Caffeine consumption among medical students: an exploratory study in a medical school in a sub–Himalayan state of India

Background: Among the psychostimulants, caffeine is the most commonly used compound with beneficial effects in low to moderate intake. Medical students due to extended scholastic work do indulge in caffeine intake. The present study aimed to explore the prevalence, determinants and its positive and negative effects among medical students in a tertiary care teaching hospital in Jammu, India. Methods: The present cross sectional study was conducted in the month of December, 2023. Online questionnaire was shared with all the undergraduate MBBS students of the medical school and were directed to submit their responses. Data thus collected was entered into Excel spread sheet and analysed. Results: Prevalence of caffeine intake among the respondents was 85.7%. The most common caffeinated beverage consumed was tea followed by coffee while energy drinks were least consumed. Among the reasons for consumption, feeling refreshed and combating drowsiness were cited as two main reasons. Respondents reported gastritis (41%), insomnia (30%), anxiety (18%) and palpitation (18%) as major side effects post consumption. Conclusions: The frequency of caffeine use among the respondents was more on the regular days in contrast to stress related exam days as reported in other studies. Intake of caffeinated beverages favourable time was morning. More studies are recommended to study long term results of consumption of caffeinated beverages.

Vasculitis masquerading as a mass: a case report of Takayasu arteritis in a 28-year-old male

Takayasu arteritis is a chronic vasculitis mainly involving the aorta and its main branches most commonly subclavian and carotid. It induces clinically varied ischaemic symptoms due to stenotic lesions or thrombus formation, including blindness, retinal haemorrhage, pulselessness, aortic regurgitation and congestive heart failure due to dilatation of the ascending aorta. More acute progression causes destruction of arterial wall, leading to the formation of aneurysms and rupture of the involved arteries. Here we present a case of Takayasu’s arteritis in a 28-year-old male who presented with nonspecific symptoms of fever and neck pain with palpitations and feeling of pulsations in right side of neck since last 20 days and was eventually diagnosed as arteritis. This case shows that it can present with many non-specific symptoms and can be diagnosed with proper examination and a high index of suspicion due to its nonspecific overlapping features with many diseases.

The anatomical relationship of the superficial branches of radial nerve: a cadaveric study

Background: The major superficial branches of the radial nerve like inferior lateral cutaneous nerve of arm (ILCNA) and posterior cutaneous nerve of forearm (PCNF) are susceptible to get injured during surgical procedure done in distal half of humerus. Methods: In this study 25 voluntary donated cadavers were dissected to define the course and position ILCNA and PCNF of the radial nerve and their ramifications in relation to anatomical landmarks such as the lateral inter muscular septum or bony landmarks such as lateral epicondyle. Results: The inferior lateral cutaneous nerve of the arm arose from the radial nerve at the lower part of the spiral groove, at a mean of 14.8 cm proximal to the lateral epicondyle and 4.2 cm proximal to the uppermost fibres of the brachioradialis muscle. The posterior cutaneous nerve of the forearm arose from the inferior lateral cutaneous nerve at a mean of 6.7 cm proximal to the lateral epicondyle. Conclusions: The described lateral approach permits assessment of any part of the radial nerve and reduces the risk of iatrogenic injury.

Assessment of the patient satisfaction level with outpatient department services in a tertiary care hospital of Jammu region

Background: Outpatient department (OPD) is that section of the hospital which is staffed and equipped to provide diagnostic, therapeutic and rehabilitative care to those patients who are not registered as inpatients while receiving the services during scheduled working hours. Objective of the study was to assess the patient satisfaction level with OPD services in a tertiary-care hospital of Jammu region. Methods: A cross-sectional study was conducted among patients visiting the OPD of the SMGS hospital GMC Jammu from January to March 2023. Exit interviews were conducted using a semi-structured questionnaire among patients availing the services from OPD. Results: Average percentage of total satisfaction score among sampled OPD patients has come out to be 68.13% whereas total average dissatisfaction score was 20.87% and the total average mild dissatisfaction score as 11.00%. Conclusions: This study suggests that patients were satisfied to a larger extent with OPD services except a few which are least satisfied especially with waiting time at registration counter.

