Global Kidney Health Atlas: a spotlight on the Asia-Pacific sector

Chronic kidney disease (CKD) is a unique public health problem in terms of high expenses required for its management and its increasing worldwide incidence. Understanding the existing structure of CKD treatment and its epidemiology is pivotal for equitable kidney care globally. The Global Kidney Health Atlas (GKHA) was launched by the International Society of Nephrology (ISN) in 2017 as a part of its “Bridging the Gaps” strategy with a vision to understand the global kidney care capacity. Two rounds of GKHA surveys were conducted and published in 2017 and 2019, respectively. The GKHA surveys showed significant variability in kidney care among global regions. Asia is the largest of all continents and distinct for its heterogeneity. The Asia-Pacific sector comprises four main regional constructs of the ISN; North and East Asia, Oceania and South East Asia, South Asia, and the Middle East. Kidney care capacity varies among these regions in terms of government spending, epidemiology of kidney diseases, and workforce availability. In this narrative review, we highlight the differences in kidney care delivery among the regions of the Asia-Pacific sector based on information from GKHA and emphasize the priority areas on which stakeholders should concentrate their efforts.

Analysis of caesarean sections at a tertiary care centre according to Robson’s criteria

Background: There has been a considerable increase in the rate of caesarean sections in the past few decades. Some demographers have argued that this increase is largely affected by the uprising trend of new medically indicated caesarean sections. M. S. Robson proposed a ten-group classification of caesarean sections in year 2001 which was appreciated by WHO in 2014 and FIGO in 2016. This classification is known as Robson’s classification which has ten groups.Methods: This is a retrospective study which was carried out at Civil Hospital, Karimnagar. The study group included all live births and still births of at least 500 gm birth weight or at least 28 weeks of gestation at Civil Hospital, Karimnagar during the period from October 2019 to December 2019. The data collected was analysed using simple statistical methods like percentage and proportion. The data was grouped according to the Robson’s 10 group classification system. The overall caesarean section rate, size of each group and the relative contribution of each group to the overall CS rate were calculated.Results: The total number of deliveries during the study period was 2493. Out of these, the number of caesarean deliveries was 1345. The caesarean section rate was calculated to be 53.95%. The group 5 (multiparous with at least one previous uterine scar with single cephalic pregnancy ≥37 weeks of gestation) contributed to 38.07% of the total caesarean section rate which is the highest.Conclusions: A regular audit into the number and indications of caesarean sections will definitely help in decreasing the primary and repeat caesarean sections.

Presence of integrase core domain in mutant type black pepper Piper nigrum L. ‘Thekken’ with altered inflorescence architecture

Black pepper (Piper nigrum L.), referred as the ‘King of Spices’, is native to India and has shown declined productivity over the years. It exhibits diverse quantitative and qualitative traits, particularly in spike length, floral composition, floral arrangement, fruit size and number. The novel mutant variety of black pepper (Piper nigrum L.) ‘Thekken’ shows a remarkable branching character in the spikes. In the present study, we analyzed RAMOSA3 (RA3) gene at the molecular level in this variety for yield improvement. Screening using degenerate primers designed for RA3 was carried out in ‘Thekken’ and a non-branching variety ‘Karimunda’ at the genomic level and at different stages of spike development at the transcriptome level. Sequence analysis of the amplicons generated in RT-PCR revealed the presence of an integrase core domain in the mutant type of black pepper, suggesting a possibility of mutation at this locus in the branched variety due to retrotransposon integration. The study suggests a possibility for introgression of the genes responsible for branching trait from the mutant variety of black pepper type ‘Thekken’ to other conventional cultivated varieties of black pepper that show single unbranched spike thereby increasing the productivity of black pepper which has very high economic value and export potential.

