GAIMS Journal of Medical Sciences <p>An official publication of Gujarat Adani Institute of Medical Sciences</p> <p> </p> <p><strong>Published by:</strong><br />Gujarat Adani Institute of Medical Sciences<br />G K General Hospital<br />Opposite Lotus Colony<br />Bhuj, Kachchh, Gujarat – 370001</p> <p> </p> <p> </p> Gujarat Adani Institute of Medical Sciences en-US GAIMS Journal of Medical Sciences 2583-1763 Does Fidaxomicin reduce Cure and Recurrence rates compared to Vancomycin in Clostridium Difficile Infection patients?: A Systematic Review and Meta-analysis <p><strong>Introduction</strong></p> <p>We searched the databases to include randomized studies evaluating the effect of fidaxomicin on cure and recurrence rate in Clostridium difficile infection (CDI). Due to its increasing severity and recurrence rates, decrease in cure rates, the Infectious Diseases Society of America (IDSA) published clinical practice guidelines in February 2018 moving away from metronidazole as the first-line treatment for initial CDI and recommending, either oral vancomycin or oral fidaxomicin.</p> <p><strong>Methodology</strong></p> <p><strong>&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;&nbsp; </strong>The outcome was summarized as odds ratios (OR) with a 95% confidence interval (CI). We used fixed effect model and assessed the heterogeneity using I<sup>2 </sup>test. We performed the meta-analysis using ‘Review manager software version 5.4.1.’</p> <p><strong>Results</strong></p> <p>The odds of recurrence rates were significantly different (P &lt; 0.00001) amongst patients treated with fidaxomicin as compared to vancomycin (OR 0.49 [95% CI: 0.36, 0.65]). Whereas no significant difference (P = 0.14) was found with regard to cure rate in both the study groups (OR 0.80 [95% CI: 0.59, 1.07]).</p> <p><strong>Conclusion</strong></p> <p>After treatment with fidaxomicin, the rates of clinical cure were non-inferior to those after treatment with vancomycin. However, fidaxomicin was associated with a significantly reduced recurrence rate of CDI including non–North American Pulsed Field type 1 strains.</p> Hiral Golakiya Tejas Khakhkhar Neelesh Khuteta Copyright (c) 2022 GAIMS Journal of Medical Sciences 2022-06-12 2022-06-12 2 1 (Jan-Jun) 30 35 Peri-Loss Dissociation and Psychotic like symptoms in a female patient: a rare presentation <p>Bereavement is a severe stressor that typically incites painful and debilitating symptoms of acute grief that commonly progress to restoration of a satisfactory, if changed, life. Complicated Grief is a bereavement specific syndrome characterized by traumatic and separation distress lasting over 6 months. A little is known about the role of dissociative experience during or immediately after the loss of loved one in Complicated Grief. Peri-Loss Dissociation may be useful in identifying individuals at risk for Complicated Grief and its relationship with treatment outcomes for different treatment approaches.</p> Riddhi Thacker Chirag Kundalia Mahesh Tilwani Copyright (c) 2022 GAIMS Journal of Medical Sciences 2022-01-20 2022-01-20 2 1 (Jan-Jun) 11 12 Anesthetic Consideration of Intraoperative Pneumothorax in Laparoscopic Surgery <p>Intraoperative pneumothorax is a rare but potentially lethal complication during general anesthesia. History of lung disease, barotrauma, and laparoscopic surgery increase the risk of developing intraoperative pneumothorax. The diagnosis during surgery could be difficult because the signs are often nonspecific. We report a case of a middle-aged women who developed right pneumothorax during an elective laparoscopic hysterectomy. Intraoperative resuscitation, management of pneumothorax and ventilatory management of this case.</p> <p>Conclusion</p> <p>It is important to have a high index of suspicion to early detect and treat such complication. In addition, good communication with the surgeon and use of available diagnostic tools will aid in the proper management of such cases.