Pulse wave analyzed cardiovascular parameters in young first degree relatives of type 2 diabetics- a cross-sectional study

Background First degree relatives (FDR) of type 2 diabetic (T2D) are predisposed for type 2 diabetes mellitus (T2DM) which accelerates cardiovascular aging. Pulse wave analysis (PWA) gives non-invasive measurement of central hemodynamics like central blood pressure (cBP), cardiac output (CO), stroke work (SW) and vascular stiffness like pulse wave velocity (PWV) and augmentation index at heart rate 75 (AIx@75). Objective To study PWA derived cardiovascular parameters in FDRs of T2D as compared to controls. Materials and methods We enrolled 117 FDRs of T2D and 117 matched controls for a cross-sectional study. We performed PWA using Mobil-o-Graph (IEM, Germany) by oscillometric method to derive cardiovascular parameters which were compared and correlated for significance. P value less than 0.05 was considered statistically significant. Results Gender, age, height, weight, body mass index (BMI), physical activity were comparable between groups. FDRs of T2D had significantly higher blood pressure (brachial-systolic 125 vs 118, diastolic 80 vs 77, mean 100 vs 96 mmHg and central- systolic 113 vs 105, diastolic 82 vs 79, pulse pressure 31 vs 28 mmHg), SW (98 vs 90 g m/bt), rate pressure product (RPP- 113 vs 107), PWV (5.14 vs 4.89 m/s), AIx@75 (30 vs 27) than control. Dependant variables correlated with brachial BP more than age or anthropometric variables. Result did not differ by maternal or paternal inheritance in case group. Conclusions Young, sedentary, non-obese FDRs of T2D have adverse cardiovascular profile which is suggested to worsen before or with onset of T2DM and definitely need attention for life style modification as primary prevention.

Continuous Professional Development: Faculty Views On Need, Impact And Barriers.

Background& Objective:Ever changing dynamic field of science, technology and health care had made it essential for a health care professional to keep abreast of the latest development. Continuous Professional Development (CPD) can be considered as a process in which individual practitioners identify their own learning needs, makes plan to meet those objectives and finally evaluates the effectiveness of the plan .Perceived barriers to CPD vary significantly by individual’s personal characteristics, job position, and organizational factors. Present study was done to explore the faculty views of CPD in terms of its need, methods, impact and barriers. Objectives: 1.To assess the perceptions of healthcare faculty about Continuous Professional Development 2.To identify the barriers perceived by health care faculty for Continuous Professional Development.Methodology:A Cross Sectional study was conducted among 32 faculty,enrolled for Foundation for Advancement in International Medical Education and Research (FAIMER) Fellowship programme at one of the regional institutes of India. A self- administered structured and modified questionnaire was given to participants as a part of Mentoring and Learning (ML) web sessions through ‘Survey Monkey”.Results:In the study, 16 (50%) out of 32 faculty members participated, where majority of participants considered attending conferences, reading journals and E-learning Modules as a CPD activity undertaken in the past one year . Nearly all participants agreed that CPD can make positive change in terms of diagnostic and treatment practices (81.25%), knowledge acquisition (100%) as well as attitude (93.75%) towards patients. Availability of study leave (56.25%) and work-life balance (75%) were significant barriers to participation. Participants strongly believed that CPD helps to recognize knowledge gaps, promoted self-reflection and focused endeavours.Conclusion:Present study reported good knowledge, favourable attitudes and practices towards Continuous Professional Development activities among health care faculty members. The study also revealed combination of responses among faculty about their own CPD activities.

“Project Eklavya”: To Transform the Indian Health Education System.

Abstract: Over 6.3 lakh students have taken this year's pre medial test in India. The total number of MBBS seats in the country is around 52,300. The current doctor population ratio is 1: 1700. The country needs 1, 00,000 graduates yearly to achieve a ratio of 1:1000. Since graduates from public and private funded medical institutions are not motivated to serve in rural settings, increasing the number of places or establishing new medical institutions may not be an effective solution to the issue, as observed by Hazarika. The medical education model proposed in this article, which includes common entry and exist test with flexibility of learning medical education, will make medical education available to all deserving candidates irrespective of their caste, creed, financial status and, most importantly, geographical location. Any deserving candidate from even the remotest part of the country can access the best medical education using the powerful tool of information technology and the vast medical educators’ pool of talent and experience available in the country and abroad.

