Impact of examination stress on response time in first-year medical students

Background: Stress has been seen to deteriorate normal physiological functions as well as the psychological functions of the brain. Medical students face a range of enduring normative stressors in the form of academic demands. This brings upon an amount of stress on the students which is related to the examinations and concerns with achieving high grades consequently referred to as academic-related stress. Thus, it becomes crucial to set upon a tool for measuring this stress in order to present methods for overcoming it. In the present study, one such method is evaluated by assessing the reaction time of first-year medical entrants. Material and Methods: The effect of stress on response time in 50 normal healthy medical students of Sawai Man Singh Medical College, Jaipur in the age group of 18 to 21 years was explored in the study. Visual Reaction Time was recorded through the computer program. Results: There was an increase in visual reaction time for the red color in both the sexes during stressful situations as compared to stress-free situations. While a decrease in Visual Reaction Time was seen for green color. A decreased auditory reaction time for both sexes was seen in stressful situations. Conclusion: The results revealed that stress within a limit facilitates positive feedback to Central Nervous System information processing consequently decreasing the reaction time.

Comparative study of preloading with ringer lactate v/s 6% hexa starch solutions to prevent hypotension following spinal anaesthesia in elective surgery.

Background: Hemodynamic variations are commonly encountered following subarchnoid block and can attribute to significant mortality and morbidity. To counteract the hypotension, fluid adminstration before spinal anaesthesia is recommended (preloading). Crystalloids and colloids are recommended as preloading fluids but both have their own merits and demerits. Objective: This comparative study was done to compare the effectiveness of ringer lactate versus 6% hydroxyl ethyl starch for preventing spinal anesthesia induced hypotension. Material and Methods: In this prospective study, we compare the effectiveness of ringer lactate versus 6% hydroxy ethyl starch at 10ml/kg over a period of 20 minutes before spinal anaesthesia in preventing hypotension. After administration of spinal anaestheisa mean arterial pressure were recorded at 1, 5, 10, 15, 30, 45, 60, 90 minutes and 3 hours after spinal anaesthesia. Number of patient, recieving injection Mephentermine sulphate for persistent hypotension was also recorded. Results: We found that hydroxy ethyl starch is more effective than ringer lactate solution as a preloading fluid in prevention of hypotension following spinal anaesthesia. Conclusion: Hydroxy ethyl starch is superior to ringer lactate in preventing hypotension in patients undergoing elective lower abdominal surgeries under spinal anaesthesia but the incidence of hypotension is not completely eliminated.

Comparative Analysis of Unilateral Subarachnoid block with Ankle block for elective foot surgery.

Background: There are many accepted anesthesia techniques for elective foot surgery ranging from general anesthesia to regional anesthesia, regional anesthesia being the preferred method. Regional anesthesia techniques employed for foot surgery includes subarachnoid block, epidural anesthesia and ankle block. Objective: The present study is aimed at providing comparative analysis of ankle block with unilateral subarachnoid block for elective foot surgeries in terms of hemodynamic safety profile and post operative analgesia. Material and Methods: Study includes prospective analysis of 80 ASA II and III patients who underwent elective foot surgery. Patients were randomly divided into two groups of 40 each, Ankle block group (AB) and Unilateral subarachnoid group (US). The parameters recorded for study includes systolic blood pressure, diastolic blood pressure, heart rate, visual analogue scale for pain severity, time of first analgesic need and the complications. Results: There were minimal blood pressure changes and heart rate variability in AB group as compared to US group when compared with basal values (p<0.05). The time for first analgesic requirement is prolonged in AB group as compared to US group. The visual analogue scale score was assessed at 2nd ,4th and 6th hours for group AB were lowered as compared to group US (p <0.05).

Ventilator-associated pneumonia: Revisited.

Ventilator-associated pneumonia (VAP) is a type of hospital acquired pneumonia commonly encountered in patients who receive mechanical ventilation and is associated with significant mortality and morbidity. VAP is associated with prolonged ventilation, increased antibiotic use, emergence of multidrug resistant organisms, prolonged critical care unit stay resulting in increased cost of care. It has been reported to occur in 9 to27 percent of all intubated patients. As per International Nosocomial Infection Control Consortium (INICC) report data summary, the overall rate of VAP was 13.6 per 1,000 ventilator days. Preventive measures, early diagnosis and treatment of VAP result in better outcome. The aim of this review was to search the literature for incidence, various risk factors, etiology, pathogenesis, treatment, and prevention of VAP. A literature search for VAP was done through the PUBMED/MEDLINE database. VAP is a commonly encountered nosocomial infection occurring in ventilated patients and is associated with increased mortality and morbidity. Outcome of patient with VAP depends on hospital setting, patient group, infection control policy, early diagnosis and judicious antibiotic use.

