International Journal of Medical Sciences and Education (IJMSE)
Vol. 6; Issue: 2 (April - June 2019), Date of Publication: 01.07.2019

Table of Contents
     Editorial

1.    THE EFFECT OF ORDER OF MCQ ITEMS ON DIFFICULTY INDEX                                                           1-6
       Ahmad Saleh Alamro                                                                                                               PDF FULL TEXT

ABSTRACT

Background: Multiple choice questions (MCQs) are substantially used to assess cognition in medical education worldwide. One of the limitations of MCQ tests is the ease of cheating. Use of a multi-version test can overcome this challenge because it makes cheating difficult while maintaining the same content to ensure fairness. The aims of the current study are to explore the effect of scrambling MCQ items on the difficulty index (DI) and to determine the subsequent effect on students’ performance Materials and Methods: Six MCQ tests with different versions were taken by 514 third-year medical students who were in the preclinical phase at the College of Medicine, Qassim University. Each test comprised 100 A-type MCQs. Each exam was divided into quintuples, and the mean DI for each quintuple was calculated and analysed. Results: Generally, there was no difference in the mean DI for the different versions of the same test. The DI of the fourth and fifth quintuples was significantly lower than the first three (p < 0.01). This change was less evident for students with a more advanced level in the programme. Conclusion: The scrambling of MCQs on a multi-version test does not affect the test’s overall difficulty. However, items may yield a lower DI when they are presented late in the test. The inclusion of more test questions may cause some difficulties regarding the length of the test rather than item quality being the cause.
Keywords: MCQ, item order, Difficulty Index, student performance

2.     EXPLORING FACTORS AFFECTING THE QUALITY OF POSTGRADUATE MEDICAL EDUCATION IN
        SUDAN: RESIDENTS PERSPECTIVE                                                                                                        7-15
        Mohamed H. Taha,  Yasar Ahmed, Mohamed E. Abdalla, Abdelrahim M. Gaffar              PDF FULL TEXT

ABSTRACT

Background: Postgraduate Medical Education (PGME) in Sudan dated back to 1953 in the last century. Despite the extended period of the delivery of training, there are limited published studies that measure the quality of the training and satisfaction of the residents with provided training. The objectives of this study were 1) to   assess the satisfaction of the internal medicine residents with the quality of their training; 2) to identify the areas of strengths and challenges; 3) to explore the factors affecting the quality of internal medicine residency program from residents’ perspectives. Materials and Methods: Cross-sectional study was conducted for the Internal Medicine Residency Program of Sudan Medical Specialization Board (SMSB) during the period June 2017 – January 2018, using anonymous, validated, Self-administered questionnaire (n=189). The SPSS version 22.0 was used for quantitative data analysis. Descriptive statistics were used to calculate frequencies, means, and SD. Results: Out of 189 residents, 181 (95.76%) responded to the questionnaire. Cronbach alpha coefficient was 0.897 for all questionnaire items and ranged from 0.891 to 0.900 for each item, suggesting a high degree of internal consistency. The study revealed that some areas were positive in this program included the duration of training, development of communication skills and life-long learning. While the residents recommended some improvement in the following areas; the implemented curriculum, learning environment, mentoring and supervision, assessment, and training in research. Conclusion: This study revealed overall average satisfaction with the training by the residents. However, some areas need improvement particularly; the training curriculum, learning environment, assessment, supervision and feedback.
Keywords: Postgraduate Medical Education; Residency Training; Residents Satisfaction; Training Program SMSB; Quality in Postgraduate Medical Education

3.    MEDICAL LEADERSHIP: IMPLEMENTING COMPETENCY BASED TRAINING AMONG UNDERGRADUATES
       POSTED IN COMMUNITY MEDICINE-A QUALITATIVE STUDY                                                                16-23
       Sree T. Sucharitha, Balaji Arumugam, Suganya E                                                                 PDF FULL TEXT

ABSTRACT

​Background: Medical leadership, an essential skill for Indian medical graduates as per MCI has been rarely implemented as a training component during undergraduate medical education curriculum. Objectives: 1.To implement the leadership skill training program for the undergraduate medical students during the clinical postings at the department of Community Medicine through innovative teaching learning method 2.To assess the leadership skills acquired by the students at the end of teaching learning sessions by pre and post questionnaire and focus group discussions. Methods: Medical leadership as a competency based training was undertaken among 35 undergraduates posted in department of community medicine in the month of November-December 2018. Triangulation of free listing, pile sorting and buzz group discussions was done to elicit their perception on acquiring leadership skills during undergraduates training. This was followed by a semi-structured focus group discussion at the end of one month. The data was analysed using Visual Anthropac 4.98.1/X software. Results: Undergraduates perceived communication skills, calmness, decision making, approachable, empathy etc, as major characteristics of effective medical leader/leadership. The respondents admitted they perceived that there is no or limited scope of leadership development during undergraduate training prior to training program. The training program helped them identify specific areas to focus on leadership development such as positive personality development during the undergraduate period. Conclusions: Medical education reforms should support the implementation of leadership training in the MBBS undergraduate curriculum.
Keywords: Buzz Group Discussion, Free listing, Medical leadership, Pile sorting, Undergraduates

4.    TECHNOLOGICAL STRATEGIES IN TEACHING AND LEARNING ANATOMY - BOON OR BANE?!    24-26
        Naveena Swargam                                                                                                                    PDF FULL TEXT

ABSTRACT

​Background: The paradigm of teaching and learning has been changed from traditional transfer of knowledge by the teacher to constructing knowledge through experiences using technology by the student. Changes in the teaching of anatomy from didactic lectures & cadaveric dissection to newly adopted teaching and learning strategies are expected to bridge the gap between teachers and students. Materials and Methods: The first MBBS students of 2016 - 2017 academic year with a strength of 100, were selected at ESIC Medical College, Sanathnagar, Hyderabad, Telangana State, India. The students were taught few chosen topics in anatomy by using different teaching methodologies like PowerPoint presentation, digital visualizer, smart board, virtual dissection table, cadaver, chalk & board, slide projection system. A written feedback was taken from the respective group of students after every session of pedagogy. Results: The results of present study were found to be encouragingly adaptable, providing conceptual framework of utilising clusters of teaching methodologies in teaching and learning anatomy. Conclusion: Successful medical teaching requires the ability of teacher to address the learner needs and understand the variations in learner approaches. To accomplish these requirements an optimal teaching-learning environment should be created by utilizing a variety of teaching methodologies.
Key Words: Digital visualizer, PowerPoint presentation (Ppt), Liquid Crystal Display (LCD) projector, Smart board, Virtual dissection table, Slide projection system.

