International Journal of Medical Sciences and Education (IJMSE)
Vol. 6 Issue: 4 (Oct. - December 2019), Date of Publication: 01.01.2020

Table of Contents
     Editorial

1.    COMPARATIVE EVALUATION OF STRUCTURED VIVA-VOCE EXAMINATION AND CONVENTIONAL
       VIVA-VOCE EXAMINATION IN II MBBS STUDENTS                                                                                     1-5
       Navpreet Kaur, Sami Manzoor, Sharanjit Kaur, Anmol Goyal                                               PDF FULL TEXT

ABSTRACT

​Background: Viva-voce examination is an important tool for student assessment. The traditional or conventional viva-voce examination (CVE) is often perceived to be associated with subjective bias. At the same time, it doesn’t meet the standards of parameters such as validity, reliability, and reproducibility. A structured viva-voce examination (SVE) can maintain a uniform pattern of questions and improve upon the conventional assessment tool of viva-voce. AIM & OBJECTIVES: To compare the structured & conventional method of viva-voce examination for assessment in Pharmacology. Materials and Methods: This study was conducted in 2nd Prof MBBS students. Question cards with answer keys covering two topics- “Drugs acting on Respiratory system” & “Drugs acting on Gastrointestinal system.” were prepared after validation from all faculty in the Pharmacology department. The teaching-learning methods employed were didactic lectures and tutorials. The students (n=113) were assessed by two types of viva-voce examination with a crossover design after dividing them into two batches. The evaluation was done by feedback questionnaire and comparison of scoring by students when exposed SVE & CVE.  Results: There was a statistically significant improvement (p<0.05) in scoring by students showing improvement with SVE. 85% faculty members & 84% students were satisfied with SVE. Conclusion: Results of this study suggest that SVE is perceived as a better assessment tool by both students & faculty and helped students in scoring better. It can be used alone or along with CVE as a tool for student assessment.
Keywords: Viva-voce examination,   Assessment tool.

2.     WHEN ALCOHOL BECKONS, EVERYTHING TAKES A BACK SEAT-CROSS SECTIONAL STUDY OF
        KNOWLEDGE, ATTITUDE AND PRACTICES ABOUT EFFECTS OF ALCOHOL ON SEXUAL FUNCTIONING
        IN PATIENTS WITH ALCOHOL USE AND SEXUAL PROBLEMS                                                                 6-11
        Dr Nilanjan Chandra, Dr Shabina Sheth, Dr Ritambhara Mehta, Dr Kamlesh Dave              PDF FULL TEXT

ABSTRACT

Background: To assess the Knowledge, Attitude, Practices (KAP) about sex with or without alcohol in patients presenting with alcohol use disorder and sexual problems attending Alcohol group meeting (ALG) and Psychosexual counselling (PSG) to see the commonalities and differences of their KAP. Materials and Methods: A cross-sectional study was carried out in patients of two different groups in a state general hospital of western India. Department of Psychiatry runs two different group meetings, (1) alcohol group meeting (ALG) for alcoholics and (2) psychosexual group meeting (PSG) for patients coming for sexual problems. After approval from Human research Ethics Committee and consent taken, A semi structured questionnaire was used to analyse and compare KAP about effects of Alcohol on sex for both groups. Results: Nearly 2/3rd patients in both the groups had adequate knowledge. While assessing attitude ALG had healthier attitude than PSG. Regarding practice, 21.1% of ALG vs 1.75% of PSG take alcohol regularly before sex. 73.7% of ALG vs 21.1% of PSG enjoy sex better after drinking alcohol. 33.3% of ALG but only 1.05% of PSG had sex with commercial sex worker after alcohol. More than half participants from ALG had casual unwanted sex and sex unknowingly without condom after alcohol consumption. Conclusion: Despite good knowledge and healthier attitude, sexual practices are significantly different in Alcohol dependents. Thus, Knowledge and Attitude do not matter when alcohol prevails.
Keywords: alcohol, psychosexual, myths and practice related to alcohol

3.     Perceptions of Medical Students Regarding Learning during Practical Sessions in Pharmacology –
        A Cross Sectional Questionnaire Based Study                                                                                        12-20
       Gurudeva C, Pallavi Kulkarni, Ravin Vijay R, Thangam Chinnathambi, Indla Ravi, 
       Regina Roy, Alice Kuruvilla                                                                                                        PDF FULL TEXT

