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| POSTER ABSTRACT |
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| Year : 2019 | Volume
: 14
| Issue : 5 | Page : 54-74 |
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Poster Abstract
| Date of Web Publication | 12-Jul-2019 |
Correspondence Address:
 Source of Support: None, Conflict of Interest: None  | Check |
DOI: 10.4103/0974-3901.262661
How to cite this article:
. Poster Abstract. J Datta Meghe Inst Med Sci Univ 2019;14, Suppl S1:54-74 |
| Poster 125 | |  |
| Assessment of Information and Knowledge of Adverse Drug Reaction among Aramedical Staff | | |
Aditya Nanote
JNMC, Sawangi (M), Wardha, Maharashtra, India
Aim: To asses awareness of Adverse Drug Reaction (ADR) Objective: (1) To asses the knowledge about ADR. 2. To observe the impact of ADR Monitoring. Materials and Methods: A study was conducted among the paramedical staff of tertiary care hospital in order to asses the knowledge regarding Adverse Drug Reactions. Location: Acharya Vinoba Bhave Hospital, Sawangi Meghe, Wardha, No. Of samples: 100 Cross sectional study was conducted in order to collect the data from the 100 samples. The questionaire was distributed to 100 nurses of various Departments and they were asked to fill it within 24 hrs. after that questionnaire was collected from them. Therefter the data gathered from these samples was analyzed. Conclusion: After the complete analysis of the collected data it showed that the nurses had some sort of knowledge regarding Adverse Drug Reactions. But they were not much known towards the measures to be taken after noticing ADR. Further they felt need for training programs in order to enhance knowledge about ADR.
Keywords: Adverse drug reaction, paramedical, awareness
| Poster 126 | | |
| Fingertip Injuries | | |
Vaibhav Thorat
JNMC, Sawangi (M), Wardha, Maharashtra, India
Introduction: Fingertip injuries are very common in day to day life. These injuries hamper daily activities. Electric injuries to finger tips are very severe and mostly lead to chronic non healing ulcers. Repair of such ulcers are important to resume daily activities. Though advances in microsurgery have resulted in better survival rates of replants, replanting crushed and avulsed digits are difficult. If replantation is not possible these digits need local tissue cover to retain length. In such cases, the main aim of surgery is to restore as much finger length as possible and to achieve near normal activity. In electric burns, the initial presentation might not reflect the exact extent of injury but after due debridement, underneath structures gets exposed and it becomes mandatory to manage such wounds with flap. Case Summary: This is a case report of a 30 years male presented to AVBRH with history of electric burn over the tip of middle finger of the left hand while welding. Surgical debridement was done on 20th day post-injury after doing daily dressings and minor debridement’s in dressing room. A cross-finger flap to cover skin defect and split-thickness nail bed grafting from the remnant of injured finger was done. Intensive monitoring of the flap was done and serial photographs were taken along each step of the course of treatment. Excellent functional and cosmetic outcome was achieved due to the surgery. Conclusion: Cross finger flaps are the best surgical treatment modality for reconstruction of finger tip injuries leading to chronic non healing ulcers. It is reliable and flexible in its application. The patients usually report their flaps to be functional, durable, and free of pain. Cold intolerance, as with other methods of reconstruction, remains a problem. Sensibility in the flaps proved to be functional in the majority of patients. The preservation of length and range of motion is reflected in the fact that disability settlement was a rare occurrence.
Keywords: Case study, electrical burn, microsurgery, ulcer
| Poster 127 | | |
| Antibody Response to Hepatitis B Vaccine among Health Care Personnel from a Tertiary Care Hospital in Central India | | |
Gaurav Sahu
JNMC, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
Introduction: Globally Hepatitis B is the most common causes of chronic liver disease and hepatocellular carcinoma. Approximately one-third of the world’s population have serological evidence of past or current infection with hepatitis B and approximately 350–400 million people are chronic HBsAg carriers. Percutaneous and mucosal exposure to infective blood or body fluids is the common mode of transmission of HBV. Due to frequent handling of blood and body fluids of patients, HCPs are four times more at risk of contracting hepatitis B infection compared to the general population. The hepatitis B vaccine is the mainstay of hepatitis B prevention. Hepatitis B vaccine provides protection against infection with HBV by producing immunity or antibodies to the surface protein (Anti-HBs). HCPs are immunized against HBV, but they are not subjected to anti-HBs level assessment after primary vaccination. Sonon-responders with inadequate immune response may pose a problem because of false sense of security after Hepatitis B vaccination. Aim and Objectives: To evaluate the anti-HBs levels among the HCPs immunized against HBV. To find out various factors associated with nonresponse. Methodology: A cross sectional study was carried outat a tertiary care hospital for two months. A total 100 HCPs who had completed three dose of recombinant DNA hepatitis B vaccine (0-1-6 month) were recruited for the study. After taking written consent information including age, sex, vaccination status, health status and other relevant data about the participant was collected in proforma. The quantification of serum anti-HBs level was done by Enzyme linked immunosorbantassay (ELISA) technique using a commercially available kitHBsAb (DIA.PRO),Milano-Italy.following the manufacturers protocol. Based on Anti-HBs levels, the subjects were grouped as under (CDC criteria).1) Less than 10 mIU/ml- Anti-HBs negative subject 2) Equal or more than 10mIU/ml - Anti-HBs positive subject Serum sample of the Anti-HBs negative subject were evaluated for HBsAg. Results and Discussion: Out of 100 subjects in the study 81 were females and 19 males. Age of the subjects ranged from 20 to 50 years. Duration of last dose was 2months-1year in 41 subjects, 1yr to 5yrs in 49 subjects and >5yrs in 10 subjects. 77/100 were Anti-HBs positive and 23/100 Anti-HBs negative .Negative Anti-HBs could be due to vaccine nonresponse or decline antibody levels over time post-vaccination. Association of various factors with immune response was studied. The inverse relationof age at primary vaccination and anti-HBs positive status was statistically significant (p value 0.01, correlation coefficient 0.532).We did not find smoking and obesity as significant risk factors as reported by other researchers probably due to small number of smokers (3/100) and obese (5/100) subjects. All the Anti-HBs negative subject were HBsAg non-reactive. Conclusion: All the HCPs with risk of occupational exposure to blood and body fluids should get HBV vaccination at the earliest age. CDC recommendation of Post-vaccination anti-HBs testing 1–2 months, revaccination and counselling should be strictly followed.
Keywords: Antibody, health personnel, hepatitis b, vaccination
| Poster 128 | | |
| To Assess the Prevalence of Hypertension among the Health Professionals | | |
Sagar Padole
JNMC, Sawangi (M), Wardha, Maharashtra, India
High blood pressure (BP) is ranked as the third most important risk factor for attributable burden of disease in south Asia (2010). Hypertension (HTN) exerts a substantial public health burden on cardiovascular health status and healthcare systems in India. Objectives: (1) To assess the prevalence of Hypertension among the health professionals. (2) To correlate the prevalence of Hypertension among health professionals with demographic variables. (3) To find out the association between hypertension with selected demographic variable. Materials and Methods: The study was conducted in Health Professionals (Doctors, Nurse, Technicians, Teaching staff, etc). of DMIMS (DU) Sawangi (Meghe) Wardha. Descriptive research design was used and sample size is 500. Non probability purposive sampling technique was used. Results: the overall results It depicts the overall comparison of systolic diastolic pressure at sitting, lying and standing position. Mean systolic blood pressure at sitting position was 121.76±8.81, at lying position it was 117.74±8.34 and at standing position it was 119.80±7.95. The statistical Student’s paired t test implies that the difference in systolic blood pressure at lying position and standing position was found to be 7.30 and 3.96 which is statistically significant at 0.05% level. Hence it is statistically interpreted that systolic blood pressure at lying and standing position was effective. Conclusion: The statistical Student’s paired t test implies that the difference in diastolic blood pressure at lying position and standing position was found to be 6.92 and 4.68 which is statistically significant at 0.05% level. Hence it is statistically interpreted that diastolic blood pressure at lying and standing position was effective.
Keywords: Health professional, hypertension, prevalence
| Poster 129 | | |
| Severe Vascular Complications following Thrombolytic Therapy in a Case of Prosthetic Mitral Valve Thrombosis | | |
Ayan Husain, Shilpa Gaidhane, Apoorva Nirmal
JNMC, Sawangi (M), Wardha, Maharashtra, India
Introduction: Prosthetic cardiac valve thrombosis is a rare but dangerous complication. Fibrinolytic therapy to treat the thrombosis is widely used nowadays with high efficacy and no severe side effects as emergency surgical treatment is associated with high mortality. Here we report a patient with thrombosis of a prosthetic mitral valve who developed severe embolic complications following the administration of the thrombolytic drug. Case Summary: On admission the patient was in heart failure. Metallic click could not be heard on cardiac auscultation. The diagnosis of thrombotic occlusion of prosthetic mitral valve was confirmed by 2D-echocardiography. The effective valve area was 0.45 cm2.Thrombolytic therapy with injection streptokinase was started. Within three hours of start of therapy he started developing weakness and pain in both lower limbs with loss of bilateral lower limb pulsation and foot drop and the thrombolysis had to be stopped. 2D-ECHO post thrombolysis showed good leaflet motion of mitral valve with no thrombus or vegetation. Bilateral lower limb angiography was done immediately which showed saddle thrombus at aortic bifurcation with slow reformation of bilateral iliac arteries. Thrombectomy of the saddle thrombus was done by the vascular surgeon at our institute and parenteral anticoagulants were started. After three days the pain and weakness in right lower limb resolved with partial relief of symptoms in left lower limb. Check angiography did not reveal any saddle thrombus but there was long segment subacute thrombus in left distal superficial femoral artery. After a few days, the patient started developing blackening of left lower limbs digits and was transferred to surgery department for further management. Conclusion: To our knowledge very few cases of severe persistent peripheral vascular complication following thrombolytic therapy has been reported. We therefore assume that the risk of severe peripheral vascular complications is underestimated. This report presents our experience of this case.
Keywords: Fibrinolytic therapy, prosthetic cardiac valve thrombosis, saddle thrombus
| Poster 130 | | |
| Neuromyelitis Optica Spectrum Disorder in a Female with Hiccups and Quadriparesis | | |
Ayush Somani
JNMC, Sawangi (M), Wardha, Maharashtra, India
Introduction: Neuromyelitis-optica (NMO)/ Neuromyelitis -optica spectrum disorders(NMOSD) is an inflammatory disease of central nervous system classically characterized by acute, severe episodes of optic neuritis and longitudinally extensive transverse myelitis (LETM), usually with a relapsing course. The identification of an autoantibody exclusively detected in NMO patients against aquaporin-4 (AQP-4) has allowed identification of cases beyond the classical phenotype. Atypical cases of NMO exist in scientific literature. These cases do not present with all the symptoms. Case Summary: We present a case of a 53 year old female who presented to us with quadriparesis, intractable hiccups. MRI revealed longitudinally extensive transverse myelitis and later was diagnosed as a case of NMOSD. Conclusion: Neuromyelitis optica spectrum disorders (NMOSD) are inflammatory disorders of the central nervous system characterized by severe, immune-mediated demyelination and axonal damage predominantly targeting optic nerves and spinal cord. Serum NMO-IgG antibody is specific for the diagnosis.
