Simran Kaur

Medical and nursing students' intentions to work abroad or in rural areas: a cross-sectional survey in Asia and Africa

Abstract Objective To assess medical and nursing students’ intentions to migrate abroad or practice in rural areas. Methods We surveyed 3199 first- and final-year medical and nursing students at 16 premier government institutions in Bangladesh, Ethiopia, India, Kenya, Malawi, Nepal, the United Republic of Tanzania and Zambia. The survey contained questions to identify factors that could predict students’ intentions to migrate. Primary outcomes were the likelihoods of migrating to work abroad or working in rural areas in the country of training within five years post-training. We assessed predictors of migration intentions using multivariable proportional odds models. Findings Among respondents, 28% (870/3156) expected to migrate abroad, while only 18% (575/3158) anticipated a rural career. More nursing than medical students desired professions abroad (odds ratio, OR: 1.76; 95% confidence interval, CI: 1.25–2.48). Career desires before matriculation correlated with current intentions for international (OR: 4.49; 95% CI: 3.21–6.29) and rural (OR: 4.84; 95% CI: 3.52–6.66) careers. Time spent in rural areas before matriculation predicted the preference for a rural career (20 versus 0 years: OR: 1.53, 95% CI: 1.19–1.98) and against work abroad (20 versus 0 years: OR: 0.69, 95% CI: 0.50–0.96). Conclusion A significant proportion of students surveyed still intend to work abroad or in cities after training. These intentions could be identified even before matriculation. Admissions standards that account for years spent in rural areas could promote greater graduate retention in the country of training and in rural areas.

Insight into the diagnosis and management of subclinical genital tuberculosis in women with infertility.

Genital tuberculosis (GTB) is an important cause of infertility in India. Lack of an accurate diagnostic test has led to an indiscriminate use of antitubercular treatment in infertile women. Apart from concerns of drug toxicity, this may be a contributing factor in the increasing incidence of multidrug-resistant TB reported in India. We conducted a study to analyze whether a combination of tests could help improve diagnostic accuracy. An algorithm for the management of GTB in infertile women based on the use of multiple tests is presented.

Do increased levels of progesterone and progesterone/estradiol ratio on the day of human chorionic gonadotropin affects pregnancy outcome in long agonist protocol in fresh in vitro fertilization/intracytoplasmic sperm injection cycles?

Background: The effect of elevated levels of serum progesterone (P 4 ) and estradiol (E 2 ) on the day of human chorionic gonadotropin and their cut-off value on in vitro fertilization (IVF) outcomes is still not clear. Aims: The aim was to evaluate the association between serum P 4 , E 2 and progesterone/estradiol ratio (P 4 /E 2 ) on pregnancy outcome in IVF/intracytoplasmic sperm injection (ICSI) cycles with long agonist protocol. Setting and Design: Retrospective, single center, cohort study. Materials and Methods: A review of complete data of 544 women undergoing fresh IVF/ICSI cycles (539 cycles) with long agonist protocol from January 2012 to February 2014 was done. Data were stratified into Three groups according to the number of oocytes retrieved: low (≤4 oocytes obtained), intermediate (5-19 oocytes obtained), and high ovarian response (≥20 oocytes obtained). Statistical Analysis: Fishers exact test/Chi-square was carried for comparing categorical data. Receiver operating characteristics analysis was performed to determine the cut-off value for P 4 and P 4 /E 2 detrimental for pregnancy. Results: A negative association was observed between pregnancy rate (PR) and serum P 4 and P 4 /E 2 levels with no effect on fertilization and cleavage rate. The overall cut-off value of serum P 4 and P 4 /E 2 ratio detrimental for pregnancy was found to be 1.075 and ≥0.35, respectively. Different P 4 threshold according to the ovarian responders were calculated, 1.075 for intermediate and 1.275 for high responders. Serum E 2 levels were not found to be significantly associated with PR. Conclusion: Serum P 4 levels and P 4 /E 2 ratio are a significant predictor for pregnancy outcome without affecting cleavage and fertilization rate while serum estradiol levels do not seem to affect PR.

Splenectomy during pregnancy: treatment of refractory immune thrombocytopenic purpura

Immune thrombocytopenic purpura (ITP) complicates 1–2/10 000 pregnancies and accounts for 5% of cases of pregnancy-associated thrombocytopenia. Corticosteroids and intravenous immunoglobulin remain the first-line therapy in pregnancy, and a majority of pregnant women respond to this conventional therapy. Other cytotoxic and immunosuppressive agents used for treatment in non-pregnant patients, for example, danazol, cyclophosphamide, vinca alkaloids and azathioprine, are potential teratogens and cannot be administered during pregnancy. For pregnant women with ITP who fail to respond to medical management and are at a significant risk of haemorrhage due to thrombocytopenia, splenectomy may be considered as an option. We report two cases of splenectomy during pregnancy for refractory ITP. In one patient, it was carried out at 24 weeks, and in the second patient it was carried out during the caesarean section. Splenectomy as a second-line option in cases of refractory severe ITP in pregnancy is discussed.

Demystifying the Association of Chemotherapy and Cognition: How Close Are We?

