International Journal of Medical Sciences and Education (IJMSE)
Vol. 6; Issue: 1 (Jan - March 2019), Date of Publication: 01.04.2019

Table of Contents
     Editorial

1.    EFFECTIVENESS OF VIDEO ASSISTED LEARNING COMPARED TO TRADITIONAL LECTURE IN
       TEACHING BIOCHEMISTRY FOR THE FIRST YEAR MEDICAL STUDENTS                                                 3-6
       Dr Shabana S,  Siva Prasad                                                                                                         PDF FULL TEXT

ABSTRACT

​Background: With each passing year it is becoming more and more difficult to retain the interest of the first year medical students as they are only exposed to didactic lectures with no contact with the patients. Therefore the aim and objectives of this study was to compare the learning outcomes and find the effectiveness of video assisted and traditional learning among first year medical students in Biochemistry. Materials and Methods: The study included 150 students who were divided into two groups. Each group was exposed to one traditional lecture and one video assisted learning. A post-test after each session was done and feedback taken through a questionnaire. Data was analyzed by an independent sample t test and frequency distribution (%). Results: Comparison of post test scores shows a significant difference in the learning outcomes between the traditional lecture and video assisted learning. The response scores for the items in the feedback showed response more favourably to video based learning than traditional lectures. In the open ended questions more preference was given to blended learning. Conclusion: Video Assisted learning helped the student in better understanding of the subject than traditional lecture. Blended learning was the preferred method of learning.
KEYWORDS - Blended learning, Traditional lecture, Video Assisted Learning

2.    PERCEPTION OF MEDICAL STUDENTS TOWARDS STUDENT-LED SEMINARS AS A TEACHING
       LEARNING TOOL IN FORENSIC MEDICINE AND TOXICOLOGY                                                              7-10
         Dr. Arti Ajay Kasulkar, Dr. Madhur Gupta                                                                               PDF FULL TEXT

ABSTRACT

Background: Teacher centered classrooms are still the basic modality of teaching in India where the students receive information from teachers and internalize it through memorization. Seminar is an effective tool to enhance the students’ self learning skills in which, a small group of students are engaged under a member of faculty. Aims & Objectives: To evaluate effectiveness of seminars through perception of students to facilitate learning process in Forensic Medicine and Toxicology. Material and Method: A questionnaire-based study was carried out in randomly selected 148 students studying in II MBBS in FMT department. They were given the topics for seminars already covered in lectures. Seminars were conducted during practical hours in 2 batches. The students presented seminar in group of 4-5 for each topic. Questionnaires were distributed after taking written consent from them. Results: Out of 148, 129 students who consented were included in study (87.2%). Out of 129 students, students 116(89.92%) agreed that seminars stimulated them to think critically about the subject and seminars assisted their learning 121(93.79%). Majority of students 126 (97.67%) appreciated the method as it was different from routine lectures and found it interactive, interesting, improving their presentation and communication skills. Majority 124(96.12%) opined that the facilitator who summarized at the end of seminar was a positive aspect of seminars. Conclusion: Interventions in the form of student-led seminars can be taken up to break the monotony of traditional seminars.
Keywords: Student led seminar, Perception, Medical students, Forensic Medicine and Toxicology

3.    SNAPPS AS A METHOD OF CASE PRESENTATION FOR INPATIENT SETTING: A RANDOMIZED
       CONTROLLED TRIAL                                                                                                                                    11-26
       Chandrashekhar C Mahakalkar, Tripti Srivastava, Sunita Vagha, Lalit B Waghmare,
       Meghali N Kaple, Sandeep Shrivastava                                                                                     PDF FULL TEXT

ABSTRACT

Background: Case presentation is a time-honored tradition in clinical medicine. During conventional case presentations, students’ reasoning skills remain mostly unknown. This study focuses on the feasibility of SNAPPS, to facilitate clinical reasoning skills in post- graduate students of surgery. Materials and Methods: In this randomized controlled trial, postgraduates were divided in two groups, SNAPPS (n=12) and control (n=12). They presented total 60 cases (30 each) in both the groups. The presentations were observed for Presentation time, Clinical reasoning, Expressed uncertainties and clarifications, Patient management plan and Identification of case related topics and resources. Results: The three variables showed statistically significant difference between two groups in Number of basic clinical attributes covered, Number of diagnoses kept in differential diagnosis and Number of justified diagnosis kept in the differential diagnosis (p value 0.0001).The four responses namely, Concisely history taking, Performing all steps of general examination, Relevant Systemic examination findings and in accordance with history and identification of sufficient case based learning issues for self study, showed significant difference between the two groups. As per tutors feedback, 25 (83.33%) in cases and 10(33.33%) in control group concisely covered all aspects of history taking. Conclusion: SNAPPS can be used effectively as a method of case presentation for postgraduate students in indoor settings. It is effective to facilitate the expression of clinical reasoning and diagnostic thinking as it involves case analysis and identification of practice points during case presentation. It also enables to dedicate uniform and more time for case discussion which gives it an advantage over conventional method where the time dedicated is less and varied.
Keywords: SNAPPS, Inpatient, Case presentation, Teaching and learning

4.    EFFECTIVENESS OF FISH BOWL METHOD IN TEACHING CLINICAL BIO-CHEMISTRY FOR
       1ST YEAR MEDICAL STUDENTS                                                                                                               27-31
       Neetha Kundoor, Sukumar Sannidhi,  Srilatha Bashetty                                                        PDF FULL TEXT

