Πέμπτη, 3 Νοεμβρίου 2016

Central Giant Cell Granuloma

Source: National Journal of Integrated Research in Medicine
Jigna Sathya Shah*, Monali Navin Prajapati**.
World Health Organization (WHO) defines central giant cell granuloma (CGCG) as an intraosseous lesion consisting of cellular fibrous tissue and contains many foci of hemorrhage, aggregations of multinucleated giant cells, and occasionally trabeculae of woven bone. Clinically and histopathologically CGCG resembles many other jaw lesions hence it has to be differentiated from them for judicious management of the lesion. Here we present a case of CGCG of palate in a 21-year-old female patient.[Jigna SNJIRM 2016; 7(5):101-104]


Conservative Management Of Endodontically Treated Mandibular Molar By Indirect Composite: A Novel Approach

Source: National Journal of Integrated Research in Medicine
Kaushik Adeshra*, Sarfaraz Memon**, Ninad Bhatt***, Ronak Patel****.
Introduction: The patients desire for esthetics, coupled with the decreasing use of amalgam, requires that clinicians be comfortable and proficient in the use and placement of tooth-colored restoratives.Case Report: A 30 yrs old male came with chief complaint of large metallic filling on lower left back region came to the department for esthetic restoration. Patient had dental history of endodontic treatment with 36,37,46,47 and periodontal surgery with 46,47. Patient was advised by endodontic department for proper restoration of endodontically treated teeth to avoid fracture of treated tooth.Discussion: Indirect composite restorations demonstrate enhanced physical properties and predictable clinical performance having less polymerization shrinkage than direct composites. There is more strength in highly filled indirect composite. One of the most important attributes of indirect composite is the ability to create ideal contours and contacts with adjacent and opposing teeth that might be difficult to achieve clinically with large, directly placed composite restorations. [Kaushik ANJIRM 2016; 7(5):98-100]


Extremely Rare Concomitance Of Tubercular Lymphadenitis With T Cell Non Hodgkin’s Lymphoma – A Diagnostic Challenge For Clinician

Source: National Journal of Integrated Research in Medicine
Anand Agrawal*, Akshat Vyas**, Amrita Duhan***, Sarita Yadav****,Chandermani Madan******.
Tuberculosis (TB) presenting with Non Hodgkin's Lymphoma is an extremely rare clinical presentation and is quite difficult to diagnose because of similar signs & symptoms including lymphadenopathy, weight loss, anorexia and generalised weakness. Herein we report a case of 40 year old male who presented with enlarged cervical and axillary lymph nodes, diagnosed and initiated on therapy for TB based on the axillary node FNAC that showed granulomatous lymphadenitis suggestive of TB but was later confirmed to be a case of non Hodgkins lymphoma by excisional biopsy followed by histopathology and immunohistochemistry . [Anand A NJIRM 2016; 7(5):95-97]


Fibroblast Heterogeneity And Its Implications

Source: National Journal of Integrated Research in Medicine
Monali Shah*, Ankit Patel**, Sunit Patel***, Jalpesh Surani****.
After acute inflammation fibroblasts participate transiently in tissue repair by regulating the structure and function of healthy tissues. They also assume an aberrant stimulatory role during chronic inflammatory states including cancer. Heterogeneity of fibroblast applies to functional and phenotypic properties within or across tissues. Fibroblasts are heterogeneous with respect to functional properties, and that certain subpopulations of these cells may be clonally selected and expanded in diseased tissues. These pleiotropic functions highlight the inherent plasticity of fibroblasts and may provide new pathways to understand and therapeutically intervene in diseases. [Monali S NJIRM 2016; 7(5):92-94]


Comparison Of Objective Structured Practical Examination To Conventional Practical Examination In Microbiology.

Source: National Journal of Integrated Research in Medicine
Namrata Kumari*,Rekha Kumari**,Shailesh Kumar*,Anima Xess***, Shivendra K. Shahi****.
Background & Objectives: Objective structured practical examination (OSPE) is a good tool to assess skill competency. The objectives of the study was to compare the score of marks obtained by Conventional method of assessment (CPE) with OSPE for assessing skill competency to perform Gram and Zeihl- Neelsen stain and to know the students and teachers perception about OSPE. Methods: Ninety two MBBS students were included in the study as OSPE and CPE groups (46+46). The two groups were assessed for their skill competency to perform Gram and Zeihl- Neelsen stain using OSPE and CPE methods respectively. Teachers perception was analysed for both the assessment methods with respect to objectivity, reliability, validity, feasibility etc. Feedback was taken from students too. Results: The difference of marks score by OSPE and CPE was found to be extremely statistically significant. The perception (students & teachers ) assessment reflected the acceptability of the method among students and teachers. Interpretation & Conclusion: OSPE is a tool which would help increase the objectivity while assessing skills in Microbiology and needs to be evaluated further so as to enable teachers to use this valuable tool alone or in combination with CPE.[Namrata K NJIRM 2016; 7(5):87-91]


Introduction Of Case Based Learning In Teaching Of Biochemistry In IGIMS Patna.

