Effectiveness of an Innovative Card Game as a Supplement for Teaching Factual Content to Medical Students: A Mixed Method Study.

Introduction Lectures and small group teaching are useful to transfer conceptual knowledge. Anatomy is the foundation of medical sciences, but it is perceived to be difficult to comprehend and recall. For such clinically relevant aspects of medical education that require memorization, educational card games can be very effective. As the complex concepts and terminology of Embryology are difficult to follow and retain, we designed a card game "MedFc" for a topic on pharyngeal arches. This study was planned to determine the effectiveness of the card game on curriculum comprehension, recall of factual topics among medical undergraduates, and its utility as a supplement to interactive lecture sessions. Methods The mixed method study was conducted in the Department of Anatomy of an undergraduate medical college. Ethical approval was obtained prior to beginning the study. Convenience sampling was done. From a batch of 50 first-year medical students, a total of 40 students consented to participate in the study, 24 (60%) were males and 16 (40%) were female participants. A lecture on the pharyngeal arches was conducted for the entire batch of 50 first-year medical students. After three weeks, the students who consented to participate in the study were randomly grouped into two groups of 20 each. The groups were the game group (which played the card game in teams of five) and the control group (which discussed the same topic in small groups of five). For both the group's pretests and posttests, 10 higher order multiple choice questions, were conducted and students' feedback regarding the effectiveness of the teaching technique was obtained. Results Students opined that playing the card game was a superb experience, a positive use of time, and a very effective method of comprehension and memorizing complex topics. The scores increased from the pretest to the posttest indicating that both methods effectively reinforced the embryological concepts, but a t test showed that card game is more effective than small group discussions, with p-value = 0.008. The improvement in scores of students who had achieved <50% in pretest for the game group was statistically significant with t-value = 0.0023, when compared with the improvement in scores of similar students from the control group. Conclusions The study has demonstrated the effectiveness of "MedFc" card game in the recall of factual topics and can be used as supplementary material for enhancing learning amongst medical graduates. This educational card game applies gamification to Anatomy education to create a fun filled learning experience and is a valuable addition to the learning resources.

Predictors of Mortality among Patients Hospitalized with COVID-19 during the First Wave in India: A Multisite Case-Control Study.

Severe acute respiratory syndrome coronavirus 2 disease (COVID-19) has caused more than 6 million deaths globally. Understanding predictors of mortality will help in prioritizing patient care and preventive approaches. This was a multicentric, unmatched, hospital-based case-control study conducted in nine teaching hospitals in India. Cases were microbiologically confirmed COVID-19 patients who died in the hospital during the period of study and controls were microbiologically confirmed COVID-19 patients who were discharged from the same hospital after recovery. Cases were recruited sequentially from March 2020 until December-March 2021. All information regarding cases and controls was extracted retrospectively from the medical records of patients by trained physicians. Univariable and multivariable logistic regression was done to assess the association between various predictor variables and deaths due to COVID-19. A total of 2,431 patients (1,137 cases and 1,294 controls) were included in the study. The mean age of patients was 52.8 years (SD: 16.5 years), and 32.1% were females. Breathlessness was the most common symptom at the time of admission (53.2%). Increasing age (adjusted odds ratio [aOR]: 46-59 years, 3.4 [95% CI: 1.5-7.7]; 60-74 years, 4.1 [95% CI: 1.7-9.5]; and ≥ 75 years, 11.0 [95% CI: 4.0-30.6]); preexisting diabetes mellitus (aOR: 1.9 [95% CI: 1.2-2.9]); malignancy (aOR: 3.1 [95% CI: 1.3-7.8]); pulmonary tuberculosis (aOR: 3.3 [95% CI: 1.2-8.8]); breathlessness at the time of admission (aOR: 2.2 [95% CI: 1.4-3.5]); high quick Sequential Organ Failure Assessment score at the time of admission (aOR: 5.6 [95% CI: 2.7-11.4]); and oxygen saturation < 94% at the time of admission (aOR: 2.5 [95% CI: 1.6-3.9]) were associated with mortality due to COVID-19. These results can be used to prioritize patients who are at increased risk of death and to rationalize therapy to reduce mortality due to COVID-19.

Role of dietary habits and personal hygiene on nutritional status of school-going adolescents: A cross-sectional study in selected schools located in slum areas of Nagpur City, Maharashtra.

