Comparative study of effectiveness of Papanicolaou smear and visual inspection using acetic acid and visual inspection using Lugol’s iodine for screening of premalignant and malignant lesions of cervix

Background: In developing and resource-limited countries alternative screening methods like VIA, VILI, and Pap smear are used in detection of premalignant and malignant lesions of cervix. The aim of our study was to compare the efficacies of VIA, VILI, and Pap smear in detection of premalignant and malignant lesions of cervix.Methods: The study was conducted for a period of one year in the department of obstetrics and gynaecology, Dr. Rajendra Prasad Government Medical College, Kangra at Tanda, Himachal Pradesh. Women who attended the outdoor patient department of obstetrics and gynecology were subjected to collection of Pap Smear, VIA followed by VILI and a thorough pelvic examination.Results: Among the 350 women studied, 59 women (16.9%) had abnormal VIA, 64 women (18.2%) had abnormal VILI. On pap smear, 10 women were reported as ASCUS, 11 as L-SIL and 1 as H-SIL. Cervical biopsy was done in 98 women, out of which 70 had one or more abnormality on VIA, VILI, or Pap, and 28 women who had normal results. Sixteen women (16.3%) reported as CIN-1 and 2 women (2.07%) as CIN-3. VIA and VILI had a higher sensitivity as compared to pap. However, pap was more specific. The PPV of pap was also much higher as compared to VIA and VILI, whereas there was no difference in NPV of the three.Conclusions: Authors observed that VIA presented the best sensitivity (88.8%), followed by VILI (83.3%), and Pap (72.2%). Pap smear had the highest specificity of 97.2%. The positive predictive value of Pap was higher as compared to VIA and VILI, whereas there was no difference in NPV of the three. VIA and VILI have good sensitivity, with reasonable specificity and because of their cost effectiveness and ease of availability, these can be an alternative screening modality for cervical cancer screening.

Perceived need and attitudes towards communication skill training in recently admitted undergraduate medical students

The Medical Council of India intends to implement an attitude, ethics, and communication training module for medical students. This study investigates undergraduate students’ attitudes towards communication skills training (CST). Forms were distributed to 81 recently admitted undergraduates, of whom 76 responded, in an anonymous cross-sectional survey. Single questions assessed knowledge of communication skills (CS), need for formal curriculum, and importance of CST. Attitudes toward CS were measured using a modified Communication Skills Attitude Scale. While 72% participants considered CST to be important and 68.4% reported a need for formal training, 43% felt CST would have a better image if it sounded more like a science subject. Forty percent of the students were ambiguous about willingness to trust information on communication skills given by non-clinical lecturers, whereas 15.8% were not receptive. Fifty-five percent felt nobody would fail because of poor communication skills, and 46% felt that the ability to pass exams would get them through medical school. We found a high prevalence of unfavourable attitudes about CS (as a subject). Course implementers should be mindful of and address attitudes towards CST while delivering the content of the course.

Experience of a faculty development workshop in mentoring at an Indian medical college.

Background. Our medical college is running a mentoring programme for undergraduate medical students since 2009. The academic leadership of the college identified the need to change the focus of the programme from mere problemsolving to professional and personal development of mentees. Methods. A core group of mentors designed and implemented a workshop on mentoring for 28 students. The workshop included reflections on the participants’ previous experiences about mentoring, discussion on perceptions of mentees about the existing mentoring programme, self-analysis of mentoring skills, overview of the Surrendering, Accepting, Gifting and Extending (SAGE) model and demonstration of effective mentoring skills using role plays and a film. We collected written anonymous feedback from participants at the end of the workshop to elicit their responses regarding various aspects of the programme, change in their views about mentoring and suggestions for future workshops. Results. A majority of the participants (17, 60.7%) said that role plays and reflection on role plays were the most valuable part of workshop as they provided clarity on the concepts about mentoring. The most frequently identified take-home messages were: building trust with the mentee (7, 25%), balance in life and approach towards the mentee (6, 21.4%), and understanding that mentoring is a process geared towards personal and professional development of the mentee (6, 21.4%). Conclusion. The participants’ reaction to the workshop was positive. The responses of participants suggested that the workshop was successful in changing their views regarding the purpose of the mentoring programme. Natl Med J India 2016;29:286–9

A Study on Clinical Profile and Antimicrobial Drug Resistance in Infection with Stenotrophomonas maltophilia at a Tertiary Care Hospital of Rural Gujarat, India.

