Volume 5 Issue 3

ABSTRACT

Denture stomatitis is an inflammatory reaction of the oral mucosa associated with the use of partial or complete dentures and has multi-factorial etiology. Ill-fitting dentures and poor oral hygiene are most common etiological factors cited for denture stomatitis. Here, we present a case of 75 year old female patient who reported with the chief complain of burning sensation in mouth since 8 - 10 months. Intraoral examination revealed inflammatory hyperplasia of maxillary alveolar mucosa. Patient was provisionally diagnosed with denture stomatitis. Confirmation of diagnosis was done by brush biopsy which revealed class II atypical.
Keyword:. Stomatitis, oral mucosa, maxillary alveolar mucosa.

International Journal of Medical Sciences and Education (IJMSE)
Vol. 5; Issue: 3 (July -September 2018), Date of Publication: 01.10.2018

Table of Contents
Editorial 292-293
THE TEACHING OF ETHICS TO MEDICAL STUDENTS TO SOLVE THE PROBLEMS OF A REAL-LIFE SITUATION
Dr. Reshu Gupta PDF FULL TEXT

1. NAVIGATING MENTORSHIP OF UNDERGRADUATE STUDENTS IN INDIA: THE STUDENTS’
PERSPECTIVE 294-296
Dr. Md Mojahid Anwar, Dr. Mohd Asrarul Haque, Hena Fatma, Dr. Afzal Ahmad,
Dr. Munawwar Husain PDF FULL TEXT

ABSTRACT

Mentoring under graduate medical students is not easy as it appears to be. In India as elsewhere, selection to medical course i.e., MBBS is highly competitive with 1:400 ratio of competing students. Therefore, it can be surmised that entrants are well read, computer savvy and language erudite. If they need mentoring that should be done by qualified mentors possessing inclination and virtue of a mentor. A mentor just cannot fool one and all medical mentees. Therefore, there should be an established process of mentoring in which the students should be free to question and raise doubts. It should a two way channel. With important apex national bodies like Human resource development (HRD), medical Council of India (MCI), University Grants Commission (UGC), Indian Medical Association (IMA) etc., the mentor must take the task seriously and goal oriented.
Keywords: MBBS students mentoring, assessment of mentor, assessment of mentee, mentoring tools

2. THE ANATOMY TEACHING ADVENTURE OF AN AMERICAN FULBRIGHT SCHOLAR IN THE MIDDLE EASTERN STATE OF QATAR: FACILITATING STUDENT SUCCESS WITH TARGETED COMMON ISLAMIC RELIGIOUS NUANCES, MNEMONICS AND ONLINE RESOURCES 297-299
Walid M. Al-Ghoul PDF FULL TEXT

ABSTRACT

Standard audio-visual tools of teaching require enhancement in topics such as anatomy where the students are required to memorize numerous terms often likened to learning a new language. Such challenge is more paramount when English is not the students’ first language as is the case of Qatar University (Doha, Qatar) where I served as a Fulbright Teaching/Research Scholar. In this work, I share my discovery of a novel connection between the layout of the appendicular skeleton and Islamic practices in the daily lives of my students. Specifically, upper limb bones could be related to the Muslims’ five obligatory daily prayers which are called and practiced almost everywhere in the Middle East including most buildings at Qatar University. Amazingly, this seemingly-simple parallel was a turning point in enhancing student engagement and motivation, which was thence maintained by mnemonic and online resources, with the ultimate outcome of hundred percent student success rate and success along with an overwhelmingly positive student feedback.
Keywords: Skeleton, appendicular, mnemonics, Islamic prayers, Fulbright scholar, Middle East

3. COMPARATIVE STUDY OF CASE BASED LEARNING WITH TRADITIONAL TEACHING METHOD IN PATHOLOGY FOR SECOND YEAR MEDICAL STUDENTS 300-305
Dr. M.Janaki, Dr. Payasam Rajeswari, Dr. Hasham Hussain, Dr. Kanaka Sreedhar Babu PDF FULL TEXT

ABSTRACT

Background :Case based learning (CBL), is a learning method aids learner to reorganize, elaborate their information and provide connection between current and new information. Moreover CBL is student centered, taken in small groups where teacher acts as facilitator or guide. Objective To perceive the need for initiating CBL , this study aimed to compare the pathology teaching among second year medical students with that of traditional teaching. Methods This is an observational study conducted from September 2016 to April 2017. This research study was conducted on all 98 students of II MBBS students. Ten ideal case scenarios on the topic of myocardial infraction and diabetes mellitus were prepared, and pre validated by the faculty of pathology and medical education department.CBL was introduced and total three sessions were conducted and compared with traditional teaching. Results The mean (±SD) value of the score of gain in knowledge was 3.99±1.88 (n=98) for the batch of students who attended case based learningwhile the mean (±SD) gain in knowledge for the batch who underwent TL was 2.63±2.31 (n=98).A paired t-test comparing didactic lectures with self-directed learning showed that the scores following didactic lectures were more compared to SDL and the results were statistically significant. An unpaired t-test comparing case based learningto SDL also showed statistically significant gain in knowledge following didactic lectures. Conclusion This study clearly showed that CBL is more effective over traditional teaching for our second year MBBS students and for covering a wider area.
Key words : Case based learning, pathology, traditional learning

4. LEARNING APPROACHES OF MEDICAL STUDENTS IN A GOVERNMENT MEDICAL COLLEGE, WEST BENGAL 306-313
Dr. Subhabrata Kumar PDF FULL TEXT

