Perceptions of undergraduate medical students regarding online classes during COVID-19 pandemic: A questionnaire survey

Background: The nationwide lockdown due to coronavirus disease pandemic lead to shutdown of medical colleges. Due to which, it was not possible to teach students in classrooms anymore. To continue with their teaching, the option of online classes was recommended. Aims and Objectives: This study was conducted with an aim to evaluate students’ perceptions regarding online lectures. Materials and Methods: This was a cross-sectional, and questionnaire survey conducted among medical college students in Uttar Pradesh, India. Online lectures were delivered routinely using online applications for 8 weeks which was followed by offline regular classes. A pre-approved, pre-validated semi-structured questionnaire containing 13 close-ended multiple-choice questions was distributed through Google forms as well as in person among all the medical students using a non-probability sampling approach after taking their informed consent. The collected data were organized and tabulated using Google spreadsheet and descriptive statistics was used to depict the results. Results: A total of 193 responses were obtained from MBBS students of first and second phase. The mean age of students was 18.73 ± 1.87 years. Mobile phones (63.21%) were the most popular device used by the students to attend classes. More than half of the students (57%) were self-motivated to attend online classes. The major barrier to online learning as reported by 76.68% students was network issues. About 44% students reported lower understanding of subject compared to offline classes. About 70.47% felt online classes to be more comfortable to attend. More number of students either preferred offline method (37.82%) or a mix of both the methods (34.20%). Conclusion: Online lectures are effective teaching method, but they cannot replace classroom teaching. Thus, online teaching serves as add-on to the offline learning.

Orexin-A levels in reproductive age group women and its association with body mass index

Objectives: Orexins are hypothalamic neuropeptides, which are involved in feeding behaviour, sleep-wakefulness, and neuroendocrine homeostasis in the body. The study was conducted with the aim to estimate the serum orexin levels in reproductive age group (RAG) women and to determine the association of serum orexin levels with body mass index (BMI) in females of RAG. Materials and Methods: One hundred and forty apparently healthy women of RAG (20–40 years) were randomly selected. Fasting serum orexin levels were measured using ELISA and BMI was calculated in women based on their height and weight. Results: Serum orexin levels were significantly higher in women with BMI ? 25 kg/m2 (P = 0.035) as compared to women with BMI < 25 kg/m2 . Conclusion: In the present study, BMI correlated significantly with mean serum orexin levels. However, serum orexin levels did not correlate with the age of women.

Status of adult immunity to hepatitis A virus in healthcare workers from a tertiary care hospital in north India

Background & objectives: Humans are considered to be the principal host for hepatitis A virus (HAV) infection. In India, heterogeneous groups of susceptible individuals coexist in different regions. There has been a decline in antibody titres to HAV among young adults which may pose a major public health problem. The objective of this study was to assess the IgG anti-HAV level among healthcare workers (HCWs) in the age group of 20-60 yr and its association with the socio-demographic variables. Methods: Blood sample (2 ml) was collected under aseptic conditions from each participant followed by the preparation of serum and storing at ?20癈. ELISA-based kits were used for the determination of IgG antibodies to HAV in the human serum samples. Results: Two hundred and fifty four HCWs were enrolled. IgG anti-HAV antibodies were detected in 97.2 per cent of the samples analyzed. No differences were observed in the levels of IgG anti-HAV antibody and education, income, occupation and socio-economic classes of the HCWs. A seropositivity rate of over 90 per cent was seen amongst all the socio-economic classes. Interpretation & conclusions: High levels of IgG protective antibodies were seen among the studied HCWs, hence HAV vaccination may not be required. It will be advisable to do a cost-benefit analysis of vaccination for HAV.

