GAIMS Journal of Medical Sciences

Revascularization in Resistant Hypertension Due to Renal Artery Stenosis

Alivia R Kusumowardani — 2024-10-04

Background: Renal artery stenosis (RAS) is a significant cause of resistant hypertension, especially in patients presenting with comorbidities. Revascularization has been initially recommended to treat resistant hypertension due to RAS. However, recent studies have shown modest benefits for blood pressure control over medical therapy only. There is limited data on revascularization in patients with resistant hypertension and RAS, particularly in patients with a high cardiovascular risk profile.

Materials and Methods: A systematic review of case reports was conducted to summarize the outcomes of revascularization in patients with resistant hypertension and RAS. The search was conducted through the Medline database (2013–2023) and was able to identify nine relevant reports documenting ten cases. Data on patient characteristics, blood pressure (BP), renal function, and antihypertensive medications before and after revascularization were extracted and analyzed descriptively.

Results: The average age of patients was 60.4 years, with an equal distribution of male and female cases. Following revascularization, systolic BP decreased from 170 mmHg (± 29.69) to 126 mmHg (± 3.53), and diastolic BP from 96 mmHg (± 16.97) to 74 mmHg (± 7.07). The average number of antihypertensive medications reduced from four to two. Renal function also improved in all cases where creatinine and eGFR data were reported.

Conclusions: Revascularization in RAS showed its benefit in lowering BP and medication burden, along with improving renal function in select cases. Decision for revascularization should be tailored to each patient while considering its potential risks and benefits.

A Study on Blood Group Distribution and its Correlation with Bleeding Time and Clotting Time among First Year Undergraduate Medical Students

Abirlal Sen — 2024-09-17

Background: There is a clear association between ABO blood group status and levels of Von Willebrandfactor (vWF). Blood group O is related with lower expression of vWF which leads to relative bleeding tendency. Thus, relationships between Bleeding time (BT), Clotting time (CT) and blood groups are important in certain conditions like epistaxis, surgery,thrombosis etc.Aims and Objectives: i)To determine the blood group, of the students and to determine their relationship with BT and CT.

Materials and Methods: Institution based cross-sectional observational study done in Departmentof Physiology, Tripura Medical College & Dr. BRAM Teaching Hospital. BT and CT were done by Duke’s Method and Capillary glass tube method respectively. Blood groups were determined on basis of presence or absence of agglutination. Qualitativedata was expressed in percentage and quantitative data in frequency, mean and standard deviations. Chisquare test was applied. P value of <0.05 was considered as statistically significant.

Results: BT more than 4 minutes was found maximum in group O (78.5%) compared to other blood groups (p = 0.001 by Chi-square analysis). Clotting time > 6 minutes found to be maximum in blood group O (53. 8%).Gender wise distribution showed CT > 6minutes in 39% females as compared to 34 %males (p value: 0.5826).

Conclusion: In our study, CT was > 6 minutes and BT was > 4 minutes’ maximum in number in blood group O. Gender-wise BT and CT were higher in females than males. Our study showed that O blood group females are prone to certain diseases like epistaxis bleeding etc.

The Analysis of Risk Factors for Periprosthetic Joint Infection in Indian Hospital Settings

Madhav Madhusudan Singh — 2024-09-17

Background: Periprosthetic Joint Infection (PJI) is a nightmare for both patient and surgeon. Despite advances made in arthroplasty still incidence is 1-2%. Many of our understanding regarding PJI come from registry data. Despite performing large number of joint replacement surgeries there is a lack of optimal registry data from this part of world. We retrospectively analysed PJI data in four NABH accredited hospital of around 5370 patients and tried to identify common risk factors in them and proposed a clinical scoring system for assessing risk of PJI.

Materials and Methods: The study population was patients requiring surgical intervention in the form of arthroplasty. PJIs were defined as patients requiring procedure at the operated site within 2 years of index surgery. We retrospectively analysed patients’ data from hospital records and lab investigations done at the time of surgery.

Results: We found that statistical significant risk factor in our study were number of joint replacement performed, poor blood glucose and serum albumin, increase duration and complexity of surgeries, Rheumatoid Arthritis (RA), Chronic Kidney Disease (CKD) and chronic liver disease and use of allogenic blood transfusion. Relative risk (RR) of diabetes (RR 2.4), liver disease (RR 1.6), connective tissue and rheumatic diseases (RR 1.5), serum albumin (RR 2.1), allogenic blood transfusion (RR 2.3), Increase duration for surgery (RR2.1), CKD (RR1.3) was there with PJI.

Conclusions: Our research consistently identified the most significant risk factors for PJI across all cases. We propose a patient-based scoring system to estimate individual PJI risk. By addressing modifiable risk factors before joint replacement, we can potentially reduce the incidence of PJI.

Prevalence of Enterococcus Species in Various Clinical Specimens and it’s Antimicrobial Susceptibility Pattern in a Tertiary Care Teaching Hospital of Central Gujarat

Priya D Mangukiya — 2024-09-27

Background: Enterococci have become common cause of hospital acquired urinary tract infections, wound infections and bacteraemia. The therapeutic challenge of multiple drug resistance (MDR) enterococci have brought their role as important nosocomial pathogens into sharper focus. Hospital acquired wound infections are among the leading cause of morbidity and huge economic burden associated with prolonged hospital.

