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Pattern of fractures in Road Traffic Accident victims admitted to the Accident Service Wards of the National Hospital of Sri Lanka

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Introduction: Though out of injuries sustained following road traffic accidents (RTA), fractures contribute to the leading cause of morbidity, the local data available with regard to fracture patterns following RTA is limited. Methods: A cross-sectional study was carried out recruiting the first 110 consenting consecutive patients who were admitted to Accident Service wards 72 and 73 of the National Hospital of Sri Lanka (NHSL) following RTA. An interviewer administered questionnaire was used to collect data. Demographic characteristics and accident characteristics were analyzed using IBM SPSS statistics 17. Results: The study revealed that males were more prone to sustain fractures and the motorcycle drivers and passengers were the most vulnerable. Except cyclists who commonly sustained upper limb fractures, most victims of other categories suffered lower limb fractures and irrespective of the category most were closed fractures. A statistically significant difference was found in occurrence of upper limb fractures among cyclists compared to other categories. Irrespective of the age group, lower limbs were found most commonly involved in fractures. Among the fracture victims, motorcyclists predominated <42 age group whereas pedestrians predominated >42 age group and it showed with increase of age the lower limbs were involved frequently and the involvement of the upper limbs declines. Use of helmets significantly reduced theseverity of fractures. Only a few of the RTA victims had received first aid care prior to hospitalization. Conclusion: Pattern and severity of fractures following RTA varied according to the category & age of the victim, the nature of the accident and use of personal protective equipment. Educating the public on first aid measures following RTA and to have better transport facilities to minimize the secondary damage are recommended.
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Proceedings of
The Sixth International Medical Students’ Research Conference
Souvenir-cum-Abstract Section
April 11-14, 2013
at UCMS, Delhi
Supported by
University Grants Commission Medical Council of India Indian Council of Medical Research
Convenor: OP Kalra
Organising Secretaries: Sonal Pruthi & Mohit Chhabra
Treasurer: Skand Shekhar
Executive President and Treasurer: Navjeevan Singh
Organizing Committee:
Advisors:
Anupam Prakash
Ashish Goel
Amitesh Aggarwal
Rajat Thawani
Satendra Singh
Upreet Dhaliwal
Patron:
Dr. Rajpal
Abhinav Agarwal
Aman Kumar
Anam Ghani
Anjali Bagaria
Arjun Ravishankar
Avvayyam Rattan
Nayan Agarwal
Sakshi Anand
Sakhsi Batra
Saurav Avi
Setu Gupta
Siddharth Chand
Vikramjeet Singh
ParthNsy
Pranav Mohan
Singhal
Rajneesh Gautam
Regina Khakha
Samiran Mukherjee
To study heart rate and blood pressure response to
cold pressor test in normotensive overweight and
normotensive normal weight individuals
Vishnu Santhosh Menon
Introduction: Overweight individuals show exaggerated response
to Cold Pressor test (CPT); but studies related to CPT response
in normotensive Overweight individuals are very scant. Since
Overweight / obesity are predisposing factors for hypertension,
therefore by observing individual’s response to CPT, one might be
able to predict susceptibility of individual to develop hypertension
in future. The present project aims to Study Heart rate and
Blood Pressure responses to CPT in Normotensive overweight and
Normotensive normal-weight individuals.
Methods: 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 overweight individuals and
control group consisting of normotensive normal-weight individuals.
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 Blood pressure changes in control
and test groups were recorded in the pre-task, task and post-task
period. The data collected was subjected to statistical analysis for
signicance 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 overweight
subjects were 19.33mmHg, 13.64mmHg and 5.10bpm respectively
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 normal-weight subjects
were 14.54mmHg (p<0.001), 5.61mmHg (p=0.005) and 6.27bpm
(p<0.001) respectively. The mean differences of SBP, DBP and the HR
between overweight and normal weights were 4.79mmHg (p=0.003),
8.03mmHg (p<0.001) and -1.18bpm (p=0.246) respectively.
Conclusion: The overweight subjects showed signicant rise in SBP
and DBP compared to normal-weight subjects. This proves that
former may have a greater susceptibility to develop hypertension
in the future.
Autonomic reactivity to stressful stimuli in
prehypertensive and hypertensive individuals
V Lavanya
Introduction: To assess the autonomic reactivity in prehypertensive
and hypertensive individuals and to compare the autonomic
reactivity between them.
Methods: It is a cross sectional observational study done in a
tertiary care hospital for two months in prehypertensive(n=25) and
hypertensive(n=25)of both sex in the age group of 25 to 60 years.
Resting heart rate,heart rate response to supine to standing(30:15
ratio)and Deep breathing difference (E:I Ratio)was done to assess
parasympathetic activity and blood pressure response to supine to
standing,cold pressor test to assess the sympathetic activity.
Results: Basal heart rate and cold pressor test showed signicance
in both the groups(p<0.005).
Conclusion: From the study there is not only sympathetic overactivity
involved in prehypertensive and hypertensive individuals but there
is also parasympathetic involvement.
Assessment of long-term quality-of-life (QOL)
outcomes in disease-free breast cancer survivors
Sukriti Rastogi, Chintamani, Megha Tondon,
Rohan khandelwal
Introduction: 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.
Methods: A follow up study in a cohort of 27 breast cancer survivors,
managed by the same oncological team at Safdarjung Hospital. A 34
item, subjective questionnaire (Cronbach’s alpha coefcient=0.89,
Spearman correlation coefcient=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.
Results: The mean age at presentation was 51.5. Physical and 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
signicant changes in their sleep & appetite pattern. Menopausal
symptoms were present in more than half of the survivors. 33%
of all, faced difculty 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.
Conclusion: 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
benets. The QOL study in breast cancer survivors will also have
positive inuence on women who are newly diagnosed with breast
cancer, on survivors & health care providers.
Practices and associated factors of smoking in male
undergraduates of the Faculty of Science, University
of Colombo, Sri Lanka
M Hian Nizam, IMMS Ihagama, IRHS Ihalagama
Introduction: Smoking is a global health hazard. Assessing
the smoking practices of University male undergraduates is of
importance to identify the impact of smoking in that population,
which represents the future educated workforce of the country.
Methods: A cross sectional study was conducted in a randomly
selected 160 male undergraduates of the faculty of science,
University of Colombo. Data of practices and associated factors of
smoking were collected using a self-administered questionnaire.
Data were analyzed using statistical software and p<0.05 was
considered signicant.
Results: Out of 160 respondents 35.83% smoked at least once in
their life time and 18.33% were currently smoking. The mean age
of starting smoking was 17.47 years. Higher percentage of current
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 147
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
smokers (10.17%) were from higher income group (>Rs.50,000). The
main reason to start smoking was peer pressure (23.83%) and main
reason to continue smoking was that smoking was pleasurable and
relaxing (18.33%). 89.47% of undergraduates smoked at outside
their home environment. highest was at university (36.84%) and
next at hostels (31.58%). The association between the prevalence
of smoking in undergraduates and their fathers smoking habit was
not statistically signicant (p>0.05) but the prevalence of smoking
among siblings was highly signicant (p<0.001). 95.45% of current
smokers were having intact families. The inuence of parental
education on the prevalence of smoking in undergraduates was not
signicant (p> 0.05). There was a direct association with smoking
in students who consumes alcohol at least monthly compared to
students who consumes alcohol occasionally (p=0.01).
Conclusion: The prevalence of undergraduate smoking is high in
our study sample. Onset of smoking was due to peer pressure prior
to entering university. Risk factors include: high income family
background and sibling’s smoking. Parental education and smoking,
residence and family status has no signicant effect. The majority
of current smokers also consumed alcohol.
The independent effects of poly cystic ovarian
synome on thyroid hormone and follicle stimulating
hormone
A Lakshmi
Introduction: To correlate the hormonal status of the patients with
a history of secondary amenorrhea for evaluation of PCOS with their
thyroid prole.
Methods: A cross sectional study of the patients attending OPD for
the evaluation of PCOS was done. Female patients in the age group
of 17 to 40 were included in this study. Blood samples were drawn
and estimated for LH, FSH,Prolactin,Free T3, Free T4,TSH.
Results: Fifty percent of the patients were in the age group of 17
to 25 years and 50% were in the age group of 26 to 40 years. In
group I, 60% of patients had altered gynaecological hormone prole
and in groupII, 53% of patients had altered gynaecological hormone
prole. The correlation between gynaecological index (LH, FSH and
prolactin) and thyroid prole (T3,T4 and TSH)was studied. It was
found that there was a signicant correlation between FSH and TSH
(r=0.809 p< 0.001).
Conclusion: When the PCOD is dignosed in the patients of mean
age of 20.8yrs, the gynaecological index is abnormal with normal
thyroid prole whereas in the mean age of the 33.5yrs, both
gynaecological index & the thyroid prole were abnormal. So, while
assessing a case of PCOS in a patient of mean age group 33yrs, both
gynaecological index and thyroid prole should be evaluvated.Hence
while assesssing a case of PCOS in a patient of higher age group both
gynaecological index and thyroid prole has to be considered.
Correlation of Ki-67 labeling index with grade and
stage of transitional cell carcinoma bladder
Ravinder Anjna
Introduction: The global burden of yearly occurrence of new cases
of TCC (Transitional Cell Carcinoma) bladder has gone up by 55% in
15 years. Incidence rates in India, vary from 2.6 to 4.8 per 100,000
in urban areas. The important prognostic factor in urothelial
carcinoma is pathological stage and the grade of tumour. Sometimes
it is difcult to accurately stage/grade and prognosticate the TCC
when only small cystoscopic biopsies are sent to the laboratory.
Early dysplasias of urothelium are likely to be missed in case only
conventional histomorphology is used. To address this issue, the
proliferation rate of tumour using Ki-67 labeling index (LI) has been
evaluated in this study
Methods: 30 cases of bladder tumours comprising of 3 papilloma,
4 PunLMP (papilloma with undetermined low malignant potential),
19 low grade and 4 high grade carcinomas were studied. The
histopathology of these cases was analyzed with 2009 TNM staging
and 2004 WHO/ISUP grading system. The sections of the tumour were
subjected to MIB-1 monoclonal antibody immunohistochemistry. The
tumours were divided into 2 groups (<10% of tumour nuclei staining
with MIB-1 and > 10%)
Results: Of the 23 cases of TCC, 15 were in Stage T1, 4 in T2, 3 in T3
and 1 case in T4 stage. There was a signicant level of correlation
of Ki-67 labeling index with stage (0.01103896) and grade of tumour
(0.00003808) using Fishers exact probability test
Conclusion: Our study has shown that the ki-67 MIB1 LI is associated
with stage and grade of TCC. Thus, together with tumour size, ki-67
MIB1 LI might be useful for stratifying patients of bladder tumours
into risk categories. It also adds to the objectivity in prognostication,
reduces the interobserver variation and accurately predicts the
tumour progression
Prediction model for low birth weight
Avantika Singh, Sugandha Arya, Harish Chellani
Introduction: Low Birth Weight plays an enormous role in neonatal
mortality and morbidity as well as adolescent and adult morbidity.
However, no prediction scale is available to predict the possibility
of a LBW neonate in Indian scenario. This study was undertaken with
the aims to assess the factors associated with LBW and formulate a
scale to predict the probability of having a LBW infant.
Methods: For this case control study, cases were dened as all live
neonates weighing < 2500g at birth and controls as those 2500g.
Maternal and neonatal data for various risk factors was collected
by personal interview (structured questionnaire) and from hospital
records. Data gathered for 200 cases and 200 controls were used to
study risk factors and build a prediction model. Validation of the
model was done on 100 neonates.
Results: Mean weight of cases was 1.99±.41 kg vs. controls 3.03±.39
kg. 39.6% of the cases were preterm and 63.2% SGA. Factors
signicantly 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,
pre-pregnancy BMI<20.621, mother’s height<1.53 metre, ANC visits
<4, pre-pregnancy weight<45 kg, inadequate spacing(<24 months)
and inadequate calories in diet (<1667.1 kcal/day) were also found
signicant. Using above data, a 6-factor prediction model was
formulated (sensitivity 71.58% & specicity 66.98%). Validation of
the model revealed a sensitivity of 72.0% & specicity 64%.
Conclusion: A simplied scale has been developed and validated as
148 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
a prediction model for LBW.
Laparoscopic surgery videos as a ‘visual aid’
to improve learning of anatomy: a prospective
controlled study
Krishna Adit Agarwal, Nayan Agarwal, Brij B Agarwal
Introduction: 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 multimedia-savvy. Practice of medicine is
also evolving with integration of multimedia technologies. Hence
multimedia tools can be incorporated in teaching and learning as
well. This study was aimed to evaluate the utility of Laparoscopic
Surgery videos in medical student’s learning of anatomy. Aim of this
study was to see if the learning of anatomy could be facilitated by
laparoscopic surgery videos.
Methods: 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. The end points
used were - Evaluation of students in the part completion test and
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 efcacy 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.
Results: 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. The results of the performance
assessment were signicant (p<0.01).Large majority (92%) of study
group students thought laparoscopic surgery videos to be ‘Very
Good’ additional learning tool.
Conclusion: Laparoscopic Surgery videos can be a good useful tool in
medical student’s learning of anatomy as shown by both acceptance
and performance of medical students. This is pertinent in view of
the dwindling cadaver population, reducing involvement of students
in dissection, negative perception of cadaveric dissection and
encouraging results of multimedia tools in learning. Laparoscopic
surgery videos are a free resource as it is a discarded product of
surgery. Hence they can easily be procured from operating room of
the medical school and incorporated in the teaching of anatomy.
Micronutrient deciency during third trimester of
pregnancy and its effect on neonatal outcome
Sheuli Paul, Akila Prashant, Prashant Vishwanath, MN Suma
Introduction: Pregnancy is a period of increased metabolic
demands, with changes in the women’s physiology and of a growing
fetus. Hence, during pregnancy adequate intake of vitamins and
minerals are recommended to prevent the adverse effects on the
mother and the fetus. Micronutrient deciency, whether clinical or
sub-clinical, may have adverse effects both on the mother and the
foetus. In our study we aim to study the levels of micronutrients like
iron, zinc and copper and to assess the neonatal outcome in those
pregnant women who exhibited these deciencies.
Methods: Fifty pregnant women aged 20-30 years after 28 weeks
of gestation on regular antenatal checkup were included. Collected
venous blood samples were used for the estimation of hemoglobin,
serum zinc, copper and ferritin. They were followed up till their
delivery and the neonatal outcome was noted. The Gestational
age, weight of the baby, length and head circumference, any
complications during and after delivery was noted in the proforma.
Results: Serum ferritin levels did not signicantly correlate with
other study parameters. Zinc levels decreased with increase
in parity. Copper level decreased with increase in BMI. With an
increase in hemoglobin there was an increase in the levels of zinc
and ferritin. With increase in parity there was decrease in neonatal
birth weight. Surprisingly, vegetarians showed a better hemoglobin
levels.
Conclusion: Our study clearly brings out a relation between
microminerals such as iron, zinc and copper during late pregnancy.
An improvement in iron status brings a positive effect on ferritin and
zinc levels thus indicating a better outcome from pregnancy.
Serum uric acid as marker of endothelial dysfunction
in type 2 diabetes mellitus and its correlation with
nitric oxide and insulin levels
KT Mimethashree
Introduction: Diabetes mellitus is one of the risk factors of
cardiovascular diseases, coronary artery diseases and dyslipedimia.
The basic pathophysiology in these conditions are endothelial
dysfunction, which also occurs when the conditions which decrease or
increase nitric oxide come to play in a milieu of oxidative stress.This
decrease or increase in Nitric oxide levels leads to vasoconstriction
which accounts for a vicious cycle of decreasing insulin sensitivity.
Assessment of the amount of endothelial dysfunction can be used
to estimate the severity of the insulin resistance in diabetes. The
best parameter representing the functional integrity of endothelium
would be Nitric oxide, whose assay poses certain bottlenecks. So,
another equivalent marker, Uric acid, whose estimation is simple
and practically feasible could be used. Aim of the study is to
estimate uric acid, Nitric oxide and insulin levels in type2 DM and
controls and correlate their values to evaluate their usefulness as
markers of endothelial dysfunction.
Methods: Case control study conducted in hospital setting by
random sampling during June to August 2012 with a study population
of 90 individuals consisting of 30 diabetic cases <5 years duration
and 30 diabetic cases >5 years duration and 30 controls.Special
investigations are Fasting blood glucose, Uric acid, Insulin, Nitric
oxide.
Results: NO and insulin levels though not statistically signicant
between cases and controls, to a certain extent becomes clinically
signicant.WhenUric acid as a marker of endothelial dysfunction
was assessed at a cut off of nitric oxide levels of 8.08 micromoles
per litre,the levels of uric acid that predict endothelial dysfunction
is 4.195.
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 149
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Conclusion: Serum uric acid can be used both as a marker of
endothelial dysfunction in type 2 DM, and as a prognostic marker for
its micro and macrovascular complications.Uric acid assay can be
used as a cheaper substitute to the costly and cumbersome assays
of NO and insulin.
Body dissatisfaction among students of a college
in Delhi and their internet usage: is there an
association?
Shobhana Sridhar, Rahul Sharma
Introduction: The prevalence of internet usage is increasing
amongst college students as shown by various studies. Body (dis)
satisfaction is also becoming a burgeoning issue amongst this young
age group. The study objective was to study the self-reported body
dissatisfaction among college students and its association, if any,
with their internet usage.
Methods: A cross-sectional study carried out in a randomly selected
general college of University of Delhi. The participants were 150
students belonging to the college. The tools included Body Shape
Questionnaire (BSQ) short form and a pre-tested questionnaire for
assessing internet use and demographic characteristics. Statistical
analysis involved proportions and chi square test.
Results: A total of 126 valid lled questionnaires were obtained from
the students including 50 (39.7%) males and 76 (60.3%) females.
The age of the respondents ranged from 17-22 years and majority
were day-scholars (81.7%). Body dissatisfaction did not have any
signicant association with age, gender, hostel status and family
income. A ‘U-shaped’ association of body dissatisfaction with BMI
was observed. It was least among those with normal BMI and high
among those both with BMI<18, and BMI>23. Body dissatisfaction
was higher among daily net users (29.7%) than those not using the
internet daily (19.2%) (p>0.05). There were signicant associations
of body dissatisfaction with high numbers of net friends (p<0.05)
and facebook friends (p<0.05) but not with number of real-life
friends (p>0.05). Body dissatisfaction scores were also higher among
those accessing facebook daily (p<0.05).
Conclusion: Body dissatisfaction was found to have an association
with BMI. There were statistically signicant associations observed
with high internet use, especially of facebook. This needs to be
explored in further large-scale studies.
Paraoxonase 1 levels in dialysis patients, a study
done in a sect of urban Chennai population
Madhusudan Vijayan
Introduction: Chronic kidney disease(CKD) is a proatherogenic
state. It is well documented that the most common cause of
mortality in CKD patients is Cardiovascular disease(CVD) . The
proatherogenic state is due to an alteration in lipid prole
occuring in an inammatory background. There is a qualitative
shift of lipoprotein prole towards atherogenicity, rather than a
quantitative shift. Thus overall Low density lipoprotein(LDL),High
Density Lipoprotein(HDL) and Total Cholesterol levels alone are
not useful predictors of atherogenic risk. Paraoxonase 1(PON1) is a
HDL associated enzyme which carries out most of the antioxidative
functions of HDL including prevention of LDL oxidation, and can be a
useful predictor. This study aims to compare PON1 levels in dialysis
patients, CVD patients and controls.
Methods: In our case-control study, 50 CKD patients were age
and sex matched with 50 cardiovascular disease patients and 50
apparently healthy controls. Fasting venous blood sample was
taken, and lipid prole was estimated. PON1 activity was estimated
spectrophotometrically using Paraoxon(0,0-diethyl-0,4-nitro phenyl
phosphate) as the substrate for hydrolysis.
Results: Total cholesterol levels were lower in CKD than in CVD
and controls,which were signicant. (166.42,210.48,192.98mg/dl
respectively, p=0.001).The LDL levels were lower in CKD than in
CVD and controls,which were signicant(94.45,118.15,114.15mg/
dl respectively,p=0.037). The HDL levels were lower in CKD than
in CVD and controls which were signicant(42.87,59.60,49.74mg/
dl,p<0.001). PON1 levels were found to be less in CKD than in
CVD and controls, which were signicant (79.70,93.44,123.40
IU/L respectively,p<0.001). PON1/ HDL ratio was lower in CKD
and CVD than in control, and was signicant (2.040,1.639,2.762
respectively,p<0.001).
Conclusion: Quantitative measurements of atherogenicity like
total cholesterol and LDL levels failed to highlight the increased
cardiovascular risk, which qualitative measurements like PON1
activity and PON1/ HDL ratio indicate. Hence PON1 and PON1/
HDL are better factors which can be used in the cardiovascular risk
stratication of CKD patients.
Counseling as method to increase participation of
undergraduate medical students in research
Rajat Choudhari, Harshita Nori, Shubhanker Mitra
Introduction: The interest and number of medical students doing
research is negligible. There are many initiatives across the country
to improve this situation. Some of the identied barriers preventing
medical students from taking up research projects are; difculty
in framing a research question, lack of motivation and insufcient
guidance. We hypothesized that counseling the interested students
could result in a higher proportion of them eventually taking up
research during their undergraduate course. In this project we tried
to explore the feasibility and the impact of a counseling among rst
year medical students.
Methods: First we surveyed medical students to identify the
proportion of them interested in research. We then, further
invited the rst clinical year students for a counseling session.
The counseling was oriented towards introduction to concepts of
research, how to go about selecting research topics and identifying
the guides. The counseling aimed to convey that the students should
select a focused research question with a suitable study design
which can be completed in a stipulated time.
Results: The survey response rate was 86.4% (203/235), 27%(55/203)
of which were rst clinical year students. 56.6% (115/203) of the
responders stated that they were interested in research, among
them 6.9%(14/203) were rst clinical year(1Y) students and the rest
49.7%(101/203)were from other batches (0Y). The 1Y students were
given counseling; among them 78.6% (11/14) students eventually
took up guided research projects. In comparison to this, only 8.9%
(9/101) OY students who weren’t given counseling took up research
projects.
Conclusion: Counseling appeared to bring about a promising
rise in the number of rst year students engaging themselves in
research projects. It could be adopted as a strategy to improve the
participation of students in medical research.
150 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Spectrum of opportunistic infections among Human
Immunodeciency Virus sero-positive patients in a
tertiary care hospital
Isha Gambhir
Introduction: Opportunistic infections (OIs) continue to cause
considerable morbidity and mortality in HIV infected individuals.
We undertook a prospective cross-sectional study to document the
spectrum of opportunistic infections in HIV seropositive patients and
to correlate them with their CD4+ counts.
Methods: One hundred consecutive HIV seropositive patients were
studied. Individuals with clinical suspicion of any opportunistic
infection were subjected to further investigations. Diagnosis of
co-infections and opportunistic infections were performed by
examination of smears, cultures and serology following standard
guidelines.
Results: Majority of the patients were in the age group of 18-49
years and 70% were males. A total of 96 OI events were reported
from 59% of study subjects. Tuberculosis including Pulmonary TB,
Extra-pulmonary TB and Disseminated TB was the most common OI
observed followed by candidiasis (21%) and P. jiroveci pneumonia
(11%). Various other OIs were reported in lesser frequencies. Co-
infections with similar modes of transmission including Hepatitis B,
Syphilis, Genital warts and Hepatitis C were found in 7.6%, 6.7%,
5% and 1.3% patients respectively. CD4+ testing was done in 47% of
patients, majority of the patients tested (95.8%) had counts < 350
Cells/μL. OIs were seen in high frequency among all patients with
CD4+ counts of <350 cells/μL.
Conclusion: This study showed the occurrence of various OIs among
patients with HIV infection. Knowledge regarding the prevalence
of various OIs might aid in making decisions regarding empirical
treatment and would help to prioritize limited resources. It is
important to understand the presentation of HIV disease in the local
context.
Pulmonary tuberculosis in diabetes mellitus patients
in a tertiary care hospital in south India-a case
control study
Avinash Kumar
Introduction: Diabetes mellitus continues to be a risk factor for
the development of tuberculosis in patients in India and worldwide.
We undertook a prospective case-control study to document the
frequency of tuberculosis in diabetes mellitus patients.
Methods: It was a case control study done in a time period of 2
months with 100 cases and 100 controls. Cases were the patients
having diabetes mellitus with respiratory symptoms and controls
were free from diabetes mellitus but had respiratory symptoms.
All the patients in both the groups were screened for pulmonary
tuberculosis by sputum smear microscopy on ziehl neelsen’s
medium and conrmed by culture on Lowenstein-Jensen’s medium.
Demographic variables including age, sex and other factors like
type (1 or 2) and duration of diabetes mellitus, any other associated
complications were analysed for the development of tuberculosis
Results: Majority of the patients (51%) were in the age group of
61-70 years and 77% were males. Among 100 cases, 94 were having
type 2 DM and 6 were having type 1 DM. Among cases 13% of the
patients were diagnosed with tuberculosis and among controls 6% of
the patients were diagnosed with tuberculosis. Among the cases, of
the thirteen patients with Pulmonary Tuberculosis, ten (77%) were
males and three (23%) were females, eight patients (61.5%) were
in the age group of 61-70 years. All thirteen patients had type-2
Diabetes mellitus .All thirteen patients had uncontrolled Diabetes
mellitus status. 62% were having diabetes mellitus since more than
10 years. Hypertension was associated with 77% cases.
Conclusion: This study showed the increased occurrence of
tuberculosis among DM patients as compared to non DM patients.
Hence it is necessary for all diabetic patients with respiratory
symptoms to undergo microbiological screening for pulmonary
tuberculosis to avoid further complications.
KAB of adolescent girls on menstruation and
menstrual hygiene in urban area
Madhuri Batyala, Kolli Karuna Murthy, Bhaskari Kolli
Introduction: In India, menstruation and menstrual practices are
clouded by taboos and socio-cultural restrictions. Traditionally in
India, it appears that there are some strategies: use of old cloth
as pads by washing them, and endangering menstrual hygiene with
long term implications for reproductive health. The aim is to study
the knowledge, attitude and behavior of adolescent girls towards
menstruation and to promote hygienic practices among them.
