The correlation of screen time with sleep quality: A cross-sectional study on undergraduate medical students

Background: Continuous and long-term exposure to the screens of electronic devices, especially smartphones, cell phones, and tablets, is associated with poor quality of sleep. Aim and Objectives: The study was undertaken to correlate screen time exposure and the quality of sleep in undergraduate medical students and to find out the effects of increased screen time exposure on the health of students. Materials and Methods: The study was carried out on 200 undergraduate medical students at Smt. B. K. Shah Medical Institute and Research Centre, Piparia, Vadodara, Gujarat with the help of an online pre-validated questionnaire constructed on Google Form after obtaining ethical approval. The questionnaire was comprised demographic profiles, screen time exposure, and Pittsburgh sleep quality index (PSQI) statements. Data were entered into an Microsoft Excel sheet. For the descriptive statistical part, means, standard deviations, and frequency tables were used. A Chi-square test was applied to detect the strength of the association. P < 0.05 was considered statistically significant. Results: The prevalence of increased screen time among the study population was found 79%. The prevalence of PSQI scores >5 observed in the present study was 73%. There was a significant association observed between increased screen time exposure and PSQI score >5. Conclusion: Increased screen time was significantly associated with poor sleep quality. The most common effect of increased screen time exposure among students found was a headache.

Students’ reflection on immediate feedback during formative assessment

Background: Providing immediate feedback to students has shown improvement in students’ knowledge, understanding, and confidence as it helps in identifying lacunae and loopholes in learning process. Despite the usefulness of feedback, common complaint from students is that they usually do not receive feedback immediately in their learning process. We also face similar situation with our students in institute. The aim of this study was to find out effect of giving immediate feedback and explore the views of medical students on immediate feedback during formative assessment. Aims and Objectives: The aims of this study were to evaluate the effect of immediate feedback on the medical students’ learning in medical education. Materials and Methods: The study was conducted in Department of Physiology, GMERS Medical College, Valsad on 183 students of 1st MBBS after ethical approval. Two types of modules were prepared on using “Hot Potatoes” software version 6.3. Module-1: Test 1 without feedback: consist of 20 MCQs and Module-2: Test 2 with feedback: consist of 20 MCQs, provide immediate feedback for each option of MCQ. Two modules were given one by one on WhatsApp group on mobile phone. Reflection writing and feedback from students were taken after that. Results: The qualitative data collected provided important information about the immediate feedback. Feedback responses of students on the questionnaire were analyzed using Likert scale. The Likert scale values were in strongly agree/agree part for Module-2 (with feedback). The students believed that immediate feedback was very helpful in clearing concepts, finding out lacunae, improvement in confidence, and self-learning. An excellent way for self-assessment and improved their deeper understanding of content areas. The students enjoyed innovative way of learning compared to conventional learning. Conclusion: Immediate feedback using this type of feedback modules should be implemented to improve students’ knowledge, understanding, memory, and confidence and can be used as self-directed learning tool.

Cutaneous Features, Autoantibody Profile, and Nailfold Capillaroscopy of Systemic Sclerosis: A Study of 60 Cases

Background: Systemic sclerosis (SSc) is an autoimmune chronic multisystem disorder with a plethora of cutaneous manifestations. These manifestations often may be the only presenting complaint. Early identification of these help in diagnosing grievous systemic manifestations and their prompt and appropriate treatment. Aims: To study the clinical profile of SSc, modified Rodnan’s skin scoring (mRSS), nailfold capillaroscopy (NFC) patterns, antibody profile in the western India population, and their association with cutaneous manifestations. Methods: Patients of SSc fulfilling the European League Against Rheumatism (EULAR) 2013 classification of SSc criteria, who attended dermatology outpatient department (OPD) between January 2017 and September 2018 were included in the study. The demographic data, cutaneous features, autoantibody profile, mRSS, and NFC pattern were noted Results: A total of 60 patients (57 females and 3 males; mean age years) of SSc were evaluated. Clinical subtypes were 40 diffuse cutaneous SSc and 20 limited cutaneous SSc. The most common presenting symptoms were Raynaud’s phenomenon (RP) (95%) and skin tightening (90%). The common cutaneous findings were sclerodactyly (86.7%), stellate scars (78.3%), parrot-beaked nose (76.7%), mask-like facies (75%), microstomia (56.7%), salt and pepper pigmentation (55%), puffy finger (46.7%), telangiectasia (46.7%), digital ulcer (38.3%), fixed flexion deformity (33.3%), and calcinosis cutis (8.33%). Limited cutaneous systemic sclerosis (lcSSc) had mRSS score of 8.3 ± 4.1 and diffuse cutaneous systemic sclerosis (dcSSc) subset had a score of 28 ± 10.4. Antinuclear antibody (ANA), Anti-topoisomerase antibody (ATA), and anti-centromere antibody (ACA) were positive in 59, 49, and 7 patients, respectively. The NFC patterns were early (23.3%), active (45%), and late (18.3%). Limitation: The sample size of the study was small. We were not able to determine the significance of other less common autoantibodies with scleroderma. Conclusion: The study highlights the importance of identifying early cutaneous findings and the role of a useful diagnostic and prognostic reproducible scoring system (mRSS) and NFC.

