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   Table of Contents - Current issue
Coverpage
April-June 2019
Volume 14 | Issue 2
Page Nos. 57-114

Online since Monday, November 25, 2019

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ORIGINAL ARTICLES  

Knowledge, attitude and practice on uses of plastic products, their disposal and environmental pollution: A study among school-going adolescents p. 57
Najnin Khanam, Vasant Wagh, Abhay M Gaidhane, Syyed Zahiruddin Quazi
DOI:10.4103/jdmimsu.jdmimsu_27_19  
Background: Toxic gases and carcinogens released from manufacturing and burning of plastics cause environmental pollution. Aims and Objectives: The objectives of this study are to study the knowledge, attitude, and practice on uses of plastic products, their disposal and environmental pollution among school-going adolescents. Materials and Methods: The cross-sectional study was undertaken in one of the senior secondary schools of Wardha city. Purposive sampling was done. Seventh standard students who were present on the day of data collection and willing to participate were instructed to fill up the pro forma. Results: The hazards of plastics could be reduced by their reduced usage (75.78%) and reuse at home (41.05%) followed by segregation and proper disposal (12%). Students (26.32%) told that plastics are not biodegradable. Students (37.89%) had knowledge regarding plastic bags banned in Wardha city. Students (35.79%) knew about fine imposed for using plastic bags. Main source of information was school (83.15%) followed by television and radio (80%) and parents (24.21%). Students (65.26%) agreed for ban on plastic bag usage, whereas 69.48% of students agreed to campaign for harmful effect of plastics in daily use. Conclusions: Proper disposal of plastic waste reflected the habit of family is a thrust area which needs to be improved. Good thing is that students are having attitude to give up the use of plastic bags and to aware others about the ill health of using plastics.
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Pattern of utilization of blood and blood components in a teaching hospital p. 61
Atul B Hulwan, Sujata R Kanetkar, Sunil V Jagtap, Pradnya P Kale
DOI:10.4103/jdmimsu.jdmimsu_90_18  
Background: Blood is the most precious and unique gift that one human being can give to another human being. The blood transfusion service is the very vital component of healthcare services. Till date we are not able to prepare whole blood artificially and no effective substitute is invented, so blood donor is very precious. The primary responsibility of blood transfusion services is to provide safe, sufficient and timely supply of blood and blood products. The component separation has maximized the utility of one whole blood unit. The emphasis has shifted from the use of whole blood to component therapy, as blood is a scarce and precious resource. Aim and Objectives: To study Pattern of utilization of blood and blood components in a teaching hospital with the indications for transfusions for different components during the study period. Material and Methods: This observational descriptive study for 18 months (July 2014- December2015) on pattern of utilization of blood and blood components was carried out in the Blood Bank of Department of Pathology in a Krishna Institute of Medical College and Research centre, Karad. Results: There were total 10358 transfusions which were carried out during the study period of 18 months. Whole blood and component utilization was calculated in all these transfusions. Conclusion: It is important for the blood bank to be able to fulfill the demands for this life-saving product and at the same time, evaluate and assess the existing trends of blood ordering. Hence, periodic review and audit of blood component usage is essential to assess the blood utilization pattern in any hospital.
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Hemodynamic changes with intravenous dexmedetomidine and intravenous esmolol for attenuation of sympathomimetic response to laryngoscopy and tracheal intubation in neurosurgical patients: A comparative study p. 67
Bitan Sen, Ashok Chaudhary, Jayashree Sen
DOI:10.4103/jdmimsu.jdmimsu_65_19  
Background: Dexmedetomidine a highly selective α2-adrenoreceptor agonist and esmolol an ultra-short-acting β1-cardioselective adrenergic receptor blocker appear to be quite suitable to control the detrimental effects of laryngeal and tracheal stimulation. The study was conducted to compare the efficacy and safety of dexmedetomidine and esmolol for attenuation of hemodynamic responses to laryngoscopy and intubation in patients of elective neurosurgical procedures under general anesthesia. Materials and Methods: Sixty patients of age 20–60 years, the American Society of Anesthesiologists I and II posted for neurosurgical procedures, randomized into two groups of 30 each to receive dexmedetomidine (Group D): 1 μg/kg and esmolol (Group E): 1.5 mg/kg, both diluted to a total volume of 20 mL with 0.9% saline, infused intravenous over a period of 10 min, before 3 min of induction. Changes in heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), rate pressure product (RPP), any side effects associated with the drugs during the study, i.e., 20 min of intubation, were observed and statistically analyzed. Result: There was no statistically significant difference (P = 0.195) in mean HR between Groups D and E during intubation but from the 1st min after intubation (T1) (0.0001) till 20th min (T20) (0.0041) a statistically significant difference in mean HR, mean SBP (P = 0.0001), mean DBP (P < 0.05), mean arterial pressure (P < 0.05), and mean RPP (P = 0.0001) was observed. Conclusion: Infusion of dexmedetomidine was better as compared to esmolol hydrochloride in attenuation of hemodynamic response to laryngoscopy and tracheal intubation.
