MRI as a Diagnostic Tool for the Determination of Acute Ischaemic Stroke: A Study in a Tertiary Care Hospital

Background: Stroke is a prevalent and potentially fatal medical condition that affects individuals worldwide. Ischemic strokes, caused by arterial blockages, are the most common type, accounting for about 80% of all cases. Hemorrhagic strokes, on the other hand, are less frequent but can have more severe consequences. Accurate and timely diagnosis of stroke is critical for effective treatment and optimal patient outcomes. In this context, diffusion-weighted imaging (DWI) has emerged as a valuable tool for identifying and monitoring ischemic stroke. This article provides an overview of the role of DWI in stroke assessment and management, with a focus on early detection and intervention. The aim of this study is to investigate the reliability of diffusion-weighted MRI (DWI) as an imaging modality in the evaluation of acute ischemic stroke. Material & Methods: This prospective cross-sectional study was conducted at the Department of Radiology and Imaging at the Combined Military Hospital (CMH) in Dhaka, Bangladesh, between June 2020 and June 2021. The study aimed to examine 120 patients clinically diagnosed with acute ischemic stroke. Prior to the study, verbal consent was obtained from all patients. The Study subjects were identified in the emergency and casualty department and had undergone an MRI of the brain in the Department of Radiology and Imaging at CMH, Dhaka. . Data were collected on pre-designed forms, and the relevant information was compiled on a master chart for statistical analysis using SPSS software. Descriptive analysis and frequency of results were presented in the form of tables, pie charts, and bar graphs. The ethical clearance of this study was obtained from the Institutional Ethics Committee of CMH, Dhaka, Bangladesh. Results: The study included 64 males and 56 females with a mean age of 65.2 ± 7.83 years. The majority of patients had an acute ischemic lesion (88.30%) in the MCA (50.0%) with small-sized lesions (41.7%) and low ADC values (90.0%). The most common clinical presentation was hemiplegia (100%), and diffusion-weighted MRI had a high diagnostic accuracy in detecting acute ischaemic lesions (96.3%). Overall, these findings highlight the importance of MRI in the evaluation of stroke patients and can guide clinical decision-making. Conclusion: The present study concluded that DWI in conjunction with ADC map MR imaging is a gold standard diagnostic modality in the evaluation and management of acute ischaemic stroke.

Validación de un instrumento para evaluar el nivel de conocimiento en la aplicación de fórceps obstétrico / Validation of an instrument to assess the level of knowledge about the application of obstetric forceps

Resumen OBJETIVO: Diseñar y validar un instrumento para evaluar el nivel de conocimiento en la aplicación del fórceps Salinas en médicos residentes de Ginecología y Obstetricia. MATERIALES Y MÉTODOS: Estudio descriptivo, transversal, tipo validación de un instrumento. El primer constructo se desarrolló con base en el marco teórico; el cuestionario fue objeto de análisis por parte de un grupo de expertos que se basaron en la metodología Delphi. Se obtuvo un constructo de 20 preguntas y se emprendió un estudio para evaluar la pertinencia del instrumento. La confiabilidad se evaluó con el coeficiente de Kuder-Richardson, prueba Kaiser-Meyer-Olkin y de esfericidad de Bartlett. Los datos se procesaron en el programa SPSS versión 21. RESULTADOS: El instrumento se aplicó a 66 médicos residentes con media de edad de 28.5 ± 0.7 años. El coeficiente de Kuder-Richardson fue 0.608. Las pruebas de Kaiser-Meyer-Olkin y Bartlett mostraron que se trató de un instrumento multidimensional. CONCLUSIONES: Se obtuvo un instrumento válido, confiable y multidimensional para determinar el nivel de conocimientos en relación con la aplicación del fórceps Salinas en médicos residentes de Ginecología y Obstetricia.

