International Journal of Medical Sciences and Education (IJMSE)
Vol. 6 Issue: 3 (July - September 2019), Date of Publication: 01.10.2019

Table of Contents
     Editorial

1.    STUDENTS’ PERCEPTION OF FOUNDATION COURSE – A NEW EXPERIENCE IN MBBS
       CURRICULUM IN INDIA                                                                                                                                     1-7
       Dr Rohit Dixit, Dr K P Joshi, Dr Suhasini P, Dr Deepak Jamadar                                            PDF FULL TEXT

ABSTRACT

​Background: As per the new curriculum by MCI, a one month foundation course has been introduced across the country. This will help a MBBS student to acclimatize the new learning environment in the medical college which is far different from high school. At the end of this foundation course this study was carried out with the aim to evaluate the perception of the students regarding the knowledge and importance of foundation course. Material and Methods: A cross sectional study was conducted by MEU, SVS Medical College, Mahabubnagar (TS). A predesigned, pre tested questionnaire was given to the students before and after the completion of one month of foundation course and were asked to rate the perception of knowledge and importance of the modules on the likert scale of 1 to 5 on various modules given by MCI. The data was analyzed by using SPSS 20.0 version. Results: A total of 66 students participated in this study. The mean scores of the perception of knowledge and importance of the various topics included in different module before the foundation course were 1.0 to 1.33 and 1.0 to 1.58 respectively but after the foundation course the mean scores increased to 3.3 to 3.5 and 3.8 to 4.3 respectively. The overall rating for the foundation course was 4.19±0.61. Conclusion: The improved scores in students’ perception of knowledge and importance of various modules in foundation course on the likert scale and overall rating for the foundation courseindicate that feedback response of newly admitted students was very satisfactory and encouraging.
Keywords: Likert scale, MBBS, MCI, Orientation, Perception, Skill

2.     IMPLEMENTAION OF NEW CURRICULUM IN UG (M.B.B.S): A DREAM PROJECT 0F MEDICAL    
        EDUCATION TECHNOLOGY                                                                                                                          8-12
        Subodh Kumar                                                                                                                            PDF FULL TEXT

ABSTRACT

Background: Medical Education System is the backbone of Healthcare Industries. Now a day’s it is facing a lot of problems due to shortage of recourse persons, Lack of skilled faculties and researchers in most of the Medical Colleges in India.  There is urgent need of improving the working environment, quality of the work and management system because lots of money devastated, due to ignorance. Reults: The newly implemented UG Curriculum was more effective than Earlier Pattern M.B.B.S Curriculum because it covers all the three domain of Learning (Cognitive for thinking,affective for emotion/ feeling and  Psychomotor for kinaesthetic) Material and Methods: The study was conducted at Vardhman Institute of Medical Sciences, Pawapuri, Nalanda (Bihar). Resource Faculty Members of different departments (Pre, para and clinical), Newly admitted M.B.B.S students, 2nd Year M.B.B.S Students, Medical Education Unit Members and Curriculum Committee Members were included in my present study. The study was designed to assess the effect of new curriculum for UG (M.B.B.S) as per MCI Guideline over existing earlier.  Conclusion: Implementation of key elements of new curriculum  in UG (M.B.B.S) would be helpful in creating holistic  and scientific environment,  not only among  the faculty but also it boost up the enthusiasm of MBBS Students to set their Professional Carrier from the beginning which in turn resulting Indian Medical Graduate(IMG) mission fruitful.
Keywords: Early Clinical Exposure (ECE), Foundation Course, AETCOM Module, Competency Based Medical Education (CBME), Indian Medical Graduate (IMG) Role, Healthcare Industries

3.     ASSESSMENT OF DEPRESSION AND ITS RISK FACTORS AMONG GERIATRIC AGE GROUP            13-16
        Dr. Bharati D. Patil                                                                                                                       PDF FULL TEXT