ABSTRACT

​Medical education is introducing different innovative methods of teaching to make learning easy, reproducible and can be implemented in a conceptual way. There are well established traditional methods of teaching yet many methods like problem-based learning, team-based learning, case-based learning, small group learning, flipped- class room learning, etc; are being introduced, practiced and are further modified according to the requirements for the quality outcomes. The present study was undertaken to observe the effectiveness of fish bowl method in teaching the clinical Bio-Chemistry. The study included a total of 100 participants who were studying first year MBBS at Apollo Institute of Medical Sciences and Research. Apparently healthy, willing participants were included in the study. Unwilling participants were excluded from the study. Majority of students showed positive attitude in the implementation of fishbowl method in teaching the clinical biochemistry. The study results support the implementation of fishbowl method in the medical curriculum to teach the clinical concepts in most efficient way. The study also recommends further detailed studies in this area.
Keywords:  Fish bowl method, medical education, Biochemistry.

5.    TYPE 2 DIABETES MELLITUS  PATIENTS WITH OR WITHOUT COMPLICATIONS CORRELATED
       WITH SERUM VITAMIN D LEVELS                                                                                                              32-39
       PANKAJ KUMAR, DHIRAJ KAPOOR, NIRAJ AGARWAL, R.S.YADAV                                   PDF FULL TEXT

ABSTRACT

​Background: Evidence suggests that vitamin D plays a vital role in modifying the risk of diabetes. Vitamin D replenishment improves glycaemia in patients with type 2 DM with established hypovitaminosis D, thereby suggesting a role for vitamin D in the pathogenesis of DM. This study determines if there is any correlation between vit. D deficiency and T2DM. Aim And Objective Of The Study: To correlate serum Vitamin D levels in patients with T2DM with or without complications. Materials And Methods: This Cross-Sectional study was conducted at Dr. RPGMC Kangra over a period of 1 year. Results: Vitamin D level in patients without microvascular complications was 25.63±13.52 ng/ml. Out of the 60 patients with microvascular complications, 40 patients (66.7%) were deficient in vit D, 15 patients (25%) were insufficient in vit D. Only 5 patients (8.3%) had a sufficient level of Vit D. In patients without microvascular complications (total 40), 37.5% were deficient in Vit D, 30% were insufficient in Vit D and 32.5% had a sufficient level of vitamin D. Conclusion : Patients with type 2 diabetes mellitus had mean Vit D level of 19.68±12.20ng/ml which is in the deficient range. The prevalence of vit D deficiency in patients with microvascular complications was more than in patients without microvascular complications (66.7% vs. 37.5%). Vitamin D levels in patients with poorly controlled diabetes (18.23±12.34) were lower than patients with well-controlled diabetes(23.07±11.35), but the difference was not significant. Vit D level decreased with increase in the duration of diabetes
Keywords: T2DM: Type 2 Diabetes Mellitus, microvascular complications, Vit D:Vitamin D

6.    KNOWLEDGE AND ATTITUDE OF NURSING STUDENTS TOWARDS PALLIATIVE
      CARE IN A GOVERNMENT NURSING TRAINING COLLEGE, WEST BENGAL                                        40-45
       Dr. Subhabrata Kumar                                                                                                                PDF FULL TEXT

ABSTRACT

​Background: Palliative care is a branch of medical science that aims at addressing problems faced by patients and their family members during life-threatening terminal illness. Material and Methods: A study was conducted in Nursing training College, Malda Medical College & Hospital. This study evaluated the knowledge and the attitude of nursing students in palliative care. Fifty four nursing students participated in this survey. Results: The mean knowledge score was 8.3 out of 20.Sixteen participants scored fifty percentage or more in the knowledge section. The mean attitude score was 106 out of 150.Thirty two participants scored seventy percentage or more in the attitude section. In participants with good knowledge the Attitude score was found to higher than those with poor knowledge (107.56 versus 105.84). However this was not found to be statistically significant at p value <0.05. Conclusion: This study gave an insight to the palliative care understanding of the nursing students and will help to recommend required changes in the curriculum. Optimal palliative care can provide a good quality of life to the patients and give support to their families.
Keywords: Palliative care, Nursing students, Knowledge, attitude, training

7.    USG GUIDED TAP BLOCK FOR LAPAROSCOPIC CHOLECYSTECTOMY                                             46-50
       Dr  Namrata Jain, Dr Saba Ahmed                                                                                            PDF FULL TEXT

ABSTRACT

​Background: Many patients experience moderate to severe pain after laparoscopic cholecystectomy. We aimed to evaluate the influence of ultrasound –guided transversus abdominis plane (TAP) block on postoperative pain scores and opioid consumption for patients undergoing laproscopic cholecystectomy. Material and method: Patients undergoing elective laproscopic cholecystectomy under general anaesthesia were divided randomly into two groups of 20 each to receive either ultrasound –guided bilateral transversus abdominis plane (TAP) block with 0.25% bupivacaine 20 ml each side (group TAP) or standard postoperative analgesia of inj. tramadol 1mg/kg IV 6h (group control).Both groups received acetaminophen 1g and inj. Diclofenac sodium (1.5 mg/kg IM) before extubation. The analgesic efficacy was judged by VAS both at rest and on movement, sedation score, and nausea score, which were also noted at 30 min, 2, 4, 6, 12, 18, and 24 h postoperatively .Inj. Tramadol (1 mg/kg) was given as rescue analgesic at visual analog scale (VAS) more than 3 in any group at rest or on movement.. Total tramadol consumption at 24 h was also assessed. Results: TAP block significantly reduced postoperative pain scores compared to standard analgesia in all periods after surgery. Tramadol consumption was significantly lower in the TAP group( 110.83) mg than in control group( 235.83 mg ). Conclusion: The USG‑guided TAP block is easy and effective supplement to general anaesthesia, as a postoperative analgesic regimen in laproscopic cholecystectomy, with opioids‑sparing effects and without any complications.
Key words: Drugs – bupivacaine and tramadol, laproscopic cholecystectomy, transversus abdominis plane block, ultrasound

