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 Table of Contents 
Year : 2018  |  Volume : 7  |  Issue : 9  |  Page : 1-26  

Research papers

Date of Web Publication24-Dec-2018

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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/2249-4863.248473

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How to cite this article:
. Research papers. J Family Med Prim Care 2018;7, Suppl S3:1-26

How to cite this URL:
. Research papers. J Family Med Prim Care [serial online] 2018 [cited 2021 Sep 19];7, Suppl S3:1-26. Available from: https://www.jfmpc.com/text.asp?2018/7/9/1/248473

  Study of association of human leukocyte antigen class II DQ1 allele in systemic lupus erythematosus patients in North India Top

Akash Sardool1

1Maulana Azad Medical College, New Delhi, India E-mail: [email protected]

Introduction: Systemic lupus erythematosus (SLE) is a multifactorial autoimmune disorder resulting from interactions among geneti c factors, immunologic factors, and environmental factors. It is a genetically complex disease with contributions from MHC and non-MHC genes. The study of human leukocyte antigen (HLA) association supports the concept that MHC genes regulate production of particular antibodies. We conducted this study to compare the HLADQB1 allelic sequence variation among SLE patients and controls and analysis of the relative contribution of HLADQB1 subclasses to the susceptibility to SLE in our patients in North India. To analyze the pathogenesis of SLE and to find association of SLE patients with MHC gene polymorphism HLA class II haplotype involving the DQB1 loci. Materials and Methods: Patients with autoimmune manifestations have at least four of the eleven criteria described by the American College of Rheumatology for SLE. Total of 20 patients with equal number of controls were included in the study which lasted for 2 months. DNA was extracted from the fresh 2 ml ethylenediaminetetraacetic acid blood sample by phenol-chloroform method. Genotyping of HLADQB1*0602 and 0201 was done using sequence specific polymerase chain reaction. Amplified products were visualized on 2% ethidium bromide-stained agarose gel following electrophoresis. Results: Result of HLADQ*0201 polymorphism, among SLE patient out of 20 patient 7 having HLADQ*0201 polymorphism and for HLADQ*0602, 12 patients had polymorphism. Out of 20 healthy controls, 3 having polymorphism and with HLADQB1*0602 4 controls showed polymorphism. Frequency of HLA*0201 polymorphism was 40% and 15% patient and healthy control, respectively and for HLADQ*0602 60% and 20%, respectively. The statistical analysis of frequency of the HLADQ*0201 and HLADQ*0602 polymorphism among the SLE patients and controls by Chi-square test showed that a statistical significance was evident between the two groups, as P value of HLADQ*0201 was 0.0863 and for HLA DQ*0602 was 0.0130. Fishers exact test was used to assess the odds ratio (95% confi dence interval [CI]) and indicated a significant difference between the frequency of polymorphism HLADQ*0201 and the frequency of the same polymorphism inadequate for opinion healthy control), odds ratio (95% CI) for HLADQ*0201 polymorphism is 3.7778 and for HLA DQ*0602 polymorphism is 6.000. Conclusion:Although our study was extremely small, it determined a positive correlation between the genetic association of the selected genes namely HLADQ0201 and HLA DQ0602. This was a pilot study meant to launch our work in studying the role of genetic factors in the pathogenesis of SLE.

  Impact of health education on health and hygiene practices among adolescent girls Top

Aniqua Sheikh1

1M.N.R Medical College, Sangareddy, Telangana, India E-mail: [email protected]

Introduction: Human body is ever evolving from a zygote to adult in continuous dynamics. Transformation into an adult from a child occurs through puberty. The reaction to pubertal changes depends upon awareness and knowledge about the subject and the manner in which she learns about it. Women having better knowledge regarding body changes and menstrual hygiene are less vulnerable to reproductive and urinary tract infections and its consequences. Aim: To study the effect of health education on awareness of adolescent school girls regarding their health and hygiene practices comparative study for knowledge status between intervened group and nonintervened group. Materials and Methods: Under MNR Educational Trust, 200 adolescent girls from 4 schools were given adolescent health education and its effects were assessed and compared. Methodology: A case–control study on impact of health education and hygiene practices of 200 school girls of classes VII-IX during the period of February 2014–July 2014 in Sangareddy based on predesigned questionnaire. At the end of the study, all their queries were answered by our team.


  • Awareness and practice of personal hygiene steps are higher after intervention
  • After educating
  • There was 39% increase in intake of breakfast
  • Preventive measures for urine infection is higher
  • Myths about food intake during periods decreased by 13%
  • Forty percent more girls were open about discussing their menstrual problems
  • There was a 28% increase in school attendance.

Conclusion:This study shows that adolescent education programs can be the tool for enriching their knowledge levels during puberty and prevention of many illnesses during adolescence.

  Health education as a tool to quit tobacco use among nonteaching staff in a medical college Top

Ankita Priydarshini1

1Jawaharlal Nehru Medical College, Belagavi, Karnataka, India

E-mail: [email protected]

Introduction: Nonteaching staff working in medical institute forms a formidable workforce and an important sector with respect to public health. It is important to know the pattern of tobacco use among them and whether health education can act as an intervention to help them quit tobacco. Materials and Methods: Interventional study conducted on 258 nonteaching staff for 2 months in a medical college. A self-administered questionnaire followed by intervention in the form of health education about the harms of tobacco was given to the participants. Follow-up was conducted after a week and at the end of one month using the same questionnaire to study the quit rate among the tobacco users. Appropriate statistical tests were used to analyze results. Results: Among the total participants (258), 98 (38%) of them were using tobacco in any form. Smoking forms of tobacco were seen in 78 (79.6%) and combined smoking and smokeless forms were seen in 20 (20.4%) participants. Among tobacco users, 41 (41.8%) had tried to quit tobacco without seeking any professional help but failed to do so. Only 92 participants were invited for intervention as 6 of them had quit the job during the study. Among them, 30 (32.60%) actually attended the intervention. First follow-up was attended by 26 participants out of 30 with compliance rate of 86.67%, but none of them had quit tobacco. Second follow-up was again attended by 26 participants. Among them, 3 participants had quit tobacco with quit rate of 11.54%, which is unsatisfactory. Conclusions: Tobacco consumption among study participants was high. Compliance for health education to quit tobacco was poor. Tobacco quit rate among those who attended the intervention, and the two follow-up sessions were very poor.

  A comparative study of prevalence of anemia among pregnant women in slums of Suraram and working women in Suraram colony, Jeedimetla Top

Anusha Baddam

E-mail: [email protected]

Introduction: Anemia is a global public health problem affecting both developing and developed countries. Pregnant women are most vulnerable groups to anemia and often present with iron deficiency anemia as a consequence of increased plasma volume during pregnancy. WHO defines anemia as a hemoglobin (Hb) concentration below 11 g/dl. Early detection and management of anemia should be undertaken to prevent adverse outcomes during pregnancy. The present study is planned to understand the prevalence of anemia among working and nonworking pregnant women of Suraram village through estimation of Hb levels and to correlate socioeconomic factors to the cause of anemia. Methodology: The study was a cross-sectional study among 50 nonworking and 50 working pregnant women among Suraram slums and colony, respectively. A standardized questionnaire was developed to collect the relevant information including demographic information, obstetric history, dietary history, and relevant past history. Hb% was estimated by Sahli's hemoglobinometer. A peripheral blood smear also was examined in those with Hb <10 g/dl to grade anemia. Result: Majority of the study population are in the age group of 20–29 years. As per modified Kuppuswamy SES scale (2012), most of the working women fall in class II followed by class I and class III. The nonworking women (slums) fall in class V followed by class IV. Prevalence of anemia is high among nonworking women (50% of class IV and 66.67% of class V) when compared to working women (11.43% of class II and 14.29% of class III). Conclusion:Anemia continues to be a major health concern among the pregnant women living in Suraram slums. The major determinants of anemia as per the study are related to low socioeconomic classes and literacy of women.

  Effect of dietary pattern and weight on cognitive function and academic performance in adolescents: A cross-sectional study Top

Deepika Ravi1

1S J Nijalingappa Medical College, Bagalkot, Karnataka, India

E-mail: [email protected]

Introduction and Objectives: Cognitive function and academic performance determine an adolescent's performance, development, and outcome in school to a great extent. They have various determinants. Keeping this in view, the aim of the study was to assess the nutritional status (dietary pattern and anthropometry, i.e., body mass index [BMI] and waist to height ratio [WTHR]), cognitive function, and academic performance in adolescents. These assessments were used to analyze the effect of dietary pattern on BMI and WTHR and their consequent effect on academic performance and cognitive function. Materials and Methodology: The study was cross-sectional, including 281 adolescents between the age of 12–18 years. Dietary assessment was carried out using 24 h recall method. Height, weight, and waist circumference were measured and using them, BMI and WTHR were calculated. Cognitive function was assessed using Raven's Progressive Matrices. Summative academic performance of the previous year was taken. Results and Conclusion:The dietary pattern showed that 97.16% of the students had a deficient calorie intake as compared to the recommended. Calculated by WTHR and BMI, 61% adolescents were normal weight, and 33% were underweight. Only 6% were overweight and obese. The relationship between BMI and WTHR with academic performance was statistically significant. Seventy percent of normal-weight adolescents had scored well, which shows the good performance of adolescents with normal dietary status. Most overweight adolescents had scored well but 44% of underweight adolescents had scored only average.

This shows that undernourishment has a negative impact on academic performance. Relationship of diet and anthropometry with cognitive function were not statistically signifi cant. It can be concluded that nutritional status does affect academic performance. Undernourishment causes a decrease while proper nourishment causes optimum functioning in academic activities.

  Undergraduate dental students' perception on “undergraduate research” in a dental teaching institution in Bengaluru city, India: A cross-sectional study Top

T. R. Gokulraj1, Jyotsna1, Harikiran1, Charu Chitra1

1DAPM R V Dental College, Bengaluru, Karnataka, India

Introduction: Imbibing research culture at the undergraduate level is vital for the future dental workforce to be well equipped for evidence-based practice and be on par with the best from across the world. In 2007, the Dental Council of India (DCI) introduced the short-term student research program in the curriculum of dental public health for the undergraduate dental students. The students are important stakeholders in any curriculum. Hence, this study, for the 1st time in India, seeks to explore the dental student's perceptions on the SWOC of an undergraduate research program in a dental teaching institution in India. Materials and Methods: In this study, dental students from 1styear to internship (261) selected by total enumeration method were administered a semi-structured questionnaire in which the students' perception on relevance of research, understanding of theoretical concepts, soft skill development, self-confidence, and the impact of research program in the dental teaching institution were assessed. Descriptive and inferential statistics were used for data analysis. Results: Ninety-seven percent of all the students said research is relevant in today's world. More than 90% of the students reported a better understanding of research process, improvement in soft skills, ability to undertake research independently, and improved attitude after their undergraduate research experience. Conclusion:Students have identifi ed that exposure to a quality research program definitely enhances their competencies in communication and practice of evidence-based dentistry. Therefore, research initiatives by UG students should be well supported by the faculty, institution, health universities, and the DCI. Policy changes should be brought about to provide adequate infrastructure, funding mechanisms, incentives, and establishment of dissemination strategies.

  Clinicoepidemiological trends of lepromatous leprosy in postelimination era Top

Dhakshitha Peddisetty1

1Kurnool Medical College, Kurnool, Andhra Pradesh, India

E-mail: [email protected]

Introduction: Leprosy has been declared eliminated at the national level on December 30, 2005, which led to decentralization and integration of services in general health system. Various epidemiological studies in postelimination era are showing a steady increase in the number of new cases detected. Objective: To know the clinicoepidemiological trends of lepromatous leprosy (LL) from May 2011 to April 2014 in a tertiary care center. Material and Methods: Consecutive cases of LL attending DVL OPD over last 3 years (May 2011– April 2014) were taken into the study. Demographic data and detailed history with emphasis on previous treatment taken were noted. A family history of leprosy was looked for. Complete clinical examination was carried out and various morphological patterns of cutaneous lesions were noted. Routine and specifi c investigations were carried out. A biopsy was done wherever necessary. Complications such as type 2 reaction and grade 2 disability were looked for. Results: Total number of LL Hansens cases over the last 3 years were 52 – male - 35 (67%); female - 17 (32%); M:F - 2:1; age range - 17–63 years with a mean age of 36.3 years. Type 2 reaction was seen in 25 cases (48%) out of which 12 cases presented directly with erythema nodosum leprosum (ENL) without prior multidrug therapy. Family history of leprosy was present in 5 patients (9.6%). Grade 2 disability was present in 13 patients (25%), with claw hand being most common followed by trophic ulcers. A case of ENL necroticans was found to be HIV positive. Conclusion:The number of LL cases in our study showed an increase postelimination and to sustain this current decline active surveillance and increasing IEC activities at all levels and in all states should be made mandatory.

  Study of psychosocial risk status of adolescent girls in rural areas using “Home, Education and Employment, Eating, Activities, Drugs, Sexuality, Suicide and Depression, and Safety” approach Top

Dintyala Venkata S. S. Mythri1

1NRI Academy of Sciences, Andhra Pradesh, India

E-mail: [email protected]

Introduction: “Adolescence” (10–19 years), a critical period of life, was characterized by rapid growth and development, physiologically, psychologically, and socially. Adolescents constitute about 22% of India's population. It is estimated that around 20% of the world's adolescents have a mental health or behavioral problem. The rate of unmet need is nearly 100% pertaining to mental health in developing countries. Preventive efforts can help forestall development and progression of mental disorders, and early intervention can limit their severity. The objectives are to study demographic profile and psychosocial risk profile of adolescent girls in rural areas by Home, Education and Employment, Eating, Activities, Drugs, Sexuality, Suicide and Depression, and Safety (HEEADSSS) approach. Materials and Methods: The cross-sectional observational study was done at Chinakakani Village, field practice area of NRIMC and GH with population of 6320. A total of 191 adolescent girls were administered a pretested, semi-structured schedule by interview technique containing demographic details and modifi ed WHO HEEADSSS questionnaire. Informed consent from study subjects and Institutional Ethical clearance were obtained before start of the study. Results: Nearly 10% of the adolescent girls were free from any psychosocial risks such as physical violence at home, run away from home, not being allowed to continue their education, making them do some job other than being a student, addiction to television, worried about their weight, alcohol or drug problems in the family, sexual relationships with nonmarital partners, suicidal tendencies, and physical and sexual abuse, 43.5% were facing mild risk, 29.8% moderate risk, and 16.7% of them are facing Severe to very severe psychosocial risk. Conclusion:Ninty percent of adolescent girls in rural area are facing psychosocial risks of different intensities.

