Assessment of stress and coping mechanisms in the 1st year MBBS students from English and Vernacular medium – An experience from a new All India Institute of Medical Sciences

Background: The stress levels among the 1st year MBBS students are high due to multiple factors. In this setting, an objective assessment of stress and coping strategies among medical students may provide a foundation to adopting specific measures to help them. Aims and Objectives: The specific objectives of the study were to compare stress levels and coping strategies among medical students from different backgrounds and mediums of instructions and to ategorize the stress level of students depending on Class X, XII marks, number of attempts, and annual family income. Materials and Methods: Forty-eight 1st year MBBS students were recruited for the study. Participants were divided into two groups, that is, Group 1 – English medium schools and Group 2 – Hindi medium schools and informed consent was taken. In a preferable time slot, the participants were given two questionnaires (Zung’s SDS and Way of Coping Revised scale) and a table of personal information to fill. Results: There were significantly higher stress scores among English medium students as compared to vernacular medium. There was no correlation between Class 10th and 12th marks with the stress. Proportion of students having high stress had AFI <1 lakh and proportion having low stress had AFI more than 5 lakh. Students having more than 3 attempts in medical qualifying examination had the least stress scores. Conclusion: Stress among medical students was found to more in students from English medium schools due to the urban background of these students. High family income acts a psychological security for the students, hence the low stress among them. Students with more than 3 attempts in qualifying examination were more mature, hence the low stress score among them.

Assessment of Knowledge, Attitude & Perception towards COVID-19 Vaccine among the rural and urban population of Navi Mumbai: An Alarming Scenario

Objective: To assess the knowledge, attitude, and perception towards COVID-19 vaccination among rural and urban areas. To study and analyze any socio-demographic barriers and economic factors affecting the immunization program. Methodology: A cross-sectional comparative study was conducted between the urban and rural populations with the help of pre-designed and pre-structured questionnaires. Data were collected from 205 subjects from the urban population with the help of Google form and 242 subjects from the rural population through an interview. Results: 97.1% of the urban population were aware of the Arogya Setu app of which 80% were using it while 87.6% of the rural population were not aware of the Arogya Setu app. 60.3% of the rural population had the perception that the Covid-19 vaccine can be eradicated without the vaccine whereas 77.1% of the urban population had the opposite perception. Conclusion: Most of the urban population had good knowledge about the Covid 19 vaccine with a positive attitude of accepting the vaccine as the most important preventive measure of prevention and control of the Covid 19 pandemic as compared to the rural population.

Vertical Distribution of TOC, TN and Other Important Soil Attributes and Their Relationship in Alfisol and Entisol of West Bengal

A study to assess the profile distribution of important soil attributes in Alfisols and Entisols of West Bengal was conducted during 2016-17. Purposefully selected random sampling was carried out to collect the soils from different locations of two study sites, viz., Kalinagar (25º27'33.9"N, 88º19'10.2"E) from Malda district and Durganagar (26º09'62.7"N, 89º53'51.7"E) from Cooch Behar district of West Bengal at 0-15, 15-30, 30-45 and 45-60 cm depths. Understanding of vertical distribution of soil fertility indicators like soil organic carbon (SOC), total nitrogen (TN) and other important properties in two different soil and climatic conditions will provide an insight regarding the behaviour of soil with the change in environmental conditions. Soil bulk density (BD), porosity, pH, SOC, TN, C:N ratio and texture were determined using standard laboratory procedures and computations. Obtained results were subjected to statistical analyses. Soils of Kalinagar sites were slightly acidic in nature while soils of Durganagar were neutral in nature. Kalinagar soils were silt clay loam in texture where Durganagar soils classified as loam to sandy loam. Soil BD values increased with depth in both Kalinagar (Alfisol) and Durganagar (Entisol). The porosity percentage progressively decreased with an increase in depth. Soils of Durganagar reported higher soil porosity at all the depths studied. An increase in soil pH with increasing depth was observed in both the sites. The mean total organic carbon (TOC) content recorded maximum in surface soil and its concentration decreased with the depth. Kalinagar soils observed 7.63% higher TOC (17.94 g kg-1) content than Durganagar (16.57 g kg-1) at surface depth (0-15 cm) and its accumulation at the lower depths was also maximum in former soil. Mean TN values were also found to decrease by increasing the depth. The accumulation of total nitrogen at the subsequent depths was relatively higher in Kalinagar than Durganagar. Increase in C:N ratio with increasing depth was noticed in Kalinagar site but the opposite trend was accorded in case of Durganagar. Accumulation of SOC and TN throughout the soil depth was found to be greater in Alfisol (Kalingar) due to higher clay and silt fractions as compared to Entisol (Durganagar). There was a significant positive relation of TOC with clay and silt (r = 0.285, p<0.05, r = 0.314, p<0.01, respectively) and of TN with clay and silt (r = 0.328, p<0.01, r = 0.262, p<0.05, respectively) irrespective of soil orders. Alfisols with high bulk density have a greater capacity to accumulate SOC and TN throughout the soil profile due to higher clay and silt fractions in comparison to Entisols with loose textural properties.

