North Bengal Medical College Research Articles

Pattern of patients attending COVID 19 screening clinic: SWOT analysis of a salutogenic endeavour in North Bengal Medical College, Darjeeling district, West Bengal.

COVID-19 pandemic is a unique public health challenge causing unprecedented disruptions in normalcy. Low-and-middle-income countries need more context-relevant approaches since a majority of the world population lives here. Pandemic response in India was graded, and routine healthcare came to a screeching halt. COVID 19 Screening clinic was initiated with the intent to screen suspects and provide needful care after required consultation. It imparted preventive health education and addressed relevant queries, alleviating stress in the process. The second wave hit hard despite vaccination. To determine the pattern of patients attending, to conduct SWOT analysis for an insight into clinic functioning and to generate a database for further simulation were primary objectives. Descriptive cross-sectional hospital-based secondary data analysis was conducted in North Bengal medical college and hospital (NBMCH) for three months with the help of preformed proforma, interview guide and available records. An exit interview was conducted. Willing participants were enrolled. Verbal consent and Institutional Ethics Clearance were taken. An induction program was held every two months by the Department of Medicine, NBMCH. The clinic recorded 60,427 cases from 23rd March 2020 to 28th February 2021. The majority were males, Hindus and from rural areas of the Darjeeling district. 60.4% were symptomatic. Total cases quarantined, tested and admitted were 39.8%, 74.9% and 34.7%, respectively. However, unlike before, from September, 80.1% of the cases were symptomatic, and the majority came only for testing as national lockdown had ceased. SWOT Analysis revealed Strength as being able to operate 24*7 with coordination among all tiers of health care workers. Select seniors helped in its smooth conduction. The Weakness identified was clinic location beside the emergency, creating confusion.

Clinico-aetiological and Demographic Profile of Pancytopenia among Children in a Tertiary Care Hospital of Northern Part of West BengalA Cross-sectional Study

Introduction: Pancytopenia is a trio of results caused by numerous medical conditions in which all blood cell lineages, such as leukocytes, erythrocytes, and platelets, are diminished in blood. Causes of pancytopenia seem to vary widely in different country and also in different regions within a country. Knowing common cause and common presentation of pancytopenia is of immense importance to determine the diagnosis, especially in resource-constraint areas. Aim: To assess the aetiology, clinical profile of pancytopenia in a tertiary hospital in northern part of West Bengal. Materials and Methods: This hospital-based, cross-sectional, study was conducted in North Bengal Medical College and Hospital, Sushrutanagar, West Bengal, India, from July 2012 to June 2013. Patients having pancytopenia, on primary haematological investigation, admitted in the Paediatric Department of the hospital were included in the study. Patients already on definitive treatment for disease causing pancytopenia like kala-azar, leukaemia were excluded from the study. A physical examination was performed after obtaining a relevant clinical history, followed by a full blood count, including Peripheral Blood Smear (PBS) examination, and appropriate biochemical assays. An aspiration and evaluation of the bone marrow was performed. Statistical Program for Social Sciences (SPSS) Version 16.0 for windows (SPSS 16) was used. Results: There were 50 children, and the mean age of presentation was 7.3 years. Females constituted 52% and males were 48%. Aplastic anaemia was noted in 44% cases, 30% cases were diagnosed as megaloblastic anaemia, Kalaazar in 18%, ALL in 6% and ITP in 2%, respectively. Mean age of presentation in aplastic anaemia was 7.6 years, while that in megaloblastic anaemia was 6.9 years. Female predominance was seen in both aplastic anaemia (59%) and megaloblastic anaemia (60%), while male preponderance was seen in ALL (66%). Generalised weakness was the most prevalent presenting symptom (100%) followed by fever (80%). Pallor (100%) was the most prevalent presenting sign, followed by glossitis (30%), which is commonly ignored. Conclusion: Though aplastic anaemia is an important cause of pancytopenia, treatable causes like megaloblastic anaemia, Kala-azar should always be looked for as other possible aetiologies for pancytopenia.

Acceptability, usability and efficacy of an automatic respiratory monitor in determining fast breathing: A pilot study in a tribal tea garden in India.

