International Journal of Medical Sciences and Education (IJMSE)
Vol. 5; Issue: 2 (April-June 2018), Date of Publication: 01.07.2018

Table of Contents
     Editorial                                                                                                                                                  123-124
      E-LEARNING IN PRESENT MEDICAL EDUCATION SYSTEM: A NEED OF AN HOUR
      Dr. Arvind Kumar Yadav                                                                                                             PDF FULL TEXT

1.    EDUCATIONAL OUTCOMES OF SMALL GROUP DISCUSSIONS  VERSUS TRADITIONAL
       LECTURE AMONG MEDICAL UNDERGRADUATES –A PROSPECTIVE STUDY                                125-131
       Dr. Suhasini Padugupati, Dr. K.P.Joshi, Dr. R.S Swaroopa Chary, Dr. DV.H.S Sarma          PDF FULL TEXT

ABSTRACT

Background : Didactic lectures which are the usual method of approach in teaching a large group, turns to be a challenging task to promote active learning among the students. Small group discussions provides a unique environment which gives a scope for the activation of prior knowledge, to exchange the views among the group and is assumed to result in deeper learning. As a result, the learning can become more interesting for the students. Our objective is to compare the academic  performance and retention capacity of students following small group discussions versus lecture and to assess the perception of students towards small group discussions. Methods: The study was carried out among first-year medical undergraduates. The 100 students were divided into two groups Group A & B, 50 in each group. Group A was exposed to regular lectures & Group B was exposed to Small Group Discussion sessions. Later a post-test was conducted, immediately & after 4 weeks of the lecture & Small group Discussion respectively. A cross over was done with another topic. Feedback was collected from all the students  by administrating a pre-validated Questionnaire. Results : Showed that the Post SGD group (15.34 ± 3.62) scored more in comparison with Post Lecture group (8.63 ± 2.74). Students reported a better learning experience and retention of the topic. 53% of the students strongly agreed, 45% agreed, 1% disagreed that SGD helped in their better performance. Conclusion: SGD’s have facilitated a better understanding of the topic, which has been reflected in the student’s performance. Thus, small group discussion sessions are more effective than traditional lectures.
Keywords: SGD- Small group discussion, DL- Didactic lecture

2.    ASSESSMENT OF EDUCATIONAL ENVIRONMENT OF UNDERGRADUATE MEDICAL STUDENTS USING
       DREEM (DUNDEE READY EDUCATION ENVIRONMENT MEASURE) QUESTIONNAIRE”
       –A CROSS SECTIONAL STUDY                                                                                                                132-139
      Dr. Gudadappanavar . A.M,  Dr. Jabannavar . B.V, Dr.Shukla. G                                              PDF FULL TEXT

ABSTRACT

Background: The Dundee ready education environment measure is a highly generic and internationally validated  study tool used to assess student perception about their educational environment. Being in medical teaching profession we are concerned about student’s views on these aspects. So far, literature search has shown that no such studies have been done in this part of the state. Aim: To assess the Educational Environment using DREEM and to compare students' response assessed by this on the basis of the year of study, gender and to identify areas of strengths and weaknesses in the current educational environment. Methods: The questionnaire was designed so as to collect the medical undergraduate student’s perception on the following aspects like learning perception of teachers, academic self perception, perception of atmosphere, and students social self perception. The students were asked to read each question and to respond using a 5point Likert scale. The   data was analysed using descriptive statistics like percentages and mean. Student ‘t’ test was used for the comparison of the scores between the gender and scores between different years of study. P < 0.05 was considered to be statistically significant. Results: The mean score of overall DREEM questionnaire was 116.22±18.86 and it was on the higher side with 2nd year MBBS students (119.9±16.08) and lowest was with 1st year students. (p<0.05). Conclusion: Our study concluded that the overall perception of our students regarding educational environment was  positive. The highlights of our study can be addressed with positive perception in order to improve and strengthen the educational environment in our institute.
Keywords: Learning, Education Environment, Dundee Ready Education Environment (DREEM) Questionnaire, Teachers, Social Perception

3.    PRIMING, REPETITION, ACTIVE LEARNING: A NOVEL & EFFECTIVE TEACHING
       -LEARNING METHOD IN MEDICAL SCHOOLS                                                                                       140-144
       Dr. Gandham Pavani                                                                                                                   PDF FULL TEXT

ABSTRACT

Background: Newer innovations in teaching learning methodologies is the need of the hour in Medical education. Our study focuses on a novel teaching learning method which is student centric where the teacher is a facilitator which is the requirement of the present day medical education. Materials and Methods: The teaching innovation was conducted for 2nd MBBS students of our Institute.  The class was divided into small groups. Each groups were given an objective test questionnaire which was answered by them by open book method in 1 hour. Every group of students was monitored by the teacher so that every group completes the questionnaire in the stipulated time. After that, a 10 minute time was given to the students to memorise the answers.  After that, the teacher elicited the answers from the students. Then the teacher summarized the chapter making use of the questionnaire only. After summarization, feedback was taken from the students and the teacher about the teaching innovation. Results: 97 - 99% of students felt that they could learn better, focus on main aspects of the chapter and recollect the chapter better with this method. Feedback from the teacher revealed utmost satisfaction in conducting the method as every student participated and enjoyed the class. Conclusion: “Priming, repetition, active learning “ is a new teaching method that can be incorporated in medical schools.
 Keywords: Teaching innovation, objective test questionnaire, Priming, Repetition, Active learning.