Source: National Journal of Integrated Research in Medicine
Rekha Kumari*, Namrata Kumari**, Shailesh Kumar**, Anand Saran***, Uday Kumar****.
Background & Objectives: Biochemistry is the basic science subject of first year MBBS course. It describes all the biochemical reactions occurring in the body, which makes the subject difficult and the student looses interest in it. In our institute, teaching is done mainly by didactic method. We introduced case based learning method (CBL) for teaching. The objective of this study was -1. To compare score of students by two methods of teaching traditional lectures and case based methodology. 2. To evaluate students feedback regarding their perception to case based learning. Methods: After getting written consent from 1st year MBBS students , they were divided into two groups. One group (50 students - case) was taught by case based learning method and another group (50 students control group) was taught by traditional method. Improvement in their performance was assessed by MCQ and statistically compared. Perception of both groups about CBL was taken by a set of questionnaire based on Likerts scale. Results: Statistically significant increase in performance of student taught by CBL method than student taught by traditional method was seen. Students and facultiess perception about CBL was positive. All students found the CBL as effective method for learning. Conclusion: CBL is a good teaching learning method to increase involvement and interest of student in learning and enhance their academic performance. [Dr. Rekha K NJIRM 2016; 7(5):82-86]


Evaluation And Comparison Of Mandibular Asymmetry Indices In Different Classes Of Malocclusion: A Radiographic Study

Source: National Journal of Integrated Research in Medicine
Manjiri U. Joshi*, Nikunj Patel**, Hina Desai***, Mansi N. Tailor****.
Objective: To evaluate contribution of condylar and ramal asymmetries in various classes of maloclussion with the use of Orthopantomographs by frontal aspect . Materials and Methods: Panoramic radiographs (PRs) are routinely taken radiographs for the diagnosis purpose. All radiographs were taken by experienced radiology technician on digital panoramic system. The subjects were positioned with the lips in rest position & head oriented to Frankfort horizontal plane as suggested by Azevedo et al. The sample consisted of study five groups including 150 subjects of different types of malocclusions. All the radioghraphic films were traced & measured by the same author and all the asymmetry indices were measured using formula developed by Habets et al. Results: Descriptive statistics and Comparison of Condylar Asymmetry index(CAI), Ramal Asymmetry index(RAI) and Combined Asymmetry index(CoAI) showed that there no statistical significance within RAI (0.216) and CoAI (0.116), but statistically significant values were recorded within CAI (0.0052).We have found more asymmetry in condyle than ramus. Conclusion: Generally for orthodontic treatment orthodontist see mainly skeletal malformation in sagittal plan but from our studies it can be said that it is equally important to look for skeletal asymmetry from frontal aspect, particularly in lower third of the face and condyle. If such asymmetries are diagnosed earlier then it is possible to intervene them with the help of asymmetrical myofunctional appliances. [Manjiri J NJIRM 2016; 7(5):78-81]


The Prosthetic Rehabilitation Of An Amputee With Rett Syndrome And Wrist Disarticulaiton

Source: The Southeast Asian Journal of Case Report and Review
Özlem Ülger, Semra Topuz, Özgen Güven.
The rehabilitation process becomes very difficult, when a permanent disability as amputation is seen with a syndrome that requires special education as Rett Syndrome (RS). The importance of prosthetic fitting, and difficulties of rehabilitation in a 10 years old boy who underwent wrist disarticulation and having the diagnosis of RS is presented. The child couldnt be fitted with a prostheses at the age of 4 because of mental retardation and sterotype movements. The patient who received special education for aproximateley 3 years, was given a long rehabilitaton program following passive prosthetic fitting at the age of 7. Firstly, the subject had experienced difficulty in accepting the prostheses and presented agressif behaviours. In time, he became aware of his loss and accepted the prostheses. It was thought that this situtation in terms of showing the success of rehabilitation is important for the child ampute with a severe neurodevelopmental disease as RS.


A study on prevalence of multi drug resistance tuberculosis and factors influencing it in Davangere district, Karnataka, India

Source: International Journal of Community Medicine and Public Health
Ravi Kumar, Kiran Shankar S..
Background: India is one of the high tuberculosis (TB) burden countries in the world accounting for nearly 20% of the global incidence. Standard anti-TB drugs have been used for decades, and resistance to the medicines is growing. The emergence and spread of multi-drug resistant tuberculosis (MDR-TB) is threatening to destabilize global tuberculosis control. Methods: Case records of all the patients put on DOTS plus therapy for MDR-TB were obtained from District Tuberculosis Centre (DTC) located at Chigateri General Hospital Davangere. Details of all the suspected MDR-TB patients registered in the DTC during January 2013 to June 2015 and sent for culture and drug sensitivity testing (DST) were obtained. MDR-TB was defined as Tuberculosis caused by bacilli showing resistant to Isoniazid and Rifampicin. Cases are analysed based on MDR Suspect criteria as per RNTCP. Further details about the influencing factors were obtained by calling the patients on their contact numbers. Corroborative evidence of the details provided by the patients regarding the influencing factors was substantiated from STLS or DOTS providers. Results: The prevalence of MDR-TB cases in three years was 32/4136 cases. Among the factors age, gender, pattern of resistant and high Random Blood Sugar level were the key determining factors influencing MDR-TB. Conclusions: A main component in stopping the spread of MDR-TB is to rapidly diagnose infectious TB disease cases and treat these so the patient can be cured and the chain of transmission will be stopped.