Study of Aesthetic Components of Smile in North Indian Males

Smile is an important physical factor for reflection of inner emotions and well being of person. People with an aesthetic smile are judged socially attractive. It would be useful to represent some desirable characteristics of the smile, which help to achieve desirable results in surgical and aesthetic oral rehabilitation. To analyze the various aesthetic components of smile, assessing the teeth displayed during smile, relationship between curve formed by incisal line of anterior maxillary teeth and the curve of lower lip, the touch of this incisal line on lower lip, the alignment of facial midline with the arch midline and compared the data with the previous studies. The study comprises of 200 North Indian males age group 18-40 years. Prior informed written consent for this study was obtained from the subjects. The exclusion and inclusion criteria for the subjects were predefined. Photographs were taken both in rest position as well as in Smile position using digital camera with high resolution. Results show that during smile the position of upper lip was average in 49% of males, alignment of upper incisal edge to lower lip was convex in 47%, tooth lower lip was non touching in 60%, no. of teeth displayed during smile was 8-10 in 68%, midline from philtrum passing through the centre of central incisors in 76% and bilateral negative space was not visible in 92% males. So, it is concluded that smile is aesthetic in North Indian males.

Study of Aesthetic Components of Smile in North Indian Males

Smile is an important physical factor for reflection of inner emotions and well being of person. People with an aesthetic smile are judged socially attractive. It would be useful to represent some desirable characteristics of the smile, which help to achieve desirable results in surgical and aesthetic oral rehabilitation. To analyze the various aesthetic components of smile, assessing the teeth displayed during smile, relationship between curve formed by incisal line of anterior maxillary teeth and the curve of lower lip, the touch of this incisal line on lower lip, the alignment of facial midline with the arch midline and compared the data with the previous studies. The study comprises of 200 North Indian males age group 18-40 years. Prior informed written consent for this study was obtained from the subjects. The exclusion and inclusion criteria for the subjects were predefined. Photographs were taken both in rest position as well as in Smile position using digital camera with high resolution. Results show that during smile the position of upper lip was average in 49% of males, alignment of upper incisal edge to lower lip was convex in 47%, tooth lower lip was non touching in 60%, no. of teeth displayed during smile was 8-10 in 68%, midline from philtrum passing through the centre of central incisors in 76% and bilateral negative space was not visible in 92% males. So, it is concluded that smile is aesthetic in North Indian males.

What makes non-cirrhotic portal hypertension a common disease in India? Analysis for environmental factors

In India, an unexplained enteropathy is present in a majority of non-cirrhotic intrahepatic portal hypertension (NCIPH) patients. Small intestinal bacterial contamination and tropical enteropathy could trigger inflammatory stimuli and activate the endothelium in the portal venous system. Groundwater contaminated with arsenic is an environmental factor of epidemic proportions in large areas of India which has similar consequences. Von Willebrand factor (a sticky protein) expressed by activated endothelium may promote formation of platelet microthrombi and occlusion of intrahepatic portal vein branches leading to NCIPH. Environmental factors linked to suboptimal hygiene and sanitation, which enter through the gastrointestinal (GI) tract, predispose to platelet plugging onto activated endothelium in portal microcirculation. Thus, NCIPH, an example of poverty linked thrombophilia, is a disease mainly affecting the lower socio-economic strata of Indian population. Public health measures to improve sanitation, provide clean drinking water and eliminate arsenic contamination of drinking water are urgently needed. Till such time as these environmental factors are addressed, NCIPH is likely to remain 'an Indian disease'.

Expanded diagnostic approach to hepatitis E virus detection in patients with acute-on-chronic liver failure: A pilot study

Introduction: Acute decompensation of pre-existing chronic liver disease (CLD), known as acute-on-chronic liver failure (ACLF), is associated with high mortality. Hepatitis E virus (HEV) as a potential cause was studied. Objectives: The objectives of this study are to evaluate the role of HEV in ACLF patients using an IgM anti-HEV antibody enzyme-linked immunosorbent assay (ELISA), HEV antigen ELISA, and a quantitative HEV polymerase chain reaction (PCR). Materials and Methods: In this prospective cross-sectional study, blood samples were collected from 50 ACLF (cases) as defined by the standard guidelines (APASL, 2014) and 50 patients with stable CLD (controls) from January 2015 to August 2016, after obtaining informed consent. Two IgM ELISAs (MP Diagnostics HEV IgM ELISA 3.0, Singapore and Wantai HEV IgM ELISA, Beijing, China) were compared using plasma from cases and controls. In addition, an HEV antigen detection by ELISA (Wantai, Beijing, China) and a real-time PCR for quantification of HEV RNA in plasma and stool were employed. Results: Ethanol was the leading cause of acute insult in ACLF (54%) cases. HEV infection accounted for 20% of cases. Ten ACLF patients (20%) had 1–3 markers of HEV versus two (4%) among controls (P = 0.0138). Among ACLF cases, one had HEV viraemia (403 IU/ml), faecal shedding (2790 IU/ml) and detectable HEV antigenaemia. Agreement between the two anti-HEV IgM ELISAs was 0.638 (kappa value). Conclusion: This study shows that alcohol is a major contributing factor for both underlying CLD and ACLF while HEV is the most common infectious cause for ACLF, suggesting a need for a vaccination in such patients, whenever made available.