Material and methods: A descriptive-cross sectional study carried out in the Department of Microbiology in Medical college Baroda & SSG Hospital, Vadodara, Gujarat, India. Various samples like blood, urine, swab, cerebro-spinal fluid (CSF), pleural fluid, body fluid, pus, catheter tip were taken from clinically suspected cases for culture and antimicrobial sensitivity testing according to CLSI guideline. A total of 90 Enterococcus spp. were isolated from these samples, which were included in this study.

Results: Out of 6555 culture positive isolates, 90 were Enterococcus species. The prevalence of Enterococci spp. in our study is 1.37%. Out of total 90 isolates, 71% (64 isolates) were Enterococcus fecalis and 29% (26 isolates) were Enterococcus faecium. The highest number of Enterococcus spp. were isolated from the urine (48%) & in infant (30%). The rate of isolation of Enterococcus was more in males (59%). Enterococcus spp. from various samples show highest sensitivity to Linezolide (99%). Incidence rate of VRE isolates in the present study is 15.5%.

Conclusion: The prevention and control of spread of multi drug resistant Enterococci require co-ordination effort from various departments and can only be achieved by education of hospital staff regarding problem of drug resistance, prudent use of antimicrobials, early detection and reporting and immediate implementation of appropriate infection control measures, improved surveillance for hospital infection control.

Early Identification of the Factors Affecting the Academic Performance of Medical Undergraduate Students and Developing an Action Plan to Improve the Same Before Academic Failure

Aditi Chaturvedi — 2024-10-01

Background: This study aims to identify factors influencing medical students' academic performance and develop a simplified action plan to prevent academic failure.

Materials and Methods: A prospective educational intervention utilized Ron Fry’s Questionnaire to assess seven performance factors (concentration, comprehension, test anxiety, organizational skills, writing skills, computer skills, and system of taking notes in class) among medical students. Standard solutions with individualized action plans including intention statements, constant reminders, identifying reasons for test anxiety, and organizing oneself were offered based on these factors to create individualized action plans. Pre- and post-study test scores were compared using paired T-tests, and feedback was collected.

Results: A total of 117 students participated, showing significant improvement in post-study marks (p = 0.00015). 31.6% of students improved and avoided failure post-study. 99% of students believed such interventions could benefit future batches in early performance identification.

Conclusions: Utilizing Ron Fry’s questionnaire to identify performance factors and offering support in the form of standard solutions, may collectively enhance academic performance and reduce academic failure.

A Study of Profile of Newly Admitted Medical Students and Their Perception Towards Family Adoption Program

Ravindra Balaram Gurav — 2024-10-04

Background: The Family Adoption Program (FAP), newly mandated by National Medical Commission for all MBBS students aims to provide an experiential learning opportunity for them towards community-based health care. This study was conducted to assess the profile of the MBBS students, their perception and of the families adopted by them on FAP.

Materials and Methods: A cross-sectional study was conducted in 2023 including 100 medical students of Rajiv Gandhi Medical College. After sensitization to the FAP proforma, each student was allotted five families for adoption from the Lokmanya Nagar located in the outskirts of Thane city. Students recorded details of families in the proforma. Feedback and perception on FAP from the families as well as from students were collected. The data was analyzed using Microsoft Excel. ꭓ2 test was applied.

Results: Out of 100 students, 48% students were males and 52% were females. 96% students were in the age group of 17-20 years and 4% were of aged >20 years. 98% of the medical students were told by the adopted families that FAP is a good initiative. All the students mentioned in the feedback, FAP will help to develop leadership skill among them, will help to enhance the health of the adopted families and will surely improve the communication skill of the Indian Medical Graduates which will be useful for their professional growth.

Conclusions: All students were delighted and gratified with this program and the same was mentioned by them in the feedback. FAP will create a significant difference in medical education and will definitely help to promote health of the adopted families.

Abnormalities in Semen Analysis in Male Partners of Infertile Couples at a Tertiary Care Hospital in Garhwal Region of Uttarakhand

Swati Pundir — 2024-10-07

Background: Infertility is “failure to achieve a clinical pregnancy after >= 12 months of regular unprotected sexual intercourse”. Abnormal semen parameters are found in 50% of the infertile couples. Thus, Semen analysis is usually the first step in evaluating male partner in infertile couples.

Material and methods: This is a 2 years retrospective study including 103 cases. Patient’s clinical history was taken and Semen sample was obtained by masturbation in sterile universal container following abstinence of 3-5 days. Using WHO standards, Samples were examined for various physical parameters and sperm motility. Sperms were counted with improved neubauer chamber and stained with Pap stain to observe morphology.

Results: Total 103 male partners of infertile couples were investigated. Abnormal seminal parameters were found in 57.2% with maximum number in 4^th decade (41.7%). Abnormal appearances included transparent (5.8%), opaque (1.9%) and redish brown (1.9%). Hypospermia was seen in 23.3% and increased liquefaction time in 1.9% samples. Sperm concentration and total sperms/ejaculate were reduced in 30.7 % and 31.7% cases respectively. Total Sperm motility was below WHO lower reference range in 16.5% cases. However, progressive motility alone was below lower reference range in 25.8% cases. On morphology, maximum defects were seen in the head of spermatozoa. Leucocytospermia was seen in in 9.9 % . Abnormalities in sperm count included oligozoospermia (21.4%), Cryptozoospermia (2.9%) and azoospermia (3.9%). Oligozoospermia was the commonest microscopic abnormality followed by Asthenozoospermia (14.6%).