Childhood pneumonia is one of the leading causes of mortality among under-five children. It is responsible for 15% of all deaths of children U5, killing 808,694 children in 2017 (1). Traditional visual inspection and manual count method is used to detect and classify fast-breathing, a key indicator of Pneumonia. In response to UNICEF's call for a reliable diagnostic tool, Philips was the first to respond with the Children's Automatic Respiratory Monitor for measuring fast breathing objectively. UNICEF and Philips Foundation initiated a field study to test the acceptability, usability and efficacy of the Automatic Respiratory Monitor in Determining Fast Breathing in low resource setting environments. Philips Foundation partnered up with the Directorate of Medical Education in West Bengal, India to conduct the field study amongst community healthcare workers and beneficiaries in a rural district of West Bengal. In collaboration with North Bengal Medical College & Hospital, a community-based study was conducted in a tribal tea garden of Naxalbari block. Acceptability and usability of the device was assessed through structtured interviews and dialogues with community health workers (CHWs), caregivers and local healthcare practitioners. Efficacy of the device was represented by the inter-rater agreement between the traditional visual inspection and manual count method and the device reading. A descriptive community based mixed method study was conducted. Satisfaction among community healthcare workers (CHWs) and beneficiaries was found to be promising across all study parameters. The paper captures the study methods, statistical analysis of the data, the conclusions, areas of further research and recommends community-wide use of the device in objectively measuring fast breathing among children under the age of five years.

Cardiac Involvement among HIV-positive Individuals less than 18 years of Age on Antiretroviral Therapy- An Observational Study from a Rural Tertiary Care Hospital, West Bengal, India

Introduction: With advancement of medical science, individuals diagnosed with Human Immunodeficiency Virus (HIV) infections are getting treated earlier and a fewer of them develop Acquired Immunodeficiency Syndrome (AIDS)-related complications. But the downside is that there is an earlier onset and higher relative risks for different chronic diseases including cardiovascular diseases. Aim: To determine the proportion and pattern of cardiac involvements among children undergoing treatment for HIV infection and to correlate various cardiac findings with duration of Antiretroviral Therapy (ART) among them. Materials and Methods: An observational cross-sectional study was conducted among 136 HIV infected patients attending Paediatrics and General Medicine Outpatient Departments of North Bengal Medical College and Hospital (NBMCH) from October 2019 to March 2021. All patients were assessed clinically and underwent two dimensional (2D) echocardiography, Motion mode (M mode) and colour doppler for assessing cardiac involvement. Collected data were analysed using Statistical Package for the Social Sciences (SPSS) software version 22.0 and Pearson’s Correlation test was applied to test association between duration of ART and different echocardiographic parameters. Results: The mean age of the study participants was 10.14 years and the mean duration of ART was 49.18 months. Almost half (48.5%) of the HIV-positive individuals had cardiovascular findings. The most common echocardiographic change noted in patients was diastolic dysfunction 39 (28.7%) followed by Pericardial Effusion (PE) 29 (21.3%) and systolic dysfunction 28 (20.6%). Statistically significant positive correlation between changes in the values of Left Ventricular Internal Diameter in Diastole (LVIDD) (r=0.982), Left Atrium (LA) (r=0.634), mean Pulmonary Artery Pressure (mPAP) (r=0.200) with duration of ART was noted. Negative correlation was seen between duration of ART with ejection fraction (r=-0.984) and Tricuspid Annular Plain Systolic Excursion (TAPSE) (r=-0.438). This indicated that all these important cardiological parameters became worser with advancement of treatment. Conclusion: Cardiac involvements among HIV positive individuals undergoing ART were still high. There was definite correlation between cardiac involvement and duration of ART.

