Himalayan Institute of Medical Sciences
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Item The Missing Link Between Opioid Use Disorder and Seizures During Opioid Withdrawal: A Case Series from North India(PUBMED, 2023-04-17) Rohit Gondwal1 ,; Priyaranjan Avinash; Robin Victor; DharuvikaThe term “opioids” includes compounds extracted from the poppy plant/pod and semi-synthetic and synthetic compounds with similar properties that can interact with opioid receptors in the brain. These produce mental relaxation, pain relief, and euphoric feelings. Their regular use, abuse, and misuse, often without medical super- vision, can lead to opioid dependence and other health problems. Almost 2.1% of the Indian population uses opioids. The pattern of use varies across different states of India. While the use of inhalational opioid (smack/brown sugar) is much more common in Uttar Pradesh, that of injectable heroin is more common in Punjab and the northeastern states. Percentage-wise, the states of Mizoram and Nagaland are the worst affected by opioid use. The prevalence of opioid use in Uttarakhand is 0.8%. According to an article published in Times of India 2020, there was a record rise in synthetic-drug trafficking in Uttarakhand, especially in our catchment area of Dehradun and the neighboring areas of Rishikesh and Haridwar. Widespread available literature mentions opioid use disorder, intoxication, withdrawal, and other opioid-induced disorders, which include depressive disorder, anxiety disorder, sleep disorder, and sexual dysfunction. However, information is scanty on seizure episodes happening during opioid intake or withdrawal. Few studies have described complicated opioid withdrawal where a seizure occurred along with other features of opioid withdrawal.Item Evaluating the influence of a psychiatry training program on nursing students’ attitudes towards mentally ill(PUBMED, 2025-07-04) Praveen Rikhari; Vishal Sinha; Gyanendra Kumar; Ayushi Bisht; Aayush Kapoor; Pragya RikhariBACKGROUND: Mental disorders are a global concern, affecting millions worldwide. Despite effective therapies, societal stigma toward mental illness persists, hindering access to healthcare and perpetuating negative stereotypes. These prejudiced attitudes are also present in nursing professionals and impact the quality of care provided by them. This study aimed to explore the impact of a month‑long residential psychiatry training program on the attitudes of nursing undergraduate students toward mental illness. MATERIALS AND METHODS: This was a longitudinal study with pre‑post design conducted at a government mental health hospital and training institute in north India using convenient sampling. The Community Attitude Towards Mental Illness (CAMI) Scale, which has subscales of Authoritarianism, Benevolence, Social Restrictiveness, and Community Mental Health Ideology was used to measure the attitudes towards the mentally ill in nursing students before and after the training program. Descriptive statistics were used to present the data while paired t‑tests and McNemar test were used for analysis. RESULTS: A total of 970 students were included. A significant improvement in Social Restrictiveness, Community Mental Health Ideology, and the total CAMI score was noted post‑training (P < 0.001 for each) while changes in Authoritarianism (P = 0.87) and Benevolence (P = 0.1) were nonsignificant but positive. Furthermore, increased willingness to work in psychiatry wards post‑training was found, indicating a positive influence on career choices (P < 0.001). CONCLUSIONS: The results emphasize the effectiveness of combining theoretical knowledge with real‑life exposure in mental health nursing. Despite limitations, like a single‑center study and no control group, the study’s pre‑post design and large sample size contribute valuable insights.Item Utility of peripheral blood oxygen saturation (SpO2)/fraction of inspired oxygen (FiO2) ratio and arterial partial oxygen pressure (PaO2)/FiO2 ratio in the diagnosis of acute respiratory distress syndrome: A comparative study(SAGE Publications, 2025-07) Srishti Rathi; Rajesh Kakkar; Shubhanshu Chawla; Sushant Khanduri; Rajeev Mohan Kaushik; Reshma KaushikOur study determined the reliability of using the ratio of peripheral blood oxygen saturation (SpO2) and the fraction of inspired oxygen (FiO2) rather than the ratio of arterial partial oxygen pressure (PaO2) and FiO2 for diagnosing acute respiratory distress syndrome (ARDS). Pulse oximetry and arterial blood gas analysis were performed to obtain both ratios, respectively, in 70 patients who fulfilled the Berlin definition criteria of ARDS. A detailed history, clinical examination, and relevant evaluation were done. There was a significant correlation between the two ratios. The former had a lower sensitivity and specificity than the latter. Thus, the SpO2/FiO2 ratio is a reliable, straightforward, non-invasive, and readily available marker for diagnosing the presence and severity of ARDS, and may be used as an alternative to the PaO2/FiO2 ratio in resource-limited settings.Item Diagnostic Utility of Fine Needle Aspiration Cytology in a Case of Pulmonary Hydatid Cyst Masquerading as Tuberculosis(PUBMED, 2025) Smita Chandra; Akanksha Aggarwal; Varuna JethaniHydatid cyst may mimic other diseases including carcinoma and tuberculosis which may raise diagnostic dilemma that may be more enhanced in areas where tuberculosis is endemic. This may result in delayed diagnosis of hydatid cyst leading to its complications. The present case is therefore being reported as it was clinically and radiologically diagnosed as tuberculosis but on fine needle aspiration cytology (FNAC) turned out to be a