Postgraduate Formative Assessment: Student Perspective.

Introduction: Assessment drives learning. It serves as a tool for student motivation, retention & transfer of learning. At our institute we have started postgraduate formative assessment as a part of improvement in teaching learning in postgraduate study. Method: Present quantitative, cross-sectional study was conducted at Government Medical College, Bhavnagar. During 2013-14, 75, third-year post graduate students of different 20 department of the Government Medical College, Bhavnagar had been assessed in this manner. The instrument (questionnaire) was distributed to all of these students. Result: The majority of students (92.96%) are of opinion that exam was well organised, 90.14% felt that it has gave confidence in them for their subject. More than 85% agreed that formative assessment has motivated them to learn subject more (88.73%) either by stimulating learning (87.32%) or by identifying the deficiencies in learning (85.92%). Regarding content of assessment, students were of opinion that assessment were focused on leaning objective (87.32%) and having broad coverage of subject (85.32%) leading to increase competence in respective subject. Conclusion: Feedback was pivotal in establishing important dialogue between students and teachers, creating a student-supported learning environment. Emphasis has been placed on front loading formative approaches in the first semester to ensure that students actively engage with feedback and act on it to feed forward, and develop transferable and metacognitive skills to facilitate both transition and academic progression.

Study of Heart Rate Variability in Hypertensive Subjects.

Introduction: Hypertension represents a multifactorial disease of blood pressure (BP) regulation with persistently elevated systolic and/or diastolic BP over 140/90mmHg. 90% cases of hypertension have to be assigned as essential hypertension. Research has proven that patients with essential hypertension, especially at an early stage without any medication, display autonomic disturbance in the form of increase in sympathetic and a reduction in parasympathetic activity of the ANS. The heart rate variability analysis is a powerful tool in assessment of the cardiac autonomic nerve function. It is non-invasive, an accurate, reliable, reproducible, yet simple to measure and to process and It is indicative of neuro-cardiac fitness and overall health. Objective – The aim of the present study was to (1) measure Heart rate variability (HRV) in Essential Hypertension (2) effect of different drugs on Heart rate variability in hypertension among hypertensive subjects. Materials and Methods: This study was conducted On 100 Hypertension subjects & 100 Normal subjects after obtaining informed written consent by use of Heart rate variability Analysis System Variowin-HR Medical System. Results: The mean values of Very low frequency (VLF), Low frequency (LF), High frequency (HF), Normalized High Frequency (HF (nu) & all time domain parameters were found to be reduced significantly in hypertensive subjects as compared to control subjects. The mean values of LF (nu), LF / HF ratio were significantly high in hypertensive subjects as compared to control subjects. Conclusion: observations in our study demonstrate that hypertensive subjects had markedly reduced heart rate variability (HRV) in comparison with normal subjects which indicate cardiac autonomic disturbances in hypertension subjects in causation of essential hypertension.

Faculty perceptions of the strengths, weaknesses and future prospects of the current medical undergraduate experimental physiology curriculum in Gujarat, India.

Over the past several years, an opinion has emerged in India that the current practical curricula in medical schools fail to meet many of the objectives for which they were instituted. Hence, this study has assessed the perception of physiology faculty members regarding the current experimental physiology curriculum in one Indian state, Gujarat. The faculty were of the opinion that many of the topics currently taught in experimental physiology (amphibian nerve-muscle and heart muscle experiments) were outdated and clinically irrelevant. Therefore, the faculty advocated that duration of teaching time devoted to some of these topics should be reduced and topics with clinical relevance should be introduced at the undergraduate level. The faculty also felt that more emphasis should be laid on highlighting the clinical aspect related to each concept taught in experimental physiology . Moreover, a majority of faculty members were in favour of replacing the current practice in Gujarat of teaching experimental physiology only by explanation of graphs obtained from experiments conducted in the previous years, with computer assisted learning in small groups.

Students’ Perception of Educational Environment in an Indian Medical School Using DREEM Inventory.

