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81
NEW INDIAN
JOURNAL OF
SURGERY
The New Indian Journal of
Surgery (ISSN 0976–4747,
Registered with Registrar of
Newspapers for India: DELENG/
2010/33158) is a peer-reviewed
journal designed for the general
surgeon
who
performs
abdominal, cancer, vascular, head
and neck, breast, colorectal, and
other forms of surgery. NIJS is a
multidisciplinary super-specialty
involving all surgical specialties
and all medicine specialties;
hence all surgeons and
physicians around the world are
involved in this field. NIJS
provides most current, most
authoritative information on
major clinical problems in the
fields of clinical and experimental
surgery, surgical education,
surgical care and its allied
subjects.
Editor-in-Chief: Dr. Chintamani, MS, FRCS (Ed), FRCS (Glas), FRCS
(Irel.), FACS, FICS, FIMSA
Contact: Consultant & Professor, Department of Surgery, Vardhaman
Mahavir, Medical College & Safdarjung Hospital, New Delhi 110029
(India)
Board of Advisors
Ashok Sharma, New Delhi
Kumar Manish, New Delhi
P.K. Jain, New Delhi
Rajendra Kumar Batra, Punjab
S.V.S. Deo, New Delhi
Parveen Bhatia, New Delhi
Sandeep Kumar, Lucknow
Seema L. Krishna, Noida
Col. Shyam Jaiswal, New Delhi
Vishwajeet Singh, Lucknow
Editorial Assistant
Rohan Khandelwal, Megha Tandon, New Delhi
Director of Membership and Marketing A Lal
In addition The New Indian
Journal of Surgery publishes
original articles that offer
significant contributions in the
fields of clinical surgery,
experimental surgery, surgical
education and related sciences.
NIJS will be of interest not only to
general surgeons, but also to
specialty surgeons and those
working in related fields.
E-mail: [email protected]
Publisher A Lal
Paper submission Shrindha Rai
Indexing Information: MedLine/Locatore plus, USA, Index Copernicus, Poland, EBSCO Publishing’s
Electronic Databases, USA, Academic Search Complete, USA, Academic Search Research & Development,
USA.
For all other quiries Red Flower Publication Pvt. Ltd., 48/41-42, DSIDC, Pocket-II, Mayur Vihar Phase-I, Delhi - 110 091
(India), Phone: 91-11-22754205, Fax: 91-11-22754205, E-mail: [email protected], Web:www.rfppl.com
Disclaimer The opinion in this publication is those of the authors and is not necessarily those of the New Indian Journal of
Surgery the Editor-in-Chief and Editorial Board. Appearance of an advertisement does not indicate NIJS approval of the
product or service.
© Red Flower Publication Pvt. Ltd. 2010 (year of first publication) all rights reserved. No part of the journal may be
reproduce, stored in a retrieval system or transmitted in any form or by any means, electronic, mechanical, photocopying,
recording or otherwise, without prior permission of the New Indian Journal of Surgery.
Printed at R.V. Printing Press, C-97, Okhla Industrial Area, Phase-1, New Delhi - 110 020.
New Indian Journal of Surgery Volume 3 Number 3 July - September 2012
82
Indexing information page of MedLine/PubMed
New Indian Journal of Surgery
July - September 2012, Volume 3 Number833
CONTENTS
NIJS
105
Childhood Cancer Awareness among Undergraduate Medical Students in South India
Chitra Lakshmi K., Angeline Prescilla R., Julius X. Scott, Magatha Sneha Latha, L.
Kannan, Arvind Moorthy
105
Study of Lipid Profile in Association with Anthropometric Indices in Adult Healthy
Individuals in Local Population
Anand A., Prashant V., Akila P., Suma M.N.
106
Evaluation of Undergraduate Students’ Perception towards Medical Research
Lakhani Dhairya Ajaykumar, Ashish Trivedi
107
Prevalence of Celiac Disease among First-Degree Relatives of Celiac Disease Patients
in North India
Kaul V., Midha V., Sood A.
107
Comparative Study of Various Types of Arrhythmias in Cardiac Patients Presenting
to a Tertiary Care Center: An ECG Study
Mittu S., Pannu H.S., Sharma A.
108
Laser Induced Breakdown Spectroscopy (LIBS) In Diagnosing Tuberculosis: A
Proposed Tool
Sandeep Singh, Sorabh Badaya
109
Knowledge, Attitudes and Practices Regarding Breast Cancer Screening among Female
Nurses at a Tertiary Level Hospital of Sri Lanka
Samarasekara K.R., Sameera R.A.C., Sameera A.W.M.K.
110
Knowledge, Attitudes and Common Myths towards Epilepsy among Inward Patients
in National Hospital of Sri Lanka
Sivasuganthan K., Somaweera B.A.C.S., Sumanatissa R.P.J., Haniffa M.R.
110
A Prospective Evaluation of Analgesic Utilization, Pain Assessment in 50Patients
after Abdominal Surgery in a Tertiary Care Centre in Different Clinical Settings
Vishakha Panicker
111
Knowledge and Utilization of Iron and Folic Acid Tablets Supplementation by the
Adolescent Girls in Ahmedabad District
Vidita V. Khatri, Rajshree Bhatt, H.K. Mehta
112
Awareness & Practice of National Guidelines on Infant and Young Child Feeding
among Working Women in Delhi
Prateek Harne, Prerna Batra
112
Typhoid Fever: A Life-Threatening Illness Fever
Vinod Kumar
113
Hallmarks of Cancer
Aman Kailash Setiya, Mikhael Yurivich Volkov
84
CONTENTS
114
Study of Heart Rate and Blood Pressure Response to Cold Pressor Test in Normotensive Overweight and
Normotensive Normal Weight Individuals
Madhu Bhatt, Anirban Bhattacharya
114
Evaluating the Knowledge, Attitude and Practices Regarding Radioactive Waste amongst the Scrap Dealerships
in Delhi
Nayani Makkar, Tany Chandra, Prachi Agrawal, Harshit Bansal, Simranjeet Singh
115
Profile of Medical Termination of Pregnancy Seekers in a Tertiary Care Teaching Hospital in Mangalore
M. Shashidhar Kotian, Ramesh Holla, Nidhi, Ayesha Arif, Mridul Rajurkar, Anshuman Kaushal, Shailova
Ranjan
116
To Study the Patient Compliance and the Impact of Various Non-Pharmacological Interventions in the
Management of Hypertension
Swati Bhayana
117
Clinico-Pathological Response Assessment in Patients Receiving Neoadjuvant Chemotherapy for Locally
Advanced Breast Cancer (Labc): KMC, Manipal Experience
Vivek Ahuja, Kriti Lakhina, Kashish Gupta
117
Clinical and Biochemical Profile of Type 2 Diabetics: A Problem Lurking for India
Sandeep Singh, Ajaypal Singh, Manish Kishore Multani, Ashish Purohit
118
Current Socio-Clinical Trend of Sexually Transmitted Diseases and Relevance of STD Clinic: A Comparative
Study from Referral Tertiary Care Center of Gwalior, India
Sandeep Singh, Sorabh Badaya, Divya Agrawal
118
Insulin Resistance in Type 2 Diabetes Mellitus: Prospect of an Untouched Area
Sandeep Singh, Maneesh Jain, Ajaypal Singh, Manish Kishore Multani, Ashish Purohit
119
Assessment of Cardiac Autonomic Dysfunction in Young Patients of Depression
Shivam Goyal, Atul Shekhar
120
Study on Knowledge about Diabetes Mellitus in Rural Adult People of Bangladesh
Elora Shyama Tanni, Masato Ahsan
121
Study of Parental Attitudes Regarding Various Aspects of Cochlear Implantation
Zahra Jafari
121
Case Report: Wilms’ Tumor
Sheikh Mahmood Hasan, Tablu Abdul Hanif
122
Attitudes, Knowledge and Practices among Medical Students Regarding Medical Management of Displaced
People Following a Disaster
Sajeev S., Samarakoon S.M.D.W., Samalai K.
123
Study the Prevalence of Cryptosporidium Parvum Infection among Immune Competent and Immune
Compromised Patients with Diarrhoea: A Descriptive Study
Partha Roy
124
Treatment Pattern of Acute Respiratory Tract Infections in General Practice with 3rd Generation Oral Cefixime
in Bangladesh
Md Sazid Rezwan
CONTENTS
85
125
A Comparison of the Cytotoxic Effects of Clostridium Difficile Toxins A and B on Peripheral Blood Monocytes
and Intestinal Macrophages
Rini Bhavik Shah, Adrian Robins, Yash Mahida
125
Prevalence of Cytomegalovirus Infection among Kidney Transplant Recipients in Bangladesh
Rajat Das Gupta, Sheikh Mahmood Hasan, Avijit Loha, Debashis Datta, Saikat Roy
126
The Opinion of 5th Year Medical Students of Bangladesh about the Status of Formative Assessment in
Clinical Subjects
Debashis Datta, Rajat Das Gupta, Sheikh Mahmood Hasan, Avijit Loha, Saikat Roy
127
Pattern of Hepatitis B Vaccination among Medical Students and Doctors in Bangladesh
Atanu Dey, Rajat Das Gupta, Sheikh Mahmood Hasan, Avijit Loha, Debashis Datta, Saikat Roy
127
Preference on Home Delivery or Hospital Delivery among the Mothers of a Rural Community of Faridpur,
Bangladesh
Tonmoy Biswas, Debjyoti Das, Niloy Das, Suja Hossain, Nowjum Noor Qunjo
128
Utilization of Maternal Health Care Services in a Rural Area of Modhukhali Upazilla, Faridpur, Bangladesh
Tonmoy Biswas, Debjyoti Das, Niloy Das, Boniface Hasdak, Nowjum Noor Qunjo
129
Knowledge and Awareness Regarding Cervical Cancer Prevention among Married Women of Reproductive
Age Group in a Rural Area of Bangladesh
Md. Ashaduzzaman Noor, Rajat Das Gupta, Sheikh Mahmood Hasan, Avijit Loha
130
Knowledge and Perceptions about Contraceptives among Postnatal Women Attending a Government
Hospital, Mangalore
Salonee S. Das, Mohan Kumar P., B. Unnikrishnan
130
Perceptions Related to Lifestyle Modifications Among Diabetes Mellitus Patients in Tertiary Care Hospitals
in Mangalore
Parul Goyal, Prasanna Mithra, Unnikrishnan, Akshay Sachdeva, Bharath Manakame, Prakhyat Shetty,
Anand Kumar
131
Relation between Body Mass Index, Serum Albumin, Sofa Score, C-Reactive Protein and the Duration of
Mechanical Ventilation
Barnamoy Bhattacharya, Akila Prashant, Prashant Vishwanath
132
Pre-Menstrual Syndrome among Students of a Medical College in Mangalore, South India
Sidharth Kharbanda, Vaman Kulkarni, Mahak Bhandari, Shweta Poojari, Sakshi Gaur, Aishwary Shivhare
133
Association of Reproductive Events as Risk Factors for Breast Cancer Cases in Mangalore (South India)
Purneetha Singh, Dinesh Pai Kasturi
133
Sleep Quality of Anesthetists in Two States of India
Aparna D., Pawan Kumar Sharma, Vijay Sharma, K.V. Raghava Rao
134
Assessment of Risk Factors for Non Communicable Diseases in an Urban Ward of Visakhapatnam
Krishnaveni
135
Pattern of Computer and Internet Use among Medical Students in Bangladesh
Maly Morshad Ahmad, Rajat Das Gupta
135
Malnourished after Cardiac Surgery: Are Healthcare Practitioners Aware?
Soumya Arora
86
CONTENTS
136
Assesment and Evaluation of CAD Risk in HIV Positive Patients in Indian Setting
Anmol Sharma, Amitabh Sagar, Navreet Singh, Biju, Ruby
137
Influence of Parental Factors on Childhood Myopia: A Case Control Study
Srivatsa Kuchibhotla
137
Assessment of Prevalence, Risk Factors and Treatment Regime Followed in Acute Diarrhoeal Diseases in a
Semiurban and Rural Area of Dakshina Kannada
S. Hariharan Bharadwaj, Punya Suvarna, Fathima Raeesa Hussain, Dhanush K.S., Mohammed Jasir
138
Assessment of the Common Problems Faced by Adolescent Students
Parul Ghildiyal, Shravya Deekonda, Divya Trivedi, Neha Dhakappa, Sumitha Subramaniam, Srividya Iyer
139
Effectiveness of an IEC(Information, Education and Communication) Campaign on the Knowledge, Attitude
and Practices Related to Cervical Cancer and its Prevention among Reproductive Women in an Urban Slum
of Central Delhi
Tripti Aneja, M. Meghachandra Singh
139
Profile of School Children Attending a Public School in Faridabad
Prince Hirdesh, Suma Nair
140
A Cyto-Histopathological Study Of Image Guided Core Biopsies
Vrishti Goel , Suchitha Satish
141
Dermoscopic Evaluation of Response to an Intralesional Corticosteroid in the Treatment of Alopecia Areata
Shikhar Ganjoo, D.M. Thappa
141
Prediction of Site of Insensate Peripheral Neuropathy in the Feet of Diabetics Using Semmes: Weinstein
Monofilament Examination
Snigdha Bhatia, Archith Boloor
142
Correlation of Hand Grip Strength and Vitamin D Levels in Type 2 Diabetes Paients
Dinesh Dhanwal, Smita Kaushik, V.K. Gupta, Vivek, Abhenil Mittal
142
Clinical Utility of C- Reactive Protein Test in Early Diagnosis of Neonatal Septicemia and its Correlation
with Blood Culture
Sunil Rao Padmaraj, Vidya, Safa Tariq Wani
143
A Rare Case of Congenital Erythrocytosis
Jayaseelan Meenaloshni, Niveditha Suvarna, Arun V.
144
Stosstherapy in Nutritional Rickets....Mysteries Unveiled
Daipayan Chatterjee, Vasu, Vikas Gupta, B.C. Kabi
144
Evaluation of Idiopathic Clubfoot Deformity in Infants by Pirani or Dimeglio Score: Attempting to Clear
the Confusion!
Vasu, Daipayan Chatterjee, Vikas Gupta
145
Poorly Differentiated Carcinoma in a Teratoma: Case Report
N.Charumithrra, Usha Vishwanath, Preet Agarwal, Rajendiran S., Gokulakrishnan, J. Thanka, Leena Dennis
Joseph
146
Prevalence of Dyslipidemia in HIV Seropositive Patients in Patiala Region of Northern India
Gurjinder Singh, Sumit Goyat
CONTENTS
87
147
Heart Rate Variability Changes during Stroop Colour and Word Test
Priyanka Satish Rao, K.Muralikrishnan, K.Balasubramanian, Shanmugapriya
147
Profile of Patients on First Line Anti-Retroviral Therapy (ART) Attending a Tertiary Care Centre in Mangalore
Ankita Singh, Anirudh Chand, Abhilash Bhat, Kanav Grover, Isha Chaudahary, Shahbaz Haroon, Mohan
Kumar Papanna
148
Study the Prescribing Pattern and Prescription Event Monitoring of Anti Retroviral Regimens and Other
Drugs Used in 75 Cases of HIV/AIDS Patients
Kushagra Maini, Purva Ranchal
149
A Study of Relationship of Physical Activity with Scholastic Performance & Body Mass Index in Children
Between 12-18 Years
Shashank Negi, B.M. John
150
Comparative Study of Frozen Section with Histopathology in Ovarian Lesions
Karan Bhatia, V. Srinivas
151
Knowledge of Family Planning Methods and Emergency Contraception in Rural Women of Reproductive
Age Group (15-45 Yrs)
Purva Ranchal, Kushagra Maini
151
Perception of Health Care Professionals about Fire Safety Measures in Tertiary Care Teaching Hospitals in
Mangalore
Rukmini M. Prabhu, Swapnil Priyadarshi, Ashish G. Rao, Sharlotte Gigy, Ankit Chandra
152
Study the Nutitional Status of Primary School Children (5-10 Years) in Gurdaspur District
Kushagra Maini, Purva Ranchal
153
The Incidence of Menopausal Symptoms in an Urban Population Attending Matured Women Clinic in a
Tertiary Healthcare Centre in Northern India: A Retrospective Study
Indrani Ganguli, Jayati Dureja, Mala Srivastava, Mamta Dagar
154
Alström Syndrome: A Diagnostic Dilemma
Ashwitha V., Rukmini M.S., Soundarya M., Madan Gopal M., Puneeth A.
155
Treatment Options for Mandibular Ameloblastoma: A Retrospective Analysis
Manu Gupta, Abhay Kamath
155
Can Counseling Promote Early Initiation of Breastfeeding in the First Hour of Life?
Amrita Talwar
156
Study of CYP17 Gene Polymorphism in Fetal Growth Restriction with Reference to Organochlorine Pesticide
Levels
Siddharth Chand, Md. Mustafa, B.D. Banerjee, Kiran Guleria
157
The Prevalence of Refractive Errors among Student Population
Kamali M., Rathnakumar, Ramasamy K.
157
To Evaluate the Utility of Immunohistochemistry in the Diagnosis of Different Types of Central Nervous
System Tumours Using a Panel of Antibodies
Saarang Hansraj, Vibha Dutta
88
CONTENTS
158
Knowledge of Ascariasis Clinical Manifestation and its Relation to the Characteristics of Children in the
Orphanage in East Jakarta
Maulana Rosyady, Saleha Sungkar
159
Evaluation of Knowledge and Practices of Prescribers Regarding Rationality of Promotional Drug Literature
Using WHO Criteria
Chirag Saluja, Ravinder Sah
160
A Case of Multiple Gastric Polyps Treated by Total Gastrectomy
Patil A.N., Godhi A.S., Mahajan Aman
160
Limb Salvage by Popliteal Artery Ligation in a Case of AV Fistula: A Case Report
Patil A.N., Godhi A.S., Mahajan Aman
161
Lifestyle Effect on Vitamin D
B.K. Agrawal, Parveen Gupta, Harjot
161
The Neurotrophic Effect of Tacrolimus (FK506) on Pyramidal Cells of Brain Cortex Following Global
Ischemic/Reperfusion in Wistar Rat
Ghazal Ansarian, Zahra-Nadia Sharifi, Shabnam Movassaghi, Hamed Shafaroodi, Nooshin Panahi Khezri
162
The Effect of Pentoxifylline on Global Ischemia/Reperfusion Induced Spatial Memory Impairment in
Estrous Phase of Female Wistar Rat
Nooshin Panahi Khezri, Shabnam Movassaghi, Zahra Nadia Sharifi, Hamed Shafaroodi, Ghazal Ansarian
163
Rethinking Cancer Immunotherapies
Venumadhav Rayasam, Kondadasula Sri Yogesh
163
Prevalence and Pattern of Alcohol Consumption in Pondicherry Adult Males: To Bring Change in Attitude
Pushparaj R., Senthilkumaran R., Sumeet Shende, Ajit Malani
164
Dermatoglyphics in Blind Versus Normal Individuals from Southern India
Ishwarya M., Akshaya E., Ajit Malani, Sumeet Shende
164
Hypopyon: A Rare Presentation of Relapsed Acute Lymphoblastic Leukemia in a Child
S. Aro Shime Hercules, Latha, Julis Scott Xavier
165
Association between Level of Knowledge about Trichuriasis and Demographic Characteristics among Orphans
in East Jakarta in 2012
Iman Setiadi, Saleha Sungkar
166
Knowledge and Awareness of Consumer Protection Act among the Medical Practitioners in Pondicherry
Lavanya S.V., Ajit Malani, Sumeet Shende
166
Study on Knowledge, Attitude and Practice Regarding Diabetes Mellitus Related Eye Complications and
Compliance to Diabetes Mellitus Treatment among Diabetes Patients of National Hospital of Sri Lanka
J.R.G Mahipala, A.V. Mahendran, V.P. Wickramasinghe
167
Nephrotic Syndrome and Cholelithiasis: A Rare Association
Nishikant Tiple
168
Non-Prescribed Utilization Pattern of Medicine by Students of Medical Faternity
Shivang Sharma, Shahruk Ahmed
CONTENTS
168
The Seroprevalence of HCV, Hbsag, HIV, Syphilis in Pregnant Women under PPTCT Programme and
Blood Donors: A Retrospective Analysis
Varshney Prateek, Roy Partha
169
Lipids, Lipid Peroxidation and Total Antioxidant Capacity as Biomarkers of Coronary Heart Disease in
Patients with Diabetes Mellitus
C. Aravind, E. Prabhakar Reddy
170
A Case of Meckel’s Diverticulitis with Perforation and Intestinal Obstruction
Yogesh Kumar, Shiwani Kamath
170
Role of Thrombophilic Mutations in Thrombosis
Kshitij Srivastava, Jyoti Kotwal
171
The Effectivity of Combination Extract Acalypha Indica Linn and Centella Asiatica on Picnotic Cells in
Gyrus Dentatus Internus in Sprague Dawley Rats Pascahypoxia
Ermono Superaya, Siti Farida
172
Assessment and Evaluation of CAD Risk in HIV Positive Patients in Indian Setting
Anmol Sharma, Amitabh Sagar
172
Twenty Four Hour Tuberculin Response in Adolescent School Children
89
Tiroumourougane Serane V.
173
Comparison of Capillary and Venous Blood Glucose Measurements in Healthy Volunteers
Senthamizh Selvan
174
Antianxiety Activity of Tylophora Indica on Ethanol Induced Anxiety in Wistar Albino Rats
Shyamjith Manikkoth, Roysten Rodrigues, S.N. Rao
174
Antidepressant Activity of an Indigenous Medicinal Plant, Tylophora Indica on Ethanol Induced Depression
in Wistar Albino Rats
Shyamjith Manikkoth, Aishwarya Raja, S.N. Rao
175
The Impact of Artificial Sweeteners on Incretins and the Level of Incretins in Type 2 Diabetes Mellitus
Patients
N. Charumithrra, D. Anusha, S. Seethalaksmi
175
Memory Enhancing Activity of Tylophora Indica Ethanolic Extract on Alcohol Induced Amnesia in Wistar
Albino Rats
Shyamjith Manikkoth, Vasudha Sanklapur, S.N. Rao
176
Prescribing Patterns, Adverse Effects and Treatment Outcome of Anti-Leprotic Drugs
Aashima, Bharti Magazine
177
TLR2 Ligation Modulates the Balance between Regulatory and Th17 Function in Human T-Cells: Implications
for Multiple Sclerosis
Abhishek Kumar, Mukanthu Nyirenda, Bruno Gran
178
Pandemic of Decadence: Is Medicine Still Unaffected?
Siddharth Sethi, J.M. Farooqui
178
Effectiveness of Intra-Discal Ozone Therapy in the Treatment of Low Backache
Vanshika Gupta, Pankaj Banode
CONTENTS
90
179
179
Prevalence of Osteoporosis and Osteopenia in Rural Adult Population of Andhra Pradesh
Anantha Krishna, Pawan Kumar Sharma
Role of Surgical Drains after Cholecystectomy as it Stands Today
Geet Midha, K. Veena, L. Karanth
180
Microbial Contamination of Soft Contact Lenses and Accessories in Asymptomatic Contact Lens Wearers
Deeksha Thakur, Ujjwala Gaikwad
181
Enginnering: 7th Sense in Dentistry
Harsh Vardhan Singh
181
Ocular Ultrasonography in the Diagnosis of Diseases of the Posterior Segment of the Eye
Ragavi P.S., S. Manavalan
182
NSAIDS Induced Ileal Strictures: A Rare Case Report
Komandur Thrupthi
182
Extensive Intratemporal Cholesteatoma: Presentation, Complications and Surgical Outcomes
Avantika Singh, Ashish Vashishth
183
Risk Factors for Gall Bladder Cancer in North India: A Case Control Study
Pranav Gupta, Anil K. Agarwal
184
Collodion Baby: A Case Report
Nipun Gumber, Ameya Sirsat, Rumana Maldar
184
Study of Risk Factor Profile for Non Communicable Diseases amongst the Medical Students
Animesh Jain, Rohan Kumar, Ankit Raj,Vishesh Sharma,Vidhika Berwal, Amritansh Pandey, Dikshy Garg
185
Kerosene Poisoning in Children
S. Krithika, D. Keerthana, S.N. Rathod
186
A Profile of the Organophosphorus Poisoning Cases in Southern India
D. Keerthana, S. Krithika, S.N. Rathod
186
Dieting in Female Medical College Students: Complete Withdrawal from Food as Opposed to Fat Restriction
for Weight Control
Gireesha Rawal
187
Increasing Awareness Regarding Emergency Contraception as a Solution to Unsafe Abortion Following
Unwanted Pregnancies
Gireesha Rawal, Jigyasa Sahu, Anuradha Mehta, Titiksha Goyal, Mohit Gupta
188
Psychiatric Co-Morbidities in Patients with Deliberate Self Harm
Sapkota N., Devkota S., Ghimre S., Budhathoki R., Goel A.M.
188
Spectrum of Mitochondrial Disorders in Children
Amrit Kaur Pannu
188
Comparative Analysis of the Impact of Low Decibel and High Decibel Sound: Waves on Fetal Heart Rate
Asmita Nandedkar, Jayant Vagha
189
To Monitor and Study the Effiency of Oral Anticoagulants in Patients of Deep Vein Thrombosis
Chitramalya Dan
CONTENTS
91
190
Melioidosis of Liver Presenting as Hepatocutanaeous Fistula: A Case Report
Rajeev Ranjan, Sudhir Kumar, Shailesh Kumar, Namrata Kumari, Anima Xess, S.K. Shahi
191
An Assessment of Iron Supplements in the Indian Market
Brinda Valecha, Preeta Kaur Chugh, C.D. Tripathi
191
To Study Theantibiotic Sensitivity of the E.Coli, Staph. Aureus, Klebsiella, Acinetobacter, Pseudomonas and
Enterococci (ESKAPE) Organisms Isolated from the Endotracheal Tubes from Intensive Care Units of a
Tertiary Care Hospital
Syed Mohammed Bilal, Narendranath S., Dinakar K.R., Vishwanath G., Somashekar H.S., Pavani S.
192
A Comparative Study of Anthropometry and Risk Factors among Diabetics and Non-Diabetics in Puducherry
Frank Jebanath F., Thiruselvakumar, Lokesh, Mathan Kumar
193
Malignant Mesothelioma with Right Pleural Effusion: A Case Presentation
Anudeep C. Kode, Abul Fazil
193
A Rare Parasitic Twin
V. Sudha Spandana
194
Edward Syndrome with Hydrocele and Ctev
V. Sudha Spandana
195
Massive Hydatid Cysts Involving Multiple Organs
Komandur Thrupthi, U.V.N. Mahati,V. Sudha Spandana,T.V.S. Vaibhav
196
Facebook and Other Social-Electronic Media Usage Including among Medical Undergraduates in Puducherry
V. Nithya, S. Vaishali, Thiruselvakumar D.
196
Mobile Phone Usage and Dependency among Medical Undergraduates in Puducherry
S. Vaishali, V. Nithya, Thiruselvakumar D.
197
Snacking Behaviour and Their Correlates among Urban School Going Adolescents
Sibi Chakravarthy R., Thiruselvakumar D., Sinuvasan K., Venkatesh E., Kailash C.
198
Factors Affecting Food Choice and Attitude of Choosing Food Items among Adolescents
Venkatesh E., Thiruselvakumar D., Sinuvasan K., Sibi Chakravarthy R., Kailash C.
198
Factors Governing Healthy Eating Behaviour among Urban School Going Adolescents
Sinuvasan K., Thiruselvakumar D., Sibi Chakravarthy R., Kailash C., Venkatesh E.
199
Clinical Characterstics and Outcome of ACS Patients
Megha Dogra, Punit Kumar, P.C. Negi
200
To Study the Correlation between Abnormalities in Lipid Profile and Severity and Disease Activity in
Rheumatoid Arthritis
Abhishek Mittal
201
Megha Dogra, Punit Kumar, P.C. Negi
201
Behavioral and External Factors Influencing Food Preference Among Adolescents
Kailash C., Thiruselvakumar D., Sinuvasan K., Venkatesh E., Sibi Chakravarthy R.
92
CONTENTS
202
The Latest Modes of Diagnosis, Management and Prevention of Acute Meningitis
M. Tasdik Hasan, Muhammad Yameen Hamid, Anindita Ghosh
203
Diagnostic Value of Alvarado Scoring System
S.M. Tajdit Rahman, Sazid Rezwan, Tamanna Bintay Ahmed
203
Comparative Study of Level of Awareness on Hepatitis B Infection among First Year Medical and Nursing
Students of Indira Gandhi Institute of Medical Sciences, Patna
Ranjan Rajeev, Kumar Sanjay, Sinha Setu
204
Pediatric Developmental Delay: Spectrum of MR Findings
Najmal Nazeer, S. Lalwani, Kavita Srivastava
205
NSAID Induced Acute Kidney Injury in Preterm Neonates with Patent Ductusarteriosus
Naved Anjum Qureshi, V.R. Kalrao, S.K. Lalwani, J.V. Sharma
205
Clinical Features and Management of Two Rare and Interesting Pediatric Oncology Cases at Our Institute
Naved Anjum Qureshi, Vibha Bafna, Shashank Shrotriya, Vijay Kalrao, Sanjay Lalwani
206
Retrospective Study of Short Term Mortality and Morbidity in Very Low Birth Weight Babies
Dinesh M., Pradeep Suryawanshi, Sanjay Lalwani
206
Hemophagocytic Lymphohistiocytosis: A Life Threatening Rare Entity
[email protected] Nazeer, V. Bafna, V. Kalrao
207
Clinical Profile of Type I Diabetes Mellitus Children
Bhakti Sarangi
207
Changes in Bone Mineral Density in Patients with Type 1 Diabetes Mellitus
Abhishek Mittal
208
To study Extended Spectrum Beta-Lactamase Producing Organisms in Neonatal Septicemia in a Tertiary
Care Hospital
Rajdeep Singh, K.J. Ghosh, R. Singh, A. Ray
208
Syndromic Deafness-Variant of Waardenburg Syndrome
Vini Balakrishnan, B.P. Belaldavar
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Spindle Cell Hemangioma: Case Report of a Rare Presentation of a Rare Tumour
Anil Harugop, Vini Balakrishnan, Lavanya Naidu
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Knowledge, Attitude and Practice about Contraception in Females Visiting a Tertiary Care Public Hospital
in Mumbai
Charu Dutt Arora, Monika M. Bhagat , Reena J. Wani, Abhiram M. Kasbe
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Nosocomial Infections: A Major Global Safety Concern
Hema Gogia, Jayanta K. Das
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To Assess Various Health Problems among Adolescent Age Group in Gwalior
Ashok Mishra, Ranjana Tiwari, Chandrapal Singh Yadav, Danish Anwar, Bhanu Sharma, Deepak Sulya
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Prediction Model for Low Birth Weight and its Validation
Avantika Singh, Sugandha Arya, Harish Chellani, K.C. Aggarwal, R.M. Pandey
CONTENTS
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Laparoscopic Surgery Videos as a ‘Visual Aid’ Improve Learning of Anatomy: A Prospective Controlled
Study
Krishna Adit Agarwal, Nayan Agarwal, Brij B. Agarwal
213
Effect of Exercise on Heart Rate Variability in Children of Diabetic Parents
Parikha Rampal, Arati Meher, Manasi Bhattacharjee, Renuka Sharma, Raj Kapoor
214
Prevalence of Type II Diabetes Mellitus and Assessment of Risk Factors Along with the Health Seeking
Behavior amongst Diabetics of Slums in Delhi
Ankit Arora, Apoorva Sehgal, Archit Goyal, Dhairya Lakhani, Devyani Mukherjee, Dipan Uppal, Kritika
Sharma, Nitika Gautam
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Predictors of Early Neurological Deterioration in Patients of Acute Ischemic Stroke with Special Reference
to Blood Urea Nitrogen/Creatinine Ratio and Urine Specific Gravity
Kunal Bhatia, Smita Mohanty, B.K. Tripathi, B. Gupta
215
Assessment of Health Profile and Relationship betwen Health Disorders with Work-Related Abuse of
Housemaids in Delhi
Ambar Prakash, Tanya Singh Kakar, Sakshi Rajoria, Tushar Dhawan, Shivani Sharma, Shikhar Chohan
216
Physicians’ Knowledge, Attitude & Practices Regarding Fertility Issues for Young Breast Cancer Patients
Arushi Devgan, Chintamani
217
Severity and Associated Risk Factors Leading to Depressive Symptoms in the Post Partum Period: A Cross
Sectional Study in a Tertiary Care Hospital
Arushi Devgan, Sukriti Gupta, Mayank Mehrotra, Pratima Mittal, Jyotsna
218
Assessment of Long-Term Quality-of-Life (QoL) Outcomes in Disease-Free Breast Cancer Survivors
Chintamani, Sukriti, Megha Tondon, Rohan Khandelwal
218
Cerebellar Tuberculoma Presenting as Acute Reversible Hemiplegia: A Rare Presentation
Harsh Bhardwaj
219
Abducens Nerve Palsy in Petrositis: A Report of Three Cases
Avantika Singh, AshishVashishth
219
Basic Life Support & Advanced Cardiac Life Support: Knowledge & Attitudes of Medical Students in New
Delhi
Akriti Sinha, Arushi Devgan, Mayank Mehrotra, Avantika Singh, Krishna Adit Agarwal
220
Basic Life Support: Awareness & Impact among Indian Medical Students
Krishna Adit Agarwal, Akriti Sinha, Avantika Singh, Mayank Mehrotra, Arushi Devgan, Pavan Nayyar
221
Perspective and Perception of Latah among Junior High School Student in Jakarta, Indonesia
Dina Faizah, Fia A. Mutiksa, Randy S.N. Rusdy, Eka S. Nugraha, Martina W.S. Nasrun, Elisna Syahruddin,
Indah S. Widyahening
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Message of the Organizing Chairman
“Without education, we are in a horrible and deadly danger of taking
educated people seriously.”
- G.K. Chesterton
Dear delegates I welcome you all to this yet another International
medical students meet MEDSICON-2013. It is vital that the real
education is imparted in a real manner rather than “run of the mill”
mumbo jumbo. Present day medical education needs to be modified
to include “hands on” training with a demonstrative performance of
all the skills and this conference stands out in that sense .The workshops
like in the last conferences have been planned to incorporate the “must
know” concepts along with “can know” issues so that information travels the right way. The
intention of the scientific programme is to put the proverbial horse (wisdom) before the
cart(information) rather than other way round.
The hands on workshops on day-1 make learning not only enjoyable but also self-explanatory.In
the present day world of science, except God everyone needs to provide evidence. Documentation
is a mandatory part of learning [publish or perish] and a significant part of the conference has
been dedicated to scientific paper writing skills to encourage young minds to publish their
thoughts and the work. We have received nearly 180 abstracts to be presented as posters and
oral papers besides the JAM sessions, debates and quiz, making this congress an academic
festival of epic proportions. All these papers find a place of publication in the “New Indian
Journal Of Surgery” and would encourage the delegates to publish further in their careers.
Such a congress was indeed an idea that was churning inside all of us for the last ten years.
Some of my dearest pupils, Rohan (now a budding breast surgeon), Megha, Amita (both senior
residents now)and others expressed the desire to expand our class room to include students
from across the globe and we owe the concept of MEDSICON to all of them for which all these
students had toiled really hard.
We owe our gratitude to our chief guest and DGHS, Padma shri Prof Jagdish Prasad for being
the beacon of excellence,our chief patron Special DGHS and Medical Superintendent Dr BD
Athani for being the leading light for all of us and Dr Jayshree Bhattacharya our Principal for
encouraging us and guiding us all the way.
So delegates let us celebrate excellence and work towards a new horizon of learning during
MEDSICON-2013.
May God bless us all
Prof Chintamani
MS, FRCS (Ed.), FRCS (Glas.), FRCS (Irel.), FACS, FICS (Surg Oncol), FIMSA
Organizing Chairman
MEDSICON-2013
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Childhood Cancer Awareness among Undergraduate Medical Students in South
India
Chitra Lakshmi K.*, Angeline Prescilla R.**, Julius X. Scott***, Magatha Sneha Latha****, L. Kannan*****, Arvind
Moorthy******
Sri Ramachandra Medical College and Research Institute, Chennai, India
Background
The demand for paediatric oncology care, when
compared to specialized medical care is found to be poor
in developing countries. We conducted a study to
determine the awareness and interest for paediatric
oncology amongst the medical under graduates.
Aims & Objectives
To evaluate the current status of childhood cancer
awareness among undergraduate medical students in
South India and their interest in paediatric oncology
career.
Material & Methods
This is a non randomized study. A 24 point
questionnaire was given to the participants. Collected
data was entered in an EXCEL SHEET and analysed by
SPSS software.
Results
CONFERENCE 2012 from various universities in south
India answered the questionnaire. 70% of them answered
the basic knowledge questions about childhood cancer
correctly. 55% of the students had not encountered
paediatric oncology patients during their clinical postings.
40% did not have enough lectures on paediatric oncology.
29.6% felt that failure in effective treatment of childhood
cancers was because of late diagnosis and referral and
21.4 % felt that it is because of lack of trained personnel
in paediatric oncology field in our country. 50% were
interested in pursuing paediatrics as their career but 80
% of them were not interested in pursuing paediatric
oncology as their career.65.5% thought that the
information they had on paediatric oncology was not
enough to suspect and refer appropriately during their
practice. 84% felt that there is a definite need to improve
paediatric oncology teaching in their medical curriculum.
Conclusions
The outcome of this study shows that the clinical
postings in paediatric oncology in the medical curriculum
will improve the outcome of pediatric oncology care
world wide.
240 students who attended the MEDHOPE
Study of Lipid Profile in Association with Anthropometric Indices in Adult Healthy
Individuals in Local Population
Anand A.*, Prashant V.**, Akila P.***, Suma M.N.****
JSS Medical College, Mysore, India
Background
Study of lipid profile requires fasting subjects to
voluntarily give blood, requiring a high level of
motivation. If simpler tests or anthropometric indices
could predict dyslipidemias or future risk of
cardiovascular events, they can be applied easily to larger
sections of the society.
Aims & Objectives
To study the lipid profile pattern in adult healthy
population of urban Mysore district along with
anthropometric indices and lifestyle history to assess the
risk of future cardiovascular disease.
Material and Methods
Lipid profile of 100 healthy individuals was studied
in a random local population across different sections of
the society, along with measurement of anthropometric
indices like BMI, Waist circumference and Waist/Hip
Ratio (WHR). We also enquired about the intake of
alcohol, smoking and dietary habits.
© Redflower Publication Pvt. Ltd.
106
Results
Anthropometric indices have a good correlation with
lipid profile parameters and hence can be used to predict
dyslipidemias and future cardiovascular risk. The study
has also shown that obesity is a global phenomenon and
is distributed across all sections of the society and
strategies to overcome obesity have to be undertaken
among all socioeconomic strata. There is a strong
association of alcohol and smoking with dyslipidemias
and hence an increased risk of cardiovascular and other
complications arising from it.
modification done at an early age can delay the onset or
reduce the incidence of cardiovascular diseases which
has assumed significant proportions in elderly patients
admitted to hospitals.
Keywords
Lipid profile; Healthy adult population;
Anthropometric indices; Waist/hip ratio.
Conclusions
The study has a major impact, suggesting that lifestyle
Evaluation of Undergraduate Students’ Perception towards Medical Research
Lakhani Dhairya Ajaykumar*, Ashish Trivedi**
S.B.K.S. Medical Institute & Research Centre, Vadodara, India
Results are displayed with the help of pie chart.
Aims & Objectives
The study was designed to evaluate the poor standards
of undergraduate medical research in Indian Medical
Collages and to compare sensitivities of different
parameters in determining the lack of interest of medical
students towards research.
Material & Methods
A prospective trial, comparing sensitivities of lack of
awareness, lack of proper mentors, lack of infrastructure,
lack of carrier as a researcher, publication issues and lack
of medical rewards, in three hundred final year medical
students was carried out.
A detailed questionnaire was formed to evaluate why
the final year MBBS students were not enrolled in medical
research and how they would be interested for the same.
Following criteria were included in the evaluation: lack
of awareness, lack of proper mentors, lack of
infrastructure, lack of carrier as a researcher, publication
issues and lack of medical rewards.
Results
Evaluation of the questionnaire suggested that, lack
of awareness in 46.3%(n=139) lack of Proper infrastructure
in 17% (n=51), lack of medical rewards in 16.3% (n=49),
lack of carrier as researcher in 10% (n=30), lack of proper
mentors in 6% (n=18) and publication issues in 4.3% (n=13)
were responsible for lack of research initiative from the
students.
Conclusions
It can be concluded that lack of awareness and proper
infrastructure were amongst the most frequent factors
resulting in lack of research work by undergraduate
medical students. Hence attempts should be made in
improving the awareness and the infrastructure.
While medical rewards, proper mentors and
publication issues were in minority. Hence proper
resources should be utilized in creating awareness and
improving the infrastructure.
Statistical Analysis
It was carried out by using proportions and odds ratio.
107
Prevalence of Celiac Disease among First-Degree Relatives of Celiac Disease Patients
in North India
Kaul V.*, Midha V.**, Sood A.***
Dayanand Medical College and Hospital, Ludhiana, India
Background
Studies have shown that first-degree relatives of
patients with celiac disease are also at a higher risk of
developing this disease. Early diagnosis is crucial for the
prevention of long-term complications in such cases.
Aims & objectives
To determine the prevalence of celiac disease amongst
the First-degree relatives of known cases of celiac disease.
First degree relatives (parents, siblings, and offsprings)
of 40 patients with CD diagnosed as per modified
ESPGHAN criteria were offered family screening and
were tested for serum IgA anti-tissue transglutaminase
(anti-tTG) antibody. Those who screened positive were
advised duodenal biopsy done through upper GI
endoscopy. Subjects with characteristic histological
findings and showing improvement on follow-up were
labeled as having celiac disease.
Results
We identified 115 relatives of 40 index cases of Celiac
Disease, out of which 90 (78.26%, including 44 parents, 18
siblings and 28 offsprings) consented to participate. AntitTG was positive in 23 out of these 90 relatives (25.55%).
The maximum seroprevalence was seen amongst the
siblings (50%, 9/18) followed by the offsprings (25%, 7/
28) and the parents (15.9%, 7/44). On subsequent
questioning 10 subjects (43.48%) reported to have some
symptoms (extra-intestinal) consistent with CD, 7 subjects
(30.43%) had a history of diarrhoea while 6 subjects
(26.09%) reported not to be having any symptom
consistent with CD. Of all the seropositives, 16/23 (69.56%)
agreed to undergo an endoscopic biopsy, amongst which
13 had histological changes suggestive of CD (2 had Marsh
II, 1 had Marsh IIIa, 3 had Marsh IIIb and 7 Marsh IIIc).
Thus, the overall prevalence rate of Celiac Disease
amongst the first degree relatives was found to be 14.44%
(n=13/90) with the maximum prevalence being amongst
the siblings (27.77%, 5/18) followed by the offsprings
(14.28%, 4/28) and then the parents (9.09%, 4/44).
Conclusions
There is a high prevalence of CD in the first-degree
relatives, particularly siblings of patients with CD in
North India suggesting the need for instituting an
extensive screening program for relatives of patients with
CD so that they can be diagnosed early.Keywords: Celiac
Disease, Gluten, first-degree relatives, Anti-tTG,
endoscopic biopsy
Comparative Study of Various Types of Arrhythmias in Cardiac Patients Presenting
to a Tertiary Care Center: An ECG Study
Mittu S.*, Pannu H.S.**, Sharma A.***
Dayanand Medical College and Hospital, Ludhiana, India
Background
The presence and complexity of both supraventricular
and venrticular arrhythmias may influence morbidity ,
mortality and the quality of life of patients. Risk factors
and the underlying mechanisms, thus, need to be further
studied to find out any association between them and
the types of arrhythmia, so that successful measures can
be taken to prevent these arrhythmias and their serious
complications.
Aims & objectives
To make a comparison between different types of
arrhythmias in cardiac patients presenting to a tertiary
care center.
Material And Methods
The study included 100 patients who presented to the
Department of Emergency or Cardiology over a period
108
of two months. The study questionnaire was filled. ECG
was used to diagnose arrhythmia. The various types of
arrhythmias were compared with respect to parameters
like age, sex, prevalence, presenting symptoms and the
final diagnosis. The statistical tools used were Mean,
Standard Deviation and Tukey’s Multiple Comparison
Test.
Results
Ventricular Tachycardia (9.00%). The most common
diagnosis in arrhythmic patients were CAD (26.00%)
and RHD (11.00%). And amongst the symptomatology,
breathlessness (65.00%), palpitations (62.00%), chest pain
(51.00%), neurological symptoms (50.00%), dizziness
(44.00%) and body weakness (44.00%) were the major
chief complaints in arrhythmic patients.
Conclusions
Prevalence of arrhythmia was more in the age group
of 60-69 years with a strong male preponderance. In our
study sample , Sinus Tachycardia (51.13 years) and Atrial
Flutter (57.86 years) were found to occur at an early age
whereas Left Bundle Branch Block (62.29 years) and AV
Blocks (62.11 years) were observed to occur somewhat
later. In order of occurrence , Atrial Fibrillation (38.00%)
was the major arrhythmic event prevalent in patients
followed by 3rd Degree AV Block (18.00%) and
Atrial Fibrillation was the most common arrhythmic
event requiring target therapy to prevent its
complications and elderly patients with CAD and RHD
were more prone to arrhythmic attacks. The influence
of Hypertension, Diabetes, Alcohol consumption,
Smoking and genetic susceptibility on the development
of arrhythmias was observed though their establishment
as a fact requires a large sized cohort study.
Laser Induced Breakdown Spectroscopy (LIBS) In Diagnosing Tuberculosis: A
Proposed Tool
Sandeep Singh*, Sorabh Badaya**
Gajra Raja Medical College, Gwalior, India
Background
The global tuberculosis epidemic, killing 2 million
and adding 9 million new cases a year, remains a major
public health concern. Low sensitivity of sputum smear
and long time taking process for mycobacterium culture
to be interpretable make them non effective tools in the
current scenario. Declining quality of the smear
examination in overburdened laboratories in HIVendemic countries like India makes acid-fast smears on
sputum specimen as a relatively insensitive test for
pulmonary tuberculosis in AIDS/ARC patients, which
is another concern. None of the commercially available
rapid tests are well enough to replace sputum smear
microscopy, thus these tests have little or no role in the
diagnosis of pulmonary tuberculosis. Therefore,
development of rapid and accurate new diagnostic tools
is imperative.
Aims & Objectives
sample material in plasma plume through a laser pulse
and its analysis through fiber spectrophotometer is the
key. The whole process can be considered as minimally
destructive and real time as nano- to micro-grams of
material is ablated in femto-to nano-seconds (depending
on the laser pulse duration). The postulated hypothesis
is aimed to use laser induced breakdown spectroscopy
(LIBS) in the detection of tubercular bacilli as trace
mineral elements acts as biological signature in living
and non living entities and store information regarding
habitat, nutrition, and other environmental conditions.
Results & Conclusions
Previous researches have shown significant
differences in trace element concentration in different
bacterial strains. The technique is exemplified by
suggested use of LIBS in studying biological samples
such as tissues, gall stones, biological aerosols in vivo
cancer detection and discrimination of E. coli strains.
To postulates a screening tool aimed to have a real
time detection of tubercular bacilli using LIBS modality
Material & Methods
Generation of elemental line spectra by converting
109
Knowledge, Attitudes and Practices Regarding Breast Cancer Screening among
Female Nurses at a Tertiary Level Hospital of Sri Lanka
Samarasekara K.R.*, Sameera R.A.C.**, Sameera A.W.M.K.***
Faculty of Medicine, University of Colombo , Colombo , Sri Lanka
Background
Breast cancer is the commonest cancer amongst
women worldwide and in Sri Lanka. It has a better cure
rate if detected early. Regular screening promotes early
detection of breast cancer. However, the practice of
breast cancer screening in Sri Lanka is still low.
Aims & Objectives
To assess knowledge, attitudes and practices
regarding breast cancer screening among female nurses
at a tertiary level hospital of Sri Lanka.
Material & Methods
This was a descriptive, cross sectional study, carried
out in the National Hospital of Sri Lanka. The study
population consisted of female nurses between 25-55
years of age, working at National Hospital of Sri Lanka
in August, 2011. Nurses already diagnosed as having
breast carcinoma or have undergone treatment for breast
carcinoma, and nurses working in specialized units were
excluded from the study. Cluster sampling method was
used. The wards to be sampled were selected randomly
and all the nurses in the selected wards were included in
the study, based on the inclusion and exclusion criteria.
A Self administered questionnaire was used to collect
the data. The data was analysed using SPSS 19.0 software.
Chi-square Test was used for testing associations.
Results
The response rate was 73%. Among the 128 female
nurses who participated in this study, 67% had poor
knowledge regarding Breast Self Examination (BSE).
Their knowledge level is significantly associated with
their working environment and the presence of family
history of breast cancer. Eighty-six-percent of participants
obtained good scores for practicing BSE. The practise of
BSE is significantly associated with working
environment, number of children, and menopause.
Seventy-two-percent had poor overall knowledge
regarding breast cancer screening (knowledge about
BSE, mammography and Clinical Breast Examination).
Eighty-four-percent and 31% of women above 40 years
of age had undergone mammography and Clinical
Breast Examination(CBE) respectively. There was no
significant association between family history of breast
cancer and undergoing screening with mammography
and CBE. The knowledge, attitudes and practises on
breast cancer screening(KAP score) level was good in
84% of participants. KAP score level is significantly
associated with district of residence, district of schooling,
working environment, occupation of spouse, number
of children, number of pregnancies, and whether
menopausal or not.
