|Year : 2019 | Volume
| Issue : 2 | Page : 108-112
Abstracts of the Paper Presented during Dr.Sushila Nayar Award Session for Undergraduate Research 2019
|Date of Web Publication||17-Sep-2019|
Source of Support: None, Conflict of Interest: None
|How to cite this article:|
. Abstracts of the Paper Presented during Dr.Sushila Nayar Award Session for Undergraduate Research 2019. J Mahatma Gandhi Inst Med Sci 2019;24:108-12
|How to cite this URL:|
. Abstracts of the Paper Presented during Dr.Sushila Nayar Award Session for Undergraduate Research 2019. J Mahatma Gandhi Inst Med Sci [serial online] 2019 [cited 2020 Apr 1];24:108-12. Available from: http://www.jmgims.co.in/text.asp?2019/24/2/108/267012
| Influence of Body Shape Index on Heart Rate Variability in Athletes|| |
S. Sharma, P. Bokariya1, R. Kothari2
III MBBS Student, MGIMS, Sevagram, Wardha, Departments of1Anatomy and2Physiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India.
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Context: Heart rate variability (HRV) is becoming one of the most useful tools for assessing the complex and constantly changing variations in the oscillations of a healthy heart. This property of interdependent regulatory systems enables us to combat any sudden physical challenge to homeostasis just like a situation which arises when a person undertakes exercise. This study was a pioneering attempt to correlate HRV with body shape index (BSI) during treadmill exercise in the athletic population. Aim: To study the influence of BSI on HRV in athletes. Objective: To study the influence of BSI with HRV indices in the athletic population. Settings and Design: It was a cross-sectional study carried out on 30 athletes and 120 age- and sex-matched controls. The study was conducted in the Department of Anatomy in collaboration with the Department of Physiology of Mahatma Gandhi Institute of Medical Sciences, Sevagram. The anthropometric data were measured using following instruments – stadiometer, digital weighing machine, and nonstretchable measuring tape. The anthropometric data in cases and controls were collected: age, height, weight, and waist circumference (WC). Body mass index (BMI) was calculated according to the formula: BMI = weight in kilogram/(height in meters)2. BSI was calculated according to the formula: BSI = WC/(BMI) 2/3 × (Height) ½. Electrocardiographic (ECG) recordings were recorded using PowerLab System 8/35, ADInstruments, Australia, and analysis was done by LabChart software. Short-term HRV (5 min) was extracted from ECG recordings obtained using PowerLab System, ADInstruments, and was analyzed by LabChart software in accordance to the standards set forth by the Task Force of the European Society of Cardiology and North American Society of Pacing and Electrophysiology. Results: Of 30 athletes, there were 17 male and 13 female subjects. Of 120 controls, 50 were male and 70 were female. It was observed that BSI in the athletic males was 48.91 ± 8.44 which was more than that of athletic females which was found to be 44.73 ± 8.82. An opposite trend was observed in the nonathletic population where males had a BSI of 40.85 ± 16.92 which was less than that of females which was 43.23 ± 10.12. The LF/HF ratio (sympathovagal ratio) in the athletic males and females was 1.30 ± 1.05 and 0.55 ± 0.26, respectively. LF/HF ratio in the nonathletic males was 0.87 ± 1.26 and 0.71 ± 1.10, respectively. Conclusion: In this study, by correlating HRV and BSI during exercise on two different instruments (treadmill and ergometer), an attempt has been made to evaluate and predict possible autonomic activity under stress. A statistically significant positive correlation between BSI and HRV was obtained in the athletic population. In a nutshell, the influence of BSI with HRV indices in the athletic population and the extent of contribution of autonomic nervous system in obesity was evaluated. Baseline values for HRV spectral- and time-domain analysis in athletes and nonathletes have also been established for its clinical use in comparing HRV of a healthy individual to that of a diseased individual or an athlete.
Keywords: Athlete, BSI, HRV
| In vitro Antibacterial Activity of Extract of Rose and Hibiscus rosa-sinensis against Escherichia coli Isolated from Clinical Samples|| |
Prachi Kamble, Deepashri Maraskolhe1, Leena Chimurkar2, Vijayshri Deotale1
III MBBS Student, MGIMS, Sevagram, Wardha, Departments of1Microbiology and2Pharmacology, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India.
