Online Medical Education: A look into the various perceptions, among students across India

Background: The students during the Covid time had been made to adopt online education to socially distance and pursue the curriculum at the safety of their homes. This type of education is important as the future demands learning to be a hybrid of both online and offline. The study was done with an objective of identifying various perceptions about online medical education among the students. Methodology: The crosssectional study was done among 578 students across various medical colleges in India and the data was collected using online platform where the questionnaire was regarding socio-demographic details, advantages and disadvantages, teacher’s quality, hinderances and suggestions with respect to online education. The data collected was analyzed using SPSS 21. Results: Out of the 578 subjects 386 (66.8%) were females and 413 (71.5%) responses were from private college. In the study 449 (77.7%) students were from the state of Tamilnadu. The study showed a significant increase in the number of students using various learning modalities like video lectures. Power point and pre-recorded lectures/tutorials after the advent of online classes. Most of the students reported the maximum concentration time for videos and pre-recorded lectures/tutorials, and least for PDF/ MS Word document. The study showed that 314(54%) students preferred blended or hybrid learning in the future. Conclusion: In the study the students reported the need for high selfdiscipline and motivation considered necessary for the online education. The students reported more biased attention and use of video-based lectures in terms of increased time spending and concentration time. So the revised modules should be made available with importance towards visual capture and to reduce the monotony of the medical education.

Sleep Quality among Healthcare Professionals in a Tertiary Care Hospital

Introduction: A person spends one third life in sleep, so the quality and quantity of sleep is of utmost importance. Health Care Professionals (HCPs) are more prone to inconsistency in sleep both in quality and quantity, which leads to deflection from health and well-being of themselves and care of others. This study aims to assess the various factors influencing sleep quality and daytime sleepiness among medical and nursing healthcare professionals. Methodology: A cross sectional study was conducted using a structured questionnaire to collect socio-demographic and work-related information, co-morbidity and quality of Sleep using ESS (Epworth Sleepiness Scale) and PSQI (Pittsburgh Sleep Quality Index) scale. Results: Among the 150 HCPs, 64.7% were medical and 35.3% were nursing professionals. 53.6% of medical and 66% of nursing professionals reported poor sleep quality. Increased coffee consumption influences sleep quality and it was found to be statistically significant. Nursing professionals had more excessive daytime sleepiness (58.5%) with significant p-value (p=0.01). Conclusion: According to our study results, sleep quality was poor among nursing professionals which highlights the need for measures to improve their quality of sleep.

Comparison of the Effects of Ezetimibe-Statin Combination Therapy on Major Adverse Cardiovascular Events in Patients with and without Diabetes: A Meta-Analysis

BACKGROUND: Ezetimibe-statin combination therapy has been found to reduce low density lipoprotein cholesterol levels and the risk of major adverse cardiovascular events (MACEs) in large trials. We sought to examine the differential effect of ezetimibe on MACEs when added to statins according to the presence of diabetes. METHODS: Randomized clinical trials with a sample size of at least 50 participants and at least 24 weeks of follow-up that compared ezetimibe-statin combination therapy with a statin- or placebo-controlled arm and reported at least one MACE, stratified by diabetes status, were included in the meta-analysis and meta-regression. RESULTS: A total of seven trials with 28,191 enrolled patients (mean age, 63.6 years; 75.1% men; 7,298 with diabetes [25.9%]; mean follow-up, 5 years) were analysed. MACEs stratified by diabetes were obtained from the published data (two trials) or through direct contact (five trials). No significant heterogeneity was observed among studies (I 2=14.7%, P=0.293). Ezetimibe was associated with a greater reduction of MACE risk in subjects with diabetes than in those without diabetes (pooled relative risk, 0.84 vs. 0.93; P heterogeneity=0.012). In the meta-regression analysis, the presence of diabetes was associated with a greater reduction of MACE risk when ezetimibe was added to statins (β=0.87, P=0.038). CONCLUSION: Ezetimibe-statin combination therapy was associated with greater cardiovascular benefits in patients with diabetes than in those without diabetes. Our findings suggest that ezetimibe-statin combination therapy might be a useful strategy in patients with diabetes at a residual risk of MACEs.