Methods: It is a randomly selected school based cross sectional
study of 100 adolescent girls from an urban area. The approval of
the College Ethical Committee is will be submitted soon. A pre-
structured and pretested questionnaire was used. The girls were
questioned about their knowledge on menstruation, type of sanitary
pads they are using, their disposal and any dietary and behavioral
changes. At the end of the study an awareness programme was
conducted to the study group. Data was statistically analyzed using
chi-square test in SPSS v16.0.
Results: The mean age of attaining menarche was 12.29 with S.D
1.05. Out of the 100 participants, only 6% of the girls knew about
the pubertal changes while 65% of them only partially know. 83% of
them consider menstruation as normal and only 37% of them knew
about it before attaining menarche. The source of information being
the mother (72.97%). Only 83% of the girls used sanitary pads while
others still preferred using cloth/cotton etc. 94% of them followed
safe disposal methods. Many restrictions were imposed on the girls
during menstrual period.
Conclusion: The study shows that the urban adolescents need to be
educated stupendously regarding menstruation and its hygiene. In
spite of the special emphasis on adolescent care the attitude and
behaviour has not changed to the expected level.
Variation in hematological parameters in burn
injuries
K Kiran Chana, AR Raghupathi, M Natarajan
Introduction: In a patient with severe burns, there would be
signicant variation in the haematological parameters and also in
coagulation factors, due to widespread damage to the coagulatory
and brinolytic system. This study was aimed to determine the
hematological changes occurring in severely burned patients in the
rst week post-burn and to observe for persistence of abnormalities
in these parameters. A comparison of the blood prole between
survivors and non-survivors was also made. Correlation of these
factors with complications can help in early identication,
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 151
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
appropriate management and improved clinical outcome.
Methods: 35 patients, with thermal burns involving body surface
area more than 20%, admitted to the Department of Plastic Surgery,
Victoria Hospital, during a period of 2 months, were observed. Blood
samples were collected from them post burn on 1st, 3rd and 7th day
in survivors and till day of survival in others. Routine hematological
tests including Hemoglobin Estimation, Total Erythrocyte Count,
Total Leukocyte Count, Platelet count and tests for Coagulation
Parameters (PT, INR and APTT) were performed. The individual mean
of each of these values in patients who survived (15 patients) was
statistically compared with that of patients who died (20 patients).
Results: It was seen that the initial polycythemia was followed
by anemia in all patients, highlighting the need to monitor the
Hemoglobin percentage. A signicant leukocytosis observed in all
the patients was not related to sepsis. The platelet count showed
an increase in number in survivors post-burn, while a decline was
observed in the non-survivors. The coagulation parameters however,
showed no signicant deviation from the normal. Hence, it was
concluded that platelet count monitoring has to be done more
frequently and any fall in the levels are of immediate concern.
Conclusion: The results of this study signify the importance of
regularly monitoring the Hematological parameters, especially,
Platelet Count and Haemoglobin Estimation to effectively manage
and treat burn patients. The parameters considered were a part
of routine patient work-up and follow up, enabling the study to be
applied in every primary health care.
Quality of life of patients after temporary ileostomy
for ileal perforation- a questionnaire based study
Rahul Gaba, Pradeep Saini, Arun Gupta, Navneet Kaur, Nitin
Agarwal, MS Faridi
Introduction: Quality of life (QoL) of the patients after a temporary
ileostomy for ileal perforation is affected by several perceptions
and concerns, stoma related complications adds on to this stress.
QoL issues and factors affecting satisfaction in these patients have
not been addressed. Study aimed at assessing the stoma related
complications and quality of life issues.
Methods: This is a non interventional, cross sectional, personal
interview based study at a tertiary care hospital. Forty (40)
consecutive patients following up in OPD were interviewed with
the help of validated questionnaire having three parts related to
demographic details; stoma morbidity and quality of life. Analysis
was done with the help of chi square, one way ANOVA and unpaired
t test.
Results: 29 males and 11 females, between 16 to 60 years
participated. Females scored less than males in all important
outcomes. Most common complications seen were excoriation/
dermatitis (90%) and Flatus & odour (57.5%). Mean general
QoL, stoma related QoL, role physical, role emotional and body
pain dimensions score were 48, 52, 19, 22 & 40(all out of 100)
respectively. Signicant associations between general QoL, stoma
related QoL, physical health and mental health with duration of
stoma at the time of interview were found. Stoma related QoL also
was signicantly associated with general QoL, physical health, and
mental health.
Conclusion: Below average general QoL score indicates an in
general dissatisfaction with quality of life; patients with below
average general QoL had a signicantly poor stoma QoL. Patients
thought they could do physical activities but were actually not doing
it as reected from the good physical function scores but poor role
physical scores. Role emotional, role physical and body pain were
the most limited domains of patients’ lives. This highlights the need
for dedicated stoma care personnel and counselors, to reduce stress
levels, alleviate concerns and clear misconceptions.
Behind the prostate, lies the hand: exploring
novelties
Anew Lourdunathan, Helena Ann Titus, Sonu Yeldose,
Edmond Fernandes
Introduction: Research is to see what everyone has seen and think
what no one has thought. The ratio of the lengths of index and ring
ngers (2D : 4D) is a marker of prenatal exposure to sex hormones,
with low 2D : 4D being indicative of high prenatal androgen action.
Recent studies have reported a strong association between 2D
: 4D and risk of prostate cancer. We intended to explore if there
are hands patterns which play a signicant role towards prostate
cancer-the most common cancer in the geriatric age group.
Methods: The study has been conducted in the coastal belt of the
west coast of India, location; Mangalore. The mean of the right
index and ring nger length was subjected to appropriate statistical
analysis, with the geriatric age group in consideration.
Results: The mean ratio of the index nger (2D) to Ring Finger (4D)
in the right hand of patients suffering from prostatic lesion was
10.03 to 10.48 ( cms) respectively.
Conclusion: The mean of ring nger being taller than index nger
in patients with prostatic lesion allows us to infer that, there could
be a possibility of exploring the digits length which will invariably
add to the etiological factors of research and a need for a larger
multi centric study may concretize the etiological realization and
necessary education & prevention can be met in an Indian context.
Metabolic synome in menopausal women in urban
population of south India
Aarthi Subramanian
Introduction: Menopause has a natural predisposition to insulin
resistance and thereby to Metabolic Syndrome due to the loss of the
benecial effects of Estrogen. The aim of the study is to assess the
Metabolic Syndrome by ATP III and IDF criteria in the study groups
and correlate it with the estrogen decient state. The incidence
of the syndrome is also compared between the groups. Sub-clinical
inammation attributed by the syndrome is correlated with hsCRP levels
Methods: Case-control study .45 menopausal women and 45 women
of reproductive age group were classied according to ATP III and
IDF criteria for metabolic syndrome.They were selected from
hospital based setting.The study period was from April to June 2012.
The patients were randomly selected from those attending the out
patient department.FSH and LH were Assessed by ELISA method.
Results: Metabolic syndrome as per IDF & ATP III criteria in cases
was 62.2% & 62.2%, & 55.6% & 48.9% in controls respectively.. By
logistic regression analysis, FSH served as an independent risk factor
for metabolic syndrome (p=0.032, CI=0.904-0.996) with a cut-off
value of 24.7mIU/ml. hsCRP levels predicted risk at 3.035mg/l. Age
at menopause was a predictor of risk for metabolic syndrome as per
IDF criteria only.
152 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Conclusion: There was no signicant association of metabolic
syndrome with menopausal status due to the estrogen decient
state caused by activation of PPAR-γ in obese reproductive women
which mediates down-regulation of FSH stimulated aromatase &
estradiol in human granulosa cells.FSH served as an independent
predictor of risk at a cut-off of 24.7 mIU/ml indirectly implying the
lack of estrogen conferring vulnerability to the syndrome.
Obesity and calcium metabolism in south Indian
urban population
Venkatachalam Veerappan
Introduction: Over expression of agouti gene in obesity leads to
increased intracellular calcium (Ca)i via calcitriol dependent
membrane vitamin D receptor (mVDR) which activates fatty acid
synthase promoting lipogenesis. Dysregulation of intracellular
calcium ux/signaling is a key factor in hypertension, insulin
resistance and obesity.In this case-control study it was proposed to
study the association of obesity and calcium metabolism.
Methods: Case-control study.31 cases with BMI>/= 25 with no co-
morbidities, 29 obese cases with co-morbidities and controls 27
normal individuals with a BMI <25 were included (Total = 87).They
were taken from hospital based setting who were randomly selected
from those attending the out patient department.The study period
was from April to June 2012.Parathyroid hormone and Vitamin D
were assessed by ELISA Method.
Results: Ca levels showed statistically least signicance between
controls & obese with co-morbidities (p=0.049).25(OH) vitamin D
levels were signicant between controls and obese without co-
morbidities (p=0.034).Levels of PTH (p=0.667) were not statistically
signicant between the 3 groups. Ca negatively correlated with PTH
(r=-0.317, p=0.003) & vit D negatively correlated with WC(r=-0.286,
p=0.008) and BMI(r=-0.217, p=0.043). PTH was an independent
predictor of calcium by multiple logistic regression (p=0.005)
Conclusion: The association of hypocalcemia in obesity was not
demonstrated in the current study population. The calcium levels in
the control group being in the low normal range and 25(OH) vitamin
D and PTH being within normal limits along with hypermagnesemia
directs the cause of lower Ca2+ levels probably to a genetic
polymorphism of either 1-alpha hydroxylase activity or to 1,25
(OH)2 vitamin D3
Role of undergraduate medical students in the
eld of pediatric hemato-oncology in a developing
country
Narayanan Balakrishnan, Julius Xavier Scott James Martin,
Adanma Anji, Vivek Jeyakumar, Guhan Ramamurthy, Haree
Shankar Meghanathan
Introduction: Developed countries have demonstrated a remission
rate of almost 60 to 70% in children with cancer. In developing
countires, the remission rate has been signicantly lower, due to
lack of social support and hence Medhope foundation was started in
Sri Ramachandra Medical University by the Medical undergraduate
students to support the children with cancer and the families under
the guidance of a pediatric hemato oncologist.
Methods: The objective of the foundation was to support the
families of children with cancer, to increase awareness about
childhood cancer and also encourage more medical students to
research and pursue a career Pediatric Hemato Oncology.
Results: Medhope has succeeded in creating a unique blood bank
reserve for Pediatric Hemato Oncology Patients. This reserve has has
helped over 80 children in the span of a year. Medhope conducted
the rst Undergraduate Pediatric Hemato Oncology conference
HOPE 2011 was attended by over 500 medical students from
across the country. A questionnaire based study conducted among
the delegates, before and after the conference demonstrated
a signicant increase in interest in Pediatric Hemato Oncology.
Medhope has published a magazine ‘Esperanza’ which comprises
of scientic articles and experiences of the cancer children and
their families thereby raising awareness about pediatric hemato
oncology. Medhope has also organized ‘Play dates’ where medical
students have spent time with cancer children. Medhope has
arranged medical camps to create awareness and has helped in
early detection of childhood cancer.
Conclusion: The foundation which was started by the interns of Sri
Ramachandra University,under the guidance of a pediatric hemato
oncologist is a support system for children with cancer and has
also increased the interest of undergraduate medical students
for pediatric hematology and oncology.This will be a model for
improving the status of pediatric oncology in developing countries.
Correlation between transcutaneous bilirubin
at multiple sites and serum bilirubin in neonatal
hyperbilirubinemia
Ajay M, Savitha MR
Introduction: Transcutaneous bilirubin(TCB) is a safe, simple, cost
effective, non-invasive modality in the screening of jaundiced
neonates. However, TCB values vary at different sites.To study
correlation between transcutaneous bilirubin at multiple sites and
serum bilirubin in jaundiced neonates
Methods: Present cross-sectional study included 149 neonates
developing jaundice within 2 weeks of life. Transcutaneous
bilirubinometer(model MBJ 20) was used to record TCB at
following sites-forehead, sternum, upper thigh and sole(near heel).
Corresponding serum bilirubin(SBR) level was obtained within
30mins of TCB reading.
Results: Of 149 neonates, there were 81 males, 68 females, 128
term, 21 preterm neonates and 42 LBW, 10 VLBW neonates. Majority
(58.3%) were between 4-6 days of life. Though all the sites correlated
with SBR, forehead (FH) TCB best predicted SBR in both preterm
and term neonates. Between FH and SBR, correlation coefcient
was 0.342 indicating a positive and signicant correlation (p=0.000).
We also found maximum agreement of 90.7% at 5mg/dl to 15mg/
dl range. The sensitivity of FH TCB was 82.9%, specicity 68.9%,
Positive predictive value 90.6% and negative predictive value was
52.38%.
Conclusion: Forehead is the most ideal site for TCB measurement.
The maximum agreement between FH TCB and SBR was in the 5mg/
dl to 15 mg/dl range
The relation of malarial onset with health facilities
in Katpady
Somanshi Sehgal
Introduction: Malaria is on the endemic diseases of Karnataka.
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 153
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Annually 3000 people of Karnataka suffer from malaria annually.
Unlike the morbidity, the disease is preventable with the use of
basic sanitary facilities at the community level. This project aims
to nd out the extent of malarial morbidity and develop a relation
between the current statistical data to actual local knowledge
about the disease and the availability of proper sanitary conditions
of the village.
Methods: This cross sectional study was conducted in village
Katpady, Udupi district of coastal Karnataka which is an endemic
area for malaria. The study was done among 140 head-of-families
from different households in a time period of 1.5 months. All types
of houses were surveyed regarding the history and knowledge of
malaria and a corresponding questionnaire was lled. The results
were evaluated.
Results: The study revealed that the incidence of malaria in Katpady
is 25%. Even after such a high incidence one-third people were not
aware of the modes of spread and preventive measures for malaria.
8.5% of the households even after such a literacy rate believed in
indiscriminate dumping. There is improper drainage supply and
disposal of waste. The condition gets worse in monsoon. Malaria is
an endemic disease of the area but still only 7% of the people had
complaints regarding its occurrence.
Conclusion: Even after such a high literacy rate, the incidence of
malaria in Katpady remains high due to lack of enthusiasm shown by
the residents in keeping the area clean and also due to the lack of
good sanitary facilities provided by the government. Thus there is a
need for active participation by residents to keep their area clean.
Thus a proposal for the same was kept in front of the Panchayat at
the village meeting and information was spread in print and speech
Evaluation of automated real-time nucleic acid
amplication technology for rapid and simultaneous
detection of tuberculosis and Rifampin resistance
Abhijith K Anil, Ashwini Agarwal
Introduction: Laboratory techniques of using direct microscopy for
the diagnosis of tuberculosis by detecting acid fast bacilli lacked
sensitivity and specicity. Culture, in spite of being the gold
standard for tuberculosis detection has a high turn around period
which varies from 2 weeks to 3 months. It also requires stringent
bio-safety norms and careful handling. Xpert assay tested in our
study uses automated system of bacterial lysis, DNA extraction,
real-time PCR amplication, and amplicon detection for diagnosis
of tuberculosis and detection of Rifampin resistance. In this study
we evaluated the performance of the Xpert assay by drawing a
comparison with the results obtained by direct microscopy, culture
and drug susceptibility testing.
Methods: This study was conducted in a pulmonary tertiary care
hospital. Hundred patients with symptoms suggestive of pulmonary
or extra-pulmonary tuberculosis were enrolled for the study at the
point of presentation to the consulting physician. Patients included
both new cases and those who have undergone previous treatment.
Samples taken were evaluated using smear test, culture and Xpert
assay. The performance of the Xpert assay was then compared with
those of culture and smear test. Drug sensitivity test was further
done on results positive for Rifampin resistance.
Results: Xpert assay was found to have high sensitivity, specicity
and high rates of positive and negative predictability when compared
with culture which is gold standard for diagnosis of tuberculosis.
Its performance was also superior to that of smear test with both
pulmonary and extra-pulmonary samples. All the Rifampin resistant
strains were correctly and rapidly identied and hundred percent
concordances were seen with the results of drug sensitivity test.
Conclusion: From the study conducted it was found that Automated
Real-Time Nucleic Acid Amplication Technology used in the Xpert
assay is ideal for rapid detection of tuberculosis and Rifampin
resistance aiding quick and correct therapy.
Correlation of foot bimalleolar angle with pirani
score to assess the severity of congenital talipes
equinovarus deformity
Pragya jain, Meenakshi Goel, Anil Mehtani, Anil Kumar Jain
Introduction: While treating clubfoot it is important to classify the
severity of deformity and the outcome.The pirani score,Demeglio
score,Catterrell and Harrold and Walker classications are in vogue
but are subjective in nature and have inter and intraobserver
variation.We still need an objective evidence of improvement and
deterioration of clubfoot deformity.The foot bimalleolar angle on
a foot print in proposed as an objective evidence of severity of
clubfoot and its correction.This study is undertaken to correlate
anteromedial foot bimalleolar angle with pirani score.
Methods: 244 club feet of 137 children (mean age 5.8 months)
attending CTEV clinic were included.All neurogenic clubfeet,
relapsed cases and age of children more than one year were
excluded.
The severity of deformity as per the pirani score was calculated
and the feet were divided into group I, II, III each with (.5-2 pirani
score) 154 feet; (2.5-4) 50 feet; (4.5-6) 40 feet respectively.The
anteromedial angle between long axis of foot and bimalleolar line
or foot bimalleolar angle (FBM) was calculated from podogram. The
mean, range and SD of FBM angle for each group was made and
multiple compression was done by Tubey HSD.
Results: The mean FBM angle for groups I was 79.20 with SD 5.13
(range 67-920). The mean FBM for group II was 68.40 with SD 3.83
(range 60-790) and in group III was 53.270 with SD 8.01 (range
42-690).The difference of mean of each group was statistically
signicant with adjacent group (p <01).
Conclusion: The FBM correlates well with severity of deformity as
assessed by pirani score and correction achieved,thus podogram
and FBM angle became objective and cost effective criteria to be
included in assessment and treatment of CTEV.
Cross-sectional retrospective study of psychosocial
impact related to physiological changes of menarche
among adolescent girls in south India
Sindu T, Bharatwaj RS
Introduction: The bodily changes associated with puberty and
menarche affect a girl’s psychological and social health. Very few
studies have been done on this topic in India. So this study attempts
to nd out the psychosocial impact of menarche,among school going
adolescent girls in, urban south India.
Methods: Following ethical approval, as an ICMR STS project, a
cross-sectional study, among 101 randomly chosen adolescent girls
by simple random sampling amongst the 150 girl students, who
have already attained menarche of an urban co-education school in
154 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Villupuram, and those who were willing to participate and have got
informed consent from their parents for participating in the study,
was undertaken .Information from the girls was collected using a
pre-tested and validated questionnaire. The collected information
was compiled and then analyzed for any signicance of differences
in proportions by Chi square and other appropriate tests using the
statistical software SPSS 15.
Results: Majority of the girls 67(66.4%) did not have sufcient
information about menarche to be previously prepared. For the
majority of the girls 57(56.4%), mother was the primary source
of information. Surprisingly mothers who were teachers were not
found to be good source of primary information to their daughters.
16(15.8%). of the girls were unable to attend school due to discomfort
and for 9(8.9%) it affected their studies. This has an overall negative
impact on their psyche, feeling bad or restricted. The girls mostly
have a negative stressful reaction when asked to think back of their
menarche. On attaining menarche the kind of information the girls
got from home, teachers and friends mainly centered on the issues
related to personal hygiene, safety and social restrictions
Conclusion: Over all the Girls lack enough information prior to
attaining menarche in order to be sufciently prepared for it.
Seroprevalence Of HIV, HBV & HCV In 1000 blood
donors at Dayanand Medical College & Hospital,
Ludhiana
Harnoor Singh Bhardwaj
Introduction: Transfusion-transmissible infections(TTI) such as
human immunodeciency virus(HIV), hepatitis B virus(HBV) and
hepatitis C virus(HCV) are among the greatest threats to blood safety
for the recipient. This study aimed to determine the seroprevalence
of these viral markers in relation to voluntary/replacement donation
& number of donations in 1000 blood donors at Dayanand Medical
College & Hospital, Ludhiana (DMCH).
Methods: Study was conducted on 1000 blood donors donating
blood in Department of Immunohematology & Blood Transfusion,
DMCH, Ludhiana and at outreach voluntary blood donation camps.
Screening and selection of blood donors was done as per criteria for
donor selection laid by Director General of Health Services, Ministry
of Health, New Delhi. Serum of these blood units was screened by
3rd generation ELISA for these three viral markers. The results were
interpreted as per the strategic guidelines provided by WHO. Chi
Square test for trend analysis was done.
Results: Out of the 1000 donors tested 83.8% were replacement
donors & 16.2% were voluntary donors. 95.3% were males and 4.7%
were females with M:F ratio of 20.27:1. Mean age in the present
study was 32.58 ± 10.24yrs. Maximum number of blood donors
were in the age group of 21-30yrs in both voluntary, 51.85% and
replacement group, 52.03% followed by 31-40yrs with voluntary
donors as 25.6%, & replacement donors 25.42%.
Seropositivity was more in rst time donors in both voluntary 1.85%
and replacement 2.02% donors. Incidence of HIV was 0.2% & were
only in replacement donors; HBsAg was 1.4%, more in replacement
donors 1.43% vs 1.23% in voluntary group. In HCV the incidence
was 1.2%, more in the replacement donors 1.31(11) vs 0.61(1) in
voluntary donors.
Conclusion: Voluntary blood donation is more safe and advocated
than replacement donation where higher incidence of TTI’s was
observed.
Learning styles and approaches to learning among
medical undergraduates and postgraduates
L Samarakoon, T Fernando, C Roigo, S Rajapakse
Introduction: The challenge of imparting a large amount of
knowledge within a limited time period in a way it is retained,
remembered and effectively interpreted by a student is
considerable. This has resulted in crucial changes in the eld of
medical education, with a shift from didactic teacher centered
and subject based teaching to the use of interactive, problem
based, student centered learning. This study tested the hypothesis
that learning styles (visual, auditory, read/write and kinesthetic)
and approaches to learning (deep, strategic and supercial) differ
among rst and nal year undergraduate medical students, and
postgraduates medical trainees.
Methods: We used self administered VARK and ASSIST questionnaires
to assess the differences in learning styles and approaches to
learning among medical undergraduates of the University of
Colombo and postgraduate trainees of the Postgraduate Institute of
Medicine, Colombo.
Results: A total of 147 participated:73 (49.7%) rst year students,40
(27.2%) nal year students and 34(23.1%) postgraduate students.
The majority (69.9%) of rst year students had multimodal learning
styles. Among nal year students, the majority (67.5%) had
multimodal learning styles, and among postgraduates, the majority
were unimodal (52.9%) learners.Among all three groups, the
predominant approach to learning was strategic. Postgraduates had
signicant higher mean scores for deep and strategic approaches
than rst years or nal years (p<0.05). Mean scores for the supercial
approach did not differ signicantly between groups.
Conclusion: The learning approach showed a positive shift towards
deep and strategic learning in postgraduate students. However a
similar shift was not observed in undergraduate students from rst
year to nal year, suggesting that their curriculum has not inuenced
learning methodology over a ve year period.
Determinants and outcome of Low Birth Weight
(LBW) infants in a secondary care hospital: a
retrospective cohort analysis
Mahjabeen Khan, Suma Nair, Dinesh Nayak
Introduction: Low birth weight (LBW) is one of the most serious
challenges in maternal and child health in both developed and
developing countries. Its public health signicance may be ascribed
to numerous factors such as its association with human wastage
and suffering; high cost of medical care and socioeconomic under –
development.This study was an attempt to identify the determinants
and outcome of low birth weight infants over a period of three years
in a secondary care hospital.
Methods: The medical records of all infants born in the year 2008
and fullling the prescribed inclusion criteria were reviewed and
relevant information recorded using a data extraction sheet.The
cohort was retrospectively followed up for a total duration of 3
years.Statistical analysis was done using SPSS version 16
Results: Of the total 800 neonates born in 2008, 105 had a recorded
birth weight of less than 2500g (13% of all births).Of these two
(1.9%) had very low birth weight (VLBW) and 102 neonates were
recorded with a birth weight between 1500-2499 grams (LBW). Mean
birth weights of boys and girls were 2290.82± 176.1 (Min= 1850,
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 155
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Max=2497) and 2246.1± 272.1 (Min= 1070, Max=2490), respectively.
Of the six neonates (5.7%) diagnosed with congenital anomaly, four
were boys. Multiple gestation [RR=4.45 (95%CI 1.3, 14.8) p < 0.05]
and preterm delivery [RR=7.14 (95%CI 1.6,30.0) p < 0.01] were
signicantly associated with LBW. All the infants had a favourable
outcome in the immediate post natal phase.
Conclusion: Preterm delivery and multiple gestation were the two
factors found to be signicantly associated with LBW in this study.
More boys than girls were in the low birth weight category and also
observed to have congenital anomaly
Laboratory tests show reliable, accuracy of the
results and interpretation of abnormal results
Ramya A, Azhalathithan T, Ayarin Glorida Stephen,
Ravi Kiren BS
Introduction: Laboratory tests are used by clinical for diagnosis,
monitoring and prognosis in patients with different diseases changes
in test results occur as a result of the normal Aging process. To
detect biochemical changes in the patients, the pre analytical and
analytical variations must be reduced to acceptable levels at which
they cause no impact as clinical interpretational of the results.
Methods: In this study were taken 25 male 20 female 20-38 years old,
from staff of the central laboratory. The study was conducted at Sri
Lakshminarayana Institute of Medical Sciences, Puducherry, Bharath
University. Patients were enrolled in the study after obtaining written
consent.To examine the differences in measurements according to
the separating of sample collecting freezing temperature and freezing
periods for Biochemical serum analysis.
Results: Our study shows UA, Triglycerides are increase at 23±1oc
for 18 hrs but no change in4±10c, serum glucose decreased in both
temperatures at 18 hrs. Increased PO4 concentration could be a
cause of prolonged storage of serum at room temperature 23±1oc,
but in 1±40c only slight changes were seen in the before 12 hrs.
Conclusion: Our study glucose, creatinine, posphorus should be
processed with in 12 hrs is best. The remaining parameters evaluated
were stable at 24 hrs at 23±1oc and 4±10c. But we have to check the
remaining factors like instruments, relaliability of technical aspects.
We hope our results will give you an idea to assess the Biochemical
parameters in a time period and sample storage conditions.