ABSTRACT

Background :Case based learning (CBL), is a learning method aids learner to reorganize, elaborate their information and provide connection between current and new information. Moreover CBL is student centered, taken in small groups where teacher acts as facilitator or guide. Objective To perceive the need for initiating CBL , this study aimed to compare the pathology teaching among second year medical students with that of traditional teaching. Methods This is an observational study conducted from September 2016 to April 2017. This research study was conducted on all 98 students of II MBBS students. Ten ideal case scenarios on the topic of myocardial infraction and diabetes mellitus were prepared, and pre validated by the faculty of pathology and medical education department.CBL was introduced and total three sessions were conducted and compared with traditional teaching. Results The mean (±SD) value of the score of gain in knowledge was 3.99±1.88 (n=98) for the batch of students who attended case based learningwhile the mean (±SD) gain in knowledge for the batch who underwent TL was 2.63±2.31 (n=98).A paired t-test comparing didactic lectures with self-directed learning showed that the scores following didactic lectures were more compared to SDL and the results were statistically significant. An unpaired t-test comparing case based learningto SDL also showed statistically significant gain in knowledge following didactic lectures. Conclusion This study clearly showed that CBL is more effective over traditional teaching for our second year MBBS students and for covering a wider area.
Keywords : Case based learning, pathology, traditional learning

5. DEVELOPMENT AND VALIDATION OF COMPETENCY GAP ASSESSMENT TOOL FOR REPRODUCTIVE HEALTH CURRICULUM FOR RESOURCE-POOR SETTINGS 314-320
Dr. Ankur Joshi, Ajay Halder PDF FULL TEXT

ABSTRACT

Background:: To construct an integrated tool serving the dual purpose of establishing specific competencies to be attained in reproductive health for Undergraduate students and to measure the extent of exposure pertaining to set competencies. Methods: A listing of potential competencies in reproductive health was done through the Delphi technique in the background of the theoretical framework. The refined competencies list (39 items) was shared with 29 experts for assessing the content validity. Items with Content Validity index [CVI] <0.80 were removed. The structured questionnaire with 34 items was distributed among 140 faculties from 12 medical colleges. Responses were analyzed for normality and suitability for Principle Component Analysis. Reliability of the questionnaire was ascertained by split-half reliability and Chroanback Alfa. Result: Total 34 items finalized through consensus, Suitability for Principle Component Analysis was checked by R-matrix determinate value(R=0.045) and by Kaiser –Meyer-Olkin (KMO) test (0.634). Five factors emerged namely- exposure to theoretical knowledge for decision making, demonstration of relevant skills, exposure to Health activism, exposure to personal attributes and advocacy to evidence-based practices. Promax rotation methods were used for factor loading (component co-relation matrix value of 0.40 between factor-1 and factor-2). Internal consistency value was determined as 0.907. The correlation between the sums of each item was computed as 0.545. The spearman-brown coefficient value was detected as 0.705. Conclusion: A reliable and valid tool has been developed which can measure the curricular exposure to reproductive health competencies at primary care level.
Keywords: Competency, Principle Component Analysis, competency-based education, validity, reliability

6. WORK RELATED STRESS AMONG MEDICAL TEACHERS: A QUESTIONNAIRE BASED OBSERVATIONAL STUDY 321-327
Dr.Swapnali.S.Kadam, Dr.Surekha.S.Khedkar, Dr.Tushar.R.Bagle PDF FULL TEXT

ABSTRACT

Background: Medical profession has witnessed a tremendous change in the last four decades, this has caused an increase in work stress in the Medical teachers. Material & Methods: A questionnaire-based study was done in medical teachers from government, semi-government and private medical college and teaching hospitals that was cross sectional observational. Institutional Ethics Committee permission was taken before starting the study. Test–retest reliability was estimated with a subsample of 10 medical teachers by taking two interviews seven days apart. The stress questionnaire was prepared from occupational stress the Bristol and Stress and Health at Work Study. Stress questionnaire had components that included Autonomy (5), Work condition (3), Communication & Relationships (5), Stress / Work out (8), Attitude (3), Support (5), Self Confidence (3), Social life (6), Performing meaningful work (3). Results: The average age in our study was 42.05 ± 9.22years. There were 45 females and 55 males. The total stress score in medical teachers was 119.45 ± 11.46, in clinical teachers was 117.15 ± 10.86 and in preclinical and paraclinical teachers was 121.8 ± 12.07 (p=0.045). The teachers had problems of insufficient space, sitting arrangement that was seen more in preclinical and paraclinical teachers while exposure to infectious diseases was seen more in clinical teachers. Teaching was done more by preclinical and paraclinical teachers and research more by clinical teachers. Conclusion: Stress is highly neglected by medical professionals. It is important to take steps to relieve the medical teachers of various stressors in the medical profession.
Keywords: Fatigue, Clinical, Teaching, Research,

7. A STUDY OF FACTORS INFLUENCING LEARNING IN MEDICAL STUDENTS 328-334
Dr. Udaragudi Prasada Rao,Dr. Samson Sanjeeva Rao Nallapu PDF FULL TEXT

ABSTRACT

Background: Adaptation of teaching methods according to students’ learning manners is likely to improve their motivation and performance. Teachers are accountable to present educational content and skills in diverse ways in tune with the varying learning modes of their students.Objective: To identify factors influencing medical students’ study routines and behaviors in a medical college from South India and to identify their learning style preferences.Methods: This cross-sectional study done at NRIMC, Guntur from July to September 2015, involved 282 medical students from the 5th and 7th semesters. A Likert type questionnaire enquired into factors like gender and semester differences and learning habits. Fleming’s questionnaire on VARK (Visual, Aural, Read & Write and Kinesthetic) was used to identify learning styles. The findings were subjected to Chi square test at 5% level of significance. Result: Female students prefer to understand subject matter, (p 0.02) and desire academic achievement (p 0.014). Statistically significant factors affecting the 5th semester students (compared to 7th) include, teacher related factors (favoritism, personality, ability to inspire) and a gap between self appraisal and academic achievement, (p 0.0000003). Attitudes, peer pressure, assessment and feedback were seen to be important. As in other studies, almost half (49.3%) prefer a single style (unimodal). Learning style inclined significantly towards Kinesthetic. Conclusion: In addition to gender, many other factors play a significant role in learning. Learning experiences also differ between batches with the teacher playing an important role. As kinesthetic style is the preferred one in a majority of students, there is a need for less lecturing and more hands on experiences.
Keywords: medical student, study habits, VARK, learning styles, performance, attitudes.

