Faculty perceptions regarding an individually tailored, flexible length, outcomes-based curriculum for undergraduate medical students / 한국의학교육

Purpose@#The perception of faculty members about an individually tailored, flexible-length, outcomes-based curriculum for undergraduate medical students was studied. Their opinion about the advantages, disadvantages, and challenges was also noted. This study was done to help educational institutions identify academic and social support and resources required to ensure that graduate competencies are not compromised by a flexible education pathway. @*Methods@#The study was done at the International Medical University, Malaysia, and the University of Lahore, Pakistan. Semi-structured interviews were conducted from 1st August 2021 to 17th March 2022. Demographic information was noted. Themes were identified, and a summary of the information under each theme was created. @*Results@#A total of 24 (14 from Malaysia and 10 from Pakistan) faculty participated. Most agreed that undergraduate medical students can progress (at a differential rate) if they attain the required competencies. Among the major advantages mentioned were that students may graduate faster, learn at a pace comfortable to them, and develop an individualized learning pathway. Several logistical challenges must be overcome. Providing assessments on demand will be difficult. Significant regulatory hurdles were anticipated. Artificial intelligence (AI) can play an important role in creating an individualized learning pathway and supporting time-independent progression. The course may be (slightly) cheaper than a traditional one. @*Conclusion@#This study provides a foundation to further develop and strengthen flexible-length competency-based medical education modules. Further studies are required among educators at other medical schools and in other countries. Online learning and AI will play an important role.

Electrocardiographic Changes in Ostium Secundum Atrial Septal Defect- Before and After Shunt Closure- A Retrospective Cohort Analysis

Introduction: Atrial Septal Defect by virtue of its left to right shunt induces geometric and electrical remodeling of the right sided chambers of the heart which produces prototypical changes in the Electrocardiogram. Various patterns produced by ASD in the ECG can give a clue in diagnosing the defect. Reversal of remodeling after the shunt closure and its accompanying changes in ECG are also helpful in follow up of these patients Methodology: This is a retrospective cohort analysis, wherein, ECG of the patients who have undergone ASD closure by percutaneous device closure or surgical closure during the study period,were obtained from hospital records and they were followed up. After screening, 60 patients met the inclusion criteria and were included in the study. ECG of the patients before closure of ASD and on immediate post procedure day, 2 weeks, 1month, 3 months, 6 months and 1year were obtained and analyzed. Results: Mean age of the study population was 28.4 ± 09 years. In analysis of ECG after closure of ASD, the mean QRS axis reduced from 108 ± 10 to 70 ±12 degrees (P = 0.016), mean QRS duration reduced from 123 ± 30 ms to 80 ± 27 ms (P= 0.28). Mean PR interval reduced from 188 ± 30 ms to 123 ± 24 ms (P value= 0.09). The Crochetage Sign disappeared in the 2 patients who had it before closure of the defect. The amplitude of R’ wave in rSR’ in right precordial leads reduced over 2 years. rR’ and qR pattern in right precordial leads reverted to rSr’ pattern in 10 out of 12 patients. The other 2 patients who did not show reversal had residual shunt. No clinically significant complete heart block was observed in any patient. Conclusion: ECG forms as an easily available tool for diagnosis of ASD as well as in assessing the success of closure in the follow up after the closure of ASD by surgical or percutaneous device therapy. Failure of reversal of electrocardiographic signs of ASD after the closure should prompt search for residual shunt or pulmonary complications.

Functional independence measure (WeeFIM) reference values in Indian children aged 3–7 years: A cross-sectional study

