Merits and demerits of technical shift of biochemistry classes of medical undergraduates from classroom to online teaching in COVID-19 pandemic: A cross-sectional survey

Background: The ongoing global pandemic due to novel corona virus (SARS-CoV2) has jeopardized our lives from all corners. With the exponential growth of cases, even Medical institutes have curtailed physical classes and shifted to virtual classrooms. The medical graduates have exposure to online education due to vanguard of technology. However, in dwindling of COVID-19 struck economy in a developing country like India, all the medical graduates may not be privileged to have access the android phone or fast-streaming internet. Aims and Objectives: The purpose of this survey was to evaluate the impact and impression of online classes among facilitators and students. Materials and Methods: This cross-sectional study was conducted in the Department of biochemistry of Nil Ratan Sircar Medical College after obtaining Institutional Ethical Clearance. The students and faculties who voluntarily agreed to participate in the study were given a questionnaire. The responses were recorded in five-point Likert Scale. Results: Both the medical undergraduates and facilitators had a consensus opinion (0.61 and 0.71, respectively) that simultaneous access to multiple website is merit of e-learning. About 81.5% had a strong consensus opinion that there less chances of interaction with the facilitators. About 66.7% of facilitators either agreed or strongly agreed that there are hurdles to motivate the students in virtual platform. The ordinal logistic regression analysis revealed interaction with facilitators and easy of assessment is important predictors for successful outcome of online education. Conclusion: The study concluded that scope of interaction and self-motivation of the students remains to be cornerstone for the successful outcome of virtual teaching sessions. The outcome of this study may guide to identify lacunae and advantages of online methodologies in comparison to the physical classrooms.

A hospital-based study on COVID-19 patients with rhino-orbital mucormycosis

Coronavirus diseases 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 virus produce opportunistic fungal infections. Mucormycosis is an acute onset rapidly progressive fatal infection. Incidence of rhino-orbital mucormycosis raised during the second wave of COVID-19 pandemic in India. Diabetes, steroid therapy, cancer, prolonged hospitalization, and metabolic acidosis are the risk factors of post-COVID-19 mucormycosis. Objectives of this study were to suggest the risk factors, clinical features, investigations, and treatment of post-COVID-19 rhino-orbital mucormycosis. This study will guide the future research and the clinician will be aware about this complication of COVID-19. After getting permission from the Institutional Ethical Committee and consent from patients, we studied 10 cases of post-COVID-19 rhino-orbital mucormycosis from April to September 2021 during our duty in COVID-19 admission desk and COVID-19 ward in NRS Medical College, Kolkata. After taking history, we observed the clinical features, investigations, and treatment of the patients. Symptoms of the patients were nasal discharge, nasal block, headache, facial swelling, and blackish discoloration of skin. Most of the patients were diabetic. Magnetic resonance imaging (MRI)-PNS was showed sinonasal mass. Amphotericin-B was used and debridement was the main surgical procedure. Microscopy showed broad aseptate hyphae suggesting mucor. Early diagnosis and proper treatment will reduce the morbidity and mortality of the patient with post-COVID rhino-orbital mucormycosis.

A study to evaluate the outcomes of traditional lecture classes and self-directed learning sessions among the first MBBS students in the department of physiology

Background: To become lifelong learners, it is essential for medical students to develop self-directed learning (SDL) skills from early medical schools. Aim and Objective: The present study was conducted to compare the outcome of traditional lecture classes (LCs) and SDL sessions among the first MBBS students in the department of physiology. Materials and Methods: This pilot study was conducted over a period of 1 year in the department of physiology among the first MBBS students to compare the outcome of traditional LCs with SDL sessions. The first 12 traditional LCs were conducted among Group A (roll no. 1–100) and the first 12 SDL sessions were conducted among Group B (roll no. 101–200). For the rest 13 traditional LCs and SDL sessions, crossover of two groups was done, that is, traditional LCs were conducted among Group B and SDL sessions were conducted among Group A. Results: Students performed significantly better in the 3rd, 7th, 10th, 11th, 12th, 13th, 15th, 18th, 19th, 21st, and 22nd SDL sessions as compared to LCs in post-test sessions. Students performed significantly better in the 4th, 6th, 8th, 16th, 23rd, 24th, and 25th LCs as compared to SDL sessions in posttests. Students performed significantly better in post-test sessions as compared to pre-test sessions. Students were highly satisfied with the program (as per evaluation done by Kirkpatrick model: Level 1). Conclusions: The students were highly satisfied with the teaching-learning program implemented by the department of physiology and their performance was better following SDL sessions as compared to traditional LCs.

