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Background: Anaemia during pregnancy continues to be a major public health problem especially in developing nations like India. The study was performed to assess the prevalence and severity of anaemia and the associated socio-demographic and obstetric factors during pregnancy in a tertiary referral hospital of Delhi, India. Method: This cross sectional study was carried out on 430 pregnant women in second and third trimester of pregnancy using systematic random sampling attending antenatal clinic of Vardhman Mahavir Medical College and Safdarjung Hospital of Delhi. A predesigned and structured questionnaire proforma was used to collect information regarding socio-demographic and obstetric factors. Haemoglobin levels were estimated using Hemocue method. Statistical analysis was carried out using STATA version 18.0 statistical software. Results: The overall prevalence of anaemia during pregnancy was 48.84% with 25.81% mild anaemia, 15.81% moderate anaemia, 6.98% severe anaemia and 0.24% very severe anaemia. Anaemia was found to be more common in younger women (<25 years) and in joint family. Anaemia was more commonly seen in low socio-economic status, low family income and in illiterate and primary education. Anaemia especially severe anaemia was more common in third gravidas and above. Anaemia was more common with advancing gestation. Anaemia was more common with no or irregular antenatal care and with no or single tetanus toxoid injection. Conclusions: The prevalence of anaemia is high in Delhi. Regular and timely antenatal care, improving socio-economic status and having lesser children can reduce prevalence of anaemia during pregnancy.
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Bacterial vaginosis (BV) is characterized by overgrowth of opportunistic bacteria and a decrease in the levels of Lactobacilli. BV is commonly encountered by gynaecologists practicing in India. The opinions of 21 gynaecologists across India regarding diagnosis and management of BV were sought via focussed group discussions. In Indian women, BV is more common in the reproductive age group, perimenopausal women, women with polycystic ovarian disease (PCOD), pregnant women, and in teenagers/pubertal age group. BV is often underestimated as it is not diagnosed by family physicians. The panel of experts opined that they preferred to conduct screening for BV in all high-risk pregnant cases, women with bad obstetric history such as premature abortions and women with a history of tuberculosis. One challenge faced by clinicians in the real-world setting is recurrent infections of BV in their patients. For the treatment of BV, antibiotics can be prescribed along with pre-probiotics to avoid dysbiosis and to prevent recurrence of BV. Pre-probiotics should be administered in sufficient amounts for adequate management of BV. More than 80% of Lactobacilli species should be present in an ideal pre-probiotic to ensure adequate production of acid and bacteriocins for the destruction of unhealthy bacteria and prevention of microfilm formation. The results with the pre-probiotics used will depend on the quality of the formulation and the maintenance of the cold chain. Prebiotic -probiotic supplementation may be considered a new adjuvant treatment for BV.
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Ocular complications in cryptococcal meningitis (CM) are commonly attributed to elevated intracranial pressure (ICP). We report a case of reversible vision loss complicating acquired immunodeficiency syndrome (AIDS) related to CM with a normal ICP. The patient had sudden onset painless blindness during the anti-retroviral therapy (ART) and anti-fungal therapy. On evaluation, clinical and radiological findings of optic neuritis were present. While reviewing the literature for causes of blindness in CM, we concluded the cause was optic neuritis due to immune reconstitution inflammatory syndrome (IRIS) because of concomitant ART intake by the patient. We witnessed dramatic visual improvement after the use of systemic corticosteroids. The potential significance of this case report is to highlight the possible role of corticosteroids in the prevention of blindness due to CM.