</p> <p><strong> </strong></p> Mandakinee Thacker Jaldeep Patel Vidhi Patel Copyright (c) 2022 GAIMS Journal of Medical Sciences 2022-04-08 2022-04-08 2 1 (Jan-Jun) 21 24 Harlequin Ichthyosis: report of three cases <p>Harlequin Icthyosis is the most severe form of congenital Icthyosis. It characteristically presents as large thickened plate like scaly skin lesions over whole body at the time of birth. Few patients survive beyond neonatal period. Mortality is due to respiratory failure, hypo/hyperthermia, infections, electrolyte imbalance and dehydration. Prevention of Harlequin Icthyosis can be done by prenatal genetic testing and counselling of parents. We are hereby reporting three cases of Harlequin Icthyosis in newborns.</p> Rekha Thaddanee Gopi Solanki Rushi Thakkar Copyright (c) 2022 GAIMS Journal of Medical Sciences 2022-05-18 2022-05-18 2 1 (Jan-Jun) 25 27 Spectrum of Imaging Findings in Posterior Reversible Encephalopathy Syndrome (PRES) from Typical to Atypical <p>Posterior reversible encephalopathy syndrome&nbsp;(PRES) is a clinico-radiological syndrome characterized by headache, consciousness impairment, seizures, and visual deficits and is associated with white matter changes predominantly affecting the posterior parietal and occipital lobes of the brain. Apart from the above-described typical location of the changes, the most common atypical location involves the brain stem/cerebellar hemispheres and basal ganglia. Additionally, PRES may be complicated in some cases by the presence of cytotoxic edema and haemorrhage.</p> <p>Since magnetic resonance imaging (MRI) is more sensitive and specific imaging technique compared to computerized tomography, establishing the diagnosis and follow-up in patients with PRES is based mainly on MRI findings. It is particularly important not to exclude PRES as a possible diagnosis when we have the appropriate clinical presentation accompanied by the atypical radiological findings, since this clinical-radiological syndrome can often be manifested with an atypical MRI image</p> Jeel Y Patel DrBhaven Shah Copyright (c) 2022 GAIMS Journal of Medical Sciences 2022-06-12 2022-06-12 2 1 (Jan-Jun) 40 46 Vigour of Competency based medical education (CBME) <p>Competency based medical education (CBME) was introduced by the Medical Council of India (MCI, now called as National Medical Commission, NMC) from 2019 batch across the India. CBME was rolled over to provide effective outcome based strategy and to develop the framework of competencies.&nbsp; Before its introduction, we were following the traditional medical curriculum put forward by Regulations on Graduate Medical Education, 1997. A strong need of change in the traditional curriculum was felt by many educationalists across the nation. This was the basis of emergence of CBME.</p> Vaibhav Anjankar Copyright (c) 2022 GAIMS Journal of Medical Sciences 2022-05-16 2022-05-16 2 1 (Jan-Jun) 28 29 Designing and Implementation of Electives Training in Competency Based Medical Education Curriculum <p><strong>Introduction</strong></p> <p>One of the characteristics of CBME curriculum is introduction of 2-month electives program in which students get an opportunity to differentiate, experience applicative use of knowledge and develop applied skills. Since students have a choice of identifying a topic of their interest for elective training, it is expected to provide a unique learning (by doing) experience (experiential learning) and greater degree of satisfaction.</p> <p><strong>Methodology</strong></p> <p>This article was prepared using the NMC Electives Module and searching the relevant published articles. Members of Medical Education Unit and Curriculum Committee were consulted as and when required.</p> <p><strong>Results</strong></p> <p>We have suggested a plan for effective implementation of Electives training at institute level. We have also suggested a timeline for implementation of Electives training and also distribution of students in two blocks for 8-week rotation for electives.</p> <p><strong>Conclusions</strong></p> <p>Electives complement core curriculum, supplement individual and team-based learning and inculcate organizational capabilities. Furthermore, students can identify their future learning needs. Accordingly, they would customize (select, organize and direct) their study designs to meet their specific individual learning needs. A carefully designed plan would enhance success of the elective program.