WIMJ2017 Vol 4, Issue 1 Complete PDF

WIMJOURNAL, Volume No. 4, Issue No.
1, 2017 pISSN 2349-2910, eISSN 2395-0684

Pendkar P G
ORIGINAL RESEARCH ARTICLE

Study of Lipid Profile and Serum Electrolytes in Patients of Chronic Renal
Failure
Pritee Pendkar 1 and Tushar Bansode 2
Assistant Professor, Department of Biochemistry, Government Medical College, Miraj,
Maharashtra, India1, 2
Abstract:
Introduction:
CRF affects multiple organs of human body like heart and brain. All these effects results due
to dyslipidemia which is due to metabolic and endocrinal disturbances. Electrolyte level alterations
are also observed in case of CRF patients.
Materials and Method:
This cross section study includes total 110 subjects. Out of these 60 subjects were clinically
diagnosed CRF patients having age more than 20 years and remaining 50 subjects were chosen from
healthy controls not having any major medical problem. Among 60 CRF cases, 30 were on
maintenance dialysis for a period of 5 months to 3 years. These patients were undergoing dialysis for
3-4 hours thrice week, Other 30 patients were on conservative line of treatment. Fasting venous
blood samples were collected and serum levels of Total cholesterol, Triglycerides, High density
lipoprotein cholesterol, Low density lipoprotein cholesterol, Very low density lipoprotein cholesterol,
Serum Na+& K+ were measured.
Results:
It is seen that Serum K+, total cholesterol, triglyceride, VLDL-C and total cholesterol to
HDL-C ratio were significantly increased in CRF on conservative management group as compared
controls while mean level of LDL-C did not show any significant difference between these two
groups i.e. controls & CRF on conservative management. The mean value of Serum Na+ and HDL-C
was significantly decreased in CRF on conservative management as compared to control. It is also
observed that Serum K+, total cholesterol, triglyceride, VLDL C and total cholesterol to HDL ratio
were significantly increased in CRF on dialysis group as compared controls while mean level of LDL
did not show any significant difference between these two groups i.e. controls & CRF on dialysis.
© Walawalkar International Medical Journal 1

WIMJOURNAL, Volume No. 4, Issue No. 1, 2017 pISSN 2349-2910, eISSN 2395-0684
Pendkar P G
The mean value of Serum Na+, HDL-C was significantly decreased in CRF on dialysis group as
compared controls.
Conclusion:
The present study indicates that due to dyslipidemia in CRF, there is increased risk of
cardiovascular complications.
Keywords:
Chronic Renal failure, Dyslipidemia, Lipid Profile, Serum Electrolytes.
How to cite this article: Pritee G Pendkar and Tushar V Bansode. Study of Lipid Profile and Serum Electrolytes
in Patients of Chronic Renal Failure. Walawalkar International Medical Journal 2017; 4(1):01-09.
http://www.wimjournal.com
Address for correspondence:

Dr. Tushar V Bansode, Assistant Professor, Department of Biochemistry, Government Medical
College, Miraj-416410, Maharashtra, India , Email- drtusharbansode@gmail.com,
Mobile No:7758051952
DOI Link: http://doi-ds.org/doilink/12.2017-77855227/
Introduction: 50ml/min). Lipid abnormalities and enhanced

CRF is the condition resulting from oxidative stress in CRF cases, promotes the
permanent and progressive deterioration of atherosclerotic process causing cardiovascular
renal function which can cause adverse effects complications. Most characteristic lipid
(1)
on other systems. Primary abnormality is increased serum triglycerides,
glomerulonephritis is the commonest cause of very low density lipoprotein , intermediate
CRF in developing countries of the density lipoprotein and low levels of high
world.(2)Itis seen that the prevalence of CRF in density lipoprotein .(4,5)
India may be up to 785 people per million Electrolyte disturbances are also seen
population.(3)Lipid abnormalities can be in case of CRF patients. It is due to
detected as early as renal function begins to progressive malfunction of kidney in CRF.(6)
decline (Glomerular Filtration Rate <

Pendkar P G
Materials and Methods: conservative line of therapy. Patients with

Present study was conducted in diabetes mellitus, hypertension, history of
Department of Biochemistry, Tertiary care familial hyper lipoproteinemias, history of
center with the help of Medicine & Surgery hepatic dysfunction, patients on hypolipidemic
Department. Institutional Ethics Committee drugs were excluded from study. Following
for research work has given approval for biochemical parameters were
research work. The selection of subjects is determined.Total cholesterol:CHOD PAP
carried out from OPD & dialysis unit of method (end point),(7) Triglycerides:GPO
Government Medical College, Nanded. A Trinder method (end point),(8) HDL:
total number of 110 subjects were participated Directmethod,(9) LDL: Direct method,(9)
in this cross section study, out of which 60 VLDL = TAG/5, Serum Na+ , Serum K+.(10)
were clinically diagnosed CRF cases having Observations &Results:
age more than 20 years and 50 were healthy The levels of Total Cholesterol,
controls without any major medical illness Triglycerides, High Density Cholesterol , Low
were included. Among 60 chronic renal failure Density Cholesterol , and very low density
patients, 30 patients on maintenance dialysis cholesterol ,Serum Na+, Serum K+ were
for a period of 5 months to 3 years. These analyzed and their results were shown in the
patients were undergoing dialysis for 3-4 following tables and graphs.
hours thrice a week. Other 30 patients were on
Table 1: Tukeys multiple comparison of Serum Na+, Serum K+ between control & CRF on
conservatives management
Parameter Control CRF on conservative p value
Rx
SerumNa+ 141.7 ± 5.23 131.0 ± 6.78 < 0.05
SerumK+ 3.2 ± 0.38 5.16 ± 0.65 < 0.05

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Pendkar P G
Table 2: Tukeys multiple comparison of lipid profile between control & CRF on conservatives
management
Parameter Control CRF on p value

conservative
management
Total Cholesterol 180.06 ± 22.3 215.8 ± 22.9 < 0.05
Triglyceride 110. ± 30.2 247 ± 36.47 < 0.05

HDL C 45.33 ± 5.0 39.10 ± 4.09 < 0.05
LDL C 113.42 ± 23.4 128.2 ± 18.41 ˃ 0.05
VLDL C 21.6 ± 6.06 49 ± 6.62 < 0.05
TC/HDL 3.97 ± 0.69 5.51 ± 0.74 < 0.05
FIG 1: Bar diagram showing comparison of Serum Na+, Serum K+inControl

Control & CRF on
conservative management
160 Control
140
120
CRF on
100
conservative
80 treatment
60
40
20
0
Urea Creatinine Sodium Potassium

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Pendkar P G
FIG 2: Bar diagram showing comparison of lipid profile in Control & CRF on conservative
management
250
Control
200
150
CRF
100
onConservative
50 treatment
0
Table 1, 2and Figure 1, 22shows management group as compared controls

Pairwise significance of study parameters while mean level of LDL-C
C did not show any
between controls and CRF on conservative significant difference between these two
management, in which mean level of Serum groups
oups i.e. controls & CRF on conservative
K+, total cholesterol, triglyceride, VLDL C management. The mean value of Serum Na+
and total cholesterol to HDL ratio were and HDL-C
C was significantly decreased in
significantly increased in CRF on conservative CRF on conservative management as
compared to control.
Table 3: Tukeys multiple comparison of Serum Na+, Serum K+ between control & CRF on
dialysis
Parameter Controls CRF on dialysis p value
Serum Na+ 140.7 ± 5.23 134.0 ± 7.90 < 0.05
Serum K+ 3.4 ± 0.38 4.84 ± 0.96 < 0.05

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Pendkar P G
Table 4: Tukeys multiple comparison between control & CRF on dialysis

Parameter Controls CRF on dialysis p value
Total Choesterol 182.06 ± 22.3 197.6 ± 22.70 < 0.05
Triglycerides 115. ± 30.2 196.8 ± 21.9 < 0.05
HDL C 44.33 ± 5.0 32.2 ± 3.05 < 0.05
LDL C 115.42 ± 23.4 125.5 ± 22.43 ˃ 0.05
VLDL C 22.9 ± 6.06 39.2 ± 4.37 < 0.05
TC/HDL 4.12 ± 0.69 6.2 ± 1.02 < 0.05
FIG 3: Bar diagram showing comparison of Serum Na+, Serum K+ in Control & CRF on
dialysis
150
Control
100
50
CRF on dialysis
FIG 4: Bar diagram showing comparison of lipid profile in Control & CRF on dialysis
200
Control
150
100 CRF on Dialysis
50
0

Pendkar P G
Table 3, 4and Figure 3, 4shows compared to controls. The mean value of

Pairwise significance of study parameters Serum Na+ was significantly decreased in
between controls and CRF on dialysis, in CRF on conservative treatment as well as CRF
which mean level of Serum K+, total on dialysis as compared to controls. CRF is
cholesterol, triglyceride, VLDL-C and total characterized by gradual decrease in nephron
cholesterol to HDL ratio were significantly number and function. Decrease in the
increased in CRF on dialysis group as concentrating ability of kidney leads to
compared controls while mean level of LDL accumulation of electrolytes.(11)
did not show any significant difference CRF is associated with
between these two groups i.e. controls & CRF hypercholesterolemia which is due to
on dialysis. The mean value of Serum Na+, associated proteinuria and renal insufficiency
HDL-C was significantly decreased in CRF on per se. Proteinuria leads to alteration in gene
dialysis group as compared controls. expression for HMG -CoA reductase which
Discussion: results in increased activity of HMG-CoA
Chronic renal failure is one of the reductase leading to hypercholesterolemia. It
leading causes for increased morbidity and is also known that LDL receptor mediated
mortality in general population. Its incidence cholesterol uptake plays an important role in
is estimated to be 785 per million of cholesterol homeostasis. Renal insufficiency
population. Deaths due to cardiovascular or in combination with heavy proteinuria leads
complications in CRF patients were 20 times to acquired LDL receptor deficiency which
higher when compared to other causes. plays a central role in the genesis of the
Patients with CRF display a clinical picture of associated hypercholesterolemia in CRF.(12)
early atherosclerosis. Disorders of lipoprotein Hypertriglyceridemia is a common
metabolism during uremia and dialysis are feature of CRF. It may be due to increased
important mechanisms of atherogenesis in synthesis and / or diminished clearance from
(6)
CRF. the circulation. CRF is associated with insulin
+
The mean value of Serum K was resistance which can promote hepatic VLDL
significantly increased in CRF on conservative production leading to increased plasma
treatment as well as CRF on dialysis as triglycerides. Presence of insulin resistance in

Pendkar P G
renal failure activates hormone sensitive lipase expression / activities and impaired HDL
causing increased FFA. The increased FFA metabolism leading to increased level of
availability, stimulate the production of apoB- VLDL-C.(12)
100 containing lipoproteins like VLDL The cause for the low TC/HDL-C ratio
leading to increased triglyceride level.(12,13,14) is due to decreased lipoprotein concentrations
The cause for decreased concentration which could be due to removal of lipoproteins
of HDL-C in CRF is not clear. It might be due by repeated dialysis and decreased peripheral
to low activities of LPL, hepatic triglyceride resistance to insulin after starting dialysis. (15)
lipase (HTGL), LCAT and increased Conclusion:
concentration of CETP and decreased The altered concentration of serum
apolipoprotein concentrations. LPL generates lipoproteins leads to accelerated
precursor of HDL during lipolysis of TG rich atherosclerosis in CRF patients. Hence by
lipoproteins and HTGL promotes conversion correcting the abnormalities of lipid profile
of HDL 2 to HDL 3, thereby they maintain the associated complications would be avoided.
normal HDL-C concentration. In CRF Conflict of interest: None to declare
patients, activities of both the enzymes are Source of funding: Nil
decreased leading to decreased HDL-C References:
concentration. LCAT is the key enzyme 1. Winearls CG. CRF In: Warrell DA, Cox
which keeps the chemical gradient of TM, Firth JD, Benz EJ, Et al. Oxford text
cholesterol from cells to plasma. LCAT book of Medicine 4 th edition, Vol 3. New
activity is also decreased in patients with CRF. York, Oxford University press; 2003:263-
Reduction of plasma LCAT activity may be 278.
due to reduced hepatic production and its 2. Levey AS, Eckardt KU, Tsukamoto Y,
inhibition by an unknown uremic toxin Levin A, Coresh J, Rossert J et al.
(12)
leading to decreased HDL-C concentration. Definition and classification of chronic
CRF are associated with impaired kidney disease : A position statement from
clearance of VLDL and chylomicrons. This is kidney disease : Improving Global
due to dysregulation of LPL, hepatic lipase, Outcomes . Kidney Int 2005; 67:2089-
VLDL receptor, hepatic ACAT and LRP 2100.

Pendkar P G
3. Abraham G, Moorthy AV, Aggarwal V. Compared with Ultracentrifugation

Chronic renal disease: A silent epidemic in Reference Measurement Procedures.
Indian subcontinent – strategies for Clinical Chemistry 2010;56:977-86.
management. Journal of Indian Medical 10. Ion selective electrode, https://en
Association 2006; 104(12):689-91. .wikipedia.org/wiki/Ion_Selective
4. Oda H, Keane WF. Lipid abnormalities in _Electrode
end stage renal disease. Nephrol Dial 11. Duerksen,PapineauN,Electrolyte
Transplant 1998; 13(Suppl 1):45-49. abnormalities in patients with
5. Wanner C. Importance of hyperlipidaemia CRFreceiving parenteral nutrition ,JPEN J
and therapy in renal patients. Nephrol Dial 12. Vaziri ND. Dyslipidemia of CRF: The
Transplant 2000; 15(Suppl 5):92-96. nature, mechanisms and potential
6. Sumathi M. E , Manjunath M Tembad, consequences. American Journal of
Jayaprakash Murthy D.S, Prethi B.P, Study Physiology Renal Physiology
of lipid profile and oxidative stress in CRF 2006;290:262-272.
.Journal of Biomedical Research , 13. Ma KW, Greene EL, Raij L.
2010,Vol. 21, issue 4 ,451- 456. Cardiovascular risk factors in chronic renal
7. Myers GL et al. A reference method failure and hemodialysis populations. Am J
laboratory network for cholesterol: a model Kidney Dis 1992;19(6):505-513.
for standardization and improvement of 14. Prinsen BHCMT, Velden MGMDS,
clinical laboratory measurement. Clinical de Koning EJP, Koomans HA, Berger R,
Chemistry 2000;46: 1762-72. Rabelink TJ. Hypertriglyceridemia in
8. Henry JB. Clinical diagnosis and patients with CRF : possible mechanisms.
management of laboratory methods. 18th Kidney Int2003;63(84):S121-S124.
edition. W. B. Saunders Philadelphia:204- 15. Shah B, Nair S, Sirsat RA, Ashavaid
11. TF, Nair KG. Dyslipidemia in patients with
9. Miller WG et al. Seven Direct Methods for CRF and in renal transplant patients. J
Measuring HDL and LDL Cholesterol Prostgrad Med 1994;40(2):57-60.

Patil A M

A Study on Clinical Profile & Management of Acute Intestinal Obstruction
Abhijeet Patil 1 and Dhirendra Wagh 2
Senior Resident, B.K.L.Walawalkar Rural Medical College, Sawarde,Dist.Ratnagiri1,
Professor, Jawaharlal Nehru Medical College, Sawangi, Wardha, Maharashtra, India2
Abstract:
Acute intestinal obstruction is a failure of aboral progression of intestinal contents. The overall
mortality and morbidity of bowel obstruction is substantial. Therefore better understanding of
pathophysiology, improvement in diagnostic techniques, fluid and electrolyte correction, much
potent antibiotics and knowledge of intensive care is required.
The present study was carried out to find out the common causes, variation in clinical features,
morbidity and mortality rate related to intestinal obstruction. Results of the study showed that
postoperative adhesions is most common cause of intestinal obstruction. Small bowel obstruction is
more common than large bowel obstruction. Large bowel obstruction is more common in patients
above 40 years than in younger group. Abdominal pain, vomiting, distension and constipation are the
four cardinal features of intestinal obstruction, present in most of the cases. Plain x-ray abdomen
taken in erect posture is the single most important investigation required for the patients. Intravenous
fluids and electrolytes, gastrointestinal aspiration, antibiotics and then appropriate surgery are still
the main stay of the treatment.
Among the factors influencing the mortality and morbidity are age, state of hydration,
nutritional status, viability of the bowel, etiology of obstruction, site of obstruction, delay in
diagnosis and surgical intervention and associated medical illness.
Therefore, early diagnosis of obstruction, skillful operative management, proper technique
during surgery and intensive postoperative treatment carries a grateful result.

