Rapid on-site evaluation and cell blocks: getting the most from the least invasive method in cytopathology.

INTRODUCTION: Fine needle aspiration cytology (FNAC) sampling is a minimally invasive procedure done to identify the pathology behind superficial and deep-seated lesions. Rapid on-site evaluation (ROSE) can be an adjunct to the FNACs. Our study aimed to identify the role of ROSE in diagnostic adequacy and to check the benefit of cell block (CB)/cell buttons prepared from the ROSE samples. MATERIAL AND METHODS: A prospective study was conducted where all patients referred for FNAC were included. ROSE using 1% aqueous toluidine blue stain and CB/cell button preparations were done for the identification of various cytological lesions. RESULTS: Among 600 cases included in the study most common age group was third and fourth decades with a mean age of 41.6 years and M: F ratio of 1:1.7. Ultrasound-guided procedures were done in 20% of cases. CB preparation was available in 14% of cases. Most CBs were from the cases wherein ROSE was performed 81% (77 out of 86), with CB helping in making an accurate diagnosis in 17% of cases. Lymph nodes 26%, and thyroid 23% were the most common sites for sampling with the highest number of repeat procedures from non-ROSE cases (14%). The non-diagnostic rate for non-ROSE cases was 7.7% (23/300) even after the repeat procedures as compared to 1.3% (4/300) for ROSE. Three slides on average were consumed in ROSE-performed procedures, as compared to an average of 5 slides in non-ROSE. The average turnaround time was 1.7 days for non-ROSE cases and 1.05 for ROSE cases respectively. Cyto-histopathological correlation was available in 40% of cases with a sensitivity of 98.1%, specificity of 96.7%, positive predictive value of 90%, negative predictive value of 99.4%, and diagnostic accuracy of 97%. The correlation of CB, number of slides consumed, and turnaround time among the 2 groups were statistically significant (P value < 0.001). CONCLUSIONS: ROSE is a method used to assess material aspirated at the time of FNAC procedures to determine the adequacy and to an extent to identify whether the lesion is neoplastic or non-neoplastic. CBs have helped in increasing diagnostic accuracy apart from the fact that the paraffin-embedded tissue material can be used for further studies.

Alarming levels of inadequate intake of B group vitamins in tribal lactating women from South India.

Background: Micronutrients are necessary for proper growth and development of the human body, though required in small amounts. Dietary intake of these micronutrients by lactating women is essential for their own health as well as children's overall growth and development. objective of present study is to assess the adequacy of dietary B-group vitamins intake during lactation and to find out the factors associated with their inadequate intake. Design and methods: It was a analysis of data from prospective cohort study for 10 months carried out among 340 Scheduled Tribes mothers in 10 clusters in Guntur district, Andhra Pradesh, India. Data collection was done using a 24 h dietary recall questionnaire. A p-value less than 0.05 was considered to be statistically significant. Results: All the mothers (n = 340) were not having adequate intake of Thiamine, Riboflavin, Niacin, Pyridoxine, Pantothenic acid, Biotin and Folic acid. Methyl cobalamin intake was inadequate in 37.5% mothers (n = 136). The mean intake of Vitamin B12 was 40.98 + 42.8 (SD) µg/day. Age at marriage, location and parity were significantly associated with inadequate intake of Vitamin B12. Conclusions: The current diet pattern of mothers of vulnerable groups might affect the growth and development of the infant. We strongly recommend for supplementation of B-group vitamins to pregnant and lactating women in India.

Impact of lockdown due to COVID-19 pandemic on neurobehavioral profile of children aged 6-12 years (NeuBeC study).

