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   Table of Contents - Current issue
Coverpage
January-March 2020
Volume 6 | Issue 1
Page Nos. 1-47

Online since Friday, March 27, 2020

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EDITORIAL  

What's new in Academic International Medicine? Local advocacy for local problems: Involving the stakeholders in the involved citizen project p. 1
Chantel Gray, Thomas J Papadimos
DOI:10.4103/IJAM.IJAM_14_20  
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REVIEW ARTICLE Top

The more the merrier: Acute care advanced practice registered nurses and antimicrobial stewardship p. 4
Cindy A Byrd, Anthony T Gerlach
DOI:10.4103/IJAM.IJAM_22_19  
In the last decade, there has been a dramatic increase in advance practice registered nurses (APRNs) in the acute care setting. In 2017, the Joint Commission issued antimicrobial stewardship (AMS) standards for the acute care setting. The role of the APRNs has not formally been recognized in the guidelines for implementing and operative AMS programs. Regardless, APRNs are increasingly performing essential roles in antibiotic stewardship, and the aim of this review is to describe areas APRNs can impact antibiotics stewardship. Articles that described AMS process were indexed from PubMed. APRNs have expertise in managing and coordinating care for across many clinical conditions and are able to improve the quality of care and improve AMS. The following core competencies are addressed in this article: Medical knowledge, Patient care.
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ORIGINAL ARTICLES Top

Development and implementation of a first responder program in rural Haiti: The involved citizen project p. 10
Annelies De Wulf, Adam R Aluisio, Briana L Hecht, Christina Bloem
DOI:10.4103/IJAM.IJAM_7_19  
Background: Northeast Haiti lacks comprehensive prehospital emergency medical services (EMS). Most patients requiring medical care are transported via motorcycle taxis or on foot. This project evaluates the feasibility and impact of a train-the-trainer program designed to improve capacity of community members to provide initial emergency care through contextually adapted first aid skills. Methods: This observational cohort study identified a geographically representative cohort of leaders to serve as trainers. These leaders were trained to teach a locally oriented first aid curriculum designed in concert with Haitian partners. This curriculum emphasized use of readily available materials in provision of care and was aimed at locally prevalent conditions. An accompanying Haitian Creole course manual with embedded teaching guides was developed. These trainers in turn trained local community members, with recruitment focused on local drivers who can ultimately act as de facto first responders in the region. Results: Thirty-five individuals were recruited, of which 51.4% achieved criteria to become independent trainers. Within 6 months of the initial training course, 44.8% of trainers reported using the skills they had been taught. The trainers taught 271 community members first aid skills within the study period. Of these, 33.1% of participants reached in follow-up surveys reported providing first aid in their communities and 19.8% had transported persons in need of emergency care to a healthcare facility since completion of the course. Conclusions: This train-the-trainer model is an effective method for strengthening the capacity of communities to care for medical emergencies in the Northeast region of Haiti. This program may be important to building a future formal EMS system in the region and may be applicable to similar resource-limited settings. The following core competencies are addressed in this article: Patient Care, Medical Knowledge, System-Based Practice.
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Insulin resistance in non diabetic individuals with acute myocardial infarction and its relationship with acute phase reactants p. 22
Smita Nath, Rina Mohanty, Uttam Kumar Patnaik
DOI:10.4103/IJAM.IJAM_9_19  
Aim: The current study was undertaken to assess the prevalence of insulin resistance (IR) in nondiabetic individuals with acute myocardial infarction (AMI) and to study the relationship between IR and acute-phase reactants in patients with AMI and to ascertain its prognostic significance. Materials and Methods: One hundred nondiabetic individuals with AMI were part of the study. A detailed physical examination and estimation of fasting blood sugar, 2 hPost prandial blood sugar (PPBS), fasting serum insulin, highly sensitive c-reactive protein (hsCRP), and lipid profile was done at admission and then after 3 months of follow-up. IR was calculated using Homeostatic model assessment IR (HOMA IR) and HOMA B method. HOMA IR value of >2 was considered as IR. Results: In the present study, the prevalence of IR was 63% (males = 63.4% females = 60.8%). hsCRP levels were elevated in 87.4% (hsCRP = 3.187 ± 1.4109 [mg/l]) of insulin-resistant individuals and 86.5% normal individuals (hsCRP = 3.950 ± 1.390 [mg/L]). At the end of 3 months, hsCRP levels in the group with IR was 2.346 ± 0.883 mg/L and in the group with no IR was 1.779 ± 0.875 mg/L (P = 0.043). The prevalence of metabolic syndrome in the study population was 24%. Mortality rate was higher in patients with IR at 3.2%. Conclusion: The study shows that the prevalence of IR is high, even in nondiabetic patients with coronary artery disease.Level of Hs CRP which is a marker of inflammation was found to be raised in the entire study population irrespective of insulin resistance status. However, in patients with IR, the level of hsCRP remained high even on follow-up study. IR and acute-phase reactants like hsCRP can be used in addition to the traditional risk factors to evaluate the progress and outcome of cardiovascular disease. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement, and Systems-based practice.
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Critical appraisal of different university assessment papers in pharmacology according to the three Rs criteria p. 28
Monica Jain, Kopal Sharma, Shivankan Kakkar
DOI:10.4103/IJAM.IJAM_21_19  
Background: In this study, we had attempted to evaluate pharmacology examination papers of various Indian medical universities according to the three Rs criteria (i.e., reduce, refine, and replace). This could provide an insight into the deficiencies in the present assessment pattern and aid in necessary improvements. Materials and Methods: The past 10-year (2010–2019) university assessment papers for the second professional medical students in pharmacology subject from Rajasthan (Group A) were evaluated and compared with the same years' assessment papers from different states outside Rajasthan (Group B). Each question paper was scored. For “Reduce” criteria, a maximum score of 40 was given. Similarly, the maximum score for “Refine” category was 40. As “Replace” is an overlapping criterion, the paper could score a maximum of 20 scores only. A question paper could score a maximum of 100 score if it fulfills all the parameters for the given criterion. Thereafter based on the scores, grades were given to the papers. Results: There was a statistically significant difference in the scores of both Group A and Group B (P = 0.037). The mean score for Group A was greater than the Group B. Papers in both the groups need improvement in terms of the three Rs criteria. Conclusion: University question papers in pharmacology from Rajasthan universities as well as outside Rajasthan need improvement. It is only through the revisions in the pattern of assessment we would be able to train the students to achieve different competencies as per the new Medical Council of India curriculum. The following core competencies are addressed in this article: Medical knowledge, Patient care, Interpersonal and communication skills, Systems-based practice.
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CASE REPORTS Top