Detection Of Treatment Adherence, Disease Control and Its Predictors in Asthma Patients by Rural Community Level Health Workers

Background: Despite the availability of effective therapy, disease control in Asthma remains suboptimal with high morbidity. Objectives: To assess treatment adherence, asthma control and its influencing fac-tors.Methodology: A prospective, observational study was conducted among 152 adult asthma patients re-porting consecutively to a BPHC for twelve months. Patients were followed up by trained healthcare workers to assess their treatment adherence and disease control using a predesigned, pretested and val-idated questionnaire.Results: Mean age was 49.6 years (SD=+14.0), males reported more cases (73.7%), addiction to tobacco was high (48.7%). 40.8% patients had high treatment adherence. Only 37.5% patients reported good asthma control of which 68.4% showed high adherence. The mean Asthma Control Test (ACT) score was 18.75 ± 4.8 SD. Increasing age (aOR=0.96, 95% CI= 0.93-0.99), tobacco smoking (aOR=2.90, 95% CI=1.20-6.99), dust allergy (aOR= 7.92, CI =3.15-19.91) and low treatment adherence (aOR=5.33, 95% CI=2.22-12.82) were found to be significant predictors of poor disease control.Conclusions: Non adherence to treatment and poor disease control was high among rural asthma pa-tients. Patient education for tobacco cessation and treatment compliance along with periodic monitoring undertaken by trained health workers can be an effective strategy to reduce disease burden in the com-munity.

Prevalence of Under Nutrition and Its Risk Factors among Children below Two Years of Age in a Tertiary Health Centre in West Bengal

Background: Malnutrition in under five children is prevalent widely. It affects growth as well as development; also causes higher morbidity and mortality among children significantly. This public health problem is multi-factorial. Aim and Objectives: This study was conducted to estimate the prevalence of under nutrition and its risk factors among children up to 2 years of age attending a tertiary health care institution of Kolkata. Material and methods: This cross-sectional study was conducted among children aged 0 � 23 months, attending the Immunization clinic of CMSDH, Kolkata, during December, 2019 朖anuary, 2020. Data were collected by interviewing the accompanying caregivers, anthropometric measurements of the study subjects and review of records. Results: Among 135 children studied, the prevalence of stunting was 14.1% (5.8% severely stunted), underweight was 9.7% (3.8% severely underweight), wasting was 18.5% (8.1% were SAM).Younger age group (0-6 months),boys and children having inappropriate feeding for age were at increased risk of under nutrition. Children having working mothers, birth spacing of <3 years, LBW and delayed initiation of breastfeeding (>1hour) were at higher risk of stunting and underweight. Incorrect age of introduction of complementary feeding had higher risk of wasting. Conclusion: Several risk factors for malnutrition were found which are amenable to prevention.

Adaptation of cognitive behaviour therapy in childhood obsessive-compulsive disorder: a case study

Cognitive behaviour therapy (CBT) has been proved to be one of the most well-researched and effective therapy. It has been found effective in many clinical conditions in children and adolescents as well. Application of therapeutic processes gets complicated by the facts that childhood and adolescent problems do not come in neat packages and tend to overlap and/or coexist. For instance, there is much overlap among clinical problems like anxiety, depression, behavioural problems, and between reading and writing difficulties, and attention and hyperactivity. Many behavioural and emotional disturbances in children are also associated with specific medical conditions. The relationship between physical and/or medical conditions and emotional and behavioural disorders in children and adolescent has been documented in various studies. This demands attention to the therapeutic intervention to the childhood problems with greater monitoring and modulation. Use of CBT in childhood and adolescent problems for efficiency and convenience may be grouped into externalising and internalising disorders, and the management techniques may be formulated and tailored to meet the two opposing dimensions. In this case study, index client was an eight years old girl who presented with compulsive behaviour along with anxiety and fear, and the application of CBT techniques, its adaptability and efficacy in this case of obsessive-compulsive disorder (OCD), with specific phobia would be discussed.