  Correlation of cytological findings of lymph node aspirate with histopathological examination of lymph node biopsy in case of tuberculous lymphadenitis Top

Shaik Karimuddin Abdullah1

1Shadan Institute of Medical Sciences, Hyderabad, Telangana, India

E-mail: [email protected]

Introduction: Tuberculosis (TB) is still a disease of public health significance. India has the highest TB burden accounting for one-fifth of the global incidence. In India per se, any regional lymphadenopathy is evaluated by the clinician with a suspicion of TB due to the huge burden and frequency of the disease. The present study is undertaken to evaluate the effi cacy of fine needle aspiration cytology (FNAC) as a diagnostic tool for detecting TB. This study was chosen because of higher inflow of TB cases in our setup. Objectives: To determine the magnitude of occurrence of tuberculous lymphadenopathy. To determine the efficacy of FNAC in detecting tuberculous lymphadenitis. To correlate the cytological findings with histopathological examination (HPE) of lymph node biopsy. Materials and Methods: The study was conducted on 31 patients of lymphadenopathy coming to the outpatient department (OPD) of Medical College and Hospital (Hyderabad) for duration of 2 months. All the suspected patients with clinical presentation of unilateral or bilateral, solitary or matted, painful, or painless mass in regional lymphatic areas such as cervical, axillary, inguinal regions were included. Accordingly, the site of lymphadenopathy was aspirated using 22 gauge needle attached to 10 ml disposable syringe under strict aseptic conditions. The aspirate was fi xed in alcohol and stained with hematoxylin and eosin stain. The patient was then advised for excision biopsy for HPE and the fresh specimen obtained was fixed; later grossing and processing was done. The prepared slides were also examined by the pathologist, and the final diagnosis was made. The results of HPE were then correlated with the cytological findings obtained earlier. Results: A total of 31 cases of lymphadenopathy were evaluated by FNAC. Of them, 14 cases were found to be of tuberculous lymphadenitis. Out of 14 cases of tuberculous lymphadenitis, cytohistological correlation was done in 10 cases, all of which were true positive. Sensitivity and specificity of FNAC in cases of TB lymphadenitis is 88.24% and 100%, respectively. Positive predictive value is 100%, and negative predictive value is 80%. Accuracy is 92%. Conclusions: On the basis of the fi ndings of the study, FNAC combined with clinical correlation is useful as a front-line investigation with high specificity which avoids invasive procedures. It is also simple, cost effective, diagnostic tool. FNAC is a rapid method, economical, minimally traumatic, OPD procedure, has good patient compliance, early availability of report, and devoid of complications.

  Effect of lifestyle determinants among middle-aged male diabetic patients - A cross-sectional study Top

K. I. Egla1, Padmini Thalanjeri2

1Yenepoya Medical College, 2Department of Physiology, Yenepoya Medical College, Mangalore, Karnataka, India.

E-mail:[email protected]

Background: India now designated as diabetes capital of the world is facing a serious threat from this pandemic. General awareness about the risk factors precipitating this illness is the need of the hour. Objectives: To analyze the effect of cigarette smoking, alcohol consumption, and total energy consumption among middle-aged male diabetics and to compare it with healthy middle-aged men. Methodology: Cross-sectional study was done among 100 middle aged men, 50 diabetics without complication or other comorbidities and 50 healthy individuals between 30 and50 years regarding their cigarette smoking, alcohol consumption, and total calorie intake. Comparison was done among the two groups. Results: There was a significant association between cigarette smoking and diabetes (P < 0.05). There was increased association between alcohol consumption and nondiabetics, but it was not statistically significant. Furthermore, total energy consumption was significantly higher among diabetics (P < 0.05) when compared to nondiabetics. Conclusion:Cigarette smoking was found to be a significant risk factor for diabetes. In addition, increased energy consumption worsened the diabetes. Alteration in lifestyle, inculcating healthy eating practices, cessation of smoking, and routine physical activity should be stressed to the general public. Only then, it is possible to contain this pandemic.

  Correlative study of hemoglobin A1c levels and asymptomatic hypertension in type 2 diabetes mellitus Top

G. Nivetha1, D. C. Arumainayagam1

1Madha Medical College and Research Institute, Chennai, Tamil Nadu, India

E-mail: [email protected]

Introduction: World is threatened by the morbidity and mortality of noncommunicable diseases and hypertension tops the list with 7.5 million (13%) deaths/year. Most of the hypertension cases are asymptomatic, and the condition worsens if diabetes mellitus is also added. Unfortunately, in India, studies on such patients are scanty. Hence, an attempt was made to correlate the prevalence of diabetes combined asymptomatic hypertension in rural population. Objective: To evaluate the prevalence of asymptomatic hypertension in type 2 diabetes mellitus and to correlate it with hemoglobin A1c (HbA1c) levels. Materials and Methods: A cross-sectional study was done in the outpatient department of Medicine in Madha Medical College and Research Institute Hospital. Hundred patients (both male and female) in the age group of 30–70 years participated in the study. The study population was known diabetic patients without the typical symptoms of hypertension such as fatigue and sleepiness, breathlessness, profuse sweating, headache, and epistaxis (bleeding from the nose). Venous blood was collected under aseptic conditions, and HbA1c was estimated by using Glycohemoglobin Kit (Ion Exchange Resin Method). Blood pressure (BP) was measured by conventional method using sphygmomanometer. Hypertension was determined by noting the BP level. Data were analyzed in SPSS version 17 with correlation coeffi cient test. Result: Among the study participants, prevalence of asymptomatic hypertension was found to be 56% (systolic BP) and 46% (diastolic BP) and 61% with overall hypertension. The correlation coefficient between the systolic BP and HbA1c levels and diastolic BP and HbA1c levels were found to be 0.534 and 0.807, respectively. Conclusion:The results of the present study reveal that hypertension and diabetes mellitus are coexisting in many cases but people are not aware of it. Hence, screening must be done for both.

  Evaluation of the utility of Bethesda system in cytology of thyroid lesions Top

Gottipati Divya Sai1

1Narayana Medical College, Nellore, Andhra Pradesh, India

E-mail: [email protected]

Introduction: The recently proposed that the Bethesda thyroid fine-needle aspiration classification system has great potential to increase the sensitivity and specifi city of fine needle aspiration cytology (FNAC) of thyroid lesions and also better coordination between surgeon and pathologist leading to better patient care.

Objectives: To determine role of Bethesda thyroid FNAC systems in increasing the specificity and sensitivity of FNAC thyroid lesions. To know the reproducibility of the Bethesda System for Reporting Thyroid Cytopathology (TBRSTC) on a day to day thyroid cytopathology reporting.

Materials and Methodology: Done by applying TBSRTC classification to routine FNAC studies of thyroid lesions statistical evaluation. Done by Galen and Gambino method and results compared with Bethesda system.

Conclusion:There is a great utility of TBSRTC in thyroid cytopathology.

  Hypolipidemic effects of fenugreek and atorvastatin - A comparative study on high-fat fed hyperlipidemic rats Top

C. S. Hema Vardhini1

1PSG Institute of Medical Science and Research, Coimbatore, Tamil Nadu, India

E-mail: [email protected]

Introduction: Dyslipidemia is the current medical problem of utmost concern with an increased prevalence among the males between 31 and 40 years. The objective of this study is to prove that one of the most common Indian spice – Fenugreek (Trigonella foenum-graecum), methi (in Hindi), can be used by dyslipidemic individuals as part of their lifestyle modifi cations in lowering their serum lipid levels by determining its hypolipidemic potential and comparing it with lipid lowering properties of a pharmacological agent -atorvastatin. Materials and Methodology: Twenty-four adult male Wistar rats were divided equally into four groups. Group A was kept as the control and fed on normal diet. Hyperlipidemia was induced in Groups B, C, and D with high-fat diet containing groundnut oil cake and dried coconut for 12 weeks. The hyperlipidemic rats were then put on the various hypolipidemic regimens under study. Group B - 2 ml emulsion of fenugreek (1 g/kg/day) orally, Group C - 2 ml emulsion of atorvastatin (30 m/kg/day) orally, Group D - 4 ml emulsion of fenugreek and atorvastatin combined. The serum samples were analyzed for lipid profile at the end of 4 weeks. Results: Administration of fenugreek to hyperlipidemic rats showed a significant reduction of serum triglycerides, cholesterol, and body weight (P < 0.05) and a significant increase in the serum high-density lipoprotein levels (P < 0.05). The combination therapy with fenugreek and atorvastatin showed a statistical signifi cance of P < 0.01. Conclusion:Fenugreek is proved to be a potent hypolipidemic agent. Lifestyle modifi cation with dietary supplement of fenugreek can be taken as an effective hypolipidemic element initially to combat the increasing risks of dyslipidemia. If they do not respond, then the individuals can switch over to pharmacological agents such as atorvastatin along with fenugreek to control dyslipidemia.

  To study the prevalence and causes of macular edema Top

Mann Ishtpreet1, Khan Balbir1

1Gian Sagar Medical College and Hospital, Patiala, Punjab, India

E-mail: [email protected]

Introduction: Macular edema occurs when fluid and proteins deposits collect on or under the macula of eye and causes it to thicken and swell. Macular edema is often painless and may display few symptoms when it develops which includes blurred or wavy central vision and/or colors appear “washed out” or changed. If left untreated, macular edema can cause severe vision loss and even blindness. Clinically signifi cant macular edema (CSME) includes any one of the following lesions: retinal thickening at or within 500 μ from the center of macular; hard exudates at or within 500 μ from the center of macular associated with thickening of adjacent retina; an area or areas of retinal thickening at least 1 disc area in size, at least part of which is within 1 disc diameter of the center of the macular. Materials and Methods: This cross-sectional, observational study will be conducted in the Department of Ophthalmology, Gian Sagar Medical College and Hospital, Patiala, for 2 months from April to August 2014. Patients with various diseases such as diabetes mellitus, hypertension, branch retinal vein occlusion, central retinal vein occlusion, and glaucoma who had macular edema were recruited in the study after they gave a written informed consent. A proforma was filled by the patients, which included their signs and symptoms. The prevalence of macular edema in a particular disease was calculated. Results: The prevalence of macular edema in all the diseases was compared. The results showed that prevalence of macular edema was highest in diabetes mellitus (38%), followed by diabetes mellitus and hypertension (24%) and cystoid macular edema (12%) with least prevalence in age-related macular degeneration (ARMD), glaucoma, CSME, and frosted branch angiitis. Conclusion:Diabetes mellitus has the highest prevalence of macular edema followed by diabetes mellitus and hypertension and postcataract surgery cystoids macular edema, and the least common causes are frosted branch angiitis, CSME, ARMD, and glaucoma.

  Effect of henna (mehndi) on pulse oximetry reading Top

Juveria Sultana1

1Deccan College of Medical Sciences, Hyderabad, Telangana, India

E-mail: [email protected]

Objective: To determine the effect of henna on the measurement of oxygen saturation using pulse oximeter. Introduction: Pulse oximetry is a noninvasive method that uses the spectrophotometric principle to monitor oxygen saturation in the blood. Pulse oximetry has now become a reliable tool for indirectly assessing the oxygen saturation in patients. Although it gives a reliable reading of oxygen saturation, it is also infl uenced by certain factors such as complexion of skin, color, or dye applied to skin and nail polish. In India, henna is traditionally used dye by women for decorating their hands. Pulse oximetry has been recognized as the 5th vital sign in clinical medicine. Skin pigmentation has been shown to influence variability in readings by as much as 4%. In critical care units where important interventional and therapeutic decisions hinge routinely upon oxygen saturation, it is important to recognize this variability. Materials and Methods: Hundred healthy females with a mean age of 18–30 were included in the study. Saturation of oxygen was determined on bilateral index fingers using pulse oximeter before application of henna. Henna was applied to the distal phalanx of the left index finger (test) (right index [control]) and kept for 2 h. After 2 h, the henna was scraped off and oxygen saturation was determined on both test and control fi ngers. Similarly, oxygen saturation was again assessed on the 2nd day and 7th day of application of henna and was statistically compared. Result: In this study, oxygen saturation was increased to a minor extent which cannot be termed clinically signifi cant. Conclusion:The results suggest that application of henna has potential of causing minor error in the measurement of oxygen saturation by pulse oximetry. In these cases, we recommend to use ear oximetry for accurate measurement of oxygen saturation.

  An epidemiological study to assess the body image perception and its effect on well-being among adolescent girls in rural Puducherry Top

Kasimkuppam Divyasree1

1Mahatma Gandhi Medical College and Research Institute, Puducherry, India

E-mail: [email protected]

Introduction: Body image is a psychosocial dimension of body size that encompasses both perception and attitudinal factors associated with human functioning, including emotions, thoughts, behaviors, and relationships. Objective: To assess and determine body image perception of adolescent girls in rural Puducherry. Materials and Methods: A study was conducted among 15–19 years 188 adolescent girls of rural Puducherry during May-June 2014, interviewed by using questions from General Health Questionnaire-12. Qualitative data regarding factors contributing perception about body image were collected in triangulated manner through two FGDs, free listing and pile sorting exercise. Quantitative data were analyzed using Epi info 7.0 version. Qualitative free list and pile sort data analysis were undertaken using Anthropac 4.98.1/X software. Observations and Results: (a) Quantitative findings: In the present study, 60.90% and 17.60% thought they are thin and fat, respectively, whereas 63.80% and 17.00% are thin and fat, respectively, which mentioned by their family members to them. 18.60% study subjects are told by their friends about being fat. More than 50% were happy with their present weight. Only 1.10% was unhappy with their current weight. 13.30% considered themselves being overweight. About 18.18% and 33.50% study subjects ever attempted weight loss and gain, respectively. 74.50% had well and 24.50% had fair opinion about their body image. (b) Qualitative findings: Study subjects identified peer pressure, family opinion about body image, effect of television and mass media, attention given by opposite sex, physical appearance, failed teenage relationships, good self-esteem and confidence, looking more attractive, depression, and better marriage proposals as factors for determining body image perceptions among adolescent girls. Conclusion:Rural Indian adolescent girls are conscious about their ideal body image for better physical look.

  Effect of type 2 diabetes mellitus on pulmonary function tests Top

Kothwal Patel Meena1

1Kurnool Medical College, Kurnool, Andhra Pradesh, India

E-mail: [email protected]

Introduction: Diabetes is a metabolic disorder having its debilitating effects on most of the organs, of which eyes, kidney, nerves, and major vessels are commonly affected. The complications of diabetes are due to microangiopathy, which occur as a result of chronic hyperglycemia. Lung has large microvascular unit, which may be affected by diabetes. There are few clinical studies regarding lung function in type-2 diabetes when compared to type-1 diabetes. Hence, the objectives of this study are - 1. To analyze the pulmonary function parameters in type-2 diabetic patients and compare them with age- and gender-matched healthy subjects 2. To correlate forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and peak expiratory flow rate (PEFR) in diabetic patients with duration of disease. Materials and Methods: Twenty type-2 Diabetic patients aged 40–65 years with diabetic duration of 1–20 years are taken from Endocrinology OPD, GGH, Kurnool. 20 nondiabetic age- and gender-matched subjects are also selected from attendants of patients. Individuals with type-2 diabetes mellitus, otherwise healthy, are included in the study. The apparent health status of subjects was determined by thorough history taking and clinical examination. Subjects with type-1 diabetes, history of smoking/ alcohol, hypertension, cardiac/respiratory/musculoskeletal disorders are excluded from study. The subject was informed about the procedure and spirometry was performed with subject in sitting position, at room temperature, using a KoKo Legend Spirometer in Pulmonology OPD, GGH, Kurnool. Fasting blood sugar and postprandial blood sugar of subjects were predicted by using GOD-POD method in Central lab, GGH, Kurnool. Results: There was a decrease in FVC, FEV1, and PEFR, but an increase in FEV1/FVC ratio in diabetic patients when compared to controls. A negative correlation of reduced pulmonary functions (FVC and FEV1) was observed with duration of diabetes. Conclusions: Reduced pulmonary functions seen in diabetics, indicating a restrictive lung pathology, show that lung is also a target organ for diabetes. Hence, we could suggest physicians to perform spirometry on diabetics occasionally for reduced pulmonary function tests and breathing exercises could be prescribed for improving lung functioning.

  Prevalence of depressive and general anxiety disorders among undergraduate (MBBS) students of a medical college in Northern India Top

S. R. Mazta1, S. Ranaut1, Kushal Kumar1

1Indira Gandhi Medical College, Shimla, Himachal Pradesh, India

E-mail: [email protected]

Introduction and Objective: Medical students lead a stressful life due to various factors. This study aimed to assess prevalence of general anxiety disorders and depressive illness among undergraduate (MBBS) students. Methods: It was a cross-sectional study involving 300 medical students studying in fi rst to third Professional pursuing MBBS in Indira Gandhi Medical College, Shimla, using GAD-7 and PHQ-9 questionnaire during the months of May 2014–July 2014. Non-MBBS students and students who did not consent to participate were excluded from the study. The collected data were analyzed using Epi info 7 software. The threshold for statistical significance was set at the standard P = 0.05. Results: Response rate was 96%. Prevalence of generalized anxiety disorder was 33.68%. GAD is seen more in age group more than 20 years of age (42.31%) with P = 0.00725. Furthermore, the prevalence of self-identifi ed depressive illness was 53.82%. There was signifi cant difference in depressive illness among students of various professionals. Conclusion:High prevalence of general anxiety disorder and depressive illness among medical undergraduates advocate measures such as screening and psychiatric counseling of this vulnerable population is needed.

