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Background: Development of esophageal varices is one of the major complications of liver cirrhosis, and endoscopy is used to see the presence, grading, and long-term monitoring of esophageal varices which is an invasive and unpleasant procedure. There is no adequate data available showing noninvasive methods can be used for the same. Methods: Seventy patients with liver cirrhosis participated in the study. Factors like portal vein diameter, spleen size, platelet count, serum bilirubin, Child-Pugh score, prothrombin time (PT), and PT INR were observed and correlated endoscopically with the presence and grading of esophageal varices in all patients. Results: The platelet count, portal vein diameter, serum bilirubin, spleen bipolar diameter, and PT had statistically significant correlations with the presence of varices. Among them, platelet count, portal vein diameter, and serum bilirubin also had statistically significant correlations with the grading of varices. Monitoring of these noninvasive parameters can help in monitoring variceal growth. Conclusions: Noninvasive parameters can be used effectively to predict the presence and grading of esophageal varices and at the same time keep the rate of undiagnosed varices acceptably low. By using noninvasive parameters, patients can be benefited by decreasing the requirement of repeated endoscopic evaluation which is an unpleasant procedure and availability is also limited.
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Background: Exemplars are the graded responses to theory questions from previous examinations and are considered as means to guide students about what is valued by assessors; hence giving feed forward to students before the exam and developing self-regulated learning among students. The present study was undertaken to compare the effect on performance of students between intervention (didactic lecture and exemplar) and control group (didactic lecture). Methods: This study was an interventional study conducted among 256 students of a medical college in Rajasthan, India. Participants were randomized to either the control group A or to the interventional group B. Outcomes included a post intervention test evaluating the knowledge gained after the session and students 'attitudes about the same. A focus group discussion was conducted investigating the perceptions. The feedback from faculty was also taken. Results: The mean post test score of intervention group was found to be 6.1 ± 1.74 and of the control group was 5.5 ± 1.6; significantly higher with p-value of 0.03. Out of 128 participants in group B, majority (n = 94,73%) believed that exemplars improve learning and created their interest in topic (n = 78, 60.9%). Most of students (66%) were of the opinion that exemplars should be regularly used with didactic lectures. Key themes identified from focus group were: advantages of the exemplars-based feedforward, challenges in implementation and ways to improve the method. Conclusion: Exemplars improved the performance of students. The faculty members and students agreed that they are an effective tool to enhance learning.
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Background: Dengue fever is a mosquito borne disease commonly manifest leucopoenia and thrombocytopenia. Dengue fever and its complications like bleeding manifestation can be life threatening. This study was conducted to study the effect of doxycycline and doxycycline with carica papaya on thrombocytopenia and leucopoenia in acute dengue fever patients. Methods: This case control study was conducted amongst the patients suffering from dengue fever with thrombocytopenia. Cases were dengue patients with thrombocytopenia and leucopenia both. Controls were dengue patients with thrombocytopenia with normal leukocyte count. An effect of doxycycline and doxycycline with carica papaya was observed on platelet and leukocyte counts at baseline and first, second, fourth, and seventh day in cases and comparison was done. Results: The maximum improvement in mean platelet count and leukocyte count was observed in doxycycline with carica papaya group followed by doxycycline alone group followed by controls (conservative treatment) in decreasing order on day 4th and 7th day of admission. Reduced hospital stay was also in the same order. Conclusion: The study results indicate that doxycycline and carica papaya are useful modality to improve leucopenia and thrombocytopenia in dengue patients and to minimize hospital stay.
