Hospital In South India Research Articles

Role of Lipid Ratios in Determining the Insulin Resistance in Polycystic Ovary Syndrome Women at a Tertiary Care Hospital in South India

Role of Lipid Ratios in Determining the Insulin Resistance in Polycystic Ovary Syndrome Women at a Tertiary Care Hospital in South India

Evaluation of a short-structured learner-centric training program on rational drug prescribing for medical interns: A quasi-experimental study.

Rational drug prescribing skills of interns remain bleak despite clinical pharmacology training during their second year, warranting the need for further training. This study was designed to evaluate the effectiveness of a short-structured learner-centric training program using the World Health Organization (WHO) guide to good prescribing in improving interns' knowledge of rational drug use and their rational drug prescribing skills. This quasi-experimental study was implemented at a tertiary care teaching hospital in South India. We conducted a short-structured learner-centric training program on rational drug prescribing for interns in September 2022, using the WHO guide to good prescribing. The medical interns who consented to participate were included in the study. A pre-test was administered at the start of the training, followed by a post-test and feedback questions at the end of the program. Statistical tests used for quantitative data were the Wilcoxon signed-ranks test and McNemar's Chi-square test. Qualitative data were analyzed using manual content analysis. Of the 77 interns who attended the training program, 73 provided consent and completed both the pre-test and the post-test. Their mean age was 22 years, with a slight preponderance of female participants (53.4%). Overall, there was a statistically significant increase in the median (interquartile range) total scores from 52 (44.6 - 60) to 84 (70 - 88) after the training (P = 0.001), out of a maximum score of 93. Also, a significantly greater number of them wrote legible prescriptions (grade 4/excellent - 44 in pre-test vs 52 in post-test; P = 0.001) after the training. The short-structured learner-centric training program based on the WHO guide to good prescribing significantly improved the knowledge of rational drug use and rational drug prescribing skills among medical interns.

131I-mIBG Therapy in the Management of High-Risk Neuroblastoma: A Retrospective Study from a Tertiary Level Hospital in South India

Abstract Introduction Neuroblastoma is the most common extracranial solid tumor in childhood. The data on the treatment experience with 131iodine-meta-iodo-benzyl-guanidine (131I-mIBG) and clinical outcome data are meager from India. Objectives This article studies the efficacy and treatment outcomes in patients treated with 131I-mIBG in high-risk neuroblastoma. Materials and Methods The study group consisted of 201 consecutive patients (aged between 1 and 15 years) with biopsy-proven neuroblastoma who underwent 131I-mIBG scans from 2012 to 2022. The majority of these children had a disease that was inoperable or had poor response to chemotherapy. Patients with positive scintigraphy were considered for therapy with 131I-mIBG. The findings were analyzed and correlated with the final diagnosis and outcomes obtained from survival during follow-up and reviewing patient records. Results Thirty-nine children, 22 males and 17 females, with a median age of 4 years had positive 131I-mIBG scintigraphy. Intra-abdominal primary lesions and osseous lesions were the most common sites of uptake on 131I-mIBG scan. Of these, 13 had upfront chemotherapy and 26 had surgery followed by chemotherapy. All the patients underwent therapy with 131I-mIBG. Fourteen patients had multiple therapies while the remaining 25 had only one therapy. Eight patients had no follow-up, and 13 had disease relapse. The remaining 18 had regression of disease which was confirmed by follow-up 131I-mIBG scintigraphy and with bone scintigraphy in patients with osseous metastases. Conclusion 131I-mIBG scintigraphy should be preferred in intermediate and high-risk neuroblastoma to know the extent of the disease and also for patient selection for early therapy with 131I-mIBG. It holds significant utility in the management of metastatic neuroblastoma, facilitating palliative pain relief and tumor size reduction in inoperable or metastatic disease.