Conclusions
The knowledge regarding the proper technique of
BSE among nurses is poor. But their practise of BSE is
good. When considering the overall knowledge
regarding breast cancer screening methods (i.e.BSE,
mammography and CBE taken together), majority has
a poor knowledge. Majority of nurses have good
knowledge, attitudes and practises regarding breast
cancer screening as a whole. Majority of the nurses in
the 40-55 years age group had undergone
mammography, whereas majority of them had not
undergone CBE. Health educational programmes should
be carried out to improve knowledge regarding the
proper technique of breast self examination. They should
also emphasise on the importance of undergoing CBE
in the >40 years age group. Further studies need to be
carried out on the >40 years age group to assess the
influence of socio-demographic factors on breast cancer
screening.
110
Knowledge, Attitudes and Common Myths towards Epilepsy among Inward Patients
in National Hospital of Sri Lanka
Sivasuganthan K.*, Somaweera B.A.C.S.**, Sumanatissa R.P.J.***, Haniffa M.R.****
Faculty of Medicine, University of Colombo, Sri Lanka
Background
People in developing countries have myths and
beliefs regarding epilepsy unlike in developed countries
where literacy level is high. Though the literacy level is
high in Sri Lanka, people have mythical beliefs, which
aggravate social morbidity.
Aims & Objectives
To assess knowledge, attitude and common myths
towards epilepsy among inward patients over 30 years.
Material & Methods
This is a descriptive cross sectional study conducted
in General medical wards at National Hospital of Sri
Lanka. Equal number of female and male adult patients
>30 years were selected randomly up to sample size of
120. Interviewer administered questionnaire was used
to collect thedata and analysis was done using SPSS 15.0.
Results
males and females. Giving metal piece to patient’s hand
to stop seizures (80%) was the most common myth. None
of the myths were associated with the educational level.
Even though 73.3% of families accepted their epileptic
patients, only 40.% of the community accepted them.
There is no significant association between attitude and
education level. Though 55.9% of the population allows
their child to play with a child who has epilepsy, only
9.2% let their children to marry a person with epilepsy.
Swimming, driving, working with machines and
climbing trees were considered as risk activities. 57.5%
of population acquired their knowledge from patients.
Conclusions
Activities to increase awareness towards epilepsy in
our population especially among females is highly
recommended. There can be factors other than literacy
level that affect the attitudes and myths towards epilepsy
which need to be further studied.
Keywords
40.8% of the study population had poor knowledge
about epilepsy and there is significant difference among
Epilepsy; Knowledge; Attitudes; Myths.
A Prospective Evaluation of Analgesic Utilization, Pain Assessment in Patients after
Abdominal Surgery in a Tertiary Care Centre in Different Clinical Settings
Vishakha Panicker
Kasturba Medical College, Mangalore, India
E-Mail: [email protected]
Background
Material & Methods:
As with all trauma, pain is an expected part of the
surgical experience. Pain assessment moves away from
pure physical estimation of pain and includes
psychological, social, spiritual and cultural dimensions.
Intensity of pain was assessed using VAS score on Postoperative day 1, day 2 and day 3 and Quality of health
care was assessed using SCQUIPP questionnaire. The
above variables were then compared between a private
and a government setting.
Aims & Objectives
Results
The present study analyzed the analgesic utilization
pattern obtained from prescriptions in post-operative
patients, intensity of pain and quality of health care
provided.
The mean age of participants in government setting
was 35.38 years and in private setting was 41.05 years. In
the government setting 29.31 percent of participants were
111
females while in private setting 65.38 percent were
females.
The present research showed that the subjective pain
experienced by the patients in private setting is
significantly lesser than those in government setting on
post-operative day 2 and day 3. This can be attributed to
better infrastructure and patient factors like expectations
etc. Gear RW, Gordon NC et al showed definite gender
difference in analgesic response. Paller CJ, Claudia M,
Dobs AS. et al reported that women experience greater
clinical pain, suffer greater pain-related distress, and
show heightened sensitivity to experimentally induced
pain compared with men. In the present study however,
even though the number of female patients were more
in the private study setting, the mean VAS score was less
on post-operative day 1 and day 3.
Despite the experiences of pain and adverse events,
most patients in the present study report were satisfied
or very satisfied with their pain treatment and the
response of their care providers to reports of pain. This is
in contrast to previous studies which reported sub optimal
pain management provided to the patients. Patients in
the government setting are better satisfied than those in
private setting. This may be due to the less cost incurred
in a government set up, almost equally efficacious drugs
available at subsidized cost as well as good paramedical
and medical staff. Also, patients in the private setting
may expect a better management for the cost incurred.
Patient satisfaction is an important guide to the success
of postoperative care and plays a major role in speedy
recovery.
Conclusions
The study showed usage of Bupivicaine in the
government study setting as compared to that of
Ropivicaine in the private setting. Previous studies
establish Ropivicaine’s better efficacy. However in the
present study, no significant difference was found in the
perception of pain between the two groups.
Knowledge and Utilization of Iron and Folic Acid Tablets Supplementation by the
Adolescent Girls in Ahmedabad District
Vidita V. Khatri*, Rajshree Bhatt**, H.K. Mehta***
B J Medical College, Ahmedabad, India.
Background
Nutritional anemia in adolescence influences women’s
entire life cycle. It increases complications such as low
birth weight of infants and raised maternal and infant
mortalities. India has about 113 million adolescent girls
and the prevalence of anemia is estimated to be about
56% in them. Due to the magnitude of problem, the
government along with UNICEF has been implementing
Adolescent Girls Anemia Control Program for over a
decade. Various studies showed that supplementing them
with iron and folic acid tablets weekly is the most effective
and cheapest alternative to prevent anemia.
Aims & Objectives
To evaluate number of adolescent girls consuming
Iron and Folic acid tablets and to assess their knowledge
about the same.
Material & Methods
The data was collected regarding IFA (Iron and folic
acid) tablets consumption, their source and adherence to
the weekly regimen from all the adolescent girls included
in the MICS (Multi Indicator Cluster Survey) of
Ahmedabad district. The data from 30 clusters consisted
of total 1060 households with the population of 6076
including 431 adolescent girls.
Results
The study showed that 51.5% (222) girls went to school
and only 36.2% (156) received IFA tablets. Out of them
66% (103) stopped taking these tablets with 32% (33) non
compliance caused by the side effects of the tablets. 47.4%
(74)girls were unaware of the effects of these tablets on
their health.
Conclusions
Though the idea behind the program is efficient, only
limited number of targeted population is utilizing this
facility. Proper education and motivation needs to be
provided to the tablet providers as well as to the
adolescent girls regarding nutritional anemia.
© Redflower Publication Pvt. Ltd.
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Awareness & Practice of National Guidelines on Infant and Young Child Feeding
among Working Women in Delhi
Prateek Harne*, Prerna Batra**
University College of Medical Sciences, New Delhi, India
Background
It is estimated that 1 out of every 3 malnourished
children lives in India and malnutrition is the leading
cause of childhood mortality. Optimal infant and young
child feeding practices determine the health and survival
of infants and young children. Government of India has
given the National Guidelines for Infant and Young Child
Feeding (NGIYCF), but optimal IYCF practices are not
reflected in the results of national surveys. With
urbanization and increased literacy rates among females,
female employment is increasing. Working women find
it even more difficult to practice these guidelines. They
need more support from government authorities and
their families. Thus, present study was planned to assess
the level of awareness and practices opted by the working
women and the factors influencing implementation of
these guidelines.
Aims & Objectives
To assess awareness and practices being followed by
working women in Delhi and the factors responsible for
suboptimal feeding practices.
Pediatrics, UCMS & GTB Hospital, New Delhi and nearby
private hospitals after obtaining clearance from the IEC.
The mothers were enrolled after taking a written
informed consent. 200 mothers were interviewed by the
investigator on the basis of a semi structured
questionnaire. The questionnaire had demographic
details of the respondent, including educational,
employment and economical status, questions on the
awareness about the national IYCF guidelines, the
practice they followed and role of counselling.
Results
There existed a gap between awareness and practice
of initiation of breastfeeding (62% vs 54%), optimal
duration of exclusive breastfeeding (67% vs 38%),
initiation of complimentary feeding (68% vs 39%) and
optimal duration of breastfeeding along with
complimentary feeding (72% vs 60%). Of the factors taken
into account, some showed statistical significance through
calculation of P value differently for awareness and
practice.
Conclusion
Despite better awareness in certain aspects, optimal
infant and young child feeding practices are lacking in
working women.
Material & Methods
The study was carried out in the Department of
Typhoid Fever: A Life-Threatening Illness Fever
Vinod Kumar
Maulana Azad Medical College, New Delhi, India
Typhoid fever, is a life-threatening illness associated
with fever i.e. a systemic infection which is caused by
Salmonella enteric serotype typhi (S. Typhi). It can also
be caused by Salmonella paratyphi, a related bacterium that
usually leads to a less severe illness. Typhoid fever also
known as Enteric fever is an infectious disease of global
distribution. Although there is a wealth of data on
Salmonella typhimurium infection in the mouse and the
interaction of this serovar with human cell lines in vitro,
there is a relatively small amount of data on S typhy and
the pathogenesis of typhoid fever. Salmonella enteric
serotype Typhi has created a significant therapeutic
problem as these strains have developed resistance to
the commonly used antimicrobials for the treatment of
typhoid fever. To reduce the morbidity and mortality
caused by typhoid fever, many preventive measures and
strategies have been employed, the most important being
vaccination. In this review, focus is on: latest symptoms
& causes of the typhoid fever, preventative strategies
including good diet, treatment and typhoid vaccine
113
Hallmarks of Cancer
Aman Kailash Setiya*, Mikhael Yurivich Volkov**
Northern State Medical University, Arkhangelsk, Russia
Background
It is considered that cancer‘s physio-pathology is fully
based on 6 basic hallmarks along with two emerging
hallmarks. N.B. Recognizing, understanding and widely
accepting these concepts will increasingly affect the
development of new means to treat cancer.Two emerging
hallmarks are being updated which include;
“development of genomic
instability” and
“inflammatory state of premalignant and frankly
malignant lesions” Objectives to explain efficacy and
importance of these hallmarks are:
1)
Sustaining proliferative signaling: Most
fundamental trait of cancer cells involve their ability to
sustain chronic proliferation. Enabling signals are
conveyed by growth factors that bind cell surface
receptors, typically having tyrosine kinase domains.
Cancer cells can acquire the capability to sustain
proliferating signalling in a number of alternative ways.
2)
Evading Growth Suppressors: Dozens of tumor
suppressors that operate in various ways to limit cell
growth and proliferation have been discovered through
their characteristic inactivation in one or another form.
3)
Resisting Cell Death: The apoptotic machinery is
composed of both upstream regulators and downstream
effector components.
4)
Enabling Replicative Immortality: Non-cancer cells
die after a certain number of divisions. Cancer cells
escape this limit and are apparently capable of indefinite
growth and division (immortality).
5)
Inducing Angiogenesis: Angiogenesis is an
important hallmark based on inducers amd inhibitors.
Inducers include vascular endothelial growth factor
(VEGF) and acetic and basic fibroblast growth factor (FGF
1/2), which bind to transmembrane tyrosine kinase
receptors displayed on endothelial cells.
6)
Activating Invasion and Metastasis: Cancer cells
can break away from their site or organ of origin to
invade surrounding tissue and spread (metastasize) to
distant body parts.The newly formed metastasis arise as
amalgams of cancer cells and normal supporting cells
conscripted from the host tissue.
Aims & Objectives
To study the future aspects of emerging hallmarks
and their influence on cancer treatment.
because tumor cells have demonstrated an ability to
develop resistance to drugs that disrupt a single pathway.
This adaptability of cancer cells suggests to Hanahan and
Weinberg that simultaneous targeting of two or more
hallmark pathways may be a more effective approach to
therapy.
Results
Inflammation can contribute to multiple hallmark
capabilities by supplying bioactive molecules to the
tumor microenvironment, including growth factors that
sustain proliferative signaling, survival factors that limit
cell death, proangiogenic factors, extracellular matrixmodifying enzymes that facilitate angiogenesis, invasion,
and meta-stasis, and inductive signals that lead to
activation of EMT and other hallmark-facilitating
programs. Additionally, inflam-matory cells can release
chemicals, notably reactive oxygen species, that are
actively mutagenic for nearby cancer cells, accelerating
their genetic evolution toward states of heightened
malignancy. In addition to providing a solid basis for
cancer research, the hallmarks have served to identify
certain cell functions that have become therapeutic
targets.
Conclusions
What does it mean for patients? New ideas will
undoubtedly influence future cancer treatment or not?
How then let’s take a look: Let’s take the blocking of new
blood vessel growth, or angiogenesis, as an example.
This is an important hallmark and subsequently a key
focus of recent drug development research. Several anti
angiogenesis drugs have now been developed (for
example, bevacizumab but even though they seem to
work as they’re supposed to in the lab, they haven’t had
the clinical impact that many predicted. Hanahan thinks
that their ‘hallmarks’ approach could explain why. In the
face of it this is a rather worrying prospect not only might
the drugs not work, they could even make things worse.
But Hanahan pointed to the positive prospect that, once
we’ve developed drugs (or drug combinations) that can
target multiple hallmarks at the same time, this would
bring these new treatments back into play.Key words
hallmarks, proliferation signaling, growth suppressors,
Resisting
cell
death,
replicating
immortality,angiogenesis, invasion and metastasis.
Material & Methods
However, the utility of such attempts has been limited
114
Study of Heart Rate and Blood Pressure Response to Cold Pressor Test in
Normotensive Overweight and Normotensive Normal Weight Individuals
Madhu Bhatt*, Anirban Bhattacharya**
Armed Forces Medical College, Pune, India
Background
Obesity is a known risk factor for hypertension. The
mechanism behind obesity induced hypertension is not
clear but has been proved to be associated with autonomic
dysregulation in these individuals, which can be screened
through various cardiac autonomic function tests like
the Cold Pressor Test (CPT). But a major portion of the
overweight population in India consists of non-obese
overweight individuals and being weight as such has
not been defined as a risk factor for hypertension. By
studying Heart rate and Blood Pressure responses to CPT
in Normotensive non-obese overweight indi-viduals and
comparing them with that of Normotensive normalweight individuals, it can be better understood.
Aims & Objectives
To understand the level of autonomic dysregulation
and hence the risk of developing hypertension in the
non-obese overweight individuals.
Material & Methods
Blood pressure changes in control and test groups were
recorded in the pre-task, task and post-task periods with
each individual in supine position and the cuff of the
Sphygmo-manometer tied to right arm. The response to
CPT which is the difference between the task and pretask values is studied individually as well as compared
with each other for both the groups. The data collected
was subjected to statistical analysis for significance both
within and between two groups.
Results
The difference between the pre-task and the task for
Systolic BP (SBP), diastolic BP (DBP) and heart rate (HR)
in the test group was 19.33 mmHg, 13.64 mmHg and 5.10
bpm res-pectively with p<0.001 in each of the cases. The
difference between the pre-task and the task for SBP, DBP
and HR in the control group was 14.54 mmHg (p<0.001),
5.61 mmHg (p=0.005) and 6.27 bpm (p<0.001) respectively.
The mean differences of SBP, DBP and the HR between
Test and Control group were 4.79 mmHg (p=0.003), 8.03
mmHg (p<0.001) and -1.18 bpm (p=0.246) respectively.
Conclusions
This is a comparative study done in a clinical setting
over a period of 6 weeks. The study population consists
of males aged between 18 to 30 who were arranged into
two groups of 16 each; test group consisting of
normotensive non-obese overweight indi-viduals (BMI
between 23 to 24.9 kg/square metres) and control group
consisting of normotensive normal-weight individuals (
BMI between 18 to 22.9 kg/ square metres). After
explaining the study protocol and obtaining informed
consent; the subjects were subjected to CPT (5 degree
Celsius for 1 min till Wrist Joint). The heart rate and
The Test group of non-obese overweight subjects
showed significant rise in the blood pressure especially
the DBP when compared to the control group of normalweight subjects. This indicates the presence of Autonomic
dysregulation in the former upon the pressor test, thus
proving that they have a greater risk of developing
persistent autonomic dysregulation and hence
hypertension in the future than the individuals with
normal weight.
Evaluating the Knowledge, Attitude and Practices Regarding Radioactive Waste
amongst the Scrap Dealerships in Delhi
Nayani Makkar*, Tany Chandra**, Prachi Agrawal***, Harshit Bansal****, Simranjeet Singh*****
Maulan Azad Medical College, New Delhi, India
Background
Aims & Objectives
With nuclear technology rapidly taking the spotlight
in the last 50 years, radiation accidents seem to be a harsh
reality of the modern world. India has luckily managed
to remain in the penumbra of radiation disasters. The
Mayapuri Radiation leak accident of 2010 was the worst
radiation accident India has yet dealt with.
To assess the awareness and practices regarding
radioactive waste amongst scrap dealers, to assess
deficiencies in radiation disaster preparedness and
guiding them to prevent similar accidents.
115
Material & Methods
This is a community based cross-sectional study. The
study population consisted of 209 volunteers(from 108
scrap dealerships) including 108 shop-owners and 101
shop-workers segregated as Group A consisting of 54
dealerships in the Mayapuri scrap colony and Group B
consisting of 54 dealerships from the rest of the city
(divided into 9 districts). After obtaining a valid and
informed consent, the subjects were asked to complete a
comprehensive questionnaire to assess their knowledge,
attitude and practices pertaining to radioactive waste
management.
Results
Awareness about radioactive waste varied
significantly with level of education (p=0.024),
Kuppuswamy’s socio-economic scale (p=0.005), age of
the respondent (p=0.049) and his work experience
(p=0.045).Knowledge of the radioactivity symbol varied
significantly with Kuppuswamy’sscale (p=0.038) and with
Per-Capita Income (p=0.052). Scrap dealers dealing in
ferrous metals, who were at a higher potential risk of
exposure, were more aware of mitigation and response
methods to deal with radiation hazard than those dealing
in non-ferrous substances. The larger dealerships in
Mayapuri were better equipped in terms of record
maintenance and monitoring of waste dispatch while
also undertaking regular preventive medical check-ups.
Conclusions
Our observations suggest that much of the knowledge
regarding radioactive waste and its handling was
inherently gained with little active intervention on part
of the governmental and non-governmental agencies.
Knowledge was greater within Mayapuri than at other
locations. This may be suggestive of either witness-based
learning or an agency-based response to the 2010 accident.
The study paved the way for designing a step-by-step
source to victim response plan.
Profile of Medical Termination of Pregnancy Seekers in a Tertiary Care Teaching
Hospital in Mangalore
M. Shashidhar Kotian*, Ramesh Holla**, Nidhi***, Ayesha Arif****, Mridul Rajurkar*****, Anshuman
Kaushal******, Shailova Ranjan*******
Background
Medical termination of pregnancy (MTP) is done
before the foetus gains viability i.e., before 20 weeks of
pregnancy. MTP has been legalized by Government of
India. Worldwide approximately 40 million abortions
have been done per year or 40-70 per 1000 women of
reproductive age group with an abortion ratio of 260450/1000 live births. In India, about 6 million abortions
take place every year; of which 4 million are induced and
2 million are spontaneous. The mortality rate associated
with MTP is 5.4 per lakh.
Aims & Objectives
To describe the socio-demographic and obstetric
profile of MTP seekers in tertiary care teaching hospital
in Mangalore and the reasons for undergoing MTP.
Materials and Methods
This was a hospital based retrospective case record
study of all the Medical Termination of Pregnancy seekers
at Lady Goschen Government Hospital, Mangalore from
January 2011 to December 2012. After the approval from
ethics committee, data was collected using a questionnaire
after analyzing the information available in the case
sheets and their MTP forms were collected. We included
variables such as age, marital status, no. of pregnancies,
no. of children, details about previous abortions,
gestational age, reason for current MTP, and acceptance
of contraception after MTP. A total of 244 MTP seekers’
details were recorded and analyzed using statistical
software SPSS version 17. Descriptive statistics like mean,
proportions and standard deviation were used for
expressing the results.
Results
From our descriptive study, the following conclusions
could be drawn- most of the MTP seekers were married
and belonged to the age group of 26-30 years (37.8%)
followed by 34.4% of 20-25 years. Majority of MTPs (79.5%)
were conducted in the first trimester and 60.66% had parity
one or two. Most common reason for the current MTP
was found to be medical (39.3%) such as threatened
abortions, incomplete abortions and cardiovascular
disorders posing a serious threat to the mother’s life,
followed by completed family (28.7%). Other reasons
were contraceptive failure (18.9%), unplanned pregnancy
(6.1%), eugenic such as anomalous fetus (4.9%), socioeconomic (1.6%) and humanitarian (0.4%). Majority of
the MTP seekers (84.8%) had no history of previous
abortion. 9% of the MTP seekers accepted contraception
after MTP, out of which 74.6% opted for Sterilization and
116
25.4% opted for IUD insertion.
Conclusions
Our recommendations were that women in the
reproductive age group should be given due importance
in MCH Programme. Family life education should be
provided to adolescent girls through schools and also
the ill effects of teenage pregnancy should be highlighted.
Proper counseling should be given to married couples,
soon after or before marriage regarding the use of
contraceptives and strengthening awareness about
emergency contraceptive measures. Genetic counseling
should be given to couples planning to have a child.
Keywords
MTP; Socio-demographic profile; Tertiary care
hospital.
To Study the Patient Compliance and the Impact of Various Non-Pharmacological
Interventions in the Management of Hypertension
Swati Bhayana
Background
Hypertension is a silent killer. It is the most prevalent
non-communicable disease in India. Prevention is
possible and treatment can lead to direct reduction in
the incidence of complications including stroke,
coronary heart disease, and heart and kidney failure.
Studies have demonstrated that multiple lifestyle
changes lower blood pressure thereby controlling
hypertension but the established evidences in India are
inadequate. While antihypertensive agents have been
used for those patients with blood pressure above the
traditional cut-off, there has been increasing emphasis
on the prevention and treatment of hypertension by
non-pharmacological means, termed ‘lifestyle
modifications’. The various advantages are
reinforcement of pharmacological treatment ,makes
over economic constraints and reduces the risk of
hypertension in pre hypertensive’s. These includeweight reduction, decreased salt intake,exercise and
yoga,high potssium diet, decreased stress, reduced
alcohol consumption, fibres intake, calcium intake and
carbohydrate diet moderation.
Aims & Objectives
To study the compliance and impact of non
pharmacological interventions in the management of
Hypertension.
Material & Methods
the Department of Medicine at Lok Nayak Hospital.
Hypertensive patients with BP more than 140/90, age
35 and above and with minimum understanding of the
language to be able to fill information’s were included.
Various patient variables were studied as weight of the
patient, average salt intake measured as high, moderate
and low, alcohol consumption, stress conditions. The
patients were motivated to incorporate certain lifestyle
modifications. On a follow up visit, patients were asked
to fill the same Performa and a comparison was made to
study the compliance. This practice of filling the
Performa twice would help in indirectly assessing the
compliance as an extent of adopting the modifications.
The impact of these interventions were studied as
changes in certain variables before and after intervention
like Blood pressure and Weight. Wherever possible,
simple descriptive statistics were calculated. Non
parametric test as Mann Whitney was employed to
compare the sub groups of people .
Results
A significant compliance was observed among the
patients for various interventions like indulging in
weight reduction exercises, limiting salt intake,
increasing dietary potassium, inculcating some form of
stress reduction activity and limiting carbohydrates in
the diet. A significant correlation was found between
reduction in BP and limiting salt intake, increasing
dietary potassium in the diet, increase in fibre intake
and an increase in knowledge towards adapting these
interventions.(p<0.05).
An interventional study was done in 50 subjects in
117
Clinico-Pathological Response Assessment in Patients Receiving Neoadjuvant
Chemotherapy for Locally Advanced Breast Cancer (Labc): KMC, Manipal Experience
Vivek Ahuja*, Kriti Lakhina**, Kashish Gupta***
KMC, Manipal, Udupi, India
Aims & Objectives
To evaluate the role of neo-adjuvant chemotherapy
in LABC patients in achieving complete clinical and
pathological response and feasibility of breast
conservation.
A total of 120 patients who received neo adjuvant
chemotherapy in the last 5 years were included in this
study and 90 were found to be eligible. Clinical and
pathological responses to neo-adjuvant chemotherapy
were assessed.
presentation. The overall clinical complete response was
found to be 45.56% and the complete pathological
response was 32.23%. BCS was possible in 33.33%.
Conclusion
Our results show that even with tumours of large
sizes there are reasonably good chances of obtaining a
favourable response and the chance of conserving breast.
Limitation
Record based study and lack of representation of
actual scenario as the study was conducted in a referral
centre.
Results
As revealed by study 60% of tumours were at T4
Clinical and Biochemical Profile of Type 2 Diabetics: A Problem Lurking for India
Sandeep Singh*, Ajaypal Singh**, Manish Kishore Multani***, Ashish Purohit****
Background
Epidemiological data over the past decades have
shown a pattern and profile variability of type 2 diabetes
mellitus from India owing to its high population
diversity. Absence of local reference data from Gwalior
region of central India creates a challenging issue for
early detection of complications and selecting the
treatment option.
Aims & Objectives
To define the profile of type 2 diabetes mellitus
population from Gwalior region of Madhya Pradesh.
Material & Methods
A case control study was carried out in the
Department of Medicine comprising of fifty newly
diagnosed type 2 diabetes mellitus patients and 50
healthy controls.
Results
BMI of the study subjects was (cases-23.94±1.83 kg/
m2, controls-22.8±1.38 kg/m2; p<0.001). Prevalence of
abnormal value of WHR was found to be 46% in cases.
58% of the cases had poor glycemic control. There was a
significant difference among male and female with
respect to mean of cholesterol (male 194.87±63.34 mg/
dl, female 162.57±38.37 mg/dl; p<0.05), HDL (male
45.33±13.72 mg/dl, female 37.66±7.31 mg/dl; p<0.05),
HbA1c (male 11.01±3.12%, female 9.39±1.73%; p<0.05)
and Hb (male 11.36±1.17 gm%, female 12.35±1.19gm%;
p<0.01). Dominating symptoms were polyuria 30% (15,
p<0.05), tingling and numbness 26% (13, p<0.01) and
blurred vision 26% (13, p<0.01). Most prevailing
complications were Retinopathy 26% (13; p<0.01) and
neuropathy 26% (13; p<0.01). Dyslipidemia was present
in the 88% of cases.
Conclusions
A vast proportion of the cases were having poor
glycemic control. Central obesity was present in the
studied population with generalized obesity, making
population prone to insulin resistance. Presence of
classical symptoms of diabetes on the back of the foot in
the study subject suggested that the disease might be on
track of changing its trend or the patients were reporting
at late stage due to health disparities. The most prevalent
118
form of dylipidema in diabetic male was low HDL-c
while in females was High LDL-c and High TG. The
pattern of dyslipidemia differs from typical diabetic
dylipidemias.
Current Socio-Clinical Trend of Sexually Transmitted Diseases and Relevance of
STD Clinic: A Comparative Study from Referral Tertiary Care Center of Gwalior,
India
Sandeep Singh*, Sorabh Badaya**, Divya Agrawal***
Background
Sexually transmitted infections (STIs) are the major
public health concern in both developed and developing
countries regulated by the cultural pattern of gender
expression in their society.
Aims & Objectives
To look into the changing pattern of sexually
transmitted infections from the Gwalior, Central India
where health condition is not in a good fashion with
poor socio-economic status and awareness.
group of 20-40 years while 35(83.33%)males were in the
age group of 18-40 years. Statistically significant
differences were found as compared to a previous study
done in the same STD clinic for discharge, lower
abdominal pain, painful micturition, nodules in genitals
as 106 (58.88%; p=0.0001), 59(32.77%; p=0.0007), 25 (13.88%
p=0.001), 1 (0.5%; p=0.005) respectively and in males
with absence of abdominal pain and nodules in genitals
as p= 0.016 and p =0.03 respectively. Preferred place for
treatment of STIs was government facility among both
males and females with statistically significant 15.76%
(p=0.0001) difference from the population seeking no
treatment.
Conclusions
Material & Methods
This is a hospital based cross sectional, questionnaire
based study with a sample size of 222 respondents
attending STD clinic at JAH Gwalior from December
2011- March 2012. Random sampling technique was used.
Study shows the very judgmental and much needed
role of counseling centers like STD clinics in changing
the due course and trend of STIs epidemiology. The
problems of low and infrequent condom use, non
adherence to treatment, having multiple non regular
sex partners were seen in a fairly good proportion.
Results
152 (84.44%) cases among females were in the age
Insulin Resistance in Type 2 Diabetes Mellitus: Prospect of an Untouched Area
Sandeep Singh*, Maneesh Jain**, Ajaypal Singh***, Manish Kishore Multani****, Ashish Purohit*****
with various risk variables.
Background
HOMA estimated insulin resistance is an independent
predictor of cardiovascular disease in type-2 diabetic
subjects. Lack of exact cutoff value in Indians and the
absence of local reference data from Gwalior region of
central India for HOMA-IR create a challenging issue
for early detection of complications and selecting the
treatment option.
Aims & Objectives
To define a local reference cutoff and its association
Material & Methods
We randomly selected 50 cases and 50 controls,
matched for age and sex, from the teaching hospital of
G.R. Medical College Gwalior, India.
Results
Mean HOMA IR for cases was 4.16±3.57 (range 0.2218.71) while for control subjects was 2.03±0.64 (range
1.08- 4.4). The normal cutoff value was found to be 3.31.
119
A significantly high proportion of the cases (22, 44%;
p<0.0001) were above the normal cutoff of 3.31 as
compared to controls (2, 4%). HOMA- IR was found to
be significantly associated with BMI (r=0.41; p=0.002),
WHR (R=0.34; P=0.01) and FPI (r=0.90; p<0.001). Mean of
HOMA-IR was significantly higher in subjects with
generalized obesity (without generalized Obesity: cases
3.04± 1.99, control 2.03±0.64; p<0.0001 vs. with
generalized obesity: cases 7.7± 5.03, control 0) and
abdominal obesity (without abdominal obesity: cases
2.85 ± 1.5, control 2.03±0.7; p=0.01 vs. with abdominal
obesity cases 5.69 ± 4.56, controls 2.05±0.56; p=0.001).
Female preponderance for the metabolic syndrome was
reported in both cases (female 15, 100%; males 33, 94.28%;
p>.9) and control (female 14, 93.33%; males 54,
54.28%p=0.002). Mean of the HOMA-IR was significantly
higher in cases with complications like retinopathy
(9.3±5.12, p<0.01), nephropathy (7.18±3.29, p<0.01),
neuropathy (5.64±2.1, p<0.01), CAD (5.76±0.8, p<0.05)
and risk of PVD (5.68±0.1, P<0.0001) as compared to cases
without complications.
Conclusions
We concluded that the cutoff of HOMA-IR was higher
in the studied population as compared to reports in other
Indian studies, with female preponderance for the
metabolic syndrome. Dietary and life style modification
could have a positive impact on decreasing the toll of
complications in these patients as non obese have less
insulin resistance, which is significantly associated with
complications in the studied population.
Assessment of Cardiac Autonomic Dysfunction in Young Patients of Depression
Shivam Goyal*, Atul Shekhar**
AFMC, Pune, India
Background
In today’s fast paced life and its associated stress &
strain, depression has become common in not only
elderly but in young working adults as well. According
to WHO, depression affects around 121 million people
worldwide. Numerous studies carried out in India as
well as abroad have found that the relative risk of
developing Coronary Artery Disease (CAD) increases 2
fold in cases of depression.Various workers in the past
have tried to assess autonomic dysfunction in cases of
depression using Heart rate Variability(HRV)analysis.A
few studies show low HRV in cases of depression. While,
some studies have shown that there is no distinct
relationship between HRV and depression. A few studies
have also questioned the reliability of HRV as a measure
of autonomic activity. Also, most of the studies have
been done on study population > 45 years of age and
similar evidence in younger population is grossly
lacking. Most of the investigators have studied only the
cases of major depression leaving out other types of
depression episodes. Therefore, the exact relationship
between depression and cardiac autonomic functions in
young patients of depression is still obscure.
Aims & Objectives
To assess the cardiac autonomic functions using a
battery of non invasive tests in 30 young cases of all
types of depression who are not on any antidepressant
medication and 30 matching controls; and compare the
two results to assess the effect of depression on the
cardiac autonomic functions.
Material & Methods
A cross-sectional study of drug naive population of
depression reporting in the Psychiatric OPD of
Command Hospital, Pune. A total of 30 male patients
aged between 20-45 years were selected randomly from
the study population and 30 matched controls were
selected from healthy volunteers. Patients already on
medication, smokers/alcoholics and with any preexisting cardiac abnormality were excluded. Tests were
carried out using CANWIN PC Windows Based Cardiac
Autonomic Neuropathy Analysis System (Genesis
Medical Systems Pvt. Ltd.(India)available in Department
of Physiology, AFMC. The male patients reporting in
the Psychiatry OPD were diagnosed as cases of
depression(ICD–10) using Beck’s Depression Inventory
(BDI), Psychosocial Performa and Psychiatrist interview.
All the patients meeting the inclusion criterion were
explained the study protocol in brief and after taking an
informed consent, a brief history, basic anthropometric
measurements and an ECG were taken in order to
exclude any preexisting cardiac disease and also for
documenting presence of any other risk factors for CAD.
120
A total of 30 matched controls were also selected
randomly from healthy volunteers. The patients as well
as the controls were then subjected to the following
tests on CANWIN to assess their autonomic functions
in Resting ECG, Deep Breathing, Valsalva Maneuver,
Postural Hypotension and sustained hand-grip.
Appropriate statistical tests were used to compare the
results between the two groups.
Results
(to be completed).
Conclusions
(to be completed).
Study on Knowledge about Diabetes Mellitus in Rural Adult People of Bangladesh
Elora Shyama Tanni*, Masato Ahsan**
Sir Salimullah Medical College, Dhaka, Bangladesh
Background
Once regarded as a single disease entity, Diabetes is
now seen as a heterogeneous group of diseases
characterized by a state of chronic hyperglycaemia,
resulting from a diversity of etiologies, environmental
& genetic factors acting jointly. Diabetes mellitus is
causing an enormous burden on the people and
economics worldwide. Now a days, it is a major concern
in the developed as well as in the developing
countries.The magnitude of awareness in Bangladesh
remains unknown due to lack of country wide survey.
Aims & Objectives
To assess the level of knowledge about diabetes
mellitus among the rural adult people of Bangladesh
and to determine their level of knowledge regarding
signs & symptoms, treatment, complications, control &
prevention of diabetes mellitus.
(30%) belonged to the age group of 18-27 yrs. Among
them, 94% respondents knew about diabetes
mellitus.66% among them said that polyuria was a sign
of diabetes mellitus. 44% of the respondents said that
they would go to upazilla health complex seeking
treatment for diabetes mellitus. 66% respondents
ensured that sugar testing could be 1 of the diagnostic
method for diabetes mellitus. Only 54% knew about
self control of diabetes mellitus. Maximum (79.8%) said
that diet control was 1 of the step for treatment of
diabetes. Complications of diabetes mellitus is admired
by 46% of respondents.71.66% knew that retinopathy is
the main complication.Only 28.50% of respondents
knew about self assessment of diabetes mellitus. Urine
testing & finger tip blood sugar estimation are basic
steps of self assessment of diabetes mellitus and were
equally(61.40%) appreciated by the respondents. Only
44% of the respondents had knowledge about risk factors
but majority of them knew that the obesity is the main
risk factor for diabetes mellitus.
Conclusions
Material & Methods
A cross sectional type of descriptive study was carried
out among 400 adults in different rural areas of
KeraniganjUpazilla,under Dhaka district. The study was
carried out from 1st March, 2013 to 31stmarch 2013. 400
respondents above 18 years of age were purposively
selected for this study. Interviewers visited the house
of the respondents. Face to face interview was taken and
a semi-structured questionnaire was filled by the
researcher.
Results
Out of 400 respondents, it was observed that majority
Health education should be given properly in the
rural community to develop awareness about diabetes
mellitus through proper media. An in depth,
epidemiological study should be carried out to clarify
public health importance of diabetes mellitus. Health
volunteers & workers should be encouraged to take up
steps regarding screening programmes at regular
intervals. Cost of modern medicines & laboratory
investigations charges should be reduced to reasonable
& affordable levels. Doctors should be more cooperative, empathetic towards the rural community.
Lastly we can say that the problems of diabetes mellitus
will be alarming if proper consciousness of the risk
factors, diabetic & post diabetic events are not promoted
immediately.
121
Study of Parental Attitudes Regarding Various Aspects of Cochlear Implantation
Zahra Jafari
Department of Audiology, School of Rehabilitation, Tehran University of Medical Sciences, Tehran, Iran
of 98.68 with 6 subgroups and a five options Likert scale
of scoring from exactly=5 to none=1 was used.
Background
Parents are important members of cochlear implant
team that analysis of their views is effective to improve
services and outcomes. The present study was down
among parents of children with cochlear implant who
passed aural rehabilitation sessions to assess “parental
attitude towards various aspects of cochlear
implantation”.
Aims & Objectives
To study Parental Attitudes Regarding Various
Aspects of Cochlear Implantation.
Results
Mean score of the six subgroups of the questionnaire
including communication skills, academic skills, social
skills, cochlear implant centers’ services, costs and make
decision process were 4.22, 3.97, 4.31, 3.94, 4.27 and 3.29
respectively. No significant difference was found
between scores of the questionnaire in age of cochlear
implantation of 4 years and lower and above 4 years,
except in the 3 items of academic skills subgroup (P e”
.049).
Conclusions
Material & Methods
This study was conducted on 51 parents of children
with severe to profound congenital hearing loss, with
the mean age of 6.98 years and the mean age of cochlear
implantation of 4.36 years, who underwent surgery and
received aural rehabilitation program in Cochlear
Implantation Center of the AmirAlam hospital at Tehran
between the years 2007 and 2012. For data gathering,
subjects’ medical records and a researcher made
questionnaire entitled “Parental attitudes of various
aspects of cochlear implantation” with content validity
Highest parental satisfaction was observed in social
skills and lowest ones in the academic skills. Because
the optimum age for cochlear implantation is less than
18 months, it is possible that due to the mean
implantation age of above 4 years in the present study,
implantation age did not remarkably affect the attitude
of parents.
Keywords: Attitudes; Children; Cochlear implant;
Implantation age; Parents; Skills.
Case Report: Wilms’ Tumor
Sheikh Mahmood Hasan*, Tablu Abdul Hanif**
Dhaka Medical College Hospital, Dhaka, Bangladesh
Background
Wilms’ tumor is an embryonal tumor of childhood
occurring in 1 out of 1,00,000 children less than 15 years
of age. An incidental case was found in the Paediatric
surgery ward of Dhaka Medical College Hospital on
20th June 2012. A 3 years old girl complained of right
sided painless abdominal mass for one month with
occasional hematuria for 15 days. Detailed history and
investigation confirmed the diagnosis as Wilms’ tumor.
In developing countries most of such cases present at
advanced stages. Having no scope for specific treatment,
multimodal approach i.e., neoadjuvant chemotherapy
followed by surgical excision has been the best choice
to reduce the morbidity and mortality of these cases.
Wilms’ tumor or Nephroblastoma is a cancer of
kidneys that typically occurs in children. Its common
name is an eponym, referring to Dr. Max Wilms, the
German surgeon (1867–1918) who first described this
kind of a tumor. It is the most common renal malignancy
of childhood containing metanephric blastema, stromal
and epithelial derivatives. It tends to be encapsulated
and vascularized tumor that does not cross the midline
of the abdomen. It usually metastesize to the lungs and
liver. It is usually unilateral and presents with
microscopic haematuria , malaise, weight loss, anaemia
and sometimes with varicocele or thromboembolic
disorder in the heart. A rupture of Wilms’ tumor puts
the patient at risk of hemorrhage and peritoneal
dissemination of the tumor. In such cases, surgical
122
intervention by a surgeon who is experienced in the
removal of such a fragile tumor is imperative.
and was uneventful.
Conclusions
Case
A girl aged 3 years, hailing from Zurain, Dhaka was
admitted into Dhaka Medical College Hospital with the
complaints of right sided abdominal mass for one month
with occasional hematuria for 15 days. The mass had
been gradually increasing in size which was painless.
There was no history of pain or burning sensation
during micturation. She had no history of fever, anorexia,
weight loss, vomiting & cough. On examination she
was apparently healthy, mildly anaemic, afebrile and
normotensive. The mass was palpable occupying right
lumbar, right hypochondriac and umbilical region,
measuring 14 cm x 11 cm. It was non tender, surface was
smooth, firm in consistency and its movement with
respiration could not be elicited. Her bladder and bowel
habits were normal. USG of whole abdomen and contrast
CT Scan of abdomen suggested renal carcinoma.
Diagnosis was confirmed by USG guided FNAC and
histopathology. She had undergone preoperative
neoadjuvant chemotherapy according to SIOP protocol
after consulting with the radiotherapy department. All
the doses of chemotherapy were administered in the
ward, so that she might not miss the sequential
chemotherapy.
After
that
right
sided
nephroureterectomy was done followed by
postoperative chemotherapy.
Mutations of the WT1 gene on chromosome 11 p 13
are observed in approximately 20% of Wilms’ tumors.
But rest of the cases have not identified genetic
association or any other significant risk factors. As it is
usually painless and relatively asymptomatic, it is
difficult to notice for the children on their own.
Moreover due to poverty and ignorance many children
in developing countries present with advanced stages
of Wilms’ tumor with higher chance of metastasis. As a
result they suffer from a bad prognosis. Except
preconceptional counseling in case of positive family
history, there is no specific way of prevention so far.
That’s why early diagnosis and effective intervention
are direly needed. The multimodal treatment especially
neoadjuvant chemotherapy may reduce the extension
of the disease that may help further surgical excision –
total or partial. This demands for multidisciplinary
collaboration of Paediatric surgery, Pathology,
Paediatric oncology and Radiotherapy department
along with social councelling. Only then we can reduce
the morbidity and mortality of the disease.
The possibility of a Wilms’ tumor should be
considered when a children presents with hematuria
and a renal mass. Although the treatment modality is
yet to be standardized, the outcome for patients
diagnosed with Wilms’ tumor is steadily improving.
Results
She attended the first follow up visit after 3 months
Attitudes, Knowledge and Practices among Medical Students Regarding Medical
Management of Displaced People Following a Disaster
Sajeev S.*, Samarakoon S.M.D.W.**, Samalai K.***
Faculty of Medicine, University of Colombo, Colombo, Sri Lanka
Background
Natural disasters are common in Sri Lanka which
affect a lot of people and displace from their own
residence and make them residein temporary shelters
with other people. Therefore they are prone to certain
health problems including physical, mental and social
health aspects. A lot of health camps are conducted to
medically manage these health issues faced by the
displaced people. Involving medical students in such
programmes may be helpful to carry out these
programmes effectively.
Aims & Objectives
amongst medical students regarding medical
management of displaced people following a disaster
in order to involve them effectively in such health camps.
Material & Methods
At faculty of Medicine, University of Colombo, a
descriptive cross sectional study was carried out among
152 medical students who were selected by cluster
sampling. 51% & 49% of them are in fourth year and
third year respectively. Final year students were excluded
because they may not have time to participate in such
camps. A self administered questionnaire was given to
assess attitudes, knowledge and practices regarding
medical management of displaced people following a
To assess the attitudes, knowledge and practices
123
disaster. Questionnaire was marked using a scoring
system prepared by the researchers. SPSS software was
used to analyze the data and chi square was used to
compare the two batches.
Results
Most medical students identify that it is their
responsibility (91%) to participate in medical
management camps organized for displaced people and
show willingness (86.2%) to get involved in such
programmes. Majority of the students have good
knowledge regarding presentation (87.5%), & mode of
transmission (97.4%) of common communicable diseases
that may occur among people when they are living as a
part of the displaced population in temporary shelters
in a common area. 53.3% of the students have good
knowledge about stress reactions that may occur acutely
and later following such disasters and are capable of
identifying people with stress reactions. 90.8% of the
study population identifies the coping strategies to
reduce stress reactions among displaced people.
Majority of the students (72.4%) have good knowledge
of the theoretical aspects of wounds & their
management. 48.7%, 43.1% & 47.1% of the study
population have satisfactory level of practices in
performing routine, wound related and life saving
procedures respectively. Fourth year medical students
show better knowledge in identifying people with stress,
wound management and also possess better level of
practice in performing procedures.
Conclusions
Medical students have good attitudes, knowledge and
possess some practices regarding medical management
of displaced people following disaster. It is helpful to
carry out effective post disaster medical camps including
the third and fourth year medical students who possess
adequate knowledge and skills regarding medical
management of displaced people.
Keywords: Disaster; Medical management; Medical
students.
Study the Prevalence of Cryptosporidium Parvum Infection among Immune
Competent and Immune Compromised Patients with Diarrhoea: A Descriptive Study
Partha Roy
Background
Cryptosporidium parvum is a protozoan causing
cryptosporidiosis. Primary symptoms are acute, watery,
and non-bloody diarrhoea. The study analyzes the
prevalence of cryptosporidium infestation in the
immune-compromised patient and compares the same
among immune-competent subjects within the same age
group having complaints of diarrhoea. The study also
helps in forming a scoring system relating the numbers
of oocysts of cryptosporidium observed per oil
immersion field with the CD4 counts of the immune
compromised patients to quantify the severity of the
decreased immunity.
Aims & Objectives
To study the prevalence of Cryptosporidium parvum
infection among immune competent and immune
compromised patients with diarrhoea.
Material & Methods
This is a descriptive study with a sample size of 150.
Stool samples of patients are used. From the sample, a
thin smear is made. For the study of oocysts modified
Ziehl-Neelsen staining (Kinyoun modification) is done.
Significant and positive result is considered as count of
oocysts more than 30 /oif. Becton- Dickinson FACS
counter is used for CD4 count following the
manufacturers guidelines. Quantitative variables are
described using mean and standard deviation and
qualitative variables using %. 95% confidence interval
is calculated for prevalence values, the difference is
tested using ‘z’ test and association with age is tested
using ‘Chi-Square test’.
Results
Prevalence of cryptosporidiosis among the studied
sample is 28.66% while that among immune competent
patients is 27.38 % and immune compromised is 30.30%
having a case distribution with a mean age of 39.32 years.
Prevalence of cryptosporidiosis in HIV+ patients is
28.75%.
Prevalence of cryptosporidiosis in non- HIV+ patients
is 32.26%.
Age group distribution
Sr. No. Age group immune competent immune-suppressed
1
< 25
4
1
2.
25-35
7
6
3
35-45
8
5
4.
45-55
2
4
124
5.
55-65
2
6.
>65
0
Scoring
Range of CD4 Mean oocysts
count
60-180
341-599
1
3
Conclusions
Score
Remarks
+++
Very low
immune
status
Low
immune
status
Moderately high
immune
status
180-300
300-310
++
300-420
277-293
+
The project brings out that cryptosporidium infection
is common not only among immun suppressed but also
has a high prevalence among immune competent
individuals. Any age group in the adult population can
be affected. The scoring system can help health care
workers in periphery to diagnose immune status of a
patient.Type 2 DM and hepatitis also presents a high
risk of cryptosporidiosis. Cancer patients have a very
high proportion of positive cases. Thus. just not AIDS
but other immune suppressing conditions also have a
high prevalence of cryptosporidiosis.
Treatment Pattern of Acute Respiratory Tract Infections in General Practice with 3rd
Generation Oral Cefixime in Bangladesh
Md Sazid Rezwan
Sir Salimullah Medical College , Dhaka , Bangladesh
[email protected]
Background
Respiratory Tract Infections (RTIs) are a major health
problem in developing countries. An estimated 2.2
million people, worldwide, die yearly because of acute
respiratory infections. . It is estimated that Bangladesh,
India, Indonesia, & Nepal together account for 40% of
global acute respiratory infection mortality. RTIs are
the most common reason for physician visits and
prescription of antibiotics. Cefixime is quickly
establishing as a potent broad-spectrum antibiotic with
a wide variety of indications. This observational study
was designed to describe the treatment pattern of third
generation oral Cefixime in managing RTIs in general
practice.
Aims & Objectives
To obtain information on clinical efficacy and safety
of cefixime in treatment of respiratory tract infections
in children and adults in Bangladesh.
Material & Methods
This non-controlled, multi-center, observational
registry was carried out from October 2012 to March
2012. During this period about 2400 patients aged 3 years
to 76 years suffering from RTIs were enrolled by general
physicians throughout the country. Study variable were
socio-demographic, sign-symptoms, clinical diagnosis,
investigation, antimicrobial prescribed and clinical
outcome etc. Clinical outcome was determined based
on improvement of signs and symptoms. Compliance,
efficacy and tolerance were assessed on days 7 and 10.
The enrolled patients were considered for analysis. The
mean age was 26.59 (±18.10) years and 62% of the patients
were male.
Results
Common presenting signs and symptoms were fever,
cough, shortness of breath and increased sputum volume
in 80%, 75%, 39%, 12% respectively. From prescriptions,
pneumonia, acute bronchitis, acute exerbation of chronic
bronchitis and lung abcess were the diagnosis made in
42% , 26%, 24% and 3% of the prescriptions, respectively.
Furthermore, the rates of adverse events were
insignificant. Cefixime is quickly establishing as a potent
broad-spectrum antibiotic with a variety of indications.
The study showed clinical symptoms improved rapidly
and high rates of clinical cure was achieved.
Furthermore, the rate of adverse events was relatively
low.