  Dose- and time-dependent effects of statins on the risk of development of new-onset diabetes mellitus Top

Rajkmari Laisana1

1Mahatma Gandhi Medical College and Research Institute, Pillayarkuppam, Puducherry, India.

E-mail: [email protected]

Introduction: Statins play a vital role in the prevention of cardiovascular disease. In spite of the beneficial effects it also has few adverse effects. The US-Food and Drug Administration has proposed a new safety warning concerning the association between dose-dependent statin therapy and the risk of new-onset diabetes mellitus (NODM). The development of diabetes is controversial. Moreover, the warning is based on the meta-analysis conducted in the US, UK, Middle East, and Africa. Aims and Objectives: (1) To find out the prevalence of NODM in subjects on statin therapy (2) to compare the dose and time dependent effects of various statins on the risk of development of NODM. Materials and Methods: The protocol was submitted to the Institutional Human Ethical Committee for approval after which the subjects were enrolled from July 2014 onward until August 2014. This is an observational, cross-sectional study. Subjects were volunteers from the cross-sectional population of Puducherry, who fit the criteria, on statin treatment for 2 months or more. Study Parameters: Body mass index (BMI) calculated and interpreted as per Quetelet index. Biochemical Parameters: (a) Fasting blood glucose (FBG) or random blood glucose (RBG). (b) Hemoglobin A1c (HbA1c). Sample Collection: 2 ml blood each was collected in test tubes for checking FBG/RBG and for estimating HbA1c levels. The data obtained were entered in Excel sheet and also analyzed for causality relationship. Results: Among 22 subjects, 17 had symptoms of hyperglycemia, 8 (36.4%) had impaired HbA1c level, and 6 (27.2%) were diagnosed as diabetic. Remaining 8 (36.4%) were normal. The prevalence of diabetes in our study group was 27%. Conclusion:The treatment increases the risk of NODM by 27% and there was a significant rise in the RBG levels after therapy along with a significant rise in HbA1c values as the drug dosages increase. The duration of treatment, type of statin, and the BMI has not significantly infl uenced HbA1c values.

  Adolescent awareness: “A tool to combat HIV/ AIDS” Top

M. Alekhya1

1M.N.R Medical College, Sangareddy, Telangana, India E-mail: [email protected]

Introduction: AIDS is world health problem of extraordinary scale and extreme urgency. Adolescents and young people are vulnerable of acquiring HIV infection, especially girls. Affected adolescent population constitutes 31% of AIDS burden in India. Between 2005 and 2012, HIV-related deaths among adolescents increased by 50%. School education described as a “social vaccine” acts as powerful preventive tool. Objectives: To assess the level of awareness, attitude, and beliefs regarding HIV/ AIDS among school children. Comparative study for knowledge status between intervened group and nonintervened group. Materials and Methods: A cross-sectional study was taken covering all students studying in the 7th to 10th standard of age group (12–17 years) in four schools of Sangareddy. Information collected by a predesigned questionnaire after taking permission from principals. Basic education was given and all queries were answered at the end of the study. Study Period: 6 months from February 2015 to July 2015. Results: 800 school children participated. 84.09% heard about HIV. Of those who had heard of HIV, 72.72% knew one mode of transmission and 63.63% were aware of at least one mode of prevention of HIV/AIDS. Around 54% boys and 62% girls had misconceptions in relation to HIV-infected person, and only 46.5% had knowledge about availability of medication. After intervention, 96% of students in intervened school able to say at least one mode of transmission, and 94% were aware of at least one mode of prevention of HIV/ AIDS. Conclusions: It is observed that school students became aware of modes of transmission (sexual contact). However, there are lapses in modes of prevention and attitude, toward aids/HIV positive person, only few had knowledge about availability of medications and ART centers. This can be achieved by classroom-based education program on AIDS/HIV.

  A cross-sectional study to identify the risk factors for ischemic heart disease in Akola district Top

Malvika Nagpal1

1Government Medical College, Akola, Maharashtra, India

E-mail: [email protected]

Introduction: Ischemic heart disease (IHD) is an important cause of morbidity and mortality in India. The prevalence of IHD has been increasing every year with a decreasing disparity in the number of the urban and rural cases. In Western countries, IHD is considered a disease of the aged, nearly double the amount of deaths takes place in India in the same workforce. As a result, India suffers from a tremendous loss of productive working years due to IHD deaths. There is a need to study the prevalence of multiple cardiovascular risk factors in different regions of India and to correlate them with variation in IHD mortality using a uniform protocol. Aims and Objectives: To identify the risk factors for IHD in a given population of Akola district. Methods: Present cross-sectional study was conducted on a random sample of the population aged ≥40 years, comprising relatives of the patients at Government Medical College and Hospital, Akola. Sample size in the present study was 207 and study period was 2 months (i.e., from 15 March to 15 May). Data were collected through a pretested, semi-structured questionnaire (Rose questionnaire) Demographic characteristics and self-reported details of smoking, alcohol intake, tobacco consumption, hypertension, diabetes, physical activity, and dietary fat and fruit intake were recorded after obtaining informed consent. Anthropometric measurements focused on height, weight, sitting blood pressure (BP), waist and hip dimensions, pulse, using methodologies prescribed by the WHO. The data collected were analyzed using suitable statistical tools. Results: Tobacco consumption is 54.6% and is the most signifi cant risk factor for this population. Forty-three percent are hypertensive with prevalence in males being significantly higher than females. 50.7% have waist-hip ratio more than 1 and 38.4% have body mass index higher than 25. Conclusion:The findings of this study indicate that the prevalence risk factors for IHD are high in Akola district. There is lack of awareness about modifi able risk factors, regular check-up regarding BP and sugar and severity of the course of the disease. Increasing population of tobacco consumers and lack of education are alarming in this population. The limitations of this study are that no blood samples could be drawn for sugar, serum cholesterol, liver function test, and kidney function test due to fi nancial constraints.

  Comparative study of stress and stress-related factors in medical and engineering colleges of a South Indian city Top

Mantri Anjali1

1Katuri Medical College, Guntur, Andhra Pradesh, India E-mail: [email protected]

Background: The process of professional education is often stressful. Various studies across the globe have emphasized that students undertaking professional courses, such as medical and engineering studies, are subjected to higher stress. Excessive stress could lead to psychological problems such as depression and anxiety and also it may cause suicides. Objectives of Study: (1) To assess the prevalence of stress among medical and engineering 1st-year students (2) to study the association of stress with various academic-, social-, and health-related factors in the professional courses such as medical and engineering. (3) To compare the factors causing stress in both medical and engineering students. Methodology: Place of study: Katuri Medical College and Hospital, Guntur. Materials and Methods: A pretested, self-administered questionnaire was used as the study instrument. It was developed with the help of published literature and fi nalized after a pilot study. The questionnaire was divided into three sections. First section includes the collection of sociocultural and demographic data. Second section consists of effect of academic stressors on the life of the subject. Third section includes effect of health, lifestyle, and environmental stressors. In health, Zung Depression scale was utilized in scoring the depression levels in the study subjects. Results: in the present study in medical course, 63% were found to be female and 37% were found to be male. In engineering, 54% were found to be male and 46% were found to be female. Respondents were belonging to the age group 18–22 years in both medical and engineering courses. Sixty-two percent of medical students 36% of engineering students were witnessing stress in their lives. Conclusion:Stress-reducing techniques need to be encouraged in professional courses and counselors for the effective addressing and solving the problems is required in all professional courses.

  Stress – The portrait of a killer Top

Wajeeha Musharraf1

1Dr. VRK Women's Medical College, Hyderabad, Telangana, India

E-mail: [email protected]

Introduction: Medical students are prone to stress in their day to day life, but the stress shoots up during examinations and may have deleterious effects on the brain. It may also affect their cognitive function. Objective: To correlate academic performance of students with the degree of stress and target prevention strategies at moderate levels. Materials and Methods: A cross-sectional, questionnaire-based survey conducted on 35 medical students of Dr. VRK Women's Medical College aged between 21 and 23 years, all females and exposed to examinations at the same time. A questionnaire was given in which 4 options were given and scored as 0, 1, 2, and 3. Nine physical parameters such as memory, sleep, menstruation, and bowel, and 10 mental parameters such as fear, blackouts, decision-making, etc., were included. The subjects were classified into three categories according to their performance in previous examination as the 1st, 2nd, and fail class as per Dr. NTR University. Response to stress was correlated with the performance of students in the previous examination. Result: Our observation indicated that there is no signifi cant difference in the total sum of parameters among three groups. However, interestingly, there are differences in various systems which are affected in the 1st and 3rd group. In the 1st group, stress affected mainly the gastrointestinal tract, skeletal and autonomic nervous system whereas in the 3rd group, memory and CVS were affected more. Respiratory system and menstrual patterns were least affected by stress in all the three groups.

  Proliferation marker Ki-67 in breast cancer and its premalignant lesions Top

Mariyam A. Motiwala1

1MGM Medical College, Mumbai, Maharashtra, India E-mail: [email protected]

Introduction: Currently, breast cancer represents a unique disease in oncology, in that specific markers are routinely used to predict response to therapy. Estrogen receptor (ER) and Her-2-neu are now well established as predictive factors for treatment response and prognosis. Ki-67 is also frequently measured as a static marker of proliferative activity. Knowledge of the biologic features of premalignant lesions, although limited, is rapidly evolving. The study tries to establish the premalignant lesions of the breast which have the potential for progression to overt malignancy; hence, we extend our studies to include the relationship between the distribution type of Ki-67 expression and biological behaviors in breast cancer. Objectives: To correlate, in breast cancers, Ki-67 expression with histological grade, tumor size, and nodal metastasis. To study degree of positivity/negativity of Ki-67 with ER, progesterone receptor (PR) and Her-2-neu in tissue surrounding tumor and premalignant conditions such as atypical ductal hyperplasia (ADH). Methodology: Ki-67 staining was done in 80 breast specimens (mastectomy and biopsies); out of which, 33 were proliferating benign tumors, 28 malignant tumors with surrounding lesions, and 19 malignant tumors (de novo); and findings were compared with ER, PR, and Her-2-neu status. Results: In our study, fibroadenomas and fibrocystic change per se showed negative or very low Ki-67 index. When they were associated with usual ductal hyperplasia and ADH, the Ki-67 index was high among the lesions also showing positive correlation with ER. In malignant tumors, a significance of P ≤ 0.05 was seen in ER, PR values, no significant difference in lymph node status (P = 0.08), and histological grade (P = 0.64) in Ki-67 positive cases. Conclusion:Fibrocystic change can be considered as a premalignant lesion. Ki-67 can be used as an independent prognostic factor. Ki-67 being inversely proportional to ER indicates that High Ki-67 value and ER-negative malignant tumors have a bad prognosis.

  Assessment of knowledge, attitude, practice of pharmacovigilance among healthcare workers in a private tertiary care teaching hospital Top

Meghna Varma1

1Mahatma Gandhi Medical College and Hospital, Jaipur, Rajasthan, India

E-mail: [email protected]

Introduction: With India growing to be the preferred clinical trials destination for to be launched drug entities, there has arisen a need for pharmacovigilance as a branch of pharmacological science, critical to effective clinical practices, and public health with immense possibility for growth. “The pharmacological science relating to the collection, detection, assessment, monitoring, and prevention of adverse effects with pharmaceutical products” - WHO (Definition, Pharmacovigilance). Pharmacovigilance is in its infant stage in India and to deal with the current scenario, it is important to improve the knowledge, attitude, and practices of the healthcare professionals regarding ADRs, and pharmacovigilance. Objectives: (1) To assess the knowledge, attitude, and practice of pharmacovigilance among the healthcare professionals. (2) To compare and analyze the result among various groups. (3) To suggest measures for improvement. Materials and Methods: This was a cross-sectional, noninterventional, questionnaire-based study. The questionnaire was administered to 215 MPs.

It consisted of 22 questions to be answered within 30 min. The data were entered on Microsoft access and analyzed using SPSS software. One-way ANOVA was used. Observation and Result: When it comes to knowledge, the overall score was “poor” (scores <6) clearly, majority of the respondents were lacking in this aspect. However, the “attitude” toward pharmacovigilance showed a significantly positive response. With regards to the “practice” of pharmacovigilance, none of the respondent categories had a poor (<1) response but they did not have a satisfactory (>2) response either. Conclusion:A culture of learning about pharmacovigilance should start early in the professional training of doctors. Unless pharmacovigilance is given its proper place in the field of medical education from both the theoretical and practical viewpoint, we may have to keep enduring easily preventable ADRs.

  Sociodemographic and morbidity profile of group “D” workers of tertiary care hospital of central India Top

Noopur Vivek Navandar1

1Indira Gandhi Government Medical College, Nagpur, Maharashtra, India

E-mail: [email protected]

Introduction: Group “D” workers involved in provision of health services face number of serious safety and health hazards. The objective is to assess sociodemographic and morbidity profi le of group “D” workers. Materials and Methods: A cross-sectional study was conducted among 100 group “D” workers of preclinical, paraclinical, and clinical departments using stratifi ed random sampling technique and having minimum experience of 5 years. Detail history and medical examination were carried out. The study has been approved by the Institutional Ethics Committee. Results: Study revealed that out of 100 subjects, 48% were males and 52% were females. Majority, i.e., 46% belong to 51–60 years age group. Eleven percent was found to be illiterate. Maximum, i.e., 48% subjects belonged to upper lower class. 35% were addicted to tobacco, 31% to alcohol and smoking each and 13% to drug addiction. Fifty percent of the study subjects are providing health care since 20–30 years. Major morbidities found among workers were arthritis (27%), hypertension (HT) and diabetes mellitus (DMs) (23%) each, chronic obstructive pulmonary disease (COPD) (8%), and coronary heart disease (CHD) and tuberculosis (1%). It was observed that with the increase of duration of service there was increase in morbidities (HT, DM, arthritis, COPD, CHD). The mean age, duration of service, exposure index, body mass index, waist-hip ratio, systolic blood pressure, and diastolic blood pressure were found to be higher in female than in male. However, on applying t-test, the difference between male and female was not found to be statistically signifi cant (P > 0.05). Conclusions: Our study reported high prevalence (62%) of major morbidities such as arthritis, HT, DMs, and obesity/overweight. Moreover, high addiction rates for different substances such as alcohol, tobacco, and drugs were also found in group “D” workers.

  Role of myeloperoxidase variants and risk of coronary artery disease in type 2 diabetes mellitus patients Top

Nausheen Sultana1

1Deccan College of Medical Sciences, Hyderabad, Telangana, India E-mail: [email protected]

Background: Type 2 diabetes mellitus (DM) is associated with increased levels of myeloperoxidase (MPO) enzyme, which in turn, causes increased oxidative stress in the body. Oxidative stress is considered as an important mechanism associated with onset of diabetes and later leading to associated cardiovascular complications (Valko M, 2007). This study was designed to understand the possible role of MPO variants in predicting risk for coronary artery disease (CAD) in patients with type 2 diabetes and normal healthy individuals. Aims and Objectives: This study was done in our research center located in Hyderabad. Sixty subjects were enrolled for our study. They were divided into three categories, i.e., CAD with DM (n = 24), CAD without DM (n = 11), and controls (n = 25). CAD patients were recruited from the Intensive Care Unit of Department of Cardiology in our hospital. Informed consent was taken from each subject before start of the study. Materials and Methods: MPO gene SNP at-463G/A was determined using sequence-specific forward and reverse primers. Chi-square test was done at df = 1 for statistical significance. Results: There was a positive correlation of GG with CAD in our study. Conclusions: In this study, GG was found to be more predominant genotype in CAD patients as compared to AG and AA. Acknowledgment: This study was partly supported by Indian Council of Medical Research through STS-2014.

