International Journal of Medical Sciences and Education (IJMSE)
Vol. 6 Issue: 3 (July - September 2019), Date of Publication: 01.10.2019

Table of Contents
     Editorial

1.    STUDENTS’ PERCEPTION OF FOUNDATION COURSE – A NEW EXPERIENCE IN MBBS
       CURRICULUM IN INDIA                                                                                                                                     1-7
       Dr Rohit Dixit, Dr K P Joshi, Dr Suhasini P, Dr Deepak Jamadar                                            PDF FULL TEXT

ABSTRACT

​Background: As per the new curriculum by MCI, a one month foundation course has been introduced across the country. This will help a MBBS student to acclimatize the new learning environment in the medical college which is far different from high school. At the end of this foundation course this study was carried out with the aim to evaluate the perception of the students regarding the knowledge and importance of foundation course. Material and Methods: A cross sectional study was conducted by MEU, SVS Medical College, Mahabubnagar (TS). A predesigned, pre tested questionnaire was given to the students before and after the completion of one month of foundation course and were asked to rate the perception of knowledge and importance of the modules on the likert scale of 1 to 5 on various modules given by MCI. The data was analyzed by using SPSS 20.0 version. Results: A total of 66 students participated in this study. The mean scores of the perception of knowledge and importance of the various topics included in different module before the foundation course were 1.0 to 1.33 and 1.0 to 1.58 respectively but after the foundation course the mean scores increased to 3.3 to 3.5 and 3.8 to 4.3 respectively. The overall rating for the foundation course was 4.19±0.61. Conclusion: The improved scores in students’ perception of knowledge and importance of various modules in foundation course on the likert scale and overall rating for the foundation courseindicate that feedback response of newly admitted students was very satisfactory and encouraging.
Keywords: Likert scale, MBBS, MCI, Orientation, Perception, Skill

2.     IMPLEMENTAION OF NEW CURRICULUM IN UG (M.B.B.S): A DREAM PROJECT 0F MEDICAL    
        EDUCATION TECHNOLOGY                                                                                                                          8-12
        Subodh Kumar                                                                                                                            PDF FULL TEXT

ABSTRACT

Background: Medical Education System is the backbone of Healthcare Industries. Now a day’s it is facing a lot of problems due to shortage of recourse persons, Lack of skilled faculties and researchers in most of the Medical Colleges in India.  There is urgent need of improving the working environment, quality of the work and management system because lots of money devastated, due to ignorance. Reults: The newly implemented UG Curriculum was more effective than Earlier Pattern M.B.B.S Curriculum because it covers all the three domain of Learning (Cognitive for thinking,affective for emotion/ feeling and  Psychomotor for kinaesthetic) Material and Methods: The study was conducted at Vardhman Institute of Medical Sciences, Pawapuri, Nalanda (Bihar). Resource Faculty Members of different departments (Pre, para and clinical), Newly admitted M.B.B.S students, 2nd Year M.B.B.S Students, Medical Education Unit Members and Curriculum Committee Members were included in my present study. The study was designed to assess the effect of new curriculum for UG (M.B.B.S) as per MCI Guideline over existing earlier.  Conclusion: Implementation of key elements of new curriculum  in UG (M.B.B.S) would be helpful in creating holistic  and scientific environment,  not only among  the faculty but also it boost up the enthusiasm of MBBS Students to set their Professional Carrier from the beginning which in turn resulting Indian Medical Graduate(IMG) mission fruitful.
Keywords: Early Clinical Exposure (ECE), Foundation Course, AETCOM Module, Competency Based Medical Education (CBME), Indian Medical Graduate (IMG) Role, Healthcare Industries

3.     ASSESSMENT OF DEPRESSION AND ITS RISK FACTORS AMONG GERIATRIC AGE GROUP            13-16
        Dr. Bharati D. Patil                                                                                                                       PDF FULL TEXT

ABSTRACT

​Background: Depression is a commonly present among geriatric age group population. The most common etiology behind that were social deprivation, loneliness and disability in some cases, as reported in previous epidemiological studies. In majority of elderly population depression remains unrecognized. However, it indirectly exerts the burden on health care infrastructure of country. Materials and Methods: In the present study, a total number of 400 patients who were more than 60 years of age were attending outpatient department enrolled for present study 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-: All participants were assessed for depression by GDS-15 scores and found that there was no depression among 176 (44%) participants, 144 (36%) had mild depression, 72 (18%) had moderate depression and8 (2%) were severely depressed. On the basis of age and GDS score we found significant association (P value > 0.05).On the basis of age and GDS-15 score we found statistically non-significant association (P value > 0.05).On the basis of gender and GDS-15 score we found significant association (P value< 0.05).On the basis of type of family and GDS-15 score we found statistically non-significant association (P value > 0.05).On the basis of socio-economic status, marital status and financial dependency status and GDS-15 score we found statistically significant association (P value< 0.05). Conclusion: We concluded from the present study that the burden of depression is very prevalent among our geriatric study population. Depression among geriatric population was significantly associated with female gender, financial dependents, patients who were divorced and widowed and individuals with low socio-economic status.
KEYWORDS: Depression, Geriatric, Morbidity.

