Is objective structured practical examination a cutting-edge assessment tool over traditional practical examination to prepare future “Indian Medical Graduate?” A study from Department of Pathology at a Government Medical College in West Bengal

Background: With the continuous evolution of medical education, an appropriate assessment method is the need of the hour. Most unavoidable drawback of traditional practical examination (TPE) is its subjectivity, which can be overcome by newer methods such as objective Structured Practical Examination (OSPE). Hence, many studies have been conducted to reevaluate the efficiency of TPE and nowadays assessment of undergraduate students who are going to be Indian Medical Graduate (IMG) always remains the topic of debate. Aim and Objectives: The aim of our study is to compare OSPE and TPE by obtaining the feedback of examiner and examinee and also by the marks obtained by students. Materials and Methods: It was an analytical study with longitudinal design. The study was conducted after receiving approval from the Institutional Ethics Committee. Total 140 students were included in the study. In 2nd professional MBBS at third semester, two internal examinations were held in 2019, first one was TPE and the second one was based on OSPE. After the completion of OSPE, students’ and teachers’ opinion were collected by given pre-validated questionnaire. Results: There were significant (P =< 0.05) difference between mean score in OSPE (17.1) and TPE (14.26) among students. According to students, OSPE reduces examiner’s bias (84.2%), was less stressful than TPE (78.5%) and also fair and objective as compared to TPE (85%). According to teacher’s opinion, OSPE requires more time, demands critical thinking of students (77.7%), more objective and eliminates bias (94.4%), ensures uniformity (64.4%), but they opined that depth of knowledge cannot be assessed by OSPE (83.3%). Most of the students (93.5%) and teachers (77.7%) said that OSPE should be included in Pathology practical examination. Conclusion: In our study, both teachers and students have given feedback in favor of OSPE as an assessment tool in practical examination of undergraduate medical students. In our opinion, OSPE should be included as an assessment tool in 2nd year undergraduate pathology practical examination to prepare future IMG.

A comparative study of endoscopic and conventional septoplasty

Objective: Nasal obstruction due to deviated nasal septum is a common problem encountered by otolaryngologist. The standard surgical treatment for symptomatic deviated septum is septoplasty which has gone through several modifications since its inception. Study objectives were to compare the endoscopic and conventional septoplasty and to evaluate the advantage, disadvantage and complication of both the procedures. Materials and Methods: Prospective observational study was conducted in department of ENT and Head-Neck-Surgery of a tertiary care teaching hospital. Sixty patients undergoing either endoscopic septoplasty or conventional septoplasty were studied prospectively for a period of 3 months to compare the efficacy of both the techniques. Objective assessment was done by doing nasal endoscopy 90 days after the operation to note the following points- (1) Persistence of deviation (2) Spur (3) Formation of synechiae (4) Septal perforation. Result: In this study the endoscopic approach showed better overall clinical result as compared to conventional technique with lesser complication. It was noted that endoscopic septoplasty group had minimum blood loss and shorter operative time than conventional method, but difference was not statistically significant. Conclusion: Endoscopic septoplasty was founded with distinct advantage over conventional method due to better illumination, improve accessibility to remote area was founded. Further surgical experience and larger similar studies will help in coming to a greater consensus.

A study of retinal neurodegeneration using optical coherence tomography in type 2 diabetes mellitus patients without retinopathy: A cross-sectional study

Background: Neurodegeneration of retina (retinal diabetic neuropathy) is the earlier sign of diabetes mellitus before the appearance of any vascular sign of diabetic retinopathy. Hence, through neurodegenerative changes, we can diagnose and monitor the early neuronal damage of the retina. Objectives: The objective of the study were to establish whether the retinal neurodegeneration is earlier than vasculopathic changes in patients with diabetes and their relationship with the duration of diabetes. Materials and Methods: A total of 180 diabetic patients and 164 healthy controls were collected from a rural-based tertiary care hospital in West Bengal for this cross-sectional study. All have gone through proper history taking, comprehensive ocular examinations and spectral-domain optical coherence tomography imaging to detect the thickness of retinal nerve fiber layer (RNFL) and ganglion cell layer (GCL). Results: Our study showed that the RNFL thickness of the right and left eyes for the cases was 37.62 μm and 37.68 μm, respectively, and that for controls were 39.68 μm and 39.70 μm, respectively. The GCL thickness of the right and left eyes was 32.63 μm and 32.43 μm, respectively, in cases and that for controls were 33.73 μm and 33.87 μm, respectively. In respect of the duration of diabetes, mean RNFL thickness of the right and left eyes for <1 year, 1–2 years, and >2 years was 40.20 μm and 40.03 μm; 38.17 μm and 38.31 μm; and 35.48 μm and 35.69 μm, respectively. Mean GCL thickness of the right and left eyes for <1 year, 1–2 years, and >2 years was 34.25 μm and 33.72 μm; 31.98 μm and 31.44 μm; and 30.82 μm and 31.35 μm, respectively. The data were analyzed by appropriate statistical methods. Conclusion: This study showed that thinning of RNFL and GCL occurred in diabetes before the appearance of microaneurysm.

