Pen and palm model to envision the coexistence of induced-fit and substrate-strain theories of enzyme action.

Competency-based physiology and biochemistry education can benefit from the creative integration of imaginative narratives into traditional teaching methods. This paper proposes an innovative model using a pen and palm analogy to visualize enzyme function theories. The pen (substrate) must fit snugly into the palm (enzyme's active site) for catalysis to occur, akin to induced-fit theory. Pressing the pen's top button with the thumb represents the strain needed to convert substrate (pen with nib inside) into product (pen with nub out, ready to write). By leveraging everyday objects creatively, students can enhance their understanding and engagement with enzymatic reactions.NEW & NOTEWORTHY Understanding how enzymes work can be tricky, but a new teaching method using everyday objects like pens and palms helps make it easier. Two main theories explain this: the induced-fit model and the substrate-strain model. To visualize this, imagine a pen as the substrate and your palm as the enzyme. When you hold the pen with your fingers (induced-fit), it's like the enzyme changing shape to hold the substrate. Pressing the pen's button with your thumb (substrate-strain) is like the enzyme applying pressure to make the pen ready to write. This simple analogy helps students better understand these complex processes, making learning more engaging and accessible.

A qualitative survey on perception of medical students on the use of large language models for educational purposes.

Large language models (LLMs)-based chatbots use natural language processing and are a type of generative artificial intelligence (AI) that are capable of comprehending user input and generating output in various formats. They offer potential benefits in medical education. This study explored the student's feedback on the utilization of LLMs in medical education. We conducted an in-depth interview with open-ended questions with Indian medical students via telephone conversation. The recording (average time 55.28±18.04 min) was transcribed and thematically analyzed to find major themes and sub-themes. We used QDA Miner Lite v.2.0.8 (Provalis Research: Montreal, Canada) for the thematic analysis of the text. A total of 25 students from eight Indian states studying from the first to final year of studies participated in this study. Three major themes were identified about usage scenario, augmented learning, and limitation of LLMs. Students use LLMs for clarifying complex topics, searching for customized answers, solving MCQs, making simplified notes, and streamlining assignments. While they appreciated the ease of access, ready reference for getting clarity on doubts, lucid explanation of questions, and time-saving aspects of LLMs, concerns were raised regarding erroneous results, limited usage due to reliability and privacy issues, and the overreliance on chatbots for educational needs. Hence, they emphasized the need for training for the integration of LLM in medical education. In conclusion, according to students' perception, LLMs have the potential to enhance medical education. However, addressing challenges and leveraging the strengths of LLMs are crucial for optimizing their integration into medical education.

Relationship of emotional intelligence and capability of answering higher-order knowledge questions in physiology among first-year medical students.

Emotional intelligence (EI) has a positive correlation with the academic performance of medical students. However, why there is a positive correlation needs further exploration. We hypothesized that the capability of answering higher-order knowledge questions (HOQs) is higher in students with higher EI. Hence, we assessed the correlation between EI and the capability of medical students to answer HOQs in physiology. First-year undergraduate medical students (n = 124) from an Indian medical college were recruited as a convenient sample. EI was assessed by the Schutte Self-Report Emotional Intelligence Test (SSEIT), a 33-item self-administered validated questionnaire. A specially designed objective examination with 15 lower-order and 15 higher-order multiple-choice questions was conducted. The correlation between the examination score and the EI score was tested by Pearson's correlation coefficient. Data from 92 students (33 females and 59 males) with a mean age of 20.14 ± 1.87 yr were analyzed. Overall, students got a percentage of 53.37 ± 14.07 in the examination, with 24.46 ± 9.1 in HOQs and 28.91 ± 6.58 in lower-order knowledge questions (LOQs). They had a mean score of 109.58 ± 46.2 in SSEIT. The correlation coefficient of SSEIT score with total marks was r = 0.29 (P = 0.0037), with HOQs was r = 0.41 (P < 0.0001), and with LOQs was r = 0.14 (P = 0.19). Hence, there is a positive correlation between EI and the capability of medical students to answer HOQs in physiology. This study may be the foundation for further exploration of the capability of answering HOQs in other subjects.NEW & NOTEWORTHY This study assessed the correlation between emotional intelligence (EI) and the capability of medical students to answer higher-order knowledge questions (HOQs) in the specific context of physiology. The finding reveals one of the multifaceted dimensions of the relationship between EI and academic performance. This novel perspective opens the door to further investigations to explore the relationship in other subjects and other dimensions to understand why students with higher EI have higher academic performance.

Student perceptions of Twitter poll-based formative assessment in a rural medical college in India.

