Status of mental stress among medical students: Experience from medical colleges in Bihar

Background: Admission in medical colleges exposes students to a new educational environment. Then, they encounter the pressure of huge syllabus, language hurdles, peer stress, stress of hostel life, etc. The coping capability in these stressful conditions varies student to student. Aim and Objectives: In this study, we aimed to ascertain the level of stress assessed by a validated questionnaire among first-year medical students. Materials and Methods: This was an online survey-based study. A validated questionnaire Kessler Psychological Distress Scale (K10) was used to ascertain the level of perceived stress. The questionnaire assesses the perceived stress for the past 1 month period. Questionnaire link was distributed among 200 students. Data were tabulated and presented by descriptive statistical tests such as mean, standard deviation, and percentage. The inferential statistical test – Chi-square test and ANOVA were conducted in Microsoft Excel 2010. Results: A total 103 student submitted completed questionnaire (survey response rate 51.5%). Among the students, 27.18% was in “no stress” category and 72.82% was among different level of “stress” category. Among the stressed students, 39.81% was in “mild stress,” 18.45% was in “moderate stress,” and 14.56% was in “severe stress.” Mean score of these four groups showed statistically significant (P < 0.001) difference when tested by ANOVA. Conclusion: The majority of medical students have mild stress. A significant percent also suffers from moderate-to-severe stress. Teacher and the stakeholders should take necessary steps to help those students in coping up with stress related to studies by counseling and other interventions.

Study of biofilm formation in bacterial isolates from contact lens wearers

Purpose: To detect biofilm forming capacity of bacterial isolates obtained from the conjunctiva, contact lens and accessories of contact lens wearers using phenotypic and genotypic methods. Methods: Bacterial strains were collected from the conjunctiva, contact lens and lens storage cases of contact lens wearers. The phenotypic detection of biofilm production was done using the tube method and congo red agar method. The biofilm-forming related genes, icaA, of Coagulase negative Staphylococcus (CONS) and Staphylococcus aureus, and pslA, of P. aeruginosa, were detected using PCR. Results: A total of 265 bacterial isolates which included S. aureus, CONS, Pseudomonas, Nil-fermenter Gram-negative bacilli (NFGNB), Bacillus spp, Diphtheroids, Micrococci, Klebsiella pneumonia, Klebsiella oxytoca, E. coli, Proteus mirabilis, Proteus vulgaris, Citrobacter koseri, Citrobacter freundii, Enterobacter cloacae, Moraxella were obtained. Of the 265 isolates, 53.5% were moderately positive, 33.2% strongly positive and 13.2% negative for biofilm production by tube method and 36.6% were moderately positive, 40% strongly positive and 23.3% negative for biofilm production by congo red agar method. Of the four S. aureus isolates, two (50%) showed the presence of icaA gene. Of the 23 CONS isolates, three (13%) showed the presence of icaA gene. All the Pseudomonas isolates were negative for presence pslA (1119 bp) gene though most of them were phenotypically positive for biofilm formation. Conclusion: Most of the bacterial isolates obtained from contact lens wearers had the potential to produce biofilms. Tube method and Congo red agar method exhibited significant statistical correlation (P-value = 0.006) and picked up a good number of biofilm-forming isolates, hence may be used for detection of biofilm production. The absence of biofilm-forming gene did not rule out the possibility for phenotypic biofilm production by bacteria.

Yet another Experiment in Medical Education

The problem of searcity of doctors for providing services to the nation is a matter of great concerned Recently T.O.I. 21-04-2019 documented that Government desired a bridge course for dental surgeon to practice the family medicine to overcome the shortage of serving doctors for the society. Recently we have also noticed a great change in MCI and the new establishment wants a great change in curriculum and syllabus and another system of learning process have been introduced in medical education. Medical colleges have been directed to switch over the new system of learning curriculum in UG. I do not know what motive conquered their concept of mind to reach at this new course model? How do they feel to bring a drastic change in medical education system, knowing that nothing have changed in civic perception of medical benefit at mass T.O.I. 09-06-2019 published an article “How Medical education became a business, one policy change at a time, more to lift fee cap one more step towards commercialization, say activists.” This requires further sensitization of the medical field. It is morbid attempt.

