International Journal of Medical Sciences and Education (IJMSE)
Vol. 5; Issue: 4 (Oct. -December 2018), Date of Publication: 01.01.2019

Table of Contents
     Editorial                                                                                                                                                   470-471
                                                                                                                                                            PDF FULL TEXT

1.    THE SIGNIFICANCE OF COMMUNICATION SKILLS IN DETERMINING EFFECTIVENESS OF
       ORGANIZATIONS                                                                                                                                     472-478
       Kalidas D. Chavan, Purushottam A. Giri, Savita Rajurkar, Sunil N. Thitme                         PDF FULL TEXT

ABSTRACT

The noteworthy contribution of ‘Communication Skills’ has been considered central to building organizational success models. Several studies on this topic unanimously concluded that, ‘The Communication skills’ is a central parameter in deciding the effectiveness of organizations and there are studies which have proved that an appropriate intervention about intent and efficacy of communication increases the communication efficiency among the students. The objective of this review paper is to throw light on the intent and extent of linkage of effectiveness of communication skills with the organizational effectiveness. Organizational effectiveness emanates from the structure of hierarchy which is linked to the channelized communications among the teams and their managers by creating strategies of cohesive working with the team spirit. This has to be focused on the organizational goals and outcomes and enriched by the employment benefits to employee. Precision in the functional communication is a prerequisite of an institutional team leader and works as a catalyst in cultivating an efficient team and interpersonal relationship among the team members transcending to optimum outcomes. Many parameters other than communication skills influence the organizational effectiveness. Therefore, the art of communication cannot be overemphasized as a unidirectional process; it is contingent upon how people respond, interact with one another based on several other factors intrinsic to job like employment benefits, job security etc. that add to the job satisfaction.
Key words: Academic organizatios, Communication Skills, Communication Structure, Organizational Effectiveness​

2.    A DESCRIPTIVE ANALYSIS OF PATIENT HISTORY BASED ON ITS RELEVANCE                             479-482
       Yogesh Acharya, Sandy Badai, Ian Vink, Michael Ebisi, Sateesh Arja,
       Tarig Fadlallah Altahir Ahmed                                                                                                   PDF FULL TEXT

ABSTRACT

Patient history is information obtained from patients and other relevant sources on the possible course of their current illness. It is an integral component of a clinical encounter. Gathering information about medical history is critical for accurate and effective decisions. It is also an important tool in successful physician-patient interactions. A good patient history decreases the burden of an unnecessary laboratory test and healthcare expenditure. This article discusses different components of the patient history and highlights its importance in the accurate diagnosis of an illness. 
Keyword: Patients; History; Review literature

3.    EFFECTIVENESS OF INDUCTION PROGRAMME FOR MEDICAL INTERNS:
       WELL BEGUN IS HALF DONE                                                                                                                483-488
       Pallavi Kulkarni, Regina Roy, Alice kuruvilla, Ravi Indla                                                       PDF FULL TEXT

ABSTRACT

Background: A well planned induction programme conducted for medical interns, is a foundation for an effective internship and eases the transition from medical college to internship. Objective: To evaluate the effectiveness of induction programme for interns. Methods: Thirty interns who were yet to start their internship and were part of induction programme were included in the study. A well-consolidated questionnaire containing ten multiple choice questions (MCQs) based on the relevant topics discussed in the programme was used to assess the effectiveness of the induction programme. Feedback was taken from the interns at the end of the programme. Data was analyzed with descriptive statistics namely mean and standard deviation and Students’ paired t-test was used to compare pre and post test score. Results: The mean pre-induction score was 4.76 ± 1.10 and the mean post induction score was 6.6 ±1.28 (statistically significant, P value <0.05). The interns' feedback indicate that majority of them (n=25, 83%) were satisfied with the programme. Interns were very satisfied/ satisfied with relevance of topics (n=28, 93%), time allotment (n=27, 90%) and clarity (n=20, 67%). Only 14 (47%) interns found the clinical skill demonstrative sessions satisfactory. Conclusion: The induction programme was effective and well received by the interns. The feedback from the interns was positive and satisfactory. More focus on time management and clinical skill demonstrations were notable aspects from the interns’ feedback. Inclusion of role plays, short period supervised workshops or onsite hospital training as a part of induction programme would be feasible approaches to further improvise the programme.
KEY WORDS: medical interns, induction programme, clinical skills

4.     KNOWLEDGE, ATTITUDE AND PRACTICE REGARDING NEEDLE STICK INJURY AMONG JUNIOR
        DOCTORS IN A RURAL GOVERNMENT TEACHING HOSPITAL, WEST BENGAL                           489-494
        Dr. Subhabrata Kumar                                                                                                             PDF FULL TEXT

