Government Medical College Jammu Research Articles

Knowledge, attitude and practices regarding dengue in a rural setting of Jammu

Background: Rapid urbanization, environmental changes and migration of communities is becoming a major reason for increase in number of cases and deaths due to dengue over recent years. Key lies in prevention, since only symptomatic treatment is available. Knowledge, attitude and practice studies provide important information about prevalent scenario regarding awareness of particular health problem in a community.Methods: The present study was descriptive and cross sectional in nature, conducted in July 2017. The study participants belonged to village Tanda of Block RS Pura which is a field practice area of Department of Community Medicine, Government Medical College Jammu. The data was collected by a face to-face interviews of respondents after obtaining informed consent. Enumerators were provided a schedule containing formalized set of questions on knowledge, attitude and practice of dengue control. Information was collected by interviewing the available adult in every second household.Results: Knowledge about dengue was intermediate. Only 35% of the respondents knew atleast two most common symptoms of dengue. They had insufficient knowledge regarding time of dengue mosquito bite and common breeding sites. However attitude of people regarding dengue was good. Almost all the respondents think that dengue is dangerous and one should consult a registered Medical Practioner in case dengue occurs. Commonly used preventive methods included coils and sprays. Drains and surroundings were cleaned to prevent mosquito breeding.Conclusions: There is an urgent need to increase awareness of people especially belonging to rural communities regarding prevention and common signs and symptoms of dengue.

Study of group education interventions for people with low back pain

Background: Backcare education administered in a group situation is one of the most effective and economic methods of treating back pain. It is based on available scientific knowledge of the physiology and mechanics of the spinal structures and their relationship to daily activities. It provides the patient with a better understanding of the problem, aiming primarily at helping the patient take responsibility for his or her back pain, while relieving pain and functional disability.Methods: This study was carried out on 100 patients of chronic low back pain, attending the OPD of Post Graduate Department of Orthopaedics, Government Medical College Jammu for a period of one year. Assessment was carried out before the treatment and after the treatment at four weeks, three months & six months post treatment. The following scales were used to measure the therapeutic response: the Modified Oswestry low back pain disability index, Visual analogue score (VAS), and clinical parameters like finger to floor distance and straight leg raising.Results: The patients showed significant improvement at 1 month, 3 months and 6 months post treatment when compared to base-line data (p<0.001).Conclusions: It was concluded that all chronic low back pain patients would benefit from a group program of back care education.

Feasibility of establishing and operationalizing basic Health and Demographic Surveillance System (HDSS) in rural area of northern India

Background: Success of public health programmes is dependent on its inherent flexibility to continually incorporate new evidence and new experiences made available through timely, accurate, and relevant information. Unfortunately, routine health management information systems do not provide desired inputs at appropriate times. Objective: To ascertain the feasibility of establishing and operationalizing health and demographic surveillance system (HDSS) in a defined rural population of district Jammu. Materials and Methods: The present study was carried out in 6 villages in field practice area of Postgraduate Department of Community Medicine, Government Medical College Jammu selected using multistage random sampling methodology. Study area was mapped manually and by using geographic information system (GPS Etrax® system) depicting all households and associated landmarks. All the households were listed and assigned an alphanumeric unique identification number. Information on predesigned formats was then obtained from all listed households at initial and subsequent visit made at 6 months. Possibility of linking facility based data was also studied. Verbal autopsy was conducted as per International network for the demographic evaluation of populations and their health (INDEPTH) standardized verbal autopsy proforma. Result: An HDSS was visibly functional within 6 months’ time of initiation of the project using available manpower, space, and local support. No constraints were felt with regard to availability of separate space for HDSS as it was provided unconditionally either by the health care institution or panchayat. Local health workers and volunteers were retrained by the investigator for which no extra funds were needed. However, no vehicle for transportation was available, therefore personal vehicle was used to move from one village to another. It took 113 days (553 h) for a team of one investigator, one health worker and one volunteer to complete mapping, assign unique identification numbers, and collect baseline information of 1030 household spread over 3.56 km2. Repeat survey took 60% less time i.e., 45 days or 225 h. Each household consumed 15–25 min on initial visit and 10 min on follow-up. A single verbal autopsy took longer time (60 min) to complete. Conclusion: The study demonstrated that HDSS can be established and operationalized using available human and non-human resources albeit with little training and technical assistance. No significant bottlenecks were encountered in operationalizing HDSS. Vehicle, upgradation of available space, data management tools, incentive for staff, and volunteers would be needed to sustain HDSS.

