Indian Journal of Medical and Health Sciences

 Most of the sudden cardiac deaths occur due to ventricular tachycardia (VT) and ventricular fibrillation(VF). VT is diagnosed when the ventricular rate is faster than 100 beats per minute with three or more irregular beats occurring in a row arising distal to bundle of His. It may arise from ventricular myocardium, distal conduction system or both.  VF is a life-threatening cardiac arrhythmia with high-frequency, disorganized ventricular myocardium  excitation, resulting in failure of the heart to pump blood. We present a case report of a 58-year-old man who was admitted with antero-lateral ST segment elevation myocardial infarction ( STEMI) and had three episodes of ventricular tachycardia during first 24 hours of hospitalization, each episode lasting for at least 30 seconds (Electric storm). 

 Primary spindle cell  carcinoma of larynx is a rare tumor representing less than 3% of all laryngeal cancers. This is one of the most lethal of all malignancies associated with frequent early wide spread metastases and dismal prognosis. Spindle cell carcinoma is composed of two components sarcomatoid and epithelial cells which make the tumor biphasic. We report a case of a 51-year-old lady with spindle cell carcinoma of the glottic larynx.

 Natural products have historically been a rich source of biologically active compounds for drug discovery (Schiff et al,1979). Tocotrienols are vitamin isomers which are “essential” meaning they cannot be manufactured by the human body. Hence they have to be obtained from food and supplements. In nature they occur in four different forms: a, b, g, and ä   Tocotrienols. Palm oil, one of the richest sources of Tocotrienols, is an ideal source since it contains more of the, g and ä than a, b- Tocotrienols. Taken orally, tocotrienols are bio available to all vital organs. Tocotrienols have wide ranging clinical effects with anticancer, radioprotective, anti hypercholesterolemic,  antiangiogenic, antioxidant, anti-inflammatory, antineurodegenration and antimicrobial properties. A safe and effective therapy for radiation injuries as well as cancer prevention is the need of the hour. Analytical and clinical study on Tocotrienols may prove vital for life. The main objective of this review study is to highlight clinical potential significance of the tocotrienols in health and diseases as a therapeutic supplement.

 Background:The characteristics of authorship involve a combination of number of authors, names and qualifications, institutional affiliations, order or sequence, and many other types of authorship misconduct namely the ghost authorship and gifted authorship. Objective: To descriptively summarize the studies on analysis of authorship and explore the existing evidence through articles indexed in PubMed. Methods: Systematic search of literature in PubMed was done using keywords “authorship”[Title] AND (trend[Title] OR trends[Title] OR analysis[Title] OR reporting[Title])” were used in the search tab, for obtaining all types of articles published in English, with available abstracts indexed until October 2012. Mutual consensus method was utilized after blinded independent search by two reviewers using a pre-decided checklist for data extraction and synthesis. Descriptive analytical approach was used to describe the data from the included studies. Results: Of the 32 included articles, there were four types of analyses- specialty based (N=21, 66%), journal-based (N=6, 19%), practice-based (N=2, 6%) and research-based (N=3, 9%). Of the 21 specialty-based articles, medicine (N=5, 23.8%) and dentistry (N=3, 14.3%) were more represented. 23 articles were on single characteristic, and 9 were on multiple characteristics, and the number of authors (11/23, 48%) and authorship criteria (5/23, 22%) were more commonly reported among the former type. Conclusion: Specialty-based analyses of authorship was more common, with more articles in the field of medicine and dentistry, and were more on analyzing a single characteristic such as number of authors or authorship criteria. 

 Background: Choosing the specialization after medical graduation is a predicament for every student. The choice of specialty depends on various factors like social, economic, others influence and career related factors. The present study was designed to assess the preferred career choice among the medical students and factors influenced the career choice. Materials and Methods: It was a cross sectional questionnaire-based study done at Kamineni Institute of Medical Sciences, Narketpally, Nalgonda District. Students of 5th Semester, voluntarily and anonymously completed a semi-structured questionnaire consisting of demographics, prior education level, specialty choice questions and reasons for choosing specialty. Results: Out of 146 students, 109 students properly filled the questionnaires. The mean ± SD of age was 19.84 ± 1.41 years with male to female ratio of 1: 2.5. A total of 90.83% students belong to urban areas. Most of them (66.97%) were from state board of higher education. Parents of 17(15.60%) students belongs medical profession. Majority of the students opted for medical specialty (67.9%) as first preference followed by surgical (32.1%). None of them opted for pre clinical, para clinical and hospital administration as first preference. The reasons like income, life style and low stress had strong influence in preferring the specialty. Only few students preferred to work in government hospitals (27.5%) and rural areas (11%). Conclusion: The study reveals majority of students inclined towards clinical specialties. Reorientation of Medical Education is needed along with policy settings to attract doctors to the scarcity and high priority disciplines so that imbalances encountered would be minimal in future.

