Madras Medical College

Employment can play a vital role in providing financial stability, opportunities for personal growth, a sense of purpose, and social inclusion. While people with mental illness could benefit greatly through employment, they often face challenges in acquiring and sustaining employment. In India, understanding the complexities of employment for those with mental illness is vital, considering the existence of societal stigma and limited resources. This review aims to explore existing articles that address employment and people with mental illness in India by identifying themes, areas for intervention, and other factors that influence employability. Following Arksey and O'Malley's framework, the existing literature was synthesized in 5 electronic databases (EBSCO, PubMed, CINHAL, PsychInfo, and Embase) using specific search terms from past 20 years (June 2003 to June 2023) of research articles. The scoping review identified several key themes and challenges including demographic and social factors, illness profile, stigma and discrimination, Challenges and barriers, and support intervention. The review underscores the multifaceted nature of barriers faced by Persons with Mental Illness in employment and emphasizes the importance of tailored supportive interventions. This finding will guide the researchers/Clinicians to create a culturally feasible and effective Supported employment model for persons with mental illness in India.

The study aimed to investigate the assessment of farm profiles, knowledge gain, and adoption behaviours of biosecurity practices following a training intervention in commercial poultry farms in Tamil Nadu. A total of 89 farmers from commercial desi (32), layer (30), and broiler (27) farms participated in the training program. The biosecurity assessment used an evaluation framework with a two‐day training program. Participants completed pre‐ and post‐training surveys to measure knowledge gained during the training. Additionally, we conducted a follow‐up evaluation of adoption behaviours after 90 days of training intervention. Questionnaire data were analysed using paired sample t‐test, chi‐square, and regression analysis. Results revealed that 89% of the trainees were male, 90% were in the age group between 21 and 60 years, and 88% had a secondary education level or higher. Further, 56.2% of farmers had 5–20 years of experience in poultry farming, and 46.1% of farmers revealed that the significant source of income is from poultry farming and agricultural practices. A pre‐ and post‐survey data comparison showed that all the farmers had significant knowledge gain (p < 0.01) in all the categories of structural and operational biosecurity practices immediately after the training. The farmer's educational qualification significantly influences the knowledge gain except for dead bird disposal (p < 0.05). Commercial desi and layer farmers have more pre‐existing knowledge compared to broiler farmers. The broiler farmers showed the highest knowledge gain compared to layer and commercial desi farmers. Still, there was no significant difference between knowledge gain among different types of poultry farmers (p > 0.05). The adoption behaviour measured after 90 days significantly increased in all categories (p < 0.05) except for rodent and pest control. This comprehensive study provided valuable insights regarding farmers’ existing knowledge and the impact of training on some behavioural changes to improve biosecurity. The study concluded that a tailored training program is essential to educate small‐scale producers about biosecurity measures to prevent poultry food‐borne diseases.

The field of medicine has long been marked by gender disparities, with men predominantly occupying higher academic ranks while women were underrepresented. In recent years, there have been marked changes in the gender ratio among medical professionals in Nephrology. This study analysed gender dynamics within the Indian Nephrology fraternity. The primary objectives were to evaluate the gender distribution among nephrology residents/fellows in subspecialty courses over the past decade (2013–2023), faculty members, and heads of departments (HODs). Data was collected from 27 academic centres. Data from 27 institutions showed a consistent increase in nephrology residents, from 76 in 2013 to 112 in 2023. The proportion of female residents increased significantly from 22.4% in 2013 to 38.4% in 2023. A statistically significant increase in female residents ( p < 0.05), alongside a corresponding decrease in male residents, was noted. Among faculty members, 22.4% were females, and 20.4% of HODs were female. Female representation on the governing council of the Indian Society of nephrology (ISN) was limited. Since its inception, the role of ISN secretary has been held by eight individuals, all of whom have been male. Since 1971, the ISN has had a total of 42 presidents, with only 4 being female. The editorialship of IJN has never been stewarded by a female member to date. The findings demonstrate a positive trend towards gender parity in India's nephrology workforce over the past decade, reflecting broader societal acceptance and enhanced support for women in nephrology.