Atypical thyroxine replacement in hypothyroidism-
a clinical audit
Sukriti Bhutani
Introduction: Change in dosage timing and frequency of L-thyroxine
administration may decrease the severity of “hypothyroid”
symptoms and contribute to patient satisfaction. This clinical audit
was planned to assess the patterns of L-thyroxine replacement in
hypothyroid patients.
Methods: A pretested, structured questionnaire collecting
information about age, gender, duration of disease, concomitant
morbidity and therapy, patient concerns, and thyroid control was
administered to 100 consecutive hypothyroid patients attending
an endocrine clinic in Karnal, Haryana, North India. Analysis was
carried out using the SPSS version 19.0.
Results: The mean age of patients was 42.14 ± 13.14 yr, with an
average duration of hypothyroidism of 5.12 ± 6.87 yr. Thirty-two
subjects were euthyroid (thyroid stimulating hormone (TSH) 0.35-
5.00 mIU/l).Eleven subjects reported a TSH < 0.35 and 57 reported
TSH ≥5.00 mIU/l. The commonest dose of L-thyroxine used was 100
mcg/day (n = 35), followed by 125 mcg/day (n = 20). The mean total
daily dose was 101.17 ± 24.91 (range 50-150) mcg/day. The daily
dose per body weight was 1.452 ± 0.38 (range 0.67-2.56) mcg/kg).
Nine patients were on atypical regimes: ve took their medication
in divided daily doses, two took it at night, and two preferred a
time “two hours after breakfast and two hours before lunch.” They
shifted from early morning administration of L-thyroxine because of
uneasiness (n = 5/9), palpitation (n= 2/9), and increased hunger (n =
1/9) post-tablet ingestion. The symptoms subsided after the timing
or frequency of L-thyroxine intake was changed.
Conclusion: Changing the time and/or frequency of L-thyroxine
dosage helps in alleviating some of the distressful symptoms among
the hypothyroid subjects.
A study to evaluate the prevalence of ophthalmic
manifestations in patients with head injury
Alagammai O
Introduction: Over 50% of all trauma deaths and about 60% of
vehicular trauma deaths are associated with head injuries. Head
injuries causes hospitalization of 200–300 persons per 100,000
population per year, and 25% of these are associated with ocular
involvement. The manifestations of head injury and its numerous
other systemic complications are so compelling that damage to the
visual system is most likely to be ignored. There are several studies
of patients with head injuries in Rehabilitation units being referred
for missed Neuro-ophthalmic ndings. Often times, when the eye is
examined as part of neurological assessment of a patient with head
injury, the purpose is mainly to gauge the severity of the head injury
itself. Thus, this study aims at recording the various ocular ndings
and neuro-ophthalmic signs in patients with head injury.
Methods: Type of study: Retrospective study. Study Population:
Patients who had sustained a head injury. Study locale: PSG
Hospitals. Sample Size: 63 patients. Sampling Method: Convenient
method. Inclusion Criteria: Patients who had sustained a head injury.
Duration of the study (in months): Two months. The hospital records
of patients who had a diagnostic code of head injury were reviewed
and the following data were collected and analysed. Patients name,
age, sex. Mode of injury. Abnormalities in the visual system such
as periorbital ecchymosis, subconjunctival hemorrhage, corneal
abrasion, globe rupture, orbital fractures, ocular motor nerve palsy,
optic nerve injury, papilloedema, pupillary abnormalities.
Results: Among the 63 patients with head injury, 60 (95.24%) were
males. Head injuries were more common in the age group of 21-40
years (range 3-81). Among the causes, Road trafc accidents were the
most common (87.30%), while fall from height accounted for 11.11%
and assault contributed 1.59%. Out of the 63 patients, 24 (38.10%)
had ocular involvement. Among the ophthalmic manifestations,
Periorbital ecchymosis was the most frequently encountered sign
(n=18, 75%) followed by Subconjunctival hemorrhage in 17 patients.
Traumatic optic neuropathy was present in 9 patients, and all had
ipsilateral relative afferent pupillary defect (37.5%). Hutchinson
pupil was noticed in 1 patient. Among the Ocular motor nerve
palsies, 4 patients had Oculomotor nerve palsy and 3 had Abducens
nerve palsy. Damage to the ocular cranial nerves occurred in 15
(62.5%) patients out of the 24 patients. 9 (37.5%) patients had only
soft tissue injuries.
156 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Conclusion: Detailed early ophthalmic assessment can serve as an
important adjunct to imaging studies in overall clinical assessment
of patients of head trauma. In this retrospective study ocular signs
were not recorded in all patients with head injury in critical care set
up. Hence some important clinical signs of neurological signicance
are liable to be missed. Emergency care personnel and intensivists
should give due importance to eye injuries and pupillary signs in
patients with polytrauma.
Childhood cancer awareness among undergraduate
medical students in south India
Chitra Lakshmi K, Angeline Prescilla R, Julius Xavier Scott,
Magatha Sneha Latha, Kannan L, Arvind Moorthy
Introduction: The demand of 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 of paediatric oncology among the medical
under graduates. PURPOSE-To evaluate the current status of
childhood cancer awareness among undergraduate medical students
in south India and their interest in paediatric oncology career
Methods: This is a non randomized study.A 24 point questionnaire
was given to the participants.Data collected was entered on to a
EXCEL SHEET and processed by spss software
Results: 240 students who attended the MEDHOPE CONFERENCE
2012 from various universities in south India answered the
questionnaire.70% of them answered correctly the basic knowledge
questions about childhood cancer.55%of the students have 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 % feel that it
is because of lack of trained personnel in paediatric oncology eld
in ourcountry.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%think that the information they
have on paediatric oncology is not enough to suspect and refer
appropriately during their practise. 84%feel that there is a denite
need to improve paediatric oncology teaching in their medical
curriculum
Conclusion: The outcome of this study shows that the clinical
postings of paediatric oncology in the medical curriculum will
improve the outcome of pediatric oncology care world wide.
Is the working population vulnerable to unsafe
cellular phone usage?
KDT Dinesha, MDP Dilhani, MKN Dilrukshi, C Arambepola
Introduction: Guidelines for safe cellular phone use to minimize
health hazards were declared by the leading international health
organizations. At present, the vast majority of the Sri Lankan
population owns at least one mobile phone.The objectives of the
study were, to ascertain the prevalence of practices linked to health
hazards of cellular phone usage, to formulate possible associations
of the identied malpractices with the characteristics of the study
population and their awareness of relevant health hazards.
Methods: The cross sectional study design was used in this study.
A convenient sample of adult bank employees in the head ofce of
Bank of Ceylon was selected. Each section of the bank was taken as
one cluster. All the clusters were listed and ones with less than 20
employees were taken out from the list. Five clusters were chosen by
simple random sampling method to select a study population of 150,
with the impression that all of them had the minimum number of
30 employees. A self administered questionnaire was used to assess
the basic characteristics of the study population, the awareness of
recently identied health risks of cellular phones and both safe and
risky practices. The prevalence of cellular phone related practices
were calculated in proportions. The knowledge regarding health
risks was categorized to good and poor knowledge with the use of a
scoring system to test the association with the detected practices.
The selected associations were analyzed by the χ2 test.
Results: Nearly equal number of males and females were found in
the study population where almost half of the population was in the
youngest age category. Majority of the participants were educated
up to or beyond Advanced level. The greater part of the study
sample was having high risk behaviours which enhance the health
hazards of cellular phones. The age and the awareness of possible
health hazards were found to have signicant associations with the
average caller time and the duration of usage respectively, where
the prevalence of unsafe practice was more towards the younger
ages and towards participants with poor knowledge.
Conclusion: It is evident that with the increasing availability of
cellular phones, as much as it was apparent internationally, the
risk behaviours were found to be very much prevalent to the same
extent, hence their consequences in years to come. It is suggested
to make this research a stepping stone to continue more researches
and make citizens of the country aware of the health risks and
preventive measures in terms of legislations as well as education
programmes, so that the public can obtain the optimum use of the
newest technology for the development of them and of the country.
Pattern of fractures in road trafc accident victims
admitted to the accident service wards of the
national hospital of Sri Lanka
Jayasinghe JASS K, Jayasekara NM, Jayasekara DP,
Pathirana S
Introduction: Though out of injuries sustained following road
trafc accidents (RTA), fractures contribute to the leading cause of
morbidity, the local data available with regard to fracture patterns
following RTA is limited.
Methods: A cross-sectional study was carried out recruiting the rst
110 consenting consecutive patients who were admitted to Accident
Service wards 72 and 73 of the National Hospital of Sri Lanka (NHSL)
following RTA. An interviewer administered questionnaire was
used to collect data. Demographic characteristics and accident
characteristics were analyzed using IBM SPSS statistics 17.
Results: The study revealed that males were more prone to
sustain fractures and the motorcycle drivers and passengers were
the most vulnerable. Except cyclists who commonly sustained
upper limb fractures, most victims of other categories suffered
lower limb fractures and irrespective of the category most were
closed fractures. A statistically signicant difference was found in
occurrence of upper limb fractures among cyclists compared to other
categories. Irrespective of the age group, lower limbs were found
most commonly involved in fractures. Among the fracture victims,
motorcyclists predominated <42 age group whereas pedestrians
predominated >42 age group and it showed with increase of age
the lower limbs were involved frequently and the involvement of
the upper limbs declines. Use of helmets signicantly reduced the
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 157
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
severity of fractures. Only a few of the RTA victims had received rst
aid care prior to hospitalization.
Conclusion: Pattern and severity of fractures following RTA varied
according to the category & age of the victim, the nature of the
accident and use of personal protective equipment. Educating the
public on rst aid measures following RTA and to have better transport
facilities to minimize the secondary damage are recommended.
Inuence of extracurricular activities on the
academic performance of students of Faculty of
Medicine, Colombo
YHH Gunathilaka, MDU Gunathilaka, PMP Gunawardena
Introduction: Despite the fact that there are many studies done
to assess the inuence of extracurricular activities on academic
performance of school students, hardly any study has been done on
medical undergraduates.
Methods: A cross sectional study was carried out on 106 medical
undergraduates of 2007 A/L batch of Faculty of Medicine, Colombo.
Information regarding type of extracurricular activities, and time
spent on each activity, marks obtained in three module exams
were collected using a pre tested structured self-administered
questionnaire. SND test for two sample means was used to analyze
the means of the mean marks obtained by the students who engaged
in extracurricular activities and who did not. Same test was utilized
to analyze the academic performance according to the average time
per week spent on extracurricular activities.
Results: According to SND test for two sample means there was no
statistically signicant difference between the means of the mean
marks obtained by the students who engaged in extracurricular
activities(mean=60.35, SD=7.035) and who did not(mean=58.52,
SD=6.395)( SND =1.145,P= 0.05). Also there was no statistically
signicant difference between means of average marks of the
students who spend more than seven hours per week(mean=60.31,
SD=7.63) and who spend less time (mean=59.86, SD=6.74) on
extracurricular activities(SND=0.256, P=0.05).
Conclusion: There is no signicant difference between the
academic performance of students who are doing extracurricular
activities and who are not doing and students who spend more time
on extracurricular activities do perform well in medical academic
carrier as the other students.
Patients’ knowledge about insulin therapy, factors
affecting it and its effect on glycemic control
NP Udawella, HKW Udayakumara, WD Udawatta
Introduction: Insulin treatment is a major component of the
pharmacotherapy of diabetes. Successful insulin therapy can
effectively control the disease and prevent its complications,
and is dependent on a large number of factors including patients’
knowledge about insulin treatment. This study was carried out
to describe patients’ knowledge about insulin therapy, factors
affecting it, and determine its relationship with glycemic control in
diabetic patients on insulin therapy, attending the diabetic clinic of
the National Hospital of Sri Lanka.
Methods: This study was a cross sectional descriptive study,
conducted on a sample of 120 diabetic patients attending the
diabetic clinic of the National hospital of Sri Lanka, selected
using a systematic sampling method. Data was collected using an
interviewer administered questionnaire and patients’ glycemic
control was recorded from the patients’ clinical records. Information
about patients’ socio-demographic factors, knowledge about insulin
treatment and patients’ glycemic control was obtained and analyzed
using Statistical package for social sciences (ver. 17.0).
Results: The study sample consisted of an urban population
mainly in the age group of 50 to 70 years (66.7%). Majority of the
participants were female (70.8%). Among the participants 85.0%
was Sinhalese while Muslims and Tamils being 10.8% and 3.33%
respectively. A majority was educated up to grade 8 (32.5%) while
31.7% was educated up to ordinary level and 20.8% was educated
below grade 8. Majority of the patients were housewives (31.7%)
while those who were employed were earning less than Rs.20000
per month (32.5%). All of patients were type 2 diabetics and were
using insulin in conjunction with other hypoglycemic drugs. Majority
of the patients had moderate knowledge about insulin treatment
(60.0%) followed by people who had poor knowledge (29.17%) and
who had good knowledge (10.84%). 62.5% of the patients had a
poor glycemic control while only 7.5% was having a good glycemic
control. The complication rate was high among the participants with
87.5% having at least one complication of diabetes. It was found
that a signicant relationship exists between the patients’ gender
and over-all knowledge about insulin treatment and also between
patients’ gender and their glycemic control. A signicant relationship
was also found between the patients’ level of income and their
complication rates. Time period since diagnosis of diabetes and
time period since commencement of insulin therapy was found to
be signicantly associated with the patients’ rate of complications.
Time period since the last education session the patient has had
was found to be signicantly associated with their glycemic control.
Conclusion: It was found that statistically signicant associations
exist between patients’ gender, income level, duration of disease
and insulin treatment, and time since their last education session
with their knowledge about insulin treatment and glycemic control.
But simple linear causal relationships were not seen in some of these
associations. It can be assumed that the relationships between
these factors are interrelated and confounded by each other.
Diabetic patients’ education sessions should be providing further
information in areas of types of insulin being used to treat and
their specic patterns of action and information about side effects
and complications of insulin therapy. A holistic and multifaceted
approach should be adopted by clinicians treating diabetic patients
to achieve optimum results.
Bacteriological prole and antibiogram of chronic
obstructive pulmonary disease cases- a prospective
study
Kalaivani, Cinthujah B, Palaniappan N
Introduction: Chronic Obstructive Pulmonary Disease (COPD)
is a spectrum of disor-ders that results in airow obstruction. It
constitutes 30% of cases seen in chest clinics and accounts for
1-2.5% admissions in hospitals all over India. Acute exacerbation
of COPD (AECOPD) is dened as a sustained worsening of the
patient’s condition, from the stable state and beyond normal
day-to-day variations, that is acute in onset and necessitates a
change in regular medication in a patient with underlying COPD.
The pathogens causing acute exacerbation of COPD by infecting the
lower respiratory tract are respiratory viruses, atypical bacteria,
Streptococcus pneumoniae, Pseudomonas aeruginosa, Klebsiella
pneumoniae and Haemophilus inuenzae The aim of our study is to
nd out the incidence of AECOPD and to study the bacteriological
158 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
prole and the antibiotic sensitivity patterns of isolated organisms.
Methods: Fifty patients clinically diagnosed with Acute Exacerbation
of Chronic Obstructive Pulmonary disease were included in the
study over a period of two months (July and August 2011).The
sputum samples were subjected to direct gram staining and culture
and the isolates were identied according to standard techniques.
Antibiotic sensitivity was done by Kirby-Bauer method according to
CLSI standards.
Results: COPD was common in age group of fty ve to sixty four
years. Out of 50 patients 90% were males and 10% were females.
The ratio of male to female is 9:1. Tobacco smoking particularly
beedi smoking was seen in many male patients.(70%) Positive
bacteriological culture was obtained in 46% of cases. Klebsiella
pneumoniae (43.47%) was the commonest isolate followed by
Pseudomonas. Most of the isolates were sensitive to Amikacin,
Ciprooxacin and cefotaxime and resistant to Cotrimoxazole,
Doxycycline and Gentamicin.
Conclusion: Sputum culture is a good and simple tool to study the
aetiology and sensitivity pattern of bacteria in COPD. It helps in
screening resistant pathogens and select better drug for treatment.
Asymptomatic throat carriage rate of Group A
Streptococcus and its association with ASO titres In
school-going children in rural areas of Haryana
Radhika Bansal, Varsha A Singh
Introduction: Group A Streptococci (GAS) are known to cause 20%
cases of upper respiratory tract infections in children. The children
generally remain asymptomatic and lead to spread of respiratory
infections in the community. They manifest in later stages of
life with serious complications like ARF, PANDAS and PSGN. We
carried out a preliminary study to investigate the rate of Group
A Streptococci carriers and associated Anti- Streptolysin O (ASO)
titres in asymptomatic school going children below 15 yrs of age in
rural areas of Haryana and to determine its association with various
epidemiological parameters.
Methods: Pharyngeal swabs were obtained to detect the presence
GAS and blood samples were collected aseptically to determine
elevated ASO titres in serum (>200IU/ml). A total of 100 samples from
healthy school going children below 15yrs of age were collected- 50
samples from government school and 50 samples from private school
respectively located in rural Haryana. The samples were cultured
for Group A Streptococci and the results were correlated with ASO
titres.
Results: Out of the 100 throat swab samples cultured, 12 samples
(12%) were positive for Beta haemolytic streptococci. The frequency
of Group A Streptococci was more in the students of government
school i.e. 18% as compared to 4% in the children of private school.
The ASO titres were positive in 35 samples (35%). The rate of ASO
titre positivity was 64% in the government school and 6% in the
private school. The incidence of ASO titre positivity was higher in
girls as compared to boys (p<0.0001, ORR=0.091, CI: 0.032-0.254).
A highly signicant association was seen between ASO Titres and the
lower socio economic status (p<0.001, ORR=0.036, CI: 0.0098-0.132).
Conclusion: The high carriage rate of beta haemolytic streptococci
seen in children poses a threat to the community and should be
checked. Regular screening needs to be done in various parts of
the country with prime focus on the girl child and the economically
weaker sections.
Knowledge and awareness of the cause and
prevention of cervical cancer
Abhishek Tandon
Introduction: Carcinoma cervix is the second most common cancer
in women worldwide, while it is the commonest cancer among
Indian women. It is imperative for at least health professionals and
students to have a sound knowledge of carcinoma cervix. In this
study, the current knowledge of female undergraduates and faculty
of health sciences regarding the various parameters like risk factors,
symptoms, screening tests and vaccinations pertaining to cervical
cancer was accessed
Methods: A cross-sectional, self-administered anonymous
questionnaire-based survey was carried out, after institutional
Ethical committee approval and written informed consent from the
subjects. The study included 260 staff and students of a medical
college in Mangalore and non-random sampling was done.
Results: Majority of the participants 185(71.4%) were aware that
cervical cancer is one of the most wide- spread gynecological
cancers in Asia. The awareness of causative agents of cervical
cancer was known to 53.9% of the undergraduates and 50% of the
faculty members. When asked about HPV 73% of the total study
group said they have heard of it and around 68% agreed that it
was detectable. 71% of the study sample had heard about the
Pap smear test and 42% have undergone the test. The questions
pertaining to the preventive measures of cervical cancer had
good faculty preponderance with 91.8% giving a positive response.
When asked about the symptoms of cervical cancer, 84.1% of the
students and 79.5% of the faculty members knew that abnormal
vaginal bleeding was a symptom
Conclusion: There is a growing risk of cervical cancer in women
in India and HPV is the main virus responsible for this sexually
transmitted cancer. Majority of our study group was well aware
of the various risk factors of cervical cancer and its preventable
nature however awareness regarding the association between
diets, multiple pregnancies and use of tobacco was poor. Awareness
campaigns are the need of hour to check the rapidly increasing
incidence of cervix cancer.
Study of utilisation pattern and the cost analysis of
antiviral agents in the management of chronic viral
hepatitis B infection
S Mohapatra, TR Swain
Introduction: Hepatitis B virus infection is a global health problem .
The antiviral drugs used in the treatment of chronic HBV infections
are the oral nucleoside or nucleotide analogs like lamivudine,
entecavir,adefovir. A newer group of anti Hepatitis B like telbivudine,
tenofovir have entered the market. Thus it was thought worthwhile
to study utilization pattern of different antiviral drugs and to throw
some light on their efcacy and cost
Methods: Serologically diagnosed cases of chronic hepatitis B
above 12 yrs of age were included in the study .It is an open label
observational study conducted during May and June 2011 at SCB
Medical College Cuttack involving patients of Gastroenterology
and Hepatology Departments. In this study data from 26 persons
suffering from chronic hepatitis B was recorded. This included the
liver enzyme levels, serological and virological markers of hepatitis
B and other related parameters. Data regarding antiviral treatment
also recorded . The result was then analyzed.
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 159
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Results: Out of 26 serologically diagnosed patients of viral hepatitis
B, 15 patients were continuing with one form of antiviral therapy.
Out of the 15 patients who were taking antiviral medication , 5 were
on entecavir , 4 on lamivudine , 3 on telbivudine , 1 on adefovir ,
2 patients who were previously on lamivudine were subsequently
switched over to entecavir. Telbivudine was signicantly more
costlier compared to any other antiviral drugs used in the
management of Hepatitis B.( Rs 180 per day)
Conclusion: Assessment of efcacy in terms of reduction of the
HBV DNA levels and other parameters showed that both entecavir
and telbivudine are highly efcacious.Entecavir proved to be more
efcacious compared to lamivudine. In contrast to telbivudine,
entecavir was less costly and equiefcacious. Lamivudine was
cheapest among all. However resistance to Lamivudine is a problem
and entecavir is better and cost effective alternative available to
tackle the situation.
Sugar dressing In the treatment of diabetic foot
ulcer- a pilot study
Kriti Kalda
Introduction: Today, antibiotic resistance has reached a critical
mass. Economic constraints make routine pus culture and antibiotics
beyond reach of poor patients. Foot ulcers are common reason for
hospital stays which is nancial burden for families. This study
provides better treatment and faster healing rates thereby reducing
length of stay and more cost effective treatment. Sugar is used
since ancient times to aid wound healing. Use of nely powdered
sugar to clean wounds was reported by Scultetus in 1679. In 1714
Zornin wrote on value of Sugar for promoting wound and ulcer
healing. Recent reports show excellent results with sugar dressing.
Sugar facilitates formation of protective layer of protein and has
bactericidal properties due to its osmotic action on wounds.
Methods: A total of 20 patients with Type 2 Diabetes Mellitus with
foot ulcer either fresh case or not treated outside for more than ve
days were taken for prospective case control study to receive either
sugar dressing or standard dressing. Bacterial colonisation, rate of
healing of the wound length, breadth and depth were assessed at
the start of treatment and at weekly intervals. Also proforma was
lled and investigation was done for a period of two months.
Results: 20 patients were enrolled. 10 received sugar dressing
and 10 standard dressing. In sugar dressing there was reduction in
bacterial ora in 3 cases, no organisms isolated in 2 cases and no
changes in bacterial ora in remaining 5 cases as compared to 2,
1, and 7 cases respectively for standard dressing. The difference in
mean length, breadth and depth in sugar dressing is 0.77, 1.4 and
0.6cm as compared to standard dressing which is 0.37, 0.65 and
0.17cm respectively.
Conclusion: The pilot study suggests that sugar appears to be more
effective in reducing bacterial ora and promoting wound healing
than in standard dressing.
Birthweight centiles for late pre term and term
neonates: prospective cross-sectional study
Shruti Sridharan
Introduction: Birthweight is one of the key indicators to assess
the health of an infant at birth. Identication of small or large
for gestational age babies is important for the management of the
individual pregnancy and neonate. They can be identied using
centile charts of birthweight by gestational age. The objective of
this study is to construct & compare ‘Gender wise’ centile charts for
birthweight of infants born from 34 to 42 weeks of gestation.
Methods: The study was conducted in a Tertiary & Secondary Care
Centre, Udupi. Prospective Cross-Sectional Study was conducted for
2 months, on Infants of 34 – 41 completed weeks of gestation. The
sample size is 300, complying to the good practice of statistical
study. Mothers with medical & obstetrical complications were
excluded from the study. Study was done with informed written
consent from the mothers. Gestational age was calculated by the
Last Menstrual Period or Ultrasound. The birthweight was measured
by electronic weighing machine.
Results: A total of 338 babies were considered for the study of the
total 386 single babies delivered, as the balance 48 babies were not
Apropriate for Gestational Age. Each of the gestational category
contains a minimum of 22 babies. In this study, majority of the
males(150) and female(123) babies lie between 10th and 90th centile.
Conclusion: Smoothened Centile Curves were not obtained as,
when the sample was further stratied on gender, the number of
subjects were reduced.A study to ascertain relationship between
birthweight/Gestational age, across genders, should be taken over
a longer period of time, enabling a healthy distribution of subjects
on the key parameters, to lead to a better study and obtaining a
better centile curve.
Prevalence of diabetes mellitus in rural Ahmedabad
of Gujarat - a camp based cross-sectional study
Bhavik Shah, Dinesh Rathod, Kriti Agarwal
Introduction: Diabetes Mellitus (DM) ranks twelfth in all-cause
mortality worldwide. India is emerging as a ‘diabetic capital’ of
the world. Though Diabetes is considered as a disease of urbanites,
several studies have documented prevalence of diabetes from 2 - 10%
among adult rural people. The rise is mainly attributed to change
in the life style and environment. The baseline data at local level
regarding the prevalence of diabetes and factors contributing to its
genesis can help for better planning, implementation, monitoring
and evaluation of National Program for control of Cancer, Diabetes,
Cardio-vascular diseases and Stroke (NPCDCS).
Methods: This was a camp based cross- sectional study conducted
at 5 randomly selected taluka villages in rural Ahmedabad. A total
of 230 visitors of medical camps with the age of above 20 years
were selected by systematic random sampling for study purpose.
Clearance from Institutional Ethics Committee (IEC) was obtained
before starting the study. Predesigned and pre tested Performa was
used for data collection. A drop of blood from the nger tip of each
participant was collected for measuring random blood sugar by the
use of rapid diagnostic kits. Data was analyzed in Epi Info 7 version.
Results: The prevalence of diabetes mellitus was 2.6 % in the
study population. The prevalence was highest (6.7%) in age group
21-30 and 51-60 years. Diabetes was signicantly associated with
hypertension,family history of diabetes and sedentary working.
Diabetes was not signicantly associated with smoking, diet habit,
caste and socio economical class.
Conclusion: In rural India, lack of awareness and specialist care
may lead to more complications and economic burden. Awareness
and early diagnosis by screening are the need of the hour to prevent
epidemic of diabetes in rural population.
