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 About Us

The Good Research Project was started by Dr. Shreya Deoghare in

May 2022; with the aim to promote genuine and hands-on research
experience for medical students and graduates.

Over a period of three, The Good Research Project has expanded to

include 850+ members and 60+ students.

Sessions conducted in July

• Introduction to Research and Publication

• Medical Article Writing workshop

• Journal Club – a poster and paper presentation workshop

Ongoing activities : Web-based observational research study

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Study of the Role of Plasma NT-proBNP in the Diagnosis of
Heart Failure
Ria Singh Rawat, Final year (MBBS), RRMCH
Cardiovascular mortality and morbidity are frequently caused by heart failure (HF), which
poses a risk, particularly for the elderly, substantial strain on healthcare resources of our
nation. Cardinal symptoms include – shortness of breath or dyspnea, orthopnea, swelling of
lower extremities, abdominal distention, right upper quadrant pain, fatigue.

To clear the diagnostic dilemma, prohormone natriuretic peptides (proBNP), was considered
as a marker. It is released during hemodynamic stress, that is when ventricles are dilated,
hypertrophic or subject to increased wall tension.

In the study, of 50 patients, the following results were obtained:-

BMI Not significant

Creatinine levels Inversely proportional
LVEF (Left Ventricular Ejection Fraction) Inversely proportional, varying levels
may have same NT-proBNP values
NYHA classification (New York Heart Highest NT-proBNP values had longest
Association) stay
Class III > IV > II
Age Directly proportional, but multifactorial
Renal function Inversely proportional

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Study of the Role of Plasma NT-proBNP in the Diagnosis of
Heart Failure
Ria Singh Rawat, Final year (MBBS), RRMCH
All these results were not independent of the other factors, they were multifactorial.

Two-dimensional echocardiography was used as a diagnostic test for HF and as a result, the
usage of NT-proBNP gave a sensitivity of 97% and low specificity of 58%. The accuracy was
found to be 86%.

We can conclude that, only in conjunction with clinical evidence can NT-proBNP help rule in
or rule out Heart Failure.

Reference : Bahaar Athavale, Jaya Pathak. Study of the Role of Plasma NT-proBNP in the
Diagnosis of Heart Failure. Journal of the Association of Physicians of India. 2022; 70(7):38-
42.

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 A CASE CONTROL STUDY OF RISK ASSESSMENT OF DIABETES
AND NEPHROPATHY WITH enos ( T786C and 27bp VNTR ) GENE
POLYMORPHISMS
By Dr. Adarshpreet Singh, MBBS, PIMS Jalandhar
Diabetes mellitus(DM) has become a common public health problem with changing lifestyles
worldwide. Diabetic nephropathy(DN) is a serious complication leading to kidney failure in
end stages. It is characterized by deranged filtration mechanism, structural alterations and
changes in metabolism.

Due to variations in diabetics who develop DN despite glycemic control, it has been
suggested that genetic factors play an important role apart from environmental factors. In
the event of advancements in genetic methods, several groups of genes which increase the
risk of DN has been identified. Among the various susceptibility genes, eNOS gene has been
given due attention.

The eNOS gene is chiefly expressed in endothelium. This gene is required in synthesis of
Nitric Oxide(NO) from L-arginine under action of enzyme nitric oxide synthase(NOS). NO acts
as vascular dilator to maintain vascular homeostasis. Previous Studies have shown that
Variants of eNOS gene( 27bp Variable number tandom repeats VNTR), T786C may affect
synthesis of NO leading to glomerular diseases DN. This study aimed to see the association of
eNOS( T786C, 27bp VNTR) gene polymorphism and risk of DM and DN in north India.
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 A CASE CONTROL STUDY OF RISK ASSESSMENT OF DIABETES
AND NEPHROPATHY WITH enos ( T786C and 27bp VNTR ) GENE
POLYMORPHISMS
By Dr. Adarshpreet Singh, MBBS, PIMS Jalandhar
The Prospective case control study was conducted. The required number of patients aged 18-
75 years diagnosed with TypeII Diabetes Mellitus( GroupA) and comparable adult healthy
patients( GroupB Control) were assigned. GroupA further was divided into A1( Diabetic
patients without evidence of DN) and A2( Diabetic patients with evidence of DN).

