Perception of first year MBBS students on objective structured practical examination as an assessment tool in biochemistry

Background: It is an undeniable fact that assessment drives learning. It is documented that traditional practical examination has several drawbacks. Further, the subjectivity also affects the correlation negatively between marks awarded by different examiners and therefore on the performance of an equivalent candidate. The objective of objective structured practical examination (OSPE) is to reduce the chances of examiner bias and assess the students� skills. Aim was to introduce objective structured practical examination (OSPE) as a method of assessment of practical skills in Biochemistry and to determine the perception of students� regarding OSPE. Methods: It is a qualitative, observational study conducted at Department of Biochemistry, Assam Medical College, Assam, India. The first Professional MBBS students were evaluated by using OSPE to assess their practical perspective in Biochemistry. A pre-validated questionnaire-based on a 5-point Likert scale and descriptive type on various components of the OSPE was administered to get the feedback. Statistical analysis used: Microsoft Excel and GraphPad Prism 8 software were applied. Results: Most of the students favoured OSPE as an assessment tool. About 82% of students agreed that OSPE helps to score better; 62.3% stated that OSPE eliminates bias in exams; 91.6% supported OSPE to be incorporated as a formative assessment. Conclusions: The study favours OSPE as a reliable assessment tool for practical examination in biochemistry. OSPE is more objective and eliminates examiner bias and helps to evaluate all three learning domains - cognitive, psychomotor and affective domains.

A comparative study of dexmedetomidine and fentanyl as adjuvants to ropivacaine on analgesic efficacy in supraclavicular brachial plexus block

Background: Various adjuvants have been added to improve the quality of the supraclavicular brachail plexus block and prolong postoperative analgesia. The aim of the present study was to compare the onset and duration of sensory and motor blockade provided by dexmedetomidine and fentanyl as adjuvants to ropivacaine in such block. Methods: In this study 60 patients with American Society of Anesthesiologists grade I/II scheduled for elective upper limb surgeries were randomly allocated into two groups. Group A received 30 mL of 0.5% ropivacaine with 1 µg kg-1 dexmedetomidine, and group B received 30 mL of 0.5% ropivacaine with 1 µg kg-1 fentanyl for supraclavicular brachial block. The onset and duration of sensory and motor block and adverse events during the perioperative period were noted. Results: The onset of sensory and motor blockade was 13.47±1.73 min and 22.87±2.27 min respectively in the dexmedetomidine group and 14.80±2.20 min and 24.33±2.63 min respectively in the fentanyl group which was statistically significant (P<0.05). The duration of the sensory blockade was significantly higher in the dexmedetomidine group as compared with fentanyl (826±58.29 vs 592±51.62 minutes, p< 0.0001). Conclusions: Dexmedetomidine provides faster onset of sensory and motor block with longer duration of block as compared with fentanyl when used as an adjuvant with ropivacaine in supraclavicular brachial plexus block without any significant side effects.

Six-minute walk test for assessment of work capability in patients with chronic obstructive pulmonary disease: A cross-sectional comparative study

Background: Chronic obstructive pulmonary disease (COPD) is a systemic disorder causing morbidity, disability, and mortality throughout the world. Although, spirometry parameters have been used for decades to diagnose COPD as well as to grade the severity of this disease, others factors such as the BMI, degree of inflation, and exercise capacity have become important outcome measures for extra-pulmonary manifestations. The 6-min walk test (6MWT) is considered as a simple test to assess the functional capacity of COPD patients. The aim of our study was to implement 6MWT in patients of COPD in our setup to predict morbidity. Aims and Objectives: The objective of our study was to implement 6MWT in patients of COPD in our setup to predict morbidity. Materials and Methods: A cross-sectional comparative study was conducted on thirty COPD patients and thirty control subjects. All the subjects were investigated through history taking, clinical examination, spirometry, and 6MWT in the Department of Physiology, R.G. Kar Medical College and Hospital, Kolkata. Statistical analysis was done by SPSS version-21. Results: The values of the spirometry parameters were significantly reduced in cases than in the controls (P < 0.05). The values of 6-min walk distance as well as 6-min work (6MWORK) were also significantly reduced in cases than in the controls (P = 0.0023 and P = 0.0028, respectively). A strong positive correlation was found between forced vital capacity and 6MWORK (r = 0.556), BMI, and 6MWORK (r = 0.84) in patients of COPD. Conclusion: Our study substantiates that 6MWT can be implemented in our set up to assess the work capability and thus to predict morbidity in patients of COPD.

