All India Institute Of Medical Sciences Research Articles

A Brief Update on Inter-lab Quality Control (ILQC) Activities for COVID-19 Reverse Transcription-Polymerase Chain Reaction (RT-PCR) by All India Institute of Medical Sciences (AIIMS) Nagpur, India

A Brief Update on Inter-lab Quality Control (ILQC) Activities for COVID-19 Reverse Transcription-Polymerase Chain Reaction (RT-PCR) by All India Institute of Medical Sciences (AIIMS) Nagpur, India

All India Institute of Medical Sciences (AIIMS), Delhi: Cyberattack Puts Digitalisation Under Scanner

‘I Dream of a Digital India where cyber security becomes an integral part of National Security’—Narendra Modi Fulling this dream one as to realise the fact ‘Cyber Security is not easy. But it comes down to three basic principles—PROTECT, DETECT AND RESPOND as early as possible’—Advent from AIIMS Case The All India Institute of Medical Sciences (AIIMS), a top public medical research facility and hospital with headquarters in New Delhi, India, announced a sophisticated cyber-incident on its servers on 23 November 2022. Several patient care services were rendered unavailable as a result of the incident, including registration, admission, billing and discharge. Several news sources claim that this cyber event, which affected the e-services of the AIIMS (New Delhi) starting at 7:00 a.m. on 23 November 2022, was of the ransomware variety. The testing runs of the e-hospital server were successful, and the majority of the lost data had been recovered during the previous few days, according to AIIMS authorities’ confirmation on 6 December 2022. The case provides background on the healthcare industry and a brief analysis of the incident, along with the measures taken to prevent such attacks in the future.

IJCM_380A: Shaping Medical Assessment with Expert Consensus: A Theory-Based: Summative Evaluation Blueprint for Community Medicine

Background: Despite their constraints and failure to adhere to evaluation criteria, conventional written assessment methods are still widely and often used in many medical colleges. The partiality and inclination of the topic setter are apparent. This results in the overrepresentation of certain themes while leaving many others neglected. Every examiner possesses their own bias and tends to construct questions according to their specific areas of expertise. The distribution and arrangement of the questions are still ambiguous for learners. Several authors have suggested comprehensive evaluation frameworks for different levels of cognitive domains. Objective: This study sought to create a theory-based summative evaluation blueprint by involving experts from the All-India Institute of Medical Sciences. Methodology: Twenty-five experts from 10 All India Institutes of Medical Science were invited via email and contributed for summative assessment for a theory paper. Each week, the study lead team sent an online form containing 25 topics. A total of 269 topics were selected to be included in the blueprint development. An Impact and Frequency score was obtained for each topic, with a score between 1 and 3 for both its “Impact (I)” and “Frequency” (F). Results: The overall response rate was 71%. “Principle of epidemiology” (14.7%) had the most weight, followed by “Epidemiology of communicable disease” (13.4%) and “National Health Program” (10%). These three chapters constituted more than one-third of the total weight of the summative assessment (theory). 20 out of 24 (83%) chapters have moderate-to-good interrater reliability. Conclusion: The proposed blueprint will serve as a reference for setting the question paper and will impart objectivity, uniformity, and validity to the construction of the written assessment tool.

Rise in the Pathogenic Status of Coagulase-Negative Staphylococci Causing Bloodstream Infection.

Coagulase-negative staphylococci (CoNS) are one of the frequently isolated bacteria from blood cultures. Since they are part of the normal skin flora, they were previously considered contaminants. But now, they can be considered as established pathogens causing bloodstream infection (BSI). This study aims to estimate the prevalence of CoNS in BSI cases. This study was conducted at the Microbiology Department, All India Institute of Medical Sciences (AIIMS), Raipur, India, for eight months (January 2022 to August 2022). Data were collected retrospectively from medical and laboratory records. Paired blood cultures from 5085 clinically suspected sepsis cases were subjected to aerobic culture for five days in the BacT ALERT 3D system. Pathogenicity was established after recovery of CoNS from paired blood cultures of symptomatic patients. CoNS were isolated from 2.35% of patients, the most common species being Staphylococcus haemolyticus (51.67%). About 90% of isolates were methicillin-resistant. All the isolates were susceptible to linezolid, teicoplanin, and vancomycin, except one isolate of S. haemolyticus which was intermediate to vancomycin. Minimum inhibitory concentration (MIC) 50 and MIC 90 for vancomycin were 1 ug/ml and 2 ug/ml, respectively. Conclusion: Paired blood cultures are necessary to determine the pathogenicity of CoNS in BSI cases. A high prevalence of methicillin resistance, accompanied by high resistance rates to other non-beta lactam antibiotics, warrants the strict implementation of antimicrobial stewardship practices.

