Ca-125: A Useful Marker to Distinguish Pulmonary Tuberculosis from Bacterial Pneumonia

Background: Ca-125 is a large molecular-weight glycoprotein synthesized by different cells originating from the coelomic epithelium. Although classically it has been used to monitor the course of ovarian epithelial cancer, there are other established circumstances associated with high serum Ca -125 levels and pulmonary tuberculosis is one of them. Diagnosing pulmonary tuberculosis, which is not bacteriologically positive often very challenging. Because many procedures are available for such cases but they are of limited use because some of them are lengthy or expensive or need sophisticated equipment, highly skilled personnel, etc. Serum CA-125 is a rapid, relatively inexpensive investigation. Objective: The present study aimed to assess the role of CA-125 in distinguishing pulmonary TB from bacterial pneumonia. Methods: This analytical cross-sectional study was conducted in the Department of Medicine, Dhaka Medical College Hospital for the period of March 2018 to September 2020.100 pulmonary tuberculosis patients were taken in group I, and 100 bacterial pneumonia patients were taken in group II according to selection criteria. Informed written consent was taken from each of the participants. All were subjected to detail clinical and demographic history along with thorough physical examination. Relevant investigations were done including serum CA-125. All final data were collected in the semi-structured and pretested case record form. After data collection, data were checked for errors, and analysis was done. Results: In this study, the mean CA-125 value was 62.29 (SD±31.51) IU/mL in group I(pulmonary tuberculosis). In group II (bacterial pneumonia) mean value was 22.95(±8.25) IU/mL. The mean value of CA-125 was significantly higher (p-value <0.001) in group I patients compared to group II. About 59.0% of patients in group I had a high level of serum CA-125 which had a significant difference from group II (p<0.001). ROC analysis of CA-125 in the diagnosis of patients with active pulmonary tuberculosis showed a cut-off value of ?31.7 IU/mL had sensitivity, specificity, PPV, NPV, PLR, NLR, and accuracy of 72%, 87%, 84.7%, 75.7%, 5.54%, 0.321%, and 79.5% respectively. Conclusion: This study’s findings stated that serum CA-125 may be a useful marker in distinguishing PTB from bacterial pneumonia. Therefore, further study with a more generalized study population is recommended.

Thyroid Dysfunction in Adults with Newly Detected Type 2 Diabetes Mellitus: A Study in a Tertiary Care Hospital, Dhaka, Bangladesh

Background: Thyroid disorders and diabetes mellitus are common endocrine disorders that often coexist and can significantly impact each other’s management. The American Diabetes Association recommends that people with diabetes be periodically screened for thyroid dysfunction due to the strong link between the two conditions. It is important for individuals to be aware of the risk factors for both conditions and to seek appropriate medical care if necessary, and for healthcare providers to consider testing for thyroid dysfunction in adults with newly detected type 2 diabetes mellitus. The aim of the study was to find out thyroid dysfunction in adults with newly detected type 2 diabetes mellitus. Material & Methods: This cross-sectional, descriptive study was conducted at the Departments of Medicine and Endocrinology at Sir Salimullah Medical College and Mitford Hospital in Dhaka. The study period lasted six months, from May to October 2019. A total of 102 adult patients (above 20 years old) with newly diagnosed type 2 diabetes mellitus who were attending the Endocrinology and Medicine Outpatient Department participated in the study. Results: Out of 102 adults with newly detected type 2 diabetes mellitus, the majority (86.3%) had normal thyroid function (euthyroid), while a smaller number (13.7%) had thyroid dysfunction. The most common subgroup of thyroid dysfunction was subclinical hypothyroidism (7.8%), followed by hypothyroidism (3.9%), subclinical thyrotoxicosis (1.0%), and hyperthyroidism (1.0%). The majority of the study population was male (66%) and from urban areas (88%), with a mean age of 45.1 years, a mean BMI of 25.0 kg/m2, and a mean waist circumference of 98.4 cm. About 45% had a family history of diabetes mellitus and 37% were smokers. The blood pressure of the study population was within normal limits. A minority (30%) had co-morbidities such as hypertension, dyslipidemia, and ischemic heart disease. The predictors of thyroid dysfunction were observed Age (OR=0.785), F/H of thyroid disorder (OR=0.495) BMI (OR=1.059), Anti-TPO Ab(OR= 0.021). Conclusion: Thyroid dysfunction and diabetes are commonly associated with each other and can impact clinical presentation and laboratory results. It is important to routinely screen for thyroid function in all patients with type 2 diabetes mellitus to detect, treat, and prevent complications of both these conditions.

