Knowledge, attitude, and practice of foot care in patients with diabetes at central rural India.

INTRODUCTION: Diabetic foot syndrome is one of the common and most devastating preventable complications of diabetes mellitus (DM). It is associated with morbidity and premature mortality due to long-term complications affecting foot. The American Diabetes Association recommends that people with diabetes should have a comprehensive foot examination once per year. Most of the foot problems can be prevented with careful foot care. It may take effort and time to build up good foot care habits, but self-care is essential. AIM: The main aim of the study is to analyze the knowledge, attitude, and practice of foot care in patients with DM in central rural India. METHODOLOGY: This study was conducted at a rural educational hospital in central part of India over 200 patients who have Type 1 and Type 2 diabetes. They were evaluated for their knowledge about foot care and footwear practices. A structured and validated questionnaire was administered to cases. RESULTS: Around 82.9% of the patients were aware of the disease and 23.2% were aware of the complications of the DM. In 63% of the patients, foot care examination and education regarding foot complications were not suggested by their treating physicians. Annual examination of feet by the physician and self-examination were not known facts to the diabetic population. CONCLUSION: It is necessary to firstly develop awareness of diabetes mellitus and the related complications, one amongst which is foot care. Certain educational strategies should be established for both the consultant physician and also the common man to create awareness for effective foot care.

Central retinal artery occlusion: an unusual complication of snakebite

Snakebites are endemic in some parts of India, being associated with a number of complications. Ocular disturbances are rare, except for injury to the cornea or conjunctiva when the eye is directly exposed to the venom. In this work, we present a case of central retinal artery occlusion caused by snakebite.(AU)

Attitude of teachers towards teaching.

INTRODUCTION: Teaching is an art and the quality of teaching depends on the love, dedication and devotion of the teacher towards the subject of the knowledge. The quality of any teaching programme cannot rise above the quality of its teachers. In medical colleges it is the teacher who is responsible for influencing a student's learning of the subject. METHODS: We assessed the attitude of 31 teachers working at MGIMS. Twenty one of them were of the rank of Reader and above and had more than five years teaching experience. Ten were of the rank of lecturers with three years of teaching experience. The assessment was done by a likert type scale containing 20 items on various aspects of teaching. All the participants were given the scale and requested to mark the agreement or otherwise on a scale i.e. strongly disagree, disagree, cannot say, disagree, strongly agree. OBSERVATION AND CONCLUSION: The mean score was 3.808, which indicates a positive attitude. There was not much difference in attitude of teachers in different group. Thus indicating that our study group has predominantly positive attitude for most of the items. This positive attitude helps the teachers to be role model for the future generation of students.

Seasonal variations in incidence of severe and complicated malaria in central India.

The geographical position and climate of India is favorable for the transmission of malarial infection. The maximum prevalence of malaria in most parts of India is from July to November months. Rainfall provides mosquitoes, a breeding ground giving rise to epidemics. We studied the seasonal variation in cases of severe and complicated malaria presenting at MGIMS, Sevagram, Wardha (Vidarbha region in Maharashtra) over a period of three years. The findings of peak of malaria observed during September-November during three years period points to the fact that the increase in vector breeding after rainy season is responsible for the upsurge in the malarial cases during these months. This also indicates that this area (Vidarbha) has an unstable transmission of malaria.

Cytodiagnosis of histoid leprosy.

This paper presents cytomorphological features of the histoid variety of lepromatous leprosy. Fine needle aspiration of a lepromatous nodule showed cytological features consistent with those of histoid leprosy. Simultaneously, a biopsy of the nodule was also performed and the case confirmed as histoid leprosy. The advantages of the fine needle aspiration technique are that it is simple, quickly reportable, and less traumatizing. Multiple aspirations from different sites may be obtained, which would add to the value of sampling. The need to differentiate a histoid nodule from a conventional lepromatous nodule is explained.

Role of oxygen free radicals in causing endothelial damage in acute myocardial infarction.