Comparison of plasma adipocytokines & C-reactive protein levels in healthy schoolgoing adolescents from private & government-funded schools of Delhi, India

Background & objectives: Obesity-mediated chronic inflammatory state is primarily governed by lifestyle and food habits in adolescents and marked by alterations in the level of various inflammatory markers. This cross-sectional study was aimed to compare the inflammatory status of healthy Indian adolescents vis-�-vis their obesity profile. The inflammatory state of urban adolescents attending private and government-funded schools, and the relationship between inflammatory marker levels and anthropometric indices in the study participants from both groups were examined. Methods: A total of 4438 study participants (10-17 yr) were chosen from various schools of Delhi, India, and their anthropometric parameters were measured. Plasma adipocytokines (adiponectin, leptin and resistin) of the study participants were measured by enzyme-linked immunosorbent assay, and plasma C-reactive protein (CRP) levels were assayed by a biochemical analyzer. Metabolic syndrome-related risk factors such as waist circumference, hip circumference (HC), fasting glucose, fasting insulin, Homeostatic Model Assessment of Insulin Resistance, total cholesterol, high-density lipoprotein-cholesterol, low-density lipoprotein-cholesterol and triglycerides of normal-weight adolescents were also evaluated. Results: The level of leptin and CRP increased with increasing adiposity, whereas adiponectin levels were found to be negatively related to obesity. All plasma cytokine levels (adiponectin, leptin and resistin) were significantly elevated in female than male adolescents. Age-based classification revealed a distinct trend of variability in the levels of all the inflammatory markers among adolescents of varying age groups. Significant differences were observed between private and government schoolgoing adolescents in terms of anthropometric and inflammatory parameters, with higher adiposity indices in the former group. The relationship of plasma adipokine and CRP levels with various adiposity indices was found to be distinctly different between private and government schoolgoing students. Interpretation & conclusions: Inflammatory markers were significantly elevated in overweight/obese adolescents. The socio-economic condition of urban Indian schoolgoing adolescents reflecting lifestyle transition has profound effects on their adiposity indices and inflammatory states. Longitudinal studies in different regions of the country need to be done to further confirm the findings.

Haplotype analysis of ADAM33 polymorphisms in asthma: A pilot study

Background & objectives: ADAM33 is implicated as a potentially strong candidate gene for asthma and bronchial hyper-responsiveness. Many polymorphisms of ADAM33 have been studied along with ADAM33 expression in various cells of the lungs. Haplotype analysis also showed association with asthma in different populations across the world. Therefore, the aim of this study was to perform a comprehensive screening of ADAM33 polymorphisms in adult patients with asthma. Methods: Thirty five polymorphisms of ADAM33 were genotyped in 55 patients with asthma and 53 controls. The association of single nucleotide polymorphisms (SNPs) and haplotypes with phenotypes of asthma was analysed. Results: The genotype, minor allele frequency, odds ratio and Hardy–Weinberg equilibrium did not show any significant difference among cases and controls. No association was found between SNPs of ADAM33 with the severity of asthma. Correlation analysis of ADAM33 SNPs to the phenotypes, based on clinical variables and allergen sensitization, did not show significant difference. Haplotype analysis showed that rs2280090 and rs2280091 were associated with asthma in the patient group. Interpretation & conclusions: Haplotype analysis showed an association of the two SNP variations with asthma. These SNPs lead to amino acid change and are prone to phosphorylation, which may affect expression levels and protein function of ADAM33 and asthma susceptibility.

Development and validation of a questionnaire to measure preferences and expectations of patients undergoing palliative chemotherapy: EXPECT questionnaire.