Abstract OBJECTIVE: To design and validate an instrument to assess the level of knowledge of Salinas forceps application in Gynecology and Obstetrics residents. MATERIALS AND METHODS: Descriptive, cross-sectional, validation-type study of an instrument. The first construct was developed based on the theoretical framework; the questionnaire was analyzed by a group of experts based on the Delphi methodology. A construct of 20 questions was obtained and a study was undertaken to assess the relevance of the instrument. Reliability was evaluated with the Kuder-Richardson coefficient, Kaiser-Meyer-Olkin test and Bartlett's sphericity test. The data were processed in SPSS version 21. RESULTS: The instrument was applied to 66 resident physicians with a mean age of 28.5 ± 0.7 years. The Kuder-Richardson coefficient was 0.608. The Kaiser-Meyer-Olkin and Bartlett tests showed that it was a multidimensional instrument. CONCLUSIONS: A valid, reliable and multidimensional instrument was obtained to determine the level of knowledge in relation to the application of Salinas forceps in Gynecology and Obstetrics residents.

A Comparison between Objective Structured Practical Examination and Traditional Practical Examination as an Assessment Tool in Biochemistry

Introduction: The competency based medical curriculum implemented in 2019 stresses on assessment systems aligned to the teaching-learning process. Assessment drives the learning process, so assessment tools have to be objective, uniform, valid and reliable. Traditional practical examination is more subjective and prone to examiner bias and is suspect to its validity and reliability. OSPE has been advocated as a tool to be used in CBME as it possesses the requisite criteria of an ideal assessment tool. However OSPE is not widely used in our st country. Methods: In this study the performance of 1 MBBS students in traditional practical examination & OSPE was compared & perception of students towards it evaluated. 150 first MBBS students of 2020-21 batch were included. Assessment by traditional and OSPE was conducted on “Blood sugar Estimation”. OSPE was conducted with 2 observer & 3 response stations. Mean was calculated and analysed for statistical significance using MS Excel. A well-structured questionnaire was administered to the same students and a feedback was obtained about the process of OSPE. Results: There was statistically significant difference between the mean scores of traditional format and OSPE (P <0.001). Analysis of students' feedback showed that more students found OSPE better in terms of scoring, passing and catering to psychomotor domain evaluation. Anumber of students felt that OSPE was more useful and comfortable than the conventional pattern of examination. Most students did not find OSPE intimidating and opined that it should be kept as assessment method in internal and university examination. Interpretation & Conclusion: Our study observed OSPE scores to be better than traditional format. OSPE eliminated examiner bias by integration of cognitive, psychomotor and affective domains. Therefore we conclude that OSPE though time and labour intensive, should be introduced and adopted as an assessment tool.

Developing a Bank of Faculty-authored, Valid and Reliable Objective Questions for Institutional Use: Sharing the Experience

@#Introduction: With the increasing number of institutions implementing competency-based education which demands to provide feedback to students at regular intervals, there is an increase in the frequency of assessments. For this purpose, the written examinations using multiple choice questions (MCQs) are the most feasible form of assessment. However, constructing MCQs is an arduous task and significantly adds to the work-load of the academic staff members. To ease this burden, the institutions may consider to develop banks of valid and reliable MCQs. Methods: Based and built on our experience and literature review, the steps – relating to the process of constructing valid and reliable questions and development of question banks (QBs) – are the actions needed to develop new QBs or improve on the existing ones. Results: We have described ten practical steps for developing and banking of MCQs. The first five steps relate to the development of quality items and the remaining steps relate to the development of QBs, their maintenance, growth and safety and security. We have also established the criteria for selection and the frequency of reuse of questions. Conclusion: Using QBs will alleviate some of the burden of constructing novel quality questions needed for frequent assessments of students using 21st century teaching/learning approaches. The use of banked questions with known psychometric properties would allow the authorities to take charge and control of items’ quality and overall examination standards.