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Role of Bethesda system for reporting thyroid lesion and its correlation with histopathological diagnosis p. 74
Deepika Agrawal, Arvind S Bhake, Naincy Rastogi, Sheronica Laishram, Akanksha Wankhade, A Agarwal
DOI:10.4103/jdmimsu.jdmimsu_76_18  
Introduction: Interestingly enough, while TBS is forging ahead to bring about uniformity a thyroid FNA cytology reporting, a similar milestone has also been reported with an application of United Kingdom (UK-RC path system or BTA/RC Path) for reporting thyroid FNA cytology. It achieved practicing activism in 2003 and later got modified in the year 2009 & 2016. The TBS and RC path system being contemporary system of reporting thyroid cytopathology, uniform system of reporting cytopathology of nodular thyroid lesion still is not achieved but activated. Aim: To study the nodular thyroid lesions on FNAC by reporting system of TBSRTC and UK RC Path. Objectives: To compare the categories of the Bethesda system with contemporary categories of UK Royal college of pathologist for cytomorphological diagnosis and overlaps as well as with conventional reporting system and to compare with tissue diagnosis of surgically resected specimen of nodular thyroid lesions for its malignancy risk. Material and Methods: This study is hospital-based observational prospective and analytic study including 255 patients with nodular thyroid lesion. FNAC were carried out with or without under the guidance of sonography. The staining performed were conventional for smears of the aspirate. The smears were classified and categorized by two systems, TBSRTC and UK-RC path system of reporting thyroid lesion. The tissue diagnosis was done for the surgically resected specimens of nodular thyroid lesion in case of patient who underwent surgery. The values of comparative statistics were bought out. Observations: Females predominated over males. The distribution of cases for into the categories of TBSRTC and UK RC Path were as follow: category I/Thy1- 23, category II/Thy2-156, category III/Thy 3a-21/19, category IV/Thy3f-22/24, category V/Thy4-21, category VI/Thy5-16. There were 57 patients underwent surgical intervention in form of total or partial thyroidectomy or lobectomy and had available histopathological examination reports for cyto-histopathology co-relation. Values of comparative analysis show high NPV, PPV and high values of specificity, as compared to conventional. Conclusion: TBSRTC and UK RC path for reporting thyroid cytology are suitable for reporting thyroid nodular lesions on FNAC because of uniformity of nomenclature categories and implication at management with high correlation percentile with subsequent surgically resected specimen of thyroid.
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Evaluation of intensive pulse polio immunization in Solapur District p. 82
AA Dhatrak, Kirti Chaudhary, Brij Raj Singh, Ujwal Gajbe
DOI:10.4103/jdmimsu.jdmimsu_56_19  
Background: Mass immunization campaigns are now an established fact for the eradication of poliomyelitis. Intensified pulse polio immunization (IPPI) campaigns using only a booth-based approach have not been sufficient to interrupt wild poliovirus transmission in different areas, where it is most persistent with low immunization coverage. Since 1995, PPI is conducted in India and IPPI was introduced in 1998. When we are progressing toward polio eradication and ever-increasing efforts are being done to administer polio drops to every eligible child, it has been observed subjectively that an element of fatigue is creeping in the health system and community. Aim and Objective: The objective of the study is to assess the operational aspects and knowledge of staff regarding PPI program. Material and Methods: Study design – A community-based cross-sectional study. Setting – Six taluks of Solapur district – Mangalwedha, Sangola, Barshi, Mohol, Pandharpur, and Madha. Study period – October 24–30, 2010, and November 21–27, 2010, i.e., 2 weeks. Sample studied – 174 booths, 359 parents, 1289 houses, and 3162 children under 5 years of age. Result: Out of 174 booths, 94.83% booths were easily accessible and IEC material displayed prominently on 85.06% booths.. Regarding source of information of IPPI, 38.16% parents got information from health workers followed by poster. Placement of teams at transit sites, teams were adequate at 80.77% sites, shifting timing appropriate at 88.46%, deployed member present at site in only 76.92% booths and supervisor cross checking the work of teams at only 50% booths. More than 85% of total booth workers were trained. On post booth day activity, in migrant's population 11.97% children were unimmunized whereas in settled population it was 2.32%. Percentage of unimmunized children in migratory population was more than settled population which is statistically highly significant. Conclusion: Special attention is required toward immunization of migratory populations, including slums with migration, nomads, sugar cane cutters, brick kiln workers, also construction site workers and also on transit sites including bus stand, railway stations, mela sites, and weekly bazaars. The role of local media and mass communication programs should be worked out and organized in a more systemic manner. Use of mass media must be done to motivate people for immunization. Supervisor work needs to improve. Community participation should be view as one of the key component for the success of the program. More voluntary agencies, persons, local leaders, and nongovernmental organizations should be motivated to come forward and work for this noble cause.
