Cultural Competency of Medical Students: An Asian Context

@#Introduction: People of different cultures perceive health and disease differently. A culturally competent healthcare team is needed to provide quality healthcare. In Asian medical schools, less emphasis is laid on cultural competency training. In this context, the study aims to assess the cultural competency of medical students in Malaysia and to fathom the demographic factors influencing it. Methods: A cross sectional survey was conducted on students from all five years of a Malaysian medical school using an adapted version of Clinical Cultural Competency Questionnaire (CCCQ) to tap the self-perceived knowledge, skills, comfort level in cross-cultural encounters and attitude towards cultural competency. Descriptive and inferential statistics was used to analyse the data. Results: Among the 291 respondents, the cultural competency was found to be significantly different among medical students of different year of study, age, and ethnicity. However, with regards to gender, country of birth or the number of languages spoken, the difference was insignificant. The clinical year students had significantly higher scores on the knowledge, skills, comfort level and attitude domains of cultural competency when compared to the preclinical students. Chinese students’ perception on cultural competence was significantly distinct from Indian and Malay students. Conclusion: Exposure to cross cultural encounters in clinical settings and personal experiences seem to influence cultural competency of the medical students. It provides valuable data to plan for interventions, training and self-development strategies aimed at providing culturally attuned patient centred care.

Detection of dermatophytes in healthy companion dogs and cats in eastern India

In recent times increasing occurrence of dermatophytosis, especially among the school children in eastern India was evidenced along with increased tendency of keeping companion animals such as dogs and cats. This study was undertaken to detect the occurrence of dermatophytes with antifungal susceptibility among the companion animals. A total of 1501 healthy companion animals comprising 1209 dogs and 292 cats belonged to individual owners in and around Kolkata [West Bengal, India] were examined for the evidence of dermatophytosis during 2011-2013. The collected samples were subjected to direct examination by standard KOH mount technique. The samples were inoculated into both Sabouraud dextrose agar [SDA] with 0.05% chloramphenicol and 0.5% cycloheximide and dermatophyte test medium [DTM]. Each of the fungal isolate was identified based upon its colony characteristics and hyphal and conidial cells it produced. Antifungal susceptibility of the isolates was tested by broth micro dilution assay using fluconazole, ketoconazole, itraconazole, miconazole, griseofulvin and amphotericin-B antifungals. Among the 1209 samples from dogs and 292 samples from cats, 253 [20.93%] and 109 [37.33%] samples were positive for dermatophytes by direct examination. Three identified species of dermatophytes with predominant occurrence were Microsporum canis, Microsporum gypseum and Trichophyton mentagrophytes. Ketoconazole [0.06-0.5 microgm/ml], itraconazole [0.03-0.5 microgm/ml] and amphotericin-B [0.03-0.5 microgm/ml] showed lowest MIC values against M. canis, T. mentagrophytes and M. gypseum, respectively. This is the first systemic report of dermatophytes in healthy companion animals with large numbers of samples in India

Post monsoon spatial distribution of uranium in water of Alaknanda and Ganges river

Uranium poses both chemical and radiological hazard to the living system. Drinking water from river is one of the major sources of uranium intake. Dissolution of minerals, washout from rain water, rock-water interaction, agricultural run off, and industrial disposals are some of the sources of uranium in river water system. Present study was aimed to determine the uranium in the water Alaknanda and Ganges rivers and its post-monsoon spatial distribution from Nandprayag to Haridwar. River water samples were collected during the post monsoon period in pre-washed polypropylene bottles from the designated locations at both of the rivers. Samples were filtered and analyzed by fluorimetric technique. The measurements showed the concentration of uranium in water of Alaknanda river varied from 3.05 micro g/l to 2.53 micro g/l along the downstream sampled locations with a mean value of 2.75 micro g/l, whereas in water of Ganges river the concentration varied in the range 1.70 micro g/l to 2.00 micro g/l with a mean value of 1.86 micro g/l. The average concentration of uranium was found significantly higher [2.75 micro g/l] in water of Alaknanda river than in Ganges river the average values [1.86 micro g/l] of. However, both the values were far lower than the permissible limits at the sampled locations. The values obtained in present studies were notably higher than that reported elsewhere which seems partly attributable to post monsoon contributing factors

Distance between Midline and Vertebral Artery Groove of Atlas – A Real Aid to the Neurosurgeon