4.   PERCEPTION OF III SEMESTER MEDICAL STUDENTS REGARDING THEIR INTEREST IN
      THE SUBJECT OF OBSTETRICS AND GYNAECOLOGY IN A PRIVATE MEDICAL COLLEGE           145-152
      Dr. Veena Vidyasagar                                                                                                                   PDF FULL TEXT

ABSTRACT

​Background: Interest in a particular medical subject during MBBS depends on various factors.  Medical students are first exposed to para-clinical and clinical subjects in III semester and that’s when inclination towards a particular specialty subject is likely to occur. Materials and methods: A survey of III semester medical students was conducted at SMSR, Sharda University, Greater Noida.  Students were divided into two groups viz. Pre-exposure group and Post exposure group (those who had attended practical classes in Obst & Gynae). Questionnaire forms were distributed to each group. Results: The questionnaire was submitted by 68% students in the pre exposure group and 64% students in the post exposure group. Proportionately, more number of boys submitted the filled up questionnaire forms as compared to girls (68.57% vs 64.62%). In the pre exposure group, 64.70% students were aware about the subject of obstetrics and gynaecology and in post exposure group the figure was 90.62%. In pre-exposure group, 57.14% gave good rating for Obstetrics and Gynaecology and in the post-exposure group the figure was 52.38%. The expectation of teaching of the subject was high among 78.26% students in the pre exposure group as compared to 65.21% in the post exposure group. Conclusion: A survey regarding interest in the subject of Obstetrics and Gynaecology among III semester medical students was carried out in a private medical college. Percentage of boys participating in the survey was more. However, proportionately, awareness and interest in Obstetrics and Gynaecology was more among girls.
Keywords: Subject of Obstetrics and Gynaecology, pre exposure group, post exposure group.​

5.   EFFECTIVENESS OF SELF-DIRECTED LEARNING WITH LECTURE METHOD IN TEACHING
      FIRST YEAR MEDICAL STUDENTS IN A MEDICAL SCHOOL                                                                153-156
      P. Srilakshmi, B Anuradha, Y. V. Ramakrishna Reddy                                                              PDF FULL TEXT

ABSTRACT

​Background: Self-directed learning (SDL) has been accepted in the medical syllabus and proposed as a successful learning method for undergraduate medical students to build up competence in knowledge achievement . The main criterion of the study is to find the advantage of self-directed learning with a traditional lecture on the similar topic in Biochemistry for first-year MBBS students. Material & Methods: First-year MBBS students comprising 150 students divided into batch A and batch B comprising seventy-five each respectively. Out of two batches, batch A received a one-hour lecture session on Biochemistry topic, whereas batch B students were encouraged for SDL on the same topic. Two batches were subjected to written examination by providing multiple choice questions (MCQ). Results: Means values were not significant (p>0.05) on comparing between the pre-Lecture to pre-SDL and between post-lecture to post-SDL groups. Conclusion: Self-directed learning can be employed as a superior  form of learning in knowledge methodology of  acquisition and knowledge acquirement and effective in discussing diseases related  topics in the in the medical syllabus of Biochemistry.
Keywords: Biochemistry, Lecture, Medical education, Self-directed learning.

6.    FEEDING PATTERN AND DEMOGRAPHIC PROFILE OF CHILDREN WITH INFANTILE
       TREMOR SYNDROME                                                                                                                               157-160
       Ashok kumar, Kuldeep Singh Rajput,  Naresh kumar, Lakhan Poswal                                  PDF FULL TEXT

ABSTRACT

Background: infantile tremor syndrome is associate with Infant and maternal diet and demographic features. Objective: the objective was to know the feeding pattern and demographic features in children with infantile tremor syndrome. Method and material: this study was carried out among 50 children of age group 6 months to 2 year with clinical feature of ITS. Demographic data, dietary history of mother and child, anthropometry, clinical features and neuro developmental status were compared. Result: A total of 50 children [30 male and 20 female (were enrolled in this study .Maximum number of children (50%) were in age group 6-12 months. Majority (52%) were ST and SC. Most of children (64%) were from BPL family. Most of children (68%) were exclusive breast fed. Conclusion: association of infantile tremor syndrome with infant diet and socioeconomic status was clearly found.
Key words: Infant, feeding pattern, maternal diet.

7.    IMMUNIZATION STATUS AND AWARENESS AMONG ELDERLY LIVING WITH DIABETES
       MELLITUS                                                                                                                                                  161-166
       Ms. Divyasree Narravula, Dr. Anand P. Ambali, Dr. Shashidhar S. Devaramani, Sai Krishnan P 
                                                                                                                                                              PDF FULL TEXT

ABSTRACT

 Background: The prevalence of diabetes mellitus in the elderly population is increasing.  Pneumonia is leading cause of death in older people for which diabetes is a major risk factor. The response to vaccines though is not cent percent in elderly population, it is said that an “ounce of prevention is worth a pound of cure”. Material & Methods: The elderly patients attending the geriatric clinic and diabetes clinic of our institute were interviewed over a period of one month to know their immunization status after attaining 60 years of age and awareness among them regarding immunization schedule in the elderly population. Results: Out of 100 elderly participants, males constitute 59% and the young old (60 -74 years) constitute 94%.Thirty participants have been immunised against either Tetanus, Hepatitis, Pneumococcal, and Influenza after attaining 60 years of age. A total of sixty eight participants were not aware about immunisation schedule. Higher immunization rates are found in the people who are graduate and those are motivated by the clinicians to receive vaccines. The elderly living with diabetes of 5 to 10years duration have received more shots of vaccine. Conclusion: The study concludes that there is less awareness among the elderly and clinicians regarding immunization schedule for the elderly living with diabetes. The people living with diabetes are prone for communicable and community-acquired diseases which can be prevented to certain extent by immunization. In the era of transplantation and replacement surgeries, the elderly need to receive protective methods.
Keywords: Awareness, Diabetes Mellitus, Elderly, Immunization.