Patil A M
Key words:
Intestinal obstruction, adhesions, morbidity, mortality, early intervention
How to cite this article: Abhijeet Patil and Dhirendra Wagh . A Study on Clinical Profile & Management of Acute
Intestinal Obstruction. Walawalkar International Medical Journal 2017; 4(1):10-27. http://www.wimjournal.com

Dr. Abhijeet Manohar Patil, Senior Resident, B.K.L.Walawalkar Rural Medical College, Sawarde,
Tal. Chiplun, Dist.Ratnagiri-415606, Maharashtra, India, Email: abhijeet455@yahoo.co.in,
Mobile No.7057586736
Introduction: the gut to the next. This form is commonly

Acute intestinal obstruction is one of referred to as ileus or pseudo-obstruction.(2)
the most common surgical emergencies. It LBO can result from either mechanical
involves a partial or complete blockage of the interruption of the flow of intestinal contents
bowel which induces mechanical impairment or by the dilation of the colon in the absence
or complete arrest of the passage of content of an anatomic lesion. Intussusception is a
through the intestine. Obstruction may occur unique type of obstruction that results from
in the small bowel (SBO) or large bowel invagination of a segment of bowel into
(LBO).(1) SBO is mainly of two types, another.(3)
Mechanical and functional obstruction. Volvulus (an axial twist of the
Mechanical obstruction means that luminal gastrointestinal tract around its mesentery),(4)
contents cannot pass through the gut tube Gallstone ileus (mechanical bowel
(5,6)
because the lumen is physically blocked or obstruction), Adhesions (postoperative or
obstructed, whereas functional obstruction postinflammatory), hernias, worm obstruction
means that luminal contents fail to pass due to Ascaris lumbricoides are frequent
because of disturbances in gut motility that causes of intestinal obstruction. Sigmoid
prevent coordinated transit from one region of volvulus, caecal volvulus, Congenital cysts

Patil A M
(e.g enterogenous cyst) and tumors (e.g. non- Material and Methods:
Hodgkin lymphoma) are also potential causes Patients that attended the outpatient
of this disorder. department and the casualty and those who got
Symptoms of intestinal obstruction admitted in the surgical wards of our hospital
includes abdominal pain (colicky), vomiting, in the period of 2 year were included in the
abdominal distension and obstipation (failure study.
to pass flatus and faeces).(7) Visible peristalsis Inclusion criteria –
may be seen in thin patients while in others • Age: 1 – 85 years of age
distention may be prominent. • Patients with acute intestinal
Complete obstruction typically is obstruction who have undergone
treated with immediate surgery, while partial operative management are included in
obstruction seldom requires surgery. Patients this study.
with partial bowel obstruction may be treated Exclusion criteria –
conservatively with resuscitation and tube • Patients who refused surgical
decompression alone. intervention were excluded
Many Indian studies demonstrated that the • Patients those who were treated
pattern of intestinal obstruction differs from conservatively for subacute intestinal
the Western world with obstructed hernias obstruction.
being the most important cause. However, Cases selection was done in the
little data is available from the Central part of criteria of history, clinical examination and
the India especially from the rural population. radiological examination. Routine blood and
Therefore, similar study has been undertaken urine investigations, as well as plain x-ray of
• To identify the common causes of acute erect abdomen to detect fluid gas levels were
intestinal obstruction . carried out in all the selected cases.
• To study the various clinical features of Immediately after the admission along
intestinal obstruction. with above procedure, resuscitation with IV
• To determine morbidity and mortality fluids especially ringer lactate and normal
rate. saline infusion started till the hydration and
urine output become normal. Nasogastric

Patil A M
decompression with Ryle’s tube was carried etiology, radiological findings, operative
out and antibiotic prophylaxis started and management, causes of mortality, post
close observation of all bedside parameters operative complications adopted.
(like pulse rate, BP, RR, abdominal girth, All the information was collected using a
bowel sounds and tenderness and guarding) structured proforma. Completed information
was done. was entered in computer software.
Patients who showed reduction in • Nominal data such as demographic
abdominal distension and improvement in data were presented as number and
general condition were managed by percentages.
conservative treatment. Such individuals are • Continuous data (age, duration of
excluded in this study. Patients with clear-cut disease, pulse BP) were expressed as
signs and symptoms of acute obstruction were mean, standard deviation and range.
managed by appropriate surgical procedure • Chi-Square test or Fisher exact test
after resuscitation. Surgery adopted and were applied as appropriate for
criteria for deciding the procedure were noted. comparison of nominal data.
The postoperative period was • For continuous data, Unpaired t test
monitored carefully and all parameters were was applied to compare two group
recorded hourly or four hourly basis Results:
depending upon the patients general condition Age
and toxaemia. Routine intermittent oxygen Out of the 102 patients, 62.75% (64)
inhalation was instituted in patients having patients were males and 37.25% (38) patients
strangulation of the bowel to reduce the were females. Male to Female ratio is 1.68: 1.
damage induced by ischemia. Postoperative Majority of patients were in the age group of
follow up after the discharge of patients was 50 – 60 years. (Graph 1)
done in majority of the patients up to 3
months. Most of the patients did not come for
follow up after one or two visits.
The results are tabulated mostly stressing on
following points age, signs and symptoms,

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Patil A M
Graph 1:: Age wise and Gender wise distribution of patients

patients:
Sign and symptoms: Of the total patients increased bowel sounds

Out of 102 patients, majority had pain, and tenderness were the major signs.
constipation, distention followed by vomiting. (Graph 2)
Graph 2:: Distribution of patients according to signs and symptoms:

symptoms
150%
97.06%
94.12%
93.14%
84.31%
84.31%
81.37%
120%
% of patients
61.76%
90%
21.57%
60%
17.65%
15.69%
13.73%
30%
0%
0%
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Signs and Symptoms

Patil A M
Of the total patients 94.12% (96) patients (39) patients and 16.67% (17) patients
complained of pain while 5.88% (6) patients complained of pain for more than 2 days.
had no pain. Duration of pain was for 1 day in (Table 1a)
39.22% (40) patients, for 2 days in 38.24%
Table 1a: Distribution of patients according to duration of pain

Duration of pain(days) No of patients Percentage (%)
1 40 39.22
2 39 38.24
>2 17 16.67
No Pain 6 5.88
Total 102 100.00
Out of 102 patients 81.3% (83) patients had more than 2 days. 3.92% (4) patients had no
vomiting for 1 day, 13.73% (14) patients complains of vomiting. (Table 1b)
complained of vomiting for 2 days, while only
0.98% (1) patient complained of vomiting for
Table 1b: Distribution of patients according to duration of vomiting
Duration of vomiting(days) No of patients Percentage (%)

1 83 81.37
2 14 13.73
>2 1 0.98
No Vomiting 4 3.92
Total 102 100.00

Patil A M
Out of 102 patients 94.12% (96) patients had complains of distention and it was absent in 5.88% (6)
patients. (Table 1c)
Table 1c: Distribution of patients according to presence of distention

Presence of distention No of patients Percentage(%)
Present 96 94.12
Absent 6 5.88
Total 102 100.00
Out of 102 patients 93.12% (95) patients had complains of constipation and it was absent in 6.86%
(7) patients. (Table 1d)
Table 1d: Distribution of patients according to presence of constipation

Presence of constipation No of patients Percentage (%)
Present 95 93.14
Absent 7 6.86
Total 102 100.00
Etiology: cause in 3.92% (4) patients. Intussusception

Of the 102 patients, around 29.41% was cause in 2.94% (3) patients. Adhesive
(30) patients suffered from the adhesions, intestinal obstruction was the most common
18.63% (19) suffered from obstructed hernias, cause of intestinal obstruction. Other causes
18.63% (19) had tuberculous obstruction, included 1.96% (2) patients, one with paralytic
while 14.71%(15) suffered from volvulus. illeus and another with mesenteric vein
Malignancy was found to be cause in 9.80% thrombosis. (Graph 3)
(10) patients while Meckel’s diverticulum was

Patil A M
Graph 3: Distribution of patients according to etiology
50%
45%
29.41%
40%
35%
% of patients
18.63%
18.63%
30%
14.71%
25%
9.80%
20%
3.92%
2.94%
15%
1.96%
10%
5%
0%
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Etiology
Of the 30 patients presenting with adhesions, 83.33% (25) patients had postoperative adhesions while
in 16.67% (5) patients cause was not known. (Table 2a)
Table 2a: Distribution of patients according to type of adhesions

Cause of adhesions No of patients Percentage (%)
Post operative 25 83.33
Others 5 16.67
Total 30 100.00
Of the 15 patients presenting with volvulus, 80% (12) patients had sigmoid volvulus, while 20% (3)
patients had illeal volvulus. (Table2b)
Table 2b: Distribution of patients according to type of volvulus

Cause of volvulus No of patients Percentage(%)
Sigmoid 12 80.00
Ileum 3 20.00
Total 15 100.00

Patil A M
Out of 19 patients presenting with obstructed hernia. 5.26% (1) patient had obstructed
hernia, 63.16% (12) patients had right sided incisional hernia, 5.26% (1) patient had
obstructed inguinal hernia, 26.32% (5) obstructed umbilical hernia. (Table 2c)
patients had left sided obstructed inguinal
Table 2c: Distribution of patients according to type of hernia

Type of hernia No of patients Percentage(%)
Right Inguinal 12 63.16
Left Inguinal 5 26.32
Incisional 1 5.26
Umbilical 1 5.26
Total 19 100.00
Out of 10 patients of malignancy, maximum malignancy 20% (2 patients each) hepatic

were of sigmoid colon 40% (4) patients, flexure and splenic flexure malignancy
followed by descending colon 20% and caecal consisted of 10% (1 patient each). (Table 2d)
Table 2d: Distribution of patients according to site of malignancy

Site of malignancy No of patients Percentage(%)
Hepatic Flexure 1 10.00
Splenic Flexure 1 10.00
Descending Colon 2 20.00
Sigmoid Colon 4 40.00
Caecum 2 20.00
Total 10 100.00
The age and sex wise distribution of various younger age group [<40 years] while
etiologies of intestinal obstruction shows that obstruction due to hernia, volvulus,
adhesive intestinal obstruction and tuberculous malignancy are more common in older age
intestinal obstruction are more common in group [>40 years]. (Table 3)

Patil A M
Table 3 - Age and sex distribution of study group against causes of obstruction #
Age 0-10 11-20 21-30 31-40 41-50 51-60 61-70 >70
Cause M F M F M F M F M F M F M F M F
Adhesions (30) 1 1 3 4 4 1 4 3 3 1 - - 3 1 1 -
Tuberculous 1 - 1 1 - 3 2 2 1 1 1 3 2 1 - -
obstruction (19)
Hernia (19) - - - - 1 - 1 - 2 - 10 1 4 - - -
Volvulus (15) - - - - - - - - - 2 6 4 2 1 - -
Malignancy (10) - - - - - - 1 - - 1 2 3 1 - 1 1
Meckel’s 1 - 2 1 - - - - - - - - - - - -
diverticulum (4)
Intussusception (3) 2 1 - - - - - - - - - - - - - -
Others (2) - - - - - - - - 1 - - 1 - - - -
Total (102) 7 12 9 13 12 31 15 3
Radiological findings: (78) patients , ground glass appearance

Out of 102 patients, x ray abdomen was seen in 4.82% (04) patients . About in
standing was done in 81.38% (83) patients. 18.62% (19) patients x ray abdomen standing
Multiple air fluid level was seen in 93.98% was not done. All of them were suffering from
obstructed hernia. (Table 4)
Table 4 - Radiological findings of x ray abdomen standing among the patients

X ray abdomen findings No of patients Percentage(%)
Multiple air fluid level 78 93.98%
Ground glass appearance 05 4.82%
Operative management: followed by resection anastomosis (19.61%)

Adhesiolysis (24.51%) was most and illiotransverse anastomosis (16.67%)
common of the operative management done followed by herniorraphy(16.67%). (Table 5)

Patil A M
Table 5: Distribution of patients according to type of operative management

Type of operative management No of patients Percentage(%)
Adhesiolysis 25 24.51
Resection Anastomosis 20 19.61
Derotation of Volvulus 12 11.76
Hemicolectomy 13 12.75
Sigmoidectomy 10 9.80
Herniorapphy 17 16.67
Illio Transverse Anastomosis 17 16.67
Causes of mortality abdomen (15.79%), 1 was of volvulous

Out of 102 patients, death occurred in (6.67%)
7 patients (6.86%), 3 patients were of All of the 7 patients died due to septicaemia.
malignancy (30%), 3 were of tuberculous (Table 6)
Table 6: Distribution of patients according to causes of mortality

Causes of mortality No of patients Mortality(%)
Adhesions 30 0(0%)
Hernia 19 0(0%)
Tuberculous Obstruction 19 3(15.79%)
Volvulus 15 1(6.67%)
Malignancy 10 3(30%)
Intussusception 3 0(0%)
Meckels diverticulum 4 0(0%)
Other 2 0(0%)
Post operative complications: illeus was seen in 9.80% (10) patients. More
Out of patients who had postoperative severe complications like burst abdomen
complications most common was fever in occurred in 4.90% (5) patients, faecal fistula
17.65% (18) patients , followed by wound in 2.94% (3) patients. Short bowel syndrome
gaping in 16.67% (17) patients. Prolonged occurred in 0.98% (1) patient. (Table 7)

Patil A M
Table 7: Distribution of patients according to post operative complications

Post operative complications No of patients Percentage(%)
Wound Gaping 17 16.67
Fever 18 17.65
Prolonged Ileus 10 9.80
Faecal Fistula 3 2.94
Burst Abdomen 5 4.90
Short Bowel Syndrome 1 0.98
Septicaemia(Death) 7 6.86
No Complications 44 43.14
In our study both 19 patients of tuberculous prolonged illeus , faecal fistula burst abdomen
obstruction and 10 patients of malignancy and even septicaemia (death).
suffered from various post operative It was found that tuberculous obstruction and
complications like fever, wound gaping, malignancy are more prone for complications.
(Table 8)
Table 8 - Association of etiology with postoperative complications

Etiology Postoperative complications Total
present absent
Adhesions 07(23.33%) 23(76.66%)** 30
Tuberculous obstruction 16(84.21%)** 3(15.79%) 19
Hernia 9(47.36%) 10(52.64%) 19
Volvulus 13(86.66%) 2(13.34%) 15
Malignancy 8(80%)** 2(20%) 10
Meckel’s diverticulum 1(25%) 3(75%) 4
Intussusception 2(66.67%) 1(33.33%) 3
Others 2(100%) - 2
Inference Tuberculous obstruction and malignancy are more
prone for complications