Comparative study of effectiveness and safety of nonsteroidal anti-inflammatory drugs in patients of knee joint osteoarthritis of knee, tertiary care hospital, Bidar, India

Background: Osteoarthritis (OA) is a joint failure and OA is the most frequent chronic joint disease causing pain and disability. Where all the structures of joints have undergone pathological changes and they are hyaline articular cartilage loss which may be focal or non-uniform, initially it will be focal then spread all over non-uniformly. Non-Steroidal Anti Inflammatory Drugs (NSAID) are the mainstay of medical management of OA. Increased in reports suggests that GIT adverse effect with old NSAID’s and cardiovascular effects with selective cyclooxygenase-2 (COX2) inhibitors had precipitated to chase for better NSAID’s with minimal adverse effects. The current study compares the clinical effectiveness and safety of newer NSAID’s, etoricoxib, lornoxicam, to diclofenac which has been standard therapy in patients of OA of the knee joint.Methods: The current study is randomized, prospective, open-label, parallel group study conducted in 120 patients with OA of the knee joint diagnosed using American College of Rheumatology criteria. After getting the informed consent, they were randomized in three groups of 40 patients each who received tablet etoricoxib 120mg BID, tablet Lornoxicam 16mg BID, tablet diclofenac 50mg TID respectively. The duration of the study is 12 weeks. Data are calculated, tabulated and analyzed using analysis of variance (ANOVA) test, and level of significance was determined by its P value.Results: After 12weeks of treatment, the severity of pain and functional indices using visual analog scale and Western Ontario and McMaster Universities Osteoarthritis score were significantly better (P <0.05) in etoricoxib group as compared to lornoxicam or diclofenac group along with a lesser rate of adverse effects.Conclusions: It is concluded that etoricoxib is more effective and tolerated NSAID than lornoxicam and diclofenac in the treatment of knee joint OA.

Natural bioceramics: our experience with changing perspectives in the reconstruction of maxillofacial skeleton

OBJECTIVES: Various bone graft substitute materials are used to enhance bone regeneration in the maxillofacial skeleton. In the recent past, synthetic graft materials have been produced using various synthetic and natural calcium precursors. Very recently, eggshell-derived hydroxyapatite (EHA) has been evaluated as a synthetic bone graft substitute. To assess bone regeneration using EHA in cystic and/or apicectomy defects of the jaws through clinical and radiographic evaluations. MATERIALS AND METHODS: A total of 20 patients were enrolled in the study protocol (CTRI/2014/12/005340) and were followed up at 4, 8, 12, and 24 weeks to assess the amount of osseous fill through digital radiographs/cone-beam computed tomography along with clinical parameters and complications. Wilcoxon matched pairs test, means, percentages and standard deviations were used for the statistical analysis. RESULTS: The sizes of the lesions in the study ranged from 1 to 4 cm and involved one to four teeth. The study showed significant changes in the formation of bone, the merging of material and the surgical site margins from the first week to the first month in all patients (age range, 15-50 years) irrespective of the size of the lesions and the number of teeth involved. Bone formation was statistically significant from the fourth to the eighth week, and the trabecular pattern was observed by the end of 12 weeks with uneventful wound healing. CONCLUSION: EHA showed enhancement of bone regeneration, and healing was complete by the end of 12 weeks with a trabecular pattern in all patients irrespective of the size of the lesion involved. The study showed enhancement of bone regeneration in the early bone formative stage within 12 weeks after grafting. EHA is cost effective and production is environment friendly with no disease transfer risks. Thus, natural bioceramics will play an important role in the reduction of costs involved in grafting and reconstruction.

Socket preservation using eggshell-derived nanohydroxyapatite with platelet-rich fibrin as a barrier membrane: a new technique

