International Journal of Medical Sciences and Education (IJMSE)
Vol. 4; Issue: 4 (Oct-December 2017) , Date of Publication: 01.01.2018
Table of Contents :
1. MAGNETIC RESONANCE CHOLANGIO-PANCREATOGRAPHY IN DIAGNOSIS OF BILIARY DISORDERS
Dr.Paresh Kumar Sukhani, Dr.Sayunkta Gupta, Dr. Suman Chaudhary
ABSTRACT
Background: Accurate diagnostic methods to detect biliary tract disorders and pancreatic disease in patients presenting with obstructive jaundice are critical for operating surgeon to carry out appropriate treatment. Therefore, surgeons elect the non-invasive, highly sensitive as well as safe diagnostic modality in diagnosing biliary tract disorder as the operative approach varies highly depending on the course and cause of obstruction. Material & Methods: In present cross-sectional study 100 patients of different age groups, having clinical sign and symptoms of biliary tract disease were included in the study after obtaining approval from the institutional ethics committee. Patients with cardiac pacemakers, prosthetic heart valves and cochlear implant or having any metallic implant were excluded from the study. Results: 46 patients (46%) fallowed by choledochal cyst (congenital) in 28 patients (28%) and gall bladder masses in 7 patients (7%). In present study, patients of biliary tract pathology especially masses, stricture and lesion in lower part of common bile duct were more effectively evaluated by MRCP. In patient diagnosed with Klatskin tumour, in which hepatic ducts were better depicted by MRCP than ERCP, histo-pathological reports along with post-operative pathologic reports findings were compared and found out 98% accuracy of MRCP in diagnosing the diseases. Conclusion: We concluded that, MRCP has high diagnostic accuracy in biliary tract disorders as well as evaluation of wall of duct, ductal lumen and surrounding soft tissue structures. MRCP has benefit of non-invasive nature and non-operator dependent and free of complications
Keywords: Magnetic resonance cholangiopancreatography; Biliary ducts; Gallstone; Cholangiocarcinoma; Cholangitis.
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2. CONSTRUCTION AND EVALUATION OF A SCRIPT CONCORDANCE TEST FOR INTERNAL MEDICINE
RESIDENTS
Moeen-uz-Zafar, Homaidan T. Alhomaidan
ABSTRACT
Background: Recently there has been a trend of using a new method of evaluation for the medical students and junior doctors. This is called ‘Script concordance test’ (SCT). It helps to check the concepts and decision making power of a physician. Materials and Methods: A cross-sectional study, conducted from December 2014 till April 2015. We constructed 5 scenarios in the field of Internal Medicine according to current guidelines for script concordance test. The questions were from the specialties of nephrology; pulmonology; gastroenterology; neurology and cardiology. Each scenario was followed by three questions, hence there were 15 questions. A total of 26 Internal Medicine residents and registrars were tested with these questions. A Performa was provided to the residents at the end of the test to evaluate the testing strategy and give their opinion. Results: The number of examinees was 26 with 16 residents and 10 registrars. All of them answered the 15 questions. The mean score for specialists and consultants was 77.7±14.2 and for the examinees it was 50.4±15.1 (p < 0.05). The Cronbach’s alpha for the test was 0.62. Item analysis showed 2 fair and 13 good items. A large proportion i.e. 76.9% (20/26) of the examinees did not know about the existence of the SCT. Those who were satisfied with the format of the test were 57.7% (15/26), whereas 53.8% (14/26) did not understand the instructional value of the SCT. Conclusions: Script concordance test is a useful tool for the evaluation of internal medicine residents though not easy to construct.
KEYWORDS: Internal medicine, residents, script concordance test
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3. SIMMAN 3G – HIGH FIDELITY SIMULATION: A METHOD TO FACILITATE PHARMACOLOGY LEARNING
BY MBBS STUDENTS
Dr. K. Bhuvaneswari, Dr. C. Deena Sangeetha
ABSTRACT
Introduction: Many students in the II MBBS curriculum find difficult to learn Pharmacology. II MBBS students do not have many opportunities to observe the clinical effects of the drugs as they read about, making learning experience largely theoretical. To improve the learning experience and to facilitate recall by providing an opportunity to observe the clinical effects of drugs using simulation a practical way of teaching method in Pharmacology would improve student understanding of the role of drugs in a given clinical scenario and it would improve their prescription writing skills. Methods: 29 II MBBS students attended a lecture class on drugs used in bronchial asthma and underwent a pre-test, followed by demonstration of management of acute exacerbation of bronchial asthma in a simulation model, in smaller groups. Later, their individual management of the simulated patient was assessed by observation & they were asked to write a prescription for maintenance therapy for their patient. A post-test was conducted one month later. Results: All students improved their post-test scores, and this was especially marked in those who had scored less than 50% in their pre-test. 70% of students were able to revert bronchospasm within 15 minutes and all students wrote a correct prescription for maintenance therapy. Conclusions: Thus, simulation mode of teaching improved the learning skill and outcome, with an added advantage of knowing to interpret clinical data to select the appropriate drugs to solve the clinical problem.
