Semi-Structured Assessment of Practical Examination : Need of Hour

Background: To evaluate the learning outcomes, objective methods of assessment play an important role.With limited resources in medical colleges, it is difficult to implement objective methods like objectivelystructured practical examination (OSPE). This study is an effort to amalgamate objectivity in conventionaltype of assessment.Methods: 33 students of first MBBS were assessed independently by 3 examiners during practical examination.One examiner awarded marks in conventional manner while two other examiners used semi-structuredassessment taking into consideration the affective, cognitive and psychomotor domain of the students.Linear mixed effects analysis of the relationship between the outcome score and methods of assessmentwere performed using statistical software R. Two models were constructed: first, a null-model without anypredictor and examiners as random effect and second, a full-model with method of assessment as fixedeffects and examiners as random effects.Results: Intra-class-correlation (ICC) was 0.24 in null model and 0.01 in full model. The decrease in variancedue to examiners between the models can be accounted to different methods of assessment. Pearson’scorrelation coefficient between the two semi-structured assessments was 0.754 as compared betweenconventional and semi-structured assessment, which was 0.488 and 0.466.Conclusion: Linear mixed effects analysis of the relationship between the outcome score and methods ofassessment shows the significant effect of types of assessment on the outcome score of the students.Semi-structured assessment is better in terms of validity, reliability, feasibility and applicability.

Clinical Profile Of Ascending Aortic Aneurysm: A Retrospective Observational Study

Background: Ascending aortic aneurysm is common incidental finding on transthoracic echocardiography performed for unrelated indications. Usually seen in patients with underlying connective tissue disorders. Methods: This was retrospective observational study involving ascending aortic aneurysm patients requiring surgical intervention during the period of Jan 2015 to Jan 2018 Results:Total 30 patients of ascending aortic aneurysm requiring surgical intervention were studied. Males outnumbered females with ratio of 5:1. Their age ranges from 14-72 years (mean=43.6years). Most of the patients of ascending aortic aneurysm also present with aortic regurgitation,43%. Hypertension being the most commonly associated co-morbidity. Bentall’s procedure, 67%, is most commonly needed surgical intervention. Bleeding, 16.67%, is the most common and independent risk factor for mortality with percentage of 26.67% Conclusion: Bleeding is independent risk factor in ascending aortic surgery and careful application of hemostasis skills can bring down mortality associated with ascending aortic surgery.

Ketotic Hypoglycemia in Children with Previous Transient Congenital Hyperinsulinism

Congenital Hyperinsulinism (CHI) is a major cause of neonatalhypoglycemia characterised by non-ketotic hypoglycemia. Wedescribe the occurrence and higher prevalence of ketotichypoglycemia (KH) in 5 children with transient CHI. Four childrenhad required diazoxide to control the persistent hypoglycemiathat was discontinued at a mean age of 11.25 (+5.25) months. KHdeveloped after an average time period of 6.7 months followingthe resolution of CHI. Children with transient CHI may be at risk ofsubsequently developing KH at a variable age period.

Tuberculous intestinal perforation in a case of Burkitt lymphoma on chemotherapy - A case report.

Intestinal perforation induced by chemotherapy in a patient of Burkitt lymphoma is a known potential complication which carries high mortality. Perforation may also occur as a result of the transmural nature of the tumour. Patients on chemotherapy are prone to contract infectious diseases due to a compromised immune system. Pulmonary tuberculosis has been reported in these patients, but abdominal tuberculosis has not. We report the case of a five year old boy on chemotherapy for Burkitt lymphoma, and who developed a tuberculous jejunal perforation. The patient underwent drain insertion and stabilization followed by exploratory laparotomy with resection of the pathological segment and closure of the duodenal stump at the fourth part. Bowel continuity was re-established by gastrojejunostomy. Histopathologic examination of the resected segment revealed intestinal tuberculosis. Anti -tubercular therapy was started and continued for nine months. The last cycle of chemotherapy was administered 1 month after surgery. At 1 year of follow up the patient is asymptomatic and thriving well.

Observational study for evaluation of clinical outcome of non-descent vaginal hysterectomy.