Conclusion: Semen analysis is the cornerstone of investigating male infertility.

Comparative Analysis of Mini-Clinical Evaluation Exercise and Traditional Practical Examination in Pediatrics Undergraduate Assessment

Rekha Thaddanee — 2024-10-19

Background: The Mini-Clinical Evaluation Exercise (Mini-CEX) is a valuable formative assessment tool in medical education. It involves direct observation of a student's clinical skills by a faculty member, followed by immediate constructive feedback. There is limited data available on the utility of Mini-CEX for undergraduate assessment. The aim of this study was to compare the effectiveness and reception of Mini-CEX and traditional practical assessments in Pediatrics among medical students and faculty members.

Materials and Methods: This prospective educational comparative study was conducted over six months, from April 2021 to September 2021, involving undergraduate medical students of Phase-3, Part-2. The students were randomly divided into four groups (A, B, C, and D). In the first encounter, two groups participated in a traditional practical examination, while the other two groups underwent a Mini-Clinical Evaluation Exercise (Mini-CEX) assessment. For the second encounter, the assessment methods were swapped between the two groups. Systematic feedback was provided to each student following the Mini-CEX assessment. Additionally, feedback was collected from both, students and faculty members, regarding their experiences and opinions on the assessment methods.

Results: This study found that Mini-CEX scores were significantly higher than TPE scores (P=0.006489). There was also significant inter-examiner variability in Mini-CEX marks (p < 0.00001). Both students and faculty members provided positive feedback regarding the Mini-CEX. Despite its benefits, the time required to conduct the examination is a major limitation for undergraduate assessment.

Conclusions: Mini-CEX is a valuable tool in undergraduate medical education for assessing and improving clinical skills. By providing structured, real-time feedback, it helps students develop into competent and confident clinicians. The time required to conduct the examination is a major limitation for undergraduate assessment.

Correlation and Association of Serum B12 Levels in Type-2 Diabetes Mellitus Patients Treated with Metformin: A Study Conducted at a Tertiary Care Hospital of Gujarat

Parth Chanv — 2024-10-23

Background: Type 2 Diabetes mellitus(T2DM) is the most common endocrine disorder, affecting millions of people, leading to morbidity and mortality. Metformin is most widely used antidiabetic drug due to various reasons. Long-term metformin treatment in type 2 diabetes mellitus patients can cause vitamin B12 insufficiency. Severe deficits, if untreated, may lead to life-threatening neurological issues, which are often overlooked and undertreated.

Objective: To analyze the correlation between the duration and dosage of metformin treatment of more than one year in T2DM Patient and their combined impact on serum B12 levels among T2DM patients.

Materials and Methods: Hospital-based Cross-Sectional observational study evaluated 42 diabetic subjects, encompassing both sexes aged 18 to 70 years, who had been on metformin medication for more than one year. Assessment involved a comprehensive questionnaire and measurements of FBS, HbA1c, and serum B12 levels. Additionally, data on Metformin Dosage and Duration of its use were collected. B12 deficiency was defined as serum B12 levels ≤ 200 pg/ml. Data analysis was conducted by statistically comparing the mean vitamin B12 levels in each group using the One-Way ANOVA test through SPSS version 23 software.

Results: Increase in the duration of metformin drug usage correlates with a significant decrease in serum vitamin B12 levels, as confirmed by ANOVA test results (p < 0.05).

Conclusions: This study finding indicate that vitamin B12 deficiency is linked to a higher risk of worsening diabetic neuropathy. Therefore, individuals with diabetes who take higher doses of metformin (over 1000mg) for extended periods (≥ 8 years) should undergo regular monitoring of their vitamin B12 levels. Proactive use of vitamin B12 supplementation, whether for prevention or treatment, can help mitigate this concern.

Evaluation of Ultrasonography and CT scan Findings in Cases of Non-Traumatic Gall Bladder Perforation

Siddhartha Sarma Biswas — 2024-11-12

Background: Gall bladder perforation (GBP) is a relatively rare complication of acute cholecystitis which results in higher mortality and morbidity. Radiological imaging plays a crucial role in determining the diagnosis and treatment of these group of patients.

Material and methods: Our study is an observational study done over a period of 1 year in Assam Medical College, where radiological modalities of CT and ultrasonography were used to study various types of non-traumatic Gall bladder perforation. Statistical analysis was done using MS excel software (2010).

Results: In our study, males were more common. Type II perforation and size of defect of more than 10 mm were most commonly seen. Imaging with ultrasonography and CT scan help in earlier diagnosis of the acute event and helps in better management of the patient as with their use we can not only determine the location, size of perforation but we can also detect the development of its complications such as abscess or fistula formation.

Conclusion: Site, size of perforation along with development of complications can be detected by using radiological modalities such as ultrasonography and CT.

One-Year Retrospective Analysis of Emergency Obstetric Hysterectomy: Insights from Sheth Lallubhai Gordhandas Municiapal General Hospital, Maninagar, Ahmedabad

Nisha Toshniwal — 2024-12-13

Background: The procedure known as Emergency Obstetric Hysterectomy (EOH) involves the removal of the uterus in response to life-threatening conditions during the postpartum period. While this intervention is crucial for saving lives, it is also linked to severe complications.

