Assessment of Educational Environment of Newly Established Medical College by UG Medical Students: A Mixed Method Study

Introduction: Educational environment always play a crucial role in the development of students as well as faculty of any institution. In India, there is a continuous increase in the number of medical colleges and the number of MBBS seats, but the quality of education with quantity is questionable. To answer this question, the present study was planned to know the educational environment in a new Medical Institution that ejected its alumni in 2018. Aim: To analyze the educational environment of a newly established Medical College in eastern Uttar Pradesh. Materials and Methods: The present study was a descriptive cross-sectional which took six months to complete. This study used the Dundee Ready Education Environment Measure (DREEM) questionnaire, open-ended questions and focus group discussions (FGDs). The study was conducted on MBBS students in Government Medical College, Azamgarh, UP. Results: The batch-wise Global DREEM scores were 169.08 (alumni), 156.23 (interns), 168.76 (2015), 164.16 (2016), 176.23 (2017), 176.94 (2018). This demonstrates that the educational environment is satisfactory in all domains and comes under the 3rd category of the educational environment index. The FGDs showed a positive response in all batches but with high variability in scores, which indicates lack of standardization in Medical Education. The open-ended questions’ responses revealed many merits and demerits about five domains. Conclusion: The variability of DREEM score, FGDs and open ended questions denotes the lack of standardization in the Medical Education system and the scores of the Education Environment Index (all domains) must move from category III (satisfactory) to category IV (excellence).

The Power and Promise of Angiotensin Receptor Neprilysin Inhibitor (ARNI) in Heart Failure Management: National Consensus Statement

Heart failure (HF) is a huge global public health task due to morbidity, mortality, disturbed quality of life, and major economic burden. It is an area of active research and newer treatment strategies are evolving. Recently angiotensin receptor-neprilysin inhibitor (ARNI), a class of drugs (the first agent in this class, Sacubitril–Valsartan), reduces cardiovascular mortality and morbidity in chronic HF patients with reduced left ventricular ejection fraction (LVEF). Positive therapeutic effects have led to a decrease in cardiovascular mortality and HF hospitalizations (HFH), with a favorable safety profile, and have been documented in several clinical studies with an unquestionable survival benefit with ARNI, Sacubitril–Valsartan. This consensus statement of the Indian group of experts in cardiology, nephrology, and diabetes provides a comprehensive review of the power and promise of ARNI in HF management and an evidence-based appraisal of the use of ARNI as an essential treatment strategy for HF patients in clinical practice. Consensus in this review favors an early utility of Sacubitril–Valsartan in patients with HF with reduced EF (HFrEF), regardless of the previous therapy being given. A lower rate of hospitalizations for HF with Sacubitril–Valsartan in HF patients with preserved EF who are phenotypically heterogeneous suggests possible benefits of ARNI in patients having 40–50% of LVEF, frequent subtle systolic dysfunction, and higher hospitalization risk.

Pattern of hemoglobinopathies in females attending in antenatal clinic with special reference to the role of RBC parameters in beta-thalassemia carrier detection

Background: Hemoglobinopathies are the major cause of anemia throughout the world complicating pregnancy outcome. Hence, detection of hemoglobinopathies in antenatal period is of critical importance as it not only predict the possibility of birth of a child with thalassemia but also reduces the complications associated with anemia in pregnancy. Hence, identification of a reliable cost-effective screening method for detection of hemoglobinopathies is of utmost importance. Aims and Objectives: The present study was conducted to evaluate the role of red blood cell (RBC) parameters including hemoglobin (Hb%), RBC count, mean corpuscular volume (MCV), and mean corpuscular hemoglobin (MCH) in detection of thalassemia carriers among healthy antenatal mothers in a tertiary care hospital of Eastern India. Materials and Methods: Venous blood samples were collected from total 1458 antenatal mothers aged 18 years or above with <17 weeks of gestation and were analyzed for complete blood count, serum ferritin level, and high-performance liquid chromatography for identification of abnormal Hb. Patients with iron deficiency anemia as diagnosed by serum ferritin <15 ng/ml were excluded from this study. Results: The prevalence of hemoglobinopathy was found to be 12.55% with ß-thalassemia trait (BTT) being the most common type (7.9%). All the RBC parameters were significantly lower among the BTT group compared to individuals with normal or other hemoglobinopathies (P < 0.05). Conclusion: RBC parameters such as Hb, RBC, MCV, and MCH can be used as cost-effective yet very effective screening method to identify different hemoglobinopathies among antenatal mothers.

