Hormonal Replacement Therapy in Surgically Induced Menopause: A Prospective Cross Section Study from a Tertiary Care Institution from A Sub-himalayan State

Background: Early surgical menopause increases risk of cardiovascular disease, osteoporosis, fracture, cognitive impairment and sexual dysfunction than women with late menopause. Estrogen therapy (ET) remains the most effective therapy for vasomotor symptoms related to surgically induced menopause. Meterials and Methods: It was a prospective cross-section study. Result: Amongst 255 symptomatic women, 163 (63.92%) women had severe vasomotor symptoms and 54 (33.12% of 163 women) of them had very incapacitating symptoms with marked reduction in their quality of life. 59 (23.13%) women had moderate symptoms with mild disturbances in their sleep while 33 (12.94%) women had only mild symptoms. Conclusion: It is agreed that women who undergo bilateral oophorectomy before the onset of natural menopause should be considered for estrogen therapy for the management of vasomotor symptoms until the average age of natural menopause.

Quiz as an adjunctive modality in teaching Clinical Microbiology for Undergraduate Medical Students

Conventional teaching modalities like Didactic lectures if practised alone fails to transfer concepts as effectively as active learning approaches. Active learning methods like Quizzing leads to active participatory involvement of students, motivates them by increasing interest in the subject and act as a driving force for more effective learning. The purpose of this study was to evaluate the effectiveness of Quiz as an adjunctive teaching modality in clinical microbiology for undergraduate medical teaching and to compare it with conventional teaching methods like Didactic lectures. In this interventional study conducted in the Dept. of Microbiology of a Govt. Medical College of Central India, Second MBBS students were divided into two groups. The topic Universal precautions was split and covered through two modules. One module was administered through lecture to one group and through Self study followed by Quiz to another group. Cross over was done for the second module. To evaluate the students performance pretest and post test were conducted for both the methods. In case of both the groups a significant absolute learning gain was observed for both the modalities. However in both the groups the learning gain and effect size were towards much higher side for Quizzing as compared to didactic lectures. Our study has shown the positive impetus of the active teaching learning modalities like Quizzing on self directed learning, and an added advantage of this approach on the learning gain as compared to the conventional teaching.

Magnetic Resonance Image Characterization of Knee Meniscus Signal Intensity using Crue’s Approach: Results from a Multi-centre Evidence

This study aimed to characterize knee meniscus signal-intensity using magnetic resonance imaging. Our research included knee MR images of 138 subjects from multi-centres in Nigeria, between September 2016 and December 2017. Knee images were retrieved from patients' folder of MRI scanners and transfered to a DICOM workstation (Onis 2.6) for image analysis. Knee meniscus was characterized into 0, 1, 2 & 3 grades using Crue’s grading approach. Our research revealed 58% incidence of meniscal lesion. Study yielded a significant relationship between meniscal lesion and gender (p <.005) with a greater proportion of these lesions in women than in men. Meniscal lesions showed significant association with osteoarthritis (OA) (p < 0.05). Grade 3 lesions (actual tears) were largely of horizontal configuration.

Intracranial Dermoid Cyst in the Posterior Fossa: A Case Report

Introduction: Intracranial dermoid cysts are benign, ectopic squamous epithelial cysts often compose of dermal structures like hair follicles, sweat glands as well as sebaceous glands. This lesions constitutes about 0.5% of all intracranial neoplasms. Thus, the occurrence of a dermoid cyst in the posterior fossa is very rare. We report a rare case of intracranial dermoid cyst in posterior cranial fossa. Case Presentation: Our first case was a 32 years old woman who presented with headaches and dizziness with no nausea, vomiting or fever. CT scan revealed a mass at occipital cistern consistent with a cystic lesion. MRI also revealed an irregular lesion in the posterior part of the medulla oblongata with enhanced edges signifying calcifications. We attained total resection of the tumor in a piece meal approach via surgery. Histopathology confirmed dermoid cyst. Two years follow-up revealed no recurrence of the lesion and no neurological deficits. Conclusion: We advocate that, the goal in surgical decision-making should be safe and total resection while monitoring the cranial nerves with electromyographic and auditory brainstem responses.

