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Mrunal Patil

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Jitendra Kodilkar ¹, Mrunal Patil ², Neelima Chafekar ³, Ashwinkumar More ¹

Affiliations
1 Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik, IN
2 Department of Ophthalmology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik, IN
3 Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik, IN

Abstract

Introduction: Echocardiography is noninvasive, most frequently used usually the initial imaging test to evaluate all cardiovascular disease related to structural, functional, or hemodynamic abnormality of the heart or great vessels. The major advantage of echocardiography is the ability to obtain instantaneous real time image even in emergency units. The present study was undertaken to evaluate left ventricular function, extent of myocardium involved and complications of acute myocardial infarction by 2D ECHO, to correlate these findings with ECG and clinical presentation, and to assess the role of 2D ECHO in management and prognosis of patients with acute myocardial infarction.

Materials and Methods: The present study was conducted on patients visiting our tertiary health centre, Nasik over a period of 2 years. 55 patients were included in the study. Patients with prior history of acute myocardial infarction, valvular heart disease, cardiomyopathy, cardiac surgery, congenital heart disease and non ST elevation MI were not included in the study. Patients were classified as per Killip classification and 2D ECHO was performed on the patients within 24 hours of admission. The findings of which were correlated with clinical and ECG findings.

Results: Of 55 patients studied it was found that MI had male preponderance with hypertension as major risk factor. Also, the severity of the infarction increased with the increase in the Killip class. Mean ejection fraction was also observed to be decreasing in patients with increase in severity of the infarction.

Conclusion: 2D ECHO performed within 24 hours of admission helps the clinician to predict and diagnose complications in patients with acute MI and take proper steps in the management of the patient.

Keywords

Echocardiography, Killip Classification, Myocardial Infarction

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Preeti Bajaj ¹, Mrunal Patil ², Balaji Almale ³

Affiliations
1 Department of Pathology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik, IN
2 Department of Ophthalmology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik, IN
3 Department of Community Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik, IN

Abstract

Medical teachers need training in pedagogic techniques in order to become better teachers. Despite the fact that our teaching techniques improve gradually over the years as we gain experience and also owing to continuous practice undertaken for different kinds of teaching learning situations; nevertheless educational technology has evolved ways and means for better development of teaching skills even at earlier stages by undertaking some methodical exercises, one of which is Microteaching. Microteaching, an innovative technique of teacher training, helps teachers to improve their teaching skills. It aims at development of competence in teaching skills through the practice of microteaching sessions1. In other words, it teaches teachers how to teach. This is especially important in cases of new faculty implying the budding teachers. Even an experienced teacher can benefit by this technique, particularly for learning some new skills1. The individual may be very sound in his/ her own subject but may not necessarily be a good teacher.

Keywords

Medical Education, Microteaching

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Mrunal Patil ¹, Dhiraj Balwir ², Hardik Jain ³

Affiliations
1 Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
2 Department of Ophthalmology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN
3 Department of Ophthalmology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik - 422003, Maharashtra, IN

Abstract

Background: Glaucoma is an optic neuropathy characterized by a typical appearance of optic nerve head and characteristic visual field loss. The diagnosis of primary glaucoma, normal tension glaucoma and ocular hypertension is made on the basis of an IOP cut-off point of 21 mmHg. Thus, any factor that alters the value of the IOP can lead to a misclassification of the patient. There is a growing consensus that assessment of Central Corneal Thickness (CCT) has become an important element of the clinical evaluation of the glaucoma patient. This study intends to analyse the CCT trends amongst three study groups: Normal subjects; Primary Open Angle Glaucoma subjects; and Ocular Hypertension subjects. It also intends to explore the relationship between CCT and GAT IOP amongst the three study groups. Lastly, this study aims to evaluate if CCT can be used as a useful tool for prognostication of disease progression in ocular hypertensives, and for glaucoma diagnosis. Aims and Objective: 1. To study and compare the CCT amongst patients with Normal IOP, ocular hypertension and glaucoma. 2. To study and compare the correlation between CCT and IOP amongst patients with Normal IOP, ocular hypertension and glaucoma. Material and Methods: IOP was measured using Goldmann’s Applanation Tonometer and CCT was measured using the ultrasound pachymeter in 60 eyes of 30 normal subjects, 60 eyes of 30 glaucoma patients and 60 eyes of 30 ocular hypertensive patients. A correction factor based on the CCT was applied and corrected IOP values were calculated for the three cohorts. Analysis of Variance and Pearson Correlation Test was used to determine any significant difference in CCT, the correction factors and the CCT adjusted IOPs between the three groups. The study was conducted between November 2014 to November 2016. Results: There was a statistically significant difference in the mean CCT of the normals (554.38 + 17.67μm) as compared to the glaucomas (554.15 + 16.39μm) and ocular hypertensives (568.18 + 30.52 μm). Applying the described correction factor for corneal thickness, 40% of eyes with ocular hypertension were found to have a corrected IOP of 21mmHg or less. Conclusion: Increased corneal thickness in ocular hypertension may lead to an overestimation of IOP in 39% of cases. Measurement of central corneal thickness is advisable when the clinical findings do not correlate with the applanation IOP.

