Effectiveness of competency-based teaching and comparison to traditional teaching of Phase I MBBS students

Background: During MBBS course, the students’ study about cardiovascular system (CVS) in physiology, pathology, pharmacology, preventive medicine, pediatrics, and medicine for the management and diagnosis of cardiovascular disorders. Blood pressure measurement is a common and a beneficial tool for the diagnosis of cardiovascular disorders (hypertension, hypotension, etc.) along with their treatment and management. Thus, knowing the proper technique of measuring blood pressure becomes an essential part of learning the course and management of cardiovascular disease. This study is designed to teach and train the first phase undergraduate students to measure blood pressure in a proper way so that they do not stumble on the first step of examination of CVS. Competency-based training is an outcome-based approach that involves identifying the skills acquired by Indian medical graduate. Competency-based teaching involves teaching of undergraduate students to support their achievement and assessment of the communication and technical skills and to develop their ability to interpret the results of blood pressure measurement for apt patient management. Aim and Objectives: This study aims to assess and compare the effect of competency-based teaching and traditional teaching in learning the skill of blood pressure measurement. Materials and Methods: Two hundred students were taken from Phase I undergraduate medical students which were randomly divided in two Groups A and B. Competency-based teaching of blood pressure measurement was done in Group A in by teaching method of demonstrate, observe, assist, and perform and Group B was taught by traditional demonstration. Pre-test questionnaire was given to both the groups before beginning of the practical session. The students learning of skill to measure blood pressure was assessed by directly observed procedural skills (DOPS) checklist after which student feedback was provided along with filling up of the post-test questionnaire. Furthermore, feedback from both student and teacher was collected. Results: Highly significant difference was found between pre-test and post-test of both Group A and Group B. Significant difference was found between Group A and Group B post-test scores. It was found that Group A in which competency-based teaching was done scored higher post-test scores then Group B. Furthermore, highly significant difference was seen among the scores of DOPS checklist between Group A and Group B. Conclusion: In the present research study, it was found that the students who underwent competency-based training of the skill of blood pressure measurement showed significantly higher scores in learning and performing the skill. Furthermore, on feedback provided by the students, 96% of the students strongly agree that the competency-based teaching and learning is better than traditional teaching.

Development And Validation Of A Simple Hplc Method For Estimation Of Mycophenolate Mofetil In Microemulsion Formulation

Objective: The present study deals with the development, validation and application of a simple, precise and accurate HPLC method for the determination of mycophenolate mofetil in pharmaceutical formulations and microemulsions. Methods: In this method, a simple isocratic mobile phase composition of methanol and water (75:25 v/v) pumped at 1 ml/minute flow rate through Phenomenex C18 column (dimension: 250 4.6 mm and 5 µm particle size) was used. Injection volume was 20 µl and analysis of mycophenolate mofetil was carried out at 250 nm. Results: The coefficient of regression was found to be 0.9996, indicating the linearity of the developed method within a range of 0.1 to 10 µg/ml. The limit of detection (LOD) and the limit of quantization (LOQ) were found to be 3.660ng/ml and 11.091ng/ml, respectively. The results showed that % deviation for change in compositions of the mobile phase, flow rate and temperature was within a range of-5.51 to 10.99%,-3.70 to 8.80% and-5.29 to 10.90%, respectively. The method seemed sensitive to change of temperature (±5 ○C) and methanol composition (±2%) as the results were at the boundary limit of 10% deviation. Conclusion: A simple, precise and accurate HPLC method for the determination of drug content from microemulsion has been developed and validated in accordance with ICH guidelines.

Role of grey scale ultrasound and Colour Doppler findings to differentiate ectopic pregnancy from corpus luteum cyst of pregnancy

