institute (CLSI) M100 guidelines were used for organism identification and antimicrobial susceptibility testing. Following AMSP implementation, culture positivity decreased from 53.2% to 41.8%, while MAR indices declined by 12-24% across major pathogens. De-escalation rates increased from 49.8% to 77.6% ( P = 0.01), guideline adherence improved from 75.2% to 89.1% ( P < 0.001), culture turnaround time compliance increased from 68% to 89% ( P = 0.01), and days of therapy per 1000 patient-days decreased from 82 to 64 ( P < 0.001). Infection-related mortality declined from 5.4% to 3.8% (odds ratio = 0.53, P = 0.011), hospital-acquired infections decreased from 58.2% to 41.8% (relative risk = 0.72, P = 0.018), and antimicrobial expenditure was reduced by 46.4%, corresponding to a monthly saving of ₹9.96 lakh. Implementation of a multidisciplinary AMSP was associated with significant improvements in microbiological, stewardship, clinical, and economic outcomes, supporting the feasibility and effectiveness of structured antimicrobial stewardship programs in tertiary-care hospitals with a high burden of antimicrobial resistance.
ABSTRACT Medicine is a sensitive science as it deals with the life and health of people. A slight error can blow up into an enormous damage when invalid results are applied to the population at large. Thus, extreme care is required in conducting and reporting medical research studies. Since medical research is mostly empirical, variations and consequent uncertainties are integral part. Statistical fallacies occur when data and database research are knowingly or unknowingly poorly done or misreported. This article highlights such instances and illustrates commonly occurring fallacies in medical research. Proper design, collection of the right data on an adequate sample, immaculate analysis, and correct interpretation can minimize such fallacies and increase the credibility of research results.
ABSTRACT:The study aimed to assess clinicians' perceptions regarding therapeutic drug monitoring (TDM), including perceived need, lacunae, extent of utilization, and barriers to TDM services in a tertiary care teaching hospital in Nagpur. We conducted a cross-sectional, questionnaire-based study among clinicians directly involved in patient care after obtaining institutional ethics committee approval. Clinicians were approached to obtain written or electronic consent. The questionnaire consisted of 18 structured, close-ended questions. Responses were collected using a three-point Likert scale, yes/no, or multiple-choice questions. The questionnaire demonstrated good reliability, with a Cohen's kappa index of 0.7, a scale-level content validity index of 0.82, and a Pearson's r value of 0.9 on test-retest reliability. The study included 75 clinicians. Among the total participants, only 36% ( n = 27) reported prior use of TDM services in clinical practice; 93.33% ( n = 70) agreed that TDM can be used to optimize drug exposure, and 96% ( n = 72) agreed that pharmacokinetic parameters are affected by concomitant medications and that TDM may prevent adverse drug reaction (ADR). Overall, 56% ( n = 42/75) reported a moderate level of awareness regarding TDM. Major barriers included limited awareness among clinicians (58.66%, n = 44), lack of practical experience (68%, n = 51), and lack of facilities (60%, n = 45). The findings of the present study highlight the need for the implementation of TDM services. While awareness regarding the role of TDM in optimizing drug exposure and preventing ADRs was high, important gaps were noted in the utilization of services, highlighting the need to facilitate education for healthcare professionals and to develop clear, evidence-based clinical guidelines to overcome the observed gaps.
ABSTRACT:To explore the potential of virtual reality (VR) as a training tool for basic life support (BLS) and other emergency procedures to achieve higher levels of knowledge in the cognitive, psychomotor, and affective domains. Sixty trainees, divided into two groups of thirty each, were trained first using conventional methods, followed by VR devices, and then crossed over in this randomized crossover trial. Data indicators included a pre-validated set of thirty-one mixed response questions administered via Google Forms and a checklist of twelve parameters. Assessment was performed using "Direct observation of procedural skills" at four time periods, at T0 (before training), T1 (post-completion of training with the conventional or immersive technique), T2 (post-completion of training with the immersive or conventional technique), and T3 (post-three months of last training with either the conventional or immersive technique). Inferential statistics were performed using the Chi-square test for categorical variables and analysis of variance (ANOVA) for continuous variables. Intra-group comparison revealed a significant difference from T0 to T3 for all parameters in groups I and II, except for the "compression depth" parameter in group I. Inter-group comparison at T0 and T3 revealed no statistically significant difference between the two techniques. Overall satisfaction levels from T0 to T3 in both groups revealed an increasing learning preference for the VR method (46.6%-73.3% in group I and 50%-80% in group II). Immersive teaching-learning methods using VR provided a scalable and consistent learning experience, highlighting its utility for BLS training in remote or resource-constrained environments. Trainees' preferences and VR's ability to foster a desired teaching-learning environment are promising signs, warranting exploration of its long-term synergistic impact with other immersive teaching-learning methods.