8. LEARNING STYLE PREFERENCES OF MEDICAL AND DENTAL STUDENTS: AN OPEN LABEL, VARK QUESTIONNAIRE BASED STUDY 335-342
Dr. Kranti Tekulapally, Dr.Vibha Rani, Dr.Padmavathi PDF FULL TEXT

ABSTRACT

Background: Learning style preferences vary among individual students.Knowing the learning styles of students will guide the faculty in tailoring their teaching methodologies to their learning styles so that they can acquire maximum knowledge and their performance can be improved.Materials and Methods: An open label cross sectional study was conducted among 231 medical students and 168 dental students belonging to Malla Reddy Group of Institutions, Suraram, Hyderabad. Paper copies of validated Visual-Aural-Reading/Writing-Kinesthetic (VARK) questionnaire consisting of 16 questions were administered to the students after taking informed consent. The responses were scored according to VARK scoring chart and were sent to the copyright holder of VARK questionnaire to convert them into VARK categories. Out of two algorithms assigned to each student, scores obtained from research algorithm were used to analyze by using descriptive statistics.Results: Majority of the students had unimodal (60.1%) learning styles while multimodal learning styles were only 39.8%. Among the unimodal learning styles, Visual mode of learning style was most preferred (58.27%).Conclusion: Since majority of the students are unimodal visual learners who learn best by visualizing the information, faculty should try to incorporate many charts, pictures, and illustrations in their teaching methodologies. Students should also be taught some strategies to learn better which includes concept maps, color coding and flash cards.
Keywords: Learning styles, Medical students, Dental students, Teaching – learning methodologies

9. ATTITUDE AND COMMUNICATION IMPLEMENTATION – 6 MONTHS EXPERIENCE WITH MBBS STUDENTS 343-352 Dr. Balaji Arumugam, Sneha Moan, Dr.Sowmya KR, Dr.Sree T Sucharita PDF FULL TEXT

ABSTRACT

Background: “A good physician treats the disease;a great physician treats the patient who has the disease.” To become a successful practitioner the most important skill is the ability to connect and communicate with patients. The paternalistic model of health care which focussed more on physician’s opinion has now been widely replaced by the new model which engages the patient in active decision making. An effective communication benefits both the patient and the doctor. Communication skills’ training in medical curriculum is still in the nascent period in our country. Priming medical students in effective doctor patient communication is important to establish good doctor patient relationship and to be a successful physician. Knowing its importance, in this article, a detailed review will be presented on the communication skill training given to students on the importance of effective doctor-patient communication in health care set-up. We implemented seven modules specified in the ATCOM (Attitude and Communication) as per the MCI guidelines and Sri Ramachandra Medical College and Research Institute FDP training to second year medical students. This training proved to be successful in fostering the importance of doctor patient relationship and has also helped to mould the students towards patient centered approach.
Keywords: Communication skills, medical curriculum, medical students, ATCOM (Attitude and Communication).

10. EFFECTIVENESS OF PRE AND POST EVALUATION METHOD OF TEACHING
IN MEDICAL PROFESSION 353-357
Neetha Kundoor, Radhakishan Narsini PDF FULL TEXT

ABSTRACT

Background: Medical education is emerging with new compelling instructional tools and methods of teaching medical concepts, providing new learning possibilities for the faculty and student. Assessments could be invaluable; this helps teachers to identify the strengths and weaknesses of each student and it also helps to guide the next steps in instruction. Pre-evaluation in one of the techniques to improvise students attention and cognitive skills to get the concepts more clearly when taught by the faculty. Objective: The present study is taken up to learn the effect of pre and post-evaluation in understanding medical biochemistry by the students. Material and Methods: A total of 100 first year MBBS students were involved in the study. MCQ questions were given to the students as prior to the class as pre-evaluation. Same MCQs was given to them after the class as post evaluation. After completion of the chapter students, perceptions were collected using a standard questionnaire. Results: The scores were high in post-assessment when compared to the pre-evaluation and were statistically significant p < 0.0001. Majority of the students strongly agreed that the use of the evaluation method was useful in medical education. Conclusion: Pre and Post- evaluation is one of the useful tools to improve the concentration and understanding of the concepts by the medical students, it is a different approach to make the didactic lectures more interesting. It improves the attention of students to learn the concepts with great ease.
Keywords: Evaluation, Biochemistry, Medical education.

11. A STUDY TO FIND OUT ASSOCIATION BETWEEN MORPHOMETRY OF PLACENTA AND NEONATES PROFILE AT TERTIARY CARE TEACHING HOSPITAL, BIKANER 358-363
Shabnam Qureshi, Dr. Jaskaran Singh, Dr. Mukesh Fulwaria, Dr. Om Prakash Yadav PDF FULL TEXT

ABSTRACT

Background: Morphometry of placenta reflects the development of fetus and disease pattern in later in life. Therefore a study was conducted to find out the association between morphometry of placenta and neonates profile at the tertiary care teaching hospital, Bikaner. Materials and Method: One hundred routine delivery cases in the Department of Gynecology & Obstetrics were interviewed, and the placentas required for measurements were collected from respective mothers. Results: Out of the 100 pregnant women 74 were uniparous, 21 were biparous, and five were multiparous. Out of hundred cases recorded the maximum pregnant women weight groups were 56 to 60 kilograms found. The mean value for the neonate weight was calculated as 2832.94 grams. Seventy-seven and twenty-three subjects had the round and oval shape of placenta respectively. No other shape was found in the present study. Conclusion: Placental morphology like weight, surface area, gender, and volume reflects the birth weight effectively for the planning of better maternal care.
Keywords: Placental Morphometry, Newborn, Pregnant Women

