Impact of COVID-19 outbreak on healthcare workers in a Tertiary Healthcare Center in India: a cross sectional study.

Numerous speculations have continually emerged, trying to explore the association between COVID-19 infection and a varied range of demographic and clinical factors. Frontline healthcare workers have been the primary group exposed to this infection, and there have been limited global research that examine this cohort. However, while there are a few large studies conducted on Indian healthcare professionals to investigate their potential risk and predisposing factors to COVID-19 infection, to our knowledge there are no studies evaluating the development of long COVID in this population. This cross-sectional study systematically utilized the demographic and clinical data of 3329 healthcare workers (HCW) from a tertiary hospital in India to gain significant insights into the associations between disease prevalence, severity of SARS-Cov-2 infection and long COVID. Most of the study population was found to be vaccinated (2,615, 78.5%), while 654 (19.65%) HCWs were found to be SARS-CoV-2 positive at least once. Of the infected HCWs, 75.1% (491) did not require hospitalization, whereas the rest were hospitalized for an average duration of 9 days. A total of 206 (6.19%) individuals were found to be suffering from long COVID. Persistent weakness/tiredness was the most experienced long-COVID symptom, while females (1.79, 1.25-2.57), individuals who consumed alcohol (1.85, 1.3-2.64) or had blood group B (1.9, 1.33-2.7) were at a significantly higher risk for developing long COVID.

Biofortification: A long-term solution to improve global health- a review.

Biofortification is a revolutionary technique for improving plant nutrition and alleviating human micronutrient deficiency. Fertilizers can help increase crop yield and growth, but applying too much fertilizer can be a problem because it leads to the release of greenhouse gases and eutrophication. One of the major global hazards that affects more than two million people globally is the decreased availability of micronutrients in food crops, which results in micronutrient deficiencies or "hidden hunger" in people. Micronutrients, like macronutrients, perform a variety of roles in plant and human nutrition. This review has highlighted the importance of micronutrients as well as their advantages. The uneven distribution of micronutrients in geological areas is not the only factor responsible for micronutrient deficiencies, other parameters including soil moisture, temperature, texture of the soil, and soil pH significantly affects the micronutrient concentration and their availability in the soil. To overcome this, different biofortification approaches are assessed in the review in which microbes mediated, Agronomic approaches, Plant breeding, and transgenic approaches are discussed. Hidden hunger can result in risky health conditions and diseases such as cancer, cardiovascular disease, osteoporosis, neurological disorders, and many more. Microbes-mediated biofortification is a novel and promising solution for the bioavailability of nutrients to plants in order to address these problems. Biofortification is cost effective, feasible, and environmentally sustainable. Bio-fortified crops boost our immunity, which helps us to combat these deadly viruses. The studies we discussed in this review have demonstrated that they can aid in the alleviation of hidden hunger.

Rhizobium mayense sp. Nov., an efficient plant growth-promoting nitrogen-fixing bacteria isolated from rhizosphere soil.

The nitrogen-fixing bacterium has great prospects in replacing synthetic fertilizers with biofertilizers for plant growth. It would be a useful tool in eradicating chemical fertilizers from use. Five nitrogen-fixing bacteria were isolated from the Tea and Groundnut rhizosphere soil out of which RSKVG 02 proved to be the best. The optimized condition of RSKVG 02 was found to be pH 7 at 30 °C utilizing 1% glucose and 0.05% ammonium sulfate as the sole carbon and nitrogen source. Plant growth-promoting traits such as IAA and ammonia were estimated to be 82.97 ± 0.01254a µg/ml and 80.49 ± 0.23699a mg/ml respectively. Additionally, their phosphate and potassium solubilization efficiency were evaluated to be 46.69 ± 0.00125 b mg/ml and 50.29 ± 0.000266 mg/ml. Morphological, and biochemical methods characterized the isolated bacterial culture, and molecularly identified by 16 S rRNA sequencing as Rhizobium mayense. The isolate was further tested for its effects on the growth of Finger millet (Eleusine coracana) and Green gram (Vigna radiata) under pot conditions. The pot study experiments indicated that the bacterial isolates used as bio inoculants increased the total plant growth compared to the control and their dry weight showed similar results. The chlorophyll content of Green gram and Finger millet was estimated to be 19.54 ± 0.2784a mg/L and 15.3 ± 0.0035 mg/L which suggested that Rhizobium sp. Possesses high nitrogenase activity. The enzyme activity proved to use this bacterium as a biofertilizer property to enhance soil fertility, efficient farming, and an alternative chemical fertilizer. Therefore, Rhizobium mayense can be potentially used as an efficient biofertilizer for crop production and increase yield and soil fertility.