Patil A M
Discussion: tenderness and abdominal masses were

(13)
Acute intestinal obstruction is one of common signs. A prospective study by
the most common surgical emergencies. The Haridimos M et al in 150 patients, absence of
overall mortality and morbidity of bowel passage of flatus (90%) and/or feces (80.6%)
obstruction is substantial.(1,2) Brewer et al and abdominal distension (65.3%) were the
analysed 1000 consecutive abdominal most common symptoms and physical finding,
surgeries and reported an incidence of 2.5%.(8) respectively.(14) The above findings indicate
The present study showed increased incidence that the clinical profile of Indian patients with
of intestinal obstruction between 51 – 60 years intestinal obstruction is same as that of others.
of age. Simillar results shown by Playforth,(9) The present study indicates that
G. J.Cole,(10) S.S. Gill.(11) adhesive obstruction is much more likely than
In our study, majority of patients had other causes, with the highest incidence rate
symptoms of distention (97.06%), pain (29.41%). Thereinto, 83.33% of the adhesions
(94.12%), constipation (93.14%), tenderness were secondary to the previous abdominal
(84.31%), increased bowel sounds (84.31%), operation. Perhaps, the evolved modern
vomiting (81.37%) and dehydration (61.76%). surgery has induced the increase in iatrogenic
However symptoms of guarding, absent bowel peritoneal adhesions. A review revealed that
sounds, fever and palpable mass was seen in adhesions might occur in more than three-
fewer number of subjects. Similar findings fourths of patients following laparotomy,
were observed by other authors. In a study by because peritoneal trauma resulted in a unique
Rehman, the commonest symptoms were inflammatory process in which fibrin
abdominal pain 54 (100%), abdominal formation and fibrinolysis played a central
distension 49 (90%), vomiting 42 (78%), role.(15)
absolute constipation 37 (68.5%), dehydration Every violation of the peritoneum
33 (61%), fever 16 (29.6%), mass right iliac carries a potentially lifelong risk of this disease,
fossa 8 (15%), inguinoscrotal swelling 10 and the effects of adhesions are unpredictable
(12)
(18%). In a study by Madziga, abdominal but widely existent in a significant health care
pain 88.7%, vomiting 84.8%, and constipation burden by its recurrent nature.(15) Increasing
78.8% were the main symptoms while utilization of laparoscopic surgery may reduce

Patil A M
the extent and incidence of adhesions, and 150 episodes of mechanical intestinal
laparoscopic adhesiolysis. In experienced hands, obstruction, external hernia accounts for the
it may be successful in managing acute largest number of cases followed by
obstruction or serve as a planned procedure volvulus.(17) In a study by Madziga, obstructed
when the obstruction has been resolved.(16) external hernias, 35.0% were the commonest
In the present study, other main causes cause of mechanical bowel obstruction; with
of intestinal obstruction were hernia and indirect inguinal hernia, 80.1% accounting for
tuberculous obstruction in 18.63 % patients, most hernias. Intraperitoneal adhesions,
volvulus in 14.71% patients, malignancy in accounted for 26.61% of cases. Other causes
9.80% patients, meckel’s diverticulum in in descending order were intussusception 80
3.92%, intusseception in 2.94% patients and (21.5%), malignant colonic obstruction 34
other causes in 1.96% patients. In volvulus, (9.14%) and sigmoid volvulus 11 (2.95%).(13).
sigmoid volvulus occurs in 80% patients while Few authors reported other major causes of
illeal volvulus occurs in 20% of patients. intestinal obstruction. In a study by Adhikari S
Right sided inguinal hernia obstruction was et al in Eastern India, the main cause of
responsible in 63.16% patients. Left sided obstruction was obstructed hernia followed by
inguinal hernia obstruction was responsible in malignancy.(18) A prospective study by
26.32% patients while incisional and umbilical Haridimos M et al, adhesions (64.8%),
hernia was seen in 5.26% of patients. incarcerated hernias (14.8%), and large bowel
Malignancy was a cause of obstruction in only cancer (13.4%) were the most frequent causes
10 patients. of obstruction.(14) In our study we found two
Similar findings were observed by other rare cases one with mesenteric vein
authors. In a study by Rehman, the commonest thrombosis causing intestinal obstruction and
etiology were adhesions and bands 23 (42.5%), other with paralytic illeus leading to
intestinal tuberculous 13 (24.07%), stricture + obstruction. Cause of illeus could not be
ileocecal mass, hernias 10 (18.51%), tumours traced out. Patient with paralytic illeus was
03 (5.5%), worm infestations 03 (5.5%), found to be chronic ganja (Cannabis) addict.
(12)
intussusception 02 (3.7%). In a study by Pal Operative management was done in all
et al in peripheral district of eastern India in patients. Out of them 24.51% patients

Patil A M
underwent adhesiolysis, 19.61% underwent with operation. The period of conservative

resection anastomosis, 16.67% patients were therapy is better to be limited within one week
treated with herniorapphy and same number of after the onset of symptoms, and then
patients underwent illio transverse conversion to surgery should be considered.(20)
anastomosis. 12.75% patients were managed In our study, mortality was 6.86%, of
with hemicolectomy, 11.76% with derotation them 3 patients had tuberculous obstruction, 3
of volvulus and 9.80 were managed with had malignancy and 1 had volvulus. All of
sigmoidectomy. The pattern of operative them died due to septicemia. It shows that the
treatment in our study reflects the standard mortality in our study is less as compared to
approach to the management of patients with mortality reported by the other studies. In a
intestinal obstruction. In a study by Rehman, study by Pal et al in 150 episodes of
the commonest etiology were managed by mechanical intestinal obstruction, operative
adhesiolysis + band division 27 (50%), mortality was 28%. The highest mortality rate
resection and end to end anastomosis 13 (24 (41.3%) was found in volvulus.(17) In a
%), Right hemicolectomy 9 (17%), simple retrospective study by Mohamed et al, the
reduction & defect repair 5 (9%), enterotomy mortality rate was 3.5%. In a study by
3 (5.5%).(12) Madziga, mortality rate was 9.14%.(13) Study
In a study by Mohamed et al in Saudi Arabia, by Chaib E et al showed operative mortality
surgical intervention was necessary in 61 9.09%.(21)
patients (73%) while 23 patients (27%) Present study showed that most of the
(19)
responded to conservative treatment. patients (43.14%) had no complications
The time interval before operation is a however fever occurred as a postoperative
critical factor for acute intestinal obstruction, complication in 17.65% of patients. In a study
because prolonged conservative therapy might by Pal et al the major adverse factors were
be harmful and potentially lethal, and on the gangrenous bowel and large bowel
(17)
other hand, too radical option of operation will obstruction. In a study by Chaib E et al,
aggravate the burden of the patients. The complications occurred in 15.7% of patients
present study indicates that all the patients following operative intervention; wound
with acute intestinal obstruction can be cured infection was the most common postoperative

Patil A M
complication.(21) Similar results shown in the fluid and electrolyte, which can be severe, and
(13)
study done by Madziga. life threatening.
In our study about 52 (50.98%) Postoperative adhesions is the common
patients turned for follow up and were cause to produce intestinal obstruction.
followed up for a period of 3 months. Clinicoradiological and operative findings put
43(42.15%) patients didn’t turn up for follow together can bring about the best and accurate
up. The results of present study are in the line diagnosis of intestinal obstruction.
with published literature, indicating that the Early diagnosis and operative treatment
sign and symptoms in Indians are more or less followed by proper postoperative management
as that of West. Etiology of acute intestinal is necessary to prevent mortality and
obstruction matches with that of West. The morbidity. Early operation is mandatory to
mortality in our study is less as compared to avoid the development of peritonitis and
published literature. It is apparent from this systemic sepsis associated with multi-system
report that increased efforts to adhesiolysis organ failure.
before complication occurs are likely to Conflict of interest: None to declare
reduce the incidence and mortality from Source of funding: Nil
intestinal obstruction. In addition research References
aimed at finding ways to reduce adhesion 1. Evers BM: Small bowel obstruction.
formation may reduce the incidence of Sabiston’s textbook of surgery.
adhesive obstructions. For affected patients, Townsend,Beauchamp, Evers, Mattox
high quality surgical expertise coupled with (Editors). W.B. Saunders Co 2001;16th
sound clinical judgment and early surgery Ed; 882 -888.
when needed will greatly improve survival. 2. Sakorafas GH, Poggio JL, Dervenis C,
Conclusion: Sarr MG: Small bowel obstruction.
Intestinal obstruction remains an Shackelford’s surgery of the
important surgical emergency. Patients with a alimentary tract. W.B. Saunder’s
clinical picture of obstruction of the bowel Company 2002;5 edition;317-341.
demand vigorous resuscitation, correction of

Patil A M
3. Ein SH: Leading points in childhood 10. Cole GJ. A review of 436 cases of
intussusception. J Paed Surg intestinal obstruction in Ibanan. Gut
1976;11(2):209-211. 1965; 6:151-162.
4. Frazee RC, Mucha P, Farnell MB, Van 11. Gill SS, Eggleston FC. Acute
Heerden JA: Volvulus of the small Intestinal Obstruction. Arch Surg 1965
intestine. Ann Surg 1988;208(5):565- Oct; 91:389-392.
568. 12. Aziz Ur Rehman, Mazhar Khan,
5. Akgur FM , Tanyel FC, Zahid Aman, Mohammad Zia Ul Haq,
Buyukpamukcu N, Hicsonmez A: Siddique Ahmad, Sarfaraz Ahmad.
Anomalous congenital bands causing Pattern of small bowel obstruction in
intestinal obstruciton in children. J adults. J. Med. Sci. April-June
Paed Surg 1992;27(4):47-473. 2010;18(2):77-78.
6. Festen C: Postoperative small bowel 13. Madziga AG, Nuhu AI. Causes and
obstruction in infants and children. treatment outcome of mechanical
Ann Surg 1982;196:580-583. bowel obstruction in north eastern
7. Winslet MC: Intestinal obstruction. Nigeria. West Afr J Med. 2008
Bailey and Love’s Short Practice of Apr;27(2):101-5.
Surgery. Russell , Williams , 14. Haridimos Markogiannakis,
Bulstrode (Editors ) . Arnold Evangelos Messaris, Dimitrios
International students edition 2004, Dardamanis, Nikolaos Pararas,
24th ed;1186-1202. Dimitrios Tzertzemelis, Panagiotis
8. Richard JB, Gerald TG, David CH, Giannopoulos, Andreas Larentzakis,
Leslie ER, Wangensteen SL. Emmanuel Lagoudianakis, Andreas
Abdominal pain. Am J Surg 1976; Manouras, Ioannis Bramis. Acute
131: 219-223. mechanical bowel obstruction:
9. Playforth RH et al. Mechanical small Clinical presentation, etiology,
bowel obstruction and plea for the management and outcome. World J
earlier surgical intervention. Ann Surg Gastroenterol 2007 January 21; 13(3):
1970; 171: 783-788. 432-437.

Patil A M
15. Senthilkumar MP, Dreyer JS. 19. Mohamed AY, al-Ghaithi A,

Peritoneal adhesions: pathogenesis, Langevin JM, Nassar AH. Causes and
assessment and effects[J]. Trop management of intestinal obstruction
Gastroenterol, 2006,27(1):11-18. in a Saudi Arabian hospital. J R Coll
16. Moran BJ. Adhesion-related small Surg Edinb. 1997 Feb;42(1):21-3.
bowel obstruction[J]. Colorectal 20. Bi XD, Zhao J, Li H, et al. Study of
Dis,2007,9 (Suppl 2):39-44. the timing of operation for acute ileus
17. Pal JC, De SR, Das D. The pattern of — 385 cases clinical treatment
acute intestinal obstruction in a analysis[J]. Zhongguo Xian Dai Yi
peripheral district of eastern India. Int Xue Za Zhi, 2006,16(24):3742-3745.
Surg. 1982 Jan-Mar;67(1):41-3. 21. Chaib E, Toniolo CH, Figueira NC,
18. Adhikari S, Hossein MZ, Das A, Santana LL, Onófrio PL, de Mello JB.
Mitra N, Ray U. Etiology and outcome Surgical treatment of intestinal
of acute intestinal obstruction: a obstruction. Arq Gastroenterol. 1990
review of 367 patients in Eastern Oct-Dec;27(4):182-6.
India. Saudi J Gastroenterol 2010 Oct-
Dec;16(4):285-7.

Sharma A K

Status of Serum Fructosamine in Diabetic Subjects in Udaipur, Rajasthan
Avdhesh Kumar Sharma 1 and Kishan Lal Mali 2
Demonstrator, Department of Biochemistry, Ananta Institute of Medical Sciences and Research
Centre, Rajsamand.1,Professor and Head, Department of Biochemistry, Geetanjali Medical
College and Hospital, Udaipur, India 2
Abstract:
Background:
Estimation of glycated haemoglobin and fructosamine in diabetic patient for the assessment
of glycemic control isgaining importance now a day. Little data is available about assessment of
fructosamine in our area. Hence the present study was undertaken to know the levels of fructosamine
in diabetic patients.
Material and Methods:
Total 150 subjects were involved in present study and divided into two groups. Out of 150
subjects 50 were healthy subjects and 100 type II diabetes mellitus patients. In all subjects, fasting
blood glucose level, postprandial blood glucose level, glycated haemoglobin and fructosamine were
measured.
Results:
Fasting and post prandial blood glucose was significantly increased in diabetic patient as
compared to healthy controls (P < 0.001). Moreover, the glycated haemoglobin and fructosamine
levels were significantly increased in diabetic patient (P < 0.001). However, when these parameters
were used to see the difference between males and females, there was no statistical difference seen.
Conclusion:
The results of current study show that glycated haemoglobin and fructosamine levels are
significantly increased in diabetic patients and measurement of fructosamine is having more
importance than glycated haemoglobin.
Key Words:
Glycated Hemoglobin, Fructosamine, Diabetes Mellitus, Rajasthan
.
How to cite this article: Avdhesh Kumar Sharma and Kishan Lal Mali Status of serum fructosamine in diabetic
subjects in Udaipur, Rajasthan. Walawalkar International Medical Journal 2017; 4(1):28-34.
http://www.wimjournal.com

Sharma A K

Avdhesh Kumar Sharma, Department of Biochemistry, Ananta Institute of Medical Sciences and
Research Centre, Rajsamand. 313202, Email ID: avdheshsharma85@gmail.com,
Mobile No. 9057243248
Introduction: alkaline labile phosphate, presumably

Endocrine system and nervous system corresponding to fructosamine 3-phosphate
are two major systems present in the body residues. This phosphorylation triggers the
which regulate all the physiological activities. spontaneous decomposition of fructosamine 3-
These two systems interact with one another phosphate residues to free amine, inorganic
and regulate the body phosphate and 3 – deoxyglucosone, which can
functions.(1)Measurement of glycated oxidize to 2-keto-3-deoxygluconate in red
haemoglobin (HbA1c) and fructosamine has blood cells.(5)
growing role in the assessment of glycemic Udaipur, which lies in southern part of
control but their utility for screening the Rajasthan, is festooned with Aravali hills and
population is questionable.(2)In the mid- presents a unique mixture of two subsets of
seventies, the measurement of glycated population with contrasting lifestyle. Due to
haemoglobin was found to be a reliable increase in mining, it is on fast track of socio-
marker for elevated glucose concentration in economic resurgence with urbanization and
(3)
the preceding 4 to 6 weeks. brisk changes of lifestyles, whereas on the
Fructosamine can also refer to a other side, peoples in rural and tribal area
specific compound 1 –amino – 1-deoxy – D – suffer from silent hunger and poverty. Till
fructose. The physiological role of date there is no data of fructosamine in
fructosamine 3-kinase has been seen by diabetic patient from Udaipur region and the
incubating human erythrocytes in presence of etiological reports are very scanty and meager.
high glucose concentration and of a specific Hence this study was undertaken to estimated
inhibitor of this enzyme.(4) It converts glycated fructosamine and glycated haemoglobin in
haemoglobin to a form of haemoglobin with diabetic patients of our region.

