Evaluation and comparison of knowledge, attitude and practice about iron deficiency anemia amongst medical students of rural and urban background.

Background: Iron Deficiency Anemia (IDA) is most prevalent anemia worldwide. Women have additional iron requirement from puberty to menopause. This arises from physiological needs of menstruation, pregnancy and lactation. Iron is required for oxygen transport, cellular oxidation, phagocytosis and immune functions. The magnitude of anemia as health problem is huge and can be tackled with increasing awareness, promotion of correct attitudes and practices. Methods: Cross sectional study consisting of 50 medical students of age group 18-22 years divided in two groups coming from rural (Group I) and urban background (Group II). A structured questionnaire of 26 questions, out of which 18 questions based on knowledge. 4 on attitude and 4 on practice. Response was assessed using Percentage analysis and Chi square test. Results: All students defined anemia as Hb <11 g/dl, RBC <4.5 million/cu.mm with pallor. 80% students having knowledge that anemia is more common in rural area. Most common sources of information were books and teachers (76% in Group I and 56% in Group II). The practice of eating green vegetables and taking tea after meals was more in Group I. Conclusions: The results of our study showed that though Group II had better knowledge regarding IDA Group I followed more favourable practices. Our study, though small in size gives a glimpse of the greater picture. The attitude and practice of students and society in general needs to be improved with intensive media campaigns. Greater awareness about causes, prevention and treatment will go a long way in combating IDA.

Self medicated Combiflam induced acute dermatological drug reaction.

A 30 year old female took a single tablet of Combiflam (ibuprofen 400mg + paracetamol 325mg) for backache following which she noticed maculopapular rashes with generalized facial and lip swelling with generalized itching. Subsequently patient was treated with antihistaminic and steroids and she responded well. The causality assessment according to Naranjo casualty assessment scale come under “Probable” category of adverse drug reaction. According to World Health Organization-Uppsala Monitoring Centre causality assessment scale it falls under “Probable/Likely” category. According to Hartweig and Siegel severity assessment scale it was level 3 and moderate adverse drug reaction. This is a rare adverse effect of combiflam with the incidence less than 0.1%. The awareness of the health care personnel to this widely used drug on its rare adverse effect is necessary.

Role of 30 kDa antigen of enteric bacterial pathogens as a possible arthritogenic factor in post-dysenteric reactive arthritis.

Background: Reactive arthritis (ReA)/Reiter’s syndrome (RS) may be caused as a sequel of infections caused by enteric bacterial pathogens, although the mechanisms through, which different pathogens cause similar disease are not clear. Aim: This study was done to look for the presence and role of any common bacterial antigen among the pathogens isolated from such patients. Materials and Methods: A total of 51 patients of ReA and 75 controls (three groups of 25 subjects each: Group 1: Patients who did not develop arthritic complications within 3 months after bacillary dysentery/diarrhea; Group 2: Patients with other arthritic diseases and Group 3: Normal healthy subjects) were included. The isolated enteric pathogens were tested to detect the immunodominant antigens. Results and Conclusions: A common 30 kDa antigen was found to be specifi cally present among seven arthritogenic enteric bacterial strains belonging to three genera, Salmonella, Shigella and Hafnia. Post-dysenteric ReA patients’ sera show higher levels of immunoglobulin G, immunoglobulin M and immunoglobulin A antibodies against this antigen as compared to the controls. Lymphocytes of ReA patients recognize this antigen, proliferate and produce interleukin-2 in response to this antigen more than the lymphocytes of controls. 30 kDa antigen may be a common arthritogenic factor associated with postdysenteric ReA/RS. The association of Hafnia alvei with post-dysenteric ReA is described for the fi rst time. Four cases of mycobacterial ReA had an association with this antigen, suggesting that the arthritogenic antigen of mycobacteria and enteric bacteria may be of a similar nature.

Knowledge and attitude towards antimicrobial self medication usage: a cross sectional study among medical and nursing students.

