International Journal of Medical Sciences and Education (IJMSE)
Vol. 7 Issue: 5 (Sept.-Oct. 2020), Date of Publication: 01.11.2020

Table of Contents
     Editorial

1.    USE OF ONLINE SURVEY TOOLS TO CONDUCT ONLINE MEDICAL EXAMINATION DURING
       LOCKDOWN TIME                                                                                                                                          1-5
       Tharun C Varghese, Kalyani Pillai, S. Ramaraj                                                                      PDF FULL TEXT

ABSTRACT

Background: During these COVID lockdown days almost all universities in India are using online classes, webinars, and online survey tools for medical education and evaluation.  But the effectiveness and acceptance of these by the medical students are unclear. Objective: To study the conduct and the perception of medical students towards online exam using online survey tools during lockdown time. Methodology: Study design - Descriptive study; Participants - Final year medical students (177 in total). Intervention - An online assessment using Google form is used to assess the basic demographics, online exams, and their perspective towards them. The same was repeated after 2 months of online exams to see the changes in their perspectives. Results: The mean age was 22.1yrs, 72.3% female, 79.7% Above Poverty Line (APL), 96% uses mobile phones out of which 94.9% had their own which later increased to 97.7%.  37.9% had problems mainly with network connectivity and power failure which later decreased to 22.5%. Initially, 92.7% could only complete the online exams but later with experience, it increased to 96.7%. According to the students, online exams were better and easier than traditional pen and paper exams with (p-value of 0.002 and 0.03 respectively). The fear of the home environment during lockdown influences their performance in online exams which got changed in time (p-value of 0.03).Conclusion: Online exams using online survey tools like Google forms are an effective means to conduct medical exams.
Keyword: COVID - 19, Medical education and examination, Medical students, Online survey.

2.    VALUE OF FLUOROSCOPICALLY GUIDED INJECTION OF BUPIVACAINE AND METHYLPREDNISOLONE
       IN PAIN RELIEF AND FUNCTION IMPROVEMENT IN PATIENTS WITH DIFFUSE DISC BULGE IN
       LUMBAR SPINE                                                                                                                                            6-10
       Shashank Sharma, Dr Amit Vyas                                                                                            PDF FULL TEXT

ABSTRACT

Background: Backache is one of the most common prevalent maladies of the mankind. TFESI has been used for symptomatic patients with radiculopathy since about half a century. The studies which have been done show conflicting evidence of efficacy of the treatment modality. Objective: To study changes in pain perception and functionality of the patients with MRI proven diffuse disc bulge in the lumbar spine using Visual analogue scale and revised Oswestry disability index after injecting with steroid and local anesthetic combination via transforaminal route. Materials and Method: 29 patients with radicular backache and MRI proven diffuse disc bulge were enrolled in the study. Their pre procedure VAS scores and revised ODI scores were calculated. Clinical and radiological evaluation of these patients was done prior to instillation of injection. Post injection, the patients were evaluated for pain relief immediately, at 3 months and 6 months. Change in function was evaluated at 3 months and 6 months. Results: The study showed male preponderance with mean age 40.7 years. There was a statistically significant pre and post intervention improvement (p value <0.05) in VAS and revised Oswestry disability index scores up to 6 months follow up. Conclusion: It was concluded that transforaminal epidural steroid injection is an effective management therapy for the patients with diffuse disc bulge even at 6 month of therapy with statistically significant improvement in pain and function at 6 months of follow up.
Key words: disc bulge, epidural injection, radicular back pain

3.    STUDY OF SERUM CYSTATIN C LEVEL IN METABOLIC SYNDROME SUBJECTS AND ITS CORRELATION
       WITH THE COMPONENTS OF METABOLIC SYNDROME                                                                          11-20
       Deepa Thadani, Shubham Maheswari, Sarla Mahawar, G.G.Kaushik, Kamlesh Tanwani    PDF FULL TEXT