Is objective structured practical examination a cutting-edge assessment tool over traditional practical examination to prepare future “Indian Medical Graduate?” A study from Department of Pathology at a Government Medical College in West Bengal

Background: With the continuous evolution of medical education, an appropriate assessment method is the need of the hour. Most unavoidable drawback of traditional practical examination (TPE) is its subjectivity, which can be overcome by newer methods such as objective Structured Practical Examination (OSPE). Hence, many studies have been conducted to reevaluate the efficiency of TPE and nowadays assessment of undergraduate students who are going to be Indian Medical Graduate (IMG) always remains the topic of debate. Aim and Objectives: The aim of our study is to compare OSPE and TPE by obtaining the feedback of examiner and examinee and also by the marks obtained by students. Materials and Methods: It was an analytical study with longitudinal design. The study was conducted after receiving approval from the Institutional Ethics Committee. Total 140 students were included in the study. In 2nd professional MBBS at third semester, two internal examinations were held in 2019, first one was TPE and the second one was based on OSPE. After the completion of OSPE, students’ and teachers’ opinion were collected by given pre-validated questionnaire. Results: There were significant (P =< 0.05) difference between mean score in OSPE (17.1) and TPE (14.26) among students. According to students, OSPE reduces examiner’s bias (84.2%), was less stressful than TPE (78.5%) and also fair and objective as compared to TPE (85%). According to teacher’s opinion, OSPE requires more time, demands critical thinking of students (77.7%), more objective and eliminates bias (94.4%), ensures uniformity (64.4%), but they opined that depth of knowledge cannot be assessed by OSPE (83.3%). Most of the students (93.5%) and teachers (77.7%) said that OSPE should be included in Pathology practical examination. Conclusion: In our study, both teachers and students have given feedback in favor of OSPE as an assessment tool in practical examination of undergraduate medical students. In our opinion, OSPE should be included as an assessment tool in 2nd year undergraduate pathology practical examination to prepare future IMG.

Role of glycemic control on lipid profile in patients with type 2 diabetes mellitus-a cross-sectional study in tertiary care hospital of West Bengal

Background: Dyslipidemia is one of the common conditions associated with poor glycemic control in Type 2 diabetes mellitus (T2DM) patients. It is associated with an increased risk of cardiovascular disease which is the leading cause of death in these patients. Glycated Hemoglobin (HbA1c) is the gold standard test for monitoring glycemic control. Thus, the level of HbA1c could potentially be utilized as a possible biomarker for predicting the risk of dyslipidemia. However, there is a discrepancy in the data available till now regarding the relationship between HbA1c and the lipid profile. Hence, it requires further studies. Aim and Objectives: The present study was conducted to assess the role of glycemic control (as indicated by HbA1c level in blood) on lipid profile of patients with T2DM. Materials and Methods: This was an analytical cross-sectional study done over a period of 5 months. Total 165 participants were randomly selected from out patient department OPD of which 138 were diagnosed cases of T2DM and 27 were age and sex-matched non-diabetic healthy individuals. Patients of T2DM were sub grouped based on American Diabetic Association Criteria (2013) as having either controlled diabetes with HbA1c ?7% or uncontrolled diabetes with HbA1c >7%. Blood samples collected from all the participants were analyzed for HbA1c and lipid profile using standard methods. The collected data were analyzed with Statistical Package for the Social Sciences software using appropriate statistical method. Results: In the present study, we found a significant positive correlation between HbA1c and total cholesterol, Triglyceride, Low-density lipoproteins, and very low-density lipoproteins (P < 0.01) though high-density lipoprotein was not significantly correlated with HbA1c level. Conclusion: We concluded that apart from a reliable index of glycemic control, HbA1c can also be used as a predictor of dyslipidemia in T2DM patients, and thus regular monitoring of it can help us to reduce the mortality of these patients.