Keywords

Glaucoma, Ocular Hypertension, CCT, GAT, IOP.

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Jitendra Kodilkar ¹, Manish Kolge ¹, Neelima Chafekar ¹, Mrunal Patil ²

Affiliations
1 Department of Medicine, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra, IN
2 Department of Ophthalmology, Dr. Vasantrao Pawar Medical College Hospital and Research Centre, Nashik – 422003, Maharashtra, IN

Abstract

Aim: To study the clinical profile of diabetic patients who present with Acute Coronary Syndrome (ACS) for the first time, to correlate the Blood Sugar Level (BSL) and Glycosylated hemoglobin (HbA_1C) at the time of admission and the severity of acute coronary syndrome; and to assess the correlation between tight glycemic control of diabetics based on HbA_1C estimation and presence of end organ damage in diabetics. Materials and Methods: The study was undertaken at our medical college in the medicine department. 64 adult patients who are known diabetics or detected for the first time presenting in outpatient department or emergency department as acute coronary syndrome were studied. Study period was 2 years from January 2011 to December 2012. Results: The study showed a definite male preponderance, with 56.23% males as compared to 43.73% females. Atypical presentations of acute coronary syndrome were more common as compared to typical chest pain (34.37%). Chest pain commonly is prevalent in younger age group. 95.30% of the patient had some or other associated risk factors like hypertension (59.37%), smoking (26.56%), obesity (15.62%) or dyslipidemia (65.62%). ST elevation MI was the commonest presentation (73.40%) and involvement of anterior wall was common (36.20%). On admission BSL (Blood Sugar Level) was not found to have a definite prognostic value in predicting outcome in diabetic patients with acute coronary syndrome. Impaired glycosylated haemoglobin was found to be an independent risk factor and had a definite prognostic value in predicting outcome. Diabetic patient with acute coronary syndrome had LV dysfunction, cardiac rhythm abnormalities, cardiogenic shock and are likely to be readmitted, thus having worst morbidity as well as mortality. Conclusion: The primary aim of this study was to study correlation of blood sugar level and glycosylated haemoglobin at the time of admission with severity of acute coronary syndrome and to study clinical profile of diabetic patients with due consideration to complications which are related to diabetes.

Keywords

Acute Coronary Syndrome, Blood Sugar Level, Dyslipidemia, Glycosylated Hemoglobin.

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Mrunal Patil ¹, Dhiraj Balwir ¹, Ajit Khune ¹, Saurabh Dhewale ¹

Affiliations
1 Department of Ophthalmology, Dr. Vasantrao Pawar Medical College Hospital & RC, Nashik - 422003, IN

Abstract

Background: Dry eye is a multifactorial disease of the tears and ocular surface that results in symptoms of dryness, grittiness, redness, burning sensation or any discomfort, visual disturbance and tear film instability leading to potential damage to ocular surface. The tear film consists of three layers starting from within outwards mucus, the aqueous layer and the lipid layer. The tear film and ocular surface form a complex and stable system that can lose its equilibrium through numerous disturbing factors. Studies which also involve tests of tear functions including Schirmer’s test, Tear break-up time, Fluorescein staining for determination of dry eye have found generally low prevalence rates.Hence the physiology of tear film and its binding with the eye shows that there is some involvement of serum calcium level with dry eye. The present study encourages us to assess the role of serum calcium level with patients of dry eye. Aims and Objective: To assess the role of calcium with dry eye. Material and Methods: Total 90 subjects (30 cases and 60 controls) who met the selection criteria were included in the study. Serum analysis has been done for calcium level in the body in the patients of dry eye.The study was conducted between August 2014 to November 2016. Results: The lower serum level of calcium was significantly associated with dry eyes in the study. Conclusion: Calcium plays an important role in the causative mechanism of dry eye in the patients of dry eye disease.