Keywords: Aquaporin-4, hiccups, neuromyelitis-optica, neuromyelitis optica spectrum disorder, quadriparesis
| Poster 131 | | |
| Designer Babies | | |
Shivika Malik
JNMC, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India
A baby whose genetic material has been altered during foetal development, to add or remove certain characteristics, is known as a designer baby. It involves two steps: the identification of genes responsible for disease or other features, called Pre- Implantation Genetic Diagnosis, and the removal of the problematic gene, known as Gene Editing. As of now, only Pre-implantation genetic diagnosis is legally allowed. Embryos on which any sort of genetic editing is performed, are required to be discarded after a few weeks. The first known case of designer babies has been born in China in 2019, twins named Lulu and Nana, created by the scientist He Jiankui, who has claimed that genetic editing has provided the twins with resistance to the HIV virus. Gene editing is done using the CRISPR-Cas9 (clustered regularly interspaced short palindromic repeats- CRISPR associated protein 9). Cas-9 is an enzyme which acts as a ‘molecular scissors’, thus removing undesirable DNA sequences. The specific sequence which is to be changed, is identified with the help of RNA strands known as guide RNA (gRNA). The Ethical Dilemma: Theoretically, the concept of designer babies is highly beneficial to humanity, as it allows us to remove all kinds of hereditary diseases by removing certain genes or introducing genes which impart resistance to several infections. It will help in eradicating inborn disorders of metabolism and congenital disabilities. It will also contribute in increasing the life span of humans. Soon, it may also be used commercially by parents to select certain characteristics for their children, such as a desired eye colour, intelligence or athletic abilities. However, gene editing is a double-edged sword. While its use may begin as harmless selection of cosmetic features, it will eventually result in a huge socioeconomic divide. Since the technology is relatively new, the results are unpredictable and may turn out to be deadly for the mother and child. Designer babies may be used as a bioweapon. As entire genomic sequences will be saved on databases, biohacking is an impending threat. It may also result in ‘gene doping’ which may lead to enhanced performance, athletically or academically, creating inequality. In conclusion, gene editing is a highly beneficial tool, one which will allow us to save lives. However, proper precautions and testing must be done before the widespread use of this technology, to ensure that the benefits outweigh the drawbacks.
Keywords: CRispr-cas9, designer babies, ethics, genetics
| Poster 132 | | |
| Practical Management of Scalp Avulsion in a Rural Based Hospital | | |
Anna Mary Jose
Department of Surgery, JNMC, Sawangi (M), Wardha, Maharashtra, India
A 20 year old woman, a week before her marriage, reports to the emergency department with an avulsed scalp. Her hair was trapped in the rotating part of the flour mill resulting in the avulsion as well as loss of eyebrows. Immediately resuscitation was started and blood loss was controlled. Assessment of intracranial injury was done. It was found that pericranium was intact, pinna were avulsed partially and eyebrows were avulsed totally. Debridement was done, pinna was placed in proper anatomical position and scalp was split skin grafted. Recovery was dramatic and satisfactory. This helped to cover the deformity to the maximum and only forehead was visible. Due to the camouflaging, the ultimate look was presentable. She later got married, had two children and went on to lead a normal life. Diagnosis: Scalp Avulsion.
Keywords: Case study, emergency, factory accident, scalp avulsion
| Poster 133 | | |
| Ethics and Medical Practice: Why Psychiatry is Distinctive? | | |
Debolina Chowdhary
Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
Background: Ethics are the moral principles that govern the patient’s behaviour or the conducting of an activity. Ethics play an indispensable role in psychiatry as it helps in effect relationship building between patient and relatives. Psychiatry entails ethical dilemmas in defining normal and abnormal, diagnosis and treatment, individual freedom, confidentiality, competency, commitment and other complex issues. The definition of mental illness and the scope of psychiatry itself remain a dilemma Description of Concept: The practice of psychiatry is different from other medical specialties in two significant respects. First, one deals with certain groups of patients whose judgement may be impaired at times due to their mental illness or who are unable to look after themselves. Second, in no other medical specialty do patients share with their doctor so many intimate details about their personal, emotional, social or even sexual life. As a result, a special kind of relationship, both positive and negative, develops between the patient and psychiatrist. This particularly happens during prolonged treatment. This raises many ethical issues depending on how the psychiatrist handles it. A healthy relationship between the therapist and the patient is a must for successful treatment in psychiatry. Polypharmacy, use of costly drugs, drugs for which lavish claims are made and several research techniques call for ethical analysis. In general, it is agreed that for any medical research on human beings, informed consent of the individual must be an essential part of the research protocol. The difficulty in seriously mentally ill patients is that due to their illness, many of them have their judgement substantially impaired. The use of ECT is another subject of intense debate in India. Conclusion: Since we have few legal regulations and medical practice breeds unbridled paternalism, higher and rigidly enforced ethical standards are called for if we wish to gain and retain public confidence.
Keywords: Ethics, medical practice, psychiatry
| Poster 134 | | |
| Study of Pulmonary Function Tests in Children with Sickle Cell Disease/Anemia | | |
Maithili P. Joshi, R. Borkar
Department of Paediatrics, JNMC, Sawangi (M), Wardha, Maharashtra, India
Introduction: Pulmonary complications account for significant morbidity and mortality in patients with sickle cell disease. Clinical lung involvement manifests in two major forms: the acute chest syndrome and sickle cell chronic lung disease. Acute chest syndrome is characterised by fever, chest pain, and appearance of a new infiltrate on chest radiograph. Sickle cell chronic lung disease, on the other hand, manifests as radiographic interstitial abnormalities, impaired pulmonary function, and, in its most severe form, by the evidence of pulmonary hypertension. Progress has been made in understanding the pathophysiology and management of these complications. During steady state sickle disease, the major abnormality in pulmonary function is restrictive ventilatory impairment characterised by a mild reduction in Total lung capacity (TLC) and reduced diffusion capacity for CO. Pulmonary function tests or lung function tests are useful in assessing the functional status in both physiological and pathological conditions. Aim and Objectives: Aim: To study the pulmonary function tests of sickle cell disease cases. Objectives: (1) To study the incidence of lung abnormality in sickle cell children. (2) To study the type of lung disease- obstructive or restrictive. Methods: The study will be conducted bedside with the help of MIR spirometer at AVBRH hospital, Savangi. Results: Out of 70 children,restrictive and /or obstructive abnormalities were only found in children over 10 years of age. 5% children(n=4) had restrictive abnormality,4%(n=3)had an obstructive abnormality and 2%(n=2) had a mixed abnormality. Conclusion: Lung function differs significantly in children with SCD. Restrictive abnormalities may become more prominent with increasing age.
Keywords: Chronic lung disease, pediatrics, pulmonary function tests, sickle cell
| Poster 135 | | |
| Filariasis with a Hidden Surprise | | |
Gaurav Sahu
Department of Surgery, JNMC (Sawangi), Wardha, Maharashtra, India
Introduction: A 70 year old male resident of Wardha district of Maharashtra presented with swelling of scrotum and penis with recurrent history of fever and lymphangitis. Since 30 years he also developed edema of right lower limb. Patient was known case of filariasis and with course of time he suffered recurrent episodes of inflammation due to which there was progressive increase in size of scrotum and penis. He was obese and hypertensive but non-diabetic. Family history was not significant. On general examination patient was obese and hypertensive other findings were normal. On systemic examination, cardiovascular system, respiratory systems were normal. Abdomen was soft and non-tender on palpation and there was no organomegaly. Local examinations revealed large thickened, firm filarial scrotum having non-pitting skin along with Ram’s horn penis which had thickened skin of prepuce and was non-retractile. The right lower limb had non-pitting lymphedema and minimal veruccae at toes. Inguinal lymph nodes of right groin were palpable. Under anaesthesia scrotectomy was performed. Prepucial skin was opened dorsally and to our surprise, a cauliflower like growth was seen over the glans involving corona and part of prepuce of 2.5x 2.5 cm infiltrating on to the shaft of the penis. Frozen section confirmation was done from growth of the biopsy and found to be squamous cell carcinoma. FNAC taken from both sides of the inguinal lymph nodes was negative for any malignancy. Diagnosis: Squamous cell carcinoma arising under chronically thickened lymphedematous prepucial skin due to filariasis.
Keywords: Cell carcinoma, filariasis, scrotectomy, squamous
| Poster 136 | | |
| A Bridge between Dark to Brighter India | | |
Harsha Dhok, Chetan Gaikwad, Sani Patel
Department of Ophthalmology, JNMC, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
India has 133 million blind population or vision impaired due to the lack of eye examination and provision of an appropriate pair of spectacles. Therefore it is imperative to establish a cadre of eye care professionals to work in association with ophthalmologists to deliver best eye care to the society and eliminate avoidable causes of blindness. For this, we optometrists and the community should be aware of the integral duties of ophthalmic assistants/technicians & optometrists under NPCB. This poster will highlight the role and responsibilities of optometrist at primary health care level and secondary health care level including out patient department and operation theatre.
Keywords: Blindness, ophthalmologists, optometrists
| Poster 137 | | |
| Mammograms Saves Lives! | | |
Nisha P. Govindani
Department of Radio Diagnosis, DMIMS, Sawangi (Meghe), Wardha, Maharashtra, India
Background: History of mammography: X-rays were first used to examine breast tissue by the German surgeon ALBERT SALOMON about a century ago. Modern mammography came in to existence since the late 1960. Technology has advanced and today’s machine is different even from those of the 1980s and 1990s. Timeline of Breast Imaging: 1950’s – Breast Self Examination, 1960’s – BSE + Mammography, 1970’s – BSE + Mammography + Thermography + Ultrasound, 1980’s – BSE + Mammography + Better US, 1990’s – BSE + Mammo + US + MRI, 2000’s – Digital Mammo + US + MRI, 2020?? – Digital Mammo + US + MRI + MR spectroscopy +Tomosynthesis + PEM + BSGI. Description: A mammogram is an x-ray exam of the breast to detect and evaluate any change in the breast. Mammography is the radiological study of soft tissue of breast. Specific type of imaging that uses a low dose x-ray system to examine breasts. Breast cancer is the leading cause of cancer deaths in women which occurs mainly between 35-55 years of age. Our chief aim is to discover cancer in the earliest stage. The importance of mammography is directly related to detection and management of cancer of the breast. Types of Mammogram: Conventional Mammography, Digital Mammography, 3D Mammography, Indications Ca breast, Evaluation of breast signs and symptoms: Pain, mass, thick, skin. Nipple discharge. Pre-op evaluation of palpable mass. Advantages: Helps to detect the cancers earlier which make it easier to remove it. Women ages 50 to 69 who take part in screening are at a lower risk of dying from breast cancer. Conclusion: Mammography remains the best screening test of the early detection of breast cancer. The diagnostic accuracy of mammography however depends upon several factors like density of the breast and the age of the patient.
Keywords: Advantages, breast cancer, mammography
| Poster 138 | | |
| Safe Handeling of Patient | | |
Nimisha Shrivastava
Department of Radio Diagnosis, DMIMS, Sawangi (Meghe), Wardha, Maharashtra, India
Background: Radiologists serve an integral role in proving health care, but reading with PACS often results in radiologists becoming less visible to patients and referring physicians. There are few studies directly addressing patient Perceptions of the radiologists. It is important that radiologists educate patients further about the scope of radiology and the contributions of Sub specialized radiology to their care. The support of patients and referring physicians is critical For radiology to continue to flourish as a specialty. Description: (1) Give clear verbal instructions to ambulatory patients about the correct manner of dressing or undressing for a radiographic procedure, and assess the need for assistance. (2) Give a written explanation of what is to be one with the patient’s belongings while he is being care for in the radiography/therapy department. (3) Demonstrate the correct manner of moving, transferring, and positioning patients to prevent injury to himself and to the patient. (4) Demonstrate the correct method of assisting the disable patient with dressing or undressing for a diagnostic examination. (5) Demonstrate the correct method of assisting the disable patient with dressing or undressing for a diagnostic examination. list three safety measures that must be taken when transferring a patient from a hospital war to the radiography department an returning him to the ward. (6) List three situations in the radiography department that might result in damage to the patient’s skin, and explain how to prevent them. (7) Demonstrate the correct method of moving a patient who is wearing a plaster cast. (8) List four signs of circulatory impairment that the RT must recognize in a patient who is wearing a plaster cast.