Lessons for the future-psychosocial perspectives of vaccine literacy among beneficiaries at a COVID-19 vaccination center in a tertiary teaching hospital in Punjab, Northern India: A qualitative analysis

Background: Due to the unprecedented magnitude of the current Coronavirus disease 2019 (COVID-19) pandemic, vaccine development was fast-tracked; yet, there were barriers to vaccination uptake. Aim and Objectives: The objectives of this study were to understand the factors promoting vaccination and the barriers to vaccination, to explore the infection prevention and control practices followed after vaccination. Materials and Methods: A qualitative study using in depth interviews, both face to face and telephonic; among beneficiaries willing to participate and given at least one dose of COVID-19 vaccine in the institutions’ vaccination center, stratified sampling technique was used. Informed consent was obtained. Absolute confidentiality was ensured. The interviews were recorded and transcribed verbatim and validated by back translation into vernacular. The results obtained were analyzed using framework approach and categorized into themes and subthemes and valid conclusions drawn. Results: Various factors promoting willingness for vaccination and barriers perceived by the participants in their community, social, and occupational setting have been revealed in the present study. Availability of vaccine along with clear and accurate information can go a long way in overcoming vaccine hesitancy and promoting vaccine literacy. Conclusion: Clear and accurate information should be disseminated. The role of social media, mass media, and dissemination of information by word of mouth cannot be undermined. It is hoped that results of the present study will aid in formulating future vaccination programs.

Pediatric-type diffuse low grade gliomas: Histomolecular profile and practical approach to their integrated diagnosis according to the WHO CNS5 classification

Department of Pathology and Lab Medicine, All India Institute of Medical Sciences, Bhubaneswar, Odisha, India

Department of Neuropathology Laboratory, Neurosciences Centre, All India Institute of Medical Sciences, Ansari Nagar, New Delhi, India

World Health Organization Classification of Tumors of the Central Nervous System 5th Edition (WHO CNS5): What's new?

The latest fifth edition of the World Health Organization classification of central nervous system tumors (WHO CNS5) has been built on the prior WHO 2016 classification as well as recommendations put forward by seven updates of the Consortium to Inform Molecular and Practical Approaches to CNS Tumor Taxonomy (cIMPACT). Various new tumor types and subtypes have been recognized which are of clinical significance. Tumor groups have been restructured and the nomenclature of some tumor types has also been revised. The use of terms 'entity' and 'variant' have been replaced by 'type' and 'subtype'. Significant changes have been introduced in the grading of tumors viz. use of Arabic numerals, grading within individual tumor types and combined histological and molecular grading. The terms 'Not otherwise specified' and 'Not elsewhere classified' can now be used for all tumor types. WHO CNS5 also for the first time endorses the use of DNA methylation profiling for the diagnosis of some tumor types/subtypes. Finally, the importance of combining histology with molecular parameters is emphasized for the “layered reporting” and “integrated diagnosis”, which will provide valuable diagnostic, prognostic, and predictive information, as well as for some entities, suggest targeted therapies.