160 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
A study on peadiatric palliative care awareness
among pediatric post-graduate students of south
India
T Ram Prakash, Narayanan Balakrishnan, M Haree Shankar, IN
Padmasani, Julius Xavier Scott, MS Latha, P Venkatramam,
L Kannan
Introduction: Currently in India there is an increase in growing
population of terminally ill patients among the pediatric age group
contributing to 15.8 percent. However, the palliative care needs of
these pediatric patients are inadequately met because of lack of
knowledge and training programs.
Methods: The objective of the study is to evaluate the palliative
care awareness among pediatric post graduate students. An
observational cross sectional study was conducted using a 19-point
questionnaire in the post graduate exam review course attended
by post-graduates from various universities of south India. 188 post
graduates attended our pediatric exam review course of which,150
postgraduates participated in this study
Results: 88% of them reported that they have never had any
palliative care training throughout their curriculum. 86%were
not aware of any palliative carecenters intheir area.60.7% were
uncomfortable with the care of theterminally ill children.87.3%felt
that a formal training in palliative care would help them.64.7%felt
that they did not have sufcient knowledge to identify the signs
of the terminally ill.77.3% were not comfortable in initiating a
discussion about palliative care.71.3% felt that the family members
of the terminally ill patient needed spiritual support.55.3% felt that
the period of taking care of the terminally ill affected their personal
life.79.3% felt that the health care providers involved in palliative
care also needed emotional support.
Conclusion: The results of the study show that the post-graduates
do not have adequate knowledge and training in palliative care and
that there is an immediate need to include palliative care training
as a part of their curriculum.
Prevalence of bronchial asthma among primary
school children in Mangalore
Siddharth Kackar, Animesh Jain, Pujitha Arthimalla, Sonia
Kaur Singh, Aditi Gupta, Ruthshee Suresh
Introduction: Bronchial asthma has a major impact on the quality
of life of children. There has been a rise in the prevalence of
bronchial asthma in the past few decades. The aim of the study
was to estimate the prevalence of bronchial asthma among school
children in Mangalore city.
Methods: A school based cross-sectional study was conducted in 4
schools in Mangalore between 16th January 2012 and 23rd January
2012. Following approval from Institutional Ethics Committee
and permission from Principals, the data was collected using
a questionnaire based on ISAAC (phase 3) which was lled and
returned by the parents. Information regarding the symptoms and a
few factors were collected regarding children. The collected data
was analyzed using SPSS vers.16.0.
Results: A total of 896 children were surveyed. The prevalence of
asthma among school children was found to be 7.1%. The prevalence
of asthma among children aged 6-9 years was 7% and among children
aged 10-13 years was 7.3%. In males, in the age group 6-9 years
the prevalence of asthma was 10.3% and that in the age group
10-13 years was 9.8%. Among females, the prevalence in the age
groups 6-9 and 10-13 years was 4.5% and 6.1% respectively. Some
(15.6%) participants with asthma reported incidence of itching
and allergic skin rashes in the family. The male to female ratio of
current wheezers in our study was found to be 1.78:1. Majority
(60.9%) of the asthmatics had wheezing with cold, whereas 19% of
the asthmatics had wheeze with exercise. 40.6% of the asthmatics
had night disturbances.
Conclusion: Our data suggests that there is a high prevalence of
asthma among school going children in Mangalore. Signicant
association between the history of allergies in family and presence
of asthma could not be found (p=0.369). The prevalence of night
disturbances and wheeze with exercise are suggestive limitation of
activity at home and school and probably lower quality of life.
Situational analysis of current status of health
facilities and e-health management
Rohan Nanda
Introduction: Aim- to improve health facilities for the patient by
maintaining proper patient database..Research basis-analysing
current problems to the patient in getting proper treatment either
due to lack of proper history or due to iatrogenic causes
Methods: method used:questionnaire method, setting:hospital
setting,period:15 january 2013 to 15 february 2013,population:105
patients from different departments in RNT medical college and
geetanjali medical college in udaipur,sampling:issues and problems
related to 5 patients from each ward of surgery, medicine,
paediatrics, gynaecology,orthopaedics,ophthalmology, E.N.T.from
RNT medical college and Geetanjali Medical college were
taken,study design:- issues and problems of indoor patients were
being asked and treatment related to the disease was seen, also
record of number of abortions that were done was seen,emphasis
was also given on patients who developed communicable diseases
like tuberculosis,HIV..Mortality rates of patients were also seen
and the cause of mortality was noted.It was also noticed that how
many patients are aware of immunization card, how many patients
follow the proper course of therapy or leave the treatment after
symptomatic relief...Analysis:it was found that complete record of
abortions were not there,some patients were devoid of appropriate
care and some patients could not recover from the disease even
if they were provided treatment- the reason being lack of proper
history of the patient
Results: If proper record of every patient can be maintained via a
common platform like a software then it could help us in bringing
down the mortality rates, controlling female foeticide, maintaining
proper medication records, maintaining proper vaccination records
Conclusion: By means of a common software, which would link group
of hospitals, for maintaining patient database; rstly, the doctors
will have a true unmodied history of patients records and can make
a better medical decision based on the past records.Secondly In
case of wrong treatment or medical carelessness it would be too
easy to track the exact responsible person.
A study on drug utilization and treatment outcomes
in complicated childhood malaria in a tertiary care
hospital
T Seetam Kumar, Bandana Rath, CS Maharana, Y Rojaramanni,
JP Behera
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 161
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Introduction: Malaria remains a major health burden in developing
countries. Around 1.5 million cases and 1000 deaths occur annually
in India of which 50% are due to Plasmodium falciparum. P.
falciparum is the most dreadful, causes severe and complicated
malaria in young children resulting in very high mortality. In view
of widespread chloroquine-resistance, detection of resistance cases
and evaluation of treatment outcomes still remains a global needThe
present study was undertaken to nd out the drug utilization
pattern and treatment outcome in terms of improvement in clinical
and laboratory ndings in complicated childhood malaria among the
pediatric age group of patients.
Methods: This was a prospective, cross sectional, hospital based
study in which clinically diagnosed complicated childhood malaria
cases (age <14 years), admitted to the pediatric ward were enrolled
with prior informed consents from parents and ethical permission.
Fever with co-infection (typhoid, HIV, TB.) and clinically suspected
cases of systemic infections due to non-malarial origin were
excluded. The baseline characteristics, presenting symptoms and
vital signs were recorded in a pre-designed CRF. The drug utilization
pattern was evaluated using WHO drug use indicator form. Treatment
outcomes were evaluated from routine laboratory tests before and
after treatment like parasitemia clearance, fever clearance time,
period of hospital stay and cure rate.
Results: Out of total 64 cases enrolled in this study the maximum
cases (71.88%) were < 5 years of age, males outnumbered females
(67.19% Vs 32.81%), mostly from low socioeconomic status (51.57%
) and rural areas (85.94%). The most frequent manifestation was
severe anemia (76.56%), followed by cerebral malaria (43.75%).
Peripheral blood smear examination revealed 81.25% slide positive
cases of which 68.75% cases were falciparum positive and 31.25%
had mixed falciparum and vivax positive. On treatment, the degree
of parasitemia reduced signicantly on day 2 (p<0.001). Again the
hematological parameters, random blood sugar,total bilirubin,
ALT, AST of hepatic dysfunction patients and ser. Urea, creatinine
of impaired renal function cases were signicantly improved as
compared to their pretreatment values( p<0.001). The mean time of
resolution of fever and total parasitimia clearance were 51.6±2.23
hrs and 1.58 ± 0.09 days respectively. The average period of hospital
stay was 6.20 ± 0.24 days and all cases were cured.The average
no. of drugs per prescription was 6.28, 41.04% were in generic
names, 64.19% were injectable preparartions and 99.05% were from
essential drug list. Other than antimalarials, antimicrobials (20.39%)
and anticonvulsants (11.19%) were also used.
Conclusion: In the present study the use of anti - malarials for
complicated childhood malaria followed national drug policy and
most of the drugs prescribed were from EDL. The treatment outcome
was 100% because early and prompt management was implemented.
Compliance to iron supplementation among pregnant
mothers attending the antenatal clinic at De Soysa
Maternity Hospital
NV Ekanayake, EMSS Ekanayake, AMBWMRNN Ekneligoda,
MC Weerasinghe
Introduction: Iron deciency is the most common nutritional disorder
worldwide. Despite the existing national programme in the country
and its extensive coverage, maternal anaemia is still prevalent.It
is evident that poor compliance to iron supplementation is a major
contributor to the reduced efcacy of the existing programme.
Therefore assessing the level of compliance to iron supplementation
during pregnancy and identifying factors contributing towards poor
compliance is a timely issue to be addressed.
Methods: An analytical cross sectional study was carried out
including 150 pregnant mothers who have not completed term and
in their subsequent ante natal clinic visit at De Soysa Maternity
Hospital.Systematic random sampling was used.An interviewer
administered questionnaire was used to assess the compliance
based on dose, frequency, time, continuity and relation to meals.
Results: 2.7% of the study population was completely compliant
while 96.0% and 1.3% were categorized as partial and nil respectively.
On sub analysis on drug compliance 44.7% was completely compliant
with 55.3% being partial and nil. It is found that there was as
association between the level of compliance and the utilization of
ante natal care services [ X2 =9.0207 ; df 2p<0.05 ] All other factors
did not show signicant association with the level of compliance.
Conclusion: Non compliance to iron supplementation among
pregnant mothers is high and a signicant proportion being partially
compliant with a small proportion being nil. Most are partially
compliant due to their poor dietary practices with regard to
supplementation.Recommendations include assessing compliance to
iron supplementation during pregnancy in a wider scale with several
studies at different centeres, further analysis for the completely
compliant group in order to identify the special features pertaining
to them, and studies focused on assessing the reasons for lack of
knowledge in this aspect among pregnant mothers.
A histological study of placenta in normal and
hypertensive pregnancies
Apurva Deshmukh, Shobha S Rawlani
Introduction: Complications of pregnancy like hypertension and
preeclampsia are life threatening for both fetus and mother during
gestation.Present study was under taking to record the morphology
and histology of Placenta from mothers with pregnancy induced
hypertension.
Methods: Present study was conducted on total one hundred
placentae, out of which fty placentae were from mothers with
high blood pressure and fty placentae from normotensive mothers
having uncomplicated pregnancy. Gross and histological changes
were recorded in both the groups.
Results: It was observed that placentae of hypertensive
mothers were small in size.In some placentae of hypertensive
mothers there was marginal insertion of umbilical cord,areas of
calcication,necrosis and infarction were also observed.Histological
ndings showed proliferation of cytotrophoblastic cells in villi.
There were formation of syncytial knots,brous tissue proliferation,
brinoid degeneration.Areas of hyalinization and calcication
were observed.Rupture of blood vessels and spillage of blood in
intervillous space was also observed.
Conclusion: These ndings suggest that above changes in placenta
are due to hypertension induced in mothers during pregnancy.
Attitude and perceptions of medical students
regarding teaching carried out by postgraduate
trainees
Vindya Gamage, Anuja Abayadeera, DG Chathumini
Introduction: Attitude and perceptions of medical students
regarding teaching by postgraduate trainees (PG) are useful for
planning teaching activities and for optimal utilization of a valuable
162 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
training source in busy teaching hospitals.
Methods: It was a descriptive cross sectional study .A self
administered questionnaire was used on undergraduates doing
clinical appointments in Faculty of Medicine, University of
Colombo,Sri Lanka during July – August 2011.
Results: Four hundred and eight ve undergraduates responded
with a male: female ratio of 45%: 55 % . Majority were taught by PG
trainees 2- 4 times a week. Teaching times lasted 30 – 60 minutes.
Majority (80%) considered PG teaching important and enjoyed it.
Most found them useful to learn clinical skills, procedures and
short/ long cases and 33% thought it important to learn theory.
Among them 90% mentioned that all PG trainees do not take equal
responsibility and 66% noted a difference between teaching by
registrars and senior registrars. Main reasons for the PGs to teach
were, for benet of students (95%), self satisfaction (82.1%) and
to remember theory (82.1%). Suggestions for improvement included
timetabling of classes and the friendly attitude of PGs.
Conclusion: Undergraduates accept post-graduate residents as
an effective personnel source. Timetabling of teaching activities
and preparing the PG trainees as educators may optimize their
contribution for undergraduate training.
Study of proportion of hypothyroidism in patients
with type 2 diabetes mellitus
Apurva Vinay Nichale
Introduction: Thyroid disorders and diabetes mellitus are quite
common endocrinopathies. Thyroid hormones affect glucose
metabolism via several mechanisms. Moreover, thyroid hormones
have signicant effects on the synthesis, mobilization and
metabolism of lipids. Thyroid diseases further increase with age
and in patients with obesity and metabolic syndrome. Thyroid
dysfunction in patients with type 2 diabetes is about 10%-31%,
with subclinical hypothyroidism representing most common thyroid
condition. This hospital-based case control study aimed primarily
to nd out the proportion of patients with hypothyroidism in
type 2 diabetes mellitus along with to compare the proportion of
complications due to hypothyroidism and diabetes mellitus among
diabetic and non-diabetic patients.
Methods: The study is a case control study. The protocol for
the present study was approved by the Medicine Department,
Government Medical College, Nagpur. Written informed consent
obtained from all participants. The study was conducted in
Government Medical College, Nagpur. The type 2 diabetes patients
were recruited from diabetic outpatient clinic. Apparently, healthy
relatives of patients and other patients attending outpatient
departments in Government Medical College were included as
controls of the same age group. Sampling is done in such a way
that controls are similar to cases with regard to variables like age
group. A total of age matched 150 female subjects were recruited
and evaluated for height, weight, waist circumference and waist:
hip ratio, blood pressure, fasting and postprandial plasma glucose,
fasting serum triglycerides and HDL-cholesterol and thyroid
examination along with structured interview method. Sera obtained
from all patients for the measurement of fasting and post – prandial
blood glucose levels, glycated hemoglobin level and a thyroid prole
test. Clinical variables studied included Sr.TSH, Sr.T3, and Sr.T4.
Statistical Analysis is done by using SPSS version 15. The association
of hypothyroidism in Type2 Diabetes Mellitus is done by calculating
Odd’s ratio along with 95% condence intervals and tested by Chi
square test.
Results: Mean age was 46.78 years with SD of 6.Demographic studies
regarding working status, 23% patients had some form of regular
employment, 59% patients were non working and rest had irregular
work. Among research variables, Sr.TSH was higher in Type2 DM
group and when compared with control group, ndings were
statistically signicant.Sr.T4 levels are lower in type2DM patients.
Cardiovascular problems were profoundly seen in diabetic patients
than the control group. The risk of retinopathy and nephropathy
is higher in diabetic individuals as and when compared to the
control group. Those not on thyroxin therapies had poor control of
diabetes.13. 48% had BMI>24.9kg/m2, 11% had BMI>30% while rest
being in normal range. Elevated sr.TSH-13.33%, elevated waist: hip
ratio-36%, dyslipidemia-18.66% while 58.6% having blood pressure
>/= 130/85 mm hg and cardiovascular symptoms while 10% and 19%
had diabetic retinopathy and neuropathy respectively.
Conclusion: Higher Sr.TSH levels are associated with deranged
glucose metabolism, suggesting positive correlation. Normal values
of body mass index, waist: hip ratio predicts better compliance as
well the working status of patient. And nally higher TSH negatively
correlates with glucose control. Dysglycemia can depress thyroid
function, but thyroid disorders can cause dysglycemia and predispose
to insulin resistance and metabolic syndrome. Thus healthy thyroid
function depends on keeping the blood sugar in a normal range,
and keeping blood sugar in a normal range depends on healthy
thyroid function. Therefore, early diagnosis and management of
hypothyroidism improved compliance with treatment with resultant
better management of illness.
Knowledge, attitude and practice of primary wound
care in prevention of rabies among victims of
mammal exposure attending Rabies Treatment Unit
Sashikala Mathotaarachchi, Sahan Mendis
Introduction: Rabies is almost a fatal disease caused by a neurotropic
lyssavirus, which is transmitted by mammals. Most of the deaths can
be prevented through post exposure prophylaxis including primary
wound washing with soap and water or antiseptics. The knowledge
and practice of primary wound care is poor in South Asian countries.
The aim of the study was to assess the knowledge, attitude and
practices among victims of mammal exposure attending Rabies
Treatment Unit of the National Hospital Sri Lanka.
Methods: A descriptive cross sectional study was carried out among
victims of mammal exposure attending Rabies Treatment Unit of
the National Hospital, Sri Lanka. Sample of 111 was selected using
non probability convenient sampling. Their knowledge, attitude
and practices were assessed using an interviewer administered
questionnaire. Frequencies, percentages and associations between
variables were analyzed using computer database.
Results: Majority of the participants were males (64.9%). 43.2%
of the population belonged to the age range 21-40 years. Majority
had dog bites (63.06%) and rest were due to rats (14.4%) and cats
(11.7%). 55.9% of injuries were due to exposure to stray animals.
Majority of the injuries were seen in legs (65.8%). 88.3% scored >50%
of knowledge score. Among the victims, (95.5%) have washed the
wound with soap and water or antiseptics and out of which 16.2%
had used hand remedies. 6.3% had received tetanus toxoid vaccine
prior to the visit to the unit. Knowledge regarding Rabies did not
correlate with the correct practice (p>0.05). Participants with good
education scored signicantly higher in knowledge score (p<0.05).
98.2% of the participants have good attitudes on correct practice of
primary wound care.
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 163
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Conclusion: Although there were few malpractices, most of
the population followed the correct practice of primary wound
care. However their knowledge on fatality of the disease was
unsatisfactory. General public should be educated regarding
prevention of rabies especially about the fatality of the disease and
the importance of proper primary wound care.
Prevalence of PAN resistant bacteria from surgical
unit of tertiary care hospital
Avinash Kumar, Vijayshri Deotale
Introduction: Patients who are ill and have suppressed immune
system have a greater risk of nosocomial infections arise from
surgical wounds and other inpatient used things like patient
wearing, IV stand, bedding etc. Also the blind antibiotic therapy
leads to the resistance in the bacteria. This trend has given rise
to the PAN resistant bacteria which are very difcult to manage.
Therefore to check the increasing burden of PAN resistant bacteria
we must know the pattern of these PAN resistant bacteria, their
colonization in the surgical wards and their association with the
disease. In the study our aim was Isolation of PAN resistant Gram
negative bacteria from clinical specimens and isolation correlation
with Environmental sources.
Methods: It was a prospective study, which depended upon the
samples sent by surgeons and then collection of samples from
environmental sources related to the same patient. Once the
identication of the organism is established we did sensitivity
testing as per CLSI guidelines and then correlation with patient
sample were done. Study was carried out on 30 patient samples in
the Department of Microbiology of a rural medical college in central
India in the duration of two months i.e. June and July of 2012.
sampling was done by sterilized swab from bed sheet, IV stand, bed
railing, IV cannula, catheter etc.
Results: E. coli , Klebsiella spp , Acinetobacter lowfi , Acinetobacter
baumannii & Pseudomonas aeruginosa were main prevalent PAN
resistant bacteria .Bed sheet, IV stand and IV cannula were main
environmental sites from where PAN resistant bacteria were
isolated. Environmental correlation were matched successfully with
3(10%) out of all 30 samples taken into consideration.
Conclusion: Klebsiella, Acinetobacter and Pseudomonas were main
prevalent PAN resistant bacteria from environmental samples in
surgical units. 10% of total PAN resistant samples were correlated
successfully.
To study and compare the prevalence of
Cryptosporidium parvum infection among immune
competent and immune compromised patients with
diarrhoea
Saikat Roy, Partha Roy
Introduction: Cryptosporidium parvum is a protozoa 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 forms
a scoring system relating the numbers of oocysts of cryptosporidium
observed per oil immersion eld with the CD4 counts of the immune
compromised patients to quantify the severity.
Methods: This is a comparative and quantitative study with a sample
size of 150. Stool samples of patients is used. From the sample,
a thin smear is made. For the study of oocysts modied Ziehl-
Neelsen staining (Kinyoun modication) is done. Signicant and
positive result is considered as count of oocysts more than 30 /oif.
Becton- Dickinson FACS counter is used for CD4 count. Quantitative
variables are described using mean and standard deviation and
qualitative variables using %. 95% condence interval are calculated
for prevalence values, the difference is tested using ‘z’ test and
association with age was 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. All age groups are equally affected with
almost similar prevalence among immune competent and immune
compromised patients of 25-35 age group. Prevalence among
immune compromised is highest aong HIV, transplant and cancer
cases.Scoring-3+ score for very low immune status with a mean
oocyst count of 341-599 corresponding with 60-180 CD4 range. 2+
score for low immune status with a mean oocyst count of 300-310
corresponding with 180-300 CD4 range. 1+ score for moderately high
immune status with a mean oocyst count of 277-293 corresponding
with 300-420 CD4 range.
Conclusion: The project brings out that the cryptosporidium
infection is common not only among immune suppressed but also
has a high prevalence among immune competent. Any age group
among adult population can be affected. The scoring system can
help health care workers in periphery to diagnose immune status
of a patient.high prevalence is seen in patients with hepatitis and
type 2 diabetes.
Subclinical hypothyroidism among rural women
K Sathya Prakash
Introduction: Subclinical hypothyroidism is a condition where Thyroid
Stimulating Hormone(TSH) is elevated in the presence of normal
serum free thyroxine and triiodothyronine levels. It may progress
to overt hypothyroidism and lead to adverse effects on pregnancy
outcomes, lipid abnormalities, hip fracture, dysfunctional uterine
bleeding etc., To nd the prevalence of subclinical hypothyroidism
among rural women attending a teaching hospital
Methods: Healthy women of all age including pregnant without any
co-morbid illnesses attending Chennai Medical College Hospital,
willing to participate in this study were investigated for subclinical
hypothyroidism after an approval from institutional ethics
committee. About 3 ml of venous blood was collected for estimation
of Thyroid function test by ELISA. The data were analysed by simple
descriptive statistics
Results: A total of 417(age range:16 to 67; median:29 years) were
screened over a period of two months. Among them 37(11.7%) had
laboratory evidences suggestive of subclinical hypothyroidism.
Another 32(7.7%) had overt hypothyroidism. There was a positive
correlation between increasing age and the prevalence.
Conclusion: The present study has identied subclinical and overt
hypothyroidism among rural women thereby indicating a need for
community based studies so as to nd out the true prevalence
of subclinical hypothyroidism and overt thyroid disorders among
women in rural areas. Further detailed investigations/ studies
are needed to nd out the probable causes, contributory factors,
presenting features and interventional strategies.
164 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
An assessment of knowledge and attitudes on pre-
hospital care among rst year medical students in a
medical faculty in Sri Lanka
MA Chamila Lakmal, PCI Wijesinghe
Introduction: Pre hospital care(i.e. rst aid) is an essential skill
required by all medical students. However, many studies have shown
that the knowledge of pre hospital care among medical students is
decient. This study aims to assess the knowledge and attitudes on
pre hospital care among rst year medical students of the Faculty of
Medicine, University of Colombo.
Methods: A cross-sectional study was performed which consisted of
135 rst year students. Data was collected using a self-administered
questionnaire. Questions to assess knowledge were obtained from
a validated questionnaire (http://www.revive2survive.com.au).
Parametric data was analyzed using descriptive statistics and cross
tabulation. A p value<0.05 was considered signicant.
Results: Male:female ratio was 31.5 : 69.5. The mean age was
21.48(range=23-19) years. 28% of students had some form of
previous training on pre hospital care. The mean score on knowledge
was 41.11% (range=68-29). 71% of the students scored < 50% for the
knowledge questionnaire. Students scored least in questions on CPR,
fainting attacks and cut injuries with 85%, 63% and 57% responding
incorrectly. Questions on rescue breaths and hypoglycemia were the
most successful with 80% and 67% responding correctly. Only 31%
of the students knew the contact number of the local emergency
ambulance service. Students with previous training on pre hospital
care scored signicantly higher (p=0.02). There was no difference
of the students’ performance with gender or age. Majority(95%)
the students scored >50% for the questions on attitudes. 85% the
students said they would like to participate in a pre- hospital training
program, out of which 80.9% preferred practical sessions. 95% of the
participants wanted an update of training at least annually.
Conclusion: Knowledge on pre hospital care among our student
sample was poor. Students with previous training performed better
than others. Students have good attitudes and are motivated to gain
skills on pre hospital care. Practical sessions with regular updates
will help students to improve their knowledge on pre hospital care.
Laser induced breakdown spectroscopy (LIBS) in
diagnosing tuberculosis: a proposed tool
Sandeep Singh, Sorabh Badaya
Introduction: The global tuberculosis epidemic, killing 2 millions
and adding 9 million new cases a year, remains a major public health
concern. Low sensitivity of sputum smear, long time taking process
for mycobacterium culture to be interpretable make them non
effective tool in the current scenario. Declining quality of the smear
examination in overburdened laboratories in HIV-endemic countries
like India makes acid-fast smears on sputum specimen as a relatively
insensitive test for pulmonary tuberculosis in AIDS/ARC patients is
another concern. None of the commercially available rapid test are
well enough to replace sputum smear microscopy, thus this test
have little or no role in the diagnosis of pulmonary tuberculosis.
Thus the development of rapid and accurate new diagnostic tools
is imperative.
Methods: This brief hypothesis postulates a screening tool aimed to
have a real time detection of tubercular bacilli using LIBS modality.
Laser Induced Breakdown Spectroscopy (LIBS) is a spectrochemical
method for determining the elemental composition of various
samples present in any phase, by simultaneously vaporizing and
exciting the sample and thus it improves the spectrochemical
techniques by eliminating the requirement of sample pre-
treatment. LIBS system focuses a high peak power laser pulse
onto a targeted material to produce a laser spark or microplasma.
Elemental line spectra is created, collected and analyzed by a
ber spectrophotometer since nano- to micro-grams of material
are ablated in femto- to nano-seconds (depending on the laser
pulse duration), the whole process can be considered as minimally
destructive and real time.
Results: 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. Previous researches
have shown signicant differences in trace element concentration
in different bacterial strains.
Conclusion: The technique is exemplied 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.
Epidemiology, KABP and reasons for defaulting
among pulmonary tuberculosis (TB) patients, being
treated at chest out-patient (OP), Chengalpattu
Medical College (CMC) Hospital
P V Sudharsan, Dinkar Sreekumar
Introduction: The top priority areas of TB research include
epidemiology, health services research and basic research. This
research project strives to fulll these research needs.
