Protamine-Induced Hypotension and Pulmonary Arterial Hypertension

Protamine is a routinely used safe antidote for heparin reversal in cardiovascular surgeries. Protamine was first introduced to prolong the action of insulin preparations. As protamine interacts with platelets and fibrinogen and has an anticoagulant effect of its own, minimal amount is given to neutralize heparin present in plasma. Although infrequent, protamine is associated with serious adverse drug reactions (ADRs), especially in patients with previous history of protamine hypersensitivity. Here, we report a case of protamine-induced pulmonary arterial hypertension and peripheral vascular collapse in a 60-year-old diabetic male patient who had undergone on-pump coronary artery bypass grafting in a tertiary care center. This was a definite, nonpreventable, severe ADR as per causality, preventability, and severity assessment scale. This patient had no previous history of protamine hypersensitivity and was not on any insulin preparations. Despite precise timely treatment and other resuscitative measures, the patient expired subsequent to these ADRs. This case report throws light on the grave requirement in urgent evolvement of pharmacogenetic and pharmacokinetic tools to detect patients who are at risk of precipitating these ADRs and thus to take precautions to prevent them

Reliability and validity of short answer questions in Pharmacology

Background: Short answer question (SAQ) is an excellent tool for assessment. Objective of this study was to understand the practices adopted in answering SAQ, assessment of reliability and validity of SAQ and faculty feedback on valuing SAQs.Methods: A cross-sectional study was done in the Department of Pharmacology of a Government Medical College in Central Kerala from December 2018-January 2019. The study participants were given 10 minutes to answer the two chosen SAQs after which the response sheets were collected and valued by 2 independent examiners. Feedback on correction of the same questions was sought from Pharmacology faculties of various Medical Colleges through online survey. The data were analysed using SPSS software.Results: 100% participants attempted to answer the SAQ ‘Definition of a drug’ but none of them came out with the World Health Organisation definition of drug. For the second SAQ, ‘Two uses of atropine’ around 25(20.8%) participants had written two uses of the drug correctly. The reliability was 0 for ‘definition of a drug’ and 0. 50 (95% CI 0.082-0.702) for ‘Two uses of atropine’ and both the questions had no validity. The feedback on valuing definition and two use of atropine was variable.Conclusions: None of the students wrote definition of a drug correctly and majority gave multiple responses to uses of atropine instead of two valid responses. The short answer questions we tested were found to have moderate to no reliability and no validity. The faculties had variable perceptions in valuing the two short answer questions.

Concept learning through question framing in Pharmacology

Background: Framing questions is a skill that requires expertise, knowledge, guidance and mentoring. It provides structure for deep learning, critical thinking and also promotes interaction and communication. Objective of this study is to analyze the question framing skills of fifth semester medical students on a ‘must know’ area in Pharmacology.Methods: A cross-sectional study was done in the Department of Pharmacology of a Government Medical College in Central Kerala. After briefing about the study, each of the participants was instructed to frame a question which were collected after 15 minutes. The data on different aspects of questions was analysed by Statistical Package for the Social Sciences 16.Results: Total 130 students, 79 females and 51 males participated in this study. 7 questions were incomplete and excluded from further analysis. From the rest 123 properly framed questions, 106(86.2%) were correct, 10(8.1%) were partially correct and 7(5.7%) incorrect with regards to the task assigned. In this study knowledge as well as application was tested in 50.4% questions, comprehension in 21.1% and application alone in 22.8%. The knowledge dimension tested was factual in 91(74%) and conceptual in 32(26%). Non-hierarchical classification showed 96(78%) convergent and 27(22%) divergent.Conclusions: In this study majority of the participants framed direct short answer questions which reflects factual knowledge indicating their lower-level cognition. Critical thinking and procurement of higher level cognition can be attained by directing them to frame the right question especially in medical education.