Τρίτη, 16 Απριλίου 2019

Datta Meghe Institute of Medical Sciences University

Role of adenosine deaminase in pleural fluid in tubercular pleural effusion
Suchita Dilip Modi, Anil Kalyandas Agrawal, Arvind S Bhake, Vikas R Agrawal

Journal of Datta Meghe Institute of Medical Sciences University 2018 13(4):163-167

Background: Each year approximately 1 million patients develop the pleural effusion. Tuberculosis (TB), the single most frequent infectious cause of death worldwide, also is one of the leading causes of pleural effusion. Despite the advent of novel improvements in the diagnosis and treatment of pulmonary TB, a definite diagnosis of TB in a significant number of patients is problematic. Measurement of the level of adenosine deaminase (ADA) enzyme in body fluids is a helpful diagnostic tool. The level of ADA elevates as the lymphocyte (T-cell) activity increases. The present study was carried out to evaluate the ADA activity in pleural fluid for early diagnosis and management of tubercular pleural effusion (TPE). Objectives: The main objective is to determine the tubercular pleural fluid ADA level and its sensitivity and specificity. Materials and Methods: The prospective analytical study was conducted at Acharya Vinobha Bhave Rural Hospital, Sawangi (Meghe), in 105 patients of suspected case of TPE. A structured proforma was used for documenting the history, symptoms, side of effusion, hemogram and erythrocyte sedimentation rate (ESR), pleural fluid findings which included pH, glucose, proteins, lactate dehydrogenase (LDH), total leukocyte count (TLC) and differential leukocyte counts and serum ADA level was also calculated. Results: ADA sensitivity, specificity, positive predictive value, and negative predictive value (NPV) are 89.47%, 48.28%, 81.93%, and 63.65%, respectively, for TB. Pleural fluid ADA activity has been shown to be a valuable biochemical marker that has a high sensitivity for TB diagnosis. Conclusion: Pleural fluid ADA is markedly raised in tubercular effusions. ADA estimation is a simple, reliable, cost-efficient, and diagnostically useful investigation. 

Knowledge of Anganwadi worker with respect to early childhood development
Shashank Gotarkar, Abhishek Ingole

Journal of Datta Meghe Institute of Medical Sciences University 2018 13(4):168-170

Background: Being world's largest outreach program targeting infants & children below six years of age, expectants & nursing mothers, ICDS has generated interest worldwide amongst academician, planners, policy makers, administrators & those responsible for implementation. Consequently, many research studies have been conducted to evaluate & assess impact of program. The need for revitalization of ICDS has already been recommended toward better maternal and child health especially in rural areas. Inspite of repeated measures to enhance effectivity of ICDS program, impact is not observed as desired by policy makers or administrators. And hence knowledge of AWWs regarding ICDS program can be assessed & evaluated so that some of attributable reasons may be pointed out. Hence present study was undertaken to find out knowledge of AWW. Aim & Objectives: The AIM is to find out knowledge of Anganwadi Workers under ICDS with regards to ECD. Materials and Methods: This was a community based Cross-Sectional study, carried out at Seloo block of Wardha district, having total under five population approx. 7634. Study participants included 167 AWWs were included in the study. The study period was one year. Data were double entered and analysed in Microsoft excel (2007). The quantitative data was presented as proportion or mean with SD. Chi square test of significance was used wherever appropriate. Results: Shows that maximum no. of AWW (37.72%) were non matriculate. AWW with SSC and HSC qualification were 22.76% & 29.34% respectively. 64% AWW were Trained workers, 19% AWW received revised training while 17% were untrained workers. Conclusions: AWWs are actually the main resource person of the program and whose knowledge and skills do have a direct impact on the implementation of the programme. As the Anganwadi Workers play an important role due to their close and continuous contact with the people of community, especially the children and women, so there is an utmost need to assess their knowledge and the level of awareness regarding services provided by them in Anganwadi Centres. 