Cyberbullying among late adolescent: A cross-sectional study in two higher secondary schools of Kolkata, West Bengal

Cyberbullying is a newer phenomenon which is becoming more prevalent among adolescent students with the use of information technology. The objective of the study was to determine the prevalence of being cyberbullied among late adolescent and to study the behavior and the attitude on cyberbullying. It was a cross-sectional study conducted on 254 school students (15� years). Data were collected by self-administered questionnaire, and results were analyzed using SPSS version 20. About 210 (82.7%) students were using any form of social networking site and out of which 22 (10.5%) students were cyberbullied. Among those who were cyberbullied, the majority (16 [72.7%]) had no opinion and more than half (15 [68.2%]) sought their friends' help. Cyberbullying is emerging as a newer social problem in our country, where students' lack of awareness and understanding of it results in underreporting of cyberbullying incidents.

Orchitis: An unusual presentation of polyarteritis nodosa

Polyarteritis nodosa (PAN), a systemic necrotizing vasculitis with multiorgan development, is generally restricted to the medium-sized muscular arteries. The varied initial clinical presentations of PAN can lead to a delayed diagnosis. We present the case of a middle-aged male patient who presented with an acute onset right-sided testicular pain as the initial clinical symptom with ischemic changes on ultrasonogram, thereby requiring orchiectomy. This was reported to be a case of tubercular epididymo-orchitis. On review, the biopsy revealed features of necrotizing arteritis as seen in PAN with fibrinoid necrosis and giant cells, thus highlighting the fact that vasculitis due to PAN may have a localized presentation at the time of diagnosis. PAN should be distinguished from other causes of epididymo-orchitis and other vasculitis lesions, the most common being tubercular etiology in the Asian population.

Research in Post graduate Programme

Research orientation in postgraduation is must to understand the natures gift which has become unknown. Interpretation of the outcome further ignite the brain to nurture the event of awareness towards the human benefit is more important. Training, information and laboratory discipline results in innovative work. Honesty in work following protocol could lead towards real attempt of scientific understanding. Determination, devotion and transparency will lay the result for the documentation of the research.

Present Trend in Medical Research in Anatomy.

Background: Effort has been made to assess the recent trend in Medical research especially related to Anatomy. Anatomy being foundation subject requires a fundamental approach to the study of its fabrics. It is therefore required that the Anatomists should work more on the basic principles of Human structure. Trends in Anatomy changes as per the availability of the infrastructure of the medical research. In India the facilities for the basic research is not upto the desired level, which could be reflected by the articles being published in National and International Journals and even by deliberation of their work in various forums. Methods: We have taken efforts to go in depth to find out the present trends in research in Anatomy by analyzing and taking help of the papers being presented in National Conference of Anatomy held recently in November 2015 at King George Medical University Lucknow. Results: It has been observed that there is a gradual decline of research related to the Animal Experimentation, which is required for in vivo screening of the embryopathic drugs which could be helpful for screening the mechanism of Teratogenecity. Availability of cadavers is also not upto the mark where people could do some research on Gross Anatomy and Oesteology. Conclusion: Sporadic research may not be very helpful in contributing to the field of Anatomy. Institutes/Medical Colleges should be given due importance in view to have a good infrastructure for the attraction of research in Anatomy to unfold some of the gaps in the description of Anatomy. This will certainly supplement its clinical values in the treatment of patients.

Non‑polio Enteroviruses in Karnataka, India: Virological surveillance of acute flaccid paralysis cases (July 1997–2013).

Background and Objectives: Since 1997 National Institute of Virology, Bangalore Unit involved in WHO's Acute flaccid paralysis paediatric cases surveillance programme to isolate and detect polioviruses. Stool samples yielded not only polioviruses but also Non-Polio enteroviruses. This report is an overview of non‑polio Enterovirus (NPEV) epidemiology in Karnataka state, India for the period of 16‑years and 6 months from July 1997–2013. Methods: A total of 19,410 clinical samples were processed for virus isolation as a part of acute flaccid paralysis (AFP) surveillance for Global Polio Eradication Programme in India at National Polio Laboratory, at Bengaluru. NPEV detection was performed by virus isolation on cell culture according to World Health Organisation recommended protocols. Results: A total of 4152 NPEV isolates were obtained. The NPEV isolation rate varied from year to year but with a total NPEV rate of 21.39%. Conclusion: A seasonal variation was noted with high transmission period between April and October with peaks in June–July. The male to female ratio was 1:1.2. The isolation of NPEV decreased significantly with the increase in age. Epidemiology of NPEVs from AFP cases in Karnataka is described.

