Kerala Medical Journal

The Integration of Artificial Intelligence in Healthcare: Ethical Considerations and Future Prospects

Kavitha Ravi — 2024-10-21

Artificial Intelligence (AI) has emerged as a transformative force across various sectors, including healthcare. AI’s promise in medical field is vast and multifaceted with unprecedented gains in productivity, therapeutic results, treatment personalization, and diagnostic research. As we get closer to this significant shift, it is crucial to thoroughly examine ethical concerns and possible future uses of AI integration.

Safety During Night Duty: Survey of 3885 Doctors Across India

Rajeev Jayadevan — 2024-10-21

Background: Reports of violence against doctors at the workplace are on the rise. In August 2024, a young female doctor was raped and murdered during night duty at her workplace in Kolkata, India. This incident prompted nationwide protests and a service shutdown by doctors’ organizations advocating for improved workplace safety.
Aim: This survey was undertaken by the Indian Medical Association to evaluate safety concerns during night shifts among
doctors. With 3,885 individual responses, it is the largest study from India on this topic.
Methods: An online survey was sent to doctors across India through a Google form. There were 3885 responses. In addition to seeking suggestions to improve safety, three separate parameters were assessed:
1. 0-10 numeric rating scale of perception of safety
2. Availability of duty room
3. Access to bathroom while on night duty
Results:

Respondents were from several states. 85% were under 35 years. 61% were interns or postgraduate trainees. Women constituted 63%, aligning with the gender ratio in some MBBS courses.
Several doctors reported feeling unsafe (24.1%) or very unsafe (11.4%), totalling one-third of the respondents. The proportion of those feeling unsafe was higher among women.
A duty room was not available to 45% of respondents during night shifts.
Those with access to a duty room had greater sense of safety.
Duty rooms were often inadequate due to overcrowding, lack of privacy and missing locks, forcing doctors to find alternative rest areas.
One-third of available duty rooms did not have an attached bathroom.
In more than half the instances (53%), duty room was located far from the ward/casualty area.
Suggestions to enhance safety included increasing the number of trained security personnel, installing CCTV cameras, ensuring proper lighting, implementing the Central Protection Act (CPA), restricting bystander numbers, installing alarm systems, and providing basic amenities such as secure duty rooms with locks. For detailed information, refer to Table 13, the synopsis and the verbatim comments section.

Conclusions: Doctors across the country, particularly women, report feeling unsafe during night shifts. There is substantial scope for improving security personnel and equipment in healthcare settings. Modifications to infrastructure are essential to ensure safe, clean, and accessible duty rooms, bathrooms, food, and drinking water. Adequate staffing, effective triaging, and crowd control in patient care areas are also necessary to ensure that doctors can provide the required attention to each patient without feeling threatened by their work environment.

Vision Related Quality of Life in patients with Diabetic Macular Edema receiving Intravitreal Ranibizumab

Allen Mathew — 2024-10-21

Introduction: Diabetic macular oedema is the most common cause of vision impairment in individuals with diabetic retinopathy. Diabetic macular oedema develops due to leakage of fluid from diseased microvasculature in the retina. Various treatment modalities exist for diabetic macular oedema, the present gold standard being the use of intravitreal anti-VEGF agents.
Aim: To assess the changes in vision-related quality of life among patients with diabetic macular oedema receiving intravitreal Ranibizumab.
Materials and Methods: A hospital-based observational longitudinal study was conducted.
Demographic details as well as details about the disease were collected. A validated National Eye Institute Visual Function Questionnaire (using the interviewer-administered format of the questionnaire) was administered by a single interviewer, on the day before the scheduled intravitreal Ranibizumab injection and again repeated over a period of 3 months at 2, 6 and 12 weeks from the date of the first injection.
The overall composite score and the various subscale scores for visual function were computed using a validated scoring method for each patient based on their response to the questionnaire.
Analysis of data was done using Statistical Packages for Social Sciences Version 24 software. Changes in the various parameters contributing to the vision-related quality of life were studied using analysis of variance for repeated measures. The level of significance was determined by the p-value. A p-value less than 0.05 was considered statistically significant.
Results: The baseline composite score was found to be 38.2±9.1, at 2 weeks 41.0±10.3, at 6 weeks 48.2±14 and at 12 weeks 51.1±15.2. Data analysis showed the increase in the mean value of the baseline composite score to be statistically significant with a p value of 0.000.
All subdomains except general health also showed statistically significant improvement.
Conclusion: Patients diagnosed with diabetic macular oedema were shown to have an improvement in their vision-related quality of life following a single injection of intravitreal Ranibizumab. Various subdomains of vision which contribute to the vision-related quality of life except general health were also noted to show statistically significant improvement.

