Himalayan Institute of Medical Sciences
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Item Draft genome sequencing of multidrug-resistant Klebsiella pneumoniae from neonatal bloodstream infections at SRHU, Dehradun, India(American Society for Microbiology, 2026-01-22) Sarkar, Indrani; Singh, Arpana et alKlebsiella pneumoniae, a gram-negative opportunistic pathogen, causes pneumonia, blood infection, meningitis along with several wound and surgical site infections and has become a leading cause of multidrug-resistant nosocomial infection. Here we present the whole-genome sequences for five K. pneumoniae strains isolated from clinical samples, Dehradun, India.Item Draft-genome sequencing of multidrug-resistant hypervirulent Klebsiella pneumoniae from neonatal septicaemia at SRHU, Dehradun, India(Microbiology Resource Announcements, 2026-07-06) Sarkar, IndraniMultidrug resistance makes the Gram-negative bacterium Klebsiella pneumoniae a growing threat and a major contributor to neonatal sepsis. At SRHU, Dehradun, India, we discovered four hypervirulent multidrug-resistant strains from bloodstream infections in neonates, highlighting their clinical significance and treatment and infection control implications.Item Ultrasound-Guided Erector Spinae Plane Block for Intractable Thoracic Cancer Pain: A Case Series of Five Patients(Taylor & Francis, 2026) Ramakrishnan, P; Mohan. AThoracic cancer pain, particularly due to lung malignancies, chest wall infiltration, or pancoast tumors, is often severe and multifactorial. When conventional systemic analgesics alone are inadequate, ultrasound-guided fascial plane blocks, such as the erector spinae plane block (ESPB), may provide rapid significant pain relief, particularly in outpatient settings. We report five cases of advanced thoracic malignancies with severe, refractory pain (Numerical Rating Scale [NRS] 8–10) despite optimized systemic analgesics. ESPB was performed using an in-plane ultrasound-guided technique at levels T4–T8 with a combination of local anesthetic and corticosteroid. All patients achieved significant pain relief (≥5-point reduction in NRS) and improved mobility immediately post-injection, with sustained pain control on reduced oral analgesic doses. During follow-up, one patient required a repeat block after one month, three maintained satisfactory analgesia with oral medications, and one patient was lost to follow-up. No procedural complications were observed. The erector spinae plane block appears to be a technically simple and effective regional analgesic technique for managing intractable thoracic cancer pain. Its rapid onset, opioid-sparing potential, and favorable safety profile make it a valuable adjunct in the palliative care of patients with advanced thoracic malignancy. Larger prospective studies are warranted to define optimal protocols and long-term efficacy.Item Improvising neonatal thrombocytopenia management: Insights from split, volume-reduced, single-donor apheresis platelets (NeoVRs-SDAP)(Wiley, 2026) Dhiman, Yashaswi; Patra, Saikat et al.Introduction: Thrombocytopenia is common in neonates, managed with platelet transfusions at defined dose. The product type varies from neonatal-specific units using platelet additive solutions to adult products split into multiple paediatric units. In low-middle-income countries, whole blood-derived random donor platelets (RDP) are common while western countries use split adult single donor apheresis platelets (SDAP). We aimed to assess preliminary effectiveness of split, volume-reduced single donor apheresis platelets (NeoVRs-SDAP) in neonatal thrombocytopenia and observe early post-transfusion outcomes. Methods: Study was conducted from August 2024 to January 2025 at a tertiary healthcare centre. Persistent thrombocytopenic neonates admitted to the NICU were transfused with NeoVRs-SDAP prepared using Spectra Optia® with modified pro gram yielding an adult dose (300 109) in a reduced 100 mL of product volume. These were split into 2–5 aliquots for transfusion. Post-transfusion platelet incre ments and percentage recovery were assessed after 20–24 h. Results: Thirteen neonates' 77% preterm, 69.2% VLBW with sepsis received 46 NeoVRs-SDAP. 10 mL of this product contained nearly 3 times more platelets than RDP and 1.5 times more than adult SDAP of same volume. The mean transfused dose was 70.56 ± 14.21 109 platelets. Median platelet increment was 64 500/μL versus 15 477/μL for RDP (p < 0.001). Platelet recovery ranged from 7.5%–52.5%. Split products reduced donor exposure by 56.5%. Survival was 62%, without any transfusion-related adverse events. Conclusion: NeoVRs-SDAP may be potential alternative in persistent neonatal thrombocytopenia, offering better increments and