To evaluate peripheral neuropathy of ulnar sensory nerve through nerve conduction studies in Type 2 diabetic patients

Background: Secretory defects or defects in action of insulin precipitate a condition of chronic hyperglycemia known as diabetes mellitus, a metabolic disorder progressive in nature with long asymptomatic stage. Diabetic neuropathy is the most life threatening complication. Aims and Objectives: Early detection of peripheral neuropathy helps to take remedial measures in controlling the progression of the disease. Materials and Methods: Forty clinically detectable peripheral neuropathy Type 2 diabetic patients and 40 age-matched control subjects were selected for the study and nerve conduction test of ulnar sensory nerve was done and distal latency (DL), sensory nerve action potential (SNAP), and sensory nerve conduction velocity (SNCV) were recorded using RMS-EMG-EP-MAK II machine to predict the extent and type of neuropathy in diabetics. Results: Significant difference (P < 0.05) of DL, SNCV, and SNAP of ulnar sensory nerve was found in clinically detectable peripheral neuropathy group as compared to controls. Predominantly, axonal type (loss of amplitude) of neuropathy was present in study group. Conclusion: Electrophysiological variables of ulnar sensory nerve were affected in most of the subjects suggesting axonal loss and demyelinating changes in the nerve.

Introduction and evaluation of “Peer-assisted learning” in department of physiology in first-year MBBS students in Muzaffarnagar Medical College, Muzaffarnagar

Background: Traditional lectures (using PowerPoint presentation or chalk and board) have become less effective, monotonous, and involve less student-teacher interaction. Introducing peer-assisted learning (PAL) may improve learning by increased student-teacher interaction, making interesting, and more effective for better student outcome, producing a competent Indian medical graduate. Aims and Objectives: The aim of the study was to introduce PAL in 1st year MBBS students, to evaluate effectiveness of PAL both from Students and Teachers perspective, and to determine feasibility of PAL in a large batch of 150 students with limited teacher availability. Materials and Methods: Place of study is Muzaffarnagar medical college, Muzaffarnagar, UP. Study was conducted on 80, 1st phase MBBS students (2020 Batch) Ethical clearance from Institutional Ethics committee was obtained. A pre-test and a post-test of ten MCQs were given. Feedback from students and faculty members was also taken. Results: As post-test scores show a significant improvement Pal can be introduced as a TL method in MBBS students. Conclusion: Feedback from both the students and teachers show that a significant percentage agree that PAL is helpful in increasing knowledge, should be included in the teaching methodology in CBME curriculum, is feasible, can be included in internal assessment, and improve critical thinking skills.

Behavioral Risk Factors of HBV Infection and its Association with HBs Ag Positivity among Residents of Kaza Sub- division of District Lahaul & Spiti in Himachal Pradesh

Background: Chronic viral hepatitis is a major global public health problem, an important cause of morbidity and mortality. We conducted this study to evaluate the behavioral risk factors of HBV infection and its association with HBsAg positivity among residents of Kaza sub-division of district Lahaul & Spiti in Himachal Pradesh. Material & Methods: The study was carried out by the Gastroenterology, Community Medicine, and Microbiology Department at Indira Gandhi Medical College Shimla at Kaza, a subdivision of Lahaul & Spiti. The cluster sampling technique was used to get the desired sample size of 4000. Forty clusters were chosen using a probability proportionate to size sampling method, and 100 research participants were added to each cluster using a simple random sampling method. The data was gathered using a pre-tested interview plan. A blood sample of 5ml from each study participant was obtained, and its HBsAg content was examined. Results: In our study, 2.7% of the interviewed respondents’ parents were positive for hepatitis B and 3.7% reported one positive family member. Injectable drug use was reported by 1.6 (68/4231). Among these users 8.8% (6/68) shared needles with other IDUs in last 12 months and 35.3% (24/68) used a common container to draw up drug solution. Sexual intercourse was reported to be experienced by 15.5 (655/4231) and 12.2% either did not disclose or were children. Out of those who ever experienced sexual/penetrative intercourse 38.3% (251/655) had reported it with someone else other than a spouse. Majority of these had two partners other than a spouse (30.3%; 76/251). Around 30% (195/655) reported of using a condom in their last intercourse. Body piercings or a tattoo from someone who doesn’t sterilize his or her equipment, including local treatment from lamas, was prevalent among 16.3% of the population (689/4231). Acupuncture was taken as a remedy for any medical condition by 9% of participants. Regression analysis also revealed that one infected family member emerged as an independent factor associated with HBsAg positive test after adjusting for confounders. Conclusion: Our study provided much important information concerning hepatitis B risk factors in this tribal group. Health education about behavioral risk factors among this tribal population should be the main intervention that might help limit the spread of these blood-borne infections.