Neurodevelopmental outcome of very low birth weight and extremely low birth weight newborn at 12 months of corrected age associated with prenatal risk factors

Background: Various neuro-developmental impairment (NDI) among very low birth weight babies (VLBW) and extremely low birth weight (ELBW) babies are common in Indian scenario. This study was designed to assess the impact between prenatal risk factors and neuro-developmental outcomes of premature infants.Methods: This descriptive study was conducted on 143 VLBW and ELBW babies admitted in SNCU of North Bengal Medical College, Darjeeling, West Bengal and discharged babies were followed up.Results: Total 143 neonates were studied among male 82 (57.3%) and female 61 (42.7%) and AGA: SGA ratio was 1.97. Birth weight ranged from 500 to 1500grams with mean was 1199.6±244.14 and the median was 1240 gm. The mean gestational age (Mean± SD) was 29.65±2.032 weeks with range 24-32 weeks and the median was 30 weeks. 28 (19.6%) had PIH, 39 (27.3%) had multiple gestation, 18 (12.6%) had perinatal infection and 25 (17.5%) had birth asphyxia. CRIB II score ranged from 3-18 with mean was 8.021±3.883 and median was 7. 73.4% (105/143) were discharged alive. Significant positive correlations were found among birth weight, gestational age, perinatal infection (p<0.001). Adverse neonatal outcome was associated with CRIB II score ≥10. Total CRIB II score with parameters of NDI like developmental delay, cerebral palsy, visual abnormality, absent ABR showed good correlation (p<0.001). Fisher Exact test revealed significant association between total score and Cerebral palsy (p=0.0005), visual abnormality (p=0.0005), absent ABR (p=0.0002).Conclusions: Perinatal risk factors influence future NDI in very low and extremely low birth weight babies. They should be identified and treated promptly to achieve good outcome.

Impacted leopard tooth in thyroid gland of victim in a case of leopard attack – A case report

Attacks by wild animals on humans are not rare in India. Most of the cases are seen in rural areas and areas adjoining forest lands. The nature of the attack may be predatory or defensive. The main culprit for this is deforestation and encroachment of humans into the natural habitats of wild animals. Wild animal attacks can cause very severe injuries, including lacerations, fractures, and vascular injuries, and are often associated with high rates of mortality. Treatment depends on the type and nature of the injury. Those who survive the initial attack often succumb to infection and septicemia during the early hospital stay. Psychiatric complications are also common in survivors. We present the case of a 70-year-old man, who was attacked by a leopard. He sustained a few lacerated bite injuries to the neck and was treated at North Bengal Medical College and Hospital. A computed tomography scan of the neck revealed a tooth of the animal impacted in the thyroid gland of the patient. The patient is currently receiving treatment for deranged thyroid function, and awaiting normalization of the same, to get anesthetic fitness for surgical removal of the tooth. Treating surgeons must be well aware of the patterns of injuries and their treatment in cases of animal attack injuries. In-depth clinical and radiological investigations are of utmost importance to find out occult injuries that may become life-threatening. A standardized treatment protocol needs to be developed for the treatment of wild animal attack victims. There is a need to extend health care into the remote areas of the nation, for early treatment of such cases.

Prevalence of Dunning Kruger effect in first year medical students in a tertiary care hospital

Background: Dunning Kruger (DK) effect refers to overestimation of one’s ability which is attributed to their inadequacy of metacognitive skills i.e., the low-performing individuals are often nescient of their incompetence which leads them to reach fallacious conclusions and make regrettable choices. Objectives of the study were to assess the degree of DK effect among the first-year medical students and to compare the associated socio-economic variables.Methods: A descriptive cross-sectional study was conducted among the interested first-year medical students of North Bengal medical college and hospital from March 2021 to April 2021 using a questionnaire. Responses were recorded in Microsoft excel 2017, analysed, and presented in form of tables and charts following principles of descriptive statistics.Results: The overall prevalence of DK effect was found to be 78.38% among the first-year medical students. Higher prevalence was observed among females (80.28%) as compared to males (75%). Students having low study hours (79.13%), no academic achievements (77.5%), and greater hours of sleep (79.74%) manifested more predisposition to DK effect.Conclusions: In our research, we have noticed a higher DK effect among the first-year medical students, which might hamper the quality of treatment and patient care in the future. Proper orientation and counselling methods are required to overcome this phenomenon.

Role of Integrative Oncology and Palliative Care Services in Improving Comfort Level and Compliance among Patients with Advanced Fungating Breast Cancer - Experience from a Rural Hospital of North Eastern India during the COVID-19 Pandemic.