Mesenteric Cysts in Children: Review of 55 Cases in A Tertiary Hospital

Background: Mesenteric cysts are rare, benign, fluid-filled tumors that occur in the mesentery, a thin layer of tissue that supports the intestines. The management of mesenteric cysts in children typically involves surgical intervention. The aim of this study was to evaluate the prevalence, the clinical presentation and management of mesenteric cysts in children. Material & Methods: This retrospective study was conducted in the Division of Pediatric Surgery, Bangladesh Shishu Hospital & Institute, Dhaka from July 2016 to June 2022. A total of 18,326 patients admitted in the Division of Pediatric Surgery, hospital records of 55 patients diagnosed with mesenteric cysts were evaluated and included in this study. Results: The prevalence of mesenteric cyst in our study was almost 1 per 333 pediatric surgical admissions. In our study, the mean (± SD) age of the patients was 36.5±13.5 months ranged between 2 days to 12 years. Majority of the patients were male (58.2%). Of the total of 55 patients, 18 patients required emergency surgery and 37 underwent elective surgery. Abdominal pain was the main presenting symptom, present in 52.7% of the patients. Fifteen of the emergency surgery were done on preoperative diagnosis of appendicitis or perforated appendicitis with peritonitis. Majority of patients (76.4%) had multiple numbers of cysts. The cysts were located in the small bowel mesentery in 23 cases, the base of the mesentery having retroperitoneal extension in 18 cases, the transverse mesocolon in 14 cases. Complete cyst excision was done in majority of the patients (65.5%) and complete excision with intestinal resection was required in 19 (34.5%) patients. With a mean follow-up of 9 months, we encountered no recurrences. Some patients are still under follow-up. Conclusion: Mesenteric cysts are usually symptomatic and CT scan is the investigation of choice. Complete surgical excision is the optimal treatment. Prognosis is excellent after complete surgical excision; long-term follow-up is needed due to the possibility of recurrence, even in adulthood. Though mesenteric cysts are a rarity in children in the literature, but it is not so uncommon in our experience.

Hypothalamic-Pituitary-Adrenal axis activity in SARS-CoV-2 infected noncritically ill hospitalized patients / Journal of the ASEAN Federation of Endocrine Societies

Objectives@#This study determined the baseline hormonal levels of the hypothalamic-pituitary-adrenal axis and their associated factors in noncritically ill hospitalized patients with coronavirus disease 2019 (COVID-19).@*Methodology@#This cross-sectional observational study was carried out in 91 noncritical RT-PCR-confirmed COVID-19 patients (18-65 years) recruited consecutively from the COVID unit, of two tertiary care hospitals over a period of six months. After screening for exclusion criteria relevant history and physical examinations were done, and blood was drawn between 07:00 am to 09:00 am in a fasting state to measure serum cortisol and plasma adrenocorticotropic hormone (ACTH) by chemiluminescent microparticle immunoassay.@*Result@#Of 91 patients, 54, 26, and 11 had mild, moderate, and severe disease respectively. Median values of serum cortisol (p=0.057) and plasma ACTH (p=0.910) were statistically similar among the severity groups. Considering cortisol cut-off of 276 nmol/L (<10 μg/dL), the highest percent of adrenal insufficiency was present in severe (27.3%), followed by mild (25.9%) and least in moderate (3.8%) COVID-19 cases. Using the cortisol/ACTH ratio >15, only 6.6% had enough reserve.@*Conclusions@#The adrenocortical response was compromised in a significant percentage of noncritically ill hospitalized patients with COVID-19, which is unrelated to infection severity, with greater percentages present in severely infected cases.

Sexual dysfunction in women with type 2 diabetes mellitus: A single-centre cross-sectional study from Bangladesh