Background: The lockdown due to the COVID-19 pandemic has affected the lives of children and resulted in behavioral and emotional disturbances in children. This study was planned to identify the prevalence of these problems in Indian children. The aim of the study was to estimate the effect of lockdown on the neurobehavioral profile of children 6-12 years of age by using the Child Behavior Checklist (CBCL) scale. CBCL is the most widely used validated scientific tool to detect behavioral and emotional problems in children. Materials and Methods: All children 6-12 years of age who were fulfilling the inclusion criteria of the study were included from all over India through an online Google form link. The children attending the outpatient department (OPD) at our tertiary-level care medical college were also included in offline mode. Data were collected and entered in an Excel sheet and analyzed statistically. Results: A total of 173 children in the age group 6-12 years were enrolled. The mean standard deviation (SD) age of all children was 8.88 (1.84) years, out of which males were of a mean age of 9.2 (1.84) years and females were 8.44 (1.74) years. Total CBCL T-scores (mean (SD)) for internalizing, externalizing, and total scores were 63.07 (7.98), 63.95 (6.51), and 62.39 (4.9), respectively. Conclusion: Lockdown has resulted in neurobehavioral changes in normal children. The independent predictors found were the increase in screen-based media use, sleep issues, or behavioral changes like aggression due to restriction of their mobility or confinement. Females exhibited more internalizing problems, and males exhibited more externalizing problems.

Prevalence of Undernutrition Among Tribal Lactating Mothers in Andhra Pradesh, India.

Background In Andhra Pradesh, India, tribal communities face unique nutritional challenges due to limited access to healthcare and a predominantly plant-based diet. Maternal undernutrition is a significant concern, impacting the well-being of both mothers and their offspring. This study focuses on assessing the prevalence of undernutrition among tribal mothers in Andhra Pradesh using the BMI-for-age criterion. Objectives The aim of this study was to comprehensively evaluate the prevalence of undernutrition among tribal mothers, explore associations with demographic factors, and assess the impact of a nutritional intervention program. The ultimate goal was to contribute to targeted interventions and policies for improving the health and well-being of these communities. Materials and methods A cohort study was conducted in the Guntur district of Andhra Pradesh, involving 340 lactating mothers and their infants. Data collection and anthropometric measurements were performed. Results The study found that 67 (19.71%) of tribal mothers were underweight at baseline. There were statistically significant associations with the Yenadi tribe, low educational status of the mother, and history of lower segment Caesarean section with a high prevalence of being underweight. No significant associations with age, occupation, or socioeconomic status were observed. Undernutrition was more common among mothers with older children and was associated with specific obstetric factors. Conclusion While the prevalence of undernutrition is lower than in some previous studies, it remains a critical concern, particularly within disadvantaged communities. These undernourished mothers face health risks, including anemia. Urgent policy interventions and nutritional programs are needed to address this issue and enhance the well-being of tribal communities in Andhra Pradesh.

Menstrual cup webinar series: A developing model of modified pre- and post-tests in the online teaching-learning of primary health care workers.

Menstrual hygiene management, especially in resource-limited settings, is challenging. The acceptability of the menstrual cup is increasing recently in western countries whereas, in developing countries like India, the awareness, acceptability, and use of menstrual cups are very limited. We assessed the effectiveness of modified pre-post-test teaching-learning methodology in an online webinar series on menstrual cups using Moore's outcome assessment. An online webinar series on menstrual hygiene and the menstrual cup was conducted to raise awareness about the usage of menstrual cups among the health care workers like Auxiliary Nurse Midwife (ANMs), Accredited Social Health Activist (ASHAs), and Anganwadi Workers (AWWs) of the Guntur district, Andhra Pradesh, India. The questions of modified pre- and post-test were displayed. The questions were displayed to participants using the polling option in zoom. A total of 1597 health care workers participated in the menstrual cup webinar series. Of the total, 72.7% of participants responded to the job title question of which ASHA, ANMs, and AWWs were 16.8%, 34.2%, and 41.9%, respectively. The baseline knowledge of menstrual cups among primary health care workers for "heard of the menstrual cup" and "ever used/know anyone using menstrual cup" was 36.89% and 11.67%, respectively. After the webinar among the primary health care workers, the maximum gain in knowledge was seen for "menstrual cup can be cleaned in the home," 94.53%, and the minimum gain in knowledge was on "unmarried girls can use menstrual cups," 50.42%. The modified pre- and post-test model predicted an overall 50 percent rise in the knowledge of primary health care workers by the webinar series about a different aspect of the menstrual cup.As online webinar providers aim to provide more performance-based learning activities, current approaches to continuing medical education may become obsolete. The single most essential shift in online webinar planners can make is to incorporate modified pre-and post-test to allow for interactive and formative assessment during webinar activities.