  Relative frequencies of single and multiple vessel blocks in diabetic and nondiabetic angiographically confirmed cases of coronary artery diseases in Hyderabad city (South India) Top

Nazia Tabassum1

1Deccan College of Medical Sciences, Hyderabad, Telangana, India

E-mail: [email protected]

Background: Diabetes mellitus often leads to the development of coronary artery disease (CAD). Coronary artery stenosis not only occurs in diabetic patients, but it has been found to be present in increasing frequency in nondiabetics as well. This study was designed to find out the relative frequencies of coronary artery stenosis in both diabetics and nondiabetics. Aims and Objectives: To compare the diabetic and nondiabetic cases of CAD for number of blocks; To investigate if there is any significant difference in the age of onset of CAD between diabetic and nondiabetic patients; To collect the information of CAD and its severity in the patients of Hyderabad. Materials and Methods: A retrospective study was conducted in the Department of Cardiology. Details of angiographically confirmed cases of diabetics and nondiabetics (198) were taken by providing a questionnaire. Results: It was found that triple vessel disease was more frequent in diabetics when compared to nondiabetics. The onset of CAD in diabetics occurred one decade earlier than in nondiabetics. Conclusions: It can be concluded that the severity of CAD both in terms of vessel involvement as well as degree of stenosis is relatively more severe in diabetic CAD compared to nondiabetic CAD in the present study. Acknowledgment: This study was partly supported by Indian Council of Medical Research through STS-2014 (Reference: 2014-01458).

  Study of fingerprints in relation to various blood groups in Central India Top

Rishikesh Rajendra Tayade1

1Indira Gandhi Government College

E-mail: [email protected]

Introduction: “Man can change, his behavior can alter thought, can diversify but the dermatoglyphics pattern will remain the same forever.” Due to the immense potential of fingerprints as an effective method of identification, an attempt has been made in the present study to analyze distribution of fingerprint pattern and the relationship between ABO, Rh blood groups, and dermatoglyphics patterns among the study subjects. Materials and Methods: Rolled fingerprints were taken of all ten fi ngers of both hands of 200 study subjects aged 17–30 years with their blood groups. The fingerprint patterns were identifi ed as loops, arches, and whorls based on the appearance of ridge lines according to Galton's system of classification with help of a magnifying lens. Result: Forty-nine study subjects having A blood group were Rh-positive and 3 Rh-negative. Similarly, blood group B had 59 Rh-positive and 4 Rh-negative subjects. Only 16 study subjects were found to be AB Rh-positive. Among O blood group 61 were Rh-positive and 8 Rh-negative. A positive study subjects predominantly had loops pattern (49.6%), whereas A-negative subjects had predominance of Whorls (53.3%). B-positive and B-negative subjects had predominantly loops 50% and 60%, respectively. AB-positive subjects had more or less same Loops and Whorls (44% and 43.4%). O-positive subjects had predominantly loops (49.5%), O-negative had almost equal number of loops and whorls (43.7% and 42.5%). In middle and little fingers, among all blood groups, predominant pattern was loop. Whorls were predominant in ring finger for all blood groups. Arches were found to be predominant in thumb and index finger. Conclusion:Our study suggests an association between fingerprint pattern and blood group with predominance of loops in blood group O and the right middle finger.

  Effectiveness of decompressive craniectomy in traumatic brain injury Top

P. Trilokhya1

1Maharajah Institute of Medical Sciences, Visakhapatnam, Andhra Pradesh, India

E-mail: [email protected]

Introduction: Decompressive craniectomy is removal of skull bone in patients with traumatic brain injury with acute subdural hematoma or contusions or epidural hematoma or diffuses cerebral edema with raised intracranial hypertension. Objective: To evaluate the outcome of patients undergoing decompressive craniectomy in traumatic brain injury and to identify the factors predicting outcome. Materials and Methods: A total of 219 patients with traumatic brain injury operated with decompressive craniectomy from to January 2015 by a single neurosurgeon were included in this study. The data were collected retrospectively and analyzed, and patients were followed-up for a mean period of 6 months. Results: There were 80% males with a median age of 39 years, the youngest age is 4 years and the oldest age is 80 years. Patients with traumatic brain injury undergoing decompressive craniectomy are more between age group 21–30 years (23%) and mortality is more in age group above 50 years (59%). Based on GCS, 34 patients with mild head injury (GCS 14–15), 90 patients with moderate head injury (GCS 9–13), and 95 patients with severe head injury (GCS <9) underwent decompressive craniectomy, and the incidence is 15.5%, 41%, 43.3%, respectively. The mortality rate is 0, 11%, and 23% in mild, moderate, and severe head injury, respectively. Unequal pupils are present in 33 cases, out of which, 7 patients (21%) expired. Hypotension is present in 11 patients, out of which 2 patients (18.18%) expired. Conclusions: As traumatic brain injury is more common in males and so decompressive craniectomy is also done more in males. Patients who underwent decompressive craniectomy in traumatic brain injury are mostly between 20 and 30 years (productive age group). Younger age group has less mortality compared to older age group. GCS at admission is important predictive factor of outcome as patients with less GCS have high mortality compared to patients with good GCS. Unequal pupils and presence of hypotension at admission are not poor prognostic factors as mortality is seen in 21% of unequal pupils and 18% of patients with hypotension.

  Study to correlate peripheral blood smear with hemoglobin value and red cell distribution width in anemic patients Top

Piyush Hari1

1Subharti Medical College, Meerut, Uttar Pradesh, India E-mail: [email protected]

Introduction: Anemia is a global problem and affects 1.62 billion people worldwide with the greatest number of individuals affected being reproductive age group females. Prevalence of anemia in females (20–50 years) is 70.1% and in males (20–50 years) 53.2%. The peripheral blood smear is an inexpensive but powerful diagnostic tool for diagnosing and categorizing the type of anemia. The red blood cell distribution width (RDW) is a red cell measurement that quantitates cellular volume heterogeneity and has been proposed to be a more sensitive indicator to reflect the range of red cell sizes. The present study was undertaken to study and correlate the peripheral blood smear findings with hemoglobin (Hb) values and RDW in anemic patients. Materials and Methods: A total of 203 anemic patients including 83 males and 120 females were randomly selected in the study with Hb values <10%. The blood samples were taken for complete blood count (CBC), RDW and peripheral blood smear examination. Results: Twenty-five patients had Hb values <6 g%, 36 had 6–8%, and 142 had 8–10 g%. Patients having RDW values <11% were 16, 11–16% were 161, and RDW values >16% were 26. Patients with mild anemia (Hb 10–8 g%) had normocytic normochromic blood picture with minimal change in RDW (RDW 13 ± 2.1). In moderate anemia (Hb 8–6 g %), blood picture was of mixed type with less change in red blood cell (RBC) morphology and relatively normal RDW value (13.7 ± 1.6). Severely anemic patients (Hb <6 g %) showed marked change in RBC morphology, and thus RDW of these patients was markedly high (RDW 14.7 ± 2.2). Conclusion:Thus in working up, a patient of anemia CBC and peripheral blood smear findings should be correlated with RDW to find out the degree and type of anemia.

  Serum light chain assay as a diagnostic marker in monoclonal gammopathies Top

Prakriti Gupta1

1Maulana Azad Medical College, New Delhi, India E-mail: [email protected]

Introduction: Monoclonal gammopathy (MG) shows the presence of monoclonal immunoglobulin or segment of immunoglobulin (light chains) in serum. This research aimed to assess serum total light chain levels by nephelometry in MG, its utility in differentiating between MG and reactive plasmacytosis (RP) and correlating the assay with tumor load in newly diagnosed patients. Methods: Ten control and 16 test (10 MG and 6 RP) patients presenting consecutively to the Pathology Department were selected for the study in July–August 2014. Serum total light chain assay was performed using Nephstar Protein Analysis System. Their bone marrow aspirate (BMA) findings were analyzed. Diagnostic accuracy of assay and its correlation with percentage plasma cells in BMA smears were determined using SPSS. Results: Sensitivity, specifi city, and positive and negative predictive value for serum total ĸ/λ ratio in diagnosing MG were 70%, 50%, 70%, and 50%, respectively, considering BM examination as gold standard for diagnosis. There was no statistically significant difference in means of total ĸ/λ ratio between MG and RP cases. Statistically signifi cant difference in means of total (ĸ+λ) levels was found between controls and patients of MG (P = 0.001), and RP and MG (P = 0.017). A significant correlation was found between percentage plasma cells in BMA smears and total (ĸ+λ) levels in test cases (P = 0.038). Conclusions: Total (ĸ+λ) level can be a novel serum marker to distinguish between normal and MG as well as to distinguish between reactive and neoplastic plasmacytosis. Total (ĸ+λ) levels correlate with tumor load in patients at the time of diagnosis. Thus, it may prove to be a useful marker of response to therapy or early relapse and may help reduce the need of an invasive test like BM examination in posttherapy patients. However, due to small sample size, further research is needed to validate these results.

  A clinicopathological study of prevalence of peripheral vascular disease in diabetic foot ulcer Top

Priyadarshini Bhattacharjee1

1Calcutta National Medical College, Kolkata, West Bengal, India

E-mail: [email protected]

Introduction: Diabetic foot problems are common worldwide. More than 50% lower limb amputations occur in diabetics. In addition to neuropathy and trophic ulcer, peripheral vascular diseases (PVDs) also play a major role in evolution and outcome in diabetic foot ulcer. The early detection of PVD in seemingly asymptomatic patient is very important and correction of vascular disease in early cases can improve blood flow and healing. The information may help in protocol of management of diabetic foot with the aim of limiting the morbidity and social cost associated with the disease. Objectives: (1) To study the prevalence of PVD in diabetic patients presenting with diabetic foot ulcer. (2) To detect the early symptoms of PVD in diabetics. (3) To gain the knowledge of prevention of such disease in seemingly asymptomatic patients. (4) To obtain a feasible method of cure of this disease. (5) To ascertain ways of diminishing the risk of limb amputation due to complications of this disease. Methodology: Study Area: Department of General Surgery, Calcutta National Medical College and Hospital, Kolkata. Study Population: All patients admitted with diabetes (type I and type II) admitted with diabetic foot ulcer. Sample Size: Approximately 30 in number. Study design: A prospective, analytical study. Study tools: Color Doppler of both lower limbs. Plan for analysis of the data: By standard statistical methods. Results: - Prevalence of Foot Ulcer: Half of the total study population had diabetes mellitus for <5 years and nearly 3 quarters were on oral hypoglycemic agents for DM control. In this study, the prevalence of diabetic foot ulcer was 16.66%. Magnitude of Risk Factors: PVD as identifi ed by ankle brachial pressure index of <0.9 was present in 13.33% of patients. Presence of PVD was found to be associated with foot ulcer in this study. Knowledge on Foot Care: Lower percentage of patients with no added risk and those at risk knew that they had to inspect inside shoes every day or every time before putting on. The mean knowledge score was infl uenced by level of education, duration of diabetes, attendance at clinic and advice on foot care. Foot Self-care Practices: Ninety percent reported to be washing feet regularly as part of general cleanliness or prerequisite during prayer sessions. This was improved among the group that had received advice on foot care and among patients whose feet were examined by doctor at least once. Conclusion:The prevalence of diabetic foot ulcers is high among patients in this population. PVD is a major risk factor for foot ulcer in this population. Avoidance of injuries of an anesthetic limb and appropriate foot care may reduce foot ulcers. Level of knowledge regarding foot care is low among patients and still can be improved.

  Study of prevalence of overweight and obesity among middle school children (5th–7th standard) in a rural area of Goa, India Top

Priyanka Prakash Vaigankar1

1Goa Medical College, Bambolim, Goa, India

E-mail: [email protected]

Introduction: Obesity is defined as the presence of excess adipose tissue in the body to such a degree that it may lead to health hazards. Studies show that in India, nearly 15–20% of children are overweight and 30% are in the risk of falling in this category. It is these statistics that is strengthening the signifi cance of this issue. This study focuses on finding the prevalence of overweight and obesity among middle school children (5th–7thstandard) in a rural area of Goa, India. The middle schools were not chosen so as to assess childhood obesity in its root stage because either the growth spurts or has menarche (in case of girl child) seldom occurred by this age. Further, this study focuses on prevalence of obesity in rural children which has not been much touched upon as most of the studies talk about obesity in urban area. Through this study, the aim is to find out whether overweight and obesity is equally serious problem in rural area which also requires great focus in addition to malnutrition which is given priority in rural areas.

Aims and Objectives: (1) To study the prevalence of overweight and obesity among rural middle school children (5th–7th standard). (2) To identify the factors influencing childhood obesity. (3) To compare the prevalence of obesity among boys and girls. Materials and Methods: The present study is a cross-sectional epidemiological study among middle school children from two schools located in rural areas North Goa District, Goa. A total number of 500 school children aged 10–13 years participated in this study. Out of them, 236 were boys and 264 were girls. The data collected included sociodemographic data, dietary data, physical activity assessed through a questionnaire and anthropometric measurements (weight, height) and a questionnaire. Indian academy of pediatrics growth charts and tables were used to determine the corresponding body mass index – for age and sex percentile. In addition, physical examination was done. In addition to this, a brief personal interview was also carried out to know about the nutritional status of their siblings and family members so as to ascertain history of overweight among siblings and parents.

Table 1: Prevalence of overweight and obesity in rural area of Goa, India

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Table 2: Prevalence of underweight, normal weight, overweight, and obesity among girls

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Table 3: Prevalence of underweight, normal weight, overweight, and obesity among boys

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Conclusion:We reported that the prevalence of overweight and obesity among middle school children (10–13 years) in the rural areas of Sanquelim and Sodiem, North Goa, Goa, India, was found to be 7.4% and 0.8%, respectively. In addition, male is associated with a higher risk of being both overweight and obese. There are very few studies which target the middle school children, neglecting the fact that intervening at this early stage will significantly reduce the prevalence of overweight and obesity in the adolescents and the adults along with the comorbidities of obesity. In addition, rural area should also be considered for prevalence of overweight and obesity because with the changing lifestyle, there is narrowing of the urban rural gap.

  Comparison of cefazolin - first generation cephalosporin and ceftriaxone - third generation cephalosporin for surgical prophylaxis Top

Prutha Dandawate1

1Bharati Vidyapeeth Deemed University Medical College, Pune, Maharashtra, India

E-mail: [email protected]

Introduction: Development of antimicrobial agents (AMAs) is the greatest development in the history of modern medicine. AMAs are used for therapeutic and prophylactic purpose. Surgical site infection (SSI) is the most common complication after any surgical procedure. National Research Council has broadly divided surgical wounds into contaminated and not contaminated. As per guidelines, cefazolin should be used for surgical prophylaxis, but ceftriaxone was used in Bharati Hospital, Pune. This study was planned to compare the effi cacy of cefazolin and ceftriaxone for surgical prophylaxis in OB-GY department. Objectives: Assessment of occurrence of SSI after cefazolin prophylaxis. Assessment of occurrence of SSI after ceftriaxone prophylaxis. Compare both the above fi ndings. Materials and Methods: Trial design: Single center, prospective, randomized, parallel group, double-blind study sample size: 50 patients posted for surgery in OB-GY department inclusion criteria: MTP lower segment cesarean section, os-tightening, dilatation and curettage; exclusion criteria: Premature rupture of membrane ,severe anemia, cardiac disease, infective focus, and immunocompromised patients. After taking informed consent, 50 patients were divided into two arms of 25 each (Arm A for cefazolin and Arm B for ceftriaxone). Patients were followed-up for 7 days to check for abdominal wound infection, pelvic cellulitis, vaginal cuff infection, or urinary tract infection. Results: There was no apparent symptom/sign of infection in any patient in both the groups. One patient in cefazolin group and three patients in ceftriaxone group had fever, which started from the 2nd postoperative day. One patient in ceftriaxone group had fever for 4 days (elderly primi). No statistical analysis was possible due to zero infection score. Conclusion:Injection cefazolin is not significantly noninferior to injection ceftriaxone as an agent for SSI cefazolin appears to be better in terms of cost-effectiveness in comparison to ceftriaxone.