A Case of Bilateral Retinal Hemorrhage with Cotton Wool Spot Following Viper Bite.

A 38 years male, admitted in the department of Internal Medicine with a history of snake bite in his left lower leg during agriculture work. He was treated with anti snake venom after admission. He had history of dimness of vision in both eyes. On examination, swelling and subcutaneous hemorrhage was noted in his left leg. His best corrected visual acuity (BCVA) was 6/60 in the both eyes. Fundus examination with 90 D lens and Indirect Ophthalmoscopy of both eyes showed retinal hemorrhage with cotton wool spots. Blood tests revealed increased titers of D-dimer and fibrin degradation products. The patient was followed up regularly at 2 weeks interval and BCVA and Fundus examination was carried out. At the end of 10 weeks, retinal hemorrhages had significantly cleared in both eyes with improvement of vision in both eyes (BCVA of right eye at last follow-up 6/6 and left eye 6/9).

articleClinico-pathological study of 273 cases of rhinosporidiosis over a period of ten years in a tertiary care institute catering predominantly rural population of tribal origin.

Introduction: Rhinosporidiosis is a chronic granulomatous infection caused by Rhinosporidium seeberi, an organism whose taxonomy is still debated. The present study was aimed to document the clinico-pathological presentation of rhinosporidiosis in different parts in reference to caste, age and gender. Evaluation of diagnostic role of cytology in the diagnosis of rhinosporidiosis was also explored. Materials and Methods: All histology confirmed rhinosporidial cases were included in the study. Detailed clinical history and examination findings including previous hematological and cytological reports, if available, were collected and tabulated. Periodic Acid Schiff (PAS) and Mucicarmine stains were used over cyto- and histological slides, if necessary. Observations: Male cases were more frequent in these series though this sex difference is less pronounced among tribal population. Majority of the cases belonged to 21-40 years age group. Nose and nasopharynx was the commonest site of infection and polypoid mass lesions were the commonest presentation. Both scrape and aspiration cytology could successfully detect rhinosporidiosis in 100% cases. Discussion: Most of the cases are among poor-socioeconomic status and probably out-door activities and pond bathing habit. Haematological data correlation did not revealed any significant association. Histology is the preferred method for confirmed diagnosis of rhinosporidiosis. Rare cases of misdiagnosis can be avoided by use of special stains. Conclusion: Rhinosporidiosis commonly presents as polypoidal lesions in nose and extra-nasal sites. Histopathology is the standard method for confirmation of diagnosis. Cytology can be used as an adjunct for pre-operative diagnosis of extra-nasal rhinosporidiosis. We recommended use of special stains for diagnosis of difficult cases

Collision tumor of ovary: a rare combination of dysgerminoma and serous cystadenocarcinoma.

Collision tumors of ovary are rare neoplasms and most commonly consist of a teratoma with mucinous tumor. Combination of papillary serous cystsdenocarcinoma and dysgerminoma was yet to be reported. A twenty years female patient presented with a large tumor of right ovary. Microscopically it was diagnosed as a collision tumor of ovary composed of dysgerminoma and serous cystadenocarcinoma. Mixed tumour can arise from divergent differentiation of a single type of stem cell. But components of collision tumor must arise from separate clones. Possibility of collision tumour should always kept in mind during assessment of difficult ovarian tumors to avoid diagnostic error. Key words: Collision tumor, dysgerminoma and serous cystadenocarcinoma.

Evaluation of Role of Ultra Sound Guided Fine Needle Aspiration Cytology for Diagnosis of Ovarian Lesions with Particular References to Diagnostic Pitfalls.