Traumatic tympanic membrane perforations: an overview in tertiary care hospital

This hospital-based prospective study was conducted in the Department of Ear Nose Throat, Head and Neck Surgery, Government Medical College Srinagar, Jammu and Kashmir, for a period of 1 year from June 2013 to June 2014 with the aim of studying the aetiological factors, clinical presentation and management options for traumatic tympanic membrane perforations. A total of 50 patients with traumatic perforations of the tympanic membrane were enrolled in the study, comprising of 34 males and 16 females patients. Age of the patients ranged from 12 to 56 years, with a mean age of 32 years. The results showed that the most common mode of trauma was slaps (56%); sudden hearing loss and tinnitus were the two most common presentations (92%). Audiometry shows that the larger the tympanic membrane perforation, the larger the air–bone gap. Hearing loss was highest at the lowest frequencies and generally decreased as the frequency increased. The differences in air–bone gaps between small and large perforations were significant at all frequencies (P<0.05, Student’s t-test). Overall, 72% of patients responded to conservative management, whereas 28% needed fat myringoplasty and/or chemical cauterization.

Estimation of Zinc Levels in Children With Lower Respiratory Tract Infections: A Prospective Observational Study from India

1Department of Paediatrics, Yenepoya Medical College, Mangalore, India 2Department of Paediatrics, Pt. B.D. Sharma Medical College, Rohtak, Haryana, India 3Department of Paediatrics, Government Medical College, Jammu, India 4SGPGI, Lucknow, India 5KDA Hospital, Mumbai, India *Corresponding author Aakash Pandita, MD Department of Paediatrics Government Medical College Jammu, India E-mail: aakash.pandita@gmail.com

Prevalence study of hypertension among adults in an urban area of Jammu

Background: Considering the epidemic of hypertension in recent decades the present study was carried out in an urban adult population to study the prevalence of the disease. Objective: To determine the prevalence of hypertension in an urban adult population aged 30 years and above of Trikuta Nagar colony Jammu. Materials and Methods: Study was conducted in urban population aged 30 years and above of Trikuta Nagar colony in Jammu district of J&amp;K falling under urban health centre, Department of Community Medicine, Government Medical College Jammu. Every alternate house was visited thus covering 50% of total houses. A conventional mercury sphygmomanometer was used for recording blood pressure. Hypertension was diagnosed when the systolic blood pressure was ≥140 mmHg and/or Diastolic blood pressure was ≥90 mmHg. Those already diagnosed as hypertensives and taking medication were also considered as hypertensives. Results: The overall prevalence of hypertension in the study population was 57.83%. A higher proportion of males were suffering from hypertension (65.21%) as compared to females (52.64%). Diabetes mellitus was found to be the most common co morbid condition. Conclusion: The study shows high prevalence of hypertension in urban population.

English

Variations in origin and insertion of muscles are common in upper limb. They may or may not be associated with neuromuscular abnormalities. Being common does not lessen their importance from the point of view of orthopaedic surgeons, cardiovascular surgeons, plastic surgeons and physiotherapists. During routine dissection of a middle aged male cadaver while teaching medical students in Government Medical College Jammu, We found a not so common variation in the insertion pattern of Brachialis muscle on the left side which beside its usual insertion was inserted as a thick muscular slip to the origin of Brachioradialis. So, a fibromuscular tunnel was formed between insertion of Brachialis and origin of Brachioradialis. The Radial nerve along with descending branch of posterior circumflex humeral artery passed beneath this tunnel. In this cadaver the Profunda brachii artery was very small and remained undivided .It continued as posterior division or middle collateral artery. The anomaly reported above is rare and can lead to neural, vascular or neurovascular compression symptoms. Normal anatomy of arm and forearm seen on the right side.

Separation of Components of Methylprednisolone Acetate Solution for Safe Intrathecal Administration

To the Editor In a recent study by Candido et al. the concentration of polyethylene glycol (PEG) in a vial of methylprednisolone acetate (Depo-Medrol) (Depo-Medrol, Pharmacia & Upjohn Company, Kalamazoo, MI) was reduced >75% by extracting and aspirating only the steroid component after keeping the vial inverted for >2 hours.1 The method described by the authors, albeit effective, requires a very precise insertion of the hypodermic needle into a vial containing a small quantity of drug (1 mL) with approximately only half of it to be aspirated carefully.2 A slight inadvertent upward movement of the needle may lead to inclusion of a larger percentage of PEG into the steroid base. We have found that it may still be better to first aspirate the entire contents of the vial into a 1-mL syringe and keeping this syringe vertical (needle up and plunger down with no air) under all sterile precautions for >2 hours. The 2 phases separate quite well within the syringe, and the upper aqueous phase being PEG can be discarded just before intrathecal injection of the steroid base. We loaded 10 vials of Depo-Medrol into 1-mL syringes and found that the mean volume of supernatant, i.e., PEG, was approximately 0.6 mL with remaining 0.4 mL of steroid seen as white base (Fig. 1).Figure 1: Showing the 2 phases being clearly demarcated in 1-mL syringe.Rajesh Mahajan, MD Anuradha Bali, MD Department of Anesthesia Government Medical College Jammu, India [email protected] Shivani Mehta, MD Department of Pathology Government Medical College Jammu, India Firdose Shafi, MD Department of Anesthesia Acharya Chander College of Medical Sciences Jammu, India