Background Community health workers (CHW) work closely with communities and therefore encounter several important ethical issues in their work. Community perceptions about their practice of ethics and professionalism are important. Methods We conducted 4 focus group discussions (FGD) among pregnant women and lactating mothers, 4 FGDs among women in the community, 3 in-depth interviews (IDI) among women and 2 IDIs among men in two districts of Tamil Nadu, India. We explored the various practices of ethics and professionalism in these discussions and interviews. We transcribed the data, coded the transcripts, and built themes by combining the codes meaningfully. Results The CHWs ensure good quality of services by effective use of mobile phones and by going beyond the call of duty. They face several challenges in doing good to the community. There were many instances where they failed to deliver their duties, which led to harm. Living far away from the community, spending less time there, delegating their work to lay persons all compromised the performance of their duties. The community pointed out CHW’s lack of good communication skills, lack of updated knowledge, and inefficient work. Treating the people as mere statistics and not caring for them as people was a reason for dissatisfaction. The quality of a CHW’s work was assessed relatively in comparison with other CHWs who were perceived as good and not in comparison with standards or expectations. Lack of honesty, demanding bribes, disrespectful treatment, discrimination of the marginalized communities, coercion, and lack of privacy and confidentiality were also reported in the CHW’s work. Reports of such unethical practices were more from people belonging to scheduled castes and tribes compared to those from dominant castes. The attributes of professionalism of a CHW reported by the community were altruism, empathy, inspiring confidence and trust, honesty, humility, kindness, relatability, adaptability, care, and tolerance. Conclusions The community identified various ethical practices as well as breach of ethics among their community health workers. These findings provide useful insights to develop a code of ethics for community health workers and training of community health workers on ethics and professionalism.

Introduction Spatial neglect is an important disabling disorder post-stroke and occurs more frequently after lesions in the right hemisphere, particularly in the parietal lobe. Spatial neglect prolongs stroke survivors’ recovery to independence. This study aims to identify the effect of hemineglect on the quality of life of stroke patients. Objective To evaluate the effect of hemineglect on the quality of life of patients in the chronic phase of stroke. Materials and Methods This is a cross-sectional study of stroke patients with hemineglect. After confirming the presence of stroke through neuroimaging examinations and of hemineglect through the Catherine Bergego Scale, patients’ quality of life was evaluated using the Stroke-Specific Quality of Life Scale (SS-QOL). Spearman’s correlation was used to validate the correlation between the patient’s hemineglect and quality of life, with P < 0.05 representing significant results. Results Thirty individuals were included in this study. When correlating the value of each domain of SS-QOL with the results of the Catherine Bergego Scale, a negative correlation was observed. Conclusion The higher the hemineglect degree, the worse the quality of life is in post-stroke patients.

Iliac artery aneurysms are rarely known to rupture into the common iliac vein causing features of high-output cardiac failure and also venous outflow obstruction, leading to deep vein thrombosis (DVT). In this case report, we present an unusual case of isolated right unilateral iliac artery aneurysm causing contralateral deep venous thrombosis due to left iliac vein compression and fistulous communication between right iliac aneurysm and inferior vena cava (IVC), the patient was successfully managed by endovascular treatment.

Objective Definitive guidance regarding the duration of antibiotics for neonatal sepsis is lacking. We hypothesised that a 7-day antibiotic course is non-inferior to a 14-day course for treating culture-proven sepsis. Design Randomised, controlled, non-inferiority trial with masked outcome assessment in eight centres in a low and middle-income country. Patients Neonates with a birth weight (BW) ≥1000 g and blood culture-proven sepsis were randomised on day 7 of sensitive antibiotic therapy provided sepsis had clinically remitted. Exclusions: Staphylococcus aureus or fungal sepsis, and infections requiring prolonged antibiotics. We planned to enrol 350 per group, assuming 10% rate of primary outcome, +7% non-inferiority margin, one-sided 5% alpha, 90% power, 10% loss to follow-up. Intervention 7 days (no further treatment); comparison: 14 days (7 days postrandomisation). Outcomes Primary: relapse (definite or probable) within day 21 postantibiotic completion. Secondary outcomes: composite of mortality or definite/probable/secondary sepsis and duration of hospitalisation. One interim analysis (per protocol (PP)) was planned. Results 126 and 135 subjects were recruited in 7-day and 14-day groups, respectively, with mean (SD) birth weight (BW) 2250.9 (741.1) and 2187.8 (718.8) g. The trial was terminated early, based on interim PP analysis. 2/125 and 6/130 subjects had the primary outcome in 7-day and 14-day groups, respectively (risk difference (RD)=−3.0% (99.5% CI −9.2%, +3.1%), below non-inferiority margin). The composite secondary outcome also favoured the 7-day regimen (RD: −3.7% (99.5% CI −12.4% to +5.1%)). Duration of hospitalisation was shorter in 7-day group (median difference: −4 days (95% CI −5 to –3)). Conclusions A 7-day course of antibiotics may be non-inferior to a 14-day course for uncomplicated bacterial neonatal sepsis. Trial registration number NCT03280147 .