Background. We sought to establish reference values of the functional independence measure (WeeFIM; Unified Data System for Medical Rehabilitation, Buffalo, NY, USA) for children aged 3–7 years in India using this cross-sectional study. Methods. We obtained permission from the Unified Data System for Medical Rehabilitation, a non-profit organization to use the WeeFIM instrument. Participants were recruited randomly from schools. After obtaining written informed consent, direct interviews for WeeFIM II Clinical Guide (version 6.0) were conducted for parent/guardian/teacher of 182 typically developing children. Results. There was a progressive increase of functional independence with increasing chronological age across all WeeFIM domains. Total score of the WeeFIM instrument showed a similar performance between boys and girls. At the beginning of 3 years, children were at WeeFIM level 3 that is moderate assistance stage in their functional independence, but by the age of 7 years, they became completely independent on all the three domains of WeeFIM functional scale. Conclusions. We have provided reference values for WeeFIM in children of India aged 3–7 years (35–84 months). There were no differences between boys and girls regarding WeeFIM performance. Children in private schools showed better performance versus children in government schools in the early age ranges. We could not find any effect of socioeconomic status on WeeFIM raw rating or functional independence level.

Perception of university students about doctors and quality of health care provision at clinics: a multi-national study in India, Pakistan, Spain and United States of America

Background: Patient satisfaction is considered as an indicator of the healthcare quality. Information on patient satisfaction based on medical expertise of the physician, interpersonal skills, physician-patient interaction time, perception and needs of the patient allow policymakers to identify areas for improvement. Primary care services and healthcare structure differ between the countries. The present study was done to determine and analyze the determinants associated with patient satisfaction in India, Pakistan, Spain and USA.Methods: This descriptive study was performed in January to August 2019 among students from Mumbai University, India, Dow University of Health Sciences, Karachi, Pakistan, University CEU Cardenal Herrera, Valencia, Spain, Texas State University, Texas, USA. On the basis of the eligibility criterion (those who gave a written informed consent and were registered students of respective university) 890 (India: 369, Pakistan: 128, Spain: 195, USA: 99) students were selected for the present study.Results: India had almost similar male (49%) to female (51%) ratio of participants. For other 3 countries (PK, ES, US), female participant percentage was nearly 20% or even more as compared to male participants. Overall participant’s satisfaction score about medial expertise of the doctor were highest in India (71%) and were lowest in Spain (43%). Overall satisfaction score about time spent with doctor were highest for India (64%) and were lowest for Spain (41%). Overall satisfaction score about communication with doctor were highest for US (60%) and were lowest for PK (53%). Overall satisfaction score for medical care given by the doctor was lowest in PK (43%) and was highest in US (64%). Overall satisfaction about doctor, highest number of US (83%) and lowest number of PK (32%) participants were satisfied about medical interaction with doctors.Conclusions: These multi-country findings can provide information for health policy making in India, Pakistan, Spain and USA. Although the average satisfaction per country, except Pakistan is more than 60%, the results suggest that there is ample room for improvement.

First Report of Agrobacterium rhizogenes-induced Hairy Root Formation in Selaginella bryopteris: a Pteridophyte Recalcitrant to Genetic Transformation

Abstract we report A. rhizogenes-induced hairy root formation in S. bryopteris, a medicinally and commercially important plant. A. rhizogenes strain LBA1334 co-cultivated with explants (root, rhizophore, stem portion near the root, and stem with intact fronds) for 24 and 48 h after transformation for induction of hairy roots. The induction of hairy root was observed after 6 days of infection in case of 48 h co-cultivation only. PCR with rolA and virC gene specific primers confirmed the induced hairy roots were due to Ri T-DNA integration and not due to contaminating A. rhizogenes. The root network as explants showed the maximum transformation efficiency. We tested different media like MS, SHFR (Stage Hog Fern Root) and KNOP's during transformation for hairy root induction. The SHFR based media showed good response in transformation as well as propagation. Further, transformation efficiency was enhanced by addition of TDZ (2 mg/L) and Bevistin (0.1%) in SHFR media. The present work would be helpful in hairy roots-based in vitro production of secondary metabolites and on aspect of functional genomics of S. bryopteris.

