Showing papers by "Mahatma Gandhi Memorial Medical College published in 2017"

Low-level laser therapy as an adjunct to conventional therapy in the treatment of diabetic foot ulcers

Abstract: Foot ulcers are serious complications of diabetes mellitus (DM) and are known to be resistant to conventional treatment. This study was conducted to evaluate the efficacy of low-level laser therapy (LLLT) for the treatment of diabetic foot ulcers in a tertiary care centre (Department of Surgery, Mahatma Gandhi Memorial Medical College and Maharaja Yashwantrao Hospital, A.B. Road, Indore). A total of 30 patients with type 2 DM having Meggitt-Wagner grade I foot ulcers of more than 6 weeks duration with negative culture were studied. Patients were randomized into two groups of 15 each. Patients in study group received LLLT (660 ± 20 nm, 3 J/cm2) along with conventional therapy and those in control group were treated with conventional therapy alone. The primary outcome measure was the absolute and relative wound size reduction at 2 weeks compared to the baseline parameter. Percentage ulcer area reduction was 37 ± 9% in the LLLT group and 15 ± 5.4% in the control group (p < 0.001). For ∼75% of wounds of the treatment group, wound area reduction of 30–50% was observed. In contrast, for the control group, ∼80% of wounds showed a wound area reduction of <20% on day 15. Further, the wounds with initial wound area 1000–2000 mm2 seems to have better final outcome than the groups with larger areas. The treated groups showed higher amount of granulation than the control group. The results suggest that LLLT is beneficial as an adjunct to conventional therapy in the treatment of diabetic foot ulcers.

Autophagy: A brief overview in perspective of dermatology

Abstract: Autophagy, literally meaning "self-eating," is an intracellular catabolic process of delivering cytosol and/or its specific content to the lysosomes for degradation.The resulting macromolecular constituents are recycled and utilized again by the cells. Basal level autophagy plays an important role in cellular homeostasis through the elimination of the old or damaged organelles, as well as aggregated intracellular proteins. Autophagy refers to sequestration of intact organelles along with a portion of cytosol, into a double-or multi-membrane structure known as phagophore, which elongates, and after closure, forms a vesicular structure known as the autophagosome. Subsequently, the mature autophagosome fuses with a lysosome, thereby forming a single membrane structure, an autolysosome. Autophagy plays a critical role in inflammation, autoimmunity and cellular differentiation. Skin serves as the first line of defense against a variety of environmental insults and autophagy is thought to be a form of an endogenous defense mechanism against such environmental derangements. Autophagy has been linked with keratinocyte differentiation and melanocyte survival, as well as with the pathogenesis of diverse skin disorders including systemic lupus erythematosus, systemic sclerosis, psoriasis, vitiligo, infectious skin diseases and cancer. Autophagy has been one of the most studied phenomena in cell biology and pathophysiology, and given its broad clinical implications, has become a major target for drug discovery. The last decade has seen a substantial upsurge in autophagy-related research and publications; still, the dermatology literature appears to be less initiated. Autophagy will probably change our understanding of dermatological disorders/medicines. Hence, a basic knowledge of autophagy is a prerequisite to understand the developments in the field of autophagy-related research.

Inhibition of DPP-4 Activity and Neuronal Atrophy with Genistein Attenuates Neurological Deficits Induced by Transient Global Cerebral Ischemia and Reperfusion in Streptozotocin-Induced Diabetic Mice

Abstract: Genistein, an isoflavonoid phytoestrogen, has been known for its potential pharmacological properties especially for neuroprotection and treating diabetes. The present study aims to determine the neuroprotective efficacy of genistein against global cerebral ischemia-reperfusion-induced neuronal injury in streptozotocin-induced diabetic mice and explore the underlying mechanisms. Streptozotocin-induced diabetic mice were subjected to transient cerebral ischemia by occluding both common carotid arteries for 30 min followed by 24 h reperfusion to induce neuronal injury. Effect of genistein (2.5, 5.0, and 10.0 mg/kg, i.p., o.d.) treatment on ischemia-reperfusion-induced neuronal injury in diabetic mice was evaluated in terms of cerebral infarct size, oxidative damage, mitochondrial activity in terms of neuronal apoptosis and cellular viability, dipeptidyl peptidase-4 activity and active glucagon-like peptide-1 concentration, and neurological functions measured as short-term memory and motor performance. Genistein administration following transient cerebral ischemia significantly (p ˂ 0.0001) counteracted cognitive impairment and re-established (p ˂ 0.001) motor performance in diabetic mice. Ischemia-reperfusion increased the infarct size, genistein administration prevented the increase in cerebral infarct size (p ˂ 0.0001) and significantly suppressed (p ˂ 0.001) the increase in cerebral oxidative stress in transient cerebral ischemia-reperfusion subjected diabetic mice. Genistein treatment significantly (p ˂ 0.001) reduced neuronal apoptosis and increased cellular viability (p ˂ 0.0001), almost completely suppressed (p ˂ 0.0001) the circulating dipeptidyl peptidase-4 activity, and enhanced (p ˂ 0.0001) glucagon-like peptide-1 concentration in diabetic mice with cerebral ischemia-reperfusion. This study suggests that genistein has potent neuroprotective activity against global cerebral ischemia-reperfusion-induced neuronal injury and consequent neurological deficits in streptozotocin-induced diabetic mice.

