Effectiveness of implementation of formative assessments as a part of competency-based medical education on summative assessment: A pilot study

Background: Assessment is an essential part of each and every education, which represents the learning of a student. If the assessments are performed regularly, it inspires active study habits and inevitably enhance learning. Aim and Objectives: Formative assessments, which are performed regularly, increase the effectiveness of the learning. Hence, we aimed to observe the effectiveness of spaced formative assessments on the performance of students in summative assessments. Materials and Methods: We selected 250 first-year medical students from the 21 to 22 batch. The students were categorized into three groups on the basis of formative assessment performance. Group I did not appear in the formative assessment, Group II scored <50% in the formative assessment, and Group III scored more than 50% in the formative assessment. Multiple comparisons of scores of summative assessments between different groups were done using ANOVA. Scores of formative assessments and summative assessment were correlated using Pearson correlation. Results: We got a statistically significant difference (P < 0.05) in mean summative assessment scores in different groups. Again, the analysis showed formative assessments had a significant (P < 0.05) relationship with summative assessment performance. Conclusion: The performance of formative assessments is predictive of summative examination scores. Academically poor medical students will be benefited from formative assessments.

Impact of yoga on lipid parameters in different age groups

Background: Cardiovascular diseases (CVDs) rise first among the causes of death occurring due to non-communicable diseases in the world. The majority of cardiovascular deaths are due to ischemic heart disease and cerebrovascular disease. Among the major risk factors, dyslipidemia is an important risk factor. Hence, the prevention of dyslipidemia results in the prevention of ischemic heart disease. Dyslipidemia can be corrected by drugs but more importantly, it can be prevented by lifestyle modification. Aim and Objectives: Our aim is to observe the impact of yoga on lipid parameters in different age groups. Materials and Methods: We included 54 subjects between the age group of 30 and 60 years for this study. They were categorized into two groups: Group I having ages between 30 and 45 years (n = 23) and Group II having ages between more than 45 years and <60 years (n = 31). The lipid parameters were measured afore of yoga training, at the end of 2 months and after 6 months of yogic practices. Statistical analysis was done using the SPSS version of 20.0. A P value of less than 0.05 is considered as statistically significant. Results: Our study revealed that yoga induces a decrease in total cholesterol, triglycerides, low-density lipoprotein cholesterol, and very LDL cholesterol and an increase in high-density lipoprotein cholesterol in both Group I and Group II subjects which were statistically significant. Conclusion: Yoga tends to improve dyslipidemia, a major risk factor for CVDs. A yoga lifestyle can be considered a preventive measure for CVDs.

COVID-19: Knowledge, attitude, and practice of health-care workers in tertiary care hospitals of Odisha – A cross-sectional survey

Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a contagious viral pathogen, creating a public health emergency, and affecting lives and livelihood of millions of populations globally. Good knowledge, attitude, and practice are essential to prevent and stop the widespread transmission. Aims and Objectives: The aim of the study was to assess the knowledge, attitude, and practices regarding COVID-19 among health-care workers (HCWs) in tertiary care hospitals of Odisha. Materials and Methods: The present study is an observational, cross-sectional, and question-based online research. Questions were created on Google forms. Link was generated and given through social media apps. The questionnaire consists of four sections. First section comprised demographic characteristics. Second, third, and fourth sections contain questions on knowledge, attitude, and practice related to COVID-19, respectively. Descriptive and inferential statistical procedures were done through IBM SPSS statistics version 24.0. The research was granted approval by Institute Ethics Committee of IMS and SUM Hospital. Results: Data were analyzed in 430 subjects, 205 females and 225 males. The majority of HCWs have good knowledge score 86.5%, attitude score 80.9%, and practice score 91.2%. The mean knowledge score was 6.6 ± 0.84 and mean attitude score was 28.5 ± 1.89. Knowledge and attitude score was found to be significantly different among age groups and gender, p<0.001. Mean attitude score had a significant difference with working status, P = 0.025. Mean knowledge and attitude score was significantly higher across professions and work experience, P < 0.001. Good practice score varies significantly across professions, P < 0.001. Conclusions: The most of HCWs had good knowledge, positive attitude, and adopted appropriate practices regarding COVID-19. Periodic educational interventions are strongly recommended for HCWs to upgrade their knowledge, attitude, and practices regarding coronavirus diseases.