ABSTRACT

Background: Pharmacology practical exercises compliment the theory classes and are effective tools to develop skills and competencies of a medical graduate. Off-late, the content and nature of pharmacology practicals have witnessed some changes such as inclusion of self-learning modules. These include seminars, clinical case discussions and problem-solving exercises. Insights about the perceptions and preferences of the students help to plan relevant exercises. There is no publication of students’ perception about the usefulness of practicals conducted during the whole course of the second year MBBS. Materials and Methods: This cross sectional study was conducted in 72 students of Karuna Medical College who had completed IInd MBBS course. The students were provided a predesigned proforma to obtain their feedbacks on two aspects of each practicals. One, whether it was interesting and other was a rating of their preferences on a scale of 1 to 5, where 1being least and 5 being excellent. Results: A majority (86.4% – 95.4%) of the students indicated all the practical exercises as interesting. The basic pharmacology exercises and group assignments were considered as interesting by 95.40% and 94.80% of students respectively. They also had marked their preference to group assignments as excellent (59.03%) and good (26.39%) indicating group assignments as the most preferred practical assignments. This was followed next by a preference for case discussions and seminars (24.30% excellent, 47.22% good) and then basic pharmacology exercises (24.07% excellent, 42.59% good). Conclusion: The structured feedbacks from students regarding pharmacology practical exercises provide valuable insights in planning interesting sessions for future.
Keywords: Computer Assisted Learning, Feedback, Group Assignments, Medical graduates, Pharmacology practicals, Students’ Perceptions.

4.     MEDICAL STUDENTS ASSESSMENT OF EARLIER STUDYING AND PRACTICING CONCEPTS OF
        MEDICAL EDUCATION                                                                                                                                 21-26
        Tarig Guma Mardi Sideeg, Abd Alsalam Nail, Naila Karkasawi, Mohammed Ahmed,
        Marouf Mohammed, Huda Hakim Abd Elrahman                                                                    PDF FULL TEXT

ABSTRACT

Background: New trends in medical education has emerged in medical curricula to ensure highly competent doctor and this involved development of teaching medical education new concepts in early setting at medical schools. The curriculum of Faculty of Medicine and Health Sciences - Omdurman Islamic University (FMHS-OIU) is competency-based curriculum; it based on specifications of adult learning that make the students proactive in group work for solving problems. As result, FMHS-OIU introduces a course of new trends in medical education to the first year students at the beginning of their study. The aim of this work is to assess undergraduate medical student's opinions on the new trends in medical education course, and to test the effect of gender assessment of early studying and practicing trends in medical education course. Materials and Methods: This analytical cross-sectional study was carried out at Faculty of Medicine and Health Sciences (FMHS), Omdurman Islamic University (OIU), 2018. The study was involved all students of first level of both gender, they are 346 male and female medical students were asked to fill pretested questionnaire which contains specific questions allocated in three domains of knowledge and skills was used to collect the data. Soft - ware program of Statistical Package for social Science (SPSS) version 20. to obtain the descriptive statistics (Frequencies, percentage) as well as inferential statistics ( Chi-squire) to identify the correlations between variables of the study. The confidence interval is 95% was taken as significant at P-value ≤ 0.05. Results: The study showed statically difference gender play no role in assessment of studying the course (P-value > 0.05), in spite they are taught separately. In addition both gender assessments revealed positive responds with high frequency and percentage regarding (cognitive knowledge, psychomotor and behavioral skills) in the course. Conclusions: Approximately all participated students were emphasized their highly agreement particularly in (Self-learning, Small Group Work and Problem Based Learning (PBL)) that studied in the course. In conclusion, no statistical difference between male and female medical students' assessment of trends in medical education course in this study.
Keywords: Assessment, Course, Medical students, Medical Education

5.    ASSESSMENT OF ACID BASE DISORDERS IN CRITICALLY ILL MEDICAL PATIENTS                        27-31
​       Dr Rakesh Modi, Dr Geetesh Mangal                                                                                       PDF FULL TEXT

ABSTRACT

Background: Acid base disorders represents the pathogenesis and gravity of the underlying disease which accounts for morbidity and mortality rates. A previous study reported that around 64% of patients admitted in intensive care unit show complex acid-base and electrolyte disorders, among them the most common was acute metabolic acidosis. Material & Methods: In the present retrospective study, patients who were admitted in ICU during the one year of study period were enrolled by simple random sampling. Clearance from hospital ethics committee was taken before start of study. Written informed consent was taken from each study participant. Results: In the present study, majority of study participants 80% (40) were in the group of non-infectious etiology, 8% (4) patients had sepsis and 12% (6) patients had other infectious cause. Out of the total study participants 16 patients had simple acid base disorder and 34 patients had mixed acid base disorder. Among the patients with simple acid base disorders 8 had metabolic acidosis, 3 had metabolic alkalosis, 1 had respiratory alkalosis and 4 had respiratory acidosis. Among the patients with mixed acid base disorders, 10 had metabolic acidosis + respiratory alkalosis, 7 had metabolic alkalosis + respiratory alkalosis, 10 had metabolic alkalosis + respiratory acidosis and 7 had metabolic acidosis + respiratory acidosis. Conclusion: We concluded from the present study that acid base disorders play important role in effective treatment of various pathological diseases specially among the critically ill patients.
Key words: Acid base disorder, Intensive care units, metabolic acidosis, respiratory acidosis.