OBJECTIVES: Socket grafting is vital to prevent bone resorption after tooth extraction. Several techniques to prevent resorption have been described, and various bone graft substitutes have been developed and used with varying success. We conducted this pilot study to evaluate the performance of nanohydroxyapatite (nHA) derived from chicken eggshells in socket preservation.MATERIALS AND METHODS: This was a prospective, single center, outcome assessor-blinded evaluation of 23 sockets (11 patients) grafted with nHA and covered with platelet-rich fibrin (PRF) membrane as a barrier. Bone width and radiographic bone density were measured using digital radiographs at 1, 12, and 24 weeks post-procedure. Postoperative histomorphometric and micro-computed tomography (CT) evaluation were performed. The study protocol was approved by the Institutional Ethics Committee.RESULTS: All patients had uneventful wound healing without graft material displacement or leaching despite partial exposure of the grafted socket. Tissuere-epithelialized with thick gingival biotype (>3 mm). Width of the bone was maintained and radiographic density increased significantly with a trabecular pattern (73.91% of sockets) within 12 weeks. Histomorphometric analysis showed 56.52% Grade 3 bone formation and micro-CT analysis revealed newly formed bone with interconnecting trabeculae.CONCLUSION: Use of a PRF membrane with nHA resulted in good bone regeneration in sockets. Use of a PRF membrane prevents periosteal-releasing incisions for primary closure, thereby facilitating the preservation of keratinized mucosa and gingival architecture. This technique, which uses eggshell-derived nHA and PRF membrane from the patient's own blood, is innovative and is free of disease transfer risks. nHA is a promising economic bone graft substitute for bone regeneration and reconstruction because of the abundant availability of eggshell waste as a raw material.

Natural bioceramics: our experience with changing perspectives in the reconstruction of maxillofacial skeleton

OBJECTIVES@#Various bone graft substitute materials are used to enhance bone regeneration in the maxillofacial skeleton. In the recent past, synthetic graft materials have been produced using various synthetic and natural calcium precursors. Very recently, eggshell-derived hydroxyapatite (EHA) has been evaluated as a synthetic bone graft substitute. To assess bone regeneration using EHA in cystic and/or apicectomy defects of the jaws through clinical and radiographic evaluations.@*MATERIALS AND METHODS@#A total of 20 patients were enrolled in the study protocol (CTRI/2014/12/005340) and were followed up at 4, 8, 12, and 24 weeks to assess the amount of osseous fill through digital radiographs/cone-beam computed tomography along with clinical parameters and complications. Wilcoxon matched pairs test, means, percentages and standard deviations were used for the statistical analysis.@*RESULTS@#The sizes of the lesions in the study ranged from 1 to 4 cm and involved one to four teeth. The study showed significant changes in the formation of bone, the merging of material and the surgical site margins from the first week to the first month in all patients (age range, 15-50 years) irrespective of the size of the lesions and the number of teeth involved. Bone formation was statistically significant from the fourth to the eighth week, and the trabecular pattern was observed by the end of 12 weeks with uneventful wound healing.@*CONCLUSION@#EHA showed enhancement of bone regeneration, and healing was complete by the end of 12 weeks with a trabecular pattern in all patients irrespective of the size of the lesion involved. The study showed enhancement of bone regeneration in the early bone formative stage within 12 weeks after grafting. EHA is cost effective and production is environment friendly with no disease transfer risks. Thus, natural bioceramics will play an important role in the reduction of costs involved in grafting and reconstruction.

Socket preservation using eggshell-derived nanohydroxyapatite with platelet-rich fibrin as a barrier membrane: a new technique

OBJECTIVES@#Socket grafting is vital to prevent bone resorption after tooth extraction. Several techniques to prevent resorption have been described, and various bone graft substitutes have been developed and used with varying success. We conducted this pilot study to evaluate the performance of nanohydroxyapatite (nHA) derived from chicken eggshells in socket preservation.@*MATERIALS AND METHODS@#This was a prospective, single center, outcome assessor-blinded evaluation of 23 sockets (11 patients) grafted with nHA and covered with platelet-rich fibrin (PRF) membrane as a barrier. Bone width and radiographic bone density were measured using digital radiographs at 1, 12, and 24 weeks post-procedure. Postoperative histomorphometric and micro-computed tomography (CT) evaluation were performed. The study protocol was approved by the Institutional Ethics Committee.@*RESULTS@#All patients had uneventful wound healing without graft material displacement or leaching despite partial exposure of the grafted socket. Tissuere-epithelialized with thick gingival biotype (>3 mm). Width of the bone was maintained and radiographic density increased significantly with a trabecular pattern (73.91% of sockets) within 12 weeks. Histomorphometric analysis showed 56.52% Grade 3 bone formation and micro-CT analysis revealed newly formed bone with interconnecting trabeculae.@*CONCLUSION@#Use of a PRF membrane with nHA resulted in good bone regeneration in sockets. Use of a PRF membrane prevents periosteal-releasing incisions for primary closure, thereby facilitating the preservation of keratinized mucosa and gingival architecture. This technique, which uses eggshell-derived nHA and PRF membrane from the patient's own blood, is innovative and is free of disease transfer risks. nHA is a promising economic bone graft substitute for bone regeneration and reconstruction because of the abundant availability of eggshell waste as a raw material.