Initial Clinical Experience with the Endologix AFX Unibody Stent Graft System for Treating Patients with Abdominal Aortic Aneurysms: A Case Controlled Comparative Study

PURPOSE: The newly designed unibody AFX endograft system for endovascular aortic aneurysm repair is the only graft with anatomical fixation to the aortic bifurcation in comparison to most other grafts that use the infrarenal neck as the main fixation point. The aim of this study was to assess the preliminary results of the AFX stent-graft system used with infrarenal aortic component and compare them with those obtained in patients treated with a well established endograft of the same material and pure infrarenal fixation as the Gore Excluder. MATERIALS AND METHODS: A retrospective analysis of prospectively collected data from March 2014 to December 2014 identified 10 elective abdominal aortic aneurysm patients treated with the AFX endograft, in comparison to a matched group of 20 patients treated with the Excluder stent-graft. Endpoints included technical and clinical success, freedom from any secondary intervention, any type of endoleak and aneurysm related death. RESULTS: Primary technical success was achieved in all patients and no 30-day device related complications or deaths were occurred. The two groups were similar in terms of radiation burden, contrast media, duration of the procedure, post implantation syndrome and in-hospital stay. During a median follow-up period of 23 months (range, 18–26 months) there were no differences in clinical success, freedom from reintervention and aneurysm related death. No type I endoleak was observed in either group. Five of the 6 type II endoleaks (1 in the AFX and 4 in the Excluder group) spontaneously resolved, while in only one patient (Excluder) the endoleak remained without however any change in aneurysm sac diameter (log rank=0.34). CONCLUSION: The initial experience with the AFX stent graft system is promising, with successful aneurysm exclusion and good short-term results. Further and larger studies are needed to fully evaluate the sort as well as the long-term results.

Is the Naming of Herpes Simplex Gladiatorum Correct?

Ηerpes Gladiatorum (HG) outbreaks should be regarded as serious long term infections that can have negative consequences on the health of individual athletes and the athletic community as a whole. Purpose: The main goal of this analysis was to provide a scientific basis and evidence that the herpes infections in athletes caused by Herpes Simplex Virus type I (HSV-1), might not be appropriately called Herpes Gladiatorum (HG), but should be renamed as Herpes Luctatorum (HL). Methods: The methodology of the current study was included the use of systematic review of the writings in the ancient Greek and the modern literature. Results: From literature review and careful consideration of sports scenes, we found that the sport in which there was extensive physical contact in antiquity is wrestling, and this is not a “mono- machia” (single combat). Therefore, the herpes simplex dermatological infections could occur at a priority, as well as in quantity in wrestler athletes (Latin: Luctators), and not in Monomachus (Latin: Gladiators). Conclusion: The most appropriate terminology for skin infections caused by HSV-1 in athletes would thus be Herpes Luctatorum and not Herpes Gladiatorum, as has been widely adopted by the medical community.

Estimating soil erosion in Natura 2000 areas located on three semi-arid Mediterranean islands.

A major initiative in Europe is the protection of its biodiversity. To accomplish this, specific areas from all countries of the European Union are protected by the establishment of the “Natura 2000” network. One of the major threats to these areas and in general to ecosystems is soil erosion. The objective of this study was to quantitatively estimate surface soil losses for three of these protected areas that are located on semi-arid islands of the Mediterranean. One Natura 2000 area was selected from each of the following islands: Sicily in Italy, Cyprus and Rhodes in Greece. To estimate soil losses, Gerlach troughs were used. These troughs were established on slopes that ranged from 35-40% in four different vegetation types: i) Quercus ilex and Quercus rotundifolia forests, ii) Pinus brutia forests, iii) “Phrygana” shrublands and iv) vineyards. The shrublands had the highest soil losses (270 kg ha-1 yr-1) that were 5-13 times more than the other three vegetation types. Soil losses in these shrublands should be considered a major concern. However, the other vegetation types also had high soil losses (21-50 kg ha-1 yr-1). Conclusively, in order to enhance and conserve the biodiversity of these Natura 2000 areas protective management measures should be taken into consideration to decrease soil losses.