Mumps disease outbreak in Davangere district of Karnataka, India.

Background: Mumps is a vaccine-preventable disease that usually occurs as a parotitis, but it can also lead to several life- threatening complications, including pancreatitis, meningitis and encephalitis. Objective: To determine and diagnosis of mumps disease, which is communicable disease usually affects childrens. Although it is seen worldwide, but outbreaks not common in India. Materials and Methods: Thirty one suspected mumps cases, who presented to the unimmunized population of Chikkahallivana village in Davangere district of Karnataka, India in January 2014, with clinical evidence of fever, cervical lymphadenitis and ear pain, manifest with self-limited uni-or bilateral parotitis. A total of 31 cases consisting of 31 blood and 31 throat swabs were tested for diagnosis of mumps disease. Results: Of the 31 suspected cases, laboratory results showed 18 positive for mumps IgM antibodies and 7 cases showed presence of mumps virus RNA by RT-PCR using MV specific nested primers. From 31 cases, 5 were positive with both the methods. Conclusion: We confirmed the cases by serological as well as a sensitive RT-nested PCR-based method and sequencing results for the molecular identification of mumps infection. Sequencing results of the SH gene identified outbreak strain as genotype C, which was consistent with other outbreaks in India.

Smokeless tobacco use: A meta-analysis of risk and attributable mortality estimates for India.

BACKGROUND: Use of smokeless tobacco (SLT) is widely prevalent in India and Indian subcontinent. Cohort and case–control studies in India and elsewhere report excess mortality due to its use. OBJECTIVE: The aim was to estimate the SLT use‑attributable deaths in males and females, aged 35 years and older, in India. MATERIALS AND METHODS: Prevalence of SLT use in persons aged 35 years and older was obtained from the Global Adult Tobacco Survey in India and population size and deaths in the relevant age‑sex groups were obtained from UN estimates (2010 revision) for 2008. A meta‑relative risk (RR) based population attributable fraction was used to estimate attributable deaths in persons aged 35 years and older. A random effects model was used in the meta‑analysis on all‑cause mortality from SLT use in India including four cohort and one case–control study. The studies included in the meta‑analysis were adjusted for smoking, age and education. RESULTS: The prevalence of SLT use in India was 25.2% for men and 24.5% for women aged 35 years and older. RRs for females and males were 1.34 (1.27–1.42) and 1.17 (1.05–1.42), respectively. The number of deaths attributable to SLT use in India is estimated to be 368127 (217,076 women and 151,051 men), with nearly three‑fifth (60%) of these deaths occurring among women. CON CLUSION: SLT use caused over 350,000 deaths in India in 2010, and nearly three‑fifth of SLT use‑attributable deaths were among women in India. This calls for targeted public health intervention focusing on SLT products especially among women.

Rising incidence of oral cancer in Ahmedabad city.

CONTEXT: In 1999, an increase in mouth cancer incidence among young men (<50 years) in urban Ahmedabad was reported to be occurring along with decreasing mouth cancer incidence in older age groups and increasing oral submucous fibrosis incidence associated with areca nut consumption among young men in Gujarat. The aim was to investigate whether the increase in the incidence mouth cancer that had started among young men in the 1990s was continuing. SETTINGS AND DESIGN: Ahmedabad urban population, comparison of reported mouth cancer cases in the population across four time period. METHODS: Age‑specific incidence rates of mouth cancer (International Classification of Diseases [ICD]‑9:143–5; ICD‑10:C03–06) in five year age groups among men aged ≥15 years for the city of Ahmedabad for years 1985, 1995, 2007 and 2010 were extracted from published reports. For comparison, lung cancer (ICD‑9:169; ICD‑10:C33–C34) rates were also abstracted. STATISTICAL ANALYSIS USED: A cohort approach was used for further analysis of mouth cancer incidence. Age adjusted incidence rates of mouth and lung cancer for men aged ≥15 years were calculated and compared. RESULTS: The age specific incidence rates of mouth cancer among men increased over the 25‑year period while lung cancer rates showed a net decrease. Using a cohort approach for mouth cancer, a rapid increase in younger age cohorts was found. CONCLUSIONS: Mouth cancer incidence increased markedly among men in urban Ahmedabad between 1985 and 2010, apparently due to increasing consumption of areca nut products, mawa and gutka. Gutka has now been banned all over India, but a more vigorous implementation is necessary.

