Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411018EnglishN2018September28HealthcarePost Lecture Multiple Choice Questions (MCQs) Test Improves the Performance of Students
English0105Pradnya Pradeep KulkarniEnglish Pradeep P. KulkarniEnglishAim: To study whether post lecture MCQs tests improves the performance of students.
English MCQs Test, Cross sectional study, Terminal examination performanceIntroduction:
Inspite of good potential, good infrastructure, many doctors and advances in medical care, health problems of our society are not reduced. We must study “Where we are going wrong?” Performance of the doctor is reduced if it is not based on proper knowledge. To gain proper knowledge students should be motivated. There are many reasons why all medical students do not become good, efficient, skilled doctors. One of these is knowledge.1 If post lecture MCQ test is conducted, students will take more interest. MCQ test is a very effective assessment technique2. They will study and will get knowledge automatically. More and more efficient doctors will serve society. Healthy community will be formed because of good doctors.
Key points: MCQs Test
Methodology:
Study design- original, Cross sectional study, qualitative and quantitative study
Study place- P.I.M.S.& R, Urun Islampur
Study Duration - 5 months
Source of funding: No big amount was required, so whatever was required, used from my pocket.
Two batches (one batch 2015-16, another batch-2016-17) of 1st MBBS students were considered for the study. Students of batch 2015-16 were not exposed to MCQs tests after lectures but students of another batch-2016-17 were exposed to MCQs tests after lectures. Results of terminal examination of both batches were compared.
Material and method:
1. Orally Informed and Written Consent of Students was taken. Approval of administrative committee & ethical committee was obtained.
2. Pre-validated MCQs were used for MCQ Tests. MCQ tests were taken after lectures of various topics for 2017-18 batch. These tests were not conducted for 2016-17 batch.
3. Questionnaire was prepared and feedback was taken.
4. Now results of terminal examination of these two batches were compared. MCQ Tests were used as these often require less time to administer3 and lower likelihood of teacher bias in the results. Terminal exams of two batches were based on same topics.
5. No Conflict of interest.
Results:
Statistical analysis was done using independent t test. P< 0.000 Results of terminal examination of two batches were considered.
Students obtaining marks below 9 (In the group 1 and 2) are many from 2016-17 batch as compared to 2017-18 batch. Students obtaining marks above 9 (In the group 3 and 4) are many from 2017-18 batch as compared to 2016-17 batch.
Discussion-
(Refer Table1, chart 2 and 3) Students of batch 2017-18 were giving MCQ tests after Lectures. In terminal examination performance of this batch was good as compared to performance of students of batch 2016-17.
Bhatt M, Thapa B and Bhattacharya A also came to the same conclusion after their work in physiology. They mansion ‘MCQ supplementation in a physiology diadactic class is a good learning tool3. Use of multiple choice questions test after lectures helps medical students to improve their performance in written formative assessment in physiology4.
Another study done by Stanger-Hall says ‘Students show improved scores in their formative written assessment when the lectures are assisted with the use of MCQs than when MCQs are not employed before and during the lecture5. The same conclusion is drawn from this study.
According to Beckert, L., Wilkinson, T. J., & Sainsbury, R. ‘While giving MCQ test every time students retrieve information from memory and use it to answer a test question, they are potentially strengthening (i.e. Better retention) and/or changing the representation of that information in memory (i.e. Deeper understanding)6.
Multiple-choice questions increases performance on a subsequent short-answer test7
Refer chart 1 which shows feedback of students about MCQs tests
1) 96.666% students strongly agree that good knowledge achieved and retained by MCQ tests.
2) 94.444% students strongly agree that MCQ tests should be conducted by other departments also.
3) 93.333 students strongly agree that interaction with students also increased by MCQ tests.
Conclusion
MCQs tests improve the performance of students. Other studies referred above also conclude the same thing.
Acknowledgement:
Without the help of students, faculties, members of management committee, members of ethical committee and Dean Madam my project would not be completed. I am very thankful to them. Head of my department also allowed me to carry on my research activity after lecture. Authors which are mentioned in references, without their published, valuable information, there would not be any weight age to my study.
Englishhttp://ijcrr.com/abstract.php?article_id=2525http://ijcrr.com/article_html.php?did=25251.Paul Root Wolpe,What is a good doctor and how can we make one? bmj.com 2002.bmj.com/cgi/content/full/324/7353/DC1
2. Abdel-Hameed AA, Al-Faris EA, Alorainy IA, Al-Rukban MO. The criteria and analysis of good multiple
choice questions in a health professional setting. Saudi Med J 2005;26:1505-1
3. Julie Considine, Mari Botti, Deakin University Shane Thomas, La Trobe University ‘Design, format, validity and reliability of multiple choice questions for use in nursing research and education’ Collegian Vol 12 No 1 2005, page-20
4. Bhatt M, Thapa B, Bhattacharya A, Bhinganiya P, Minhas S, Sharma S. MCQ supplementation in a physiology diadactic class: A learning tool. Natl J Integr Res Med.2015;6(1):72-6
5. Stanger-Hall, K.R. (2012). Multiple-choice exams: An obstacle for higher-level thinking in introductory science classes. Cell Biology Education—Life Sciences Education, 11 (3), 294-306
6. Beckert, L., Wilkinson, T. J., & Sainsbury, R. (2003). A needs-based study and examination skills course improves students' performance Medical Education 37 (5),
424–428.doi:10.1046/j.1365-2923.2003.01499.x
7. The Journal of General Psychology Volume 142, 2015 - Issue 2
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411018EnglishN2018September28HealthcareExtraction of Decayed and Dilapidated First Permanent Molars in Mixed Dentition and Spontaneous Space Closure: A Case Report
English0609Zaroui JiheneEnglish Jazi ImeneEnglish Jemmali BadiaaEnglishThe replacement of dilapidated or already extracted first permanent molars (FPMs) is the subject of multidisciplinary discussion.
