MMJ - A Journal by MIMER Medical College, Pune, India
EDITORIAL
Shashwat Banerjee

From the Editor's Desk

[Year:2017] [Month:July-December] [Volume:1 ] [Number:2] [Pages No:1]



Maharashtra Institute of Medical Education and Research, Pune, India’s scientific offering, the MIMER Medical Journal (MMJ) is a multidisciplinary periodical to showcase and share novel research and clinical studies by enthusiastic, translational research-minded medical professionals. The initiative promises high quality manuscript processing, expert peer review by experienced and practicing clinical/non clinical academicians and publishing amongst notable research papers. With publishing of high quality articles, MMJ is in the pursuit of greater readership, higher impact on research and promotion of clinical and biomedical research in the field. The manuscript submission process is non-chargeable, and in turn the review process will be very stringent to accept only the most quality-driven research manuscripts.


EDITORIAL
Derek SJ D'Souza

Integrated Bioethics in Medical Curriculum: An Essential Aspect ofMedical Education and Training

[Year:2017] [Month:July-December] [Volume:1 ] [Number:2] [Pages No:2-4]



The entire domain of medical education is presently facing many challenges on multiple fronts. There are many issues that plague the manner in which medical education is imparted and very often it is accused of being purely commercial and not patient-centered. This is further complicated by the lackadaisical manner in which some of the medical practitioners interact with the patients which does not set the right example for the students. Many of the youngsters join medical educational institutions with idealistic dreams to serve the society, relieve patients of pain or suffering, and being able to treat debilitating diseases. However, within the short span of their clinical training, they are appalled to observe the shocking reality of health science practice and experience what has been termed as "traumatic de-idealization." This is translated into a feeling of apathy toward patients who are entrusted to their care. The ultimate catastrophe happens when the newly qualified doctors, with no ideal role models to emulate, repeat these misdemeanors and another generation joins the vicious cycle of neglect and moral decay.’1,21

How to cite: D’Souza DSJ. Integrated Bioethics in Medical Curriculum: An Essential Aspect of Medical Education and Training. MIMER Med J 2017;1(2):2-4.

Source of Support: Nil.

Conflict of Interest: None declared.


ORIGINAL ARTICLE
Swati Raje, Mohit Patki, Zoha Nizami, Saudamini Oke

Evaluation of Knowledge and Practices about First Aid among Medical Student

[Year:2017] [Month:July-December] [Volume:1 ] [Number:2] [Pages No:5-8]



Objectives: To evaluate the awareness about first aid and the practical skills among MBBS students and to prepare them for providing first aid.

Methods: A 3 days course of first aid by Red Cross Society of India was arranged for the students of MBBS. It consisted of theory as well as practical sessions regarding first aid for various common situations. Feedback was taken after each session, regarding contents of the session, its presentation, and practical usefulness. Overall evaluation of the course was done on a scale of 5-1, where "5" was highest and 1 was lowest rating. Qualitative feedback was recorded with the help of open-ended questions and was analyzed separately.

Results: Maximum participants (82.2%) felt that the course was useful to them. Feedback of 45 students who attended the training shows that session of cardiopulmonary resuscitation was appreciated by maximum students, followed by that on casualty management. A minimum improvement of 40% can be seen over the pretest scores of the students. The willingness of students to be trained in first aid skills and their agreement in favor of introduction of such training at the earliest was similar to findings of other studies from Asia.

Conclusion: The study emphasizes the need for first aid training as a felt need among medical students. A 3-day training in first aid included as a part of the curriculum during the course of MBBS will be useful in preparing the medical students to face emergencies.

Key words: First aid, medical students, practical skills

How to cite: Raje S, Patki M, Nizami Z, Oke S. Evaluation of Knowledge and Practices about First Aid among Medical Students. MIMER Med J 2017;1(2):5-8.

Source of Support: Nil.

Conflict of Interest: None declared.


ORIGINAL ARTICLE
Aparna Shinde, Sandhya Kulkarni

Study of Organisms Causing Surgical Site Infections and their Antimicrobial Susceptibility Pattern in Rural Teaching Hospital

[Year:2017] [Month:July-December] [Volume:1 ] [Number:2] [Pages No:9-12]



Background: Surgical site infections (SSIs) are the most common nosocomial infection accounting for 14% healthcare-associated infections and are estimated to double the length of post-operative stay and significantly increase the cost of care. SSI rate varies between 2.5% and 41.9%. Staphylococcus aureus, Pseudomonas aeruginosa, Enterobacteriaceae, and Acinetobacter spp. are the predominant organism in SSI.

Objectives: (1) To find the incidence of post-operative surgical wound infection in clean and clean-contaminated surgeries in orthopedic, surgery, and obstetrics and gynecology ward. (2) To determine the bacteriological profile and antimicrobial susceptibility pattern of an isolate.

