Computer assisted learning vs. conventional teaching in experimental Pharmacology: perception of second year medical students

Background: The main pool of pharmacology practical teaching is formed by the use and demonstration of animal experiments. Animals have been used to demonstrate the effect of various drugs in experimental pharmacology classes, in the lab. The practical sessions in pharmacology training involving animal experiments are still taught by traditional teaching methods. Rapid development of information technology has led to newer trends in teaching and learning using Computer Assisted Learning (CAL). Keeping it in mind we decided to undertake this study to assess the perception of CAL in 2nd year MBBS students over conventional teaching in experimental pharmacology.Methods: This was an observational, questionnaire-based study. A total of hundred undergraduate MBBS (2nd year) students participated. Participants were first demonstrated an animal experiment by conventional teaching method followed by the same animal experiment demonstration on CAL. Students� feedback was recorded on a questionnaire and analyzed.Results: The mean age of the participants was 19.88�28 years. The study overall observed that 62% preferred CAL to conventional (38%). Majority of the participants� thought CAL (63%) helps to understand better over conventional (28%) and that CAL (63%) is time independent over conventional (28%). More than 85% felt that CAL was more explanatory and provided a better learning experience.Conclusions: Students preferred CAL to conventional teaching, in experimental pharmacology. It also provided insight on perception and experience of students towards CAL for experimental pharmacology. However, further studies are warranted to assess the knowledge, cognitive and psychomotor skills of students.

Magnitude and determinants of adverse treatment outcomes among tuberculosis patients registered under revised national tuberculosis control program in a tuberculosis unit, Wardha, central India: a record-based cohort study

Introduction: Deaths, defaults, relapses, and treatment failures have made the control of TB difficult across the globe

Methodology: This study is a record-based follow-up of a cohort of patients registered under Revised National Tuberculosis Control Program in the year 2014 in Wardha Tuberculosis Unit, India. Data was collected from the records available at the District Tuberculosis Office

Results: Data of 510 patients was analyzed. The sputum conversion rate was 88%. The overall treatment success rate was 81.9%, and rates of any adverse outcome, deaths, defaults, failure, and shift to Category IV regimen were 32.60/100 person years at risk [PYAR], 16.88/100 PYAR, 11.12/100 PYAR, 3.45/100 PYAR, and 1.15/100 PYAR, respectively. The median times for the above outcomes were 81 days, 110 days, 66 days, 118 days, and 237 days, respectively. The cumulative probability of occurrence at 6 months of any adverse outcome, deaths, default, failure, and shift to Category IV regimen was 0.145, 0.056, 0.088, 0.002, and 0.004, respectively. On multivariate analysis, the determinant of any adverse outcome was age >45 years, whereas extrapulmonary disease was protective. The hazard of defaulting was also significantly higher in male patients and those aged >45 years

Conclusion: Appropriate interventions and program implementation to reduce the adverse treatment outcomes and interruptions will help in improving program performance

Psychological disorders and personality characteristics of with gastro-esophageal reflux disease.

Background: Gastro-esophageal reflux disease (GERD) can be traced back to disorders of the gastro-esophageal junction but several psychological factors interact to affect treatment outcomes. There is sparse literature from India regarding psychological co-morbidity and personality characteristics in patients with GERD. Aim and Objectives: To study the co-morbid psychological disorders and personality profiles in patients suffering from GERD. Methods: Two hundred patients with GERD-related symptoms were randomly screened for psychological disorders and personality characteristics using 30-item General Health Questionnaire (GHQ) and Sixteen Personality Factor Questionnaire (16PF) respectively. Patients who screened positive for presence of co-morbid psychological disorders were further interviewed using Structured Clinical Interview for DSM-IV Axis 1 Disorders (SCID-1) to find out the type of psychological disorder. Results: The prevalence of psychological co-morbidity in patients with GERD-related symptoms in our sample was found to be 40%. Major depressive disorder was the most common psychological disorder found co-morbid in these patients. Alcohol dependence was significantly observed in males; while in females, major depressive disorder and generalized anxiety disorder was more commonly seen. Regarding personality characteristics, a higher degree of neuroticism and risk-taking attitudes was found in patients of GERD with associated psychological co-morbidity Conclusions: This study suggests that the management of GERD may include psychological evaluations and possibly interventions in standard treatment protocols.