Early onset mixed cryoglobulinemia in hepatitis C.

Cryoglobulinemia is one of the most common forms of extrahepatic manifestation of chronic hepatitis infection. The phenomenon is generally seen after several years of chronicity predominantly in the female population resulting in arthralgias, purpuras, and other symptoms, due to vasculitis. Here we present a case of incomplete mixed cryoglobulinemia Type III (as per Brouet’s classifi cation) in a young boy aged 13 years who presented with an unusual symptom of pruritus. Diagnosis was confi rmed by cryoprecipitation test followed by immunofi xation. We aim to highlight the diffi culty in diagnosis of this rare case/presentation, important investigation pitfalls and how to avoid them.

Heparin Co-factor II Thrombin Complex as a Biomarker for Mucopolysaccharidosis: Indian Experience.

Background: Serum heparin cofactor II-thrombin complex (HCII-T) is an emerging biomarker for mucopolysaccharidosis disease (MPS I and MPS II). Methods: Seventeen cases (6 MPS I and 11 MPS II) and sixty healthy controls were enrolled in study, conducted from September 2008 to December 2012. The mean ± SD age of MPS1 (n=6, 5 males) and MPS II was 7.02 ± 3.25 and 5.2 ± 2.15 years, respectively. Disease status was confirmed by clinical features and enzyme assay. Urinary glycosaminoglycans were measured in spot urine samples and expressed in relation to creatinine content. HCIIT measurement was done using sandwich ELISA at enrolment and after 12 and 24 months of recruitment. Results: Urinary glycosaminoglycans and HCIIT were elevated in all patients compared to their healthy controls. Both markers could not discriminate between the type of mucopolysaccharidosis. Conclusion: Heparin Cofactor II Thrombin Complex is a good biomarker for mucopolysaccharidosis I and II.

Vitamin E Supplementation in Exclusively Breastfed VLBW Infants.

We conducted this study to evaluate the adequacy of breastmilk as a source of vitamin E in exclusively breastfed VLBW infants. Such infants (n=44) were randomly allotted to receive vitamin E supplementation (n = 23); the rest (n = 21) did not receive vitamin E. After 21 days, the vitamin E level in the supplemented group was 0.78 + 0.26 mg/dL as compared to 0.77+ 0.25 mg/dL in the unsupplemented group (P=0.69). The ratio of Vitamin E to lipids was also comparable in the two groups, (P=0.65). We concluded that vitamin E supplementation is not routinely needed in VLBW infants.

Myocardial dysfunction in rheumatic carditis--does it really exist?

OBJECTIVES: Acute rheumatic fever (ARF) continues to affect millions of children in developing countries. Aim of the present study was to evaluate the role of myocardial dysfunction in the genesis of heart failure in patients with rheumatic carditis. There are limited studies on this subject. METHODS AND RESULTS: In this prospective study, 108 consecutive patients of ARF were evaluated by echocardiography and assay of cardiac troponin I blood levels. The patients were divided into three groups. Group A (n = 30): patients with no evidence of carditis; Group B (n = 45): patients with first attack of carditis; and group C (n = 33): patients with recurrent attacks of carditis. Left ventricular dimensions tended to be larger in Group B and C patients. Left ventricular ejection fraction did not differ between the groups (Group A: 63 +/- 8.1%, Group B: 58 +/- 7.9%, Group C: 61.2 +/- 9%, p = ns). Heart failure was present in 37.7% patients of Group B, and in 60.6% patients of Group C (p = < 0.05). Ejection fraction was normal in majority of heart failure patients (75.7%). It was reduced in 29.4% of patients in Group B and in 20% of Group C patients with heart failure (p = ns). All patients with low ejection fraction had hemodynamically significant regurgitant valvular lesions. Mean cardiac troponin I values, an index of myocardial damage, did not differ between the three groups (Group A: 0.062 +/- 0.027 ng/ml, Group B: 0.068 +/- 0.019 ng/ml, Group C: 0.071 +/- 0.031 ng/ml, p = ns). CONCLUSION: The present study did not demonstrate any echocardiographic abnormalities or cardiac troponin I elevation suggesting significant myocardial involvement during acute rheumatic fever. This lends credence to the view that myocardial involvement does not play any significant role in the genesis of heart failure in patients with rheumatic carditis.

Estimation of rewarming time in transported extramural hypothermic neonates.

