Dilemmas and Perceptions regarding Medical Education in Hindi medium among Medical Community of Northern India: A Cross Sectional study

Introduction: The medical curriculum, the medium of instruction and evaluation in India, is primarily English. While it has the advantage of preparing Indian medical graduates to represent and interact globally, it also translates into learning difficulties for a substantial population of Indian medical students. Hindi is the common language of communication among majority of the population in Uttar Pradesh.Madhya Pradesh Government in India has already started the option of pursuing the allopathic graduate medical course in Hindi. There is paucity of data regarding opinion of medical professionals about implementation of Medical Education in Hindi in Uttar Pradesh and nearby states. Objective: To assess the attitude and opinion of medical students and medical professionals towards using Hindi in Medical Education. Method: A cross-st stsectional web-based online survey was conducted between 1 December 2022 and 31 January 2023. Undergraduate medical students, interns, residents and faculty from medical colleges, hospitals of Uttar Pradesh and neighbouring states (Uttarakhand and Bihar) were contacted to participate in this survey using pretested structured questionnaire. Results: A total of 1606 participants responded and answered the questionnaire and 1575 responses were found complete and used in analysis.Most participants (52.8%) believed that Medical Education in Hindi would attract more students from Hindi backgrounds to join the medical field. Similarly, 58.9% of participants were of the opinion that Medical Education in Hindi would improve communication with patients. However, about half of the participants (49.5%) perceived teaching in Hindi as a hurdle in acquiring higher education. Conclusion: More than half of the participants thought that medical education in Hindi will attract more students from Hindi backgrounds to join the medical field. Similarly, Medical Education in Hindi was perceived to improve communication skills with patients, at least where Hindi is a vernacular language by majority of the participants.

Ellagic acid & gallic acid from Lagerstroemia speciosa L. inhibit HIV-1 infection through inhibition of HIV-1 protease & reverse transcriptase activity.

Background & objectives: Banaba (Lagerstroemia speciosa L.) extracts have been used as traditional medicines and are effective in controlling diabetes and obesity. The aim of this study was to evaluate the anti-HIV property of the extracts prepared from the leaves and stems of banaba, and further purification and characterization of the active components. Methods: Aqueous and 50 per cent ethanolic extracts were prepared from leaves and stems of banaba and were evaluated for cytotoxicity and anti-HIV activity using in vitro reporter gene based assays. Further, three compounds were isolated from the 50 per cent ethanolic extract of banaba leaves using silica gel column chromatography and characterization done by HPLC, NMR and MS analysis. To delineate the mode of action of the active compounds, reverse transcriptase assay and protease assay were performed using commercially available kits. Results: All the extracts showed a dose dependent inhibition of HIV-1-infection in TZM-bl and CEM-GFP cell lines with a maximum from the 50 per cent ethanolic extract from leaves (IC50 = 1 to 25 μg/ml). This observation was confirmed by the virus load (p24) estimation in infected CEM-GFP cells when treated with the extracts. Gallic acid showed an inhibition in reverse transcriptase whereas ellagic acid inhibited the HIV-1 protease activity. Interpretation & conclusions: The present study shows a novel anti-HIV activity of banaba. The active components responsible for anti-HIV activity were gallic acid and ellagic acid, through inhibition of reverse transcriptase and HIV protease, respectively and hence could be regarded as promising candidates for the development of topical anti-HIV-1 agents.

Effectiveness of Muskaan Ek Abhiyan (The Smile Campaign) for Strengthening Routine Immunization in Bihar, India.