Pulmonary Manifestations in Patients of Rheumatoid Arthritis and its Correlation with Severity of Disease

Background: Rheumatoid arthritis (RA) is a chronic inflammatory disease of unknown etiology marked by symmetric, peripheral polyarthritis. RA has a prevalence of 1–2% in the general adult population. The mortality rate in patients with RA increases during the course of the disease, with a tendency to accelerate after 15 years. Aim: To study the pulmonary manifestations and their severity using [Disease Activity Score (DAS)—28 score] in patients of RA. Materials and methods: Present study was conducted in the Department of Medicine, Sardar Patel Medical College and Associated Group of Hospitals Bikaner, Bikaner, Rajasthan, India, on 100 patients. This study was a cross-sectional, observational study conducted over 1 year. Consecutive cases of RA patients attending the outpatient department or admitted to the medicine wards were selected according to the inclusion and exclusion criteria. Results: Pulmonary manifestation was present in a total of 38% of cases, while the remaining 62% of cases had no pulmonary manifestation. The presence of comorbidity and C-reactive protein (CRP) was significantly associated with pulmonary manifestation in RA patients. On high-resolution computed tomography (HRCT), the most common finding was interstitial lung disease (ILD) (60.5%), with usual interstitial pneumonia (UIP) as the most common pattern. On performing a pulmonary function test (PFT), 33 patients (86.84%) had an abnormal result, with restrictive as the most common pattern. Conclusion: The patients of RA, especially those with advanced age, long duration of disease, male sex, and associated comorbidity, should be screened for pulmonary complications of RA using X-ray chest and PFT, supplemented by HRCT chest wherever required.

Assessment of Wave V latency and Wave I-V Interpeak latency in preterm babies by Brainstem Evoked Response Audiometry

Background: Early screening of hearing impairment optimizes communication, social, academic, and vocational outcomes for each child with hearing loss measurement of the auditory brain stem response which is considered the most sensitive method of assessing the auditory activity of neonates. Aims and Objectives: This study aims to compare wave V latency and interpeak I-V latency by brainstem auditory evoked response in preterm babies (32 weeks–36 weeks) with age-specific normal response and intergroup comparison (Group 1–32 weeks, Group 2–34 weeks, and Group 3–36 weeks) for the identification of hearing impairment if any. Materials and Methods: The present study was done on 50 preterm newborn, and after satisfying inclusion and exclusion criteria, preterm babies were subdivided into three groups on the basis of gestational age (Group A: 32 weeks [n = 12], Group B: 34 weeks [n = 18], and Group C: 36 weeks [n = 20]). Babies were subjected to brainstem evoked response audiometry (BERA) test on RMS EMG EP MARK-II machine in the neurophysiology unit of the Department of Physiology, Gandhi Medical College, Bhopal. Interpretation of the data as compared to normal values was done. Results: A trend toward decrease in absolute peak latencies of wave V with advancing gestational age was observed indicating progressive maturation, but the values recorded in all the three groups were longer as compared to the normal term values suggesting impairment in the maturation process. Wave I-V interpeak latencies values showed appreciable prolongation in all groups as compared to normal term values. Conclusion: The present study has shown that the preterm babies had altered BERA findings signifying hearing impairment.