Body Surface Topography and Radiology in Adolescent Idiopathic Scoliosis (AIS): Is there a Correlation? : A Pilot Study Based on Clinical Photographs

Shiju Majeed — 2024-10-21

Background: Cosmesis is of paramount importance in adolescent idiopathic scoliosis. Conventional evaluation of scoliotic deformity is based on radiological parameters like Cobbs angle. However aesthetic parameters are the ones that are readily perceived by the patients, peers and parents. Patient Reported Outcome measures and self-image perception of these patients may not be dependent on radiological parameters alone. So there is a need to know whether there is a correlation between body surface topography and radiology in these patients.Background: Cosmesis is of paramount importance in adolescent idiopathic scoliosis. Conventional evaluation of scoliotic deformity is based on radiological parameters like Cobbs angle. However aesthetic parameters are the ones that are readily perceived by the patients, peers and parents. Patient Reported Outcome measures and self-image perception of these patients may not be dependent on radiological parameters alone. So there is a need to know whether there is a correlation between body surface topography and radiology in these patients.

Material and Methods: Cross-sectional, pilot study of 15 patients (10 thoracolumbar/lumbar and 5 thoracic curves. Clinical evaluation was done via Spinal Appearance Questionnaire, SRS 22 r questionnaire. Surgeon evaluation is done via the POTSI app and TRACES index. Body Surface Metrics were also calculated. Radiological parameters studied were Cobbs angle, apex deviation, Clavicle angle, Coracoid angle First Rib angle, T1 tilt and C7 Plumbline deviation.

Results

POTSI had a strong correlation between SAQ (r value 0.735, p value 0.002).
SAQ has a moderate correlation with cobbs angle of main curve (r value 0.519 p,0.047) and secondary curve (r value 0.539 p 0.038)
SAQ had a moderate inverse correlation with SRS22r (r value-0.560, p =0.030).
LWA-RWA has a moderate inverse correlation with Main Cobbs angle (0.551 p 0.033). WHA has a moderate correlation with Cobbs angle of main curve (0.545, p=0.036)
However there was also a moderate correlation between apex deviation of the lumbosacral fractional curve with the WHA (0.567, p value 0.035).
AHA has a moderate correlation between clavicle angle (0.523, p value 0.046) and mild correlation with FRA (0.390) and coracoid angle (0.393)
SHA had no significant correlation between any of the parameters studied.

Conclusion: Trunk aesthetic parameters should be given due importance in assessing children with Adolescent idiopathic Scoliosis. They have only moderate correlation with Cobbs angle. However, patients and surgeons perception of deformity has strong correlation. Studies on larger cohorts will be useful to validate the findings of the present study. Shoulder balance continues to be an enigma that requires further studies

Influence of Risk Perception and Physician Recommendations on the Adoption of Examinations for Early Detection of Breast, Cervical, Oral and Colon Cancers in Rural Thiruvananthapuram

Regi Jose — 2024-10-21

Early cancer detection is crucial in reducing mortality rates, especially in rural areas with limited healthcare access. This cross-sectional study investigates how risk perception and physician recommendations influence the adoption of screening practices for breast, cervical, oral, and colon cancers among 160 women aged 30-65 years in rural Thiruvananthapuram. The findings show that a significant proportion of participants perceived their cancer risk as low, which correlates with lower screening rates. Physician recommendations played a key role in motivating patients to undergo screening, but many did not receive such advice. This highlights the need for enhanced communication between healthcare providers and patients to improve risk awareness and increase cancer screening uptake.

