All India Institute of Medical Sciences, Patna

Major histocompatibility complex class I deficiency results from deleterious biallelic variants in TAP1, TAP2, TAPBP, and B2M genes. Only a few patients with variant-curated TAP1 deficiency (TAP1D) have been reported in the literature and the clinical phenotype has been variable with an emphasis on autoimmune and inflammatory complications. We report TAP1D in a Nepalese girl with a severe clinical phenotype with serious viral infections at a very young age. A novel frameshift termination variant near the protein’s amino (N-) terminal was found. Variants in exon 1 of the TAP1 gene (as in our case) have not been reported previously. We also perform a brief review of TAP1D that hints at potential genotype-phenotype correlations. However, these findings need to be interpreted with due prudence given the small number of patients with TAP1D reported thus far.

Background Children with autism spectrum disorder (ASD) exhibit atypical responses to sensory stimuli. These sensory and perceptual issues persist as hyper-, hypo-, or atypical sensory reactivity that impacts their daily activities. The present protocol describes a method for developing a locally relevant and simple instrument for identifying and estimating the severity of sensory reactivity in children with ASD. Novelty Employing a consultative approach, the authors aim to develop and validate an Indian instrument to assess sensory reactivity in children with ASD. Objectives To gather insights from parents and experts about sensory reactivity patterns in children with ASD and to use this information to create and validate a culturally relevant tool for measuring the severity of sensory reactivity in these children. Methods This study will be conducted in two phases following an exploratory sequential mixed-method design. In the first phase, data will be collected through in-depth interviews of parents of children with ASD and focused group discussions with the experts. The collected data will be used to identify different themes and domains related to sensory reactivity. A questionnaire will be developed based on their inputs. In the second phase, the instrument will be analyzed further using exploratory factor analysis to obtain the factor structure and confirmatory factor analysis to test the factor structure of the developed instrument. Expected Outcome A simple, reliable, and validated severity instrument will be developed for children with ASD and made accessible to all for convenient use.

Background Panic disorder is associated with autonomic nervous system dysfunction and reduced heart rate variability (HRV). Enhancing HRV may help mitigate symptoms of panic disorder. This study investigated the effects of Rajyoga mindfulness meditation training on HRV in patients with panic disorder. Methods This prospective randomized controlled trial included 110 patients with panic disorder recruited from a psychiatry department in India. Participants were randomized to either an 8-week Rajyoga meditation intervention (n = 55) or a waitlist control group (n = 55) receiving standard treatment alone. HRV was measured at baseline and after 8 weeks using time domain (SDRR, RMSSD, pNN50) and frequency domain (total power, HF, LF, LF/HF ratio) parameters. Results At baseline, there were no significant differences in demographics or HRV parameters between groups. After 8 weeks, the Rajyoga group showed significant increases in SDRR, RMSSD, pNN50, and total power compared to controls ( P < 0.05), indicating improved parasympathetic activity. The LF/HF ratio decreased in the Rajyoga group versus controls, suggesting a shift toward parasympathetic predominance. Conclusions Eight weeks of Rajyoga mindfulness meditation training improved HRV and parasympathetic activity in patients with panic disorder compared to standard treatment alone. Rajyoga meditation may be a beneficial adjunctive intervention for enhancing autonomic regulation in panic disorder.

Postoperative nausea and vomiting (PONV) are among the most distressing postoperative complications, affecting up to 30% of all surgical patients and up to 80% of high-risk individuals.[1,2] While operating room and post-anaesthesia care unit (PACU) protocols effectively manage early-phase PONV, gaps emerge during transitions to the ward or intensive care unit (ICU).[3,4] These discontinuities prolong recovery, increase costs and reduce patient satisfaction.[5] Multimodal strategies for PONV prophylaxis are effective,[6,7] but inconsistent implementation limits their impact. To address this, we developed the continuum-based PONV prophylaxis protocol (CBPPP), a stepwise protocol covering the entire perioperative continuum, and designed a checklist for clinical application.