Association of interleukin‑28B rs12979860 and rs8099917 polymorphisms with sustained viral response in hepatitis C virus genotype 1 and 3 infected patients from the Indian subcontinent.

Background: Polymorphisms of the IL28B gene (rs12979860 and rs8099917) have been shown to impact treatment responses in hepatitis C virus (HCV) infected patients. The association of these polymorphisms with sustained viral response (SVR) has been studied in HCV genotype 3 infected patients in India, but not in genotype 1. Objectives: This study aimed to determine the association of IL28B gene polymorphisms and other host and viral factors with treatment response in patients with HCV genotype 1 and 3 infection. Materials and Methods: DNA from 42 HCV‑infected patients on antiviral therapy was analysed for the IL28B polymorphisms using polymerase chain reaction‑restriction fragment length polymorphism (PCR‑RFLP). Bidirectional sequencing was performed on a subset of samples for verification of PCR‑RFLP results. Information on age, weight, height, diabetic status, pre‑treatment viral load and alanine aminotransferase (ALT) levels was obtained from clinical records. The IL28B genotypes and the other factors were analysed for their association with SVR. Results: The frequency distribution of rs12979860 CC/CT/TT genotypes was found to be 66.7%, 26.2% and 7.1%, respectively. For rs8099917 genotype, the TT/GT/GG distribution was 73.8%, 21.4% and 4.8%, respectively. SVR was seen in 61.9% of cases (55.6% in genotype 1 and 62.5% in genotype 3). CC genotype at rs12979860 and TT genotype at rs8099917 were significantly higher in responders (P = 0.013 and 0.042, respectively). Lower baseline ALT and rapid viral response were also found to be associated with SVR. On logistic regression analysis, CC genotype at rs12979860 emerged as the most powerful predictor of treatment response. Conclusion: IL28B polymorphisms are strong predictors of SVR in patients from the Indian subcontinent infected with HCV genotype 3 and genotype 1.

Correlation of 2D-Echocardiography Findings in Young Patients of Myocardial Infarction with Prevalence of Risk Factors

Background: The prevalence of Coronary Artery Disease (CAD) has progressively increased in India during the later half of the last century. Projection based on the Global Burden of Disease Study estimate that by the year 2020, the burden of atheroembolic cardiovascular disease in India would surpass that in any other region in the world. Objectives: To Correlation Of 2D-Echocardiography Findings In Young Patients Of Myocardial Infarction With Prevalence Of Risk Factors in Ghaziabad, Uttar Pradesh area, From May 2010 to April 2011. Materials and methods: 50 patients of aged 18 – 45 yrs with acute myocardial infarction were evaluated on the basis of age, sex, socioeconomic status, family history of coronary artery disease, smoking, obesity, history of hypertension, diabetes, dyslipidemia, ECG and Ejection Fraction on 2DECHO. Results: Mean age of study group was 36.2. Male were more affected than female. Prevalence of family history of coronary heart disease was 35%. 55% of patients were smokers. 20% of patients were obese. 75% patients had dyslipidemia. 25% had history of hypertension and 20% were diabetic. Goel A, Goel D, Yadav Y, Gupta SK. Correlation of 2D-Echocardiography Findings in Young Patients of Myocardial Infarction with Prevalence of Risk Factors. IAIM, 2016; 3(10): 221-227. Page 222 64% of patients in present study had anterior wall MI. Left Ventricle End Diastolic Diameter (LVEDD) mean 49.84 mm. Left Ventricle End Systolic Volume (LVESD), mean was 38.36 mm. Interventricular Septum thickness (IVS) mean was 9.86 mm. 56% had moderate LV dysfunction. MR mostly present in EF less than 40%. 12% cases had presence of pericardial effusion. 66.66% smokers have MR on 2D-Echocardiography. Conclusion: The Incidence of Myocardial Infarction is rising in young individuals owing to change in lifestyle pattern, eating habits, more stress and workload. Incidence remained highest in Males as compared to females. Highly associated risk factor in young myocardial infarction patients are dyslipidemia and smoking. Other traditional risk factors associated with myocardial infarction like diabetes, hypertension, obesity are also very much correlated and their incidence is also seems to be increasing. The role of 2D-Echocardiography in establishing the diagnosis, location, and extent of MI, in diagnosing mechanical complications of infarction, and in providing prognostic information that is important for risk stratification.

