Effectiveness of case-based learning among medical interns using microbiology laboratory report as a tool

Background: Due to lack of consensus of teaching learning methods during undergraduate period, intern doctors face many challenges in clinical settings. Knowledge gaps related to clinical application of laboratory medicine leads to poor case management. Active learner centered training with real clinical cases is a need to help the interns to link their basic science knowledge into a practical context. Aims and Objectives: The present study was done to evaluate the effect of case based learning (CBL) on the interns’ knowledge and clinical decision-making skill of interpretation of laboratory investigation reports and to assess perception of participants about CBL. Materials and Methods: CBL method was used to train the interns in clinical application microbiology reports. This is a pre- and post-test type study, carried out for 2 months with 43 Medical interns, willing to participate. The process included evaluation of CBL by pre-validated questionnaires by multiple choice questions, clinical case scenarios before, immediately after and 10 days after the intervention and perception toward CBL was assessed. Statistical analysis was done using Student’s t-test and SPSS 17 software. The value of P < 0.05 was considered as significant. Results: A significant improvement in the interns’ knowledge and problem solving following CBL sessions had been observed in present study. The post-test scores of all the CBL sessions were significantly higher than pre-test scores (P < 0.05). The perception of interns toward CBL was assessed and it was responded positively. It helped in strengthening the critical skills of interns such as problem solving, critical thinking, and teamwork. Conclusion: The present study proved that interns during internship require to be trained in laboratory medicine. CBL is an effective teaching method to train interns in enhancing their problem solving skill with correct use of laboratory test results and strengthening critical thinking, teamwork, and time management skills.

Comparison of clinical utility of Cancer Ratio, CEA, Malignant Cytology in diagnosis of suspected malignant pleural effusion

Introduction: Pleural effusion is one of the manifestation of a malignant disease which may be malignant pleural effusion with demonstrable malignant cells in the fluid or para-malignant pleural effusion which is reactive response or due obstruction of lymphatic drainage rather than invasion of pleural cavity. Various modalities are there to investigate this condition including routine microscopy, cytology, biopsy etc. Objective: To understand and compare the utility of cancer ratio, tumor markers, malignant cytology in cases of suspected malignant pleural effusion. Material and Methods: This Case Control Cross sectional study was conducted among patients attending respiratory OPD at Sir Sunder Lal Hospital, BHU, Varanasi, diagnosed with malignant pleural effusion and non-malignant pleural effusion. Results: Significant association was found between Cancer Ratio-Carcinoembryonic Antigen, CEA (p = 0.0069), CEA-Cytology (p = <0.01801)

Impact of microteaching workshop on the teaching skills of postgraduate students, Odisha, India

Background: Young teachers can skill for better teaching-learning ways can be acquired through structured and cheaper faculty training techniques. Microteaching can be adopted as one such measure to improvise teaching-learning skills among young teachers. Aims and Objectives: This study was conducted also to knew the impact of knowledge and perception regarding microteaching among postgraduate medical students and improvise on them. Also to knew the improvement in teaching skills after training and established the usefulness of this modality of microteaching by looking into its effectiveness. Materials and Methods: The participants were 29 1st year postgraduate students of Kalinga Institute of Medical Sciences, Bhubaneswar, Odisha. One day microteaching workshop was arranged for them in the Medical Education Unit of KIMS. The participants were surveyed through questionnaires (A, B, C, D, and E). McNemar’s Chi-square test did this by comparing between pretesting and post-testing scores of Questionnaire A and D (Kirkpatrick level 1, 2, and 3) as well as B and C (Kirkpatrick level 4) by use of the STATA software. A three-point Likert scale (0 = Not useful, 1 = Doubtful, 2 = Useful) was used to assess the participants’ responses based on the qualitative analysis method from questionnaire E. Results: Pre-post testing revealed improvement in knowledge and perception about microteaching among the majority (P < 0.05). They improved skills-wise too (P < 0.05). All the participants believed that microteaching is useful with a score of 2 on a three-point Likert scale. Conclusion: The microteaching among postgraduate medical students before proper lecture is very much useful. This type of workshop and training should be done in regular interval.

A Comparative Study between Indigenous Low Cost Negative Pressure Wound Therapy with Added Local Oxygen versus Conventional Negative Pressure Wound Therapy

@#Introduction: The incidence of compound fractures and severe soft tissue loss has increased manifolds due to high speed traffics. Negative Pressure Wound Therapy (NPWT) is a treatment modality for managing soft tissue aspect of such injuries. It reduces the need of flap coverage. However, many patients from developing countries cannot afford a conventional NPWT. We developed an indigenous low cost NPWT for our patients and supplemented it with Topical Pressurised Oxygen Therapy (TPOT). We conducted this study to compare its treatment outcome with the use of conventional NPWT. Materials and Methods: The study was conducted from 2018 to 2020 at a tertiary care teaching hospital. A total of 86 patients were treated with NPWT and their results were assessed for various parameters like reduction in wound size, discharge, infection, etc. We included patients with acute traumatic wounds as well as chronic infected wounds, and placed them in three treatment groups to receive either conventional NPWT, Indigenous NPWT and lastly NPWT with supplement TPOT. Results: We observed a significant reduction of wound size, discharge and infection control in all three groups. The efficacy of indigenous NPWT is at par with conventional NPWT. Only six patients who had several comorbidities required flap coverage while in another four patients we could not achieve desired result due to technical limitations. Conclusion: Indigenous NPWT with added TPOT is a very potent and cost effective method to control infection and rapid management of severe trauma seen in orthopaedic practice. It also decreases the dependency on plastic surgeons for management of such wounds.

