Caffeine consumption among medical students: an exploratory study in a medical school in a sub–Himalayan state of India

Background: Among the psychostimulants, caffeine is the most commonly used compound with beneficial effects in low to moderate intake. Medical students due to extended scholastic work do indulge in caffeine intake. The present study aimed to explore the prevalence, determinants and its positive and negative effects among medical students in a tertiary care teaching hospital in Jammu, India. Methods: The present cross sectional study was conducted in the month of December, 2023. Online questionnaire was shared with all the undergraduate MBBS students of the medical school and were directed to submit their responses. Data thus collected was entered into Excel spread sheet and analysed. Results: Prevalence of caffeine intake among the respondents was 85.7%. The most common caffeinated beverage consumed was tea followed by coffee while energy drinks were least consumed. Among the reasons for consumption, feeling refreshed and combating drowsiness were cited as two main reasons. Respondents reported gastritis (41%), insomnia (30%), anxiety (18%) and palpitation (18%) as major side effects post consumption. Conclusions: The frequency of caffeine use among the respondents was more on the regular days in contrast to stress related exam days as reported in other studies. Intake of caffeinated beverages favourable time was morning. More studies are recommended to study long term results of consumption of caffeinated beverages.

Assessment of the patient satisfaction level with outpatient department services in a tertiary care hospital of Jammu region

Background: Outpatient department (OPD) is that section of the hospital which is staffed and equipped to provide diagnostic, therapeutic and rehabilitative care to those patients who are not registered as inpatients while receiving the services during scheduled working hours. Objective of the study was to assess the patient satisfaction level with OPD services in a tertiary-care hospital of Jammu region. Methods: A cross-sectional study was conducted among patients visiting the OPD of the SMGS hospital GMC Jammu from January to March 2023. Exit interviews were conducted using a semi-structured questionnaire among patients availing the services from OPD. Results: Average percentage of total satisfaction score among sampled OPD patients has come out to be 68.13% whereas total average dissatisfaction score was 20.87% and the total average mild dissatisfaction score as 11.00%. Conclusions: This study suggests that patients were satisfied to a larger extent with OPD services except a few which are least satisfied especially with waiting time at registration counter.

The Usefulness of Multivariate Analysis in Forestry Research: A Case Study of Wild Pomegranate (Punica granatum L)

The present study deals with the Contrast, Cluster, Discriminant and Principal Component Analysis. The data for the present study was collected. Data on different morphological and seedling characters, namely Tree height (m), Tree diameter (cm), Crown spread E-W (m), Crown spread N-S (m), Fruit weight (g), Leaf length(cm), Internodal length(cm), Collar diameter (mm), Number of branches per plant and leaf petiole (cm) were considered from five different districts comprising of ten seed sources. Two seed sources were considered from each district viz; Narag and Neripul from Sirmour district, Waknaghat and Sadhupul from Solan district, Sundernagar and Rewalsar from Mandi district, Mohal and Banjar from Kullu district, Basantpur and Sunni from Shimla district. Different morphological and seedling characteristics of ten seed sources were evaluated by contrast analysis, which varied significantly among the different districts and within the districts. It is concluded that Tree diameter (cm), Crown spread E-W (m) and Crown spread N-S (m)was found Maximum in Solan district and Minimum in Shimla district, whereas Collar diameter (mm), Leaf length (cm) and Number of branches per plant was found Maximum in Mandi district and Minimum in Shimla district. Tree height (m) and Leaf petiole was recorded maximum in Kullu and Sirmour district and minimum in Shimla district whereas Fruit weight (g) and internodal length (cm) was found Maximum in Mandi district and minimum in Solan and Sirmour district.Cluster analysis was performed and the seed sources were grouped into three clusters. Discriminant analysis was carried out to categorize the seed sources into high and low yielders. Tree diameter, Tree height and Crown spread E-W are the most important characters that discriminate the two groups. Six seed sources from Mandi, Kullu and Shimla district were high yielder whereas other four seed sources were low yielder. Three principal components (PCS) were extracted out of ten which explained 34.675, 23.002, and 11.587 per cent of the total variation respectively amounting to 69.26 per cent of total variation.

