Ambedkar Medical College Research Articles

Prospective Observational Study Of Hyperhomocysteinemia In Patients With Recurrent Pregnancy Loss In Teaching Hospital

Background: Spontaneous pregnancy loss can be physically and emotionally taxing for couples, especially when faced with recurrent losses. Recurrent pregnancy loss (RPL), also referred to as recurrent miscarriage or habitual abortion, is historically defined as 3 consecutive pregnancy losses prior to 20 weeks from the last menstrual period . RPL is also defined by two or more failed consecutive pregnancies. It is estimated that fewer than 5% of women will experience two consecutive miscarriages and only 1% experience three or more. At present, there exists a small number of accepted etiologies for RPL. Most of the diagnosed etiologies include endocrine abnormalities, autoimmune disorders, uterine anomalies, and genetic factors. After evaluation for these causes, approximately half of all cases will still remain unexplained. Hence the present study was taken up to investigate the association between hyperhomocysteinemia and recurrent pregnancy loss, evaluating prevalence, potential mechanisms and implications for management. Materials and Methods: The prospective observational study was conducted on 50 patients in the Department of OBG in Dr. B. R. Ambedkar Medical College and Hospital for a period of 18 months. Prior to the initiation of the study, Ethical and Research Committee clearance was obtained from Institutional Ethical Committee. Results: The majority of participants in both groups were aged 35 to 40 years (32.35% in Group A and 37.5% in Group B).Statistically significant differences were observed between the groups regarding hypertensive disorders of pregnancy, co-morbidities, adverse pregnancy outcomes, the nature of abortion (primary vs. secondary), fetal outcomes, APGAR scores at 1 and 5 minutes, neonatal birth weight, and NICU admissions, with p-values of 0.001 across these measures.Group B (with hyperhomocysteinemia) showed higher instances of hypertensive disorders, co-morbidities, adverse pregnancy and fetal outcomes, abnormal APGAR scores at 1 and 5 minutes, lower neonatal birth weight, and NICU admissions.The mean homocysteine levels were 13.28 ± 1.8 µmol/L in Group A and 73.98 ± 5.1 µmol/L in Group B, with a highly significant difference (p: 0.0001).Most subjects in Group B had intermediately severe hyperhomocysteinemia (50%), with 37.5% experiencing moderately severe hyperhomocysteinemia and 12.5% with severe hyperhomocysteinemia. All abortions in Group A were primary, whereas Group B had 60% primary and 40% secondary abortions. Conclusion: Hyperhomocysteinemia is a risk factor for recurrent pregnancy loss. About 1 in 3 patients of RPL have hyperhomocysteinemia and therefore as a routine workup for RPL serum homocysteine measurement should also be included. Treatment of hyperhomocysteinemia with folic acid and vitamin B12 decreases homocysteine levels significantly.

Prospective Observational Study Of Surgical Site Infections In Obstetrics And Gynaecological Operations In Teaching Hospital

Background: Surgical site infections (SSI) are defined as infections occurring upto 30 days after surgery or (upto one year in patients receiving implants) and affecting either the incision or deep tissue at the operative site. SSIs are potential complications associated with any type of surgical procedure. Even though SSIs are among the most preventable hospital acquired infections, they still symbolize a significant burden in terms of patient’s morbidity and mortality leading to prolonged hospital stay and increase the patient susceptibility to other nosocomial infections affecting the financial condition of patients. Risk factors for SSIs are grouped as patient related, preoperative or pre pregnancy, intraoperative or intrapartum, and postoperative. SSI causes a substantial risk to patients and financial loses for health system because the multi-factorial causes achieving a measurable and sustained reduction in SSIs. In this context it becomes important to determine the prevalence of SSI, assess the magnitude of problem and provide a rationale to set priorities in infection control in the hospitals. Materials and Methods: The present prospective observational study was conducted on 200 patients in the Department of Obstetrics and gynaecology, at Dr B R Ambedkar Medical College and Hospital for a period of 12 months. Prior to the initiation of the study, Ethical and Research Committee clearance was obtained from Institutional Ethical Committee. Results: There was a significant statistical difference in the incidence of SSIs basing on the body mass index of subjects (pvalue:<0.001). SSI incidence was high in morbidly obese subjects. There was a highly significant statistical difference in the incidence of SSIs basing on the history of previous surgeries of subjects (p-value: <0.0001). SSI incidence was low in subjects with no history of previous surgeries. There was a highly significant statistical difference in the incidence of SSIs basing on the type of surgery (p-value: 0.48). SSI incidence was high in caesarean and low in tubectomy surgeries. There was a significant no statistical difference in the incidence of SSIs basing on the type of incision (p-value: 0.70). There was a highly significant statistical difference in the incidence of SSIs basing on the methods of skin closure (p-value: 0.002). SSI incidence was high in mattress method of skin closure and low in subcuticular method of skin closure. There was a highly significant statistical difference in the incidence of SSIs basing on the class of wound (p-value: 0.00001). SSI incidence was high in dirty wounds and low in clean wounds of skin closure. Conclusion: Although several preoperative risk factors (e.g., age, morbid obesity, ability to pursue a minimally invasive approach, type of gynaecologic surgery, type of incision, methods of skin closure, class of wound) may not be within the surgeon’s control, several evidence based interventions can limit the incidence of SSIs.