AIIMS ICU Rehabilitation (AIR): development and description of intervention for home rehabilitation of chronically ill tracheostomized patients

Background The paucity of state-supported rehabilitation for chronically ill patients with long-term tracheostomies has ramifications of prolonged hospital-stay, increased burden on acute-care resources, and nosocomial infections. Few interventions describe home rehabilitation of adult tracheostomized patients. Almost none involve stakeholders. This paper describes the All-India Institute of Medical Sciences (AIIMS) ICU rehabilitation (AIR) healthcare intervention developed to facilitate home rehabilitation of chronically ill tracheostomized patients. Methods The AIR intervention development was based on the experience-based codesign theory (EBCD). A core research-committee studied prevalent knowledge and gaps in the area. Patients-carer and health-care stakeholders’ experiences of barriers and facilitators to home care resulted in an intervention with interlinked components: family-carer training, equipment bank, m-health application, and follow-up, guided by the Medical Research Council (MRC) framework. Healthcare stakeholders (doctors, nurses, medical equipment vendors) and patient-carer dyads were engaged to gather experiences at various stages to form smaller codesign teams for each component. Multiple codesign meetings iteratively allowed refinement of the intervention over one year. The Template for Intervention Description and Replication (TIDieR) checklist was used to report the AIR intervention. Results The first component comprised a minimum of three bedside hands-on training sessions for carers relating to tracheostomy suction, catheter care, monitoring oxygenation, enteral feeding, skincare, and physiotherapy, buttressed by pictorial-books and videos embedded in a mobile-application. The second was an equipment-bank involving a rental-retrieval model. The third component was a novel m-health tool for two-way communication with the core group and community of other patient-carers in the project for follow-up and troubleshooting. Home visits on days 7 and 21 post-discharge assessed patient hygiene, nutrition, physiotherapy, and established contact with the nearest primary healthcare facility for the future. Conclusions Findings support the EBCD-based development using active feedback from stakeholders. Assessment of feasibility, process and effectiveness evaluation will follow.

Facilitating Factors and Barriers to Physical Activity among Undergraduate Medical Students in North India: A Qualitative Study.

Medical undergraduate students are the doctors of the future. Evidence supports that medical students who practice physical activity (PA) regularly will continue to perform PA in the future and are more likely to counsel patients about it in their practice. This study was planned to understand the facilitating factors and barriers to PA among Bachelor of Medicine and Bachelor of Surgery (MBBS) students using a qualitative approach. This study is part of a larger study on PA among undergraduate medical students from a medical college in North India. A cross-sectional study with a qualitative approach was conducted on undergraduate medical (MBBS) students enrolled from 2012 to 2017 at the All India Institute of Medical Sciences (AIIMS), New Delhi. The most common facilitating factors identified in the study were self-motivation and personal preference, followed by health consciousness to maintain fitness and the continuation of habits from early childhood. Other facilitating factors reported are being good at sports, having sports-loving friends, an increase in self-confidence, the desire to build six packs, and reducing weight. Those with a concern for self-health, prevention of disease in the future, or a family member already suffering from a disease related to PA were also likely to practice it. Barriers found in the study broadly were competing for time, gender issues, resource-related issues, and sole focus on academics. Rigorous efforts are needed from the individual level to the system level to reinforce the facilitators and fight the barriers. Future studies should focus on finding ways to overcome the barriers and strengthen the facilitating factors for PA among medical students in India.

Profile of Acute Kidney Injury in the Pediatric Age Group in a Tertiary Care Hospital: A Prospective Observational Study.