ABSTRACT

Background: Health care workers are to exposed needlestick injuries during their routine work. Doctors who have just passed MBBS and join for duty in various departments are most vulnerable in this early part of their career. This study was conducted to increase the awareness regarding the risks of needlestick injury, ways to prevent it and finally management of needle stick injury. Material and Methods: Twenty-six doctors who are working in the various department of Malda Medical College and Hospital, West Bengal participated. These doctors are working as house staff or interns. A 15 item questionnaire was answered by the doctors. The reply to this questionnaire was used for assessment regarding needle stick injury. Results: Majority of the doctors that is eighty-one percent (n=21) had good awareness regarding needle stick injury.  Exposure to needle stick injury was reported by seventy-three percent of doctors (n=19). Conclusion: This study showed that doctors are highly exposed to the occupational risk of needle stick injury. Therefore awareness about needle stick injury is essential both for the prevention and management of this health hazard.
KEYWORDS: needle stick injury, re-capping, junior doctors, post-exposure prophylaxis

5.     A NOVEL ANALYSIS TO UNDERSTAND THE VARIABLE IN MULTIPLE RESPONSE
        MCQ (MR) SCORE                                                                                                                                  495-501
        Sonali B. Rode, Harsh V. Salankar, Vinayak H. Bhavsar, Nazeem Siddiqui                        PDF FULL TEXT

ABSTRACT

Background: In the light of certain deficiencies of MCQs Type A, multiple correct response MCQs (MR) came into existence. However, MR format is not in common use, possibly because of difficulties in its marking scheme. We have reflected upon the approach of the students while solving the MR format and put forth a hypothesis about unintentional passive response which results into higher score in MR format. To prove this hypothesis the present study was planned. Material and methods: An adequate experimental design was used where same questions were created in MR and modified multiple true and false (MTF) formats. Same batch of the students solved both the formats in one sitting. Results: Mean score in MR format (13.33 + 2.38) was significantly higher compared to MTF modified format (9.66 + 2.78), thus proved the hypothesis. Conclusion: Higher score in MR format is attributed to unintentional passive response. Study highlights the importance of analysis of approach of the students while handling a particular format of MCQs.
Keywords: MCQ, Multiple Response MCQ, MTF MCQs, modified MTF, marking scheme

6.     CLINICAL PROFILE OF PSYCHIATRIC MORBIDITY AMONG CHILDREN VISITING OUTPATIENT
        DEPARTMENT OF TERTIARY CARE CENTER                                                                                    502-506
        Dr. Anup Mitra, Dr. Abdul Sajid                                                                                               PDF FULL TEXT

ABSTRACT

Background: Psychiatric morbidity among children includes disorders of psychological development (e.g. autistic disorders and specific learning disorders), mental retardation (MR) and behavioral disorders with onset usually occurring in childhood (e.g. enuresis and hyperkinetic disorders). Age is an important factor in the clinical profile pattern of the psychiatric morbidity. Material & Methods: a total number of 300 children of age 1 to 16 years were included in study by simple random sampling. The mental health and psychiatric morbidity were evaluated after a thorough clinical examination. Intelligence quotient was calculated and recorded. All the diagnoses were made on the basis of DSM 4th Edition, Text Revision criteria. Results: Most the study participants belonged to the age group of 7–16 years (72%), out of the total 70% were boys and 30% were females. Most of the study participants were from rural background (64%) and 61% of the study participants were from nuclear families. ADHD was the most common diagnosis in present study reported in 32.6% of the study participants, this was followed by MR which reported in 28.3% of the study participants. 11.3% of the study participants had PDD and 5.6% of the study participants had borderline intellectual functioning. Conclusion: the psychiatric morbidity was found higher in ≥7 years of age group with male gender predominance. Most of the study participants were from a rural background living in nuclear families. ADHD and MR were the most common psychiatric disorders reported.
Key words: ADHD, Children, Psychiatric Morbidity.