Psychological pain as predictor of impulse control among BAMS new entrants: A correlation study
Rupali Dhananjay Sarode, Vaishali Dinesh Tendolkar

Journal of Datta Meghe Institute of Medical Sciences University 2018 13(4):171-174

Background: Emotional discomfort in health professional students many times results in mental health-related problem in the future. First-year students face emotionally stormy transitional phase which leads to more psychological pain. Impulse control (patience) is considered as an absolute virtue of health professionals. Health professional students are expected to possess good impulse control for they come across varied natured people with diverse health problems in different stages of severity. Objectives:(1) The primary objective of this study is to identify the relationship between psychological pain and impulse control among new entrants studying in BAMS course. Research Design: This was correlation study. Population: First-year students both male and female from 1st year BAMS course. Sample Size: 100, (50 males and 50 females). Setting: Ayurveda Science Colleges in Nagpur and Wardha districts. Materials and Methods: Orbach Mikulincer Mental Pain Scale and Impulse control scale by Shrivastava and Naydoo. Results: Psychological pain and impulse control among male new entrants show a strong negative nonsignificant correlation (r = −0.475, P > 0.05), and for females, the correlation is statistically significant weak-positive (r = 0.181, P < 0.05). Together male and female new entrants have a negative statistically significant correlation (r = −0.363, P < 0.05). Conclusion: The findings suggest that higher the psychological pain, lower is the impulse control for both male and female new entrants of Ayurveda Science discipline. Male students show the greater magnitude of negative relation as compared to that of female students. 

Retrospective analysis of intracranial and intraspinal space-occupying lesions at a tertiary care center: A 5-Year study
Meena B Patil, Manjiri N Karandikar

Journal of Datta Meghe Institute of Medical Sciences University 2018 13(4):175-182

Background: Incidence of central nervous system (CNS) tumors is 2% of all malignancies. Low-grade tumors progress to high-grade tumors. CNS is a common site for metastasis from other organs. Aims: The aim is to study the incidence of various lesions in light of the World Health Organization (WHO) classification of tumors of the CNS, 2016, and to study relevant statistics. Objectives: The objective of this study is to provide an overview of intracranial and intraspinal space-occupying lesions at a single tertiary care referral center. Materials and Methods: A total of 124 cases were studied. Intraoperative diagnosis was desired in 70 cases. The final diagnoses in all the cases were made by routine histopathology. Results: Neoplastic lesions comprised 83.88%, including metastatic tumors, while 16.12% were nonneoplastic. Classification and grading of CNS tumors was done according to the WHO, 2016. Astrocytic tumors constituted the largest category. Incidence was more in females than males and in the fifth and sixth decades of life. Conclusion: This study highlights histological diversity of CNS tumors in adults and children. The most common destructive but nonneoplastic lesions such as infections/abscesses, infarcts, and cysts can be diagnosed, by crush cytology and frozen section for the definitive management. 

Oral health-related quality of life of institutionalized elderly in Satara District, India
KM Shivakumar, Snehal Patil, Vidya Kadashetti, Vaishali Raje

Journal of Datta Meghe Institute of Medical Sciences University 2018 13(4):183-189

Context: Almost in every country, the proportion of people aged over 60 years is growing rapidly than any other age group as a result of both longer life expectancy and declining fertility rates. Aims: The aim of this study is to assess the oral health status, oral health-related quality of life (OHRQoL), and the dental care utilization of institutionalized and homebound elderly in Satara district, India. Materials and Methods: A descriptive cross-sectional study was conducted among the 150 institutionalized elderly participants of Satara district. Type 3 clinical examination was done to detect dental caries, missing tooth, periodontal diseases, and any other oral findings followed by interview with elderly patients. A questionnaire was administered to assess OHRQoL according to the Geriatric Oral Health Assessment Index (GOHAI), dental visiting pattern, and sociodemographic and self-perceived oral health status of elderly. The descriptive and analytic statistics were used to analyze the data; Chi-square test or Fisher's exact test was performed to determine the prevalence of poor OHRQoL by independent variables. Results: Poor OHRQoL according to GOHAI was observed among 64.7% of the men and 67.1% of the women, and there was no statistically significant difference observed. In community periodontal index, 42.6% of men and 36.6% of women had all sextants excluded, and of those remaining, 95.6% of men and 96.3% of women needed one or other periodontal treatment. Regarding decayed, missing, and filled teeth index, mean was 22.5 in men and 24.2 in women. Conclusion: Institutionalized elderly with 65 years and older showed higher prevalence of poor oral health status and unmet needs for dental care that were associated with poor OHRQoL. Therefore, it is necessary to improve health and social importance of oral health care for elderly. 