8.    A STUDY OF OBESITY AND OVERWEIGHT IN MIDDLE AGE CHILDREN OF RURAL &
       CITY AREAS OF JAIPUR, RAJASTHAN                                                                                                  167-172
       Dr. Sitaram Gupta                                                                                                                        PDF FULL TEXT

ABSTRACT

​Background: Present study was done to determine the condition of overweight and obesity in city & rural middle aged children in Jaipur, Rajasthan. Methods: Present study was done in year 2017 and the informations were gathered from children who are studying in government schools. Demographic data like age, gender, weight and height were recorded. BMI was calculated using standard formula. IOTF criteria-2000 (International Obesity Task Force) was used to classify overweight and obesity as per. Result: Students chosen for the study were aged between 14-16 years. Student selected from rural schools were 180. Students selected from schools of urban areas were 215. Males were slightly more in study population than female candidates (56% Vs 44%). The overall mean BMI in rural areas was (20.8 + 2.9) which is significantly less than the BMI of urban areas (21.9 + 3.2 Kg/M2). A significant difference was found in the prevalence of obesity in rural and urban areas that is 11.1% and 14.1% respectively (p<0.01). After adjusting for age and gender a statistically significant difference was found in rural and urban areas with regards to obesity.  An interesting observation in this study is also noticed that urban male students are having more risk of becoming obese than urban females and rural male and female students. Conclusion: Present study successfully illustrated that overweight and obesity in urban students is relatively high and urban males are relatively more affected with these problems.
Keywords: Body Mass Index (BMI), Overweight, Obesity.

9.   SERUM SODIUM AND POTASSIUM LEVELS AMONG PATIENTS WITH SENILE
      CATARACT AND INDIVIDUALS WITHOUT CATARACT                                                                        173-176
      Dr. Kavita bansal, Dr. Nikhil Agrawal, Dr. Mahendra K. Jharwal                                           PDF FULL TEXT

ABSTRACT

Background: Senile cataract is among one of the commonly seen consequences in the aging process. Approximately three fourth of population over 75 years of age suffer from cataract or lens opacity. Multiple mechanisms such as oxidative stress, protein aggregates, osmotic graduation, phase separation and post-translational protein changes were proposed for cataract formation. Biochemical researchers had reported significant results in relation to serum electrolytes concentration in patients suffering from age-related cataract. Material & Methods: A total of 200 patients who came for ophthalmic evaluation were enrolled for study by simple random sampling. Out of these 200 patients, 100 patients age and gender-matched individuals who had no cataract served as the control group and 100 with nuclear/cortical/posterior sub-capsular cataracts formed the study group. Results: Mean serum sodium levels were 143.83±4.16 meq/l in the case group and 139.02±3.26 meq/l in the control group. This difference was found statistically significant (p<0.001). The mean serum potassium levels were 4.28±0.13 meq/l in the case group and 4.09±0.27 meq/l in the control group. However, this difference was statistically non-significant (p-value = 0.03) Conclusion: Serum sodium levels in patients had senile cataract were observed to be higher in comparison to the control group, while this was not found for potassium levels. These findings indicate that diets that are rich in sodium content are a risk factor for the development of senile cataract.
Keywords: senile cataract, serum sodium, serum potassium.

10.   A STUDY OF PREVALENCE OF MEIBOMIAN GLAND DYSFUNCTION IN NORTH INDIAN
        ADULTS IN HOSPITAL BASED POPULATION                                                                                       177-181
         Virendra Singh Lodha                                                                                                              PDF FULL TEXT

ABSTRACT

Background: To study prevalence of meibomian gland dysfunction in adults attending Ophthalmology outpatient department. Methods and Materials: Patients between 40 to 70 years of age attending outpatient services of Ophthalmology department for defective vision or other symptoms were included in the study after applying exclusion criteria. After taking a thorough history the patients were examined on slit lamp. Meibomian gland dysfunction (MGD) was labeled if any one eye showed capping, stenosis, and occlusion of meibomian gland orifices, telangiectasiasis of posterior lid margin and or increased volume and turbidity of meibum on expression by digital pressure. Results: In the present study 200 persons of 40 or more years of age (100 males and 100 females) attending outpatient department were examined clinically for presence or absence of meibomian gland dysfunction (MGD). The prevalence of MGD was found to be increased with advancement of age. The prevalence of total and symptomatic MGD was observed to be 29 % and 12.5% respectively with higher prevalence in males. Conclusions: Prevalence of MGD is significantly high in patients attending outpatient departments of Ophthalmology and may be responsible for their symptoms, hence should be kept in consideration while examining a patient.
KeyWords: Indian, meibomian gland dysfunction, dry eye

11.   COMPARATIVE STUDY OF SERUM AST, CK-MB, IN MYOCARDIAL INFARCTION WITH
        SURVIVAL AND MYOCARDIAL INFARCTION WITHOUT SURVIVAL                                                  182-187
         Dr. Dileep Singh Nirwan, Dr. Uttam Kumar                                                                            PDF FULL TEXT

ABSTRACT

Background: Myocardial infarction has varied presentation and associated high mortality. Patient’s identification with acute myocardial infarction (MI) is very critical for their management and the prognosis. The goal of present study was to correlate the diagnostic value of cardiac biomarkers like AST (SGOT) and CK-MB in MI patient with and without survival. Materials and methods: This study was conducted on 50 MI patients admitted to the Emergency Department of Government DB Hospital Churu within 12 hours of acute chest pain and 50 healthy volunteers (age and gender matched) as a control group. Serum creatine kinase-MB (CK-MB), and aspartate transaminase (AST) were measured. For Analyzing the Data, Statistical software SYSTAT version 12 was used. The results were revealed in mean ± standard deviation. Comparisons of cases and control groups were done by applying Z test. Student’s t-test at 5% (p = 0.05) and 1% (p = 0.01) level of significance was used for correlation. Results: Mean levels of serum CK-MB and AST levels were significantly higher (p < 0.01) in patients with MI in contrast with healthy volunteers. Serum levels of above cardiac biomarkers were significantly elevated (p < 0.01) in MI patients without survival as compared with MI with survival. Conclusion: The serum levels of biomarkers were raised in MI without survival as compared with MI with survival. These study data manifest that these changes might be useful to obtain a comprehensive view of the infarct size and severity of vascular stenotic lesions.
Keywords: Acute myocardial infarction, Creatine kinase-MB, Myocardial infarction, AST (SGOT).