Comparative study of maternal and fetal outcome between low and normal amniotic fluid index at term

Abstract: Background: Amniotic fluid index (AFI) is kind of an estimate of the amount of amniotic fluid. It is an index for the fetal well-being. The aim was to study fetal and maternal out come in cases of low AFI and normal AFI. Methods: This was a case control prospective comparative study performed on 200 randomly selected low risk pregnant patients at term (37-40 weeks of gestation) admitted in Obstetrics and Gynaecology Department. 100 patients with AFI <5 cm (cases) and 100 patients with AFI 8-20 cm (control). Results: Increased number of LSCS in cases that is 35 while only 10 in control and almost equal incidences of MSL and FD in both the groups, while in cases 17 women were planned for elective LSCS for various indications in expectation of better fetal outcome. There was significant low APGAR score in babies of cases, but clinically we refute this. In present study almost double the no. of babies in cases was IUGR or FGR. Significant association between low AFI and congenital anomalies in babies. Most of the anomalies were of urinary tract system. Conclusions: An AFI ≤5 cm detected at term that was at or after 37 completed weeks of gestation in a low risk pregnancy was an indicator of poor perinatal outcome. Oligohydramnios was being detected more frequently now-a-days due to ready availability of ultrasonography these days.

Knowledge attitude practice and acceptance of postpartum intrauterine devices among postpartal women in a tertiary care center

Abstract: Background: PPIUCDs are the only method for couples requesting a highly effective and reversible, yet long acting, family planning method that can be initiated during the immediate postpartum phase. World Health Organization (WHO) medical eligibility criteria state that it is generally safe for postpartum lactating women to use a PPIUCD, with the advantages outweighing the disadvantages. PPIUCDs are cost-effective and they are low-cost intervention that reduces maternal, infant, and under-five Child mortality. Methods: After approval from the ethical committee and consent from the patients, the study was performed on 1000 postpartum women within 10 min. of delivery and up to 6 weeks of delivery at Labour Room of, M.Y. Hospital, Indore. Results: Majority of acceptor (72.5%) belong to age group of 18-25 years and 53% belonged to urban area. Acceptance was more in those who completed their secondary school level education (33%). Working women (55.5%) accepted PPIUCD more than the non-working. Out of 1000 women counselled only 10% agreed for PPIUVD insertion. During the study of 1 year duration (3.5%) of non-acceptors become pregnant and none of the acceptors conceived. Most common reason stated for accepting PPIUCD among acceptors, was that it is a reversible method (66%). Most common reason for not accepting PPIUCD among non-acceptors, because they are interested in Other Method of Family Planning (60%). Conclusions: Verbal acceptance is more than actual insertion of PPIUCD because of adoption of other method of family planning, family pressure, nonacceptance by partner, lack of awareness, fear of complication. Proper counselling can help to generate awareness and compliance for PPIUCD use in postpartum mother who have institutional delivery. Inserting CuT 380A within 10 min after placental delivery is safe and effective, has high retention rate. The expulsion rate was not high, and further can be reduced with practice could not be predicted.

Evaluation of burnout in medical interns: an institutional study

Abstract: Background: Burnout is a psychological syndrome characterised as state of emotional exhaustion, negative attitude towards the recipient of care (depersonalisation) and a feeling of low accomplishments in human service professionals. However, there is very limited literature about Burnout syndrome among medical interns from India. Thus, this study aimed to found out the prevalence of burnout syndrome among medical interns and to find any gender differences between male and female interns. Methods: The study was a cross sectional study with a convenient sample of 100 medical Interns. Subjects filled a pretested semi-structured questionnaire, which consisted of demographic data and measures of assessment. Burnout was assessed by application of Masalach Burnout Inventory. Definition of burnout was taken as high score (>27 points) on Emotional exhaustion subscale, along with high scores (>10 points) on depersonalization subscale and Low score (<33 points) on personal accomplishment subscale. Results: Mean age of the sample was 23.9 years. 48 % were males and 52% were females. Burnout syndrome was found to be present in 22% subjects. 34% scored High on Emotional exhaustion subscale, while 46% scored High on depersonalization subscale and 77% scored Low on personal accomplishment subscale. Burnout status and subscales scores did not vary significantly with gender. Conclusions: Considering the higher ratings on various domains of Burnout among medical interns there is a need for targeted action and further research for a healthy workforce development in field of Medical care.

