Systematic Evaluation of Published Research Studies Conducted Among Medical Undergraduate Students on Learning Environment in Medical Colleges of India Using the DREEM Inventory Tool

Objective: To evaluate original studies conducted among medical undergraduate students to assess education and learning environment in India using DREEM (Dundee Ready Educational Environment Measure) tool. Material & Methods: The online search engine PUBMED and Google scholar were utilized to short list original published research studies on learning environment. The eligibility criteria included: study conducted in India upon medical students using DREEM tool; information on sample size, total, and sub-domain DREEM score available. Fourteen original research publications with a total sample size of 4215 medical students were considered. Results: Total DREEM score (range, 0-200) was 119.5 that indicated that there was more positive education environment in selected medical colleges of country. The average score of different sub domains of DREEM also supported the positive environment. Sub-domain DREEM mean scores derived through this analysis was SPL-28.7 (range, 0-48); SPA-28.4 (range, 0-48); SPT-25.8 (range, 0-44); SASP-20.2 (range, 0-32); and SSSP-16.4 (range, 0-28). The scores of all the studies were in the similar range except two. Mean score of most (80%) of the items (40/50) lied between 2 and 3 (range, 0-4) indicating that these areas were ‘neither strong nor weak’ but could be ‘enhanced’. Some aspect of the learning and education environment with average score of less than 2 include inherent challenges of the extensive medical course; the teaching over-emphasizes factual learning (item-25); students are able to memorize all the matter (item-27); and rarely feel bored (item-14) require attention. However, issues like teaching is too teacher centered (item-48); the teachers are authoritarian (item-9); and the teachers get angry in class (item-39) requires sensitization and introspection by the esteem faculty members. Conclusion: Overall students perceived progressive and positive developmental milieu in the learning environment in the selected medical colleges of India.

Incidentally detected asymptomatic hepatitis C virus infection with significant fibrosis: Possible impacts on management

Background and Aims: Liver biopsy may be considered in patients with hepatitis C virus (HCV) infection to assess the severity of liver injury and stage of fibrosis, thereby guiding therapeutic decisions. In addition, advanced stage also necessitates surveillance for hepatocellular carcinoma. The aim of this study was to assess whether transaminase (alanine transaminase [ALT]) levels and RNA titers correlate with the histological activity index (HAI) and fibrosis (F) stage in asymptomatic patients with incidentally detected HCV (IDHCV). Patients and Methods: Retrospective evaluation of liver biopsies was done in 113 patients with IDHCV, diagnosed during routine screening. Decision of liver biopsy was made on the basis of age, genotype, acceptable clinical, hematological, and biochemical profiles, and willingness of the patients to undergo treatment. Serum ALT levels, HCV RNA titers, and genotypes were correlated with HAI and F stage. Results: Genotyping was done in 77 of the 113 patients, of which genotype 3 was seen in 43 and genotype 1 in 25 patients. A higher fibrosis stage (Ishak's >F2) was noted in 23.8% of the biopsies. Serum ALT showed a significant correlation with the HAI score on liver biopsy (P = 0.01) but not with the stage of fibrosis (P = 0.52). HCV RNA titers did not reveal any correlation with HAI score or fibrosis stage. Conclusion: Serum transaminases and HCV RNA titers are poor predictors of disease severity and fibrosis. Since HCV shows a slow disease progression, higher stage may predict a worse prognosis irrespective of the low viral RNA load. Liver biopsy may help guide therapeutic decisions in IDHCV infection.

Clinical Profile of Neurological Manifestations in HIV-Reactive Patients and Their Relation with CD4 Count.

Background: Neurologic abnormalities have been noted in one-third of patients with AIDS, but at autopsy the nervous system is affected in all of them. Aim: To study the clinical profile of neurological manifestations in HIV reactive patients and their correlation with CD4 counts. Methods: A randomized case study was conducted at Department of Medicine, Government Medical College, Patiala over a period of 2 years. 200 HIV-infected adult and adolescent patients (>15 years of age) were studied. The diagnosis of HIV was confirmed by 3 HIV ELISA& RAPID positive reports in symptomatic patients. Results: In the present study, 37% of the patients were in the age group of 26-35 years. Males are affected more frequently than females, with a male to female sex ratio of 2.56: 1. Meningitis, HIV associated dementia, Progressive multifocal leukoencephalopathy& peripheral neuropathy are the commonest neurological disorders observed in HIV-infected patients. Tuberculosis is the commonest opportunistic infection in retroviral positive patients. Conclusion: Central nervous system infections, intracranial mass lesions, stroke, and HIV-associated dementia are more common in patients with a CD4+ count less than 200.

Young onset colorectal cancer: How does it differ from its older counterpart.