12. CLINICAL PROFILE OF ACUTE ALCOHOLIC LIVER DISEASE 364-368
Dr. Ravindra K Hadakshi, Dr Gaurav Modi PDF FULL TEXT

ABSTRACT

Background: The Alcoholic liver disease has a varied spectrum of complications ranging from liver steatosis to severe liver cirrhosis. Liver disorders from alcoholism were reported since ancient times. Chronic and excessive alcohol abuse is the most common known causes of chronic liver disease worldwide. In India also alcoholism is the most common cause of the eclectic range of liver diseases. Material & Methods: A total of 100 patients were enrolled for study, who were attending the OPD of general medicine department of Zydus medical college and hospital, Dahod Gujarat. The patients who were diagnosed clinically and also biochemically as acute onset alcoholic liver disease enrolled for study by simple random sampling. Results: The most common clinical feature reported among patients of alcoholic liver disease was nausea and vomiting seen in 84% of patients, which was followed by jaundice, which was reported among 83% of cases. The third most common feature was hepatomegaly which was present in 68% of patients, accompanied by signs of liver failure present in 60% of patients which was followed by anorexia present in 56% of patients. Splenomegaly was present in 35% of patients, fever was present in 31% of patients, abdominal pain was present in 26% of cases, and ascites was reported among 17% on patients. Conclusion: Alcohol consumption in larger quantities over a longer duration of time leads to high morbidity and even mortalities. Alcoholic liver disease is a social burden which required frequent hospitalization and results to be unwanted out of pocket expenditure, economic loss along hindrance for the health care system.
Keywords: alcoholic liver disease, hepatomegaly, liver cirrhosis.

13. CORRELATION BETWEEN DIABETIC RETINOPATHY AND LIPOPROTEIN(A)IN PATIENTS WITH TYPE 2 DIABETES MELLITUS 369-373
Dr.Kavita bansal, Dr. Nikhil Agrawal, Dr.Mahendra K. Jharwal PDF FULL TEXT

ABSTRACT

Background: Retinopathy is a significant complication among patients of diabetes mellitus. Raised serum Lipoprotein(a) [Lp(a)] levels have found to be an independent risk factor for thromboembolic events and atherogenesis. Also, the capillary occlusion is a frequent observation in diabetic retinopathy, Lp(a) is postulated to play a critical role in the initiation and progression of diabetic retinopathy. Material & Methods: 200 patients with type 2 diabetes mellitus of five years or more duration were enrolled for study by simple random sampling. Patients enrolled in this study have been diagnosed to have type 2 diabetes mellitus as per the American Diabetes Association criteria. Among these 200 patients, 100 patients who had no retinopathy served as the control group, and 100 who had retinopathy enrolled in the study group. Results: The average Lp(a) levels in patients who had retinopathy were 69.38 mg/dl and in the control group 28.11 mg/dl. This difference was obtained to be statistically significant.TheLp(a) levels in patients who had NPDR were 66.49 mg / dl and in patients with PDR Lp(a) levels were 105.10 mg/dl. This difference was also reported to be statistically significant. On applying logistic regression analysis, diabetic retinopathy was reported to be statistically related to serum Lp(a) levels (P<0.001, odds ratio 1.068). Conclusion: Lipoprotein (a) levels were found significantly greater in patients with diabetic retinopathy in comparison to patients who had no retinopathy. Hence Lipoprotein (a) may act as an independent risk factor for developing diabetic retinopathy.
Keywords: Diabetic retinopathy, lipoprotein(a), diabetes mellitus.

14. A COMPARATIVE STUDY OF PREOPERATIVE TRANSARTERIAL EMBOLIZED V/S UNEMBOLIZED CASES OF JUVENILE NASOPHARYNGEAL ANGIOFIBROMA 375-384
Dr. Anjani Kumar Sharma, Dr. Khushboo Jain, Dr. Shubash Manth, Dr. Digvijay Singh Rawat, Dr. P C Mishra PDF FULL TEXT

ABSTRACT

Background: Aim: This prospective study was conducted to assess and compare the effect of preoperative transarterial embolization v/s non embolization in nasopharyngeal angiofibroma patients on intraoperative blood loss in different stages of tumor and local tumor recurrence. Patients and Methods: 40 male patients of diagnosed Juvenile angiofibroma from May 2012 to Sept 2017 were randomly divided into 2 groups. Group A included 20 patients who underwent preoperative transarterial embolization by polyvinyl alcohol particles and underwent surgery 24-72 hours later while Group B included 20 patients who underwent surgery directly without preoperative embolization. Tumors were graded using Fisch classification. We measured intraoperative amount of blood loss and did follow up scans for assessment of tumor recurrence. Results: The mean amount of blood loss in Group A patients was 350 ml while in Group B patients was 1000 ml. No residual tumor was seen in Group A patients (0/18) on 6 months follow up while residual tumor was seen in 4 patients in Group B (4/17). The technique of embolization was safe with no procedure related mortality. Conclusion: Preoperative embolization of JNA is a safe and effective method to significantly reduce intraoperative blood loss there by making tumor resection easier and complete and reducing the chances of residual disease.
Keywords: Juvenile Nasopharyngeal Angiofibroma, Embolization, Bleeding

15. DEPRESSION IN GERIATRIC AGE GROUP: MAGNITUDE AND ITS RISK FACTORS 385-389
Dr. Anup Mitra, Dr. Abdul Sajid PDF FULL TEXT

ABSTRACT

Background: Depression is a significant public health problem in the present scenario among developing countries. This problem of depression is not new, in the 1990, the World Health Organization (WHO) classified depression as a major public health problem and cause of disability around the globe. Material & Methods: In the present study, a total number of 200 patients were included in the study by simple random sampling over a period of one year. Cognitive impairment was evaluated by application of the Mini-Mental State Examination (MMSE), and study participants with an MMSE score of less than 25 (cognitively impaired) were excluded from the study. Results: Mild depression was present in one-fourth (28%) of the study population followed by moderate depression (12%). Out of total 3% of the elderly were severely depressed. Females were found to be more diagnosed with depression than males (p <0.001). The proportion of study participants in higher socioeconomic strata (middle and above) were reported to have more depressive symptoms than the lower one (p <0.001). Even the association between depression and financial dependency was found to be statically significant (p <0.001). Conclusion: The study concluded the need for the development of community-based comprehensive mental health programs for prevention, early diagnosis and prompt treatment of depression among the geriatric population and as well as to promote the overall mental health.
Keywords: Depression, Morbidity, Elderly.

