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Medical education and assessment processes in India are expected to undergo a paradigm shift with the introduction of the National Medical Commission Act, 2019. The Government of India intends to introduce a national exit test (NEXT) which is supposed to act as a single examination for graduation from medical school, granting licence to practice modern medicine, and allocating postgraduate residencies. As the nature, scope and stakes of these are different, various options regarding the content and conduct of the examination require careful consideration. We explore the options for implementation of this examination on a national scale. These options include theoretical (multiple assessment methods) with clinical examinations, multiple-choice question (MCQ)-based examination with separate clinical examination, only an MCQ-based examination, and multistep examination including screening followed by mixed assessment methods and clinical evaluation. We discuss the possible strengths and challenges of different options of implementing NEXT, and the caveats of the options.
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Cholecystectomy preferably laparoscopy is gold standard treatment for symptomatic cholelithiasis. However for some anatomical and/or pathological reasons the procedure is converted to open. Conversion rates at high volume centres is <5%. We present a case report of 48 aged lady, previously operated multiple times for hydatid liver and lung with symptomatic cholelithiasis. She was planned for laparoscopic cholecystectomy. During the procedure, inadvertent anatomy of “the wandering gallbladder” was noted. Here we describe the management approach selected for this type of unusual presentation. We recommend noting down detailed past history (preferably surgical) and preoperative consideration of deviant anatomical location and findings of gallbladder. We should maintain a low threshold for conversion to open.
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Background: Rates of caesarean delivery continue to riseworldwide. Maternal preferences are an important influence ondecisions about mode of delivery. At present, evidence oflonger-term complications of caesarean delivery has not beenadequately synthesized to allow fully informed decisions aboutmode of delivery to be made. Hence; the present study wasundertaken for assessing maternal consequences ofcaesarean section.Materials & Methods: Data record of a total of 130 womenwas enrolled in the present study. These 130 women werebroadly divided into two study groups as follows: Group 1:Primary elective group (n=58), and Group 2: Failed vaginaldelivery (n=72). Complete demographic details of all thesubjects were obtained from the data record files. An excelchart was prepared and outcome and complications wererecorded systematically.Results: Overall, out of 130 females, complications were foundto be present in 18 women (13.85%). However; among patientsof Group 1, complications were found to be present in 5patients (8.62%) while among patients of Group 2,complications were found to be present in 13 patients(18.06%). On comparing statistically, overall prevalence ofcomplications was significantly higher among patients of group2. Uterine corpus was the most common maternal complicationwas found to be present in 2 patients of group 1 and 4 patientsof group 2.Conclusion: Emergency caesarean section is associated withsignificantly higher risk of maternal complications incomparison to elective caesarean procedures.
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Background: Headache is a common chief complaint inpediatric offices and may be a symptom of a host of illnessesfrom viral infection to intracranial neoplasm to migraine. Thepresent study was conducted to assess the profile of migrainein children.Materials & Methods: This study was conducted on 348pediatric patients of both genders. Information such as name,age, gender, type of house, mother’s education, duration ofillness, site of headache, frequency of headache wererecorded. Symptoms such as visual disturbances, vomiting,abdominal pain etc. were recorded.Results: Out of 348 patients, 210 were males while 138 werefemales. Clinical features were nausea/ vomiting seen in 310patients, visual disturbances in 280, vertigo in 302 patients andmore than 1 symptom in 238 patients. The difference wassignificant (P < 0.05).Conclusion: Migraine headache is not uncommon in children.Common clinical features were nausea/ vomiting, visualdisturbances and vertigo.
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The challenge in the management of tuberculosis is further compounded by the liver injury associated with anti-tubercular treatment (ATT) drugs. The problem of drug-induced liver injury (DILI) associated with ATT drugs is significant in the developing countries because of high disease burden, limited monitoring due to scarce resources and lack of awareness. There is heterogeneity in the pharmacokinetics and pharmacodynamics of the various first line ATT drugs. There are various genetic and environmental factors that affect DILI. Various guidelines have been proposed to treat and monitor DILI. This article reviews the problem, risk factors, mechanism, and management strategies of the DILI associated with ATT.