A Rare Case of Giant Cell Tumour of Bilateral Achilles Tendon Sheath - Reconstruction with Dual Tendon Transfer: A Case Report

@#Giant cell tumour of tendon sheath is a benign soft tissue lesion most commonly found in the flexor aspect of hand and wrist. However, it is uncommon in foot and ankle and rare in bilateral achilles tendon. We report a case of 17-year-old female who presented with progressive enlargement of bilateral achilles tendon for six months. MRI findings showed that most of the tumour had intermediate to low signal intensity. Histopathology confirmed the diagnosis of giant cell tumour of tendon sheath. To help the patient regain the strength of the achilles tendon and walking abilities, a large area of tendon tumour was excised, followed by reconstruction with transfer of the peroneus brevis (PB) and posterior tibial (PT) tendon autograft. At two years followup, functional result was satisfactory.

Ultrasound-guided fine-needle aspiration cytology of gallbladder masses – A solution to diagnostic dilemmas

Background: Advances in medical technology has revolutionized patient care. Ultrasound (USG)-guided fine-needle aspiration cytology (FNACs) is enlarging the realm of diagnostic cytology. This merger has increased the diagnostic accuracy especially in inaccessible body sites like the gall bladder (GB) masses. Impalpable, deep, and small lesions are now no longer a dilemma, thanks to image-guided FNACs. Objectives: The objective of the study was to study the ultrasound-guided FNACs of GB masses for a 10 year period and evaluate the efficacy of ultrasound-guided FNACs in GB lesions. Materials and Methods: USG-guided FNACs were collected and analyzed over a 10 year period (2007–2016) in the Department of Pathology North Eastern Indira Gandhi Regional Institute of Health and Medical Sciences (NEIGRIHMS), Shillong. This is a retrospective study and is in accordance with the ethical standards as laid by the Helsinki Declaration, 2000. Descriptive statistics were used for analysis. Results: The age ranges from 27 to 83 years and the mean age was 53.2 years. The majority were females which constituted around 94.3% (50) and males constituted around 5.7% (3). Out of all the adequate cases (42 in number) that were evaluated, 37 (88%) were malignant and 5 (12%) were benign and inflammatory; 11 out of 53 cases (20.8%) were inadequate. Conclusion: Although FNAC is established as a reliable diagnostic method, our study of 10 years has further proven that this test has stood the test of time, and with our high diagnostic yield and in the hands of a dedicated radiologist and cytopathologist, it will prove to surpass its expectations.

Chronic Obstructive Pulmonary Disease (COPD): Current Scenario in India

Chronic obstructive pulmonary disease (COPD) is a group of symptoms, which defined as persistent airflow limitation due to alveolar and airway abnormality which caused by chronic inflammation of airway and lung parenchyma. It is stated that it has leading cause of mortality and morbidity. It is projected to rank third among all causes of death by 2020. It has complex pathology with marked heterogeneity all over India. Now days it is markedly increasing in India due to biomass, occupational and household exposures. COPD leads to variety of intra and extra-pulmonary component and considerable effect of public health incidence are increasing in India mainly Uttar Pradesh and Bihar due to increase dependence to biomass and conventional exposure to noxious agents (Smoke, Biomass fuel, Dust particles).

The clinical utility of Adenosine Deaminase (ADA) levels for the differentiation of tubercular and non-tubercular pleural effusion

Background: Extra pulmonary TB accounts for 15% of all TB cases. Its incidence is much higher about 50% in HIV positive patients. Tuberculous pleurisy is present in around 4% of all TB cases2. Tuberculosis is always the leading etiology of pleural effusions in the developing countries3. Aims and Objectives: We have lot of investigations to diagnose pulmonary tuberculosis like sputum AFB, CBNAAT, LPA. These tests have some limitations in pleural fluid. So we are in need of a better test for diagnosis of tuberculous pleural effusion especially in high burden countries like India. Methods: In this study we have evaluated the usefulness of ADA level in pleural fluid for diagnosis of tuberculous pleural effusion. This study conducted from May 2017 to June 2018. Conclusion: This is a case control study done in a tertiary care center in Varanasi included 100 cases (Tuberculous pleural effusion) and 100 controls (Non Tuberculous pleural effusion).

Effect of whole body gamma radiation on hepatic LDH activity, lactate, pyruvate concentration and rate of oxygen consumption in Bufo melanostictus.