Prevalence of transfusion-transmitted infection and reactive donor response rate in a tertiary care hospital in South India: A retrospective observational study

Abstract Background: Transfusion-transmitted infections (TTIs) are a serious problem to our blood centers as they necessitate utilization of massive resources and labor to detect and remove infected blood donations and also turn out to be a source of great distress to the patients recieving blood components and the doctors treating them. The main diseases that are made mandatory by the government to be screened are hepatitis B virus, hepatitis C virus (HCV), human immunodeficiency virus (HIV), and syphilis. Adding to this, India does not have a centralized donor notification system to notify the donors of their TTI positivity status causing the blood centers to be blind and not having a system to verify the credentials of donors making sure they were not tested positive in other centers in the country. Materials and Methods: We have done a retrospective study that aims to analyze blood center samples and look for the number of TTI positivity in our donations and compare with the total number of donations during the period of January 2016 to March 2023. The data were collected from the blood donor questionnaire and data were put up in an Excel sheet which was later analyzed on the Statistical P program. Results: During the study period, 14,257 donors donated blood. Of which 11,674 (83%) were voluntary donors and 2413 (17%) were replacement donors. About 98.7% were male donors. Among the total donors, 182 (1.27%) were positive for transfusion-transmitted infections. Among the 182 serology-positive donors, 179 (98.3%) were males and 3 (1.7%) were females. Among the 14,257 donors, 160 (1.12%) were positive for hepatitis B surface antigen (HbsAg), 2 (0.014%) for HCV, 2 (0.014%) for HIV, and 18 (0.126%) for syphilis. Among the 182 positive TTI, 160 (87.9%) donors were positive for HBsAg, 18 (9.9%) were positive for syphilis, 2 (1.1%) donors with HIV, and 2 (1.1%) with HCV positivity. Among the 182 donors positive for TTI, 81 (44.5%) donors had donated previously in various hospitals and they were not aware of their positive status. Conclusion: This study mainly aims to bring awareness to the problems that blood centers face in TTI from having to screen every sample to independently verifying donors making sure that they have never tested positive for TTI and counseling them on further tests and referrals.

Prevalence of ESKAPE pathogens and Antibiotic Susceptibility Status in Skin and Soft Tissue Infections from a tertiary care teaching hospital in South India

Background: ESKAPE “(Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa and Enterobacter sp.)” pathogens are commonly found in infections affecting the skin and underlying tissues. ESKAPE pathogens often exhibit widespread multidrug resistance in hospitals, contributing significantly to Hospital-acquired infections. ESKAPE pathogen prevalence can combat the vast challenge of Antibiotic Resistance (ABR). Materials and Methods: “The microbiological statistics of ESKAPE infections and sensitivity between January 2020 and October 2022 were extracted from the laboratory records and analysed for the bacterial profile and antibiotic sensitivity pattern”. Results: Out of the 2037 pathogens isolated from Skin and soft tissue infection, 1308 were ESKAPE pathogens accounting for a prevalence of 64.2%. Staphylococcus aureus (n=340/1308; 25.99%) was the predominant pathogen followed by Pseudomonas aeruginosa (n=332/1308; 25.38%). Among Gram-negative isolates, 29.43% exhibited multidrug resistance (MDR). Carbapenemase was found to be a frequent mechanism of resistance, highest among Acinetobacter species (n=99; 64.7%), followed by Klebsiella pneumoniae (n=109; 37.07%). Amp C production was seen most commonly in Enterobacter species (n=93; 61.2%), followed by Klebsiella pneumoniae (n=172; 58.5%) whereas ESBL production was seen in Enterobacter species (n=46; 30.03%). Conclusion: ESKAPE pathogens are critical etiologic agents of Skin and soft infections. Regular studies are vital for evaluating bacterial susceptibility and highlighting the importance of policies to reduce hospital infections and enhance antibiotic prescription oversight. Understanding virulence and resistance markers is critical for tailoring treatment strategies based on local antibiograms and managing related infections.