A case report of ocular Stevens–Johnson syndrome: An important condition for the internist to see p. 33
Patrick Jenkins, Alexander Enurah, Dmitriy Scherbak
DOI:10.4103/IJAM.IJAM_33_19  
A patient was admitted with Stevens–Johnson syndrome (SJS) and found to have ocular manifestations including eyelid edema, conjunctival hyperemia, and worsening pseudomembranes which threatened his vision. He was referred to a corneal specialist and successfully treated with topical therapy and amniotic membrane grafts. This case is important because while ocular manifestations of SJS are common, there is a lack of awareness of its prevalence and available treatment modalities. Rapid diagnosis and initiation of treatment is crucial to avoid devastating and permanent ocular complications. The following core competencies are addressed in this article: Patient care, Medical knowledge, and System-based practice.
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Is emphysematous pyelitis a precursor lesion of emphysematous pyelonephritis? A case report of bilateral emphysematous pyelitis caused by extended-spectrum beta-lactamase Escherichia coli and literature review p. 36
Mehboob Ahmed Rehan, Asma Rashid, Quincy Tran, Ahmed Mahmood, Usman Khan, Speirs Shawn, Douglas Whatmore
DOI:10.4103/IJAM.IJAM_27_19  
The presence of air in different parts of renal excretory system needs accurate assessment, and careful consideration as its progression to renal parenchyma can lead to fulminant course with substantial mortality. Bilateral emphysematous pyelonephritis is a well-known entity, but bilateral emphysematous pyelitis (EP) along with emphysematous cystitis is extremely rare. An internet search with the term “bilateral emphysematous pyelitis” and “bilateral emphysematous pyelitis and ureteritis with cystitis” only found three case reports in English. We present an interesting case of bilateral EP, ureteritis, and cystitis in a nondiabetic male patient without any history of immunodeficiency (HIV or chronic steroid use) but with a history of nonobstructing bilateral multiple renal calculi who was successfully managed medically. EP, if diagnosed early and managed properly, has an excellent prognosis with complete recovery following medical treatment. The following core competencies are addressed in this article: Practice-Based Learning and Improvement, Patient care and Procedural skills, Medical Knowledge.
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SHORT COMMUNICATION Top

Assessing the impact of e-learning in medical education p. 40
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/IJAM.IJAM_5_19  
E-learning in the field of medical education has been associated with multiple benefits, especially in terms of testing the higher skills of the cognitive domain. E-learning has resulted in a major impact as it has given an opportunity for adaptability to diverse learning styles of the students and that it can meet the learning needs of the increasing number of medical students. The findings of different studies done to assess the impact of adoption of e-learning have indicated highly encouraging results. However, despite all the available evidence suggesting the effectiveness of the adoption of e-learning, it is also important to consider the inherent limitations. In conclusion, adoption of e-learning has resulted in a major positive impact on the acquisition of knowledge and skills in the field of medical education. Now, it is the time to take steps to integrate it within the existing curriculum and help students to become a self-directed and a lifelong learner. The following core competencies are addressed in this article: Medical knowledge, Practice-based learning and improvement, Interpersonal and communication skills, Professionalism, and Systems-based practice.
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HYPOTHESIS GENERATING RESEARCH Top

Halting dehumanization in medicine p. 43
Vijayaraghavan Padmanabhan
DOI:10.4103/IJAM.IJAM_23_19  
Dehumanization in medicine extends beyond doctor–patient relationship and affects the whole health-care system. It affects the physician himself who has become more of a doctor-machine. The constant expansion of medical information, the objective approach, and the compulsion to remain in touch with evidence-based updates, takes the physician away from the patient. Much of the increase in medical knowledge is downstream (body dimension), whereas the primary cause may remain the same upstream (mental and spiritual dimensions). In the conventional body medicine, there is little requirement for empathy and a persistent demand for use of the analytic mind. Intuitive approach being efficacious, fundamental, and creative, is able to connect the physician to inner joy but is neglected. The “quantum-aware” approach, where there is balanced consideration of all the three components: body, mind-body and mind-body-spirit medicine, allows the physician to be competent, intuitive, creative and empathetic. Health-care delivery and the process of medical education are modified accordingly. The following core competencies are addressed in this article: Patient care, Medical knowledge, Interpersonal and communication skills, Systems-based practice.
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ERRATUM Top

Erratum: Evaluating patients using mission services in the dominican republic p. 46

DOI:10.4103/2455-5568.281458  
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