RESUMO
BACKGROUND: Second year undergraduate medical students lack an integrated approach towards the basic laboratory data. So, they find it difficult when analytical exercises are asked for in pathology practical examinations. A Complete Health Checkup (CHC) is one exercise where an individual undergoes a clinical examination, followed by various basic laboratory tests, along with other tests like ECG, X-ray and USG of the abdomen. A critical analysis of such charts would help in developing higher cognitive skills in the form of integration of all the data which is available, in order to arrive at a final diagnosis. We hypothesized that facilitating the students to analyze a set of clinical pathology tests by using CHC charts as modules would enhance their integrated approach towards the laboratory data. AIM: To evaluate the use of pre designed complete health charts which were designed to enhance the students' ability to apply and integrate their knowledge on the clinical pathology data. MATERIALS AND METHODS: Two batches of 44 students each (Group 1 and Group 2), who attended the clinical pathology postings, were included in the study (totally 88 students). Informed consents were obtained from all of them. In addition to their routine posting schedules, the students in Group 2 were exposed to fifteen CHC charts, one at a time, with the subsequent analysis of each chart by using an objective test and a discussion. At the end of their clinical pathology postings, an OSPE was conducted for all the students and the test scores were analyzed. The statistical analysis was done using SPSS, version 15. RESULTS: Group 1 obtained a score which ranged from 48% to 78%, with a mean±SE (mean) of 62.0% ± 1.21 and Group 2 obtained a score which ranged from 65% to 94%, with a mean±SE (mean) of 86.2% ± 0.96. The Student's-t-test for the equality of means with a value of 15.59 (p=0.000), implied a statistical significance in the mean score, as was observed between the two groups. CONCLUSION: Facilitating the students' learning by using CHC charts helps in improving the students' capacity to analyze and interpret the clinical pathology data and so, it can be utilized on a routine basis.
RESUMO
BACKGROUND: Alcoholism is a major problem in India thereby causing a heavy toll on the health related expenditure of the country. Detection of alcohol abuse rely mainly on clinical details which is sometimes inaccurate or unreliable and hence using a specific diagnostic parameter might be of immense use not only for early diagnosis but also during follow up of the cases. AIMS AND OBJECTIVES: This case control study aimed at evaluating the usefulness of Carbohydrate Deficient Transferrin (CDT) as a sensitive marker to diagnose alcohol abuse. MATERIALS AND METHODS: The study was approved by Institutional research and ethical committee. Twenty five known male alcoholics who attended to the OPD (Out Patient Department) of Alcohol de-addiction centre of a tertiary care hospital were selected as cases. All of them were diagnosed to have a strong likely hood of hazardous alcohol consumption based on 'Alcohol Use Disorders Identification Test" (AUDIT) questionnaire. Twenty five age matched, gender matched healthy individuals who were teetotalers were selected as controls. They scored zero in AUDIT questionnaire. Informed consent was obtained from all the cases and controls. The following tests were done: Liver function tests including Serum Bilirubin, Total Proteins, Aspartate Amino Transferase (AST), Alanine Amino Transferase (ALT), Alkaline Phosphatase (ALP), Gamma Glutamyl Transferase (GGT) and Blood glucose levels were estimated using a fully automated biochemistry analyser, XL - 300 (Trans Asia Biomedical systems) and Mean Corpuscular Volume (MCV) was done using an automated hematology analyser Sysmex KX-21. Percentage of Serum Carbohydrate Deficient Transferrin (%CDT) was assessed using immuno Turbidimetric assay, ELISA method (iMark, Bio-Rad Laboratories,). Statistical analysis of the data obtained was done using SPSS 16.0. RESULTS: There was a statistically significant difference in values of AST, ALT, ALP, MCV, GGT and % CDT in cases as compared to controls. ROC curves drawn to assess the sensitivity and specificity of each parameter showed that %CDT has the highest sensitivity and specificity (84% and 92% respectively) and MCV (48% and 52% respectively) had the least. GGT when compared to % CDT had a lower sensitivity and specificity (64% and 72% respectively). CONCLUSION: % CDT is a sensitive biomarker which can be used to diagnose alcohol abuse and is superior to GGT in terms of sensitivity as well as specificity.
RESUMO
CONTEXT: Welding fumes are considered as a risk factor for pulmonary diseases and a periodic spirometry is essential to evaluate the lung function of the welders. The Red Cell Distribution Width (RDW) is a red cell measurement which is provided by automated haematology analyzers. It reflects the range of the red cell sizes which are measured within a sample. Few studies have shown a relationship between the RDW values and the changes in the spirometry. AIMS: This study was aimed at correlating the RDW% and the spirometry FEV1/FVC ratio (%) among automobile welders (cases). Further, we have analyzed the effect of smoking on the FEV1/FVC ratio% and the RDW% in the cases. SETTINGS AND DESIGN: A cross sectional study was done on 50 welders and 50 non-welding office workers (controls) who were working in an automobile industry on the outskirts of Chennai, india. All the cases were arc welders and the controls were from the same production unit, who had never worked as welders. This study was conducted during the period from March 2012 to May 2012. METHODS AND MATERIAL: The demographic data, smoking habits, work history and the respiratory symptoms were gathered by using a standard self -administered questionnaire. A complete haemogram study was done and pulmonary function tests were performed for both the cases and the controls. All the cases and the controls were examined in the hospital outpatients room and subsequently, their blood samples were collected. The pulmonary function tests were conducted in the spirometry room in the hospital. The statistical analysis was done using the SPSS, version 15.0. RESULTS: A statistically significant inverse correlation was found between the RDW% and the FEV1/FVC ratio% in the cases. CONCLUSIONS: RDW can be used as a biomarker to identify the pulmonary compromise in automobile welders.
RESUMO
There is an extremely high prevalence of Thromboangiitis Obliterans (TAO) or Buerger's disease (BD) in India among people of low socioeconomic class who smoke beedies (homemade cigarettes with raw tobacco). The aim of this study was to study the clinical and histo-morphological aspects of Buerger's disease with relevance to age at presentation in the local population. The study comprised of 25 cases (all were men and were smokers) of clinically diagnosed BD based on Shionoya's criteria. The mean age was 47 years. The specimens consisted of 21 biopsies, 2 end-arterectomies and 2 amputations. Formalin fixed, routinely processed, paraffin embedded tissue sections were stained with Haematoxylin and Eosin (H and E) and Verhoeff's elastic stain. They had claudication pain either in the ankle (5) or in the calf (2) or both (13). 24 had infrapopliteal disease and 9 showed upper limb involvement. 21 showed migratory thrombophlebitis also. Histomorphological presentation included the following features: Luminal thrombosis (14), fresh thrombosis (4), chronic inflammation in the vessel wall (10), within the thrombus (1) and around perivascular channels and nerve bundles (4). Internal elastic lamina showed reduplication in 13, undulation in 9 and fragmentation in 9 cases. Media of the vessel showed the following features: fibrosis (9), hypertrophy (9) and calcification (5) Adventitial haemorrhage, cholesterol clefts and atherosclerotic plaque formation were the other changes seen. In our study the following histopathological features were consistently seen. Thrombus (with or without recanalisation), inflammatory cell infiltrate (within the thrombus wall or periadventitial tissue), subintimal and medial fibrosis and changes in internal elastic lamina. These features were also highlighted in other studies. However in our study, medial hypertrophy and calcification were observed as additional features.
