Item analysis to identify quality multiple choice questions/items in an assessment in Pharmacology of II MBBS students in Guntur Medical College of Andhra Pradesh, India

Background: In medical education, multiple choice questions/Items are the more frequently used assessment tools to assess the knowledge abilities and skills of medical students, for being their objectivity, wide coverage in less time. However only the Quality Items gives a valid and reliable assessment. The quality of an Item is determined by difficulty index (DIF I), Discrimination Index (DI) and Distractor efficiency (DE). Aim of the study was to know the quality of Items in pharmacology by Item analysis and to develop a MCQs bank with quality Items.Methods: The present study was conducted on 150 II MBBS students of Guntur Medical College, AP, India. A class test containing 50 Items with 150 distractors from topic chemotherapy was conducted. Item with the correct choice/response was awarded with one mark and with the wrong choice zero marks, no negative marks. Each test Item was analysed with DIF I, DI and DE and the results were tabulated and tested statistically, with unpaired "t" test.Results: Mean DIF I, DI, DE values with standard deviations in the present study are 44.72+17.63%, 0.30+0.12%, 84.48+24.65 respectively. DIF I of 32 (64%) items was good to excellent range (31%-60%) 9 (18%) Items were easy (>61%) and 9(18%) Items were difficult (>30%). DI of 10 (20%) Items was good (0.15 to 0.24.) 29 (58%) Items were excellent with DI > 0.25 and 11 (22%) Items were poor with DI <0.15. Among 150 distractors, 127 (85%) were functional distractors (FDs) and 23 (15%) were non-functional distractors (NFDs). DE of 33 (66%) items with nil NFDs was 100%, for 12 (24%) Items with one NFD, was 66.6%, for 4 (8%) items with 2 NFDs was 33.3% and for 1 (2%) Item with 3NFDs DE was 0%. When unpaired "t" test was applied to the means of "difficult" and "easy" Items, 96.22+11.33% SD, 51.44+29.31% SD respectively, the p-value obtained was 0.00058, which was highly significant.Conclusions: The study showed that Item analysis is a valid tool to identify quality Items, which assess, the students� knowledge abilities and discriminate different levels of performance abilities of students effectively.

Prevalence of work-related musculoskeletal complaints among dentists in India: A national cross-sectional survey.

Context: Work-related musculoskeletal disorders (WRMSD) had been previously reported to have a high prevalence among dentists in different parts of the world. Aims: The study aimed to assess the prevalence of self-reported WRMSD among dental professionals in India. Material and Methods: A cross-sectional survey of 646 dentists (response rate of 82.97%) was done using self-administered questionnaire which consisted of 27 items based on Nordic questionnaire for screening WRMSDs. Additional items of the questionnaire were added after preliminary content validation from six experienced dentists. Participant socio-demographic characteristics, work-related physical load characteristics, musculoskeletal symptom characteristics were evaluated. Statistical analysis used: All data were analyzed descriptively using percentiles and association between work-related physical load and WRMSD prevalence was done using Chi-square test. Results: All 536 dentists had at least one work-related musculoskeletal symptom in the previous year with an overall period prevalence rate of 100%. The type of symptoms present were pain (99.06%), stiffness (3.35%), fatigue (8.39%), discomfort (12.87%), clicks/sounds (4.1%), and other neurogenic (20.14%). The regions of symptoms were neck (75.74%), wrist/hand (73.13%), lower back (72.01%), shoulder (69.4%), hip (29.85%), upper back (18.65%), ankle (12.31%), and elbow (7.46%). Number of regions affected were two (82.83%), three (51.86%), four, or more (15.11%). Recurrent symptoms were present in 76.11%. Strong association was noted between sustained work postures and symptom regions for pain in WRMSD. Conclusion: The study found an overall one-year period prevalence rate of 100% for WRMSDs among Indian dentists. Measures for improving education and ergonomic evaluations are indicated on a large scale to prevent decline in work performance and incidence of WRMSDs among Indian dentists.

Awake craniotomy - for management of intracranial lesions safely in eloquent areas of brain.