OBJECTIVES: To evaluate the time taken for rewarming hypothermic neonates and to correlate the time taken for rewarming with severity of hypothermia (WHO classification), weight, gestational age and associated morbidity. METHODS: 100 extramural neonates transported to the Referral neonatal unit of a teaching hospital, with weight more than 1000 grams and abdominal skin temperature less than 36.5 oC at admission were included in the study. Hypothermia was classified as per WHO recommendations. Clinical features including age, weight, gestational age, clinical diagnosis and vitals were recorded at the time of admission. Rewarming was done under a servo-controlled radiant warmer, in skin mode at set temperature of 37 oC. Skin and air temperatures measured by the thermistor probe were recorded at the time of admission and then at least every 15 minutes till skin temperature reached 36.5 oC. The neonates were monitored for oxygen saturation, blood glucose and capillary filling time and stabilized promptly. RESULTS: The mean abdominal skin temperature was 34.9 +/- 1.4 oC. 72% of babies were moderately or severely hypothermic as per WHO classification. The duration of rewarming was 4.9 +/- 0.8 min, 17.5 +/- 9.5 min and 42+/-7.9 min for mild, moderate and severe hypothermia respectively (p=0.021). The difference in rate of rewarming between various grades of hypothermia was also significant. The duration of rewarming a baby did not differ significantly between the different weight and gestational age groups. When the rate of rewarming was expressed as rise in oC per Kg body weight per hour, it was higher in smaller and more premature babies. The rate of rewarming was slower in asphyxiated babies. CONCLUSIONS: The duration of rewarming depends on the severity of hypothermia. When rewarmed under radiant warmer using servo mode, the duration of rewarming a baby is the same irrespective of weight and gestational age. Asphyxiated babies take longer time to rewarm.

Left ventricular dysfunction in patients with subclinical hypothyroidism and its reversibility after hormone therapy.

AIM: To ascertain the presence of LV dysfunction in patients of subclinical hypothyroidism and its reversibility after hormone therapy. METHODS AND METERIAL: Thirty two patients with subclinical hypothyroidism (SH) were included in the study, along with thirty two age and sex matched individuals serving as controls. The patients with SH had normal serum T3 and T4 with an elevated TSH value. All patients and the controls were subjected to detailed echocardiographic examination for assessment of LV systolic and diastolic function before and one year after hormone (thyroxine) therapy. RESULTS: The systolic function of LV was normal in patients with SH. There was significant diastolic dysfunction in the SH patients as compared with controls. There was prolongation of deceleration above time (169 +/- 6.1 msec. vs. 148.1 +/- 5.4 msec in controls, p < 0.05), isovolumic relaxation time (89.1 +/- 7.3 msec vs. 79.4 +/- 5.9 msec., p<0.05), increased A wave (0.63 +/- 0.6 m/sec. vs. 0.54 +/- 0.05 m/sec) and reduced E/A ratio (0.7 +/- 0.09 vs. 1.4 +/- 0.3, p < 0.05). Echocardiography at the end of one year of hormone therapy revealed considerable improvement in diastolic function of the LV. There was significant improvement in DT (from 169 +/- 6.1 msec. to 151 +/- 5.2 msec, p < 0.05), IVRT (from 89.1 +/- 7.3 msec. to 80.2 +/- 6.5 msec, p < 0.05) and increased E/A ratio (from 0.7 +/- 0.09 to 1.3 +/- 0.1, p < 0.05). CONCLUSION: Hypothyroidism, even in subclinical stage, can cause diastolic dysfunction of the LV. These abnormalities in diastolic function can be reversed by thyroxine therapy.

Predictors of fatality in neonates requiring mechanical ventilation.