Study on knowledge of front-of-pack labeling and food group-based dietary intake among chronic gastritis patients.

Introduction: Chronic gastritis is one of the most prevalent disorders affecting individuals, which affects hundreds of millions of people in different ways around the world. The significant incidence of poor dietary quality and diet-related illnesses may be addressed by orienting customers toward healthier food options. The objective of the study was to estimate the knowledge of front-of-package labels (FoPLs) and food group-based dietary intake of nutrients among patients with chronic gastritis. Materials and Methods: The study design was a hospital-based cross-sectional study that was done in Guntur district of Andhra Pradesh. The study population included 208 chronic gastritis patients between 20 to 60 years of age selected by systematic sampling. Detailed information on sociodemographic and lifestyle factors was collected using a questionnaire and 24-h dietary recall was done. The objective assessment of Knowledge of FoPLs was assessed mock package images representing a fictional brand to prevent other factors from interfering with product evaluation. Results: A total of 208 patients were studied with a near-equal proportion of males and females. Among participants, more than half (57.2%) can interpret FoPL, more than three-fourths (77.4%) have a belief that they eat a healthy diet mostly and only half (52.4%) of participants are somewhat knowledgeable about nutrition, and finally almost half (46.6%) of participants are not seeing the FoP label during food purchase. The mean score of knowledge of FoP labeling was 0.92 ± 1.135. Knowledge of FOPL was positively associated with the age of study participants OR 0.178 (95% CI: 0.178 to 0.856) with P value = 0.02. Grains have the maximum intake among all the food groups with a mean intake of 123.21 g/day. Conclusion: The majority of participants do not know the food labeling, thus methods of education that focus on dietary interventions are urgently needed to raise awareness among the people.

Factors Contributing to Rapidly Increasing Rates of Caesarean Section in Andhra Pradesh, India: A Case-Control Study.

Introduction In some obstetric situations, a caesarean section (CS) can be a crucial, life-saving treatment for both the mother and the infant. Nonetheless, unnecessary CS can raise the risk of morbidity for both. The present study was conducted to study the factors associated with CS delivery and to study the patterns of utilization of health facilities by pregnant women in the state of Andhra Pradesh in India. Materials and methods A community-based case-control study was done in Mangalagiri mandal, Guntur district, Andhra Pradesh, India in 2022. A total of 268 mothers (134 CS and 134 normal vaginal childbirth) who delivered between 2019 to 2022 with at least one biological child less than three years of age were studied. The data was collected using a structured questionnaire. Robson's 10-Group Classification was used to differentiate the type of deliveries of the participants. A p-value less than 0.05 was considered to be significant. Results The mean age of the 268 women studied was 25.49±3.73 years. We found that 47 of the 82 (57.3%) women who went to government healthcare facilities and 87 of the 181 (48.1%) women who went to private healthcare facilities had a CS. Of the total CS studied, approximately 83.5% were emergency CSs. All four mothers who had twins had undergone CS. All women with oblique or transverse fetal lie underwent CS irrespective of parity. On multivariate analysis, participants' education status less than or equal to 10th standard was positively associated with CS and identification of complications in the third trimester by healthcare provider was significantly protective for CS. Conclusion CS rate reduction necessitates a multi-faceted strategy that includes a variety of programming initiatives. Audits of CS performed as part of health programs and other creative monitoring techniques can be useful tools for assessing the standard of maternity care, particularly emergency CS.

A Case of Delusional Disorder With Abuse of Isoniazid, Rifampicin, Pyrazinamide, and Ethambutol, the First-Line Anti-tuberculosis Therapy Drugs in India.