Materials and Methods: The prospective study was carried out for a period from June 2016 to February 2017. Approval from IEC was obtained. Patients were followed from the time of admission till discharge and also for 30 days postoperatively. The wound was examined at the time of dressing and considered infective if serous, purulent, or non-purulent discharge from the wound with sign of inflammation was seen. Sample was processed by Gram staining, culture on blood agar and MacConkey agar, biochemical tests for identification of organism. Antimicrobial susceptibility was done using disc diffusion tests.

Result: Total 100 patients were followed during the study. 15 cases were positive for SSI. Total SSI rate was 15%. Among 31 clean surgeries, 3 cases showed infection. SSI rate in clean surgery was 9.6%. Out of 69 clean-contaminated surgeries, 12 cases were positive for SSI, and infection rate in clean-contaminated surgery was 17.39%. S. aureus was the predominant organism isolated in 9 cases followed by P. aeruginosa (2), Pseudomonas species (1), Escherichia coli (1), Citrobacter species (1), and Acinetobacter (1). Staphylococcus isolated was 100% resistant to penicillin, 22.22% susceptible to cefoxitin, 55.55% susceptible to tetracycline, 44.44% sensitive to gentamicin, and 66.66% sensitive to clindamycin.

Conclusion: SSI is more common in clean-contaminated surgery as compared to clean surgery as rate increases with increase in the degree of contamination. S. aureus is the predominant organism involved in SSI. Considering the risk of methicillin-resistant S. aureus, its isolation from the surgical wound is major threat due to cross infection and multidrug-resistant strains. Reducing preoperative stay, use of pre-operative antibiotics, reducing the duration of surgery can control SSI.

Key words: Clean surgery, clean-contaminated surgery, nosocomial infection, surgical site infection

How to cite: Shinde A, Kulkarni S. Study of Organisms Causing Surgical Site Infections and their Antimicrobial Susceptibility Pattern in Rural Teaching Hospital. MIMER Med J 2017;1(2):9-12.

Source of Support: Nil.

Conflict of Interest: None declared.


ORIGINAL ARTICLE
Prajakta Sambarey, Swati Raje, Anand Gupta, Ritika Dikshit

Dealing with Complacency and Non-Compliance in Contact Lens Use and Care

[Year:2017] [Month:July-December] [Volume:1 ] [Number:2] [Pages No:13-17]



Background: Medical students often visited the Ophthalmology Department for contact lens-associated problems. Non-compliance in use and storage of contact lenses is known to cause ocular surface disorders and sight-threatening infections.

Objective: The objective of this study is to know the procedures followed in the use and care of contact lenses and to institute corrective measures.

Material and Methods: Participants were asked to fill a questionnaire along with comprehensive ocular examination and advice.

Results: Forty-six females and 31 males participated. Twenty-six (33.76%) had their lenses on the eyes for more than 8 h, and 11 (14.28%) of these wore lenses for more than 12 h. Only 5 (6.49%) participants washed hands before inserting and removing the lenses. Seventy-five (97.40%) participants washed hands before inserting lenses, and 70 (90.90%) participants washed hands while removing. All participants stored lenses in the cases. Five (6.49%) participants washed cases with tap water, and one washed with warm water. Three (3.89%) topped off the solution. No one changed the case unless worn out or lost. Only 37 (48.05%) participants were willing to undergo refractive surgery. Conjunctival papillary hyperplasia in 50 subjects, giant papillary conjunctivitis in one subject, concretions in seven, and meibomian gland dysfunction in one were the ocular surface abnormalities observed.

Conclusion: Medical students were casual and complacent in use and care of contact lenses. Proactive strategies by ophthalmologists and optometrists such as developing awareness about problems, good rapport with contact lens users, having regular feedback, and timely corrective measures are likely to improve compliance and prevent site-threatening problems.

Key words: Contact lens, feedback, non-compliance, proactive strategies

How to cite: Sambarey P, Raje S, Gupta A, Dikshit R. Dealing with Complacency and Non-Compliance in Contact Lens Use and Care. MIMER Med J 2017;1(2):13-17.

Source of support: Nil.

Conflict of Interest: None


ORIGINAL ARTICLE
Poonam Nayak, Shilpa A Pratinidhi, Gayatri More, Rajendra Zope

Association between DMFT Score and Iron Studies in Children up to 12 Years

[Year:2017] [Month:July-December] [Volume:1 ] [Number:2] [Pages No:18-22]



Background: Iron deficiency anemia (IDA) is a major health problem in both developing and developed countries. However, it can be diagnosed only by laboratory testing. Severe tooth decay is known to affect the health and well-being of children. The purpose of this research was to determine if dental checkup could be used as a screening test for IDA.