Sharma A K
Material and Methods: time nitroblue tetrazolium method.(8) The

The study was carried out at Geetanjali blood glucose and glycated haemoglobin tests
Medical College and Hospital, Udaipur were performed on Roche/ Hitachi Cobas C –
between the period of October 2014 to March 311 fully automated analyser and
2015. Total 150 subjects participated in this fructosamine test on Erba Chem 5 plus V2
study, out of which 50 were healthy control semi-automated biochemistry analyser. Data
and 100 were type II Diabetes Mellitus. The obtained were analysed statistically by using
controls and subjects (cases) were age online student t – test calculator. P value less
matched. Inclusion criteria were patients than 0.05 was considered statistically
proven type II diabetes mellitus and significant.
undergoing treatment for the same. Exclusion Results:
criteria were patients undergoing treatment for Out of the 50 healthy control subjects,
any thyroid disorders, patients taking lipid- 29 were male and 21 female, whereas in
lowering drugs, patients with malignancy, and diabetic group, out of 100 subjects, 62 were
pregnant women. The study was approved by male and 38 female. Fasting blood sugar level
ethical committee of Geetanjali Medical was 88.02 + 8.4 in control and 214.45 + 21.1
College and Hospital, Udaipur. in diabetic group and was statistically
Blood sample were collected and serum significant (P value 0.001; Table 1). Post
was separated. The following parameters were prandial blood glucose was 121.17 + 9.3 in
estimated in all subjects. control and 327.62 + 33.24 in diabetic group
1. Fasting and Post prandial blood and was statistically significant (P value
glucose level. 0.001; Table 1). In healthy controls, glycated
2. Glycated Hemoglobin (HbA1c) haemoglobin was 5.44 + 0.32 and in diabetic
3. Fructosamine was 9.51 + 1.49 and was statistically
Estimation of blood glucose level was significant (P value 0.001; Table 1). In healthy
(6)
done by hexokinase method. Glycated controls, fructosamine level was 223.84 + 9.0
haemoglobin was estimated by the and in diabetic was 395.33 + 70.24 (P value
turbidimetric inhibition immunoassay 0.001; Table 1).
method(7) and fructosamine by kinetic fixed

Sharma A K
Table 1: Showing values of various parameters in control and diabetic group

Control (n = 50) Diabetic (n = 100) P Value
Fasting blood glucose 88.02 + 8.4 214.45+ 21.1 0.001
(mg/dL)
Post prandial blood glucose 121.17+ 9.3 327.62+ 33.24 0.001
(mg/dL)
Glycated haemoglobin 5.44+ 0.32 9.51+ 1.49 0.001
(%HbA1c )
Fructosamine (µmol/L) 223.84+ 9.0 395.33+ 70.24 0.001
We also tried to see the statistically group. However, no statistical significance

significance of values of glycated was seen in between males and females of
haemoglobin and fructosamine between males glycated haemoglobin level of control group
and females of healthy control and diabetic (P value 0.912; Table 2) and diabetic group
(0.974; Table 2).
Table 2: Showing values of glycated haemoglobin (%HbA1c) in male and female of control and
diabetic group
Male 5.45+ 0.31 9.52 +1.56 0.001
Female 5.44+ 0.30 9.51 +1.36 0.001
P value 0.912 0.974
Similarly, there was no statistical significance fructosamine level of control group (P value
seen in between males and females of 0.830; Table 3) and diabetic group (P value
0.320; Table 3).

Sharma A K
Table 3: Showing values of fructosamine (µmol/L) in male and female of control and diabetic group
Male 223.54 + 9.95 387.75 +74.25 0.001
Female 224.15 + 0.30 402.92 +73.03 0.001
P value 0.830 0.320
Discussion: 6-8 weeks, a glycated hemoglobin

In our study, we found that fasting and measurement reflects the average glucose
post prandial blood glucose was significantly concentration over this longer period.(13)
increased in diabetic patient as compared to Fructosamine explains the short-term diabetic
healthy controls. Also the glycated control as opposed to the longer term for
haemoglobin and fructosamine levels were glycated hemoglobin.
significantly increased in diabetic patient as Chronic hyperglycemia may be the
compared to healthy controls. However, when responsible for vascular complications of
these parameters were used to see the diabetes mellitus, and methods of accurate
difference between males and females, there assessment of glycemic control should be
was no statistical difference. encouraged. The fructosamine levels has been
The results of our study also correlated found to be more sensitive than random
with the study done by other authors.(9–12) But glucose measurement for glycemic control
since this study was related to an area where determinations and contributed a different
less data is available to come to a conclusion, view of glycemia than that of glycated
the results obtained in our study add more to hemoglobin. Since the half-life of albumin and
the existing data. other serum proteins is considerably shorter
Fructosamine and glycated hemoglobin are than that of hemoglobin, the concentration of
two different parameters and both are used to fructosamine levels can change more rapidly
monitor diabetic control. Each measurement than those of glycated hemoglobin.
provides information for a specific time frame Conclusion:
that is related to the analyte being measured. The results of our study show that
Since the life span of red blood cells is near to glycated haemoglobin and fructosamine levels

Sharma A K
are increased in diabetic patients. Considering 06. D’Orazio P et al. Approved IFCC
the time frame, measurement of fructosamine recommendations on reporting results
is more reliable than glycated haemoglobin. for blood glucose (abbreviated). Clin
Conflict of interest: None to declare Chem. 2005; 51 (9): 1573 – 76.
Source of funding: Nil 07. Junge W et al. Determination of
References: reference levels in adults for
01. Regmi A et al. Serum lipid profile in haemoglobin A1c (HbA1c). Poster
patients with thyroid disorders in presentation EUROMEDLAB,
central Nepal. Nepal M Coll J. 2010; Barcelona 2003
12 (4): 253 – 256 08. Johnson RN et al. Fructosamine: a
02. Cavallo P and Bifulco M. “Thyroid in new approach to the estimation of
the medieval medical school of serum glycosylated protein. An index
Salerno. Thyroid. 2007; 17 (1): 36 – of diabetic control. Clin Chem Acta.
40 1983; 127: 87 - 95
03. Laube H. Is the determination of 09. Chang J et al. Evaluation and
HbA1C effective in the management interference study of haemoglobin
of diabetes? Dtsch Med A1c measured by turbidimetric
Wochenschr. 1985. 24;110(21):823-5. inhibition immunoassay. Am J Clin
04. Amela B and Edina BK. The Pathol. 1998; 109: 274 – 278
importance of HbA1c control in 10. Baker JR et al. Clinical usefulness of
patients with subclinical estimation of serum fructosamine
hypothyroidism. Mat Soc Med. 2012; concentration as a screening test for
24 (4): 212 – 219. diabetes mellitus. Brit Med J. 1983;
05. Walter F, Boron. Chapter 48, 257: 863 – 867
“synthesis of thyroid hormones”. 11. Cohen RM and Sacks DB. Comparing
Medical physiology. A cellular and multiple measures of glycemia: How
Molecular Approach Elsevier/ to transition from biomarker to
Saunders. P. (2003): 1300. ISBN 1 – diagnostic test? Clinical Chemistry.
4160 -2328 – 3. 2012; 58 (12): 1615 – 1617

Sharma A K
12. Malmstrom H et al. Fructosamine is a from the AMORIS cohort. PLoS one.
useful indicator of hyperglycemia and 2014; 9(10): e111463
glucose control in clinical and 13. American Diabetes Association.
epidemiological studies – cross Standards of medical care in
sectional and longitudinal experience diabetes. Diabetes Care. 2004;27:S15–
35.

Modak A R

“Prevalence of Dental Caries and Designing the Interventional Strategies for
School Children in Rural Konkan Region”
Asawari Modak1 and Maruti Desai2
Department of Dentistry, B.K.L Walawalkar Rural Medical College and Hospital Sawarde,
Tal:Chiplun, Dist:Ratnagiri, Maharashtra, India.
Abstract:
School remains an important setting offering an effective and efficient ways to reach over to
children and through them, families and community members.(1) Dental caries is very common
disease in childhood, interfering with food intake affecting physical development in the form of
malnutrition, child’s school attendance and academic performance. Tooth decay or cavities caused by
dental caries is an infectious disease and is diet and oral hygiene dependent. If left untreated result in
toothache, permanent cavitations and children with active disease become adult with tooth decay.
Also poor dentition and malocclusion decreases the masticatory performance effecting oral health
and quality of life. Fortunately dental caries is both preventable and treatable with effective home
care and regular access to preventive dental services. The present study was carried out in the rural
area of Konkan region to assess the awareness regarding oral hygiene, prevalence of dental caries, to
assess the masticatory performance.
Key words:
Dental caries, oral hygiene, pre and post masticatory performance/ functional
capacity, treatment, school children
How to cite this article: Asawari R. Modak and Maruti Desai. Prevalence of dental caries and designing the
interventional strategies for school children in rural konkan region. Walawalkar International Medical Journal
2017; 4(1):35-40. http://www.wimjournal.com

Dr. Asawari R. Modak
Department of Dentistry, B.K.L Walawalkar Rural Medical College and Hospital Sawarde,
Tal: Chiplun, Dist:Ratnagiri, Maharashtra, India, E-mail: asawarimodak@yahoo.com,
Mobile No.8446377515

Modak A R
Introduction: program to record dental screening and

Oral health care in rural areas are often treatment.
limited due to shortage of dental manpower, Objectives:
financial constraints, and the lack of perceived 1) To assess the awareness about oral hygiene.
need for dental care among rural masses(2) 2) To determine the prevalence of dental
Various studies indicates the overall caries among 6yrs to 15yrs school going
prevalence of dental caries as , the World children in the rural area of konkan region.
Health Organization (WHO) recognizes dental 3) Assessing the awareness, prevalence of
caries as a pandemic and reports that the dental caries and designing the interventional
prevalence of dental caries among school strategies along with proper dental treatment
children is 60 to 90%.(3) According to National for caries and to improve oral functional
Oral Health Survey caries prevalence in India capacity / masticatory performance.
was 51.9% at age 5yrs,53.8% 12yrs and Methodology:
63.1% at 15yrs respectively(4). Oral health is A retrospective record base analysis of school
about much more than having good health. It dental health program implemented by Rural
is critical to good health and well being for Walawalkar hospital in Ratnagiri district was
children and in adulthood. If dental carries is conducted in the selected Kendra’s and school
going to affect general health and nutrition of zilla parishad in chiplun taluka. Total of
then the only way to combat this pandemic is 300 schools from remote area where selected.
to focus on dental health in childhood itself Prior permission from concerned authorities
and prevent it. In rural area where were seeked. All the schools were visited by a
compromised life is lived the brushing habits team of dentist, nurse and medical social
of the children are highly unsatisfactory. workers and dental assistant twice. Health
Many of the children do not clean their teeth awareness session by dentist and social
at all, some may not have access to a workers was conducted for all students
toothbrush and many use the traditional participated in the program. Filling of
cleaning aids like datun, salt, oil, coal ash and proforma for each student and taking
locally made powders etc. There was a need anthropometry measurements (height and
for special designed community based weight, BMI). A self designed questionnaire

Modak A R
was given to each student during program. screened. For better assessment the study was
Dental assessment by dentist was done in divided in two groups:- 6yrs to 10yrs was
which status of each individual tooth was group I and 11yrs to 15yrs was group II.
noted using universal numbering system and Results:
decayed, missing and filled teeth (dmft index) Table no 1: Indicates the caries prevalence
were recorded. Assessment of posterior teeth rate in overall screened school children 7646,
to check the oral functional capacity / out of 6444 children (84.27%) were found to
masticatory performance was done. have dental caries and were referred for the
Indicated treatment like filling, extractions, treatment to the hospital and after treatment
scaling were provided. Awareness session decreased by 62.54% and about 21.73%
were taken in which introduction to proper incomplete treatment. After six months
brushing techniques, use of toothpaste and follow up it was 2.61% caries. The caries
tooth brush , maintaining proper oral hygiene, prevalence rate in Group I was 89.38% before
and ill effects of tobacco were explained. and after treatment decreased by 62.54%.
School children in batches of 20 each were After six months follow up it was 2.84%
brought to the hospital and treatment was caries. The caries prevalence rate in Group II
provided as indicated. Follow up after six was 75.76% before and after treatment
months was done were the children were decreased by 43.20%. After six months follow
screened and the finding were recorded. Data up it was 2.23% caries. Over the entire caries
analysis using appropriate statistical software. prevalence rate was decreased by 97% after
Total number 7646 school children from 300 treatment and proper intervention and
schools age group 6yrs to 15yrs were awareness sessions.
Over all 6yrs to10yrs 11yrs to 15 yrs

Total 7646 4778 2868
Caries before treatment 6444(84.27%) 4271(89.38%) 2173(75.76%)
Caries after treatment reduced by 4782(62.54%) 3543(82.95%) 1239(43.20%)
After six month follow up 200(2.61%) 136(2.84%) 64(2.23%)

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Table no 2: functional capacity was overall increased by

Masticatory performance /functional 76.16%. In group I 6yrs to 15yrs by 83.98% in
capacity or chewing ability in over all group II 11yrs to 15yrs by 59.42%.Overall
screened children and age wise Group I and 2.44% was not restored and in group I 6yrs to
Group II. Difficulty in chewing, decreased 15yrs 2.63 % in group II 11yrs to 15yrs
functional capacity/decreased masticatory 12.12% was not restored because of badly
performance found was 99.16 % at the time of carious deciduous molars in group I and
screening. Difficulty in chewing or decreased requirement of root canal treatment (RCT) for
functional capacity in group I 6yrs to 15 yrs permanent molars in group II. Over all there
was 94.64% and 65.13% in group II 11yrs to was increase by 76%in masticatory
15 yrs. After treating with Glass Inomer performance or chewing ability of screened
Cement (GIC)a permanent filling. The school children.
Over all 6yrs to10yrs 11yrs to 15 yrs

Total 6444 4778 2173
%No of children with loss of chewing ability 6390(99.16%) 4522(94.64%) 1868(65.13%)
Treated molars with GIC filling cement 4908(76.16%) 3798(83.98%) 1110(59.42%)
improved by
After six month follow up loss of chewing 187(2.44%) 126(2.63%) 61(12.12%)
ability
Table no 3:- Treatment provided, indicates maximum caries, over retained teeth in group I and over
all poor oral hygiene.
Total GIC filling Scaling Extraction
7646 4791(13.98%) 1065(13.92%) 1163(15.28%)
Group I
4778 3375(70.63%) 609(12.74%) 709(14.83%)
Group II
2868 1416(49.37%) 456(15.89%) 460(0.55%)

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Discussion: caries prevalence rate recorded in our study

The konkan region on the western that is 89.38%of caries in Group I and75.76%
coast of Maharashtra is characterized by of caries in Group II. The exact magnitude of
mountainous terrain with hot humid weather the oral health is seldom recognized in India;
and poverty. In addition to paucity of as a result oral health always remains a low
secondary and tertiary health care facilities, priority. It is concluded that oral hygiene
deep rooted superstitious beliefs, ignorant awareness education and motivation are the
health seeking behaviors and relying on basic steps for improving the oral hygiene
quacks for health problems has lead to wide practices among the school children.
spread health issues among konkan people. Conclusion:
All these majorly affect children in this region. Oral hygiene awareness education and
They are seen malnourished because of motivation are the basic steps for improving
poverty, low socio-economic status, and poor the oral hygiene practices. The school health
awareness regarding general as well as oral policy should be used to promote oral health
health. Oral health conditions, particularly the by provision of oral health instructions and
rural areas of India has a large range of education on harmful dietary practices.
population from 31.5% to 89% affected by Preventive practices such as regular dental
dental caries.(5)Dental caries is the main reason check up should be advocated and promoted
for the extraction in both deciduous and in school and society.
permanent dentition, especially the first molar Acknowledgement:
which erupts at the age of 6years and goes for We thank the staff of the Community
(6-7)
extraction at the age of 12 yrs. Hence need dental unit for conducting the interviews,
to pay adequate attention to prevent and making measurements and data collected; we
enable the pediatric population reach are particularly grateful to School teachers,
adulthood with healthier dentition. According ANM-GNM nurses, MSW, Dietitians, &
to the National Oral Health Survey caries department of pediatrics in BKLWRMC for
prevalence rate in India was 51.9% at 5yrs, initiatively participate in research.
53.8% at 12yrs and 63.1% at 15yrs,
respectively, which is also correlated by the

Modak A R
Conflict of interest: None to declare 5] Joshi N; Sujan S et.al. Prevalence, severity

Source of funding: B.K.L.Walawalkar and related factors of dental caries in
Hospital, Diagnostic and Research Centre, schooling children of Vadodara city- An
Dervan, Dist-Ratnagiri epidemiological study . J Int Oral Health
References: 2013.
1] Syeda Nikhat Mohammad; G.M.Prasant
et.al. Dental caries status in 6-14yrs old school 6] Grewal H, Verma M, Kumar A. Prevalence
going children of rural channagiri; Davangere: of dental caries and treatment needs in rural
A cross sectional survey. Journal of Indian child population of Nanital District;
Association of Public Health Dentistry 2015. Uttaranchal .J Indian Soc Pedod Prev Dent
[serial online] 2009 [citied 2010 Jan 2015].
2] Ramachandran Karunakaran, Sujatha
Somasundaram et al. Prevalence of dental 7] Mohit Bansal, Nidhi Gupta et.al. Reasons
caries among school-going children in for extraction in primary teeth among 5-12
Namakkal district: A cross-sectional study.J years school children in Haryana, India- A
Pharm Bioallied Sci 2014. cross-sectional study. J Clin Exp Dent. 2017.
3] Anand Hiremath, Vikneshan

Murugaboopathy et.al. Prevalence of Dental
Caries Among Primary School Children of
India – A Cross-Sectional Study. J Clin Diagn
Res. 2016 .
4] Navin Anand Ingle, Harsh Vardhan Dubey

et.al. Prevalence of dental caries among school
children of Bharatpur city, India. J Int Soc
Prev community Dent 2014 .