Introduction: Ectopic pregnancy and corpus luteum cyst are two most common differential diagnosis in a patient with UPT positive and no sonographic evidence of intrauterine pregnancy. Aim: To diagnose ectopic pregnancy and to differentiate ectopic pregnancy from corpus luteum cyst of pregnancy on the basis of grey scale ultrasound and colour Doppler findings. Material and Methods: This was a hospital based prospective study carried out on a study group of 40 patients with UPT positive and clinical features suggestive of ectopic pregnancy over a period of two years.Grey scale ultrasound and colour Doppler parameters were studied. Results: Out of 40 patients,30 were diagnosed with ectopic pregnancy and 10 with corpus luteum cyst. Ectopic pregnancies had thicker walls as compared to corpus luteum cysts. Most of the ectopic pregnancies had hyperechoic walls as compared to ovaries (80%) and endometrium (60%). Free fluid with echoes was seen in the pelvis in 70% ectopic pregnancies whereas most of the corpus luteum cysts (80%) had no free fluid. Most of the corpus luteum cysts (70%) had clear internal echotexture whereas ectopic pregnancies were mostly lacy or solid.Yolk sac was seen exclusively in ectopic pregnancy (30%). RI <0.4 and RI >0.7 was found to be highly specific for diagnosing ectopic pregnancy. Conclusion: Wall thickness of the mass, echogenicity of the wall as compared to ovaryand endometrium, internal echotexture of the cystic mass, presence of yolk sac and presence of free fluid with echoes are significant ultrasound parameters which help to differentiate between the two. RI <0.4 and RI >0.7 was found to be highly specific for diagnosing ectopic pregnancy.

Azithromycin resistance mechanisms in typhoidal salmonellae in India: A 25 years analysis

Background & objectives: Azithromycin has been in use as an alternate treatment option for enteric fever even when the guidelines on the susceptibility testing were not available. There is lack of data on susceptibility and mechanisms of resistance of azithromycin in Salmonella Typhi and S. Paratyphi A. The aim of the present study was to determine the azithromycin susceptibility and resistance mechanisms in typhoidal salmonellae isolates archived in a tertiary care centre in north India for a period of 25 years. Methods: Azithromycin susceptibility was determined in 602 isolates of S. Typhi (469) and S. Paratyphi A (133) available as archived collection isolated during 1993 to 2016, by disc diffusion and E-test method.PCR was done for ereA, ermA, ermB, ermC, mefA, mphA and msrA genes from plasmid and genomic DNA and sequencing was done to detect mutations in acrR, rplD and rplV genes. Results: Azithromycin susceptibility was seen in 437/469 [93.2%; 95% confidence interval (CI), 90.5 to 95.1%] isolates of S. Typhi. Amongst 133 isolates of S. Paratyphi A studied, minimum inhibitory concentration (MIC) of ?16 mg/l was found in 102 (76.7%; 95% CI, 68.8 to 83.0). MIC value ranged between 1.5 and 32 mg/l with an increasing trend in MIC50and MIC90with time. Mutations were found in acrR in one and rplV in two isolates of S. Typhi. No acquired mechanism for macrolide resistance was found. Interpretation & conclusions: Azithromycin could be considered as a promising agent against typhoid fever on the basis of MIC distribution in India. However, due to emergence of resistance in some parts, there is a need for continuous surveillance of antimicrobial susceptibility and resistance mechanisms. There is also a need to determine the breakpoints for S. Paratyphi A.

Comparative Analysis of Unilateral Subarachnoid block with Ankle block for elective foot surgery.

Background: There are many accepted anesthesia techniques for elective foot surgery ranging from general anesthesia to regional anesthesia, regional anesthesia being the preferred method. Regional anesthesia techniques employed for foot surgery includes subarachnoid block, epidural anesthesia and ankle block. Objective: The present study is aimed at providing comparative analysis of ankle block with unilateral subarachnoid block for elective foot surgeries in terms of hemodynamic safety profile and post operative analgesia. Material and Methods: Study includes prospective analysis of 80 ASA II and III patients who underwent elective foot surgery. Patients were randomly divided into two groups of 40 each, Ankle block group (AB) and Unilateral subarachnoid group (US). The parameters recorded for study includes systolic blood pressure, diastolic blood pressure, heart rate, visual analogue scale for pain severity, time of first analgesic need and the complications. Results: There were minimal blood pressure changes and heart rate variability in AB group as compared to US group when compared with basal values (p<0.05). The time for first analgesic requirement is prolonged in AB group as compared to US group. The visual analogue scale score was assessed at 2nd ,4th and 6th hours for group AB were lowered as compared to group US (p <0.05).

Seminogram in male partners of Infertile Couples.

