Future specialization interests among medical students in southern India.

BACKGROUND: A consideration of the future specialization interests of undergraduate medical students might help to understand the needs of higher medical education and future manpower availability for healthcare. METHODS: A cross-sectional study was conducted among 373 undergraduate students of a medical college in southern India using a self-administered questionnaire. RESULTS: Of the 373 students, 188 (50.4%) were men. Almost all of them (370 [99.2%]) wanted to pursue postgraduation. Of these, 267 (72.4%) wanted to pursue postgraduation in India. Overall, the first choice subject was surgery (120 [32.2%]) followed by internal medicine (85 [22.8%]) and paediatrics (43 [11.5%]). The third preference for men and women differed, with men choosing orthopaedics and women choosing obstetrics and gynaecology. The factors that influenced the choice of specialization were interest in the speciality (Likert scale score 4.7), job satisfaction (4.6), employment opportunities (4.0), job security (4) and high income potential (3.9). CONCLUSION: It was evident from the proportion of students desiring to do postgraduation and their choice of specialties that most of them will end up working at hospitals instead of at primary healthcare centres. The deficiencies of certain specialists such as ophthalmologists are likely to persist. This is a cause for concern as the majority of our population lives in rural areas and there is already a maldistribution of doctors.

A comparison of responses to alcohol expectancy questionnaire (CEOA) of Indian and Malaysian medical students.

Alcohol addiction is a social problem faced by every country worldwide. Young people are more at risk of this menace. In spite of a clear knowledge and message about the effects of alcohol on individual health and social fabric, it is hard to curb the overuse of this beverage. In the present study, we compared the outcome of a survey using Comprehensive effects of Alcohol (CEOA) in two private Medical institutions in two Asian countries, viz. KMC, Mangalore, India (n=180) and AIMST, Kedah, Malaysia (n=170). The study included both males and female students. The result suggested that the negative reinforcement responses were rated higher in both the study groups. But those who have tasted alcohol before had a higher rating that alcohol may cause positive reinforcement. Both groups of respondents showed similar trend suggesting that the alcohol expectancies are similar in Indian students and Malaysian students. From the results we could conclude that the responses of the two sample groups were comparable to each other. While the male respondents were inclined show higher affinity towards acceptance of alcohol females are very much less so. However, the respondents of both groups appeared to be well aware of the negative aspects of alcohol. Importantly previous exposure to alcohol intake dramatically changed the perception and showed increased inclination towards alcoholism. This study thus provides an important clue to the clinician, counselors and parents regarding the importance of guiding the young people about the alcoholism.

Safety and radiosensitizing efficacy of sanazole (AK 2123) in oropharyngeal cancers: randomized controlled double blind clinical trial.

UNLABELLED: Oropharynx is an important site of cancer in India. Global comparison indicates higher incidences in India. Radiotherapy remains an important treatment modality. Efforts to improve loco-regional treatment and prolong survival are areas of focus. Radiosensitizers in hypoxic tumors have shown promise. AIM: To study the safety and radiosensitizing efficacy of sanazole in oropharyngeal squamous cell carcinoma (stage T2-4, N0-3, M0) as phase-II double blind controlled trial in patients treated with conventional radiotherapy. SETTINGS AND DESIGN: Single institutional, randomized, double-blind, placebo-controlled trial. MATERIALS AND METHODS: Group 1 (control; n = 23) received normal saline infusion, group 2 (test; n = 23) received sanazole biweekly 1.25 g intravenous infusion 15 minutes before radiotherapy. Surrogate end points of efficacy were tumor and nodal size; safety parameters were mucositis, salivary and skin reactions, dysphagia, vomiting, dysgeusia and neurological deficit. Investigators blinded to the trial evaluated patients, weekly during treatment for six weeks and thereafter monthly for three months. STATISTICAL METHODS: Non-parametric, Friedman's, Chi square, Mann-Whitney U tests. RESULTS: In the test, 15 (65%) patients had complete response, five (22%) partial/no response, two (9%) died, one (4%) lost to follow up. In the control, five (22%) patients had complete response, 16 (70%) partial/no response, one (4%) died, one (4%) lost to follow up. Short-term loco-regional response was better in the test (DF = 3, 95% Confidence Interval 0.418, 0.452, P = 0.0048). In the test group significant vomiting and one case of grade 3 neurological deficit was observed. CONCLUSION: The study validates the usefulness of sanazole for initial loco-regional control in oropharyngeal cancers.

Immunohistochemical evaluation of expression of cytokeratin 19 in different histological grades of leukoplakia and oral squamous cell carcinoma.