Clinicopathological Study of Fibroepithelial Lesions of the Breast in a Tertiary Care Hospital in South India.

Introduction Fibroepithelial lesions of the breast mainly include fibroadenoma and phyllodes tumors with overlapping morphological features and varied clinical behavior. This study aims to determine the histopathological spectrum of fibroepithelial lesions of the breast in a tertiary care hospital. Methods This is a cross-sectional study that was carried out in the pathology department from 1stJanuary 2015 to 31stDecember 2023. Relevant data of all fibroepithelial lesions reported during the study period were retrieved from the medical records, tabulated, and analyzed. The Pearson chi-square test was used to determine the significant association between the various clinicopathological parameters of fibroepithelial lesions. A p-value of less than 0.05 was taken as statistically significant. Results Out of a total of 195 fibroepithelial lesions, 185 (95%) were fibroadenoma, 07 (3.5%) were phyllodes tumors, and three (1.5%) were fibroadenoma with tubular adenoma. The most common age group was 21 to 40 years, with the majority of phyllodes tumors being more than 5 cm in size compared to fibroadenomas. The association between the clinicopathological characteristics such as age of patients, tumor size, and histological grade was statistically insignificant in this study. Conclusions The implementation and usage of morphological diagnostic criteria will help in diagnosing and categorizing this broad group of fibroepithelial lesions, thereby facilitating appropriate treatment forpatients.

Deep Learning-Based Liver Histopathology Image Classification: State-of-the-Art Techniques and Emerging Trends

This research investigates the application of deep learning techniques to enhance the diagnostic accuracy of liver tumour classification in collaboration with a prominent hospital in South India. By leveraging a carefully curated dataset of histopathological images, we evaluated the performance of several advanced deep learning architectures, including DenseNet 121, ResNet50, and VGG16. Our findings reveal that DenseNet121 outperformed the other models, achieving the highest accuracy in both training and testing phases, thus exceeding our predefined accuracy benchmarks. The superior performance of DenseNet121 is attributed to its dense connectivity, which facilitates improved feature and gradient propagation throughout the network. This study highlights the significant potential of AI-driven diagnostics in enhancing liver tumour classification, thereby optimizing the diagnostic workflow and providing substantial benefits for patient care and healthcare system efficiency.

Rationalizing irrational prescribing-infection-related attitudes and practices across paediatric surgery specialties in a hospital in South India.

Antibiotic use in paediatric surgical specialties is understudied. We investigated the antibiotic prescribing practices of paediatric general and cardiovascular surgical teams in a tertiary hospital in South India. Mixed-methods study including observations from ward rounds, semi-structured interviews, and review of antibiotic prescribing. Field notes from observations and interview transcripts were coded using NVivo and thematically analysed. Data collection and analysis were iterative and continued until thematic saturation. Quantitative data were analysed using descriptive statistics. Data included 62 h of observation, 24 interviews, one case study and 200 patient chart reviews (100/specialty). Senior surgeons make key decisions, referring to their own experience when prescribing antibiotics. Being outcome-driven, the doctors often prescribe antibiotics at the earliest indication of infection with a reluctance to de-escalate, even when an infection is not diagnosed. This practice is more acute among surgeons who consider themselves responsible for their patients' health and attribute the consistently low surgical site infection rates to this practice.In general surgery, 83.3% (80/96; 4 lost to follow-up) of patients were prescribed antibiotics for the duration of their stay with oral antibiotics prescribed at discharge. The surgeons use antibiotics prophylactically for patients who may be vulnerable to infection. The antimicrobial stewardship team was considered to have limited influence in the decision-making process. Outcome-driven decision-making in surgery leads to overprescription of antibiotics and prolonged surgical prophylaxis. The rationale for suboptimal practices is complicated by the surgeons' beliefs about the contextual determinants of health in India.

Risk Factors and Stroke Subtyping in Young Adults: A Study From a Tertiary Care Hospital in South India.

