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CASE REPORTS
The partial pressure of oxygen in arterial blood: A relation with different fraction of inspired oxygen and atmospheric pressures
NK Agarwal, Sumit Trivedi
October-December 2017, 12(4):280-283
DOI:10.4103/jdmimsu.jdmimsu_31_18  
As an anesthesiologist and critical care intensivist, it is mandatory to have thorough knowledge of variable partial pressure of oxygen, at different fraction of inspired oxygen (FiO2), and effect of various atmospheric pressures in alveoli, diffusion, and transport of oxygen to tissue. The partial pressure of oxygen in arterial blood gas shall always be expressed with respect to the atmospheric pressure and FiO2; unless these conditions are mentioned, one may not be able to assess the exact respiratory status of patient.
  4,998 212 -
ORIGINAL ARTICLES
System Analysis of Biomedical Waste Management Across Health Care Clinics of Udupi Taluk
Greeshma Tony, Naveen Kumar, Brayal Dsouza, Rajesh Kamath, Sagarika Kamath
October-December 2018, 13(4):199-201
DOI:10.4103/jdmimsu.jdmimsu_94_17  
Background: Improper Biomedical Waste (BMW) management by healthcare facilities can pose severe hazardous effects on the larger population, the environment, and its resources. Due to resurgence in number of clinics in urban areas, there is need to understand the practices and compliance to BMW management. It can be understood by studying and observing their practices and processes of BMW management and understanding the knowledge, attitude, and practice among the staff in the clinics. Aim: The objective of the study was to analyze the BMW management process across the healthcare clinics in Udupi taluk. Methods: A cross-sectional, observational study was conducted using self-administered questionnaires and checklists across 15 clinics in Udupi taluk. The sample size is 130 out of which Doctors, Nurses, housekeeping staff and descriptive Statistics were reported. Results: Of the 15 clinics only eight of them had basic requirements of BMW management; lack of trained workforce, non-compliance to segregation of waste, and non-compliance to collection and storage of waste are seen among majority of the clinics. Other findings during our study are 73.3% had inadequate transportation facility, while only 13.3% had adequate storage space. Doctors and nurses had 100% knowledge and positive attitude, environmental health workforce (housekeeping staff) had poor knowledge and attitude.
  5,024 162 -
Mentolabial sulcus: An esthetic-based classification
Dinesh Rokaya, Bishwa Prakash Bhattarai, Kanokwan Suttagul, Dashrath Kafle, Manoj Humagain
January-March 2018, 13(1):16-19
DOI:10.4103/jdmimsu.jdmimsu_80_17  
Objectives: The objectives of this study were to study the mentolabial sulcus in Nepalese, to compare the sulcus between male and female, and to classify the sulcus according to the angle. Materials and Methods: This study was conducted in 160 university students (65 males and 95 females) between April and September 2016. Photographs of all the students were taken using a digital camera. Mentolabial sulcus angles were measured from the lateral photographs using an angle instrument. The data were analyzed using SPSS 22. The comparison of sulcus between male and female was done using two-sample t-test at 95% confidence interval. Results: The mean mentolabial sulcus angle in Nepalese was 118.19° ±12.28° (male: 119.43° ± 9.99° and female: 117.61° ± 13.23°). There was no statistically significant difference of sulcus angle between males and females (P = 0.098). The sulcus was classified as deep, average, and shallow in males and females. In total students, the average was more predominant followed by deep and shallow. Conclusions: The mean mentolabial sulcus angle in Nepalese was 118.19° ± 12.28°, in male was 119.43° ± 9.99°, and in female was 117.61° ± 13.23°. The sulcus was classified as deep, average, and shallow. There was no statistically significant difference of sulcus angle between males and females. The average type of sulcus was more predominant in Nepalese.
  4,878 298 1
Morphometric measurement of fetal femur length for the prediction of gestational age in the IInd and IIIrd trimester of pregnancy by ultrasonography
Monalisa Roy, Ujwal L Gajbe, Brij Raj Singh, Priti Thute
July-September 2017, 12(3):187-190
DOI:10.4103/jdmimsu.jdmimsu_71_17  
Introduction: Femur length (FL) is a fetal biometric parameter used for estimation of gestational age. Gestational age determination by ultrasonography (USG) is very essential as it gives an accurate estimation. Aim and Objectives: This study is an attempt to measure FL of the fetus for the prediction of gestational age in the IInd and IIIrd trimester of pregnancy by USG. Materials and Methods: Five hundred pregnant women in the IInd and IIIrd trimester with the single live fetus and having no other complications either in mother or fetus, were selected for the study. Fetal FL was measured, and results were analyzed for accuracy in estimation of gestational age and were compared with findings of other workers. Observation and Results: Gestational age estimated from FL in 500 cases between 20 and 36 weeks of gestation showed that in the mean FL in each week of gestation the maximum difference of ±0.7 mm was found in the IInd trimester and ±2 mm was in the IIIrd trimester. The accuracy of the correctly diagnosed cases and P value decreases as pregnancy advance. Conclusion: Sonographic examination was found to be effective to assess the accurate FL parameter for different weeks of gestation. FL was found to be more appropriate in predicting gestational age in the IInd trimester and its reliability decreases in the IIIrd trimester.