Recent progress in understanding the biology of keratins together with the development of monoclonal antibodies to individual keratin proteins provide the foundation for studying the keratin expression in normal and pathological oral epithelia. Cytokeratin (CK) alterations have been reported in carcinomas and these have been associated with specific aspects of tumour behaviour. Immunohisto-chemistry with monospecific CK19 antibody was used to study the expression pattern in normal mucosa, dysplasias, and oral squamous cell carcinomas (OSCC). In non-keratinzed normal mucosa, CK19 was detected in the basal cell layer, while in dysplasias (diagnosed in H and E stained sections, mild-severe) stained strongly for CK 19 in the basal and supra basal cell layers indicating layer specificity for CK 19 expression. In OSCC, in the number of CK19 labelled cells increased from well to poorly differentiated tumour. Thus the results of the present study indicate an alteration in synthesis of keratin proteins when exposed to carcinogens.

Mandibular canine index--a clue for establishing sex identity.

A preliminary study for establishing sex identity by Mandibular Canine Index is described. Seven hundred and sixty six individuals from a South Indian population of either sex, ranging in age from 15 to 21 years, with fully errupted, healthy and non-worn mandibular permanent canines were studied. The data collected was analysed statistically. Accurancy of sex determination identity was found to be 84.3% in the male and 87.5% in the female. The method is simple and inexpensive to conduct and therefore can be applied in Forensic Odontology, as a method for establishing sex identity.

Exponential model for weight using 'RJ index'.

We screened a sample of 204 children between the age of 3 months to 5 years and 3 months were during a general health survey conducted by the Department of Community Medicine, Kasturba Medical College, Mangalore from March 1992 to December 1993 at Kumpala village under PHC Ullal about 10 kms from Mangalore City. We developed a new index RJ as RJ = Mid upper Arm Circumference x (Height)2 x 10(-4) and tested the correlation of RJ index and weight for age. We found the correlation coefficient (r = 0.8) to be very significant (P < 0.001). Thus we propose the model as Weight = A x exp (RJ x B). We found that the available data fit in this model. We hope that this study will be a new step in looking at arm circumference as a tool in estimating weight of pre-school children.

Topical phenytoin in diabetic ulcers: a double blind controlled trial.

Data of 57 patients who completed the trial and 13 who did not, were analysed. With phenytoin, there was a marginal: increase in the reduction of mean ulcer area and acceleration of effect 3rd on 4th week. With control: the number completing the trial was larger: response to treatment was better in grade II ulcers, Table IV. This study has the hall marks of a real clinical trial, has raised the possibility of wound healing properties of phenytoin and confirms the results of others.

Evaluation of immunoglobulin G synthesizing plasma cells in periapical granuloma and cyst.

Immunoglobulin synthesizing plasma cells for IgG were quantitated in 20 periapical granulomas and 20 periapical cysts, using unlabelled antibody peroxidase-antiperoxidase complex method. Result showed that immunoglobulin G producing plasma cells were predominant in periapical cyst as compared with periapical granuloma. A statistical significant relation was observed between these two lesions.

Vaccination coverage assessment survey in Mangalore (urban), Karnataka.

A vaccination coverage assessment survey regarding the U.I.P. vaccines, among 210 children aged 12-23 months and 210 mothers of infants was undertaken in Mangalore (urban) in February--March 1991, with the specific objectives of assessing the extent of achievement here of the U.I.P. objectives for the vaccine coverages, and identifying the reasons for immunization failures as well the sources of immunization. The sample population was selected by the standard WHO. 30 cluster sampling technique. A door-to-door survey was undertaken in the study population and the data was elicited by interview of mothers (and confirmed from vaccination cards or registers if available). The investigator inquired about DPT 3, OPV 3, one dose each of BCG and Measles vaccine and TT2/B for mothers. The coverages for the individual vaccines were observed as follows (and indicated in parentheses) DPT 3 (91.9%) OPV 3 (92.3%), BCG (91%), Measles vaccine (69.5%) and TT2/B for mothers (94.7%). The drop-out rates from first to third dose of both DPT and OPV were observed to be 2.5%. The major reasons for immunization failures were reported to be unawareness of need, illness of child, and fear of side reaction. Hospitals were availed of more than private sources for immunization services. The universal immunization coverage in Mangalore (urban) was found to be highly satisfactory.

Sex estimation from foramen magnum dimensions in an Indian population.