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Background: Mucormycosis cases are managed by extensive debridement of the affected tissues, with correction of predisposing risk factors and antifungal drugs. Amphotericin B is the drug of choice; however, few azoles also have a good activity against Mucorales. Therefore, the present study was done to determine the minimum inhibitory concentration (MIC) of antifungal drugs against Mucorales, causing COVID-19 associated mucormycosis in North India. Methods: After obtaining written and informed consent, we processed the received tissue, sputum, and gastric lavage samples as per standard mycological procedures. Subsequently, we determined itraconazole, posaconazole, isavuconazole and amphotericin B MIC against the isolated Mucorales (one from each patient) by broth microdilution using CLSIM38A3 guidelines. Results: We received 615 samples from the enrolled 269 patients with CAM. We observed broad aseptate hyphae in 329 fresh tissues, ten sputum and one gastric lavage sample, whereas 163 follow-up excised tissue had broad aseptate hyphae. In addition, 209 Mucorales were isolated with a predominance of Rhizopus arrhizus (n=183), followed by Rhizopus microsporus (n=21) and Rhizopus homothallicus (n=5). We determined MIC against 77 and 8 strains of R. arrhizus and R. microsporus, respectively. Posaconazole had the least MIC. 0.25, 1, 0.5, and 2µg/ml were the MIC50 of posaconazole, amphotericin B, isavuconazole and itraconazole against R. arrhizus strains, respectively, whereas it was 0.125, 0.1875, 0.5 and 2 µg/ml against R. microsporus, respectively. Conclusions: Lower posaconazole MIC makes it a preferred drug for managing the mucormycosis cases; however, availability and cost are the limitations. Thus, amphotericin B and itraconazole may be used in such conditions.
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Background: Immunization stands as a vital bulwark against vaccine-preventable diseases, especially for children under the age of 5. Cross-sectional study into the knowledge, attitude, and practices (KAP) of mothers concerning childhood immunization and the interplay of sociodemographic factors on immunization practices required. Methods: A descriptive cross sectional study was conducted in an immunization clinic at a private medical college and hospital in Bhubaneswar for a total period of 4 weeks). A population purposive sampling technique was used for this study enlisting 70 mothers with children under 5 years old. Results: The majority of mothers had attained secondary-level education, and significant proportion being homemakers (75.7%). An overwhelming percentage (97.5%) of mothers exhibited a positive attitude towards vaccination, considering it beneficial and safe for their children. However, some exhibited gaps in knowledge concerning the significance of vaccinating from the day of birth and vaccine-related contraindications (24.29%). Crucially, 97.5% of the children had received all mandatory childhood vaccines, and all mothers adhered to the vaccination schedule outlined in the NIS. Socio-demographic factors, such as maternal age and literacy status, are determinants of knowledge about immunization. Younger mothers and those with higher educational attainment were more likely to possess a better understanding of childhood immunization. Conclusions: This study underscores the pivotal role of maternal KAP in ensuring successful immunization for children under 5. The findings advocate for targeted awareness campaigns and interventions aimed at enhancing maternal knowledge, particularly among younger and less educated mothers.
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Background: Brain metastasis is a common, debilitating and undesirable neurological complication of systemic cancer and a significant cause of morbidity and mortality. Methods: 39 patients of brain metastasis with Ca breast/Ca lung as primaries were randomized into a study arm and control arm in between 1st August 2018 to 31st July 2019 at IGMC Shimla. Control arm consisted of WBRT (30 GY/10 fractions/5 days a week). Study arm consisted of WBRT with same dose and temozolamide administered 75mg /m2/day during RT days. Results: Out of 39 patients 34 patients completed treatment out of which 17 in study and 17 in control arm. Response to brain lesions could not be assessed in 20 out of 39 patients. In remaining 19 patients 36.8% patients in study arm and 20% patients in control arm had partial response (PR). 5.3% patient in study arm and none in control arm has complete response (CR). 25% patients in control arm and 15.8% patients in study arm had stable disease. Improvement in QOL (FACT- G) seen in both study and control arm post Rx, however improvement sustained in study arm at 1st F/u. Conclusions: Leveraging the additional radio-sensitizing effect of TMZ may hold promise as an attractive strategy to enhance the quality of life in patients with a favourable performance status. Moreover, RPA could serve as a decisive factor in tailoring the treatment approach, guiding the choice between palliative radiotherapy and best supportive care for these individuals.