Introduction: Hysterectomy is the fairly common operative procedures carried out in the gynecological practice. Abdominal hysterectomy has it own limitation in high risk groups and had post operative complications. So the present study was undertaken with objective to find out the efficacy of vaginal hysterectomy in other plan prolapse patients to assess its safety and to determine efficacy of adjunctive procedures by vaginal route. Material and methods: Total 60 patients having indication had vaginal hysterectomy without vaginal prolapse having uterus up to 14 weeks size. Patients having capability of lithotomy position and adequate vaginal access were included in the study. Patients suspected or undiagnosed malignancy of urogenital organs and associated other pelvic pathology or abdominal pathology was excluded. After thorough general and systemic examination after USG patient were posted for vaginal hysterectomy. Preoperative and post operative complications were noted and managed accordingly. Results: In present study 80% of the patients were above the age of 40 years. 76.7% of the vaginal patients were having parity 3 or more. Most patients were having more than one complaint. But most common complaint among them was menstrual irregularities and associated medical problems were noted in 51.7% patients. Previous abdominal or pelvic surgery was not a contraindication for vaginal surgery. Most common indication for vaginal hysterectomy was fibroid Uterus in 41.7% and dysfunctional uterine bleeding 38.3%. In the present series, patients with fibroid size up to 14 weeks were operated vaginally successfully. The amount of blood loss was less than 50 ml in this study. Significant blood loss requiring blood transfusion was not found in this study. There was no bladder or bowel injury the special techniques used was bisection, myomectomy, morcellation and combination. The most commonly used technique was bisection. hysterectomies was 48.6 minutes, period more than that was required when there was presence of concurrent A and P repair. No patient required blood transfusion maximum i.e. 63.3% patient’s blood loss was less than 50 ml. There was no bowel or bladder injury during procedure and immediate post operative pain. Febrile episode and UTI was complained with no long term complications. Average hospital stay was 3 days. Conclusion: Vaginal hysterectomy in patients with up to 14 weeks for non-descent large uterus is safe and practical. It ensures minimal blood loss, early postoperative recovery, early ambulation, reduced duration of hospital stay.

Comparative study to evaluate anesthetic effect of Thiopentone Sodium and Propofol in electroconvulsive therapy.

Introduction: In therapeutic management of psychiatric illness the response to electroconvulsive therapy may be attenuated if anesthesia that is used abolishes or inhibits seizures. Anesthetic agents used for electroconvulsive therapy should provided smooth and rapid induction, a rapid recovery, minimal alteration of the physiological effects of electroconvulsive therapy as well as minimal antagonistic effects on seizure activity. Material and methods: In study of 120 patients with ASA grade I or II, having indication for Electroconvulsive therapy, half were randomly anaesthetized by 2.5% Thiopental Sodium with dose 3 mg/kg (Group I) and 1% Propofol in 1.5 mg/kg dose (Group II). A current of 110 volts was psychiatrist. Pulse and Blood pressure monitoring and Seizure response were evaluated along with side effects if any. Observation: After Induction, systolic BP in the 2 Groups did not show any significant (p>0.05) difference while the diastolic BP was significantly (p<0.05) lower in the propofol group. After suxamethonium systolic and diastolic BP were significantly (p<0.05) decreased in the propofol group. After completion of seizure systolic BP came down to basal level at 10 mins and diastolic BP came down to basal level at 15 mins. While in the thiopentone sodium group, the BP did not come down even the end of 15 mins. The duration of seizure activity in the propofol group was markedly reduced (p<0.05) as compared to the thiopentone sodium group. The time from induction to eye opening and induction to walking unaided were significantly (p<0.001) lower in the propofol groups suggesting faster recovery. During induction, higher percentage of patients showed discomfort on injection in the propofol group while during recovery headache, nausea and vomiting were noted in more patients within thiopentone group. Conclusion: Propofol group compared to thiopentone sodium had reduced increase in BP and pulse rate, reduced duration of seizure activity. Recovery was faster and side effects were reduced during recovery.

An unusual presentation of rectal atresia with rectal duplication cyst in a neonate: A case report.

A 10 days old male baby brought with abdominal distension and cystic swelling in the left buttock. Radiological investigations suggested para-rectal abscess or rectal duplication cyst. Patient underwent transverse loop colostomy and later definitive surgery by posterior sagittal approach. Intra-operative findings were suggestive of small atretic rectal segment with duplication cyst of the rectum. To the best of our knowledge, neonatal rectal atresia with rectal duplication cyst has not been reported in English literature.

Dental complications of herpes zoster: Two case reports and review of literature.

Herpes zoster (HZ) (shingles) results due to reactivation of varicella‑zoster virus. Unusual dental complications like osteonecrosis, exfoliation of teeth, periodontitis, and calcified and devitalized pulps, periapical lesions, and resorption of roots as well as developmental anomalies such as irregular short roots and missing teeth may arise secondary to involvement of 2nd or 3rd division of trigeminal nerve by HZ. Such cases pose both a diagnostic as well as a therapeutic challenge. We report two such rare dental complications of HZ‑spontaneous tooth exfoliation and osteonecrosis of the maxilla in a 70‑year‑old female patient; and multiple periapical pathoses affecting right half of the mandibular teeth in a 45‑year‑old female patient. Both the patients did not have any associated systemic illness. The aim of this paper was to compare the present cases with all the 46 cases of osteonecrosis and 6 cases of multiple periapical pathoses secondary to trigeminal zoster reported in literature till date The article also throws light that the occurrence of such dental complications of HZ is not entirely dependent on the immune status of the host.

Departmental equipment maintenance system in Government Medical College.

