Diagnostic radiology training for medical students - a Brazilian multicenter survey

ABSTRACT Objective This study aimed to assess diagnostic radiology training and exposure during medical school, from the perspective of medical students in Brazil. Methods In this multicenter study approved by the Institutional Review Board, medical students from multiple universities in Brazil filled out an online questionnaire regarding their perception about diagnostic radiology training during medical school, including knowledge and use of the American College of Radiology Appropriateness Criteria and their confidence level in interpreting common radiological findings. Medical students from different regions of Brazil were sent invitations to participate in the anonymous survey through radiology group emails initiated by radiology professors and a group of ambassadors representing different institutions. Informed consent was obtained electronically at the beginning of the survey. Results The survey demonstrated diagnostic radiology is frequently included in preclinical exams; however, radiology training during medical school was considered inadequate from the medical students´ perspective. Overall, radiological imaging teaching was provided by radiologists for more than half of the survey respondents; however, radiological imaging is frequently shown to students by non-radiologist physicians during case discussion rounds. Moreover, few respondents had a mandatory radiology training rotation during medical school. Conclusion This Brazilian medical student survey demonstrated that from the medical students' perspective, diagnostic radiology is an important subject in clinical practice; however, their radiology training and exposure are overall heterogeneous.

Medical laboratory practice in Malawi ­ Current status

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A Case Control Study of Vitamin D Levels in Chronic Obstructive Pulmonary Disease Patients and Healthy Volunteers in South Gujarat, India

Introduction: The Global Initiative for Chronic Obstructive Lung Disease (GOLD) programme states that COPD is a common, treatable, and preventable disease that is characterized by a persistent airflow restriction that usually progresses and is connected to an exaggerated chronic inflammatory response in the airways and the lung to harmful particles or gases. The combined severity of a patient's co-morbid illnesses and exacerbations increases. The purpose of the study was to assess the vitamin D status of COPD patients and healthy participants. Methodology: This case-control study was conducted among 75 cases and 75 control at the Surat Municipal Institute of Medical Education and Research General Medicine department. Result: The mean vitamin D of subjects in cases was 32.21 � 12.68 and it was 52.05 � 1.99 in controls. The difference in vitamin D between the two groups was statistically significant (P Value<0.001). Conclusion: COPD patients had lower amounts of vitamin D. As COPD severity increases, vitamin D levels decrease. Along with a rise in COPD exacerbations, vitamin D levels are also decreasing

Colchicine for pericarditis due to COVID-19: a case report

The pericardium is a fibroelastic sac made up of visceral and parietal layers separated by a (potential) space, the pericardial cavity.The most troublesome complication of acute pericarditis is the development of recurrent episodes of pericardial inflammation, occurring in 15% to 32% of cases. Therapeutic modalities are nonspecific and include non-steroidal anti-inflammatory drugs(NSAIDs) and corticosteroids. Here we present a case of a patient presenting with pericarditis due to COVID-19. He was successfully treated with colchicine. To our knowledge acute pericarditis due to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2)might be an under diagnosed condition in this pandemic. We want to share our findings, given the urgent need for different diagnostic and therapeutic strategies in order to better manage COVID-19 patients, and diminish the SARS-CoV-2 complications.

A comparative study of ferric carboxymaltose and iron sucrose as a parenteral iron treatment in iron deficiency anaemia during pregnancy

Background: Iron deficiency anemia during pregnancy is a serious global concern specially in developing country, which is preventable with effective measures. In women who cannot tolerate oral iron or have moderate to severe anemia, parenteral iron in the form of iron sucrose or ferric carboxymaltose can be very much useful. This study aimed to compare efficacy and safety of iron sucrose and ferric carboxymaltose in iron deficiency anemia during pregnancy.Methods: This prospective interventional comparative study was conducted during May 2016 to April 2018 at tertiary care hospital and total 100 antenatal women from 28 to 34 weeks of gestation having moderate to severe anemia were included in this study and all women were divided in to 2 groups randomly and were given either iron sucrose or ferric carboxymaltose according to iron requirement. Rise in haemoglobin and serum ferritin were noted and data analysed statistically.Results: The mean rise of haemoglobin with iron sucrose was 1.8 gm% and with ferric carboxymaltose was 2.6 gm%. The mean rise of serum ferritin with iron sucrose was 82.4 ng/ml and with ferric carboxymaltose was 100.9 ng/ml. Other than minimal local reaction one woman had developed severe anaphylactic reaction after receiving iron sucrose.Conclusions: Intravenous ferric carboxymaltose is better and safe molecule than iron sucrose and it has advantage of ability to administer large dose in single sitting which reduce overall cost of therapy.  Hence ferric carboxymaltose is a drug of choice as parenteral iron therapy in iron deficiency anemia during second trimester of pregnancy.