Acute kidney injury (AKI) is a menace in the pediatric intensive care unit (PICU) and is responsible for significant morbidity and mortality all over the world. There are limited data available on pediatric AKI in central India. Our primary objective is to determine the clinical, etiological, and outcome profile of AKI in the pediatric age group of 3 months to 15 years admitted to the All India Institute of Medical Sciences (AIIMS), Raipur. The secondary objective(s) is to predict the association of mortality in children diagnosed with AKI and to estimate the number of patients developing chronic kidney disease (CKD) at three-month follow-up. This observational study was conducted in the Department of Pediatrics at AIIMS Raipur, Chhattisgarh, from September 2021 to February 2023. All patients aged 3 months to 15 years of age satisfying the Kidney Disease: Improving Global Outcomes (KDIGO) criteria for AKI and presenting to the hospital were included, and those refusing consent or having CKD stage ≥3 were excluded. A total of 66 children were assessed for eligibility. Out of these 66 patients, 2 were excluded as they had AKI on CKD, and a total of 64 patients were included. For all included patients, details of their demography, clinical features, etiology workup, and hospital stay were collected. Their outcome was observed and categorized into complete response, partial response, no response, left against medical advice (LAMA), or death. Patients who were discharged were followed up for three months and observed for the recovery or development of CKD. The incidence of AKI in the PICU was 15.48% (64/413). Ventricular septal defect with pneumonia and pneumonia (12.5%, 8/64 each) were the most common diagnoses at presentation, resulting in AKI. The most common clinical presentations were fever (54.7%, 35/64) and respiratory distress (43.8%, 28/64). Out of them, 73.4% (47/64) had sepsis, and 62.5% (40/64) had shock. About 56.2% (36/64) of children had non-oliguric AKI as compared to 43.8% (28/64) who had oliguric AKI. Among total children with AKI, 54.7% (35/64) of patients had prerenal AKI, 43.8% (28/64) had renal AKI, and 1.6% (1/64) had postrenal AKI. Of all the children included, 32.8% (21/64) experienced complete resolution of AKI, while 18.8% (12/64) showed partial resolution, and 1.6% (1/64) remained unresolved. Among them, 3.1% (2/64) LAMA, and 43.8% (28/64) died. The median duration of the hospital stay in our study was 16.5 days. Out of them, 59.4% (38/64) of patients required renal replacement therapy (60.5% required peritoneal dialysis (PD), 36.8% required hemodialysis (HD), and 2.6% required both). Among survivors, 19.35% (6/31) developed CKD on a three-month follow-up. The incidence of AKI was seen in critically ill children in the PICU, and it was associated with high mortality.

Craniofacial Injury in a Child by Agricultural Fan Blade: A Case Report

AbstractFarm machine-related injuries in children are common modality of head injury. We describe here a case of threshing fan blade injury to head and its successful management. A 10-year-old male was brought to the emergency department of All India Institute of Medical Sciences (AIIMS) Patna with the complains of accidental fall on the fan blade of the thresher machine. On arrival he had a Glasgow Coma Scale of E1VTM5 status, bilateral pupil mid-dilated and sluggish reaction to light. On secondary survey, he had a lacerated wound of size 15 × 4 × 2 cm extending from left side forehead to right temporal region exposing bone and brain parenchyma herniation through the wound. A noncontrast computed tomography head showed B/L frontal contusion with gross edema, subarachnoid hemorrhage, and intraventricular hemorrhage. There was fracture of bilateral frontal bone extending to right parietotemporal bone. Patient was taken to operating room, where after painting and draping, the wound was irrigated with normal saline. The herniated brain was removed, securing hemostasis with surgical and Bovie cautery. He underwent a prolonged neurorehabilitation and made a complete recovery after 3 months of injury. Bihar is an eastern part of India where agriculture plays a major role in rural livelihood. Winnowing fan machines are used to separate the grain from the husk. Children have peculiar behavior to inspect things and this curious behavior leads to coming in contacts with the open blade. Falling on even a stationary blade can sometimes lead to head injury. Early surgery with meticulous wound debridement and closure of dura is required. Covering the fan blade as well as careful parenting of children will prevent further injuries.

Distribution and Uniqueness in the Pattern of Lip Prints.

Introduction Lip prints are the characteristic pattern of wrinkles and grooves on the labial mucosa. Lip prints can be classified into various patterns and can be used for personal identification as they are unique and do not change during the life of a person. Cheiloscopy is a forensic investigation technique that deals with the identification of humans based on lip traces. Objectives This study aimed to investigate the distribution of lip print patterns, to assess gender differences, and to calculate the lip score using a weighted value scoring system. Material and methods A cross-sectional study was carried out in the Department of Anatomy, All India Institute of Medical Sciences (AIIMS), Guwahati, India, from May to October 2023, after getting approval from the Institutional Ethics Committee (IEC). A total of 200 individuals (100 males and 100 females) were included in the study. Each lip print was divided into four quadrants. In each quadrant, up to 14 grooves were marked from the midline, and the pattern of each groove was observed. Each pattern was given an Arabic numeral score. Weighted values were given for the grooves in descending order from 15 to 1 with reference to their position from the midline of the lip print.The product of the Arabic numeral score of the groove and the weighted value of the groove is the lip line score. The sum of the lip line scores was calculated. Results The most common pattern observed in the present study is type II, with 3,816/12,000 (31.8%), followed by type I'with 3,146/12,000 (26.21%), type I with 1,865/12000 (15.54%), type III with 1,491/12,000 (12.42%), type IV with 1,133/12,000 (9.44%), and type V with 549/12,000 (4.5%). The mean total lip score is 1,467.68 (1,486.41 in males and 1448.96 in females). Conclusion Lip prints are unique and useful for personal identification, as the lip score in various quadrants and the total lip score are different for different individuals.