Conclusions:
The results support the use of Cefixime for a variety
of infections in adults and pediatric patients in
Bangladesh.
125
A Comparison of the Cytotoxic Effects of Clostridium Difficile Toxins A and B on
Peripheral Blood Monocytes and Intestinal Macrophages
Rini Bhavik Shah*, Adrian Robins**, Yash Mahida***
University of Nottingham, Nottingham, United Kingdom
Background
Results
Clostridium difficile associated colitis is mediated by
its toxins A and B and results in recruitment of immune
cells to the intestinal mucosa. Subsets of immune cells
have previously been shown to be differentially
susceptible to toxin A. However, there is little research
on their interactions with toxin B.
Aims & Objectives
To compare the effects of toxins A and B on peripheral
blood monocytes and intestinal macrophages.
Material & Methods
Varying concentrations of purified toxins were
incubated with either human intestinal lamina propria
cells or washed whole blood cells at 37°C for 1h. The
reduction in cell size (indicative of subsequent cell death)
was analysed by flow cytometry, using antibody
markers for CD14 and HLA-DR to identify the cells of
interest.
Compared with that of toxin A, a significantly greater
reduction in both monocyte and macrophage cell size
was elicited by toxin B at 2.5, 5 and 10ìg/ml in a
concentration-dependent manner. In addition,
monocytes were significantly more susceptible than
macrophages to the effects of toxin B, although the same
was not shown to be true for toxin A. A subpopulation
of macrophages expressing CD14 appeared to be more
susceptible to toxin B than CD14- macrophages.
Conclusions
Our study demonstrates that toxin B exhibits greater
cytotoxic effects on monocytes and macrophages
compared to toxin A, which may have implications in
the immune response to Clostridium difficile infection. A
difference in susceptibility of the immune cell subsets
to toxin B has also been suggested.
Prevalence of Cytomegalovirus Infection among Kidney Transplant Recipients in
Bangladesh
Rajat Das Gupta*, Sheikh Mahmood Hasan**, Avijit Loha***, Debashis Datta****, Saikat Roy*****
Dhaka Medical College, Dhaka, Bangladesh
Background
Cytomegalovirus (CMV) is one of the most frequently
encountered opportunistic viral pathogens in kidney
transplantation.
Aims & Objectives
To identify prevalence of cytomegalovirus Infection
among kidney transplant recipients in Bangladesh.
Material & Methods
This descriptive cross sectional study was conducted
during the period from February 2012 to February 2013.
Study population was kidney transplant recipients in
Bangladesh. Sample size was 79. Data was collected in
the form of a semi structured questionnaire. Blood
sampling was done via venopuncture. All sera were
investigated for anti-CMV IgM, and the seropositive
cases were investigated with Polymerase Chain Reaction
(PCR) assay.
Results
Majority 32(40.5%) respondents belong to the age
group of 60-65 years. 45(56.96%) respondents had history
of blood transfusion. Majority 42 respondents (53.16%)
were seropositive for anti-CMV IgM, 8 respondents
(10.13%) were in borderline range, and rest 29
respondents (36.71%) were seronegative. By considering
the respondents with bor¬derline anti-CMV IgM levels
as seropositive, 50 (63.29%) patients were seropositive
for anti-CMV IgM. Among 50 seropositive cases, the
126
cytomegalo virus infection was confirmed in 35 (70%)
of them by using PCR. Risk factors that were statistically
significant in the development of CMV disease were
recipient/donor relationship (P = .008), CMV donor+/
recipient- (P = .0095), and recent rejection treatment (P =
.0015).
kidney transplant recipients in Bangladesh is high. Risk
factors for developing cytomegalovirus disease are
recipient/donor relationship, CMV donor+/recipientand recent acute rejection treatment. ELISA is the method
for screening for cytomegalovirus infection but it has
low specificity. All the seropositive cases should be
investigated by PCR to confirm the diagnosis.
Conclusions
The prevalence of cytomegalovirus Infection among
The Opinion of 5th Year Medical Students of Bangladesh about the Status of
Formative Assessment in Clinical Subjects
Debashis Datta*, Rajat Das Gupta**, Sheikh Mahmood Hasan***, Avijit Loha****, Saikat Roy*****
It was entered and analyzed by computer by help of
SPSS 17.0.
Background
Formative assessment is defined as “Information
communicated to the learner that is intended to modify
his or her thinking or behavior for the purpose of
improving learning”. It is part of a feedback process in
which a learner is able to evaluate their response in
light of the information received, and learn. Feedback
is most effective if it focuses students’ attention on their
progress in mastering educational tasks. Feedback to
any pupil should be about the particular qualities of his
or her work, with advice on what he or she can do to
improve, and should avoid comparisons with other
pupils.
Aims & Objectives
To find out the opinion of 5th year medical students of
Bangladesh about the status of formative assessment in
clinical subjects.
Material & Methods
This study was a cross sectional study, conducted in 8
Medical Colleges of Bangladesh during the period from
May 2013 to October 2013. Study population was 5th
Year medical students of Bangladesh. 5th Year medical
students of Bangladesh who were co-operative and
willing to take part voluntarily were included. Noncooperative students and those medical students of who
were not studying in 5th year were excluded from the
study. Sample size was 981. Data was collected through
face to face interview based on structured questionnaire.
Results
Among different types of formative assessments,
highest 86.96% were item examination. In written
examinations, in 50% cases written script was not given
to students and 45% of cases marks were displayed on
notice board. Only in 1% of cases written script was
given back with explanation of getting low score. In
case of Oral examination, 65% of respondents agreed
that reasons for failure were not well explained.
Majority (35.2%) of the respondents thought that
formative assessments helps them give more attention
to study. 57.59% of the respondents were not satisfied
about the present formative assessments. 65% of the
respondents suggested that the minimum time interval
between two item examinations should be more than 3
days. 86.65% of the respondents agreed that quality of
formative assessment should be improved. 68% of the
respondents agreed that certain percentage of marks
should be adopted in final examination. 75% of the
respondents suggested that teachers should put efforts
in designing an assessment to make it better.
Conclusions
Our study revealed that in most of the cases adequate
feedback is not given to the students and most of them
are not satisfied with the present formative assessments.
The authority should try to increase the quality of the
present formative assessments
127
Pattern of Hepatitis B Vaccination among Medical Students and Doctors in
Bangladesh
Atanu Dey*, Rajat Das Gupta**, Sheikh Mahmood Hasan***, Avijit Loha****, Debashis Datta*****, Saikat
Roy*****
Background
The prevalence of HBsAg among general population
in Bangladesh is 3%. Bangladesh is moderately endemic
for HBV infection. Vaccination is an effective way to
prevent HBV infection as its protective efficacy is 9095%. Doctors and medical students are at a high risk of
acquiring HBV infection.
Aims & Objectives
To find out the pattern of Hepatitis B vaccination
among medical students and doctors in Hospitals of
Bangladesh.
Material & Methods
This cross sectional study was conducted in 11 Medical
College Hospitals of Bangladesh. Study population was
medical Students and doctors of Bangladesh. Medical
Students and doctors of Bangladesh, Bangladeshi
nationals and co-operative personals were included.
Non Bangladeshi nationals and non co-operative
personals were excluded. Final sample size was 345.
Data was collected through face to face interview based
on structured questionnaire. All data were entered and
analyzed by computer by help of SPSS 17.0.
Results
Among 345 respondents, majority that is 123 (35.65%)
respondents were found between the age group of 18-22
years. 43.48% of them were medical students and 56.52%
were doctors. Though majority (93.33%) was vaccinated,
72.36% of them completed the series of 3 primary doses.
91.33% of the medical students and 94.87% of the doctors
were vaccinated. Among those who were vaccinated,
majority 72.36% completed the series of 3 primary doses.
11.50% had received at least one dose. 16.14% had
received 1st and 2nd dose. Among those who completed
the primary 3 doses, 43.35% were medical students and
56.65% were doctors. Among those who had taken at
least one dose 59.46% were medical students and 40.54%
were doctors. Among those who received first and
second doses, 26.92% were medical students and 73.08%
were doctors.
199 Respondents received at least one booster dose.
Among them 43.22% were medical students and 56.78%
were doctors. Among the respondents who were not
vaccinated,56.52% were Medical Students and 43.48%
were Doctors.
Among 123 respondents, 39.84% who did not
complete the primary series or did not take booster
dose were due to forgetfulness. 11.38% were due to
financial reasons. The time interval between first and
second dose was correct for 84.91% respondents and time
interval between second and third dose was correct for
82% respondents.
Conclusions
The studies revealed that majority of the respondents
are effectively protected against Hepatitis B. The practice
of vaccination against Hepatitis B is higher among the
doctors than the medical students. All the doctors and
medical students should be vaccinated against Hepatitis
B. Hepatitis B vaccination should be made mandatory
for all the health workers.
Preference on Home Delivery or Hospital Delivery among the Mothers of a Rural
Community of Faridpur, Bangladesh
Tonmoy Biswas*, Debjyoti Das**, Niloy Das***, Suja Hossain****, Nowjum Noor Qunjo*****
Faridpur Medical College, Faridpur, Bangladesh
Background
The delivery which occurs at home without adequate
hygiene and treatment facilities under the birth attendant
(trained or untrained) is called home delivery. On the
other hand, delivery which occurs in hospitals or health
institutions with adequate hygiene and treatment
facilities under trained birth attendants is called hospital
or institutional delivery.
128
July - September 2012, Volume 3 Number 3
Aims & Objectives
To assess the preference of home or hospital delivery
among the mothers and the factors behind the preference.
Material & Methods
A descriptive type of cross sectional study was carried
out at Modhukhali Upazilla, Faridpur, Bangladesh. In
this study, 170 respondents were interviewed.
Results
Out of 170 respondents, a significant number (77.06%)
showed preference for home delivery while 22.94% went
for hospital delivery. It was revealed in the study that
majority of the respondents were between 25 to 29 years
(40%) who received education up to secondary level
(32.94%) and those who belonged to lower middle socioeconomic status were 53.30%. It was also noteworthy
that 23.53% of respondents were illiterate and among
them, 21.77% showed preference for home delivery.
Those who became pregnant for the first time at 16 to 20
years were 64.7%. Among 170 respondents 42.90% of
the mothers had two children under 5 years of age. It
was also revealed that for home delivery, 77.06% were
influenced by the senior family members, close
neighbours and trained birth attendants. A small fraction
(22.94%) who had hospital delivery were mainly
influenced by family members, friends & neighbours.
Many respondents who favoured home delivery
ventilated their idea as they felt it comfortable in having
a homely environment. Some other findings in this study
that prevented them from availing hospital delivery
were fear, shyness, financial barrier and the distance of
health care centre from their residence. On the other
hand, reasons in favor of hospital delivery were also
many. They were of the opinion that it was safe,
complications could be handled (those having previous
obstetric history) and emergences were also taken care
of. Another important factor that came out in this study
was DSF (Demand Site Financing) where a mother soon
after conception was taken care of by getting ANC and
safe delivery (normal or LSCS). After delivery, there
were incentives both for mother and new born baby.
Conclusion
Health education, knowledge of maternal health care
is recommended. Awareness programme is essential in
the rural area.
Utilization of Maternal Health Care Services in a Rural Area of Modhukhali Upazilla,
Faridpur, Bangladesh
Tonmoy Biswas*, Debjyoti Das**, Niloy Das***, Boniface Hasdak****, Nowjum Noor Qunjo*****
Faridpur Medical College, Faridpur, Bangladesh
respondents.
Background
Maternal health refers to the health of women during
pregnancy, childbirth and the postpartum period. While
motherhood is often a positive and fulfilling experience,
for too many women it is associated with suffering, illhealth and even death. In many developing countries,
complications of pregnancy and childbirth are the
leading causes of death among women of reproductive
age. A woman dies from complications from childbirth
approximately every minute.
Aims & Objectives
To explore utilization of maternal health care services
by rural people at Modhukhali upazilla, Faridpur,
Bangladesh.
Material & Methods
A cross sectional type of descriptive study carried
out.
A preformed interview schedule was used to collect
data from purposively selected sample of 546
Results
It was revealed from the study that majority of the
mothers (78.2%) had recieved ANC. Most of the
respondents recieved more than 3 ANC visits (89.5%). It
was found that majority of mothers (50.45%) recieved
ANC from UHC and a good proportion of rural mothers
recieved ANC from family welfare centers and satellite
clinic.Majority of the mothers (54.8%) delivered their
last baby at home. It was revealed that people preferred
hospital delivery in the study area.
About family planning, the survey showed that 68.5%
of the couples were found practising family planning
methods. Most of them preferred oral pills (55.9%) and
injectables (17.9%).Most of the respondents (93%) had
recieved TT vaccine and among them 61% completed
the doses. The findings of the survey indicated that
utilization of maternal health care services was higher
amongst the educated mothers.
129
Conclusions
MCH programme should be strengthened to
improve the health status of the community particularly
for the mothers and children in rural area. There is also
the need for supervising and monitoring maternal health
care services throughout the country. EOC programme
should be implemented in every Rural Health Center
as early as possible. It is also necessary that a well
designed community based research should be carried
out in rural areas to collect accurate information about
the utilization of maternal health care services in rural
Bangladesh.
Knowledge and Awareness Regarding Cervical Cancer Prevention among Married
Women of Reproductive Age Group in a Rural Area of Bangladesh
Md. Ashaduzzaman Noor*, Rajat Das Gupta**, Sheikh Mahmood Hasan***, Avijit Loha****
Background
Worldwide, cervical cancer is the second most
common and the fifth deadliest cancer in women.
Approximately 80% of cervical cancers occur in
developing countries. In Bangladesh, every year 17676
women are diagnosed with cervical cancer and 10364
die from the disease. It has been proved that cervical
cancer is a preventable disease. Most common types of
cervical cancer can be prevented by regular cytological
screening program. To achieve this there must be a high
rate of acceptance by the women.
Aims & Objectives
To determine the knowledge and awareness
regarding cervical cancer prevention among married
women of reproductive age group in a rural area of
Bangladesh.
Material& Methods
The study was descriptive cross sectional study, done
in Mulaid village of Sreepur upazilla under Gazipur
district. The study was conducted during the period from
January 2013 to May 2013 in the women above the age
of 15 years and below 49 years. Married women of
reproductive age group (15-49 years), who were
permanent residents of Mulaid village and were cooperative and willing to take part voluntarily were
included in the study. Married or unmarried women
below 15 years and above 49 years of age and unmarried
women of reproductive age (15-49 years) were excluded.
Final sample size was 200 from whom data was collected
using a structured questionnaire. Data was collected
through face to face interview based on structured
questionnaire. After meticulous checking and rechecking
all data were entered and analyzed by computer by help
of SPSS 17.0.
Results
Majority 79 (39.5%) women belonged to the age group
of 20-24 years and the least 13 (6.5%) were found between
the age group of 45-49 years. 87 (43.5%) respondents had
heard about cervical cancer. Doctors and health workers
were the source of information for majority 66.67% (n=58)
respondents. 23 (11.5%) respondents knew that cervical
cancer was a preventable disease. Among them 82.6%
respondents knew about the dose schedule of the vaccine
against Human Papillomavirus. Education (P=.00012)
had a significant effect upon the knowledge of the
respondents.
Conclusions
The level of awareness regarding cervical cancer
prevention among rural women was not satisfactory.
All the women should be educated about cervical cancer
and learn how to prevent it. Vaccination against Human
Papillomavirus should be mandatory for all the women
of reproductive age group.
130
Knowledge and Perceptions about Contraceptives among Postnatal Women
Attending a Government Hospital, Mangalore
Salonee S. Das*, Mohan Kumar P.**, B. Unnikrishnan***
Background
Family planning methods are used by many women
in developing countries to prevent unwanted
pregnancies. Lack of knowledge about contraceptives
acts as a barrier to use contraceptives among many
women leading to unplanned pregnancies. The current
study is proposed to explore knowledge, perception
about contraceptive among the postnatal women
attending government hospital.
Aims & Objectives
To study knowledge and perceptions related to
contraceptive use among women having unplanned and
planned pregnancies.
Material & Methods
unplanned pregnancy (10.9%) as compared to women
with planned pregnancies (2.7%). Women with
unplanned (78.2%) and planned (90.9%) pregnancies
were aware that contraceptives were used for birth
control. Knowledge related to Emergency
contraceptives, Male sterilization and Female
sterilization were found to be significant higher among
women with planned pregnancies as compared to women
with unplanned pregnancies. Main sources of
information were friends, staff nurses, AW, ASHA’s.
More number of women with planned pregnancy (44.5%)
as compared to unplanned (32.7%) felt that contraceptives
may have negative effects on menstrual cycles. Most of
the women with unplanned (60%) pregnancy and 74.6%
with planned pregnancy perceived OCPs to have many
side effects. Around 30% of women under both groups
found use of Copper T to be convenient.
Conclusions
A Cross sectional study conducted among postnatal
mothers during postnatal stay in the hospital. A total of
165 postnatal women were included in the study of
which 55 women had unplanned pregnancy and 110
planned pregnancies.
The findings suggest that postnatal women lack
knowledge about family planning methods and also
have misconceptions about family planning methods.
Hence, the need is to effectively utilize the period of
postnatal stay in the hospitals to provide information
and resolve misconceptions related to contraceptives.
Results
Most mothers were below 30 years and the number
of illiterates was higher among the women with
Keywords: Postnatal women; Unplanned pregnancy;
Contraceptive use.
Perceptions Related to Lifestyle Modifications Among Diabetes Mellitus Patients in
Tertiary Care Hospitals in Mangalore
Parul Goyal*, Prasanna Mithra**, Unnikrishnan***, Akshay Sachdeva****, Bharath Manakame*****, Prakhyat
Shetty******, Anand Kumar*******
Kasturba Medical College (Manipal University), Mangalore, India
Background
Diabetes mellitus is a chronic condition which has
reached epidemic proportions throughout the world.
According to World Health Organization, in India in
the year 2000 there were 31,705,000 diabetics and it is
estimated to double by the year 2030. The two basic
approaches to keep Diabetes under control are Lifestyle
modification and pharmacological approach. Diabetes
requires a lifelong management plan, and people with
diabetes have a central role in this plan. Lifestyle
modifications provide an opportunity for diabetics to
take charge of their health.
Aims & Objectives
To study the Lifestyle Modification practices and their
131
socio-demographic correlates among Diabetes Mellitus
patients seeking healthcare in the selected hospitals of
Mangalore.
Material & Methods
This hospital based cross sectional study was carried
out in the tertiary care hospitals attached to Kasturba
Medical College (Manipal University), Mangalore. After
obtaining the clearance from the Institutional Ethics
Committee (IEC), the hospitals were visited for data
collection. A total of 109 subjects aged 20 years and
above, who had been diagnosed with Diabetes Mellitus
for at least 5 years, were included in the study. The data
was collected using a semi structured, pre-tested
proforma. The grading scale used to indicate good and
poor practices used an average of scores and an average
higher than 75% indicated good practices whereas a lower
average indicated poorer practices. The data was entered
using Statistical Package for Social Sciences (SPSS)
version 11.5. The results were expressed as graphs and
proportions.
Results
Out of the 109 subjects 77(70.65%) were males, most
of them (68.80%) belonged to the age group 41-60 and
106 (97.24%) were married. Also, 95(87.15%) of them
were treated on outpatient basis. A total of 67 (61.46%)
had been diagnosed within last 1-5 years and 97(88.99%)
of the total were receiving regular treatment. Out of 109
subjects 80 (73.39%) consumed alcohol and 78 (71.55%)
smoked. Dietary modification was good in only 8 (8.25%)
patients majority of them belonging to lower socio
economic status (calculated based on modified
Kuppuswamy Scale), 16 (14.67%) subjects had good
exercise behaviour most of them belonged to middle
socio economic status, only 1(0.91%) subject had good
sugar monitoring practice, 14 (12.84%) subjects had good
foot care practices majority them belonging to middle
socio economic status.
Conclusions
Majority of the subjects were taking regular treatment
which is a good indication. The practices related to diet,
exercise, blood sugar monitoring and foot care were
low among the subjects. Most of the good Lifestyle
Modifications were restricted to Lower and Middle
Socioeconomic Status. The substance abuse rates were
high among the study population. The study indicates
need for implementation of diabetes self- management
education programmes and need for regular counseling
towards quitting substance abuse.
Relation between Body Mass Index, Serum Albumin, Sofa Score, C-Reactive Protein
and the Duration of Mechanical Ventilation
Barnamoy Bhattacharya*, Akila Prashant**, Prashant Vishwanath***
J.S.S Medical College, Mysore, India
Background
The prediction of duration of mechanical ventilation
(MV) is difficult. Vital capacity, forced expiratory volume
in one second (FEV1) and arterial oxygen pressure, before
surgery can predict the duration of MV. For emergency
intubation, respiratory parameters cannot be measured
before the tracheal intubation. Prognostic factors such
as nutritional depletion as assessed by body mass index
(BMI) and serum albumin and overall systemic
inflammation as estimated by C-reactive protein (CRP)
appear to be major determinants of hospitalization.
Aims & Objectives
To determine the predictive ability of BMI, Sequential
Organ Failure Assessment (SOFA score), serum albumin
and CRP in assessing the duration of MV.
Thirty patients aged >18 years who required MV were
enrolled for the study. They were divided into 2 groups;
patients who improved (Group 1), patients who expired
(Group 2). Group 1 was further divided into two groups;
patients on MV for <5 days (Group A), patients on MV
for >5days (Group B). BMI and SOFA score were
calculated and serum albumin and CRP were estimated.
Results
Out of the 30 patients, 18 patients successfully
improved after MV (Group 1) and 12 patients expired
(Group 2). Among the 18 patients in group 1, ten patients
improved within 5 days (Group A) and 8 patients after 5
days (Group B). SOFA score and CRP were significantly
increased (p-value 0.0003 and 0.0001 respectively) in
group 2 when compared to group 1. However, BMI and
serum albumin did not show any statistical difference
in the two groups. In our study, CRP showed a significant
relationship with the outcome of patient from MV. Also,
patients who had a high SOFA score could not survive
indicating that SOFA score can act as a good predictor of
outcome from MV. The above parameters did not show
132
any statistical difference when group A was compared
to group B.
CRP and assessment tools of critically ill patients with
SOFA score are important determinants of possible
outcomes of a patient from MV.
Conclusions
Simple, economic and easily accessible markers like
Keywords: Body mass index; SOFA Score; Serum
albumin; C-reactive protein; Mechanical ventilation.
Pre-Menstrual Syndrome among Students of a Medical College in Mangalore, South
India
Sidharth Kharbanda*, Vaman Kulkarni**, Mahak Bhandari***, Shweta Poojari****, Sakshi Gaur*****, Aishwary
Shivhare******
Kasturba Medical College (Manipal University), Mangalore, India
Background
Results
Premenstrual Syndrome (PMS) is a collection of
emotional symptoms related to a woman’s menstrual
cycle, with or without the presence of any physical
symptoms. While most women of child-bearing age
report having experienced physical symptoms related
to normal ovulatory function, medical definitions of
PMS are limited to a consistent pattern of emotional
and physical symptoms occurring only during the luteal
phase of the menstrual cycle. PMS is particularly
common in the younger age groups, thus representing
a significant public health problem in young girls. There
is a need for health and educational authorities need to
recognize the problem and provide appropriate support
for female students with premenstrual disorders.
Aims & Objectives
To study Pre-Menstrual Syndrome in medical
students of South India.
Material & Methods
In this cross sectional study we calculated a sample
size of 348 medical students considering an absolute
error of 5%, a confidence interval of 95% and prevalence
of PMS among medical students to be 35.6%. The
required information was obtained using a pre-tested,
semi-structured questionnaire from female medical
students of Kasturba Medical College, Mangalore, after
obtaining approval from the Institutional Ethics
Committee of KMC Mangalore. A written informed
consent was obtained from those willing to participate.
All the collected information was kept confidential. Data
analysis was done using SPSS ver. 17. Analysis was done
in terms of descriptive and bivariate statistics (chi-square
test). The proportion of PMS among medical students
was calculated on the basis of the ACOG (The American
College of Obstetrics and Gynecology) criteria.
We approached 348 female students among them 327
filled and returned the questionnaire (response rate94%). Among the 327 study participants, 219 (67%) were
found to be suffering from Premenstrual Syndrome
according to ACOG criteria. Irritability was found to be
the most common affective symptom (n=252, 77%)
followed by anger outbursts (n=208, 63%). Abdominal
bloating was found to be the most common somatic
symptom (n=169, 52%). The daily activity that was
affected the most due to the prevailing symptoms was
found to be the going out habits (n=188, 57.5%) and loss
of concentration (n=196, 59.9%). Majority of the students
managed their symptoms by taking pain killers (n=81,
25%). The affective symptoms were found to affect
mostly the overweight category, though the somatic
symptoms were found to be distributed equally among
the groups. Among the affective symptoms, the
prevalence of depression, anxiety and irritability was
found to be significantly higher (p<0.05) in the
overweight category. The proportion of PMS was found
to be marginally higher among obese/overweight girls
but there was no statistical significance.
Conclusions
After doing a research among female medical
students, we can conclude that there was a high burden
of PMS among the study participants. Hence, we need to
intervene by various methods such as providing proper
counseling, forming support groups and promoting
lifestyle changes such as regular exercise, meditation
and reduction in sugar intake. Further research in this
area needs to be conducted among other sub-groups of
students and general population to reduce the morbidity
and improve the quality of life of women in
reproductive age group.
133
Association of Reproductive Events as Risk Factors for Breast Cancer Cases in
Mangalore (South India)
Purneetha Singh*, Dinesh Pai Kasturi**
KMC Mangalore, Mangalore, India
Background
Incidence of Breast Cancer is rising alarmingly all
over the world, and India is no exception. Reproductive
risk factors such as age at menarche and menopause,
age at first pregnancy and the parity of the woman are
considered contributory.
Aims & Objectives
To find out the association of reproductive events as
the risk factors for developing breast cancer.
Material & Methods
Breast cancer cases at the Kasturba Medical College
Hospital from January 2008 to December 2010 were
recorded in this retrospective study. Data regarding their
age at menarche, first pregnancy and at menopause,
along with parity was collected and analyzed from a
total of 371 case files. Age distribution charts were made
for each category. Early age at menarche was considered
to be less than 14. For age at first pregnancy the following
categories were made, <20 years, >20 - <25 years and
>25 years (latter two having higher risk). Excluding the
nulliparous women, the others were categorized into
two groups on the basis of their parity i.e. parity <2 or
>2. For age at menopause the age groups were divided
into <42 years, >42 - <47 years and > 47 years (latter two
having higher risk).
Results
A total of 276 case files were seen out of which
majority (96%) of the females had attained early
menarche. Only 10% of the women (24) had conceived
before the age of 20 out of a total of 241 cases observed.
For the 181 case files with data on age at menopause, it
was analyzed that 145 females (80%) attained menarche
after the age of 42. All these risk factors had a positive
correlation with the occurrence of breast cancer. In
addition, it was seen that 62 women were nulliparous,
and out of those who had conceived, only 28% had parity
greater than 2.
Conclusions
There is a positive correlation of age at menarche,
first pregnancy and at menopause with the incidence of
breast cancer.
Sleep Quality of Anesthetists in Two States of India
Aparna D.*, Pawan Kumar Sharma**, Vijay Sharma**, K.V. Raghava Rao***
Mediciti Institute of Medical Sciences, Hyderabad, India
Background
Material & Methods
Anesthetists in India have long and erratic working
hours. They lack regular intervals of rest and sleep. The
strenuous nature of their work also causes disturbed
sleep among anesthetists and also the quality of sleep is
poor. Prolonged periods of sleep deprivation may affect
their judgment, performance, and poses risk to the
patients’ lives.
Aims & Objectives
Ethical clearance for the study was provided by the
Institutional Ethics Committee. Anesthetists from
different tertiary care hospitals in Andhra Pradesh and
Maharashtra were recruited using simple random
sampling. The Pittsburgh sleep quality index (PSQI) was
adapted after pretesting, and used to assess subjective
sleep quality. Anesthetists’ work stress was assessed
using a questionnaire. Data was entered and analysed
using Epi Info 3.5.3 statistical software.
To investigate sleep quality of anesthetists through a
subjective questionnaire.
134
Results
Conclusion
34, of the recruited 129 anesthetists, completed the
study till date. Preliminary analyses shows that about
75% of them had a PSQI score of e”5. Anesthetists with
relatively less years of job experience were observed to
be have higher risk of sleep disturbance compared to
the ones with more than 10 years of experience.
The study demonstrated that poor sleep quality is a
common health problem among anesthetists. To
discover other possible factors affecting sleep quality
and to develop a systemic strategy to cope with the
problem, further studies are required.
Assessment of Risk Factors for Non Communicable Diseases in an Urban Ward of
Visakhapatnam
Krishnaveni
Andhra Medical College, Visakhapatnam, India
tests will be applied
Background
Non communicable diseases are the major, emerging
and growing public health threats which have been
silently creeping down our public health care system. If
the current trend continues, NCD’S are expected to
account for 73% of the deaths and 63% of the global
disease burden, thus becoming the leading cause for
mortality and morbidity. So a systematic approach
towards these modifiable risk factors and their
assessment is required.
Aims & Objectives
To study the socio demographic profile of the study
population and to assess the core risk factors for noncommunicable diseases among the study population
Material & Methods
Study Setting
:
Study Population
:
Sample Size
Study Tools
:
:
Study Variables
:
:
urban residential colony
of Visakhapatnam city
individuals between age
of 18-65 yrs
250
WHO step up approach
questionnaire(step-1 and
step-2)
Measuring tape, B.P
apparatus, weighing
scale, Age, Alcohol, BMI,
Blood pressure, Dietary
pattern, Gender,
physical activity,
Smoking
Data will be analyzed
using SPSS PACKAGE
and relevant statistical
Results
In our study, 62% are males and 38% are females .The
minimum age of the study population is 18 years and
the maximum is 65 years.61% are married.69% are
hindus,25% Christians, and 6%Muslims.37% belong to
the upper income group , 54% to the middle income
group and 9% to the lower income group.1/3 rd of the
study population are smokers and the mean age at which
they started smoking was found to be 21 years.30% of
the study population are alcoholics and the mean age at
which they started alcohol was found to be 22.nature of
work of 62%of population is sedentary. Regarding
dietary habits,6% take extra salt in their food.13% take
red meat regularly.43%take fruits only once a month or
not even that.38% take food from outsideregularly.27%
of study population are diabetics,24% are
hypertensives,7% have heart problems and 29% are preobese ,28% are obese.
Conclusions
Even among the urban population the incidence of
these risk factors was found to be very high .The higher
and middle income groups are equally effected by them
.The mean age at which they started smoking or
consuming alcohol is an indication for us to make them
the target age group and try to educate them. Sedentary
life style has strong impact. Regular exercise in the form
of jogging ,gym or yoga is found to be more effective
.People who have family history of these NCDs are
more vulnerable and they have to be educated .The
varying BMI and waist hip ratio patterns are indicative
of increased threat of these risk factors which have to be
modified.
135
Pattern of Computer and Internet Use among Medical Students in Bangladesh
Maly Morshad Ahmad*, Rajat Das Gupta**
Background
Internet has become the world’s biggest library,
where retrieval of scientific resources can be done within
minutes. Web-based search tools and techniques in order
to find high-quality information resources (Romanov
& Aarnio, 2006). The development and evolution of
internet has brought profound changes in the health
care delivery systems across the globe ranging from
education and training to diagnosis and patient
management. Internet has fundamentally transformed
the patient management practices of health care
professionals. According to an estimate, 30% of a
physician time will be spent in the use of various
information and communication technology tools in
2010.
Aims & Objectives
To find out the pattern of computer and internet use
among medical students of Bangladesh.
Material & Methods
face interview based on structured questionnaire. After
meticulous checking and rechecking, all the data was
entered and analyzed by computer by help of SPSS 17.0.
Results
Among 591 respondents, majority 36.72% belong to
theage group of 18-19 years. 54.65% are male and 45.35%
are female. Majority (28.26%) are studying in 1st year
and least 6.43% are interns. Majority 87.99% have the
experience of internet use. Among the respondents who
have the experience of internet use, 52.12% use internet
frequently followed by 27.88% who use internet
regularly. Majority 61.73% use mobile phones to browse
internet followed by 20.38% who use laptop. Most
frequently visited sites are Face book (22.63%) followed
by news websites (20.54%). Majority 71.92% use internet
for social networking followed by 17.69% who use it for
academic purposes. Majority 347 (66.73%) use internet
for 4-6 hours in a week. Among the students who don’t
use internet majority 40.85% do not use it because of
lack of interest.
Conclusions
This was a descriptive cross sectional study done in
11 Medical Colleges of Bangladesh.The study was
conducted during the period from January 2013 to May
2013. All Medical Students of Bangladesh who were
Bangladeshi Nationals and Co operative were included.
Non co operative non Bangladeshi Nationals were
excluded. Purposive sampling technique was followed
for data collection. Final sample size was 591. Data was
collected using a structured questionnaire to bring out
the objectives and variables of the study. Questionnaire
was duly pretested.Data was collected through face to
Our study has shown that majority of the respondents
have used internet. Nearly half of the respondents use
internet regularly. Face book is the most frequently
visited site for the purpose of social networking. Only
few of the medical students use internet for academic
purpose. Awareness should be created among the
medical students for using the vast ocean of cyber space
for the academic purpose and steps should be taken to
reduce the misuse of internet.
Malnourished after Cardiac Surgery: Are Healthcare Practitioners Aware?
Soumya Arora
SGT Medical College, Hospital & Research Institute, Gurgaon, New Delhi, India
Background
The deleterious effects of peri-operative malnutrition
on recovery after general surgery are established. Since
the effects of peri-operative malnutrition on recovery
after cardiac surgery are not known.
Aims & Objectives
To examine the effects of nutritional status and risk
factors predictive of malnourishment – as an outcome
of cardiac surgery.
136
Material & Methods
Aneurysms involving the ascending aorta and aortic
root can be repaired with low operative risk with proper
analysis. Operations such as composite valve-graft root
replacement or valve-sparing root reconstruction carry
expected mortality <5% with few peri-operative
complications. The primary outcome was mortality;
secondary outcomes included infection and nutritional
risk index (NRI) scores.
Results:
One Hundred Thirty Six Cardiac surgery cases were
performed during the study period. Nutritional
depletion developed in 65% of patients and was more
likely in patients undergoing valve-graft root
replacement (82%) or valve-sparing root reconstruction
(59%) ( P = .0005). Patients who developed malnutrition
had similar mortality as patients who did not develop
postoperative malnutrition (7.7% vs. 2.2%; P =0.68);
however, malnourished patients had higher rates of
postoperative infection (19.2% vs. 6.7%; P = .03).
Conclusions
Patients undergoing major composite valve-graft root
replacement or valve-sparing root reconstruction have
high rates of postoperative malnutrition, with patients
undergoing operations on the ascending aorta and aortic
root having the highest rates of postoperative
malnourishment and infection. Patients with chronic
state undergoing cardiac surgery are associated with
increased risk for postoperative malnourishment and
may be a group to target for peri-operative risk factor
modification and nutritional supplementation. A
thorough and thoughtful review of all peri-operative
data and analysis is essential to achieve a successful
outcome.
Assesment and Evaluation of CAD Risk in HIV Positive Patients in Indian Setting
Anmol Sharma*, Amitabh Sagar**, Navreet Singh***, Biju****, Ruby*****
Background
Cardiovascular disease is the leading cause of nonHIV-related death in people with HIV infection. Risk in
HIV-infected persons appears to reflect contributions of
non-HIV-related cardiovascular risk factors, the chronic
inflammatory response in HIV infection, as well as
metabolic adverse effects of antiretroviral therapy like
insulin resistance, dyslipidemia, abnormal fat
distribution, and hypertension.
matched controls. Each individual in the study
underwent basic biochemical analysis, Electrocardiogram, CD4 count (Only for TEST ARM) along with
basic history. All cases were subjected to a 2D
Echocardiogram and Tread Mill Test. The controls were
matched for age, smoking, exercise habits as required.
Standard protocol forms were made for each patient.
Anonymity of all patients was strictly ensured. Consent
was taken in all cases. Ethical clearance from the
institution had been taken.
Results
Aims & Objectives
To ascertain the magnitude of the problem of
coronary artery disease in HIV positive patients and to
ascertain if Framingham screening score can be used in
HIV patients.
Material & Methodology
This cross sectional study was conducted in a
multispecialty hospital. All male patients above the age
of 35 years were included. The study included 25
consecutive HIV positive male inpatients and 15 age
Bio statistical comparative analysis of the data
showed greater Framingham heart score and Risk
percentage of CAD to be more in retropositive patients
as compared to the controls in age matched sub groups.
Preliminary biochemical analysis also showed
association with the results.
Conclusion
Risk of developing CAD is more in HIV positive
patients than HIV negative patients in Indian Setting.
137
Influence of Parental Factors on Childhood Myopia: A Case Control Study
Srivatsa Kuchibhotla
Gandhi Medical College, Hyderabad, India
Background
Nearsightedness, or myopia, as it is medically
termed, is a vision condition in which close objects are
seen clearly, but objects farther away appear blurred.
Nearsightedness occurs if the eyeballs are too large or
the cornea, the clear front cover of the eye, has increased
curvature. As a result, the light entering the eyes isn’t
focused correctly and distant objects look blurred.
Nearsightedness is a very common vision condition.
Some research supports the theory that nearsightedness
is hereditary. There is also growing evidence that it is
influenced by the visual stress of too much close work.
Generally, nearsightedness first occurs in school-age
children. Because the eye continues to grow during
childhood, it typically progresses until about age 20.
According to literature, some parental factors like
parental myopia, duration of breastfeeding, smoking,
alcoholism may influence occurrence of prevalence of
myopia among school children.
Aims & Objectives
To study the influence of parental factors on childhood
myopia.
been interviewed.
Data collection procedure: An identity blinded
questionnaire consisting of 25 questions related to study
objectives was prepared after pretesting. The parents of
Vidyanagar and Padmarao Nagar, Hyderabad who had
a child between the age groups of 7-12 were interviewed
and responses were noted. Analysis was done by
dividing the study population into two groups (myopic
and non-myopic) and the responses into four categories
namely influence of breastfeeding, smoking,
alcoholism, overusage of NSAIDS. Chi square test of
significance was applied.
Results
The incidence of myopia was seen to decline with
exclusive breastfeeding till 9 months and started rising
after that. 2% of children’s parents gave history of
consuming alcohol during pregnancy of which 50%
developed myopia. Factors like parental myopia,
smoking, alcohol, and regular usage of NSAIDS had
significant influence as compared to the non myopic
children. Though not included in the study, chicken pox
during pregnancy was been observed to be having
statistically significance impact.
Conclusions
Study design: A community based case control study.
Study subjects: Children among age groups 7-12.
Identification of subjects: A door to door survey was
conducted and 500 parents of 7-12 year old children have
All the study factors have a statistically significant
impact on occurrence of myopia in children. This study
will be more clear if the individual factors are studied
in detail.
Assessment of Prevalence, Risk Factors and Treatment Regime Followed in Acute
Diarrhoeal Diseases in a Semiurban and Rural Area of Dakshina Kannada
S. Hariharan Bharadwaj*, Punya Suvarna**, Fathima Raeesa Hussain***, Dhanush K.S.****, Mohammed Jasir*****
Background
Diarrhoea is defined as the passage of loose, liquid
or watery stools, more than three times a day. It is a
major public health problem and is one of the leading
causes of illness and death, in children, living in
insanitary conditions. World Health Organization
(WHO) estimates that about 3.5 million deaths occur
each year because of diarrhoea and its related
complications of dehydration and malnutrition.
Aims And Objectives
The aim of this study was to assess the prevalence,
risk factors and treatment regime followed in acute
138
diarrhoeal diseases in a semiurban and rural area of
Dakshina Kannada. Awareness about the signs and
symptoms of dehydration and the popular home
remedies taken to combat diarrhoea and dehydration
was also evaluated in the study population.
A cross sectional study was carried out in
Jeppinamogaru(Semi-urban) and Ullal(Rural), field
practice areas of Department of Community Medicine,
Kasturba Medical College, Mangalore, South India, in
the month of February 2013. It was carried out among
575 individuals by using a pre-tested, semi-structured
questionnaire. Each participant was asked for history of
diarrhoea over the past one year.
Results
Out of the 575 individuals interviewed, 69(12%) had
suffered from diarrhoea in the past year. Maximum
number of cases,i.e, 22(31.8%) were found in the age
group of 0-5 years. It was seen that 39(56.6%) of the cases
occurred in the lower middle class population (p=0.357)
with 30.7% of the cases occurring in individuals with
unsatisfactory living conditions (p=0.02). 42(62.3%) of
the cases occurred during the winter season. It was
shocking to see that 49% of the population took no
treatment for this problem. 89% of the population had
moderate awareness about the signs and symptoms of
dehydration and the home remedies available for its
treatment. However, 20.5% of males had poor awareness
as compared to 5.5% females (p=0.01).
Conclusions
Children below the age of five years are more
susceptible to diarrhoeal diseases. Also, most of the cases
were attributed to poor socioeconomic status and
unsatisfactory living conditions. Also because of poor
awareness amongst individuals, adequate treatment
may not be sought out for at an earlier stage of the
disease. It is important to increase awareness of the
people on the necessity of adequate personal and public
hygiene practices so as to prevent the occurrence of
diarrhoea. It is also necessary to highlight the importance
of acquiring treatment so as to prevent further
complications of dehydration and malnutrition.
Assessment of the Common Problems Faced by Adolescent Students
Parul Ghildiyal*, Shravya Deekonda**, Divya Trivedi***, Neha Dhakappa****, Sumitha Subramaniam*****,
Srividya Iyer******
Background
Adolescence is a period of transience and turmoil.
Adolescents are under pressure to find their place in
society, get recognised by their peers and be accepted as
individuals. This often leads to restlessness, anxiety and
feelings of insecurity, which may lead to pathological
disorders.
Aims & Objectives
To understand the influences affecting adolescent
students.
Material & Methods
A cross sectional study was conducted by taking 392
students of class 7, 8 and 9, from three high schools in
Mangalore. Convenience sampling was done to select
participants in the study after taking permission from
the institution and an informed consent from the parents
and assent from the students. Ethical approval was
obtained from Institutional Ethics Committee. A semistructured questionnaire was distributed. The
questionnaire included questions dealing with the
school, family, and health, eating habits, society and
effect of media. Data was analysed using SPSS version
17.0
Results
A total of 392 students responded. It was found that a
major proportion of the students easily made friends
and were comfortable with them, whereas only about
half of them were at ease with their teachers. Chronic
health problems affected a very small fraction of the
students, and virtually all of them received ample
attention when they were ill. More than half of them
desired to be the most popular person in class and also
felt that their company influenced them. A significant
percentage of them skipped meals, watched TV and
browsed the Internet regularly. A notable number of
them tried to imitate people they saw on TV and felt
that watching movies affected their mindset.
139
Conclusions
Peer pressure, audio-visual media and the Internet
significantly influence adolescents. Addictions were
present amongst a proportion of adolescents and their
family members as well. Adult influences on adolescents
were present; though lesser at school, and more at home.
Effectiveness of an IEC(Information, Education and Communication) Campaign on
the Knowledge, Attitude and Practices Related to Cervical Cancer and its Prevention
among Reproductive Women in an Urban Slum of Central Delhi
Tripti Aneja*, M. Meghachandra Singh**
Maulana Azad Medical College, New Delhi 110002, India
Background
Cervical cancer claimed over 250,000 deaths in 2005,
of which 80% occurred in developing countries. In India
it is projected to rise by 25% over the next 10 years. Lack
of awareness is considered to be a barrier in the control
of cervical cancer. A study from Kolkata reported limited
knowledge about cervical cancer. Another study
revealed a correlation of literacy with higher awareness
levels. Studies related to assessing effectiveness of
awareness campaigns related to cervical cancer are scanty
in India.
Aims & Objectives
1.
2.
3.
To assess the knowledge, attitude and practices
related to risk factors, symptoms, signs and
prevention of cervical cancer amongst women aged
18-45 yrs .
To launch an IEC campaign related to risk factors,
signs and symptoms and prevention of Cervical
Cancer among the study subjects.
To evaluate the effectiveness of the IEC campaign
in terms of changes in the knowledge, attitude and
practices related to cervical cancer.
schedule before and after group discussion on cervical
cancer.
Data was analyzed using SPSS version 17.0.
Results
The median family size was 6 in the study population,
29% were illiterate, and 72.9% were housewives. Before
intervention, 70% study subjects had heard about cancer.
Intervention led to an increase in naming two common
women cancers (38.6% in pre to 94.3% post intervention).
The change in awareness post intervention regarding
signs and symptoms were: bleeding in between
periods(+55.8%); bleeding after intercourse(+57.2%); foul
smelling discharge (+57.2%). The change in awareness
about risk factors were : multiple sex partners (+37.1%);
early marriage(+61.4%); HPV infection (+37.1%); early
sexual debut(+41.4%). The changes related to pap smear
was (32.9% in pre to 94.3% in post –test), about HPV
vaccine (8.6% in pre to 50% in post-test). In pre-test,
3.4% relied on home remedies for vaginal discharge;
and 5.7% had got pap smear test done. Attitudinall
changes observed were: agreement on the predispositon
of multiple sexual partners to cervical cancer,
examination by a gynecologist (+8.6%) etc.
Conclusions
It was a community based interventional study carried
out in an urban slum of central Delhi. Seventy women
(18-45 yrs.) selected by systematic random sampling
were interviewed using a pre-tested semi structured
Group discussion was effective in changing
knowledge and attitude on some aspects of cervical
cancer. More such educational sessions are required to
sustain the effect in the population.
Profile of School Children Attending a Public School in Faridabad
Prince Hirdesh*, Suma Nair**
Kasturba Medical College, Manipal, Udupi, India
Background
School health is a medium for primary prevention
wherein promotion of positive health and early
diagnosis of preventable problems form the core
components.
140
Aims & Objectives
To identify and study the distribution of common
medical disorders among children in a public school.
This was a Cross-sectional Study carried out in school
children at Faridabad in Haryana. Students in the age
group 3 to 19 years were included in the study. Besides
a general physical examination, a standardized School
Health Questionnaire was used to identify various
aspects pertaining to health.
Results
Of a total of 700 children enrolled in the school, 514
were available for assessment. There were equal number
of male & female children with 49.4% & 50.6%
respectively. Majority (82.5%) were under nourished
(BMI<18) but none had signs of any other deficiency.
Dental caries was noted in 3%, fluorosis in 28% and 35%
had decreased vision. Impacted ear wax (10%), CSOM
(2%) and perforated tympanic membrane (4%) were some
of the other notable disorders. Of those whose Blood
Pressure (BP) was recorded almost 78% had it in the
range of < 110/70 mm of Hg and there appeared a
positive correlation of BP with age (0.47 p< 0.01).
Conclusions
There is an urgent need to tackle the problem of
under-nutrition and decreased vision among this group
of school children. An effective school health program
with early identification and effective referral could
bring about a significant change in these preventable
childhood problems.
A Cyto-Histopathological Study Of Image Guided Core Biopsies
Vrishti Goel *, Suchitha Satish**
Background
Non-operative pathology diagnoses should constitute
an essential part of comprehensive work-up of mass
lesions. A quick and reliable preliminary diagnosis is
essential in the management of such cases as information
is valuable for the same day patient counselling and
management planning. The possibility of severe
complications such as respiratory distress or circulatory
compression mandates rapid diagnosis and treatment of
lung/mediastinal masses. With an on-site approach,
imprint cytology(IC) on core biopsy (CB) can assess the
adequacy of biopsy specimens, optimise the biopsy
procedure and provide a rapid diagnosis regarding the
malignancy or benignity of a lesion. It is an attempt to
get the best of both worlds i.e., cytology and histology
without significant extra cost.
Imprint cytology(IC) on core biopsy (CB) offers an
attempt to get the best of both worlds i.e., cytology and
histology without significant extra cost.
Aims & Objectives
To study and compare IC and histopathology (HP) of
CB.
Material & Methods
Image guided core biopsy was done on patients with
a clinically or radiologically detected mass lesion. Coaxial needle of 18-gauge in a core biopsy gun was used.
Imprints were made on 4-6 slides by rolling the core of
tissue over them. The slides were evaluated using May
Grunwald Giemsa, Papanicolaou, Haematoxylin & Eosin
stains. Biopsies were placed in 10% formalin for
histopathological examination and special stains were
done wherever necessary.
Results
Core biopsy and IC were done in 57cases. Out of which,
39cases (68.43%) were neoplastic and 18cases (31.57%)
were non-neoplastic/inflammatory. IC correlated with
histopathology examination (HPE) in 54cases (94.73%).
IC correlated with HPE in all cases of neoplastic lesions.
Out of 17 non-neoplastic/inflammatory cases, IC
correlated with HPE in 14cases (82.35%). The overall
sensitivity was100 %, specificity was 94.73 %, positive
predictive value was 97.43%, negative predictive value
was 100 % and diagnostic accuracy was 98.24%.
Conclusions
Imprint cytology provides a rapid, accurate
preliminary diagnosis and might contribute to the final
diagnosis. IC helps to guarantee that the specimens
obtained adequately represent the lesion. When IC is
used, there is a reduction in diagnostic waiting time (over
CB) and an increase in diagnostic performance (over
FNAC). Regardless of the diagnosis of benign versus
malignant, assessment of the adequacy of the specimen
and immediate interpretation of the results leads to better
treatment planning.
Keywords: Imprint cytology; Core biopsy; Mass
lesions.