ABSTRACT Objective: Sexual dysfunction among women with diabetes is a common but neglected health issue worldwide. The objective of the present study was to investigate the prevalence of sexual dysfunction and its associated factors among women with type 2 diabetes mellitus (T2DM). Subjects and methods: This cross-sectional comparative study comprises 150 women with diabetes and 100 healthy women without diabetes who visited the endocrinology outpatient department of Mymensingh Medical College Hospital (MMCH). The data were collected from July to December 2019. Sexual dysfunction was assessed by the 19-item Female Sexual Function Index (FSFI). Informed consent was obtained before participation. Collected data were analysed by SPSS 26. Results: More women with diabetes than control subjects reported sexual dysfunction (79% vs. 72%; p = 0.864). The global FSFI score was lower among the diabetes patients than among the healthy controls (20.8 ± 7.2 vs. 23.7 ± 4.8; p < 0.001). Patients with T2DM scored significantly lower in the domains of desire (p = 0.04), lubrication (p = 0.01), orgasm (p = 0.01), and satisfaction (p < 0.001), but not the domain of arousal (p = 0.09). A prolonged duration of diabetes was the primary contributor to orgasm problems (adjusted odds ratio, aOR 1.3, 95% CI 1.1-1.7) and painful intercourse (aOR 1.2, 95% CI 1.1-1.5). Conclusion: Sexual problems are frequent in women with diabetes. Inclusion of sexual health in comprehensive diabetes management is crucial to address this problem as well as to improve the quality of life of female diabetes patients.

Effect of Cissus quadrangularis on Fracture Healing in Laboratory Animal / Efeito do Cissus quadrangularis na cicatrização de fraturas em animais de laboratório

Objectives: The present study was designed to examine the efficacy of Cissus quadrangularis paste on fracture healing in artificially induced fractured rabbits. Methods: Fifteen rabbits were separated into three groups namely A, B, and C. Veldt grape paste was applied in groups B and C (Treatment Group) by close reduction and open reduction methods of fracture management; respectively, while group A was kept as control. The blood parameter and fracture healing properties in all animals have been monitored and examined routinely during the study period. Results: Both treated groups revealed lower serum calcium levels (SCL) than the control group after 24 hours of fracture that became within the normal range on the 14th day. Fracture healing in the treated groups has been commenced more rapidly than the control group with complete bridging of discontinuity by a distinct osseous callus in the fracture line on day 7 and complete effacing of fracture line on day 14. Conclusion: We did not find any type of anomalousness, clinical deviations, and alteration of serum calcium level on the 14th day of the fracture in treated animals hence Veldt Grape paste could be readily applicable to the management of the fracture in animals.

Objetivos: avaliar a eficácia da pasta de Cissus quadrangularis na consolidação de fraturas em coelhos fraturados artificialmente. Metodos: quinze coelhos foram separados em três grupos (A, B e C). A pasta foi aplicada nos grupos B e C (Grupo de Tratamento) pelos métodos de redução fechada e redução aberta de gerenciamento de fraturas; respectivamente. O grupo A foi mantido como controle. O parâmetro sanguíneo e as propriedades de cicatrização de fraturas em todos os animais foram monitorados e examinados, rotineiramente, durante o período do estudo. Resultados: ambos os grupos tratados revelaram níveis séricos de cálcio (SCL) mais baixos do que o grupo controle, após 24 horas de fratura que se tornou normal no 14º dia. A cicatrização da fratura nos grupos tratados foi iniciada mais rapidamente do que o grupo controle, com ponte completa de descontinuidade por um calo ósseo distinto na linha de fratura no dia 7 e apagamento completo da linha de fratura no dia 14. Conclusao: não encontramos nenhum tipo de anomalia, desvios clínicos e alteração do nível sérico de cálcio no 14º dia da fratura nos animais tratados, portanto, a pasta Veldt Grape pode ser aplicável ao manejo da fratura em animais.

Characterization and survival of broad-spectrum biocontrol agents against phytopathogenic fungi / Caracterización y supervivencia de agentes de control biológico de amplio espectro frente a hongos fitopatógenos

