How Difficult Is It To Implement A Competency-Based Medical Education In India: The Next Steps?

Background:Medical Council of India is in the revamping mode to align the medical curriculum to the emerging health care needs of the society, by introducing Competency-Based Medical Education (CBME). This new medical curriculum intends toimpartthecompetencies that are needed to produce medical graduates who would function efficiently as Physicians of first contact or basic doctorsin the community. The ECE program would enhance the knowledge, skills, and attitude of the medical graduates if it is implemented. We conducted this study to assess the challengescurrently facedby faculties for the implementation of this new curriculum.Material and Methodology:It is a cross-sectional study conducted at NC Medical College, Israna during the study period was July 2021 to November 2021. The study team regularly scrutinized the data collection process and met periodically to review the study conduct and computing of data. At the end of the study period, the consolidated data were analyzedusing IBM SPSS version 22.Result:A total of 50 teaching faculties, we acknowledged 48questionnairesthat were complete. 96% faculties showed positive and opportunistic be haviourtowards the new curriculum of CBME with constructive ideas but 4% faculties declined.Conclusion:CBME is theparadigm shift in the teaching and learning approach of medical education. Mostof the medical facultymembersare aware of the need and have attained a positive attitude for theapplication of CBME. However significant barriers do exist in the form of manpower, new time mapping and resources which need to be addressed.

Mupirocin-resistant methicillin-resistant Staphylococcus aureus – Are these strains wrongly reported and treated?

Background: Mupirocin is an antibacterial drug and it is used for topical application either alone or along with other antiseptics, in areas where ever infections or colonization of methicillin-resistant Staphylococcus aureus (MRSA) are found. Enhanced use of mupirocin ointment these days for local application has led to the rise in data of its resistance. Many carriers and patients are treated inappropriately due to lack of sensitivity testing and improper reporting for mupirocin and development of different levels of resistance in these strains. Due to the lack of next level treatment possibilities, we need to report sensitivity accurately, record prevalence of resistant strains, and figure out the cause of resistance. Objective: We carried out this study to demonstrate levels of mupirocin resistance in MRSA strains isolated from patients samples and to check the resistance pattern of these strains to other antibacterial, in our hospital located in Delhi, North India. Materials and Methods: The study is framed as prospective type and performed on the strains of MRSA collected from the different samples from outpatient departments and inpatient departments from January 2017 to December 2017. Out of 221 Staphylococcus aureus collected from different clinical specimens, 113 isolates were confirmed as MRSA strains. Two of the suggested methods were selected to detect mupirocin resistance: Disk diffusion method by 5 μg disc and microbroth dilution method. Results: From our 113 MRSA isolates, resistance for mupirocin was noted in 16 (14.15%) isolates when subjected to disk diffusion and microbroth dilution test. These 16 strains showed varied level of resistance. High-level resistance was shown by 4 (3.5%) isolates and 12 (10.6%) isolates were found as low-level resistant (MuL). Mupirocin resistant MRSA isolates showed higher antibiotic resistance to erythromycin (81.26% vs. 78.76%), clindamycin (56.25% vs. 42.47%), linezolid (12.50% vs. 7.90%), and tigecycline (6.25% vs. 6.19%) as compared to MRSA strains. Not even single MRSA isolates were identified as vancomycin-resistant strain. Conclusion: Both high- and low-level mupirocin-resistant MRSA was found in high numbers from these patients. It is recommended that routine test must be performed to detect resistance for mupirocin subsequent to the detection of MRSA colonization among visitors, patients, and health care workers and its isolation from local sites. Treatment and decolonization of mupirocin-resistant strains are mandatory to reduce infection and spread in hospital after having done proper sensitivity testing only.

Post-Ranibizumab injection endophthalmitis in aggressive posterior retinopathy of prematurity

A preterm infant with zone 1 aggressive posterior retinopathy of prematurity developed infectious endophthalmitis after intravitreal injection of ranibizumab. Urgent empirical intravitreal therapy with vancomycin, ceftazidime, and dexamethasone along with intravenous therapy with amikacin and meropenem helped in early resolution. Vascularization/activity of disease subsided on follow-up, media cleared, and laser photocoagulation was completed. Later the disease reactivated, developed vitreous membranes and central retinal traction, for which 25-gauge lens-sparing vitrectomy was performed. Emergent treatment helped in salvaging the eye from both aggressive ROP disease and devastating endophthalmitis. Rationale approach to such a case is being discussed.

Retinopathy of prematurity in oculocutaneous albinism

We report a case of retinopathy of prematurity (ROP) in an infant with oculocutaneous albinism (OCA), with the challenges faced in diagnosis, and subsequent management. Poor fundus contrast and blanching of retinal vessels on indentation caused significant visualization problems in detection of ridge and extraretinal vessel proliferation. Careful examination revealed zone 2 Stage 3 ROP with preplus disease in both eyes. Laser photocoagulation was attempted, but laser uptake was poor. The disease regressed over 3-week close follow-up. ROP along with OCA is a rare finding. There is a need for high index of suspicion and caution while screening and managing such babies.

