Virtual microscopy as a teaching-learning tool for histology in a competency-based medical curriculum.

Background: Histology forms an important component of first-year medical education. Unfortunately, it is limited to the practical laboratory due to the need for a microscope and good quality slides. Virtual microscopy is a recent advancement, which uses computers as an alternative to microscopes. The aim of the study was to compare virtual microscopy (VM)-based practical classes with traditional microscopy (TM)-based practical classes for two cohorts of first-year medical students, by comparing learning achieved using two different test scores as well as a qualitative assessment of student and faculty perspectives regarding the feasibility and usefulness of VM. Methods: Each cohort of students was divided into two equal batches and each batch underwent eight histology modules of which, four utilised traditional microscopes and four utilised virtual microscopes. Quantitative analysis was performed using a theory test (which assessed preparation, theory knowledge and understanding) as well as a spotter test (which assessed identification skills, reasoning, and recall). Qualitative analysis was performed using a structured questionnaire and focus group discussions. Results: Modules using VM were better when compared with those using TM, showing statistically significant and better grades. Qualitative analysis performed, yielded important information as to how this technology can serve as a good adjunct to traditional histology classes in the competency-based curriculum by increasing student interest, enabling self-study, and reducing students dependence on the tutor. Conclusions: VM forms a good adjunct as well as a standalone modality of learning to TM, as it improves accessibility to slides and promotes self-learning.

Structured, functional histology practical modules: An answer to medical students' histology nightmare and the way forward for relevant histology instruction in the Indian undergraduate medical curriculum?

Background: . It is often a challenge to make histology instruction relevant and interesting. We assessed whether structured, worksheet-based histology practical modules with emphasis on functional histology and clinical application, would improve the learning experience and help students focus on relevant functional and clinical correlates. Methods: . In eight practical sessions, 100 students worked as two groups, one group undergoing new intervention practical modules and another group undergoing the routine laboratory practical exercises as a control group. For every pair of laboratory practical exercises, the groups alternated. Spot tests administered in the following week assessed identification ability as well as application of knowledge. Feedback was collected in the form of written questionnaires from faculty and students, student focus group discussion and in-depth interviews. Analysis of test scores as well as feedback was done. Results: . Test scores were better following the intervention method when comparing the overall score as well as its subcomponents of identification and analysis-type questions (p<0.001). The weaker performers in the class as well as high achievers showed better test scores with the intervention method (p<0.001). Feedback from faculty and students reflected better student experience with the intervention method. Suggestions were made to improve the approach further. Conclusion: . Studying histology through structured modules, which emphasize functional and clinical correlates, appears to improve the identification and application ability of the student as well as the student experience.

Do turbinate reduction procedures restore epithelial integrity in patients with turbinate hypertrophy secondary to allergic rhinitis? A histopathological study.

PURPOSE: Consensus has not been reached regarding the optimal reduction procedure for inferior turbinate hypertrophy in allergic rhinitis and whether such procedures result in improvement in mucosal architecture. METHODS: Twenty-nine patients aged 18-45 years (mean 26.8 years), with allergic rhinitis and inferior turbinate hypertrophy not responsive to medical therapy who underwent endoscopic submucosal diathermy (ESMD) (14 patients) or endoscopic submucosal resection (ESMR) (15 patients) with intraoperative and 3-6 months postoperative inferior turbinate biopsies, were included in the study. Epithelial and mucosal architecture was compared between the two groups. RESULTS: Both groups showed a significant decrease in epithelial denudation (p < 0.001), reversal of basement membrane thickening (p < 0.001) and increase in density of cilia (p < 0.001). The degree of improvement in histological characteristics between ESMD and ESMR groups was not significant. CONCLUSIONS: Surgical intervention for inferior turbinate hypertrophy by both ESMD and ESMR results in significant restoration of nasal mucosal epithelium in patients with allergic rhinitis as early as 3-month postoperatively. There was, however, no significant difference in the histological changes between those who underwent ESMD and ESMR. CLINICAL TRIALS OF INDIA, REGISTRY NUMBER: CTRI/2015/01/005373.