Background & objectives: Stenotrophomonas maltophilia causes opportunistic infections and is emerging as an important hospital-acquired pathogen. Present study was undertaken to investigate the prevalence, clinical profile, associated factors and antimicrobial susceptibility of S. maltophilia. Methods: Cross sectional retrospective study was conducted whereby patients’ details including type of infection, hospital stay, indwelling devices, co-morbid conditions and outcome till discharge were collected from January 2012 to March 2016. Identification and antimicrobial susceptibility were done by using Vitek2-compact-microbiological system. Results: 45 (0.17%) S.maltophilia strains were isolated from 27,132 samples received, forming 1.63% of total non-fermenters. Prevalence of S.maltophilia infection ranged from 0.06% in 2012 to 0.26% in 2015. Common sites involved were respiratory tract i.e. 55.5%, followed by bloodstream (20%), urinary tract (13.3%) and soft tissue (11.1%). 64.4% patients were male, and adults (26.7%) between 51-60 years of age. 66.7% of the isolates were from critical care units followed by wards (33.3%). Co-morbid conditions observed were COPD with respiratory complications i.e. 26.7% followed by cardiovascular diseases 22.2%, malignancy 11.1%, post surgical patients 11.1%, complicated UTI and trauma 8.8% each, CNS complications 6.7%, burns and cellulitis 2.2% each. All patients had exposure to broad-spectrum antibiotics and 66.6% had indwelling devices. 17.8% isolates were resistant to trimethoprim-sulfamethoxazole. Mortality observed was 20%. Interpretation & conclusion: S maltophilia is an emerging pathogen and its prevalence has gradually increased at our hospital. ICUs are the main hospital sites and respiratory infections main clinical condition. [Disha S NJIRM 2016; 7(5):5-8]

Prevalence Of Human Brucellosis Among High Risk, Symptomatic Cases In Anand District Of Gujarat-India.

Abstract: Background and Objectives: Brucellosis is a bacterial zoonosis causing high economic losses worldwide. Because of nonspecific and chronic symptoms, diagnosis requires high clinical suspicion and laboratory confirmation. Prevalence of brucellosis in India, more so in Anand district, is not well studied. This study was conducted as a pilot to find prevalence of human brucellosis among high risk symptomatic cases along with the clinical profile and associated risk factors. Methodology: This is a cross-sectional descriptive study conducted in Anand district of Gujarat, India. Samples from 50 high risk symptomatic cases were subjected to serology, blood culture and genome detection by conventional Polymerase Chain Reaction (PCR) using B4/B5 primers, for detection of brucella infection. Data was analyzed using Epi Info software (version: 3.5.1). Results: We detected sero-prevalence of 14% and genome detection of 16% with no isolation in blood culture. Among them four (8%) were positive by serology and PCR both. Titers in seropositive cases ranged from 1:40 to 1:160. Fever was the most common clinical complain among sero-positive (71.4%) and PCR positive (62.5%) cases. History of direct contact with cattle was present in all serology and PCR positive patients. Consumption of unpasteurized milk or milk products (86%), consumption of uncooked or partially cooked meat (28.5%) and working as veterinarian (14.3%) were other risk factors identified. Conclusions: Thus we found brucellosis to be a significant health problem. A larger Indian study with follow up of positive cases, comparative study for standardization of various diagnostic modalities and response to therapy is strongly needed.

Spinocerebellar ataxia 7 (SCA7) in Indian population: predilection of ATXN7-CAG expansion mutation in an ethnic population.

Background & objectives: spinocerebellar ataxia 7 (SCA7) is a rare form of neurodegenerative disorder with the clinical manifestation of cerebellar ataxia and retinal degeneration. In this study we describe the clinico-genetic characteristics of nine SCA7 families of Indian origin and cross compare these with other available worldwide studies. Methods: Thirty five individuals from nine SCA7 families were clinico-genetically characterized and CAG repeat distribution analysis was carried out in 382 control DNA samples from healthy controls (derived from 21 diverse Indian populations based on ethnic and linguistic and geographical location). Results: Of the nine families studied, 22 affected individuals and one asymptomatic carrier were identified. The average age at disease onset was 23.4±12.6 yr. The length of expanded CAG ranged from 40-94 with mean value of 53.2±13.9. The main clinical findings in affecteds individuals included cerebellar ataxia, and retinal degeneration along with hyper-reflexia (95%), slow saccades (85%) and spasticity (45%). Analysis of the association of number of CAG repeats with disease onset revealed that <49 repeats were associated with earlier age at onset in South East Asians compared to European populations. Further analysis of CAG repeats from 21 diverse Indian populations showed pre-mutable repeats (28-34) alleles in the IE-N-LP2 population. Six of the nine families identified in this study belonged to the same ethnic population. Interpretations & conclusion: Our results show that presenece of SCA7 is relatively rare and confined to one ethnic group from Haryana region of India. We observed a homogeneous phenotypic expression of SCA7 mutation as described earlier and an earlier age of onset in our patients with CAG <49. The identification of pre-mutable allele in IE-N-LP2 suggests this population to be at the risk of SCA7.

A rare case of subconjunctival dirofilariasis by Dirofilaria repens in rural Gujarat.

