Sougat Ray

Best practices of medical journalism: Role of editors, peer reviewers, and authors

Medical writing is an art which requires a fine blend of new scientific information and rhetorical skills. An article in a reputed journal ensures recognition and career advancement, and there has been a rush among doctors to publish their research work. Several indexed “predatory” journals have mushroomed and are accepting articles without a blinded peer review. The standard impact factor (IF) scoring for a journal has been debatable and so has been the authenticity of indexing. Awareness regarding standard guidelines is required for reliable and valid research. Evidence from a scientific research is the need of the day for an emerging economy like India to help build universal health coverage and meet sustainable developmental goals. This article analyses the concepts of IF and indexing and discusses the best practices for the editors, peer reviewers, and authors.

Impact of Nutritional Determinants and Associated Socio-Environmental Factors in Pulmonary Tuberculosis Patients: An Observational Study

Introduction: The risk of developing pulmonary tuberculosis (PTB) increases with concurrent nutritional deficiency, of the specific nutrients, social and environmental conditions. PTB, on the other hand, gives rise to both muscle andfat wasting due to loss of appetite and increased catabolic activity. It is also associated with an increased risk of relapse and secondary Multidrug Resistant (MDR) TR Indoor air pollution, smoking and alcohol are well known strong predictors and surprisingly still quite prevalent in rural and urban areas. Methodology: A cross sectional study was carried out over a period of 06 months in PTB cases, above 15 years of age, attending the DOTS centres in an urban area. Extra PTB cases were excludedfrom the study. The sample size was worked out to be 118. Results: Overcrowding was present in 76 (64.4%) of the respondents, 91 (77.1%) had kitchen within the living rooms and 52 (44.1%) of them used cylinders (LPG) and kerosene oil as the cooking fuel Current smoking was reported by 70 (59.3%) patients, and 44 (37.2%) reported alcohol consumption. Of the 118 respondents, 10 (8.2%) had HIV/AIDS and 31 (26.2%) had Diabetes as co morbidities. Around, 69 (58.5%) of them had low BMI (Thinness), PBFwas low in 83 (70.3%) cases andSMM was low in 80 (72%) cases. Conclusion: Proper dietetic advice, taking into consideration local dietary preferences, may be required to be included in the TB management protocol at the DOTS centre. Indoor air pollution needs to be curbed in our society both in the rural as well in the urban area by empowering the community with better fuel.

Relationship between Barthel Index (BI) and the Modified Rankin Scale (mRS) Score in Assessing Functional Outcome in Acute Ischemic Stroke

Introduction: A more than one third of stroke survivors are left with permanent disability in the form of significant residualphysical, cognitive andpsychological impairments. The increasing emergences of new therapies for acute stroke suggest that there will be an increase in number of survivor living with disabilities. Accurate outcome prediction following stroke is important for the proper delivery ofpost stroke care and establishment of an effective continuing care program. Numerous trials have been undertaken to study the prognosis of stroke. Recent literature suggests the early clinical courses of the neurological deficit after acute stroke is dependent on the initial stroke severity. Methodology: Study was conducted at a tertiary care centre in over a period of 2 years. The diagnosis of stroke due to vascular event was confirmed in each case by neuroimaging (plain CT Scan Head/ MRIBrain) apart from the clinical evaluation. Patients screened were evaluated at enrolment (within 7 days from stroke onset) and during follow up at 04 weeks and 12 weeks after stroke by the same observer employing the same criteria used at the time of presentation using following scales: Barthel′s index (BI) and modified Rankin Scale (mRS) score. All the patients were given standard care as per the guidelines of American Stroke Association. Primary outcome was to study the co-relation between BI and mRS in assessing functional outcome in acute ischemic stroke at the end of 4 weeks and 12 weeks and secondary outcome was to study the correlation between the functional outcome scales andfindings on neuroimaging of brain. Results: Sixty nine patients were screened for the study and 58 patients met the eligibility criteria. Out of 58 patients, 8 patients hadpresented within window period (3h - 41/2 h). The overall mortality during 12 weeks amounted to 10.3% and was higher in men (6.9%) than women (3.4%). Thefunctional outcome scores were calculated by using the BI and mRS at admission and follow up. The mean BI score at admission and at 12 weeks was 36.72 ± 23.72 and 63.88 ± 29.85 respectively. The mean mRS score at admission and at 12 weeks was 4.09 ± 0.77 and 3.00 ± 1.40 respectively. Correlation between the BI score and mRS score at admission, and during follow up showed a significant negative correlation (p< 0.001). Infarct size and BI score at admission, 4 weeks and at 12 weeks were found to be negatively correlated (p< 0.001) which means that as the infarct size increased, BI score decreased Infarct size and mRS score at admission, 4 weeks and at 12 weeks werefound to be positively correlated (p< 0.001) which means that as the infarct size increased, mRS increased. Conclusion: Our study has demonstrated that stroke functional outcome can be predicted from the baseline BI and mRS scales. It is concluded thatBI and mRS Stroke scale can be used to prognosticate functional outcome at admission and at follow up.