The efficacy of intravenous Paracetamol versus Tramadol for postoperative analgesia after elective surgery.

Background: Pain is an unpleasant sensory or emotional experience usually occurs due to potential tissue damage associated with surgical trauma. Opioids and Non steroidal antiinflammatory drugs are commonly used to alleviate pain but both have their own limitations in clinical use. Objectives: This prospective randomized clinical trial was undertaken to evaluate the efficacy and quality of recovery with intravenous paracetamol versus tramadol for post operative analgesia after elective surgery. Material and Methods: 40 ASA I&II patients of age group 15-40 years scheduled for elective surgery under general anaesthesia were enrolled in the study. After premedication, patients were randomized into two groups. Following induction of general anaesthesia patients of group 1 [n=20] received 15mg/kg of IV paracetamol and group 2 [n=20] received 1.0 mg/kg of IV tramadol over 15 minutes. During measurements, modified hanallah pain observation scores, Aldret scores [readiness for discharge], Sedation scores and Time to first rescue analgesia were recorded every 5 minutes during the first 30 minutes, then every 10 minutes for the remaining 30 minutes of the PACUs stay and upto first 2 hours in the ward. Statistical Analysis was done using SPSS Software Ver. 17. Results: Results reveals there is statistically significant difference in mean postoperative observational pain score, aldret score and time to first rescue analgesia though the mean post operative nausea & vomiting incidence and sedation score between two groups are statistically non significant . Conclusion:Clinically intravenous paracetamol offers better analgesic benefits to the patients than that of tramadol and due to early recovery characterstics in paracetamol group, patients are discharged early in case of paracetamol group and thus are economically effective in day care surgeries.

Identification of pregnancy-associated glycoproteins by peptide mass fingerprinting in water buffalo (Bubalus bubalis).

Ruminant placentas synthesize pregnancy-associated glycoproteins (PAGs) during pregnancy, which serve as biomarkers of pregnancy. The present study was conducted to verify, whether PAGs are expressed in buffalo placenta by using lectin-based affinity chromatography and peptide mass finger printing (PMF). Fetal cotyledonary tissues were collected from gravid uteri procured from slaughtered house. Proteins were extracted and subjected to wheat germ agglutinin (WGA) lectin affinity chromatography to isolate the PAGs. The isolated glycoproteins were separated by one-dimensional SDS-PAGE. PMF results of the 75 kDa protein revealed presence of two PAGs (PAG-7 and -11). The PAG-7 consisted of about 170 mass signals, of which 16 were assigned to corresponding/translated cDNA sequences of buffalo PAG-7, leading to sequence coverage of 40%. PMF result of PAG-11 showed 170 mass signals, of which 15 were assigned to buffalo PAG-11, leading to sequence coverage of 34%. In conclusion, the glycoprotein isolated from placental extract corresponding to 75 kDa band on SDS PAGE gel was a mixture of PAG-7 and -11, which may help in development of suitable diagnostics for pregnancy in buffalo.

Negative pressure pulmonary oedema after routine elective surgery.

Negative Pressure Pulmonary Oedema (NPPE) is known to occur in healthy subjects in the early post anaesthesia period, in the absence of fluid overload or left ventricular dysfunction. This type of non cardiogenic pulmonary oedema is also reported in literature following upper airway obstruction. We report two such cases of negative pressure pulmonary edema. Both the patients developed NPPE during postanaesthesia period due to persistent laryngospasm leading to upper airway obstruction. Both the patients were treated with diuretics, bronchodilators & antibiotics in intensive care unit. Within 24 hours the coarse crepitations disappeared and the patients were weaned off the ventilator. Awareness, early recognition and prompt treatment of negative pressure pulmonary oedema could be life saving.