Variations Of Origin And Distance Of Axillary Nerve: A Descriptive Study

Background–Axillary nerve, one of the terminal branches of posterior cord of brachial plexus is more prone for inju-ries. Lack of proper anatomical knowledge and variations of axillary nerve leads to risk of nerve injuries. The present study describes the origin of axillary nerve, its distance of origin from tip of coracoids process. Method: Thirty brachi-al plexuses from fifteen formalin fixed human cadavers of both the sexes were studied by dissection method. Origin and branching pattern of axillary nerve and its distance of origin from the anteromedial aspect of tip of coracoid pro-cess & posterolateral aspect of acromion process was recorded. Results:Out of the 30 specimens studied, axillary nerve was originating from the posterior cord of brachial plexus in 90% of specimens, remaining 10% specimens showed a common trunk of origin of axillary nerve from posterior cord of brachial plexus. The mean distance of origin of axillary nerve from the anteromedial aspect of tip of coracoid process and posterolateral aspect of acromion process is 3.98cm & 6.30cm respectively. The axillary nerve terminated into anterior and posterior branch within quadrangular space in 29 specimens. In one specimen articular branch for shoulder joint was not directly arising from axillary nerve instead it is arising from anterior branch of axillary nerve. Conclusion: In studied population Axil-lary nerves display variations in the origin and distance of origin. Knowledge of this variation in axillary nerve is very important to clinicians, anaesthetists and orthopaedic surgeons during surgical exploration of neck, axilla and upper arm, shoulder dislocation, infraclavicular brachial plexus block and fracture of surgical neck of humerus.

Prevalence Of Vitamin D Deficiency In Hashimoto‘S Thyroiditis And Its Relation To Anti–Thyroid Peroxidase Antibodies

Context: vitamin D deficiency has been considered a risk factor for several autoimmune diseases. Few studies examined prevalence of vitamin D deficiency in autoimmune thyroid disease and have produced conflicting results. Aims: To study the prevalence of vitamin D deficiency in Hashimoto’s thyroiditis (HT)and to assess the correlation between vitamin D and Anti– thyroid peroxidase antibodies (TPO–Ab). Settings and Design: This is a cross sectional case control study. Methods and Material:A total of 100 subjects, 50 HT patients and 50 healthy controls who were age and sex matched were included in the study. Serum 25(OH)D, fT4, TSH, TPO–Abwere measured. Subjects were categorized as vitamin D deficient(<12 ng/ml),vitamin D insufficient(12–20 ng/ml) and vitamin D sufficient (>20 ng/ml) based upon recent consensus guidelines. HT patients were categorized into euthyroid, sub clinical hypothyroid and overt hypothyroid based on fT4 and TSH. Results:The mean 25(OH)D level was 13.19±7.43ng/ml and 13.66±8.61ng/ml in HT patients and healthy controls respectively.Prevalence of vitamin D deficiency was 56% in HT and 50% in controls. Vitamin D insufficiency was observed in 20% of HT and 36% of healthy controls. There was no significant difference in 25(OH)D levels of overt hypothyroid, subclinical hypothyroid and euthyroid HT patients(p=0.23). Pearson correlation analysis showed no significant correlation between vitamin D and TPO–Ab,TSH and fT4. Conclusions: The prevalence of vitamin D deficiency in hashimoto’s thyroiditis and healthy controls was similar. Vitamin D deficiency did not differ between euthyroid,sub clinical hypothyroid and overt hypothyroid patients of HT.There was no correlation between vitamin D and TPO–Ab.