Tuberculosis (TB) and mental illnesses frequently coexist and are both extremely common worldwide. Through the National Program for Elimination of Tuberculosis (NTEP), anti-tuberculosis therapy (ATT) medications are used to treat tuberculosis in India. We want to report a case 45-year-old patient from the state of Andhra Pradesh, India with comorbid delusional disorder leading to daily ATT drug consumption for the past 20 years. This unusual presentation demonstrates that abuse of a Schedule "H" substance like ATT is also conceivable. To stop "Off-label" purchases, strict measures must be taken. Before beginning ATT, evaluating the patient's mental health may be a wise move.

The association of psoriasis and psoriatic arthritis with periodontitis: A hospital-based case-control study.

Background Periodontitis can trigger and perpetuate inflammation in several chronic inflammatory diseases. The association of periodontitis with psoriasis has been investigated earlier, but data are incomplete and the influence of confounders has not been fully evaluated. We examined the relationship of dental and periodontal health parameters in patients with psoriasis and/or psoriatic arthritis. Methods This hospital-based cross-sectional analytical study was conducted in patients with chronic plaque psoriasis, psoriatic arthritis or both, and compared with controls. Dental and periodontal health parameters were assessed based on the WHO oral health assessment method. Multivariate logistic regression was done on variables with significant or near-significant values to find the association between periodontitis and psoriasis and/or psoriatic arthritis after adjusting for confounders. Results Psoriasis and/or psoriatic arthritis were independently and significantly associated with periodontal pockets ≥4 mm in depth. Limitations Causality and temporal relationship cannot be established as this was a cross-sectional study. As in all observational studies, the possibility of unmeasured or unknown confounders exists. Psoriatic arthritis was present only in a small subset of patients. Conclusion Patients with psoriasis and/or psoriatic arthritis have significant periodontal inflammation. This needs to be addressed by dental examination and intervention.

Evaluation of the Effectiveness and Perceived Benefits of Interventional Structured Infection Prevention and Control Training Module Introduced in the Undergraduate Medical Curricula.

Introduction: Assessing and improving infection prevention and control (IPC) knowledge and practicing skills among medical students who are the future medical practitioners is crucial for reducing the burden of healthcare-associated infections (HAIs). In this study, we assessed the IPC knowledge of undergraduate clinical-year medical students before and after interventional IPC modular training and evaluated the effectiveness and students' perception on structured modular IPC training presented to them. Methods: This cross-sectional interventional study was conducted on single medical cohort comprising of 145 final-year undergraduate medical students of the academic year 2022-23 at COMHS. Pre-test, post-test, and feedback questionnaire were used as the assessing tools. The data were collected, entered into Excel sheet, and analyzed using SPSS software version 22. McNemar and Paired-T tests were carried out, and a p value<0.05 was considered significant. Feedback of the questionnaire was analyzed using 3 Point Likert Scale as agree, neutral, and disagree. Results: Overall, mean IPC knowledge scores after training (37.65±1.37) was significantly higher as compared to before training (25.13±4.51). Prior knowledge scores on certain aspects of IPC such as duration of hand washing, steps of hand washing, sequence of donning and doffing of PPE, use of N95 mask, and appropriate sharp and needle precautions, and biomedical waste management were varied from 13.6% to 65.6%. However, overall participants' knowledge (p value <0.001) on these aspects increased significantly after the training. The majority of the participants (>90%) perceived IPC training as an excellent tool to improve IPC knowledge and practicing skills. Conclusion: IPC training had a significant impact in gaining adequate IPC knowledge and practicing skills among our participants. Therefore, it is recommended that IPC training should be implemented in the undergraduate medical curriculum with greater emphasis on practicing skills.

Mysterious Outbreak of Acute Neurological Syndrome in Eluru, Andhra Pradesh, India: A Post-outbreak Geo-Spatial Analysis.