This study aimed to determine the risk factors and stroke subtypes for young ischemic stroke patients and their outcomes at the time of discharge. This is a retrospective cross-sectional study of ischemic stroke patients (n = 264) between the age groups of 18 and 45. The study population was divided into two broad age groups: 18 to 35 years and 36 to 45 years; and compared based on demographics, risk factors, the Trial of Org 10172 in Acute Stroke Treatment (TOAST) classification, and outcomes. The outcomes were compared based on the National Institutes of Health Stroke Scale (NIHSS) and Modified Rankin Scale (MRS) systems at the time of admission and discharge. The mean age of patients was 37.84±6.19 years. The male-to-female ratio was 2.5:1. The most common vascular risk factors identified were diabetes (29.16%), hypertension (49.62%), dyslipidaemia (DLP, 44.4%), and smoking (10.9%). The most common TOAST subtype was large vessel disease (38.63%), followed by the undetermined category (35.6%). The elderly group showed a high proportion of strokes secondary to small vessel disease (14.13%; p = 0.03), while cardioembolic strokes were common in the female subgroup (p = 0.05). The majority of strokes were in the anterior circulation (66.6%) as compared to the posterior (25.75%), and nearly 50% of the patients had intracranial disease. Overall, there was a favourable MRS outcome at discharge. Conventional vascular risk factors are equally prevalent, even among young stroke patients. The benchmark for young stroke age is showing a downward shift as more stroke patients above the age of 35 are showing similar risk factor trends as those of their older counterparts. The majority of stroke burden still falls under the undermined category, which requires aggressive risk factor identification and management.

Study of Serum Gamma-Glutamyl Transferase Levels in Patients With Acute Ischemic Stroke.

Background Gamma-glutamyl transferase (GGT) mediates intracellular uptake of glutathione which is a known antioxidant. GGT levels are found to be elevated in conditions of oxidative stress. Ischemic stroke results in anoxic injury, which liberates free radicals, causing glutathione to rise, which may be accompanied by a rise in serum GGT levels. This study aimed to compare serum GGT levels in acute ischemic stroke patients with normal controls and to ascertain the relation of serum GGT levels with National Institute of HealthStroke Scale (NIHSS) scores. Materials and methods This cross-sectional study was carried out in a tertiary care hospital in South India from August 2023 to February 2024. The study included 57 patients who presented with acute ischemic stroke within 24 hours of onset and 57 age- and sex-matched controls. The serum GGT levels of the cases were compared with age- and sex-matched controls using an independent t-test. Mean serum GGT levels were compared among groups with varying NIHSS scores and different locations of infarction using the ANOVA test. Serum GGT levels were also compared based on age, gender, and various comorbidities. Results The mean serum GGT levels were significantly increased (p < 0.0001) in acute ischemic stroke patients, 43.96 ± 28.02 (mean ± SD), when compared to controls, 26.14 ± 5.93 (mean ± SD). The difference in serum GGT levels with NIHSS scores of 5-15 (moderate strokes) with 34.17 ± 18.39 (mean ± SD), 16-20 (moderate-severe strokes) with 46.64 ± 21.95 (mean ± SD), and >21 (severe stroke) with84.62 ± 39.35 (mean ± SD) was significant (p < 0.00001).Serum GGT levels were not significant while comparing age, gender, location of infarction, type 2 diabetes mellitus, and hypertension. Conclusion Serum GGT levels were significantly elevated in acute ischemic stroke patients within 24 hours of presentation. Serum GGT levels were significantly elevated with increasing severity of stroke as calculated by NIHSS scores at the time of presentation. Serum GGT levels are a potential marker of ischemic stroke and its severity.

A Retrospective Hospital-Based Study to Evaluate the Results of Extensor Tendon Injuries of the Hand, Wrist, and Forearm Treated Surgically in a Tertiary Care Hospital.