A study of potent biofertiliser and its degradation ability of monocrotophos and its in silico analysis.

Potassium (K) and phosphorus (P) are the important macronutrients needed for the plant development, but it is widely present in an insoluble form for the plant's uptake. In order to increase the productivity, biofertilisers play crucial role in plant growth enhancement. Our present work focused to isolate potassium-phosphate solubilizing bacteria from the agricultural soil of tomato cultivated soil. Potassium and phosphate solubilization and degradation of monocrotophos was estimated spectrophotometrically. Out of thirteen isolates, two isolates proved to be the best P and K solubilizers. The bacterial isolates (SDKVG02 and SDKVG04) were optimized to obtain maximum P and K solubilization of 57.5 mg L-1 and 15.07 mg L-1 by the isolates. Pot experiments were conducted using SDKVG 02 and 04, immobilized on carrier materials, peat proving the best carrier with the total average green gram and chick pea length of 11.66 ± 0.0666 22.22 ± 0.0577. The MCP degradation percentage was achieved at 80 ppm of MCP with 75.8% and 64.10% by SDKVG 02 and SDKVG 04. Furthermore, production of organic acids such as malic acid, phthalic acid, ascorbic acid, nicotinic acid, and tartaric acid paves solubilization of P and K. The isolates were recognized based on 16S rRNA gene sequencing as Enterobacter hormaechei- SDKVG-02, Enterobacter cloacae SDKVG- 04. The KSB-PSB isolates also express N-fixing activity which is proved through In-silico analysis. It is worth to highlight SDKVG 02 and 04 would be potent biofertiliser exploited in increasing the soil fertility and crop productivity as well in degradation of monocrotophos present in the soil.

Mixed polyaromatic hydrocarbon degradation by halotolerant bacterial strains from marine environment and its metabolic pathway.

Accidents involving diesel oil spills are prevalent in sea- and coastal regions. Polycyclic aromatic hydrocarbons (PAHs) can be adsorbed in soil and constitute a persistent contaminant due to their poor water solubility and complex breakdown. PAHs pollution is a pervasive environmental concern that poses serious risks to human life and ecosystems. Thus, it is the need of the hour to degrade and decontaminate the toxic pollutant to save the environment. Among all the available techniques, microbial degradation of the PAHs is proving to be greatly beneficial and effective. Bioremediation overcomes the drawbacks of most physicochemical procedures by eliminating numerous organic pollutants at a lower cost in ambient circumstances and has therefore become a prominent remedial option for pollutant removal, including PAHs. In the present study, we have studied the degradation of Low molecular Weight and High Molecular Weight PAH in combination by bacterial strains isolated from a marine environment. Optimum pH, temperature, carbon, and nitrogen sources, NaCl concentrations were found for efficient degradation using the isolated bacterial strains. At 250 mg/L concentration of the PAH mixture an 89.5% degradation was observed. Vibrio algiolytcus strains were found to be potent halotolerant bacteria to degrade complex PAH into less toxic simple molecules. GC-MS and FTIR data were used to probe the pathway of degradation of PAH.

Application of Salvinia sps. in remediation of reactive mixed azo dyes and Cr (VI) - Its pathway elucidation.

The emerging industrialization has resulted in the rapid growth of textile industries across the globe. The presence of xenobiotic pollutants in textile wastewater threatens the ecosystem. Applying different microbes (bacteria, fungi & algae) has paved the way for phytoremediation - the eco-friendly, cost-effective method. The present study focuses on the phytoremediation of reactive dyes - Reactive red, Reactive Brown & Reactive Black and Cr (VI) in synthetic textile wastewater using Salvinia sps. The mixed azo dyes of each 100 mg/L showed decolourization of 75 ± 0.5% and 82 ± 0.5% of removal of 20 mg/L of Cr (VI) after eight days of incubation in a phytoreactor setup. Chlorophyll analysis revealed the gradual decrease in the photosynthetic pigments during the remediation. The degraded metabolites were analyzed using FT-IR and showed the presence of aromatic amines on day zero, which were converted to aliphatic amines on day four. The GC-MS analysis revealed the disruption of -NN- bond, rupture of -CN- bond, scission of -N-N-bond, and loss of -SO3H from the Reactive Black dye leading to the formation of an intermediate p-Hydroxy phenylhydrazinyl. The rupture of Reactive red dye resulted in the formation of p-Hydrazinyl toluene sulphonic acid, Naphthyl amine -3,6-disulphonic acid and 8-Hydroxy Naphthyl amine -3,6-disulphonic acid. Decarboxylation, desulphonation, deoxygenation and deamination of Reactive Brown dye showed the presence of different metabolites and metabolic pathways were proposed for the reactive azo dyes which were phytoremediated.

