Job Burnout Assessment Among Officer Grade Bank Employees of Meerut District

Background: India is in a transitioning state and so is it’s banking sector with wide socioeconomic differences and rapidly growing economy. In order to ensure smooth implementation of these policies, bank employees in banks are required to put in extra labor and hours of work and the fact that policies keep on changing time to time are a constant stressors in bank employees which may lead to burnout. Methods and Material: This was cross sectional study carried out among of Officer grade bank employees of urban block Meerut district situated in Uttar Pradesh. A total of 216 samples were collected through self-designed and semi structured questionnaire which included socio demographic profile and Shirom-Melamed Burnout Questionnaire (SMBQ) for assessing burnout. The simple random sampling technique was applied through computer random tables method for selection of banks and data was analyzed through SPSS19 and Microsoft excel .Results: 19.4% bank officers have pathological burnout and 55.1% of bank officers who are at brink of developing burnout. Conclusions: The Physical fatigue factor was found to be the least responsible for burnout in our study and the prevalence of burnout was found significantly more among married bank officers, living with nuclear type of family.

Effectiveness of competency-based teaching and comparison to traditional teaching of Phase I MBBS students

Background: During MBBS course, the students’ study about cardiovascular system (CVS) in physiology, pathology, pharmacology, preventive medicine, pediatrics, and medicine for the management and diagnosis of cardiovascular disorders. Blood pressure measurement is a common and a beneficial tool for the diagnosis of cardiovascular disorders (hypertension, hypotension, etc.) along with their treatment and management. Thus, knowing the proper technique of measuring blood pressure becomes an essential part of learning the course and management of cardiovascular disease. This study is designed to teach and train the first phase undergraduate students to measure blood pressure in a proper way so that they do not stumble on the first step of examination of CVS. Competency-based training is an outcome-based approach that involves identifying the skills acquired by Indian medical graduate. Competency-based teaching involves teaching of undergraduate students to support their achievement and assessment of the communication and technical skills and to develop their ability to interpret the results of blood pressure measurement for apt patient management. Aim and Objectives: This study aims to assess and compare the effect of competency-based teaching and traditional teaching in learning the skill of blood pressure measurement. Materials and Methods: Two hundred students were taken from Phase I undergraduate medical students which were randomly divided in two Groups A and B. Competency-based teaching of blood pressure measurement was done in Group A in by teaching method of demonstrate, observe, assist, and perform and Group B was taught by traditional demonstration. Pre-test questionnaire was given to both the groups before beginning of the practical session. The students learning of skill to measure blood pressure was assessed by directly observed procedural skills (DOPS) checklist after which student feedback was provided along with filling up of the post-test questionnaire. Furthermore, feedback from both student and teacher was collected. Results: Highly significant difference was found between pre-test and post-test of both Group A and Group B. Significant difference was found between Group A and Group B post-test scores. It was found that Group A in which competency-based teaching was done scored higher post-test scores then Group B. Furthermore, highly significant difference was seen among the scores of DOPS checklist between Group A and Group B. Conclusion: In the present research study, it was found that the students who underwent competency-based training of the skill of blood pressure measurement showed significantly higher scores in learning and performing the skill. Furthermore, on feedback provided by the students, 96% of the students strongly agree that the competency-based teaching and learning is better than traditional teaching.

Primary omental gangrene presenting as acute abdomen

Primary omental gangrene is a very rare but important cause of an acute abdomen. We came across a case of an acute abdomen which was taken up for emergency laparoscopic appendicectomy. On laparoscopy, torsion of the free part of the omentum, leading to distal gangrene, was found. Intraoperative diagnosis of primary omental gangrene was made. Preoperative diagnosis of this condition is difficult. Through our case report, we want to highlight about this rare cause of pain abdomen as knowledge of this pathology is important to the surgeon because it mimics the other common causes of the acute surgical abdomen.

Fungal retinitis following influenza virus type A (H1N1) infection

A 43-year-old male presented with left eye foveal retinits causing an acute visual loss following influenza virus type A infection (H1N1 infection or Swine flu). Considering viral (influenza) etiology, a prompt treatment with oral corticosteroids was started. But an initial poor response prompted an immediate diagnostic vitrectomy, which revealed Candida albicans. The retinitis healed with scar formation following anti-fungal therapy. This case highlights that even in the setting of an acute retinitis in an immunocompetent patient with recent history of viral systemic illness, a high index of suspicion of a fungal (rather than viral) infection should be kept in mind.

