Rural Medical College Hospital Research Articles

Conventional Pterygium Excision with Conjunctival–Limbal Autograft Compared with Supra-Tenon Excision of Pterygium Along with Small Limbal Autograft

ABSTRACT Context: New pterygium surgery methods have been developed over the years because recurrence is high (30–70%) after simple excision. Aims: To compare the surgical time, ocular discomfort score, and recurrence rate in conventional pterygium surgery, where excision of pterygium and Tenon’s capsule is performed and the area is covered using conjunctival–limbal autograft (CLAU) with supra-Tenon excision of pterygium (STEP) along with small limbal autograft in patients with primary pterygium. Settings and Design: A Prospective comparative study was conducted at a rural medical college–hospital from November 1, 2017, to October 31, 2019, among 110 participants after ethical approval from Institutional Ethics Committee. Materials and Methods: All participants had primary pterygium of grades I and II depending on corneal encroachment and Tan’s stages T1 and T2 morphologically. Fifty-five underwent conventional surgery with CLAU (group A), and STEP with small limbal autograft (group B) was performed in the remaining fifty-five. The follow-up period was one year. The ocular problem, comfort of subject, recurrence, or other complications were documented, and statistical analysis was carried out with Statistical Package for the Social Sciences (SPSS) software version 21. Results: The mean surgical time was significantly less in group B (38.79 vs. 42.04 minutes) (Z = 11.38, P = 0.001 with confidence interval 10.81–13.38) and ocular discomfort score (ODS) was lower in group B as compared with group A (P < 0.05). Group B had two eyes with recurrence, though not statistically significant (P = 0.49). Conclusion: STEP with small limbal autograft is worth consideration for primary pterygium management.

Outcome of varicose vein surgery in a general surgical unit

Background: Varicose veins are tortuous, widened veins in the subcutaneous tissues of the legs and are often easily visible. In our country, we do have not sufficient vascular surgery centers or vascular surgeons. So general surgeons have training in vascular surgery and performing operations of varicose veins. This study aimed to show the operative procedure, results of treatment in terms of symptom improvement, and complications of varicose vein surgery done by general surgeons in a rural medical college hospital in Bangladesh. Methods: This retrospective study was conducted at the Department of General Surgery in Sheikh Hasina Medical College, Jamalpur, Bangladesh from January 2017 to December 2022. A total of 20 patients were selected as study subjects by simple random sampling. Operative procedure depended upon pre-operative duplex imaging findings, and patients were kept under 6 months follow-up. The outcome was based on the cure and recurrence rate of varicose veins. Collected data were analyzed using descriptive statistics. Analysis of data was carried out by using a statistical package for social science (SPSS) 22.0 for Windows. After analysis, the data were presented in tables and charts. Results: It was observed that 3 (15.0%) patients experienced ulceration after surgical procedure, followed by 2 (10.0%) developed DVT, 1 (5.0%) patient had wound hematoma, and 1 (5.0%) patient showed recurrence. Concerning the outcome of varicose veins after surgical procedures, the majority (18,20.0%) of the patients showed complete cure, 1 (5.0%) patient presented with recurrence, and 1 (5.0%) patient developed complication. Conclusions: Despite the relatively low occurrence of complications and recurrence following surgery for varicose veins, the substantial 90% cure rate it offers is noteworthy. This study underscores the feasibility of conducting varicose vein surgery by general surgeons equipped with training in vascular surgery, ensuring safety and minimizing complications.

Free flap reconstruction at a rural-based tertiary medical college hospital: Barriers and outcomes.

In a rural-based setting, providing optimal treatment is often difficult owing to the limited resources and financial constraints being rampant in cancer care delivery. Oncological resections often result in large, complex defects requiring free flap reconstruction to achieve cosmetic and/or functional goals. This article focuses on our experience of starting and promoting microvascular reconstruction in a rural tertiary medical college hospital. Retrospective observational study of patients undergoing free flap reconstruction for oncological indications was included. Standard oncological principles were followed for cancer extirpation. Free flap reconstruction was done using loupes of 4× magnification. Flap-related outcomes and barriers in doing free flap reconstruction were analysed. A total of 56 patients were included. The most common free flap undertaken was free anterolateral thighflap in 21 (37.5%) patients. The mean duration of reconstruction was 438 min. Re-exploration was undertaken in 17 patients (30.4%). Nonsalvageable flap loss was 19.64%. Adjuvant treatment was administered in all patients as per oncological indications, albeit with some delay in 12.5%. Barriers to reconstruction were noted in the pre-, intra- and postoperative periods. Reconstruction with free flaps is feasible in a resource-constrained setup with careful planning and a multidisciplinary team approach to overcome the barriers.