A comparative study on awareness of cardiovascular risk determinants among rural and urban women population of Davangere district, Karnataka, India

Source: International Journal of Community Medicine and Public Health
Ravi Kumar, Sharan Kumar H..
Background: The prevalence of cardiovascular disease (CVD) is rising worldwide and it accounts for 17% of the total mortality. This acceleration in the prevalence of CVD has been attributed to the Prototype shift in lifestyle. Methods: A cross sectional study was conducted for a period of one month (July 2015 to August 2015). Patient attender coming to the rural and urban hospital will be taken as study participants. Data was collected by interviewing the patient attender coming to urban as well as rural hospital by using pre tested semi-structured questionnaire. Descriptive statistics was used to describe the results. Results: Mean age of study participants was found to be 51.01±5.9 years. About 18% of the study participants were illiterate. Rural women had more awareness in 15 out of 20 risk determinants as compared to urban women. Conclusions: The present study showed that rural women had more awareness as compared to urban women with respect to cardiovascular risk determinants.


Study of type II diabetes mellitus risk assessment in medical students of Davangere district, Karnataka, India using India diabetic risk score

Source: International Journal of Community Medicine and Public Health
Ravi Kumar, Aswin Kumar.
Background: Diabetes as a non-communicable disease is significant public health problem all over the world. In a non-communicable disease due to lack of clear etiological agent, it is heavily dependent on identifying and tackling risk factors. The disturbing finding of diabetes mellitus as the earlier age of onset combined with increasing prevalence of diabetes could have adverse effects on the nations health and economy this underscores the need for mass awareness and screening programs to detect diabetes at an early stage. The main objectives were to study the type II diabetes mellitus risk among medical student and to understand the association of Indian diabetes risk score (IDRS) with the body mass index (BMI). Methods: A cross sectional study was done among 600 students belonging to class I to class III part II in SSIMS & RC Davangere, from 1st February 2015 to 1st March 2015. A predesigned questionnaire was developed and was used to collect the data. Microsoft Office 2013 version was used for analysis of data. Results: According to body mass index (BMI) of the subjects, majority 225 (50.6%) were normal, 102 (20.2%) were pre-obese and 147 (29.2%) were considered as obese. Most of pre-obese and obese students were consuming mixed diet. IDRS shows that 80% (405) of the study population were having mild risk and chances of developing diabetes in future, whereas 6% (28) of the study participants had high risk and were counselled and asked to cut down weight and were told about life style modifications and 14% (71) of the volunteers had a moderate risk of developing diabetes. Conclusions: There is increased risk of type 2 diabetes mellitus among the First Grade College students. BMI has strong association with Indian Diabetes Risk Score, which indicates that most of the risk is modifiable with life style modifications and dietary changes in the students.


Study of Nocardia in HIV positive chest symptomatic individuals.

Source: National Journal of Integrated Research in Medicine
Ravindra K Khadse*, Mrudula N Dravid**, Hitesh R Adchitre***, Shubhangi C. Dange***.
Introduction: Pulmonary nocardiosis is a well-described infection in patients with neoplastic disease, human immunodeficiency virus (HIV) infection. The radiographic appearance of pulmonary nocardiosis is varied and nonspecific. Since the clinical and radiologic manifestations are non-specific, and the microbiological diagnosis is often difficult. In some patients, pulmonary nocardiosis will be mistaken for other infections, such as tuberculosis or bacterial pneumonia. Hence this study was undertaken to detect the prevalence of nocardiasis in HIV infected patients. Material and Methods: One hundred chest symptomatic patients screened for HIV infection and the samples of HIV positive patient processed for Nocardia using kinyouns modification of zeihl Neelsen stain and culture. The CD4 count of HIV patients with Nocardial infection and co-infection by mycobacterium tuberculosis studied. Observations: Out of 100 patients with cough and fever more than 2 weeks, 58 turned out to be HIV positive. Most of the patients included in the study were in their 3rd and 4th decades of life. The male to female ratio was 1:0.38. The open tuberculosis cases were 43.45% and sputum positive for acid fast bacilli. The nocardiosis was observed in 3.45% cases by modified Kinyouns method of staining and culture. In 80.65% tuberculosis cases, CD4 count less than 200/μl, while 19.35% had CD4 count more than 200/μl. The cases with nocardiosis had CD4 count less than 200/μl. Co-infection with tuberculosis and nocardiosis is not observed. The history of family contact for tuberculosis was found in 9.68% cases. Conclusion: The prevalence of nocardia in HIV positive individuals for north Maharashtra region is observed. The nocardia are easy to treat if diagnosed correctly and this will help in preventing morbidity in chest symptomatic patients. Unnecessary treatment with higher antibiotics can be avoided and cost effective treatment will be possible. Patients with CD4+ count less than 200 cells/μl should be screened for Nocardia. [Ravindra K NJIRM 2016; 7(5):73-77]


A Morphological Study Of Sacral Hiatus In Dry Human Sacra And Its Clinical Importance

