A quasi-experimental study to compare the acquisition of basic clinical skills in novice medical students taught by George and Doto’s five-step method compared to those taught by the traditional approach (SODOTO)

Objectives: The aim of this study was to compare the acquisition of basic clinical skills by George and Doto’s five step method compared to the Traditional SODOTO approach, and to ascertain the perception of the students regarding these diverse methods. Materials and Methods: Fifty-four 2nd MBBS 1st semester students posted in the Department of Medicine at GMERS, Gotri, were enrolled for the study. After teaching the theory, both groups were taught per abdomen (P/A) examination and respiratory system (R/S) examination – one system by the five-step method and the other by the SODOTO approach. Skill acquisition was tested by pre-validated checklists. Finally, feedback was collected on the perception of students using a pre-validated questionnaire. The data were analysed using GraphPad. Results: There was an average 20% improvement (P < 0.001) in the group taught by the five-step method compared to the one taught by the traditional approach (P/A – 45.14/60 [5.64] vs. 57.86/60 [1.83] [Group B vs. Group A]) (R/S examination – 26.17/40 [6.65] vs. 34.79/40 [3.56] [Group A vs. Group B]). Conclusion: George and Doto’s five-step method has been found to be more effective than the traditional SODOTO approach.

Is There Any Correlation Between Computed Tomography (CT) Attenuation Value (Hounsfield Unit) Of Dural Venous Sinuses And Hemoglobin Level: A Prospective Observational Study

Background:In our routine practice patient were undergone CT scan of brain as well as other laboratory investigation for various traumatic brain injury and neurological complain and its management. They visit many premises for diagnosis and investigation. If we can predict the hemoglobin level from CT brain itself, we can reduce turnaround time for patient and increase throughput of patients for hospital. Keeping this in mind we had conducted this study to see the correlation between hemoglobin level and CT attenuation value of cranial Dural sinuses.Material And Methods:A prospective observational study was performed to demonstrate association between computed tomography (CT) attenuation value (Hounsfield unit (HU)) of dural venous sinuses and hemoglobin level from unenhanced CT scan of the brain. The non-contrast CT brain of total 245 patients done during October 2017 to September 2018 at medical college attached tertiary care was observed. Two measurements of HU value were taken on two adjacent slices using 10mm2 of ROI for each site, from superior sagittal sinus (SSS) and torcular herophili (TOH). The value was averaged for superior sagittal sinus, confluence of sinus and is compared with hemoglobin of patients.Result:Mean HU VALUE in SSS of females and male had 48.47 and 51.85 respectively. Mean HU VALUE in TOH of females and male had 47.46 and 50.93 respectively. Positive and significant correlation was noted between HB and SSS average, HB and TOH Average.Conclusion:Based on our result CT attenuation value (HU) value of torcular herophili and superior sagittal sinus from unenhanced CT scan of brain can be used to predict the hemoglobin level of a person. The HU value of sinus can give insight into pathology such as anemia, polycythemia or cranial sinus thrombosis.

Virtual Resus Room An Innovative, Collaborative Approach To Online Simulation Education

Physical distancing restrictions during the COVID-19 pandemic have dramatically impacted medical education, challenging educators around the world to create interesting, novel ways to engage learners remotely. Virtual resusroom(VRR)is an online simulation tool which can be used to supplement or temporarily replace in-person simulation in times when it cannot be held. The infrastructure of the Virtual Resus Room is simple, using separate audio and visual inputs. The visualportion is provided by a shared Google Slide that has been designed to feature the essential components of a resuscitation room.Every participant and facilitator will have the same slide open on their computer –so it can be interactedwith in real time. Audio is provided using Zoom or any teleconferencing program of your choice.Through this, the facilitators can present the case and provide pertinent verbal updates.The team members can communicate to delegate roles, verbalize when they have completed tasks, and brainstorm together.

Causes of delayed presentation of pediatric cataract: A questionnaire-based prospective study at a tertiary eye care center in central rural India