Prospective evaluation of the quality of life of oral cancer patients undergoing post-operative radiotherapy in a Regional Cancer Centre of central India

Background: The assessment of the quality of life (QOL) has become an important aspect of oral cancer research. It has allowed the evaluation of the impacts of the disease as well as the treatment from the patient’s perspective. Objectives: The objective of this study is to assess the QOL of oral cancer patients undergoing post-operative radiotherapy (PORT) during treatment as well as after the completion of treatment. Materials and Methods: It is a hospital-based prospective observational study. It was carried out in Regional Cancer Centre, Dr. Bhim Rao Ambedkar Hospital, Raipur, India. A total of 108 oral cancer patients with cancer-free survival after surgery who satisfied the study criteria and got registered for PORT were included as study participants. The data with regard to their QOL were collected using the European Organization for Research and Treatment of Cancer QOL Core Questionnaire-C30 and the European Organization for Research and Treatment of Cancer Head and Neck Module (QLQ-H and N35) at three time-points, i.e., just before initiation, just after completion, and 6 months after completion of PORT. Mean, median, standard deviation, standard error, and 95% confidence intervals were calculated. Statistical significance was set at P < 0.05. The association between QOL at various time points was analyzed using Wilcoxon signed-rank test and Friedman’s ANOVA. Results: It was elicited that various scales of functional and symptomatic domains of QOL were significantly impaired at the end of RT and either restored to or improved from pre-RT level, at 6 months after completion of PORT. However, social functioning, nausea vomiting, appetite loss, dry mouth, and sticky saliva remained significantly deteriorated at the final assessment as compared to pre-RT level. Conclusions: This study concludes that QOL alters significantly over a short period of time from pre-RT to subsequent post-treatment period. However, it emphasizes the all-important need for psycho-social support in addition to disease cure for oral cancer patients during their treatment as well as a later period.

Microfilaria In Bone Marrow Aspirate: A Case Report

Wuchereria bancrofti is the most common parasite causing lymphatic filariasis. Microfilariae are dem­onstrated in the peripheral blood, body fluids, fine needle aspirates and in onchial ushings but it is an uncommon finding in the bone marrow. We report a case of a 45-year old male who presented with pyrexia of unknown origin and on peripheral blood and bone marrow examination found to have pan­cytopaenia with megaloblastoid changes in the bone marrow and W. bancrofti microfilariae.

Colorectal Cancer In Adolescents And Young Adults As Compared To Adults With Review Of Literature

INTRODUCTION: Colorectal cancers are relatively uncommon malignancies in India as compared to the western world as here there is less consumption of red and processed meat. According to recent cancer data in India, incidence of colorectal cancer is 4th in men and 3rd in women. Rectal cancers are more common in India[1].Considering such a low incidence in adults, it would be rare to find colorectal cancers in pediatric age group. We present a study on total 46 cases of colorectal cancers, among which 6 cases were in age below 25 years including two cases of adolescents. MATERIALS AND METHODS: A two year retrospective study from June 2016 to May 2018 was done. We came across total 46 cases of colorectal cancers, among which 18 cases were of females and 28 of males. Maximum number of cases were in age group 41- 50 i.e 14 cases. Two very rare cases of age 10 and 14 years were encountered which had very dismal prognosis at diagnosis itself. Other four cases were below 25 years of age and were also in advanced stage. CONCLUSION: Colorectal cancers are generally cancers of 5th to 6th decades. They are less commonly encountered before 30 years of age; being extremely rare in pediatric age group i.e 1 case/ million. If they do so, they usually present in advanced stage and have poor histological stage and grade thus making them inoperable. A high level of suspicion coupled with a digital rectal examination followed by sigmoidoscopy and/or colonoscopy if required can result in early diagnosis which will go a long way in providing effective therapy [2].