Study of patient satisfaction regarding linen and laundry services in a tertiary care hospital of north India

Background: Linen and laundry services are meant to provide clean, comfortable and hospitable services to the patients. The clean linen inculcates a sense of psychological confidence in the patients and the public and enhances their faith in the services rendered by the hospital. Objective was to study the provision of efficient linen and laundry services in a tertiary care hospital of north India. Methods: A cross-sectional study was conducted in linen and laundry services of SMGS Hospital Jammu from October 2020 to March 2021. Using convenient sampling, 300 patients or their attendants were interviewed about their satisfaction levels regarding provision of linen and laundry services. Another questionnaire was administered to the laundry plant staff to enquire about their satisfaction and motivation levels. The data was analysed and chi-square was the test of significance. Results: The findings of the study revealed an overall satisfaction rate of 91.9% among the patients/attendants regarding provision of efficient linen and laundry services. Time of recruitment and nature of job were the variables found to be significantly associated with job satisfaction among the laundry staff workers (p<0.05). Conclusions: High levels of satisfaction among the end users reflect quality of the services provided by this tertiary care hospital. Levels of motivation and job satisfaction were equally adequate among the laundry workers.

A Study of Comprasion of Conventional Cytology with Liquid Based Cytology of Thyroid FNAC – A Study of 100 Cases

Background: Fine Needle Aspiration (FNA) cytology of the thyroid has been increasingly utilized for the investigation of thyroid lesions. FNA of the thyroid gland is considered to be most cost effective and accurate primary diagnostic procedure for thyroid nodules. In the recent years many approaches has been devised to improve the quality of thyroid FNA cytology because the conventional smear (CS) is subject to error in sample collection and slide preparation. The liquid based cytology (LBC) originally developed for the application of gynaecologic cervical smears, has progressively gained for application of both non gynaecologic and fine needle aspiration cytological material. According to the Wilcoxon signed ranked test for thyroid lesions LBC was not useful in goitre and infectious lesions. It gave better results in anaplastic and medullary carcinoma. So conventional smear is more sensitive, specific and accurate than LBC. Methods: in this prospective study, we had 100 cases of thyroid. In each case, two passes were performed. The first pass was for CS and the second pass yielded material for LBC. Both CS and LBC smears were compared for cellularity, background blood and necrotic cell debris, cell architecture, informative background, presence of a monolayer of cells and nuclear and cytoplasmic details and test on an for statistical analysis. Results: Diagnostic accuracy was better in CS compared withLBC smears as CS was most sensitive (93.18%) and accurate (91.75%) method for analysis of thyroid while LBC method is sensitive (89.04%) and accuracy (86.59%).Conclusion: Conventional smear is more sensitive, specific and accurate than LBC because LBC introduce more cytological artifacts to thyroid aspirates.

Assessment Of Examination Stress And HRV in Adolescents.

Objective.The present study was designed to define and evaluate examination stress among ,adolescents in the age group of 12–18 years in relation to heart rate variability (HRV), an index of sympathovagal interplay, one of the sensitive neurophysiological axes to be influenced initially, when an individual is exposed to any stressor.Methods. Hari’s stress inventory for students was used to qualify examination stress was collected on 69 healthy school students, free from any acute or chronic ailment, one month and seven days before the start of final examinations along with acquisition of short – term HRV to profile the sympathovagal interplay, a sensitive index of both physical and mental stress. Results. The stress inventory depicted that the sample population was under an enhanced mental stress 7 days before the examination as compared to that observed 1 month before the ratios of HRV 1month and 7 days before the final examination. Significant appreciable difference could also be appreciated in the values of SDANN in time domain and amplitude of the waveforms in HF, LF on the frequency domain of HRV.Conclusion. An enhanced sympathetic outflow as discerned through increase in LF/HF ratio and LF power with a concomitant decrease in HF power along with significant decrease in SDANN values profiling a decreased vagal outflow of the student population denotes an autonomic neurophysiological status that needs a specialist attention in terms of proper and adequate guidance and counselling.

