Unmasking the Understanding of Academic Dishonesty Among Undergraduate Medical Students: "Is That Cheating?"

Introduction Academic dishonesty threatens the environs of medical education, wherein medical graduates are expected to exhibit professional honesty. Despite the efforts of institutions and governing bodies, the implementation of an environment of academic integrity is a challenge. We hypothesized that what medical students perceive as academic dishonesty might be different from the prevalent understanding of academic dishonesty among the teaching fraternity. This exploratory study was done to identify and explore in depth what constitutes cheating in the eyes of a medical student. Methods This qualitative study was planned as a semi-structured interview among undergraduate medical students in the second year of study (n=25). The dimensions studied were the individual perceptions of what constitutes cheating, self-reported responses with underlying reasoning to hypothetical academic cheating scenarios, and responses on instances of self-experienced or self-observed instances of academic dishonesty.  Results The responses indicate the ambiguous interpretation of academic honesty by students and four chief themes of the interpretation of dishonesty, based on student understanding. Our results identify core areas, such as the need for a clear and unambiguous institutional academic integrity policy, an environment of academic honesty, and strict enforcement of penalties for breach of ethical conduct, that need to be addressed to tackle the menace of academic dishonesty. Conclusion Themes derived from our study describe student factors, including trivialization of academic integrity, that lead to academic dishonesty. Advocacy for academic honesty in educational institutions must address these factors to enforce institutional standards.

Exploring Knowledge of Cognitive Disposition to Respond in Clinical Decision-Making among Early Clinical Learners.

Introduction: Background: Errors in clinical medicine are a constant occurrence leading to litigations. Cognitive disposition to respond (CDR) was considered the underlying cause of errors in the decision-making process. The rapid thinking system used by early clinical learners leads to cognitive errors. The scenario gets compounded by a limited awareness and lack of exposure to cognitive dispositions to respond (CDRs) in the formal medical graduate curriculum. Variation in the frequency of occurrence in a real-life context, contradictory claims over the influence of clinical expertise, specialty, and methods of teaching about cognitive biases led to this exploratory study among early clinical learners. Methods:In the present research, subjects' recruitment was based on voluntary participation of medical graduates, interns, and residents, who were assigned to equal groups of 30. All study groups were first exposed to six commonly occurring CDRs as role-play-based videos, followed by a case scenario-based exposure to 13 uncommon CDRs in the clinical setting. Participants were then asked to reflect on the experience. Data was analyzed by descriptive and thematic analysis. Results:Among the 19 tested biases, 75.6% of participants identified Hindsight bias. The sunk cost was found out by 34.4% of participants only. Information processing bias was identified more frequently than psychological processing bias. Intergroup variability showed that residents were not identifying biases as frequently as medical graduates and interns. The role play video with reflective writing was voiced as the suitable training method for cognitive bias. Conclusion:The study concludes that medical graduates must be sensitized to CDRs using role-play-based reflection methods.

The Impact of COVID-19-Related Psychological Stress on Fetoplacental Circulation: A Doppler Scan of Umbilical Vessels in Third-Trimester Antenatal Women.

INTRODUCTION: The placenta is an important organ of pregnancy. A multitude of physiological and pathological factors influence blood flow in the placenta during pregnancy. However, the fetal effects of maternal psychological stress were inconclusive. The recent COVID-19 pandemic had unprecedented economic, social, and psychological effects. The effect of COVID-19-induced psychological stress in antenatal women and its resultant fetal impact were studied by observing the Doppler waveforms of the uterine and umbilical arteries. METHODS: The cross-sectional study was conducted on 26 healthy third-trimester antenatal women who satisfied pre-set inclusion and exclusion criteria. A pandemic-related pregnancy stress scale (PREPS) was used to evaluate the stress in pregnant women and categorize it into mild, moderate, and severe levels. The Doppler ultrasound of the uterine and umbilical vessels was done along with a routine growth scan in the third trimester of pregnancy. The arterial waveforms, Pulsatility index (PI) of uterine and umbilical arteries, umbilical vein blood flow, and biometric parameters of the fetus were recorded and analyzed. RESULTS: Seventeen of the 26 participants were found to be moderately stressed. Among the three dimensions of the PREPS tool, the perinatal infection stress dimension was expressed predominantly. A strong expression of the positive affirmation dimension was seen in antenatal women. The mean Pulsatility index in the mild, moderate, and severe groups was 0.74, 0.93, and 0.63, respectively. The association between the PREPS score and the Pulsatility index of the umbilical artery alone was found to be significant at p=0.02. CONCLUSION: The COVID-19 pandemic caused moderate to severe levels of psychological stress in pregnant women. The statistically significant association between the PREPS score and the umbilical artery PI indicates possible fetoplacental compromise, suggesting the need for cognitive therapy to manage psychological stress in antenatal women.

A Morphological Study of Myocardial Bridges in the Fetal Heart.