An Unusual Case Of Myocardial Tuberculosis Alongwith Involvement Of Kidneys

Pulmonary tuberculosis is one of the commonest infectious disease encountered in clinical practice and more so in the developing countries. Despite of effectiveness of treatment,it is still a major cause of death. Tuberculosis can effect almost every organ of the body with maximum cases in the lungs accounting to 80%[1]. It is seen that extrapulmonary site have increased morbidity and mortality. Cardiovascular involvement is rare about 1-2%[2] and that too seen usually in the pericardium.The involvement of myocardium is even rarer. Here is a case of autopsy finding in 47 years old female showing myocardial involvement due to tuberculosis. Tubercular findings were also found in the bilateral kidneys.

Research Priorities in the field of Anaemia in India

Anaemia is a health problem that caused most disability in India over a decade (2005-2016) according to the Global Burden of Disease study(1). India has the maximum number of anaemic women and children in the world(2). As per the recent National Family Health Survey-4 (2015-16), about 58% children (6-59 months), 53% women (15-49 y) and 23% men were suffering from various degrees of anaemia(3). Aanaemia affects the general health of the total population taking toll for high mortality as well as morbidity and attenuating the optimal expression of the potentials of both physical and mental capacity of our population. Improving nutritional status of the vulnerable sections of the population and reducing anaemia is of paramount importance for improving health and the human capital development in the country(4).

Choice of point of Care diagnostic device in anemia prevalence surveys: policy-level Implications in monitoring progress and guiding further action.

Anemia is highly prevalent disease of global concern. Childhood anemia can result in irreversible damage to brain and affect cognitive, intellectual, and pyscho-motor development. In pregnant women, it is a significant contributor to adverse maternal outcome (1–4). In 2011, alone it was responsible for loss of 42 million Disability adjusted life years and among the top three causes of disability worldwide (5). In an attempt to address this huge public health problem, guidelines have been issued by various leading international organizations and targets have been set to monitor progress towards its control. One such indicator is 50% reduction of anemia in women in reproductive age group (WRA) between 2011 and 2025 (6). This makes it necessary to carry out huge population-based anemia prevalence surveys repeatedly, to measure the progress and guide policy makers in carrying out specific interventions needed to reduce its prevalence.

Profound Sensorineural Hearing Loss with Overlay of Middle Ear Pathology-Diagnostic Implications.

This study aimed to demonstrate the diagnosis of profound mixed hearing loss which is inappropriate to be studied vigorously to prove that at the level of profound degree of severity there is a little contribution of conductive pathology. Two groups of 15 subjects each in the age range of 18-25 years with mean age of 21 years were included. Group I consisted of pure sensorineural hearing loss of profound degree and Group II was made up of pure sensorineural hearing loss of profound degree who later reported with middle ear disorder. Pure tone measurements were conducted on all the subjects following standard procedures. Conductive hearing loss was induced with insertion of the insert ear plugs/ear moulds without sound bore for subjects in Group I and pure tone threshold measurements were repeated. Air-conduction and bone-conduction thresholds were compared for subjects in Group II prior and later to check for any middle ear pathology. Results showed that when Group I was induced with conductive hearing loss, the pure tone average did not change and for Group II, there was no change in air-conduction thresholds by later developed outer ear/middle ear pathologies. Diagnosis of profound sensorineural hearing loss with the overlay of middle ear pathology will bring insights into physiology of hearing and highlight the important issues of management of middle ear pathology, not for the purpose of improvement of absolute hearing thresholds but for the case of wearing of amplification device restricting the further growth of pathology, etc.

Clinicopathological analysis of ovarian tumors in perimenopausal women: A study in a rural teaching hospital of eastern India.

Introduction: Ovarian tumors are important in perimenopausal women as they are more likely to be malignant. Aim: The aim was to study the various histological pattern of ovarian tumors and their clinical presentation in perimenopausal age group. Materials and Methods: The study was carried out in the departments of Gynaecology and Obstetrics and Pathology in a teaching hospital for two years from June 2007 to May 2009. All patients presented with ovarian tumors of perimenopausal age group (40- 50 years) were included. Detailed clinical information, radiological findings and histopathological reports were recorded. Results: A total 52 ovarian tumors were included in this study. Most common histological types were surface epithelial tumors (92.3%), out of which 54.2% were benign, 41.7% were malignant and 4.2% were borderline. Serous cystadenoma was the most common benign tumor and serous cystadenocarcinoma was the commonest malignant tumor. Abdominal discomfort was the commonest presenting symptom both in benign and malignant tumors (85.7% and 45.4% respectively). Most of the malignant tumors were presented in stage III (50%), followed by stage II (27.3%). Conclusion: In this: study, we found a relatively higher proportion of ovarian malignancies. So, any ovarian tumor in perimenopausal age group is more likely to be malignant and that require a thorough evaluation and management. Further research should be advocated in this field.