COVID 19: Respiratory Management by Non Invasive Ventilation

Background:During this long COVID-19 pandemic outbreak, continuous positive airway pressure (CPAP) and noninvasive ventilation (NIV) are being widely used to treat of NIV in COVID-19 acute respiratory distress syndrome (ARDS) are lacking, and for this reason it is extremely important to accurately determine the outcomes of this strategy. This study aimed to evaluate clinical data and outcomes of NIV in patients with COVID-19 ARDS.Material And Methods:This is retrospective observation study conducted at government hospital during April 2020 to July 2020. The study was approved by local ethical committee.We analyzed patients with the laboratory confirmed case of COVID-19 infection admitted in intensive care unit who require positive pressure ventilation and perfusion which are not able to maintain on simple O2 masks/ nasal cannula /NRBM. Data related to clinical features and co-morbidities were recorded at admission and clinical laboratory data were recorded at start of NIV and respiratory parameter were recorded at the time of admission, start of NIV and at the time of weaning or shift to invasive ventilation.Result:Out of 119 patients 42 patients were successfully weaned off from non invasive ventilation while remaining were shifted to invasive mechanical ventilation. The patients who were shifted to invasive ventilation were all died. Low P/F ratio, high CRP, high D-dimer, high LDH and high ferritin levels were related to conversion to invasive ventilation and high mortality among the group.Conclusion:Although there is a role for non-invasive respiratory therapies in the context of COVID-19 ARF, more research is still needed to define the balance of benefits and risks to patients. Indirectly, non-invasive respiratory therapies may be of particular benefit in reducing the risks to healthcare workers by obviating the need for intubation, a potentially highly infectious procedure.

Acute Viral Hepatitis E Infection With Conjugated Hyperbilirubinemia In 9-Year Boy

Hepatitis E virus (HEV) infection is most common among acute viral hepatitis (AVH) infections in developed countries. It is an enteric virus which usually causes a self-resolving hepatitis. We report the case of a 9-year old boy who presented with anorexia, fever, pain in abdomen and jaundice. Ultrasound revealed no signs of cholestasis. Laboratory findings revealed conjugated hyperbilirubinemia, transaminitis, and bilirubinuria. There was no evidence of any autoimmune or metabolic disease, and routine viral serology was normal except for immunoglobulin M to HEV suggestive of acute origin of disease. The jaundice resolved slowly after a period of 2 months. Hepatitis E virus RNA was not detectable in the convalescent serum. This case is an example of conjugated hyperbilirubinemia seen in acute phase of viral hepatitis caused by HEV.

Significance Of Ahara Vidhi Vishesh Ayatan In The Management Of Normal Health (special Direction Of Food)

Ayurveda defines normal health as a balanced state of Doshas, Dhatus, Agni, mala and happiness of Atma, Indriyas and Manas as well as the physical mental and social wellbeing. According to WHO’s definition of health “a state of physical mental and social wellbeing and not merely an absence of diseaseâ€. proper nutrition is very essential for healthy life. Ahara (food) is the main source of nutrition. Ahara (Food) sustains the life of living beings. All living beings in the universe require Ahara (food), complexion, clarity, good voice, longevity, geniusness, happiness, satisfaction, nourishment, strength and intellect are all conditioned by Ahara (food). Professional activities leading to happiness in this world, Vedic rituals leading to abode in heaven and observance of truth, Brahmhacharya leading to salvation are all based on food. Only the individual having a healthy body can afford to perform all activities leading to happiness, heaven and salvation, and for the preservation of health intake of food is essential. Hence food is the basic factor for the attainment of all of them. Ahara Vidhi Vishesha Ayatan (Eight types of special directions for ingestion of food). According to Acharya Charaka only the normal quantity of Ahara cannot provide the good result of Ahara because the result of Ahara depends upon Ahara, Vidhi, Vishesh, Ayatan Eight types of special direction have been given by Acharya Charaka for ingestion of food.