Association of OSTA index with bone mineral density (BMD) and its comparison with calcaneal quantitative ultrasound for the prediction of low BMD in peri-menopausal Indian women.

Background: Osteoporosis is characterized by low bone mineral density (BMD) and an increased risk of fractures with advancing age in postmenopausal women. BMD measurements with dual energy X-ray absorptiometry (DEXA) are costly and not widely available The Osteoporosis Self-Assessment Tool for Asians (OSTA) index is a simple tool based on age and body weight to predict low BMD and identify women at risk of osteoporosis. The objective was to study the association of OSTA index with BMD (T-score) and to validate OSTA index in comparison with calcaneal Quantitative Ultrasound (QUS) for the prediction of low BMD in peri-menopausal Indian women. Methods: This was a prospective, cross-sectional, descriptive study carried out in department of physiology of a tertiary care teaching hospital (Navi Mumbai). Seventy two peri-menopausal women between 40 to 55 years with no previous diagnosis of osteoporosis were included. Participants’ socio-demographic detail, anthropometric measurements, OSTA index and QUS-based BMD was recorded. Pearson’s correlation test was used. Sensitivity, specificity, positive and negative predictive value was calculated. Results: OSTA index did not correlate with BMD in the entire samples. On subgroup analysis, OSTA index significantly correlated in a positive direction with BMD (T-score) in women in the age group of 50-55 years. OSTA index had a sensitivity of 70 %, and specificity of 84.62 % at T-score cutoff value of < -1. Conclusions: OSTA index is a simple risk assessment tool that can be used to identify women with low BMD in the age group of 50-55 years.

An evaluative study on integrated child development services in urban slums of Jamnagar City, Gujarat.

Background: Integrated Child Development Services (ICDS) is one of the world’s largest community based schemes running in India for over three decades. Frequent evaluations of the scheme have been conducted to make it more effective to promote early childhood care. Objectives: Comprehensive assessment of services provided under ICDS in urban slums of Jamnagar city of Gujarat state. Methods: It was decided to study 15% of the total 297 AWCs of the city through Simple Random Sampling technique. The AWCs visited were evaluated with respect to infrastructure facility of the centre, record keeping activity & knowledge of AWWs, availability of essential drugs & logistics. Results: A total of 48 centers were evaluated. 24 centers operated from Kutcha or semi-pucca buildings and toilet facilities were lacking at 20 of the centers. Only about 44% of the enrolled 3-6 years children were present at the AWC on the day of visit. Nearly 40% of the enrolled children had varying grades of malnutrition. Unavailability of medicine kits & other logistics, was observed. Three fourth of the AWW described providing non-formal preschool education & supplementary nutrition as their only responsibilities forgetting other essential components of their service. One fourth of the AWW did not know proper time to initiate Breast Feeding and over one third (37.5%) of them did not know the Universal Immunisation Program schedule fully. Less honorarium & poor quality of supplementary food were their main difficulties. Conclusion: the AWC currently acts merely as a food distribution centre with minimal provision of other services. Regular growth monitoring of the children along with supervision of the services provided would be far more effective in improving the nutritional status of the children than supplementary nutrition alone.

Seroprevalence of Hepatitis B and C Infections among Healthy Volunteer Blood Donors in the Central California Valley

BACKGROUND/AIMS: The Central California Valley has a diverse population with significant proportions of Hispanics and Asians. This cross-sectional study was conducted to evaluate the prevalence of hepatitis B virus (HBV) and hepatitis C virus (HCV) in healthy blood donors in the Valley. METHODS: A total of 217,738 voluntary blood donors were identified between 2006 and 2010 (36,795 first-time donors; 180,943 repeat donors). RESULTS: Among the first-time donors, the HBV and HCV prevalence was 0.28% and 0.52%, respectively. Higher HBV prevalence seen in Asians (3%) followed by Caucasians (0.05%), African Americans (0.15%), and Hispanics (0.05%). Hmong had a HBV prevalence of 7.63% with a peak prevalence of 8.76% among the 16- to 35-year-old age group. Highest HCV prevalence in Native Americans (2.8) followed by Caucasians (0.59%), Hispanics (0.45%), African Americans (0.38%), and Asians (0.2%). CONCLUSIONS: Ethnic disparities persist with regard to the prevalence of HBV and HCV in the Central California Valley. The reported prevalence may be an underestimate because our study enrolled healthy volunteer blood donors only. The development of aggressive public health measures to evaluate the true prevalence of HBV and HCV and to identify those in need of HBV and HCV prevention measures and therapy is critically important.