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Background: An extraordinary impact on health-care personnel has been caused by the coronavirus disease-2019 (COVID-19) pandemic, a health-care crisis. Aims and Objectives: Our aim was to assess the effects of a changing lifestyle on anthropometric measurements, blood glucose levels, atherogenic lipid profiles, and blood pressure over the course of a year in Indian healthcare workers (HCWs). Materials and Methods: A prospective study was carried out on 40 HCWs including 23 male and 17 females between the age of 22 and 59 years. The study was conducted in the Department of Physiology and the Department of Biochemistry, Government Medical College, Kathua, UT of Jammu and Kashmir. Informed written consent was obtained from the subjects and ethical clearance was obtained from the Institutional Ethics Committee. Height, weight, waist circumference, and systolic and diastolic blood pressure were measured using standard methods. Body mass index was calculated as weight in kilograms divided by the square of height in meters. Results: The present study found statistically significant increase in systolic blood pressure and statistically significant decrease in mean HDL-cholesterol before and after COVID-19 pandemic in HCWs. Conclusion: The onset of metabolic syndrome and its potential effects could be stopped by early use of preventative interventions in the changed parameters.
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Rhabdomyosarcoma (RMS) is a rare and in adult accounts for only 1-3% of all malignant soft tissue tumors. The most frequent sites of origin is within head and neck area. One of the least common sites is the retrorectal-presacral space. This case of 61 years old female is probably the fifth well-documented case of primary abdominopelvic RMS. She presented with abdominal distensions, obstipation, vomiting for 5 days. Excision of the gut wall along with soft tissue mass was done and sent to our department for histopathological examination. On microscopic examination, a diagnosis of malignant mesenchymal tumor with closest resemblance to RMS was made. It is a rare case and needs to bring in notice as there is very few information regarding intraabdominal RMS. This case initially thought to be metastasis from gynecologic malignancy. It is important for pathologists, gynecologists and radiologists to recognize RMS as differential diagnosis of masses arising in abdomen and pelvis.
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Rhabdomyosarcoma (RMS) is a rare and in adult accounts for only 1-3% of all malignant soft tissue tumors. The most frequent sites of origin is within head and neck area. One of the least common sites is the retrorectal-presacral space. This case of 61 years old female is probably the fifth well-documented case of primary abdominopelvic RMS. She presented with abdominal distensions, obstipation, vomiting for 5 days. Excision of the gut wall along with soft tissue mass was done and sent to our department for histopathological examination. On microscopic examination, a diagnosis of malignant mesenchymal tumor with closest resemblance to RMS was made. It is a rare case and needs to bring in notice as there is very few information regarding intraabdominal RMS. This case initially thought to be metastasis from gynecologic malignancy. It is important for pathologists, gynecologists and radiologists to recognize RMS as differential diagnosis of masses arising in abdomen and pelvis.
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Background: Chronic kidney disease (CKD) is an irreversible deterioration of renal function and cardiovascular disease is the leading cause of mortality in CKD patients. Aims and Objectives: The aim of this study was to assess the pattern of lipid profile among cases of CKD. Materials and Methods: A cross-sectional study was conducted for 1 year covering total 200 cases (males and females) of newly diagnosed or known cases of CKD. Parameters recorded were as follows: Fasting blood sugar, Serum urea (S. Urea), Serum Creatinine (S. Creatinine), and lipid profile. Estimated glomerular filtration rate (eGFR) was calculated by Cockcroft-Gault formula. Results: Mean age was 51.04 years in conservative management patients and 53.20 years in hemodialysis patients. Overall, male-to-female ratio was 1.82:1. S. Creatinine, S. Urea, and eGFR were deranged more in patients on hemodialysis (Group 2). Mean values of low-density lipoprotein (LDL)-cholesterol, very low-density lipoproteins (VLDL), and serum triglycerides (TG) were significantly higher in patients on hemodialysis compared to those on conservative management, while mean high-density lipoprotein cholesterol was significantly lower. Dyslipidemia was more common in female CKD patients (P = 0.02). Conclusion: Dyslipidemia in CKD worsened as patients progressed to severe stages with significant increase in TG, LDL, and VLDL levels in hemodialysis cases in comparison to conservatively managed, confirming presence of atherogenic lipid profile needing early intervention to prevent cardiovascular complications.
