Analysis Of Design Of Online Animations In Biochemistry Using A Framework Based On Multimedia Learning Principles

Background:MBBS 1styear students access online animations in Biochemistry whichin turn helps them understand the rationale behinddiagnosis and management of diseases. However,there is a paucity of studies that have analysed online animations in Biochemistry based on Mayer’s Multimedia learning principles.Our objective was to analysethe design of freeonline animations in Biochemistry using a framework based on Multimedia Learning Principlesthat reduceextraneous processing.Material And Methods:In this cross-sectional study, design of 102 online Biochemistry animations was analysed using a framework based on Multimedia learning principlesthat reduce extraneous processing, and Focus Index (FI) score was calculated.Result:41.2 % of the animations had a FI score of less than 5, suggesting that these animations do not comply with all Multimedia learning principles.Animations violated individual principles in the range of 11 -17%. Conclusion:Significant proportion (41.2%) of online Biochemistry animationsdo not comply with all the Multimedia learning principles, suggesting that users of these animations may be distracted by extraneous content in the animationsleading to poor learning outcomes. Multimedia learning principles should be incor porated while designing animationsto enhance theirpotential as learning aids for MBBS students.

A cross sectional study on stress among doctors, working in college of medicine and Sagore Dutta Hospital, Kamarhati, India

Background: The word “stress” was defined by different scholars. The word was first defined by Hans Selye in 1936 as “a nonspecific response of the body to any demand of change”. The modern medical workplace is a complex environment, and doctors respond differently to it, some finding it stimulating and exciting, whereas others become stressed and burned. The medical workplace also provides an environment where new skills are continually being learned, both as a result of medical knowledge evolving and because a doctor's work changes. Objective of the present study was to find out the level of stress among the doctors working in CMSDH and to find out the possible sources of stress from their perspective.Methods: The study was an institution-based cross-sectional study conducted from 26th October 2017 to 22nd November 2017 among the enlisted 257 working doctors of CMSDH present during the period of data collection. It was intended to include all the doctors working in this college for this study.Results: A total of 257 doctors including faculty132 (51.4%), interns 80 (31.1%) and house staffs 45 (17.5%) consented and participated in the study of whom 172 (67.0%) were male and 85 (33.0%) female. Interns are the most stressed ones mean 20.4, SD±5.2, followed by house staff mean 17.5, SD±5.1 and faculty mean 16.9, SD±5.3. Unmarried faculty members mean 19.2, SD±5.2 are slightly more stressed than married mean 17.0, SD±5.3. Preclinical faculty has more stress, mean 17.1 ±SD5.2, where the clinical intern has maximum level of stress, mean 20.4 ±SD5.2.Conclusions: Doctors who are in massive stress need counseling and regular psychotherapy to reduce their stress level. A system of monitoring information and communication between administrative and working doctors should be evolved regularly.

Awareness regarding self care among diabetics in urban slum of Kolkata: a community-based, cross-sectional study

Background: Diabetes mellitus is a disease associated with significant morbidity and mortality. Patients with diabetes have higher rates of coronary artery disease, peripheral vascular disease, retinopathy, neuropathy and nephropathy. Many of these complications can be prevented with appropriate medical care that often requires significant alterations in lifestyle and strict adherence to self-care tasks to obtain good control of disease. Awareness regarding the complications of this disease will play a vital role in its prevention and control. While lack of adherence to the treatment and self-care leads to poor glycemic control, thereby, increasing hazardous complications. Objective of the study was the present study was conducted to assess the knowledge of diabetic patients regarding the disease and its complications, and to estimate the knowledge and adherence to self-care practices concerned with Type 2 diabetes mellitus.Methods: The study was conducted in Tangra an urban slum of Kolkata from July 2018 to December 2018. A house to house survey was conducted to identify the known diabetics in the community and data of 362 patients were collected.Results: A total of 362 diabetic patients consented and participated in the study of whom 191(52.76%) were male and 171(42.74%) female. Majority of the respondents (26.52%) between the age of 50-59 years, 140(38.67%) belonged to upper middle class. Though 332(91.71%) respondents were aware regarding diet control but only 170(46.96%) were actually practicing the recommended diet schedules. Knowledge of the respondents regarding eye, foot, skin and dental care was very low, only 67(18.51%), 102(28.28%), 62(17.13%) and 46(12.71%) respondents were aware respectively and practices were still lower.Conclusions: Overall the level of self-care activities among diabetic patients in our study was quite low. Government policies should help in creating guidelines on comprehensive diabetes management within the primary health care setting including availability of medicines and diagnostic services and creating public awareness.