141
Dermoscopic Evaluation of Response to an Intralesional Corticosteroid in the
Treatment of Alopecia Areata
Shikhar Ganjoo*, D.M. Thappa**
JIPMER, Pondycherry, India
Aims & Objectives
To evaluate the efficacy of intralesional triamcinolone
acetonide in the treatment of alopecia areata and to use
dermoscopy to identify signs of early clinical response
and adverse effects.
Material & Methods
Seventy patches in 60 patients were injected with
steroid at 4 weeks interval and followed up for 24 weeks.
Treatment response was evaluated using regrowth scale
(RGS). Heine DELTA 20® dermatoscope was used to assess
disease activity, response to treatment and side effects.
Results
Twenty eight patients responded early and achieved
RGS of 4 within 12 weeks and 29 patients responded late
and achieved RGS of 4 within 24 weeks of initiating
therapy. There were 3 patients who did not achieve RGS
of 4 at 24 weeks. Late and incomplete responders showed
statistically significant association with family history
of alopecia areata (p<0.0001), presence of recurrent disease
(p=0.0147) and presence of nail changes (p=0.0007).
Dermoscopically, 60 patches demonstrated regrowth of
new vellus hair at 4 weeks. Tapering hair disappeared
maximally at 4 weeks. At 12 weeks, complete
disappearance was seen in tapering hairs, broken hairs
and black dots whereas for yellow dots to disappear
completely in all patches it took 16 weeks. The adverse
effects were observed at an earlier stage using
dermoscopy than clinically.
Conclusions
Intralesional triamcinolone acetonide is efficacious for
treatment of localized patchy alopecia areata.
Dermoscopy is very useful to identify signs of early
clinical response, adverse effects and markers of disease
activity.
Prediction of Site of Insensate Peripheral Neuropathy in the Feet of Diabetics Using
Semmes: Weinstein Monofilament Examination
Snigdha Bhatia*, Archith Boloor**
Background
Among Diabetic patients, peripheral neuropathy is
an important factor that predisposes to plantar ulcers
and amputation. It is imperative to diagnose the onset of
neuropathy early. The Semmes- Weinstein Monofilament
examination is appropriate for the same, as a simple
diabetic neuropathy screening instrument generalizable
to the clinical setting. The 5.07/10g Monofilament, as
recommended by the American Diabetes Association has
been used in this study.
Aims & Objectives
To determine the incidence of peripheral neuropathy
among diabetics using Monofilament testing, and
determine the most sensitive site on the foot for testing
its onset.
Material & Methods
The study was conducted over 2 months on a random
sample of 120 diabetic patients. Monofilament was
applied to the plantar surface of 4 sites of both feet. The
Monofilament was applied perpendicular to the skin
surface and sufficient force was applied to bend it to a cshape. The pressure was applied until the filament just
buckled with a contact time of 2 sec. Inability to perceive
the sensation at any one site before the Monofilament
bends, was considered abnormal. Data was analyzed
using SPSS 17 Statistical Program. Two-Sample T-Test
was done to study the prevalence.
142
Results
Majority of the subjects studied (42.5%) were recently
(less than or equal to one year) diagnosed with diabetes.
Out of these subjects, 27% already had some form of
neuropathy present in their feet. This was significant as
it highlighted the importance of early diagnosis of
neuropathic symptoms in these patients to propose
interventions. It was observed that the duration of
morbidity significantly affects the setting in of
neuropathy among diabetics (p=0.005), especially patients
with diabetes for over 10 years tend to develop
neuropathic symptoms over time. The most commonly
affected site was found to be the plantar aspect of the
great toe of the left foot (83%), in accordance with the
gait cycle, implying that this site was highly suitable for
the Monofilament examination due to its high sensitivity.
Diabetic Peripheral Neuropathy, especially painful
diabetic peripheral neuropathy, was associated with poor
quality of life.
Conclusions
The management of DPN relies on its early recognition
and needs to be individually based on co-morbidities
and tolerability to medications. Determination of
appropriate site for testing the Monofilament reduces
the possibility of false negatives, and makes this bed
side tool more suitable for the determination of
neuropathy.
Correlation of Hand Grip Strength and Vitamin D Levels in Type 2 Diabetes Paients
Dinesh Dhanwal*, Smita Kaushik**, V.K. Gupta***, Vivek****, Abhenil Mittal*****
Background
Diabetes is an emerging epidemic of the current
scenario.It is evident now that the role of vitamin D
extends beyond calcium homeostasis and includes
modulationincludes modulation of skeletal and cardiac
muscle function and immune cell function. One of the
major site of involvement of Diabetes Mellitus is
musculoskeletal system.
diabetic clinic of LNJP hospital on 65 diabetic subjects
over 40 years of age who have had diabetes for more
than 5 years. After taking consent, their clinical assessment
was done including hand grip strength evaluation by
JAMAR’s hand grip dynamometer .5 ml blood sample
was taken for biochemical investigations including
fasting blood glucose,hba1c, vitamin d levels. T test was
done for the same.
Results
Aims & Objectives
Under evaluation at present.
To elucidate the relationship between hand grip
strength and vitamin D levels in patients of type 2
diabetes mellitus.
Conclusions
To be evaluated
Material & Methods
A comaparative cross sectional study was done in
Clinical Utility of C- Reactive Protein Test in Early Diagnosis of Neonatal Septicemia
and its Correlation with Blood Culture
Sunil Rao Padmaraj*, Vidya**, Safa Tariq Wani***
Yenepoya Medical University, Mangalore, India
Aims & Objectives
To isolate the infective organisms from blood and
know their sensitivity pattern and to correlate with CRP
levels in serum of babies with neonatal septicemia in
NICU of a teaching hospital in Mangalore, India.
143
Material & Methods
A prospective study was designed and the study group
comprised 205 neonates of less than 7 days age, admitted
in NICU for clinical features of sepsis. Blood cultures and
CRP estimation were done for all the neonates. The results
of both were correlated.
Results
One hundred and twenty five neonates out of 205 had
positive blood cultures. Staphylococcus aureus and
Pseudomonas aeruginosa were the most common
organisms. The gram negative isolates were most
sensitive to Amikacin and Cefotaxime, whereas all the
gram positive isolates were sensitive to Vancomycin .
Serum CRP was high in 48.78% neonates. CRP test had
86.38% sensitivity and 82.43% specificity .
Conclusions
A simple and rapid diagnostic method like C-reactive
protein test needs to be carried out with other sepsis
screening methods. Though blood culture remains the
gold standard for the diagnosis of neonatal septicaemia,
a raised C-reactive protein levels certainly helps in early
diagnosis which has to be correlated later with blood
culture report. It is also concluded that Staphylococcus
aureus remains the principle organism for neonatal sepsis
in a tertiary care setting.
A Rare Case of Congenital Erythrocytosis
Jayaseelan Meenaloshni*, Niveditha Suvarna**, Arun V.***
Background
Erythrocytosis (increased RBC mass or polycythemia)
maybe primary due to an intrinsic defect in the bone
marrow stem cells/erythroid progenitor cells or
secondary where the red cell production is driven by
factors external to the erythroid compartment, such as
increased erythropoietin production for any reason.
Primary and secondary causes can be further classified
into congenital and acquired causes. The classical acquired
primary erythrocytosis is Polycythemia Vera where
patients have an abnormal clone and frequently an
increased white blood cell and platelet count. Majority
of patients have a clone of cells with gain of function
mutations in JAK2. Congenital causes include mutations
of the erythropoietin receptor and defects in oxygen
sensing pathways including VHL, PHD2 AND HIF2A
mutations.
Case
15 yrs male presented with complaints of head ache,
leg pain and redness in the eye with significant history
of redness of the eye and weakness since birth. Clinical
examination revealed splenomegaly. Laboratory
investigations showed erythrocytosis with RBC count of
10.46 million/cumm, haemoglobin 22.7gm/dl,
haematocrit 76.2%, normal WBC and platelet count.
Lactate dehydrogenase levels was increased 925IU/L,
renal function and liver function tests were normal. Bone
marrow examination with FISH for t(9,22) and JAK 2
mutational analysis was negative which ruled out
Polycythemia Vera. Serum erythropoietin levels was
increased 290mIU/ml. Oxygen saturation studies was
normal. Haemoglobin electrophoresis showed normal
adult pattern. Ultrasound, CT scan and PET scan revealed
no significant lesion known to cause secondary
erythrocytosis. Diagnosis of congenital erythrocytosis
?cause was made. Since there was no provision locally
for testing defects in oxygen sensing pathways it could
not be done. The patient was managed with venesection
and aspirin.
Results
A raised red cell count will increase blood viscosity
and thus will have clinical consequences resulting in
thromboembolic events. Once an erythrocytosis is
established, identification of the cause is the next focus. It
starts with a complete history and examination with
exploration for secondary causes. EPO levels is an initial
way to guide further investigations.The above case also
emphasises the importance of EPO. There is little evidence
to guide management of erythrocytosis due to congenital
defects or in those with idiopathic erythrocytosis.
Reducing the HCT by phlebotomy/venesectiondecreases
the blood viscosisty and may be ofbenefit. Low dose
aspirin may help to reduce thrombosis.
Conclusions
The above case is a rare case of congenital
erythrocytosis. All causes of erythrocytosis should be
kept in mind while evaluating a case of erytrocytosis.
Since there are many causes of erythrocytosis an
algorithmic and reflexive testing strategy is useful and
serum EPO levels serve as an initial guide to further
investigations.
144
Stosstherapy in Nutritional Rickets....Mysteries Unveiled
Daipayan Chatterjee*, Vasu**, Vikas Gupta***, B.C. Kabi****
Vardhaman Mahavir Medical College, New Delhi, India
Background
High dose Stosstherapy (600000 IU intramuscular
vitamin-D) is being used since 1930 to treat nutritional
rickets. However, lack of treatment guidelines and
inadequacy of studies evaluating it’s safety, efficacy and
follow-up schedule has led to wrong practices. Physicians
give multiple vitamin-D injections using alkaline
phosphatase as a surrogate marker, leading to the
possibility of vitamin-D toxicity. This along with frequent
follow-up biochemical and radiological tests increases
the cost of therapy and negates Stosstherapy’s main
advantage of better compliance.
Aims & Objectives
To assess the efficacy of high dose Stosstherapy in the
treatment of nutritional rickets.
Material & Methods
A total of 72 cases (33 male, 39 female) with nutritional
rickets were given single intramuscular injection of
Vitamin D (600000 IU) along with oral calcium (50mg/
kg) and Vitamin D (400IU/day) till complete radiological
resolution. Radiological scoring was done based on
Thacher’s 10 point scoring system. Follow-up done at 3
weeks, 6 weeks, 3 months, 6 months, 9 months, and 12
months. Pre and post treatment clinical, biochemical and
radiological parameters were compared and analyzed
statistically.
Results
The mean age of presentation was 3 years 5 months
(range 6 months – 12 years). Inadequate sunlight exposure
(mean 20 minutes/week) and breast feeding more than 6
months (mean 1 year 8 months) were found to increase
the incidence, severity and recovery time in nutritional
rickets statistically significantly(p<0.05). Swollen wrist
and ankle were the commonest presentation (96%) which
started improving by 6 weeks and 80% resolved by 1
year. Angular deformity of the leg was present in 90%.
Improvement was noted at 3 months with 60% resolving
by 1 year. Initially high alkaline phosphatase was noted
in 96%, low 25, hydroxy vitamin-D (calcidiol) in 95%,
hypocalcaemia in 70%, hypophosphataemia in 63% cases.
90% achieved normal calcidiol by 3 weeks. At 3 months
90% had normal calcium and phosphate, 100% had normal
calcidiol. Normal alkaline phosphatase was noted in 50%
by 3 months, 70% by 6 months and by 100% by 9 months.
The mean initial radiological score was 6.8±3.3. 70% cases
had radiological resolution by 3 months and 100% by 6
months. Time for radiological resolution and initial
radiological score were linearly associated on regression
analysis implying that radiologically more severe rickets
took a longer time to heal. Distal ulna resolved last
marking the completion of radiological resolution in
65% cases. But when initial score was 8 or more or
resolution took more than 3 months, distal femur was a
better indicator being the last to resolve in 70% cases. All
the clinical, biochemical and radiological changes were
statistically significant (p<0.05).
Conclusions
Mega dose of vitamin-D (6,00,000 IU) restores normal
calcidiol levels by 3 weeks, hence obviates the need for
multiple injections. The results of the study can be used
to prognosticate the parents regarding the expected time
of resolution. Serial vitamin-D assay is not required at
follow-up visits. Rather, alkaline phosphatase and serial
radiographs of wrist at 3 monthly intervals can
sufficiently monitor the improvement. Breast feeding
more than 6 months should be discouraged. This study
concludes that high dose stosstherapy is safe, effective
and ensures compliance in treating nutritional rickets.
Evaluation of Idiopathic Clubfoot Deformity in Infants by Pirani or Dimeglio Score:
Attempting to Clear the Confusion!
Vasu*, Daipayan Chatterjee**, Vikas Gupta***
VMMC & Safdarjung Hospital, New Delhi, India
Background
The advent of Ponseti’s technique has made the
management of idiopathic clubfoot simple and effective.
Though a number of scoring systems have been used in
the past Pirani and Dimeglio scoring systems have stood
145
the test of time for classification of clubfoot deformity in
daily practice. Still superiority of any one scoring system
over another has not been validated yet.
Aims & Objectives
To evaluate idiopathic clubfoot deformity in infants
by Pirani or Dimeglio score
Material & Methods
Total 70 feet of idiopathic clubfoot deformity below 1
year age were evaluated and managed by classical
Ponseti’s two hands technique. Pirani 6 point scoring
system and Dimeglio 20 point scoring system were used
to score the deformity pretreatment and prior to casting
every week till deformity was completely corrected.
Percutaneous tendoachillis was done in accordance with
principles of Ponseti’s method and when midfoot Pirani
score was less than 1, hindfoot score was more than 1 and
talar head was not palpable. Post correction the patients
were followed regularly for minimum of one year.
Results
Mean age of presentation was 115.5 days
(approximately 17 weeks), youngest child being 7 days
and oldest being 332 days (47 weeks) old. Bilateral
involvement was found to be 35%. Right limb was more
involved (68%). Evaluating a single foot took an average
of 60 seconds in Pirani system and almost double the
time in Dimeglio system. At presentation the mean Pirani
score was 4.6 and mean Dimeglio score was 14.3.
Complete correction was achieved in all 70 cases. Post
correction mean Pirani score was 0.2 and Dimeglio score
was 3.1. Positive correlation was found between pre and
post correction Pirani and Dimeglio score and also
between pretreatment Pirani and Dimeglio score and
number of casts required for complete correction. Pirani
score fell by average of 0.6 (10%) and Dimeglio score by
1.5 (7.5%) with each cast. Mean Dimeglio score at
tenotomy was 6.4±1.1.
Conclusions
With each casts the fall in score was more in Dimeglio
score but Pirani being a 6 point scoring system the
percentage fall is more in Pirani score. Pre and post
treatment Pirani and Dimeglio score correspond with
each other, although they do not accurately predict the
number of casts required for correction. Pirani score
plateaus just prior to tenotomy unlike in Dimeglio system
in which there is a gradual fall. However the Dimeglio
method took longer time as compared to Pirani but once
mastered the time taken to score gradually declined. It
was observed that tenotomy can be done with Dimeglio
score of 5 or less which corresponds to the Pirani score
for tenotomy. We conclude that both Pirani and Dimeglio
scoring methods can be used for club foot evaluation
with ease and do not show superiority over another.
Hence both can be used effectively in daily practice
depending on the surgeon’s choice.
Poorly Differentiated Carcinoma in a Teratoma: Case Report
N.Charumithrra*, Usha Vishwanath**, Preet Agarwal***, Rajendiran S.****, Gokulakrishnan*****, J.
Thanka******, Leena Dennis Joseph*******
Sri Ramachandra University, Chennai, India
Background
Teratomas are neoplasms that arise from the
primordial germ cells. They can undergo malignant
transformation, with squamous cell carcinoma being the
most common type. Other malignancies that can arise in
a teratoma include adenocarcinoma, thyroid
malignancies, carcinoid tumors and mucinous
adenocarcinoma etc.
Case
A 70 yr old post menopausal lady presented with
abdominal distension for the past three months and
abdominal pain for the past one month. Examination of
the abdomen revealed a 6x5 cm mass in the suprapubic
region, extending upto the umbilicus. All the
haematological and biochemical parameters were within
normal limits.Ultrasonogram abdomen showed a
complex mass with a cystic component of size 6.6x5.6 cm
with mural nodule and focal wall thickening. Per speculum
and per vaginal examination did not show any
abnormalities.
A CT scan of the abdomen , showed a large dermoid
cyst on the right side. There was a large ill-defined lesion
with a solid and a cystic component in the midline ,
slightly to the left. The uterus and ovary on the left were
not visualised separately. A malignant ovarian lesion
was suggested on the left. On laprotomy, the uterus and
the adnexa were all adherent to the dermoid cyst and the
omentum. Frozen section of the demoid and the omentum
was sent which was given as positive for malignancy. On
routine processing, the right ovary was a teratoma with
its wall infiltrated by a poorly differentiated carcinoma.
Similar looking cancer cells were seen on the other side
146
ovary, around the tube and also in the omentum which
was sampled extensively. A final diagnosis of malignancy
in a teratoma was given. There was also a poorly
differentiated carcinoma on the other ovary,fallopian tube
and omentum.
Results
The final report in pathology was given as poorly
differentiated carcinoma in a teratoma with involvement
of the other side adnexa and omentum, and was staged as
pT2bNxcM0.
Conclusions
This case is presented for its rarity. Squamous cell
carcinoma in a teratoma has been reported, but very few
cases of poorly differentiated carcinoma in a teratoma
are seen in literature.
Keywords:
differentiated.
Teratoma;
Malignancy;
Poorly
Prevalence of Dyslipidemia in HIV Seropositive Patients in Patiala Region of
Northern India
Gurjinder Singh*, Sumit Goyat**
Government Medical College and Rajendra Hospital Patiala, Patiala, India
in their serum.
Background
Dyslipidemia which has been closely linked to the
pathophysiology of cardiovascular disease is a key
independent risk factor for cardiovascular disease.
Highly active antiretroviral (HAART) has dramatically
reduced AIDS morbidity and mortality; however the
studies have shown that HAART is associated with
increase in incidence of dyslipidemia. So it is very
necessary to screen every individual seropositive with
HIV who is going to start HAART to minimize the comorbid risk of cardiovascular disease in AIDS and ensure
proper planning of health actions for both primary and
secondary prevention of cardiovascular disease.
Aims & Objectives
Results
There were 200 total number of screened patients out
of which 64.5% were males. Elevated levels of Serum
Triglycerides were found in 25% of screened population.
29.5% of total females and 23.25% of males were having
high TG’s.
Serum Cholesterol was elevated in 6% of patients.
7.04% of females and 5.42% of males from total screened
females and males respectively had high cholesterol.
Dyslipidemia was found to be more prevalent with
female sex in our study.
Conclusions
To find the Prevalence of Dyslipidemia in HIV
Seropositive Patients In Patiala Region Of Northern India.
Material & Methods
Cross-sectional study was conducted on 200 HIV
positive patients who have just started HAART therapy
from period of November 2012 to May 2013 at GMC
Patiala ART centre. The patients were screened for Total
Serum Cholesterol levels and Serum Triglycerides level
The prevalence of dyslipidemia is high in HIV positive
patients in Patiala region, which necessitates the
community based intervention strategy to prevent and
manage cardiovascular risk factors. Regular monitoring
of lipid profile in patients with HAART therapy is
recommended and start of proper lipid lowering agents
be instituted with appropriate combination of HAART
to decrease morbidity, delay mortality and improve the
quality of life of these patients.
147
Heart Rate Variability Changes during Stroop Colour and Word Test
Priyanka Satish Rao*, K.Muralikrishnan**, K.Balasubramanian***, Shanmugapriya****
Stanley Medical College, Chennai, India
Background
Stress is a reaction of the body to any change that
requires physical, mental or emotional adjustments.
Individual differences in stress reactivity have been
proposed as a potentially important risk factor for genderspecific health problems in men and women. The
Autonomic regulation of the cardiovascular system is
most commonly affected and is assessed by means of
spectral analysis of short term heart rate variability
(HRV). HRV was measured in time and frequency domain
parameters.
Aims & Objectives
To investigate the cardiovascular Autonomic Nervous
System response to a mental stressor among young
adults.
to perform the Stroop Word and Colour test for Five
minutes. ECG and Blood Pressure recording was done
during this period. The mean RR interval, Blood pressure
and indices of HRV before and after the Stroop Word and
Colour Test were compared. The results were statistically
analysed.
Result
The Stroop Word and Colour Test showed significant
changes in Blood Pressure and Mean RR interval.
Conclusion
HRV parameters seem to be unaffected by the test.
Material & Methods
Fifty male and female subjects (19-23 years) were asked
Profile of Patients on First Line Anti-Retroviral Therapy (ART) Attending a Tertiary
Care Centre in Mangalore
Ankita Singh*, Anirudh Chand**, Abhilash Bhat***, Kanav Grover****, Isha Chaudahary*****, Shahbaz
Haroon******, Mohan Kumar Papanna*******
Kasturba Medical College, Mangalore (Manipal University), Mangalore, India
Background
Over 33 million people world-wide and 2.40 million
Indians are suffering from HIV/AIDS. The first-Line ART
proposed by WHO includes two Nucleoside Reverse
Transcriptase Inhibitors (NRTIs) and a Non-Nucleoside
Reverse Transcriptase Inhibitor (NNRTI). The ART
treatment was initiated in India in the year 2004.
Aims & Objectives
To assess the profile of patients on first-Line ART based
on their CD4, Hemoglobin levels, Total Leukocyte count
and opportunistic infections.
A retrospective record based study was carried out at
a tertiary care hospital at Mangalore. All the patients on
first-Line ART registered at ART centre in the last 3 years
were included. The Study was conducted duration the
month of May 2013. Prior to starting the study, permission
to access the records was obtained from the Medical
Superintendent. The data was collected from the records
using a proforma. Ethical clearance was obtained from
Institutional Ethics Committee of Kasturba Medical
College. Data was entered in Microsoft Office Excel
Worksheet. Analysis was done using statistical software
SPSS Version 11.5. Descriptive statistics like mean,
148
proportions and standard deviation were used for
expression of the results.
followed by 337 after treatment.
Conclusions
Results
A total of 109 patients received first line ART of which
69.71% were in the age group of 31-50 years.64.22% of
patients were males,78.89% were married, and 52.29%
patients were from Dakshina Kannada district. The most
common opportunistic infection was found to be
Tuberculosis (Pulmonary+ Extra-pulmonary) 27.52%
followed by other respiratory infections of 23.85%. The
patients had a median CD4 of 181 at the start of treatment
Our study found that most of the patients were in the
Reproductive age group and were married. As the most
common Opportunistic Infections were Tuberculosis and
other Respiratory Tract Infections hence, screening for
these Opportunistic Infections is of prime importance.
Keywords: Anti Retro-Viral Therapy (ART);
Opportunistic infection; Retrospective; Tuberculosis.
Study the Prescribing Pattern and Prescription Event Monitoring of Anti Retroviral
Regimens and Other Drugs Used in 75 Cases of HIV/AIDS Patients
Kushagra Maini*, Purva Ranchal**
Government Medical College, Patiala, India
Background
The Government of India estimates that about 2.40
million Indians are living with HIV (1.93 3.04 million).
Children (<15 years) account for 3.5% of all infections,
while 83% are the in age group 15-49 years. A study
prescribing patterns is an important tool to determine
rational drug therapy and maximum utilization of
resources. The incidence of HIV is currently on the rise.
Therapeutics in HIV positive patients is complicated and
involves poly-pharmacy. Presence of co-morbidities
further complicates the situation. In such a scenario it
is necessary to be aware of the prescribing patterns in
current existence and to evaluate them for their
appropriateness. There is currently a dearth of data on
the subject and this hinders us in taking appropriate
decisions.
Aims & Objectives
To develop baseline data on drug prescribing pattern
and evaluate the rationality of prevalent prescribing
practices.
Material & Methods
months will be analyzed and number of prescriptions
selected randomly will be 75. It is to be conducted in a
tertiary care teaching Hospital. Permission for access to
data (prescriptions) has been applied to PSACS and
preliminary permission obtained. Patient identity will
be kept confidential and prescription will be anonymized
before analysis.
Results
The project is under process and will be completed
soon.
Conclusions
Data that will be generated as a part of this research
project can help in understanding the current prescribing
patterns and identifying deficiencies thus helping to
improve future prescribing. Such research can be used to
help set priorities for Rational Allocation of Health Care
budget. Current trends can then be compared with
recommended guidelines to identify inadequacies. It will
also help to study the patterns of existing co-morbidities
and compliance of patients on highly active antiretroviral
therapies (HAART).
It is an enumerative retrospective study. Data of 2
149
A Study of Relationship of Physical Activity with Scholastic Performance & Body
Mass Index in Children Between 12-18 Years
Shashank Negi*, Wing Commdr B.M. John**
Background
Physical activity and Sports are generally promoted
for their positive effect on children’s health. In addition
to the positive physical & mental health impact of physical
activity there is a strong belief that regular participation
in physical activity is linked to enhancement of brain
function & cognition Regular participation in sport
activities may improve children’s classroom behavior &
increase the odds of better concentration on classroom
teachings. Participation can help students to set goals,
manage time & build self-esteem. Thus, these students
are determined to do better in life than those students
who do not undergo any Physical activity.
The time a student devotes to his physical activity is
inversely proportional to his Body Mass Index (BMI), a
reliable indicator to classify an individual as healthy or
otherwise .In our country, due to the increased syllabus
& academic pressure, supplemented by pressure from
parents, many students now prefer to study in their play
time hours. This has resulted in increased obesity with
increased BMI.
Aims & Objectives
To study the effect of physical activity on scholastic
performance and BMI in school going children of age
group 12-18 years by:
(i) Assessing the correlation between the duration of
physical activity with scholastic performance & Body
Mass Index
(ii) Assessing the association between the duration of
physical activity with scholastic performance & Body
Mass Index
Material & Methods
I.
II.
Type of study: Prospective, descriptive, analytical
study involving interview and questionnaire
Study period & Sample size: The study period for the
research was of three months duration during which
students were selected on consecutive availability
in selected schools.
A sample size of 400 was considered to be adequate
based on a correlation coefficient r=0.22 (á =0.05 and power
of 0.8) in the pilot study
A Performa of questions was prepared to assess the
Physical Activity, Academic Performance & BMI of the
students. The average of academic performance of the
preceding two years was considered for the purpose of
the study. Obtained data was analyzed with appropriate
statistical methods.
Criteria for selection were only the Age of the students.
Children with any acute/chronic illness or disability were
excluded from the study.
Results:
The study conducted on 400 children in the age group
12-18 years showed a positive effect of sports on
children’s scholastic performance & their Body Mass
Index.
The correlation of physical activity & scholastic
performance was +0.47 & the correlation with BMI was
+0.67.
The study concluded that there was a definite
association of physical activity with scholastic
performance & BMI showing that the students who put
in more hours of physical activity daily were found to
have better average & also had a healthy BMI
Conclusions
This study was unique as it aimed to look at the
relationship between Physical Activity with Scholastic
Performance & Body Mass Index, particularly in view of
the paucity of data from our country. We made a
recommendation promoting physical activity in school
going children after the results showed a significant
relationship. The Study will help to promote the necessity
of sports & physical exercise for the benefits of academic
performance & Child Health of School children. This
would be a positive step in promoting overall healthy
physical and mental development of a child, the effects
of which are likely to continue into adulthood.
150
Comparative Study of Frozen Section with Histopathology in Ovarian Lesions
Karan Bhatia*, V. Srinivas**
Background
The main purpose of Frozen Section (FS) reporting is
to provide rapid diagnosis to guide intra or peri-operative
patient management. The indications of FS are rapid
diagnosis of benign versus malignant in an undiagnosed
tumour, identification of tissue and unknown
pathological processes, evaluation of margins,
identification of lymph node metastasis, confirmation of
presence of representative samples for paraffin section
diagnosis.
Clinically detected ovarian masses have a
heterogenous nature, including neoplasms and benign
non-neoplastic lesions or cysts. The 3 main categories of
ovarian neoplasms are benign, borderline and malignant,
which differ with respect to their biological
characteristics, management and prognosis. Perioperative imaging have only limited value in
differentiating between these tumor categories. Intraoperative pathology consultation or frozen sections can
help clinicians in making an appropriate decision on the
surgical management of ovarian neoplasms.The extent
of surgical management is based on the histologic
diagnosis and the category of tumors.
Methods
Gross examination: The entire specimens received were
processed to obviate any sampling errors. None of the
cases were assessed by touch prep or fine-needle
aspiration.
Frozen Section: Specimens received for FS were sampled
from representative areas. 50 consecutive cases of ovarian
lesions were studied. Sections for FS study were cut using
a Leica cryostat machine and stained with Toluidine blue
and Hematoxylin-Eosin (H&E). Subsequently, for the
permanent sections, specimens were fixed in 10%
formalin, grossed and adequate representative sections
were taken according to the standard guidelines. The
sections were then evaluated by H&E stain. The intraoperative consultation diagnoses (benign versus
malignant) were compared with that obtained from H&E
stained permanent section (taken as the gold standard).
Routine histological processing: Once FS reporting is over,
specimens were fixed in 10% buffered formalin and
paraffin-embedded. Five – seven micron serial sections
stained by routine hematoxylin-eosin (H&E) were studied
by light microscopy.
Statistical evaluation: A comparison of the accuracy of
FS diagnosis with the histopathological diagnosis (gold
standard) was done and tabulated.
Aims & Objectives
Results
1.
2.
3.
To do a Frozen Section examination on 50
consecutive ovarian lesion cases at our institution.
To do a Histopathological study on these 50 ovarian
lesions at our institution.
To compare the results of Frozen section and
histopathology of these 50 cases.
After the research,the findings stated frozen section as
a good intra-operative tool in relation to histopathology
in ovarian lesions. Sensitivity,Specificity, and predictive
values were calculated for the accuracy of FS diagnosis.
Conclusions
Material & Methods
Cases
All ovarian lesions at our institution are routinely
analyzed for FS study. At least 50 consecutive intraoperative consultations of ovarian lesions are evaluated.
Both retrospective and prospective cases were considered
for the study. Tumors of varying grades and types were
included in the study.
The study helped to assess the accuracy of the FS
diagnosis and its comparision with the gold standard of
histopathology diagnosis. This quality control study on
FS in our institution helped improve the diagnostic
accuracy and better patient care as it has a direct bearing
on the therapy and prognosis of the lesion.
151
Knowledge of Family Planning Methods and Emergency Contraception in Rural
Women of Reproductive Age Group (15-45 Yrs)
Purva Ranchal*, Kushagra Maini**
Background
Unintended pregnancies are pregnancies that were
unwanted at the time of conception. Unwanted
pregnancies are the primary cause of induced abortion.
Unwanted pregnancy is linked to numerous maternal
and child health problems. Most of the deaths occurred
in less developed parts of the world, where family
planning and reproductive health services were less
available. In recent years, unwanted pregnancy has
emerged as an important public health concern in both
developed as well as developing countries because it is
not only distressing for the affected women and children,
but can also have far-reaching health, social and economic
consequences.
Aims & Objectives
To obtain information from women of reproductive
age group regarding knowledge of family planning and
emergency contraception in rural area.
Material & Methods
A cross sectional survey of 102 eligible women was
carried out in rural area of malawe di kothi, distt.
Gurdaspur from March to May 2013. After taking consent
from the subjects,they were given self completing
questionnaire in their regional language (punjabi).
Questions were asked to those who were illiterate. Only
volunteered responses were recorded.
Results
Total 102 participants were enrolled in the study from
the age group of 15 - 45 years out of which only 70.2% (71
females) ever heard about family planning ; most
common source being either television or friends.
Percentage of women ever heard about oral contraceptive
pills (OCP) were 61% (62 females) and 33.4% (34 females)
were the ones to use them. Percentage of women ever
heard about Copper-T (Cu-T) were 27.45% (26 females)
and 14.7% (15 females) were the ones to use them.
Percentage of women ever heard about barrier method
(Condom) were 65% (66 females) and 40.19% (41 females)
were the ones to support their use. Percentage of women
ever heard about emergency contraception were 3.92%
(4 females) and 0.98% (1 female) were the ones to use
them. Percentage of women having adequate knowledge
of correct time of administration of OCP were 3.92% (4
females). Percentage of women ever heard about
sterilization were 61.76% (63 females) and those who
were interested in getting the procedure done after
completing their family were 43.13% (44 women).
Conclusions
Emergency Contraception should be taken as a part of
Family Planning methods. Information about Emergency
Contraception must be disseminated to the people by all
the service providers of Family Planning. Educational
media campaign on Emergency Contraception would be
an effective method to disseminate knowledge about
Emergency Contraception for the large number of people
in a short period of time. Activities to uplift the educational
status of people should be accelerated, there should be
provision of appropriate information and access to
Emergency Contraception and the practice of Emergency
Contraception should be encouraged. Further studies are
needed to find out the level of knowledge about Family
Planning & Emergency Contraction in other parts of the
country and among the Family Planning service
providers.
Perception of Health Care Professionals about Fire Safety Measures in Tertiary Care
Teaching Hospitals in Mangalore
Rukmini M. Prabhu*, Swapnil Priyadarshi**, Ashish G. Rao***, Sharlotte Gigy****, Ankit Chandra*****
Kasturba Medical College, Manipal University, Mangalore, India
Background
Hospitals have hundreds of patients, visitors and
health care professionals who are at risk in case of a fire.
Health care setups are particularly high risk zones for
fires because of the chemicals, materials and other
152
consumables used. Hospitals may be well equipped with
all gears required to combat a fire emergency, but lack of
knowledge among staff regarding its usage will prove it
futile. All healthcare facilities must have a plan for the
protection of all persons on their premises and for their
evacuation from the building in case of fire. Recent fire
accidents in two of the reputed tertiary care teaching
hospitals in Mangalore and the ill-fated fire accident in
AMRI Hospital, Kolkata have provoked the need for this
study.
Aims & Objectives
To determine the perception of health care
professionals regarding fire safety measures, the
application of their knowledge in case of fire and to
determine the steps taken by the institution to prevent
fire disaster.
Material & Methods
A cross sectional study was done after distributing
self-administered, semi-structured questionnaire among
105 health care professionals (which included doctors,
nurses, lab technicians and post graduates with at least 1
year experience who had given their informed consent)
in tertiary care teaching hospitals, i.e. Kasturba Medical
College Attavara and Government Wenlock Hospital,
Mangalore. The sampling was done using convenient
sampling method.
accident in the hospital. 69.4% of the individuals are aware
of the fire escape route and only 59.5% of the individuals
are aware of the correct number to be called on in case of
fire emergencies. 67.6% of individuals are aware of the
location of the nearest fire extinguishers and only 44.1%
are aware of the nearest fire alarm. Majority (77%) of the
participants have not been trained regarding fire safety.
Majority of the participants (80.8%) in the private hospital
said the patients would be relocated to an outside ground,
courtyard or another hospital, whereas most (47.5%) of
the participants in the Government Hospital had no idea
with regard to relocation in case of fire. About 51% of the
participants know how to operate a fire extinguisher,
but less than half of them are aware of the right fire
extinguisher for the different types of fires. Only 23%
have received training regarding fire accidents. Of the
participants who are aware of the mock fire drills being
conducted in the hospital, only 9.9% attend them. 87%
thought faults in the electrical system and inefficient
checks of electrical safety is the cause of fire in hospitals.
37% recommend regular training for the staff regarding
fire safety measures.
Conclusions
The study revealed the adequate knowledge of health
care professionals regarding guidelines to be followed
in case of a fire and first aid for a burnt victim. It also
brought to light, the lack of proper fire safety training
and poor attendance of the mock drills conducted in the
hospitals.
Results
84% of the study participants have not witnessed a fire
Study the Nutitional Status of Primary School Children (5-10 Years) in Gurdaspur
District
Kushagra Maini*, Purva Ranchal**
weight, making them vulnerable to further malnutrition
and disease.
Background
In India, around 46% of all children below the age of
three are too small for their age, 47% are underweight
and at least 16% are wasted. Many of these children are
severely malnourished. Malnutrition in early childhood
has serious, long-term consequences because it impedes
motor, sensory, cognitive, social and emotional
development. Malnourished children are less likely to
perform well in school and more likely to grow into
malnourished adults, at greater risk of disease and early
death. Around one-third of all adult women are
underweight. Inadequate care of women and girls,
especially during pregnancy, results in low birth weight
babies. Nearly 30% of all newborns have a low birth
Aims & Objectives
To study the nutritional status of primary school
children and to estimate the prevalence of malnutrition
and associated social demographic factors.
Material & Methods
Community based study was done in Batala City
(Block 1), Distt Gurdaspur of Punjab in the months of
April to June among 275 (133 males and 142 females)
153
primary school going children aged 5 to 10 years. Socio
demographic information and anthropometric
measurements were obtained by using standard
techniques after taking the consent of the school head.
Height and weight of each child was compared with WHO
child growth standard 2006 reference data for that
particular age and sex to get W/A and H/A indices and
below 2SD of the reference median on any of these
indices were considered as underweight and stunted
respectively.
Results
Prevalence of underweight and stunting was 45.09%
(124 children) and 11.27% (31 children) respectively. Out
of the 45.09% of children suffering from malnutrition,
31.27% (86 children) were of Grade 1, 10.90% (30 children)
were of Grade 2 and 2.90% (8 children) were of Grade 3.
According to sex 18.54% (51 children) were males and
26.54% (73 children) were females. Out of 11.27% stunted
children 12.12% (16 children) were males and 10.56% (15
children) were females.
Conclusions
Malnutrition in children is not affected by food intake
alone; it is also influenced by access to health services,
quality of care for the child and pregnant mother as well
as good hygiene practices. Girls are more at risk of
malnutrition than boys because of their lower social
status. The findings suggest that addressing the problem
means addressing the underlying causes of malnutrition
such as poverty, food and security, poor education and
gender inequity. A right balance of adequate nutritional
diet and affordable food industry spear headed by public
and private sectors as well as community level initiatives
could provide solutions to tackle this multi-causal
problem. The package of interventions must be widely
inter-sectoral so as to address at least majority of the
causes.
The Incidence of Menopausal Symptoms in an Urban Population Attending Matured
Women Clinic in a Tertiary Healthcare Centre in Northern India: A Retrospective
Study
Indrani Ganguli*, Jayati Dureja**, Mala Srivastava***, Mamta Dagar****
Sir Ganga Ram Hosiptal, New Delhi, India
Background
Menopause marks the end of the reproductive phase
of a woman’s life. A range of symptoms are experienced
by women at this stage of life. These symptoms are mainly
vasomotor, somatic and psychological in nature and
disrupt the quality of life of women in that age group.
Sufficient data from Indian studies to formulate strategies
to alleviate these problems faced by a large proportion
of women is still lacking from both rural and urban
populations.
Aims & Objectives
1.
2.
To determine the incidence of menopausal
symptoms in an urban population attending Matured
Women Clinic in a tertiary healthcare centre.
To study the mean age at onset of menopause for
this population and its relation with the sociodemographic profiles of the women.
Material & Methods
The data was collected in specially designed booklets
with detailed list of symptoms, over 13 years in a Tertiary
healthcare centre in the heart of New Delhi, with OPD
patient inflow from urban population of New Delhi and
semiurban population from surrounding states. This
data was fed in a customised Visual Basic hospital
software, which was converted to Microsoft excel format
and analysed using SPSS version 17.
Results
The highest frequency of symptoms experienced were
joint pains(35.03%) and vasomotor symptoms(Hot
flushes, 34.77%), followed by genito-urinary problems
like burning and increased frequency of micturition
(28.53%) and increased white discharge per vaginum
(18.99%); and neuro-psychological symptoms such as
irritability (25.49%) and Insomnia (12.57%). The mean
age at onset of menopause for the urban population was
45 years, with a slight variation for natural menopause
at 46 years and surgical cases at a mean of 44 years.
Conclusions
The frequency of symptoms experienced by women
residing in urban areas of northern India were lower
than the rural counterparts, which could be attributed to
higher awareness of lifestyle changes and early treatment
of symptoms. However, the symptom clusters
experienced are consistent with other Indian studies, with
women experiencing more of vasomotor symptoms and
154
musculoskeletal symptoms as compared to sexual life
disturbances or neuro-pschological symptoms.
Menopause is an important stage within the
continuum of the health in a women’s life, has gained a
lot of attention since the last century. The age of onset of
menopause has remained unchanged whereas the
longevity of women is increasing. Thus, a woman spends
one-third of her life with oestrogen deficiency which
results in a variety of symptoms apart from those that
accompany the diseases and changes related to ageing.
The presence of post-menopausal symptoms may
decrease the health related quality of life in women,
because a majority of them still do not take any treatment
for these symptoms. Population differences in
menopausal symptom clustering will provide clues for
targeted treatment of these distressing symptoms and
strengthen public health strategies aimed at alleviating
these distressing life changes.
Alström Syndrome: A Diagnostic Dilemma
Ashwitha V.*, Rukmini M.S.**, Soundarya M.***, Madan Gopal M.****, Puneeth A.*****
Background
Alström syndrome is a rare autosomal recessive
genetic disorder characterised by multi organ dysfunction
with an estimated prevalence of less than 1 in 1 million
has about 700 cases reported worldwide and only about
20 cases from India.It is a rare autosomal recessive genetic
disorder, first described in 1959, by Carl Henry Alstrom.
It is caused by mutation in the ALMS1 gene, located on
the chromosome 2p13.
The clinical features usually start from childhood with
congenital progressive cone-rod retinal dystrophy
leading to blindness, sensorineural deafness, truncal
obesity. They also have features of insulin resistance with
hyperinsulinemia, type 2 diabetes and acanthosis
nigricans. The other biochemical alteration is
hypertriglyceridemia which may lead to pancreatitis. The
endocrinal abnormalities are hypothyroidism and
hypogonadism with gynecomastia and reduced fertility.
Increased incidences of serous otitis media and fluid
retention have also been reported.
Case
A 9 year old boy was referred to the paediatric
Outpatient Department of a Tertiary Care Hospital, for
evaluation of elevated blood glucose of 145 mg/dL. He
presented with history of increased frequency of
micturition (> 10 times), increased hunger and thirst for
the past 3 days, drowsiness and excessive fatigability
since the last few days. His past history revealed poor
vision since birth; he was diagnosed to be having
blindness from the age of 5 months. His developmental
milestones - gross and fine motor skills were
consequently delayed. Ophthalmologic evaluation
(Electroretinogram) done at another centre, a year ago,
suggested cone dystrophy. Karyotype analysis was
normal. There was no history of hospitalization in the
past. He has been attending special school for the blind
and has no difficulty in learning or hearing. However,
he had frequent episodes of serous otitis media since the
age of 6 years. He is the only child of consanguineous
parents, both alive and well.
On physical examination, he had stable vital
parameters, his blood pressure was 130/70 mmHg. There
was evidence of central obesity with body mass index of
24.24 kg/m2. The patient had a flat occiput and frontal
bossing with deeply inset eyes. Fingers were short and
stubby; there was no evidence of poly or syndactyly. The
feet were wide and the 4th metatarsal was short. He also
had a micropenis and the testes were atrophic.
Investigations
Fasting Blood Glucose 181 mg /dL
Glycosylated Haemoglobin
10%
Fasting insulin levels 94.93 µIU/mL
Homeostasis Model Assessment Insulin Resistance
42.43
Fasting triglycerides level 1183 mg/dL
High Density Lipoprotein cholesterol 25 mg/dL
Serum creatinine 1.4 mg/dL
Microalbuminuria 89.8 mg/L
serum Thyroid Stimulating Hormone 5.16 µIU/mL
free Thyroxine 0.888 ng/dL
Results
Peripheral blood smear showed microcytic
hypochromic anaemia with lymphocytic leukocytosis.
Ultrasound of abdomen revealed hepatomegaly (19 cms)
with increased cholestasis and fatty changes.
Conclusions
He was started on regular human insulin (30 units/
day), metformin (1000 mg/day), fibrates (145 mg/day)
along with a low fat, moderate carbohydrate diet with
high protein and fibre. Parents were advised regular
review for management of his diabetes.
155
Treatment Options for Mandibular Ameloblastoma: A Retrospective Analysis
Manu Gupta*, Abhay Kamath**
Manipal College of Dental Sciences, Manipal, India
curettage)
Background
Ameloblastoma is a benign odontogenic tumor,
usually affecting the posterior region of mandible. It is
seen in the third to fifth decades of life. It is believed to
arise from dental lamina remains, the enamel organ in
development, epithelial cover of odontogenic cysts or
from the cells of the basal layer of the oral mucosa. Its
clinical presentation is that of an asymptomatic slowgrowing tumor. Despite being a benign tumor, it has an
invasive behaviour with a high rate of recurrence if not
treated properly.
Aims & Objectives
To present our experience with the management of 11
mandibular ameloblastomas treated with different
treatment modalities.
Results
Enucleation with curettage was done in 1 case whereas
10 cases were treated surgically.
Histologically there were 8 patients who had Unicystic
ameloblastoma and three had Multicystic
ameloblastoma.
Enucleation with curettage was done in 1 case.
Segmental resection with reconstruction with
reconstruction plate was done in 3 cases. Segmental
resection with reconstruction with sternocleidomastoid
(SCM) flap was done in 5 cases. Composite excision of
mandible with reconstruction with Synthis AO plate and
SCM flap was done in 1 case.
The aesthetic and functional outcomes were satisfying
in all patients.
Conclusions
The present hospital-based retrospective study was
conducted by reviewing the clinical and histopathological
records of mandibular ameloblastoma cases from 2010
to 2013, available in the archives of the department. The
data of a total of 11 patients was analysed.
The posterior region of mandible (i.e. molar-angleramus region) was more affected than the anterior region.
The methods of treatment consisted of radical surgery
(i.e. segmental resection) with or without reconstruction
and conservative treatments (i.e. enucleation with bone
The various treatment modalities are decided
according to the histologic variant of ameloblastoma by
the surgeon. According to our opinion, radical surgical
resection of ameloblastoma is the treatment of choice,
followed by the reconstruction of the defects, allowing
good functional and aesthetic outcome.
And while treating ameloblastoma one should not
forget about the micro vascular surgery as a treatment
option.
Can Counseling Promote Early Initiation of Breastfeeding in the First Hour of Life?
Amrita Talwar
Army College of Medical Sciences, New Delhi, India
Background
Since 1992, the World Health Organization(WHO) has
recommended initiation of breastfeeding in the first hour
of life. Early initiation reduces neonatal mortality and
long term morbidity in children. According to WHO , an
estimated 4 million newborn deaths occur every year of
which most are caused by infections which can be
prevented by early initiation of breastfeeding. Also, early
successful establishment of breastfeeding sustains
breastfeeding throughout infancy. Even after 21 years of
the recommendation, early breastfeeding is followed by
only a mere 23% of Indian women. Lack of knowledge is
a major barrier, and hence this study was conducted to
determine if counseling improved the statistics of early
breastfeeding.
Aims & Objectives
To determine if counseling can promote Early
Initiation Of Breastfeeding In the First Hour Of Life.
156
Material & Methods
Prospective questionnaire based study conducted on
100 pregnant women admitted at term.
Inclusion Criteria: Pregnant females who were
admitted at term.
Exclusion Criteria: women with lacerations & tears
requiring repair in OT, extended episiotomy, prolonged
surgery, ICU or NICU admissions, stillbirths, HIV
positive.
Keeping inclusion and exclusion criteria in mind,100
women were chosen with written consent and randomly
divided into 2 groups of 50 each(group A ; group B).
Group A was counseled regarding importance of early
initiation and how to breastfeed and group B was not.
Post-delivery, subjects were asked to fill a questionnaire,
which included time of initiation of breastfeeding and
reasons for delay. The results in the 2 groups were
compared using Chi square test.
Results
Group A: 29 women initiated early breastfeeding.
Group B: 16 women initiated early breastfeeding.
Chi square test was applied, p=0.0090, making it
statistically significant. 90% women in group A were
unaware regarding initiation of breastfeeding in the first
hour.
Hence, it was established that counseling women
regarding initiation of breastfeeding did have a positive
effect on its actual practice.
Conclusions
With the establishment of significant relation between
verbal counseling regarding early breastfeeding and the
actual practice of the same, other forms of counseling
like audio-visual, antenatal classes, etc, should be adopted
not only in hospitals but also at the peripheries.
This will not only decrease neonate mortality rate,
but will also prevent other morbities and help in
establishment of maternal-fetal bond.
Also, while conducting the study it was realized that
lack of knowledge regarding early initiation is only one
of the many factors causing a delay in early initiation of
breastfeeding. Hence, doctors, breastfeeding counselors
and other hospital staff have to work together to promote
early initiation.
Study of CYP17 Gene Polymorphism in Fetal Growth Restriction with Reference to
Organochlorine Pesticide Levels
Siddharth Chand*, Md. Mustafa**, B.D. Banerjee***, Kiran Guleria****
University College of Medical Sciences and GTB Hospital, Delhi, India
Background
The cytochrome P-450c17alpha enzyme encoded by
the P-450c17alpha (CYP17) gene functions in the key steps
of the estrogen synthesis pathway. The genetic variation
in the maternal CYP17 gene leads to differences in
estrogen level which affects fetal growth and causes fetal
growth restriction (FGR). Organochlorine pesticides
(OCPs) are endocrine disruptors which alter the normal
estrogen-progesterone balance and are reported to be
associated with adverse reproductive outcomes.