KEYWORDS: Bronchial asthma, II MBBS learning, novel pharmacology practical method, novel teaching method.
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4. SCOPE OF EARLY FORMATIVE ASSESSMENT IN PROMOTING ACADEMIC SUCCESS IN MEDICAL
STUDENTS
P M Atapattu, A D A Fernando, S Wasalathanthri
ABSTRACT
Background: Formative assessment has an important role in higher education. This study aimed at evaluating multiple aspects of early formative assessment to determine its scope in promoting academic success in first-year medical students. Methods: A formative assessment with a physiology structured essay question was conducted for all first-year medical students at University of Colombo, Sri Lanka. The model answer and marking scheme were discussed and students self-marked their answers. The answer scripts were also marked by tutors and returned with feedback. Student and tutors marks were compared and correlated with physiology summative assessment marks using t-test, Pearson’s correlation coefficient and Chi-square test. Results: Of 204 students 163 participated, but only 117 (57%) were used for analysis. The mean +/- standard deviation of student self-marks and tutor-marks were 24.53+/-20.66 and 34.53+/-22.35 respectively. The mean tutor-mark was significantly higher than (p<0.0001) and showed significant positive correlation with (r=0.801, p<0.01) the mean student self-mark. The student self-marks and tutor-marks had significant positive correlation (p<0.01) with marks of all first-year physiology summative assessments and their written components. In all summative assessments, the percentage of students who obtained >50% marks was greater in study participants than non-participants. Participants, compared to non-participants had a significantly higher (p<0.01) pass rate at all physiology summative assessments and multiple choice question component. Conclusions: The academic performance in physiology throughout first year positively correlated with performance at an early formative assessment and was significantly better in study participants than in non-participants. Students’ had good self-assessment accuracy at the formative assessment.
Key Words: formative assessment, summative assessment, medical undergraduate, academic performance, basic sciences
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5. NEAR-PEER TEACHING OF ANATOMY IN LOW PERFORMERS – AN ENHANCING LEARNING EXPERIENCE
K Suba Ananthi, N Isai Vani, S Aruna
ABSTRACT
Background: Near-peer teaching involves senior students tutoring juniors and is now widely incorporated into medical and dental curriculum. The objective of the study was to assess the effectiveness of near- peer teaching in low performers in Anatomy and also to evaluate the near-peer teacher perceptions towards this programme in their learning process. Materials and Methods: Semester 6 students who pursue Otolaryngology, Ophthalmology and Community Medicine were taken as near-peer teachers. Those students who have not passed the previous Anatomy university examination and students of semester 2 who scored less than 35% in Anatomy internal assessment conducted in the period of August 2014 to March 2015 were considered as low performers in Anatomy. 15 near-peer teachers and 10 tutees took part in the study. Effectiveness of near-peer teaching was assessed through the post-test and feedback from low performers about the near-peer teaching. Perception towards this programme in their learning was assessed through a feedback from near- peer teachers. Results: Analysis of average pre and post-test scores revealed a mean of 2.1±0.99 and 8.2±0.63 respectively and the difference between the scores was found to be statistically significant using paired t test with the p value ˂ 0.0001. Conclusion: Performance of the low performers improved after the near-peer teaching. Near-peer teachers understand the learning difficulties faced by the low performers and the students communicate more effectively with the tutors.
KEYWORDS: Anatomy, low performers, near-peer teachers, feedback.
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6. ROLE OF pLDH ANTIGEN AS NON MICROSCOPIC IMMUNOLOGICAL MARKER IN DIAGNOSIS OF
MALARIAL PARASITE
Dr. Manisha Baraiya, Dr. Gulshan Mukhiya, Dr Geeta Mukhiya
ABSTRACT
Background: Malaria is a serious condition and prognosis depends on timely diagnosis. Although microscopy remains the cornerstone of diagnosis, plasmodium LDH antigen detection test are increasingly used. They are easy to use, provide results rapidly and require no specific training and equipment. Reported sensitivities vary but are generally good for Plasmodium falciparum. Methods: - total 100 cases were taken. Thick and thin smear are prepared using 10% guess stain and examined under microscope. Malaria test done by pLDH dipstick method based on immune-chromatography. Results: - comparing pLDH antigen detection test with microscopy the sensitivity is 85.42% and specificity is 100%. Specificity for P. falciparum is 58% and for P. vivax is 22%. Conclusion: - These tests have several limitations, including cross-reactions of P. falciparum with the non-falciparum test line and vice versa and (rare) false-positive reactions due to other infectious agents or immunological factors. In the diagnostic laboratory, dipstick methods are a valuable adjunct to (but not a replacement for) microscopy for the diagnosis of malaria.
Keyword: pLDH antigen, immunochromatography, malaria.