8.    ROLE OF VARIOUS THERAPIES IN ASTHMA MANAGEMENT                                                                51-57
       Atul Bhargava,  Dr. Jyotsana Khandelwal, Dr. Deepak Sharma                                            PDF FULL TEXT

ABSTRACT

Asthma and chronic obstructive pulmonary disease (COPD) are increasing at a rapid pace in the last decade. Research is going on, but the fact remains that prevalence is on the increasing trend. The important question is why it is so? Cost of treatment is an issue worldwide but the major problem for a country like India. The combination therapy of Ayurveda, Homeopathy, Unani, Allopathy, and Yoga can resolve up to a great extent in a country like India. The treatment should not be restricted to a particular medical stream. It should be structured in such a way that patient condition can be made reversible. They should be treated with Ayurveda/homeopathy/ Unani/yoga/Allopathy so that the patient can be cured. Govt need to design a separate course in medical college which should be a combination of the various stream for Asthma.
Keywords: Asthma, Allopathy, Homeopathy, Ayurveda, Unani, Yoga, Cure

9.    ASSESSMENT OF SERUM AST, ALT, GGT & ALP LEVELS IN PATIENTS WITH THYROID FUNCTION
       ALTERATIONS                                                                                                                                               58-62
       Dr. Pankaj  K Gaadhe, Dr. Asha Khubchandani,  Dr. Harsha Gaadhe                                    PDF FULL TEXT

ABSTRACT

Background: Thyroid function alterations causes alterations in various enzymes. AST, ALT, GGT and ALP are among the significant ones. Objective: To establish significance of change and find out the relationship between alteration in thyroid function and various Enzyme levels. Materials and Method: In the present Cross Sectional study, samples of 100 cases (50 for hyperthyroidism and 50 for hypothyroidism)  and 50 controls (normal healthy persons) were selected from Civil Hospital  Ahmedabad (CHA), Gujarat.Serum AST, serum ALT, serum GGT and serum ALP levels were measured on XL-640 fully-auto biochemical analyser. Results: Results showed increase in serum AST, ALT, GGT and ALP in patients with altered thyroid function compared to normal subjects. Conclusion: This study clearly revealed a significant relationship between increased serum enzyme AST, ALT, GGT & ALP in hyperthyroidism and hypothyroidism.
Keywords: Aspartate Aminotransferase (AST), Alanine Aminotransferase(ALT), Gamma Glutamyl Transferase (GGT), Alkaline phosphatase (ALP)

10.    ALTERATION IN TRACE ELEMENTS (S.IRON, S.ZINC, S.COPPER ) IN THALASSEMIA MAJOR
         PATIENTS AFTER CHELATION THERAPY                                                                                             63-65
         Dr. Anuja Adarsh, Dr. Asha Khubchandani, Dr. Disha Gajjar                                             PDF FULL TEXT

ABSTRACT

Introduction: Alterations in various trace element serum iron, serum copper and serum zinc in patients suffering from beta thalassemia major patients who are undergoing blood transfusion and receiving chelation therapy. Objective: Present study was conducted to evaluate the effect of iron chelation therapy on trace elements (Iron, Copper, Zinc) in patient of beta thalassemia. Materials and Method: In the present Cross Sectional study, samples of 50 cases and 50 controls (normal healthy persons) were selected from Civil Hospital Ahmedabad (CHA), Gujarat. Serum Iron, serum Zinc, and serum copper levels were measured on XL-640 fully-auto biochemical analyser. Results: Results showed increase in serum Iron and Copperin patients with compared to normal subjects while serum Zinc decreased in patients as compared to heathy subject. Conclusion: This study clearly shows a positive association between increased serum Iron and Copper while decrease serum Zinc in beta thalassemia major patients who are undergoin blood transfusion and receiving chelation therapy.
Keywords: Beta Thalassemia, Iron, Zinc, Copper.

11.    ASSESSMENT OF SERUM CERULOPLASMIN LEVELS  IN TYPE II DIABETES MELLITUS
        PATIENTS                                                                                                                                                  66-69
        Dr. Ruhan H Oza, Dr. Asha Khubchandani, Dr. Bhavesh Prajapati                                    PDF FULL TEXT