ABSTRACT

​Background: Depression is a commonly present among geriatric age group population. The most common etiology behind that were social deprivation, loneliness and disability in some cases, as reported in previous epidemiological studies. In majority of elderly population depression remains unrecognized. However, it indirectly exerts the burden on health care infrastructure of country. Materials and Methods: In the present study, a total number of 400 patients who were more than 60 years of age were attending outpatient department enrolled for present study 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-: All participants were assessed for depression by GDS-15 scores and found that there was no depression among 176 (44%) participants, 144 (36%) had mild depression, 72 (18%) had moderate depression and8 (2%) were severely depressed. On the basis of age and GDS score we found significant association (P value > 0.05).On the basis of age and GDS-15 score we found statistically non-significant association (P value > 0.05).On the basis of gender and GDS-15 score we found significant association (P value< 0.05).On the basis of type of family and GDS-15 score we found statistically non-significant association (P value > 0.05).On the basis of socio-economic status, marital status and financial dependency status and GDS-15 score we found statistically significant association (P value< 0.05). Conclusion: We concluded from the present study that the burden of depression is very prevalent among our geriatric study population. Depression among geriatric population was significantly associated with female gender, financial dependents, patients who were divorced and widowed and individuals with low socio-economic status.
KEYWORDS: Depression, Geriatric, Morbidity.

4.   ASSESSMENT OF RISK FACTORS OF POST-PARTUM HEMORRHAGE AND ITS OUTCOME
        AT TERTIARY CARE CENTER                                                                                                                   17-20
        Dr Mohini Nanani                                                                                                                      PDF FULL TEXT

ABSTRACT

Background: Post-partum hemorrhage (PPH) is responsible for approximately 23% of maternal mortality worldwide and also reported as the most common cause of maternal mortality in Asian continent. The most common direct cause of maternal deaths and as well as maternal morbidity in India is post-partum hemorrhage, reported in various researches and accounts for 25% maternal deaths. Material & Methods: A total of 200 cases who had vaginal delivery with blood loss of 500 ml or more and cases who had caesarean section with blood loss of 1000 ml or more, were enrolled for study. Written informed consent from each and every participant was taken prior to study. Results: The most common risk factor for the post-partum hemorrhage was the atonicity of the uterus which was seen in 168 (84%) of the total pregnant women. PIH was seen in 74 (37%) pregnant women followed by APH which was seen in 45 (22.5%) pregnant women. Prolonged labour was accounts for 28 (14%) cases of PPH and retained placental products accounts for 17 (8.5%) cases of PPH. Large baby induced PPH was seen in 14 (7%) pregnant women and Genital tract Injuries accounts for 13 (6.5%) cases of PPH. PPH due to ruptured uterus was seen in 9 (4.5%) pregnant women and multi parity accounts for 9 (4.5%) cases of PPH. Infections were accounts for 5 (2.5%) cases of PPH and Uterine Inversion accounts for 2 (1%) cases of PPH. Conclusion: We concluded from the present study that Post-partum hemorrhage can be managed effectively by active management of the third stage of labour with use of uterotonics and blood transfusions.
Keywords: Postpartum haemorrhage, Atonicity, Maternal mortality.

5.    COMPARATIVE EVALUATION OF LUNG CANCER BY CT GUIDED FINE NEEDLE ASPIRATION
       CYTOLOGY AND TRUCUT BIOPSY                                                                                                               21-25
​       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,

6.    HEMOLYTIC DISEASE OF NEWBORN DUE TO ALLOIMMUNISATION TO ' c ' ANTIGEN                        26-30
       Dr. Rashmi  Parashar,  Dr. Sunita bundas,  Dr. B. S. Meena, Dr. Pamendra  Pachori             PDF FULL TEXT

ABSTRACT

Among the blood group systems, Rh blood group system showing highly polymorphism and most of its antigens are highly immunogenic and can cause clinically significant hemolytic reactions, if antibodies are developed against them (1). In Rh system, D is highly immunogenic and one of the commonest cause of severe hemolytic disease of newborn (2) .Other common Rh antigen in sequence of immunogenicity are c, E, C, e (3). Here we are reporting a case of HDN due to Anti-c.