Lipoprotein Ratios: Correlations With Glycated Hemoglobin Among Type 2 Diabetes Mellitus Patients.

Introduction Diabetes mellitus (DM) has become a common disorder in India, and can be even considered as an epidemic in most developing countries. It usually adds a big burden on the economy through its macro and microvascular complications which often require hospitalisation. Glycated hemoglobin (HbA1c) is considered a well-established test to track long-term glycemic control, and hence can be used for both diagnosis and prognosis of disease. On the other hand, lipid profile is a significant marker of cardiovascular risks. Objective To investigate the clinical relevance of lipid profile and correlate with glycemic control in type 2 DM patients. Methodology This observational study used laboratory results (HbA1c and lipid profile) of 140 patients who attended various out-patient departments (OPD) of All India Institute of Medical Sciences (AIIMS), Gorakhpur. On the advice of clinicians, for routine follow-up, blood samples were collected from the patients (aged 20-50 years, 84 males, and 56 females, with a history of more than three years of type 2 DM). The sera were analyzed for HbA1c and lipid profile [which included triglycerides (TG), total cholesterol (TC), low density lipoprotein cholesterol (LDL-C) and high density lipoprotein cholesterol (HDL-C)]. Based on HbA1c levels the study subjects were divided into three groups, namely group I (HbA1c <7%, n=14), group II (HbA1c7%-8.5%, n=91), and group III (HbA1c >8.5%, n=35). Correlation studies between HbA1c and parameters of lipid profile were explored in the study. Data generated were checked for normality and correlation studies were accordingly done. Results Elevated levels of HbA1c were associated with a notable parallel increase in LDL-C levels (P<0.05), TG, and TC. There was no notable correlation observed between HbA1c and HDL-C levels. However, as HbA1c levels increased, the TG/HDL-C and LDL-C/HDL-C ratios displayed a gradual rise (P<0.05). Conclusion LDL-C and the LDL-C/HDL-C ratio serve as valuable tools for evaluating and mitigating cardiovascular disease risk and are correlated to glycemic control among individuals with type 2 DM.

Knowledge, attitude and practice towards Ayurveda among patients attending cardiology and neurology clinics at a tertiary care institute in India.

Background Ayurveda, the Indian system of medicine, has been practised in India since ages. We evaluated the overall awareness regarding Ayurveda among patients attending two specialty clinics at a tertiary care institute. Methods We did a cross-sectional study on patients attending the cardiology and neurology clinics at a tertiary care hospital in India. We conducted this paper-based survey using a standardized, validated questionnaire. Statistical analysis was performed using STATA version 14.2. Results Three hundred and ninety-seven patients agreed to participate in the study. Their mean (SD) age was 45.65 (15.02) years. Among them 68.5% were men and 56.9% were from urban areas. Participants perceived that Ayurveda comprised herbal drugs (77.6%), metallic/herbo-mineral preparations (44.3%), Panchakarma therapy (22.2%) and personalized medicine (37.8%). Principal sources of information were TV promotional programmes (34.7%) and newspaper advertisements (13.9%). Nearly two-thirds (63%) of participants opined that Ayurveda is effective in chronic disorders. Although only 9.1% of participants reported the use of Ayurvedic medicines, 89.2% believed it would be beneficial if the All India Institute of Medical Sciences (AIIMS), New Delhi had Ayurveda services. Three-fourths (75.8%) of respondents were interested to participate in research studies integrating Ayurveda with modern medicine. Conclusion Imprecise knowledge and awareness towards Ayurveda appears to prevail in addition to the low practice among the patients surveyed. We found imprecise knowledge of Ayurvedic therapies and its low usage among patients attending specialized OPDs in a tertiary care hospital. The major source of information reported was promotional advertisements in the print and electronic media. Our survey shows a need for awareness programmes for general public at various levels.