5.    EARLY CLINICAL EXPOSURE (ECE) - NEED OF AN HOUR: STUDY OF KNOWLEDGE,
       PERCEPTION AND ATTITUDE OF MEDICAL STUDENTS                                                                       27-31
       Dr Vikram Patel,  Dr Neha A. Patel                                                                                          PDF FULL TEXT

ABSTRACT

Background: The Medical Council of India’s Vision-2015 document envisages coordinated inter-departmental efforts to provide early clinical exposure and to develop communication skills among students during the first year of Bachelor of Medicine, Bachelor of Surgery (MBBS) course. (1). In the traditional curricula of medical education, students learn theoretical knowledge without contact with the patient in a clinical context. With this background in mind the current study was planned. Objectives: - To study the knowledge difference after ECE, - To study the perceptions and attitude of students regarding ECE Methods: The study was conducted with 50 first year MBBS students posted in physiology department. They were exposed to patients of the theory they learnt in theory lectures. Pre and post test results were been noted to observe changes in their knowledge. Focal group discussions were done to find out perception and attitude of students towards ECE. Ethical approval was taken, Consent of students was obtained before entering study. Statistical analysis was done with Microsoft office excel. Results: There is a significant difference in knowledge of students on studying pre and post test results (p<0.001). Also students showed positive attitude towards ECE. Conclusion: ECE is not only the requirement but also demand by students.it has great impact on grasping of students.it should be included in curriculum asap.
Keywords: early Clinical Exposure (ECE), Case based Learning (CBL),Focal Group Discussion(FGD)

6.    NEWER TEACHING TOOLS- DIGITAL EDUCATION, E- LEARNING, AND HOLISTIC APPROACH IN
       TEACHING OF GROSS AND MICROSCOPIC FEATURES OF ANATOMICAL AND PATHOLOGICAL
       SPECIMEN FOR MBBS STUDENTS                                                                                                          32-36
       Dr. Vidya K. Satapara, Dr. Killol N. Desai                                                                                PDF FULL TEXT

ABSTRACT

​Background: Our experience show that most of the student of MBBS cannot answer properly the questions related to gross-microscopic feature when asked by the examiners. This is due to conventional method of teaching like only lectures method, which is not suitable for clearing of concepts in anatomy and pathology subjects. AIMS: To assess the impact of  New teaching tools- Digital education, E- learning, and holistic approach in teaching of gross and microscopic features of specimen for MBBS students. MATERIALS AND METHODS: In first one hour, each group was taken power point presentation and related question answer. In next one hour there were taken gross specimens in both way like mounted specimen and photographs and microscopic features with digital trinocular microscope with computer and smart television live motion slide projection. Assessment was done by teachers of Medical College by three mock tests like Viva, Multiple Choice Questions and Short assay questions with routine internal assessment. Also comparison was made with regards to presence or absent of students and successive three mock tests and internal assessment. RESULT : New teaching tools- Digital education, E- learning, and holistic approach in teaching of gross and microscopic features of specimen increased percentage of passing student in mock tests, routine internal assessment and average attendance of students significantly. CONCLUSION : This newer method increased interest, clear the concept and removing phobia regarding gross-microscopic features with increased attendance of students in practical classes. This was reflected by significantly increased performance of student in both internal and external examinations.
KEYWORDS : Digital education, E- learning, holistic approach

7.    IMROVING COMMUNICATION SKILLS OF FIRST M.B.B.S. STUDENTS                                                  37-45
       Dr. Manoj Kumar Sharma, Dr. Hemlata Sharma                                                                      PDF FULL TEXT

ABSTRACT

​BACKROUND: Present day scenario, we are used to take didactic lectures to impart knowledge in the undergraduate curriculum. But it’s now desirable to make some change in it to make learning more meaningful. Many students felt difficulty to express themselves confidently among teachers, examiners and their colleagues during first M.B.B.S. course due to lack of communication. MATERIAL & METHODS: The present research work was done on first M.B.B.S students (batch -2014) at Jhalawar Medical College, Jhalawar, and Rajasthan, India to promote the communication of students at the workplace with teachers, colleagues & peers and enables them to acquire specialized competence in communication skills. A predesigned questionnaires pre & posttest were given to them before and after the lecture & role play regarding verbal & nonverbal communication skills to evaluate the improvement. RESULTS: The pre and post test scores mean values were 34.89 and 40.87 respectively and difference was statically significant (P<0.0001). The 360* evaluation showed that 46% students exhibited skilled behavior most of time (50 to 75% of the time), 19% students showed skilled behavior majority of time (more than >75% of time) and only 10% students rarely demonstrate the skilled behavior (less than<25% of the time) which they learned by session given by course coordinator. CONCLUSION: The results showed that almost all students are ready to learn new things like communication skills with their regular study schedule which make them more confident among teachers, examiners and their colleagues during M.B.B.S course& finally a good practitioner.
KEY WORDS: Communication skill, 360* evaluation, Feedback, Verbal and Nonverbal communication.