Source: National Journal of Integrated Research in Medicine
Satish M Patel*, Sanjay K Vikani**.
Background & objectives: The opening at the inferior end of sacral canal is known as sacral hiatus.It formed due to the failure of fusion of laminae of the fifth (occasionally fourth) sacral vertebra. Sacrum is one of the bones which exhibit variations and the variation of sacral hiatus is of great clinical significance. Present study determined the landmarks for caudal epidural block (CEB) after morphometric measurements of the sacral hiatus on dry sacra bones .Methods: 120 sacral bones are used for the study. Anatomical measurements were measured by using Vernier caliper accuracy to 0.1mm. Results: Agenesis of sacral hiatus was detected in two sacral bones. Various shapes of sacral hiatus were observed which included inverted U (31%), inverted V (25.8%), irregular (20.6%), Elongated (17.2%) and dumbbell (5%). Apex of sacral hiatus was commonly found at the level of 4th sacral vertebra in 50.8%. The distance between the two superolateral sacral crests and the distance between the apex of sacral hiatus and the right and left super lateral crests were 69.5 (5.8) mm, 61.4 (11.2) mm, 57.4 (9.7) mm respectively, on average. The mean, mode, SD is calculated for all the measurements. Interpretation & conclusion: The sacral hiatus has anatomic variations. Understanding of these variations may improve the reliability of, caudal epidural block (CEB). [Satish P NJIRM 2016; 7(5):69-72]


Oral Health Knowledge, Attitude And Practices Of Indian Tribal Children

Source: National Journal of Integrated Research in Medicine
Rajal S. Pathak*,Sapna Hegde**,Amit Mendiratta***,Dinesh Rao Bolar****,Dhara J Pandya*****.
Background: The present study aimed to assess the oral health knowledge, attitude and practices of tribal schoolchildren of Gujarat, India. Methods: In this cross-sectional study, a total of 693 tribal schoolchildren were surveyed using a self-administered, structured questionnaire. Children were grouped by age into 3 groups - 1 (3-5 years), 2 (6-9 years) and 3 (10-13 years). Analysis of Variance, Karl Pearsons coefficient of correlation and linear regression analysis were used to assess the relationship between oral health knowledge-attitude (KA) scores and practice (P). Results: KA and P scores were highest for Group 2, followed by Group 3. The differences between scores of Groups 1 and 2, and Groups 1 and 3 were of statistical significance (P


Knowledge Of Cervical Cancer And Pap Smear Among Indian Women

Source: National Journal of Integrated Research in Medicine
Urvi Rutvij Parikh*, R. N. Gonsai*, Hansa M. Goswami*.
Introduction: Cancer of the uterine cervix is an important cause of morbidity and mortality among women worldwide and a leading public health problem. Currently cervical cancer is potentially curable, but still continues to be the second most frequent cause of death by neoplasia in women and the survival rate in 5 years varies from 44 to 66%. Method: This study was carried out during the period of January 2012 to June 2012in one of the tertiary care teaching hospital. In depth interview of 100 women were taken before and after awareness program in the form of lecture on cervical cancer- the occurrence and prevention. The data before and after were compared and analyzed. Results: most of the patients are in 4th decade of life (59 %). The educational level of respondents ranged from primary to tertiary level. Only a few patients (20 %) were aware that early detection and treatment regarding cervical cancer. Risk factors for cervical cancer were known by less than 35 % of the patients. Only 8 % of the respondents had heard of HPV or knew about its association with cervical cancer. Twenty-seven patients asserted that they had knowledge of the Pap smear test. Conclusion: By improving their knowledge and awareness regarding cervical cancer, we are able to reduce the incidence. [Parikh U NJIRM 2016; 7(5):60-63]


To Evaluate The Antimicrobial Efficacy Of Green Coffee Bean Extract On Periopathogens- A Clinico-microbiological Study

Source: National Journal of Integrated Research in Medicine
Sachin M**, Jiji J*, Poonam S***, Abhishek S*, Sweety S***, Pooja B***.
Aim - To evaluate the Antibacterial efficacy of three different dilution of green coffee bean extract on periopathogens. Objective- To achieve a dilution of green coffee bean extract which has the maximum inhibitory effect on P. gingivalis and A. actinomycetocomitans. Methods- The sterilised blood agar culture plate was prepared on which colonies of P. gingivalis and A. actinomycetocomitans were cultured by subgingival sample taken from Chronic Generalized Periodontitis cases. Three dilution of green coffee bean extract were prepared i.e 10 -8, 10 -9 and 10 -10 with the serial dilution method using Distilled water. Then streaking of colonies was done on three different areas of culture plate on which different dilution was added. Minimum inhibitory concentration (MIC) on culture plates was observed to see the inhibitory effect of Green Coffee Bean extract on periopathogens by Agar Diffusion Method.Result- 10-9 was found have maximum inhibitory effect on periopathogens especially P.Gingivalis Conclusion- P.Gingivalis is more susceptible to 10-9 concentration of Green Coffee Bean Extract [Sachin M NJIRM 2016; 7(5):56-59]


Evaluation Of Efficacy Of 0.2% Chlorohexidine Mouthwash As A Pre-Procedural Rinse In Reduction Of Streptococcal Colonies Following Ultrasonic Scaling: A Pilot Study