12.    A STUDY TO ASSESS THE READINESS OF MEDICAL STUDENTS TOWARDS SELF-DIRECTED   
         LEARNING AND ITS ASSOCIATION WITH ACHIEVEMENT GOALS AMONG MBBS STUDENTS
         IN A MEDICAL COLLEGE OF CHENNAI, 2017                                                                                     188-198
         Sudharshini Subramaniam, Joy Patricia Pushparani                                                          PDF FULL TEXT

ABSTRACT

Background: Medical education is expanding in such a rate that it is difficult to be covered in the 5 ½ years curriculum. Heutagogy or Self-directed learning is a concept which can help in matching with the ever-expanding medical knowledge. The present study was carried out to measure readiness for self-directed learning and its relationship with the student’s achievement goals among eighth semester medical students in a tertiary care teaching hospital. Methods and Materials: Readiness assessment was carried out among 103 eighth  semester MBBS students using Fishers’ 40-item self-directed learning readiness score instrument after taking informed written consent. The 12-item Achievement Goal Questionnaire was used to measure the achievement goal orientation of the students namely: mastery-approach, mastery-avoidance, performance-approach, and performance-avoidance. Correlation test and multiple logistic regression was used to elicit relationship between readiness assessment and Achievement goal orientation. Results: The mean Self Directed Learning Readiness score was 141.97±22.6, with only 41students (39.81%) scoring more than 150 indicating high readiness. Among the different achievement goal approaches, mastery approach had the highest mean score, followed in the order of performance avoidance, performance approach and mastery avoidance. Mastery approach and Performance avoidance was found to be positively correlated with Self-directed Learning Readiness score which was statistically significant. Conclusion: The Self- directed learning readiness among medical students is low. The readiness towards SDL was correlating with the motivational factor, mastery approach and performance avoidance. This provides an indication to modify our curriculum and create medical education innovation programmes, which could kindle the mastery goal motivation factors.
Keywords: achievement goal orientation, self-directed learning readiness

13.     RETROSPECTIVE REVIEW OF OUR ANESTHETIC PRACTICES IN PEDIATRIC
          THORACIC SURGERY                                                                                                                         199-205
          Fatih Doğu Geyik, Attila Özdemir, Kutlu Hakan Erkal, Yücel Yüce                                   PDF FULL TEXT

ABSTRACT

Background: Several types of pediatric thoracic surgeries has been increasingly performed in clinical practice. In this retrospective study, we evaluated the demographic characteristics and anesthetic management of pediatric patients who underwent thoracic surgery under eighteen years of age at the University of Health Sciences Kartal Dr. Lutfi Kirdar Education and Research Hospital, Istanbul. Material and Methods: After obtaining approval from the ethics committee. We investigated a retrospective analysis of the database of all patients undergoing pediatric thoracic surgery in our clinic from January 2010 to December 2017. Demographic data of the patients, type of the operations, duration of surgeries, ASA classifications and the anesthesic methods were all evaluated. Furthermore, we tried to determine surgical and anesthetic methods applied, intraoperative hemodynamic changes, length of stay in the intensive care unit, and postoperative complications. Results: During this period, a total of 90 pediatric patients had been operated. While 68.2% (n=62) of all patients were ASA I, 23.2% (n=21) of them ASA II, 7.8% (n=7) of all patients ASA III. The most common surgical procedure were wedge resection 25.6%, (n=23) and the most common airway device was double lumen endotracheal tube 53.3%, (n=48). In all patients balanced general anesthesia was performed. Conclusion: Due to the technologic advances in surgery and anesthesiology, various anesthesic techniques could be performed safely with proper selections due to the patient characteristics in pediatric thoracic surgery.
Keywords: Anesthesia, pediatric, thoracic surgery

14.    CLINICAL, MICROBIOLOGICAL AND RADIOLOGICAL PROFILE OF BRONCHIECTASIS: A TERTIARY
         CARE HOSPITAL STUDY IN SOUTHERN RAJASTHAN                                                        
         Dr. Prithviraj Methe,  Dr. Gaurav Chhabra, Dr. S. K. Luhadiya, Dr. Rishi Kumar Sharma,              206-216
         Dr. Atul Luhadiya                                                                                                                     PDF FULL TEXT

ABSTRACT

Background: Bronchiectasis is an irremediable dilatation of more than one bronchus, with decrease clearance of secretions and expiratory flow. Secondary bacterial infection is very common and leads to worsening of disease. The sequel of the disease leads to poor quality of life, with higher morbidity and mortality. This issue has limited literature. Material & Methods: All patients with diagnosis of bronchiectasis by HRCT thorax in tertiary care hospital in Udaipur were included after obtaining informed consent. Detailed clinical history was recorded. Sputum for microbiological profile was sent. Symptomatic along with supportive treatment was initiated. Results of microbiological profile were obtained and analyzed on the basis of inferential statistics to fulfill the objectives of the study. Results: Total of 50 patients were enrolled for this study. There was female predominance 29 patients (58%) over males 21 patients (42%) in our study. Out of all patients, 34 (68%) patients were smokers.  Commonest symptom/sign was Cough (100%), Dyspnea (76%), Fever (16%), Hemoptysis (12%) and Crepitation (72%). All patients shown increased growth of aerobic bacteria in sputum specimen. Pseudomonas Aeruginosa (34%), Klebsiella Pneumoniae (20%), Acinetobacter (10%), Stapylococcus Aureus (8%) and Streptococcus Pneumoniae (8%), Acinetobacter (10%) and Aspergillus (8%). Conclusion: Pseudomonas being the most common colonizing organism in bronchiectasis patients, it must be underlined that the intensification of anti-Pseudomonas Aeruginosa antibiotic therapy among these cases (e.g., with higher doses, prolonged treatment, or combined therapy) possibly could slower even stop the impairment of lung function over the longer term.
Keywords: Bronchiectasis, Colonization, Pseudomonas