OBJECTIVE: The objective was to design and validate the questionnaire for capturing palliative chemotherapy‑related preferences and expectations. DESIGN: Single arm, unicentric, prospective observational study. METHODS: EXPECT questionnaire was designed to capture preferences and expectations of patients undergoing palliative chemotherapy. This questionnaire underwent a linguistic validation and then was tested in patients. Ten patients are undergoing chemotherapy for solid tumors who fulfilled the inclusion and exclusion criteria self‑administered the EXPECT questionnaire in regional language. After filling this questionnaire, they self‑administered quick questionnaire‑10 (QQ‑10). SPSS version 16 (IBM New York) was used for analysis. Completion rate of EXPECT questionnaire was calculated. The feasibility, face validity, utility and time taken for completion of EXPECT questionnaire was also assessed. RESULTS: The completion rate of this questionnaire was 100%. All patients completed questionnaire within 5 min. The QQ‑10 tool confirmed the feasibility, face validity and utility of the questionnaire. CONCLUSION: EXPECT questionnaire was validated in the regional language, and it’s an effective tool for capturing patient’s preferences and expectation from chemotherapy.

An audit of cytoreductive surgeries in ovarian cancer from a rural based cancer center.

BACKGROUND AND OBJECTIVE: Ovarian cancers are frequently seen at an advanced stage in our center. This audit was planned to see the morbidity and efficacy of different types of cytoreductive surgeries (radical vs. ultra‑radical) done in such patients. METHODS: This was a retrospective analysis of all ovarian cancer patients who underwent cytoreductive surgery at our center from January 2009 to August 2013. The case records of these patients were reviewed and the demographic, disease‑related and treatment‑related data were extracted. RESULTS: Fifty‑fivepatients were identified. Ten (18.2%) patients underwent primary cytoreduction while 45 patients had (81.8%) interval cytoreduction. The resections achieved were optimal in 50 patients (90.9%) and suboptimal in five patients (9.1%). The postoperative median blood loss was 400 (350–600) mL. The median time interval for surgery was 4.0 h (3–5 h). The type of resection achieved (optimal vs. suboptimal) was the only factor affecting the progression free survival (PFS) (Hazard ratio = 0.08 95% confidence interval 0.02–0.3). There was no significant difference in postoperative morbidity in patients undergoing the ultra‑radical surgery as compared to those who underwent radical surgery. CONCLUSION: Optimal cytoreduction may improve PFS in advanced ovarian cancer patients and needs to be done even if it mandates an ultra‑radical surgery.

Tolerance of weekly paclitaxel and carboplatin as neoadjuvant chemotherapy in advanced ovarian cancer patients who are unlikely to tolerate 3 weekly paclitaxel and carboplatin.

OBJECTIVE: There are little data regarding safety and effectiveness of neoadjuvant chemotherapy (NACT) in patients who are considered unfit for receiving 3 weekly paclitaxel and carboplatin. The aim of this study was to study the toxicity and response rates of weekly paclitaxel and carboplatin as NACT in such cohort of patients. METHODS: Study population included advanced ovarian cancer patients who were unlikely to tolerate 3 weekly paclitaxel and carboplatin and hence received weekly paclitaxel (80 mg/m2) and carboplatin AUC‑2 as NACT. The data regarding the baseline characteristics, chemotherapy tolerance, completion rates, toxicity (CTCAE version 4.02), and radiological response rates are presented. SPSS version 16 was used for analysis. Descriptive statistics is presented. RESULT: Eleven patients received this schedule. Nine patients completed nine cycles of NACT. Except one, all patients completed NACT with an average relative dose intensity of >0.8. There was no chemotherapy‑related mortality. Grade 3–4 life‑threatening complications were seen in two patients. The post NACT response rate was 100%. CONCLUSION: Weekly paclitaxel and carboplatin chemotherapy is safe and efficacious in patients who are unsuitable for 3 weekly paclitaxel and carboplatin chemotherapy schedules.

Does the use of induction chemotherapy in oral cavity cancer compromise subsequent loco‑regional treatment delivery: Results from a matched pair analysis.

