Perception of the medical faculty for online teaching and assessment in coronavirus disease 2019

Background: Online teaching assessment was the only available choice for faculties and students during coronavirus disease 2019 (COVID-19) pandemic to continue medical education. Because of this sudden transition, there were many challenges faced by both faculties and students. Aim and Objectives: To determine perception of faculty and to evaluate the feasibility of online teaching-assessment in medical education. Materials and Methods: An observational cross-sectional study was conducted after obtaining institutional ethical approval, using pre-designed and semi-structured questionnaire administered through Google form to 101 participants who gave consent for participation. A 5-point Likert scale was used for collecting responses regarding perception and attitude. Responses were collected, tabulated and analyzed statistically in Microsoft excel by calculating percentages, mean score, and standard deviation. Chi-square test was used to analyze qualitative data. Results: Out of 101 participants, 46% wanted to restrict online teaching to the COVID era only.71% thought that they required more training, better infrastructure, and technical resources for effective online learning and assessment. 84% agreed that online teaching has a limited role in learning of practical skills which is a very important aspect of medical studies. Conclusion: Perception of faculties about online teaching-assessment is that it should be restricted to COVID era only or as a supplement with better infrastructure and training for effective learning and to enhance self-directed-learning in medical students along with routine off-line teaching-assessment.

Perception of medical students for online learning and assessment during the COVID era

Background: Online learning became a popular mode of education in the recent Corona Virus Disease-2019 (COVID-19) pandemic. For medical field in India, online mode of learning and assessment is novel. Aims and Objectives: This study aims at determining the attitude of students, identifying unacknowledged problems and their possible solutions associated with online learning, and to explore the future scope of online learning and assessment for medical education in India. Materials and Methods: The study population consisted of 199 medical students who had taken continuous six months of online learning and assessment in the 2020 COVID-19 pandemic period over varzious platforms such as Google Classroom, Zoom Meet, Cisco Webex etc. A questionnaire was made on Google form and distributed through online platforms, and students’ responses with informed consent were collected and analyzed. Responses were in form of Likert scale that ranged from “Strongly agree” to “Strongly disagree.” Results: About 41.4% of participants agreed that online learning and assessments save time and resources. About 78.3% of students agreed that technical errors make it difficult to continue online classes. About 78.3% of students agree that responsibility of learning is on students. About 77.7% of students agreed that academic integrity and honesty are vital in online assessment. Conclusion: If online classes can be improved by solving technical errors, better infrastructure, and faculty training, it may be continued as a supplement to classroom education for lectures, but not for practicals.

Need of the hour: pharmacovigilance study of SGLT-2 inhibitors

Background: Diabetes mellitus represents a global pandemic. Various pharmacotherapy and non-pharmacotherapy measures are advocated for its control. The latest in the pharmacotherapy are Sodium Glucose Transporter -2 (SGLT-2) inhibitors, widely used. Many studies suggest adverse effects related to SGLT-2 inhibitors, evidence still not conclusive and few data from India. Hence this study was planned.Methods: Cross-sectional study over a period of 02 months, recorded demographic details and history of various adverse drug reactions reported with the use of SGLT-2 inhibitors.Results: Majority of the study participants were females (58%) and belonged to the age group of 40-70 yrs. Urinary tract infections (UTI) and genital infections was more seen in the users of dapagliflozin, followed by empagliflozin and canagliflozin.Conclusions: SGLT-2 Inhibitors offer a unique therapeutic approach to the management of Diabetes Mellitus. Further evaluation of the safety profile and the risk-benefit analysis is the need of the hour.

An analysis of adherence to the World Health Organisation guidelines pertaining to drug promotional literature by pharmaceutical firms