A study on evaluation of ASHAs for their knowledge, attitude and practice towards newborn care in Howrah district of West Bengal

Background: : Accredited Social Health Activist (ASHA) is a trained female community health activist. ASHAs are local women trained to act as facilitator and promoters of health care in their communities. ASHA is trained to work as an interface between the community and the public health system. ASHA play an important role in newborn care to reduce their morbidity and mortality.Methods: Data were collected from ASHAs working in Shibbur area of Howrah District, west Bengal. The study sample consisted of 70 ASHAs working in the Shibpur area that fulfilled the inclusion criteria. A predesigned pretested questionnaire of ASHA was used to collect data in the study.Results: The mean age of ASHAs was 35.74 years. Only 32 (45.71%) had received middle level (class VIII) education. Only 45.71 % of ASHAs had good knowledge and practice regarding hypothermia and its complication and the procedure of providing warmth the baby after delivery. Only 57.1% of ASHA had good knowledge regarding counseling and problem solving on breast feeding. Only 38.57% had good knowledge and practices on identification and basic skill on management of Low Birth Weight (LBW) having birth weight of <2.5kg and pre-term baby (<37 weeks of gestation).Conclusions: In the present study, we found that Knowledge, Attitude and Practice of ASHAs were inadequate in some aspects of newborn care. This gap of knowledge should be taken seriously during training procedures so that effective knowledge and essential skill for newborn care can be imparted. During recruitment of ASHAs higher literally status should be given preferences.

A prospective study of gestational trophoblastic disease profile with special reference to mortality and pregnancy outcome after successful management of the same

Background: Gestational trophoblastic disease (GTD) is a group of rare tumors that involve abnormal growth of cells inside a woman's uterus. GTD does not develop from cells of the uterus like cervical cancer or endometrial (uterine lining) cancer do. Instead, these tumors start in the cells that would normally develop into the placenta during pregnancy. GTD is unique because the maternal lesions arise from the fetal tissue as a molar pregnancy. All forms of GTD can be treated. In most cases the treatment produces a complete cure. The study was conducted to assess the various presenting features of GTD and factors associated with it.Methods: It was an observational hospital based prospective epidemiological study. Complete enumeration technique was followed and a total of 305 female patients were included in the sample. A pre-designed and pre-tested interview schedule was used to record different information and detailed history.Results: Of the 305 patients studied, 67.2% were diagnosed with H. mole, 23% patients were diagnosed with gestational trophoblastic tumor, among them 4.9% had choriocarcinoma. Majority were primigravida and of blood group O type. Pregnancy outcome after successful management of GTD were 63.3% had full term pregnancy, 20% cases had repeat molar pregnancy, 10% had spontaneous abortion while 6.7% (2/30) had pre term delivery.Conclusions: Gestational trophoblastic disease is seen most commonly in reproductive age group. If it is not diagnosed on time it can be fatal. This is a highly curable tumor even in the presence of distant metastasis.

Estimation of prevalence of risk factors for coronary artery disease in a rural population in Howrah, West Bengal

Background: Coronary artery disease (CAD) is a major cause of death globally in both developed and developing countries. Coronary artery disease which was once thought to be a disease of the urban population is now involving the rural community in an increased number. So a study of major coronary risk factors in rural communities will help to adopt various strategies particularly behavior change and communication relevant for these communities to prevent these risk factors and lower CAD related mortality and morbidity. Objective was to estimate rates of the various risk factors for CAD and identify the high-risk groups in the rural community.Methods: A community based cross sectional study was carried out in a rural area in the Howrah district of West Bengal. Four hundred and eighteen (418) persons (212 males and 206 females) were subjected to study using structured, pretested and predesigned schedule. Coronary artery disease risk factors were assessed. Statistical analysis was done with the help of statistical software, the SPSS 20.0 for windows.Results: The study observed that prevalence of tobacco use among the study population was the most significant risk factor (42.3%). The prevalence of other coronary risk factors ranged from 10-20%. Tobacco use, alcohol consumption and sedentary life style were significantly more amongst males. Whereas truncal obesity and systolic hypertension more among females.Conclusions: Various comprehensive strategies particularly behavior change and communication targeting these high risk population need to be emphasized to lower CAD related morbidity burden in the community.