OBJECTIVES: This work was done in order to study the oxidant and anti-oxidant status in a disease resulting from endothelial injury. The disease selected for study was acute myocardial infarction. METHODS: Sixty patients of acute myocardial infarction were selected after being diagnosed in accordance to the guidelines laid down by the WHO. Thirty subjects were included as controls. Plasma levels of certain markers of oxidative stress and anti oxidant activity were measured in all the subjects. Malonaldehyde (MDA) and nitrite (NO2) were measured as markers of free radical mediated endothelial injury, and superoxide dismutase (SOD) enzyme as an indicator of antioxidant activity. RESULTS: It was found that the plasma levels of MDA and nitrite were significantly elevated in the patients of acute myocardial infarction compared to the control group (7.29 +/- 3.28 v/s 4.57 +/- 0.63 nmol/ml and 12.85 +/- 8.71 v/s 0.97 +/- 0.25 microM respectively), thereby indicating that oxygen free radicals cause endothelial damage in them. The superoxide dismutase levels were also found to be elevated in these patients (5.57 +/- 1.47 v/s 3.91 +/- 0.66 U/ml). CONCLUSION: These results indicate that acute myocardial infarction is a state of enhanced free radical activity, which causes endothelial damage. The elevated SOD levels may imply that the body attempts to combat this oxidative stress by raising it's level of anti-oxidants.

Prevalence of sputum-positive pulmonary tuberculosis in tribal and non-tribal populations of the Ashti and Karanja tahsils in Wardha district, Maharashtra State, India.

SETTING: Ashti and Karanja tahsils, Wardha district, Maharashtra State, Central India. OBJECTIVE: To find and compare the prevalence of bacillary positive pulmonary tuberculosis amongst the different tribes and in the non-tribal population. DESIGN: Prevalence study of pulmonary tuberculosis by house-to-house survey of symptoms among tribal (n = 20596) and non-tribal (n = 93 670) populations aged 5 years and over, between September 1989 and November 1990. RESULTS: The prevalence of smear and/or culture-positive tuberculosis/100000 population was 133 in the tribal and 144 in the non-tribal population. The difference in prevalence of symptomatic individuals and sputum-positive cases among the tribal and the non-tribal populations was statistically significant only in the symptomatic individuals/100000 (P = 0.01). The prevalence of cases in both groups was higher in males than females; however this difference was significant only in the tribal group (P = 0.05). Only two of the 46 tribes encountered, the Mana and Pawara tribes, showed a high prevalence, of 730 and 612/100000, respectively. The three other tribes with positive cases (the Gond group) had prevalences comparable to that of the nontribal population. CONCLUSION: The prevalence of tuberculosis in tribal people was comparable to that of the non-tribal population.

Spontaneous bacterial peritonitis in liver cirrhosis with ascites.

OBJECTIVE: The study was designed to elucidate the correlation of spontaneous bacterial peritonitis (SBP) with aetiology of liver cirrhosis, overall mortality, ascitic fluid and systemic microbial infections. METHODS: Sixty three patients with cirrhosis of the liver were included in this study. These patients were diagnosed on the basis of clinical evaluation, biochemical investigation, ultrasonography, ascitic fluid examination for protein, cells, pH, and bacterial culture. RESULTS: SBP developed in 22 (34.92%) patients of cirrhosis. Culture positive SBP was present in 18 (81.81%) and culture negative neutrocytic ascitis (CNNA) in 4 (18.18%). In the culture positive group, 14 (77.7%) patients had monomicrobial bacterascites (MNB), the commonest organism being coagulase positive Staphylococcus aureus eight (44.44%) followed by E. coli (22.22%). Only 4 (22.22%) had infection by more than one organism. Direct bed side inoculation of ascitic fluid into blood culture bottle was a better method for bacterial yield than the conventional method of ascitic fluid culture (81.8% vs. 18.2%). Only 22.8% patients with SBP had ascitic fluid protein less than 1 gm%, ascitic fluid pH < 7.3 and polymorphonuclear cell count > 250/cmm. CONCLUSION: Spontaneous bacterial peritonitis is common complication in Child Pugh class C cirrhosis. Alcoholic cirrhosis with SBP carries high mortality than their non-alcoholic group. The most common organisms isolated were coagulase positive Staphylococcus aureus followed by E. coli.

Effect of short term vitamin E supplementation on lipid peroxidation in acute myocardial infarction.