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Introduction: Phytotherapy is considered to be less toxic and minimal or no side effects in comparison to modern allopathic medicines. As antimicrobial resistance has been increasing, interest has been developed in herbal medicine. Therefore, the study was planned to look for antibacterial activity of alcoholic extract of leaves and petals of rose and Hibiscus rosa-sinensis against Escherichia coli isolates as they possess components such as flavonoids, tannins, alkaloids, and triterpenoids, which are known to have antibacterial activity against methicillin-resistant Staphylococcus, Candida species, E. coli, Pseudomonas aeruginosa, and Salmonella species. With an aim to study the antibacterial activity, rose and H. rosa-sinensis petals and leaves alcoholic extract against E. coli. Objectives: (1) To study the antibacterial activity of rose and H. rosa-sinensis both petals and leaves. (2) To compare the antibacterial activity of all extracts. Materials and Methods: This is a hospital-based, prospective study done during April–September 2018 (6 months). Ethical clearance has been taken from the ethical committee. Of 51, 35 (68.63%) E. coli isolates found to be resistant to antibiotics were again tested for antibacterial activity of the alcoholic extract of both rose and H. rosa-sinensis. The fresh rose and Hibiscus flowers and leaves were collected. Power was prepared after washing and then dried in hot air oven at 50°C and it was stored in dry place. Solvent extraction was done by Soxhlet apparatus using ethanol was prepared as per Kumar et al. Then, the resistant isolates were tested for antibacterial activity of extract with the resistant antibiotic by disc diffusion method and antibiotic without extract as a control on the same plate. Results: Of 51 E. coli isolated from urine, sputum, wound swab, and blood, 35 (68.63%) were resistant. 85.72% resistant isolates were from urine. 68.57% were female and 31.43% were male. 48.57% belonged to 21–40 years of age group. 80% were resistant to ampicillin, 74.28% to ofloxacin, 68.57% to cefotaxime, 60% to cotrimoxazole and cefuroxime, 57.14% to ceftazidime, 48.57% to cefazolin, 40% to levofloxacin, 37.14% to piperacillin, 31.43% to meropenem, 28.57% to gentamicin, and 11.43% to amikacin. We found that the action of rose petal extract was found to be better than those of rose leaves extract. We found that antibiotics such as ampicillin (10.71%), cefotaxime (29.17%), cotrimoxazole (23.81%), and piperacillin (30.77%) showed more enhancement in the zone size after addition of rose petal extract. Levofloxacin showed enhancement of zone with rose leaves extract only. Both with rose leaves and petals extract, no effect was seen with amikacin. Among H. rosa-sinensis leaves and petals effect of leaves than the petals. With Hibiscus leaves, antibiotics such as cotrimoxazole (19.05%), ceftazidime (25%), cefazoline (17.65%), piperacillin (23.08%), gentamicin (50%), and cefotaxime with clavulanic acid (66.66%) showed better enhancement than petals. Hibiscus petal showed more enhancement with ampicillin (7.14%), ofloxacillin (19.23%), cefuroxime (19.05%), and meropenem (63.63%). Both have equal effect with cefotaxime (20.83%), amikacin (25%), and ceftazidime with clavulanic acid (50%). We found that some antibiotic antibacterial action was enhanced only with some extract. Like levofloxacin only with rose leaves. Amikacin showed only with H. rosa-sinensis (petal and leaves) not with rose extract. Conclusion: In our study, we found that rose extract has more antibacterial action than Hibiscus. Rose petals showed better antibacterial activity than leaves, while Hibiscus leaves have shown better effect than petals.
Keywords: EscherIchia coli, Hibiscus rosa-sinensis, Rose
| In Vitro Detection of Virulence Factors of Candida albicans and Non-albicans Candida Species Isolated from the Samples in Intensive Care Unit Patients|| |
Sakshi Chandak, Ruchita Attal1, Vijayshri Deotale1
III MBBS Student, MGIMS, Sevagram, Wardha, Departments of and1Microbiology, MGIMS, Wardha, Maharashtra, India.