Optical coherence tomography angiography versus fluorescein angiography in diagnosing choroidal neovascularization in chronic central serous chorioretinopathy

Purpose: Diagnosis of choroidal neovascular membrane (CNVM) is difficult in chronic central serous chorioretinopathy (CCSC) due to overlapping features of both on conventional dye angiography. Optical coherence tomography angiography (OCTA) allows a quick and noninvasive detection of CNVM in these eyes. We compared the fluorescein angiography (FA) features of CNVM with those of OCTA to assess the role of FA in detecting CNVM in CCSC eyes. Methods: Patients with CCSC undergoing FA, spectral domain (SD)-OCT, and OCTA were identified (March 2015–June 2015). Four retina specialists individually reviewed FA images (without OCTA and SD-OCT) to determine whether CNVM was present. In parallel, two other retina specialists reviewed all images (FA/SD-OCT/OCTA) for CCSC features and confirmed whether CNVM was present using OCTA as the gold standard. The inter- and intraobserver variability was measured by Kappa (k) coefficient. The FA features of CNVM were compared and correlated with those on OCTA. Results: Of 43 eyes (26 patients, mean age 45.6 ± 8.5 years, all males), a definite CNVM (detected by OCTA) was present in nine (20.9%) eyes. FA alone detected CNVM in 13 (30.2%) eyes [sensitivity 44.4% (95% confidence interval (CI): 11.9–76.9), specificity 73.5% (95% CI: 58.7–88.3), positive and negative predictive values 30.8% and 83.3%, respectively, and accuracy 67.44% (95% CI: 53.4–81.4)]. Conclusion: When compared with OCTA, the FA was unable to characterize CNVM in CCSC (with a very low sensitivity and moderate specificity) as none of the specific dye leakage patterns on FA correlated with CNVM seen on OCTA, limiting its usefulness and accuracy in detecting CNVM in these eyes.

Increased trunk fat along with decreased peripheral fat as an important predictor of hypertriglyceridaemia & hypercholesterolaemia in Indians with HIV infection

Background & objectives: Dyslipidaemia is a major contributor to cardiovascular morbidity, which is increased in HIV. Data on dyslipidaemia in Indians with HIV are scant. This study was undertaken to determine the predictors of dyslipidaemia and lipoatrophy in Indians with HIV infection and their relation with body composition parameters. Methods: A total of 382 consecutive patients with HIV infection were screened, of whom 257 clinically stable patients, without any acute comorbidity, having at least one year follow up underwent biochemical and DEXA analysis. Results: The most common dyslipidaemia was hypertriglyceridaemia (47.08%), followed by hypercholesterolaemia [total cholesterol (TC)] (38.91%) and low high-density lipoprotein (HDL) cholesterol (38.52%), in patients having median age 37 (32-42) yr and HIV duration 57 (33-101) months. Patients with at least one dyslipidaemia (78.99%) had significantly higher insulin resistance (IR), per cent body fat, per cent trunk fat (PTF) and trunk limb fat ratio (TLFR). Baseline CD4 count and delta CD4 count (change in CD4 count 6-12 months following ART) had significant inverse correlation with triglycerides and TC. Patients with highest triglycerides and cholesterol quartiles had significantly higher immune reconstitution, metabolic syndrome, IR, trunk fat mass (FM), PTF and TLFR, with comparable total FM. Logistic regression revealed that body mass index, HIV duration and PTF were independent predictors of hypertriglyceridaemia, with only PTF being significant predictor of hypercholesterolaemia. Every unit increase in PTF was associated with 13 and 4.1 per cent increased hypertriglyceridaemia and hypercholesterolaemia. Lipoatrophy was present in 8.57 per cent patients and was a poor predictor of dyslipidaemia. Interpretation & conclusions: High occurrence of dyslipidaemia was observed in patients with HIV on anti retroviral therapy. Central adiposity (TFM) was the most important predictor of dyslipidaemia in these patients.

Spiritual dimension of health: an ignored aspect of adolescent care and parenting

Are we not disturbed that more and more adolescents are getting involved in negative lifestyles like drug use, too much of fast foods, very less physical activity leading to poor health outcomes? “22% Rohilkhand teens may become impotent” say a Times of India article dated 11th Jan,2016. The article says that hormonal imbalance, adulterated food, depression and watching too much porn in formative years are reasons behind this. “Even 9 years old are taking drugs: Report”- another glaring headline in Times of India on 20th Jan, 2015 this article highlights following – 20% of child and adolescent population have mental illnesses; substance use rate of 40% - 88% reported in various studies on street children in different metros. Among students of rural Tamil Nadu, 10% of children were found to be hypertensive (1).

