International Journal of Medical Sciences and Education (IJMSE)
Vol. 3; Issue: 2 (April-June 2016) , Date of Publication: 01.07.2016

1. Vitamin D levels and diabetic microvascular complications.

Dr Gaurav Modi , Dr Smita Bahediya  , Dr. Ashish Sharma 
 
ABSTRACT:
Background: Vitamin D deficiency is related to glucose intolerance and type 2 diabetes mellitus. Microvascular complications are common in patients of type 2 diabetes. Objectives: To see the effect of long term type 2 diabetes microvascular complications on vitamin D levels.Methods: This observational study was conducted in patients; coming to department of endocrinology of either sex and age of type 2 diabetes in tertiary care teaching hospital. Finally diagnosed cases with microvascular complications either one or two or all the three in single patient were analyzed. Levels of 25(OH) D3 and HbA1c were measured by Chemiluminescence method. Chi square test, Student’s t test and ANOVA were used to analyse the data.Results: The mean age of all patients in our study was 55.9.2 +12.6 years. Mean duration of diabetes in patients was 7.4+4.02. Out of the 250 type 2 diabetics cases 54 (21.6%) had no microvascular complication. Single microvascular complications (retinopathy or neuropathy or nephropathy) was present in 83 (33.20%) of cases, while the combination of two was present in 67 (26.80%) and all three in 46 (18.40%) of cases. Mean Vitamin D level was found 21.03+2.61 in patients of no complication. Mean Vitamin D level further decreased in patients of single complications; nephropathy (19.18+2.13), retinopathy (18.49+2.53) and neuropathy (18.11+1.97). Mean Vitamin D level (16.22+1.02) was found lowest in patients of all three microvascular complications.Conclusion: Mean vitamin D levels are decreased in all patients of microvascular complications and as the severity or numbers of microvascular complications increase; mean vitamin D levels further decrease.

​Key words: Vitamin D, Diabetes, microvascular complications, HbA1c, Chemiluminescence method

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2. DELIVERY OF BABY IN OBSTRUCTED LABOUR BY PATWARDHAN TECHNIQUE – AN OBSERVATIONAL STUDY

Dr.Radheshyam Bairwa ,Dr.Ganga Shankar Garg, ,Dr.Manju Agrawal ,Dr.S.P.Chittora

ABSTRACT:
Background: Obstructed labour accounts for a significant proportion of maternal morbidity and mortality in India. The study was conducted to compare the foeto-maternal outcome associated with Patwardhan technique and conventional method, to extract the deeply wedged head during caesarean section.  The study also aimed to determine the complications of delivering the wedged foetal head during caesarean section by both techniques. Methods: Prospective study done on 100 cases with single fetus at term, admitted in labour room emergency of Obstetrics and Gynaecology at Jhalawar Medical College, Jhalawar from January to November 2015. Of these, 50 cases constituted study group on which Patwardhan technique was applied, and 50 comprised of control group, which were delivered by the conventional method. Results: Obstructed labour came across as the most common cause for performing Caesarean section in both groups. Only 12% of the patients in the study group suffered complications, as compared to 68% in the control group. Post-partum haemorrhage was the major complication in both the groups. The occurrence of lateral and vertical extension was higher in the control group as compared to study group. 24% of the patients in the study group required blood transfusion at the end of the procedure, as against 42% in the control group. The APGAR score at the end of 5 minutes was relatively similar in both the groups. Conclusion: Patwardhan technique is associated with less maternal and foetal morbidity as compared to the conventional method. It can be effectively applied to improve the foeto-maternal outcome in cases where the head is deeply impacted in the pelvis.
Key Words: Patwardhan technique Obstructed labour, Caesareans section.

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3. AEROBIC BACTERIOLOGICAL PROFILE OF SKIN AND SOFT TISSUE INFECTIONS (SSTI`S) AND IT`S ANTIMICROBIAL SUSCEPTIBILITY PATTERN AT M. B. GOVT. HOSPITAL IN UDAIPUR, RAJASTHAN