Below is the Comparison of demographic features and clinical investigation findings

• Age was significantly higher in GroupA1 and GroupA2 than GroupB.

• Glycemic values( Fasting blood sugar, Post-prandial blood sugar, Glycosylated

haemoglobin) were statistically significant higher in Group A1, Group A2 than Group B and
comparable among Group A1 and Group A2.

• eGFR was significantly lower in GroupA2 as compared to GroupA1 and overall controls had
significant higher eGFR.

• 24 hour urine albuminuria was also significantly higher in GroupA2 as compared to

GroupA1 and both of which were significantly more than control groupB.

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 A CASE CONTROL STUDY OF RISK ASSESSMENT OF DIABETES
AND NEPHROPATHY WITH enos ( T786C and 27bp VNTR ) GENE
POLYMORPHISMS
By Dr. Adarshpreet Singh, MBBS, PIMS Jalandhar
• Serum creatinine values were significantly higher in cases as compared to controls with
GroupA2 have significantly more mean value than GroupA1.

Below is the Comparison of gene variants of eNOS( namely T786C and 27bp VNTR) in study
groups and control group

• Both variants were genotyped using Polymerase chain reaction- restriction fragment
length polymorphism( PCR-RFLP) methods. However 27 VNTR of eNOS gene characterized
by presence of four 27bp repeats( a allele) or five 27bp repeats( b allele). T786C variant
characterized by presence of 162bp and 61bp( T allele) and 116bp, 61bp, 46bp( C allele).

• It is found that 27 VNTR b allele was present in majority of subjects( study groups and
control group), however it was not statistical significant.

• After removing confounders of Age and Gender, the adjusted Odds ratio( OR) of Ab in all
groups was lower than Aa. However again it was not statistical significant. No correlation was
seen between a allele and b allele.

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 A CASE CONTROL STUDY OF RISK ASSESSMENT OF DIABETES
AND NEPHROPATHY WITH enos ( T786C and 27bp VNTR ) GENE
POLYMORPHISMS
By Dr. Adarshpreet Singh, MBBS, PIMS Jalandhar
• 786T>C T allele was found in majority of subjects( study group and control group),
however it was not statistical significant.

• The adjusted Odds ratio( OR) in all groups was lower in TC than CC. Again it was not
statistical significant. No correlation seen between T allele and C allele.

Conclusion: In the present study, it was found that eNOS( T786C and 27bp VNTR) gene
polymorphism showed no significant increased risk of DN in Diabetics. Diabetes being a
polygenic trait requires identification and assessment of multiple genes together to adjust for
confounding caused by various genetic mechanisms(e.g. DNA methylation, functional non-
coding RNAs). Future large sample studies are required based on ethnic variation which may
give clear association of genes and their associated risk with Diabetes and its complications.

Reference: Anju, Singh H, Kalra O, Shankar D, Kumar A. A Case control Study of Risk
Assessment of Diabetes and Nephropathy with eNOS( T786C and 27bp VNTR) Gene
Polymorphisms. JAAPI. 2022; 70: 75-79.
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 Extracorporeal membrane oxygenation in patients with
severe respiratory failure from COVID-19
By Japleen Kaur, MBBS, GMC Amritsar

Coronavirus disease (COVID-19) is a contagious disease that has affected over 500 million
people and has caused death of more than 6 million people globally. It can sometimes cause
severe respiratory failure. Treatment of severe respiratory failure initially includes following
conventional therapies:

•Prone positioning

•Invasive mechanical ventilation with lung protective strategies

•Inhaled pulmonary vasodilators

Veno-venous extracorporeal membrane oxygenation (ECMO) is considered in patients with

progressive severe respiratory failure despite the conventional therapies. ECMO works by
temporarily drawing blood from the body to allow artificial oxygenation of the red blood cells
and removal of carbon dioxide. It is being used in several countries for covid-19.

Clinically, eligible patients for ECMO are those with PaO2/FiO2 <100 mmHg while receiving
invasive mechanical ventilation.

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 Extracorporeal membrane oxygenation in patients with
severe respiratory failure from COVID-19
By Japleen Kaur, MBBS, GMC Amritsar

Relative contradictions for ECMO are age above 70 years and terminal malignancies. Patients
suffering from any chronic condition may be eligible for ECMO depending on severity and
duration of disease.

