Impact Of Communication Skills Training in Postgraduate Medical Education

Background: Effective communication is a key feature of optimal doctor-patient relationship. As the postgraduate curriculum lacks standardized teaching and assessment, this study aimed to assess effec-tiveness of training program on communication skills of postgraduate medical students. Materials and methods: A prospective, interventional study was conducted among first year postgrad-uate medical students from different clinical specialty. Training program included introduction to prin-ciples of communication with basics of doctor-patient relationship, administering informed consent, breaking bad news and counselling patients with HIV/cancer. Pre and post-test skill assessment by Fac-ulty and postgraduate (PG) self-rating was carried out using KEECC-A Assessment tool for seven core communication competencies. Perception of students on training program was collected via feedback questionnaire. Results: Forty-three postgraduate medical students participated. Statistically significant increase in communication skills scores was observed post training with mean post-test assessment scores of 24.26�94, p<0.001(rating by faculty), 25.19�76, p<0.001(PG self-rating) and high degree of internal consistency was found. Students perceived the training program as valuable and highlighted its im-portance as a part of curriculum. Conclusion: Training program significantly enhanced communication skills of postgraduate medical students. Integration of standardized teaching and assessment of communication skills is essential for better healthcare practice and optimal doctor-patient relationship.

Characterization, In Vitro Antioxidant And Hepatoprotective Activity Of Fungal Endophytic Extracts Of Andrographis Paniculata Leaves In Ccl4 Induced Hepatotoxicity

Objective: To isolate and characterize the endophytic fungi from the leaves of Andrographis paniculata for free radical scavenging antioxidant and hepatoprotective activity against CCl4 induced hepatotoxicity Methods: Two fungal endophytes, APLF-3 (Andrographis paniculata leaf fungi-3) and APLF-4 (Andrographis paniculata leaf fungi-4) were isolated from leaves of Andrographis paniculata to get chloroform (A3C, A4C), ethyl acetate (A3EA, A4EA) and n butanol (A3nB, A4nB) extracts. rDNA sequencing by PCR technique was carried out for identification of APLF-3 and APLF-4. All the APLF-3 and APLF-4 extracts were assayed for in vitro free radical scavenging activity against 2, 2-diphenyl-1-picrylhydrazyl (DPPH), hydroxyl radical and reducing power. Then, A4EA and A4nB were screened for hepatoprotective activity against CCl4 induced hepatotoxicity at 50 mg/kg and100 mg/kg doses. Results: The endophytic fungi, APLF-3 and APLF-4, were identified as Phyllosticta sp. ZLY-2010 isolate M13 and Aspergillus tubingensis strain Cs/7/2 respectively based on their morphological and molecular characterization. A4EA and A4nB showed significant in vitro free radical scavenging activity as compared to other extracts. A4EA and A4nB (50 mg/kg and100 mg/kg) reversed the increased serum biochemical parameters as compared to CCl4 treated group (p<0.001). A4EA and A4nB (100 mg/kg p. o) also restored the LPO, SOD and CAT levels. Conclusion: These findings suggested that the extracts (A4EA and A4nB) obtained from endophytic fungi APLF-4 contributed towards hepatoprotective activity.

Quantification of Neurons of Human Nucleus Accumbens by Fractal Analysis

Background: Analysis of volumetric and morphological neuronal data has been of keen interest to neurologists and neuroscientists because of its implications in pathological conditions such as schizophrenia, autism, obsessive compulsive disorder etc. One such part of human brain which has been explored in recent years is nucleus accumbens, a part of ventral striatum leaning against septal nuclei. An easier, freely accessible and cost effective technique to measure neurons of nucleus accumbens is the use of Image J -Fiji software. One of the applications of software is Fractal box analysis. This technique helps in analysis of the Euclidean geometry of neurons (Parameters such as length and breadth which are not good characteristics of multipolar neurons). Aim and Objectives: The present study was undertaken to study and analyze images of morphology of neurons of nucleus accumbens using Image J as an automated image analysis technique. Methods & Results: A qualitative cross sectional study was done using fifty five serial sections of nucleus accumbens. The 4 μ tissue sections were stained with hematoxylin and eosin. Freely downloadable Image J software was installed, images of serial sections were imported to Image J, processed and fractal box analysis was done. Fractal Box analysis of image of neurons of nucleus accumbens revealed statistically significant value (D= 1.99). Conclusion: Results of the present study can be extrapolated to correlate with pathological conditions associated with emotional and behavioral disorders involving nucleus accumbens Image J is cost effective software which is beneficial to identify and measure neurons of Nucleus accumbens

Isolation And Antimicrobial Susceptibility Pattern Of Staphylococcus Aureus.