E-mail: firstname.lastname@example.org, email@example.com, firstname.lastname@example.org
Aim: To isolate and identify Candida albicans and non-albicans Candida from various clinical specimens of intensive care unit and to investigate some virulence factors and to perform their antifungal susceptibility. Materials and Methods: Overall, 32 isolates (12 C. albicans and 20 non-albicans Candida spp.) were included in this study. Virulence factors were studied. In isolates, egg yolk agar was used for determining phospholipase activity, while sheep and human plasma was used to determine coagulase activity, Sabouraud dextrose agar with sheep blood for hemolysin activity. Biofilm formation was detected by the tube adherence method. Results: In both Candida spp., it was found that hemolytic activity was higher next to phospholipases activity. It was also found that coagulase activity was detected in Candida species found to be higher with sheep plasma compared to human plasma. Biofilm production was found to be less and mostly was from blood culture isolates. Conclusion: Knowledge of these virulence factors is an important tool to understand the pathogenesis of candidiasis and in addition will help explore new antifungal drug targets for improved therapeutic regimens.
Keywords: Candida spp., non-albicans Candida spp., virulence factors
| Study of Visual Evoked Potentials in Schoolchildren: A Potential Aid to Pediatric Ophthalmology|| |
S. Srivastava, R. Kothari1
III MBBS Student, MGIMS, Sevagram, Wardha,1Department of Physiology, Mahatma Gandhi Institute of Medical Sciences, Wardha, Maharashtra, India.
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Context: Visual evoked potential (VEP) is a test of the visual pathway between the eyes and the vision centers of the brain. It shows if the brain is correctly receiving information about what eyes see. It can give us clues about the working of the visual pathway from the eye along the optic nerve to the brain. It is a highly objective tool in detecting abnormalities of visual system. The VEP test that we perform is a simple, noninvasive, quick, painless technique which is clinically proven. It is highly accurate and is particularly appropriate for young children who cannot communicate visual symptoms or cooperate for standard vision assessment. Aim: To demonstrate that the VEP can be used as an objective measure of visual function in schoolchildren. Settings and Design: The study was conducted in the Neurophysiology Unit of Department of Physiology, MGIMS, Sevagram. It was a short-term, observational study. Materials and Methods: The stimulus configuration for VEP recording was transient pattern reversal method in which a black-and-white checkerboard was generated (full field) on a VEP Monitor by an Evoked Potential Recorder (RMS EMG EP MARK II). P100 latency, P100 amplitude, P100 duration, N70 latency, and N155 latency were the study parameters. Statistical Analysis Used: Chi-square test and Student's t-test for statistical significance were used to analyze the data using appropriate statistical software. Results: Of 60 subjects, 12 subjects were from Class III, 11 from Class IV, 10 from Class V, 11 from Class VI, 8 from Class VII, and 8 from Class IX. The intereye differences of all the parameters among the subjects were within normal limits and statistically nonsignificant. It was found that P100 latency was markedly prolonged in 8 of 24 eyes (33.33%) in Class III group, 8 of 22 eyes (36.36%) in Class IV group, 6 of 20 eyes (30%) in Class V group, 3 of 22 eyes (13.63%) in Class VI group, 8 of 16 eyes (50%) in Class VII group as well as in Class VIII group. Similarly, P100 amplitude was found to be markedly reduced in 2 of 20 eyes (10%) in Class V group, 2 of 16 eyes (12.5%) in Class VII group and in Class VIII group making a total abnormality in P100 amplitude in 5% eyes out of all eyes investigated. Conclusions: VEPs proved to be particularly useful in not only providing the current visual status of the children in whom normal latencies and amplitudes were obtained but also providing complementary information in some children who had abnormal VEP responses. It will probably play an increasingly important role in the future, primarily due to the difficulty in assessing visual system function in young or ill children.
Keywords: Schoolchildren, visual evoked potential
| Understanding the Health Needs of Elderly Population in Rural Wardha, Central India: A Qualitative Study|| |
Akanksha Nath, Shabbir Gheewala, Sourav Goswami1
First MBBS Student,1Department of Community Medicine, MGIMS, Wardha, Maharashtra, India.