20 Years of Continuous Glucose Monitoring in India: Options and Indications

Jothydev Kesavadev — 2024-10-21

The increasing prevalence of diabetes worldwide is a major concern, especially in developing countries where achieving optimal glycemic control is challenging. Continuous Glucose Monitoring (CGM) systems have revolutionized diabetes management by providing detailed and real-time insights into glucose fluctuations. Over the past 20 years, CGM technology has significantly evolved with improved accuracy, user-friendliness, and clinical utility. This review discusses the progressive development of CGM systems in India, types of CGM systems including professional, real-time, intermittently scanned, and integrated CGMs, and their specific indications. The review also highlights novel innovations in CGM and explores the importance of metrics such as Time in Range (TIR) and Time in Tight Range (TITR) in glycemic management. By enhancing patient and healthcare provider decision-making, CGM systems have become an inevitable part of diabetes care, offering a more comprehensive and effective approach to managing the condition.

Spontaneous Arterial Dissection Secondary to Graves’ Disease: A Possible Association

Lakshmi Priya — 2024-10-21

Arterial dissection is one of the common etiologies of young ischemic strokes. We report a case of Graves’ disease presenting as isolated spontaneous cervical internal carotid artery dissection followed by subarachnoid haemorrhage. A young female in her early 40s presented with 3-day history of headache and left hemiparesis. MRI of the Brain showed acute right hemispheric watershed infarcts. CT Angiogram showed a short segment right cervical internal carotid artery dissection. Her serum TSH was markedly reduced with an elevated free T3/free T4 ratio (1.78) and strongly positive Anti TSH-R antibodies. She was treated with anticoagulants and antithyroid medications. Still, later she developed an episode of focal seizure following right frontal subarachnoid hemorrhage, when anticoagulation was stopped and started on a single antiplatelet, with which she recovered well. Spontaneous cervical internal carotid artery dissection and focal subarachnoid haemorrhage presenting secondary to Graves’ disease without any other symptomatic systemic manifestations of hyperthyroidism is probably rare.

A Case of Pyloric Web with Fenestration

MM Ramadas — 2024-10-21

Congenital gastric outlet obstruction can be caused by pre pyloric or pyloric abnormalities. Pyloric atresia is a rare congenital anomaly that causes partial or complete obliteration of the gastric lumen. It constitutes about 1% of all intestinal atresias. The pyloric web is the most common type of pyloric atresia which presents in the neonatal period with nonbilious vomiting just like more common conditions like idiopathic hypertrophic pyloric stenosis.1 We report a case of a newborn with a pyloric web detected within the first week of life.

Linezolid In Filariasis

KK Mathew — 2024-10-21

Two cases of filariasis responding well to the drug Linezolid are presented.

A Rare Infectious Trigger for Acute Disseminated Encephalomyelitis

S Sreenath — 2024-10-21

Acute disseminated encephalomyelitis (ADEM) is an infrequent demyelinating disorder of the central nervous system precipitated by infections and immunizations. ADEM following scrub typhus infection is a rare manifestation. Here, we are reporting a case of ADEM triggered by Scrub Typhus infection.

Case of Bilateral Pheochromocytoma in a Young Female with VHL Mutation - A Glance into Novel Insights on Genetics of Pheochromocytoma

Minna P S Basania — 2024-10-21

Pheochromocytoma is a tumour of chromaffin cells arising in the adrenal medulla, for which genetic susceptibility is the only known causative factor. Here we describe a case of a 15-year-old girl who presented with hypertension and associated symptoms like headache and chest tightness lasting for nearly one month. On evaluation, she was found to have bilateral Pheochromocytoma, following which she underwent bilateral adrenalectomy and the diagnosis was confirmed by histopathology. Being a bilateral tumor we proceeded with further genetic studies. Clinical exome sequencing revealed a VHL gene mutation. Management of Pheochromocytoma Paraganglioma (PPGL) has now taken new turns which is based on molecular classification that groups them into three specific gene clusters based on underlying gene mutations, which have definite clinical, biochemical, imaging and prognostic significances. Molecular characterization of Pheochromocytoma hence becomes of utmost importance in the era of personalized patient management plans.