A Comparison of Anteromedial Plating Versus Anterolateral Plating for Humerus Shaft Fractures Using the Anterolateral Approach.

Background Plate osteosynthesis is the gold standard treatment for the management of humeral shaft fractures. In the present study, we performed plate osteosynthesis on the anteromedial and anterolateral surfaces using the anterolateral approach to compare the functional outcomes. Aims and objectives To study and compare the functional outcome, time to achieve union and associated complications of anteromedial and anterolateral plating in humerus shaft fracture by anterolateral approach. Methods This prospective, randomised control study was performed at Dr Baba Saheb Ambedkar Medical College and Hospital, New Delhi, India.This study had 46 patients in total, who were divided into two equal groups at random. All of the fractures in group A were treated using a limited contact dynamic compression plate (LCDCP) on the anterolateral surface using an anterolateral approach, while all of the fractures in group B were corrected using an anteromedial surface using an anterolateral approach using LCDCP. All the patients were followed for six months at regular intervals. At each follow-up, patients were assessed radiologically with X-rays and clinically by Rodriguez-Merchan criteria (RM criteria). Results and conclusions The union was achieved in the majority of the cases of the anteromedial plating group within 12 weeks (78.3%) with a mean union time of 11.7±1.5 weeks than the anterolateral group (56.5%) with a mean union time of 12.3±1.8 weeks. Based on functional assessment according to RM criteria, the excellent outcome was achieved in 69.6% and 65.2% of the anterolateral and anteromedial plating groups, respectively.There was no case of non-union and radial nerve palsy in anteromedial plating cases whereas in anterolateral cases one patient did not achieve union and two (8.7%) had radial nerve injury, which recovered completely by the end of the study.An anterolateral approach with anteromedial surface plating on the flat medial aspect of the humerus is a good technique for fixing humeral fractures.

Effectiveness of Benson’s Relaxation Technique In Stressed PCOD Women

Background: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrinological disorder in women, causing metabolic dysfunction and body composition changes. As of June 30, 2022, WHO estimates indicate over 116 million women (3.4%) globally are affected by PCOS. Stress, defined as worry and mental tension from difficult situations, is a major contributor to reproductive dysfunction. Reports increasingly highlight stress's role in PCOS manifestation. The study aims to assess the Benson relaxation technique's effectiveness in alleviating stress in women with PCOS. Aim: To determine the effectiveness of Benson's relaxation technique in stressed PCOD. Methodology: Study Design: Experimental study, Study setting: Dr. B.R. Ambedkar Medical College and Hospital, Department of Physiotherapy, Bangalore -560045 Sample design: Purposive sampling. Sample size: 30 patients. Result: A significant reduction in stress among PCOD women was observed with the use of Benson’s Relaxation Technique. The pre-perceived stress score before the technique was 22.63±5.26, decreasing to 18.23±5.98 post-intervention. The enhancement score was 4.40, with a t-value of 11.08. The analysis indicates a substantial stress reduction among PCOD women using Benson’s Relaxation Technique, as assessed through the Perceived Stress Scale (p<0.001). Conclusion: The study conclusively demonstrated the efficacy of Benson's Relaxation Technique in alleviating stress among women with PCOD. The analysis revealed a significant shift in stress levels, with 33.4% transitioning from high to moderate stress, 30.3% from moderate to low, and 30% maintaining moderate stress. Only 3.3% had low stress persisting, and the same percentage had persistent high stress. The pre-intervention stress score was 22.63526, decreasing to 18.2315.98 post-intervention, yielding a noteworthy enhancement score of 4.40. This signifies a statistically significant reduction in perceived stress (p<0.001), supported by a t-value of 11.08. KEYWORDS: Benson’s relaxation technique, PCOD, Perceived Stress Scale Stress.