The Tonkin weakfish, Cynoscion similis (Sciaenidae, Perciformes), an endemic species of the Amazonas-Orinoco Plume

Despite its importance in biogeographical, ecological, and commercial terms, the fish fauna of the northern Brazilian coast is still poorly known, representing the least sampled portion of the Brazilian Exclusive Economic Zone. We collected Tonkin weakfish, Cynoscion similis specimens during extensive surveys of the northern Brazilian coast and concluded that C. similis is common in this region. While the species had not previously been reported for the northern Brazilian state of Pará, it may have been recorded in studies of industrial fisheries, being identified only as Cynoscion sp. or by the common name pescada negra. This reinforces the need for the reliable taxonomical identification of species, to guarantee the collection of accurate data on ecology and fisheries, and ultimately, support the development of effective conservation strategies. Here we provide additional morphological and molecular data to distinguish Cynoscion similis from the closely related Cynoscion jamaicensis, and other congeners. (AU)

Study of serum levels of CRP and procalcitonin as early marker of sepsis in children with sepsis above neonatal age group

Background: Sepsis caused by infection remains a major cause of mortality and morbidity among children.' Blood culture though gold standard requires lot of time for diagnosis, hence it's necessary to rely on early diagnostic markers such as blood counts, micro-ESR, CRP, Procalcitonin. The objective of this study is to evaluate the serum levels of CRP, Procalcitonin as reliable and as early marker of sepsis in pediatric patients above neonatal age group.Methods: Children aged above neonatal age group with clinically suspected sepsis as per the definition given by the International Paediatric sepsis Consensus Conference were selected. Patients were classified as those with sirs, sepsis, severe sepsis and septic shock. Patients were divided into two groups one with culture proven sepsis and the other with non-culture proven sepsis. All patients had CRP, Procalcitonin levels measured at admission and 24hrs after admission. The primary outcome was to determine reliable marker in differentiating between the culture proven and non-culture proven sepsis, and to determine the early marker of sepsis.Results: Total 104 patients formed the study group, of which 42 belonged to SIRS group, 26 were sepsis, 19 were severe sepsis and 17 were septic shock. A total of 36 cases had culture positive. In present study PCT was found to be more reliable marker of sepsis as the sensitivity and specificity of PCT was more than CRP and AUC for PCT was significantly higher than CRP. PCT was found to be early marker as the AUC for CRP at 24hrs was significantly more than AUC for CRP at admission and there was no statistically significant difference between AUC for PCT at admission and 24 hours after admission.Conclusions: Both CRP and PCT levels have favourable test performance but PCT is more reliable. PCT is earlier to rise compared to CRP.

Weight Perception among Non-pregnant Urban Malaysian Women: Is It Reliable?

In maternal healthcare, pre-pregnancy weight is used to predict pregnancy outcomes. Since no recorded data on pre-pregnancy weight, perceived weight is used alternatively. This study examines the relationship between perceived and actual weight among non-pregnant urban Malaysian women of childbearing age and identifies differences in perceived and actual weight by selected socio-demographic characteristics. A cross-sectional study was conducted between April and June 2013 among urban Malaysian women attending public health clinics in the Klang Valley. Information on height, perceived current weight and time when their weight was last taken were obtained and actual weight was the average of two measurements (TANITA-HD-323-digital-scale). Socio-demographic data collected were age, ethnicity, education level, marital and employment status and total household income. Mean age of 371 women in this study was 28.81±5.65, 82.2% were Malays, 62.8% had tertiary education, over 75% were married and employed, with more than half from middle-income households. Overall, the mean perceived and actual weight was 59.29±11.59 and 59.20±11.90 respectively. Pearson’s Correlation test showed a very strong positive correlation between perceived and actual weight (r=0.957;p<0.0001), ranging between 0.852 to 0.994 among subgroups; 258 (69.5%) perceived their weight accurately (±2.0 kg of actual weight), 49 (13.2%) under and 64 (17.3%) overestimated their weight. Main outliers were among younger women, Malays, tertiary educated, employed, middle-income and had weight last measured a month or more ago. Strong correlation between perceived and actual weight among women in this study reassured weight perception can be used more confidently in patients’ history taking and future research among urban Malaysian women using public health services.​