Background: Infertility is defined as failure to conceive within one or more years of regular unprotected coitus. The infertility state is dependent on the female factor as well as masculine factor; an altered masculine factor is designated when any cause or causes of infertility reside in the male. The masculine factor as a cause of infertility is present in 40-50% of cases hence the importance of an integral evaluation of the male alterations and its fertility. Objectives: The present study aims to assess the seminal patterns of male partners of 100 infertile couples for various parameters and their possible contribution to infertility. Material and Methods: The present study was conducted on male partners of 100 infertile couples who were referred by Gynecology and Obstetric department to Pathology Department, Government Medical College, Patiala for semen examination. The semen was collected by masturbation in all cases in a clean dry detergent free container. After liquefaction and mixing, basic analysis was done which includes volume, viscosity, pH, spermatozoal concentration, motility and morphology. Data was evaluated by means of chi-square test. Results: Of 100 seminogram, 43% showed alterations in the seminal indexes; with asthenospermia in 39.5%, Oligoasthenospermia in 30.2%, Oligospermia in 16.2%, and Azoospermia in 13.9%. Conclusion: Male factors were mostly responsible as a cause of infertility. Asthenospermia was the most common type of semen defect present in these infertile males. Most of the males with semen defect were of age group >30yrs. Incidence of semen defect among males increased with duration of infertility.

A Comparative Study Between Cleavage Stage Embryo Transfer at Day 3 and Blastocyst Stage Transfer at Day 5 in IVF/ICSI on Clinical Pregnancy Rates.

Objective: To evaluate the efficacy of blastocyst transfer in comparison with cleavage stage transfer. Study design: A randomized, prospective study was conducted in Infertility Clinic, Dept. of Obstetrics and Gynecology, Mahatma Gandhi Hospital, Jaipur on 300 patients aged 25-40 years undergoing in vitro fertilization/intracytoplasmic sperm injection (IVF/ ICSI) cycle from May 2010 to April 2011. When three or more Grade I embryos were observed on Day 2 of culture, patients were divided randomly into two study groups, cleavage stage transfer and blastocyst transfer group having 150 patients each. Primary outcomes evaluated were, clinical pregnancy rate and implantation rate. The results were analyzed using proportions, standard deviation and Chi-square test. Results: Both the groups were similar for age, indication and number of embryos transferred. Clinical pregnancies after blastocyst transfer were significantly higher 66 (44.0%) compared to cleavage stage embryo transfer 44 (29.33%) (p < 0.01). Implantation rate for blastocyst transfer group was also significantly higher (p < 0.001). Conclusion: Blastocyst transfer having higher implantation rate and clinical pregnancy rate leads to reduction in multiple pregnancies.

A Study of Outcome of Induction of Labor: Medical Versus Surgical.

The aim of this article is to study the outcome of induction of labor using medical and surgical methods. Two hundred and twelve patients with >28 weeks pregnancy requiring induction of labor were studied for a period of 1 year in the Government Medical College and Rajindra Hospital, Patiala, Punjab. In 25 patients (Group 1), artificial rupture of membranes was done to induce labor, 52 patients were induced with oxytocin, and 83 patients were induced with misoprostol (Group 2). In 52 patients (Group 3), medical and surgical methods were used in combination. The incidence of labor induction came out to be 13.86%. The induction delivery interval was shortest in Group 3 (85.42% delivered within 12 h) compared to 62.72% and 64.60% in Groups 1 and 2, respectively. The lower segment cesarean section rate was least in Group 3 (7.69% vs 12% and 16.30%, respectively). Postpartum hemorrhage and maternal pyrexia were observed more in Group 1 (20% and 8%) than in Group 2 (2.96% and 0.74%) and Group 3 (5.77% and 3.85%). All methods were equally effective in induction of labor in terms of induction delivery interval and mode of delivery.

Prevalence and distribution of cardiovascular risk factors in an urban industrial population in south India: a cross-sectional study.

