Randomized placebo controlled study of diclofenac as premedication for endoscopic retrograde cholangiopancreatography

Background: Endoscopic retrograde cholangiopancreatography (ERCP) is a complex procedure which is commonly performed at various centres. It causes considerable amount of pain and discomfort to patients, and various centres have their own protocols regarding its management. Authors aim to study the efficacy of intravenous diclofenac as a premedication to reduce the pain and discomfort during and after ERCP.Methods: This was a randomized placebo-controlled trial evaluating 40 patients. The pain and degree of discomfort was investigated using a 4- point ordinal scale questionnaire.Results: The use of intravenous diclofenac as premedication for ERCP significantly reduces pain and discomfort during and after the procedure.Conclusions: Intravenous diclofenac should be used as a premedication for ERCP procedure as it significantly reduces the pain and discomfort during and after the procedure.

Endoscopic assessment and Helicobacter pylori status evaluation in operated cases of peptic ulcer perforation

Background: Helicobacter pylori’s role in delaying ulcer healing after surgical repair for peptic ulcer perforation causing ulcer persistence hasn’t been definitively established as it has been for uncomplicated ulcers.Methods: Authors performed an endoscopy and H. pylori status evaluation in 30 patients at an average of 6.2 weeks after simple omental patch closure for perforated peptic ulcer.Results: A positive H. pylori status was found in 12 patients (40%) of which 9 had active ulcers. None in the negative group had an active ulcer. H. pylori infection was the only factor found to be responsible for ulcer persistence after surgery.Conclusions: A reasonable approach would thus be to perform an endoscopy 6 weeks after surgery to assess ulcer healing and H. pylori status. H. pylori eradication therapy should then be selectively initialled for patients with an active ulcer or positive H. pylori status.

A Prospective Study to Evaluate Efficacy & Safety of HBOT in Acute Traumatic Brain Injury.

Background: The purpose of this study was to test the effectiveness and safety of Hyperbaric Oxygen HBOT group (HBOT) in improving brain function in Traumatic brain injury patients suffering acute neurocognitive impairments. Aims: To study efficacy & safety of hyperbaric oxygen HBOT group on mortality and morbidity in acute traumatic brain injury with respect to degree of recovery, speed of recovery, length of stay in the hospital. Methods: In this prospective study we present 100 cases of head injuries. Patients were included in the study according to inclusion criteria. Fifty of them assigned to the control group and 50 to the HBO treatment group. Allocation is done by chit method in control and HBOT group. Glasgow coma score was obtained pre HBOT and post HBOT. The outcome was assessed by two blinded independent examiners. Results: All patients were assessed for improvement in GCS score. The average improvement in GCS score was 5.29% and 3.87% in HBOT and control group respectively. Similarly the average hospital stay was 12.26% days in the HBOT and 27% in the control group. Conclusion: Hence we would like to conclude that, HBOT is safe and effective for acute brain injury.

Modified Hassabs Procedure for control of Esophageal Varices in Portal Hypertension - A Prospective Study.

Background: Modified Hassab’s surgery is one of the Devascularisation procedure for controlling hemetemesis due to oesophageal varices. It has less chances of encephalopathy and mortality. We have studied 20 patients of oesophageal varices with portal hypertension and operated for Modified Hassabs Procedure. Aim: To determine the efficacy of Modified Hassab’s procedure for portal hypertension, due to causes other than Schistosomiasis, to determine the short term outcome and long term follow up of patients treated with this procedure regarding oesophageal varices, rebleeding, liver function, ascitis, encephalopathy and mortality following Modified Hassab’s procedure. Methods: This study was conducted at a single teaching hospital in Mumbai over a period of six years. 20 patients were studied for immediate and long term complications. Results: Oesophageal varices resolved in 11 patients (55%), regressed in 7 patients (35%), Fundic varices completely resolved in all the 4 patients. There was rebleed in two patients and was treated by sclerotherapy. There was no encephalopathy or mortality. Conclusion: We conclude that Hassabs Procedure is effective, and good control of varices can be achieved in portal hypertension patients due to Portal Vein Thrombosis and Portal Cavernoma, Cirrhosis of liver, Non Cirrhotic Portal Fibrosis.

A review of classification of disease in Ayurveda.

According to Charaka Samhita, the disease is the state in which both the body and mind are subject to pain and misery. There is need of classification of disease which is caused by exogenous and endogenous factors. Generally, the classification gives the idea about the type and difference between diseases. Classification of disease is very essential for the treatment of the diseased individual. Unskilled physicians, who are unable to identify nature of disease, examine patient by applying sensory organ which provides only superficial knowledge of disease. To know the whole nature of disease, one should know the classification of disease which is based on origin of disease causative factor, surgical cure or nonsurgical cure, infected organ etc.

Innovative Integrated Teaching for MBBS Undergraduates.

Medical colleges in India follow a curriculum with a large body of knowledge pertaining to basic sciences and clinical disciplines. Use of innovative techniques in teaching has certain advantages which include increasing teacher and learner enthusiasm and improving participation of the students. We combined the use of pre-/post-test in vertical integrated teaching to increase the effectiveness of the teaching process. An innovative vertical integrated teaching session was carried out for final MBBS students. A total of 35 students participated. A pre-test questionnaire was given to all the students to identify basic knowledge about the subject (HIV). Then the faculty conducted sessions on HIV, followed by a post-test questionnaire. This study revealed that students have improved their knowledge by the new teaching-learning method. The students were enthusiastic towards the new teaching-learning method. The faculty showed enthusiasm towards this new approach but were of the opinion that this method could be applicable only to selected topics. The teachers agreed that immediate feedback can be obtained from the students regarding acquisition of knowledge.