BACKGROUND: An outbreak characterized by sudden-onset seizures, loss of consciousness, and complete recovery within a few hours was reported from Eluru town in Andhra Pradesh on December 6, 2020. This study was conducted to assess the environmental correlates of the outbreak using geo-mapping tools. METHODS: A post-outbreak survey was conducted among affected cases in January-February, 2021. A house-to-house survey tool collected information on demographics, clinical profile, and environmental and psychological aspects (Impact of Event Scale). Geo-mapping and news media content analyses were done using QGIS and Atlas.ti software, respectively. RESULTS: A total of 394 cases were studied. The median (interquartile range [IQR]) age of the participants was 27 (17-39) years and comprised mostly male students. There was no clustering of cases within 48 hours of illness onset in the spatial analysis. Loss of consciousness was the first (50.7%) and the most common symptom. All cases were taken to a health facility and were discharged after a median duration of 48 minutes. COVID-19-related and environmental practices were not associated with the clinical manifestations. Awareness about pesticides was low. The outbreak reportedly had a psychological impact on 24.4% of the participants. The most common co-occurring themes in the news media analysis were water contamination and pesticides. CONCLUSION: The geo-spatial analysis did not find case clustering or points of convergence during the incubation period. The geo-locations did not distribute around water bodies or suspected landmarks although news media projected water contamination and pesticides as probable causes of the outbreak.

Exploring Unknown Predictors of Maternal Anemia Among Tribal Lactating Mothers, Andhra Pradesh, India: A Prospective Cohort Study.

Introduction: Anemia is a serious public health issue in India, especially among women, adolescent girls, and young children. Tribal people reside mostly in remote underserved regions with little or no basic civic amenities which makes them a highly vulnerable group of Indians. The study aimed to identify unknown risk factors for anemia among tribal lactating mothers. Methodology: It was a mixed method prospective cohort study for 10 months carried out among 340 scheduled tribes (ST) mothers in 10 clusters in Guntur district, Andhra Pradesh, India. Data collection using a questionnaire, 24 hours dietary recall, anthropometric measurement, and hemoglobin estimation was done. Weekly local recipe talk in the mother's kitchen, informal group discussions, was conducted for 12 weeks after baseline data collection. The audio and video tapes of the weekly local recipe talk in the mothers kitchen were transcribed verbatim and then translated into English. The individual responses were grouped as barriers related to acceptability, availability, accessibility, use and utilization, appropriateness, and nutrition environment. Results: A total of 340 mothers were enrolled initially of which 315 mothers were studied in an end-line survey with an attrition rate of 7.3%. Over 80% mothers belonged to Yerukula, Yenadis, Lambadi/Sugali tribes, respectively. A total of 345 weekly local mother kitchen recipe talks were conducted in 10 clusters. In the present study, only few mothers mentioned food accessibility and availability issues. Surprisingly, lack of skill to cook the commonly consumed local food item among Indian mothers were recorded. Lack of time for cooking, lack of knowledge of nutritious benefits of food, and use of ready to eat food were other important key findings. Conclusion: The study documents initiation of transition of the tribal lactating mothers towards urbanization. The lack of knowledge of cooking, coupled with lifestyles of urban areas exposes the early aged, poor, low literate mothers to the trap of anemia.

Concept maps in immunology: A metacognitive tool to promote collaborative and meaningful learning among undergraduate medical students.

Introduction: Concept maps are graphical representations of knowledge that connect concepts, ideas, and relationships. The present study aims at assessing the perception of medical students in utilization of concept maps as a tool to foster their lifelong learning skills in immunology. Methods: The current study was approved by Institutional Ethics and Review Committee. Third-year undergraduate (MD3) medical students of the academic year 2021-22 were sensitized about the concept map study and included after obtaining their informed consent. The students worked in teams to find answers and link the different words or phrases of the concept maps. At the end of the immunology course, students' perception on concept map-based learning strategy was assessed. A pre-designed, self-administered questionnaire, pre-validated by subject experts for relevance and feasibility, was used for the study. The questionnaire included some quantitative questions assessed by using 3-point Likert Scale and an open-ended question to receive students' comments on concept map-based learning strategy. The responses were collected and analyzed using SPSS version 22. Descriptive statistics was used for the quantitative variables, tabulated as numbers and percentages while the qualitative data was analyzed by thematic analysis. The quantitative data results were prioritized but supported by students' comments on open ended question. Results: Out of 133 eligible participants, 109 students who volunteered and completed the study were included. Majority of our participants (>80%) welcomed the concept map-based learning strategy. Almost 4 out of 5 expressed that concept maps are interesting and enjoyable, encourage active participation, peer discussion, and enhance critical thinking and problem-solving skills. More than 80% of the students agreed that concept maps promoted deep understanding of the topic and lifelong learning. Nearly 3 out of 4 students suggested including concept maps in many immunology topics in future. Majority of students penned down positive comments indicating concept map tool facilitates metacognitive skills. Conclusion: From the study, it can be concluded that concept maps are effective active learning strategies to improve the metacognitive domain of medical students in immunology course, thus assisting them to become better lifelong learners.