Background: Ovarian lesions are quite common among females of all age groups. Ovarian cancers account for 6% of female malignancy. ULTRASONOGRAPHY(USG) can help in proper identification and categorization of these lesions. Fine needle aspiration cytology (FNAC) under USG guidance can be an effective modality for early diagnosis of ovarian masses. Aims And Objectives: To evaluate the role of USG guided FNAC over ovarian space occupying lesions (SOLs) for proper categorization into non-neoplastic, benign & malignant variants and to identify possible underlying causes of cytological misdiagnosis, if any, in comparison to histopathological diagnosis. Materials and Methods: FNAC under USG guidance were performed over one hundred and sixteen cases with radiologically proved ovarian SOLs during a period of five years. Aspirated materials were interpreted as non- neoplastic, benign or malignant lesions. Histopathological study was possible in 47 of these cases. Results: Out of 116 aspirations, non neoplastic, benign and malignant diagnosis were given in 51, 42 &23 cases, respectively. During histopathological correlation 41 out of 47 cases(87.2%) show exact cytohistological parity.Rest six cases with cytological misdiagnosis were discussed in detail. Conclusion: USG guided FNAC can effectively diagnose ovarian lesions in more than 87% cases. Scrutiny about failed diagnosis will help to improve accuracy in future.

Comparative evaluation of clindamycin phosphate 1% and clindamycin phosphate 1% with nicotinamide gel 4% in the treatment of acne vulgaris.

Eighty patients with moderate acne vulgaris were enrolled from out-patient department for the comparative evaluation of clindamycin phosphate 1% and clindamycin phosphate 1% with nicotinamide gel 4%. In group I forty patients were given clindamycin phosphate 1% alone.ln group II forty patients were given clindamycin phosphate 1% and nicotinamide gel 4% in combination. The study did not show any added advantage of clindamycin phosphate 1% in combination with nicotinamide gel 4% over clindamycin phosphate 1% alone.

Distribution of HIV-1 subtypes in female sex workers of Calcutta, India.

BACKGROUND & OBJECTIVES: Different routes for the transmission of HIV-1 in India have been reported and the majority of infections occurred through heterosexual route of transmission. In order to understand the dynamics of HIV-1 transmission, a systematic study was undertaken to determine the viral subtypes circulating among the female sex workers in Calcutta, India. METHODS: Peptide enzyme immunoassay (PEIA), heteroduplex mobility assay (HMA) and DNA sequence analysis were used to ascertain the HIV-1 subtypes. RESULTS: V3 serotyping of 52 HIV-1 seropositive samples identified 33 (60%) to be subtype C. A DNA fragment within C2-V3/C2-V5 regions of HIV-1 gp120 was amplified directly from the lymphocyte DNA to avoid any bias in selecting viral variants and used in HMA. Of the 40 samples analyzed, 38 (95%) belonged to subtype C and 2 were found to be non-typable. Further analysis of these 38 samples revealed that 26 (68%) had maximum homology to the C3-Indian reference strain (IND868), 11 (29%) were most homologous to C2-Zambian strain (ZM18) and 1 (3%) showed close resemblance to C1-Malawi strain (MA959). Nucleotide sequence of 11 subsamples encompassing about 325 base pairs was aligned for the Indian and other geographically distinct isolates. On distance and parsimony trees, most of the samples (8/11) clustered together as subtype C. INTERPRETATION & CONCLUSIONS: Subtype C was the major circulating HIV-1 strain in this geographical region, although variation within this subtype was also noticed. DNA sequence analysis was found to be the best method in determining the nature of the HIV-1 subtype followed by HMA and peptide enzyme immunoassay. These findings may have important implications for the design of effective vaccines in India and emphasizes the need for constant monitoring of the HIV-1 subtypes in different parts of India.

Evaluation of women seeking sterilisation reversal.

A total of 1120 women attending at Regional Centre of Excellence (RCOE), RG Kar Medical College and Hospital, Calcutta from October, 1989 to July, 1998 with the request for sterilisation reversal (SR) were evaluated step by step for fitness of SR operation on the basis of history, clinical examination, pre-operative investigations, fertility status and laparoscopic findings. One thousand and sixty couples completed their evaluation. Majority of the SR seekers were young (< 30 years) and significant number (8.9%) of women came in late age (> 40 years). Most (85.8%) of the women had one or no child. The main reason for requesting reversal was death of children (91.8%). Only 43.3% were ultimately found fit for SR operation and rest (56.7%) were refused. Presence of 2 or more children in not remarried couple (13.8%), gross pelvic pathology (2.35%), advanced age (8.7%), seminopathy (4.05%), and some medical diseases (3.2%) were important reasons before pre-operative investigations for refusal. Faulty sterilisation technique (11%) was responsible for refusal at laparoscopic evaluation. The need of critical evaluation of all women seeking reversal has been emphasised in this study. Various aspects related with demand for SR and preventive measures to improve the success of this procedure have been critically discussed.

The prevalence of HIV in female sex workers in Manipur, India.

