Impact Of Communication Skills Training in Postgraduate Medical Education

Background: Effective communication is a key feature of optimal doctor-patient relationship. As the postgraduate curriculum lacks standardized teaching and assessment, this study aimed to assess effec-tiveness of training program on communication skills of postgraduate medical students. Materials and methods: A prospective, interventional study was conducted among first year postgrad-uate medical students from different clinical specialty. Training program included introduction to prin-ciples of communication with basics of doctor-patient relationship, administering informed consent, breaking bad news and counselling patients with HIV/cancer. Pre and post-test skill assessment by Fac-ulty and postgraduate (PG) self-rating was carried out using KEECC-A Assessment tool for seven core communication competencies. Perception of students on training program was collected via feedback questionnaire. Results: Forty-three postgraduate medical students participated. Statistically significant increase in communication skills scores was observed post training with mean post-test assessment scores of 24.26�94, p<0.001(rating by faculty), 25.19�76, p<0.001(PG self-rating) and high degree of internal consistency was found. Students perceived the training program as valuable and highlighted its im-portance as a part of curriculum. Conclusion: Training program significantly enhanced communication skills of postgraduate medical students. Integration of standardized teaching and assessment of communication skills is essential for better healthcare practice and optimal doctor-patient relationship.

Association of UGT1A6 gene polymorphism with clinical outcome in pediatric epileptic patients on sodium valproate monotherapy

Pediatric epilepsy comprises chronic neurological disorders characterized by recurrent seizures. Sodium valproate is one of the common antiseizure medications used for treatment. Glucuronide conjugation is the major metabolic pathway of sodium valproate, carried out by the enzyme uridine 5′-diphosphate (UDP) glucuronosyl transferase (UGT) whose gene polymorphisms may alter the clinical outcome. The objective of this study was to assess the association between UGT1A6 genetic polymorphism and clinical outcome in terms of efficacy and tolerability in pediatric epileptic patients on sodium valproate monotherapy. Pediatric epileptic patients (n=65) aged 2-18 years receiving sodium valproate monotherapy for the past one month were included. Genetic polymorphism patterns of UGT1A6 (T19G, A541G, A552C) were evaluated by PCR-RFLP. Clinical outcome was seizure control during the 6 months observation period. Tolerability was measured by estimating the hepatic, renal, and other lab parameters. Out of 65 patients, TT (40%), TG (57%), and GG (3%) patterns were observed in UGT1A6 (T19G) gene, AA (51%), AG (40%), and GG (9%) in (A541G) gene, and AA (43%), AC (43%), and CC (14%) in (A552C) gene. No statistical difference in clinical outcome was found for different UGT1A6 genetic polymorphism patterns. We concluded that different patterns of UGT1A6 genetic polymorphism were not associated with the clinical outcome of sodium valproate in terms of efficacy and tolerability. Sodium valproate was well-tolerated among pediatric patients with epilepsy and can be used as an effective antiseizure medication.

Can high normal TSH level predispose to hypercholesterolemia?

Background: Thyroid hormone plays an important role in carbohydrate, protein, and lipid and electrolyte metabolism. Studies have demonstrated the association of hypothyroidism with dyslipidaemia. However the impact of high normal TSH on lipid profile is lacking. Also, thyroid hormone is known to influence glomerular filtration rate, and renal electrolyte handling. So, this study compared TSH levels in normal ranges with fasting lipid profile and electrolytes. Objectives: To measure and compare the levels of serum TSH, fasting lipid profile and electrolytes in euthyroid individuals with normal TSH and to correlate serum TSH with lipid profile and electrolytes across different age groups in both sexes. Materials and methods: After obtaining ethical clearance, 2 ml of fasting venous blood sample was drawn from 200 subjects (males=100, females=100) aged between 20-75years who consented to participate. Serum was used for estimation of TSH, lipid profile and electrolytes. TSH was measured by 4th generation Immunoassay in Cobas 6000 e601 autoanalyzer (Roche). The lipid profile and electrolytes were assayed in Cobas 6000 c501 autoanalyzer (Roche). Results: Serum TSH values showed significant positive correlation with total cholesterol (p=<0.001), triglycerides (p=<0.001) and LDL cholesterol (p=<0.001), but did not show any significant correlation with HDL cholesterol. Also serum TSH showed significant negative correlation with sodium (r=- 0.185, p=0.048) and potassium (r=-0.205, p=0.028) levels. Conclusion: TSH and thyroid status can influence lipid and electrolyte metabolism. High normal TSH level may predispose to hypercholesterolemia and hypertriglyceridemia. High normal TSH patients can have lower serum electrolytes.

Recurrent Kimura's disease: excellent response to cyclosporine.

Kimura's disease is a chronic inflammatory disorder involving the skin, subcutaneous tissues and lymph nodes, predominantly in the head and neck region. Though surgery, intralesional or systemic steroids or radiation therapy have been the mainstay of treatment recurrence is a common problem. On the basis of occasional case report of Kimura's disease responding to cyclosporine, we attempted oral cyclosporine in our patient with dramatic improvement.

Pulmonary hydatid cyst in HIV-1 disease.

A 36-year-old male patient, a known case of retroviral disease, presented with clinical features suggestive of pneumonia and was found to have bilateral lower zone lung consolidation which on resolution showed a cystic change on the chest radiograph. A subsequent CT scan revealed the true nature of these cysts to be ruptured pulmonary hydatid cysts showing a 'water lily sign'. The rare association of pulmonary hydatid cyst and HIV from India is described.

Plus minus lid syndrome with ataxia.

Plus minus lid syndrome is an ocular syndrome characterized by unilateral ptosis and contralateral lid retraction. Also when the ipsilateral lid is raised manually, the contralateral retracted lid does not revert. This patient presented with features of plus minus lid syndrome with ataxia due to a vascular mesencephalic lesion.

Kaposi's sarcoma with thrombocytopenia in a heterosexual Asian Indian male.

A 45-year-old heterosexual male patient with retroviral disease since 12 years presented with hyperpigmented lesions, misdiagnosed initially as purpura due to an associated thrombocytopenia, but was biopsy proven to be Kaposi's sarcoma (KS). Bone marrow examination revealed excess megakaryocytes. Low CD4 count and absence of platelet specific IgG reduced the likelihood of immune thrombocytopenia (ITP). However after 6 weeks of antiretroviral therapy the patient's lesions have reduced and platelet counts are improving, possibly suggesting a sequestration thrombocytopenia in the abnormal tumor vessels of KS.

Acinetobacter sepsis in neonates.

Twenty-six neonates were diagnosed to have acinetobacter sepsis during 1986-90, representing 6.5% of all cases of bacteriologically proven sepsis. Of these 19 neonates were low birth weight (LBW) 12 were small for gestational age (SGA). Nineteen neonates had early-onset sepsis. The male to female ratio was 9:17. The hematological profile was suggestive of sepsis in 17 cases. All infants had clinical evidence of multi system infection. Eleven babies died; the cases-fatality rate was 42.3%. Only 15/25 culture isolates were sensitive to gentamicin and resistance to other antibiotics was even more frequent. Acinetobacter was cultured from other sites: eye swabs, skin pustules and umbilical catheter tips. Environmental nursery surveillance cultures done during the study period yielded Acinetobacter once from a crib, but no cases of sepsis occurred around that time. The epidemiological features of this organism illustrate the value of vigilance and precautionary measures.