Aims & Objectives
To investigate the gene-environmental interaction
between maternal and cord OCPs level, and maternal
CYP17 gene polymorphism with the risk of FGR.
Material & Methods
Maternal and cord blood samples of 50 term FGR cases
(birth weight <10th percentile for gestational age as per
Lubchenco’s growth chart) and of equal number of
normal pregnancies were collected. Women with
occupational exposure to OCPs, anemia, hypertension,
antiphospholipid antibody syndrome, medical disease,
parity more than four, history of smoking, alcohol
consumption or chronic drug intake were excluded from
both the groups. The samples were collected at the time
of delivery/after delivery and were analyzed for OCPs
levels by Gas chromatography system equipped with
electron capture detector and for polymorphic analysis
of CYP17 gene using PCR-RFLP.
Results
Significantly higher levels of á-HCH, â-HCH, and ãHCH were found in maternal blood and cord blood
samples of FGR cases as compared to controls. The
frequency of A1A2/A2A2 genotype was significantly
lower (p=0.041, OR=0.421, 95% CI=0.184-0.966) in FGR
cases as compared to controls. When gene environmental
interaction between the CYP17 gene polymorphism and
OCPs level was considered, significant (p=0.004)
association was seen between endosulfan and CYP17
A1A1 genotype with an estimated reduction in birth
weight of 315g.
157
Conclusions
Higher levels of OCPs and CYP17 homozygous A1/
A1 in pregnant women may be considered as an important
etiological factor in ‘idiopathic’ FGR. The present study
provides evidence that genetic variation and its interaction
with the environmental exposure may increase the risk
of FGR. Further studies are needed with larger sample
size, incorporating other gene polymorphism and
environmental exposures to strengthen the observations
obtained in the present study.
The Prevalence of Refractive Errors among Student Population
Kamali M.*, Rathnakumar**, Ramasamy K.***
Sri Lakshmi Narayana Institute Of Medical Sciences, Puducherry, India
surfaced as the most common refractive error.
Aims & Objectives
The prevalence of refractive errors among student
population was surveyed based on a validated
questionnaire.
Material & Methods
The presence of problem, life style and entertainment
along with dietary habits were examined.
Results
In a target population of 250 students, 83 did not have
any refractive error (Hypermetropia, Myopia,
Astigmatism) while 47 had one of the problems but
postponed the remedy, 52 had problem, corrected but
did not follow it up regularly, while only 68 attended to
their problem and had regular check –up. Myopia
Conclusions
Those suffering from errors appear not to follow the
suggested guidelines while watching television after
getting their vision corrected and almost all participants
use electronic devices like cell phone, laptop, computer
etc., constantly which is identified as a major source that
aggravates refractive errors. Additionally, the absence
of healthy dietary habits also might have attributed to
the errors with which they suffer.
It is suggested that an awareness program for
prophylaxis of refractive errors besides precautionary
measures for those suffering from them appears to helpful
for controlling refractive errors amongst students.
Keyword: Refractive errors; Dietary habits; Awarness
program.
To Evaluate the Utility of Immunohistochemistry in the Diagnosis of Different Types
of Central Nervous System Tumours Using a Panel of Antibodies
Saarang Hansraj*, Vibha Dutta**
Armed Forces Medical College (AFMC), Pune, India
Background
Primary malignant brain tumours are rare with high
mortality rate. Management and prognostication of these
tumours remain as the greatest challenge in oncology.
Correct identification of the lineage of origin and also
differentiating primary from secondary neoplasms
constitute the basis for definitive management of these
tumours.
In many cases the clinical profile, neuroimaging
studies, and histological appearances of the tumour may
not be diagnostic of a particular neoplasm.
Aims & Objectives
1.
2.
3.
To evaluate the immunoexpression pattern in
different types of central nervous system tumours
using a panel of antibody
To compare the immunoexpression pattern with
tumour histology in terms of type, grade, mitotic
activity, microvascular proliferation, and necrosis.
To correlate the utility of immunohistochemistry in
the diagnosis of different types of central nervous
system tumours using a panel of antibody.
158
Material & Methods
Cases
Biopsies from a total of at least 40 consecutive cases of
CNS tumours of varying grades and types were included
in the study.
Method
Gross examination
The entire specimens received were processed to
obviate any sampling errors.
Routine histological processing
Specimens were fixed in buffered formalin and
paraffin-embedded. Five – seven micron serial sections
stained by routine hematoxylin-esoin (H&E) were studied
under light microscope (LM). Data regarding type of
tumour, pleomorphism, mitosis, vascular proliferation
and necrosis was recorded in all cases.
Immunohistochemistry
Representative formalin-fixed paraffin-embedded
sections of four - five micron from tumour were stained
immunohistochemically using labeled streptavidin
biotin (LSAB) technique. After deparaffinisation and
rehydration, antigen retrieval was performed as per the
specific antibody. Then, the sections were cooled at room
temperature for 60 min, immersed in 3% hydrogen
peroxidase for 10 min to block endogenous peroxidase
activity, and then washed in tris-buffered saline (TBS) for
5 min.
The following panel of antibodies (all prediluted) were
used :
• Glial fibrillary acidic protein (GFAP)
• S-100 protein (S-100)
• Epithelial membrane antigen (EMA)
• Vimentin (CK)
• Synaptophysin (Synapto)
• Neurofilament (NFP)
In every case immunoexpression expression was
correlated with tumour histology in terms of type, grade,
mitotic activity, microvascular proliferation, and necrosis.
Result
Immunohistochemistry helpsed determine the cellular
lineage and histology in the 40 samples analyzed. It had
diagnostic and prognostic implications.
Conclusions
The study will help to correctly identify various
astrocytic and non-astrocytic CNS tumours, as well as
differentiate primary from secondary neoplasms. This
knowledge is vital in cases of primary CNS tumours
since it directly influences the therapy and prognosis of
the tumour.
Knowledge of Ascariasis Clinical Manifestation and its Relation to the Characteristics
of Children in the Orphanage in East Jakarta
Maulana Rosyady*, Saleha Sungkar**
Faculty of Medicine Universitas Indonesia, Jakarta, Indonesia
Background
Indonesia as a tropical country is a good place for the
growth of A. lumbricoides. Infection of A. lumbricoides is
usually asymptomatic, but it can manifest symptomps
such as abdominal pain, nausea, diarrhea an respiratory
disorder.
Aims & Objectives
To determine the knowledge about ascariasis, its
clinical manifestations and its relation to the
characteristics of children in the orphanage in East Jakarta.
five questions about the clinical manifestations of
ascariasis. The questionnaire was given to 153 students,
64 men and 89 women. A total of 90 people were in
elementary school, 58 in junior high and 15 in senior
high school.
Results
Students who were well aware of were 14, with
moderate awareness were 47, and with least awareness
were 92. Based on chi-square test, the level of knowledge
ofclinical manifestations of ascariasis was not significant
(p>0,05) by sex, age and history of helminth infection,
but significantly different (p<0,05) for different levels of
education.
Conclusions
Material & Methods
This was a cross-sectional study. Data collection was
done on June 10, 2012 through a questionnaire containing
The knowledge of orphanage students is generally
classified as less and is not associated with gender, age
159
and history of helminthic infection but related to the
educational level. Based on this study, level of knowledge
needs to be increased by giving counseling to all children
by paying more attention on their education and not on
gender, age and history of helminth infection
Keywords: Knowledge; A. lumbricoides; Clinical
manifestation; Orphanage.
Evaluation of Knowledge and Practices of Prescribers Regarding Rationality of
Promotional Drug Literature Using WHO Criteria
Chirag Saluja*, Ravinder Sah**
Vardhaman Mahavir Medical College, Delhi, India
Background
Pharmaceutical Promotion refers to all the information
and persuasive activities by manufacturers and
distributors in order to induce the prescription, supply,
purchase and/or use of medicinal drugs. There is evidence
that drug utilization problems are increasingly
encountered in many developing countries due to
irrational drug advertisement, lack of knoweledge and
practice regarding WHO Ethical Criteria for medicinal
drug promotion among prescribers and medical
representatives.
Aims & Objectives
The study was aimed to evaluate collected drug
promotional brochures for accuracy, consistency, and
validity of the medicinal drug advertisements as well as
knowledge and practice of prescribing physicians and
medical representative about WHO Ethical Criteria for
Medicinal Drug Promotion and about the existing
regulations
This observational and questionnaires based crosssectional study was conducted in the department of
pharmacology at Vardhman Mahavir Medical College
and associated SafadarJang Hospital Delhi, India. One
thousands advertisement were collected in 3 months
from medical journals and from various OPDs and
analyzed for fulfillment of “WHO criteria, 1988. The
evaluation of knowledge and practices of physicians and
medical representatives about WHO ethical criteria for
medicinal drug promotion was done by a separate
questionnaire containing 6 items with multiple options.
The participants were provided 15 minutes to answer the
questionnaire.
Results
None of the promotional literature fulfilled all WHO
criteria. Very few brochures mentioned about adjuvant
(2%) and safety (15.8%). Only 40.7% were presented with
content of active ingredient(s) per dosage form or
regimen. Although 100% of brochures were containg
brand name. The evaluation of knowledge and practices
of physicians showed that although 100% of prescriber
were aware about WHO Criteria for Medicinal Drug
Promotion but only 31% evaluated the text in
pharmaceutical advertisements. Few prescribers
evaluated references (17%) and claims regarding
pharmacokinetic properties (22%) . The evaluation of
knowledge and practices of medical representatives
showed 100% of them have knowledge about WHO
Criteria. Majority (92%) of medical representatives
stressed on brand name and efficacy and very few (8.2%)
explain about references. None of medical representatives
talks about pictures and images of pharmaceutical
advertisements.
Conclusions
The study showed that the compliance with the
implementation WHO-EC in medicinal drug promotion/
advertisement is very poor. Health-care professionals
receive little or no instruction on how to assess
pharmaceutical promotion and how to understand its
often subtle influence on their prescribing behaviour.
Medical representatives were lacking in sufficient
medical and technical knowledge and integrity to present
information on products and carry out other promotional
activities in an accurate and responsible manner.
160
A Case of Multiple Gastric Polyps Treated by Total Gastrectomy
Patil A.N.*, Godhi A.S.*, Mahajan Aman***
Jawaharlal Nehru Medical College, Belgaum, India
Background
Result
Multiple gastric polyps are a very rare occurrence and
are most often seen as part of polyposis syndromes of
the gut. The polyps have considerable malignant
potential.
Histopathology
reported
villoglandular/
adenomatous polyps. Postoperatively the patient
recovered uneventfully, barring minimal weight loss.
Conclusion
Case
A 56 year old female presented with gross anemia and
weakness since one year. Upper GI endoscopy revealed
multiple gastric polyps. Endoscopic biopsy showed
hyperplastic polyp. Lower GI endoscopy showed normal
colon. Patient underwent total gastrectomy with jejunal
pouch reconstruction – Roux-en-Y esophagojejunostomy.
This case is an example of a less known entity and an
aggressive approach undertaken to prevent a potentially
life-threatening complication of polyposis viz
malignancy.
Limb Salvage by Popliteal Artery Ligation in a Case of AV Fistula: A Case Report
Patil A.N.*, Godhi A.S.**, Mahajan Aman***
Jawaharlal Nehru Medical College, Belgaum, India
Case
An young boy of 12 yrs presented with chronic non
healing ulcers on the left ankle of many years duration
due to congenital, diffuse, extensive infrapopliteal A-V
fistula. The ulcers were frequently bleeding profusely
necessitating repeated blood transfusions. Angiography
and embolization of arteries around the ankle had
proved futile. Multiple ligation and excision of vessels
along the posterior tibial artery did not make any
difference. Out of desperation and as a life saving measure,
the parents were requesting for amputation of the leg
and the boy was prepared for it. As a last resort before
sacrificing the limb, and with profound scepticism, we
performed popliteal artery ligation. Soon after, the ulcers
stopped bleeding and started healing. Thrill and bruit on
the leg disappeared; the limb remained viable except the
tip of the great toe which developed dry gangrene. He
developed fixed flexion at knee joint which was corrected
by POP cast.
At present the ulcers have healed completely and he is
ambulating. Experience with popliteal artery ligation
for AV fistula is uncommon and isolated. This has saved
the precious limb and prevented a major disabilty.
161
Lifestyle Effect on Vitamin D
B.K. Agrawal*, Parveen Gupta**, Harjot***
MMIMSR, Ambala, India
moderate,37.6 TO 50 nmol/l were mild, above 50 nmol/
l were normal.
Background
Sedentary lifestlye affects health of the population.
Results
Aims & Objectives
To determine the effect of lifestyle on Vitamin D
levels.
The study showed 65% had deficiency of vitamin
D.(14% had severe, 21% had moderate and 30% had mild
deficiencies while 35% had normal levels of vitamin D.
Conclusions
Material & Methods
A simple study was done on 50 patients without any
illness in whom vitamin D levels (concentration of serum
25 (OH) vitamin D3) were evaluated. Values below 20
nmol/l wereconsidered severe, 20-37.5 nmol/l were
The study showed their is high prevalence of vitamin
d deficiency in the city. Low exposure to sunligth,low
intake of vitamin d and calcium rich food stuff may be
the important factors in causing deficiency of vitamin D.
The Neurotrophic Effect of Tacrolimus (FK506) on Pyramidal Cells of Brain Cortex
Following Global Ischemic/Reperfusion in Wistar Rat
Ghazal Ansarian*, Zahra-Nadia Sharifi**, Shabnam Movassaghi***, Hamed Shafaroodi****, Nooshin Panahi
Khezri*****
Pharmaceutical Science Branch, Islamic Azad University, Tehran, Iran
Background
Cerebral ischemia is known as a major problem in the
world. Transient global cerebral ischemia causes loss of
pyramidal cells of brain cortex following global
ischemic/reperfusion. Recently, using immunophilin
ligands has been considered as a potential and appropriate
strategy for neuroprotection. Since it was observed that
tacrolimus (FK506), a useful immunosuppressant used
in organ transplantation, provides neuroprotection and
prevents neuronal damage,the importance of
immunophilins in the development of neuroprotectors
has emerged.
Material & Methods
Animals (n=25) were assigned to control (intact),
ischemia and 3 FK506 treated (1,3,6 mg/kg) groups. Both
common carotid arteries were occluded for 20 minutes
followed by reperfusion. In 3 experimental groups, FK506
was given as a single dose exactly at the time of
reperfusion respectively as 1,3,6 mg/kg by intravenous
administration(IV).
The same doses (1,3,6 mg/kg) repeated by
intraperitoneally administration (IP) 48 hours after
reperfusion.
After 4 days the rats were sacrificed and brain sections
were stained with Nissl.
Aims & Objectives
Results
To investigate the neurotrophic effect of immunosuppressant agent FK506 in rats after global cerebral
ischemia.
Our findings showed that 20 min ischemia decreased
162
the number of the cortex pyramidal cells. But there were
no significant differences between number of cortex
pyramidal cells in both control and FK506 (6mg/kg)
groups.
effect on pyramidal cells of brain cortex and may
candidate for treatment of ischemia brain damage.
Keywords: Neurotrophic; FK506; Brain cortex;
Pyramidal cell.
Conclusions
Our study suggests that tacrolimus has a neurotrophic
The Effect of Pentoxifylline on Global Ischemia/Reperfusion Induced Spatial
Memory Impairment in Estrous Phase of Female Wistar Rat
Nooshin Panahi Khezri*, Shabnam Movassaghi**, Zahra Nadia Sharifi***, Hamed Shafaroodi****, Ghazal
Ansarian*****
Pharmaceutical Science Branch, Islamic Azad University, Tehran, Iran
Background
The short discontinuance of cerebral blood flow causes
permanent brain injury and behavioral dysfunction. The
hippocampus, specifically the CA1 pyramidal cell layer,
is highly vulnerable to ischemic injuries. There is no
effective pharmacological strategy for improving brain
tissue damage induced by cerebral ischemia. Previous
studies reported that pentoxifylline has a neuroprotective
effect on brain trauma and it is well known that
endogenous estrogen improves stroke outcome during
vascular occlusion by exerting both neuroprotective and
flow-preserving effects. The possible positive effects of
pentoxifylline and endogenous estrogen on behavioral
deficit were studied in female Wistar rats in estrous phase
subjected to an experimental model of transient global
brain ischemia.
Aims & Objectives
To determine the effect of pentoxifylline on global
ischemia/reperfusion induced spatial memory impairment in estrous phase of female Wistar rat.
Material & Methods
Animals (n= 56) were assigned to control, ischemia,
vehicle, and pentoxifylline - treated (200 mg/kg IP)
groups and according to vaginal smear and methylene
blue staining, all of them were in their estrous phase of
estrous cycle. Pentoxifylline (200 mg/kg IP) administered
at 1 hour before and 1 hour after ischemia. Global cerebral
ischemia was induced by bilateral common carotid artery
occlusion, followed by reperfusion. Memory dysfunction
was determined by Morris water maze and histological
changes of CA1 pyramidal cells were studied by Nissl
staining method.
Results
According to Morris water maze test results,
pentoxifylline administration in cerebral ischemia
significantly improved hippocampal-dependent memory
and cognitive spatial abilities after reperfusion as
compared to ischemia and vehicle-treated animals. In
Nissl study, Four days after ischemia/reperfusion, the
rats were sacrificed and brain sections were stained. There
were no significant differences between number of
pyramidal cells in both control and pentoxifylline treated groups (Pd”0.05).
Conclusions
Our study illustrated that pentoxifylline can reduce
CA1 cells damages and cognitive impairment in female
rats (in estrous phase ) were subjected to brain global
ischemia.
Keywords: Pentoxifylline; Spatial memory; Brain
ischemia; Estrous phase.
163
Rethinking Cancer Immunotherapies
Venumadhav Rayasam*, Kondadasula Sri Yogesh**
Background
Immune checkpoint pathways are the signaling
pathways which regulate the immune response to
minimize the peripheral tissue damage during an
immune response. These immune checkpoint signaling
pathways are activated by receptor-ligand mediated
interactions. As seen in the formation of many kinds of
tumors, the improper regulation of the immune
checkpoint receptors and/or ligands in the tumor
microenvironment lead to a suppressed immune response
against the tumor. Cytotoxic T lymphocyte associated
antigen 4 (CTLA4) or CD 152 is an immune checkpoint
receptor expressed on T lymphocytes. When engaged
with its ligands, which also happen to be the ligands for
the T cell Co-stimulatory Receptor, CTLA4 inhibits T cell
activation. Experimental data suggests that CTLA4 is
overexpressed in the tumor microenvironment leading
to a suppressed immune response against the tumor.
Ipilimumab, a fully humanized monoclonal antibody
for CTLA4 was developed and rigorously tested in the
clinic. In 2010, Ipilimumab was US FDA approved for the
treatment of patients suffering from advanced and
unresectable metastatic melanoma as it was the first ever
drug to show a survival benefit in advanced metastatic
melanoma. Even though treatment with Ipilimumab
showed a survival benefit, the response rates were not
satisfactorily high. The response was also delayed and in
few patients the response was seen after an initial
increase in the tumor burden. In this poster we suggest
the administration of different therapeutic agents in
synergy with Ipilimumab, also known as combination
therapies, for a faster and more efficient response. The
delayed response might be explained due to an
insufficient immune response which might happen due
to the following three possibilities:
(i) Insufficient amounts of antigen available.
(ii) The increase in T cell activation due to the blockade
of CTLA4 might not be sufficient.
(iii) The effector T cell functioning might be reduced.
We put forward a few combination therapies with
Ipilimumab that can overcome the above three
possibilities and hopefully increase the response rates as
well as time for response in the treatment of advanced
metastatic melanoma.
Prevalence and Pattern of Alcohol Consumption in Pondicherry Adult Males: To
Bring Change in Attitude
Pushparaj R.*, Senthilkumaran R.**, Sumeet Shende***, Ajit Malani****
Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India
Background
Alcohol abuse and alcoholism are one of the major
public health problems in both developed and developing
countries. It is major cause of mortality and morbidity.
Consumption of alcohol has increased in Indian society
in recent years. Alcohol consumption accounts for nearly
4% disability -adjusted life years (DALYs) lost. It not only
causes chronic disease like liver cirrhosis, pancreatitis
but also has social consequences such as road traffic
accidents, family and domestic problems, interpersonal
violence and received more public and research attention.
Pondicherry is place where there was French rule
before independence and influenced by mix culture
.Tourism and easy availability of alcohol in shops in
comparatively low rate increases alcohol consumption
in this Union Territory.
Aims and Objectives
To identify the pattern of alcohol consumption among
Pondicherry adult males and its impact on their health
and social life.
Material & Methods
This community based, cross sectional study carried
out with the help of predesigned ,pretested questionnaire
using Alcohol use disorder identification test(AUDIT).
Institutional Ethical committee permission obtained
prior.
Result
To be completed.
164
Dermatoglyphics in Blind Versus Normal Individuals from Southern India
Ishwarya M.*, Akshaya E.**, Ajit Malani***, Sumeet Shende****
Background
Materials And Methods
Dermatoglyphics have been correlated with different
diseases by many of the studies. Several studies have
explored the relationship of dermatoglyphics to
schizophrenia, alopecia, mental retardation, congenital
heart defects and diabetes melli-tus. Special space is
occupied by the ones with the severe congenital and
hereditary ocular diseases. There were reports on isolated
clinical cases only, or in a small number of patients which
demonstrated the presence of important abnormalities
or distortions, with clinical implications, in the
dermatoglyphic picture of the affected people. However,
there is no documented work concerning
dermatoglyphics in blind patients of South India.
Aims & Objectives
1.
2.
Palmar prints of both hands were taken by using
standard methods. The handswere washed with soap and
water and dried with a hand towel to avoid dirt from
interfering with prints. The printers ink was used. Fingers
placed on stamp pad one after other and transferred to
white paper to take rolled prints. Palmar prints were
taken on paper by extending hands at the wrist with
fingers fully abducted, starting with the proximal part of
the hand and lowering it until the digits came in contact
with the paper, applying little pressure. Palmar angles
were measured.
Prior approval of Institutional Ethical Committee
taken.
Results:
To study the dermatoglyphic features of blind
persons.
To establish the dermatoglyphic patterns of blind
patients.
To be completed
Written informed consent taken from person /
guardian prior to the participation.
Hypopyon: A Rare Presentation of Relapsed Acute Lymphoblastic Leukemia in a
Child
S. Aro Shime Hercules*, Latha**, Julis Scott Xavier***
Sri Ramachandra Medical College and Research Institute, Chennai, India
Background
Leukemia showing relapse in the eye, may have the
ocular manifestations ranging from leukemic
retinopathy to involvement of the iris and anterior
chamber. Ocular manifestations presenting as hypopyon
may occur in relapse Acute lymphoblastic leukemia
(ALL), Acute Myeloid Leukemia (AML), and Chronic
Myeloid Leukemia (CML).
We report a case of unilateral hypopyon as a rare
presenting feature of relapsed Acute Lymphoblastic
Leukemia (ALL) in a paediatric patient. Relapse in ALL
usually occurs in bone marrow, CSF and testis. Ocular
manifestations are extremely rare. We report a 5- year
old male child presented with unilateral hypopyon after
completion of chemotherapy. Anterior chamber aspirate
showed malignant cells (leukemic infiltrates).
Subsequently, he was found to have relapse in bone
marrow and CSF too. After initiation of chemotherapy,
his hypopyon resolved and he is doing well in follow
up.
Case
A five year old child was diagnosed with acute
lymphoblastic leukemia in december 2009, when he
presented with hyper leucocytosis, hepatomegaly and
generalized lymphadenopathy. His bone marrow was
confirmed of pre-B CALLA positive ALL. CSF analysis
was normal. Cytogenetics did not reveal any
abnormality. He underwent chemotherapy and
prophylaxis cranial irradiation till December 2012. After
completion of treatment, one month later he was found
to have abnormality in the left eye, for which he went to
165
the ophthalmologist, who suspected relapse and
confirmed with aspiration of anterior chamber fluid. He
was referred back to paediatric oncologist , he confirmed
relapse of ALL in bone marrow and CSF. He has
completed 3 month chemotherapy and he is doing well.
After 1 month, his hypopyon resolved.
Hypopyon is a leucocytic exudate seen in the anterior
chamber. It is a sign of inflammation of the uvea and iris.
Hypopyon can also present in corneal ulcer, particularly
of fungal etiology like Aspergillus and Fusarium sp. ,
Behcets disease, endophthalmitis and panuveitis/
panophthalmitis. Rarely hypopyon may be the
presenting feature of relapse in acute lymphoblastyic
leukemia or other leukemias.. In ALL, anterior chamber
involvement has been estimated at 2.5 to 18% of relapse
cases depending upon the stage of the disease. The
mechanisms by which the cells migrate into the anterior
chamber are not clear. One hypothysis holds that the
cells are sequestered in the long posterior ciliary vessels
and pass into the anterior chamber through the iris
vessels. A hypopyon child would make a suspicion of
masquerade syndrome. A relapse should be suspected
in the background of leukemia, and anterior chamber
paracentesis and other studies to rule out relapse should
be done in a child , especially if it is a treatment resistant
hypopyon. Early diagnosis can save vision. Periodic
ocular examination including slit lamp eaxamination
should be performed in all leukemic patients on
remission. We report this so that ophthalmologist should
be aware of this rare manifestation of hypopyon and
leukemia.
Association between Level of Knowledge about Trichuriasis and Demographic
Characteristics among Orphans in East Jakarta in 2012
Iman Setiadi*, Saleha Sungkar**
University Indonesia, Jakarta, Indonesia
Background
Trichuriasis is a worldwide problem for public health
and estimated 25% of world population infected with T.
Trichiura or Trichuriasis. Trichuriasis is an infection of
the gastrointestinal tract caused by T. trichiura. Especially
in Indonesia, trichuriasis has high prevalence because
Indonesia located in tropical and subtropical regions that
have a warm and humid climate. The prevalence of
intestinal worms (including Trichuriasis) in Indonesia is
still relatively high at 40% -60%, but in children the
prevalence of infection can reach 90% it is caused by
frequent contact with soil, poor sanitation, the type of
soil and the lack of awareness to maintain hygiene.
Trichuriasis can cause a variety symptomps, but in
children can lead to failure growth and development. In
East Jakarta, there is an orphanage that housed many
orphans with varying characteristics demography and
relatively poor hygiene, hence susceptible to get
Trichuriasis and need to educate. Appropriate education
depend by prior knowledge and demographic
characteristics. Therefore need to understand the
relationship between characteristics demographic and
level of knowledge about Trichuriasis.
Aims & Objectives
To find out any association between Level of
Knowledge about Trichuriasis and Demographic
Characteristics among Orphans in East Jakarta in 2012
Material & Methods
This study used analytical cross-sectional design. Data
were taken on June 10, 2012 in East Jakarta Orphanage by
distributing validated questionnaires about morphology,
life cycle and symptoms T.trichiura. The repondents (n =
153) were selected by total population sampling. Data
processed with SPSS version 20 and analyzed using
Kolmogorov-Smirnov test.
Results
In this study, the majority of subjects were aged under
13 years (54.2%), the level of education was dominated
by elementary school (SD) and there were more female
than male subjects. The study show that 2% respondent
had good knowledge, 22.2% had fair knowledge and
75.8% had poor knowledge. There were no significant
difference (p> 0,05) between the level of knowledge with
demographic characteristics (age, gender, educational
level, and experience Trichuriasis).
Conclusions
Level of knowledge about trichuriasis not associated
with age, gender, level of education and experienced of
Trichuriasis. Then, education about Trichuriasis can be
done to all orphans regardless of characteristics
demographics.
Keyword: Trichuriasis; Characteristics demography;
Knowledge; Orphans
166
Knowledge and Awareness of Consumer Protection Act among the Medical
Practitioners in Pondicherry
Lavanya S.V.*, Ajit Malani**, Sumeet Shende***
Background
The Consumer Protection Act(CPA) was enacted by
Parliament of India in 1986. CPA was passed to provide
better protection of the interests of consumers which
turned out an important milestone in Indian Legislation
giving rise to consumer jurisprudence.The medical
profession was brought under the ambit of CPA in 1995
by Supreme Court. Before this act the medical negligence
disputes were dealt by relevant sections of Indian Penal
Code. These claims expensive and time consuming. The
changes in the trends of practice of medical profession,
increasing awareness of consumers, changing concepts,
updated laws makes it imperative on part of medical
practitioners to have adequate knowledge and awareness
about CPA with updates to provide better services and
prevent consumer disputes.
2.
3.
4.
among medical practitioners in Puducherry.
To study knowledge about CPA.
To study and suggest the corrective measures
required.
To know the attitude of medical practitioners
towards CPA.
A cross sectional study was done among medical
practitioners in Puducherry. A self administered
questionnaires was used.
Written Informed consent was taken prior.
Institutional Ethical Committee Approval was taken
prior.
Results
Aims And Objectives
To be continued.
1.
To study awareness about Consumer Protection Act
Study on Knowledge, Attitude and Practice Regarding Diabetes Mellitus Related Eye
Complications and Compliance to Diabetes Mellitus Treatment among Diabetes
Patients of National Hospital of Sri Lanka
J.R.G Mahipala*, A.V. Mahendran**, V.P. Wickramasinghe***
Epidemiology Unit, Ministry of Health, Sri Lanka, Colombo , Sri Lanka
among diabetes patients.
Background
Diabetes mellitus is a metabolic disease characterized
by hyperglycemia resulting from defect in insulin
secretion, insulin action or both. The chronic
hyperglycemia of diabetes mellitus is associated with
long-term damage, dysfunction and failure of various
organs, especially retina, kidney, nerves, and in addition
an increased risk of cardiovascular disease. 347 million
people worldwide have diabetes and it is a major health
problem for developing and developed countries.
Diabetes retinopathy is a one of the major diseases
causing blindness. It is important to assess the knowledge,
attitude and practices regarding eye complications and
eye care in order to prevent the occurrence of diabetes
retinopathy and to implement effective health promotion
Aims & Objectives
To assess the knowledge, attitude and practices
regarding Diabetes Mellitus related eye complications
and compliance to Diabetes Mellitus treatment among
Diabetes patients.
Material & Methods
A descriptive cross sectional study was carried out
among diagnosed diabetic patients who have been
followed up for one to three years in the Diabetic clinic,
National Hospital of Sri Lanka. A sample of 150 was
167
selected by using convenient sampling method. Their
knowledge, attitude and practices were assessed using
an interviewer administered close ended questionnaire.
Frequencies, percentages and associations between
variables were analyzed using SPSS computer database.
Results
Among them 55.3% were females and 44.7% were
males. 54 (36 %) of them were between 51 to 60 years of
age. 122 (83.3 %) of them were studied up to ordinary
level. Majority of the population were housewives 77
(51.3%). 33 (22%) were retired and 22 (14.7%) were doing
business. Of 150 participants, Good level of knowledge
regarding diabetes related eye complications, eye care
and management options were seen among 77(51.3%),
146(97.3%) and 11(7.3%) persons respectively, but 113
(75.3%) of participants have poor knowledge on
treatment options for Diabetes relates eye complications.
Level of compliance was satisfactory among 75 (50%),
good among 64 (42.7%) and poor among 11 (7.3%). Also
it was revealed that 74% of participants had a good attitude
in eye care. 64 (42.7%) of the participants showed good
compliance to treatment but 75 (50%) showed satisfactory
level. There is a significant difference in level of education
with knowledge of eye complication, care and treatment
options. But there is no statistically significant association
between level of knowledge on eye complications and
the level of compliance (p = 0.057). There is no
statistically significant relationship between age and
knowledge on eye complications, eye care, treatment
options and compliance to treatment.
Conclusions
In this study, the recommendations made were to
further strengthen health education on diabetes related
eye complications and treatment options at clinic level
and to have individual and group level discussions to
improve compliance to treatment. Also further studies
are recommended to be carried out to identify the factors
affecting knowledge, attitude and practices regarding
diabetes related complications and compliance to
treatment.Key wordsDiabetes Mellitus, Retinopathy.
Nephrotic Syndrome and Cholelithiasis: A Rare Association
Nishikant Tiple
SVNGMC Yavatmal, Yavatmal, India
Background
Nephrotic syndrome and cholelithiasis is very rare
association though not unexpected. Nephrotic syndrome
itself or prolonged steroid therapy can lead to persistent
hyperlipidemia which may cause atherosclerosis and
glomerular injuiry. But association of nephrotic
syndrome and cholelithiasis has not been described in
literature and very few cases have been reported
previously.
Case
We report 8 year male child presented with history of
generalized anasarca and oliguria since 7 days. Birth
history is not contributory. Development history has been
normal for age. On examination he had generalized
anasarca with periorbital edema, abdominal distension,
fluid thrill, shifting dullness and tenderness in right upper
abdomen. Laboratory finding suggestive of protenuria
(3+ to 4+), hypoalbuminemia (1 gm/dl) and
hypercholesterolemia (450 gm/dl). Blood urea,
creatinine, hemoglobin were normal with normocytic
normochromic peripheral smear. Sonogram of abdomen
reveals 2 large Gall stones with normal gall bladder and
hepatic architecture. Patients have been taking steroid
since age of five year during relapse. This time patient
started on steroid therapy 2mg/ kg till remission occur,
after then steroid were tapered over 4 week. After 2
months sonogram was repeated which shows persistent
of gallstones and normal gall bladder.
We describe here an association between
asymptomatic gallstones and nephrotic syndrome of
which prevalence, natural history and response to
treatment are still unknown.
Keyswords: Nephrotic syndrome; Cholelithiasis;
Hyperlipidemia.
168
Non-Prescribed Utilization Pattern of Medicine by Students of Medical Faternity
Shivang Sharma*, Shahruk Ahmed**
Rural Medical College, Ahmednagar, India
Background
Self medication is the use of medication without
prescription, orientation or supervision of a physician
or dentist. Self medication may create a serious health
problem in a young generation of medical fraternity.
Aims & Objectives
To identify the prevalence and factor associated with
self medication among the students of medical fraternity
at rural medical and dental college of western
Maharashtra.
Material & Methods
college of western Maharashtra among 500 students of
medical fraternity (medical and dental) after receiving
approval from institutional ethical committee. Study was
conducted with the help of pre-tested, validated, semistructured questionnaire after obtaining consent from
the study subjects. The students answered questionnaire
covering demographic variables, use of medication, and
medication knowledge. Information was collected on the
conditions treated with medication, the medications used
and attitude towards self medication.
Results
Data collection is in process, observations and results
will be drawn after the analysis of data. Study is in
progress and will be completed very soon.
A cross sectional study was conducted at rural medical
The Seroprevalence of HCV, Hbsag, HIV, Syphilis in Pregnant Women under PPTCT
Programme and Blood Donors: A Retrospective Analysis
Varshney Prateek*, Roy Partha**
Background
WHO progress report- 2011 on HIV/AIDS in South
East Asia Region reveals that 34 million people were
living globally with HIV , and 2.4 million were in India.
National prevalence rate was found to be 0.31% and 0.48%
in women attending Antenatal clinics. The Indian
subcontinent is classified as an intermediate Hepatitis B
Virus (HBV) endemic (HBsAg carriage 2-7%) zone. India
has 43 million HBV positive and 15 million HCV positive
persons. The risk of transfusion transmission of these
viruses may be alarming due to high seroprevalence of
HIV, anti-HCV, and HBsAg (0.5%, 0.4%, and 1.4%,
respectively) among blood donors. Blood is one of the
major sources of transmission of hepatitis B, hepatitis C,
HIV, syphilis, and many other diseases. In July 1989,
mandatory screening of blood and blood products for
HIV antibodies was initiated by Indian National AIDS
Control Origination (NACO). Testing for human
immunodeficiency virus (HIV), syphilis, and hepatitis B
surface antigen (HBsAg) in pregnancy and labor is
medically indicated to prevent vertical transmission.
Prevalence of these infections among the antenatal
population may be a reliable indicator of general
population prevalence and determinant of vaccination
policy . Successful interventions to prevent vertical
transmission linked to intrapartum rapid testing have
been demonstrated in a variety of limited resource settings
Keeping in mind the grave consequences of these
infections and to restrain the transmission to minimum,
it is very important to remain vigilant about the possible
spread. Routine surveillance, screening of blood donors,
strengthening the services for treatment of sexually
transmitted diseases, preventing mother to child
transmission of blood borne pathogens has been put
forward by NACO for strict implementation.
Aims & Objectives
To determine the seroprevalence of HCV, HBsAg, HIV,
Syphilis in pregnant women under PPTCT programme
and Blood donors.
Material & Methods
A record based retrospective analysis of blood donors
and antnatal mother’s data of the last 10 years was
169
recorded at AFMC Hospital,Pune. After taking written
informed consent blood samples were collected from :
1. Voluntary blood donors.
2. Antenatal mothers attending ANC clinic.
Standard work precautions were taken during the
blood collection and screened for HBsAg, anti HCV
antibodies, anti HIV antibodies and Reagin antibodies.
Results
Out of a total of 80,500 apparently healthy ,voluntary
blood donors screened; 1339(1.7%) were HBsAg
positive,551 (0.68 %) were positive for antibodies to HIV
,271(0.34%) were positive for antibodies to HCV and 352
(0.44%)were reactive by VDRL.Out of 3289 pregnant
women registered for antenatal checkup 34(1%) were
found to be positive for antibodies to HIV.
Conclusion
Screening of blood donors helps in deferring of
infected donors and thus reduce wastage of huge
resources and in reducing transmission rates , similarly
screening of asymptomatic antenatal mothers for HIV
prevent transmission to their children and also receiving
timely intervention thus reducing disease burden in the
community. The need of the hour is to provide universal
access to these services by involving the NGOs and the
private sector.The main issue remains that screening
methodologies need to be not only well utilized but also
to be replaced by more sensitive and better techniques
so as to further reduce risks of transmission .
Lipids, Lipid Peroxidation and Total Antioxidant Capacity as Biomarkers of Coronary
Heart Disease in Patients with Diabetes Mellitus
C. Aravind*, E. Prabhakar Reddy**
Sri Lakshmi Narayana Institute of Medical Sciences, Puducherry, India
Background
Diabetes represents a major public health burden, both
locally and globally. Future projections have estimated
the prevalence of diabetes to exceed 300 million cases by
2030, with the majority of growth occurring in developing
countries. It is well known that diabetes is associated
with significant morbidity and mortality.
Aims & Objectives
To identify the biomarkers of coronary Heart disease
in patients with diabetes mellitus.
Material & Methods
In the present study 50 diabetic patients attending OPD
at SLIMS, Pondicherry were taken as the study group and
50 healthy age and sex matched individuals were taken
as control group. Inclusion criteria: Diabetic patients
without any micro and macro vascular complications.
Exclusion criteria: Alcoholics and smokers. A ‘P’ value
<0.05 was considered as statistically significant.
Results
to increase significantly (p<0.001) when compared to
controls. There was a significant decrease (p<0.001) in
FRAP levels when compared to the control levels. It is
significantly associated with increased concentrations of
low density lipoprotein cholesterol, decreased
concentrations of high density lipoprotein cholesterol,
and increased triglyceride concentration, haemoglobin
A1c, systolic blood pressure, fasting plasma glucose
concentration, and a history of smoking. The absolute
excess coronary risk due to diabetes was greater in the
presence of other risk factors, including cigarette
smoking, hypertension, and obesity.
Conclusions
Our findings in the present study shows a decrease in
antioxidant capacity which indicates that in DM with
CHD, there is hyperglycemia induced oxidative stress
and abnormal lipid levels associated with a depleted
antioxidant status which sets the stage for further disease
progression.
Keywords: Coronary heart disease; Diabetes mellitus;
Oxidative stress; Malondialdehyde; Total antioxidant
capacity.
A significant increase in (LPO) MDA levels were found
170
A Case of Meckel’s Diverticulitis with Perforation and Intestinal Obstruction
Yogesh Kumar*, Shiwani Kamath**
Background
Meckel’s diverticulum, an anomaly of the
gastrointestinal tract, is usually asymptomatic, but can
cause intestinal obstruction.
were seen on x-ray. Dilated bowel loops with mild ascites
were seen on USG of whole abdomen. On exploratory
laparotomy, a perforated Meckel’s diverticulum was
identified with small intestine distention and obstruction
and bowel herniation. Meckel’s diverticulum with a
segment of small intestine was resected.
Case
In this case, a 24 year old male patient developed
sudden colicky, generalized abdominal pain with
abdominal distention, bilious vomitus, and obstipation.
During investigation, total blood count confirmed
presence of inflammation. Multiple fluid levels and gas
Histopathology report confirmed Meckel’s
diverticulum with perforation. Patient did well
postoperatively.
Role of Thrombophilic Mutations in Thrombosis
Kshitij Srivastava*, Jyoti Kotwal**
Background
The present study looked at 9 mutations (mentioned
in the findings) in young Indian thrombophiliacs for the
first time to extensively study their role in the
pathogenesis of thrombosis.
•
•
•
Aims & Objectives
To extensively study the role of thrombophilic
mutations in the pathogenesis of thrombosis.
•
•
Material & Methods
This study included all cases of thromboembolic
disorders in individuals less than 45 years. 15 cases were
studied for the mutations while another 15 normal
healthy young individuals were studied to act as a control.
The patients were worked up for coagulation based
markers for thrombophilia which are routinely available.
For the mutation analysis,
• The Single Tube Multiplex PCR system was designed
to identify the mutations and their polymorphism.
• The blood sample was collected in EDTA vacutainers.
• The DNA was extracted by the column method with
the reagents provided in the kit.
• The DNA was mixed with the forward and reverse
•
•
•
•
•
primers for mutations, buffer and dNTPs
PCR was carried out in thermal cycler as per protocol.
The particular mutation or wild product was
amplified as per the patient’s genotype.
The PCR products were biotinylated in the tubes
and incubated. The biotinylated product were then
reverse dot blotted on to the strip with prefixed
oligonucleotides which gave a positive colour band
as per the mutation or normal gene amplified.
Detection of the specifically bound mutant or wild
type was visible by enzyme colour reaction which
was interpreted as 3 patterns.
These were- wild homozygous (normal pattern with
only one band), both wild and mutant pattern
(heterozygous for mutation) and only mutant
positive as mutant homozygous.
Thus for nine mutations, a total of 27 polymorphisms
were studied.
These polymorphisms were correlated to the clinical
features of the patient.
The clinical presentation, age, family history,
presence of multiple mutations, interaction with
environmental factors and any correlation if any,
were noted in a performa.
Analysis of the data was done by using appropriate
statistical tests.
The study was done for finding out the proportion
171
•
•
of the various genetic mutations {Factor V Leiden
(G1691A; R506Q) : FV R2 haplotype (H1299R):
Prothrombin (PTH & Factor II): G20210A MTHFR
C667T: MTHFR A1298C Factor XIII (FXIII) V34L:
PAI – 1,Serpin E1 4G/5G: EPCR 4600 A>G (A3
haplotype EPCR 4678 G>C (A1 haplotype) } and
their polymorphism in Indian patients < 45 yrs of
age presenting with thromboembolic disorders.
The various mutations and their polymorphisms
with the clinical presentations of thrombotic
disorders in young Indians were then correlated.
The statistical data and findings of the project will
be discussed during the conference.
The study has helped in providing data on the
prevalence of nine mutations encountered in
thrombophiliac patients and the role of these in the
pathogenesis of thrombosis. Thus the preventive
strategies for this disease which causes morbidity,
mortality and loss of manhours in our young soldiers is
now possible.
The Effectivity of Combination Extract Acalypha Indica Linn and Centella Asiatica on
Picnotic Cells in Gyrus Dentatus Internus in Sprague Dawley Rats Pascahypoxia
Ermono Superaya*, Siti Farida**
Universitas Indonesia, Jakarta, Indonesia
Background
Stroke is cerebrovascular disease caused by cessation
of arterial blood flow to the brain. Approximately 8085% of strokes are ischemic strokes caused by arterial
obstruction in the circulation of cerebellum. Cerebral
hypoxia caused by ischemia of the brain gives result in
alteration of cells morphology and cell death in which
neuron cells become picnotics. This will later manifests
in the form of neurological disability shown in the
affected individuals resulting in the need to take long
term medication. Citicoline is an effective drug for stroke
based on research but has drawbacks in term of usage
and high price which cause it to be less efficient in the
community. The herbs cat root and Indian pennywort
are alternative drugs for stroke therapy because of its
neuroprotective effects. Combination dose of these two
herbs are expected to provide a change in number of
picnotic cells in rat’s brain.
Aims & Objectives
To determine the effectivity of combination extract
acalypha indica linn and centella asiatica on picnotic cells
in gyrus dentatus internus in Sprague Dawley rats
pascahypoxia.
Material & Moethods
This research experiments on giving the extract of cat
root and indian pennywort to 5 groups of hypoxic rats in
various dose (150, 200, 250 mg of cat root combined with
150 mg of Indian pennyworts), negative control is given
aquades and positive control is given citicoline. The
cerebellum of the rats is then taken and is made to
histopathologic preparation to see the changes of picnotic
cells in gyrus dentatus internus.
Results
From the One Way Anova test results, it can be seen
that there is no meaningful changes in the number of
picnotic cells after the treatments are given to the rats
(p>0,05).
Conclusions
In conclusion, therapy with combination of cat root
and Indian pennywort does not provide changes in
number of picnotic cells in gyrus dentatus internus of the
rats.
172
Assessment and Evaluation of CAD Risk in HIV Positive Patients in Indian Setting
Anmol Sharma*, Amitabh Sagar**
Background
Cardiovascular disease is the leading cause of nonHIV-related death in people with HIV infection. Risk in
HIV-infected persons appears to reflect contributions of
non-HIV-related cardiovascular risk factors, the chronic
inflammatory response in HIV infection, as well as
metabolic adverse effects of antiretroviral therapy like
insulin resistance, dyslipidemia, abnormal fat
distribution, and hypertension.
matched controls. Each individual in the study will
undergo basic biochemical analysis, Electrocardiogram,
CD4 count (Only for TEST ARM) along with basic history.
All cases will be subjected to a 2D Echocardiogram and
Tread Mill Test. The controls will be matched for age,
smoking, exercise habits as required. Standard protocol
forms will be made for each patient. Anonymity of all
patients will be strictly ensured. Consent will be taken
in all cases. Ethical clearance from the institution has
been taken.
Results
Aims & Objectives
To ascertain the magnitude of the problem of coronary
artery disease in these patients and to ascertain if
Framingham screening score can be used in HIV patients
and then if feasible give recommendations for routine
preventive screening in HIV positive patients.
Material & Methods
Bio statistical comparative analysis of the data showed
greater Framingham heart score and Risk percentage of
CAD to be more in retropositive patients as compared to
the controls in age matched sub groups. Preliminary
biochemical analysis also showed association with the
results.
Conclusions
This cross sectional study will be conducted in a
multispecialty hospital. All male patients above the age
of 35 years will be included. The study will include 25
consecutive HIV positive male inpatients and 15 age
Risk of developing CAD is more in HIV positive
patients than HIV negative patients in Indian Setting.
Twenty Four Hour Tuberculin Response in Adolescent School Children
Tiroumourougane Serane V.
Sree Lakshmi Narayana Institute of Medical Sciences & Hospital, Puducherry, India
response in adolescent school children.
Background
The tuberculin test is a time tested immunological
tool used for the diagnosis of Mycobacterium tuberculosis
infection. Only very few studies are available reporting
the prevalence of tuberculin positivity in adolescents, a
high risk population for tuberculosis. Tuberculin reaction
is read after 48 to 72 hours, which results in delay in the
diagnosis of infection. Recent studies in healthy younger
children have shown that 24 - hour tuberculin skin test
evaluation is possible.
Aims & Objectives
To study the prevalence of tuberculin positivity and
the predictive value of twenty-four hour tuberculin
Material & Methods
Tuberculin (1 TU PPD RT23 Tween 80) was
administered to 548 healthy adolescent school children.
The induration at 24 hours was compared with that at 72
hours in these children.
Results
Ninety six children (18.3%) had a positive tuberculin
reaction. The prevalence of tuberculin positivity was least
(13.8%) in the 10 year age group and maximum in 14 year
age group (24.1%). When the effect of BCG scar status on
tuberculin reaction was studied, it was noted that the
induration size was not affected by the BCG scar status.
173
When the individual values of the tuberculin reaction at
the end of 24 and 72 hours were compared, a significant
difference was noted irrespective of the tuberculin status
(F = 7.9, P = 0.001). However, when the tuberculin reaction
was considered as positive or negative, this difference
was not significant (P > 0.05).
positive or negative at 24 hour, irrespective of their BCG
scar status.
Keywords: 24 hour reading; Mantoux test; Tuberculin;
Adolescent.
Conclusions
The tuberculin status in adolescents can be read as
Comparison of Capillary and Venous Blood Glucose Measurements in Healthy
Volunteers
Senthamizh Selvan
Sree Lakshmi Narayana Institute of Medical Sciences & Hospital, Puducherry, India
Background
The burden of diabetes in Asian countries is
disproportionately high in young to middle-aged
adults.Evidence of glucometer in self monitoring of blood
glucose in diabetes mellitushas been found satisfactory.
Capillary blood glucose also being used for screening
purpose in epidemiological studies.In view of increased
use due to its quick result and easy to use property it is
imperative to conduct a study to know its efficacy and
correlation venous blood glucose.
Aims & Objectives
To establish the correlation between capillary blood
glucose measured by glucometer and venous blood
sample tested by biochemistry laboratory.
Material &Methods
It was a cross sectional study carried out at Sri
LakshmiNarayana Institute of Medical Sciences,
puducherry, between May to JUNE 2013. Apparently
healthy 50 non diabetic volunteers in the age group of 20
– 35 years were enrolled in the study.Two samples were
taken from each volunteer simultaneously in a non
fasting state for assessment of capillary and venous blood
glucose. Glucose levels were measured using glucometer
for capillary sample.Exclusion criteria:
1.