Introduction- Staphylococcus aureus is one of the principal human pathogens that colonizes healthy individuals as well as causes severe infections in hospitalized patients. They have differential ability to spread and cause outbreaks in hospitals. The study was done to isolate S.aureus from various clinical samples and to know their antibiogram. Methodology- The study included a total of 312 Staphylococcus aureus strains isolated from various clinical specimens. The specimens received were processed further for identification by standard microbiological procedures like direct microscopic examination, culture and various standard identification methods. Antimicrobial susceptibility testing was done by Kirby-Bauer disc diffusion method on Mueller-Hinton agar as per CLSI guidelines. Result- A total of 312 isolates of S. aureus were obtained from various clinical samples. Male to female ratio was 1.6:1. Infection rate was more in age group 46-60 years. Staphylococcus aureus isolates were more commonly obtained from surgery department (38.78%) followed by orthopedics. All the strains were 100% sensitive to Vancomycin, Netilmicin, Linezolid and Teicoplanin. Higher resistance was noted against Penicillin(94.87%), Trimethoprim/Sulfamethoxazole(72.44%).Lower resistance was noted against Nitrofurantoin(13.33%). Conclusion- The determination of the anti-microbial susceptibility is also crucial for an optimal therapy, for epidemiological purposes and for infection control measures.

Phytochemical screening and evaluation of analgesic and antiinflammatory activities of Phaseolus vulgaris linn., seeds in rodents.

With an objective of developing some novel analgesic and antiinflammatory natural agents with fast acting and low toxicity profile here in, the different extracts of Phaseolus vulgaris (Linn) seeds were evaluated for analgesic and antiinflammatory activities using glacial acetic acid induced writhing and carrageenan induced rat paw oedema method respectively. For screening of the extracts for analgesic and antiinflammatory activities aspirin and diclofenac were used as standard drugs respectively. Petroleum ether extract exhibited significant analgesic and antiinflammatory activities. The petroleum ether extract can be considered as a potential candidate for analgesic and antiinflammatory activities. The presence of steroids and flavonoids in petroleum ether extract of Phaseolus vulgaris Linn., seeds could be attributed for the analgesic and antiinflammatory activities.

Phytochemical screening and evaluation of analgesic, anti-antiinflammatory activities of Peganum harmala Linn., seeds in rodents.

The objective of this research work is to carryout the phytochemical screening and evaluate the analgesic, antiinflammatory activities of Peganum harmala Linn., seeds. In this study different extracts of Peganum harmala (Linn) seeds were evaluated for analgesic and anti-inflammatory activities using glacial acetic acid induced writhing and carrageenan induced rat paw edema models respectively. For analgesic and anti-inflammatory activities aspirin and diclofenac were used as standard drugs respectively. The ethyl acetate extract showed significant analgesic and anti-inflammatory activities, thus it can be considered as a potential candidate for analgesic and antiinflammatory activities. The presence of alkaloids, steroids, flavonoids in ethyl acetate extract of Peganum harmala (Linn) seeds could be attributed for the claimed analgesic and anti-inflammatory activities.

Study of effect of Oligohydramnios on maternal and fetal outcome.