Background: Pharmaceutical companies used Drug Promotion Literatures (DPLs) as a major tool to advertise their new products. World Health Organization (WHO) has set some guidelines for promotion of drug literature. Thus, this study aimed to evaluate various DPLs for their accuracy and credibility as per WHO ethical criteria.Methods: This was an observational and cross-sectional study. Total 100 drugs advertisements published in various medical journals were collected from the library of the college. Advertisements were selected based on inclusion and exclusion criteria. The selected advertisements were evaluated based on the WHO ethical criteria for drug promotion.Results: From 100 advertisements, 73 were single drug whereas 27 were fixed drug combinations. Antimicrobials (16%) were the most promoted advertisements. Only 28% of the advertisements carried references to support their claim. Out of which majority (91.78%) were from journal articles. The generic name, brand name, names of active ingredients, manufacturer, distributor and dosage regimen were mentioned in majority of advertisements. Drug interactions (12%), contraindications (22%), precautions (24%) and side effects (22%) were least mentioned in the advertisements.Conclusions: It was observed that none of the advertisement followed all the guidelines laid down by WHO. Pharmaceutical companies should follow ethical regulatory measures to promote their product in various journals. The regulatory authority must ensure the pharmaceutical companies to follow ethical guidelines for publishing various drug promotional literatures.

Ovarian fibroma with luteinized thecal cells and minor sex cord element: A rare case report

Ovarian fibroma with minor sex cord element (MSCE) is a rare tumor. The increased estrogen production due to the presence of MSCE and/or luteinized thecal cells within fibroma can be a risk factor for endometrial hyperplasia or carcinoma.

Unusual presentation of a case of intra cystic papillary carcinoma of breast

The term “intra cystic papillary ductal carcinoma in situ”, has recently changed and is now more appropriately referred to as “intra cystic papillary carcinoma’’ constituting only 0.5% to 1% of all breast cancers. Herein, we discuss an unusual case of intra cystic in situ papillary carcinoma of breast in a postmenopausal woman, the diagnosis of which was made on histopathology. So careful histopathological evaluation is the mainstay to arrive at the correct diagnosis to avoid untoward complications related to under diagnosis and/ over diagnosis.

Sarcomatoid Renal Cell Carcinoma: A Rare Case Report

Sarcomatoid renal cell carcinoma (SRCC) is an aggressive variant of renal cell carcinoma. It is thought to originate predominantly from clear cell carcinoma through de-differentiation. It is a rare entity constituting about 1-5% of all renal malignant neoplasms and is more commonly associated with conventional (clear cell) renal cell carcinomas. We report a case of 62 years old male who presented with complaints of haematuria and abdominal pain. The histopathology confirmed sarcomatoid renal cell carcinoma.

A Rare Case of an Adult with Untreated Bladder Exstrophy Presenting with Adenocarcinoma of Urinary Bladder.

Untreated bladder exstrophy in an adult is rare, as the defect is obvious and primary reconstruction is usually done in infancy. There are less than 90 reported cases of primary adenocarcinoma in an untreated bladder exstrophy in literature and only two such case reports from India. We report the case of adenocarcinoma in a 29 year old male with untreated bladder exstrophy to highlight the extreme rarity, yet distinct possibility and challenges faced in surgical management of such cases.

Uterus Didelphys presenting with ruptured uterus in third pregnancy: A rare case report

Uterus Didelphys “double uterus” is a congenital malformation that results from complete failure of fusion of the ipislateral paramesonephric ducts during embryonic development. Ideally, diagnosis should be made before pregnancy and labor to prevent adverse outcomes. Here we report a case of uterus didelphys in 30 year old female Gravida4 Para3 Living2 at 31st week of pregnancy admitted with prolonged rupture of membrane, hypovolemic shock and intrauterine fetal death. Postoperative recovery of the mother was uneventful. Clinicians should have high index of suspicion of uterine anomaly when assessing cases of dysfunctional labor to avoid delayed diagnosis and the associated adverse outcome

Quality of life and nutritional status in alcohol addicts and patients with chronic liver disease.