OBJECTIVE: To evaluate initial arterial blood gas, pulmonary pressures, pulmonary mechanics (compliance and resistance), pulmonary volumes, oxygenation indices and serum carotenoid levels as predictors of fatality in mechanically ventilated neonates. DESIGN: Cross Sectional. SETTING: Referral neonatal unit of a teaching hospital. SUBJECTS: 83 mechanically ventilated outborn neonates. METHODS: 83 neonates consecutively put on mechanical ventilator from March to December 2001 were enrolled in the study. The mechanical ventilator used was pressure limited time cycled ventilator with facility for online measurement of volumes and pulmonary mechanics. Arterial blood gas after half an hour of initiation of mechanical ventilation and initial pulmonary pressures, pulmonary compliance, resistance and duration of mechanical ventilation were recorded in a pre structured proforma. Initial serum carotenoid levels were also measured using spectrophotometric method. The neonates were regularly followed up for outcome. Multiple logistic regression analysis was done to find out the predictors of fatality for those variables that were significantly associated with outcome on univariate analysis. RESULTS: On univariate analysis weight ( < 2000 g), gestational age <34 weeks, pH <7.3, duration of mechanical ventilation <72 hours, a/A <0.25, compliance <1 mL/cmH2O, fraction of inspired oxygen (FiO2) >60%, oxygenation index >10, AaDO2 >250 and serum carotenoid levels < 100 microg/dL were significantly associated with fatality in neonates requiring mechanical ventilation. However, on multiple regression analysis only FiO2, gestational age and serum carotenoids < 100 microg/dL were found to be independent predictors of fatality. CONCLUSIONS: Initial FiO2 > 60%, gestational age <34 weeks and initial serum carotenoid levels < 100 microg/dL were independent predictors of fatality in neonatal mechanical ventilation. Even in a setting with high fatality rates, high risk of mortality in mechanically ventilated neonates can be identified.

Myocarditis as an initial manifestation of systemic lupus erythematosus.

We report a case of systemic lupus erythematosus (SLE) whose initial presentation was in the form of myocarditis. The patient did not have arthritis, fever or butterfly rash. Presence of LE cell phenomenon, positive ANA, anti-DS DNA antibodies, leucopenia and high ESR with polyserositis indicated the diagnosis to be SLE. Therapy with steroid resulted in complete recovery. The patient developed atrial fibrillation during her course of acute illness which is being reported for the first time.

Amlodipine-induced gingival hyperplasia.

Gingival hyperplasia can occur during use of drugs such as diphenylhydantoin, cyclosporine and nifedipine. We report, three cases of gingival hyperplasia induced by amlodipine, a second generation calcium channel blocker. Exact cause of induction of thehyperplasia is not known. Individual variation in metabolism of the drug may be a factor.

Percutaneous balloon angioplasty of membranous obstruction of the inferior vena cava.

BACKGROUND: Membranous obstruction of the inferior vena cava is common in African and Asian countries. METHODS AND RESULTS: Between January 1999 and January 2002, 19 patients were prospectively studied. The mean age of the patients was 38+/-6.9 years. All of them had swelling of the abdomen and ankle edema. Five patients (26.3%) had jaundice, 9 (47.3%) had hepatomegaly, and 5 (26.3%) splenomegaly. Ultrasonography could detect the site of obstruction in 18 patients (94.7%). Vena cavography demonstrated obstruction of the inferior vena cava at the level of the diaphragm, with 2 patients (10.5%) having additional intrahepatic obstruction. The mean pressure gradient was 22+/-3.5 mmHg. Seventeen patients underwent balloon angioplasty using a Joseph balloon. The procedure was successful in 15 patients (88.2%). The post-angioplasty mean pressure gradient was 5+/-1.4 mmHg. On follow-up, 3 patients (20%) developed features of restenosis: out of them, 2 underwent successful redilatation. CONCLUSIONS: Balloon angioplasty of membranous obstruction of the inferior vena cava is feasible with a high success rate, without any rupture of the inferior vena cava.

Has the prevalence of rheumatic fever/rheumatic heart disease really changed? A hospital-based study.