The knowledge of the relationship of the vertebral artery with the atlas is very important, in order to avoid any injury to the vertebral artery, during surgeries in the craniovertebral region. Different researchers have measured the distance of the vertebral artery from the midline along the posterior arch of atlas (oblique distance), but some authors have measured the perpendicular distance of vertebral artery from the midline. Usually, it is the perpendicular distance along which the surgeons are exploring in this region. Hence, the present study was planned to study and compare both oblique and perpendicular distances of the vertebral artery from the midline and find out statistical differences between these two parameters. It was carried out on 30 atlas vertebrae of Indian origin. The oblique and perpendicular distances of vertebral artery groove from midline and the thickness of vertebral artery groove were measured. The results suggest that dissection on the posterior aspect of the arch of atlas should remain 17.00 mm lateral to the midline and dissection on the superior aspect of the arch of atlas should remain 8.00 mm from the midline to prevent injury to the vertebral artery. It was also observed that “oblique distances of vertebral artery groove from the midline to the medial margin of inner and outer cortex are larger than the corresponding perpendicular distances from the midline”. Although, the differences of oblique and perpendicular distances are not statistically significant but it may be clinically significant for the surgeons operating in the craniovertebral region. Hence, it is concluded that the surgeon should be aware of both the distances while operating in the craniovertebral region to avoid any iatrogenic injury to the vertebral artery.

Isolation, characterization and therapeutic potential assessment of bacteriophages virulent to Staphylococcus aureus associated with goat mastitis

In the present study, the therapeutic potential of bacteriophages virulent to Staphylococcus aureus associated with goat mastitis were isolated, identified and assessed. Staphylococcus aureus [host or indicator bacterium] was isolated from a goat suffering from clinical mastitis. Based on cultural, morphological, biochemical tests and amplification of S. aureus specific thermonuclease gene in PCR, the identity of the organism was confirmed as S. aureus. Bacteriophages were isolated from soil and faecal samples [n=42] collected from different parts of the Mathura district in Uttar Pradesh [India], and their identity was confirmed by amplification of the bacteriophage-specific endolysin gene fragment in PCR. The thermal tolerance study revealed that all phage isolates were stable at 30 and 40°C with 100% lytic efficacy and their activities reduced to 62-80% at 50°C declining sharply at 60°C with less than 5% efficacy. Likewise, at pH = 6.5 and 7.5, the survivability of all isolates was 100% which reduced to 70-79% and 84-91% at pH = 5.5 and 8.5, respectively. All isolates were stable up to 3 months at 37°C, and for 16 months at 4°C but the stability of their respective endolysins only lasted for 12-23 days at 37°C and 6 months at 4°C. Three of the bacteriophage isolates, S. aureus phage/CIRG/1, S. aureus phage/CIRG/4 and S. aureus phage/CIRG/5 exhibited lytic activity against over 80% of the staphylococcal isolates. The results of the present study provide insight for the use of lytic bacteriophages for therapeutic interventions against multi-drug-resistant S. aureus inducing mastitis in goats

Comparative assessment of N-terminal pro-B-type natriuretic peptide, nitric oxide and echocardiography for diagnosis of dilated cardiomyopathy in dogs

The aim of the study was to evaluate the clinical usefulness of N-terminal pro-brain natriuretic peptide [NT-Pro BNP] and nitric oxide [NO] with echocardiography [gold st and ard test] in diagnosis of canine cardiomyopathy. Out of 374 cases, 82 cases showing cardiovascular abnormalities including 16 cases of cardiomyopathy were further selected for st and ardization of biomarkers. Significant [P<0.01] increase in plasma NT-Pro BNP was found in dogs with cardiomyopathies. The plasma concentration of NO showed non-significant increase in comparison to healthy dogs. The sensitivity of NT-Pro BNP and NO was 72.20% and 62.50%, with specificity 93.90% and 89.40%, respectively when compared with echocardiography. The correlation between echocardiography and NT-Pro BNP was 89.30% with kappa value of 0.675 suggesting substantial agreement between the two tests. The positive and negative predictive value was estimated at 0.765 and 0.925, respectively. It is concluded that NT-Pro BNP and NO may be an alternate diagnostic tool for diagnosis of cardiomyopathy where the facility of echocardiography is not available. Key words: Cardiomyopathy, Echocardiography, N-terminal pro-brain natriuretic peptide, Nitric oxide

Seroprevalence of leptospirosis among suspected cattle in eastern part of India: a comparative study between rLipL32ELISA and MAT