8.    BEHAVIORAL FACTORS INFLUENCING PHYSICIANS’ DECISION IN CHOOSING A NEW DRUG:
       AN EMPIRICAL RESEARCH AMONG THE UNITED ARAB EMIRATES HEALTHCARE PROVIDERS   46-51
       Dr. ANUJ MATHUR                                                                                                                    PDF FULL TEXT

ABSTRACT

Background: Doctors are reported to be the final decision makers of which brand / drug should be prescribed to the patients. Therefore, all the marketing strategies and plans are being focused towards them. Marketing strategies are concerned around drug / product, price and promotions and pharma companies are making marketing strategies to push the medical practitioner or physicians' prescribing behavior toward their products Material & Methods: The present cross-sectional study aims to describe physicians' prescribing behavior toward a new product introduced to the market. A questionnaire developed using Surveymonkey.Com to assess factors, based on the demographic, psychological, educational and legal characters were distributed randomly among 103 healthcare providers from various specialties. Results: Majority of the participant doctors were mainly Gynecologists and they were represented by 89.3%, second come Urologists representing 10.7% of participants. The range of healthcare providers' age gathered for this survey is 35-65 years. All 103 participants were subjected to questionnaire assessed by Surveymonkey.Com and interpreted on Likert scale from 1 to 5, where 1 indicates "Highly Important" factor and a value of 5 indicates "Negligible" factor. Patient’s financial status, Personal Experience & Knowledge and Governmental guidelines were the factors of the highest importance. Drug Samples, Company’s reputation and Using Google\UpToDate websites were the factors of the least importance. Conclusion: Main findings showed that most of physicians exhibit significant depending on their own experience and knowledge in the first place, then pharmaceutical representatives’ guidance and related meetings and conferences before deciding regarding certain medical conditions. Direct to Consumer (DTC) advertising, Patient's financial status and the adverse effects of the current therapy comes is of high importance however in second place after mentioned factors.
Key words: Pharmaceutical marketing, healthcare providers, Direct to Consumer advertising.

9.    INCORPORATION OF INTEGRATIVE COMMUNICATION SKILLS TRAINING IN GENERAL
​       NURSING CURRICULUM                                                                                                                          52-59
       Sally John,Tripti K Srivastava, G K Vankar                                                                           PDF FULL TEXT

ABSTRACT

​Background: Communication is vital for nurses in all areas of patient care. Better communication skills in nurses is associated with higher patient satisfaction and greater treatment adherence. To attain competence in communication skills, nurses need proper training and evaluation which is found to be lacking in the current curriculum in many places. Objective: To study the impact of incorporating integrative communication skills training in the curriculum of 2nd year General Nursing students in patient care. MATERIALS AND METHODS: It was a hospital based interventional study of 6 months duration, consisted of 24 second year General Nursing and Midwifery students (who completed the initial phase) who were divided into control and intervention groups. Attitude and knowledge were assessed using Communication Skill Attitude Scale. Objective evaluation was done using Mini-Clinical Evaluation Exercise. A didactic lecture on communication skills was given to both groups. Intervention group received additional skill training by role plays, demonstrations and bedside training. Pre and post-test assessments, patient satisfaction and students’ satisfaction were obtained using quantitative and qualitative methods. Results: Improved scores of attitude and knowledge in positive items in Communication Skill Attitude Scale and overall improvement in communication skills after intervention. Patient and student satisfaction were comparatively better in intervention group. Conclusion: Traditional classroom teaching of skills allow less practical application. Our study shows that integrative training and evaluation have better outcome in student perception and patient satisfaction. This study calls for incorporation of communication skills in nursing curriculum with an integrative teaching and evaluation approach.
Keywords: Communication skills, didactic lecture, general nursing students, curriculum, integrative training, patient satisfaction

10.    EVALUATION OF ADHERENCE TO HAART REGIMENS ON THE BASIS OF WHO CLINICAL
        ​ STAGE AND INITIAL CD4 COUNT AT TERTIARY CARE CENTER                                                         60-63
        Dr. Vinita Ghosliya, Dr. Rakesh K Karnani                                                                              PDF FULL TEXT

ABSTRACT

Background: Adherence is generally defined as a patient’s ability to follow a treatment plan, take medication at prescribed times and frequency and follow restrictions regarding food and other medications. Since the time of Hippocrates patients often tend to lie about taking their medicines. Material & Methods: The present cohort study was conducted at our tertiary care hospital. The study duration was of six months from September 2008 to April 2009. At the start of study around 260 HIV patients were registered for ART out of which 120 patients were enrolled for the study and were followed for six months. Results: The WHO clinical stages I and II were highly associated (p < 0.001) with adherence. There was highly significant (p < 0.001) association between initial III and IV WHO clinical stages and low adherence. In the present study the no relation was found between the initial CD4  count and adherence (p>0.05). Association of linkage with PLHA peer group and adherence was highly significant (p < 0.001), whereas absence of linkage with PLHA was associated with low adherence (p < 0.001). Conclusion:  The most common reasons for missing of doses were observed as forgetting, being busy in other things and away from home. It can be stated from over study that good adherence is a valid region for the improvement in CD4 count. Also, it was observed that the highly adherent patients were found to have a significant improvement in WHO clinical stage (p < 0.01).
Key words: HAART, Adherence, WHO clinical stage, CD4 count.

11.    RETROSPECTIVE EVALUATION OF ADVERSE TRANSFUSION REACTIONS FOLLOWING BLOOD
         PRODUCTS TRANSFUSION FROM SMS HOSPITAL, JAIPUR                                                          64-69
         Dr. Rashmi Parashar, Dr. Sunita Bundas,Dr. Amit Sharma, Dr. B.S. Meena,
         ​Dr. Pamendra  Pachori, Dr. Sarita sharma                                                                          PDF FULL TEXT

ABSTRACT

Background: To improve the quality of blood transfusion and enhancing it's safety, hemovigilance system is established. Reporting of adverse transfusion reactions under hemovigilance system emphasizes on detailed description of adverse event, thus helpful in correctly identifying of adverse transfusion events. Thus taking an appropriate steps can reduce their incidences, and thus helpful for improving the safety of blood transfusion. Aim: To evaluate retrospective data on adverse transfusion reaction reported under hemovigilance system in our institute from Sept. 2017 to May 2018. Materials & Methods: A retrospective study of data from Sept. 2017 to May 2018 were analyzed at SMS Hospital, Jaipur, RAJ. Continuous variables were evaluated as mean and standard deviation. Nominal/categorical variable were summarized as proportion (percentage) and analyzed by using Chi-Square test/Fisher exact test. p value < 0. 05 was taken to indicate significant difference. Results: During the study period total 61069 blood & blood product issued from our blood bank, out of these adverse transfusion reaction reported were 77 (0. 12%) under the hemovigilance system . Most common reaction observed were allergic 45% (n=25) . Not a single case of bacterial contamination was observed. Conclusions: Developing institutional guidelines related to correctly identify adverse events and reporting them under hemovigilance system should be implemented for enhancing the quality and safety of blood transfusion.
Keyword: surveillance, blood transfusion, hemovigilance, transfusion reactions.