BACKGROUND: Cardiovascular diseases (CVD) are leading cause of death in developing countries including India. The huge burden of CVD in Indian subcontinent is the consequence of the large population and high prevalence of cardiovascular risk factors. This study was done to determine the prevalence of cardiovascular risk factors in two industrial units in Chennai, India. METHODS: Survey of behavioural risk factors using structured questionnaires and anthropometric measurements were done for the study population. Blood samples were collected for the fasting plasma glucose and serum cholesterol. Trend chi-square was employed to test the linear trend. RESULTS: The total study population included 2262 male subjects. Blood samples were collected for 2148 (95.0%) subjects. Age range was 18-69 years. Prevalence of major cardiovascular risk factors was: current smokers 462 (20.2%), body mass index > or = 23 kg/m2 1510 (66.8%), central obesity 1589 (70.2%), hypertension 615 (27.2%), diabetes mellitus 350(16.3%) and total cholesterol > or = 200mg/dl in 650(30.3%). CONCLUSIONS: The study results indicated high prevalence of behavioural risk factors, central obesity, hypertension and diabetes in a select group of middle and high-income young urban males. The long-term follow-up in such settings will provide an opportunity to understand the influence of risk factors on cardiovascular disease outcomes.

Role of in vivo proton MR spectroscopy in the evaluation of adult brain lesions: our preliminary experience.

CONTEXT: A definite diagnosis and characterization of intracranial mass lesions, based on structural Magnetic Resonance Imaging (MRI) alone may be difficult. In such cases Proton Magnetic Resonance Spectroscopy (1H-MRS) along with other non-invasive techniques represents an advance in the specificity of brain lesion diagnosis. AIMS: The primary aim of this study was to evaluate the extent of the utility of 1H-MRS in adult brain tumors and their differentiation from similar-appearing space-occupying lesions. MATERIAL AND METHODS: MRS studies were performed on 1.5 Tesla whole body MR system using standard imaging head coil. Sixty patients (aged 30-65 years), including 35 males (31-65 years) and 25 females (30-65 years) were studied, along with 25 age-matched healthy volunteers (30-64 years). The Student 't' test was used to statistically analyze the spectroscopic data for significant difference in the metabolite ratios of the lesions from normal brain tissue. RESULTS: The Cho/Cr ratio was significantly raised in low and high-grade glioma and meningioma patients (1.85 +/- 0.36, 3.50 +/- 1.00 and 6.65 +/- 2.83 respectively) (mean +/- standard deviation), as compared with the control group (1.16 +/- 0.18); and NAA/Cr and NAA/Cho ratios were found to be lower than normal values in our study (P<0.01). However, in the non-neoplastic lesions, the Cho/Cr ratios were not statistically significant. The tubercular lesions revealed an average Cho/Cr ratio of 1.24 +/- 0.18, while it was 1.14 +/- 0.07 for infarcts. CONCLUSION: MR Spectroscopy was useful to arrive at a more definitive diagnosis in doubtful intracranial space-occupying lesions with similar morphological imaging patterns.

Conservative management of a complication of neonatal teeth: a case report.

A case report of neonatal teeth in a 4 month old male infant with ulceration on ventral surface of the tongue and its conservative management, is presented.

A prospective study of sensitivity and specificity of adenosine deaminase estimation in the diagnosis of tuberculosis pleural effusion.

We prospectively evaluated the usefulness of adenosine deaminase [ADA] estimation in the diagnosis of tuberculosis [TB] pleural effusion. Seventy five subjects with pleural effusion were studied. Forty eight of them had TB pleural effusion [M:F: 37:11; mean age 33 +/- 14.4 years range 17-76] and the remaining 27 had pleural effusion due to causes other than TB [non-TB group] [M:F: 19:8; mean age 47.3 +/- 16.5 years; range 17-75]. Pleural fluid [PF] ADA levels were significantly higher in TB (n=48; mean 95.8 +/- 57.5 IU/L) compared with non-TB group (n=27; mean 30.7 +/- 27.2 IU/L) [p<0.001]. Serum ADA [S-ADA] levels were also significantly higher in TB (n=45; mean 39.6 +/- 18.3 IU/L) compared with non-TB group (n=26; mean 18.0 +/- 13.7 IU/L) [p<0.001]. PF-ADA levels were higher compared to S-SDA in TB (p <0.001) and non-TB groups [p<0.01]. Using a cut off of 35 IU/L, the sensitivity and specificity of PF-ADA in the diagnosis of TB was computed to be 83.3% and 66.6% respectively. At a cut-off level of 100 IU/L, PF-ADA was found to have a sensitivity 40% and specificity 100%. From this study it is concluded that, using 100 IU/L as the cut-off, it is possible to avoid pleural biopsy to ascertain the diagnosis of TB in as much as 40% of the patients.