Levels and trends of smokeless tobacco use among youth in countries of the World Health Organization South-East Asia Region.

BACKGROUND: At least two rounds of the Global Youth Tobacco Survey (GYTS) have been completed in most of the countries in the World Health Organization South‑East Asia region. Comparing findings from these two rounds provides trend data on smokeless tobacco (SLT) use for the first time. METHODS: This study uses GYTS data from Bangladesh, Bhutan, India, Indonesia, Maldives, Myanmar, Nepal, Sri Lanka, Thailand, and Timor‑Leste during 2006–2013. GYTS is a nationally representative survey of 13–15‑year‑old students using a consistent and standard protocol. Current SLT use is defined as using any kind of SLT products, such as chewing betel quid or nonbetel quid or snuffing any other products orally or through the nasal route, during the 30 days preceding the survey. Prevalence and 95% confidence intervals were computed using SAS/SUDAAN software. RESULTS: According to most recent GYTS data available in each country, the prevalence of current use of SLT among youth varied from 5.7% in Thailand to 23.2% in Bhutan; among boys, from 7.1% in Bangladesh to 27.2% in Bhutan; and among girls, from 3.7% in Bangladesh to 19.8% in Bhutan. Prevalence of SLT was reported significantly higher among boys than girls in Bhutan (boys 27.2%; girls 19.8%), India (boys 11.1%; girls 6.0%), Maldives (boys 9.2%; girls 2.9%), Myanmar (boys 15.2%; girls 4.0%), and Sri Lanka (boys 13.0%; girls 4.1%). Prevalence of current SLT use increased in Bhutan from 9.4% in 2009 to 23.2% in 2013, and in Nepal from 6.1% in 2007 to 16.2% in 2011. CONCLUSION: The findings call for countries to implement corrective measures through strengthened policy and enforcement.

Dual use of tobacco among Bangladeshi men.

INTRODUCTION: Dual use of tobacco (using smoking and smokeless forms) in Bangladesh is uncommon in women but common in men. Dual users are at additional risk of cancers and heart diseases compared with a single form of tobacco use. Knowledge about their socioeconomic background is necessary for planning appropriate interventions. We report here socioeconomic background of the dual users of tobacco from a nationally representative survey. METHODS: The study adopted a probability proportionate to size sampling technic of divisional population stratified into urban and rural areas to recruit men aged 25 years or older from their households. A total of 4312 men were recruited. Variables included questions on 20 household assets, tobacco use and other behavioral risk factors, and measurement of body weight and height. RESULTS: The average age of dual users was 46.7 years old compared to 43.4 and 52.3 years for smokers and smokeless tobacco users. Prevalence of “smoking only,” “smokeless only” and “dual use” of tobacco was 40.6%, 15.2%, and 14.2%, respectively. Among all tobacco users, dual users constituted 20%. These dual users had lower educational achievement, rural residence, lower intake of fruit, and higher intake of alcohol. They were more undernourished as indicated by a thin body mass index compared to nonusers and smokers. Dual users were of socioeconomically deprived as measured by wealth quartiles constructed out of household assets. CONCLUSION: Dual use of tobacco is common in Bangladesh, and it is intimately linked with socioeconomic deprivation. Poverty reduction strategy and campaigns should address tobacco control not only tobacco in general, but its dual use in particular.

Prevalence and sociodemographic determinants of tobacco use in four countries of the World Health Organization: South-East Asia region: Findings from the Global Adult Tobacco Survey.