New analytical strategies amplified with carbon-based nanomaterial for sensing food pollutants.

The most significant topic currently under the moonlight is Nanobiotechnology and engineered nanomaterials. The novel characteristics displayed by engineered Nanomaterials, especially carbon-based nanomaterials, have spurred interest in its potential application in the food industry. It has provided opportunities for finding solutions to the long-standing challenges in the food industry to assess food safety, maintain food quality, extend the shelf life of produce, and efficiently deliver nutrients. Nanomaterials can be incorporated in food sensors facilitating efficient monitoring of crop maturity and detecting biological and chemical contaminants. When integrated into food packages, nanomaterials could aid in assessing the freshness and improving the quality of packaged foods. In addition, more efficient delivery of nutrients could be possible in foods fortified using nano compounds. The initial section of this review gives an overview of the broad application of nanotechnology in the food industry and carbon-based nanomaterials. The latter part focuses on nanotechnology in biosensors for food safety and quality monitoring.

Carbon nanomaterials and its applications in pharmaceuticals: A brief review.

Nanotechnology for the past decade has made tremendous improvement and diverse applications in various sector. Among the nanomaterials synthesized, carbon allotropes are advantageous due to its easy functionalization, conductivity, surface area and electrical activity. Hence, they are termed as "Wonder materials". Allotropes such as carbon nanotubes, graphene, graphene oxide, fullerens, and carbon dots has paved its importance in the pharmaceuticals. They are coated in the biomedical devices, applied in the therapeutics and diagnosis. These are also used in the treatment of cancer and they possess anti-microbial and antiviral activity. Carbon nanomaterials possess several applications from biosensors to remediation of pollutants. Detection of hazardous compounds in food, pharmaceutical products, gene and drug delivery. They are also used in tissue regeneration and gene therapy. Application of carbon allotropes in the current scenario provides a wide scope in future with improvisations in building electrochemical biosensors. Its selectivity, sensitivity and cost-effectiveness prove it to be better alternative compared to other nanomaterials. The review focuses on the carbon allotropes used in pharmaceuticals, biosensors, pollutants detection and treatment were discussed in detail.

Application of a novel nanocomposite containing micro-nutrient solubilizing bacterial strains and CeO2 nanocomposite as bio-fertilizer.

Chemical fertilizers are used in modern agricultural practice to increase plant output. They possess anthropogenic compounds which are hazardous, result in poor soil quality, poor crop nutrition and pollutes the water table. Currently, food crops that lack in micro-nutrients (Zn, silicates and Se) can be enriched with micronutrients by use of fertilizers. Eco-friendly bio-fertilizers have been proved to provide a known population of microorganisms that create a mutual benefit to the plants & the rhizosphere soil. Nanomaterials are often used in plant fertilizer formulation, allowing for controlled release and targeted delivery of beneficial nanoscale components, as well as to boost plant production and reduce environmental pollutants. In the present study we identified a multipotent micronutrient solubilizing bacterium (MSB) - Pseudomonas gessardi and Pseudomonas azotoformans as a bio-fertiliser. Comparative study of the formulated MSB, with nanocomposite prepared with the soya chunks as natural carrier material and chemically synthesized cerium oxide was performed on the growth of fenugreek for its effectiveness. The SEM images of nanocomposite showed the non-uniform distribution of CeO2 in bio-inoculant with an average size of 25.24 nm. The current study deals with increase in the shoot and root length of the fenugreek plant with only 75 ppm of CeO2 in nanocomposite, thereby preventing bioaccumulation of Ce in soil. This work gives a potential use of CeO2 nanocomposite with MSB bio-inoculants which could be applied to soil deficient with the micronutrients that can enhance the crop yield.

Treatment of textile wastewater containing mixed toxic azo dye and chromium (VI) BY haloalkaliphilic bacterial consortium.