The awake craniotomy is a procedure where the craniotomy and excision of the lesion is done in awake patient without general anaesthesia. This surgical technique enable surgeons to avoid damaging normal cerebral regions and allow real-time patient feedback while operating on important functional areas of brain like motor cortex and speech areas (motor, somatosensory, and language areas). Such surgical interventions would not be possible without anesthesia. This technique was originally introduced for the surgical treatment of epilepsy and has subsequently been used in patients undergoing surgical management of supratentorial tumours, deep brain stimulation and near critical brain regions. This surgical approach aims to maximize lesion resection while sparing important areas of the brain.

Human immunodeficiency virus (HIV) prevention education in Singapore: challenges for the future

We reviewed the current human immunodeficiency virus (HIV) prevention education programmes in Singapore, discussed the challenges faced and proposed prevention education interventions for the future. Education programmes on HIV prevention have shown some success as seen by reduced visits to sex workers among the general adult population and a marked increase in condom use among brothel-based sex workers. However, we still face many challenges such as low awareness of HIV preventive strategies and high prevalence of HIV stigma in the general population. Voluntary HIV testing and condom use remain low among the priority groups such as men who have sex with men (MSM) and heterosexual men who buy sex. Casual sex has increased markedly from 1.1% in 1989 to 17.4% in 2007 among heterosexuals in Singapore, with the majority (84%) practising unprotected sex. Sex workers have moved from brothels to entertainment venues where sex work is mostly hidden with lack of access to sexually transmitted infections (STIs)/ HIV prevention education and treatment programmes. Education programmes promoting early voluntary testing is hampered because of poor access, high cost and stigma towards people living with HIV. It remains a challenge to promote abstinence and consistent condom use in casual and steady sexual relationships among heterosexuals and MSM. New ways to promote condom use by using a positive appeal about its pleasure enhancing effects rather than the traditional disease-oriented approach should be explored. Education programmes promoting early voluntary testing and acceptance of HIV-infected persons should be scaled up and integrated into the general preventive health services.

Large congenital melanocytic nevus with metastatic melanoma with a probable primary in the lung.

Large congenital melanocytic nevi (>20 cm in greatest diameter) are very rare and are seen in approximately 1 in 20,000 newborns. The major risk these patients face is the development of neurocutaneous melanosis or malignant melanoma. We report a rare case of large congenital melanocytic nevus with metastatic melanoma in a 40-year-old woman. In this case, though the primary was not established with certainty, on the basis of clinical course and radiological evaluation of various organs, we presume that the primary could be in the lung.

Comparative evaluation of marginal microleakage in amalgam restorations of permanent and primary teeth a stereomicroscopic study.

Microleakage and lack of adhesion to the tooth structure are shortcomings that have limited dental amalgam’s use in certain clinical conditions. Studies have shown that the use of adhesive resins as liners under amalgam will create greater retention than mechanical undercuts. The objective of this study is to evaluate the sealing ability of a dentin bonding agent when used as a liner around dental amalgam restorations of both the permanent and the primary teeth.

Diferenciais de raça/cor da pele em anos potenciais de vida perdidos por causas externas / Race/skin color differentials in potential years of life lost due to external causes

OBJETIVO: As mortes por causas externas representam um dos mais importantes desafios para a saúde pública, sendo a segunda causa de óbito no Brasil. O objetivo do estudo foi analisar os diferenciais de mortalidade por causas externas segundo raça/cor da pele. MÉTODOS:Estudo descritivo realizado em Salvador (BA), com 9.626 registros de óbitos por causas externas entre 1998 e 2003. Dados foram obtidos do Instituto Médico Legal e Instituto Brasileiro de Geografia e Estatística. O indicador "anos potenciais de vida perdidos" foi utilizado para identificar diferenciais entre grupos etários, de raça/cor da pele e sexo. RESULTADOS: As mortes por causas externas determinaram perda de 339.220 anos potenciais de vida, dos quais 210.000 foram devidos aos homicídios. Indivíduos negros morreram em idades mais precoces e perderam 12,2 vezes mais anos potenciais de vida devido a mortes por homicídio que indivíduos brancos. Embora a população negra (pardos e pretos) fosse três vezes maior que a população branca, o número de anos perdidos daquela foi 30 vezes superior. A população de pretos era 11,4% menor que a população branca, mas apresentou anos perdidos quase três vezes mais. Mesmo após a padronização por idade, mantiveram-se as diferenças observadas no indicador de anos potenciais perdidos/100.000 hab e nas razões entre estratos segundo raça/cor. CONCLUSÕES: Os resultados mostram diferenciais na mortalidade por causas externas segundo raça/cor da pele em Salvador. Os negros tiveram maior perda de anos potenciais de vida, maior número médio de anos não vividos e morreram, em média, em idades mais precoces por homicídios, acidentes de trânsito e demais causas externas.