The predictive role of combined adenosine deaminase activity in Serum and body fluids to diagnose extrapulmonary tuberculosis

EPTB comprises 10-15% of all TB cases in developing countries. Diagnosis of TB from body fluids like pleural, peritoneal and cerebrospinal fluid (CSF) is challenging as all these fluid samples possess very few bacilli.: To determine the role of adenosine deaminase (ADA) assay for reliable prediction of EPTB from different body fluids, particularly in low-resource areas with high disease prevalence. This prospective study was out in a rural medical college hospital. An enzymatic deamination method in a kinetic manner was used to monitor the ADA activity. The study processed 100 serum samples from 50 Suspected TB patients and 50 from the control group and 100 samples of body fluids from 50 Suspected TB patients and 50 control samples. Data were recorded in MS Excel sheets, and statistical analysis was performed using MS Office software. Out of 50 serum samples from the suspected TB patient and control groups, 48 (96%) and 17 (34%) were positive for ADA, respectively. Out of 50 samples of body fluids obtained from both suspected TB patients and the control group, 16 (32%) and 3 (06%) were positive for ADA, respectively.Serum ADA positivity was significantly high in suspected TB patients as compared to the control group In our study,observations suggest that serum and serosal fluid Adenosine deaminase (ADA) measurement has good prediction potential for EPTB. Hence, it can be used as a supportive surrogate marker for challenging to diagnose extrapulmonary TB. ADA activity in body fluids is also a sensitive biomarker, especially when combined with serum ADA levels and may become a routine investigation for early detection of extrapulmonary TB. Serum and serosal fluid Adenosine deaminase (ADA) measurements have good prediction potential for PTB & EPTB.

Hypothyroidism in Pregnancy: A Prevalence study in a Rural Medical College Hospital in North East Bihar

Hypothyroidism in Pregnancy: A Prevalence study in a Rural Medical College Hospital in North East Bihar

Endometrial Patterns Among Rural Women Undergoing Gynecological Procedures in a Tertiary Care Hospital.

Introduction Women with endometrial diseases often present in outpatient departments, and outpatient procedures easily enable diagnosis. Histopathological patterns vary with age, menstrual cycle, drug use, and pathological state. Teaching hospitals are often located away from rural areas. Materials and methods An ambispective study was performed over 33 months in a rural medical college hospital by perusing the histopathological registers of the department. Details of history and endometrial samples (biopsy and hysterectomy) were obtained using biopsy numbers and requisition forms. Functional and organic histopathology findings were manually entered into a spreadsheet, and statistics were performed using Statistical Package for the Social Sciences (SPSS)for Windows version22 (IBM SPSS Statistics, Armonk, NY, USA). Results There were 226 women, with total abdominal hysterectomies (TAH) performed in a significantly higher proportion of middle-aged women(range: 41-59 years). Of the middle-aged women, 70% presented with excessive menstrual bleeding, and a similar percentage of older women presented with uterovaginal (UV) prolapse. Hysterectomy specimens constituted most samples in this study. Proliferative endometrium was observed in 40% of patients andmetaplasia (papillary syncytial, tubal, and squamous)in only 1.7%.Normal proliferative and secretory endometrium wereobserved in91 (40.3%) and 41 (18.1%) patients, respectively. The presence of hyperplasia, decidualization, stromal breakdown, adenocarcinoma, adenomyosis, and endometrial polyps did not vary significantly among thethree agegroups (elderly, middle-aged, and young). Conclusion Most women in rural areas presented to the gynecologist with uterine bleeding; middle-aged women constituted most of those with gynecological complaints. Normal endometrium was observed in nearly half of the patients. Adenomyosis was the most common cause of uterine bleeding. Uterine endometrial malignancies were rare.