Prior to ECMO:

•It is important to administer intravenous heparin to the patient to prevent clotting and
thrombus formation.

•Blood investigations and pulmonary function tests should be done.

Complications:

•Bacterial pneumonia

•Bleeding

•Thrombotic events

•Acute kidney injury requiring renal replacement therapies

•Intracranial hemorrhage and stroke

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 Extracorporeal membrane oxygenation in patients with
severe respiratory failure from COVID-19
By Japleen Kaur, MBBS, GMC Amritsar

It is noted that 50-70% of patients who received ECMO survived to the hospital discharge or
60 days following ICU admission. Some patients may require some form of rehabilitation post
discharge. Thus, ECMO has shown benefit in covid-19 patients provided appropriate covid-19
patients are selected who can derive greatest benefit from ECMO.

Reference: Shaefi S, Brenner S, Gupta S, O’Gara B, Krajewski M, Charytan D and et al.

Extracorporeal membrane oxygenation in patients with severe respiratory failure from covid-
19. ICM. 2021; 47:208-221.

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 Clinical Spectrum of Rheumatic Manifestations in HIV Infected
Males at a Tertiary Care Hospital
By Dr.Abhijeet Kaur, MBBS, Government Medical College Patiala

Human Immunodeficiency Virus-Acquired ImmunoDeficiency Syndrome(HIV-AIDS) – an

immunodeficiency disease caused by HIV virus which attacks T-helper cells , predisposes the
individual to a variety of opportunistic pathogens and malignancies due to
immunocompromised state of the individual.

Occurrence of Immunological and rheumatic disease in these , though uncommon , is an

apparent paradox due to overwhelming immunodeficiency and immunosuppression. Variety
of immunological reactions include immediate hypersensitivity , reactive arthritis and diffuse
infiltrative lymphocytosis. Initiation of Anti Retroviral Therapy (ART) may lead to exaggerates
immune response to existing opportunistic infections known as IMMUNE REACTIVATION
SYNDROME.

Rheumatic manifestations could be due to direct and indirect effects of HIV virus with
genetic and environmental factors playing a key role. The virus may cause abnormal
polyclonal B cell activation and polyclonal hypergammaglobulinemia.

Autoimmune diseases like SLE and RA have reported to improve with decrease in CD4 count
in HIV.

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 Clinical Spectrum of Rheumatic Manifestations in HIV Infected
Males at a Tertiary Care Hospital
By Dr.Abhijeet Kaur, MBBS, Government Medical College Patiala

Table 1 summarises rheumatic manifestations observed in HIV patients

HIV patients presenting with rheumatic manifestations usually belong to the age group of 36-
40 yrs followed by 31-35 yrs . most if these patients had contacted HIV through heterosexual
exposure to commercial .

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 Clinical Spectrum of Rheumatic Manifestations in HIV Infected
Males at a Tertiary Care Hospital
By Dr.Abhijeet Kaur, MBBS, Government Medical College Patiala
DISCUSSION-

Arthritis could manifest in any disease stage of HIV and could be the initial presentation as
well. Most common form of inflammatory arthritis seen in HIV patients is
Spondyloarthropathy. The first described arthritis in HIV – REITER’s SYNDROME has a
prevalence of about 0- 10%. This increased prevalence has been attribute to the sexually
active nature of the population at the highest risk for HIV infection and the secondary
infection in the gastrointestinal and genitourinary tract due to arthritogenic organisms.

CONCLUSION-

Although pathogenesis of these rheumatic manifestations is not well understood , early

recognition and treatment of opportunistic infections is important as they can be inciting
agents for rheumatic disorders. Most of the patients had relief of symptoms as HIV
responded to ART.

REFERENCE –

Khurana H , Jha V , Khurana A , Kumar A . Clinical Spectrum of Rheumatic Manifestations in

HIV Infected Males at a Tertiary Care Hospital . JAAPI. 2021; 69,10:69-73
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 Symptoms of PTSD Higher Among Family Members of
Patients Admitted to ICUs with COVID-19
By Nilashis Dutta, DYPMC Pune
Healthcare systems of different countries around the world vary a lot, but all of them got
tested to their limits by the COVID-19 pandemic. Mortality rates among people with COVID-
19 respiratory failure were as high as 60% to 80% since the initial days of the pandemic.
Many hospitals banned visitors during the early months of the pandemic in order to reduce
viral transmission, and some still do to differing degrees. These measures have put the family
members of the patients under significant stress.