Hybrid clear corneal micro-incision surgical technique for stage 5 retinopathy of prematurity

A safe technique for entry incisions and closure in stage 5 retinopathy of prematurity (ROP) surgery is being described. Three 23G clear corneal incisions are made which allow for safe and snug entry of 25G calibrated infusion and 25G instruments for performing lensectomy, membrane removal and vitrectomy. At the end of surgery, air is injected and corneal entries are hydrated for sutureless closure. The technique was performed in 50 eyes of 36 children with stage 5 ROP. The hybrid technique ensured safe entry and exit with stable anterior chamber during surgery. None of the cases developed retinal breaks during surgical entry nor had any complications such as hypotony, flat anterior chamber, hyphaema or corneal edema in post operative period. Clear corneal entry using 23G incisions for 25G instrument access is a safe and effective technique for performing lensectomy and vitrectomy with sutureless closure in cases with stage 5 ROP.

Short-term incidence and management of glaucoma after successful surgery for stage 4 retinopathy of prematurity

Purpose: The purpose of this study is to describe the short-term incidence, clinical features, and management of glaucoma in children after successful surgery for stage 4 retinopathy of prematurity (ROP). Methods: The retrospective study included all eyes undergoing successful surgery for stage 4 ROP with good outcomes at a tertiary eye care center between June 2014 and June 2016. Cases developing postoperative glaucoma underwent examination under anesthesia for measurement of intraocular pressures (IOP), corneal diameters, Retcam-assisted fundus imaging, and gonioscopy. Outcomes of glaucoma management were evaluated. Results: Hundred eyes of 70 babies underwent successful surgery for stage 4 ROP (with postoperative attached retina, and minimal sequelae) with minimum follow-up of 15 months. Six eyes (6%) developed postoperative glaucoma. Of these, four eyes had undergone lens-sparing vitrectomy and two were managed with lensectomy and vitrectomy (LV). Median time duration for development of glaucoma after primary vitreous surgery was 17.5 weeks. Two cases could be managed with topical IOP-lowering agents alone, whereas four required filtering surgeries (trabeculotomy with trabeculectomy and 0.04% mitomycin C [MMC] application). Average IOP decreased from 25 ± 2.36 to 12.2 ± 2.05 mmHg at 12 months from glaucoma diagnosis. Conclusion: Glaucoma is a potential adverse event following successful vitreous surgery for stage 4 ROP. A combined trabeculotomy–trabeculectomy along with MMC gives favorable outcome.

Surgical outcomes of immediate sequential bilateral vitreoretinal surgery for advancing retinopathy of prematurity

Purpose: Bilateral eye surgery in the same session may be required for advancing stage 4 retinopathy of prematurity (ROP). The purpose of this study was to evaluate the outcomes of immediate sequential bilateral vitreoretinal surgery (ISBVS) in stage 4 ROP. Methods: In a retrospective interventional study at a tertiary care center, 60 eyes of 30 infants who underwent ISBVS for stage 4 ROP between December 2015 and May 2017 were studied. In cases with clear retrolental access, 25G or 27G lens sparing vitrectomy (LSV) was performed and in the rest 25G lensectomy with vitrectomy (LV) was performed through clear corneal entries. The final anatomical outcome measures were the status of tractional retinal detachment (TRD) and macular status. Results: The mean gestational age was 28.4 ± 2.0 weeks and birth weight was 1214.5 ± 329.7gms. The mean postconceptional age at surgery was 40.8 ± 2.2 weeks. Stages 4a and 4b were present in 86.7% and 13.3% eyes respectively. LSV was performed in 95% eyes whereas LV was performed in the rest. None of the eyes developed lens touch, choroidal hemorrhage, postoperative hypotony, corneal decompensation, or endophthalmitis. At last follow-up (mean 45 weeks, range 20–68 weeks), macula was attached in 90% eyes with the TRD resolved completely in 61.7% eyes and significantly decreased in another 25% eyes. Sequalae included macular drag, epiretinal membrane, and progression to fibrotic stage 5 disease. Conclusion: ISBVS is safe and effective for bilateral stage 4 ROP and should be recommended in rapidly progressive cases.

Posterior laser barrage in advancing retinopathy of prematurity: A prospective randomized study

Purpose: To compare the outcomes of conventional laser photocoagulation versus additional posterior barrage laser in advanced stage 3 retinopathy of prematurity (ROP). Methods: A total of 20 infants with bilateral symmetric zone 2 stage 3 advancing ROP were treated with conventional laser treatment followed by randomization of one eye to receive additional posterior retinal laser treatment. Disc–fovea and inter-arcade distance was measured. The patients were followed up prospectively for 3 months. Structural and functional outcomes and safety profile were analyzed. Results: 18/20 (90%) eyes in the study group and 19/20 (95%) eyes in the control group achieved regression of disease. Faster and complete regression was observed at 4 weeks after posterior laser compared to the control group (P = 0.024). Disc–fovea and inter-arcade distance was comparable in both groups. Conclusion: Additional posterior barrage laser is a safe technique that led to faster and more complete regression in eyes with advancing ROP. Final regression profile was comparable in both treatment modalities.