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Incultating Core Competencies in Physiology in a Playful Learning
Environment
Neeta Nanaware 1, Ajay Gavkare 2 and Baban Adgaonkar3
Assistant Professor of Physiology, SRTR Government Medical College Ambajogai1,
Associate Professor of Physiology, MIMSR Medical College Latur 2,
Professor and Head of Physiology, MIMSR Medical College Latur, Maharashtra, India3
Abstract:
Background:
Medical Council of India emphasizes the need for self directed active learning among
undergraduate students. Traditional lectures alone are poor means of transferring/acquiring
information less effective at skill development. Hence it is the need of time to incorporate innovative
teaching learning strategies in undergraduate MBBS curriculum so we planned to undertake a study
to incorporate flipped classroom model in teaching Human Physiology.
Methodology:
One hundred and fifty students of first MBBS were divided two groups of 75 students each
(Batch A and B) as per their roll calls. For the present study, students from Batch A (n = 75) were
taken as cases and Batch B (n = 75) students were taken as controls. The control group attended
traditional classes that involved didactic sessions while study population was exposed to Flipped
classroom model. Student’s perceptions to Flipped classroom were obtained. Performance of students
in flipped classroom is compared with that of the control population.
Result:
Students involved in the study group showed better performance and understanding of
subject matter.
Conclusion:
Flipped classroom model make active student participation incultating key concepts in
physiology in a playful learning environment making it an enjoyable, lovable learning experience.
Key Words: Flipped class room, active learning, undergraduate education
How to cite this article: Neeta Laxman Nanaware , Ajay Madhavrao Gavkare and B D. Adgaonkar. Incultating
core competencies in physiology in a playful learning environment . Walawalkar International Medical Journal
2017; 4(1):41-51. http://www.wimjournal.com

Nanavare N L

Dr. Ajay Madhavrao Gavkare, Associate Professor, Department of Physiology, MIMSR Medical
College, Latur, Maharashtra, India. E mail: drajaygavkare1998@gmail.com, Mobile: 9890942743
Introduction: Medical Council of India about developing a

Medical Council of India in its future medical graduate.
regulations on Graduate Medical education Rationale:
emphasizes the need to provide enough At present, students attend lectures
experiences for self directed learning so as to without prior preparation of the topic. Lecturer
cultivate logical and scientific habits of delivers a ‘one – size – fits – all’ lecture.
thought, clarity of expression and Grasping of knowledge and development of
independence of judgment, ability to collect desirable attitudes is variable among learners.
and analyze information and to correlate them. In this type of teaching learning activities
Traditional lectures alone are there is no interaction, teamwork or
generally not adequate as a method of training leadership. Best thing about it is that learners
and are a poor means of transferring/acquiring will know the contents of the topic but will
information and even less effective at skill forget all but 20% of it tomorrow(3-5).
development and in generating the appropriate Flipped classroom is an innovative
attitudes(1). Hence it is the need of time to instructional strategy that has becoming
incorporate innovative teaching learning popular now a days (6-8). It involves a blended
strategies in undergraduate MBBS curriculum learning method such that the activities carried
which will encourage students to learn in out during traditional didactic lecture session
small groups through peer interactions so as to and self directed learning by the students are
integrate knowledge, formulate plans, use reversed or flipped i.e. self – directed learning
higher-order thinking skills (2), so that students phase (individual phase) precedes the
(9)
will be confident enough to work as a team to classroom – instruction phase (Figure 1).
solve complex cases fulfilling the vision of In 1998, Barbara Walvoord and
Virginia Johnson Anderson in the book

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“Effective Grading” introduced an idea of performance, perception has been studied.

flipped-class room model for the first time to However in Indian scenario there have been
teach fundamentals from history, physics and no studies that assess the practical
biology.(10) applicability of this student centric
But in recent years and in the era of instructional innovative modality in teaching
Digital India Mission rapid expansion of Physiology to first year medical undergraduate
internet availability has made implementing students.
this instructional modality possible, scalable Keeping this view in mind, we
and customizable in the field of medical planned to undertake a study to incorporate
education as a means for improved flipped classroom model in teaching Human
instructional efficiency. Physiology to 1st year medical undergraduates
Several renowned educational so as to analyze its effectiveness in overall
institutes and universities in the world are academic performance of 1st year
implementing this model and students’ undergraduate students.
Figure 1: The schematic comparison of traditional lecture and the Flipped / inverted classroom
model as per Bloom’s revised taxonomy (9)

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Objectives: were taken as controls. The cases included 34

1) To incorporate flipped classroom male and 41 female students between the age
model in teaching Human Physiology group of 17 – 18 years. Control group had 32
for better learning. male and 43 female students between the age
2) To assess the impact of flipped group of 17 – 18 years. No participant had
classroom on development of previously been exposed to flipped classroom
cognitive, affective and psychomotor teaching.
domains. Controls:
3) To compare teaching learning The students belonging to control
outcomes using flipped classroom - a group attended traditional classes that
student centric activity and traditional involved didactic sessions. The topics chosen
didactic lectures – a teacher centric were 1) Transport across cell membrane 2)
activity. Action potential 3) Skeletal muscle
4) To give suggestions about effective contraction and 4) Cardiac Output. Learning
implementations of flipped classroom objectives of each of these topics were defined
model for better learning in Human at the beginning of each class and intellectual
Physiology. content related to each topic was explained in
Materials and methods: the lecture of one hour duration. At the end of
A non – randomized interventional the class summary of the topic and key points
study carried out in the Department of were highlighted. Most likely questions on
Physiology involving First year MBBS each topic were told to them as a part of
students. After getting Institutional Ethical homework. Finally Students were given
Committee clearance, informed consent was opportunity to ask if they have any difficulty
taken about participation in the study. One about the topics. After one week these learners
hundred and fifty students of first MBBS were were subjected to a summative assessment
divided two groups of 75 students each (Batch exam.
A and B) as per their roll calls. For the present Cases:
study, students from Batch A (n = 75) were Cases (n = 75) were subjected to
taken as cases and Batch B (n = 75) students flipped classroom model with same above

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topics as were taught to controls. Students A 43 – year – old man presents to the
were divided into three subgroups (with 25 physician’s clinic with complaints of
participants in each) two weeks prior to the epigastric pain. After a thorough workup, the
planned session. patient is diagnosed with peptic ulcer disease.
The general lesson plan and learning He is started on a medication that inhibits
objectives were stated well in advance. The “proton pump” of the stomach.
module consisted of two parts – offloading Questions:
contents by self directed learning and second, What is the “proton pump” that is
creating a learner centered interactive referred to above?
classroom. What type of cell membrane transport
For the first part, involving self study would this medication be blocking?
as well as group discussion, study material in What are four other types of transport
the form of relevant lecture notes was across a cell membrane?
provided to each participant in each subgroup.
All the students were instructed to go through Now the learners having basic
the given study material outside the background knowledge of the topic prior to
classroom. Students working in isolation or in actual class sessions working in groups
small groups come prepared with the topic. discussed among themselves about the given
In the second part of this flipped case scenario. Here in the class they spent
classroom model, a learner centered classroom their time on higher order thinking skills like
was planned over two hours. At the beginning problem solving, worked in collaboration,
of each session, an objective type written pre – constructing knowledge with the help of their
test was administered pertaining to the topic of teachers and peers as teacher’s interaction was
discussion. A case scenario related to each of more often personalized and less didactic.
the topic prepared by students in first part of A member of the group was randomly
the flipped classroom was projected to each chosen by the facilitator to explain the answer
group as case handouts. An example of one to each question which was discussed amongst
such case scenario is as follows: rest of the students in the class. Supplemental

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information was provided by the faculty Statistical analysis:

members as mentor. Both pretest and post-test exam result
Data Collection: of the study population was compared and
Perception of learners towards this using paired t test statistical significance of
new learning model was evaluated by difference was calculated. Correlation
administering a questionnaire to be filled up between score of study population in post –
by respondents. The questionnaire had a test and in summative assessment was
closed set of items graded using the Likert five calculated by Spearman’s correlation
- point scale. A 5 – point Likert scale with a coefficient. Performance of study population
score of 1 = poor, 2 = satisfactory, 3 = good, 4 on summative assessment was compared with
= very good, and 5 = excellent was used to that of control population. During statistical
find out rating from the students. The number analysis P ≤ 0.05 was considered to be
and percentage of students responding to each significant.
item was noted. The mean rating pertaining to Results:
each item was calculated. (Table 2) All 75 students in study population
Assessment part included a responded to the questionnaire. The mean age
summative exam on the topics comprising of students was 17 years and majority was
short note and essay type questions scheduled females. Contents of the items in the
a week after the flipped classroom session. questionnaire delivered to participants in the
study are given in table 1.
Table 1 : Questionnaire
Item No Contents
1 Learning objectives defined prior to beginning of each session were helpful for
preparation in self directed learning phase before actual classroom phase
2 The topic notes given prior to classroom session were very useful to understand it.
3 The additional references and web sources given in notes arouse interest to read in detail.
4 Compared to traditional didactic lectures, we were more engaged in flipped method
5 Deeper understanding of key physiological aspects and applied part of topic using flipped
model

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6 Such teaching learning activities should be organized again in future

7 Enough time allotted to each case
8 Helps actively participate with enjoyable learning experience in playful atmosphere
9 Pre class preparation of the topic enhanced ability to ask questions, difficulties and clear
doubts of the topic.
10 Better University exam preparation for theory as well as practical ; makes students
confident enough by minimizing pressure to perform, exam anxiety and stress.
Table 2 : Questionnaire Response Sheet
Item No Response Mean Total

1 2 3 4 5 Rating
1 45 15 12 3 0 1.5 75
(60 %) (20 %) (16 %) (4 %)
2 54 16 5 0 0 1.3 75
(72 %) (21 %) (7 %)
3 57 16 2 0 0 1.3 75
(76 %) (21 %) (3 %)
4 59 15 2 0 0 1.2 75
(77 %) (20 %) (3 %)
5 53 16 5 1 0 1.3 75
(71%) (21 %) (6 %) (2 %)
6 64 6 5 0 0 1.2 75
(85%) (8%) (7%)
7 51 7 6 7 4 1.7 75
(68%) (9%) (8%) (9%) (6%)
8 44 15 5 7 4 1.8 75
(58%) (20%) (7%) (9%) (6%)
9 55 15 5 0 0 1.3 75
(73%) (20%) (7%)
10 53 15 7 0 0 1.4 75
(71%) (20%) (9%)
Table 3: Pre and Post test Objective questions grades in Study group.

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Grade Pre test (N = 75) Post test (N = 75)

A (90 – 100%) 14 26
B (80 – 89%) 36 39
C (70 – 79%) 21 9
D (60 – 69%) 4 1
Discussion:
With advancement of technology there is members and students during group
paradigm shift in teaching learning discussion.
methodology, methods of utilization of Most of the students felt this new
faculty, space, finances, and other resources teaching method very favorable and
which in turn are determinants of future of interesting which made the students get
medical education. engaged in the class. Students performance
Some of the most important aspects of also improved during this new teaching
training at medical colleges include problem technique.
solving, acquiring knowledge, developing similar findings and results were found
bedside manners, teamwork, and interpersonal with the studies from various health science
communication skills.(11) These aspects are in educationists.(15-19) The feedback obtained
accordance with opinion of most of the after introduction of flipped classroom models
medical practitioners and medical mirrors the findings from other study.(20) The
educationists all over the world and highliting features which are noteworthy to
(12-
Association of American Medical Colleges. mention in the study population are active
14)
student engagement , availability of ample
In this study, we assessed students time to discuss and clarify their doubts with
perceptions and performance during flipped the facilitator. Hence students perceived that
classroom model in first MBBS Physiology flipped classroom approaches promoted active
course. Flipped classroom design was based learning and acts as driving force to perform
on principles of good teaching practices, better in their exams compared to traditional
active learning coupled with good interaction didactic lectures. Last but not the least to
among students and also between faculty mention is that this entirely new methodology

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helped students to learn and incultate faculty members and administrators on

physiological key concepts in a playful the use of technology in the classroom.
learning environment making it an Am J Pharm Educ.2013;77(4):Article
enjoyable,lovable learning experience. 75
Acknowledgements: (6) Bergmann J, Sams A. Flip Your
We acknowledge the students for Classroom: Reach Every student in
enthusiastically participating in this study. Every class Every day.Washington
Conflict of interest: None to declare DC: International Society for
Source of funding: Nil Technology Education ;2012.
References: (7) Lage MJ, Platt GJ, Treglia M.
(1) Medical Council of India regulations Inverting the classroom: a gateway to
on graduate medical education, 1997 creating an inclusive learning
(published in part III, section 4 of the environment. J Econ
gazette of india dated 17th may Educ.2000:31(1):30-43
1997*) (8) Day JA, Foley JD. Evaluating a web
(2) Accreditation standards and Key lecture intervention in a human
elements for the professional program computer interaction course. IEEE
in pharmacy , http://www.acpe- Trans Educ.2006:49(4):420-431.
accredit.org/pdf/Standards2016FINAL (9) Lorenz A , Einert A, Dinter B.FC
.pdf Wlnf: Flipped classroom in der
(3) Dipiro JT. Why do we still lecture? Wirtschaftsinformatik. In Kawalek J,
Am J Pharm Educ.2009;73(8):Article Hering K , Schuster E (Hrsg).
137 (10) Effective Grading: A Tool for
(4) Blouin RA, Riffee WH, Robinson ET, Learning and Assessment in College,
et al. Roles of innovation in education 2nd Edition Barbara E.
delivery. Am J Pharm Walvoord, Virginia Johnson Anderson
Educ.2009;73(8):Article 154 ISBN: 978-0-470-50215-0
(5) DiVall MV, Hayney MS, Marsh W, et (11) The Ohio State University
al , Perceptions of pharmacy students , College of Medicine, College of

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Medicine news: the State Medical (16) Mc Laughlin JE, Roth MT, G
Education . latt DM, et al. The flipped classroom:
http://medicine.osu.edu/news/archive/ a course design to foster learning and
2014/11/20/the-state-of-medical- engagement in health professions
education.aspx. school.Acad Med.2014;89(2):236-243
(12) Pershing S,Fuchs VR. (17) Pierce R, Fox J. Vodcasts and
Restructuring medical education to active learning exercises in a “flipped
meet current and future health care classroom” model of a renal
needs. Acad Med.2013 pharmacotherapy module. Am J
Dec;88(12):1798-1801. Pharm Educ. 2012;76(10):Article196
(13) Kebede S, Pronovost P. It is (18) Ferreri SP, O’Connor SK,
time to reinvent the wheels of medical Redesign of a large lecture course into
training. Acad Med.2015 a small group learning course. Am J
Feb;90(2):126. Pharm Educ. 2013;77(1):Article13
(14) Association of American (19) Wong T, Ip EJ, Lopes I,
medical colleges. Recommendations Rajagopalan V. Pharmacy students’
for clinical skills curricula for performance and perceptions in a
undergraduate medical education. flipped teaching pilot on cardiac
http://www.aamc.org/download/13060 arrhythmias. J Pharm Educ.
8/data/clinical skills. 2014;78(10):Article185
(15) Missildine K, Fountain R, (20) Raveendranath Veeramani et
Summers L, Gosselin K.Flipping the al : Perceptions of MBBS students to
classroom to improve students ‘flipped classroom” approach in
performance and satisfaction. J Nurs neuroanatomy module.
Edu. 2013:52(10):597-599 http://dx.doi.org/10.5115/acb.2015.48.
2.138