ABSTRACT

Background: Diabetes Mellitus (DM) is a metabolic disorder with disturbances of carbohydrate, fat and protein metabolism which occurs due to defect in insulin secretion and/or insulin action, which results in hyperglycemia. Hyperglycemia in long run causes toxic effects on macro as well as microvascular structure and affects proper functioning of organs. Ceruloplasmin, as an acute phase protein, its level reflects acute and chronic inflammation. The purpose of this study was to evaluate oxidative stress and to understand relation of serum Ceruloplasmin levels in type II diabetes mellitus patients. Objective: To estimate the levels of serum Ceruloplasmin and to determine the effect of oxidative stress in patients of Type II Diabetes Mellitus patients.  Its comparison with that of healthy individuals. Materials and Method: A cross-sectional study was conducted in 100 individuals (50Type II diabetes cases and 50 normal controls). Fasting blood Glucose level, 2-hour post prandial plasma glucose level, serum ceruloplasmin levels were estimated on fully automated chemistry analyser. Results: Serum ceruloplasmin is increased in cases as compared to controls (42.79±11.56 mg/dL, 37.45±10.36 mg/dL respectively). Conclusion: Ceruloplasmin  have an anti-oxidant effect and its levels rise due to oxidative stress in the body, detection of serum Ceruloplasmin,  in addition to other biochemical variables in the early stage of diabetes will help patients to prevent complication and reduce their morbidity rate.
Keywords: Diabetes mellitus- type II, Serum Ceruloplasmin, anti-oxidant.

12.    EVALUATION AND COMPARISON OF DOPPLER SONOGRAPHY IN CASES OF ACUTE RENAL
         OBSTRUCTION AND ROLE OF INTRAVENOUS UROGRAPHY?                                                           70-75
         Dr. Harish Chandra Chaturvedi                                                                                               PDF FULL TEXT

ABSTRACT

Background: Renal colic disease is among the most frequent presentation in urologic practice. Urolithiasis is the most common cause of renal obstruction and reported frequently. The presentation of renal obstruction is more prevalent among males, approximately 6% and around 5% in females. There are published case reports of devastating effects on urinary tract structure because of renal obstruction due to urolithiasis. Material & Methods: The present case-control study was conducted at Department of Radiodiagnosis of our tertiary care hospital. Patients presenting to the emergency department with symptoms suggestive of acute unilateral renal colic were enrolled for the study. The kidney on the side of obstruction was taken as case kidney and the healthy contralateral kidney taken as the control. All study participants were subjected to USG, IVU, and Doppler USG using a 3.5 to 5 MHz transducer. Results: In the present study, 120 patients were enrolled, out of them 82 were males, and 38 were females. The mean age of males was 34.22±5.68 years, which is nearly similar to the mean age of females 33.61±7.48 years. This difference between age groups was statistically non-significant. The mean resistivity index (RI) was found to be higher in obstructed kidneys in all study participants. The delta RI, i.e., the difference in RI of obstructed and healthy contralateral kidney was ranged from 0.03 to 0.14 with a mean delta of 0.075. Most of the study participants (58%) were assessed between 6-12 hours, 24% patients within 13-18 hours, and 18% patients within 19-24 hours after the onset of symptoms. RI values were nearly similar in all three groups, and their difference was statistically non-significant. Conclusion: Doppler sonography was a better diagnostic tool for unilateral acute renal obstruction, with RI values being statistically significantly higher in complete obstruction than partial obstruction. the overall sensitivity of Doppler sonography was 92%, and specificity reported to be 94%.
Keywords: Acute renal obstruction, Doppler sonography, Complete obstruction, Partial obstruction

13.   SUB-DURAL HEMATOMA FOLLOWING ACCIDENTAL DURAL PUNCTURE WHILE CONDUCTING
        LABOR EPIDURAL: A RARE COMPLICATION                                                                                        76-78
        Dr. Samaresh Das, Dr. Nilay Chatterjee, Dr. Aziz Haris, Dr. Noor Ghanim
         Abdallah Al Dhahri                                                                                                                  PDF FULL TEXT

ABSTRACT

Subarachnoid block and epidural techniques are commonly employed for anaesthesia and analgesia in parturients. Sub-Dural Haemorrhage (SDH) is an extremely rare complication of such techniques but mandates prompt diagnosis and treatment to circumvent the neurological complications or mortality associated with it. We report an interesting case of SDH in a young lady who had an accidental dural puncture while attempting a labour epidural. This report highlights the importance of timely diagnosis and effective management of post-dural puncture headache keeping in mind the rare possibility of SHD, and its’ consequence if remains undetected. We also emphasize the need for appropriate imaging modality in order to diagnose the occurrence of SDH in such cases.

14.    EFFICACY OF LOW DOSE DEXMEDETOMIDINE INFUSION ON HAEMODYNAMIC STRESS, ANALGESIA
         AND SEDATION WITH SPECIAL REFERENCE TO LAPROSCOPIC ABDOMINAL SURGERIES       79-84
         Dr. Khayyam,  Dr. Swapnil Kumar Shailesh Kumar Modi                                                     PDF FULL TEXT

ABSTRACT

Background: Nitroglycerine, beta-blockers and opioids are used in laproscopic surgeries as they provide hemodynamic stability during pneumo-peritoneum, but now less commonly used due to their disadvantages. Aims and Objective: To assess use of low dose dexmedetomidine infusion on post-operative analgesia requirements, sedation levels, haemodynamic response, and occurrence of adverse effects in patients undergoing laparoscopic surgery. Material and Methods: In the present study the patients included were randomly divided into three groups of 15 patients each, Group A (patients receiving normal saline 0.9% infusion), Group B (dexmedetomidine infusion 0.2 mcg/kg/h) and Group C (dexmedetomidine infusion 0.4 mcg/kg/h). Result: The pulse rate and mean arterial blood pressure was not effective at the time of pneumoperitoneum and when we increased the dose of dexmedetomidine to 0.4 microgram per kg per hour, the result were satisfactory. First rescue analgesia is required after more time compared to group A patients. Total analgesic requirements in first 24 h post‑operatively is also found to be decreased in both dexmedetomidine groups i.e. group A and B. Conclusion: Low dose infusion of dexmedetomidine provides lighter sedation and reduces the post‑operative analgesic requirements without any significant adverse effects.
KeyWords : Dexmedetomidine, Pulse rate, Mean arterial pressure, haemodynamic stress