Background: In Bihar State, proportion of fully immunized children was only 19% in Coverage Evaluation Survey of 2005. In October 2007, a special campaign called Muskaan Ek Abhiyan (The Smile Campaign) was launched under National Rural Health Mission to give a fillip to the immunization program. Objectives: To evaluate improvement in the performance and coverage of the Routine Immunization Program consequent to the launch of Muskaan Ek Abhiyan Intervention: The main strategies of the Muskaan campaign were reviewing and strengthening immunization micro-plans, enhanced inter-sectoral coordination between the Departments of Health, and Women and Child Development, increased involvement of women groups in awareness generation, enhanced political commitment and budgetary support, strengthening of monitoring and supervision mechanisms, and provision of performance based incentive to service providers. Methods: Immunization Coverage Evaluation Surveys conducted in various states of India during 2005 and 2009 were used for evaluation of the effect of Muskaan campaign by measuring the increase in immunization coverage in Bihar in comparison to other Empowered Action Group (EAG) states using the difference-indifference method. Interviews of the key stakeholders were also done to substantiate the findings. Results: The proportion of fully immunized 12-23 month old children in Bihar has increased significantly from 19% in 2005 to 49% in 2009. The coverage of BCG also increased significantly from 52.8% to 82.3%, DPT-3 from 36.5 to 59.3%, OPV-3 from 27.1% to 61.6% and measles from 28.4 to 58.2%. In comparison to other states, the coverage of fully immunized children increased significantly from 16 to 26% in Bihar. Conclusions: There was a marked improvement in immunization coverage after the launch of the Campaign in Bihar. Therefore, best practices of the Campaign may be replicated in other areas where full immunization coverage is low.

Measles vaccination response during kosi floods, Bihar, India 2008.

The Kosi floods of Bihar in 2008 led to initial rapid displacement followed by rehabilitation of the affected population. Strategically planned phase-wise activity of supplementary as well as primary measles vaccination combined with a variety of other interventions proved to be successful in preventing outbreaks and deaths due to measles. While 70% supplementary measles vaccination coverage was achieved in relief camps, the coverage of primary measles doses in the latter phases was dependant on accessibility of villages and previous vaccination status of eligible beneficiaries. The integrated diseases surveillance system, which became operational during the floods, also complemented the vaccination efforts by providing daily figures of cases with fever and rash. The overall response was not only successful in terms of preventing measles mortality, but also provided vital lessons that may be useful for planning future vaccination responses in emergency settings.

Two doses of measles vaccine reduce measles deaths.

Two doses of measles vaccine to children reduce measles related deaths. The first dose is delivered through the routine immunization system to infants and the 2nd dose through campaigns or routine immunization system, whichever strategy reaches the highest coverage in the country. Experience in 46 out of 47 measles priority countries has shown that measles vaccination using mass vaccination campaigns can reduce measles related deaths, even in countries where routine immunization system fails to reach an important proportion of children. The gradual adoption of this strategy by countries has resulted in 74% reduction in measles related deaths between 2000 and 2007. The 2010 goal to reduce measles mortality by 90% compared with 2000 levels is achievable if India fully implements its plans to provide a second dose measles vaccine to all children either through campaigns in low coverage areas or through routine services in high coverage areas. Full implementation of measles mortality reduction strategies in all high burden countries will make an important contribution to achieving Millennium Development Goal 4 to reduce child mortality by two thirds in 2015 as compared to 1990.

Role of testicular fine-needle aspiration cytology in infertile men with clinically obstructive azoospermia.

BACKGROUND: Azoospermia due to obstruction of the vaso-epididymal junction is one of the few surgically correctable causes of male infertility. In patients where all clinical and laboratory parameters suggest a vaso-epididymal junction block amenable to surgery, failure to find normal spermatogenesis on fine-needle aspiration cytology (FNAC) of the testis may necessitate a change in treatment modality to the more expensive intracytoplasmic sperm injection. We evaluated the validity of FNAC findings in predicting failure of surgical exploration when clinical parameters suggest otherwise. METHODS: Infertile, azoospermic men in whom the semen volume and fructose content, testis size, follicle-stimulating hormone level were normal and the vas deferens was palpable with no evident cause for obstruction, underwent FNAC of the testis to confirm the presence of normal spermatogenesis before surgical exploration. Men with hypospermatogenesis or maturation arrest on FNAC and a normal karyotype with absence of Y chromosome microdeletion were offered assisted reproduction or surgical exploration to identify a reconstructable obstruction. Men who chose surgery were included in the study and the findings on exploration were compared with the FNAC reports. RESULTS: Of the 10 men who satisfied the inclusion criteria, 6 had hypospermatogenesis and in 4 FNAC showed maturation arrest. On surgical exploration, none had sperm in the epididymis. A biopsy of the testis taken at the time of exploration confirmed the FNAC findings. CONCLUSION: Clinical parameters are insufficient for diagnosing obstructive azoospermia. FNAC can accurately evaluate the testicular pathology and predict whether or not surgical exploration should be undertaken.