Virtual Versus Light Microscopy Usage among Students: A Systematic Review and Meta-Analytic Evidence in Medical Education.

BACKGROUND: The usage of whole-slide images has recently been gaining a foothold in medical education, training, and diagnosis. OBJECTIVES: The first objective of the current study was to compare academic performance on virtual microscopy (VM) and light microscopy (LM) for learning pathology, anatomy, and histology in medical and dental students during the COVID-19 period. The second objective was to gather insight into various applications and usage of such technology for medical education. MATERIALS AND METHODS: Using the keywords "virtual microscopy" or "light microscopy" or "digital microscopy" and "medical" and "dental" students, databases (PubMed, Embase, Scopus, Cochrane, CINAHL, and Google Scholar) were searched. Hand searching and snowballing were also employed for article searching. After extracting the relevant data based on inclusion and execution criteria, the qualitative data were used for the systematic review and quantitative data were used for meta-analysis. The Newcastle Ottawa Scale (NOS) scale was used to assess the quality of the included studies. Additionally, we registered our systematic review protocol in the prospective register of systematic reviews (PROSPERO) with registration number CRD42020205583. RESULTS: A total of 39 studies met the criteria to be included in the systematic review. Overall, results indicated a preference for this technology and better academic scores. Qualitative analyses reported improved academic scores, ease of use, and enhanced collaboration amongst students as the top advantages, whereas technical issues were a disadvantage. The performance comparison of virtual versus light microscopy meta-analysis included 19 studies. Most (10/39) studies were from medical universities in the USA. VM was mainly used for teaching pathology courses (25/39) at medical schools (30/39). Dental schools (10/39) have also reported using VM for teaching microscopy. The COVID-19 pandemic was responsible for the transition to VM use in 17/39 studies. The pooled effect size of 19 studies significantly demonstrated higher exam performance (SMD: 1.36 [95% CI: 0.75, 1.96], p < 0.001) among the students who used VM for their learning. Students in the VM group demonstrated significantly higher exam performance than LM in pathology (SMD: 0.85 [95% CI: 0.26, 1.44], p < 0.01) and histopathology (SMD: 1.25 [95% CI: 0.71, 1.78], p < 0.001). For histology (SMD: 1.67 [95% CI: -0.05, 3.40], p = 0.06), the result was insignificant. The overall analysis of 15 studies assessing exam performance showed significantly higher performance for both medical (SMD: 1.42 [95% CI: 0.59, 2.25], p < 0.001) and dental students (SMD: 0.58 [95% CI: 0.58, 0.79], p < 0.001). CONCLUSIONS: The results of qualitative and quantitative analyses show that VM technology and digitization of glass slides enhance the teaching and learning of microscopic aspects of disease. Additionally, the COVID-19 global health crisis has produced many challenges to overcome from a macroscopic to microscopic scale, for which modern virtual technology is the solution. Therefore, medical educators worldwide should incorporate newer teaching technologies in the curriculum for the success of the coming generation of health-care professionals.

Efficacy of Lanthanum Carbonate and Sevelamer Carbonate as Phosphate Binders in Chronic Kidney Disease-A Comparative Clinical Study.

(1) Background: Hyperphosphatemia is correlated with an increased rate of mortality and morbidity due to cardiovascular diseases in chronic kidney disease (CKD) patients. It can be improved by restricting dietary intake of phosphate and oral phosphate binders, such as lanthanum carbonate and sevelamer carbonate. (2) Objective: To evaluate the clinical efficacy of sevelamer carbonate in comparison to lanthanum carbonate as phosphate binders for the treatment of hyperphosphatemia in CKD patients. (3) Methods: A randomized control comparative clinical study was conducted for one year on 150 CKD patients associated with hyperphosphatemia, divided into two groups, i.e., Group 1 (n = 75) treated with sevelamer carbonate 800 mg thrice daily and Group 2 (n = 75) treated with lanthanum carbonate 500 mg thrice daily. The patients were assessed at the time of enrollment in the study, after three months and after six months from baseline for different parameters, i.e., complete blood count, liver function tests, renal function tests, electrolytes, and serum phosphate level. (4) Results: 150 CKD patients aged 51-60 participated in the study. The mean age of patients was 54 ± 4.6 years, and males (55.71%) were more common than females (44.29%). Hypertension was the common comorbidity in both groups with chronic kidney disease. After six months of treatment, the mean serum phosphate level was significantly decreased from 8.31 ± 0.09 mg/dL to 5.11 ± 0.18 (38%) in Group 1 and from 8.79 ± 0.28 mg/dl to 4.02 ± 0.12 (54%; p < 0.05) in Group 2, respectively. In both groups, no significant difference was found in other parameters such as parathyroid hormone, calcium, uric acid, LFT, RFT, CBC, etc. (5) Conclusion: Lanthanum carbonate is more efficacious in lowering serum phosphate concentrations and effectively managing hyperphosphatemia as compared to sevelamer carbonate.

Human Epidermal Growth Factor Receptor 2 (HER2) Expression in Colorectal Carcinoma: A Potential Area of Focus for Future Diagnostics.