Potential application of β-1, 3 glucanase from an environmental isolate of Pseudomonas aeruginosa MCCB 123 in fungal DNA extraction.

Pseudomonas aeruginosa MCCB 123 was grown in a synthetic medium for β-1,3 glucanase production. From the culture filtrate, β-1,3 glucanase was purified with a molecular mass of 45 kDa. The enzyme was a metallozyme as its β-1,3 glucanase activity got inhibited by the metal chelator EDTA. Optimum pH and temperature for β-1,3 glucanase activity on laminarin was found to be 7 and 50 °C respectively. The MCCB 123 β-1,3 glucanase was found to have good lytic action on a wide range of fungal isolates, and hence its application in fungal DNA extraction was evaluated. β-1,3 glucanase purified from the culture supernatant of P. aeruginosa MCCB 123 could be used for the extraction of fungal DNA without the addition of any other reagents generally used. Optimum pH and temperature of enzyme for fungal DNA extraction was found to be 7 and 65 °C respectively. This is the first report on β-1,3 glucanase employed in fungal DNA extraction.

Relationship of Body Mass Index, Waist Circumference and Waist-Stature Ratio with Body Fat of the Indian Gorkha Population

Introduction: Body mass index (BMI) has traditionally been the chosen indicator by which to measure body size, composition, and to diagnose underweight and overweight. However, alternative measures that reflect abdominal adiposity, such as waist circumference, waist–hip ratio and waist–height ratio, have been suggested as being superior to BMI in predicting cardio-vascular diseases (CVD) risk. This study was aimed at determining the predictive power of anthropometric indicators like body mass index, waist circumference and waist stature ratio with body fat in an Indian military personnel population group, and to establish cut-off points as discriminators of high body fat. Methods: The study was crosssectional in nature with a sample size of 388 active Gorkha male personnel aged 20-49 years (mean age 33.1±5.33). Anthropometric indicators included body mass index, waist circumference, waist-hip ratio and waist-stature ratio. The analysis of receiver operating characteristic curves (ROC) with a confidence interval of 95% was adopted to identify predictors of obesity. Subsequently, the cut-off points with their relevant sensitivities and specificities were identified. Result: Areas under the ROC curves with 95% confidence intervals were body mass index = 0.86 (0.84-0.88); waist circumference = 0.82 (0.80-0.84); waist- hip ratio = 0.74 (0.71-0.77); waist-stature ratio = 0.81 (0.78-0.84). Different cut-off points of anthropometric indicators with better predictive power and their relevant sensitivities and specificities were identified. The following cut-offs with their corresponding sensitivity and specificity values are suggested for determining obesity for the study population: body mass index= 23.4 (98.00, 62.00), waist circumference= 77.8 (98.00, 60.50) and waist stature ratio= 0.47 (98.60, 68.00) respectively. Conclusion: The results showed that among active military personnel, BMI, WC and WSR may serve well in classifying individuals into broad categories corresponding to percentage fat categories. Further studies on different populations should be undertaken for the verification of the cut-off levels identified.

Dermatophytes, related keratinophilic and opportunistic fungi in indoor dust of houses and hospitals.

Dermatophytes, related keratinophilic and opportunistic fungi were isolated from indoor dust samples of 46 hospitals and 47 houses in Kanpur. A total of 19 fungi represented by 11 genera were isolated by the hair-baiting technique from 230 and 235 samples from hospitals and houses respectively. The isolated fungi are Acremonium implicatum (Indian Type Culture Collection) ITCC 5266 , A. strictum (Germplasm Centre for Keratinophilic Fungi) GPCK 1137 , Aphanoascus fulvescens GPCK 1081 , Arthroderma simii GPCK 1275 , Chrysosporium queenslandicum ITCC 5270 , C. indicum ITCC 5269 , C. pannicola GPCK 1022 , C. tropicum GPCK 1269 , Ctenomyces serratus ITCC 5267 , Gymnoascus reessii ITCC 5265 , Malbranchea fulva GPCK 1075 , Malbranchea pulchella ITCC 5268 , Micosporum gypseum GPCK 1038 , Microsporum cookei GPCK 2001, M. fulvum GPCK 2002 , Paecilomyces lilacinum GPCK 1080 , Penicillium expansum GPCK 1082, Trichophyton mentagrophytes GPCK 2003 and T. terrestre GPCK 2004. In hospitals, the minimum frequency was of Ctenomyces serratus ITCC 5267 while the maximum frequency was of Arthroderma simii GPCK 1275 . In houses, Chrysosporium queenslandicum ITCC 5270 and C. tropicum GPCK 1269 were with minimum and maximum frequencies respectively. This makes the first report of these fungi with keratinolytic ability in the indoor dust of hospitals and houses.