OBJECTIVE: The aim of the study was to assess and compare the nutritional status and quality of life in chronic liver disease (alcoholic and non-alcoholic) patients and alcohol addicts. METHODS: Patients with alcoholic liver disease (n=41), nonalcoholic liver disease (n=40), alcohol addicts (n=25) without liver disease and healthy controls (n=25) were randomly selected. Nutritional status was assessed using anthropometric measurements viz. skin fold thickness, arm muscle circumference and area. Biochemical estimations included liver function tests. Food intake was assessed using 48 hour recall and macro-nutrient intake was calculated. Quality of life was assessed using the SF-36 questionnaire. RESULTS: The mean value of mid-arm muscle area was significantly lower in patients from the non-alcoholic liver disease group when compared with the other 2 groups (p= 0.0). Body fat store depletion was significantly lower in the alcohol addict group when set against the alcoholic liver disease and non-alcoholic liver disease groups (p= 0.0). The mean percentages of ideal calories (p= 0.0) and proteins (p= 0.0) were significantly higher in alcohol addicts but no significant differences in the mean percentage of fat intake (p= 0.1) was observed. The frequency of macro-nutrient deficiency was highest in the non-alcoholic liver disease group (p= 0.0). Ethanol consumption was not significantly different between alcohol addicts and patients suffering from alcoholic liver disease (p=0.06). Patients with liver disease (irrespective of aetiology) scored significantly lower on the quality of life scale when compared to alcohol addicts. CONCLUSIONS: Malnutrition is more frequent and severe in patients suffering from chronic liver disease in comparison to alcohol addicts. The health status is significantly poorer in patients suffering from alcoholic liver disease. Alcohol does not seem to play a primary role in the pathogenesis of liver disease and malnutrition.

Achalasia cardia: A study of 113 patients managed with indigenous dilator.

BACKGROUND: Endoscopic dilatation of achalasia cardia is an effective nonsurgical management option. It requires costly pneumatic dilators which are used under fluoroscopic guidance. This study assesses the efficacy and safety of an indigenous pneumatic dilator used without fluoroscopic guidance. METHODS: Over a period of eleven years, 113 patients (69M, 44F) ofachalasia cardia underwent dilatation with indigenous pneumatic dilators without fluoroscopic guidance. The dilatation was performed under endoscopic vision. RESULTS: The procedure was successful in all patients. After six weeks following dilatation, there was significant improvement in the mean dysphagia score 3.63 + 0.61 to 0.53 + 0.93 (P<0.01). The response was still significant (0.78 + 1.03, P <0.05) at the end of one year. Excellent response with single dilatation was seen in 70.7% patients. After two dilatation sessions 92% of patients showed an excellent response. One patient had perforation. There was no mortality. CONCLUSION: Pneumatic dilatation under endoscopic vision without fluoroscopic assistance with the indigenous dilator is very effective and safe for short term treatment of achalasia carida.

Reproductive health awareness of school-going, unmarried, rural adolescents.

OBJECTIVE: In 1996, India included Adolescent Health in Reproductive and Child Heatlh Programme. This Task-Force Study was planned to test the awareness level of adolescents regarding various reproductive health issues and to identify lacunae in knowledge, particularly in legal minimum age of marriage, number of children, male preference, contraceptive practices, about STIs /AIDS etc. METHODS: It was a multicentre study, done in rural co-education/higher secondary schools of 22 districts located in 14 states through Human Reproductive Research Centre (HRRC's) of the Indian Council of Medical Research (ICMR). A sample of 8453 school going adolescents (aged 10-19 years) was surveyed by means of open ended, self-administered questionnaires maintaining confidentiality. RESULTS: Mean age of adolescents was 14.3 +/- 3.4 years. Awareness of legal minimum age of marriage was present in more than half of adolescents. Attitude towards marriage beyond 21 years in boys and 18 years in girls was favorable. Mean number of children desired was 2.2 +/- 1.4. However, number of children desired by boys (2.2+/-1.6) was significantly more (p< 0.000) than those desired by girls (2.0+/-1.1). More boys (23.7%) than girls (9.4%) wanted three or more children with male preference. Only 19.8% of adolescents were aware of at least one method of contraception. Only two-fifth (39.5%) were aware of AIDS and less than one-fifth (18%) were aware of STDs and most of them thought it is same as AIDS. Awareness of at least one method of immunization was present in three-fifth (60.1%) of students. It was least for DPT (13.5%) and most (55%) were aware of polio only. Awareness of all Reproductive Health matters was more in boys than girls and more in late teens (15-19) than earlier teens (10-14). CONCLUSION: The study showed tremendous lacunae in awareness of all Reproductive Health (RH) matters. There is a need for evolving information, education, and communication strategies to focus on raising awareness on RH and gender related issues. A sociocultural research is needed to find the right kind of sexual health services for young girls and boys.

Endoscopic band ligation for non variceal bleed.