Sexuality Education- Understanding adolescents’ perspective

Introduction: Adolescence is very dynamic phase in life and if child is not able to cope up with the changes then the effects on health are lifelong. Evidence supporting role of holistic/ comprehensive sexuality education empowering children in this coping process is present. But still the controversies exists in all countries about either acceptance, content or delivery of the sexuality education. To make curriculum more acceptable, engaging and effective, it is very important to take into consideration adolescent’s perspective. In present study, we tried to understand felt need of adolescents about sexuality education. Objective: To understand need for sexuality education. Methods: The methods used were question box, selfadministered questionnaire, and name the organs in blank human figure activity all in different set of students. Results: 48% questions were to seek scientific information but extent was up to enquiring about sex toys.12% about emotional changes, 11% about cultural norms,9% about romantic relationship and 6% to clear myths. The basic knowledge about human body, pubertal changes was poor, more so in girls. The attitude towards pubertal changes was mostly negative in girls, curious in boys. The inhibition in mentioning reproductive system organs was significant in both, indicating attitude. 98% were willing to have correct knowledge about the pubertal changes and effects on life. Conclusion: The comprehensive sexuality education is unmet need in India. Taking into consideration perspective of adolescents, it should contain scientific knowledge and other relevant topics.

Knowledge of rural women regarding activities of accredited social health activist in three different villages of District Amritsar: A cross-sectional study

Background: Accredited Social Health Activist (ASHA) is the grass root level worker and hence plays a prime role in making primary healthcare accessible to rural areas. She creates awareness on health and persuading the community toward local health planning and hence plays major role in increasing utilization of health services. The knowledge of the people about the availability of ASHA in their area and about the activities performed by her also play important role in utilization of services given by ASHA. Hence, keeping this in view the present study was conducted. Aim and Objectives: (1) The aim of the study was to assess the knowledge of the rural women about the availability of ASHA in their area and (2) to assess the knowledge of the rural women about the activities performed by ASHA. Materials and Methods: The study was conducted in rural field practice area of Government Medical College, Amritsar, Punjab. The study was a cross-sectional type and the adult decision maker female of the family was interviewed using a pre-designed and semi-structured pro forma after approval from Institutional Ethics committee. A total of 1521 females were interviewed. Results: The present study revealed that majority (52.3%) of the respondents were in the age group of 24–45 years, 41.7% illiterate and 54.6% in the upper lower class. It was found that 45.8% respondents were visited by ASHA and out of these, majority of the respondents (78.2%) were visited for Maternal and child health services followed by health awareness (20.7%) and minor illnesses (9.9%). Conclusion: The visits by ASHA were irregular and majority of the respondents were visited by ASHA for maternal and child health services in all the three villages and hence knowledge regarding these activities was seen to be more among the respondents. However, overall less knowledge was seen among the villagers about other activities being performed by ASHA worker.

Critical Evaluation Of Complications Of Neck Dissection

BACKGROUND: Radical neck dissection is a reliable method of treating patients with head and neck cancer; it carries substantial morbidity and complications. This surgery has become a routine in many oncological centres but knowledge of possible complications and their management is a must for treating surgeons METHODS: In this study 60 patients undergoing neck dissection as elective or therapeutic, comprehensive or selective, as a sole procedure or combined with other surgery, with or without other modalities of treatment were selected and managed and all the complications were critically analysed. RESULTS: A total of 26 complications (43.3%) occurred in this study. There were 7 cases of thoracic duct injury (11.6%), 5 cases of post operative chyle leak (8.3%) and 2 cases of RLN injury (3.3%) and 1 case of injury to main trunk of facial nerve (1.6%), 2 patients had temporary paresis of marginal mandibular nerve (3.3%). Post operatively marginal necrosis of skin flap was present in 8 patients (13.3%) and 1 patient had facial and glottic oedema (1.6%). CONCLUSION: Despite the best planning, complications can still occur but their impact can be minimised by a vigilant and proactive emphasis in the entire peri-operative period.