Family members of COVID-19 patients admitted to ICUs have been identified with symptoms
of post-traumatic stress disorder (PTSD), as well as some other stress-related symptoms like
depression and anxiety, and the presence of any of these symptoms have been termed to be
the post-intensive care syndrome family. Many studies have found that active involvement of
the families at the bedside of patients with COVID-19 decreases stress-related symptoms.

More specifically, it has been observed that increased family member engagement and
control at the bedside of any moderate to severely ill patient, has been linked to a reduction
in stress-related symptoms among the family persons. Getting an understanding of this effect
on the family members of the patients in a normal day-to-day healthcare scenario, aids us in
the identification of measures to lessen the consequences when family members are unable
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A study has examined the negative repercussions of visitation limitations on family members
 Symptoms of PTSD Higher Among Family Members of
Patients Admitted to ICUs with COVID-19
By Nilashis Dutta, DYPMC Pune
to attend at the bedside due to the pandemic-related protocols.

A study has examined the negative repercussions of visitation limitations on family members
of very sick COVID-19 patients. The hypothesis that came out of this study pointed out that
these family people would exhibit severe psychiatric symptoms like depression, anxiety, and
PTSD. This cohort study was done at more than 10 US healthcare centers in Massachusetts,
New York, Louisiana, Colorado, and Washington.

Close kins of every patient who was admitted to the COVID-ICU from February 1 through July
31, 2020, with elevated oxygen needs were qualified for the study. Approximately three to
four months following the patients' ICU stay, eligible family members were interviewed to
look for any PTSD symptoms and again they were surveyed at around six months, which was
like 2 months after the first survey. The revised Impact of Events Scale (IES-r)- questionnaire
was used for the PTSD symptom screening. A score of more than 10 on the IES-6 scale, which
is a minimized version of the IES-r scale, is indicative of significant PTSD, though not
absolutely diagnostic. And scores under 10 may still represent clinically significant
posttraumatic stress.

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 Symptoms of PTSD Higher Among Family Members of
Patients Admitted to ICUs with COVID-19
By Nilashis Dutta, DYPMC Pune
Around 350+ people among the eligible 900+ family members, who had consented to take
part in the 2-part PTSD screening interview and have completed it, among them more than
60% had an IES-6 PTSD score of 10 or more. At any time earlier than this COVID-19 pandemic,
only around 30% of family members of general ICU patients showed some posttraumatic
stress symptoms. The study has also found that lower mean IES-6 scores were linked to
higher levels of schooling. Participants with college degrees had a mean IES-6 score that was
2.3 points lower than those with a high school diploma or its equivalent, and those with a
graduate degree had a mean IES-6 PTSD score that was 3.3 points lower.

This particular study has also demonstrated that people who scored higher had more
mistrust towards practitioners. This lack of trust may result in a rise in stress-related illnesses
as the pandemic continues to make it difficult for family members to develop close
connections with the treating physicians at the patient's bedside. Inventive ways of
connecting with family members may assist to compensate for the physical distance, which is
the main cause behind the development of stress among family members.

The consequences of these findings imply that the restrictions to visit COVID ICU patients
may unintentionally cause an epidemic of stress-related illnesses among ICU patients'
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 Symptoms of PTSD Higher Among Family Members of
Patients Admitted to ICUs with COVID-19
By Nilashis Dutta, DYPMC Pune
families, leading to a secondary public health catastrophe. To determine how to enhance the
experiences of family members who are unable to be there while a loved one is admitted to
the COVID ICU, more research initiatives are required.