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Background The COVID-19 vaccination was launched in a phased manner by the government of India prioritizing healthcare workers. This study assessed the perception of healthcare workers regarding COVID-19 vaccination. Methods This cross-sectional study was conducted among healthcare workers vaccinated at a tertiary care center of southern Rajasthan. Logistic regression analysis was used to note the association of perception regarding vaccine safety and other variables. Results Out of 3,102, 56.8% were male, and the majority (73.7%) were in the age range of 20-35 years. Out of the total, 80.7% and 73.2% of subjects perceived the vaccine as safe and effective, respectively. The perception regarding the timing of rolling out of vaccine and readiness for COVID-19 appropriate behavior after vaccination was statistically significant (p<0.001). The commonest undesirable effect following vaccination was pain at the injection site. Most of the subjects did not report undesirable effects following vaccination. Logistic regression analysis showed that the involvement in the direct care of COVID-19 patients (OR: 1.58; 95% CI: 1.29, 1.94), the experience of COVID-19 infection in the past (OR: 0.68; 95% CI: 0.50, 0.91), the timing of the rollout of vaccine (OR: 3.60; 95% CI: 3.24, 4.10) showed a significant association with perception of the safety of COVID-19 vaccine. Conclusions The vaccine was perceived safe and effective by healthcare workers and reported minimal undesirable effects. The COVID-19 vaccine safety is also dependent on the past COVID-19 infection, involvement in patient care, and time of rollout of the vaccine.
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BACKGROUND: It has been over a year since the declaration of novel coronavirus disease (COVID-19) as pandemic by World Health Organization on March 11, 2020. Although mortality in India is low, as compared to western countries, the steady increase in the number of cases is still a worrying sign. The objectives of this study were to identify and quantify the association between sociodemographic and clinical characteristics with mortality among patients, suffering from COVID-19 at a tertiary care hospital in Udaipur, Rajasthan. MATERIAL AND METHODS: This retrospective observational study involved 824 patients hospitalized for COVID 19 at a tertiary hospital in Udaipur, who were discharged or had died. Electronic health records of the patients were accessed to retrieve the sociodemographic information (age, gender, residence, religion, socioeconomic status), history of exposure, clinical characteristics on admission, comorbidities, and outcomes (recovery or death). The Cox regression model was used to calculate associations between mortality and baseline characteristics in the form of hazard ratios (HRs). RESULTS: Mortality in this study was found to be 5.82%. The mean age of the patients was 48.14 ± 16.2 years. The median time from time of admission to discharge was 8 days (interquartile range (IQR) 5-11), whereas the median time to death was 5 days (IQR 4-10). The variables found to be associated with higher mortality were age (HR 1.17; 95% confidence interval (CI) 1.15-1.24), residing in urban area (HR 1.29; 95% CI 1.17-2.15), diabetes mellitus (HR 1.3; CI 1.02-5.57), and patients having both diabetes and hypertension (HR 2.4; CI 1.69-3.14). CONCLUSION: Sociodemographic variables and comorbidities impact the mortality among COVID 19 patients. The variables most clearly associated with a greater hazard of death were older age, urban area, diabetes, and having both diabetes and hypertension.
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BACKGROUND: Indian subcontinent has highest rates of cardiovascular diseases (CVDs) worldwide. Metabolic syndrome (MS) is a condition which can lead to many complications including CVDs. Most of the studies in India have been done about prevalence of MS; this study intends to study their awareness and perceptions about CVD risk factors, which can help to plan and implement the educational health programs in a better and effective manner to prevent complications in these patients. MATERIALS AND METHODS: It was a cross-sectional study conducted from April 2017 to March 2018 in a teaching hospital of Udaipur, Rajasthan. It involved 402 patients of MS diagnosed using National Cholesterol Education Program - Adult Treatment Panel III criteria with an anthropometric modification of waist circumference (WC) value that is specifically applicable to South Asians. A 43-item questionnaire was used to assess knowledge, attitude, and health-seeking behavior (KAP) toward CVD disease risk factors. KAP scores were characterized into poor, average, and good. Data were analyzed using descriptive statistics, Chi square, and ANOVA. RESULTS: Majority (58%) of the MS patients were males and belonged to middle socioeconomic status (63%). The study subjects were found to have average knowledge and good attitude but poor practices. Males, patients with lower WC, and lower fasting blood sugar showed significantly better knowledge scores. Good attitude scores were associated with education and WC. Younger subjects, patients having better sugar control, and lower WC had significantly better practices. CONCLUSION: Despite having good attitude, MS patients were not following good lifestyle practices to prevent CVD. Results in this study call for intensive educational interventions required to prevent complications in these patients.