Study of etiology of pleural effusion in Telangana population

Background: Among 86 patients aged between 18 to 65 of both sexes having pleural effusion due to various clinical etiologies were studied.Methods: Chest x-ray PA. was studied, 20 ml of pleural fluid was aspirated to study bio-chemically, microbiologically and pathological. Echo-cardiography, USG abdomen and biopsy of pleura was also done in same patients in whom diagnosis or etiology was unclear.Results: Among 59(68.6%) had fever, 68(79%) had cough, 40(46.5%) had breathlessness, 20(23.2%) had pedal edema, 42(48.8%) had chest pain, 5(5.8%) had abdominal distention. 52(60.4%) had tubercular pleural effusion 34(39.5%) had non- tubercular pleural types of non-tubercular PE effusion (PE) included 8(23.5%) synpneumonic, 5(14.7%) had CCF, 11(32.3%) had malignancy, 2(5.88%) had RA, 2(5.88%) had dengue fever, 2(5.88%) had pancreatitis, 4(11.7%) had Hypoproteinaemia.Conclusions: This pragmatic approach to pleural effusion for patients with different clinical manifestations as pleural fluid analysis is gold standard method in evaluation pleural effusion of different etiology.Background: Among 86 patients aged between 18 to 65 of both sexes having pleural effusion due to various clinical etiologies were studied.Methods: Chest x-ray PA. was studied, 20 ml of pleural fluid was aspirated to study bio-chemically, microbiologically and pathological. Echo-cardiography, USG abdomen and biopsy of pleura was also done in same patients in whom diagnosis or etiology was unclear.Results: Among 59(68.6%) had fever, 68(79%) had cough, 40(46.5%) had breathlessness, 20(23.2%) had pedal edema, 42(48.8%) had chest pain, 5(5.8%) had abdominal distention. 52(60.4%) had tubercular pleural effusion 34(39.5%) had non- tubercular pleural types of non-tubercular PE effusion (PE) included 8(23.5%) synpneumonic, 5(14.7%) had CCF, 11(32.3%) had malignancy, 2(5.88%) had RA, 2(5.88%) had dengue fever, 2(5.88%) had pancreatitis, 4(11.7%) had Hypoproteinaemia.Conclusions: This pragmatic approach to pleural effusion for patients with different clinical manifestations as pleural fluid analysis is gold standard method in evaluation pleural effusion of different etiology.

Study of nonalcoholic fatty liver Telangana population

Background: Among 83 patients of both sexes aged between 25 to 65 adults had NAFLD with metabolic syndrome were studied.Methods: U.S.G. biochemical study included total cholesterol, AST, ALP, S, Albumin total Bilirubin, FBS, HbA1c and blood pressure was recorded.Results: Among 16(19.2%) had grade-I (mild steatosis) 38(45.7%) had grade-II (Moderate steatosis), 29(34.9%) had grade-III (severe steatosis), The clinical manifestation were 49(59%) had BMI 22.8 to 23.2, 34(40.9%) had BMI 23.3 to 24.2. D.M status was 33(39.7%) were pre-diabetic, 50(60.2%) were diabetic mellitus. 19(22.8%) were norma- tensive, 64(77.1%) were hypertensive, 63(75.9%) were hyperlipidemic, 23(27.7%) had IHD. 4(4.81%) had MI. Mean value of total cholesterol was 223±9.2, Triglyceride 24.8±13.3, HDL 42.3±2.5, LDL 128±13.8, AST 52.8±3.6, ALT 67.2±6.8, ALP 107±11.8, S. Albumin 3.50±0.12, Total bilirubin 0.93±0.10, FBS 13.±12.2, HB A/c 9.10±402.Conclusions: The present study of NAFLD was performed by combination of radiological and laboratory techniques, greatly reducing the requirement for invasive biopsy and reduce the morbidity and mortality.