Reference:

Amass T, Van Scoy LJ, Hua M, et al. Stress-Related Disorders of Family Members of Patients
Admitted to the Intensive Care Unit With COVID-19. JAMA Intern Med. 2022;182(6):624–633.
doi:10.1001/jamainternmed.2022.1118

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 Dermatological Disorders in the Intensive Care Unit
By Dr. Gurmehak Kaur, MBBS. JR, Dr RML Hospital New Delhi
With patients admitted in the Intensive care unit (ICU), more often than not dermatological
concerns are neglected as they aren’t life-threatening. They might not be life threatening but
can severely impair the quality of patient’s life. It’s harder for dermatologists to diagnose
these conditions in ICU patients than regular ward ones because of the inability to take
history and examination in these patients.

The most common disorders found in these patients were Rhinocerebral Mucormycosis,
Herpes zoster, Oral candidiasis, Palpable purpura, Purpura fulminant, Pressure sores, Miliaria,
Xerosis and Gangrene.

Results-

This long intensive study of one year on ICU patients showed males to be more susceptible
than females, with most patients having pre-existing dermatological conditions and a few
with new lesions after their stay in the ICU.

These conditions were divided into infectious and non-infectious disorders. Fungal infections

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 Dermatological Disorders in the Intensive Care Unit
By Dr. Gurmehak Kaur, MBBS. JR, Dr RML Hospital New Delhi
and purpura being the most common in infective and non-infective disorders. A lot of the
treatments had to be modified for these disorders due to co-morbidities and other
medications these patients were on.

There were 3 conditions that were pure dermatological conditions requiring ICU care -
Herpes Zoster, Pemphigus Vulgaris, Erythroderma and Toxic epidermal necrolysis.

Various factors such as trauma during procedures, immobility, poor nutrition lead to reactive
dermatological conditions. In several patients the therapy needed to be modified a little due
to systemic illnesses eg- antivirals needed to be decreased in chronic kidney disease patients,
delaying immunosuppressants.

All in all, with this study, it was concluded that the best patient care was possible when the
intensivist and dermatologist collaborated to identify these disorders and gave timely
treatments.

Reference: Srivastava A. Mathur AD. Agarwal S. Dermatological disorders in the Intensive care
unit. JAAPI. 2021; 69(11): 36-40.

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 The Importance of an Early Diagnosis in Systemic Lupus
Erythematosus
By Anagha SK, MBBS. GMC Thiruvananthapuram.
Systemic lupus erythematosus is an autoimmune disease mostly affecting women during
their thirties and forties. Its nature of being a “multisystemic disease” is associated with a
high degree of variability at onset, ranging from more specific symptoms such as the typical
malar rash, nephropathy and anti-double-stranded DNA antibodies (anti-dsDNA), to non-
specific findings such as fever, anemia, arthritis and antinuclear antibodies (ANA). Thus,
especially at the onset, the diagnosis of SLE can be challenging, in some cases even for
experienced physicians, and this can result in a dangerous diagnostic delay.

The new Systemic Lupus International Collaborating Clinics (SLICC) classification criteria have
a higher sensitivity when compared to the revised ACR criteria that were used earlier.
However, even the SLICC classification criteria are not diagnostic criteria and cannot be
applied to every individual case.

So, the diagnosis of SLE remains very difficult, especially in the early stages of the disease
when it is crucial to start the correct treatment. It is well known that delay in treatment is
associated with a worse prognosis; the progressive decrease in the time elapsed between
disease onset and diagnosis is one of the major contributors to increased survival and
improved quality of life in SLE patients over time.
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 The Importance of an Early Diagnosis in Systemic Lupus
Erythematosus
By Anagha SK, MBBS. GMC Thiruvananthapuram.
In 2012, a multicenter prospective study of patients with recent-onset SLE (<12 months)
collected information on the clinical and laboratory characteristics of SLE patients at the start
of the disease and during the first years of follow-up.

The following auto antibodies : antinuclear antibody (ANA), anti-dsDNA, anti-SSA (Ro), anti-
SSB (La), anti-Sm, anti-RNP, anticardiolipin (aCL), anti-beta2 glycoprotein I (anti-β2GPI), and
lupus anticoagulant (LA) were assessed for SLE diagnosis.

ANA is measured by immunofluorescence using Hep2 cells as substrate. The anti-dsDNA is

measured either by immunofluorescence using Crithidia luciliae or the Farr technique. The
anti-SSA, anti-SSB, anti-Sm, and anti-RNP antibodies are measured using the immunoblot
technique. aCL and anti-β2GPI are measured by enzyme-linked immunosorbent assay
(ELISA). Lupus anticoagulant is measured by coagulometric assay.