Deep convolutional neural network for glaucoma detection based on image classification

PURPOSE: Many researchers have found that the improvement in computerised medical imaging has pushed them to their limits in terms of developing automated algorithms for the identification of illness without the need for human participation. The diagnosis of glaucoma, among other eye illnesses, has continued to be one of the most difficult tasks in the area of medicine. Because there are not enough skilled specialists and there are a lot of patients seeking treatment from ophthalmologists, we have been encouraged to build efficient computer-based diagnostic methods that can assist medical professionals in early diagnosis and help reduce the amount of time and effort they spend working on healthy situations. The Optic Disc position is determined with the help of the LoG operator, and a Disc Image map is projected with the help of a U-net architecture by utilising the location and intensity profile of the optic disc. After this, a Generative adversarial network is suggested as a possible solution for segmenting the disc border. In order to verify the performance of the model, a well-defined investigation is carried out on many retinal datasets. The usage of a multi-encoder U-net framework for optic cup segmentation is the second key addition made by this proposed work. This framework greatly outperforms the state-of-the-art in this area. The suggested algorithms have been tested on public standard datasets such as Drishti-GS, Origa, and Refugee, as well as a private community camp-based difficult dataset obtained from the All-India Institute of Medical Sciences (AIIMS), Delhi. All of these datasets have been verified. In conclusion, we have shown some positive outcomes for the detection of diseases. The unique strategy for glaucoma treatment is called ensemble learning, and it combines clinically meaningful characteristics with a deep Convolutional Neural Network.

Study on good clinical practices among researchers in a tertiary healthcare institute in India.

Good clinical practice (GCP) is put in place to protect human participants in clinical trials as well as to ensure the quality of research. Non-adherence to these guidelines can produce research that may not meet the standards set by the scientific community. Therefore, it must be ensured that researchers are well-versed in the GCP. But not much is known about the knowledge and practices of the GCP in the medical colleges of North India. To assess the knowledge and practices of researchers about GCP and analyze these with respect to the demographics of participants. This is a cross-sectional study. A self-structured questionnaire about GCP, after expert validations, was circulated among researchers, at a tertiary healthcare institute, All India Institute of Medical Sciences (AIIMS), Rishikesh. A total of 59 individuals, who were selected by universal sampling, participated in the study. All healthcare workers who have been investigators of Institutional Ethics Committee-approved research projects, except residents and faculty, and are still a part of the institute have been included in the study. The study was approved by the Institutional Ethics Committee of AIIMS, Rishikesh. We used descriptive analysis and the Chi-squared test to analyze data. P value < 0.05 was considered significant. Out of 59 participants, only 11 (18.6%) were certified for GCP. Most of the participants (64.4%) had "Average" knowledge, 33.9% had "Good" knowledge and 1.7% had "Poor" knowledge. Only 49% of participants had satisfactory practices related to GCP. There was a significant difference in the knowledge based on the current academic position for the items assessing knowledge of institutional review board (P = 0.010), confidentiality & privacy (P = 0.011), and participant safety & adverse events (P < 0.001). There was also a significant difference in knowledge of research misconduct (P = 0.024) and participant safety & adverse events (P = 0.011) based on certification of GCP. There was a notable difference in the practices related to recruitment & retention on the basis of current academic position (P < 0.001) and certification of GCP (P = 0.023). We also observed a considerable difference between the knowledge and practices of GCP among the participants (P = 0.013). Participants have basic knowledge of GCP but show a lack thereof in certain domains of GCP. This can be addressed by holding training sessions focusing on these particular domains.

Impact of Sleep Duration, Quality, and Chronotype on Learning and Academic Performance: A Cross-Sectional Study Among First Year Medical Students of a Tertiary Care Institute.

