Video projected practical examination as an introduction to formative assessment tool for undergraduate examination in pathology

Background: Assessment of the medical students includes theory as well as practical assessment. Traditional practical examination in pathology which includes viva and spots is now increasingly being questioned because of their inherent lack of validity and reliability, time consumption, and human resource requirement. Therefore, a need was felt for another form of practical examination which can be used as formative assessment, and if found feasible, can be employed in summative assessment too. Aim: The aim of the study was to develop and implement a new method of video projected practical examination (VPPE) as a formative assessment tool for MBBS second professional students so as to improve their learning and academic performance in practical pathology and also to obtain students' perception regarding the effectiveness of VPPE. Methodology: The study was carried out with the MBBS second professional students before their end-of-semester examination in the Department of Pathology. In this new method, slide video projection was used as a formative assessment tool during practical examination. Students were randomly divided into two groups. Group I was subjected to VPPE, while simultaneously conventional practical examination was held for Group II. Assessment results of VPPE were compared with conventional practical examination. Faculty and students feedback was also taken at the end of the examination. Results: Mean marks of the students who undertook VPPE was higher than those who gave conventional practical examination. Majority (95.3%) of the students agreed that VPPE is better than conventional practical examination. Most of the faculty members also felt that it is a more valid and reliable assessment tool. Conclusions: Introducing VPPE as a formative assessment tool in practical pathology enhanced their learning and academic performance. Opinion of examiners and students also showed that VPPE has several advantages over conventional practical examination.

Evaluation of the Antibody Response against Hepatitis C Virus Infection in Patients on Maintenance Hemodialysis (MHD): A Pilot Study.

Majority of the patients with end stage renal disease (ESRD) are on maintenance hemodialysis (MHD) in Bangladesh. Dialysis patients are at high risk for contracting blood borne infection including hepatitis C virus (HCV) infection. The aim of this study was to evaluate the antibody response of hepatitis C virus infection in patients on MHD by detecting different viral markers in blood. A total of 88 patients with chronic kidney disease (CKD)were recruited from BIRDEM and BSMMU during the period from June 2006 to June 2007. Of them 63 patients on MHD and 25 predialysis patients were taken as cases and controls respectivly. Anti-HCV antibody were positive in 38% of dialysis patients but none of the controls were positive for Anti-HCV. When HCV positive MHD patients (38%) were compared to HCV negative MHD patients (62%), it showed that HCV positive patients had longer duration of dialysis (24±25 vs 9±6 months, p<0.001), increased number blood transfusions (29±34 vs 10±9 units, p<0.004) and elevated serum alanine aminotransferase level (35±23 vs 20±9 U/L, p=0.001). Implementing comprehensive infection control program by routine screening of the CKD patients, safe blood transfusion program, reducing transfusion of blood by use of erythropoietin and proper disinfection and cleaning of hemodialysis units may reduce the infection by HCV Virus.

Developing and maintaining website of department of forensic medicine and toxicology: a need of the hour.

With recent advancement of civilization, man has been inventing various tools to assist him in living in the changed environment. Online Medical Education System has now become reality. Developing and maintaining website of Department of Forensic Medicine and Toxicology by every medical college is the need of the hour. Developing and maintaining a website is not a difficult task for any department irrespective of the status of the institution. The financial burden is not very much. What makes this task so difficult is the lack of knowledge in this area rather than hurdles on the way. Authors have tried to clarify the various doubts regarding this area i.e. how the website can be developed, the financial burden to register a website, website maintainence, role of on-line medical education, undergraduate and postgraduate students benefits by the website, website use to associate different departments and institutions, obtaining updated information via Internet and other websites, the security issues while sharing the information as well as updating. It is envisaged that whence the departments develop their website, they may be affiliated to IAFM website for their greater visibility.

Percutaneous vertebroplasty: an experience of 31 procedures.

A prospective study of 31 percutaneous vertebroplasty procedures (PVP) in 22 patients treated during January 2000 to December 2001 is presented. PVP was performed using polymethylmethacrylate (PMMA) to treat vertebral collapse due to osteoporosis and vertebral metastasis, to obtain analgesia and spinal stabilization. We analyze the efficacy and complications related to the procedure. PVP is a safe, effective and a daycare surgery. It can be performed under local anesthesia and has minimal and manageable complications.

Necrosectomy followed by closed cavity lavage for necrotising pancreatitis--report of three cases.

Necrotizing Pancreatitis is a life threatening condition involving pancreas, peripancreatic and retroperitoneal tissues. It's serious regional and systemic involvement causes multiple organ or system failure. Planned and carefully performed necresectomy followed by closed cavity lavage can significantly reduce the mortality and morbidity of this catastrophic condition. Meticulous preoperative resuscitation, preparation and operative necrosectomy followed by continuos irrigation in the postoperative period were done in three consecutive patients. The operative procedure including postoperative management and follow up is reported and analyzed.

Evaluation of cysticercus fasciolaris antigen for the immunodiagnosis of neurocysticercosis.