Formative assessment is vital for student learning and engagement. Social media platforms like Twitter have gained popularity in medical education, but little research has explored student perceptions of formative assessment through Twitter. This study aimed to observe participation rates in Twitter poll-based formative assessment and survey students' perceptions of it in a rural medical college in India. Fifteen formative assessment sessions were conducted using a Twitter poll after physiology lectures, with five multiple-choice questions per session. The number of participants in each poll was recorded. A questionnaire collected student perceptions after the sessions. Across 15 Twitter poll sessions, we received an average of 12.65 ± 5.53 (median 12) responses. Most students (63%) did not participate, with only 4% participating in over 10 sessions. A total of 107 students participated in the survey, resulting in an 85.6% response rate. Students found social media-based formative assessment interesting and effective for increasing attention in class. However, they preferred alternative platforms like Telegram and Instagram for formative assessment. In conclusion, most students in a rural medical college in India do not participate in Twitter poll-based formative assessment. Nevertheless, students found it interesting and effective, highlighting the importance of considering students' platform preferences for implementing social media-based formative assessment.NEW & NOTEWORTHY The study presents the participation of medical students in Twitter poll-based formative assessment in a rural medical college in India. Despite low participation rates, students found social media-based formative assessment highly effective in increasing their attention during class. The study also reveals student preferences for alternative platforms like Telegram and Instagram. These insights contribute significantly to understanding the impact and relevance of social media-based formative assessment in diverse educational contexts.

A Brief Review on Good Clinical Practice and its Training Methods.

The field of clinical research continues to advance, and for ethical conduct of research, researchers need to have a strong foundation in good clinical practice (GCP). GCP guidelines are internationally recognized standards that govern the conduct of clinical trials, ensuring the protection of human subjects and the generation of reliable data. However, novice researchers or postgraduate medical students who would delve into research activities may face difficulty getting avenues for GCP training. Hence, in this brief review article, we discuss the significance of GCP in the field of clinical research with a glimpse of its history, development, and key principles. We provide a list of online courses, benefits, and disadvantages of those courses, and a list of organizations that conduct GCP workshops or continued medical education programs in India.

Comparison of corrected QT (QTc) interval of electrocardiogram calculated from various formulas.

QT interval in an electrocardiogram (ECG) is interpreted after correction (QTc) by various formulas. This study aimed to compare the QTcs calculated by nine formulas. Sinus rhythm ECG reports of 1140 anonymous subjects showed uncorrected QT interval of 388.49 ± 42.74 ms. The QTc calculated by Bazett (443.96 ± 57.58 ms), Fridericia (424.37 ± 50.1 ms), Dmitrienko (433.59 ± 53.37 ms), Framingham (422.59 ± 45.55 ms), Schlamowitz (433.89 ± 48.05 ms), Hodges (421.6 ± 46.4 ms), Ashman (434.33 ± 54.05 ms), Rautaharju (427.75 ± 47.4 ms), and Sarma (429.22 ± 48.67 ms) showed a significant difference F (8, 10251) = 22.78 p < 0.0001. Hence, ECG should contain the formula for proper reporting and ease of interpretation by clinicians.

Structured Online Systematic Review Training for Medical Students: An Elective Module in Physiology.

Background Recently, elective posting has been introduced by the National Medical Commission (NMC) of India in the undergraduate competency-based medical education (CBME) curriculum. To successfully implement it in medical colleges, facilitators (medical teachers) need to commit extra time. Hence, this study aimed to evaluate the impact of online teaching-learning methods for implementing an elective module for undergraduate medical students at Burdwan Medical College and Hospital, West Bengal, India. Methods An online module for systematic review methods was developed using the Delphi method. This module was used to train 30 medical students divided into six groups. One resident and one faculty facilitated each group. After the elective program of 15 days, program feedback and evaluation using the Kirkpatrick model were obtained from the students. Results A total of 30 undergraduate medical students with a mean age of 22.7±0.95 years participated in the study. All of them successfully conducted a systematic review per group. The students' feedback was 86.33% positive, and the project evaluation showed an 84% positive opinion. The highest score was for understanding, facilitators' knowledge, and experience. The lowest score was for the immediate applicability of the knowledge. Conclusion An online systematic review training module can be used for elective teaching-learning for final-year medical students, particularly within limited time and resource constraints. Students appreciated the module's clear objectives, appropriate complexity, and facilitators' expertise, leading to improved communication, engagement, and critical-thinking skills. Despite some limitations, these findings suggest that online learning can complement traditional methods and address logistical challenges in medical education, warranting further research on its long-term impact and broader applicability.