 Pap smear More Details">  Study of awareness among women in rural and urban areas about early detection of cervical cancer by Pap smear Top

Radhika Anand1

1Mayo Institute of Medical Sciences, Lucknow, Uttar Pradesh, India

E-mail: [email protected]

Introduction: One in every five women in the world suffering from cervical cancer belongs to India, which has the largest burden of cervical cancer patients in the world. More women die from cervical cancer every year in India than anywhere else in the world, this is due to the unawareness amongst the females of India about early screening. Therefore, awareness about regular screening for cervical cancer is needed in the most vulnerable age group, i.e., 30–45 years. Despite the existence of effective screening, using Pap smear, the uptake of screening is poor. Objectives: The primary objective is to find out the prevalence of awareness amongst women living in rural and urban areas, about the utility of Pap smear in early diagnosis of cervical cancer. Secondary objective: (1) To study the various reasons for inhibitions among Indian women in undergoing screening for cervical cancer. (2) To create awareness about the utility of early screening in cervical cancer. Materials and Methods: Study design: a cross-sectional study. Study population: women are living in rural and urban areas in and around Lucknow. Sample size: 100 women (Urban) 100 women (Rural) Selection criteria: Women between the age group of 17–60 years living in both rural and urban areas. Data collection: A questionnaire including demographic characteristics, knowledge of the disease, knowledge about Pap smear screening, completed by an interview with the women. Plan of analysis: Data were collected with the help of the questionnaire, from both the rural and urban areas, to evaluate the prevalence of awareness about cervical cancer and the utility of Pap smear for its early diagnoses. Then evaluation was done to understand the reasons of inhibitions and unawareness about the disease and its screening. Result: About 19% of women living in the rural area and 58% women living in the urban area were aware of the disease cervical cancer. About 10% of women living in the rural area and 32% women living in the urban area were aware of the early screening by Pap smear for cervical cancer. Very few ever opted for the screening procedure because of the various reason which were discussed in the questionnaires and the major reasons other than lack of knowledge were evaluated. Conclusion:The results show that there was inadequate knowledge and practice among certain women groups, especially those above 30 years old, married at young age, and those with low education level. However, women have a positive attitude towards cervical screening services although they need to have reassurances that can reduce the barriers to having a test. A well-organized cervical cancer screening program providing the Pap smear test through primary health care services is recommended. this should include raising awareness of women regarding risk factors and overcoming barriers to having the test such as fear and embarrassment.

  Effects of sleep deprivation on cardiovascular parameters, cognitive function, and well-being index in female medical students Top

Raghavi Abhilesh Bembey1

1Bharatiya Vidyapeeth Deemed University and Medical College, Pune, Maharashtra, India

E-mail: [email protected]

Objectives: To compare between normal and sleep-deprived students for WHO well-being index, cognitive function, and cardiovascular parameter such as resting pulse rate and blood pressure. Materials and Methods: In a cross-sectional study, 100 female medical students were tested for sleep patterns by using Pittsburg Sleep Quality Index questionnaire and were classifi ed as normal or sleep deprived and were checked for resting pulse rate and blood pressure using sphygmomanometer; WHO well-being index by using standard 5-question questionnaire; cognitive function by testing listening, memory, association skills, spatial anticipation, verbal fluency, and writing. Observation and Result: Around 70% students were sleep deprived in the study and a significant increase in cardiovascular parameters and decrease in well-being index and cognitive function with P < 0.01. Conclusion:For good mental health, 7–8 h of peaceful sleep is required. A large number of our study population exhibited sleep deprivation. Sleep-deprived subjects showed altered cardiovascular parameters such as pulse rate, systolic blood pressure, and diastolic blood pressure. They exhibited lower values of subjective well-being. Sleep-deprived students also showed statistically significant lower scores in tests of cognitive functions. All the finding clearly point at creating awareness about detrimental effects of sleep deprivation in medical students and the importance of skillful time management to minimize sleep deprivation.

  Occurrence of Candida species in vaginitis Top

Raksha Makam1

1Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India

E-mail: [email protected]

Objectives: To determine the occurrence of Candida species in women presenting with vulvovaginitis to the Department of Gynaecology and Skin and Venereology at Rajarajeswari Medical College and Hospital. To correlate the signs and symptoms with Gram stain and culture. To speciate Candida based on Germ tube test and growth on HiChrom Candida Differential Agar. Methods: A prospective and cross-sectional study was carried out for a period of 2 months from June to August 2014. A total of 60 high vaginal swabs were collected from clinically suspected cases of candidal vaginitis. The samples were subjected to Gram stain and culture on blood agar and Sabouraud dextrose agar. Isolates were speciated based on germ tube test and colony morphology on HiChrom Candida differential agar using a standard control strain. Results: Out of 60 samples, 8 (13.33%) were positive for Candida species both on direct smear as well as on culture. 5 (62.5%) were speciated as Candida albicans and the remaining 3 (37.5%) as nonalbicans species. Among the nonalbicans species, 2 (25%) were Candida tropicalis and 1 (12.5%) was Candida parapsilosis. Conclusion:This study showed hundred percent correlation of clinical signs and symptoms of candidal vulvovaginitis with Gram stain and culture. The study highlights the importance of speciation of Candida indicating its importance in the accurate diagnosis so as to avoid indiscriminate use of antifungal agents. The study showed that candidal vulvovaginitis was more common in women of sexually active age group and pregnancy was an important predisposing factor suggesting screening of pregnant women visiting the antenatal clinics for candidial vulvovaginitis.

  Role of oxidative stress in hypertensive type 2 diabetes mellitus Top

O. M. Ramya1

1Kilpauk Medical College, Chennai, Tamil Nadu, India E-mail: [email protected]

Introduction: Cardiovascular diseases (CVDs) are the major causes of mortality in persons with diabetes and hypertension. Long-term complications of hypertension in diabetes mellitus (DMs), in part, are mediated by increased free radical generation and subsequent oxidative stress. Oxidative stress is proposed as the cause of hypertension in diabetics. In hyperglycemic state, superoxide radical is stimulated which in turn inactivates endothelial nitric oxide synthase resulting in decreased NO, causing reduced vasodilation, which in turn favors the development of hypertension. In hypertension, oxidative stress initiates a vicious cycle by angiotensin II-induced nicotinamide adenine dinucleotide phosphate oxidase mechanism. This increased reactive oxygen species bioactivity leads to hypertensive vascular damage and contributes to atherogenesis. Thus this study aims to measure malondialdehyde (MDA) and NO as markers of oxidative stress in hypertensive type 2 diabetics emphasizing the need for aggressive glycemic control to prevent CVD complications. Objectives: This includes estimating MDA, NO, fasting lipid profile levels in study population, comparing MDA levels in cases and controls, and correlating the levels of MDA with NO as a marker of oxidative stress. Methodology: 50 cases with recently diagnosed hypertension in type 2 DMs were compared with 50 normotensive diabetics matched for age and sex. 5 ml of venous blood was drawn and sent for analysis of serum lipid profile, NO based on Griess assay, MDA based on chemical method. Results: The tests showed that there was a significant elevation in MDA in the cases as compared to the controls (P = 0.007). However, no signifi cant difference was observed in the NO levels among the two and no significant correlation between NO and MDA levels. From ROC curve, analysis test results best cut-off value for MDA to indicate the oxidative stress is ≥2.28. Conclusion:This study shows that the NO value is lesser and MDA levels are higher in cases when compared to controls indicating higher oxidative stress in hypertensive diabetics when compared to diabetes alone, correlating with the increased risk factor for vascular complications produced by hypertension.

  Social networking site addiction among the youth of Trivandrum city Top

Raphael Thomas1

1Dr. SMCSI MCH, Karakonam, Thiruvananthapuram, Kerala, India

E-mail: [email protected]

Background: Excessive use of social networking sites (SNSs) is becoming a concern and now, people cannot even go on for a day without logging into their SNS account, so it is rightly proposed to be taking the role of an addiction, which the latest studies suggests can even be a potential mental health problem in many users. Objectives: (1) To study the prevalence and determinants of SNS addiction (SNSA) Among the youth of TVM City. (2) To know the most addictive site and modes of access to these sites. (3) To study the motivation for use and problems faced by SNS addicts. (4) To look for association of owning smartphones and period of SNS use to SNSA. Methods: A cross-sectional study was conducted among 638 school students residing in TVM city. Data were collected using a predesigned and pretested questionnaire based on Diagnostic and Statistical Manual IV criteria for gambling addictions. The survey was done among 2 divisions each from classes XI and XII of 6 randomly selected schools. All the students were given the questionnaire regardless of whether they were a user or not. Results: 15% of SNS users have been found to be addicts. Risk of addiction found to be highest in smartphone users. Addicts have been found to be suffering from a lot of physical and mental stress; procrastination being the main problem they face. 34% also claim to have got wrong information through SNSs. Conclusion:The increased number of SNSA in the population, smartphone users were maximally addicted and the result indicating SNS provide wrong, indecent or unwanted information to nearly 34% population; it show that it can be misused by antisocial elements and cheats leading to fraud and corruption of young minds.

  Impact of “Color” on brain-our “Think Tanks” Top

Rohit Jacob1

1Mahatma Gandhi Mission Medical College, Aurangabad, Maharashtra, India

E-mail: [email protected]

Introduction: Color is a powerful communication tool and can be used to signal action, influence mood, and cause physiological reactions. Colors play a vital role in our daily lives, and it has been proven that our activities and responses are influenced by them. A research by the University of British Columbia has proven that blue color enhances creativity whereas color red helps to be focused and has a positive effect on memory. This concept of color psychology has become a hot topic in marketing, art, design and why, even medicine! Thus, color is nature's own powerful signaling system - the universal, nonverbal language. Hence, this study is of great importance. Aims and Objectives: (1) Understanding the effects of various colors on people's body, mind, and soul (2) establishing a definite link between color and mind control and concentration (3) understanding that response to color is not dependent on age or gender, as the contrary was previously thought (4) understanding the great difference between color psychology and color symbolism (5) last, attempting to overcome the general lack of research in this area. Duration of the Study: 2 weeks. Materials and Methods: 50 normal healthy human volunteers of varied age groups. Color groups and group of adjectives. Various color symbols. 2 color wheels. Methods: (1) Match the color groups with the set of adjectives given (2) personality test (Modification: with colors for each emotion) (3) correlate with the trait of the individual and with the surrounding environment (4) the famous Wright's Theory on Color Harmony. Results: Considering the fi rst experiment, it was observed that 60% candidates from the age group of 10–15 years were able to match the set of adjectives with the correct wheel and so was 80% candidates from 16 to 30 years, 70% candidates from 31 to 40 years, 60% candidates from 41 to 50 years, and 60% candidates from age beyond 50 years. On assessing the second experiment, it was found that 95% candidates were able to choose the correct wheel given the kind of environment. On evaluating the third experiment, it was found that 70% candidates from 10 to 15 years, 80% candidates from 16 to 30 years, 70% candidates from 31 to 40 years, and 50% candidates from 41 to 50 years and beyond 50 years, chose blue color as their favorite and for rest of the colors, the responses were variable. On evaluating the fourth experiment, it was found that 80% candidates were able to correlated red with rose and 90% candidates were able to correlate blue color with the sea or sky. For remaining colors, variable results were obtained. Conclusion:Hope, this research article asserts every individual and growth spurts, both physically and emotionally among teenagers and young adults and also brings about a vision in every person of how to control one's mind, body, and soul.

  An educational intervention on the risk factors of lifestyle diseases among adults aged 30–50 years in an urban slum in Coimbatore Top

S. Hamsa Nandhini1

1PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India

E-mail: [email protected]

Aim: To determine the level of awareness on risk factors of lifestyle diseases such as hypertension and diabetes mellitus, to impart health education on the risk factors of lifestyle diseases and the lifestyle changes to combat the same, and to determine the impact of health education. Methodology: A cross-sectional study was conducted in a randomly selected urban slum in Peelamedu, Coimbatore. 100 men in the age group of 30–50 years were administered a questionnaire to determine the awareness of risk factors of lifestyle diseases. Health education was given to the respondents regarding risk factors. The same questionnaire was given to the respondents after the health education to determine the effectiveness of health education. Statistical analysis was performed with SPSS version 20. Prevalence of risk factors was presented in percentage. Paired t-test was used to find out the effectiveness of health education. Results: Among the study population, 26% knows that smoking causes cancer, 8% knows that it causes lung diseases, 30% do not know about the effects of smoking and the rest know that smoking causes cancer and lung diseases. Moreover, only 2% knows that alcohol causes cancer, 15% know that it causes liver diseases and 40% don't know about the effects of alcohol. The effect of health education on risk factors of lifestyle disease was statistically significant with smoking (P = 0.000), alcohol (P = 0.02), and physical activity (P = 0.001). Conclusion:The level of awareness about the carcinogenic effects of smoking and alcohol is poor. More awareness regarding the ill effects of smoking and alcohol should be created through health education. Implementation of relevant health promoting activities and regular health check-ups are advised for people who are under the high risk category. The importance of lifestyle modifications should be reinforced.

  A clinical study on assessment of autonomic functions among normotensive offspring of hypertensive parents Top

S. G. Vijayasri1, K. Tamilselvan1, N. Nirmala1

1Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Puducherry, India

E-mail: [email protected]

Background: Hypertension runs in families and parental history of hypertension increases the risk of developing the condition, especially if both the parents are hypertensives. Genes play a vital role in its inheritance by influencing the autonomic nervous system. Normotensive subjects with family history of hypertension have greater sympathetic activity and also early parasympathetic attenuation. Aim and Objective: To assess the autonomic nervous system functions of the normotensive offspring of the hypertensive parents and compare their findings with healthy volunteers without parental history of hypertension. Methodology: This cross-sectional study was performed on 60 subjects (30 normotensive offspring of hypertensive parents and 30 normotensive offspring of nonhypertensive parents) in the Department of Physiology, SVMCH and RC, and the following autonomic function tests were carried out to assess their sympathovagal balance: orthostatic test, cold pressor test, isometric hand grip test, heart rate response from supine to standing (30:15 ratio), deep breathing test, and Valsalva ratio. Results: Of the tests performed, significant findings (P < 0.05) suggestive of sympathetic activity was obtained in orthostatic test for sympathetic assessment with the immediate, 2nd, and 5th min systolic blood pressure values significantly higher in the study group and parasympathetic attenuation by 30:15 ratio with a P = 0.013. Conclusion:The findings of our study suggest sympathetic overactivity and vagal attenuation in the study population, thus foreshadowing the impairment of cardiovascular health in normotensive offsprings of hypertensive parents, inferring the genetic predisposition of these individuals to hypertension in the future.