Long term stay at low altitude (1,200 m) promotes better hypoxia adaptation and performance.

Acute exposure to high altitude hypoxia is known to decrease physical performance. The exercise performance increases during moderate altitude training (2000-3000 m) but benefits are overshadowed by adverse effect associated with hypoxia. Therefore, the study was designed to address whether low altitude of 1200 m could increase exercise performance without any adverse effects and a correlation with stay period (stay > 6 month) was optimized. In the present study residents of lower altitude (1200 m altitude) (LA) and sea level (SL) residents were subjected to sub-maximal exercise test and their exercise response in terms of postexercise heart rate and change in oxygen saturation was compared. Post-exercise peak heart rate (129.89±13.42 vs 146.00±11.81, p<0.05) was significantly lower and arterial oxygen saturation (SpO2) after exercise had a significant fall (95.3±2.26% vs 98±0% p<0.001) in LA residents. The hematological parameters like hemoglobin (Hb) and hematocrit (Hct) taken as markers of physiological adaptation, were also found to be significantly higher in LA as compared to SL residents (Hb 16.13±0.70 vs 14.2±0.87, p<0.001 and Hct 47.42±2.08 vs 44.05±0.72, p<0.001). Overall, the study highlights that physiological adaptation at 1200 m results into a better exercise response and hematological benefit compared to sea level residents.

Colorectal carcinoma up to the second decade of life: An 8‑year experience in a tertiary care center.

AIMS AND OBJECTIVES: To evaluate the demographic pattern, incidence, and histological characteristics of colorectal carcinomas (CRCs) in very young adults diagnosed in the center. MATERIALS AND METHODS: We retrieved and reviewed slides and data pertaining to all the cases of CRCs and “segregated into decade wise age‑groups” from the archives of Department of Pathology. Patients with age ≤20 years diagnosed during the last 8 years (2006–2013) were further evaluated. RESULTS: Totally, 590 cases of CRCs diagnosed over last 8‑year period, of which 4.2% (25 cases) presented in the study group (age ≤20 years) with a mean age of 17 years. About 50% of the tumors were either signet ring cell, mucin‑secreting or poorly differentiated carcinomas. Four cases occurred in a background of familial adenomatous polyposis (FAP), three of which showed high‑grade dysplasia, while in one case, carcinoma‑in‑situ was diagnosed. In all but two cases, rectum was the site of involvement except FAP cases in which colorectal location was noted. CRCs show a sharp rise in earlier age onset (≤40 years) and an increasing trend was followed in patients between age groups third, fourth, and fifth decades of life over the last 8 years. CONCLUSION: Colorectal carcinomas show an increasing trend in young age (≤40 years). This change may be attributed to dietary, lifestyle changes, and newer genetic alterations in developing countries. In very young age group (≤20 years), a higher grade and stage at the time of diagnosis and predominantly rectal involvements are the distinct features.

Efficacy of Spodoptera litura multiple nucleopolyhedrovirus after serial passage through the homologous insect larval host.

An originally isolated baculovirus, Spodoptera litura multiple nucleopolyhedrovirus (SpltMNPV) was serially passed through the S. litura larvae for upto four generations to determine the mean number of occlusion bodies (OBs) harvested per larva and their efficacy in terms of infectivity, feeding cessation and speed of kill of host larvae. The results revealed that the mean number of OBs harvested per larva increased significantly with increase in the dose of SpltMNPV at each passage and the yield was significantly lower in original stock wild-type SpltMNPV (P0) as compared to serially passed SpltMNPV (P1, P2, P3 and P4). Laboratory bioassays indicate that median lethal doses (LD50), median times to feeding cessation (FT50) and median survival times (ST50) of P0, P1, P2, P3 and P4 were significantly different from each other. The OBs of each passage when tested for their cross-infectivity against Spodoptera exigua and Spilarctia obliqua revealed significant reduction in their mortality. These results indicate that serially passed SpltMNPV is more host specific and more effective biocontrol agent than the original stock wild-type virus and can be adopted for mass production as a viral pesticide for control of the S. litura.