Methods: A 2-month long, cross-sectional, hospital-based study on
188 pulmonary TB patients, attending chest OP in CMC Hospital was
conducted using a pre-designed pre-tested structured questionnaire.
Convenience sampling was used and data analysed using SPSS Inc.
Version 18.0.
Results: In this study, 54% of the patients affected were in the age
group of 16-40 years of age, and 70% were males. The distance to the
tertiary care centre (for initial diagnosis and other investigations)
didn’t have a role to play in defaulting (P value – 0.034) but is
found to be a major player for delay in diagnosis of tuberculosis
(P < 0.001). The highest defaulting was seen during the 2nd month
of the treatment, especially when 85% of the patients had felt a
signicant improvement of their symptoms. Also, it was found that
67.1% patients are not directly observed as per DOTS provisions.
With regard to the KAPB aspect of the study, 60% were either unsure
of the cause of TB or thought it was related to smoking. However,
79% knew that they can prevent their disease from spreading to
others by covering their mouth, while coughing/sneezing, with a
hand-kerchief. 19.7% patients said they had faced discrimination
from others owing to their disease.
Conclusion: Being a male (3-fold risk), alcoholism (2-fold; P value-
<0.03), smoking (2-fold; P value - <0.001) and an improvement in
symptoms (p = 0.032) tend to have a higher risk of defaulting. Other
factors – age, education level, employment, type of house, social
stigma or poor treatment supervision do not have a role to play
in defaulting. The KAPB of the given population is poor and hence
has to be addressed by proper IEC activities, through appropriate
media.
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 165
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Electrocardiographic abnormalities in persons with
asymptomatic type 2 diabetes of rural area of
Amravati districts in Maharashtra
Sujata Shivlal Rawlani
Introduction: Coronary Artery Disease has a high prevalence in
Asian Indians. Coronary artery disease is the leading cause of
morbidity and mortality in patients with type 2 diabetes and is
often asymptomatic because of silent myocardial ischaemia. The
objectives of the present study were to nd out the prevalence of
asymptomatic coronary artery disease in type 2 diabetes mellitus
with Electro cardiogram.
Methods: This is a cross-sectional study carried out at the Diabetes
Clinic of the Department of Medicine. The study population
comprised one hundred consecutive persons with T2DM, (aged
30-70years). Diabetes mellitus was diagnosed using the World
Health Organization diagnostic criteria of fasting plasma glucose.
Information on age, sex and anthropometric measures were
obtained from all patients and controls. Family history of diabetes,
hypertension, IHD, stroke, and sudden cardiac death were obtained.
A 12-lead resting ECG reading was recorded on all subjects using
the ECG machine (Schiller, Baar Switzerland). Prevalent rates were
calculated as percentages and comparison by chi- square test. The
data was considered statistically signicant when P < 0.05
Results: In the present study out of 100 patients, ECG changes were
positive in 43 (43%) and was normal in 57 patients (57%). Out of 43
positive cases 28 (65%) were males and 15 (35%) were females.
Conclusion: This study suggests that the prevalence of coronary
artery disease in type 2 diabetes mellitus who are asymptomatic,
without past history of ischemic heart disease, CVA or hypertension
is 43%.
Wormian bones with os inca - a rare dissection
nding
Dinkar Sreekumar
Introduction: A large Wormian bone at the ‘LAMBDA’ is often
referred to as INCA BONE (OS INCAE/OS PARIETALE) [Le Double,
1903] is the topic of interest of this study. The New World
Populations have generally high-frequency of the Inca bone whereas
lower frequency occurs in North East Asians, with lesser frequency
in Indians - especially in south Indians(1). The squamous part of
the occipital bone consists of two parts – supra-occipital and
interparietal. Embryologically, the interparietal portion ossies
intra-membranously and in rare cases, may be separated from the
supra-occipital part by a suture. It is then called as interparietal or
Inca bone(2).Wormian bones, also known as “extra” sutural bones
are extra bone pieces that occur within a suture in the cranium.
Methods: An Os Inca accompanied by sutural bones on either side
was found in a male cadaver of approximately sixty-ve years of
age, of the south-Indian population, during the conventional method
of dissection.The calvarium was also subjected to radiological
examination.
Results: An incomplete, divided, median Os Inca was found with
multiple wormian bones placed laterally on it’s both sides. The
radiological anatomy of this Inca bone will be revealed during the
poster presentation.
Conclusion: The knowledge of Inca ossicles and wormian bones in
the human skulls play an important role, clinically, for the Neuro-
surgeons, Orthopaedic surgeons, Anthropologists, radiologists; the
anatomists in view of teaching; Forensic experts with respect to
reporting.Also, wormian bones are a marker for various diseases
and important in the primary diagnosis of Osteogenesis imperfecta.
Wormain bones are also seen in Pyknodystosis, rickets, cleidocranial
dysostosis, hypo-parathyroidism, Down’s syndrome, etc. The
embryology, genetic, and aetiological factors of diseases associated
with Os Inca and wormian bones will be listed at the valuable time
of presentation.
A prospective study to assess relationship of
homocysteine with stroke
Shikha Adil, Suresh BV, Shivananda Pai
Introduction: A stroke or a cerebrovascular accident is a medical
emergency and a leading cause of morbidity and mortality amongst
adults. Marked increase in plasma homocysteine may present as
Homocystinuria. Our aim is to nd out the association of urine
homocysteine with incidence of stroke.
Methods: Patients admitted in Government Wenlock Hospital,
Mangalore and KMC Hospital, Ambedkar Circle, Mangalore; and
diagnosed with Stroke during the month of July and August were
included in the study. Permission was obtained from the Institutional
Ethics Committee and Medical Superintendent of the respective
hospitals to communicate and examine the patient, to assess
investigation reports and to conduct Urine Homocysteine Test.
After informed consent, age and sex matched healthy controls were
evaluated for urine homocysteine.
Results: 50 cases were reported with male preponderance in the
ratio of 3:1. Mean age was found to be 60.66. Most common symptom
observed was weakness of limbs. Only 8 patients were urine
homocysteine positive with relative risk of 2.19, which included 1
patient without association of any known risk factors. None of the
controls were proved to be Urine homocysteine positive.
Conclusion: The current study concludes that age has a strong
inuence on incidence of stroke as most of the cases were seen
in elder age especially in age group of 60-70 years. Amongst
females, incidence of stroke almost doubled after menopausal age
depicting strong inuence of sex hormones. Other risk factors like
Hypertension, Diabetes mellitus, Dyslipidemia, smoking, Alcohol
intake were found to be associated with incidence of stroke. Even
in patients without any risk factors, who form a small portion of the
total disease burden at present, Homocysteine is an important and
independent risk factor.
Normative data of tibial motor nerve conduction
study from exor hallucis brevis in central Indian
male subjects
Aafreen Bari
Introduction: Posterior tarsal tunnel syndrome(PTTS) is tibial nerve
compression at the ankle. Nerve conduction and electromyographic
studies are considered denitive tests for PTTS which most commonly
compromises medial plantar motor branch of the tibial nerve. The
most common recording techniques for it involves recording over
the motor point of the abductor hallucis(AH) but Flexor Hallucis
Brevis(FHB) is also innervated by it.Tibial motor nerve recording
from the FHB may be an alternative to AH recording.It is possible that
recording from the FHB may be valuable especially when recording
from the AH has become problematic. However, normative data has
166 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
not been established for this technique. The purpose of our study
was to establish normative values for Tibial motor studies recorded
from the FHB.
Methods: One hundred male subjects were selected from healthy
volunteers between the age group of 18-40 years from central India
most of which were residents of the district. Subjects with known
causes of neuropathy, malignancy etc. were excluded. After relevant
clinical history, neurological examination was done and patient was
subjected to electrophysiologic examination with due consent.
Nerve conduction study consisted of Motor nerve conduction and
F wave study of tibial nerves with recording from FHB of non-
dominent leg. Study was done in supine position using RMS EMG
EP Mark-II machine.The normative data consists of parameters like
distal motor latency, compound muscle action potential amplitude,
conduction velocity and F wave minimum latency of motor nerve
which were recorded and analyzed using Microsoft excel 2007 and P
value signicant if found to be <0.05.
Results: This study examined the nerve conduction parameters of
motor Tibial nerve with recording from FHB in healthy adult male
subjects. Normative and reference values for the healthy adult
population of Central India were established.
Conclusion: Our study results indicate that motor recording from
FHB produces a clear and consistent initial negative deection from
baseline, allowing an accurate assessment of nerve conduction
velocity across the tarsal tunnel. This may make recording from the
FHB preferable in assessing posterior tarsal tunnel syndrome when
technical challenges occur with AH recording.
Utility of 99mTc– ECD SPECT in prognostication of
moderate and severe traumatic brain injury
Jigish Ruparelia, Roopesh Kumar, Dhanapathi Halanaik
Introduction: Traumatic Brain Injury (TBI) contributes to 11% of
total deaths in India. Many structural imaging modalities, including
CT scan and MRI have traditionally been used for diagnosis. However,
it has been observed that patients with normal or near normal CT
often have functional disabilities. Functional neuroimaging using
PET (Positron Emission Tomography) and Brain SPECT (Single Photon
Emission CT) can probe into these dimensions. No documented
studies in India have yet assessed the benets of Brain SPECT in
determining the outcome of patients after TBI. Hence, we carried
out a study to assess the diagnostic benets of Brain SPECT over a
plain CT scan, as well as to determine the outcome and compare
this with the SPECT ndings.
Methods: Patients aged 12 to 60 years with an index Glasgow Coma
Score of 3 to 12, and having a normal or near normal CT were
included. Approval was obtained from Institutional Ethics Committee
and informed consent was acquired from each participant. Brain
SPECT was carried out within 72 hours of the injury, and ndings
analysed by a nuclear physician. SPECT data was then compared
with the CT scan and clinical ndings. Outcome of patients was
assessed, 30 days post-injury, using Glasgow Outcome Scale.
Results: 12 patients were included. Outcome data was available
for 9 patients. We observed that Brain SPECT was a more sensitive
diagnostic modality than CT scan as it was better in picking up
abnormalities in brain function. However no concordance was
observed in the Brain SPECT ndings and the 30-day outcome of
the patients.
Conclusion: Brain SPECT using 99mTc-ECD is more sensitive and
can detect areas of brain with functional abnormality better than
a CT scan. However, the prognostic benets of Brain SPECT could
not be satisfactorily determined in this study due to the lack of an
adequate sample size, and resource and time constraints. Further
studies with a larger sample size and greater time period of follow
up are required in this eld.
Central obesity, its relation to obesity and its various
associations
Shipra Goel, Anupam Prakash
Introduction: Malnutrition continues to prevail in India; diseases of
undernutrition have been supplanted by diseases of over nutrition.
The pandemic of obesity threatens the whole world today. Although
Body Mass Index (BMI) is a good yardstick to ascertain the nutritional
status of an individual, over the years there has been a paradigm
shift in focus on central obesity. The increasing recognition of a
strong link between central adiposity and metabolic disturbances
prompted this study to identify the association of central adiposity
with obesity and to identify its various correlates.
Methods: A cross-sectional study was conducted in which 250
adult subjects in the age group of 30-60 years who attended the
medical out-patient departments of LHMC & Smt. Sucheta Kriplani
Hospital, Delhi were evaluated after obtaining an informed
written consent. Waist circumference and BMI were determined by
the standard technique. Each subject was evaluated for various
variables like blood pressure, fasting/post prandial plasma sugar,
serum triglycerides, serum total cholesterol, serum high density
lipoprotein-cholesterol, serum alanine transaminase, serum
alkaline phosphatase and mid upper-arm circumference. Statistical
analysis was done to nd out the correlationship between waist
circumference and BMI and also with other variables determined
using Karl Pearson’s coefcient of correlation. Rejection criteria for
null hypothesis was p < 0.05.
Results: 69.6% subjects in the study were found to be centrally
obese as regards to 66.4% subjects with higher BMI of greater
than 23 kg/m2. 68.4% were found to be hypertensive and 62.7%
were found to have dyslipidemia. There was a strong correlation
between central obesity and BMI (r=0.83) and also with Mid Upper
Arm Circumference (r=0.76). There was also a signicant relation
found between serum cholesterol level and central obesity (r=0.3).
The prevalence of Central Obesity was higher in diabetics as against
non-diabetics. Also, 74.3% hypertensives were centrally obese
(r=0.23) as compared to 56.9% centrally obese non-hypertensives.
Conclusion: The present study clearly reveals that waist
circumference is intimately linked to BMI, weight, diastolic blood
pressure, serum triglycerides, serum total cholesterol and Mid-
Upper Arm Circumference
Cross-sectional study on post-exposure prophylaxis
(PEP) practices among health care workers (HCW)
Rahul P Nambiar, Sarbjit Mohapatra, Aditi Khanna, Praveen
R, D Sai Bhavana
Introduction: The risk of acquiring Hepatitis B infection is greater
than that of acquiring HIV infection (30% to 0.3%) following needle
stick injury (NSI). PEP practices reduces the risk of developing
Hepatitis B. This study was conducted with the aim of comparing
PEP practices among doctors and paramedical staff of teaching
hospitals in Mangalore.
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 167
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Methods: This cross sectional study was conducted in teaching
hospitals afliated to Kasturba Medical College, Mangalore. A
pretested semi-structured questionnaire was prepared to collect
details about basic socio-economic information and details of
PEP practices following NSI (Local measures, Reporting incident,
Evaluation of blood sample, Follow up of the report, Immunoglobulin
therapy) . After obtaining consent from institutional ethics
committee, questionnaire was administered to HCW in their
respective workplace. The collected forms were analyzed using
SPSS version 12. Chi square test was used to compare vaccination
details between doctors and other para medical staff. ‘p’ < 0.05 was
considered signicant.
Results: A total of 291 HCW responded. Out of which 70 had NSI
/ exposure to potentially infectious body uids. The PEP practices
of the HCW were as follows (%): local measures (59), blood sample
evaluated for seropositivity (34), follow up with report (27),
reported the incident (19) and took immunoglobulin therapy (1).
Outcomes were as follows (%): Seronegative (75.9), Seropositivity
(1.7), Did not make an attempt to know (22.4). Comparison of
PEP between doctors and the paramedical staff were as follows
(%): Local measures (77.6, 22.4), Report (50, 50), blood sample
evaluation (72.7, 27.3), follow up (69.2, 30.8). One doctor had
taken immunoglobulin therapy.
Conclusion: The PEP practices were better followed among the
nurses than the doctors. HCWs must be educated about post
exposure prophylaxis practices for better management of NSI.
A cross sectional study on needle stick injuries (NSI)
among health care workers in Mangalore
Aditi Khanna, Rahul P Nambiar, Praveen R, Sarbjit
Mohapatra, D Sai Bhavana
Introduction: Hepatitis B virus is 50 to 100 times more infectious
than HIV. Due to its enhanced prevalence health care workers
(HCWs) are at higher risk of acquiring hepatitis B infection. So the
study was conducted with the aim of nding out type of needle stick
injuries (NSI) / nature of exposure among HCWs.
Methods: This cross sectional study was conducted in teaching
hospitals afliated to Kasturba Medical College, Mangalore. A
pretested semi-structured questionnaire was prepared to collect
information about basic socio-economic information and details of
NSI / exposure to potentially infectious body uids (like nature of
exposure, clinical activity / procedure during which NSI occurred,
etc.). After obtaining approval from institutional ethics committee,
the questionnaire was handed to HCWs in their respective workplace.
The collected forms were analyzed using SPSS version 12.
Results: A total of 291 HCWs responded. Out of which 70 had NSI
/ exposure to potentially infectious body uids. Majority of the
HCWs had it between 1-6 months. The nature of exposures are (%)
: prick with glove on (68.1), intact skin without gloves (26.1),to
skin with a cut or abrasion (7.2), transcutaneous exposure by a
suturing needle (13) &injection needle (20.6). The incidence of NSI
exposures are more in doctors (79.7%) as compared to para medical
staff (20.3%). The comparison of NSI / exposure between doctors
and para-medical staff are (%): prick with glove on (78, 22), intact
skin without gloves (100, 0), skin with a cut / abrasion (80, 20),
transcutaneous exposure by suturing needle (100, 0) & injection
needle (79, 21).
Conclusion: The NSI rates are higher than those reported previously.
It is essential to educate doctors on universal precautions and post-
exposure prophylaxis practices.
A cross sectional study on hepatitis-B vaccination
status among health care workers in teaching
hospitals in Mangalore
Sarbjit Mohapatra, Aditi Khanna, Rahul P Nambiar, Praveen
R, D Sai Bhavana
Introduction: India with 350 million cases is the second largest
global pool of chronic HBV infections. The most effective and
feasible means of preventing HBV infection is by vaccination. As
Health Care Workers (HCWs) are at higher risk of acquiring Hepatitis
B, this study aimed to investigate their vaccination status.
Methods: This cross sectional study was conducted in teaching
hospitals afliated to Kasturba Medical College, Mangalore. A
pretested semi-structured questionnaire was prepared to collect
details about basic socio-economic information and vaccination
status (like number of doses, booster doses, time interval between
doses etc.). After obtaining consent from institutional ethics
committee, questionnaire was administered to HCWs in their
respective workplace. The collected forms were analyzed using
SPSS version 12. Chi square test was used to compare vaccination
details between doctors and other para medical staff. ‘p’ < 0.05 was
considered signicant.
Results: A total of 291 HCWs responded to our study. Majority
(278 i.e. 95.2%) of them were vaccinated. But only 49.5% of
them completed the primary series of vaccination according to
the schedule. Only 17.2% subjects have adequate titre value. The
common reasons for not completing the primary series/taking the
booster doses were forgetfulness (26.3%), due date not yet (17.2%),
no time (10%). The comparison of vaccination characteristics
between doctors vs. paramedical staff as follows (%): vaccination
coverage (56, 44), number of primary doses (51.7, 48.3), correct
time interval between 1st and 2nd dose (75.5, 24.5) and 2nd and
3rd dose (63, 37), taken at least 1 booster dose (66.7, 33.3).
Conclusion: A low (49.5%) coverage among HCWs means there is
ample scope for improvement. The doctors have better vaccination
coverage than para-medical staff. Hepatitis B vaccination should be
made mandatory for all HCWs.
Urinary tract infection (UTI) in the elderly- a clinical
and microbiological study
Soorya M, Rejitha IM, Palaniappan N
Introduction: Urinary tract infection (UTI) is the second most
common infectious complaint in geriatric clinics overall. The common
risk factors for UTI in the elderly are the use of urinary catheters,
living in a long-term care facility or nursing home, hormonal
factors, anatomical factors, functional factors and metabolic
factors.Chronic urinary symptoms are common in elderly persons,
and the classic triad of UTI-frequency, urgency, and dysuria occurs
routinely in older persons without infection. The common organisms
causing UTI are E.coli, Klebsiella, Proteus, Staphylococcus aureus
etc. Antimicrobial resistance among uropathogens is increasing. The
knowledge of microbiology and antibiotic susceptibility of micro-
organisms causing the disease is vital for dening the empirical
treatment. This study will be undertaken to nd the distribution of
isolated uropathogens and their antibiotic susceptibility pattern in
elderly people
168 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Methods: A total of 100 elderly patients aged 65 years and above with
symptoms of UTI who were treated at Government Medical College
Hospital Tirunelveli were included in this cross sectional study over
a period of two months. The antimicrobial susceptibility to various
drugs was studied by the disc diffusion method, following the CLSI
guidelines. Conrmation of the extended spectrum β-lactamase
(ESBL) production was done by the Double Disc Synergy Test (DDST)
and they were further conrmed by the E-test ESBL strip randomly.
Results: Of the 100 samples, 28 were culture positive and 72 were
negative. Klebsiella species was the predominant isolate in this
study (12 isolates) followed by E.coli (5) and Proteus mirabilis(4).
Two isolates of Acinetobacter and Citrobacter and one each of
Pseudomonas and Candida were identied. One patient had a
growth of Coagulase negative Staphylococcus. The antibiotic
resistance of the organisms isolated in this study was unusually high.
Most isolates were resistant to Fluroquinolones and Cotrimoxazole.
Only one-third of the uropathogens were susceptible to Amikacin
and Gentamicin. The most troublesome nding of the present study
is that ESBL-positive organisms (22 isolates) accounted for 84.6% of
the total infection. The isolates of K. pneumoniae (42.3%) were the
most common ESBL producers, followed by Escherichia coli (15.4%),
Proteus vulgaris (11.5%) and others. These resistant uropathogens
showed highest sensitivity to Carbapenems and Cefaperazone
sulbactam.
Conclusion: It is essential to report ESBL production in urinary
isolates along with the routine susceptibility testing, which will
help the clinicians in prescribing proper antibiotics. Rational
prescribing of antibiotics should be encouraged through educational
programs, surveillance and audit. Practice of proper infection
control procedures will prevent horizontal transfer of drug-resistant
organisms.
Questionnaire based study to judge signicance of
olfaction in general population
Varsha Venkataraman
Introduction: Olfaction appears to be signicant in everyday life and
the three main categories of function are those related to ingestion
behavior, those related to avoidance of environmental hazards,
and those related to social communication. Around 3.6% of random
population are known to be functional anosmic, and around 18%
have some level of olfactory disturbance. Various causes have been
considered for these including head injury, aging, paranasal sinus
disease, neoplasm, medications, toxic exposure, upper respiratory
tract infection, surgical trauma, and congenital defects.Patients
with olfactory disorders do report problems in daily life for example
while eating, cooking, social situations, and have been reported to
have high depression scores and reduced quality of life. Thus the
aim of present study was to perform a questionnaire based study
on general population to understand the how important is the sense
of smell, and correlate in relation to age and gender in the Indian
context.
Methods: Questionnaire(pre–validated) based survey study done
over a period of 2 months from 1 August to 30 September; includes
200 subjects from Pune above the age of 18 yrs. with written
informed consent. The questionnaire consists of 18 questions each
having four scales: I totally agree(8-10 points), I mostly agree(5-7
pts), I mostly disagree(2-4 pts), I totally disagree(0-1 pt).There
are three categories of questions with 6 questions each. These are
of “Association”( emotions, memories and evaluation, that are
triggered by the sense of smell), “Application”(how much the person
uses the sense of smell in daily life), and Consequence”(conclusions
the person draws from the olfactory impression). For analysis, every
response was scored and the average score for each question was
calculated; they were further analysed based on age and gender.
Results: 200 patients out of which 93 were males and 107 were
females.At 0–20y(13 male,16 female,total 29); at 21–40y(62 male,76
female,138 total); at 41–60y(18 male,15 female,33 total). Average
response for each question was scaled accordingly. Further analysis
by gender showed that all the 107 females had answered ‘totally
agree’ to all the question of ‘application’ , ‘association’ and
‘consequence’.
Conclusion: Olfaction is considered important sense for functioning
in routine life. It plays role associative function, applications in daily
life and in making and altering decisions in life. Women allot more
signicance to smell as compared to male, and the signicance level
remains same in all the age groups.
Diagnostic efcacy of nerve conduction parameters
in cervical radiculopathy
Aditi Sudhakar Kashikar, Sachin Pawar
Introduction: Cervical radiculopathy(CR) is the dysfunction of a
cervical spinal nerve, its roots or both mostly because of cervical
spondylitis(70%).No universally accepted diagnostic criteria are
established.Studies found patient’s history, examination and
radiological evaluation to be insufcient.This study evaluates the
diagnostic utility of electrophysiological parameters in CR with
aims to study the diagnostic efcacy of motor and sensory nerve
conduction parameters in CR and to determine diagnostic efcacy
of F wave in CR.
Methods: This is a cross-sectional study including 100 subjects, above
40 years of age, who are clinically diagnosed having CR referred
to M.G.I.M.S, Sevagram from April to July, 2012.After documenting
detailed history and clinical examination, the study was performed
by RMS.EMG.EP.Mark II machine in the Clinical Neurophysiology Unit,
Dept. of Physiology for the following.Motor Nerve Conduction Study
by stimulating Median, Ulnar, Radial, Axillary, Musculocutaneus and
Suprascapular nerves with electrodes on corresponding muscles
to evaluate conduction velocity(CV), distal motor latency and
compound muscle action potential(CMAP).Sensory conduction study
of Median and Ulnar nerves to record sensory nerve action potential
and CV.F wave study of motor nerves for F min latency.Statistical
Analysis by SPSS 16.0.
Results: Motor Conduction showed CMAP was more sensitive(~70%)
with high positive predicative value(~70%) and CV has greater
specicity(63%). Proximal nerves have greater sensitivity and
specicity.Sensory nerve conduction parameters have higher
specicity(~85%).F min latency has highest sensitivity(~85%) and
positive predictive value(67%) amongst all.
Conclusion: Motor nerve conduction studies and late response study
are useful supportive diagnostic tools due to reliable sensitivity
and specicity. CMAP is more sensitive as compared to DML and CV.
F-minimum latency is more sensitive. Thus, these can be explored
to be ne and economical diagnostic tools for CR.
Awareness and consequences of consanguineous
marriages - a community based cross sectional study
Keshava Pavan K, Nitin Joseph, Keerthan Ganapathi,
Apoorva P, Parul Sharma, Jai Aditya Jhamb
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 169
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Introduction: Our research aimed to nd out the level of awareness
among women about consanguineous marriages and the various
consequences of consanguineous marriages in the study area.
Participants were included from semi-urban and rural population;
Hindu, Muslim and Christian religions; and of different age groups.
Methods: Study design: cross sectional. Study setting: semi-urban
and rural localities of Mangalore. Study period: January 2013.
Study population: married women of the study area. Sampling
method: convenient sampling. Sample size: 187. Institutional Ethics
Committee clearance: obtained. Informed consent from study
participants: obtained. Data collection: done by a self-administered,
semi-structured questionnaire. Analysis method: SPSS vers. 17.0 and
Chi Square test.
Results: Consanguineous marriages were found in 12.3% of
the study population. The awareness level of the people on
consequences of consanguineous marriages was poor (18.72%).
65.2% of the consanguineous marriages were between rst cousins.
Consanguineous marriages were found to be more in Muslim
population. Signicant association was found between consanguinity
and health problems for the child (p = 0.02), along with growth
retardation and low birth weight (p = 0.05). Consanguineously
married couples gave signicantly higher history of parental
consanguinity than the non-consanguineous group.
Conclusion: The study showed that the awareness among public
about consequences of consanguineous marriages is poor. Various
disorders were found to be signicantly high in children of those
married consanguineously. It is necessary to implement programmes
to increase their awareness about the subject.