15.    ANALYSIS OF QUANTITATIVE ADHERENCE TO HAART REGIMENS AT TERTIARY
         CARE CENTER                                                                                                                                         85-88
         Dr. Vinita Ghosliya, Dr Rakesh K Karnani                                                                            PDF FULL TEXT

ABSTRACT

Background: HAART (Highly Active Anti-Retroviral Therapy) has changed the HIV infection from a rapid progressive illness (often fatal) to a more manageable chronic ailment. Although HAART is a major advancement, its adherence is a very important aspect as regards the achievement of significant viral suppression. Material & Methods: The present cohort study was conducted at our tertiary care hospital. The study duration was of six months from September 2008 to April 2009. At the commencement of study around 260 HIV patients were registered for ART out of which 120 patients were recruited for the study and were followed for six months. Results: In the present study the Mean Quantitative Adherence (MQNA) for each patient was calculated. 94 patients (78.33%) reported high Mean Quantitative Adherence i.e.>90% and 26 patients (21.66%) reported low Mean Quantitative adherence i.e. < 90%. Conclusion:  The level of Overall Mean Quantitative Adherence (MQNA) was found to be high i.e. 92.14% and this high level was reported in 78.33 % patients. The adherence has shown dynamic behavior over time in our study.
Key words: Adherence, HAART, Follow-up, Quantitative.

16.    ASSESSMENTS OF INFECTION PROFILE AFTER TOTAL KNEE REPLACEMENT                            89-92
         Dr. Laxmi Narayan Jajoriya                                                                                                    PDF FULL TEXT

ABSTRACT

Background: Infection following TKAs sometimes difficult to diagnose and treat. Diagnosis of infections after total knee arthroplasty is multifactorial and depends on the clinical spectrum, radiographs, bone scans, synovial fluid examination, serologic tests and intra-operative culture with histology. Newer diagnostic modalities including ultrasound and molecular studies are playing a helpful role. Material & Methods: The present study was conducted in department of orthopedics at our tertiary care hospital. The study was conducted in duration of three years, after seeking approval from the Institutional Ethics Committee. All protocols of ethical conduct including written and informed consents of the patients enrolled for the study was strictly complied. Study procedure was explained to all the individuals who consented and undergone TKA in study duration. Results: Infection was reported in 15 patients in the present study. It was found that culture was done in all 15 patients and it was reported that Staphylococcus and E. coli were the most common organism identified. On the drug sensitivity testing it was found that, Staphylococcus was sensitive to Flucloxacillin and E. coli were found sensitive to Chloramphenicol. Out of the 15 patients four patients had treated with single stage joint debridement with prosthesis retention and three patients had two-stage revision of primary TKA surgery in which first stage was debridement with use of antibiotic spacer and second stage was reimplantation with prosthesis. 2 patients undergo the total debridement and two patients refused for the surgery and six were kept on antibiotic for long period. Rest of all the patients were started on oral and intravenous antibiotics. The knee score was reported to be normal at the end of their treatment. Conclusion: We found that infections after primary total knee arthroplasty were less frequent but devastating and generally result in poor outcome. We recommend from the present study that all the cases of infections after primary total knee arthroplasty should promptly treated with radical debridement.
Key words: total Knee arthroplasty, knee replacement, periprosthetic infection. 

17.    STUDY OF INFECTIOUS DERMATOSES PATTERN IN PAEDIATRIC PATIENTS IN SOUTHEAST
          RAJASTHAN                                                                                                                                           93-97
         Dr Sanjay Purohit                                                                                                                  PDF FULL TEXT

ABSTRACT

Background: In children both infectious and non-infectious agents are found to be responsible. Present study was planned to see the pattern of infectious dermatoses in paediatric population in a region of south east Rajasthan. Materials and methods:  The study was conducted at Department of the dermatology of Ananta Institute of Medical Sciences and Research Centre, Rajsamand in the period of 10 months from Feb. 2017 to Aug. 2017. Total 746 patients below 14 years visiting the dermatology department during the study period were included in the study. The cases suspected having infectious dermatoses were further followed. The patients were divided into four age groups: below 1 year, 1-5 years, 5-10 years and 10-14 years and the results were analysed. Results- Out of 746 cases included infectious dermatoses were diagnosed in 310 cases (41.55%) with a slight predominance of male patients (175 males; 135 females). The maximum patients were from the age group of 5-10 years. The maximum patients were from the age group of 5-10 years. most common types of infections were bacterial followed by fungal infections, infestations and viral infections respectively. Conclusion- Younger school going children of 5-10 years are the most affected age group. Regular skin checkups should be encouraged at school and awareness should be raised about hygiene and screening of skin problems among parents.
Keywords: infectious and non-infectious agents, skin disorders, Impetigo, Furuncle, Folliculitis, carbuncle, Acne vulgaris

18.    RELATIONSHIP BETWEEN EDUCATION LEVEL AND HEMOGLOBIN STATUS OF
        PREGNANT WOMEN?                                                                                                                              98-102
         Dr. Kiran Manohar Dabholkar                                                                                                 PDF FULL TEXT

