Online Interactive Flipped Classroom Teaching in Pediatrics for Medical Undergraduates.

OBJECTIVES: To introduce online flipped classroom teaching for medical undergraduates in Pediatrics and to assess students' engagement and satisfaction with the students and faculty with the flipped classroom teaching method. METHODS: An interventional education study was conducted on online flipped classrooms for final-year medical undergraduates. The core team of faculty members was identified, students and faculty were sensitized, and pre-reading material and feedback forms were validated. Students were engaged using the Socrative app, and feedback from students and faculty was collected using Google Forms. RESULTS: One hundred sixty students and six faculty members participated in the study. During the scheduled class, 91.9% of students were engaged. The majority of the students strongly agreed that the flipped classroom was interesting (87.2%) and interactive (87%) and developed an interest in the subject of Pediatrics (86%). Faculty were also motivated to adopt this method. CONCLUSION: The present study revealed that introducing flipped classroom strategy in an online model improved students' engagement and increased their interest in the subject.

Assessment of clinical and virological outcomes of rural and urban populations: COVID-19.

Objective: To assess the clinical and virological status in urban and rural populations. Methods: A cross-sectional study was conducted in a tertiary care hospital, Postgraduate Institute of Medical Sciences, Rohtak for a period of six months. Upper respiratory tract (URT) specimens including nasopharyngeal and oropharyngeal swabs were collected from the patients and their contacts and processed by RT-PCR technique for COVID-19 detection. Further, clinical and virological response in both the population were assessed and compared. Results: A total of 37,724 URT samples were tested, out of which 20,144 (53%) samples were from the rural population and 17,580 (47%) from the urban population. Out of the total samples from urban and rural population, COVID-19 positivity was 13.9% in urban population and 6.2% in rural population. Around 86% patients or contacts were asymptomatic in both the rural and urban population and rests were symptomatic 14%. Among the symptomatic patients, sore throat was seen as the most common presenting symptom (95-100%) followed by fever (80-83%), dry cough (55-61%), nasal discharge (18-23%), and breathlessness (3-5%) in both the rural and urban population. Conclusion: Our outcomes provide novel facts that the COVID-19 epidemic severely affected both rural and urban populations but with few differences. In our study, positivity rate in case of urban population was 13.9% as compared to 6.2% in rural population. There are two foremost facets that contributed variation in positivity in both the population. First, better immune response in rural population as compared to urban population which can be due to the fact that rural people in India are more exposed to various pathogens during their early lifetime thus, improving their immune status. Second, factor could be elevated population densities in urban areas which can contribute to increased infectiousness thus higher positivity rate. In addition, people living in urban population have to commute more for their work and are exposed to more people throughout the day thus, having more possibility to get infection of COVID-19 as compared to the rural population. To the best of our knowledge, there are no studies conducted on COVID-19, among rural population of Haryana. Hence, this study will allow us to fill the gap in knowledge about the variation in contagion spread and immune response in both rural and urban populations.

Approach to Handling a Problem Resident.

Many medical postgraduate teaching programs have residents with professional and personal problems that may limit their performance. A Problem resident is the one who does not meet the expectations of the training program owing to deficits in knowledge, skill or attitude. Medical administration and faculty of every institution must have a system that is sensitized to handle a difficult learner. Problems need to be addressed before they escalate or result in compromise of patient care. The present review discusses a broad approach to recognizing a Problem resident and provides suggestions on remedial measures.

Identification of extended spectrum beta lactamases, AmpC and carbapenemase production among isolates of Escherichia coli in North Indian tertiary care centre.

INTRODUCTION: Identification of Extended spectrum beta lactamases (ESBL), AmpC production and carbapenemase production among isolates of Escherichia coli, helps clinician to rationalize the choice of antibiotics. However, there is a lack of simple and effective method for simultaneous identification of these beta lactamases. AIM: To determine the concurrent production of beta lactamases using twelve disc method on E. coli isolates. MATERIALS AND METHODS: A total of 200 multidrug resistant E. coli were screened using twelve disc method. The isolates of ESBL were confirmed by ceftazidime/clavulanic acid and cefotaxime/clavulanic acid method. Metallo-beta-lactamases (MBL) were confirmed by imipenem EDTA combined disc method. RESULTS: Among the 200 isolates, 42.5% were ESBL producers, 9% were MBL and 6.5% were Klebsiella pneumoniae carbapenemase (KPC) and AmpC each respectively. Coproduction was seen in 54 (27%). A significant difference in sensitivity was seen in cefuroxime, aztreonam, cefoxitin and ceftriaxone among inpatient and outpatients. CONCLUSION: The present study highlights burden of ESBL, AmpC, KPC and MBL along with their coproduction in a tertiary care hospital. In-house antibiotic policy, infection control and epidemiological surveys will help us in controlling these resistant bugs. We believe, the twelve disc method is a simple, inexpensive screening method for beta lactamase production.

Antibiotic Resistance Pattern of Uropathogens: An Experience from North Indian Cancer Patient.

Empirical treatment of urinary tract infections (UTIs) can be made evidence based if it is governed by the resistance pattern of common uropathogens. A retrospective study was carried out at a tertiary care cancer institute to identify the common uropathogens and to know their resistance profile. 20.82% of the outpatients' urine samples (community-acquired urinary tract infection (CA-UTI)) and 24.83% of the indoor patients' urine samples (hospital-acquired urinary tract infection (HA-UTI)) grew uropathogens. Escherichia coli was the predominant pathogen both in CA-UTI (68%) and HA-UTI (45%) followed by Klebsiella spp and Enterococcus spp. High level of resistance to fluoroquinolones and third generation cephalosporins was noted. Nitrofurantoin was found to be a reliable oral drug for treatment of most of the uropathogens.

Achromobacter Xylosoxidans Bloodstream Infection in Elderly Patient with Hepatocellular Carcinoma: Case Report and Review of Literature.

Achromobacter xylosoxidansis a nonfermentative Gram-negative organism, known to cause opportunistic infection in humans. We report a case of septicemia in a 76-year-old male patient with underlying hepatocellular carcinoma due to A. xylosoxidans, which showed a different antimicrobial susceptibility pattern from what is usually reported. From aerobic blood culture of the patient, A. xylosoxidans was isolated which was found to be sensitive to amoxicillin-clavulanic acid, piperacillin-tazobactam, ceftazidime, cefoperazone-sulbactam, meropenem, minocycline, tigecycline, and trimethoprim/sulfamethoxazole. The patient recovered with amoxicillin-clavulanic acid treatment, which was given empirically to the patient. The present case highlights the possible role of amoxicillin-clavulanic acid for treatment of bloodstream infection with A. xylosoxidans.