Many treatment options are considered to restorate a dilapidated FPM like: crown restoration after an endodontic treatment or, replace an exAtracted FPM like: space maintainer or orthodontic treatment for space closure.
This case-report described another alternative of treatment in which spontaneous space closure (SSC) is obtained after extraction of first permanent molars in mixed dentition.
Indeed, if some conditions are reunited, the SSC by the eruption of the second permanent molars, which will take up
EnglishExtraction, First permanent molars, Space closure, Mixed dentitionIntroduction
First permanent molars are frequently affected by caries and are quoted as being the most caries-prone in the permanent dentition. 1
This can be explained by the high susceptibility of these teeth to dental caries due to: an early exposure to the oral environment unperceived by the parents, a slow eruption which can last from 5 to 32 months, an anfractuous occlusal surface and an immature and porous enamel.2, 3,4
FPMs can also be severely affected by molar–incisor hypomineralization (MIH) and aggressive periodontitis.5
Applying preventive measures of dental caries in newly erupted first permanent molars would greatly save those teeth and thus help practitioner avoid many dilemmas in the clinical management of gross carious lesions, which may render the teeth not restorable.6
Improvements in restorative techniques and high parental expectations lead to heavily restored teeth.1
FPMs will enter the restorative cycle, in deed, large amalgam and composite restorations generally have limited life and need to be replaced within 5-10 years because of the possibility of secondary caries.6
The second cavity preparation will need to be larger than the first due to the necessity to remove more carious structure, and this undoubtedly weakens the remaining tooth substance and thus threatens the life of the molar’s pulp. Besides, endodontic treatment of molar teeth has a relatively high failure rate which usually increases the later risk of tooth loss.6
In the right circumstances, first permanent molar extraction can be followed by successful eruption of the second permanent molar to provide a suitable replacement, and ultimately third molar eruption to complete the molar dentition, but it’s not guaranteed.7
That’s why the timing and consequences of FPM’s extractions should well studied and based on adequate diagnosis and case analysis.6,8,9
Case report
9.4 years-old-male with hypothyroidism, growth retardation was referred to our clinic because of many caries lesions and dilapidated first permanent molars. He was not schooled and belonged to a low socioeconomic status and had bad oral hygiene.
Three first permanent molars 16, 26, 46 had poor prognosis with repetitive abscess. (Fig.1)
The dental age determined by the hand X-ray was 8 years and didn’t match with the civil age. (Fig.2)
In order to postprone the loss of molars, we decide to try endodontic treatment on 16 and 46. The patient was not cooperative and didn’t show cooperation to the oral hygiene instructions and appointments.
One year later, we decided to extract the four FPM’s. (Fig.3)
The patient may never be expected to consult an orthodontist as he belongs to a low socioeconomic status.
The second permanent molar has not yeterupted (immature tooth: Nolla 6) and wisdom teeth were in correct morphology and well position. (Fig.3)
In these conditions, we hoped for a successful eruption of the second permanent molar to provide a suitable replacement, and ultimately third molar eruption to complete the molar dentition.
After six months and one-year follow-up, the x-ray control showed a completely spontaneous mesialization of the second maxillary permanent molars and space closure contrary to a long-lasting mesialization of the second mandibular permanent molars. (Fig.4, 5,6)
Discussion:
Good SSC can be expected when extracting a FPM prior to eruption of the permanent second molar and in the presence of correct morphology and well-positioned wisdom tooth germ.
It constitutes a natural rehabilitation whose longevity of which is verifiable, without prosthetic artifices or implant.2
In our case-report, the spontaneous mesialization of the second maxillary permanent molars was very satisfactory contrary to the second mandibular molars, which was long lasting and associated to mesial tilting, as mentioned in the literature. The SSC on the mandibular will take more time.
However, before extraction it is necessary to check the following points: restorative state of the FPM’s, dental age of the patient, the presence of crowding and malocclusion, presence and condition of the other teeth, socio-economic level and patient and parents motivation.2
On the maxilla, the spontaneous mesialization of the second molar satisfactorily occurs until the age of 12 years of dental age. After that age, the rotation of the second molar around its palatal root is pronounced. A moderate distal translation of the second premolar occur but not systematic.2, 5, 8
In the mandibule, the consequences are much less satisfactory. Spontaneous mesialization of the second molar is very often associated to a mesial tipping and a disto-buccal rotation. A significant distal translation occurs with an appearance of a diatema.2,8,7
Offman1987 we shall look for a spontaneous mesialization of one or several second molars, in the maxilla.