15.     A RECENT NEW DISASTER IN INTENSIVE CARE UNITS: SYNTHETIC CANNABINOID
          INTOXICATIONS                                                                                                                                    217-222
          Kutlu Hakan Erkal, Fatih Doğu Geyik, Yucel Yuce, Banu Eler Çevik                                 PDF FULL TEXT

ABSTRACT

​Background: We aimed to evaluate the clinical presentation and hospital course of patients admitted to the intensive care unit with synthetic cannabinoid intoxication. Materials and Methods: We performed a retrospective review of medical records of all patients admitted from January 2010 to December 2017 at Kartal Dr. Lutfi Kirdar Education and Research Hospital general intensive care unit in Istanbul, Turkey with synthetic cannabinoid exposure. Results: 31 patients (30 males, 1 female) were treated with synthetic cannabinoid intoxication and the median age was 28.4±12.3. The most common findings in the patients were discomfort (n=17 case, 54.8%) and the most frequent laboratory findings were leucocytosis (n=13 case, 41.9%). 10 patients (32.2%) required mechanical ventilation, 14 patients (45.1%), required vasopressors, and 2 patients (6,4%) needed dialysis. 28 patients (90.4%) were discharged and 3 patients (9.6%) died. Conclusion: Synthetic cannabinoid intoxication, has no specific treatment. The treatment should be symptomatic and should be planned according to the developing complication in these cases. We should consider the use of synthetic cannabinoid in differential diagnosis and the symptomatic treatment should be started early in intensive care unit.
Keywords: intensive care unit, synthetic cannabinoid, intoxication.

16.    ASSESSMENT OF MENTAL HEALTH OF MEDICAL UNDERGRADUATE STUDENTS BY
         GLOBAL MENTAL HEALTH ASSESSMENT TOOL                                                                           223-230
         Vinayak Kapoor,  Ramesh Kumar Mishra, Lokendra Sharma, Kusum Gaur, Kopal Sharma,
         Ashwani Kumar Parashar, Dr. I D Gupta                                                                             PDF FULL TEXT

ABSTRACT

Background: In our country we often neglect mental health. In the present study we intend to understand the different psychological morbidities that are experienced by medical undergraduate students and also to train the enrolled students about the Global Mental Health Assessment Tool. Materials and methods: Fifty students who gave their informed consent were enrolled and assessed for any psychological morbidity using Global Mental Health Assessment Tool (GMHAT). Each of them was asked to fill the first part of the pre-designed performa consisting of six questions. The second part of performa was filled by the assessor based on the interview which consisted of 25 questions, each focusing on different types of psycho- morbidity. Global Mental Health Assessment tool generates computer based diagnosis for the candidate and also helps to rate symptoms and assess self harm risk. It is easy to use tool to assess mental health in primary care settings. Significance of difference in proportion was inferred by Chi-square Test of significance. Significance of difference in mean scores was inferred by unpaired student t-Test of significance. For significance P value equal to or less than 0.05 was considered as significant. Results: The response rate of our study was 100%. Out of which 80% of the participating students had some or other kind of psychological morbidity. Depression was the most prevalent psychological morbidity, followed by obsessions/compulsions and anxiety respectively. Psychological morbidity showed a significant change based on the type of residence.Depression was significantly associated with type of residence and family history of mental health problem. Obsessions/compulsions were evenly distributed among all groups of students while anxiety was associated significantly with the history of stressful events. Conclusion: We found that mental health issues affect a significant proportion of medical undergraduate students. So this study highlights the need of appropriate interventions to improve the mental health of medical students.
Keywords: First MBBS Students, GMHAT questionnaire, Mental Health, Stress

17.    THYROID FUNCTION ASSESSMENT IN TYPE 2 DIABETES MELLITUS PATIENTS                      231-235
         Dr.Ravindra K Hadakshi, Dr Gaurav Modi                                                                           PDF FULL TEXT

ABSTRACT

Background: Diabetes Mellitus is the most common endocrine metabolic disorder seen among all other metabolic disorders. Thyroid disorders are also prevalent among population; however, the prevalence is not as high as diabetes. Since both disorders are endocrine in nature, there was always a curiosity to find out the association between these two.Material & Methods: A total of 100 patients and 100 controls were enrolled for study, which were attending the OPD of general medicine department of GMERS Medical college, Vadnagar, Gujarat. The diagnosed patients with type 2 diabetes were enrolled for study by simple random sampling.Results: The magnitude of subclinical hypothyroidism among the control group was 8% and among the type II diabetes group was 19% (p=0.743). The magnitude of Clinical Hypothyroidism among the control group was 3% and among the type II diabetes group was 12% (p=0.461). The magnitude of subclinical hyperthyroidism among the control group was 1% and among the type II diabetes group was 2% (p=0.612). The magnitude of Clinical hyperthyroidism among the type II diabetes group was 1% and it was absent among the control group (0.745)Conclusion:  The higher prevalence of thyroid dysfunction was observed among type 2 diabetes group in comparison to healthy controls, though the difference was not statistically significant. The most prevalent thyroid dysfunction found in present study was subclinical hypothyroidism among both the study groups
Key words: diabetes mellitus, thyroid dysfunction, hypothyroidism, hyperthyroidism.