Resumen Este estudio tuvo como objetivo aislar, caracterizar e identificar bacterias de control biológico que poseen actividad antifúngica de amplio espectro de la filosfera de diferentes cultivos, incluidos el maíz, el trigo y la papa, así como evaluar su actividad en la promoción del crecimiento. En este estudio, 14/113 bacterias de control biológico mostraron actividad antifúngica. Los aislamientos bacterianos M11 y M33 (de maíz), del total de 113, fueron reseleccionados debido a su fuerte actividad antifúngica de amplio espectro (más del 50%) después de su evaluación contra cuatro hongos fitopatógenos que afectan cultivos de alta importancia económica, entre ellos, Alternaría alternata, Rhizoctonia solani, Fusarium oxysporum y Fusarium verticillioides. Los aislamientos se evaluaron, adicionalmente, para determinar los rasgos que promueven el crecimiento de las plantas, es decir, producción de ácido indolacético, solubilización de fosfato, producción de celulasa, compuestos orgánicos volátiles microbianos, cianuro de hidrógeno y sideróforos. Las 14 cepas aisladas mostraron resultados positivos para la producción de la hormona ácido indolacético y la enzima celulasa; 10 cepas fueron positivas para la producción de cianuro de hidrógeno. Además, se observó producción de sideróforos en el caso de 7 cepas, mientras que 5 pudieron solubilizar fosfato inorgánico. Los compuestos orgánicos volátiles microbianos solo fueron sintetizados por los aislamientos M11 y M33, que fueron identificados como Bacillus amyloliquefaciens y Bacillus subtilis, respectivamente, mediante secuenciación del gen ARNr 16S. El estudio de supervivencia mostró que las bacterias de control biológico, es decir, B. amyloliquefaciens y B. subtilis, tienen la capacidad de sobrevivir sobre un sustrato a base de melasa, por un período de tres meses.

Prevalence of vitamin D deficiency in exclusively breastfed infants at a tertiary healthcare facility in Nairobi, Kenya

ABSTRACT Objective: To determine the prevalence of vitamin D deficiency (VDD) in exclusively breastfed infants at the Aga Khan University Hospital Nairobi, Kenya (AKUHN). The relationships between 25-hydroxyvitamin D; 25OHD, parathyroid hormone (PTH), maternal vitamin D supplementation, and sunlight exposure were also determined. Subjects and methods: Blood from 98 infants was assayed for 25OHD, calcium, phosphate, and PTH. Socio-demographic and clinical characteristics were analyzed using descriptive statistics and inferential analysis (p < 0.05). Results: The prevalence of VDD (25OHD <12 ng/mL), vitamin D insufficiency (VDI, 25OHD 12-20 ng/mL) and vitamin D sufficiency (VDS, 25OHD >20 ng/mL) was 11.2% (95% CI 8.0%-14.4%), 12.2% (95% CI 8.9%-15.5%), and 76.5% (95% CI 72.3%-80.8%) respectively. There was no difference in the mean age, head circumference, length, or weight of infants in VDD, VDI, and VDS groups. PTH was elevated when 25OHD was <12 ng/mL and normal when 25OHD was between 12-20 ng/mL. 25OHD and PTH were normal in infants whose mothers received vitamin D supplements. Infants who received <30 minutes/day of exposure to sunlight were 5 times more likely to have VDI than infants who received ≥30 minutes/day (p = 0.042). Conclusions: The prevalence of VDD in exclusively breastfed infants at AKUHN is low. The current national policy that recommends exclusive breastfeeding of infants in the first 6 months of life appears to be effective in staving off vitamin D deficiency but those infants with < 30 minutes sunlight exposure may benefit from low dose supplemental vitamin D during times of low sunlight exposure.

Prevalence and comorbidity of psychiatric symptomology in Pakistani female adolescents

Abstract Background Previous researchers have demonstrated the co-existence of psychiatric conditions across clinical as well as non-clinical samples in diverse situations. The present study examined the prevalence and co-morbidity of various psychiatric symptoms (e.g. learning disabilities, depression and anxiety) in school-age female adolescents. Methods In a cross-sectional random sampling method, 252 girls from two government schools in Lahore were assessed by Learning Disabilities Checklist, Children Depression Inventory and the Spence Anxiety Scale. Results The results demonstrate significant prevalence and co-morbidity of psychiatric symptoms. Of the 252 participants, 34%, 21% and 68% had significant learning disabilities, depression and anxiety symptoms respectively. In addition, 27% of them presented symptoms of three studied psychiatric conditions. A highly significant positive correlation was found between learning disabilities, depression and anxiety symptoms. Methods There is a dire need for preventative intervention programs to promote mental health at school level. Further, assessment plans for the screening of psychiatric symptoms in normative samples also need to be put in place.

Bone marrow involvement as a rare manifestation of relapsed choroidal melanoma

Choroidal Melanoma is the most common primary intra-ocular malignancy. Incidence of primary choroidal melanoma is about 6 cases per 1 million population. It disseminates hematogenously. The most common site of metastasis is liver. Metastatic melanoma involving the bone marrow is rare, occurring in 5% of patients with disseminated disease. However, Choroid melanoma with bone marrow involvement is very rare. Only a few case reports are published in literature.  Authors present a case of bone marrow metastasis from choroid melanoma in 55 years old female who has been treated for primary choroidal melanoma by enucleation of left eye three years back. In the evaluation of symptomatic anemia, features suggestive of bone marrow infiltration by choroidal melanoma were observed on bone marrow aspiration and biopsy. The diagnosis was confirmed by positivity of immune-histochemistry markers HMB-45 and Melana.