Study of heart rate variability to assess autonomic dysfunction in patients with chronic obstructive pulmonary disease of a tertiary care hospital of West Bengal: A cross-sectional comparative study

Background: Chronic obstructive pulmonary disease (COPD) is one of the major causes of morbidity and mortality throughout the world. COPD and its complications also lead to a large number of deaths every year in our country. Cardiac arrhythmias and sudden cardiac death are the major complications of COPD leading to death and disability. Such cardiac complications are often a result of autonomic dysfunction. Aims and Objectives: This study aims to find out the autonomic dysfunction in moderate COPD patients by comparing their heart rate variability (HRV) parameters with age and sex matched healthy controls. Materials and Methods: After obtaining approval from the Institutional Ethics Committee, 48 patients of moderate COPD and 54 healthy subjects were assessed and compared with respect to their HRV parameters which included Mean RR, Mean HR, SDNN, NN50, pNN50, root mean square of successive differences (RMSSD), high frequency (HF), low frequency (LF), LF/HF ratio, and SD2/SD1 ratio. Results: It was found that in comparison to healthy controls, patients of moderate COPD had significant alteration in the following HRV parameters – Mean HR (P: 0.001), RMSSD (P: 0.002), SDNN (P: 0.015), NN50 (P: 0.001), pNN50 (P: 0.000), HF (NU/normalized unit) [P: 0.033], HF (%) [P: 0.002], LF (NU/normalized unit) [P: 0.033], LF (%) [P: 0.012], and LF/HF (P: 0.033). Conclusion: As there is a significant alteration of several HRV parameters in moderate COPD patients, we conclude that HRV measurement may subserve as a simple and non-invasive tool to assess autonomic dysfunction in patients of COPD at the earliest.

Are Parents Willing to Vaccinate Their 6- To 11-Year-Old Children Against COVID-19? A Community Based Study in Murshidabad, India

Context/Background: The future of Corona virus disease is still uncertain due to viral mutations. Immuniza-tion against COVID-19 has not yet been introduced for children aged 6-11 years. Parents are instrumental for the success of any immunization programme, being the chief decision makers for their wards. The study aims to assess the perceptions of parents regarding COVID 19 vaccination among children aged 6-11 years in an urban slum of Murshidabad and identify the factors influencing such perceptions among them. Methodology: A cross sectional study was conducted among 106 parents in a slum area of Murshidabad, West Bengal. Participants were interviewed using a validated WHO Vaccine Hesitancy Scale (VHS). Bivariate and multivariable analysis were done using Chi square test and binary logistic regression respectively. Results: Majority of the study subjects instead of parents were unlikely to vaccinate their children against COVID-19. The major concern centered around the safety (73.5%) of the vaccine. Higher level of education (p=0.003), previous history of COVID-19 infection in the family (p=0.004) and having a children aged between 6-8 years (p=0.006), influenced such perceptions, with the latter being the single most important predictor (AOR 4.126, P=0.007). Conclusions: The likelihood of parents to vaccinate their child was found to be low. This underscores the im-portance of an effective communication strategy when such programme will be rolled out.

Prediabetes, dyslipidemia and c-reactive protein levels among stroke patients: a hospital-based study in north-east India