Material and Methods: This retrospective observational study was conducted at Sheth Lallubhai Gordhandas Municipal General Hospital in Maninagar, Ahmedabad, over one year, focusing on Emergency Obstetric Hysterectomy (EOH) cases. The study included cases with complete medical records and excluded those with incomplete documentation. Data variables included demographic details, indications for EOH, maternal outcomes, surgical details, and neonatal outcomes. Descriptive statistics were used to analyze the data, along with comparative analysis based on demographics and indications for EOH. Statistical tests, such as chi-square or t-tests, were applied to assess outcomes, including maternal morbidity and mortality rates.

Results: Study revealed the majority of cases (37.1%) were women aged 26-30, with multiparity (65.7%) and abnormal placentation (45.7%) as common risk factors. Caesarean hysterectomy had a higher survival rate at 65.7% compared to 11.4% for postpartum hysterectomy. The average operating time was 74.57 minutes, and patients had an average hospital stay of 9.34 days.

Conclusions: This study underscores the need for enhanced antenatal care and emergency management strategies to address severe obstetric conditions, as evidenced by the high incidence of complications and variability in outcomes observed.

Role Play as a Pedagogical Strategy for Cultivating Empathy

Biju Bahuleyan — 2024-12-15

Background: Empathy is considered as the cornerstone of exemplary patient care and training medical graduates in empathy is the most challenging task for the medical educators. The traditional teaching method lacks strength in implementing this skill into the receivers.

Aims and Objectives: To explore role play as a pedagogical strategy to provide an immersive learning experience for medical students to capture empathetic principles.

Materials and Methods: This observational study was performed in a medical college of South India, among Phase I students. Jefferson scale of empathy was used to quantify empathy level among the participants and following which, they were asked to conduct role play sessions enacting various case scenarios. Post role play session, feedback was taken from the participants as well as the faculty. The empathy scores and the components were compared among males and females using an independent sample t-test and ANOVA respectively.

Results: The mean empathy score of the participants were above the cut off points (119.42 ± 9.768). There was no significant difference in total or component wise empathy score among genders, although “putting yourself into patient shoes” was significantly lower when compared to other components (5.93 ± 0.71, 6.29 ±0.52, 4.53 ± 1.35). From the students and teachers’ perspective, role play was an effective method in learning empathy.

Conclusions: The facilitators reported organizing role-play sessions to be labor intensive but the insightful reflection of the students far outweighs the effort. In this backdrop, role-play can be considered as an effective teaching method.

Morphometric Analysis of Human Occipital Condyle and its Clinical Significance

Shaheen Sajid Abbas Rizvi — 2024-12-16

Background: There are several approaches to operate on brainstem and craniovertebral lesions and involve a resection of occipital condyles (OC). Morphological assessment of occipital condyles, aids in determining the extent and direction of condylar drilling, helping to prevent occipito-cervical destabilization and accidental damage to the neurovascular structures related here.

Aim: To analyze the morphometry of occipital condyles and the frequency of occurrence of different morphological types of occipital condyles and its clinical significance.

Materials and Methods: 100 dry human skulls were studied in the Department of Anatomy, K. J. Somaiya Medical College, Mumbai. The dimensions of the occipital condyles, including their length, width, height and shape were measured. In addition to this, the anterior and posterior intercondylar distances and the distance from the posterior end of the occipital condyle to the hypoglossal canal were recorded using digital Vernier calipers. Paired ‘t’ test was used for significance between the length, width and height of occipital condyles with that of its sides (right and left respectively).

Results: The mean measurements of the occipital condyles in terms of length, width, and height were identified as 23.52, 23.13 and 9.49 mm respectively. As the value of p was less than 0.05, the differences between right and left side were insignificant. The average anterior intercondylar distance and posterior intercondylar distance was found to be 21.16 mm and 43.35 mm respectively. Commonest shape seen was oval in 38% of skulls followed by “S” shaped condyle in 22% skulls. On an average, the hypoglossal canal was positioned 8.78 mm from the posterior end of the occipital condyles.

Conclusions: These results confirm the variability in different parameters of occipital condyles. The safest area of the occipital condyles to be resected is maximum up to 12mm from the posterior end because there is no location for the hypoglossal canal orifice.

Prevalence of Acinetobacter Species in Various Clinical Samples and its Antibiotic Sensitivity Pattern in Tertiary Care Hospital, Vadodara

Arpita T Parmar — 2024-12-16

Background: Acinetobacter species are Gram negative, non-fermentative bacteria commonly present in soil and water as free living saprophytes. They are isolated as commensals from skin and throat. Acinetobacter has emerged as an important nosocomial pathogen involved in outbreaks of hospital infections in hospitalized patients like septicaemia, pneumonia, wound sepsis, endocarditis, meningitis and urinary tract infections. Moreover, most of those outbreaks were caused by multi-drug resistant (MDR) strains of this organisms.

Material and Methods: Various samples like blood, urine, swab, cerebro-spinal fluid (CSF), pleural fluid, body fluid, pus, catheter tip were taken from clinically suspected cases for culture and antimicrobial sensitivity testing. A total of 164 Acinetobacter species. were isolated from these samples, which were included in this study.