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7. COMPARATIVE STUDY OF LAPAROSCOPIC VARICOCELE LIGATION VERSUS INGUINAL
VARICOCELECTOMY
Dr Vineet Choudhary, Dr Ravi Kumar Mathur , Dr Bhuvnesh Kumar Sharma
ABSTRACT
Background: The research for ideal technique for varicocele correction would have preferably less complication rates and low recurrences. In recent studies laparoscopic varicocelectomy (LV) has been preferred and has gained vast acceptance among surgeons. Both laparoscopic varicocelectomy and inguinal varicocelectomy (varicocele ligation) have shown to be better outcome in many studies. Material & Methods: The present study was a randomized clinical study which includes Fifty patients with idiopathic symptomatic varicocele of grades I–III diagnosed by clinical examination and Doppler ultrasonography were randomly assigned to Laparoscopic varicocelectomy or inguinal varicocelectomy (25 patients in each group). Results: LV was associated with shorter operative time, shorter hospital stay and cosmetically better compared to IV. The overall incidence of postoperative complications including hydrocele, epididymitis and local pain was significantly higher among patients undergoing IV compared with LV (17.5% vs 5%). The incidence of persistent varicoceles was not significantly different between the 2 groups, but the varicocele recurrence rate was significantly lower in the LV compared to the IV group (5% vs. 17.5%, p ≤ 0.02). Conclusion: Laparoscopic varicocelectomy is a less invasive treatment than Inguinal varicocelectomy for managing male varicoceles. It is also associated with short hospital stay and better outcomes.
Key words: varicocele, laparoscopic varicocelectomy, inguinal varicocelectomy.
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8. THE EFFECT OF DEPRESSION AND ANXIETY ON THE PERFORMANCE STATUS OF CONGESTIVE
HEART FAILURE PATIENTS
Dr Ashok Goyal , Dr. Fiza Hasny
ABSTRACT
Individuals who are diagnosed with congested heart failure (CHF) undergo major changes in lifestyle. The present cross-sectional study was conducted to identify the relationship between CHF patients and their performance status, and how it is influenced by the presence of the level of depression and anxiety. 84 eligible participants were enrolled in the study between June 2005 and March 2006 at the Department of Cardiology, Mahatma Ghandi Medical College & Hopital, Jaipur. The patients were screened using the General Health Questionnaire to screen for co-morbid psychiatric conditions. The patients were assessed for depression and anxiety, and their performance status using 17-item Hamilton Depression Rating Scale, Montgomery-Asberg Depression Rating Scale, Hamilton Anxiety Rating Scale and Short-Form Health Survey (SF-36) for the health-related quality-of-life measurements. The study findings indicate that there is a positive correlation between anxiety and depression in CHF patients. The findings also indicated that depression and anxiety are positively correlated with the performance status of CHF patients. The duration of CHF correlated with the performance status of CHF patients. It can be concluded that anxiety and depression are prevalent among CHF patients and that they interfere with the performance status; additionally, duration on CHF also interferes with performance status. Addressing depression and anxiety can help in enhancing the patient’s performance status.
Key word: CHF, depression and anxiety, performance status in CHF
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9. COMPARISON OF METHODS OF SCREENING OF CERVICAL CANCER IN UDAIPUR DISTRICT.
Dr. Abha Gupta
ABSTRACT
Background: Cervical cancer is the commonest cancer cause of death among women in developing countries. Two commonly used methods of screening of cervical cancer are cervical cytology (pap smear), and visual inspection using acetic acid (VIA). The following study was done with the objective of comparing the outcome of Pap smear, and to simultaneously screen the women of Udaipur district for cancer cervix. Methods: The community based study was carried out in the village of Badgaon (near Udaipur), between November 2015 to November 2016, by the Department of Obstetrics and Gynaecology of Anantha Institute of Medical Sciences. Women that were screened positive by either cytology or VIA were followed up by cervical biopsy. Results: Out of 400 women, 46 tested positive on VIA (11.5%) and 35 tested positive on Pap smear (8.75%). The prevalence of cervical cancer in the study population was found to be 7%. The no. of False positive cases for VIA was 21 and that for Pap smear cytology was 17. Conclusion: VIA is a more sensitive test as compared to Pap smear for screening of cervical cancer, although it comes with more false positives and only 11% of biopsy proven cases of Cancer cervix are asymptomatic, and majority had the complain of abnormal discharge per vaginum.
Key Words: Pap smear, VIA, Cancer Cervix.
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10. SEX DETERMINATION OF HUMAN HIP BONES BY DISCRIMINANT FUNCTION ANALYSIS BY USING
TOTAL PELVIC HEIGHT AND ACETABULAR HEIGHT
Dr. Mohammad Sharique, Dr. Tejendra Singh, Dr. Jaskaran Singh
ABSTRACT
Background: Methods of sex determination of an individual based upon skeleton can classified into three main categories visual criteria, measurements or objective techniques and discriminant function analysis. The methods of sex determination of skeletons are not accurate and constant efforts are being timely to improve them. Hence, we conduct the present study for sex determination of human hip bones by discriminant function analysis. Material & Methods: The present study was been conducted in the department of Anatomy, S.P. Medical College, Bikaner and Other Medical Colleges of Rajasthan. 200 dry adult human hip bones presenting with no deformity or fracture were selected for the study. Total pelvic height and Acetabular height (diameter) were measured and defined. Our study index was defined as = Total pelvic height / acetabular height (diameter) and used for sex determination and discriminant function analysis. Results: Mean differences of acetabular height was highly significant between definite male and definite female with P-value is <0.001. Total pelvic height and our study index were also shows significant difference P –values of 0.0417 and 0.005 respectively. Between definite male and probable female, mean differences of total Pelvic height, acetabular height and study index were non-significant. Total Pelvic height, acetabular height and study index were also showed non-significant difference between definite male and probable male also same results with definite male and don't know. Between probable male and definite female, Acetabular height. (P=<0.0012) and our study index (P- 0.001) were highly significant. Between definite female and don't know, mean differences of acetabular height (P=< 0.0030) and our study index (P=0.0057) were highly significant. Conclusion: We concluded from the present study that the single best variable found by discriminant function analysis in our study is Acetabular height. But still there was considerable overlapping in the range. Along with it total pelvic height was also good discriminators of sex. We found our study index (total pelvic height/acetabular height) to be non-significant for sexing. Therefore, it should not be use for sexual differentiation.