Keywords: Etiquettes, guidelines, patient care, radiologists
| Poster 139 | | |
| Analyzing Knowledge, Attitude and Practice of Medical Undergraduate Students towards Plagiarism | | |
Pratap Kumar, Pratyush Prateek, Akhila Dinesh, Ashwin Kotnis, Sukanya Ray
All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India
Background: plagiarism is a dark truth of the exciting field of research. People often rationalise the practice of plagiarism, many may not know what constitute the act, and some do not know the severe consequences like suspension from college, being removed from the programmed, legal issues, etc. Young researchers are especially vulnerable to this. Few studies have been conducted which reveal that the knowledge of plagiarism is low in medical students but these studies have considered only few factors to correlate with the attitude towards plagiarism. Objective: To evaluate the baseline knowledge, attitude about plagiarism and its practice in medical undergraduate students and correlate attitude towards plagiarism with various demographic factors. Methodology: Permission was obtained from the IHEC and the RRB . Validated Questionnaires were given to students of various years of MBBS course in their classes after obtaining informed consent from them. Questionnaire consisted of Demographic details (Age, semester, research involvement, training in research were obtained from), Attitude and practice questionnaire(used with permission from Martina Mavrinac) and knowledge questionnaire(used with Theodore Frick’s permission). Data obtained was entered in MS Excel; scores were given for knowledge; permissive, critical, personal norms. These scores were then correlated with demographic factors like Gender, year of study, research experience, etc using Epi info software. Results: 89% of the college students (400) participated in the study. Average knowledge score was 5.652 (out of 10), permissive attitude score was 5.282 (out of 12), critical attitude score was 4.023 (out of 7), personal norms score was 3.742 (out of 10). Scores for permissive attitude showed significant positive correlation with personal norms (correlation coeff= 0.584, p<0.0001) and negative correlation with critical attitude score (correlation coeff= -0.1092, p=0.0392). Permissive attitude for plagiarism was more in boys and in students who have not done any research and have no training in research methodology. Students trained in research methodology and participated in research showed more critical attitude towards plagiarism. Conclusion: Knowledge of plagiarism is not up to the mark in medical undergraduate students. This makes them more vulnerable to the act and consequences of plagiarism. This may be improved by training them in research methodology and educating them about plagiarism. Medical institutes should devise a course in Plagiarism and help students identify and abstain from plagiarism.
Keywords: Awareness, medical students, plagiarism
| Poster 140 | | |
| Placebo in Clinical Practice: An Ethical Review | | |
Gopika Manoj
K. S. Hegde Medical Academy, Mangalore, Karnataka, India
Background: Placebo is a medicine or procedure prescribed for the psychological benefit to the patient rather than for any physiological effect. Its use in both clinical practice and clinical trials is a relevant topic of discussion. But, the use of deceptive placebo in clinical settings raises a stronger ethical concern. The ethical issues involved in the use of placebos in clinical practice will be reviewed in this poster. Objectives: (1) Is placebo treatment ethical? (2) How can placebo effects be promoted without deception? Methodology: Articles on the use of placebo treatment in clinical practice, published in the last ten years have been reviewed in this poster. The articles were taken from Google Scholar Articles and PubMed. Review Findings: Though the administration of placebo therapy to the patient deceptively as therapeutic treatment violates the informed consent and demolishes the trust between patient and doctor, placebo therapy may be used under certain practical guidelines. But, the use of active treatment with a primary intention of placebo response is not ethical. Alternative methods of placebo treatment without deception have gained importance, but with their own limitations. Conclusion: After reviewing articles on the ethical concerns regarding the use of placebo treatment in clinical practice, I have come to the conclusion that in the modern world where much importance is given to the patient’s autonomy and his role in making decisions regarding his health treatment, placebo treatment can be ethical only when administered under strict guidelines. Methods of placebo without deception have their own ethical concerns highlighting the need for further research.
Keywords: Autonomy, ethics, medical practice, placebo
| Poster 141 | | |
| Coarctation of Aorta Presenting as Hypertensive Encephalopathy in a Young Female | | |
Nikita Rajgire
Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India
Coarctation of Aorta (CoA) is a congenital cardiac defect which can present in adults. The incidence of CoA is 4 in 10,000 live births. It can complicate as systemic hypertension, coronary heart disease, congestive cardiac failure, aortic dissection and stroke. The usual presentation is hypertension. Though it has subtle clinical signs but they can go undetected if not sought for. We report a case of a 40 year old female who presented to us with hypertensive encephalopathy which is a medical catastrophe and finally diagnosed as CoA.
Keywords: Coarctation of Aorta, hypertension, hypertensive encephalopathy
| Poster 142 | | |
| Scalp Reconstruction | | |
S. Rashmi
Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India
Background: Anatomy of Scalp, Scalp extends from the external occipital protuberance and superior nuchal lines to the supraorbital margins. Scalp consists of 5 layers: 1.Skin, 2.Connective tissue, 3.Epicranial aponeurosis, 4.Loose areolar tissue, 5.Pericranium. Objective: To compare different scalp reconstruction procedures. Methods: Examining and follow up of patients who came to JNMC for scalp reconstruction. Results: Split skin grafts are used in scalp reconstruction when bone is covered with soft tissue or pericranium and/or wound is granulating so the graft can take. Flaps are considered in scalp reconstruction if skin loss is significant so that it cannot be co-opted primarily and specially more so when graft is not applicable or not a good option. Conclusion: Both grafts and flaps are good modalities in scalp reconstruction but choice should be as per the need of local condition as well as ultimate outcome. Though grafts have inferior results than flaps but simplicity of the procedure and availability of grafts in plenty have a definite advantage as is seen in a scalp avulsion. Scalp reconstruction procedures can be done by a general surgeon, in a cost effective way and provide the best possible outcome to the patients.
Keywords: Flaps, scalp, split skin grafts, surgery
| Poster 143 | | |
| Platelet Rich Plasma and Sole Regeneration | | |
Kshitija Chandanwa
Department of General Surgery, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India
It is very difficult to treat non healing ulcers, especially over pressure bearing areas like soles. At present there is no defined guidelines for treatment of non healing ulcers. Current management requires multiple surgical interventions, drugs and intense local dressing and wound care followed by grafting or by flaps. Not to mention the pain associated with dressings and the decreased quality of life. Many patients undergo amputations to reduce the morbidity. Platelet rich plasma, an emerging cellular therapy can be applied in such cases. A 14 year old female child presented with non healing ulcer over left sole since 9 years. She was treated with platelet rich plasma. PRP being the source of regenerative growth factors lead to complete healing of her wound. A complete healing of a non healing ulcer without surgery and intense dressing is a milestone in wound management. PRP is a safe, affordable and an innovative modality of management of such cases.
Keywords: Cellular therapy, platelet rich plasma, ulcer
| Poster 144 | | |
| Ethical Dilemma Faced by a Doctor While Management of a Unconscious Patient | | |
Aakash Sethi, Ankur Bhavsar
SSG Hospital and Government Medical College, Vadodara, Gujarat, India
Introduction: This case describes the ethical dilemma faced by a doctor while managing a patient of Stroke where performing a life saving measure would be in the best interest of saving him but the relative refused to give consent for the same. Case Summary: A 67 year old male patient with a brief history of unconsciousness since 2 hours came to the emergency ward of a tertiary care hospital. On general examination the patient was found to have impaired motor function on one side of his body and not responding to verbal or painful stimulus. The patient had labored breathing. A provisional diagnosis of Stroke was established. Further Radiological investigation and a rigorous Systemic examination had to be done. But as the first measure the patient needed to be intubated. As a critical life saving measure the doctor decided to intubate the patient to secure the airway. After explaining the risk, benefit, prognosis and the procedure of endotracheal intubation to the patient’s relative, he was not sure whether or not to give consent to the procedure. Discussion: This case highlights one of the ethical dilemma a doctor faces while performing critical care measure. If the complete prognosis had to be determined further workup was required. For the same the patient has to be stabilized first. There could be various reasons possible for the relative denying to give the consent. It could be his father’s advanced age, how much prolonging life on supportive measure be actually beneficial, the amount of pain his father would suffer due to intubation. If seen from the doctor’s perspective, performing the intubation would allow the further management of the patient and deciding the outcome based on investigations. The doctor is faced with an ethical dilemma and a conflict of interest with the patient’s relative. A few questions can be asked keeping in in this case. If the patient survives with poor quality/permanent disability then, is there someone to take care of the patient in such a state? If the prognosis is bad, can one doctor alone take the decision whether or not to withhold a particular treatment? What steps can be taken to better deal with a patient who is incompetent to make his own decisions?
Keywords: Critical care, ethics, stroke, unconscious patient
| Poster 145 | | |
| Patterns of Antibiotic Use and Its Association with Hospital Acquired Infections in Medicine ICU of a Tertiary Care Teaching Hospital in Rural Area | | |
Sushmita Deshmukh, Abhay Gaidhane, Shilpa Gaidhane
Department of Community Medicine, JNMC, DMIMS, Sawangi (Meghe), Wardha, Maharashtra, India
Background: Hospital Acquired Infections (HAIs) are a serious threat to the patient’s safety in any health care facility. The prevalence of HAI is relatively higher in Intensive Care Units (ICU) than other areas of hospital. In India, the contributing factors for HAIs associated deaths are overcrowded hospitals with poor infrastructure, low doctor to patient ratio, inappropriate use of antibiotics and invasive devices and lack of basic hygiene. However, the evidence regarding the pattern and use of antibiotics in ICU settings, determinants and rate of HAIs in ICU is scarce. The study will serve as a starting point to setup the surveillance system for HAIs in health care facility and will be of use to develop protocols and strategies for preventive measures for HAIs. Objectives: To find out the burden of the Hospital Acquired Infections (HAIs) in medicine ICU setting in the rural area of the central India. To study out the antibiotics use pattern in medicine ICU setting in the rural area of the central India. To find out the determinants of the HAIs in medicine ICU of a tertiary care hospital of rural area. To study the association of antibiotic use patterns and HAIs in medicine ICU of a tertiary care hospital. Methodology: This will be a prospective study which will be conducted in Medicine ICU of a tertiary care teaching hospital of a Medical College of Deemed to be University situated in a rural area of central India. Data will be collected over a period of two months. The sample size will be of 200 patients. Data will be collected using the structured tool using the android / mobile tablets. The tool will be pilot tested. The tool will include sections on socio-demographic data, including the data and time of admission, diagnosis, current antibiotic prescription, culture and drug sensitivity report with date and time of culture, and patient outcome. Data will be collected at multiple time points. First time point will be at the time of admission where demographic and social data will be collected and thereafter the data will be collected on every third day till the patient is discharged from ICU. Implications: The study will provide the useful information / guidelines for prevention of HAIs in tertiary care settings. The study will also generate a standardised and validated electronic tool, with real time data analytics useful for setting up of surveillance system to monitor and track the antibiotic use pattern and HAIs in health care setting.
Keywords: Antibiotics, hospital acquired infections, ICU, surveillance system
| Poster 146 | | |
| Impact of Community Based Awareness Education by Imparting Knowledge Regarding Chikungunya in Rural Population of Wardha District | | |
Sirjan Singh, Komal Meshram
Jawaharlal Nehru Medical College, Wardha, Maharashtra, India
Background: Chikungunya is a re-emerging debilitating viral disease for which any specific cure or vaccine is not available. Efforts should be made to reduce human-mosquito contact or eliminate vector populations. The knowledge that could be gained in this investigation would help rural population to take certain preventive measures and also guide policy makers and health authorities to plan, design and initiate initiatives, programs, and policies regarding chikungunya prevention. Objective: To assess the knowledge practiced for preventing chikungunya and measure the impact of community based education. Methodology: Follow up study (cross-sectional study repeated at intervals), conducted at Rural village population near AVBRH hospital and Jawaharlal Nehru Medical College, DMIMS. Seventy five participants were studied from Salod village from Wardha district, over a period of two months. After obtaining written informed consent, each participant’s house was visited by investigator using validated questionnaire. The data was gathered. The questionnaire consisting part –A has to be filled by participants and part –B to be filled by investigator with marks allotted to each question. Awareness was imparted to the participants by oral discussion regarding chikungunya as well as pamphlet consisting of information was provided in local language to each participant. The participant was informed about next visit by the investigator after seven days in which the same questionnaire was given to check the improvement in the knowledge regarding chikungunya and sanitation improvement after those seven days. Statistical Analysis Used: Data was analyzed using descriptive and inferential statistics. Statistical analysis was done by using descriptive and inferential statistics using chi-square test and software used in the analysis were SPSS 17.0 version and GraphPad Prism 6.0 version and p<0.05 is considered as level of significance. Results: Positive correlation in knowledge regarding chikungunya fever was found at post-test among participants and information imparted, drastic change was observed with respect to pre- test taken, and questionnaire helped individuals to gain more knowledge regarding the disease and its prevention. Conclusion: This study concludes that the knowledge score of participants regarding chikungunya fever and invigilator increases at post test. Hence a better and healthy community can be achieved just by imparting simple doorstep knowledge.