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The Indian elderly population is rising slowly but significantly. The healthcare initiatives have failed to benefit them desirably. We planned this study to understand the health needs of the elderly residing in rural India, for it is high time to work for the holistic improvement of quality of their life via intersectorial coordination in the part of government and family support. Introduction: According to the Population Census 2011, there are nearly 104 million elderly persons (aged 60 years or above) in India which is expected to grow to 173 million by 2026. The geriatric population constitutes 8.6% of the Indian population as compared to 13% of the world population. Older adults, those aged 60 or above, are at risk of developing mental, neurological disorders, substance use problems, diabetes, hearing loss, and osteoarthritis. They may experience reduced mobility, chronic pain, frailty, or other health problems. In addition, they are more likely to experience events such as bereavement or a drop in socioeconomic status with retirement. This can result in isolation, loneliness, or psychological distress, which requires long-term care. They are also vulnerable to elder abuse including physical, verbal, psychological, financial; abandonment; neglect which can cause depression and anxiety. Promoting healthy aging, and building systems to meet the needs of older adults, will be sound investments in a future where older people have the freedom to be and do what they value. Objectives: (1) Understanding the health issues of elderly. (2) Role of social and financial determinants of health of elderly. (3) To propose measures to empower them. Methodology: Study Design: It was a qualitative study including in-depth interviews, key-informant interviews, and focused group discussion. Study Setting: The study was conducted in villages of rural Wardha district of Maharashtra, India. (1) In-depth interviews of 30 elderly (>60 years) people were conducted including 15 males and females each. (2) Four key informant interviews of two doctors, a social worker, and a community health volunteer. (3) A focused group discussion with 16 elderly people was conducted. (4) All the interviews were audio-recorded that were later analyzed manually. Results: On content analysis, three major needs emerged: physical, social, and financial. Positive and negative deviant practices were recorded under each. The health problems can be divided into subtopics as physical, mental, and health facilities' problems. The physical problems include joint pain, eye ailments, and hypertension. Mental problems include depression, lonely life, and verbal abuse. Facilities such as primary health centers and subcenters are far away and not easily accessible. Money is a burden. They often work as daily wage laborers, but irregular nature of work possesses a great problem. Savings and knowledge about government schemes are also absent. Physical, financial, and emotional support is important for a patient. There are few children who provide their old parents with financial support, but most of them are driven only by societal pressure which leads to lack of emotional concern, leading the elderly into depression. The transport facilities are poor and unaffordable. The government schemes targeting the elderly are very few and not properly implemented. Conclusion: In case of the elderly people living in the rural areas, the problem of aging is further aggravated by the lack of financial support and emotional concern due to negligence from family and community and ineffective implementation of the government schemes. Recommendations: For the betterment of the current situation, medicines, transport facilities, and health volunteers should be provided. Better implemented schemes and policies are required. Certain clubs could be opened for better mental health.
Keywords: Elderly PoPulAtion, heAlth needs, rurAl wardha
| Effect of Short Message Service-Based Daily Messages on Child–Parent Interaction: A Quasi-Experimental Study|| |
Cheryl Mankar, Subodh S. Gupta1
Fourth MBBS Student,1Department of Community Medicine, MGIMS, Wardha, Maharashtra, India.
E-mail: firstname.lastname@example.org, email@example.com
Context: Considering the evidence available regarding benefits of age-appropriate stimulation for children during early childhood (ECD), there is a need for developing powerful strategies for parents' empowerment. The new technology including short message service (SMS) holds huge promises for the same. Aim: To assess the feasibility and effectiveness of daily SMS delivered in local language to parents with a child below 3 years of age for improving child–parent interactions and bonding. Methodology: A total of 125 parents of children aged between 0 and 3 years visiting the outpatient department using mobile phones, satisfying inclusion–exclusion criteria, and who have given written informed consent were enrolled in the study, and baseline questionnaire regarding child–parent interaction was administered. As a part of intervention, the parents were briefed regarding the importance of age-appropriate stimulus for child development and messages were sent to them daily for 90 days describing the activity they had to perform with their child. All children were grouped into three age groups – (a) 0–1 year of age, (b) 1–2 years of age, (c) 2–3 years of age. Phone calls were made twice in 3 months to discuss if parents were acting on SMS sent to them and one at the end of 3 months to assess child–parent interaction postintervention. The questions were taken from a questionnaire developed for this purpose in a WHO/INTERVIDA collaborative project for ECD development. Child–caregiver interaction score was developed to compare child–caregiver interaction pre- and post-intervention. The study was initiated after taking approval from the institutional ethics committee. Data were entered in Open Epi. Data analysis was done in MS Excel and R version 3.4.3. Results: Around 50% parents reported that they read and acted on at least more than 75% of SMS received. The mean child–caregiver interaction score increased from 20.2 ± 4.1 to 24.5 ± 2; paired t-test was highly significant (P < 0.0000001). Statistically significant increase in scores was observed in each subgroup that was analyzed based on age group of children, socioeconomic status, mothers' education, and mothers' employment status. Invariably, the higher gains in child–caregiver interaction were for the subgroups with lower scores at preintervention. More than three-fifth of the parents expressed that the daily SMS helped the family members improve interaction and bonding with the child. Conclusion: Daily SMS helped the most disadvantaged groups the most proving that ECD is one of the most “Powerful Equalizer.”