Source: National Journal of Integrated Research in Medicine
Sachit Anand Arora*, Shivjot Chhina**,Divya Sahay***,Gunjan Puri****, Navneet Kaur*****, Deeksha Bhardwaj******.
Objectives: To evaluate the efficacy of chlorohexidine mouthrinse as a pre-procedural rinse in reducing streptococcal bacterial colonies.Study Design: A single-centre, double-masked, placebo-controlled randomised clinical trial conducted over a period of 15 days. 6 patients were included in the study, patients were first asked to rinse with the placebo (distilled water) for 1 minute before the scaling of control site followed by test site rinsing with chlorhexidine mouthwash for 1 minute. The microbial contamination was checked in the operatory, operators mouth mask, the patients chest, the operators chest and the patients breath with the help of agar plates. Results: The results revealed that there was statistically significant reduction in the Colony Forming Units (CFU's) formation. Paired sampled t test was used for checking the statistical significance, confidence interval (CI) was 95% and (p


Evaluation Of Charlson’s Co-Morbidity Index And Risk Factors Among Patients With And Without Extended Spectrum Β-Lactamase Producing Enterobacteriaceae Spp. Urinary Isolates In A Super-Specialty Hospital

Source: National Journal of Integrated Research in Medicine
Mohit Bhatia*, Abha Sharma**, Bibhabati Mishra***, Archana Thakur****, Vinita Dogra*****, Poonam Sood Loomba******.
Background & Objectives: Extended-Spectrum Beta-Lactamase (ESBL) producing members of the family Enterobacteriaceae are emerging worldwide The aim of this study was to evaluate risk factors, co-morbidity status and short term mortality rates among hospitalized patients with and without ESBL producing Enterobacteriaceae spp. urinary isolates. Methods: An analytical cross-sectional study conducted in a super-specialty hospital from December 2014 to July 2015. Urine samples from 100 patients which repeatedly yielded significant colony counts of Enterobacteriaceae spp. isolates were identified using standard biochemical tests. Antibiotic susceptibility testing of these isolates was carried out by modified Kirby Bauer disk diffusion method as per CLSI guidelines 2014. Isolates which were resistant to cefotaxime and/or ceftazidime were tested for the production of ESBL by phenotypic confirmatory disc diffusion test. Relevant clinico-epidemiological details of these patients were subsequently obtained from Medical records as per the proforma formulated. The original version of the Charlson Index (CI) was used to assess co-morbidity and short term mortality rates. Results & Interpretation: Escherichia coli followed by Klebsiella pneumonia were the predominant isolates. 40 isolates were confirmed as ESBL producers. All isolates had Multiple Antibiotic Resistance (MAR) index of >0.2. The p-value of difference in proportion of all the risk factors distributed among patients with and without ESBL producing urinary Enterobacteriaceae spp. isolates respectively was found to be >0.05. The p-value of difference in mean Charlson index scores between these two groups of patients was 0.45. Conclusions: The results obtained in our study are largely inconclusive. It is imperative that more number of multicentre studies should be conducted in order to generate conclusive evidence on this subject. [Mohit B NJIRM 2016; 7(5):40-45]


Diagnostic Efficacy Of Gene X-Pert/ MTB-RIF Assay And Its Implication For The Treatment Of MDR TB In Rural Medical College

Source: National Journal of Integrated Research in Medicine
B.B.Bhadke*, R.K.Rathod**, D.G.Deshmukh***, A.B.Luniya****, P.A.Bulle*****, A.V.Surjushe******.
Aims and objectives: To diagnose and treat the MDR Tuberculosis by XPERT MTB/RIF assay as early as possible so that transmission of infection can be minimized and To find out prevalence of MDR TB in our rural district of Maharashtra. Methods: This is a observational ,prospective study conducted over a period of 14 months ( Jan 15 to April 16 ) in the Dept. of Pulmonary Medicine, Shri Vasantrao Naik Gov.t Medical College, Yavatmal, Maharashtra. We have subjected 613 patients who fulfill the clinical criteria for RNTCP - MDRTB suspect 1.Treatment failure. 2. Retreatment case sputum positive at the end of 4 months, 3.Contact of known MDRTB case, 4.Sputum positive at diagnosis, retreatment case, 5. Any follow up sputum positive, 6.Other category (sputum negative retreatment cases), and 7. HIV-TB Cases. We have excluded all new cases (sputum positive, sputum negative and extrapulmonary cases ). With all precautions two sputum samples collected in the designated microscopy centre. One sample was subjected for routine ZN staining and other one for GENE X-PERT MTB/RIF assay. Result. Out of 613 MDR suspect subjects, 314 (51.23%) were found in the age group 30 to 50 which is economically productive age group. There were 428 (69.82%) male and 185 (30.18%) female. Out of total study patient 44 (7.18 %) were detected Rifampicin resistance by X-PERT MTB/RIF assay. Amongst MDR suspect criteria highest no (4.07 %) of Rifampicin resistant were found in Retreatment cases ( group 4 ) followed by 1.47 % in any follow up sputum positive ( group 5 ) , 0.65 % in sputum negative retreatment cases ( group 6), 0.32 % in treatment failure ( group 1 ) , 0.49 % in HIV TB cases (group7 and0.16 % in contacts of known MDR ( group 3) .There were 144 ( 23 .5 ) were co infected with HIV.TB. Conclusion: We conclude that GENE XPERT MTB /RIF assay has significant role in detecting Rifampicin resistance, patient can be started on treatment at the earliest thereby reducing morbidity, progression to XDR, mortality and transmission of MDR/XDR TB in the community can be minimized. However it has some shortcomings that it cannot detect resistance of other anti- tubercular drugs and atypical mycobacteria.[B.B.Bhadke NJIRM 2016; 7(5):33-39]