ABSTRACT

​Background: Anaemia is a global public health problem affecting both developing and developed countries. Iron deficiency anaemia accounts for 2.4% of the total global DALYs and 4.05% losses in Gross Domestic Product per annum, thereby stalling social and economic development. In the World Health Organization (WHO)/World Bank rankings, Iron Deficiency Anaemia (IDA) is the third leading cause of Disability-Adjusted Life Years lost for females aged 15–44 years. Material & Methods: The present prospective study was conducted at department of obstetrics and gynecology of our tertiary care hospital. The study duration was of one year. A sample size was calculated at 95% confidence interval at 10% acceptable margin of error. The data were collected by predesigned, multiple response type of questionnaire from each pregnant woman (above 18 years of age and beyond 12 weeks of amenorrhea) after taking the written consent. Results: Among primary education group 18 (78.3%) females had moderate anemia and 5 (21.7%) females had severe anemia. Among middle education group 8 (12.1%) females had no anemia, 27 (40.9%) of pregnant women had mild anemia, 29 (43.9%) of pregnant women had moderate anemia and 2 (3.1%) of pregnant women had severe anemia. Among the group of secondary or senior secondary education, 26 (36.6%) females had no anemia, 31 (43.7%) of pregnant women had mild anemia, 14 (19.7%) of pregnant women had moderate anemia and none of pregnant women had severe anemia. Among the group of graduates or post graduate level education, 25 (62.5%) females had no anemia, 15 (37.5%) of pregnant women had mild anemia and none of pregnant women had moderate and severe anemia. These differences in burden of anemia was statistically highly significant (p value < 0.001).Conclusions: We concluded from the present study that the literacy level has a significant association with hemoglobin level of pregnant women. Higher education status reported to have less severity of anaemia and this correlation was statistically highly significant.
Key words: Anemia, Pregnancy, literacy level, education status.

19.    ASSESSMENT OF CLINICAL PROFILE OF DENGUE FEVER                                                           103-106
         Dr. Chetan Nayak                                                                                                                    PDF FULL TEXT

ABSTRACT

Background: World health organization also reported that as the high prevalence of dengue infection seen worldwide it requires immediate action and planning to combat the situation. It is reported that globally more than 2.5 billion of population living in the areas which are endemic for dengue viral infection. Approximately near about 50 million new dengue infections reported each year. Material & Methods: The present cross-sectional study includes 100 Patients who had dengue IgM antibody positive were enrolled from outdoor and from ward by simple random sampling. Clearance from Institutional Ethics Committee was taken before start of study. Written informed consent was taken from each study participant. Results:  92 % patients had myalgia which was followed by headache in 86% patients, 84% patients had retro-orbital pain and 83% patients had vomiting. Out of the total pain abdomen was present among 72% patients, bleeding tendencies were found among 21% patients, petechiae/purpura was present in 13% patients. Oliguria was found among 2% patients, 1% patient had altered sensorium and convulsions was present among 1% patient. Conclusion:  The common presenting symptoms of dengue viral infections were fever, headache, myalgia, retro orbital pain, vomiting, pain abdomen, purpura and bleeding tendencies. The most common presenting sign was skin rash followed by ascites and splenomegaly. The most common presented complication was hepatic dysfunction.
Key words: Dengue fever, Clinical profile, Complications.

20.    EPIDEMIOLOGICAL EVALUATION OF ACUTE ABDOMINAL PAIN AT TERTIARY
         CARE CENTER                                                                                                                                      107-110
         Dr. Abhishek Jain, Dr. Robhin Bothra                                                                                   PDF FULL TEXT

ABSTRACT

Background: The management of acute abdominal pain is an emergency and act as great challenge for the medical professionals. The diagnostic algorithm for acute abdominal pain is also very vast and one of the most difficult for the surgeons and physicians. Material & Methods: The present observational study was conducted at of our tertiary care hospital, with study duration of six months from January 2018 to June 2018. 300 Patients with non-traumatic acute abdominal pain were enrolled for the study after written informed consent. Clearance from Institutional Ethics Committee was taken before start of study. Results: Perforation Peritonitis was reported the most common cause of acute abdomen pain which was found in 117 (39%) patient which was followed by appendicitis in 111 (37%) patients. Intestinal obstruction was found in 42 (14%) patients, ruptured liver abscess was found in 9 (3%) patients, gall bladder pathology and bowel ischemia were found in 6 (2%) patients, respectively and Meckel’s diverticulitis was found in 3 (1%) patients. Conclusion: The acute abdomen pain represents a group of abdominal signs and symptoms which can be rapidly deteriorate and need a urgent surgical treatment. Early diagnosis and prompt treatment decrease the major morbidity and mortality as well as the duration of hospital stay.
Key words: Acute Abdomen, Appendicitis, Perforation peritonitis. 