Anshu Sharma, Sandeep Gupta
 
Abstract:- Introduction: Skin and soft tissue infections (SSTI`s) are a common type of infection. The overall incidence of wound sepsis in India is from 10-33%. A predictable bacterial profile in the wound infections is very important for clinicians, who intend to start empirical treatment for patients, while laboratory culture reports are awaited. Objectives: To identify the common aerobic bacterial isolates and their antimicrobial susceptibility pattern along with methicillin resistance in Staphylococcus aureus and CoNS, production of extended spectrum beta lactamases in Escherichia coli and Klebsiella spp and Biofilm production in Staphylococcus aureus and CoNS. Material and Methods:  A total of randomly 207 pus samples received for aerobic bacteriological culture and sensitivity in the microbiology department of R.N.T. Medical College Udaipur, from various departments (OPD/IPD) of M.B.G. Hospital, Udaipur. This prospective study was done the period of six month (Dec.2014 to June 2015). The samples were processed in the laboratory by standard techniques. Results: Out of 207 samples 178(86%) were positive for aerobic bacterial culture while 29 (14%) samples had no growth.  Among the 178 culture positive pus samples, 151(84.83%) yielded pure bacterial isolates and 27(15.17%) yielded mixed infection. In the present study, Staphylococcus aureus 77 (37.5%) was the commonest organism isolated. Out of 77 Staphylococcus aureus isolated, 31 (40.25%) were MRSA and ESBL producers among Escherichia coli and Klebsiella species were 30 (85.71%) and 4(50%) respectively. Out of 103 Staphylococcus aureus (77) and CoNS (26) isolates, 33 (32.03%) were biofilm producer. Conclusion: The commonest isolates of skin and soft tissue infections are Staphylococcus Aureus (37.5%) followed by Escherichia Coli (17%), CoNS (13%) and Pseudomonas spp (12%) and there is a high level of resistance against commonly used antimicrobials due to methicillin resistance, ESBL and Biofilm production. Staphylococcus aureus were 100% sensitive to vancomycin and Escherichia coli were 80% sensitive to amikacin so these antimicrobials can be included in empirical treatment of skin and soft tissue infections.
Keywords: Antimicrobial Susceptibility, Biofilm, ESBL, MRSA, Staphylococcus aureus, skin and soft tissue infections (SSTI`S).

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4. A STUDY ON MYOCARDIAL  FUNCTION IN CHILDREN  WITH SEVERE ACUTE MALNUTRITION
 
Prashant Agrawal, Virendra kumar Gupta, Shagun Gupta,M.L.Gupta
 
ABSTRACT
Objective: To compare the myocardial function in severely acute malnourished and apparently healthy children of 6- 59 months of age group. Design: Observational cross sectional study. Setting: Sir padampat mother and child health institute, attached to SMS medical college, Jaipur. Patients:  from September 2011 to December 2012, 32 children with severe acute malnutrition and 32 apparently healthy children. Methods: 32 children with severe acute malnutrition (SAM) as cases were compared with 32   apparently healthy children as controls, all of them were undergone thorough history and clinical examination and investigations including CPK-MB and Echocardiography to assess cardiac function.Main outcome measures: cardiac enzyme (CPK-MB) and cardiac dimensions, muscle mass and functions to assess myocardial function. Results: Cardiac dimensions of malnourished group LVEDD(23.06±3.21vs. 28.36±4.23mm) ,LVESD (23.06±3.21vs.18.54±3.11mm), LVPWD(4.08±0.72 vs.5.03±0.86mm) and LVM(18.31±7.66 vs.31.71±10.17mm)( p<0.001) were significantly reduced, while IVSD(4.76±1.18mm vs. 5.43±0.82mm), FS(34.39±3.73 VS. 35.25±3.13), EF(65.75±5.40 vs. 66.44±4.34) and LVMI(54.18±17.68 vs. 61.81±14.28) (p>0.05) were not changed in malnourished as compared to healthy children. FS (30.85±3.58vs.35.38±3.58 %) and EF (60.58±5.24vs.67.2±5.15%) were reduced in edematous malnourished group in comparison to non edematous malnourished group.
Mean value of CPK-MB in malnourished group (51.5±30.71 mg/dl) was significantly higher than control group (23.5±12.27 mg/dl).Conclusions: in present study cardiac enzyme levels were found to be elevated and some of the left ventricular dimensions were found to be reduced in malnourished children, hence assessment of these parameters may proved to be an important tool in early detection of cardiac dysfunction in severe acute malnutrition, which may help in reducing morbidity and mortality related to severe acute malnutrition.
 
Key words: Children, myocardial function, Severe Acute Malnutrition, Echocardiography.
 