In India, Gender-Based Violence (GBV) continues to be a significant issue affecting women across all sectors, including healthcare. This violence is driven mainly by the societal norms of patriarchy as well as systematic inequalities that have numerous and devastating effects on the social life of women, leading to psychological trauma, poorer health outcomes in underserved communities, and loss of trust in the healthcare system. There have been several legal frameworks, such as the Protection Human Rights Act, the Sexual Harassment of Women at Workplace Act, and the Protection of Women from Domestic Violence Act. Despite these initiatives, gaps still exist, mainly in enforcing and reducing the cultural stigmas contributing to the ongoing vulnerability of female healthcare professionals. By strengthening security measures and educating the public on gender sensitivity while empowering female healthcare workers, GBV may be mitigated. This paper highlights the urgency for a comprehensive and intensive approach towards ensuring a safer environment for women in healthcare to work and thrive in India. Cultural shifts, legal enforcement, and continuous advocacy efforts are also required.

Adherence to the highest ethical standards is mandatory while handling precious human tissues received through the altruistic act of body donation. In 2019, misconduct at the Body Donation Center in Paris led to its closure. This adversely affected the hands‐on human dissection sessions within the anatomy education program at Université Paris‐Saclay. Consequently, the anatomy education program needed to be modified to bridge the gap between theoretical anatomy knowledge and its reinforcement by hands‐on human dissection. Anatomy educators at Université Paris‐Saclay designed an “illustrator‐anatomist‐clinician” triad‐based pedagogical model, which was incorporated as a core component of an elective module for third‐year medical students. This model involves a combination of live illustration, dissection‐demonstration, and clinical correlation of anatomical details of selected regions of the human body. An illustrator presents and interprets anatomical detail as the anatomist reveals these structures in a stepwise dissection approach, and a clinician completes the triad by presenting clinical cases relevant to the respective anatomical region with their surgical and radiological details. The present study aims to describe the structure, implementation, and outcome of this triad‐based pedagogical model. It may be applicable to other anatomy education programs that face access problems to hands‐on human dissection for various reasons and demonstrate its feasibility as a resource when human dissection is not available.

Background Congenital intracranial lipomas are rare, representing only 0.1–0.5% of brain tumors, and are typically asymptomatic. An extracranial component is exceedingly rare, usually reported in slow-growing adult cases. This report presents a unique case of a rapidly growing congenital intracranial lipoma with extracranial extension in a pediatric patient. Case Description A 3-year-old girl with a progressively enlarging forehead mass, present since birth, was found to have a large interhemispheric lipoma (12 × 10 × 9 cm) extending into the left lateral ventricle and connected to an extracranial mass (17 × 10 × 10 cm) through a frontal bone defect. Additional findings included corpus callosal agenesis and venous drainage from the scalp lesion into the superior sagittal sinus. The microsurgical intervention involved the excision of the extracranial lipoma and subtotal resection of the intracranial component, preserving critical neurovascular structures. Conclusion This case of rapid lipoma growth in a pediatric patient is atypical, differing from slow-growing, asymptomatic presentations in adults. High-magnification microsurgery and Doppler guidance facilitated safe resection with a positive outcome. This case highlights the need for further research into developmental factors and rapid growth mechanisms in pediatric intracranial lipomas with extracranial components, potentially representing a distinct clinical entity.