Cytoadherence and Severe Malaria

Malaria is a disease that causes enormous human morbidity and mortality. One feature of mature Plasmodium falciparum-infected erythrocytes leading to the development of severe malaria is thought to be cytoadherence and blockage of the microvasculature. Therefore, an understanding of mechanisms that mediate parasite adhesion leading to malaria pathology is needed to yield new treatments for malaria. However, to date, cytoadherence-associated pathology is still under debate. Is cytoadherence needed to develop severe malaria? This review will discuss the available information on associations of cytoadherence with the development of severe malaria.

Prevalence of cirrhosis in patients with thrombocytopenia who receive bone marrow biopsy

Thrombocytopenia is a common finding in patients with cirrhosis and may lead to unnecessary referral for bone marrow [BM] biopsy. To date, the prevalence of cirrhosis in patients with thrombocytopenia who receive BM biopsy is largely unknown. Between fiscal years 2006-2010, 744 patients [>/= 18 years] who underwent BM biopsies for thrombocytopenia at our hospital were identified retrospectively. 541 patients were excluded who had hematologic malignancies and received chemotherapy. Remaining 203 patients with predominant isolated thrombocytopenia were included in the study. Of 203 patients, 136 [67%] had a normal and 67 [33%] had an abnormal BM examination. Prevalence of cirrhosis in the study population was 35% [95% CI: 28.4-41.9]. 51% patients with normal BM were found to have cirrhosis compared to 3% of patients with abnormal BM exam [P < 0.0001]. Common causes of cirrhosis were nonalcoholic steatohepatitis [NASH] [47%], followed by alcohol and Hepatitis C virus infection. Idiopathic thrombocytopenia and myelodysplastic syndrome were most frequent causes of thrombocytopenia in patients without cirrhosis. Patients with NASH had higher body mass index [BMI] [33.4 vs. 25.8, P < 0.001] and lower MELD scores [11.1 vs. 16, P = 0.028] when compared to non-NASH patients with cirrhosis. Approximately, one third [35%] of patients with cirrhosis induced thrombocytopenia may undergo unwarranted BM biopsies. Clinical diagnosis of cirrhosis is still a challenge for many physicians, particularly with underlying NASH. We propose cirrhosis to be the prime cause of isolated thrombocytopenia

Health-promoting school initiative in Ashram schools of Wardha district.

Background. We studied the effect of a health-promoting school-based intervention for disadvantaged children in the residential Ashram schools of rural Wardha, Maharashtra. Methods. At baseline, 1287 children in 10 Ashram schools were examined using a locally adapted Global Schoolbased Student Health Survey questionnaire. The haemoglobin level of all children was estimated using the haemoglobin colour scale. Body mass index and physical activity score for each child were calculated. The intervention was carried out through school health committees. After 1 year, 1226 children were examined using the same questionnaire. Results. There was significant improvement in personal hygiene and reduction in hygiene-related morbidity among the children. The median haemoglobin level of the children increased from 10.7 g/dl to 11.4 g/dl. There was also a significant increase in the proportion of children with body mass index that was normal for age (5th–85th percentile) from 32.2% to 38.5%. Conclusion. The need-based participatory health-promoting school initiative for disadvantaged children in Ashram schools led to an improvement in their personal hygiene and health.

Vascular anatomy of strictured small bowel.

Aim: To investigate the role of ischemia in the pathogenesis of small bowel strictures. Methods: Vascular anatomy of 39 small bowel strictures was studied using modified Spalteholtz method. Ten normal small bowel segments were studied as controls. Results: 71.8% of small bowel strictures showed block in the mesenteric vessels (p=0.008). Subset analysis of tuberculous strictures showed block in the mesenteric vessels in 70.8% of strictures (p=0.0098). Conclusions: Ischemia plays a significant role in the pathogenesis of small bowel strictures. Mesenteric vasculopathy has a significant association with tuberculous strictures of the intestine.