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5. DIAGNOSTIC VALUE OF ADENOSINE DEAMINASE (ADA) IN TUBERCULAR PLEURAL EFFUSION

Dr.Alpna Goyal, Dr.Madhav Uppadhyay, Dr.Chitra Uppadhyay, Dr.Shubra Jain

ABSTRACT:
Background: Tubercular pleurisy is a complication often seen to be associated with pleural effusion, however, its diagnosis is cumbersome and confirmation is prolonged. Adenosine deaminase has been shown to be useful in early diagnosis of tubercular pleurisy. This study is planned to evaluate the diagnostic value of adenosine deaminase in tuberculous pleural effusion in terms of its sensitivity, specificity, positive predictive value, negative predictive value and overall diagnostic accuracy. Material and Methods: A cross sectional study of patients presenting with pleural effusion were enrolled in the study and underwent thorough clinical examination, radiological, hematological and biochemical investigations. Pleural Fluid adenosine deaminase (ADA) levels were also assessed. Final diagnosis was made on the basis of a criteria developed combining clinical, radiological and biochemical assessment as well as on the basis of response to ATT. Results: Mean Pleural fluid ADA levels were found to be significantly higher (94.5±41 .8 U/I) in tubercular cases as compared to non-tubercular cases (57.9±17.7 U/I). The proposed cut-off value of ADA at 65 U/I was 83.3% sensitive, 72.2% specific, had a positive predictive value of 80% and a negative predictive value of 76.5%. The accuracy of the criteria was 78.6%.Conclusions:The findings in present study suggested a useful role of pleural fluid ADA in the diagnosis of tubercular pleurisy which needs further improvisation with the help of evolution of a universally acceptable cut-off value in association with some other clinical or laboratory parameter.
Keywords :  ADA, pleural effusion, tubercular pleurisy.

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6. MARKERS OF CARDIOVASCULAR CO MORBIDITY IN CHRONIC OBSTRUCTIVE PULMONARY DISEASE
 
Vipul Garg,Harjeet Singh,Balveer Singh Gurjar,Suresh Meena,Manisha Verma , S.K. Vardey

ABSTRACT
Objective: The purpose of this study was to provide an overview of the lipid derangements in COPD because India is one of the most affected countries in the world with COPD and contributes significantly to the mortality and morbidity of the disease. CVD is the most prevalent cause of co morbidities and the second most common cause of mortality, next to respiratory failure. Traditionally, dyslipidemia is considered to be one of the most important risk factors for the development of atherogenesis. Methods: This study was conducted in central Lab, Department of Biochemistry of S.M.S. Medical College and Hospital, Jaipur, India from the period of Dec.2013 to Nov.2014. In this study 33 patients of COPD taken as cases and 29 healthy controls. We analysed the levels of total cholesterol, triglycerides (TG), low density lipoproteins (LDL), high density lipoproteins (HDL) in COPD patients and control patients. Results: we found in this study that mean value of  BMI, LDL,TCH of patients  was 16.36 + 2.82 kg/m2, 117.48 + 30.93mg/dl, 177.21 + 30.58mg/dl respectively  in cases as compared  to  20.00 + 1.71 kg/m2 101.32 +  15.42 mg/dl, 164.45 + 14.40  mg/dl respectively  in controls. These relations are statistically significant. BMI decreases with severity of disease and LDL and TCH increases in COPD. Conclusion: To conclude, this study gives us an idea that the derangement in levels of LDL and TCH may be associated with cardiovascular co morbidities and it needs to be studied further.
Key words: Triglycerides, Total Cholesterol, Basal Metabolic Index, Chronic Obstructive Pulmonary Disease, Low Density Lipoprotein.

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7. HISTO-PATHOLOGICAL STUDY OF  100 CASES OF PROSTATIC NODULES
 
Dr. Sudha Gupta , Dr. Dinesh K. Gupta, Dr. Himanshu Lamba

ABSTRACT:
Objective: This study is planned to evaluate the histological lesions of prostatic specimens and it’s correlation with the clinical data.Materials and Methods: The present study is a prospective study, undertaken in the Department of Pathology, Mahatma Gandhi Medical College, Jaipur, Rajasthan, during the period of July 2010 to May 2012. This study was conducted on 100 prostatic specimens referred to department of pathology. Brief clinical data were noted from the case records, which included the age, presenting symptoms, DRE findings, serum PSA levels and clinical diagnosis. All the prostatic specimens were subjected to H&E, AgNOR staining method. Results: Out of 100 cases studied, commonest pathology encountered was benign lesion constituting 92% and malignant lesions were 08%.Out of 92 cases of benign lesions, 70 cases (63.64%) were diagnosed as nodular hyperplasia without prostatitis, 20 cases(17.69%) were diagnosed as nodular hyperplasia with prostatitis & graulomatous prostatitis and squamous metaplasia in 01 case and clear cell hyperplasia in 01 case. Clinical diagnosis of prostatic carcinoma was made in 08 cases which correlated histologically. Gleason’s score of 7 was seen in 75% of the cases and 6 was seen in 25% cases. Mean AgNOR count in benign and malignant lesions were 1.57±0.13 and 4.8±0.2 respectively. Conclusion: Prostatic carcinoma shows heterogeneity of differentiation, nuclear anaplasia, cytoplasm, functional differentiation and DNA content. There is a need for research on all aspects of this disease. Further refinement of diagnostic techniques and the development of new therapeutic modalities for the treatment of systemic disease.
Keywords: nodular hyperplasia ,graulomatous prostatitis, squamous metaplasia,Adenocarcinoma,