Background: Antimicrobial drug resistance is a fast mounting universal crisis. Many factors like self medication, inappropriate use and unregulated sale of medicines and self medication have been attributed to this problem. The objective was to determine extend and causes of antimicrobial self medication and to compare the knowledge attitude of senior and junior medical/nursing students. Methods: We conducted a cross-sectional study on randomly selected 410 students from Baba Farid University of Health Sciences Faridkot, Punjab. A total sample of 220 medical students were enrolled from GGS Medical College, Faridkot (1st year students 50 and 170 above 1st year senior medical students ) and 190 nursing students were enrolled from University College of Nursing, Faridkot. Results: prevalence of antimicrobial self medication came out to be around 74%. The most common cause for seeking antimicrobial (self therapy) was upper respiratory tract infection. A statistical significant knowledge/attitude gap was found between senior and fresher medical/nursing students. Conclusions: High prevalence of antimicrobial self medication among medical/nursing students is a matter of concern and it should be discouraged at appropriate level to safeguard students from preventable adversary exposure.

Growth, photosynthetic activity and oxidative stress in wheat (Triticum aestivum) after exposure of lead to soil.

The present study was conducted to assess quantitative information about lead (Pb) contamination in soil on the growth and physiology of wheat. Solutions with three different concentrations of Pb as [Pb(NO3)2 at 500, 1000 and 2500 >M] were incorporated into the soil to achieve Pb-stressed conditions in comparison to unstressed, water treated, control variant. Wheat growth measured in terms of root length, shoot length and dry weight exhibited a significant decline with increasing Pb concentrations in the soil. Root and shoot length and seedling weight declined in the range of ~23–51, ~17–44, and ~21–44% in response to 500 to 2500 >M Pb. In addition, there was a significant reduction in the levels of photosynthetic pigments-chlorophyll a (16-66%) and b (10-24%) and total chlorophyll content (by 14-39%) in plants growing in Pb-contaminated soil. It indicated a negative effect on photosynthetic activity in wheat and was confirmed by reduced photochemical efficiency of PSII (Fv/Fm) in the range of ~ 3-37% in response to 500 to 2500 >M Pb. The reduction in wheat growth in Pb-contaminated soil was accompanied by induction of oxidative stress as indicated by enhanced lipid peroxidation in terms of malondialdehyde (MDA) content (by 18-40%) and hydrogen peroxide (H2O2) content (by 34-123%) and alterations in the activity of enzymes, superoxide dismutases (SOD) and guaiacol peroxidases (GPX) in wheat roots. The study concludes that Pb in soil inhibits growth and phototsynthetic activity in wheat through induction of oxidative stress.

Phytotoxic effect of 2-benzoxazolinone (BOA) against some vegetable crops.

Benzoxazolin-2(3H)-one (BOA) is a well known allelochemical that is being explored for its herbicidal activity. However, not much is known about its effect on crop plants. The present study investigated the effect of BOA on germination and early growth of four vegetable crops viz. Pisum sativum L., Raphanus sativus L., Brassica oleracea L. var. botrytis and Brassica oleracea L. var. capitata. At 1000 <M, germination of P. sativum, R. sativus and B. oleracea var. botrytis was reduced by more than 50%, whereas that of B. oleracea var. capitata was completely suppressed. Further, BOA reduced the root and shoot length of the test plants by ~ 40-82% and ~55-85%, respectively. In general, the effect was more pronounced on the root (~82% in B. oleracea var. botrytis) than on the shoot growth (~73% B. oleracea var. botrytis). 2- Benzoxazolinone significantly enhanced the contents of proteins (by 6-28%) and carbohydrates (by 61- 189%) in B. oleracea var. capitata and decreased the activities of related enzymes like proteases (by 13- 36%), a-amylases (19-60%) and b-amylase (25-70%). The observed decline in the activities of hydrolytic enzymes amylases suggest that BOA interferes with the vital metabolic processes in the germinating seedlings leading to growth reduction. The study reveals that BOA interferes with the germination and early seedling growth of vegetable crops and induces biochemical alterations.

Prosthetic aortic valve endocarditis due to Ochrobactrum anthropi.

Ochrobactrum anthropi is an emerging pathogen increasingly affecting the immunocompromised host. Only four cases of infective endocarditis have been documented in literature. Therapeutic approach is a rising challenge as it is resistant to most of the currently available beta lactam antibiotics with the exception of carbapenems. We report a case of prosthetic valve endocarditis secondary to Ochrobactrum anthropi infection; the host was temporarily immunocompromised due to disseminated herpes zoster after surgery.