16. EVALUATION OF ACUTE RENAL OBSTRUCTION BY USING DOPPLER SONOGRAPHY 390-394
Dr. Kundan Lal Porwal PDF FULL TEXT

ABSTRACT

Background: Acute renal obstruction is the most common presenting condition observed in inpatient departments as well as in outpatient departments. Unilateral obstruction is more common than bilateral obstruction and resultant for minimal change in patient's renal function, but in the bilateral obstruction, cases show deteriorate renal functions although it is less common. Methods: All the cases which were presented to the emergency department with unilateral acute renal colicky pain within 24hof onset of symptoms were considered for this analysis. A total of 50 patients who had unilateral acute renal obstruction were enrolled for study by simple random sampling. Hence we had 50 healthy kidneys which were served as controls and 50 obstructed kidneys which were served as cases. Result: The mean resistivity index (RI) was reported, and it was found higher in the cases with obstructed kidneys diseases compared to unobstructed kidneys. In 56% of the cases, evaluation was done between 6-12 hours, within 13-18 hours in 24% of cases and within 19-24 hours in 20%. The mean resistivity index of the obstructed kidney diseases with proximal obstruction was found to be higher (0.70 ±0.02), than with the distal obstruction (0.68 ± 0.02). The mean resistivity index value incomplete renal obstruction (0.71 ±0.02) was statistically higher than partial renal obstruction (0.68 ±0.02). Conclusion: Doppler ultrasound was the better diagnostic modality for the acute unilateral renal obstruction and even detects an obstruction when there were negative USG results.
Keywords: Doppler ultrasound, resistivity index, acute renal obstruction.

17.    ORAL MISOPROSTOL V/S INTRAVAGINAL DINOPROSTONE GEL IN PREMATURE RUPTURE OF
  MEMBRANES AT TERM: COMPARATIVE STUDY 395-400
Jain Vimla, Sharma Archana, Gupta Meeta   PDF FULL TEXT

ABSTRACT

Objective: To compare the efficacy and safety of oral misoprostol and intravaginal dinoprostone gel for induction of labour in premature rupture of membranes at term gestation. Methods: One hundred woman with premature rupture of membrane at term fulfilling inclusion criteria for the study, were consented to participate in this study. 50 cases were included in misoporstol group and a 75 microgm misoprostol tablet (3/4 of 100microgm tablet) was given orally. Another 50 cases were included in dinoprostone gel group, instilled in posterior fornix of vagina. Two groups were compared with respect to mode of delivery, labour characteristics, neonatal and maternal outcome. Results: The mean induction to active phase of labour duration was significantly shorter in misoprostol (3.23±1.34hrs) as compared to PGE2 gel (3.93±1.74 hrs, p<0.05). The mean interval from induction to delivery was also significantly shorter in misoprostol group [(5.41±1.2 hrs) v/s (6.37±1.66 hrs)p<0.001]. Tachysystole and hyperstimulation observed more in PGE2 gel 8 % and 6% as compared to 6% and 2% in misoprostol group. There was no difference in regard to rate of cesarean delivery. Apgar score at 1 and at 5 minutes, NICU admission, maternal and neonatal outcome had no significant difference in both group. Conclusions: oral misoprostol is more effective and as safe as intravaginal dinoprostone gel for induction of labor in premature rupture of membrane at term.
Keywords: premature rupture of membrane at term, oral misoprostol, intravaginal dinoprostone gel, induction of labor.

18.    EVALUATION OF CLINICAL PROFILE AND ASSESSMENT OF RISK FACTORS AND OUTCOME
  AMONG PATIENTS OF ISCHEMIC HEART DISEASE 401-405
  Dr. Jagdish Chandra Sharma, Dr. Rajesh Khoiwal   PDF FULL TEXT

ABSTRACT

Background: The prevalence of communicable diseases shows decline in the 20th century and as a result there was increase in life expectancy and a major shift from the communicable to non-communicable diseases throughout the world. During this epidemic transition, cardiovascular diseases (CVD) reported as the most common cause of morbidity and mortality worldwide. Material & Methods: The present cross-sectional prospective study was conducted at department of general medicine of our tertiary care hospital. 60 Patients who were diagnosed for unstable angina on basis of classical sign of angina chest pain or with ECG finding showing ST segment depression in consecutive 2 leads and with a normal serum trop -T levels were included in the study. Results: In present study, out of 41 participants who had post prandial hypertriglyceridemia,34 had diabetes mellitus and 07 had normal blood sugar levels. out of 19 participants who had post prandial hypertriglyceridemia, 06 had diabetes mellitus and 13 had normal blood sugar levels. There was significant association found between diabetes mellitus and high PP4TG level (p value 0.001). Out of 41 participants who had post prandial hypertriglyceridemia,28 had low fasting HDL levels and 13 had normal fasting HDL levels. out of 19 participants who had post prandial hypertriglyceridemia, 07 had low fasting HDL levels and 12 had normal fasting HDL levels. There was significant association found between HDL Level and high PP4TG level (p value 0.022). Conclusion: In present studysmoking, hypertension, diabetes mellitus and dyslipidemia are important cardiovascular risk factors. Postprandial hypertriglyceridemia was found to be strongly associated with Diabetes Mellitus. Postprandial hypertriglyceridemia despite normal fasting triglyceride may be independent risk factor for atherosclerosis subsequently ischemic heart disease.
Key words: Cardiovascular risk factors, Diabetes Mellitus, Dyslipidemia, Ischemic heart disease

19.    STUDY OF PRODUCTION OF ALLO-ANTIBODIES IN MULTIPLE TRANSFUSED THALASSEMIA
PATIENTS IN PEDIATRIC AGE GROUP (2-16 YEARS) 406-410
    Dr. Jitendra Kumar Gupta, Pawan Kumar, Usha acharya   PDF FULL TEXT