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8. ASSESSING PROFESSIONALISM IN UNDERGRADUATE MEDICAL STUDENTS USING A TEACHING MODULE
 
Deepti Shastri, Sankar Radhakrishnan

ABSTRACT:
Background: The MCI regulations for Graduate Medical Education state that at the end of MBBS program, a medical student should demonstrate professionalism. However, the medical curriculum does not focus on delivery and assessment of professionalism. Hence a study was conducted by introducing a teaching module on professionalism to medical students.  Objectives: At the end of the three months of implementing the teaching module, a medical student should be able to: discuss issues related to professionalism, demonstrate the attributes of professionalism and assess attributes of professionalism in self and peers. Materials and methods: Interactive student lectures and role plays introducing various aspects of professionalism, followed by students’ brainstorming sessions were conducted for 2nd MBBS students (n=50).Self, peer and faculty assessment of professionalism demonstrated by students was obtained by using validated scale anchors. Knowledge of professionalism was tested by written examinations (MCQs: Pre-test/post-test). The teaching module was evaluated by student and faculty perception questionnaires. Results: Self, peer and faculty assessment scores of professionalism showed preferred ratings of 4 on a scale of 1-7. ANOVA analysis for comparing scores of self assessment with peer and faculty assessment indicated no significant difference in ratings (p value > 0.05) by the three methods. Pre-test /Post-test evaluation compared with paired student t-test showed higher post-test scores (p=<0.0001). Perception questionnaires indicated both students and faculty were satisfied with the teaching module. Conclusion: Implementing such a teaching module improves knowledge of professional behavior in medical students. Professionalism can be assessed in medical students by self and peer assessment.
 
Key words: Scale anchors, self assessment, peer assessment, faculty assessment, role play, brainstorming sessions.
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9. CHEMICAL ANALYSIS OF URINARY TRACT CALCULI  BY DUAL SOURCE CT IN ARAVALI HILLY AREA
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Dr. Dwarka Prasad Agarwal , Dr. Kapil Vyas

ABSTRACT:
Objective: To qualitatively analyze the uroliths in vivo using dual source CT by crystallography as the reference standard in Udaipur, an Aravalli Hilly area located in southern region of Rajasthan (India) so as to evaluate the predominant constituent present in them and report its significance. Materials and Methods: The study was conducted in Radiology department of Pacific Medical College & hospital, Udaipur on 25 patients of all age group (4 to 70 years) with clinical suspicion or known/ suspected calculi on X-ray or USG. The 128 slice Somatom definition dual source CT was used to analyse chemical composition of renal, ureteric and vesicle stones. Results: Of the 25 patients studied, 13 were males and 12 females. 22 patients (88%) had oxalate stones, 2(8%) had uric acid stones and 1(4%) had mixed calculus of oxalate and hydroxyapatite. There were total 48 calculi of which 30 were in kidneys (62.5%), 14 in ureters (29.2%) and 4 in urinary bladder (8.3%) of these 25 patients. 12 patients had single calculus and 13 had multiple calculi. The CT density for calcium oxalate stones was around & more than 1000 HU, for uric acid stones around 500 HU to 600 HU and for the mixed stone 876 HU. Conclusion: The study reveals significantly high incidence of calcium oxalate stones in Aravali hilly areas which may be due to altered eating and drinking habits which promoted its formation in these individuals. The MDCT without dual source was accurate in classifying urinary stone composition. Randomized clinical trials should be encouraged for validating this technique on large populations.This may help the health care providers to look through the risk factors for calculi formation in this area which might enable them to plan therapies and prevent recurrence of stone formation.
Key Words: Urolithiasis, dual source CT, chemical composition.