Introduction The important factors determining the treatment of extensor tendon injuries include the anatomical zone, type of injury, mode of injury, chronicity, and pathology of the adjacent tissues (principally the skin, bone, and joints). Very few studies have collectively studied the outcomes of all the wrist, forearm, and hand extensors.Hence, the major aim of this study was to evaluate the resultsof extensor tendon injuries of the hand, wrist, and forearm that were treated surgically. Methodology This was a hospital-based retrospective study done in a tertiary teaching hospital in South India. A total of 30 patients (23 males, seven females) were included in the study.All the cases of extended tendon injuries of the wrist, hand, and forearm were treated surgically, and those willing to participate were included in the study afterobtaining institutional ethics committee approval. Results The study included 30 patients, predominantly males (76.66%). The majority were aged 31-40 years (33.33%). Occupational injuries were the most common cause (36.66%), followed by road traffic accidents (RTAs) and glass cuts (26.66%). Right-sided injuries were more frequent (56.66%), with zone VI being the most affected (43.33%). Extensor digitorum communis was the most injured tendon (40%). Various suture techniques were used, including horizontal mattress and modified Kessler's. Complications occurred in four patients, including hematoma and surgical site infections. Functional outcomes, assessed by Miller's Criteria, indicated extension lag and flexion loss as key recovery measures. Conclusion Hand function is essential for daily life activities, and optimal repair and reconstruction of extensor tendon injuries are crucial to avoid functional disability. While the present study demonstrated positive outcomes, further research with larger sample sizes and more rigorous designs is needed to validate these findings and improve treatment strategies for hand injuries.

A Study of the Knowledge, Attitude, Practices, and Burden of Full-time Family Caregivers in the Care of Older Adults in Bengaluru, India

Abstract Background: Globally, the aging population is expanding rapidly, impacting every aspect of the society. In developing nations like India, where family members primarily serve as caregivers for older adults, inadequate knowledge about their complex needs increases caregiver burden. The topic of caregiving has been extensively studied worldwide, mainly focused on the negative aspects of caregiving. The present study aims to assess the knowledge, attitude, practice, and burden of family caregivers providing care to older adults at homes in South India. Methods: This was a descriptive, observational study, which was conducted using a questionnaire-based approach. In this study, a purposive sampling technique was used, and a total of 56 family caregivers participated, who were caregivers to the patients admitted to a tertiary hospital in South India. Data Collection: A prevalidated questionnaire from previous studies was used to explore the knowledge, practices, and attitudes of caregivers of older patients.Caregiver burden was measured using Zarit Burden Interview. Results: The data were analyzed using SPSS v21. Caregiver burden was found to be high among those who cohabited with the patient (P &lt; 0.05). Sons/daughters and grandchildren had a better grasp about the medical conditions of older people, P &lt; 0.05. Attitude toward caring for older adults was strongly positive irrespective of the age category. Conclusion: Our study revealed that caregivers’ knowledge on the medical needs of the older population was inadequate. This study could pave the way for developing hospital policies, as well as planning action research, training, and counseling programs to strengthen family caregiver capacity and promote active and healthy aging.

Impact of Noncommunicable Diseases and Heat Stress on Estimated Glomerular Filtration Rate in Security Officers at a Tertiary Care Hospital in South India

Impact of Noncommunicable Diseases and Heat Stress on Estimated Glomerular Filtration Rate in Security Officers at a Tertiary Care Hospital in South India

Knowledge, attitude and practice towards sunscreen use among undergraduate medical students in a tertiary care teaching hospital in south India: a cross-sectional study