Different subsets of Langerhans cells in human uterine tubes and uterus.

AIM: Langerhans cells (LC) are antigen-presenting cells present in tissues with high antigenic exposure. Their role in the upper female reproductive tract is not fully understood. This study aims to determine the distribution and morphology of LC in the normal and post-partum human uterine tubes and uterus by staining with the specific LC markers, CD1a and zinc iodide-osmium (ZIO), and to determine their association with helper and cytotoxic T cells. MATERIAL AND METHODS: Normal and post-partum uterine tube and uterine specimens were stained with CD1a and ZIO and their morphology and distribution noted. Double immune staining with CD1a-CD4 and CD1a-CD8 in post-partum uterine tube were also done. RESULTS: It was noted that CD1a-positive cells were significantly fewer and smaller in diameter than ZIO-positive cells in the uterine tube and both types of cells were significantly more prevalent in post-partum tubes. Perivascular clusters of ZIO-positive cells were seen in the post-partum tubes. Close association of CD1a-positive cells with CD4- and CD8-positive T cells was noted in the post-partum uterine tube. In the uterus, scanty CD1a-positive cells were present in the surface and glandular epithelium and endometrial stroma. ZIO-positive cells were absent. CONCLUSION: This study suggests that CD1a-positive and ZIO-positive cells may be different subsets of LC that are needed for presentation of antigen to immunocompetent cells. Their respective functions are yet to be determined.

Vertical integration of basic science in final year of medical education.

BACKGROUND: Development of health professionals with ability to integrate, synthesize, and apply knowledge gained through medical college is greatly hampered by the system of delivery that is compartmentalized and piecemeal. There is a need to integrate basic sciences with clinical teaching to enable application in clinical care. AIM: To study the benefit and acceptance of vertical integration of basic science in final year MBBS undergraduate curriculum. MATERIALS AND METHODS: After Institutional Ethics Clearance, neuroanatomy refresher classes with clinical application to neurological diseases were held as part of the final year posting in two medical units. Feedback was collected. Pre- and post-tests which tested application and synthesis were conducted. Summative assessment was compared with the control group of students who had standard teaching in other two medical units. In-depth interview was conducted on 2 willing participants and 2 teachers who did neurology bedside teaching. RESULTS: Majority (>80%) found the classes useful and interesting. There was statistically significant improvement in the post-test scores. There was a statistically significant difference between the intervention and control groups' scores during summative assessment (76.2 vs. 61.8 P < 0.01). Students felt that it reinforced, motivated self-directed learning, enabled correlations, improved understanding, put things in perspective, gave confidence, aided application, and enabled them to follow discussions during clinical teaching. CONCLUSION: Vertical integration of basic science in final year was beneficial and resulted in knowledge gain and improved summative scores. The classes were found to be useful, interesting and thought to help in clinical care and application by majority of students.

Langerhans cells in the human tympanic membrane in health and disease: a morphometric analysis.

HYPOTHESIS: The normal tympanic membrane contains Langerhans dendritic cells, and they play a role in the pathogenesis of chronic suppurative otitis media. BACKGROUND: The presence of Langerhans dendritic cells in the normal tympanic membrane is disputed. However, they have been identified in tympanic membranes of patients with otitis media. A quantitative analysis of the distribution and morphology of these cells in the types of chronic suppurative otitis media has not been undertaken. METHODS: Samples of normal cadaveric tympanic membranes and those from patients with chronic suppurative otitis media of the tubotympanic and atticoantral varieties were stained with the immunohistochemical marker CD1a. The number of cells per unit length of basement membrane, diameters of cells, and number and length of dendritic processes were compared between the groups. RESULTS: CD1a-positive Langerhans dendritic cells were present in the normal tympanic membrane. The number of cells per unit length of basement membrane, diameters of cells, and the length of dendritic processes increased significantly in tubotympanic disease and in atticoantral disease, the difference being more pronounced in the latter form of otitis media. CONCLUSION: Langerhans cells are present in the normal tympanic membrane, and they probably play differing roles in the pathogenesis of tubotympanic and atticoantral forms of chronic suppurative otitis media.