Aparato experimental de escolha: desenvolvimento de sistema informatizado para estudo de comportamento de escolha / Experimental apparatus of choice: development of computerized system for the study of choice behavior / Aparato experimental de elección: desarrollo de sistema informatizado para el estudio del comportamiento de elección

Realizar escolha é fundamental para a conduta adaptativa de qualquer indivíduo em seu ambiente social, principalmente para pessoas com deficiência intelectual ou atraso no desenvolvimento que não possuem essas habilidades em seu repertório. Conduzir estudos sobre escolha que exigem a apresentação de estímulos de difícil manipulação podem ter sua viabilidade prejudicada devido aos procedimentos de apresentação serem complicados para se executar. O objetivo deste estudo foi o desenvolvimento de um Aparato Experimental de Escolha capaz de mecanizar a disponibilização e controle de cada exposição de tarefas de trabalho, o que representa uma vantagem uma vez que as tarefas podem ser preparadas rápida e antecipadamente e apresentadas diversas vezes, o que proporcionaria diminuição do tempo de aplicação, além de possibilitar o registro fidedigno das respostas, da latência, do tempo de execução da tarefa e de liberação da consequência. O aparato consiste de uma mesa redonda giratória com botões acoplados e permite a aplicação de esquemas de reforçamento de razão fixa e variável, intervalo fixo e variável, além do uso de esquemas concorrentes simples ou concorrentes com encadeamento. O controle é feito diretamente pelo computador, que armazena os dados automaticamente e diminui as possibilidades de erros manuais. A utilização de recursos mecânicos aliados aos computacionais parece bastante promissora, com a possibilidade adicional de proporcionar um uso mais frequente e por um maior número de pessoas.

Perform choice is fundamental to adaptive behavior of any individual in his/her social environment, especially for intellectually or developmentally delayed people that often lack these skills in their repertoire. Conducting studies of choice that require the presentation of difficult-to-handle items may face insurmountable barriers due to choice procedures that are complicated to implement. The objective of the present study was to develop an Experimental Apparatus of Choice capable of mechanize the delivery and control of each exposure, which is an advantage since the tasks can be set up quickly and previously and presented several times, which would allow the reduction of application time, and enable reliable record of responses, latency time of task execution and consequence presentation. The apparatus consists of a rotating roundtable with buttons attached. The apparatus allows the application of reinforcement schedules of fixed and variable ratios, and fixed and variable intervals, besides the use of simple concurrent schedules of reinforcement or concurrent-chain schedules of reinforcement. The control is done directly by the computer, which automatically stores data and decreases the chances of manual errors. The use of computing resources seems quite promising, with the additional possibility of providing more frequent use to a greater number of people. A validation of the experimental apparatus of choice has been made by a study.

Efectuar elección es fundamental para el comportamiento adaptativo de cualquier individuo en su entorno social, especialmente para las personas con discapacidad intelectual o retraso en el desarrollo, a menudo carecen de estas habilidades en su repertorio. Conducir estudios de elección que requieren la presentación de artículos de difíciles manipulación, pueden tener su viabilidad afectada debido a los procedimientos de presentación que son difíciles de realizar. El objetivo de este estudio fue desarrollar un Aparato Experimental de elección capaz de mecanizar la exposición y control de cada exposición, que es una ventaja ya que las tareas se pueden construir rápidamente y por adelantado y presentado varias veces, lo cual proporcionaría tiempo de aplicación reducido, además de permitir el registro fidedigno de las respuestas, el tiempo de latencia de la ejecución de la tarea y la liberación de refuerzo. El aparato consta de una mesa redonda giratoria con botones adjuntos. El aparato permite la aplicación de esquemas de refuerzo de proporción fijo y variable, intervalo fijo y variable, además del uso de esquemas competidores simples o competidores con encadenamiento. El control se realiza directamente por el ordenador, que almacena automáticamente los datos y reduce las posibilidades de errores manuales. El uso de los recursos informáticos parece bastante prometedora, con la posibilidad adicional de proporcionar un uso más frecuente y un mayor número de personas. Una validación del aparato experimental de elección ha sido hecha por un estudio.

