International Journal of Medical Sciences and Education (IJMSE)
Vol. 3; Issue: 4 (Oct-Dec 2016) , Date of Publication: 01.01.2017
1. MEDICAL PROFESSION AS CAREER - PRESSURE OR PASSION: A CROSS SECTIONAL SURVEY AMONG UNDERGRADUATE MEDICAL STUDENTS
N. Asha Rani, Aliya Nusrath, Dhanalakshmi T A
ABSTRACT
Background: To become an eminent doctor one has to work hard, endure lengthier periods of training both at undergraduate and postgraduate level, compromise personal and family time, and dedication for lifelong learning. In spite of these many shortcomings, in India lakhs of students still aspire to pursue medical profession. Hence the present study was designed to assess the probable factors influencing the students to choose medical profession as career. Methods: A questionnaire based survey was carried out among 126 first MBBS students to document motives for choosing medical profession, career aspiration on completion of a medical degree and willingness to serve in rural area immediately after completion of degree. Results: Out of 126 students, 79 (62.7%) were females and 47 (37.3%) were males. Passion (41.26%) was the major motivational factor for choosing medical profession as career. 50% had decided to join medical profession before 10th standard and proportion was more among females (63%). Nearly 80% and 96% students planned to do rural service and post-graduation respectively. Majority of females preferred for Obstetrics and Gynecology and males preferred surgical specialty as their post-graduation subjects. Less than 3% of the participants preferred to do post-graduation in pre-clinical and para-clinical subjects. Conclusion: The present study revealed that the students were early deciders and passion as their major motivational factor and inclined to do rural service. There was a traditional gender based choices in choosing post-graduation specialty among males and females. So educational polices and career counselling seminars should be formulated to guide and encourage them to pursue career fields in medicine which are most needed. Key words: Motivational factor,Medical Students, Passion, Parental pressure, Career choice.
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2. POST TRAUMATIC TRIFID CONDYLE WITH TEMPOROMANDIBULAR JOINT ANKYLOSIS: A CASE REPORT
Dr. Divya Rana, Dr. Harshdeep Dhaliwal
ABSTRACT
Trifid mandible condyle is an exceedingly rare entity with only 8 cases reported to date. The aetiology of the disorder is unknown, though like bifid mandibular condyle, a correlation with prior trauma is usually seen. We present a unique case of a 17-year-old male who presented with restriction of movements at the temporomandibular joint, with a history of trauma 10 years back. Imaging revealed unilateral temporomandibular joint ankylosis with trifid condyle.
KEYWORDS: Temporomandibular joint ankylosis, Trifid condyle.
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3. UTILITY OF ERYTHROCYTE INDICES FOR SCREENING OF β – THALASSEMIA TRAIT IN PREGNANT WOMEN ATTENDING ANTENATAL CLINIC
Dr. Ashok Kumar Sharma, Dr. Sudhir Mehta, Dr. Shrikant Sharma
ABSTRACT
Background: This study was undertaken to see the utility of erythrocyte indices for screening of beta thalassemia trait in pregnant women, as these indices are based on complete blood count reports which are routinely available and nowadays generated by automated hematology analyzer. Material and methods: The study was a cross sectional in which the complete blood count report of 300 pregnant women attending antenatal clinic mahila chikitsalaya,sms medical college, Jaipur with microcytosis (MCV <80fl) was analyzed. Four red blood cell indices namely – Mentzer index, England Fraser index, RBC count & Green king index were calculated for all patients from the complete blood count (CBC) reports. Among these, for those patients who were suspected to have beta thalassemia trait on the basis of the red blood cell indices , Hb A2 estimation by high performance liquid chromatography (HPLC), serum iron, total iron binding capacity (TIBC) & serum ferritin was done. The collected data was analyzed statistically and the sensitivity & specificity of the four red blood cell indices was calculated & compared according to Youdens test. Results: In our study the patients in the beta thalassemia trait group had significantly decreased mean corpuscular volume(MCV), mean corpuscular hemoglobin(MCH)and packed cell volume(PCV) compared to those in non beta thalassemia group. Mentzer index was the best among the four discrimination indices used. Green king index and Mentzer index,when both indices are combined this yield is more informative.Conclusion: Mentzer index is a useful screening test for detection of beta thalassemia trait.
Key words: Beta thalassemia trait, Red blood cell indices, Screening.
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4. PERCEPTIONS OF MEDICAL STUDENTS REGARDING TEACHING-LEARNING METHODS ADOPTED BY FACULTY MEMBERS IN MICROBIOLOGY
Ved Prakash , Prem Prakash Mishra
ABSTRACT
Background: The Medical education has been undergoing dramatic reforms globally. As a result various Teaching-learning (T-L) methods are adopted worldwide. Therefore, reforms in undergraduate teaching are of utmost importance. Objective: To determine the perception of 3rd semester MBBS students regarding prevailing T-L methodology adopted by various faculty members and to get the feedback and suggestions for the reform. Material & Methods: Cross sectional study involving 3rd semester MBBS students conducted in the Department of Microbiology, RMCH after the approval of IEC over a period of 8 months. A pre and post questionnaire (Likert scale) containing 10 questions regarding the teaching methodologies adopted by the faculty members were administered to the students. Feedback and suggestions were recorded and the feedbacks were again taken after implementation of the suggestions in teaching. Further the feedbacks from faculties were also recorded. Microsoft excel, SPSS were used for data analysis. Student’s t test was used and the significance was checked using P value <0.05. Results: About 69% of the students were of the opinion of using A-V aids and other modern techniques. 57% & 52% suggested that there should be more discussion about clinical aspects and recent advances related to the topic respectively. Majority wanted optimal use of class time; clarity in conversations. There was a marked change in the perception of the students after meeting and incorporation of suggestions by faculty. Conclusion: Various lacunae in the T-L methodologies were established. The study revealed the priority areas for improvement. Regular feedbacks and conduction of the Faculty Development Program may help teachers to plan and improve their teaching.
Key words: MBBS, Teaching, faculty, Perception.