Introduction The link between sleep and cognitive processes, such as memory and learning, continues to be one of the most intriguing and perplexing theories. Undergraduate medical students in their first year are particularly vulnerable to sleep disturbances. Academic achievement and learning have been linked to sleep patterns, which include not only the quantity and quality of sleep but also the timing of sleep in relation to the natural sleep onsets, or chronotypes. There have been conflicting reports on the outcomes of sleep and relatively fewer researches focused on the impact of chronotypes on learning and academic achievement among medical students. The current study thus sought to determine the chronotypes of medical students, evaluate the quantity and quality of sleep, and determine the impact of these factors on learning and academic performance. Methods The study was conducted in the Department of Physiology, All India Institute of Medical Sciences (AIIMS) Gorakhpur, India. Sleep health was assessed in 167 first-year medical students using the Pittsburgh Sleep Quality Index (PSQI), Epworth Sleepiness Scale (ESS), morningness-eveningness questionnaire (MEQ), and sleep log books. Learning and memory assessment was performed using Raven's progressive matrices test. Grade point average (GPA) was used to assess their academic performance. The relationship of sleep scores with GPA and RPM scores were obtained by linear regression analysis. One-way analysis of variance (ANOVA) and unpaired t-test were used to investigate other comparisons among categories of chronotypes and those of mean GPA. A p-value of <0.05 was considered as significant. Results The mean GPA and RPM scores obtained in the groups with PSQI ≥ 5 (2.67± 1.1, 49.51 ±6.24, respectively) and PSQI < 5 (3.15± 0.59, 54.73± 4.01, respectively) and those in the group with ESS ≥ 10 (2.72± 1.17, 50.97± 5.92, respectively) and ESS < 10 (3.15 ± 0.6, 54.18± 3.91, respectively)varied with statistically significant differences (p < 0.05). Statistically significant R-squared values for the relationship of PSQI and ESS scores with RPM and GPA scores were obtained. No correlation between academic grades and chronotype was found. Poor GPA scores were found to be associated with reduced mean sleep duration for one week before the exams. Conclusion Learning and academic performance are negatively impacted by poor sleep quality and daytime sleep dysfunction. No definite evidence for the association of sleep chronotypes with the learning and memory could be attained. Higher test performance is more closely linked to the average sleep length over a duration of time preceding the exams.

A Knowledge, Attitude, and Practice (KAP) Study on Phlebotomy Among Nurses in a Tertiary Hospital in Patna, India.

For most clinicians and nursing officers, laboratory testing is an unfamiliar part of medical caregiving, and ignorance may lead to serious avoidable errors. Phlebotomy, the first basic step towards laboratory testing, is to be taken seriously otherwise unnecessary repeat testing becomes mandatory. We hypothesized that there are some gaps in knowledge, attitude, and practice (KAP) among these nursing officers regarding practices of phlebotomy, which may influence the quality of blood samples. This study aims to assess the overall nurses' knowledge, attitude, and practice of phlebotomy to provide a remarkable improvement in blood sampling practice in our hospital. A prospective study was conducted involving nurses posted in different wards in All India Institute of Medical Sciences (AIIMS) Patna, India. A phlebotomy questionnaire was designed based on KAP on the clinical and laboratory standards of the WHO guidelines. A total of 30 questions were distributed among the nursing staff, 10 each from knowledge, attitude, and practice. Descriptive and logistic regression analyses were used to analyze the KAP levels and their influencing factors.All continuous variables were tested for normality conditions using the Shapiro-Wilk test and P>0.05 were considered for normality. The total average score of knowledge among the nurses was 7.62 (95%CI: 15.77-16.56). It was found that the nurses, on average, had a very strong positive attitude (93.36%). Regarding the distribution of practices of nurses, it was found that 87% had good practice as most of the positive practice items had high responses. The knowledge of phlebotomy among nurses was found to be satisfactory, except in a few areas. An education program on phlebotomy should be developed for nurses to improve and enhance their knowledge of phlebotomy.

Evaluation of the Diurnal Cycle of Blood Pressure and Sleep in Shift Workers.

Circadian misalignment of physiological factors in shift workers is poorly studied in the Indian population. In the present study, 24-hour blood pressuremeasurements were taken on the same subject twice, once during his morning and night shifts. Sleep was also monitored by a self-reported sleep diary, which was confirmed with an activity monitor, and the sleep quality was assessed using sleep questionnaires. This study aimed to discover the pattern of blood pressure variation, the dipping and non-dipping status, and its correlation with sleep. This observational study was conducted in the Department of Physiology, All India Institute of Medical Sciences (AIIMS), Rishikesh, from April 2019to September 2019, among security guards working rotating shifts in theRishikesh hospital premises. Participants were given an activity sheet with instructions to document their daily activities for a complete 24-hour period on the designated measurement day, including recording the time of waking up and going to sleep. A wrist-worn activity monitor was utilised to assess the self-reported sleep duration provided by each participant on the activity sheet. The present study showed the mean age of the participants as 27.03 ± 2.71 years, along with a mean body mass index (BMI) of 22.10 ± 1.64.Sleep duration was significantly higher during the morning shift (5.81 ± 1.08 hours) compared to the night shift (4.02 ± 1.70 hours) on the day of ambulatory blood pressure monitoring (ABPM) recording.The mean difference in systolic blood pressure between night shift workers between their awake and sleep periods was 15.91 ± 8.44 mmHg.However, no statistically significant disparity was seen when comparing the systolic blood pressure at the 24-hour mark during wakefulness and sleep between those working morning and night shifts(p >0.05). The current study's findings indicate that participation in shift work, particularly night shift work, could potentially play a role in the emergence of irregular circadian blood pressure patterns and potentially lead to a lack of nocturnal blood pressure decline.