Multi Detector Computed Tomography and Ultrasound Evaluation of Neck Masses with Pathological Correlation

Introduction: Neck imaging has always been a diagnostic challenge. High-resolution sonography being inexpensive and safe has become the initial investigation of choice for neck pathologies; it provides information regarding the origin and extent of the lesion. Computed tomography (CT) has a unique capacity for displaying soft tissue, bone and airway details and provides critical anatomical information about lesions involving the neck. This study aims to determine the role of USG and CT in neck masses for pre-operative characterization based on location, extent, morphological characteristics and enhancement pattern and to compare USG and CT findings with histopathological diagnosis.
 Material and Methods: A total number of 60 adult patients with suspected neck masses were studied in the department of Radiodiagnosis, SSIMS&RC, Davanagere and inputs from Dr. B. R. Ambedkar Medical College, Bengaluru over a period of 24 months. Ultrasound was done using GE Voluson E6 machine & Contrast enhanced CT was done using GE Revolution Multidetector CT scan machine. Post processing techniques (like volume rendered techniques) were applied wherever useful.
 Results: The findings on USG and CT were conclusive in nearly 90% of cases. Enhancement patterns and presence/absence of bony invasion were found to be more specific in differentiating benign/malignant nature.
 Conclusion: High-resolution sonography can be used as the first-line modality for evaluating cervical soft tissue masses, it helps the clinicians to characterize the lesion. Multi-detector computed tomography is a sensitive diagnostic tool for diagnosing neck masses and differentiating between benign and malignant lesions with high accuracy. The extent of pathology with local/ contiguous spread predicted by CT examination was conclusive. The overall findings suggest that MDCT and Ultrasound, when used in conjunction with pathological correlation, can be effective tools for accurately characterizing and diagnosing the neck masses.

Prevalence of Complications in Patients with Newly Detected Type-2 Diabetes Mellitus in Dr. B.R. Ambedkar Medical College and Hospital

Prevalence of Complications in Patients with Newly Detected Type-2 Diabetes Mellitus in Dr. B.R. Ambedkar Medical College and Hospital

Implementation of Competency Based Medical Education Curriculum in Paediatrics for Phase 2 MBBS UndergraduatesA Descriptive Study

Introduction: Adoption of Competency Based Medical Education-Undergraduate (CBME-UG) curriculum is made mandatory in medical colleges by National Medical Commission (NMC). CBME-UG curriculum enumerates the expected knowledge and skills in detail and it focuses more on observable outcomes that are important in day-to day medical practice. This curriculum holds the teacher as well as learner equally responsible in running the educational programme. Aim: To put forth the approach adopted in implementation of CBME-UG curriculum for phase 2 MBBS students in paediatric subject. Materials and Methods: This article describes the steps applied in transforming the traditional structured teaching method to the CBME method for undergraduate phase 2 MBBS students in the Department of Paediatrics at Dr. B R Ambedkar Medical College and Hospital, Bengaluru, Karnataka, India, during January 2021 to December 2021. The duration of one year was divided into preimplementation phase (three months) and implementation phase (nine months). The faculty of the department, a coordinator to overview the programmeme, the postgraduate residents, and the students of phase 2 MBBS were the stakeholders identified in order to run the CBME-UG educational programmeme. Results: Preimplementation phase consisted of designing the department module and sensitisation of involved stakeholders. The contents of the module were curriculum planner for three years, time-table plan for phase II MBBS students, structuring of teaching sessions, designing the assessment method, and designing the feedback method. Implementation phase during clinical postings for the phase II MBBS students incorporated the strategies designed in preimplementation phase. The teaching sessions, assessment, the feedback sessions, and student-doctor programmeme were implemented with realistic and feasible planning. Conclusion: The CBME curriculum was successfully implemented among undergraduate second year medical students in term of student feedback and performance. It was noted that appropriate planning and sensitisation of students as well as the teachers, helped in running the programme smoothly.