12.    CLINICAL PROFILE OF PSYCHIATRIC DISEASE BURDEN AT TERTIARY CARE HOSPITAL           70-73
         Dr. Bharati D. Patil                                                                                                                  PDF FULL TEXT

ABSTRACT

Background: According to the WHO reports stated that there is a considerable burden of psychiatric morbidity among all ages. Among them mental, neurological, and substance abusers accounts for 13% of global disease burden. The magnitude of mental, neurological, and substance abusers has increased by 40% from 1991 to 2011 due to increase in population. Majority of cases are belonging to lower, lower-middle and middle socio-economic status. Many of these were illiterates and have poor access to health care services. Materials and Methods: The present prospective study was conducted at with100 patients who were attending outpatient department. Written informed consent was taken from each study participant. Data was collected by a pretested questionnaire format to evaluate and record the socio-demographic data. The mental health and psychiatric morbidity evaluation on the basis of DSM 4th Edition, Text Revision (DSM‑IVTR) criteria. Results-: Substance abuse was the most common finding in present study which was reported in 54% of the study participants, which was followed by mood disorders which reportedamong15%of the study participants. 14% of the study participants had Neurotic and somatoform disorder which was followed by Bipolar affective disorder which reportedamong11%of the study participants.8% of the study participants had unipolar depression which was followed by Other psychiatric disorders which reportedamong4%of the study participants. Only one percent of study participants had psychotic disorders. Other general medical conditions present in 9% of study participants. Conclusion: We concluded from the present study that there is high psychiatric disease burden and there is huge treatment gap which needs a decentralized network of health system which can provide mental health services at the community level. Therefore, there is need of development of efficient, effective, sustainable mental health services at community level which is culturally and socially acceptable.
KEYWORDS: Psychiatric Morbidity, neurological disease, substance abuse

13.    ASSESSMENT OF PLACENTAL FUNCTION BY USING SERUM COPPER LEVELS                            74-77
         Dr. Kuldeep Wagh                                                                                                                   PDF FULL TEXT

ABSTRACT

Background: The simple and accurate method for measuring falling placental function is always been a topic of research for obstetricians. Several researches have been conducted in past years for identifying the simple and reliable tool that aids in the diagnosis of declining placental function. During the antenatal period, many physiological changes are takes place which result in increased serum ceruloplasmin levels and also the increase concentration of serum copper values. Material & Methods: In the present prospective observational study 200 Pregnant women were enrolled from outdoor, antenatal clinic and from ward by simple random sampling and divided into two groups of non-pregnant women with normal menstrual cycle and another of Pregnant women in different trimesters of pregnancy. Clearance from Institutional Ethics Committee was taken before start of study. Written informed consent was taken from each study participant. Results: Among non-pregnant women the mean value of serum copper levels (mean ± S.D.) was124 ± 5.76 μg/dL and among pregnant women the mean value of serum copper levels (mean ± S.D) was 232.08 ± 25.3μg/dL. Among 1st trimester pregnant women the mean value of serum copper levels (mean ± S.D) was 178 ± 6.31 μg/dL, among 2nd trimester pregnant women the mean value of serum copper levels (mean ± S.D) was 224.2± 5.42 μg/dL and among 3rd trimester pregnant women the mean value of serum copper levels (mean ± S.D) was 265.7± 8.93 μg/dL. This difference between value of serum copper levels of both these groups was statistically significant (P value < 0.05). Conclusions: There were higher values of serum copper reported among pregnant women than non-pregnant women. Likewise, this increasing trend also reported in all three trimesters. Hence, serum copper values can be used as an indicator of the normal function of fetoplacental unit, and it is very simple, easy method to determine the functional condition of fetoplacental unit.
KEYWORDS: Serum copper levels, Pregnancy, Placental function.

14.    BURDEN OF ANEMIA AMONG PREGNANT WOMEN IN CORRELATION WITH BIRTH INTERVAL    78-82
         Dr. Archana Singhal, Dr. Nitin S. Gupte                                                                                 PDF FULL TEXT

ABSTRACT

Background: Anemia reported during pregnancy is a burdensome public health problem all around the world, problem is vast among developing¬ countries. Women during pregnancy are more prone for developing anemia not only because of increased iron demand and its poor bioavailability along with hemodilution physiological increase in plasma volume (physiological increase in plasma volume) which acts synergistically. Material & Methods: In the present prospective observational study 400 Pregnant women were enrolled from outdoor, antenatal clinic and from ward by simple random sampling. Clearance from Institutional Ethics Committee was taken before start of study. Written informed consent was taken from each study participant. Results: In the present study out of total primigravida 118 (54.6%) had no anemia, 72 (33.3%) females had mild anemia, 26 (12%) females had moderate anemia and there were no cases of severe anemia in this group. Among the group of birth interval of less than two years, there were no cases of no anemia, 42 (45.6%) of pregnant women had mild anemia, 38 (41.4%) of pregnant women had moderate anemia and 12 (13%) of pregnant women had severe anemia. Among the group of birth interval of more than two years, there were no cases of no anemia, 32 (34.8%) of pregnant women had mild anemia, 58 (63.1%) of pregnant women had moderate anemia and 2 (2.2%) of pregnant women had severe anemia. These differences in burden of anemia was statistically highly significant (p value < 0.001). Conclusions: The magnitude and burden of anemia is very high and the population living among rural areas were at high risk of developing anemia. We found statistically significant correlation of anemia with birth interval and reported that the burden of severe anemia was higher among pregnant women who had birth interval of less than two years.
Key words: Anemia, Pregnancy, Birth interval.