Objectives:Malignant fungating breast cancers are a definite challenge to treatment due to limited knowledge and prevailing distressing symptoms. Various treatment protocols with regard to radiotherapy (RT) and chemotherapy have been reported in the literature but the knowledge of proper integration of these regimes with effective palliative care nursing care, particularly in resource poor settings, is not well understood. Hence, this study was undertaken to assess the change in the degree of comfort achieved before and after treatment of these fungating breast cancer wounds along with issues regarding compliance to such treatment in a peripheral rural medical college hospital.Materials and Methods:A total of 20 patients were selected from the medical records files of the RT department of North Bengal Medical College and Hospital who were registered and treated during the period 1 June 2019– 31 July 2021. Palliative care nursing of malodour, bleeding, maggots, pain and assessment of psychological parameters was done based on the 11-point revised Edmonton Symptom Assessment Scale at the beginning and at each subsequent follow-up visits. Patients were also individualised for receiving palliative RT, chemotherapy, surgery and hormone therapy based on their clinicodemographic profiles. Informed consent was taken from all patients and every treatment was in accordance with the ethical permissions as sought from the Institutional Ethics Committee. Statistical analysis was done based on descriptive statistics and SPSS version 22.Results:Median follow-up was 13 months. Overall, there was a significant improvement in comfort and well-being as assessed by paired t-test before and after treatment (paired t-test = 16.548; P = 0.000). However, there was no significant correlation with palliative radiation dose and schedule as per spearman’s correlation coefficient. The mean radiation dose was BED 48.56 Gy3 (EQD2 = 29.3 Gy3) and the median number of fractions used was 10. Almost 50% of patients were noncompliant to treatment and this might be attributed to the prevailing COVID-19 pandemic situation. There was maximum relief with regard to bleeding control (100%), malodour dissipation (76.9%) and control of maggots infestation (71%) and these results were also found to be strongly associated with treatment as per analysis done by Chi-square test of difference of proportions.Conclusion:Effective comfort can be achieved with proper judicious combination of palliative care nursing and other oncological treatment such as radiation, chemotherapy and surgery.

Epidemiological Study of Cases of Death Due to Drowning at Mortuary of North Bengal Medical College Hospital

Drowning is a mode of asphyxia which literally means, ‘suffer death by submersion in water or any other liquid’ or ‘suffocation by submersion in water or any other liquid because of being unable to breath’. As per WHO, in 2015, an estimated 360 000 people died from drowning, making drowning a major public health problem worldwide. We have conducted this study in Morgue of North Bengal Medical College, Siliguri to find out the demographic profile of drowning cases of North Bengal Region. In this study we have analysed the 55 cases of drowning deaths autopsied in the mortuary of Department of Forensic Medicine, NBMCH, Darjeeling, West Bengal in the last one year from 1st January 2020 to 31st December 2020. All data were analysed by appropriate statistical tools like SPSS software. In this study we found that most of the cases belong to young adult age group (29%) and cases are mostly of males (82%). In the month of July to September (34.54%) cases of drowning deaths were high and most of deceased died due to fall inside the well (43 %). Incidence of drowning deaths were mostly seen between 12 noon to 4 pm (60%) and 89.09 % cases of drowning deaths occurred immediately after the incidence.

Demographic Studies of Autopsied Cases at North Bengal Medical College Hospital During the National Lockdown Period Due to COVID 19 Pandemic

The outbreak of COVID 19 pandemic in India has started from the month of March when many cases weretested positive for novel coronavirus. The high infectivity of the disease led many governments to imposestrict lockdown with the aim of limiting its spread. To restrict its spread and save the people of India ourgovernment has also imposed strict nationwide lockdown in a phase wise manner. Though the lockdown wasimposed to restrict the spread of COVID 19 but it had severe undesirable impact on the socio-economicaland psychological status of the people especially of low to medium income groups involved in private jobs.The aim of this study was to study the cases of autopsied unnatural deaths with special emphasis to find outthe correlation between demographic pattern of deceased with the lockdown. In this study we have analysedthe 961 cases of autopsied unnatural deathsin the mortuary of Department of Forensic Medicine, NBMCH,Darjeeling, West Bengal from the first day of lockdown up to the month of September (24th March 2020 toSeptember 2020). All data were analysed by appropriate statistical tolls like SPSS software. In this study wefound that male (66.4%) predominated over the females and most of the cases belongs to adult age group(44.27%). Persons involved in private jobs (44%) were more severely affected compared to the governmentjobs and cases of suicidal deaths (45.7%) rises but cases of deaths due to road traffic accidents (13.9%)drastically reduced during lockdown period.