Background Ketamine (KT) is known to have analgesic and sedative effects. Intranasal (IN)/inhalational KT has been used in different trials involving paediatric patients for analgesic and anxiolytic function. The present meta-analysis was conducted to establish the role of IN/inhalational KT compared to that of inhalational opioids (OPs). Summary A systematic literature search was performed through the Cochrane Library, Pub Med and ClinicalTrials.gov databases from inception to February 2024 using the following keywords: inhalational OR IN OR nebulised’ and ‘ketamine’ and ‘analgesia’. Randomised clinical trials published in English that analysed the efficacy and safety of inhalational KT either alone or as an adjunct to the standard of care (SoC) compared to OP in paediatric patients undergoing various procedures were included in the analysis. The important outcomes included patients who were pain responders, required rescue analgesics, achieved mild-moderate sedation and experienced any adverse events (AEs), dizziness, nausea/vomiting or unpleasant taste. A trial sequential analysis (TSA) was also performed. The analysis included seven studies with 489 paediatric patients. In the KT group, a smaller number of patients were pain responders and required rescue analgesics (RR = 0.94; 95% CI = 0.78–1.13; P = .52 and RR = 0.80; 95% CI = 0.44–1.43; P = .45, respectively). Similarly, more patients in the KT group achieved mild-moderate sedation and experienced any AEs (RR = 1.44; 95% CI = 0.95–2.18; P = .09; and RR = 1.99; 95% CI = 1.47–2.69; P < .00001, respectively). A greater number of patients experienced dizziness (RR = 5.47; 95% CI = 3.12–9.58; P < .00001) and an unpleasant taste (RR = 2.91; 95% CI = 1.51–5.61; P = .001) in the KT group. In the meta-analysis, the required information size (RIS) could not be obtained. Key Message KT had efficacy outcomes comparable to those of OP, but KT had very high adverse effects. OP seems to have better tolerability than KT. However, as the number of patients was less than the RIS, it was not possible to draw any conclusions.

BACKGROUND “Emphasizing time on task” has been included in the seven principles of undergraduate medical education. Improper time management (TM) leads to frustration, dissatisfaction, anxiety, and depression of not achieving the desired academic performance. This study was planned to examine the relationship between TM, self-directed learning readiness, and academic performance among the medical students of a tertiary healthcare institution. MATERIALS AND METHODS This cross-sectional study was conducted among 295 medical undergraduate students for six months using a standard tool Fisher’s self-directed learning readiness (SDLR) questionnaire for SDL readiness and Britton and Tesser’s TM questionnaire for TM-skills. An SDLR score of ≤150 and a TMQ score of ≤58 were taken as low readiness for SDL and poor TM skill. Descriptive analysis was performed, and a multivariable binary logistic regression analysis was performed to discover the correlation of good TM skills. RESULTS A total of 175[59.3%, 95% CI: 53.6–64.9] had low readiness for SDL, and 216[73.2%, 95% CI: 67.9–77.9] had poor TM skills. Academic scores showed a weak positive correlation (r = 0.2, P = <0.001) with TM scores. Females [adjusted odds ratio (AOR) = 2.9,95% CI: 1.6–5.6], students belonging to rural domicile [AOR = 2.3, 95% CI: 1.1–3.8], and high readiness for SDL [AOR = 4.8, 95% CI: 2.6–8.8] were independent correlates of good TM skills. CONCLUSION Every six and seven out of ten medical undergraduates were found to have low readiness for SDL and poor TM skills, respectively. Emphasizing SDL as a part of professional education and the importance of TM in professional courses such as Medicine and Bachelor of Surgery is important.

Initially developed as a nootropic agent, levetiracetam is now widely used as a treatment for convulsive disorders including partial seizures, myoclonic seizures, and idiopathic generalised epilepsy. Levetiracetam has also been found to be useful in acute mania, and as an add-on treatment for major depression [1]. The most common side effects of levetiracetam include drowsiness, dizziness, ataxia, diplopia, memory impairment and paresthesia. There are very few case reports showing significant weight loss occurring due to use of levetiracetam. We are reporting such a case, where a 24 year old married women who was treated with levetiracetam lost 10 kgs in 3 months. Keywords: Levetiracetam, myoclonic seizures, idiopathic generalised epilepsy, complex partial seizure, weight loss.