4.   ASSESSMENT OF RISK FACTORS OF POST-PARTUM HEMORRHAGE AND ITS OUTCOME
        AT TERTIARY CARE CENTER                                                                                                                   17-20
        Dr Mohini Nanani                                                                                                                      PDF FULL TEXT

ABSTRACT

Background: Post-partum hemorrhage (PPH) is responsible for approximately 23% of maternal mortality worldwide and also reported as the most common cause of maternal mortality in Asian continent. The most common direct cause of maternal deaths and as well as maternal morbidity in India is post-partum hemorrhage, reported in various researches and accounts for 25% maternal deaths. Material & Methods: A total of 200 cases who had vaginal delivery with blood loss of 500 ml or more and cases who had caesarean section with blood loss of 1000 ml or more, were enrolled for study. Written informed consent from each and every participant was taken prior to study. Results: The most common risk factor for the post-partum hemorrhage was the atonicity of the uterus which was seen in 168 (84%) of the total pregnant women. PIH was seen in 74 (37%) pregnant women followed by APH which was seen in 45 (22.5%) pregnant women. Prolonged labour was accounts for 28 (14%) cases of PPH and retained placental products accounts for 17 (8.5%) cases of PPH. Large baby induced PPH was seen in 14 (7%) pregnant women and Genital tract Injuries accounts for 13 (6.5%) cases of PPH. PPH due to ruptured uterus was seen in 9 (4.5%) pregnant women and multi parity accounts for 9 (4.5%) cases of PPH. Infections were accounts for 5 (2.5%) cases of PPH and Uterine Inversion accounts for 2 (1%) cases of PPH. Conclusion: We concluded from the present study that Post-partum hemorrhage can be managed effectively by active management of the third stage of labour with use of uterotonics and blood transfusions.
Keywords: Postpartum haemorrhage, Atonicity, Maternal mortality.

5.    COMPARATIVE EVALUATION OF LUNG CANCER BY CT GUIDED FINE NEEDLE ASPIRATION
       CYTOLOGY AND TRUCUT BIOPSY                                                                                                               21-25
​       Dr. Sonal Agarwal, Dr. D.P. Agarwal                                                                                            PDF FULL TEXT

ABSTRACT

​Background: Lung carcinoma is the most common type of malignancy all around the globe, especially in males. Lung cancer is the most common cause of cancer-related deaths, and the average five-year survival rate of lung cancer is near about 17%. Material & Methods: The present cross-sectional observational study was conducted over a period of one year with a sample size of 54 was calculated at a 95% confidence interval. All the patients, who had suspected mass lesion finding on chest X-ray and clinical correlation suggestive of lung carcinoma were undergone for CT guided FNAC and Biopsy. Results: CT guided FNAC examination revealed that 39 study participants were positive for malignancy (72.22%), among 10 study participants results were suggestive for malignancy (18.52%) and among 5 study participants results were negative for malignancy (9.25%). Biopsy results were positive for malignancy among all study participants. Results showed that small cell carcinoma was positive among 4 (7.41%) study participants while non-small cell lung carcinoma was positive among 49 (90.74%) study participants. The sensitivity of CT guided FNAC and Biopsy in the evaluation of lung cancer was found 90.74% and 100% respectively. The specificity of CT guided FNAC was 100% for the diagnosis of lung carcinoma. Conclusion:  CT guided lung FNAC is a safe, accurate and highly specific and also well-tolerated procedure which confirms the diagnosis of Lung cancer. Though the specificity of FNAC is high for diagnosing Lung carcinoma, still Biopsy had high sensitivity and would be preferable diagnosis Lung cancer and its various subtypes.
Keywords: Lung cancer, CT guided FNAC,

6.    STUDY OF SERUM IRON, SERUM ZINC AND SERUM ALKALINE PHOSPHATASE IN PREMATURE       
​       DELIVERY                                                                                                                                                       26-30
       Ajay Kumar Hurmale, Sanjay Kumar Deshwali, Jaidev Singh                                                 PDF FULL TEXT

ABSTRACT

​Background: Preterm labour can be multifactorial syndrome caused by multiple etiological mechanisms. It may present a short- circuiting of overwhelming of the normal parturition cascade whereby the feto-placental unit can trigger labor prematurity if intra-uterine environment becomes hostile and intimidate the wellbeing of the foetus. Material & Methods: The study will include 58 subjects who had preterm delivery taken as case.20 women taken as control and delivered at term (after 37 weeks).All subjects will be between 18 to 35 years of age. Serum alkaline phosphatase, Serum Zinc and Serum Iron was estimated. Result: The maternal serum levels of alkaline phosphatase is greater while serum iron and serum zinc was lowered in preterm group as compared to the term. Conclusion: To conclude the present study gives us an idea that the studied biochemical parameters have some association with preterm delivery
Keywords: Premature delivery,  Serum Zinc, Serum Iron, Serum Alkaline phosphatase

7.    HEMOLYTIC DISEASE OF NEWBORN DUE TO ALLOIMMUNISATION TO ' c ' ANTIGEN                        31-33
       Dr. Rashmi  Parashar,  Dr. Sunita bundas,  Dr. B. S. Meena, Dr. Pamendra  Pachori            PDF FULL TEXT

ABSTRACT

Among the blood group systems, Rh blood group system showing highly polymorphism and most of its antigens are highly immunogenic and can cause clinically significant hemolytic reactions, if antibodies are developed against them (1). In Rh system, D is highly immunogenic and one of the commonest cause of severe hemolytic disease of newborn (2) .Other common Rh antigen in sequence of immunogenicity are c, E, C, e (3). Here we are reporting a case of HDN due to Anti-c.