Data on STDs and sexual practices in commercial sex workers (CSWs) is in general limited in India. Manipur in north-east Indian has a high prevalence of HIV in injecting drug users but the rate in CSWs is not known. The site selected for the study was Moreh, on the Myanmar border of Manipur. One hundred blood samples were collected, 7 from migrants from Myanmar, the remainder from Manipuri women. The HIV seropositivity rate was 12% (95% CI = 5.6-18.4). The age of the women ranged from 15 to 42 (mean = 24.5 years, median 23.7 years). The proportion of HIV positives increased significantly with number of customers per day and number of years in the profession. The HIV prevalence among Injecting drug using CSWs was 9.4 times higher that among non-IDU CSWs. Vaginal discharge was strongly associated with HIV positivity. Effective intervention programmes among CSWs in Manipur to prevent further spread of HIV are strongly indicated by the results of this study.

Beyond medical model of STD intervention--lessons from Sonagachi.

Sonagachi, a red-light area in Calcutta has experienced a successful STD control program. Social issues behind this success and importance of non biological parameters to evaluate the success of the project are highlighted.

Community based survey of STD/HIV infection among commercial sex workers in Calcutta (India). Part-IV: Sexually transmitted diseases and related risk factors.

Community based survey on a sample of commercial sex workers in one red light area of Calcutta, was carried out to determine prevalence of sexually transmitted diseases (STD) including HIV infection and related risk factors. An alarmingly high prevalence of STDs (80.56 per cent) but low HIV-seropositivity (1.13 per cent) was observed. Candida albicans, Neisseria gonorrhoeae and Trichomonas vaginalis were detected in 23.24, 13.24 and 11.11 per cent of genital specimens respectively. BY TPHA test 62.97 per cent of the sera were reactive for Treponema pallidum. Duration in the profession of sex workers was found to have an association with seropositivity for syphilis. Prevalence of HIV infection might be low at present, but conditions were highly favourable for rapid spread of infection.

Community based survey of STD/HIV infection among commercial sex-workers in Calcutta (India). Part-III: Clinical findings of sexually transmitted diseases (STD).

On physical examination of 418 sex workers, 202 (48.32 per cent) were found to have vaginal discharge, which was found to be most common among younger age class. Endocervical pus, genital ulcer, and swelling of inguinal lymph glands were observed in 13.16, 6.22 and 1.91 per cent of the sex workers respectively. Clinically 16.51, 15.31, 11.96 and 4.78 per cent were found to suffer from candidiasis, trichomoniasis, cervicitis and syphilis respectively.

Community based survey of STD/HIV infection among commercial sex-workers in Calcutta (India). Part II. Sexual behaviour, knowledge and attitude towards STD.

A community based sample survey of STD/HIV infections was carried out among 450 commercial sex workers, (CSW) of one red light area in Calcutta. In this paper, sexual practices of sex workers, their knowledge about sexually transmitted diseases (STD) and practice of preventive and curative measures against STDs, is described. Vaginal intercourse was the usual sexual practice. But as many as 74.44 per cent also practised oral sex. About 82.67 per cent had the practice of washing external genitalia with antiseptic solution after sexual intercourse. About 69.11 per cent of sex workers were aware of sexually transmitted diseases and 30.67 per cent had knowledge about AIDS. About 70.22 per cent had symptoms related to genital tract during one year preceding the survey and 34 per cent of sex workers took medical treatment during last one month.

Community based survey of STD/HIV infection among commercial sexworkers in Calcutta (India). Part I. Some social features of commercial sexworkers.

A community based sample survey of sexually transmitted diseases and Human Immuno deficiency Virus infection was carried out among commercial sex workers of a red-light area in Calcutta. In this paper socio-demographic aspects of sex workers are discussed. For the survey, 450 sex workers were selected by random sampling method. Among the sex workers surveyed, 84.89 per cent were in the age group 15-29 years. Lowest age was 13 years and mean age was 23.12 years. Large number of sex workers were from Nepal (15.11 per cent) and Bangladesh (11.78 per cent). About 38 per cent were from three districts of West Bengal bordering Bangladesh. About 84.44 per cent of the sex workers were illiterate. Extreme poverty forced 49.10 per cent to choose this profession and family disturbances led 21.56 per cent to this profession. Almost all sex workers (448) had addiction, alcohol being taken regularly by 81.11 per cent. Number of clients of sex workers varied from 2 to 10, average being 3. About 67.33 per cent gave history of pregnancy, 46 per cent had abortion and 41.11 per cent had living children. About 27.11 per cent took precaution against pregnancy regularly. Use of oral pills was found to be the most common practice against pregnancy (13.65 per cent), followed by ligation (11.56 per cent). Only 1.11 per cent reported that their clients used condom regularly.