Purpose: Adolescence is a nutritionally vulnerable time when rapid physical growth increases nutrient demand. Addressing the nutrition needs of adolescents could be an important step toward breaking the vicious cycle of intergenerational malnutrition. Under the healthy school initiative, a baseline assessment was carried out to assess the nutritional status, dietary habits, and personal hygiene of school-going adolescents to plan the future interventions at school level. Materials and Methods: A cross-sectional study was conducted in two government-aided schools for 6 months among 814 students of Class VI-IX to assess their dietary habits and personal hygiene by using the GSHS( Global School based student Health Survey) -2007(Indian version) tool. Anthropometric measurement was taken by standard technique. Results: The study found the proportion of thinness, stunting, and overweight/obesity as 40%, 20%, and 4.2%, respectively. Male students were found more thin (61.1% vs. 38.8%) and stunted (55.6% vs. 44.4%) as compared to female students. Less than one-fourth (13.7%) of the students reported <5 servings of fruits and vegetables. In multivariable analysis, male students, children of homemaker mother, skipping breakfast on all days of week, consumption of fast food ≥3 times/week, consumption of high sugary ready to use food, and infrequent handwashing after toilet were found to be predictors of thinness. Conclusion: Dietary habits and personnel hygiene were found to be important factors of undernutrition; promoting health behavior through school health policy with involvement of teachers, students, and parents is highly recommended to reduce the problem of undernutrition among adolescents.

Résumé Objectif: L'adolescence est une période de vulnérabilité nutritionnelle pendant laquelle une croissance physique rapide augmente la demande en nutriments. Répondre aux besoins nutritionnels des adolescents pourrait constituer une étape importante vers la rupture du cercle vicieux de la malnutrition intergénérationnelle. Dans le cadre de l'initiative pour une école saine, une évaluation de base a été réalisée pour évaluer l'état nutritionnel, les habitudes alimentaires et l'hygiène personnelle des adolescents scolarisés afin de planifier les futures interventions au niveau de l'école. Matériels et Méthodes: Une étude transversale a été menée dans deux écoles subventionnées par le gouvernement pendant 6 mois auprès de 814 élèves des classes VI à IX pour évaluer leurs habitudes alimentaires et leur hygiène personnelle à l'aide du GSHS (Enquête mondiale sur la santé des élèves en milieu scolaire) -2007 (version indienne) outil. La mesure anthropométrique a été prise par la technique standard. Résultats: L'étude a révélé que la proportion de maigreur, de retard de croissance et de surpoids/obésité était de 40 %, 20 % et 4,2 %, respectivement. Les étudiants de sexe masculin se sont révélés plus minces (61,1 % contre 38,8 %) et rabougris (55,6 % contre 44,4 %) que les étudiantes. Moins d'un quart (13,7 %) des élèves ont déclaré <5 portions de fruits et légumes. Dans une analyse multivariée, les étudiants de sexe masculin, les enfants d'une mère au foyer, le fait de sauter le petit-déjeuner tous les jours de la semaine, la consommation de restauration rapide ≥ 3 fois/semaine, la consommation d'aliments prêts à l'emploi riches en sucre et le lavage peu fréquent des mains après la toilette se sont révélés être des prédicteurs de minceur. Conclusion : Les habitudes alimentaires et l'hygiène du personnel se sont révélées être des facteurs importants de dénutrition ; la promotion de comportements sains par le biais d'une politique de santé scolaire avec la participation des enseignants, des élèves et des parents est fortement recommandée pour réduire le problème de la dénutrition chez les adolescents Mots-clés: Adolescent, habitudes alimentaires, hygiène personnelle, dénutrition.

Perception of health-related case studies in the context of introduction to clinical medicine course: students' and teachers' perspective.

BACKGROUND: Integrating theoretical and practical knowledge and stimulating students' active learning is the most important task of modern and high-quality healthcare education. By analyzing clinical cases, undergraduate medical students are trained to make accurate diagnoses, to choose appropriate therapy based on laboratory results and on adequate diagnostic tests. AIM: To examine the effect of clinical cases presentations on short-term memory as well as on the student's and teachers' evaluation of this method of teaching and learning in undergraduate medical studies. METHODS: A total of 107 students in term 4 and term 5 enrolled in Trinity Medical Sciences University in St. Vincent and the Grenadines participated in this cross-sectional study. At the end of the semester, the students and the faculty were asked to complete a survey to assess their perception of case presentations (10 items, 4-point Likert-type scale, strongly agree to strongly disagree). The results of pre- and post-presentation quizzes were evaluated using the Wilcoxon signed rank test for paired samples. RESULTS: Term 4 and term 5 students significantly improved their achievement after intervention (Wilcoxon test Z = - 11.282, p < 0.001, and Wilcoxon test Z = - 10.167, p < 0.001, respectively). The analysis of progress among low- and high-performance students in both terms showed a significant increase in performance. Overall, median students' and teachers' attitude scores were positive. CONCLUSION: Clinical case presentation has a learning potential and facilitates positive interaction between instructors and students and supporting students to become reflective and competent physicians.

Coverage of mass drug administration for elimination of lymphatic filariasis in urban Nagpur, Central India: A mixed method study.