Results: Out of 6555 culture positive isolates, 164 (2.50%) were Acinetobacter species. Out of total 164 isolates, 77% (126 isolates) were Acinetobacter baumannii and 23% (38 isolates) were Acinetobacter lwoffii. The rate of isolation of Acinetobacter was more in males (58%) & in infants (25%). Highest number of Acinetobacter species were isolated from the blood (30%) & from the Extramural-NICU (24%). Acinetobacter isolates from various samples other than urine samples show highest sensitivity to colistin (100%) & for urine samples, sensitivity to cotrimoxazole, cefotaxime, cefuroxime, levofloxacin and doxycycline was 25%. The prevalence of Acinetobacter spp in the present study is 2.50%.

Conclusions: To prevent the spread of the resistant bacteria, it is critically important to have strict antibiotic policies while surveillance programmes for multidrug resistant organisms and infection control procedures need to be implemented.

Prevalence of Asymptomatic Gallstone during Routine Ultrasonography and its Associated Factors: Cross-Sectional Study from a Tertiary Care Teaching Hospital

Prabha Thangaraj — 2024-12-18

Background: Gallstones are the most important risk factor for gall bladder carcinoma. Understanding the burden of asymptomatic gallstone and its associated factors is essential to identify risk group likely to develop complication.

Objectives: To estimate the burden of asymptomatic gallstone (AGS) and assess the factors contributing towards the same.

Material and methods: A cross-sectional study was done during February to August 2023 in a tertiary care teaching hospital among adults aged above 18 years undergoing ultrasound of the abdomen as a part of routine master health check-up. A questionnaire was used collect the socio-demographic details, medical history and laboratory investigation. A total 1300 individuals were screened for AGS and included for analysis.

Results: The mean age of study participants was 55.99 ± 15.83 years. The study found 36 individuals with AGS i.e 2.8% (95% CI:1.9-3.8%). The mean size of gallstone was 8.19 ± 4.6 mm with a range of 2 to 25 mm. Medical condition such as diabetes, hypertension and body mass index was found to be associated with AGS (p<0.000). Among the lipid parameters it was found that, low density lipoprotein (LDL) , triglyceride (TG) and cholesterol (CH) mean values were more while high density lipoprotein was lesser among individual with asymptomatic gallstones when compared to their counterparts which was found to be statistically significant (p<0.000).

Conclusion: Though the burden of asymptomatic gallstone was low in our setting, our study found diabetes, hypertension, body mass index and lipid profile to be associated with greater risk of gallstone formation. We suggest further studies on follow up of individual with AGS to assess their risk of developing complication due to gallstone.

Usage Patterns and Awareness of Mobile Health Applications Among Smartphone Users in Assam

Madhur Borah — 2024-12-22

Background: Mobile health (mHealth) initiatives offer significant potential for enhancing healthcare delivery in Assam, where health infrastructure and workforce are limited.

Aims and Objectives: This study aimed to assess the awareness and usage patterns of mHealth applications among smartphone users in Assam.

Study Design: Online cross-sectional study. Community-based study among adult smartphone users across various districts in Assam.

Methodology: The study involved 327 adult smartphone users selected through two-stage sampling. Data were collected using Google Forms and analyzed using Microsoft Excel and SPSS. Statistics: Frequencies and percentages were calculated to describe the data. Statistical associations were examined using the chi-square test and multiple regression analysis.

Results: The study found that 82.6% of participants were aware of mHealth apps, primarily recognizing their use for monitoring physical activities (85.2%) and improving doctor-patient communication (84.7%). Urban residents, males, and those with higher education and longer smartphone usage had significantly higher awareness. Additionally, 87% of users had recently used the internet for health information, with Google being the most utilized source (92.6%), followed by social media (62.7%). However, trust in online health information varied, with only 3.7% expressing absolute trust, with male participants and less-educated individuals showing higher trust levels.

Conclusion: The study underscores the growing role of mHealth in Assam, highlighting significant awareness. However, trust in online health information remains a concern. These findings suggest the need for targeted educational initiatives and authentic digital information to maximize the benefits of mHealth technologies.

A Survey to Assess the Effectiveness & Utility of the District Residency Program Implemented for the Resident Doctors

Anjali Goyal — 2024-12-27

The District Residency Program (DRP) was one of the novel changes introduced by the National Medical Council (NMC) advocating a community centric objective for the post-graduate medical students. A survey was conducted to study the strengths, weaknesses, opportunities & threats to the program. The residents chiefly complained of the logistics, accommodation & the duration of the program. Despite the early implementation issues amongst other challenges, the program might serve as an important learning module & pave the way forward for improving the health services in the developing countries like India where more than 60% of the population has a limited access to the specialized health care facilities.

Antenatal Care Services and its correlation with Outcomes of Pregnancy amongst Beneficiaries in Rural Health Training Center Jetalpur, Ahmedabad

Bansi Davda — 2025-01-08

Background: Antenatal care is crucial for reducing maternal and neonatal mortality by ensuring the health of both the mother and fetus during pregnancy. Effective ANC services can significantly impact pregnancy outcomes, especially in rural settings where healthcare access is often limited. Our study aimed to evaluate the antenatal care services provided at a rural health center in Gujarat, India, focusing on early pregnancy registration rates, anemia prevalence, compliance with Iron-Folic Acid (IFA) supplementation, and delivery outcomes.

Materials and Methods: A cross-sectional, record-based study was conducted at Jetalpur, PHC, a Rural Health Training Centre under Narendra Modi Medical College, Ahmedabad, using Technology for Community Health Operations (TeCHO+). Data from 387 pregnant women registered between April 2021 and March 2023 were analyzed using descriptive and comparative statistics.