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Transvaginal sonography and elastography evaluation of ectopic pregnancy p. 86
Suresh Phatak, Deepti Shrivastav, Gulam Marfani, Sakshi Daga, Kaustubh Madurwar, Samida Samad
DOI:10.4103/jdmimsu.jdmimsu_13_19  
Aim: The aim of the study is to assess the effectiveness of ultrasound and elastography in the detection of ectopic pregnancy in women presenting for ultrasound with a clinical suspicion of ectopic pregnancy. Subjects and Methods: Prospective analysis of 40 women presenting for sonography over a 2.5-year period was performed. Women were classified as having a confirmed ectopic pregnancy on the basis of surgery and laparoscopy. Results: The sensitivity and specificity of transvaginal ultrasound for the detection of confirmed ectopic pregnancy was 95.2% and 94.4%, and accuracy was 94.9%. Elastography revealed one case of ectopic pregnancy which was not diagnosed on sonography. Blue eye sign was positive in 100% of patients with transvaginal elastography. Conclusions: Transvaginal sonography elastography in the radiology setting of a tertiary hospital has excellent diagnostic performance for the detection of ectopic pregnancy.
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Student participation in assessment: A strategy for improving learning p. 90
H Shyamala Hande, Jessica Sushma D'Souza, Surekha R Kamath
DOI:10.4103/jdmimsu.jdmimsu_2_19  
Background: It is well known that framing of questions can be a valuable learning exercise. The designing of questions requires knowledge and understanding of the subjects being taught. We designed a study to improve the student understanding of the basic human functions, in the physiology class, whereby 1st-year medical students were asked to create multiple true-false (MTF) questions, based on their learning objectives. Aim: The present study was undertaken to find the effectiveness of question construction as a strategy for learning. Methods: The current study was conducted on 1st-year medical students (n = 222) of Melaka Manipal Medical College, Manipal Academy of Higher Education, Manipal, India. The study was conducted in one of the muscle physiology revision classes, where students were asked to prepare a set of MTF questions. Following the activity, the questions prepared by the students were collected and analyzed by the subject experts. A questionnaire with ten questions, on a 4-point Likert scale was administered to the student groups to understand perceptions of this activity. The pre- and postclass tests were conducted and scores were computed and analyzed. The comparison of scores was done using Student's t-test. Results: The MTF questions prepared by students showed that the majority of the MTF questions tested knowledge (23.5%) and comprehension (45%). However, 20% of the MTF questions were in the application level and 11.5% of the questions produced had ability of testing higher-order cognitive skills. The student feedback regarding the construction of MTF questions revealed that activity helped them in better understanding of muscle physiology (70%), increased their critical thinking skills (62.5%), and helped them to revise the muscle physiology in a short duration of time (85%). There was no statistical significance between the pre- and postclass test scores. However, 115 (52%) students scored better in posttest than pretest. Conclusion: Our current study results revealed that the interest and active participation of 1st-year medical students in question setting was proved to be an activity which encouraged active learning. This student learning activity is adaptable to all systems in physiology and to other subject specialties.
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Predictive value of glasgow coma score and its components in interpreting outcome in trauma patients Highly accessed article p. 94
V Anil Kumar, Prashant Bhandarkar, Nobhojit Roy, Vineet Kumar, Jyoti Kamble, Amit Agrawal
DOI:10.4103/jdmimsu.jdmimsu_16_18  
Background: Glasgow coma score (GCS) are widely used as primary diagnostic tool in trauma cases. In literature study of GCS is seen to be addressed in specific trauma context such as traumatic brain injury, ischemic trauma, and neurotrauma. GCS score on admission is said to be associated with survival of trauma patients. Aims: This study aims to evaluate the efficacy of GCS and its components, eye, verbal, and motor response in all types of trauma in multicenter trauma database in India. Settings: Towards Improved Trauma Care Outcome (TITCO) registry conducted in four city government hospitals in India. Materials and Methods: TITCO database contains information of 16,047 patients, we included 13,836 patients with valid GCS and its components score in this study. The total GCS score is classified as mild (>12), moderate (9–12), and severe (<9). Logistic regression is applied considering GCS and components as independent with overall mortality as a dependent variable. Receivers operating characteristic (ROC) curve is drawn to evaluate the efficacy of GCS and components. Results: Compared to severe GCS score, moderate and mild GCS score is found to have better chances of survival with odds of 6.45 and 17.25, respectively. Similar results are found to be replicated in cases eye, verbal, and motor response. Motor component appeared as a better predictor than eye and verbal response. Area under the curve of ROC was 0.813, 0.775, 0.791, and 0.798 for GCS total, eye, verbal, and motor response, respectively. Conclusions: GCS and components are appeared as the best indicator of predicting overall mortality in all the trauma cases.
