Knowledge, attitude, and practice of health-care ethics among doctors in Tamil Nadu – A cross-sectional study

Background: Proficiency in medical ethics is central to valuable patient care. The current medical education gives limited help in dealing with the ethical dilemmas. Objective: The objective of the study was to assess the knowledge, attitude, and practice of health-care ethics among doctors in Tamil Nadu. Materials and Methods: A questionnaire-based cross-sectional study covering all doctors on payroll (171) as on August 1, 2018, was carried out in August 2018 at Government Tiruvannamalai Medical College. A total of 165 doctors were contacted and 148 questionnaires were collected back. The pre-tested questionnaire comprised 44 questions. Approval from the Institutional Ethics Committee was obtained. SPSS version 22 was used to analyze data. Association between sociodemographic variables and attitude, practice of the doctors toward the health-care ethics was compared using Chi-square test. Results: About 87.8% of respondents were aware of the definition of health-care ethics. About 78.4% of respondents knew the duties of ethical committee. Books and journals were the source of knowledge for 66.2% of respondents. About 52% of the respondents preferred to consult their guide/head of department when they faced an ethical/legal issue. Nearly 60% were aware of existence of ethical committee. About 62.2% of the respondents had positive attitude toward health-care ethics. About 69% of the respondents had good practice of health-care ethics. Age group, sex, specialty, and duration of work experience had no significant association with attitude toward health-care ethics. Age group had significant correlation with practice while sex, specialty, and duration of work experience did not. Conclusion: Nine-tenth of respondents were aware of the definition of health-care ethics. Three-fourth was aware of duties of ethical committee. Nearly two-third of the respondents had positive attitude toward health-care ethics. More than two-third of the respondents had good practice of health-care ethics.

A study of clinical manifestations of right ventricular myocardial infarction

Introduction: Myocardial Infarction is the term used when the myocardium is necrosed due to ischemia. It may be trans mural or subendocardial. Inferior wall infarction has got some special features like the association with Right ventricular infarction and Brady arrhythmias especially sinus bradycardia and heart blocks. Clinically Right Ventricular Myocardial Infarction can be suspected when a patient with Inferior Wall Myocardial Infarction presents with elevated JVP, positive Kussmaul's sign, hypotension, right-sided third or fourth heart sounds, tender hepatomegaly, and oliguria rarely TR and clear chest. Aim of the study: To study the various clinical manifestation of Right Ventricular Myocardial Infarction. To study the Clinical profile, Risk factors, ECG features, Complications and Outcome of Right Ventricular Myocardial Infarction. Materials and methods: This study was mainly conducted to find out the clinical manifestations of right ventricular myocardial infarction and its risk factors, ECG features, complications and outcome of RVMI. All patients admitted to Intensive Coronary Care Unit with ST elevation in V4R were taken for study. Presence of an aneurysm, mitral regurgitation, left ventricular clot or pericardial effusion was noted. Ejection fraction was determined by-Mode and2-D using Simpson’s rule. Results: During the study period 474 cases of acute myocardial infarction were admitted and. Out of 474 cases, 242 were acute inferior wall myocardial infarction. 106 cases showed evidence of right ventricular myocardial infarction in ECG. All the 106 cases were associated with inferior wall myocardial infarction. Angina was present in 73% of patient. Angina was equivalent to 27%. All patients with chest pain were associated with sweating. Nausea, vomiting, and Indigestion were the V. Magesh, Karthikeyan K. A study of clinical manifestations of right ventricular myocardial infarction. IAIM, 2018; 5(1): 121-128. Page 122 common presenting angina equivalents in young. Dyspnea was the predominant symptom in elderly people. Most of the patients with angina equivalents were Diabetes. Conclusion: All cases of Inferior Wall Myocardial Infarction should have Right sided chest leads recorded during ECG examination as more the ST elevation more the severity of Right Ventricular Myocardial Infarction and its complications and mortality rate. If the diagnosis of Right Ventricular Myocardial Infarction is correctly made earlier and thrombolysed the prognosis is usually good even in patients with complications.

Pyopericardium due to group D streptococcus.

Beta-hemolytic Enterococcus faecalis was isolated from the pericardial fluid obtained from a patient with pyopericardium. The patient was immunocompetent and had mild pleural effusion. He was treated with parenteral co-amoxiclav and amikacin, had underwent pericardiectomy with repeated pericardial aspiration, and recovered completely. To our knowledge, this is the first report of pyopericardium due to E. faecalis .

Diversity of root associated microorganisms of selected medicinal plants and influence of rhizomicroorganisms on the antimicrobial property of Coriandrum sativum.