Content Validity and Test-Retest Reliability of the Gujarati Version of the Central Sensitization Inventory

Source: National Journal of Integrated Research in Medicine
Bid Dibyendunarayan D*, Soni Neela C**, Rathod Priyanshu V***, A. Thangamani Ramalingam****.
Background: Central sensitization (CS) is a state of heightened sensitivity of the central nervous system to both noxious and non-noxious stimuli. The Central Sensitization Inventory (CSI) is a sound screening tool to help clinicians to detect patients with CS. To date, no Gujarati version exists. Objectives: The aim of this study was to translate and cross-culturally adapt the CSI into Gujarati, and to check content validity, face validity, internal consistency, test-retest reliability, agreement and minimum detectable change (MDC) of CSI-G in chronic low back pain (CLBP) patients. Methods: Translation and cross-cultural adaptation of the original English version of the CSI-G was performed according to published guidelines. The content validity was ascertained by 23 healthcare professionals. The internal consistency, test-retest reliability, agreement and MDC was determined on CLBP patients (n=31) with a time interval of 7-days. Results: The content validity and Face validity was found to be excellent. The internal consistency was excellent (Cronbachs α=0.914) and MDC was found to be 5.092 points. The test-retest reliability showed very high correlation in CLBP patients (ICC = 0.971). Conclusion: The original CSI was translated into Gujarati and did not pose any problems during data acquisition. The CSI-G seems to be reliable instruments to measure CS in Gujarati patients with CLBP. [Bid D NJIRM 2016; 7(5):18-24]


Clinico-Histopathological Analysis In Patients With Abnormal Uterine Bleeding

Source: National Journal of Integrated Research in Medicine
Falguni R. Shah*, Grishma S. Thaker**, Jayshree M. Shah***.
Background: Menstrual disturbance is one of the commonest gynecological problems for the curettage or hysterectomy specimen received by pathologist. During reproductive age group, approximately 9-30% of women suffer from menorrhagia or abnormal uterine bleeding & the incidence increases as age advances. Being most common gynecological problem, present study is aimed to know full spectrum of AUB and its pathological aspects. Methods: 200 cases were taken from NHL Municipal Medical College, Ahmedabad over a period of 3 years. Clinical history and radiological findings of cases of abnormal uterine bleeding were noted. Histopathological analysis was done. Data were analyzed and correlation between clinical and histopathological findings were studied. Results: Maximum numbers of patients were in 41-50 years (41.5%) of age group and next are in 31-40 years (38%) of age group. Proliferative pattern (24%) was most common pattern in non-structural causes of AUB and Leiomyoma (22.5%) was the most common structural cause of AUB. Pregnancy related causes of AUB were common in less than 40 years of age group. Malignancy was more common in more than 50 years of age group. Atrophic endometrium (33.33%) was the most common cause of post-menopausal bleeding. Conclusion: Endometrial specimen examination by histopathological evaluation is gold standard procedure to know the exact pathology for AUB and for further management of patients.[Falguni S NJIRM 2016; 7(5):14-17]


Association Of Anxiety And Quality Of Life With Internet Addiction Among Medical Students

Source: National Journal of Integrated Research in Medicine
Nidhi Nagori*, Ashok Vala**, Bharat Panchal***, Imran Ratnani*, Kinjal Vasava*.
Objective: Internet addiction is characterized by excessive or poorly controlled preoccupations, urges or behaviours regarding computer use and Internet access that lead to impairment or distress in individuals psychological state. This study was aimed to assess the frequency of internet addiction and its possible association with anxiety severity and quality of life among medical students. Methods: This was an observational, cross sectional, single-centred, self-assessable questionnaire based study administrated among 525 consenting medical students. The participants were assessed by proforma containing demographic details,variables related with internet use, questionnaires of IAT (Internet Addiction Test for Internet Use), BAI (Becks Anxiety Inventory) and WHOQOL-BREF (World health organization quality of life assessment scale). Statistical data were analysed by Graph Pad InStat version 3.06 using Chisquare test and Mann-Whitney test. Results: Frequency of problematic users among medical students was 9.3 % with frequency of internet addiction 0.9%.Participants with problematic internet use were likely to experience high severity of anxiety (p


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

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


Insulin Resistance: Detection By Fasting Insulin In North Indian Obese Adults

Source: National Journal of Integrated Research in Medicine
Anshu Khatri*, Parshant Changotra**.
Background&objectives:Several studies have shown that obesity is closely related to Insulin resistance(IR). Insulin resistance has been suggested as a primary cause for metabolic syndrome. Identifying such individuals would help to prevent progression of comorbidities associated with IR. Hence present study was planned to assess the importance of Fasting Insulin(FI) as a measure of IR and to analyze its correlation with other indirect methods for the assessment of IR . Methods: Study was conducted in fifty obese and overweight subjects.Body Mass Index of all subjects was calculated . Blood glucose, and FI were assayed after twelve hours of fasting. Homeostasis model assessment (HOMA) and Quantitative insulin sensitivity check indices (QUICKI) were calculated. Results: Present study showed that 90% of subjects had IR by HOMA and QUICKI.Correlation of FI with HOMA and QUICKI was statistically significant (P