18.    CLINICAL EVALUATION OF NON-RESOLVING PNEUMONIA AT TERTIARY CARE CENTRE      236-240
         Dr.Mridul Bhushan,Ritesh Singh Gangwar                                                                        PDF FULL TEXT

ABSTRACT

Background: The diagnosis of pneumonia is done on the basis of clinical sign and symptoms, however chest x-ray findings of consolidation of one segments or more or even lobes of the lung is still the gold standard. Among patients of community acquired pneumonia (CAP) non-resolving pneumonia or slowly resolving pneumonia is also seen, which accounts for 10-20% of admitted cases. Normal resolution of community acquired pneumonia is depends upon the patient’s immunity status and the infective nature of pathogen.Material & Methods: A total of 50 patients who were visited the medicine department at our hospital between March 2017 and August 2017. Patients of non-resolving pneumonia with signs and symptoms along with a chest X-ray reporting less than 50% of resolution even after 2 weeks of antibiotic course. These diagnosed patients were enrolled for study by simple random sampling.Results: On CT scan chest, 40 patients with consolidation pattern on X-ray chest, reported additional findings of mediastinaladenopathy in 10 patients (20%), pleural effusion in 6 (12%) patients and collapse observed in 2 (4%) patients. Nearly all the patients presented with cough (96%), fever (86%), hemoptysis (40%), shortness of breath (60%), constitutional symptoms (36%), palpable lymph node (16%) and clubbing (22%).Conclusion: Apart from tuberculosis and malignancy as the common cause for non-resolving pneumonia, Age itself act as major risk factor. Other most common risk factors were smoking, diabetes and alcoholism. We should incorporate newer modalities of diagnosis like fiber-optic bronchoscopy; CT scan guided FNAC/biopsy in non-resolving pneumonia.
Key words: Non-resolving pneumonia, Fibre-optic bronchoscopy, tuberculosis.

19.    PRACTICES RELATED TO PRENATAL DIAGNOSTIC TECHNIQUES AMONG ANTENATAL
         CASES                                                                                                                                                  241-246
         Dr. Mahendra Khatri, Dr. Shweta Asthana, Dr. Shivprakash Sharma                               PDF FULL TEXT

ABSTRACT

Background: Gender inequality in India is an acknowledged and well-documented fact, but its causes and its future is still a mystery. Another valuable way of thinking about gender disparity is female empowerment. Moreover, empowerment has the potential to alleviate other aspects of gender inequality, since some women may choose to promote their own or other women’s equality as their goal. Material & Methods: The present community-based prospective and cross-sectional study was conducted at department of community medicine and Zanana Hospital associated with PBM group of hospitals in Bikaner and attached to S.P. Medical College. Study duration was of one year, from September 2011 to January 2012. Results: 12.9 % of study population confessed that they have done MTP during previous pregnancy. Out of 160 women who are willing to do sex determination in future 71.2% (114) women confessed that they will go for MTP after sex determination. In the present study out of 1000 pregnant women we found that 21% of study population has experienced miscarriage in previous pregnancy. Out of them majority (61.43%) have done MTP due to various reasons. Among the total cases who were opted for miscarriage by the means of MTP, 87.1% of study population never done MTP. 11% women have done it once while 1.9% women have done MTP twice during previous pregnancy. Conclusion: Socio-demographic factors like age, literacy, socioeconomic status, parity sex of the previous child and pressure by family or husband affect the practices towards the PC & PNDT Act and woman’s preference for her next child.
Key words: sex determination, PC & PNDT Act, female feticide.

20.    ASSESSMENT OF PRE-OPERATIVE PREDICTING FACTORS FOR A DIFFICULT LAPAROSCOPIC                         CHOLECYSTECTOMY                                                                                                                        247-252
         Dr. Surendra kumar Samar, Dr. Shyam Prakash Mathur, Dr. Rajkumari Samar             PDF FULL TEXT

ABSTRACT

Background: The estimated prevalence of cholelithiasis is approximately around 15% in our country, and the conversion rate from asymptomatic patients to symptomatic patients is approximately around 1-2% who required cholecystectomy as intervention every year. Cholelithiasis is among the commonest biliary pathology which required surgical intervention. Material & Methods: The present was prospective and cross-sectional study and conducted at the department of general surgery of our tertiary care center. Study duration was of one year, from June 2015 to July 2016. A hundred patients who had symptomatic cholelithiasis and gave consent to undergo laparoscopic cholecystectomy were enrolled by in the present study. Results: In the present study we found a statistically significant association between the intra-operative difficulty during laparoscopic cholecystectomy and multiple episodes of acute cholecystitis, acute cholecystitis, palpable gallbladder lump, biliary colic and BMI of the patient. Out of total 19 patients took more than 90 min of intra-operative duration to undergo the laparoscopic cholecystectomy, bleeding more than 100 ml seen in 10 patients, difficult anatomy was found in 15 patients, adhesions with subsequent adhesiolysis was done in 18 patients, difficulty in gallbladder extraction was seen in 19 patients, intra-peritoneal gallbladder contents spillage seen in 28 patients (bile alone and stones along with bile were spilled in 22 and 7 patients respectively) and conversion to open surgeryseen in 4 cases. Conclusion: Increased gallbladder wall thickness, gallstones>2 cm in diameter, acute cholecystitis, gallstone impacted at gallbladder neck, biliary colic, palpable gallbladderand BMI >30 kg/m2 had a significant association with difficult laparoscopic cholecystectomy.
Keywords: Laparoscopic cholecystectomy, Gallbladder, Cholelithiasis, Difficult cholecystectomy.

21.    COMPARATIVE EVALUATION OF BLUNT ABDOMINAL TRAUMA WITH CT SCAN AND                                           ULTRASONOGRAPHY​                                                                                                                       253-257
         Dr. Kundan Lal Porwal                                                                                                        PDF FULL TEXT

ABSTRACT

Background: The emergency care of the patient with blunt abdominal trauma is critical and requires accuracy and efficiency with speed. Treating patients who had blunt abdominal trauma (BAT) is challenging and remains most demanding and criticalfor the acute trauma care. BAT accounts for the common cause of preventable deaths among cases of missed intra-abdominal trauma. Material & Methods: A total of 50 patients who had blunt abdominal trauma who were stable enough to give consent and undergo for both USG and CT scan were enrolled for study by simple random sampling. Clearance from Institutional Ethics Committee was taken before the start of the study and written informed consent for the study purpose was obtained from all the enrolled participants. Results: Out of the 50 patients of blunt abdominal trauma, 44 patients (88%) were detected by ultrasonography and 6 (12%) were missed. However, there was none case (0%) missed by CT scan, thereby having a sensitivity of 100%. This difference was statistically highly significant and the p-value was 0.013. Conclusion: CT scan is highly sensitive and better diagnostic modality for BAT than USG. USG can be preferred as an initial diagnostic modality for blunt abdominal trauma but it can leave some of the crucial and critical details of injuries which need immediate correction for the resuscitation of the patient. Hence, It is recommended if patients condition is stable than USG should be supplemented by CT scan.
Keywords: blunt abdominal trauma, CT scan, ultrasonography.