case of hydatid cyst. In addition, vigilant cytological examination revealed only protoscolices and hooklets instead of laminated cyst membrane which is more commonly and easily observed. FNAC serves as a valuable adjunctive tool in the diagnosis of hydatid cysts providing rapid and accurate diagnosis that can guide clinical management and improve patient outcome.Item Designing and assessing the impact of a competency-based training program in transfusion medicine among MBBS interns(SCOPUS, 2025) Manish Raturi; Yashaswi Dhiman; Naveen Bansal; Basanta Khatiwada; Dushyant Singh Gaur; Poonam RawatIntroduction: It has been widely recognized that there is a pressing need to strengthen transfusion medicine education for both undergraduate and postgraduate medical trainees across various clinical specialties to enhance patient safety. In response to this, the National Medical Commission (NMC) of India implemented a competency-based medical education (CBME) framework in 2019 for undergraduate MBBS students across all medical colleges in the country. The present study aimed to assess the impact of a training program designed for medical interns, developed in alignment with the CBME curriculum prescribed by the NMC. Materials and methods: This was a questionnaire-based cross-sectional study conducted among MBBS interns undergoing rotatory training in different departments of a tertiary care teaching hospital. A structured two day educational program was organized, comprising six modules—three focusing on bedside transfusion practices and three addressing blood donation and laboratory-based transfusion medicine. Each module was designed to reflect the competencies outlined in the CBME curriculum and included pre- and post-training assessments to evaluate knowledge improvement. A pre-test was conducted to assess the knowledge of transfusion medicine among the participants and the post-test was conducted to assess the impact of the training program. Results: Overall, the pre-test score in the present study was 14.1 (47%) which increased to 22.3 (77.6%) in the post-test. Analysis of the pre-test scores showed that 80% of the interns had weak knowledge of blood transfusion reactions and its management. 55.6% of the interns had weak knowledge of indications of blood component therapy whereas 32.2% of the interns had weak knowledge of bedside transfusion medicine practices. 73.3% of the interns had weak knowledge of blood donor selection and counselling. 62.3% of the interns and 73.3% of the interns had weak knowledge of transfusion transmitted infections and basic blood banking including compatibility testing and storage conditions for various blood components, respectively. Post-training results showed a significant improvement across all domains. Effect size analysis using Cohen’s d indicated that the training program was highly effective in five out of six domains, with moderate effectiveness observed in the domain of immunohematology. Conclusion: Although transfusion medicine knowledge is essential for routine practice in core medical and surgical specialties, a substantial knowledge gap exists among medical interns. This study demonstrates that a structured, CBME program is an effective strategy to improve transfusion medicine knowledge among MBBS internsItem Assessment of awareness on basic life support among healthcare workers in a tertiary care teaching hospital in northern region of India(Springer, 2025-08-30) Himadri Mamgain; Omkarnath Sivarchaka; Sundar Lal Jethani; VaibhavBackground Basic Life Support (BLS) serves as the basis for preserving lives following cardiac arrest, especially considering that heart disease ranks as the leading cause of death and constitutes a silent epidemic within the Indian population. Ischemic Heart Disease (IHD) stands out as the primary global cause of mortality, concurrently contributing significantly to the loss of disability-adjusted life years (DALYs). Hence it is crucial for healthcare workers (HCW) to have substantial knowledge and awareness of BLS to help patients when they need it the most. This study aimed to assess the awareness on BLS among HCWs in a tertiary care teaching hospital. Methods A cross-sectional study was conducted among HCWs in a tertiary care teaching hospital. A self-administered questionnaire was developed to assess knowledge on key BLS components, including cardiopulmonary resuscitation (CPR) techniques, use of an automated external defibrillator (AED), and the chain of survival. Data were analyzed using descriptive statistics and chi-square tests. Results Out of 206 responders, 60 were doctors, 122 were nursing staff and 24 were technicians. None of the responders have complete knowledge of basic life support, 58.8% mean percentage of knowledge. There was a significant difference in BLS knowledge between different professional groups, with doctors scoring higher than nurses and paramedics (p<0.001). Conclusion Even though healthcare professionals receive BLS training at a high rate, there remains a knowledge and retention gap in BLS abilities. Regular skills practice and updated training is recommended to enhance BLS proficiency.Item To study the survival analysis and recurrence pattern in women treated for breast cancer: Retrospective study, a tertiary cancer center experience from Sub‐Himalayan Region of India(Wiley, 2024-01-04) Shivangi Sundram; Sourabh Nandi; Anshika Arora; Sunil SainiBackground: Breast cancer is a leading health concern in India, comprising 25% of female cancers with significant mortality. This study was conducted at the Cancer Research Institute in the Northern Sub‐Himalayan region of India from 2016 to 2021, evaluated 674 breast cancer cases to analyze factors