ABSTRACT

BACKGROUND: Metabolic syndrome and Cystatin C consists independent and strong indicator of metabolic abnormalities that confer increased risk of cardiovascular, renal and diabetes mellitus and all cause of mortality and morbidity along with more sensitive parameter than creatinine clearance and creatinine level of renal function test. AIMS AND OBJECTIVE: To determine serum Cystatin C levels in healthy controls and metabolic syndrome subjects and its correlation with components of MetS. MATERIAL AND METHODS: The present study is a case control study, included 90 subjects of MetS and healthy controls (n=30). Total 120 Subjects were selected from Medical OPD of JLN Medical College and associated group of Hospitals, Ajmer, India. MetS subjects defined 5 components (NCEP-ATP III) and it was further subdivided into 3 groups of 30 patients each. Anthropometric components are BMI, Waist circumference and Fasting plasma glucose and Dyslipidemia and Blood Pressure which are divided into Group 2 (3 components)  group 3(4 components) and group 4(5 components) of MetS Subjects of MetS were compared with 30 apparently healthy controls were included in group 1. All components were assessed by detailed history, clinical examination and biochemical methods. Sample collected under aseptic condition. RESULT: CysC was significantly increased in MetS subjects as compared to that in the healthy controls (p<0.0001). Level of CysC is positively correlated with BMI, waist circumference, fasting glucose level, triglycerides, Systolic and diastolic blood pressure and negatively correlated with HDL. No significant difference found in urea and creatinine. CONCLUSION: The present study shows that the level of Cystatin C is raised in metabolic syndrome subjects. The Present study has also revealed a positive correlation between the serum Cystatin C level with all 4 components except negative correlation with the HDL. Therefore CysC may be used as early marker of metabolic syndrome and renal dysfunction.
Keywords: Metabolic syndrome (MetS), Cystatin C (CysC), High Density Lipoprotein (HDL), Triglyceride (TG).

4.    PROPOLIS: THE NATURAL HEALER –A CLINICAL STUDY                                                                     21-25
       Dr. Sonal Saxena                                                                                                                        PDF FULL TEXT

ABSTRACT

​Background: Propolis is a naturally-occurring bee product which is made up of flavones, flavanones, and flavanols. Propolis has been found beneficial in dentistry. Aim of the present study was to investigate the effectiveness of a propolis-containing mouth rinse in inhibition of plaque formation. Material and Methods: This study was carried out for a period of two years in patients undergoing fixed orthodontic treatment at a tertiary care dental hospital. A total of 100 subjects were randomly divided into 2 groups of 50 subjects each. Subjects in Group A (Study Group) were advised to swish and spit 10 ml of Propolis mouthwash two times in a day, Similarly, subjects in Group-B(Control Group) were advised CHX mouthwash and were given the same instructions.%). Plaque index and gingival index were assessed on Ramjford teeth at baseline and at a three-day interval.  Indicators of plaque, gingival, and periodontal status(PI,GI) were determined by the University of North Carolina-15 Probe. Results: The average age of patients in both groups A and group B were 34.3±11.3 and 33.8±12.5 respectively. Mean values of Plaque index(PI) and Gingival index(GI) before and after using Propolis(group-A) were 1.3&0.8 and 1.6&1.4 respectively and before and after using Chlorhexidine(group-B) were 1.4&0.8 and 1.7&1.3 respectively. Differences in PI and GI indices between both groups were statistically significant. Conclusion: It appears that using Propolis mouthwash has a required effect on gingival health of patients. The propolis extract might be used as an alternate to CHX in the prevention of periodontal and gingival problems.
Keywords: gingivitis; Propolis mouthwash; Chlorhexidine mouthwash;

5.    PRESUMPTIVE COLIFORM COUNT AND DIFFERENTIAL COLIFORM COUNT OF THE WATER SAMPLES
       FROM AN URBAN SLUM AREA IN LUCKNOW                                                                                         26-32
       Saurabh Kashyap, Shilpi Srivastava, Ashish Rawat                                                              PDF FULL TEXT