Stability Indicating Method for the Determination of Mefenamic Acid in Pharmaceutical Formulations by HPLC.

A simple, RP-HPLC stability indicating method was developed for determination of mefenamic acid in pharmaceutical formulations and its degradation products using C8 column with the mobile phase containing mixture of Buffer : Acetonitrile + THF in the ratio of 55:45 v/v at a flow rate of 1.0 ml/min was found to yield satisfactory retention time of about 18.253 min with sharp symmetrical peak at a detection wavelength of 285 nm. The method was validated using ICH guidelines and was found to be linear in the range 0.5-2 μg/ mL. The proposed method shows good separation of mefenamic acid and its degradation products. The developed method can be applied successfully for the determination of mefenamic acid and its degraded products.

Microarchitecture of the Palatine Tonsil in Sheep (Ovis aries) / Microarquitectura de la Tonsila Palatina en Oveja (Ovis aries)

The tissue pieces of palatine tonsil were collected from different postnatal age groups of sheep from the Corporation Slaughter House, Perambur, Chennai. The palatine tonsil consisted of a surface epithelium, capsule, tonsillar lobes, crypts, crypt epithelium and tonsillar follicles. The surface epithelium over the palatine tonsil was made up of non-keratinized stratified squamous epithelium in all the postnatal age groups studied. The palatine tonsil was clearly demarcated from the surrounding structures by a distinct connective tissue capsule and one septa dividing the tonsil into two lobes. The surface epithelium was invaginated into the substance of the tonsil to form primary and secondary crypts in each lobe. The crypt epithelium covered the regions of lymphoid follicles became lymphoepithelium. The macrophages were also observed in the epithelium. In the areas of lymphoepithelium the basement membrane was interrupted since lymphocytic infiltration was heavy into the epithelium. Numerous secondary tonsillar follicles with germinal centers separated by interfollicular areas were observed in the palatine tonsil. The tonsillar follicles consisted of a mantle zone, which was heavily populated with small darkly stained lymphocytes. These mantle zones were always oriented towards the crypts. The tonsillar follicles of young sheep showed many medium and small sized lymphocytes, lymphoblasts and also reticulocytes. The reticular cells usually appeared larger than lymphocytes and had a more abundant and organized cytoplasm with vacuoles.

Fueron recolectadas piezas de tejido desde la tonsila palatina de ovejas con diferentes edades postnatales, desde la Corporación Slaughter House, Perambur, Chennai. La tonsila palatina consistía en un epitelio de superficie, cápsula, lóbulos de las tonsilas, criptas, epitelio de las criptas tonsilares y folículos. El epitelio superficial sobre la tonsila palatina estaba compuesto, en todos los grupos estudiados, de epitelio escamoso estratificado no-queratinizado. La tonsila palatina se delimitó claramente de las estructuras circundantes por un tejido conectivo capsular y un septo dividiendo la tonsila en dos lóbulos. El epitelio superficial se invaginó dentro de de la tonsila para formar criptas primarias y secundarias en cada lóbulo. El epitelio de las criptas cubrió las regiones de folículos linfoides transfomándose en linfoepitelo. También se observaron macrófagos en el epitelio. En las áreas de linfoepitelo la membrana basal estaba interrumpida por la infiltración linfocitaria y fue mayor en el epitelio. Fueron observados numerosos folículos tonsilares secundarios con centros germinales separados por áreas interfoliculares. Los folículos tonsilares consistían en una zona del manto que estaba densamente poblada con pequeños linfocitos intensamente teñidos. Estas zonas del manto se orientaron siempre hacia las criptas. Los folículos tonsilares de las ovejas jóvenes mostraron muchos linfocitos de tamaño medianos y pequeños, linfoblastos y también reticulocitos. Las células reticulares usualmente aparecían más grandes que los linfocitos y tenían un citoplasma más abundante y organizado con vacuolas.

Protective effect of α-tocopheral on biochemical and histological alterations induced by cadmium in rat testes.