English

BACKGROUND Ascariasis is a type of roundworm infestation caused by the helminth Ascaris lumbricoides. In spite of advancements in the diagnosis and management of ascariasis, it remains one of the commonest infections in the world, especially in the tropical and subtropical countries, causing both acute and chronic illnesses. Ultrasound offers a quick and non-invasive way to diagnose ascariasis of the intestine and hepatobiliary system. In this study we have described the imaging appearance of ascariasis through a series of cases and demonstrated key imaging characteristics according to location. METHODS This is an institution based observational and descriptive study. A cross-sectional study was conducted in the Department of Radiodiagnosis of North Bengal Medical College & Hospital for a period of 15 months (Oct 2018 - Jan 2020). This study was conducted among the patients who were referred to the Department of Radiodiagnosis for evaluation of abdominal symptoms. RESULTS Intestinal and extra-intestinal ascaris worms have a typical appearance which is easily identifiable in on ultrasound, but diagnostic confidence is affected by several factors related to the patient, worms and the ultrasound technique. CONCLUSIONS Ultrasound is a rapid, inexpensive and easily available modality with a high success rate in diagnosing ascariasis and its complications. It is important to be aware of the characteristic appearance of ascaris in the intestines and the hepatopancreato-biliary tree and it must be remembered that the typical appearance is grossly affected by several factors such as the number, whether living or not as well as the luminal distension of the organ. KEYWORDS Ultrasound, Ascariasis, Intestinal Obstruction, Cholecystitis, Cholangitis, Pancreatitis, Appendicitis

SOCIODEMOGRAPHIC AND ANTHROPOMETRIC PROFILE OF DIABETIC PATIENTS ATTENDING IN A DIABETIC CLINIC IN A TERTIARY MEDICAL COLLEGE AND HOSPITAL, WEST BENGAL

Background: Diabetes mellitus is one of the important causes of morbidity and mortality. With a rise in non communicable diseases in India, diabetes has become a modern epidemic showing a rising trend in West Bengal also. A large number of diabetes patients come to the diabetes clinic of our tertiary care hospital in North Bengal Medical College and Hospital, Darjeeling, West Bengal. The large proportion of patients presenting with this condition prompted us to study the Sociodemographic and Anthropometric Prole of such patients. Methods: This was a descriptive hospital based cross sectional study involving a total of 344 diabetic patients enrolled in the diabetes clinic of a tertiary care teaching hospital from December 2019 to February 2020. A self-administered questionnaire was used to collect data and was analyzed in Microsoft excel sheet and using SPSS 20.0 software. Results: Among the 344 study participants, we found that 220 (63.95%) were males and 124 (36.05%) were females. Diabetes was more common among those aged 51-60 years 108 (31.40%). Family history was present among 188 (54.65%) of the diabetic patients. Almost 160 (46.51%) patients have diabetes 1.1 – 5 years. Hypertension was present among 216 (62.79%) patients. Almost 218 (63.37%) of the patients were overweight and 84 (24.42%) were obese. Conclusions: The diabetic patients presenting to this tertiary care hospital belong lower socioeconomic strata and having limited education in their age group. There is high proportion of obesity and hypertension among them.

THYROID PROFILE IN NEWLY DIAGNOSED HIV PATIENTS IN A TERTIARY CARE CENTRE OF NORTH BENGAL-A CROSS-SECTIONAL STUDY.