22.   COMPARISON OF SURGICALLY TREATED FRACTURE FOREARM BONES WITH PLATING IN BOTH                    BONE VERSUS PLATING IN RADIUS AND NAILING IN ULNA                                                        258-263
        Dr Wasim Hussain, Dr Abhishek Gupta, Dr SK Bhaskar                                                  PDF FULL TEXT

ABSTRACT

Background: Internal fixation of radius and ulnar shafts fractures are done by Plate & screw fixation and intra medullary nailing. The purpose of this study is to compare the functional results of both bone plating and combined plate and intramedullary (IM) nail fixation in BFBFs. Material and methods: 34 out of a test group of 52 patients underwent plate fixation only (group A) while 18 (group B) had combined plate and IM nail fixation. Results: According to Grace and Eversmann rating system, group A had 15 excellent, 14 good, one acceptable and one unacceptable result. Group B had 3 excellent, nine good, two acceptable and two unacceptable results. The average DASH score was 7.1 in group A and 15.1 points in group B. Three cases of nonunion achieved a bony union by additional procedures and the functional results of these cases improved to good or excellent. Conclusion: Overall results were a better with DCP fixation in both bones to combined square nail and DCP fixation, especially in case of lower 1/3 transverse fracture of the ulna. Keywords: Internal fixation, forearm bones fracture, plating, nailing.

23. QUANTITATIVE SPECTRAL DOPPLER PARAMETERS FOR DIFFERENTIAL DIAGNOSIS OF                                     PARENCHYMAL THYROID DISEASES                                                                                            264-268
       Dr. Roopa Goyal                                                                                                                      PDF FULL TEXT

ABSTRACT

Background: Thyroid diseases, encompassing a wide array of disorders affecting the thyroid gland, present a significant challenge for radiologists due to their often subtle and overlapping clinical manifestations. The use of quantitative spectral Doppler parameters, such as resistivity index (RI) and acceleration time (AT) has emerged as a promising approach for the differential diagnosis of parenchymal thyroid diseases. The present study aims to evaluate the efficacy of RI and AT in distinguishing between various thyroid pathologies, including Hashimoto's disease, multinodular goiter, and nodular hyperplasia. Methods: A total of 200 adult participants, aged between 18 and 58 years and representing both genders, were enrolled after receiving comprehensive information regarding the study's procedures, associated risks, and potential outcomes. The participants were categorized into five groups based on their clinical presentation and thyroid pathology: normal thyroid function (Group I), newly detected untreated hashimotos disease (Group II), chronic hashitosis under treatment or follow-up (Group III), thyroid cystic lesions (Group IV), and thyroid nodules coexisting with hashiosis (Group V). Results: These differences were statistically significant for both RI (p=0.02) and AT (p = 0.003), indicating distinct thyroid function profiles among patients with different thyroid disorders. Conclusion: The combined assessment of resistivity indices, RI, and AT, proves to be a dependable approach for distinguishing among various thyroid diseases, offering insights that contribute to more effective patient care and outcomes.
Keywords: Thyroid Diseases, Spectral Doppler Parameters, Resistivity Index (RI), Acceleration Time (AT), Hashimoto's Disease, Multinodular Goiter.

24.   ASSESSMENT OF KNOWLEDGE REGARDING ASTHMA & BREATHING EXERCISES
        AMONG BRONCHIAL ASTHMA PATIENTS                                                                                        269-274
        Dr Naresh Kumar, Mrs Sapna Kamdar,  Dr Rakesh K Karnani                                           PDF FULL TEXT

ABSTRACT

Background: Asthma is chronic inflammatory, airway hyper-responsiveness, reversible disorder and patients’ awareness of the disease, medication adherence and treatment outcomes. The objective of the present study was to assess the knowledge of the patients towards their disease and breathing exercise in asthma patients. Materials and methods: This was a cross-sectional hospital-based study in a tertiary care teaching hospital at SMS Medical College, Jaipur for two months. The data was collected by face to face interview of out-patients and inpatients of Medicine departments by administering the questionnaires for the assessment of knowledge towards the bronchial asthma disease and breathing exercise.Results: A total of 60 confirmed case of bronchial asthma were included, out of which male patients were 37(62%) and female patients 23(38%). The knowledge score was assessed in two areas such as knowledge on Asthma and knowledge on breathing exercise with test items of 12 & 9 in each.  The mean knowledge of Asthma was 7.6 ± 2.42 while the mean score of knowledge on Breathing exercise was 4.08 ±1.3.  The overall knowledge on asthma and Breathing exercise has resulted with mean 5.84±1.87. On an average, the sampled subjects had poor knowledge on breathing exercise. Conclusion:This study shows that the knowledge of asthma self-management of adult patients in is low & there is a need to improve knowledge of asthma self-management among adult patients especially those who are less well educated, either via their physicians or by other appropriate means.
 
