Online archived Ward rounds from 2013 Bhopal

 Date: Sun, Feb 24, 2013, 3:39 PM

Reviewed 23/f(malabsorption syndrome with Rickets and weakness):

I had shown her to Dr HR and he felt we can also put her on Inj Arachitol (considering that she is having malabsorption). Here is a good study that supports its usage in Vitamin D deficiency:https://www.mja.com.au/journal/2005/183/1/annual-intramuscular-injection-megadose-cholecalciferol-treatment-vitamin-d

Arachitol (3 lac) - Injection, manufactured by Solvay Pharma India Pvt Ltd contains Generic Medicine Vit D3- 300000 iu.
Arachitol (3 lac)- Vit D3- Injection costs about Rs.19.25 per 1 ml in India as of date.
Duracal (3 lac) - Injection, manufactured by Ultramark Healthcare Pvt Ltd. contains Generic Medicine Vit D3- 300000 iu.
Duracal (3 lac)- Vit D3- Injection costs about Rs.18 per 1 ml in India as of date.
Systa D3 (3 lac) - Injection, manufactured by Systacare Remedies contains Generic Medicine Vit D3- 300000 iu.
Systa D3 (3 lac)- Vit D3- Injection costs about Rs.13.25 per 1 ml in India as of date.http://thedu.in/compare_prices/index.php/medicines-s/article/83723-systa-d3-3-lac-vit-d3-injection

I am not sure if we could carry out all the stool tests for malabsorption that we planned yesterday. Prof Ramakantan from KEM, Mumbai feels the X-rays are consistent with Osteomalacia and Hyperparathyroidism.

Ela, Anshul, Kartikeya, Please upload the images (clinical 'jar of pickles,' bowed bones and x rays) to tabula rasa so that it can be discussed there further.

Tue, Feb 19, 2013 at 10:54 PM

ICU 35M CKD What is his Kidney size? Any RBCs in his urine? If his Kidney size is normal we can plan for a biopsy.

For 23/f(malabsorption syndrome with Rickets and weakness):
Check history of current menstruation.
Get X ray Knees bilateral and X ay wrists bilateral (if affording). Collect patient's previous biopsy from Dr Virendra Chowdhury and help them to meet him tomorrow.

Tue, Feb 19, 2013 at 9:16 PM

ICU
42/m(myxodema coma) still in icu bleed from nose, BP-140/90,T-97.4,rbs-148,t3t4tsh report awaited

35/m(CKD)pt is irritable , no fresh complaints
U/C-106/9.10,Ur/m- albumin 3+, sugar trace , pus cell 15-20/HPF bacteria 3+
WBC- 9.3*10*9/l, hb-2.9,plt-66*10*9//l, PT-20 second , INR -1.31
LFT s.protein a-2.9,g-1.7,a/g-1.7,s.bilirubin T-0.39 d-0.27 I-0.12,sgot-19,sgpt-18.3,sap-68

33/m(TB peritonitis & ald) no fresh complaints , Ur/m- albumin -nil, sugar-nil , U/C-57.3/1.75, LFT- s.protein T-5.0,a-1.5,g-3.5,a/g-0.4 s.bilirubin T-1.5,d0.77,i-0.73 sgot-117,sgpt-21.3,sap-259
Peritoneal biopsy - suggestive of chronic granulomatous infiltration (?tubercular)

62/m(tbm) no fresh complaints ,
Na/k-122/5.34
Ct- sub acut infarct in bilateral frontal region in ACA territory in left capsular thalamic region tributaries of PCA, peri ventricular ischemic changes

65/m(cva) c/o pt is unconscious and shift to icu.

FMW

27/f(5month anc with viral hepatitis) no fresh complaints ,
U/C-5.4/0.31 ,sgot-1110,sgpt-844,sap-175,albumin-2.5,PT-30 second , INR 2.1 ,aptt-38 second , hb -9.7, Na/k-131/2.8 shift to fmw

50/f(foreign body sensation in neck) no fresh complaints , U/C-37.3/0.63

60/m(t2dm) no fresh complaints , hba1c-9.80,rbs -281

23/f(malabsorption syndrome with Rickets and weakness)