BACKGROUND: Neoadjuvant chemotherapy is being increasingly used in patients with unresectable oral cavity cancers to make them resectable. However, its impact on locoregional treatment delivery in such setting remains poorly studied. AIMS: To evaluate the impact of neoadjuvant chemotherapy on delivery of further locoregional treatment. SETTINGS AND DESIGN: Mono institutional retrospective audit of patients with oral cavity squamous cell cancers treated with neoadjuvant triplet chemotherapy in India. MATERIALS AND METHODS: Patients receiving neoadjuvant chemotherapy (n = 14) from May 2012 to April 2014 were matched 1:2 to patients undergoing upfront surgery (n = 28) based on age (>60 or 60 and less), gender (male or female) and subsite site (tongue and floor of mouth or buccoalveolar complex). Data regarding factors related to the delivery of locoregional treatment and toxicities were compiled. STATISTICAL ANALYSIS: Descriptive analysis in the form of median (range) for continuous variables and frequencies for categorical variables. RESULTS: Patients undergoing neoadjuvant chemotherapy required more extensive resections and had greater operative time (460 vs. 415 min, P < 0.001). A greater incidence of locoregional wound complications was seen as a consequence (57.1% vs. 14.3%, P, 0.01). However, toxicities during radiotherapy were not substantially different between the two groups and compliance to radiation was also similar. Total package time of 100 days or less, was maintained in 90% of patients in both groups. CONCLUSIONS: Delivery of neoadjuvant chemotherapy does not impair the ability to deliver locoregional treatment.

Patterns of care in geriatric cancer patients – An audit from a rural based hospital cancer registry in Kerala.

BACKGROUND: There is deficit of data from India on elderly patients with cancer. Comprehensive geriatric assessment may lead to a better decision making capacity in this population. However, routine implementation of such assessment is resource consuming. AIM: The aim of this study was to determine the patterns of care in elderly patients treated at a tertiary rural cancer center in India. MATERIALS AND METHODS: All patients with age 70 or above with solid tumors without any definitive treatment prior to the registration at our center and registered between 01/01/2010 and 31/12/2011 were selected for this study. The baseline demographic pattern and the pattern of care of treatment were analyzed. SPSS version 16 (IBM Inc, Armonk, New York, U.S.) was used for analysis. Descriptive data are provided. RESULTS: A total of 761 patients were evaluable subject to the aforementioned inclusion criteria. The median age of this cohort was 75 years (70‑95 years). The most frequent primary sites of malignancies in 451 males were head neck (32.4%), lung (23.3%) and gastrointestinal (23.3%). In 310 females, the most common sites were head neck (31.6%), gynecological (18.4%) and gastrointestinal (24.5%). 228 (30%) of the patients had localized disease, 376 (49.4%) had loco‑regionally advanced disease and 145 (19.1%) had distant metastases at presentation. 334 (46.32%) of patients were treated with curative intent. On logistic regression analysis the factors that predicted use of curative intent treatment were age <75 years, performance status 0‑1, primary site and clinical extent of disease. CONCLUSION: Routine comprehensive geriatric assessment needs to be implemented in our setting as almost 50% of our geriatric patients undergo curative intent treatment.

Tolerance and toxicity of neoadjuvant docetaxel, cisplatin and 5 fluorouracil regimen in technically unresectable oral cancer in resource limited rural based tertiary cancer center.

BACKGROUND: Recent studies indicate neoadjuvant chemotherapy (NACT) can result in R0 resection in a substantial proportion of patients with technically unresectable oral cavity cancers. However, data regarding the efficacy and safety of docetaxel, cisplatin and 5 fluorouracil (TPF) NACT in our setting is lacking. The present audit was proposed to evaluate the toxicities encountered during administration of this regimen. It was hypothesized that TPF NACT would be considered feasible for routine administration if an average relative dose intensity (ARDI) of ≥0.90 or more in at least 70% of the patients. MATERIALS AND METHODS: Technically unresectable oral cancers with Eastern Cooperative Oncology Group PS 0-2, with biopsy proven squamous cell carcinoma underwent two cycles of NACT with TPF regimen. Toxicity and response rates were noted following the CTCAE 4.03 and RECIST criteria. Descriptive analysis of completion rates (completing 2 cycles of planned chemotherapy with ARDI of 0.85 or more), reason for delay, toxicity, and response are presented. RESULTS: The NACT was completed by all patients. The number of subjects who completed all planned cycles of chemotherapy are with the ARDI of the delivered chemotherapy been equal to or >0.85 was 11 (91.67%). All toxicity inclusive Grade 3-5 toxicity was seen in 11 patients (91.67%). The response rate of chemotherapy was 83.33%. There were three complete response, seven partial response, and two stable disease seen post NACT in this study. CONCLUSION: Docetaxel, cisplatin and 5 fluorouracil regimen can be routinely administered at our center with the supportive care methods and precautionary methods used in our study.