Levels of oxidative stress and antioxidant status in
diabetes mellitus patients
Janaswamy Vibhav Sri Narayana, Manohar, Rakesh Sahay,
Vijay Kumar
Introduction: To evaluate the oxidative status of DM patients
as oxidative stress is associated with development of various
complications
Methods: Both IDDM and NIDDM patients with duration of DM >1
year without any end organ failure were recruited. Along with detail
clinical history and systemic examination, specic investigations
like glycosylated hemoglobin(HbA1c), oxidative stress indicators like
plasma malondialdehyde (MDA) and protein carbonyl (PC) content
and protective antioxidant sulfhydrel content(SH) were done .
Results: 74 NIDDM (mean age 57 yrs), 25 IDDM patients (mean age
32 yrs) and 25 controls were recruited. Mean duration of DM was >
99 months in both the groups. Average fasting blood sugar (FBS) was
144.7 mg/dl, 185.8 mg/dl in NIDDM & IDDM patients respectively.
Elevated plasma MDA (> 1 nanomole/ml), PC (> 1 nmol/mg) and
decreased SH levels (< 509 μmol/L) were noted in 17/74(22.97%),
48/74(64.9%), 62/74(83.7%) NIDDM and 16/25 (64%), 16/25(64%),
23/25(92.7%) IDDM patients respectively. Average MDA, PC and SH
levels in NIDDM, IDDM and controls were 3.6±1.2 nanomole/ml,
3.95±1.2 nanomole/ml , 2.9±0.6 nanomole/ml ; 1.5±0.9 nmol/
mg, 1.8±1.5 nmol/mg , 0.5±0.2 nmol/mg and 405±131.3 μmol/L,
365.9±109.5μmol/L , 539.3±56.9 μmol/L respectively. Plasma MDA,
PC levels were elevated and SH levels were decreased in both NIDDM
and IDDM patients in comparison with the control group which was
statistically signicant (p value =0.0001, 0.0003, p value= 0.0004,
0.004, p value = 0.002, 0.0007 respectively). There was no difference
in the oxidative stress levels among NIDDM and IDDM groups. When
FBS was increasing there was a decrease in SH level in both the
types of DM patients. There was no correlation of oxidative status
with HbA1C or with duration of DM.
Conclusion: Increased levels of oxidative stress and decreased
antioxidant capacity were noted in both the groups of DM. With
increase in FBS there was a decrease in protective antioxidant SH
levels.
Epidemiological survey of skin ora in hospitalised
patients in a tertiary care center
KR Gindhusha, M Mithurshana, Karthikajayakumar
Introduction: The hospital environment is not only thronged
by healthcare workers, patients and their attainders but also by
microbial pathogens. The objective of this study was to analyse the
bacterial ora in hospitalised patients in our hospital and interpret
the incidence of nosocomial infections.
Methods: The specimens with sterile swabs were taken from cubital
fossa, anterior nares, palms of consented patients and it was taken
on zero day (i.e) the day of admission and on 2nd&5th day. Swabs
will be collected by clinicians by sterile technique. Swabs are
transported in Amies transport media to the microbiology laboratory
& processed as per NCCLS procedure. Antibiotic sensitivity of all
isolates was done. Patient distribution was, 28 General Medicine,
18 General Surgery, 8 OBG, 3 TB & Chest diseases, 2 Pediatrics,
1 Orthopaedics.
Results: The commonest organism is micrococci in palms and cubital
fossa. In anterior nares, it had staphalococcus aureus, micrococci,
streptococcus species and diphtheriods. Palms 60 micrococci,
Cubital fossa 54 micrococci, 4 staphalococcus aureus, 2 aerobic
spore bearers. Nasal swab 30 staphalococcus aureus, 20 micrococci,
2 streptococcus, 8 diphtheroids. All staphalococcus aureus isolated
from these were methicillin sensitive. Micrococci were the
commonest organism in the palm & cubital fossa which has been
proved to a transient ora, not associated with any infections. Our
study also reveals that the patient did not develop any healthcare
associated infections & other iatrogenic infections. The absence of
the transient ora, micrococci in the 5th day further augments the
good infections control policies practised in our centre.
Conclusion: Periodical surveillance of hospital acquired infection
among the inpatients is a must for evaluating the hospital guidelines
of infection control policies & assesses the status of the health
education programme and antibiotic policy & help the patient to
have an infection free life.
Relationship between malaria and ABO blood group
types in Mangalore, Karnataka, India
Sharana Hegde, Ruchi Sinha
Introduction: Malaria affects 1 billion people and results in 1-3
million deaths each year worldwide. P.falciparum causes more
severe forms. A study found that patients with blood group O
have reduced chances of developing severe falciparum malaria.
Clinical severity, rather than incidence or prevalence of detectable
parasitemia, is a more relevant outcome to assess ABO group and
survival. There is a paucity of studies on the relationship between
ABO blood group and its inuence on malarial infection. Hence,
this study has been planned to study the relationship of severity of
malaria with blood groups and to evaluate if ABO blood groups show
170 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
differential susceptibility to P.falciparum malaria.
Methods: 200 malaria positive patients were considered.
Patients who had atleast one of the following complications were
considered complicated malaria cases: Cerebral malaria, severe
anaemia-(haemoglobin<9 g/dl), circulatory collapse-(systolic blood
pressure<80 mmHg in patients >5 years of age;< 50 mmHg in children
aged 1-5 years), jaundice, hematuria, bleeding manifestations,
acute respiratory distress syndrome and death.Blood group was
tested. Data analysis was done by chi-square test and a p-value less
than 0.05 was considered statistically signicant.
Results: Majority(43%) were of blood group O.Distribution of
blood groups in South India:O(38.75%), B(32.69%),A(18.85%),
AB(5.27%).14.5% had falciparum malaria, rest vivax.73% were males,
parasite load 3(+) formed majority(35%).No signicant relationship
between blood groups and type of infection(p=0.236) ,between
parasite load and blood groups(p=0.851) and between complicated
cases or multiple complication cases and parasite load(p=0.067).31%
cases had complications and 12.9% of them multiple complications.
Among complicated cases, O dominated (37.09%) followed by
A(30.65%). Among uncomplicated, O dominated (45.65%) followed
by A(28.99%). No signicant relation between blood groups and
distribution of complicated and uncomplicated cases(p=0.473) and
between complicated falciparum cases and blood groups(p=0.126).
A and O made 35 % each of the total number of mixed malaria cases.
In A ,57.1% of the mixed malaria cases had complications,whereas in
O only 14.3% had complications.There was a statistically signicant
relation between complicated mixed malaria cases and blood
groups. (X2=15.131,p=0.019).
Conclusion: Blood group O was the dominant blood type in both
complicated and uncomplicated malaria cases. Blood group A was
more prone to severe mixed malaria infections while, blood group O
had a favourable outcome.
Signicance of CSF adenosine deaminase and
C-reactive protein estimation in meningitis in adults
Ponnila T, Amudha VP, G Palaniappan N
Introduction: Rapid and accurate diagnosis of meningitis is
important, because delay in proper treatment can be harmful
or even fatal.The clinician must sort out the form of clinical
presentation and make a specic etiological diagnosis with CSF
analysis, Gram’s staining, Ziehl-Neelsen staining, latex agglutination
tests, bacteriological and tuberculosis culture, viral diagnostic
tests and PCR, the basis on which selection of potentially effective
antimicrobial therapy is predicted. Since each these techniques
have their limitations, the search for more specic, sensitive,
and rapid diagnostic methods continues. Combined use of the
rapid screening tests like C Reactive Protein level and Adenosine
Deaminase activity could be of much help in the differentiation of
various types of meningitis in adults.
Methods: A total of 50 samples of CSF and Serum were collected
from Patients attending in-patient departments of Tirunelveli
medical college hospital with meningitis were taken for study.
CSF ADA was estimated in all patients by colorimetric method of
GALANTI and GIUSTI and C Reactive Protein in CSF was estimated
based on latex agglutination.
Results: Out of 50 cases, 46% cases were Tuberculous Meningitis,
10% was of Pyogenic Meningitis and 44% was of viral Meningitis.TB
meningitis occurred more in the younger age group and pyogenic
meningitis was noted in the extremes of age group. The incidence
of tuberculous and pyogenic meningitis was more in males and viral
meningitis was more in females. The range of ADA was between
1.2 to 15.4 U/L. ADA level in tuberculous meningitis was 10.4-
15.4U/L with a mean level of 14.1 ± 1.96 (X ± SD) U/L.In pyogenic
meningitis it was 3-10.1 U/L with a mean level of 4.92 ± 1.27 (X ±
SD) U/L and in viral meningitis it was 1.2-4.9U/L with a mean level
of 3.66 ±1.03 (X ± SD) U/L .At 10 U/L cut off value, sensitivity and
specicity of the test for diagnosis of tuberculous meningitis was
95.65% and 96.29% respectively. CRP level in CSF was positive in all
cases of pyogenic meningitis. All the 22 cases of viral meningitis
and 23 cases of tuberculous meningitis showed a negative result
for CRP.
Conclusion: Many patients are needlessly receiving antitubercular
treatment and antibiotics in high doses on erroneous interpretation
of CSF. The tests for ADA and CRP in CSF are simple and can be
carried out in a central laboratory with a rapid diagnosis, thus
reducing undue delay or initiation of unwarranted harmful therapy
for patients.
Study of CYP17 gene polymorphism in fetal growth
restriction with reference to organochlorine
pesticide levels
Siddharth Chand, Mohammad Mustafa, BD Banerjee
Introduction: The cytochrome P-450c17alpha (CYP17) gene encodes
the enzyme cytochrome P-450c17alpha, which functions in the
estrogen synthesis pathway. The genetic variation in the maternal
CYP17 gene polymorphism 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. This study
was designed to investigate the gene-environmental interaction
between maternal and cord OCPs level, and maternal CYP17 gene
polymorphism with risk of FGR.
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 equal number of normal
pregnancies were collected. Women with occupational exposure to
OCPs, anemia, hypertension, antiphospholipid antibody syndrome,
medical disease, parity more than four, BMI < 19 or >26 kg/m2,
history of smoking, alcohol consumption or chronic drug intake
were excluded from both 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 polymorphic analysis for CYP17 gene using
PCR-RFLP.
Results: Signicantly higher levels of α-HCH, β-HCH, and γ-HCH
were found in maternal blood and cord blood samples of FGR cases
as compared to controls. The frequency of A1A2/A2A2 genotype was
signicantly lower (p=0.041, OR=0.421) in FGR cases as compared
to controls.
Conclusion: 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 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.
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 171
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Clinicopathological spectrum of lupus nephritis
correlating clinical variables with histomorphological
features, immune-uorescence in renal biopsies.
Anurag Danda, Sonia Badwal
Introduction: Lupus Nephritis (LN) is a signicant cause of morbidity
and mortality in patients of Systemic Lupus Erythematosus (SLE).
Renal biopsy is crucial for histological categorization of LN and also
for assessment of disease-activity and chronicity, thus guiding the
treatment.This study seeks to correlate clinical variables of LN
with histomorphological features and immune uorescence in renal
biopsies,thereby eliciting whole spectrum of the disease (Class &
severity) and help in its precise diagnosis.
Methods: This is a cross-sectional study involving 30 patients of
LN diagnosed as per ARA criteria, who underwent renal biopsy.
Both archival and freshly diagnosed cases presenting to Nephrology
department of a tertiary care hospital formed part of the study group.
The clinical data was accrued from the requisition forms,ward and
OPD register.Demographic,laboratory data along with management
modalities undertaken with response to therapy were recorded.
The renal biopsies were evaluated as per standard protocol and
were classied according to ISN/RPN criteria for LN.Histological
activity and chronicity indices were then correlated with clinical
parameters.
Results: Mean age of study population was 26 ±SD 9.8 years with
females outnumbering males.Mean age of diagnosis of SLE was
24.9 ±SD 8.7 years while mean years to onset of lupus nephritis
1.2 years±SD1.4 years.Acute Nephritic syndrome (66.6%) was
the predominant clinical presentation while Class IV LN (73.33%)
was the commonest histological pattern observed. Mean serum
creatinine levels posttreatment of the patients with high activity
index was 2.1 +/-SD 1.9 mg% which was signicantly less than the
serum creatinine at presentation. (t=5.2, P=0.0001,unpaired t test)
while there was no signicant difference in the mean creatinine
levels at presentation (3.62 +- SD 0.58 mg/dl) and after treatment
(3.08+-SD0.99 mg/dl) in patients with chronic histological features.
t=1.89,P=0.107.No statistically correlation was observed between
histological indices with clinical syndromes,C-Reactive protein,ANA,
dsdna or complement levels.
Conclusion: There is no absolute clinical and lab parameter which
predicts disease-activity & chronicity to direct management.Kidney
biopsy is essential in establishing diagnosis and prognostication and
should incorporate disease-activity & chronicity scores.Chronic
cases tend toward bad clinical outcome due to irreversibility
of histological lesion.Activity index represents reversible lesion
and may not predict outcome but is valuable in cases with high
scores which reect more signicant destruction,warranting more
aggressive management. A study with larger sample size and longer
follow-up is required to validate the results of this study.
A study on management practices of private medical
practitioners in patients newly diagnosed with
pulmonary tuberculosis
Ankita Bajpai, Vaman Kulkarni
Introduction: India accounts for about one-fth of the global
burden of TB. In spite of a signicantly strengthened TB programme
and the progress made, 50–80% of TB patients in India still seek care
at private clinics and TB treatment offered in the private health
sector remains substandard. Sub-optimal prescribing is one of the
main causes of tuberculosis (TB) treatment failure and emergence
of drug resistance. This study was conducted to address this issue
along with some exploration on other factors like categorization of
pulmonary tuberculosis patients and prevention of MDR-TB.
Methods: A cross sectional study of 112 private medical practitioners
who were practicing allopathic medicine in the city of Mangalore was
conducted. Respondents were selected using convenient sampling. A
semi-structured questionnaire was used to collect the information.
The data was analysed using SPSS Version 11.
Results: Only 58% of the subjects identied the correct denition
of TB suspects. Regarding the knowledge about the denition of
defaulter, only 13.4% identied the correct answer. About their
opinion about DOTS strategy of RNTCP 70.5% responded positively
while 29.5% said that it needs improvement. The MDR-TB denition
was correctly identied by 86.6%, whereas only 47.7% identied the
MDR-TB suspects. There was a signicant association between various
aspects of TB management and variables such as qualication, years
of experience, age of the practitioners and patient load (p<0.05).
Conclusion: To conclude, we think that the number of regimens
recommended by the various international/national professional
bodies should be reduced to a minimum and that xed-dose/
compliance kit formulations of different drug strength suitable for
different weight ranges should be made widely available. These
measures would lead to the desired changes in prescription of
treatment for effective TB management and control. Besides Private
General medical practitioners should be trained in the National
TB Control Programme guidelines and public awareness should be
raised to identify the main symptoms of pulmonary TB.
Evaluation of cytochrome P450 2C19 activity in
normal, healthy, adult subjects in western Indian
population
Harshavardhan N Sant, Urmila Thatte, Nithya Gogtay, Shital
Bendkhale, Natasha Bala
Introduction: Polymorphism of CYP2C19 activity in Western
Indian population has not yet been studied; hence the objective
of the present study is to evaluate the polymorphism of CYP2C19
(Poor metabolizers and extensive metabolizers) in Western Indian
population. This will be achieved by investigating the frequencies
of CYP2C19*1, CYP2C19*2 and CYP2C19*3 alleles and CYP2C19
genotypes in a Western Indian population.
Methods: Ethics committee approval was taken and written informed
consent obtained from all participants. A total of 144 consecutive
subjects were studied. They were recruited from the medical and
paramedical staff as well as the local population by word of mouth.
A sample of 5 ml of EDTA anticoagulated blood was drawn from the
participants. DNA was extracted by Phenol chloroform method.
This was followed by Polymerase Chain Reaction and Restriction
Fragment Length Polymorphism for the genotype of CYP2C19*2 and
CYP2C19*3.
Results: The frequencies of CYP2C19*1 and *2 in Western Indian
population were 0.638 [95% CI, 0.557, 0.713] and 0.361 (95% CI,
0.308, 0.418) respectively. No *3 alleles were found. The distribution
of CYP2C19*1/*1, *1/*2 and *2/*2 genotypes was 0.395 (95% CI,
0.319, 0.477), 0.486 (95% CI, 0.405, 0.567), 0.118 (95% CI 0.063,
0.206) respectively.
Conclusion: *2 was the most frequently identied mutant allele in
the Western Indian population. The frequency is similar to that of
South Indian population but different from Caucasians and Africans.
172 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
The CYP2C19*1/*2 genotype is signicantly higher in Western
Indians when compared with populations of other countries.
Notably, the CYP2C19*1/*3 genotype which has been identied in
2.7% of the Tamilian population, was not reported in the Western
Indian population. This study is likely to provide useful baseline
information on allele prevalence and may help practicing clinicians
at a later date for individualizing drug therapy.
An epidemiological study assessing the factors
causing delay in denitive diagnosis of cancer
Sanyukta Rajpurohit
Introduction: The problem of delay in diagnosing cancer as a
result of late presentation by individuals, or through healthcare
system inefciency is currently the subject of close attention as
part of a broader approach to reduce cancer mortalities, since it
is seen to be important for prognosis. The aim of this study was to
examine whether patients’ psycho-socio-economic characteristics
are predictors of long patient-, doctor- and system-related delay;
identifying root causes for delay; analyzing the average time lapses
involved in conrming diagnosis; and analyzing delay at the health
practitioner level.
Methods: A group of 100 patients with different types and diagnostic
stages of cancer at the RK Birla Cancer Centre of Sawai Man Singh
Hospital, Jaipur was selected and in-depth interviews conducted
with them and their family members. using a semi-structured
questionnaire, after their Informed Consent. The data collected was
organized in tabular form and retrospectively analyzed for various
parameters, using MS Access, MS Excel and SPSS.
Results: The most common reason cited for delay was ‘Lack of
Awareness of Symptoms’, followed by ‘Misattribution’ and ‘Lack
of good healthcare facilities’ by respectively 92, 83 and 65 % of
the patients. 79% of the women reported a delay of 30-60 days
before rst consultation. 89.5 % of the patients rst consulted a
GP, albeit at a village / small town. 7% considered alternative/
self-medication, while a minor 3.5 % went directly to a specialist.
Delay of <10 days was seen between rst visit to specialist and the
time the recommended investigations were done. 98% patients were
scheduled for chemotherapy/surgery with nil delay once diagnosis
was conrmed.
Conclusion: Higher socio-economic and education level of the
patient results in lesser delay. Women, children and elderly people
were delayed more, possibly due to sociopsychological causes.
Delay was more for rural patients than urban. Treatment-level delay
was negligible.
Suicides and factors associated with suicides-a study
in a rural setup of Puducherry in south India
Kangujam Anand Singh, Bharatwaj RS, Madhumitha M,
Niranjana Devi N
Introduction: Of the half million people reported to die of suicide
worldwide every year, 20% are Indians. In India, the southern
states have a suicide rate of greater than 15 per 100,000 . At
Pondicherry, we often hear of suicide reports from the local village
of koodapakkam located within half a kilo-meter from our college
and for which currently no statistics are available regarding suicide
rates. So the present study aims to nd the rate and identify risk
factors associated with suicide in this area
Methods: After ethical approval a cross sectional study was done
and Information of suicides in the last three years was collected
by house to house survey in Koodapakkam village, using a
pretested questionnaire, containing questions pertaining to socio-
demographic factors, health etc. Details were collected by the
trained interviewers from the relatives or close neighbours after
obtaining informed consent. Information was later compiled and the
percentages were obtained for comparison.
Results: The area has a total of 13 suicides and annual average
suicide rate of 88.59/ 100,000 population. Majority of suicides were
committed by married people 9 (69.2%). Commonest age category
for suicide was 15-45 years 6(46.16%). The main reason for suicide
was family problems leading to stress 9(78.84%).The commonest
mode of suicide was by hanging 6(46.15%) and least by burning
3(23.07%). Only 3(23.07%) of them had ever visited a psychiatrist
Conclusion: The study area has suicide rate more than eight times
the national average of 10.3. The prole of a person most likely to
commit suicide emerges as ‘ A middle aged, married male, occupied
as a labourer, with family problems leading to stress, who is likely to
commit suicide, inside the house, by the method of hanging, during
early morning or late night hours. There is an urgent need to address
the issue of suicides in this area.
Screening for G6PD deciency in blood donors
Swathi S Rao
Introduction: Glucose-6-phosphate dehydrogenase (G6PD)
deciency is the most common known inherited human enzyme
disease, affecting 10% of the world population. In India the
incidence of G6PD deciency has been variably reported as 0–37%
in different castes and communities. Severe manifestations of
G6PD deciency can be prevented if necessary precautions are
taken, by screening for the enzyme deciency in the asymptomatic
population represented by healthy blood donors before transfusing
their blood into recipients. The aim of this study was to determine
the prevalence of the enzyme disorder in the study area and thence
determine the need for a routine screening for it among the healthy
blood donors in blood banks.
Methods: 100 healthy donor individuals (93 males and 7 females)
in the age group of 18 – 49 years and of all the eight blood groups
were screened for the deciency in a period of 2 months, using
the methemoglobin reductase method. The test consists of the
oxidation of Hb to MethHb by Sodium nitrite and the subsequent
enzymatic reconversion to Hb in the presence of Methylene blue
by stimulation of the Pentose phosphate pathway and activation
of Methaemoglobin reductase. Study design – Observational study,
Sampling design – Purposive sampling. G6PD enzyme assay was
done for conrmation of deciency wherever possible. All the
data collected in this study was analysed by computing descriptive
statistics like mean, standard deviation and percentages.
Results: All the samples collected during the time of study tested
negative for G6PD deciency.
Conclusion: None of the samples tested positive for the enzyme
deciency, bringing us to the conclusion that screening for G6PD
deciency need not be added as a routine test in blood banks.
Further studies with a larger no. of individuals from different
geographical areas, castes and communities are needed to clearly
determine the prevalence and necessity of routine screening for the
enzyme deciency.
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 173
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Aerobic and anaerobic bacterial analysis in
appendicitis
M Nishanthi, SV Priyanka, Karthikajayakumar
Introduction: There is no unifying hypothesis regarding the etiology
of appendicitis. It may be due to faecolith, stricture, foreign body,
bacterial infection, parasitic infestations, viral infection, carcinoma
caecum near the base, etc. A mixed growth of aerobic & anaerobic
organism is usual. Hence we want to analyze both aerobic and
anaerobic microorganism in appendicitis.
Methods: 60 samples were collected in our hospital over a
period of four months. Appendicectomy was done through open
appendicectomy or laparoscopic appendicectomy. Under sterile
condition the specimen was immediately transported to microbiology
department in saline and thioglycolate broth separately, after
obtaining the consent of the patient in regional language. Appendix
from saline was subjected for culture to analyze aerobic organisms
which was incubated for 48hours. For anaerobic organism the
specimen from thioglycollate broth cultured in neomycin blood agar
in gas pack for 48 hours and , if growth not seen further incubated.
The aerobic & anaerobic organisms were further subjected for
biochemical reactions and antibiotic sensitivity pattern as per CLSI
GUIDELINES.
Results: Sixty specimens of appendix were collected from patients
with age group ranging from 8 - 50 yrs. Male to Female ratio is 37:23.
There was an incidence of 100% positivity in aerobic culture and 27%
positivity in anaerobic culture. The bacterial isolates were: Escherichia
coli-42%, Klebsiella pneumonia-17%, Proteus-12%,Citrobacter koseri-
10%,Pseudomonas aeruginosa & Klebsiella oxytoca -7%,Acinetobacter
-3%,Enterococcus-2%. Anaerobic isolates: Peptostreptococcus-15%,
Bacteroides species-12%. The antibiotic sensitivity pattern was:
Imipenum-100%, Gentamycin-95%, Ciprooxacin-78%, Amikacin-67%,
Cephotaxime-57%, Ceftazidime-33%, and Cotrimoxazole-30%. Males
were more affected than females. The study shows more number of
gram negative bacterial isolates which correlates with the mbrial
activity that establishes attachment and adhesion causing infection.
The commonest cause of appendicitis, was E coli which accounts for
42%. There were 21 cases (35%) with mixed infections which again
indicates the close association of bacterial proliferation within
inamed appendix.
Conclusion: Our study shows the presence of both these microbes
with predominant aerobes (63%) and minimum anaerobic ora
(27%). The commonest aerobic organism that is associated with
appendicitis is E.coli and anaerobe is Peptostreptococcus.The
antibiogram pattern showed a favorable high sensitivity towards the
drugs which are effective against gram negative bacteria.
Assessment of the reactive hyperaemia through
quantication of colour changes using pixel analysis
software
Tanwi T
Introduction: A sound cardiovascular system is essential for
human health. There are many effective tests to measure cardiac
performance, but no matching test exists to detect vascular
reactivity. Hence the acute need for a sensitive, non-invasive, cost-
effective screening test especially as incidence and prevalence of
Peripheral Vascular Diseases (PVD) as a complication of diabetes
is increasing. Early detection of asymptomatic patients in primary
care setting is the sole key to contain this modern pandemic. Most
of the presently available investigations techniques do not cater
to the above needs. The present study purports a simpler non-
invasive method of assessing variation in blood ow by quantifying
colour changes visible in palm secondary to reactive hyperaemia for
detection of presence of vascular lesions.
Methods: Colour changes in palms of test and control hands were
recorded in healthy young volunteers (5 males, 5 females) by taking
a series of photographs at 5 seconds interval in pre, during and
post occlusion periods. Sphygmomanometer was used to produce
arterial occlusion in test hand. The colour changes were analysed
for red pixels by indigenously developed colour analysis software
“Chitradeepam”. Mean of values for each hand in above-mentioned
periods were calculated for all subjects and corresponding values of
test and control hands were compared using student’s t test.
Results: No difference was observed in baseline values of both
hands. During occlusion, there was signicant decrease in test
hand colour in females compared to their control hand but not in
males. Post occlusion, signicant colour increase was observed in
test hands of males compared to control. A similar trend, though
statistically not signicant was seen in females.
Conclusion: This technique can be useful in determining normal
vascular response in healthy individuals through quantication of
reactive hyperaemia which in turn can be a parameter to assess the
decreased vascular response in Peripheral Vascular Disease.