Drug utilization pattern of antimicrobials in OPD of ENT in teaching hospital

Background: A drug utilization study may be helpful to identify the problems, suggest the remedial measures and promote rational use. Antimicrobials are commonly used to treat infections caused by bacteria, viruses, protozoa and fungi, evidently require huge prescriptions in India.Methods: A prospective, observational study was carried out for a period of four months from February to May 2019 in the Department of ENT (OPD) at NRI Medical College and General Hospital. Prescriptions were collected randomly from around 300 patients attending the ENT outpatient department after obtaining informed consent. The data were collected in the predesigned proforma for analysis.Results: 300 ENT patients were selected for the study, 62% were male and 38% were female. Out of 300 patients 190 ear disorders, 50 nasal, and 60 throat infections. Antimicrobial therapy were most commonly instituted in ear diseases (67.66%), nose (16.95%) and throat (15.37%) respectively. The most commonly used agents were amoxicillin with clavulanic acid- n=295, cefixime- n=1260, gentamicin- n=200, ciprofloxacin- n=157, azithromycin- n=199, nitroimidazoles (metronidazole- n=111).Conclusions: Cefixime and amoxicillin+clavulanic acid combination was the most commonly prescribed antibiotic in our study. Interventions to rectify the use of brand names are necessary to promote rational drug use. An antibiotic policy has to be developed for the doctors in treating infections so that rationality in using the antibiotics will be developed and the occurrence of antibiotic resistance can be reduced.

How knowledgeable and practicable are the mothers of under five children in urban slum, Tamil Nadu on: utilization of ORS, homemade fluids and feeding practices during acute diarrhoeal diseases

Background: Globally, acute diarrhoea claims around 1.5 million lives of under-five children. In India, ADD accounts for 8% of deaths in <5yrs age group. Child may be pushed into an irreversible outcome as stunting because of inadequate nutrition and repeated bouts of infection during the first 1000 days of life. Oral rehydration therapy is the most effective treatment intervention which can avert about 14% of deaths in under five children. Methods: A cross sectional study was done among 270 mothers of under five children from our urban health centre service area of PSGIMSR. Results: Among 270 mothers of under five children most of them belonged to the age group of ≤25 years. Only 10.7% of the mothers were aware that infection or germs cause diarrhea, signs of dehydration were not known by 80% of mothers. Mothers’ with more than one child and mothers with education more than 8th class were emerged as the factors affecting ORS preparation. Conclusions: The knowledge on diarrhoea was low. Although awareness regarding spread of diarrhoea and ORS was adequate in this community, knowledge regarding continuation of feeding and signs of dehydration were deficient. Thus educating the mothers of under-five children regarding correct practices of home management of diarrhoea is likely to further reduce diarrhoea morbidity and mortality.

Knowledge of medical students on clinical trials

Background: Basic research can help medical school students improve critical thinking skills required by medical practice. In this era of evidence-based medicine, the combination of medical education with clinical research is the key to ensure scientific discoveries are translated into clinical practice. This study’s objective was to know the awareness about clinical trials among undergraduate medical students.Methods: After obtaining approval from the Institutional Ethics Committee of NRI Academy of Medical Sciences, Guntur, India, this cross sectional study was conducted in second year medical students after taking their consent. A sample of 90was considered for statistical analysis. A structured questionnaire was used to measure the objective of this study, which had general, regulatory and ethical questions related to clinical trials. Qualitative data variables were expressed by using frequency and Percentage (%).Results: Out of 90 students, it was observed that in the general questions category, 70% of students were aware of the purpose of conducting clinical trials, 50% were aware of the pre-requisites for a participant before participating in a clinical trial and 50% were aware of the parameters evaluated in a clinical trial. 95% of students did not know the response for regulatory questions. The students’ awareness regarding ethics related to clinical trials was better than the other two categories.Conclusions: The overall awareness of clinical trials was low among students though they demonstrated good awareness regarding few aspects of clinical trials.

A study to assess knowledge and attitude towards HIV among students from Mumbai university

Background: India has the third largest HIV epidemic in the world. The Indian epidemic is characterized by low levels in the general population and elevated concentrations among high-risk groups. The present study was planned to determine the awareness of HIV among students from Mumbai University.Methods: A cross-sectional study was carried out among students from Mumbai University, India during May–June 2017. Two hundred and fifty students were approached to participate in the study of which 199 agreed to participate (males: 132; females: 67). Pretested questionnaire was distributed and collected data was analyzed using IBM SPSS version 23.Results: Study participants had high knowledge (86%) and attitude score (87%). There was no significant difference between males and female participants for attitude and knowledge, except for one question regarding knowledge about HIV transmission via breastfeeding to child.Conclusions: Present study showed that there are no misconceptions or negative attitudes regarding HIV among students. A longitudinal study with a larger sample size across India is recommended for further investigation.

