Microlearning and online simulation-based virtual consultation training module for the undergraduate medical curriculum - a preliminary evaluation.

BACKGROUND: Virtual consultation is a synchronous mode of telemedicine provided remotely via information and communication technology. The projected growth of digitalization in healthcare delivery, however, necessitates medical student training in virtual consultation (VC) to ensure safe and effective patient care. This study describes the implementation and preliminary evaluation of a competency-based VC training module for undergraduate medical students. METHODS: A newly developed six-week VC module was implemented online through asynchronous microlearning and synchronous simulation-based experiential learning modalities. Clinical students in years 4 and 5 and fresh graduates, who had not started pre-registration house officer or residency programmes, were invited to participate. Training outcomes using checklist-based video-recorded assessments of VC encounters between medical students and simulated patients were compared. Each video was independently assessed by two facilitators trained in VC teaching and assessment, using a direct observed virtual consultation skills checklist derived from established VC competencies. The participants completed course evaluations electronically as additional outcome measures. RESULTS: Fifty-two clinical phase medical students and alumni completed both the instructional and practical phases of this module. Altogether, 45 (95.7%) students found the module beneficial, and 46 (95.9%) reported increased self-efficacy for conducting VC. In total, 46 (95.9%) students would recommend the course to others. Post-test results showed a significant increase in the students' abilities to conduct a VC (t-test = 16.33, p < 0.05). CONCLUSION: Microlearning and simulation-based sessions were effective instructional delivery modalities for undergraduate medical students in their attainment of VC competencies.

Sleep deprivation and its association with diseases- a review.

Sleep deprivation, a consequence of multiple health problems or a cause of many major health risks, is a significant public health concern in this era. In the recent years, numerous reports have been added to the literature to provide explanation and to answer previously unanswered questions on this important topic but comprehensive updates and reviews in this aspect remain scarce. The present study identified 135 papers that investigated the association between sleep deprivation and health risks, including cardiovascular, respiratory, neurological, gastrointestinal, immunology, dermatology, endocrine, and reproductive health. In this review, we aimed to provide insight into the association between sleep deprivation and the development of diseases. We reviewed the latest updates available in the literature and particular attention was paid to reports that detailed all possible causal relationships involving both extrinsic and intrinsic factors that may be relevant to this topic. Various mechanisms by which sleep deprivation may affect health were presented and discussed, and this review hopes to serve as a platform for ideas generation for future research.

Detection of genotype-1 of dengue virus serotype 3 for the first time and complete genome analysis of dengue viruses during the 2018 epidemic in Mandalay, Upper Myanmar.

BACKGROUND: Dengue (DEN) is a neglected tropical disease, and surveillance of dengue virus (DENV) serotypes and genotypes is critical for the early detection of outbreaks. Risk factors for outbreaks include the emergence of new genotypes and serotype shifting. METHODOLOGY AND PRINCIPAL FINDINGS: To understand the genomic and viral characteristics of DENV-infected patients, we conducted a cross-sectional descriptive study among pediatric patients admitted at the 550-bedded Mandalay Children Hospital during the 2018 DEN endemic season. We conducted virus isolation, serological tests, viremia level measurement, and whole-genome sequencing. Among the 202 serum samples, we detected 85 samples with DENV (46 DENV-1, 10 DENV-3, 26 DENV-4 and three multiple serotype co-infections) via reverse transcription quantitative/real-time PCR (RT-qPCR), and we obtained 49 DENV isolates (31 DENV-1, 10 DENV-3 and 8 DEN-4). We did not detect DENV-2 in this study. The viral genome levels in serum did not differ significantly among virus serotypes, infection status (primary versus secondary) and disease severity. Based on the phylogenetic analysis, we identified DENV-1 genotype-1, DENV-4 genotype-1 and DENV-3 genotype-3 and genotype-1 which was detected for the first time. Next-generation sequencing analysis revealed greater frequencies of nonsynonymous and synonymous mutations per gene in the nonstructural genes. Moreover, mutation rates were also higher among DENV-1. CONCLUSION/SIGNIFICANCE: In conclusion, there was an increasing trend of DENV-3 cases during DENV endemic season in 2018 with the first detection of the genotype 1. However, DENV-1 has remained the predominant serotype in this study area since 2013, and we identified stop codon mutations in the DENV-1 genome. This report is the first to feature a complete genome analysis of the strains of DENV-3 and DENV-4 circulating among pediatric patients in Myanmar. This study highlighted the importance of annual surveillance for a better understanding of the molecular epidemiology of DENVs.

Inapparent dengue virus infection among students in Mandalay, Myanmar.