Risk factor of type 2 diabetes mellitus among
adolescent from rural area of Wardha district
Vani Mittal
Introduction: Diabetes Mellitus is a highly prevalent disease in
India, which is responsible for many of its complications including
hypertension, hyperlipidaemia, nephropathy, and retinopathy.
Although the causes of type 2 diabetes are unknown, there are
some key risk factors which includes various sociodemographic
factors (gender, education, per capita income), behavioural risk
factors (tobacco, alcohol, sedentary lifestyle, dietary factors
and stress), physiological factors (weight, BMI, waist: hip ratio,
BP, blood glucose, urine albumin and history of weight gain) and
genetic factors owing to family history of DM. The study aimed at
nding the prevalence of behavioural and physiological factors for
type 2 DM and their association with sociodemographic factors and
family history of TDM, among adolescence from rural area or wardha
district, Maharashtra.
Methods: Our study was conducted in adopted village of Wardha
including 202 participants of age group 10-19 yrs using systemic
random sampling technique at 95% CI with the help of a structured
interview schedule which including measuring various physiological
parameters like Waist: Hip ratio, BMI, RBS, urine albumin.
Results: The results were presence of the various risk factors in
the participants with predominance of sedentary lifestyle, high
waist: hip ratio, obesity (high BMI), presence of urine albumin,
high RBS, dietary factors (non vegetarians are at a higher risk
than vegetarians), and a positive family history. Few other factors
were alcohol intake, smoking, sociodemographic factors including
gender, education and socioeconomic status. The awareness pattern
was also studied among the adolescents of the rural area, showing
predominance in girls. Awareness level was associated with students
in higher classes as compares to primary school.
Conclusion: Hence, this study concluded that awareness need to be
spread among the adolescents of rural area about the various risk
174 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
factors for type 2 Diabetes Mellitus and measures taken to prevent
this metabolic disease as far as it is possible.
Clinical factors associated with mortality in Dengue
infection in pediatric population at tertiary care
center of Davangere, Karnataka
Naren Srinath Nallapeta, CR Banapurmath, S Mruthyunjaya,
Shrujana Ambati Nagaraj, Sangam DK
Introduction: Dengue affects an estimated 50-100 million with 24,000
deaths occurring worldwide annually, of which 90% occur in children
principally in the tropics and subtropics and mortality is on the rise.
Our aim was to investigate the relationships between the clinical
features associated with dengue infections in a tertiary care centre.
Methods: A retrospective analytical study was conducted in Bapuji
Child Health Institute and Research Center, Davangere by reviewing
the case records of children admitted and diagnosed clinically/
serologically of Dengue fever. Data was collected on a predesigned
pretested form, which was analysed using SPSS version 16. Mortality
was the primary outcome measure.
Results: The mortality rate was 2.9% (45). When comparing
the demographics of those who survived (636) and those who
died (45), signicant differences were found with female sex
(45% and 64.4%; p=0.01), and infants (9.6% and 26.7%; p=0.01).
When comparing with those who survived, the clinical features
signicantly associated with mortality were convulsions (3.9% and
26.7%; p<0.05), hepatosplenomegaly (43.1% and 75.6%; p<0.001),
shock(6.4% and 88.9%; p<0.001) and hemorrhage (14.8% and 33.3%;
p=0.01). The mean white blood count in those who died was
12,883/cmm, in those who survived was 7,842, the difference being
signicant (p<0.001). When comparing with those who survived, the
complications signicantly associated with mortality were acute
respiratory distress syndrome (7.9% and 60%; p<0.001), hepatitis
(11.5% and 26.7%; p=0.024), encephalopathy (94.2% and 24.4%;
p=0.002), disseminated intravascular coagulation (p=0.004) and
pulmonary hemorrhage (p=0.001).
Conclusion: Dengue fever has a wide spectrum of clinical
presentation. Infants and female sex are at higher risk of mortality.
Clinical features like convulsions, hepatosplenmegaly, shock,
hemorrhage and complications such as acute respiratory distress
syndrome, hepatitis, encephalopathy, disseminated intravascular
coagulation and pulmonary hemorrhage were associated with
mortality in children with dengue viral infection. We recommend
children with dengue infections with such predictors of mortality on
presentation warrant management in high dependency units.
Use of adenosine deaminase as a rapid diagnostic
tool for tuberculous pleural effusion
Jerinevanjelin F, Amudha VP, G Palaniappan N
Introduction: Tuberculosis is a common cause of pleural effusion.
Conventional methods like tuberculin test, pleural uid biochemistry,
and direct examination for AFB have proven to be insufcient for
diagnoses of pleural TB. Because of the non-availability of tests
like pleural uid culture, pleural biopsy, ELISA, PCR & Interferon
in all centres, the conrmation is difcult. Pleural uid Adenosine
deaminase levels in TB effusion are signicantly higher and it is
considered as a pleural uid marker for tuberculosis.
Methods: After approval by the institutional ethical committee
pleural uid and serum was collected from 50 adult patients with
clinical and/or radiological evidence of pleural effusion. The samples
were analysed for protein, sugar, LDH, cholesterol, albumin, total
cell count, differential cell count, Gram stain and Ziehl Neelson
staining. Pleural uid ADA was estimated by colorimetric method
of GALANTI and GIUSTI. An accurate diagnosis of transudate versus
exudate was made using Light’s criteria. Statistical analysis was
done by‘t’ test and two sided chi test.
Results: Males constituted 32 and females 18 cases. The range of
ADA was between 5 to 162 U/L with a mean ADA value of 54.5 U/L.
ADA level in tuberculous pleural effusion was 40.4 - 162 U/L with
a mean level of 88 ± 38.91 U/L while in non-tuberculous pleural
effusion it was 4.6 – 38 U/L with a mean level of 21 ± 10.85 U/L.
The cut off value of ADA for diagnosing tuberculous pleural effusion
in our laboratory was >40 U/Twenty eight out of 29 patients with
tuberculous effusion had pleural uid ADA level > 40 U/L and one
had pleural uid level < 40 U/L.Twenty out of 21 patients with non
tuberculous effusion had pleural uid ADA level < 40 U/L and one
had pleural uid ADA level > 40 U/L. The Sensitivity , Specicity
,Positive Predictive Value and Negative Predictive Value of ADA test
for diagnosis of tuberculous pleural effusion was 96.6% , 95.2%,
96.6% and 95.2% respectively. All cases of tuberculous pleural
effusion had L/N ratio > 0.75. Of the ten cases with nontuberculous
exudative pleural effusion, ADA was < 40 U/L in nine cases and L/N
ratio was < 0.75 in all ten cases.
Conclusion: ADA estimation is a sensitive and specic test, helpful
in differentiating tubercular from non-tubercular etiology in pleural
effusion. The combined use of ADA and L/N ratio in exudative
effusions increases the specicity of ADA.
Hanta and Dengue seropositivity in febrile patients
Swarjith Nimmakayal
Introduction: RESEARCH QUESTION:prevelence of dengue and hanta
virus in febrile patients im mysore.aim:The main aim of this study is
to nd out the seropositivity of hanta virus and dengue fever IgM/IgG
by SD rapid test (ICT) kit and dengue duo Immunochromatographic test
(ICT) respectively in Adult patients presenting with acute febrile illness
Methods: Adult patients presenting with acute febrile illness.about
80 patients with acute febrile illness and with 20 healthy individuals
will be taken as controls.The serum sample is tested for Dengue NS1
antigen, Dengue IgG /IgM antibodies by ICT kit . The same sample is
also tested for hanta viruses IgM/IgG antibodies by ICT kit.
Results: A total of 100 samples were studied of which 80 formed the
cases group who are febrile with thrombocytopenia and 20 formed
the control group who were healthy.out of 21 positive dengue cases
10 were dengue ns1 antigen positive 4 were dengue igm antibody
positive 4 were dengue Igg antibody positive 1 case showed both igm
antibody and ns1 antigen seropositivity and 2 cases showed both igm
and igg antibodies positive.
Conclusion: ICT helps in rapid diagnosis of dengue and hanta virus
infection and also reduces the mortality and morbidity and low
platelet count is associated with complications of dengue fever.
Occurrence of ESBL and MBL in clinical isolates of
Pseudomonas aeruginosa– an emerging threat to
clinical therapeutics
Vignesh G, Velvizhi G, Palaniappan N
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 175
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Introduction: Pseudomonas aeruginosa is an opportunistic pathogen
with innate resistance to many antibiotics and disinfectants. In
addition to the intrinsic resistance of P. aeruginosa, it also produces
the enzymes, namely β-lactamases and MBLs (Metallo β-lactamases)
and their continued spread is going to be a major therapeutic
challenge. Hence, the present study was undertaken to detect the
Extended Spectrum β Lactamases (ESBL) and Metallo β Lactamases
(MBL) in isolates of Pseudomonas aeruginosa which were isolated
from wound infections and to evaluate their susceptibility patterns.
Methods: One hundred isolates of P.aeruginosa were analyzed to
study their sensitivity patterns. The presence of the ESBL enzyme
was detected by the phenotypic conrmatory test and the MBL
enzyme was detected by the Imipenem – EDTA Double Disk Synergy
test and Modied Hodge test.
Results: Out of 100 samples which were cultured, 26[26
%] yielded the growth of Pseudomonas aeruginosa. The
resistance pattern of P. aeruginosa was noted as follows,
Amikacin-15(58%), Gentamicin-15(58%), Ciprooxacin-14(54%),
Cotri¬moxozole-13(50%), Ceftazidime-12(46%), Imipenem-6(23%)
and Meropenem-6 (23%). Among the 26 Pseudomonas aeruginosa
isolates, 8 [30.76%] were ESBL producers and 4[15.4%] isolates were
metallo β lactamase producers. The modied Hodge test detected
2 strains as metallo-β-lactamase producers (MBL).The EDTA disc
synergy test detected the same 2 strains as well as an additional
two strains as MBL producers. None of the isolates showed the
coexistence of ESBL and MBL. All the ESBL producing isolates were
sensitive to Imipenem, while the MBL producing isolates showed
widespread resistance to Aminoglycosides, Ciprooxacin and the
Piperacillin with Tazobactam combination
Conclusion: The present study underlines the unique problem that
the presence of ESBL and MBL mediated resistance in Pseudomonas
aeruginosa has created a therapeutic challenge for the clinicians
and microbiologists. Hence, we suggest that the detection of ESBL
and MBL in Pseudomonas aeruginosa should be a routine practice in
the hospital.
Detection of high level aminoglycoside resistance
and vancomycin resistance in Enterococcus isolates
from laboratory samples in Mangalore, Karnataka
Vadanya Shrivastava, Shrikala Baliga
Introduction: Enterococci are an increasing cause of nosocomial
infections due to their resistance intrinsic resistance to
aminoglycoside and most beta-lactam antibiotics.High level
Aminoglycoside resistant (HLAR) enterococci are usuallydened as
minimum inhibitory concentration of aminoglycoside for the isolate
>2000µg/ml. In this study we aimed to study the pattern of High-
level Aminoglycoside Resistance and Vancomycin resistance among
clinical isolates from a tertiary health care centre in Mangalore.
Methods: All enterococci isolated from exudates, urine and blood in
the microbiology laboratory of a tertiary care Hospital in Mangalore
for a period of 2 monthswere included in the study.Enterococci were
identied asE.faecium or E.faecalis by standard microbiological
techniques.Each isolate was tested for High level Aminoglycoside
resistance (HLAR) by standard Disk-diffusion method using 120µg
gentamicin disc and 300µg streptomycin disc and interpreted as per
CLSI guidelines.The isolates weretested for Vancomycin resistance
by E-testusing according to CLSI guidelines. Relevant case histories
including risk factors were taken.
Results: Out of 93 isolates, 80.6% were E.faecalis and 19.4% were
E.faecium. 45.2% isolates showed HLAR( 40% E.faecalis and 66.6%
E.faecium). Only one isolate of E. feacium showed Vancomycin
resistance. 56% of the patients with enterococcal infections had
Diabetes mellitus. 35.5% were polymicrobial out of which 43.4% were
from exudate samples. Co-infections with E.coli or Klebsiellaspp
were the most common.
Conclusion: The study shows an increase in High Level
Aminoglycoside resistance and the emergence of Vancomycin
resistance. Gentamicin is widely used to treat serious enterococcal
infections and injudicious administration can lead to an increase
in resistance and hence routine screening for HLAR is mandatory.
Emergence of vancomycin resistance anticipates its spread and
warrants caution and surveillance during treatment.
Neurocognitive dysfunction among asymptomatic hiv
positive patients using international HIV dementia
scale
Shivani Priyadarshni, Basavaprabhu A, Unnikrishanan B
Introduction: A variety of neurocognitive disorders may develop
in HIV patients at any point of time during infection whether
otherwise symptomatic or not. Cognitive impairment may impact
medication adherence which will be ultimately affecting morbidity
and mortality. Hence this study was undertaken to evaluate the
neurocognitive disorder among asymptomatic HIV positive patients.
Methods: This cross sectional, prospective study was conducted in
a tertiary care hospital attached to a medical college that caters to
a large number of HIV positive patients. The study population for
this analysis included asymptomatic HIV positive patients belonging
to WHO staging 1 or 2, only were included in the study. Data
collection was done using a pretested standard questionnaire, the
International HIV Dementia scale.
Results: Out of the 101 patients studied, 69(68.3%) were males and
32(31.7%) were females. Among these patients, 88 (87.1%) were
receiving antiretroviral therapy (ART), 84 (83.2%) were in WHO
stage 1 and 17(16.8%) were in WHO stage 2. Around 91 (90.1%) of
patients had HAND and the remaining 10 (9.9%) did not have HAND.
There were statistically signicant differences in the gender and
educational level between patients with or without HIV associated
neurological dysfunction (HAND). As the WHO staging advanced from
1 to 2 there was an increase in the percentage of patients having
HAND from 89.3% to 94.1%. Also as the age advances, percentage of
patients having HAND also increased.
Conclusion: There was high prevalence of HIV associated
neurocognitive dysfunction among asymptomatic HIV positive
individuals despite receiving antiretroviral therapy. Also there
was an increase in HIV associated neurocognitive dysfunction with
advance in age and WHO stage of the disease.
Correlation between degree of thrombocytopenia
and severity of bleeding in dengue infection
Kumudumalie Perera
Introduction: Thrombocytopenia is a common feature in dengue
infection. Many times platelets are transfused not based on medical
rationale but due to fear of the complications that can arise if
bleeding occurs. The aim is to nd if there is a correlation between
thrombocytopenia and severity of bleeding to avoid platelet
transfusions which are unnecessary and potentially dangerous. As a
176 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
result unnecessary costs of platelet transfusion can be curtailed and
the cost of treatment can be cutback.
Methods: This prospective study was conducted in KMC hospitals,
Mangalore from July to August 2012 with a total of 50 patients. The
data was taken and analyzed using SPSS (statistical package for
social sciences) version 11.5. Chi squared test was used for nding
signicance. P value < 0.05 was taken as signicant.
Results: Severe bleeding was recorded in 16% of the patients which
included haemetemesis, malaena, and intracranial bleed. These
patients had a platelet count less than 20,000. However 1 patient
had a fatal pontine bleed with a platelet count of 85,000. Minor
bleeding such as epistaxis and petechiae were seen in 25% of the
patients with platelet count between 50,000 and one lakh. 4 patients
with platelet count between 50,000 and 1 lakh received platelet
transfusion. In 5 patients, platelets were given after the onset of
bleeding. 10 patients received prophylactic platelet transfusion
for platelet count less than 50,000. Dengue encephalitis, pontine
haemorrhage and multi organ dysfunction resulted in 4 deaths in
the hospital.
Conclusion: The study showed that there was no correlation
between thrombocytopenia and risk of bleeding. Even in patients
with platelet count greater than 50,000 fatal pontine haemorrhage
was seen. The role of platelet transfusion also did not have any
signicance in preventing bleeding manifestations. However
our study has shown that the duration of hospital stay has been
considerably reduced by giving platelet transfusion.
Relation between lung function and red cell
distribution width in a population based study
Tejashvee Teresa
Introduction: Pulmonary function is dependent on nutritional
status. Since an increased RBC distribution width (RDW) has been
associated with nutritional deciencies, we postulated that RDW
has an inverse relation to pulmonary function. The purpose of this
study was to test this hypothesis.
Methods: A cross-sectional study was conducted of a random sample
of patients attending the out patient department of chettinad
health city, Kelambakkam. A total of 200 subjects of both genders
who were aged 20 to 70 years and were free of respiratory disease
and no history of smoking. Pulmonary function test - FEV1, FVC, %
FEV1, %FVC using a spirometer; Height, body weight; Hemoglobin
concentration and hematologic indices like MCV, MCH, MCHC and
RDW were done using an automated haematological analyser.
Results: We found an inverse relation between FEV1 and FVC with
RDW.
Conclusion: Based on the results from this study, these are the
conclusions: There is a weak but signicant negative correlation
between RDW and lung function( FEV1 & FVC). There is a weak
positive correlation between Haemoglobin and lung function. (FEV1
& FVC). There is a weak but signicant negative correlation between
Haemoglobin and RDW. Even though there is a weak negative
correlation of RDW with lung function probably a larger study
sample size with adjustments for the other confounding factors may
be required for the establishment of RDW as a biomarker of lung
function.
A study of the correlation of expiratory muscle
strength with spirometric lung functions in healthy
Indian adults
S Chatterjee, A Chawla
Introduction: An important variable that affects spirometric
lung function is expiratory muscle strength. This study was done
to determine if a demonstrable correlation exists between
expiratory muscle strength, as measured with a modied mercury
sphygmomanometer and certain lung function parameters as
measured by spirometer.
Methods: The study was conducted on 40 randomly selected
healthy non-smoking male and female subjects in the age group
of 18-25 years. Spirometry was performed as per the guidelines of
the American Thoracic Society and European Respiratory Society
and the following parameters were recorded-FVC,FEV1,FEF
0.2-1.2,PEFR,MVV. A standard mercury sphygmomanometer was
modied for recording the maximum expiratory pressure. Subjects
were instructed to blow into a modied mouth piece attached to
the sphygmomanometer tube with maximum force and to hold it
at that level for maximum amount of time possible. The following
readings were noted: maximum pressure attained during the forced
expiration and time, in seconds, for which maximum pressure was
held.
Results: Male subjects generated signicantly higher maximum
expiratory pressures than female subjects (p=0.0001).The
maximum expiratory pressure showed signicant correlation with
anthropometric variables and spirometric lung functions for the
study population. However no signicant correlation was seen when
data for male and female subjects was analysed separately.
Conclusion: Maximum expiratory pressure (MEP), measured using
a modied mercury sphygmomanometer, is positively correlated
with anthropometric variables of height and weight. The MEP is
signicantly correlated with parameters of lung function in the
form of FVC, FEV1 and FEF 0.2-1.2. This simple test may provide
an objective assessment of functional work capacity in patients
with lung disease. There is a need to dene population norms and
reference values for the MEP in Indians.
Haematological and biochemical prole of
complicated malaria
Madhav Kumar Kedia, Chandrashekhar Mohapatro
Introduction: Malaria is a major health problem in india being
one of the biggest burdens in terms of mortalitiy and morbidity
among all infectious diseases.Severe malaria is dened as per by
the working group of world health organization1Presence of one
or more following criteria along with the asexual parasetemia
denes severe malaria.Cerebral malaria,anaemia,parasetemia
>100000/µl,renal failure,acute respiratory distress syndrome
,Hypoglycemia,hypotension shock,bleeding,convulsion,acido
sis,haemoglobinuria. The biochemical risk factors associated
are hypoglycemia,acidosis,elevated serum creatinine,elevated
total bilirubin,elevated liver enzymes and haematological risk
factors-leucocytosis,severe anaemia,coagulopathy.as there is a
greatendemism of this disease in Orissa,so The aim of our study is
that it is an analysis of parameters which have a poor prognostic
indication which will help in early diagnosis,treatment,prevention
Methods: Laboratory analysis of the diagnosed cases of complicated
malaria admitted in the departmentof medicine and pediatrics in
S.C.B Medical College,cuttack.during ythe period of may 1 to june
30.For Haematological prole testto be done are Hb%,diffrential
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 177
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
counting,total leucocyte count ,total platlet count,Erytrocyte
sedimentation rate.Peripheral smear for morphological changes in
rbc.For Biochemical prole test to be done are- liver function test
(total and direct bilirubin and liver enyme estimation); and kidney
function test- serum urea, creatinine. Sample size- 132.
Results: The complications in adult poppulation arecerebral
malaria in 31.4%,acute renal faliure in 19.4%,hepatopathy12.2%,in
paeditric cases cerebral malaria in 50%,acute renal faliure
in 11.9%,hepatopathy in 11.9%.Haematoogical observation
leucocytosis 36.5%,anaemia 28.6%,increased E.S.R 66.3%,decreased
platelet 59.2%in adults leucocytosis 26.4%,anaemia 41.4%,increased
E.S.R 56.8% decreased platelet 55.9%in paediatrics.Biochemical
observation raised,total biliruin 59%,direct bilirubin 43%,liver
enzymes58.9%,serum urea 82%,serum creatinine 59% in adults,total
biliruin 32%,direct bilirubin 23%,liver enzymes 20%,serum urea
18%,serum creatinine 23% in paediatrics,hypoglcemia in 80% adults
and 74% paediatrics.
Conclusion: Puropose is to study the effect on haematological
and biochemical parameter and to have comparative study of
complication between p.falciparum and p.vivax,moreover while
studying various types of complications frequency of changes of
various biochemical and haematological parameter that commonly
encountered will be noted.By analysing the parameter having poor
prognosisit would be helpful in diagnosis and treatment which would
be helpful in saving life of patient.
Drugs during pregnancy: prescription pattern, prior
self- medication and teratogenic risk categorization
of the drugs among pregnant inpatients
Mohammed Omar Farooq, Suneel Kumar Reddy
Introduction: Drug exposure during pregnancy is necessary for
treating pre-existing conditions, for managing medical problems
that develop during pregnancy as well as for pregnancy related
complications. Drug exposure may also have occurred due by self-
medication with over the counter (OTC) drugs. Drug exposure during
pregnancy is important because of the risk of teratogenicity. Clinical
trials are rarely done on pregnant women for ethical and regulatory
reasons. Prescription pattern studies help to identify current drug
prescribing practices, perform comparisons, provide feedback to
prescribers etc.
Methods: The study was conducted over a 2 month period among the
pregnant inpatients in Department of Obstetrics and Gynaecology,
JJM Medical College after obtaining ethical clearance. Data was
obtained from the case-sheets and interviewing the patients. The
prescriptions were analysed for different classes of drugs prescribed
and their FDA pregnancy risk categories. The DU90% methodology
was applied for quantitive analysis.
Results: The mean number of drugs prescribed were 4.5 and 4.7 in
the second and third trimester.90% of the prescriptions fell under
seven pharmacological groups:Pregnancy supplements (Iron, Folic
acid, Calcium and Vitamins C and B complex), Antimicrobials,
Antihypertensives, Drugs acting on Gastrointestinal tract(Antiemetic,
antacids, antidiarrheals), NSAIDs, Drugs Acting on the CNS(Opioids,
Benzodiazepines, Anticonvulsants), Antihelminthics. The most
widely prescribed drugs were supplements like vitamins, calcium
and iron constituting 34.6%, followed by antibiotics and anti-
hypertensive drugs. Self-medication was less than <1% among the
pregnant women. The largest number of prescriptions fell into FDA
Risk Category B(40%) followed by C(27%) and D(24%).
Conclusion: High extent of prescribing pregnancy supplements is
warranted as there is evidence of benecial maternal and foetal
effects. The level of drug exposure during pregnancy by self-
medication is low. The use of FDA Category D drugs in this study was
higher but is rational taking into consideration the serious nature of
illnesses that required admission.
Prevalence of prediabetes in students of a medical
college in central India
Priyanka Mondal, Bharati Ganvir
Introduction: According to a study conducted by ICMR-INDIAB the
projections for the whole of India would be 62.4 million people with
diabetes & 77.7 million people with prediabetes. Pre-diabetes is a
condition where blood glucose levels are higher than normal but not
high enough to be called diabetes therefore it is a stage prior to
clinical diabetes. The main risk factors for developing prediabetes
are parental diabetes, pubertal stage and extreme obesity. Screening
for prediabetes seems meaningful in subjects with either a parental
history of diabetes or both with parental history and obesity. We aim
to nd the prevalence of prediabetes in the students of a medical
college to recognize such students who are at risk of developing
diabetes in their later years.
Methods: Prospective community based observational study was
carried out in a tertiary care hospital on 200 medical students
in a duration of 2 months. According to a pre-formed proforma,
information was taken & blood glucose was estimated in fasting and
post-meal state.
Results: According to Fasting blood glucose estimation, 27% students
were prediabetic and only 1% students were diabetic. According to
Post-meal blood sugar estimation, surprisingly no one was in the
prediabetic range and only 1% students were diabetic. According to
relation of family history with prediabetes, 37% students had positive
family history for diabetes out of which 59.5% were prediabetic, 77%
students had negative family history out of which 8% students were
prediabetic and 1% were diabetic.
Conclusion: Among the 200 participants 27% were found to be
prediabetic out of which 64% were females and 36% were males.
Out of 64% prediabetic females 23% had waste hip ratio above cut
off value. Among 200 participants 37% had positive family history for
diabetes out of which 59.5% were prediabetic.
Alert-normal values of IgG4 In healthy Indian adults
found higher than the previous reports
R Pratheesh Chandran, George Kurian
Introduction: IgG4 is reported to be increased in certain
autoimmune conditions such as auto immune pancreatitis. It is
not clear if it is merely a marker of the disease or if it is involved
in the pathogenesis. Normal serum values of IgG4 have not been
estimated in Indians. This is critical if IgG4 levels have to be used
as a diagnostic criterion in diseases such as autoimmune hepatitis,
pancreatitis and cholangitis. Purpose of this study is to establish the
normal levels of IgG4 among healthy Indian adults.
Methods: Normal levels of IgG4 in healthy Indian adults were
measured using nephelometric methods. This was done by
collecting blood samples from healthy solicited staff and students
of our institution and volunteers from two villages near Pondicherry.