MODIFIED MASSON'S METHOD OF STAINING TISSUES- AN EXPERIMENTAL MICROANATOMY STUDY

Staining of the the tissues is an art which gives fruitful results over a period of time. Many researchers have used various stains, some are costly and some are economical. Special stains like Mallory's trichrome and Massson's trichrome are routinely used for staining various tissues. As few ingredients of Masson's Trichrome were not available, we replaced certain ingredients which were not available by readily available ingredients on an experimental basis and a study was carried out. We used Ponceau S instead of Ponceau 2R and Ehrlich's Haematoxylin instead of Weigert's Iron Haematoxylin for staining parafn sections of tongue, pituitary gland, colon, adrenal gland and hyaline cartilage. Tissues were collected from the cadavers allotted for rst year MBBS students for dissection at Dr B R Ambedkar medical college, Bangalore. After processing the tissues, parafn embedded blocks were prepared and the sections were taken and later washed in tap water followed by staining with special stains with certain ingredients replaced due to non availability. After that, sections were washed by water, dehydrated in graded alcohol, cleared in xylene and mounted in DPX and the Photographs of the slides were taken through the microscope by focusing both under low power and high power. In routine Masson's Trichrome stain, Ponceau S was used instead of Ponceau 2R because of it's non-availability. Further the cost of Ponceau S is very much lesser than Ponceau 2R. Also Ehrlich's Haematoxylin was used instead of Weigert's Iron Haematoxylin. We obsereved that various components like nuclei, cytoplasm, muscle, acidophil and basophil granules, collagen, cartilage, mucin were all well differentiated. On an experimental basis, we replaced the components Ponceau 2R by Ponceau S and Weigert's Iron Haematoxylin by Erhlich's Haematoxylin in Masson's Trichrome method of staining and various tissues were stained with good results.

Incidence of prostatic intraepithelial neoplasia in TURP specimens with special reference to p63 expression in various lesions of prostate

Introduction: Prostate cancer is the second common malignancy in men. Prostatic intraepithelial neoplasia (PIN) is the precursor lesion of prostatic carcinoma. Histopathological examination is necessary to diagnose PIN lesions. Objective: The aim of the study is to determine the incidence of Prostatic intraepithelial neoplasia and to analyse the usefulness of basal cell marker p63 expression in various lesions of prostate. Methods: This is a two-year prospective study of 65 transurethral resection specimens of prostate, carried out in the Department of pathology, Dr B R Ambedkar Medical College, Bangalore. mmunohistochemical marker p63 is used and its expression in various lesions was analysed. Results: Out of 65 cases studied, 4 were inflammatory lesions, 52 were benign prostatic hyperplasia (BPH) and 9 were malignant lesions. Low grade PIN was identified in 8(12.3%) cases of BPH. High grade PIN was seen in 9(13.8%) cases and tufting pattern was the commonest. HGPIN was predominantly associated with adenocarcinoma. p63 was expressed in all the benign glands in BPH and HGPIN. Malignant glands were negative for p63 expression.

Cross sectional study on self medication practice of analgesics among nursing students

Background: Self medication with analgesics is prevalent worldwide among medical students due to easy availability as over the counter drugs. Materials and Methods: A cross-sectional study was conducted on nursing students of Dr. B.R. Ambedkar Medical College, Bengaluru. A Pre-designed questionnaire was used to collect relevant information on self medication of analgesics. Data was analyzed using descriptive statistics. Results: A total of 90 students participated in the study. Practice of self-medication was reported by 87.3% nursing students. The most common condition for self-medication was headache (42.86%), followed by dysmenorrhoea (32.38%). Non seriousness of illness (69.4%) was the major reason followed by prior experience (62.6%) for seeking self medication. Most common source of drug information was previous prescription of a physician (61.2%) followed by pharmacist’s advice (46.7%). Among these students, 34.4% were unaware about adverse drug reactions and 51.1% were unaware about drug interactions. Conclusion: The present study indicates that self-medication is widely practiced among nursing students. Consumption of over the counter analgesics can mask the actual diagnosis of the underlying disease. It is also necessary to create awareness among the nursing students regarding the dangers of self medication.