Background: Medical equipments are necessary to effectively monitor, treat and support the care of patients by doctors in the management of their medical conditions. Proper maintenance affects the performance and safety of equipment. As equipments are part of health care provision in hospital, it is necessary to have well planned and managed equipment maintenance system in the organization. Aim: The study revealed the medical equipment maintenance system in Physiology Department of tertiary care government teaching institute. Material and methods: A retrospective observational study, during February to June 2014 of fifty two equipments costing more than 10,000 rupees was done for their maintenance system in the department. Information about equipment was collected by onsite inspection and departmental equipment records in structured proforma. Results: In the study, 45 mechanical and 7 electrical equipments costing less than 100,000 rupees were evaluated. It was found that 94.2% equipments did not have any service contract. From time of installation in the department it was found that most equipment i.e. 53.8% had crossed the life period of 15 years. Maximum i.e 85.7% electrical equipments had crossed their average life period. There was no proper maintenance of logbook and non availability of the user manual by the side of 84.6% of the equipments in department. Service history in worksheet of all 52 instruments was not recorded, post warranty maintenance in all equipments was by local personals only which was needed in 90.4% equipments. Out of equipments needing the maintenance and repair, it was corrective type in 98.2% times and reactive type in 1.8% times. There was no special training of the technicians about the maintenance of equipments. 73.1% equipments were working while 21.2% were awaiting repair. The procedure of ‘maintenance request" was noted in log book for all equipments. 3 of the equipment were having the long down time period above 5 years. Non functional equipment with long down time period was due to non availability of the spare parts in 21.2% equipment and vendor was not responding for maintenance in 5.7% equipment Conclusion: There was need of proper equipment maintenance system in department. The long down time period of equipment was due to old technology, non-availability of parts and non-responding vendors.

Awareness of healthcare workers regarding Biomedical Waste Management (BMW) at Tertiary Care Government Hospital in Dhule (Maharashtra).

Background and objectives: Biomedical waste has been a growing concern due to increased awareness in public regarding HIV/AIDS, hepatitis B and exposure to other potential infectious diseases. Good BMW disposal practices lead to reduction in medical expenditure, unsightly scenes at various disposal bins and dumping sites. Improper biomedical waste management practices and indiscriminate disposal of hospital waste causes spread of illness leading to financial burden to society. The money saved by reduction in hospital acquired infections is much more than spent on control of hospital acquired infections. Therefore it is necessary to educate the staff, patients and community about the management of the infectious waste. The present study was designed to assess the awareness regarding biomedical waste in health care workers at a tertiary care Government hospital, Dhule (Maharashtra). Methods: Shri Bhausaheb Hire Government Medical College and Hospital is a 545 bedded tertiary care teaching Government hospital situated in rural area of Maharashtra at Dhule where per day approximately 90 Kg biomedical waste is generated .The present cross-sectional study was conducted during 1st August 2011 to 30th September 2011. Knowledge and practices about BMW was assessed among 153 health care workers (81 nursing staff, 35 laboratory technicians and 37 sweepers) handling BMW in the tertiary care Government hospital at Dhule. Results: It was found that only 70.6% of the health care workers were aware of biomedical waste management and 50.3 % had undergone training. 72.5 % of the health care workers were aware of 3 color coded bags used for collection of BMW. In the study only 41.8% of the workers were vaccinated against shepatitis B and 81.7% had received tetanus toxoid vaccine. Conclusion: For proper handling and disposal of BMW, all health care providers must undergo regular training in BMW management.

Variability and accuracy of sahli’s method in estimation of haemoglobin concentration.

Background: Haemoglobin concentration provides information about the status of anaemia in the population. Haemoglobin estimation is the routine and frequently performed screening haematological test of laboratory services. The Type of methods used and sites of collection of blood samples has found to make differences in haemoglobin concentration. The methods used in routine measurement are needed to be adjusted to obtain comparability with the haemiglobincyanide method. So the present study was undertaken with a objective to test the reliability of Sahli’s method in estimation of haemoglobin concentration and standardizing it in district hospital laboratory of Dhule in Maharashtra. Material & Methodology: Haemoglobin concentration (gm/dl) in blood is compared in 173 apparently healthy medical college students within 18 to 23 years age. Results from Sahli’s method were compared to Haemiglobincyanide (HiCN) method within capillary and venous blood of same subjects. Results: Sahli’s method has lower values than Haemiglobincyanide method with mean difference of 0.62gms/dl(95%CI; 0.51 to 0.73, p<0.01) in capillary blood and 1.1gms/dl(95%CI; 0.92 to 1.26, p<0.01) in venous blood. By Sahli’s method’s ability to diagnose anaemia has sensitivity of 83.7% & 90% and specificity of 63.2% & 60.2% in capillary & venous blood respectively. Sahli’s method has significant (p<0.01) positive correlation coefficient in capillary blood & venous blood. Variability of haemoglobin concentration in Sahli’s method is less in capillary blood then venous blood in caparison to HiCN method. Interpretation & conclusion: Sahli’s method had lower values of haemoglobin in capillary and venous blood compared to HiCN method. Haemoglobin concentration was lower in capillary blood than venous blood by both methods. For Accuracy of Sahli’s method the correction factor should be considered to ensure comparability of results with the reference method.