recovery, reduced donor expo sure, and leukoreduction. Further RCTs comparing NeoVRs-SDAP and RDP are recommended.Item The Crimson Laureate’s vision: Establishing a Paw Blood Bank for all creatures great and small(Elsevier, 2026-02-01) Raturi, Manish; Paudel, PurshotamThe Crimson Laureate envisions setting up an animal blood bank in North India, where science and compassion would unite to save animal lives. A systematic journey from ancient transfusion beliefs to modern veterinary transfusion science is discussed. There is a promise of species-specific, infection-screened blood availability for all the creatures great and small.Item SWOT Analysis on the Perception of Indian Medical Graduate Toward the Family Adoption Program(Wolters Kluwer, 2026-02-26) Sharma, Ashish; Agrawal, Apurva; Mathur, Medha; Sharma, AnitaThe National Medical Commission (NMC) of India introduced Family Adoption Programme (FAP) as a part of curriculum based medical education (CBME) for undergraduate medical students in March 2022. This program was started to provide experiential learning opportunities to undergraduate students towards community-based healthcare. A descriptive cross-sectional study was conducted including undergraduate medical students from all over the country through an online survey. A structured and validated questionnaire was circulated that consisted of both closed and open-ended questions related to perceptions regarding FAP, challenges faced and suggestions for better implementation. Data were collected, responses were analysed and SWOT (Strength, Weakness, Opportunity and Threats) analysis was conducted.Responses were received from 1054 undergraduate medical students from government & private medical colleges across the country. 51.2%, 41.2% and 5.1% participants were from the 1st Professional Year, 2nd Professional Year and 3rd Professional Year respectively. 85% and 87% students agreed/strongly agreed that FAP is helpful to gain an understanding of rural life and to develop a sense of social responsibility respectively. 90% agreed/strongly agreed that FAP is helpful to develop AETCOM skills. Language barrier and resistance offered by families were major challenges. Frequent community visits, training in the local language, provision of benefits to the families and development of a digital database are suggestions for better implementation.Undergraduate medical students are enthusiastic towards the family adoption program and consider it important in the development of social responsibility and AETCOM skills. Future studies are required to include perception of all stakeholders.Item Risk Factor Assessment and Comorbidity Profile in Gallstone Disease: A Cross-Sectional Study in Uttarakhand, India(2026-03-31) Sinha, Richa; Maheshwari, Sonam; Joshi, Parmarth; Shikha, Deep et al.Background: Gallstone disease (GSD) remains a major global health concern, typically benign but can lead to life-threatening complications. Risk factors such as advanced age, female gender, and overweight are well-established, yet gaps remain in understanding the regional epidemiology and associated comorbidities. Aim & Objective: To explore the demographic and epidemiological patterns, assess risk factors, and evaluate comorbid conditions related to GSD. Settings and Design: Cross sectional study was conducted at a tertiary care hospital at Dehradun. Methods and Material: The study was conducted among 233 patients who underwent laparoscopic cholecystectomy. Data was collected via patient interviews, medical records, and pathology reports. Statistical analysis used: Mann-Whitney U tests for continuous variables and z-tests for proportions, with multilevel logistic regression used to identify predictors of symptomatic GSD. Results: Out of the 233 participants, 143 were symptomatic and 88 were non-symptomatic. Symptomatic patients had significantly higher median BMI (p=0.021), waist circumference (p=0.014), systolic blood pressure (p=0.021), diastolic blood pressure (p=0.032), and insulin levels (p=0.004) compared to non-symptomatic patients. In multivariate analysis (Model 5), six significant covariates were identified: age (OR: 1.43, p<0.05), BMI (OR: 1.29, p<0.05), waist circumference (OR: 1.33, p<0.05), systolic blood pressure (OR: 1.27, p<0.05), insulin resistance (OR: 2.17, p<0.05), and the presence of comorbidities (OR: 2.41, p<0.05). Conclusions: The study highlights that symptomatic GBD in Uttarakhand is strongly associated with higher BMI, waist circumference, insulin resistance, and multiple comorbidities. These findings underscore the importance of early intervention strategies targeting modifiable risk factors to reduce the burden of symptomatic GSD.Item Prevalence of silent brain lesions in rheumatic