Keywords: Early childhood development, child–caregiver interaction, short message service
| Audit for Endocrine Assay in a Rural Tertiary Care Center: Clinical Chemistry Laboratory Perspective|| |
Shreya Namjoshi, Mimansa Dixit, Ajay Kedar, Kanchan Mohod, Kalyan Goswami1, Satish Kumar
III MBBS Student, MGIMS, Sevagram, Wardha,1Department of Biochemistry, AIIMS, Raipur, Chhattisgarh, India.
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Context: Endocrine disosrders account for a significant amount of the global burden of disease. There has, however, been no compilation of data regarding the epidemiology of endocrine and metabolic disorders to serve as a unified source of information about these conditions. Hospital-based data provide substantial insight into the patterns of disease at community level which would be invaluable in the rational setting of priorities in view of the limited resources allocated for management of these disorders if analyzed retrospectively. Aim: Our objective was to bridge the gaps in the literature about the epidemiology of specific endocrine disorders, to aid in early diagnosis and identify priority areas for resource allocation. Study Design and Methodology: It was a cross-sectional study conducted in the Department of Biochemistry, MGIMS, Sevagram. Secondary data analysis of electronic medical records spanning over the years 2016 and 2017 was done. The patients were separated according to outpatient/inpatient department (OPD/IPD), age, sex, the wards from which the test was raised, and the specific hormones assayed. Results: A total of 1739 patients, 702 in 2016 and 1037 in 2017, were included in which substantially more investigations were ordered for females in OPD, whereas in IPD, more tests were ordered for male patients. The distribution of thyroid-related investigations showed a similar trend. The odds ratio indicated that males were 0.64 times more likely to have a thyroid disorder than females. Other than thyroid hormones, Vitamin D assay was the investigation ordered most across both OPD/IPD and both years. This was followed by cortisol, prolactin, parathormone, and FSH, and only one investigation each for insulin and testosterone over 2 years. Other hormones included were not assayed at all. The highest number of thyroid hormone investigations among both sexes as ordered from medicine wards followed by cortisol and Vitamin D assay for males and Vitamin D assay among females. Although the number of insured patients was found to be more than noninsured, the endocrine assays were not covered under their insurance, indicating increased out-of-pocket expenditure. The age distribution for thyroid-related investigations was spindle shaped whereas that for Vitamin D showed that more assays were ordered for older age groups. Despite the high prevalence of parathyroid abnormalities in females, more investigations were conducted for men.
Keywords: Clinical chemistry, endocrine assay, rural care center
| Assessment of the Quality of Complementary Feeding: A Mixed-Method Cross-Sectional Study from a Rural Medical College in Central India|| |
Priyanka A. Joshi, Shiv H. Joshi1, Abhishek V. Raut1
Fourth MBBS Student,1Department of Community Medicine, MGIMS, Wardha, Maharashtra, India.
