International Journal of Medical Sciences and Education (IJMSE)
Vol. 6 Issue: 4 (Oct. - December 2019), Date of Publication: 01.01.2020

Table of Contents
     Editorial

1.    COMPARATIVE EVALUATION OF STRUCTURED VIVA-VOCE EXAMINATION AND CONVENTIONAL
       VIVA-VOCE EXAMINATION IN II MBBS STUDENTS                                                                                     1-5
       Navpreet Kaur, Sami Manzoor, Sharanjit Kaur, Anmol Goyal                                               PDF FULL TEXT

ABSTRACT

​Background: Viva-voce examination is an important tool for student assessment. The traditional or conventional viva-voce examination (CVE) is often perceived to be associated with subjective bias. At the same time, it doesn’t meet the standards of parameters such as validity, reliability, and reproducibility. A structured viva-voce examination (SVE) can maintain a uniform pattern of questions and improve upon the conventional assessment tool of viva-voce. AIM & OBJECTIVES: To compare the structured & conventional method of viva-voce examination for assessment in Pharmacology. Materials and Methods: This study was conducted in 2nd Prof MBBS students. Question cards with answer keys covering two topics- “Drugs acting on Respiratory system” & “Drugs acting on Gastrointestinal system.” were prepared after validation from all faculty in the Pharmacology department. The teaching-learning methods employed were didactic lectures and tutorials. The students (n=113) were assessed by two types of viva-voce examination with a crossover design after dividing them into two batches. The evaluation was done by feedback questionnaire and comparison of scoring by students when exposed SVE & CVE.  Results: There was a statistically significant improvement (p<0.05) in scoring by students showing improvement with SVE. 85% faculty members & 84% students were satisfied with SVE. Conclusion: Results of this study suggest that SVE is perceived as a better assessment tool by both students & faculty and helped students in scoring better. It can be used alone or along with CVE as a tool for student assessment.
Keywords: Viva-voce examination,   Assessment tool.

2.     WHEN ALCOHOL BECKONS, EVERYTHING TAKES A BACK SEAT-CROSS SECTIONAL STUDY OF
        KNOWLEDGE, ATTITUDE AND PRACTICES ABOUT EFFECTS OF ALCOHOL ON SEXUAL FUNCTIONING
        IN PATIENTS WITH ALCOHOL USE AND SEXUAL PROBLEMS                                                                 6-11
        Dr Nilanjan Chandra, Dr Shabina Sheth, Dr Ritambhara Mehta, Dr Kamlesh Dave              PDF FULL TEXT

ABSTRACT

Background: To assess the Knowledge, Attitude, Practices (KAP) about sex with or without alcohol in patients presenting with alcohol use disorder and sexual problems attending Alcohol group meeting (ALG) and Psychosexual counselling (PSG) to see the commonalities and differences of their KAP. Materials and Methods: A cross-sectional study was carried out in patients of two different groups in a state general hospital of western India. Department of Psychiatry runs two different group meetings, (1) alcohol group meeting (ALG) for alcoholics and (2) psychosexual group meeting (PSG) for patients coming for sexual problems. After approval from Human research Ethics Committee and consent taken, A semi structured questionnaire was used to analyse and compare KAP about effects of Alcohol on sex for both groups. Results: Nearly 2/3rd patients in both the groups had adequate knowledge. While assessing attitude ALG had healthier attitude than PSG. Regarding practice, 21.1% of ALG vs 1.75% of PSG take alcohol regularly before sex. 73.7% of ALG vs 21.1% of PSG enjoy sex better after drinking alcohol. 33.3% of ALG but only 1.05% of PSG had sex with commercial sex worker after alcohol. More than half participants from ALG had casual unwanted sex and sex unknowingly without condom after alcohol consumption. Conclusion: Despite good knowledge and healthier attitude, sexual practices are significantly different in Alcohol dependents. Thus, Knowledge and Attitude do not matter when alcohol prevails.
Keywords: alcohol, psychosexual, myths and practice related to alcohol

3.     Perceptions of Medical Students Regarding Learning during Practical Sessions in Pharmacology –
        A Cross Sectional Questionnaire Based Study                                                                                        12-20
        Gurudeva C, Pallavi Kulkarni, Ravin Vijay R, Thangam Chinnathambi, Indla Ravi, 
        Regina Roy, Alice Kuruvilla                                                                                                       PDF FULL TEXT

ABSTRACT

Background: Pharmacology practical exercises compliment the theory classes and are effective tools to develop skills and competencies of a medical graduate. Off-late, the content and nature of pharmacology practicals have witnessed some changes such as inclusion of self-learning modules. These include seminars, clinical case discussions and problem-solving exercises. Insights about the perceptions and preferences of the students help to plan relevant exercises. There is no publication of students’ perception about the usefulness of practicals conducted during the whole course of the second year MBBS. Materials and Methods: This cross sectional study was conducted in 72 students of Karuna Medical College who had completed IInd MBBS course. The students were provided a predesigned proforma to obtain their feedbacks on two aspects of each practicals. One, whether it was interesting and other was a rating of their preferences on a scale of 1 to 5, where 1being least and 5 being excellent. Results: A majority (86.4% – 95.4%) of the students indicated all the practical exercises as interesting. The basic pharmacology exercises and group assignments were considered as interesting by 95.40% and 94.80% of students respectively. They also had marked their preference to group assignments as excellent (59.03%) and good (26.39%) indicating group assignments as the most preferred practical assignments. This was followed next by a preference for case discussions and seminars (24.30% excellent, 47.22% good) and then basic pharmacology exercises (24.07% excellent, 42.59% good). Conclusion: The structured feedbacks from students regarding pharmacology practical exercises provide valuable insights in planning interesting sessions for future.
Keywords: Computer Assisted Learning, Feedback, Group Assignments, Medical graduates, Pharmacology practicals, Students’ Perceptions.