15.    CLINICO-MYCOLOGICAL STUDY OF DERMATOPHYTIC INFECTIONS IN SOUTHEAST
         RAJASTHAN                                                                                                                                              83-86
         Dr Sanjay Purohit                                                                                                                      PDF FULL TEXT

ABSTRACT

Background: Dermatophytosis is the cutaneous fungal infection of skin, hair and nails which are for aesthetic issue and discomfort due to consistent itching. This study was planned to observe the trend of dermatophytic infections in the area. Materials and methods: 360 skin samples from the suspected dermatophytic infections by clinical diagnosis were subjected to KOH mount and fungal culture and analysed. Result: 190 (52.77%) samples were found to be positive in KOH mount while 183 (50.83%) by fungal culture. Total number of positive cases by any test (culture or KOH mount) was 196/360 (54.44%). Maximum number of samples were received and found positive in the age group of 20-30 years followed by 10-20 years. Males outnumbered females with a male female ratio of 1.86 (119/64). The most common clinical presentation observed was tinea corporis followed by tinea cruris. The most common dermatophyte observed was T. rubrum followed by T. mentagrophytes. Conclusion: The present study shows that Trichophyton rubrum was the predominat dermatophyte observed in the study population followed by T. mentagrophyte. This finding revealed that the transmission of fungal infection was occurring by humans and the most common clinical presentation was tinea corporis followed by tinea cruris.
KEYWORDS : Dermatophytosis, tinea corporis, tinea cruris

16.    EVALUATION OF RISK FACTORS AND CLINICAL PROFILE OF PATIENTS OF LOWER
         LIMB VARICOSE VEIN                                                                                                                              87-90
         Dr. Abhishek Jain, Dr. Robhin Bothra                                                                                   PDF FULL TEXT

ABSTRACT

Background: Lower-limb varicose veins are commonly found disorders associated with occupational causes. The prevalence of varicose veins is published in several previous studies were ranging from 10% to 30% worldwide. The etiology of lower-limb varicose veins is not clearly established, but in previous studies risk factors and precipitating factors have been identified. Material & Methods: The present cross-sectional prospective study enrolled 50 patients of lower-limb varicose veins, aged above 15 years of age of both the genders were enrolled for the study. Clearance from Institutional Ethics Committee was taken before start of study. Written informed consent was taken from each study participant. Results: The most common presenting symptom was pain and prominent veins (50%) which was followed by Prominent veins (14%), prominent veins and ulcer (10%) and Prominent veins with swelling of limb (10%). Prominent vein, pain and ulcer was present in 6% cases and bleeding present in 6% cases. Prominent vein, swelling of limb and pain was present in 4% cases. varicosities on right lower limb in 44% cases and isolated left lower limb involved in 42% cases. Isolated long saphenous system involved in 84% of cases both long and short saphenous system involved in 16% of cases. 48 (96%) participants had incompetence of perforator veins. Conclusion: We concluded from the present study that the most common affected age group was 20 - 40 years of life. Occupations which requires prolonged periods of violent muscular efforts and standing associated with varicose veins.
Key words: Varicose veins, Lower limbs, Saphenous veins.

17.    ASSESSMENT OF CLINICAL PROFILE OF MALARIA  AT SOUTHERN RAJASTHAN                         91-95
         Dr. Radhey Shyam Gupta                                                                                                        PDF FULL TEXT

ABSTRACT

Background: Malaria is an ancient disease, epidemics were reported and various studies were conducted to halt its diseases cycle and implement the vector control measures. The diseases burden is widely distributed among subtropical, tropical and monsoon zones worldwide along with cultural and socio-economic factor. The most commonly associated parasite namely Plasmodium falciparum is responsible for the most serious and life-threatening complications which all are termed as medical emergencies. Material & Methods: In present prospective study 100 patients of malaria Patients were enrolled from outdoor and from ward by simple random sampling. Clearance from Institutional Ethics Committee was taken before start of study.Results: The most presenting symptom was fever which was present in 100% of cases which was followed by headache and body ache which was present in 98% cases, followed by nausea and vomiting in 69% cases. Weakness was present among64% patients and abdominal pain was present in 31% patients. Splenomegaly was the most common organomegaly finding, which was present in 26% and hepatomegaly was present in 21% patients. Among 8 patients there was both Hepato-splenomegaly present.72% patients had hyperbilirubineamia, out of them 6% patients had serum bilirubin levels of more than >3 gm% and icterus was present in these 6% patients.53% had thrombocytopenia and serum creatinine values were higher among 22% of patients. Conclusion: Majority of patients were diagnosed with Plasmodium falciparum infection in compared to Plasmodium vivax infection. Fever was the most common presenting symptom which was high grade in majority of the patients and associated with rigors. There was thrombocytopenia, deranged liver function and renal functions also reported.
Keywords: Malaria, P Falciparum, P Vivax.