that influence recurrence. Methodology: Retrospective clinical audit assessing patients’ survival outcomes using Kaplan–Meier curves and Cox proportional hazard regression. Factors including age, molecular subtype, TNM staging, and treatment modalities were evaluated. Results: Notable findings include a high occurrence of breast cancer in young patients (24.48% ≤ 40 years) and varying recurrence rates among molecular subtypes with human epidermal growth factor receptor 2 neu‐enriched (25.24%) and triple‑negative breast cancer (22.58%) being the most common. Advanced T and N stages, neoadjuvant chemotherapy, and the number of nodes dissected showed significant associations with higher recurrence rates. Conclusion: This study sheds light on survival and recurrence patterns in Northern Sub‐Himalayan breast cancer patients, emphasizing the need for tailored treatment strategies, comprehensive follow‐up care, with improved understanding of regional outcomes. These findings contribute valuable insights for optimizing patient care and improving survival rates in this region.Item Duplicated Ureter: A Rare Anatomical Variation Diagnosed Incidentally During Open Radical Hysterectomy for Carcinoma Endometrium and Avoidance of Mishappening: A Case Report(Springer, 2024-04-24) Shivangi Sundram; Sourabh NandiThis case report presents a rare anatomical variation known as double ureter, where a comprehensive unilateral duplication of the left ureter originating from a single renal tissue was incidentally discovered during staging laparotomy for CA endometrium. This congenital anomaly significantly heightens the possibility of unintentional damage to the ureter during surgeries involving the pelvic area. In summary, ensuring careful exposure of both ureters along with the continuous vigilance of surgeons remains pivotal for ensuring a secure surgical procedure.Item Comparative performance of biofire pneumonia panel and standard culture-based methods for diagnosing pneumonia in critically ill patients: Impact on antibiotic stewardship(Elsevier, 2024-04-22) Barnali Kakati; Rajender Singh; Garima Mittal; Nupur KoulIntroduction: Lower respiratory tract infections (LRTIs) are a common cause of morbidity and mortality worldwide. Accurate identification of the pathogens causing LRTIs is crucial for ensuring of diagnostic and antibiotic stewardship. The Biofire Pneumonia Panel (BFPP) is a molecular diagnostic test that allows rapid detection of various bacterial and viral pathogens. In this study, we compared the performance of BFPP with standard culture methods for the detection of pathogens. Materials and methods: Respiratory samples from 70 patient with suspected LRTIs were tested using both BFPP and standard culture methods. The distribution of isolated bacterial pathogens was analyzed, and the sensitivity and specificity of BFPP were calculated. Additionally, the performance of BFPP in detecting antimicrobial resistance genes was evaluated. The results were compared with those obtained from VITEK-2 antimicrobial susceptibility testing and culture-based methods. Results: Among the suspected LRTI cases, BFPP identified a single pathogen in 32.8% of cases and multiple pathogens in 40% of cases. The standard culture method detected a single pathogen in 47.1% of cases. BFPP showed a sensitivity of 93.9% and a specificity of 45.9% for the total sample. The performance of BFPP in detecting antimicrobial resistance genes varied for different pathogens with overall sensitivity of 40.1% and specificity of 95.9%. Conclusion: The Biofire Pneumonia Panel (BFPP) demonstrated high sensitivity for several bacterial pathogens, indicating its potential as a rapid diagnostic tool. However, its performance varied for different microorganisms, and it had limitations in detecting certain pathogens and antimicrobial resistance genes for which still required more further studies to explore different resistance gene mechanism that can be incorporated in this panel in future. The BFPP can complement standard culture methods as a rapid tool in the diagnosis of LRTIsItem Vonoprazan causes symptomatic improvement in non-erosive gastroesophageal reflux disease: A systematic review and meta-analysis(Elsevier, 2024-06-06) Sanjay Bandyopadhyay; Pooja Verma; Shambo Samrat Samajdar; Saibal DasObjective: To evaluate the efficacy and safety of vonoprazan therapy as compared to conventional proton pump inhibitors (PPIs) or no vonoprazan for non-erosive esophagitis. Methods: A thorough search was conducted across databases. The primary outcome was to determine the mean variance in the gastroesophageal reflux disease (GERD) score after vonoprazan treatment. Secondary outcomes comprised alterations in the scores for epigastric pain and post-prandial distress, the proportion of patients displaying improvement, and the occurrence of adverse events. Pooled mean differences and relative risks were determined utilizing random effects models. Results: A total of 1,944 articles were screened and nine of them were included. As compared to PPI or no vonoprazan therapy, vonoprazan treatment led to a significant reduction in the GERD score [mean difference: -3.88 (95 % CI: -5.48, -2.28), p < 0.01, i 2 =95 %]. As compared to PPI or no vonoprazan therapy, vonoprazan treatment led to a significant reduction in the epigastric pain score [mean difference: -3.02 (95 % CI: -5.41, -0.63), p = 0.01, i 2 =75 %] and post-prandial distress score [mean difference: -2.82 (95 % CI: -3.51, -2.12), p < 0.01, i 2 =0 %] (all moderate GRADE evidence). Vonoprazan therapy was found to be safe. Conclusion: Treatment with vonoprazan could significantly improve symptoms in patients with non-erosive esophagitis or non-erosive GERD.