Development & validation of a quantitative anti-protective antigen IgG enzyme linked immunosorbent assay for serodiagnosis of cutaneous anthrax.

Background & objectives: Anthrax caused by Bacillus anthracis is primarily a disease of herbivorous animals, although several mammals are vulnerable to it. ELISA is the most widely accepted serodiagnostic assay for large scale surveillance of cutaneous anthrax. The aims of this study were to develop and evaluate a quantitative ELISA for determination of IgG antibodies against B. anthracis protective antigen (PA) in human cutaneous anthrax cases. Methods: Quantitative ELISA was developed using the recombinant PA for coating and standard reference serum AVR801 for quantification. A total of 116 human test and control serum samples were used in the study. The assay was evaluated for its precision, accuracy and linearity. Results: The minimum detection limit and lower limit of quantification of the assay for anti-PA IgG were 3.2 and 4 μg/ml, respectively. The serum samples collected from the anthrax infected patients were found to have anti-PA IgG concentrations of 5.2 to 166.3 μg/ml. The intra-assay precision per cent CV within an assay and within an operator ranged from 0.99 to 7.4 per cent and 1.7 to 3.9 per cent, respectively. The accuracy of the assay was high with a per cent error of 6.5 - 24.1 per cent. The described assay was found to be linear between the range of 4 to 80 ng/ml (R2=0.9982; slope=0.9186; intercept = 0.1108). Interpretation & conclusions: The results suggested that the developed assay could be a useful tool for quantification of anti-PA IgG response in human after anthrax infection or vaccination.

Incidence and sero epidemiology of brucellosis from a tertiary care centre of rural Maharashtra.

Background: It is usually difficult to diagnose brucellosis clinically in the absence of specific clinical features. Hence serological testing forms the mainstay of diagnosing the disease. Seroepidemiological determinants of brucellosis in rural western Maharashtra have not been closely investigated. Aim: The present study was therefore conducted to determine the incidence and to analyze seroepidemiological determinants of Brucellosis in cases of pyrexia of unknown origin (POU) in rural western Maharashtra. Material and methods: The present hospital based cross sectional survey was carried out in Rural Medical College, Loni on 500 cases of PUO. SPSS version 20.0 was used for analysis. The serum samples were subjected to serological tests like Rose Bengal Plate Test (RBPT) and Standard Tube Agglutination Test (STAT). The inoculated agar plates were watched daily for the presence of growth Brucella on culture. Results: Males (51.6%) outnumbered females (48.4%) in the study sample. Out of 500 cases 10 samples showed the presence of Brucella agglutinins. The male female ratio in the seropositive cases was 2.33:1. Headache and joint pain was observed in 5 and 3 cases respectively. 50% samples yielded the growth of Brucella on culture. All the culture positive samples had titer of 640 IU or more. Conclusion: Agglutination test if properly performed can be used as a very dependable laboratory procedure for rapid diagnosis of Brucellosis.

Seminogram in male partners of Infertile Couples.