Assessment of periodontal status among dental fluorosis subjects using community periodontal index of treatment needs.

Aim: To determine the periodontal status and treatment needs among dental fluorosis subjects residing in Ennore, Chennai, using Community Periodontal Index of Treatment Needs (CPITN). Materials and Methods: All the subjects with dental fluorosis above 15 years of age, permanent residents of Ennore, were included in the study. Subjects with known systemic diseases and subjects with other intrinsic dental stains were excluded from the study. Periodontal status was estimated using CPITN and Dental fluorosis was recorded using Dean's Dental Fluorosis Index. Results: The total number of study subjects was 1075, of which 489 were males and 586 were females. Males were predominantly affected with periodontal disease than females. This was found to be statistically significant (P=0.000). The association between Degree of Fluorosis and Periodontal Status is statistically significant (P=0.000). There was statistically significant difference in mean number of sextants between the degree of fluorosis in each of the periodontal status (P=0.000). Conclusion: The finding that the lower prevalence of shallow pockets in the study area, where the fluoride level in the drinking water ranges from 1.83 to 2.01 ppm, indicates that the use of fluoride in water is beneficial to the periodontal tissues.

Portfolio based approach for teaching Community Medicine among medical undergraduates and assessment of their learning in a medical college in rural India

Objective: The study was undertaken to explore what and how first year medical undergraduates could learn about Community Medicine using a portfolio-based learning approach during the period of Social Service Camp in the village Pulai.  Methods: Study participants were 65 first year medical undergraduates participating in Social Service Camp in the village Pulai, during 10 - 24 October 2008. The first step was to set Specific, Measurable, Actionable, Realistic and Time bound (SMART) learning goals focused on Community Medicine. These learning goals were to be achieved during the fifteen days and within the existing curriculum, using existing resources and opportunities. The portfolio based records of students who accomplished their learning objectives were subjected to qualitative content analysis.  Results: Of 65 students, 41 (63.1%) completed and reflected on their portfolios. Methods adopted for learning were; interaction with community based groups (48.8%), interaction with allotted family members (43.9%), lectures series, role plays and demonstrations (36.6%), interactions with village level healthcare providers (31.7%) and journal exercises (26.8%). The portfolio based exercises were useful to 30 (46.2%) students to understand the social, economic and health problems of the villagers and their life style. Twenty four (36.9%) students said that it improved their communication skills. This exercise helped 11 (16.9%) students to explore weaknesses such as poor communication skills, poor knowledge of local language, inability to adjust in new environment.  Conclusion: The Social Service Camp in the village Pulai offered opportunities for portfolio based leaning to medical undergraduates. The students learned about the major topics of primary health care through self-directed learning.

Metabolic syndrome in adult population of rural Wardha, central India.

Background & Objectives: Prevalence of metabolic syndrome is high among Asians including Indians. Scarce information is available about the magnitude of metabolic syndrome in rural areas and hence present study in rural area of Wardha district, central India. Methods: In 300 randomly selected subjects, blood pressure and anthropometric measurements such as height, weight, waist circumference and hip circumference were noted. Blood sample was collected after overnight fasting and was subjected to biochemical quantification such as fasting blood sugar, total cholesterol, triglycerides, HDL-C, VLDL-C and LDL-C. Data were analyzed using ATP-III definition as well as by modifying the waist circumference cut-offs as per Asia-Pacific guidelines. Results: Overall metabolic syndrome as per ATP-III criteria was observed in 5.0 per cent adult rural population. When ATP-III criteria were modified using waist circumference cut-offs recommended by Asia-Pacific guidelines, metabolic syndrome was seen in 9.3 per cent. It was 10.7 per cent among females and 8.2 per cent among males. Receiver operating characteristic curve was plotted to find out the best cut-off of BMI to identify the individuals with metabolic syndrome. The best cut-off for BMI came out to be 23.32 kg/m2. Interpretation & conclusions: The magnitude of metabolic syndrome was low among rural adults of Wardha as compared to reported values in urban areas. BMI of 23.32 kg/m2 and higher was found to predict significant risk of metabolic syndrome in these study subjects. However, studies with larger sample need to be conducted to confirm these findings.