6.    VENTILATOR ASSOCIATED PNEUMONIA-STUDY OF DEMO-GRAPHIC PROFILE, RISK FACTORS,
       PATHOGENS AND MORTALITY IN CRITICAL CARE UNIT IN A TERTIARY CARE CENTER                32-36
       Dr Shuchita Vaya, Dr Ashish Jain                                                                                         PDF FULL TEXT

ABSTRACT

​Background: Admission to the critical Care unit carries high chances of acquiring ventilator associated pneumonia (VAP). Presence of risk factors like variety of illnesses, immunocompromised states, number of organ involvement and duration of invasive mechanical ventilation increases the hospital mortality and morbidity, the cost of the treatment and duration of ICU stay with VAP. Objective: The aim of Our study is to calculate the incidence and identify risk factors, pathogens and attributable mortality associated with VAP in the critical care areas. Materials and methods: The present prospective observational study was conducted over a period of one year in the department of critical care of our tertiary Care hospital. Patients more than 18 years of age who developed pneumonia after 48 hours of mechanical ventilation were included in the study. Modified clinical pulmonary infection score (CPIS) was followed as a screening method to diagnose VAP. Result: In our study at tertiary care center, the incidence of VAP was 27.1 8% and incidence density of VAP was 19 per 1000 ventilator days. Mean age for VAP was 48.1 2 +/-15.21 years. The most common etiology associated with VAP was Trauma followed by malignancies and respiratory failure patients. Previous use of broad spectrum antibiotics within 7 days of ICU admission and mechanical ventilation, previous use of steroid and immunosuppressive drugs was significantly associated with the development of VAP .Microbiological analysis showed majority of Gram negative bacterial isolates (Klebsiella Pneumoniae and Acinetobacter species ) which were responsible for approximately 50% of total VAP cases. The overall mortality observed among VAP group was 39.20% and among non VAP group was 24% (significantly low). Conclusion: Our study showed VAP are highly fatal infections and are common cause of longer ICU stay , increased morbidity and mortality and higher cost of treatment. We found significant association of prior use of antibiotics, steroids and immunosuppressive agents with VAP.
 Keywords: Risk factors, morbidity,mortality ,incidence, ventilator-associated pneumonia.

7.    ASSESSMENT OF PALMO-PLANTAR PSORIASIS AND ASSOCIATED FACTORS                              37-40
       Dr Sanjay Purohit                                                                                                                    PDF FULL TEXT

ABSTRACT

​Background: Psoriasis is characterized by immune mediated chronic, non-infectious, inflammatory and proliferative condition which affects 2-4% population worldwide and associated with genetic and environmental factors. Palmoplantar psoriasis is a subtype of psoriasis that characteristically involves the skin of the palms and soles. Material & Methods: The present study was conducted at department of dermatology of our tertiary care hospital. All patients who had Palmoplantar psoriasis variant were enrolled for the study. All patients who had psoriasis other than Palmoplantar psoriasis were excluded from the study.  Clearance from Institutional Ethics Committee was taken before start of study. Results: In present study, Instep involvement and extension beyond the sole in to heels were present among 46% of patients and hyperkeratosis, scaling, fissures with well-defined borders present among 35% of patients and diffuse involvement of both palms and soles present among 19% of patients. On the basis of occupation 63% of patients involved in household work, 27% patients involved in agriculture and 10% patient were involved in clerical work. Majority of patients were underweight 42% and normal BMI 40%. Diabetes was found among 11 patients, dyslipidemia was found in 24% and hypothyroidism was reported among 6% patients. Conclusion: The overall prevalence of psoriasis and Palmoplantar psoriasis was low in our study. Middle aged females affect predominantly in our study. High BMI, diabetes mellitus, dyslipidemia and hypothyroidism were the associated comorbidities found in present study.
Keywords: Palmoplantar psoriasis, Hyperkeratosis, Comorbidities.