AN OVERVIEW OF THE MANAGEMENT OF ANKLE FRACTURES IN GERIATRIC POPULATION

Background : Recent clinical studies have identified a significant increase in the incidence and severity of ankle fractures in the elderly population. Kannus et al reported that between 1970 and 2000 there was a three-fold increase in the number of ankle fractures among Finnish patients over 70 years old [1]. In addition, the authors demonstrated an increase in the more severe Lauge-Hansen supination-eversion stage four fracture, compared to more stable ankle fracture patterns in this elderly patient population. In the data available from the United States, ankle fractures have been reported to occur in as many as 8.3 per 1000 Medicare recipients, a figure that appears to be rising steadily [2] . There continues to be controversy within the orthopaedic community regarding the optimal management of geriatric ankle fractures. Operative fixation has been proven to be a safe and effective method of managing unstable ankle fractures in younger patients [3 ] . However, certain authors have recommended conservative treatment in older patients, based on poor surgical outcomes secondary to osteoporosis, diabetes, peripheral vascular disease and skin issues commonly seen with advanced age [4, 5, 6, 7] . Recommendations on appropriate management also appear to differ based on geographical location, evidenced by a recent study by Koval et al [2] . The authors demonstrated that the percentage of ankle fractures in patients older than 65 treated with surgical stabilization varied considerably in various parts of our country. The current paper reviews the complex issues associated with ankle fractures affecting the geriatric patient population, focusing on risk factors for fracture and surgical versus nonsurgical management. 30 patientsMethods: with closed displaced bimalleolar ankle fractures presenting to Dr B R Ambedkar medical college casualty from September 2020 to February 2022 who underwent surgery were taken into the study . The maximum studyResults: population belonged to the geriatric age group .At the end of follow-up (64.8%) had excellent clinical result, (35.2%) had good clinical result, and no patient had a poor functional outcome. For the radiological assessment, there were 20 patients (66.6%) with excellent, 7 (23.3%) with good, 3(10.%) with fair, while none with poor resu :Conclusion Treatment bimalleolar ankle is challenging because of limited soft tissue cover, poor bone quality with osteoporosis and less vascularity. There are various treatment options for these fractures starting from closed reduction with casting to open reduction and internal fixation with a plate. The excellent functional results and lack of soft tissue complications suggest that a surgical management with CC screw and plating should be considered as an option in bimalleolar ankle fractures. A balance between anatomical reduction and soft tissue stripping is required to avoid any complications.

A retrospective study of the prevalence and management of complications of proliferative diabetic retinopathy and its visual outcome in patients in a tertiary care hospital

To provide the prevalence of complications of proliferative diabetic retinopathy (PDR) in patients visiting the retina clinic in Dr. B. R. Ambedkar Medical College and Hospital and to evaluate their visual acuity (VA) status. A retrospective study in which the chart review was done of the patients diagnosed with PDR, attending the retina clinic in Dr. B.R. Ambedkar Medical College and Hospital. Patients with a diagnosis of type 1 or 2 diabetes with a clinical diagnosis of active PDR in any or both eyes, who had long term follow-up for up to at least 5 years were included. Evaluating the prevalence of the complications of PDR, presenting VA of people with PDR, short-term outcomes at 6 months and 5 years are the main outcomes of the study. The most common complication of PDR was diabetic macular edema (DME). Eyes receiving treatment early in the disease course (i.e. baseline VA 6/18 or better) had significantly better VA outcomes at 5 years versus eyes treated at a later stage (i.e. baseline VA <6/18 - ≥3/60). The treatment of patients with VA <3/60 can also lead to significant improvement in visual outcome. Our results suggest that early diagnosis and treatment of patients with PDR is of utmost importance in preventing severe vision loss due to advanced diabetic eye disease. People with diabetes in India need to be made aware of annual screening and treatment of their eyes to avoid vision impairment and blindness.

To study the clinical efficacy of Nd Yag peripheral iridotomy in narrow angle glaucoma

: To examine the clinical efficacy of laser peripheral iridotomy (LPI) in subjects with primary angle closure (PAC).134 patients with angle closure glaucoma were included in this retrospective study which was carried out at the glaucoma clinic, department of ophthalmology at DR B.R Ambedkar medical college and hospital over a period of 2 years. A total of 134 patients, 268 eyes were participated in this study. All were treated with LPI. The 268 eyes with Successful opening of angle more than 2 for at least 24 weeks. Follow-up ranged from 4 to 24 weeks. Gonioscopy was performed in each visit to confirm the angle status and patency of iridotomy. Success is defined as opening of more than 2 angles ITC for at least 24 weeks, with no need for further medication or laser treatment.The percentage of open angle at 4 weeks was more 2 angles in 72 eyes(26.9%), ITC>3 angles in 56eyes, (20.9%) and ITC>4 angles in 140 eyes are (52.2%), at 12weeks more 2 angles 48 eyes (17.9%), ITC> 3angles in ,60 eyes (20.9%) ITC>4 angles in 160 eyes (59.7%) and 24 weeks was more 2 angles eyes 28 (10.4%), ITC> 3,60 eyes (22.4%) ITC>4 angle in180 (67.2%). The success rate at 24 weeks ITC more than2 angle was 10.4%, ITC>3angles 22.4% and ITC> 4angles in 67.2% respectively.In all cases, IOP was measured within 1 hour and IOP elevation of greater than 8 mm Hg was observed in eyes (15.7%). Mild-to-moderate anterior chamber reaction is seen in 128 eyes, hyphema in 12 eyes, ghost images seen in 4 eyes, 4cases of macular edema, cataract progression seen in 32 eyes, and iridotomy in 52 eyes were noted.Post laser procedure combination of steroid and antibiotic medication was prescribed for 5 days and IOP pressure more 8 mmHg seen in 42 eyes(15.7%), antiglaucoma medications started and oral T. Diamox 250mg 2 tablets were prescribed followed up after 5 days to reassurance. LPI is an effective treatment option for all patients with in Primary Angle Closure suspect to prevent the acute angle closure glaucoma. LPI is a effective, compliance free, repeatable, most PACS eyes don’t receive further treatment and safe therapeutic modality having only minor, transient, self-limiting or easily controlled side effects with no sequelae. Progression to PACG is uncommon in PACS and PAC. Despite our methodology, the inherent limitations of studies should be considered, and conclusion drawn from our pooled results should be interpreted with caution. Future large-volume, well-designed with extensive follow-up are awaited to confirm and update the findings of this analysis.