Scientific empowerment in this century created a positive and negative impact on the ecosystem's biotic and abiotic components. The current scenario of emerging recalcitrant pollutants in the environment is encountered using various remediation approaches are enforced and applied. The need for mineralization of the toxic pollutants to non - toxic forms accomplished the application of microbes (bacteria, fungi and algae) and plants individually or in a combined manner. The current research on the removal of pollutants from synthetic textile wastewater containing 1200 ppm concentration of mixed azo dyes -Reactive red (RR), Reactive Brown (RB) & Reactive Black (RBl) and 300 ppm Cr (VI) metal using haloalkaliphilic bacterial strains LBKVG1, LBKVG2, LBKVG3 & LBKVG4 in a Moving Bed Biofilm Reactor (MBBR), showed decolorization of 82 ± 0.5% of mixed azo dyes and degradation 56 ± 0.5% of Cr (VI) metal at 37 °C and pH 8.5 in the fifth day of the study. The isolated bacterial strains in the consortium were molecularly and morphologically characterized by 16SrRNA sequencing and SEM analysis. FT-IR and GC-MS analysis scrutinized the metabolites obtained. The findings suggest the degradation of hazardous pollutants even at higher concentrations and attempt to decolourize the mixed azo dyes simultaneously using the eco-friendly bacterial consortium.

Structural, functional, resistome and pathogenicity profiling of the Cooum river.

The microbial community's structure and functions determine the health, quality, and anthropogenic conditions of the river ecosystems. The presence of Bacteria such as Arcobacter spp, Escherichia spp, and Campylobacters spp, have been shown to reflect the poor water quality of rivers. Apprehension of the microbial community in polluted water bodies is significant because it affects human health and the environment. Culture-independent metagenomic and metatranscriptomic approaches employed in the current study of the Cooum river unraveled the taxonomic classification of diverse microbes, including archaea, bacteria, viruses, and phages. The presence of abundant Macellibacteroides fermentans, Arcobacter bivolvorium, Arcobacter butzleri, Methanothrix soenhngeii, and Bacteroides graminisolvens were noted. Viruses and phages like Caudovirales, Human mastadenovirus C, Siphoviridae, Escherichia phage, Erwinia phage, Synechoccus phage, and Vibrio phage were relatively predominant. Various metabolic pathways like methane, sulfur, and nitrogen metabolism adopted by the microbiome confer dangerous gases. Mechanisms such as secretory systems, signal transduction, Chemotaxis, quorum sensing, transportation of chemicals and ions were significantly enriched. The microbes expressed antimicrobial resistance mechanisms as identified from the genes encoding beta-lactamase enzymes and aminoglycoside phosphotransferase enzymes. Metal resistance mechanisms against copper, tellurium, chromium, and cadmium were plentiful. Presence of human pathogens interactions with Yersinia pestis, Campylobacter jejuni, Escherichia coli, Helicobacter pylori, and Francisella tularensis subsp. tularensis suggested the possibilities of transmission of pathogenesis to humans. The current study is the first to apprehend the detailed microbiome composition of one of the highly polluted rivers in South India. The study elaborated the microbiome's structure, functions, and metabolic potential at a specific site of the polluted river.

Mixed azo dyes degradation by an intracellular azoreductase enzyme from alkaliphilic Bacillus subtilis: a molecular docking study.

The rise of pollution due to the dye industries and textile wastes are evolving rapidly every day. The dyes are used in different trade names by the textile industries. The actual chemistry of dye is vague and difficult to understand even today though we are equipped technically. The toxic effects of the dyes and the reasons behind the acute toxicity are also an undiscovered mystery; therefore, no effective measures can be employed to degrade dyes. Deploying physical or chemical methods to pre-treat the azo dyes are expensive, extremely energy-consuming, and are not environment friendly. Hence, the use of microbes for textile dye degradation will be eco-friendly and is probably a cost-effective alternative to physicochemical methods. The present study was conducted to investigate the degradation of azo dyes isolated from textile effluent contaminated soil by employing the bacterial strains for degradation. The bacterial strains could degrade the optimum concentration of mixed azo dyes (200 mg/L) with an incubation up to 5 days. The decolourization of the dyes was expressed in terms of percentage of decolourization, and was found that about 87.35% of degradation by Bacillus subtilis strain. The enzyme responsible was analyzed as intracellular azoreductase involved in the degradation of mixed azo dyes. The enzymatic pathway and 1-phenyl-2-4(4-methyl phenyl)-diazene 1-oxide was observed as the major metabolite by GC-MS analysis. The in silico study determined the binding of mixed azo dye with azoreductase and hypothesized that their linking could be the main reason for the degradation of mixed azo dye.

Metabolic and molecular modelling of zebrafish gut biome to unravel antimicrobial peptides through metagenomics.