Leptospirosis in cattle is a worldwide problem associated with abortion, agalactia, still birth and infertility resulting in major economic losses to dairy industry. There is lack of data regarding seroprevalence of bovine leptospirosis in eastern India. So, with the aim to investigate the prevalence of the disease in OdishaandWest Bengal state of eastern India, a total of 350 cattle serum samples were collected with distinct geographical attributes having history of infertility, abortion, and haemogalactia. Serum samples were tested by microscopic agglutination test [MAT] using a battery of twelve Leptospira serovars as live antigen to detect the serovars present in the studied area. Further a recombinant protein [LipL32] based ELISA was carried out for comparative study. Overall seropositivity using MAT and rLipL32ELISA were found to be 50.85% and 56%, respectively. The sensitivity and specificity of rLipL32ELISA relative to MAT was calculated and found to be 100% and 89.53%, respectively. In the current study among the serovars, icterohaemorrhagiae was the most predominant serovar reported in this study. So to conclude, this study warrants further investigations in this area to establish the risk factors involved in disease transmission cycle. Key words: Cattle, Leptospirosis, MAT, rELISA, India

Groundwater arsenic contamination and associated health risks in Bihar, India

The extent of groundwater arsenic [As] contamination and associated health-risks were studied in the four villages: Chaukia and Terahrasiya [Vaishali]; Mamalkha and Masharu [Bhagalpur] in Bihar, India. Groundwater samples were tested using the standard Silverdiethyledithiocarbamate method at 520nm by Thermo UV-1 spectrophotometer. The As levels in both the districts exceeded the WHO standard of 10microg/L for drinking water with a maximum value of 20microg/L in Vaishali and 143microg/L in Bhagalpur. However, the FAO standard of 100microg/L of As for irrigation water was only exceeded in Bhagalpur. The calculated range of the hazard index [HI] for Vaishali was 0.9 to 10, and for Bhagalpur was 10.40 to 40.47. Both ranges exceed the accepted normal toxic HI of 1.00. The cancer risk was derived as 1-5/1000 people to 5-16/10,000 people in Vaishali, and 7-21/1000 and 5-16/1000 people in Bhagalpur. Prevalence of skin pigmentation was double in Vaishali in comparison to Bhagalpur. The analysis of principal components showed that only two components had a fundamental role in defining variance for cancer risk assessment. A more extensive screening of As contamination of groundwater and a follow-up clinical study are necessary to accurately assess the likelihood of As-related cancers in these districts

A QSAR study on a series of simplified digitalis-like compounds acting on Na+,K+-ATPase

Among the cardiotonics (agents against congestive heart failure), the most important group is of the digitalis cardiac glycosides, but since these compounds suffer from a low therapeutic index, attention has been paid to investigating safer cardiotonic agents through the inhibition of Na+,K+-ATPase, the mechanism by which the digitalis cardiac glycosides elicit their action. Recently, a series of perhydroindenes were studied for their Na+,K+-ATPase inhibition activity. We report here a QSAR study on them to investigate the physicochemical and structural properties of the molecules that govern their activity in order to rationalize the structural modification to have more potent drugs. A multiple regression analysis reveals a significant correlation between the Na+,K+-ATPase inhibition activity of the compounds and Kier’s first order valence molecular connectivity index of their R5-substituents and some indicator parameters, suggesting that the R5-substituents of the compounds containing atoms with low valence and high saturation and the R1-substituents having =N−O− moiety will be conducive to the activity.

Dengue fever presenting as acute liver failure--a case report

Dengue fever (DF) and dengue haemorrhagic fever (DHF) are important mosquito-borne viral diseases of humans and recognized as important emerging infectious diseases in the tropics and subtropics. Compared to nine reporting countries in the 1950s, today the geographic distribution includes more than 100 countries worldwide. Dengue viral infections are known to present a diverse clinical spectrum, ranging from asymptomatic illness to fatal dengue shock syndrome. Mild hepatic dysfunction in dengue haemorrhagic fever is usual. However, its presentation as acute liver failure (ALF) is unusual. We report a patient with dengue shock syndrome who presented with acute liver failure and hepatic encephalopathy in a recent outbreak of dengue fever in Delhi, India.

