International Journal of Medical Research & Review (IJMRR)
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Perceptions and Suggestions of II year M.B.B.S. Students Regarding Updated Pathology Teaching Curriculum: An Analytic Study
Get PDFIntroduction: In most of the medical colleges of India, the knowledge regarding basic science subjects is taught mainly through didactic lectures, tutorials and practicals. And hence the system is more of teacher centered with less interaction or involvement from the students. There is a need to explore innovations, so as to sustain interest.
Objectives: To introduce interactive teaching and assessment methods during lectures and examinations respectively and to elicit student’s perception about them.
Materials and Method: A number of interactive methods were introduced in the pathology curriculum in a batch of 153 medical students of 2nd year M.B.B.S. Later the perceptions of the students were elicited regarding these sessions using a questionnaire based on Likert scale.
Results: Validation of the scale indicated good internal consistency with Crohnbach’s alpha coefficient of 0.9. Majority (83%) of the students agreed or strongly agreed to like the interactive sessions. Similarly, 86% agreed or strongly agreed to like teamwork in group discussions and quiz sessions. Most popular interactive mode was MCQ’s followed by Cinemeducation. Most students were also of the view that interactivity during lectures keeps them active, more attentive in the class, makes the atmosphere more lively, also improved their communication skills, helps in retention of the topic, clearing doubts, improves attention span and hence results in better understanding of the subject.
Conclusion: This project clearly proves that updated pathology curriculum is preferred by students. So, teacher should take a new role of facilitating the process of interactive learning rather than delivering elaborative lectures
Pre-treatment de-ritis ratio as a marker for cervical cancer: a study at regional cancer centre
Get PDFBackground: The role of AST/ALT ratio in prognostication of cancer cervix is not established in different study settings except for very few where they have highlighted on circulation of higher levels of AST and ALT in the cervical cancer patients. Moreover, there is a biological plausibility explained in one of the studies hence the study was conducted to elicit if the AST/ALT ratio could predict the prognosis of advanced cancer cervix before the initiation of treatment.
Methodology: A follow up study was conducted among 122 newly diagnosed locally advanced carcinoma cervix patients in a regional cancer centre Bangalore from June 2015 to May 2018. All the basic data, normal and abnormal levels of serum Aspartate transaminase (AST), Alanine transaminase (ALT) and AST/ALT ratio were collected, followed up for one year and compared for overall survival using Log-rank test along with Kaplan-Meir curves. Receiver Operator Characteristic curves (ROC curves) were plotted to determine the poor outcome (death). Data was analysed using SPSS 18.0 and P value < 0.05 was considered statistically significant.
Results: The mean age of the study participants was 50.4±10.6years. Mean follow up period was 4±3 months (1-12 months). Median serum AST, ALT and de-ritis ratio did not differ among the different stages of cervical cancer. Area under the curve (AUCs) for de-ritis ratio was found to be not significant with very poor accuracy (AUC = 0.47;P> 0.05). It was observed that there was no statistically significant difference between the groups in their survival rates.
Conclusion: AST/ALT ratio cannot predict the prognosis of advanced cancer cervix before the initiation of treatment
Evaluation of corticosteroid use in outpatient department of dermatology of a tertiary care teaching hospital: a prospective observational study
Get PDFBackground: Corticosteroids are widely prescribed drugs in dermatology. Rational prescribing of steroids is important for best therapeutic outcome at lowest possible dose. A study was carried out at a tertiary care teaching hospital in order to evaluate the use of corticosteroids which provided a picture of trends in the usage of corticosteroids in dermatology at that set-up.
Materials and Methods: This prospective, observational study was carried out in department of dermatology for 1 year after ethical approval. Data was analysed for parameters related to corticosteroids, their potency, WHO drug prescribing indicators, effectiveness as well as effects of corticosteroids on quality of life of patients. Statistical analysis was done using Microsoft Excel Office 365.
Results: In the 223 patients, 44.84% patients belonged to 21-40 years age group. Mostcommon indication was eczema in 29.15% cases. Topical betamethasone (25.11%) and oral prednisolone (20.17%) were most frequently prescribed. 95/140 topical steroids prescribed were super highly potent. Among concomitant drugs, a majority of 38% were antihistaminics. Degree of polypharmacy showed 04 drugs in a majority (43.15%) of prescriptions. Only 6.27% drugs were prescribed by generic name.
Conclusion: Corticosteroids were beneficial to a large no. of patients. Initial usage of low potency steroids topically wherever possible can be emphasized. WHO drug prescribing indicators analysis indicated the need to adhere to WHO guidelines as well as prescribing drugs by generic name. To maintain a balance between judicious use and frequent abuse with corticosteroid is important along with physician’s vigilance and patient education
Virological outcomes of second-line antiretroviral therapy for HIV-1 patients in center of excellence, Gandhi Hospital, Secundrabad, Telangana
Get PDFIntroduction: In India, ART service was established in 2004 and viral load facility was started in 2009 through National Public Health Laboratory (NPHL). Phased scale-up has been planned to efficiently and successfully expand viral load testing services, taking into account the targets for enrollment of People Living with HIV in to Anti Retroviral Therapy program.