MMW

60/m(k/c/o HTN ) rbs-93,u/c-44/2.18,hb-9,adv - 2d echo

42/m(rt hemiperesis with facial paralysis ) report awaited , adv - c.ecosprin av

60/m(k/c/o t2dm with htn) no fresh complaints fbs/ppbs-123/268

40/m(pTB) no fresh complaints att cat 1 started

80/m c/o chest pain , neurophysician ref due

50/m(cml) no fresh complaints report awaited

65/m(?ald) c/o swelling over both legs , ascites, jaundice report awaited

18/m c/o pain in abdomen plan for usg guided fnac for lymph node
FHDU

45/f(CAD with post MI with CHF) no fresh complaints , wbc-7.4*10*9/l,hb -11, Na/k-140/3.2,U/C-27.4/0.76

47/f(old pTB with b/l fibrosed lungs ) no frsh complaints and pt is on intermitent oxygen

65/f c/o- echymosis all over the body chest pain *1day

Sent from BSNL with my BlackBerry® smartphone

 

Birding analogies to medical cognition

We regularly use "medical cognition" system 1 and system 2 tools to tackle clinical complexity and some of these are are often used through various medical cognitive platforms such as synchronous face to face interactions (often system 1) and asynchronous communication and learning between multiple stakeholders in connected web space (user driven healthcare UDHC, patient journey records PaJR) blended offline and online to form "case based blended learning ecosystems CBBLE (often a blend of system 1 and 2). 

More here : 

https://userdrivenhealthcare.blogspot.com/2022/10/medical-cognition-tools-to-resolve.html?m=0

Medical cognition riddle of the day :

Birding and medical cognition toward pattern recognition, faster system 1 diagnosis, has similarities and with this video sharing, I am trying to take this cognitive process toward slower system 2 processing of the captured patient/bird data! 

Currently myself and others have different opinions about the diagnosis of the bird here : https://youtu.be/iy1hb_bGT0I

While my diagnosis is  driven by the physical attributes of the bird as in phenotype, my friend's is driven by it's call that doesn't appear to closely match the other captures of the assumed same bird's call available globally in YouTube. 

What is your diagnosis?

This question was circulated in various online fora and some of the reactions have been summarized in the answer below 

Answer : Well I must admit I missed the diagnosis and below is a longish description of today's learning also in medical cognition! 

There were various inputs on the video ranging from :

Need better clarity in the video to not getting the family or genus to at least coming close to the genus. 

 When I first saw this bird today while my friend took the video, I was silently thrilled and kept murmuring that I was witnessing a "lifer" and kept racking my system 1 cognition to help search the nooks and crannies of my biological brain! I vaguely recalled the book written by Salim Ali in my childhood and I thought I could visualize a crest and a name flashed across, South African crested cuckoo! It was a venerated bird of Indian mythology aka chatak, a South African visitor during rains and reputed to keep looking up at the sky till it could have the first drop of  rain. There were other names such as Jacobin's cuckoo and I was quite satisfied with the diagnosis based on this recall bias of a few data points such as crest, rain, similar call (or so I thought). 

My friend wasn't satisfied. She had for some phenotypic reason thought of thrush (and not any cuckoo)  earlier and had spent more time watching this bird than me and her major disagreement was about the bird's call which she thought was plaintive but the Jacobin's (my diagnosis) suggested it was more assertive. 

She took a much more meticulous strategy of looking up whatever birds were sighted in our state in this month from this site https://ebird.org/region/IN-APand zeroed in on the 126th bird in that list and yes on matching the call of this particular species on YouTube here:

https://youtu.be/uj3uYSEA38M

it was an auscultatory finding that appeared to be a perfect match! 

Amazing thrill to tick a new bird in the list of a lifetime also known as lifer. 

Responses from group :

MA: Sir many birds a chirping here,,, how can u say that the is cuckoo's only,,,

In the beginning of vedio only cuckoo's sound came,,, after that no sound of her,,, many other birds were chirping,,, so many times I played and heard this video!!

RB :  Yes the call is at the beginning only of the video and the local offline physicians who captured the video here had the advantage of what in medical cognition terms would be labeled, "data capturer's advantage" and would be able to better localize the auscultation findings (bird call) to the phenotype! Thanks for pointing out this limitation of system 2 user driven learning 🙂🙏

From one of our other global user driven learner not in the group 👇

[8/16, 7:43 AM] Metapsychist 3 Hyderabad: Haven't heard this type of beautiful sound of the bird so far,  but it sounds little similiar to Indian Koila

[8/16, 7:46 AM] Rakesh Biswas: You are close. 

Can you figure out which species of cuckoo using the internet. 