4.     MEDICAL STUDENTS ASSESSMENT OF EARLIER STUDYING AND PRACTICING CONCEPTS OF
        MEDICAL EDUCATION                                                                                                                                 21-26
        Tarig Guma Mardi Sideeg, Abd Alsalam Nail, Naila Karkasawi, Mohammed Ahmed,
        Marouf Mohammed, Huda Hakim Abd Elrahman                                                                    PDF FULL TEXT

ABSTRACT

Background: New trends in medical education has emerged in medical curricula to ensure highly competent doctor and this involved development of teaching medical education new concepts in early setting at medical schools. The curriculum of Faculty of Medicine and Health Sciences - Omdurman Islamic University (FMHS-OIU) is competency-based curriculum; it based on specifications of adult learning that make the students proactive in group work for solving problems. As result, FMHS-OIU introduces a course of new trends in medical education to the first year students at the beginning of their study. The aim of this work is to assess undergraduate medical student's opinions on the new trends in medical education course, and to test the effect of gender assessment of early studying and practicing trends in medical education course. Materials and Methods: This analytical cross-sectional study was carried out at Faculty of Medicine and Health Sciences (FMHS), Omdurman Islamic University (OIU), 2018. The study was involved all students of first level of both gender, they are 346 male and female medical students were asked to fill pretested questionnaire which contains specific questions allocated in three domains of knowledge and skills was used to collect the data. Soft - ware program of Statistical Package for social Science (SPSS) version 20. to obtain the descriptive statistics (Frequencies, percentage) as well as inferential statistics ( Chi-squire) to identify the correlations between variables of the study. The confidence interval is 95% was taken as significant at P-value ≤ 0.05. Results: The study showed statically difference gender play no role in assessment of studying the course (P-value > 0.05), in spite they are taught separately. In addition both gender assessments revealed positive responds with high frequency and percentage regarding (cognitive knowledge, psychomotor and behavioral skills) in the course. Conclusions: Approximately all participated students were emphasized their highly agreement particularly in (Self-learning, Small Group Work and Problem Based Learning (PBL)) that studied in the course. In conclusion, no statistical difference between male and female medical students' assessment of trends in medical education course in this study.
Keywords: Assessment, Course, Medical students, Medical Education

5.     ASSESSMENT OF ACID BASE DISORDERS IN CRITICALLY ILL MEDICAL PATIENTS                       27-31
​        Dr Rakesh Modi, Dr Geetesh Mangal                                                                                      PDF FULL TEXT

ABSTRACT

Background: Acid base disorders represents the pathogenesis and gravity of the underlying disease which accounts for morbidity and mortality rates. A previous study reported that around 64% of patients admitted in intensive care unit show complex acid-base and electrolyte disorders, among them the most common was acute metabolic acidosis. Material & Methods: In the present retrospective 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, majority of study participants 80% (40) were in the group of non-infectious etiology, 8% (4) patients had sepsis and 12% (6) patients had other infectious cause. Out of the total study participants 16 patients had simple acid base disorder and 34 patients had mixed acid base disorder. Among the patients with simple acid base disorders 8 had metabolic acidosis, 3 had metabolic alkalosis, 1 had respiratory alkalosis and 4 had respiratory acidosis. Among the patients with mixed acid base disorders, 10 had metabolic acidosis + respiratory alkalosis, 7 had metabolic alkalosis + respiratory alkalosis, 10 had metabolic alkalosis + respiratory acidosis and 7 had metabolic acidosis + respiratory acidosis. Conclusion: We concluded from the present study that acid base disorders play important role in effective treatment of various pathological diseases specially among the critically ill patients.
Key words: Acid base disorder, Intensive care units, metabolic acidosis, respiratory acidosis.

6.    VENTILATOR ASSOCIATED PNEUMONIA-STUDY OF DEMO-GRAPHIC PROFILE, RISK FACTORS,
       PATHOGENS AND MORTALITY IN CRITICAL CARE UNIT IN A TERTIARY CARE CENTER                32-36
       Dr Shuchita Vaya, Dr Ashish Jain                                                                                            PDF FULL TEXT

ABSTRACT

​Background: Admission to the critical Care unit carries high chances of acquiring ventilator associated pneumonia (VAP). Presence of risk factors like variety of illnesses, immunocompromised states, number of organ involvement and duration of invasive mechanical ventilation increases the hospital mortality and morbidity, the cost of the treatment and duration of ICU stay with VAP. Objective: The aim of Our study is to calculate the incidence and identify risk factors, pathogens and attributable mortality associated with VAP in the critical care areas. Materials and methods: The present prospective observational study was conducted over a period of one year in the department of critical care of our tertiary Care hospital. Patients more than 18 years of age who developed pneumonia after 48 hours of mechanical ventilation were included in the study. Modified clinical pulmonary infection score (CPIS) was followed as a screening method to diagnose VAP. Result: In our study at tertiary care center, the incidence of VAP was 27.1 8% and incidence density of VAP was 19 per 1000 ventilator days. Mean age for VAP was 48.1 2 +/-15.21 years. The most common etiology associated with VAP was Trauma followed by malignancies and respiratory failure patients. Previous use of broad spectrum antibiotics within 7 days of ICU admission and mechanical ventilation, previous use of steroid and immunosuppressive drugs was significantly associated with the development of VAP .Microbiological analysis showed majority of Gram negative bacterial isolates (Klebsiella Pneumoniae and Acinetobacter species ) which were responsible for approximately 50% of total VAP cases. The overall mortality observed among VAP group was 39.20% and among non VAP group was 24% (significantly low). Conclusion: Our study showed VAP are highly fatal infections and are common cause of longer ICU stay , increased morbidity and mortality and higher cost of treatment. We found significant association of prior use of antibiotics, steroids and immunosuppressive agents with VAP.
 Keywords: Risk factors, morbidity,mortality ,incidence, ventilator-associated pneumonia.