Methods: This is an observational study conducted at the Centre of Excellence (COE), Gandhi Hospital Secundrabad. It is a referral centre for evaluation of patients suspected of treatment failure from ART centers. Data of all patients >18 years of age who were started on second line therapy due to failure of first line ART was taken in the study. The data of patients admitted between the time period of January 2009 to January 2010 was included.
Results: A total of 147 HIV infected patients received second line ART of which 114 were men and 33 were women. Of these, 147 were treated with regimen TL, ATV/r. The most common cause to switch on second line ART was combined immunological and clinical failure (135) followed by all three failure (12).Mean baseline CD4 count was 220.06 (95% confidence interval [CI]: 243.73-196.38) and mean base line of PVL of patients was 291356.6 cells/mm3 (95% CI: 364843.8-217869.29) copies/ml, respectively.
Conclusion: Good long term outcome as well as virological suppression in patients starting second line therapy under programmatic conditions in India. This early mortality can be circumvented by introducing routine virological monitoring in the program which will help in early detection of patients with failure
A study on serum vitamin B12 levels in type 2 diabetic women and its correlation with metformin therapy
Get PDFBackground: Diabetes Mellitus (DM) is a major emerging health issue and the risk factors are varied in women making them susceptible to it. Metformin is most preferred and widely used drug worldwide due to various reasons. Vitamin B12 deficiency in DM caused by Metformin is least known side effect.
Objective: This study was taken up to assess the correlation between deficiency and duration and dose of metformin treatment.
Methods: This being a hospital based observational study, 650 Diabetic women were evaluated by detailed questionnaire, general physical examination, fasting blood glucose (FBS), post prandial blood glucose (PPBS), serum Vitamin B12 levels, CBC and NCS.
Results: The mean age of the cases was 51.98±5.17years. 164/408 cases (on metformin therapy for >3 months) had low vitamin B12 as against 22/242 controls (never on metformin therapy). Mean Serum vitamin B12 was low in cases with less duration of DM when compared to cases with longer duration. Vitamin B12 deficiency was correlated with anemia and neuropathy.
Conclusions: Metformin treatment in cases is associated with higher prevalence of Vitamin B12 deficiency which increases with duration of DM and dose of metformin. Deficiency correlated with development of macrocytic anemia and worsening of neuropathy. In some, symptoms of deficiency are difficult to diagnose and can be irreversible if left untreated (like neuropathy). Routine screening of Vitamin B12 levels, CBC, NCS should be done in all diabetic women at the beginning of metformin therapy, and yearly thereafter. Treatment and prevention of deficiency is easy, cheap, safe, and effective
An analysis on the study habits among undergraduate medical students
Get PDFIntroduction: Study habits is one important factor which influences the academic performance of students. The learning strategies of high achievers are likely to be more effective. The study was aimed to analyse the study habits among undergraduate medical students and compare the study habits of high, average and low achieving undergraduate medical students. Application of effective learning strategies may be helpful in achieving better academic outcomes.
Materials and Methods: The study was conducted as a cross sectional, observational study with 118 Final year MBBS students as study participants using Dennis Congos Study Skills Inventory Questionnaire consisting of 51 study habits questions classified according to domains of Text Book reading, Notes taking, Memory, Test Preparation, Concentration, Time management.
Results: The percentage of students scoring above the cut off levels in each domain were: Memory: 61/118 (51.69%), Concentration: 67/118 (56.77%), Notes taking: 7/118 (5.93%), Time management: 17/118 (14.40%), Test preparation: 31/118 (26.27%), Text book reading: 35/118 (29.66%). The only Study habit that showed significant difference across the high, medium and low achievers was: Ability to pay attention in the class (p: 0.006).
Conclusion: Though the students are talented and fare better in Memory and Concentration skills, there is glaring lack of attitudinal skills like Notes taking, Time management, Test preparation and Textbook reading skills. Paying attention in the class seems to be one most important distinguishing learning strategy determining the academic performance. Teaching– Learning methodologies need to be made more interesting so as to actively engage the attention of low achievers also
Prevalence and clinical profile of patients with resistant hypertension
Get PDFObjective: To find prevalence and clinical profile of patients with resistant hypertension.
Methods: In a Prospective Observational Study, 100 Hypertensive patients were evaluated in Hypertension OPD, Medical OPD, and Medical Wards. Hypertensive Patient on more than 3 drugs with uncontrolled BP were included for this study. Patients were subjected to Clinical examination, Laboratory investigations and Ultrasound. BP is recorded in all 4 limbs with appropriate cuff size, Patients drug history (Both antihypertensive and other medications for concomitant illness will be enquired), Physical activity and Drug compliance were enquired.