Prevalence and severity of dysmenorrhea : A problem related to menstruation, among first and second year female medical students.

Dysmenorrhea is the most common of gynecologic complaints. It affects half of all female adolescents today and represents the leading cause of periodic college/school absenteeism among that population. To evaluate the menstrual problem specially dysmenorrhea and its severity in female medical students and its effect on their regular activities. This is a cross-sectional descriptive study; conducted on 107 female medical students, all participants were given a questionnaire to complete; questions were related to menstruation elucidating variations in menstrual patterns, history of dysmenorrhea and its severity, pre-menstrual symptom and absenteeism from college and /or class; to detect the severity of dysmenorrhea we used the verbal multi-dimensional scoring system, participants were given 20 minutes to complete the questionnaire. The mean age of subjects at menarche was 12.5 (±1.52) years, with a range of 10-15 years. The prevalence of dysmenorrhea was 73.83%; approximately 4.67%of dysmenorrhic subjects had severe dysmenorrhea. The average duration between two periods and the duration of menstrual flow were 28.34 (±7.54) days and 4.5 (±2.45) days respectively. Prevalence of other menstrual disorders like irregularity, prolonged menstrual bleeding, heavy menstrual bleeding and PCOD were 7.47%, 10.28%, 23.36% and 3.73% respectively. Among female medical students who reported dysmenorrhea; 31.67% and 8.68% were frequently missing college & classes respectively. Premenstrual symptom was the second most (60.50%) prevalent disorder and 67.08% reported social withdrawal. Dysmenorrhea and PMS is highly prevalent among female medical students, it is related to college/class absenteeism, limitations on social, academic, sports and daily activities. Maximum participants do not seek medical advice and self treat themselves with prostaglandin inhibitors; like Ibuprofen.

Angioplasty of congenital pulmonary vein stenosis.

We present a unique case of idiopathic pulmonary vein stenosis in an adult who presented with progressive dyspnea and severe pulmonary arterial hypertension. Magnetic resonance imaging confirmed the diagnosis. The patient was treated by balloon angioplasty and is well at 6 months post-treatment follow-up. The etiology of pulmonary vein stenosis in this case is difficult to ascertain, but is likely to be congenital.

Acute myocardial infarction secondary to myocardial bridge treated with drug-eluting stent.

We report a case of myocardial bridge in left anterior descending coronary artery associated with acute anterior wall myocardial infarction. The patient had many unusual features like coronary ectasia and atherosclerosis within the myocardial bridge segment. The patient was treated with drug-eluting stent under intravascular ultrasound guidance with good result over 6 months follow-up.

Congenital atresia of left main coronary artery.

We report a rare case of congenital atresia of left main coronary artery in an elderly male presenting with angina and positive stress thallium test. Coronary angiogram showed absence of left main coronary artery in the left aortic sinus. Collaterals from right coronary artery supplied left anterior descending artery and left circumflex artery territories. Despite collaterals, the left anterior descending and left circumflex arteries were rudimentary. Poor size of left-sided arteries precluded any surgical revascularization which is the treatment of choice in this rare entity.

Percutaneous transluminal angioplasty in an embolic middle cerebral artery occlusion.

A young lady developed left middle cerebral artery embolism after percutaneous transseptal mitral commissurotomy. She was successfully treated with immediate percutaneous transluminal angioplasty. There was complete recovery of neurological deficit.

Percutaneous transluminal angioplasty of transplant renal artery stenosis.

Renal artery stenosis after renal transplant is a dreaded complication. We report two cases of post-renal transplant stenosis in internal iliac artery used for end-to-end anastomosis with the graft renal artery. Both patients were successfully treated by percutaneous transluminal angioplasty with stenting of the internal iliac artery.

Isolation of the left subclavian artery.

Two cases of isolation of the left subclavian artery from the aortic arch are reported for the rarity of this lesion. One patient was diagnosed clinically, the other after angiography. The isolated left subclavian artery was reimplanted in one patient. This rare anomaly has clinical and surgical relevance and should be diagnosed by diligent clinical and angiographic evaluation.