Comparative study of brainstem auditory evoked responses in females having premenstrual symptoms with normal population

Background: Premenstrual symptoms (PMS) have largely been ignored, because ages so present study are done in females specifically having PMS comparing with females with no PMS. Very little work has been done in past in this field, because females revealing menstrual history are a big taboo in our society. Aim and Objective: The aim of this study was to study brainstem auditory evoked potential (BAEP) in females having premenstrual symptoms and comparing it with females having no premenstrual symptoms. Materials and Methods: BAEP was conducted on 60 females age group of 18–40 years in two groups in Research laboratory, Department of Physiology, Lala Lajpat Rai Memorial Medical College in collaboration with SVBP Hospital, Meerut for 6 months. The subjects were divided into two groups, Group A having premenstrual symptoms and Group B having no premenstrual symptoms. The test was conducted in later part of luteal phase 23rd–25th day of menstrual cycle. The absolute latencies (ALs) and interpeak latencies (IPLs) were the parameters measured for the analysis of BAEP. Results: IPL, that is, interpeak latencies I–III and III–V in age group 18–25 years, showed statistically significant decrease in luteal phase in females having premenstrual syndrome (PMS) as compared to normal cycling females. Conclusion: Premenstrual symptoms females are showing few significant changes in auditory responses at mid brain level as recorded by BAEP study which can be due to the modulatory effect of female gonadal hormones progesterone and estrogen on neurotransmitters (serotonin, gamma-aminobutyric acid, and glutamate) in central nervous system.

Gastric Outlet Obstruction: Don’t Miss Duodenal Tuberculosis

We report a case of isolated duodenal tuberculosis (TB) in a patient who presented with features of gastric outlet obstruction. The diagnosis was made on repeat endoscopic duodenal biopsy after initial histopathology failed to reveal the diagnosis. The patient recovered with antitubercular therapy. The index of suspicion has to be high in TB endemic countries as clinical, radiological, and endoscopic features are nonspecific.

Knowledge, attitude, and practice of safety precautions among laboratory technologist of clinical microbiology laboratory

Background: Laboratory workers are exposed to a variety of potential occupational health hazards including infectious materials and cultures, toxic and flammable chemicals, as well as electrical hazard. It is important for laboratory workers to be aware of the potential hazards and ensure safety in practices. Carelessness, negligence, and unsafe practices may result in serious injuries not only to the individual but also coworkers and patients as well. Objective: The objective of the study was to assess the knowledge, attitude, and practice (KAP) of laboratory safety precautions among technicians working in clinical microbiology laboratory. Materials and Methods: The study was a cross-sectional study on KAP of laboratory safety precautions among technicians. A close-ended structured questionnaire was canvassed to the technicians and responses were analyzed. Results: A total of 30 laboratory workers participated in the study. The overall correct responses regarding knowledge of laboratory safety precautions were 74% (673/900) and practices of the same were 79% (427/540). Few (10/30) perceived biomedical waste management as a burden and some (9/30) felt that too much of effort is required to follow optimal hand hygiene. Conclusion: Training and retraining on laboratory safety precautions are required along with counseling to induce a positive attitudinal change.

Pattern of uveitis in a tertiary eye care center of central India: Results of a prospective patient database over a period of two years

Purpose: To identify the pattern of uveitis at a tertiary eye center in the central India and to compare with other reported studies. Methods: This prospective observational study was undertaken with all new uveitis cases attending the uvea clinic between January 2016 and September 2017. A standard clinical protocol and detailed investigations were done to find out the specific cause of uveitis. Results: A total of 210 patients with uveitis were evaluated. Anterior uveitis (47.1%) followed by intermediate uveitis (31.90%) were the most common type of uveitis in this study. Specific etiology of uveitis could be established in a majority of cases of uveitis (51.91%), except in intermediate uveitis group where the cause was mostly idiopathic (77.61%). Conclusion: Tuberculosis (46.29%) and viral etiology (38.88%) were the most common forms of infective uveitis (25.71%), whereas spondyloarthropathy (27.27%) and traumatic cause (14.54%) were the most common in the noninfective group of uveitis (26.19%).