8.    CORRELATION OF CARRYING ANGLE OF ELBOW WITH LENGTH OF FOREARM AND
​       HEIGHT OF BODY                                                                                                                                      41-43
       Dr. Sanjay Kumar Sharma, Dr. Sadiq Wadood Siddiqui                                                       PDF FULL TEXT

ABSTRACT

Background: The angle between the median axis of arm and that of the fully extended and supinated forearm is known as Carrying angle. In females the carrying angle is greater and in the dominant upper limb. To identify deformities of elbow Carrying angle knowledge is important. In the sex determination the role of carrying angle is important. In this study find out correlation of carrying angle with height and length of forearm. Material & Method: In this present study total 266 (146 female & 120 male) asymptomatic, healthy students of RajShree Medical Research Institute Bareilly were selected. There ages ranged 17 to 22 years. Carrying angle is measured by Goniometer. The carrying angle is inversely related with height and length of forearm of person. Greater carrying angle In female is considered as secondary sex characteristic. Conclusion: it is clear that the height & length of the forearm are directly related to each other. Length of the forearm in female is 24.9 cm on right side and 24.8 cm on left side where as in male this value is 27.8 cm on right side and 26.6 cm on left side which is inversely related to the carrying angle. It may be considered as secondary sex characteristics in female.
key words: Carrying angle, height, goniometer, length of forearm, puberty, secondary sex characteristic

9.     A STUDY OF MORPHOLOGY OF PLACENTA IN ECLAMPSIA OF PREGNANCY AND ITS EFFECT
        ON FETAL OUTCOME                                                                                                                                 44-47
       Dadhich Abhilasha, Saini Pankaj, Agarwal Chandra Kala                                                      PDF FULL TEXT

ABSTRACT

The placenta is the most important organ for maintaining healthy pregnancy. Eclampsia is one of the common disorders during pregnancy. The present study was carried out at Department of Anatomy Dr. S. N. Medical College, Jodhpur to find out the morphological changes in placentae of eclamptic group in comparison to those of control group. In the present study 100 placentae with normal pregnancy and 100 placentae with eclampsia of pregnancy were collected and the newborns were also evaluated for birth weight, type of birth and NICU admission. It was found that the eclamptic group had low placental weight, less maximum diameter, less thickness at center and less number of cotyledons (p<0.01). Thus, eclampsia of pregnancy had adverse effect on placenta and in turn on the fetus as the mean birth weight of new born in eclamptic subjects was lower than normal subjects.
Keywords:  Eclampsia, Placenta, Morphology, Fetus.

10.    A STUDY OF SUBCLINICAL HYPOTHYROIDISM IN PATIENTS OF WESTERN INDIA FOR PREVALANCE
        OF ANTI THYROID PEROXIDASE ANTIBODY AND ITS ASSOCIATION WITH DYSLIPIDEMIA          48-55
        Dr Jaspal Dhamija, Dr Prakharanshu Singh Dhakar, Dr. Ankit Jain,
        Dr Omprakash Choudhary, Dr Garvit Mundra                                                                        PDF FULL TEXT

ABSTRACT

Background: In comparison to overt hypothyroidism Subclinical hypothyroidism (SCH) is more common and considered as mild thyroid failure. SCH is also having high probability to convert into overt hypothyroidism. It is well established fact that overt hypothyroidism is associated with dyslipdemia but It is controversial in SCH and there are few Indian studies suggesting correlation between TPO positivity and lipid abnormalities in SCH. Hence, Aim of this study to find the association between dyslipidemia and TPO positivity in SCH patients. Methods: 175 cases of subclinical hypothyroidism were recruited fromOPD&IPD department of medicine Mahatma Gandhi Medical College & Hospital Jaipur. After overnight fasting blood samples were drawn in the morning and serum TSH, free thyroxine (FT4), free triiodothyronine (FT3), anti-thyroid peroxidase antibody (TPO-Ab) levels, as well as lipid concentrations were measured. Results: Significantly high(p < 0.001) Cholesterol, LDL, TG level in Anti-TPO (+ ve) group while HDL level was significantly low(p=0.003) in Anti TPO (+ ve)group. Patients were divided according to levels of TSH. Significantly high(p value< 0.001) levels of Anti-TPO, Cholesterol, LDL was found in patients having TSH levels >10 in comparison to TSH levels ≤ 10. while there were no statistical difference (p value >0.05)in values of TG, VLDL, HDL levels between both groups. Conclusions: In SCH patients, dyslipidemia is significantly associated with TPO positivity and it may be associated with levels of TSH, such patients may convert into overt hypothyroidism in future. Hence to prevent adverse outcomes early screening, diagnosis, and treatment of SCH patients are recommended.
Keywords: Total cholesterol level, Thyroid-stimulating hormone, Euthyroidism, Subclinical hypothyroidism,Dyslipidemia, Thyroid antibodies