Asynchronous e-learning in microbiology for undergraduate medical students

Background: The most common teaching method in medical institutes in India and throughout the globe is standard lesson-based teaching. E-learning is the use of internet technology to facilitate conscious learning and increase knowledge and competences, notably during the COVID-19 epidemic. Aim and Objectives: The aim of study was to develop a module for an interactive disease-based e-learning teaching session to impart knowledge to undergraduate medical students regarding the microbiological diagnostic techniques for enteric fever/the given organism with objectives of the study was (i) to investigate how Phase II MBBS students feel about e-learning; (ii) to evaluate the impact of this intervention on students; and (iii) to encourage application of this imparted knowledge and skill for rapid, precise, and early diagnosis of the disease. Material and Methods: The research was conducted at the department of microbiology. This was done for the session 2020–2021 of Phase II undergraduate students. All the second professional MBBS were enrolled in the study n = 229 and were better informed about the definition of e-learning. The course material was provided in the form of PowerPoint presentations, questionnaires, and text questions using Google Docs. Students provided feedback in the form of a semi-structured pre-validated set of questions at the conclusion of the week, and the collected data were quantitatively analyzed. There were both closed-ended and open-ended questions in the survey. Results: The results of the feedback questionnaire revealed that the program was of benefit to the students. Nearly 77% of students felt the new teaching and learning method enhanced their grasp of the courses and that the issues presented were important to them. Conclusion: The students responded in a positive way to the new teaching and learning method. It was informative, applicable, and effective to the students. It also increased the level of communication and feedback between teacher and students. To conclude, in the medical program, e-resources may be used to enhance conventional lesson-based instruction.

An open-label, randomized study to unfold the potential of Ficus benghalensis in modulation of cognitive impairment using diabetic (Streptozotocin induced) rats

Background: Diabetes mellitus is associated with cognitive, neurophysiological, and structural changes in the central nervous system. Aim and Objective: The aim of the study was to evaluate the effect of Ficus benghalensis on cognitive behavior and acetylcholinesterase levels in brain of diabetic rats, and to compare with Piracetam and Glimepiride. Material and Methods: Wistar rats of either sex weighing 150–200 g were randomized into ten groups of ten each (five groups of diabetic rats and five groups of non-diabetic rats) where one group of diabetic and one group of non-diabetic rats each received F. benghalensis dose I (50 mg/kg), F. benghalensis dose II (100 mg/kg), Piracetam (200 mg/kg) and Glimepiride (0.5 mg/kg), and one group of diabetic rats and one group of non-diabetic rats served as the control group. The blood glucose levels were assessed at 0 and 30th days. The assessment of acquisition phase of each cognitive behavior test was done on 0, 14th, and 29th days, whereas retention phase was assessed on 1st, 15th, and 30th days. Results: In comparison with diabetic control group, F. benghalensis at both doses showed significant decrease in blood glucose levels as well as acquisition and retention of Transfer Latency in elevated plus maze on 29th and 30th days, respectively. Further, both doses exhibited significant increase in retention of step-down latency (SDL) on 30th in continuous avoidance apparatus, but only dose II showed significant increase in acquisition of SDL on 29th day. Similarly, significant increase in retention of Quadrant-time in Morris Water Maze was also observed with both doses of F. benghalensis and other groups compared to controls on 30th day. However, significant decrease in brain AChE level, was observed with only F. benghalensis dose II. Conclusion: Overall, the positive effects of F. benghalensis on cognition were comparable to other two groups, namely, Piracetam and Glimepiride. Hence, it can be concluded that F. benghalensis might be effective in alleviating the behavioral and biochemical changes in diabetes mellitus.

Detection of Extended-Spectrum Beta Lactamases and AmpC Beta Lactamases Producing Uropathogenic Escherichia coli in a Tertiary Care Hospital