Background: Amniotic fluid acts like a cushion and helps in growth of fetus, decrease in amniotic fluid volume may lead to increased risk of intrauterine growth retardation (IUGR), meconium aspiration syndrome, severe birth asphyxia, low APGAR scores and congenital abnormities. Objective: This study was done to see effects of Oligohydramnios on fetal outcome in the form of neonatal morbidity and mortality and maternal morbidity. Material and Methods: Present study was done in 100 patients who have completed 28 weeks of pregnancy and above with oligohydramnios, selected randomly after satisfying inclusion and exclusion criteria. Detailed examination done and oligohydramnios was confirmed by measuring AFI on ultrasonography. Associated complications, type of delivery conducted, and fetal outcome for perinatal morbidity & mortality studied. Results: Common causes for Oligohydramnios were idiopathic (56%) and PIH (24%). Most common reason to perform caesarean was fetal distress. Oligohydramnios was related to higher rate of growth retardation and neonatal intensive care unit admission. Conclusion: Oligohydramnios is frequent occurring condition. This condition requires antepartum and intrapartum care. Due to oligohydramnios intrapartum complications, perinatal morbidity and mortality are increasing. Decision between vaginal delivery and caesarean section should be well balanced. Unnecessary maternal morbidity can be prevented. Timely intervention can reduce perinatal morbidity and mortality.

Case Study: Magnetic Resonance Imaging of Squamous Cell Carcinoma of Perianal Region, Vulva and Cervix.

Squamous cell carcinoma is the second most common skin carcinoma, which most commonly affects sun-exposed areas. However squamous cell carcinoma can rarely involve the anal and perianal region. It has been found in association with human papilloma virus infection, uterine cervix dysplastic changes and high-grade anal intraepithelial neoplasia (AIN). We report a case of extensive carcinoma of the perianal region, vulva and cervix. A 49 years old female came with complaint of swelling in the right inguinal region since one year, pain and swelling in the gluteal region since 7-8 months. Contrast enhanced CT scan and MRI were done which showed a mass involving the perianal region, vulva and cervix with a large inguinal lymph node. Biopsy revealed squamous cell carcinoma.

Clinical Profile of Multiorgan Involvement in Malaria.

Background and aims: In view of high incidence, increasing morbidity and mortality due to malaria in an endemic area like Bikaner, it was planned to study the clinical profile of multiorgan involvement in Plasmodium vivax, Plasmodium falciparum and mixed type of malaria. Material and methods: Prospective data were collected from 201 adult patients with multiorgan involvement, admitted in classified malaria ward and confirmed by asexual parasitemia in peripheral blood film. Results: Prevalence of renal failure was 57.7%, cerebral malaria 47.8%, jaundice 41.8%, severe anemia (hemoglobin [Hb] ≤5 g/dl) in 31.8%, severe thrombocytopenia, shock, septicemia in 19.9%, 12.4%, 8.96%, respectively. Out of this P. vivax was associated with renal failure in 10.4%, with cerebral malaria in 7.46%, with jaundice in 9.5% and with severe anemia in 3.5%. Multiorgan dysfunction was a major cause of death in 25.87% patients (18.4%, P. falciparum 6%, P. vivax 1.5%, mixed). Acute respiratory distress syndrome (ARDS) was found in 14 (7%) of patients out of which 13 expired. Conclusion: P. vivax which was previously considered to be benign, has now turned to be malignant. ARDS came out with the worst outcome. Early institution of dialysis and use of antimalarial drugs aggressively can result in better prognosis.

Reversal of CRF- and stress-induced anorexia by an ayurvedic formulation

Trikatu churna is one of the commonly used Ayurvedic formulations in the traditional system of medicine in India for the treatment of agnimandya, i.e. anorexia. Trikatu contains equal amounts of finely powdered rhizomes of Zingiber officinale Roscoe (Zingiberaceae) and fruits of Piper longum L. and Piper nigrum L. (Piperaceae). The chief objective of the study was to determine the antianorectic effects of three drugs individually and to compare these effects with the effect of Trikatu. The activity of the drugs was studied after anorexia was induced in rats by (1) physical stress arising from immobilization for 60 min; (2) intraperitoneal injection of Escherichia coli lipopolysaccharide (LPS, 100 μg/kg body weight); and (3) intraperitoneal administration of fluoxetine (8 mg/kg body weight). Similar doses of the extracts were tested on freely feeding rats and on rats that had been deprived of food for 20 h. Corticotrophin-releasing factor (CRF, 0.3 μg/rat) can induce anxiogenic-like behavior and reduced food intake. This model was also studied, and the results were compared. The components of Trikatu churna failed to individually reverse the inhibition of feeding. In contrast, Trikatu churna pretreatment reversed stress-, fluoxetine- and CRF-induced anorexia. The study provides strong evidence of the synergistic action of Ayurvedic formulas and also proves the ability of Trikatu churna to reduce stress and CRF-induced anorexia.