A rare case of Lecythophora endogenous endophthalmitis: Diagnostic and therapeutic challenge

Fungal endogenous endophthalmitis (EE) secondary to contaminated intravenous fluid infusion is frequently seen in developing countries. Molds and yeasts are commonly implicated as the causative agents. Dematiaceous fungi such as Lecythophora have been linked to exogenous endophthalmitis but have never been reported to cause EE. We report a case of Lecythophora EE that was successfully managed with pars plana vitrectomy along with intravitreal and systemic voriconazole. Endogenous endophthalmitis (EE) is a potentially devastating intraocular infection caused by intraocular spread of pathogens through blood stream. It generally accounts for 2%�% of all reported endophthalmitis cases.[1] Predisposing risk factors include diabetes mellitus, malignancies, intravenous drug use, organ abscess, immunosuppressive therapy, indwelling catheters, urinary tract infection, organ transplant, end-stage renal or liver disease, and endocarditis.[2] It may occur in patients with no overt signs of systemic infection, particularly in the setting of contaminated intravenous fluid infusion in a rural setting.[3] Among the three broad categories of pathogens responsible for EE-bacteria, yeast, and molds, cases caused by molds are most infrequent and have the worst outcomes.[4] While Candida and Aspergillus are the most common species among fungal causes of EE, Lecythophora has been rarely reported as a cause of endophthalmitis due to exogenous causes.[5],[6],[7],[8] We, herein, report a case of EE caused by Lecythophora species.

Hepatic Arterial System- A Radioanatomical Analysis With Multidetector Computed Tomography

Background: Aim: The aim of this study was to analyze the branching pattern of hepatic arterial system with Multi Detector Computed Tomography (MDCT). Methods: 100 patients who underwent Contrast Computed Tomography of abdomen for any medical reasons were evaluated retrospectively. Results: Out of 100 patients analyzed 38% shown variations in hepatic artery branching pattern. Conclusion: Knowledge about hepatic artery variations using MDCT provides valuable guidance particularly for hepatobiliary and liver transplant surgeons and radiologist to make appropriate diagnosis and treatment.

Occurrence & predictors of osteoporosis & impact of body composition alterations on bone mineral health in asymptomatic pre-menopausal women with HIV infection

Background & objectives: Data on bone mineral density (BMD) and sarcopenia are scant from young females with HIV. This study was conducted to determine occurrence, predictors and impact of body composition alterations on osteoporosis in pre-menopausal women with HIV. Methods: A total of 214 females with serologically documented HIV infection were screened, of whom 103 pre-menopausal women, 25-45 yr age, clinically stable, having at least one year follow up data, underwent hormonal and dual-energy X-ray absorptiometry analysis for BMD and body composition. Seventy five matched controls were also evaluated. Results: Females with HIV had significantly lower BMD and Z-score at lumbar spine (LS), total femur, neck of femur (NOF), and radius ultra-distal (UD) compared to controls. Osteoporosis at least at one site was observed in 34.95 per cent patients, compared to eight per cent in controls (P<0.001). Most common site of osteoporosis in females with HIV was radius UD (24.27%), followed by radius 33 per cent (17.48%), radius total (15.53%) and greater trochanter, NOF and LS (6.80% each). HIV patients had significantly lower bone mineral content, lean mass (LM), fat per cent, android (A) fat, gynoid (G) fat, and A/G ratio. LM and fat mass (FM) were ?15.65 and ?11.54 per cent lower in HIV patients, respectively. Osteoporosis patients had significantly higher use of antiretroviral therapy and lower LM, FM and fat per cent. On logistic regression, LM followed by A/G ratio and BMI were the best predictors of osteoporosis. Sarcopenia was observed in 17.5 per cent patients. Interpretation & conclusions: Our results showed that osteoporosis and sarcopenia were significant problems in young women with HIV. HIV was associated with greater LM loss, which was critical for bone health. Sarcopenia may predict low BMD in HIV.

Bilateral central retinal artery occlusion as presenting manifestation of human immunodeficiency virus infection

A 30-year-old male with bilateral acute visual loss presented with retinal edema in the posterior pole and peripapillary region with extensive retinal hemorrhages. Fluorescein angiography revealed delayed arterial filling in the right eye and absent arterial filling in the left eye, suggesting bilateral central retinal artery occlusion. Systemic evaluation revealed a history of chronic low-grade fever and generalized lymphadenopathy. HIV (ELISA) was positive, and other systemic comorbidities were ruled out. Cervical lymph node biopsy stained positive for acid-fast bacilli, with large areas of necrosis, palisaded by epithelioid cell granulomas, macrophages, and multinucleated giant cells, suggesting lymph node tuberculosis. Despite antiretroviral and antitubercular therapy, he developed optic atrophy at 4 weeks.

Retinal pigment epithelium aperture: A late-onset complication in adult-onset foveomacular vitelliform dystrophy

Purpose: The purpose of the study was to report aperture of retinal pigment epithelium (RPE) as a late complication and an unreported finding during the natural course of adult-onset foveomacular vitelliform dystrophy (AFVD). Methods: Four diagnosed cases of AFVD followed for a period ranging from 4 to 8 years. All patients had documented records of clinical examination, fundus autofluorescence and fluorescein angiography, and spectral domain-optical coherence tomography at regular intervals. Results: Besides the known stages in the natural course of AFVD, RPE aperture was noted as an additional finding during the vitelliruptive stage of the disease. The vitelliform material was noted beneath the disrupted RPE before disappearance. Accumulation of vitelliform material continued even after the vitelliruptive stage. Conclusion: RPE aperture may represent an ongoing process in the natural course of AFVD.