Significance of differentiation of round cell count in semen in infertile men: A cost-effective study
Seema Balasubramaniam, Vishrabdha Rahul Pawar

Journal of Datta Meghe Institute of Medical Sciences University 2018 13(4):190-194

Background: The significance of the presence of immature germ cells (IGCs) and leukocytes in semen have not very frequently been highlighted in the diagnostic criteria of male infertility. Round cell count differentiation aids in better clinical correlation. Aim and Objectives: To differentiate the round cells into IGCs and leukocytes in the semen and to find their correlation with the total sperm count and sperm motility. Materials and Methods: Semen samples from patients at Bharati hospital, Sangli for evaluation of infertility from July 2014 to January 2015 were analyzed as per the WHO criteria. After the consent and collection of the semen sample, routine semen analysis was done. Smears of semen were prepared and stained by Leishman stain. The round cells were counted and differentiated into IGCs and leukocytes. Results: We studied 103 cases. Semen parameters such as total sperm count, motility were noted. The smears were studied for differential counts of round cell count into IGC count and leukocyte. The cases were divided into four groups based on total sperm count. Maximum number of cases was found in group III. Our study shows that round cell count is 5%–10% of the total sperm count. Negative correlation was noted between the total sperm count and IGCs. The correlation of total sperm count and leukocytes was negative and significant. Conclusion: The present study shows that differentiation of round cells in the semen can be effectively differentiated into spermatogenic and nonspermatogenic cells with the use of simple and cost-effective stain like Leishman stain. The correlation of sperm count with the IGCs and leukocytes and sperm motility is of immense use to find out the possible cause of infertility. 

Association between C-reactive protein and interleukin-6 levels in subclinical hypothyroid patients
Satya Devi Uppu, Madhur Gupta

Journal of Datta Meghe Institute of Medical Sciences University 2018 13(4):195-198

Background: The relationship between subclinical hypothyroidism (SCH) and cardiovascular disease has been one of the most popular topics recently. Our study aims to investigate the presence of the well-known preceding clinical situations of atherosclerosis such as endothelial dysfunction and inflammation in SCH. Materials and Methods: The study population comprised 50 patients with recently diagnosed SCH and 50 healthy controls. Thyroid-stimulating hormone (TSH), free triiodothyronine (FT3), and free thyroxine (FT4) were estimated by enzyme-linked fluorescent immunoassay for the diagnosis of SCH. Total cholesterol (TC), triglycerides, and high-density lipoprotein cholesterol (HDLC) were estimated by kit method in Siemens machine. Low-density lipoprotein cholesterol (LDLC) and very LDLC were calculated using Friedewald formula. Inflammatory marker C-reactive protein was estimated by kit method in Siemens and IL-6 by enzyme-linked immunosorbent assay. Results: In this study, the level of TSH ± standard deviation (8.56 ± 1.26 vs. 0.63 ± 0.16) was significantly higher (<0.001) in SCH patients, whereas FT3and FT4levels were within the normal range. TC, triglycerides, and LDLC were significantly higher in patients group, while the HDLC was significantly lower in SCH patients compared to euthyroid group. TSH level was positively correlated with inflammatory markers in SCH. Conclusion: This study suggests that SCH patients have increased inflammatory markers along with dyslipidemia due to that the future risk of further development of cardiovascular disorder can occur. Level of inflammatory makers increases in patients as disease progresses if left untreated. 