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5. ASSESSMENT OF COAGULATION PROFILE OF DENGUE PATIENTS AND ITS RELATION TO EXTRINSIC AND INTRINSIC COAGULATION PATHWAY
Dr. Puneet Sharma, Dr. Abhijit Basu, Dr Saurabh Duggad, Dr MadhuSudhan Singh, Dr. D.C. Kumawat
Abstract
Objective: Assessment of coagulation profile of Dengue patients and its relation to extrinsic and intrinsic coagulation pathway using PT/INR, APTT. Material and methods:In this descriptive-analytic study, 100 patients were involve from Department of medicine for outpatient management. Patients were categorized into dengue fever (DF), dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS) Coagulation profile and liver enzymes were compared in all patients and means were analysed using appropriate statistical tests .Results :Our study shows that dengue infection affects both intrinsic and extrinsic pathway but severity of dengue infection significantly correlates with intrinsic (aPTT) coagulation pathway. Conclusion: In patients with dengue viral infection raised APTT is the best predictor of bleeding and severity of dengue infection. INR and liver transaminases could be used as supportive predictors.
Keywords: Aspiration cytology, Bone marrow Biopsy, Leukemia.
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6. Comparison of Montelukast and ketotifen as add on therapy in moderate and severe persistent bronchial asthma
Dr. Gaurav Chhabra, Dr. Shubhakaran Sharma
Abstract
Background: Asthma is chronic debilitating disease, various treatment modalities including inhaled steroids in combination with other drugs are widely used ,therefore to compare efficacy as well as safety of montelukast / ketotifen as add-on therapy in moderate and severe persistent asthma is done in present study Methods: Asthmatic patients receiving treatment of inhaled steroids and long acting b-agonist ( base line treatment) get add on treatment of montelukast and ketotifen and assessed for PEF, ACT, Improvement in shortness of breath and improvement in nocturnal awakening over period.Results: Combination therapy of ICS, LABA and monelukast is showing better results in patient compliance, improvement in shortness of breath (113%) compared to base line treatment (77%) and combination with Ketotifen (59%). A significant increase in PEF was observed in add on montelukast group (99%) as compared with add on ketotifen (6%) at the end of study. At the end of treatment 80% patients shows better status of control with add on montelukast therapy in comparison with patients on kitotifen (28%).Conclusion. Present study suggest that the addition of montelukast as add-on therapy in moderate persistent asthma is defiantly beneficial in comparison with add on ketotifen therapy.
Keywords: Asthma, Inhaled corticosteroids, Montelukast, Ketotifen, Peak Expiratory Flow
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7. COMPARATIVE ANALYSIS OF ELECTROPHYSIOLOGICAL CHANGES IN NORMAL AND TYPE 2 DIABETIC SUBJECTS
Anshul Sharma, Anupriya A Deshpande, S.V Brid
ABSTRACT
Aim and Objective: Diabetic neuropathy is a common complication of diabetes mellitus. Effective blood glucose control retards changes in nerve conduction velocity in type 2 diabetes. This aim of the study was to analyze the relationship between glycemic control and electro physiologic changes in diabetic patients. Material and Methods: It was a cross-sectional comparative study were 37 diabetes mellitus patients with normal HbA1c levels and 63 diabetes mellitus patients with elevated HbA1c levels were selected, making it a total of 100 diabetes mellitus patients. 50 non-diabetic, healthy subjects were chosen as a control group. The Motor and sensory nerve conduction studies of right median, peroneal and sural nerves were tested in all the diabetic subjects and the healthy controls using RMS EMG EP MARK-II machine manufactured by the RMS recorders and medicare system, Chandigarh. Motor and Sensory Distal latency (DL), Amplitude (Amp) and Conduction Velocity (CV) were measured. Results: The analysis showed that the nerve conduction velocity progressively decreased from the controls to the diabetics with a good glycaemia control, to the diabetics with a poor glycemic control. There is a progressive neuronal involvement in the diabetic process which is accelerated by poor glycemic control. Therefore, nerve conduction studies can be employed for testing and for the early indication of neuropathy in diabetic patients. Conclusion: The estimation of both NCV and the HbA1c levels in diabetics is helpful in identifying the risk category for Diabetic neuropathy, which is one of the main causes for severe morbidity among the diabetes mellitus patients.
Key Words: Nerve Conduction Velocity; HbA1c; Diabetes Mellitus
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8. EFFECT OF FLUORIDE AND REACTIVE OXYGEN SPECIES ON HEALTHY POSTMENOPAUSAL WOMEN
Kumari Minakshi , Sharma Sunil, Pahwa Manjubala, Menka K., Singh Veena, Meena Suresh
ABSTRACT
Objective:-To determine the effects of fluoride level & reactive oxygen species on healthy postmenopausal women. Material & methods:-Seventy five volunteer healthy postmenopausal women from Rohtak city (Haryana) were recruited for the study. Subjects were divided in two groups on the basis of age- Group I (45-49years) and Group II (50-55years). Measurement of the biochemical parameters viz. serum calcium, inorganic phosphorus and alkaline phosphatase, fluoride & total antioxidant capacity was done. Result: - It was observed in present study that the fluorine indirectly stimulated oxidative stress in postmenopausal women. Conclusion:-The results of the present study suggest that fluoride induces oxidative stress in postmenopausal women. Reactive oxygen species derived from fluoride induced oxidative stress appear to stimulate bone resorption.