8.    ASSESSMENT OF FEBRILE THROMBOCYTOPENIA  AT A TERTIARY CARE CENTRE                         34-37
       Dr. Radhey Shyam Gupta                                                                                                            PDF FULL TEXT

ABSTRACT

Background: Thrombocytopenia is a common manifestation reported among cases of pyrexia which can also manifest as purpura. However, purpura can be divided in two types either thrombocytopenic or non-thrombocytopenic. According to morphology platelets are anucleate cells with a life span of 8 to10 days and play vital function for hemostasis. In various studies it was reported that cases of febrile thrombocytopenia had very wide etiology which also influenced by the treatment modality. Material & Methods: In present study200 Patients who were presenting with pyrexia and confirmed with thrombocytopenia from laboratory investigations were enrolled from outdoor and from ward by simple random sampling. Clearance from Institutional Ethics Committee was taken before start of study. Results: In the present study, 74 (37%) patients had viral fever which was followed by malarial infections in 44 (22%) patients, which was followed by dengue fever among 40 (20%) patients. Scrub typhus was reported among 26 (13%) patients and septicemia was reported among 12 (6%) patients. Leptospirosis was reported among 4 (2%) patients. Majority of patients 102 (51%) had platelet countbetween100000 to 150000 per cubic mm, which was followed by platelet count between 50000 to 100000 per cubic mm among 66 (33%) patients. 24 (12%) patients had platelet count less than 20000 per cubic mm. Conclusion: Viral fever reported among most of the patients of febrile thrombocytopenia followed by malaria and dengue fever. Fever was the most common symptom followed by headache, myalgia, chills and rigors, pallor, cough, rashes, jaundice, breathlessness and bleeding diathesis.
KEY WORDS: Fever, Thrombocytopenia, Viral fever.

9.    EPIDEMIOLOGICAL STUDY OF DERMATOLOGICAL DISORDERS AT TERTIARY CARE CENTER        38-41
       Dr Sanjay Purohit                                                                                                                          PDF FULL TEXT

ABSTRACT

Background: Skin disease are considered very upsetting, especially in younger age groups. The burden and type of any disease in particular geographical area depends on the genetic constitution of the individuals, their social background and nutritional and hygiene status. The prevalence of disease is depending upon environmental conditions and the quality of medical care provided to them. Material & Methods: The present retrospective study was conducted at department of dermatology of our tertiary care hospital. In this epidemiological study patients of age of both the genders who were consented were enrolled for the study. Clearance from Institutional Ethics Committee was taken before start of study. Results: The most common presenting symptom was skin infections present among 23.66% patients. After infections next common finding was eczema which was present among 168 (14%) patients which was followed by contact dermatitis among 128 (10.66%) patients, urticaria was found in 114 (9.5%) patients and xerosis in 96 (8%) patients followed by acne in 7.4% and infestations in 7.2% patients. Hair disorders was present in 5.6% cases and atopic dermatitis was present in 4.3% cases. Post in flammatory changes seen in 3.58% and vitiligo was present in 1.66% cases followed by P.alba in 1.16% cases. Conclusion: The climate, occupation, socio-economic status, gender and age of the patient were associated in the occurrence of skin diseases. Fungal diseases, eczema and contact dermatitis were seen more commonly and scabies was the most common infestation.
Key words: Fungal infections, Contact dermatitis, Acne.

10.  EVALUATION OF MANAGEMENT AND OUTCOME OF PAEDIATRIC FOREARM RE-FRACTURES        42-45
       Dr. Sohan Lal Gupta                                                                                                                     PDF FULL TEXT

ABSTRACT

​Background: Forearm fractures are one of the commonest injuries accounting for 40% of paediatric fractures with a refracture rate of nearly 5%. Forearm refractures are increasing probably due to poor bone mineralization as a result of decreased physical activity, Vitamin D deficiency. These are treated by conservative measures with closed reduction and casting or by surgical fixation with flexible nails or plates. There are no definitive guidelines for management of forearm refracture and implant removal. Material & Methods: The study is aimed at the epidemiology, methods and difficulties of management and functional outcome of forearm refracture treatment. A prospective study of all the cases of forearm refracture who presented to Preksha Hospital & Chetna Ivf Research Centre and Manidhari Hospital & Maloo Neuro Centre,Jodhpur from 2016 to 2018 with refractures treated either by conservative methods or by IMN. All cases were followed up and functional outcome was assessed serially according to price et-al criteria. Results: Our study contained 17 males and 8 females between 6 years and 14 years. 76% refractures occurred before 16 weeks and majority had only tricortical union at this time. 42% patients underwent surgical fixation following refracture. Price et al criteria showed excellent results in 72% of patients. Conclusion: Forearm refractures in children can be treated both conservatively and surgically like a primary fracture depending on the indications but needs 2 to 3 more weeks of immobilization. A good functional outcome was obtained in majority of the cases. We suggest using splints till quadricortical union is achieved to prevent chances of refracture.
Keywords:  Refracture, Forearm fracture, Paediatric, Outcome.

11.    BACTERIAL PROFILE AND ANTIBIOGRAM FROM DIFFERENT SPECIMENS OF INTENSIVE
         CARE UNIT                                                                                                                                                    46-50
         Dr Rakesh Modi, Geetesh Mangal                                                                                             PDF FULL TEXT

ABSTRACT

Background: According to the reports of Global Burden of Diseases study among the low and lower- middle-income countries the major cause of mortality was infections. They reported several risk factors responsible for this high mortality rate which are poverty, increasing old age, illiteracy, rapid urbanization and emerging bacterial infections and viral infections. Material & Methods: In the present prospective study, patients who were admitted in ICU during the one year of study period were enrolled by simple random sampling. Clearance from hospital ethics committee was taken before start of study. Written informed consent was taken from each study participant. Results: In the present study a total of 640 specimens were sent for isolation of causative pathogens out of them 300 (46.8%) were culture positive with 80% from sputum, 66% from urine, 21% from CSF and 22% from blood. Out of the total Gram-negative bacteria were found predominantly and included Escherichia coli (21%), Acinetobacter baumanii (14%), Klebsiella pneumoniae (13%), Pseudomonas aeruginosa (10%) and Enterobacter aerogenes (6%). Among the gram-positive bacteria Coagulase negative staphylococci (12%) found most commonly which is followed by MRSA (6%), Streptococcus pneumoniae (3%) and Enterococcus faecalis (3%). Candida sp were found in 12% cases. Conclusion: We concluded from the present study that on the basis of antibiotic sensitivity among the gram-negative isolates maximum drug sensitivity is shown by the drugs colistin, polymyxin-b and tigecycline and on the basis of antibiotic sensitivity among the gram-positive isolates maximum drug sensitivity is shown by the drugs vancomycin, clindamycin and linezolid.
Key words: APACHE-2, Gram-negative infections, Intensive care units.