</p> Ajeet Kumar Khilnani Rekha Thaddanee Copyright (c) 2022 GAIMS Journal of Medical Sciences 2022-01-10 2022-01-10 2 1 (Jan-Jun) 1 5 S-I-R approach to teach and learn Attitude, Ethics & Communication (AETCOM) <p>AETCOM teaching and assessment have already become explicit part of MBBS curriculum in India. Obviously, medical faculties should now master effective appropriate teaching-learning methods for this domain also. Most fundamental teaching-learning methods are - Sensitization (S), followed by Immersion (I), which in turn in followed by Reflective writing (R). It can be remembered as S-I-R approach. Over and above, Immersion should be impactful and reflection should be effective, then and then, optimum learning outcome can be obtained. So, this is highly recommended.</p> Suman Jain Gauri Mahajan Neeraj Mahajan Copyright (c) 2022 GAIMS Journal of Medical Sciences 2022-02-21 2022-02-21 2 1 (Jan-Jun) 13 14 Study of early outcome of Austin Moore’s prosthesis in fracture neck femur in elderly <p><strong>Introduction: </strong>Femoral neck fractures, one of the most common injuries in the elderly and its prevalence has increased with improvement in life expectancy, increased incidence of osteoporosis, and changes inlifestyle leading to sedentary habits. In last four decades hip arthroplasty is evolved as the best treatment for intra capsular fracture neck of femur in elderly in terms of both short-term and long-term results.However, it is still not popular as a first treatment modality because of complications like dislocations and higher morbidity associated with the procedure and also cost. This study is design to gain a deeper understanding of the results and problems associated with this procedure and complications like thigh pain, stem loosening and peri prosthetic fractures.<br /><strong>Materials and Methods: </strong>A prospective study was carried out at G K General Hospital, Bhuj during the period of August 2019 to July 2020. 22 patients satisfying the inclusion criteria like Intra- capsular fracture of the neck of femur and aged above 60 years were included in the study.While patients with pathological fractures, arthritic changes involving the acetabulum, below 60 years of age, not willing for surgery and medically unfit for surgery were excluded from the study.</p> <p><strong>Results: </strong>Out of total 22 patients majority of patients (90.9%) had transcervical type of fracture. Commonest time of presentation of patients were after 72 hours and average delay in surgery after injury was 12 days.Early postoperative complications like shortening, superficial infection, deep vein thrombosis was seen. However, no late postoperative complications like loosening, dislocation, erosion, calcar resorption, protrusioacetabuli or periprosthetic fracture were found. Progressive improvement in Harris Hip Score seen at each follow up visit with average final score at one year was 84.53 with a maximum score of 93 and a minimum score of 65.8.</p> <p><strong>Conclusion: </strong>Hemiarthroplasty using Austin Moore prosthesis for fractures of the femoral neck provides freedom from pain, better range of movement and more rapid return to unassisted activity with an acceptable complication rate.</p> Vraj J Patel Vivek A Patel Tej Rudani Vishal Pushkarna Copyright (c) 2022 GAIMS Journal of Medical Sciences 2022-01-19 2022-01-19 2 1 (Jan-Jun) 6 10 Haematological Profile of Adolescents at a tertiary care centre in Konkan region of Maharashtra state, India <p><strong>Introduction </strong></p> <p>Lack of studies and information on hematological parameters for adolescent population (10-19 yrs) &nbsp;is obvious on extensive research. In adolescent stage, nutritional deficiency is more common, more so in girls which are vulnerable to anaemia. Assessment of Hematological parameters in young, growing population is important in determination of normal values worldwide and for identification of anemia.