Dirofi lariasis is a worldwide zoonotic fi lariasis with over 782 cases reported so far from diff erent parts of the world. Human dirofi lariasis, caused by Dirofi laria repens, have been reported to occur widely throughout Asia, Europe, and Africa. It has not been widely recognized in India, however; several cases have been reported in last few years. There is probably a focus of human infection with D. repens in Kerala. Herein, we present a review of human infections by D. repens, along with a case report of subconjunctival dirofi lariasis from rural part of Gujarat.

Extended spectrum beta-lactamases in escherichia coli & klebsiella spp - prevalence, associated risk factors and clinical outcome in hospitalized patients.

Objective: Infection by extended spectrum beta-lactamase (ESBL) producing strains of Escherichia coli and Klebsiella spp. is variably associated with presence of co-morbid conditions, predisposing factors and poor outcome. Objective of this study was to determine the prevalence of ESBL producing strains along with the outcome and risk factors in patients infected with such strains. Materials and Methods: This observational study was conducted on 6910 clinical samples. E coli & Klebsiella spp. were identified with detection of ESBL production according to Clinical and Laboratory Standards Institute (CLSI) guidelines. Patients’ clinical and demographic details along with risk factors and co-morbid conditions, type of response to antimicrobial therapy, length of hospital stay and mortality were collected. Results: 69.62% out of 563 E.coli and 62.80% out of 342 Klebsiella spp. were isolated from 6910 samples were ESBL producers respectively. Male:Female ratio was 1.36:1 and 2.37:1 for E coli and Klebsiella spp. respectively. Blood Stream Infection (p=.006), soft tissue infections (p=0.08), genital tract infections (p=0.03) and admission in intensive care units were significantly associated with risk of infection by Klebsiella spp. Immunosuppressive therapy (p=0.02) and diabetes mellitus (p=0.04) were significant comorbid conditions in ESBL producing E coli infections. The mean duration of hospital stay for ESBL producing E coli and Klebsiella spp. was 13.65 ± 12.6 and 17.89 ± 14.76 days with mortality of 8.6% and 13.34% respectively. Conclusions: Several co-morbid conditions and invasive devices were significantly associated with infection by ESBL-producing, strains of E. coli and Klebsiella spp. with longer duration of hospital stay and increased mortality in comparison to ESBL non-producers.

Epidemiological profile of vitiligo in Northern India.

Vitiligo is an acquired, progressive, common pigmentary disorder of the skin and hair characterized by well circumscribed milky white macules, devoid of identifiable melanocytes. From the Indian subcontinent the highest incidence has been reported in India. The aim of the study is to find the precipitating factor and clinical features of vitiligo patients in North India. Total of 275 subjects were enrolled for the study. The study was observational and was conducted over a two year period.118 were females while rest 82 were males. The most common type of vitiligo is vulgaris (45.5%). 78.5% cases had age of onset around the age of 40 years .40% cases were in 1-5 years duration of disease. Vitiligo does not show any significant association with any addiction. 22% patients are associated with the positive family history. 44% patients showed lower limb as a site of onset of vitiligo. There was no significant correlation with dietary habits in vitiligo. 59.5% cases belong to active vitiligo & rest of 40.5% is of stable category. 17.5% cases reported physical trauma as the precipitating factor. 12% patients were associated with thyroid disease. Majority of cases 68.5% were from urban areas. Clinoepidemiologic study in North India shows that vulgaris is the commonest subtype with female preponderance. Research on the presence of autoimmune disease; particularly thyroid disorder is of great interest.

Application based learning through hospital projects for teaching microbiology to medical students.

Microbiology in-spite of being a crucial subject for understanding the basic principles with their application in infectious disease fails to impress the undergraduate medical students probably because they are taught the subject in isolation without much clinical context. To help students learn important concepts of microbiology by shifting the focus from didactic classroom setting to the patient care setting, we introduced hospital projects focusing on selected concepts of microbiology. The students (n=103) in their 2nd phase of MBBS studying para-clinical subjects were randomly divided in test and control groups. Test group was sent to the hospital with specific objectives for a defined duration. The difference in the level of understanding and knowledge in the selected topics for both the groups was judged by pre and post test. Perception of faculty and students towards the whole process was collected through feedback questionnaires, framed with a four point scale as per the Kirkpatrick's evaluation model. The test group (average pre-test score 9.64 to post-test score 16.28) showed a remarkable improvement in the understanding and knowledge of topics in comparison to the control group (average pre-test score 10.12 to post-test score 12.5). This was highly significant (P value <0.001) by statistical analysis (paired T test). The process of sending the students to hospital for strengthening of the important microbiology concept is a novel idea. Students appreciated the process as they could understand the practical significance and relevance of the theory taught to them in classrooms. Time constraint was perceived as a major limiting factor. [Suman Singh et al. NJIRM 2011; 2(3) : 1-7]