That's how one of our team members found out that I can share after you give it a shot yourself

[8/16, 7:46 AM] Metapsychist 3 Hyderabad: Will try sir !

[8/16, 7:51 AM] Metapsychist 3 Hyderabad: https://youtube.com/clip/UgkxSJW3T7HPh7ynRVrkDKa3PoQr0nzz1eQi

[8/16, 7:51 AM] Metapsychist 3 Hyderabad: Found it sir.....grey bellied cuckoo!

[8/16, 7:51 AM] Metapsychist 3 Hyderabad: I have cropped the sound clip here and sharing for comparison. They both sound same !

Similarly there are so many user driven learning approaches in medical cognition!👇

https://www.irma-international.org/chapter/user-driven-learning-environment-botany/49258/

https://www.igi-global.com/chapter/user-driven-learning-environment/49256

MA :  Understood Sir now,,,🙏

Really it was thrill to search the answer,,, happy to know the correct one,,,😇

What I have described above using a birding analogy is a small world model for "medical cognition" that in the birding analogy is perhaps more akin to what in humans is currently represented as "clinical epidemiology driven evidence based medicine EBM" based on average "homo sapiens" data that can be mapped out at a generalizeable species level (again analogous to generic cuckoo where we were simply trying to identify it at a species level for example which cuckoo, pied crested, or grey bellied) v what we are trying to develop, going beyond just generalizing it to a single human species level such as homo sapiens (as we do not have to deal with other human species such as Neanderthals or homo erectus), we are free to tackle more complex problems at the individual homo sapiens level and that is an emerging area called clinical complexity driven precision medicine that not only utilizes the system 2 clinical epidemiology tools of current EBM but newer tools such as those conceptualized here👇

https://pubmed.ncbi.nlm.nih.gov/15533257/

Above from Wikipedia under CC licence 

Project illustration of how to process particular patient data into learning themes and demonstrate it's effect on patients illness outcomes (as well as how it can demonstrate learning competence of the learner)

Let's take an ongoing patient example 

from it's PaJR EHR here: https://chat.whatsapp.com/BkEyIsqmfSI20yynkYhhpI

And case reported here : https://elurivishnuvandana44.blogspot.com/2023/07/46-y-old-male-with-spasm-of-upper-limbs.html?m=1

where we sort out the learning points (themes) according to the afore mentioned points revisited below 👇

1) General knowledge learning (pull existing knowledge) 

2) Discovery driven insightful learning (push and expand knowledge frontiers ) 

Let the ongoing example be 

1) What are the general knowledge learning points that we gain from this patient's data that is easily accessible online? 

a) Diabetes type 2 v type 3 definitions, pathophysiologies and solutions 

b) Alcoholism current problems and solutions 

c) Pancreatitis current problems and solutions 

2) What are the particular discovery driven learning questions around this patient :

a) Internal Medicine : Diagnostic (type 2 v type 3) and therapeutic uncertainty (insulin v oral hypoglycemics for type 3 therapy) in this particular patient with diabetes, pancreatitis and alcoholism 

b) External Medicine (social determinants of health) 

[7/31, 8:25 AM] Keen Student: 

good morning sir,

our diabetic pajr groups are highly active and we are glad that patient’s are giving their time and effort. But what about the cost burden we are putting on them sir? how can we cut it ? As i have seen they are around 3-6 pajr groups in which 7 point profile of grbs is being posted daily.

each strip costs a minimum of 10 rupees which costs them 70 for a day and 

which is 2100 for a month.!

[7/31, 8:40 AM] Rakesh Biswas: Very good question 👏👏

Further themes represented by our students in the same particular patient data :

Clinical complexity 

Biological:

• Chief complaints of spasm of fingers in upper limbs with tremors, generalized weakness, excessive sweating, and decreased pitch of voice.

• History of neck and shoulder pain, leading to surgery in 2007.

• Diagnosis of pancreatitis in 2008, which required surgery.

• Diagnosis of diabetes and initiation of insulin therapy, but poor follow-up with healthcare.

Psychological:

• Experience of depression following the demise of his father in 2004.

• Increased alcohol consumption as a coping mechanism due to peer pressure and curiosity.

• Stress and emotional strain due to spouse health issues and financial burden.

Social:

• Limited educational background, discontinuing studies after 10th standard.

• Agricultural laborer by occupation, engaged in farming and rearing domestic cattle.

• Lives with his wife, daughter, and son in a house he acquired through a home loan.