E-mail: firstname.lastname@example.org, email@example.com, firstname.lastname@example.org
Introduction: Undernutrition among under-five children is one of the most important public health problems in India. Despite several years of efforts to tackle undernutrition, India has not been able to make any significant dent on the proportion of undernutrition. Among the various recognized causes or risk factors of undernutrition, complementary feeding (CF) practice is a significant one and quality of CF given to children is a parameterless focused upon. Objective: This study was carried out with an objective to assess the quality of CF practices using a CF index (CFI). Materials and Methods: In our study, we consecutively recruited 190 mothers and children aged between 6 and 23 months who visited immunization outpatient department of hospital. This age group was focused as undernutrition usually sets in during this age. The children were enrolled after obtaining written informed consent from the mother. Children born with congenital birth defects and low birth weight and those with acute illness in preceding 2 weeks were excluded. Sociodemographic details of the study participants were recorded. Anthropometric measurements of children were recorded with calibrated infantometer and electronic weighing scale. The adapted CFI was administered that included questions on continuation of breastfeeding, initiation of CF, dietary diversity, food frequency, and responsive feeding. Mothers were asked for 24-h dietary recall of the child to estimate the nutritive value of CF given. Freelisting was done with another 20 mothers to identify commonly given and avoided food items to the child. Results: The magnitude of underweight, stunting, and wasting was 25.8%, 27.9%, and 10%, respectively. The CFI score of all the children under study was mostly in the range of medium (88.6%) to high (10.3%), and only one child had low score, indicating overall good CF practices among the study population. It also showed that almost all (91.6%) of the children had timely initiation of CF practices, but only 67.4% children received desired dietary diversity. Only around 75.5% of nonbreastfed and 77.7% of breastfed children received appropriate meal frequency. The CFI and calorific value of food had significant positive correlation. CFI score was significantly associated with Stunting (POR 8.37 95%CI 1.09-64.2). The findings of CFI triangulate with findings of Freelisting. Study participants showed poor intake of flesh foods (meat, eggs) and Vitamin A-rich fruits and vegetables. Starchy staples and other fruits were consumed more readily. Conclusion: Although majority had a medium CFI score, complementary feeds given were not adequate in terms of minimum dietary diversity, meal frequency, and provision of required calories and protein. CFI helps to readily assess the quality of CF and can be used as a proxy for assessing the nutritive value of food, as filling it up is easier than calculating protein and calorie intake of CF given to child. This can be of great use to assess children at various health centers in community, and this would result in prompt changes in any faulty feeding practices or referral in case of severity.
Keywords: Malnutrition, infant and young child feeding, responsive feeding, complementary feeding
| Diagnostic Accuracy of Clinical Signs in Determining Type of Anemia|| |
Sethi Ayushi, Jyoti Jain1
Fourth MBBS Student,1Department of Medicine, MGIMS, Wardha, Maharashtra, India.
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Context: Nutritional anemia is a major public health problem in poor and middle-income countries. Iron deficiency is characterized by microcytic red blood cells (RBCs) and megaloblastic anemia by macrocytic RBCs. Considering koilonychia, knuckle pigmentation, and diffuse pigmentation can be an important diagnostic tool for microcytic and macrocytic anemia, respectively, an attempt was made to study the diagnostic accuracy of these tools in anemic patients. Aim: The aim of the study was to study diagnostic accuracy of koilonychia for detection of microcytic and knuckle pigmentation and/or diffuse pigmentation for detection of macrocytic anemia. Settings and Design: This cross-sectional study was conducted in the Medicine Department at Mahatma Gandhi Institute of Medical Science. Materials and Methods: All consecutive anemia patients irrespective of their etiology of anemia of age 12 years and above admitted to the Department of Medicine were included and patients who were known to be treated with iron supplements, folate, or Vitamin B12 were excluded. Presence and absence of pallor, koilonychia, knuckle pigmentation, and diffuse pigmentation were recorded. All study subjects had undergone reference standard test, i.e., complete blood count and peripheral smear to confirm the type of anemia. Statistical Analysis Used: We constructed a 2 × 2 table to compute point estimates and 95% confidence intervals for the measures of diagnostic accuracy such as sensitivity, specificity, positive predictive value, and negative predictive value. Results: Among 150 patients, koilonychia was seen in 49 patients (33%), knuckle pigmentation in 60 patients (40%), diffuse pigmentation in 39 patients (26%), and 26 patients had both knuckle and diffuse pigmentation (17%). Maximum distribution of subjects was in the age group of 30–60 years that is 70 (46.6%) and majority of the subjects included were males. Koilonychia had the maximum sensitivity, specificity, and positive predictive value (PPV) when compared to red distribution width (RDW) and maximum negative predictive value (NPV) when compared to mean corpuscular volume (MCV). Knuckle pigmentation and diffuse pigmentation, when compared to MCV, mean corpuscular hemoglobin, and RDW, had a sensitivity of 100% and specificity and NPV of 0% and maximum PPV when compared to RDW. Conclusion: Knuckle pigmentation and diffuse pigmentation had very high sensitivity in diagnosing megaloblastic anemia but has a low specificity and NPV. Sensitivity of koilonychia is less in diagnosing microcytic anemia; however, it has moderate specificity and high PPV.
Keywords: Diagnostic accuracy, diffuse pigmentation, iron deficiency anemia, knuckle pigmentation, koilonychia, megaloblastic anemia