mitral valve disease(Elsevier, 2026-05-19) Singh, Vatsal; Chaudhari, Lokesh et al.Background: Patients with rheumatic heart disease (RHD) are at high risk of stroke. Silent brain lesions (SBL) on brain MRI represent subclinical neurological injury, but their prevalence and predictors in RHD are not well defined. Methods: We conducted a prospective, single-center study of consecutive adults with RHD and moderate-to- severe mitral valve disease. Patients with a history of stroke, hypertension, diabetes, smoking, or ventricular dysfunction were excluded. All participants underwent a standardized protocol including clinical assessment, electrocardiography, echocardiography, and 3T brain MRI. Results: Among 79 patients (mean age 44.3 ± 11.4 years, 69.6% female), SBL were present in 14 (17.7%). Most patients (81%; n = 64) had atrial fibrillation (AF). The prevalence of SBL was similar between those with AF and those in sinus rhythm (17.2% vs. 20%). There were no significant differences in age, gender, valve lesion type (stenosis vs. regurgitation), left atrial size, or the presence of LAA thrombus between patients with and without SBL. The majority of SBL (85.7%) were located in cortical regions. Conclusions: Silent brain lesions on MRI were detectable in 17.7% RHD patients with significant mitral valve disease, even in the absence of traditional stroke risk factors. We did not find any association between occurrence of these brain lesions and atrial fibrillation or left atrial enlargement. Alternative mechanisms like pro- thrombotic states or atrial cardiomyopathy may be responsible. These findings warrant further investigation into the clinical significance and management of subclinical brain injury in RHDItem Prevalence and patterns of workplace violence against doctors of North India: a cross-sectional study(Frontiers, 2026-05-04) Vyas, Shaili; Singh, Abhinav et al.Background: Workplace violence (WPV) against physicians represents an esca lating global concern, with significant implications for India. This phenomenon substantially undermines the mental health, professional morale, and clinical performance of healthcare providers. A comprehensive understanding of the prevalence, patterns, and contextual factors associated with WPV is essential to develop evidence-based prevention and mitigation strategies. Methods: A cross-sectional study was conducted with 200 physicians (100 employed at a tertiary care teaching hospital and 100 in private healthcare settings) in Dehradun, Uttarakhand, North India. Data were collected using a pretested, self-administered questionnaire assessing experiences of workplace violence, contributing factors, physicians’ perceptions, and recommended pre ventive measures. Both descriptive and inferential statistical analyses were per formed using SPSS version 23. Results: Workplace violence was reported by 75% of the respondents (95% confidence interval [CI]: 68.9–81.0%), with verbal abuse representing the most prevalent form (59.33%; 95% CI: 51.4–67.1%). Violence occurred more frequently among male physicians, particularly in private healthcare settings and surgical specialties. A majority of incidents occurred during junior residency and were perpetrated by patients’ relatives (68%) or organized groups (mobs). Notably, only 18% of cases were formally reported by police authorities. Conclusion: Workplace violence was highly prevalent among physicians in Uttarakhand, with verbal abuse and mob-related incidents constituting the pre dominant manifestations. Urgent interventions, including enhanced security measures, structured physician-patient communication programs, and stringent legal enforcement, are necessary to establish a safer and more supportive work ing environment for healthcare professionals.Item Pleural amyloidosis: timely unmasking of apple- green birefringence in pleural biopsy(BMJ, 2026-01-17) Khanduri, Rakhee; Vashishtt, Meghaa; Baveja, Avriti; Pundir, Sammi; Singh, Monika8%–25% of cases of pleural effusion remain undiagnosed after routine workup. Some of the causes for pleural effusion are less often considered as a differential diagnosis owing to their rarity. While not all require a pleural biopsy, it remains a valuable tool for the definitive diagnosis of uncommon pleural effusions and guides treatment decisions. This case exemplifies the value of timely intervention in uncovering an unconventional form of pleural amyloidosis. An elderly male presenting with right- sided pleural effusion. The patient underwent timely medical thoracoscopy and was subsequently diagnosed with AL amyloidosis. Following therapy, the patient demonstrated marked clinical improvement, with radiographic resolution of the effusion and a favourable haematologic response.