In view of sufficient body of evidence to substantiate the role of free radical mediated oxidative injury in myocardial infarction (M.I.), the utility of exogenous supplementation with antioxidant substance, vitamin E was studied. Forty patients of acute myocardial infarction were divided into two equal groups, one who received vitamin E and the other who did not. Plasma MDA levels showed a reduction in patients of M.I. who received vitamin E as well as in those who did not, however, the decrease was significantly more in the vitamin E treated subgroup.

Interobserver variations in clinical signs for diagnosis of pleuritis.

A study was conducted on 150 patients admitted in a teaching hospital to find out reliable clinical signs for diagnosing pleuritis. Cases were selected based on suspicion of pleural involvement by history and examination. Final diagnosis was made by correlations with radiographic and ultrasonographic reports. Reliability of the signs was determined on the basis of high concordance of independently observed variations between two medical consultants. Inflammatory involvement of pleura was seen in 69.3% cases and 30.7% were due to oedema disorders. Concordance between observers was high for crepitations (95.5%) and pleural rub (93.8%) followed by vocal resonance (87.6%), dull percussion note (76.9%) and mediastinal shift (76.9%).

The prevalence of hypertension in rural population around Sevagram.

To detect the prevalence of hypertension in an asymptomatic rural community from Central India, we screened 4045 subjects (2247 men and 1798 women) aged 20 and beyond. The prevalence of hypertension was 34.12 per thousand population, being higher in women (40.60 per thousand) than in men (28.92 per thousand). Level of physical activity, economic status, smoking and body mass index showed real association with hypertension.

False positive ECG and coronary heart disease.

In 1983, we carried out a cross-sectional, rural community based study and highlighted an abysmally low prevalence of probable coronary heart disease in resting electrocardiogram. A seven year follow-up (1983-1990) of 179 suspects showed no morbidity or mortality from coronary heart disease. Eighty one out of 98 suspects tested negative on a symptom limited maximal exercise test. Though seventeen suspects had an asymptomatic exercise-induced ST depression (> 1.0 mm) their haemodynamic response to exercise and effort tolerance was excellent. Of the twelve subjects who took a repeat exercise test six months later, eleven failed to show ST depression on exercise. We attribute the false positivity of exercise test and its poor reproducibility to labile electrocardiographic changes unmasked by exercise.

M-mode echocardiographic diagnosis of left ventricular hypertrophy.

To assess the utility of various primary and derived M-Mode Echocardiographic parameters for the purpose of defining left ventricular hypertrophy (LVH), 74 subjects with LVH were subjected to M-mode echocardiographic examination. It was concluded that except for cross sectional area, the other echocardiographic parameters performed too poorly to be of any clinical utility for defining LVH by echocardiography.

Left ventricular M-mode echocardiographic measurements of Indian population.

The left ventricular dimensions of 506 normal healthy subjects (men = 317, women = 189) in the age group of 17 to 80 years were measured echocardiographically. The measurements were found to differ significantly from the western data. A separate limit for left ventricular echocardiographic parameter for the normal Indian population was established.

Evaluation of clinical variables as predicators of left ventricular function in acute myocardial infarction.

In 43 rural patients, all survivors of acute Myocardial infarction, left ventricular function was studied by 2-D echocardiography and evaluated in relation to 18 clinical predictors of left ventricular function. The mean left ventricular ejection fraction (LVEF) was 41.53 +/- 12.92% as compared to 70.02 +/- 7.02% in 506 healthy controls. LVEF was dichotomised at < 40% (n = 24) and > 40% (n = 19). Out of various clinical variables analysed following were found to be strong predictors of low LVEF. S3 gallop (p < 0.001) pulmonary rates (p < 0.001); Creatine phosphokinase > 200 I.U. (p < 0.001); Cardiomegaly on X-ray (p < 0.001); pulmonary congestion on chest X-ray (p < 0.001); and proportional pulse pressure (p < 0.001). There was a stepwise decline in the LVEF for each additional clinical variable. The over all predictive accuracy was 90%. It is concluded that readily obtainable clinical variables provide a useful bedside method of estimating LVEF after acute myocardial infarction.