Effectiveness of teaching medical ethics to medical students on an online platform: An analysis of students’ perceptions and feedback

Medical ethics education along with attitude and communication training has been incorporated into the regular MBBS curriculum in India from 2019, so as to encourage a caring and communicative approach by doctors towards patients. It would be important to understand the relevance of the educational module in the form of cases to ensure an optimal learning process for future students and doctors in the making. We selected three cases and conducted online debates among small groups of second year MBBS students. Students submitted narratives and their reflections after discussing each case and gave overall feedback. Our findings suggested that the students recognised the complexity of taking decisions when presented with ethical dilemmas and appreciated the opportunity to voice opposing views. The online platform was effective and may be considered in the future as a medium to help integrate discussions on medical ethics alongside clinical work.

Mechanism of Unstable Inter-trochanteric Fractures in the Elderly

The aim of this prospective comparative study is to analyse the short term follow-up results of unstable inter-trochanteric fractures in the elderly treated with Bipolar hemi-arthroplasty and Dynamic hip screwfixation done in our institution from March2017 to October2018. Proximal femoral fractures in the elderly individuals have a tremendous impact on both the health care system and society. Upon treatment of inter-trochanteric factures with conservative management, it usually unites with a mal-union,non-union and with shortening, but the problem of non –union in trochanteric fractures has lessincidence. Because of complications associated with prolonged recumbency and its associated morbidities. Primary hemiarthroplasty in these patients provides for adequate fixation and early mobilization. It alleviates pain and improves function. It also prevents post-operative complications such as pneumonia, lung atelectasis and pressure sores. From our clinical observation we would suggest that unstable intertrochanteric fractures in elderly result most frequently from accidental fall (52.5%), being the most common described mechanism of injury

Assessment of well water quality in Tsunami affected regions of south-west coast of Kerala, India.

The quality of well waters, based on 23 parameters of water, at 12 stations of south-west coast of Kerala, India, was assessed during monsoon, 2009 and summer, 2010, to determine their suitability for drinking and other domestic purposes. The stations selected were grouped into four regions viz. least, slightly, moderately and severely affected ones based on the severity of 2004 Asian Tsunami at each station. The depths of wells showed variations depending on the seasons and on their distance from the seacoast. The average water temperatures during monsoon and summer seasons were 28.5oC and 30.2oC respectively. The pH of well waters were below 6.5 in least and slightly affected regions and above this value in moderately and severely affected regions. In all the four regions, the well water parameters of electrical conductivity, hardness, fluoride, free chlorine, copper, zinc, calcium and nickel were below, and phosphorus, lead, iron cadmium and manganese were above the standard permissible levels set for them in drinking water. The values of salinity, sodium and potassium in the well waters of moderately and severely affected regions, and the values of nitrate-nitrogen, nitrate and magnesium in the well waters of severely affected regions were above the permissible limits set for them in drinking water. Water quality index calculated on the basis of drinking water standards revealed that the well waters of least and slightly affected regions were moderately polluted in both monsoon and summer seasons and the same of moderately affected region were excessively polluted during monsoon and severely polluted during summer seasons, whereas the well waters of severely affected regions were severely polluted in both seasons. Suitable recommendations were made to improve the quality of well waters of least and slightly affected regions.

Cytokine gene polymorphisms in Irritable bowel syndrome in Indian population - A pilot case control study.

Aim: This study aimed at evaluating the single nucleotide polymorphisms (SNPs) in five cytokine genes regulating inflammation at altogether 8 different loci and compared their frequencies in patients with Irritable bowel syndrome (IBS) versus healthy age and sex matched controls. Methods: Peripheral blood was collected for DNA cytokine analysis from 23 patients with IBS and 20 healthy controls. The cytokine SNPs studied include TNF-á (-308G/A), TGF-â1 (codon10T/C, codon25G/C), IL-10 promoter (-1082A/G; -819T/C; -592A/C), IL-6 promoter (-174G/C), and IFN-ã (+874T/A). Results: There was a significant difference between a SNP in IL-10 (-592A/C) among cases and controls. There was also a trend to significance as regards to IL-6 promoter (-174G/C). Frequencies of other SNPs were not significantly different between the two groups. Conclusion: This pilot study shows that there are polymorphism differences in cytokine genes between patients with IBS and healthy controls from India.

ATP7B mutations in families in a predominantly Southern Indian cohort of Wilson's disease patients.

OBJECTIVE: To analyze ATP7B mutations in Wilson's disease (WD) patients from the Indian subcontinent and to correlate these with WD phenotype. METHODS: We studied 27 WD patients from 25 unrelated families. Twenty-two families were from three southern Indian states - Tamil Nadu andhra Pradesh and Kerala. We applied conformation- sensitive gel electrophoresis (CSGE) to screen for the mutations in patients and their families. PCR products exhibiting aberrant patterns in CSGE were subjected to direct DNA sequencing. As siblings affected by WD within a family share identical ATP7B genotype, we compared WD phenotype among affected siblings within families. RESULTS: ATP7B mutations were detected in 22 of the 25 probands -13 were homozygotes and 9 were compound heterozygotes. Eleven novel mutations were detected. Only two common mutations were found: G3182A in 4 (16%) and C813A in 3 (12%) probands. 'Hot spots' for ATP7B mutations were exons 18 and 13. Lack of common dominant mutations prevented correlation of individual ATP7B mutations with WD phenotype. Symptomatic WD in a live sibling was not found in any family. In 8 families, a sibling died of presumed WD - in 6 of these, WD phenotype was identical to that in the proband. CONCLUSIONS: We describe the spectrum of ATP7B mutations including 11 novel mutations in Indian WD patients and document lack of a single dominant mutation. Identical WD phenotype among siblings in only 6 of 8 families with >1 child affected by WD suggests that factors other than ATP7B mutations influence WD phenotype.