System Analysis of Biomedical Waste Management Across Health Care Clinics of Udupi Taluk
Greeshma Tony, Naveen Kumar, Brayal Dsouza, Rajesh Kamath, Sagarika Kamath

Journal of Datta Meghe Institute of Medical Sciences University 2018 13(4):199-201

Background: Improper Biomedical Waste (BMW) management by healthcare facilities can pose severe hazardous effects on the larger population, the environment, and its resources. Due to resurgence in number of clinics in urban areas, there is need to understand the practices and compliance to BMW management. It can be understood by studying and observing their practices and processes of BMW management and understanding the knowledge, attitude, and practice among the staff in the clinics. Aim: The objective of the study was to analyze the BMW management process across the healthcare clinics in Udupi taluk. Methods: A cross-sectional, observational study was conducted using self-administered questionnaires and checklists across 15 clinics in Udupi taluk. The sample size is 130 out of which Doctors, Nurses, housekeeping staff and descriptive Statistics were reported. Results: Of the 15 clinics only eight of them had basic requirements of BMW management; lack of trained workforce, non-compliance to segregation of waste, and non-compliance to collection and storage of waste are seen among majority of the clinics. Other findings during our study are 73.3% had inadequate transportation facility, while only 13.3% had adequate storage space. Doctors and nurses had 100% knowledge and positive attitude, environmental health workforce (housekeeping staff) had poor knowledge and attitude. 

The Efficacy of Tamsulosin as Medical Expulsion Therapy in Ureteric Calculus of <8 mm Size
Nagesha Shivanna, Abhishek Kumar Singh, Prateek Jugalkishore Laddha

Journal of Datta Meghe Institute of Medical Sciences University 2018 13(4):202-205

Introduction: Many conservative medical therapies have been researched and studied for ureteric stones. Alpha 1- Adrenergic blocker Tamsulosin reduces muscle spasm in the ureteric wall, decreases peristalsis below and raises pressure above the stone thus facilitating stone passage. Material and Methods: Patients diagnosed with ureteric stones from OPD, Casualty/Emergency Room and wards were included in the study. The patients were randomized into the study and the control arms. This was a prospective, randomized, controlled, open label clinical trial conducted on patients presenting to tertiary care center in north India with ureteric colic. Study group received Tamsulosin along with the analgesics, whereas the control group received only symptomatic treatment and hydration. Results: There were 29 (52.7&#37;) subjects in the study group and 25 (45.4&#37;) subjects in the control group had a subjective score of over 9 on arrival. The minimum pain score at presentation was 4 in the study group whereas it was 5 in the control group. Majority of the patients received Inj. Morphine after the initial Inj. Diclofenac sodium, 33 (60&#37;) in the study group and 36 (65.45&#37;) from the control group. There were 12 and 11 in the study and the control group who received an additional morphine infusion pump for pain control. The mean number of colic episodes during treatment was 1.75 (SD&#61;1.534) in study group which was marginally less when compared to that of the control group 1.93 (SD&#61;1.138) (P&#61;0.288).In the study group 41 patients had expelled the stone whereas in the control group 30 of them had expelled at the end of study period, the difference was statistically significant (P&#61;0.03). Conclusion: There was decreased pain score, number of colic episodes on treatment and duration of expulsion in the study group as compared to the control group (P &#62;0.05). The difference in the number of patients who expelled the calculus among both the groups was statistically significant (P&#61;0.03) noted in this study. 

Bilateral axillary accessory breast with ductal ectasia: Ultrasonography and elastographic appearance
Samida A Samad, Suresh V Phatak

Journal of Datta Meghe Institute of Medical Sciences University 2018 13(4):206-208

Ectopic breast tissue can present in any part of the body except normal breast region. Ectasia of the breast is a condition where the lactiferous ducts are dilated and blocked by secretions. Both accessory breast tissue and duct ectasia are common entities presenting separately, but the coexistence is rare with a normal breast finding. Here, we report a case of a 28-year-old lactating female presented with firm bilateral painful axillary lump of 6-month duration. This case is reported for its rarity and to give an overview of simultaneous coexistence of bilateral axillary accessory breast with duct ectasia, in a lactating normal breast. 

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