Malignant Melanoma of the Anal Canal - A Rare Case Report from a Tertiary Care Center in South India

Satish G Prabhu — 2024-10-21

Anorectal melanoma is a rare entity that accounts for less than 1% of all anorectal malignancies. It is often mistaken for benign anorectal conditions since the symptoms resemble each other. The predominant symptoms of anorectal melanoma are per rectal bleeding, anorectal pain, mass per rectum, tenesmus and altered bowel habits. All suspected cases of anorectal malignancy should be subjected to sigmoido-colonoscopy and biopsy. Management of anorectal melanoma remains controversial including surgery, chemotherapy, radiotherapy and target therapy as treatment options. Surgical treatment is considered as the primary treatment modality for anorectal melanoma. Anorectal melanoma must be kept in mind as differential diagnosis for patients pesenting with per rectal bleeding and pain.

Stereoscopic Visualization: A Novel Approach to Anatomy Teaching and Procedural Planning

Dinesh Raja Palanisamy — 2024-10-21

Traditional anatomy teaching in medical curricula, particularly in India, relies heavily on cadaveric dissection and two-dimensional diagrams. While these methods provide foundational knowledge, they fail to convey the intricate three-dimensional complexities necessary for understanding anatomical structures in the context of surgical and interventional procedures. Stereoscopic visualisation, which leverages binocular vision to simulate depth perception when adapted for medical education, offers a promising alternative by enhancing spatial understanding of anatomical structures.
The stereoscopic visualisation system, developed collaboratively by the Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST) and Government Engineering College Barton Hill (GECBH), successfully provided 3D visualisations of patient anatomy, enhancing spatial understanding. Key features included real-time processing of CT and MRI data, the ability to visualise large groups simultaneously, and cost-effectiveness. The system allowed for direct visualisation of DICOM files without preprocessing and included customisable features such as windowing techniques and arbitrary plane sectioning. Users reported significant improvements in understanding complex anatomical relationships and planning surgical interventions. Additionally, the system was superior to cadaveric learning for certain visceral anatomies due to its ability to maintain anatomical orientation and spatial relationships. All this makes it a valuable tool in medical education and practice. Despite challenges such as the need for specific software, hardware, and a dark room setup, the system’s benefits outweigh these limitations. Future improvements could enhance its capabilities and applicability in medical education and surgical precision. The system thus represents a significant advancement in leveraging stereoscopic technology to bridge the gap between traditional anatomy education and modern clinical requirements.

Breast Cancer in Kerala: Addressing the Concerns and Improving Outcomes

Paul Augustine — 2024-10-21

Breast cancer is on the rise among women in Kerala, with a significant number of cases being diagnosed at a younger age compared to Western populations. This article discusses the challenges faced in early detection and management of breast cancer in Kerala, the limitations of relying on mammography for screening in younger women with dense breast tissue, and the potential benefits of clinical breast examinations as a cost-effective alternative. It also highlights the importance of proper management practices and the adoption of more intensive early detection methods to improve patient outcomes, reduce mortality, and enhance the quality of life for breast cancer patients.

Diabetes Mellitus: Tasting to Testing and Treatment - Part 2

J Sajikumar — 2024-10-21

The discovery of insulin stands as a remarkable milestone, not only in medicine but also in the history of humanity. For children with type 1 diabetes, who are unable to produce insulin, survival was once limited to mere weeks or months. For them, insulin is far more than just a medication—it is a lifeline.