Improving the self-confidence level of medical undergraduates during emergencies using high fidelity simulation

Introduction: Medical practice involves routinely making critical decisions regarding patient care and management. Many factors influence the decision-making process, and self-confidence has been found to be an important factor in effective decision-making. With the proper transfer of knowledge during their undergraduate studies, selfconfidence levels can be improved. The purpose of this study was to evaluate the use of High Fidelity Simulation as a component of medical education to improve the confidence levels of medical undergraduates during emergencies. Methodology: Study participants included a total of 60 final year medical undergraduates during their rotation in Medical Senior Posting. They participated in a simulation exercise using a high fidelity simulator, and their confidence level measured using a self-administered questionnaire. Results: The results found that the confidence levels of ‘Assessment of an Emergency Patient’, ‘Diagnosing Arrhythmias’, ‘Emergency Airway Management’, ‘Performing Cardio-pulmonary Resuscitation’, ‘Using the Defibrillator’ and ‘Using Emergency Drugs’ showed a statistically significant increase in confidence levels after the simulation exercise. The mean confidence levels also rose from 2.85 to 3.83 (p<0.05). Conclusion: We recommend further use of High Fidelity Simulation in medical education to improve the confidence levels of medical undergraduates.

Situation analysis of plasma collected for the production of DMR Hepatitis B vaccine

The Department of Medical Research (DMR) has been producing a safe and effective plasma derived hepatitis B (HB) vaccine since 1997 to meet the criteria of quality control tests recommended by the WHO. The production of this HBvaccine requires the HBs antigen (Ag) pasitive blood as raw material which has been collected from blood banks of the various hospitals in Yangon area. Among these collected blood bottles, only those with high HBsAg titre were pooled and purified for further manufacturing process. In this study, HBsAg titre of the blood bottles collected during the year 1992, 1993,1999 and 2000, and those used for production of various batches of HB vaccine were determined and compared. It was found that the quantities of blood bottles available for HB vaccine production and their HBsAg titres have been apparently reduced in the last two years. This may affect the production capacity of the vaccine. This could be one of the major obstacles ofr the large scale production of the plasma-derived HB vaccine tho meet the requirement of Extended Program of Immumization (EPI) in the near future. To fulfil this requirement, several solutions have been considered and discussed in this study.

Studies on the stability of DMR hepatitis B vaccine

The stability of the DMR hepatitis B vaccine at 4C and room temperature has been followed over a period of one year by monitoring its physical, chemical and biological characteristics bimonthly starting from February 1996. The pH and protein content of the vaccine did not change for both storage conditions throughout the study. The vaccines were found to be sterile and free from pyrogens and passed the general safety test on mice. The HBsAg titer started to decline after eight months of storage at 4C and after 10 days of storage at room temperature. However, the HBsAg adsorption rate to the adjuvant remained over 95 per cent for both storage conditions.

Effect of Azadirachta indica neem seed kernel extracts on Anopheles dirus mosquitoes

Neem oil (seed kernel extract) produced a strong repellent action on An. dirus mosquitoes (the major vector of malaria) in Myanmar even at concentrations as low as 0.5 and 1.0 percent. At a concentration of 2 percent no anopheles biting and the protection provided was 100 percent during 10-12 hrs periods. The larvicidal effects of neem oil on An. dirus (larvae) were determined by using 3rd instar and above. The LC90 and LC50 were found to be one percent and 0.45-0.5 percent respectively, The residual effect of neem oil under laboratory condition with 2 and 4 percent persisted ca 72+/-5 hrs. Moreover, under laboratory condition with 2 and 4 percent, the ovicidal effect was found to be 100 percent control.

The effect of antimalarials on reticulocyte count of patients with falciparum malaria

One hundred and eleven adult patients who attended North Okkalapa General Hospital for uncomplicated falciparum malaria were chosen for the study. They were treated with dihydroartemisinine (Cetexin), quinine, artesunate tablets and artemether injection. Fifty nine adult male and female without malaria were chosen as controls. They were treated with sulfadoxine-pyrimethamine, quinine and artesunate. Thick and thin blood films were taken from the patients daily and were stained and counted for malaria parasites. Packed cell volume (PCV), WBC count and reticulocyte count were also done. Among the patients treated with drugs, there was a significant fall in the mean reticulocyte count (number concentration and number fraction) at day 3. But the reticulocytes were raised back to normal at days 7 and 14. There was no significant changes in the mean packed cell volume (PCV) and mean level of total WBC count of the patients in all 4 groups. Among normal controls treated with artesunate tablets, there was also a significant fall in the mean reticulocyte count at day 3 but the mean reticulocytes count was also raised back to normal at days 7 and 14. Among normal controls treated with quinine and sulfadoxine-pyrimethamine tablets, there was no significant fall in the mean reticulocyte count. And there was no significant changes in PCV and WBC count in all 3 groups of controls. The fall in reticulocyte counts can be due to part of the disease malaria as well as to the drug including quinine and not singly to artemisinine therapy alone.

Anticholinesterase activities of some anthelmintic agents and some medicinal plants

It is known that anthelmintic drugs are potent cholinesterase inhibitors. A biochemical system for measurement of anticholinesterase activity of chemical agents and some reputed medicinal plants was established. Some of Myanmar medicinal plants were found to be cholinesterase inhibitors. Lettokegyi, an antidysenteric medicinal plant which was found to contain high anticholinesterase activity, can therefore be considered as a potential anthelmintic drug.

A study of maternal deaths at the Central Women's Hospital (1975-1979)

A study of maternal deaths during the 5-year period between1975 and 1979 is presented During the 5.year period studied there was a total of 242 maternal deaths.185 cases were due to obstetric causes and 57 cases were due to nonobstetric causes. Heart disease particularly rhuematic heart lesion and viral hepatitis were responsible for most of the deaths in non-obstetric causes. Out of 185 obstetric deaths 115 cases or 62.16 per cent were due to abortion. Sepsis is the main cause of maternal death. It accounts for 65.4 per cent of obstetric deaths. Septic abortion is a major contributory factor in the cause of maternal deaths due to infection. The overall trend in maternal deaths have reduced from 1965 to 1979. The pattern of change as regards the cause of deaths have also altered; infection alone being on the rise whereas other causes such as haemorrhage, pre-eclampsia, pulmonary embolism etc are on the decline.

Salmonella isolation from raw meat in Rangoon

Six hundred and ninety samples of raw meat collected from the slaughter house and markets of Rangoon were tested at the Bacteriology Section and Food and Drug Section of National Health Laboratory from June 1973 to July 1974. 63 salmonella of 9 different serotypes were isolated. Out of which S.anatum and S. derby are found to be the most frequent serotype all three kinds of raw meat. This is the first time salmonella from raw meat is reported.

Hysterectomy in Mandalay General Hospital

Hysterectomies were performed during the period 1965-1969 in the Obstetrics and Gynaecological Department of Mandalay General Hospital. The incidence of hysterectomy is found to be 55 per cent of all the major gynaecological operations: the commonest indication of hysterectomy being myoma of the uterus and the commonest age group between 41 and 45 years. The mortality of hysterectomy is found to be 0.84 per cent and the morbidity is 33.6 per cent.