Histophysiological responses in ovary and liver of Cyprinus carpio after short term exposure to safe concentration of mercuric chloride and recovery pattern.

Effect of short term (7 days) exposure to safe concentration of HgCl2 (0.5 ppm) and changes 7 days after withdrawl of the treatment on histophysiology of ovary and liver in yearlings of Cyprinus carpio were assessed during active phase of reproductive cycle. Noticeable degenerative histophysiological changes were observed in both ovary and liver after exposure which were more prominent in the group with abnormal behaviour. After withdrawl of the HgCl2 treatment the recovery was apparent in both organs but was more appreciable in liver. These observations indicated that even safe concentration of HgCl2 might not be fully devoid of deleterious influence on reproductive functions in Cyprinus carpio.

Co-infection of herpes simplex virus (HSV) with human immunodeficiency virus (HIV) in women with reproductive tract infections (RTI).

In India, HSV seroprevalence and its coinfection with HIV among female patients with reproductive tract infections (RTI) are sparse. We aim to ascertain the seroprevalence of HSV and its coinfection with HIV and common sexually transmitted infections attending Obstetrics and Gynaecology outpatient department, RIMS. The study included 92 female patients with RTI. Diagnostic serology was done for HSV-1 and HSV-2 using group specific IgM indirect immunoassay using ELISA, HIV by 3 ELISA/Rapid/Simple (E/R/S) test of different biological antigen. Diagnosis of RTI was made on clinical grounds with appropriate laboratory investigations--microscopy, Gram stain smear etc. Bacterial vaginosis was diagnosed using Nugent's criteria, Syphilis by rapid plasma reagin (RPR) card test and Chlamydia trachomatis by IgG ELISA. Out of 92 sera tested for HSV, 18 (19.6%) were IgM HSV positive and 9 (9.8%) were HIV positive. Co-infection rate of HSV in HIV positive was 16.7%. None of the patients had clinical herpes genitalis, all were subclinical cases. 55.5% of HSV positives belongs to age group 21 to 30 years. Of the HSV-1 and HSV-2 IgM positives 3 (15%) had HIV, 4 (22.2%) bacterial vaginosis, 2 (11.1%) were RPR positive, 4 (22.2%) Chlamydia trachomatis, 3 (15%) were pregnant. 16 (88.8%) were unemployed, 14 (77.7%) had education level below 10 standard. Our study suggest that every case of RTI, be it an ulcerative or nonulcerative must be thoroughly evaluated by laboratory testing for primary subclinical genital HSV coinfection as this has profound implications on their judicious management and aversion of complications. Early diagnosis and treatment of HSV infection together with prophylaxis for recurrent HSV disease will prevent progression and spread of HIV disease.

Ovarian development in Labeo dyocheilus (McClelland) during active reproductive phase under captive and wild conditions.

Ovarian development in Labeo dyocheilus was assessed during active reproductive phase under ambient environmental conditions in captivity and wild. Increasing day length and water temperature seemed favourable for ovarian development in female L. dyocheilus under both conditions. Gonadosomatic index (GSI) was lower in May and higher in July in captivity (6.168 and 13.366) and wild (5.798 and 16.166) respectively Ovarian development started little bit in advance in captivity with late yolk vesicle stage oocyte in May when yolk globule stage oocytes were prominent in wild. Fully grown oocytes with germinal vesicle migration (GVM) and germinal vesicle breakdown (GVBD) stages were observed in July in both conditions. Degree of transformation of developing oogonials into advance stage oocytes was observed to be better in wild fish compared to captivity reared ones. The histophysiological changes in liver corresponded well to the progression of ovarian development. Successive granulation and vacuolization of hepatocyte cytoplasm were indicative of augmented synthetic activity and probably mobilization of energy content for oocyte growth. These observations indicated that normal ovarian development of L. dyocheilus under captivity in Tarai region of Uttarakhand would be useful for success of its seed production in captivity for stock augmentation in wild or species diversification in aquaculture.