A descriptive study to assess the knowledge and practices related to cough and sneeze etiquette among health care providers, respiratory patients and their attendants in a tertiary care centre

Background: The emergence of respiratory infections including Tuberculosis, COVID-19, influenza A and B viruses have a significant impact on health worldwide. Cough and sneezing etiquette including respiratory hygiene have been recommended as most cost-effective preventative tool to reduce such transmission. Methods: A cross-sectional descriptive study was conducted among health care providers, respiratory patients and their attendants admitted in the Respiratory Medicine department at a tertiary care hospital for 6 months duration i.e., from December 2022 to May 2023, aiming to assess the knowledge and practices related to cough and sneeze etiquette. A total of 200 study subjects were interviewed with the help of a semi-structured questionnaire. The study findings were recorded and analyzed using SPSS version 20. Results: Out of 200 subjects, most 95 (47.5%) of subjects belonged to the age group between 40 to 60 and 109 (54.5%) were females and 91 (45.5%) were male. Majority of the participants were medical students; 62 (31%) followed by paramedical staff; 49 (24.5%), laborers and doctors; 26 (13%). Only 88 (44%) participants had heard about cough etiquette. Most common source of information regarding the proper cough and sneeze etiquette among the participants was television or internet;112 (61%). The patients and their attendants were having poor knowledge regarding the proper cough and sneeze etiquette. Conclusions: The knowledge and practice of cough and sneezing etiquette was not satisfactory especially among the general population. There is the utmost need for awareness regarding the knowledge and correct practice of cough etiquette.

Correlation and Heritability Analysis for Seed Quality under Controlled Conditions in Wheat (Triticum aestivum L.)

A study was conducted on wheat (Triticum aestivum L.) in laboratory at Acharya Narendra Deva University of Agriculture and Technology, Kumarganj, Ayodhya, Uttar Pradesh, during the 2019–20 for correlation and heritability analysis for seed quality under controlled conditions in wheat. In a wheat crop research, 30 germplasm were tested using three checks each for the parameters of seed weight, seed width, seed length, shoot length, root length, seedling length, seedling dry weight, germination (%), first count, final count, and vigour index-I and vigour index-II. In this study, the germplasm was assessed using parameters and the correlation coefficient. The vigour index-II demonstrated a very significant positive phenotypic connection with root length (0.828), final count (0.564), and first count (0.552), as well as a genotypically significant positive correlation with final count (1.165), root length (0.867), and first count (0.552). The high estimates (>15%) of phenotypic coefficient of variation (PCV) and genotypic coefficient of variation (GCV) were registered in the case of vigour index-I (PCV=17.36%, GCV=17.24%), shoot length (PCV=15.96%, GCV= 15.77%), seed width (PCV= 15.35%, GCV= 15.19%). The moderate estimate (10%) of PCV and GCV were recorded for root length (PCV=12.72%, GCV=12.56%), and seedling length (PCV= 11.46, GCV= 11.30).

Genetic Diversity and Path Analysis in Rice Germplasms (Oryza sativa L.)

The present study was based on the germplasm evaluation experiment, which involved the evaluation of 45 germplasms/lines including three checks viz. NDR-97, NDR2065 and Saraju-52. The experiment was conducted in Augmented Block Design with three replications. The field experiment was carried out in Kharif season 2022 at the Crop Research Station (CRS), Masodha and lab experiments were conducted in the Seed Testing Laboratory, Seed Technology Section, Acharya Narendra Deva University of Agriculture and Technology, Kumarganj, Ayodhya (U.P.). The path coefficient analysis was worked out by using simple correlation among 13 characters to estimate the direct and indirect effect of different characters on grain yield per plant. The highest positive total effect (direct + indirect) on grain yield per plant was exhibited by panicle bearing tiller per plant (0.699) followed by germination % (0.360), seed viability (0.227) and vigour index – I (0.209). The highest number of genotypes appeared in the cluster – II (13), followed by cluster – III (8), cluster – IV(6), cluster – V(6), cluster – I(5), cluster – IX(5), cluster – VI(3), cluster – VII(1), and cluster – VIII(1). The maximum intra-cluster distance was observed in case of cluster – IX (64641.91) followed by cluster – V (5584.50), cluster – VI (5363.09), cluster – I (3918.44), cluster – II (3483.30), Cluster – IV (3303.54), Cluster – VII(0.00) and cluster – VII (0.00). The highest cluster mean for days to 50% flowering was recorded for Cluster-I (102.8) followed by Cluster – VII (99), cluster-V (96.66), cluster-VIII (96) cluster IX (96), Cluster III (95.75) cluster IV (95.65) cluster VI (94.67) cluster II (91.51).