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CASE REPORTS Top

Prosthetic rehabilitation for hemimaxillectomy p. 99
Sharayu Nimonkar, Vikram M Belkhode, Seema Sathe, Anjali Borle
DOI:10.4103/jdmimsu.jdmimsu_40_19  
All the acquired maxillary defects are caused due to the surgical resection of malignancies of the palate and paranasal sinuses. Their extent of resection influences the treatment outcome and also challenges a maxillofacial prosthodontist to restore them prosthetically. Obturator prosthesis is a common and effective way of rehabilitating such maxillary defects. The aim of this prosthesis is to distinct oral and nasal cavities to facilitate deglutition and articulation, to achieve acceptable esthetics, and to support orbital contents to avoid diplopia. This case report describes a definitive obturator prosthesis treatment for a young female patient who has undergone hemimaxillectomy for palatal malignancy.
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Benign fibrous histiocytoma of male breast: Ultrasonography, doppler, and elastography imaging with pathological correlation p. 103
Kaustubh Anil Madurwar, Suresh Vasant Phatak
DOI:10.4103/jdmimsu.jdmimsu_44_18  
Benign fibrous histiocytoma is a benign soft tissue tumor that can occur anywhere in the body, commonly in the dermis and rarely in the deep soft tissues and parenchyma organs. High-frequency ultrasound and Doppler ultrasound can help us characterize the tumors. Sonoelastography is a new improvement of ultrasound technique which is used to characterize soft tissue masses of the breast, thyroid, and lymph nodes, which can be used to identify the nature of pathology. Here, we report a case of benign fibrous histiocytoma in male breast, and ultrasound, Doppler, and sonoelastography features are discussed.
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Choroidal melanoma in a young patient ultrasonography and magnetic resonance imaging p. 106
Konika S Chaudhary, Suresh Vasant Phatak
DOI:10.4103/jdmimsu.jdmimsu_48_18  
Most common primary intraocular malignant tumor of an adult is choroidal melanoma. It is found rarely in general population. It is usually found in the sixth decade of population. Diagnosis of choroidal melanoma is made by fundoscopy, ultrasonography, and magnetic resonance imaging. Here, we report a case on choroidal melanoma and its imaging features are also discussed.
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Large bladder stone formed over suprapubic cystostomy catheter leading to renal failure: An uncommon complication p. 109
Gaurav Kochhar, Sharanabasappa Baburao Rudrawadi, Prateek Jugalkishore Laddha, Prathik Ramadev
DOI:10.4103/jdmimsu.jdmimsu_92_18  
Urinary bladder stones commonly develop in sitting of bladder outlet obstruction and infection. We had one patient who had large bladder stone causing renal failure, which is an uncommon complication. The patient had a suprapubic cystostomy catheter inserted for urethral stricture two years back. This case highlights the uncommon complication of urinary bladder stone and the importance of proper patient education.
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Epidural analgesia for a 36-week parturient with severe mitral stenosis and pulmonary edema for spontaneous vaginal delivery p. 111
S John Paul, Srinivasan Parthasarathy
DOI:10.4103/jdmimsu.jdmimsu_54_19  
A 26 year old near-term pregnant patient with severe mitral stenosis and pulmonary edema presented to us with labor pain. After starting her on oxygen, diuretics, we provided labor analgesia with a combination of low-dose epidural local anesthetics with fentanyl. The conduct of the delivery was uneventful. We recommend the use of labor analgesia to attenuate the response of pregnancy and labor on the cardiovascular system, especially in parturients with valvular disease like mitral stenosis. We also state that a multidisciplinary approach is necessary in handling such sick parturients.
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IMAGES Top

Keratinizing variant of pleomorphic adenoma p. 113
Treville Pereira, Subraj Shetty, Swati Gotmare, Sandeep Kale
DOI:10.4103/jdmimsu.jdmimsu_9_18  
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