Keywords: Bronchial Asthma, Breathing exercise, Knowledge, 

25.   EVALUATION OF CYTOLOGICAL ANALYSIS OF ASCITIC FLUID IN OVARIAN CARCINOMA     275-280                  Dr. Vnita Jain                                                                                                                            PDF FULL TEXT

ABSTRACT

Background: Ovarian carcinoma is among the commonest cause of high mortality and morbidity among the cancerous causes all around the globe. However, with advancement in medical science and research the mortality rates had shown declining trends in the past decades. Materials and methods: Ovarian carcinoma is among the commonest cause of high mortality and morbidity among the cancerous causes all around the globe. However, with advancement in medical science and research the mortality rates had shown declining trends in the past decades. Results: 62.2% patients had serous cystadenomas, mucinous cystadenomas was found in 19.5% of the cases, dermoid cysts were present in 12.2% of patients and fibromas present in 2.4% of the cases. There was only one sample of mucinous cystadenoma with Brenner tumor. Among the two false positive samples, one was of tubercular salpingo-oophoritis and another was sample of non-specific chronic salpingo-oophoritis. out of the malignant tumors, most common were serous cystadenocarcinomas, which was found among 50% of the cases. We found three cases of Krukenberg tumors, along with two- two cases of mucinous cystadenocarcinomas and endometrioid carcinoma of ovaries respectively. In the present study we found two false negative cases one was of yolk sac tumor and second case was of teratoma with squamous cell carcinoma. Conclusion: The ascitic fluid cytology for detecting the ovarian carcinoma is a highly specific (97.6%) and highly sensitive (88.9%) with the positive predictive value of 88.9% and negative predictive value of 97.6%. The accuracy of ascitic fluid cytology was found to be 96%.
Keywords: Ascites, Ovarian carcinoma, Peritoneal fluid cytology.

26.   PREVALENCE OF NASH IN NAFLD PATIENTS WITH PRE-DIABETES AND DIABETES MELLITUS
                                                                                                                                                                     281-285                   Dr. Arun Kumar                                                                                                                     PDF FULL TEXT

ABSTRACT

Background: Prevalence of pre diabetes and diabetes is increasing with the increasing number of patients with NAFLD or NASH. Previous studies have suggested pathological linking of diabetes mellitus type 2 with NAFLD. Impairment of insulin metabolism, either insulin resistance or hyperinsulinemia with oxidative stress and inflammation contribute to development of diabetes and NAFLD. Material & Methods: The present single Centre observational study was conducted at Mahatma Gandhi Medical College and Hospital, Jaipur. The study was conducted in Department of Biochemistry in association with Department of Gastrologer & Endocrinology. The study was conducted in duration of one year, after seeking approval from the Institutional Ethics Committee. Results: Total 200 patients were enrolled for the study. The mean age of subjects of both groups was comparable. All indices of diabetic profile namely blood sugar fasting, blood sugar postprandial, HbA1c, insulin and HOMA-IR were significantly significant in the diabetic subject as compared to pre Diabetics group. The prevalence of NASH is in Association with the progression from pre diabetic to diabetic conditions positively affect the occurrence of NASH and it was found statistically significant. However glycemic index measured by HbA1c did not have a significant impact on the occurrence of NASH in enrolled NAFLD patients. Conclusion:  The diabetes patients are at high risk to develop NAFLD or worse condition. Early diagnosis of NAFLD helps patients to improve their condition with NAFLD by daily exercises and with Lifestyle changes and the prognosis would be better.
Key words: NAFLD, Diabetes, Pre-diabetes, NASH.

27. EVALUATION OF ELECTROLYTE IMBALANCE IN MYOCARDIAL INFARCTION PATIENTS AT TERTIARY              CARE CENTER                                                                                                                                     286-290               
       Dr. Sunil Kumar Jain, Dr. Ramesh Chand Sharma                                                              PDF FULL TEXT

ABSTRACT

Background: Cardiovascular disease is among the leading causes of mortality and morbidity across the globe. According to the World Health Organization (WHO), cardiovascular disease as a non-communicable disease is a modern epidemic. Acute myocardial infarction (AMI) is one of the manifestations of cardiovascular disease leading to mortality and morbidity.  Material & Methods: The present case-control study was conducted at of our tertiary care hospital, with a study duration of six months from January 2018 to June 2018. We enrolled 50 patients with AMI and 50 healthy controls in the present study. Clearance from Institutional Ethics Committee was taken before the start of the study. Results: There were 38 male and 12 female patients in the present study. Mean age of male patients was found to be 58.12 ± 14.28 and female patients was 51.27 ± 13.26. We found a statistically significant difference among serum concentration of sodium between control (94.315±4.372 mmol/L) and case group (83.598±5.424 mmol/L). There was a non-significant difference observed related to serum potassium and serum chloride concentration. We found statistically significant difference among serum concentration of serum calcium (p-value = .004) and magnesium (p-value = .001). Conclusion: Assessment of serum electrolytes is very significant and important for the diagnosis and prognosis of acute MI. The present study shows that lower values of serum sodium were reported in patients with acute MI as compared to healthy controls.
Keywords: Acute MI, Hypokalemia, Hyponatremia, Serum electrolytes

28.   BURDEN OF ROTAVIRAL DIARRHEAL CASES AT TERTIARY CARE HOSPITAL                            291-295
        Dr.Jaswant Mahawer                                                                                                               PDF FULL TEXT

ABSTRACT

Background: Rotavirus is highly contagious, with a very low infective dose of fewer than 100 virus particles. These viruses are shed in high concentrations in the feces of infected children and can spread through feco-oral routes, fomites, close person-to-person contact, and even through fecally contaminated food, water, and respiratory droplets. Material & Methods: The present cross sectional, prospective study was carried out at department of Pediatric, at our tertiary care hospital. The study duration was of six months from July 2017 to December 2017. In this prospective study we enrolled 100 children of age up to 5 years presented at outpatient department with a diagnosis of acute watery diarrhea and enrolled by simple random sampling. Results: In the present study, out of total enrolled participants, on the basis of clinical diagnosis it was found that 30% children were diagnosed with Rota viral diarrhea and 60% children were diagnosed with non-rota viral diarrhea. On the basis of comorbidities among rotaviral diarrheal cases it was found that 44% children had mild diarrhea, 34% children had moderate diarrhea and 22% children had severe diarrhea. 70% children had vomiting, 60 % children had fever and 70% children were lethargic. There was no mortality reported in present study. Conclusion: We concluded from the present study that; rotavirus is a public health concern. Proper surveillance is essential to determine the exact prevalence of the disease, both among admitted children in hospitals and those in the community.
Keywords: Rotavirus, Acute diarrhea, Dehydration.