Introduction: Students’ perception of the environment within which they study has been shown to have a significant impact on their behaviour, academic progress and sense of well-being. The study, by way of student perceptions recorded on the Dundee Ready Educational Environment Measure (DREEM) inventory, reveals the strength & weakness of educational environment at our institute. This understanding can be aided for refining the learning environment. Method: Perceptions of students recorded by DREEM inventory anon-ymously and mean global scores and domain scores were expressed as mean + standard deviation (SD). Result was recorded gender wise and the difference in the result of male and female compared using rank sum test to see if the difference between the perception is significant or not. Result: Students’ Perceptions of Learning: The mean domain score was 31.40/48 (SD 4.63) Students’ Perceptions of Teachers: The grouped mean SPT score was 28.24 /44 (SD 4.63) Students’ academic self-Perceptions: The grouped mean score was 22.05 /32 (SD 4.9) Students’ Perceptions of Atmosphere: The grouped mean score was 31.30/48 (SD 5.5) Students’ Social Self-Perceptions: The grouped mean SSP score was 17.70/28 (SD 3.9). Female students indicated a more pos-itive perception of their environment than did males on almost all aspects. Conclusion: Study using DREEM inventory revealed problematic areas of learning environment in our medical school, which help us in de-ciding priority areas for reform of educational environment.

Students’ Perception of Educational Environment in an Indian Medical School Using DREEM Inventory.

Introduction: Students’ perception of the environment within which they study has been shown to have a significant impact on their behaviour, academic progress and sense of well-being. The study, by way of student perceptions recorded on the Dundee Ready Educational Environment Measure (DREEM) inventory, reveals the strength & weakness of educational environment at our institute. This understanding can be aided for refining the learning environment. Method: Perceptions of students recorded by DREEM inventory anon-ymously and mean global scores and domain scores were expressed as mean + standard deviation (SD). Result was recorded gender wise and the difference in the result of male and female compared using rank sum test to see if the difference between the perception is significant or not. Result: Students’ Perceptions of Learning: The mean domain score was 31.40/48 (SD 4.63) Students’ Perceptions of Teachers: The grouped mean SPT score was 28.24 /44 (SD 4.63) Students’ academic self-Perceptions: The grouped mean score was 22.05 /32 (SD 4.9) Students’ Perceptions of Atmosphere: The grouped mean score was 31.30/48 (SD 5.5) Students’ Social Self-Perceptions: The grouped mean SSP score was 17.70/28 (SD 3.9). Female students indicated a more pos-itive perception of their environment than did males on almost all aspects. Conclusion: Study using DREEM inventory revealed problematic areas of learning environment in our medical school, which help us in de-ciding priority areas for reform of educational environment.

The relationship between emotional intelligence and academic achievement in medical undergraduate.

Background: In today’s era of technology, intelligence and success are not viewed the same way they were before. New theories of intelligence have been introduced and are gradually replacing the traditional theory. Academic achievement is based on creativity, emotions, and interpersonal skills. Methods: The aim of this study was to see whether there is a relationship between emotional intelligence and academic success. Study was done on 1st MBBS students of Govt. Medical College, Bhavnagar. The sample size was 75 students (boys and girls). The emotional intelligence questionnaire from Institute for Health and Human Potential was given to the students, Depending on the EQ score we divided the students in to five groups and compared with their academic performance. Results: Study showed inverse relationship between emotional intelligence and academic achievement. Conclusion: There is a negative relation among emotional intelligence and academic achievement of the participants.

Small group structured oral examination: An innovation in oral examination.

Assessment drives learning, For the past years, we have been using an Traditional oral exam i.e. one examiner or tow examiner taking oral examination of one student, as a part of the examination process for the First MBBS formative and summative assessment. There appears to be tremendous variation on what constitutes the "traditional" oral examination. Studies analyzing characteristics of oral examinations vary most often by format and number of examiners. Considering above pros and cons of traditional oral examination and on the basis of examiners’ feedback, the new format of viva voce examination is started in the form of “Small Group Structured Oral Examination”(SGSOE). In SGSOE Students will be divided in the small group of 10 to 12 students in each group. They have to sit in chronological order in group. Two examiners will be assigned to group . For examination, according to roll no, they have to randomly select a chit from box. Than student has to give answer of main question mention in structured viva card of the topic Than rest of the students one by one, has to give answer of leading question related to that topic. after completion of Group Viva (GV) group of two examiner present at group viva will decides Marks, depending number of topic attend by all the students. Thus, It is one of the new exam systems designed to make an objective, valid and reliable assessment of different components of subject.