Aims and Objectives: The objective of this study is to find: (1) An association of decayed, missing, and filled teeth (DMFT) index with the serum ferritin and hemoglobin (HB) levels and (2) if DMFT index score can be used as a screening test for diagnosis of IDA.

Materials and Methods: Children were recruited as a part of a cross-sectional case-control study. They were recruited from the dental and pediatric OPD of MIMER Medical College from April 2016 to June 2016. The study included 119 cases (those with a DMFT score of more than 0) and 47 controls. The study was approved by the college ethical committee. The parents gave an informed consent and the children then underwent a venipuncture. The blood collected was sent to the central laboratory where a complete hemogram and serum ferritin was done. The data collected were analyzed using appropriate technology.

Results: The mean age was 8.5 ± 2.5 years. Overall, the mean serum ferritin concentration was 30.82 ± 20.86 ng/ml (range 6-55 ng/ml), and the mean HB level was 12.04 ± 1.24 g/dl (range 11.5-14.5 g/dl). It was found that the cases were much more likely to have lower levels of HB. It was found that there was a moderately significant negative correlation between serum ferritin and the individual scores.

Conclusion: Based on the findings from this study, we can conclude that: (1) HB levels are significantly associated with the presence of caries and (2) children with higher DMFT scores tend to have lower serum ferritin levels.

Key words: Childhood caries, dental caries, decayed, missing, and filled teeth score, iron deficiency anemia

How to cite: Nayak P, Pratinidhi SA, More G, Zope R. Association between DMFT Score and Iron Studies in Children up to 12 Years. MIMER Med J 2017;1(2):18-22.

Source of support: Nil.

Conflict of Interest: None


CASE REPORT
Supriya Kulkarni, Shilpa Gurav, Uma Gothivarekar

Anaesthetic Management of a Super Obese Patient for Emergency Lower Limb Fasciotomy

[Year:2017] [Month:July-December] [Volume:1 ] [Number:2] [Pages No:23-25]



Obesity leads to several hazardous changes in cardiovascular, respiratory, endocrine, hepatic, and renal system functions. It also causes anthropometric changes in airway as well as the whole of the areas of interest of regional anesthetic techniques. Collectively it leads to difficulties in the perioperative anesthetic management of obese patients. Emergency lower limb debridement and fasciotomy was planned for a 41-year-old male patient weighing 130 kg, 158 cm height, and a body mass index of 52 kg/m2. The patient had a history of hypertension, diabetes mellitus, hypothyroidism, and anemia. He had short neck, MPC Grade III mouth opening. Tachycardia of 120 beats/min and blood pressure of 140/80 mm Hg. Case conducted under spinal anesthesia with a 25G spinal needle, 6 mg of 0.5% bupivacaine. With adequate preloading, continuous oxygenation, use of small quantity of local anesthetic drug and appropriate positioning case was conducted without any hemodynamic changes.

Key words: Emergency fasciotomy, spinal anesthesia, super obesity

How to cite: Kulkarni S, Gurav S, Gothivarekar U. Anaesthetic Management of a Super Obese Patient for Emergency Lower Limb Fasciotomy. MIMER Med J 2017;1(2):23-25.

Source of support: Nil.

Conflict of Interest: None


CASE REPORT
Meenakshi Surve, Shashikant Pawar, Patit Paban Panigrahi

A Case Report ofFirst In mester Spontaneous Uterine Scar Rupture

[Year:2017] [Month:July-December] [Volume:1 ] [Number:2] [Pages No:26-28]



Rupture uterus during early pregnancy is very rare and will cause life-threatening compromise to mothers and fetal life. Rupture of the uterus is a disastrous complication, occurring mostly in the second and third trimesters. Spontaneous rupture uterus in early pregnancy is a rare event. The uterine rupture risk increases with previous surgeries on the uterus and uterine anomalies. Termination of early pregnancy, in women with a scarred uterus, using sublingual misoprostol can lead to uterine rupture. Placenta percreta and scar pregnancy are predisposing factors of spontaneous mid-trimester uterine rupture. Rupture uterus in early pregnancy is non-specific clinically and should be differentiated from other acute causes of abdominal emergency conditions like ectopic pregnancy. The clinical signs and symptoms of rupture uterus are nonspecific and give a very small duration for instituting definitive management, making rupture uterus during pregnancy a much dreadful situation. Herein, we report a patient with spontaneous uterine rupture in early pregnancy with serious bleeding and shock.

Key words: Rupture uterus, hemoperitoneum, exploratory laparotomy

How to cite: Surve M, Pawar S, Panigrahi PP. A Case Report of First Trimester Spontaneous Uterine Scar Rupture. MIMER Med J 2017;1(2):26-28.

Source of Support: Nil.

Conflict of Interest: None declared.