Recently efforts have been taken for unravelling mysteries between host-microbe interactions in gut microbiome studies of model organisms through metagenomics. Co-existence and the co-evolution of the microorganisms is the significant cause of the growing antimicrobial menace. There needs a novel approach to develop potential antimicrobials with capabilities to act directly on the resistant microbes with reduced side effects. One such is to tap them from the natural resources, preferably the gut of the most closely related animal model. In this study, we employed metagenomics approaches to identify the large taxonomic genomes of the zebra fish gut. About 256 antimicrobial peptides were identified using gene ontology predictions from Macrel and Pubseed servers. Upon the property predictions, the top 10 antimicrobial peptides were screened based on their action against many resistant bacterial species, including Klebsiella pneumoniae, Pseudomonas aeruginosa, Staphylococcus aureus, E. coli, and Bacillus cereus. Metabolic modelling and flux balance analysis (FBA) were computed to conclude the antibiotic such as tetracycline, cephalosporins, puromycin, neomycin biosynthesis pathways were adopted by the microbiome as protection strategies. Molecular modelling strategies, including molecular docking and dynamics, were performed to estimate the antimicrobial peptides' binding against the target-putative nucleic acid binding lipoprotein and confirm stable binding. One specific antimicrobial peptide with the sequence "MPPYLHEIQPHTASNCQTELVIKL" showed promising results with 53% hydrophobic residues and a net charge +2.5, significant for the development of antimicrobial peptides. The said peptide also showed promising interactions with the target protein and expressed stable binding with docking energy of -429.34 kcal/mol and the average root mean square deviation of 1 A0. The study is a novel approach focusing on tapping out potential antimicrobial peptides to be developed against most resistant bacterial species.

A Novel Approach towards Early Detection of Obliteration in Lumbar Lordosis.

The millennial age group (18 to 30 years) spend at least 6 hours sitting, either in college or at their workspace. High screen time as a routine, is the major cause for numerous spinal problems. Despite the wide research carried out on postural abnormalities, there exists numerous unrequited queries with regards to lumbar lordosis estimations, due to indeterminate parameters such as age, gender, lifestyle and diet. This work emphasizes the proficient method by observing the posture of a person for early detection of obliteration in Lumbar Lordosis. This further contributes to efficient diagnosis and treatment of spine ailments. With a novel approach to hardware using the myRIO hardware coupled with LabVIEW for interactive interface, the calibration is enhanced using machine learning (ML) - kNN Classifier. The use of machine learning accounts for the variations in the ideal angles of segmented sagittal measures with respect to different subjects. The device is developed to be a non-invasive, user friendly instrument to analyse the casual seated posture trends of the subject. The male subjects are expected to show the tilt angles in the range of -16.3 to -17.2 degrees and similar threshold for females are -15.8 to -16.8 degrees. Out of 120 subjects taken into consideration, the device could accurately classify subjects with obliterated or normal lumbar lordosis). An accuracy and f1- score of 94% and 90% respectively was achieved by the ML model.

Bioremediation of a pentacyclic PAH, Dibenz(a,h)Anthracene- A long road to trip with bacteria, fungi, autotrophic eukaryotes and surprises.

Dibenz(a,h)Anthracene (DBahA), classified as a probable human carcinogen (B2) is the first Poly Aromatic Hydrocarbons (PAH) to be chemically purified and used for cancer-based studies. Till date, only 30 papers focus on the bioremediation aspects of DBahA out of more than 200 research publications for each of the other 15 priority PAHs. Thus, the review raises an alarm and calls for efficient bioremediation strategies for considerable elimination of this compound from the environment. This article reviews and segregates the available papers on DBahA bioremoval from the beginning till date into bacteria, fungi and plant-mediated remediation and offers suggestions for the most competent and cost-effective modes to bioremove DBahA from the environment. One of the proficient ways to get rid of this PAH could with the use of biosurfactant-enriched bacterial consortium in DBahA polluted environment, which is given considerable importance here. Among the bacterial and fungal microbiomes, unquestionably the former are the beneficiaries which utilize the breakdown products of this PAH metabolized by the latter. Nevertheless, the use of plant communities for efficient DBahA utilization through fibrous root system is also discussed at length. The current status of DBahA as reflected by the publications at https://www.ncbi.nlm.nih.gov and recommendations among the explored groups [bacterial/fungal/plant communities] for better DBahA elimination are pointed out. Finally, the review emphasizes the pros and cons of all the methodologies used for selective/combinatorial removal of DBahA and present the domain to the researchers to carry forward by incorporating their individual ideas.