Result: Among the 100 patients studied, 18% patients were found to have Resistant hypertension. Of this, 5 patients were in incorrect drug combination, 7 patients were not drug compliant, 12 patients had Uncontrolled Diabetes, 15 patients had Dyslipidemia, 6 patients had Medical Renal disease, 2 patients had Fatty Liver, 1 patient had Contracted Kidney and 1 patient had Aortailiac Thrombosis.
Conclusion: Incorrect Drug prescription, non-adherence to drugs and metabolic factors played a major role in resistant hypertension in the present study group
Reconstruction of orbital floor fracture using porous polyethylene mesh
Get PDFObjective: Treatment of traumatic orbital injury has long been a formidable challenge to maxillofacial and oculoplastic surgeon. Significant complication can occur as a result of these injuries including enopthalmus, persistent diplopia, vertical dystopia and restriction of gaze. Surgical techniques have been more aggressive with primary surgical repair directed at restoring bony orbital volume and contour while repositioning the herniated tissues. The study was undertaken to assess the treatment results with alloplastic graft for reconstruction of orbital floor.
Material and methods: It is a prospective randomized study during the period of January 2010 to December 2012 including the follow up of six months on ten orbital floor fractures.
Results: Eyeball movement restriction and infraorbital nerve paresthesia improved in all patients. One patient who also had associated head injury and the fracture of supraorbital rim, frontal and temporal bone had persistent enopthalmus, vertical dystopia and diplopia postoperatively.
Conclusion: We conclude that early exploration of orbital floor minimizes the morbity associated with late reconstruction due to the fibrosis of tissues entrapped. Use of prolene mesh reduces the operating time and donor site morbidity
Open label case control prospective study to evaluate the impact of aceclofenac on antihypertensive action of amlodipine and ramipril in hypertensive patients with osteoarthritis
Get PDFObjective: To study the impact of aceclofenac on antihypertensive action of amlodipine and ramiprilin hypertensive patients with osteoarthritis in an open label case control prospective study.
Methods: This was an open label case control prospective study. Hypertensive patients on either amlodipine or Ramipril were included in control groups. A total of 120 patients were included in the study and divided into 4 groups: Group A- Hypertensivepatients on Ramipril; Group B – Hypertensive patients with concomitant osteoarthritis taking Aceclofenac and Ramipril; Group C– Hypertensive patients on Amlodipine and Group D- Hypertensive patients with concomitant osteoarthritis taking Aceclofenac and Amlodipine.
Results: At the end of the first month (phase I), the ramipril subgroup in the control group had a mean systolic blood pressure of 136.73±3.80 which was an 8.19% decrease from the baseline and it was found significant (p<0.05). The systolic blood pressure measurements at the end of the second month (phase II) in the control groups revealed further fall in mean systolic blood pressure. The cases of osteoarthritis on aceclofenacand ramiprilshowedan increase in BP. The mean Systolic BP was 159.2 ± 5.816.An increase of 9.74%from the base line and 16.09% was noted at the end of phase-I (P<0.5). Patients on aceclofenac and amlodipine in contrast showed a fall in BP from base line in phase 0 and their mean systolic blood pressure at positive in of second month of phase-II was 142.07± 2.43 about 1.88% fall baseline and 2.94% increase in BP compared to Phase-I. Almost similar observations were recorded for diastolic blood pressure.
Conclusion: The interaction of NSAIDs on the antihypertensive action of the ACE inhibitors is significantly greater than their blunting action on the calcium channel blockers
Clinical spectrum of AKI in chronic liver diseases
Get PDFIntroduction: Acute kidney injury (AKI) is a heterogeneous syndrome of different aetiologies, and often multifactorial. Occurrence of Acute kidney injury in patients with chronic liver disease is frequent finding which makes prognosis of CLD even poorer.
Material and methods: A prospective cohort observational study on 100 adult patients of chronic liver disease with AKI conducted over a period of 24 months from August 2016 to August 2018 at Sri Aurobindo medical college and postgraduate institute. Detailed clinical examination and biochemical tests were done. Univariate and multivariate logistic regression (odds ratio) analyses were used.
Result: 87% are males and 13 % are females. The most common cause of cirrhosis is alcoholic 77% followed by hepatitis Bvirus related 10%, unknown etiology 7%, hepatitis C 3%, NASH 2%, Wilson 1. The most common sign of decompensation of liver is jaundice 78% followedby ascites 70%, hepatic encephalopathy 37% and upper GI bleed 30%. Distribution of child class as a prognostic indicator showed the maximum no. ofpatients found in class C 56% followed by class B 34% and class A 10%.
Conclusion: Acute kidney injury is very common in chronic liver disease patient in our hospital and majority of them have intrinsic cause of AK