  In vitro activities of colistin, polymyxin B, and rifampicin against carbapenem-resistant Acinetobacterbaumannii at a tertiary care hospital from South India Top

S. Sudhishnaa1, M. Dheepa1

1PSG Institute of Medical Sciences and Research, Coimbatore, Tamil Nadu, India

E-mail: [email protected]

Introduction and Objectives:  Acinetobacter baumannii Scientific Name Search pidly emerging as a potent organism causing a multitude of nosocomial infections. The organism also carries various resistance mechanisms to antibiotics, making treatment more difficult. Very few choices are left, as Acinetobacterbaumannii strains have begun to develop resistance against cephalosporins, aminoglycosides, and even carbapenems. The study examined the sensitivity pattern of three older antibiotics namely colistin, polymyxin B, and rifampicin against carbapenem-resistant Acinetobacterbaumannii. Materials and Methods: 100 clinical isolates of carbapenemase Acinetobacterbaumannii were tested for sensitivity to colistin, polymyxin B, and rifampicin by Kirby– Bauer disc diffusion method. They were also tested for sensitivity to colistin by VITEK 2C (biomérieux) automated microbial identification system. The zone diameters and minimum inhibitory concentration values for the above two methods respectively were observed. All the antibiotic susceptibility tests were done according to the Clinical Laboratory Standards Institute guidelines. Results: By Kirby–Bauer disc diffusion method, 78% of the carbapenem resistant strains were found to be sensitive, 12% intermediate sensitive and 10% resistant to colistin. All the isolates were sensitive to polymyxin B and 80% were resistant to rifampicin. By the VITEK automated system, 99% of the isolates were sensitive to colistin (more in number than by disc diffusion method). Conclusion:Polymyxins (colistin-polymyxin E and polymyxin B) are the next choice for multidrug-resistant serious nosocomial infections such as those of Acinetobacterbaumannii, while waiting for newer antibiotics. The rifampicin resistance was found to be very high and hence, is not advised for monotherapy.

  Rotavirus: A common cause of preventable diarrhea? Assessment of rotavirus incidence by immunochromatography in children <2 years Top

A. Sagethya1

1Rajarajeswari Medical College and Hospital, Bengaluru, Karnataka, India

E-mail: [email protected]

Objective: To assess the incidence of rotavirus infection in children below 2 years of age presenting with severe diarrhea. Materials and Methods: This study was carried out over a period of 2 months in a tertiary referral hospital. Children below 2 years of age presenting with acute diarrhea without previous vaccination against rotavirus were included in the study. After obtaining informed consent, clinical information and detailed history were taken. Fecal sample was collected. SD Bioline Rotavirus test was used for detection of rotavirus group A. This test is an immunochromatographic assay. It is sensitive, specifi c, and convenient. Results: A total of 40 samples were assessed. The study included 22 male and 18 female patients. 11 patients were under 6 months of age, 13 patients between 6 and 12 months, and 16 between 12 and 24 months. 10 samples (25%) were positive for rotavirus antigen. 50% of children with rotaviral diarrhea were in the age group of 6–12 months. High incidence was seen in the month of September. Conclusion:Rotavirus is one of the most common causes of diarrhea in children below 2 years. Rotavirus is highly contagious, and there is a need to stress the importance of personal hygiene to prevent transmission. Further, considering the high incidence of rotavirus, it underscores the need for immunization as it is preventable.

  Study of intraocular pressure in patients with diabetes mellitus, systemic hypertension and in normal individuals, in a tertiary care hospital in South India Top

Saiprasad S. Baliga1

1Kasturba Medical College, Mangalore, Karnataka, India E-mail: [email protected]

Introduction: Intraocular pressure (IOP) is defined as the tissue pressure exerted by the intraocular contents of eyeball. Studies have shown that systemic hypertension and diabetes mellitus may lead to increase in IOP, which is harmful. In this study, IOP of the individuals aged 40 years and above, was measured and correlated with the presence of diabetes mellitus and systemic hypertension in the individuals. This was the main objective of the study. Applanation tonometry technique was used. Materials and Methods: 256 eyes of 123 patients aged 40 years or above were examined and the subjects were divided equally into 3 categories. Applanation tonometry and ophthalmoscopy were done between timings 8 a.m and 12 p.m. Subjects not suffering from diabetes mellitus or hypertension served as controls. Subjects with hypertension and diabetes mellitus were selected by criteria used bythe British hypertension society and WHO, respectively. Descriptive analysis showed the values for means, standard deviations, minimum and maximum IOP in all patient groups, in addition to the differences of values in each group. One-way ANOVA test, with normal distribution and 5% significance, was used to compare the mean IOP values between the study groups. Results: The mean IOP in the control group was 13.09 and 12.69 mmHg in the right and left eye, respectively. Similarly, in hypertensive subjects, it was 13 and 13.57 mmHg, and in diabetic subjects, it was 13.31 and 13.54 mmHg. Discussion: We found that subjects with higher duration of diabetes had higher IOP levels. This pattern was also observed in hypertensive subjects. There is no established direct relation of IOP with diabetes mellitus or that with systemic hypertension. Assessment of cognitive functioning and quality of life in sickle cell anemia patients.

  Taking hydroxyurea versus those not taking hydroxyurea in Central India Top

Sakhare Vaibhav1

1Vikas Government Medical College and Hospital, Nagpur, Maharashtra, India

E-mail: [email protected]

Introduction: Sickle cell disease (SCD) is a group of inherited red blood cell disorders in which patient suffers from different complications such as vaso-occlusive and hematological and infectious crises. Measurement of quality of life (QoL) is important for knowing the effect of disease on psychosocial parameters and to judge adequacy of treatment and compliance of the patient with the therapy. Hydroxyurea is used to decrease the crises inpatient of SCD. Extremely scarce data is available regarding comparison of disease-related QoL of patients with SCD who are receiving hydroxyurea therapy compared to patients with SCD who are not receiving therapy. Hence, the present study was planned with the objective of assessing and comparing disease specific-QoL using SCD-QoL and cognitive functioning using mini mental state exam (MMSE) in SCD adolescent patients taking hydroxyurea and those not taking hydroxyurea. Materials and Methods: Total SCD patients: 60. Taking hydroxyurea: 30; not taking hydroxyurea: 30. Age group: 13–18 years having Hb-SS pattern. Questionnaire: SCD QoL questionnaire and MMSE questionnaire. GraphPad prism 5.01 was used for statistical analysis. Results: Mean age of patients on hydroxyurea was 15.96 ± 15.35 years while those not taking hydroxyurea was 16.68 ± 18.32 years. Significantly higher MMSE summary score was seen in SCD patients on hydroxyurea treatment (28.23 ± 1.278; P < 0.0001). No significant difference was seen between the two groups in terms of overall SCD-QoL score. Conclusions: No beneficial effect on disease-specific QoL has been observed in hydroxyurea group. Hydroxyurea has beneficial effect on cognition although the mechanisms by which hydroxyurea may improve cognitive outcomes are not clear which warrants further clinical trial in this regard.

  Morphometric analysis of foramen transversarium of cervical vertebra in South Coastal Zone of Andhra Pradesh Top

Samudrala Pavithra1

1Narayana Medical College, Nellore, Andhra Pradesh, India

E-mail: [email protected]

Introduction and Objectives: All the 7 cervical vertebrae are considered to be the smallest movable vertebrae and are identified by their transverse processes, which are perforated by a foramen named foramen transversarium. The second part of the vertebral artery ascends through the foramen transversarium of upper six cervical vertebrae. A clear detailed understanding of course, branches, and termination of vertebral artery in posterior cranial fossa is essential for planning and performing any surgical procedures that involve the cervical vertebra. The objective of the present study is to measure the size, shape, number of foramen, and distance between foramen transversarium and vertebral canal in cervical vertebra. The present study is a preliminary attempt to report a detailed morphometric analysis in south coastal population. Materials and Methods: The study is conducted using a total number of 100 sets of cervical vertebra obtained from Department of Anatomy, Narayana Medical College, Nellore, and various medical colleges in and around south coastal region. Materials and methods used (a) 100 sets of cervical vertebra. (b) Vernier Calipers. Standard methods are used for analyzing the measurements.
Table 1: Incidence of seven types of transverse foramina in C1 to C6 Indians

Click here to view

Conclusion:The variations in size, number, and shape of foramen transversarium of cervical vertebra and their compression may be one of the causes for conditions like occipital headache, migraine, and fainting attacks.

  Differentiation of round cells in semen - correlation with total sperm count and sperm motility Top

Seema Balasubramaniam1

1Bharti Vidyapeeth Deemed University Medical College and Hospital, Sangli, Maharashtra, India

E-mail: [email protected]

Introduction: Infertility is defined as the time of 1 year of unprotected intercourse without conception. Male factor contributes to 40–50% fertility problems. Semen analysis is the initial recommended investigation to fertility detection. This study was done to find out whether the inclusion of differentiation of round cells in semen would add to further details in a semen report. The objectives include: to perform routine semen analysis including physical, chemical, and microscopic examination. Further to differentiate the round cells in the semen into immature germ cells and leukocytes and to seek a correlation between the total sperm count with round cells in the semen into immature germ cells and leukocytes. Materials and Methods: The required materials for the analysis: Semen jar, Glass slides, Centrifuge, Fixative, Leishman stain, Microscope. Semen samples were collected from the male patients who had come to Bharati Hospital, Sangli, for evaluation of infertility in the period of July 2014 to September 2014. The study was cross-sectional. It was a convenience sampling and those male patients were considered who had come for infertility evaluation. The data were subjected to Student's t-tests to seek the correlation between the parameters. The correlation that was sought was then statistically analyzed to interpret the results. Results: The analysis revealed that the correlation between the total sperm count and immature germ cell count was negative. Similarly, the correlation of immature germ cell count and sperm motility was negative. Conclusion:The study shows that inclusion of round cell count and their further differentiation into immature germ cell count and leukocytes and their correlation with the total sperm count becomes an essential part of the semen report. The differentiation of the round cells helps the clinician to proceed with the treatment.

  Observational study on the prevalence of diabetes mellitus among ultrasonographically diagnosed cholelithiasis patients Top

Shadan Taskeen1, Mohammed Abdul Hannan Hazari1, Mehnaaz Sameera Arifuddin1

1Deccan College of Medical Sciences, Hyderabad, Telangana, India

E-mail: [email protected]

Background: Diabetes and cholelithiasis are common diseases worldwide in this era of modern epidemics of noncommunicable diseases. Studies revealed that diabetes pose as a risk factor for diabetes. Since both the diseases are related to altered carbohydrate and lipid metabolism, we hypothesized that the vice-versa, i.e., gallstone disease can be a risk factor for development of diabetes. Aim and Objective: To know the prevalence of diabetes mellitus in gallstone disease patients and to correlate the severity of gallstone with metabolic control of diabetes. Materials and Methods: This was a hospital-based observational study conducted between May 2014 and September 2014 in which 30 gallstone patients belonging to both gender and between the ages 20–80 years were enrolled. The study was approved by Institutional Review Board, and informed consent was taken from all patients. Presence of gallstones, either solitary or multiple, size of the largest gallstone was noted from the ultrasound report. Random blood sugar was also noted from the available biochemical reports. 2 ml of venous blood was collected in ethylenediamine tetraacetic acid vacutainers and hemoglobin A1c and mean blood glucose was determined by commercially available kits based on Ion Exchange Resin method (Excel Diagnostics Pvt. Ltd., Hyderabad, India.). Results: Out of 30 patients, 2 patients were dropped from the analysis because of missing data. In this study, we found that the prevalence of diabetes among cholelithiasis patients was 32.1% and out of 9 diabetic patients, 2 developed gall stones before the diagnosis of diabetes mellitus. Socioeconomic status did not have any bearing on the occurrence of diabetes and gallstones in our patients. HbA1c levels did not correlate with the severity of gallstone disease which is assessed in the form of solitary/ multiple stones and size of the largest gallstone. Conclusion:Our hypothesis of gall stones acting as risk for diabetes could not be proved.

  Role of mobile phones as vectors in hospital-acquired infections Top

Shakthivel Mani1

1Sri Venkateshwaraa Medical College Hospital and Research Centre, Ariyur, Puducherry, India

E-mail: [email protected]

Background and Objectives: The use of cell phones has increased as an easy mode of communication. Healthcare workers (HCWs) have made it a potential fomite in transmission of hospital-acquired infections. At present, there are no guidelines for the care and disinfection of cellphones in the health care setting. This study is aimed to determine the resident organisms, its frequency, antibiotic susceptibility, and efficacy of isopropyl alcohol in disinfecting mobiles. Methods: Swabs from 100 cell phones were taken 50 each from study and control group. Two samples were collected from each phone using sterile cotton swabs and cultured as per standard protocol. Phones were disinfected with 90% isopropyl alcohol using sterile gauze piece. Interpretation and Results: 70% of cellphones of HCW were contaminated, with a predominance of Pseudomonas spp. of 71.4%. The disinfection procedure was effective only in 57% of cellphones.

  A study to compare the prevalence and degree of anemia between patients with diabetic nephropathy and chronic renal disease due to other cause Top

Shreyasi Paul1

1Nilratan Sircar Medical College, Kolkata, West Bengal, India

E-mail: [email protected]

Introduction: A normochromic normocytic anemia is observed in advanced stages of chronic renal disease (CRD). Reduced hemoglobin levels increases the risk for cardiovascular complications and mortality. Some studies have suggested that the prevalence and degree of anemia is greater in patients with diabetic nephropathy than in CRD due to other cause. Again according to some others, although smaller studies have suggested that the prevalence of anemia is increased in diabetes, these surveys have generally selected patients with overt nephropathy. Objectives: To estimate the occurrence of anemia in CRD and to compare the prevalence and degree of anemia between patients with diabetic nephropathy and CRD due to other cause. Materials and Methods: Study design: Cross-sectional study. Study period: 2 months. Study population: Diagnosed patients of CRD either due to diabetic nephropathy or nondiabetic cause visiting the outpatient department of nephrology department. Sampling: Random sampling. Results: Incidence of anemia was significantly higher in patients with GFR <60 than in patients with GFR ≥60 in both groups. In spite of high prevalence of anemia in CRD, only 5.6% of anemic patients were further investigated for anemia. However, the difference in the occurrence and degree of anemia in diabetic and nondiabetic group was not statistically signifi cant. Conclusion:This study provides an estimate the occurrence of anemia in CRD in Indian population. In addition, it provides a comparison of prevalence and degree of anemia between diabetic and nondiabetic CRD. Further research will perhaps lead to better understanding and management of anemia in CRD.

  Prospective study on correlation between serum lactic acid levels, uric acid levels, and lactate clearance in acute coronary syndrome Top

H. Shyam Chandrasekar1

1Government Mohan Kumaramangalam Medical College, Salem, Tamil Nadu, India

E-mail: [email protected]

Introduction: India represents the highest burden of acute coronary syndrome (ACS) in the world. There is rising trend in the incidence and mortality of coronary heart disease in the rural as well as urban India. Various diagnostic and prognostic markers are under study for ACSs. Surveys suggest the negative prognostic role of hyperlactatemia in several critically ill diseases but data in patients with ACSs are scarce. Uric acid levels are also found to be elevated in coronary heart disease patients and marked hyperuricemia in patients with more severe disease is associated with poor to fatal outcome. Aims and Objectives: (1) Lactic acid levels, uric acid levels, and lactate clearance - prognostic indices in ACS patients? (2) To correlate the lactate clearance and hyperuricemia with the duration of intensive care unit (ICU) stay. (3) To correlate the lactic acid and lactate clearance with the Global Registry of Acute Coronary Events (GRACE) score. (4) To correlate serum uric acid levels with Killip class. Materials and Methods: Sample population included 50 patients admitted for ACS in ICU at Government Mohan Kumaramangalam Medical College Hospital. Duration of study: 2 months. Sample collection: 3 ml of venous blood was collected on admission and 48 h after admission, serum lactic acid levels were estimated on admission and 48 h after in 50 patients and uric acid levels were tested on admission. Observation and Results: The study showed male preponderance with maximum incidence in the age group of 40–60 years. Various risk factors noted including smoking (56%), diabetes (40%), hypertension (34%), and dyslipidemia (46%). Serum lactic acid levels were higher in patients with ACS. Patients with higher GRACE score had higher serum lactic acid levels (P = 0.022541), decreased lactate clearance (correlation coefficient 0.63100386), and higher serum uric acid levels (P = 0.01694). Combination of GRACE score and lactic acid level is found to be a good predictor of mortality after acute myocardial infarction. Patients in higher Killip class had higher serum uric acid levels. Combination of Killip class and serum uric acid levels has been a good predictor of mortality after ACS. Hyperuricemia and lactate clearance has been a good predictor of ICU stay. Conclusion:Lactate and uric acid levels can serve as a cost-effective, simple, and easy way of assessing the disease severity and also lactate monitoring can guide therapy of ACS patients.

