Adenoid cystic carcinoma at base of the tongue with rare cervical lymph node metastasis diagnosed on fine needle aspiration cytology

Adenoid cystic carcinoma (ACC) is an uncommon malignant tumourof salivary glands. Occurrence at base of the tongue is rare. Distant metastasis is common, however, metastasis to regional lymph node is not seen commonly, but if occurs carries a bad prognostic value and lessens the average survival age of the patient. Fine needle aspiration cytology (FNAC)in such cases provides early diagnosis for rapid management of the patient. Review of literature shows that very occasional cases are reported with ACC at base of tongue with regional lymph node metastasis. Here, we present such a rare case of a 55years old male patient with metastatic adenoid cystic carcinoma of cervical lymph node diagnosed on FNACwith primary at base of the tongue

Outcome analysis of a newly setup pediatric intensive care unit in a teaching hospital of northern India

Background: Pediatric intensive care units (PICU) have brought about dramatic increase in the survival of critically ill children. The aim of pediatric intensive care is not just to save lives but also to maximise the quality of those lives. Evaluation of the outcome of an intensive care unit is necessary as a measure of quality improvement in patient care.Methods: A retrospective observational study was done in a PICU of a teaching hospital between February 2017 to August 2018. Records of all admissions, transfer outs, discharges and deaths were collected along with age, sex, diagnosis, length of stay, and outcome.Results: Mean age of the 601 patients admitted over a period of nineteen months was 4 years. 36% patients were between 1-5 year and 32% were infants. Major indication for admission to the PICU was respiratory (30%) followed by neurological illnesses (25%) and infections (22%). Increased length of stay (LOS) (>5 days) was seen in respiratory, neurological diseases and infections. A significant relation (p value <0.05) was found between outcome and patients admitted with sepsis and the group classified as others. Patients admitted with involvement of nephrology system had a significant relation with LOS (p value <0.05). The mortality rate was 2%.Conclusion: The outcome analysis of our newly setup PICU is comparable with other studies in the Indian subcontinent. Active surveillance or audit of PICU admissions help capture lapses in management and bring a better outcome with available resources.

Analysis of multiple choice questions from a formative assessment of medical students of a medical college in Delhi, India

Background: Assessment is a dominant motivator to direct and drive students learning. Different methods of assessment are used to assess medical knowledge in undergraduate medical education. Multiple choice questions (MCQs) are being used increasingly due to their higher reliability, validity, and ease of scoring. Item analysis enables identifying good MCQs based on difficulty index (DIF I), discrimination index (DI), and distracter efficiency (DE).Methods: Students of second year MBBS appeared in a formative assessment test, that was comprised of 50 “One best response type” MCQs of 50 marks without negative marking. All MCQs were having single stem with four options including, one being correct answer and other three incorrect alternatives (distracter). Three question paper sets were prepared by disorganizing sequence of questions. One of the three paper sets was given to each student to avoid copying from neighboring students. Total 50 MCQs and 150 distracters were analyzed and indices like DIF I, DI, and DE were calculated.Results: Total Score of 87 students ranged from 17 to 48 (out of total 50). Mean for difficulty index (DIF I) (%) was 71.6+19.4. 28% MCQs were average and “recommended” (DIF I 30-70%). Mean for discrimination index (DI) was 0.3+0.17. 16% MCQs were “good” and 50% MCQs were in “excellent” criteria, while rests of the MCQs were “discard/poor” according to DI criteria. Mean for distracter efficiency (DE) (%) was 63.4+33.3. 90% of the items were having DE from 100 to 33%. It was found that MCQs with lower difficulty index (<70) were having higher distracter efficiency (93.8% vs. 6.2%, p=0.004).Conclusions: Item analysis provided necessary data for improvement in question formulation and helped in revising and improving the quality of items and test also. Questions having lower difficulty index (<70) were significantly associated with higher discrimination index (>0.15) and higher distractor efficiency.

Use of Computer Assisted Learning as an Alternative to Experimental Pharmacology Teaching: Student's Opinion.

To evaluate student opinion on use of CAL in the MBBS 2nd professional experimental practical pharmacology curriculum.Also to get their views on the advantages and disadvantages of using CAL over traditional methods. A cross-sectional questionnaire based study was conducted at HIMS, Dehradun and Uttarakhand. After explaining the purpose of the study, voluntary inform consent was taken from the subjects before the start of the study. Students were instructed on experiments followed by computer simulation of the same. Thereafter avalidated self-designed questionnaire form was duly filled by each respondent.Out of the total 98 students, 88 (90%) of these thought that CAL is an effective method of teaching practical aspects. They also agreed to the fact that CAL should be conducted as an adjuvant to practical classes. Majority of students agreed that using CAL was advantageous to them .CAL is accepted as a welcome change byundergraduate students. However on the other hand practical knowledge of how to do the experiment is lost.