Needs assessment to identify the areas for the development of self learning modules in subject ashtang hridaya of first BAMS course.

Background and Objectives: M The new syllabus for the Ashtang hridaya by CCIM has addition of few more concepts. On the other hand number of lectures for the subject are reduced. It is practically difficult to teach complete syllabus in the given time. In the changed course structure and reduced lecture hours. The classroom teaching hours can be managed by development of self learning modules for the subject. Objectives: To identify the need of self learning modules. To enlist the must know, nice to know and desired to know areas of Ashtang Hridaya. To enlist the areas for Self learning and Classroom teaching. To evaluate efficacy of Self learning e Modules. Materials and Methods : Online Survey Faculties working in the Department of Basic Principles. with Questionnaire (www.qualtrics.com) was conducted. (63 completed Responses) and data was analysed. Development of Self learning eModule:- on the Chapter “Gandushadividhi” in Ashtang Hridaya. Testing of Module. Results: Study indicates that faculty came out with a clear mandate of Need of Self Learning Module.( Chi squared P<0.01) Ashtang hriday syllabus was classified is 18 Chapters in for Must Know(18), Nice to know (4) and desirable to know(7). Chapters were identified for Classroom teaching(20) and self learning(10). Insignificant distribution was observed for 7 chapters. Self learning module created on Gandishadividhi Chapter was tested on I BAMS students by Pre test and Post Tests (with Questionnaire containing 15 Questions) shows statistically significant (p<0.001) results for paired t test. Conclusions: There is certainly need of self learning modules for the I BAMS course. Study distributes in must know, nice to know and desired to know and chapters in Ashtang hridaya and classifies chapters for Classroom teaching and self learning. The self learning e Module shown statistically significant results when evaluated on I BAMS students.

Use of mini-cex as an effective tool of assessment in second B.A.M.S. students in rognidan.

Background and Objectives: Mini-CEX method of assessment is widely accepted method which includes structured assessment of an observed clinical encounter, provides feedback to the student on skills essential to the provision of good clinical care, and improves the competencies expected & the confidence level of the student. There has been limited or negligible research in this area in the field of Faculty of Ayurved. Methodology: 45 students from 2nd BAMS students were included in the study. The standard nine point scale format was adopted for rating the students. Each student was assessed twice on real patients, with low or moderate complexity level. The cases were not repeated for the successive encounter. Each student was rated for the competencies; the time required for observation & providing feedback, the evaluators’ & trainees’ satisfaction using mini-CEX were noted. Feedback was obtained from the trainees after completing the entire task. Results: Total 81 encounters with 44 students against a planned figure of 90 were recorded giving a completion rate of 90%. The mean observation time was 22 minutes & feedback time was 08 minutes. The scores in medical interviewing, physical examination, communication & professional qualities, counselling skills, clinical judgement, organisation efficiency & overall clinical performance (p< 0.0001, paired t-test) show statistically significant change in the successive encounter. The satisfaction level of the students and the assessors achieved high score with the mean of 7.7/8.1 and 8.3/8.1 respectively. Feedback analysis from the faculty & trainees is as follows: Average 40% trainees were felt anxious being observed. The method helped the students to: be more attentive & regular in clinical postings, achieve the confidence level, improve interpersonal skills, & to analyse strengths and weak areas of the students. Conclusions: The mini-CEX is an effective tool of assessment in second B.A.M.S. students in Rognidan to improve the expected competencies in case presentation skills with confidence.

Perforation of jejunal non Hodgkin's lymphoma.

Primary gastrointestinal lymphomas are rare. Jejunal non Hodgkin's lymphoma presenting as perforative peritonitis is extremely rare. We report a 51-year-old man who presented with perforative peritonitis and was detected to have jejunal non Hodgkin's lymphoma. He was treated with resection of the affected segment with its mesentery and postoperative chemotherapy, and was asymptomatic 5 months later.

Giant lobulated seborrheic keratosis at an unusual site.

Seborrheic Keratoses(SK) are common benign skin tumors of elderly occurring commonly on face, scalp, extremities, chest, back with genital and perianal sites being rare. Lesions are usually few millimeters to several centimeters, reaching pendulous proportions in areas of constant friction, especially in obese individuals. Though malignant transformation is rare, it is reported in irritated lesions, especially in flexures. An unusual case of giant lobulated seborrheic keratoses occurring in perianal area, without any evidence of malignancy on histopathology, in an otherwise healthy obese female is reported here.

Recurrent inflammatory pseudotumor of small bowel mesentery presenting as perforative peritonitis.

A 62-year-old man with recurrent inflammatory pseudotumor of the small bowel mesentery presented with perforative peritonitis; such a presentation has not been reported. The mass was excised successfully.

Degloving injury of small intestine.

Self-inflicted stab wounds are seldom very grave. We report a 25-year-old man who inflicted stab wounds with a glass piece under the influence of alcohol. This led to evisceration and later degloving injury to the small bowel. He recovered following surgery.