7.    ASSESSMENT OF PALMO-PLANTAR PSORIASIS AND ASSOCIATED FACTORS                              37-40
       Dr Sanjay Purohit                                                                                                                    PDF FULL TEXT

ABSTRACT

​Background: Psoriasis is characterized by immune mediated chronic, non-infectious, inflammatory and proliferative condition which affects 2-4% population worldwide and associated with genetic and environmental factors. Palmoplantar psoriasis is a subtype of psoriasis that characteristically involves the skin of the palms and soles. Material & Methods: The present study was conducted at department of dermatology of our tertiary care hospital. All patients who had Palmoplantar psoriasis variant were enrolled for the study. All patients who had psoriasis other than Palmoplantar psoriasis were excluded from the study.  Clearance from Institutional Ethics Committee was taken before start of study. Results: In present study, Instep involvement and extension beyond the sole in to heels were present among 46% of patients and hyperkeratosis, scaling, fissures with well-defined borders present among 35% of patients and diffuse involvement of both palms and soles present among 19% of patients. On the basis of occupation 63% of patients involved in household work, 27% patients involved in agriculture and 10% patient were involved in clerical work. Majority of patients were underweight 42% and normal BMI 40%. Diabetes was found among 11 patients, dyslipidemia was found in 24% and hypothyroidism was reported among 6% patients. Conclusion: The overall prevalence of psoriasis and Palmoplantar psoriasis was low in our study. Middle aged females affect predominantly in our study. High BMI, diabetes mellitus, dyslipidemia and hypothyroidism were the associated comorbidities found in present study.
Keywords: Palmoplantar psoriasis, Hyperkeratosis, Comorbidities.

8.    CORRELATION OF CARRYING ANGLE OF ELBOW WITH LENGTH OF FOREARM AND
​       HEIGHT OF BODY                                                                                                                                      41-43
       Dr. Sanjay Kumar Sharma, Dr. Sadiq Wadood Siddiqui                                                        PDF FULL TEXT

ABSTRACT

Background: The angle between the median axis of arm and that of the fully extended and supinated forearm is known as Carrying angle. In females the carrying angle is greater and in the dominant upper limb. To identify deformities of elbow Carrying angle knowledge is important. In the sex determination the role of carrying angle is important. In this study find out correlation of carrying angle with height and length of forearm. Material & Method: In this present study total 266 (146 female & 120 male) asymptomatic, healthy students of RajShree Medical Research Institute Bareilly were selected. There ages ranged 17 to 22 years. Carrying angle is measured by Goniometer. The carrying angle is inversely related with height and length of forearm of person. Greater carrying angle In female is considered as secondary sex characteristic. Conclusion: it is clear that the height & length of the forearm are directly related to each other. Length of the forearm in female is 24.9 cm on right side and 24.8 cm on left side where as in male this value is 27.8 cm on right side and 26.6 cm on left side which is inversely related to the carrying angle. It may be considered as secondary sex characteristics in female.
key words: Carrying angle, height, goniometer, length of forearm, puberty, secondary sex characteristic

9.     A STUDY OF MORPHOLOGY OF PLACENTA IN ECLAMPSIA OF PREGNANCY AND ITS EFFECT
        ON FETAL OUTCOME                                                                                                                                 44-47
       Dadhich Abhilasha, Saini Pankaj, Agarwal Chandra Kala                                                      PDF FULL TEXT

ABSTRACT

The placenta is the most important organ for maintaining healthy pregnancy. Eclampsia is one of the common disorders during pregnancy. The present study was carried out at Department of Anatomy Dr. S. N. Medical College, Jodhpur to find out the morphological changes in placentae of eclamptic group in comparison to those of control group. In the present study 100 placentae with normal pregnancy and 100 placentae with eclampsia of pregnancy were collected and the newborns were also evaluated for birth weight, type of birth and NICU admission. It was found that the eclamptic group had low placental weight, less maximum diameter, less thickness at center and less number of cotyledons (p<0.01). Thus, eclampsia of pregnancy had adverse effect on placenta and in turn on the fetus as the mean birth weight of new born in eclamptic subjects was lower than normal subjects.
Keywords:  Eclampsia, Placenta, Morphology, Fetus.

10.    A STUDY OF SUBCLINICAL HYPOTHYROIDISM IN PATIENTS OF WESTERN INDIA FOR PREVALANCE
         OF ANTI THYROID PEROXIDASE ANTIBODY AND ITS ASSOCIATION WITH DYSLIPIDEMIA          48-55
         Dr Jaspal Dhamija, Dr Prakharanshu Singh Dhakar, Dr. Ankit Jain,
         Dr Omprakash Choudhary, Dr Garvit Mundra                                                                       PDF FULL TEXT

ABSTRACT

Background: In comparison to overt hypothyroidism Subclinical hypothyroidism (SCH) is more common and considered as mild thyroid failure. SCH is also having high probability to convert into overt hypothyroidism. It is well established fact that overt hypothyroidism is associated with dyslipdemia but It is controversial in SCH and there are few Indian studies suggesting correlation between TPO positivity and lipid abnormalities in SCH. Hence, Aim of this study to find the association between dyslipidemia and TPO positivity in SCH patients. Methods: 175 cases of subclinical hypothyroidism were recruited fromOPD&IPD department of medicine Mahatma Gandhi Medical College & Hospital Jaipur. After overnight fasting blood samples were drawn in the morning and serum TSH, free thyroxine (FT4), free triiodothyronine (FT3), anti-thyroid peroxidase antibody (TPO-Ab) levels, as well as lipid concentrations were measured. Results: Significantly high(p < 0.001) Cholesterol, LDL, TG level in Anti-TPO (+ ve) group while HDL level was significantly low(p=0.003) in Anti TPO (+ ve)group. Patients were divided according to levels of TSH. Significantly high(p value< 0.001) levels of Anti-TPO, Cholesterol, LDL was found in patients having TSH levels >10 in comparison to TSH levels ≤ 10. while there were no statistical difference (p value >0.05)in values of TG, VLDL, HDL levels between both groups. Conclusions: In SCH patients, dyslipidemia is significantly associated with TPO positivity and it may be associated with levels of TSH, such patients may convert into overt hypothyroidism in future. Hence to prevent adverse outcomes early screening, diagnosis, and treatment of SCH patients are recommended.
Keywords: Total cholesterol level, Thyroid-stimulating hormone, Euthyroidism, Subclinical hypothyroidism,Dyslipidemia, Thyroid antibodies