In the mandibule, the mesialization is rather satisfactory until 9-10 years of dental age although the tooth-buds of the last molars are hardly visible at this age.2,9,10
Conclusion:
Treatment planning for the enforced extraction of first permanent molars can present a complex problem.
In the right circumstances, FPM can be followed by successful eruption of the second permanent molar to provide a suitable replacement, and ultimately third molar eruption to complete the molar dentition.3, 6
Orthodontic closure of the extraction space can be another alternative of treatment.
Acknowledgment:
Authors acknowledge the immense help received from the scholars whose articles are cited and included in references of this manuscript. The authors are
also grateful to authors / editors / publishers of all those articles, journals
and books from where the literature for this article has been reviewed anddiscussed.
Source of Funding: None
Conflict of interest: None
Englishhttp://ijcrr.com/abstract.php?article_id=2526http://ijcrr.com/article_html.php?did=2526
Gill DS1, Lee RT, Tredwin CJ. Treatment planning for the loss of first permanent molars. Dent Update. 2001 Jul-Aug;28(6):304-8.
Bassigny F What to do in case of a dilapidated or already extracted first molar? Justification for orthodontic option. Rev Odont Stomat 2008;37:135-148
King NM, Shaw L, Murray JJ. Caries susceptibility of permanent first and second molars in children aged 5-15 years. Community Dent Oral Epidemiol. 1980 Jun;8(3):151-8.
Penchas J1, Peretz B, Becker A The dilemma of treating severely decayed first permanent molars in children: to restore or to extract. ASDC J Dent Child. 1994 May-Jun;61(3):199-205.
B.Jalevik, M.Moller Evaluation of spontaneous space closure and development of permanent dentition after extraction of hypomineralized permanent first molars International Journal of Pediatric Dentistry 2007; 17: 328- 335
El Sheikh M1, Ali A Planned extraction of first permanent molars during late childhood: A clinical note and mini-review Dent Oral Craniofac Res, 2015 Volume 1(3): 77-80
Cobourne MT, Williams A, Harrison M. National clinical guidelines for the extraction of first permanent molars in children. Br Dent J. 2014 Dec 5;217(11):643-8
Mathu-Muju KR1, Kennedy DB2 Loss of Permanent First Molars in the Mixed Dentition: Circumstances Resulting in Extraction and Requiring Orthodontic Management. Pediatr Dent. 2016 Oct 15;38(5):46-53.
Telli AE, Aytan S. Changes in the dental arche due to obligatory early extraction of first permanent molars Turk Ortodonti Derg. 1989 Apr;2(1):138-43
Innes N, Borrie F, Bearn D, Evans D, Rauchhaus P, McSwiggan S and col. Should I eXtract Every Six dental trial (SIXES): study protocol for a randomized controlled trial. Trials. 2013 Feb 27;14:59.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411018EnglishN2018September28HealthcareCore Biopsy Diagnosis of Infantile Fibrosarcoma: Case report
English1012Sachin B. IngleEnglish Chitra R. Hinge (Ingle)EnglishClinical as well as radiologic diagnosis of infantile fibrosarcoma (IFS) is often a challenging problem due to Similarities with tumors of vascular origin. Consequently, in the majority of cases, histological and immunohistochemical studies are considered gold standards for the final diagnosis. Herein we are reporting an interesting case of infantile fibrosarcoma in a female child with unusual presentation of swelling at first web space on palmar aspect. diagnosis of which was done on histopathology and confirmed on immunohistochemistry.
English Infantile fibrosarcoma, Upper extremity tumors, Vascular tumors, Core biopsy and ImmunohistochemistryIntroduction
IFS are a mesenchymal malignant hypervascular tumor and the most common soft tissue sarcoma in children younger than 1 year of age. The incidence of IFS was
Found to be more common in the male gender. It is less commonly presenting beyond the age of 2 years. This tumor frequently gets misdiagnosed initially as a hemangioma
or an arteriovenous malformation due to its vascularity and presentation. Several literature reports discuss the similarities in differential diagnosis between vascular
Tumors and infantile fibrosarcoma (IFS) [1]. This case report, presented a 2 years old girl with a mass in her hand which was relapsed locally. The tumor location, radiological and histopathological findings proved the diagnosis of fibrosarcoma. In this age, infantile fibrosarcoma is rare and generally misdiagnosed because of histological similarities to benign tumors.
Core tip-Juvenile fibrosarcoma have real diagnostic dilemma on histopathology because of its resemblance with benign vascular neoplasms.So careful evaluation of biopsy and IHC is must to hit the diagnosis
Case Report:-
A 2 year female child came in YCR hospital, Latur with the complaint of swelling over the first web of the right hand since 2 months. She was previously operated for the same and diagnosed as infantile capillary hemangioma on histopathology at other centre. The recurrence of swelling occurred. The core needle biopsy of the swelling was planned and performed and the biopsy sample sent to histopathology department. We suspected it as a sarcoma on morphological grounds.. In view of local recurrence and mitotic activity we decided to send the blocks for immunohistochemical evaluation to rule out sarcoma. At higher centre oncopathologist revealed a cellular spindle cell sarcoma showing nuclear atypia, brisk mitotic activity (approximately 15/10 HPF) and a pericytomatous vascular stroma. A sprinkling of lymphocyte is noted within the tumor. (Fig 1)
Then they went for immunohistochemistry. On immunohistochemical evaluation the tumor cells were immunopositive for CD 34 (Fig2) and SMA (focal) (Fig3) and are immunonegative for desmin and S-100 protein. Finally the case was diagnosed as infantile fibrosarcoma and treated with wide excision with negative margins and on follow up doing well since last one year.