2.
Diabetes mellitus
Age < 20 yrs
3.
Critically ill patients.
Appropriate statistical method was applied to analyse
the results.
Results
Fifty healthy volunteers blood samples on analysis
revealed a mean capillary blood glucose levels of 99.76
±14.48 mg/dl and venous blood glucose levels of
90.86±8.13 mg/dl, which was statistically significant with
a p value of <0.0001.the result was found to be
statistically extremely significant.
Conclusions
As per the results the capillary blood glucose
estimation using glucometer over estimates the blood
glucose level in non diabetic individuals in non fasting
state. The traditionally used venous blood glucose
estimation gives an exact value of blood glucose, though
it is time consuming and requires more man power.
Capillary blood glucose estimation can hence be used in
non diabetic individuals in an acute emergency where
blood glucose estimation by venous blood glucose
analysis is not feasible. Use of capillary blood glucose is
of limited help in assessing a diabetic status of an
individual.
174
Antianxiety Activity of Tylophora Indica on Ethanol Induced Anxiety in Wistar
Albino Rats
Shyamjith Manikkoth*, Roysten Rodrigues**, S.N. Rao***
Yenepoya University, Mangalore, India
Background
The non-medical usage of habit-forming drugs is not
a new phenomenon. Its pattern and trends may have
differed, but it has been with us for generations. The
problem in recent times has reached precarious
magnitudes. Chronic alcohol consumption plays a pivotal
role in habit formation. Its usage has proven to cause
behavioral abnormalities.
Aims & Objectives
Ethanol in rats for 14 days orally. This was confirmed
after 14 days by using Elevated plus maze, an established
model of anxiety. The duration of time spent in open
arm of the maze (in seconds) was noted in the test. It was
observed that animals which received ethanol spent less
time in open arm, than the normal rats. The anxiolytic
activity of the ethanolic extract of Tylophora indica was
assessed using another set of animals, which received
concomitant administration of alcohol and the plant
extract.
To investigate the anxiolytic activity of ethanolic
extract of Tylophora indica, an indigenous medicinal plant
on ethanol induced anxiety behaviour in Wistar albino
rats.
Material & Methods
It was noteworthy that animals which received plant
extract spent more time in open arm, than the ethanol
alone administered rats. Based on our findings we
conclude that Tylophora indica has an anxiolytic
activity.Key Words: Ethanol, Anxiety, Wistar albino rats,
Tylophora indica, ethanolic extract, Anxiolytic.
Anxiety was induced by administering 7.5% v/v
Antidepressant Activity of an Indigenous Medicinal Plant, Tylophora Indica on
Ethanol Induced Depression in Wistar Albino Rats
Shyamjith Manikkoth*, Aishwarya Raja**, S.N. Rao***
Background
Alcohol is one of the important agents belonging to
the group of drug abuse and drug addiction. The
consumption of alcohol has been dramatically increased
for the quite few years. Human society has been engulfed
by the deleterious effect of alcohol. It is proven to cause
behavioral abnormalities on long term use.
the test. Tylophora indica ethanolic leaf extract at a dose of
100 mg/kg, orally was administered concomitantly to
rats receiving ethanol .The ethanol administered rats,
treated with Tylophora indica ethanolic extract, has
shown a significant reduction in the duration of
immobility (in seconds), in the swimming test on
comparing with alcohol alone administered rats.
Aims & Objectives
To test the antidepressant activity of Tylophora indica
extract on ethanol [7.5% v/v] induced depression in Wistar
albino rats, using an established model for depression
i.e., Forced Swimming Test.
The data suggests that alcohol administration can cause
depression, which can be prevented by the coadministration of Tylophora indica ethanolic leaf
extract.Key Words: Ethanol, Depression, Wistar albino
rats, Tylophora indica, ethanolic extract, Antidepressant.
Material & Methods
The duration of immobility (in seconds) was noted in
175
The Impact of Artificial Sweeteners on Incretins and the Level of Incretins in Type 2
Diabetes Mellitus Patients
N. Charumithrra*, D. Anusha**, S. Seethalaksmi***
Sri Ramachandra University, Chennai, India
Background
Type 2 diabetes mellitus(T2DM) has attained a state of
epidemic of late. It is known to predispose many a
number of systemic complications, starting from
myocardial infarction till candidial infections and still
the count goes on. A lot of drugs are in use and also in the
process of making to control diabetes. Incretin and its
analogues are a recent advancement. Artificial sweeteners
are also used to control blood sugars. Could they have
an impact on the level of incretins as well?
Aims & Objectives
To study the impact of artificial sweeteners on incretins
and the level of incretins in type 2 diabetes mellitus
patients.
Material & Methods
Standard analysis of the articles, standard
pharmacology textbooks and online search engines has
resulted in the present review. Incretins are the Gastro
Intestinal hormones that are released after meals and
stimulate insulin secretion and hence oral glucose has
more insulinogenic action than intravenous glucose
(incretin effect). They are Glucagon Like Polypeptide
(GLP-1) and Glucose Dependent Insulinotropic
Polypeptide (GIP), the expression of which is lowered in
type 2 diabetes mellitus patients . Artificial sweeteners
like sucralose, aspartame, etc are being used rampantly
for its calorific value. Certain studies show that these
artificial sweeteners do stimulate the “gut receptors”
hence enhancing insulin production and glucose uptake
by the cells which could be beneficial in normal
individuals. While certain studies disagree with this and
say that artificial sweeteners only have a calorific
advantage and do not have an impact on the incretins
and thus no insulinogenic activity. They further say that
due to the lack of insulinogenic potential there exists no
difference in their mechanism of action. This forms the
basis of this literature review.
Results
On analysis of many articles, it is found that artificial
sweeteners given along with a carbohydrate source like
glucose, etc might have an effect on the incretins
especially GLP in normal individuals, but their role in
T2DM patients is still a query. Certain studies also show
that artificial sweeteners cause excessive stimulation of
insulin receptors, hence aiding obesity.
Conclusion
On doing this review, a deeper analysis of incretins
and artificial sweeteners was done and helped in a better
understanding of their mechanism of action. More studies
have to be done in this field to analyse the effect of
artificial sweeteners in type 2 DM patients to reiterate
the findings from the previous researches or to come up
with new results itself.
Keywords: Incretins; Artificial sweeteners; Type 2
DM.
Memory Enhancing Activity of Tylophora Indica Ethanolic Extract on Alcohol
Induced Amnesia in Wistar Albino Rats
Shyamjith Manikkoth*, Vasudha Sanklapur**, S.N. Rao***
Background
People consume drugs to alter the way, they feel,
think, or behave. These kinds of substances are named
psychoactive and cover alcohol and tobacco as well as
natural and manufactured drugs. Drug abuse affects most
countries in the world, both rich and poor. This drug
menace crosses national, racial, religious and gender lines.
Drug addicts vary from the homeless, to white-collar
professionals, college students to rural farmers, street
children to urban teenagers. Alcohol being a habit
forming drug can be harmful in a number of ways,
176
through both immediate effects and damage to health
over time. Chronic use of alcohol affects cognitive
development and short-term memory.
Aims & Objectives
To investigate the memory enhancing activity of
ethanolic extract of Tylophora indica, an indigenous
medicinal plant on ethanol induced memory loss in
Wistar albino rats.
Material & Methods
Cognitive impairment was induced by administering
7.5% v/v Ethanol in rats for 14 days orally. This was
confirmed by using Hebb William maze, an established
model of memory. The latency of the time spent to reach
the reward chamber of the maze (in seconds) was noted.
took more time to reach the reward chamber, than the
normal rats. The antiamnesic activity of the ethanolic
extract of Tylophora indica was assessed using another
set of animals, which received parallel administration of
alcohol and the plant extract. It was striking to observe
that animals which received plant extract spent less time
to reach the reward chamber, than the ethanol alone
administered rats.
Conclusions
The data suggests that alcohol administration can cause
memory loss, which can be prevented by the coadministration of Tylophora indica ethanolic leaf extract.
Keywords: Ethanol; Amnesia; Wistar albino rats;
Tylophora indica; Ethanolic extract; Antiamnesic.
Results
It was observed that animals which received ethanol
Prescribing Patterns, Adverse Effects and Treatment Outcome of Anti-Leprotic Drugs
Aashima*, Bharti Magazine**
Kasturba Medical College, Manipal, India
Background
Leprosy continues to be a significant problem in certain
pockets of developing countries. India is the leading
responsible country for the world-prevalence of leprosy.
Globally, 60% of the estimated cases are contributed by
India. MDT (Multi-drug therapy), which is the treatment
recommended by WHO, cures patients and interrupts
transmission of leprosy and prevents disabilities.
However, MDT has been associated with problems like
undesirable side- effects, poor compliance, drug resistance
and high relapse rates. Considering the number of cases
contributed by India, it has serious implications. Thus,
present study was undertaken to analyse the prescribing
pattern and drug-related problems in patients with
Hansen’s disease.
Aims & Objectives
• To analyse the prescribing patterns of patients with
leprosy
• To assess the adverse effects of the drugs used
• To assess the treatment outcome in patients who
received MDT.
It was a retrospective study in which medical records
of patients with leprosy who attended Dermatology
clinic at Kasturba Hospital, Manipal in 2011-12 were
analysed. Prescribing patterns, adverse-effects, drugs
used to treat the side-effects and treatment outcome were
recorded in a proforma. Appropriate statistical tests were
done to analyse the data.
Results
Records of 100 patients were analysed. Most of the
patients were in age group of 30-60 years. The drugs
prescribed for leprosy were Dapsone, Clofazimine,
Rifampicin and Ofloxacin. Many patients experienced one
or more reactional states , majority being recurrent
erythema nodosum leprosum (31 patients), including
necrotic ENL , bullous ENL and exacerbation of ENL
.Type 1 lepra reaction was also common (14 patients).
Late Reversal reaction was seen occasionally. Drugs
prescribed for these reactions were Prednisolone,
Methylprednisolone and thalidomide. Side-effects of
MDT were frequent. Dapsone was incriminated in
adverse-effects like anemia ( 13 patients) and Dapsone
Hypersensitivity syndrome (4 patients). Other side effects
with MDT were deranged LFTs, Neuritis , gastrointestinal
problems, fever. 4 patients developed steroid induced
diabetes and 5 got pedal edema secondary to treatment
with thalidomide. 11 patients were restarted on second
course of MDT. Most of the patients reported
177
improvement in symptoms. However, non-adherence
to treatment was not uncommon.
Conclusions
The drugs were prescribed as per WHO guidelines.
Adverse-effects secondary to current drug regimen are
threatening factors in leprosy control. So, there is a need
to monitor adverse effects so as to avoid defaulters and
improve adhesion to treatment to eradicate Hansen’s
disease as a public health issue.
TLR2 Ligation Modulates the Balance between Regulatory and Th17 Function in
Human T-Cells: Implications for Multiple Sclerosis
Abhishek Kumar*, Mukanthu Nyirenda**, Bruno Gran***
Brighton and Sussex Medical School, Brighton, United Kingdom
Background
By maintaining immunological self-tolerance, a subset
of lymphocytes known as regulatory T cells (Tregs) play
a key role in preventing the development of
autoimmunity. These Tregs express a host of receptors,
including pathogen recognition receptors (PRRs) of the
innate immune system known as Toll-like receptors
(TLRs). Ligation of these TLRs with pathogenic antigens
known as pathogen associated molecular patterns
(PAMPs) has been reported to modulate Treg function.
Ligation of TLR2 in particular, has been reported to
reduce the suppressive capacity of murine and human
Tregs by unknown mechanisms. However this was
recently elucidated upon when ligation of the TLR1/2
heterodimer was observed to enhance interleukin (IL)-6
and transforming growth factor (TGF)-â expression by
Tregs. These cytokines have a vital role in regulating the
reciprocal and mutually inhibitory relationship between
Tregs and T-helper (Th) 17 cells- a subset of lymphocytes
which are key in the pathogenesis of autoimmune
diseases and protection against bacterial infections. The
presence of IL-6 can alter the balance between Tregs and
Th17 cells in favour of the latter by inducing
differentiation of naïve T cells towards the Th17 lineage,
whilst also inducing concomitant inhibition of Treg
differentiation.
Aims & Objectives
To study the effects of different TLR2 ligands on the
phenotype of Tregs.
Material & Methods
We examined the effect of different TLR2 ligands on
the phenotype of Tregs isolated from HS and RR-MS
patients.
Results
With this in mind, it was interesting to observe TLR1/
2 ligation of human Tregs resulted in not only abrogation
of their suppressive capacity, but also their differentiation
towards the Th17 lineage. Based on these findings, we
hypothesised that Tregs from relapsing remitting
multiple sclerosis (RR-MS) patients are more susceptible
to TLR2-induced differentiation towards the Th17 lineage,
compared with healthy subjects (HS). We examined the
effect of different TLR2 ligands on the phenotype of Tregs
isolated from HS and RR-MS patients. We found that
ligation of the TLR1/2, but not TLR2/6 heterodimer,
increased the differentiation of Tregs from RR-MS
patients towards the Th17 lineage, compared with HS.
Conclusions
Though such TLR2-induced modulation of Treg
activity may lead to effective clearance of some pathogens,
it could potentially increase the risk of autoimmunity,
or even exacerbation of ongoing disease activity in RRMS patients. With this in mind, it may be important to
revaluate the idea of using autologous Tregs as cell-based
alternative to conventional immunosuppressants.
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Pandemic of Decadence: Is Medicine Still Unaffected?
Siddharth Sethi*, J.M. Farooqui**
Pravara Institute Of Medical Sciences, Loni, Ahmednagar, India
•
•
Background
The current medical scenario in India has faced a drastic
change. A place where doctors were considered next to
gods and worshiped now sees them being dragged to the
roads and beaten. Moral degeneration has engulfed the
noblest profession of them all, in the most ferocious way.
Hence, it is important to inculcate moral values in a doctor
right from the beginning of the course. And the study is
based on such budding doctors of the nation.
•
•
Study area: Pravara Rural Hospital, Loni
Study population: 70 medical interns working at
Pravara Rural Hospital, Loni
20 questions based on Code of Medical Ethics (Rules
and Regulations), 2002 were supplied after obtaining
the consent of the study participants and
confidentiality was maintained.
Data analysis done and presented using charts and
graphs.
Results
Aims & Objectives
•
•
•
•
To find the level of awareness of medical ethics
amongst the budding doctors of nation.
To gather and assess the knowledge of professional
misconduct amongst the medical interns.
To assess the knowledge of the medical interns about
the Medical councils.
•
•
As a whole, most of the interns studied could answer
60-75% of the answers right (44.28%).
The second largest group of interns was between the
ranges of 50-60% (34.29%)
The number of interns in the category of <50% was
more than the interns in the category of >75%.
Conclusions
Material & Methods
•
•
Ethical clearance taken from the Institutional Ethical
Committee of PIMS(DU).
Study type: Prospective cross sectional study
Ethics are moral principles which a person should
abide to. They should be inculcated in an individual right
from the beginning of the course. It is a continuous process
that requires upgradation.
Effectiveness of Intra-Discal Ozone Therapy in the Treatment of Low Backache
Vanshika Gupta*, Pankaj Banode**
Jawaharlal Nehru Medical College, DMIMA (DU), Wardha, India
Background
Material & Methods
Ozone therapy has shown promising results due to its
analgesic, anti-inflammatory & immunomodulatory
effects in treating lumbar disc herniation (LDH). As such,
little data is available regarding the efficacy of ozone in
Indian literature, evincing it’s low prevalence despite its
numerous advantages.Thus, we aim to study the
effectiveness of intra-discal ozone therapy in reducing
pain & disability in patients of LDH.
Aims & Objectives
A retrospective study was carried out at a tertiary care
hospital. Case files of fifty-five adult patients in the age
group of 20 to 65 years, who were treated with oxygenozone therapy following complaint of low back pain,
were collected and analyzed. The clinical outcome was
assessed by the follow-up data, pursued after 48 hours, 4
weeks and 6 months of treatment by applying the
modified MacNab method and Visual Analog Pain Scale
(VAS) scoring. Statistical Analysis was performed by
paired student t test.
To study the effectiveness of intra-discal ozone therapy
in the treatment of low backache.
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27.4% had no improvement.
Results
52.7% patients belonged to the age group of 40-59yrs
and 80% were male. 30.90% suffered from co-morbid
conditions, predominantly hypertension (14.54%). Level
of disc involvement was L4-L5 in 54.54%, followed by
L3-L4, L5-S1 and multiple discs. Pre-ozone assessment of
VAS score revealed moderate pain in 38.18% patients,
severe in 52.72% and excruciating pain in 9.09% patients.
Significant difference was found in the mean VAS score
on all follow-ups. On evaluating the therapeutic
effectiveness, based on MacNab’s criteria, 63.6% patients
showed complete recovery, 9% had significant relief and
Conclusions
The level that was found more prone for disc prolapse
was L4-L5. The most common cause of LDH was found to
be lifting heavy weights. There was significant
improvement in most patients who failed to respond to
conservative therapy after ozone therapy, both in pain
and disability. Intradiscal oxygen-ozone, thus, proved to
be a safe & cost-effective therapy in treating LDH.
Prevalence of Osteoporosis and Osteopenia in Rural Adult Population of Andhra
Pradesh
Anantha Krishna*, Pawan Kumar Sharma**
Mediciti Institute Of Medical Sciences, Hyderabad, India
in Microsoft Excel and analyzed using Microsoft Access.
Background
Osteoporosis and osteopenia are emerging as a major
public health problem in India, associated with substantial
morbidity and socio-economic burden. An early
detection can help in reducing the fracture rates and
overall socio-economic burden in adult population.
Aims & Objectives
To 4screen the bone status (osteopenia and
osteoporosis) in rural adult population above the age of
25 years in Medchal mandal of Andhra Pradesh.
Ethical clearance was obtained from the Institutional
Ethical Committee. A hospital based study was carried
out from April through June 2013 in 150 men and women
of Medchal Mandal after taking informed consent.
Information was collected on a pretested questionnaire
by direct interviewing and Bone mineral density was
tested using QUS at the right tibia following which WHO
T-scores were calculated. Data is currently being entered
Results
The preliminary result (of 58 entries made so far)
suggested that a substantial rural population had
osteopenia and osteoporosis after the age of 45 years.
The prevalence of osteoporosis was 24.88% and
osteopenia 32.75%. Maximum number of both
osteoporosis and osteopenic adults were found in the 5564 years age group. Almost 100% prevalence of either
osteopenia or osteoporosis was seen beyond the age of
65 years amongst women. Socio economic status also
seems to influence the outcome of osteopenic and
osteoporosis score in present study.
Conclusions
Rural population should be routinely screened for
osteoporosis and osteopenia using tibial QUS method
utilizing WHO ‘T’ score criteria so that they may be
diagnosed early and do not progress to face the
complications of osteoporosis.
Role of Surgical Drains after Cholecystectomy as it Stands Today
Geet Midha*, K. Veena**, L. Karanth***
Kasturba Medical College, Manipal, India
Background
Insertion of drains after surgery has been a matter of
constant discussion over the past many decades, yet there
is neither conclusive evidence nor guidelines over their
benefits and use of drains after surgery. The decision
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rests on the surgeon’s choice, who takes into consideration
patient’s co morbidities and disease conditions.
prepared. The results were analysed using spss software.
Aims & Objectives
To study the use of drains in patients operated for
cholecystectomy.
Material & Methods
A study proposal was drafted and institutional ethical
clearance was obtained. Proforma chart was created to
include all patient details. A total of 379 files were
obtained from Medical Record Department of Kasturba
Hospital and were studied according to the proforma
The use of drains is seen to be associated with presence
of co morbidities, emergency procedures, longer duration
of use of antibiotics and longer hospital stay. It can be
implied that if laparoscopic cholecystectomy is performed
electively in a patient without co morbities, drains can
be avoided. Further, considering this to be a pilot study,
randomised control trials in age, gender, clinical
condition and co morbidities matched patients in large
series can be designed which will provide data to establish
guidelines on the decision of insertion of drains in
surgery.
Microbial Contamination of Soft Contact Lenses and Accessories in Asymptomatic
Contact Lens Wearers
Deeksha Thakur*, Ujjwala Gaikwad**
JNMC, Sawangi, Wardha, India
IMVIC test using standard laboratory protocols.
Background
Soft contact lenses are finding more users by the day,
who often opt for using contact lenses without being
aware of the proper usage and handling instructions
leading to their contamination and thus, the incidence of
contact lens induced infections is also increasing.
Aims & Objectives
To assess the risks associated with improper use of
contact lenses, type of microbial flora involved and their
potential to cause ophthalmic infections to create
awareness among the lens users.
Materials & Methods
Four samples each from 50 participants (n=200) were
collected from the lenses, lens care solutions, lens care
solution bottles and lens cases along with a questionnaire
regarding their lens use practices. The samples were
cultured on Sheep Blood agar and Mac Conkey’s agar
and Sabouraud’s dextrose agar. Gram positive organisms
were identified using tests like catalase and coagulase
tests while Gram negative organisms were identified
using catalase, oxidase test, sugar fermentation tests and
Results
Overall rate of microbial contamination amongst total
samples was 52%. The most contaminated sample was
found to be lens case (62%), while the least contaminated
sample was lens care solution (42%). The most frequently
isolated contaminant was Staphylococcus aureus (21%)
followed by Pseudomonas species (19.5%). The
participants were classified according to their level of
compliance to the lens care protocol into three groups,
i.e. High, Medium and Low. Majority (64%) of the
participants showed medium grade of compliance to lens
cleaning practices. Rate of contamination was 100% and
93.75% respectively in those participants who showed
low and medium compliance to lens care practices.
Conclusions
Lens care practices amongst the participants were not
optimum which resulted into high level contamination
obtained in them which is potentially harmful. Hence
increased awareness among the users about the lens care
practices and regular cleaning and replacements of lens
cases is warranted.
181
Enginnering: 7th Sense in Dentistry
Harsh Vardhan Singh
Govt. Dental College & Hospital, Patiala, India
Background
The human character of curiosity to explore new
things is as old as history of mankind and when he starts
exploring different streams of science, it creates wonders.
So, let’s engineer dentistry. For a long time,
Prosthodontics therapy focused mainly on the technical
and clinical expertise required to fabricate complete
dentures. This approach helped nurture the development
of new ideas. The masticatory functions depend upon
muscular forces and facility with which the patient is
able to coordinate with these movements.But in complete
denture wearers, computed tomographic study of
masseter and medial pterygoid muscles have
demonstrated greater atrophy and so is the reduced biting
force. The sequele of this is impaired nutrition and this
leads to poor and debilitated health in old age. The
condition becomes worse in which motor control of
muscle is affected as in Parkinsonism and Myasthenia
Gravis (disorder which interfere with impulses and hence
results in weak, easily fatigued muscle). Further more to
attenuate problems of elderly debilitated patients in
which denture wearing, its retention and mastication is
almost impossible.
Aims & Objectives
To make a type of denture: ELECTRONIC DENTURE.
Material & Methods
(Lucitone, Trevalon) or metal base base gold or cobalt
chromium. After diagnosis and treatment planning for
implants; Implants will be placed in the mandible in
routine protocol. Implant prosthesis electric denture will
be constructed in two parts. The lower part will be fixed
over the implants and between two parts of denture,
biocompatible sensors will be placed (which can be
manipulated with the help of remote outside the mouth).
But the movement of second half of lower denture would
be such with the remote that lower half of lower denture
remains fixed to ridge and occlusal half of denture
maintain contact during movement.
ELECTRONIC DENTURE will have fixed base (implant
supported for retention) and mobile teeth . The chemical
sensors will be placed in the denture that will get
stimulated on receiving the food, resulting in activation
of tactile sensors further activating the spring loaded
teeth which may serve the purpose of mastication, The
synchronization of these two sensors prevent tongue and
cheek biting overcoming the drawback of complete
denture in which tongue and cheek biting is seen. In
short, weakness of muscles will be taken care by
movement of teeth. This is done view of bringing
renaissance to patients who have motor disabilities. This
is a humble attempt by me. It is mere thought that has to
be churned into action. Research work and brilliant minds,
when shall come together, will prove to be a boon for
this noble idea.
High strength heat cure denture base material
Ocular Ultrasonography in the Diagnosis of Diseases of the Posterior Segment of the
Eye
Ragavi P.S.*, S. Manavalan**
Rajah Muthiah Medical College and Hospital, Chidambaram, India
Background
Ocular ultrasonography imaging is a diagnostic
technique to analyse the intra-ocular structures especially
in opaque media like cataract and vitreous haemorrhage.
It is useful in cases of injury to the eyeball,posterior
segment diseases of vitreous, retina, choroid, opticnerve,
retro-bulbar spaces and orbits in addition to calculation
of intra-ocular lens power.
Aims & Objectives
To study Ocular ultrasonography in the diagnosis of
diseases of the posterior segment of the eye.
Material & Methods
This prospective study was conducted among patients
attending ophthalmic Out-Patient Department of
182
RMMCH, Chidambaram, T.N. The study was performed
for a period of four months from January to April 2013.
All patients planned to undergo cataract surgery were
routinely subjected to both A and B scans ultrasonography to estimate IOL power and to exclude
posterior segment pathology, respectively. The results
were stored and documented.All patients with other causes
of media opacities were screened for posterior segment
diseases.
Results
1. Exact IOL power was calculated prior to cataract
surgery for all patients.
2. Among the persons subjected to ultrasound, 30
patients were found to have posterior segment
diseases including retinal detachment, vitreous
haemorrhage, posterior vitreous detachment,
3.
4.
posterior staphyloma and vitreous opacities.
A case of ultrasonography revealed a case of
retinoblastoma, a childhood tumour.
Post-operative ultrasonography revealed
endophthalmitis, dropped nucleus into vitreous in a
couple of patients.
Conclusions
Thus ultrasonography serves as an effective method
to diagnose ophthalmic diseases especially those of the
posterior segment in opaque media like cataract and
vitreous haemorrhage. It is faster, accurate and reliable
with added advantages of being non-invasive,patientfriendly and less expensive technique.
NSAIDS Induced Ileal Strictures: A Rare Case Report
Komandur Thrupthi
Bhaskar Medical College, Hyderabad, India
Background
NSAID’s though useful in the treatment of
inflammatory conditions, caused increased mucosal
damage to upper git. During the past two decades the
deleterious effects of NSAID’s on small intestine and colon
have been recognized like strictures, ulcerations,
perforation and villous atrophy. However the proportion
of patients who develop clinically important NSAID
induced enteropathy remains relatively small.
using tablet voveran 50 mg since 2 years .An upper gi
endoscopy was suggestive of a small growth in second
part of duodenum. On laprotomy multiple strictures were
found in the distal 30 cms of ileum. On treatment
resection of the terminal ileum and ileo ascending
anastomosis was done. Post operative biopsy was
suggestive of chronic non specific inflammation. Patient
is on follow up receiving paranteral and oral b12
supplementation and is doing well.
Material & Methods
A 25 year old gentleman presented with complaints
of pain abdomen, malena since two months, easy
fatigability, and shortness of breath and constipation since
5 days. Patient’s past history was unremarkable apart
from an intramedullary nail placed in the right femur 2
years back for fracture shaft of femur for which he was
NSAID enteropathy exists and may have clinically
significant squeal. COX isozyme non-selective NSAIDs
induces git side effects reflecting their widespread use
and high toxicity. The forthcoming generation of selective
and preferential COX-2 inhibitors, offer a potential
therapeutic advance in terms of reducing side-effects
throughout the gastrointestinal tract.
Extensive Intratemporal Cholesteatoma: Presentation, Complications and Surgical
Outcomes
Avantika Singh*, Ashish Vashishth**
Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, INDIA
invasive extensive cholesteatomas and intracranial
complications of squamous chronic otitis media.
Aims & Objectives
To review the clinical features, complications, surgical
management and post-operative outcomes of medially
183
Material & Methods
Retrospective review at a tertiary referral center
included 20 patients presenting with extensive intratemporal cholesteatomas or intracranial complications
of cholesteatoma from 2011-2013. Inclusion criteria were
involvement of the labyrinth, facial nerve, posterior fossa
dura and intracranial complications of cholesteatoma.
Patients with acute or chronic mucosal otitis media with
intracranial or intratemporal complications were
excluded.
Results
The mean age of patients was 20 years. The presenting
features in decreasing order of frequency were profuse
foul smelling otorrhoea (19/20), severe otalgia/temporal
headache (17/20), fever (8/20), altered sensorium (5/20),
vertigo (5/20) and acute onset facial palsy (3/20).
Intracranial complications were observed in 9 patients,
with ipsilateral temporal lobe abscess being most
common (6/20), followed by lateral sinus thrombosis,
pyogenic meningitis and petrositis. 14/20 patients
exhibited profound hearing loss on the involved side.
The average duration of discharge was 5 years.
Cholesteatoma extension medial to labyrinth with
complete involvement of petrous apex and internal
auditory canal was observed in one case. Most common
identifiable pathologies observed were postero-superior
and epitympanic retraction pockets. Computed
tomography provided adequate disease assessment,
intra-operative correlation and cost effectiveness. All
cases of facial nerve involvement had co-existing
labyrinthine destruction with cochlear and semicircular
canal fistulas in 3 and 4 cases respectively. Lateral
semicircular canal was the most frequently eroded
portion of inner ear (10 cases). Management of intracranial
complications preceded definitive surgical management.
All patients underwent canal wall down mastoidectomy
with or without partial labyrinthectomy except petrous
apical cholesteatoma where subtotal petrosectomy
(transotic) with blind sac closure was performed. Gross
infiltration of facial nerve was observed in one case
whereas 8 cases exhibited gross dehiscence of fallopian
canal, most commonly of the tympanic segment. Intraoperative macroscopic disease clearance was complete
in all casesTwo mortalities occurred in patients with
intracranial complications with one caused by unrelated
co-morbidities. Intra-operative and post-operative course
was uncomplicated in all other patients except a single
case of wound dehiscence.All patients continue to be in
follow up with maximum and minimum follow-up being
2 years and 6 months respectively and remain free of
disease.
Conclusions
Extensive intra-temporal cholesteatomas and
intracranial complications caused by them continue to
pose a challenge in the management of otitis media in
the current era and merit early recognition, surgical
management and follow-up. Simultaneous or early
definitive surgical management of cholesteatoma in the
form of mastoidectomy is recommended along with
neurosurgical brain abscess drainage.
Risk Factors for Gall Bladder Cancer in North India: A Case Control Study
Pranav Gupta*, Anil K. Agarwal**
Background
The incidence of Gall Bladder cancer (GBC)is on a rise
in India, particularly in the northern parts of the
country.The incidence of GBC among women in northern
India is one of the highest in the world.The
etiopathogenesis of GBC is not well understood.
However, the wide geographical and ethnic variations
in the incidence of GBC suggest a role of genetic and
environmental influences on its carcinogenesis. While
gall stones are considered as an important risk factor for
GBC only 1 to 3 percent of patients with symptomatic
cholelithiasis develop GBC. Other proposed risk factors
include female sex, Salmonella typhi carrier status, dietary
factors, heavy metals in drinking water and other
environmental exposure to specific chemicals. However,
the current knowledge about the risk factors for GBC is
limited.
Aims & Objectives
To study the risk factors for GBC in northern India.
Material & Methods
The study was conducted in the Department of
Gastrointestinal Surgery, G. B. Pant Hospital, New Delhi,
a tertiary referral center. Patients with gallstones are also
included in the study since they share many of the risk
factors with GBC patients and it is important to take into
account the confounding effect of gallstones. Study was
done on total 150 subjects. 50 consecutive newly diagnosed
patients with GBC were included as group A. 50
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consecutive patients with cholelithiasis were included as
group B. 50 healthy controls were labelled as group C.
To study the risk factors a questionnaire was administered
to each subject to elicit information on various variables.
history suggestive of diet lacking in vitamin C and E.
Increase in risk of cancer was there with an increase in
age of menarche but is not statistically significant.
Conclusions
Results
Majority of case patients were middle aged or older
Hindu women with total family income more than 5000
INR. 24% cases were resident of areas around river ganges
implicating role of pollutants in carcinogenesis. 46% cases
had gall stones. 22% cases had porcelain bladder. 10% of
gall stone patients were typhoid carriers. Patients gave
The study results will help in identifying the risk
factors of GBC in northern India, a region endemic for
GBC. Identification of risk factors can help in
understanding the etiopathogenesis of the GBC. In
addition, the findings of the study will have an important
implications for the prevention of this cancer.
Collodion Baby: A Case Report
Nipun Gumber*, Ameya Sirsat**, Rumana Maldar***
Jawaharlal Nehru Medical College , Belgaum, India
Background
Collodion baby is a rare congenital autosomal
recessive skin disorder characterised by parchment like
taught membrane covering the whole body.Incidence of
collodion baby is very low, 1 in 3, 00,000 cases of
newborns worldwide.Neonatal complications can occur
in 45% of all collodion babies.
Material & Methods
A 22 year old lady presented as G2P1L1 with 34 weeks
period of gestation with polyhydramnios and breech
presentation. Per abdominally uterus corresponds to 34
weeks gestation.Patient was undertaken for emergency
LSCS at 35 weeks POG indication being PPROM with
breech and delivered a 2.4 kgs female child showing
features of collodion baby.
The baby presented with typical features of collodion
baby ie.white thick taught like membrane along with
ectropion, eclabium, transverse and vertical groove
running through the membrane, flat pinna and oedema
of the limbs.Baby expired 2 days later due to pulmonary
complications.This case is an example of a less known
entity and prenatal diagnosis holds atmost importance
in this case followed by genetic counselling.
Study of Risk Factor Profile for Non Communicable Diseases amongst the Medical
Students
Animesh Jain*, Rohan Kumar**, Ankit Raj***,Vishesh Sharma****,Vidhika Berwal*****, Amritansh
Pandey******, Dikshy Garg*******
Background
Aims & Objectives
A non-communicable disease, or NCD, is a medical
condition or disease which by definition is non-infectious
and non-transmissible among people. They include heart
disease, stroke, diabetes and more. Medical students,
owing to the pressure associated with this field often
ignore their health,unhealthy eating habits,sleeping less
and not exercising enough, the reason being the stress
associated with this field.
To assess certain factors responsible for susceptibility
to non communicable diseases among medical
students,along with the awareness and attitude towards
prevention of these diseases and lastly to recommend
remedial measures.
185
Material & Methods
The study was conducted in Kasturba Medical
College.The study population consisted of students of
1st year MBBS. The students were given a
questionnaire,which was based on some past surveys
and guidelines given by the WHO. Consenting students
were made to fill the form.The students also underwent
weight and height measurements.The data so collected
was analysed using SPSS version 11.5.
Results
tobacco and alcohol in the past 30 days. While most of
them preferred to sleep 37 (33%) or watch television/
surf the internet 32 (29%),only 17 (15%) indulged in
physical activity and 24 (22%) preferred to read novels in
their free time. Majority of the students played
sports(76%) out of which only 10 preferred indoor sports.
Majority of the students didnt go to the gym 88(79%).
19(17%) students had parents who suffered from NCDs,
23(21%) had grandparents who suffered from NCDs.
13(12%) had more than one relative who suffered from
NCDs.
Conclusions
111 students were interviewed, 54 were males and 57
were females,all in the 18 to 20 year age group. Based on
the BMI 64 (61%) were normal 30 were underweight (29%)
and 11(10%) were overweight.Based on the food habits,
71% consumed non vegetarian food.Fruit consumption
was less than 3 times for 59 (54%) students and 37 (33%)
had more than 3 servings of fruits in a week,while 15(13%)
couldnt recall.Most of the students had more than 6
servings of vegetables in a week(76(68%)),while only
18(8%) consumed vegetables less than 3 times a
week.36(33%) consumed restaurant food more than 3
times a week. 49(44%) consumed junk food more than 3
times a week. 4(4%) of the students mentioned using
Even though not many students are overweight,the
trend regarding healthy eating habits was disappointing.
That along with lack of physical activity and genetic
predisposition makes them susceptible to NCDs as adults.
The students were educated about the illeffects of
unhealthy habits and NCDs in general.
Recommendations were made to the college regarding
the same. In a world plagued by non communicable
diseases,it is imperative that people inculcate a healthy
lifestyle,and that can be brought about by creating
awareness,this research aimed at doing that amongst
medical students.
Kerosene Poisoning in Children
S. Krithika*, D. Keerthana**, S.N. Rathod***
Aims & Objectives
1.
2.
To identify, the social and environmental aspects of
kerosene poisoning in children
To recommend strategies for prevention of the
poisoning in children.
Material & Methods
This is retrospective hospital record based study
conducted in a GVMCH, Vellore from Jan 2013 to May
2013. All patients of kerosene Poisoning were included
in study. Information was collected regarding history,
mode of poisoning, sex, age, domicile, family type, family
size, mother’s education, time of first aid &
hospitalization treatment, circumstances, complications
and outcome. The data has been analyzed with SSPS.
Results
31cases were included, male: female ratio was 1: 1.38,
29 (93.55%) cases falls under the age limit of 5 years.
Mother of all the children were fundamentally literate.
Rural ambiance cropped up almost 23 (74.19%) cases. 9
(29.03%) cases of poisoning were found between 8 to 11
am. All patients mother were housewives. Kerosene was
found to be stored in reused mineral bottles. Majority of
the patients have been recognized as most of those hailed
from nuclear family 26 (83.87%). The mean time interval
for first aid & hospitalization was 60.48 minutes with a
mean hospital stay of 5 day, 22 hours. Respiratory
complication developed in 2 cases (6.45%). Circumstances
of the poisoning were accidental.
Conclusions
Child less than 5 years belongs to nuclear family. All
patients mother were housewives with rural background.
They were storing kerosene in the mineral bottle and
kept unintentionally accessible to children probably not
having a LPG gas at home. This environment is most
likely candidature for accidental poisoning. Health
messages focusing on the safe storage of kerosene and
the use of child resistant containers may play a key role
in decreasing the burden of poisoning.
186
A Profile of the Organophosphorus Poisoning Cases in Southern India
D. Keerthana*, S. Krithika**, S.N. Rathod***
Background
Acute pesticide poisoning is one of the most common
causes of intentional death worldwide
Aims & Objectives
1.
2.
To identify, the social and environmental aspects of
Organophosphorus (OP)poisoning in adult.
To determine the outcome of victims.
Material & Methods
This is retrospective hospital record based study
conducted in a GVMCH, Vellore from Jan 2013 to May
2013. All adult patients of OP Poisoning were included in
study. Information was gathered regarding history, mode
of poisoning, sex, age, domicile, marital status, family
type, monthly income, time of first aid & hospitalization
treatment, circumstances, complications and outcome.
The data has been analyzed with SSPS.
Results
Seventy cases were included, male: female ratio was
1: 1.69, most cases of poisoning presented among male
age group 21-30 years 9 (35%) followed by 41-50 years 8
(31%) and, among female 21-30 years 20 (45.5%) followed
by 31-40 years 10 (23%). Highest cases were found in
married female. 37 (60%) of married female cases were
consumed poison within 10 years of married life. 28
(63.64%) females and, 25 (96.15%) males were literate.
Information about literacy status of 16 (36.36%) female
and 1 (3.85%) male were not available. Hindus were 68
(97.2%). Majority of patients were belonging from grade
4 of Prasad’s socio-economic class. Sex wise distribution
of time of consumption of the poison were studied, which
showed 23 (52.27%) female were between 4 AM to 12 PM
and, in male 18 (69.23%) between 1 PM to 9 PM. The mean
time interval for first aid & hospitalization was 50.72
minutes with a mean hospital stay of 4 day, 6hours & 47
minutes. Mortality rate was 2 (2.86%). The commonest
circumstance of the poisoning was suicide (98.6%).
Conclusions
Majority of poisoning cases were suicide attempt. The
occurrence was high in the age group of 21 – 30
years.Highest cases were found in married female.
Majority of married female cases were consumed poison
within 10 years of married life.Agriculture workers and
females are high risk groups and may be associated with
the fact that they have easy access to the poison. The
incidence of poisoning and its morbidity and mortality
can be reduced by developing and implementation of
effective prevention strategies.
Dieting in Female Medical College Students: Complete Withdrawal from Food as
Opposed to Fat Restriction for Weight Control
Gireesha Rawal
Vardhman Mahavir Medical College & Safdarjang Hospital, New Delhi, India
Background
Aims & Objectives
Dieting is emerging as the preferred mode for weight
loss among adolescent females. Despite being medical
students, the adverse effects of improper dieting may be
ignored by many. Healthy diet restriction and restriction
of majority of food components for weight loss is
perceived assimilar. Thus, often in the process of
unguided dieting, intake of even those nutrients which
are essential for health is neglected. This may lead to
various deficiencies and disorders, e.g. deficiencies of fat
soluble vitamins (A,D,E,K), osteoporosis, menstrual
abnormalities, etc.
To study the prevalence of dieting among female
medical college students and the physical and
psychological effects of dieting on the same.
Material & Methods
It is a cross-sectional descriptive type of study. 181
female students of various medical colleges of New Delhi
were enrolled in this questionnaire based study consisting
187
of questions related to dieting patterns, knowledge of
minimal essential nutrients, adequate consumption of
essential nutrients and nutrient deficiencies in dieters.
All the data obtained was recorded systematically and
analyzed using standardized statistical softwares, MSExcel and SPSS-13.
Results
Dieting behavior was reported in 42% of the study
population. The reasons for dieting were weight loss
(64.4% dieters) and peer pressure (13.2% dieters). Physical
and psychological problems were more among dieters
as compared to non dieters. With increase in duration of
dieting, significant increase was observed in physical
symptoms, e.g. joint pain (p=.013), hairfall (p=.005) and
menstrual problems (p=.001). One finding of utmost
significance was that the ratio of students having the
perception of being overweight to those who were
actuallyoverweight was significantly high in the study
population (p< 0.05).
Conclusions
This study shows that dieting is prevalent, not only
among the obese, but also among those with normal
BMI, or those who are underweight. Despite adequate
knowledge of essential body nutrient requirements, their
adequate consumption is hardly taken care of. A diet
with higher protein and reduced carbohydrates combined
with exercise additively improves body composition
during weight loss. This study will help health
professionals to educate students about modifications in
their dieting patterns, so that they can achieve body
fitness without having undue ailments.
Increasing Awareness Regarding Emergency Contraception as a Solution to Unsafe
Abortion Following Unwanted Pregnancies
Gireesha Rawal*, Jigyasa Sahu**, Anuradha Mehta***, Titiksha Goyal****, Mohit Gupta*****
Background
Unwanted pregnancy followed by unsafe abortion is
one of the major worldwide health problems,which has
many negative consequences on the health and well being
of women. Information about women’s knowledge,
attitude and practice of emergency contraceptives plays
a major role in the reduction of unwanted pregnancy.
Many misconceptions and misunderstandings abound
regarding emergency contraception.
Aims & Objectives
To assess the knowledge,attitude and practice of
emergency contraception and to further elucidate the
relationship between these factors and socioeconomic
and demographic characteristics.
Material & Methods
based methods.
Results
More than three fourth (89.6%) of the study population
were sexually active of which 27.3% had experienced
unintended pregnancies.Almost three fourth (71.5%) had
heard of emergency contraception.Only 10.4% had used
emergency contraceptives of which 30.4% had
experienced adverse effects.
Conclusions
Interventions like improving knowledge and bringing
attitudinal change on use of emergency contraception,as
well as education of masses by health facilitators about
emergency contraception,emphasizing available
methods,are necessary to tackle the aforementioned
problem.
The study was carried out among the female
population of Aliganj, New Delhi using questionnaire
188
Psychiatric Co-Morbidities in Patients with Deliberate Self Harm
Sapkota N.*, Devkota S.**, Ghimre S.***, Budhathoki R.****, Goel A.M.*****
BPKIHS, Dharan, Nepal
Aims & Objectives
To study the pattern and profile of admitted cases of
Deliberate Self harm in hospital in eastern Nepal.
Material & Methods
A hospital based retrospective study of 132 patients
admitted in Department of Internal Medicine, BPKIHS,
Nepal between Baisakh 2069-Asar 20695.
35 years old and females outnumbered males (58%:42%).
Among the 132 patients, suicide rates were higher in
married ones as compared to the unmarried. Out of 132
subjects, 71% received informal education and 6% were
uneducated. Majority of the subjects were house-wives
(40%) followed by students (20%). 28% of the subjects
had psychiatric disorders with personality disorders
being the major contributor (51%) followed by
depression (46%). Impulsive act contributed to the bulk
of the causes with interpersonal conflicts (64%) being the
major one.
Majority of the suicide attempters (79%) were less than
Spectrum of Mitochondrial Disorders in Children
Amrit Kaur Pannu
Bharaty Vidyapeeth Deemed University Medical College, Pune
Aims & Objectives
Results &Conclusions
To study the spectrum of mitochondrial disorders in
children.
Material & Methods
The spectrum of mitochondrial disorders in children,
the presentations, inheritance, diagnosis and progression
was studied in 19 subjects. This study included all patients
with Mitochondrial disease that were diagnosed in our
hospital over a period of five years.
Out of 19 patients 78% were males and 63% presented
during infancy. 100% of the patients presented with
primary developmental delay and neuro-regression.
Family history was significant in 31%. Diagnosis was
made from clinical profile, metabolic workup and MRI
Brain findings. Muscle biopsies were done when
indicated. 3 patients were diagnosed as LEIGHS, 2 as
MELAS and 1 as KSS while the others remained
unclassified.
Comparative Analysis of the Impact of Low Decibel and High Decibel Sound: Waves
on Fetal Heart Rate
Asmita Nandedkar*, Jayant Vagha**
Jawaharlal Nehru Medical College, Wardha, India
1.
Aims & Objectives
To study the effects of high decibel sound-waves and
low decibel sound-waves on fetal well beingObjective:
2.
To study the effects of high decibel sound waves on
fetal heart rate and movements.
To study the effects of low decibel sound-waves on
fetal heart rate and movements.
189
3.
To do a comparative analysis of the two above
mentioned objectives.
Material & Methods
The study will be conducted over a period of two
months from July 2012 to end of August 2012 in Jawaharlal
Nehru Medical College, Sawangi (Meghe). The proposal
has been sent to IEC and has been approved.
Study Design: Interventional
Study Group: 50 pregnant mothers
Inclusion criteria
1. Pregnant females in 3rd trimester without any
complications, like-systemic diseases or
otherobstetric illnesses
2. Those who would give consent for the study
1.
2.
Exclusion Criteria
Pregnant females who are not willing to give consent
Pregnant females with any obstetric or systemic
illnesses
Methodology
Pregnant women in their third trimester, willing to
consent and who fulfill the inclusion criteria will form
the substance of our study. Fifty such women would be
selected. They will be divided into groups, twenty-five
in each, after randomization. Their preliminary
information will be entered in the predesigned proforma
after careful history and clinical examination. The fetal
heart rate would be measured by a standard
cardiotopograph machine and the maternal perception
of the movements of every fetus will be noted before the
intervention. The mothers belonging to both the groups
will then be made to listen to music of different decibel.
Immediately after the session the fetal heart rate and
perceptions of fetal movements by the mother during
the session would be measured and would be noted down
in the proforma. At the end of the study, various
parameters would be studied depending on the objectives,
effects of high decibel sound-waves on fetal heart rate
and movements, effects of low decibel sound-waves on
fetal heart rate and movements and, the comparative
analysis of the two above mentioned objective.
To Monitor and Study the Effiency of Oral Anticoagulants in Patients of Deep Vein
Thrombosis
Chitramalya Dan
AFMC, Pune, India
Background
Deep Vein Thrombosis (DVT), a kind of Venous
Thromboembolism (VTE), is a potentially fatal disease
causing significant morbidity, mortality and expenditure.
Treatment aims at preventing the thrombus extension
and pulmonary embolism (PE) and decrease the incidence
of recurrent VTE and post-phlebitic syndrome (PPS).
Many lines of treatment were tried, however now its
dealt with heparin for a week overlapping with Oral
Anticoagulants (OACs) and once effects of these are
established OACs are continued for 3-6 months with
International Normalised Ratio (INR) monitoring. INR
is roughly the ratio of the patient prothrombin time to
the mean normal prothrombin time. The recommended
INR for prophylaxis and treatment of thrombotic disease
is 2-3. Resistance to warfarin has been described as the
inability to prolong the prothrombin time or raise the
INR into the therapeutic range (TTR) when the drug is
given at normally prescribed doses. Warfarin resistance
is very difficult to determine because it varies within a
population depending on individual dietary habits,
metabolic status let alone the genetic makeup. Warfarin
failure is also reported, defined as a new thrombotic event
despite a therapeutic prothrombin time and INR.
Moreover, warfarin differs from most other drugs in that
the dosage required to achieve a desired therapeutic effect
varies greatly among individuals, hence many patients
are also unable to achieve or maintain the target desired
INR.
Aims & Objectives
1.
2.
3.
To study the incidence of fresh thrombosis and
bleeding in patients on OACs.
To determine the baseline incidence of Coumadin
resistance and Coumadin over anticoagulation in
patients on OACs.
To study the modifiable factors associated with
Coumadin resistance and over anticoagulation in
patients on OACs.
Material & Methods
It was proposed to follow up 30 patients attending
Haematology OPD of a tertiary care centre who are kept
on OAC treatment at least once a month. On each follow
up efficacy of OAC in prevention of thromboembolic
episodes and adverse events in form of bleeding would
be studied in details and recorded.
190
Inclusion criteria
All patients on OACs would be included in the study.