7.    STUDY OF SERUM IRON, SERUM ZINC AND SERUM ALKALINE PHOSPHATASE IN PREMATURE       
​       DELIVERY                                                                                                                                                       31-33
       Ajay Kumar Hurmale, Sanjay Kumar Deshwali, Jaidev Singh                                                 PDF FULL TEXT

ABSTRACT

​Background: Preterm labour can be multifactorial syndrome caused by multiple etiological mechanisms. It may present a short- circuiting of overwhelming of the normal parturition cascade whereby the feto-placental unit can trigger labor prematurity if intra-uterine environment becomes hostile and intimidate the wellbeing of the foetus. Material & Methods: The study will include 58 subjects who had preterm delivery taken as case.20 women taken as control and delivered at term (after 37 weeks).All subjects will be between 18 to 35 years of age. Serum alkaline phosphatase, Serum Zinc and Serum Iron was estimated. Result: The maternal serum levels of alkaline phosphatase is greater while serum iron and serum zinc was lowered in preterm group as compared to the term. Conclusion: To conclude the present study gives us an idea that the studied biochemical parameters have some association with preterm delivery
Keywords: Premature delivery,  Serum Zinc, Serum Iron, Serum Alkaline phosphatase

8.    ASSESSMENT OF FEBRILE THROMBOCYTOPENIA  AT A TERTIARY CARE CENTRE                         34-37
       Dr. Radhey Shyam Gupta                                                                                                            PDF FULL TEXT

ABSTRACT

Background: Thrombocytopenia is a common manifestation reported among cases of pyrexia which can also manifest as purpura. However, purpura can be divided in two types either thrombocytopenic or non-thrombocytopenic. According to morphology platelets are anucleate cells with a life span of 8 to10 days and play vital function for hemostasis. In various studies it was reported that cases of febrile thrombocytopenia had very wide etiology which also influenced by the treatment modality. Material & Methods: In present study200 Patients who were presenting with pyrexia and confirmed with thrombocytopenia from laboratory investigations were enrolled from outdoor and from ward by simple random sampling. Clearance from Institutional Ethics Committee was taken before start of study. Results: In the present study, 74 (37%) patients had viral fever which was followed by malarial infections in 44 (22%) patients, which was followed by dengue fever among 40 (20%) patients. Scrub typhus was reported among 26 (13%) patients and septicemia was reported among 12 (6%) patients. Leptospirosis was reported among 4 (2%) patients. Majority of patients 102 (51%) had platelet countbetween100000 to 150000 per cubic mm, which was followed by platelet count between 50000 to 100000 per cubic mm among 66 (33%) patients. 24 (12%) patients had platelet count less than 20000 per cubic mm. Conclusion: Viral fever reported among most of the patients of febrile thrombocytopenia followed by malaria and dengue fever. Fever was the most common symptom followed by headache, myalgia, chills and rigors, pallor, cough, rashes, jaundice, breathlessness and bleeding diathesis.
KEY WORDS: Fever, Thrombocytopenia, Viral fever.

9.    EPIDEMIOLOGICAL STUDY OF DERMATOLOGICAL DISORDERS AT TERTIARY CARE CENTER        38-41
       Dr Sanjay Purohit                                                                                                                          PDF FULL TEXT

ABSTRACT

Background: Skin disease are considered very upsetting, especially in younger age groups. The burden and type of any disease in particular geographical area depends on the genetic constitution of the individuals, their social background and nutritional and hygiene status. The prevalence of disease is depending upon environmental conditions and the quality of medical care provided to them. Material & Methods: The present retrospective study was conducted at department of dermatology of our tertiary care hospital. In this epidemiological study patients of age of both the genders who were consented were enrolled for the study. Clearance from Institutional Ethics Committee was taken before start of study. Results: The most common presenting symptom was skin infections present among 23.66% patients. After infections next common finding was eczema which was present among 168 (14%) patients which was followed by contact dermatitis among 128 (10.66%) patients, urticaria was found in 114 (9.5%) patients and xerosis in 96 (8%) patients followed by acne in 7.4% and infestations in 7.2% patients. Hair disorders was present in 5.6% cases and atopic dermatitis was present in 4.3% cases. Post in flammatory changes seen in 3.58% and vitiligo was present in 1.66% cases followed by P.alba in 1.16% cases. Conclusion: The climate, occupation, socio-economic status, gender and age of the patient were associated in the occurrence of skin diseases. Fungal diseases, eczema and contact dermatitis were seen more commonly and scabies was the most common infestation.
Key words: Fungal infections, Contact dermatitis, Acne.