• Consanguineous marriage and has two children.

• Financial stress due to home loan and family responsibilities.

• Increased alcohol consumption and smoking as social and coping habits.

• Recent stress due to wife’s surgery, leading to binge drinking.

Now coming to the most important and challenging part of our learning 

exercise :

1) Answers to the above raised questions which are again sorted themes in the data 

2) Thematic analysis: Coding is the primary process for developing themes by identifying items of analytic interest in the data and tagging these with a coding label. More here :

 https://en.m.wikipedia.org/wiki/Thematic_analysis

3) Product from above processing of input data : Learning points from the above thematically analysed patient data 

4) Showing the positive (convenience of oral hypoglycemics v inj insulin since 10 years) and negative (too much initial monitoring monetary investment  potential overdiagnosis and overtreatment) impact of the above learning on the patient's illness outcomes 

How does the above demonstrate learning competence of the learner?

Let's revisit the steps the learner needs to develop the competence within to be able to achieve the impactful learning around the patient :

1) Competence in patient data capture 

2) Competence in asking questions around the captured patient data (also known as sorting the themes for thematic analysis) 

3) Competence in finding the answers to the above questions and generating learning points that 

a) may be already known to other more experienced and advanced learners  

b) hitherto unknown to the world and takes us to the edge of discovery and promise of breaking new ground 

4) Competence to demonstrate and communicate (through publications in local and global logs) as to how the above learning points gleaned from the individual patients can influence their own immediate illness outcomes as well as future similar patient illness outcomes. 

Opd project: Creating persistent clinical encounters through first contact physician user driven EMRs followed by patient user driven PHRs (patient journey records PaJRs) collectively archived in dynamic case reports (EHRs)

The opd project aims to improve health professionals and students OPD patient handling and learning competences that may improve patient illness outcomes. 

This is attempted through regular logging of every patient visiting us in the daily OPD by our interns and students. Senior residents posted to the OPD for that day are responsible for supervising this daily there

Regularly logged data currently archived in links below :

https://manogynab87.blogspot.com/2023/05/collation-of-opd-data-for-pla-book-draft.html?m=1

https://muskaangoyal.blogspot.com/2023/06/28-2023-week-1-28523-to-4623.html

https://drsaranyaroshni.blogspot.com/2023/07/opd-data-audit-archive-from-13th-june.html

For every opd patient shared here :

Health professionals and students in the opd develop competences to log their:

Sequence of events beginning with the time they had absolutely no problems they can recall. 

Their routine when they were perfectly alright 

Next what happened to their routine once the disease took hold on their lives 

Specifically which part of their hourly routine was disrupted 

Their current requirements from us like if we had to give them a single medicine which problem would they prefer it to address 

Their examination findings with images of visceral fat and muscle mass for everyone among other more specific findings 

Prepare their problem list and perceived requirements list in order of priority 

Formulate a plan for each one of the problem requirements  listed

More here on how they may create a dynamic case report (EHR)  : 

https://sites.pitt.edu/~super1/lecture/lec53671/002.htm

The original project published decades back outlined the conceptual model to create persistent clinical encounters detailed here in the link below : 

https://www.researchgate.net/publication/289874209_Persistent_Clinical_Encounters_in_User_Driven_E-Health_Care

The dynamic case report EHR, archiving persistent clinical encounters  is fed by the OPD first contact physician user driven EMRs followed by patient user driven PHRs  (patient journey records PaJRs) 

Key considerations for the translation of the conceptof the Patient Journey Record Systems (PaJR) into 

real world systems was first shared and archived here below :

"Patient Journey Record Systems (PaJR): The Development of a Conceptual Framework for a Patient Journey System. In R. Biswas, & C. Martin (Eds.), User-Driven Healthcare and Narrative Medicine: Utilizing Collaborative Social Networks and Technologies (pp. 75-92). Hershey, PA: Medical Information Science Reference. doi:10.4018/978-1-60960-097-6.ch006 at http://www.igi-global.com/chapter/patient-journey-record-systems-pajr/49246

The key concept lies in the use of regular patient reported outcomes to locate the phase of illness in a 

patient journey.