Key words: Total pelvic height,Acetabular height, discriminant function analysis.
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11. THE ASSOCIATION OF PLASMA HOMOCYSTEINE LEVELS WITH DURATION AND HBA1c LEVELS IN
TYPE 1 DIABETES MELLITUS
Dr. Prahlad Dhakar, Dr. Govind Sharan Sharma, Dr.Sudhir Bhandari
ABSTRACT
Background: Type 1 diabetes (previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. The cause of type 1 diabetes is not known and it is not preventable with current knowledge. Material & Methods: The present hospital based Case-Control study was conducted in our tertiary care hospital, in the department of general medicine. Total 62 diagnosed cases of type 1 diabetes mellitus were randomly selected as cases and controls based on complications for the study after obtaining ethical clearance and informed written consent from the study subjects. Results: In cases, mean plasma homocysteine levels were higher as compared to controls (14.27±4.99 vs.10.21±3.07). This difference was statistically highly significant (P-value <0.01). Cases had a positive correlation with duration of diabetes and plasma homocysteine levels (r-value + o.447, P-value <0.05). There was also a positive correlation between plasma HbA1C and plasma homocysteine in case group (r +0.604, P < 0.01). Conclusion: Plasma homocysteine levels were higher in type 1 diabetes patients with vascular complications compared to patients without these complications. Plasma homocysteine level has a positive correlation with duration of disease and HbA1c levels.
KEY WORDS: Plasma homocysteine, Type 1 diabetes, vascular complications.
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12. ANALYSIS OF CLINICAL PROFILE OF DENGUE FEVER IN CHILDREN
Dr. Ashok Kumar, Dr. Govardhan Meena, Dr.Madan Singh, Dr. Indra Rathore, Dr. Girdhari Singh
ABSTRACT
Background: The main objective of the present study is to assess the clinical profile of dengue fever among children. Material & Methods: The present study was an observational cross-sectional study. A total of four hundred children of the age group of 0 to 18 years were included in the study after undertaking written informed consent. Study participants admitted with signs and symptoms of dengue fever based on WHO criteria and also NS1 antigen and IgM dengue antibody positive patients by ELISA technique. Results: Majority of study participants were in the age group of 10 - 18 years 159 (39.75%) and males were more common 213 (53.25%). Fever was seen in 362 patients (90.5%) followed by myalgia in 354 (88.5%), retro-orbital pain in 338 (84.5%), vomiting 336 (84%) and the least common symptoms presented were convulsions 3 (0.8%) and altered sensorium in 4 subjects (1%). Skin rash 262 (65.5%) and followed by ascites 126 (31.5%) and hepatic dysfunction in 124 (31%) patients. Conclusion: The common presenting symptoms were fever, myalgia, headache, retro-orbital pain, vomiting and decreased appetite. The commonest signs present were skin rash and ascites and hepatomegaly. The most common complication presented was hepatic dysfunction.
Keywords: Dengue fever, Clinical profile, Complications.
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13. ESTIMATION OF SERUM GAMMA GLUTAMYL TRANSFERASE IN CORONARY ARTERY DISEASE
PATIENTS AND ITS CAUSAL RELATIONSHIP
Dr. Kamlesh Kumar Sharma, Dr. Vandana Sharma, Dr. Aradhana Singh
ABSTRACT
Background: Coronary Artery Disease(CAD) is the emerging cause of death all over the world causing mortality; hence it is one of the most researched pathologies (2). An early diagnosis of the atherosclerotic condition is very important as many serious consequences may be prevented. Individuals may be attributable to high risk due to their genetic predisposition; hypertension; diabetes etc. Serum Gamma Glutamyl Transferase (GGT) and development of Coronary Artery Disease (CAD) has been investigated for long. Method: The study is aimed to find out the significance of raised serum GGT in patients with CAD. In this study, we included 40 CAD patients as a test group and an equal number of controls based on exclusion and inclusion criteria. All individual subjects were assessed for biochemical and anthropometric parameters. All tests were performed using IFCC approved methods. Results: The present study showed a significant increase in levels of serum GGT in the test group (146.35±84.59) as compared to control group (48.93±39.51) with a significance of more than 0.001. Other atherogenic factors as total cholesterol (p<0.005) and LDL-C (p<0.00) vary significantly with higher GGT value quartiles. HDL-C (p<0.001) also dipped significantly in higher quartiles of serum GGT. Conclusion: serum GGT levels were significantly associated with the development of CAD and can serve as a viable marker of CAD along with total cholesterol, LDL-C, HDL-C.