Identification of skeletal remains is vital in forensic investigations. The need for methods to estimate sex from cranial fragments becomes apparent when only a part of skull is brought for identification. The present research is an attempt to study the sexual dimorphism of the anteroposterior diameter, transverse diameter and area of foramen magnum in a population of costal Karnataka region using statistical considerations. Ninety adult dry skulls of known sex (50 male and 40 female) were included in the study. Morphometric analysis of foramen magnum was conducted using vernier calipers and the area of foramen magnum was calculated. The anteroposterior diameter, transverse diameter and area of foramen magnum are found to be significantly larger in males than females. Binary Logistic Regression (BLR) analysis was performed to derive models for estimation of sex from the different measurements of foramen magnum and Receiver Operating Characteristic (ROC) curve was drawn for the predicted probabilities obtained from BLR analysis. The predictability of foramen magnum measurements in sexing of crania was 65.4% for transverse diameter and 86.5% for the anteroposterior diameter. For the area of foramen magnum that was calculated using the formula derived by Radinsky and Teixeria, the predicted probabilities were observed to be 81.6% and 82.2% respectively. When anteroposterior and transverse diameter were used together in BLR analysis the predictability of sex increased to 88%. However, considering the overlapping in the male and female values for the foramen magnum measurements it is suggested that its application in sex estimation should be restricted to cases where only a fragment of base of the skull is brought for examination. In such cases, the anteroposterior diameter and area of the foramen magnum can be employed as better tools for sexing the skulls than the transverse diameter of the foramen magnum.

Association of depression with social support and self-esteem among HIV positives.

BACKGROUND: Depression in Human Immunodeficiency Virus (HIV) positives has implications such as poor drug compliance, lower quality of life, faster progression to full blown Acquired Immunodeficiency Syndrome (AIDS) and higher mortality. AIMS: To assess depression, social support and self-esteem in HIV positives and to find out the association of depression with social support and self-esteem among HIV positive patients. SETTING AND DESIGN: Kasturba Medical College (KMC) Hospital, a tertiary care hospital, Mangalore, India and cross-sectional design. METHODS AND MATERIALS: Study constituted of 105 HIV positive subjects; depression was assessed using BDI (Beck depression inventory), social support was assessed using Lubben social network scale and self-esteem was assessed using Rosenberg self-esteem scale. STATISTICAL ANALYSIS: Kappa statistics was used to measure the agreement of depression assessed by BDI with clinical diagnosis of depression. Logistic regression analyses were done to find out predictors of depression among HIV positives. All analyses were conducted using Statistical Package for Social Sciences (SPSS) version 11.5. RESULTS: Depression was found to be present in 43.8% of HIV positives. Among the study subjects, 10.5% had high risk for isolation and low self-esteem was found only among 5.7%. In univariate analysis both gender and self-esteem were significantly associated with depression whereas in multivariate analysis only self-esteem was found to be significantly associated with depression. CONCLUSION: The present study shows a high prevalence of depression in HIV positive patients along with the importance of self-esteem.

Determinants of low birth weight: a case control study in a district hospital in Karnataka.

A Case-control study was conducted in District Lady Goschen hospital, Dakshina Kannada district, Southern Karnataka. Subjects were mothers who underwent normal delivery and their neonates. A total of 150 cases and 300 controls were selected. Significant risk factors identified in univariate analysis included pre pregnancy maternal weight (<45 kgs)(OR=6.77), anaemia in pregnancy (Hb<11 gm%) (OR=3.11), age less than 20 years (OR=2.96) and maternal height (<145 cms) (OR=2.79). Multiple logistic regression analysis revealed that pre pregnancy maternal weight (<45 kgs)(OR=7.02), anemia in pregnancy (OR=4.37) and maternal age less than 20 years (OR=3.96) were the significant risk factors of low birth weight of term babies. The strategy needs to focus attention on nutrition education to facilitate better weight gain during adolescent period. Discouraging teenage pregnancy is also essential in order to reduce the burden of LBW babies.

Stature estimation from foot length using universal regression formula in a North Indian population.

Stature is a significant parameter in establishing identity of an unknown. Conventionally, researchers derive regression formula separately for males and females. Sex, however, may not always be determined accurately, particularly in dismembered remains and thus the need for a universal regression formula for stature estimation irrespective of sex of an individual. The study was carried out in an endogamous group of North India to compare the accuracy of sex-specific regression models for stature estimation from foot length with the models derived when the sex was presumed as unknown. The study reveals that regression equation derived for the latter can estimate stature with reasonable accuracy. Thus, stature can be estimated accurately from foot length by regression analysis even when sex remains unknown.

Prevalence of goitre among school children in Belgaum district.

OBJECTIVE: A school survey was conducted to estimate the prevalence of goitre among schoolchildren in Belgaum district. METHODS: A cross-sectional study was conducted in primary, middle and high schools of villages selected. All the children of the selected schools were examined for the presence of goitre and the salt samples obtained from their homes were tested for iodine content. RESULTS: Overall prevalence of goitre was 16.7%. Prevalence of palpable goitre was 16.4 % and visible goitre was very low (0.3%). Higher prevalence was found among females (21.1%) when compared to that of male children (12.8 %). Prevalence of goitre increased significantly with advancement of age until 16-yr. 72.1 % children were consuming rock salt and only 27.9 % were consuming powdered salt at their homes. Estimation of Iodine content in the salt samples showed that 68.7 % of the sample had inadequate iodine content. Prevalence of goitre was significantly high among children who consumed rock salt (16.2%) as compared to those who used powdered salt (11%) CONCLUSION: Strict implementation of salt codization and marketing in rural area is desired. Also health education programme be showed.