Effect of perinatal asphyxia on thyroid stimulating hormone and thyroid hormone levels in a rural tertiary care center in Mandya district of Karnataka, India

Source: International Journal of Contemporary Pediatrics
Sunil Kumar P., Haricharan K. R., Venugopala K. L..
Background: Studies have shown a difference between serum concentrations of TSH, T4, T3 and FT4 in asphyxiated newborns than in normal newborns which suggesting abnormal thyroid function in asphyxia. We planned this study to assess and compare the effect of perinatal asphyxia on thyroid stimulating hormone and thyroid hormone levels. Methods: This was a tertiary care teaching hospital based, prospective case control study conducted on normal full term and full term asphyxiated neonates delivered and admitted in the neonatal intensive care unit at Adichunchanagiri Institute of Medical Sciences, B. G. Nagara, Karnataka, India from December 2012 to May 2014. Results: The means for thyroid hormones, in cord blood, were similar in both groups, except rT3are higher for non-asphyxiated new born as compared to asphyxiate ones. In newborns with 18-24 hours of life, lower levels of T4, T3, FT4, and TSH were observed in asphyxiated newborns, in which the basal levels (in cord blood) with exception of FT4, failed to increase. Conclusions: Our study suggests that lower T4, free T4, and T3 levels are secondary to lower TSH levels in asphyxiated newborns; also, peripheral metabolism of T4 in asphyxiated infants can be altered due to low T3 and normal reverse T3 levels.


Isolation of Spermatogonial stem cell and its viability in mice by different enzymatic digestion methods

Source: International Journal of Livestock Research
Kannan T.A, Sabiha Hayath basha, Vairamuthu S., Geetha Ramesh.
The mouse SSCs can be isolated using two step enzymatic digestion method using different enzyme combinations. To conclude, Type II enzymatic digestion method yielded cells, more in number and viable percentage in both pre-pubertal and post-pubertal age groups, than in Type I enzymatic digestion method. The present study provided basic protocol for isolation of maximum yield of functionally viable, spermatogonial stem cell population for further research or therapy.


To assess the role of multisite instillation of bupivacaine-xylocaine combination for reducing post-operative pain after elective laparoscopic cholecystectomy

Source: International Journal of Research in Medical Sciences
Jignesh A. Gandhi, Pravin H. Shinde, Pratik D. Patil, Samarth A. Thakkar, Rohan D. Digarse.
Background: Pain following laparoscopic surgery is multifactorial, arising from trocar sites (somatic pain), operative site (visceral pain) and shoulder pain (referred from diaphragmatic irritation because of pneumo-peritoneum). Currently no standard of care exists to reduce post-operative pain by use of local analgesia in laparoscopic cholecystectomy. Despite many studies, there are contradictory results. Aim of the study was to assess whether instillation of local anaesthetics at trocar sites and intraperitoneally, reduces the amount of pain experienced in the immediate postoperative period after laparoscopic cholecystectomy. Methods: This prospective study was carried out in the Department of General Surgery in a tertiary medical Centre in Mumbai. 75 subjects were randomized into 2 groups. Group A consisting of 38 patients were subjected to multisite instillation of LA combination (bupivacaine+xylocaine) at trocar site, gall bladder fossa, sub diaphragmatic space. Group B, (control group) consisting of 37 patients was given no such LA. Post operatively, pain was assessed by VAS scale (0-100) at 1,4,24 hours. Both the groups were compared and analysed. Results: Group A showed significantly reduced pain scores at 1, 4 and 24 hours post operatively as compared to group B. Conclusions: Our results indicate that multisite infiltration of local anesthetic combination (bupivacaine+xylocaine) after laparoscopic cholecystectomy surgery significantly reduces pain at 1, 4 and 24 hours postoperatively.


Vitamin deficiency prevalence in primary school children in Punjab, India

Source: International Journal of Research in Medical Sciences
Meenal Batta, Naveenta Gupta, Geetika Goyal, Amit Jain.
Background: Vitamin deficiencies are the conditions which are prevalent in the society and parents are unaware of them due to their asymptomatic nature. Overcoming this deficiency is integral in achieving the second Sustainable Development Goal charted out by the United Nations. Treatable and preventable nature of these conditions needs to be emphasized. Aims and objectives of the study were to study the prevalence of clinical features of vitamin deficiencies in primary school children. Methods: This single point cross sectional study was conducted in primary school children in Faridkot and comprised of students in the age group of 5-11 years. A total of 849 students were clinically examined. The clinical features of vitamin deficiencies were recorded. Descriptive analysis was used for interpretation. Results: Overall incidence of vitamin deficiency features was 18.96%. The features of vitamin A, B complex, C, and D deficiency were seen in 7.18%, 18.02%, 3.06% and 8.48% respectively. Some children have more than one deficiency features. Conclusions: The primary school children do suffer from vitamin deficiencies and there should be timely evaluation for these diseases. Larger studies substantiated with blood levels would provide more insight into these conditions.