Patil S N
CASE REPORT
A case of Occupational Methemoglobinemia (MetHb): A Rare Entity and
Unique Treatment
Suvarna Patil1, Anup Nillawar2, Sonal Jagtap3, Abhijit Jagtap4 and Nitin Narwade5
B.K.L.Walawalkar Rural Medical College and Hospital, Sawarde, Maharashtra, India
Abstract:
Methemoglobinemia is acute emergency which have precise and effective treatment if
instituted in time. Methemoglobinemia due to chemical exposure is a known entity. But it required a
high index of suspicion to look for it in busy casualty. Treatment with methylene blue is safe and
truly lifesaving if instituted in time. Here we are presenting a case of Occupational
methemoglobinemia who was treated successfully.
Key words:
MetHb, Normal partial O2 pressure, Methylene Blue, Potassium ferricyanide test,
NADPH dependent MetHb Reductase, Riboflavin.
How to cite this article: Suvarna Patil, Anup Nillawar, Sonal Jagtap, Abhijit Jagtap and Nitin Narwade. A case of
Occupational Methemoglobinemia (MetHb): A Rare Entity and Unique Treatment. Walawalkar International
Medical Journal 2017; 4(1):52-60. http://www.wimjournal.com

Dr. Suvarna N. Patil, Medical Director, B.K.L.Walawalkar Rural Medical College and Hospital,
Sawarde - 415606, Tal- Chiplun, Dist.-Ratnagiri, Maharashtra, India,
E-mail: dr.suvarnapatil@gmail.com, Mobile no.9921251695

Patil S N
Introduction: given fast. No improvement in arterial O2

Case Report: saturation. Endotracheal intubation was done.
24 years old chemical factory worker from The arterial O2 saturation did not improved
Industrial Area was admitted to hospital in even after intubation. ABG reports shows
gasping condition at 6.30 p.m. His friends pH=7.32, pCO2 =32mm of Hg, pO2 =134 mm
gave history, that on the day of incidence he of Hg, HCO3 = 16 mEq/L. Glucose -6-
was working in a factory since 10 a.m. had Phosphate dehydrogenase activity was normal.
lunch at 2 p.m. and then started feeling giddy. Colour of blood was chocolate brown.
He had nausea, vomiting andhis skin, nails, Clinical impression:
and lips turns muddy to blue. He was brought Based on clinical examination and
to the hospital in unconscious state. He had laboratory investigations it reveals that the
history of exposure to noxious gases and case was methemoglobinemia. Following
chemicals in one of the chemical company in laboratory tests were performed to confirm the
Industrial area. The nature of exposure could diagnosis of methemoglobinemia.
not be detailed out and substantiated for 1. Blotting paper Test: Drop of blood was
various reasons. put on the paper and color was observed.
There was no past history of cyanotic Chocolate brown color did not change even
heart disease and no history of any drug after oxidation.(1)
consumption. 2. Potassium ferricyanidetest: 5ml distilled
Clinical examination showed that water + 3 -5 drops of blood + a pinch of
Comatose, Pulse rate was100/ min. Blood potassium ferricyanide powder. Mix gently by
pressure was 90/60 mm Hg. Respiration was inversion and observe through hand
shallow. Tongue was cyanosed. Extremities spectroscope. A single prominent band in red
werecold, clammy and cyanosed. Pupils were region of spectrum (630nm) is observed. (2,3)
bilaterally equally reacting to light. Laboratory It was also observed that Chocolate brown
investigations shows that his Sa O2was 80%, colour changed to red pink after serially
Blood Sugar was 84mg%. diluting with potassium ferricyanide
He was started with 100 % O2 by (K3Fe(CN)6).
mask. IV fluids Ringer lactate and 5%DNS

Patil S N
3. Urine colour: The colour of urine was brown.
Blotting paper test After extubation

put on non-invasive ventilation, methylene
Result: blue infusion and all of them recovered well.
Above tests confirmed the presence of Clustering of patients in the same chemical
abnormal hemoglobin (more than 5% of total company, around the same time confirmed the
Hb), most likely methemoglobin. exposure to single methemoglobin causing
Methemoglobin estimation assay facility was agent at work place. This gave valuable
not available. information for occupational safety in the
Treatment: similar (???Benzocaine/ benzene related
After confirmation of diagnosis of compounds) chemical factories.
methemoglobinemia, intravenous methylene
blue was infused (1 mg /kg.) over 10 minutes.
Saturation of oxygen was monitored
continuously. Dose was repeated till patient
maintained SaO2>95%.Blood was collected
for blotting paper test. Oneunit of blood was
infused as SaO2 was improving. Next day
morning patient was conscious, SaO2 was
100% and extubated.
There were 3 more patients with same history
of working in the same company. They were

Patil S N
Discussion: oxygen, acertain amount of physiologic

Methemoglobinemia refers to the oxidation of methemoglobin formation occurs
++ +++
ferrousiron (Fe ) to ferric iron (Fe ) within continuously. Several endogenous reduction
the hemoglobinmolecule.(4) This reaction systemsexist to convert methemoglobinto
impairs the ability of hemoglobin to transport functional Hb. Only about 1% of total
oxygen and carbon dioxide, leading to tissue hemoglobin ismethemoglobin at any given
hypoxemia and in severe cases, death. time. Excess of methemoglobinlead to
Methemoglobinemia is most commonly impaired aerobic respiration, metabolic
results from exposureto an oxidizing chemical, acidosis, and in severe cases, death.
but may also arise fromgenetic, dietary, or Methylene blue (MB) is the treatment for
even idiopathic etiologies Hemoglobin methemoglobinemia. Methylene blue reduces
molecules contain iron within a methemoglobin to functional Hb with the
porphyrinheme structure.(5,6) The iron in utilization of NADPH dependent
hemoglobin is normallyfound in the Fe++state. methemoglobin reductase enzyme. (fig) This
If Fe++ of hemoglobinis oxidized to Fe+++ enzyme system donot play active role in
methemoglobin is formed. Once normal conditions and is stimulated by the
methemoglobin is formed; the molecule loses presence of methylene blue and riboflavin
its ability to carry molecular oxygen. which forms the basis of treatment.(8–10)The
Additionally hemoglobin molecule loses the constant supply of NADPH in RBCsis ensured
ability to release oxygen at tissue level leading by functioning HMP pathway which is
to leftward shift of Hb-O2 dissociation impaired in G-6PD deficiency.
(4)(7)
curve. Because RBCs are bathed in Nonresponsiveness to MB should arose

Patil S N
suspicion of G-6PD deficiency (Haemolysis the recent data on human studies establishing
should be ruled out) Normally, through the the benefit of riboflavin over MB. But
NADH dependent methemoglobin reductase certainly, riboflavin could be used safely
enzymes, methemoglobin is reduced back to (Being water soluble vitamin, no risk of
hemoglobin. This spontaneous reaction is slow overdose toxicity) in MB intolerant patients.
and it contribute upto 5 % for conversion of Doses in the range of 30 to 60 mg/day of
methemoglobin to functional Hb. When large riboflavin ( Vit B2) were found useful in
amount of methemoglobin is formed, controlling methemoglobinemia(<5%) in
methemoglobin reductases are overwhelmed. familial methemoglobinemia.(16) Vitamin C
Methylene blue, when injected intravenously could be used as adjuvant or second line of
as an antidote, is itself first reduced to drug owing to its antioxidant properties
leucomethylene blue, which then reduces though exact mechanisms not established.(17)
methemoglobin to hemoglobin. Methylene In emergency medicine, cases due to exposure
blue reduce the half-life of methemoglobin to various drugs is common but cases due to
from hours to minutes.(11)(12)Methylene blue is industrial exposure is on decline. (5)
Acute
quiet safe drug till 2mg/kg and have wide Hypoxia with relatively stable patient, normal
therapeutic window. MB induced hemolysis pO2 on ABG and non effective oxygen
which is expected in G-6PD deficient patients treatment is highly suggestive of
is seen in the dose range of 2-4 mg/kg and methemoglobinemia. Methylene blue is the
beyond.(13) NADPH dependent methemoglobin only effective medicine which can revert
reductase is either MB or flavin dependent for methemoglobin to hemoglobin. Methylene
its activity. This make flavin or MB as choice blue is a rarely availablein any ICU.In our
(14)
of activator for this enzyme. One in-vitro case, clinical diagnosis,high index of
study have shown the effectiveness of suspicion of methemoglobinemia and blotting
riboflavin in reducing the half-life of paper test and very critical condition of
methemoglobin though less effective than patients made us to use this drug. Timely use
(15)
MB. One case study clearly underlined the of methylene blue proved highly effective in
utility of riboflavin in familial these cases.
methemoglobinemia.(16) But we could not find

Patil S N
Table enlisting the causes of Methaemoglobinemia:

Industrial Chemical Drugs Clinical conditions
Acetanilid Benzocaine Sepsis (18)(19)
Alloxan Bivalent copper
Aniline Bismuth subnitrate
Arsine Bupivacaine
Benzene derivatives hydrochloride
Chlorates Chloroquine
Chromates Clofazimine
Exhaust fumes Dapsone
Naphthalene Dimethyl sulfoxide
Nitrates Dinitrophenol
Phenol Ferricyanide
Smoke inhalation Flutamide
Trinitrotoluene Hydroxylamine
Lidocaine hydrochloride
Metoclopramide
hydrochloride
Methylene blue
Nitric oxide
Nitrites
Nitrofuran
Nitroglycerin
Sodium nitroprusside
Phenacetin
Phenytoin
Prilocaine hydrochloride
Primaquine phosphate
Rifampin
Silver nitrate
Sodium valproate
Sulfasalazine
Sulfonamides
Highlights of Clinical presentation of compounds and drugs causing MetHb

Methemoglobinemia: is attached)
1. History of exposure to offending 2. Features of Hypoxia , (May appear
agent. (Separate list of industrial cyanotic, Not always), relatively stable
patient, Normal Partial pressure of

Patil S N
oxygen , Non-responsive to Oxygen pii/S0196064409012815

therapy 2. A S Yadav. Comprehensive practical
3. Dark brown color of blood on tissue and viva in Biochemistry. 2004. 87-89
paper and not turning pink after p.
exposure to air 3. Ranjana Chawala. Practical Clinical
4. Pulse oximetry is not useful to monitor Biochemistry Methods and
recovery of methemoglobinemia. Interpretations. 2014. 87-93 p.
5. Spectroscopic analysis of Hb/ assay 4. Wright RO, Lewander WJ, Woolf AD,
based on co-oximetry for definitive al. et. Methemoglobinemia: Etiology,
diagnosis Pharmacology, and Clinical
6. Quick clinical response to IV Management. Ann Emerg Med
methylene blue treatment. [Internet]. 1999 Nov 1 [cited 2017 Aug
7. Rule out Haemolysis/G-6PD 8];34(5):646–56. Available from:
deficiency in cases nonresponsive to http://linkinghub.elsevier.com/retrieve/
MB pii/S0196064499701678
8. Observation needed till 24 hours as 5. Rehman HU. Evidence-Based Case
late activation of offending agent is Review: Methemoglobinemia. West J
possible. Med [Internet]. 2001;175(3):193–6.
Available from:
Conflict of interest: None to declare http://www.ncbi.nlm.nih.gov/pmc/articl
Source of funding: Nil es/PMC1071541/
References: 6. Bradberry SM, Aw T-C, Williams NR,
1. Shihana F, Dissanayake DM, Buckley Vale JA. Occupational
NA, Dawson AH. A Simple methaemoglobinaemia. Occup Environ
Quantitative Bedside Test to Determine Med. 2001;58(9):611–5.
Methemoglobin. Ann Emerg Med 7. Rehman HU. Methemoglobinemia.
[Internet]. 2010 Feb [cited 2017 Aug West J Med [Internet]. 2001 Sep [cited
8];55(2):184–9. Available from: 2017 Aug 5];175(3):193–6. Available
http://linkinghub.elsevier.com/retrieve/ from:

Patil S N
http://www.ncbi.nlm.nih.gov/pubmed/1 8];66(1):109–12. Available from:

1527852 http://www.ncbi.nlm.nih.gov/pubmed/7
8. Warburg O, Kubowitz F CWÜ die 974833
katalytische W von. Methylenblau in 12. Bradberry SM. Occupational
lebenden Zellen. Biochem Z. methaemoglobinaemia. Mechanisms of
1930;227–45. production, features, diagnosis and
9. Xu F, Quandt KS, Hultquist DE. management including the use of
Characterization of NADPH-dependent methylene blue. Toxicol Rev [Internet].
methemoglobin reductase as a heme- 2003 [cited 2017 Aug 5];22(1):13–27.
binding protein present in erythrocytes Available from:
and liver. Biochemistry [Internet]. 1992 http://www.ncbi.nlm.nih.gov/pubmed/1
[cited 2017 Aug 9];89:2130–4. 4579544
Available from: 13. Clifton J 2nd1 LJ. Methylene blue. Am
https://www.ncbi.nlm.nih.gov/pmc/arti J Ther [Internet]. 2003;10(4):289–91.
cles/PMC48610/pdf/pnas01080- Available from:
0142.pdf https://www.ncbi.nlm.nih.gov/pubmed/
10. Steele C W, Spink ww. Methylene Blue ?term=American+Journal+of+Therape
in the Treatment of Poisonings utics%3A+July%2FAugust+2003+-
Associated with Methemoglobinemia. +Volume+10+-+Issue+4+-+pp+289-
N Engl J Med [Internet]. 1933 Jun 4 291+Therapeutic+Reviews
[cited 2017 Aug 9];208(22):1152–3. 14. Hultquist DE, Xu F, Quandt KS,
Available from: Shlafer M, Mack CP, Till GO, et al.
http://www.nejm.org/doi/abs/10.1056/ Evidence that NADPH-dependent
NEJM193306012082205 methemoglobin reductase and
11. Shugaleĭ I V, L’vov SN, Baev VI, administered riboflavin protect tissues
Tselinskiĭ I V. [Protective effect of from oxidative injury. Am J Hematol
sodium bicarbonate in nitrite ion [Internet]. 1993 Jan [cited 2017 Aug
poisoning]. Ukr biokhimicheskii 19];42(1):13–8. Available from:
zhurnal [Internet]. [cited 2017 Aug http://www.ncbi.nlm.nih.gov/pubmed/8

Patil S N
416288 dapsone-induced methemoglobinemia.