11.    ROLE OF MRI IN DIAGNOSIS OF ANTERIOR CRUCIATE LIGAMENT INJURIES OF KNEE ASSUMING
         ARTHROSCOPY AS GOLD STANDARD                                                                                                  56-62
         Dr. Iqbal Khan, Dr. Chaturbhuj Prasad Swarnkar, Dr. Raj Kumar Yadav                            PDF FULL TEXT

ABSTRACT

​Background: The knee is a complex joint with a number of internal structures, all of which can give rise to symptoms in knee injuries. Magnetic Resonance Imaging (MRI) is a good non-invasive procedure to study the injured knee avoiding invasive procedures and further morbidity. The present study was conducted to assess the diagnostic usefulness of MRI in evaluating anterior cruciate ligament pathologies. Materials and methods: It was a cross-sectional, observational study that was carried out in the Department of Radiodiagnosis and Modern Imaging, S.M.S. Medical College, Jaip[ur (Rajasthan). The duration of the study was from July 2018 to August 2019. After getting permission from the institutional ethics committee 55 knee injury patients who had given consent were recruited for the study. After obtaining a detailed history, MRI and Arthroscopy were done and findings were noted in pre-tested, semi-structured proforma. The data were statistically analyzed. P-value < 0.05 was considered as statistically significant. Results: In the present study, the accuracy of MRI in the diagnosis of anterior cruciate ligament tear of the knee was 94.55% for complete tears, 85.45% for partial tears and 90.91% for interstitial edema. Partial tear of ACL was present in 52.7% cases while a complete tear was found in 43.6% cases. The most common location of ACL tear was at mid-substance. Meniscal tears with bone marrow edema/contusions of femoral and tibial condyles were most commonly associated with ACL tears. Conclusion: MRI has proven to be effective in defining complete and partial ACL tears with good diagnostic accuracy. It is cost-effective in the acute knee injury setting, in terms of cost and quality of life perception as a non-invasive replacement for arthrography and non-therapeutic arthroscopy.
Keywords: Knee injuries, Anterior Cruciate Ligament, MRI, Arthroscopy.

12.    CORRELATION BETWEEN ATTENDANCE AND PERFORMANCE IN FORMATIVE ASSESSMENT OF
         FIRST MBBS STUDENTS IN SUBJECT OF BIOCHEMISTRY                                                                  63-66
         Dr Ajay S. Rajput, Dr Pratik H. Raghavani, Dr Uday Vachhani, Dr Deepak Parchwani      PDF FULL TEXT

ABSTRACT

​Background: Traditionally attending classes is always recommended for better understanding of the subject, but in today’s digital era, students have multiple sources to select from, to acquire knowledge and understanding about the subject, apart from the traditional academic tools, which may lead to low attendance in the classroom. Aims and Objectives: Study was conducted to assess correlation between attendance in classroom and performance in formative assessment in First year MBBS students in the subject of Biochemistry. Materials and Methods: Attendance records collectively taken for three academic batches were segregated into three distinctive heads namely, total attendance (theory and practical combined), attendance; in theory and in practical and were expressed in percentage. Correspondingly, marks of formative assessment were segregated into total marks (theory and practical combined), marks; in theory and in practical and expressed as percentage. On the basis of theory class attendance, students were divided into 3 groups, namely group I (attendance less than 80%); group II (attendance between 80% - 90%) and group III (attendance more than 90%). Academic performance was analyzed in terms of percentage of total marks obtained in formative assessments of all theory examinations and compared among the groups. In similar manner, based on practical class attendance and total attendance, groups were formed and comparison was carried out using Microsoft Excel 2010 and MedCalc free trial version 19.1. Results: Statistically significant positive correlation in academic performance was found when compared with respective attendance using Kruskal-Wallis test. Spearman correlation analysis showed significant positive correlation between attendance and academic performance. Conclusions: Our study demonstrates that classroom attendance has significant positive correlation with the performance in the formative assessment in subject of Biochemistry.
KEYWORDS: Attendance, Biochemistry, Correlation, Formative Assessment, MBBS

13.    COSMETOVIGILANCE: A SYSTEM ENSURING SAFE USE OF COSMETICS                                      67-71
         Dr. Heena Rathi, Dr. Priyanka Rathi, Dr. Mohit Biyani                                                         PDF FULL TEXT

ABSTRACT

​Cosmetics, now a days have become the need of an hour since each individual is using them almost every day. Various products which are being consumed as cosmetics include products for skin care, hair and scalp, nails and cuticle and for maintaining hygiene of oral cavity. These products may show adverse effects or reaction in some individuals they contain many chemicals which may be harmful to some population and may cause contact dermatitis, photo allergic reactions and long term use may also lead to carcinogenicity or some systemic disease. Cosmetovigilance is a recent concept wherein information on safety of cosmetic products and their ingredients is collected and analysed. Several countries like France, Netherlands, the United States of America, Japan, East Asian countries and European countries have already established their cosmetovigilance system. Although India is the 4th largest cosmetic market in Asia but the unwanted or adverse reaction due to cosmetic products go unnoticed due to lack of proper organised reporting system. So, a proper vigilance system is required to protect health of Indian population.