BACKGROUND: A school- and laboratory-based cross-sectional descriptive study was conducted to find out the burden of inapparent dengue virus (DENV) infection in Mandalay where DENV is endemic and there is circulation of all four DENV serotypes. METHODS: A total of 420 students who had no history of fever and visited the hospital within 6 months were recruited from three monastic schools. Serum samples were collected and the DENV genome was checked by conventional one-step RT-PCR and anti-DENV IgM and IgG antibodies were determined. Inapparent dengue (DEN) infection is defined as individuals who were either RT-PCR-positive or anti-DENV IgM-positive with no clinical manifestations or mild symptoms, and which are not linked to a visit to a healthcare provider. RESULTS: Among 420 students, 38 students (9.0%, 95% CI, 6.4 to 12.2) were confirmed as recent inapparent DEN infection. The DENV serotype-1 was detected in six students. Thirty-one out of 38 (81.6%) laboratory-confirmed inapparent DEN-infected students had primary infections and seven (18.4%) had secondary infections. CONCLUSION: This study explored the prevalence of inapparent DEN infection rate in urban monastic schools in Mandalay and showed that the rate of primary infection among inapparent DENV-infected children was high.

Evaluation of commercially available three dengue rapid diagnostic test kits for diagnosis of acute dengue virus infection at the point-of-care setting in Myanmar.

Early and accurate diagnosis of dengue virus (DENV) infection is very important and Rapid Diagnostic Test (RDT) Kits are been used as a point-of-care test to check DENV infection. A Hospital and Laboratory-based descriptive study was conducted at 550-bedded Mandalay Children Hospital in 2018. Acute-phase serum samples were collected from 202 dengue suspected patients to evaluate the efficacy of RDT Kits for the diagnosis of DENV infection. Commercially available three test kits which include: ((i) CareUs Dengue Combo, Korea, (ii) Humasis Dengue Combo, Korea and (iii) Wondfo Dengue Combo, China) were validated against WHO-based reference standard tests. 140/202 patients (69.3%) was confirmed to have DENV infection. All four serotypes of dengue viruses (57 DENV-1, 7 DENV-2, 6 DENV-3 and 10 DENV-4) were identified from 80 dengue confirmed patients and DENV-1 was the dominant serotype. Combining the NS-1 antigen and IgM antibody results from the CareUs Dengue Combo Kit gave the best sensitivity (92.1%, 95% CI 86.4%-96.0%) and specificity (75.8%, 95%CI 63.3%-85.8%). Among the three RDT Kits, the performance of CareUS Kit was better than the other two. This study explored the evidence of the usefulness of RDT Kits at the point-of-care setting for diagnosis of acute dengue infection.

Scope of anatomy teaching in problem-based learning (PBL) sessions of integrated medical curriculum / Alcance de la enseñanza de la anatomía en sesiones de aprendizaje basado en problemas del curriculum integrado de medicina

Problem based learning (PBL) made a great impact on the methodology of teaching. The major advantage of PBL method of teaching is integration of basic and clinical sciences in an integrated curriculum. This is achieved by presenting clinical problems to students which contain learning objectives from subjects related to the given clinical problems. In recent reports deficiencies have been reported regarding quantity of anatomy content of the clinical problems which has resulted in difficulty in understanding of theanatomy. We have made an attempt to quantify the content of anatomy and its sub-disciplines in PBL curriculum by a case study method using 'documentary analysis' at School of Medicine and Health Sciences, UCSI University, Kuala Lumpur, Malaysia. From the results of our study it is apparent that learning objectives for anatomy is not sufficiently spread across all the clinical problems and there is very less coverage of the sub-disciplines of anatomy particularly osteology and embryology. The benefits of PBL method of teaching is definitely more than that of traditional method, the uneven distribution of anatomy and its sub-disciplines had a major impact on the students during their clinical years.

El aprendizaje basado en problemas (ABP) generó un gran impacto en la metodología de la enseñanza. La principal ventaja del método ABP es la integración de las ciencias básicas y clínicas en un curriculum integrado. Esto se consigue mediante la presentación de los problemas clínicos a los estudiantes, que contienen objetivos de aprendizaje de temas relacionados con los problemas propuestos. En informes recientes se han reportado deficiencias en cuanto a la cantidad de contenido de la anatomía en los problemas clínicos, lo que se ha traducido en dificultades en la comprensión de la anatomía. Hemos hecho un esfuerzo para cuantificar el contenido de la anatomía y sus sub-disciplinas en el curriculum de ABP mediante el método de estudio de caso con "análisis documental" en la Facultad de Medicina y Ciencias de la Salud, UCSI University, Kuala Lumpur, Malasia. A partir de los resultados de nuestro estudio es evidente que los objetivos de aprendizaje para la anatomía no se extienden suficientemente a través de todos los problemas clínicos, y hay poca cobertura de la anatomía en las sub-disciplinas, en particular osteología y embriología. Los beneficios del método de ABP en la enseñanza es, sin duda, mayor que la de los métodos tradicionales, además la distribución desigual de la anatomía y sus sub-disciplinas, tuvieron un gran impacto en los estudiantes durante sus años clínicos.