A clinical study and management of ulceromembranous lesions of oral cavity

<p class="abstract"><strong>Background: </strong>This study was done at Dr BR Ambedkar Medical College, Bangalore between November 2019 to May 2021 in the department of ENT to know the clinical profile of patients presenting with ulceromembranous lesions in oral cavity.</p><p class="abstract"><strong>Methods: </strong>A longitudinal prospective study done with the patients coming to Department of Otorhinolaryngology and also the patient referred from other departments of Dr. B R. Ambedkar medical college from November 2019 to May 2021.After obtaining informed written consent, all patients with ulceromembranous lesions in the oral cavity, a detailed medical history recorded, thorough ENT clinical assessment as well as a systemic check up done. Swab was obtained and sent for Gram's stain, culture, and sensitivity, KOH mount. In suspected malignant ulceroproliferative lesions, biopsies were collected from the edges of the lesions. All information was entered into a custom-made case preforma. Patients were treated symptomatically with appropriate antibacterials and antifungal medicines. Patients with malignant ulcers who gave consent were taken for surgery.</p><p class="abstract"><strong>Results: </strong>There were 100 cases of ulceromembranous lesions in oral cavity. Females (60%) were most commonly affected. Majority of patients had tobacco chewing as a risk factor for the development of malignant lesions.15% of study subjects had aphthous ulcer as the most common cause of ulceromembranous lesion. Malignant lesions constitute 27% of total cases.</p><p class="abstract"><strong>Conclusions: </strong>Malignant etiology is most commonly associated with ulceromembranous lesions in oral cavity in our study.</p>

Comparison of Axillary Digital and Infrared Forehead Thermometer

Introduction: Although digital thermometers have made the temperature recording easy, quick and safe, with the risk of mercury completely excluded, there is still a risk of transmission of infection from one individual to another. Infrared thermometers offer a non-touch, rapid and convenient method of temperature recording, with virtually no risk of disease transmission. We conducted a study to assess and compare temperature recordings from an infrared forehead thermometer and axillary digital thermometer during fever, and once the fever subsides. Methods: Hundred patients attending the out-patient department of Department of Pediatrics at Dr.B.R Ambedkar medical college and hospital from September 2019 to December 2019, or those admitted in the wards with a complaint of fever were screened using two techniques – Axillary temperature recording using a digital thermometer and a forehead temperature was recorded using a non-contact infrared forehead thermometer. Patients were given antipyretics to treat the fever and temperature was again recorded once the fever subsided using the same method. Two medical personnel were trained to screen and record the respective findings from each method and they were blinded from the other outcome of other recording. Results: The mean IFR temperature measured in the febrile phase was 100.85 (± 0.76), which was significantly higher than the mean AD temperature, 100.21 (± 0.74). (p-value <.0001). In the afebrile phase as well, the mean IFR temperature was significantly higher than the mean AD temperature. Conclusion: IFR thermometers do provide an advantage of no-touch technique over the digital thermometer. However, as the results showed a weak correlation between IFR and axillary digital recordings, it is suggested that IFR thermometers be used for screening of children for fever as it decreases the contact and reduces the infection.