Key words : Fluorosis, Postmenopausal women, Oxidative stress, Reactive oxygen species
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9. ASSOCIATION OF VITAMIN D DEFICIENCY WITH DEMOGRAPHIC FACTORS AND SOCIO ECONOMIC STATUS OF PARENTS OF INDIAN CHILDREN UNDER 5 YEARS OF AGE
Deepandra Garg, Reshu Gupta, Jitendra Ahuja
ABSTRACT
Background: Except for a few studies, inadequate data exists on the association of hypovitaminosis D in children aged 6 months to 5 years with socioeconomic (household income, number of family members, and parents’ education level) and demographic factors. Looking at the magnitude of problem, the following study was conceptualized. Materials and Methods: The present study was a hospital based cross sectional study conducted on 80 children from 6 months to 5 years of age attending OPD in department of Pediatrics, JLN Medical College and were diagnosed of hypovitaminosis D. Vitamin D was estimated using commercially available kit by chemiluminiscence technique (CLIA). For categorisation of the population into rural or urban, criterion proposed by department of census (2011) Government of India was used. Assessment of SES was done by modified BG Prasad classification (2013).Results: A significantly higher percentage of hypovitaminosis was seen in female child as compared to the male child. The mean vitamin D levels were lower in children with uneducated or poorly educated mothers than in children with low and highly educated mothers. 60% belonged to class II & III socioeconomic status. Among the vitamin D deficient children 57% were from class II+ class III. The deficient and insufficient vitamin D status was found in lesser percentage of children belonging to class IV and V. No significant difference was seen in rural or urban children regarding vitamin D status. Conclusion: Vitamin D deficiency is more prevalent in infants and children (less than 5 yrs of age) of upper socio-economic strata in the Indian population, probably linked to lesser sunlight exposure. In view of this high prevalence of hypovitaminosis D, judicious sun exposure should be encouraged by active outdoor lifestyle in school and home as well as promotion of dietary foods and supplements rich in vitamin D. Further larger studies are needed to evaluate the role of vitamin D supplements as well as the role of sunlight exposure in this group of children.
Key words : hypovitaminosis, supplements, hypophosphatemia. sunlight exposure.
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10. PREVALENCE AND CAUSES OF BLINDNESS AND VISUAL IMPAIRMENT AMONG THE ELDERLY POPULATION IN A RURAL AREA OF RAJASTHAN
Dr. Kausar Vaseem, Dr. Vaseem Naheed Baig, Dr. Madhusudan Swarnkar, Dr. Arvind Kumar Sharma
ABSTRACT
Background: To study the prevalence and the causes of blindness and visual impairment among the elderly population in rural area in Jhalawar district of Rajasthan. Materials and Methods-for estimation of burden of blindness, severe visual impairment and moderate visual impairment, we enrolled elderly patients of age more than 50 years of age and we used Snellen’s chart (presenting and best corrected vision) for diagnosis of visual acuity while Intraocular pressure was measured by schiotz tonometry. Visual impairment were classified into preventable, treatable and no treatment possible. Results-Total number of 1544 person was examined with mean age of 63.2 years. Out of these 51.94% participants were females. Prevalence of blindness was 1.42% while the prevalence of severe visual impairment was 4.98% and that of moderate visual impairment was found to be 12.88% in our study. Cataract was the major cause of blindness (59.09%) and visual impairment (56.52%). Uncorrected refractive errors accounted for 25% of cases of visual impairment and 13.63% of blindness. Conclusion-Cataract and uncorrected refractive errors are the major causes of blindness in our study which are curable.
Key words: Refractive error, Visual impairment, Blindness, Cataract.
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11. THE PREVALENCE AND PATTERN OF DYSLIPIDEMIA AMONG PATIENTS OF TYPE 2 DIABETES MELLITUS
Dr. Alpana goyal, Dr Anurag Dhaker
ABSTRACT
Background: Diabetes mellitus is a leading cause of dyslipidemia, particularly in individuals with poor blood sugar control, which finally precipitate as an important risk factor for developing atherosclerosis and coronary heart disease and other macrovascular complications. Dyslipidemia, especially in individuals with raised blood sugar levels, is an important risk factor for developing micro and macro vascular complications. Material & Methods: Patients who were between 30-80 years of age with type 2 diabetes mellitus randomly selected irrespective of duration of diabetes were enrolled from outdoor department and from ward by simple random sampling. Institutional Ethics Committee Clearance was obtained before start of study and written and informed consent for the procedure was obtained from all the patients. Strict confidentiality was maintained with patient identity and data and not revealed, at any point of time. Results: The magnitude of dyslipidemia in our study was 72%. Out of total 56 males 40 Male patients found to had dyslipidemia, i.e. the prevalence of dyslipidemia in males was 71.4% whereas 32 out of 44 female patients had dyslipidemia i.e. the magnitude of dyslipidemia among female DM patients was 72.7%. However, this difference was statistically non-significant (P value > 0.05). In the present study, out of the total study participants, 16% had well controlled diabetes mellitus (HbA1C less than 7) and 84% patients had poorly controlled diabetes mellitus (HbA1C more than 7). There was a significant association between prevalence of dyslipidemia and glycemic control (p value < 0.05). Dyslipidemia was more common in patients with uncontrolled diabetic status. Conclusion: The present study reported the burden of dyslipidemia in patients with type 2 diabetes mellitus patients and that there was a highly significant association of associated poor glycemic control (HbA1C more than 7) with serum lipid parameters. Hence serum lipid profile must be done annually in all cases with diabetes.
Keywords: Diabetes mellitus, Lipid profile, Dyslipidemia.
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12.GEL CARD AND CONVENTIONAL DIRECT COOMBS TEST IN THE DIAGNOSIS OF AUTOIMMUNE HAEMOLYTIC ANEMIA
Dr. Siddhartha Shanker Sinha
ABSTRACT
Background: The prognosis of autoimmune hemolytic anemia (AIHA) needs concern of hemolysis and demonstration of autoantibodies next to red cells. Most laboratories use the conventional Coomb's test for the demonstration of the autoantibodies. The present study aims to compare the efficacy of Gel card Coomb’s test with conventional Coomb’s test in the diagnosis of AIHA. Material and Methods: The present study was carried at the Department of Pathology and the blood bank in the Integral institute of medical sciences and research, Lucknow, Uttar Pradesh from January 2016 to October 2016. Written informed consent was obtained from all subjects prior to the performance of any study-related procedure. The study was approved by the ethical committee of the institute.MS Excel was used for data entry and descriptive statistics. Result: DCT Positive in 11 cases done by Conventional Methods and DCT Positive in 13 cases done by gel card method. The gel card selected the antibodies in all the cases spotted positive by the conventional test. The sensitivity and specificity of the gel card Direct Coomb's test (DCT) as compared to the conventional method test for DCT was found to be 100% & 95% and 100% & 92% respectively. Conclusion: Reliable and speedy method for detection of autoantibodies, antibodies against RBCs.Considering the high sensitivity, specificity, and simplicity of the method (Gel Method) may be effectively used for diagnosis of AIHA.