Background: This study was done to evaluate the knowledge, attitude and practice (KAP) of medical undergraduate students toward the usage of sunscreen as protective measures against ultraviolet (UV) radiation. Methods: A cross-sectional survey was conducted among the undergraduate medical students in a tertiary care teaching hospital in South India. A pre-designed and validated questionnaire containing 13 questions was used to assess knowledge, attitude and practice. The filled KAP questionnaires were analyzed using descriptive statistics. Results: A total of 100 medical students participated in our study. The mean age of respondents was 19.9±0.73 years. Half of the study participants (50%) were aware of the association between long term sun exposure and skin cancer. Only 17.5% of students were aware of the correct quantity of sunscreen to be used for effective sun protection.65% of respondents did not apply the sunscreen product 30 minutes prior to sun exposure. Only 40% of students could name at least 1 ingredient in sunscreen. Reapplication rates were 39.1% among respondents. Conclusions: This study indicated that the awareness and level of knowledge of sunscreen use is not adequate among the medical personnel, thus requiring health education programs to emphasize the importance of regular and correct sunscreen use. It is imperative that the medical students are adequately informed regarding sunscreen benefits and skin cancer prevention as they form the future healthcare system.

An Imperative Role of Fetal Autopsy in Previable Fetuses - ADAM Complex Revisited

Abstract Objective To identify the occurrence of the amniotic deformity adhesions, mutilation (ADAM) complex and imperative role of fetal autopsy in diagnosing this condition. Methods A retrospective descriptive study spanning nine years, from January 2014 to January 2022, was conducted at the Department of Pathology within a tertiary care hospital in South India. The study focused on analyzing the clinical presentation, prenatal ultrasonogram, and morphological features of fetuses with the ADAM complex, limb body wall complex, or amniotic bands. Results Among the 438 fetuses assessed during the study period, five fetuses showed features of the ADAM complex (0.01%). The most frequent gestational age observed was 12–18 weeks and most fetuses were female. The common anomaly encountered was limb defects, followed by abdominal and cranial anomalies. Conclusion The diagnosis of the ADAM complex relies primarily on fetal autopsy to differentiate it from similar conditions like anencephaly or body-stalk anomalies. The pathologist plays a crucial role in understanding the complexities of the ADAM complex. Advanced antenatal imaging and therapies offer potential for prevention through improved counseling.

A retrospective study of the yield of next-generation sequencing in the diagnosis of developmental and epileptic encephalopathies and epileptic encephalopathies in 0-12 years aged children at a single tertiary care hospital in South India.

Studies on the genetic yield of developmental and epileptic encephalopathy and Epileptic encephalopathies using next-generation sequencing techniques are sparse from the Indian subcontinent. Hence, the study was conducted to assess the yield of genetic testing and the proportion of children where a positive genetic yield influenced treatment decisions. In this retrospective observational study, electronic medical records of children (0-12 years) with suspected genetic epilepsy who underwent genetic testing using whole exome sequencing, focused exome sequencing and epilepsy gene panels were retrieved. Genetic yield was ascertained based on the detection of pathogenic and likely pathogenic variants. A total of 100 patients with epilepsy underwent genetic testing. A yield of 53.8% (42/78) was obtained. Pathogenic variants were identified in 18 (42.8%) cases and likely pathogenic variants in 24 (57.1%) cases. Yield was 66.6% each through whole exome sequencing, focused exome sequencing and 40% through Epilepsy gene panels (p = .07). Yield was not statistically significant across different age groups (p = .2). It was however found to significantly vary across different epilepsy syndromes with maximum yield in Epilepsy in infancy with migrating focal seizures in 2 (100%), followed by developmental and epileptic encephalopathy unspecified in 14 (77.7%), Dravet syndrome in 14 (60.8%), early infantile developmental and epileptic encephalopathy in 3 (60%), infantile epileptic spasm syndrome in 5 (35.7%), and other epileptic encephalopathies in 4 (30.7%) cases (p = .04). After genetic diagnosis and drug optimization, drug-refractory proportion reduced from 73.8% to 45.3%. About half of the cases achieved seizure control. A reasonably high yield of 53.8% was obtained irrespective of the choice of panel or exome or age group using next-generation sequencing-based techniques. Yield was however higher in certain epilepsy syndromes and low in Infantile epileptic spasms syndrome. A specific genetic diagnosis facilitated tailored treatment leading to seizure freedom in 28.6% and marked seizure reduction in 54.7% cases.