Implementation of stress coping skills programme in dental students’ curriculum to improve the validity of their assessment.

The key dictum to build reliability (and validity) for any assessment is to have multiple tests on multiple content areas by multiple examiners using multiple tools in multiple settings. Moreover, stress coping skills will have positive impact on all the domains which in turn give a boost to positive tendencies, viz., increasing their attentiveness in class, concentration, and learning and thereby reduce the altered performance due to stress. As a result, the CIV (noise in the assessment) is reduced and hence the validity of assessment is improved. Psychologist and Psychometricians are to be appointed in every institute.

Comparative study of lipid profiel on healthy smoker and non smokers.

Background: Smoking is considered to cause heart disease, cancer, stroke and also have close relationship with gastric ulcer, periodontal disease, sudden infant death syndrome, and metabolic syndrome. Aims & Objective: (1) Study the effect of smoking on lipid profile of healthy smokers (2) To compare the lipid profile of both smokers and non-smokers (3)To study the effect of severity and duration of smoking on lipid profile. Material and Methods: The present study “Comparative study of lipid profile on healthy smoker and non-smokers” was carried out at Department of Physiology, Govt. Medical college, Bhavnagar on 100 healthy smokers and non-smokers. Results: The total serum cholesterol, LDL, VLDL and Triglyceride values were higher in smokers as compared to Non-smokers. These values increased with increase in number of Cigarette/bidis smoked. Serum levels of HDL are lower in smokers than the same in non-smokers. Serum HDL levels decrease with increase in number of Cigarette/bidis smoked. Association of HDL had inverse relationship with cigarettes/bidis smoked per day. Increase in duration of smoking adversely affects lipid profile. Bidi smoking has more adverse effects HDL than cigarette smoking although statistically significant results were not obtained. It shows that serum anti-atherogenic HDL-C level is significantly low in chronic smokers irrespective of the number of cigarettes smoked. The serum level of total cholesterol, LDL-C and VLDL-C and TG are significantly increased with the severity of smoking. The results shows that smoking influences the lipid profile adversely hence causing dyslipidaemia in smokers. Smoking results in increase in oxidized LDL-cholesterol level which plays a key role in the development of atherosclerosis, and also raising the cardiovascular disease risk. Conclusion: Tobacco smoking is associated with dyslipidaemia (Increase LDL-C and decrease HDL-C levels), which is atherogenic in nature. As tobacco smoking interacts with other risk factors, the tobacco smokers get additional benefit if these factors are diagnosed and managed adequately. These risk profiles may be helpful in developing preventive cardiovascular strategies for adolescents.

A prospective study for comparison of hematological parameters in healthy young adult and elderly age group subjects.

Aims & Objectives: This study of hematological parameters is the object of continuing intensive research of hematopoietic system to the functional integrity in aging. (1) Assessment of Hb, total RBC count in healthy young adult as well as in elderly subject.(2) Assessment of Hct & blood indices (MCV, MCH, MCHC) in healthy young adult as well as in elderly subject.(3) Comparing the values of Hb & total RBC count in healthy young adult with the elderly subject.(4) Comparing the values of Hct & blood indices (MCV, MCH, MCHC) in healthy young adult with the elderly subject.(5) To co-relate the results of present study with findings of other studies. Material & Methods: The hematological indices analysed were Hb, HCT, and Total RBC Count, Blood indices like MCV, MCH & MCHC. Hematological values were measured by the different method in laboratory with the use of standard test reagent. Results: In present study, the result shows that a significant decrease in Hb concentration and RBC count are associated with decrease in Hct, MCH, MCHC and little increase in MCV. Conclusion: In present study, the overall assessment shows that a significant decrease in Hb concentration, reticulocyte count and RBC count are associated with decrease in Hct, MCH, MCHC and little increase in MCV. These results show a significant decrease in haematological parameters in old age and fairly accurate reflection of decreased erythropoietic activity of bone marrow.

Impact of gibberish meditation on students learning in a dental school.

