“Fever clinic duty” during Covid-19: through the eyes of a preclinical doctor–teacher

In this narrative, a teacher of physiology writes about her shifts at an out-patient fever clinic during the Covid-19 pandemic. Apart from describing the author’s own struggle during her return to a clinician’s role, the narrative reveals the anxieties, fears, challenges and stigma faced by patients and the pressures on the healthcare team in a pandemic situation.

Exposure to Repeated Mini-objective Structured Practical Examinations as A Formative Assessment Tool to the Students and Faculty in Physiology Practicals.

The study aimed to look at the influence of mini-Objective Structured Practical Examinations (OSPEs) as a formative assessment tool for students and teachers. All first year MBBS students of 2013-14 batch of St. John’s Medical College (n=60) went through four mini-OSPE sessions consisting of 5 sets of 6 stations each during 3 months of hematology practicals and final OSPE after 2 months. Feedback of the students and faculty was obtained. The students were categorized into tertiles based on the cumulative scores obtained in the first three-OSPEs and final-OSPE session and were significantly associated from Chi square test. [c2(4, N=54) =15.2, p=0.004]. Low performers with high probability of performing poorly were recognized early in the term. High performers largely remained soandmid performersshowed highly variable performance. The feedback obtained supported the role of OSPE as a formative assessment tool. Thus, OSPE could be used as a formative tool for students and teachers.

Trace Element and Light Microscopic Studies on Testis of Albino Rats Treated with Sildenafil Citrate (Caverta).

Background: Caverta (Sildenafil citrate), an oral therapy for Erectile Dysfunction (ED), being the citrate salt of Sildenafil, is a selective inhibitor of cGMP- specific phosphodiestrase type (PDE5). Aim: To study the drug- induced (i) changes in the trace element content of Testis and (ii) changes in the histoarchitecture of Testis of the experimental Albino rats. Materials and Methods: For the present study, totally 48 animals were selected on weight basis and divided into 8 groups (S1, S2, S3, S4, S5, S6, S7 and S8) with six animals in each group. Control animals (S1) were fed with conductivity water while the experimental animals (S2, S3, S4 and S5) were treated with a single dose of Caverta (@ 1μg/g body weight). Control animals were sacrificed at zero hour while the experimental animals (S2, S3, S4 and S5) were sacrificed after 1 hour, 2½ hours, 4 hours and 24 hours of drug administration respectively S6, S7 and S8 group of animals were fed with a single dose of the chosen drug (@ 1μg/g body weight) daily for all the 15, 30 and 45 days respectively. These animals were sacrificed after 4 hours of the last dosage. Vertical ventral midline incision was made in the abdominal wall to collect the left and right Testes. Results: The spectral analysis indicates that the long term Caverta treatment of Albino rats results in the accumulation of Iron and Copper levels accompanied by a depletion of Nickel levels in the Testis. The histological studies indicate that long term exposure of Testis to Caverta leads to distorted histoarchitecture of the seminiferous tubules, interstitial space dilation and separation of Spermatogenic cells. Conclusion: Long term Sildenafil Citrate (Caverta) treatment of Albino rats will bring in adverse effects and will completely alter the histoarchitecture of the Testis.

The effect of vocal and instrumental music on cardio respiratory variables, energy expenditure and exertion levels during sub maximal treadmill exercise.

The purpose of the study was to investigate the effect of vocal and instrumental music on various physiological parameters during submaximal exercise. Each subject underwent three sessions of exercise protocol – without music, with vocal music, and instrumental versions of same piece of music. The protocol consisted of 10 min treadmill exercise at 70% HRmax and 20 min of recovery. Minute to minute heart rate and breath by breath recording of respiratory parameters, rate of energy expenditure and perceived exertion levels were measured. Music, irrespective of the presence or absence of lyrics, enabled the subjects to exercise at a significantly lower heart rate and oxygen consumption, reduced the metabolic cost and perceived exertion levels of exercise (P<0.05). There was faster recovery of systolic and diastolic blood pressures and exertion levels during the post exercise period. Music having a relaxant effect could have probably increased the parasympathetic activation leading to these effects.

Effect of different musical tempo on post-exercise recovery in young adults.

The role of music in increasing the exercise performance is well recognised. There is very little information about effect of music on time taken for post exercise recovery. We examined the effect of music and different musical tempo on post exercise recovery time, following treadmill work. 30 volunteers (15 male, 15 female) subjected to isotonic exercise (submaximal treadmill work) on three consecutive days. They were allowed to rest in silence on the first day, rest by hearing slow music on second day and rest with fast music on third day. Parameters such as Pulse rate, blood pressure, rating of perceived exertion (RPE) were measured at predetermined intervals. Repeated measures ANOVA test showed that with slow music, recovery time of systolic blood pressure (SBP) (7.9±2.5), diastolic blood pressure (DBP) (5.5±3.4) pulse rate recovery (PR) (8.0±2.3) and recovery from exertion (RPE) (7.7±2.5) were significantly faster when compared to both no music and fast music. The individual music preference made no significant difference in the relaxation time. The study concluded that music hastens post exercise recovery and slow music has greater relaxation effect than fast or no music, recovery time being independent of the gender and individual music preference.

Effect of surgical stress on neutrophil function.