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10. RADIO-PATHOLOGICAL CORRELATION OF LUNG MASSES :A PROSPECTIVE STUDY OF 100 CASES

Dr. Dinesh K. Gupta , Dr. Sudha Gupta , Dr.Swati Kukkar
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ABSTRACT:
Objective: The present study was undertaken to establish the role of CT in comprehensive evaluation of lung masses, especially in our set-up and to study the efficacy and safety of CT guided fine needle aspiration cytology. Materials and Methods: In this study, 45 patients of lung mass of varying ages and both sexes were referred to the Department of Radio-diagnosis, Mahatma Gandhi Medical College, Hospital, Jaipur from various department of this institution, were were further evaluated with CT scan and guided biopsy of lung mass lesions.Results: Based on CT evaluation and guided biopsy of lung mass lesions, there were 38(84.44%) malignant and 7 (15.55%) benign. In the malignant group, majority 17 (37.78%) were squamous cell carcinomas, followed by poorly differentiated carcinoma 10 (22.22%) and small cell carcinomas 6 (13.33%).In the benign group, the majority 4 (8.88%) were tubercular infections. Conclusion: In addition to morphological evaluation, CT provides additional information regarding staging of the disease which increases the specificity and sensitivity of the CT diagnosis. On its own, CT showed high sensitivity (97.36%), specificity (100%) and diagnostic accuracy (97.6%) in evaluation of lung masses in our study. CT guided FNAC is of utmost use in cases where pre-biopsy evaluation and imaging suggests that a high probability of malignancy is present and where facility of on-site cytopathologist is available with high sensitivity, specificity and diagnostic accuracy.
Keywords: CT scan, CT guided FNAC, Lung carcinoma.

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11. PRE AND POST-PRANDIAL CHANGES IN BP IN OBESE AND NON OBESE POPULATION: A COMPARATIVE STUDY AT A TERTIARY CARE HOSPITAL
 
Dr.Rashmi Modwal ,Dr.Kishore Moolrajani

ABSTRACT:
Background: A higher or lower sympathetic tone having higher or lower catecholamine levels along with varied abnormalities in autonomic nervous system associated with obesity which finally leads to change in the function of heart such as arrhythmia along with involvement of other systems, ultimately lead to sudden death. This study planned to find pre and post-prandial changes in BP in obese and non obese persons in the age group of 15 to 45 years. Materials and Methods: 40 obese and 40 non obese patients admitted to our hospital over a period of two months were included in the study. Random selection of patients was made from Department of Medicine, JNU Medical College and Hospital, Jaipur.  Both systolic and diastolic blood pressure was measured in supine position of the right arm using sphygmomanometer 30 minutes before and 30 minutes after meals. Then fall in BP was recorded. BMI of patients was measured to identify grade of obesity. Results: Mean systolic (pre-prandial 126.28, post-prandial 117.9) and diastolic blood pressure (pre-prandial 79.2 and post-prandial 74.6) was found, which was higher in obese than non obese patients. This study was statistically significant (p value <0.05).Conclusion: Fall in BP was significantly higher in obese (14 patients out of 50) as compared to non obese (3 patients out of 40) patients. Reduced cardiac sympathetic tone leads to post-prandial hypotension were significantly associated in obese patients.
Key Words: Systolic BP, Diastolic BP, Post-prandial, Obese, Non-obese.

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12. CORRELATION BETWEEN TRACE METALS (COPPER, ZINC IRON, SELENIUM) LEVELS AND THE SEVERITY OF LIVER CIRRHOSIS
 
Dr. Sunil Gupta,Dr. Harjeet Singh ,Dr. Sunil Kumar Bairwa, Dr. Vijay Laxmi Gupta

ABSTRACT:
Background: Liver cirrhosis is a major cause of death and in India its most common cause is viral hepatitis. The triad of parenchymal necrosis, regeneration and scarring is always present regardless of individual clinical manifestations. Trace elements act protective against oxygen free radicals in the development of liver cirrhosis. Material & Methods: 100 patients of liver cirrhotic diseases of age between 20 to 60 years and fifty healthy controls were taken for this present case control study. Written informed consent by the subjects and ethical approval was appropriately sought before the study. After taking detailed history the blood samples were collected after 12 hours of fasting for the estimation of serum copper, selenium, iron and zinc levels with the help of an Atomic Absorption Spectrophotometer. Results: The study results showed that levels of Zn, albumin in the serum of patients with child-pugh class C were significantly lower than those with child-pugh class A&B. In contrast we did not observe statistically significant difference in the levels of Cu, Fe and Se in three groups. Conclusion: We concluded from the present study that Serum Zinc may consider as associate marker to assess severity of liver cirrhosis.
Key words:  liver cirrhosis, trace elements, Child-Pugh classification.

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