Keywords: Serum GGT, Coronary Artery Disease, Total Cholesterol, LDL-C, HDL-C
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14. STUDY OF RECURRENCE IN DOTS CURED AND COMPLETED TREATMENT PATIENTS UNDER RNTCP
Dr. Ashok Kumar Mehrotra, Dr. Shashi Prakesh Agnihotri
ABSTRACT
Background: Recurrences potentially contribute to the spread of new tuberculosis infection in the community. Early identification and treatment of recurrences can effectively break the chain of transmission and reduce the incidence of new infection and disease. The study was done to find out methods for the early detection of recurrence, and the pattern of recurrence, in DOTS (Directly Observed Treatment Short course) cured and completed treatment patients.” Methods: This was a retrospective observational cohort study, approved by the Hospital Ethic Committee. It was done on the DOTS declared, cured and treatment completed patients, 1-5 years earlier, under Revised National Tuberculosis Control Program (RNTCP) at Jaipur Urban district. Result: 16.45% successfully completed DOTS treated patients were found symptomatic. About half of them were diagnosed as recurrence. Significantly more symptomatic and recurrences were observed, in new sputum smear-positive (NSP) patients. Recurrences markedly reduce after the first 12 months of completion of DOTS treatment. Conclusion: Monthly follow up of DOTS cured and completed treatment NSP patients for 12 months is suggested. The RNTCP Technical and Operational Guidelines-2016, now advocates a regular follow-up of all cured and successful treatment cases every 6 months, for up to 2 years. Monthly follow-up may be more rewarding than delaying first follow up for 6 months. The RNTCP Guidelines-2016 needs to be reviewed in the light of available evidences.
Keywords: Retreatment, Recurrence, Relapse, follow- up, RNTCP, DOTS
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15. RADIOLOGICAL EVALUATION OF CALLUS FORMATION IN LONG BONE FRACTURES OF LOWER LIMB
TREATED BY VARIOUS METHODS
Dr. Anurag Dhaker, Dr. Shesakanta Rout , Dr. Alpana goyal, Dr. Mahesh Bansal, Dr. Pankaj Jain
ABSTRACT
Background: Fracture healing is different from other tissue healing by the absence of a scar at the healing end. The fracture can heal by primary healing or secondary healing depending on the type of treatment offered. Callus formation is an integral part of secondary fracture healing. Material and methods: We Compared the callus tissue formation during healing of tibial diaphyseal fracture treated by the conservative method and intramedullary nailing (IMN). C T Scan is used to take a serial measurement of callus index at fixed intervals and compared between the two groups. Results: The onset of callus formation is early in case of conservatives treatment as compared to intramedullary nailing is the most striking feature. Whereas maximum callus formation at 6 months is more in case of intramedullary nailing when compared to conservative groups. Conclusion : The appearance of the callus tissue is influenced by intramedullary nailing but growth of callus has more rapid accent in case of IMN group compared to POP group which persisted up to 6 months and at the end of 6 month maximum callus reached was more in Nailing cases. Though number of complication is more in this method of treatment.
Keywords : secondary fracture healing, intramedullary nailing (IMN), periosteum.
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16. STUDY OF LIPID PROFILE IN CORD BLOOD OF FULL TERM NEONATES OF NORMAL LABOUR
Dr Sunita Mahla, Dr Rati Mathur, Dr Oby Nagar
ABSTRACT
Background: Neonates of mothers having a family history of hypertension & coronary heart disease have a high risk of developing atherosclerosis in later life as they have increased blood lipids & cholesterol since birth. Therefore efforts are being made for screening for hyperlipidemia in the cord blood to screen the newborn who is at risk of developing atherosclerosis in later life so that necessary steps can be taken for its prevention at an early age. Material and methods: This work was undertaken to study lipid profile of cord blood of full-term pregnant women in normal labor. The parameters evaluated were serum triglyceride (TG), cholesterol (CHOL), high-density lipoprotein (HDL), low-density lipoprotein (LDL), very low-density lipoprotein. The family history of coronary artery disease and hypertension is recorded in each case. Results: The difference of mean for TG, CHOL, HDL, LDL, VLDL of cases is highly significant compared to control by ANOVA test. Serum TG, CHOL and VLDL were highly significant in all the three groups when compared to each other by post hoc test. Mean values were high for all parameters in female neonates but it was significantly high in CHOL and LDL levels. Conclusion: The genetic factors plays an important role in the transmission of hyperlipidemia and cord blood lipid estimation may provide a useful means to detect hyperlipidemia in high risk babies of full term pregnant women having family history of hypertension and coronary artery disease so that preventive measures could be taken early to retard the process of atherosclerosis.
Keywords: hyperlipidemia, hyperlipidemia, atherosclerosis, of cardiovascular disease.