12.    A PROSPECTIVE CROSSECTIONAL  STUDY OF PREVALENCE OF NEUROPSYCHIATRIC
         MANIFESTATIONS IN ADOLESCENTS WITH VITAMIN BI2 DEFICIENCY ANAEMIA                            51-56
         Dr Rishi Sodawat, Dr Nayan Kumar, Dr Chaturbhuj Singh                                                    PDF FULL TEXT

ABSTRACT

Background: Megaloblastic anemia is one of the common causes of anemia in adolescent population. Anemiabeing the most common presentation of B12 deficiency, the neuropsychiatric features are often overlooked. In India limited studies are available on vitamin B12 deficiency in adolescents. The aim of this study was to determine the prevalence of neuropsychiatric features in adolescents presenting with vitamin b12 deficiency. Method: A Prospective, tertiary hospital based, cross sectional open label clinicoepidemiological analysis of  100 anaemic patients of adolescent age group (excluding aplastic anaemia, hemolytic anaemia associated with jaundice and organomegaly, leukaemia, anemia of chronic inflammatory diseases, those who had received blood transfusion or haematinics in past (< 6months) ) admitted in pediatric ward of tertiary care centre in Ajmer region was done. In all the cases detailed clinical history and general examination along with lab investigations were done. In all the cases vitamin B12 level was done. Results: Out of 100 patients 38% were found deficient with female predominance. A prominent association could be ascertained between neuropsychiatric symptoms and B12 deficiency.  Conclusion: Deficiency of B12 is increasing among adolescents during recent years, with neuropsychiatric symptoms being common clinical features as seen in our study. B12 deficiency might present with these symptoms in absence of anemia. Supplementation through implemented nutritional programmes and education regarding diet patterns may overcome this deficiency.
Keywords: Megaloblastic Anemia, Neuropsychiatric Morbidity, Adolescents Age

13.    A COMPARATIVE STUDY OF SERUM BETA HUMAN CHORIONIC GONADOTROPHIN AND OCULAR
        CHANGES IN PREGNANCY INDUCED HYPERTENSION IN
        SECOND TRIMESTER OF PREGNANCY                                                                                                 57-65
        Dr Neha Jaiswal, Dr Sandeep Shivran                                                                                  PDF FULL TEXT

ABSTRACT

​Background: Hypertension disorder of pregnancy affects up to 8% of all gestations. Pregnancy induced Hypertension is defined as hypertension that develops for first time in pregnancy after 20 weeks of gestation. Pathophysiological placental abnormalities are seen consistently by increasing secretion of hormone HCG. Most ocular changes in pregnancy are harmless. For example, 14% of pregnant women need a new eyeglass prescription. Some changes, however, are serious, such as retinal effects of hypertension, which can be a sign of pre-eclampsia. METHOD The present study was being conducted on 50 healthy pregnant controls and 50 clinically established pregnancy induced hypertensive subjects. Serum hCG was measured and Fundoscopy for retinal changes was done. For analyzing the Data, Statistical software SYSTAT version 12 was used. The results were revealed in mean ±standard deviation. Comparisons of cases and control groups were done by applying Z test. Student’s t-test at 5% (p=0.05) and 1% (0.01) level of significance was used for correlation. RESULTS: Serum βHCG was significantly higher (t=18.14; p˂0.01) in pregnancy induced hypertensive subjects as compared with healthy pregnant control subjects.40% to 100% of pregnant women with high blood pressure have retinal changes whose severity is correlated with the severity of pre-eclampsia or eclampsia. CONCLUSION: Abnormally high serum β HCG in PIH Subjects is a dreaded complication of pregnancy. Serum β HCG should be included in routine investigation. Most ocular diseases can be treated with the usual drugs in pregnant women and Recommendations about drug treatment should be checked against current information that can be found on the embryotox.de and reprotox.de websites
KEYWORDS: Pregnancy induced hypertension, βhCG, Funduscopy, hyperplacentosis.

14.   ASSESSMENT OF BURDEN OF URINARY TRACT INFECTION AMONG MALNOURISHED CHILDREN AT              TERTIARY CARE CENTRE                                                                                                                      66-69
       Dr Ashwin  Dangi,  Dr Ashwin Sanghavi                                                                               PDF FULL TEXT