BACKGROUND: Colorectal cancer in the young has been a debated topic in literature with conflicting reports as to its pattern of occurrence and survival as compared to the older age group. MATERIALS AND METHODS: Retrospective study to analyze the clinicopathological characteristics, treatment modalities and survival of sporadic young‑onset colorectal cancer (YOCR) patients (<40 years) and compare them with the older group (>40 years). RESULTS: Of 172 patients managed, 72 (42%) were in the YOCR group. Among 72 patients, six were excluded because of hereditary syndromes. Incontinence (P = 0.02) and obstruction at time of presentation (P = 0.03) was significantly more common in the YOCR group. Left sided disease was more common in YOCR group (47/66) compared to the older group (65/100), but the difference was not statistically significant (P = 0.45). The proportion of rectal cancers was significantly more in the YOCR group (39/47) compared to the older group (39/65) (P = 0.01). Significant difference in resectability was noted in the left sided (YOCR 26/47 vs. older 49/65 P = 0.04) and the rectal cancers (YOCR 18/39 vs. Older 29/39 P = 0.02). The survival was similar among the two groups. CONCLUSIONS: Sporadic colorectal cancers in the young are more advanced and less resectable when compared to older population. Genetic studies are needed to elaborate the reasons for left sided predominance and aggressiveness of sporadic colorectal cancers in the younger subgroups.

Solitary fibrous tumour of lung.

Fibrous tumours arising entirely within the substance of the lung are rare. We report one such rare case in whom the diagnosis was established after surgical removal.

Gastroduodenal dysmotility in patients with gallbladder carcinoma: frequency of occurrence and clinical importance.

BACKGROUND: Gastric stasis, common in patients with gall-bladder carcinoma (GBC), results from anatomical obstruction or motor abnormalities. We studied patients with GBC for antroduodenal motor dysfunction using manometry. METHODS: Forty-one patients with GBC without endoscopic gastric outlet obstruction and 10 healthy controls were evaluated using a symptom scoring system for gastric stasis, saline load test and water perfusion antroduodenal manometry. Fasting, post-prandial and post-octreotide motility were recorded and analysed on a computer using GiPC manometry software. RESULTS: Sixteen of 41 patients (39%) with GBC reported recurrent vomiting; patients with vomiting had a higher symptom score (13 [11-17] v. 6 [4-10], p<0.0001] and higher volume of aspirate on the saline load test (460 ml [210-650] v. 160 ml [70-260], p<0.0001) as compared with those without vomiting. Healthy subjects more often had spontaneous fasting migratory motor complex than patients with GBC (9/10 v. 13/41, p=0.002). The amplitudes of contractions in the antrum and duodenum were significantly lower in patients with GBC than in healthy subjects. Patients with GBC had lower fasting (157 [68-284] v. 190.5 [150-284], p=0.01) and post-prandial (200 [96-395] v. 284 [178-395], p<0.0001) antral motor indices than healthy subjects. Patients with GBC and vomiting had significantly lower contraction amplitude and motility indices than those without vomiting. Motility indices correlated inversely with the symptom score and volume of aspirate on the saline load test (Spearman correlation, p = 0.01 for all). CONCLUSION: Antroduodenal motor abnormalities are common in patients with GBC. These may explain the symptoms of gastric stasis and abnormal results of the saline load test in the absence of anatomical obstruction in such patients.

Acquired toxic methaemoglobinaemia.

Eighty Six adult males presented with central cyanosis and constitutional symptoms 2 to 4 hours following ingestion of meal from a common kitchen. On spectrometry methaemoglobin was detected. All recovered fully in 12 to 36 hours on symptomatic treatment. Epidemiological study and toxicological examination revealed that metanil yellow used for colouring the rice was responsible.

Affinity chromatography of estrogen- and progesterone-binding proteins of human uterus.

The purification of estrogen- and progesterone-binding proteins of human uterus by employing affinity resins coupled with steroid-bovine serum albumin conjugates, led to the isolation of preparations with estrogen- and progesterone-binding sites having Kd values in the range of 0·96 to 1·20 × 10–9 M. These were different from the Kd values of 10–10 Μ and 10–8 Μ obtained for two types of binding sites present in the crude cytosolic and nuclear fractions. The purified proteins sedimented on sucrose gradient with S values in the range of 3·6–4·4. The cytosolic and nuclear estrogen- and progesterone-binding proteins, thus purified, showed differences in specificity of binding to the hormone. While the cytoplasmic proteins were more specific in their binding to estradiol or progesterone, the nuclear proteins bound Cortisol with equal or moderate affnity. These results demonstrate the presence of distinct physiological forms of estrogen- and progesterone-binding proteins in the cytoplasm and nucleus, thus pointing to the importance of both these compartments in hormone action. Keywords. Human.