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17. A COMPARATIVE STUDY OF INTRATHECAL ISOBARIC BUPIVACAINE (0.5%), LEVOBUPIVACAINE (0.5%)
AND ROPIVACAINE (0.5%) IN PATIENTS UNDERGOING TURP
Dr. Sanjay Kumar Morwal, Dr Trishala Jain
ABSTRACT
Background:This study was done to compare the anesthetic efficacy and safety of three local anesthetic agents : racemic bupivacaine and its two isomers : ropivacaine and levobupivacaine, in patients undergoing transurethral resection of prostate. Material and methods: One hundred-sixty two patients, ASA I-III, were randomized to receive an intrathecal injection of one of three local anesthetic solutions. Group B (n = 54) received 2 ml of isobaric bupivacaine 5 mg/ml(10 mg). Group R (n = 54) received 2 ml of isobaric ropivacaine 5 mg/ml (10 mg). Group L (n = 54) received 2 ml of isobaric levobupivacaine 5 mg/ml (10 mg). The onset and duration of sensory block at dermatome level T10,time to achieve highest level of sensory block, regression of sensory block up to L-1 as well as the onset, and duration of motor block were recorded, as were any adverse effects, such as bradycardia, hypotension, hypoxia, tremor, nausea and/or vomiting. Results: The onset of motor block was significantly faster in the bupivacaine group compared with that in the ropivacaine group and almost the same of that in the levobupivacaine group (P < 0.05). Ropivacaine presented a shorter duration of both motor and sensory block than bupivacaine and levobupivacaine (P < 0.05). Conclusion: Bupivacaine required more often the use of a vasoactive drug (ephedrine) compared to both ropivacaine and levobupivacaine and of a sympathomimetic drug (atropine) compared to the ropivacaine group.
Key words : Anesthetic techniques, regional ; anesthetic techniques, subarachnoid ; anesthetics local, bupivacaine ; ropivacaine ; levobupivacaine ; surgery.
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18. SEROPREVALENCE OF TORCH INFECTION IN PATIENTS ATTENDING A TERTIARY CARE HOSPITAL WITH
BAD OBSTETRIC HISTORY
Dr. Nilofar Khayyam, Khayyam Moin, Leela Vyas, Gaurav Dalela, Aruna Vyas
ABSTRACT
Background : Bad obstetric history (BOH) can be defined as unfavourable foetal outcome such as two or more consecutive spontaneous abortions, early neonatal death intrauterine foetal death, intra uterine growth retardation, still birth, and/or congenital anomalies. Aims and objectives : To see the prevalence of TORCH infections in women with Bad Obstetric History. Material and methods : The present study included 250 female patients of child bearing age (18-35 years) having bad obstetric history attending three hospitals in Jaipur city namely Zenana Hospital, Mahila Chikistalaya and ESI hospital for the period of March 2005 to March 2006. Serum was subjected to ELISA for the detection of igm and igg antibodies against TORCH group of organisms. Result : Out of 250 cases of bad obstetric history included in the study, 180 were having history of abortions, 15 of preterm delivery, 14 of still birth and 27 were of the mothers of congenitally abnormal children. 14 were cases having more than one of the above conditions. Maximum positivity (62.5%) was found in 21-25 years of age. Conclusion : Screening of TORCH organism in women with bad obstetric history as well as in babies with congenital anomalies should be done on routine basis to avoid the fatal outcome and to show the extended picture of TORCH infections.
Keywords : Bad Obstetric History (BOH), TORCH Infection, IgM, IgG, Mixed infection
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19. PSYCHIATRIC ILLNESS IN PATIENTS WITH PSORIASIS
Dr. Bansi M Suwalka, Dr. Shaurya Rohatagi
ABSTRACT
Background: Psoriasis patients also experience added financial burden because of workplace absence which add up to the cost of treatment. Several other factors, including race, genetics, geographical variation, infection, injury smoking, diet, alcohol and psychological issues in particularly emotional stress which plays important role in its pathology or potentiation of psoriasis. All these factors can modify or affect outcome of treatment. Material & Methods: A total of 50 patients enrolled for study, who was suffering from psoriasis, attending the dermatology (inpatient and outpatient) department of our hospital. These diagnosed patients with psoriasis were enrolled for study by simple random sampling. The control group consisted of 50 healthy subjects without a known clinical disease. Institutional Ethics Committee Clearance was taken before the start of the study. Results: 32% of psoriatic cases had psychiatric morbidities in comparison to 6% of the healthy control. This was statistically significant (P < 0.001). The participant with GHQ score ≥ were further compared by HADS Scale for severity of anxiety and depressive. It was found that cases had scored more than control on HADS Scale. This difference was however not statistically significant (P = 0.624, P = 0.705). Conclusion: Prevalence of psychological morbidities among the patients of psoriasis was found to be significantly more in comparison to healthy controls. There was positive correlation found between the severity of psoriasis and the psychological disorders. Cases of psoriasis with lesions at exposed parts of the body had more psychological disorders and poorer QOL.
Key words: Psoriasis, psychiatric morbidity, anxiety, depression.