Background: Stroke is defined as an abrupt onset of a neurologic deficit lasting for more than 24 hours that is attributable to a focal vascular cause. Hyperglycemia and dyslipidemia are often documented in stroke patients. Elevated CRP level is independently associated with the excessive risk of ischemic stroke. Aim and Objectives were to evaluate the glycemic status, lipid profile and c-reactive protein level in stroke patients admitted in a teaching institute of north-east India. Methods: A cross-sectional hospital-based study conducted in the department of medicine, Agartala Government Medical College and GBP hospital, within a period of January 2020 to June 2021. Data were analyzed by SPSS software version 15 using appropriate statistical tests. Results: Among 200 patients of stroke, 50% was found to be pre-diabetic, 40% known diabetic and 10% newly diagnosed diabetic. 60% were hypertensives. Among them, 80% had ischaemic stroke and 20% hemorrhagic stroke. 70% of the patients had hypercholesterolemia, 60% had hypertriglyceridemia. 80% had raised serum LDL and 57% decreased serum HDL. Out of 200 patients, 60% was found to have raised serum CRP level. 55% of ischaemic stroke patients and 5% of hemorrhagic stroke patients had raised CRP level. Conclusions: Prediabetes and newly diagnosed diabetes are highly prevalent in patients with stroke or TIA. As the prevalence of prediabetes is growing rapidly, prediabetes might become one of the most important modifiable therapeutic targets in both primary and secondary prevention. Early detection of dyslipidemia and treatment with drugs along with dietary modifications and lifestyle changes can reduce the risk of stroke. Since, it was a cross-sectional study, these results need to be validated by further long-term prospective studies.

A note on the insecticide susceptibility status of secondary malaria vector An. annularis in Jharkhand state of India

Background & objectives: An. annularis van der Wulp (1884) is the secondary malaria vector of importance in India. In Jharkhand state it is present in almost all the districts abundantly and transmits malaria. The development of resistance to Dichlorodiphenyltrichloroethane (DDT) in An. annularis was reported from various parts of India. The main objective of this study was to generate information on insecticide susceptibility status of An. annularis to DDT, malathion, deltamethrin and permethrin in different districts of Jharkhand state. Methods: Adult An. annularis female mosquitoes were collected form villages of six tribal districts Simdega (Kurdeg and Simdega CHC), Khunti (Murhu and Khunti CHCs), Gumla (Bharno and Gumla CHCs), West Singhbhum (Chaibasa and Bada Jamda CHCs), Godda (Poraiyahat and Sunderpahari (CHCs) and Sahibganj (Borio and Rajmahal CHCs). Insecticide susceptibility status was determined by using WHO tube test method against prescribed discriminatory dosages of insecticides, DDT - 4.0%, malathion - 5.0%, deltamethrin - 0.05% and permethrin - 0.75%. Results: An. annularis was reported resistant to DDT in six districts, possible resistant to malathion in districts Gumla, Khuntiand Sahibganj and susceptible to deltamehrin (98% to100% mortality) and permethrin (100% mortality). Interpretation & conclusion: An. annularis, the secondary vector species is associated with the transmission of malaria reported resistant to DDT and susceptible to pyrerthroids deltamethrin and permethrin. In view of large-scale distribution of long-lasting insecticidal nets (LLINs) in all the districts, the response to synthetic pyrethroid needs to be periodically monitored to assess the effectiveness.

Perinatal and Fetal Autopsies in Neuropathology: How I do it

Fetal and perinatal autopsies are useful to identify the accurate cause of death and in the process recognize disorders which may require counselling for future pregnancies. Abnormalities of the CNS are an important cause of fetal loss and perinatal deaths. Most of these are structural abnormalities of the CNS, however a smaller portion show changes pertaining to prematurity, infections and even congenital tumors. In this review we evaluate CNS abnormalities of the fetus and the newborn as detected in autopsy series. We also describe our experience in a tertiary care hospital with a specialized neonatology unit over the last 8 years and discuss some of the newer methods like virtual autopsy.

COVID Vaccine Hesitancy among the Tribal Population and Its Determinants: A Community-Based Study at Berhampore Block of Murshidabad District, West Bengal