Portfolio based approach for teaching Community Medicine among medical undergraduates and assessment of their learning in a medical college in rural India.

Objective: The study was undertaken to explore what and how first year medical undergraduates could learn about Community Medicine using a portfolio-based learning approach during the period of Social Service Camp in the village Pulai. Methods: Study participants were 65 first year medical undergraduates participating in Social Service Camp in the village Pulai, during 10 - 24 October 2008. The first step was to set Specific, Measurable, Actionable, Realistic and Time bound (SMART) learning goals focused on Community Medicine. These learning goals were to be achieved during the fifteen days and within the existing curriculum, using existing resources and opportunities. The portfolio based records of students who accomplished their learning objectives were subjected to qualitative content analysis. Results: Of 65 students, 41 (63.1%) completed and reflected on their portfolios. Methods adopted for learning were; interaction with community based groups (48.8%), interaction with allotted family members (43.9%), lectures series, role plays and demonstrations (36.6%), interactions with village level healthcare providers (31.7%) and journal exercises (26.8%). The portfolio based exercises were useful to 30 (46.2%) students to understand the social, economic and health problems of the villagers and their life style. Twenty four (36.9%) students said that it improved their communication skills. This exercise helped 11 (16.9%) students to explore weaknesses such as poor communication skills, poor knowledge of local language, inability to adjust in new environment. Conclusion: The Social Service Camp in the village Pulai offered opportunities for portfolio based leaning to medical undergraduates. The students learned about the major topics of primary health care through self-directed learning. Key words: Social Service Camp, community based teaching.

Effect of improvement of pre-school education through anganwadi center on intelligence and development quotient of children.

Objective. To find usefulness of a package of interventions to improve preschool education through Anganwadi centers on psychosocial development of children. Methods. A case-control study was undertaken to evaluate an intervention. Eight Anganwadi centers were selected using simple random sampling out of sixteen Anganwadi centers in Talegaon PHC area where intervention was done. Ten children in age group of 4-6 years were selected randomly from each of the eight Anganwadi center in intervention arm. For each child from intervention arm, one agematched child was selected from the matched Anganwadi center. For each subject, Intelligence Quotient and Development Quotient were assessed. Results. Mean Development Quotient (DQ) and Intelligence Quotient (IQ) values were higher among children in intervention Anganwadi centers (16.2 points for DQ and 10.2 points for IQ). This difference was found statistically significant (p = <0.01). Mean DQ among boys was found 10.1 points higher than that among the girls in control arm, this was statistically significant. According to multivariate linear regression model, the determinants of DQ were: intervention; age of the child; education of mother; sex of child; and PEM grade and the determinants for IQ were: intervention; age of the child; and income. Conclusions. This study shows that intervention to improve the Early Childhood Education and Development component through Anganwadi centers results in improvement in Developmental and Intelligence Quotient of children.

Health expenditure and care seeking on acute child morbidities in peri-urban wardha: A prospective study.

Objective. To find out health expenditure in public and private sector consultations for common childhood (under 5) morbidities and to compare the clinical practices and the duration of illness for morbidities treated by public and private doctors. Methods. The present prospective study over 12 months period was undertaken in the field practice area of a urban health centre in rural India. We could interview mothers of 202 enlisted children at monthly interval for one year. At each visits, mothers were asked to recall any morbidity for the child in the past four weeks, date of onset of symptoms and relief, source of treatment and recorded both direct and indirect expenditure. The data was entered and analyzed by using Epi_info 6.04 software package. Results. Overall, there were 625 episodes of respiratory infection, out of which 377 (60.3%) were treated by private doctors, 158 (25.3%) were treated by government doctors and remaining 90 (14.4%) were treated at home. Significantly more episodes treated in government health facilities i.e., 12 (5.7%) were recommended or done laboratory test where only 13 (2.3%) consultations with private doctors were advised or done laboratory tests (p=0.015). Notably, 145 (25.5%) and 17 (8.1%) episodes treated by private doctors and government doctors respectively received injections (p=0.001). Average total expenditure on treatment of child morbidity was 189 INR (10% of total household income). Families with less monthly income (<1500) had significantly more expenditure (16.1%) on treatment of morbidities than those families who had higher (>1500) monthly income. Conclusions. About 10% of total household income was spent on the treatment of acute child morbidities. Private providers are preferred for the treatment of acute illnesses where both direct and indirect cost of treatment was high. Household with lower monthly income had to spend more on treatment of their sick children. Hence, while devising PPP and health care financing strategies for urban poor should emphasize to reduce health expenditure.