A study on pulmonary manifestations in patients with malaria from north-western India (Bikaner).

Background & objectives: Plasmodium falciparum (Pf) and Plasmodium vivax (Pv) are responsible for most of the global burden of malaria. With changing spectrum of clinical presentation in malaria, pulmonary system involvement has always been under diagnosed. The present study was planned to estimate the pulmonary system involvement in patients with malaria from north-western India (Bikaner). Study design & description of the patients: Our study was conducted during 2007 to 2009 in 200 cases of severe malaria [Pf , Pv, and mixed (Pf + Pv)] with pulmonary involvement. It included adult patients of both sexes (145 males and 55 females) belonging to all age groups. The diagnosis of Pf and Pv was confirmed by demonstrating asexual form of parasites in peripheral blood smear and OptiMal test. Main outcome measures: Pulmonary involvement was observed in 30% (60/200) patients among which cough in 24% , dyspnea in 12%, acute respiratory distress syndrome (ARDS) in 7% , bronchitis in 3% and pneumonia in 1.5% were the major clinical manifestations of malaria. Metabolic acidosis and low oxygen saturation was observed in 7% patients. Chest X-ray abnormality in 11.5% patients, 7% had bilateral infiltrates, 1.5% had inflammatory patch and 3% had findings suggestive of bronchitis. Spirometry findings showed 17% patients had early small airway obstruction. All the patients with ARDS had poor disease outcome. Results & conclusion: Our results suggest that pulmonary system involvement was observed in patients infected with Pf and Pv. If these clinical presentations are ignored, it may lead to delay in diagnosis and can alter the outcome and prognosis of the disease. Therefore, early diagnosis of malaria induced ARDS can significantly affect the outcome.

Biphasic demyelination of the nervous system following anti-rabies vaccination.

Acute disseminated encephalomyelitis (ADEM) is an acute or subacute condition characterized by widespread multifocal neurological deficits of variable severity. We report a case of a 45-year-old man with ADEM following anti-rabies vaccine (ARV).

Comparative evaluation of efficacy of sodium fluoride, chlorhexidine and triclosan mouth rinses in reducing the mutans streptococci count in saliva : an in vivo study.

The primary objective of this study was to compare the efficacy of sodium fluoride (0.05%), chlorhexidine (0.12%) and triclosan (0.3%) mouth rinses in reducing the mutans streptococci count in saliva. 60 subjects in the age group of 12 to 14 years were selected from the schools of Mumbai and were equally divided into 4 groups. First 3 groups were test groups and the 4th group was control group. The subjects were instructed to rinse one full marked measure of mouth rinse for 1 minute, twice daily. Salivary samples were collected at baseline and after 2 weeks and cultured on M.S.B.agar. The number of mutans streptococci colonies were counted on agar medium. The results of the study confirmed that chlorhexidine mouth rinses are more efficient in reducing mutans streptococci count in saliva as compared to other mouth rinses.

Lipid peroxidation and antioxidant enzymes in male infertility.

BACKGROUND AND AIM: Mammalian spermatozoa are rich in polyunsaturated fatty acids and are very susceptible to attack by reactive oxygen species (ROS) and membrane lipid peroxide ion. Normally a balance is maintained between the amount of ROS produced and that scavenged. Cellular damage arises when this equilibrium is disturbed. A shift in the levels of ROS towards pro-oxidants in semen and vaginal secretions can induce an oxidative stress on spermatozoa. The aim was to study lipid peroxidation and antioxidant enzymes such as catalase, glutathione peroxidase and superoxide dismutase (SOD) and to correlate the same, with the 'water test', in male infertility. SETTINGS: Experimental study. SUBJECTS AND METHODS: Ejaculates from a total of 83 infertile and fertile healthy individuals were obtained. Lipid peroxidation and antioxidant enzyme levels were studied and correlated with water test. RESULTS: The results indicate that (i) the antioxidant enzyme catalase showed no significant changes in the various pathological samples, (ii) antioxidant enzymes SOD and glutathione peroxidase correlate positively with asthenozoospermic samples and (iii) the degree of lipid peroxidation also correlates positively with the poorly swollen sperm tails. The increase in SOD and glutathione peroxidase values, in the pathological cases represents an attempt made to overcome the reactive oxygen species. CONCLUSION: Water test could be used as a preliminary marker test for sperm tail damage by reactive oxygen species, since it correlates very well with lipid peroxidation and antioxidant enzymes.