The present study was undertaken to find out the effect of surgical stress on nonspecific immune response. Twenty patients posted for various elective surgeries participated in the study (male : 17, female : 3, age : 43.4±2 yrs). The blood samples were taken preoperatively (4 to 6 days prior to surgery) and the following parameters were assessed: phagocytic index of neutrophils, avidity index of neutrophils and percentage of neutrophils in differential count. These were compared with the respective parameters assessed in the blood samples taken 24 hours after surgery. There was a significant (P=0.0001) decrease in the phagocytic index of neutrophil and a significant (P=0.003) increase in the percentage of neutrophils in differential count in the postoperative blood samples. However, the avidity index did not show a significant change. It could be tentatively concluded that surgical stress causes depression of nonspecific immunity in the early postoperative period.

Attire and appearance of pediatrician: parents'/guardians' opinion.

Professional appearance of a pediatrician is an important element affecting the perception of competence of the doctor among patients and their parents/guardians, thus influencing their compliance. As there is no study on this issue addressing the Indian scene, we requested responses to a questionnaire containing 15 questions from the parents/guardians of the children. The purpose of the study was to assess their opinion regarding attire and appearance of pediatricians. Five each of the questions were related to common aspects of appearance and attire of the pediatrician in general and that of the male and the female pediatrician in particular. A total of 210 parents/guardians responded to see the question listed in the questionnaire. Assertive responses to each question were analysed for any association with the following categories--Urban, Rural, Males, Females, Urban Males, Rural Males, Urban Females, Rural Females, age below 40 years and age 40 years or more. Majority of the total assertive respondents preferred a formal/traditional attire and appearance for the pediatrician. Although most of the above categories concurred with this general opinion, some categories showed statistically significant, but practically unimportant, differences in the extent of agreement. The respondents generally favoured a white coat and nameplate on the pediatrician, shoes and a necktie for the male pediatrician and saree for the female pediatrician. They did not approve clothes with bizarre designs, use of perfumes by the pediatrician, long hair, T-shirts and jeans pant for the male pediatrician, chudidar, lipstick and other make-ups, costly jewelery and short hair for the female pediatrician.

Pre hospital issues in acute myocardial infarction.

OBJECTIVES: Time is of prime importance in the management of acute myocardial infarction (AMI). Time to hospital admission should be minimised for maximum thrombolytic benefit. The present paper has evaluated some socio-demographic factors influencing pre hospital delay. METHODS: This prospective observational study of 1,072 patients with AMI admitted to 14 hospitals in South India was done over one year. Socio-demographic factors viz. time of symptom onset, place of residence, type of transportation to hospital, distance travelled, as well as clinical and treatment details were recorded. Hospitals were grouped based on their location into metropolitan and town hospitals. RESULTS: Males predominated (85%) and had AMI at a younger age than females. Most patients (74%) travelled less than 30 km to a hospital. The mean distance travelled to a town hospital was longer than that to a metropolitan hospital (24.2 km vs 21 km; p < 0.0001); however there was no significant difference in the type of transportation or time taken to reach either of the hospitals. Majority (79%) of patients arrived at a hospital within the thrombolytic window of 12 hours (mean time = 11 hours). The occurrence of a previous MI had no influence on time taken to hospital arrival, questioning the role of symptom education as an interventional strategy to reduce pre hospital delay. Patients older than 70 years and females in towns with symptom onset during the day (6 am to 6 pm) took a longer time to reach hospital. CONCLUSION: Community facilities do not affect pre hospital delay. Interventions should focus on reducing decision time to call for help and the role of symptom education needs further evaluation.

Treatment of acute myocardial infarction: does the type of hospital make a difference? PPAMI Study Group.

There is sparse data on the treatment practices being followed for acute myocardial infarction at various hospitals that differ in their financial infrastructure, availability of facilities and attachment to a medical college. In this prospective observational study, we evaluated the treatment practices for acute myocardial infarction, its appropriateness based on ACC/AHA guidelines and possible influence by type of hospital and certain patient characteristics. Thrombolysis, beta-blockers and angiotensin-converting enzyme-I inhibitors were used in 674 (63%), 506 (47%) and 413 (38%) respectively of 1072 patients. However, when evaluated according to ACC/AHA guidelines, appropriate use was noted in 83 percent, 78 percent and 99.3 percent, respectively. Thrombolysis was inappropriately denied to 14.7 percent patients whereas in 2.4 percent it was used contrary to recommendations. The most common reason for ineligibility for thrombolysis was late arrival. Beta-blockers were denied to 25.1 percent patients. Decision on use of angiotensin-converting enzyme-I was appropriate in most patients. Aspirin was used in 1027 (95.8%) patients. Government hospitals were least likely to thrombolyse a patient as compared to private, industrial and voluntary hospitals; however, this difference was not seen with the use of beta-blockers and angiotensin-converting enzyme-I. Hospitals attached to medical colleges follow guidelines for use of thrombolysis and beta-blockers more closely than non-teaching hospitals. To conclude, evaluation of appropriateness of a therapeutic modality is of greater clinical significance than mere absolute use. Benefits of thrombolytic therapy can be extended by minimising pre-hospital delay; and there is scope for improved utility of beta-blockers which are cost-effective. In addition, the hospital type also has an impact on the treatment practice being followed for acute myocardial infarction.