Study of nutritional assessment of children between 6 months to 5 years

Background: Nearly half of all deaths in children under 5 are attributable to under nutrition. Under nutrition puts children at greater risk of dying from common infections, increases the frequency and severity of such infections, and contributes to delayed recovery. The WHO recommends the use of Z scores or standard deviation score (SDS) for evaluating anthropometry, so as to accurately classify individuals with indices below the extreme percentile. In India most paediatricians use IAP classification to classify malnutrition. The aim of the study is to assess the nutritional status of children between 6 months to 5 years of age attending tertiary rural hospital according to WHO criteria and to compare the result of this study with IAP classification for grading malnutrition. The objectives of the study is to assess the knowledge of mothers regarding feeding practices among these children particularly below 2 years of age and to observe associated clinical problems and state of other nutrient deficiencies. Materials and methods: A cross sectional and observational study of 200 children admitted in pediatric ward and NRC (nutritional rehabilitation centre) of Dhiraj Hospital were taken for the study, Piparia, Waghodia, Vadodara. Study was carried for a period of 18 months from April 2015 to September 2016 to assess the nutritional status of children according to WHO criteria and to compare it with IAP classification. Assessment of the nutritional status was done by clinical examination and anthropometry. Interrogation was done with children’s mothers in the language they understood regarding young children feeding practices and accordingly their knowledge was assessed. Data was compiled, categorized and analyzed by appropriate statistical method in consultation with a statistician. Pathak S, Yadav T, Joshi C, Sharma N, Gulabani S, Gandhi D. Study of nutritional assessment of children between 6 months to 5 years. IAIM, 2017; 4(2): 42-52. Page 43 Results: Total 200 patients were taken in the study. Result shows that out of 200 patients 108(54%) were males and 92(46%) were females. The distribution of patients was more in age group between 13 and 36 months with 86(43%), of which distribution of males more than females were. Distribution of patients according to SAM and MAM (WHO classification) shows 127(63.5 %) fall under SAM and73 (36.5%) fall under MAM. Distribution of patients according to SAM and MAM (WHO classification) was studied. Result shows that out of 200 children taken in the study 127(63.5 %) fall under SAM and73 (36.5%) fall under MAM according to WHO classification. Distribution of children according to IAP classification in the present study interprets that 103 (51.5%) of the total children came under grade II of IAP classification. WHO classification detected more children with malnutrition than IAP classification, which was true for both boys and girls. Comparison of MUAC (WHO) with WHO (SAM and MAM) of children taken in the present study interprets that 67 (33.5%) had SAM and 95 (47.5%) had MAM according to MUAC criteria, remaining 19% did not fall under SAM and MAM. Comparison of MUAC (SAM) with WHO (SAM) of children in present study interprets that only 67 (52.75%) children came under SAM according to MUAC criteria out of the 127 children of SAM according to WHO classification. Comparison of MUAC (WHO) and IAP classification of children in the present shows that 67 children had MUAC <11.5 cm, out of 67 children (with SAM according to MUAC criteria) 28 (41.79%) came under grade II and 21 (31.3 %) came under grade III of IAP classification. Out of 95 children (MUAC between 11.5 cm and 12.5 cm) 18 (18.94%) came under grade I and 58 (61.05%) came under grade II of IAP classification. Associated co morbidities among children in the present study shows that among 200 patient 152 (76%) had anaemia, 44 (22%) had diarrhoea, 14 (7%) had pedal oedema, 12 (6%) had vitamin A deficiency, 44 (22%) had URTI and 24 (12%) had LRTI. Knowledge Aptitude and Practice study was done among 50 mothers and the result shows that mothers had less knowledge regarding what to be given in complementary feed, importance of immunization, birth spacing interval, and danger signs indicating illness. Conclusion: The present study shows that WHO classification detected more children with malnutrition than IAP classification, which was true for both boys and girls. There was also disparity among results of WHO criteria IAP classification and MUAC classification. Single criteria can’t be justified in assessing malnutrition. KAP study reveals that mother’s knowledge is important in combating malnutrition

Single dose amoxicillin induced toxic epidermal necrolysis A rare life threatening dermatological condition.

Toxic epidermal necrolysis is a severe cutaneous drug reaction, mainly involving skin and mucous membranes. We have presented here a case report of 16 year old female patient who was diagnosed with toxic epidermal necrolysis clinically as well as histopathologically. The patient presented with history of fever, oral cavity ulcer, skin lesions which were ill defined, erythematous macular with darker hemorrhagic centre. Skin biopsy showed full thickness necrosis of dermis, dermal-epidermal separation and paucity of upper dermal cellular infiltration. The patient was treated with intravenous immunoglobulins, low dose steroids and systemic antibiotics and the patient improved significantly. The main purpose of the case report was to emphasize that even one single dose of amoxycillin can induce a toxic epidermal necrolysis.

Cytogenetics in recurrent abortions.

The present study comprised of 40 couples with bad obstetric history. Aim of the study was to find out whether any specific chromosomal abnormalities exist in couples with recurrent abortions. Karyotyping with ‘G’ banding was done. The study revealed that, out of 80 positive metaphases, chromosomal anomalies were seen in 3 cases (3.75%). The abnormal karyotypes seen were 45XX,t(21;21), 45XY,t(13;21), 45XY,t(15;15). These translocations are known as Robertsonian translocaitons, which occur between D and G group of chromosomes.