Keywords: Chikungunya, community, mosquito, practices, prevention
| Poster 147 | | |
| Inequity in Accessing Healthcare in India: Systematic Review | | |
Devshri Pajai, Abhay Gaidhane
Indian Institute of Public Health
Background: Equity in health means equal opportunity to be healthy. In India, despite improvements in access to health care, inequalities are related to socioeconomic status, geography, gender, caste and inequities in the availability, utilisation and affordability of health services causes high out-of-pocket expenditures, with more than three-quarters of the increasing financial burden of health care being met by households. Large inequities in health and access to health services continue to persist and have even widened across states, between rural and urban areas, and within communities. Methodology: A review of peer-reviewed, literature was conducted using the electronic databases Google Scholar and PubMed. The search was performed using a list of search terms designed to capture published papers from India on (1) maternal and reproductive health, and (2) equity, including disadvantaged populations, (3) Geographical inequity (4) gender inequity (5) inequity in resource allocation. A matrix was developed to sort relevant information. In this way, the main sources of inequity regarding healthcare in India and their inter-relationships were determined. Review Finding: Inequities in healthcare utilization is still persisting in in India. The main causes are caste, wealth, and education, resource allocation and geographical area, these are significantly associated with access to the lower access to healthcare, institutional deliveries, poor immunization status and more out of the pocket expenditure. There is a significant relationship between being poor and access to less utilization of ANC services independent of caste category or residence and lower access to healthcare facilities because of higher out of the pocket expenditure. Conclusion: Poverty major role in accessing healthcare services in India. Despite Pradhanmantri Jan Arogya Yojna currently working in India, there is a lesser enrolment for health insurance according to NFHS data (28.2%) In addition, social position (i.e. caste) has a strong independent effect on health service use. Infant (46%) and under-five mortalities (56%) is higher in rural as compared to an urban setting, it shows the poor healthcare in rural. The mother who had full ANC 31.1% in urban and 16.7% in rural. Percentage of full immunization attained by children is 62%. More focused and targeted efforts towards these disadvantaged groups need to be taken at the policy level in order to achieve targets and goals as per the MDGs. In particular, the Government should invest more in basic education and infrastructural development and complete insurance coverage to begin to remove the structural causes of disparities in society.
Keywords: Healthcare, poverty, health insurance, inequity, government schemes
| Poster 148 | | |
| Bioethics and Geriatrics: Aging with Grace | | |
Shruti Agrawal
Department of General Surgery, Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India
Background: India is the second most populous country of the world, with about 50% of its population below the age of 25yrs and about 65% below the age of 35 yrs. There will be a major demographic shift when this population ages and the healthcare system needs to take into account the specific problems of the elderly, therefore different adult and geriatric specialties should be considered. Concept: Medicine should evolve and adapt to accommodate the older generations living with chronic conditions, although modern medicine has helped improve the quality of life in all patients across age groups, it is pertinent that the healthcare system take into account the wishes of the elderly patients and does not merely prolong their life without improving it. It is important to counsel the patient and the patient’s families regarding all the options available to them and not let ageism be a deterrent in improving the patients quality of life with all due risks considered, it is frankly observed when the relatives refuse an elective surgery or medical intervention(eg catar that could improve quality of life because they feel that the patient does not have many years ahead of him/her. A new speciality with trained professionals who can educate the patient and their relatives about the ethical implications and the right to life of the patient is of the utmost importance. Conclusion: Geriatric medicine is important to protect the best interests of the elderly while ensuring that adequate medication, prudent use of invasive procedures is done but they are not undertreated.
Keywords: Bioethics, geriatrics, healthcare, quality of life
| Poster 149 | | |
| Designer Bebies: An Ethical Dilemma | | |
Yashika Sharma
Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
Designer babies is said to be the future that we don’t want. For some it is like going towards the impending doom towards humanity, but for some it is automation of humanity. In this era of technology, where we are trying to simplify the most complex structure on the earth (the human body), is like a step towards a future of millions of Einstein and Hawking. It not only promises to solve the genetic vulnerability problems of the human race but also flags off the race to “design” a superior human being. The recent advancement in medical science from IVF to the crispr gene editing has not only set a new level of accomplishment for us as humans but also paves the way towards a future hich is getting unpredictable. Every ehical issue has its own set of thinking processes, some people are in its support while some are against it. The most important thing is the birth of the technology. Now it is upto us how to handle it.
Keywords: Crispr, designer babies, ethics
| Poster 150 | | |
| Can Smoking Affects Our Kidney? | | |
Vivek S. Borkar
Department of Dialysis
Background: Cigarette smoking is common worldwide, despite the numerous deterrent measures that have been put in place over the decades. The number of smokers reported in 2015 was 1.1 billion. Worldwide, tobacco use causes nearly 6 million deaths per year, and current trends show that tobacco use will cause more than 8 million deaths annually by 2030. On average, smokers die 10 years earlier than non-smokers. Description: Cigarette smoking can cause acute and chronic effects. Acutely, cigarette smoking increases sympathetic nervous system activity resulting in tachycardia and high blood pressure. How smoking can harm kidneys Here are some of the possible ways smoking is thought to harm kidney, Increases blood pressure and heart rate, Reduces blood flow in the kidneys, Increases production of angiotensin II (a hormone produced in kidney), Narrows the blood vessels in the kidneys, Damages arterioles (branches of arteries), Forms arteriosclerosis (thickening and hardening) of the renal arteries, Accelerates loss of kidney function. Diabetes, high blood pressure and chronic kidney disease Diabetes and high blood pressure are the two leading causes of CKD. Studies have found that people with diabetes and/or high blood pressure who smoke add to the risk of getting CKD. In both groups smoking increased the chances of getting renal disease. Smoking also accelerated the occurrence of kidney disease. Stopping smoking was shown to help a person maintain kidney function. Smoking even hurts healthy kidneys According to information from the Multiple Risk Factor Intervention Trial, men in the general population, who don’t have kidney disease, are at an increased risk for getting end stage renal disease if they are smokers. The risk gets even higher for heavy smokers. Cigarette smoking has been called the most preventable risk factor for maintaining good health. Studies show that in addition to heart disease, cancer and the other diseases attributed to smoking, it has also contributed to renal failure among those who were not kidney disease patients. Conclusion: Cigarette smoking has significant implications for both kidney donors and recipients. Cigarette smoking has been associated with perioperative complications, wound infections, and mortality in transplant recipients. Kidney donation increases health consciousness and decreases cigarette smoking in significant number of donors. However, more work is needed to assess the impact of cigarette smoking on renal function and mortality in kidney donors. Cigarette smoking causes increased cardiovascular events and leads to decreased patient and graft survival. Cigarette smoking may also be associated with rejections, but this needs further studies for verifications. Additionally, cigarette smoking is associated with opportunistic infections and malignancies in kidney transplant recipients.
Keywords: Cigarette smoking, chronic kidney disease, renal failure
| Poster 151 | | |
| Correlation of Dyslipidemia and Type 2 Diabetes Mellitus amongst the People of Vidarbha Region of India | | |
Karuna Kachhawa, Ajay Meshram
Department of Biochemistry, Jawaharlal Nehru Medical College, (Deemed University), Sawangi (Meghe), Wardha Maharashtra, India
Background: Cardiovascular diseases are most universal in patients in Type2 DM and Type1 diabetes mellitus. High density lipoprotein (HDLc) and serum low-density Lipoprotein cholesterol (LDLc) and relatively constructive lipid profiles, as it may help to diagnosis of theT2DM. Objective: To examine T2DM with dyslipidemia and their correlation is the aim of the present study in residents of Vidarbha Region. Methodology: This case-control study was carried out in Jawaharlal Nehru medical college, Sawangi (Meghe), Wardha, on total of 100 subjects, with 50T2 DM patients and 50 controls (non-diabetic cases) and, to study their HDL and LDL profiles. Results: The present study showed increased levels of and LDL cholesterol 121.79±44.33 than in control 120.04(30.57). Fasting blood sugar 97.70±12.05 than. In control 94.3±19.5 in T2DM subjects; conversely, serum HDL cholesterol 35.5± 9.27 level was reduced significantly in T2DM patients than in controls 45.0±4.10. Conclusion: Findings of the present study reveals significant correlation between serum LDL and HDL cholesterols in T2DM patients.
Keywords: Dyslipidaemia, type2-diabetes mellitus
| Poster 152 | | |
| Trend of Anemic Status in Tribal Community of Pench Forest Reserve Area | | |
Sarika Dakhode, Zahir Quazi, Abhay Gaidhane, Santosh Tungare
Department of Community Medicine, JNMC, DMIMS, Sawangi (Meghe), Wardha, Maharashtra, India
Background: WHO estimates, highest burden of anemia is in India as compared to other countries and its prevalence ranges from 50-60 percent in most tribal region of the country. As per NFHS–4, prevalence of anemia among children and adults is high in rural than urban areas. Majority of women of age 15–49 years (53%) in India is facing a problem of Iron Deficiency anemia which is again highly prevalent among rural and tribal region (54.2%). Anaemia lowers resistance to fatigue, affects working capacity under conditions of stress and increases susceptibility to other diseases. Objective: To study the trend of anemia in tribal community of Pench forest reserve area during the period of four years. Methodology: This is a community based intervention study was conducted in Pench forest reserve area covering total 39 villages of Nagpur District (Maharashtra) and Sioni district (Andhra Pradesh). Under this ‘Aarogya Plus Project’, fortnightly mobile clinic was arranged in every selected village to provide primary health care services throughout four year (2015-2018). Colorimetric (cynmethemoglobin) method was used to diagnose anemia and treated by supplementing the iron and folic acid tablets for adults and syrup for children. Follow up Hb% was recorded to assess the change in anemic status. Results: Mean Hb of non anemic and all types of anemic beneficiaries in the studied tribal community was increased successively every year during these four years of intervention. Evident Mean +SD Hbgm% level was 9.61 (1.82), 10.12 (1.77), 10.47 (1.75) 10.71 (1.73) during 2015, 2016, 2017, 2018 respectively. Trend for non anemic and mild anemic during four years found to be yearly increase in percentage. However, moderate and severe anemic patient’s trend was found to be decreased in percentage every year. Anemic status of female was improved more significantly than male. Conclusion: Overall anemic status of tribal community was improved by providing consistent and basic primary care services to remote tribal communities, under this project. Implementing mobile health clinic program and running it consistently will be definitely results in progress of health status of tribal people.