A Study on etiology and outcome of acute kidney injury patients requiring haemodialysis in a rural tertiary medical college hospital, Kishoreganj

Background and objectives: AKI is an increasingly common complication of critical illness, with some researches showing that as high as 1 in 5 adults and 1 in 3 children experiencing AKI per hospital admission. Whether occurring in the community or in the hospital, the clinical and public health importance of AKI is well established due to the association with high mortality and its separate independent effect on the risk of death and resource use. This study was aimed to find out the etiology and outcome of acute kidney injury patients requiring haemodialysis.
 Methods: A retrospective study was done on 70 patients of AKI who required haemodialysis support in dialysis unit of medicine department of Jahurul Islam Medical College Hospital, Kishoreganj during the time period from Jan - 2018 to Dec – 2020. All patients of age 13 and above with AKI and have been dialyzed at least once during the study period were included.
 Results: In this study, there was an overall male preponderance (70%) with age range of 13-40 years (48.57%). Most common features of presentation were oliguria, cough, respiratory distress, drowsiness, disorientation, reddish urine, pedal edema, fever and high blood pressure. The most common causes of AKI were sepsis (30%), hypovolemia (21.42%), acute glomerulonephritis (AGN) (14.29%) and pregnancy related causes (10%). Common indications for haemodialysis of AKI patients were refractory fluid overload (70%), features of uraemic encephalopathy (22.86%). In this study, 78.57% of AKI patients requiring haemodialysis were improved and discharged, 08.57% patients were progressed to end stage renal disease, 07.15% patients were expired and 05.71% patients were absconded.
 Conclusion: It is concluded that sepsis, hypovolemia, AGN, obstetric causes, surgical causes and nephrotoxins were the primary causes of AKI patients requiring haemodialysis in this study. Most of these causes can be prevented with simple interventions such as appropriate management of infections, health education on oral rehydration, quality prenatal and emergency obstetric care and taking appropriate precautions when prescribing potentially nephrotoxic medications. Majority of the patients of AKI with complications were improved with haemodialysis. So, expansion of haemodialysis services to all parts of the country is necessary.
 AKMMC J 2021; 12(2): 98-103

Evaluation of Adverse Outcome Predictors in Neonatal Seizure: A Longitudinal Study from a Tertiary Centre of Eastern India

Introduction: Neonatal seizures are common but can be manifestations of serious underlying disorders and sometimes have a grave prognosis. Predictors for adverse outcomes are important for early referral and advanced interventions. Aim: To study the incidence and factors associated with neonatal seizure and to determine the predictors of adverse outcomes. Materials and Methods: This was a longitudinal study, conducted from April 2020 to March 2021 at a Rural Medical College (Midnapore Medical College and Hospital, West Bengal) in Eastern India. All the admitted newborns (N=143) in the Special Newborn Care Unit (SNCU), who had clinically evident seizures, were included in the study. Data were collected regarding the perinatal history, gestational age, type of delivery, birth weight, APGAR score at 1 and 5 minutes, and need for resuscitation at birth. The onset of the seizure, seizure type, investigation findings, possible aetiological diagnosis, and final outcome was noted. The management of neonatal seizures was as per the institutional protocol. Babies were followed up for a minimum of 28 days or throughout their hospital stay till discharge/death. The outcome was categorised into two categories: ‘favourable’ when there was a normal neurological examination and ‘unfavourable’ when there was any neurological impairment or death. Statistical analyses were performed using the Statistical Package for Social Sciences software version 25 (SPSS Inc., Chicago, IL, USA). Risk factors were determined by analysing outcomes using simple and multivariate logistic regression analysis. The p-values less than 0.05 were considered as statistically significant. Results: A total of 143 newborns had seizures out of 3126, making the incidence of neonatal seizures 4.57%. Males outnumbered females. Total 64.33% were preterm. Five minutes APGAR score <7 was noticed in 44.75%. The most common type was subtle seizure. Advanced resuscitation manoeuvre was required for 46.8% cases whereas mechanical ventilation was required in 11.88%. The most common aetiology was birth asphyxia (46.15%), and the cranial ultrasound showed Hypoxic Ishchaemic Encephalopathy (HIE) changes in 30.77% of cases. Multiple logistic regressions revealed only four factors, namely, preterm delivery (OR 5.82), need for extensive resuscitation manoeuvre (OR 6.21), presence of status epilepticus (OR 3.49) and abnormal cranial ultrasound (OR 1.02) to be the independent risk factors for unfavourable outcome. Conclusion: Clinical diagnosis of neonatal seizure could be useful in resource poor centers, where video-Electroencephalogram (EEG) is not available. Premature delivery, need for extensive resuscitation, presence of status epilepticus and abnormal cranial ultrasound were associated with poor short-term outcome.