Barriers to timely presentation for appropriate care of retinopathy of prematurity in Odisha, Eastern India

Purpose: To analyze the causes for late presentation in a series of patients with advanced retinopathy of prematurity (ROP) in a tertiary eye care institute in Eastern India. Methods: We analyzed our medical records and ROP database retrospectively from 2007 to 2015 and prospectively thereafter till 2017 to identify the factors for late presentation in babies with advanced ROP (stages 4 and 5). Results: A total of 71 eligible subjects were analyzed. The mean chronological age was 15.1 months (2 months to 14 years). The three important barriers were: (1) the system and neonatal care policy failure (n = 45; 63.3%), (2) parental negligence and ignorance (n = 19; 26.7%), and (3) ophthalmologist's misdiagnosis or unavailability (n = 7; 10%). Majority of the babies (63.3%) were admitted in the neonatal care unit when they were due for ROP screening with an average duration of stay of 35.5 days. Conclusion: The main barriers to early screening for ROP were related to availability of trained human resources, ignorance of “parents and health care personnel,” and distance from the point of care. This calls for training of ophthalmologists, advocacy with neonatologists and parents, and create systems for better coordination and compliance of the care providers.

Glycemic status in diabetic and nondiabetic ESRD Patients with or without hemodialysis in rural hospital of Central Maharashtra.

Background: Diabetes is a potent cardiovascular risk factor in the general population as well as in people with end-stage renal disease (ESRD) undergoing maintenance dialysis treatment. Previous observational studies have yielded inconsistent results regarding the association between glycemic controls in patients receiving maintenance hemodialysis (MHD). Studies provide evidence that very poor glycemic control is associated with higher mortality in dialysis patients. The significance of the levels of glycosylated haemoglobin in non-diabetic patients with renal disease receiving maintenance hemodialysis remains unclear at the present time. The knowledge of HbA1c in patients with renal diseases could be important in assessing the overall prognosis in such patients and it also has implications in the assessment of their glycaemic status and in preventing post-dialysis morbidity and mortality. Aims & Objective: (1) To study the role of HbA1c as a marker of glycemic status in patients of kidney disease with or without MHD. (2) To compare the utility of fasting glucose level and HbA1c in accessing glycemic status and their relationship. Material and Methods: Study was conducted in the AVBRH, Jawaharlal Nehru medical college, Sawangi (M) Wardha by department of Biochemistry in collaboration with Department of Medicine. 30 patients undergoing maintenance hemodialysis and 30 patients of kidney diseases who are not undergoing MHD, has been taken from ABVRH Sawngi (Meghe). 30 age and sex matched healthy controls were also included in the study. 5.0 ml of blood has been collected from each subject after informed consent .Different parameters such as HbA1c, Fasting and random blood glucose, Urea creatinine, sodium potassium were evaluated in all the groups. Results: Study concluded that the HbA1c values in CKD patients undergoing hemodialysis is found above the normal range (6.71 ± 0.99) as compared to the control group (4.38 ± 0.52) while the results of HbA1c in CKD patients not going through hemodialysis found to be within the normal range (4.93 ± 0.52) and less than the patients going through the hemodialysis (6.71 ± 0.99) but more than the control group (4.38 ± 0.52). Conclusion: In non-diabetic patients with ESRD undergoing hemodialysis HbA1c may be used as a marker of impaired glucose metabolism and glycemic control is necessary to prevent future complications in these patients. Secondly in CKD patients not undergoing hemodialysis HbA1c value are more than control though they are under normal limit but it should be strictly monitored.

Extra Adrenal Pheochromocytoma Presenting as Hypertensive Crisis in a Young Male.

Pheochromocytoma is a tumor of aderenal medulla which secrets catecholamines and usually presents as hypertension. Extra-adrenal pheochromocytomas are extremely rare. They occur in the organ of zukerkundle, bladder, retroperitonium, posterior mediastinum and sympathetic chain. We present a case of a young male who presented with hypertension and eventually was found to have extra adrenal pheochromocytoma of the bladder.

Progressive Supranuclear Palsy (PSP).

We present 2 cases of Progressive supranuclear palsy (PSP), both of the cases presented to us with typical signs of Parkinson’s disease (PD), but they also had history of falls and difficulty in looking downwards. PSP is one of the variants of Parkinson Plus Syndromes.

Multiple visceral abscesses due to tuberculosis.