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Background: A person’s preferred method of collecting, processing, interpreting, and organizing knowledge is referred to as his/her “learning style” and several models exist to assess one’s preferred learning style. The VARK model that encompasses four sensory modalities, namely, Visual (V), Auditory (A), Read/Write (R), and Kinesthetic (K) provides students with insight into their preferred forms of sensory information perception. Aims and Objectives: The aim of the study was (1) to evaluate the learning styles of medical undergraduates, and (2) to determine the gender-specific relationship between learning style and academic performance. Materials and Methods: A cross-sectional study was carried out for duration of three months, covering 200 MBBS students (males and females both) from all phases of the MBBS. The VARK self-administered structured questionnaire, version 7.8, was distributed among students and their response collected. Results: About 53% of pupils in the current study utilized multimodal learning, while 47% utilized unimodal knowledge. Kinesthetic approach was the most prevalent unimodal approach (22%), followed by auditory (21%). Bimodal was the most common multimodal strategy, accounting for 31% of all multimodal techniques (Audio and kinesthetic together). About 1% were tetramodal (visual, aural, read/write, and kinesthetic), and 21% were trimodal (auditory, read/write, and kinesthetic). There was no statistically significant correlation between gender and learning styles. Conclusion: VARK is a useful tool to collect information about different learning styles. It makes the student as well as the educator aware about different learning style preferences. Moreover, it is better if students in a teaching medical institute are made aware of their preferred learning style.
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Background: Spirituality is recognition of a sense that there is something greater than myself. Physical exercise is any bodily activity that enhances physical fitness and overall health. Music is a universal language to express mind through tone and emotions. Nature is the physical world or the universe. Intelligence is the global capacity of the individual to act purposefully, to think rationally. Emotional intelligence is the ability to understand one’s own emotions and emotions of others. Adversity quotient deals with ability of a person to deal with adversities in life. Aims and Objectives: The present study was designed to study the effect of different interventions on intelligence, stress and cognitive functions. Materials and Methods: The present study was performed on 144 subjects in age group of 30–39 years. Their basal level of intelligence quotient (IQ), emotional quotient (EQ), resilience score (RS), acute stress score (ASS), perceived stress score (PSS), isometric handgrip (IHG), and stroop tests was recorded. The subjects were divided into four groups of 36 each. Four groups were allotted different interventions of spirituality practices, moderate intensity physical exercise, receptive music, and engagement with nature respectively for 1 month duration. Statistical analysis: ANOVA and post hoc tests along with student t-test were used for computing the results. Results: IQ, EQ, RS, ASS, IHG, PSS, and stroop subtests yielded mixed results with four interventions at different levels of significance. Conclusion: Although every intervention had different and positive impact on parameters, overall spiritual practices exhibited better response on parameters.
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Background: With improvement in living conditions in the population and the availability of treatments for various communicable and non-communicable diseases, the life expectancy and consequently the elderly population have increased. Stress leads to mental and physical problems. Aim and Objective: The aim of this study was to assess the effect of stress on muscle functions in the elderly. Materials and Methods: One hundred apparently healthy persons (50 males and 50 females) took part in the study. Perceived stress scale was used to measure their level of stress. Maximum voluntary contraction (MVC) and endurance time were measured with the help of a handgrip dynamometer. Results: The elderly population sample in our study showed a moderate level of stress, but there was no significant difference between the three age groups under study. Conclusion: A significant positive correlation between MVC and stress level was observed in our study subjects.
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Background: The nationwide lockdown due to coronavirus disease pandemic lead to shutdown of medical colleges. Due to which, it was not possible to teach students in classrooms anymore. To continue with their teaching, the option of online classes was recommended. Aims and Objectives: This study was conducted with an aim to evaluate students’ perceptions regarding online lectures. Materials and Methods: This was a cross-sectional, and questionnaire survey conducted among medical college students in Uttar Pradesh, India. Online lectures were delivered routinely using online applications for 8 weeks which was followed by offline regular classes. A pre-approved, pre-validated semi-structured questionnaire containing 13 close-ended multiple-choice questions was distributed through Google forms as well as in person among all the medical students using a non-probability sampling approach after taking their informed consent. The collected data were organized and tabulated using Google spreadsheet and descriptive statistics was used to depict the results. Results: A total of 193 responses were obtained from MBBS students of first and second phase. The mean age of students was 18.73 ± 1.87 years. Mobile phones (63.21%) were the most popular device used by the students to attend classes. More than half of the students (57%) were self-motivated to attend online classes. The major barrier to online learning as reported by 76.68% students was network issues. About 44% students reported lower understanding of subject compared to offline classes. About 70.47% felt online classes to be more comfortable to attend. More number of students either preferred offline method (37.82%) or a mix of both the methods (34.20%). Conclusion: Online lectures are effective teaching method, but they cannot replace classroom teaching. Thus, online teaching serves as add-on to the offline learning.