7.     COMPARATIVE EVALUATION THE INCIDENCE OF VENTILATOR ASSOCIATED PNEUMONIA
        AMONG TRACHEOSTOMIZED AND NON-TRACHEOSTOMIZED PATIENTS                                    507-511
        Dr. Ashish Jain, Dr Anchin Kalia                                                                                           PDF FULL TEXT

ABSTRACT

Background: Hospitalizations in intensive care units has a high risk of acquiring nosocomial infections or hospital acquired infections. In majority of patients, the underlying conditions and invasive diagnostic and therapeutic procedure unavoidably contributes to the risk of hospital acquired infections. Material & Methods: The present cross-sectional prospective study was conducted at department of respiratory medicine of our tertiary care hospital. 150 Patients who were requiring mechanical ventilation for 7 days or more for various etiology and who had APACHE 4 score less than 200 were enrolled for the study. Results: In present study, out of 150 patients, 51 (34%) patients reported to had ventilator associated pneumonia. Out of these 150 patients 87 were in non-tracheostomized group and among them 33 (38%) had developed VAP. Out of 63 patients who had undergone tracheostomy 18 (28.6%) patients had developed VAP. Among them, 5 (27.7%) developed VAP in the period 7 to 10 days, between 11-14 days 6 (33.3%) patients developed VAP and after 14 days, 7 (38.8%) patients developed VAP. Conclusion: The incidence of VAP was higher among non-tracheostomized patients compared to patients who underwent tracheostomy. Tracheostomy done early as 7-10 days after mechanical ventilation results in lesser incidence of VAP.
Key words: Ventilator associated pneumonia, Tracheostomy, APACHE 4 scoring system.​

8.     CERVICO-VAGINAL CYTOLOGY AND ADVANTAGES OF ITS CLASSIFICATION BY
        THE BETHESDA SYSTEM                                                                                                                     512-518
        Dr Aditi Maurya, Dr Hemraj Tungria                                                                                       PDF FULL TEXT

ABSTRACT

​Objective(s): To study the cervicovaginal cytology and advantages of its classification by The Bethesda System 2014. Method(s): A prospective study was carried out comprising 500 married women between the age of 25 to 65 years attending Gynaecology OPD at tertiary care hospital. These were subjected to pap's smear and classified according to The Bethesda System 2014. In selected cases, a cervical biopsy was done. The cytohistological correlation was obtained. Results: Out of 500 women subjected to cytological evaluation only 35 patients had epithelial cell abnormality and 84 patients showed infective organisms in pap's smear reporting. The cytohistological correlation was 84.23% with 84.61% sensitivity and 97.80% specificity. Conclusion(s): Classification of cervicovaginal cytology by The Bethesda System 2014 is of immense value as it categorises not only the premalignant and malignant lesions but also atypical, inflammatory and infectious lesions, so cost-effectiveness of cervicovaginal cytology is increased. 
Keywords: The Bethesda System, cytology, histology

9.     CLINICAL AND MANOMETRIC PROFILE EVALUATION OF PATIENTS WITH  GASTRO
        ESOPHAGEAL REFLUX DISEASE (GERD)                                                                                         519-523
        Dr. Mridul Bhushan, Ritesh Singh Gangwar                                                                         PDF FULL TEXT

ABSTRACT

​Background: Gastro Esophageal Reflux Disease (GERD) has a high prevalence all over the world, and this disease has considerable geographical variation. GERD may act as a significant risk factor in the etiopathogenesis of esophageal adenocarcinoma and Barrett's esophagus. Material & Methods: In the present study 100 patients of both sexes of age between 20-65 years were included in the study after obtaining ethical clearance. Patients who were presented with symptoms of heartburn or acid regurgitation (GERD) for at least more than three months were included in the study after obtaining their informed written consent. Results:  Out of total patients 64 were males, and 36 were females with their mean age of 42.18± 14.53. Their clinical presentations were heartburn (52.8%), acid regurgitation (36.4%), chest pain (19.3%), nausea and vomiting (6.7%). Among 100 study participants diagnosed with GERD 30% were reported to have ineffective esophageal motility and out of them only 9% had low LES pressure. Among 30 study participants diagnosed with ineffective esophageal peristalsis 38.7% reported to have failed peristalsis, and 61.3% study participants had weak peristalsis. Conclusion: Ineffective or abnormal esophageal motility was higher than the low pressure of LES inpatients had GERD. Hence, Ineffective esophageal motility and Hypotensive sphincter were the leading cause for GERD and also not always correlated with esophagitis.
Keywords: High-Resolution Manometry, Ineffective peristalsis, esophageal adenocarcinoma, Barrett's esophagus.