Discussion:- IFS is also known and described in the literature in many synonyms such as congenital fibrosarcoma, juvenile fibrosarcoma, medullary fibromatosis of infancy, aggressive infantile fibromatosis, desmoplastic fibrosarcoma of infancy. It is histologically indistinguishable from the adult fibrosarcoma. The sites most commonly involved are the extremities, followed by the spine, head and neck). IFS incidence is very low and is estimated to be five per million infants. It is a mesenchymal malignant hypervascular tumor and the most common soft tissue sarcoma in children younger than 1 year of age with slight male predominance. Our case was a 2 year female child presented with swelling over the first web space of the right hand.
IFS are typically large tumors that grow very rapidly. These tumors are highly vascularised and may have ulcerations and bleeding, making it clinically difficult to differentiate them from hemangiomas. Our case was also diagnosed as hemangioma at other centre on histopathology. IFS are more commonly seen in boys than girls and typically involve distal extremeties (66 %) and trunk (25 %).
However, for unknown reasons, IFS has a much better prognosis, a lower rate of metastasis, and a high 10-year survival rate (89–90 %) as compared to the adult patients whose 5-year survival does not exceed 50 %. Fibrosarcoma is less common in infants than in adults, where it tends to present in a more central distribution [1].
While considered a non-aggressive form of sarcoma, complete surgical resection is rarely feasible at diagnosis. Nearly half of the patients require chemotherapy to reduce tumor size before surgery, and/or to prevent recurrence after surgery. The role of radiotherapy is debated and is mostly reserved as salvage therapy or to preserve the organ function [3]. Each radiation schedule can be converted to biologically effective doses (BEDs) using the following formula and are compared on the same scale, where n is the number of fractions; d, the dose per fraction; and α/β, the alpha beta ratio for irradiated tissue with the BED for spinal cord being 3 (BED3)9).
BED=nd (1+ d ) α/β[2] Surgery has traditionally been considered the treatment
Of choice for IFS. The radicality of first surgery, aimed at achieving histopathologically negative margins, is associated with best prognosis. If a negative histopathological margin is obtained, long term disease free survival can be achieved even without any adjuvant
Therapy as happened in our case. However the role of adjuvant therapy is controversial in such cases. In patients with IFS involving the limbs, however, the issue of loss of function after surgery assumes importance. In such patients, chemotherapy has the potential of decreasing
the size of tumor, thereby obviating the need of extensive surgery and making function preserving surgery a possibility. This case emphasizes the importance of radical excision with negative margins is an important determinant of long term disease free survival in infantile fibrosarcoma.
Conclusion:- For the better prognosis and early treatment of the tumor, the meticulous diagnosis should be made early. The contribution of pathologist and his suspicion is required for accurate histological diagnosis.
Acknowledgement- We are grateful to our executive president Prof Dr V D Karad and executive director Shri Rameshappa Karad for the invaluable support for our work and also thankful to scientific officer Mrs Shilpa from IJCRR for the technical guidelines
Englishhttp://ijcrr.com/abstract.php?article_id=2527http://ijcrr.com/article_html.php?did=25271) Hayek SN, Janom HH, Ibrahim A, Moran SL, et al; Infantile fibrosarcoma misdiagnosed as a vascular tumor- American association for Hand Surgery 2013. 20 March 2013.
2) Cheng-Hsiang Lo, M.D., Shin-Nan Cheng, M.D., Kuen-Tze Lin, M.D., Yee-Min Jen, M.D., Ph.D., et al; Successful Treatment of Infantile Fibrosarcoma Spinal Metastasis by Chemotherapy and Stereotactic Hypofractionated Radiotherapy-J Korean Neurosurg Soc 54 : 528-531, 2013.
3) Daniela Alexandru, Denise K. Van Horn, Daniela Annenelie Bota, et al; Secondary fibrosarcoma of the brain stem treated with cyclophosphamide and Imatinib- J Neurooncol (2010) 99:123–128.
4) Amirataollah Hiradfar. Tala Pourlak. Davoud Badebarin, et al; Primary Pulmonary Fibrosarcoma With Bone Metastasis: a Successful Treatment With Post-Operation Adjuvant Chemotherapy- Iran J Cancer Preven. 2015 May; 8(3):e2328.
5) Nirali N. Shah, MD, Mitchell R. Price, MD, David M. Loeb, MD, PhD, et al; Cardiac Metastasis and Hypertrophic Osteoarthropathy in Recurrent Infantile Fibrosarcoma-Pediatr Blood Cancer. 2012 July 15; 59(1): 179–181.
Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411018EnglishN2018September28Life SciencesPrevalence of Mycobacterium Tuberculosis and Multidrug Resistance Tuberculosis by Using GeneXpert MTB/ RIF System at a Tertiary Care Center in Maharashtra
English1317Kishor IngoleEnglish Sonika Wathmore (Kamble)English Sapana MundhadaEnglishBackground: Despite of tuberculosis control programme and anti-tuberculosis drugs, tuberculosis (TB) and multidrug-resistant tuberculosis (MDR-TB) is a serious public health issues worldwide. Rapid laboratory detection of M. tuberculosis is needed for the early diagnosis and treatment of TB and MDR TB.Recently GeneXpert MTB/RIF system is a new molecular technique introduce for early detection of M. tuberculosis.
Aim: To find out prevalence of MTB and MDR TB by using GeneXpert MTB/RIF system and also find out associated risk factor with MTB.
Material and Method: Total 250 patients with suspected MDR pulmonary tuberculosis visited to TB & Chest OPD over a period of 2 years were included in study. Sputum sample was taken from each patient and tested by the GeneXpert MTB/RIF assay according to standard protocol.
Result: Among 250 patients, 159 (63.6%) patients were detected as MTB positive. Out of 159 MTB patients 15 (9.43%) were detected with MDR. Maximum number of MTB was detected in patients from lower socioeconomic status. Out of 159 MTB patients, 25.15 % had showed HIV and TB coinfection. Among 15 MDR patients, 7(46.67%) were found to be defaulter,1(6.66%) due to failure & 7 (46.67%) were newly diagnose. out of 159 MTB detected patients 93 (58.49%) were cured,41 (25.79%)were died & 25 (15.72%) were still on treatment.
Conclusion: Newer rapid molecular diagnostic techniques like GeneXpert will help to diagnose tuberculosis & multidrug resistant tuberculosis early so prompt treatment can be initiated for better outcome.
EnglishTuberculosis, GeneXpert MTB/RIF, Multidrug resistanceIntroduction:
Mycobacterium tuberculosis (MTB) remains one of the most significant cause of morbidity worldwide, it affect up to one third of the world population. More than 9.4 million incident cases noted and almost two million people are killed each year by TB.1 Universal access to high-quality, patient-centred treatment is emphasized by WHO's Stop TB Strategy.2 Significant challenges are faced for disease control due to the emergence and spread of drug resistant Mycobacterium tuberculosis complex (MTBC) strains (multidrug resistance and extensively drug resistant).3 India is the country that bears highest burden of TB. Out of a global incidence of 9 million, World Health Organisation statistics for 2013 gives an estimated incidence figure of 2.1 million cases of TB for India. The proportion of multidrug-resistant tuberculosis (MDR TB) cases among all cases is 4.9% while in new cases and previously treated cases it is 2.9% and 15.5% respectively.4
Failure to recognize and effectively treat patients with MDR tuberculosis (Resistance to isoniazid and rifampicin, which are the 2 most effective first-line drugs for TB) and XDR TB (Resistant to isoniazid, rifampicin, any fluoroquinolone, and at least one of 3 injectable second-line drugs i.e. amikacin, kanamycin, or capreomycin) leads to increased morbidity, mortality, nosocomial outbreaks and resistance to additional antituberculosis drugs.5 However, proper identification of MDR and XDR tuberculosis can lead to an effective treatment. The gold standard technique considered for diagnosing TB is culture, but it may take 2 to 8 weeks. Another method for diagnosis is sputum smear microscopy for acid-fastbacilli (AFB) which is rapid and inexpensive, but has poor sensitivity.6, 7 In our country TB diagnosis rely on acid-fast staining and the conventional Lowenstein Jensen culture method in conjunction with assessment of patients clinical symptoms and radiographic evidence to diagnose TB.8
Rapid detection of Mycobacterium tuberculosis (MTB) is essential for diagnosis and treatment of tuberculosis because of the high risk of transmission from one person to another as well as high rate of morbidity and mortality. Presently the major problem in management of Tuberculosis is a lack of accurate and rapid diagnostic test for detection of Mycobacterium tuberculosis. In last decade Several molecular methods like line probe assays and real-time polymerase chain reaction (PCR) has been developed for rapid detection of Mycobacterium tuberculosis and drug resistance in clinical samples.7 These methods were helpful for early diagnosis and treatment of tuberculosis which in turn improving patients’ outcomes and allow taking effective public health measures.
GeneXpert mycobacterium tuberculosis (MTB)/rifampicin (RIF) is a new cartridge based, automated and rapid molecular diagnostic device that performs sample processing and hemi-nested real-time PCR analysis in a single, hands-free step for identifying Mycobacterium tuberculosis and rapid detection of rifampicin(RIF) resistance in sputum samples.8 The present study aimed to find out prevalence of MTB and MDR TB by using GeneXpert MTB/RIF system(CB NATT) at tertiary care center, Maharashtra and also find out associated risk factor with it.
Material and method
This cross-sectional study was done at a tertiary care center after Institutional Ethics Committee approval over a period of two year from January 2014 to December 2015. Total 250 patients with suspected MDR pulmonary tuberculosis visited to TB & Chest OPD were included. At least two sputum specimens taken from each patient for bacteriological examination.