ABSTRACT

​Background: Urinary tract infection was reported as the major cause of health-related morbidity among the children in various studies. The most common presenting signs and symptoms are unexplained fever, nausea, vomiting and also diarrhea and failure to thrive among infants. However, among older children, these signs and symptoms are coupled with increased frequency of micturition and sometimes presents with nocturnal enuresis. Material & Methods: The present prospective study was conducted at department of pediatrics of our tertiary care hospital. The study was an observational study conducted for during a period of nine months. The study done at 95% confidence interval at 10% of maximum allowable error. All children of age 6 months to 5 years, who were diagnosed with both moderate acute malnutrition (MAM) and severe acute malnutrition (SAM), according to WHO criteria were enrolled into the study. Results: In present study, out of total study participants, based on the symptoms, the most common clinical presenting symptom was fever present in 29% patients which was followed by symptoms  of urinary tract infections present in 7% patients, which was followed by diarrhea present in 6% patients which was followed by vomiting present in 4% patients. Conclusion:  We concluded from the present study that the most common presenting symptoms were fever, urinary tract infections, diarrhea and vomiting. We found high prevalence of urinary tract infection among children diagnosed with both moderate acute malnutrition and severe acute malnutrition.
Keywords: Urinary tract infection, moderate acute malnutrition, severe acute malnutrition.​

15.   PERINATAL OUTCOME OF BABIES BORN OUT OF ASSISTED REPRODUCTIVE TECHNOLOGY    70-73
       Dr Priyanka Singh,  Dr Naresh Kumar                                                                                     PDF FULL TEXT

ABSTRACT

​Background: Over the past40 years ART (Assisted Reproductive Technology) has been greatly refined and expanded resulting in millions of births. However, in many studies the concern has been raised regarding the health outcome of babies born out of ART. Material and methods: To assess the perinatal outcome we prospectively studied 75 ART (Assisted Reproductive Technology) babies which were all IVF, born in Mahatma Gandhi Medical College& Hospital, Jaipur between Dec 2012-June 2014. Results:  Out of total 75 babies, 50.66% babies were born preterm, 43 babies (57.33%) were small for dates (SFD), 49.33% were Low Birth Weight (LBW). NIne babies (12%) had morbidities after birth in the form of Septicemia, Respiratory distress, Hypocalcemia and NEC. Conclusion: We conclude that babies born out of ART have comparable and favorable outcome and ART including IVF is a safe and reliable procedure as far as outcome in term of healthy babies are concerned.
Key Words: Assisted Reproductive Technology, Perinatal, In vitro fertilization, Pre term, Small for date

16.   COMPARATIVE EVALUATION OF TWO APPROACHES OF BRACHIAL PLEXUS ANESTHESIA       74-77
        Dr Ajay Singh Chundawat                                                                                                      PDF FULL TEXT

ABSTRACT

Background: The brachial plexus blockade of is a proven and very effective method for achieving anesthesia for the upper limb which involves shoulder to fingertips. There are multiple theories and various approaches for achieving brachial plexus blockage which are varies on the block indication, procedure of surgery which being performed, specific patient-body habitus, associated medical comorbidities and anatomical individual variations. Material & Methods: The present single Centre observational study was conducted in department of anesthesia at our tertiary care hospital. The study was conducted in duration of one year, after seeking approval from the Institutional Ethics Committee. Calculated Sample size of study was 100, and patients who had American society of anesthesiologists (ASA) physical status I to II and in the age group of 18 to 65 years, who were scheduled for surgery of the upper limb under brachial plexus anesthesia, were enrolled for the study. Results: The block performance time (min) was 3.8±0.90 in supraclavicular brachial plexus block (group I) and block performance time (min) was 5.4±0.7 in infraclavicular brachial plexus block (group II) (P <0.05). The Onset time for sensory and motor block was 29 and 30 minutes for supraclavicular brachial plexus block (group I) and Onset time for sensory and motor block was 30 and 31 minutes for infraclavicular brachial plexus block (group II) (P >0.05). The most common complication after supraclavicular brachial plexus block was Horner syndrome 31 (62%) and Vascular puncture 3 (6%). Complication after infraclavicular brachial plexus block was Horner syndrome 3 (6%) and Vascular puncture 3 (6%). Conclusion: The supraclavicular brachial plexus block was easier to perform compared to the infraclavicular brachial plexus block. Both the approaches of the brachial plexus block have nearly similar duration of onset. The infraclavicular brachial plexus block approach had minimal complications.
Keywords: Brachial plexus block, Supraclavicular block, Infraclavicular block.

17.   ASSESSMENT OF THYROID DYSFUNCTION AMONG PATIENTS OF CHRONIC KIDNEY DISEASE
        AT TERTIARY CARE CENTRE                                                                                                                  78-82
        Dr Bakul Gupta                                                                                                                        PDF FULL TEXT

ABSTRACT

Background: Chronic kidney disease is differentiated from acute kidney disease or acute kidney injury by its longterm form of kidney disease in which symptoms are presents for over 3 months. Several studies from all over the world reported prevalence of chronic kidney disease varies from 5-10% and recognized as public health problem globally. Material & Methods: The present prospective study was conducted among the patients of Chronic Kidney Disease above 18 years of age and diagnosed on the basis of history, detailed clinical examination based upon National Kidney Foundation (NKF) criteria were enrolled into the study. Written informed consent was taken from each study participant. Results: In present study, out of total study participants, based on the Serum creatinine (mg%) status, among the study participants who had serum creatinine levels less than 5 mg%, 18% had TSH less than 5, 6% had TSH between 5-10 and none of them had TSH more than10. Among the study participants who had serum creatinine levels more than 5 mg%, 52% had TSH less than 5, 20% had TSH between 5-10 and 4% had TSH more than10. among the study participants who had 24 hour urine protein levels less than 1 gm%, 20% had TSH less than 5, 4% had TSH between 5-10 and none of them had TSH more than 10. Among the study participants who had 24-hour urine protein levels more than 1 gm%, 50% had TSH less than 5, 22% had TSH between 5-10 and 4% had TSH more than 10. Conclusion: We concluded from the present study that sub-clinical hypothyroidism is significantly associated as an additional risk factor in patients of Chronic Kidney Disease. We found significant association of serum creatinine, serum albumin levels and 24-hour urine protein with sub-clinical hypothyroidism.
Keywords: Chronic kidney disease, Subclinical hypothyroidism, Thyroid dysfunction.