Oral Physical Findings in Patients with Chronic Nasal Obstruction

Background: Although chronic nasal obstruction causes mouth breathing, it causes changes in orofacial anatomy to compensate reduced airflow and facilitate breathing. As a result there is a mismatch between growth and evolution of orofacial structures.The aim of this study is to find oral physical findings in patients with chronic nasal obstruction. Methods: All patients referred to the clinic and ward in Imam Reza Hospital during 2019-2020, who suffered from chronic nasal obstruction, were examined and the findings of the examination included Tonsil size, tongue size, mallampati, tonsillar pillars size, palate height, palate thickness, ovula length, hypertrophy of nasal turbines,septal deviation, long face, neck circumference were compared among case and control groups.And also STOP-BANG score was calculated and risk of OSAS was shown. Results: In this study, the average age of people with nasal obstruction was 42.89±14.30. In physical examinations of the mouth, the size of the tonsils and the size of the neck did not differ significantly between two groups, but other positive examinations were significantly higher in patients with chronic nasal obstruction and there was no significant difference in blood pressure, diabetes, hypercholesterolemia, IHD, fatty liver in the control group. Only patients with nasal obstruction complained significantly more than the control group of hearing loss. Conclusion: The frequency of tongue enlargement, soft palate, and thick palate and Malapmati score were significantly higher in people with chronic nasal obstruction.

Determination of Specific Anti - Toxocara Antibodies in Patients with Cardiac Disease

Aim of this study is to find the seroprevalence of specific anti - Toxocara IgG antibodies among patients with inflammatory heart disease and to evaluate the significance of this parasite as a possible etiological agent of such pathology. We performed a serological study of 41 patients with heart disease (myocarditis, pericarditis and endocarditis) for presence of specific anti-Toxocara IgG antibodies. We used ELISA for primary screening, and Western blot as a confirmatory method. Presence of specific anti-Toxocara IgG antibodies in ELISA was detected in three (7.3%) of the serum samples, and another two (4.9%) were with borderline values. These serum samples were further examined in Western blot and three of them (7.3%) displayed disease-specific bands. We do not in any way claim that in these cases Toxocara infection is the cause of inflammatory heart disease, but the data from the study shows that such a link is possible.

Non-COVID Health Care Workers with Positive Antibody Responses: Are We Heading Towards Herd Immunity?

Background: Antibody testing against SARS-CoV-2 complimentary to RT-PCR could be an effective method for its detection. Development of immunity against COVID-19 in context of reinfection and herd immunity still remains debatable and needs further elucidation. The present study was conducted to investigate the immunity status against SARS-CoV-2 in terms of IgG antibody positivity in health care workers at a tertiary care center. Methodology: This single center study was conducted at a tertiary care center, that involved 1039 healthcare workers and other staff members. The testing of all subjects was performed using ELIFAST (SARS-CoV-2 IgG ELISA) kits. The sample population was then segregated into RT-PCR positive and negative/status unknown groups. Groups were further segregated on the basis of IgG positivity status and the sensitivity and specificity was also calculated. Results: Among the 1039 enrolled subjects, 179 (17.23%) were RT-PCR positive for SARS-CoV-2 positive and remaining were either RT-PCR negative or status unknown cases. Among 179 COVID-19 recovered subjects, 19 (10.61%) were negative for IgG, whereas 160 (89.39%) came out IgG positive. Out of 860 (82.77%) RT-PCR Negative/Status unknown, 248 (28.84%) came out IgG positive and the remaining 612 (71.16%) were negative for IgG. The overall sensitivity and specificity were 89.39 and 71.16, respectively. Conclusion: A combined approach of testing for COVID-19 using RT-PCR and rapid antibody assays could be more beneficial. Serological studies project a higher antibody response in population that compel us to think about plausibility of herd immunity. However, variability in serological response could be affected by several factors and the underlying complex immune process of COVID-19 is yet to be fully understood.

Obstructing Trachea Tumor: Myoepithelial Carcinoma about a Case

Myoepithelial carcinoma, also called malignant myoepithelioma, is an extremely rare tumor of the salivary gland type. It is defined as a malignant neoplasm in which the tumor cells exhibit exclusively myoepithelial differentiation. Our case is a 48-year-old patient with no specific history who was presented to the hospital emergency room for respiratory difficulty and dysphagia progressively evolving for 08 weeks. A cervical CT was done which revealed a hypodense tumor process in T1 of 4 cm long axis obstructing the trachea well limited and richly vascularized. The diagnosis of tracheal myoepithelial carcinoma was made after histological and immunohistochemical analysis on a biopsy pending analysis of the operative specimen. Treatment remains initially surgical with appropriate postoperative radiotherapy and chemotherapy.