Cadmium (Cd) is a potential environmental pollutant and causes severe damage to reproductive organs in adults including ovary and testes. Of all antioxidants α-tocopheral is considered to be most potent chain breaking antioxidant. Our aim was to study the effect of α-tocopheral on biochemical and histological alterations induced by Cd in testes of rats. Group 1 served as control, while groups 2 and 3 received subcutaneous injections of CdCl2 (3 mg/kg b.wt) once a week for four weeks. Group 3 in addition received α-tocopheral (75 mg/kg b.wt.) orally, daily for six weeks. Cadmium caused testicular tissue biochemical alterations such as significant increase in MDA, a peroxidation marker, decrease in antioxidant markers viz SOD, CAT and GSH and functional markers viz ALP and LDH. Histological alteration induced by Cd consisted of desquamation of basal lamina, shrunken tubules, generalized germ cell depletion with multinucleated gaint cells, degenerating Leydig cells, vascular congestion, interstitial edema and significant reduction in spermatodynamic count. α- tocopheral significantly reversed all the Cd induced alterations. These results indicate that α-tocopheral has a protective effect against Cd indced biochemical and histological alterations in rat testes.

Sarcoidosis--three clinical vignettes with a short review.

Sarcoidosis is a multi system disorder of unknown cause most commonly affecting the young and middle age adults and frequently presents bilateral hilar lymph-adenopathy. The diagnosis of sarcoidosis is often delayed following the onset of symptoms. The reason being first, the disease is often sub clinical; second as the disease affects any system, the diagnosis of sarcoidosis may not be considered; third, the symptoms are not disease specific hence often treated as other chronic pulmonary diseases; finally economic issues or barriers to access for further workup may affect the timeliness of the diagnosis. No laboratory diagnosis is specific for diagnosing sarcoidosis but histological confirmation from the lymph nodes accessible for biopsy either direct or by intervention may be more specific.

Why treat? Better prevent: adult immunization.

Immunization is a safe, effective and simple way to prevent life threatening illnesses not only in children but also in adults. Vaccines are some of the safest medicines available which can relieve suffering costs related to these preventable diseases. The reason for underutilization of vaccines in adults are 1) Low prioritization of the importance of vaccines preventable diseases among adults 2) Uncertainty or lack of knowledge about the safety and efficacy 3) Lack of universal recommendations for all adults and 4) Financial constraints, especially in developing countries. Adult immunizations are administered in primary series like previously immunized, booster doses and periodic doses. Agents include Toxoids (Diphtheria and Tetanus), Live Virus Vaccines (Measles, Mumps and Rubella), and inactivated virus vaccines (Influenza), Inactive viral particles (Hepatitis B), inactivated bacterial polysaccharide vaccine (Pneumococcal) and Conjugate / Polysaccharide vaccine (Meningococcal). And also vaccines like Hepatitis A, Polio and Varicella may be recommended in some. Since the economy and literacy rate has shown a steady rise in the South Asia and people are being aware of different health problems through the recently advanced global communication, the education and awareness for immunization not only in children but also in adults need a special consideration. Keeping in view the statistical data of suffering costs related to the non-utilization of immunization in adults, the need of hour has come for utilization of immunization to emphasize its importance.

Diagnostic delay in a multi-organ tuberculosis immunocompetent patient: a case report.

A 67-year-old immunocompetent male presented with intermittent fever for 3 months associated with urinary incontinence, altered bowel habits and history of loss of appetite and weight. He was treated as having enteric fever at various clinics in the city by different physicians. On evaluation the patient was found to have disseminated tuberculosis with involvement of the lungs, eyes, testes, brain, bone, kidneys, liver, spleen and possibly the gastrointestinal tract. This paper reports a case of disseminated tuberculosis to many organs with significant diagnostic delay more than twelve decades after the discovery of the tuberculosis bacillus by Robert Koch.

Drug induced hepatitis with anti-tubercular chemotherapy: challenges and difficulties in treatment.

Tuberculosis is a major health burden worldwide. In Nepal, it is a significant cause of morbidity and mortality. Although better drugs are available for managing tuberculosis, treatment failure is one of the common problems encountered. Among the various causes which can cause treatment interruption, drug induced hepatotoxicity is a common cause. Isoniazid and Pyrazinamide are the common drugs causing hepatotoxicity. Upon occurrence of hepatotoxicity, the hepatotoxic drugs should be stopped and reintroduced as per the available guidelines. The healthcare professional should also counsel the patients for recognizing the early symptoms due to hepatotoxicity which could prevent morbidity.