The morphology of central tympanic membrane perforations.

The objective of this study was to assess the extent of conductive hearing loss in relation to different sizes and sites of simple central tympanic membrane perforations. Total 100 cases attending ENT OPD, BPKIHS during period of April 2003 to Mar 2004 without any discrimination of sex, race and religion were taken for the cross sectional prospective study. Dry, clean central tympanic membrane perforations due to various causes like chronic suppurative otitis media-tubotympanic, post acute suppurative otitis media residual perforations or simple traumatic perforations with conductive hearing loss and without preexisting hearing loss were clinicoaudiologically evaluated and analyzed. Hearing loss was found to be directly proportional to the size of perforation irrespective of their cause, which was statistically significant. Hearing loss in the study was found to range from negligible to 53dB. Overall, perforations involving posterioinferior quadrant were found to have maximum hearing loss.

Effect of adenotonsillitis on peak exploratory flow rate in children.

Peak Exploratory Flow Rate (PEFR) is a simple, economical, reproducible, non-invasive test, which can be quickly performed with ease. PEFR was assessed in 36 children with adenotonsillar enlargement with mean age 10.75 years and equal number of age and sex matched normal children who acted as controls. PEFR was found to be 250. 61 +/- 66.92 lt/min in controls and 216.85 +/- 59.76 lt/min in children with adenotonsillar enlargement signifying impairment of PEFR in children in the second group.

Emphysematous pyelonephritis: a consequence of adenocarcinoma of urinary bladder in a nondiabetic patient.

Emphysematous pyelonephritis (EP) is a life threatening condition of acute necrotising renal parenchymal infection that encompasses a much wider spectrum of complicated urinary tract infections such as renal abscesses, emphysematous pyelitis, pyelonephritis, acute renal papillary necrosis, and sepsis. We report an unusual case of adenocarcinoma bladder in a middle aged nondiabetic patient, presenting with EP. Emphysematous pyelonephritis was the initial symptom in this case with an underlying carcinoma of the bladder. The role of imaging is prime in management of such cases, if an early diagnosis is to be made and a potentially devastating outcome is to be avoided. The literature regarding EP has been reviewed and discussed. The goals of managing EP should be (1) early institution of parenteral antibiotics and a (2) a staged nephrectomy (preceded by a temporary percutaneous drainage particularly with antibiotic resistant septicemia) so as to maximize survival rather than proceeding directly to emergency nephrectomy.

Compound composite odontome associated with an unerupted deciduous incisor - A rarity.

Odontomes are considered to be hamartomatous malformation rather than true neoplasm and are generally asymptomatic. Here is a case presentation of compound composite odontome with impacted deciduous teeth in an 11-year-old girl. A calcified mass was revealed in the radiograph and the case was finally diagnosed to be compound composite odontome. The mass was surgically excised.

Seasonal ovarian cycle in freshwater teleost, Labeo rohita (Ham.) in Tarai region of Uttaranchal.

Seasonal ovarian cycle, based on histophysiological changes, and correlative variations in liver were studied in an Indian major carp, Labeo rohita reared in captivity under ambient environmental conditions in Tarai region of Uttaranchal. The oocyte features used for marking ovarian cycle included nuclear-ooplasmic ratio, yolk vesicle incorporation into ooplasm, number and size of nucleolus and differentiation of follicular layer. Based on these features the ovarian cycle in L. rohita was divided into five phases i.e. resting, preparatory, pre-spawning, spawning and post-spawning/regression. The resting and preparatory phases were characterized by the dominating presence of chromatin-nucleolar and yolk-vesicle stage oocytes. The pre-spawning phase ovary was marked by the prevalence of yolk globule stage oocytes having cortical alveoli and differentiating follicular wall. The oocytes containing densely packed yolk-granules and large masses of yolk vesicles and also exhibiting germinal vesicle movement (GVM) signified the ovary of spawning phase. The ovary in regression phase contained pre-ovulatory atretic oocytes and significant number of oogonia. The histophysiological changes in liver showing augmented biosynthetic activity during preparatory and pre-spawning phases seemed well correlated with the gonadal development. The increasing water temperature and day-length apparently was favourable for the gonadal development in L. rohita.