Exclusion criteria: 1.Patients with extra pulmonary tuberculosis.
2. Non complaint patients.
GeneXpert MTB/RIF assay.10, 11
Sputum sample was taken from patient and tested by the GeneXpert MTB/RIF assay. Using a sterile pipette, briefly 2.0 ml of GeneXpert MTB/RIF sample reagent was added to 1.0mlof sputum specimen. The closed specimen container was agitated twice manually during 15min at room temperature and then 2ml of the inactivated material was transferred to the test cartridge. GeneXpert MTB/RIF (CBNAAT) is a rapid cartridge based nucleic acid amplification technique based on principle of Real time PCR gives result within 2 hours with sensitivity and specificity of 90.6% & 94.3% respectively. It is highly effective for diagnosis of tuberculosis and rifampin-resistant strains even in smear-negative sample.
Statistical analysis:
Data was entered in MS-Excel, corrected for typographic errors. For qualitative data (binomial and orderly data) chi-square test used and analyzed by using SPSS V. 16 software and quantitative data expressed in proportion or percent using MS Excel (MS office 10). Graphical presentation of the result was done using MS-Excel. The p- value of < 0.05 was considered significant.
Result:
Among 250 patients, 159 (63.6%) patients were detected as MTB positive while in 62 (24.8%) MTB was not detected, 19 (7.6%) were error& 10 (4%) were invalid. (Chart no 1) Among 159 MTB patients 15 (9.43%) were MDR detected. Among MTB detected patient mean age was 36.47 years and M: F ratio was 2.7:1(117 were male & 42 were female).
Maximum number of MTB was detected in patients from lower socioeconomic status which was statistically significant.(P value =0.001) (Table no 2)when different risk factor associated with MTB were studied, we observed that among MTB patients,45 (28.30%) were smoker &114 (71.69%) were nonsmoker(P value=0.026) as well as 49 (30.81%) were alcoholic &110 (69.18%) were nonalcoholic.(P value= 0.08) when checked for MTB and HIV co-existence we found that out of 159 MTB detected patients, 40 (25.15%)were HIV positive &119 (74.84%) were negative. (P value =0.03) (Chart no 2) Out of 159 MTB detected patients, 18 (11.32 %) having family history of contact with MTB positive patient. In present study we checked for association of different illness in MTB positive (159) patients, it was found that 4 (2.51%) were diabetic&155 (97.48%) were nondiabetic (P value= 0.39) and 5 (3.14%) were suffering from renal diseases &154 (96.85%) were not.(P value= 0.06).
Among 221 patients in our study we found that 23 (10.40%) were defaulter, 11 (4.49%) were due to treatment failure &1 (0.45%) was due to relapse & 178 (80.54 %) were newly diagnose cases. Out of 15 MDR patients, 7(46.67%) were found to be defaulter, 1(6.66%) due to failure & 7 (46.67%) were newly diagnose which was found to be statistically significant (P value=0.003). In present study, out of 159 MTB detected patients 93 (58.49%) were cured, 41 (25.79%) died& 25 (15.72%) were still on treatment. While among MDR patients, 1 (6.67%) patient was cured, 6 (40%) died &8 (53.33%) were still on treatment.
Discussion:
In present study we examined total 250 patients satisfying the criteria for WHO recommending TB testing on Gene Xpert MTB/RIF system.12) Due to error & invalid results we excluded 29 samples and total 221 patients were studied further in final analysis. In our study we found the prevalence of MTB was 63.6% by using GeneXpert MTB/RIF system, similar observation noted in other study by Kumar M et al.13 Early detection of drug resistance in tuberculosis is essential to reduce morbidity and mortality associated with it. In present study we observed that prevalence of MDRTB was 9.43 %. Other studies by Chakroborty et al14 and Khalil et al15 observed similar result in their studies.
Among MTB detected patient mean age was 36.47 years and M: F ratio was 2.7:1(117 were male & 42 were female). Various reasons has been suggested to explain the gender imbalance in MTB patients. Social behavior among men, difference between male and female susceptibility to TB and less access to health care for women in many developing countries, and therefore unreported TB cases.16,17 Various studies showed that patients age, gender and race have no correlation with occurrence of drug-resistant tuberculosis.18,19 similar results were observed in our study.
Early detection of drug resistant & assessment of various factors that may increase the likelihood of drug resistant in tuberculosis is important. For that reason we had studied the patient’s sociodemographic profile, lifestyle, habitat &their illnesses in present study. Studies by Lonnroth et al 20& Muniyandi M et al21 had observed that people with lower socioeconomic status having more risk for development of tuberculosis. Similar finding were observed in our study also which was statistically significant. (PEnglishhttp://ijcrr.com/abstract.php?article_id=2528http://ijcrr.com/article_html.php?did=2528
World Health Organization. Global Tuberculosis Report 2015, Geneva: WHO, WHO/HTM/TB/2015.22
The global plan to stop TB, 2006-2015. Geneva, World Health Organization, (WHO/HTM/STB/2006.35) (2006).
WHO. 2010. Multidrug and extensively drug-resistant TB (M/XDR-TB): 2010 global report on surveillance and response. WHO/HTM/TB/2010.3. World Health Organization, Geneva, Switzerland.