Keywords: Anaemia, intervention, tribal
| Poster 153 | | |
| Euthanasia in Indian Context | | |
Mahjabeen Ahmed, Mahnaaz Khatib, Lt. Col. Ziauddin Quazi, Zaheer Quazi, Abhay Gaidhane
JNMC, DMIMS (DU), Sawangi (Meghe), Wardha, Maharashtra, India
Background: Euthanasia literally means “good death.” It is also popularly known as “mercy death” as it is practiced lessening the pain of an individual and ensure a dignified death. Although, 80% of the deaths worldwide occur in middle- and low-income countries such as India, there is less awareness of euthanasia for people with chronic, serious, progressive, advanced life-limiting illnesses or with terminal illnesses like advanced cancer, AIDS and others psychological illness like dementia, depression have become an important concern for clinicians. Parallel to this concern has arisen another controversial issue-euthanasia or “mercy –killing” of terminally ill patients and it is an extremely sensitive topic in our sociocultural ethos. In a country where euthanasia policies are widely debated, dignified death is a desired form of death. Objectives: The aim of the study is to synthesize the existing published and non-published empirical evidence on euthanasia practices and the social, cultural, and religious dimensions associated with those practices in India. This study explores its current trends and future directions in India. Search Method: Two review authors independently searched online databases like MEDLINE, CENTRAL, and EMBASE for relevant studies. We applied no language, date, or publication status restrictions. A third reviewer resolved discrepancies. Selection Criteria: We included studies of patients with chronic, serious, progressive, advanced life-limiting illnesses or with terminal illnesses like advanced cancer, AIDS and others psychological illness like dementia, depression. Patients/participants of studies were both male and female from rural as well as urban areas. Data Collection and Analysis: Two reviewers pre-screened studies identified in the electronic search. We resolved discrepancies by discussion with a third reviewer. Two reviewers independently extracted data from the included studies using a pre-defined and piloted data extraction form and the third reviewer cross-checked the data. We used an approach proposed by the Cochrane Collaboration to assess the risk of bias. We had planned to use effect measures of either risk ratio (RR) or odds ratio (OR) or risk difference (RD) for dichotomous data, and Mean difference (MD) or standardized mean difference (SMD) for continuous data. We had planned to measure the extent of heterogeneity by chi2 statistics. As the studied differed in the types of intervention and reporting of outcomes; we did not undertake meta-analysis. We used GRADE profiler to assess the overall quality of the evidence. Main Results: We included 28575 studies out of which 103 studies were from India. ut of these 103 studies, 3 studies were with patient suffering from cancer and 5 studies were with patients suffering from chronic disease.2 studies cover patients suffering from depression and 8 studies were with patients who were terminally ill. Authors’ Conclusion: We conclude that although medical science is progressing in India as in the rest of the world, and hence currently we are having devises that can prolong life by artificial means. This may indirectly prolong terminal suffering and may also prove to be very costly for the families of the subject in question. In India, only recently a landmark verdict on the passive euthanasia has been passed by the Supreme Court. However, still it is an unmet need in the community leading to several practices intertwined with economical to social, cultural and religious beliefs. Realizing the importance of this issue and considering the ongoing and pending litigation before the different courts in this regard, the Ministry of Health and Family Welfare, Government of India issued a public notice on May 2016 that invited opinions from the citizens and the concerned stakeholders on the proposed draft bill entitled The Medical Treatment of Terminally ill Patients (Protection of Patients and Medical Practitioners) Bill. The ongoing developments have raised a hope of India getting a discreet law on euthanasia in the future. Moreover, concerns for its misuse remain a major issue which ought to be addressed before it becomes a law in our country.
Keywords: Cultural, euthanasia, religious, social
| Poster 154 | | |
| Vaginal Foreign Body: A Diagnostic Dilemma! | | |
Sonaakshi Kushwaha
Jawaharlal Nehru Medical College, Sawangi (Meghe), Wardha, Maharashtra, India
Introduction: The foreign body in the vagina in pediatric population are not commonly suspected and are usually introduced accidently and history is negative. Case History: A 6 year old female child was admitted in paediatric ward of AVBRH Rural Hospital, with chief complaint of Blood Stained discharge from vagina since 1 year. Patient had history of trauma over the abdomen 1 year back following which the complaint started. The spotting was present each and every day since one year. The discharge was foul smelling. No history of abdominal pain, urinary discomfort, local pain or swelling. No h/o sexual abuse, familial discordance. No history of bleeding from any other sites. Mental status of the child was also normal. She was normal in other activities. No restriction of activity due to complaint
Examination: General condition of child was good. Vital parameters were within normal limits. Local Examination: Genitals were normal. Foul smelling blood stained discharge was present. Investigations: USG of abdomen and pelvis was done 3 times which was normal. CT scan of genitourinary tract was done which was also normal. Diagnosis: Gynecology opinion was taken and vaginal examination under short general anesthesia was done and 3-4 muddy stones were extracted from vaginal 1x1 cm in size.
Keywords: Diagnostic dilemma, foreign body, vagina
| Poster 155 | | |
| Multiple Sclerosis-tumefactive Demyelination in a Child | | |
Soumya Shukla, Sachin Damke
Jawaharlal Nehru Medical College, Datta Meghe Institute of Medical Sciences, Sawangi (Meghe), Wardha, Maharashtra, India
Introduction: Multiple sclerosis is a chronic demyelinating disorder of the brain, spinal cord and optic nerves characterized by a relapse-remitting course of neurologic episodes separated in time and space. Pediatric multiple sclerosis is rare, with an estimated 2-5% of MS patients experiencing their 1st symptoms before age 18 year. It has slight male predominance when disease seen before age of 6 year, but by 12 year, female outnumbered males 2:1. Ataxia is a most common initial feature followed by seizures, encephalopathy and hemiparesis. A polyphasic course is characterstic. Repeated episodes of demyelinaton occur in non contagious areas of the nervous system. Case Summary: A 12 year old female came with chief complaints of not able to speak and weakness in all four limbs since 2 months which was progressive in nature, more on the right side, unable to make eye contact with constant staring look towards the left side with inability to chew with loss of control of bowel and bladder movements with history of abnormal movements of all four limbs associated with frothing and up rolling of eyes 1.5 years back with exposure and treatment for tuberculosis taken for 6 months with previous history of normal development with under nutrition with contracture over the right ankle with hypertonia in all four limbs with exaggerated deep tendon reflexes with ankle clonus with involvement of second, third and sixth cranial nerves with normal interval of 8 months between two episodes. Conclusion: This was 12 year old female child with typical relapsing and remitting course of neurologic episodes. Age and presentation are typical of demyelinating disease. The hemiparesis with mild improvement and later 2nd episode after an interval of >1 month point towards demyelinating disease. The MRI scan report which shows variable sized altered signal intensity lesions in various part of the brain is very typical diagram of multiple sclerosis. EEG also points towards cerebral insult. It implies that a child of this age group presenting with neurological signs and symptoms should undergo MRI scan. The drastic improvement with pulse therapy of steroids shows that early diagnosis and treatment would go a long way in decreasing morbidity in children with MS. Isolated new lesion on follow up with MRI and classical improvement with pulse therapy give a positive window towards these patients. Discrete T2 lesions in MRI and tumefactive T2 lesions are diagnostic of multiple sclerosis.
Keywords: Demyelination, multiple sclerosis, tumefactive
| Poster 156 | | |
| Severe OHSS after Low Dose of FSH in PCOD Patient | | |
Puja Kumari
Department of Obstetrics and Gynecology (JR 2)
Introduction: Women with polycystic ovarian syndromehave abnormalities in the metabolism of androgens and estrogen and in the control of androgen production. PCOS can result from abnormal function of the hypothalamic pituitary ovarian (HPO) axis. A woman is diagnosed with polycystic ovaries (as opposed to PCOS) if she has 12 or more follicles in atleast one ovary. In my poster presentation, I have explained with a case scenario how low dose of FSH in PCOD can result in severe OHSS and this has been explained with pictures. CONCLUSION: Ovarian stimulation in PCOS is a very delicate issue. One should be aware of such type of complications even with the low dose of gonadotrophins.
Keywords: Hormone, polycystic ovarian disease
| Poster 157 | | |
| Smart Phones Revolution in Anaesthesia: An Ethical Concern | | |
Amol Singham, Neeta Chaudhary, Sinjini Agarwal
Department of Anaesthesia, Jawaharlal Nehru Medical College, Swangi (Meghe), Wardha, Maharashtra, India
Background: Smartphones have taken the centre stage in anaesthesiologists’ lives in revolutionizing the present health care scenario. They have become an integral part and parcel of a physician’s life in imparting quality health facilities as well as honing their own skills as professionals. However,the benefits of the smartphones often are outweighed by the ethical disadvantages they have to offer. The major concern that looms around is the privacy and security of the patient which might be breached at any point during the process. The smart phones carry a significant risk of causing nosocomial infections. In addition to this they are a big source of distraction for the doctor on duty which may affect the patients’ outcome. Description: Smart phones offer the advantage of having information at the fingertips, all the updates on the go, direct connection with the patients. Smartphones, despite of being resourceful can be hazardous in many ways. Ethical and Legal Concerns: Mobile phones with a camera facility can constitute a considerable risk to patient’s privacy. Their risks can be identified as a possible breach of medical confidentiality, intrusion into patient’s private life. There can be a leak of patient’s personal data as anyone can access the data amounting to medico legal actions. Also, to be able to access the data via multiple devices poses a risk of security issues. There is a possible contravention of data protection act 1998 and breach of patient confidentiality. There is a possible risk of safety and welfare of children in contravention of the children act 2007 and can be a cause of nuisance to staff and other patients. So, this leaves us with a bigger question that whether or not usage of smartphones around the patients is ethically right. Other Hazards Include: Nosocomial infections like MRSA, coagulase negative staphylococcus aureus and klebsiella associated infections. Any kind of distraction, be it in the form of smartphones or handheld devices can significantly distract the anaesthesiologist from their primary goal and eventually affect patient outcome. Conclusion: Even though smartphones have become incorporated in anaesthesiologist’s life like salt and pepper in food, the risk against benefit ratio has to be taken into consideration. They compromise security and privacy, quality of patient care and efficiency and are sources of distraction and nosocomial infections. A thin line marks the difference between “the smartphone a friend or a foe”. So we will have to adopt a more sensible, evidence base balanced and ethical policy towards mobile phone usage in our clinical practice.
Keywords: Anaesthesia, ethics, smart phones
| Poster 158 | | |
| Relationship between Children’s Media Habits and Their Dental Anxiety and Behavioral Management Problems during Dental Treatment | | |
Shravani Deolia, Renuka Kohale, Abhishree Chaurasia, Sonal Makode
Sharad Pawar Dental College, Sawangi, Wardha, Maharashtra, India
Objective: The previous researchers suggested that media habits may have moderating role on children’s psychological adjustment in the dental setting. The aim of this study was to investigate the relationship between children’s media habits and their anxiety and behaviour management problems during dental treatment in Wardha region. Methodology: A total of 50 children aged 3-6 years old were included. The proforma consisted of two close ended questions related to the type of media used by children and average time spent daily on media. Along with this, Proforma included assessment of clinical anxiety scale and Frankel’s rating scale was also recorded for rating the behaviour of the patient. Both the scales were recorded by a single investigator within 5 minutes of the starting of the dental procedure. Also same two questions were asked about parents and one question was related to the dental anxiety of parents. After recording all this the data was then analysed. Results: The children with dental anxiety had significantly higher amount of using electronic media than those without dental anxiety. The amount of using electronic media were significantly higher in the children with behaviour management problems than those without behaviour management problems. Conclusions: A significant relationship was reported between the amount of electronic media usage and dental anxiety and behaviour management problems in 3- to 6-year-old children.