</p> <p><strong>Methodology </strong></p> <p>The present study was a cross sectional, observational, retrospective study. The study period is of 1 year and 3 months (1<sup>st</sup> January 2020 to 31<sup>st</sup> March 2021). This study is based on hematological profile of 250 Adolescents (aged 10-19 years). For each of the adolescents, a blood sample by venipuncture was derived in an EDTA vacutainer. The blood sample was used to determine both the complete blood count and peripheral smear findings in each case. The automated hematology analyzer "Horiba Yumizen 500" was used to measure the variables of full blood count. All the data was tabulated in Microsoft excel sheet and analyzed using descriptive statistics.</p> <p><strong>Results </strong></p> <p>In our study, out of 250 cases studied, Males were 95 (38%) and females were 155 ( 62%). According to Age distribution, maximum cases were in 17-19 years of age group (57.6%) and minimum cases were in 10-13 age group (19.2 %). The haemoglobin level among these adolescents ranged from 12-18 gm/dl (52.4%) . 28.8% cases were present in 10-12 gm/dl range . The hemoglobin level &lt;10 gm/dl were present in 18.8% cases. RBC count ranged from 4.20-6.00 millions/cu mm in the maximum cases of adolescents with 69.2%. In the present&nbsp; study, the hematocrit range in adolescents (10-19 yrs) age group, the maximum cases (66.8% cases) show &lt;39% haematocrit. Cases with MCV between 76-100 fl, 69.6% cases were seen. The level of MCV count &lt;76 fl , cases of adolescents were 27.6%. In the present study, MCH count &lt;32 pg was seen in&nbsp; 90.4%&nbsp; adolescents.&nbsp; MCH level &gt;35 pg was seen in 0.8% cases. MCHC count &gt;34 g/dl was seen in 53.6%&nbsp; cases, whereas &lt;26 gm/dl seen in 0.8% cases. The total leucocytes count less than 4,000 cell/mm<sup>3</sup> was present in 7.2% cases, whereas a total leucocytes count more than 11,000 cell/mm<sup>3</sup> was present 26% cases. Maximum cases had platelet count range from 150000 to 4,50,000 /cu mm. 2.4% cases show thrombocytopenia. Thrombocytosis was noted in 4.45% cases.</p> <p><strong>Conclusions </strong></p> <p>Nutritional deficiency anaemia was more prevalent in adolescent girls in this region. Anaemia was seen more in girl adolescents compared to boys. Hematological parameters were better in boys compared to girl adolescents&nbsp; in this region.</p> Shweta S Joshi Bhushan M Warpe Dikshita A Lad Copyright (c) 2022 GAIMS Journal of Medical Sciences 2022-04-05 2022-04-05 2 1 (Jan-Jun) 15 20 Effect of The Covid-19 Pandemic on Teaching In Subject of Anatomy For First MBBS Students <p><strong>Introduction:</strong> Anatomical knowledge is very crucial to the practice of medicine; thus, its acquisition is foundation base for clinical<br />subjects. Many studies have shown that cadaveric dissections strengthen respect and empathy among medical students. Many<br />students felt the stress and anxiety due to online teaching classes during the pandemic</p> <p><strong>Material and methods:</strong> This cross-sectional study was conducted among first year MBBS students of Gujarat Adani Institute of<br />Medical Sciences, Bhuj, Gujarat, India, during 2020-2021. Informed consent was taken from the students when they came back to<br />offline classes after the pandemic was controlled</p> <p><strong>Results:</strong> Students were of opinion that offline teaching is more stimulating, it is easy to engage with teacher and more interaction<br />and doubt can be cleared. But during online teaching fear of facing teacher was less in minds of students.<br />The disadvantages which are associated with online teaching as per our study were mostly poor internet connection and less<br />interactivity with teacher. Regarding advantages of online teaching, students were most happy with flexibility of location and<br />comfort of home. Other few advantages were time and cost saving due to travel.</p> <p><strong>Conclusion:</strong> The present study revealed that for anatomy being a vast subject, online teaching cannot replace the offline teaching.<br />But in current corona pandemic, online teaching is the only way out. To make online teaching effective it should be more interactive<br />and practical topic has to be revised on specimens and models when students are back to offline classes. The exams should not just<br />include MCQs but also viva and assignments</p> Sachin Patil Sagnik Roy Nivedita Roy Copyright (c) 2022 GAIMS Journal of Medical Sciences 2022-06-08 2022-06-08 2 1 (Jan-Jun) 36 39