Association Between Neonatal Thyroid Stimulating Hormone Status and Maternal Urinary Iodine Status

Background: Maternal urinary iodine concentration (MUIC) andpercentage of neonates with Thyroid stimulating hormone (TSH)>5 mIU/L are amongst the parameters suggested for assessingadequate iodine status.Objective: To assess the correlation between MUIC andneonatal TSH levels.Study design: Cross-sectional.Settings: Tertiary care center in Delhi, India, between November2015 to November 2016.Participants: Postnatal mother-neonate dyads.Methods: TSH levels assessed among neonatal samples werestratified as below and above 5 mIU/L. MUIC was measured in544 mothers, 400 mother-neonate dyads with neonatal TSHlevels >5 mIU/L (cases) and 144 mother-neonate newbornmother dyads with neonatal TSH <5 mIU/L (controls).Results: The percentage of mothers with iodine insufficiency(9.8% vs 5.6%) as well as iodine excess (54.3% vs 41.7%) weresignificant higher in cases than controls. Mean TSH was alsohigher (P=0.0002) in both the iodine deficient and iodine excessgroup. There was no correlation between neonatal TSH valuesand MUIC.Conclusions: Lack of correlation between neonatal TSH andMUIC is due to iodine excess together with iodine deficiency.

A Case Report- Management Of Ardita Through Ayurveda

Ardita is considered among eighty vataja nanatamaj vikara by Acharya Charaka. The objective of present study was to find out the effective Ayurvedic management in Ardita. A 15 yrs. old female patient reported to outpatient department of kaumarbhritya A&U Tibbia College & hospital with complaints of right side deviation of mouth and difficulty in eating through left side of mouth. The patient was diagnosed as Ardita on the basis of history and examination and treated on the line of Ardita chikitsa. The patient was given dashmoola kwath, kumar kalyan ras and Anu tailam pratimarsha nasya. There is significant improvement in presenting complaints. Before starting the treatment the Sunnyook facial grading score of facial nerve was 17 and after commencement of 30 days treatment it was 73. There was no side effect observed during and after the treatment

Oral cancer awareness among students from Mumbai University

Background: Oral cancer is among the top three types of cancers in India. Severe alcoholism, use of tobacco in the form of cigarettes, smokeless tobacco, and betel nut chewing are the most common risk factors for oral cancer. Often individuals with pre cancer even notice the alterations, such as reduced mouth opening in oral submucous fibrosis (OSMF), but they are not aware about the causes and consequences of these changes. Awareness about causes and features of oral cancers can be very helpful in prevention, control and early diagnosis of oral cancer.Methods: A cross-sectional study was carried out among students from Mumbai University, India during May-June 2017. Five hundred students were approached to participate in the study of which 400 agreed to participate. Pretested questionnaire was distributed and collected data was analyzed using IBM SPSS version 23.Results: There were 199 (49%) males and 201 (50%) females in the study and response rate was (80%). Respondents had good knowledge about oral cancer. Seventy four percent (268/362) respondents correctly identified smoking, and tobacco chewing as possible causes of oral cancer. Almost all (96%; 348/362) respondents correctly responded that oral cancer does not spread from person to person through touch or speaking. Seventy two percent (260/362) respondents believed that oral cancer is curable. Significantly higher number of male (98%) compared to female participants answered correctly to questions regarding spread of disease and occurrence of oral cancer in AIDS patients.Conclusions: Participants showed good knowledge about oral cancer. Female participants showed lesser knowledge compared to male counterparts. Details about oral cancer should be incorporated in the undergraduate curriculum and periodic awareness programs should be organized for students.