Keywords: Behavioural dental treatment, children’s, dental, habits, media
| Poster 159 | | |
| Oral Manifestations of Renal Diseases | | |
Namrata Jidewar, Radhika Gadge
Department of Oral Pathology and Microbiology, Sharad Pawar Dental College, Sawangi, Wardha, Maharashtra, India
Background: Patients with improper kidney functions requiring maintenance and treatment exhibit an increased prevalence of oral lesions. The objectives of this study wil be to analyze the prevalence of oral lesions in renal patients compared to healthy individuals and to find a possible link between different subjective symptoms and objective clinical findings. Oral cavity is the mirror of systemic health. Renal complication is one such condition which presents with a spectrum of oral manifestations (dry mouth,Uremic Stomatitis, Xerostomia, Taste change, Mucosal Petechiae and EcchymosisMucosal Lesions, Periodontal Disease, Infections) often due to the disease itself and treatment. With growing awareness about the inter-relationship between dental and medical problems, the role of dentist has become pivotal in overall health care of patients with renal conditions and also to render services for the oral findings of such diseases. Objectives: To asses oral health of patients having renal diseases and undergoing treatment. Management of these oral manifestations. Materials and Methodology: Oral health examination study will be conducted on 30 patients who are undergoing treatment for various renal conditions. Oral examination will be done by using mouth mirror and community periodontal index (CPI) probe at A.V.B.R.H sawangi (m), wardha with verbal consent taken taken from the patients and results will be analysed to know the prevalance of any conditions. Expected Results: Comparatively poor oral health in patients having renal diseases with dry mouth,Uremic Stomatitis, Xerostomia,Taste change,Mucosal Petechiae and EcchymosisMucosal Lesions,Periodontal Disease,Infections. Conclusion: Oral health conditions are affected by renal diseases for which management is required and they can be used as an indication for underlying renal diseases.
Keywords: Oral cavity, oral manifestations, renal diseases
| Poster 160 | | |
| Do Doctors Discriminate against Older Patients? | | |
Glenn Jo
K. S Hegde Medical Academy, Mangalore, Karnataka, India
Background: Physicians are often accused of providing too much care to elderly patients at the end of life there’s evidence that these patients also get far too little care before reaching that point. Physicians are divided on whether older patients deserve as much care as younger ones. Some believe in diverting scarce or costly resources away from older people to younger patients who have their whole lives ahead of them. The care of the dying patient must be considered within the context of the psychological, physical, and social experiences of a person’s life. Recently there have been activities moving towards legalization of physician-assisted dying, involving a terminally ill person, with less than 6 months to live, can request pills that will cause them to die. Some healthcare professionals believe that older people have the right to end their lives with dignity when they decide they have “completed life.” Others are concerned that physician-assisted dying for people who are needy or lonely is wrong, and that combating loneliness and helping older people live with dignity is better than enabling them to die. Objectives: A review of articles was done with these objectives: To understand and identify key ethical issues in geriatric healthcare. To identify challenges to deliver end of life care. Review Findings: The discrimination seen may be due to the physicians’ lack of curiosity and knowledge of how to treat older patients; and the time constraints imposed on doctors by today’s healthcare system, which often means that older patients, who require more time, get perfunctory and often inadequate care. Healthcare professionals contend that some healthy older people might want to end their lives because they are afraid of being a burden to their families and other financial constraints and patients themselves often prefer that their physicians offer minimal care. Issues such as autonomous decision making, importance of advance directives, rationing of care in futile treatments and costs are involved in providing end-of-life care. It appears that palliative care for elderly patients is often occurring only as an afterthought rather than a properly planned one made with the patient and family members sitting together to develop an end-of-life care plan. Conclusion: This review paper sums up the challenges faced by doctors in treating elderly patients and why they occur. It emphasizes on the need to treat them equally and understands the constraints they face while approaching better medical care. It also explains the ethical issues faced during end of life care.
Keywords: Doctors, discriminate, older patients
| Poster 161 | | |
| Estimating the Frequency of Candida in Oral Squamous Cell Carcinoma Patients | | |
Radhika Gadge, Namrata Jidewar
Department of Oral Pathology and Microbiology, Sharad Pawar Dental College, Sawangi, Wardha, Maharashtra, India
Background: Oral squamous cell carcinoma refers to cancer occurring between the vermillion border of lips and the junction of hard and soft palate or posterior one third of the tongue. In US, 3% of cancers in men and 2% in women are oral squamous cell carcinomas. It is the most common form of oral cancer mostly occurring in middle aged and older individuals. The chief risk factors for oral squamous cell carcinoma include: Smoking, Alcohol abuse, Tobacco and Beetel nut chewing, Environmental factors. Early, curable lesions are rarely symptomatic but the uncurable lesions require detection by screening followed by surgery. The worldwide incidence of oral cancer is estimated to be around 260,000 cases annually. In developed countries it is eighth most common form of cancer. Candida is an opportunistic pathogenic yeast that proliferates outside the human body. Its presence is about 40-60% in skin and the mucosa. It can cause infections in immunocompromised patients under a variety of conditions. Candida albicans is the most common of the Candida group. It is a dimorphic fungus and can be easily cultured in the labs. One of the risk factors of oral squamous cell carcinoma is the Candidal infection whose role is to be confirmed. Objectives: To estimate the frequency of Candida in oral squamous cell carcinoma and healthy controls. To relate Candidal infection with oral carcinoma. To help in easy diagnosis and prognosis of oral squamous cell carcinomas. To confirm the role of Candidal infection in risk factors for oral squamous cell carcinoma. Materials and Methods: 25 samples from oral squamous cell carcinoma patients along with 25 control samples will be taken following the verbal consent of the patient. Each sample will be inoculated on Saboraud’s Dextrose Agar. Gram staining will be done to confirm the candida species. Results will be interpreted to compare the frequency of candida in both the groups. Expected Results: Increased levels of candida in oral squamous cell carcinoma patients.
Keywords: Candida, oral cancer, squamous cell
| Poster 162 | | |
| Body Mass Index versus Dental Maturity: Assessment of the Relationship between Chronological Age, Dental Age and Body Mass Index in Children | | |
Anjali Vashisth, Aarati Panchbhai
Department of Oral Pathology and Microbiology, Sharad Pawar Dental College, Sawangi, Wardha, Maharashtra, India
Background: The degree of development and timing of dental treatment onset may be crucial in selection of treatment protocol especially for children undergoing orthodontic treatment. The childhood obesity is the matter of concern it may influence the development of child including dental development that in turn may affect the dental or oral treatment of child. Discussion: The ethic committee approved the study conducted at SPDC, Sawangi, Wardha, to investigate the relationship between dental development, chronological age and body mass index in growing children. The weight and height of patient were recorded for 100 patients (11 to 18 years) as per the norms and the BMI was calculated by dividing weight in kilograms by the square of height in meters. Modified demirjian method was used to access the dental development on orthopantomogram. The Anova test and Pearsons correlation coefficient was used for statistical analysis. Notably, the dental age was found to be lesser compared to chronological age in the age group 11-16 years, reverse was true in >16 years age group. Insignificantly dental age range in females was higher than males. We found the positive correlation between BMI and dental age. Conclusion: The study highlights the importance of correlation of dental development with chronological age and body mass index in the children undergoing orthodontic treatment so as to have reliable treatment outcomes
Keywords: Body mass index, chronological age, dental age, dental maturity
| Poster 163 | | |
| To Assess the Effectiveness of Structured Teaching Programme on Knowledge Regarding Prevention of Specific Postnatal Complications among Primigravida Mothers | | |
Sampada V. Late
SRMMCON, Sawangi (Meghe), Wardha, Maharashtra, India
Introduction: Maternal conditions, such as haemorrhage, sepsis, and obstructed labour, as a group constitute one of the leading causes of the burden of disease for women of reproductive age throughout the world and contribute to high levels of mortality and disability in developing regions. According to the estimates of disability-adjusted life-years in the 1990 Global Burden of Diseases Study, reproductive ill-health accounts for 22% of the global burden of diseases among women of reproductive age. Maternal conditions dominate the burden of reproductive ill-health, accounting for 14.5% of the global burden of diseases, particularly in areas such as sub-Saharan Africa and India. Objectives: (1) To assess the knowledge of primigravida mothers regarding prevention of specific postnatal complications. (2) To implement the structured teaching programme on prevention of specific postnatal complications among primigravida mothers. (3) To evaluate the effectiveness of structured teaching programme on prevention of specific postnatal complications among primigravida mothers. (4) To find out the associations between socio-demographic variables and knowledge regarding postnatal complications among primigravida mother. Materials and Methods: PRE experimental research design one group pre test post test design and sample of 100 women aged between 18 to 33 years above were selected from acharya vinoba bhave rural hospital wardha. Results: That none of the samples had poor, average and 1 (1%) had good level of knowledge score, 43 (43%) of them had very good level of knowledge and 56 (56%) had excellent level of knowledge score respectively. The minimum score was 15 and the maximum score was 27, the mean score was 21.84± 3.290 with a mean percentage score of 72.8%.
Keywords: Postnatal complications, primigravida mother, structured teaching programme
| Poster 164 | | |
| To Compare the Emotional Intelligence of Male and Female Professional College Students | | |
Abigail K. T. Zaizai, Tessy Sebastian
Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Medical Science (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
Background: Emotional Intelligence is the capability of people to recognize their own feelings, thoughts, emotions and those of others discern between different feelings, label them appropriately, and use emotional information to guide thinking, behavior, manage and adjust emotions to adapt to the environment and to achieve one’s goals. Aim and Objective: (1) To assess emotional intelligence among students of professional colleges. (2) To compare the level of emotional intelligence among male and female students of professional colleges. (3) To compare the level of emotional intelligence among subjects from different professional colleges. (4) To associate the emotional intelligence with selected demographic variables among students of professional colleges. Materials and Methods: Research approach: Exploratory approach. Research Design: Comparative Study. Population: Students of professional colleges. Sample: Professional college students from Wardha. Sample size: 300. Sampling Technique: Convenience sampling technique. Results: Levels of emotional intelligence were seen into: below poor, average, good and excellent, 4% of mechanical professional students had average level of emotional intelligence, 44% had good and 52% had excellent level of emotional intelligence. Mean emotional intelligence score of the mechanical professional students were 222.81 ± 38.23. Emotional intelligence score of male students were higher 211.32 with SD of ±44.40 when compared with mean intelligence score of female professional students which was 209.46 with SD of ±33.86. Conclusion: In this study, the emotional intelligence of male and female professional college students were compared in which male professional college students have higher emotional intelligence level than female professional college students.
Keywords: Emotional Intelligence, students
| Poster 165 | | |
| A Case Study on Pyoderma Gangrenosum | | |
Lal Tanpuii
Department of Child Health Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
Introduction: A male child of age 7 years, was brought by his relative and got admitted on 17th Jan19 in AVBRH: Pediatric 23 with a case of Pyoderma Gangrenosum (Rt. Leg). History collection, physical examination and other investigations reveals Pyoderma Gangrenosum in right leg. Chief Complaints: Fever, Pain, Burning sensation. Definition: Pyoderma gangrenosum is an uncommon noninfectious ulcerative cuteneous condition of uncertain etiology. Clinical Types of Pyoderma Gangrenosum: Ulcerative Pyoderma Gangrenosum, Pustular Pyoderma Gangrenosum, Bullous Pyoderma Gangrenous, Vegetative Pyoderma Gangrenosum. Etiology: 50% - Unknown cause, Trauma, Inflammatory bowel disease, Arthritis, Blood disorder, Neutrophil disfunction. Pathophysiology: Poorly understood, Dysregulation of the imune system, specifically altered neutophil chemotaxis is believed to be involved. Clinical Manifestations: Small Pustule, Red Bump/Blood Blister, Ulcer, Fever Pain. Investigations: History collection, Characteristics appearance, Wound swab and culture for micro – organism (but it is not the cause), Blood Test (Mostly blood test are not particularly helpful). Treatment Modalities: Medical Management: Local application of strong steroid preparation or calcineurin inhibitor. Inj / Oral treatment by antibiotics or dapsone. Steroid tablets for reducing inflammation. Gently removal of necrotic tissue. Saline soaked dressing while occlusive dressing is discouraged. Nursing Management: History taking, Assess the client needs. Complication: Infection, Scarring, Uncontrolled pain, Depression, Loss of mobility. Conclusion: My client was admitted to AVBRH on 17th Jan 2019 with a case of Pyoderma gangrenosum and tratment was started on the day of admission. He was showing improvement, there is no pus though the lesion does not completely healed yet and the pain level is also reduced.