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Tubo-ovarian abscess (TOA) is a sequela of pelvic inflammatory disease (PID) found in 15-34% of patients, is comprised of an infectious, inflammatory complex encompassing the fallopian tube and ovary. We are presenting a case of TOA with endometriosis in a patient who underwent total abdominal hysterectomy and bilateral salpingo-oophorectomy. Histopathological findings were compatible with endometriosis with xanthogranulomatous salpingitis and oophoritis. In our patient there was no history of any chronic infection, gynecological procedures or intra uterine device and single partner. The purpose of this case is to make aware of this condition and requirement of further studies to investigate the risk of TOA in patients with endometriosis to find out the exact cause to prevent unnecessary surgery at later stage.
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Background: Lung cancer is one of the most common cancers in males worldwide and its number is increasing every year. Of these cases 75-80% case are of non-small cell type. Methods: This study was conducted on 30 patients of stage IV non-small cell lung cancer in the department of radiation oncology at tertiary care center, Shimla, Himachal Pradesh India from 1st Jun 2019 to 30th Jun 2020 by dividing them into study and control arm for assessing quality of life (QOL) with EORTC QLQ-C30 version3.0. Results: We observed significant improvement in Global health scale of control arm (p=0.005) but it got worse in study arm (p=0.743). All the parameters of Functional scale i.e. Physical (p=0.584; 0.170), Role (p=0.213; 0.016), Emotional (p=0.239; 0.002), Cognitive (p=0.793; 0.247) and Social functioning (p=0.030; 0.231) got worse in study arm while they improved in control arm. As far as Symptom scale is concerned, in the study arm; dyspnea (p=0.724), appetite (p=0.836), constipation (0.192), diarrhea (p=0.341) improved but other symptoms like fatigue (p=0.566), nausea (p=0.347), pain (p=0.305), insomnia (p=0.025), financial difficulties (p=0.082) got worse while in control arm; fatigue (p=0.003), pain (p=0.000), dyspnea (p=0.022), insomnia (p=0.336), appetite (p=0.028), constipation (0.019), diarrhea (p=0.336), financial difficulties (p=0.336) improved and nausea (p=0.120) got worse. Conclusion: QOL assessment by the physician before commencement of the treatment and later on at every visit seems to be beneficial for symptom relief and to allay the anxiety of both patient and their attendants.
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Context: COVID-19 caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is an emerging pandemic that is rapidly spreading with more than 114 million confirmed cases and 2.5 million deaths by far. Nasopharyngeal swab (NPS) in VTM has been used as the gold standard respiratory specimen for SARS-CoV-2 reverse-transcriptase real-time PCR (rRT-PCR) tests. But now the virus can also be detected in other clinical specimens like bronchoalveolar lavage, sputum, saliva, throat swab, blood, and stool specimens. Aims: The aim of this study was to determine the diagnostic potential of saliva as a sample in comparison to NPS for detection of SARS-CoV-2 by rRT-PCR. Settings and Design: A cross-sectional study was conducted among 256 paired samples (NPS and Saliva) received in the Department of Microbiology, SMS Medical College, Jaipur over a period of 2 months Methods and Material: NPS from individuals were collected in a sterile tube containing Viral Transport Medium™. Before swab collection, whole saliva was collected by spitting from the suspected patient into a sterile container. Both were stored at room temperature and transferred to the diagnostic laboratory within four hours of collection where extraction was done using Perkin Elmer chemagic extractor and rRT- PCR was performed using NIV, Pune mastermix. Results: Sensitivity, specificity, PPV, and NPV of RT-PCR for the diagnosis of COVID-19 in saliva were 84.26%, 100%, 100%, and 54.05%, respectively. The accuracy of detection of COVID-19 by saliva samples compared to the routinely used NPS samples (considered as the standard reference) for RT PCR was 86.72%. Conclusions: Our results show that saliva as a reliable sample type for SARS-CoV-2 detection.