Whole body Co60 gamma radiation induced changes in lactic dehydrogenase (LDH) activity, pyruvate, lactate content and rate of oxygen (O2) consumption in a tropical hibernating anuran (Bufo melanostictus). In 3.5 and 7 Gy treated groups, a significant increase in LDH activity and lactate/pyruvate ratio was observed, whereas a significant decrease in O2 consumption rate was observed in treated animals on post-irradiation day (PID) 1, 5 and 10. Increase in LDH activity was observed on PID-1 in both the treated groups, reached to a peak on PID-5 in 7 Gy treated group and then declined on PID-10.

An appraisal of post-irradiation metabolic changes in toad liver (Bufo melanostictus).

Whole body 60Co gamma irradiation of B . melanostictus with two sublethal doses of 3.5 and 7 Gy resulted in a significant increase (P < 0.001) in total lipid (hyperlipidemia), cholesterol content (hypercholesterolemia) and total free amino acid content, and significant decrease (P < 0.001) in total protein content in the liver tissues on post-irradiation day (PID) 1, 5 and 10 as compared to controls. The ratio of total lipid to cholesterol showed a gradual declining trend by PID-10 in the treated groups as compared to controls. However, it was more pronounced in the 7 Gy treated group. An observation on the ratio of total protein to total free amino acid content also showed a similar declining trend by PID-10 in both the treated groups as compared to controls.

Recognition of cyclooxygenase-2 (COX-2) active site by NSAIDs: a computer modelling study.

The energetics and models of COX-2 complexed with nonsteroidal anti-inflammatory drugs (NSAIDs) having different degrees of selectivity for two isoforms of COX (COX-2 and COX-1) have been studied using computer modelling approach. The models are obtained for complexes of NS398 (NS), a selective COX-2 inhibitor; indoprofen (Ind), a non-selective inhibitor; di-tert-butylbenzofurans (DHDMBFs) with substituents at the 5th position: CONH(CH2)2OMe (BF1), CONH-c-Pr (BF2), 3-methylene-gamma-butyrolactonyl (BF3) and oxicams namely, meloxicam (Mel), piroxicam (Pir) and tenoxicam (Ten). These were optimized using molecular mechanics (MM) and molecular dynamics (MD) techniques. The binding energies and structures were compared with pharmacological parameters and available results with COX-1. In case of NS a larger difference in the binding energies between COX-2 and COX-1 was noticed as compared to that of Ind. It also had stronger interaction with His90 and Tyr355 which is considered important for COX-2 selectivity. There was a difference in the compactness at the channel entrance between COX-2 selective and non-selective ligands. Models with DHDMBFs and oxicams showed a similar correlation. The results were used to design a peptide inhibitor, Tyr-Arg-Cys-Ala-delta Phe-Cys (Pept) which could fit better in the COX-2 cavity. As per our MD simulation results this peptide inhibitor showed both higher activity and COX-2 selectivity.

Enzyme selectivity of new cyclooxygenase-2/5 lipoxygenase inhibitors using molecular modeling approach.

We have studied the conformational flexibility of three 5-keto-substituted 7-tert-butyl-2,3-dihydro-3,3-dimethylbenzofurans (DHDMBFs) which show dual cyclooxygenase (COX) and 5-lipoxygenase (LOX) inhibition and are potential candidates as antiinflammatory agents and analgesics. The conformations were studied by systematic search, molecular mechanics (MM) and simulated annealing molecular dynamics (SAMD) techniques. We also studied several structure based parameters and distribution of molecular electrostatic potential (MEP) around these molecules. All the three compounds were docked in the active cavity of cyclooxygenase-2 (COX-2) using graphical and energy grid search techniques. The complex geometries were optimized by MM. The results on conformational flexibility, inter-atomic distances and angles, MEP distribution and points of contacts with peptide side chains in active cavity have been used to understand the mechanistic cause of differential action of these molecules.

Changes in serum protease inhibitors and liver specific enzymes in experimental jaundice.

Changes in the different fractions of the serum protease inhibitors were studied in experimentally produced cases of obstructive jaundice in rabbits to correlate with other liver specific diagnostic parameters. The heat stable antiprotease fraction and alkaline phosphatase levels in serum were the only parameters which did not show significant fluctuations in the normal as well as in the experimental controls and were significantly elevated due to bile duct ligation. However, due to smaller change in the magnitude, the heat stable antiprotease levels were not found to be of much diagnostic use and the determination of bilirubin, alkaline phosphatase and alanine aminotransferase levels in serum appeared to be better indicators for detection of liver damage in such cases due to appreciable alterations in their levels.

Abdominal suture proctopexy for complete prolapse of rectum.

Eighteen patients, 13 males and 5 females, with complete rectal prolapse have been treated by suture proctopexy during the period 1987-1989 with no operative mortality and very little morbidity. There was only one case of recurrence during a 3-year follow-up for which a repeat identical procedure was successful. There was some disturbance in faecal continence pre-operatively in 14 cases, of whom, 13 cases were improved by suture proctopexy. There was no significant change in bowel habit postoperatively, with the exception of 2 patients who had constipation postoperatively but one reverted to normal on re-education of bowel habit. All the patients had normal urinary and sexual function. This relatively simple procedure was well tolerated by the patients.