19 ABSTRACT

Background- Thalassemia is a inherited disorder in which abnormal haemoglobin is form which required regular blood transfusion. Due to regular transfusion there are chances of transfusion of unexpected antibodies other than anti A and anti B. Aim-is to detect and subtype these unexpected antibodies in serum of multitransfused patient in Jaipur. Materials & Methods- A total of 100 patients of proven Thalassemia were included in study at Mahatma Gandhi Medical College & Hospital and JK Lon Hospital, Jaipur. Information on transfusion history was recorded, 5 ml of blood was collected from each subject and plasma was separated. These samples were subjected to direct Coomb Test by CGA (Column Gel Agglutination) technique. Result- In the present study, the Allo-antibodies which were most common among the 7 positive samples out of 100 are Anti D, Anti K, Anti E and Anti MN with an incidence of 28.57%, 28.57%, 28.57% and 14.3% respectively. Blood group O had maximum number of Allo-antibodies (57%). According to number of transfusions, Allo-antibodies of Thalassemia major patients showed statistically significant increase with increase in number of transfusion. Conclusion- From the current studies, it can be concluded that Allo-antibodies to minor group also cause hemolysis and they required more frequent blood transfusion.
Keywords: CGA, alloantibody, DCT, thalassemia, paediatric age, mean frequency

20. POST-OPERATIVE OUTCOME EVALUATION OF MOBILIZATION AMONG OPERATED
CASES OF TIBIAL FRACTURE 411-415
Dr. Yogesh Kumar Gautam, Dr.Saleh Mohammed Kagzi PDF FULL TEXT

ABSTRACT

Background: The incidence of road traffic accidents (RTA) is increasing day by day in today’s mechanizing modern world. It is the parallel effect of our scientific and technological progress. This increase in RTA is proportional to increased incidence of polytrauma associated with complicated musculoskeletal injuries along with post traumatic problems, stress and fracture disease. Material & Methods: The present cross-sectional prospective study was conducted at department of orthopedics of our tertiary care hospital. 100 Patients who had unilateral, distal tibial shaft fractures and operated with either intramedullary nailing or plating were enrolled for the study. Results: In present study in 57% cases left limb was affected. In majority of cases 66% mode of injury was RTA. This was followed by fall from height 31%. In the present series full weight bearing time was early (<3 weeks) with 60% and 40% patients within delay (>3 weeks) of surgery. VAS score was significant (<0.05) better in first month (7.6±084) and (2.3±0.5) six month in early (<3 weeks) mobilization. In delay mobilization (>3 weeks) VAS score was statistically significant (<0.05) better in first month (8.1±0.3) and (3.4±0.4) six month. Conclusion: Closed interlocking nailing in distal tibial fractures appears to provides adequate stabilization and helps in early weight bearing in most of cases.
Key words: Tibial fractures, VAS scoring, Mobilization.

21. AGE SPECIFIC PREVALENCE OF STRABISMUS IN WALK IN POPULATION OF A TERTIARY
EYE CARE HOSPITAL IN RAJASTHAN 416-421
Dr. Monisha Sahai, Dr.Reshu Gupta, Dr. Anshu Sahai, Dr. Chitra Sitaraman PDF FULL TEXT

ABSTRACT

Background: The study was carried out with the objectives of identifying the prevalence of squint in the walk-in population in a tertiary eye care centre in Jaipur(Rajasthan) and identify the age group that was maximally affected. Methods: This study on strabismus was undertaken in the eye OPD of Sahai hospital and research centre, Jaipur over a period of 6 months. 6283 consecutive walk in patients seen in the OPD were screened for this study. The visual acuity was tested by retinoscopy and refraction, followed by ophthalmoscopy and slit lamp examination. Orthoptic screening included the Hirschberg reflex test& alternate cover test. Only those testing positive for these two tests, were further subjected to prism bar cover/ reflex test and binocular single vision assessment. Assessment of both “phorias” and “tropias” was included in the study. Results: The prevalence of squint in this hospital's OPD population was found to be 4.23% 23.3% of the patients found to be having squint in this study group belonged to the age group 11-20 years .The age relative prevalence of squint was highest (7.71%) in the under 10 years age group, with a subsequently declining trend. The study found a very significant prevalence of Amblyopia(24.43%) and absence of Binocular single vision(82.81%) in the patients with squint. In the squint patients, there was a slight preponderance of males over females (53.38% versus 46.62%).Conclusion: A sizeable number of patients with a significant proportion of paediatric population attending a tertiary level eye care hospital in Rajasthan suffer from squint(astigmatism)about which they may not be aware. Besides refraction, the Hirschberg reflex test and alternate cover test can serve as suitable screening tools for squint in children.
Key Words: Strabismus, Squint

22. ASSESSMENT OF MATERNAL RISK FACTORS ASSOCIATED WITH MACROSOMIA AT A RURAL
HEALTH TRAINING CENTER OF SOUTHERN RAJASTHAN 422-427
Dr. Kalpana Katiyar PDF FULL TEXT

ABSTRACT

Background: Fetal macrosomia is a common complication seen nowadays, which can cause complications to both mother and the child. Fetal macrosomia is also associated with a high risk of mortality and morbidity and data were reported from all over the globe. Fetal macrosomia is defined and characterized when birth weight is more than or equal to 4000 gms, or we can say that birth weight is more than the 90th percentile. Material & Methods: The present community-based retrospective and cross-sectional study was conducted at the rural health training center of the department of community medicine of our tertiary care hospital. Study duration was of two and half month. Results: Out of 24 mothers of age ≥ 40 years 10 (55%) had a macrosomic child showing a significant association. Out of 40 mothers of high socioeconomic status 6 (34%) had macrosomic child (p-value<0.05). In the present study, we found that there was the non-significant association between macrosomia and mother's height ≤145 cm, i.e. p-value > 0.05. Out of 46 mothers of high Parity ≥4, 6 (34%) had macrosomic child (p-value<0.05). Out of 348 mothers of anemia during pregnancy, 5 (27.7%) had macrosomic child (p-value<0.05). In the present study, we found a non-significant association between macrosomia and ≥three abortions and hypertension during pregnancy, i.e. p-value > 0.05. A highly significant association was found between diabetes during pregnancy and macrosomia, i.e. p-value <0.001. Conclusion: Macrosomia was significantly associated with maternal diabetes, both the gestational and previously existing. Macrosomia was also associated with mother's age more than 40 years and the parity level of more than 4 children.
Keywords: Macrosomia, Risk factors, Newborn.