BACKGROUND: Rheumatic fever and rheumatic heart disease still remain major public health problems. With a dramatic rise in the incidence of coronary artery disease cases, the focus of the physician seems to be shifting away from rheumatic fever and rheumatic heart disease. The aim of the present study was to assess the prevalence of rheumatic fever and rheumatic heart disease, and to ascertain if there was any decline in the prevalence of the disease. For the first time, data on the prevalence of rheumatic fever and rheumatic heart disease are reported from Orissa, an underdeveloped state in eastern India. METHODS AND RESULTS: We scrutinized the records of cardiac patients admitted to the medicine, pediatrics and cardiology wards of the SCB Medical College and Hospital, Cuttack from 1981 to 1990 and 1991 to 2000. During the period 1981-1990, out of 11,782 cardiac patients, 5537 (46.9%) were suffering from rheumatic fever and rheumatic heart disease. During 1991-2000, out of 14,803 cardiac patients, 6670 hospitalized patients (45%) were found to have rheumatic fever and rheumatic heart disease. During the first and second periods, the number of patients with rheumatic fever admitted was 1079 (9.2%) and 1330 (8.9%), respectively. The decline in the percentage of rheumatic fever cases was statistically not significant (p>0.05). During the two periods, the number of rheumatic heart disease patients admitted was 4458 (37.8%) and 5340 (36.1%), respectively. During both the periods studied, the decline in the percentage of rheumatic heart disease cases admitted was statistically not significant (p>0.05). We also compared rheumatic fever and rheumatic heart disease cases admitted during 1981-1985 with those admitted during 1996-2000. This analysis also did not show any demonstrable decline in the prevalence of the disease (2692 [46.2%] v. 3296 [44.4%], p>0.05). CONCLUSIONS: Our results show that rheumatic fever and rheumatic heart disease cases constitute a significant percentage of the admissions of total cardiac cases to our hospital. Over the past 20 years, there is no significant decline in the percentage of rheumatic fever and rheumatic heart disease cases being admitted to a major government hospital.

Effects of exogenous vitamin E supplementation on the levels of oxidants and antioxidants in chronic obstructive pulmonary disease.

Oxidative stress has been recognized as a central feature of smoke induced chronic obstructive pulmonary disease (COPD). Imbalance between oxidant and antioxidant enzymes is also an established fact in these patients. But studies in regard to stable COPD patients and effect of vitamin E supplementation are lacking. Thirty patients with COPD were included in the study. Their baseline clinical examination, spirometry, plasma malondialdehyde (MDA), alpha-tocopherol and red blood cell superoxide dismutase (SOD) levels were mea sured. Twenty healthy non-smokers who were matched for age and sex served as controls. All the above parameters were repeated after 12 weeks of supplementation with 400 IU of vitamin E daily. The mean malondialdehyde levels in the patients at baseline were higher than controls (5.91 +/- 1.23 nmol/ml vs 4.55 +/- 1.51 nmol/ml, P = 0 001), so also was plasma alpha-tocopherol levels (P < 0 001), while SOD levels were lower in the patients compared to controls (1692 +/- 259 units g/Hb vs 2451 +/- 131 units g/Hb, P < 0 001). Exogenous vitamin E (400 IU per day) supplementation did not bring about any significant change in plasma alpha-tocopherol and SOD levels. The Pearson s co-efficient of correlation between the levels of MDA, vitamin E, SOD; and spirometric measurements were not significant either on day 1 or after 12 weeks of vitamin E supplementation. The present study shows that initially the plasma lipid peroxide (MDA) levels are high and antioxidants (alpha-tocopherol and SOD) are low in patients with COPD. Exogenous supplementation with vitamin E does not have any significant effect on the spirometric measurements though it brings down the levels of MDA showing attenuation of further damage. However, inclusion of larger number of patients and supple mentation with vitamin E for longer periods may throw more light on free radical injury and protective effects of antioxidants.

A study of lipid peroxide and alpha tocopherol in acute myocardial infarction.

Thirty patients of acute myocardial infarction proven by electrocardiography (ECG) and enzymes were included in the study. All of them received streptokinase. A single lead showing the largest ST elevation, a proportional value for the shift in ST segment > or = 0.5 was taken as criteria for reperfusion. ECG was recorded at 0 hour, 3 hours and 72 hours. At the start of streptokinase and 3 hours after, marker of free radical activity malondialdehyde (MDA) and antioxidant alpha tocopherol was measured. Mean value of serum alpha tocopherol level at start of streptokinase (t0) 10.03 +/- 2.5 micrograms/ml and at (t3) 3 hours after streptokinase was 8.60 +/- 2.6 micrograms/ml (P < 0.001) and mean value of serum lipid peroxidation level was 6.86 +/- 2.92 nanomol/ml at t(o) and at t3 value was 8.4 +/- 3.88 (P < 0.012) in successfully reperfused patients. In unsuccessful reperfusion group serum alpha tocopherol level at t(o) was 8.89 +/- 2.55 micrograms/ml and at t3 8.23 +/- 2.9 micrograms/ml (p > 0.05). Serum lipid peroxidation level in the same group at t0 was 6.53 +/- 2.26 nanomol/ml and at t3 was 6.29 +/- 2.27 nanomol/ml (p > 0.05). The increase in free radical marker MDA and decrease in one of the important antioxidant alpha tocopherol suggest that free radicals are increased after coronary vessels open up. As a result reperfused patients may be at risk of free radical mediated injury which may deny him the full benefit of reperfusion.