Evaluation of Bilateral Ureteral Urinary Jet Flows for Patency of Uretero- Vesical Junctions by Color Flow Imaging

Background: Ureters are meant to transport urine from the pelvis to the urinary bladder in the form of urinary jet. This is continuous process with intermittent release of urine at uretero-vesical junction. This is regulated by autonomous nervous system. The urine coming to urinary bladder can be seen by color flow imaging (CFI) .This also reflects the patency of the ureter without any obstruction in the pathway. Methods: The size of the population was 30 patients (20 males and 10 females). In this study, the Color Doppler ultrasound was used to evaluate the ureteral jets flow in 10 healthy patients and 20 patients with obstructive uropathy. A probability sampling method was employed while collecting samples. Results: In the right ureteral-vesical junction there was complete absence of detectable jets in 5 patients, 6 patients had weak flow of jet and 19 patients had normal flow of jet. Similarly, in the left ureteral-vesical junction there was complete absence of detectable jet in 3 patients, 12 patients had weak flow and 15 patients had normal flow. Conclusions: The color Doppler evaluation of the ureteral jets is a valid method of evaluating ureteral and renal calculi obstruction and could be a first line of investigation to detect ureteric obstruction in patients with obstructive uropathy.

Developmental and Morphological Variations of Frontal Sinus in Pediatric Age Group in Gurugram Region of Haryana – A Study

Background: The aim is to know gender wise development and morphological variation of the frontal sinus in the pediatric age group of Gurugram district of Haryana. The development and pneumatisation of the frontal sinus is the predictor of skeletal growth pattern. The craniofacial structures grow proportionately with the normal development of the body structures. Methods: In this prospective study, a total of 36 subjects were studied. The study was conducted in the Department of Radiodiagnosis of SGT Medical College, Budhera (Gurugram) Haryana from January 2019 to March 2019. This included 12 females and 24 males falling in the age group of 8-18 years. The frontal sinuses were evaluated on various morphological features. Plain X-Ray of paranasal sinus was evaluated by Caldwell’s view. The sinuses were evaluated for width, height, number of scallops, septations and supraorbital cells. Results: Average width and height of left frontal sinuses were 23.8 mm with the range of 5.5 – 43 mm and 28.4 mm with the range of 13-45 mm respectively. Average width and height of right frontal sinuses were 20.4 mm with the range of 9.8 – 39 mm and 20 mm with the range of 13-38 mm respectively. The average number of scalloping on right and left were 1.9 and 2.19 respectively. The septations were noticed in 13 (36.11%) on left and in 16 (44.44%) on right side. Supraorbital cells were found in 16 (44.44%) on left side and 17 (47.22%) on right side. Conclusion: There is a lot of variation in the appearance and development of the frontal sinus in pediatric age group. The dimensions had been found smaller on right side as compared to left side. Scalloping and supraorbital cells had been found more on right side than on the left side. Septations were more on left side as compared to right side.

A study on clinical profile and etiological agents of empyema in hospitalised children in Jaipur, India

Background: Objective is to study the clinical profile and etiological agents of empyema in hospitalised children in Jaipur.Methods: This hospital based prospective study was carried out in the Department of Pediatrics, SMS Medical College, Jaipur between April 2016 to March 2017. Children between 1 month to 18 year of age having empyema thoracis (pleural tap showing pus cells under microscopy or on gross examination purulent exudates) were included in the study. Children with Empyema secondary to post-surgical or post-traumatic cause and with tubercular effusion were excluded from the study. Relevant history, clinical examination and investigation were done. Pleural fluid studies were done for cytology, biochemical analysis , culture and antibiotic sensitivity pattern.Results: Total 100 patients were included in study. Out of total 100 patients 62 (62%) were between 1 month to 5 years. Most common symptoms were fever (94%), breathlessness (87%) and cough (85%). 27% patients were severely malnourished as per IAP classification of PEM. Pleural fluid culture was positive in 29 (29%) patients. Most common organism isolated was Staphylococcus aureus (27%), 87.5% isolates of Staphylococcus aureus had sensitivity to vancomycin and linezolid.Conclusions: Empyema thoracis is frequently encountered complication of bacterial pneumonia. Fever, cough, and respiratory distress were the most common presenting complaints and severe acute malnutrition was an important risk factor. Staphylococcus aureus was found to be the most common organism for childhood empyema.