15. Dötsch J, Demirakça S, Kratz M, Repp Am J Emerg Med [Internet]. 2014 Jun
R, Knerr I, Rascher W. Comparison of [cited 2017 Aug 19];32(6):684.e1-
methylene blue, riboflavin, and N- 684.e3. Available from:
acetylcysteine for the reduction of http://www.ncbi.nlm.nih.gov/pubmed/2
nitric oxide-induced 4439259
methemoglobinemia. Crit Care Med 18. Rutledge C, Brown B, Benner K,
[Internet]. 2000 Apr [cited 2017 Aug Prabhakaran P, Hayes L. A Novel Use
19];28(4):958–61. Available from: of Methylene Blue in the Pediatric
http://www.ncbi.nlm.nih.gov/pubmed/1 ICU. Pediatrics [Internet]. 2015 [cited
0809266 2017 Aug 18];136(4). Available from:
16. Kaplan JC, Chirouze M. Therapy of http://pediatrics.aappublications.org/co
recessive congenital ntent/136/4/e1030.long
methæmoglobinæmia by oral 19. Mutlu M, Erduran E, Aslan Y.
riboflavine. Lancet [Internet]. 1978 Acquired methemoglobinemia in
Nov [cited 2017 Aug infants. Turkish J Hematol [Internet].
19];312(8098):1043–4. Available from: 2011 Jun 1 [cited 2017 Aug
http://linkinghub.elsevier.com/retrieve/ 18];28(2):131–4. Available from:
pii/S0140673678923577 http://www.journalagent.com/z4/downl
17. Park S-Y, Lee K-W, Kang T-S. High- oad_fulltext.asp?pdir=tjh&plng=eng&u
dose vitamin C management in n=TJH-83584

Thakur N P
CASE REPORT
Peripheral Ossifying Fibroma: A Case Series
Neha Thakur1and Purushottam Rakhewar2
Assistant professor, Department of Dentistry, B.K.L. Walawalkar Rural Medical College &
Hospital, Sawarde, Chiplun, Ratnagiri1, Professor and HOD of Periodontology, SMBT Dental
College, Sangamner, Maharashtra, India2.
Abstract:
Solitary gingival growths are fairly common oral finding. Intraoral ossifying fibromas have
been described in the literature since the late 1940s. Due to clinical and histopathological similarities,
some peripheral ossifying fibroma (POFs) are believed to develop initially as a pyogenic granuloma
that undergoes fibrous maturation and subsequent calcification. It has been suggested that POF
represents a separate clinical entity rather than a transitional form of pyogenic granuloma or irritation
fibroma. This paper describes a case series of female patients who reported with gingival growth
which was histopathologically confirmed as POF.
Keywords:
Gingiva, Fibroma, Ossifying
How to cite this article: Neha Pramod Thakur and Purushottam S.Rakhewar . Peripheral Ossifying Fibroma: A
Case Series. Walawalkar International Medical Journal 2017; 4(1):61-65. http://www.wimjournal.com

Dr. Neha Pramod Thakur, Assistant professor, Department of Dentistry, B.K.L. Walawalkar Rural
Medical College & Hospital, Sawarde, Tal- Chiplun, Dist Ratnagiri , Maharashtra State, India.
Email: nehathakurrr@gmail.com, Mobile No. 9673327986
Introduction: (POF) is a reactive soft tissue growth that is

Benign fibrous overgrowths arising usually seen on the interdental papilla.(2) It is a
from the mucous membrane are termed as non-neoplastic entity, which occurs in
fibromas and are more frequent growth in the response to trauma or irritation.(3)
oral cavity.(1) Peripheral ossifying fibroma

Thakur N P
It occurs in the younger age group inflammation and calculus deposits were seen
with a female preponderance. It has a in patients mouth. (Fig 1)
predilection for maxillary arch and most of
them occur in the incisor-cuspid region. It can
be pedunculated or sessile, usually smooth
surfaced and varies from pale pink to cherry
red in color. It is believed to comprise about
9% of all gingival growths.(4) An important
clinical aspect of POF is the high recurrence
rate, which ranges from 8% to 45%.(5)
(Fig 1): At Baseline
This paper describes a case series of
female patients who reported with growth on
gingiva, which were surgically removed. After routine blood examinations
Further histological examination confirmed treatment was carried out. Phase I therapy was
the diagnosis of POF. done in the form of scaling and root planning.
The lesion was excised completely along with
Case series:
Periosteum under local anesthesia. Scaling and
Case 1:
A 48-year-old female patient reported root planning was carried out to remove local
to the department of periodontology with the irritants. Periodontal pack was given. The
chief complaint of painless growth on the pack was removed after 7 days. Healing in
gingiva in the upper right front region of area of excision occurred uneventfully within
mouth three years ago. It was gradually 1 month and the patient was followed up for 6
increasing in size. The patient did not give any months after surgical excision. No recurrence
history of trauma. was reported. (Fig 2)
Intraoral examination revealed a

solitary, sessile gingival growth in maxillary
right lateral incisor-canine area. The growth
was pale pink in colour, with a size ranging
from 1.5 × 1.5 cm. Generalized gingival

2395
Thakur N P
Case 2:
42 years of female reported to the
department of periodontology with
overgrowth in the lower front teeth region
since 7 months. Intraoral examination revealed
irregular, pinkish red gingival growth in
mandibular central incisor area measuring
1×1.5 cm. (Fig 4, 5)
(Fig 2): 6 months follow up
Histopathological Examination:
Excised tissue growth was given for
histological examination. It revealed fibrous
lesion covered with stratified squamous
epithelium. The underlying connective tissue
stroma was highly collagenous with increased (Fig 4): At Baseline
fibroblasts. Deeper zone showe

showed numerous
blood vessels with endothelial cell
proliferation. Bony trabeculae with osteoclasts
and lined by osteoblast were seen.. (Fig 3)
(Fig 5) 6 months follow up
Case 3:
(Fig 3): Histopathological examination 43 year old female patient showed
gingival overgrowth that was exophytic and

Thakur N P
arising from interdental papilla between Discussion:

maxillary left central incisor and lateral Peripheral ossifying fibroma has been
incisor. It was approximately 2×2.5 cm in described as separate lesion since 1872 by
size. Lesion was pinkish red, smooth surfaced Menzel. It is benign, reactive lesion exclusive
and firm in consistency. (Fig 6, 7) to gingiva. Dental calculus, plaque,
microorganisms, dental appliances, and
restorations are considered to be the irritants
triggering the lesion.Various nomenclatures
had been used for peripheral ossifying fibroma
such as peripheral cementifying fibroma,
ossifyingfibro-epithelial polyp, peripheral
fibroma with osteogenesis, peripheral fibroma
(Fig 6) At Baseline with calcification, calcifying or ossifying
fibrous epulis and calcifying fibroblastic
granuloma.(6)
POFs usually measure <1.5 cm in
diameter even though lesions of 6 cm and 9
cm in diameter are recorded in the literature.
The female to male ratio reported in the
literature varies from 1.7:1. Most lesions are
reported in or after second decade with
(Fig 7) 6 months follow up decrease in its incidence at later age. POF has
predilection for maxilla and mostly affects
Similar treatments were carried out in
anterior region. But, its occurrence in
case 2 and case 3 as performed in case 1. Both (6)
mandible is not uncommon.
cases were evaluated upto 6 months. No
The etiology and pathogenesis of POF
recurrence was found. Histopathology of
are not yet clear. Some authors have
exisional biopsy of both cases showed
hypothesized a reactive lesion originating
increase in fibrous area along with bony
from the periodontal ligament as a result of
trabeculae.

Thakur N P
irritating agents such as dental calculus, hypothesized that these dendrocytes could
plaque, orthodontic appliances, and ill-fitting play a distinct pathogenic role.(8) No further
restorations. The presence of oxytalan fibers studies supporting this hypothesis were found
interspersed among the calcified structures, till date.
the almost exclusive occurrence on the Cundiff observed 16% recurrence rate
gingiva, and the age distribution inversely and a series studied by Eversole and Robin
correlating with the number of lost permanent showed 20% recurrence rate.(9) In the
teeth support the hypothesis of an origin from literature, time interval for recurrence is not
the periodontal ligament. Moreover, the evident. In the present report the cases were
fibrocellular response of POF is similar to that followed up to 6 months. However, no
observed in other reactive gingival lesions recurrence was seen.
originating from the periodontal ligament (e.g. Though the treatment includes local
fibrous epulis). In vast majority of cases, there surgical excision and oral prophylaxis, it is
is no apparent underlying bone involvement necessary to remove all putative risk factors,
visible on radiograph. However, superficial including plaque, calculus and plaque-
erosion of bone is noted occasionally.(7) retentive restorations to minimize the
Hormonal influence has also been possibility of recurrence.(6)
considered a cause of POF. Its occurrence is Conclusion:
rare in prepubertal age. The present case series Clinically it is difficult to differentiate
supports the hormonal influence as a cause of between most of the reactive gingival lesions
POF along with plaque and calculus. particularly in the initial stages. POF shares a
However, a recent study failed to demonstrate varied clinic-pathological presentation.
the expression of estrogen or progesterone Surgical excision is considered curative
receptors in the proliferating cellular treatment but may present a high recurrence
(1)
component. rate compared with other reactive lesions.
Regezi et al. found a large number of Therefore it is important to eliminate the
+
XIIIa cells, a subset of etiological factors and the tissue has to be
monocyte/macrophages, in POF and in other histologically examined for confirmation. It
oral fibrovascular reactive lesions; it was

Thakur N P
helps to accurate patient evaluation and 6. Giovanni Mergoni, Marco

management. Meleti, Simone Magnolo, Ilaria
Conflict of interest: None to declare Giovannacci, Luigi Corcione
Source of funding: Nil and Paolo Vescovi: Peripheral
References: ossifying fibroma: A clinicopathologic
1. Savitha B, Ruhee L Chawla, Sanjay J study of 27 cases and review of the
Gawali, Alka S Waghmare, Amita D literature with emphasis on
Ahire: Peripheral Ossifying Fibroma: histomorphologic features. J Indian
A Case Report. Int J Health Sci Res. Soc Periodontol 2015 Jan-Feb; 19(1):
june 2013; 3(6):106-109 83–87.
2. K. S. Poonacha, Anand L. 7. Meenakshi Bhasin,Vinny
Shigli, Dayanand Shirol: Peripheral Bhasin, and Abhilasha Bhasin.: Case
ossifying fibroma: A clinical report. Report Peripheral Ossifying Fibroma.
Contemp clinic dent. Jan-Mar 2010; Case Reports in
1(1):54–56. Dentistry. 2013 ;Article ID 497234,1-
3. Khizer Mohiuddin, N. S. 3.
Priya, Shivamurthy Ravindra 8. Regezi JA, Nickoloff BJ, Headington
and Sarvani Murthy: Peripheral JT: Oral submucosal dendrocytes:
ossifying fibroma. J Indian Soc Factor XIIIa+and CD34+dendritic cell
Periodontol. 2013 Jul-Aug; 17(4): populations in normal tissue and
507–509. fibrovascular lesions. J Cutan
4. Bhaskar NS, Jacoway JR: Peripheral Pathol. 1992; 19:398–406.
Fibroma and Peripheral Fibroma with 9. Jain A, Deepa D: Recurrence of
Calcification: Report of 376 Cases. J peripheral ossifying fibroma: A case
Am Dent Assoc. 1966; 73:1312–20. report. People's J Sci Res. 2010; 3:23–
5. Cuisia ZE, Brannon RB: Peripheral 5.
ossifying fibroma – A clinical
evaluation of 134 pediatric
cases. Pediatr Dent. 2001; 23:245–8.

Karnik S S
CASE REPORT
Negative Impact of Troublesome Peer Interactions and Authoritarian
Parenting Style on Academic Performance of a 15 year Old Boy
Samruddhi Karnik 1 and Neha Sahasrabudhe 2
B.K.L Walawalkar Rural Medical College and Hospital, Sawarde, Tal-Chiplun, Dist-Ratnagiri,
Maharashtra, India2
Case Report:
Abstract:
Adolescence is a period of great turbulence characterized by cognitive, emotional, social and
physical changes. Family environment and role of peers is extremely crucial in the development of
an adolescent. Presenting here is a brief case of 15 year old boy who was referred for counseling by
his parents for lack of concentration in studies. In the counseling sessions with the boy and his
parents it was found that the boy was psychologically disturbed as he was teased at school by his
peers. In addition his father had an authoritarian parenting style which was adding to his troubles
resulting in low academic scores. The boy’s scores on “The Study Habits Inventory” were lower,
indicating poor study habits which includes study concentration. The counsellors used an eclectic
approach for the boy and his parents, to develop a healthy family environment, which improved his
self-esteem and study habits.
Keywords:
Parenting style, Peer interactions, Academic performance, Eclectic counseling, Therapies.
How to cite this article: Samruddhi Karnik and Neha Sahasrabudhe . Negative Impact of Troublesome Peer
Interactions and Authoritarian Parenting Style on Academic Performance of a 15 year old Boy. Walawalkar
International Medical Journal 2017; 4(1):67-65. http://www.wimjournal.com

Samruddhi Karnik , B.K.L Walawalkar Rural Medical College and Hospital, Sawarde, Tal-Chiplun,
Dist-Ratnagiri, Maharashtra, India, E-mail: samruddhi.s.karnik@gmail.com, Mobile No:9765245329

Karnik S S
Introduction:
In India, adolescents account for Case report:
nearly one quarter of the total population. A 15 years old boy was referred for
They deserve our attention as they hold the counselling. The parents had come to the
key to breaking cycles of poverty & counsellors to talk about their son. Their
inequity.(1) Recent researches suggest that socio-economic status was middle class. Their
more young people are beginning to report of presenting complaint was that he was always
mental health problems. Indian Council of distracted and not able to concentrate on his
Medical Research reported that about 12.8 per studies. He was in 10th standard and thus his
cent of children (1-16 years) suffer from parents were tensed. They informed the
mental health problems. The children and counsellors that he had recently failed in his
adolescents living in rural konkan region can Maths exam. He used to previously play
be counted in disadvantaged communities who football and was good at the game but because
face multiple stressors like family poverty, of his declining academic performance,
family conflict and increased prevalence of parents had stopped his football practice. The
deviant peers. Also male members in majority parents also informed about the boy’s anger
of the families have migrated to Mumbai due and irritated behaviour when asked about
to low employment potentials in the konkan studies.
region. All these factors add up to the troubles The counsellors took semi structured
of the children living in this area. Educational interviews of the boy’s mother, father, and
backwardness and superstitious beliefs, are friends to gather information about the client.
some of the reasons of an authoritarian After a brief discussion with the parents, the
parenting style of most of the parents living in counsellors found out that the boy was teased
this region. Thus objective of this case study on his skin tone by his peers in school
was to know the negative effects of such a (especially girls), which was affecting his
family environment on the well being of an concentration in studies and might have led to
adolescent and how troublesome peer his anger and irritable behaviour. Father
interactions can also affect adversely on the complained that he spent his time at home
academic performance. playing games on the mobile. His father was

Karnik S S
of the opinion that he should play outdoor After asking some questions about his family
games like ‘kabbaddi’, ‘cricket’ etc and make environment, it was seen that the boy’s father
new friends. had an Authoritarian parenting style (strict
The counsellors then took an parenting) because of which he was scared of
individual session with the boy. He informed his father and there was a total lack of
the counsellors about his failure in Maths and communication in them. The boy failed to
said that it was hard for him to remember the verbalise his views and emotions and
steps of a sum but his performance in other sometimes also had quarrels with the father
subjects was average. After gathering which led to punishment. His relationship with
information about his study timings, place of his mother was cordial. Thus all these factors
study, time given to a particular subject and contributed to a negative impact on his studies
his way of studying, “The Study Habits and self-confidence (2).
Inventory” was administered to him who Methodology:
showed that his study methods were not Semi structured interviews of the
appropriate. When asked about his leisure mother, father, child, and friends were
time he said that he mostly played mobile conducted. The eclectic approach of therapy
games as none of his friends were available to was used. This approach incorporates a variety
play outdoor games. Most of them had tuitions of therapeutic principles and range of
and others went for football practice. This techniques from all schools of therapy in order
could have led to his distraction from studies to create the ideal treatment program to meet
as he loved to play football. the specific needs of the patient or client. Thus
The counsellors noticed a lack of self techniques from therapies like Reality
esteem in him due to the teasing at school Therapy, Transactional Analysis and Rational
especially by girls. In adolescent age, anything Emotive Behaviour Therapy were used in the
said by the members of the opposite sex is counselling sessions. The study skills were
taken seriously and thus he used to get given to the boy who focused on reading,
agitated and frequent quarrels used to take improving concentration, note taking, memory
place. techniques and time management.