More here :

http://userdrivenhealthcare.blogspot.com/2022/09/current-pajr-workflow-and-how-to-make.html?m=0

KNRUHS Document 2 : Medicine department publications with summary, author details and citations 2023-2018

Document 2 : Medicine department publications with summary, author details and citations 2023-2018 (in the KNRUHS university reference circular dated 18/07/2023  format of departmental publications, image below) :

Medicine department citations image :

KNRUHS circular :

2023:

1) Samitinjay A, Vaishnavi K, Gongireddy R, Kulakarni SC, Panuganti R, Vishwanatham C, Manikanta AK, Biswas R. Understanding clinical complexity in organ and organizational systems: Challenges local and global. J Eval Clin Pract. 2023 Jun 19 doi: 10.1111/jep.13886.PMID: 37335625.

Summary : Complexities exist clinically in making a diagnosis, and organizationally, in the variables and nodes dictating patient outcomes. Clinical complexities cannot be simplified but have to be navigated in an optimized way to improve clinical outcomes.We present our analysis of the complexities faced clinically and, in our local healthcare system.

Author details : Aditya Samitinjay 1, Karnati Vaishnavi 2, Reethika Gongireddy 3, Sai Charan Kulakarni 1, Raveen Panuganti 1, Chandana Vishwanatham 1, Achuta Kesava Manikanta 4, Rakesh Biswas 1

1Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, India.2 Department of General Medicine, Government Medical College, Sangareddy, India.3Independent Researcher.4Department of General Medicine, Vijaya Hospital, Godavarikhani, Telangana, India

2022 : 

2) Dhavala A, Samitinjay A, Khairkar P, Podder V, Price A, Fatima SH, Biswas R. Integrated case-based clinical approach in understanding pathways, complexities, pitfalls and challenges in neurodegenerative disorders. Am J Neurodegener Dis. 2022 Jun 20;11(2):22-33. PMID: 35874938; PMCID: PMC9301093.

Authors: Aashitha Dhavala 1, Aditya Samitinjay 2, Praveen Khairkar 3, Vivek Podder 4, Amy Price 5, Syeda Hira Fatima 6, Rakesh Biswas 7

Affiliations:1Junior Resident in General Medicine, Kamineni Institute of Medical Sciences Narketpally, India.2Senior Resident in General Medicine, Government General & Chest Hospital Erragada, Hyderabad, India.3HOD & Professor in Psychiatry, Kamineni Institute of Medical Sciences Narketpally, India.4Visiting Lecturer, The University of Adelaide Australia.5Senior Research Scientist Stanford School of Medicine CA, USA.6Junior Resident in Psychiatry, Kamineni Institute of Medical Sciences Narketpally, India.7HOD & Professor in General Medicine, Kamineni Institute of Medical Sciences Narketpally 508254, India.

Summary: We performed this study within our existing framework of a CBBLE (publication number 2018) when we received an invitation from the American Journal of Neurodegenerative Disorders (AJND). Psychoses can develop in patients with brain disorders secondary to neurodegenerative disorders, tumours, or cerebrovascular accidents. We explored the organic psychopathology of psychosis in neurodegenerative disorders. We postulate that movement disorder is an obvious, logical bio-clinical marker towards organic psychopathology of psychiatric symptoms found in neurodegenerative disorders. 

3) Talukder AK, Schriml L, Ghosh A, Biswas R, Chakrabarti P, Haas RE. Diseasomics: Actionable machine interpretable disease knowledge at the point-of-care. PLOS Digit Health. 2022 Oct 20;1(10):e0000128. doi: 10.1371/journal.pdig.0000128. PMID: 36812614; PMCID: PMC9931276.

Summary: This paper presents an artificial intelligence (AI)-based approach for integrating comprehensive disease knowledge, to support physicians and healthcare workers in arriving at accurate diagnoses at the point-of-care.

Authors: Asoke K Talukder 1 2, Lynn Schriml 3, Arnab Ghosh 4, Rakesh Biswas 5, Prantar Chakrabarti 6 7, Roland E Haas 8

Affiliations:1SRIT India, Bangalore, India.2Computer Science & Engineering, National Institute of Technology Karnataka (NITK), Surathkal, India.3University of Maryland School of Medicine, Maryland, United States of America.4Indian Institute of Technology Bombay, Mumbai, India.5Kamineni Institute of Medical Sciences, Narketpally, Telangana, India.

4) Samitinjay A, Ali Z, Biswas R. Nontubercular mycobacterial cough. BMJ Case Rep. 2022 Mar 7;15(3):e246285. doi: 10.1136/bcr-2021-246285. PMID: 35256362; PMCID: PMC8905925.