  4,347 214 -
Assessment of maternal and perinatal outcome in postdated pregnancy
Ritika Bhriegu, Manjusha Agrawal, C Hariharan
January-March 2017, 12(1):35-40
DOI:10.4103/jdmimsu.jdmimsu_20_17  
Objective: To study maternal and neonatal outcome in postdated pregnancies. Study Design: Prospective observational study. Results: Of 100 cases 79(79%) cases were under 20 to 25 years, majority cases were primigravida (62%), overall caesarean rate was 34%, Meconium stained liquor with fetal distress was the most common indication for LSCS 8(23.5 %) , fetal distress was the most common fetal complications, rate of NICU admission was 33.33% at 41 weeks 1 day to 42 weeks, rate of induced labour is 71.43% at 41 weeks 1 day to 42 weeks. Conclusion: In our study we concluded that prolonged pregnancy was associated with significant risk of perinatal complications like fetal distress, meconium aspiration syndrome and IUGR. There was significantly increased risk of obstetric complications like oligohydramnios, perineal tear, atonic pph and shoulder dystocia.
  3,598 444 -
A comparative study of cilostazol and pentoxifylline in intermittent claudication in peripheral arterial disease
Kshitij Gupta, Chandrashekhar Mahakalkar, Meghali Kaple, Swati Deshpande, Prateek Ladhha, Niket Jain
January-March 2017, 12(1):11-16
DOI:10.4103/jdmimsu.jdmimsu_13_17  
Aims: A comparative study of Cilostazole and Pentoxifylline on intermittent claudication in patients of peripheral arterial disease. Materials and Methods: A total of 70 patients clinically proven occlusive peripheral arterial disease admitted at wards of General Surgery at Acharya Vinoba Bhave Rural Hospital, Sawangi, Wardha. It was prospective study the patients were randomized in two groups in 1:1 ratio. The randomization was done using a random allocation sequence generated by computer program and sequential patient consenting to participate in the study was allocated in the respective treatment arms - Cilostazole and Pentoxyphylline per the allocation sequence. Group I Patients (n=35) were administered Tab. Pentoxifylline 400 mg thrice a day; Group II (n=35), Tab Cilostazol 100 mg twice a day. History, clinical examination, all routine investigation including lipid profile, color Doppler study of lower limb and Angiography of lower limb vessels was performed at the start of the trial. Patients were re-evaluated at the time of enrolment and at 24 weeks for Intermittent Claudication Distance (ICD), Absolute Claudication Distance (ACD), and Ankle Brachial Index (ABI). Results: The group II (Cilostazole Group) showed more rise in intermittent claudication distance and Acute Claudication Distance as compared to Pentoxifylline. There was also statically improvement in ankle brachial index of Group II (Cilostazole Group) as compared to Group I (Pentoxifylline). Conclusion: Thus, the comparative analysis revealed that the efficacy of Cilostazole is more than the Pentoxifylline in increasing the ICD and ACD in patients of occlusive peripheral arterial disease with stable intermittent claudication in patients of peripheral arterial disease.
  3,073 367 -
Effect of music therapy in patients with moderate-to-severe traumatic brain injury
Bobba Ushasree Reddy, P Phanisree, M Priyanka, D Kavitha, S Indira, Prashant Bhandarkar, Veda Dhruthy Samudrala, Amit Agrawal
January-March 2017, 12(1):51-54
DOI:10.4103/jdmimsu.jdmimsu_23_17  
Introduction: Following traumatic brain injury (TBI), there are different innovative approaches to improve or enhance the recovery of brain. Musical therapy has shown promising results in better improvement of TBI patients. Such studies from our country are meager. The present study investigates the effect of musical therapy on TBI patients who have undergone brain surgery. Methodology: It is a prospective study conducted at Tertiary Hospital at Nellore. Moderate-to-severe brain injury patients who have undergone neurosurgery were selected. Three Indian classical ragas were selected and given as follows; Hindola in the morning, Todi in the afternoon, and Kalyani in the evening. The mp3 music was given over earphones at specific time for 30 min duration throughout a week. Vitals parameters such as heart rate, systolic blood pressure (SBP), respiratory rate, pupillary movement, and motor activity of patients were documented before and after music therapy. The SPSS version 20.0 software was used for statistical analysis. Results: Ten selected patients were undergone through predefined session for three times a day with consecutive 7 days. Mean age of the patients was 48.5 (23–71 years) and majority (90%) were male. Two hundred and ten responses of each, like this for ten patients, heart rate changes were observed in 77% with mean change of 0.92 units. On average, 5.20 units heart rate was decreased and 6.20 units increased after music therapy. Changes in SBP were observed in 63%with mean change of 1.36 units. About 9.10 units were lower and 10.95 units were higher after therapy. Nearly 64% responses of patients were changed for respiratory rate, with mean change of 0.13 units. On an average of 3.00 units, respiratory rate was decreased, and 4.22 units increased after musical therapy. Conclusion: The present study reports that musical therapy for TBI patients after neurosurgery has an important role in changing the vitals parameters such as respiratory rate, heart rate, and SBP. Detail prospective studies with larger number of patients are required to get in-depth knowledge on effect of musical therapy.