Keywords

Calcium, Dry Eye, Serum Level, Tear Film.

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Gouri Diwan ¹, Anand Diwan ², Pradip Barde ³, Ashok Vankudre ⁴, Akshay Bhagat ⁵, Mrunal Patil ⁶

Affiliations
1 Department of Anaesthesia, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon, Nashik – 422003, Maharashtra, IN
2 Department of Paediatrics, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon, Nashik – 422003, Maharashtra, IN
3 Central Research Laboratory, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon, Nashik – 422003, Maharashtra, IN
4 Department of Community Medicine, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon, Nashik – 422003, Maharashtra, IN
5 Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon, Nashik – 422003, Maharashtra, IN
6 Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Adgaon, Nashik – 422003, Maharashtra, IN

Abstract

Aim: Risk Factors Associated with Stroke Patients of Tertiary Care Institute. Objective: To analyse the few determinants of prognosis of stroke patients admitted to tertiary care Institute. Materials and Methods: This is a Retrolective-cross section study. Anonymised data of stroke patients admitted in 2016-2017 were analysed using appropriate statistical method (SPSS). Data were randomly collected after approval of Institutional Ethics Committee (IEC). Result: Among total 70 patients’ (44 Males, 26 Females) data were included for analysis. The majority of patients were in the age group of 35 to 80 years. Among the subtype of strokes, 35 were of an ischemic type and 35 were of the hemorrhagic type. Overall stroke is more common in male as compared to females. Hypertension was commonest risk factor i.e., 61% followed by tobacco i.e. 32%, then alcohol consumption 24%, Diabetes Mellitus 20% ischemic heart disease 4.2% among the study population. Diabetes Mellitus as a risk factor was present in 25% of patients with stroke. Commonest presenting symptom observed in the study population was hemiplegia 77% followed by speech involvement 28.6%. The majority of patients were from poor socioeconomic strata. Conclusion: Our study re-identifies the pivotal importance of aetiology and prognosis of stroke where alcohol, tobacco and unawareness for treatment for Diabetes and Hypertension were common to socioeconomic status and attention to correction of modifiable risk factors.

Keywords

Hemorrhagic Stroke, Ischemic Stroke, Risk Factors, Socioeconomic Status.

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Ashwin Parati ¹, Mrunal Patil ², Kalpana Gadsingh ³, Anup Shah ⁴

Affiliations
1 Former PG Resident, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, IN
2 Professor of Ophthalmology and Dean, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, IN
3 Associate Professor, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra, IN
4 Associate Professor, Department of Ophthalmology, Dr. Vasantrao Pawar Medical College, Hospital and Research Centre, Nashik – 422003, Maharashtra

Abstract

Introduction: Pathological myopia (PM) is defined as the presence of structural changes due to axial elongation in eyes with high myopia. Numerous vision-threatening conditions are known to be more prevalent in eyes with pathological myopia including retinal detachment, myopic retinoschisis, macular holes, choroidal neovascularization, and chorioretinal atrophy. These pathological changes often lead to progressive loss of vision. Present study was conducted to find out the burden of pathological myopia and its associated factors at a tertiary care centre. Materials and Methods: A hospital based cross sectional study was conducted including a sample size of 345 with at least -5.0 D spherical equivalent of myopia in both eyes. Each subject was interviewed followed by extensive ophthalmologic screening examination, including measurements of visual acuity and fundus examination by Direct & Indirect Ophthalmoscopy. Data was analysed using SPSS ver. 21.0 using appropriate statistical tests. Results: Prevalence of pathological myopia among myopia cases between 7 to 40 years old was 9%. Among 31 cases of pathological myopia, juvenile and youth onset was seen in 29% cases each while early adult onset was seen in 41.9% cases. Prevalence was more in females (12.4%) as compared to males (5.7%). Low visual acuity, high spherical/ cylindrical error and high intra-ocular pressure were significantly associated with pathological myopia. Mean axis length in both right and left eye was significantly more in cases with pathological myopia (p<0.05). Conclusion: Around one in ten myopia cases suffers from pathological myopia. Pathological myopia is more common in males especially during adulthood and is associated with poor visual acuity and axial elongation. Another important finding observed in present study was presence of raised intra-ocular pressure among high myopic cases which can be a risk factor for development of optic neuropathy.

Keywords

High Myopia, Keratometry, Myopia, Pathological Myopia, Visual Acuity

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