Off-pump coronary artery bypass is a safe option in patients presenting as emergency

<p><b>INTRODUCTION</b>The applicability of off-pump coronary-artery bypass (OPCAB) in patients who present as emergency remains controversial. Herein, we explore the efficacy and safety of OPCAB in patients who were indicated for emergency surgery.</p><p><b>MATERIALS AND METHODS</b>Between 2002 and 2007, a total of 282 patients underwent OPCAB, of which 68 were presented as emergency. This cohort (group A) was compared to 68 patients who had traditional on-pump coronary artery bypass grafting (CABG, group B) under emergency indications during the same period of time. Baseline demographics, intraoperative data and postoperative outcomes were analysed.</p><p><b>RESULTS</b>Preoperative demographics were comparable in both groups. Mortality during the first 30 days was comparable in both groups and no stroke occurred in the whole series. Patients in group A had significantly less pulmonary complications (4.4% vs 14.7%, P = 0.04), less ventilation time (30.3 ± 33.6 hours vs 41.5 ± 55.4 hours, P = 0.18) and were less likely to have prolonged ventilation, (19.1% vs 35.3%, P = 0.03). Similarly, OPCAB patients had less postoperative renal-failure/dysfunction (5.9% vs 8.8%, P = 0.51) and required less inotropic support (66.2% vs 88.2%, P = 0.002), bloodtransfusions (23% vs 86.8%, P <0.0001), and atrial- (17.6% vs 35.3%, P = 0.02) or ventricular-pacing (17.6% vs 41.2%, P = 0.002). Although the number of diseased vessels was comparable in both groups, patients in group A received less distal anastomoses. (2.78 ± 1.19 vs 3.41 ± 0.89, P = 0.002). Similarly, complete revascularisation was achieved less frequently in group A (76.5% vs 94.1%, P = 0.004).</p><p><b>CONCLUSION</b>OPCAB strategy is a safe and efficient in emergency patients with reasonable good short-term postoperative outcomes.</p>

Description and analysis of genetic diversity among squash accessions

In this work, the part of the squash core collection, maintained in the Greek Gene Bank, was assessed using the morphological and molecular data. Sixteen incompletely classified accessions of the squash were characterized along with an evaluation of their resistance against two isolates of Fusarium oxysporum. A molecular analysis using Random Amplified Polymorphic DNA (RAPD) markers was also performed, revealing high level of polymorphism. To study the genetic diversity among the squash accessions, a clustering procedure using Unweighed Pair Group Method and Arithmetic Average (UPGMA) algorithm was also adopted. Two independent dendrograms, one for the morphophysiological and one for molecular data were obtained, classifying the accessions into two and three main clusters, respectively. Despite the different number of the clusters there were many similarities between these two dendrograms, and a third dendrogram resulting from their combination was also produced, based on Gower's distance and UPGMA clustering algorithm. In order to determine the optimal number of clusters, the upper tail approach was applied. The more reliable clustering of the accessions was accomplished using RAPD markers as well as the combination of the two different data sets, classifying the accessions into three significantly different groups. These groups corresponded to the three different cultivated species of C. maxima Duch., C. moschata Duch., and C. pepo L. The same results were also obtained using Principal Component Analysis.

A abobrinha de inverno compõe um cultivo agrícola com valor econômico determinado exercendo, no entanto, um papel importante em zonas caracterizadas por um cultivo menos intensivo. Na Grécia, o cultivo da abobrinha se baseia, principalmente, em variedades locais conservadas a muitos anos por agricultores locais. Uma parte do cultivo nuclear da abobrinha, que é conservada pelo Banco Grego de Genes, foi melhorada utilizando-se dados morfológicos e moleculares, especialmente dezesseis cultivos de abobrinha classificados incompletamente, que foram diferenciados apenas com base em características morfológicas, em relação a uma avaliação à resistência contra o Fusarium Oxysporum, em dois isolamentos. Foi realizada uma análise molecular utilizando DNA Polimórficos Casual Amplificados índices (RAPDs), revelando um alto nível de polimorfismo. Para estudar a diversidade genética entre a coleção de abobrinhas, um procedimento de agrupamento foi realizado usando-se o algoritmo U.P.G.M.A. Dois dendrogramas independentes, um morfofisiológico e outro para dados moleculares, foram coletados, classificando as coleções em dois e três grupos básicos, respectivamente. Apesar do número diferente dos grupos, foram introduzidas muitas semelhanças entre os dois dendrogramas e um terceiro dendrograma foi produzido como resultado da combinação dos dois primeiros, baseado na distância de Gower e no algoritmo de agrupamento U.P.G.M.A. Para determinar o número ótimo dos grupos, a aproximação "upper tail" foi aplicada. O grupo mais aceitável das coleções foi conseguido usando-se índices RAPD, assim como a combinação dos dois grupos de dados diferentes, classificando as coleções em três grupos consideravelmente diferentes. Os grupos que correspondem às três espécies cultivadas diferentemente, que correspondem às três espécies cultivadas diferentemente por C.máxima Duch., C.moschata Duch. e C. pepo L. além disso, os mesmos resultados foram conseguidos usando-se a "Principal...