  3,027 346 -
Correlation between dermatoglyphic pattern of right thumb; learning methodologies; and academic performance of medical students
Satheesha B Nayak, Jeevan Velan, Ng Leong Shern, Loi Fuang Zoung, Abihirami Jeyarajan, Ashwini P Aithal
July-September 2017, 12(3):177-180
DOI:10.4103/jdmimsu.jdmimsu_12_16  
Background: Dermatoglyphics is developing its importance in everyday life and researchers are keen to unveil various unknown aspects of dermatoglyphics in biology, anthropology, genetics, and medicine. The present study was conducted to assess the relationship of thumbprint, learning methodologies, and academic performance of medical students. Methodology: A total of 143 medical students voluntarily participated in this study. Ethical committee clearance was obtained before the study. Validated questionnaires were distributed to the students, and their right-handed thumbprints were collected simultaneously. The data were analyzed using Microsoft Excel. Results: The most common dermatoglyphic pattern observed among the students was whorls. Malays, Malaysian Indians, and Chinese mostly had whorl pattern, while among the Sri Lankans the most common pattern was radial loop. A high percentage of students with ulnar loop scored distinction while students with other patterns mostly scored pass marks. Active learning strategies such as bringing reference books to class, revising previous chapters before class, taking notes in class, surfing internet for learning was seen mostly among the students with ulnar loop. Conclusion: Most of the students with whorl pattern were either in low or average scoring groups. Individuals with ulnar loop were significant for this study as they had higher scores and better learning methodologies compared to other students.
  2,960 278 -
Cholangiohepatitis: Radiological spectrum of the disease amid the rising prevalence in India: A case study in a tertiary institute in South India
Sonali Dattatray Prabhu, Dattatray A Prabhu, Sandeep N. R Gopal Krishna, Ashwini Kumar, Santosh P. V Rai, Ajit R Mahale
October-December 2017, 12(4):261-268
DOI:10.4103/jdmimsu.jdmimsu_34_17  
Introduction: There is a rising incidence of Oriental cholangiohepatitis (OCH) also known as recurrent pyogenic cholangitis (RPC), in Indian population. The condition which presents with classical triad of recurrent upper abdominal pain, obstructive jaundice and fever is characterized by biliary sludge, intrahepatic bile duct calculi, strictures, duct dilatation and cholangitis resulting from chronic biliary parasitic infestation and associated chronic secondary portal bacteremia. Aim: The purpose of this retrospective study was to understand the spectrum of radiological manifestations of oriental cholangiohepatitis by MRI which helps in differentiating it from other differential causes of biliary obstruction and cholangitis. Materials and Methods: This was a retrospective study of cases of oriental pyogenic cholangitis diagnosed by MRI over a period of 3 years in department of radio diagnosis who were referred from gastroenterology department with clinical suspicion of cholangitis and diagnosed as having OCH based on MRI finding's and later confirmed by ERCP or biochemical parameters. Results: Out of the total 950 MRCP scans evaluated, 150 cases were of suspected cholangitis and only 9 cases had features of oriental pyogenic cholangitis. These patients showed the characteristic MRCP finding's like ductal changes including intraductal calculi with dilatation and strictures in RHD and LHD, segmental and subsegmental IHBRs and in extrahepatic biliary tree i.e. CHD and CBD with decreased arborization of peripheral biliary radicals; wall thickening in biliary tree and pneumobilia; and parenchymal abnormalities like fatty liver, hepatomegaly, segmental atrophy or diffuse liver atrophy. Complications like portal hypertension, splenomegaly and ascites that occur were also observed. Though literature mentions complications like hepatic mass/SOL i.e. hepatic abscess or malignancy, we didn't have any in our case series. Conclusion: To summarise, presence of hepatolithiasis and choledocholithiasis with significant biliary duct dilatation and short segment strictures in the biliary tree with peripheral IHBR pruning, usually in the absence of gallstones on MRCP is nearly pathognomonic of oriental pyogenic cholangitis in patients presenting with classical clinical triad of abdominal pain, jaundice and fever and obviates the need for diagnostic ERCP.
  2,962 258 -
Study and correlation of clinical, radiological, cytological, and histopathological findings in the diagnosis of thyroid swellings
Anuja Raniwala, DD Wagh, Ashwini Dixit-Shukla, Ninad Shrikhande, Mangesh Padmawar
April-June 2017, 12(2):138-142
DOI:10.4103/jdmimsu.jdmimsu_61_17  
Objectives: To study the clinical profile of patients with thyroid swellings. To study the radiological findings of these patients. To study the histopathological outcome. To correlate these factors in order to make diagnosis of malignant thyroid swellings in patients more accurate. Study Design: The present study: 'Study and correlation of clinical, radiological, cytological with histopathological findings in the diagnosis of thyroid swellings' was carried out in Jawaharlal Nehru Medical College and Acharya Vinoba Bhave Rural Hospital, Sawangi Wardha from July 2013 to October 2015 It was carried out as a cross sectional observational study involving OPD based patients requiring further management. The sample size was fixed at 60 patients. All the patients of any age and either gender having goitre requiring surgery were included. Every patient was evaluated in terms of detailed history, thorough examination and relevant investigations. Results: Out of 60 patients, 51 (85%) were female and 9 (15%) were males. Maximum i.e. 22 (36.67%) cases belonged to the age group 41-60 years. More than half i.e. 34 (56.67%) of the patients came with a swelling on one side of the neck. 11 (18.33%) patients came with complains of Solitary nodule of Thyroid. The main complaint was anterior neck and was of grade 3 as per WHO Grading in 28 patients (46.67%). The duration of swelling was between 1-7 years in 30 (50%) patients followed by < 1 year in 17 (28.33%) patients. On clinical examination, 53 (88%) were diagnosed as benign and remaining 7(22%) as malignant swellings. Later on FNAC (done under ultra sound guidance), 8 (13%) patients were diagnosed with malignant swellings. Malignancy was noted in 13 (21.67%) cases on histopathology. A correlation between the diagnosis made pre-operatively on clinical examination, USG and FNAC was made with the Gold Standard for diagnosis of malignant thyroid swellings i.e. Histopathology. Conclusion: Goitre was common in females of middle age and majority had single lobe enlargement. Most of them presented with large goitres which were present since many years. On clinical evaluation, the symptoms suggestive of malignancy were pressure symptoms and lymph node enlargement. Multinodular goitre and colloid cysts were the commonest findings on FNAC. FNAC is a reliable tool of investigation for thyroid nodule. Using a thorough clinical examination, ultrasound and FNAC, a surgeon can reliably diagnose malignancy in thyroid glands and choose appropriate surgery for the treatment of the same. Histopathology is gold standard for confirmation of the diagnosis of malignancy post operatively.