18.    BURDEN OF ANEMIA AMONG PREGNANT WOMEN IN CORRELATION WITH
         ABORTION STATUS                                                                                                                                  96-100
         Dr. Nitin S. Gupte, Dr. Archana Singhal                                                                                  PDF FULL TEXT

ABSTRACT

Background: Anemia itself is not a disease but a precursor and predictive sign of the presence of disease. Anemia reported during pregnancy is a burdensome public health problem all around the world; problem is vast among developing countries. Women during pregnancy are more prone for developing anemia not only because of increased iron demand and its poor bioavailability along with hemodilution. Material & Methods: In the present prospective observational study 400 Pregnant women were enrolled from outdoor, antenatal clinic and from ward by simple random sampling. Clearance from Institutional Ethics Committee was taken before start of study. Written informed consent was taken from each study participant. Results: Among pregnant women with nil past abortions 108 (29.7%) had no anaemia, 140 (38.5%) females had mild anemia, 106 (29.1%) females had moderate anemia and 10 (2.7%) had severe anemia in this group. Among pregnant women with 1 abortions 10 (35.7%) had no anaemia, 6 (21.4%) females had mild anemia, 12 (42.9%) females had moderate anemia and there was no cases of severe anemia in this group. Among the group of pregnant women with 2 abortions, 4 (66.7%) of pregnant women had moderate anemia and 2 (33.3%) of pregnant women had severe anemia. Among the group of pregnant women with >2 abortions, 2 (100%) of pregnant women had severe anemia. (p value < 0.001) Conclusions: The magnitude and burden of anemia is very high and the population living among urban and rural areas both was at higher risk of developing anemia. We found statistically significant correlation of anemia with increasing number of abortions.
Key words: Anemia, Pregnancy, Abortion status.

19.    ASSESSMENT OF INTERTROCHANTERIC FRACTURES: A CROSS-SECTIONAL
         PROSPECTIVE STUDY                                                                                                                          101-104
         Dr. Sohan Lal Gupta                                                                                                                PDF FULL TEXT

ABSTRACT

Background: Fracture of hip has always been a subject for research for various researchers, various studies had been conducted to evaluate the newer operative and management approaches to provide a better quality of life to patients. Fracture of hip includes two types of distinct anatomical variants: among them one is fractures of the intertrochanteric region and another one is fractures of the femoral neck. Material & Methods: The present cross-sectional prospective study was conducted at department of orthopedics of our tertiary care hospital. The study duration was of one year from January 2018 to December 2018. A sample size of 50 was calculated at 95% confidence interval at 5 % acceptable margin of error. Patients of more than 18 years of age with intertrochanteric fractures were enrolled for the study. Results: Trivial trauma was the most common mode of injury which was accounts for fracture in 36 (72%) patients which was followed by road traffic accidents accounts for fracture in 14 (28%) patients. Among the patients operated with intramedullary hip screw 69% were had fracture due to trivial trauma while 31% cases had fracture due to RTA. Majority of patients 31 (62%) had fractures of right sided hip bone. Out of the total patients, majority of patients 29 (58%) had type II intertrochanteric hip fractures which was followed by type III among 10 (20%) patients and type I in 8 (16%) patients and type IV in 3 (6%) patients. Conclusion: We concluded from the present study that male was encountered more than females with an age group of more than 60 years of age. Most common mode of injury was trivial trauma which was followed by road traffic accidents. Right side hip bone fracture was the most common with majority of them were type II.
Key words: Intertrochanteric fractures, Hip Joint, domestic fall.

20.    CERVICAL ICA STENOSIS WITH GOOD COLLATERAL CIRCULATION: OPTIONS FOR MANAGEMENT 
         Narendra Mal, Manisha Vajpeyee, Sigit Dewanto Hendrani, Dan Neftalie Juangco,                       105-109
         Atulabh Vajpeyee                                                                                                                     PDF FULL TEXT

ABSTRACT

Background: Management of acute ischemic stroke due occlusion of the cervical ICA remains to be ill-defined. The rate of recanalization using standard therapy from guidelines remains low. Generally good prognosis of patients corelates with good collateral circulation. However, studies on augmentation of collateral blood flow have not been successful in demonstrating clinical benefit. Here we illustrate a case of a patient where current standard therapy and effect of collateral circulation are inadequate to achieve a good outcome. A patient with a stroke due to a cervical ICA stenosis, with good collateral flow noted on angiography, was managed medically adhering to the current guidelines. However, patient still evolved with a full blown stroke. Possible explanations for this include hemodynamic stability and distal embolization due to partial thrombolysis. Conclusion: The current management for the subset of patients with acute ischemic stroke caused by stenosis or occlusion of the cervical ICA, and with good collateral circulation, needs to be examined further. The use of intravenous thrombolysis, antiplatelets, and statin are not enough to achieve good outcomes. The utility of IV rt-PA or mechanical thrombectomy this subset of patients need further research.
 
Keywords: Collateral Circulation, Cervical ICA Stenosis, Stroke

21.    ROLE OF SERUM LIPID PROFILE IN OCCURRENCE OF DIABETIC NEPHROPATHY?                   110-114
         Dr. Chetan Nayak                                                                                                                      PDF FULL TEXT

ABSTRACT

Background: The prevalence of non-communicable diseases is increasing compared to communicable diseases. Among the non-communicable diseases, diabetes mellitus is rapidly increasing globally and affecting all the age groups. Diabetes is a chronic disease in etiology and occurs when the pancreas does not produce enough amount of insulin or when there is resistance towards its action on the body. Material & Methods: In the present study a total 200 patients with type 2 diabetes mellitus and confirmed with laboratory investigations were enrolled from outdoor and from ward by simple random sampling. Clearance from Institutional Ethics Committee was taken before start of study. Written informed consent was taken from each study participant. Results:  The mean value of total cholesterol among study participants was 194.2 ± 36.4 mg/dl, mean value of HDL- cholesterol was 32.4 ± 6.2 mg/dl, mean value of LDL- cholesterol was 112.8± 42.5 mg/dl and mean value of Serum triglycerides was 201.6 ± 58.7 mg/dl. 32 (16%) diabetes patients had diabetic Nephropathy. On the estimation of GFR, it was found that Out of total diabetic patients, 168 (84%) diabetic patients had GFR > 90 ml/min/1.73 m2, 30 (15%) diabetic patients had GFR of 60-90 ml/min/1.73m2 and 02 (1%) diabetic patients had GFR < 60 ml/min/1.73 m2. There was a significant association found between High LDL-cholesterol, High serum triglycerides and High total cholesterol levels. (p value < 0.05). Conclusion: We concluded from the present study that there was a significant association was found between dyslipidemia and diabetic nephropathy in patients with type 2 diabetes mellitus. Hence, serum lipid profile should be assessed annually among all the patients of diabetes.
Key words: Diabetes mellitus, Diabetic nephropathy, Dyslipidemia.