Objective In this study, we aimed to explore the potential diagnostic utility of human epidermal growth factor receptor 2 (HER2) expression in colorectal carcinoma. We investigated the association of HER2 expression with the type and grade of the tumor along with the pattern, staining intensity, and the percentage of cells stained. Methods This was an observational study involving 50 cases of colorectal carcinoma that underwent immunohistochemistry to analyze the HER2 expression. Results The positive expression of HER2 was seen in 16 (32%) cases. The majority of the study population was between the fifth-seventh decades of life. The most commonly diagnosed tumor was conventional adenocarcinoma with grade II, cytoplasmic pattern, +2 positivity, and moderate intensity. The maximum positivity for HER2 was seen in tumors of the rectum in eight (16%) cases. Conclusion A substantial rate of HER2 overexpression paves the way for it to become a potential future target in cancer therapeutics.

Environmental lead levels in a coastal city of India: the lead burden continues.

BACKGROUND: Urbanization, rapid industrialization, increased vehicular traffic, and consequent increase in the use of petroleum fuels in India are constantly emitting lead along with other pollutants into the environment. Apart from atmospheric lead, this element is the most widely used in everyday life. Although infants and children are the most susceptible to the effects of lead, adults are also affected to varying degrees and it had ranked as one of the most serious environmental threats to human health. Hence, we must understand the benefits of preventing lead exposure as it reduces treatment costs, increases productivity in industry, and also reduces infant mortality. These are good enough reasons for a nation wide program to prevent lead poisoning. OBJECTIVES: In the view of elevated blood lead levels (BLL) in majority of the school children in the city of Mangalore, we aimed to identify the potential sources of lead in the environment which would have probably caused the elevated BLL. MATERIALS AND METHODS: More than 600 readings were taken throughout the city of Mangalore using X-ray fluorimeter. RESULTS: Our results showed that there were elevated levels of lead in the environment surrounding the battery repair shops, battery recyclers, automotive workshops, and tyre retreaders, but interestingly, the soil around the petrol bunks did not show elevated levels of lead. Among the paints, the yellow paint showed high levels of lead. CONCLUSION: Similar surveys would be useful elsewhere in India and in other developing countries in order to identify the potential sources of lead and to prevent lead poisoning.

Effect of solar eclipse on microbes.

OBJECTIVE: A solar eclipse was observed in India on 15(th) January, 2010. It was a total eclipse in some parts of the country, while it was a partial eclipse in other parts. Microorganisms play an important role in various phenomena on the earth. This study was undertaken to know the influence of solar eclipse on nature indirectly, by analyzing certain genotypic and phenotypic variations in prokaryotes and eukaryotes. Since yeast have similar gene expression as that of humans, investigations were pursued on Candida albicans. Hence the study of the effect of solar eclipse on cultures of Staphylococcus aureus, Klebsiella species, Escherichia coli,and C. albicans was performed in the laboratory. The effect of the total or partial eclipse on the microorganism isolated from clinical isolates was investigated during the time period from 11.15 am to 3.15 pm. MATERIALS AND METHODS: Cultures of S. aureus, Klebsiella species, and E. coli colonies on nutrient agar slants and broth and C. albicans on Sabouraud's dextrose agar plates and broth. Slants were exposed to sunlight during eclipse and exposure to normal sunlight at Mangalore, Dakshina Kannada district, Karnataka state, India. RESULTS: There was significant change observed during exposure to normal sunlight and eclipse phase. Bacterial colonies showed difference in morphology on smear examination and sensitivity pattern during this study. One fungal species and three bacterial isolates were studied and changes were recorded. Fungal species showed a definite change in their morphology on exposure to sunlight during eclipse observed by stained smear examination from broth, plate, and slant. CONCLUSION: Present study concludes that blocking of the sun rays during eclipse does not harm prokaryotes and eukaryotes, instead promoted the progeny of predators in the race of better acclimatization and survival in the natural and changing environmental conditions.

Screening of school children for blood lead levels and attempts to reduce them by nonpharmacological means in a coastal city of India.

CONTEXT: Lead is a major health hazard, especially in children. Impact of lead poisoning on our society is not known. Effectiveness of environmental interventions in reducing blood lead levels is not exactly known, though the Center for Disease Control and Prevention strongly advocates use of such means. AIMS: We aimed at screening school children for blood lead levels (BLLs) and reducing the BLLs of children with preliminary BLL> 20 microg/dL by environmental intervention and intensive education. MATERIALS AND METHODS: To assess the extent of lead poisoning, a screening of 106 children was done, which showed that children belonging to a particular government primary school had higher BLLs. A second screening program of 87 children conducted in that school showed that only 19% had BLL < 10 microg/dL; whereas 44% had BLL between 10 and 20 microg/dL, and 37% had BLL> 20 microg/dL. Thirty-eight children having BLL> 20 microg/dL were selected from the two screening programs. After removing all potential sources of lead from their environment and educating them about the ways to prevent exposure to lead, follow-up of their BLLs was carried out at an interval of 6 months for a period of 1 year. STATISTICAL ANALYSIS: Values of the different follow-up studies were compared using repeated-measure ANOVA. RESULTS: Our results showed that there was a significant (P < 0.0001) reduction in the BLLs in the first and second follow-up studies. CONCLUSIONS: The study is a proof of the concept that a decline in the BLLs can be achieved by intense education and avoiding the potential environmental sources of lead.