  2,891 269 1
Local infiltration anaesthesia for lateral internal anal sphincterotomy; a safe and effective alternative to regional or general anaesthesia
D Kishan, Gayatri Priyanka Gadiraju
July-September 2018, 13(3):130-134
DOI:10.4103/jdmimsu.jdmimsu_46_18  
Background: Chronic fissure in ano is one of the most common anal disorders in all age groups which causes significant distress to the patient even though the disease is benign in nature. Several treatment options are available ranging from medical to surgical of which surgical division of sphincter, lateral internal anal sphincterotomy, is one the most common surgical procedures done to relieve anal sphincter spasm and aid healing of fissure. Most commonly, surgery for fissure in ano is performed under regional or general anesthesia due to severe pain associated with disease. Patient acceptance is also low as the perianal area is very sensitive to pain which may be aggravated by patient positioning during surgery. Materials and Methods: This is a prospective study was done in Osmania General Hospital over a period of 3 years in patients who were treated in our unit with acute and chronic fissure in ano. All patients were counseled regarding disease and treatment options. Informed and written consent was obtained from all patients willing to undergo sphincterotomy under local anesthesia. These patients include females and males >15 years of age and also patients having medical comorbid conditions, such as chronic obstructive pulmonary disease, uncontrolled diabetes, and others in whom surgery under regional or general anesthesia was deferred or contraindicated due to high risk. Results: All lateral internal anal sphincterotomies were performed under local anesthesia. There was significant pain relief following surgery. Intraoperative complications related to administration and drug, and surgery were negligible, and the duration of surgery was very less compared to regional or general anesthesia cases. Patient acceptance was also very good as local anesthesia provided good pain relief during and after surgery and fissure healing rates were high with less complications and no recurrences. Conclusion: Local infiltrative anesthesia is a very effective and safe form of anesthesia for lateral anal sphincterotomy for acute and chronic fissure in ano in terms of minimal complications, ease of giving anesthesia, and cost-effective as no extensive pre-operative preparation and investigations are required. It can also be safely administered in all age group, and also in patients with medical comorbid conditions which precludes administration of spinal or general anesthesia.
  2,903 182 -
Internet addiction and its correlates among undergraduate college students in Udupi Taluk, Karnataka
Binita Sharma, Lena Ashok, Varalakshmi Chandrasekaran, Ashma Monteiro
April-June 2018, 13(2):95-99
DOI:10.4103/jdmimsu.jdmimsu_44_17  
Background: Due to the rapid expansion of technology, internet has become the most vital part of human life and youth are found to be more dependent on it for various purposes. Aim: This study aims to estimate the prevalence of internet addiction and identify its associated factors among undergraduate college students. Materials and Methods: A cross-sectional study design was adopted. A total of 1304 college students were included through convenient sampling. A self-administered questionnaire was used which consisted of a semi-structured pro forma on sociodemographic profile, characteristics of internet usage, Young's Internet addiction test and depression, anxiety and stress test. Descriptive statistics were reported, and Chi-square test was used to assess the relationship between expected outcomes. Results: Out of the total 1304 participants, 716 (54.9%) were females and 588 (45.1%) were females. The mean age of the participants was 19.16 years. The prevalence of internet addiction was found to be 44% and it was significantly associated with factors such as gender, father's occupation, mother's education, availability of personal gadgets, use of smartphone, exposure to internet at young age; and with increase in internet addiction, there was subsequent increase in the level of depression, anxiety, and stress. Conclusion: Although internet technology is considered the most effective tool and one is compelled to use it for various purposes, however, every individual should be able to recognize the point where internet starts to overrule one's life and further hinders other activities of daily living.