In this study conducted during a 2-year period on 122 patients with recent-onset SLE, there
were 103 females and 19 males among them (84.4% and 15.6%, respectively). It is found that
the mean age of onset of symptoms was 35 years. The mean age at which SLE is diagnosed is
37 years (when four or more of the ACR criteria for SLE are met). Therefore, the mean time
between the first manifestations and the final classification of SLE was 2 years. It is noted
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 The Importance of an Early Diagnosis in Systemic Lupus
Erythematosus
By Anagha SK, MBBS. GMC Thiruvananthapuram.
that the lag time between the onset and the diagnosis of SLE reported in major cohort
studies before 1980 was approximately 50 months and about 25–26 months after 1980.

The frequency of the manifestations (from onset until enrolment) included in the
classification criteria in comparison with two other studies done earlier were analysed and it
was found that :

Anti-dsDNA antibodies are the hallmark antibodies for SLE diagnosis and were present at
baseline in the large majority of patients (78%), representing the most frequent SLE-specific
classification criterion.

In the recent cohort study, it was found that ANA was present in all but three patients at
disease onset. Two of these three ANA-negative patients had anti-Ro antibodies and one had
antiphospholipid antibodies only (aCL anti-β2GPI at medium-high titer). All three patients
reported to be ANA negative at disease onset were found to be ANA positive at the
enrolment visit.

The second most important serologic feature was hypocomplementemia in about 50% of
patients. Low complement levels are much more prevalent in SLE than in other connective

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 The Importance of an Early Diagnosis in Systemic Lupus
Erythematosus
By Anagha SK, MBBS. GMC Thiruvananthapuram.
tissue and inflammatory joint diseases and, when combined with the presence of anti-
dsDNA, will probably be highly specific for SLE as well, strongly suggesting the diagnosis.

It is also found that only 31.1% of patients were presented with a typical malar rash at the
onset. On the contrary, the majority of patients presented with non-specific symptoms such
as arthritis and constitutional symptoms, e.g., fever (about 50%). This could make the early
diagnosis of SLE more difficult as in different studies patients were presented with different
predominant symptoms.

The relatively high proportion of musculoskeletal manifestations in SLE onset suggests that a
prompt referral of such patients to the rheumatologist could significantly reduce the delay of
the correct diagnosis.

In another study done earlier, it was found that arthritis was a predominant symptom at SLE
onset, but in their patients, leukopenia (54%) and malar rash (53%) were also more
prevalent, suggesting that SLE phenotypes are susceptible to genetic and geographic
influences.

It is to be noted that when comparing the prevalence of the major clinical features and of the

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 The Importance of an Early Diagnosis in Systemic Lupus
Erythematosus
By Anagha SK, MBBS. GMC Thiruvananthapuram.
major immunologic features at the onset of the disease in recent studies and studies done 20
years earlier, it was found that hematologic manifestations, serositis and nephropathy are a
much more common finding in recent studies than 20 years earlier.

Under the Study's Drug Therapy, main drugs used were Prednisolone, Hydroxychloroquine,
Azathioprine, Cyclophosphamide and Methotrexate

Glucocorticoids is the most commonly (85.1%) used drug in lupus patients compared to
other immunosuppressive drugs.

Hydroxychloroquine is also given to a high proportion of patients (63.6%).

In conclusion, it is understood that Systemic lupus erythematosus (SLE) is an autoimmune

disease with a high degree of variability at onset, making it difficult to reach a correct and
prompt diagnosis. It is characterised by a broad spectrum of clinical manifestations and a
multitude of laboratory abnormalities. Thus, it is difficult to identify SLE patients at an early
stage of the disease. The progressive decrease in time between disease onset and diagnosis
is one of the major contributors to the improvement in survival and quality of life in SLE
patients over time. However, additional efforts should be made to further improve the

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 The Importance of an Early Diagnosis in Systemic Lupus
Erythematosus
By Anagha SK, MBBS. GMC Thiruvananthapuram.
diagnostic procedures, which would help us make the diagnosis of SLE as early as possible.