Effect of estradiol on expression of cytoskeletal proteins during spermatogenesis in testis of sexually mature rats.

Earlier studies had shown that long term treatment with estradiol arrests spermatogenesis in adult male rats, at a dose of 0.1 mg/kg/day. The present study was therefore undertaken to ascertain the causes underlying the reduction in sperm counts by administering estradiol for a short term, at the dose of 0.1 mg/kg/day. Estradiol valerate was injected at a dose of 0.1 mg/kg/day, for a period of 10 days to one group of adult male rats, which were administered saline for 12 days prior to estradiol injection, and sacrificed after 22 days. The control group was administered saline for 22 days. The sera were analyzed for testosterone and FSH levels. One testis of each male was immersion fixed for histology, and for immunohistochemistry of two testicular cytoskeletal proteins, vimentin and vinculin. The contralateral testes were used for analysis of vimentin and vinculin gene expression by reverse transcriptase polymerase chain reaction (RTPCR) and western blotting. Another group exposed to estradiol for 10 days was injected with bromodeoxyuridine (BrdU), at a dose of 100 mg/kg/day, to ascertain the effect on germ cell proliferation, and sacrificed 12 days later, while estradiol treatment was continued till sacrifice. BrdU, at a dose of 100 mg/kg/day was injected i.p. to a group of control rats treated with saline for 10 days, and sacrificed 12 days later. The testes from both groups were immersion fixed for immunohistochemical detection of BrdU. Histology of estradiol treated testis showed predominance of tubules with round spermatids with accumulation of lipid droplets in Sertoli cell cytoplasm and decreased cell height, whereas controls showed elongating spermatids. BrdU immunolocalization in the testis, irrespective of treatment, indicated its incorporation in deoxyribonucleic acid (DNA) suggesting that estradiol sustained germ cell proliferation. Both vimentin and vinculin could be immunolocalized to the testis. The testicular levels of vimentin and vinculin, quantified after western blotting, were unaffected. The testicular expression of vimentin and vinculin seen by RTPCR was also unaffected. The study suggested that estradiol induced reduction in sperm counts was not due to adverse effects on proliferation. The observed predominance of seminiferous tubules showing round spermatids, accumulation of lipid droplets as compared to controls suggested that reduction in elongated spermatids occurred through reduced spermiation and phagocytosis. The study also suggested that reduction in Sertoli cell height after short-term estradiol treatment was not due to reduced expression of vimentin and vinculin, which could be maintained by estradiol. However, reduction in Sertoli cell height could have been due to suppression of FSH and testosterone, implicated in the polymerization of vimentin and organization of vinculin, two cytoskeletal proteins involved in inter-Sertoli or Sertoli-germ cell junctions. The study suggested that disorganization of Sertoli cell cytoskeleton and reduction in the volume of Sertoli cells could be an important factor for reduced efficiency of spermatogenesis after exposure to estrogenic molecules.

Diagnostic evaluation of extrapulmonary tuberculosis by fine needle aspiraton (FNA) supplemented with AFB smear and culture.

One hundred forty-three patients, 72 males and 71 females, with extrapulmonary tuberculosis were aspirated and subjected to cytological (Ziehl-Neelsen stain) examination and culture in Lowenstein-Jensen media. Routine haematological examination and Mantoux test were done in all the cases, x-ray chest in 112, skeletal x-ray in 3 relevant cases and sputum was examined for AFB in 16 cases where pulmonary tuberculosis was associated/suspected with extrapulmonary tuberculosis. HIV status was evaluated in 51 cases and 9 (7.64%) were seropositive. FNA cytology in 102 cases (71.3%) had caseating epithelioid granulomas while smear for AFB was positive in 57 cases (39.8%). Both culture and smear were positive in 29 (20.2%) cases. Combining both smear and culture yielded positive results in 47.5% cases. It was observed that AFB positivity was higher in untreated patients and with HIV positive cases. Further more, the triad of FNAC, AFB smear and culture were cheaper, foolproof and confirmatory than costlier tests like TB IgG, IgM, RTPCR and BACTEC.

Tracheal lymphoepithelioma-like carcinoma: a case report.

Lymphoepithelioma like carcinoma is rare in locations other than nasopharynx. We report the second case of this tumour in trachea, in a young female patient, who was managed with concomitent surgery, radiotherapy and chemotherapy. The patient is disease free in the one-year follow up. The tumour presented difficulties during intubation for general anaesthesia and during surgery. Association with Epstein-Barr virus was not found in our case.