ABSTRACT

Background: Faecal contamination in water sources is still found worldwide, particularly in urban slum areas of mid-low-income countries. Faecal infection might increase the risk of waterborne diseases in developing countries and in turn suggests poor hand hygiene and sanitation. This study aimed to assess quality of all water sources and to estimate the presumptive coliform count and differential coliform count of the water samples from an urban slum area in Lucknow. Materials and Methods: A cross-sectional survey design was conducted during the period of January to June 2019. Samples were collected from all the taps, hand pumps which are currently in use, along with potable water stored in households of Sarvodya Nagar (an urban slum area), Lucknow and were processed in Microbiology department of IIMS&R, Lucknow. Results: A total of 47.6% samples from various sources were found to be unsatisfactory, and 25.0% were found to be intermediate after multiple tube fermentation tests for coliforms.The highest value of MPN was found to be >180 both in Submersible and Public supply water.The most common isolates obtained was Pseudomonas sp. fallowed by E.coli and Klebsiella Spp. Among 40 unsatisfactory samples 38 (95%) showed growth of E.coli or Thermotolerent E.coli which is an indicator of the recent fecal contamination of the water sources. Conclusions: The most contaminated sources of water were found to be the Public supply.MPN is a good indicator for analysis of water quality for drinking purpose. Bacteriological valuation of all sources of drinking should be intentional and conducted on consistent basis to prevent waterborne diseases.
Key words: Bacteriological, water; coliforms, Escherichia coli,

6.    EVALUATION OF SERUM ALKALINE PHOSPHATASE LEVEL IN NON-DIABETIC CHRONIC KIDNEY
       DISEASE PATIENTS IN INDIAN POPULATION                                                                                           33-38
       Sarla Mahawar, Deepa Thadani, G.G.Kaushik, Asha Makwana, Shubham Maheshwari      PDF FULL TEXT

ABSTRACT

Background: Chronic kidney disease (CKD) is a worldwide health problem, affecting millions of people. Causes of chronic kidney disease include diabetes, high blood pressure, glomerulonephritis, polycystic kidney disease, lupus, and other forms of cardiovascular diseases. Serum Alkaline Phosphatase (ALP) is mainly a marker of hepatobiliary disease and bone turnover but its level is also high in chronic renal disorder. Our study was aimed to assess and compare the status of serum Alkaline Phosphatase level in non-diabetic chronic kidney disease subjects and healthy controls. Materials and Methods: The present study is a case-control study, conducted on 100 non-diabetic CKD patients. Cases were selected from the Urology and Medical ward of Jawahar Lal Nehru Medical College and Associated Group of Hospitals, Ajmer. Age and sex-matched healthy controls (n = 50) were selected from MOPD. The present study is approved by Institutional Ethical Committee. All samples were collected under aspect conditions from the antecubital vein. Results: The mean activity of Serum ALP was significantly higher in non-diabetic CKD subjects as compared to healthy controls (p < 0.0001). The observations of this study also revealed that 84 out of 100 nondiabetic CKD patients have higher serum Alkaline Phosphatase levels more than  (>100 U/L). Conclusion: Serum ALP can be used as a biomarker for the early detection of CKD in the general population to prevent the morbidity and mortality which are associated with CKD. If CKD is detected early and managed appropriately the deterioration in kidney functions can be slowed and the risk of cardiovascular diseases in renal patients can be reduced.
Keywords: Chronic kidney disease (CKD), Alkaline Phosphatase (ALP), End-stage renal disease (ESRD), Glomerular filtration rate (GFR), chronic renal failure (CRF)

7.    A COMPARATIVE STUDY OF ANTIDEPRESSANT EFFECT OF AMOXAPINE WITH FLUOXETINE ON MICE             USING WATER WHEEL TEST                                                                                                                    39-43
       Rajveer Singh Rathore, Dr. Manjula Bhargava                                                                      PDF FULL TEXT

ABSTRACT

Background: Major depression is a common disorder that causes morbidity and mortality.A number ofdrugs are being used for treatment of depression, but most of them have many adverse effects. So there are more possibilities and opportunities for finding newer drugs for treatment of depression. Objective: The present study was designed to compare the antidepressant effect of amoxapine with fluoxetine on mice. Materials and Methods: The antidepressant activity of Amoxapine with Fluoxetine was evaluated by Water Wheel Test after drug doses in mice. Test was done in three groups of mice, with six mice in each group. Group I was treated withNormal Saline (0.1ml/ 10g) as control group, group II was treated with Fluoxetine (20mg/kg i.p.), group III receivedAmoxapine (10mg/kg, i.p.),The drugs were administered once daily for 2 weeks and 20 min before the test. In each group, the mice were evaluated after intraperitoneal administration of drugs on 1st, 7th and 14th day by Water Wheel Test.Statistical analysis was done by two way analysis of variance (ANOVA). Results: Amoxapine and Fluoxetine showed a significant antidepressant activity. They significantly(P < 0.05) increased the number of turns of wheel as compared to control group. Conclusion: Amoxapine shows significant antidepressant activity comparable to that of Fluoxetine. The antidepressant effect of Amoxapine increases with prolonged use.
Keywords: Amoxapine, Depression, Fluoxetine, water wheel Test.