  A pilot study on patients with urinary tract infections attending rural hospital Top

Siddarth Amuthan Rajah1

1Muthiah Medical College, Annamalai University, Chidambaram, Tamil Nadu, India

E-mail: [email protected]

Objectives: (1) To study the prevalence of  Pseudomonas aeruginosa Scientific Name Search ong the patients with urinary tract infections (UTIs). (2) To study the antibiogram pattern of P. aeruginosa isolated from UTI cases against selective group of antibiotics. (3) To study the phenotypic and genotypic characterization of extended spectrum beta lactamase (ESBL) of P. aeruginosa isolated from UTI. Materials: The study was conducted in Rajah Muthiah Medical College and Hospital, Chidambaram, Cuddalore district, Tamil Nadu (1210 bedded hospital). A total of 500 urine samples were collected from patients attending Departments of Medicine and Urology with symptoms of UTI, pyelonephritis, cystitis, and benign prostate hypertrophy. Methodology: Processing of urine samples. Direct microscopic examination – grams stain. Culture methods: (1) nutrient agar (2) blood agar (3) MacConkey's agar and (4) cetrimide agar. Biochemical reactions: (1) sugar fermentation (2) indole test (3) methyl red test Voges Proskauer's test (4) citrate utilization (5) oxidase (6) catalase (7) nitrate reduction and (8) oxidative-fermentative test antibiogram with Kirby–Bauer disc diffusion technique on Muller-Hinton agar. Aminoglycosides, cephalosporin, carbapenems, monobactams, fluoroquinolones, and extended-spectrum penicillin ESBL phenotype by double disc synergy test. Genotypic by polymerase chain reaction amplification and gel electrophoresis. Conclusion:The prevalence of P. aeruginosain UTI was 4%. Among 500 urine samples screened 13.3% were positive for bacterial isolates. The prevalence of various bacteria in UTI was  Escherichia More Details coli 29.2%, Klebsiella pneumonia 12.8%,  Proteus mirabilis Scientific Name Search  11.2%, Staphylococcus aureus 8.8%, P. aeruginosa 4%, and Enterococci 0.4%. P. aeruginosa isolated from urine against various group of selective group of antibiotics were aminoglycosides 80%, carbapenems 80%, extended spectrum penicillin 70%, and resistance to monobactams 80% and cephalosporins 60% P. aeruginosa isolated from urine showed 90% multidrug resistance and 10% single drug resistance. When compared to single drug resistance, multidrug resistance pattern was statistically significant (P = 0.049). Phenotypic expression of ESBL positive P. aeruginosa isolated from urine was 40%. The genotype characterization of ESBL showed 30% CTX-M and 40% SHV genes in P. aeruginosa. The expression of ESBL and antimicrobial susceptibility pattern of P. aeruginosa was very well correlated. Choice of antimicrobial therapy must be guided by local and regional laboratories after culture results. In addition clinicians should consider the relative risk of emerging multi-drug resistance during treatment in each patient. Empirical therapy requires more than one antibiotic.

  Quality of life in patients undergoing treatment for breast cancer Top

Siddhartha Basuroy1

1Goa Medical College, Bambolim, Goa, India

E-mail: [email protected]

Introduction: Breast cancer is the most common of all cancers among women worldwide. Understanding the effect of breast cancer treatment on a patient's quality of life (QOL) has been a central clinical and research question. The emotional and the psychological impact of the disease and its treatment can be severe. Not all breast cancer patients experience their illness in the same manner, and the problems can reflect upon their social life as well. The objectives of this study were to study of QOL of women admitted to GMC with breast cancer during their treatment and to make recommendations based on this study. Materials and Methods: The study was based on the department of surgery at GMC. The ethics committee approval was taken. 50 patients were recruited for the study with informed consent, and strict confidentiality was maintained. The basic demographic details and the history of the participant had been collected. Further, patients were asked about their knowledge of breast self-examination. The details about the QOL were collected using the EORTC modules QLQ-C30 and QLQ-B23. It has been validated worldwide for the assessment of QOL in patients with breast cancer. The authors have obtained the necessary permission for the use of this questionnaire. In addition, open-ended questions were also asked. Results and Conclusions: The QOL in breast cancer patients has been impaired greatly. Pain is the chief complaint amongst them. Moreover, they have become more worried and tense. Many patients are upset about the effect on their body image due to the surgery and side effects of chemotherapy. Only 5 (10%) patients were aware about breast self-examination. The QOL worsened with the cycles. It was best on the first cycle and progressively worsened.

  Prevalence of obesity and its influencing factors among school children of Bagalkot city, Karnataka Top

Siera Mariyam Thomas1

1S.N. Medical College, Bagalkot, Karnataka, India E-mail: [email protected]

Introduction: At present, the potential health issue that is emerging is the increasing incidence of obesity in developing countries and the resulting socioeconomic and public health burden that will be faced in our country in near future.1 In India, childhood obesity is increasingly being observed with the changing lifestyle of families with increased purchasing power, increasing hours of inactivity due to television, video games, and computers have replaced outdoor games and other social activities.8 Childhood obesity is associated with high chance of obesity, premature deaths, and disability in adulthood. The exact prevalence of the condition is unknown in our country because of lack of national data. Studies of such a nature will be useful tools in planning and developing appreciable intervention methods. In this context, the present study has been conducted. Aims and Objectives: (1) To determine the prevalence of obesity in school children and (2) to identify the factors influencing childhood obesity. Materials and Methods: Study setting: The present study has been undertaken at one of the school of Vidyagiri, Bagalkot. Duration of study: July and August 2014 Study participants: 750 students. Type of study: It is a cross-sectional descriptive study. Data collection: Predesigned and pretested questionnaire was used. The first part of questionnaire consists of the information about sociodemographic factors, family history of obesity and diabetes. The second part of the proforma contained dietary history, physical activity and anthropometric measurements such as height and weight. The questionnaire was explained to students beforehand. Obesity was assessed by body mass index (BMI) for age. A prior written consent for the study was taken from each student in a consent form. The children were categorized into obese and nonobese by using K.N. Agarwal percentiles 42, children with 95th percentile of BMI is taken as cut-off point. Children with BMI more than this cut off point with respect to age and sex is considered as obese. Statistical Analysis: Data were entered in excel spread sheet. The frequency distributions of age, sex, educational status and occupation were derived and were presented. The association of each of the variables with obesity was assessed with the Chi-square test. Variables showing statistical significant association with the outcome variable (P < 0.005) were considered as potential risk factors of overweight and obesity. Results: The total prevalence of obesity was 2.80%. The prevalence of obesity among male was 2.01% and in female it was 0.79%. Conclusion:Prevalence rate of obesity in the study population was 2.8%. Factors which were independently associated with obesity were family history of obesity and diabetes number of items of high energy food intake outdoor games activity and Education of mother.

  Quality of life in young adults with premenstrual syndrome: Case–control study Top

Sukaina Furniturewala1, Shaunak Ajinkya1, Pradeep Jadhav1

1Medical College and Hospital, Navi Mumbai, Maharashtra, India

E-mail: [email protected]

Background: Premenstrual syndrome (PMS) involves a variety of physical, physiological, and emotional symptoms experienced by some women during the late luteal phase of the menstrual cycle (7–14 days before menstruation). The nature and severity of the symptoms could be within a spectrum from minimal to disabling. The morbidity of PMS results from the severity of symptoms, the chronicity of the disorder and the resulting impairment in domestic and work settings, in social and professional relationships, and in activities. Aim: To compare the quality of life in young adults with PMS versus normal menstruation. Materials and Methods: This was a case–control study conducted in the month of March 2015 to May 2015 at a teaching Institute in Navi-Mumbai. Young adult females between 18 and 25 years were interviewed. A total of 35 PMS (cases) and 70 with normal menstruation (control) were included participant's sociodemographic and menstrual history was recorded. Premenstrual symptoms screening tool was used to identify females suffering from PMS. Quality of life was assessed using WHO-BREF QOL, which measured the following broad 4 domains: physical health, psychological health, social relationships, and environment. Results: Overall, QOL mean scores in PMS were lower than controls. There was a signifi cant difference of quality of life of PMS in the psychological health, social relationships, and environment domain of WHO-BREF QOL in comparison to control group (P < 0.05). Conclusion:Young individuals with PMS experience significant impoverished and poor quality of life. To address this issue, there is a need for early identification and treatment intervention to improve the QOL.

  Nasal carriage of methicillin-resistant Staphylococcus aureus among healthcare workers in a teaching hospital Top

Suprabha Chaudhary1

1Mayo Institute of Medical Science, Lucknow, Uttar Pradesh, India

E-mail: [email protected]

Introduction: Staphylococcus aureus is a common cause of community-acquired and hospital-acquired infections worldwide.

Limiting the transmission of methicillin-resistant Staphylococcus aureus (MRSA) might reduce the potential for these strains to spread asymptomatically colonized patients and healthcare workers (HCWs) are the major sources of MRSA in the hospital environment, with the latter being more commonly identifi ed as the link in the transmission of MRSA between the patients. The nosocomial transmissions of MRSA from and through health caregivers to the hospitalized patients have been documented and these may be greater than was previously thought. Objective: The primary objective of this study is to detect the prevalence of MRSA isolates obtained from anterior nares of the health care staff in a teaching hospital setup of Northern India. The secondary objective of the study is to (1) determine the prevalence of S. aureus nasal carriage in HCWs (2) study the in vitro susceptibility profile of isolates to various antimicrobial drugs. Materials and Methods: Study design: A hospital-based, cross-sectional study. Study Population: HCWs working in our hospital sample size: 100. Data Collection: Demographic (age, sex, and occupation), clinical conditions data (history of antibiotic usage in the past 2 weeks, duration of hospitalization, and history of fever in the past 2 weeks), and other relevant information about the participants will be recorded on pretested proforma. Procedure:Nasal swabs will be collected from 100 HCWs working in teaching hospital of Northern India. Informed consent will be obtained from all participants before specimen collection. Epidemiological information will be obtained by interviewing the participants at the time that the nasal swabs will be collected. Specimen Collection: The specimens will be taken from the subjects by using a sterile moistened swab inserted into the nostril, to a depth of approximately 1 cm, and rotated 5 times. For each subject, both nostrils will be sampled using the same swab. Detection of methicillin resistance all confirmed Staphylococcus aureus Scientific Name Search  are further tested for detection of methicillin resistance by Kirby– Bauer disc diffusion method using cefoxitin 30 μg discs (HI media Labs, India) as per Clinical Laboratory Standards Institute 2013 guidelines7. For cefoxitin, zone size of <21 mm was taken as resistant and >22 mm as sensitive. Antibiotic susceptibility testing the antibiotic susceptibility testing will be performed by using the Kirby–Bauer disc diffusion method on Muller Hinton agar using the criteria of standard zone sizes of inhibition to defi ne sensitive, intermediate, or resistance to different antimicrobials. Results: Of the 100 HCWs who were screened, 14% showed nasal carriage of MRSA. Nursing orderlies were the predominant carriers (6%). The antibiogram of the MRSA isolates revealed the highest resistance to penicillin. All the MRSA isolates were sensitive to linezolid. Conclusion:The MRSA carriage rate among the HCWs in our hospital is high, particularly among the nursing orderlies.

  Pseudothrombocytopenia - Cause and incidence Top

Ujjwala Tulluri1

1Bharathi Vidyapeeth University, Sangli, Maharashtra, India

E-mail: [email protected]

Over the past few years, the field of medical science has rapidly with advancements that have been capable of providing humanity with the insight on various subjects. However, there are many more queries that remain unanswered in this ever-growing fi eld, and the need to resolve them is becoming a keen necessity day after day. The subject under discussion for this project is one such matter. Pseudothrombocytopenia is the condition that reveals low platelet count on blood reports, but the patient does not present with any manifestations of thrombocytopenia. In other words, it is a rare finding caused by an in vitro aggregation of platelets in sampling bottles containing ethylene diamine tetraacetic acid (EDTA). The proposed cause for such an occurrence is the use of vacutainers containing EDTA as the anticoagulant, whose involvement in this association will be discussed further. Though the condition is extremely rare, proving its mere existence along with incidence and cause can be exceedingly helpful for those who would otherwise be going through unnecessary platelet transfusion procedures.

  Direct and indirect costs incurred by diabetic patients admitted in a tertiary care hospital – A cross-sectional study Top

V. V. Anupama1

1Kamineni Institute of Medical Sciences, Narketpally, Telangana, India

E-mail: [email protected]

Introduction: Diabetes is a major noncommunicable disease causing huge economic burden to patients. To address this problem, a cross-sectional study was conducted with an objective to estimate the direct and indirect costs incurred by diabetic patients admitted in a tertiary care hospital during a study period of 2 months. Materials and Methods: Before the study, approval from Institution Ethics Committee was obtained. A total of 80 patients were interviewed after obtaining written informed consent, using a structured questionnaire for direct and indirect cost assessment and socioeconomic status. The data thus obtained were analyzed using SPSS version 19. Results: The mean total direct cost at the time of study was found to be Rs. 11007.50 ± 10297.9 and mean indirect costs was Rs. 1965 ± 4134.23. The mean duration of diabetes was 8.18 ± 5 years. The sociodemographic factors age, education, and socioeconomic status were not associated with total direct costs at the time of study whereas gender was found to be significantly associated (P < 0.0001) with it. Moreover, signifi cant association has been found between indirect costs and the days lost due to hospitalization (P = 0.001). Presence and absence of complications were significantly associated with the mean total direct costs incurred by patients in the past 2 years on independent sample t-test (P = 0.029). Conclusions: Thus, it is evident that in a sample of 80 where around 70% belong to middle class, 53.8% of the total subjects being from the economically productive age group, the direct costs incurred by diabetic subjects is quite higher and is associated with presence of complications when costs are calculated for a longer duration, and there is a need to take measures to bring down the economic burden caused by diabetes.