Clinical and etiological profile of neonatal sepsis in children admitted to tertiary care hospital

Background: Neonatal sepsis is leading cause of mortality in children. The clinical presentation of neonatal sepsis is non-specific and variable. This study was undertaken to study clinical and etiological profile of neonatal sepsis.Methods: This was a prospective study conducted over a period of one year from March 2018 to March 2019. The patients with clinically suspected sepsis were included in this study. Detailed history and examination was done in all patients. In addition to baseline investigations, C-reactive protein and blood culture was done in all patients. Blood culture was done prior to administration of antibiotics.Results: In this study there were total of 102 patients out of which 54 were male and 48 were female. Among 102 patients, 69 patients were premature born before 37 weeks of gestation. Prematurity   emerged to be the most common   risk factor. In this study 62% patients had EOS (<72 hours of life) and 38% had LOS (>72 hours of life). The most common presenting feature were refusal of feeds, lethargy, respiratory distress and hypothermia. Other features were seizures, abdominal distension, apnea and sclerema. Blood culture was positive in 41% patients. The most common organism isolated on culture was Kleibsella followed by E. coli.Conclusions: Neonatal sepsis is leading cause of mortality in children. Early diagnosis and treatment is of paramount importance to prevent mortality. The clinical presentation of neonatal sepsis is non-specific and variable. So, high index of suspicion is required to detect sepsis at earliest. Gram negative organism like Kleibsella and E. coli are the common causative organism in neonatal sepsis.

Effect of Foot Reflexology on Fatigue, Stress and Serum Cortisol Levels in Women with Multiple Sclerosis

Fatigue, stress, and increased cortisol are common problems experienced by MS patients. Given that there is little research in Iran and abroad on the effects of foot reflexology, the present study explored the impact of foot reflexology on fatigue, stress, and serum cortisol levels in women with multiple sclerosis. MethodsIn this randomized clinical trial study, conducted among 60 women with multiple sclerosis referred to Multiple Sclerosis Society of Yazd. Sampling was initially performed by targeted sampling method based on entry and exit criteria and then 60 samples were randomly divided into two groups of intervention and control using a random number table. The foot reflexology was performed for the intervention group and simple food massage was performed for the control group for 4 weeks, 3 times a week for 15 minutes for each foot. The data were collected using Fatigue Severity Scale, Stress Symptom Index, and the Demographic Information Form, and analysed using the chi-square test, independent samples t-test, and two-way repeated-measures ANOVA with SPSS software (Version 18). ResultsThe mean serum levels of cortisol and fatigue showed a significant decrease at different times in the intervention group compared to the control group (P<0.00001). The mean stress scores in the intervention group were significant in the pre-test-post-test and pre-test-follow-up phases (P <0.00001) but not significant in the post-test phase with one-month follow-up (P = 0.074). ConclusionsThe results of the study suggested that foot reflexology has a long-term effect on fatigue and cortisol serum levels and a short-term effect on stress in women with multiple sclerosis

Neurocognitive outcome in young child with Isovaleric Acidemia

Isovaleric Acidemia (IVA) is inherited as an autosomal recessive trait, caused by the deficiency of the enzyme isovaleryl CoA dehydrogenase. It has the prevalence of 1 in 62,500 (in parts of Germany) to 1 in 250,000 live births (in the United States). Acute episodes of metabolic decompensations may occur, which may mimic sepsis, ketosis or shock. Early diagnosis & early initiation of treatment has been reported to correlate with a good neurocognitive outcome. This is case of child presenting in Paediatric emergency department with fever, vomiting, increased respiratory activity and lethargy. Child had GCS score of 8/15, acidotic breathing, hypotonia with hyporeflexia. Sepsis screen, metabolic work up and neuroimaging were all normal except for high anion Gap acidosis with ketosis. So further neurometabolic screening work up was done in view of persistent metabolic acidosis, developmental delay, and bad obstetric history in mother. It revealed increased excretion of isovalerylglycine 1(IVG 1), Isovalerylglycine 2 (IVG2) Lactate, 3-Hydroxypropionate (3HP) and 3-Hydroxybutyrate (3 HB).Serum lactate 358.54 (control 1.1-208.1) confirming the diagnosis of Isovaleric Acidemia. After recovery from the acute attack, the patient was advised low-protein diet (1.0-1.5 g/kg/24 hrs.) and carnitine (100 mg/kg/24 hrs. orally) supplements. On follow up child is asymptomatic & showing neurological improvement as he started achieving further developmental milestones during 6 months follow up.Early diagnosis and early treatment of IVA cases definitely results in favorable outcome and better prognosis. But chronic intermittent cases presenting late should not be neglected, proper medical management can reverse neuromotor consequences in them also.