Isolation of a strain of pseudomonas putida capable of metabolizing anionic detergent sodium dodecyl sulfate [SDS]

Sodium Dodecyl Sulfate [SDS] is one of the most widely used anionic detergents. The present study deals with isolation and identification of SDS-degrading bacteria from a detergent contaminated pond situated in Varanasi city, India. Employing enrichment technique in minimal medium [PBM], SDS-degrading bacteria were isolated from pond water sample. Rate of degradation of SDS was studied in liquid PBM and also degradation of different concentrations of SDS was also studied to find out maximum concentration of SDS degraded by the potent isolates. Alkyl sulfatase activity [key enzyme in SDS degradation] was estimated in crude cell extracts and multiplicity of alkyl sulfatase was studied by Native PAGE Zymography. The potent isolate was identified by 16S rRNA sequence analysis. Using enrichment technique in minimal medium containing SDS as a sole carbon source, initially three SDS degrading isolates were recovered. However, only one isolate, SP3, was found to be an efficient degrader of SDS. It was observed that this strain could completely metabolize 0.1% SDS in 16 h, 0.2% SDS in 20 h and 0.3% SDS in 24 h of incubation. Specific activity of alkyl sulfatase was 0.087 +/- 0.004 micromol SDS/mg protein/min and Native PAGE Zymography showed presence of alkyl sulfatase of Rf value of 0.21. This isolate was identified as Pseudomonas putida strain SP3. This is the report of isolation of SDS-degrading strain of P. putida, which shows high rate of SDS degradation and can degrade up to 0.3% SDS. It appears that this isolate can be exploited for bioremediation of this detergent from water systems

Laparoscopic surgery recording as an adjunct to conventional modalities of teaching gross anatomy

In order to increase their effectiveness, methods of teaching morphological sciences need to be revised to incorporate the recent technological advances made in the field of medicine. Teaching human structure with conventional methods of prosections using dissected cadaveric specimen alone quite often fails to prepare students adequately for their clinical training. A learner-oriented method, incorporating three dimensional spatial anatomy and more closely mirroring the clinical setting, is required. With these challenges in mind, a 30-minute slow-paced video recording of a cholecystectomy performed laproscopically on a 45 year-old lady was adapted to supplement the conventional teaching of anatomy of the abdomen and pelvis. This study was carried out in October 2010. The subjects of this study were 84 students in a first year preclinical MD course in human structure at the private Oman Medical College. Their feedback was obtained via questionnaire and revealed that the video presentation helped the students to realise the significance of the anatomical details learnt during the human structure course. Recordings of laparoscopic surgeries are an effective preclinical anatomy teaching resource in student-centred learning. They also help the students to appreciate the clinical relevance of gross anatomy and enhance their motivation to learn

Glued intraocular lens implantation for eyes with defective capsules: a retrospective analysis of anatomical and functional outcome

To analyze the anatomical and functional outcome of glued intra ocular lens [IOL] implantation technique and its modifications. Design: Retrospective observational case series. This is a retrospective analysis of the patients who underwent glued intra ocular lens implantation from December 2007 to August 2010. Post operative uncorrected vision, best corrected visual acuity [BCVA], intra ocular pressure, IOL position, endothelial cells and anterior chamber reaction at their last follow up are analyzed from their concerned case sheets documentation. Subjective changes are analyzed via individual questionnaire. Immediate and late postoperative complications are also evaluated. Surgical modifications and the difference in the operated eyes are analyzed. Total 210 glued IOL eyes have been reviewed. Out of this 210, there are 152 [PMMA glued IOL] 21 [three piece foldable IOL], 5 [multifocal foldable IOL], 12 [pediatric glued IOL], 5 [20G sutureless vitrectomy], 2 [glued iris prosthesis] and 3 [transposition of posterior chamber IOL into anterior chamber]. In combined surgeries there are, 5 [optical penetrating keratoplasty], 2 [desc-emet's stripping endothelial keratoplasty] and 3 [iridoplasty]. The modifications in glued IOL are handshake technique, injectable or foldable glued IOL, Multifocal glued IOL and intraoperative 23/25G trocar cannula infusion. Decentration [1.97%], macular edema [1.97%] and optic capture [2.63%] are the post operative complications encountered in rigid glued IOL. Good patient satisfaction is seen in the eyes with IOL repositioning, IOL exchange and multifocal glued IOL. There is significant improvement in BCVA in PMMA IOL [p = 1.35xl0[-5] and foldable IOL [p = 0.000]. Glued IOL seems to be a good alternative in IOL implantation in eyes with deficient capsules. The modifications in the existing technique decrease the learning time and risk for complications