INTRODUCTION: Tobacco use is a leading cause of deaths and Disability Adjusted Life Years lost worldwide, particularly in South‑East Asia. Health risks associated with exclusive use of one form of tobacco alone has a different health risk profile when compared to dual use. In order to tease out specific profiles of mutually exclusive categories of tobacco use, we carried out this analysis. METHODS: The Global Adult Tobacco Survey (GATS) data was used to describe the profiles of three mutually exclusive tobacco use categories (“Current smoking only,” “Current smokeless tobacco [SLT] use only,” and “Dual use”) in four World Health Organization South‑East Asia Region countries, namely Bangladesh, India, Indonesia and Thailand. GATS was a nationally representative household‑based survey that used a stratified multistage cluster sampling design proportional to population size. Prevalence of different forms of usage were described as proportions. Logistics regression analyses was performed to calculate odds ratios (OR) with 95% confidence intervals. All analyses were weighted, accounted for the complex sampling design and conducted using SPSS version 18. RESULTS: The prevalence of different forms of tobacco use varied across countries. Current tobacco use ranged from 27.2% in Thailand to 43.3% in Bangladesh. Exclusively smoking was more common in Indonesia (34.0%) and Thailand (23.4%) and less common in Bangladesh (16.1%) and India (8.7%). Exclusively using SLT was more common in Bangladesh (20.3%) and India (20.6%) and less common on Indonesia (0.9%) and Thailand (3.5%). Dual use of smoking and SLT was found in Bangladesh (6.8%) and India (5.3%), but was negligible in Indonesia (0.8) and Thailand (0.4%). Gender, age, education and wealth had significant effects on the OR for most forms of tobacco use across all four countries with the exceptions of SLT use in Indonesia and dual use in both Indonesia and Thailand. In general, the different forms of tobacco use increased among males and with increasing age; and decreased with higher education and wealth. The results for urban versus rural residence were mixed and frequently not significant once controlling for the other demographic factors. CONCLUSION: This study addressed the socioeconomic disparities, which underlie health inequities due to tobacco use. Tobacco control activities in these countries should take in account local cultural, social and demographic factors for successful implementation.

Improvement in prevalence of tobacco use among teachers in Bihar after COTPA.

CONTEXT: A high prevalence of tobacco use, even among educated professionals like teachers, has been reported from Bihar. After passing of the Cigarette and Other Tobacco Products Act (COTPA) in 2003, there have been major improvements in tobacco control nationwide. AIMS: To compare tobacco use prevalence among school teachers in Bihar reported in 2000 with a survey in 2008 and investigate correlates of current and past tobacco‑use. METHODS: Data from the baseline survey of a cluster random sample of 72 government schools conducted during the beginning of two consecutive school years was analyzed. RESULTS: The prevalence of current tobacco use was 35.5% and past use, 11.3%. Likelihood of current use compared with no use increased with age (odds ratio [OR] =3.27 for > 50 years compared to < 30, 95% confidence interval [CI]: [1.50, 7.13]); whereas that of past use compared to current use decreased (OR = 0.25, 95% CI: [0.09–0.68] for age > 50 years compared to < 30 years). DISCUSSION: Compared to the tobacco use prevalence among Bihar school teachers reported from a survey in the year 2000 (77.4%), the prevalence in this survey in 2008 was much lower and past use, much higher. In the earlier survey, lal dantmajan was counted as a tobacco product. If we do the same in the current survey, and consider ever use, the prevalence even then was 53.9%, lower than the earlier figure. Although the tobacco use among teachers in Bihar is still high, it has decreased after the implementation of COTPA and the cessation has increased.

Influence of tobacco industry advertisements and promotions on tobacco use in India: Findings from the Global Adult Tobacco Survey 2009-2010.