 Background: The profession of Nursing had grown across a range of application in liaison with almost all interprofessional disciplines and the role of nurses in healthcare is increasingly been recognized in a multidisciplinary collaborative framework. Objective: To critically summarize and identify the results of analyses of Nursing journals, published in journals indexed in PubMed.  Methods: A systematic overview and quantitative analysis of 46 published reviews was performed to identify relevant themes in nursing profession. Types of journals (nursing, other), between-journal comparison of articles, number of authors, types of methodological approach (descriptive or analytical) and domains of profession (practice, education, research and administration). All analyses were done descriptively using numbers and percentiles and were computed using SPSS version 17 for Windows (SPSS Inc, IL, Chicago). Results: Nursing journals (N=40) had published more articles than other journals (N=6). International Journal of Nursing Studies had published the greatest number of such articles (N=5), followed by Journal of Advanced Nursing (N=4), and Image Journal of Nursing Scholar (N=3). Articles on research (N=30) were much more than practice (N=8). Conclusion: The present study found that larger number of reviews and analyses of nursing journals were published in nursing journals, which confirmed the specificity of source of evidence retrieval for better decision-making. 

 Aims & Objectives: Recently high incidence of acute renal failure (ARF) in malaria has been reported from various parts of world including India. This study was planned to evaluate the clinical predictors and prognostic indicators of ARF in malaria. Methods: This prospective observational study was done on 60 consecutive confirmed cases of  malaria admitted in the department of medicine. 40 had ARF (study group) and 20 did not (control group). All cases were thoroughly studied for clinical features, laboratory evaluation and outcome. Diagnosis of ARF was made as per WHO criteria. RIFLE criteria were used to stratify severity of acute kidney injury. Prognostic evaluation was also done by different Score system. Results: Out of 40 patients who had ARF  57.6% had P. vivax infection, 32.5% P. falciparum while 10% had mixed infection, thus  we  observed  significantly high number of cases of ARF due to vivax malaria. Clinical predictors for ARF were longer duration of fever, marked chills, severe tiredness, nausea, vomiting, jaundice, altered sensorium, decrease urine, low  GFR , low hemoglobin, high parasite density, TLC, RDW, LDH, bilirubin, SGOT, SGPT, urea, creatinine, APACHE II, SOFA, MODS  and low GCS score. There was no difference in age and sex distribution but rural patients were more affected by ARF. 65% of our cases had non-oliguric ARF. Other manifestations of severe malaria like cerebral malaria (20%), malarial hepatitis (42.5%) and severe anemia (20%) were commonly associated with ARF. 15 cases of ARF needed dialysis. Two patients died both with mixed malaria, RIFLE-F category. Poor prognostic indicators were severe anemia (p<0.01), higher TLC (p<0.01), Blood urea (p<0.001), serum creatinine (p<0.001), SGOT (p=0.001), SGPT (p<0.01), serum bilirubin (p<0.01), parasite density (p<0.05), lower platelet count (p<0.05), and those with higher APACHE II score (p<0.01), SOFA score (p<0.05) and MODS score (p<0.001) and lower GCS score (p<0.001). Conclusions: Our study shows clinical predictors associated with increased risk for development of ARF and poor prognostic indicators associated with serious morbidity and mortality in ARF caused by malaria , if we give due attention to these factors at the time of clinical presentation we can reduce morbidity and mortality due to ARF caused by malaria.

 Context: Palliative care practice, education, research and administration depend upon an evidence-based shared interpersonal decision-making process which in turn is based upon individual knowledge/awareness and existing research evidence. Aims: This study aimed to perform a quantitative analysis of research publications in palliative care journals for reporting of articles on knowledge and awareness. Settings and Design: Systematic review of palliative care journals. Methods and Material: Twelve palliative care journals were searched for articles with ‘knowledge’ or ‘awareness’ in title of the articles published from 2006-2011. The reporting rates of all journals were compared. The selected articles were categorized into assessment and treatment which were subsequently grouped into original and review articles. The original articles were sub-grouped into qualitative and quantitative studies, and the review articles were grouped into narrative and systematic reviews. Each subgroup of original articles category was further classified according to study designs and target sample populations. Statistical Analysis Used: Descriptive analysis using frequencies and percentiles was done using SPSS for Windows version 11.5. Results: The overall reporting rate among all journals was 1.50% (43/2854) and Indian Journal of Palliative Care (IJPC) had the highest reporting rate of 6.48% (7/108) followed by BMC Palliative Care (BMCPC) at 3.37% (3/89), and Journal of Palliative Medicine (JPM) at 1.67% (11/657). Conclusions: The overall reporting rate for knowledge/awareness articles in palliative care journals was 1.5% and there were no randomized clinical trials and systematic reviews found. The study findings indicate a lack of adequate evidence base for knowledge/awareness in palliative care literature.

 It is a well known fact that hypertension is a silent killer. Is it too silent or can we identify some underlying predictors of mortality? Isolated systolic hypertension, isolated diastolic hypertension and the difference of systolic and diastolic pressure i.e. pulse pressure, each have their role to play in affecting the outcome of hypertension - the most common cardiovascular disease. The present case-control study was planned to determine the effect of these parameters as predictors of all cause mortality in patients aged 60 yrs and above who were either discharged or expired after at least one week of inpatient care at a tertiary level hospital of north India. We conclude that undiagnosed hypertension, isolated systolic hypertension and wide pulse pressure (>60.3 ± 16.2 mm of hg) are associated with increased mortality in the hospitalized elderly patients. 

 This editorial aimed to throw light on the use of PubMed as an evidence resource to inform the quality and quantity of research as an implication into practice. This editorial performed a short review of literature that reported on quantitative analysis of PubMed from the authors’ perspective. The nine identified reviews provided descriptive summary assimilated from volumes of scientific information in terms of indexing characteristics useful for researchers and clinicians searching for evidence in fields related to medical and health sciences.