14.    EFFECTIVENESS OF VIDEO-ASSISTED TEACHING PROGRAM AND TRADITIONAL DEMONSTRATION
         OF MECHANISM OF LABOR ON UNDERGRADUATE MEDICAL STUDENTS                                       72-76
         Dr Nishi Roshini K., Dr Andrews MA                                                                                      PDF FULL TEXT

ABSTRACT

​Background: In the obstetric curriculum of undergraduate medical students teaching and learning of normal mechanism of labor is very important. We planned to study the effectiveness of video-assisted teaching combined with traditional method on improving the competence of undergraduate medical students regarding mechanism of normal labor Materials and Methods: A total of 120 students attending labor room posting in Medical College, Thrissur Obstetrics department were selected and divided in to two groups of 60 each by lottery method. Pre-test was conducted using a self-administered questionnaire for both groups. Subsequent video assisted teaching and traditional teaching was conducted by the investigator after which post test was conducted. Clinical skills were tested by Objective Structured Clinical Examination (OSCE). Results and Conclusion: The knowledge, attitude and practice are improved by video-assisted teaching program. The post-test intervention scores were not improved by the video assisted teaching as compared with the traditional group indicating that traditional demonstration has impact which is non-inferior to video assisted teaching in improving the skill. (p- 0.35028). For practical skill learning sense of touch is essential and this cannot be imparted by videos alone though the classes may be made interesting. Females scored more compared with males in video assisted learning (p-value 0.017488.)
Keywords: Effectiveness of video-assisted teaching, Traditional Teaching, OSCE, Mechanism of Labor

15.    COMPARATIVE ASSESSMENT OF LOCAL ANESTHESIA AND SPINAL ANESTHESIA FOR
         EMORRHOIDECTOMY                                                                                                                               77-80
         Dr Ajay Singh Chundawat                                                                                                      PDF FULL TEXT

ABSTRACT

Background: Various researchers had clinically classified piles or hemorrhoids into four grades. For the treatment of piles or hemorrhoid the most commonly used and widely considered operative technique is open hemorrhoidectomy and reported to be the most effective operative technique for grade III and IV hemorrhoids among various studies Material & Methods: Patients who were diagnosed clinically as third- and fourth-degree hemorrhoids and planned for conventional hemorrhoidectomy were enrolled by simple random sampling and randomized for two equal groups. Clearance from hospital ethics committee was taken before start of study. Written informed consent was taken from each study participant. Results: Out of the total study participants of group 1 10 (40%) were females and 15 (60%) were males. The mean age of study population was 36.2 ± 5.8 years. On the basis of degree of hemorrhoids 14 (56%) patients had third degree piles and 11 (44%) patients had fourth degree piles. The need for general anaesthesia was reported among 2/25 (8%) patients. The mean operative duration (minutes) was 22.54 ± 6.98. Out of the total study participants of group 2, 9 (36%) were females and 16 (64%) were males. The mean age of study population was 38.4 ± 6.2 years. On the basis of degree of hemorrhoids 13 (52%) patients had third degree piles and 12 (48%) patients had fourth degree piles. The need for general anaesthesia was reported among 1/25 (4%) patients. The mean operative duration (minutes) was 21.32 ± 5.21. Conclusion: Local anesthesia for hemorrhoidectomy along with intravenous sedation is a safe procedure and should be considered as an alternative to spinal anesthesia. Present study reported that it has lesser postoperative pain scores, no hypotension, no headache and no urine retention in comparison to spinal anaesthesia.
Key words: Hemorrhoidectomy, Local anesthesia, Spinal anesthesia.

16.    RELATIONSHIP BETWEEN GRAVIDA STATUS AND SEVERITY OF ANEMIA?                                   81-84
         Dr. Sangeeta Gupta Prasad                                                                                                      PDF FULL TEXT

ABSTRACT

Background: Worldwide, it is estimated that anemia contributes to 20% of maternal deaths. Among these; about half of the global maternal deaths occur in South Asian countries out of which 80% is contributed by India.  WHO estimates that over two-thirds of pregnant mothers in developing countries suffer from nutritional anemia. India continues to be one of the countries with the highest prevalence of anemia. Material & Methods: The present prospective study was conducted at the department of obstetrics and gynecology of our tertiary care hospital. The study duration was of one year from November 2017 to August 2018. A sample size of 200 was calculated at a 95% confidence interval at a 10% acceptable margin of error. Pregnant women were enrolled from the outdoor, antenatal clinic and from the ward by simple random sampling. Results: There were 108 females in the group of primigravida and 92 females in the group of multigravida. Among pregnant women with no previous child 59 (54.6%) had no anaemia, 36 (33.3%) females had mild anemia, 13 (12%) females had moderate anemia and none of them had severe anemia in this group. Among pregnant women who were multigravida (0%) had no anaemia, 37 (40.2%) females had mild anemia, 61 (30.5%) females had moderate anemia and 7 (7.6%) had severe anemia in this group. These differences in the burden of anemia were statistically highly significant (p-value < 0.001). Conclusions: We concluded from the present study that the magnitude and burden of anemia are very high and the population living among urban and rural areas both were at higher risk of developing anemia. We found a statistically significant correlation of anemia with an increasing number of children and gravida status.
Key words: Anemia, Pregnancy, gravida status.

17.    CLINICO-EPIDEMIOLOGIC STUDY OF ACUTE LOWER RESPIRATORY TRACT INFECTIONS
         IN CHILDREN LESS THAN 5 YEARS OF AGE NEEDING HOSPITAL ADMISSION                                85-91
         Hemant Tahilramani, Minakshi Misra                                                                                     PDF FULL TEXT

ABSTRACT

​Background: In children under 5 years of age Acute Lower Respiratory Tract Infections (ALRI) contributes to a major share of childhood illnesses and deaths. As per WHO report in 2010, four and half million deaths among children per year were because of respiratory tract infection. Globally 5.9 million (including 1.2 million deaths in India alone) deaths have been reported among children due to RTI. Present study was undertaken to study various risk factors, clinical profile and outcome of ALRI in children below 5 years of age. Material & Methods: 300 ALRI cases needing hospital admission, below 5 years of age were evaluated for risk factors, clinical profile and outcome in the Pediatric Department of JNU Medical College and Hospital, Jaipur, Rajasthan, India. Results: Study showed that ALRI was more common in male children, in the age group of 2 to 12 months, from lower socioeconomic class family, with malnutrition and with incomplete immunization status. Conclusion: Morbidity and mortality in children, specially, below five years of age, can be brought down drastically, by dealing with potential risk factors responsible for ALRI.
Keywords: Acute Lower Respiratory Tract Infection (ALRI), Respiratory Tract Infection (RTI), Protein Energy
Malnutrition (PEM).