  2,709 304 -
A clinical study of self-stigma among the patients of schizophrenia and alcohol dependence syndrome
Lipsy Modi, Imran Ali Shivji, Prakash B Behere, Kshirod K Mishra, Pradeep S Patil, Arvind Goyal
July-September 2017, 12(3):161-165
DOI:10.4103/jdmimsu.jdmimsu_104_17  
Background: Most patients with mental illness hesitate to use health services mainly because of two reasons. First, they do not want to be labeled as a “Mental Patient” and second to avoid the consequences associated with stigma. With this study, we intend to compare self-stigma between two illnesses and correlate it with sociodemographic and clinical variables. Materials and Methods: The study was conducted on consecutive male and female patients (50 with a diagnosis of schizophrenia and 50 with alcohol dependence syndrome as per International Classification of Diseases-10 diagnostic criteria), evaluated on sociodemographic pro forma and Internalized Stigma of Mental Illness Scale. Results: The total stigma scores were significantly different for all the three age groups, being more in the patients of age <30 years (2.78 ± 0.51) than the patients of other age groups. Furthermore, patients belonging to rural locality (2.77 ± 0.41) had higher scores than the patients from urban locality (1.92 ± 0.49). Patients with alcohol dependence syndrome (2.66 ± 0.54) had significantly higher total stigma scores than patients with schizophrenia (2.29 ± 0.59). However, patients with schizophrenia (2.55 ± 0.39) had higher scores on subscales of stigma resistance than of patients with alcohol dependence (2.34 ± 0.51). Conclusion: Patients with alcohol dependence experience higher level of self-stigma as compared to patients suffering from schizophrenia. Future research in stigma needs to be clinically driven and should help to develop standards of care because self-stigma acts as barrier which prevents people with mental illness to use health services consequently affecting the course and prognosis of their illness.
  2,561 305 -
Prevelance of tobacco use among school children reporting to dental hospital for treatment
Utkarsha Basakhetre, Ashish Jaiswal, Shravani Deolia, Sourav Sen, Malsawm Dawngliani, Arpan Jaiswal
October-December 2017, 12(4):242-245
DOI:10.4103/jdmimsu.jdmimsu_28_18  
Objective: The objectives of this study are to study the pattern of tobacco use in Indian school children aged 10–15 years in Wardha district and to study the role of psychosocial factors in initiation and prevention. Materials and Methods: A descriptive questionnaire cross-sectional study to evaluate the patterns of tobacco use in India among school children aged 10–15 in Wardha district. Results: Of the total of 1000 children selected, 5.9% were tobacco users and out of these 3.7% claimed to be addicted to it. Among the habitués, the mean age of initiation of tobacco use was 11.65 ± 2.62. The possible causes being peer pressure (35.08%), tension (49.12%), to achieve the aim (5.26%) and influence from parents (10.52%). Among the habitués, a mean number of 2.71 ± 2.03 children were using tobacco regularly with the range of 1–5 times per day. Conclusion: The peer group influence was the reason for initiating this habit in majority of the users. It is better to prevent the initiation of the habit than trying to stop the habit. The present study suggests the need for school-based tobacco prevention programs. Joint efforts from family, school, and social welfare groups are needed to address these factors for effective prevention, in addition to raising awareness against tobacco use among the school students.
  2,524 291 1
An epidemiological study of acute malnutrition in children of age 6 months to 5 years in an Urban Slum of Mumbai, Maharashtra
Durgesh Prasad Sahoo, Armaity Dehmubed, Mahesh B Jajulwar
July-September 2017, 12(3):181-186
DOI:10.4103/jdmimsu.jdmimsu_31_17  
Introduction: Malnutrition continues to be one of the major causes of morbidity and mortality among under-five children in developing countries. There are numerous factors that directly or indirectly affect the nutritional status of the children. Aim: This study aims to study the prevalence and associated risk factors of acute malnutrition in children 6 months to 5 years of age in an urban slum. Subjects and Methods: This community-based cross-sectional study was carried out in an urban slum in Mumbai. A total of 270 children of age 6 months to 5 years were enrolled in the study. Samples were selected by simple random sampling from various sectors. All mothers/informant were interviewed, and anthropometric measurements were recorded. Data were analyzed using SPSS version 20.0 and Chi-square test was used to find out the association between two qualitative variables. Results: The prevalence of underweight, stunting, and wasting were 52.2%, 42.2%, and 50.4%, respectively. The factors associated with acute malnutrition were age of the child, mother's educational status, occupation of mother, type of family, socioeconomic status, age at marriage below 18 years, children who were given prelacteal feeds, were not exclusively breastfed and were partially immunized. Conclusions: The findings of the present study revealed that higher prevalence of acute malnutrition was found in the children of urban slum in Mumbai. Socioeconomic development along with counseling on breast-feeding practices and nutrition education among the urban slum masses needs to be ensured which is an important factor to combat malnutrition.
  2,425 299 -
Oral treatment of urinary tract infection: Could the answer lie in a sachet?
Simit Kumar, Maitreyi Bandyopadhyay, Abhishek Sengupta, Manas Kumar Bandyopadhyay, Prabir Kumar Mukhopadhyay, Mitali Chatterjee
July-September 2018, 13(3):135-139
DOI:10.4103/jdmimsu.jdmimsu_96_17  
Introduction: Fosfomycin trometamol is a phosphonic acid derivative, which acts primarily by interfering with bacterial peptidoglycan synthesis with broad spectrum of activity against agents causing urinary tract infections (UTIs) with good antibiofilm activity and limited reports of resistance. There are limited studies from India regarding the efficacy of the drug, so the study was conducted to determine the in vitro efficacy of fosfomycin. Materials and Methods: Two hundred and thirty nonrepetitive urinary isolates over a period of 4 months were included in the study. Antibiotic susceptibility and extended-spectrum β-lactamase (ESBL) detection following the Clinical and Laboratory Standards Institute guidelines were performed. Results: One hundred and seventy (73.91%) out of the 230 urinary isolates were sensitive to fosfomycin in our study with equivalent efficacy among outdoor and indoor patients. Among the Gram-positive isolates, 34 (60.71%) out of 56 isolates were sensitive to fosfomycin. Among the Gram-negative isolates, 136 (78.16%) out of 174 were sensitive to fosfomycin which was higher than other commonly used drugs for UTI. ESBL production did not affect the overall susceptibility to the drug. Conclusion: The convenience of a single-dose regimen, broad range of activity proven in vitro and in vivo, and minimal propensity for promoting resistant pathogens make fosfomycin an attractive regimen for the treatment of complicated and uncomplicated community- and hospital-acquired UTIs. This study also reveals an alarming finding of high level of resistance among Klebsiella spp., which could well turn out to be a limiting factor in the clinical usefulness of this drug, which warrants further clinical studies regarding the drug in India.