Tuberculosis is a global epidemic, especially in India. In immuno-competent host, abdominal tuberculosis most commonly presents as ileo-caecal tuberculosis and ascitis. Presented is a rare case of immuno-competent host with abdominal tuberculosis in the form of multiple visceral abscess.

The quality of life of women volunteering as live-related kidney donors in India.

Background. Women outnumber men 6:1 as live-related donors in our renal transplant programme. Women donors in developing regions are often illiterate and unemployed. This study was done to assess the change in quality of life of women who donate kidneys. Methods. We prospectively studied 73 consecutive women volunteering as live-related kidney donors over a 6-month period using the World Health Organization Quality of Life Brief (WHO QoL Bref) Questionnaire and Hospital Anxiety and Depression Scale (HADS). Each woman was interviewed 2 weeks before and 6 months after kidney donation. Results. There was a significant improvement in all the domains, namely physical (p=0.0001), psychological (p<0.0001), social relationship (p=0.037) and environment (p<0.0001) of the WHO QoL Bref questionnaire. Donors who were mothers had a greater improvement in all 4 domains than donors with other relationships. There was a significant decrease in the depression score (p<0.0001), but no change in the anxiety scores (p=0.065) following kidney donation. All donors would donate again, if possible. Conclusion. In live-related women kidney donors, quality of life improves and depression scores decline after kidney donation.

Prediction of lymph node metastases by preoperative nuclear morphometry in oral squamous cell carcinoma: A comparative image analysis study.

Context: Prediction of metastases of oral squamous cell carcinoma (OSCC) using incisional biopsy. Aims: To assess the efficacy of nuclear morphometry in predicting the nodal metastases of OSCC and to compare manual and computer-based image analyses. Materials and Methods: Sixteen cases of moderately differentiated squamous cell carcinoma (8 with metastasized lymph nodes and 8 node-negative cases) were examined using manual and computer-based image analyses. Nuclear area, perimeter, circular rate, larger to shorter axis ratio, and coefficient of variance of nuclear area (NACV) were calculated from 100 nuclei of the processed incisional biopsy specimen. Statistical Analysis: The parameters were compared between the node positive and negative cases using Student's t test and with the level of lymph node involved using ANOVA test and Bonferroni's post hoc assessment. Manual and computer-based image analyses were compared by Spearman's correlation. Results: A significant variation between the node positive and negative groups was observed with respect to circular rate (P = 0.031) and NACV (P = 0.036). The nuclear area (P = 0.009), perimeter (P = 0.0001), circularity (P = 0.045), and larger to shorter diameter ratio (LS ratio) (P =0.02) were significantly different in the levels of the nodes involved. There was good a correlation between manual and computer-based analyses (Spearman's rho, 0.616-0.824) in nuclear size parameters and the circular rate had a negative correlation (-0.118, P = 0.664). Nuclear circularity was better assessed by computer-based analysis. Conclusion: Preoperative morphometric assessment of the nuclear features may detect early cellular changes and thus, are useful in predicting nodal metastases in OSCC.

Kaposi's sarcoma: A presenting manifestation of HIV infection in an Indian.

Kaposi's sarcoma (KS) is a multifocal neoplastic proliferation of endothelial cells predominantly involving skin and other organs. HIV-associated Kaposi's sarcoma has been rarely reported from India. A 38-year-old male presented with persistent swelling on the left lower limb for one year along with multiple erythematous to dusky papules and plaques of one and half months duration and swelling and black discoloration of right lower limb for one month. Cutaneous examination revealed numerous skin colored and erythematous papules and plaques distributed on the left lower limb on the anteromedial aspect and verrucous plaque on the left sole. Multiple erythematous, grouped papules were present over the soft palate. Skin biopsy showed numerous slit like spaces dissecting into the collagen of the upper and mid-dermis along with 'promontory sign' suggestive of Kaposi's sarcoma. Patient was found to be HIV-positive by ELISA test.

Rare presentation of a common disease of tropics.

A 19 years male presented with fever, oliguria and purpuric lesions involving both hands. The patient was diagnosed as a case of purpura fulminans with disseminated intravascular coagulation due to complicated falciparum malaria. The case is presented to sensitize the physicians to keep malaria as a differential in cases of fever with purpura fulminans.