10.  EVALUATION OF MANAGEMENT AND OUTCOME OF PAEDIATRIC FOREARM RE-FRACTURES        42-45
       Dr. Sohan Lal Gupta                                                                                                                     PDF FULL TEXT

ABSTRACT

​Background: Forearm fractures are one of the commonest injuries accounting for 40% of paediatric fractures with a refracture rate of nearly 5%. Forearm refractures are increasing probably due to poor bone mineralization as a result of decreased physical activity, Vitamin D deficiency. These are treated by conservative measures with closed reduction and casting or by surgical fixation with flexible nails or plates. There are no definitive guidelines for management of forearm refracture and implant removal. Material & Methods: The study is aimed at the epidemiology, methods and difficulties of management and functional outcome of forearm refracture treatment. A prospective study of all the cases of forearm refracture who presented to Preksha Hospital & Chetna Ivf Research Centre and Manidhari Hospital & Maloo Neuro Centre,Jodhpur from 2016 to 2018 with refractures treated either by conservative methods or by IMN. All cases were followed up and functional outcome was assessed serially according to price et-al criteria. Results: Our study contained 17 males and 8 females between 6 years and 14 years. 76% refractures occurred before 16 weeks and majority had only tricortical union at this time. 42% patients underwent surgical fixation following refracture. Price et al criteria showed excellent results in 72% of patients. Conclusion: Forearm refractures in children can be treated both conservatively and surgically like a primary fracture depending on the indications but needs 2 to 3 more weeks of immobilization. A good functional outcome was obtained in majority of the cases. We suggest using splints till quadricortical union is achieved to prevent chances of refracture.
Keywords:  Refracture, Forearm fracture, Paediatric, Outcome.

11.    BACTERIAL PROFILE AND ANTIBIOGRAM FROM DIFFERENT SPECIMENS OF INTENSIVE
         CARE UNIT                                                                                                                                                    46-50
         Dr Rakesh Modi, Geetesh Mangal                                                                                             PDF FULL TEXT

ABSTRACT

Background: According to the reports of Global Burden of Diseases study among the low and lower- middle-income countries the major cause of mortality was infections. They reported several risk factors responsible for this high mortality rate which are poverty, increasing old age, illiteracy, rapid urbanization and emerging bacterial infections and viral infections. Material & Methods: In the present prospective 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 a total of 640 specimens were sent for isolation of causative pathogens out of them 300 (46.8%) were culture positive with 80% from sputum, 66% from urine, 21% from CSF and 22% from blood. Out of the total Gram-negative bacteria were found predominantly and included Escherichia coli (21%), Acinetobacter baumanii (14%), Klebsiella pneumoniae (13%), Pseudomonas aeruginosa (10%) and Enterobacter aerogenes (6%). Among the gram-positive bacteria Coagulase negative staphylococci (12%) found most commonly which is followed by MRSA (6%), Streptococcus pneumoniae (3%) and Enterococcus faecalis (3%). Candida sp were found in 12% cases. Conclusion: We concluded from the present study that on the basis of antibiotic sensitivity among the gram-negative isolates maximum drug sensitivity is shown by the drugs colistin, polymyxin-b and tigecycline and on the basis of antibiotic sensitivity among the gram-positive isolates maximum drug sensitivity is shown by the drugs vancomycin, clindamycin and linezolid.
Key words: APACHE-2, Gram-negative infections, Intensive care units.

12.    A PROSPECTIVE CROSSECTIONAL  STUDY OF PREVALENCE OF NEUROPSYCHIATRIC
         MANIFESTATIONS IN ADOLESCENTS WITH VITAMIN BI2 DEFICIENCY ANAEMIA                            51-56
         Dr Rishi Sodawat, Dr Nayan Kumar, Dr Chaturbhuj Singh                                                    PDF FULL TEXT

ABSTRACT

Background: Megaloblastic anemia is one of the common causes of anemia in adolescent population. Anemiabeing the most common presentation of B12 deficiency, the neuropsychiatric features are often overlooked. In India limited studies are available on vitamin B12 deficiency in adolescents. The aim of this study was to determine the prevalence of neuropsychiatric features in adolescents presenting with vitamin b12 deficiency. Method: A Prospective, tertiary hospital based, cross sectional open label clinicoepidemiological analysis of  100 anaemic patients of adolescent age group (excluding aplastic anaemia, hemolytic anaemia associated with jaundice and organomegaly, leukaemia, anemia of chronic inflammatory diseases, those who had received blood transfusion or haematinics in past (< 6months) ) admitted in pediatric ward of tertiary care centre in Ajmer region was done. In all the cases detailed clinical history and general examination along with lab investigations were done. In all the cases vitamin B12 level was done. Results: Out of 100 patients 38% were found deficient with female predominance. A prominent association could be ascertained between neuropsychiatric symptoms and B12 deficiency.  Conclusion: Deficiency of B12 is increasing among adolescents during recent years, with neuropsychiatric symptoms being common clinical features as seen in our study. B12 deficiency might present with these symptoms in absence of anemia. Supplementation through implemented nutritional programmes and education regarding diet patterns may overcome this deficiency.
Keywords: Megaloblastic Anemia, Neuropsychiatric Morbidity, Adolescents Age