Cysticercus cellulosae antigen has been frequently used to detect antibodies for immunodiagnosis of neurocysticercosis. We have, for the first time, used membrane extract of cysticercus fasciolaris, the larval stage of Taenia taeniaeformis, in ELISA, with successful results. IgM and IgG antibodies against cysticercus were measured in serum from cases of neurocysticercosis (217), normal and diseased controls (89). 203 sera from cases of neurocysticercosis were positive for either or both IgG and IgM antibodies while 157/217 cases showed IgM and 158/217 showed IgG antibodies. Ten controls showed false postivity in IgG ELISA. Eight of these cases also had IgM antibodies. The test had an overall sensitivity of 93.54% and a specificity of 84.2% with a positive predictive value of 93.54% and a negative predictive value of 84.2%. Cysticercus fasciolaris can be conveniently produced in the experimental laboratory host, Rattus rattus, and would be of practical value in the immunodiagnosis of cysticercosis in humans.

AgNOR expression in CNS neoplasms.

Silver colloid staining of nucleolar organiser regions (AgNORs) is used for assessing the proliferative potential of tumours. The present study aimed at evaluating the AgNOR indices in normal and reactive CNS tissue, benign and malignant CNS neoplasms. The study group comprised of tissue from 22 controls and 100 cases (53 benign & 47 malignant neoplasms). The mean AgNOR index of controls was 0.95, benign neoplasms 1.25 and malignant neoplasms 2.12. A statistically significant difference was observed in controls and cases (p < 0.001) and between benign and malignant tumours (p = 0.002). Mean indices for low and high grade astrocytoma also significantly differed (p < 0.001). Using ROC curves cut off values were obtained for differentiation of neoplastic from non neoplastic (AgNOR index 1.10), benign from malignant (AgNOR index 1.75) and low grade (I & II) from anaplastic (Gr III & IV) Astrocytomas (AgNOR index 1.62). A spectrum of gradually increasing AgNOR indices from normal, reactive, benign to low and high grade malignancy indicates the usefulness of this simple technique as a proliferative marker.

A Bangladeshi family with three sisters 'Bombay' or Oh phenotype.

Three sisters in a same family (MIAH FAMILY) are of 'Bombay' phenotype. These being the first known female examples of 'Bombay' blood group have been detected in Bangladesh. As predicted by current theory their red cells are Le(a+b-) and their saliva do not contain any of the antigens A, B and H except Lea substance. Family studies showed that individuals with 'Bombay' or Oh phenotype may have A or B gene which are not expressed. This very particular type of blood is one of the rarest in any other parts of world except in India. Due to the presence of anti-H antibody in the plasma of Oh phenotype, when considering such patients for transfusion only blood of identical Bombay type can be safely transfused.

Development of an enzyme-linked immunosorbent assay for detection of IgE antibodies specific to Dermatophagoides pteronyssinus.

Allergy to Dermatophagoides pteronyssinus was determined in 61 rhinitis patients using prick test (PT), enzyme-immunoassay (EIA) and enzyme-linked immunosorbent assay (ELISA). A total of 43 patients tested positive with PT. Forty six patients were positive when tested with EIA and ELISA. With PT as standard test, EIA was found to have 83.7% sensitivity and 44.4% specificity; ELISA had 81.4% sensitivity and 38.9% specificity. There was a linear relationship between absorbance values obtained by EIA and ELISA. The performance time was 8 hours, 24 hours and 30 minutes for ELISA, EIA and PT respectively. The cost per test for ELISA, EIA and PT was US$ 0.20, US$ 5.20 and US$ 0.14 respectively. It was concluded that ELISA was more cost-effective than EIA should be used to supplement PT for a more complete diagnosis of allergy.

Hepatic and extra-hepatic glutathione-S-transferase activity in wild pigeons (Columba livia).

Glutathione-S-transferase (EC 2.5.1.18) activity was assayed in hepatic and extrahepatic tissues of pigeons using l-chloro-2,4-dinitrobenzene and l,2-dichloro-4-nitrobenzene as substrates. Gluthathione-S-transferase activity towards l-chloro-2,4-dinitrobenzene in pigeon was in the order: kidney >liver >testes >brain >lung>heart. The enzyme activity with 1- chloro-2,4-dinitrobenzene as substrate was 40-44 times higher in pigeon liver and kidney than that observed with l,2-dichloro-4-dinitrobenzene as substrate. Km values of hepatic and renal glutathione transferase with l-chloro-2,4-dinitrobenzene as substrate were 2.5 and 3 mM respectively. Double reciprocal plots with varying reduced gluthathione concentrations resulted in biphasic curves with two Km values (liver 0.31 mM and 4mM; kidney 0.36 mM and 1.3 mM). The enzyme activity was inhibited by oxidized gluthathione in a dose-dependent pattern. 3-Methylcholanthrene elicited about 50% induction of hepatic glutathione transferase activity whereas phenobarbital was ineffective.