Clinical study of the management of scrotal swelling in adult patients at a rural medical college and research hospital

Background: Scrotal swellings are commonest clinical entities in surgical practice. Hydrocele is abnormal collection of serous fluid in the tunica vaginalis or any part of the processus vaginalis, which needs to be differentiated from other conditions and surgically managed. Methods: This prospective, observational study was carried out on 90 adult male patients between January 2021 to August 2021 diagnosed with scrotal swelling, admitted, treated at MVJMC and RH. Inclusion criteria were male patients of age >18 years. Exclusion criteria were patients with paediatric scrotal swellings. Routine blood investigations, COVID test and ultrasound of the scrotum was done. The patients underwent one of the standard surgical procedures and were observed for post-operative complications during their stay at the hospital and were followed up for 3 months. The collected data was analyzed using SPSS-21 software.Results: Collected data was analysed using SPSS-21. In our study hydrocele was seen in 48 (53.33%), epididymo-orchitis 5 (5.56%). 3 (3.33%) cases of varicocele, 2 (2.22%) cases of epididymal cyst and 1 (1.11%) each of sebaceous cyst, spermatocele, hematocele, sebaceous cyst, Fournier’s gangrene, infected encysted hydrocele, pyocele, scrotal abscess and filarial hydrocele. 2 (2.22%) testicular tumour and 21 (23.86%) testicular torsion. Of 90 patients 81 (90%) underwent surgery, while 9 (10%) patients were managed conservatively.Conclusions: Primary vaginal hydrocele was the commonest scrotal swelling. Ultrasound of the scrotum is diagnostic tool in differentiating from other swellings in the scrotum especially in testicular torsion when the testis can be saved. Jaboulay’s procedure was the commonest surgery performed with least complications.

Association of Pulmonary Tuberculosis and Dermatological Conditions Among Patients of a Rural Medical College Hospital

Pulmonary tuberculosis (PTB) affects a significant proportion of the population. There are many contributory aetiological factors common to tuberculosis (TB) and dermatological conditions. To study the spectrum of concurrent skin conditions in patients with PTB and to compare with patients having other diseases. All patients with PTB admitted to our Institute during the period of the study were included in the study. A comparable number of patients admitted in other departments constituted the control group. All patients were screened for skin diseases. There were 498 patients in each group, matched for age and gender. There were 126 patients with skin conditions in the study group as against 60 patients in the control group. Pityriasis versicolor was the commonest skin condition in both the groups. Whereas acniform eruptions and pruritis were more common in the control group. Pityriasis versicolor, herpes zoster, erythema nodosum and leprosy were significantly more frequent among patients. There is a high frequency of concurrent skin diseases in patient with PTB that should be managed along with it.

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.

A retrospective study of colorectal cancer – An audit from a rural medical college hospital over a 6 year period

Aim: Colorectal cancer (CRC) is one among the most common cancers all over the world. Though more number of CRC is diagnosed in India it is being underreported. Our aim was to study the data regarding demography and predominant presenting complaint of CRC patients. We also wanted to find out their correlation with the side of tumor and compare with available Indian and Western literature.Methods: A retrospective study was done to collect the data of 214 patients who underwent colonoscopy and diagnosed with CRC over a six-year period in a rural medical college hospital. Their age, gender, anatomical distribution, symptoms and histology reports were collected and analyzed. Results: The mean age of occurrence of CRC in our study was 59.5 years with majority of the cases in the age group 61-70 years. Twenty-seven patients (12.6%) with CRC were less than 40 years age. With 73.8% left sided tumors in our study, rectum was the most common site. As the predominant presenting symptom, bleeding per rectum [PR] and mass had statistically significant association with left sided and right sided tumors respectively. Conclusion: The side of the tumor can be related to the predominant presenting symptom. CRC is more common on left side with majority occurring in the rectum. This can be identified early by screening sigmoidoscopy. With lifestyle changes there is an increase in CRC in younger age even in rural population. In a rural population per rectal examination, sigmoidoscopy and colonoscopy are considered embarrassing which delays the diagnosis. So, a complaint of bleeding PR should not be taken lightly in age group more than 40. Persistent motivation regarding benefits of screening colonoscopy is important particularly in rural areas for early diagnosis and treatment, to reduce disease specific morbidity and mortality.