Outcomes of limb and life in patients with acute lower limb ischema presenting before and after the “golden six hours”

Background: Acute limb ischemia (ALI) is any sudden decrease in limb perfusion causing a potential threat to limb viability. It is generally accepted that in a patient without underlying arterial disease who develops an acute arterial blockage has approximately six hours for revascularisation before irreversible damage occurs. This study endeavoured to analyse and evaluate the causes and clinical outcome of acute lower limb ischemia.Methods: 80 successive patients visiting Jain Institute of Vascular Sciences, Bangalore who were diagnosed to have ALI were included in this prospective study. Thromboembolectomy was performed in 48% of patients, 9% of patients were managed with anticoagulation alone, 8% of patients were treated by catheter directed thrombolysis and primary amputation was inevitable in 16 patients of class III ischemia.Results: All the five patients who presented within the golden six hours survived and their limbs could be salvaged without any morbidity. Even in patients with delayed presentation but viable limb (47 patients) functional limb salvage was possible in 39 patients (82.9%). Overall there was 72.73% limb salvage and 27.27% patients underwent amputation. There was a mortality rate of 13.16% in the study.Conclusions: Overall there was 72.73% limb salvage and 27.27% patients underwent amputation. Revascularization within six hours is ideal (only 6.25% of patients in our study); however, in delayed presentation (93.75%), physiological state of the limb, rather than elapsed time from onset of occlusion will determine the operability. Late revascularization may thus be indicated and is often successful if limb still exhibits signs of viability.

Association of CTG repeat polymorphism in carnosine dipeptidase 1 (CNDP1) gene with diabetic nephropathy in north Indians.

Background & objectives: CNDP1 gene, present on chromosome 18q22.3-23, encodes carnosinase, the rate-limiting enzyme in hydrolysis of carnosine to β-alanine and L-histidine. Linkage of CTG trinucleotide (leucine) repeat polymorphism in CNDP1 gene with diabetic nephropathy has been observed in several populations. However, this association is conflicting and population-dependent. We investigated this association in type 2 diabetes mellitus (T2DM) patients with and without nephropathy in north India. Methods: A total of 564 individuals [199 T2DM without nephropathy (DM), 185 T2DM with nephropathy (DN) and 180 healthy individuals (HC)] were enrolled. CNDP1 CTG repeat analysis was done by direct sequencing of a 377 base pair fragment in exon 2. Results: The most frequent leucine (L) repeats were 5L-5L, 6L-5L and 6L-6L. 5L-5L genotype frequency was reduced in DN (24.3%) as compared to DM (34.7%, P=0.035) and HC (38.4%, P=0.005). Similarly, 5L allele frequency was lower in DN (46.8%) as compared to DM (57.3%, P=0.004) and HC (60.5%, P<0.001). The genotype and allelic frequencies were similar in DM and HC groups. No gender specific difference was observed in the genotype or allelic frequencies between groups. Interpretation & conclusions: Compared to healthy individuals and those with diabetes but no kidney disease, patients with diabetic nephropathy exhibited lower frequencies of 5L-5L genotype and 5L allele of CNDP1 gene, suggesting that this allele might confer protection against development of kidney disease in this population.

Sociodemographic Profile of Patients of COPD and Bronchial Asthma in Tertiary Care Centre of Uttarakhand.

Background: Burden of chronic respiratory disease is alarming. International studies suggest that chronic respiratory disease are under surveyed & under diagnosed worldwide. The purpose of the study is to investigate the sociodemographic profile of patient with COPD and bronchial asthma patients presenting to tertiary care centre of Uttarakhand. Objective: To study the sociodemographic profile of patients with COPD and bronchial asthma attending the Sushila Tiwari hospital Haldwani, Uttarakhand. Methods: All patients with respiratory complaints meeting the inclusion criteria & willing to undergo spirometry were recruited from outpatient department and emergency department of government college Haldwani and associated Sushila Tiwari hospital Haldwani. Results: 154 patients (70 females and 84 males) were evaluated by spirometry. Male dominance was seen in COPD that is 47(59.5%), while female dominance was seen in bronchial asthma that is 17(54.8%). Bidi smoking was common in male, smoking and exposure to smoke from biofuel was responsible for COPD in female patients. Maximum number of patient presented in stage 2 COPD (moderate) 45(56.9%) followed by 23(29.11%) patient of severe COPD (stage 3). Conclusion: In our study tobacco product most frequently used was bidi both in man and women. Contrary to popular belief in developing countries, women exposed to tobacco smoke, whether active or passive, whether by bidi or hukka, like men are at increased risk for the development of COPD. Asthmatic subjects showed more reversibility than COPD subject. In evaluation of obstructive lung disease spirometry remained an investigative tool.