Management Of Unstable Intertrochanteric Fracture In Older Age Paitent With Fixation Versus Hemi Or Total Primary Replacement

Background and Objectives: For many decades, attempts have been made to overcome the difficulties which surgeons encounter in the treatment of proximal femoral fractures. Extra medullary and intramedullary implants have improved in recent years, although consensus is lacking concerning the definition and classification of unstable intertrochanteric fractures, with uncertainties regarding treatment. In this era of technologically sound and tested fixation methods we shall compare functional outcomes and complications of various methods available for unstable it fracture fixation. The purpose of this study is to analyze the role of primary hemi arthroplasty in cases of unstable osteoporotic intertrochanteric femur fractures and compare the outcomes with conventional fixation techniques to find out a better management plan for the patient Materials and Methods: This is a prospective study of fifty cases of unstable intertrochanteric fractures, either treated with primary replacement (hemi or total) or fixation. Between january 2016 to january 2018, fifty patients with an unstable comminuted intertrochanteric femoral fracture (AO/OTA type 31A2.2, A2.3, A3.2, A3.3) were enrolled in the study, which was approved by our institutional review board. Inclusion Criteria: 1. More than 60 years of age. 2. All patients with unstable IT femur fracture type a. 31- A2.2 and 31- A2.3 (AO/OTA classification) b. Posteromedial fragmentation c. Basicervical d. Reverse oblique e. Displaced greater trochanter (lateral wall fractures) f. Patient must be ambulatory before sustaining injury Exclusion Criteria: a. Chronically debilitated and bed ridden patients. b. Compound fracture c. Medically compromised patients- ASA grade iv &v d. Local infection ¾ Stable fracture Results: Maximum patients (88%) belonged to 60-80 years of age. Since most of the patient belong to elderly age group, medical comorbidities are very common. Average requirement of blood transfusion needed was significantly higher in hemi replacement group than in fixation group. (Z= 3.56, p<0.05). This indicated the surgical complexity of hemi replacement There was significant shortening of limb in fixation group as compared to hemi replacement. (Z=6.98,p value <0.05) Thus hemi replacement provided faster rehabilitation to the patient. This implies that those patients who had hemi replacement had a significantly better activity of daily living. Harris hip scores were significantly better in hemi replacement group. (Z=4.31, p value<0.05) suggesting better functional outcomes. There was no significant difference between immediate postoperative complications though skin incision, operating time, and blood loss were significantly higher in hemi replacement group.(Z=0.7, p>0.05) but the rate of delayed complications and revision surgeries were significantly higher in fixation group. (p<0.05) There was no significant difference in mortality rates of both groups despite more blood loss and duration of surgeries in hemi replacement group. Interpretation and Conclusion: In conclusion we state that hemi replacement arthroplasty, is a valid treatment option for mobile and mentally healthy patients, as compared to fixation for faster rehabilitation and better activity of daily living. Aims & Objectives: To study the results of primary replacement (hemi or total) in unstable intertrochanteric fractures and compare it with conventional methods of fixation. To assess functional outcome in patients having unstable intertrochanteric fractures in both groups as per Harris hip score. To study the effect of pre-existing illness on final outcome of the patients in both groups. To study the stability of fixation in osteoporotic bones. To note any complication developed. To compare final outcome of this study with that of the other studies

Outcome of Only Posterior Approach in Acetabular Fractures Involving Both Columns

Objective : Clinical outcome in patients with acetabular fractures involving both columns was done in civil hospital, Ahmedabad, aiming to evaluate the efficacy of posterior approach and its radiological and functional outcome.Quality of reduction directly correlates with functional outcomes and increases rate of anatomical reduction when performed <2 weeks. (p<0.05) Materials and methods : 20 cases were included with both column fractures. T-fractures and severely displaced both column with spur sign were excluded. Preoperative radiographs and CT scan were done to evaluate the fracture. Timing of surgery was noted. Surgery was performed under fluoroscopic guidance.Follow-up radiographs and functional status was assessed using Harris hip score. Result : Majority of the patients i.e., 12 out of 20 patients had Harris Hip score >90 after 6 months of the post-op. 4 patients had satisfactory score of 70- 90. 4 patients had poor outcome with score <60. Follow-up radiographs showed good reduction maintenance and union in 15 patients (75%). Conclusion : Its suggested that acetabular fractures involving both columns (excluding severely displaced both column and T fractures) can be managed by a single posterior approach with good clinical outcome along with lesser soft tissue complications and lesser hospital stay.