  Evaluation of pulse oximetry as a screening test for early detection of critical congenital heart defects in newborn Top

M. S. Varun Venkat Raghavan1

1 Bangalore Medical College and Research Institute, Bengaluru, Karnataka, India

E-mail: [email protected]

Introduction: Congenital heart diseases are a group of congenital malformations, being the leading cause of infant deaths. Current diagnostic tools are too costly and cannot be afforded by most developing nations. Therefore, there is considerable interest in improving the detection of Critical Congenital Heart Diseases (CCHDs) with novel diagnostic techniques. Role of pulse oximetry in this study. Hypoxemia manifested by cyanosis is difficult to detect in newborns. In addition, newborns with oxygen saturation between 80% and 95% will have no visible cyanosis. Dark skin color also interferes with detection of cyanosis in newborns.[4] To overcome these difficulties, the use of pulse oximetry has been proposed. Pulse oximetry is based on the different absorption spectra between oxygenated and deoxygenated hemoglobin. Pulse oximetry thus has the potential to identify hypoxemia that might not otherwise produce visible cyanosis. Objectives: To evaluate the utility of using pulse oximetry as a tool for early diagnosis of congenital heart defects in newborn, especially CCHDs. To determine the percentage of false positive outcomes with pulse oximetry and to evaluate its sensitivity and specificity. Methodology: Requisite approvals from the Institutional Review Board/Ethics Committee were obtained. The current study was a prospective study of 4169 newborns admitted in well baby nursery of Vani Vilas Hospital, Bengaluru, which is a teaching hospital attached to Bangalore Medical College and Research Institute. Sample size: 4169 newborns. Statistics: Descriptive statistics is used to necessitate all data. 4169 sample of subjects cross-classifi ed according to whether a certain condition is present or absent, and according to whether a test designed to indicate the presence of that condition proves positive or negative, the following will be calculated at 95% confidence interval. Sensitivity and specifi city false positive rate. Inclusion criteria: all babies born at term (born after ≥37 weeks of gestation) were included in the study. Exclusion criteria: the following groups were excluded from the study - preterm babies (born after <37 weeks of gestation). Babies diagnosed to have congenital heart defects through prenatal ultrasonography. Babies with symptoms suggestive of cardiac disease at birth. Babies undergoing phototherapy. Pulse oximetry was done after the neonate was moved to the general postnatal wards i.e., after photo therapy. Study protocol pulse oximetry was done using Masimo Rad 5 neonatal pulse oximeter with LNCS multisite reusable sensor, between 24 h and 48 h of birth for all asymptomatic newborns admitted in well-baby nurseries. Pulse oximetry was measured in either foot. If the oxygen saturation was <94%, or if the baby was uncooperative, a repeat saturation measurement was done after 1 h. If the saturation remained below 94%, the neonate was considered abnormal. A full clinical examination was done by qualifi ed medical personnel (intern/resident) for all newborns with saturation <94%. Any emergent respiratory or cardiac condition was attended to immediately. Thereafter, all such newborns were referred for echocardiography. Echocardiography was done using M-mode, two-dimensional, Doppler echocardiogram. If echocardiography was abnormal, coronary heart disease (CHD) was confirmed, and appropriate therapeutic intervention was done. Telephonic follow-up was done for all screened newborns after 2 weeks – to determine false negatives, if any. Results and Discussion: Of 6400 newborns screened by pulse oximetry, 30were screened to have, i.e., SpO2 <94% (test positive), which is a prevalence of 7–8/1000 births. By descriptive analysis, the sensitivity is calculated as 100%, and the specificity is 99.35%. Since no abnormal asymptomatic newborns with CCHD were missed by pulse oximetry, sensitivity of pulse oximetry for detecting CHDs in this study comes out to be 100%. The number of false positives is 27 out of 4169 and the false positive rate is 0.64%. Patent foramen ovale (PFO) defects are known to be asymptomatic and benign. Low oxygen saturations in PFOs (also atrial septal defects [ASDs] and ventricular septal defects [VSDs]) are due to episodes of pulmonary congestion leading to defective gas exchange at the lungs rather than a shunt or mixing of oxygenated with deoxygenated blood. Thus, these can be considered as false positive outcomes. Results of telephonic follow-up: 1839 of the 4169 newborns were followed up 2 weeks after Pulse oximetry screening by telephone. 1838 of these newborns turned out to be normal. However, the silver lining is that we have been able to detect 2 CCHDs very early, which has led to quick intervention and management of the newborns concerned. We were able to detect a case of total anomalous pulmonary venous connection (TAPVC) in a newborn within 48 h of birth, using pulse oximetry. Unrecognized and untreated TAPVC is associated with an 85% mortality rate. We were similar able to detect a case of right ventricular outflow tract obstruction, with right ventricular hypertrophy within 48 h of birth using pulse oximetry.

  • 1 was diagnosed to be a case of TAPVC – Mixed type, ostium secumdum ASD, and patent ductus arteriosus (PDA) with the right to left shunt.
  • 1 was diagnosed as right ventricular outflow tract obstruction with infundibular stenosis, right ventricular hypertrophy, and PFO with right to left shunt.
  • 1 was diagnosed as a case of apical VSD with PDA, PFO – with left to right shunt
  • 1 was diagnosed as ostium secundum ASD with septal aneurysm.
  • 2 were diagnosed as ostium secundum ASD with dilated right chambers.
  • 1 was diagnosed as cor triatraitum with PDA and ostium secundum ASD
  • 2 cases were diagnosed as ostium secundum ASD with left to right shunt.
  • 21 cases were diagnosed as PFO with left to right shunt.

Conclusion:It can be concluded that pulse oximetry is efficacious in detecting CHD's-leading to early intervention for the affected newborns. This is particularly of importance in a country like India, which has a high incidence of congenital heart disease. Further, with some studies revealing that pulse oximetry can be used to screen for other diseases of the newborn such as sepsis and pneumonia, the combined screening program (i.e., screening for CHD, pneumonia, and sepsis) may have a huge impact in a country like India with a very high neonatal mortality rate.

  Mortality and morbidity profile of low birth weight babies at Niloufer hospital Top

Vibhav Srinarayana Janaswamy1, Pothuraju Lathasree1

1Pothuraju Lathasree, Dr. Y. Kodandapani, Osmania Medical College, Hyderabad, Telangana, India

E-mail: [email protected], [email protected]

Introduction: The definition of low birth weight (LBW, wt. <2000 g), very LBW (VLBW) (<1500 g), extremely low birth weight (ELBW) (<1000 g), and small for gestational age (SGA, <10th percentile) helps in identifying neonates who require special care. Incidence of LBW in India is approximately 25%. LBW is associated with neonatal mortality or morbidity. Aims: To compute the rate and determine the determinants of mortality and morbidity of LBW babies at Niloufer Hospital. Methodology: Retrospective analysis of LBW babies of either sex weighing <2000 g admitted to the department of neonatology at Niloufer hospital over a period of 30 days. Birth weight, gestational age, risk factors (RF), length of hospital stay, and outcome at discharge were noted. General condition of the baby at admission and throughout the hospital stay along with the relevant laboratory investigations, type of delivery, and morbid conditions were noted. Results: Out of 91 cases (M:F = 1.9:1) preterm versus term were 69 (75.8%) and 22 (24.2%). 39 (42.9%) neonates were LBW, 22 (24.2%) VLBW, and 11 (12.1%) ELBW. 19 neonates were SGA (20.9%). HR showed positive correlation with both length of stay (r = 0.7) as well as number of RFs (r = 0.6). Univariate analysis showed that preterm babies of either sex had bad prognosis with prognosis being worse in preterm males than in females which was not statistically signifi cant in multivariate analysis (expired vs. alive) (r = 0.001, P = 0.971, vs. r = 0.032, P = 0.86). There is correlation between morbid conditions and birth weight (r = 100.912, P = 0.0001). The order for bad prognosis in terms of mortality was ELBW (P = 0.00009) > VLBW > LBW. Babies who were not SGA showed good prognosis (P = 0.03). 44 (48.4%) were NVD's and 47 (51.6%) were LSCS (21 EM LSCS). The worst prognosis was for babies born through NVD followed by emergency LSCS followed by elective LSCS as per univariate analysis but not with multivariate analysis (r = 11.120, P = 0.51). As the number of RF increase (1,2, >2) prognosis becomes worse which was shown in both univariate and multivariate analysis (r = 28.000, P = 0.0000036). Determinates of mortality as per general regression analysis are birth weight, number of RFs, and respiratory rate. The equation is as follows: chance of mortality = 1.5+ (0.0004 × birth weight in grams) + (0.1 × no of RFs) − (0.01 × RR). Conclusion:Major determinants for mortality in LBW babies were birth weight in grams, number of RFs, and respiratory rate at the time of admission but not other parameters. Heart rate can be used to determine the length of hospital stay.

  Identification of stressors and evaluation of stress levels among the undergraduate medical students: Pre- and post-examination period Top

Yendala Laharika1

1Kamineni Institute of Medical Sciences, Narketpally, Telangana, India.

E-mail: [email protected]

Introduction: Stress is a nonspecific response or reaction to demand made on it or to distributing events in the environment. It is the emotional disturbances caused by stressors. Excessive stress was also related with student suicide. Hence, it is necessary to detect the level of stress first and defend the stress among them. Materials and Methods: The study was done among the final year medical undergraduates of Kamineni Institute of Medical Sciences, Narketpally, of Telangana state using MSSQ questionnaire. The subjects were enrolled after the permission from Institutional Ethics Committee and written informed consent. Data were collected using the preformed questionnaire before and after the examinations. Collected data were analyzed using Microsoft excel and SPSS software. Results: Academic-related stressors (40.28%) are causing high level of stress in pre-examination period but causing moderate stress (51.39%) in postexamination period, social-related stressors are causing moderate stress in pre and mild stress in postexamination period, and teaching and learning-related stressors are causing mild stress in pre-examination period but moderate stress in postexamination period. There is a decrease in severe stress level but the increase in all other stress levels from the pre- and post-examination period. Conclusion:From this study, it was clearly observed that moderate to high levels of stress among the medical students were prevalent throughout their study period. This study ultimately help in knowing the type of stressor responsible for the stress and thereby take necessary steps in reducing the levels of stress and suicide rate among the students by counseling them and appropriate treatment is suggested whether physical, psychological, or in the form of medication.

  Health problems of adult population among three primitive tribes of Maharashtra, India: a clinico-epidemiological study Top

Yogesh Khandagale1, Neelam Sukhsohale1, Mohan Khamgoankar1, Rishikesh Tayade1, Pravin Sasane1

1IGGMC, Nagpur, Maharashtra, India.

Introduction: The tribal population has distinctive high burden of health and nutritional problems governed by their habitat, socioeconomic, cultural, and ecological settings. The present study is an attempt to study health problems prevalent in tribal adult population and various clinico-epidemiological factors associated with it. Materials and Methods: A Community-based cross-sectional study was conducted among 100 tribal adults aged 30 years and above residing at tribal areas (Bhaurad, Beldur, and Kalakamtha) of Taluka Malegaon, District Washim of Maharashtra State. A house to house survey was conducted, and eligible adults were interviewed after obtaining written informed consent. Detailed history regarding socioeconomic, demographic, occupational history, habitat, and nutritional status was inquired. In addition, anthropometric measurements were estimated. Results: Maximum study subjects belonged to age group of 30–40 years (29%) followed by 60–70 years (27%). Males were 41%, and females were 59%. Majority of tribals were illiterate (61%). Considering occupation, maximum were involved in farming (75%) followed by biba worker (15%). Most of the tribes was addicted to tobacco (40%) and had multiple habits (37%). The prevalence of malnutrition was found to be 57% with underweight 49% and overweight 8%. The most common symptom was found to be a weakness (84%) followed by acute respiratory infection (10%). The most common morbidities found in study works were anemia (36%), arcus senilis (33%), hypertension (17%), acute dermatitis with allergic reaction of biba oil (16%), cataract (14%) followed by less common morbidities such as tuberculosis, goiter, blindness, bronchitis, and piles. Conclusion:High prevalence of malnutrition, anemia, arcus senilis, hypertension, and skin problems were reported in adult tribal population. This warrants the implementation of a special health care strategy to reduce the health problems. Emphasis should also be given to appropriate nutrition education in view of the high prevalence of undernutrition.

  Antibiotic susceptibility and determination of minimum inhibitory concentration of some antibiotics against Staphylococcus aureus Top

Zoya Kausar1

1People's College of Medical Sciences and Research Centre, Bhopal, Madhya Pradesh, India

E-mail: [email protected]

Introduction: Staphylococcus aureus is one of the important pathogens in humans and animals, responsible for nosocomial and community-acquired infections. The emergence of its antibiotic-resistant forms is a global problem in clinical medicine. The present study was undertaken to investigate the antibiotic sensitivity pattern of pathogenic strains of S. aureusand determination of minimum inhibitory concentration (MIC) of standard antibiotics against the test isolates. Materials and Methods: All the isolates were initially grown on mannitol salt agar media to observe mannitol fermentation. Agar well diffusion assay was employed to evaluate the in vitro antibiotic susceptibility of 10 pathological isolates to 6 antibiotics, namely, amoxicillin, ampicillin, bacitracin, chloramphenicol, ciprofloxacin, and neomycin at 50 μg/ml concentration. MIC of these antibiotics was studied in terms of broth dilution method by observing turbidity (growth) in the presence of different antibiotic concentration. Results and Conclusion:For antibiotic susceptibility test, chloramphenicol showed a higher zone of inhibition against the isolates followed by amoxicillin, neomycin, ampicillin, and ciprofloxacin. On the other hand, bacitracin was unable to inhibit the growth of any of the bacteria tested. The MIC result revealed that none of the isolates showed sensitivity toward all the 6 antibiotics tested at administered concentration. Only one isolate was found to be sensitive to 4 antibiotics. The result also indicates that only chloramphenicol has proved to be active, to some extent, against the isolates. The result showed a wide range of antibiotics resistance by S. aureus isolates. The study also highlights the need for continuous surveillance of antibiotic sensitivity pattern of S. aureus. It would be helpful in formulating and monitoring the antibiotic policy and ensure proper empiric treatment against S. aureus infections.

  A case of Canavan's disease (a type of leukodystrophy) Top

A. Sirichitra1

1Osmania Medical College, Hyderabad, Telangana, India

E-mail: [email protected]

Introduction: An 8-month-old male child Pawankumar, resident of bidar, born to the consanguineous couple, was brought with chief complaints of loss of mile stones and excessive cry. History: A well thriving child with normal development was brought with the loss of motor milestones for 2 months and excessive cry for 5 days. No H/O fever, no H/O seizures, and no H/O trauma. The child was fully immunized with no perinatal insult. On examination, the child was conscious and appeared anxious, normal anthropometry with normal fundus, cranial nerve functions, and higher mental functions were normal. Motor examination revealed increased tone (spasticity) in all four limbs predominantly involving lower limbs. Upon ventral suspension scissoring of lower limbs is seen. Other systems were normal, and there was no organomegaly. Differential Diagnosis: Canavan's disease, Krabbe disease, Alexander disease, metachromatic leukodystrophy, infantile adrenoleukodystrophy, Pelizaeus–Merzbacher disease, SNE of leigh, and neurodegeneration of brain with iron accumulation. Investigations: Complete blood picture: Hb 9.6 g% thin layer chromatography: 8000/cubic.mm. Complete urine examination, arterial blood gas, renal function test-normal, serum electrolytes-normal, random blood glucose: 102 mg/dl, chest X-ray-normal, erythrocyte sedimentation rate-normal, mantoux-nil, C-reactive protein: normal, serum lactate-normal, PV PF-'-ve', and normal urine metabolic profile. Computed tomography scan showed significant bilateral periventricular ischemic lesions. MRS: NAA peak in subcortical and deep periventricular white matter, urinary levels of NAA-elevated. Diagnosis: Elevated amounts of NAA in the urine-Canavan's disease. Treatment: At present, no specific treatment is available. Treatment is symptomatic and supportive. Parents were reassured, and psychological support was given. Nutritional education and genetic counseling were given. Muscle relaxants were advised. Prognosis: The prognosis for Canavan's disease is poor. Follow-up: Follow-up was advised, but they dint make it. Discussion: Canavan's disease is a rare autosomal recessive disorder, more prevalent in Ashkenazi Jewish (incidence-1 in 12, 996), characterized by megalocephaly, hypertonia, blindness, and signs and symptoms of white matter injury, beginning in early infancy and relentlessly progressing to death within few years of onset. There is accumulation of N-acetyl aspartic acid as a consequence of loss of mutations in the gene encoding the deacylation enzyme “Aspartoacylase”. Mechanism of myelin injury is uncertain. NAA peak in MRS is suggestive of Canavan's and elevated levels of urinary NAA establish a definitive diagnosis.


  [Table 1], [Table 2], [Table 3], [Table 4]


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