21.    A PROSPECTIVE STUDY OF SURGICAL MANAGEMENT OF THYROID SWELLINGS                    111-118
         Dr. Kanak Yadav, Dr. Tarun Ojha, Dr. Pratibha Vyas, Dr. Abhishek Sharma,
         Dr. Saurabh Gakhar,  Dr. Vaishali Kataria                                                                              PDF FULL TEXT

ABSTRACT

Background: As the number of patients with palpable thyroid swellings and incidental thyroid nodules raised with the advent of newer imaging modalities, the number of thyroid surgeries being performed also increased. Through understanding of the surgical anatomy has been crucial in decreasing the morbidity. The pathologically enlarged gland make difficult to recognize the vital structures and the variations in the surgical anatomy which further increase the morbidity. This study was conducted to study Incidence and prevalence of thyroid swellings presenting in Otolaryngology department. Age and sex related incidence of benign & malignant thyroid disease, the surgical management of thyroid swelling, its histopathology and complications of surgery were observed. Materials and Methods: The present study was Observational study conducted on 100 patients of thyroid swelling, who were admitted in Department of Otorhinolaryngology, Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan. The study duration was one year. A six month follow up of all the patients was made. The study protocol was reviewed and approved by the Ethics Committee of Hospital.  Results and conclusion: Solitary nodule (62%) is commonest thyroid swelling presentation on USG. Thyroid swelling is more common in female (89%), majority of which belong to 21-40 years of age group. The chief complaint in majority of the patients is swelling (100%) in front of the neck. FNAC and USG neck are very useful in the diagnosis and management of thyroid swelling. Frozen section is useful intra-operatively after hemithyroidectomy to prevent inadvertent total thyroidectomies, to prevent need for revision (completion) thyroid surgeries. Commonest surgical procedure performed was Hemi thyroidectomy in 77 cases and total thyroidectomy in 23 cases. Complications noted were   four cases of Reactionary haemorrhage, Temporary recurrent laryngeal nerve palsy in 3 cases (3%), which recovered within a month and Transient hypoparathyroidism was seen in 27 patients are were managed. 
KEYWORDS: goitre, hemithyroidectomy, total thyroidectomy

22.    ASSESSMENT AND MANAGEMENT OF PREAURICULAR SINUS AT TERTIARY CARE CENTRE   119-122
         Dr Pardeep Balia                                                                                                                      PDF FULL TEXT

ABSTRACT

Background: Preauricular sinus is a type of congenital anomaly which present around the external ear. According to Heusinger preauricular sinus is formed due to incomplete fusion of six auditory hillocks during the development of the auricle. Preauricular sinus characterized as a small opening or pit close to the anterior border of ascending part of the helix. Material & Methods: The present prospective study was conducted at department of otorhinolaryngology of our tertiary care hospital. All patients who were diagnosed with preauricular sinus were enrolled into the study. Written informed consent was taken from each study participant. Results: In the present study, out of total study participants on the localization of periauricular sinus it was reported that in 13 patients it was unilateral and in one patient it was bilateral. Among unilateral cases 8 patients had periauricular sinus on right side and 5 patients had periauricular sinus on left side. The most common finding was periauricular pit which was found in 9 patients. Swelling in preauricular area was reported in 4 patients, 3 patients presented with discharge from sinus and 3 patients presented with erythema. Conclusion: Periauricular sinus it was reported to be unilateral in majority of cases and periauricular sinus on right side was more common than left side. The most common findings were periauricular pit, Swelling in preauricular area, discharge from sinus and erythema. Keywords: Preauricular sinus, Supraauricular dissection, Sinusectomy

23.    THE RARE CASE OF RUPTURED VERTEBROBASILAR JUNCTION ANEURYSM POINTING TO LEFT SIDE           AFTER ANTIPLATELETS TREATMENT                                                                                               123-126
         Dr. Atulabh Vajpeyee, Dr. Rahul Pathak, Dr. Manisha Vajpeyee, Dr. Ramakant,               PDF FULL TEXT
         Dr. Narendra Mal     

ABSTRACT

Mental Vertebrobasilar junction aneurysm are uncommon with incidence 0.5% and usually pointing to right side. They often associated with fenestration. Endovascular treatment is more favorable than surgical for this aneurysm. There was increased risk of bleeding with addition clopidogrel on aspirin. A fifty eight years old woman had ruptured the vertebrobasilar junction aneurysm. One month back she had ruptured right ICA wide neck aneurysm near at the right ophthalmic artery and unruptured vertebrobasilar junction aneurysm and she underwent stent assisted coiling for ophthalmic aneurysm only. She continued dual antiplatelet for the stent . This time patient underwent endovascular coiling for the vertebrobasilar aneurysm.  After coils  embolization, there was no aneurysm filling.
Keywords : vertebrobasilar junction aneurysm, dual antiplatelets, multiple aneurysms.

24.    CLINICAL PROFILE OF MORBIDITY PATTERN AMONG ELDERLY POPULATION
         AT TERTIARY CARE CENTER                                                                                                        127-130
         Dr. Abdul Rehaman Pathan, Dr. Abdul Wahid Qureshi, C.P. Meena,
         Fazil Hussain, Dr. Hamant                                                                                                   PDF FULL TEXT

ABSTRACT

Background: The burden of morbidity among elderly population is reported to very vast and especially non-communicable diseases found to be prevalent among elderly population such as cardiovascular illness and hypertension, endocrine disorders like diabetes and thyroid disorders, psychological diseases, musculoskeletal disorders and malignancies. Material & Methods: The present prospective study was conducted among 400 study participants who were more than 60 years of age were enrolled from outdoor department by simple random sampling. Written informed consent was taken from each study participant. Results: The most common morbidity was anemia, found among 264 (66%) of patients which was followed by ophthalmic disorders present in 216 (54%) of patients. 192 (48%) patients had disorders of Gastrointestinal system and 188 (47%) patients had disorders of musculoskeletal system. 168 (42%) of patients had diseases related to respiratory system, 156 (39%) patients had dental problems, 124 (31%) patients diagnosed with skin disorders and diseases related to ear, nose and throat were found in 88 (22%) patients. Diseases related to female genitourinary tract were found in 64 (16%) of patients, psychiatric disorders present among 60 (15%) patients, diseases of male genitourinary diseases found in 56 (14%) of patients. Diseases related to cardiovascular system was found in 56 (14%) patients, endocrine diseases found in 48 (12%) patients and 20 (05%) patients had diseases of central nervous system. Conclusion:  We concluded from the present study that there was higher burden of morbidities reported among elderly population, hence geriatric health care should be given preference in health policy making and implementation.
Key words: elderly population, morbidity, health care.​