Introduction: Adverse drug reactions (ADRs) are an important cause of morbidity, prolonged hospital stay, and increased healthcare costs. Monitoring and reporting ADRs through pharmacovigilance systems help identify drug-related risks and improve patient safety. This study aimed to describe the pattern, characteristics, and outcomes of ADRs reported at a tertiary care teaching hospital under the Pharmacovigilance Programme of India (PvPI).Materials and Methods: A retrospective, observational, cross-sectional study was conducted at the ADR Monitoring Center of a tertiary care teaching hospital. Individual Case Safety Reports submitted to the Vigiflow database between January 2023 and December 2024 were analyzed. This study got approval by ethics committee. Data were evaluated for patient demographics, suspected drugs, system organ class involvement, seriousness, outcomes, and causality using the World Health Organization-Uppsala (WHO-UMC) scale. Descriptive statistics were used to summarize the data.Results: A total of 299 ADRs were described and analyzed. Adults accounted for the majority of cases, with a slight male predominance. Antimicrobials (29%) were the most commonly implicated drug class. Most ADRs were non-serious. On causality assessment, the majority of reactions were classified as "probable (90.63%)". The most common adverse event was headache (8.6%). The ADR outcome was recovered/resolved in 64.6%.Conclusion: ADRs are commonly encountered in tertiary care settings, with antimicrobials being the most frequent contributors. Describing and analyzing reported ADR data, increasing awareness among medical students, healthcare professionals, and encouraging regular ADR reporting are essential steps to enhance patient safety and promote rational drug use.
Introduction: Skin, hair, and nail diseases can greatly impact psychosocial well-being, making an accurate diagnosis essential. Skin biopsies are a key diagnostic tool in dermatology, aiding in identifying and distinguishing various skin conditions. This study was done to determine the spectrum of diseases requiring skin biopsy and the level of clinicopathological concordance. Materials and Methods: We retrospectively reviewed 5000 skin biopsy records at a tertiary care center over 2 years. Data included demographics, biopsy sites, lesion morphology, clinical indications, and histopathological diagnoses. The Chi-square test assessed the concordance between clinical and histopathological findings (P < 0.05). Results: Of 5000 biopsies, 56.2% were from males, with peak incidence in the 35-40 age group. The most biopsied sites were the lower limb (22%), with plaques being the most common lesion morphology (37.9%). Papulosquamous disorders (24.7%) were the leading indication, particularly Lichenoid dermatitis (9.6%), followed by cutaneous infections (14.7%), mainly mycobacterial (9.2%). Lichen planus (6.2%) and psoriasis (4.5%) were the most frequent histopathological diagnoses. Overall, clinicopathological concordance was 86%, with 50.6% full and 35.4% partial concordance. Variability in concordance rates was seen across disease categories. Conclusion: Skin biopsy plays a vital role in diagnosing dermatological conditions, with an 86% concordance rate. Variability across conditions highlights the importance of clinicopathological correlation and careful clinical evaluation.
ABSTRACT:As the WHO puts it, breastfeeding is the cornerstone of child survival, nutrition, development, and maternal health. According to NFHS data of India, only 71.2% of children under six months are exclusively breastfed in Maharashtra. The problem may be more prevalent in tribal communities due to their geographical location and strong cultural norms. This community-based cross-sectional observational study was conducted among consenting mothers of the Scheduled Tribe category with children aged six months to one year residing in the area under the Primary Health Center in a tribal village. A list of mothers fulfilling inclusion criteria was obtained from seven subcentres, and participants were selected by random sampling from each. Data was obtained by a structured interview schedule. Descriptive analysis estimated the prevalence of exclusive breastfeeding (EBF), and the association between qualitative variables was assessed by the Chi-square test. Multivariate logistic regression was applied to determine the predictors of EBF, using the software SPSS-28. A P value of ≤ 0.05 was used as the cut-off for statistical significance. Prevalence of EBF was 63.4%. Factors like age, education, occupation of mother, maternal education, place of delivery, practice of colostrum feeding, are statistically significantly associated with the practice of EBF. Multivariate logistic regression revealed that the age of the mother and the education of the father are determinants of EBF. The prevalence of EBF in the study area is lower than the state prevalence, highlighting the need for focused intervention. Furthermore, EBF practices are influenced by a mix of social, cultural, and economic factors.