Interaction between warfarin and tamoxifen: a case report.

Warfarin is a commonly used anticoagulant with documented reports of drug interactions. Tamoxifen is used in the adjuvant hormonal treatment of women with oestrogen-receptor- positive breast cancer. Warfarin and tamoxifen are known to interact with each other with a resultant increase in the bleeding tendency. These reports are mainly from the white population. We report a case of drug interaction between warfarin and tamoxifen with an acute onset. This report suggests that when these drugs are co administered, careful monitoring of the coagulation profile is needed.

Characterization of beta-thalassaemia mutations in 57 beta-thalassaemia families seen at Lucknow.

As an initial step towards establishing prenatal diagnostic service for beta-thalassaemia in the state of Uttar Pradesh, we have investigated the prevalence of five common mutations reported from India in 57 families, each with an index patient of thalassaemia major, by amplification refractory mutation system (ARMS). Thirtyone of the 57 families (54.3%) hailed from Uttar Pradesh; 11 (19.3%) from Sindh in Pakistan, 6 (10.5%) from Punjab, 6 (10.5%) from North-West Pakistan and one each (1.8%) from Bengal, Madhya Pradesh and Bihar. In the 31 families from Uttar Pradesh, 29 were of beta-thalassaemia and 2 of HbE/beta-thalassaemia. IVS-1 nt 5 (G-C) mutation was the most common mutation in families native to Uttar Pradesh. This mutation was identified in 60 per cent (33 out of 55) of the obligate heterozygotes. Amongst the 43 obligate heterozygote carriers originating from Western India, the prevalence of IVS-1 nt 5 (G-C) mutation was 46.5 per cent; 619 bp deletion 23.3 per cent; Co 8/9 (+G) mutation 11.6 per cent and Co 41/42 (-CTTT) mutation 4.6 per cent. In 23.6 per cent of carriers from Uttar Pradesh and 7.0 per cent of carriers from Western India, none of the 5 mutations tested were detected. IVS-1 nt 1 (G-T) mutation was found in one family native to Sindh.

Action of DL-alpha-difluoromethyl ornithine on Acanthamoeba culbertsoni.

The multiplication of A. culbertsoni in the peptone medium was not inhibited by 10-20 mM concentration of alpha-difluoromethyl ornithine (DMFO) while a partial and transient inhibition of cell multiplication was observed by 10-20 mM DFMO in proteose peptone, yeast extract, glucose (PYG) medium. Ornithine decarboxylase (ODC) activity in the cells and cell free extracts was strongly inhibited by DFMO, excluding enzyme refractoriness and impermeability of cells for DFMO as the possible causes of DFMO resistance. The presence of polyamines in the peptone and PYG media as well as uptake of polyamines by the amoebae has been demonstrated. The growth and multiplication of A. culbertsoni in chemically defined medium was not affected by 1-5 mM DFMO while 10-20 mM DMFO yielded partial inhibition. A lowering of diaminopropane levels and enhancement of spermidine levels was observed in DFMO inhibited cells and level of ODC was drastically reduced in the inhibited cultures. Uptake of polyamines from the growth media may partly account for DFMO resistance of A. culbertsoni. Alternative mechanisms for DFMO resistance are indicated.

Action of methylglyoxal bis (guanyl hydrazone) and related antiprotozoals on Acanthamoeba culbertsoni.

Methylglyoxal bis(guanyl hydrazone) (MGBG) and the related diamidine compounds berenil and pentamidine inhibited multiplication of A. culbertsoni. The growth inhibition by MGBG (2.5 mM) in the peptone medium was accompanied by the disappearance of spermidine and a marked reduction in the level of diaminopropane. MGBG and berenil completely inhibited growth in a chemically defined medium at 1 mM and 1-2 microM concentration, respectively. However, there was no decrease in the polyamine levels in the early stages of growth inhibition by these agents. Uptake of putrescine, spermidine and spermine by A. culbertsoni has been demonstrated but addition of exogenous polyamines did not reverse the growth inhibitory action of MGBG and berenil. Inhibition of S-adenosylmethionine decarboxylase and decrease in polyamine synthesis do not seem to be the primary targets for the antiamoebic action of MGBG and berenil.