Keywords: Auto-Immune hemolytic anemia, Gel Card, Direct Coomb’s test
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13.ACUTE EFFECT OF KAPALBHATI (A YOGIC KRIYA) ON REACTION TIME
Dr. Dheeraj Jeph, Dr. Sanjay Kumar Singhal
ABSTRACT
Background: Reaction time (RT) is an index of the processing ability of central nervous system. It has been reported that Pranayama training produces a significant decrease in visual reaction time (VRT) and auditory reaction time (ART). The present study was done to determine the effect of Kapalbhati Kriya ( In it inhalation is slow and exhalation vigorous) on central neural processing by studying its effect on RT. Methods: 22 healthy Medical college students who were practicing yoga for the past 3 months were included for the present study. VRT and ART were recorded before and after 120 rounds (2 min) of Kapalbhati. Results: Before Kapalbhati, VRT was 244.56±5.87ms and the ART was 198.81±5.85ms. Immediately after performing 120 strokes of Kapalbhati Kriya, VRT and ART decreased to 227.15±5.85ms and 179.57±6.36ms respectively, the decrease being statistically significant (P<0.01). Conclusion: A decrease in reaction time indicates an improved sensory- motor performance and enhanced processing ability of central nervous system. This may be due to greater arousal, faster rate of information processing, improved concentration and/or an ability to ignore extraneous stimuli.
Keywords: Kapalbhati, reaction time, central neural processing
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14.EFFECT OF FOLIC ACID ON SERUM HOMOCYSTEINE LEVELS IN PATIENTS WITH CARDIOVASCULAR DISEASES (CVD)
Dr.Ashok Tukaram Pardeshi
ABSTRACT
Background: Previous studies have demonstrated a reduction of serum homocysteine levels through the supplementation of folic acid. Aims - To evaluate the effect of folic acid (5mg) supplemention for five months on serum homocysteine levels in patients suffering from cardiovascular diseases.Material & Methods- The present prospective was conducted in the Department of Medicine of our tertiary care hospital from April 2015 to Jan 2016. The study recruited 50 patients who were admitted with the chief complaints of chest pain aged > 40 yrs of age as the test group. Study subjects in the test group were administered 5 mg folic acid per day orally for five months in addition to their drug regimen. Venous blood samples were collected after overnight fasting at baseline and after 5 months for the assessment of Serum total homocysteine, serum total glyceride, total cholesterol and high density lipoprotein. Results- The serum levels of homocysteine were significantly higher in the test group than control group at baseline (p<0.005). In the test group, Serum homocysteine levels , TC, TG, LDL, SBP, DBP observed a statistically significant reductions from baseline at 5 months after administration of folic acid (p<0.005). This reduction was observed in all the study subjects whether they were smokers/ non smokers , alcoholics/non alcoholics, suffered from angina or acute MI.Conclusion- An intake of folic acid 5mg/day for three months resulted in significant reduction of homocysteine, blood pressure,low density lipoprotein & total cholesterol.
Keywords – homocysteine, folic acid, cardiovascular diseases, hypertension.
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16.CLINICAL SPECTRUM OF WHEEZING IN PEDIATRIC PATIENTS: A TERTIARY CARE EXPERIENCE
Dr.Satish Kumar Srivastav
ABSTRACT
Background: Globally one in three children experiences at least one episode of wheezing before their third birthday, and the cumulative prevalence of wheeze reaches almost 50% by the age of 6 years. The respiratory sound produced during the passage of air through the larynx, trachea, and bronchi is a result of vibrations caused by air movement. Material & Methods: The present cross sectional, prospective study was carried out at department of pediatrics, at our tertiary care hospital. The study duration was of six months from July 2016 to December 2016. In this prospective study we enrolled 100 children of age group of 2 months to 14 years presented at outpatient department with conditions giving rise to wheezing and enrolled by simple random sampling. Results: Out of the total enrolled children 58% were males and 42% were females. Mean weight of study participants was 16.3 ± 2.4kg. Out of total, 21% were in group of less than 5years, 27% were in the age group of 5-10 years, 52% were in the age group of 10-15 years. On the basis of clinical presentation of children with wheezing it was found that 72% bronchial asthma, 8% children were diagnosed with bronchiolitis, 14% children were diagnosed with worm infestations and 6% children were diagnosed with tropical eosinophilia. There was no mortality reported in present study. Conclusion: We concluded from the present study that, on the basis of clinical presentation of children with wheezing it was found that bronchial asthma, bronchiolitis, worm infestations and tropical eosinophilia were major clinical diagnosis.
Keywords: Wheezing, Asthma, Pediatric patients.
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17.ASSESSMENT OF CLINICAL AND HEMATOLOGIC PROFILE OF CHILDREN WITH MEGALOBLASTIC ANEMIA
Dr.Jaswant Mahawer
ABSTRACT
Background: Megaloblastic anemia is traditionally described as a macrocytic anemia distinguished by a characteristic megaloblastic bone marrow morphology, featuring metamyelocytes and megaloblasts, often accompanied by leukopenia and thrombocytopenia. The spectrum of diseases associated with vitamin B12 deficiency varies widely, ranging from asymptomatic cases to life-threatening conditions like pancytopenia or myelopathy. Material & Methods: The present cross sectional, prospective study was carried out at department of pediatrics, at our tertiary care hospital. The study duration was of six months from July 2015 to December 2015. In this prospective study we enrolled 100 children of age group of 6 months to 18 years presented at outpatient department with a diagnosis of Megaloblastic Anemia and enrolled by simple random sampling. Results: In the present study, out of total enrolled participants, on the basis of clinical presentation it was found that 100% children had pallor, 90% children had Anorexia and generalized weakness, 68% children had Hyperpigmentation and 36% children were diagnosed with Irritability/ tremors/ neurologic involvement. On the basis of hematological parameters it was found that 100% children had Macrocytic anemia ( MCV >100 μg/L), 100% children were diagnosed by VitaminB12 assay and 32% children had Severe Anemia (Hb <6 g/dl). There was no mortality reported in present study. Conclusion: We concluded from the present study that, most frequent presenting symptoms in megaloblastic anemia due to Vitamin B12 deficiency typically include anorexia, generalized weakness, and irritability, clinically manifested as pallor and hyperpigmentation.