Double trouble: hemophagocytic lymphohistiocytosis in a child with Dengue fever

The epidemic of Dengue is steadily increasing in more than 100 endemic countries. During critical phase, of this disease, shock with organ dysfunction and severe bleeding, can occur. Rarely, it can be further complicated by Hemophagocytic lymphohistiocytosis (HLH), which results from aberrant activation of immune mechanism. HLH is a rare, frequently fatal if untreated condition. It challenging to diagnose because initial symptoms mimic other conditions which are more common. Dengue induced Secondary Hemophagocytic lymphohistiocytosis (HLH), may be responsible for severe form of Dengue with adverse outcomes. We describe a case of an infant, with Dengue fever whose clinical situation deteriorated after being stable during initial phases of illness due to development of Secondary Hemophagocytic lymphohistiocytosis (HLH). The child had persistent fever, anemia, hepatomegaly with deranged coagulation which directed towards diagnosis of Secondary Hemophagocytic lymphohistiocytosis (HLH). We discuss the features of our case and its management to sensitize the clinicians to consider this condition in patients with severe Dengue fever.

Parental stress: a neglected entity

Background: Parents feel very stressed when their child is sick and in Intensive care unit. Objectives of study were to identify common parental stressors during their child's critical illness and to examine its relationship with demographic variables.Methods: It's a Cross-sectional questionnaire based study done in PICU & NICU of a tertiary care medical college hospital in Mumbai, 62 parents of children admitted to PICU and NICU for at least 24 hours were interviewed using the Parental Stress Scale. The demographic variables were also recorded.The data analyzed using Cluster Analysis, Kruskal Wallis test, Chi- square test and spearman correlation.Results: The main cause of parental stress was to witness the child's sufferings (unresponsiveness/pain, procedures, tubes, monitors around child) (median of standardized score = 3.9, IQR = 0.5, p <0.005). The median of standardised stress score due to hospital environmental factors (monitor alarms, nurses, doctors around baby, other sick children) was 3.7 (IQR = 0.5) and that due to lack of intimacy with child was 3.6 (IQR =0.4). Age of parent inversely correlated with the level of stress (r = -0.638) and parents of infants were more stressed (p = 0.005). Number of children, socioeconomic status didn't affect the stress levels.Conclusions: Young parents and parents of infants were more stressful. Socioeconomic status, residential area and parental sex didn't affect stress. Few stress factors need remedial steps to meet parental needs. The clinician's awareness about these stressors, may help to provide optimized family-directed care.

Knowledge and practice among the pediatric post graduate residents regarding the technique of blood culture sampling

Background: Errors in sampling during blood culture, may lead to contaminants or poor yield which result in faulty reports increasing patient's suffering, endanger patient safety and increasing cost of health care. Optimal knowledge about the sampling method for important microbiological test like blood culture translates into appropriate practices. Authors objectives was to assess the knowledge and practice of the Pediatric resident doctors, regarding sterile technique during blood culture collection. The change in the knowledge of the residents during blood culture sampling with regards to maintaining asepsis after watching educational video was evaluated.Methods: A quasi experimental, questionnaire based study with pre–post intervention,  involved post graduate resident’s knowledge and  practice regarding the sterile technique during blood culture collection. The data   analyzed using paired t test and Chi-square Test.Results: 18(60%) participants accepted that they have collected blood culture not maintaining complete asepsis at some time in past. The reasons for the same were lack of knowledge 14 (46.66%), no assistance from staff for the procedure 14 (46.66%), non-availability of sterile gloves 4 (13.33%), non-availability of antiseptic solution 4(13.33%), time consuming 8 (26.66%).Conclusions: Ultimately, blood culture contamination is a complex, challenging problem that requires a multidisciplinary approach. Regular teaching modules for the health personnel and ensuring environment conducive to correct practises would definitely help in improving the sampling practises for aseptic procedures.