The Influence of Test-Retest Interval on the Significant Change Indices for the K-MMSE

BACKGROUND: The Mini-Mental State Examination (MMSE) has been commonly used to measure cognitive change over time. The aim of present study was to investigate the normative rates of change for the MMSE across test-retest intervals. METHODS: We administered the Korean MMSE (K-MMSE) to 1055 community-dwelling middle aged and older adults three times over 6 years. Based on the Christensen's health screening criteria (1991), 234 middle-aged healthy adults (104 men, 130 women; mean age 55.95+/-6.20 years; age range 45-64 years; mean education 7.63+/-4.06 years) and 505 healthy elderly (200 men, 305 women; mean age 71.00+/-4.62 years; age range 65-79 years; mean education 5.61+/-5.12 years) were selected for the statistical analysis. Reliable change indices were computed using two different statistical methods, the Reliable Change Index adjusted for practice effects (RCIPE; Chelune et al., 1993) and the Standardized Regression-Based Change Index (SRBCI; McSweeny et al., 1993). RESULTS: For the middle-aged healthy adult group, the 90% confidence intervals of the RCIPE and SRBCI were the same such as +/-4 in 2-year, +/-5 in 4-year, and +/-6 in 6-year test-retest intervals. For the healthy elderly group, the 90% confidence intervals of the RCIPE were -5 and +4 in 2-year interval and -7 and +5 in 4- & 6-year intervals. The 90% confidence intervals of the SRB change index were +/-4 in 2-year interval and +/-6 in 4- & 6-year intervals. CONCLUSIONS: The result provides the normative data of the reliable change scores for the K-MMSE for the middle-aged and older adults. It shows that the reliable change indices were varied across different age groups as well as test-retest intervals.

Use of Verbal Autopsy as a Proxy to Determine the Possible Cause of Neonatal Deaths.

Introduction: Information on causes of death is extremely important for policy making, planning, monitoring, field research, future management statergies and epidemic awareness. The best method of finding the cause of death is by post mortem examination but since this is difficult, post death analysis by verbal autopsy is a good method to determine the same. Objective: To asses the role of verbal autopsy method in the investigation of neonatal death and to determine the probable, causes of neonatal death. Materials and Methods: A pre-tested questionnaire in Hindi was administered to 50 mothers and/or next of kin or other care givers of the deceased residing in villages around 200 Kms. of Bhopal and in urban slums of Municipal Corporation, Bhopal. Results: 84 % of the total death occurred with in seven days of birth, 88 % of death occurred in villages where health facilities were available. As per verbal autopsy 36 % and 20 % of the infants died because of Birth asphyxia and Respiratory Distress Syndrome respectively and further 2%, 4% and 6% because of neonatal tetanus, hypothermia and other causes respectively. Conclusion: Verbal autopsy could be one of the possible cost effective and a reliable tool for determining the causes of neonatal deaths at present.

A Study on coding application of ICD-9 / 대한의료정보학회지

In Korea medical record administrators/technicians are coding diagnoses and procedures of discharged patients based on their medical records mostly using International Classification of Diseases, 9th revision(ICD-9) and International Classification of Procedures(ICPM) by WHO. This study examined consistency of coding in 63 hospitals in the year of 1992. The statistical data showed great inconsistency in coding patterns among many hospitals. The main reasons of inconsistency were coders errors, ill-defined diagnoses/procedures, no unified route to make new code numbers for the new or ambiguous diagnoses/procedures, inconsistency of selection of using optional(additional) codes, and inconsistency of reference records on coding. Near half of the hospitals do not recheck the accuracy of coding after completion of medical records by physicians. Most of the coders review operation record, admission and discharge record, discharge summary, progress notes, pathology report, and consultation record as references on coding, but 14 hospitals do not review the whole record when they code diagnoses and procedures. Twenty-three hospitals discuss with physicians when they have questions in assigning code numbers. Further study should be done continuously for valid and reliable statistics of diseases and operations and for establishing a systematic unified channel for the new and ambiguous cases.