Exclusion criteria
Patients with chronic kidney disease or chronic liver
disease.
Results
and is associated with significant morbidity and mortality
not only due to its thrombotic effects but also due to
complications caused from use of OACs, hence a need to
carry out a study which will try to elucidate the factors
affecting safety and efficacy of OACs. We will be
assessing the patients showing warfarin resistance or
warfarin sensitivity and thus analyse the rationale of use
of OACs as gold standard. Attempt will be done to
pinpoint the cause of occurrence and precipitation of
thrombotic episode in each case.
Yet to be tabulated; to be presented at the conference.
Conclusions
DVT is a very common disease seen in all age groups,
Melioidosis of Liver Presenting as Hepatocutanaeous Fistula: A Case Report
Rajeev Ranjan*, Sudhir Kumar**, Shailesh Kumar***, Namrata Kumari****, Anima Xess*****, S.K. Shahi******
Indira Gandhi Institite Of Medical Sciences, Patna, India
Background
Melioidosis is an emerging infection in India caused
by gram negative non -fermentative Burkholderia
pseudomallei. This bacteria is also known as Vietanami
timebomb or remarkable imitator. Infection may be acute
or chronic, localised or disseminated. Several reviews
have summarized the clinical manifestation of
meliodiosis as mild and sub clinical infection, latent
infection, clinical disease either septicaemic or localised.
Up to 80% of cases have underlying disease, most
frequently diabetes mellitus. It may involve any system
of the body namely lung, liver, spleen, kidney, prostate,
bone and joints. Visceral abscess is one of the most
common presentation in melidiosis specially splenic
involvement.
Materials & Methods
A 55 year old male presented to the emergency patient
care department at IGIMS, Patna with fever and altered
sensorium for 10 hours and pus discharging wound in
right lower rib cage for 3 years . He was a known diabetic
.He had no history of migration from endemic area. No
abnormal findings were detected on chest , cardiovascular
system and central nervous system examination except
for altered sensorium. On ultrasound a small , hypoechoic
area suggesting solitary pus collection in liver with
hepatojejunal fistula was seen. Pus from wound was
received in Microbiology laboratory. On inoculation over
blood agar, Mac Conkey agar, nutrient agar and
sabouraud agar media at 37degree C, white, dry, dull,
wrinkled colonies grew. On Ashdown’s selective medium
dry, wrinkled, purple coloured colonies grew in 48 hrs
.In Gram stain of pus smear, typical safety- pin appearance
bacilli were seen. The isolate was identified as B.
pseudomallei based on biochemical reactions, antibiotic
sensitivity test and further confirmed by Vitek-2 system.
Melioidosis is underdiagnosed in many regions since
sophisticated laboratory facilities are necessary to
confirm the diagnosis. Melioidosis should be considered
in any patient who has ever visited an endemic area,
who presents with septicaemia particularly if there is
evidence of an underlying disease such as diabetes
mellitus.
191
An Assessment of Iron Supplements in the Indian Market
Brinda Valecha*, Preeta Kaur Chugh**, C.D. Tripathi***
Background
India is one of the countries with a very high
prevalence of anemia in the world, affecting almost 75%
of the Indian population. Iron supplements are the
mainstay of therapy. They are also used for prophylaxis
of iron deficiency anemia. There is an increasing concern
over the large-scale availability of various iron
supplements as fixed dose combinations with other
vitamins/minerals/antioxidants as ‘over the counter’
agents, thereby escalating cost of treatment.
Aims & Objectives
To determine the number, composition and
pharmacological rationale of the various iron supplement
formulations available in the Indian market.
Materials & Methods
Data was collected from an annual Drug Compendium
entitled ‘THE DRUG TODAY’ of the year 2013 (JanuaryMarch). Medications were assessed for total number,
different formulations, and number of constituents
present in each formulation, their pharmacological group,
amount of each constituent and rationality.
Results
Indian market, and more than 90% of the preparations
were fixed-dose combinations (FDCs) with various
minerals and vitamins. The majority of preparations
(46%) contain carbonyl iron or ferrous sulphate. In a large
number of products, the amount of iron was not specified
(31%). The most common formulation for oral
administration was capsules (35%). Majority of the
preparations had 2-3 constituents. A wide variation in
the amount of each constituent present per dose in
different formulations was observed. Rationality
assessment of the various FDC preparations (iron with
minerals, vitamins, amino acids, antioxidants and
miscellaneous products) revealed that most of these
preparations were irrational, priced higher than single
constituent formulations and had no documented benefit
in the treatment of iron deficiency anemia.
Conclusions
The composition and amount of each constituent in an
iron supplement should be detailed and properly labelled
to ensure adequate treatment of iron deficiency anemia
and prevent toxicity due to overdose. Availability of a
large number of preparations with unknown composition
as ‘over the counter’ agents requires a serious review of
the legal provisions and regulations in India for drug
manufacturing, labeling and marketing. Strict
enforcement of such provisions is essential to safeguard
the health of the population and limit the escalating cost
of treatment of this important public health problem.
There are over eight hundred iron supplements in the
To Study Theantibiotic Sensitivity of the E.Coli, Staph. Aureus, Klebsiella,
Acinetobacter, Pseudomonas and Enterococci (ESKAPE) Organisms Isolated from the
Endotracheal Tubes from Intensive Care Units of a Tertiary Care Hospital
Syed Mohammed Bilal*, Narendranath S.**, Dinakar K.R.***, Vishwanath G.****, Somashekar H.S.*****, Pavani
S.******
J.J.M. Medical College, Davangere, India
Background
In the recent past, antibiotic resistance observed from
the isolates of the intensive care units was one of the
biggest problems faced by the clinicians. E.coli,
Staph.aureus, Klebsiella, Acinetobacter, Pseudomonas
and Enterococci (ESKAPE organisms) are the most
commonly implicated organisms when multi drug
resistant pathogens are discussed.
Aims & Objectives
To study theAntibiotic sensitivity of the E.coli,
Staph.aureus, Klebsiella, Acinetobacter, Pseudomonas
192
and Enterococci (ESKAPE) organisms isolated from the
endotracheal tubes from Intensive care units of a tertiary
care hospital.
Materials & Methods
Data was collected from the Microbiology department,
J.J.M. Medical College, Davangere, where the culture and
sensitivity was done for all the Endotracheal tube tip/
aspiration samples received from both pediatric and adult
ICUs. Prevalence of ESKAPE organisms in our hospital
and percentage of these isolates that are sensitive to the
commonly used antibiotics was analyzed.
Acinetobacter, Klebsiella, Staphalococcus aureus and
Pseudomonas constituted 89.40%. 100% of Acinetobacter
and Staph.aureus isolates showed sensitivity to
Imipenem and Doxycycline. Among Klebsiella and
Pseudomonas 85.71% isolates showed sensitivity to
Imipenem. 4.68% and 7.07% of the isolates were
Escherichia coli from pediatric and adult ICU respectively
and 100% pediatric isolates were sensitive only to
Imipenem whereas 100% adult isolates were sensitive to
Amikacin, Ceftriaxone, Imipenem and Co-amoxyclav.
Citrobacter was isolated in 2 samples each from both
pediatric and adult ICU and all of the isolates were
sensitive to Imipenem.
Conclusions
Results
122 culture and sensitivity results were analyzed in
the study. 64 of the samples were from pediatric ICU and
57 were from adult ICU. ESKAPE organisms constituted
99.18% of the total results; 96.87% in the pediatric isolates
and 98.24% in the adult isolates. Among the pediatric
isolates Klebsiella, Acinetobacter and Pseudomonas
constituted 87.48%. 100% of Acinetobacter and
Pseudomonas isolates showed sensitivity to Imipenem
and 87.50% isolates of Klebsiella sensitivity to Imipenem.
Among the isolates obtained from the adult ICU,
Among all the ESKAPE organisms, Acinetobacter,
Klebsiella, Staphalococcus aureus, E.coli and
Pseudomonas were isolated from the Intensive Care Units
of this tertiary care hospital. Resistance of these
organisms is widespread none of the commonly
prescribed antibiotics is ideal for a patient intubated in
these ICUs. Imipenem is the only antibiotic that seems
ideal which can be administered until the cultures are
reported.
A Comparative Study of Anthropometry and Risk Factors among Diabetics and NonDiabetics in Puducherry
Frank Jebanath F.*, Thiruselvakumar**, Lokesh***, Mathan Kumar****
Sri Lakshmi Narayana Institute of Medical Science , Pondicherry, India
Background
Material & Methods
Diabetes has emerged as a major healthcare problem
in India. According to Diabetes Atlas published by the
international diabetes federation (IDF) there were an
estimated 40 million persons with diabetes in India in
2007 and this number is predicted to rise to almost
70million people by 2025. Diabetes Mellitus is
multifactorial disease main risk factors include
modifiable variables like Body Mass Index (BMI), physical
inactivity, diet, infections and non–modifiable variables
like age, family history of Diabetes Mellitus.
Aims & Objectives
To assess Body Mass Index (BMI), Waist Hip
Circumference (WHR) and Waist Circumference (WC)
of known diabetics and also to compare the known risk
factors of diabetes between diabetics and non-diabetics.
Thirty diabetic patients and thirty non-diabetic healthy
persons were randomly selected from the Villiyanur
commune Panchayat of Pondicherry aged 35-70 years in
the service area of Sri Lakshmi Narayana Institute of
Medical Sciences (SLIMS) in June 2013 .They were
subjected to anthropometric analysis in the form of Body
Mass Index (BMI) ,Waist and Hip ratio. The diabetic
subjects were already “known diabetic patients”
registered for follow up in SLIMS Medical College
Hospital. Age and gender matched neighborhood
controls were selected for each known diabetics. Selection
of variable: Height, Weight, BMI, WC and WHR were
measured following the standard procedures.
Anthropometric measurements were taken with subjects
in light clothing and without shoes. Height and weight
were measured using calibrated stadiometer and portable
weighing machine respectively. The height and weight
193
were recorded to the nearest centimeters and kilograms,
respectively. BMI was calculated by dividing weight (kg)
by square of height (m2). Data was analyzed by SPSS
Version 16 using student ‘t’ test for comparing the
anthropometric variables.
Results
No statistically significant difference was observed
with respect to BMI. However there was a statistically
significant (p<0.05) when the Waist Hip ratio was
compared.
Conclusions
On calculating the Body Mass Index (BMI) and Waist
and Hip Ratio (WHR) in Thirty known Diabetic patients
where the variants of Waist and Hip Ratio are increased.
. This further strengthens the evidence that Waist Hip
ratio as a better indicator/ predictor of diabetes.
Malignant Mesothelioma with Right Pleural Effusion: A Case Presentation
Anudeep C. Kode*, Abul Fazil**
Background
Malignant Mesothelioma is an uncommon and
aggressive form of cancer that develops in the membrane
lining of visceral organs especially lungs. This tumor
occurs in men who are exposed to asbestos for over 30
years and is associated with a poor prognosis.
Case
A 57 year old gentleman presented with chief
complaints of breathlessness since 1 month. He was
admitted & found to have right pleural effusion. There
was no history of loss of weight, appetite, chest pain. No
other co morbidities were present. On examination,
patient had mild tachycardia, tachypnea, trachea shifted
to left, diminished breath sounds on right side. Patient
was diagnosed to have pulmonary tuberculosis and was
started on anti-tubercular therapy. But biopsy suggested
existence of Malignant Mesothelioma. Investigations
revealed raised serum urea, Alkaline Phosphatase and
Carcinoembryionicantigen in the late stages. Patient
showed no classical diagnostic features of mesothelioma
except for biopsy.
Pleural Fluid Analysis
Carcinoembryonicantigen
40.1 IU
Neutrophils
13 cells/mm3
Lymphocytes
83 cells/mm3
Protein
4.3g
LDH
1297 IU
Case report
Final Diagnosis: Malignant Mesothelioma with Right
Pleural EffusionTreatment: In view of Malignant Pleural
Effusion Inter Costal Drainage (ICD) was done and more
than 150ml of Pleural Fluid was drained. Pleurodesis
was done with Oxytetracycline. Opinion of Oncology
was taken and patient was planned to start on
chemotherapy. But patient who did not consent for
chemotherapy was discharged.
A Rare Parasitic Twin
V. Sudha Spandana
Background
A Parasitic twin is also known as an asymmetrical or
unequal conjoined twin. Parasitic twins occur when a
twin embryo begins developing in utero, but the pair
does not fully separate, and one embryo maintains
dominant development at the expense of the other. The
undeveloped twin is defined as parasitic and the
independent twin is called the autosite. The estimated
incidence of heteropagus parasitic twins is approximately
1 per 1 million live births. Isolated case reports comprise
most of published work on this rare congenital anomaly.
Case
A one and a half year old male child presented with
globular cystic swelling over the abdomen since birth.
Swelling was gradually increasing in size. On
194
examination swelling was covered with skin with a tuft
of hair at one end. It was extending from epigastrium up
to the umbilical region. Clinically this can be diagnosed
as umbilical hernia. Radio imaging diagnosing was
Teratoma. Surgical Excision was performed and sent for
Histopathological Examination.
Gross:A globular soft mass with a flap of skin and
umbilicus. There was a head like structure with presence
of hair on it along with upper limb buds and lower limb
ridges.
Cut section: Rudimentary structures resembling brain,
HEART, gastrointestinal system and urogenital sac were
noted.
Microscopy: Features were suggestive of ill formed
foetus of 16-18 weeks gestational age.
Investigations
The Clinical Findings: Except for the presence of swelling
the clinical and laboratory findings were normal.
Radiological Findings
Ultrasound: Multi cystic mass.
Impression: Teratoma.
CT scan: Multi cystic lesions with fat and calcification
in the upper abdominal wall.
Impression: Multi cystic calcified lesion.
Intraoperative Findings: Laprotomy was done. Findings
revealed that the mass was attached to the anterior surface
of liver.
Histopathological Findings: Rudimentary facial parts,
Foetal Liver, Foetal Intestine, Rudimentary heart with
Necrosis and Calcification at 16-18 weeks of Gestational
Age.
Treatment: Many factors weigh heavily in the decision
to pursue separation. Surgical excision is the choice for
the treatment.
Prognosis: Prognosis is good for the main child, if it
does not have any vital organ connection with the
parasite.
The conjoined twins will be very closely monitored
throughout pregnancy. Doctors work to learn as much as
possible about conjoint twins’ anatomy, functional
capabilities and prognosis after birth. This information
can help doctors form a treatment plan for twins.
Edward Syndrome with Hydrocele and Ctev
V. Sudha Spandana
Bhaskar Medical College , Hyderabad, India
Background
Trisomy 18 is second most common multiple
malformation syndrome due to chromosomal abberation
with an incedence of 1:3500 to 1:7000 newborns. This report
shows a case presentation of a 7 year old male child with
edward syndrome associated with hydrocele.
overlapping of toes in legs associated with scrotal
swelling and micropenis. Radiography revealed CTEV
of left foot. Ultrasonography concluded bilateral
hydronephrosis and chromosomal analysis confirmed
trisomy of 18th chromosome. Infant treated with ICU
care and given ventilatory support.
Case
A male child born to Mrs. Shravanti is presented on
7th day of his life with respiratory distress, abnormal
facial features, scrotal swelling and foot deformity. Birth
weight was 3 kg. Respiratory distress started at 2nd day
of birth. Microcephaly, microstomia and flattened nasal
bridge are seen. Overlapping of fingers in arms and
Edward syndrome is a condition which can be detected
before birth. Ultrasonography, amniocentesis and
chorionic villus sampling are some of the tests which
reveal edward syndrome during pregnancy. Association
of hydrocele is not so common till date and there is no
proven explanation for this association.
195
Massive Hydatid Cysts Involving Multiple Organs
Komandur Thrupthi*, U.V.N. Mahati**,V. Sudha Spandana***,T.V.S. Vaibhav****
Background
Hydatid disease is a parasitic infestation that is caused
by Echinococcus granulosis. The liver is the most
frequently involved organ (75%), followed by the lung
(15%). The solitary retro-peritoneal localization is
extremely rare, and its incidence is unknown. In our
patient, the hydatid cyst was located intra-abdomen,
retro-peritoneal, retro vesicular wall which makes this
an interesting case.
Case
A 60 year old male (Shepard) Mr. Obleshu presented
with chief complaints of breathlessness since 15 days not
associated with cough. He had abdominal pain since many
months which he cannot recall. The pain worsened in the
last 15 days. Rest of the organ systems were functioning
normal. He was suffering with similar complaints since
10 years and progressed to the present stage. No history
of hemoptysis and hematemesis. No history of vomitings
and decreased urine output.
Investigations
Routine investigations included CBP: Hb 10.5%
Upper GI Endoscopic findings revealed antral erosions,
ulcer with a clear base on the pylorus, oesophagus and
duodenum was normal.
Ultrasound abdomen and chest: Liver is enlarged in size,
shape and shows normal homogenous echo-texture.
Large exophytic heterogeneous lesion 21x12.6x14 cm is
noted arising from right lobe extending up to pelvis
region with multiple (daughter cysts) cystic area. Lesion
are causing compression on other structures with
displacement of right kidney posterior inferiorly. Lung
shows hypo-echoic cystic lesion 13x11x10 cm in the right
lung with hyper-echoic internal echoes. (hydatid cyst with
right empyema) Pancreas, gall bladder spleen were
normal in size and echotexture. CTscan of chest and
abdomen revealed hepatomegaly, multiple well defined
lobulated heterogeneous lesions predominantly
hypodense with iso hyperdense peripheral region noted
in liver and also extending into the lower abdomen on
right side.
Large well defined hypodense lesion with air fluid
level noted in right lung extending upto the apical
segments of right upper lobe causing compression and
displacement of right upper lobe bronchus.
Treatment:
1) Thoracotomy with Decortication
Indications: Right sided empyema, hydatid cyst. Entry
through 6th ICS and about 500ml pus is drained out. 6th
rib taken out and 2 ICD drains are placed.
2) Pericystectomy of liver hydatid cyst and
Marsupilisation of retrovesicular, pelvic cysts and
retroperitoneal hydatid cysts.
Indications: Multiple intraperitoneal hydatid cysts, liver
hydatid cysts, retroperitoneal cysts, right empyema.
Intra-Op findings
i)
20x10 cm single retroperitoneal hydatid cyst.
ii) 16x10 cm liver cyst.
iii) Small multiple abdominal (intra-peritoneal) cysts.
iv) 8x6 cm single retro-vesicular hydatid cyst.
Hydatid disease remains a public health problem
(endemic) in many districts in Andhra Pradesh. Liver
localizations are the most common. Lung hydatid cysts
represent 5-8% of the visceral forms of this disease. The
hydatid cyst is a life threatening disease having
considerable morbidity and mortality. A person who is
diagnosed should be treated promptly. The survival of
this patient Mr. Obleshu can be considered a great example
of how far the boundaries of modern treatment has gone
in saving the lives of common people.
196
Facebook and Other Social-Electronic Media Usage Including among Medical
Undergraduates in Puducherry
V. Nithya*, S. Vaishali**, Thiruselvakumar D.***
Sri Lakshminarayana Institute of Medical Sciences, Pondicherry, India
Background
Undergraduates enrolled in various institutes are
highly exposed to usage of internet and most of them are
having Facebook accounts. With the advent of availability
of internet as data packages in smartphone, which are
predominantly preferred by undergraduates worldwide,
Most of them are engaged in some form of media use,
particularly texting, music, the Internet and social
networking like Facebook. So far most of the Indian
studies have limited themselves to certain media such as
cellphone and internet.
Aims & Objectives
To find the quantum and quality of time spent on
various media such as internet in specific Facebook,
reading habits, listening to music, watching television
and also the quantum of time spent on cellphone related
features including calls, SMS, playing games, internet
surfing.
The study included undergraduate medical students
(>350 students) from SLIMS Puducherry. Both male and
female undergraduate medical students in the age group
of 18-20 years were enrolled in the study. A five point
Likert type Bregen Facebook Addiction Scale was used
to assess the addiction of medical undergraduates to
Facebook. Also the validated and most reliable Young’s
Internet addiction scale to assess the problematic
dependence or any addiction among the medical
undergraduates to internet in general were administered
through a self-administered questionnaire.
Results
Data analysis in progress. Frequencies, Factor analysis
and reliability analysis of Likert scale questionnaire are
being done. The total time spent on various media by
the medical undergraduates and their dependence or
addiction to Facebook or internet in general were being
analysed.
Complications
The study will document the central role of social
media in the lives of medical undergraduates. The study
indicate these forms of media are being used more on
campus, including during theory classes and clinical
postings, reducing the quality time being used for
academic purposes. Given the popularity of social
networking and internet, it is hard to reduce students’
use of these media forms. Instead, institutions should
devise methods to integrate internet and social media
into their classrooms
Mobile Phone Usage and Dependency among Medical Undergraduates in
Puducherry
S. Vaishali*, V. Nithya**, Thiruselvakumar D.***
Background
For many people now, mobile phone is essential to
their life. Young adults who are enrolled in professional
or other graduation studies in India, apart from using
cell phones for call functions and sending and receiving
SMS, often use them to play games, surf the internet, and
send/receive emails. They also prefer playing with
features on the cell phone (including reading online news
and downloading songs, wallpaper, and ring tones)
appears to have become the adolescent leisure
phenomenon in recent years. As the phones have become
cheaper and more sophisticated, sales of cell phones to
teenagers have become more common. However, as the
cell phones become more compact, concerns about
problem use are growing. To date, there has been almost
no study of whether cell phone use is addictive or
dependence-forming among medical undergraduates, a
major professional stream in India.
197
Aims & Objectives
The primary objective of the study was to assess the
cell phone usage including smartphones among the
medical undergraduates in a private medical college in
Pondicherry and to elicit any dependence or addiction
formation among them.
This cross-sectional study was carried out on
undergraduate medical students (>350 students) from
SLIMS Puducherry. Both male and female undergraduate
medical students in the age group of 18-20 years were
enrolled in the study. The instrument used were
Diagnostic and Statistical Manual of Mental Disorders
(DSM) IV modified questionnaire for mobile phone
addiction in a five point Likert scale and modified
Young’s addiction scale to assess the problematic
dependence or any addiction among the medical
undergraduates. Descriptive analysis was done for
various variables. Factor analysis and reliability analysis
of Likert scale questionnaire are being done. The
dependence and addiction were group in Inability to
Control Craving, Feeling Anxious & Lost, and
Withdrawal/Escape and productivity loss.
Results
More than 90 percent of the medical undergraduates
have a mobile phone and the predominant type of mobile
being the new breed smartphones. On an average they
use the mobile phone.
Conclusions
Today, as the capability of the cell phone becomes
sophisticated and multifunctional, young users like the
medical undergraduates are becoming increasingly
dependent or “addicted” to this technology, not only for
voice or text (such as SMS) but also as a tool for seeking
information online, for entertainment, relaxation, passing
time by playing games, picture and video taking and
other yet-to-be invented applications, and as an
expression of status and identity.
Snacking Behaviour and Their Correlates among Urban School Going Adolescents
Sibi Chakravarthy R.*, Thiruselvakumar D.**, Sinuvasan K.***, Venkatesh E.****, Kailash C.*****
Background
The rapid increase over the past three decades in the
prevalence of childhood obesity in urban areas across
India has led to increased concern about the diets of
adolescents and children. Snacking is likely to play an
important role in the development of overweight and
obesity, yet little is known about the contexts of snacking
in adolescents.
Aims & Objectives
To study the contexts associated with demographic
characteristics of adolescents and with meal skipping,
affordability and taste and presentation of food item
including advertisements promoting certain snacks.
Materials & Methods
A cross-sectional survey was administered to 564
higher secondary students in grades of eleventh and
twelfth standards. The students were drawn from 2
private higher secondary schools one from Puducherry
and another from Trichy, Tamilnadu. In order to
maximize the students’ participation, the questionnaires
were distributed in classrooms.
Results
The adolescents select snacks based on taste over
nutrition; they more often choose salty, crunchy foods as
snacks over healthier alternatives. More frequent
snacking reported among boys than girls. The most
important factor they consider while buying any snacks
is tastiness. Only 15% felt that the healthy nature of the
snacks matters for them.
Conclusions
The study suggests that adolescent irrespective of the
gender snack frequently. The increasing prevalence of
snacking has as a potentially important influence on
energy regulation in adolescents. Snacking is also
commonly associated with undesirable health outcomes
and dietary patterns. Understanding the context in which
the adolescent snack and also the covariates such as
skipping meals especially breakfast or dinner, may assist
the medical professionals in the promotion of healthy
food habits among adolescents.
198
Factors Affecting Food Choice and Attitude of Choosing Food Items among
Adolescents
Venkatesh E.*, Thiruselvakumar D.**, Sinuvasan K.***, Sibi Chakravarthy R.****, Kailash C.*****
dietary intake, food fads and factors governing their
choice of food among schoolchildren.
Background
The teenage is a period of acceptance for many
negative health behaviour including choice of sfood,
vegetable and fruit consumption, etc. Several dietary
behaviour have been linked with childhood obesity,
including increased number of meals eaten outside the
home, larger portion sizes of meals at restaurants and
fast-food takeaways, and increased consumption of
snacks and soft drinks. The ideations formed during the
mid-adolescence lead to adoption of either favorable or
unfavorable dietary pattern.
Aims & Objectives
To assess and examine the various food choices, food
fads among school going adolescents in Pondicherry and
Tamilnadu as most of them are enrolled is schools in
these states.
Results
Three fourth (74%) of the children were already
deciding on what food they consume, a major factor to
consider in theory of planned behavior model to bring
about any change in the food choice behaviour among
adolescents. More than 55 percent of adolescents were
often decide on what food they consume in the weekends,
however most of them are not able to decide at home.
Around 25 percent take less than 3 hours break between
a meal or snacks. Almost all of them have 3 divided
meals in a given day, with an option for snack once. Two
third of the adolescents did not consume any fruits in the
previous one week of the study. Only 10 percent had
consumed on more than 3 days in the last week.
Conclusions
Materials & Methods
A purposive and convenient sampling method was
employed and two private schools one each from
Puducherry and Trichy were selected. A validated foodchoice questionnaire was administered to assess the
This study further demonstrates the importance to
study the existing pattern of dietary intake to determine
the food preferences, beliefs and food fads of adolescent
school children, so as to plan an appropriate nutrition
education package in schools.
Factors Governing Healthy Eating Behaviour among Urban School Going
Adolescents
Sinuvasan K.*, Thiruselvakumar D.**, Sibi Chakravarthy R.***, Kailash C.****, Venkatesh E.*****
Background
Aims & Objectives
Children need to develop good eating habits early in
life. Overweight is a common nutrition problem among
urban children in India today, because of reduced physical
activity and faulty food habits. Healthy eating does not
become habit overnight. Eating foods of little nutritional
value such as candy, cookies, chips, savories, and soft
drinks contributes empty calories to the diet. This usually
prevents children from being open to eating the wide
variety of foods needed for growth and good health.
To study the factors governing ‘Healthy Eating’
behaviour among urban school going adolescents.
Materials & Methods
Five hundred and sixty four children between 14 – 18
years of age belonging to 11th and 12th grades from two
higher secondary schools one each from Puducherry and
199
Trichy, Tamilnadu, were enrolled and administered a
questionnaire on ‘healthy eating’ and their choice of food
items. They were also asked about the food items usually
involved in weight gain, meal skipping, and socialization
and food choice.
Results
percent felt that it is easier for them to consume fruits or
vegetables regularly. Another variable to consider is that
more than sixty percent of the adolescents do decide to
order only “half portion” of what they usually eat at
home, while they have to eat out.
Conclusions
Half of adolescent think that “eating out” is a healthy
habit and 27% of them strongly believe in “eating out” is
healthy. On the contrary, 60 % agree with the fact that
consumption of outside food has higher risk of food
poisoning. More than 60 percent of adolescent school
children feel that all healthy foods should be tasteful.
Only five percent feel that is fairly difficult to consume
fruits or vegetables in their regular diet. In fact, seventy
Though many adolescents were snacking and eat too
much during socialization events, most of them exhibit
the understanding of healthy food as a choice. They prefer
to take their own decisions regarding choice of food items,
which is a major factor in utilizing the theory of planned
behaviour is formulating various health promotion
events regarding healthy eating and livelihood.
Megha Dogra*, Punit Kumar**, P.C. Negi***
Primary Health Centre , Banikaht Distt. Chamba Hp, Dalhousie, India
Aims & Objectives
To study the Clinical characterstics and outcome of
ACS patients.
Materials & Methods
Clinical characteristics, management practices and
Inhospital outcome of ACS are reported from hill station
of HP. Data of 299 consecutive cases of ACS diagnosed
using standard criteria admitted in IGMC hospital Shimla
from 12 Nov. 2012 to 30 may 2012 were prospectively
recorded and analyzed. Patients of ACS were grouped
into STEME and NSTEMI (NSTEMI and Unstable angina).
154 (51.5%) were STEMI 145 (48.5) were NSTEMI.
Results
The mean age was (59.6±29.7) Patients with STEMI (59.6
± 12.7) and NSTEMI (59.4 ± 12.6) P value .05. Males formed
73.2% (219) of the ACS while 26.8% (80) were female.
Mean age of the men and women with ACS was 59±13 vs
62±12 (p value- .02). Proportion of ACS cases from urban
and rural were 36.1% vs.63.9% Median pre hospital delay
was 13 hours (10 min to 11 days). Only 36.4% reported
within 6 hours of symptom onset. Prevalence of
hypertension, Diabetes and tobacco consumption were
46.8 %, 23.1%, 64.2% respectively. Distribution of
hypertension, Diabetes and tobacco consumption among
STEMI and NSTEMI patients were 41.6 % vs 52.4%, 22.7%
vs 23.4% and 66.9% vs 61.4 % respectively with p value.03,
.4, .1. Only 31.2% of STEMI patients received reperfusion
therapy, 29.9% Thrombolytic and 2.7% Primary PCI. The
reason of not receiving thrombolytic therapy was
primarily due to late reporting 52.4%. Percentage of
patients who receive ASA, Clopidogrel, Statin, BB
Blockers and ACE inhibitors/ARB were 100%, 96.3%,
93.6%, 91%, 91.6% respectively. In hospital mortality was
11.7%. Inhospital mortality among patients of STEMI and
NSTEMI was 16.2% vs. 6.9% respectively with p value .006)
Conclusions
A considerable proportion of patients with ACS were
tobacco consumer, hypertensitive, diabetic. Proportion
of males affected considerably more than females, also
males were affected at younger age. There are certain
proven therapeutic reperfusion therapies (thrombolysis,
PCI ) that remain underused due considerable prehospital
delayed accounted by hilly terrain and non availabilty
of adequate medical facilities at primary level and
ignorance of symptoms. A more widespread awareness
of these risk factors and a more diligent use of treatment
approaches at primary level can considerably improve
outcome of ACS patient.
200
To Study the Correlation between Abnormalities in Lipid Profile and Severity and
Disease Activity in Rheumatoid Arthritis
Abhishek Mittal
Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi, India
Background
Rheumatoid Arthritis (RA) is a chronic systemic
inflammatory disease that primarily affects peripheral
synovial joints and is characterized by joint swelling,
joint tenderness and leads to destruction of the affected
joints. However, persistent uncontrolled inflammation
among poorly managed patients may cause several
complications in RA known as extra-articular
manifestations. RA is a common disease which affects all
populations of the world though the prevalence varies
in different populations. In a recent study the incidence
of RA was found to be 1 %. Recent studies have shown
that the cardiovascular disease plays an important role
in increased mortality associated with RA. The excess
cardiovascular disease encountered is believed to be due
to the contribution of traditional risk factors (e.g.
dyslipidemia, smoking, obesity, hypertension) as well
as due to novel risk factors (e.g. systemic
inflammation).In various studies it has been documented
that lipid profile in RA is adversely affected. In general
most studies have demonstrated a decrease in HDL –
Cholesterol (HDL-C), while the effect on LDL-Cholesterol
(LDL-C) has been found to be variable. The present study
is being conducted as there is paucity of data on
prevalence of lipid abnormalities in patients of
rheumatoid arthritis in Indian literature. Lack of extensive
research in this field necessitates further studies to
establish a definitive conclusion in the Indian population.
Aims & Objectives
To study the correlation between abnormalities in
lipid profile and severity and disease activity in
Rheumatoid Arthritis.
subjected to detailed clinical history and examination
with special emphasis on evaluation for swollen joint
count and tender joint count. All patients underwent the
following investigation: Hemoglobin, TLC, DLC, ESR,
Platelet count, Blood glucose fasting, C-Reactive Protein
(CRP), Rheumatoid factor (RF), Lipid profile. Disease
Activity Score – DAS 28 was calculated for each patient.
Correlation between variables i.e. lipid profile indices
and DAS 28 score, CRP and ESR was examined using the
Pearson’s correlation coefficient (r) and ANCOVA test .
To find out the significance of Pearson’s coefficient value,
student-t test was used, and a p value of less than 0.05 was
considered statistically significant.
Results
The mean age of patients was 44.6 ±12.6 years. Out of
30 patients, 23 (76.66%) were females and 7 (23.33%) were
males.Number of swollen and tender joints in individual
patients varied from 0 to 16 and 0 to 23 respectively, out
of maximum possible score of 28. Value of DAS 28 score
varied in patients from 1.97 to 7.38 with mean of 4.72 ±
1.40.Value of atherogenic index varied from 2.4 to 14.4
with mean of 4.61 ± 2.21 which was on a higher side. DAS
score was statistically significantly correlated with serum
HDL cholesterol. While other lipid profile indices such
as serum LDL cholesterol, serum triglyceride, serum
VLDL cholesterol and atherogenic index did not have
significant relationship with DAS score. Pearson’s
correlation coefficient value ranged from -0.19 (serum
total cholesterol) to 0.26(serum VLDL and triglyceride)
for different lipid indices but none of the values was
statistically significant.CRP values in our study did not
correlate significantly with any of the lipid indices.
Conclusions
Materials & Methods
Thirty patients of Rheumatoid Arthritis satisfying The
2010 American College of Rheumatology –European
League Against Rheumatism (ACR/EULAR) classification
criteria were enrolled in the study. The study included
all patients of Rheumatoid Arthritis irrespective of their
treatment or remission status. The patients were
Rheumatoid arthritis is dyslipidemic state. There is
significant inverse correlation between serum HDL
cholesterol level and disease activity. There is no
significant relationship between disease activity and
levels of serum cholesterol, serum LDL cholesterol, serum
VLDL cholesterol, serum triglyceride level and
atherogenic index.
201
Megha Dogra*, Punit Kumar**, P.C. Negi***
Indra Gandhi Medical College and Hospital, Shimla, India
Aims & Objectives
To study the Clinical characterstics and outcome of
ACS patients.
Materials & Methods
Clinical characteristics, management practices and
Inhospital outcome of ACS are reported from hill station
of HP. Data of 299 consecutive cases of ACS diagnosed
using standard criteria admitted in IGMC hospital Shimla
from 12 Nov. 2012 to 30 may 2012 were prospectively
recorded and analyzed. Patients of ACS were grouped
into STEME and NSTEMI (NSTEMI and Unstable angina).
154(51.5%) were STEMI 145(48.5) were NSTEMI.
Results
The mean age was (59.6±29.7) Patients with STEMI (59.6
± 12.7) and NSTEMI (59.4 ± 12.6) P value .05. Males formed
73.2% (219) of the ACS while 26.8% (80) were female.
Mean age of the men and women with ACS was 59±13 vs
62±12 (p value- .02). Proportion of ACS cases from urban
and rural were 36.1% vs.63.9% Median pre hospital delay
was 13 hours (10 min to 11 days) .Only 36.4% reported
within 6 hours of symptom onset . Prevalence of
hypertension, Diabetes and tobacco consumption were
46.8 %, 23.1%, 64.2% respectively. Distribution of
hypertension, Diabetes and tobacco consumption among
STEMI and NSTEMI patients were 41.6 % vs 52.4%, 22.7%
vs 23.4% and 66.9% vs 61.4 % respectively with p value.03,
.4, .1. Only 31.2% of STEMI patients received reperfusion
therapy , 29.9% Thrombolytic and 2.7% Primary PCI. The
reason of not receiving thrombolytic therapy was
primarily due to late reporting 52.4%. Percentage of
patients who receive ASA, Clopidogrel, Statin, BB
Blockers and ACE inhibitors/ARB were 100%,
96.3%,93.6%,91%,91.6% respectively. Inhospital mortality
was 11.7%. Inhospital mortality among patients of STEMI
and NSTEMI was 16.2% vs. 6.9% respectively with p value
-.006).
Conclusions
A considerable proportion of patients with ACS were
tobacco consumer, hypertensitive, diabetic . Proportion
of males affected considerably more than females , also
males were affected at younger age. There are certain
proven therapeutic reperfusion therapies (thrombolysis,
PCI ) that remain underused due considerable prehospital
delayed accounted by hilly terrain and non availabilty
of adequate medical facilities at primary level and
ignorance of symptoms. A more widespread awareness
of these risk factors and a more diligent use of treatment
approaches at primary level can considerably improve
outcome of ACS patient.
Behavioral and External Factors Influencing Food Preference Among Adolescents
Kailash C.*, Thiruselvakumar D.**, Sinuvasan K.***, Venkatesh E.****, Sibi Chakravarthy R.*****
Background
The eating behaviour of adolescents had become
increasingly under spotlight in recent years I India, amid
claims that many adolescents have a poor diet. Irregular
meal pattern and skipping meals are common among
adolescents in school going age group. Their food
preference and the food fads are mainly formed by the
environmental stimuli such as siblings, television
advertisements, classmates, social gatherings, etc.
Aims & Objectives
predictors and influencing factors of their eating practices
need to be known to formulate targeted approach in
healthy eating.
Materials & Methods
A cross-sectional survey of 564 higher secondary
students from 2 private higher secondary schools one
from Puducherry and another from Trichy, Tamilnadu
was done using a self-administered questionnaire
designed to find and assess the various food preferences
and factors governing them among school going
adolescents.
To study the attitudes of food preference and the
202
Results
Around 25 percent take less than 3 hours break between
a meal or snacks. Almost all of them have 3 divided
meals in a given day, with an option for snack once. Two
third of the adolescents did not consume any fruits in the
last week. More than 55 percent of adolescents were often
decide on what food they consume in the weekends,
however most of them are not able to decide at home.
Only 18 percent of children were able to control
themselves from consuming too much of chocolates,
sweets, savories or snacks. Fifty percent of the adolescents
agreed to the fact they often eat too much on socializing
events or functions. Only around 20 percent of them feel
that the food preference is dependent of the family
members or people whom they live with currently.
Conclusions
The preference for various food items for consumption
by adolescents provides a gateway for medical fraternity
in framing guidelines regarding healthy eating behaviour
apart from methods to promote physical activity.
The Latest Modes of Diagnosis, Management and Prevention of Acute Meningitis
M. Tasdik Hasan*, Muhammad Yameen Hamid**, Anindita Ghosh***
Shaheed Suhrawardy Medical College, Dhaka University, Dhaka, Bangladesh
Background
Meningitis is an acute inflammation of leptomeninges
and CSF caused by mainly bacteria, virus and less
commonly fungus which has 50% case fatality rate if
untreated. The most common symptoms are a stiff neck,
high fever, sensitivity to light, confusion, headaches and
vomiting. Meningitis is potentially fatal and should
always be viewed as a medical emergency. Thus early
diagnosis and effective management of suspected cases
of meningitis will lead to significantly reduction in
mortality.
Aims & Objectives
To study the latest modes of diagnosis and treatment
have been discussed along with preventive measure.
Materials & Methods
This study was done by reviewing 15 journals, online
clinical articles and clinical books from June, 2013 to July,
2013.
Results
In laboratory investigation, CSF profile shows
different characteristics in bacterial and viral etiology.
CSF pressure is elevated with low glucose level; high
protein level and predominant neutrophil in bacterial
cause. In viral cause pressure is almost normal,
lymphocyte is predominant, glucose and protein levels
are normal. PCR and ICT detecting bacterial DNA show
100% specificity. CT or MRI is not diagnostic usually.
The latest treatment plan includes empiric therapy,
specific therapy, adjunctive therapy by Dexamethasone,
outpatient antimicrobial therapy & antiviral therapy and
treatment of special situation. Empiric antimicrobial
therapy should be started as soon as possible after
diagnosis proven or suspected. Specific therapy depends
on Gram’s staining and culture of CSF. Ciprofloxacin is
used successfully in multidrug resistant gram-negative
bacilli. In HSV, VZV and CMV meningitis acyclovir and
ganciclovir is given. Dexamethasone is effective in
bacterial meningitis as adjunctive therapy. In special
situation as in fulminant meningococcemia
benzylpenicillin is drug of choice, in increased ICP
mannitol is administered and patient is monitored ICU.
Vaccines that are available to control the disease are
meningococcal A conjugate vaccine, C conjugate vaccines
(MCV4), tetravalent A, C, Y and W135 conjugate vaccines
and meningococcal polysaccharide vaccines.
Meningococcal A conjugate vaccine elicited a stronger
response to group A antibody than the tetravalent vaccine.
Conclusions
Early recognition and initiation of appropriate empiric
therapy can reduce the mortality to 10%. If rapid and
specific identification of the etiologic agent is done and
adjusting therapies are given as indicated, it will
efficiently manage a patient with meningitis. Optimize
management is possible in complicating features.
Prevention can be done in epidemic areas by proper
vaccination mentioning MCV4 and HIB vaccine.
203
Diagnostic Value of Alvarado Scoring System
S.M. Tajdit Rahman*, Sazid Rezwan**, Tamanna Bintay Ahmed***
Sir Salimullah Medical College, Dhaka, Bangladesh
Background
Misdiagnosis of acute appendicitis is a problem
encountered in general surgery. There are different
scoring systems for its diagnosis. Alvarado Score was
suggested for diagnosis of Acute Appendicitis but this
criterion ignores some factors such as age, gender and
race.
Aims & Objectives
To evaluate the diagnostic value of Alvarado scoring
system in reducing the percentage of negative
appendectomy in our setup.
Materials & Methods
This study was conducted in Sir Salimullah Medical
College and Mitford Hospital. A cross-sectional study
comprising 220 patients suspecting acute abdomen,
admitted in the surgical unit 1,2 & 3 of our setup was
conducted over a period of one year. Patients of both
sexes were included in the study and their Alvarado scores
calculated, on the basis of which patients were divided in
two groups: Group A (with score <7) and Group B (with
score e”7). The signs, symptoms, laboratory values,
surgical interventions and pathological reports of each
patient were evaluated. Histopathological examination
was considered as gold standard of diagnosis. Sensitivity,
specificity, positive and negative predictive values were
calculated.
Results
Out of total 220 cases (139 males, 71females), 62
belonged to Group-A (28.2%) and 158 belonged to GroupB (71.8%). Surgical procedures were performed in 98.2%
of cases. Final diagnosis by histopathology was
confirmed in 154 cases (71.3%). The overall negative
appendectomy rate was 28.7% (males: 28.2%, females:
30%). Sensitivity and specificity of Alvarado scoring
system was found to be 93.5% and 80.6% respectively.
Positive and negative predictive values were 92.3% and
83.3% respectively and accuracy was 89.8%.
Conclusions
Alvarado score can be used effectively in our setup to
reduce the incidence of negative appendectomies. It helps
to make prompt decision in suspected cases. However,
its role in females was not satisfactory and needs to be
supplemented by other means. Alvarado scoring system
should be used in clinical practice for determining the
most probable management option in patient with
different scores and clinical suspicion.
Comparative Study of Level of Awareness on Hepatitis B Infection among First Year
Medical and Nursing Students of Indira Gandhi Institute of Medical Sciences, Patna
Ranjan Rajeev*, Kumar Sanjay**, Sinha Setu***
Indira Gandhi Institute Of Medical Sciences, Patna, India
Background
Hepatitis B virus (HBV) infection is a global public
health problem. More than 2 billion people worldwide
have evidence of past or current HBV infection and 350
million are chronic carriers of the virus, which is
harboured in the liver and causes an estimated 600,000
deaths from cirrhosis of liver and Hepatocellular
carcinoma.
Aims & Objectives
with respect to Hepatitis B infection among first year
medical and nursing students at IGIMS, Patna.
Material & Methods
A pre designed, pretested, anonymous, self
administered, semi structured questionnaire containing
a set of 26 questions was circulated to obtain responses
from the available 84 & 33 first year MBBS and nursing
students respectively of IGIMS, Patna during June 2013.
Data entry and analysis were done using MS excel.
To determine the level of knowledge and awareness
204
infection in contrast to 81% medical students.
Results
The majority (84.61%) of medical and nursing students
were aware that Hepatitis B is the major cause of Hepatitis.
The study shows that about 80.95% medical students were
aware that HBV may be transmitted through semen in
comparison to only 54.5% nursing students. The
awareness regarding high risk categories like truck
drivers and male homosexuals was seen more amongst
the medical students (67.9%) who considerably
outnumbered the nursing students (39.4%) in this respect.
However, transmission of infection through vaginal
secretions was reported by 67.85% of medical and 75.8%
nursing students. Also, a larger number of nursing
students (78.8%) reported that HBV transmission may
occur through breast feeding in comparison to 64.3% of
medical students. Despite the fact that 89.3% of medical
and 96.9% of nursing students were already immunized
against Hepatitis B Virus, only 75.8% nursing students
were willing to attend to patients suffering from HBV
Conclusions
In the first year of their respective academic
curriculums, both the medical and nursing students
showed variable levels of awareness pertaining to the
various aspects of Hepatitis B infection. While on one
hand they exhibited good knowledge regarding the mode
of transmission and high risk behaviour, misconceptions
seemed to exist with respect to prophylaxis, vaccination
and treatment of HBV. It is thus, very important to focus
on the need to improve the knowledge and attitude of
the future doctors and nurses towards Hepatitis B for
better professional approaches in the times to come.
Keywords: Hepatitis B; Awareness, Transmission,
High risk category.
Pediatric Developmental Delay: Spectrum of MR Findings
Najmal Nazeer*, S. Lalwani**, Kavita Srivastava***
Bharati Vidyapeeth Deemed University Medical College, Pune, India
Aims & Objectives
To study spectrum of findings on MR in developmental
delay.
Materials & Methods
A hospital based retrospective study was done over a
period of 1 year (June 11–June 12) with patients in
pediatric age group (Birth–18 years), presenting with
history of developmental delay primarily or secondarily
in association with other presenting complaints who
underwent MR brain with/without contrast. Sedation
was used wherever necessary under the care of anesthetist.
The results were tabulated into columns of age, sex ,
presenting complaints and summary of findings on MR.
The results were interpreted statistically.
commonly encountered abnormality was periventricular
leukomalacia with / without thinning of corpus callosum.
Widening of CSF spaces was also seen. Other less
commonly encountered causes were TORCH infections,
Rasmussen’s encephalitis, Kearne Sayre syndrome,
semilobar holoprosencephaly and lissencephaly.
Conclusions
Developmental delay encompasses etiologies with
varying imaging findings which pose a challenging task
for a radiologist and pediatrician. The underlying cause
remains a mystery despite extensive clinical examination
and laboratory investigations.What happens to a child
in the early years of neurodevelopment stays forever.
MR imaging gives a leading insight into ongoing
pathological changes in the brain and helps narrow down
the possibilities for initiating timely treatment.
Results
A total of 75 patients were studied on MR. The most
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NSAID Induced Acute Kidney Injury in Preterm Neonates with Patent
Ductusarteriosus
Naved Anjum Qureshi*, V.R. Kalrao**, S.K. Lalwani***, J.V. Sharma****
Bharati Vidyapeeth Deemed University and Medical College, Pune, India
0.5mg/dl.
Background
The standard care for patent ductus arteriosus (PDA)
closure in preterms is
by cyclo-oxygenase inhibitors
i.e. non-steroidal anti-inflammatory drugs (NSAID)
indomethacin or brufen. Administration of NSAIDs may
precipitate acute kidney injury (AKI).
Aims & Objectives
To study neonates with NSAID induced AKI.
Materials & Methods
Retrospective review of case records of 1 year of
preterms who received NSAIDs for PDAclosure. Data
collection included maternal history and neonatal details
of gestational age, gender, weight, intake, urine output,
serum biochemistry, presence of sepsis, use of
nephrotoxic drugs. AKI was diagnosed if there was a fall
in urine output <1ml/kg/hr or rise in creatinine of >
Results
Thirty one preterms received NSAIDs for PDA closure.
All received aminoglycoside as per NICU protocol, none
had sepsis prior to study drug administration and
received fluids as per the recommendations for
gestational age and day of life. None of the mothers had
risk factors for neonatal AKI.Eight(26%) developed AKI;
low urine output in 5 (16%), high SCr was in 5 (16%),
both were affected in 2 (6.4%) . 5 were discharged when
SCr showed a falling trend, 1 was discharged against
medical advice and 2 died.
Conclusions
Our observations of NSAID use in preterms reiterates
that AKI is a risk hence renal function should be closely
monitored.
Clinical Features and Management of Two Rare and Interesting Pediatric Oncology
Cases at Our Institute
Naved Anjum Qureshi*, Vibha Bafna**, Shashank Shrotriya***, Vijay Kalrao****, Sanjay Lalwani*****
Aims & Objectives
To describe clinical features and management of two
rare and interesting Pediatric oncology cases admitted
in our institute.
Materials & Methods
Case 1 is a case of Wilms tumour with thrombus in the
IVC extending upto right atrium managed with the help
of cardiothoracic surgeons. Case 2 is a case of malignant
histocytosis.
tumour thrombosis of left renal vein and inferior vena
cava till the right atrium. He was given neoadjuvant
chemotherapy and later underwent nephrectomy and
removal of the tumour thrombosis from the IVC and
right atrium with the child on heart lung machine. This
was followed by radiotherapy and chemotherapy and is
well now.