OBJECTIVE: Deaths by external causes represent one of the most important challenges for public health and are the second cause of death in Brazil. The aim of this study was to analyze differentials in mortality by external causes according to race/skin color. METHODS: A descriptive study was carried out in Salvador, Northeastern Brazil, using 9,626 cases of deaths by external causes between 1998 and 2003. Data were obtained from the Forensic Medicine Institute and from Instituto Brasileiro de Geografia e Estatística (Brazilian Institute of Geography and Statistics). The indicator "potential years of life lost" was utilized to identify the existence of differences among age groups, sex groups and race/skin color groups. RESULTS:Deaths by external causes provoked the loss of 339,220 potential years of life, of which 210,000 were due to homicides. Nonwhite individuals died at earlier ages and lost 12.2 times as much potential years of life due to deaths by homicidies than white individuals. Although the nonwhite (black and mixed) population was three times larger than the white population, its number of potential years of life lost was 30 times higher. The population of blacks was 11.4% smaller than the white population, but its loss of potential years of life was almost three times higher. Even after the adjustment for age, the differences observed in the indicator potential years of life lost/100,000 inhabitants and in the ratios between strata according to race/skin color were maintained. CONCLUSIONS: The results showed differentials in mortality by external causes according to race/skin color in Salvador. The nonwhite population had greater loss of potential years of life, higher average number of years not lived and, on average, they died at an earlier age due to homicides, traffic accidents an all other external causes.

OBJETIVO: Las muertes por causas externas representan uno de los más importantes desafíos para la salud pública, siendo la segunda causa de óbito en Brasil. El objetivo del estudio fue analizar los diferenciales de mortalidad por causas externas según raza/color de la piel. MÉTODOS: Se realizó estudio descriptivo en Salvador, BA, con 9.626 registros de óbitos por causas externas entre 1998 y 2003. Los datos se obtuvieron del Instituto Médico Legal e Instituto Brasilero de Geografía y Estadística. El indicador "años potenciales de vida perdidos" fue utilizado para identificar diferenciales entre grupos erarios, de raza/color de la piel y sexo. RESULTADOS: Las muertes por causas externas determinaron pérdida de 339.220 años potenciales de vida, de los cuales 210.000 fueron debidos a los homicidios. Individuos negros murieron en edades más precoces y perdieron 12,2 veces más años potenciales de vida debido a homicidios que individuos blancos. A pesar de que la población negra (pardos y negros) era tres veces mayor que la población blanca, el número de años perdidos de la primera fue 30 veces superior. La población de negros era 11,4% menor que la población blanca, pero presentó años perdidos casi tres veces mayor. Aún después de la estandarización por edad, se mantuvo las diferencias observadas en el indicador de años potenciales perdidos/100.000 hab y en las razones entre estratos según raza/color. CONCLUSIONES: Los resultados muestran diferenciales en la mortalidad por causas externas según raza/color de la piel en Salvador. Los negros tuvieron mayor pérdida de años potenciales de vida, mayor número promedio de años no vividos y murieron, en promedio, en edades más precoces por homicidios, accidentes de tránsito y demás causas externas.

Morbidity pattern and time trends of filaria cases at a PHC in Dakshina Kannada District.

A study on morbity pattern and time trends of filaria cases was carried out in a PHC of Dakshin Kannada District during November 2000 to January 2001. The age and sex distribution of all 416 filaria cases recorded revealed that 235 (56.49%) were females and maximum concentration of 263 (63.21%) was in the age group of 16-45 years. The seasonal distribution revealed that rainy season accounted the highest number of cases 197 (47.35%). The prevalence was highest, 1.96/1000 population in the year 1993 and lowest, 0.71/1000 population in the year 1995.