Follicular dendritic cells (FDC) are mesenchymal-derived dendritic cells in B-cell follicles. They play a crucial role in initiating and maintaining the adaptive immune response of B-cells. In 1986, Dr. Juan Rosai first reported a series of neoplasms showing features of FDC and defined it as a Follicular Dendritic Cell Tumor, subsequently renamed as “sarcoma” (FDCS). The diagnosis of FDCS is based on a combination of clinical examination, histopathologic features, electron microscopy, and confirmation through immunohistochemical studies. Here, we report a case of a 55–year–old female who presented to our OPD with complaints of recurrent throat pain and difficulty during swallowing for the past 2 years, along with a foreign body sensation in the throat with occasional minimal bleeding from the left tonsillar region. Left ECA ligation with left tonsillectomy by cauterization method was done under GA. The Histopathological report came to be Follicular Dendritic Cell Sarcoma of the tonsil after IHC confirmation. After the diagnosis, the patient received post-operative radiotherapy. The patient is on a six-month follow-up, which is uneventful. FDCS is a rare tumor, particularly in extranodal sites. The diagnosis must be kept in mind when confronted with uncommon histological features in lymphoid tissue, and the final diagnosis can be rendered only after proper immunohistochemical examination.

Background & objectives COVID-19 is a complex disease that affects multiple systems and causes inflammation due to the SARS-CoV-2 virus’s attraction to ACE-2 receptors. The severity of the disease ranges from mild upper respiratory tract infections to multi-organ failure and disseminated intravascular coagulation. Critical clinical features, such as respiratory failure, myocarditis, acute kidney injury, and a hypercoagulable state, are common in severe COVID-19 illness. Identifying patients at higher risk of rapid disease progression leading to severe complications and death is crucial. Available biomarkers lack specificity and accuracy in identifying the severity of COVID-19 infections. Therefore, there is a need to identify specific endothelial biomarkers that can predict early organ damage, facilitate effective management of patients, and categorise multisystem involvement during COVID-19 infection. Methods The participants constituted laboratory-confirmed COVID-19-positive patients with influenza-like illness (ILI) features under home isolation or moderate to severe acute respiratory infection (SARI) manifestations requiring admission. The chosen markers were analysed using the Human Luminex multiplex bead-based assay system. Results Our study revealed that certain markers, such as intercellular adhesion molecule (ICAM) and Galectin-3 were elevated in all COVID-19-positive patients, while others, like vascular cell adhesion molecule (VCAM), Angiopoietin-2, Thrombomodulin, and tumour necrosis factor receptor 1 (TNFR1) were specifically elevated in patients requiring admission. Such findings indicated the potential of some biomarkers in disease prognostication. Interpretation & conclusions Effective management of COVID-19 requires proper risk stratification. The findings of our investigation underscore the necessity for additional research to confirm the clinical utility and importance of these biomarkers and to fully leverage their capabilities in informing the management of severe COVID-19 disease.

A BSTRACT Background Diabetic foot ulcers (DFU) are a devastating complication of diabetes mellitus, having a significant impact on the quality of life of patients and indeed putting an enormous burden on health care systems, especially in low- and middle-income countries like India. Understanding socio-demographic risk factors is, therefore, essential in designing successful prevention strategies adapted to the Indian population. Methods The duration was one year, and the study was conducted in India on 150 cases. Cases consisted of patients with diabetic foot ulcers, while controls were diabetic patients without foot ulcers, consisting of 75 cases and 75 controls, respectively. Information on socio-demographic variables, history, and lifestyle factors was collected through structured interviews and medical records. Logistic regression analysis was used to identify risk factors independently associated with DFU. Results Low socioeconomic status was significantly associated with an increased risk of DFU (OR = 3.45, 95% CI: 2.1–5.7), as were poor glycemic control (HbA1c >8%) (OR = 2.96, 95% CI: 1.9–4.8), living in a rural area (OR = 2.72, 95% CI: 1.8–4.1), and lack of formal education (OR = 2.30, 95% CI: 1.5–3.5). Risk factors were smoking, diabetes of more than 10 years’ duration, and history of bad foot care practice. Conclusion Socioeconomic disparities and lack of awareness about diabetic foot care contribute significantly to the DFU burden in India. Targeted interventions, education, better glycemic control, and accessible health services are ultimately needed to manage this potentially preventable complication.