Karnik S S
Discussion: memory exercises given to him. Also he

Content analysis of the semi structured started ignoring his peers when the counsellors
interviews indicated that troublesome peer made him understand the axioms of choice
interactions and the father’s authoritarian theory.
parenting style was affecting negatively on the In the session with parents ,the father
boy’s academics. The boy’s mother also was told about the long term effects of his
(4)
confirmed the father’s authoritarian parenting strict parenting and was made to realise
style and his peers confirmed teasing him. that because of his strictness and ways of
Thus he could not concentrate on his studies punishment his relation with the son is getting
and this adversely affected his self-esteem. largely hampered. Rational Emotive
(3)
The boy and his parents were given separate Behaviour Therapy was used and cognitive
counselling sessions. The study skills were dispute was done to correct his faulty beliefs
given to the boy who focused on reading, about parenting. Also with the help of
(3)
increasing concentration, note taking, memory Transactional Analysis he was informed
techniques and time management to improve about the ego states to improve the father-son
his academics. With the help of reality therapy communication. Over the sessions the father
(3)
he was motivated to study and also with the agreed and accepted his mistakes. He took all
help of choice theory he was counselled about the efforts to improve his relation with his son
the individualistic difference and that to make it friendly and benevolent.
everyone is unique and has some abilities. This shows how authoritarian
Thus it does not matter whether you are fair or parenting style can affect the academics and
dark. It’s the capabilities you have and your emotional stability of an adolescent in a
(5)
hard work that help to make you successful in negative way . Also peer group acceptance
life. The boy after the sessions realised the plays an important role because adolescents
importance of academics in achieving the spend a lot of time with peers and their advice
dreams and agreed to study hard and use all and acceptance is more important for them.
the study skills given by the counsellors. It Conclusion:
was noted that he had started working as he Counselling sessions were given to the
had completed all the homework and the parents and the boy over a month.

Karnik S S
Psychotherapeutic counselling gave positive in Engineering and Technology, 2013, 310-

results for both parents and the boy as it aided 315.
to enhance their family environment and the 3) Nelson-Jones R. Theory and Practice of
father-son relationship. It also helped to Counselling and Therapy. 5th ed. Sage
improve the boy’s peer group interactions. Publications Pvt Ltd. 2012
The use of study skills reformedthe boy’s 4) Sharma, G., &Pandey, N. Parenting Styles
study habits and his overall level of and its Effect on Self-Esteem of Adolescents.
concentration increased. In India, the International Journal of Indian Psychology,
awareness about the need and importance of 2015, 3(1), 29-39.
counselling is quite low. Further in the konkan 5) Hoskins, D.H. Consequences of parenting
region, there is hardly any awareness about on adolescent outcomes. Societies, 2014, 4(3),
psychological health and thus counselling is a 506-5306-53
herculean task here. Considering the positive
effects of counselling, it can be said that it is
of utmost importance in the rural konkan area.
More and more awareness should be raised on
mental health among adolescents, parents and
teachers so that the children and adolescents
living in this region prosper in all aspects of
their life.
Conflict of interest: None to declare
Source of funding: Nil
References:
1) Karin Hulshof. Adolescents : An Age of
Opportunity (Unicef Report India). New
Delhi: United Nations Children’s Fund, 2014
2) Deshpande, A., Chhabria, M. Parenting
Styles and its Effects on Adolescents’ Self-
Esteem. International Journal of Innovations

Nagoba B S
SPECIAL ARTICLE
Current Status of Medical Research in India- Where are we?
Basavraj Nagoba 1 and Milind Davane 2
Assistant Dean (R & D) & Professor of Microbiology, MIMSR Medical College, Latur1,
Assistant Professor of Microbiology, MIMSR Medical College, Latur-413 531, Maharashtra,
India2
Abstract:
Medical research, particularly clinical research adds enormous value in furthering science
and adding quality to medical practice. Evidence based medicine is a new buzz world of Modern
medicine. Medical colleges are expected to be the forerunner in the endeavor. But presently, medical
colleges in India and also other institutes contribute very less to their present capacity. Lack of
training and lack of appreciation are the major hindrances. They need to be corrected to the root
cause to guide the medical practice in the country and further the Evidence Based Medicine which is
a need of hour.
Keywords:
Medical research, training, evidence based medicine
How to cite this article: Basavraj Nagoba and Milind Davane. Current Status of Medical Research in India-
Where are we? Walawalkar International Medical Journal 2017; 4(1):66-71. http://www.wimjournal.com

Dr. Basavraj S. Nagoba, Assistant Dean (R & D), MIMSR Medical College, Latur-413 531,
Maharashtra, India, E-mail: dr_bsnagoba@yahoo.com, bsnagoba@gmail.com,
Mobile No.: 9423075786
Research is an integral part of with evidence- based medicine, which helps in

learning, development and innovations in any better understanding of the subject. Research
subject. It is one of the key areas which help helps to refresh and update the entire
in advancement of science. In Medical knowledge of the subject and thus, pave the
Sciences, it is important to produce documents path for further addition, improvement, up-

Nagoba B S
gradation and introduction of discoveries and neglected part in a large number of medical
new innovations. The quality medical practice colleges, in India. The scenario which we see
is possible only through constant up-gradation today deludes our expectations. The research
of knowledge and skills. This habit of up- in medical sciences in India is not what it
gradation automatically ignites the probing should be. Not only the quality of research is
mind and provides the motivation to enter into poor and low but also it is headed in wrong
research. direction. Also it is irrelevant to the needs of
Medical education and medical our soil. The problems common to Indian soils
research are nonseparable components of such as infectious diseases, childhood
healthcare. Health research is of paramount problems, tropical diseases, etc. are
importance as it provides knowledge ignored/given less importance and irrelevant
regarding the health status, diseases relevant fields like neurosciences, oncology and others
to our soil, changing pattern of disease are given more importance.(1,2)
prevalence, treatment strategy to be adopted, Analysis of Data:
impact of various health programs initiated by Analysis of data shows that in 1998
Government, etc. (Nandy S.) out of 128 medical colleges, only
To remain globally competitive, the 10 medical colleges were active in research
need-based clinically oriented research useful and their papers were published in 113 Indian
to patients in particular and general public at Journals out of which only 27 journals were
large is crucial and hence, quality research is indexed in index medicus. This shows that the
must. It is an indicator of quality education overall quality of research was low.(6)
and clinical care in medical institutes. Thus, As per the ICMR report (2002), 27 out
research in medical sciences is an integral part of 156 medical colleges did not produce a
of medical education and crucial to sustain single paper and 29 medical colleges
(1-5)
quality. published only one paper. The report further
Present Status of Medical Research in adds that only eight top institutes were active
India: in research as a result of which India’s share
Research is an integral part of medical in global literature in indexed journals
education, but unfortunately it is the most declined from 0.9% to 0.5% during the period

Nagoba B S
1990-1994, which was much lesser than From the year 2015, after the
China, Thailand and Philippines. As per the obligatory requirement of publication of
data analysis report of index medicus (1998), papers by MCI for promotion of higher posts
India’s share was only 0.714%, i.e., only 2974 has lead to the phenomenon of publish or
articles out of 41656.(1-3) perish. Again after the liberty to publish
As per the report of 1998-2008, the journals indexed in index Copernicus, there is
India’s share increased to 1.6% in the world mushrooming of large number of predatory
research output. Unfortunately, a large number journals with a system to pay and publish. A
of medical colleges have shown dismal large number of articles are being published
performance and it is shocking to note that from almost all colleges from India; most of
332 (57.3%) medical colleges from India had these articles are published in predatory
not a single publication to their credit during journals. In last two years, literally
2004-2014. A total of 157 researchers per uncountable numbers of papers have been
million populations were reported in India in published in predatory journals, most of these
2010, which was much less than the global journals are from India.(7,8)
average of 1023.(3,4) Reasons for Poor State of Medical Research
As per the recent report of 2016, only in India:
four Indian Medical colleges are among the The quality of research is poor for the
top 10 global institutes that have publications following two types of reasons:
in peer- reviewed journals. These are AIIMS, 1. Specific Reasons:
New Delhi, PGI Chandigarh, CMC Vellore The quality of research is likely to be poor
and SGIMS, Lucknow. AIIMS, New when the resources and training in research
Delhi with more than 1100 annual are lacking. In most of the medical colleges –
publications ranked third in the world after both Government and Private – there is lack of
Massachusetts General Hospital, Boston, USA basic infrastructure and facilities. Most of the
(74600) and Mayo clinic, Rochester, USA medical colleges are lacking even in a
(3700). The results of this review concluded minimum infrastructure required for research.
that the India has the best and the worst However, in some of the medical colleges, the
medical education in the world.(6) infrastructural facilities are available to the

Nagoba B S
fullest extent, but they are lacking in trained funding for research purpose. Hence, lack of
manpower. Thus, either gross shortage of funding is also an important reason, disinterest
resources or gross shortage of trained of Deans and Directors in most of the medical
manpower or both are the important reasons institutes, and surprise inspections by MCI are
for poor quality medical research. No one of the small reasons, which do not allow
exposure or less exposure of faculty and faculty and students to attend conferences
consequently of students to the latest tools in meant for academic up-gradation and
biomedical research is another important presentation of their research papers. Most of
reason which makes faculty and students the conferences are organized during the
reluctant to use modern techniques. Lack of months of November to February, a period
appropriate training programmes in research during which surprise inspections are
methodology is also one of the reasons. Lack conducted by MCI and hence, there is
of developing research project is another academic hindrance are some of the general
important reasons for poor quality of Medical and non-specific reasons. Moreover, research
research.(1-4) is a very long journey to get academic acclaim
General Reasons: that is one of the reasons for less interest in
These include lack of scientific temperament, research. (1-4)
less weightage to research in academic What can be done to enhance the quality of
progression, lack of Research?
encouragement/motivation for research, non- To remain globally competitive,
availability of structured mentorship quality research is must. To enhance the
programs, lack of writing skills required for quality of research, we need to rethink about
biomedical publications especially of the following issues:
international level, no extra incentives/benefits Funding:
for research, lack of accountability, lack of Currently, the research funding in
fully functioning academic committee/body to general and medical research in particular is
promote research both within and outside the very less in India. Only Indian Council of
institute. Only one body – Indian Council of Medical Research gives funding for medical
Medical Research. MCI does not provide any research. For qualitative as well as

Nagoba B S
quantitative increase in medical research, Proper credit for research to real workers is to
funding should be increased and optimum and be given. Their work should not be high-
proper utilization is to be ensured. jacked and published as an own work by the
Resources: bosses.
The quality of research is likely to be Incentives:
poor when the resources are lacking. Hence, Extra incentives to faculty members
the availability of useful resources is very involved in research may act as an impetus to
crucial in conducting quality research. work further. Hence, the researchers should be
Training: offered extra incentives for good quality
The quality of research is likely to be research and good quality publications.
poor when appropriate training of faculty and Many countries have made it mandatory for
students in research methodology is lacking. their medical faculty to do research; some
The proper training in research methodology other countries give incentives to conduct and
would be helpful to enhance the quality of publish. (1-4, 8, 9)
research. It is proved beyond doubt that research is
Motivation: expensive, but in the long run, not doing
The lack of motivation is one of the the research is more expensive.
important reasons for poor quality of research References:
in India. Hence, the real workers 1. Nagoba BS. What is research? In:
(MD/MS/PhD students) are to be encouraged Nagoba BS & Mantri SB (ed).
and motivated for high quality research. Proceedings of Medical Council of
Credit: India, New Delhi Sponsored National
Most of the times, the actual work is Workshop on Health Research
done by one or two persons but the PG Methodology. Latur: Department of
teachers, head of the departments, etc. Medical Education; 2010.
consider it their right to be included as the first 2. Chandorkar AG, Nagoba BS, eds.
or second authors and the actual workers are Research Methodology in Medical
ignored or their work is high-jacked by their Sciences, Himalaya Publishing House
bosses and published as their own work. Pvt. Ltd., Mumbai, 2003.

Nagoba B S
3. Dev MG. Undergraduate medical 7. Nagoba B, Selkar S, Mumbre S,

students’ research in India. J Postgrad Davane M, Suryavanshi N. Where to
Med 2008; 54:176-9. publish? Choosing the right journal for
4. Garg R, Goel S, Singh K. Lack of research work. JKIMSU 2016; 5:136-
research amongst undergraduate 141.
medical students in India: it’s time to 8. Aggarwal R, Gogtay N, Kumar R,
act and act now. Ind Ped 2017; 54:357- Sahani P. et al. The revised guidelines
60. of the Medical Council of India for
5. Ratnakar KS. Medical education and academic promotions: Need for a
research in India. rethink. Natl Med J Ind 2016; 29(1):
http://www.thehansindia.com/post/inde e1-1 - e1-4.
x/Health 2016-06-09/medical accessed 9. Nagoba B, Davane M, Mumbre S. New
on 9th Oct 2017. guidelines required for publications by
6. Nandy S. What can be done about medical academia. Natl Med J India
Indian medical research? Natl Med J 2016;29:113.
Ind 1998;11:1-2.

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WIMJOURNAL, Volume No. 4, Issue No.

1, 2017 pISSN 2349-2910, eISSN 2395-0684

ORIGINAL RESEARCH ARTICLE

© Walawalkar International Medical Journal 1

Address for correspondence:

Introduction: 50ml/min). Lipid abnormalities and enhanced

© Walawalkar International Medical Journal 2

Materials and Methods: conservative line of therapy. Patients with

© Walawalkar International Medical Journal 3

Parameter Control CRF on p value

Triglyceride 110. ± 30.2 247 ± 36.47 < 0.05

VLDL C 21.6 ± 6.06 49 ± 6.62 < 0.05

TC/HDL 3.97 ± 0.69 5.51 ± 0.74 < 0.05

FIG 1: Bar diagram showing comparison of Serum Na+, Serum K+inControl

© Walawalkar International Medical Journal 4

Table 1, 2and Figure 1, 22shows management group as compared controls

Serum Na+ 140.7 ± 5.23 134.0 ± 7.90 < 0.05

Serum K+ 3.4 ± 0.38 4.84 ± 0.96 < 0.05

© Walawalkar International Medical Journal 5

Table 4: Tukeys multiple comparison between control & CRF on dialysis

© Walawalkar International Medical Journal 6

Table 3, 4and Figure 3, 4shows compared to controls. The mean value of

© Walawalkar International Medical Journal 7

© Walawalkar International Medical Journal 8

3. Abraham G, Moorthy AV, Aggarwal V. Compared with Ultracentrifugation

© Walawalkar International Medical Journal 9

ORIGINAL RESEARCH ARTICLE

mortality and morbidity of bowel obstruction is substantial. Therefore better understanding of

pathophysiology, improvement in diagnostic techniques, fluid and electrolyte correction, much

potent antibiotics and knowledge of intensive care is required.

the main stay of the treatment.

diagnosis and surgical intervention and associated medical illness.

Therefore, early diagnosis of obstruction, skillful operative management, proper technique

during surgery and intensive postoperative treatment carries a grateful result.

© Walawalkar International Medical Journal 10

Intestinal Obstruction. Walawalkar International Medical Journal 2017; 4(1):10-27. http://www.wimjournal.com

Address for correspondence:

Introduction: the gut to the next. This form is commonly

© Walawalkar International Medical Journal 11

© Walawalkar International Medical Journal 12

© Walawalkar International Medical Journal 13

Graph 1:: Age wise and Gender wise distribution of patients

Sign and symptoms: Of the total patients increased bowel sounds

Graph 2:: Distribution of patients according to signs and symptoms:

Signs and Symptoms

© Walawalkar International Medical Journal 14

Table 1a: Distribution of patients according to duration of pain

Table 1b: Distribution of patients according to duration of vomiting

Duration of vomiting(days) No of patients Percentage (%)

© Walawalkar International Medical Journal 15

Table 1c: Distribution of patients according to presence of distention

Table 1d: Distribution of patients according to presence of constipation

Etiology: cause in 3.92% (4) patients. Intussusception

© Walawalkar International Medical Journal 16

Graph 3: Distribution of patients according to etiology

Table 2a: Distribution of patients according to type of adhesions

Table 2b: Distribution of patients according to type of volvulus

© Walawalkar International Medical Journal 17

Table 2c: Distribution of patients according to type of hernia

Out of 10 patients of malignancy, maximum malignancy 20% (2 patients each) hepatic

Table 2d: Distribution of patients according to site of malignancy

© Walawalkar International Medical Journal 18

Radiological findings: (78) patients , ground glass appearance