Knowledge and behaviour of chest symptomatics in urban slum populations of two states in India towards care-seeking.

Background: Little information is available on triggers and barriers for seeking appropriate healthcare among chest symptomatics (CS) from slum populations in India. Methods: Urban slums in Uttar Pradesh (UP) and Karnataka (KA) were selected based on case detection rate (2008), population size and geographic distribution. A door-to-door survey was conducted in 2010 and CS were identified and interviewed. Action taking patterns were collected and factors influencing these among behavers (CS visiting qualified providers) and non-behavers (CS not taking action or resorting to self-medication) compared. Results: Of 1526 CS in UP and 1515 in KA interviewed, 75% in UP and 58% in KA sought care; of them 79% in UP and 99% in KA visited a qualified provider. More than 80% in both UP and KA underwent recommended tests within a week (mean days: UP-1.8; KA-2.4). Only 16% of respondents in UP and 48% in KA reported that private qualified providers recommended sputum microscopy. Important triggers of visiting a qualified provider were being females; of higher economic status, self-efficacy, suspicion of having TB when suffering from persistent cough and that sputum microscopy should be done to diagnose TB. Additional triggers included knowledge that TB is caused by germs and can affect anyone (UP) and perceptions of quality of care and knowledge that TB is curable (KA). Implications: There is need to carry out targeted area-specific communication in slums to improve appropriate treatmentseeking behaviour and demand creation for DOTS by CS. The study recommends investments to focus on changing private provider behaviour.

Primary disseminated extrapulmonary multidrug resistant tuberculosis.

Disseminated tuberculosis is a common mode of presentation of tuberculosis in patients both with and without HIV/AIDS in India. However, primary multidrug resistance in disseminated tuberculosis involving only the extrapulmonary sites in an immunocompetent adult is rare. Here, we report a case of a 19-year-old man who had disseminated tuberculosis involving left pleura, pericardium, peritoneum and intraabdominal lymph nodes. He was initially taking WHO category I antituberculous drugs, but was not responding in spite of 5 months of chemotherapy. Culture of the pleural biopsy specimen grew Mycobacterium tuberculosis which was resistant to isoniazid and rifampicin. He was put on therapy for multidrug resistant tuberculosis,following 24 months of chemotherapyhe had an uneventful recovery.

Colonic Strictures after Necrotizing Enterocolitis in Infants: Case Series.

The fate of neonates with necrotizing enterocolitis is variable, with colonic strictures being one rare phenomenon after the insult. We describe here two infants with colonic strictures, which developed secondary to neonatal necrotizing enterocolitis. Infants recovered or in the process of recovery after it should be investigated for possibility of development of colonic strictures.

Evaluation of a rapid dipstick test for identifying cholera cases during the outbreak.

Background & objectives: Intermittent cholera outbreaks are major problem in many of the states of India. It is essential to identify cholera at the earliest for timely mobilization of public health responses and to abort the outbreaks. The present study was a part of a diarrhoeal outbreak investigation in Secunderabad, India, during May 2009 where the usefulness of Crystal VC rapid dipstick kit was assessed for detecting the aetiologic agent of the outbreak. Methods: Stool specimens were collected from 15 hospitalized patients with acute watery diarrhoea and analyzed for detection of cholera vibrios using Crystal VC rapid dipstick kit and the usefulness of the kit was determined by comparative analysis of the same set of specimens using both microbiological and real-time PCR (RT-PCR) based assays. Results: Detection of Vibrio cholerae O1 from 10 of 15 specimens was recorded using dipstick assay. Microbiological methods detected V. cholerae O1 positivity among 11 specimens. However, RT-PCR based assay showed all 15 specimens positive for the presence of V. cholerae O1. In addition, the same assay showed that the pathogen load in the dipstick as well as RT-PCR positive specimens ranged from 106 colony forming units (cfu)/ml or more. Interpretation & conclusions: Crystal VC kit had the potential to identify cholera cases in 10 min in field conditions without having good laboratory support. Therefore, dipstick kit may be considered as cholera detecting tool in diarrhoeal outbreak investigations. Specimens from clinically typical cholera cases, if negative by dipstick, should be reanalyzed by culture based methods.