Síndrome de Ehlers Danlos, ¿subregistro clínico en ortopedia pediátrica? / Ehlers Danlos syndrome, a clinical subregister in pediatric orthopedics?

Introducción. El comportamiento del síndrome de Ehlers Danlos hizo que se interpretara como un subregistro clínico, poco conocido y con escasas referencias. Esta genodermatosis generalmente está condenada a no tener un tratamiento específico. El objetivo del presente estudio fue, principalmente, describir la morbilidad de este síndrome, desde el punto de vista ortopédico. Métodos. Se realizó un estudio descriptivo prospectivo de 5 años, que incluyó a todos los pacientes con síndrome de Ehlers Danlos, atendidos en la consulta de ortopedia y traumatología entre julio de 2001 y julio del 2006, en el Hospital Pediátrico Docente José Martí (Sancti Spiritus, Cuba). Se consideró un tiempo mínimo de seguimiento de 6 meses para la validación de los resultados. Resultados. Fueron estudiados 41 pacientes afectos de 72 enfermedades de origen ortopédico. La frecuencia estuvo próxima a 1,7 enfermedades por paciente, con predominio no significativo del sexo femenino (n = 24). Uno de los antecedentes perinatales más importantes fue la presencia de grados diversos de displasia de la cadera. La presencia de otras afecciones no ortopédicas no fue significativa. Los principales hallazgos ortopédicos fueron el pie plano flexible (37), el genus recurvatum (11) y la cifoescoliosis (9). La cirugía estética y la cirugía correctora ortopédica fueron las más utilizadas. Conclusiones. La dispensarización de esta enfermedad y su tratamiento oportuno es un método de control eficaz que ayudaría a evitar la degeneración articular, generalmente antesala de la osteoartrosis.

Introduction. The behavior of Ehlers Danlos syndrome caused it to be interpreted as a clinical subregister, little known, and with a few references. This genodermatosis is generally condemned not to have a specific treatment. The objective of this study was mainly to describe the morbidity of this syndrome from the orthopedic point of view. Methods. A 5-year prospective and descriptive study was conducted among all the patients with Ehlers Danlos syndrome that were seen at the Orthopedics and Traumatology department of José Martí Teaching Pediatric Hospital (Sancti Spiritus, Cuba) from July 2001 to July 2006. A minimum follow-up time of 6 months was considered for the validation of the results. Results. 41 patients affected with 72 diseases of orthopedic origin were studied. The frequency was approximately 1.7 diseases per patient, with a non significant predominance of females (n = 24). One of the most important perinatal antecedents was the presence of diverse hip dysplasia degrees. The presence of other non-orthopedic affections was not remarkable. The main orthopedic findings were the flexible flat foot (37), the genus recurvatum (11) and kyphoscoliosis (9). Aesthetic surgery and the corrective orthopedic surgery were the most used. Conclusions. The categorization of this disease and its timely treatment is an efficient method of control that would help to prevent the articular degeneration that generally precedes osteoarthritis.