References

1. Sebastiani GD, Prevete I, Piga M, et al. Early Lupus Project – a multicentre Italian study on
systemic lupus erythematosus of recent onset. Lupus 2015; 24: 1276-82.

2. Sebastiani GD, Prevete I, Iuliano A, Minisola G. The Importance of an Early Diagnosis in

Systemic Lupus Erythematosus. Isr Med Assoc J. 2016 Mar-Apr;18(3-4):212-5. PMID:
27228646.

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 Predictors of Outcome in Acute Respiratory Distress Syndrome
in Acute Febrile Illness in Medical Intensive Care Unit
By Dr. Snigdha Karnakoti, MBBS,
Malla Reddy Institute of Medical Sciences, Hyderabad
Introduction

Acute febrile illness (AFI), also known as acute undifferentiated fever, is defined as a fever
lasting two weeks or less. AFI is a leading cause of hospitalization in India, particularly
between the months of June and September. Depending on the underlying cause of AFI, the
most common complications are hypotension, acute kidney injury, acidosis, superimposed
bacterial infections, acute respiratory distress syndrome (ARDS), thrombocytopenia, acute
liver failure, or DIC.

The Sequential Organ Failure Assessment (SOFA) score is an objective score that determines
the severity of organ dysfunction across six organ systems (liver, cardiovascular, renal,
neurologic, respiratory, coagulopathy). It can assess individual or group organ dysfunction.

Summary

After obtaining permission from the Institutional Ethics Committee, this prospective
observational study was conducted on 130 patients at the Medical Intensive Care Unit of
Seth GS Medical College & KEM Hospital Mumbai from March 2016 to August 2017. The
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 Predictors of Outcome in Acute Respiratory Distress Syndrome
in Acute Febrile Illness in Medical Intensive Care Unit
By Dr. Snigdha Karnakoti, MBBS,
Malla Reddy Institute of Medical Sciences, Hyderabad
study included patients diagnosed with ARDS according to the Berlin definition. The study
included people who had an existing diagnosis of ARDS when they were admitted to the ICU,
as long as they survived the first 24 hours.

Diabetes mellitus and hypertension were the major comorbidities in this study, but neither
had a significant correlation with disease outcome. The most common presenting symptoms
were fever, cough, shortness of breath, myalgia, and vomiting. The majority of the study
population had been symptomatic for 1-6 days prior to presenting to the hospital with ARDS.
Dengue, H1N1, undifferentiated fever, leptospirosis, vivax malaria, and falciparum malaria
were the etiologies.

Males were more than females among nonsurvivors, with a statistically significant gender
gap. This is most likely explained by sex hormones' immunomodulatory role, as studies have
shown that female sex hormones are immunostimulatory while male sex hormones are
immunosuppressive.Some of the non-survivors were hypotensive on admission, which was
also found to be statistically significant. Patients with undifferentiated fever had the highest
mortality rate in AFI complicated by ARDS, followed by leptospirosis, H1N1, and dengue.

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One of our study's objectives was to assess the utility of SOFA score (at 0 and 48 hours) and
 Predictors of Outcome in Acute Respiratory Distress Syndrome
in Acute Febrile Illness in Medical Intensive Care Unit
By Dr. Snigdha Karnakoti, MBBS,
Malla Reddy Institute of Medical Sciences, Hyderabad
One of our study's objectives was to assess the utility of SOFA score (at 0 and 48 hours) and
delta SOFA score in predicting outcome in patients with AFI admitted with ARDS, and both
were found to be predictors of outcome.It had a significant predictive value for H1N1,
leptospirosis, and undifferentiated fever.

PaO2/FiO2 at admission was only a significant outcome predictor in leptospirosis and

undifferentiated fever, but it was significant at 48 hours in all etiologies of ARDS due to AFI.

Conclusion

AFI complicated by ARDS was associated with a 25.4 percent mortality rate. Delta SOFA score,
serum albumin, bicarbonate levels, BUN, and creatinine levels were significant predictors of
outcome in the patients in our study, as were SOFA score and PaO2/FiO2 at admission and 48
hours.

Reference: Varmudy A.Sonawale A.Gupta V. Karnik N. Predictors of Outcome in Acute

Respiratory Distress Syndrome in Acute Febrile Illness in Medical Intensive Care
Unit.JAPI.2022;70:45-49.