Sample was collected after obtaining an informed consent. The
normal levels were determined using 49 samples(samples collected
178 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
50 and one lost in transit). These samples were age stratied 21-
30 years,31-40 years ,41-50 years,51-60 years ,61 years and above
each having equal number of males and females except in one group
where the sample was lost. Inclusion criteria: healthy individuals
not suffering from any diseases. Including common conditions such
as asthma, diabetes, hypertension and heart diseases.Exclusion
criteria: People with a history of chronic diseases like diabetes,
hypertension, asthma and thyroid diseases will be excluded because
there is a likelihood of autoimmune diseases occurring together
with the diseases said above. It is a crossectional study and study
was undertaken in the months of august and September 2012 . the
ethical clearance was obtained on 25/4/2012.
Results: The range of values for the whole group was
between80.70mg/L to 5594.60mg/L. Then for males it is between
154.80mg/L and 5594.60mg/L and for females between 80.70mg/L
and 3565.10mg/L respectively.
Conclusion: The range of IgG4 levels in normal Indian population
is 154.80 mg/L to 5594.60 mg/L. There appears to be a gender
difference in these levels and no urban and rural differences and no
differences noted between different age groups. The upper limit of
normal in Indian population is 5594.60 mg/L. This is higher than the
upper limit cutoff quoted by Morselli and Labate(1350mg/L).
Giant cell arteritis of aorta with aortic dissection and
superimposed complicated atheromatous plaque-an
unusual case
Farook Majeed, Meenakshi Bamalwa, Syed Nazeer Mahmood,
Anuradha CK Rao
Introduction: Giant cell arteritis is a granulomatous systemic
vasculitis of unknown etiology and is the most common form of
systemic vasculitis in patients above 50 years of age. It usually
involves medium sized arteries causing conditions like temporal
arteritis but can involve the large vessels in upto 27% of cases. Aortic
involvement can remain asymptomatic for many years thereby
increasing the incidence of aortic aneurysms and dissections. Aortic
dissection/Aneurysms occur in around 18% of cases with large artery
involvement. Case Report- A 68 year old male patient presented
to the OPD with sudden onset chest pain radiating to the back.
Diagnosed clinically to be in cardiogenic shock, an echocardiogram
detected aortic dissection. The patient was operated upon
with grafting and insertion of AV prosthesis. Histopathological
examination of the resected segment of aorta revealed endothelial
hyperplasia, inammation, intimal atheromatous plaque, medial
cystic change, calcication with granulomas and giant cells in outer
media and transmural inammation. It was diagnosed as a case of
Giant cell arteritis of Aorta with Aortic dissection and superimposed
complicated atheromatous plaque.
Methods: Histopathological Examination of the resected segment
was done.
Results: Histopathological examination of the resected segment
of aorta revealed endothelial hyperplasia, inammation, intimal
atheromatous plaque, medial cystic change, calcication with
granulomas and giant cells in outer media and transmural
inammation.
Conclusion: Giant cell arteritis of Aorta when associated with aortic
dissection is a medical emergency thus owing to the low mean
survival rate in such patients. A superimposed atheromatous plaque
futher enhances chances of dissection, on an already weakened
media and intima. Histo-pathological examination assumes an
integral role in conrming the diagnosis, besides establishing the
cause of dissection in some cases. It further enables clinicians to take
adequate measures, in view of the chances of other complications
secondary to the vasculitis affecting other branches of the aorta,
hence reducing the complications and thereby decreasing morbidity
and mortality.
Frog as an experimental animal to evaluate analgesic
activity of drugs
Harshata Harti, Prabhakar Patil
Introduction: Many animals and methods are used for evaluating
analgesic activity of a test substance e.g. rats , mice,dogs and
monkeys.Different species of frogs had been used by many
researchers for evaluation of analgesic drugs e.g Rana pipiens and
African Claw frog . In our study we used RanaTigrina (Indian bull
frog) which was never used for evaluation of analgesic activity of
drugs. So by doing this project we judged usefulness of RanaTigrina
to evaluate analgesic drugs.
Methods: Animals used were Rana Tigrina of either sex weighing 100-
150 grams.Glass ask with porous platform was used for observation
of frog. Drugs were be procured from pharmacy in Navodaya Hospital.
The frogs were divided into seven groups (each group containing 6
frogs). Group I control (distilled water S.C.), Group II(Buprenorphine
S.C.), Group III (Pentazocin S.C.),Group IV (Fentanyl S.C.),Group
V (Piroxicam S.C.), Group VI (Diclophenac sodium S.C.),Group VII
(Ketoprofen S.C.). All groups were treated with 4% NaCl solution
S.C. on abdomen). Characteristic parameter i.e. number of eye
blinkings (This parameter was observed during pilot study after 4%
NaCl S.C. injection on lower third of frogs abdominal wall ) were
observed before and after drug administration. Each observation
was for 5 minutes. Same procedure was repeated weekly for four
weeks to check the reproducibility of this experiment.
Results: Buprenorphine, pentazocine and fentanyl inhibit rise
in number of eye blinkings. Buprenorphine inhibits the rise very
signicantly. Piroxicam diclofenac sodium and ketoprofen decreased
rise in number of blinks but it was not signicant as compared to
control.
Conclusion: This animal may be used as cost effective alternative to
existing methods of evaluating analgesics in Indian setup.
Gender difference in hand grip strength and
electromyogram (EMG) changes in upper limb
Swetha Rajkumar, Manjunath Hemberal
Introduction: Hand grip strength is a reliable measurement
when standardized methods and calibrated equipment are used.
Longitudinal studies suggest that poor grip strength is predictive
of increased mortality from cardiovascular disease and from cancer
in men. Endurance time during sustained submaximal isometric
handgrip exercise is dependent upon the intensity of the effort.
This intensity of effort in turn depends on the IEMG. The aim was
to compare the hand grip strength, the time to task failure during
sustained submaximal isometric handgrip exercise and the EMG
changes between males and females.
Methods: A total of 60 participants were recruited: 30 males
and 30 females (mean (SD) age, 18.66±0.92). Grip strength was
measured with a computerized Hand Dynamometer and subjects
performed sustained submaximal contractions of the right handgrip
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 179
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
at two different intensities: 30% and 75% of the pretrial maximum
voluntary contraction (MVC). EMG was sampled in 1-s epochs every
15 s during the contractions and the integrated EMG (IEMG) values
were normalized to that of the pretrial MVC.
Results: There was a signicant difference in hand grip strength
with males (367.97±80.51N) having greater values than females
(174.24±55.36N) p<0.05. But women performed consistently
longer than men at each of the two intensities [woman vs men;
174.51±82.93 vs 157.43±80.31 s for 30% MVC p>0.05 and 50.79±24.33
vs 38.86±11.63s for 75% MVC p<0.05]. Females had greater IEMG
(51.65±24.13% at 30% MVC and 92.17±26.44% at 75% MVC) than males
(40.00±16.77% at 30% MVC and 71.30±26.89% at 75% MVC) p<0.05.
Conclusion: Males have greater hand grip strength but females have
longer time to fatigue and higher IEMG during sustained submaximal
contractions owing to the differences in blood supply to the muscle,
in type of bres that constitute the muscle, the central drive and the
proportionality of IEMG to the intensity of effort which inuences
the endurance.
Knowledge, attitude and self-medication practices
of outpatients towards over-the-counter drugs
Khushboo Kanwal, Darpan Kaur, Shaunak Ajinkya, Rakesh
Ghildiyal
Introduction: The growing trend of self-medication is due to
easy availability of drugs, extensive advertisement, poverty, or
inadequate health services. Inappropriate use of drugs could lead
to problems like antimicrobial drug resistance, increased load of
morbidity, mortality and economic loss. Currently, little information
is available about self medication practices in developing countries.
This study was undertaken to assess the knowledge, attitudes and
self medication practices of patients using OTC drugs.
Methods: Open label cross sectional survey. Patients attending OPD
at MGM Medical College, Navi-Mumbai were provided information
about the study. Data was collected from patients who fullled the
eligibility criteria and were willing to participate during July-August
2012. Sample size calculated apriori was 330. Institutional Ethics
clearance was obtained. Materials and measures were a predesigned
data collection form, informed consent document, pre validated
and reliable self rated questionnaires comprising of Knowledge,
attitude and practices of self-medication by Taipei University and
Questionnaire on Reasons, Indications and Source of information by
Balamurugan and Ganesh. Data was analysed using descriptive, chi-
square and correlation tests with SPSS 17.
Results: Prevalence of self medication practices was 32.67%;
signicantly more common in males (p=0.035). Most common
reason for self medicating was minor illness (40%). Most common
source of information and indication were prescription of previous
illness (44%) and headache (33%) respectively. Correlation analysis
between Knowledge of drug safety and Self medication practices
was signicantly positive (+0.144; p=0.004). Knowledge of drug
safety and Attitude towards medical consultation with pharmacists
had a signicantly negative (-0.148; p=0.004) correlation.
Conclusion: Patterns that emerged signicant in self medication
practices were male patients, minor illness, headache and
prescription of previous illness. Overall, knowledge of medical
outpatients was average however their attitudes towards pharmacist
consultation were less favourable. Further research may be directed
towards improving existing lacunae and planning appropriate
interventions.
Post-induction morbidity in children (age 1 to 18
years) treated for acute lymphoblastic leukemia: a
retrospective cohort study
Shruti Khurana, Bhavna Dhingra
Introduction: ALL, (Incidence- 3-4 cases/100,000 children) is the
single most common malignancy in children. Although, the cure
rates have improved substantially, India has not kept pace with
the > 80% survival outcome in developed countries. After the initial
induction phase, the myelosuppressed child may suffer from several
infection related morbidities and mortalities. There has been no
systematic analysis available in the literature from India addressing
these problems which may even require hospitalization, intensive
treatment and may cause delay in the scheduled chemotherapy,
which has an adverse effect on the outcome. The aim of the research
is to study the morbidity prole of the patients and correlate the
outcome to their present Nutritional and Socio-Economic Status and
estimate the Over-all survival rates.
Methods: An Observational, Retrospective Cohort Study of 33 cases
of ALL treated at a tertiary care hospital - pediatric hematology-
oncology division. Pearson and Spearman’s correlation and Chi-
square test were used for the categorical data analysis.
Results: Out of the 33 patients treated, 20 (60.6%) survived. 5 (15.2%)
died in the post-remission period mainly due to stroke, pyogenic
meningitis, septic shock, Infective Enterocolitis and Fungal/ P.
jiroveci pneumonia. 5 patients were lost to follow-up. Each patient
received approx. 90 weeks (89.45±47.8) of treatment. The median
age was 5 years (M/F=5.6:1). Two relapses after completion and
one after 2-year abandonment of therapy was observed. The patient
weeks for hospitalization (4.34), delay in chemotherapy (8.24),
antibiotics (9.75), antifungals (1.3) and antivirals (0.2) given; and
blood products support required (PRBCs-2.15±2.21,PLTs-1.27±3.03,
FFP-0.18±0.73) was calculated.
Conclusion: The condition of children undergoing chemotherapy
for ALL in India is signicantly different from those recorded in
the developed countries due to different socio-economic (nancial
burden, high drop-out rates and poor compliance), disease biology
and genetic characteristics, and treatment-related factors. The
study may help the hospitals to identify areas, which need to be
strengthened such as achieving better nutritional status of the
already immuno-compromised patients, implementing better
hygiene and sanitation practices and help the physicians to be aware
of the possible morbidities that the child is liable to suffer from
during the post-induction period and take necessary steps towards
preventing such diseases including early recognition and treatment.
Methicillin-resistant Staphylococcus aureus(MRSA)
prevalence and risk factor assessment in a tribal
Indian district: a study among health care workers
Mathai Jolhf Koshy, Deshmukh D
Introduction: Methicillin-resistant Staphylococcus aureus(MRSA)
is a well-known nosocomial pathogen but awareness and control
strategies are still lacking in various regions of developing countries.
Our hospital lacked baseline health care worker data.The present
study was carried out to assess the prevalence and to establish
signicant risk factors for colonization with MRSA in health care
workers.
Methods: A cross sectional study was carried out throughout the
hospital. Nasal swabs were collected from ninety one health care
180 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
workers and were screened for MRSA. MRSA strains were detected
by disc diffusion and chromogenic agar. The D test was also carried
out to detect inducible clindamycin resistance in the isolates. Hand
hygiene practices were surveyed by means of a study questionnaire.
Results: Twenty MRSA carriers were identied among the 91 health
care workers (21.98%;CI95:13.97-31.88 %). Among different locations
a very high prevalence was found in emergency ward (62.5 %; CI95:
24.49 -91.48 %) (P <0.05) .The surgical and orthopedic departments
also showed a very high prevalence (54.55% and 75% respectively)
(P< 0.001). Thus the location and department of health care workers
are signicant risk factors for colonization. Inducible clindamycin
resistance was found in 20.45% samples, which emphasizes the use
of the D test in routine culture and sensitivity testing. Chromogenic
agar was found to have high sensitivity and results were similar to
those of disc diffusion (P<0.001). The present study has established
baseline health care worker data.
Conclusion: The presence of signicant risk factors aids in
identication of high risk groups among hospital staff. Selective
surveillance, decolonization, preventive strategies coupled with
effective lab techniques implemented in these groups will go a long
way in reducing the burden of MRSA in the hospital environment.
Chelioscopy and its patterns in comparison with ABO
blood groups
Sagar B Patel
Introduction: Lips are two eshy folds surrounding the oral orice.
They are lined externally by skin and internally by mucosa. A reddish
zone covered by thin keratinized epithelium. The lip has many
elevations and depressions forming a characteristic pattern called
lip print. The study of lip prints is called cheiloscopy. It is used for
personal identication since lip prints are unique for individuals and
do not change during the life of a person.
Methods: The present study was carried out in the KLES V.K.Institute
of Dental Sciences and K.L.E Hospital and MRC, Belgaum. A sample of
450 individuals was randomly selected for study. Subjects with any
pathology involving lips like ulcer, mucocele, erosion, inammatory
edema, surgical scar, post traumatic scar, Congenital defects like
cleft lip, lip pits, van der woude syndrome were excluded from
study.
Results: Branched type of lip prints was the most common pattern
followed by intersecting,vertical, reticular and undetermined type.
Among the total of 150 individuals most common blood group “O
Positive”, followed by “A Positive”, “B Positive”,“AB Positive” and
“A Negative” and “B Negative” and “AB Negative”.Then the lip
prints were correlated with blood group.
Conclusion: Lip print (Cheiloscopy) pattern does not show any
correlation with blood groups.
Evidence based dentistry among private dental
practitioners in Belgaum city: a knowledge attitude
practice(KAP) survey
Chetan Agarwal, Anusha Chintala
Introduction: Evidence based dentistry (EBD) is the practice that
integrates best evidence with clinical experience in making clinical
decisions. It serves to develop the clinical skills of dentists by making
decisions on evidence rather than opinions. Although EBD has been
accepted in Western countries, there are no studies related to its
application among dental practitioners in India. The present study
aims to evaluate the knowledge, attitudes and practice of EBD
among dental practitioners in Belgaum City.
Methods: A self designed questionnaire will be administered to
dental practitioners of Belgaum city. The questionnaire will consist
of several items addressing the socio-demographic and professional
aspects, and their knowledge, attitudes and practice of evidence
based dentistry mainly in the form of close ended responses.
Results: 89% of the respondents were aware of EBD and agreed
(87%) that it is a process of making clinical decisions on scientic
evidence. They (85-88%) agreed that it allows dentists to gain
knowledge and improves patient care. When faced with clinical
dilemmas, most responded that that they ask their colleagues or
consult electronic databases. 69% considered EBD important for
clinical practice and 87% were interested to learn more about it.
This attitude is substantiated by the mixed response for access to
specialist EBD scientic journals and websites and the ability of UG
training to equip them to practice EBD. Though, 53% believed that
EBD is practical in routine practice, the main barriers identied
were lack of time, knowledge and skills to practice EBD.
Conclusion: Though majority of the dentists were aware of EBD, they
did not seek best evidence i.e referring to scientic journals and
preferred to consult textbooks and colleagues. These shortcomings
can be overcome by continuing dental education programs focusing
on enhancing their knowledge and practice of EBD.
Prevalence of refractive errors in school going
children of Mangalore city, Karnataka, India
Tanya Jain
Introduction: A refractive error may be dened as a state in
which the optical system of the non accommodating eye fails to
bring parallel rays of light to focus on the retina. Childhood visual
impairment due to refractive errors is the second leading cause
of treatable blindness and very common in eye clinics. Refractive
errors are a also a part of the Vision 2020 programme. This study
presents the prevalence of refractive errors among school children
of Mangalore city along with sex and age distribution. This warrants
early detection and treatment of refractive errors to prevent
permanent disability such as squint, amblyopia etc.
Methods: Distant visual acuity was assessed by Snellen’s visual
acuity chart from 6 meter for both eyes for 781 students between
10 and 14 years studying in 5th to 10th standard. Children whose
eye sight was not good i.e. who have a visual acuity of less than 6/9
were considered as ‘eye sight not good’ and they were advised for
detailed evaluation and refraction. Examination data was entered
into pro forma and analysed. Data analysis was done by chi-square
test and a p-value less than 0.05 was considered statistically
signicant
Results: For the 781 students examined 12.45% had refractory error
in left eye, 11.6% showed refractive error in right eye while 10.8%
in both eyes. The overall prevalence was 12.5%. Students from the
age group of 10 to 13 years were examined. From the 781 students
examined 148, 298,312,16 belonged to the age group of 10,11,12,13
years respectively. Prevalence was maximum in 11 and 12 years 4.3%
and 5.4% respectively out of the overall prevalence. For the 731
boys and 50 girls 91 boys and 6 girls had refractory errors.
Conclusion: The prevalence of refractive errors in school going
Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013 181
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
children of Mangalore is 12.5% with peak in children between 10
and 12 years with no major difference according to gender of the
children. The data supports that vision screening of school children
could be useful in detecting correctable causes of decreased vision
especially refractive errors which lead to amblyopia and squint thus
minimising long term visual disability.
Avoidable non-pathological factors delaying the
medical care and increasing mortality and morbidity
in young infants
PVS Phani Sastry, Y Kodandapani
Introduction: In India IMR is 46/1000 in 2012 which is far from the
Millennium Development Goal of 28/1000 by 2015. More than 2/3rds
of this is contributed by young infants (<2 months age). Timely
medical intervention has huge impact on outcome. In this study, we
studied the factors delaying the timely arrival of sick young infant
to local hospital/ Tertiary care-center, the level of awareness of
households regarding identication of sick young infant at home
and whether mothers/ decision makers were imparted knowledge
regarding new-born care and danger-signs at the time of delivery
and later.
Methods: This is a cross-sectional study involving 400 sick young
infants admitted to NICU/ wards in our tertiary care-center during
the study period 2 months. Young infants born in our hospital and
admitted directly in NICU and born outside and shifted directly to
our NICU/wards were excluded. 27 well structured questions were
posed to parent/ attendant and information is obtained.
Results: Delay due to parents occurred in 52% of cases. Mother’s
inability to identify the symptom contributed 48% and 52% by
decision makers’ delay. Once decided, 92% reached a hospital
within 4 hrs. After referral, 28% failed to reach our hospital in time.
Factors causing delay at various stages were analyzed. At the time
of delivery-4%, at time of immunization-24% and at rst level health
ceter-1% of house-holds were imparted any child health related
knowledge.
Conclusion: lack of awareness is the leading delaying factor
followed by distance and lack of transportation. Fear of child being
small leads them to a hospital and not the awareness of danger-
signs. Opportunities in health education should be properly utilized.
IEC activities should focus on both mother and decision maker. A
pediatric care centre within a radius of 5kms & a referral centre
within a radius of 50kms are required.
Local anesthesia in diagnostic nasal endoscopy :
packing versus spray
Tanvi Seth, Prasun Mishra
Introduction: To have proper visualization of structures with
minimal discomfort to patient and surgeon during nasal endoscopy,
it is essential that the nose is well prepared before the procedure.To
compare and evaluate the efcacy of cotton pledget packing versus
topical sprays in Preparation of Nose for Nasal Endoscopy.
Methods: Prospective randomized blinded study on 100 patients
divided in 2 groups. In rst group the nose was packed with
4% lignocaine with adrenaline and in the other group with 10%
lignocaine topical spray and xylometazoline drops. Following the
procedure, patient and the surgeon’s response were documented
in a data sheet.
Results: The packing group required more preparatory time as
compared to the spray group. There was signicant difference in
visualization of structures during endoscopy which was better in
packing group, the spray group experienced signicant discomfort
as compared to the packing group. 8 patients had mucosal bleed
during the process of packing which was not seen in the spray group.
Conclusion: Both the methods have some merits and demerits
in terms of patient’s comfort and preparation time. However,
visualization of structures was better when nose was packed.
Evaluating awareness and practices pertaining to
radioactive waste management among scrap dealers
in Delhi
Nayani Makkar, Tany Chandra, Prachi Agrawal,
Simranjeet Singh, Harshit Bansal, Mannan Kumar
Gupta, Rajesh Kumar
Introduction: 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. Two years thereafter, we designed a study to judge
the awareness and practices regarding radioactive waste among
scrap dealers aiming to assess deciencies in radiation disaster
preparedness and guide to prevent similar accidents.
Methods: It 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 valid, 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 signicantly 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 signicantly
with Kuppuswamy’s scale (p=0.038) and with Per-Capita Income
(p=0.052). Scrap dealers dealing in ferrous metals, at a higher
potential risk of exposure, were aware of mitigation and response
methods to a radiation hazard signicantly more 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.
Conclusion: 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 even in the aftermath of the Mayapuri
incident. 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.
STEP criteria to compare three oral iron preparations
in pregnant women attending rural teaching hospital
Aditi Singh Parihar, Nitin Gaikwad
182 Indian Journal of Medical Specialities, Vol. 4, No. 1, Jan - Jun 2013
INDIAN JOURNAL OF MEDICAL SPECIALITIES 2013;4(1):MEDICON 2013 Abstracts
Introduction: Oral iron therapy is preferred for its convenience
for administration in iron deciency anemia in pregnant women.
However there is paucity of data for comparison of oral iron
preparations with different elemental iron contents with reference
to safety, tolerability,efcacy and price of drugs (STEP criteria).
Hence, we decided to compare ferrous sulphate, ferrous fumarate
and ferrous ascorbate and provide evidence based rationale to
manage iron deciency anemia effectively in pregnant women of
rural areas
Methods: This was a prospective, randomized, parallel group,
controlled, double blind clinical study conducted in Department
of Pharmacology and Department of Obstetrics and Gynecology,
of Rural Tertiary Care Teaching Hospital of Central India. Total
84 pregnant women aged between 18-40 yrs in gestation period
of 13-26 weeks with baseline hemoglobin level between 8g/dl-
10g/dl were recruited during the entire study conducted over a
period of 4 months (May-August 2012)and were randomized into
three treatment groups A, B and C. One group received ferrous
sulphate, other group ferrous fumarate and third group received
ferrous ascorbate daily for 6 weeks. At week 0, week 4 and week
6 complete hemogram (Hb%, MCV,MCH, MCHC , reticulocyte count)
was done. Adverse effects were recorded on every visit. Compliance
with study medication was determined by pill counting at each visit.
The parameters of individual groups which are assessed at multiple
point over a period were analyzed using Repeated-measure ANOVA
followed by Bonferroni’s test. One-way ANOVA followed by Tukey’s
test was applied to compare the data between groups. A p< 0.05 was
considered as signicant.
Results: The participants in Group A i.e. ferrous sulphate experienced
more gastrointestinal adverse effects (85.71%) as compared to
Group B i.e. ferrous fumarate (78.57%) and Group C i.e. ferrous
ascorbate (67.86%). In addition, dropout rate was higher (57.14%)
and compliance (47.88%) was poor in Group A. The signicant rise
in hemoglobin concentration, MCV, MCH and reticuocyte count was
observed in all the three groups at Day 45 when compared with
Day 0.However all three groups showed no signicant rise in MCHC
value from baseline at Day 45. The average treatment cost per
patient was observed to be less in Group B i.e. ferrous fumarate as
compared to other two treatment groups.
Conclusion: Based on STEP criteria,ferrous fumarate was found
to be relatively safe, tolerable, efcacious and cost-effective as
compared to ferrous sulfate and ferrous ascorbate especially in
treatment set-up of rural areas.
A study of prevalence, duration and course of
delirium in patients admitted in the cardiology ICUof
a tertiary care hospital
Meenakshi Bamalwa, Syed Nazeer Mahmood, Samir Kumar
Praharaj
Introduction: Prevalence rates of delirium ranging from 47 to 80%
have been reported in the intensive care unit (ICU) setting. There
is a scarcity of Indian studies on delirium, though it is a common
reason for psychiatric referrals in multispecialty hospitals. No
study has specically looked at the rates of delirium in Cardiac ICU
patients. Since the predominant goal of elective cardiac surgeries is
to preserve and improve function, the fact that the occurrence of
delirium can signicantly contribute to cognitive decline is of major
concern. The objectives of the study were to assess the prevalence,
course and duration of delirium in patients admitted in the cardiac
ICU and to outline risk factors associated with the occurrence of
delirium.
Methods: This was a prospective study, conducted at a multispeciality
tertiary-care centre, in Karnataka. Sample comprised of 50
consecutive patients above the age of 15 years, admitted in the
cardiac ICU. All the patients were rated on Confusion Assessment
Method (CAM) to ascertain the presence or absence of delirium on
day 1, day 2, and every two days thereafter, until delirium subsided,
or until they were discharged from the ICU.
Results: Among the sample of 50 patients, eight (16%) developed
delirium. The mean duration of delirium was 1.5 (SD 0.53) days.
The mean days for onset of delirium was 1.63 (SD 0.74) and mean
days for offset of delirium was 3.12 (SD 0.83). The presence of
electrolyte abnormalities signicantly predicted delirium in our
sample (OR 0.16, 95% CI 0.03 to 082), which accounted for 16.5%
of the variance.
Conclusion: 16% of the patients admitted to the Cardiac ICU had
delirium during their stay. Deranged electrolytes appeared as
signicant predictor of appearance of delirium in our sample.
Student’s perceptions of educational environment:a
study conducted among intern in rural India using
Dundee Ready Educational Environment Measure
score
Denita Fernandes
Introduction: DREEM score measures the strongest & weakest
aspects of educational environment in institutions which directly
impacts on student’s learning & outcome.
Methods: DREEM questionnaire consisting of 50 questions
,divided into 5 Domains including Student’s perceptions of
learning,Teachers,Academic Self Perception,Atmosphere &Social
sel