Case 2
A 3 year old child with high grade fever,
hepatosplenomegaly, lymphadenopathy and pancytopenia. He had HLH in bone marrow and lymph node
biopsy. Morphology and IHC of the lymphnode showed
evidence of malignant histiocytosis, which is an
extremely rare entity in children. The child succumbed
to the illness.
Case 1
A 8 yr old male presented with Wilms tumour and
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Retrospective Study of Short Term Mortality and Morbidity in Very Low Birth
Weight Babies
Dinesh M.*, Pradeep Suryawanshi**, Sanjay Lalwani***
Background
Outcomes of very low birth weight (VLBW) infants
have improved after improvement of medical care.
Aims & Objectives
To study mortality and morbidity in VLBW babies
before discharge in our NICU.
Materials & Methods
Retrospective data collection was done from case
records of all VLBW admitted in NICU from 01-01-2010
to 31-10-2012. Data was collected for gestational age (GA),
birth weight (BW) and morbidities like retinopathy of
prematurity (ROP), patent ductus arteriosus (PDA),
intraventricular haemorrhage (IVH) , respiratory distress
syndrome (RDS), necrotising enterocolitis (NEC), culture
proven sepsis and mortality. Data was analysed with
SPSS software.
Results
Data of 369 babies was analysed. Mean gestational
age was 31.89 weeks+ 2.63. Mean birth weight was
1.25kg+0.16. Multiple birth composed 22.7 % of total
infants and 20.3 % were twins and 2.4% were triplets.
RDS was diagnosed in 50%. PDA was diagnosed in 27.8%
babies and all received treatment. Incidence of all grades
of IVH was 18.5%. Incidence of other morbidities was
like ROP (12%), NEC (1.8%) and culture proven sepsis
(10.9%). Overall mortality was 8.4%.
Conclusions
There is significant decrease in morbidities like RDS,
PDA, IVH/PVL, ROP and NEC. Increasing trends are seen
in sepsis. Overall mortality shows rising trends. Probable
causes can be increasing sepsis and increasing number of
admissions of babies with birth weight <1kg.
Hemophagocytic Lymphohistiocytosis: A Life Threatening Rare Entity
Najmal Nazeer*, V. Bafna**, V. Kalrao***
Bharati Vidyapeeth Deemed University Medical College, Pune, India
with the established criteria at our institution:
Background
Hemophagocytic Lymphohistiocytosis (HLH) is a rare
disorderofthe immune system,affecting macrophages
that grow abnormally and accumulate in body organs
which include liver, spleen, bone marrow, CNS and skin.
There are 2 types of HLH:
Primary: An inherited condition where there is a
genetic mutation in:
• Perforin (PRF-1)
• Gene encoding Munc 13-4 protein which alters the
NK & Tcell function.
Secondary: Triggered by infections (viral, bacterial,
fungal), autoimmune disorders, primary immune
deficiencies or cancer.
Materials & Methods
Case 1
4 year old boy, case of Griscelli Syndrome with
hypopigmented hair came with recurrent episodes of
fever, bilateral ear discharges and abdominal distention
since past 2 years, presented with significant pallor with
moderate hepato-splenomegaly.
Case 2
3 year old boya case of Malignant Histiocytosis with
fever and severe pancytopenia presented with significant
hepato-splenomegaly and lymphadenopathy.
Case 3
4 year old boy, with massive hepatosplenomegaly with
severe anemia and fever since 1 month, presented with
abdominal distention, pallor and seborrhoeic dermatitis.
Hereby we are presenting 3 cases of HLH, diagnosed
207
as per HLH 2004 protocol.
All our 3 cases were investigated, and satisfied the
diagnostic criteria of HLHand were started on treatment
Clinical Profile of Type I Diabetes Mellitus Children
Bhakti Sarangi
Background
Aims & Objectives
To study the clinical profile of children with Type I
Diabetes.
Materials & Methods
This is a Cross sectional observational study conducted
at Pediatric out-patient department of Bharati hospital,
Pune. Children aged 6 months to 18 years with Type I
DM w ere recruited over a study duration of 22 months.
The children were assessed for signs and symptoms of
Diabetes, glycemic control, growth and vital parameters
and insulin requirement.
Results
Of the total 50 children enrolled in the study, maximum
(60%) presented between the age of 10-15 years. Polyuria
was the commonest symptom at onset being present in
all 50 cases (100%). 42 of the 50 patients (84%) presented
with diabetic ketoacidosis. Children who monitored
sugars only weekly and had poorer glycemic control. 5
out of the 50 cases had developed microalbuminuria,
their average duration of illness being 5 years and average
HbA1c being 9.96.
Conclusions
Type 1 Diabetes is the commonest endocrine disorder
of childhood with peak age of onset being in the preadolescent age groups with no sexual preponderance.
The commonest symptom of Type 1 Diabetes is polyuria
with a significant number of patients presenting with
Diabetic ketoacidosis. Poor glycemic control has a direct
effect on development of complications including
impaired growth velocity and early changes of diabetic
nephropathy.
Changes in Bone Mineral Density in Patients with Type 1 Diabetes Mellitus
Abhishek Mittal
Vardhman Mahavir Medical College & Safdarjung Hospital, New Delhi
Background
Materials & Methods
Diabetes Mellitus is a chronic hyperglycemia
condition caused by absolute or relative insulin
deficiency. In the course of the disease, metabolic changes
occur affecting building blocks of fats, proteins and
electrolytes especially calcium. Dexa machines allow
early diagnosis and monitoring of minimal changes of
1%. Prolonged bad glycoregulation induces metabolic
acidosis in patient with diabetes mellitus, which may
cause disturbance in calcium metabolism.
The study includes 108 patients with Diabetes Mellitus
Type1. There were 50 women and 58 men, mean age was
31.4 years and disease duration of 9.7 years, all treated
with insulin. In the control group was 80 healthy subjects,
40 men and 40 women, mean age was 33.8. The study
included clinical assessment, laboratory research,
hormone analysis, bone densitometry.
Aims & Objectives
To assess changes in bone mineral density in patients
with Type1 diabetes,thus establishing a relationship
between Osteoporosis and Diabetes Mellitus Type1.
All parameters were normal in control group.In the
group with DM1,values of glucose, cholesterol and
triglyceride levels exceed the upper limit of normal
values. The values of PTH, Estradiol, Calcium, Phosphorus
Results
208
and Phosphatase were lower in the experimental group
(p<0.001). In the group of the patients with DM1 ,values
of bone mineral density were 1.114 gr/cm2 ,SD was 0.142.
density of patients with this form of DM. Changes in
bone mineral density in correlation with gender shows a
significantly greater loss in females.
Conclusions
DM1 leads to significant changes in bone mineral
To study Extended Spectrum Beta-Lactamase Producing Organisms in Neonatal
Septicemia in a Tertiary Care Hospital
Rajdeep Singh*, K.J. Ghosh**, R. Singh***, A. Ray****
Mata Gujri Memorial Medical College, Kishanganj, India
Background
Neonatal mortality in developing countries accounts
for 30 – 50 % of infant deaths. Almost 20% of neonates
develop sepsis and 1% die of sepsis related causes.
Frequently isolated causative pathogens (Klebsiella
pneumonia, Staphylococcus aureus, Pseudomonas, etc)
known to be ESBL (Extended Spectrum Beta-Lactmase)
producers are resistant to third generation
cephalosporins, penicillins as well as to monobactams.
The rampant irrational use of ordinary and high end
antibiotics is responsible for this bacterial resistance.
Aims & Objectives
To study micro-organisms and prepare an effective
antibiogram policy to serve the helpless neonates.
Materials & Methods
biochemically. Antibiogram test was done with Extended
Spectrum antibiotics - cefpodoxime, ceftazidime,
aztreonam, cefotaxime, ceftriaxone. Cefotaxime or
ceftazidime disks with or without clavulanate were used
for phenotypic confirmation as advocated by CLSI. A
difference of >5mm between the zone diameter of either
cepahlosporin disk and its respective cephaoshorin/
clavulanate disk was taken as phenotypic confirmation
of ESBL production.
Results
16% of 50 samples showed positive cultures, 75% were
gram negative and rest gram positive organisms. 25% of
culture positive isolates were ESBL producer, Klebsiella
spp. and E.coil being 12.5% each. All mentioned antibiotics
were resistant to these ESBL producers. ESBL production
was confirmed by phenotypic confirmation.
Conclusions
Fifty suspected cases from Neonatal intensive-care unit
(NICU) were selected on the basic clinical features based
on Early and Late Onset Sepsis. 1-ml aseptically drawn
venous blood incubated in 9-ml of Brain-Heart Infusion
broth at 37°C for seven days, was observed for growth
and sub-cultured on Blood agar and MacConkey’s
medium. Any organism from sub-culture was identified
In presence of high resistance it becomes imperative
to detect resistance patterns against different antimicrobial agents, for the septic neonates in NICU. With
increasing levels of resistance, a careful and constant
monitoring of antibiotic usage at regional and national
level is sought.
Syndromic Deafness-Variant of Waardenburg Syndrome
Vini Balakrishnan*, B.P. Belaldavar**
JN Medical College, Belgaum, India
Background
Deafness in children is alarming and a cause of worry
to near and dear ones. EBM documents that serious
hearing impairment is found in one in 800 newborns.
Amongst the 50 percent of permanent childhood deafness,
30 percent is syndromic and is thought to be because of
abnormal genetic makeup. Syndromic cases of deafness
are more accurately diagnosed by the associated
additional features of the syndrome. Waardenburg
209
syndrome is a rare, autosomally inherited disorder with
distinct clinical manifestations of dystopia canthorum,
white forelock, congenital hearing loss and
heterochromia iridis.
Aims & Objectives
Syndromic Deafness-Variant of Waardenburg
syndrome.
with Waardenburg syndrome.
Herewith, we are reporting 2 siblings who presented
with deaf mutism and with clinically significant notable
variations suggestive of a rare presentation of type 1
and type 2 Waardenburg syndrome in the same family.
Keywords: Waardenburg syndrome; Deaf mutism;
Syndromic deafness.
Materials & Methods
A study of deaf mutism in 2 siblings, who presented
Spindle Cell Hemangioma: Case Report of a Rare Presentation of a Rare Tumour
Anil Harugop*, Vini Balakrishnan**, Lavanya Naidu***
JN Medical College, Belgaum, Belgaum, India
Background
Spindle Cell Hemangioma (SCH) is a vascular tumour
first described in 1986 by Dr. Sharon Weiss. It was initially
considered to be a low grade malignant tumour due to
its propensity for lymph node metastasis and recurrance
after excision. But due to its excellent prognosis, it is now
considered to be a benign tumour. It shows a male
preponderance with the most common site affected being
distal extremities. SCH is a pathological diagnosis with
combined features of Cavernous Hemangioma and
Kaposi’s sarcoma on histology.
Aims & Objectives
Spindle Cell Hemangioma-Case Report of a rare
presentation of a rare tumour.
progressive unilateral nasal obstruction and unilateral
epistaxis. A thorough medical history and clinical and
endoscopic examination was done. Extent of lesion was
confirmed radiologically with MRI. Mass was completely
excised and specimen sent for histopathological analysis
following which the diagnosis of Spindle cell
hemangioma was established.
Conclusions
SCH is documented to have a male preponderance,
however, our patient was a female. This report is the first
presentation of SCH in the nasal cavity. Histology is the
mainstay of diagnosis. Hence, clinical diagnosis,
especially with presentation in unusual sites maybe
challenging. High degree of suspicion is necessary for
early diagnosis and appropriate treatment.
Materials & Methods
A 25 year old female presented with a short history of
Knowledge, Attitude and Practice about Contraception in Females Visiting a Tertiary
Care Public Hospital in Mumbai
Charu Dutt Arora*, Monika M. Bhagat** , Reena J. Wani***, Abhiram M. Kasbe****
Topiwala National Medical College, Mumbai, India
Background
India was the first country in the world to formulate
the national family planning program in the year 1952
with the objective of “ reducing the birth rate of the extent
necessary to stabilize the population at a level consistent
with requirement of National economy”. One of the main
objective of the programme is to spread the knowledge
210
of family planning methods and develop among the
people an attitude favourable for adoption of
contraceptive methods. The progress achieved in this
sphere is normally assessed from the result of
Knowledge, Attitude and Practice (KAP) Survey. Despite
the fact that contraceptive usage has increased over a
period of time, there exists a KAP- gap i.e. a gap between
the knowledge, attitude and practices regarding
contraception. In a developing country like India, over
population is a major concern. Despite progress resulting
from making contraception widely available, there is
poor acceptance of contraceptive methods either due to
ignorance or fear of complications using them. Inadequate
knowledge about contraceptive methods and incomplete
or erroneous information about their use or where to
procure them are the main reasons for not accepting
family planning. Keeping all the se facts in view this
study was carried out to assess the knowledge, attitude
and practice of contraceptive methods among females
visiting a tertiary care public hospital in Mumbai.
Aims & Objectives
was predesigned and pretested questionnaire for
recording of individual informations.
Result
The knowledge about one or more methods of
contraception, particularly modern contraceptive
methods was 56% (112). The knowledge about traditional
methods of contraception was a mere 30% (60). The most
common source of knowledge for females in general
was the “Exposure to family planning messages”
(62%)followed by discussion with doctors and other
health care workers (30%). Of 200 interviewed subjects,
82 (41%) were practicing different contraceptive methods.
Completion of family was found to be the most common
reason for using contraception (81%). Fertility related
reasons (45%) followed by husband’s opposition (28%)
were the common reasons for not using contraception.
Positive attitude for contraception was shown by 158
(79%) females.
Conclusions
To assess the knowledge, attitude regarding family
planning and the practice of contraceptives among
females visiting a public hospital in Mumbai.
Materials & Methods
This is a cross-sectional study with 200 females in the
reproductive age group. The primary tool in this study
The study reveals good knowledge and favourable
attitude of females towards contraception. The study also
highlights that awareness does not always lead to the
use of contraceptives. A lot of educational and
motivational activities and improvement in family
planning services are needed to promote the use of
contraceptives and reduce the high fertility rate.
Nosocomial Infections: A Major Global Safety Concern
Hema Gogia*, Jayanta K. Das**
National Institute of Health and Family Welfare, New Delhi, India
Background
Results
Nosocomial infections, or Hospital Acquired
Infections (HAI), are a major global safety concern for
both patients and healthcare professionals. Despite
progress in public health and hospital care, infections
continue to develop in hospitalized patients, and may
also affect hospital staff.
Aims & Objectives
To assess the impact of nosocomial infections in a
hospital setting.
Materials & Methods
Retrospective study from the review of literature and
data analysis.
The burden of HAI is substantial in developed
countries, where it affects from 5% to 15% of hospitalized
patients in regular wards and as many as 50% or more of
patients in intensive care units. In developing countries,
the magnitude of the problem remains underestimated
or even unknown largely because diagnosis of hospital
acquired infection is complex and surveillance activities
to guide interventions require expertise and resources.
The high rate of hospital acquired infections has resulted
in 12-80% mortality rates associated with nosocomial
infections due to device-related infections, increase in
the length of stay to two and a half times longer than
uninfected patients, and increase in the socio-economic
costs due to HAI: direct medical costs; indirect costs related
to lost wages, diminished worker productivity on the
job, short term and long term morbidity, mortality,
income lost by family members, forgone leisure time
211
and time spent by family/friends for hospital visits,
travel costs, home care; and intangible costs related to
diminished quality of life. It is observed that while the
increase in the overall annual direct cost to hospitals due
to HAI range from $35.7 billion to $45 billion (CDC data
of US hospitals), the benefits of prevention due to
effectiveness of possible infection control interventions
range from $25.0 to $31.5 billion for inpatient hospital
service. Also, apart from the high annual costs due to
HAI, the hospital also loses its reputation and credibility
along with demoralization of the caregivers.
nosocomial infections is to strategically implement
Quality Assurance and Quality Control measures to the
healthcare sectors, and evidence-based management can
be a feasible approach. Conclusively, assessing the impact
of hospital acquired infections in the healthcare setting
can greatly help improve the quality of healthcare for
patients and focus on means of implementing preventive
measures to reduce these types of infections and help
prevent getting a bad name to the hospital.
Conclusions
Perhaps the most effective technique for controlling
To Assess Various Health Problems among Adolescent Age Group in Gwalior
Ashok Mishra*, Ranjana Tiwari**, Chandrapal Singh Yadav***, Danish Anwar****, Bhanu Sharma*****, Deepak
Sulya******
Background
Adolescents constitute a large percentage of
population, 21.3% of the total population of India is of
adolescent age group. A wide range of issues and concerns
faced by adolescents in India include nutritional
deficiency, reproductive health problems, sexually
transmitted diseases and mental and physical stress
related problems. Many adolescent girls and boys are
sexually active but lack information and skill for self
protection. Communication gap exists with parents and
other adults (lack of family connectedness). Habit and
behavior picked up during adolescence have a lifelong
impact. Adolescence is the last chance to correct these
mal-habits.
Aims & Objectives
To assess various health problems among adolescent
age group in Gwalior.
Materials & Methods
This is a community based cross-sectional study
comprising of 400 students from 9th to 12th standard
from the three schools of Gwalior conducted during a
period of September, 2012 – November, 2012. After taking
permission from the school authorities a briefing was
done narrating the purpose of study, maintaining
confidentiality regarding the study participants. A predesigned, pre-tested questionnaire was presented to the
study participants after sighting the verbal informed
consent and they were given option to leave the study at
any point of their own free will. None of the participants
declined the participation. Data was analyzed using
Microsoft excel.
Results
Study comprised of 400 students with 250 boys and
girls. The age group of the participants ranged from 1218 years with 83.25% (333) of participants in 13-15 year
age group. Majority of the students 96% (384) were Hindu
by religion. 40.75% (163) participants’ fathers were
running their own business while 33.50% (134) were
government employee and 91% (364) of the participants’
mothers were homemakers. 68.50% (274) participant’s
fathers were having maximum education of graduate to
post graduate level while only 46.75% (187) of mothers
comprised this group. Participants owned to threatening
at school by their class mates or seniors were 227(56.75%)
& related to partiality in school were 150(37.50%).
107(26.75%) were having tendency to commit suicide and
those having violent behavior among friends were
125(31.00%). 350(87.50%) were having problem of
disorientation in studies and 46(11.50%) were having
feeling of jealousy among siblings. 169(42.25%) were
attracted towards opposite sex and those who had had
sex were 27(06.75%) and 21(5.25%) used contraceptive
measures.
Conclusions
The present study concludes that a large no of study
participants showed a tendency of violent behavior with
their peer groups and a large no of them were having
suicidal tendency. This unwanted and risky behavior
could be a reason for their distraction from their studies,
212
seen in majority of participants and could be a reactionary
protective mechanism towards the threats gained from
their peer groups in the school. Study concludes that it’s
time for appropriate intervention among these adolescent
to prevent any future mis-happening owing to the
generated protective mechanism and the seen risk
behaviors among them.
Prediction Model for Low Birth Weight and its Validation
Avantika Singh*, Sugandha Arya**, Harish Chellani***, K.C. Aggarwal****, R.M. Pandey*****
Background
Despite the enormous role of Low Birthweight in
neonatal mortality and morbidity as well as adolescent
and adult morbidity, no clinical attempt is made to
predict the possibility of a LBW neonate. A study
conducted in Cleveland, Ohio proposed a Four-factor
scale (low family functioning, stressful events, Quetelet’s
Index, cigarette smoking) which predicted LBW with
65% sensitivity, 84% specificity and 42% positive
predictive value. The need for such a scale in the Indian
context was strongly felt and the present study
undertaken.
Aims & Objectives
To assess the factors associated with LBW and
formulate a scale to predict the probability of having a
LBW infant.
Material & Methods
Cases were defined as all live neonates weighing
<2500g at birth and controls as those e”2500g. Maternal
and neonatal data for various risk factors was collected
by personal interview(structured questionnaire) and
from hospital records. Data for a total of 250 cases and
250 controls were gathered out of which 200 cases and
200 controls were selected using a table of random
numbers and were used to study the risk factors and to
arrive upon a prediction model. Validation of the
prediction model was then done on the rest of 50 cases
and 50 controls. Various statistical tests were employed
including Goodness-of-fit test and ROC curve obtained
for the prediction model.
Results
Mean weight of cases was 1.99±.41kg vs. controls
3.03±.39kg. 39.6% of the cases were preterm and 63.2%SGA.
Factors significantly associated with LBW by multivariate
analysis were: weight gained by mother during
pregnancy <8.9 kg(OR, 6.1 [95%CI, 1.3 -27.8]; P=0.02),
inadequate proteins in diet (<47 g/day) (OR,6.1 [95%CI,
1.2 -36.1]; P=0.04), female sex of baby (OR,4.2 [95%CI, 1.1
-16.4]; P=0.04), anaemic mother(Hb<11.0g/dL)(OR,20.0
[95%CI, 1.6 -246.5]; P=0.02), passive smoking (by
father)(more than 5 cig/bidi per week) (OR,5.6 [95%CI,
1.1 -29.4]; P=0.04), previous preterm baby (OR,6.9 [95%CI,
1.4 -33.8]; P=0.02) and previous LBW baby(OR,6.2 [95%CI,
1.7 -23.3]; P=0.01).On univariate analysis: primigravida,
nulliparity, pre-pregnancy BMI<20.621, mother’s
height<1.5324 metre, inadequate calories(<1667.1 kcal/
day), Educational Status (less than or equal to
intermediate), ANC visits <4, pre-pregnancy weight<45
kg, multiple births(twins), hypertension (chronic/
gestational), proteinuria, acute serious infections,
recurrent UTI, inadequate spacing(<24 months) and
inadequate calories in diet (<1667.1 kcal/day) were also
found significant. Having a single live issue appeared
protective. Previous abortion did not increase risk for
LBW neonate. Using above data, a prediction model was
then formulated and scores were given to each of the
factors: weight gain by the mother during pregnancy
<8.9 kg, proteins in diet <47 g/day, previous preterm
baby, previous LBW baby, Hb <11.0g/dl in mother and
smoking e”5 cig/bidi by father. A cut-off score was chosen
which gave this model a sensitivity of 71.58% & specificity
of 66.98%. Validation of the model was done and it
revealed a sensitivity of 72.0% & specificity 64%.
Conclusions
Prevalence of LBW can be reduced by addressing the
specific risk factors many of which are preventable. Based
on above results, a simplified scale has been developed
and validated as a prediction model for LBW.
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Laparoscopic Surgery Videos as a ‘Visual Aid’ Improve Learning of Anatomy: A
Prospective Controlled Study
Krishna Adit Agarwal*, Nayan Agarwal**, Brij B. Agarwal***
Background
Approaches to teaching correlate with quality of
learning. Knowledge of anatomy, a foundation for
practice of medicine, can improve by visualization.
Dissection on dwindling ‘available cadaver’ population
fails to achieve this in totality. Easily available
laparoscopic surgery videos can be useful as visual
teaching aids. Aim of teaching anatomy is to produce
competent physicians. Today’s generation is multimediasavvy. Practice of medicine is also evolving with
integration of multimedia technologies. Hence
multimedia tools can be incorporated in teaching and
learning as well.
Aims and Objectives
To assess if the learning of anatomy could be facilitated
by laparoscopic surgery videos.
Materials & Methods
This is a prospective controlled study from August
2007 – July 2008. One hundred medical students were
divided into study group and control group. Control
group students underwent the existing system of
dissection, didactic lectures and tutorials.Study group
students were shown edited videos of laparoscopic
surgery by a teacher in addition to routine teaching. The
division of students into two groups was along the
routine practice of dividing an academic batch into two
groups. The teacher incorporating the surgery videos
utilized them for the study group only.
End points
1. Evaluation of students in the part completion test.
2. Student’s perception of the utility of videos.
Student’s perception of surgery videos as a learning
tool was assessed on 4 point Likert Scale i.e. Excellent,
Very Good, Good and Can’t say.Five criteria for learning
perception were used to measure the efficacy according
to aforesaid Likert scale. These were:
• Improved memory
• Help in revision
• Improved drawings
• Helpful in group discussion and
• Appeal for career selection
The data collected was collated in a Microsoft Excel
sheet for analysis.
Conclusions
Performance of the study group was better than the
control group in theory as well as practical for the part
covered by laparoscopic surgery videos. Large majority
(92%) of study group students thought laparoscopic
surgery videos to be ‘Very Good’ additional learning
tool. Complete results withheld in the abstract.
Effect of Exercise on Heart Rate Variability in Children of Diabetic Parents
Parikha Rampal*, Arati Meher**, Manasi Bhattacharjee***, Renuka Sharma****, Raj Kapoor*****
Background
Diabetes mellitus is a chronic heterogeneous disorder
characterized by chronic hyperglycaemia that develops
as a result of interplay between the genetics and
environmental factors. A high prevalence of Type 2
Diabetes Mellitus in relatives, especially offsprings,
confirms that some individuals have an inherited
susceptibility to development of disease. Diabetes is an
important risk factor for development of cardiovascular
& cerebrovascular diseases and an increased risk of
mortality is strongly associated with the presence of
cardiovascular autonomic neuropathy.Alteration of
circadian rhythm of autonomic activity in offspring of
type 2 diabetic parents has been reported, more so if they
are insulin resistant. Heart Rate Variability(HRV),the
computer assisted quantification of beat to beat
fluctuation in heart rate, is a powerful tool for diagnostic
& prognostic purposes in pathologies such as diabetes
mellitus. Exercise, isotonic or isometric, has been
reported to have a beneficial effect on the HRV response.
214
Aims & Objectives
To determine the early changes in cardiac autonomic
modulation by measuring heart rate variability after
exercise among healthy subjects and those with parental
history of Type 2 DM.
Materials & Methods
The study was conducted in the Department of
Physiology, Vardhman Mahavir Medical College &
Safdarjung Hospital, New Delhi. It was a cross-sectional
study and included subjects, in 18-25 age group,
categorized into two groups: Group I: Cases i.e. children
of either one or both diagnosed Diabetic parent. Group
II : Controls i.e. subjects with no family history of
Diabetes. The subjects were selected on the basis of a
questionnaire on ‘personal information’ filled by medical
students studying in Vardhman Mahavir Medical College
& Safdarjung Hospital. Anthropometric measurements
in the form of Height (ht), Weight (wt), Waist
circumference (WC), Waist to hip ratio (WHR), Body
surface area (BSA), Body mass index (BMI). BSA and BMI
were calculated from height and weight using DuBois
nomogram and formula [wt/ (ht) 2]. Heart rate and Blood
pressure were recorded, before & after 1 min, 5min and
20min of cessation of exercise. Heart rate variability
(HRV) was deduced from the Electrocardiogram (ECG)
which was recorded for 5 minutes prior to exercise and
20 minutes post exercise. Isotonic, moderate exercise was
performed using the bicycle ergometer while the
handgrip dynamometer was used for isometric exercise.
Results
BMI was observed to be significantly different in the
two groups. In response to isotonic exercise, the systolic
blood pressure changes acquired statistical significance
immediately and 20 minutes after exercise. HRV
parameters also showed significant difference in the basal
state as well as post-exercise. The response to isometric
exercise, while revealing a similar trend in heart rate
variability and systolic blood pressure, also displayed
statistically significant changes in diastolic blood
pressure.
Conclusions
It was concluded that HRV is an effective tool to detect
early autonomic dysregulatory changes in asymptomatic
offsprings of diabetic parents which may be crucial in
preventing future morbidity and mortality.
Prevalence of Type II Diabetes Mellitus and Assessment of Risk Factors Along with
the Health Seeking Behavior amongst Diabetics of Slums in Delhi
Ankit Arora*, Apoorva Sehgal**, Archit Goyal***, Dhairya Lakhani****, Devyani Mukherjee*****, Dipan
Uppal******, Kritika Sharma*******, Nitika Gautam********
Background
India has earned the dubious distinction of being the
“diabetes capital of the world”. As cited by the
International Diabetes Federation Atlas 2012, there are
63million diabetics in India. The slum population seems
to be at greater risk of developing diabetes.
administered to subjects after a written informed consent.
Status of type II diabetes mellitus was based on available
health records. Indian diabetes risk score (IDRS) was used
to assess individuals at risk of developing diabetes. Data
was analyzed using SPSS v16.0. ‘p-value’ less than 0.05
was considered significant.
Results
Aims & Objectives
To ascertain the prevalence of type II diabetes and its
risk amongst the slum population of Delhi and to assess
their health seeking behavior.
Material & Methods
A cross sectional study was carried out in urban slums
with 1000 participants aged 18 years and above. A predesigned, pre-tested, semi-structured questionnaire was
The interim data of 349 participants (53.9% males,
46.1% females) is being presented. Prevalence of diabetes
was 6.0% (5.9% amongst males, 6.2% amongst
females)(p>0.05), higher in age e”50 years (20.5%)
(p<0.001), sedentary workers (16.7%)(p=0.001), IDRS score
>50 (18.5%)(p<0.001). Education, per-capita income, waisthip ratio, family history did not have significant
relationship with risk of DM. General symptoms reported
were giddiness (47.6%), thirst (57.1%), frequent urination
(85.7%), weight loss (28.6%), infections (14.6%). 2 out of
21 diabetics did not take medication and 2 were on insulin.
215
Conclusions
The prevalence of type II DM was 6%, with increased
risk among individuals aged 50 years or more, sedentary
workers and IDRS score e”50. There is a need to promote
healthy lifestyle focusing on regular exercise and balanced
diet.
Predictors of Early Neurological Deterioration in Patients of Acute Ischemic Stroke
with Special Reference to Blood Urea Nitrogen/Creatinine Ratio and Urine Specific
Gravity
Kunal Bhatia*, Smita Mohanty**, B.K. Tripathi***, B. Gupta****
Background
Stroke is a major cause of long- term disability and
has potentially enormous emotional and socioeconomic
consequences for patients, their families, and health
services. Early neurological deterioration (END) occurs
in about 20% to 40% of patients with ischemic stroke and
results in increased mortality and functional disability.
In recent studies relative dehydration has been found to
be associated with END in patients with acute ischemic
stroke.
Aims & Objectives
To study the factors useful for predicting early
neurological deterioration in ischemic stroke patients.
Materials & Methods
Various parameters comprising demographic, clinical,
laboratory and radiological variables along with stroke
severity (NIHSS and GCS scores) were assessed and
studied as predictors of END in patients with acute
ischemic stroke. BUN/creatinine >15 and urine specific
gravity >1.010 were studied as markers of relative
dehydration contributing to END. RESULTS: A total of
114 patients were enrolled in this study. END was
observed in 21.9% of the patients. NIHSS e” 12 at
admission was found to be an independent risk factor for
END. Amongst markers of relative dehydration, BUN/
creatinine>15 at admission was found to be an
independent risk factor for END, as compared to
USG>1.010. Of the various radiological parameters that
were studied in this study, only cerebral edema on cranial
CT and size of hypodensity>1/3rd of the middle cerebral
artery territory were observed to be independent risk
factors for END.
Results
Our findings suggest that a BUN/Cr ratio > 15, at
admission, is an independent risk factor for END in
patients with acute ischemic stroke.
Conclusions
Dehydration being a treatable condition, the use of
BUN/creatinine>15 as a marker of relative dehydration,
can be helpful in detecting patients with dehydration
early and thus play a role in preventing END.
Assessment of Health Profile and Relationship betwen Health Disorders with WorkRelated Abuse of Housemaids in Delhi
Ambar Prakash*, Tanya Singh Kakar**, Sakshi Rajoria***, Tushar Dhawan****, Shivani Sharma*****, Shikhar
Chohan******
Vardhman Mahavir Medical College , Maulana Azad Medical College, New Delhi, India
Background
Housemaid is a female servant employed in domestic
work like cleaning house, mopping floors, laundry and
cooking. In India there are no laws to regulate the
placement agencies for housemaids or even to define the
rights of India’s unofficially estimated 90 million
domestic workers. These women belonging to low socioeconomic class are subjected to heavy workloads and are
thusprone to high health risks.
216
Aims & Objectives
To assess the health profile of housemaids in Delhi
and compare the prevalence of health disorders with
work-related abuse.
A cross-sectional study was carried out among 315
female housemaidsfrom 9 geographical zones (35 per
zone) of Delhi working full-time/ part-time since at least
1 year.Interim data using a subset of 69 housemaids (Age:
31.28 ± 8.12 years)was analysed.Data was collected using
a self-designed questionnaire after obtaining a written
informed consent.Chi-square test/ Fischer’s exact test (p<
.05) was used to associate work-related abuse and various
disorders. Data was analysed using SPSS, Version 16.0.
Results
years(47.1%), mainly immigrants from Uttar Pradesh
(33.3%), working since 11.75± 7.52 years and were
illiterate(76.5%).Health Profile: Chronic smokers (4.3%),
tobacco abusers (20.3%) and alcoholics (2.9%). Back
pain(52.2%), bursitis(36.2%) and hypotension (23.2%) were
major disorders reported.23.2% reported abuse, mostly
verbal. Psychiatric illness (23%) was significantly
associated with abuse(p=0.001).Unintentional fallinjuries,
burns and scalds were significantly related (p<0.003) to
long working hours (9-12 hrs/day).
Conclusions
Housemaids in Delhi are exposed to definite physical
and psychological stressors and thus suffer from various
disorders, especially psychiatric illnesses and
musculoskeletal disorders. Both physical and psychiatric
evaluations should be performed at regular intervals
along with strict regulatory measures to ensure a healthy
lifespan.
Majority of housemaids were in age group 30-39
Physicians’ Knowledge, Attitude & Practices Regarding Fertility Issues for Young
Breast Cancer Patients
Arushi Devgan*, Chintamani**
Vardhman Mahavir Medical College, New Delhi, India
Background
Breast cancer is the most common cancer among Indian
women. Approximately 6% to 7% of women diagnosed
with breast cancer are younger than 40 years at the time
of their diagnosis. For many young women with early
breast cancer, fertility is a priority. Increasing survival
rates in patients affected by oncological disease and
advances in reproductive medicine have led to the
development and increasing use of various fertility
preservation techniques.
Aims & Objectives
To study physicians’ knowledge, attitude and
behaviour regarding fertility issues for young breast
cancer patients.
Materials & Methods
The study was a cross sectional study carried out at a
tertiary care centre in New Delhi. The sampling technique
was non probability sampling and the sample size was
N=300. The study tool was a self administered preformed
structured Performa. It included questions on knowledge
about fertility issues, practice behaviour, potential
barriers for discussing fertility issues, attitude toward
fertility preservation and responding physicians’ sociodemographic backgrounds. The study period was March
to May 2013.
Results
300 physicians responded to the performa. These
included general surgeons, surgical oncologists,
gynaecologists & medical oncologists. 49% were females.
Physicians who had better knowledge score and positive
attitudes towards fertility preservation were more likely
to discuss potential fertility issues with cancer patients.
Regarding knowledge, there was no significant difference
with gender and religion. There was significant
association with number of breast cancer surgeries
performed in a week and number of breast cancer patients
(<40 yrs) seen in a week. With reference to attitude, there
was no significant difference with gender and between
various specialties. Those with a positive attitude had a
positive practice behaviour. Ladies were more likely to
discuss impact of cancer treatment on future fertility with
patients, consult a reproductive specialist and refer
patients with questions about fertility to reproductive
specialists. Frequency of General Surgeons agreeing with
the above statements was maximum followed by
Gynecologists. Social stigma, socioeconomic status, lack
of knowledge and awareness, psychological and
217
emotional issues, and illiteracy were identified as major
barriers for discussing fertility issues with the patients.
Conclusions
Proper knowledge and a positive attitude, of the
physician, towards fertility preservation in young breast
cancer patients is very important in today’s clinical
scenario. Effective programs and protocols should be
developed for a better approach towards fertility
preservation by the physician. Better awareness about
breast cancer and fertility preservation should be spread
among the masses, to overcome a few of the issues that
were identified as barriers for discussing fertility issues
with the patients.
Severity and Associated Risk Factors Leading to Depressive Symptoms in the Post
Partum Period: A Cross Sectional Study in a Tertiary Care Hospital
Arushi Devgan*, Sukriti Gupta**, Mayank Mehrotra***, Pratima Mittal****, Jyotsna*****
Background
Depression significantly contributes to the global
disease burden. It is important to identify maternal
depression in India since death rates due to suicide, a
large proportion of which occur in women, are among
the highest in the world here. Post partum depression
has also been shown to have negative effects on the
overall development of the infant. Several studies have
been done on the prevalence of and risk factors leading
to post partum depression, but there is still scarcity of
data in our local context. There is also no standardised
objective method, included in our routine post natal
checks, to assess depressive symptoms. It is therefore
important to study these symptoms in our hospital, it
being one of the largest in India. Based on the DSM IV
(Diagnostic and Statistical Manual of Mental disorders)
criteria, post partum depression falls under the diagnostic
criteria for Major Depressive Episode with postpartum
onset. It states that symptoms must begin within four
weeks of delivery, last a minimum of two weeks and
cause clinically significant impairment in daily
functioning.
Aims & Objectives
To assess the severity of depressive symptoms in
mothers, 6-8 weeks after delivery and to identify risk
factors leading to these depressive symptoms.
Material & Methods
The cross-sectional study was planned at a tertiary
care hospital in New Delhi. The study universe included
women visiting the immunisation centre. The inclusion
criterion was women who had delivered a live child 6-8
weeks before the interview. The exclusion criteria were
those coming before 6 weeks post partum , women who
had been previously diagnosed with PPD, and those
whose children had died at birth or in the period before
being interviewed. The sampling technique used was
non probability sampling and the sample size was N=
106. The study tools used were the Edinburgh Postnatal
Depression Scale, Beck’s Depression Inventory (Hindi)
and a Structured Performa. The study period was April
to July 2013.
Results
According to Beck’s Depressive Inventory II, 45% of
the ladies interviewed had depressive symptoms ranging
from mild to very severe. Mild depression (score 0f 1116) was seen in 19.8 %, borderline (score of 17-20) in 8.4
%, moderate (score 21-30) in 9.4 %, severe (score 31-40) in
5.7 % and very severe (score >40) in 1.9 %. According to
EPDS, 32% of them had possible depression (>10 score on
EPDS). Suicidal ideation was present in 19.8% of those
interviewed (Q 10 EPDS). Those who showed depressive
symptoms with daily dysfunction and were willing for
treatment, were referred to the Department of Psychiatry.
Occupation and educational status of the lady, female
gender of the baby, low socioeconomic status, poor role
in decision making and absence of any hobbies were
significantly associated with development of depressive
symptoms in the post partum period.
Conclusions
Depressive symptoms are found to occur commonly
in women, 6-8 weeks post partum. Identification and
prompt treatment of these symptoms can significantly
reduce harmful effects on the mother, her child and her
family. Government policies should also be made to
reduce gender bias, domestic violence and to encourage
familial support during pregnancy.
218
Assessment of Long-Term Quality-of-Life (QoL) Outcomes in Disease-Free Breast
Cancer Survivors
Chintamani*, Sukriti**, Megha Tondon***, Rohan Khandelwal****
Background
Breast cancer is the most prevalent malignancy
amongst women in India. Increasing use of
multimodality approach has led to an increase in the
number of long term breast cancer survivors. To
determine the long term effects of breast cancer and to
evaluate the complete outcome of cancer treatment, it is
essential to assess quality of life (QOL) of the survivors.
Aims & Objectives
To assess long term QOL outcomes in disease free
breast cancer survivors.
Material & Methods
social functioning was excellent. Easy fatigueability and
pain severely affected 15% of the survivors. The most
frequently mentioned complaint was of painful/swollen
arm. More than 30% suffered significant changes in their
sleep & appetite pattern. Menopausal symptoms were
present in more than half of the survivors. 33% of all,
faced difficulty in concentrating and memorizing.
Majority of survivors were emotionally stable. 80% were
having an active social life. Severe depression was
profound in 10% of all the cases. Spiritually & religiously
inclined survivors showed better QoL. Almost all the
survivors with good QoL had strong support from family
& friends. Also, 94 % of physically healthy survivors had
socially active life indicating strong co-relation between
physical health & social life.
Conclusions
It was a follow up study in a cohort of 27 breast cancer
survivors. They were managed by the same oncological
team at Safdarjung Hospital. A 46 item, subjective
questionnaire (Cronbach’s alpha coefficient=0.89,
Spearman correlation coefficient=0.92) was used to assess
QoL in four domains: physical, psychological, social and
spiritual. Socio-demographic and clinical data included:
age, education, marital status, disease stage, family
history, parity and other co-morbid conditions.
During the follow up, it was found that majority of
the survivors were leading a good quality of life. The
fact that social support was a predictor of a better QoL
indicates that interventions aimed at increasing such
support may have additional long-term benefits. The QoL
study in breast cancer survivors will also have positive
influence on women who are newly diagnosed with
breast cancer, on survivors & health care providers.
Results
The mean age at presentation was 51.5. Physical and
Cerebellar Tuberculoma Presenting as Acute Reversible Hemiplegia: A Rare
Presentation
Harsh Bhardwaj
Tuberculosis (TB) is an infectious disease caused by
the bacillus Mycobacterium tuberculosis which typically
affects the lungs (pulmonary TB) but can affect other sites
as well (extrapulmonary TB). CNS tuberculosis is one of
the most dangerous forms of tuberculosis and is noted in
5 to 10% of extrapulmonary TB cases, and accounts for
approximately 1% of all TB cases. Any part of the CNS
can be involved, from intracranial lesions to spinal
lesions. Intracranial lesions can present as an abscess or a
tuberculoma. Tuberculomas in the cerebellum are more
common in children and usually present with raised intra
cranial pressure and ipsilateral cerebellar signs. Our
patient, a healthy adult male with no comorbidities,
presented with chief complaints of hemiplegia and was
later on diagnosed to be having an ipsilateral cerebellar
tuberculoma which is a rare presentation which
219
strengthens the diverse presentations of CNS tuberculosis
and the need to work up the patient in detail.
Keywords: CNS tuberculosis; Mycobacterium
tuberculosis; Cerebellar tuberculoma; Hemiparesis.
Abducens Nerve Palsy in Petrositis: A Report of Three Cases
Avantika Singh*, AshishVashishth**
Background
Nowadays, antibiotics are widely available and they
can decrease the incidence of petrositis to approximately
2 per 100,000 children with acute otitis media. However,
if left untreated, the condition may lead to morbidity
and mortality from meningitis, brain abscess and lateral
sinus thrombophlebitis. Petrositis may be associated with
acute or chronic otitis media, as a result of spread of
infection from the middle ear cleft to the petrous apex
through perilabyrinthine and peritubal air cells. This
study was done to discuss the management and outcome
of abducent nerve palsy in petrositis associated with otitis
media.
Case Report
This is a clinical report of three patients with petrositis
and abducent nerve palsy. Computed tomography (CT)
scans of the temporal bone demonstrated soft tissue
opacification and expansion of mastoid and petrous air
cells without bony erosion. Two patients recovered
completely from diplopia on medical management. One
patient underwent transcanalinfracochlear drainage of
the petrous apex after non-responsiveness to medical
treatment. All patients had complete resolution of
abducent nerve palsy.
Discussion
With advances in antibiotics, medical treatment should
initially be offered to all patients with petrositis. Surgical
intervention should be reserved for patients not
responding
to
medical
management.
A
transcanalinfracochlear approach is an effective drainage
route for apical petrositis with complete recovery of the
sixth nerve and hearing preservation.
Key words: Petrositis; Sixth nerve palsy; Otitis media.
Basic Life Support & Advanced Cardiac Life Support: Knowledge & Attitudes of
Medical Students in New Delhi
Akriti Sinha*, Arushi Devgan**, Mayank Mehrotra***, Avantika Singh****, Krishna Adit Agarwal*****
Background
The chain of survival includes Basic Life Support (BLS)
as an important element. Advanced Cardiac Life Support
(ACLS) too plays an important role in its multiple key
links. ACLS interventions depend upon the BLS
groundwork of immediate recognition and activation of
the emergency response system, early CPR, and rapid
defibrillation to increase the chances of survival. The
likelihood to achieve return of spontaneous circulation
increases with drug therapy, advanced airway
management and physiological monitoring. Knowledge
of CPR is an important part of a medical student’s
training, but there is still no routine training included in
the medical undergraduate teaching in developing
countries like India. Therefore medical graduates often
face difficulty in emergency situations. Aims & Objectives
To assess knowledge and attitudes among medical
students of New Delhi from different professional years
towards BLS & ACLS. Methodology
Study design
This multi-centric study was planned as an analytical
cross-sectional study with the study sample being drawn
from medical students enrolled in various professional
years during the session 2012-13 at six medical colleges
of New Delhi.
220
Sample size
The sample size was 1000 with 20% sample being
drawn each from 1st professional, 2 nd professional,
3 rd professional part-1, 3 rdprofessional part-2 years
respectively and the rest 20% being interns from various
Teaching Hospitals of New Delhi.
Study duration
The study was conducted from May to July 2013.
Study tool
The study tool was a pre-designed self-administered
objective questionnaire with 15 minutes given to each
participant. The questionnaire was multiple-choice based
with 20 questions devoted to BLS and 10 questions
devoted to ACLS.
The data gathered was periodically entered into
Microsoft Excel 2010 and subsequently analysed using
Microsoft Excel 2010 and Stata S.E 9.0. The scores obtained
by each participant were tabulated and comparisons made
among various aspects and among various subgroups of
the study population. Results & Conclusions
Being compiled
Basic Life Support: Awareness & Impact among Indian Medical Students
Krishna Adit Agarwal*, Akriti Sinha**, Avantika Singh***, Mayank Mehrotra****, Arushi Devgan*****, Pavan
Nayyar******
after successful completion of the Workshop.
Background
Early intervention, quality of CPR and time to
defibrillation improves survival rate after
cardiopulmonary arrest. BLS is an important component
of the chain of survival. The proper practice of BLS is an
important part of a medical student’s training, but there
is still no standard protocol and routine training
incorporated in the medical undergraduate training in
developing countries like India. Medical graduates, never
having had any formal training in CPR or BLS, often face
difficulty in emergency situations. Aims & Objectives
1) To study the knowledge and attitudes among Indian
medical students towards Basic Life Support
2) To assess the knowledge and attitudes among these
students after study of the American Heart
Association Cardio Pulmonary Resuscitation Basic
Life Support (AHA CPR BLS)for Health Care
Providers (HCP) – Student Manual and again
Methodology
A longitudinal prospective cohort study was planned
to be conducted during an International Medical Students’
conference held at New Delhi. The study participants
were medical students participating in the AHA CPR BLS
for HCP Workshop conducted at the conference. The
sampling technique was non probability sampling.
Inclusion criterion was medical students registered for
the workshop at this conference. Those who successfully
completed this workshop preceding the conference were
excluded from the study. The sample size was 75 students.
The study tool was a predesigned, close ended, timed
self-administered questionnaire. The study period was
from July to August 2013. Result & Conclusions
Being compiled
221
Perspective and Perception of Latah among Junior High School Student in Jakarta,
Indonesia
Dina Faizah*, Fia A. Mutiksa**, Randy S.N. Rusdy***, Eka S. Nugraha****, Martina W.S. Nasrun*****, Elisna
Syahruddin******, Indah S. Widyahening*******
Faculty of Medicine Universitas, Indonesia
Introduction
Latah is a curious mental state, seemingly localized to
Malaysia and Indonesia where a person gets wound-up
to such a degree that they show an exaggerated startle
response, are highly suggestible, and may produce
unintentional words, movement or behavior sequences
when provoked by others. The condition is described by
Western psychiatry as a culture-bound syndrome
although the medical literature has had an ongoing debate
about whether other cultures have the same phenomenon
under a different name. Anthropologists have often refer
to the psychiatric definition of Latah as a syndrome. The
aim of study is to obtain a perspective of Latah among
junior high school student in Indonesia and their
perception towards Latah phenomenon besides look at
prevalence.
Method
A cross-sectional study was done on a total of 113
students in 13 Junior High School, Jakarta, during May 2013.
The sampling method was consecutive sampling. Data
was obtained by direct questionnaire. Data were analyzed
by chi-square tests.
student was 19,5%. None of the Latah sufferer seeks any
professional help. Most of respondents know about Latah
(62,8%). Type of latah mostly was echolalia, the rest was
in combination echolalia and echopraxia. There were
significant association between latah and women (p=
0,040), latah in family member (p = 0,012), latah in
surroundings (p = 0,026). Perception of Latah is varied;
most of respondents consider Latah as a disease (62,8%),
disturbing (83,2%), embarrassing (86,8%), curable (87,6%),
funny and entertaining (89,4%). Meanwhile only few
respondents agreed that Latah is dangerous (40,5%),
infectious (23,2%), due to genetics (34,9%), make the
people famous (46,4%), should be pitied (37,5%).
Conclusion
Latah phenomenon was quite well known, is still exist
in Indonesia, mostly sufferer is women. However, none
of the Latah sufferer seeks any professional help, even
though they think it is a disease and curable.
Key words: Latah; Indonesia; Perception; Perspective;
Student.
Results
The prevalence of Latah among junior high school
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[1] Flink H, Tegelberg Å, Thörn M, Lagerlöf F. Effect
of oral iron supplementation on unstimulated salivary
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[2] Twetman S, Axelsson S, Dahlgren H, Holm AK,
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D, Lemeshow S. Applied logistic
nd
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Chapter in book
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composition of saliva. In: Fejerskov O, Kidd EAM,
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management. Oxford: Blackwell Munksgaard; 2003. p.
7-27.
No author given
[8] World Health Organization.
Oral health surveys th
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230
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