Background: HIV infection can lead to thyroid gland endocrinopathy. There is limited data regarding prevalence, pattern and correlates associated with thyroid dysfunction in India. The study will help to assess whether universal screening of thyroid function should be enforced in HIV infected patients. Objectives: To determine the prevalence and pattern of thyroid dysfunction and also to nd out association between thyroid dysfunction with other factors like age, gender, and CD4 count in newly diagnosed HIV infected patients attending North Bengal Medical College. Methods: A cross-sectional observational study was conducted among 95 HIV infected patients attending indoor and outdoor of North Bengal Medical College and Hospital after fullment of inclusion and exclusion criteria. Data were collected using predesigned pre tested schedule after having informed consent and subjected to clinical and laboratory examination. Collected data were analysed using SPSS statistical software and presented using principles of descriptive statistics. Results: Overall 34.7% of study subjects had thyroid dysfunction. Mostly found dysfunction was subclinical hypothyroidism (23.2%). Direct correlation was observed between T3, T4, CD4 Count whereas TSH was inversely correlated with all others parameters. Conclusion: Biochemical abnormalities in thyroid function is commoner among patients with HIV. The severity of hypothyroidism is inversely correlated with CD4 counts. The screening of thyroid function in HIV patients thus indicated to improve the quality of life.

English

A 7-day-old new-born was referred to Department of Radiodiagnosis of North Bengal Medical College and Hospital to evaluate enlargement of head circumference. On clinical examination of this new-born we found macrocephaly and absent right thumb as well as deformed left thumb. No other clinical abnormalities were seen in this new-born apart from this. Facial structures, spine, upper and lower limbs, trunks were normal clinically. Transcranial ultrasound was done using LOGIQ P9 ultrasound machine which revealed an open lip schizencephaly involving right cerebral hemisphere with absence of corpus callosum. Trans abdominal sonography revealed non visualisation of left kidney in left renal fossa as well as in its usual ectopic position. Therefore, the new-born underwent magnetic resonance imaging (MRI) of brain and whole abdomen which confirmed ultrasound findings. MRI additionally revealed there was no ocular, anorectal and genito-urinary malformations. Infantogram was done to evaluate the skeleton of this new-born. Fetal echocardiography revealed no obvious cardiac anomalies.

English

A 22-year-old woman, single, came to Radiodiagnosis Department of North Bengal Medical College and Hospital for ultrasonography examination of whole abdomen for evaluation of amenorrhoea and vague cyclical lower abdominal pain. She had been treated outside the hospital for several years for above symptoms without any fruitful outcome. There was no history of any surgical management to this patient. Careful clinical examination of pelvis revealed an imperforate hymen. No other clinical signs were found except mild lower abdomen tenderness. Routine ultrasound was done with curvilinear probe with frequency of 5 MHz in GE LOGIQ P 9 model ultrasound sonography (USG) Machine. Cervical agenesis was suspected based on sonographic findings, non-visualization of the cervix with a uterus like structure (measuring approx. 30 x 36 x 30 mm.) in right adnexal region. Mild collection seen in pouch of Douglas. Both ovaries and bilateral adnexa were normal. Vagina showed no abnormal collection. Other abdominal organs like liver, gallbladder (GB), common bile duct (CBD), portal vein (PV), pancreas, spleen, both kidneys, and bladder appeared normal. Transvaginal examination as well as transvaginal sonography could not be performed as imperforate hymen. Therefore, the patient underwent magnetic resonance imaging (MRI) examination of whole abdomen which confirmed the ultrasonographic findings and the case diagnosed as congenital atresia of uterine cervix with imperforate hymen.

A Correlational Study of Hepatic Steatosis (Fatty Liver Disease) and Liver Enzymes (ALT, AST, GGT) In The Scenario of Insulin Resistance Among Young Medicos.