  2,450 239 -
CASE REPORTS
Management of endodontically treated teeth with endocrown
Nikita Oswal, Manoj Chandak, Rajesh Oswal, Manali Saoji
January-March 2018, 13(1):60-62
DOI:10.4103/jdmimsu.jdmimsu_38_17  
With multiple options available to restore an endodontically treated tooth, endocrowns represent a simple, conservative, and esthetic alternative to conventional crowns. Endocrown is a one-piece restoration, usually indicated in cases with decreased crown height. The preparation comprises “sidewalk” as the cervical margin and a preparation into the pulp chamber that may or may not extend into the root canals. It prevents interferences with periodontal tissues, due to the presence of supragingival position of the restoration margins. The rationale of this technique is to use the surface area available in the pulpal chamber to assume the stability and retention through adhesive procedures. Principally, endocrowns are full ceramic restorations. A case report is presented here, where a porcelain-fused-to-metal endocrown was fabricated using the similar protocols and clinical procedures.
  2,267 318 1
ORIGINAL ARTICLES
A comparison between intrathecal dexmedetomidine with hyperbaric bupivacaine and intrathecal fentanyl with hyperbaric bupivacaine in lower abdominal surgeries: A prospective double-blinded study
Lyba Ann Varghese, Karuna Taksande
April-June 2017, 12(2):99-109
DOI:10.4103/jdmimsu.jdmimsu_55_17  
Background: The aim of this study is to compare the efficacy and safety of injection dexmedetomidine 5 μg and injection fentanyl when given intrathecally as adjuvant to injection bupivacaine in patients undergoing total abdominal hysterectomy in terms of the following parameters: (1) Characteristics of onset of sensory and motor block. (2) Characteristics of regression of sensory and motor block. (3) Level of sedation (4) Hemodynamic stability as assessed by pulse rate, systolic, and diastolic blood pressure (BP) and requirements of vasopressors. (5) Quality of postoperative analgesia as assessed by visual analog scale. (6) Evaluation of complications associated with injection dexmedetomidine and injection fentanyl when used as an adjuvant to injection bupivacaine. Materials and Methods: Ninety patients of the American Society of Anesthesiologists Class I and II posted for lower abdominal surgeries were allocated randomly into three groups of thirty patients each. C group: (n = 30) received 0.5 mL normal saline with hyperbaric bupivacaine 17.5 mg in 3.5 mL to make 4 mL. D group: (n = 30) received dexmedetomidine 5 μg with hyperbaric bupivacaine 17.5 mg in 3.5 mL diluted with 0.4 mL normal saline to make it 4 mL. F group: (n = 30) received fentanyl 25 μg with hyperbaric bupivacaine 17.5 mg in 3.5 mL to make 4 mL. Results and Conclusion: We observed that the groups were comparable with respect to demographic data (age, weight, height and duration of surgery) and onset time of sensory and motor blockade. The onset of sensory and motor block was slightly delayed in both groups. Two segment regression time of sensory blockade and time to reach Bromage scale 0 was greatly significant in dexmedetomidine and fentanyl. However, in comparison of the two, dexmedetomidine was clearly superior. The groups were comparable in terms of hemodynamic parameters, oxygen saturation, and respiratory rate, though there had been a statistically significant fall in BP and heart rate when compared to baseline. Sedation scores were found to be statistically significantly higher in group dexmedetomidine as compared to Fentanyl. The results showed statistically significant increase in the duration of postoperative analgesia in group using dexmedetomidine as compared to group fentanyl. The requirement of first rescue analgesic was greatly significant. The group using fentanyl had an postoperative pain free period of unto 4 h and dexmedetomidine had analgesia period unto 7 h. We found some adverse effects such as hypotension, bradycardia, nausea and vomiting with dexmedetomidine and fentanyl; however, the results were statistically insignificant. To conclude, the addition of dexmedetomidine prolonged the sensory and motor block significantly when used with hyperbaric bupivacaine intrathecally, to a much greater extent to the addition of fentanyl without increasing the incidence of significant adverse effects.
