Abstract 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.

Abstract 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.

Abstract 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.

Abstract Background: Glycaemic gap is a marker of stress-induced glycaemic excursion in patients with diabetes that can be used to predict the adverse outcomes in patients with diabetes admitted to the intensive care unit (ICU). Methods: The present observational study was conducted in type 2 diabetes mellitus (T2DM) admitted to the ICU of tertiary care hospital. The association between glycaemic gap and outcome of patients was studied. Results: The mean age of the participants was 61.4 years. Among 128 study participants, 81 improved during their ICU stay; the condition of 47 worsened; Of these 47 patients who had worsened, 17 died. The glycaemic gap was found to be significantly higher in the worsened group when compared to the improved group ( P < 0.001). Conclusions: The present study showed that higher glycaemic gap is a simple marker for predicting the adverse outcome in diabetes patients. The glycaemic gap may serve as an effective tool to evaluate the severity and prognosis of patients with T2DM, who have been admitted with critical illness.

Abstract 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.

Abstract Background: The traditional laboratory spirometry methods used for pre-operative assessment of post-operative pulmonary complications (PPC) are costly and time-consuming. Simple bedside tests such as breath-holding time (BHT) and portable spirometers offer comparable efficacy in assessing lung dysfunction. We studied the correlation between BHT and Hand-held Portable Contec™ Spirometer in Pre-operative pulmonary function assessment. Methods: This prospective, observational study enrolled 67 patients aged 18–65 years who were American Society of Anesthesiologists grade 1–2, undergoing non-cardiothoracic elective surgeries under general anaesthesia. Correlation between BHT and spirometric indices of forced vital capacity (FVC), forced expiratory volume in the first sec (FEV 1 ), peak expiratory flow rate (PEFR) and forced expiratory flow (FEF) at 25% (FEF 25 ), 75% (FEF 75 ) and 25%–75% and (FEF 25–75 ) of lung volume was studied. Results: Of 67 patients, 48 were male. A significant positive correlation was observed between BHT and with the absolute values of FEV 1 , FVC, PEFR, FEF 25 and FEF 25–75 in males, females and in all patients ( P < 0.05). A positive correlation was noted between FEF 75 and BHT exclusively in females ( P < 0.05). PPC did not occur in any patient. Conclusions: We observed a strong correlation between BHT and Contec™ spirometer. This simple, effective and non-technician-dependent bedside tool is helpful identifying individuals at risk of PPC in low-risk non-cardiothoracic surgeries. Clinical Trial Registry of India No. CTRI/2020/09/027700 .

Abstract Background: During the pandemic period, knowledge on promoting severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) disease (COVID-19) affected post-natal mothers to breastfeed with necessary precaution is mandatory. Methods: The community-based analytical cross-sectional study was conducted for period of 3 months in the rural field practices area of the Department of Community Medicine covered by Thirubhuvanai Primary Health Centre, Puducherry. A predesigned structured questionnaire was used to assess the baseline knowledge level on COVID-19 and breastfeeding among the post-natal mothers and to assess the effect of health education session on the knowledge level of post-natal mothers about breastfeeding. Results: There was a significant improvement in the knowledge scores of post-natal mothers after the health education session on COVID-19 and breastfeeding. Conclusions: Health education sessions during the COVID-19 pandemic significantly enhance the knowledge and confidence of post-natal mothers regarding breastfeeding.

Abstract 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.