Study of gastrointestinal toxicity of selective COX-2 inhibitors in comparison with conventional NSAIDs

Source: International Journal of Research in Medical Sciences
Hima Bindu K., Venkat Rao G..
Background: Adverse gastrointestinal events are the commonest unwanted effects of the NSAIDs, and are believed to result mainly from the inhibition of gastric COX-1, which is responsible for the synthesis of prostaglandins that normally inhibit acid secretion and protect the mucosa. Previous studies report, that selective COX-2 inhibitors are safer when compared to non-selective cyclooxygenase inhibitors, regarding their adverse effects on gastrointestinal system. But, recent studies reveal, that gastrointestinal safety of these selective COX-2 inhibitors is not much better than that of conventional NSAIDs. In view of the wider usage of selective COX-2 inhibitors, the study has been taken up to report, whether selective COX-2 inhibitors have got any advantages over conventional NSAIDs or not, in regard to their gastrointestinal side effects. Methods: Patients were divided into eight groups, fifteen patients of each. Each group was given one of the NSAIDs from the eight drugs those were selected for the study, for 15 days. In the selected group, along with the symptomatic assessment of gastric toxicity, both pre and post-treatment values of Hb% are estimated, tabulated & subjected to statistical analysis. Results: Both the drugs, diclofenac & meloxicam have shown significant changes in the Hb% values (p value 0.02 each), whereas selective COX-2 inhibitors like nimesulide & celecoxib were no less in gastric toxicity, in comparison with diclofenac, on symptomatic assessment. Conclusions: In our short-term study, selective COX-2 inhibitors did not show any advantage over non-selective NSAIDs regarding their gastrointestinal toxicity.


Computed tomography guided fine needle aspiration cytology of thoracic lesions: 10 year experience of an interventional pulmonologist

Source: International Journal of Research in Medical Sciences
Varinder Saini, Kranti Garg, Uma Handa, Surabhi Jaggi, Ravi Kumar Garg.
Background: Diagnosis of thoracic lesions may be challenging, due to various factors associated with the lesion and subsequent invasive investigations. Computed tomography guided fine needle aspiration cytology (CT-guided FNAC) is a minimally invasive method for thoracic lesions considered non approachable by other modalities. Methods: Retrospective analysis of patients subjected to CT-guided FNAC during year 2004 to 2014 was done. In these patients, non-invasive and invasive methods like fibre-optic bronchoscopy/ ultrasound guided FNAC were inconclusive/ expected to be inconclusive. Records were statistically analyzed for patient related, lesion related and procedure related factors, and their effect on yield and complications. Results: 435 patients underwent CT-guided FNAC. Age ranged from 10 to 95 years, with male preponderance. Diagnostic yield was 80.2%. Neoplastic lesions (255/435 (58.6%)) were most commonly diagnosed with majority (206/255 (80.8%)) being non-small cell lung cancer (NSCLC). This was followed by non-neoplastic lesions (94/435 (21.6%)) with Tuberculosis (42/94(44.7%)) being most common in this group. In 227/435 patients, other details like side and size of the lesion, position of patient during the procedure, depth of lesion from skin surface, number of passes undertaken and complications, if any, were also available. They were separately analyzed. Mean size of lesion was 5.7575 X 5.4173cms (maximum vertical X maximum horizontal diameter). Mean depth to which needle was inserted was 5.6663cms. Mean number of passes per patient were 1.98. Right sided lesions were more commonly sampled than left. Supine positioning was most commonly employed. Overall complication rate was 4% (9/227). Conclusions: CT-guided FNAC for thoracic lesions can serve as early diagnostic tool and guide in planning effective management strategies.


Low dosage iron supplementation: the impact of hemoglobin levels and the side effect of non-anemic pregnant women in Denpasar city, Bali, Indonesia, 2016

Source: International Journal of Research in Medical Sciences
Novia Arini, Sukma Adnyani.
Background: Nearly 95% of anemia in pregnancy is caused by iron deficiency. Iron tablet is recommended in pregnant women, but only 18% who consume iron tablet. One of the factors that influence compliance is the side effects such as constipation, nausea and vomiting. Pregnant women need additional iron supplementation of 30 mg / day, along with folic acid and vitamin C. Based on the above it is necessary to create Iron tablet formulations with low doses but can be optimally absorbed by the body. Methods: Randomized pre and posttest control group design. The inclusion criteria pregnant women 20-35 years, a distance of children ≥2 years, live in Denpasar city and the number of single fetus. Simple random sampling technique to determine the treatment group and the control group. The statistical test used in analyzing is the normality test, homogeneity, Chi-Square test and test the T-group. Results: During research of 44 respondents obtained the results of 44 (100%) are in a healthy reproductive age and no respondents were vegetarian. The analysis data with statistical test T-test, obtained no difference between low-dose iron supplementation and conventional doses of the hemoglobin of non-anemic pregnant women. Also showed that the low-dose iron supplementation can significantly lower incidence of side effects of iron supplementation in non-anemic pregnant women. Conclusions: The proper used of iron in the appropriate dose, will affect the effectiveness of absorption in the body and helps in reducing the side effects that arise from taking iron tablets during pregnancy.


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