Traumatic extradural hematoma - role of non-surgical management and reasons for conversion.

To study the role of conservative management and various reasons for conversion to surgical intervention in traumatic extradural hematoma (EDH). Government Medical College Jammu. One hundred-twenty trauma patients diagnosed as extradural hematoma on CT scan were managed during 1 year period. Role of conservative management and various reasons for conversion to surgical intervention were studied. Out of these 120 patients admitted 67 were managed conservatively, 53 cases were operated upon. 31 were operated upon immediately and 22 were operated upon as delayed. There was 1 death and 4 had poor outcome in this group of patients. It is stressed that small size <10 ml, GCS >12 and locations other than temporal area are the criteria for conservative management. Twenty-two patients out of 89 were needed to be treated surgically during the course of conservative management due to neurodeterioration, increase in size of hematoma on CT, bradycardia, hemiparesis, pupillary abnormalities, delay in referral and only 18% had poor outcome. A strict vigilance is to be kept for clinical deterioration and various reasons mentioned above are to be kept in mind and patients should be subjected to repeated CT scan. Early diagnosis and immediate surgical intervention had good outcome, which shows the fruitful results of early diagnosis and intervention.

Retrieval of Aspirated Nasopharyngeal Airway Using Foley Catheter

To the Editor: A nasopharyngeal airway (NPA) is a simple airway adjunct used to maintain a patent airway and to facilitate nasotracheal suctioning.1 We report a sudden airway obstruction caused by a nasal airway that slipped into the trachea and its retrieval. An 83-year-old man presenting with a stroke and a Glasgow coma score of 12 responded to verbal commands but had snoring with partial airway obstruction. A size 7.5 NPA was inserted via the right naris and successfully relieved the airway obstruction. Thirty hours later, the SpO2 decreased to 91% to 92%, and the patient had repeated bouts of forceful coughing. On attempting to suction via the NPA, it was found to be missing. After mask ventilation with 100% oxygen, 60 mg propofol was administered, the oropharynx and hypopharynx were sprayed with 10% lidocaine, and direct laryngoscopy revealed the tip of the NPA to be protruding through the cricoid with its flange barely visible. Two attempts to retrieve the NPA using Magill forceps failed. A well-lubricated sterile Foley catheter (14F, Rusch, Teleflex Medical GmbH, Kemen, Germany) was passed into the lumen and beyond the tip of the NPA and its balloon inflated with 6 to 7 mL air. Thereafter, gentle traction on the Foley catheter led to retrieval of the NPA and relief of the airway obstruction. Aspiration of an NPA has been reported and can be life threatening.2,3 To prevent this, either a safety pin inserted through the flange of the NPA or a 15-mm tracheal tube connector/adaptor inserted into the proximal end of the NPA has been recommended.4,5 In our case, a tracheal tube connector was used but became loose and was dislodged allowing aspiration of the NPA to occur. If we had failed in our attempt to retrieve the NPA, we would have continued with mask ventilation with 100% oxygen and asked an ear-nose-throat surgeon to remove the NPA using a rigid bronchoscope and forceps. Rajesh Mahajan, MBBS, MD Rishab Bassi, MBBS, MD Department of Anesthesia ASCOMS Medical College Jammu and Kashmir India [email protected] Shivani Mehta, MBBS, MD Department of Pathology Government Medical College Jammu and Kashmir India

Operative Management Of Intercondylar Fractures Of The Distal End Humerus In Adults