Prescription audit in post-operative patients of Dr. B. R. Ambedkar Medical College and Hospital, Bengaluru

Background: Prescribing drugs are an important skill which needs to be continuously assessed and refined accordingly. Many drugs especially antimicrobials and fixed dose combinations that maybe irrational are being prescribed. Hence, this study was undertaken to analyze the rational prescribing guidelines in post-operative patients which will help doctors to update their knowledge and improve their attitude toward selecting cost effective treatment. Aim and Objectives: The aims of this study were as follows: (i) To evaluate prevailing prescription trends and (ii) to evaluate rationality of prescriptions in post-operative cases of surgery, orthopedics, obstetrics, and gynecology (OBG), and Otorhinolaryngology (ORL) departments. Materials and Methods: A prospective observational study was conducted in post-operative wards of departments of surgery, orthopedics, ORL, and OBG of Dr. B. R. Ambedkar Medical College and Hospital, Bengaluru. The study duration was 15 months from December 2018 to March 2020 with a sample size of 2000. Results: In the present study, female preponderance (54.4%) was seen. Majority of the drugs (77.3%) were prescribed under brand name. The most common group of drugs prescribed was non-steroidal anti-inflammatory drugs (135%) and the antibiotic was Cephalosporins (77.5%). As per the World Health Organization (WHO) core prescribing indicators, 6.25 were the average drugs per prescription. Conclusion: According to the WHO core prescribing indicators, polypharmacy was observed and prescribing by generic name was also less. However, there was no irrational use of antibiotics in post-operative cases in our study which reduces the chances of development of antibiotic resistance. Practice of prescribing drugs from the essential drugs list (EDL) was less. The study suggests incorporating educative initiative, development of drug policy, and an EDL-based hospital formulary to ensure rational use of medicines.

Expression of Melan-A (MART-1) in Various Pigmented Melanocytic Nevi and Close Mimickers

Introduction: Melanocytic nevi are neoplasms resulting from the proliferation of melanocytes. Diagnosis of melanocytic tumours can be tricky, considering two factors,to diagnose origin and determination of its benign or malignant nature. Visualisation of melanin or other pigments are non specific with Hematoxylin and Eosin (H&E) staining and specific with Melan-A Immunohistochemistry (IHC). Intensity and pattern of these reactions shows marked variability in different melanocytic lesions. Aim: To study the intensity and pattern of Melan-A expression in various pigmented melanocytic nevi and to understand its utility to differentiate close mimickers. Materials and Methods: A cross-sectional study of 50 lesions (45 cases and 5 controls) was conducted in the Department of Pathology of Dr. B.R. Ambedkar Medical College (tertiary hospital), Bengaluru, Karnataka, India, between September 2020 to October 2021. The skin biopsies received were fixed in formalin and paraffin embedded. Sections were stained with H&E and Melan-A IHC marker, using A103 antibody and a high temperature antigen retrieval was performed. Pattern and intensity of Melan-A expression were studied and its evaluation was done with normal skin (control). Results: Melan-A showed varied intensity (+ weak; ++ moderate; +++ strong), pattern (patchy, diffuse), distribution and on various pigmented melanocytic lesions and mimickers were analysed. Dermal nevi (18) showed +++ diffuse pattern in dermis and two cases showed ++ moderate and patchy staining. Five cases of Compound nevi showed ++ intensity, diffuse pattern in Dermoepidermal Junction (DEJ) and dermis, Deep penetrating nevi (in one case) +++ intensity and diffuse pattern in DEJ, Dermis. Two cases of pigmented Basal Cell Carcinoma (BCC) showed + intensity and no definitive pattern in dermis. Four cases in fibrohistiocytic lesions and Malignant Peripheral Nerve Sheath Tumour (MPNST) shows negative Melan-A. In control melanocytes show dendritic pattern of staining and melanophages were negative. Conclusion: Melan-A is specific melanocytic marker as it stains only melanocytic lineage and no other cell types in background thus it is a marker of histogenesis instead of malignancy indicator. It highlights important architectural features and confirms the origin of lesions thus aiding the pathologist towards accurate diagnosis and differentiates from close mimickers.

Comparison of Conventional Pap Smears versus Liquid Based Cytology for Clinicopathological Patterns of Cervical Lesions at a Tertiary Care Centre, Bangalore, India