Results: The study found a high early pregnancy registration rate of 89.66%, reflecting effective community outreach. However, anemia prevalence was significant at 78.87%, and only 3.79% of women completed the full course of IFA supplementation. Normal deliveries accounted for 71.21% of births, while Cesarean sections were 28.78%. Preterm births were recorded at 28.79%.

Conclusions: The study underscores the need for enhanced health strategies in rural areas to address anemia and improve compliance with ANC protocols. Continued efforts are essential to strengthen maternal health services and reduce disparities in rural healthcare.

Comparative Evaluation of Cytologic and Histologic Grading in Invasive Ductal Carcinoma Breast

Saloni Singhla — 2025-01-10

Background: Accurate pathological diagnosis is crucial for further treatment and estimation of an outcome in cases of breast cancer. The cytologic grade may provide information about the aggressive behavior of the tumor, thus guiding optimal therapy with prognostic information. The widely used Nottingham histologic grading method is a tumor grading system with strong prognostic connections.

Material and methods: This cross-sectional study was conducted over one year in the Department of Pathology in IGMC, Shimla. Our study aimed to determine the role of Robinson’s grading in cases of primary infiltrating ductal carcinoma, breast, on cytology, confirm and grade the tumor on histopathology, and find the concordance between cytologic and histologic grading.

Results: On comparing cytologic and histologic grading, 37(68.5%) cases were graded based on cytology, which is comparable to most of the published data. The cytohistologic correlation was maximum in cases of grade III tumors (80%), followed by grade II tumors (70.2%), and minimum with grade I tumors (58.3%).

Conclusion: In this era of neoadjuvant chemotherapy, FNAC reports in cases of breast cancer should be incorporated with grading for prognostication. Considering the present study's data and other comparative studies, it can be concluded that Robinson’s cytologic grading correlates reasonably well with the histologic grading system, especially the grade III tumors, and paves the way for recommending neoadjuvant chemotherapy. Cytologic grading correlates reasonably well with the histologic grading system, especially the grade III tumors, and paves the way for recommending neoadjuvant chemotherapy.

Does Extended Serum Sample Storage Impact Laboratory Results?

Balaji Pillai — 2025-01-22

Background: Prolonged storage of samples can result in changes to routine biochemical parameters.

Aim: This study aimed to examine the biochemical changes in serum samples stored at –20°C for extended periods (72 hours), focusing on various routine biochemical parameters.

Results: Significant changes were noted in serum glucose, aspartate aminotransferase (AST), alanine aminotransferase (ALT), creatinine, and potassium levels after 72 hours of storage, with further deterioration observed over 3 months. The remaining parameters showed no significant alterations.

Conclusion: Prolonged sample storage results in changes in analyte concentrations in serum. Serum glucose, AST, ALT, creatinine, and potassium levels should be measured within 72 hours if extended storage is necessary. All parameters should ideally be analyzed within 24 hours to prevent misinterpretation of results and ensure optimal patient care.

Bacteriological Profile and Antibiotic Susceptibility Patterns in Lower Respiratory Tract Infection at a Tertiary Care Teaching Hospital

Jitendra Singh — 2025-02-02

Aim: To study the bacterial profile, along with antibiotic susceptibility pattern of isolates from suspected cases of LRTIs attending the tertiary care study area.

Materials and Methods: Respiratory samples like sputum, BAL & ET secretions from patients clinically suspected with LRTIs received from both in patient and OPD of a tertiary care teaching hospital, were processed as per standard protocol in Department of Microbiology. The bacterial isolates were identified using Gram’s stain, motility and sets of biochemical tests. Antimicrobial susceptibility testing was performed and interpreted as per CLSI guidelines.

Results: This was a retrospective study based on the evaluation of data from January 2023 to June 2023. A total of 1943 respiratory samples (1709 sputum, 211 ET secretions and 23 BAL) were received during the study period. 669 sputum samples (39.14%), 102 ET secretion (48.34%) and 2 BAL fluid (8.69%) were positive for bacterial isolates. Out of these 773 culture positive samples, 855 microorganisms were isolated. Klebsiella spp. was the most common isolates being 39.5% (338 isolates) followed by E. coli 23.97% (205 isolates), Pseudomonas spp. 16.9% (145 isolates), Acinetobacter spp. 14.61% (125 isolates), S. aureus 3.04% (26 isolates) and Enterococcus spp. 1.87% (16 isolates).

Conclusion: Culture and susceptibility test is vital for proper diagnosis and management of patients with LRTIs. 39.78% culture positivity was observed in all the samples received with predominance of Gram-negative isolates.

The Prevalence of Methicillin Resistant Staphylococcus Aureus (MRSA) and its Antimicrobial Susceptibility Pattern at Tertiary Care Hospital

Nisarg Trivedi — 2025-02-27

Background: Staphylococcus aureus is a very common human pathogen isolated from various clinical specimens. Staphylococcus aureus can cause various infectious diseases like endocarditis, skin and soft tissue infections, osteomyelitis, pneumonia and bacteremia. Methicillin resistant Staphylococcus aureus (MRSA) can cause a major trouble mostly in tertiary care center. The present study is aimed to determine the prevalence of Methicillin Resistant Staphylococcus aureus (MRSA) and its antimicrobial susceptibility pattern at Tertiary Care Hospital, Vadodara.