The Effect of Climate Change on Wheat Production: Present Patterns and Upcoming Difficulties

Climate refers to the mean weather conditions in a certain region, impacting every aspect of the environment. Urbanisation and industrialization are causing woods to be cleared for living communities. The equilibrium of the ecosystem is upset by this shift, affecting producers, consumers, and decomposers. Plants, or producers, are an important component of the ecosystem because they supply energy. Plant sustainability and production are impacted by this change. A staple grain, wheat is greatly impacted by both temperature and CO2 levels. In addition to decreasing wheat productivity, it also increases wheat's susceptibility to many illnesses. Elevated temperatures result in increased transpiration, which in turn triggers drought, which in turn causes reduced production. According to predictions, in the next 20 to 30 years, a 2° C temperature shift might result in a serious water crisis. A scarcity of water during the grain filling and milking stages can impact production. This article covers the following topics: climate-related variables, effects on wheat production and growth, influence on disease severity, temperature increase prediction model, and CO2 curve in 2050.

Genome Sequencing in Field Crops: Unlocking Agricultural Potential

Genome sequencing has revolutionized agriculture by providing crucial insights into the genetic make-up of field crops. This paper explores the importance of genome sequencing in unlocking the agricultural potential of various field crops. By sequencing the DNA of crops such as wheat, maize, rice, and soybean researchers are gain a comprehensive understanding of their genetic diversity, disease resistance and yield-enhancing traits. This knowledge enables the development of precision breeding strategies, leading to the creation of high-yielding, stress-tolerant and nutritionally enhanced crop varieties. In addition, genome sequencing is facilitating the identification of key genes involved in plant-microbe interactions and adaptation to environmental stressors. Such knowledge can inform sustainable agricultural practices, reduce chemical inputs and increase crop resilience in the face of climate change. This paper highlights the transformative impact of genome sequencing on crop improvement, food security and global agricultural sustainability.

The Usefulness of Multivariate Analysis in Forestry Research: A Case Study of Wild Pomegranate (Punica granatum L)

The present study deals with the Contrast, Cluster, Discriminant and Principal Component Analysis. The data for the present study was collected. Data on different morphological and seedling characters, namely Tree height (m), Tree diameter (cm), Crown spread E-W (m), Crown spread N-S (m), Fruit weight (g), Leaf length(cm), Internodal length(cm), Collar diameter (mm), Number of branches per plant and leaf petiole (cm) were considered from five different districts comprising of ten seed sources. Two seed sources were considered from each district viz; Narag and Neripul from Sirmour district, Waknaghat and Sadhupul from Solan district, Sundernagar and Rewalsar from Mandi district, Mohal and Banjar from Kullu district, Basantpur and Sunni from Shimla district. Different morphological and seedling characteristics of ten seed sources were evaluated by contrast analysis, which varied significantly among the different districts and within the districts. It is concluded that Tree diameter (cm), Crown spread E-W (m) and Crown spread N-S (m)was found Maximum in Solan district and Minimum in Shimla district, whereas Collar diameter (mm), Leaf length (cm) and Number of branches per plant was found Maximum in Mandi district and Minimum in Shimla district. Tree height (m) and Leaf petiole was recorded maximum in Kullu and Sirmour district and minimum in Shimla district whereas Fruit weight (g) and internodal length (cm) was found Maximum in Mandi district and minimum in Solan and Sirmour district.Cluster analysis was performed and the seed sources were grouped into three clusters. Discriminant analysis was carried out to categorize the seed sources into high and low yielders. Tree diameter, Tree height and Crown spread E-W are the most important characters that discriminate the two groups. Six seed sources from Mandi, Kullu and Shimla district were high yielder whereas other four seed sources were low yielder. Three principal components (PCS) were extracted out of ten which explained 34.675, 23.002, and 11.587 per cent of the total variation respectively amounting to 69.26 per cent of total variation.