Third-Stage Complications Among In Vitro Fertilization Pregnancies: An Observational Study.

This study aimed to determine the third-stage complications and their risk factors in in vitro fertilization (IVF) pregnancies. This prospective observational study was conducted from March 2022 to November 2023 at a tertiary care university hospital in South India. We included a total of 217 women following IVF conception, and details of the third-stage labor complications were documented and expressed as the frequency with percentage. The risk factors were analyzed using a logistic regression model. Among 217 participants, 51 (23.5%) had third-stage complications. Postpartum hemorrhage (PPH) was the most common, complicating 20% of the deliveries. Multiple gestations (adjusted odds ratio (aOR) 2.7, 95% confidence interval (CI) 1.03-7.46, p = 0.04), operative vaginal delivery (aOR 57, 95% CI 4.2-770, p = 0.002), and emergency cesarean section (aOR 14.8, 95% CI 1.3-160.5, p = 0.026) were the risk factors for PPH. Intrapartum infection was found to be associated with a risk for the retained placenta (aOR 8, 95% CI 1.37-46.4, p = 0.02) and adherent placenta (aOR 6.06, 95% CI 1.07-34.3, p = 0.04). Assisted reproductive technology (ART)-related factors were not found to be significantly associated with third-stage complications. There is a risk of third-stage complications, especially postpartum hemorrhage, among IVF pregnancies. The type of embryo transfer was not associated with third-stage complications.

Why are You Late? A Descriptive Study of Delay in Treatment Seeking among Patients of Carcinoma Breast Presenting to a Tertiary Care Hospital in South India

Objectives: The objectives of this study were as follows: Primary: To estimate the proportion of breast cancer patients with delay in presentation. Secondary: To assess the reasons for delay in presentation among patients with breast cancer. To identify the sociodemographic and clinical characteristics associated with delayed presentation among patients with breast cancer. Materials and Methods: We conducted a hospital-based descriptive study at a tertiary care hospital- Jawaharlal Institute of Postgraduate Medical Education and Research (JIPMER), from a period of January 2016 to June 2016. The participants were interviewed at the time of their hospital visit with a standardised questionnaire after obtaining informed consent. The patients were asked to recall the time interval between the first recognition of symptoms and the first medical consultation. A duration of &gt;3 months was considered a patient delay. The patient reported the first symptom, and the symptoms at presentation were noted. Through clinical examination of the breasts, axilla and other systems was performed, and the positive clinical features were recorded. Results: A total of 126 women were included in the study. Out of 126 patients, 37 patients (29.4%) presented to healthcare personnel within 3 months of identifying their symptoms, and 89 patients (70.6%) presented later than 3 months. The mean duration of delay is 171.5 days, with a standard deviation of 229.45 and a median delay being 120 days. The most common cause for delay was due to the patient’s perception that the lump was harmless or temporary. The average time taken by the patients to present to JIPMER for definitive management of breast cancer after visiting a local physician was a median of 25 days and a mean of 48.77 days. The time taken for confirmation of diagnosis from the time of presentation to JIPMER was a median duration of 13 days and a mean duration of 16.58 days with a standard deviation of 12.31. About 90% of the patients had their diagnosis confirmed within 1 month. Conclusion: In our study, the proportion of delayed presentation among breast cancer patients was found to be 70.6%. Patients from rural areas and with lower educational status were found to have a higher incidence of delayed presentation. Lack of awareness of breast cancer symptoms and their misinterpretation as harmless, temporary and benign are the main reasons for delayed presentation. Patients who practised breast self-examination presented earlier. Further studies with a larger sample will help in identifying the other sociodemographic and clinical characteristics responsible for delayed presentation.