Intramedullary Neurocysticercosis Successfully Treated with Medical Therapy

Abstract: To the Editor: Spinal cysticercosis is a rare presentation of neurocysticercosis. Surgical excision of cysticercus followed by cysticidal therapy remains the mainstay of treatment [1]. Authors have reported variable success of treating intramedullary cysticercus with praziquantel or albendazole alone [2–4]. Treatment with cysticidal drug alone in intramedullary lesion remains controversial and paradoxical worsening is feared [5]. We describe an eight-year-old boy with a history of back pain and slowly progressive weakness of both upper limbs and lower limbs for the last 1 mo. Weakness was most prominent in left upper limb with a history of numbness in entire left upper extremity. Examination revealed spinal tenderness along the cervical and thoracic spine. Motor system examination revealed asymmetric spastic quadriparesis (left upper limb predominant) with brisk deep tendon reflexes and extensor plantar response bilaterally. Sensory examination showed decreased response to pain from C6 dermatome to T1 dermatome on left upper limb. Magnetic resonance imaging (MRI) spine revealed intradural intramedullary cysticercosis at C5-C6 level with surrounding cord edema (Fig. 1). MRI brain study was normal. He was started on albendazole therapy (15 mg/kg/d) for 28 d under the cover of oral dexamethasone (0.6 mg/kg/d for 5 d). He had a remarkable improvement in motor weakness and sensory symptoms. In view of clinical improvement with medical treatment, surgically inaccessible intramedullary lesion and fear of post-operative myelotomy related complication, surgical intervention was deferred. At 4 wk follow-up, he had no residual motor weakness and complete resolution of sensory symptoms. There were no adverse effects in terms of the fresh neurological deficit on oral albendazole therapy. The presence of ring enhancing lesion with an eccentric scolex in an endemic area favors neurocysticercosis over other radiological differentials of the intramedullary cystic lesion. The present case describes a child with intramedullary cysticercosis who showed remarkable improvement with albendazole under the cover of steroids with no adverse consequences. The debate of whether steroid worked or albendazole worked in our patient remains unanswered. This report in conjunction with the similar observation by other authors warrants re* Jaya Shankar Kaushik jayashankarkaushik@gmail.com

A Comparative Study of Pet Owners and Non-Pet Owners to find out the Difference between their Physical, Mental, and Social Well-Being

Abstract: Introduction: The human-animal bond is a mutually beneficial and dynamic relationship between people and animals that influence the health and well-being of both. While many of us intuitively understand the benefits of positive interactions with animals in our lives, an emerging body of research is recognizing the impact the human-animal bond can have on individual and community health. Objective: The objective of this study was to study the effects of keeping pets on the physical, mental, social, and emotional well-being of participants. Methodology: A cross-sectional study was done on predecided sample of 120, i.e., 60 pet owners and 60 non-pet owners randomly selected from residential areas of Indore city, to compare the effects of keeping pets on the physical, mental, social, and emotional well-being of participants using appropriate scales for various parameters. Results: About 63.33% of pet owners were found physically healthy, while only 20% of non-owners were physically healthy and 76.66% were having mild-to-moderate physical problems. Pet owners are found to be happier in comparison to non-pet owners (P < 0.001). None of the pet owners were found to have low self-esteem, as opposed to 36.6% of non-pet owners who were found to have low self-esteem. 43.33% of non-pet owners were found to have moderate anxiety levels while only 13.33% of owners had moderate anxiety (P = 0.011). 86.66% of pet owners were found to have no depression; in contrast, 40% of non-owners had severe depression (P < 0.001). 86.66% of pet owners were found to have no depression; in contrast, 40% of non-owners had severe depression (P < 0.001). Only 46.66% of pet owners were found to be lonely as compared to 80% of non-pet owners. Conclusion: The study shows that pet owners are physically more healthy, mentally more happier, less anxious, less depressed and are more social in comparison to non-pet owners. Key words: Pet owners, non-pet owners, physical, mental and social well being