Awareness and health care seeking for newborn danger signs amongmothers in Peri-Urban Wardha.

Objective. To find out awareness of mothers about newborn danger signs and their health care seeking behavior for sick newborns in the peri urban field practice area of Urban Health Centre in Wardha. Methods. Triangulated study of quantitative (survey) and qualitative (mapping, pair-wise ranking exercise) methods were undertaken. 72 identified mothers of children (0-11 months) in social mapping exercise were interviewed by trained social workers using pre-designed and pre-tested questionnaire and by paying house to house visits. The structured questionnaire covered information on newborn danger signs, health care seeking and socio-demographic information. The data was analyzed by using Epi_info software package. A pair-wise ranking exercise for assessment of preferred health care facility for sick newborn was undertaken with the group of purposively selected mothers. Results. Out of 72 mothers, 29 (40.3%), 16 (22.2%) and 10 (13.9%) identified difficulty in breathing, poor sucking and lethargy/unconsciousness as newborn danger signs respectively. Only 7(9.7%) and 2 (2.8%) identified convulsion and hypothermia as newborn danger signs respectively. About 27 (37.5%) babies were sick during newborn period. About 11(15.3%) and 8 (11.1%) were reported to have poor sucking and difficulty in breathing respectively. All sick newborns with danger signs were taken to the doctor and only two mothers consulted faith healer for treatment. Conclusion. Considering the poor awareness of mothers regarding newborn danger signs, there is need for raising awareness building which required for early recognition and prompt treatment. Apart from strengthening government health facilities, the capacity of intermediate non government health care providers should be developed for newborn care.

A community based approach to improve health care seeking for newborn danger signs in rural wardha, India.

OBJECTIVE: To find out the effect of community mobilization and health education effort on health care seeking behavior of families with sick newborns, and to explore the rationale behind the changed health care seeking behaviors of mothers in a rural Indian community. METHODS: In the present community based participatory intervention, a triangulated research design of quantitative (survey) and qualitative (Focus group discussions, FGDs) method was undertaken for needs assessment in year 2004. In community mobilization, women's self help groups; Kishori Panchayat (KP, forum of adolescent girls), Kisan Vikas Manch (Farmers' club) and Village Coordination Committees (VCC) were formed in the study area. The trained social worker facilitated VCCs to develop village health plans to act upon their priority maternal and child health issues. The pregnant women and group members were given health education. The Lot Quality Assurance Sampling (LQAS) technique was used to monitor awareness regarding newborn danger signs among pregnant women. In year 2007, a triangulation of quantitative survey and a qualitative study (free list and pile sort exercise) was undertaken to find out changes in health care seeking behaviors of mothers. RESULTS: There was significant improvement in mothers' knowledge regarding newborn danger signs. About half of the mothers got information from CLICS doot (female community health worker). The monitoring over three years period showed encouraging trend in level of awareness among pregnant women. After three years, the proportion of mothers giving no treatment/home remedy for newborn danger signs declined significantly. However, there was significant improvement in mothers' health care seeking from private health care providers for sick newborns. CONCLUSION: The present approach improved mothers' knowledge regarding newborn danger signs and improved their health care seeking behavior for newborn danger signs at community level. Due to lack of faith in government health services, women preferred to seek care from private providers.

Eosinophilic pancreatitis with pseudocyst.

Eosinophilic pancreatitis is a rare entity in patients having underlying systemic manifestations such as peripheral eosinophilia, elevated serum IgE levels and/ or eosinophilic infiltrates in other organs, including the gastrointestinal tract. We report a 38-year-old woman with peripheral eosinophilia in association with acute pancreatitis, pancreatic ascites and pseudocyst.