Purpose: To find out the sociodemographic, sociocultural, and socioeconomic factors leading to delay in pediatric cataract surgery and its impact on final visual outcome. Methods: A prospective interview-based analytical cohort study was conducted on 156 children aged 0� years with either unilateral or bilateral congenital/developmental cataracts. Caregivers were interviewed using a pretested validated questionnaire. Time intervals between recognition by a caregiver to consultation were denoted as Delay-1 and between consultations to surgical intervention as Delay-2. Spearman's rank correlation was used to determine the presence of correlation between causes of delay and visual outcome. Results: The mean age of presentation was 7.78 � 4.34 years. Mothers were the first informant of the problem (n = 110, 70.5%). Out of 156 children, only 8 (5.1%) children presented to the hospital within 1 month by caregivers and 26 (16.7%) children underwent surgery within 2 months of advice. About 22 (14.1%) children had total cumulative delay of 1�months, 11 (7%) had delay of 6� months, and 115 (73.71%) had delay of >12 months. The most common cause identified for Delay-1 was unawareness in 41 cases (26.28%), however, for Delay-2 major factor responsible was cost (n = 38, 24.35%). The median preoperative visual acuity was 1.31 logMAR and median postoperative visual acuity at 4 weeks was 0.61 logMAR. (P < 0.001) Less age at surgery, upper socioeconomic status, less time delay, and better preoperative vision were positively correlated to better visual outcomes. Conclusion: Delay in presentation for childhood cataract surgery remains a significant problem in central rural India. Delay in surgery is multifactorial which includes unawareness, cost, misdiagnosis, self-treatment, distance from the hospital, lack of family support, and poor socioeconomic status.

Audit of 1000 consecutive cases of sutureless cataract surgery in children above two years of age

Purpose: To study the safety of sutureless cataract surgery and risk factors for wound leak of clear corneal incision in children affected with congenital or developmental cataract. Methods: It is a retrospective, noncomparative interventional case study involving children in the age group of 2 to 16 years, who underwent cataract surgery with intraocular lens implantation with the minimum follow up of 1 month. Results: Out of 1000 eyes studied, lens matter aspiration with intraocular lens implantation with or without primary posterior capsulorhexis and anterior vitrectomy was done in 609 and 391 eyes, respectively. Incisions of 943 eyes did not require sutures while sutures were applied for wound leak in 57 eyes on the table and in 5 eyes on postoperative day 1. Risk of wound leak for suture application was found to be greater in patients; having age less than 5 years (P < 0.0001), surgeries performed by junior surgeons (P < 0.0003), wound problems (P < 0.0001), intraocular lens (IOL) related factors (P < 0.0001), use of iris hooks (P < 0.0001), and anterior capsulorhexis extension (P < 0.0001). On the first postoperative day, anterior chamber reaction (P < 0.0001) and fibrinous membrane (P = 0.0007) were significantly more in the sutured group. Incidence of postoperative complications was 0.98 per sutured eyes (59 complications in 60 eyes). One patient developed endophthalmitis after suture removal. Conclusion: Sutureless clear corneal incision in pediatric patients undergoing cataract surgery can achieve stable wound. However, after hydro closure, every wound should be checked for water tightness and the leaky wound should be sutured.

Pattern of steroid misuse in vernal keratoconjunctivitis resulting in steroid induced glaucoma and visual disability in Indian rural population: An important public health problem in pediatric age group

Purpose: To know the pattern of presentations and management outcome of steroid induced glaucoma in vernal keratoconjunctivitis (VKC). Methods: Children of VKC using steroid with two of the following criteria were enrolled: Intraocular pressure (IOP) >21 mm Hg, glaucomatous optic disc and visual field defects. Misused topical steroids were classified in 4 groups; A- Highly potent drugs (dexamethasone, betamethasone), B- Moderate (prednisolone), C- Weak (loteprednol, fluorometholone), D- Unknown drugs. Active/conservative interventions were done to control IOP. Corrected distance visual acuity (CDVA), IOP, anterior segment and fundus examinations were noted. One-way ANOVA test and post hoc Tukey HSD test were used to compare the groups. Results: Out of 1423 VKC patients, 240 were using topical steroid without prescriptions. 92 eyes of 47 patients had steroid induced glaucoma. Hence prevalence of this complication was 3.30% in this study population. Mean age was 14.1 ± 3.8 years. Mean IOP was 38 ± 12 mm of Hg and mean vertical cup disc ratio was 0.67 ± 0.25. IOP was controlled by withdrawal of steroids (9 eyes), with antiglaucoma medications (27), trabeculectomy (57) and glaucoma drainage device (1). Mean CDVA at presentation was better in group C (0.23 log MAR). Mean IOP was highest in group A (43.1 mm Hg) followed by group D (40.5 mm Hg). At presentation 17 were blind (CDVA <3/60). Post treatment marginal improvement in CDVA was found (P = 0.46). However, statistically significantly improvement was noticed in IOP (P < 0.00001). Conclusion: Injudicious use of steroids leads to vision threatening complications like ocular hypertension and glaucoma in children of VKC. Weak steroids like loteprednol or fluorometholone should be used instead of higher potency drugs. Vision and IOP should be monitored fortnightly in children using topical steroids to detect steroid responders at the earliest.

Basilar imagination : a rare cause of "top of basilar artery" syndrome.