Background: On January 16, 2021, India rolled out the COVID vaccination drive. A successful and effective vaccination campaign requires much more than the availability of a safe and effective vaccine. This includes identifying vulnerable populations with lower vaccine confidence and identifying the drivers of vaccine hesitancy. Objective: This study aims to find out vaccine hesitancy among the tribal population regarding COVID‑19 vaccination. Methods: It was an observational descriptive cross‑sectional study, conducted at Manindranagar and Hatinagar gram panchayat of Berhampore Block of Murshidabad district, West Bengal, from June 2021–November 2021, among tribal people aged >18 years. A total of 198 tribal people were selected by applying the probability proportional to size sampling method. Participants were interviewed using predesigned, pretested, and semi‑structured schedules. Potential predictors of hesitancy were investigated using the multivariate logistic regression model. Results: Vaccine hesitancy was present among 36.9% of the study participants. Fear of side effects (78.1%) was the most common reason of vaccine hesitancy. Only 30.8% of them received at least one dose of vaccine. Vaccine hesitancy was associated with decreased family income in the last 1 year (adjusted odds ratio [AOR] = 8.23), knowledge regarding vaccine (AOR = 0.41), adherence to COVID‑appropriate behavior (AOR = 0.45), and trust on the local health‑care worker (AOR = 0.32). Conclusion: Vaccine hesitancy among the tribal population is driven by a lack of knowledge and awareness. Their economic status, attitudes toward the health system, and accessibility factors may also play a major role in vaccine hesitancy. Extensive information, education, and communication activity, more involvement of health‑care workers in the awareness campaign, and establishment of vaccination centers in tribal villages may be helpful.

Factors Influencing Contribution of Geriatric Persons in the Society: A Glance from a Rural Area of West Bengal

Background: To facilitate healthy aging in India, it is important not only to acknowledge older people’s contribution but also to understand their perception regarding their impact in the society along with society’s attitude toward them. Objectives: This study aims to assess their self‑perceived contribution in the society and the factors related with their contribution. Methods: It was an observational, descriptive, cross‑sectional study, conducted at Amdanga block of North 24 Parganas district, West Bengal, during July 2021–June 2022. A total 0f 384 geriatrics were interviewed by the house‑to‑house survey with the help of a predesigned, pretested and semi‑structured schedule. Potential predictors of contribution were investigated using the multivariate logistic regression model. Results: 78.9% of participants had contribution in the society. 85.9% were taking care of family members when they were sick. 93.2% were sharing their opinion with the family members. 86.5% were participating in various social works. 79.1% were suffering from at least one physical health problem. With increase in the number of health problems, chances of good contribution decreases. In case of self‑perceived contribution in the society family type, employment, physical health and social participation are influencing the most. Conclusion: Elderly people are taking care of not only family members, but even relatives and neighbors also. They are sharing their knowledge and experience with family members and in the society. They are also contributing financially. Employment and proper health‑care infrastructure for geriatric may be helpful to maximize their contribution.

Variability in Colletotrichum infecting chilli plants of Andaman and Nicobar Islands, India

Aim: The aim of the present study was to understand the basic pathogen dynamics of Colletotrichum species infecting chilli crop in the Andaman and Nicobar Islands for disease management practices. Methodology: Twenty fungal isolates associated with chilli (Capsicum annuum) anthracnose disease from diverse locations of tropical Andaman, India were characterized using polyphasic approaches. Results: Upon morphological studies, out of twenty isolates, fourteen isolates were found chromogenic and eleven showed concentric ring pattern of mycelial growth. Based on conidial morphology, the isolates were grouped into two species (C. capsici and C. gloesporioides). The pathogenicity tests on three chilli varieties revealed difference in the pathogenic potential among the collected isolates. The sequence analysis using internal transcriber spacer (ITS) region revealed the presence of two other species C. siamense and C. plurivorum, in addition to C. gloesporioides and C. capsici. Interpretation: The present study revealed the presence of high level of genetic and pathogenic variability among the Colletotrichum isolates infecting chilli in Andaman Islands.

Retiform hemangioendothelioma: An uncommon vascular neoplasm

Retiform hemangioendothelioma is a rare vascular neoplasm of intermediate grade, the diagnosis of which can be challenging. We report a case of 35-year-old man with swelling in the postauricular region. He had undergone FNAC which had revealed blood only. Microscopic examination showed narrow, arborizing, vascular channels resembling normal rete testis. Evidence of mitoses or cytological atypia were lacking. Immunohistochemistry showed diffuse and strong staining for CD34 along with CD31 positivity. Immunostains for D240 and GLUT1 were negative. A diagnosis of retiform hemangioendothelioma was made. Histologically, it should be distinguished from Kaposiform hemangioendothelioma, Dabska tumor, epithelioid hemangioendothelioma, and angiosarcoma.