The Origin Variability Of The Iliolumbar Artery: A Cadaveric Study With Clinical Significance

Introduction: Hemorrhage represents has been considered as the leading cause of maternal death in developingcountries and one of the major causes of morbidity and mortality in obstetrics and gynecological surgery.Iliolumbar artery (ILA) is one of the branches of the posterior division of the internal iliac artery. The source ofILA has been documented from all possible neighboring arteries. So the course and ramification of the ILA havereceived attention for gynecologists and surgeons.Materials and methods: Study was conducted on 30 bisected pelvises specimens in Department of Anatomy,Gulbarga Institute of medical sciences, Gulbarga. The pattern of origin of the iliolumbar artery (ILA) was identified.The origin and course of ILA were evaluated.Results: In the present study, we observed the ILA was most commonly originated from the trunk of IIA in 36.67%,from posterior division of IIA in 23.33%, and from the common iliac artery in 13.33%. The incidence of absenceof ILA was recorded in 26.67% specimen.Conclusion: The surgeons, especially while doing pelvic surgeries or obstetrics and gynecology surgeries, shouldbe aware of the normal anatomy of the internal iliac artery and its variations for the successful ligation of theinternal iliac artery and for the safe surgical outcomes.

A fixed dose combination of ofloxacin and ornidazole induced fixed drug eruptions

Fixed drug eruptions (FDEs) may account for 16-21% of all cutaneous drug eruptions. Recent research suggests a cell-mediated process that initiates both the active and quiescent lesions. The major categories of causative agents of fixed drug eruption include antibiotics, antiepileptics, nonsteroidal anti-inflammatory agents, sildenafil, and phenothiazines, although numerous other agents and certain foods such as cashews and licorice have also been reported as causative agents. A 38 year old male presented to the dermatology OPD with hyperpigmented and erythematous macular eruptions on the neck, chest, right arm, left scapular region, left wrist and left knee. The eruptions were associated with burning sensation and itching. He informed having taken medications for gastroenteritis the night before. The medications were Ofloxacin and Ornidazole (FDC), Omeprazole and Domperidone (FDC) and Paracetamol. He gave a history of a similar event, a year ago, with the same antimicrobial combination (Ofloxacin and Ornidazole), although the macular eruptions were restricted to the neck, arm and knee with bleb formation and severe burning sensation. Since the macular eruptions reoccurred, although with extra regions being affected, a diagnosis of FDEs was made. The most probable cause for these FDEs seems to be FDC of Ofloxacin and Ornidazole, because the patient gives history of taking Omeprazole and Paracetamol before without any FDEs. According to Naranjo’s Adverse Drug Reaction Probability Scale, the FDC of Ofloxacin and Ornidazole is a definite cause for the FDEs. (Score = 9).

Study of awareness of diabetes mellitus among diabetics and non-diabetics and drug utilisation pattern in diabetics attending tertiary care general hospital in India

Background: Diabetes Mellitus (DM) is one of the most challenging public health problems. It is important to know about the awareness level of a disease condition in a population, which plays a vital role in future development, early detection and prevention of disease.Methods: A total of 200 subjects were interviewed and their details were noted in a specially designed data collection form. The questionnaire contained a series of questions related to demographic characteristics and awareness of DM including general knowledge, risk factors and complications of diabetic and non-diabetic patients.Results: Among 150 subjects were diabetic and 50 were non-diabetic. 60 (40%), 14(28%) of diabetics and non- diabetics were between the age of 41-50. 101 (67.3%) were male, 49 (32.6%) were female. 101 (67.3%) of the study participant had family history of diabetes in diabetic. 45 (44.5%) diabetic, 20 (40.81%) non-diabetic male knows the risk factor for diabetes mellitus and 35 (34.6%), 21 (42.8%) were aware of symptoms, 09(8.9%), 03(6.1%) awareness on complication of diabetes. 21 (20.7%), 06 (12.2%) doesn’t know about Risk factors.Conclusions: The present study conclude a current situation of knowledge and awareness of diabetes mellitus and also emphasizes the need for improvement in knowledge and awareness on diabetes mellitus among the diabetic as well as non-diabetic subjects in order to achieve prevention and better control of diabetes risk factors, complications and its management.