Sex-related disorders are often underreported entities in developing countries probably due to social stigma, lack of knowledge, and the personal significance of sex in their life [1]. Digital media offers portability, access, and visually explicit depictions of sexual acts in high-definition that leave nothing to the imagination [2]. Terms like sex addiction or compulsive sexuality are not incorporated in DSM-5, however, we do come across such cases in Psychiatry practices. Many sex addicts have an associated psychiatric disorder and there exists a correlation between sex addicts and substance-use disorders (up to 80 percent in some studies), which needs specific treatment in the line of dual diagnosis. The ICD-11 codes for impulse control disorders are 6C70-6C7Z. Impulse control disorders can involve a range of behaviours, including fire-setting, stealing, explosive outbursts, etc. ICD11, in its code 6C72, describes Compulsive Sexual Behaviour Disorder as a separate entity [3]. We are reporting such a case where the initial presentation prompted us to work on the line of Schizophrenia, but later it turned out to be a case of Compulsive Sexual Behaviour Disorder. Keywords: Compulsive Sexual Behaviour Disorder, Digital Media, Pornography

Background and Objectives Chronic Obstructive Pulmonary Disease (COPD) is now one of the top three causes of death worldwide. Recently, increased focus has been on COPD patients displaying eosinophilic inflammation and asthma-like features of bronchial hyperreactivity and bronchodilator responsiveness. The objective of the study was to measure the proportion of chronic obstructive pulmonary disease patients with bronchodilator reversibility and to compare the eosinophilic biomarkers between the bronchodilator non-reversible and reversible groups. Materials and Methods This hospital-based cross-sectional study included COPD patients who visited the Pulmonary Medicine OPD at the All-India Institute of Medical Sciences, Patna. Spirometry and eosinophilic biomarkers such as blood eosinophil, sputum eosinophil, FeNO, and serum IL-5 were measured. All statistical calculations were conducted using SPSS (Statistical Package for the Social Science 22 version (SPSS, Chicago, IL, United States). Results A total of 160 COPD patients were included in the study. The mean age of the study population was 61 (±10) years. Males (68.1%) and non-smokers (55%) respectively were predominant. The prevalence of bronchodilator reversibility was found to be 32%. There was a significant difference in eosinophil biomarker levels, of sputum eosinophil count, peripheral eosinophil count, and FeNO levels between the bronchodilator non-reversible and bronchodilator reversible groups. Serum IL-5 levels were higher and more significant in GOLD group D patients. Conclusion Eosinophils are crucial to the underlying inflammatory response in this subset of COPD patients, as evidenced by the observation that eosinophil biomarkers were significantly higher in COPD patients with bronchodilator reversibility. Also, sputum eosinophil levels had a better correlation in comparison to peripheral eosinophil level in this subset.

Endometriosis is an ectopic implantation of uterine tissue and can affect the thoracic cavity, resulting in Thoracic Endometriosis Syndrome (TES). TES is rare and presents with catamenial pneumothorax, haemothorax, and hemoptysis, often coinciding with menstruation. We report a case of a 46-year-old female with a decade-long history of hemoptysis and periodic chest pain associated with her menstrual cycle. High-resolution CT scans revealed persistent pneumothorax and pleural nodules. A dry thoracoscopy was performed, and biopsies confirmed the diagnosis of TES through histopathology and immunohistochemistry. This case highlights the importance of considering TES in women with cyclic respiratory symptoms and demonstrates the diagnostic value of dry thoracoscopy in benign conditions of the pleura. Raising awareness among clinicians is crucial for timely diagnosis and management of TES, reducing patient morbidity.

Scleral‑fixated intraocular lenses (SFIOLs) are proving to be a great choice for the management of aphakia and loss of ample capsular support. The optimal technique for treating aphakia without capsular support remains uncertain. Sutured, glued,and sutureless glueless techniques have evolved, each having advantages and caveats. This article discusses various methods of scleral fixation of intraocular lenses highlighting the innovations in the field for the awareness of ophthalmic surgeons regarding the gamut of options available enabling them to make the best choices for their patients.