10.   COMPARATIVE EVALUATION OF  INTRAVENOUS MIDAZOLAM AND TOPICAL LIGNOCAINE
        FOR INSERTION OF LARYNGEAL MASK AIRWAY WITH PROPOFOL                                             524-530
        Dr. Namrata Jain, Dr. Saba Ahmed, Dr. Sanjay Saksena                                                      PDF FULL TEXT

ABSTRACT

​Background: To evaluate whether midazolam or topical lignocaine eases LMA insertion during propofol anaesthesia. Material And Method: 60 patients of age group 16-45years of both sexes, ASA Grade I and II undergoing elective surgeries. Group 1: (n=30) propofol (2.0mg/kg) & midazolam (.04mg/kg) &  Group 2: (n=30)   Propofol (2.0mg/kg) & lignocaine aerosol 40 mg topically. Conditions of LMA insertion, gagging laryngospasm ,coughing noted at time of insertion, ECG, NIBP, SPO2 & ETCO2 were recorded according to scheduled times. Results: In Conditions of insertion, difference between groups reached significance, p< 0.05. In both groups at first min, rise in heart rate, fall in DSP,SBP and MAP was significant. At two and three minutes post LMA insertion these parameters change slightly but statistically not significant. Conclusion: Topical Lignocaine 10% aerosol prior to propofol induction provide excellent conditions for LMA insertion without the use of neuromuscular blockages.
KEYWORDS: LMA Laryngeal mask airway, Topical Lignocaine aerosol , Midazolam

11.   ASSESSMENT OF LIPID PROFILE IN STROKE PATIENTS AT TERTIARY CARE CENTRE OF
        SOUTHERN RAJASTHAN                                                                                                                     531-534
        Dr. Jagdish Chandra Sharma, Dr.Rajesh Khoiwal                                                               PDF FULL TEXT

ABSTRACT

​Background: The prevalence of non-communicable diseases shows incremental growth after the 20th century and a decrease in the prevalence of communicable disease. Stroke is defined as symptoms and signs rapidly developing of focal or global loss of cerebral function which is lasting for 24 hours or more with the cause of vascular origin with no other apparent cause. Material & Methods: The present cross-sectional prospective study was conducted at the department of general medicine of our tertiary care hospital. 50 Patients who were diagnosed with acute cerebrovascular disease admitted to the medical ward of the hospital were enrolled for the study. Clearance from Institutional Ethics Committee was taken before the start of the study. Results: Total cholesterol was abnormal in 80% of ischemic stroke and 20% of hemorrhagic stroke. LDL cholesterol was abnormal in 83.3% of ischemic stroke and 16.6% of hemorrhagic stroke. Triglyceride levels were abnormal in 70.5% of ischemic stroke and 29.5% of hemorrhagic stroke. Non-HDL cholesterol was abnormal in 74% of ischemic stroke and 26% of hemorrhagic stroke. (p-value <0.05). Conclusion: Primary prevention by the regular monitor of lipid profile may decrease the risk of atherosclerosis and cerebrovascular disease.
Keywords: Lipid profile, Stroke, Total cholesterol.

12.   EVALUATION OF HISTOPATHOLOGICAL PATTERN OF THYROID LESIONS AT TERTIARY
        CARE CENTER                                                                                                                                     535-538
        Dr. Vinita Jain                                                                                                                         PDF FULL TEXT

ABSTRACT

Background: The thyroid hormones control the metabolism of macromolecules, oxygen consumption and the basal metabolic rate (BMR) of body cells and are essential for healthy growth and maturation of the body as well as they are essential for proper development of the peripheral and central nervous system. Material & Methods: In the present cross-sectional prospective study 100 biopsies specimen were fixed in formalin and then embedded in paraffin, and after that, the sections were stained with hematoxylin and eosin stain. Special stains like Periodic acid Schiff, Congo Red, and reticulin, were used whenever and as needed. Results: Multinodular goiter was the most common non-neoplastic thyroid lesion (54%) which is followed by thyroiditis. There were only three patients of toxic goiter among all the thyroid specimens received and examined. There were 17% of specimens diagnosed as carcinomas. Papillary carcinoma was found the most common malignancy, out of which half of the specimens were of the micropapillary subtype. One of the thyroid lesion specimens showed two different primary malignancies (papillary microcarcinoma and follicular carcinoma). Conclusion: Most common type of lesion was non-neoplastic and among this most common type was multinodular goiter and among the neoplastic lesions and the most common type was papillary carcinoma of the thyroid.
Keywords: Multinodular goiter, Thyroiditis, Thyroid carcinoma, Papillary carcinoma

13.   ASSOCIATION BETWEEN TOPHUS INVOLVEMENT OF TENDON AND SERUM URIC
        ACID LEVELS?                                                                                                                                      539-543
        Dr. Yogesh Kumar Gautam, Dr.Saleh Mohammed Kagzi                                                     PDF FULL TEXT