22.    MEASUREMENT OF BLOOD GLUCOSE LEVEL RATIO FOR MICROVASCULAR FLAP
         MONITORING                                                                                                                                          115-120
         Dr. Sumit Singhal, Dr. Vandana Singhal                                                                                PDF FULL TEXT

ABSTRACT

Background: Microsurgical post operative vascularity of flap-finger is a difficult issue. No ideal method is available till date. By studying ratio of flap to fingertip blood glucose level we can reach to a conclusion for salvage of congested flap whether non surgical or surgical intervention is required. Material and Methods: A prospective study done from 2018 to 2019 for 31 patients who underwent microvascular surgeries, out of which 29 patients were operated for free flap while 2 patients were of finger replantation, were included to assess the reliability of new flap monitoring method. Result: In our study total 23 flaps – finger survived well without any significant complications (group A), three flaps were salvaged well with non surgical interventions (group B), two flaps were salvaged fully with surgical interventions (group C), one TFL (tensor fascia lata) flap was salvaged with surgical interventions but there was distal marginal loss (group D), one fibula osteocutaneous flap for post commando reconstruction and one finger replantation were necrosed fully in spite of all surgical interventions (group E). Conclusion: Multiple sequential measurement of ratio of fingertip to flap glucose level is a very good indicator of venous thrombosis in clinical cases.
Key Words: Microsurgery, Free flaps, Blood glucose level

23.    ANALYSIS OF MORPHOMETRIC SEGMENTS OF HUMERUS WITH CLINICAL RELEVANCE IN
         RAJASTHAN REGION                                                                                                                           121-127
         Dr. Pratima Jaiswal, Dr. Rajiv Kumar Verma                                                                         PDF FULL TEXT

ABSTRACT

Background: Long bones have long been used to determine the stature and identification of an individual. There are studies to determine the variation in anatomical segments focusing on ethnicities and with the need for required implant design for an individual. The aim of this is to contribute to the data on morphometric segments of the humerus of the Rajasthan region. Materials and Methods: A total of 100 (R-50 & L-50) humeri were used in this study. A total of eight morphometric segments were measured in each of these bones and their mean+SD were derived and compared with others. All measurements are in millimeters. Results: The results were 1. MH: mean maximum humeral length (R-290.16, L-288.48); 2. H1: mean distance between the most proximal point of the articular segment of the humeral head to the most proximal point of the greater tuberosity (R-5.3,L-5.16); H2: mean distance between the most proximal point of the caput humeri and most distal point of the anatomical neck (R-34.91,L-35.78); H3: mean distance between the most proximal point to the most distal point along the edges of the olecranon fossa (R-18.77,L-19.15); H4: The distance between the most distal point of the olecranon fossa and trochlea of the humerus (R-20.84, L-19.79); H5: The distance between along the proximal edge of the olecranon fossa and the most proximal point of the trochlea (R-36.04, L-34.90); WOF: Width of olecranon fossa (R-24.53,L-24.13); DOF: Depth of olecranon fossa (R-10.79, L-11.39). Conclusion: Analysis of data revealed that our results were in correlation with Indian studies but most of the foreign studies showed higher values of the segments studied. This difference is either be due to ethnic, genetic, nutritional or stature differences among different populations. We believe that data obtained herein can contribute to anthropologists and orthopedic surgeons.
Keywords: humerus, morphometry, arthrometry, tubercle, olecranon

24.    BACTERIOLOGICAL PROFILE AND COMPOSITION OF GALL STONE                                           128-131
         Dr. Ashok Kumar Meghwal                                                                                                    PDF FULL TEXT

ABSTRACT

Background:  Chronic calculous cholecystitis is the benign disease affecting the gallbladder, frequently female population of middle age. This study was done with the objective of study the composition of gall stones, microbiological spectrum and their association in chronic calculous cholecystitis patients. Material & Methods: This is a prospective study done on 131 cases of chronic calculous cholecystitis admitted in the department of General Surgery, for cholecystectomy during January 2018 to January 2019. 31 patients were excluded from the study based on exclusion criteria. USG of abdomen was done in all 100 cases. Results: Out of 100 cases, 76 cases underwent LC and 24 cases were done with OC. Female dominance was seen in the study (69%). The predominant type of gall stone in present study was cholesterol (68%). The bile culture test was positive in 20% of cases. The most common isolated microorganism was E. coli (50%). No significant association was observed between composition/type of gall stone and isolated microorganisms in bile (p=0.126).Conclusion:The result concluded that chronic calculous cholecystitis was more common in females of middle age group. Bile culture was positive in 20% cases and E. coli was the common organism isolated. Identification of the type of organism is crucial for early management of the disease condition.
Keywords:  Gallstone, Bile culture, Chronic calculous cholecystitis.

25.    EVALUATION OF RISK FACTORS ASSOCIATED WITH ACUTE SEVERE ASTHMA                      132-135
         Dr Deepali Kamdar                                                                                                                PDF FULL TEXT

ABSTRACT

​Background: Acute severe asthma is reported as one of the most common emergency conditions which results in hospitalization among children. Asthma is reported in previous studies as most distributed diseases around the world with an approximate burden of 300 million patients. In childhood age, asthma is reported to be most frequent chronic respiratory diseases. Material & Methods: The present prospective study was conducted at department of respiratory medicine of GCS Medical College, Hospital and Research Centre,Ahmedabad, Gujarat. The study duration was of six months from June 2016 to December 2018. A sample size of 100 was calculated at 95% confidence interval at 10% acceptable margin of error. Clearance from Institutional Ethics Committee was taken before start of study. Written informed consent was taken from each study participant. Results:  In the present study, out of total study participants it was reported that among majority of cases 68% poor drug compliance was present while drug compliance was good in 32% children. This difference was statistically significant (P value <0.05). Among 74% cases house dust exposure history was present while it was negative in 26% cases. This difference was statistically significant (P value <0.05).  Among 51% cases smoke exposure history was present while it was negative in 49% cases. This difference was statistically significant (P value <0.05).Conclusion: acute severe asthma is a preventable and treatable condition. Attack of acute asthma was found to be associated with poor drug compliance, house dust exposure and smoke exposure. Hence, education of parents and children both is necessary for prevention of acute severe asthma.
Keywords: Acute severe asthma, Children, Risk factors.