Ayurvedic management of Ulcerative Keratitis – A case report

Ulcerative Keratitis is a sight-threatening corneal infection. It is one of the most common global causes ofirreversible blindness due to corneal diseases. This case report highlights the potential of Ayurvedicmanagement in nonresponding ulcerative keratitis. A 20 year old boy came to the outpatient departmentwith redness, discharge, photophobia and defective vision in the right eye since 4 months following aforeign body injury. He was treated at leading ophthalmic hospital for keratitis but due to poor responsewas suggested keratoplasty and the patient had opted for Ayurvedic treatment. He was initially treated inthe OPD and since he started responding well to treatment, he was admitted in the hospital. He underwent Jaloukavacharana, Snehapana, Virechana, Nasya, Anjana, Tarpana and Putapaka. He wascompletely relieved of pain, redness, discharge, photophobia. His BCVA was hand movements at the timeof the first visit and it improved to 6/24 at the time of discharge. Ayurveda has an important role to playin infective eye diseases which needs to be explored scientifically.© 2018 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Obstetric fistula: A challenge to public health

Obstetric fistula (OF) is one of the most important consequences of a prolonged obstructed labor, a big issue for low-income countries (LICs) like India. The objective is to identify and explore the knowledge regarding OF as a public health problem in LICs from peer review literature. The PubMed, Google Scholar, and Science Direct databases were searched to identify the prevalence, risk factors, and management of OF in LICs. Quantitative evidence-based paper reviewed. Twenty-seven articles met the inclusion criteria. The 15 provided population-based OF prevalence data of OF and 12 provided risk factors and social causes of OF rates associated with the birth that caused an OF. OF has one of the big public health problems. There is a lack of scientific research on the prevalence and risk factors of OF in LICs. This review helps to eradicate or alleviate the problem of OF in LICs like India.

Adaptation of 2016 European Society of Cardiology/European Atherosclerosis Society guideline for lipid management to Indian patients – A consensus document

In the year 2016, European Society of Cardiology/European Atherosclerosis Society (ESC/EAS) guidelines provided recommendations on dyslipidemia management. The recommendation from these guidelines are restricted to European subcontinent. To adapt the updated recommendations for Indian subset of dyslipidemia, a panel of experts in management of dyslipidemia provided their expert opinions. This document provides expert consensus on adapting 2016 ESC dyslipidemia guidelines recommendations in Indian setting. The document also discussed India-specific relevant literature to support the consensus opinions provided in management of dyslipidemia.

Molecular characterisation and phylogenetic analysis of dengue outbreak in Pasighat, Arunachal Pradesh, Northeast India

Background and Objectives: Dengue is one of the most prevalent arboviral diseases in the world with 390 million dengue infections per year. In this study, we report the molecular characterisation of dengue outbreak in Pasighat, Arunachal Pradesh, Northeast India during 2015. Subjects and Methods: A total of 613 dengue-suspected cases were screened for dengue virus by dengue NS1 Ag and anti-dengue IgM antibody depending on the duration of sample collection and onset of symptom. Further, molecular characterisation was done by amplifying the C-PrM region by real-time polymerase chain reaction followed by phylogenetic analysis. Results: Molecular characterisation revealed that the dengue outbreak was predominantly due to dengue virus serotype-1 (DENV-1) (90.9%) while DENV-2 was detected in 7.5% of samples. Co-infection of DENV-1 and DENV-2 was detected in one case. Phylogenetic analysis of the DENV-1 strains with the prototype revealed that the DENV-1 strains were grouped within genotype III. Similarly, DENV-2 strains were clustered within genotype IV. The study revealed a change in the predominant serotype in recent years with DENV-3 in 2012 to DENV-1, 2, 3 and 4 in 2014 to DENV-1 in 2015 in the study region. A unique L24M mutation was observed in the DENV-1 strains of Arunachal Pradesh which was absent in all the circulating strains in India except one strain from the state of Kerala in South India. Marked variation within the DENV-2 strains was observed at A102V and I163V in one strain similar to earlier circulating isolates in India. Conclusions: The present study reveals a shift in the serotype dominance in the study region. As serotype shifts and secondary infection with a heterologous DENV serotype are frequently associated with disease severity, there is an urgent need for sustained monitoring of the circulating serotypes and enhanced surveillance operations, especially in the monsoon and post-monsoon periods to prevent large-scale, severe dengue outbreaks in this region.