New normal of academic virtual conference: Imperative during pandemic.

In COVID pandemic, attending the continuing medical education, workshops, and conferences with physical attendance is not possible. We designed, developed, and hosted the first of its kind academic virtual/online conference at par with an in-person academic conference to disseminate the expertise of the renowned subject experts along with researchers to present their research work due to the ongoing pandemic. We, in this article, had summarized the most critical steps in order to make the process easier for first-timers while providing our more comprehensive walkthroughs on each step. We choose a live session of the speakers on the Zoom meeting mode to retain the atmosphere of a live conference. WhatsApp, Google (Google Meet and E-mail), and Kahoot were other platforms to communicate with speakers, researchers, and participants to seamlessly participate. A number of advantages in terms of protection for delegates/speakers and their families came from the Virtual Conference on Nutrition and Health, restricting the spread of COVID-19, low budget for organizers, economically much cheaper alternatives both for speakers and participants, dissemination of knowledge, time productive, and meeting research paper presentation eligibility for a professional course. When one is new to technology, try adding an innovative aspect as a starting point to future virtual and in-person events, and seeing how it works is imperative. Ensuring Internet bandwidth, updated hardware, or webcam and/or microphone functionality at the participant end is critical.

Storm of a rare opportunistic life threatening mucormycosis among post COVID-19 patients: A tale of two pathogens.

Mucormycosis is a rare but life-threatening opportunistic fungal infection caused by a group of molds that belong to Zygomycetes of the order Mucorales. These fungi are found in the environment such as soil, decaying vegetation, and organic matters. Sporangiospores present in the environment enter the human body through inhalation or direct skin inoculation by trauma or ingestion and result in pulmonary, cutaneous, and gastrointestinal mucormycosis, respectively, in immunocompromised hosts. Patients with uncontrolled diabetes, hematological malignancies, high-dose glucocorticoid therapy, iron overload, and organ transplantation are at high risk of acquiring mucormycosis. The second wave of severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] affected India severely with the highest number of cases and deaths compared to all other countries. Additionally, the country was affected by emergence of rare but life-threatening mucormycosis. Currently, many coronavirus disease 2019 patients with underlying risk factors such as uncontrolled diabetes, high-dose steroid therapy, and exposure to mechanical ventilation have developed mucormycosis. Inhalation is the most common mode of transmission that results in colonization of sporangiospores in the nose. In immunocompromised host, sporangiospores germinate, and subsequently form hyphae. These hyphae invade into tissues, and produce tissue infarction, necrosis, and thrombosis. Angioinvasion causes hematogenous dissemination to many organs, predominantly to brain, that result in rhino-orbital-cerebral mucormycosis. Clinical characteristics, radio imaging, fungal culture, histopathology, and molecular techniques are the key diagnostic methods. Surgical intervention and aggressive antifungal therapy are the main management strategies. Amphotericin B is the drug of choice for treatment of mucormycosis, whereas posaconazole or isavuconazole is used for step-down therapy and salvage therapy.

Learning out of the box: Fostering intellectual curiosity and learning skills among the medical students through gamification.