Drug susceptibility profiles of mycobacterium tuberculosis isolates at Jaipur.

PURPOSE: To find prevalence of drug resistance in Mycobacterium tuberculosis isolated from patients attending SMS Medical College, Jaipur during 1997-99. METHODS: Sputum samples from 164 patients with pulmonary tuberculosis were processed and cultured on Lowenstein Jensen medium and M.tuberculosis isolates were tested for drug sensitivity. RESULTS: M. tuberculosis was isolated in 122/164 (74.3%) samples and comprised 97.6% (122/125) of mycobacterial isolates. There were only three isolates of nontuberculous mycobacteria -one each of M.kansasii, M.avium and M.fortutium. Primary drug resistance in M.tuberculosis was estimated to be 3/44 (6.8%) to rifampicin, 6/44 (13.6%) to isoniazid and 2 strains (4.5%) were multi drug resistant i.e. resistant to both rifampicin and isoniazid. Among the isolates from cases with previous history of treatment of varying duration (acquired drug resistance) resistance to rifampicin was estimated to be 28.2% and for isoniazid to be 39.7%. 24.3% strains of these drug resistant isolates were multi drug resistant. CONCLUSIONS: While this information may not reflect true prevalence of drug resistance in the region this may help in further planning long term surveillance studies to know the trend of drug resistance in this area.

Accuracy of clinical manoeuvres in detection of minimal ascites.

A study was conducted to assess the clinical accuracy of various clinical manoeuvres and signs used routinely for detection of ascites. Sixty-six patients admitted in medical ward of a teaching hospital after initial screening by a consultant were selected. Exclusion criteria were; cases with previous history of ascites, who had undergone paracentesis in the recent past or with evidence of ascites from history. Another clinician blind to history and clinical details assessed the presence of ascites by the selected methods a sonographer blind of clinical and historical details assessed the cases for presence of ascitic fluid. The clinical findings were compared using ultrasonographic (USG) findings as gold standard. Ascites was detected in 35 patients by USG. the mean weight and abdominal girth of study subjects with or without ascites were comparable (p > 0.05). Sensitivity of auscultatory percussion was highest (65.7%) followed by flank dullness (57.1%) and least for fluid wave sign (20.0%). Fluid wave sign had the highest specificity (100%). We found that none of the manoeuvres studied for detection of ascites was both highly sensitive and specific. However, auscultatory percussion could be useful for initial screening of patients to detect ascites.

Accuracy of palpation and percussion manoeuvres in the diagnosis of splenomegaly.

A study was conducted on 80 patients admitted in a teaching hospital to see the accuracy of two palpatory methods (Supine palpation and Middleton's manoeuvre) and three percussion methods (Traube's space percussion, Castell's and Nixon's manoeuvres) in the diagnosis of splenomegaly. Ultrasonographic findings were considered as gold standard for diagnosing splenomegaly. Mean age of study subjects was 31.5 years and mean Quetelet's index was 17.8 +/- 2.6 kg/m2. Sensitivity of Middleton's and Castell's manoeuvres was similar (85.7%) and higher than other manoeuvres. Nixon's manoeuvre had the least sensitivity (66.7%). Specificity was highest (92.1%) with supine palpation and least (31.6%) with Castell's manoeuvre. Supine palpation showed highest positive predictive value (91.7%). Receiver Operating Characteristics curves showed greater area with middleton's manoeuvre (0.93) followed by supine palpation (0.92), Castell's manoeuvre (0.75) and Traube's space percussion (0.74), the findings of the study suggests that palpatory methods like Middeton's manoeuvre and Supine palpation should be routinely used for diagnosing splenomegaly among non-obese individuals.

Interobserver variations in clinical signs for diagnosis of pleuritis.

A study was conducted on 150 patients admitted in a teaching hospital to find out reliable clinical signs for diagnosing pleuritis. Cases were selected based on suspicion of pleural involvement by history and examination. Final diagnosis was made by correlations with radiographic and ultrasonographic reports. Reliability of the signs was determined on the basis of high concordance of independently observed variations between two medical consultants. Inflammatory involvement of pleura was seen in 69.3% cases and 30.7% were due to oedema disorders. Concordance between observers was high for crepitations (95.5%) and pleural rub (93.8%) followed by vocal resonance (87.6%), dull percussion note (76.9%) and mediastinal shift (76.9%).