Endoscopic band ligation (EBL) is an infrequently used modality for treatment of non-variceal hemorrhage. We report the successful use of this technique for the management of bleed from blue rubber bleb nevus syndrome lesions and post polypectomy bleeding stalk.

Early enteral nutrition after surgical treatment of gut perforations: a prospective randomised study.

BACKGROUND: Withholding enteral feeds after an elective gastrointestinal surgery is based on the hypothesis that this period of "nil by mouth" provides rest to the gut and promotes healing. AIMS: To assess whether early postoperative naso-gastric tube feeding in the form of a balanced diet formula is safe in and beneficial to patients who have undergone surgical intervention for perforation of the gut. SETTING: A surgical unit of a Medical College Hospital. DESIGN AND SUBJECTS: Prospective randomised open control study. METHODS AND MATERIAL: Patients undergoing surgical intervention for peritonitis following perforation of the gut were randomised to the study group receiving feedings of a balanced diet formula through a naso-gastric tube from the second postoperative day, or the control group in which patients were managed with the conventional regimen of intravenous fluid administration. The groups were compared for incidence and duration of complications, biochemical measurements and other characteristics like weight loss/gain. STATISTICAL ANALYSIS: Chi square test and "T" test. RESULTS: One hundred patients were enrolled in each group. 88% subjects in the study group achieved positive nitrogen balance on the eighth postoperative day as compared to none in the conventionally managed group. The relative risks (95% confidence interval) of morbidity from wound infection, wound dehiscence, pneumonia, leakage of anastomoses and septicaemia were 0.66 (0.407-1.091), 0.44 (0.141-1.396), 0.70 (0.431-1.135), 0.54 (0.224-1.293) and 0.66 (0.374-1.503) respectively. Average loss of weight between the first and tenth day was 3.10 kg in the study group as compared to 5.10 kg in the conventionally managed group ("P" value < 0.001, 95% Confidence Interval - 2.46 - 1.54). CONCLUSION: Early enteral nutrition is safe and is associated with beneficial effects such as lower weight loss, early achievement of positive nitrogen balance as compared to the conventional regimen of feeding in operated cases of gut perforation.

Resuscitation of asphyxiated newborns with room air or 100% oxygen at birth: a multicentric clinical trial.

OBJECTIVE: To compare the short-term efficacy of room air versus 100% oxygen for resuscitation of asphyxic newborns at birth. DESIGN: Multicentric quasi randomized controlled trial. SETTING: Teaching hospitals. INCLUSION CRITERIA: Asphyxiated babies weighing greater than 1000 grams, with heart rate less than 100 per min and/or apnea, unresponsive to nasopharyngeal suction and tactile stimuli and having no lethal abnormalities. INTERVENTION: Asphyxiated neonates born on odd dates were given oxygen and those on even dates room air for resuscitation. OUTCOME MEASURES: Primary: Apgar score at 5 minutes; Secondary: Mortality and Hypoxic ischaemic encephalopathy (HIE) during first 7 days of life. RESULTS: A total of 431 asphyxiated babies, 210 in the room air and 221 in 100% oxygen group were enrolled for the study. Both the groups were comparable for maternal, intrapartum and neonatal characteristics. The heart rates in room air and 100% oxygen groups were comparable at 1 minute (94 bpm and 88 bpm), 5 minutes (131 bpm and 131 bpm) and 10 minutes (135 bpm and 136 bpm). Median apgar scores at 5 min [7 versus 7] and 10 minutes [8 versus 8 ], in the room air and oxygen groups respectively, were found to be comparable. Median time to first breath (1.5 versus 1.5 minutes) was similar in the room air and oxygen group. Median time to first cry (2.0 versus 3.0 minutes) and median duration of resuscitation (2.0 versus 3 minutes) were significantly shorter in the room air group. The number of babies with HIE during first seven days of life in the two treatment groups (35.7% babies in room air and 37.1% in the 100% oxygen group) were similar. There was also no statistically significant difference in the overall and asphyxia related mortality in the two treatment groups (12.4% and 10.0% in room air versus 18.1% and 13.6% in oxygen group). CONCLUSION: Room air appears as good as 100% oxygen for resuscitation of asphyxic newborn babies at birth.