The Efficacy of Utilizing the Anatomage Table as a Supplementary Educational Resource in Osteology Instruction for First-Year Medical Students.

Introduction Osteology is the detailed study of the structure of the bones. This study assesses the effectiveness of employing the 3D visualization tool Anatomage table as a learning adjunct to osteology training in first-year medical students bypost-test evaluations related to the humerus, radius, and ulna bones. Method This study was conducted in first-year medical graduate students in the Department of Anatomy, All India Institute of Medical Science (AIIMS), Raipur, India. Students included in the study were divided into two groups by simple random sampling after voluntary consent. The study group students, Group A, were taught osteology by traditional teaching and visualizing bone with a tool, an Anatomage table. The control group (Group B) is for traditional teaching. The study involved demonstrating each group's humerus, radius, and ulna bones, with sessions lasting 60 minutes. After each topic, a post-test was administered. A total of 94 students for the test for the humerus bone, 98 students for the radius bones, and 85 students for the ulna bones responded to the post-test conducted after sessions. Descriptive statistics were assessed using mean and standard deviation. Independent sample t-tests compare the mean marks obtained post-test by two groups of students. Results The results indicated that students in Group A scored higher mean marks than their counterparts in Group B across all three bone post-tests, but the significance of the differences varied. For humerus, mean marks obtained by students of Group A (Anatomage table teaching) (mean±SD: 4.00±1.10) were higher than those of Group B (traditional teaching) (mean±SD: 3.63± 1.36). Still, we do not observe a statistically significant difference in mean marks of students of Group A vs. students of Group B(P=0.166,P>0.05). For radius,we observe statistically higher mean marks among students of Group A (mean±SD: 3.72±0.944) compared to students of Group B (mean±SD: 3.22±1.08) (P=0.021, P<0.05). Similarly, for ulna, we observe higher mean marks for Group A (mean±SD: 3.18.00±1.55) as compared to Group B (mean±SD: 3.13±1.21) but do not observe a statistically significant difference in mean marks of students of Group A vs. students ofGroup B(P=0.875, P>.05). Conclusion Including the Anatomage table for visualization during osteology sessions yielded benefits for all three sessions. Future studies could employ more extensive and diverse samples to validate the findings further and incorporate qualitative methods to gain insights into students' perceptions of both teaching methods.

The Characteristics of Ocular Findings and the Presence of SARS-CoV-2 in the Tears of Coronavirus Disease 2019 Patients.

Purpose The purpose of the study is to observe the characteristics of ocular manifestationsin coronavirus disease 2019 (COVID-19)patients and to analyzethe presence of severe acute respiratory syndrome coronavirus 2 ribonucleic acid (SARS-CoV-2 RNA) in the tears of patients with moderate-to-severe COVID-19. Material and methods We conductedthis prospective cross-sectional study from February to June 2021 at the AllIndia Institute of Medical Sciences, one of the tertiary eye care centers in Nagpur, India. The study included confirmed COVID-19 patients based on real-time reverse transcription-polymerase chain reaction (RT-PCR) nasopharyngeal swabs, whether or not the patients exhibited ocular symptoms. We recorded detailed information regarding the patients' history, including demographic profile, ocular symptoms, systemic symptoms, and radiologic findings. We collected ocular samples within 48 hours of collecting naso-oropharyngeal samples from the patients' eyes. We used conjunctival swabs to obtain tear samples, which we then placed in viral transport media (VTM) for cold chain transportation to the microbiology department. We performed RT-PCR on the tear samples to detect the presence of the SARS-CoV-2virus. Result We included 40 patients in the study, with 26 (65%) classified as having moderate COVID-19, six (15%) classified as having severe COVID-19, and the remaininghaving mild COVID-19. Out ofthe 40 patients, five (12%) tested positive for SARS-CoV-2 in the tear sample using RT-PCR, seven (17%) exhibited ocular signsand symptoms, and only one tested positive for SARS-CoV-2 in their tears. The ocular manifestations observed in COVID-19 patients included dry eye, conjunctivitis (including conjunctival hyperemia and epiphora), and lid edema. Notably, we detected a positive COVID-19 tear sample in patients both with and without ocular symptoms. Conclusion Limited reports have focused on ocular involvement in patients with COVID-19. However, our study demonstrates the detection of SARS-CoV-2 in conjunctival swabs from confirmed COVID-19 patients, albeit with a lower positivity rate. Despite the low prevalence of the virus found in tears, there is a potential risk of transmission through ocular routes. It is noteworthy that we observed a COVID-19-positive tear sample in patients with and without ocular symptoms. Therefore, it is important to consider the possibility of ocular transmission even in the absence of ocular manifestations. Medical personnel should takecareful precautionsduring ocular examinations of patients diagnosed with COVID-19 to minimize the risk of transmission.