Mitomycin-C-augmented trabeculectomy for neovascular glaucoma. A preliminary report.

PURPOSE: This study aimed to investigate the safety and efficacy of trabeculectomy with intraoperative mitomycin C (MMC) in the management of eyes with neovascular glaucoma (NVG). METHODS: Fifteen eyes of 14 patients with NVG were included in the study. NVG was secondary to central retinal vein occlusion (3 eyes), hemiretinal vein occlusion (2 eyes), proliferative diabetic retinopathy (8 eyes), branch retinal vein occlusion (1 eye) and idiopathic (1 eye). Preoperative retinal ablation was performed in eyes with evidence of posterior segment ischaemia. Following this, all eyes underwent trabeculectomy with intraoperative MMC (0.4 mg/ml for 3 minutes). Clinical outcome assessment included visual acuity, intraocular pressure (IOP), bleb appearance, identification of complications and antiglaucoma medications required to control IOP. RESULTS: The mean IOP decreased from 38.6 +/- 12.9 mmHg (range, 15-64 mmHg) to 17.4 +/- 9.33 mmHg (range, 4-34 mmHg) (P = 0.001). Preoperative visual acuity ranged from light perception to 6/9 in the affected eye. Thirteen (86.6%) of 15 eyes improved vision or retained preoperative vision, one (6.7%) eye lost light perception and one (6.7%) eye developed tractional retinal detachment two years after trabeculectomy. Ten (66.7%) of 15 eyes were classified as surgical success with a mean follow-up of 28.6 +/- 26.3 months (range, 2-82 months). None of the patients developed choroidal haemorrhage, hypotony maculopathy, late onset bleb leak or endophthalmitis. CONCLUSION: Trabeculectomy with intraoperative MMC is a good treatment modality in the management of eyes with NVG.

Safety and efficacy of simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma.

PURPOSE: To establish the safety and efficacy of simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma. METHODS: We studied 109 consecutive patients who underwent planned simultaneous bilateral primary combined trabeculotomy-trabeculectomy for developmental glaucoma by a single surgeon from January 1990 through December 1999. The main outcome measures were postoperative intraocular pressure (IOP), corneal clarity and diameter, visual acuity, bleb characteristics, time of surgical failure and complications. Postoperative complications including endophthalmitis and anaesthetic morbidity and mortality were also analysed. RESULTS: The series consisted of 218 primary combined trabeculotomy-trabeculectomy surgeries during 109 anaesthesias. The mean follow-up period was 16.33 +/- 16.22 months. The IOP reduced from 26.4 +/- 5.9 mmHg to 13.5 +/- 4.5 mmHg, with a mean percentage reduction of 46.2 +/- 23.7 (P < 0.0001). The success (IOP < 16 mmHg) probabilities were 90.9%, 88.0% and 69.3% at first, second and third year respectively (Kaplan-Meier analysis). The success probability of 69.3% obtained at third year was maintained till 6 years of follow-up. One hundred and sixty six (76.1%) eyes had significant corneal oedema. Postoperatively, the cornea cleared in 93 (57.8%) eyes. Clinically, well functioning blebs were present in 114 of 171 eyes (66.6%). Postoperatively, 18 (8.3%) eyes developed shallow anterior chamber and 6 (33.3%) of them required surgical reformation. There was no incidence of endophthalmitis or any other sight-threatening complication. Of the anesthetic complications, apnea occurred in 17 (15.6%) patients and all were successfully resuscitated. The most serious post-anaesthetic complication was cardio-pulmonary arrest that occurred 5 hours postoperatively following aspiration during feeding in one child; this child could not be resuscitated. Two children had delayed recovery (2 and 4 hours respectively). The child who had delayed recovery by 2 hours survived and has completed 3 years of follow-up while the other child expired 48 hours later. CONCLUSION: Simultaneous bilateral primary combined trabeculotomy-trabeculectomy is safe and effective for developmental glaucoma. It obviates the need for long second anaesthesia with its attendant risks. It offers several other benefits to the patients and families.