Cupriavidus pauculus (Ralstonia paucula) concomitant meningitis and septicemia in a neonate: First case report from India.

Ralstonia paucula (formerly classifi ed as CDC (Centre for Disease Control) group IVc-2, Wautersia paucula; recently renamed as Cupriavidus pauculus) is an environmental Gram-negative bacillus isolated from water sources and can cause serious human infections. Patients recover bacteriologically indicating low virulence. A total of 32 cases have been reported world-wide, but no isolation has ever been reported from cerebrospinal fl uid or in India. The fi rst case of R. paucula meningitis and septicemia is being reported here along with the brief summary of cases reported world-wide.

Review: Predictive and Prognostic Features and Their Impact on Outcome for Early-stage Breast Cancer in Mid-Western Ireland.

Aims: Predictive and prognostic features have served to allow prognostication for patients with early stage breast cancer. We sought to document our own outcomes for these features to see if our cohort corresponded to published reports. Study Design: Retrospective pilot cohort study. Place and Duration of Study: Department of Medical Oncology, Mid-Western Cancer Centre (MWCC), Mid-Western Regional Hospital (MWRH), Limerick, Ireland, between 1st January 2002 and 31st December 2002. Methodology: A retrospective analysis was designed to include with early stage breast cancer seen at our institution for the aforementioned period, information was derived from the patients’ records and indices were derived from prognostic tools. Information was analyzed using descriptive statistics and χ2 or Fisher’s exact test. Results: Seventy-seven (77) patients were found, with a median age of 52.2 years. Median overall survival of 84 months for the 10-year period of follow-up. The majority presented with moderately differentiated oestrogen receptor positive invasive ductal carcinoma and lymph node involvement (60%). 64% of patients underwent mastectomy as opposed to breast conservation. Adjuvant cytotoxic chemotherapy uptake was 61%, which was comparable to proportion of node positive disease. The predictive and prognostic features including axillary nodal status, tumour size, tumour grade, age at presentation and oestrogen receptor status were all significant indicators for outcome, but particularly within patients under 50 years of age. Conclusions: This report underscores that these predictive and prognostic factors were more significant within for patients under the age of 50 years.

Multiple virulence factors regulated by quorum sensing may help in establishment and colonisation of urinary tract by Pseudomonas aeruginosa during experimental urinary tract infection.

Purpose: Damage caused by an organism during infection is attributed to production of virulence factors. Different virulence factors produced by the organism contribute to its pathogenicity, individually. During infectious conditions, role of virulence factors produced by the pathogen is different, depending upon the site of involvement. Pseudomonas aeruginosa is an opportunistic nosocomial pathogen known to cause infections of the respiratory tract, burn wound, urinary tract and eye. Importance of virulence factors produced by P. Aeruginosa during infections such as keratitis, burn wound and respiratory tract is known. The present study was designed to understand the importance of different virulence factors of P. aeruginosa in urinary tract infection in vivo. Materials and methods: An ascending urinary tract infection model was established in mice using standard parent strain PAO1 and its isogenic mutant, JP2. Mice were sacrificed at different time intervals and renal tissue homogenates were used for estimation of renal bacterial load and virulence factors. Results: Both parent and mutant strains were able to reach the renal tissue. PAO 1 PAO1was isolated from renal tissue till day 5 post-infection. However, the mutant strain was unable to colonise the renal tissue. Failure of mutant strain to colonise was attributed to its inability to produce protease, elastase and rhamnolipid. Conclusion: This study suggests that protease, elastase and rhamnolipid contribute to pathogenesis and survival of P. aeruginosa during urinary tract infection.