BACKGROUND AND AIMS: Mass Drug Administration (MDA) coverage remains an important indicator in elimination of Lymphatic Filariasis (LF), especially in context of recent changes in programme strategies in India, such as incorporation of Ivermectin and involvement of urban Accredited Social Health Activists (ASHAs). This study aimed at assessing the coverage and compliance with MDA of Filariasis as well as exploring perspective of beneficiaries for non-consumption in selected slum area of Nagpur city. METHODS: Mixed-method study design comprising of quantitative assessment of MDA coverage, followed by qualitative method to explore the reasons of non-compliance was used in selected slum areas of Nagpur city. Using cluster sampling, 240 households were selected and house-to-house visits were made to interview the eligible participants. In-depth interviews were conducted among selected non-compliant participants. STATISTICAL ANALYSIS: Multivariable logistic regression analysis to identify the factors associated with non-consumption. Thematic analysis was done to obtain the reasons of non-consumption as perceived by the beneficiaries. RESULTS: Among the 1096 individuals studied, distribution and consumption coverage were 55.2% and 48.5%, respectively. Effective supervised consumption was further low (28.9%). Coverage compliance gap (CCG) was 12.1%. Male sex and younger age (2-5 years) were significant socio-demographic determinants of non-consumption. No repeat visit to houses left in first round, fear of side effects, pill burden, poor understanding about the need were important reasons as revealed by qualitative inquiry. CONCLUSION: Effective pre-campaign awareness, incorporation of context specific drug delivery strategies and strengthening monitoring system are essential for successful MDA implementation.

Co-existence of extramammary Paget's disease and Bowen's disease of vulva.

Extramammary Paget's disease and Bowen's disease are histologically similar and immunohistochemistry is often required to make the diagnosis. We present a case of vulval Paget's disease with Bowen's disease in an elderly female. Strong positivity for cytokeratin 7, anti CAM 5.2, carcinoembryonic antigen (CEA) and periodic acid-Schiff (PAS) stain in clitoral, left labial and interface regions of the vulvectomy specimen confirmed the diagnosis of Paget's disease (PD) while positive staining for p63 in the right labial and interface regions helped in establishing the diagnosis of concurrent Bowen's disease (BD).

Relationship of Lipid Profile and Serum Ferritin levels with Acute Myocardial Infarction.

INTRODUCTION: National Health and Nutrition Examination Survey (NHANES III), 1988-1994, first time reported a significant, positive association in iron storage and heart disease risk. Thereafter several researchers have found an association between iron overload, serum ferritin (SF) and MI. No such Indian study was available in the literature and so we decided to find out the relation of lipid profile and Serum Ferritin with myocardial infarction (MI). MATERIALS AND METHODS: Fifty indian patients of AMI (study group) and fifty indian healthy volunteers (control group) were included for the present study. Lipid profile including TC, HDL-c, LDL-c, VLDL-c & TG and SF levels were estimated in all subjects. OBSERVATIONS AND RESULTS: Mean ± SD of TC level was 250.64 ± 25.61, of HDL-c was 36.52 ± 2.86, of LDL-c was 165.69 ± 26.80, of VLDL-c was 42.35 ± 8.53 and of TG was 211.83 ± 42.65 in study group while these values were 174.46±47.68, 43.2±12.52, 98.37±41.13, 32.88±21.45 and 164.42±107.29 respectively in control group. All the parameters were found not only raised in patients of acute myocardial infarction (AMI) but were also statistically significant when compared with control group (p=<0.01). Mean ± SD of SF levels was 268.43±30.17 ng/ml in study group and 110.96±56.5 ng/ml in control group; this level was found not only raised in patients of AMI but were also statistically significant when compared with control group (p=<0.01). CONCLUSION: TC, LDL-c, VLDL-c, TG and SF levels were raised in patients of AMI and found to be statistically significant; while HDL-c levels were reduced in such patients and is also statistically significant. It can be concluded that there exists an association in lipid profile and SF with AMI therefore dyslipidemia and raised SF levels are the features of AMI.

Co-existence of extramammary Paget's disease and Bowen's disease of vulva.

Extramammary Paget’s disease and Bowen’s disease are histologically similar and immunohistochemistry is often required to make the diagnosis. We present a case of vulval Paget’s disease with Bowen’s disease in an elderly female. Strong positivity for cytokeratin 7, anti CAM 5.2, carcinoembryonic antigen (CEA) and periodic acid‑Schiff (PAS) stain in clitoral, left labial and interface regions of the vulvectomy specimen confirmed the diagnosis of Paget’s disease (PD) while positive staining for p63 in the right labial and interface regions helped in establishing the diagnosis of concurrent Bowen’s disease (BD).