World psychiatric assocation position statement on the use and safety of electroconvulsive therapy

This position statement on the use and safety of electroconvulsive therapy [ECT] has been prepared on behalf of the WPA Section on Biological Psychiatry at the request of the Executive Committee of the WPA. The statement is informed by available evidence and reference will be made to guidelines produced by a number of authoritative bodies, including the American Psychiatric Association, the Royal College of Psychiatrists, the UK National Institute of Clinical Excellence [NICE] and the World Federation of Societies of Biological Psychiatry. Moreover, for depressive disorders particular reference will be made to the recently published systematic review and meta-analysis by the UK ECT Review Group [2003]

Fever of unknown origin in carcinoma of the colon

To report a case of fever of unknown origin in a patient with carcinoma of the colon but without gastrointestinal symptoms. Clinical Presentation and Intervention: A 65-year-old man presented with a long-standing fever [of 38°C, about two months' duration], night sweats, fatigue, malaise and anxiety. General physical examination including rectum, radiographic examinations of the chest, abdomen and bones [including ultrasonography and CT scanning] was normal. Biochemistry profile as well as other laboratory studies including blood, urine and stool cultures were normal except for erythrocyte sedimentation rate, which was 105 mm/h. A barium enema showed a rectosigmoid carcinoma. A left sigmoidal colectomy was performed. The patient recovered quickly and remained well for eight years postoperatively. This case shows that carcinoma of the colon should be included in the differential diagnosis of patients with fever of unknown origin

Treatment of ureteral colic with diclofenac sodium

The efficacy of diclofenac sodium, a potent inhibitor of prostaglandin synthetase, was compared with the efficacy of a spasmolytic agent, hyoscine butylbromide, in the treatment of 78 patients [53 men and 25 women] suffering from acute ureteral colic. Forty-two patients [group A] received diclofenac sodium intramuscularly and 36 [group B] hyoscine butylbromide intramuscularly. Both groups were comparable for weight, age and sex. Diclofenac sodium relieved the colic effect in 38 out of 42 patients [90%] within 30 min after the injection and 7 of 36 patients in the hyoscine butylbromide group [19%]. In 4 patients of group A, a second injection of diclofenac sodium, given 30 min later, completely relieved the pain within 30 min. In group A, side effects, such as nausea, vomiting, and headache, occurred in 4 patients. In conclusion, diclofenac sodium, administered intramuscularly, is more effective in treating ureteral colic than hyoscine butylbromide and has fewer side effects

Quantitative structure activity relationship in diphenyl ureas for insect growth regulating activity.

Insect growth regulating (IGR) activity of 29 diphenyl urea compounds was determined against the filariasis vector, Culex quinquefasciatus. The variations in the activity of these compounds were analysed with the physicochemical substituent parameters and regression analysis. Quantitative structure activity relationship (QSAR) studies revealed that the IGR activity was influenced by lipophilicity, electron withdrawing effect of the substituents on the aniline moiety, the steric effect of the substituents in the acidic moiety and the position of substitution. This diphenyl ureas for IGR activity seem to offer a successful model for the application of QSAR method in the development of new vector control agents.

Evaluation of cyclosporine-A obtained from Tolypocladium sp. for immunosuppressive potential.

Cyclosporine-A obtained from an indigenous isolate of Tolypocladium sp. was evaluated for immunosuppressive potential by skin grafting in rats using the commercially available Sandimmune as reference at 15 and 30 mg/kg/day for a period of 14 days. The Sandimmune treated animal group showed 83 per cent acceptance of skin grafts while the test preparation treated group showed 67-83 per cent acceptance. The degree of nephro- and hepatotoxicity was comparable for both the preparations.

Structure-activity relationships in diphenyl ethers for insect growth regulating activity against mosquitoes.

Out of the 30 substituted diphenyl ethers synthesized and tested for insect growth regulating (IGR) activity against mosquitoes, three compounds viz., DPE-16, 19 and 28 showed promising IGR activity. While DPE-16 and 19 were found to be effective against all three vector species tested viz., Culex quinquefasciatus, Aedes aegypti and Anopheles stephensi, with the respective EI50 values of 0.1485, 0.3650, 0.2225 mg/l and 0.1474, 0.1392, 0.1145 mg/l, DPE-28 was found to be highly effective against C. quinquefasciatus with an EI50 value of 0.0022 mg/l. The structure-activity relationship in the diphenyl ethers with respect to their octanol-water partition coefficients showed an increase of lipophilicity when both the ortho positions of the phenolic moiety are substituted by tertiary butyl group. The simulated field trial carried out with DPE-16, 19 and 28 showed that these compounds were effective for 7, 7 and 9 days respectively at 0.1 mg/l against C. quinquefasciatus.