TO THE EDITOR: The article by Jacolaet al 1 addressed the issue of cognition in patients with acute lymphoblastic leukemia (ALL) treated with a uniform protocol with assessment at predecided time points. There are a few pertinent points that we want to highlight in this study or other studies considering cognition as an outcome in ALL. First, although the authors have done serial monitoring of cognition tests at various times, baseline cognition testing is conspicuously missing. Remission induction in the St Jude Total Therapy XV study is a multidrug-regimen phase along with intrathecal therapy; therefore, there is the chance that 6 weeks of cognition testing might not be a good substitute for baseline testing. 2 Assessment of pretreatment cognitive status is essential because, at times, the change in cognition is so subtle that scores after chemotherapy might fall within the normal range. 3 In that scenario, percentage variation from the baseline can help yield the exact cognitive deficit. Thus, we think that baseline cognitive status would have served as a better control for the cognitive deficits at the end of therapy and 2 years thereafter, as also recommended by InternationalCognitionandCancerTaskForcerecommendationsto harmonize studies of cognitive function in patients with cancer. 4 Taken further, baseline cognitive function should also be compared with national normative data to see if it differs from the normal population. There is a possibility that oncology patients have preexisting cognitive dysfunction that might get compounded by other modalities of treatment. This has been conclusively shown in various cancers; however, this has all the more relevance in ALL because it is a systemic disease. 5,6

Neural substrates of emotional interference: A quantitative EEG study

Emotional stimuli are known to capture attention and disrupt the executive functioning. However, the dynamic interplay of neural substrates of emotion and executive attentional network is widely unexplored. The present study attempts to elucidate the areas implicated during emotional interference condition. Fifteen right handed individuals [24.64 ± 2.63 years] performed two emotional interference tasks - Face Word Interference and Word Face Interference. Single trial EEG was recorded during baseline (eyes open) and during the tasks. The activity of the cortical sources was compared between the tasks and baseline for 66 gyri using sLORETA software. Eighteen gyri in Face Word Interference and fifty-four gyri in Word Face Interference have shown significantly decreased activity [p < 0.05/66] with respect to baseline respectively. Interestingly, in both the interference tasks, there was disengagement of fronto-parietal attentional networks (implicating the probable ability of emotional stimuli to disrupt cognition) and the areas associated with default mode network. Further, during baseline there was significant activity in premotor cortical areas, which may be due to active inhibition of motor movements associated with response.

Deficit in specific cognitive domains associated with dementia in Parkinson’s disease

Impairment in different cognitive domains such as executive functions, language, memory and visuospatial skills occur frequently in Parkinson disease (PD) leading to significant disability and deterioration in quality of life. Heterogeneity of cognitive impairment enhances risk of developing dementia as disease progress. The objective is to explore the pattern of cognitive impairment with reference to the affected domains in PD with or without dementia relative to healthy controls. In this study, 110 PD patients and 26 healthy control were categorized into groups using Mini Mental State Examination and Clinical Dementia Rating scores as PD without dementia (PDND, n = 65; MMSE score >24; CDR = 0-1), PD with dementia (PDD, n = 45; MMSE score ≤24; CDR = 0.5-3) and healthy control (HC, n = 26; MMSE score >26; CDR = 0). Both Patients and controls underwent individual assessments of working memory, semantic memory, attention, language, executive functions, psychomotor and visuospatial skills and dementia using different cognitive function tests. Findings revealed lower scores of word memory, attention, psychomotor speed, visuospatial skills and executive functions in PDD compared to PDND. Interestingly, in PDD scores of picture memory, semantic memory and language functions were comparable with PDND. Compared to HC, PDND had no impairment in working memory, attention and executive functions, whereas PDD had lower scores in all the cognitive domains tested. Results indicate that the deficits in word memory, attention, psychomotor speed, visuospatial skills and executive functions distinguishes PDD from PDND. Impairment in specific cognitive domains may be a biomarker for predicting onset of dementia in Parkinsons disease.

A novel method for assessing patients with schizophrenia and their first-degree relatives by increasing cognitive load of visuo-spatial working memory

In patients with schizophrenia, social and functional outcome is determined by the cognitive impairment. Assessment of visuo‐spatial working memory (VSWM) which can simulate the day‐to‐day activities by simultaneous involvement of various elements of working memory may reflect disorganized thinking and fragmentation of thoughts in schizophrenia.

Pulmonary function tests in type 2 diabetes mellitus

Background: Diabetes mellitus is a chronic disease with microvascular and macrovascular complications. Effect of diabetes on lung capacity has been reported previously but with controversial results. This study will help to reassess whether or not Pulmonary Function Tests should be done in diabetics or not. Aim and Objective: Our study aimed to evaluate pulmonary function testing in patients of type 2 diabetes mellitus (T2DM). Study Design: Randomized Case control study. Materials and Methods: 50 diabetics and 50 matched apparently healthy volunteers taken for this study. After taking an informed consent, all underwent screening with detailed history, anthropometry, blood sugar (fasting and post parandial), and pulmonary functions (using medspiror). Statistical Analysis: Student t test was used to compare PFTs of diabetic and control groups. Frequencies were generated for categorical variables and compared with chi square test. Results: There was significant reduction in all the PFT parameters (FVC%, FEV1% and FEV1/FVC) in diabetics as compared to controls. Thus, mixed obstructive-restrictive pattern of pulmonary dysfunction is seen in diabetics. Also strong positive correlation was seen between fasting blood sugar and FEV1/FVC in diabetics. Although body mass index (BMI) was more in study group versus control group, but the difference was not significant. Conclusion: Lungs are indeed effected in patients of diabetes and pulmonary function testing should be mandatory in diabetics in order to prevent complications thereby improving quality of life.