18.    ASSOCIATION OF PERIPHERAL RETINAL DEGENERATION WITH RETINAL DETACHMENT
​         IN MYOPIA                                                                                                                                                 92-95
         Dr Nutan Bedi, Dr Mauli Shah                                                                                                PDF FULL TEXT

ABSTRACT

Background: Retinal degenerations occur commonly in the peripheral retina and are considered as risk factors for rhegmatogenous retinal detachment. Rhegmatogenous retinal detachment occurs when the liquified vitreous passes through the retinal breaks in the neurosensory retina separating it from retinal pigmemt epithelium. Material & Methods: In the present study cross sectional, observational study which was carried out at the Department of Ophthalmology in a tertiary health care centre in Southern Rajasthan from July 2017 to June 2019.The study was undertaken in 560 myopic eyes studied in three groups.. Clearance from hospital ethics committee was taken before start of study. Written informed consent was taken from each study participant. Results: Out of the total study participants majority of participants were in 2-3 decade of life in group I and majority of participants were in 4-5 decade of life in group II and III. On the basis of lattice degeneration 42 eyes were involved in group I, 45 in group II and 28 in group III. Most common site was Superotemporal quadrant (65%) among group I. Retinal Detachment (RD) was present as Superior RD in 25 patients among group II. Retinal holes were found in 37 eyes in group II and 30 eyes in group III. Horse shoe tears were found in 15 eyes among group II. C/O light flashes present in 10 eyes among group III. Conclusion: Increased association of retinal detachment with peripheral retinal degenerations mainly lattice degeneration steers our way towards thorough examination of peripheral retinal in myopic patients using indirect ophthalmoscopy.
Key words: Retinal degenerations, Retinal detachment, Lattice degeneration.

19.    THE STUDY OF BLUNT TRAUMA ABDOMEN: CONSERVATIVE MANAGEMENT AND OUTCOME       96-98
         Dr. Hukam Chand Meena, Dr. Chandra Mauli Vyas, Dr. B.C. Mewara, Dr. Akhilesh Meena  PDF FULL TEXT

ABSTRACT

Background: The changing era of industrialization is coupled with an increase in the number of road traffic accidents because of the increase in automobile number and increased vehicular accidents which results in the very high incidence of blunt trauma abdomen. The present study was conducted to assess the effectiveness of conservative management in blunt trauma abdomen patients at our tertiary care center. The present study was conducted to evaluate the nature and cause of injury, its management and outcome due to blunt trauma abdomen. Methods: A series of 45 patients admitted with BTA over a period of one year (January 2018 - December 2018) in JMCH Jhalawar, Rajasthan, India were enrolled in the study. The most common age group affected was 15 - 30 year and the male to female ratio was 2.7:1. Results: The most common mode of injury was motor vehicle accident (75%). The most common organ injured was liver (44.44%) followed by spleen (22.2%). Conservative management was done in 40 (88.88%) patients and was successful in 32 (71.11%) patients and 8 (17.77%) patients later required surgery. Conclusions: Operative treatment was done in 5 (11.11%) patients because of hemodynamic instability. Mortality was 13.33%. In our study conservative management of BTA was found highly successful.
Keywords: Blunt trauma abdomen, Non-operative managements

20.    LASERS IN DENTISTRY                                                                                                                          99-104
         Dr. Arpita Srivastava, Dr. Rahul Shrivastava, Dr. Rashi Srivastava, Dr. Deepak Goel,
         Dr. Rohit Kumar Khatri, Dr. Setu Mathur                                                                               PDF FULL TEXT

ABSTRACT

​The term LASER is an acronym for, “Light Amplification by the Stimulated Emission of Radiation”. Lasers are an important tool for dental treatment. They are used in dentistry since 1987.They are useful in treating hard and soft tissue lesions as their wavelength is ideally suited for both hard and soft tissue procedures. Laser technology has positively influence various branches of dentistry. With the help of lasers, dental treatments can be made less time consuming and more comfortable for the patients. There are various types of lasers available in the market. This article will explain the uses of laser in various fields of dentistry.
Key Words: Lasers, dentistry, wavelengths, dental applications

21.    EVALUATION OF CLINICAL PROFILE OF POST-PARTUM HAEMORRHAGE AT A TERTIARY
         CARE CENTER                                                                                                                                         105-109
         Dr. Sanchita Dashora,  Dr. Kamlesh Dhanjani, Dr. Vijaya Soliriya, Dr. Shruti Bhatia, Dr. Abha Gupta                                                                                                                                                                          PDF FULL TEXT

ABSTRACT

​Background: Post-partum haemorrhage (PPH) is defined as a loss of more than 500ml blood from the genital tract after vaginal delivery and more than 1000ml at caesarean section. It is termed Primary when bleeding occurs within 24 hours of delivery and secondary when blood loss occurs more than 24 hours but within six weeks after delivery. PPH remains the most common direct cause of maternal mortality and morbidity in India as well as all around the globe. The prevalence of postpartum haemorrhage is 2-6% of all deliveries and was 6% in our study. Material & Methods: A total of 100 pregnant women who had postpartum haemorrhage after normal vaginal delivery, caesarean section, or assisted vaginal deliveries were enrolled for the study. Results: The majority of the cases were booked multiparous women between the age group of 21-30 years. The commonest etiology for PPH was uterine atony which accounts for 72% % of the total cases followed by genital tract trauma in 9%. Among the risk factors, Prolonged labour was seen in the maximum number of patients. Through various available modalities of treatment were used to manage a postpartum haemorrhage, most of the cases 67% were managed conservatively by medical treatment. No maternal mortality was reported in our study. Conclusion: Postpartum haemorrhage is a serious threat responsible for maternal mortality or morbidity, especially in developing countries. Hence to avoid this serious condition it is necessary to correct the avoidable risk factors, promote institutional deliveries, increase awareness, and increase trained health care professionals and all accurate and prompt measures to minimize the blood loss during and after the delivery.
Keywords: Postpartum haemorrhage, PPH, maternal mortality and morbidity

22.    ASSESSMENT AND EVALUATION OF PROFILE OF FATTY LIVER AT TERTIARY CARE HOSPITAL                                                                                                                                                                                          110-113
         Dr. Munesh Kumar, Dr Varun Kumar Saini, Dr Prahlad Dhakar, Dr Sunil Gupta                PDF FULL TEXT