Introduction: Conventional Pap Smear (CPS) technique has been the mainstay for early detection of cervical cancer. However, its extensive use has not been possible due to the limitations, like presence of obscuring blood and inflammation, reducing its sensitivity markedly. False negativity of CPS is also very high so Liquid Based Cytology (LBC) was introduced. Aim: To compare cytomorphological patterns, diagnostic utility and adequacy of smears of cervical lesions on CPS and LBC. Materials and Methods: This study was a Prospective descriptive study, conducted in Department of Pathology of Dr. B R Ambedkar Medical College and Hospital, Bangalore for 19 months during November 2018 to May 2020 on 250 cases. The samples were taken with cervix-brush. First, a CPS was prepared and was immediately alcohol-fixed. After that same brush head was rinsed in LBC vial containing methanol. Statistical analysis was done using Statistical Package for Social Sciences 22.0 (SPSS) and R environment 3.2.2 for data analysis. Results: Most of the patients were in the fourth decade of life and 160 cases (64%) presented as white discharge per vaginum. Total 231 (92.4%) smears were satisfactory on CPS and 233 (93.2%) smears on LBC. The number of Low grade Squamous Intraepithelial Lesions (LSIL) increased from 4 cases (1.6%) in CPS to 6 cases (2.4%) in LBC in this study. Rate of detection of High grade Squamous Intraepithelial Lesion (HSIL) was more with LBC (11 cases, 4.4%) compared to that of CPS (7 cases, 2.8%). It was seen that in this study, sensitivity and specificity of LBC is better than CP in detecting LSIL and HSIL, but except specificity of CP was more than LBC in detecting LSIL. Present study showed overall sensitivity of 77.1% in CP and 94.3% in LBC and specificity of 97.2% and 100% in CP and LBC, respectively. The p-value calculated was <0.001 which was highly significant. Conclusion: The LBC technique showed clear background, well preserved cytomorphological details, removal of extra mucus, blood and inflammatory cell infiltrate as compared to CPS technique. Atypical cells or abnormal cells were seen better and were detected more by LBC as compared to CPS.

Unmasking the Mask Issues among Healthcare Workers in COVID-19 Era

Introduction: Recent pandemic have showed importance of adequate availability of Personal Protective Equipment (PPE) most importantly the face mask and training of Healthcare Workers (HCWs) for its proper usage for protection from various infections to maintain smooth functioning of healthcare facility. Aim: To examine practices and barriers to compliance regarding face mask usage among HCWs. Materials and Methods: The present study was a crosssectional observational analytical study which was conducted at Dr. Baba Saheb Ambedkar Medical College and Hospital, Delhi, India, from 30th June, 2020 to 24th July, 2020 during Coronavirus Disease-2019 (COVID-19) pandemic. Data was collected through semi-structured bilingual online questionnaire using Google form based on recommendations for mask use by World Health Organisation (WHO) and Centers for Disease Control and Prevention (CDC). Data was recorded in MS Excel and Statistical Package for the Social Sciences (SPSS) 16.0 software was used for statistical analysis. Qualitative data was expressed in percentages and continuous data was summarised in mean±Standard Deviation (SD). Chi-square test was used to check the association between the categorical variables. Results: Total 362 HCWs submitted responses, of which 44.7% respondents wore N95 masks to protect themselves from COVID-19. Only 34.2% were satisfied with availability of masks in healthcare facility. Itching and sweating on part inside mask was major problem faced by 52.8% of respondents. Only 58% followed proper hand hygiene precautions while handling mask whereas 62.7% took proper measures while doffing. Conclusion: There appears to be a lack of awareness about proper hand hygiene while handling mask, appropriate precautions for reuse and doffing. Availability of mask also needs to be addressed. Regular trainings are needed to increase awareness, improve behaviour and practices regarding mask usage for prevention of occupational spread of infection among HCWs.

Functional outcome of distal end femur fracture treated with locking compression plate

Aim of the study: The aim of this study is to assess the functional outcome of distal femur fracture treated with a locking compression plate. Materials and methods: The study was conducted from July 2019 to February 2021 at Dr BR Ambedkar Medical College and Hospital with follow-up period of six months. 20 skeletal mature patients fulfilling the inclusion criteria with distal end femur fractures were surgically treated with distal femoral locking compressive plate using a direct lateral approach. The clinical assessment was conducted for at least a period of 6 months postoperatively using the oxford knee scoring system. Results: At six months of follow-up, 10 patients achieved range between 120 to 140°, 9 achieved between 100 to 120 and 1 had 95° flexion. In the present study, 18 out of 20 cases (90%) showed a radiological union at 3 months’ follow-up. 2 cases (10%) had radiological union at 6 months (24 weeks) of follow-up. In the present study, 85% of cases that is 17 of 20 cases had Oxford Knee Score of more than 41, 2 cases that is 10% had a score between 34 and 40, and only 1 had a score between 27 and 33. In the present study, 17 cases, i.e., 85% showed excellent functional outcome, while 2 cases showed good and 1 case had a fair outcome. Conclusion: The use of LCP in distal femoral fracture promotes early radiological union, good knee range of movement and early recovery when fracture fixation is done following all the basic principles of fracture fixation. Finally, it can be concluded that the use of LCP provides a good functional outcome for distal femur fractures, particularly in osteoporotic bones.