A Cross-Sectional Study on Motor and Sensory Nerve Functions in Women Newly Diagnosed and Untreated for Hypothyroidism in a Tribal Area of Odisha, India.

Introduction: Altered levels of thyroid hormones can impact various body systems, including the nervous system. Hypothyroidism may disrupt nerve conduction due to pathophysiological changes associated with hormone deficiency. The tribal population, characterized by distinct lifestyles and dietary habits, may experience unique influences on their growth and development. Aim: This study aimed to compare nerve conduction in newly diagnosed and untreated tribal women affected by hypothyroidism with euthyroid tribal women. Methods:A cross-sectional study was conducted in southern Odisha, India, spanning from April 2020 to January 2021. Forty-five newly diagnosed hypothyroid tribal women were enlisted from the outpatient department of general medicine as the case group. Additionally, 45 age-matched apparently healthy euthyroid tribal women were included as the control group. The subjects' height and weight were measured by an expert clinician. Nerve conduction (motor and sensory) study on both extremities (left and right side) were conducted for all participants in the human physiology laboratory. Results:The mean age of participants was 48.13±12.12 years in the case group and 47.18±12.2 years in the control group. In hypothyroid tribal women, a significant decrease in conduction velocity was observed in the majority of motor nerves (right median [p = .03], left median [p = .02], left ulnar [p = .04], right posterior tibial [p = .001], left posterior tibial [p = .0001]) and sensory nerves (right median [p =.005], right ulnar [p = .02], right sural [p = .001], and left sural [p = .02]). Conclusion:In newly diagnosed cases of hypothyroidism in tribal women, there is a risk of neuropathy that impacts both motor and sensory neurons. Therefore, it is crucial to initiate early diagnosis and immediate treatment to prevent additional neurological damage.

Predictors of Recovery in Facial Nerve Palsy: Insights From an Observational Study in Odisha, India.

Background Facial nerve paralysis, leading to the loss of facial expression, poses significant discomfort to patients. While most individuals exhibit a favorable response to treatment, a subset experiences enduring facial deformities without clearly defined etiology. This study aimed to identify prognostic factors influencing outcomes and quality of life in facial nerve palsy patients, contributing to enhanced clinical management. Methods A prospective observational study was conducted in the Otorhinolaryngology Department of Maharaja Krishna Chandra Gajapati Medical College and Hospital, a tertiary care hospital. We included patients presenting with any clinical variety of facial nerve palsy, irrespective of age and gender. Only moribund and noncompliant cases were excluded. Patients underwent clinical assessment using the House-Brackmann (HB) grading at presentation and were subsequently monitored at three weeks, three months, and six months post-onset to assess recovery. Results Out of 66 patients, 18 (27.27%) fully recovered at three weeks, 50 (75.76%) recovered at three months, and 54 (81.82%) at six-month follow-up. Incomplete recovery was observed in 13 (19.69%) patients. Factors associated with favorable outcomes included younger age of onset (p = 0.003), lower baseline HB grade (IV or less) (p = 0.001), Electroneurography Degeneration Index (ENoG DI) of <70% (p < 0.0001), early initiation of treatment (within five days of onset) (p = 0.0003), and absence of comorbid conditions (p = 0.03). Gender and affected side (left or right) did not influence the outcome. Conclusion In summary, age, associated comorbid conditions, baseline HB grade, and extent of facial nerve degeneration are crucial predictors of outcomes in facial nerve palsy. This knowledge can guide clinicians in optimizing treatment strategies for improved patient care.

Comparative Evaluation of Pulmonary Function in Male Street Vendors Versus Smokers: Insights into Occupational and Lifestyle Impact.

BACKGROUND: Occupational and lifestyle factors, such as smoking and street vending, may pose risks to pulmonary health. Previous studies explored the effect of both smoking and exposure to street pollutants on health. However, a study comparing the pulmonary functions of street vendors (who do not smoke) and smokers has not been conducted before. OBJECTIVE: The objective of this study was to compare the pulmonary function parameters among three groups consisting of smokers, street vendors and controls in order to discern potential differences in respiratory health between the three groups. METHODS: This cross-sectional study was conducted in the Deoghar district of the Jharkhand state, in India, over a period of five months (between January 2023 and May 2023). A total of 90 male participants, including 30 smokers, 30 street vendors and 30 age-matched control research participants, underwent pulmonary function testing (forced spirometry) using standardized methods. The comparison among the three groups was conducted by one-way analysis of variance with the post-hoc test. RESULTS: A total of 30 controls with a mean age of 33.77±6.01 years, street vendors with a mean age of 32.93±6.29 years and smokers with a mean age of 32.27±7.86 years participated in the present study. There was an average exposure to road pollutants for 13.47±9.48 years and smoking for 13.23±8.29 years (P=0.92). Lung function parameters, except for the forced expiratory volume in one second divided by the forced vital capacity (FEV1/FVC), were lower in street vendors and smokers than controls. CONCLUSION: Street vendors in Deoghar, Jharkhand, have lung function parameters comparable to smokers. Hence, although they are not smoking tobacco, their lung health is at risk. Hence, early interventions are required to protect them from pollutants.