Spigelian Hernia with Homolateral Direct Inguinal Hernia: A Rare Case Report.

A Spigelian hernia (or lateral ventral hernia) is a hernia through the spigelian fascia, which is the aponeurotic layer between the rectus abdominal muscle medially and the semilunar line laterally. There is a common misconception that they protrude below the arcuate line owing to deficiency of the posterior rectus sheath at that level, but in fact, the defect is almost always above the arcuate line. These are interparietal hernias, meaning that they do not lie below the subcutaneous fat but penetrate between the muscles of the abdominal wall; therefore, there is often unnoticeable swelling. Spigelian hernias are usually small, and therefore, the risk of strangulation is high. Most occur on the right side (4-7th decade of life).

The live kidney donor: Do we now understand the risks better.

Grams ME, Sang Y, Levey AS, Matsushita K, Ballew S, Chang AR, Chow EK, Kasiske BL, Kovesdy CP, Nadkarni GN, Shalev V, Segev DL, Coresh J, Lentine KL, Garg AX; Chronic Kidney Disease Prognosis Consortium. (Division of Nephrology, Johns Hopkins University School of Medicine, Department of Epidemiology, Johns Hopkins Bloomberg School of Public Health, and the Departments of Surgery and Epidemiology, Johns Hopkins University, Baltimore; Division of Nephrology, Tufts Medical Center, Boston; Division of Nephrology, Geisinger Medical Center, Danville, Pennsylvania; Department of Medicine, Hennepin County Medical Center, University of Minnesota, Minneapolis; Memphis Veterans Affairs Medical Center and University of Tennessee Health Science Center, Memphis; Division of Nephrology, Department of Medicine, Icahn School of Medicine at Mount Sinai, New York, USA; Medical Division, Maccabi Healthcare Services and Sackler Faculty of Medicine, Tel Aviv University, Tel Aviv, Israel; Centers for Abdominal Transplantation and Outcomes Research, Saint Louis University, St Louis; Departments of Medicine and Epidemiology and Biostatistics, Western University, and the Institute for Clinical Evaluative Sciences, London, Ontario, Canada). Kidney-failure risk projection for the living kidney-donor candidate. N Engl J Med 2016;374:411–21.

Clinical profile of patients with vernal keratoconjunctivitis.

Background: Ocular allergy is a common disorder, which can be debilitating for patients and at times challenging physicians to diagnose and treat. Allergic disease affects 30-50% of the population. Vernal keratoconjunctivitis (VKC) has predilection for young age group and the diagnosis is generally based on signs and symptoms of the disease. This study was undertaken to stress upon the disease and those secondary to its long-term medication. Methods: 74 patients with VKC detected at random, who attended the Department of Ophthalmology KIMS, Hubli from December 2012 to May 2014. The relevant details of history and clinical examination of the patients were recorded on a specifically designed Proforma. The type and severity of VKC was noted. Clinical observation and evaluation of clinical signs and symptoms were performed before and after drug therapy at first visit, weekly interval for 2 weeks and at the end of 3 months. Results: 22 out of 74 (29.72%) were in the 6-10 years of age. The male: female ratio was 2.7:1.13. Majority of the patients presented in the month of May. Family history of allergy was present in 4 (5.04%) of patients. 59 (72.72%) patients showed seasonal symptoms and 15 (20.27%) patients showed perennial symptoms. Mixed type was found in 60.81%. Itching was present in 59 (79.72%). 72 (97.29%) had papillae on the upper tarsal conjunctiva. Conclusions: VKC was common in males, during hot climate. Mixed type of VKC was more commonly present.