  2,251 276 -
A comparative study of scalpel versus surgical diathermy skin incisions in clean and clean-contaminated effective abdominal surgeries in AVBRH, Wardha, Maharashtra, India
Noopur Priya, YR Lamture, Luv Luthra
January-March 2017, 12(1):21-25
DOI:10.4103/jdmimsu.jdmimsu_15_17  
Aim: To study the safety and efficacy of diathermy as a modality to give skin incisions. Study Design: Observational study conducted in department of surgery at AVBRH, over 2 years from 2013 to 2015. Material and Methods: 100 cases were studied. In 50 cases incision was given by scalpel and in 50 incisions was given by diathermy. Primary outcome variable was the incisional blood loss, calculated by measuring the weight of swabs used exclusively during incision until complete hemostasis was achieved. Secondary outcome variables were incision time, operative time, pain verbal rating scale (VRS), wound healing, and wound complications. Incision time was defined as the time from the beginning of skin incision until subcutaneous fat arrived, with complete haemostasis; it was expressed in s/cm2. Severity of pain was defined using VRS. Results: we reported shorter time for skin incision, lesser blood loss during surgery and lesser wound complication in cases of diathermy incision, and has more significant pain reduction as compared to scalpel group. Conclusion: The findings of the present study shows that diathermy seems to provide some benefit with respect to postoperative wound pain and has obvious safety advantages to the surgical team compared with scalpel.
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Comparative study of type I tympanoplasty with or without mastoidectomy in tubotympanic type of chronic suppurative otitis media patients
Disha Amar Methwani, Prasad T Deshmukh
April-June 2017, 12(2):85-88
DOI:10.4103/jdmimsu.jdmimsu_8_16  
Objectives: The aim is to compare the results of type I tympanoplasty alone and tympanoplasty with cortical mastoidectomy in safe chronic suppurative otitis media (CSOM) patients in terms of graft uptake, improvement in hearing and clinical improvement. Study Design: This was prospective study. Materials and Methods: Sixty cases of safe type of CSOM were included in the study. Type I tympanoplasty was done in thirty cases and tympanoplasty with cortical mastoidectomy was done in another thirty cases. Patients were followed up postoperatively at 3, 6, and 12 weeks for graft uptake and any complication. Pure-tone audiometry was done at 6th and 12th week postoperatively to note the hearing improvement. Results: Graft uptake was 76.67% in tympanoplasty alone group and 83.33% in tympanoplasty with cortical mastoidectomy group. In the present study, pre- and post-operative pure-tone average was compared and the statistical difference between tympanoplasty group and tympanoplasty combined with cortical mastoidectomy group was not statistically significant. Recurrence of discharge was seen in 6 cases of tympanoplasty alone group. Although tympanoplasty combined with cortical mastoidectomy is better in hearing yield, graft acceptance rate, and clinical benefit, but the difference in two groups is statistically insignificant. Conclusion: Hearing outcome, graft acceptance rate, and clinical benefit were statistically unequalled in two groups. Tympanoplasty combined with cortical mastoidectomy will not give an additional advantage in terms of hearing gain, disease clearance, and graft uptake.
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Laparoscopic approach to adnexal mass in adolescents: A retrospective analysis
Kavitha D Yogini, Devi Balasubramaniam, Chinnusamy Palanivelu, Amrutha Kakollu
January-March 2017, 12(1):55-60
DOI:10.4103/jdmimsu.jdmimsu_26_17  
Background: Adnexal masses result from benign or malignant lesions of ovarian, tubal and paratubal origin as well as pregnancy related causes such as mullerian anomalies, infectious causes and ectopic pregnancy. The current study aimed to evaluate the preoperative diagnosis, surgical procedure and histopathological findings of adolescent girls who underwent laparoscopic surgery for adnexal mass in our hospital. Materials and Methods: A retrospective chart review of patients with adnexal mass was conducted over a period of one year from Jan 2014-2015. Overall 96 patients were included in the study after reviewing clinical records. In all the patients' malignancy was excluded by preoperative imaging with sonography, CT or MRI and tumor marker study. Results: Laparoscopy was the operative approach for all 96 patients. None resulted in malignant histology. Majority of the adnexal masses were simple cyst (28%), 11.4% were dermoid cyst, 2% were endometriotic cyst. One patient had tubal ectopic, 3 patients had Koch's abdomen and pelvis. Among them one 13 year old girl underwent rudimentary horn excision who presented as a para tubal mass with acute abdomen. Almost half of the patients (68.7%) presented with acute abdomen of which 41.6% were adnexal torsion. All adnexal masses were resected laparoscopically and the outcome was uneventful in all the patients. Conclusion: Laparoscopy is regarded as an appropriate surgical method for benign adnexal masses which was safe and effective even for giant ovarian cyst in well selected cases as most of the pelvic adnexal masses seen in adolescents and young girls are of benign nature.
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Ultra-fast-tracking in cardiac anesthesia “Our Experience” in a rural setup
Manisha Taware, Manish Sonkusale, Rashmi Deshpande
April-June 2017, 12(2):110-114
DOI:10.4103/jdmimsu.jdmimsu_56_17  
Background: Fast-track cardiac anesthesia refers to extubation within 6 h of the end of surgery, whereas ultra-fast-track anesthesia (UFTA) refers to extubation within 2 h of the end of surgery. Objectives: We have tested a protocol for early extubation to see safety, efficacy of ultra-fast tracking, and its cost containment in the present study of forty patients in cardiac surgery department in a tertiary care rural center. Materials and Methods: We have observed in our study the outcome of UFTA on a set of forty patients posted for cardiac surgery, using a protocolized approach and have prospectively noted the duration of mechanical ventilation, extubation time, length of Intensive Care Unit (ICU) stay, rate of re intubation, and other complication. Results: Extubation could be achieved within 30 min in 29 patients (72.5%). Mean length of ICU stay could be cut to 1.6 days (39 h). 55% patients could be mobilized on postoperative day 1, With approximate cost savings of 5000 rupees/patient/day. No cases of reintubation or serious complications noted. Conclusion: Ultra-fast-tracking is found to be feasible in our cardiac surgical setup. It is safe in all age groups, with proper selection of cases and rational utilization of available resources, besides it is found to be cost-effective.