Summary: Habitual cough suppression leading to non-tuberculous mycobacteria infections and bronchiectasis has been reported. We aim to highlight two key issues-diagnosing MAC infections in a tuberculosis endemic country, and OSA and its long-term clinical implications

Authors: Aditya Samitinjay 1, Zulfikar Ali 2, Rakesh Biswas 3

Affiliations 1General Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India.2Radiology, Sree Venkateswara Diagnostics, Kadapa, Andhra Pradesh, India.3General Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India

5) Samitinjay A, Karri SR, Khairkar P, Biswas R. Traumatic subdural haematoma: integrating case-based clinical judgement with guidelines. BMJ Case Rep. 2020 Sep 6;13(9):e233197. doi: 10.1136/bcr-2019-233197. PMID: 32895250; PMCID: PMC7476468.

Summary : This paper, aims to present two pressing issues—first, strict adherence to guidelines may not always bring the best outcomes and that clinical judgement and critical appraisal of literature is required to improve patient-related outcomes. Second, in a country where nearly two-third of the total annual health expenditure comes from out of pocket, expensive equipment like invasive ICP monitors and advanced neurosurgical equipment may not be readily available and hence it becomes imperative that general surgery residents, particularly in rural tertiary hospitals, are adequately trained in basic neurosurgical care before an appropriate referral is made.

Authors: Aditya Samitinjay,1 Satya Revanth Karri,2 Praveen Khairkar,2 and 1Rakesh Biswas1Department of General Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India

2Department of Psychiatry, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India

2020:

6) Ghosh R., Dubey S., Chatterjee S., Finsterer J., Biswas R., Lahiri D., Ray B.K. Primary hypoparathyroidism and multiple neuraxial involvement in mitochondrial disorder due to the variant m.15043G>A in MT-CYB. J. Neurol. Sci. 2020;414 

Authors: Ritwik Ghosh 1, Souvik Dubey 2, Subhankar Chatterjee 3, Josef Finsterer 4, Rakesh Biswas 5, Durjoy Lahiri 2, Biman Kanti Ray 2

Affiliations: 1Department of General Medicine, Burdwan Medical College & Hospital, Burdwan, West Bengal, India.2Department of Neuromedicine, Bangur Institute of Neurosciences, Institute of Postgraduate Medical Education and Research & SSKM Hospital, Kolkata, West Bengal, India.3Department of General Medicine, Rajendra Institute of Medical Sciences, Ranchi, Jharkhand, India.4Department of Neurology, Krankenanstalt Rudolfstiftung, Messerli Institute, Vienna, Austria

.5Department of Medicine, Kamineni Institute of Medical Sciences, Narketpally, Nalgonda, Telangana, India.

Citation and summary:

Cited by : Alston CL, Blakely EL, McFarland R, Taylor RW. The m.15043G > A MT-CYB variant is not a pathogenic mtDNA variant. J Neurol Sci. 2020 Oct 15;417:116950. doi: 10.1016/j.jns.2020.116950.

Summary :This report highlights the importance of full and thorough interpretation of patient genetic data to ensure that the correct diagnosis is ascribed [1]. Moreover, it validates the clinical utility of a diagnostic biopsy and the use of patient material for the functional validation of genetic findings as the inadequate assessment of pathogenicity has the potential to result in patient misdiagnosis and mismanagement.

2019

7) Podder V, Price A, Sivapuram MS, Biswas R. Middle-aged man who could not afford an angioplasty. BMJ Case Rep. 2019 Mar 31;12(3):e227118. doi: 10.1136/bcr-2018-227118. PMID: 30936331; PMCID: PMC6453268.

Summary: This report highlights the challenges and consequences of inappropriate overuse of percutaneous coronary interventions PCI. Also, we outline the current lack of shared decision-making among patients and physicians for the PCI procedure. The challenges, inherent in the assumptions that overuse of PCI is evidence-based, are discussed including recommendations for the practice of evidence based medicine for this intervention.

Authors: Vivek Podder 1, Amy Price 2 3, Madhava Sai Sivapuram 4, Rakesh Biswas 5

Affiliations 1Department of Medicine, Tairunnessa Memorial Medical College and Hospital, Gazipur, Bangladesh.2Department of Continuing Education, University of Oxford, Oxford, UK.3Stanford MedicineX, University of Stanford, School of Medicine, Stanford, USA.4Department of Medicine, Dr Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinoutapalli, Andhra Pradesh, India.5Department of Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India.