23. DENTURE STOMATITIS: A CASE REPORT 428-431
Dr. Arpita Srivastava, Dr.Rahul Shrivastava, Dr. Setu Mathur,
Dr. Rohit Kumar Khatri, Dr. Shikha Gupta PDF FULL TEXT

ABSTRACT

24.   A COMPARISON OF EPIDURAL AND GENERAL ANAESTHESIA TECHNIQUE FOR
RENAL SURGERIES 432-437
   Dr. Jalad Kapoor, Dr Abeezar Hussain PDF FULL TEXT

ABSTRACT

Background: Hemodialysis is compared inferior to renal transplantation as the 5 year survival rate in patients is 30% as compared to 70% in patients with transplanted kidneys. Now a day renal surgeries are more commonly done by epidural or neuraxial anaesthesia as compared to general anaesthesia. Methods: Sixty adult patients according to American Society of Anaesthesiologists (ASA) physical status‑I and II of both male and female in the age group of 20-49 years were randomly assigned, undergoing renal surgeries, into 30 patients in each group i.e. Group A and Group B. Group A patients were delivered with conventional general anaesthesia (GA) while Group B had received epidural anaesthesia (EA) with 3 mg/kg of ropivacaine and 0.5 μg/kg of dexmedetomidine. Various parameters were measured such as cardio-respiratory parameters, patient’s satisfaction, doctors’s satisfaction and the side effect associated with the medications. P Value of < 0.05 was considered as statistically significant. Results: Cardio-respiratory parameters, patient’s satisfaction status, surgeon’s satisfaction scores, side effect associated with the medications, demographic profile, and duration of anaesthesia, surgical time, haemodynamic parameters, and blood transfusion requirements were compared in both groups. During the post‑operative period, in Group B patient’s satisfaction score was more as the post operative complication were less compared General Anaesthesia. Side effect such as headache, nausea, vomiting and shivering was more in Group A (P < 0.001) while the incidence of dry mouth was higher in Group B (P < 0.001). Conclusion: On the basis of more patient satisfaction and decreased side effects, Epidural anaesthesia with ropivacaine and dexmedetomidine can be efficiently used in patients undergoing renal surgeries.
Key words: Renal surgery, General Anaesthesia, Epidural Anaesthesia, Ropivacaine, Dexmedetomidine.

25. MAGNETIC RESONANCE ANGIOGRAPHY (MRA) AND CORRELATION WITH COLOR DOPPLER
ULTRASOUND (CDUS) IN EVALUATION OF THE CAROTID BULB AND PROXIMAL INTERNAL
CAROTID ARTERY. 438-444
Dr. Kapil Vyas, Dr. Ravi Soni , Dr. Bharat Jain, Dr. Sunil Saini PDF FULL TEXT

ABSTRACT

Background: The aim of the study is to compare the magnetic resonance angiography (MRA) with color Doppler ultrasound (CDUS) for evaluation of the carotid bulb and proximal internal carotid artery. Material & Methods: The carotid arteries of 60 patients were studied using MRA &CDUS. All of the patients underwent both the investigations. MRA done with time-of-flight sequence and 3D- reconstruction. Carotid bulb and proximal internal carotid arteries were graded as normal, mild, moderate, or severe stenotic. Results: There was significant difference in the results of MRA as compared to CDUS in mild to moderate stenosis and it proved relatively more accurate in the diagnosis of severe stenosis. MRA had few false positives for complete occlusions and more false negatives in partial occlusion of the carotid arteries. In few cases MRA overestimated stenosis and in many cases underestimated the stenosis. Conclusions: MRA has advantages which may make it the screening test of choice. It can be done with MRI brain, can assess distal ICA and intracranial vessels but the sensitivity and specificity of MRA as compared to duplex ultrasonography is significantly lower for mild to moderate stenosis (non-surgical) however, in case of severe stenosis (surgical), it is having good sensitivity and specificity, almost equal to color doppler study. This preliminary study suggests that concordant CDUS may be used to clarify equivocal findings of MRA.
Key words: Arteries, carotid; Arteries, stenosis and occlusion; Magnetic resonance angiography (MRA); Ultrasound, Doppler

26. ASSESSMENT OF SURGICAL PROFILE OF PATIENTS UNDERGOING FOR APPENDECTOMY
AT TERTIARY CARE CENTER 445-448
Dr. Ramraj Goyal, Dr. Surendra Mertia PDF FULL TEXT

ABSTRACT

Background: Acute appendicitis is one of the leading causes of acute abdomen pain which require surgical intervention. The global prevalence of acute appendicitis is approximately 7% of the total population. The peak incidence of acute appendicitis is between 15-19 years among males and 10-14 years among females. The benefits of early and prompt diagnosis of acute appendicitis significantly eliminate the risk of anticipated complications such as sepsis, perforation and death. Material & Methods: The present cross-sectional observational study was conducted at department of surgery of our tertiary care hospital. The study duration was of one year from June 2017 to May 2018. A sample size of 100 was calculated at 95% confidence interval at 10% acceptable margin of error. Results: Abdominal pain was reported and presented by each and every study participant. Next most common symptom reported from the study participants was loss of appetite which found in 89% of subjects followed by nausea in 88% of study participants. Fever was reported from 73% of subjects and 59% of study participants suffered from vomiting. Right iliac fossa tenderness was also found in all subjects. Abdominal mass was not found in any patient on clinical local examination. Conclusion: Males have higher incidence of acute appendicitis than females. Acute appendicitis was more common in younger age groups. The most common presenting symptom in present study was abdominal pain.
Key words: Appendicitis, Abdominal mass, Right iliac fossa.