Introduction:Myocardial bridges (MB) are congenital anomalies of hearts observed as muscle fibers covering epicardial branches of the coronary artery. The left anterior descending artery (LAD) was found to be commonly showing myocardial bridges (MBs). Clinically, MBs were claimed to cause varied symptomatology. The data on the morphology and prevalence of MBs in fetuses was limited, despite the commonly accepted congenital origin. Material and methods:Fetal hearts obtained from 37 fetuses from the donation program were used. The hearts were dissected out from the thorax by standard dissection procedure. The pericardium and epicardium were dissected. The coronary arteries were delineated, and MBs were observed and noted. The coronary artery segment having MBs, its distance from the ostium as well as the direction and length of the MBs were studied. Results:The MBs were observed in 20 out of 37 fetal hearts studied over the left anterior descending, right coronary, posterior interventricular and circumflex arteries. The mid or distal part of the coronary arteries frequently exhibited MBs. The mean length of the MB was 4.2 mm, with MBs being situated about 1.5 cm away from the coronary ostium. The oblique pattern of MB was more frequently noted. Conclusion:The morphology and prevalence of fetal MBs showed common occurrence in the LAD artery, with a predominant oblique morphological pattern.

Molecular docking analysis of glycogen phosphorylase with inhibitors from Cissampelos pareira Linn.

Cissampelos pareira Linn. is a climbing herb known in Indian traditional medicine as laghupatha. It belongs to the Menispermaceae family. The enzyme glycogen phosphorylase (GP) is a promising target for the treatment of type-2 diabetes (T2DM). A variety of natural product inhibitors with both pharmaceutical and nutraceutical potential have been reported in the search for powerful, selective and drug-like GP inhibitors that could lead to hypoglycemic medicines. Therefore, it is of interest to document the molecular docking analysis data of glycogen phosphorylase with compounds from Cissampelos pareira Linn. We report the optimal binding features of 4 compounds namely Trans-N-feruloyltyramine, Coclaurine, Magnoflorine, and Curine with the target protein for further consideration in the context of T2DM.

Molecular docking analysis of PARγ with compounds from Ocimum tenuiflorum.

The ligand-activated transcription factor peroxisome proliferator-activated receptor (PPAR) has become a major target for type 2 diabetes. It belongs to the nuclear receptor superfamily, which controls the expression of proteins involved in glucose metabolism, lipid metabolism, adipocyte proliferation and differentiation, and insulin sensitivity. Ocimum tenuiflorum, often known as Krishna tulsi, is the most sacred herb in India. It was utilized for a variety of medicinal purposes. Therefore, it is of interest to document the molecular docking analysis data of PARγ modulators from Ocimum tenuiflorum. Four of the twenty substances (rosmarinic acid, permethrin, luteolin, and isosakuranetin) have a considerable binding affinity for the PPARγ. These phytochemicals are a source of potential anti-diabetic medicines.

Dyke-Davidoff-Masson syndrome.

Dyke-Davidoff-Masson syndrome (DDMS) refers to atrophy or hypoplasia of one cerebral hemisphere, due to an insult to the developing brain in fetal or early childhood period. Age of presentation depends on the time of neurologic insult, and characteristic changes may be seen only in adolescence. Male gender and left hemisphere are more frequently involved. A 17-year-old female adolescent with a history of recurrent refractory seizures, hemiplegia and mental retardation reported to Department of Radiology for computed tomography (CT) assessment of brain. On examination, she had facial asymmetry, delayed milestones, and spastic hemiplegia. The CT brain showed right cortical atrophy with ventricular dilatation, prominent sulci, and shifting of falx to the right side. Bone window image showed asymmetry in skull vault thickness, the width of diploic space, the size of paranasal air sinuses and inclination of the petrous ridge between the affected and normal sides. As the above case deviates from the usual presentation of male left sided DDMS, hence the report.

A Prospective Study of Variability in Glycemic Control during Different Phases of the Menstrual Cycle in Type 2 Diabetic Women Using High Sensitivity C - Reactive Protein.

INTRODUCTION: Diabetes mellitus (DM) is one of the metabolic syndromes prevalent worldwide, with more concentration in the Asian region. Many studies have been conducted in order to understand the complex pathogenesis of this disease. Yet, there exists a lacuna in our knowledge about DM. This study aims at establishing the reason for glycemic variation in menstruating Type-2 diabetic women by estimation of C-reactive protein, an inflammatory marker that exhibits significant association with changes in blood glucose levels. METHODOLOGY: A prospective study was undertaken in Type-2 diabetic women of reproductive age group to assess the variability of glycemic control during different phases of menstrual cycle using high sensitivity C reactive protein (hs-CRP) as the biomarker. Fifty women were enrolled after satisfying a set of inclusion and exclusion criteria. The fasting blood glucose, hs-CRP concentration and endogenous female hormones were assayed in follicular and luteal phases of the cycle. The observed parameters were analyzed statistically for significant correlation. Observation and Result: The result showed that hs-CRP level significantly correlates with increasing levels of fasting blood glucose level in both the phases of menstrual cycle in Type-2 diabetic women. The significance is statistically stronger during luteal phase of the cycle (r = 0.807; p<0.05). The correlation observed between hs-CRP and Estrodiol in follicular phase (r = -0.311; p < 0.05) was not statistically significant. The hs-CRP level increased significantly with progesterone level during luteal phase (r = 0.826; p <0.05). CONCLUSION: This study concludes that Type-2 diabetic women of reproductive age group encounter a period of poor glycemic control during luteal phase, as shown by statistically high hs-CRP level mediated by endogenous progesterone hormone. Therefore, this study advocates careful monitoring, life style adjustments and drug regime to reduce the fluctuation in glycemic level experienced by Type-2 diabetic premenopausal women in the luteal phase.