Prescription Audit and the Compliance of Medicines Prescribed in Pregnant Women.

Proper use of medicines can be ensured in the society through various ways. Scientific and rational prescription is one of them, but at the same time judicious use of medicines by the patients is also equally important. Compliance of therapy can determine fate of any medicine. This study was planned to explore some important aspects of use of medicines in pregnant women in remote villages of India. This was an observational, cross sectional study using face to face interview of the pregnant ladies and also auditing the prescriptions available from them. Present study revealed that the average age of the study population was 23.6 years and primi-gravida (51.4%) constituted slight majority over multi-gravida. Most commonly prescribed medicine during pregnancy was iron, folic acid (79%) and injection tetanus toxoid (91%). A large number of pregnant women (37.5%) were non compliant with the medicine prescribed for them. In modern therapeutics, drugs or medicines play an important role in the health of any individual. But at the same time its proper use should be ensured. This study showed the importance of use of medicines by the patient. Judicious use of scarce resources on medicines not only improves the quality of therapy but also the quality of life.

Clinical & molecular characterization of human TT virus in different liver diseases.

Background & objectives: TT virus (TTV) is a newly discovered non-enveloped, single stranded DNA virus of high genotypic variability, found frequently in patients with acute or chronic hepatitis of non A-G aetiology. This study was carried out to look for the presence of TTV and its genotypes in patients with different types of liver diseases from northern India. Methods: A total of 262 serum samples from patients of acute viral hepatitis (AVH; n=72), fulminant hepatic failure (FHF; n=49), chronic active hepatitis (CAH; n=93) and liver cirrhosis (LC; n=48), were analyzed for hepatitis A-G viral markers. TTV DNA was detected in all cases by nested polymerase chain reaction (PCR) using the primers from N22 and untranslated (UTR) region. TTV-DNA was also tested in 150 volunteer blood donors. Direct nucleotide sequencing of N22 amplicons were carried out to look into the prevalent TTV genotypes. Results: TTV-DNA was detected in 73.6, 59.2, 21.5 and 29.1 per cent cases with AVH, FHF, CAH and cirrhosis, respectively. In AVH and FHF groups, TTV showed co-infection with all A-G hepatitis cases whereas in CAH and cirrhosis groups, TTV co-infection observed with HBV, HCV and HGV. TTV-DNA was detected in 45.3 per cent volunteer blood donors. No statistically significant difference was observed amongst the mean liver function profile of UTR PCR positive and negative cases in different liver disease groups except AVH cases, in whom the various biochemical parameters between TTV positive and TTV negative patients were marginally significant. However, no significant evidence of biochemical or histological deterioration of the liver was observed in TTV positive cases amongst FHF, CAH and cirrhosis. Predominance of genotype 1a was observed in all the cases from north India. Interpretation & conclusions: TTV is a frequent virus isolated from patients with various types of liver diseases as well as in healthy individuals from northern India. TTV has no effect on biochemical markers of associated liver diseases. Genotype 1a was the most predominant type in different liver disease groups. The occurrence of TTV did not further influence the course of the disease.

Carcinosarcoma of the gallbladder.

Carcinosarcoma of the gallbladder is an uncommon neoplasm. We herein report the case of a patient with carcinosarcoma of the gallbladder, treated by simple cholecystectomy for a tumor which was confined to the gallbladder.

Pediatric femoral hernia.

Pediatric femoral hernias account for less than 1% of all groin hernias. Pediatric femoral hernias are rather uncommon more so in males, often overlooked, misdiagnosed and treated as inguinal hernia. Femoral hernia masquerading as inguinal hernia in a seven year old male is reported along with review of relevant literature.

Myocardial damage in hair dye poisoning--an uncommon presentation.