Assessing the Capability of Large Language Models in Naturopathy Consultation.

Background The rapid advancements in natural language processing have brought about the widespread use of large language models (LLMs) across various medical domains. However, their effectiveness in specialized fields, such as naturopathy, remains relatively unexplored. Objective The study aimed to assess the capability of freely available LLM chatbots in providing naturopathy consultations for various types of diseases and disorders. Methods Five free LLMs (viz., Gemini, Copilot, ChatGPT, Claude, and Perplexity) were used to converse with 20 clinical cases (simulation of real-world scenarios). Each case had the case details and questions pertinent to naturopathy. The responses were presented to three naturopathy doctors with > 5 years of practice. The answers were rated by them on a five-point Likert-like scale for language fluency, coherence, accuracy, and relevancy. The average of these four attributes is termed perfection in his study. Results The overall score of the LLMs were Gemini 3.81±0.23, Copilot 4.34±0.28, ChatGPT 4.43±0.2, Claude 3.8±0.26, and Perplexity 3.91±0.28 (ANOVA F [3.034, 57.64] = 33.47, P <0.0001. Together, they showed overall ~80% perfection in consultation. The average measure intraclass correlation coefficient among the LLMs for the overall score was 0.463 (95% CI = -0.028 to 0.76), P = 0.03. Conclusion Although the LLM chatbots could help in providing naturopathy and yoga treatment consultation with approximately an overall fair level of perfection, their solution to the user varies across different chatbots and there was very low reliability among them.

Efficacy of ChatGPT in solving attitude, ethics, and communication case scenario used for competency-based medical education in India: A case study.

BACKGROUND: Competency-based medical education (CBME) is a method of medical training that focuses on developing learners' competencies rather than simply assessing their knowledge and skills. Attitude, ethics, and communication (AETCOM) are important components of CBME, and the use of artificial intelligence (AI) tools such as ChatGPT for CBME has not been studied. Hence, we aimed to assess the capability of ChatGPT in solving AETCOM case scenarios used for CBME in India. MATERIALS AND METHODS: A total of 11 case scenarios were developed based on the AETCOM competencies. The scenarios were presented to ChatGPT, and the responses generated by ChatGPT were evaluated by three independent experts by awarding score ranging from 0 to 5. The scores were compared with a predefined score of 2.5 (50% accuracy) and 4 (80% accuracy) of a one-sample median test. Scores among the three raters were compared by the Kruskal-Wallis H test. The inter-rater reliability of the evaluations was assessed using the intraclass correlation coefficient (ICC). RESULTS: The mean score of solution provided by ChatGPT was 3.88 ± 0.47 (out of 5), indicating an accuracy of approximately 78%. The responses evaluated by three raters were similar (Kruskal-Wallis H P value 0.51), and the ICC value was 0.796, which indicates a relatively high level of agreement among the raters. CONCLUSION: ChatGPT shows moderate capability in solving AETCOM case scenarios used for CBME in India. The inter-rater reliability of the evaluations suggests that ChatGPT's responses were consistent and reliable. Further studies are needed to explore the potential of ChatGPT and other AI tools in CBME and to determine the optimal use of these tools in medical education.

Social Media and Urticaria - A Data Audit of Facebook®, LinkedIn®, and Twitter® Posts.