18.   COMPARISON OF PROBLEM-BASED LEARNING WITH TRADITIONAL LECTURE-BASED LEARNING
        FOR FIRST MBBS STUDENTS IN BIOCHEMISTRY USING PRE AND POST MCQ TEST OF
        THE STUDENTS                                                                                                                                          83-86
        Dr Piyush Tailor, Dr Sarita Patel                                                                                            PDF FULL TEXT

ABSTRACT

Background: The traditional learning technique is lecture-based learning (LBL) sessions taught by the faculty to the student without clinical correlation and without integration with other subjects. Problem-based learning (PBL) can be utilized for teaching small groups as well as a large group. It can produce more retention and correlation of knowledge about the topic and clinical condition which is required during the management of real patients. Objectives:  Comparison of problem-based learning with traditional lecture-based learning techniques for first MBBS students in Biochemistry. Methodology: For both learning methods, two diseases were selected. A total of 100 students samples from 1st MBBS are selected randomly and randomly divided into 2 groups of 50 students.  The cross-over of each group was done with the clinical case as well as with the teaching-learning method. Pre and Post-expose MCQs test of 10 marks for the students were taken. Results: Both the groups show significant differences result in posttest MCQ marks in compare to pre-test MCQ marks with problem-based learning (p’ Value < 0.05). Also, there is a very significant difference in the result of pre & post-learning MCQ marks in problem-based learning in comparison to traditional learning methods. (Group-1 p-value <0.0001 and Group-2 p-value < 0.001). Conclusion: Performance of 1st MBBS students in the subject of biochemistry improved significantly during the MCQ test after problem-based learning but did not improve significantly during the MCQ test after traditional learning.
Keywords: LBL (Lecture Based Learning), PBL (Problem Based Learning)

19.   ASSESSMENT OF KNOWLEDGE, ATTITUDE AND PRACTICES OF BIOMEDICAL WASTE MANAGEMENT
        AMONG NURSING STAFF OF HOSPITALS OF RAJSAMAND DISTRICT, RAJASTHAN                         87-90
       Dr Neeta Mishra, Dr Dilip Kumar L, Dr. Sanjeev Kumar Sharma                                             PDF FULL TEXT

ABSTRACT

Background: Biomedical waste defined as any waste which is generated during the diagnosing, treating, and surgical intervention and immunizing and also conducting research activities on humans as well as on animals. Health care facilities are aimed to provide health care services to the general population to remove potential health hazards to people. Material & Methods: The present observational, prospective and cross-sectional study was conducted at the Department of Community Medicine of our medical college and hospital. The study duration was of six months, from May 2017 to October 2017. We include the nursing staff of our medical college along with two other hospitals of Rajsamand district, Rajasthan in the present study. Clearance from Institutional Ethics Committee was taken before the start of the study. Results: In the knowledge domain 51% of study participants answered Correct response on color-coded bags with respective waste and 77% of study participants answered Correct response on knowledge about colour coded bags. In the attitude domain, 94% of study participants had a positive attitude towards bio-medical waste (BMW) management categorization needs and 96% of study participants had a positive attitude towards bio-medical waste management necessary and reduction of health hazard.   In the practice domain, 62% of study participants show a positive response towards disinfecting bio-medical waste (BMW) and 70% of study participants had a positive response towards the bio-medical waste treatment. Conclusion:  We concluded from the present study that nursing staff had good knowledge and had a positive attitude towards biomedical waste management and positive findings towards practices related to BMW. However there still a knowledge attitude and practice gap exit. Therefore, the training programs for the nursing staff should be necessary to reduce this KAP gap related to biomedical waste management.
Keywords: Bio-medical waste management, knowledge, attitude, practice.

20.   ASSESSMENT OF CLINICAL PROFILE AND ENDOSCOPIC PROFILE OF PATIENTS WITH UPPER
        GASTROINTESTINAL BLEED                                                                                                                     91-94
        Dr. Munesh Kumar, Dr. Sandeep Kothari, Dr. Prahlad Dhakar, Dr. Sunil Gupta                   PDF FULL TEXT

ABSTRACT

Background: Upper gastrointestinal bleeding is reported as a common medical emergency around the globe. UGIB refers to bleeding from the stomach, esophagus, or duodenum. Patients generally presented with hematemesis or melena; however, hematochezia can also present in the cases of major bleeding. Previous studies reported that higher incidence of mortality rates in the patients presented with hematemesis than patients presented with melena. Material & Methods: The present prospective observational study was conducted at the Department of Medicine at tertiary care hospital. A sample size of 100 was calculated at a 95 % confidence interval at a 10 % acceptable margin of error by epi info software version 7.2. Patients were enrolled from the outpatient department and ward by simple random sampling. Clearance from Institutional Ethics Committee was taken before the start of the study. Results: In the present study, among the total study participants the most common presentation was in form of both hematemesis and Malena (46%), which was followed by hematemesis (36%) whereas only 18% of patients presented with complaint of Malena alone. Based on the endoscopic profile of patients with upper GI bleeding among the total study participants, the most common cause of upper gastrointestinal bleeding was portal hypertension leading to esophageal and/or gastric varices (52%), which was followed by peptic ulcer (17%), which was followed by erosive gastro-duodenitis (14%), which was followed by Mallory weis tear (5%) and gastrointestinal malignancy (2%). No endoscopic lesion could be identified in 10% of patients with upper gastrointestinal bleeding. Conclusion: We concluded from the present study that based on the endoscopic profile of patients with upper GI bleeding the most common cause of upper gastrointestinal bleeding was portal hypertension leading to esophageal and/or gastric varices which were followed by peptic ulcer.
Keywords: Upper gastrointestinal bleeding, endoscopic intervention, hematemesis.