Study of awareness of insulin usage in diabetics attending NRI Medical College and General Hospital

Background: India had 69.2 million diabetic patients. Insulin is an important part of diabetes treatment, but one-third of patients fail to take their insulin as prescribed, and many adults intentionally skip their doses. Since, diabetes treatment continues for lifetime, there is a need to assess the knowledge and understanding of patients in relation to their disease process and its management.Methods: A cross sectional, observational, knowledge and attitude survey were carried on patients with type II diabetes mellitus who are taking insulin therapy and attended medicine diabetes OPD in tertiary care Hospital during the period of April 2017 to Dec 2017. 200 diabetic patients’ ?18 years of age who were willing to respond to the study questionnaire were interviewed.Results: Total of 200 study participants were interviewed using structured questionnaires, almost 75 (37.5%) of the respondents were age group of 41 - 50 years. 109 (54.5 %) male, 67 (33.5%)Hindus, 121 (60.5 %) married,79 (39.5%) were primary school, 120 (73.8%) were family history of diabetes, duration of treatment1-3 years 72 (31.5 %), 160 (63%) of the study subjects know about diabetes is high blood glucose, 119(59.5%)of subjects know complications of diabetes, 165(82.5%) were know about insulin used for diabetes, 115 (57.5%) of patients know other substitute for insulin, 94 (47%) of the study subjects have knowledge of complications of insulin therapy, 85 (42.5) were know different types of insulin preparations, 141 (70.5%) were know insulin is mandatory in some patients,159 (79.5%) were understood the route of administration of insulin.Conclusions: The finding of present study showed that, diabetes patients had average knowledge and less favourable attitude among diabetic patients toward insulin therapy.

Cow's Milk-related Symptom Score as a predictive tool for cow's milk allergy in Indian children aged 0–24 months

BACKGROUND: Cow's milk protein causes an unfavorable and unwanted reaction in some individuals called cow's milk protein allergy (CMPA). It is more often imprecise and easily missed in primary care settings. Cow's Milk-related Symptom Score (CoMiSS) was developed as a screening and awareness tool to suggest the presence of CMPA using general, dermatological, gastrointestinal, and respiratory symptoms. OBJECTIVE: Assess the utility of CoMiSS in the diagnosis of CMPA in Indian children aged between 0 and 24 months. METHODS: A pilot multicentric, observational, longitudinal study was conducted over a period of 4 months among infants aged 0–24 months with symptoms suggestive of CMPA to measure the positive and negative predictive value of CoMiSS. A predesigned questionnaire was used to record the information via CoMiSS. The patients were confirmed of having CMPA via oral food challenge/skin prick test or ImmunoCAP test. RESULTS: A total of 83 children were enrolled in the study and majority of them had gastrointestinal complaints (61%, 51 of 83) followed by respiratory (41%, 34 of 83) and skin complaints (33%, 27 of 83). CoMiSS was >12 in 72.3% of the infants and amongst them 84.3% were confirmed via oral food challenge/ImmunoCAP test. The positive and negative predictive values for CoMiSS were 93% and 33% respectively. CONCLUSION: CoMiSS can help predict CMPA in children aged less than 2 years in the Indian primary care setting, aiding in early diagnosis. Prospective randomized studies are needed to evaluate the use of CoMiSS further.

Anti-proliferative and anti-angiogenic activities of ion-channel modulators: In-ovo, in-vitro and in-vivo study

Objective Angiogenesis is the development of new blood vessels. The ion channels on endothelium play a vital action in cell proliferation and so in the related angiogenesis. We aimed to investigate the anti-angiogenic effects of Mefloquine (Cl− channel blocker) and 4-Aminopyridine (K+ channel blocker). Methods The anti-angiogenic activities of Mefloquine and 4-Aminopyridine (4-AP) were investigated by in-vivo (sponge implantation method), in-vitro (aortic ring assay) and in-ovo (CAM, Chick Chorioallantoic membrane) methods. The standard antiangiogenic drug used was Bevacizumab. Results In the CAM assay, both the ion channel blockers exhibited noticeable antiangiogenic activity at the concentrations of 10