Background and Objectives In the last few decades,Nonalcoholic Fatty Liver Disease (NAFLD) has become a common health issue that leads to serious complications like cirrhosis, cardiovascular disease, etc. Insulin resistance (IR) is the key pathogenic factor for NAFLD. The young medicos being habituated in stressful and sedentary lifestyle and representative of the youth as well can fully justify their selection as study population and help to build social awareness by emphasizing the importance of early lifestyle modifications in preventing or delaying the severe complications of NAFLD. This study is aiming to find out if there is any correlation of hepatic steatosis with IR, Alanine Transaminases (ALT), Aspartate Transaminases (AST) or Gama Glutamyl Transferases (GGT) and also to identify if one enzyme is better correlating with hepatic steatosis than others in the scenario of Insulin Resistance among young medicos. METHODS: 132 medical students of North Bengal Medical College, aged between 18-25 years were included in this institution based observational cross-sectional study. Their Fasting Insulin, glucose, ALT, AST, GGT were measured, and IR was calculated by the Homeostatic Assessment of Insulin Resistance (HOMA-IR) calculator. Sonography was done to assess Hepatic steatosis. RESULTS: Among 132 subjects normal, grade 1 and grade 2 fatty changes have been found in 67.4%, 25%, and 7.6% of the study population respectively. The Grouping was done using the cut-off value of IR (i.e. subjects with IR<1.525 vs. IR≥1.525). Significant differences were found in the mean values of ALT, AST, GGT between groups. Significant positive concordances were found between enzymes ALT, GGT, and hepatic steatosis in subjects having IR ≥ 1.525.Regression analysis showed that higher GGT values have a stronger positive correlation with hepatic steatosis than ALT among the same. Interpretation and Conclusion From this study, we can interpret that subjects having higher GGT values are better associated with steatosis than those having higher ALT values and can lead us to the conclusion that GGT might be an important independent marker for NAFLD associated with IR. Furthermore, such observations may suggest considering GGT as a marker for assessing the severity of fatty liver irrespective of etiopathogenesis, though the population-based vivid evaluation is highly recommended.

Changing Trends of Antimicrobial Resistance in Neonatal Sepsis: Experience from a Tertiary Care Hospital from West Bengal, India

Introduction: Sepsis is the second leading cause of neonatal mortality in India. Emergence of highly resistant microorganisms as an aetiology of neonatal sepsis is a matter of serious concern. Aim: To study the prevailing aetiological agents in neonatal sepsis and their antimicrobial susceptibility pattern. Materials and Methods: A prospective observational study was performed in a tertiary care teaching hospital in neonatal care units in North Bengal Medical College and Hospital, West Bengal, India, over a period of two years from March 2017 to February 2019. All the neonates having clinical features suggestive of sepsis were subjected to blood culture using BacT/ALERT® PF Plus. Microbial identification and antibiotic susceptibility testing was done by VITEK-2 automated systems. Chi-square test was done using Epi info software version 7.1 and p-value <0.05 was considered significant. Results: Out of 403 neonates investigated for suspected sepsis, 156 (38.7%) were found to be culture positive. Klebsiella pneumoniae was the most common organism isolated (n=90, 57.7%) followed by Staphylococcus aureus (n=24, 15.4%) and Acinetobacter baumannii (n=10, 6.4%). Klebsiella pneumoniae showed a very high degree of resistance to ampicillin, amoxycillin- clavulenic acid (100% each), cefotaxime (93.4%), ceftazidime (92.3%), gentamycin (94.5%) and tobramycin (94.5%). High resistance of Staphylococcus aureus was seen against ampicillin (100%), cloxacillin (62.5%), amoxicillin-clavulenic acid (70.9%), and cefotaxime (79.2%). Few isolates of Klebsiella pneumonia (6.6%), Acinetobacter baumannii (60%) and Enterobacter cloacae (50%) were sensitive only to colistin and tigecycline. Conclusion: Most of the isolates showed very high degree of resistance against first line of antibiotics recommended by World Health Organisation (WHO) (ampicillin and gentamycin or amikacin) for empirical treatment of neonatal sepsis. Emergence of highly resistant organisms sensitive only to colistin and tigecycline should be considered as an eye opener. Strict adherence to sepsis prevention along with regular surveillance of organisms and their sensitivity patterns is the need of the hour to improve survival by contributing to antibiotic stewardship.

Assessment of Online Learning Procedure through the Eyes of Medical Students inCOVID-19 Scenario