Tuberculosis Service. 2009. Tuberculosis report in Turkey. Ministry of Health, Ankara, Turkey.
Extensively Drug-Resistant Tuberculosis (XDR TB). Centers for Disease Control and Prevention
Farmer, P., J. Bayona, M. Becerra, J. Furin, C. Henry, H. Hiatt, J. Y. Kim, C. Mitnick, E. Nardell, and S. Shin. 1998. The dilemma of MDR-TB in the global era. Int. J. Tuberc. Lung Dis. 2:869-876.
Zeka AN, Tasbakan S and Cavusoglu C. Evaluation of the GeneXpert MTB/RI Fassay for rapid diagnosis of tuberculosis and detection of rifampin resistance in pulmonary and extrapulmonary specimens. J Clin Microbiol 2011; 49: 4138–4141.
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Radiance Research AcademyInternational Journal of Current Research and Review2231-21960975-52411018EnglishN2018September28HealthcareCataract Burden in a Peri-Urban Local Government in a Low Income Country: The Need for Government Intervention
English1824Onabolu OluwatoniEnglish Fakolujo VictoriaEnglish Ajibode HarounEnglish Bodunde OlubunmiEnglish Otulana OlusolaEnglishObjective: To determine the prevalence of cataract in Sagamu Local Government Area (SLGA), in Ogun State of Nigeria and suggest strategies for government intervention.
Methods: The study was conducted among adult population who were 30 years and above and regular residents of SLGA, Ogun state, Nigeria. After ocular examination of the respondents their pupils were fully dilated with tropicamide 1% and crystalline lens focused with the plus +9diopters on the direct ophthalmoscope. Lens opacity was graded into no opacity, few dot opacities, observed opacity less than clear area, observed opacity more than clear area, opacity obscuring total field, aphakia or displaced lens, pseudophakia, and unable to assess due to corneal opacities. Lens opacities more than clear area and total lens opacities were designated as “cataracts”.
Results: Six hundred and eight participants were included in this study consisting of 369 females (60.7%) and 239 males (39.3%) with M:F of 1:1.6 Age range was 30-80 years. Prevalence of “cataracts” affecting vision in the right eye was 9.04%. Twenty participants (3.28%) had uniocular blindness (visionEnglishCataract prevalence, Cataract surgical uptake, Government interventionIntroduction
Cataract is the most common cause of blindness worldwide with its high prevalence responsible for unfavourable social burdens as well as functional disabilities.[1] Age related cataract is the most common type and elderly people in rural areas of the world are most affected.[1] The vision loss expert group in 2015 estimated that about 36 million people are blind in the world and that cataract remains the leading cause of blindness contributing to 26% of visual impairment out of which 12.6 % are blind.[2] Cataract blindness is more prevalent in poorer regions of the world especially in low and middle income countries.[3] The Nigerian National Survey of blindness found that about 43% of blindness is due to cataracts.[4]
World Health Organization (WHO) and International Agency for the Prevention of Blindness (IAPB) launched VISION 2020 in 1999 to reduce causes of avoidable blindness world- wide. Cataract was one of the diseases targeted.[5] The only treatment for cataract is surgery. Modern surgery of cataract is visually rewarding, cost effective and has been found to improve the quality of lives of individuals.[6] Researchers have found that there are barriers in accessing cataract surgery especially in low income countries in Africa.[3] Cost of cataract surgery is an important barrier because often times people pay out of pocket and the elderly cannot afford high cost of surgery.[7] Lack of awareness of surgical intervention, fear of surgery, distance to the hospital and having an escort are notable barriers. [8,9] There is also gender preference for males to be treated first and socio cultural practices delaying access to surgery in females.[10] .Poor outcome of surgery is a barrier that is often not considered especially when offering free surgery.[11,12] In order to reduce the barrier of cost in cataract surgery some countries have implemented free surgery especially to the poor.[13]
. Although South West of Nigeria had the lowest prevalence of blindness of 2.8%, cataract is still the most common cause of blindness.[14] The cataract surgical rate in Nigeria is low at 300 per million. [5] More than 10 years after the Nigerian National survey of blindness there is a need to determine the magnitude of cataract blindness in Nigeria especially in rural areas. Sagamu Local government area is largely peri-urban having a tertiary health center with comprehensive eye care service in Sagamu town. Research has shown that it is possible to find a high prevalence of cataracts even where surgical services are readily available.[16] The aim of this study is to determine the prevalence of vision disabling cataract in Sagamu Local Government Area and suggest strategies for government intervention to reduce cataract blindness.
Materials and Methods
Sagamu Local Government Area(SLGA) is one of the 20 Local Government areas in Ogun state of Nigeria. Ogun state is in the South West of the country..[17] The people are mainly Yorubas and the occupation of the rural areas is subsistence farming. The urban underserved is populated by factory workers and petty traders who are indigenes and migrant workers from other states.
The population is about 255,885 comprising 126,855 males (49.6%) and 129,030 females (50.4%).[19] Population estimates for those 30 years and older was 74,974. There is one teaching hospital where four ophthalmologists, six residents and seven ophthalmic nurses render comprehensive eye care services. There are ophthalmologists in private settings who operate on cataracts but they do not render comprehensive services. Local government clinics (28) do not have eye care workers nor render eye care services.