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Significance of differentiation of round cell count in semen in infertile men: A cost-effective study
Seema Balasubramaniam, Vishrabdha Rahul Pawar
October-December 2018, 13(4):190-194
DOI:10.4103/jdmimsu.jdmimsu_32_17  
Background: The significance of the presence of immature germ cells (IGCs) and leukocytes in semen have not very frequently been highlighted in the diagnostic criteria of male infertility. Round cell count differentiation aids in better clinical correlation. Aim and Objectives: To differentiate the round cells into IGCs and leukocytes in the semen and to find their correlation with the total sperm count and sperm motility. Materials and Methods: Semen samples from patients at Bharati hospital, Sangli for evaluation of infertility from July 2014 to January 2015 were analyzed as per the WHO criteria. After the consent and collection of the semen sample, routine semen analysis was done. Smears of semen were prepared and stained by Leishman stain. The round cells were counted and differentiated into IGCs and leukocytes. Results: We studied 103 cases. Semen parameters such as total sperm count, motility were noted. The smears were studied for differential counts of round cell count into IGC count and leukocyte. The cases were divided into four groups based on total sperm count. Maximum number of cases was found in group III. Our study shows that round cell count is 5%–10% of the total sperm count. Negative correlation was noted between the total sperm count and IGCs. The correlation of total sperm count and leukocytes was negative and significant. Conclusion: The present study shows that differentiation of round cells in the semen can be effectively differentiated into spermatogenic and nonspermatogenic cells with the use of simple and cost-effective stain like Leishman stain. The correlation of sperm count with the IGCs and leukocytes and sperm motility is of immense use to find out the possible cause of infertility.
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Evaluation of knowledge and awareness about the ebola virus disease among the medical undergraduate students: A cross-sectional study
P Abhinitha, Camelia Putri Binti Yusof, Shaktesh Shanmugam Muthusamy Sinniah, Naveen Kumar
April-June 2017, 12(2):89-92
DOI:10.4103/jdmimsu.jdmimsu_48_17  
Introduction: Ebola virus disease (EVD), also known as Ebola hemorrhagic fever, is a fatal illness and it can be transmitted to people from wild animals and spreads in the human population by human-to-human transmission. Proper awareness of viral infection is necessary for both general population and medical professionals in minimizing the rate of mortality of the infected individual. The current cross-sectional study has been undertaken to evaluate the level of awareness about EVD in medical undergraduate students at their early academic curriculum. Materials and Methods: A total of 282 MBBS students of Malaysian origin studying in India were included in the study. Faculty-validated close-ended questionnaire was designed which comprised the questions related to general and medical-related aspects of Ebola virus. Results: Overall knowledge on EVD was moderate (score 2) with a majority of students (59%) followed by 35% of students having a low level (score 1) of awareness and only minimal number (6%) of students having an adequate level of awareness (score of 3). Conclusion: Overall knowledge about EVD among the medical undergraduate students at their preliminary curricular stages was in a satisfactory range with a score of 2. Nevertheless, their awareness of medical perspectives of EVD is comparatively more than that of general aspects.
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Knowledge of Anganwadi worker with respect to early childhood development
Shashank Gotarkar, Abhishek Ingole
October-December 2018, 13(4):168-170
DOI:10.4103/jdmimsu.jdmimsu_92_17  
Background: Being world's largest outreach program targeting infants & children below six years of age, expectants & nursing mothers, ICDS has generated interest worldwide amongst academician, planners, policy makers, administrators & those responsible for implementation. Consequently, many research studies have been conducted to evaluate & assess impact of program. The need for revitalization of ICDS has already been recommended toward better maternal and child health especially in rural areas. Inspite of repeated measures to enhance effectivity of ICDS program, impact is not observed as desired by policy makers or administrators. And hence knowledge of AWWs regarding ICDS program can be assessed & evaluated so that some of attributable reasons may be pointed out. Hence present study was undertaken to find out knowledge of AWW. Aim & Objectives: The AIM is to find out knowledge of Anganwadi Workers under ICDS with regards to ECD. Materials and Methods: This was a community based Cross-Sectional study, carried out at Seloo block of Wardha district, having total under five population approx. 7634. Study participants included 167 AWWs were included in the study. The study period was one year. Data were double entered and analysed in Microsoft excel (2007). The quantitative data was presented as proportion or mean with SD. Chi square test of significance was used wherever appropriate. Results: Shows that maximum no. of AWW (37.72%) were non matriculate. AWW with SSC and HSC qualification were 22.76% & 29.34% respectively. 64% AWW were Trained workers, 19% AWW received revised training while 17% were untrained workers. Conclusions: AWWs are actually the main resource person of the program and whose knowledge and skills do have a direct impact on the implementation of the programme. As the Anganwadi Workers play an important role due to their close and continuous contact with the people of community, especially the children and women, so there is an utmost need to assess their knowledge and the level of awareness regarding services provided by them in Anganwadi Centres.
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