Background and Aims Pregnancy in women with a prosthetic heart valve is considered high risk, primarily due to the need for effective anticoagulation. However, data on the relationship between anticoagulation practices and pregnancy outcomes are very limited. Methods The Registry of Pregnancy and Cardiac disease is a global registry that prospectively enrolled pregnancies in women with a prosthetic heart valve between January 2018 and April 2023. Detailed data on anticoagulation, including dosage and monitoring, and cardiovascular, pregnancy, and perinatal outcomes were collected. Results In total, 613 pregnancies were included of which 411 pregnancies were in women with a mechanical valve and 202 were in women with a biological valve. The chance of an uncomplicated pregnancy with a live birth in women with a mechanical valve was 54%, compared with 79% in women with a biological valve (P < .001). Thromboembolic and haemorrhagic complications most frequently occurred when low-molecular weight heparin (LMWH)–based regimens were used. Valve thrombosis occurred in 24 (6%) women, and a prosthetic valve in mitral position was associated with valve thrombosis (odds ratio 3.3; 95% confidence interval 1.9–8.0). A thromboembolic event occurred in 12 (10%) women with anti-Xa monitoring and in 9 (21%) women without (P = .060). Foetal death occurred in 20% of all pregnancies. Conclusions More favourable outcomes were found in women with a biological valve compared with a mechanical valve. In women with a mechanical valve, the use of LMWH was associated with an increased risk of thromboembolic complications. A mitral prosthetic valve was identified as a predictor for valve thrombosis. The benefit could not be confirmed nor refuted, in terms of reduced thromboembolic events, from using anti-Xa level monitoring in women on LMWH.

Introduction An ideal and long-lasting adhesive and sealant is essential during endoscopic endonasal skull-base surgery to hold the reconstruction intact and prevent cerebrospinal fluid (CSF) permeation until complete healing occurs. Fibrin glue is the most common material used. Regenerated oxidized cellulose (ROC) has not been mentioned in the literature as sealant and adhesive, and, hence, we intended to study this role. Objective To evaluate the role of ROC as tissue sealant and adhesive in the reconstruction of skull-base defects in endoscopic endonasal skull-base surgery. Methods We retrospectively analyzed the medical records of patients who underwent endoscopic endonasal skull-base surgery with skull-base defect and intraoperative CSF leak, for which reconstruction was performed using fibrin glue or ROC, or both, as a sealant and adhesive. The type of sealant and adhesive used and postoperative CSF leak rates with different agents used were analyzed. Results A total of 64 patients were investigated. Fibrin glue alone was used initially in 6 patients, of which 4 (66.6%) experienced postoperative CSF leak. Both fibrin glue and ROC were used in 26 patients, among which 2 (7.6%) exhibited postoperative CSF leak. Regenerated oxidized cellulose alone was used in 24 patients, wherein 2 (8.3%) presented with postoperative CSF leak. Fibrin glue alone was once again used later in the learning curve in 8 patients, of which 2 (25%) experienced postoperative CSF leak ( p = 0.002). Conclusion Fibrin glue provides intraoperative watertight seal. Regenerated oxidized cellulose has better intraoperative and long-term sealant and adhesive action in endoscopic endonasal skull-base reconstruction.

Budd-Chiari syndrome is a disorder that is characterized by obstruction of hepatic venous outflow, with thrombosis being the primary cause of the obstruction. This case report describes a 47-year-old Indian male presenting with distension of the abdomen and umbilical swelling for 1 year. Investigations revealed hepatic venous outflow obstruction and a partial web with focal calcification in the Inferior Vena Cava. Despite using standard medical therapeutic options such as diuretics, beta-blockers, and anticoagulation, his ascites remained uncontrolled. Interventional radiology with inferior vena cava venoplasty using 10 and 14 mm angioplasty balloons was performed, leading to the resolution of inferior vena cava stenosis and improved condition. Post-procedure, the patient was put on anticoagulation therapy and was discharged in good condition. This case highlights the successful management of Budd-Chiari syndrome with inferior vena cava occlusion using a multidisciplinary approach combining interventional radiology and medical therapy.

Hegar’s dilators are a set of innocuous instruments, which have found utility in various fields of medicine from gynecology to cardiac surgery. In this article, we document its role as a lifesaver in controlling emergency major vessel bleed, its role in unique technique of left ventricular assist device (LVAD) insertion and briefly review its other documented uses in cardiac surgery, showcasing its true versatility.

Secondary spontaneous pneumothorax is typically caused by tuberculosis or emphysema. Other causes include interstitial lung disease, pneumoconiosis, organizing pneumonias, and rare conditions like Langerhans cell histiocytosis and lymphangiomyomatosis. Rheumatoid arthritis is an uncommon cause of recurrent secondary spontaneous pneumothorax due to the rupture of subpleural necrobiotic nodules. Drugs like methotrexate and leflunomide are known to accelerate the development and progression of these necrobiotic nodules. Although the exact mechanism is unknown, it is believed to result from decreased monocyte activity and increased rheumatoid factor, with macrophages acting as a nidus that interacts with rheumatoid factor to form a nodule, ultimately leading to pneumothorax when it communicates with the pleural space. This report presents a rare case of recurrent spontaneous pneumothorax resulting from the rupture of subpleural necrobiotic nodules in a patient with rheumatoid arthritis-associated lung disease.