Keywords: Macrocytic anemia, VitaminB12 deficiency, Pallor.
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N. Asha Rani, Aliya Nusrath, Dhanalakshmi T A
ABSTRACT
Background: To become an eminent doctor one has to work hard, endure lengthier periods of training both at undergraduate and postgraduate level, compromise personal and family time, and dedication for lifelong learning. In spite of these many shortcomings, in India lakhs of students still aspire to pursue medical profession. Hence the present study was designed to assess the probable factors influencing the students to choose medical profession as career. Methods: A questionnaire based survey was carried out among 126 first MBBS students to document motives for choosing medical profession, career aspiration on completion of a medical degree and willingness to serve in rural area immediately after completion of degree. Results: Out of 126 students, 79 (62.7%) were females and 47 (37.3%) were males. Passion (41.26%) was the major motivational factor for choosing medical profession as career. 50% had decided to join medical profession before 10th standard and proportion was more among females (63%). Nearly 80% and 96% students planned to do rural service and post-graduation respectively. Majority of females preferred for Obstetrics and Gynecology and males preferred surgical specialty as their post-graduation subjects. Less than 3% of the participants preferred to do post-graduation in pre-clinical and para-clinical subjects. Conclusion: The present study revealed that the students were early deciders and passion as their major motivational factor and inclined to do rural service. There was a traditional gender based choices in choosing post-graduation specialty among males and females. So educational polices and career counselling seminars should be formulated to guide and encourage them to pursue career fields in medicine which are most needed. Key words: Motivational factor,Medical Students, Passion, Parental pressure, Career choice.
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2. POST TRAUMATIC TRIFID CONDYLE WITH TEMPOROMANDIBULAR JOINT ANKYLOSIS: A CASE REPORT
Dr. Divya Rana, Dr. Harshdeep Dhaliwal
ABSTRACT
Trifid mandible condyle is an exceedingly rare entity with only 8 cases reported to date. The aetiology of the disorder is unknown, though like bifid mandibular condyle, a correlation with prior trauma is usually seen. We present a unique case of a 17-year-old male who presented with restriction of movements at the temporomandibular joint, with a history of trauma 10 years back. Imaging revealed unilateral temporomandibular joint ankylosis with trifid condyle.
KEYWORDS: Temporomandibular joint ankylosis, Trifid condyle.
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3. UTILITY OF ERYTHROCYTE INDICES FOR SCREENING OF β – THALASSEMIA TRAIT IN PREGNANT WOMEN ATTENDING ANTENATAL CLINIC
Dr. Ashok Kumar Sharma, Dr. Sudhir Mehta, Dr. Shrikant Sharma
ABSTRACT
Background: This study was undertaken to see the utility of erythrocyte indices for screening of beta thalassemia trait in pregnant women, as these indices are based on complete blood count reports which are routinely available and nowadays generated by automated hematology analyzer. Material and methods: The study was a cross sectional in which the complete blood count report of 300 pregnant women attending antenatal clinic mahila chikitsalaya,sms medical college, Jaipur with microcytosis (MCV <80fl) was analyzed. Four red blood cell indices namely – Mentzer index, England Fraser index, RBC count & Green king index were calculated for all patients from the complete blood count (CBC) reports. Among these, for those patients who were suspected to have beta thalassemia trait on the basis of the red blood cell indices , Hb A2 estimation by high performance liquid chromatography (HPLC), serum iron, total iron binding capacity (TIBC) & serum ferritin was done. The collected data was analyzed statistically and the sensitivity & specificity of the four red blood cell indices was calculated & compared according to Youdens test. Results: In our study the patients in the beta thalassemia trait group had significantly decreased mean corpuscular volume(MCV), mean corpuscular hemoglobin(MCH)and packed cell volume(PCV) compared to those in non beta thalassemia group. Mentzer index was the best among the four discrimination indices used. Green king index and Mentzer index,when both indices are combined this yield is more informative.Conclusion: Mentzer index is a useful screening test for detection of beta thalassemia trait.
Key words: Beta thalassemia trait, Red blood cell indices, Screening.
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4. PERCEPTIONS OF MEDICAL STUDENTS REGARDING TEACHING-LEARNING METHODS ADOPTED BY FACULTY MEMBERS IN MICROBIOLOGY
Ved Prakash , Prem Prakash Mishra
ABSTRACT
Background: The Medical education has been undergoing dramatic reforms globally. As a result various Teaching-learning (T-L) methods are adopted worldwide. Therefore, reforms in undergraduate teaching are of utmost importance. Objective: To determine the perception of 3rd semester MBBS students regarding prevailing T-L methodology adopted by various faculty members and to get the feedback and suggestions for the reform. Material & Methods: Cross sectional study involving 3rd semester MBBS students conducted in the Department of Microbiology, RMCH after the approval of IEC over a period of 8 months. A pre and post questionnaire (Likert scale) containing 10 questions regarding the teaching methodologies adopted by the faculty members were administered to the students. Feedback and suggestions were recorded and the feedbacks were again taken after implementation of the suggestions in teaching. Further the feedbacks from faculties were also recorded. Microsoft excel, SPSS were used for data analysis. Student’s t test was used and the significance was checked using P value <0.05. Results: About 69% of the students were of the opinion of using A-V aids and other modern techniques. 57% & 52% suggested that there should be more discussion about clinical aspects and recent advances related to the topic respectively. Majority wanted optimal use of class time; clarity in conversations. There was a marked change in the perception of the students after meeting and incorporation of suggestions by faculty. Conclusion: Various lacunae in the T-L methodologies were established. The study revealed the priority areas for improvement. Regular feedbacks and conduction of the Faculty Development Program may help teachers to plan and improve their teaching.
Key words: MBBS, Teaching, faculty, Perception.