Study on body mass index, lipid profile and lipid peroxidation status in coronary artery disease.

Among the many known risk factors of coronary artery disease (CAD) obesity and hypercholesterolaemia are important ones. Whatever may be the risk factor, the basic pathology of CAD is deposition of altered lipids on the endothelium. One of such altered lipid is oxidatively modified low density lipoprotein (LDL). Lipid peroxidation has been assessed by several methods. Quantitation of malondialdehyde (MDA) by thiobarbituric acid (TBA) method is one of the commonly utilised method in several laboratories. In this study 40 cases of CAD were selected for evaluation. The body mass index (BMI), lipid profile and the level of lipid peroxidation (MDA) were measured. Seventeen cases (42.5%) had normal BMI (20-25), 20 cases (50%) were in the overweight range of BMI (26-30) and only 3 cases (7.5%) were in the obese group with a BMI more than 30. BMI correlated better with the level of total cholesterol (Tc), low density lipoprotein cholesterol (HDLc) and MDA. BMI did not show any correlation with triglyceride (Tg) or high density lipoprotein cholesterol (HDLc). MDA level correlated better with Tc, Tg levels and BMI, poorly correlated with LDLc and in inverse relationship was observed with HDLc.

Lipid peroxide, beta-carotene and alpha-tocopherol in ischaemic stroke and effect of exogenous vitamin E supplementation on outcome.

30 patients with CT proven infarct presenting within 24 hours of the acute event were included in the study with 20 age and sex matched controls. On day 1 and day 15 of stroke, levels of plasma lipid peroxide (oxidant) and plasma alpha-tocopherol and beta carotene (antioxidant) were estimated. The patients were randomly assigned to two groups, one group receiving 300 mg/day of vitamin E for 15 days. Neurological examination was conducted according to Mathew scale on day 1 and day 15 and rehabilitation assessment was done at day 15 and at 6 weeks according to Barthel Index. On day 1, the mean value of plasma lipid peroxidation in controls was 4.97 +/- 1.44 nmol/ml and in stroke patients 5.89 +/- 1.56 nmol/ml (p < 0.05). The plasma beta-carotene in controls was 2.35 +/- 1.09 mg/L while in stroke patients was 1.07 +/- 0.55 mg/L (p < 0.001) and plasma alpha-tocopherol in control 9.74 +/- 2.76 micrograms/ml as compared to 7.57 +/- 2.92 micrograms/ml in stroke patients (p < 0.02). Initially the plasma lipid peroxide levels are high and antioxidant levels are low in patients of ischemic stroke. Exogenous vitamin E supplementation does not have any significant effect on early neurological outcome but it does bring about significant changes in subsequent recovery and rehabilitation of patients of stroke.

Nociception, antinociceptive potency of morphine in streptozotocin induced diabetic rats.

There are controversial reports on the effect of diabetes on the pain threshold. We used male Wistar rats to see the effect of streptozotocin induced diabetes on the tail flick, vocalisation and vocalisation after discharge responses. These represent the spinal, lower brain stem and hypothalamic responses respectively. The effect of morphine in these parameters was studied for both the control and diabetic group. In diabetic rats, the pain threshold was increased. However, this increase was not significant. Morphine produced significant analgesia after thirty minutes for tail flick and vocalisation responses and after fifteen minutes for after discharge in the control group. The antinociceptive effect of morphine was delayed and reduced for all three pain threshold confirming the antagonistic action of glucose on opiate receptors.

Immobilisation stress induced analgesia in diabetic rats.

Stress is known to produce analgesia. The pain threshold is altered in diabetes. We studied the effect of 1 hr of immobilisation stress on pain threshold in male Wistar rats. The same effect was tested in streptozotocin induced diabetic rats. The pain threshold of tail flick, vocalisation and vocalisation after discharge increased in the control group after the stress procedure. Significant analgesia was also obtained in diabetic rats, for flick and after discharge pain threshold. However the vocalisation threshold was not altered, probably due to the antagonistic action of glucose on opiate receptor at the level of brain stem.