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Leprosy is the oldest disease affecting humankind since ancient times. Despite MDT’s availability for disease curability, vast pockets of multi-bacillary (MB) cases persist in the community. We conducted this study to know the clinico-epidemiological trends of leprosy over four years and five months in this era of the COVID-19 pandemic (C19P). A total of 90 cases were registered; 59 (65.5%) were males, and 31 (34.5%) were females. The majority (69%) of cases were in the 15-45 age groups. Childhood leprosy was detected in 3(3.3%) cases. A history of contact with leprosy patients could be established in 16 (17.8%) cases. The cases comprised 54.5% local inhabitants and 45.5% were migrants. The MB cases 77 out of 90 (85.6%) were in higher proportion than pauci-bacillary (PB) cases. In the clinical spectrum, BL leprosy was most common in 39% of cases, followed by LL and BT leprosy. Thirty-seven (41%) patients were suffering from lepra reactions (LR), and out of them, 59.4% had type 2 reactions (T2R), and the rest had type 1 reactions (T1R). Disabilities were found in a total of 56 (62.2%) cases, and grade 2 disabilities (G2D) were recorded in 25 (44.6%) patients. Ulnar nerve (UN) was most commonly affected nerve in 64.4% of cases, followed by lateral peroneal (LPN) and posterior tibial nerve (PTN). We observed the impact of Covid 19 infection peak C19P in two ways; firstly, during the C19P peak in 2020, there was a drastic fall in total registered cases (TRC) to 4/year against 22/year in pre-C19P with a relative increase in LRs and disabilities. In post-C19P peak periods, not only was there a marked rise in TRC (20/5 months), but LR (50%) and disabilities (75%) also showed a significant rise. A high proportion of MB cases, LRs and disability rates indicate the need for population-based studies and subsequent public health measures for early diagnosis and treatment. Further large sample-sized, in-depth studies can tell the exact impact of C19P on leprosy.
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Background: Digitization of health records and health delivery processes in health care settings may have an impact on the Patient-Physician communication, wait times, that affect the overall patient satisfaction with the health care services. Aim & Objective: We ascertained the effect of digitization of medical case files on the doctor patient relationship (DPR) domain of patient satisfaction at an urban primary health center in India. Settings and Design: Comparative, cross-sectional study in primary health centres. Methods and Material: The patient satisfaction was compared between the patients attending the Public Health Dispensary (PHD) that uses digitized medical case file system and a Civil Dispensary (CD) which follows the conventional paper based medical records, using a Patient Satisfaction Questionnaire (PSQ). Statistical analysis used: Univariate analysis was done by chi-square test and adjusted analysis was done by multiple linear regression. Results: Patient satisfaction in DPR was found to be same between the digitized medical case files based and conventional OPD (p=0.453). Significantly higher overall patient satisfaction was reported in the conventional paper based OPD than the digitized OPD (p<0.001). Conclusions: Patient satisfaction towards the doctor-patient relationship (DPR) was same between paper based OPD and the digitized medical case files based OPD.
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Background: The reaction time (RT) of an organism refers to how quickly it reacts to a stimuli. The rate at which the central nervous system analyses sensory data and then executes it as a motor response is measured by RT. The human body responds to different sensory modalities in different ways and at different rates. This is critical in both routine and emergency situations. Gender, age, physical fitness, level of exhaustion, distraction, and alcohol have all been shown to influence RT. Aims and Objectives: The aims of this study were to compare the visual RT of first phase MBBS and BDS students to red and green colors. Materials and Methods: Following ethical approval, 250 first phase medical students, ranging in age from 17 to 20, were selected, and all participants provided written informed consent. Anand Agencies Pune designed an audiovisual RT gadget that was utilized to collect visual response time (VRT). The unpaired t-test was performed to assess the data statistically. Results: The individuals’ VRT for the colors Red (R) (Mean: 0.199 s) and Green (G) (Mean: 0.218 s) were statistically significant (P < 0.001). In addition, the variance of VRT in men (Mean: [R] 0.192 s, [G] 0.206 s) was significantly greater than in females (Mean: [R] 0.209 s, [G] 0.226 s; P < 0.001). The results were tallied and examined statistically. Conclusion: As a result of our research, we discovered that the VRT for green was significantly greater than that of red. This might be due to the fact that green takes longer to process than red. Males react to stimuli faster than females.