Studies on the Effect of Lugol’s Iodine on Reproductive Efficiency of Dairy Cattle.

The present investigation was conducted to study the effect of intra uterine infusion of 20 ml Lugol’s iodine (0.25 %) on day 5 (Group I; n= 18), day 17 (Group II n= 17) on reproductive performance as compared to untreated animals (Group III; n= 18). The average inter estrus interval in the animals in treatment group I (14.12 ± 0.396 days) was significantly (P<0.01) shorter than group II (23.93 ± 0.330 days) and control group III (20.93 ± 0.870 days). The average duration (days) for first postpartum fertile estrus was shortest (88.93 ± 10.053 days) in group I, followed by group II (106.46 ± 8.743 days) and control group III (113.72 ± 7.131 days). The number of artificial insemination (A.I.) required per conception was observed to be only 1.38 in group I while the values were 1.50 and 1.91 for group II and III, respectively.

Childhood Intussusception: A Prospective Institutional Study at BPKIHS.

Introduction: Intussusception is the commonest cause of bowel obstruction in infancy and childhood. The present study deals with the presentation, management and outcome of children presenting with intussusception at the Department of Surgery, B. P. Koirala Institute of Health Sciences, Dharan, Nepal. Materials and Methods: Forty-seven children presenting at Department of Surgery, B. P. Koirala Institute of Health Sciences over a 5-year period were prospectively studied. Results: There were 27 (58.6%) males and 20 (41.4%) females, with male-to-female ratio of 1.4:1. The ages ranged from 2 months to 13 years, with a median age of 30 months. The mean duration of presentation was 10.7 ± 30.66 days (range 1-180 days). The triad of abdominal pain, bloody mucoid stools and palpable abdominal mass was seen in 10 (21%) of the cases. Surgical exploration was done in 42 (89.3%) patients. The commonest lead point was non-specific hyperplastic lymph nodes, occurring in 22 (54.3%), followed by idiopathic variety (16.6%), Meckel’s diverticulum (9.5%), ileocaecal junction (7.1%), submucous lipoma (4.7%), Non- Hodgkin’s lymphoma (4.7%), appendix (2.3%) and a mucosal polyp (2.3%). Overall mortality rate was 6.3%. Conclusion: The presenting age group and the time of presentation are higher than other studies. The mortality rate of 6.3% is comparable to other studies in the developing world. Earlier presentation could have avoided surgery, with a higher possibility of cases being managed conservatively.

Aerosolized L-epinephrine vs Budesonide for Post-extubation Stridor: A Randomized Controlled Trial.

Objective: To compare the efficacy and adverse effects of aerosolized L-epinephrine vs budesonide in the treatment of post-extubation stridor. Study design: Randomized controlled trial. Setting: Pediatric intensive care unit (PICU) of a tertiary teaching and referral hospital. Subjects: Sixty two patients with a stridor score ≥4 following extubation. Intervention: Patients were randomized to receive either aerosolized L-epinephrine (n=32) or budesonide (n =30). Respiratory rate, heart rate, stridor score, blood pressure and oxygen saturation were recorded from 0 min to 24 hours. Outcome measures: Stridor score remaining at ≥4, need for re-nebulization and re-intubation between 20 min –24 hours were primary outcome measures. Tachycardia (HR > normal for age), hypertension (BP >95th centile for age) and hypoxia (SpO2 <92% for 5 min) were secondary outcome measures. Results: Both drugs showed a significant and comparable decline in the median (95% CI) stridor scores from baseline to 60 min [4 (4.10-4.50) to 2.00 (1.46-2.67) for budesonide vs 4 (4.12-5.00) to 2.00 (1.31 -2.75) for epinephrine]. At 2 hours, the stridor scores were significantly lower in the epinephrine as compared to budesonide group [0.00 (0.69-1.81) vs 3.00(1.75-3.32); P =0.02)]. However, the proportion of patients with stridor score ≥4 at any time between 20min-24 hrs (53.3% vs 53.1%; P=0.99), need for renebulization (40 % vs 43.8 %; P=0.76) and re-intubation (20% vs 25%, P=0.638), and adverse effects were similar in both groups. Conclusions: Both aerosolized L-epinephrine and budesonide were equally effective in their initial therapeutic response in post-extubation stridor. However, epinephrine showed a more sustained effect.