Zeta-associated protein 70 expression in chronic lymphocytic leukemia: Relevance in Indian context

Background: Chronic lymphocytic leukemia (CLL) is prognosticated using the Rai and the Binet's staging. In the past few years, new parameters have been considered for prognostication. One such marker that has been a subject of speculation and found useful by some western studies is zeta-associated protein 70 (ZAP-70). Aim: To investigate the prevalence of ZAP-70 and find out its association with other prognostic markers like Rai and Binet's stage and CD38 in Indian CLL patients. Materials and Methods: Twenty-nine newly diagnosed cases of CLL were selected over 1 year. Immunophenotyping was done and expression of CD38 and ZAP-70 was evaluated on gated CLL cells. Statistical Analysis: Qualitative data were expressed as frequency and percentage. Differences between groups were evaluated using Student's t-test for quantitative data and Chi-square test/Fisher's exact t-test for qualitative variables. A P value less than 0.05 was considered significant. Results and Conclusion: We found a lower prevalence rate of ZAP-70 (2/29, 6.89%) with no association with any of the conventional poor prognostic factors. A large number of our CLL patients fall into the good prognostic group (22/29, ZAP 70?/CD38?) with a least number in the poor prognostic group (2/29, ZAP-70 + CD38+). Also, no association was found between ZAP-70 and CD38. The findings of the present study suggest that the majority of CLL patients in India have a good prognosis, may not require treatment, and have good overall survival. Geographical variations, genetic makeup, and natural history of the CLL could be the cause of such differences from western literature.

An assessment of knowledge regarding breast cancer among educated women in Kanpur Nagar, Uttar Pradesh, India

Background: Most common female cancer worldwide including India is breast cancer. Awareness about breast cancer is very necessary for early detection and prevention as diagnosis at advanced stages of disease contributes to the high mortality rate. An assessment of existing levels of knowledge regarding cancer is a pre-requisite to find out gaps and to plan for proper educational programmes. Methods: This cross-sectional study was carried out in a women’s college, study subjects were students, female faculty members and female staff. A structured questionnaire was given, data was collected and analysed. Results: In this study it is found that knowledge regarding risk factors for breast cancer was low, only 47.68% knew that family history predisposes for breast cancer, 28.48% knew late menopause is risk factor. 76.82% of respondents knew that lump in breast is a sign of breast cancer, whereas only 31.13% knew that discharge from nipple is sign of breast cancer. Merely 6.40% of respondents knew the procedure of breast self-examination. Majority of respondents i.e. 54.53% told media as source of information. Conclusions: Regarding breast cancer low level of knowledge was found among the study subjects which suggests that proper information should be provided in colleges, especially health facilities and schools should increase their role in providing related information.

Study of patient satisfaction regarding linen and laundry services in a tertiary care hospital of north India

Background: Linen and laundry services are meant to provide clean, comfortable and hospitable services to the patients. The clean linen inculcates a sense of psychological confidence in the patients and the public and enhances their faith in the services rendered by the hospital. Objective was to study the provision of efficient linen and laundry services in a tertiary care hospital of north India. Methods: A cross-sectional study was conducted in linen and laundry services of SMGS Hospital Jammu from October 2020 to March 2021. Using convenient sampling, 300 patients or their attendants were interviewed about their satisfaction levels regarding provision of linen and laundry services. Another questionnaire was administered to the laundry plant staff to enquire about their satisfaction and motivation levels. The data was analysed and chi-square was the test of significance. Results: The findings of the study revealed an overall satisfaction rate of 91.9% among the patients/attendants regarding provision of efficient linen and laundry services. Time of recruitment and nature of job were the variables found to be significantly associated with job satisfaction among the laundry staff workers (p<0.05). Conclusions: High levels of satisfaction among the end users reflect quality of the services provided by this tertiary care hospital. Levels of motivation and job satisfaction were equally adequate among the laundry workers.