Rotavirus (RV) is a leading cause of severe gastroenteritis in infants and young children, often resulting in dehydration and hospitalization. Although global data on RV is well-documented, there is limited information on its prevalence and genetic diversity in Bihar, India. This study aimed to investigate the prevalence of RV infections in the patient, from January 2021 to June 2024, and assess the associated molecular and epidemiological patterns. In this retrospective study conducted at the Rajendra Memorial Research Institute of Medical Sciences, Patna, 1,820 stool samples from patients suspected of RV infection were collected. Enzyme immunoassays were used to detect RV antigens, and positive samples were confirmed by real-time polymerase chain reaction targeting the VP4, VP6, and VP7 genes. Phylogenetic analysis was performed to examine genetic diversity. Results showed a 10% positivity rate for RV, with 5% showing equivocal results. The highest prevalence was in the 6–11 years age group (72 positive cases), followed by the 0–5 years group (62 positive cases). Prevalence decreased in older age groups, suggesting immunity through natural infection or vaccination. Phylogenetic analysis revealed distinct regional clusters and genetic variability between strains from Bihar and other parts of India, such as New Delhi and Kolkata. This study provides valuable baseline data on RV prevalence and genetic diversity in Bihar, emphasizing the need for vaccination and surveillance, particularly for younger children at higher risk. The observed genetic diversity suggests regional variations, highlighting the importance of continuous surveillance across India.

Podocyte infolding glomerulopathy (PIG) is a rare kidney disorder characterized by the infolding of podocyte processes into the glomerular basement membrane. The condition presents with nephrotic syndrome, yet its pathogenesis and clinical implications remain poorly understood due to limited case reports. Most documented cases have originated from Japan, highlighting a significant gap in the literature regarding its prevalence and characteristics in other regions, including the Indian subcontinent. A 5-year-old boy presented with hypertension, edema, nephrotic range proteinuria, and 3 weeks later developed macroscopic hematuria. Kidney biopsy revealed characteristic microtubule formation within the glomerular basement membrane, confirming the diagnosis of PIG. Initial treatment with prednisolone was unsuccessful, leading to the addition of tacrolimus which resulted in significant improvements in the child’s proteinuria and hematuria. This case contributes to the limited literature on PIG and highlights the need for more research to establish standardized treatment protocols.

Background The Association of Plastic Surgeons of India (APSI) felt the need to create an opportunity for the residents to participate in a mock viva voce patterned course on the national platform in front of examiners from the various centers and instill a feeling of confidence and healthy competition among them. Apart from the responsibilities of teaching departments running the formal plastic surgery training programs, the association also took upon itself to further strengthen the academics, especially of residents working at centers that lack regular teaching classes, and started the postgraduate medical education course in October 2022. Materials and Methods The course module was divided into nine sections: one long case, five short cases, instrument, radiology, operative. It was conducted over 2.5 hours for two consecutive evenings on an online platform (apsi.vidocto.com). The flow comprised presentation by the resident with two faculty examiners for asking questions and two course mentors for observation followed by feedback to the resident on his/her performance. Course feedback was collected in a Google form. Results A total of eight courses have been conducted to date. The online synchronous viewership varied from 83 to 172 (mean, 115.94 ± 34.01), out of which 62 to 67% (mean, 74.18 ± 4.06) were residents and 33 to 38% (mean, 40.28 ± 3.93) were faculty. These courses were also archived for later access. The feedback showed that 96.6% participants agreed that the objective to enhance knowledge was achieved and 100% agreed that such a program will benefit in gaining confidence. Thirty-one percent students rated their learning experience after the course as 10 on a scale of 1 to 10. The majority of the faculty and residents preferred the online mode. Conclusion Being a maiden initiative of its kind, the APSI-PGME is a competency-driven course that has significantly enhanced the residents' confidence as a result of gain in knowledge and understanding.

India contributes one-third of the global burden of rabies. In 2021, the National Action Plan for Rabies Elimination (NAPRE) was introduced to eliminate dog-mediated human rabies. The major challenges in the path of eliminating dog-mediated rabies are toward achieving the high level of dog vaccination coverage and its sustenance, as well as rigorous tracking of dogs and continuous outreach activities. Oral vaccination of dogs (OVD) is a measure that has been implemented in several countries. For a deeper understanding of the OVD strategy, a systematic search was conducted and free full-text articles related to feasibility of OVD adoption and field trials published in the past ten years were included in the present review. Based on evidence, OVD can be implemented in India along with existing government initiatives as a pilot project in selected hotspots and subsequently expanded to improve vaccination coverage.