Dr. P.C. Sen Memorial Award--1994. Role of various risk factors in the epidemiology of hypertension in a rural community of Varanasi district.

1572 persons above 30 years were screened for hypertension in a rural community of Varanasi district. 113 persons were diagnosed as hypertensive giving an overall prevalence of 7.19%. Prevalence rates among males and females were found 5.57% and 8.82% respectively. 203 controls, age and sex matched, were selected. Various risk factors including intake of salt, fat, socio-economic status were studied. On doing analysis by logistic regression, salt consumption and obesity were found significant predictor of hypertension.

Effect of noise stress on some cardiovascular parameters and audiovisual reaction time.

A study of the effect of noise stress on some of the physiological parameters was carried out on healthy male workers of thermal power station (exposed to sound level 90-113 dBA) and compared with age and sex matched healthy controls (exposed to sound level 48-66 dBA). The parameters recorded were heart rate (HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), galvanic skin resistance (GSR), auditory and visual reaction time (ART and VRT) and audiogram. Significant impairment in audiogram at 3000 Hz and 4000 Hz, increase in HR, SBP, DBP and decrease in GSR, ART and VRT were recorded in workers who were exposed to noise stress. Also a higher prevalence of hypertension was observed in them and that they were at a higher risk of developing hypertension than the control group. It was also observed that these modifications are related to duration of exposure to noise stress. It is presumed that all the above extra auditory effects are due to activation of autonomic nervous system and hypothalamo-hypophyseal adrenal axis, and the resultant release of catecholamines from adrenal medulla due to noise stress.

Japanese encephalitis virus is an important cause of encephalitis among children in Penang.

This study was carried out to determine if Japanese encephalitis virus is an important causative agent of viral encephalitis among pediatric admissions in Penang, Malaysia. 195 children with CNS symptoms and 482 children with non-specific febrile illness admitted into the Pediatric Ward of Penang Hospital during a 16 month period were entered into the study. The presence in serum of cerebrospinal fluid (csf) of Japanese encephalitis virus (JEV) specific IgM was determined by an IgM capture ELISA and cytomegalovirus (CMV) specific IgM was determined using a commercially available kit (Behringwerke AG). It was determined that 5 of 13 children with a discharge diagnosis of viral encephalitis had JEV specific IgM in csf, indicating that 38.5% of the viral encephalitis cases was due to JEV. One of the non-JEV cases was found to have mumps virus specific IgM in csf, while no etiology was determined for the other cases. It was also determined that 4 of the 195 (2.1%) cases with CNS symptoms had IgM to CMV, suggesting CMV may be an agent of encephalopathy in children in Penang. Other viruses found to be associated with CNS symptoms in children admitted into our study were measles and herpes simplex virus. A viral etiology was confirmed for 13 or the 195 cases (6.7%). We also screened 482 non-specific febrile cases for IgM to JEV and to dengue viruses and found that 2 (0.4%) had IgM specific for JEV and 9 (1.9%) had IgM specific for dengue virus.

Transferable beta lactam resistance against cephalosporins in Salmonella typhimurium strains in India.

From 14 strains of S. typhimurium which were resistant to three cephalosporins (cephalexin, cefadroxil and sodium cefotaxime) the resistance plasmids were transferred to two different strains (Escherichia coli K12F-Lac-Rifr and S. typhimurium LT2). The plasmids were autotransferable and the donors as well as transconjugants showed high levels of MIC (80-320 micrograms/ml or more) against these antimicrobial agents. The resistance was demonstrated to be mediated by a 15 kilobase plasmid.

Food practices during diarrhoea.

A study was conducted to find out the pattern of food and fluid practices during diarrhoea among 2,160 children under five. Mothers were educated to give home made fluids during diarrhoea. Their personal hygiene was studied and a positive correlation between diarrhoea and poor personal hygiene was found. After the health education programme, it was observed that mothers started giving home made fluids to the children during diarrhoea but the amount was not increased. Normal feeding was continued only in 38.2% of the episodes.