Role of visual evoked potential as a window to detect functional changes that occur without signs of diabetic retinopathy in fundoscopy: Case series involving symptomatic overt diabetic pregnant women

Diabetic retinopathy (DR) is a microvascular complication associated with diabetes mellitus. Pregnancy is a major risk factor for DR in diabetic women. Recent evidenced suggests that in course of DR functional changes including damage of pre-ganglionic and ganglionic cells in retina precede structural microvascular changes. A number of studies in the past have highlighted the role of pattern visual evoked potential (VEP) in detecting such functional changes. However, the study of VEP changes in diabetic pregnancies remains unexplored. This case series has the objective of exploring VEP changes in symptomatic OVD cases, who had no signs of DR on fundoscopy. We present two cases of overt diabetic women who complaint of straining of eyes, headache, and difficulty in reading during pregnancy. Complete ophthalmic examination was done in both the cases followed by a VEP test. VEP test was done as a part of a research project. The ethical clearance for the project was obtained from the Institute’s Ethics Committee before the commencement of the study. Fundoscopic examination in both cases revealed that the retina was within normal limits with no signs of retinopathy. In Case 1, P100 latency was increased for the left eye and was normal for the right eye during the first visit. While P100 latency was increased for both left and right eye during the second visit. There was a substantial increase in P100 latency for both eyes in second visit as compared to first visit. In Case 2, P100 latency was increased for both left and right eye and amplitude decreased for the left eye. This is a case series consisting of symptomatic overt diabetic pregnant women who had increased P100 latency despite no signs of retinopathy in fundoscopy. The previous studies have reported that multiple follow-ups with ophthalmoscopy may not be cost-effective in diabetic pregnant women. VEP provides a window for detection of early functional changes that may help identify at risk patients for follow-up and early intervention.

Effect of spiritual practices on higher brain functions, psychological health, and stress response

Background: Spiritual beliefs include the relationship to a superior being and recognition of a sense that there is something greater than myself. Psychological health is not just absence of mental disorder but a state of well-being in which an individual realizes his/her own abilities, can cope up with normal stresses of life, can work productively, and is able to make a contribution to his/her community. Aims and Objectives: The present study was designed to analyze the impact of spiritual practices on memory, cognitive functions, psychological health, adjustment level, and stress response. Materials and Methods: The present study was conducted in two phases on 150 subjects. In the first phase of study, subjects were divided into low, average and high spirituality groups on the basis of spirituality scores. Each group was required to perform memory test, stroop test along-with assessment of psychological health, and adjustment level. Their basal level of stress parameters was recorded. A stressor was introduced and stress parameters were again assessed. Subjects were asked to perform spiritual practices for 1 month duration and the parameters were again assessed. ANOVA and post hoc tests were used for inter group comparison. Student’s t-test was used to analyze data between baseline values and post spirituality values for various parameters. Results: On comparison of parameters in low, average and high spirituality groups, significant and non-significant results were obtained at baseline level and after 1 month practice of spirituality. Conclusion: Spiritual practices have positive effect on parameters studied.