ABSTRACT

Background: Fatty liver is a typical histological and clinical finding. Fatty liver can be two types, non-alcoholic fatty liver disease (NAFLD) or alcoholic fatty liver disease (AFLD) extensively. Non-alcoholic fatty liver disease (NAFLD) is characterized as a liver fat of more than 5-10% of total liver weight, which isn't because of overabundance liquor utilization or different reasons for steatosis. Material & Methods: The present prospective observational study was conducted at the Department of Medicine at tertiary care hospital. The study duration was September 2014 to March 2016. In the present study, we enrolled 100 patient’s fatty liver diagnosed by ultrasonography method. Those who were found to have fatty liver were included in the present study. Results In the present study, among the total study participants the most common presentation of fatty liver was seen in associated with dyslipidemia in (69%) patients, which was followed by smoking history in (21%) patients, which was followed by alcohol consumption history in (18%) patients. Elevated SGPT/ SGOT levels were found in 20% of patients in the biochemical investigation, specifically elevation of SGPT levels was more significant than SGOT levels. Among the total study participants, the most common presentation of fatty liver was seen in associated with obesity in (44%) patients and the following associations were found with different disease respectively hypertension in (33%) patients, diabetes mellitus in (27%) patients CAD in (5%) patients and CKD in (2%) patients. Conclusion: We concluded from the present study that most of the patients with fatty liver disease when diagnosed by ultrasound abdomen examination followed necessary healthy lifestyle modifications, can prevent the development and progression of metabolic syndrome, hepatocellular carcinoma, and mortality.
Keywords: Fatty liver, NAFLD, AFLD.

23.    A STUDY ON DIAGNOSTIC ACCURACY OF FRESH FROZEN BIOPSY IN THE DIAGNOSIS OF FNAC                     INCONCLUSIVE BREAST LUMP                                                                                                         114-119
         Dr. Durba Roy, Dr. Tasneem Zohra , Dr. Rekha Singh, Dr. Abbas Ali Zaidi,
         Dr. Sandeep Kothari, Dr. Madhu Gupta, Dr. Nidhipriya, Dr. Gajendra Singh Rajput,
         Dr. Rinku Gupta, Dr. Niharika Pryadarshini                                                                           PDF FULL TEXT

ABSTRACT

Background: The breast lump comprises wide spectrum of diseases ranging from benign to malignant   diseases. So far as treatment is concerned, benign breast diseases are managed with simple assurance or excision and those which are malignant need much extensive procedures. Early diagnosis of the diseases limits the extensive procedures and also cuts down the waiting period and hence the study. Material and Method: It is prospective study conducted at department of general surgery of Govt. RDBP Jaipuria Hospital attached to RUHS CMS including 50 patients taken over a period of 1 year who came with clinically palpable breast lump and whose reports to be FNAC  inconclusive. Results: In this study, the most common age group is 40-60. Upper outer quadrant of right breast being the most common site involved (34%). Conclusion: fresh frozen biopsy is simple and safe without significant morbidity and thus can be used a tool in the management of breast lump where FNAC reports are inconclusive.
Keywords: Breast lump, FNAC, fresh frozen biopsy, mammography, BIRADS.

24.    ANALYSIS OF IRON INDICES IN PRE-DIALYSIS CHRONIC RENAL INSUFFICIENCY PATIENTS      120-126
         Uday Vachhani, Chandrakant Kamariya, Deepak N Parchwani                                             PDF FULL TEXT

ABSTRACT

Background: Anemia is a common and debilitating condition in patients with chronic renal insufficiency (CRI), where its related complications can be avoided if patients receive optimal and quality care of anemia. Aims: To ascertain the prevalence of anemia in pre-dialysis chronic renal insufficiency patients and to examine the iron indices in the patient group so as to establish any putative relationship. Materials and Methods: This cross-sectional analytical study included 124 CRI patients and 157 control participants. Blood samples were analyzed for serum iron, serum ferritin, serum Total Iron Binding Capacity (TIBC) and other hematological/hemodynamic parameters by standard methods. Suitable descriptive statistics was used for different variables. Results: In CRI patient group, mean serum ferritin was 546.6 + 103.5 ng/ml, which was significantly greater than healthy control population (81.2 + 13.4 ng/ml; p<0.0001). On the contrary mean estimated levels of serum iron in healthy controls and CRI patients were 108.0 ± 21.0 µg/dl and 46.4 ± 11.6 µg/dl respectively  and exhibited a significant difference (p<0.0001). TIBC in healthy controls and CRI patients were 332.4 ± 39.8 µg/dl and 304.6 ± 43.7 µg/dl respectively which is in accepted reference range. Of the enrolled patients, in CKD stages 1, 2, 3 and 4, there were 18, 42, 50, and 14 patients, respectively. Anemia was observed in 81.45% of the enrolled patients. Prevalence of anemia and alterations in iron indices were significantly increased (ANOVA; p<0.05) with advancing stages of disease. Conclusions: Anemia prevalence was very high in studied CRI cohort, characterized by low iron and elevated serum ferritin levels. Additional studies are warranted to guide an ideal biomarker which should provide optimization of iron status; correlate with degree of anemia along with predict response to iron repletion.
Keywords: Chronic renal insufficiency, Ferritin, Iron, TIBC

25. ASSESSMENT OF THYROID DYSFUNCTION AMONG CRITICALLY ILL PATIENTS ADMITTED IN THE                    INTENSIVE CARE UNIT AT TERTIARY CARE HOSPITAL                                                                       127-131
         Dr Kishore Moolrajani, Dr Puneet Rijhwani                                                                           PDF FULL TEXT