This is a prospective study which includes 26 adult patients of intercondylar fracture of distal humerus, both male (20 patients) and female (6 patients) of different age group treated with open reduction and internal fixation with 4.5 mm malleolar screw or 6.5 cancellous screw and reconstructed condyles of the humerus were fixed to the diaphysis with either dual reconstruction plates or one third tubular plates or small fragment DCPs preferably via trans-olecranon approach. Immediate post operative mobilization was started as patient was pain free. Most of the patients (50%) were between age group of 21-40 years. Mode of injury in 18 (70%) cases was road traffic accident and rest cases were due to fall from height. 20 cases (77%) belong to AO/ASIF classification C1 and14 case (54%) belong to Riseborough and Radin’s classification type III. 22 (85%) of 26 cases showed timely union at 18 weeks. Pain and stiffness in 3 (11.5%) patients, implant loosening in 3 (11.5%) patients were the common complications of this study. In our study 13 (50%) patients had range of motion (ROM) between 100 and 120 degrees. Based on Jupitar et al system 20 patients (77%) had ‘Excellent’ to ‘Good’ results and 6 patients (23%) had fair to poor results. INTRODUCTION Intercondylar fractures of the distal humerus are relatively rare and difficult to manage. Since the original description by Desault in 1811, the intercondylar fracture of distal humerus remained one of the most difficult of all the fractures to manage. Although it is a less common fracture, but in the past few years the incidence is increasing due to modernization and increased road traffic accidents. MECHANISM OF INJURY Wilson and Cochrane (1928), described mechanism of injury. They suggested that the separation of condyles in this type of fracture may be created by the splitting effect of humeral shaft as it is forced distally. The injury can occur either in flexion or extension of elbow. The fracture is probably caused by the impact of olecranon in the trochlear groove thereby diverging the condyles of distal humerus apart. MATERIAL AND METHODS This is a prospective study which includes 26 adult patients of intercondylar fracture of distal humerus, both male and female of different age group treated in the Department of Orthopaedics, Government Medical College Jammu. Once the General Condition stabilized, patients were sent for Xrays and fracture was classified according to AO/ASIF as well as Riseborough and Radins’s classifications. However compound fractures were thoroughly irrigated with Normal saline, antiseptic dressing done, limb splinted and then sent for x-rays. OPERATIVE TECHNIQUE ANAESTHESIA AND POSITION General anaesthesia was given and then patient was turned in either lateral or prone position with elbow flexed at 90 and supported on one side of the table. Tourniquet was applied; whole of upper limb was painted with iodine solution and draped with sterile sheets. Tourniquet was inflated and time noted. APPROACH About 20 cm long incision was given extending about 10 cm proximal and 10 cm distal to the elbow joint on the posterior aspect. Subcutaneous tissue and fascia was incised in the line of skin incision. Ulnar nerve is identified first and is retracted medially with a finger of gloves. Fracture site was exposed either through a trans-olecranon approach or campbell’s posterior approach. Assembling of fragments of distal humerus: (1)Reduction and fixation of condyles: Operative Management Of Intercondylar Fractures Of The Distal End Humerus In Adults 2 of 6 Both the condyles were reduced and held together with the help of bone holding clamps. Condyles are temporarily fixed with K-wires and then with 4.5 mm malleolar screw or 6.5 mm cancellous screws of adequate length. K-wire is now removed and stability as well as congruity of joint surface was assessed. ii) Reduction and fixation of condyles to metaphysis After the reduction of condyles to the humerus metaphysis, fixation is done with either single or dual (contoured) reconstruction plates or one third tubular plates or sometimes small fragment DCP and cortical screws. K-wires, malleolar screws or cancellous screws can be used in addition. When transolecranon approach was used, the osteomised olecranon was re-fixed with Tension Band wire.

Prevalence of HIV infection among patients of pulmonary tuberculosis attending chest diseases hospital, Jammu (Jammu and Kashmir)

In the backdrop of increase in reporting of HIV positive cases in chest and tuberculosis hospital at Jammu a study was carried out to assess the prevalence of HIV infection among cases of pulmonary tuberculosis (PTB) attending this hospital. The study was carried out in the chest diseases hospital of Government Medical College Jammu which is the only referral centre for cases of PTB in province. It included all such cases attending this centre during the study period w.e.f. 1 April 2003 to 30 June 2004 and involved analysis in respect of the demographic variables i.e. age sex marital status occupation and religion. A structured schedule was employed to interview the patients. Diagnosis was based on clinical examination by the chest disease specialist for TB or TB with HIV/AIDS followed by appropriate investigations i.e. sputum for AFB and/or sputum for culture of AFB and/or radiological (X-ray chest PA view). Tuberculin test ELISA for HIV infection (repeated with different kits in case ofpositivity). A total of 5387 patients were diagnosed who were suffering from PTB; 84 were dually infected with PTB and HIV. Seroprevalence of HIV among PTB patients was 1.6%. (excerpt)