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20. BREASTFEEDING PRACTICES IN MOTHERS IN VATIKA RURAL AREA OF JAIPUR, RAJASTHAN
Dr.Ishaan kalavatia, Dr.Veerbhan Singh, Dr. S L Bhardwaj
ABSTRACT
Objectives: To study breastfeeding practices in mothers in Vatika rural area of Jaipur, Rajasthan. Material and methods: A incidence based cross-sectional research study was performed in the rural area of Jaipur, includes 400 mothers and their infants. Data obtained for feeding practices were collected and analyzed. Results: Out of 400 infants 223 has started breastfeeding immediately. Among 177 infants of having delayed breastfeeding, in maximum cases that is 92 (51.98%) reason is delayed lactation followed by child illness. A 91.25% infants breastfeeding given on demand were Conclusion: The survey area was dominated with multiple health problems dominated by dual problems of malnutrition along with infective diseases; socioeconomic factors mainly responsible for these problems were mother’s illiteracy, mother working conditions, family income and socioeconomic status. Thus socioeconomic status is a vital aspect distressing the care of infants in requisites personal hygiene, weaning and very importantly breastfeeding.
Keywords: socio-economic aspect, breastfeeding, malnutrition, multiple health problems occupations, literacy status
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21.HISTOPATHOLOGICAL AND CYTOLOGICAL ANALYSIS OF VARIANTS IN CERVICAL LESION AT PACIFIC MEDICAL COLLEGE, UDAIPUR
Dr. Sonal Agarwal
ABSTRACT
Background: Histopathological and cytopathological analysis is the primary basis of clinical and scientific research to formulate guidelines for treatment and prevention of cervical cancer. Histopathological examination reveals precancerous lesions and determines treatment protocols according to grade and extent of the lesion. The histopathological examination also forms the basis of newer treatment techniques and preventive measures. Material & Methods: A total of 100 patients specimens were analyzed, which includes biopsy specimens and hysterectomy to examine the cervical lesions pathology. After fixation by 10% formalin for 24 – 48 hours specimens were dehydrated in alcohol, which was cleared by xylene and then embedded in paraffin blocks. Cut sections of size 4 -5 microns from different sites were stained by Hematoxylin and Eosin (H & E) stain. Results: Among the total specimens of cervical lesions 89% were non-neoplastic, and 11% were neoplastic. Among all the non-neoplastic lesions 77% were reported to be the inflammatory pathology. Among the total specimens, 11% reported to be of neoplastic pathology, 7% reported to had benign pathology and 5% reported to had cervical intraepithelial neoplasia respectively. Conclusion: chronic inflammatory cervical lesions were the most common genital tract lesions, and its association was found with 30-40 years age group. Cervical intraepithelial neoplasia and cervical carcinomas were reported in few numbers of cases, and their association was found with 40-60 years age group. Therefore, females of older age group complaining of bleeding per vagina should be screened for cervical neoplasia.
Keywords: Cervicitis, Cervical Intraepithelial Neoplasia, Cervical Cancer.
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22.BACTERIOLOGICAL PROFILE OF MEIBOMIAN GLANDS IN MEIBOMIAN GLAND DYSFUNCTION
Dr. Virendra Singh Lodha, Dr. Pragnesh Patel
ABSTRACT
Background: Meibomian gland dysfunction (MGD) is a common ocular disorder, often underdiagnosed, and is a major contributory factor causing dry eye disease and ocular discomfort due to compromised quality of tears. Oral antibiotics particularly doxycycline and azithromycin are used and observed to provide relief in MGD due to their antibacterial and anti-inflammatory properties, but their exact mechanism of beneficial action in MGD is yet not fully defined. Aims: The present study was undertaken to study the bacterial profile of Meibomian glands secretions in cases of MGD and normal subjects (no signs of MGD) by culture for aerobic bacteria to find out the difference between the two groups. Methods and materials: In the present study 80 patients attending outpatient department of Ophthalmology, Pacific Medical College and Hospital, Udaipur were included comprising 50 patients clinically diagnosed with MGD and 30 patients without evidence of MGD (control group). Culture tests of manually expressed meibum were performed in the Microbiology Department of Pacific Medical College and Hospital, Udaipur. Results: No difference was found in the bacterial profile of MGD and control group. Conclusions: The mechanism by which antibiotics provide relief in MGD appears to be due to another mode of action than their antibacterial properties, as the bacterial profile is observed to be similar in MGD and normal persons.
Key Words: ocular disorder, dry eye disease, Meibomian gland, tear film
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23. ASSESSMENT OF GERIATRIC MORBIDITY PATTERN AT TERTIARY CARE CENTER
Dr. Mahendra Khatri, Dr. Shweta Asthana, Dr. Shivprakash Sharma
ABSTRACT
Background: In the scenario of India the proportion of the elderly population tends to rise day by day. The health status of the geriatric group depends on several direct and indirect factors, for example, socio-economic status, personal health status, standards of healthcare, psycho-social well-being and other associated factors. Material & Methods: All the patients who were more than 60 years of age attending the outpatient department were considered for this analysis. A total of 200 patients were enrolled for study by simple random sampling. Results: The most common morbidity was anemia in 74% of patients followed by ophthalmic disorders which were found in 71% of patients. CVS disorders including hypertension were found in 64% patients, 59% of patients had complications of GIT and musculoskeletal system. 48% of patients had disorders of the respiratory system, 46% had dental problems, 32% of patients had skin disorders and ENT diseases found in 26% patients. Female genitourinary disease seen in 19% of patients followed by psychiatric disorders in 18%, diseases of male genitourinary diseases found in 14% of patients, endocrine diseases saw in 13% and 11% CNS diseases. Conclusion: There was a higher prevalence found of morbidities and multi-morbidities among the geriatric population; hence elderly health care should be emphasized in health programs, planning, and policy-making and implemented through health care services.