25.   RETROSPECTIVE ASSESSMENT OF CASES OF HIP FRACTURES
        AT A TERTIARY CARE CENTER                                                                                                      131-135
        Dr. Bharat H. Patel                                                                                                                PDF FULL TEXT

ABSTRACT

Background: Hip fracture has been recognized as the most serious consequence of osteoporosis because of its complications, which include chronic pain, disability, diminished quality of life, and premature death.Material & Methods: In the present hospital based retrospective study, 100 case files of patients were studied for various parameters including age, gender, place of residence, duration of trauma, mechanism of injury, comorbidities, interval between admission and surgery, operation notes. Radiographs were assessed for type of fracture, presence of osteoporosis (Singh’s index) and type of implant used. Results: Hip fracture characteristics included intertrochanteric fractures (61%), followed by neck fractures (28%) and sub trochanteric fractures (11%). In the sub trochanteric fracture group, mostly patients were <60 years old and had a history of high energy trauma. About 6% fractures were pathological (excluding osteoporosis), mainly lytic lesions of proximal femur, primary and secondary malignancies. Prior hip fracture in the same or opposite limb was present in 12% of patients. >60 years old. Conclusion: With increased longevity, hip fractures are an increasing health care problem. Various preventive measures for osteoporosis and falls will decline the prevalence of these fractures.
Key words: Hip fractures, Epidemiology, Osteoporosis

26.   MOODLE: A TOOL FOR SELF- DIRECTED LEARNING IN FIRST YEAR MEDICAL STUDENTS   136-143
        Dr. Puneet Saxena, Dr. Alok Parekh                                                                                   PDF FULL TEXT

ABSTRACT

Background: Self-directed learning has been a central theme for decades. In medical education, the ability to direct and regulate student’s own learning experience is crucial for their success. Skills learned by self-directed way learning are associated with life-time learning Modular Object-Oriented Dynamic Learning Environment (MOODLE) is an open-source software learning management system, developed on the principles of andragogy by Martin Dougiamas for educators to create interactive and collaborative courses. Because of its modular structure and dynamic nature it has been used for flipped classrooms, blended learning, and distance education self-directed learning in various educational institutes. Methodology: 41 first-year MBBS students were randomly divided into study and control groups. The students of the study group were enrolled for the MOODLE course on “Glycogen metabolism”. On a prefixed day study group logged on to MOODLE course and in a parallel session the same topic was taught to control group as a didactic lecture.  After cross-over of the group same exercise was repeated with another topic i.e. Biochemical basis of complications of diabetes mellitus after each MOODLE session students’ feedback was recorded. The difference between pre and post-tests for both groups was analyzed. Results: The mean score in the study group (n=47) was 8.43 + 2.66 and in control group's mean score was 8.90 + 3.45. After crossover pre-test mean of study group was 7.00 +1.66 and post-test mean 13.24 +1.46 . The pre-test mean of the control group was 6.34 + 1.46 and post-test mean was 10.97 + 1.464. Students of the study group showed significant improvement in scores before and after the crossover of the groups. Conclusions: MOODLE is effective in promoting self-directed learning. Students preferred blended learning over e-Learning.
Keywords :Self-directed learning, MOODLE, Access restriction.
​

27.   ASSESSMENT OF PSYCHIATRIC ILLNESS IN PATIENTS WITH ACNE VULGARIS                      144-148
       
        Dr. Ashutosh Pandya                                                                                                           PDF FULL TEXT

ABSTRACT

Background: Acne vulgaris, is one of the most common skin diseases, it is highly prevalent in adolescents. However, it is also prevalent among the adult population. The magnitude of acne vulgaris is between 30% to 85% in young adults and adolescents. Cases of acne have been demonstrated as the symptoms of depression and anxiety. Many researches showed that patients with acne have problems with interpersonal relationships and their self-image. These patients have generally exhibited signs of social anxiety, depression, and suicidal tendencies and thoughts. Material & Methods: A total of 50 patients (40 women and 10men) who have visited the dermatology department at our hospital between August 2016 and January 2017. These diagnosed patients with adult acne were enrolled for the study by simple random sampling. The control group consisted of 50 healthy subjects without a known clinical disease (20 men and 30 women). Results:  The SCL 90-R GSI (Z=-6.78, p＜0.001), somatization (Z=-6.46, p＜0.001), depression (Z=-7.01, p＜0.001), and anxiety scores (Z=−7.03, p＜0.001) were statistically significantly higher in the case group than the control group. A very strong statistically positive correlation was reported between the following SCL 90-R subscales: GSI, somatization, depression, and anxiety. Conclusion:  Incidence of common psychiatric disorders was occurring with high frequencies in acne vulgaris patients. Adult patients with acne vulgaris were experiencing psychosomatic disease at higher rates.
Keywords: Acne, Anxiety, Depression.