20.   ASSESSMENT OF CLINICAL PROFILE AND ENDOSCOPIC PROFILE OF PATIENTS WITH UPPER
        GASTROINTESTINAL BLEED                                                                                                                     91-94
        Dr. Munesh Kumar, Dr. Sandeep Kothari, Dr. Prahlad Dhakar, Dr. Sunil Gupta                   PDF FULL TEXT

ABSTRACT

Background: Upper gastrointestinal bleeding is reported as a common medical emergency around the globe. UGIB refers to bleeding from the stomach, esophagus, or duodenum. Patients generally presented with hematemesis or melena; however, hematochezia can also present in the cases of major bleeding. Previous studies reported that higher incidence of mortality rates in the patients presented with hematemesis than patients presented with melena. Material & Methods: The present prospective observational study was conducted at the Department of Medicine at tertiary care hospital. A sample size of 100 was calculated at a 95 % confidence interval at a 10 % acceptable margin of error by epi info software version 7.2. Patients were enrolled from the outpatient department and ward by simple random sampling. Clearance from Institutional Ethics Committee was taken before the start of the study. Results: In the present study, among the total study participants the most common presentation was in form of both hematemesis and Malena (46%), which was followed by hematemesis (36%) whereas only 18% of patients presented with complaint of Malena alone. Based on the endoscopic profile of patients with upper GI bleeding among the total study participants, the most common cause of upper gastrointestinal bleeding was portal hypertension leading to esophageal and/or gastric varices (52%), which was followed by peptic ulcer (17%), which was followed by erosive gastro-duodenitis (14%), which was followed by Mallory weis tear (5%) and gastrointestinal malignancy (2%). No endoscopic lesion could be identified in 10% of patients with upper gastrointestinal bleeding. Conclusion: We concluded from the present study that based on the endoscopic profile of patients with upper GI bleeding the most common cause of upper gastrointestinal bleeding was portal hypertension leading to esophageal and/or gastric varices which were followed by peptic ulcer.
Keywords: Upper gastrointestinal bleeding, endoscopic intervention, hematemesis.

21.   USEFULNESS OF ANTHROPOMETRIC PARAMETERS AND THE BIOELECTRICAL IMPEDANCE
        ANALYSIS IN ASSESSMENT OF OBESITY IN YOUNG ADULTS                                                               95-98
        Dr. Chandrakant Kamariya, Dr. Uday Vachhani                                                                       PDF FULL TEXT

ABSTRACT

Background: Overweight and obesity defined as abnormal or excessive accumulation of fat among the body which will impair health. It is one of the imperial factor in associated with increased metabolic risk and development of many chronic illnesses such as heart disease, respiratory illness, diabetes, hypertension, and some cancers. Body mass index (BMI), the most applicable anthropometric measure, is a general adiposity predictor, whereas bioelectrical impedance analysis (BIA) was established as measures of body fat percentage. Material & Methods: Total 202 medical students, 94 males and 108 females, age between 17-20 years were enrolled in this cross sectional study. BMI and waist-to-hip ratio (WHR) were obtained by measuring Weight, height, waist circumference (WC), and hip circumference (HC). Total body fat, visceral fat and skeletal muscle mass and their distribution in different parts of the body were measured by professional bioelectrical impedance analyser. Results: Total body fat and visceral fat were higher in overweight males (26% and 10%) and females (34% and 7.3%) respectively. Significant positive correlation was observed between anthropometric parameters and regional distribution of subcutaneous fat and skeletal muscle mass in male and female. The correlation between BMI values and body fat percentage were 0.86 and 0.72 in males and females respectively (P<0.001) and for visceral fat were 0.99 and 0.95 in males and females respectively (P<0.001). Conclusion: From the findings, it could be inferred that body fat percentage analysis by BIA is as reliable as anthropometric parameters like BMI and WC for obesity assessment.
Keywords:: Body mass index, Bioelectrical impedance analyser, Overweight, Obesity

22.   ALTERATIONS IN THE PARAMETERS OF CONVENTIONAL LIVER FUNCTION TESTS IN LIVER DISEASE            AND NON-LIVER DISEASE: DOES IT INDICATE THE REQUIREMENT OF NEWER PARAMETERS?   99-102
        
        Dr. Jignesh H Gorasia, Dr. Gaurang K Anandpara                                                               PDF FULL TEXT

ABSTRACT

Background: The present study was carried out to evaluate the alterations in the levels of Conventional Liver Function Tests (CLFTs) in liver disease patients and to differentiate it from non-liver disease. Material and method: This cross-sectional study was conducted at Sir T Hospital in 50 liver disease patients and 50 non-liver disease patients, who were examined clinically and confirmed sonographically for liver involvement. Out of 50 liver disease patients, 17 had cirrhosis and 17 were of chronic hepatitis mainly. All the parameters of CLFTs including serum bilirubin, SGPT, SGOT, ALP, Total protein and albumin were estimated and compared in liver disease and non-liver disease patients. Results: Data was analyzed by non-parametric Mann-Whitney test and statistical significance was calculated. It showed that serum bilirubin was highly significant (p<0.001), while SGPT and SGOT were raised in liver disease patients, but they were not statistically significant (p>0.05). All the parameters of CLFTs were lacking the sensitivity and specificity to correctly diagnose liver involvement. It was also observed that all the parameters of CLFTs were also altered in many non-liver disease patients. So none of the individual test can predict the liver disease and at times it can lead to a confusing situation between liver disease and non-liver disease. Conclusion: The present study concludes that more sensitive and specific parameters are needed to correctly diagnose liver disease and at the same time it must rule out non-liver diseases.
Keywords: Conventional Liver Function Tests, Liver disease, Non-liver disease.