Background: Gibberish meditational technique claims to reduce the stress and decrease unnecessary thought currents helping the practitioner to be relaxed and attentive. Aims & Objective: The aim of the present study was to know the effect of this technique, just prior to a learning session, on the student’s academic performance, perception and pulse rate. Material and Methods: 87 dental students were divided into two groups by systematic allocation. One group practiced Gibberish meditation technique and the other was control group. Both groups attended a one hour lecture as a part of their regular lecture series. Results: Results did not show any significant difference between the groups in academic performance, although meditation group scored higher. Significant number of students in gibberish group reported to be more attentive, comfortable, relaxed and had better memory and had significant reduction in mean pulse rate. Students expressed a feeling of relaxation and of having a fun filled learning atmosphere after meditation. Conclusion: This simple and easy technique of meditation could be adopted to enhance student learning.

Predicted maximal oxygen consumption (VO2MAX) values obtained during the maximal treadmill test using different protocols.

Background: VO2MAX is the sole major criterion for endurance assessment. By using the regression equation the necessity of the sophisticated gas analyzer is eliminated. The usability and applicability of such equations are questioned due to non-uniformity, standardization and other variables. Methods: 100 healthy young male subjects were recruited and each performed all the four selected treadmill protocol viz. Bruce, Modified Bruce, Ellestad and Balke. VO2MAX was calculated for each person for each protocol by using regression equation. Results: Mean and SD values of VO2MAX of each protocol were, Balke (41.94 ± 2.15), Bruce (64.55 ± 6.7), Ellestad (61.17 ± 7.5), Modified Bruce (64.36 ± 5.4). There was difference among different protocols (p<0.05), except between Bruce and Modified Bruce (p>0.05). These were compared with ACSM predicted equation based on age and height (51.5+7.4). Later Paired t-test was applied. There is no statistically significant difference between the Bruce and Modified Bruce protocols. Highest difference was observed between the Balke and Bruce protocol and between Balke and Modified Bruce, as was the difference between Balke and Ellestad protocol. Conclusion: For endurance testing Ellestad protocol can be a suitable option in resource crunch settings as the Balke protocol underestimates and Bruce overestimates the VO2MAX. Devising a ramp protocol for the population subset’s need can be the best option.

A comparative study of reticulocyte count in healthy young adult and elderly age group subjects.

Introduction: Aging process has been viewed as progressive decline in physiological process necessary for maintenance of a constant milieu interior and death as the ultimate failure to sustain homeostasis. Reticulocytes are juvenile red cell. It is flat non-nucleated disc shaped, slightly larger than mature erythrocyte .The number of reticulocyte present in the peripheral blood is a fairly accurate reflection of erythropoitic activity of bonemarrow. Normal values in young adult- 0.5 to 2.5% of total RBC count. The present study was conducted to find out changes in the reticulocyte count in the elderly subject. Aims: to uncover the effect of aging on reticulocyte count. Material and method: 90 subjects were divided into two groups, normal control group (n=30, mean age 35.83yrs) and elderly group (n=60, mean age62.55yrs). Reticulocyte counts were done by new Methylene Blue method. Result & Observations: significant decrease in reticulocyte count was observed in elderly group as compare to normal control group. Conclusion: our data suggests that aging may alter haematological parameters including reticulocyte count.

Effect of blood pressure on diabetic nephropathy.

Background: Hypertension is known to be risk factor for the development of proteinuria in patients with uncontrolled diabetes mellitus type2, leads to progression of end stage renal disease Aims & Objective: To study the effect of hypertension on diabetic nephropathy in type 2 diabetic patients. Material and Methods: We investigated, progression of diabetic nephropathy by measuring arterial blood pressure , serum creatinine and glomerular filtration rate(GFR) level in 60 (35 men and 25 women) type 2 uncontrolled diabetes mellitus patients on antihypertensive treatment. Results: The survey was done for 6 months during which 30 (group 1) -uncontrolled diabetes mellitus patients with normal blood pressure were compared with 30 (group 2) -Uncontrolled diabetes mellitus patients with hypertension who had mean systolic blood pressure (SBP) was 148.86 ± 5.12 mmHg. In group 2 the mean level of serum creatinine (1.71 ± 0.46 mg/dl) was significantly higher and mean GFR (54.57 ± 35.26 ml/min) was significantly lower than group 1 (P < 0.05). Conclusion: Uncontrolled hypertension leads to progression of diabetic nephropathy with decline in GFR earlier than normotensive uncontrolled diabetic patients.