Stature estimation from foot dimensions.

Identification of an individual is the mainstay in forensic investigations. The dimensions of the foot have been used for the determination of sex, age, and stature of an individual. The present study examines the relationship between stature and foot dimensions among Gujjars, a North Indian endogamous group. Stature, foot length and foot breadth of 200 subjects comprising 100 males and 100 females were measured. Statistical analyses indicated that the bilateral variation was insignificant for all the measurements except foot breadth in males (p<0.01). Sex differences were found to be highly significant for all the measurements (p<0.01). Linear and multiple regression equations for stature estimation were calculated using the aforementioned variables and multiplication factors were computed. The correlation coefficients between stature and foot dimensions were found to be positive and statistically highly significant. The highest correlation coefficient between stature and foot length in males and foot breadth in females indicates that the foot length provides the highest reliability and accuracy in estimating stature of an unknown male and foot breadth in a female. Prediction of stature was found to be most accurate by multiple regression analysis.

Prevalence and pattern of mental disability using Indian disability evaluation assessment scale in a rural community of Karnataka.

BACKGROUND: In the present era, mental disability is a major public health problem in the society. Many of the mental disabilities are correctable if detected early. OBJECTIVES: To assess the prevalence and pattern of mental disability. SETTING AND DESIGN: Community-based cross-sectional study. One thousand subjects in all age groups were randomly selected from four villages in Udupi district, Karnataka. MATERIALS AND METHODS: The study was conducted by making house-to-house visits, interviewing, and examining all the individuals in the families selected with pre-designed and pretested questionnaire. STATISTICAL ANALYSIS: Proportions, chi-square test. RESULTS AND CONCLUSION: The prevalence of mental disability was found to be 2.3%. The prevalence was higher among females (3.1%) than among males (1.5%). The prevalence was higher among the elderly age group and illiterates. There is ample scope for community-based rehabilitation of the mentally disabled.

Alcohol expectancy responses from first year medical students: are they prone to alcoholism?

CONTEXT: Modern life style and affluence lead to changes in people's outlook on various habits, including alcohol intake. Some of them will fall prey to the addictive nature of the drink. AIMS: Present study was done to evaluate the responses to comprehensive alcohol expectancy questionnaire (comprehensive effects of alcohol--CEOA) in order to test the tendency towards alcohol intake among the First Year Medical (MBBS) students of our college--that is, to assess the positive or negative reinforcement they would expect if they consumed alcohol. SETTINGS AND DESIGN: The study was done by giving a set of questionnaires to be answered by the students. MATERIALS AND METHODS: Questionnaires of CEOA had 38 responses, in which both negative and positive feelings were represented. All questions were again grouped into four groups of positive and three groups of negative responses. Each question was rated to what degree they agreed, by 4-point Likert-type scale (1 = disagree, 2 = slightly disagree, 3 = slightly agree, 4 = agree). The positive and negative responses were analyzed to group them into agreeing or disagreeing type. STATISTICAL ANALYSIS USED: Analysis of responses by Student 't' test and 2-way ANOVA was done to analyze the results. 'P' RESULTS: Results showed that negative expectancies outweighed positives significantly (2.8017 +/- 0.58554 vs. 2.3055 +/- 0.67604, t = 7.526; P< 0.001.). Females rated the negatives more firmly (P< 0.001). However, there was no statistically significant difference with respect to different religious beliefs, places of origin or incomes of the respondents. An experience of alcohol had a significant effect on the responses where they had stronger positive expectancy, which is an important point revealed in this study. CONCLUSIONS: In this study, we have observed a general acceptance that alcohol could provide positive reinforcement, especially among those who have had a prior experience of intake of alcohol. Thus, this study throws light on whether there is likelihood of youngsters falling into addiction in the later part of their life; hence it can act as a useful predictor for parents, health professionals, social counselors and the society as a whole so that they can take preventive measures against alcohol addiction.

Occupational dermatoses in beedi rollers.

A total of 91 beedi workers were analyzed for the pattern of cutaneous lesions. Period of rolling beedi ranged from 2 months to 40 years. Dermatological findings included; callosities seen in 51 (56.04%) of workers on fingers and feet, nail changes in 22 (24.18%) like pigmentation, paronychia, dystrophy which were more prominent on the right index finger, fungal infections in 15 and eczemas in 29. Callosities and localised nail changes can be considered to be occupational marks in beedi rollers correlated to use of scissors for cutting leaves and use of gum and artificial metallic nails for rolling beedis.