Subclavian Vein Collapsibility as a Predictor of Fluid Responsiveness in Spontaneously Breathing Hypotensive Patients

Background and Objective: Volume replacement remains the cornerstone of resuscitation in critically ill patients. This study explored the ability of the subclavian vein collapsibility index to predict fluid responsiveness. Methods: In this prospective observational study conducted in the Department of Medicine, All India Institute of Medical Sciences (AIIMS), New Delhi, sonographic evaluation of inferior vena cava and the right subclavian vein was carried out at three time points for hypotensive patients admitted to the emergency department. The study population was divided into two groups: responders and non-responders, based on a ≥ 15 % increase in stroke volume following fluid bolus. Results: Among 45 recruited patients, 33 patients were responders. The area under the ROC curve for SCV CI at baseline to predict fluid responsiveness was 0.745 (95% confidence interval: 0.549 – 0.941; p = 0.014). An SCV-CI of 46 % predicted fluid responsiveness in a hypotensive patient in terms of change in stroke volume by 15% following fluid bolus with a sensitivity of 87.88 % (95 % confidence interval: 71.80% to 96.60%) and specificity of 66.67 % (95 % confidence interval: 34.89% to 90.08%). Spearman’s correlation coefficient between IVC CI and SCV CI was 0.59 (p &lt; 0.001, n = 135). Conclusion: The results of the study demonstrated that right subclavian vein respiratory variation has the ability to predict fluid responsiveness in a spontaneously breathing patient in circulatory shock and correlates with the inferior vena cava collapsibility index. The subclavian vein can be an alternative to the inferior vena cava in predicting fluid responsiveness in spontaneously breathing patients.

P25 Healthcare associated candiduria in ICU patients: experience from a surveillance network in India, 2017–22

Abstract Background Urinary tract infections (UTI) are common healthcare associated infections (HAI) in low-and-middle-income countries including India, with limited information on Candida UTI. An ICU-based HAI surveillance network of tertiary care hospitals across India, coordinated by the All-India Institute of Medical Sciences, New Delhi and the Indian Council of Medical Research, modified the US CDC’s National Healthcare Safety Network (NHSN) case definitions to record UTI. Unlike NHSN, India surveillance includes fungal pathogens, such as Candida spp., as eligible pathogens causing HAI-UTI. We describe the epidemiology, microbiology and antimicrobial resistance (AMR) profile of candiduria cases reported to this network to address the knowledge gap on Candida UTI in India. Methods Patients with at least one UTI symptom and a positive urine culture with Candida sp. who had spent at least 2 calendar days in a participating ICU were included as candiduria events. All candiduria events reported by participating sites from 1 November 2017 to 31 May 2022 were extracted from overall UTI reported for all pathogens. The distribution of events by age, gender, ICU type, urinary catheterization, pathogen and drug resistance profile were performed. UTI rate and device utilization ratio (DUR) were calculated. Network sites performed antifungal susceptibility testing (AST) on Candida isolates using MIC-based method as per CLSI guidelines. Results Data was reported by 131 ICUs in 39 hospitals. Overall network UTI events including all pathogens were 3600; UTI rates were 2.6 (adult ICUs) and 1.3 (paediatric ICUs); DUR was 0.8 (adult ICUs) and 0.4 (paediatric ICUs). There were 1111 candiduria events, 95% were classified as catheter-associated UTI (CAUTI), and the median age of patients was 65 years (IQR 32–74 years) and 58% were male. Among 739 Candida isolates speciated, Candida tropicalis (37%), Candida albicans (36%), Candida glabrata (6%) and Candida auris (6%) were the top four species isolated. Among 220 C. tropicalis isolates tested with AST, 6.9% were fluconazole resistant and 2% of 140 were caspofungin resistant; 7% of 177 C. albicans isolates were fluconazole resistant and 6.5% of 92 isolates were caspofungin resistant; and 48% of 28 C. glabrata isolates were fluconazole resistant and 44% of 18 isolates were caspofungin resistant. Conclusions Candiduria events reported from ICUs to the HAI surveillance network-India are common and the majority are classified as CAUTI. Most of the species isolated are susceptible to fluconazole and caspofungin. Additional work is needed to understand the clinical significance of candiduria events reported to the network.