BACKGROUND: Gamification involving application of elements of game play that provides unique opportunities to learners to sail through complex medical concepts is gaining importance in medical education. The current study was aimed at assessing the perception of medical students regarding checkerboard game in enhancing learning process. MATERIALS AND METHODS: The present prospective cross-sectional study was conducted at the microbiology department. The fifth-year medical students of the academic year 2018-19 were the participants. Pre- and post-test scores and self-administered questionnaire regarding effectiveness of the checkerboard game-based learning were used as assessing tools. The data were collected, tabulated, and statistically analyzed using SPSS version 20. The pre- and post-test scores of students were statistically analyzed using paired t test. A descriptive analysis on the 3-point Likert scale of effectiveness survey was measured and expressed in percentages. RESULTS: In total, 124 fifth-year medical students participated in the study. Majority (89.5%) of them liked the game, nearly 86% opined that game was enjoyable and created interest. Approximately 88% indicated game helped them to understand the topic, enhanced learning, and thus improved the knowledge. Most students (79%) also believed that game encouraged critical thinking and problem solving, while 75% felt that it improved their communication skills. Around 70% felt that game was also useful for exam preparation and nearly 90% recommended to use the game more frequently. CONCLUSION: From the results of the study, it can be concluded that checkerboard game-based learning method is effective in fostering learning process and cognition of medical students in the microbiology course.

Are Online Synchronous Team-Based-Learning (TBL) pedagogy effective?: Perspectives from a study on medical students in Oman.

INTRODUCTION: Team-based learning (TBL) is a highly structured, instructive, and student-focused pedagogy used by medical educators to foster the students' learning. The present study aimed to qualitatively explore the students' perception of the effectiveness of online synchronous TBL pedagogical strategy in promoting learning outcomes. METHODS: A cross-over interventional study was conducted on MD4 year medical students, using four modified TBL sessions on common immunological diseases on four different dates. 139 participants were divided into 4 groups [35 each in A, B, C, & 34 in D]. For TBL session 1, Group A and group B were the study and control groups, respectively. For the second session on different topics, the groups were reversed with group B and group A as the study and control groups, respectively. The same was followed for groups C and D. The means and standard deviations of the pre-test and post-test scores were compared after calculating the improvement in scores from pre- to post-tests. Repeated measures ANOVA suitably coded in SPSS for cross-over design was used to find out confounding by sequence of interventions with a p-value of <0.05 signifying the significance.  Students' feedback on online TBL sessions was collected through a predesigned questionnaire on a 3-point Likert scale. The data were analyzed using SPSS version 22 and expressed as number and percentage. RESULTS: The post-test scores of the students who participated in the TBL session were significantly higher when compared to the self-study (SS) arm. The overall improvement in scores was 4.98 (1.4) in TBL group, whereas in the SS arm it was only 2.29 (1.51). The new method was found far superior to the self-study method regardless of being applied before or after the comparison mode of self-study (P<0.0001). The scores of the self-study was marginally better when offered first rather than after a TBL session, indicating the negative effect of cross-over on SS mode (P=0.024). The overall response of our students toward the effectiveness of online TBL pedagogy was overwhelmingly positive in terms of an opinion survey which had a Cronbach's alpha of 0.932. The majority (>80%) perceived TBL as an enjoyable active session that promoted their active participation and engagement through student-led discussions. Many stated that TBL enhanced their critical thinking, problem-solving ability, communication skills, and knowledge. CONCLUSION: TBL is an instructive and highly structured teaching-learning strategy, welcomed by the majority of our participants. Online TBL sessions are effective in fostering the students' learning and can be used confidently when needed.

Encouraging students' engagement and promoting deep learning in immunology through an interactive clinical case problem-solving (CCPS) approach: Perception among cohort of medical students in Oman.