The total heterotrophic bacteria, actinomycetes and fungus were enumerated from the rhizosphere and non-rhizosphere soil of 50 selected locally available medicinal plants in and around Bharathiar University. In all the plants, population of microorganism were higher in the rhizosphere soil than in the non rhizosphere soil. Among the microorganisms, bacterial population was higher in number followed by fungus and actinomycetes. Of the medicinal plants, the maximum rhizosphere effect was observed in Annona squamosa and the minimum effect was seen in Eclipta alba and Cassia auriculata. Among the bacteria the dominant species was Bacillus followed by Pseudomonas, Enterobacter, Corynebacterium, Micrococcus and Serratia. The Streptomyces species was found to be dominant followed by Deuteromycetes and Frankia among the actinomycetes. Among the fungal isolates Rhizopus was found to be higher in number followed by Aspergillus, Penicillium, Mucor and Fusarium. About 70.96% of the bacterial isolates were found to be nitrate reducers and 90.60% of the bacteria solubilised phosphate. The rhizosphere bacterial isolates were also capable of hydrolyzing starch, cellulose, casein, urea and gelatin. The isolates of bacteria, actinomycetes and fungus were also able to produce phytohormone Indole-3-acetic acid (IAA). The maximum IAA production was recorded by Fusarium sp (5.8 mg/l). The rhizosphere bacterial isolates showed resistance to 14 commercially used antibiotics. In an attempt to check the influence of these plant growth promoting microorganisms on the antimicrobial property of Coriandrum sativum against Escherichia coli MTCC-443 and Aeromonas hydrophila MTCC-646, the results observed was not encouraging since the inoculants did not influence the antibacterial property. However extensive and in depth study is required to find out the influence of rhizomicroorganisms on the antibacterial property of medicinal plants. The other results clearly indicated that the rhizosphere microorganisms could be exploited for its innumerable properties and active metabolites.

Detection of genetic polymorphism in the populations of brinjal shoot and fruit borer, Leucinodes orbonalis (Guenee).

In the present study six different populations of L. orbonalis were collected and subjected to analysis of genetic variability in terms of carboxylesterase isozyme pattern and DNA polymorphism using RAPD-PCR. Pattern of carboxylesterase revealed a similar isozyme cluster in the populations namely, sivaganga (population-3), dindigal (population-4), virudhunagar (population-5) and coimbatore (population-6). Similarly, the populations of L. orbonalis recorded 3 distinct randomly amplified polymorphic DNA markers in all populations grouped above. This pattern of genetic variability in the populations was also supported by the analysis of the similarity indices and UPGMA dendrogram.

Modular teaching programme on leprosy.

Though repeated attention has been drawn to a lack of proper teaching-learning modules in leprosy endemic countries, no satisfactory module exists. Keeping in view this fact, we attempted to draft a suitable module on leprosy that could be used to teach leprosy to undergraduate medical students in a simple and comprehensive manner. We used two different modules, Module A and Module B, to teach two different batches of students of the pre-final year (VI and VII semesters) of the MBBS course. Both these modules were conducted by the Department of Dermatology and STD, with participation by the Departments of Microbiology, Pathology and Preventive and Social Medicine. The drafts of the modules were discussed before hand in the Department, keeping in mind the number of days allotted to us. Both the modules were different in certain aspects, but the basic concept was the same. Because Module A had more time, certain practical aspects were also discussed. It was interesting to note that the percentage of increase in the post-test score was 17 for Module A and 15 for Module B, thus proving that both the modules were effective in conveying the core message about leprosy.

Squamous cell carcinoma in plantar ulcers in leprosy: a study of 11 cases.

The objectives of our study were to describe and analyse the malignancies that occurred in plantar ulcers of leprosy patients. The possible predisposing conditions, duration and extent of the spread of the tumour were also studied. All patients with trophic ulcer of the foot attending the urban leprosy clinic in our hospital from January 1998 to January 2003 were screened for change to malignancy. During the study period, 79 cases of plantar ulcers in leprosy were seen. The mean age of these cases was 39.9 years with male-to-female ratio of 4:1. Eleven cases with plantar ulcers and malignant change were diagnosed in our hospital during the study period. The male-to-female ratio was 4.5:1. The mean age of these patients was 60.6 years. Their age ranged from 46 to 75 years. Nine of the cases were treated cases of borderline tuberculoid leprosy, while two had treated lepromatous leprosy. In our study, two distinct morphological types of malignant changes were seen. Histopathologically, all cases, except one, were of well-differentiated squamous cell carcinoma variation; one case had verrucous carcinoma. Though trophic ulcers are common in leprosy cases, only long-standing and neglected ones undergo malignancy.

Localized lepromatous leprosy presenting as a painful nodule in a muscle.

Lepromatous leprosy is a generalized disease usually presenting with numerous macules, papules, nodules or plaques involving wide areas of the skin. It is generally believed that in India lepromatous leprosy often originates from the borderline spectrum (Jha et al, 1991). Localized lepromatous or borderline lepromatous disease is a rare variant of multibacillary leprosy (Yoder et al, 1985; Jha et al, 1991; Pfaltzgraff & Ramu, 1994; Vijaikumar et al, 2001). This variant usually presents as a single nodule or a localized area of nodules and papules, while most of the body surface appears normal (Pfaltzgraff & Ramu, 1994; Vijaikumar et al, 2001). Its occurrence in our case as a single painful nodule in the bicep muscle of left forearm was indeed intriguing, such presentation being rarely reported in the literature.