CASE REPORT
Sonali Khake, Dhanaji Jadhav, Swati Belsare

Clinical Implications of Accessory Anterior Belly of Digastric Muscle: A Case Study

[Year:2017] [Month:July-December] [Volume:1 ] [Number:2] [Pages No:29-30]



The digastric is one of the suprahyoid muscle has an anterior belly, intermediate tendon, and posterior belly. Variation in the digastric muscle is not seen very often. We report a case of unilateral accessory anterior belly of digastric on the right side, which was detected during routine dissection of 65-year-old male cadaver. The accessory belly was medial to the anterior belly of the right digastric, had tendinous attachment on the mandible and fleshy attachment on greater cornua of hyoid bone. It is important to be aware of possible occurrences of such anomalies during surgical and radiological procedures of the neck region.

Key words: Accessory anterior belly, diagastric muscle, suprahyoid muscle

How to cite: Khake S, Jadhav D, Belsare S. Clinical Implications of Accessory Anterior Belly of Digastric Muscle: A Case Study. MIMER Med J 2017;1(2):29-30.

Source of support: Nil.

Conflict of Interest: None


CASE REPORT
Smita Pathak, Shruti Desale, Sneha Joshi

Hidradenoma Papilliferum of the Vulva - A Case Report

[Year:2017] [Month:July-December] [Volume:1 ] [Number:2] [Pages No:31-33]



Hidradenoma papilliferum is a rare benign cystic and papillary neoplasm arising from apocrine glands. It occurs commonly on the vulval or perianal regions of middle-aged women. The present case is a 36-year-old female patient who presented with an asymptomatic nodule of 2 months duration in the vulval region. Hidradenoma papilliferum characteristically occurs in the anogenital region of women between the ages of 30 and 49 years. Clinically, the neoplasm is a unilateral asymptomatic, skin colored papule or nodule approximately 0.5 cm in diameter. Treatment of choice is local excision. Simple excision is usually curative, however, because malignant transformation has been reported, long-term clinical follow-up is suggested.

Key words: Apocrine, hidradenoma papilleferum, vulva

How to cite: Pathak S, Desale S, Joshi S. Hidradenoma Papilliferum of the Vulva - A Case Report. MIMER Med J 2017;1(2):31-33.

Source of support: Nil.

Conflict of Interest: None


CASE REPORT
Janice Jaison, Rupali Katre, Sneha Joshi

Primary Fallopian Tube Carcinoma: A Case Report

[Year:2017] [Month:July-December] [Volume:1 ] [Number:2] [Pages No:34-36]



Primary fallopian tube carcinoma (PFTC) is an uncommon tumor accounting for approximately 0.14-1.8% of female genital tract malignancies. We report a case of PFTC in a 65-year-old female who presented with abdominal pain and watery vaginal discharge. The peak incidence of PFTC is between the ages of 60 and 64 years. Very often the diagnosis is mistaken for an ovarian carcinoma or a tubo-ovarian mass. The criteria for the diagnosis of primary tubal carcinoma should be very rigid. In primary tubal carcinoma, the uterus and ovaries should appear largely normal on gross examination. The prognosis of tubal carcinoma depends more on staging than histologic grade. Invasion of tubal serosa, of the ovary or corpus uteri, or of other pelvic and abdominal structures indicate poor prognosis.

Key words: Carcinoma, primary fallopian tube, total abdominal hysterectomy, serous papillary adenocarcinoma

How to cite: Jaison J, Katre R, Joshi S. Primary Fallopian Tube Carcinoma: A Case Report. MIMER Med J 2017;1(2):34-36.

Source of support: Nil.

Conflict of Interest: None


CASE REPORT
Sunaina Thakur, Sapna Parab

Case of Nasal Glial Heterotopia: A Diagnostic Dilemma

[Year:2017] [Month:July-December] [Volume:1 ] [Number:2] [Pages No:37-40]



Nasal glial heterotopia (nasal glioma) is a mass of mature brain tissue isolated from cranium, located mostly on the nasal bridge. We present a case of nasal glial heterotopia in a 1-year-old female child. She came with a swelling over nasal dorsum since birth which was fluctuant, non-tender. It did not increase on crying or coughing. Computed tomography scan showed soft tissue density over nose with extension in between nasal bones, no intracranial extension but a small oval defect in crista galli anteriorly. Based on the clinical picture we made a provisional diagnosis of congenital nasal dermoid. Child was taken for excision of mass under general anesthesia once her blood parameters were normal. The mass was approached through a central midline incision over nose. The adherent posterior part of the mass was dissected meticulously from the nasal bones without any residual damage. Histopathological examination of the mass revealed it to be nasal glial heterotopia.

Key words: Mass, nasal glial heterotopia, nasal dorsum

How to cite: Thakur S, Parab S. Case of Nasal Glial Heterotopia: A Diagnostic Dilemma. MIMER Med J 2017;1(2):37-40.

Source of Support: Nil.

Conflict of Interest: None declared.