"Top of Basilar Artery" Syndrome as the presentation of CVJ anomalies is extremely rare. The association between skeletal CVJ anomalies and vertebro-basilar insufficiency (VBI) is recognised and angiographic abnormalities of the vertebro-basilar arteries and their branches have been reported. Atlanto-axial dislocation (AAD) is the commonest skeletal cranio-vertebral junction (CVJ) anomaly in India, followed by occipitalisation of atlas and basilar invagination. They usually present with a progressive neurological deficit (70 - 94% cases) implicating the high cervical cord, lower brainstem, and cranial nerves. We report one such case with the even more rare presentation of "Top of Basilar Artery" Syndrome as the initial presentation of basilar invagination.

A study of histopathological assessment of mastectomy specimens at tertiary care centre in western India.

Background: Carcinoma of the breast is the most common malignancy in adult women and the second leading cause of cancer death in women. There is an uncertainty over natural history and factors leading to emergence of cancer of breast in women as well as in men. Aims & Objective: To study the various morphological types of malignant lesions and their age distribution, from Mastectomy and Post lumpectomy Mastectomy received from in and around Ahmadabad district, at Department of Pathology, Smt NHL MMC and Sheth VS Hospital, Ahmedabad. Material and Methods: Out of the specimens of breast which presented as mastectomy and post lumpectomy mastectomy specimens of breast to the Department of Pathology, Smt NHL MMC and Sheth VS Hospital, Ahmedabad for histopathological examination, 100 cases were taken up for this study. Detailed clinical data were noted as per the proforma with emphasis on history, gross examination and microscopic examination. Results: Majority of cases were carcinoma (87%). Majority of women (63%) were of age 41-60. Painless lump (77%) was found as most common symptoms, while nipple retraction was found in 3% cases and Peaude orange skin was found in 1% cases. Majority of patients had lump in the left breast (53%) followed by right breast (47%). 40% of patients presented with lump in the upper outer quadrant and 11% in lower outer quadrant. Out of the total 88 carcinomas of breast encountered, 85.2%, were Infiltrating Duct Carcinoma [IDC (NOS)], 1.1% were Ductal Carcinoma in Situ (DCIS), 1.1% each of mucinous carcinoma, invasive papillary carcinoma and acinic cell carcinoma, 2.2% were metaplastic carcinoma and 6.8% were invasive lobular carcinoma. Most of tumour was T3 (53.48%) followed by T2 (29.06%). In the case of pathological staging The majority of patients were present in stage IIIA (25.58%), stage IIB (24.41%) and stage IIIC (22.09%), followed by Stage IIA (18.60%). Vascular invasion was 21.3% in the case of IDC, 66.6% in the case of ILC and 25% in the case of stromal carcinoma. Conclusion: This study highlights the importance of histopathological examination in breast lumps not only in establishing the final diagnosis, but also in predicting the prognosis by typing, staging and grading malignant neoplasm of breast.

A comparative study of visual reaction time in basketball players and healthy controls.

Introduction:-Reaction is purposeful voluntary response to different stimuli as visual or auditory stimuli. The present study was conducted to measure visual reaction time in 100 subjects, 50 basketball players and 50 healthy controls. Material & Method: - The visual reaction time was measured by the reaction time instrument in healthy controls and basketball players. Simple reaction time and choice reaction time measured. During the reaction time testing, visual stimuli were given for three times and minimum reaction time was taken as the final reaction time for that sensory modality of that subject. The results were statastically analyzed and were recorded as mean+ standard deviation and student’s unpaired t-test was applied to check the level of significance. Result:- The study shows that basketball players shows faster reaction time than healthy controls. Conclusion: - As reaction time gives the information how fast a person gives a response to sensory stimuli, it is a good indicator of performance in reactive sports like basketball.

Ambulance response time and emergency medical dispatcher program: a study in Kelantan, Malaysia.

This study provided data by a simple method of acquiring information related to ambulance response time (ART) and determined whether it met the international standards of ART. Additionally, this paper also compared the duration of ART at this hospital before and after the implementation of an Emergency Medical Dispatcher (EMD) program. The ART, which started when details like phone number of the caller, exact location of the incident and the nature of the main complaint were received and ended when the emergency team arrived at the scene of the incident. The parameters recorded include call processing time, time taken to prepare the team and time taken to travel to the scene. The results of the study revealed that the ART for the university hospital (HUSM) was at 913.2 +/- 276.5 seconds (mean +/- SD) and it was far below the international standard of ART as a benchmark of a good ambulance service. However, the study suggested that the EMD program that was recently implemented at the HUSM gave a significantly improvement to the ART score.

Laparoscopic surgery for reflux esophagitis and paraesophageal hernia.