A study on demographic, clinical and prognostic profile of pesticide poisoning cases in a rural tertiary care medical college hospital

A study on demographic, clinical and prognostic profile of pesticide poisoning cases in a rural tertiary care medical college hospital

Risk Factor Evaluation of Preterm Labour/ Births in Rural Medical College Hospital

Introduction: Preterm Birth (PTB) is a major problem associated with neonatal morbidity and mortality globally. In developing countries magnitude of the problem is much more. Aim: The present study was undertaken to find out the incidence of preterm labour/births, to evaluate different related risk factors and to assess the neonatal mortality in PTBs. Materials and Methods: This cross-sectional study was conducted in a Maternal and Neonatal Units of Rural Teaching Hospital among all cases who delivered during study period of two months from mid-February 2019 to mid-April 2019. Probable maternal risk factors for preterm labour, neonatal clinical profile and risk factors for neonatal mortality were recorded. Frequencies and proportion of variables were computed. Results: The incidence of PTB/labour was 8.5%. Pregnancy duration of less than 34 weeks was observed in 35.6% mothers. It was observed that major factors contributing to PTBs were hypertensive disorders of pregnancy, maternal medical illness/severe anaemia, Bad Obstetric History (BOH)/ previous preterm labour and Ante-Partum Haemorrhage (APH). Survival rate amongst preterm babies was 90.5%. Conclusion: The morbidity amongst newborns is mainly caused by PTB. The study found lower incidence of PTB as compared to previous studies conducted in this region. Many of the risk factors evaluated are modifiable. Risk factor modifications and timely interventions will help in the reduction of PTBs and associated mortality.

Stress, anxiety, depression, and resilience in cancer patients on chemotherapy

Background: Cancer chemotherapy is an intense and cyclic treatment that is associated with a number of distressing side effects that may affect the person's psyche. Aim: The aim of the study is to evaluate stress, anxiety, depression, and resilience in cancer patients undergoing chemotherapy. Materials and Methods: Consecutive cancer patients undergoing chemotherapy at a tertiary care rural medical college hospital were included in the study with their consent. Patients having comorbid medical or psychiatric disorders were excluded. Demographic and clinical characteristics of the patients were recorded. The Depression Anxiety Stress Scale and Abbreviated Connor-Davidson Resilience Scale were administered and scored as per the test manual. The data were analyzed using the SPSS software with t-test, Chi-square test, Mann–Whitney U-test, Spearman's correlation, and multiple regression analysis. Results: The study included 32 male and 68 female cancer patients on chemotherapy. Depression was found in 33 patients, anxiety was observed in ten patients while stress was present in three patients. Stress was positively correlated to anxiety and depression, while resilience was negatively correlated to depression. There were no gender differences in stress, anxiety, depression, or resilience. A multiple regression was run to predict depression from stress, anxiety, and resilience. These variables statistically significantly predicted depression, F (3,96) =55.075, P < 0.0001, R2 = 0.632. All three variables added statistically significantly to the prediction (P < 0.05). Conclusion: One-third of cancer patients on chemotherapy suffer from depression which is negatively correlated with resilience. Significant predictors of depression in these patients were stress, anxiety, and resilience. Psychiatric management in addition to reducing depression, stress, and anxiety should also aim to increase resilience in these patients.

Assessment of Nutrition, Morbidity &amp; Immunization Status of Children (24 to 59 months) attending a Rural Medical College Hospital of West Bengal

Background: Nearly half of India’s children - 43% are underweight, 45% are stunted and 20% are wasted;26.3 million cases of ARI were reported in 2011 with an incidence rate of 2179 per lakh population; 10.6 million cases of diarrhoea with 1293 deaths were reported in 2011; fully immunized coverage in the age-group of 12-23 month old children was 61%.. This study was conducted to assess the morbidity profile, under nutrition and immunization status of 24 to 59 months old children in a medical college hospital of West Bengal. Methods: An Institution based cross sectional study was conducted among 450 children of 24 – 59 months, attended Paediatric Out Patient Department and Immunization Clinic of Midnapore Medical College &amp; Hospital, from July to September 2013 using a predesigned pretested schedule. Results: the prevalence of underweight, wasting and stunting was 42.44%, 20.22% and 51.78% respectively. Boys suffered more than girls in all three indicators. Acute Respiratory Infections (54.22%) and diarrhea (52.66%) were the common morbidities; 79.33% were fully immunized; 14.67% were partially immunized and 6% were unimmunized. Conclusion: The problem of under-nutrition, common morbidities and low immunization amongst pre-school children needs to be addressed through comprehensive preventive, promotive, curative and social measures.