13.    A COMPARATIVE STUDY OF SERUM BETA HUMAN CHORIONIC GONADOTROPHIN AND OCULAR
        CHANGES IN PREGNANCY INDUCED HYPERTENSION IN
        SECOND TRIMESTER OF PREGNANCY                                                                                                 61-69
        Dr Neha Jaiswal, Dr Sandeep Shivran                                                                                  PDF FULL TEXT

ABSTRACT

​Background: Hypertension disorder of pregnancy affects up to 8% of all gestations. Pregnancy induced Hypertension is defined as hypertension that develops for first time in pregnancy after 20 weeks of gestation. Pathophysiological placental abnormalities are seen consistently by increasing secretion of hormone HCG. Most ocular changes in pregnancy are harmless. For example, 14% of pregnant women need a new eyeglass prescription. Some changes, however, are serious, such as retinal effects of hypertension, which can be a sign of pre-eclampsia. METHOD The present study was being conducted on 50 healthy pregnant controls and 50 clinically established pregnancy induced hypertensive subjects. Serum hCG was measured and Fundoscopy for retinal changes was done. For analyzing the Data, Statistical software SYSTAT version 12 was used. The results were revealed in mean ±standard deviation. Comparisons of cases and control groups were done by applying Z test. Student’s t-test at 5% (p=0.05) and 1% (0.01) level of significance was used for correlation. RESULTS: Serum βHCG was significantly higher (t=18.14; p˂0.01) in pregnancy induced hypertensive subjects as compared with healthy pregnant control subjects.40% to 100% of pregnant women with high blood pressure have retinal changes whose severity is correlated with the severity of pre-eclampsia or eclampsia. CONCLUSION: Abnormally high serum β HCG in PIH Subjects is a dreaded complication of pregnancy. Serum β HCG should be included in routine investigation. Most ocular diseases can be treated with the usual drugs in pregnant women and Recommendations about drug treatment should be checked against current information that can be found on the embryotox.de and reprotox.de websites
KEYWORDS: Pregnancy induced hypertension, βhCG, Funduscopy, hyperplacentosis.

14.   ASSESSMENT OF BURDEN OF URINARY TRACT INFECTION AMONG MALNOURISHED CHILDREN AT              TERTIARY CARE CENTRE                                                                                                                      70-73
       Dr Ashwin  Dangi,  Dr Ashwin Sanghavi                                                                               PDF FULL TEXT

ABSTRACT

​Background: Urinary tract infection was reported as the major cause of health-related morbidity among the children in various studies. The most common presenting signs and symptoms are unexplained fever, nausea, vomiting and also diarrhea and failure to thrive among infants. However, among older children, these signs and symptoms are coupled with increased frequency of micturition and sometimes presents with nocturnal enuresis. Material & Methods: The present prospective study was conducted at department of pediatrics of our tertiary care hospital. The study was an observational study conducted for during a period of nine months. The study done at 95% confidence interval at 10% of maximum allowable error. All children of age 6 months to 5 years, who were diagnosed with both moderate acute malnutrition (MAM) and severe acute malnutrition (SAM), according to WHO criteria were enrolled into the study. Results: In present study, out of total study participants, based on the symptoms, the most common clinical presenting symptom was fever present in 29% patients which was followed by symptoms  of urinary tract infections present in 7% patients, which was followed by diarrhea present in 6% patients which was followed by vomiting present in 4% patients. Conclusion:  We concluded from the present study that the most common presenting symptoms were fever, urinary tract infections, diarrhea and vomiting. We found high prevalence of urinary tract infection among children diagnosed with both moderate acute malnutrition and severe acute malnutrition.
Keywords: Urinary tract infection, moderate acute malnutrition, severe acute malnutrition.​