A 22-year-old female presented to us after consuming hair dye with features of angio-neurotic edema, asphyxia and irregular pulse. Serial ECGs revealed presence of ST segment elevation and T wave inversion in anterior chest leads. Strongly positive c-troponin-T test further confirmed the myocardial damage. This is a rare manifestation of para-phenylene diamine poisoning mentioned in literature. Patient also had elevated liver enzymes and oliguria.

Disease associations of mannose-binding lectin & potential of replacement therapy.

Mannose-binding lectin (MBL) is an important component of the immune defence able to bind to repeating mannose based structural patterns typical of microbial surface (bacteria, viruses, fungi, parasites) leading to opsonization and phagocytosis, and activation of the complement pathway resulting in lysis of the pathogen. MBL thus plays a very important role in the first line of host immune response. MBL deficiency has been implicated in susceptibility and modulating the severity in viral, bacterial, fungal, and protozoan infections. High MBL levels, on the contrary might be helpful to intracellular organisms, which take the advantage of C3 opsonization and C3 receptor on monocytes/macrophages to enter their host. MBL replacement therapy to help patients with MBL deficiency has undergone phase I clinical trials. Phase II and III trials and production of recombinant MBL for replacement therapy are currently underway.

Effect of carbon and nitrogen source amendment on synthetic dyes decolourizing efficiency of white-rot fungus, Phanerochaete chrysosporium.

Decolourization activity of Phanerochaete chrysosporium for three synthetic dyes viz., congo red, malachite green and crystal violet and impact of additional carbon and nitrogen supply on decolourization capacity of fungus were investigated. Maximum decolourizing capacity was observed up to 15 ppm. Addition of urea as nitrogen source and glucose as carbon source significantly enhanced decolourizing capacity (up to 87%) of fungus. In all the cases, both colour and COD were reduced more in non-sterilized treatments as compared to sterilized ones. Significant reductions in COD content of dye solutions (79-84%) were recorded by fungus supplied with additional carbon and nitrogen. A highly significant correlation (r = 0.78, p < 0.001) between colour and COD of dye solutions was recorded. Thus, a readily available carbon and nitrogen source is imperative to enhance the bioremediation activity of this fungus which has been the most suitable for synthetic dyes and textile industry wastewater treatment.

Outcome of sixty four cases of ethylene dibromide ingestion treated in tertiary care hospital.

BACKGROUND AND AIMS: In view of high incidence and mortality due to ethylene dibromide poisoning, a prospective study was planned to assess demographic, toxicological, clinical profile and outcome. MATERIAL AND METHODS: Prospectively collected data of sixty four patients with ethylene dibromide poisoning were reviewed. All the patients were from Gwalior and neighbouring districts. RESULTS: Majority were males in the age group 21-30 years. Out of sixty-four cases 26 patients (40.6%) survived and 38 patients (59.4%) expired. Nausea vomiting and pain abdomen were most common symptoms at presentation. Diarrhoea, drowsiness, palpitations and oliguria were other features. Pulse rate was normal (< 100) in 22 (84.6%) survived patients whereas it was > 100 in 24 (63.1%) of expired patients at the time of admission (p value = 0.0004199). Half ampoule (1.5ml.) of ethylene dibromide was sufficient as fatal dose. Mortality was 20% and 46.15% with half and one ampoule respectively. Best outcome was when the patient presented to the hospital within six hours. Death occurred anywhere between twelve hours and five days. Gastrointestinal toxicity was predominant at presentation. Nausea, vomiting and abdominal pain was present in all the patients. Nephrotoxicity 32 (50%), hepatotoxicity 28 (43.8%), cardiotoxicity 28 (43.8%), central nervous system 8 (12.5%) toxicity and hypoglycemia 24 (37.5%) were also observed. CONCLUSION: Ethylene dibromide is highly toxic. Patients who consumed half to one ampoule usually survived with supportive care provided they presented to the hospital within six hours. Pulse rate more than 100 at presentation was a poor prognostic factor. Patients with normal pulse and blood pressure at admission had better prognosis.