Interlead distance and left ventricular lead electrical delay predict reverse remodeling during cardiac resynchronization therapy.

BACKGROUND: Both anatomic interlead separation and left ventricle lead electrical delay (LVLED) have been associated with outcomes following cardiac resynchronization therapy (CRT). However, the relationship between interlead distance and electrical delay in predicting CRT outcomes has not been defined. METHODS: We studied 61 consecutive patients undergoing CRT for standard clinical indications. All patients underwent intraprocedural measurement of LVLED. Interlead distances in the horizontal (HD), vertical (VD), and direct (DD) dimensions were measured from postprocedure chest radiographs (CXR). Remodeling indices [percent change in left ventricle (LV) ejection fraction, end-diastolic, end-systolic dimensions] were assessed by transthoracic echocardiogram. RESULTS: There was a positive correlation between corrected LVLED and HD on lateral CXR (r = 0.361, P = 0.004) and a negative correlation between LVLED and VD on posteroanterior (PA) CXR (r =-0.281, P = 0.028). To account for this inverse relationship, we developed a composite anatomic distance (defined as: lateral HD-PA VD), which correlated most closely with LVLED (r = 0.404, P = 0.001). Follow-up was available for 48 patients. At a mean of 4.1 +/- 3.2 months, patients with optimal values for both corrected LVLED (>or=75%) and composite anatomic distance (>or=15 cm) demonstrated greater reverse LV remodeling than patients with either one or neither of these optimized values. CONCLUSIONS: We identified a significant correlation between LV-right ventricular interlead distance and LVLED; additionally, both parameters act synergistically in predicting LV anatomic reverse remodeling. Efforts to optimize both interlead distance and electrical delay may improve CRT outcomes.

Usefulness of cardiac resynchronization therapy in the management of Doxorubicin-induced cardiomyopathy.

Doxorubicin is a widely used antineoplastic agent that may cause irreversible dilated cardiomyopathy. Doxorubicin-induced cardiomyopathy (DIC) can occur several years after exposure and carries a poor prognosis. Although cardiac resynchronization therapy (CRT) is a useful intervention in end-stage heart failure unresponsive to optimal medical therapies, its efficacy in DIC remains unknown. Four consecutive patients receiving CRT for DIC were evaluated before and after CRT. CRT resulted in improvements in the mean left ventricular ejection fraction at 1 month from 21+/-4.7% to 34+/-5% (p=0.03) and at 6 months (to 46+/-7.5%, p=0.01). CRT-induced reverse remodeling was observed, with a mean reduction in left ventricular internal diameter at end-diastole from 54.75+/-3.7 to 52.5+/-1.9 mm at 1 month (p=0.06) and further to 47+/-2.3 mm at 6 months (p=0.03). All patients experienced reductions in heart failure symptoms and improvements in New York Heart Association functional class (p<0.05). The impact of CRT was sustained over a follow-up of 18.5+/-3.5 months. In conclusion, this study suggests that patients with DIC, refractory to optimal pharmacologic therapy and meeting criteria for resynchronization device implantation, may achieve sustained benefit from CRT.

Implementation and evaluation by formal assessments and term end student feedback of a new methodology of clinical teaching in surgery in small group sessions.

The existing clinical teaching in small group sessions is focused on the patient's disease. The main dual limitation is that not only does the clinical skill testing become secondary but there is also a slackening of student involvement as only 1 student is evaluated during the entire session. A new methodology of small group teaching being experimented shifted the focus to testing students' clinical skills with emphasise on team participation by daily evaluation of the entire team. The procedure involved was that the group underwent training sessions where the clinical skills were taught demonstrated and practiced on simulated patients (hear-see-do module). Later the entire small group, as a team, examined the patient and each student was evaluated for 1 of 5 specific tasks--history taking, general examination, systemic examination, discussion and case write-up. Out of 170 students, 69 students (study) and 101 students (control) were randomly chosen and trained according to the new and existing methods respectively. Senior faculty (who were blinded as to which method of teaching the student underwent) evaluated all the students. The marks obtained at 2 examinations were tabulated and compared for tests of significance using t-test. The difference in the marks obtained showed a statistically significant improvement in the study group indicating that the new module was an effective methodology of teaching. The teaching effectiveness was evaluated by student feedback regarding improvement in knowledge, clinical and communication skills and positive attitudes on a 5-point Likert scale. Psychometric analysis was very positively indicative of the success of the module.