Ultrasonographic and Hormonal Evaluation of Clinically Suspected Cases of Polycystic Ovarian Syndrome

Polycystic ovarian syndrome (PCOS) is a physiological disorder that causes many negative effects involving a variety of systems in the body, such as the endocrine, metabolic, psychological, and reproductive systems. An individual may present with a variety of reproductive, metabolic, and psychological problems. Method In this descriptive cross-sectional study, women of reproductive age group (15–35 yrs), presenting with infertility, irregular menstruation, acne, hirsuitism and obesity were included. Consecutive sample method and total 139 patients were included. Detailed history with specific emphasis on history of infertility, age, menstrual history (oligomenorrhoea; regular or irregular menses), and obesity was done. Serum FSH, LH, and LH:FSH ratio levels were estimated. TVS/TA, increase in number of follicles in ovary (multiple follicles), and increase in ovarian volume were noted. Result Out of the 139 patients studied at PRH, maximum patients (88.5%) had normal levels of Sr. LH. These normal levels were of follicular and luteal phase. Remaining 16 (11.5%) had increased levels of Sr. LH. Out of the 139 patients studied at PRH, majority (99.3%) of the patients had normal levels of Sr. FSH. These normal levels were of follicular and luteal phase. Only 1(0.7%) patient had decreased level of Sr. FSH. Of the 139 patients studied at PRH with evidence of PCOS, 58 (41.7%) patients had increased ratio of Sr. LH:Sr. FSH (i.e., ≥2:1). Remaining 81(58.3%) patients had normal ratio. In the present study of 139 patients, 65 patients had exclusive USG findings, 13 (9.4%) patients had exclusive hormonal evidence and 45 patients had combined USG and hormonal evidence. Overall 16 (11.5%) patients had neither of the evidence (although they had clinical features of PCOS). Conclusion Hormonal evidence of PCOS was present. Of these serums, LH levels were raised in majority of the cases and also raised LH:FSH ratio despite the values of hormones being in normal range. Both, i.e., USG alone and USG combined hormonal, were good evaluators for clinically suspected cases of PCOS.

Evaluation of Patients of Acute Pain in Abdomen Attending the Emergency Medicine Department at SSG Hospital, Baroda.

Background: Present study was aimed to study the clinical pattern, etiology and management outcomes of patients presenting with acute pain in abdomen in the Emergency Medicine Department (EMD), SSG Hospital. Aims: 1) To study Acute Pain in Abdomen, and various clinical presentation of acute abdominal pain in patients attending casualty at S.S.G.hospital. 2) to compare clinical judgment with radiological, intraoperative, and histopathological findings. Methods: A prospective observational study of total 700 patients was carried out from January 2013 to October 2013. All patients of acute pain in abdomen, except pregnant women & penetrating /blunt abdominal injury, comes to EMD in the casualty, at SSG Hospital were included. Results: Majority of female patients presented with generalised, colicky (predominantly) or dull aching pain, in mild to moderate intensity, within three days of onset of pain; while majority of male patients presented with generalised, dull aching (predominantly) or colicky pain, in severe to excruciating intensity, after the three days of onset of abdominal pain. Conclusion: In our study, majority of patients presenting to EMD with Abdominal Pain were male and belong to age group of 21-50 years. Patients with generalised abdominal pain and Left Upper Quadrant pain were found to be having Nonspecific Abdominal Pain. Patients diagnosed as Acute Pancreatitis had come with pain in periumbilical area, Epigastric region, & back; while patients with Right Upper Quadrant, Right Lower Quadrant and Flank pain turned out to be Acute Cholecystitis, Acute Appendicitis, and Ureteric Colic, respectively. Patients with generalised abdominal pain, nausea, vomiting and fever were found to be having Acute Appendicitis. Patients diagnosed as Bowel Obstruction had come with Abdominal Distension and Constipation; with anorexia, were diagnosed Nonspecific Abdominal Pain; with jaundice, were diagnosed Liver Abscess; with burning micturition, all were diagnosed Nonspecific Abdominal Pain.