Introduction: Urticaria is a common debilitating dermatological disorder impairing a patient's quality of life. Such patients are increasingly using socialmedia to manage their health and interact with peers, particularly during the ongoing COVID-19 pandemic. Objectives: To explore and analyse the quality of urticaria related social-media information available to patients. Materials and Methods: An in-depth data audit of the three most commonly used social networks viz. Facebook®, LinkedIn®, and Twitter® were done on a single day, as posts may change or lose relevance over time. The word "urticaria" was searched on three social media, and the first 100 posts in each were further analysed. The post-creator was either categorised as "individual" or "group", and non-English posts were excluded. All types of posts have been analysed, including text, images, video, and website links. We also collected the comments/replies, share/re-tweet, and likes on the posts. Results: Among the total 300 social-media posts, the highest number of "individual" posts was on LinkedIn® followed by Twitter® and Facebook® (χ2 = 82.86, P < 0.0001). Regarding thematic content, most Facebook® posts discussed disease symptoms, followed by the promotion of journal or blog posts, and discussion about causative and triggering agents. LinkedIn® was primarily used for the promotion of journal articles or blog posts, followed by educational webinars and urticaria treatment stories. Twitter® users mostly interacted with peers about their urticaria symptoms and perceived etiologic and triggering factors. Regarding the type of post, images were maximally shared on Facebook®, while video/video links and web links were highest on LinkedIn® (χ2 = 21.59, P < 0.0001). Conclusion: The overall quality of urticaria related information on these 3 social media platforms is satisfactory for patients. Dermatologists may consider utilising social media to further educate such patients and improve the overall treatment outcome. The use of such networking channels will continue to grow, as communication remains crucial for urticaria management.

Accuracy of a Non-Invasive Home Glucose Monitor for Measurement of Blood Glucose.

Introduction: Patients with diabetes mellitus monitor their blood glucose at home with monitors that require a drop of blood or use a continuous glucose monitoring device that implants a small needle in the body. However, both cause discomfort to the patients which may inhibit them for regular blood glucose checks. Photoplethysmogram (PPG) sensing technology is an approach for non-invasive blood glucose measurement and PPG sensors can be used to predict hypoglycaemic episodes. InChcek is a PPG-based non-invasive glucose monitor. However, its accuracy has not been checked yet. Hence, this study aimed to evaluate the accuracy of InCheck, a non-invasive glucose monitor for the estimation of blood glucose. Methods: In a tertiary care hospital, patients who came for blood glucose estimation were tested for blood glucose non-invasively on the InCheck device and then by the laboratory method (glucose oxidase-peroxidase). These two readings were compared. We used International Organization for Standardization (ISO) 15197:2013 (95% of values should be within ± 15 mg/dL of reference reading if reference glucose <100 mg/dL or within ± 15% of reference reading if reference glucose ≥100 mg/dL and 99% of the values should be within zones A and B in consensus error grid), and Surveillance Error Grid for analyzing the accuracy. Results: A total of 1223 samples were analyzed. There was a significant difference between the reference method glucose level (135 [Q1-Q3: 97 - 179] mg/dL) and monitor-measured glucose level (188.33 [Q1-Q3: 167.33-209.33] mg/dL) (P < 0.0001). A total of 18.5% of readings were following ISO 15197:2013 criteria and 67.25% of coordinates were within zone A and zone B of the consensus error grid. In the surveillance error grid analysis, about 29.4% of values were in the no-risk zone, 51.8% in slight risk, 18.6% in moderate risk, and 0.2% were in the severe risk zone. Conclusion: The accuracy of the InCheck device for the estimation of blood glucose by PPG signal is not following the recommended guidelines. Hence, further research is necessary for programming or redesigning the hardware and software for a better result from this optical sensor-based non-invasive home glucose monitor.

Naturopathic Interventions for Reduction of Perceived Pain in Patients Suffering from Arthritis: A Systematic Review and Meta-Analysis.

Arthritis affects millions of lives with its pervasive effects on physical health and quality of life. Addressing the complexities of managing symptoms such as swelling, inflammation, and pain requires prolonged treatment. Naturopathy is a treatment method that enhances the body's innate ability to restore optimal health through a holistic approach including natural products and lifestyle modifications. This systematic review addresses the intersection of naturopathy and arthritis treatment to provide current evidence about its potential benefits. Four databases (PubMed, AYUSH Research Portal, Web of Science, and Google Scholar) were searched with the keywords "Naturopathy" AND "Arthritis". Randomized, non-randomized, and cross-over studies in English were included. Studies reporting perceived pain using a visual analogue scale (VAS) were selected for meta-analysis. A total of 15 studies were included in the systematic review. The studies were from Denmark, Egypt, France, Hungary, Israel, Italy, Spain, and Turkey, and the study periods ranged from 1992 to 2017. They suggested that naturopathic treatment modalities like exercise, mud compress, sand bath, or hydrotherapy may be used in addition to conventional modes of treatment for added benefit. There was a diversity of naturopathic treatment modalities and outcome evaluation methods. Most studies used mud compress or mud baths with reported improvement of symptoms. The meta-analysis of 10 studies (11 sets of data) showed a significant improvement in pain measured by VAS. The studies included in the review have a high level of heterogenicity. There is a need for more studies and uniform assessment methods with standardization of interventions for robust evidence. More clinical trials from countries where naturopathy is approved treatment modalities are needed.