Macular hole-associated retinal detachment in Best vitelliform dystrophy: Series of two cases and literature review

Two eyes of 2 patients with macular hole-associated retinal detachment in clinically diagnosed vitelliruptive stage of Best vitelliform dystrophy were surgically managed by 25-gauge sutureless pars plana vitrectomy, internal limiting membrane (ILM) peeling with inverted ILM flap, and short-acting (SF6) gas tamponade. The patients were assessed with respect to best-corrected visual acuity, color fundus photographs, shortwave fundus autofluorescence, and swept source optical coherence tomography. Surgical intervention led to Type 1 closure of macular hole, resolution of retinal detachment, and improvement in vision in both patients.

Evaluation and comparison of transverse and impact strength of different high strength denture base resins.

Aim: The present study was undertaken to evaluate and compare the impact strength and transverse strength of the high‑impact denture base materials. A conventional heat polymerized acrylic resin was used as a control. Materials and Methods: The entire experiment was divided into four main groups with twenty specimens each according to denture base material selected Trevalon, Trevalon Hi, DPI Tuff and Metrocryl Hi. These groups were further subgrouped into the two parameters selected, impact strength and flexural strength with ten specimens each. These specimens were then subjected to transverse bend tests with the help of Lloyds instrument using a three point bend principle. Impact tests were undertaken using an Izod–Charpy digital impact tester. Results: This study was analyzed with one‑way analysis of variance using Fisher f‑test and Bonferroni t‑test. There was a significant improvement in the impact strength of high‑impact denture base resins as compared to control (Trevalon). However, in terms of transverse bend tests, only DPI Tuff showed higher transverse strength in comparison to control. Trevalon Hi and Metrocryl Hi showed a decrease in transverse strength. Conclusions: Within the limits of this in vitro study, (1) There is a definite increase in impact strength due to the incorporation of butadiene styrene rubber in this high strength denture base materials as compared to Trevalon used as a control. (2) Further investigations are required to prevent the unduly decrease of transverse strength. (3) It was the limitation of the study that the exact composition of the high‑impact resins was not disclosed by the manufacturer that would have helped in better understanding of their behavior.

Cadmium toxicity induced changes in plant water relations and oxidative metabolism of Brassica juncea L. plants.

Excess of cadmium (Cd) induced changes in oxidative scenario and water status of plants viz.., total water content, specific water content, water saturation deficit (WSD) and transpiration of Brassica juncea plants grown in soil pot culture. Although lower and marginal levels of excess cadmium (100 and 250 ppm) improved growth but higher levels (500 ppm) caused significant suppression. Significant accumulation of proline, an indicator of water stress, occurred at higher level of Cd. Gradual increases in activities of certain antioxidant enzymes such as catalase and peroxidase along with increased lipid peroxidation are suggestive of disturbed oxidative metabolism. Taking together, the deleterious effects of Cd and its effects on oxidative metabolism clearly indicate enhanced generation of reactive oxygen species (ROS) to be instrumental in producing toxic effects of Cd. The excess levels of Cd also decreased the concentrations of soluble protein and chlorophylls and increased the ratio of chlorophyll a/b.

Immune responses in histoplasmosis, a prototype of respiratory mycoses.

The cellular and molecular mechanisms of host defenses to histoplasmosis, a prototype of respiratory fungal infections are described. Although, cell-mediated acquired immunity is considered as a hallmark of protective immunity to histoplasmosis, the recent findings provide mounting evidence on the importance of natural cellular immunity in host resistance to fungal infections. The natural immunity to Histoplasma capsulatum infection is primarily mediated by natural killer cells, endothelial cells and platelets but mechanisms of intercellular communication and their interactions with the pathogen are not clearly defined.

Electrokinetic energy conversion studies of aqueous solution of urea, glucose and their mixtures across urinary bladder membranes.

Electrokinetic studies of aqueous solutions of urea, glucose, urea-glucose mixture (urea concentration increasing and glucose fixed) and glucose-urea mixture (glucose concentration increasing and urea concentration fixed) have been carried out across urinary bladder membranes of goat. Results have been analysed using methodology of non-equilibrium thermodynamics. It has been found that energy conversion maxima and degree of coupling for mixtures is higher than urea and glucose solutions. It has also been found that in the case of urea-glucose mixtures, the value of maxima and degree of coupling first decreases and then increases with increase in concentration while in the case of glucose-urea mixture, the trend is not definite. With urea solutions only, both these values increase with increase in concentration. It has been observed that energy conversion maxima and degree of coupling for urine is much higher as compared to other permeants. It appears that second order phenomenological coefficient L112 is related with degree of coupling (qe) as the trend of two is quite similar.