Material and Methods: Present study was conducted from October 2023 to April 2024 at tertiary care hospital, Vadodara. Total 1127 clinical specimens were tested for the study. The isolates were identified as per laboratory standard protocol including staining, colony morphology & biochemical reactions. All isolates were subjected to antibiogram study by modified Kirby Bauer disk diffusion method. Among 1127 clinical specimens, 361 Staphylococcus aureus were isolated and tested for MRSA by Cefoxitin disc diffusion test.

Results: Among 361 Staphylococcus aureus isolates, 159 were positive for MRSA. Overall prevalence rate for MRSA isolates was 44.04%. Maximum number of MRSA was isolated in Orthopedic ward (53, 33.33%), Surgery ward (39, 24.52%), Intensive Care Unit (28, 17.61%), Medicine ward (17, 10.69%) Pediatric ward (15, 9.43%). Maximum MRSA isolated from Pus and swab (81, 50.94%) followed by Urine (36, 22.64%), Blood (27, 16.98%). MRSA were most sensitive to Vancomycin (159, 100%) followed by Teicoplanin (149, 93.71%), Linezolid (142, 89.30%), Clindamycin (71, 44.65%) and least sensitive to Ciprofloxacin (29, 18.23%) followed by Erythromycin (42, 26.41%) and Gentamycin (62, 38.99).

Conclusion: Prevalence of MRSA in our study is 44.04%, which are multidrug resistance though Vancomycin, Linezolid and Teicoplanin are still effective treatment option. Screening of MRSA and their antibiogram is very essential for early detection of MRSA and for management of the condition.

Prevalence of Self-Medication among First Year Medical Students in Government Medical College at Jamnagar, Gujarat

Nileshwari H Vala — 2025-02-28

Background: Self-medication is medication taken by person without professional advice. MBBS students are future professionals but during first year they don’t have proper knowledge about different medications. So, during first year of study, they are more vulnerable to self-medication and their potential side effects.

Material and methods: Pretested structured validated self-medication questionnaire was used in this study.

Results: We have found that out of 360 participants 289 (80.30%) students accepted that they had taken self-medication within one-year duration after taking admission in first year MBBS.

Conclusion: Self-medication is present in medical students prior to any proper knowledge about hazards of medications. Students should be properly guided about self-medication and their hazards during their first year MBBS study to protect them from self-medication inflicted hazards.

Integrating Tradition and Modernity: The Gharana System for Effective Mentorship at GAIMS

Ajeet Kumar Khilnani — 2025-02-08

This editorial highlights the key features and benefits of the GAIMS Gharana System, an innovative and a unique blend of ancient traditions of knowledge and modern mentoring practices.

Case of Rhinosinusitis with Secondary Orbital Cellulitis Complicating further as Cavernous Sinus Thrombosis: A Rare Sequelae

Shweta S Joshi — 2024-09-18

Background: Orbital cellulitis is an acute inflammatory disorder of the orbit. It results from an acute infection spread from the blood, adjacent sinuses and facial skin. Cavernous sinus thrombosis (CST) typically occurs due to an infection originating from regions such as the face, sphenoid and ethmoid sinuses, or the oral cavity.

Case report: An eleven-year-old girl was brought by her parents to our hospital with a complaint of right nasal discharge and fever for the last 10 days. She developed right-sided periorbital oedema for the past six days. She was under treatment at a local hospital. After that her parents noticed an increase in swelling associated with redness in her right peri-orbital region, so she came to our hospital. MRI brain showed changes of cavernous sinus thrombosis. A functional endoscopic sinus surgery (FESS) was performed for right nasal blockage on the second day of admission and about 10 ml of pus was drained. Fragmented fibrovascular tissue bits received from the frontal sinus and maxillary sinus revealed numerous pus cells with Gram-positive bacterial cocci on the third day. She responded to treatment as she was without fever by the day fourth on admission. The aerobic culture of the pus swab was positive and the organism detected was staphylococcus aureus on the eighth day after admission.

Conclusion: Cavernous sinus thrombosis is a serious complication of orbital cellulitis with high morbidity and mortality. Unusually, orbital cellulitis occurs as sequelae of cavernous sinus thrombosis. Gram-positive bacteria noted on the nasal lesion's histopathology helped in starting antibiotics in the patient before the culture report was positive.

Dengue and Scrub Typhus Coinfection: Navigating Diagnostic and Therapeutic Challenges in a Child

Rekha Thaddanee — 2024-09-27

Coinfection with Dengue fever and Scrub Typhus presents significant diagnostic and therapeutic challenges, particularly in pediatric cases. We report a 6-year-old girl with fever, headache, maculopapular rash, and a vesicular lesion on the knee that progressed to a black eschar. She developed generalized edema, oral bleeding, decreased urine output, and renal dysfunction. Laboratory tests revealed anemia, leukocytosis, thrombocytopenia, elevated serum urea and creatinine, hypoalbuminemia, and hyponatremia. The Weil-Felix test was positive for OXK titer 1:320, and Dengue IgM antibodies were detected, complicating the diagnosis. Treatment with doxycycline, azithromycin, and local care for the eschar led to clinical improvement. This case highlights the importance of considering coinfection in febrile illnesses and emphasizes the need for accurate and timely diagnosis for effective management.