23.   OXIDATIVE STRESS AND ANTIOXIDATIVE PARAMETERS IN CHRONIC FATIGUE SYNDROME   103-108

       Ghizal Fatima, Hemali Jha                                                                                                        PDF FULL TEXT

ABSTRACT

Background: The etiology of Chronic Fatigue Syndrome (CFS) is unknown; the recent reports suggest excessive involvement of free radicals generation. Therefore, in this study we assessed the oxidative and antioxidative parameters in CFS patients and also evaluated their correlation with fatigue assessment scale (FAS).   Methods: Oxidative stress was determined by measuring the levels of Protein carbonyls, Lipid Peroxides (LPO) in plasma and antioxidative parameters like catalase, Glutathione peroxidase (GPx) and Glutathione Reductase (GR) in blood lysate in 25 patients of CFS and 25 healthy patients without CFS. Clinical parameters of CFS were evaluated by FAS.    Results: Activity of enzymes catalase, GR and GPx were significantly reduced in patients with CFS than in controls, and levels of markers of oxidative stress like LPO and protein carbonyls were significantly elevated in CFS patients than in controls. A significant positive correlation was observed between protein carbonyls and FAS among patient group. Additionally, a significant positive correlation was also found between LPO and FAS among CFS group than in control group.    Conclusion: The result of the present study indicates that patients with CFS have high oxidative stress parameters in their blood and this increased oxidative stress may play a role in the etiopathogenesis of the CFS disease.   Furthermore, our results also showed that this increase in oxidative stress parameters is more strongly amalgamated with severity of CFS.  
Keywords: Chronic fatigue syndrome, Oxidative stress parameters, Antioxidative parameters.

24.  PSORIASIS AND PSYCHIATRIC MORBIDITY: AN ASSESSMENT FROM A TERTIARY CARE CENTRE OF               SOUTHERN RAJASTHAN INDIA                                                                                                          109-112
​
       Dr. Ashutosh Pandya, Dr Gajanand Ojha                                                                              PDF FULL TEXT

ABSTRACT

Background: Psoriasis patients also experience added financial burden because of workplace absence which adds up to the cost of treatment. Several other factors, including race, genetics, geographical variation, infection, injury smoking, diet, alcohol, and psychological issues in particularly emotional stress which plays important role in the pathology or potentiation of psoriasis. All these factors can modify or affect the outcome of treatment. Material & Methods: A total of 50 patients enrolled for the study, who was suffering from psoriasis, attended the dermatology (inpatient and outpatient) department of our hospital. These diagnosed patients with psoriasis were enrolled for the study by simple random sampling. The control group consisted of 50 healthy subjects without known clinical disease. Results: 32% of psoriatic cases had psychiatric morbidities in comparison to 6% of the healthy control. This was statistically significant (P < 0.001). Participants with GHQ score ≥, were further compared by HADS Scale for the severity of anxiety and depression. It was found that cases had scored more than control on HADS Scale. This difference was however not statistically significant (P = 0.624, P = 0.705). Conclusion: Prevalence of psychological morbidities among the patients of psoriasis was found to be significantly more in comparison to healthy controls. There was a positive correlation found between the severity of psoriasis and psychological disorders. Cases of psoriasis with lesions at exposed parts of the body had more psychological disorders and poorer QOL.
Keywords: Psoriasis, psychiatric morbidity, anxiety, depression.

25.  A SINGLE CENTER OBSERVATIONAL STUDY TO ASSESS THE PREVALENCE OF THYROID DISORDERS           DURING PREGNANCY AND THEIR IMPACT ON MATERNAL AND FETAL OUTCOMES                113-119
 
       Dr. Jay Manojbhai Sheth, Dr. Bhumika H. Bhagat                                                                PDF FULL TEXT

ABSTRACT

Background: Thyroid disorders can silently affect pregnant women and their babies, causing serious problems, weaving intricate threads that affect both the bearer of life and the life within. The role of thyroid function in pregnancy emerges as a critical axis upon which maternal and fetal well-being status is impacted. Objective: To investigate how common thyroid disorders are during pregnancy and how they affect pregnancy outcomes for both mothers and babies. Methods: Over the course of one year, we enrolled 400 pregnant women who were between 13 and 26 weeks into their pregnancies. Results: The prevalence of thyroid dysfunction was found to be 20%; prevalence of hypothyroidism was 13.25%, with 4.25% having overt hypothyroidism and 9% having subclinical hypothyroidism. Adverse maternal and neonatal outcomes, including spontaneous abortion, preterm birth, low birth weight (LBW), and intrauterine growth retardation (IUGR), were significantly more prevalent in overtly and subclinically hypothyroid women, encompassing adverse fetal outcome such as spontaneous abortion (P = 0.038), preterm delivery, LBW, and IUGR, while adverse maternal outcomes such as preeclampsia and placental abruption. Subclinical hyperthyroid status was also associated with adverse maternal and newborn outcomes. Conclusions: Early detection and management of thyroid disorders during pregnancy are crucial to improving pregnancy outcomes. Our findings emphasize the importance of close monitoring and timely intervention in pregnant women with thyroid dysfunction.
Keywords: thyroid disorders, Maternal health, Fetal well-being, Subclinical hypothyroidism,Low birth weight (LBW)