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5. ASSESSMENT OF COAGULATION PROFILE OF DENGUE PATIENTS AND ITS RELATION TO EXTRINSIC AND INTRINSIC COAGULATION PATHWAY
Dr. Puneet Sharma, Dr. Abhijit Basu, Dr Saurabh Duggad, Dr MadhuSudhan Singh, Dr. D.C. Kumawat
Abstract
Objective: Assessment of coagulation profile of Dengue patients and its relation to extrinsic and intrinsic coagulation pathway using PT/INR, APTT. Material and methods:In this descriptive-analytic study, 100 patients were involve from Department of medicine for outpatient management. Patients were categorized into dengue fever (DF), dengue hemorrhagic fever (DHF), dengue shock syndrome (DSS) Coagulation profile and liver enzymes were compared in all patients and means were analysed using appropriate statistical tests .Results :Our study shows that dengue infection affects both intrinsic and extrinsic pathway but severity of dengue infection significantly correlates with intrinsic (aPTT) coagulation pathway. Conclusion: In patients with dengue viral infection raised APTT is the best predictor of bleeding and severity of dengue infection. INR and liver transaminases could be used as supportive predictors.
Keywords: Aspiration cytology, Bone marrow Biopsy, Leukemia.
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6. Comparison of Montelukast and ketotifen as add on therapy in moderate and severe persistent bronchial asthma
Dr. Gaurav Chhabra, Dr. Shubhakaran Sharma
Abstract
Background: Asthma is chronic debilitating disease, various treatment modalities including inhaled steroids in combination with other drugs are widely used ,therefore to compare efficacy as well as safety of montelukast / ketotifen as add-on therapy in moderate and severe persistent asthma is done in present study Methods: Asthmatic patients receiving treatment of inhaled steroids and long acting b-agonist ( base line treatment) get add on treatment of montelukast and ketotifen and assessed for PEF, ACT, Improvement in shortness of breath and improvement in nocturnal awakening over period.Results: Combination therapy of ICS, LABA and monelukast is showing better results in patient compliance, improvement in shortness of breath (113%) compared to base line treatment (77%) and combination with Ketotifen (59%). A significant increase in PEF was observed in add on montelukast group (99%) as compared with add on ketotifen (6%) at the end of study. At the end of treatment 80% patients shows better status of control with add on montelukast therapy in comparison with patients on kitotifen (28%).Conclusion. Present study suggest that the addition of montelukast as add-on therapy in moderate persistent asthma is defiantly beneficial in comparison with add on ketotifen therapy.
Keywords: Asthma, Inhaled corticosteroids, Montelukast, Ketotifen, Peak Expiratory Flow
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7. COMPARATIVE ANALYSIS OF ELECTROPHYSIOLOGICAL CHANGES IN NORMAL AND TYPE 2 DIABETIC SUBJECTS
Anshul Sharma, Anupriya A Deshpande, S.V Brid
ABSTRACT
Aim and Objective: Diabetic neuropathy is a common complication of diabetes mellitus. Effective blood glucose control retards changes in nerve conduction velocity in type 2 diabetes. This aim of the study was to analyze the relationship between glycemic control and electro physiologic changes in diabetic patients. Material and Methods: It was a cross-sectional comparative study were 37 diabetes mellitus patients with normal HbA1c levels and 63 diabetes mellitus patients with elevated HbA1c levels were selected, making it a total of 100 diabetes mellitus patients. 50 non-diabetic, healthy subjects were chosen as a control group. The Motor and sensory nerve conduction studies of right median, peroneal and sural nerves were tested in all the diabetic subjects and the healthy controls using RMS EMG EP MARK-II machine manufactured by the RMS recorders and medicare system, Chandigarh. Motor and Sensory Distal latency (DL), Amplitude (Amp) and Conduction Velocity (CV) were measured. Results: The analysis showed that the nerve conduction velocity progressively decreased from the controls to the diabetics with a good glycaemia control, to the diabetics with a poor glycemic control. There is a progressive neuronal involvement in the diabetic process which is accelerated by poor glycemic control. Therefore, nerve conduction studies can be employed for testing and for the early indication of neuropathy in diabetic patients. Conclusion: The estimation of both NCV and the HbA1c levels in diabetics is helpful in identifying the risk category for Diabetic neuropathy, which is one of the main causes for severe morbidity among the diabetes mellitus patients.
Key Words: Nerve Conduction Velocity; HbA1c; Diabetes Mellitus
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8. EFFECT OF FLUORIDE AND REACTIVE OXYGEN SPECIES ON HEALTHY POSTMENOPAUSAL WOMEN
Kumari Minakshi , Sharma Sunil, Pahwa Manjubala, Menka K., Singh Veena, Meena Suresh
ABSTRACT
Objective:-To determine the effects of fluoride level & reactive oxygen species on healthy postmenopausal women. Material & methods:-Seventy five volunteer healthy postmenopausal women from Rohtak city (Haryana) were recruited for the study. Subjects were divided in two groups on the basis of age- Group I (45-49years) and Group II (50-55years). Measurement of the biochemical parameters viz. serum calcium, inorganic phosphorus and alkaline phosphatase, fluoride & total antioxidant capacity was done. Result: - It was observed in present study that the fluorine indirectly stimulated oxidative stress in postmenopausal women. Conclusion:-The results of the present study suggest that fluoride induces oxidative stress in postmenopausal women. Reactive oxygen species derived from fluoride induced oxidative stress appear to stimulate bone resorption.
Key words : Fluorosis, Postmenopausal women, Oxidative stress, Reactive oxygen species
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9. ASSOCIATION OF VITAMIN D DEFICIENCY WITH DEMOGRAPHIC FACTORS AND SOCIO ECONOMIC STATUS OF PARENTS OF INDIAN CHILDREN UNDER 5 YEARS OF AGE
Deepandra Garg, Reshu Gupta, Jitendra Ahuja
ABSTRACT
Background: Except for a few studies, inadequate data exists on the association of hypovitaminosis D in children aged 6 months to 5 years with socioeconomic (household income, number of family members, and parents’ education level) and demographic factors. Looking at the magnitude of problem, the following study was conceptualized. Materials and Methods: The present study was a hospital based cross sectional study conducted on 80 children from 6 months to 5 years of age attending OPD in department of Pediatrics, JLN Medical College and were diagnosed of hypovitaminosis D. Vitamin D was estimated using commercially available kit by chemiluminiscence technique (CLIA). For categorisation of the population into rural or urban, criterion proposed by department of census (2011) Government of India was used. Assessment of SES was done by modified BG Prasad classification (2013).Results: A significantly higher percentage of hypovitaminosis was seen in female child as compared to the male child. The mean vitamin D levels were lower in children with uneducated or poorly educated mothers than in children with low and highly educated mothers. 60% belonged to class II & III socioeconomic status. Among the vitamin D deficient children 57% were from class II+ class III. The deficient and insufficient vitamin D status was found in lesser percentage of children belonging to class IV and V. No significant difference was seen in rural or urban children regarding vitamin D status. Conclusion: Vitamin D deficiency is more prevalent in infants and children (less than 5 yrs of age) of upper socio-economic strata in the Indian population, probably linked to lesser sunlight exposure. In view of this high prevalence of hypovitaminosis D, judicious sun exposure should be encouraged by active outdoor lifestyle in school and home as well as promotion of dietary foods and supplements rich in vitamin D. Further larger studies are needed to evaluate the role of vitamin D supplements as well as the role of sunlight exposure in this group of children.