Application and Evaluation of Case-Based Learning as a Part of Early Clinical Exposure for Undergraduate Medical Education Program

Introduction: Medical Education is witnessing a significant transition and global shift towards competency based medical education (CBME) which includes early clinical exposure (ECE) program to help students apply and correlate principles of preclinical subjects with clinical scenarios, in various forms and in a variety of settings. One of the easy and feasible methods of ECE being Case Based Learning (CBL), our study aimed to design a case scenario and to evaluate impact of case base learning as a part of ECE module in first year undergraduate medical teaching program in nerve muscle physiology. Methods: The present study was conducted in 96 students at Ashwini Rural Medical College Hospital and Research Centre, Solapur after obtaining institutional ethics committee approval. 3 hrs session of CBL was conducted for a case scenario on myasthenia gravis in the nerve muscle physiology module. The students’ responses on pre-test, post-test and their insights regarding the CBL were taken through a pre validated questionnaire using 5-point Likert scale. Results: High impact of CBL was seen as significant improvement in student’s performance. Maximum students felt CBL to be easy method of learning and was highly appreciated through their feedback. Conclusion: CBL was found to have positive impact on understanding and perception of topic. CBL helped students to understand, evaluate, analyze, diagnose and interpret the case, paving them towards newer approach of self-directed and vertical integrated learning. CBL is easier, feasible an effective method among other early clinical exposure methods as it involves students in deeper and self-directed active learning, encouraging and promoting them to reach higher levels of cognitive domain of Bloom’s taxonomy. This method will be very useful in its practical implementation during online classes for ECE module in the threat of COVID 19 situation as well.

Five years trend of bacteriological profile and antibiogram of urinary tract infections at a rural medical college hospital in North Kerala, India: 2012-16

Urinary tract infections (UTI) are amongst the most common bacterial infections in developing countries. The etiology of UTI and the antibiotic resistance of uropathogenes vary in regions and change through times. Regular surveillance of the changing trends in its bacteriological profile and antibiotic sensitivity pattern is therefore mandatory. This study aims to find out the changing trends in the prevalence and antibiotic susceptibility patterns of urinary isolates of over five consecutive years. A retrospective, record based study was conducted on all culture and sensitivity (C/S) reports of urine samples obtained in the microbiology laboratory in a tertiary care centre, Central Kerala (January 2012- December 2016). The C/S reports which were positive for significant growth were analyzed to find out its prevalence and antibiotic susceptibility patterns. Descriptive statistics was used for data analysis and the results were expressed in percentages. Of the 14105, urine specimens received, 27.93% were positive. Highest rate of UTI is seen in female patients (67.58%) and geriatric age group 47.58%. and Klebsiella are the two most common isolates from all five years of study period and constituted ~ 72% of total. The year wise analysis of antibiotic resistance showed fluctuating pattern. The resistance rate to drugs like Piperacillin –tazobactam and carbepenem showed increasing drug resistance. was found to be more sensitive to Amikacin and nitrofurantoin. Drug resistant strains are markedly high in our area. Antibiotic resistance does not show a consistent trend over years and vary from region to region. Therefore each institution should have an antibiotic policy based on the local antibiogram which is to be renewed regularly.

Comparison of correlation of various methods of gestational age assessment in term neonates

Knowledge of gestational age of newborn babies may modify the details of their care. Though gestational age is usually calculated from the date of mother’s last menstrual period this date is not known with certainty in large majority of pregnancy. In others there may be misleading information especially when the menstrual cycle is irregular, when conception is shortly after a previous pregnancy or when the mother was taking oral contraceptives shortly before conception. Hence the need of multiple modalities to confirm the gestational age and the reliability of modalities is a major concern. Our study is undertaken to compare the correlation of gestation age assessment by three methods viz., gestational age assessment by last menstrual period dates, gestational age assessment by last trimester ultrasound and gestational assessment by post-natal assessment of modified Ballard score. This study is a prospective study conducted in a rural medical college hospital. Total of 150 term babies were enrolled in the study. Duration of the study was two years. The gestational age of the neonates was calculated by all 3 methods and the correlation was assessed. The study concluded that the modified Ballard score overestimates the gestational age and the third trimester ultrasound underestimates the gestational age.

A Clinical Study of Kerosene Poisoning Among Children in a Rural Medical College Hospital

A Clinical Study of Kerosene Poisoning Among Children in a Rural Medical College Hospital