Effect of Dexmedetomidine as an Adjuvant to Caudal Ropivacaine for Postoperative Analgesia in Paediatric Patients Undergoing Subumblical Surgery

Caudal block is most popular regional anesthetic technique used in children. It provides excellent analgesia duringsurgery as well as in postoperative period in subumblical surgeries. In this study, we compared the analgesic efficacyand safety of caudal dexmedetomidine added to caudal ropivacaine for postoperative analgesia in children. 60patients aged 1 to 8 years scheduled for subumblical surgeries were randomly allocated into two groups of 30 patientseach. Group RD received 1ml/kg of 0.2% ropivacaine with dexmedetomidine 2ìg/Kg in normal saline 1 ml. Group Rreceived 1ml/kg of 0.2% ropivacaine with normal saline 1ml.Hemodynamic parameters, duration of analgesia, painscores using observational pain scoring (OPS), requirement of rescue analgesia, and various complications wererecorded.The duration of analgesia in group R was 8.4± 1.4 hours while in group RD the duration was 10.4 ± 2 hours.Maximum OPS scores were lower in group RD compared to group R.It was concluded that caudal dexmedetomidinewhen added to ropivacaine as an adjuvant increases the efficacy and duration of analgesia, reducing the need of postoperative rescue analgesia with no additional side effects.

Assessment of the knowledge, attitude and practice of self medication among second year undergraduate medical students in a tertiary care teaching hospital

Background: Inappropriate self-medication is a cause of concern as it can result in wasteful expenditure, prolonged suffering, drug dependence, resistance and increase in morbidity. Self medication assumes significance among medical students as they have knowledge about ailments and medicines. The aim of the study was to assess the knowledge, attitude and practice of self-medication among undergraduate medical students.Methods: The present study was conducted in December 2017 among second professional undergraduate medical students in the Department of Pharmacology and Therapeutics, GMC Jammu after obtaining approval from the Institutional Ethics Committee of GMC, Jammu. A total of 123 students who took self-medication during last six months were included and given a questionnaire that included open and close ended questions about self-medication. Data was analysed using Microsoft Excel and presented as number and percentages.Results: Total of 123 second professional undergraduate MBBS students were analysed. 72 (58.53%) were males and 51 (41.46%) were females. 96 (78%) students practised self-medication. Allopathic drugs were most commonly used for self medication (93.5%), followed by Ayurvedic drugs. Fever and headache were common ailments treated with self medication. Common class of drugs used for self medication were antipyretics (66.6%), antibiotics (42.2%). Adverse drug reactions were perceived as the most common disadvantage of self medication. Analysis of source of information revealed that old prescriptions (33%), internet (18%) were the main sources of information. Regarding prevention of self medication, many students perceived that enhancing awareness was the most effective solution (72.3%) followed by stoppage of supply of medicines without prescription(39.8%).Conclusions: Self medication is practised by a majority of students. As responsible self medication is now increasingly being considered as a component of self-care, there is need for review of educational programs especially teaching of rational and judicious use of medicines to the undergraduate medical students.

Expression of MUC5AC in normal gastric mucosa, intestinal metaplasia and gastric carcinoma by immunohistochemistry

Background: Carcinomas of the stomach are a heterogeneous group of lesions in terms of architecture, pattern of growth, cell differentiation, and histogenesis. Altered MUC5AC expression patterns have been reported previously in intestinal metaplasia as well as in gastric cancer. The aim of the study was to analyse the expression pattern of MUC5AC in normal, pre-neoplastic and neoplastic gastric epithelium.Methods: Formalin fixed paraffin embedded sections of sixty cases which include twenty cases of each normal gastric mucosa, intestinal metaplasia and gastric carcinoma were taken up for the study and subjected to immunohistochemistry using MUC5AC.Results: The intensity of MUC5AC immunostaining in normal gastric mucosa, intestinal metaplasia and gastric carcinoma was evaluated. Immunoreactivity was graded as 0 (negative), ± (trace positive), + (positive) or ++ (strongly positive). Statistical analysis was performed with Chi-Square test and significant differences were noted between these 3 groups (p value <0.05).Conclusions: Authors concluded that MUC5AC expression rates might be good parameters in progression of intestinal metaplasia to gastric carcinoma and might be a good prognostic marker for gastric carcinoma as it is very well implicated in understanding of gastric carcinogenesis.