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 Sufferings of Black Pregnant Women; An Insight
By Bhavana Jala Nerella (Intern,MBBS, Dr.PSIMS&RF, Gannavaram)

A group of scientists at the Yale School of Public Health have conducted a study with the aim
of understanding how black pregnant women experienced intersectional judgment with
regard to race and gender.

Using grounded theory techniques 24 black pregnant women in New Haven, Connecticut
were interviews based on their experiences of gendered racism and concerns related to
pregnancy.

For many, radicalized pregnancy stigma was a source of stress and counteracted with many
coping responses

Black women have a maternal mortality rate 3.2 times greater than white women.Black
infants have a infant mortality rate 2.5 times greater than white infants.The preterm birth
rate for black infants is 1.5 times greater than white infants.Low birth weight babies are 2
times greater to be born black than white.

What is interesting is that neither socioeconomic status, prenatal care, or health behaviors
nor neighborhood poverty and unemployment completely explain these disparities. Even
more insightful is the fact that foreign black women are not susceptible to the same stress as
US born black women and also have better birth outcomes.
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 Sufferings of Black Pregnant Women; An Insight
By Bhavana Jala Nerella (Intern,MBBS, Dr.PSIMS&RF, Gannavaram)

Stigmatization and marginalization of black women has been perceived to be a causal factor
for poorer birth outcomes. These women are both judged on sex and color- this is termed as
“gendered racism.”

Both create a synergistic form of oppression. The intersection is a core of the reproductive
justice movement which addresses reproductive and social issues.

The stigmatization of black women in the US throughout history has come to justify the
exploitation and control of black women’s sexuality and fertility.

Coping mechanisms that black pregnant women have used include:

1. Active- feeling angry, anxious, sad (emotional), working harder to prove others wrong,
praying

2. Passive responses- feeling powerless, hopeless (emotional) and ignoring, accepting/ no

speaking up

The participants interviewed had felt their lives were devalued by society. These women
were encountering stigmatization throughout their pregnancies in many contexts such as
healthcare, social services, and housing related contexts. This has influenced their access and
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 Sufferings of Black Pregnant Women; An Insight
By Bhavana Jala Nerella (Intern,MBBS, Dr.PSIMS&RF, Gannavaram)

quality of services.

Example 1.)A participant recounting her experience in a grocery store where despite her
financial stability was presumed to be of low income and receiving public assistance benefits.

Example 2.) Assumption that black pregnant women have multiple children.

Example 3.) Black pregnant women are single mothers

Example 4.)Lack of acknowledgement in medical offices.

Example 5.)Insinuating Black pregnant women to undergo tubal ligation or other permanent
forms of contraception to control her fertility

Example 6.) Stereotypical questioning regarding marriage, or what the women will do with
another child

Example 7.)Assumption that Black pregnant women are not educated

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 Sufferings of Black Pregnant Women; An Insight
By Bhavana Jala Nerella (Intern,MBBS, Dr.PSIMS&RF, Gannavaram)

The Pattern of Racialized Gender Discrimination in Pregnant Black Women

Racialized pregnancy stigma—> poor maternal healthcare, increased stress, reduced access
to quality healthcare, services, resources, social support—> delays in health seeking
behavior, financial, and material hardship (inadequate food, housing, medical care)—>
reduced stress buffering—> poor infant outcomes

Some policies for the upliftment of the Black Pregnant Community proposed are:

1. By instituting bias training for healthcare and social service providers

2. Screening for racialized pregnancy stigma in healthcare settings

3. Providing evidence based coping strategies and creating pregnancy support groups in
healthcare and community settings

4. Developing a discourse that values Black women and their pregnancies and addressing the
structural challenges that Black communities confront

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 Sufferings of Black Pregnant Women; An Insight
By Bhavana Jala Nerella (Intern,MBBS, Dr.PSIMS&RF, Gannavaram)

In conclusion, by understanding and addressing radicalized stigmatization of pregnancy we

may be able to diminish its consequences and leading effects on future generations

References

Renee M, Lisa M, Urania M, Trace S. Jeannette R, Danya E. Womens Health Issues.

2020;30(6):484-492

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