Outcome of Prelabor Rupture of Membranes in a Tertiary Care Center in West Bengal.

The etiology is unknown in majority of cases though bacterial infection, cervical incompetence, hypertensive disease, recent coitus, malpresentation, antepartum hemorrhage (APH), malnutrition are recognized causes of prelabor rupture of membranes (PROM). A study was conducted in our institution in 2011, where 478 cases out of a total obstetric admission of 9,637 presented with PROM. Spontaneous rupture of membranes after 28 weeks of gestation before the onset of labor is called PROM. When it occurs before 37 completed weeks of gestation it is called preterm PROM (pPROM). The term PROM cases were induced after waiting for 24 hours for a spontaneous onset of labor. The preterm population were divided in three groups and were given treatment as; Group A: with beta-mimetic, antibiotic, steroid, iron and folic acid (IFA); Group B: With steroid, antibiotic, natural progesterone and IFA; Group C: With only antibiotic and IFA. Observed neonatal mortality in the very preterm group (<34 weeks) was 10% as compared to 5.8% in preterm (34-37 weeks) and nearly 3% among term pregnancies. Treatment of pPROM cases with steroid and antibiotic compared with addition of natural progesterone with or without beta-mimetic did not show any significant difference in terms of Apgar score, need for resuscitation in absence of maternal infection. Elective lower segment cesarean section (LSCS) showed a zero neonatal mortality, better Apgar score and significantly lesser requirement of neonatal resuscitation compared to emergency LSCS. It was concluded that gestational age at the time of delivery is the main determinant of neonatal body weight as well as survival among PROM cases. Beta-mimetics and progesterone showed no role to prolong pregnancy in PROM cases.

QRDR mutations, efflux system & antimicrobial resistance genes in enterotoxigenic Escherichia coli isolated from an outbreak of diarrhoea in Ahmedabad, India.

Background & objectives: Diverse mechanisms have been identified in enteric bacteria for their adaptation and survival against multiple classes of antimicrobial agents. Resistance of bacteria to the most effective fluoroquinolones have increasingly been reported in many countries. We have identified that most of the enterotoxigenic Escherichia coli (ETEC) were resistant to several antimicrobials in a diarrhoea outbreak at Ahmedabad during 2000. The present study was done to identify several genes responsible for antimicrobial resistance and mobile genetic elements in the ETEC strains. Methods: Seventeen ETEC strains isolated from diarrhoeal patients were included in this study. The antimicrobial resistance was confirmed by conventional disc diffusion method. PCR and DNA sequencing were performed for the identification of mutation in the quinolone resistance-determining regions (QRDRs). Efflux pump was tested by inhibiting the proton-motive force. DNA hybridization assay was made for the detection of integrase genes and the resistance gene cassettes were identified by direct sequencing of the PCR amplicons. Results: Majority of the ETEC had GyrA mutations at codons 83 and 87 and in ParC at codon 80. Six strains had an additional mutation in ParC at codon 108 and two had at position 84. Plasmid-borne qnr gene alleles that encode quinolone resistance were not detected but the newly described aac(6’)-Ib-cr gene encoding a fluoroquinolne-modifying enzyme was detected in 64.7 per cent of the ETEC. Class 1 (intI1) and class 2 (intI2) integrons were detected in six (35.3%) and three (17.6%) strains, respectively. Four strains (23.5%) had both the classes of integrons. Sequence analysis revealed presence of dfrA17, aadA1, aadA5 in class 1, and dfrA1, sat1, aadA1 in class 2 integrons. In addition, the other resistance genes such as tet gene alleles (94.1%), catAI (70.6%), strA (58.8%), blaTEM-1(35.2%), and aphA1-Ia (29.4%) were detected in most of the strains. Interpretation & conclusions: Innate gene mutations and acquisition of multidrug resistance genes through mobile genetic elements might have contributed to the emergence of multidrug resistance (MDR) in ETEC. This study reinforces the necessity of utilizing molecular techniques in the epidemiological studies to understand the nature of resistance responsible for antimicrobial resistance in different species of pathogenic bacteria.