Key words : hypovitaminosis, supplements, hypophosphatemia. sunlight exposure.
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10. PREVALENCE AND CAUSES OF BLINDNESS AND VISUAL IMPAIRMENT AMONG THE ELDERLY POPULATION IN A RURAL AREA OF RAJASTHAN
Dr. Kausar Vaseem, Dr. Vaseem Naheed Baig, Dr. Madhusudan Swarnkar, Dr. Arvind Kumar Sharma
ABSTRACT
Background: To study the prevalence and the causes of blindness and visual impairment among the elderly population in rural area in Jhalawar district of Rajasthan. Materials and Methods-for estimation of burden of blindness, severe visual impairment and moderate visual impairment, we enrolled elderly patients of age more than 50 years of age and we used Snellen’s chart (presenting and best corrected vision) for diagnosis of visual acuity while Intraocular pressure was measured by schiotz tonometry. Visual impairment were classified into preventable, treatable and no treatment possible. Results-Total number of 1544 person was examined with mean age of 63.2 years. Out of these 51.94% participants were females. Prevalence of blindness was 1.42% while the prevalence of severe visual impairment was 4.98% and that of moderate visual impairment was found to be 12.88% in our study. Cataract was the major cause of blindness (59.09%) and visual impairment (56.52%). Uncorrected refractive errors accounted for 25% of cases of visual impairment and 13.63% of blindness. Conclusion-Cataract and uncorrected refractive errors are the major causes of blindness in our study which are curable.
Key words: Refractive error, Visual impairment, Blindness, Cataract.
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11. THE PREVALENCE AND PATTERN OF DYSLIPIDEMIA AMONG PATIENTS OF TYPE 2 DIABETES MELLITUS
Dr. Alpana goyal, Dr Anurag Dhaker
ABSTRACT
Background: Diabetes mellitus is a leading cause of dyslipidemia, particularly in individuals with poor blood sugar control, which finally precipitate as an important risk factor for developing atherosclerosis and coronary heart disease and other macrovascular complications. Dyslipidemia, especially in individuals with raised blood sugar levels, is an important risk factor for developing micro and macro vascular complications. Material & Methods: Patients who were between 30-80 years of age with type 2 diabetes mellitus randomly selected irrespective of duration of diabetes were enrolled from outdoor department and from ward by simple random sampling. Institutional Ethics Committee Clearance was obtained before start of study and written and informed consent for the procedure was obtained from all the patients. Strict confidentiality was maintained with patient identity and data and not revealed, at any point of time. Results: The magnitude of dyslipidemia in our study was 72%. Out of total 56 males 40 Male patients found to had dyslipidemia, i.e. the prevalence of dyslipidemia in males was 71.4% whereas 32 out of 44 female patients had dyslipidemia i.e. the magnitude of dyslipidemia among female DM patients was 72.7%. However, this difference was statistically non-significant (P value > 0.05). In the present study, out of the total study participants, 16% had well controlled diabetes mellitus (HbA1C less than 7) and 84% patients had poorly controlled diabetes mellitus (HbA1C more than 7). There was a significant association between prevalence of dyslipidemia and glycemic control (p value < 0.05). Dyslipidemia was more common in patients with uncontrolled diabetic status. Conclusion: The present study reported the burden of dyslipidemia in patients with type 2 diabetes mellitus patients and that there was a highly significant association of associated poor glycemic control (HbA1C more than 7) with serum lipid parameters. Hence serum lipid profile must be done annually in all cases with diabetes.
Keywords: Diabetes mellitus, Lipid profile, Dyslipidemia.
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12.GEL CARD AND CONVENTIONAL DIRECT COOMBS TEST IN THE DIAGNOSIS OF AUTOIMMUNE HAEMOLYTIC ANEMIA
Dr. Siddhartha Shanker Sinha
ABSTRACT
Background: The prognosis of autoimmune hemolytic anemia (AIHA) needs concern of hemolysis and demonstration of autoantibodies next to red cells. Most laboratories use the conventional Coomb's test for the demonstration of the autoantibodies. The present study aims to compare the efficacy of Gel card Coomb’s test with conventional Coomb’s test in the diagnosis of AIHA. Material and Methods: The present study was carried at the Department of Pathology and the blood bank in the Integral institute of medical sciences and research, Lucknow, Uttar Pradesh from January 2016 to October 2016. Written informed consent was obtained from all subjects prior to the performance of any study-related procedure. The study was approved by the ethical committee of the institute.MS Excel was used for data entry and descriptive statistics. Result: DCT Positive in 11 cases done by Conventional Methods and DCT Positive in 13 cases done by gel card method. The gel card selected the antibodies in all the cases spotted positive by the conventional test. The sensitivity and specificity of the gel card Direct Coomb's test (DCT) as compared to the conventional method test for DCT was found to be 100% & 95% and 100% & 92% respectively. Conclusion: Reliable and speedy method for detection of autoantibodies, antibodies against RBCs.Considering the high sensitivity, specificity, and simplicity of the method (Gel Method) may be effectively used for diagnosis of AIHA.