Background: The multidrug resistant among uropathogenic E. coli has become a potential threat to global health. The aim of the current study to evaluate the antimicrobial activities of nitrofurantoin and fosfomycin along with other antimicrobials against Extended Spectrum β-Lactamases (ESBL) and AmpC producer isolates from the most common organism E. coli. Methods: A total of 6046 clean catch midstream urine samples were collected and processed in Microbiology department of tertiary care hospital. The antimicrobial susceptibility of E. coli isolates was initially screened by Kirby-Bauer disk diffusion method. The resistant isolates were confirmed to be ESBL and AmpC producers by their respective phenotypic confirmatory tests of combined disc method. Results: Out of 6046 patients there were 1855 E. coli positive patients. Maximum patients in the age group of 21-30 years were 51.5% followed by 31-40 years where patients were 26%. 64.4% E. coli were isolated from female patients and 35.6% from male patients. E. coli showed higher sensitivity towards, fosfomycin (100%), imipenem (100%), nitrofurantoin (84.1%), piperacillin and tazobactam (77.3%), amikacin (76.1%) and while they showed high degree resistance pattern against Penicillin, cotrimoxazole, ciprofloxacin, norfloxacin and 2nd and 3rd generation cephalosporin. Out of 1855 E. coli, multi drug resistance was seen in 520 E. coli isolates. ESBL production was observed among 50% of E. coli isolates by combined disk method. Out of 520 isolates, 150 isolates showed resistance to one or more extended-spectrum cephalosporins and cefoxitin by Kirby-Bauer disk diffusion method. These were selected and screened for ESBL and AmpC production. Among 150 cefoxitin-resistant isolates, AmpC phenotype was detected in 100 isolates (66.6%) by AmpC disc method. The overall occurrence of AmpC in the study was found to be 19.2%. Susceptibility of ESBL and AmpC producers to fosfomycin, imipenem, nitrofurantoin and amikacin were found to be 100%, 98.5%, 89% and 75% respectively. Conclusions: There is increased prevalence of ESBL and AmpC producing E. coli. Thus, early detection of ESBL and AmpC producer E. coli by simple phenotypic methods is necessary to avoid treatment failure, where molecular techniques are not available.

articleIndicators of maternal ‘near miss’ morbidity at different levels of health care in North India: A pilot study.

Introduction: Maternal morbidity and mortality in India continues to remain high despite concerted efforts during the past decades. Objective of this study was to determine the prevalence and indicator of Potentially Life Threatening Conditions (PLTC) and ‘near miss’ obstetric cases at different tiers of health care. Material and Methods: A cross-sectional epidemiological study was carried out over a period of 12 months as per the WHO criteria for ‘near miss’. Probability sampling was done to systematically and randomly select health facilities i.e. two primary health centers (PHC), one community health centre (CHC) and a tertiary hospital all from Doiwala block of Dehradun, Uttarakhand, India. The study included all the women attending health-care facilities, who were pregnant, in labour, or who had delivered or aborted up to 42 days ago arriving at the facility. A convenient sampling was done (a hundred percent enumeration of eligible study subjects) for the audit. Result: A total of 937 pregnant women who accessed health care had 688 live births and 231 women had one or more of the Potentially Life Threatening Conditions (PLTC). Among them, 61 women had Severe Maternal Outcome (SMO) - 51 with maternal ‘near-miss’ and 10 maternal deaths. The Severe Maternal Outcome Ratio (per 1000 live births) was 88.66. The Maternal ‘near miss’ Mortality Ratio (MNM-MR) and Mortality Index (MI) were 5.1 and 16.39% respectively. Conclusion: The WHO ‘near miss’ approach has been found to be an effective measure to assess quality of care in maternal health across countries including India.

Comparative bioavailability of slow release diclofenac (Voveran SR) with enteric coated tablet and internationally used Voltaren Retard.

The objective of the study was to compare the enteric coated diclofenac sodium (Voveran), the slow release formulation developed in India (Voveran SR) and the internationally marketed formulation Voltaren Retard. Ten healthy volunteers were administered 100 mg each of the three formulations in a three-way crossover fashion. Blood samples were collected over 24 hours following administration of the drug; plasma levels of unchanged drug were determined by gas chromatography. Pharmacokinetic parameters for the three formulations were compared. The extent of the drug available from the three formulations was the same as the mean AUC values were not significantly different. Cmax and MRT values for the two slow release formulations were comparable but were significantly different from the values obtained with the enteric coated formulation. Tmax values for the two slow release formulations were similar while the enteric coated tablet had faster time to peak. Voveran SR is comparable to Voltaren Retard and has the distinct advantage of a slow release formulation in that its Cmax is much lower and levels are maintained over 12 hours and detectable upto 24 hours. This slow release formulation will offer clinical advantages of better compliance, relief of early morning symptoms and better tolerability over long term usage.