Study design: This was a population based; descriptive, cross-sectional study conducted using a multi-stage stratified, cluster random sampling technique with probability proportional to size. It was part of a study on “Presbyopia: Prevalence and impact on quality of life in adults of SLGA of Ogun State”.[17]It took place between 17th of September and 25th of November 2012. The setting was among adult population 30 years and above who were regular residents of the SLGA. The minimum sample size was calculated using the Leslie-Kish formula.[18] The minimum sample size was 441, but was adjusted to 662 by 1.5 for design effects. Each cluster had 50 participants. The sampling unit was the household which was taken to consist of all individuals who live under the same roof.
Each eligible individual was given an identification slip to bring to the examination centre where interviews were conducted. The socio-demographic details of the respondents were obtained in addition to visual acuity, ocular examination with a pen torch, refraction and fundoscopy. .[17] After the preliminary tests, participants were seated in a darkened area of the room where the pupils were dilated with1% Tropicamide. The crystalline lens was examined with a brightly lit direct ophthalmoscope held with its dial on +9 diopters at about 20cm from the eye. This was conducted by two independent ophthalmologists (OO and VO). There was good Inter rater agreement of ≥0.6
The lens opacity was classified thus: (1) Normal-no lens opacities, (2) few dot opacities, (3) observed opacity less than clear area, (4) observed opacity more than clear area, (5) opacity obscuring total field, (6) Aphakia or displaced lens, (7) Pseudophakia, (8) Unable to assess due to corneal opacities.[19] Lens opacities more than clear area and total lens opacities were designated as “cataracts”. Operable cataracts in this study were those whose vision were ≤ 6/60, had total lens opacities and lens opacities more than clear areas with best corrected vision and no other pathology.
The results were grossly similar in both eyes therefore the Right eye was used for analysis. The only government hospital where cataract surgery was done was assessed for regular provision of cataract surgical services.
Ethical approval for this study was obtained from the ethical committee of OlabisiOnabanjo University Teaching Hospital Sagamu. Permission to carry out the study was obtained from the health department of Sagamu Local Council. Oral /written consent was obtained from each participant prior to interview and examination.
The data was entered into a computer spreadsheet of Statistical package for Social Sciences IBM Version 20 and comparison analysis done. Discrete variables were compared using chi square and odds ratio with a significant difference determined at p value < 0.05. Continuous variables were compared using arithmetic proportions.
Results: Out of the 662 participants enumerated, six hundred and eight completed the interview and examination giving a response rate of 91.7% There were 369 females (60.7%) and 239 males with M:Fof 1:1.6 Age range was 30-86 years with a mean of 49.74 ±Standard Deviation 11.0 years Fig 1.
Two hundred and seventeen participants had lens opacities in the Right eye (35.69%). Fifty five (9.04%) had “cataracts “ ( visually disabling lens opacities). Tables 1 and 2 showed an overview of all participants with lens opacities in both eyes. This implied that while some might require surgery as soon as possible others will require surgery later. The result of the Right eye was similar to the Left therefore the Right eye was used for analysis.
Five hundred and forty two participants out of 608 (89.14%) had no visual impairment i.e. vision ≥6/18 in their Right eyes. Sixty six (10.85%) had visual impairment (vision≤ 6/18) Table 3. Best corrected visual acuity showed that 10 participants were blind (visual acuityEnglishhttp://ijcrr.com/abstract.php?article_id=2529http://ijcrr.com/article_html.php?did=25291. Kolawole O, Mahmoud A, Adeoti C, Ashaye A. Cataract blindness in Osun state, Nigeria: Results of a survey. Middle East Afr J Ophthalmol. 2012;19(4):364-71
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3. Aboobaker S, Courtright P. Barriers to cataract surgery in Africa: A systematic review. Middle East African Journal of Ophthalmology. 2016;23(1):145-149
4. Rabiu MM, Kyari F, Ezelum C, Elhassan E, Sanda S, Gudlavalleti V. S, Sivasubramaniam MS et al. Review of the publications of the Nigeria national blindness survey: Methodology, prevalence, causes of blindness and visual impairment and outcome of cataract surgery. Ann Afr Med. 2012;11(3):125–30.
5. WHO | Blindness: Vision 2020 - The Global Initiative for the Elimination of Avoidable Blindness. WHO [Internet]. World Health Organization; 2010 [cited 2018 May 31]; Available from: http://www.who.int/mediacentre/factsheets/fs213/en/
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10. Geneau R, Lewallen S, Bronsard A, Paul I, Courtright P. The social and family dynamics behind the uptake of cataract surgery: Findings from Kilimanjaro region, Tanzania. Br J Ophthalmol. 2005;89(11):1399–402.
11. Mitsuhiro MH, Berezovsky A, Belfort R, Ellwein LB, Salomao SR. Uptake, Barriers and Outcomes in the Follow-up of Patients Referred for Free-of-Cost Cataract Surgery in the Sao Paulo Eye Study. Ophthalmic Epidemiol. 2015;22(4):253–9.
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