Introduction: Coronavirus Disease 2019 (COVID-19) pandemic has necessitated closure of physical classroom for maintaining social distancing norms, prompting learning environment to shift from offline to online. Medical education has also undergone similar changes, and online education and assessment methods had to be implemented. Student’s perception regarding the same was assessed through this study. Aim: To assess the perception of first year MBBS students about the online education and assessment during the lockdown period of two months. Materials and Methods: A descriptive cross-sectional study was carried out on the first year MBBS students of North Bengal Medical College (NBMCH) during the COVID-19 Lockdown period. All first year MBBS students of NBMCH were added in WhatsApp groups created for academic purposes by Department of Anatomy, NBMCH during the lockdown period. Respective teachers in the academic groups carried out sharing of Digital Education Material (DEM), holding Online Interaction (OI) and correspondence with students, and taking Online Assessments (OA) through sharing questions framed in Google Forms. After two months, the perception of the students was assessed through a voluntary participation based online survey designed in google forms, the results of which were tabulated later and analysed. Results: A total 95 students (54 Male, 41 Female) out of 200 had participated in the survey. Most students were reliant on smartphones (n=90, 94.7%) and mobile internet (n=78, 82%). Most agreed on DEM being relevant (83.2%) and informative (80.7%) but showed diverging opinion on ease of understanding, revision and overall fulfillment of learning objective. On OI majority students responded positively on promptness, relevancy, informative and helpfulness but only46.8% considered DEM and OI fulfilled the overall learning objective. Regarding OA students had an overall positive opinion. Comparing the online mode with offline, students mostly preferred the latter, though agreeing that online method of education was effective and it was easier to score in OAs. Conclusion: While most students accepted online education, interaction and assessment positively, at the end most of them still preferred offline mode of education and assessment. This could reflect lack of student-student interaction and indicated need of further studies to explore the matter, to help us approach online education better.

Study of oropharyngeal ulcers with their commonest anatomical sites of presentation correlated with histopathological diagnosis among the north Bengal population

Introduction: Oropharyngeal ulcers are very common in North East part of India due to bad oral habits like chewing of tobacco etc. A study was performed at North Bengal Medical College and Hospital among the patients attending otorhinolaryngology outdoor to explore the relationship of different types and proportion of oropharyngeal ulcers with their commonest anatomical sites and to elicit the relationship with bad oral habits. Aims: To elicit the different types and proportions of oropharyngeal ulcers. To explore the relationship of different histopathological types with anatomical sites. To identify the relationship with addiction. Material and Methods: This is a Cross-sectional Observational Hospital based study, conducted in the Otorhinolaryngology outdoor of North Bengal Medical College and Hospital twice a week. 102 patients were selected as study population after maintaining inclusion and exclusion criteria. Results: The study shows that the most common type of ulcer is aphthous (25.49%) and the least common types are erythroplakia and autoimmune ulcers (1.96%). It is found that most of the ulcers affect the tongue (28, 27.45%) and the least affected site is the retromolar trigone (4, 3.92%). In the tongue the lateral border is the most commonly affected site. Chewing betel nut is the commonest addiction associated with oropharyngeal ulcers. Conclusion: The study performed to determine different histopathological types, proportions and commonest anatomical site of presentation of different oropharyngeal ulcers which are very common in the North East part of India. Since no such study found in this area previously this study although very preliminary, might help for future studies of similar nature in an area where oral ulcer is very much prevalent. However a short study of this nature cannot be a conclusion and a detailed cohort study is essential to cover all the clinical and pathological aspects of the problem. Keywords: Ulcer, Oral Ca

Parotidectomy, complications and management: our experience

<p><strong>Background:</strong> Salivary gland neoplasms constitute 0.3% of all malignancies and 2%-6.5% of the head-and-neck tumors. Considering the unique anatomy of the gland and its intricate relationship with the facial nerve, significant complications may arise which can result in varying degrees of morbidity.</p><p><strong>Methods:</strong> We present here our experience of Parotid surgery done at two institutes, NRS medical College in Kolkata and North Bengal medical College and Hospital in the Darjeling district from 2013 to 2019 in the department of ENT and Head neck Surgery. Patients were subjected to superficial parotidectomy, total conservative and total parotidectomy depending upon the preoperative FNAC report.</p><p><strong>Results:</strong> 47 patients were subjected to different types of parotidectomies. Pleomorphic adenoma was the most common pathology encountered and facial nerve palsy was the most common post-operative complication in our series, followed by GAN injury, flap necrosis and Frey’s syndrome.</p><p><strong>Conclusions:</strong> This demographic study will help future parotid surgeons to understand various complications encountered during the surgery and management of those aforesaid complications, improving surgical outcome.</p>