Clinical Signs of Base of Skull Fracture in the South Indian Population.

Objective The clinical signs of base of skull fracture (BSF) are often ambiguous and difficult to identify, but are often used to make decisions on early medical interventions. This study aimed to assess the prevalence of the clinical signs of BSF, their dependency to diagnose this injury and to assess the correlation between the presence of these clinical signs and the severity of head injury and patient outcome. Materials and Methods A cross-sectional study was conducted in a tertiary care hospital in South India over a period of 3 years (2020-2023). Patients older than 18 years, with radiological or surgical evidence of BSF were monitored for developing the clinical signs including Battle's signs, raccoon's sign, otorrhea, and rhinorrhea. The presence of these clinical signs was correlated with demographical characteristics, patient presentation, complications, and their outcome. Results A total of 292 patients were included in the study. The mean age of the cohort was 36.27 ± 18.68 years. A total of 55 (18.8%) showed at least one of the four signs of BSF. Raccoon's sign was seen in 9.5% cases, Battle's sign in 5.5%, otorrhea in 5.5%, and rhinorrhea in 2.4% cases. Patients with frontal ( p = 0.021) or ethmoid (0.049) fractures and ENT bleeding ( p = 0.022) were significantly more likely to present with at least one sign of BSF. The patients who presented with clinical signs were more likely to have a complication during the course of the hospital stay ( p = 0.024) than those without clinical signs, including cranial nerve palsy ( p < 0.001) and cerebrospinal fluid leak ( p < 0.001). The outcome of the patient did not change based on the presence of clinical signs ( p = 0.926). Conclusion These study results indicate a limited diagnostic value of BSF clinical signs in the South Indian population. Thus, other modalities should be considered for the diagnosis when suspected. These results also discourage the use of the nasal route in all patients with suspected head injury and emphasize that during the nasal aspiration procedure, the use of a rigid device is fundamental to avoid false passage of the aspiration tube from the nasal to the intracranial region.

Perspectives of medical undergraduate students toward self-directed learning

Objectives: Self-directed learning (SDL) is a process in which individuals take the initiative with or without the help of others in diagnosing their learning needs, formulating goals, identifying human as well as material resources for learning, implementing appropriate strategies and evaluating learning outcomes. In SDL, the onus of learning is on the learner and learning control is slowly transferred from facilitator to learner. Hence, this study helped to understand the SDL readiness in undergraduate medical students and figure out whether it differed between students of 2nd and 3rd professional years. Materials and Methods: The study was conducted on undergraduate medical students of 2nd and 3rd professional year of tertiary care medical college hospital in south India after receiving permission from the Institutional Ethics Committee. A total of 285 students were considered in this study from both years after informed consent. A pre-validated questionnaire of the self-rating scale for SDL (SRSSDL) tool was included, and it comprised five components, namely, awareness, learning strategy, learning activity, evaluation and interpersonal skills, with 12 questions in individual sections. Demographic data were expressed in percentages while the Chi-square test and independent sample Mann–Whitney U-test were applied to understand the differences between 2 professional years. Results: Out of 285 students, 56.8% had a moderate level of readiness, followed by a high level of readiness (42.9%). The majority of the students from both academic years had a moderate level of readiness toward SDL. Learning strategy had the highest mean response score of 3.7 ± 0.52, followed by awareness with 3.69 ± 0.49. This mean score reflects that the majority of participants’ responses recorded were either ‘sometimes’ or ‘often’ for various components of the SRSSDL tool. The distribution of awareness, learning strategy, learning activities, evaluation and interpersonal skills did not show any significant association across academic years and gender. Conclusion: The moderate level of readiness shows that areas of improvement must be identified and evaluated with teacher guidance when necessary. The SRSSDL tool can be used as a measure of evaluation, as it helps to classify student readiness toward SDL.