Molecular stratification of high-grade urothelial carcinoma by immunohistochemistry with its histomorphological and clinical correlation

Introduction: Urothelial carcinoma poses a significant cause of morbidity and mortality. The recent classification of Tumors of Urinary System by World Health Organization fourth edition) has elucidated its molecular subtypes and its associated prognostic significance. Methods: We used immunohistochemistry marker expression (CK5/6, CK20, CD44, EGFR) as a surrogate marker, to stratify 150 cases of high-grade urothelial carcinoma into the intrinsic molecular subtypes. A correlation was also done with immunohistochemical markers p53, p21, E-cadherin and Ki-67. Results: On subtyping, 47.3% cases were basal, 42.7% luminal and 10% remained unclassified. We did not find GATA3 useful for molecular stratification in our study. Muscle invasion was seen in 59% of basal and 31% of luminal subtype (P = 0.016). Squamous differentiation was most commonly associated with basal subtype (P < 0.001). EGFR expression was seen in 62% of basal and 38% of luminal subtype (P = 0.014), and thus can be used as an additional marker for molecular stratification. Overexpression of p53 was seen in 64% cases of muscle invasive and 36% of non-muscle invasive high-grade carcinomas (P < 0.0001). An inverse relationship was observed between p53 and p21 immunoexpression (r = –0.494) (P < .0001). The overall survival at 1- and 2-year interval was more in the luminal subtype, suggesting an early mortality in basal group, (P = 0.827), and at 6 years both the groups had almost similar results. Conclusion: High-grade urothelial carcinoma is challenging in terms of therapeutic strategy. Increased understanding of underlying molecular basis helps identifying targetable treatment options, and newer biomarkers will enhance predictive and prognostic stratification.

RUPTURED TUBO-OVARIAN ABSCESS RARE PRESENTATION OF PELVIC INFLAMMATORY DISEASE - A CASE REPORT

Background: Infection of the endometrium, fallopian tubes, ovaries, pelvic peritoneam, and adjacent structures is known as Pelvic Inflammatory Disease (PID). Pelvic inflammatory disease and its consequences are still at epidemic levels, Despite the availability of effective broad-spectrum antibiotics. Tubo-ovarian abscess (TAO) may be difficult to identify since the clinical signs are comparable to those of other pelvic and abdominal illnesses. Case Description: Here we are reporting a case, 34 years nulligravida came to emergency department with acute abdomen, she was a known case of chronic PID, Emergency laparotomy was performed, per operatively ruptured tubo-ovarian abscess was present. Conclusion: The clinical diagnosis of PID and TAO is similar, imaging evidence from ultrasonography (US) or magnetic resonance (MR) should be used to supplement the clinical diagnosis. Clinical Significance: To avoid complications and resultant emergency surgeries and their consequences, a vigilant eye must be kept to promptly diagnose, and manage PID at the earliest.

An assessment and correlation of emotional Intelligence and mental health of medical students

Introduction: Emotions like joy, anger, grief, jealousy, love, fear make our life worthwhile. Whatever we do, incites some emotion in us. If we are able to enjoy our emotions, without them having excessive control over us, then we can make ours as well as others’ lives better. Aim of the study was to assess and correlate emotional Intelligence with mental health. Methods: Type of study: Descriptive type of cross sectional study. Sampling: Simple random sampling. Study population: Under graduate students in a private medical college in western Uttar Pradesh. Sample size: 246. Results: The average emotional intelligence score was 26.82 with standard deviation of ±5.80. Average emotional intelligence among males was 27.04(±6.72) and was 26.63(±5.07) among females. Spearman Rank correlation coefficient “r” =0.789, showed highly positive correlation between ranks from both the score. (p=0.0000). Conclusions: The medical students showing higher scores of emotional intelligence are less likely to be mentally stressed.

Diagnostic dilemma of cognitive decline in a young female: considering congenital rubella, depressive disorder, and moyamoya disease

We report a case of a 20-year-old young female patient from North India presenting with headache, decline in scholastic performance, irritability, and low mood, and having a history of hemiparesis, who had rubella infection in her antenatal period, who was investigated and diagnosed as persistent depressive disorder (PDD) with left-sided hemiparesis in remission with moyamoya disease (MMD) based on history, examination, and relevant investigation (magnetic resonance imaging [MRI] brain/magnetic resonance [MR] angiogram). We highlight the difficulties we faced in attributing whether the cognitive decline was due to congenital rubella, PDD, MMD, or a combination of any of these three diagnoses.