Evaluation of the vitreous chamber depth: An assessment of correlation with ocular biometrics

Purpose: The mechanism of ocular growth eludes us and research on vitreous chamber depth (VCD) is lacking. The purpose of this study was to evaluate the role of VCD and its ratio to axial length (AL) in relation to ocular biometry. Methods: This retrospective study of patients planned for cataract surgery was performed at a tertiary center. Data regarding AL, anterior chamber depth (ACD), lens thickness (LT), and central corneal thickness (CCT) of 640 eyes was noted. Anterior segment (AS) was measured as sum of CCT, ACD, and LT, while VCD was calculated as the difference between AL and AS. Correlation of VCD and VCD: AL with ocular biometry was the primary outcome measure. Three groups were formed on the basis of AL and Pearson correlation coefficient (R) was applied. Results: Mean VCD was 15.38+/?1.14 mm. Mean VCD: AL was 0.66+/?0.02. VCD had a very strong relation with AL (R = 0.9, P < 0.001) only, whereas VCD: AL had a good--strong relation with AL (R = 0.5, P < 0.001), AS (R = 0.7, P < 0.001), ACD (R = 0.3, P < 0.001), and LT (R = 0.5, P < 0.001). The relation of VCD: AL with AS was very strong across all groups (R ? -0.8, P < 0.001 in all groups). 85% of eyes in group with AL <22 mm had VCD: AL <0.67, conversely 85% of eyes with AL >24.5 mm had VCD: AL >0.67. Conclusion: We found VCD to have the strongest relation with AL. VCD: AL was more consistent and showed a strong relation to ocular biometry across all ALs. This suggests the possible utility of the ratio VCD: AL while evaluating ocular growth, refractive status, and myopia-related complications.

Analysis of Demographic Profiles among Cases of Isolates of Enterococci at a Tertiary Care Teaching Hospital

Introduction: Therapy for infections due to Vancomycinresistant Enterococci presents real challenge for the clinician.Despite increasing reports of VRE from different countries,there is a paucity of information on this issue from our country.Hence, the present study aims to study of demographic profileamong cases of isolates of Enterococci from various clinicalsamples of PBM and associated group of hospital SPMC,Bikaner up to the species level.Materials and Methods: The present descriptive study wascarried out in the Department of Microbiology, S.P.M.C.Bikaner over a period of one year. 194 isolates of Enterococcalwere obtained from various clinical samples of patientsattending P.B.M. Hospital, Bikaner.Results: The maximum number of samples (30.41%) wasisolated from patients in the 0-10 year age group. It should benoted that out of the 59 patients in this group, 21 (35.59%)were <1year old. The mean age of incidence of enterococcalinfections was 31.53 years. 21 babies included in the 0-10 yearage group were <1 year old. Out of the 194 enterococcalisolates, 79 (40.72%) were from female patients, and 115(59.28%) were from male patients.Conclusion: Majority of the isolates were from the pediatricage group as the maximum number of samples was isolatedfrom patients in the 0-10 year age group The E.faecium strainsshowed a higher percentage of resistance to all the antibioticstested, as compared to the E.faecalis strains.

Characterization of Bacteria from Blood Cultures of Cancer Patients Admitted to Cancer Institute at a Tertiary Care Hospital

Background: Infection is a continuous and significant problemin patients with cancer. Bloodstream infection remains a majorcause of morbidity and mortality in patients undergoingtreatment for cancer. Bloodstream infection (BSI) is a leadinginfectious complication among cancer patients and has anegative impact on patients' outcome. Hence; the presentstudy was undertaken for characterizing bacteria from bloodcultures of cancer patients admitted to cancer institute.Materials & Methods: A total of 344 blood samples werecollected for culture from the suspected cases blood streaminfection from cancer patients. Blood samples were collectedbefore starting the antimicrobial therapy. Regardless of visualappearance every blood culture bottle was sub cultured afterovernight incubation and on the fourth and seventh days. Theinoculated pates of solid media were incubated overnight at37°C. Organism identification was done. All the results weresummarized in Microsoft excel sheet.Results: Out of 344 blood culture samples, 86 blood streaminfections were recovered from blood culture samples from allages and both sexes. Out of total 61 blood culture samples forneutropenic patients, Gram positive cocci, CONS was isolatedin 7(11.5%) while 2(3.3%) COPS were isolated. In GramNegative bacilli enterobacteriaceae members, E. coli wasisolated in 3(4.9%) and klebsiella was isolated in 6(9.8%). andin gram negative bacilli non fermenter, pseudomonas wasisolated in 8(13.1%) and acinetobacter was isolated in7(11.5%) of blood stream infection.Conclusion: The study highlighted the variations observed inthe pattern of aerobic bacterial profile from suspected cases ofBSIs and also the changing trends in the susceptibility patternsof the isolates to routinely used antibiotics.