Acute appendicitis following laparoscopic live donor nephrectomy

Acute abdominal pain following laparoscopic live donor nephrectomy [LLDN] might be a diagnostic dilem- ma, and prompt diagnosis and management is of paramount importance. Herein, we describe a case of acute appendicitis in a 62-year-old kidney donor who presented with acute abdominal pain 16 days following LLDN with features inconsistent with a diagnosis of acute appendicitis. An ultrasound scan suggested stran- gulated Spigelian hernia unrelated to the operative wound. Exploration of the wound and mini-laparotomy showed no evidence of wound dehiscence or a hernia, but revealed an inflamed appendix wrapped up with omentum. Appendectomy led to complete recovery of the patient. It is imperative to maintain a high index of suspicion for acute appendicitis in this situation to avoid septic complications that might adversely affect the residual renal function and cause negative impact on kidney donation. To the best of our knowledge, this is the first reported case of acute appendicitis following LLDN

Concentration of uranium levels in groundwater

The uranium isotopes during their course of their disintegration decay into other radioactive elements and eventually decay into stable lead isotopes. The cause of environmental concern is the emanation of beta and gamma radiation during disintegration. The present study tends to estimate uranium in groundwater trapped in granite and gneiss rocks. Besides, the study aims at estimating the radiation during natural disintegration process. The water samples were collected and analyzed following inductively coupled plasma mass spectrometric technique while water sample collection was given to the regions of Kolar District, South India, due to the representation. The significant finding was the observation of very high levels of uranium in groundwater compared to similar assays reported at other nearby districts. Also, the levels were considerable to those compared to groundwater levels of uranium reported by other scientists. On the basis of this study, it was inferred that the origin of uranium was from granite strata and there was a trend of diffusion observed in the course of flow-path of water in the region

Cyanide removal by combined adsorption and biodegradation process

Investigation of the effectiveness of simultaneous adsorption and biodegradation [SAB] process over individual processes by using microbes Rhizopus oryzae and Stemphylium loti with granular activated carbon [GAC] as adsorbent was carried out. The maximum removal efficiency of cyanide had been achieved by biodegradation alone was 83% by R. oryzae, while it was 90% by S. loti at initial pH of 5.6 and 7.2 respectively and at initial CN[-] concentration of 150 mg/L. In the combined process efficiency of R. oryzae closer to S. loti [95.3% and 98.6% respectively]

Role of serum zinc and copper in health and disease

The study included 637 controls [healthy individuals, males:females, 335:302] and 1403 patients [males:females, 699:704] of various diseases. Serum levels of Zinc and Copper were estimated on atomic absorption spectrophotometer [GBC-902] and were compared to their controls. The present study is done by compiling the data of all these studies to evaluate the role of serum Zinc and Copper in health and disease. It was observed that the mean serum zinc level was significantly decreased in pregnancy, acne vulgaris, bum, oral sub mucous fibrosis and malignancy. The mean serum zinc was increased in epilepsy, vitiligo, urolithiasis, primary hypertension and non malignant prostatic disorders. Mean serum copper was significantly increased in pregnancy, thoracic surgery, ischemic heart disease, primary hypertension, oral sub mucous fibrosis and malignancy and it was decreased in epilepsy, burn and prostatic disorders

Induction-intubation response - smokers vs non-smokers

Tobacco smoking has been established to be a hazardous activity. Changing social attitude is bringing a decline in tobacco consumption but a significant proportion of patients presenting for surgery still continues to smoke, putting themselves at risk of perioperative complications. We evaluated induction-intubation response in 40 male patients [ASA-I] divided into two groups of 20, each consisting of smokers and non-smokers. All patients received standard premedication and general anesthesia. Heart rate, blood pressure and rate-pressure product were measured prior to induction, just before intubation and at 1,3,5 and 10 minutes after intubation. Continuous electrocardiography [EKG lead II] monitoring was done. Carboxyhemoglobin and total hemoglobin were estimated at the time of securing venous access. Arterial blood gases were analyzed 5 minutes before and after the tracheal intubation. Incidence of arrhythymias [30%] was higher in smokers compared to non-smokers [10%]. Mean carboxyhemoglobin [COHb] level in smokers was 3.81 +/- 2.17 gdL[-1] as compared to 2.95 +/- 1.33 gdL[-1] in non-smokers. Four patients who continued to smoke till the day of surgery had higher COHb levels [8.2, 5.9, 6, 8.8 gdL[-1]]. PaO[2] and PaCO[2] levels were comparable in both groups. During induction-intubation period, heart rate; systolic, diastolic and mean arterial pressure and rate-pressure product showed more pronounced fluctuations in smokers than in non-smokers [p<0.05]