Keywords: geriatric diseases, morbidity, health care.
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23. A COMPARATIVE STUDY OF LAPAROSCOPIC VERSUS OPEN CHOLECYSTECTOMY
OUTCOME IN YOUNG ADULTS
Dr. Sita Ram, Dr.Bihari lal
ABSTRACT
Background: Several studies have suggested that laparoscopic cholecystectomy is associated with shorter hospital stays i.e. an earlier return to activities, and lower mortality and morbidity rates than the patient undergoing open cholecystectomy. Aims and Objectives: To compare the length of stay and complication associated laparoscopic and open cholecystectomy. Material and Methods: All the 400 patients who underwent cholecystectomy were divided into two groups. Group I with open cholecystectomy (100 patients) and group II with laparoscopic cholecystectomy (300 patients). Result: The patients have common bile duct stones detected at the time of surgery were 12 (3%). The rate of all complications was low in both either laparoscopic or open procedure, especially among the serious complications. The prevalence of most of the complications was less than 2%. Rates greater than 5% were observed for the less serious complications, such as the requirement of transfusion, urinary retention or ileus. Conclusion: Laparoscopic cholecystectomy can be safely considered in young patients presented with cholelithiasis as compared to open cholecystectomy.
Keywords: Laparoscopic cholecystectomy, Open cholecystectomy, Cholelithiasis, Complication.
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EVALUATION OF FINE-NEEDLE ASPIRATION CYTOLOGY IN SALIVARY GLAND LESIONS AT TERTIARY CARE HOSPITAL
Dr. Indu Saxena
ABSTRACT
Background: Pathological changes in salivary glands nowadays are commonly studied with FNAC However, a wide variety of benign and malignant tumors of these glands were difficult to diagnose by imaging modality. Fine needle aspiration cytology (FNAC) of suspected salivary gland lesions has an edge in preoperative diagnosis over imaging modality. Material & Methods: The present prospective study was conducted at the department of pathology of our tertiary care hospital. The study duration was of one year from September 2016 to August 2017. A sample size of 50 was calculated at a 95% confidence interval at a 10% acceptable margin of error. Patients with swelling or lesions of salivary glands were included in the present study irrespective of age, sex duration of history, and etiology. Results: In the present study a total of 50 patients with swelling or lesions of salivary glands were included in the present study irrespective of age, sex duration of history, and etiology. In our study the patients were aged from 12 to 68 years, the mean age of the enrolled patients was 36 ± 4.89 years. Out of the total, the majority of study participants were male 58%, and 42% of study participants were female. On the FNAC findings, the most common interpretation was Pleomorphic adenoma among 20 cases. Myoepithelioma, Adenoid cystic carcinoma, and Adenocarcinoma NOS were found among 1 case respectively. Mucoepidermoid carcinoma was found in 2 cases. Conclusion: We concluded from the present study that Fine needle aspiration cytology findings can differentiate various salivary gland pathology. FNAC of the salivary gland is a safe and reliable diagnostic technique for the primary diagnosis of salivary gland pathology.
Keywords: FNAC, Histology, Salivary gland pathology.
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THE USEFULNESS OF PLATELETS AS AN EARLY DIAGNOSTIC TOOL IN THE DIAGNOSIS OF SEPSIS IN NEONATAL INTENSIVE CARE UNITS
Dr. Atul Kumar Heda, Dr. Krishna Heda
ABSTRACT
Background: Sepsis remains a formidable challenge in neonatal healthcare, posing a substantial threat to the vulnerable population in Neonatal Intensive Care Units (NICUs). Platelet indices, specifically platelet count, platelet distribution width (PDW), and mean platelet volume (MPV), emerge as potential candidates for early detection and differentiation of sepsis-causing pathogens. The present study aimed to investigate the utility of platelet counts as an early diagnostic tool for sepses in a NICU setting. Methods. This prospective study utilized a convenient sampling method, recruiting 150 neonates who met the inclusion criteria. Using the National Neonatal Forum (NNF) criteria, the neonates were categorized into three groups: clinically suspected (probable), culture-positive, and culture-negative. Sensitivity, specificity, positive predictive value, and negative predictive value were calculated. Results: The specificity of Platelet count was determined to be 69.23%, signifying its accuracy in correctly identifying individuals without probable septic infection. The overall accuracy of the test was reported as 71.8%. Conclusion. Platelet counts are a reliable marker for early diagnosis and management of neonates, evident in specificity and sensitivity analyses.
Keywords: Neonatal Sepsis, Platelet Dynamics, Mean Platelet Volume (MPV), Plateletcrit, Blood Culture
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