A new ‘Hydration Protocol’ for Prevention and Management of Heat Stroke in High Endurance Military Training

Background: Rigorous exercise is a hallmark of military training and more than often gives rise to dehydration and stress related injuries. Proper hydration and carbohydrate loading can overcome dehydration and protein supplement can prevent its imminent complications. Severe dehydration gives rise to loss of fluid, electrolyte imbalance and acid base disorders and needs to be managed with correct fluids, quantitatively and qualitatively. Objectives. To develop and implement a new hydration protocolfor military endurance training in hot and humid climatic conditions. Methodology: A longitudinal pilot study was conducted amongst the under trainees in a military academy in Southern India which has a hot and humid climate throughout the year. Data was collected for all heat exhaustion and heat stroke cases admitted to the hospital A new hydration and diet protocol based on extensive review of existing and current literature was developed The protocol was divided into three parts Le. pre exercise, during exercise and post exercise. Results: Out of a total of 1200 under trainees being trained in each term of six months (both in 2014 and 2015), there were a total of 95 cases of heat exhaustion and 05 cases of heat stroke in 2014 and 48 cases of heat exhaustion and 05 cases of heat stroke in 2015. Conclusion: The results of implementation of the new protocol for endurance training is encouraging with a sharp decline in number of cases of heat exhaustion in 2015 post introduction of the new hydration and dietprotocol An appropriate selection of food andfluid, timing of intake, and supplement choices as per the new hydration protocol we developedfor the study are highly recommended for optimal health and exercise performance in military training and to prevent heat related illnesses.

Effect of prolonged exercise on blood glucose levels of under-trainee divers : A pilot study

Introduction: Diving training involves prolonged exercise at high intensity on daily basis, continued for months. During the daily prolonged training (also known as circuit training), the under-trainee divers carry out running, swimming and other strengthening exercises for a 2-21/2 hrs at a stretch. The divers are not provided with any form of supplementation during the exercise routine. There are occasional incidences of exhaustion and unexplained syncope in these under-trainees especially just before finishing the exercise schedule, which could possibly be due to hypoglycemia. In order to investigate this unexplained syncope, a pilot study was carried out on a batch of under-trainee divers to evaluate their capillary blood sugar levels before and after the training schedule. Material and methods: 36 under-trainee divers (all males) were included in the study. Their blood glucose levels were checked using glucometer (Accuchek active) before and after the circuit training. The findings were recorded on excel worksheet and analysed. Their mean blood glucose levels were calculated pre and post training and a paired t test was done to analyse the significance of the change in blood glucose levels. Results: The mean BMI of the under-trainee divers was 22.41±1.25 Kg/m2. The mean blood glucose levels pre-training was 113.92±22.48 mg/dl. 3 0 % under-trainees were found to have pre-exercise blood sugar < lOOmg/dl. Six divers(16.66%) were found to have blood sugar value >140mg/dl. The mean blood glucose after exercise was significantly lower at 91.50±10.80 mg/dl. 75 % divers were found to have post exercise blood glucose< lOOmg/dl. All of the divers with high pre-training glucose levels had post exercise blood glucose < lOOmg/dl. The mean fall in blood sugar values of these was significantly greater as compared to those having pre-training blood sugar < 140mg/dl (65.66±10.01 mg/dl vsl3.76±20.08 mg/dl). Conclusion & Recommendations: It is recommended that HbAlC measurements of all undertrainee divers be carried out prior to induction for training and if found > 6.5%, it should be further investigated using blood sugar fasting (F) and Post Prandial (PP). Also the undertrainee divers should be provided with carbohydrate, salt and fluid supplementation during the circuit training to prevent exhaustion.