2018

8)Webb E, Kali Vanan N, Biswas R. Empirical treatment of tuberculosis: TB or not TB? BMJ Case Rep. 2018 Jul 10;2018:bcr2018224166. doi: 10.1136/bcr-2018-224166. PMID: 

29991543; PMCID: PMC6047727.

Summary : In this report we highlight the challenges faced due to lack of centralised medical records (which can prevent unnecessary investigations and treatment and we also share a few  user driven healthcare solutions deployed).

Authors: Eika Webb 1, Narmadha Kali Vanan 1, Rakesh Biswas 2

Affiliations: 1Barts and the London School of Medicine and Dentistry, Queen Mary University of London, London, UK.2Medicine, Kamineni Institute of Medical Sciences, Narketpally, Telangana, India.

9) Podder V, Price A, Sivapuram MS, Ronghe A, Katta S, Gupta AK, Biswas R. Collective Conversational Peer Review of Journal Submission: A Tool to Integrate Medical Education and Practice. Ann Neurosci. 2018 Jul;25(2):112-119. doi: 10.1159/000488135. Epub 2018 Apr 3. PMID: 30140123; PMCID: PMC6103343

Summary: In this study, we demonstrate a collective collaborative, conversational, pre-publication peer review of a randomized controlled trial. Open peer review involving a group of reviewers at a time produces multidirectional reviewing concepts, thus helps to improve the quality of paper and also may reduce the time between review and publication.

Authors: Vivek Podder 1, Amy Price 2 3, Madhava Sai Sivapuram 4, Ashwini Ronghe 5, Srija Katta 6, Avinash Kumar Gupta 7, Rakesh Biswas 8

Affiliations:1Undergraduate Medical Student of Tairunnessa Memorial Medical College, Dhaka, Bangladesh.2Patient Editor (Research and Evaluation), The BMJ, London, United Kingdom.3Continuing Education, The University of Oxford, Oxford, United Kingdom.4Undergraduate Medical Student of Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Vijayawada, India.5Undergraduate Medical Student of Grant Medical College and Sir JJ Group of Hospitals, Mumbai, India.6Undergraduate Pharmacy Student of St. Peters Institute of Pharmaceutical Sciences, Warangal, India.7Undergraduate Medical Student of Universal College of Medical Sciences, Bhairahawa, Nepal.8Professor of Medicine, Kamineni Institute of Medical Sciences, Nalgonda, India.

6 Citations as of July 2023

https://scholar.google.co.in/scholar?oi=bibs&hl=en&cites=16930503501442910552&as_sdt=5

10) Podder V, Dhakal B, Shaik GUS, Sundar K, Sivapuram MS, Chattu VK, Biswas R. Developing a Case-Based Blended Learning Ecosystem to Optimize Precision Medicine: Reducing Overdiagnosis and Overtreatment. Healthcare (Basel). 2018 Jul 10;6(3):78. doi: 10.3390/healthcare6030078. PMID: 29996517; PMCID: PMC6163835.

Summary: We examine the role of precision medicine within a case-based blended learning ecosystem (CBBLE) as a practicable tool to reduce overdiagnosis and overtreatment.

Authors: Vivek Podder 1, Binod Dhakal 2, Gousia Ummae Salma Shaik 3, Kaushik Sundar 4, Madhava Sai Sivapuram 5, Vijay Kumar Chattu 6, Rakesh Biswas 7

Affiliations:1Department of Internal Medicine, Tairunnessa Memorial Medical College, Gazipur 1704, Bangladesh. drvivekpodder@gmail.com.2Division of Hematology/Oncology, Medical College of Wisconsin, Milwaukee, WI 53226, USA. bdhakal@mcw.edu.3Department of Internal Medicine, Kamineni Institute of Medical Sciences, Narketpally 508254, India. drshaiksalma@gmail.com.4Department of Neurology, Rajagiri Hospital, Chunanangamvely, Aluva 683112, India. skaushik85@gmail.com.5Department of Internal Medicine, Dr. Pinnamaneni Siddhartha Institute of Medical Sciences and Research Foundation, Chinaoutapalli 521101, India. madhavasai2011@gmail.com.6Department of Paraclinical Sciences, Faculty of Medical Sciences, The University of the West Indies, St. Augustine 0000, Trinidad and Tobago. vijay.chattu@sta.uwi.edu.7Department of Internal Medicine, Kamineni Institute of Medical Sciences, Narketpally