BACKGROUND: Laparoscopic surgery has become the standard for treatment of several abdominal diseases. We analyzed our data on laparoscopic treatment of reflux esophagitis and paraesophageal hernia. METHODS: Twenty patients (mean age 61 y; 14 men) - 18 with reflux esophagitis and sliding hiatus hernia, and two with paraesophageal and sliding hernia - were operated on using laparoscopy between March 1999 and March 2001. All patients were investigated by upper GI endoscopy, barium study and routine pre-operative work-up. Nineteen patients underwent a modified Nissen fundal wrap along with repair of the diaphragmatic crura; one patient had only crural repair with no fundal wrap. RESULTS: All procedures were completed laparoscopically. The mean operating time was 140 min (range 90 to 240). Eighteen patients were discharged on the third postoperative day and two on the fifth day. One patient had perforation of intrathoracic part of the esophagus during passage of an esophageal bougie; he presented with empyema 10 days after discharge and was treated by intercostal drainage. There were no other complications. All patients have been followed up on an outpatient basis for 3 months to 2 years. All are presently off acid-suppressive therapy. Seventeen patients are free of symptoms; two patients have gas bloat-like symptoms and one has occasional grade I dysphagia. CONCLUSIONS: Laparosopic surgery is a safe and effective method of treating esophagitis and paraesophageal hernia.

Adenosine-induced ventricular fibrillation.

The use of adenosine has been suggested as a diagnostic tool in the evaluation of wide ORS complex tachycardia. However, adenosine shortens the antegrade refractoriness of accessory atrioventricular connections and may cause acceleration of the ventricular rate during atrial fibrillation. We observed ventricular fibrillation in 2 patients who presented to the emergency department with pre-excited atrial fibrillation and were given 12 mg of adenosine.

Endoscopic retrograde cholangiography in the era of laparoscopic cholecystectomy.

OBJECTIVE: To assess the value of endoscopic retrograde cholangiography (ERC) as an adjunct in patients undergoing laparoscopic cholecystectomy (LC). METHODS: Four hundred and sixty consecutive patients with cholelithiasis were evaluated for LC over a four-year period (January 1991 to January 1995). Forty four (9.6%) patients underwent pre-operative ERC on a suspicion of harboring common bile duct (CBD) stones. Ten other patients who presented with acute gallstone pancreatitis also had pre-operative ERC as soon as the acute attack had settled. Endoscopic sphincterotomy (ES) and stone extraction were done if indicated. After LC, four patients underwent ERC for cystic or CBD related complications. RESULTS: Cannulation was possible in all patients undergoing ERC. Of 44 patients with suspected CBD stones, 33 (75%) actually had stones. In 30 patients the stones could be extracted. Three patients had large stones which could not be extracted. Of 10 patients with acute gallstone pancreatitis, CBD stones were found in only one. In the 4 patients who developed ductal complications, ERC was used to place stents in three and to extract a missed CBD stone in one. Three patients developed fever after ERC and three others had transient hyperamylasemia. There were no other ERC related problems. CONCLUSION: In patients undergoing LC, ERC is a useful adjunct both pre- and post-operatively.

Acquired tracheo-oesophageal fistula.

Acquired tracheo-oesophageal fistula is rare. The most common causes are tuberculosis and malignancy. Here we report a patient who had come with dysphagia and aspiration pneumonia with paratracheal lymphnodes on X-ray chest and was diagnosed to have a tracheo-bronchial fistula on barium studies. Transtumoral intubation by pull-through method was carried out.

Laparoscopic cholecystectomy: analysis of 100 cases.

OBJECTIVE: To study the efficacy and safety of laparoscopic cholecystectomy. METHODS: One hundred patients with symptomatic cholelithiasis were subjected to laparoscopic cholecystectomy. Preoperative ERCP and sphincterotomy were performed to detect and treat patients suspected to have associated common bile duct (CBD) stones on clinical, biochemical and imaging methods. RESULTS: Ninety patients underwent successful laparoscopic cholecystectomy. The mean operating time was 90 minutes. There were no deaths and morbidity was minimal (6%). Eighty five patients were discharged within 48 hours of surgery. In ten patients the procedure was converted to open surgery. Previous upper abdominal surgery; associated CBD stones; empyema gall bladder; and shrunken, non distensible gall bladder could make the laparoscopic procedure difficult and forewarn the surgeon about a possible conversion to open surgery. CONCLUSION: Laparoscopic cholecystectomy is a safe and effective method of gall bladder removal.

Persistent complete heart block following acute rheumatic fever in a 12 year old girl.

Rheumatic fever can cause a variety of cardiac conduction disturbances. A case of rheumatic fever with rare complication of narrow QRS - complex complete heart block in a 12 year old girl is presented. The complete heart block has persisted even after 12 months of followup.