ABSTRACT

Background: Thyroid disorders are reported in higher magnitude among the general population, although its prevalence is also high reported among critically Ill patients. Thyroid disorders are endocrine in nature and various studies were conducted to find out the correlation between the severity of illness. Material & Methods: All critically ill patients admitted to the intensive care unit at our tertiary care hospital with Acute Renal failure, Congestive cardiac failure, Acute Respiratory failure, Diabetic Ketoacidosis, and Sepsis were enrolled in the present study. Patients were enrolled from the intensive care unit by simple random sampling. Results:  Among the 29 (58%) patients who had low T3 levels, 4 (8%) patients had acute renal failure, 4 (8%) patients had Congestive cardiac failure, 5 (10%) patients had respiratory failure, 14 (28%) patients had sepsis and 2 (4%) patients had diabetic ketoacidosis. Among the 7 (14%) patients who had low T4 levels, 1 (2%) patient had acute renal failure, 2 (4%) patients had Congestive cardiac failure, 1 (2%) patient had respiratory failure, 2 (4%) patients had sepsis and 1 (2%) patient had Diabetic ketoacidosis. Among the 2 (4%) patients who had high T4 levels, 1 (2%) patient had Congestive cardiac failure and 1 (2%) patient had respiratory failure. Among the 5 (10%) patients who had high TSH levels, 1 (2%) patient had acute renal failure, 1 (2%) patient had Congestive cardiac failure, 2 (4%) patients had respiratory failure and 1 (2%) patient had Diabetic ketoacidosis. Among the 2 (4%) patients who had low TSH levels, 1 (2%) patient had sepsis and 1 (2%) patient had Diabetic ketoacidosis. Conclusion:  A low T3 level was the most common finding in 58% of patients. We recommend the thyroid profile of all patients admitted with critical illness in the intensive care unit to treat the thyroid dysfunction early.
Keywords: Thyroid dysfunction, critically ill patients, intensive care unit. 

25. RISK FACTORS FOR THYROID DYSFUNCTION IN PATIENTS WITH TYPE 2 DIABETES MELLITUS AND ITS          ASSOCIATION WITH DIABETIC COMPLICATIONS                                                                                132-139

        Dr. Hemali Jha, Dr. Saurabh Kashyap                                                                                      PDF FULL TEXT

ABSTRACT

Background: Diabetes mellitus patients are prone to the development of thyroid disorders. Many studies on diabetic patients have shown the development of thyroid dysfunction over a period of time. Diabetic patients with hypothyroidism have an increased risk of cardiovascular disease. Timely detection of thyroid dysfunction in these patients is important. The objective of this present study was to assess frequency and risk factors for thyroid dysfunctions among patients with type 2 diabetes mellitus and to identify the association of thyroid dysfunction with complications in diabetic patients. Materials and Methods: This was a cross-sectional study conducted at 2 tertiary care teaching hospitals in north India. Two hundred thirty patients with type 2 diabetes mellitus attending the outpatient department without having a prior history of thyroid disease and chronic liver disease were recruited into the study. All subjects were examined for diabetes-related complications.
Results: Mean age of study participants was 56.5 years. The mean duration of diabetes was 6.43 ± 1.92 years and the mean HbA1c was 9.4 ± 2.76%. The frequency of thyroid dysfunction was 16.08% among the study population. Hypothyroidism was more frequent than hyperthyroidism (13.04% vs 3.04%). Thyroid dysfunction was more common among females than males. On multivariate analysis, duration of DM <5 years had a greater chance of having thyroid dysfunction than the duration of DM ≥ 5 years (OR = 3.2, p = 0.00). Similarly, obesity (OR = 2.6, p = 0.00), HbA1c ≥7 (OR = 3.8, p = 0.00), and absence of diabetic foot ulcer (OR =3.7, p = 0.00) were risk factors for thyroid dysfunction. There was no association observed between thyroid dysfunction and other diabetic complications among the study participants.  Conclusion: The study concluded that thyroid disorders are common among diabetic patients with hypothyroidism being commoner. A higher frequency of thyroid disorder was observed among diabetic patients who had a higher HbA1c, who were obese, and who had a more recent onset DM (<5 years duration). The frequency of thyroid disorder was lower among diabetic patients with foot ulcers whereas no association was observed between thyroid dysfunction and other microangiopathic complications of DM.
Keywords: thyroid dysfunction, type 2 diabetes mellitus, hypothyroidism, risk factors

26.   ASSESSMENT OF PSYCHIATRIC ILLNESS IN PATIENTS WITH ACNE VULGARIS                      140-144
       
        Dr Gajanand Ojha, 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 Department of  Dermatology ,Venereology and Leprosy at our hospital between January 2019 and June 2019. 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.​

26.   PELLAGRA ASSOCIATED WITH PSYCHIATRIC ILLNESSES IN AREAS NEAR GORAKHPUR      145-149
       
        Dr Prabhat Kumar Agrawal                                                                                                       PDF FULL TEXT

ABSTRACT

Background: Pellagra characterized by triad of diarrhea, dermatitis, and dementia but other common manifestations includes neuropsychiatric involvement including depression, delusions and hallucinations and others are decreased muscle strength and peripheral neuropathy. Material & Methods: In the present study total number of 200 people were enrolled from two equal groups, Chotanagpur group and Gorakhpur group respectively. Every index person was examined by both the investigators from each centre. Socio-demographic data were recorded and clinical examination was done. In Chotanagpur group only those were included who were eating maize only and Gorakhpurones who were eating wheat or rice. The Chotanagpur  group and Gorakhpur group were matched in terms of demographic data. Results:  Among the two study groups niacin deficiency was reported only from Chotanagpur group in 22% of study subjects. SCL 90-R depression subscale shows significant finding with mean value of 1.23±0.17 (p＜0.001). Similarly SCL 90-R anxiety, SCL 90-R somatization and  SCL 90-R Global Symptom Index subscales shows significant finding with mean value of 1.21±0.53, 1.28±0.39 and 1.26±0.21 respectively (p＜0.001). Conclusion: Patients with pellagra were mainly vegetarian and especially from low socioeconomic group. Diet pattern including untreated maize, jowar (Sorgum vulgare) and food faddism responsible for niacin deficiency along with alcoholism, malabsorption states and tuberculosis treatment also account for disease. A very strong statistically positive correlation was reported between the following SCL 90-R subscales.
Keywords: pellagra, niacin deficiency, psychiatric illness.