Background: Infertility is defined as failure to conceive within one or more years of regular unprotected coitus. The infertility state is dependent on the female factor as well as masculine factor; an altered masculine factor is designated when any cause or causes of infertility reside in the male. The masculine factor as a cause of infertility is present in 40-50% of cases hence the importance of an integral evaluation of the male alterations and its fertility. Objectives: The present study aims to assess the seminal patterns of male partners of 100 infertile couples for various parameters and their possible contribution to infertility. Material and Methods: The present study was conducted on male partners of 100 infertile couples who were referred by Gynecology and Obstetric department to Pathology Department, Government Medical College, Patiala for semen examination. The semen was collected by masturbation in all cases in a clean dry detergent free container. After liquefaction and mixing, basic analysis was done which includes volume, viscosity, pH, spermatozoal concentration, motility and morphology. Data was evaluated by means of chi-square test. Results: Of 100 seminogram, 43% showed alterations in the seminal indexes; with asthenospermia in 39.5%, Oligoasthenospermia in 30.2%, Oligospermia in 16.2%, and Azoospermia in 13.9%. Conclusion: Male factors were mostly responsible as a cause of infertility. Asthenospermia was the most common type of semen defect present in these infertile males. Most of the males with semen defect were of age group >30yrs. Incidence of semen defect among males increased with duration of infertility.

Study of lower lip proportions in north Indian adults.

Background: Anthropometry, the science of measurement of living subjects has been shown to be useful in reconstructive surgery and in orthodontics, where the soft tissue morphology of the face can be studied more reliably as compared to radiographs. Objectives: The purpose of the study was to create base data of the vertical measurements of the lower lips and proportion of lower lip parameters. Material and methods: The study comprises of lower lip proportion of 600 North Indian adults (300 males and 300 females). Prior informed written consent for this study was obtained from the subjects. The exclusion and inclusion criteria for the subjects were predefined. The measurements were statistically analyzed by using ‘t test’ by SPSS version 15. Results: The lower lip parameters showed sex dimorphism. The height of cutaneous lower lip, height of vermilion lower lip and total lower lip height was significantly (p<0.001) more in males. Two Lip indices was calculated. The lip index 2 was significantly more in males. Conclusion: In case of lower lip, less than half of total lower lip height was occupied by cutaneous portion of lower lip and rest was covered by vermilion portion of lower lip. This study highlights the applied significance of observations of present study to forensic namely personal identification, racial and sex dimorphic criteria of identification.

Nasal spirometery.

Nasal obstruction is a common symptom which is difficult to quantify clinically. Rhinomanometry, Acoustic Rhinometry and Forced Oscillation methods are available for estimating nasal resistance but, these require sophisticated machines. Because of limited availability of these techniques, this potential physiological measure has not been tapped fully for research and clinical purposes. Here, we describe the use of pulmonary spirometer with little modification for quantification of nasal flow. Nasal inspiratory and expiratory flow rates along with oral inspiratory and expiratory flow rates are used to derive different nasal resistance indices. This way of reporting nasal resistance is not new but, the data for these variables is currently not available in published literature. The reproducibility of nasal flow rates were tested as variation after one day and the interclass coefficient for inspiratory and expiratory nasal flow rates were found to be with in acceptable limits. Thus, nasal spirometery is able to describe the nasal resistance in a reliable manner and may be used to quantify nasal obstruction in pathological condition and also to study the physiological phenomenon like nasal cycle.

Circadian rhythm of peak expiratory flow rate in healthy north Indian men.

Peak expiratory flow rate (PEFR) variability follows a specific pattern in asthmatics as well as in healthy individuals. There is scarcity of data for Indian healthy subjects. The PEFR (L/min.) was measured with Wright's portable peak flow meter at 05:00, 8:00, 11:00, 14:00, 17:00, 20:00 and 23:00 hours in 42 healthy, non-smoking adults of age group between 18-26 years. The variability of PEFR revealed a circadian pattern. PEFR levels tend to increase from morning at 5:00 hours till evening at 17:00 hours, with peak PEFR in evening at 17:00 hours, after which there was a progressive fall in PEFR levels, till morning 5:00 hours. This study provides the preliminary reference data of circadian pattern of PEFR in healthy individuals.

Pituitary tuberculosis.

Tuberculous involvement of pituitary is extremely rare and is usually not suspected while dealing with pituitary adenomas, even in patients with history of systemic tuberculosis. We report a case of pituitary tuberculoma in a patient who was undergoing treatment for prostatic tuberculosis. Although diagnosis of sellar tuberculomas is difficult on clinical and radiological examinations, pituitary tuberculomas should be considered in the differential diagnosis of suprasellar masses, especially in developing countries as the condition is potentially curable with antituberculous treatment.