Natl Med J India
-
Background Autologous stem cell transplantation (ASCT) is potentially beneficial for patients with myeloma-related renal impairment but is associated with high rates of complications in dialysis-dependent patients and requires specific precautions. Methods Patients diagnosed with myeloma and concomitant dialysis-dependent renal dysfunction were admitted for ASCT after achieving at least partial response with bortezomib-based induction therapy. For both patients, mobilization consisted of granulocyte colony stimulating factor for 5 days and CD34 directed Plerixafor on Day 1. ⋯ Conclusions ASCT in dialysis-dependent patients is associated with a higher risk of drug toxicity, infections and transplant-related mortality. Use of reduced dose melphalan, pre-emptive dialysis after 24 hours and monitoring for acidosis and symptoms of uraemia to identify acidosis at an early stage allows safe administration of high dose chemotherapy. A major proportion of patients can potentially achieve reduction or freedom from dialysis support post-transplant.
-
Background We initiated a conversation regarding the concept of professional identity formation (PIF) with faculty of Institute of Nursing at our university through a participatory workshop. We report the planning and conduct of the workshop, as well as lessons learnt from the discussions in the workshop. Methods We designed and implemented a day-long workshop for 28 nursing faculty at Institute of Nursing, Bhaikaka University, Gujarat. ⋯ Key themes identified from the participants' reflections were: (i) their different views about professional identity, (ii) experiences and reactions and (iii) their future action plan. Conclusions The workshop was well received by the participants. Our approach to the workshop might help other institutions design and implement similar activities as a part of their faculty development programme.
-
Continuing medical education (CME) credits has been mandated by the National Medical Commission for registered medical practitioners in India as a part of continuing professional development and a minimum of 30 credits in 5 years is required for the renewal of the medical license. Undoubtedly, credit hours for CME attendance is an essential yardstick for professional and career growth, the modus operandi adopted to grant these credit hours needs a serious look. Targeted learning with adequate feedback either with a post CME examination or questionnaire should become the norm and every publication in high impact indexed journal deserve a higher credit point than the rest of the publications.
-
As Covid-19 becomes, for better or worse, an endemic disease, the future of the revolutionary Covid-19 Vaccine Intelligence Network (Co-WIN) platform needs to be considered seriously. Rather than being made obsolete, the Co-WIN platform can serve as a stepping stone to catalyse a true digital healthcare revolution in India if steps are taken to harness its features and data for varied uses as part of the Ayushman Bharat Digital Mission. By bringing these features to other vaccinations, as well as integrating outbreak data from the Integrated Health Information Platform for public knowledge and awareness, disease responses can become faster and more public-driven (rather than government-driven as currently). This will also create a data pool that will be of value in post-vaccination monitoring.
-
Wilson disease is a rare genetic disorder of copper metabolism causing hepatic dysfunction and neuro-psychiatric manifestations. While psychosis in Wilson disease is uncommon, it can occur, especially with certain medications. We describe a 40-year-old woman diagnosed with Wilson disease who developed psychotic symptoms following the initiation and dose escalation of amantadine, a drug commonly used to treat parkinsonism associated with the disorder. ⋯ The psychosis resolved after discontinuing amantadine, without worsening her neurological symptoms. This underscores the importance of monitoring for psychiatric side-effects, particularly Schneiderian first-rank symptoms, in patients with Wilson disease being treated with amantadine. The findings suggest a probable adverse drug reaction, highlighting the need for careful evaluation and dose adjustments in such complex clinical cases.