BACKGROUND: Modern competency-based medical education emphasizes student-centered teaching-learning strategies where students take responsibility of their own learning. Student-centered approaches facilitate multifaceted learning such as observation, critical evaluation, analysis, deeper understanding, and application of knowledge. The current study aims at assessing the students' perception on utilization of clinical case problem-solving approach (CCPS) to promote their lifelong learning. MATERIALS AND METHODS: The present cross-sectional study was conducted at College of Medicine and Health Sciences (CoMHS) during the year 2021-2022. MD3 students of the academic year 2021-2022 were the study participants. The study was approved by institutional Ethic and Review Committee. Students' performances were assessed through pre-test and post-test performances. Students' feedback was collected through a predesigned questionnaire on a 3-point Likert scale. Cronbach's alpha coefficient test was used to assess the reliability of the questionnaire. The data was entered to Microsoft Excel and analyzed using SPSS software version 22. Paired t-test was used to compare pre-test and post-test scores and the data was expressed as numbers and percentages. RESULTS: In total, 103 participants were included in the study. Post-test scores were significantly higher compared to pre-test scores (p < 0.05). Questionnaire results showed that CCPS approach was accepted as an effective learning strategy. Majority (>90%) of the students expressed CCPS approach was interesting, motivated to learn, encouraged peer discussion, enhanced knowledge, and clarified their topic-related doubts. More than 80% students opined that CCPS enhanced their critical thinking, problem-solving ability, deep learning, and lifelong learning skills. Nearly 90% of the students suggested for including such sessions for more topics in immunology course in future. CONCLUSION: From our study results, it can be concluded that CCPS is an effective learning strategy to encourage students' engagement and promote their deep learning skills.

Effectiveness of weekly local mothers' kitchen recipe talks to improve dietary iron intake among tribes of Andhra Pradesh, India: A prospective cohort study.

Introduction: Anemia is a major public health problem in India, especially among tribal women. The study was done to estimate the prevalence of iron intake below the estimated average requirement in the diet and to study the effectiveness of weekly local mothers' kitchen recipe talks. Methodology: A total of 340 women from scheduled tribes participated in a prospective cohort study over 10 months in 10 clusters in the Guntur district of Andhra Pradesh, India. A questionnaire, a 24-hour dietary recall, and an assessment of hemoglobin were done to gather information at baseline and after three months of weekly local recipe talks in mothers' kitchens. Results: A total of 340 women were studied. The mean age of the mothers was 23.5 ± 3.6 years. At baseline prevalence, the mean intake of daily iron in diet among mothers was 9.04 ± 3.18 (SD) mg/day. The prevalence of anemia among mothers at the baseline was 63.8%. The mean intake of daily iron in the diet at the end line was significantly higher with a P value of 0.019 among mothers who attended 10 or more weekly local mothers' kitchen recipe talks and did not take iron folic acid (IFA). Mothers who attended 10 or more weekly local mothers' kitchen recipe talks without IFA intake have a significant drop in the prevalence of severe anemia. Conclusion: The integration of weekly local mothers' kitchen recipe talks in the ongoing Integrated Child Development Service Scheme can be a boon for early-aged, less-literate, inexperienced, and financially poor mothers.

Spice Intake Among Chronic Gastritis Patients and Its Relationship With Blood Lipid Levels in South India.

INTRODUCTION: Chronic gastritis is one of the most prevalent disorders affecting individuals. It affects hundreds of millions of people in different ways around the world. The objective of the study was to estimate the spice intake and its relationship with the blood lipid level among patients with chronic gastritis in the outpatient department of tertiary care hospital. METHODOLOGY: The study design was a hospital-based cross-sectional study that was done in the Guntur district of Andhra Pradesh. The study population included 208 chronic gastritis patients between 20 and 60 years of age selected by systematic sampling. Detailed information on sociodemographic and lifestyle factors was collected using a questionnaire. Individual dietary intake data were collected by the detailed 24-hour dietary recall. Spice intake was calculated using Diet Calc Software. An independent t-test was used as a test for significance. The correlation was used to study the relationship between spicy food intake and dyslipidemia. P-value <0.05 was significant. RESULTS: A total of 208 patients were enrolled in the study with a response rate of 91%. The mean age of the studied patients was 45.15 ± 9.27 years, with 46.6% males and 53.4% females. Almost half (45.7%) of the participants had "mild" spicy food in their diet and almost two-fifths (39.9%) of participants had a "moderate or middle" degree of spice in their food. The mean dietary intake of condiments and spices by the participants was 34.19 (±22.18) gm/day. The current study showed higher spice intake was significantly correlated with impaired lipid profile levels with Kendall's tau_b correlation coefficient of 0.17 (p=0.01). CONCLUSION: Because of the excessive use of spices in the Guntur region of Andhra Pradesh, people have grown accustomed to eating spicy food since childhood and therefore is at a higher risk of developing chronic gastritis, and dyslipidemia.