ABSTRACT

​Background: The balance between the rate of uric acid renal excretion and the breakdown of purines can be represented by the estimation of serum urate (SU) concentration. The solubility threshold for serum urate is approximately 7 mg/dL when its concentration raised above threshold levels, then oversaturation is seen in interstitial fluids. Material & Methods: In the present study 100 Patients with the diagnosis of gout according to the American College of Rheumatology (ACR) criteria and qualifying the entry criterion of serum uric acid levels between 5.5 - 9 mg/dl along with one or more episode of pain, swelling, or tenderness at peripheral joint were enrolled for the study. Results: Uric acid level between 7 - 9 mg/dl found in 68%, and it was in age between 21yr – 45 years of age. 27% of patients had a history of serum uric acid more than 7 mg/dl and a previous history of joint pain. The patellar tendon is the most frequently involved tendon which is followed by quadriceps tendon, Achilles tendon, and peroneus tendon. In this study involvement of isolated patellar tendon seen in 8 patients, the involvement of isolated quadriceps tendon seen in 7 patients, isolated Achilles tendon in 4 patients. Both quadriceps tendon and Achilles tendon involved in 7 patients. Conclusion: Ultrasound imaging found to be right noninvasive imaging procedure to detect the intra-tendinous tophus. Patients with hyperuricemia and pain in enthesis site, Ultrasound can detect monosodium urate crystals deposition in the early stage.
Keywords: Tophus, Tendon, Ultrasound, Uric acid.

14.   A PROSPECTIVE STUDY OF POST BURN CONTRACTURE: INCIDENCE, PREDISPOSING FACTORS,
        MANAGEMENT, AND OUTCOME?                                                                                                      544-548
        Dr. Ramraj Goyal, Dr. Surendra Mertia                                                                                 PDF FULL TEXT

ABSTRACT

Background: Burn injury is among the prevalent cause of trauma especially in the scenario of middle- and low-income countries. Disabling outcomes are reported if the full-thickness and deep partial-thickness burns are not managed with early excision and grafting. Full-thickness and deep partial-thickness burns if not managed with adequate splinting and positioning then they often lead to burn scar contractures. Material & Methods: The present cross-sectional observational study was conducted at the department of surgery of our tertiary care hospital. Fifty subjects with post-burn contractures who give consent with post-burn contractures of either age and gender were included in the study, and the patients who refused to give consent were excluded. Results: Split-thickness skin grafting (STSG) conducted in 28 (56%) patients. Burn contracture release with K wire insertion along with coverage was performed in 9 patients (18%), contracture release with split-thickness skin grafting with flap cover was performed in 8 patients (16%), and Z plasty was done in 5 patients (10%). Postoperatively, out of total of 47 cases (94 %) had a good postoperative outcome, and the grafts and flaps were taken up. Conclusion: We concluded from the present study that due to significant advances in postburn care in the last decades the postoperative functional outcomes are improved with better quality of life.
Keywords: Management, Outcome, Post-burn contracture.

15.   COMPARATIVE EVALUATION OF LUNG CANCER BY CT GUIDED FINE NEEDLE ASPIRATION
        CYTOLOGY AND TRUCUT BIOPSY                                                                                                   549-553
        Dr. Sonal Agarwal, Dr. D.P. Agarwal                                                                                    PDF FULL TEXT

ABSTRACT

Background: Lung carcinoma is the most common type of malignancy all around the globe, especially in males. Lung cancer is the most common cause of cancer-related deaths, and the average five-year survival rate of lung cancer is near about 17%. Material & Methods: The present cross-sectional observational study was conducted over a period of one year with a sample size of 54 was calculated at a 95% confidence interval. All the patients, who had suspected mass lesion finding on chest X-ray and clinical correlation suggestive of lung carcinoma were undergone for CT guided FNAC and Biopsy. Results: CT guided FNAC examination revealed that 39 study participants were positive for malignancy (72.22%), among 10 study participants results were suggestive for malignancy (18.52%) and among 5 study participants results were negative for malignancy (9.25%). Biopsy results were positive for malignancy among all study participants. Results showed that small cell carcinoma was positive among 4 (7.41%) study participants while non-small cell lung carcinoma was positive among 49 (90.74%) study participants. The sensitivity of CT guided FNAC and Biopsy in the evaluation of lung cancer was found 90.74% and 100% respectively. The specificity of CT guided FNAC was 100% for the diagnosis of lung carcinoma. Conclusion:  CT guided lung FNAC is a safe, accurate and highly specific and also well-tolerated procedure which confirms the diagnosis of Lung cancer. Though the specificity of FNAC is high for diagnosing Lung carcinoma, still Biopsy had high sensitivity and would be preferable diagnosis Lung cancer and its various subtypes.
Keywords: Lung cancer, CT guided FNAC,