Evaluation of complications and visual outcome in various nucleus delivery techniques of manual small incision cataract surgery

Purpose: To evaluate various methods of nucleus delivery in manual small incision cataract surgery, with reference to visual outcome, intraoperative, and postoperative complications. Methods: In this prospective randomized interventional study, five groups of 40 cases each were constituted, with reference to nucleus delivery technique: (a) phacosandwich, (b) fishhook, (c) irrigating vectis, (d) viscoexpression, and (e) anterior chamber maintainer (ACM). Visual outcome, intraoperative, and postoperative complications were evaluated in detail. Follow-up was done on first and seventh postoperative days (PODs) and then at fourth and eighth postoperative weeks. Results: The most common intraoperative complication was intraoperative miosis, followed by intraoperative hyphema, seen more in phacosandwich and irrigating vectis groups. The most common postoperative complication was striate keratopathy followed by transient postoperative corneal edema and AC inflammatory response, seen more in phacosandwich and fishhook groups. With reference to visual acuity, on the first POD 95% cases of ACM group achieved visual acuity >+0.5 logMAR unit. The difference in the visual outcome among groups was statistically significant. On fourth and eighth postoperative weeks, best-corrected visual acuity among various groups was comparable. Conclusion: ACM and viscoexpression are effective techniques for early visual rehabilitation. Fishhook has limited utility in softer nuclear grades and black cataracts. Phacosandwich is more suitable for nuclear sclerosis Grades 3–4. Irrigating vectis, viscoexpression, and ACM technique are effective techniques for all grades of nucleus Postoperative surgical-induced astigmatism was comparable in all techniques.

Determine the Antimicrobial Susceptibility Pattern of Different Antimicrobials Used for Treating Infections in Cancer Patients: An Institutional Based Study

Background: Malignancy is a leading cause of deathworldwide, and accounted for 7.6 million deaths (around 13%of all deaths) in 2008. Broad spectrum antibiotics arecommonly used as empirical therapy in febrile cancer patients.Hence; the present study was undertaken for determiningantimicrobial susceptibility pattern of different antimicrobialsused for treating infections in cancer patients.Materials & Methods: From the suspected cases of bloodstream infection from cancer patients, a total of 344 bloodsamples were collected for culture. Blood samples werecollected before starting the antimicrobial therapy. Theantibiotic susceptibility testing of the isolates were done byKirby- Bauer disk diffusion method on Mueller Hinton agar.Isolates were grown in peptone water by incubating at 37°Cand turbidity was matched with 0.5 MacFarland standards.Then lawn culture was done on Mueller Hinton agar plate andcommercial antibiotic disks were placed. The plates wereincubated at 37°C overnight and on the next day the zones ofinhibition were measured and susceptibility/ resistanceinterpreted.Results: Out of total 30 CONS cases, sensitivity was found inVancomycin (100%), Linezolid (93.3%), Amoxy-clav (80%),Cefoxitin (80%), Amikacin (73.3%), Ceftriaxone (73.3%),Ciprofloxacin (53.3%), Cotrimaxazole (33.3%), Erythromycin(26.7%), and Tetracycline (20%). Out of total 12 COPS cases,sensitivity was found in Vancomycin (100%), Linezolid (91.7%),Amoxy-clav (83.3%), Ceftriaxone (83.3%), Amikacin (66.7%)Ciprofloxacin (41.7%), Erythromycin (41.7%), Tetracycline(41.7%), Cotrimaxazole (25%) and Cefoxitin (25%). Out of total12 isolates of Staph aureus (COPS) 3(25%) cases were foundto be MRSA. Above table shows sensitivity pattern of gramnegative bacilli enterobactericae (E coli and klebsiella).Conclusion: The clinicians should have thorough knowledgefor appreciating empirical therapy as well switch over to thebest regime based on antibiotic susceptibility pattern toimprove the overall outcome of the patient’s health.