An Unusual Case of Ileal Obstruction Secondary to a Large Primary Enterolith

Shweta S Joshi — 2024-10-05

Primary enterolith is also known as a gastrointestinal concretion. In this condition, stone formation occurs in small bowel.
Enterolithiasis is an uncommon pathological condition in humans. Its prevalence is 0.3-10%. We present an uncomplicated case of primary enterolith in a small bowel. A 50-years old female patient came with abdominal pain due to small bowel obstruction and intestinal stricture on clinico-radiological correlation. After clinical examination and investigations, she was taken up for exploratory laparotomy wherein segment of ileum was resected and sent for histopathology examination.

Pompe’s Disease in Infancy: A Case Report

Deepkumar K Patel — 2024-10-17

Glycogen storage disorders (GSDs) are inherited metabolic disorders characterized by defects in glycogen metabolism, leading to abnormal glycogen accumulation in various tissues. Pompe’s disease, a severe form of GSD, results from a deficiency in the enzyme acid alpha-glucosidase (GAA), causing lysosomal glycogen accumulation, primarily affecting cardiac and skeletal muscles. This case study presents a 45-day-old female infant with Pompe’s disease, initially presenting with fever, cough, cold, and respiratory distress. Clinical assessment revealed tachypnoea, elevated heart rate, hypotension, hepatosplenomegaly, elevated liver enzymes, and metabolic acidosis. Diagnostic tests confirmed Pompe’s disease through low alpha-glucosidase activity. Despite initiating antibiotic treatment and ventilatory support, the patient’s condition worsened, necessitating re-intubation. Pompe’s disease presents a broad spectrum of clinical manifestations, with early diagnosis and intervention being crucial for managing the infantile form. Enzyme replacement therapy (ERT) with recombinant human GAA has markedly improved patient outcomes, yet challenges remain, including variability in treatment response and the high cost of therapy. Ongoing research focuses on novel therapeutic approaches and enhancing patient care. This case underscores the importance of early recognition and comprehensive management to improve prognosis in Pompe’s disease.

A Rare Case of Honeycomb Gallbladder in a Patient of Chronic Calculus Cholecystitis

Raghav Bansal — 2024-12-18

Background: Honeycomb gallbladder (GB) is a rare condition characterized by multiple septations in the GB wall, giving it a honeycomb appearance. First described by Knetsch in 1952, this anomaly is typically congenital but can also be acquired. Patients with a honeycomb GB often present with a variety of symptoms, the most common being abdominal pain.

Case Description: We present the case of a 62-year-old female with a history of symptomatic chronic calculus cholecystitis. She underwent a laparoscopic cholecystectomy, which resolved her symptoms. Preoperative ultrasound imaging showed no evidence of multiple septations; however, post-operative examination revealed a multiseptated gallbladder.

Conclusions: Honeycomb GB is an unusual presentation. Among the theories explaining multiseptated GB, one suggests that chronic calculus cholecystitis leads to extensive denudation of the epithelial lining, causing fibrosis and calcification beneath, which results in contraction. Our case supports this theory, as these pathological changes likely contributed to the honeycomb appearance. While medical management typically focuses on symptomatic relief, cholecystectomy has been shown to completely resolve symptoms.

Rare Type 4 Hiatal Hernia: An Incidental Cadaveric Discovery

Sagnik Roy — 2025-01-02

A hiatal hernia (HH) occurs when a portion of the stomach slides up into the thorax through the esophageal hiatus of the diaphragm. Most of these hernias are acquired and result from factors which increase the intra-abdominal pressure resulting in laxity of phreno-esophageal ligament and an increase in size of the esophageal hiatus. HHs are classified into 4 types. Type-1 HH is the commonest and frequently associated with gastroesophageal reflux disease (GERD). Type-4 HH is rare and is prone to develop mechanical complications such as gastric volvulus and obstruction. Awareness and early diagnosis and treatment of these complications can reduce morbidity and mortality and ensure a positive outcome.

Ewing Sarcoma of Neck - A Rare Case Report

Rachna Chaurasia — 2025-02-04

This case report details a rare presentation of cervical Ewing's sarcoma in a 4-year-old female, emphasizing its clinical presentation, diagnostic process, and treatment challenges. The patient initially presented with a rapidly growing neck mass and neurological symptoms; MRI confirmed a well-defined mass at the C5-C6 vertebral level, and histopathological examination verified the diagnosis of Ewing's sarcoma. Treatment involved neoadjuvant chemotherapy, followed by surgical resection with clear margins, and the patient is currently being monitored for recurrence with a guarded prognosis. This case underscores the need for a multidisciplinary approach, early intervention, and thorough surgical planning in managing rare and aggressive tumors in complex anatomical locations, contributing valuable insights to the limited literature on this uncommon malignancy.

Eosinophilic Perimyositis In a Young Male: A Case Report and Review of Literature

Bimal Patel — 2025-02-04

Eosinophilic myositis is rare group of disorder characterized by eosinophilic infiltration of skeletal muscles. It generally presents with pain, swelling and weakness of the affected muscle group or limb. The main cause of skeletal muscle eosinophil infiltration is parasitic infections. Other conditions such as hypereosinophilic syndrome, muscle dystrophies, drugs or toxins can also cause such a condition. However, most cases have no known etiological factor and are considered as idiopathic. Idiopathic eosinophilic myositis can be classified into three subtypes: focal eosinophilic myositis, eosinophilic polymyositis, and eosinophilic perimyositis which can be differentiated by pathological studies. The present report is a case of eosinophilic perimyositis who presented with pain and swelling in the region of right thigh.