Keywords: Pyoderma gangrenosum, ulcerative pyoderma
| Poster 166 | | |
| To Assess the Effectiveness of Planned Teaching on Knowledge Regarding Prevention of Chronic Suppurative Otitis Media among School Children | | |
Sneha Tadulwar
SRMMCON, Sawangi (M), Wardha, Maharashtra, India
Background: Chronic suppurative otitis media (CSOM) is a notorious infection and a major health problem in developing countries causing serious local damage and threatening complications. Early and effective treatment based on the knowledge of causative microorganisms and their antimicrobial sensitivity ensures prompt clinical recovery and possible complications can thus be avoided1. Chronic suppurative otitis media is one of the leading causes of preventable disabling hearing impairment in developing countries. Early detection and management complements advances made in other survival programs, improves work capacity, and enhances learning opportunities for school children. We aimed to prevention ofcsom among school children aged in between 13 to 15. Aim and Objectives: (1) To assess the existing knowledge regarding prevention of chronic suppurative otitis media among school children. (2) To evaluate the effectiveness of planned teaching on knowledge regarding prevention of chronic suppurative otitis media among school children. (3) To associate the knowledge scores with selected demographic variables. Materials and Methods: This study was carried out to assess effectiveness of planned teaching through a structured knowledge questionnaire. Interventional research approach and pre-experimental one group pretest & posttest research design was adopted to conduct study. Non-probability convenience sampling technique was used and 100 children of both sexes of 13 to 15 year was included. This study was carried out through a period of 7 days starting from 28 february to 7march 2019. Results: The mean score of posttest knowledge 15.45 was apparently higher than the mean score of pre-test knowledge 3.38. There was significant difference between the mean pre test and posttest knowledge score (t = 2.00, p = 0.00) at p<0.05 level and no significant association found between selected socio demographic variables like age, gender, standard, religion and residence. Planned teaching was highly effective in enhancing the knowledge of school children regarding prevention of chronic suppurative otitis media. Conclusion: This study concluded that there was improvement in the level of knowledge of school children which indicates that the planned teaching was effective. The development of planned teaching will help the school children to enhance their knowledge regarding prevention of chronic suppurative otitis media.
Keywords: Chronic suppurative otitis media, effectiveness planned teaching, knowledge
| Poster 167 | | |
| A Qualitative Study: Experiences of Cancer Patients during Chemotherapy | | |
Ranjana Sharma
Smt. Radhikabai Meghe Memorial College of Nursing, Sawangi (Meghe), Wardha, Maharashtra, India
Background: Cancer patients receiving chemotherapeutic treatment routinely experience a wide range of distressing side effects, including nausea, vomiting, and dysphoria. Such symptoms often compromise patients’ quality of life and may lead to the decision to postpone or even reject future, potentially life-saving, treatments. In this article, we discuss the hypotheses that have been offered to explain the development of such symptoms. We also review, in greater detail, the research evidence for the efficacy of five treatments for such symptoms: hypnosis, progressive muscle relaxation training with guided imagery, systematic desensitization, intentional diversion or redirection, and biofeedback. We discuss the implications of this treatment research, paying particular attention to factors associated with treatment outcome, mechanisms of treatment effectiveness, and issues associated with clinical application. Aim and Objective: To explore the experiences from the perspective of patients during chemotherapy. Materials and Methods: Descriptive phenomenology research designs were used. The research approach exploratory, subjects were selected through non-probability purposive sampling technique, the sample size were 20 and data collection done by semi-structured interview. Results: Semi-structured interviews was taken for lasting 15-30 minutes each were held with 15 women and 5 men, aged 19- above 40 years between one and six months after they started the present treatment. The patients’ cancer types were breast cancer (07 patients), oral cancer (03 patients), gynaecologic cancer (08 patients), and prostate cancer (02 patients). Conclusion: Experiences of the patients during chemotherapy was reported 25% were having anorexia, 5%, anxiety, 30% abdominal pain and discomfort, 5% burning sensation on feet, 5% dizziness, 65% fatigue, 20% hair loss, 5% headache, 5% of patients experienced lethargy, 15% nausea, 5% poor sleep, 5% thirsty feeling, 5% taste changes, 5% tiredness, 5% vomiting and 25% weakness were experienced by the patients.
Keywords: Cancer, chemotherapy
| Poster 168 | | |
| Hydrocephalus: A Case Study | | |
Lalzampuii
Department of Child Health Nursing, Smt. Radhikabai Meghe Memorial College of Nursing, Datta Meghe Institute of Medical Sciences (Deemed to be University), Sawangi (Meghe), Wardha, Maharashtra, India
Introduction: A known case of 2 years old child was admitted on 6..9.2018 with the complaints of enlargement of head, gradual in onset with delayed developmental milestone. Etiology: Congenital – Intrauterine infection, brain tumour, intracranial haemorrhage, congenital malformations. Acquired – Inflammation, trauma, neoplasm, connective tissue disorder, degenerative atrophy of brain, arteriovenous malformations. Clinical Manifestations: Enlargement of head, protruding forehead, eyebrows and eyelids Drawn upwards, sunset sign, increased ventricular size. Diagnostic Evaluation: History collection, physical examination, CT-Scan, MRI, blood investigations. Management: MEDIACAL: Syp. Cefaloc 5ml PO BD. SURGERY: Ventriculo-Peritoneal Shunt to be performed when patient is fit for surgery. Conclusion: Hydrocephalus is the abnormal accumulation of cerebrospinal fluid (CSF) in the intracranial spaces leading to increased pressure and increased ventricular size due to imbalanced between production and absorption of CSF or due to obstruction of CSF pathways. It results in dilatation of cerebral ventricles and enlargement of head.
Keywords: Clinical care, hydrocephalus, rural
| Poster 169 | | |
| Significance and Relevance of Shadvidhopkram in Non-communicable Disorders | | |
Mukul Pratap Singh
Department of Kayachikitsa, Mahatma Gandhi Ayurved College, Hospital and Research Centre, Salod (H), Wardha, Maharashtra, India
In Ayurveda, Yuktivyapashraya is the fundamental measure to manage any disease. It is the principle by which a physician has to understand the involvement of Dosha, Dhatu, Mala and Strotas to select treatment strategy. AcharyaVagbhat emphasized on the concept of Dvividhopkram i.e. Santarpanupakram & Apatarpanupakram. Shadvidhopkram is described by AcharyaCharak. It includes six upakramas i.e. Langhan (De-nourishing therapy), Bruhan (Nourishing therapy), Snehan (Oleating therapy), Swedan(Sweating therapy), Rukshan (Drying therapy) and Stambhan(Astringent therapy).Objectives of this review are to analyze,explore and correlate the concept of Shadvidhopkram with the help of conducted researches and discuss its application in today’s era. In Non-communicable diseases, Metabolic syndrome is a major and intensifying worldwide problem. It can be considered as Santarpanajanyavikar. These disorders can be tackled by applying Langhan, Rukshan or Swedanupakram. Apatarpanjanyavikar are caused due to Vataprakopak Ahar-Vihar, chronic illness, improper absorption of nutrients. Nutrition deficiency disorders, Immunodeficiency and Degenerative disorders can be included in Apatarpanjanyavikar. The treatment principle for Apatarpanjanyavikar is Bruhan, Snehan and Stambhan. In this review, multiple treatment modalities are correlated with shadvidhopkram. From this critical review, it can be concluded that, every disease can be treated by applying one or combination of two or three of these principles appropriately.
Keywords: Apatarpanjanyavikar, Dvividhopkram, Shadvidhopkram, Santarpanjanyavikar
| Poster 170 | | |
| Concept of Bioethics in Ayurveda and Modern Era | | |
Meenakshi Jaiswal
Department of Rasashatra and Bhaishajya Kalpana, MGACH and RC, Salod (H), Wardha, Maharashtra, India
Introduction: Ethics deals with the principles of right conduct. In medical science, Ayurveda, Modern medicine and other alternative therapy also have some principles of medical practise with major similarities and a fewer differences among them. Although it is found that the importance of ethics is very well defined and described in the fundamental texts of Ayurveda; the four basic principles namely: i) Autonomy, ii) Beneficence, iii) Non maleficence, and iv) Justice which collectively known as “Principlism” .But since ancient times bio- ethics in Ayurvedic compendia like CharakaSamhita, SushrutaSamhita, AshtangaHriday, etc are well described in the form of Sadavritta, Chatushpada, Acharrasayana, Yogya,and Vaidyavritti. So, Ayurveda should be considered as a trailblazer in establishing the basic fundamentals of bio- ethics. Aim and Objectives: Discussion of the Bio- ethics in Ayurveda. To explore the concept of Bio- ethics with special reference to Autonomy. Materials and Methods: The data is collected from classical text books of Ayurveda, literature available related e- media and articles. Results and Observation: In ayurvedic compendia, it is mentioned that physician should speak justly, gently, purely, truth in wholesome and moderate manner with affection. However Charaka infers that sometimes in special situation speaking truthfully to the patient is not absolute and states, because it may harm the diseased person or someone another. Discussion and Conclusion: Ayurvedic ethics differs preference to the physician to determine whether such truthful information should be or not to be given which might potentially add further harm and suffering to the patient or some other person and this is the fundamental ethic expression of Ayurveda paternal beneficence.
Keywords: Autonomy, ayurvedic ethics, principlism
| Poster 171 | | |
| Optometrist Bringing India a Step Closer to Achieve Vision 2020 | | |
Ashwini Meghare
Department of Ophthalmology, Data Meghe Institute of Medical Science, Sawangi (Meghe), Wardha, Maharashtra, India
Aim: To highlight the role of optometrist in bridging healthcare gap b/w rural & urban areas and in achieving goal of vision 2020. Introduction: Avoidable blindness includes cataract, refractive error, glaucoma, Corneal scar, diabetic retinopathy, childhood blindness, Trachoma, Onchocerciasis .Refractive error is the second leading cause of blindness. Rural area has deficiency of ophthalmologist, so as an optometrist following can be done to bridge the healthcare gap: camp’s can be Conducted regarding the Diagnosis and referable of other causes of blindness such as, cataract, trachoma, childhood blindness. They can conduct camp’s for screening of other disease and can refer Them to higher centres. Refractive error can be diagnosed & Treated by an optometrist. Hence an optometrist provides increased manpower in rural areas to Achieve the goals of vision 2020.
Keywords: Eye care, optometrist
| Poster 172 | | |
| A Frontine Service Provide in Tertiary Eye Hospital | | |
Shweta Bhagat
Department of Ophthalmology, Data Meghe Institute of Medical Science, Sawangi (Meghe), Wardha, Maharashtra, India
Optometrist play a major role in a tertiary eye hospital. Apart from its role in performing basic OPD duties such as history taking, performing clinical refraction. They play a significant role in various ocular condition - Firstly as a biometrist in cataract surgery. They measure corneal curvature had axial length and IOL power using appropriate formula for surgeon’s targeted refractive outcome. Next as a independent vision provides in OLD setup. They evaluate central retina if needed. As a binocular vision provider As a low vision practitioner In diseases like Glaucoma. They play a key role starting from measurement of IOP to performing perimetry of patient. In association with oculoplasty. They perform a role of ocularist This poster depicts the Role an optometrist plays in management of ocular diseases at Out Patient level in a Tertiary level Hospital.