Quantitative study of muscle spindles in suboccipital muscles of human foetuses.

The proprioceptive inputs from the cervical musculature play an important role in head-eye co-ordination and postural processes. Deep cervical muscles in humans are shown to have high spindle content. The density, distribution and morphology of muscle spindles were studied in superior oblique capitis, inferior oblique capitis and rectus capitis posterior major and minor three small suboccipital muscles. The muscles were obtained, post-mortem from stillborn human foetus. The spindle density was calculated as the ratio of mean spindle content to the mean wet weight of that muscle in grams. The distribution and arrangement of spindles within the muscle and their arrangement was studied. The spindle density of superior oblique muscle was found to be 190, that of inferior oblique was 242 and the rectus capitis posterior contained 98 spindles per gram of muscle. No tendon organs were seen. The serial transverse sections of inferior oblique muscle revealed muscle spindles of varying sizes, length varying between 100-650 microns and, diameter 50-250 microns. A complex parallel arrangements of group of large spindles were seen in the belly of the inferior oblique muscle, while the polar regions contain few small isolated spindles. The relevance of such high spindle receptor content in these tiny muscles is discussed.

Hypertension in the elderly.

OBJECTIVES: To study the clinical profile of hypertension in the elderly, development of end organ complications and the effect of hypertension with other risk factors in producing these complications. METHODS: One hundred and thirty six elderly patients attending the Hypertension Clinic were included in the study. A detailed history was taken that included presenting illness, family history of hypertension, diabetes, coronary artery disease, dyslipidaemia and history of addictions. Physical examination included systemic examination with measurement of waist to hip ratio and fundoscopy for retinopathy. Renal and liver function tests (RFT, LFT), blood sugar, lipid profile, X-ray chest, electrocardiography (ECG), 2-D echocardiography, abdominal ultrasound and computed tomography (CT) scan head (if indicated) were other important investigations done. RESULTS: Seventy-nine patients were in the age group of 60-65 years, of which 42 (30.9%) were males. Headache was the commonest chief complaint in 77.9% patients; whereas 24 patients were asymptomatic. Obesity, diabetes, alcohol, dyslipidaemia and family history were important determinants of hypertension. Lipid profile was abnormal in 55.9% patients. Isolated systolic hypertension (ISH) was found in 56.6% patients. Grade II hypertensive retinopathy was observed in 29.4% patients with uncontrolled blood pressure. Left ventricular hypertrophy (LVH) was the commonest ECG manifestation seen in 36.8% patients of which 26.5% had uncontrolled blood pressure. LVH could be diagnosed in 46.4% patients by 2-D echo. Patients with uncontrolled blood pressure and ISH had increased incidence of cardiovascular and cerebrovascular complications. Cardiovascular complications were seen in 19.1% patients having dyslipidaemia and hypertension. Cerebrovascular complications were seen in 15.4% patients having hypertension with LVH. Treatment included calcium channel blockers and/or other drugs. CONCLUSIONS: The elderly hypertensive patients tend to have ISH. Family history of hypertension is an important determinant of hypertension. Uncontrolled hypertension, ISH, LVH and other associated risk factors are responsible for cardiovascular and cerebrovascular morbidity.

Ruptured true aneurysm of the splenic artery: an unusual cause of haemoperitoneum.

True aneurysm of the splenic artery is rare. Two cases of ruptured true splenic artery aneurysms are presented. The first patient was a 62-year-old female who presented within 6 hours of the onset of symptoms. The other was a 27-year-old non-alcoholic male patient who was admitted in a state of shock after 2 days of observation in a peripheral hospital. Both patients had haemoperitoneum and were subjected to exploratory laparotomy. Aneurysmectomy was performed in both the patients in addition to left splenopancreatectomy in the first case and splenectomy in the second. However, due to the prolonged preoperative shock, the second patient succumbed on the third postoperative day.