27. ASSESSMENT OF CLINICAL PROFILE AND OUTCOME OF FISTULA IN ANO CASES
AT TERTIARY CARE CENTER 449-453
Dr. Shyam Prakash Mathur, Dr. Surendra kumar Samar, Dr. Rajkumari Samar PDF FULL TEXT

ABSTRACT

Background: Fistula-in- Ano is characterized by an abnormal hollow tract which is lined by granulation tissue. Fistula-in- Anohas two openings one which is called, a primary one which opens inside the anal canal and a secondary one which opens in the perianal skin. Material & Methods: The calculated sample size was 54, all the patients above 16 years of age with specific anorectal lesion with an external opening, patients with a history of perianal discharge or any past history of recurrent attacks perianal abscess and its treatment, all these patients were included in the study. Clearance from Institutional Ethics Committee was taken before the start of the study. Results: The most common clinical presentation found was perianal discharge present in 75.9% patients followed by perianal pain in 68.5% patients. 38.8% of patients had a past history of perianal abscess and perianal swelling and irritation found in 18.5% and 12.9% patients respectively. 74.1% of patients had a posterior opening and 25.9% patient had an anterior opening of the fistula. Internal opening below anorectal ring i.e. low type of fistula found in 83.3% patients and 16.6% had the high type of fistula. The single opening of fistula in ano present in 68.5% of patients and multiple openings were present in 31.4% of patients. Out of the total study participants in 46 patients (85.2%), complete healing of fistula in ano was observed. Among the 8 patients, (14.8%) recurrence of fistula in ano was reported. Conclusion: We concluded from the present study that the fistula in ano is a common disease but with serious complications and morbidity. Proper preoperative evaluation after the operative procedure is essential to counter any recurrence and to prevent complications.
Key words: Fistula in ano, Fistulectomy, Fistulotomy, Seton placement.

28. PREVALENCE OF NASH IN NAFLD PATIENTS WITH RAISED HEPATIC ENZYME LEVELS 454-457
Dr. Arun Kumar PDF FULL TEXT

ABSTRACT

Background: Nonalcoholic fatty liver disease (NAFLD) has been considered a benign condition related to obesity and with metabolic syndrome. It is a chronic condition ranging from simple steatosis (hepatic triglyceride accumulation more than 5.5% in MRI or more than 5% corresponding 250 mg program by wet weight) up to hepatic carcinoma. Material & Methods: The present single Centre observational study was conducted by following all protocols of ethical conduct including written and informed consents of the patients. Confirmed patients of NAFLD by ultra-sonography (USG) who were visiting outpatient department of our hospital were enrolled in our study. The study was conducted in Department of Biochemistry in association with Department of Gastrologer & Endocrinology. Results: Serum ALT, AST levels were also significantly higher in the diabetic NAFLD patients. Serum ALT levels were significantly more elevated than serum AST levels. For the pre diabetic group mean level of AST (U/L) was 33.08 ± 13.35 and for the diabetic group mean level of AST (U/L) was 47.72 ± 46.70 (t value = -3.014; P=0.003). Similarly, for the pre diabetic group mean level of ALT (U/L) was 48.37 ± 20.63 and for the diabetic group mean level of ALT (U/L) was 77.72 ± 72.99 (t value = -3.870; P=0.000). It was reported that Serum ALT, AST levels were also significantly higher in the diabetic NAFLD patients. Conclusion: By help of clinical findings and with can biochemical markers, we can screen NAFLD early and almost all centers. 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, Hepatic enzyme, AST, ALT, NASH.

29. THE ROLE OF SELF INSTRUCTIONAL MODULE ON KNOWLEDGE REGARDING BREATHING
EXERCISE AMONG BRONCHIAL ASTHMA PATIENTS AT TERTIARY CARE HOSPITAL 458-462
Dr Naresh Kumar, Mrs Sapna Kamdar, Dr Rakesh K Karnani PDF FULL TEXT

ABSTRACT

Background: Asthma is one of the most common chronic diseases worldwide. Despite advancement in science and technology and pharmacological revolutions, worldwide asthma prevalence is uncontrolled, morbidity and mortality from asthma. The most common reasons are non-adherence to treatment, poor knowledge and skills in disease management. The objective of present study was to assess the impact of Asthma Education on self-care management among Bronchial asthma patients. Materials and methods: Study was done to assess the effectiveness of structured asthma education program on self-care management of Bronchial asthma. Sixty patients, meeting the inclusive criteria, were selected by simple random sampling, and were tested for their knowledge levels on identification of asthma triggers, and warning signs, adherence to specified drugs, diet and breathing exercises. Based on the patient needs, structured education program was developed, validated and administered. Two weeks after administering structured asthma education, post-test was conducted. The Pre-test and Post-test scores were compared to evaluate the effectiveness of the Asthma education. Results: knowledge on Asthma before and after SIM was 7.6 and it was statistically significant at 0.0001 level (i.e., P<0.0001, highly significant). Similarly knowledge on breathing exercise has got increased after SIM. The paired t-test was carried out and the results (t-value = 2.47, df=59 & P<0.0001) significant. The knowledge assessed through entire tool on an over-all was also statistically significant at 0.0001 levels. Conclusion: The findings reveal that educating patients remarkably increased their knowledge
Keywords: Impact, Asthma Education, Self-Care Management, Adult Asthmatics

International Journal of Medical Sciences and Education (IJMSE)Vol. 5; Issue: 3 (July -September 2018), Date of Publication: 01.10.2018

International Journal of Medical Sciences and Education (IJMSE)
Vol. 5; Issue: 3 (July -September 2018), Date of Publication: 01.10.2018