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Portal vein thrombosis is considered a relative contraindication for transarterial chemoembolization [TACE] in hepatocellular carcinoma. The purpose of our study was to evaluate the efficacy of TACE treatment in patients with hepatocellular carcinoma with portal vein [PV] thrombosis. From April 2011 to June 2013, 17 patients with unresectable hepatocellular carcinoma with PV thrombosis were studied. Patients were assessed for tumor response by imaging at regular intervals and the data compared with the baseline laboratory and imaging characteristics obtained before treatment. Univariate analysis was used to assess the treatments impact on patient survival. Survival analysis was performed using Kaplan-Meier estimations. Overall survival rates at three, six and 12 months were 82%, 71%, and 47%, respectively, with a median of 10 months. Patients in Child-Pugh class A had a median survival of 15 months compared to five months for those patients in Child-Pugh class B. The median survival period of patients responsive to treatment was 13 months while that of non-responders was five months. Patients with ascites at the time of presentation had median survival period of six months while those who did not had a median survival period of 13 months. In univariate analysis, response to chemoembolization [p < 0.001], ascites [p < 0.050] and Child-Pugh class at diagnosis [p < 0.050] were found to be significant prognostic factors. TACE is a promising procedure in unresectable hepatocellular carcinoma with PV thrombosis. Response to chemoembolization, ascites and Child-Pugh class were the most important determining factors of survival
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Background & objectives: The field of medical education in our country remains deeply fragmented and polarised between the biomedical technical domains which are overrepresented and the humanitarian domains which are under-represented within the universe of medical pedagogy. To overcome this imbalance, we designed a module that integrates the two domains in a holistic biomedical and socio-cultural framework with the objective of providing unified field of learning experience to the undergraduate medical students attending rotatory clinical postings in a medical college in New Delhi, India. Methods: Undergraduate medical students of 6th and 8th semesters were enrolled in humanities based study module (HSM) on voluntary basis for a total duration of six months. During their compulsory rotatory medicine ward posting, they were introduced and exposed to learning bedside experience of HSM with various tools of art and literature in the form of poem, short narratives, paintings, sketches and group discussions to express their feelings about patients’ sufferings. Students’ feed-back was recorded through an anonymized questionnaire. Result: Of the 235 students, 223 (95%) enrolled themselves voluntarily and 94 per cent (210 of 223) of them completed the total six month duration of the study module. Seventy three per cent of the students found HSM effective in improving their affective motivational behavior, 82 per cent found it effective in motivating them to learn more about core medical subjects, and 85 per cent wanted its continuation as part of medical curriculum. Interpretation & conclusions: The positive response of the students towards the HSM was an indicator of the potential for integrating the module within the undergraduate medical curriculum.
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BACKGROUND: The etiology of malabsorption syndrome (MAS) may differ in different geographical regions. Limited data are available on the etiological spectrum of MAS among Indian adults. METHODS: Ninety-nine consecutive adult patients with MAS (urine d-xylose <1 g/5 g/5 h with or without increased fecal fat (> or =7 g/24 h) were evaluated for cause of MAS using standard criteria. Past medical records were examined to know the nature of treatment received. RESULTS: The etiology of MAS was: tropical sprue 39, celiac disease 9, Crohn's disease 9, giardiasis 8, small intestinal bacterial overgrowth in absence of another cause of MAS 8, panhypogammaglobulinemia 2 (one with strongyloidiasis), intestinal lymphangiectasia 1, intestinal tuberculosis 4, idiopathic 15, acquired immunodeficiency syndrome 2, and amyloidosis 2. Twenty-eight patients had received anti-tubercular treatment earlier. CONCLUSIONS: Tropical sprue, celiac disease and Crohn's disease are common causes of MAS in Indian adults. Inappropriate anti-tubercular treatment is common in them and needs to be discouraged.
Subject(s)
Adult , Celiac Disease/complications , Crohn Disease/complications , Female , Humans , India/epidemiology , Malabsorption Syndromes/epidemiology , Male , Sprue, Tropical/complicationsABSTRACT
The pathogenesis of Crohn's disease (CD) involves an abnormal immune response to enteric bacteria in genetically susceptible individuals. There are no family studies regarding the association of CD with human leucocyte antigens (HLA) class II. In the present study, we have studied the association of HLA class II antigens in patients with CD and their first-degree relatives. Nine patients with CD and their first-degree relatives were studied. A group of 110 healthy unrelated and ethnically matched subjects were used as controls. Molecular HLA typing was done using the sequence-specific primer-based method. The transmission disequilibrium test (TDT) was used to analyze the results. A total of 65 individuals were included in the study; 52/56 first-degree relatives (92.8%) of 9 patients with CD consented to the study. The median age of patients was 40 years. When the distribution of the HLA class II antigens in patients was compared to that in controls no significant differences were observed even after applying the Yates correction. As the sample size of the population was small, the association of CD with DR and DQ alleles was further analyzed by using the TDT. Even after applying TDT, no significant association was observed. Familial aggregation of CD is uncommon in India. Crohn disease is not associated with HLA class II antigens in Indian patients. Genes of the major histocompatiblity complex are likely to contribute little to the susceptibility to Crohn disease in Indian patients.