Motivation and preparedness of first semester medical students for a career in medicine.

Purpose : To determine motivation of medical students towards a medical career, and their knowledge of and preparation for it. Methods : After ethical committee approval, students admitted in 2009, who volunteered, were administered an anonymous questionnaire. Descriptive analysis was done. Results : Of 150 students admitted, 103 (68.7%) submitted completed questionnaires. Fifty-seven students (55%) got admission after ≥2 attempts; 65 (63%) decided on a medical career before class ten. Accurate knowledge about the curriculum was poor even though many had a family member in the health field and were encouraged to take up medicine. Only half had sought guidance from a medical person; most had never undergone career preparation activity. Conclusion : Students are early deciders and highly motivated to join medicine. Family is a strong motivator and could encourage career preparation activities. Policy makers could design interventions to inform school students before they make the critical decision to join medicine.

Comparison of cardiac autonomic functions among postmenopausal women with and without hormone replacement therapy, and premenopausal women.

The aim of present study was comparison of cardiac autonomic status during different phases of reproductive life in women – in premenopausal women between proliferative and secretory phase, in postmenopausal women and in postmenopausal women receiving hormone replacement therapy (HRT). The study included 30 premenopausal women (Group 1) who were assessed in both proliferative (Group 1A) and secretory phase (Group 1B) of menstrual cycle, 30 postmenopausal women (Group 2) and 30 postmenopausal women on HRT (Group 3). Various autonomic function tests were done to assess parasympathetic and sympathetic functions. Results were obtained by ANOVA followed by Tukey test. The postmenopausal women (Group 2) showed increased sympathetic and decreased parasympathetic tone compared to premenopausal women (Groupl). The women on HRT (Group 3) showed parasympathetic dominance and decrease in sympathetic activity compared to postmenopausal women (Group 2). Across the menstrual cycle, increased parasympathetic activity was seen in secretory phase while no change was observed in the sympathetic activity in the two phases.

Autonomic status and pain profile in patients of chronic low back pain and following electro acupuncture therapy: A randomized control trial.

Pain is a syndrome characterized by several neurophysiological changes including that of the autonomic nervous system. Chronic low back pain (LBP) is a major health problem and is a frequent reason for using unconventional therapies especially acupuncture. This study was conducted to evaluate the autonomic status and pain profile in chronic LBP patients and to observe the effect of electro acupuncture therapy. Chronic LBP patients (n=60) were recruited from the Department of Orthopaedics, GTB Hospital, Delhi. Age and sex matched healthy volunteers were selected as controls (n=30). Following a written consent, LBP patients were randomly allocated into two study groups – Group A received 10 sittings of electro acupuncture, on alternate days, at GB and UB points selected for back pain, while the Group B received a conventional drug therapy in the form of oral Valdecoxib together with supervised physiotherapy. Controls were assessed once while the patients were assessed twice, before and after completion of the treatment program (3 weeks). The autonomic status was studied with non-invasive cardiovascular autonomic function tests which included E: I ratio, 30:15 ratio, postural challenge test and sustained handgrip test. Pain intensity was measured with the visual analogue scale (VAS) and the global perceived effect (GPE). Statistical analysis was performed using repeated measure’s ANOVA with Tukey’s test. Pain patients showed a significantly reduced vagal tone and increased sympathetic activity as compared to the controls (P<0.05 to P<0.001 in different variables). Following treatment, both the study groups showed a reduction in vagal tone together with a decrease in the sympathetic activity. There was also a considerable relief of pain in both groups, however, the acupuncture group showed a better response (P<0.01). We conclude that there is autonomic dysfunction in chronic LBP patients. Acupuncture effectively relieves the pain and improves the autonomic status and hence can be used as an alternative/ additive treatment modality in these cases.

Evaluation of Neurophysiological Parameters: Autonomic Status and Acute Pain Perception in Migraneurs.

Introduction: Painful conditions are associated with autonomic dysfunction and altered pain perception. However, data regarding autonomic status in migraineurs is not conclusive and there are few studies regarding acute pain perception in these cases. Aims: This study was conducted to assess various neurophysiological parameters namely autonomic functions using the autonomic function tests and acute pain perception using the cold pressor test in migraneurs. Material and methods: 60 migraineurs and 30 age and gender matched control subjects were included in this study after screening for the exclusion criteria and following a written consent. Diagnosis of migraine was made according to the International Classification of Headache Disorders(ICHD) – 2 Criteria. In the pain free state of the subjects, autonomic function tests including basal heart rate variability, E:I ratio, 30:15 ratio, postural challenge test and sustained handgrip test were carried out together with the cold pressor test. Unpaired t-test was used for analysing the data. Result: Migraineurs showed a trend towards increased parasympathetic tone, as compared to the control subjects, though the p-values were not significant. The pain threshold was lower while the pain tolerance was significantly lower in migraineurs as compared to controls (p= 0.00).Conclusion: In our study we observed an increased vagal tone together with lower values of pain threshold and pain tolerance in migraineurs, indicating that certain neurophysiological parameters are affected in painful conditions like migraine.

Introducing problem-based learning in physiology in the conventional Indian medical curriculum.

BACKGROUND: Problem-based learning (PBL) is a widely acclaimed student-centred learning method. However, there are few reports of its use in the traditional lecture-practical-tutorial model of learning. We used PBL for teaching one module of Physiology to first-year medical undergraduate students who had no prior exposure to PBL. METHODS: One hundred first-year medical undergraduates enrolled in a medical college, which follows the traditional teaching-learning methods, participated in the exercise. The scheduled classes on 'Physiology of the thyroid gland' were converted into a PBL block to be covered over a week. An orientation of the teachers and students to PBL was done, clinical cases selected and tutor guides prepared before the actual PBL week. During the PBL week, students were exposed to small group discussions and Interactive resource sessions, and were given time for self-study. The PBL week concluded with a review session and evaluation of the PBL block using questionnaires. RESULTS: A comparison of the pre- and post-PBL questionnaire showed a clear preference for PBL over the conventional curriculum for the interactive resource sessions and group discussions. Both students and teachers found PBL rewarding. CONCLUSION: Implementation of PBL is feasible even in a traditional set-up despite limited resources, rigid time schedules and little interaction among various disciplines. We hope our experience would encourage other teachers to introduce appropriately modified PBL in their ongoing curriculum.