Keywords: Eye, frontine service, health care
| Poster 173 | | |
| Ethical Issues in Decision-Making in Geriatric Population | | |
Khushbu Lichade
Datta Meghe College of Physiotherapy, Nagpur, Maharashtra, India
Focus of the ethics in geriatrics. The ethics of geriatric patient care focus on principles of respect for autonomy and beneficence. The physiotherapy goals are to keep therapy person-centred and co-ordinating treatment which include; Competence and Decision-Making Capability, Confidentiality and Mandatory Reporting Laws, Diagnostic Disclosure, Informed Consent, Advance Care Planning (Goals of care). Description: The goals should be towards management and improvement of a condition rather than passive ‘care’ towards old person. Consent and confidentiality is vital before, or when assessing managing vulnerable people. In Decision making the therapist should explain patient the present state, facts and consequences. Competence and decision-making capability is important for the clinician to evaluate for if he/she has ability to act reasonably. If not then on his or her own behalf requires an agent to act for him or her. Confidentiality and reporting laws, as codified in the Hippocratic Oath, “whatever I see or hear professionally or privately, which ought not to be divulged, I will keep secret and tell no one.” Diagnostic disclosure depends upon; 1] the capacity of persons to understand and appreciate the diagnosis, 2] their expressed desire to know what is wrong, 3] and the emotional and moral impacts that this knowledge may have. Informed consent is the process by which the patient determines whether to accept or refuse the treatment offered by a physician or another clinician. Advance care planning is discussing and may documenting their preferences for future medical care thereby preserving patients’ autonomy even after they have lost the decision making capacity. Goals of care; cure, life prolongation, participation in future events, remain independent, maintain clear thinking, maximize comfort. Conclusion: One helpful intervention is for the team to talk about the case and the aspects of the case that are giving each of them moral distress. To assess decision making capacity is to whether they can demonstrate the ability to communicate a choice, is patient understanding his or her condition and the relevant facts, can the patient understand the available options and consequences of his or her decision making, is decision based on patients’ consistent values/preferences. Confidentiality has several exceptions to an ever more complex society. Diagnostic disclosure leads to an understanding and appreciation of the illness. Adequate information should be given to get informed consent. Advance care planning use advance directive mechanism.
Keywords: Decision-making, ethical, geriatric population
| Poster 174 | | |
| Effect of Spiral Suit and Exercises to Improve Motor Functions of 5 Years Old Male Quadriplegic Cerebral Palsy Child: A Case Study | | |
Nivedita Sing Bele, Mohd. Irshad Qureshi
Department of Neurosciences, RNPC, DMIMS (DU), Sawangi (Meghe), Wardha, Maharashtra, India
Introduction: Cerebral palsy is a common developmental disability first described by William Little in the 1840s. Cerebral palsy is primarily a disorder of movement and posture. It is defined as an “umbrella term covering a group of non-progressive, but often changing, motor impairment syndromes secondary to lesions or anomalies of the brain arising in the early stages of its development”. CP is a common problem, the worldwide incidence being 2 to 2.5 per 1000 live births. There is a substantial overlap of the affected areas. In most studies, diplegia is the commonest form (30% - 40%), hemiplegia is 20% - 30%, and quadriplegia accounting for 10% - 15%. In an analysis of 1000 cases of CP from India, it was found that spastic quadriplegia constituted 61% of cases followed by diplegia 22%. The severity levels of CP were evaluated with the use of the Gross Motor Function Classification System Level (GMFCS). The GMFM-88 is designed to capture alterations in gross motor function in children with CP. It is important to stabilize the part to be treated during exercise including ankle foot orthosis, spiral suit etc. Aim: The aim of this case study is to find out effect of spiral suit and exercises to improve motor functions of 5 years old male quadriplegic cerebral palsy child. Case Study: A 5-years-old male a diagnosed case of quadriplegic cerebral palsy came to the OPD with the complaint of inability to walk, unable to sit without support, inability to hold object, and dependent for his ADLs on his parents. Methods: After signing informed consent, patient was assessed by using Neurological assessment proforma and GMFM-88 and received a Physiotherapy exercise programme including stretching, strengthening, balancing and gait training for the period of once a day for one month. Each session consisted of 40- 45 minutes. Conclusion: This case study concluded that, patient showed improvement in motor functions including sitting, standing, walking and gripping activities.
Keywords: Cerebral palsy, motor functions, quadriplegia, spiral suit
| Poster 175 | | |
| Effect of Electrical Muscle Stimulation and Facial Massage Techniques in Rural Bell’s Palsy Patient: A Case Study | | |
Ashish W. Bele, Mohd. Irshad Qureshi
Department of Electrotherapy and Electrodiagnosis, RNPC, DMIMS (DU), Sawangi (Meghe), Wardha, Maharashtra, India
Background: Bell´s palsy, or idiopathic facial paralysis (IFP), is defined as an acute peripheral palsy of seventh cranial nerve. It is one of the most common neurological disorders which usually manifests with facial weakness, ear pain, taste disturbance, hyperacusis, and increased tearing. The worldwide incidence of IFP is 11 to 40 per 100,000 people annually. The most common causes of the abrupt onset of unilateral facial weakness are stroke and Bell´s palsy. The most common cause of acute onset unilateral peripheral facial weakness is Bell’s palsy. The incidence of Bell’s palsy is 20-30 cases for 100,000 and accounts for 60-70% of all cases of unilateral peripheral facial palsy. Either sex is affected equally and may occur at any age, the median age is 40 years. Aim: The aim of this case study is to find out effect of Electrical muscle stimulator and Facial Massage techniques in rural Bell’s Palsy Patient. Case Study: A 58-year-old male a diagnosed case of unilateral Bell’s palsy came to the OPD with the complaint of deviation of mouth towards the left side, dribbling of saliva from right side of mouth, unable to closed his right eye and lacrimation from eye. Methods: After signing informed consent, patient was assessed by using Neurological assessment proforma and House-Brackmann Scale and received a Physiotherapy programme including Electrical Muscle Stimulation, facial massage and home exercise programs for the period of once a day for six weeks. Each session consisted of 45 minutes. Conclusion: This case study concluded that, patient showed improvement of facial functions along with the improvement in closure of eye, decrease in lacrimation of eye and deviation of mouth.
Keywords: Bell’s palsy, electrical muscle stimulation, facial massage
| Poster 176 | | |
| A Pilot Case Study on the Recommendations for the Use of Botulinum Toxin Type A in Gait Habilitation and Functional Improvement in a 6 Years Female Diplegic Cerebral Palsy Child | | |
Mohd. Irshad Qureshi, Ashish W. Bele
Department of Neurosciences, RNPC, DMIMS (DU), Sawangi (Meghe), Wardha, Maharashtra, India
Introduction: Cerebral palsy (CP) is a group of permanent disorders of the development of movement and posture, causing activity limitation, that are attributed to non-progressive disturbances that occurred in the developing foetal or infant brain. Spasticity is a major challenge for patients with neurological problems. Children with CP always encounter different degrees of movement disorder in the presence of spasticity. Although there are many possible causes of spasticity, most of whom have diagnoses of cerebral palsy; approximately two thirds of all cerebral palsy patients suffer from spasticity. In an analysis of 1000 cases of CP from India, it was found that spastic quadriplegia constituted 61% of cases followed by diplegia 22%. More than 80% of children with cerebral palsy in Hong Kong belong to the spastic type. Spasticity prevents or limits the development of motor function. Chemo-denervation such as using botulinum toxin type A, has proved easier, more effective, and less painful for patients having spasticity. Some results suggest that botulinum toxin type A can be effective in reducing muscle tone over a longer period, but not in preventing development of contractures in spastic muscles. Aim: To find the efficacy of BOTULINUM TOXIN TYPE A in Gait Habilitation & Functional Improvement in spastic Diplegic Cerebral Palsy. Case Study: A 6 year female child was brought to the department diagnosed Spastic diplegic Cerebral palsy with complains of inability to stand & walk and inability to perform activity of daily living independently. Brief history included administration of Botox injection recently followed by above knee plaster cast for 3 weeks. Methods: After signing informed assent, from patient’s parents she was assessed using Gross Motor Function Measure-88 (GMFM-88) and Short Sensory Profile. She received physiotherapy treatment for six months which included Stretching, Swiss ball activity, strengthening of muscles, balance board activities, various activities in sitting & standing and assisted gait training. Conclusion: This pilot study helped to conclude that post botulinum toxin type A injection Physiotherapy is beneficial for children with spastic diplegic Cerebral Palsy with long term benefits, hence it is recommended.
Keywords: Botulinum toxin, diplegic cerebral palsy, gait, habitation
| Poster 177 | | |
| Cardiac Temponade as Initial Presentation of Primary Hypothyriodism: A Case Report | | |
Deep Hathi, Aditya Bhagwat
Department of Medicine, JNMC, DMIMS (DU), Sawangi (Meghe), Wardha, Maharashtra, India
Patient with primary hypothyroidism are often complicated with pericardial effusion(3-6%) but its association with cardiac temponade is rare in medical literature. Here we report an unusual case of 45 year old female who presented with breathlessness and bilateral lower limb edema was found to have primary hypothyroidism with massive pericardial effusion with cardiac temponade. Patient was managed with emergency pericardiocentesis and thyroid hormone replacement.
Keywords: Cardiac temponade, pericardial effusion, pericardiocentesis, primary hypothyroidism, thyroxine
| Poster 178 | | |
| Breaking The Bad News | | |
Kartik Singhai
Academic JR, Department of Psychiatry, AIIMS, Jodhpur, Maharashtra, India
As we mostly refer it to, is often one of the worst nightmares of a medical practitioner. While announcing the death of a close one remains the most dreaded of all, often there are various facets to this heart-wrenching phenomenon. As a psychiatrist, the profession inherently doesn’t expose you to dealing with death and the aftermath quite often. But, nature in its own manner sporadically uncloaks you to unexpected circumstances, sometimes worse than breaking the bad news in its most common form.
What could though, be worse than death of a near one?
It was an usual history of psychosis. The middle aged lady just admitted in the ward, had been now suffering from it for 5 years. Nothing so very different clicked during the usual history taking procedure until the husband uttered about the speech and gait disturbances the patient had developed for the past few months. It still didn’t bother much until a similar history in 3 family members was confirmed, all of them had died at an age earlier than 40. Enter jitteriness.
A Neurology referral was sought, Huntington’s disease was suspected and the sample for genetic testing sent. While the report in itself took time, the gut feelings of the treating team were quite clear , as if the result had already come. 10 days later, the test reports just confirmed the clinical suspicion and more importantly, the intuitions.
The prospect of genetic counselling was deliberated upon by various departments in concern and it was concluded to postpone it to when imperative, since the children of the patient were still very young.
The patient now harbouring a couple of devastating illnesses, with one of them ultimately being nothing but lethal, it was then the turn to explain the husband about the illnesses and the prognosis.
Though various protocols exist to break the bad news to facilitate smooth adjustment to the shock, the whole event in itself is discomforting to clinicians and devastating at the least to the bearer.
The husband was called to a room to get the process undergoing. But before we could move much ahead, the husband had already sensed the situation and he went on
“Jaanta hun sir ki yeh theek nahi ho payegi. Aanuvanshik (genetic disorder) bimari hai, iska koi ilaaj to hai nahi. Iske pita ji, bhaiya aur chacha bhi issi bimari se yeh duniya chod ke gaye the. Isko bhi ab wahi lakshan hai. Iske pass bhi ab shayad jyada saal nahi bache hai. Main to bus itna chahta hun ki baki ka jeewan iska shanti se nikle. Ilaaj ke chakkar main bahut ghum liya , ab isko aur pareshan nahi karna chahta…Bura to lagta hai par ab kar bhi kya kar sakte.
Rahi bacho ki baat…to shayad aisa theek hai…abhi se unko bata kar kya karna ki unhe bhi yeh bimari ho sakti hai…jab samay ayega, jaroorat padegi, to unki bhi jaanchein kara denge”
Apparently coming to terms with the situation so smoothly, thousands of moments of agony must have passed through the troubled man before finally being able to get some reconcilement. He had been juggling and struggling for years now with his wife’s illnesses on one hand and his work and responsibility of the children on the other. All he had now wished for is a few peaceful last years for his wife, very swiftly hiding his pain behind his glowing face.
As for the patient, her psychosis in its truest sense, had brought along with it apathy ( a complete sense of indifference to almost anything) coupled with loss of touch to reality, so very grim in this case. Probably, just probably, nature had blessed her with psychosis to protect her from the dire reality she would have had to face otherwise.
What could then be worse than death of a loved one? Presumably, knowing that a loved one is inevitably facing death at close quarters.
Keywords: Bad news, genetic counselling, psychosis
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