26.    ESTIMATION OF SERUM IRON LEVELS IN TYPE 2 DIABETIC PATIENTS AND ITS
         RELATION WITH HbA1C LEVEL                                                                                                         136-140
         Dr Pardeep Agarwal, Namrata Vinubhai Shah, Dr Deepak Gupta,
         Dr Maheep Sinha, Dr Bushra Fiza                                                                                         PDF FULL TEXT

ABSTRACT

Background: Excessive iron store is associated with higher risk of metabolic disorders including hypertension, metabolic syndrome and cardiovascular disease. This study determines levels of S. Iron and Total Iron Binding Capacity (TIBC) in type 2 diabetic patients and its correlation with HbA1c. Methods: The study was conducted in Department of General Medicine in association with Department of Biochemistry of Mahatma Gandhi Medical College & Hospital, Sitapura, Jaipur. 100 confirmed cases of Type 2 Diabetes Mellitus and 50 age and sex matched healthy subjects were enrolled in study. All were screened for HbA1c, Fasting blood sugar, Post prandial blood sugar, Serum Iron and Total iron binding capacity. Results: The fasting blood sugar, post prandial sugar, HbA1c levels were significantly higher in the diabetic subject. S.Iron was significantly lower in diabetic group while S.TIBC did not show any significant variation. S.Iron was highest 62.15±33.96 µg/dl in the HbA1c ≤ 6.0% subgroup and as low as 37.08±14.30 µg/dl for the poor glycemic control group. Conclusion: Iron metabolism may participate in etiopathogenesis of type 2 diabetes mellitus. An elevated iron store induces oxidative damage of pancreatic beta cells with impairment of insulin secretion and interferes with hepatic glucose production. Thus leading to development of diabetes.
Keywords: Serum iron, Total iron binding capacity, Type 2 diabetes mellitus, Serum Ferritin.
 

27.    COMPARISON OF QUALITY OF LIFE IN PATIENTS WITH DIABETES MELLITUS TREATED
         WITH ORAL HYPOGLYCEMICS AND INSULIN                                                                                  141-145
         Dr. Mukesh Batra                                                                                                                    PDF FULL TEXT

ABSTRACT

Background: Diabetes is a chronic disease in etiology and occurs when the pancreas does not produce enough amount of insulin or when there is resistance towards its action on the body. The aim of present study was to evaluate factors affecting quality of life among patients diagnosed with type-2 diabetes mellitus and taking treatment with insulin and oral hypoglycemic drugs. Material & Methods: 200 patients who were diagnosed with type-2 diabetes mellitus and taking either insulin or oral hypoglycemics drugs for at least 12 weeks who were attending outpatient department enrolled for present study by simple random sampling. Written informed consent was taken from each study participant. Patients who had chronic illness other than diabetes and patients who were being treated by both insulin and oral hypoglycemics drugs were excluded from the study. Results: About 68% of the patients who were on insulin while 76% of the patients who were on oral hypoglycemics had satisfactory quality of life. The cut off value was being 87.5 i.e. the 50% of total possible mean score value. On the basis of mean quality of life score among study participants it was found that mean quality of life score values among patients on oral hypoglycemic drugs was 115.3 and mean quality of life score values among patients on insulin was 105.9. This difference was statistically non-significant (P value >0.05). Conclusion: We concluded from the present study that patients who were on oral hypoglycemics had satisfactory quality of life in compared to the patients on insulin therapy. The poor quality of life scores was significantly (P value <0.05) associated with lower socioeconomic status, lesser physical activity and lesser education, duration of illness and positive family history.
Key words: diabetes mellitus, quality of life, oral hypoglycemic drugs.

28.    AN EPIDEMIOLOGICAL STUDY OF ESTIMATION OF BURDEN OF CATARACT AMONG
         GERIATRIC AGE GROUP                                                                                                                      146-149
         Dr. Navin D. Patel                                                                                                                     PDF FULL TEXT

ABSTRACT

Background: Cataract can be present among any age group and has vast etiology and represents the major burden of blindness and poor vision worldwide. In a previous study it was estimated that approximately 60 million people are suffering from elderly onset cataract in the world. Some studies among developing world also reported that higher burden of age related cataract in comparison to the developed countries. Material & Methods: The present prospective study was conducted at department of ophthalmology of our tertiary care hospital. The study duration was of one year. A sample size of 100 was calculated by the software epi info v.7 at 95% confidence interval at 10% acceptable margin of error. Patients who were aged more than 60 years were enrolled from outdoor and from ward by simple random sampling. Results: We found that out of total study participants 78% patients had cataract and 22% of total study participants had found negative for cataract on the examination.72% belong to age group of 60 to 69 years among them 52% patients had cataract and 20% found negative for cataract.19% study participants belong to age group of 70 to 79 years among them 17% patients had cataract and 2% found negative for cataract.9% study participants belong to age group of above 80 years and all of them had cataract. This difference was statistically significant (p value < 0.05). Out of total study participants 51% were male and among them 38% patients had cataract and 13% found negative for cataract.49% study participants were females and among them 40% patients had cataract and 9% found negative for cataract. This difference was statistically non-significant (p value > 0.05). Conclusion: We concluded from the present study that the higher prevance of cataract was reported among patients of geriatric age group. We found statistically association of senile cataract with increasing age, living area as urban and rural and employment status. However, results were found statistically non-significant with gender of patient and type of family.
Key words: senile cataract, geriatric, elderly population.