Prevalence of myopia among school going children.

Background: Poor vision in childhood affects performance in school or at work and has a negative influence on the future life of the child. Moreover planning of a youth’s career is very much dependent on the visual acuity, especially in jobs for navy, military, railways and aviation. This warrants early detection and treatment of refractive errors to prevent permanent disability. Hence present study was planned with the objective to determine, the prevalence of myopia among school children. Methods: An institution based cross sectional study was carried out among primary and high school children of 7 – 15 years of age. A total of 4429 children were studied over a period of one year. Visual acuity was performed among all children. Myopic children were referred for further evaluation and management. Data was entered in excel and analyzed using proportions and chi square test. Results: The prevalence of myopia was 6%. It was more among girls 155 (58.27%) than boys 111 (41.73%) were boys. 91.73% had bilateral myopia. Visual acuity improved in 95% of cases after correction. Myopia was more common among social class IV compared to social class VI. Conclusions: Early diagnosis and visual rehabilitation of myopic students can be achieved by periodic eye examination at regular intervals by school teachers and basic health workers and this can help in preventing the development of amblyopia thereby reducing the burden of morbidity due to myopia.

Effect of mesenchymal stem cells transplantation on glycaemic profile & their localization in streptozotocin induced diabetic Wistar rats.

Background & objectives: Bone marrow is a rich source of adult stem cells that can differentiate into various cell types. Administration of mesenchymal stem cells (MSCs) in irradiated diabetic rat model has transiently shown to decrease blood glucose level. This study examines the effect of high dose and multiple injections of MSCs on glycemic profile, their localization and regeneration of islet in diabetic Wistar rat. Methods: The study was carried out in male Wistar rats categorized into three groups (n=6, in each group): Group 1 as control, group 2 streptozotocin (STZ) (50 mg/kg) induced diabetic group and group 3 experimental group; 5-bromo-2-deoxyuridine (BrdU) labelled allogenic MSCs were injected in the non-irradiated diabetic rat of the experimental group through tail vein. The blood glucose profile was subsequently monitored at regular intervals. Rats were sacrificed on day 45 and pancreas was examined for localization of BrdU labelled stem cells by immunofluorescence and islet-neogenesis by immunohistochemistry . Results: There was a significant reduction in blood glucose level after administration of MSCs in the experimental group (p<0.001). The presence of BrdU labelled MSCs in islet suggested their localization in the pancreas. Co-expression of anti-BrdU and anti-insulin antibody indicated trans-differentiation / fusion into insulin producing cells evidenced by significant increase in total number of islet (p=0.004) and insulin positive cells (p<0.0001) in experimental group. Interpretation & conclusions: Our results showed that the MSCs administration in non-irradiated diabetic Wistar rat reduced hyperglycaemia and was accompanied by increased islet-neogenesis, possibly through trans- differentiation/fusion.

Students Perception on Methods of Anatomy Teaching and Assessment.

Objectives: An opinion regarding curriculum, teaching methodology & assessment techniques in anatomy was taken from the first year MBBS students at People’s College of Medical Science & Research Centre, Bhopal with specially designed questionnaire. Materials and Method: Input from the students were collected from the 129 MBBS students of 2013-14 batch who completed first year MBBS. It was done by using a specially designed questionnaire comprising of points relating to the curriculum, teaching methodology and assessment techniques used at People’s College of Medical Science and Research Centre, Bhopal for its effectiveness and capacity to meet specific objectives need. Results: Majority of the students feel the curriculum can be taught in present one year duration. The best method of learning is the chalkboard and dissection hall teaching. Students agreed for multimedia teaching methods for better understanding. Majority students opined that the best method of assessment is part ending tests. Students favoured descriptive & short essay questions with MCQ as examination pattern. Use of visual aids is the best solutions for problems in histology and embryology. Students favoured teacher’s notes as a best source of study material. Majority felt that class attendance and internal assessment both considered for allowing students to appear for university examination. Conclusion: The study concluded that chalkboard teaching and dissection hall teaching would be the best approach for Anatomy teaching and learning and the best method of assessment is part ending tests.