Ocular manifestations of isolated corneal bee sting injury, management strategies, and clinical outcomes

Purpose: The purpose of this study is to describe the presenting features, management strategies, and clinical outcome following bee sting injury to the cornea. Methods: Retrospective case series involving 11 eyes of 11 patients with corneal bee sting injuries who presented over a period of 2 years. Nine of these 11 eyes had the presence of intact bee stinger in the cornea, which was removed immediately under an operating microscope and sent for microbiological and histopathological evaluation. The patients were managed as per the individual treatment protocol of the respective treating physicians. Results: Six eyes (54.5%) had a good clinical outcome (best-corrected visual acuity [BCVA] >20/40) with medical therapy alone with no need for surgical intervention. Five eyes (45.5%) had a poor clinical outcome (BCVA <20/40) with medical therapy and required surgery; of which three required a combined penetrating keratoplasty with cataract surgery, while one required isolated cataract surgery and one underwent penetrating keratoplasty. Glaucoma was present in 3/5 eyes undergoing surgery, one of which required a trabeculectomy. Five of the six eyes who had a good clinical outcome with medical therapy alone had been treated with concomitant oral steroids, along with topical antibiotic-steroid combination therapy. Conclusion: Oral corticosteroid supplementation to the topical steroid antibiotic treatment in patients with corneal bee sting injury where corneal involvement and anterior reaction is severe at presentation or inflammation not ameliorating with topical steroids alone prevents serious vision-threatening complications such as corneal decompensation, cataract, and glaucoma.

Management protocols for chronic heart failure in India

Heart failure is a common clinical syndrome and a global health priority. The burden of heart failure is increasing at an alarming rate worldwide as well as in India. Heart failure not only increases the risk of mortality, morbidity and worsens the patient’s quality of life, but also puts a huge burden on the overall healthcare system. The management of heart failure has evolved over the years with the advent of new drugs and devices. This document has been developed with an objective to provide standard management guidance and simple heart failure algorithms to aid Indian clinicians in their daily practice. It would also inform the clinicians on the latest evidence in heart failure and provide guidance to recognize and diagnose chronic heart failure early and optimize management.

Genomic profile of antibiotic resistant, classical ctxB positive Vibrio cholerae O1 biotype El Tor isolated in 2003 and 2005 from Puri, India: A retrospective study.

Objectives: To examine eight strains of Vibrio cholerae O1 isolated in 2003 and 2005 from Puri, India, for antibiotic susceptibility, presence of virulence and regulatory genes, cholera toxin (CT) production, CTX arrangement and genomic profiles. Materials and Methods: Bacterial strains were tested for antibiotic susceptibility using disc diffusion assay. Polymerase chain reaction determined the presence of antibiotic resistance, virulence and regulatory genes. To determine the type of cholera toxin subunit B (ctxB), nucleotide sequencing was performed. Southern hybridisation determined the number and arrangement of CTXΦ. Ribotyping and pulsed‑field gel electrophoresis (PFGE) were used to determine the genomic profile of isolates. Results: All the eight strains, except one strain, showed resistant to nalidixic acid, sulphamethoxazole, streptomycin and trimethoprim and possessed the sullI, strB, dfrA1 and intSXT genes. All the strains carried the toxin‑co‑regulated pilus pathogenicity island, the CTX genetic element, the repeat in toxin and produced CT. Restriction fragment length polymorphism (RFLP) analysis showed that V. cholerae O1 possess a single copy of the CTX element flanked by tandemly arranged RS element. Nucleotide sequencing of the ctxB gene showed the presence of classical ctxB. RFLP analysis of conserved rRNA gene showed two ribotype patterns. PFGE analysis also showed at least three PFGE patterns, irrespective of year of isolations, indicating the genomic relatedness among them. Conclusion: Overall, these data suggest that classical ctxB‑positive V. cholerae O1 El Tor strains that appeared in 2003 continue to cause infection in 2005 in Puri, India, and belong to identical ribotype(s) and/or pulsotype(s). There is need to continuous monitor the emergence of variant of El Tor because it will improve our understanding of the evolution of new clones of variant of V. cholerae.