Study of the Effect of Health System Reform Plan Administration on the Satisfaction Level among Medical Doctors and Nurses in Tabriz State Hospitals, East Azerbaijan, Iran

Having three orientations, the Health System Reform Plan (HSRP) has been administered to financially support and protect people, provide fair health services and promote the quality of health services. To be unsatisfied about health and medical services brings undesirable outcomes. The present investigation aimed to study the effect of Health System Reform Plan (HSRP) on the satisfaction level among medical doctors and nurses of Tabriz state hospitals, East Azerbaijan province, Iran in a period from 21th February; 2015 to 22th June; 2015. Statistical population included those patients who referred to Tabriz state hospitals. We used stratified sampling method. To collect data we used questionnaire being presented to the samples after assessing its validity and reliability. We also utilized descriptive and inferential statistics in a way that we used descriptive method to classify, summarize and interpret of obtained data. Then after demonstrating the abnormality of data by Kolmogorov-Smirnov test we used linear and multiple regressions to test research hypothesis and effect from the perspective of inferential method. Obtained results confirmed the research hypothesis and explained that the administration of HSRP affected medical doctors’ level of satisfaction. Also, according to the results of multiple regression tests, doctors and nurses’ satisfaction level was placed at the top of most affected issues from HSRP.

Pattern of Mosquito Borne Parasitic Infection in the Night Blood Samples of Patients with Elevated TNF-α of> 5.0 pg/ml

Study Background: Plasmodium spp., (Protozoan) and Wuchereria bancrofti (Nematode) are transmitted by mosquitos to cause insect borne diseases known as malaria and Lymphatic filariasis/Elephantiasis. Apart from the social implication of these parasitic infections the infections can also elicit immune responses. Aim and Objective: This work was therefore designed to determine the pattern of mosquito borne parasitic infection in the night blood samples of patients with elevated TNF-α of > 5.0 pg/ml. Materials and Methods: Seventy (70; aged 31 – 76 years; Male- 35; Female-35) volunteers with plasma TNFα of 5.8 ±0.7 pg/including age-matched control participants ( n= 50 ; TNFα of 2.2 ± 0.3 pg/ml). All participants were negative to Acid Fast Bacilli, ant-HCV, HBsAg and HIV tests were recruited for the study. Night blood samples and sputum samples were obtained from the participants. Blood sample was used for determination of TNFα, HIVp24ag-Ab, anti-HCV, HBsAg by ELISA and identification of Plasmodium and Wuchereria by Geimsha thick blood film staining while sputum samples were used for the demonstration of Acid Fast Bacilli by Ziehl Neelsen staining. Results: The results showed a frequency of Plasmodium spp., in individuals with plasma TNF-α of 5.8 ±0.7 pg/ml as 31.4%(22) as against a frequency of 18%(9) in subjects with plasma TNF-α of 2.2 ± 0.3 pg/ml.. The results also showed a frequency of 5.71%(4) and2%(1) Wuchereria bancrofti in subjects with plasma TNF-α of 5.8 ±0.7 pg/ml and TNF-α of 2.2 ± 0.3 pg/ml. respectively. The overall frequency of parasitic infection obtained in both test and control subjects include: 33.3% (40)Plasmodium spp., and 4.2%(5) Wuchereria bancrofti.The overall results from both test and control subjects also showed a gender distribution of 20%(24) and 13.3%(16) Plasmodium spp.,in female and males respectively while a distribution of 1.7%(2) and 2.5%(3) Wuchereria bancrofti in females and males respectively. Conclusion: This work revealed increase in the frequency of Plasmodium spp. and Wuchereria bancrofti infections with increase in plasma TNF-α while the overall frequency of parasitic infection obtained in both test and control subjects was found to be 33.3% (40)Plasmodium spp., and 4.2%(5) Wuchereria bancrofti with possible variations in regional and gender distributions. Mosquito borne parasitic infection of Plasmodium spp., was found to be more prevalent in patients with elevated TNF-α of> 5.0 pg/ml.