INTRODUCTION: The developing world, including countries like India, has become a major target for the tobacco industry to market its products. This study examines the influence of the marketing (advertising and promotion) of tobacco products on the use of tobacco by adults (ages 15 and over) in India. METHOD: Data from Global Adult Tobacco Survey 2009–2010 was analyzed using methods for complex (clustered) sample designs. Multivariate logistic regression was employed to predict the use of different tobacco products by level of exposure to tobacco marketing using adults who have never used tobacco as the reference category. Odds ratios (ORs) were adjusted for education, gender, age, state of residence, wealth index, and place of residence (urban/rural). RESULTS: Adults in India were almost twice as likely to be current smokers (versus never users) when they were exposed to a moderate level of bidi or cigarette marketing. For bidis, among adults with high exposure, the OR for current use was 4.57 (95% confidence interval [CI]: 1.6, 13.0). Adults were more likely to be current users of smokeless tobacco (SLT) with even a low level of exposure to SLT marketing (OR = 1.24 [95% CI: 1.1, 1.4]). For SLT, the ORs showed an increasing trend (P for trend < 0.001) with greater level of exposure (moderate, OR = 1.55 [95% CI: 1.1, 2.2]; high, OR = 2.05 [95% CI: 0.8, 5.1]). The risk of any current tobacco use rose with increasing level of exposure to any marketing (minimum, OR = 1.25 [1.1–1.4]; moderate, OR = 1.38 [1.1–1.8]; and high, OR = 2.73 [1.8–4.2]), with the trend highly significant (P < 0.001). CONCLUSION: Exposure to the marketing of tobacco products, which may take the form of advertising at the point of sale, sales or a discounted price, free coupons, free samples, surrogate advertisements, or any of several other modalities, increased prevalence of tobacco use among adults. An increasing level of exposure to direct and indirect advertisement and promotion is associated with an increased likelihood of tobacco use.

An assessment of the effectiveness of tobacco control measures on behavior changes related to tobacco use among adolescents and young adults in a district in Sri Lanka.

Introduction: Sri Lanka became a signatory to the WHO Frame Work Convention on Tobacco Control in September 2003, and this was ratified in November 2003. With a view to reduce the use of tobacco in Sri Lanka, the National Authority on Tobacco and Alcohol Act (NATA) No. 27 of 2006 was implemented. Aim: To assess the behavior changes related to tobacco use among adolescents and young adults following exposure to tobacco control measures were implemented by NATA. Materials and Methods: A case-control study was conducted on 42 adolescent (aged 13-19 years) and 156 young adult (aged 20-39 years) men living in Anuradhapura Divisional Secretary area in Sri Lanka. Cases (current quitters) and controls (current smokers) were compared to ascertain the outcome following the exposure to tobacco control measures. A self-administered questionnaire and focus group discussions were used to ascertain the exposure status in cases and controls. Confounding was controlled by stratification and randomization. Univariate analysis was performed by Backward Stepwise (Likelihood Ratio) method. Results: Among 198 respondents, 66 (27.3% adolescents and 72.7% young adults) were quitters, while 132 smokers (18.2% adolescents and 81.8% young adults) were current smokers. Exposure to the anti-smoking media messages revealed that TV was the strongest media that motivated smokers to quit smoking. Majority (66%) of cases and control were not exposed to tobacco promotion advertisements, while 47% of the cases and 50% of the control had never seen tobacco advertisements during community events. All cases (66) as well as 89% (118) of the control had not noticed competitions or prizes sponsored by tobacco industry during last year ( P = 0.13). Conclusion: Tobacco control measures implemented by NATA had a favorable influence on behavior change related to smoking among quitters and current smokers.

Tobacco use and cessation counseling in India-data from the Global Health Professions Students Survey, 2005-09.

Context: Tobacco use by health professionals reflects the failure of healthcare systems in protecting not only beneficiaries of the system but also those involved in health care delivery. Aim: The aim of this study was to report findings from the Global Health Professions Students Survey (GHPSS) conducted in medical, dental, nursing and pharmacy schools in India. Settings and Design: A cross-sectional survey was conducted in Indian dental and medical schools (in 2009), nursing (in 2007), and pharmacy (in 2008) schools. Materials and Methods: Anonymous, self-administered GHPSS questionnaire covering demographics, tobacco use prevalence, secondhand smoke (SHS) exposure, desire to quit smoking and training received to provide cessation counseling to patients was used. Statistical Analysis: Proportions and prevalence were computed using SUDAAN and SPSS 15.0. Results: Current cigarette smoking and other tobacco use ranged from 3.4-13.4% and 4.5-11.6% respectively, in the four health professional schools, with the highest numbers for medical schools and males. Enforcement of smoking ban in medical schools was low (53%) compared to nursing (86.4%), pharmacy (85.5%), and dental (90.8%) schools. Ninety percent students thought health professionals have a role in giving smoking cessation advice to their patients. Three out of five current smokers wanted to quit. However, one out of two reported receiving help/advice to quit. Although all expressed the need, 29.1-54.8% students received cessation training in their schools. Conclusion: Tobacco control policy, cessation training and initiatives to help students quit smoking should be undertaken.