Keywords: Auto-Immune hemolytic anemia, Gel Card, Direct Coomb’s test
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13.ACUTE EFFECT OF KAPALBHATI (A YOGIC KRIYA) ON REACTION TIME
Dr. Dheeraj Jeph, Dr. Sanjay Kumar Singhal
ABSTRACT
Background: Reaction time (RT) is an index of the processing ability of central nervous system. It has been reported that Pranayama training produces a significant decrease in visual reaction time (VRT) and auditory reaction time (ART). The present study was done to determine the effect of Kapalbhati Kriya ( In it inhalation is slow and exhalation vigorous) on central neural processing by studying its effect on RT. Methods: 22 healthy Medical college students who were practicing yoga for the past 3 months were included for the present study. VRT and ART were recorded before and after 120 rounds (2 min) of Kapalbhati. Results: Before Kapalbhati, VRT was 244.56±5.87ms and the ART was 198.81±5.85ms. Immediately after performing 120 strokes of Kapalbhati Kriya, VRT and ART decreased to 227.15±5.85ms and 179.57±6.36ms respectively, the decrease being statistically significant (P<0.01). Conclusion: A decrease in reaction time indicates an improved sensory- motor performance and enhanced processing ability of central nervous system. This may be due to greater arousal, faster rate of information processing, improved concentration and/or an ability to ignore extraneous stimuli.
Keywords: Kapalbhati, reaction time, central neural processing
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14.EFFECT OF FOLIC ACID ON SERUM HOMOCYSTEINE LEVELS IN PATIENTS WITH CARDIOVASCULAR DISEASES (CVD)
Dr.Ashok Tukaram Pardeshi
ABSTRACT
Background: Previous studies have demonstrated a reduction of serum homocysteine levels through the supplementation of folic acid. Aims - To evaluate the effect of folic acid (5mg) supplemention for five months on serum homocysteine levels in patients suffering from cardiovascular diseases.Material & Methods- The present prospective was conducted in the Department of Medicine of our tertiary care hospital from April 2015 to Jan 2016. The study recruited 50 patients who were admitted with the chief complaints of chest pain aged > 40 yrs of age as the test group. Study subjects in the test group were administered 5 mg folic acid per day orally for five months in addition to their drug regimen. Venous blood samples were collected after overnight fasting at baseline and after 5 months for the assessment of Serum total homocysteine, serum total glyceride, total cholesterol and high density lipoprotein. Results- The serum levels of homocysteine were significantly higher in the test group than control group at baseline (p<0.005). In the test group, Serum homocysteine levels , TC, TG, LDL, SBP, DBP observed a statistically significant reductions from baseline at 5 months after administration of folic acid (p<0.005). This reduction was observed in all the study subjects whether they were smokers/ non smokers , alcoholics/non alcoholics, suffered from angina or acute MI.Conclusion- An intake of folic acid 5mg/day for three months resulted in significant reduction of homocysteine, blood pressure,low density lipoprotein & total cholesterol.
Keywords – homocysteine, folic acid, cardiovascular diseases, hypertension.
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16.CLINICAL SPECTRUM OF WHEEZING IN PEDIATRIC PATIENTS: A TERTIARY CARE EXPERIENCE
Dr.Satish Kumar Srivastav
ABSTRACT
Background: Globally one in three children experiences at least one episode of wheezing before their third birthday, and the cumulative prevalence of wheeze reaches almost 50% by the age of 6 years. The respiratory sound produced during the passage of air through the larynx, trachea, and bronchi is a result of vibrations caused by air movement. Material & Methods: The present cross sectional, prospective study was carried out at department of pediatrics, at our tertiary care hospital. The study duration was of six months from July 2016 to December 2016. In this prospective study we enrolled 100 children of age group of 2 months to 14 years presented at outpatient department with conditions giving rise to wheezing and enrolled by simple random sampling. Results: Out of the total enrolled children 58% were males and 42% were females. Mean weight of study participants was 16.3 ± 2.4kg. Out of total, 21% were in group of less than 5years, 27% were in the age group of 5-10 years, 52% were in the age group of 10-15 years. On the basis of clinical presentation of children with wheezing it was found that 72% bronchial asthma, 8% children were diagnosed with bronchiolitis, 14% children were diagnosed with worm infestations and 6% children were diagnosed with tropical eosinophilia. There was no mortality reported in present study. Conclusion: We concluded from the present study that, on the basis of clinical presentation of children with wheezing it was found that bronchial asthma, bronchiolitis, worm infestations and tropical eosinophilia were major clinical diagnosis.
Keywords: Wheezing, Asthma, Pediatric patients.
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17.ASSESSMENT OF CLINICAL AND HEMATOLOGIC PROFILE OF CHILDREN WITH MEGALOBLASTIC ANEMIA
Dr.Jaswant Mahawer
ABSTRACT
Background: Megaloblastic anemia is traditionally described as a macrocytic anemia distinguished by a characteristic megaloblastic bone marrow morphology, featuring metamyelocytes and megaloblasts, often accompanied by leukopenia and thrombocytopenia. The spectrum of diseases associated with vitamin B12 deficiency varies widely, ranging from asymptomatic cases to life-threatening conditions like pancytopenia or myelopathy. Material & Methods: The present cross sectional, prospective study was carried out at department of pediatrics, at our tertiary care hospital. The study duration was of six months from July 2015 to December 2015. In this prospective study we enrolled 100 children of age group of 6 months to 18 years presented at outpatient department with a diagnosis of Megaloblastic Anemia and enrolled by simple random sampling. Results: In the present study, out of total enrolled participants, on the basis of clinical presentation it was found that 100% children had pallor, 90% children had Anorexia and generalized weakness, 68% children had Hyperpigmentation and 36% children were diagnosed with Irritability/ tremors/ neurologic involvement. On the basis of hematological parameters it was found that 100% children had Macrocytic anemia ( MCV >100 μg/L), 100% children were diagnosed by VitaminB12 assay and 32% children had Severe Anemia (Hb <6 g/dl). There was no mortality reported in present study. Conclusion: We concluded from the present study that, most frequent presenting symptoms in megaloblastic anemia due to Vitamin B12 deficiency typically include anorexia, generalized weakness, and irritability, clinically manifested as pallor and hyperpigmentation.
Keywords: Macrocytic anemia, VitaminB12 deficiency, Pallor.
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