8.   PREGABALIN AND GABAPENTIN A STUDY FOR MANAGEMENT IN NEUROPATHIC PAIN WITH CHRONIC          LUMBAR RADICULPATHY                                                                                                                          44-46
      Dr.Ranjeet  Kumar Jha                                                                                                                 PDF FULL TEXT

ABSTRACT

Background: Chronic lumbar radiculopathy is a medical terminology which covers back and leg pain associated with sensory, reflex, or motor deficits in the area of nerve distribution lasting for > 12 weeks. The lumbar radiculopathy has reported to be 5.3% in men and 3.7% in women. Pregabalin and gabapentin, which is a new category of drugs called as alpha-2-delta (α2δ) modulators, have discovered to be good in the treatment of neuropathic pain related. So this study was done for comparison of effectiveness and safety profile of pregabalin and gabapentin in the pain management along with chronic lumbar radiculopathy. Materials and Methods: This was a randomized trial with comparative prospective study. Total 160 study participants were enrolled for the study and randomized into 2 equal groups. Study participants of group I had received capsule pregabalin 75 mg bd orally, Study participants of group II had received tablet gabapentin 300 mg bd orally. Assessment of pain was done at 0 week (start of study), at 6 weeks and after 12 weeks of onset of the treatment according to numeric pain rating scale. Results: There was significant improvement in pain after 12 weeks of onset of the treatment among both the study groups (p<0.0001), there was no statistically significant difference among the groups. The reported adverse effects were found more in study group I. Conclusions: Both the drugs are having approximate efficacy but tolerability of gabapentin is more among such cases.
Keywords: Lumbar radiculopathy, Pregabalin, Gabapentin.

8.   A COMPARATIVE STUDY OF FENTANYL AND DEXMEDETOMIDINE FOR EPIDURAL ANALGESIA FOR                LOWER LIMB ORTHOPEDIC SURGERY – A PROSPECTIVE DOUBLE-BLIND STUDY                       47-52
      Dr.Rama Kant                                                                                                                                PDF FULL TEXT

ABSTRACT

Background: Epidural adjuncts to local anesthetics have a synergistic effect and are frequently used. This study compared the analgesic efficacy & side effects of 50mcg Fentanyl and 50mcg Dexmedetomidine with 0.75% epidural ropivacaine in lower limb orthopedic surgery.  Method:This prospective randomized double-blind study was conducted on 70 patients of ASA  Grade I & II in the age range 20-65 yrs. The patients were randomly divided into two groups Group I (n=35) and Group II (n=35).  Group I- received Fentanyl 50 mcg  1ml  as an adjuvant to Ropivacaine 0.75%  15 ml. Group II – received Dexmedetomidine 50mcg  1ml  as an adjuvant to Ropivacaine 0.75%  15   ml. The Groups were compared for hemodynamic parameters, the onset of sensory block & motor block, total duration of analgesia, and side effects. Results: The demographic & hemodynamic variables at baseline were comparable. The onset of sensory block was quicker in Group II (10.35 ± 0.375 min)   in comparison to group I (12.21±0.234 min )with the difference being statistically significant (p< 0.05). The onset of motor blockade was quicker in Group II (14.73±0.33 min) compared to group I (18.32±0.37min) with the difference being statistically significant (p< 0.05). The duration of analgesia was statistically significantly prolonged in Group II (383.4 ±18.45min) as compared to Group I (278.6 ± 16.756 min).  Few incidences  of bradycardia, hypotension & dry mouth  were observed in Group II and nausea & vomiting in Group I with no statistically significant difference. Conclusion :  Dexmedetomidine as an adjuvant to 0.75% epidural Ropivacaine offered a better alternative to Fentanyl & provided an early onset of sensory & motor blockage, deeper sedation levels, longer duration of analgesia postoperatively, comparable hemodynamic variables, and fewer side effects in lower limb orthopedic surgeries.
Keywords: Dexmedetomidine, Fentanyl, Ropivacaine, epidural analgesia.