To Evaluate the Efficacy of Biomarkers as Monitoring Tool in Patients with Fascial Space Infections of Odontogenic Origin: A Clinical Study.

Introduction: The objective was to evaluate the efficacy of biochemical markers (WBC, CRP and fibrinogen) and the course of odontogenic space infections in 50 patients. Material and Methods: Blood samples were taken preoperatively and postoperatively at day 0, day 4, day 8 and day 12 for measuring the levels of all three biomarkers. The trends of the biomarkers were observed and compared with assessment parameters such as dental etiology, number of teeth involved, number of spaces involved, mouth opening and pain. Active pus discharge, dysphagia, hoarseness and swelling were assessed and scored accordingly. Results: The data were subjected to paired 't' test, McNemar's and Pearson's bivariate correlation as appropriate. Statistical analysis found strong correlation between laboratory values of markers and parameters used to measure severity of infection. All three biomarkers (WBC, CRP and fibrinogen) are significant markers for hospital stay (p < 0.01). Prospective analysis indicates that only one biomarker cannot be used to rule out specific diagnosis. Conclusion: The combination of three biochemical markers assessed in the present study (WBC, CRP and fibrinogen) should be used as prognostic factor in assessment, clinical severity and efficacy of treatment regime for patients as these can reliably predict the clinical course of odontogenic infection.

Delivering Electives the Clerkship Way: Consolidating the Student Doctor Method of Training.

Student doctor method of clinical training or clinical clerkship provides students with exposure to the entire longitudinal illness of the patient. The students participate in patient care as a part of treating team and can refine their clinical, communication and procedural skills. It provides them with an opportunity to work with the faculty and experience the future workplace. Although the graduate medical education regulations (GMER) provide for student doctor method of training, the time provided is too little and opportunistic. Electives have also been recently added to the new curriculum for the first time. We propose a model to deliver the electives using the clerkship method, so as to consolidate what students learn from the ongoing clerkship. This model is feasible, practical and can be introduced in the current GMER for Indian medical undergraduates without any major disruptions.

Stages of Concern of Medical Faculty toward Adoption of Competency-based Medical Education in India: A Multicentric Survey.

Context: Currently, a major curricular reform in the form of competency-based medical education (CBME) curriculum is being rolled out across all medical colleges in India. However, it is important to find out and address the concerns of faculty regarding various aspects of this new curriculum. Aim: To analyze the concerns of the faculty members of medical colleges in India in response to the changes emerging from the adoption and implementation of the new curriculum through the concerns-based adoption model by applying the stages of concern (SoC) questionnaire. Methodology: A multicentric, cross-sectional quantitative study involving faculty members currently working in medical colleges and with more than 2 years of teaching experience was conducted using SoC questionnaire (SoCQ). The questionnaire was delivered as Google Form. Results: Of the 744 faculty participants, 41.1% (306) of faculty belonged to the 31-40 years age group followed by the 41-50 years age group (267, 35.9%). Respondents rated their level of concern differently among the seven SoC - percentile scores were highest in Stage 0- awareness (94) and least in Stage 4- consequences (59). An appreciably higher percentile scores were seen at the consequences stage (63 vs. 54), collaboration stage (80 vs. 68), and refocusing stage (77 vs. 69) in those faculty members who were trained in curriculum implementation support program (CISP) compared to the untrained group. However; the SoCQ profiles of CISP trained and untrained faculty were very much similar. SoCQ profiles of holders of advanced training in medical education and non-holders were also the same. Conclusion: Almost after 2 years of well-planned introduction of the CBME curriculum in India, the generalized faculty profile is still suggestive of interested but non-user type for the adoption of CBME. However; compared to untrained faculty, CISP trained faculty is more concerned about the impact of CBME on students, collaborating with colleagues for its proper implementation and exploring more benefits from the implementation of CBME, indicating that more hand-holding is required for faculty development beyond CISP.

How to Improve the Efficacy of Student Feedback.

CONTEXT: Feedback processes are intricate, generally misunderstood, hard to execute efficiently, and often fail in their goals to influence students learning. Research highlights that students usually do not value the benefits of feedback. This paper reviews the literature on the definition, purpose, and models of feedback; and on exploring why some students do not value feedback, what factors are influencing the effectiveness of feedback, and how to improve the efficacy of feedback. EVIDENCE ACQUISITION: The relevant articles were searched through 'Google Scholar,' 'CINAHIL' and 'PubMed' using the key terms- "Student feedback," "Frameworks of feedback," "Barriers to effective feedback," and "Students' perspectives on feedback." The search criteria included: review and original research articles in the English language published in high-impact journals in the past ten years. RESULTS: The results of different studies have illuminated diverse factors demanding the attention of educators to the effectiveness of feedback. Personal, relational, procedural, and environmental factors seem to affect the utility of feedback. To be effective, feedback should be actionable, non-judgmental, descriptive and specific, based on observable behavior, and should be given at a mutually agreeable time and place. CONCLUSION: The efficacy of feedback can be enhanced by creating students' feedback literacy, addressing students' perceptions and expectations, encouraging productive educational alliances, improving procedural elements of feedback, and environmental conditions.

Multimedia Instructional Design Principles: Moving from Theoretical Rationale to Practical Applications.

Since the introduction of cognitive theory of multimedia learning more than a decade back much empirical evidence has substantiated the theoretical rationale of multimedia instructional design principles. Medical educators use multimedia mostly for delivering lectures in the form of power-point presentations. Abundant literature is available giving instructions on the appropriate use of font type and size etc. to be used in power-point slides, but the literature applying multimedia instructional design principles for preparing effective presentations leading to active and meaningful learning is scanty. This paper deals with theoretical aspects of multimedia instructional design principles and the ways of effectively incorporating these principles for designing meaningful power-point presentations.

Risk Factor Analysis for Breast Cancer in Premenopausal and Postmenopausal Women of Punjab, India.

OBJECTIVE: Amritsar, the second largest town of agrarian state of Punjab, India reports high number of breast cancer cases every year. The present study investigated the etiology of breast cancer using various obesity indices and other epidemiological factors among breast cancer patients residing in and around Amritsar city. METHODS: In this case control study, risk factors for breast cancer were analyzed in 542 female subjects: 271 females with breast cancer patients and 271 unrelated healthy females matched for age as control females. RESULTS: Bivariate analysis for risk factors in cases and controls showed a lower risk (OR=0.65, 95% CI 0.43-0.99, p=0.04) in obese cases with BMI≥25kg/m2 as compared to subjects with normal BMI. Risk factor analysis showed that parameter which provided risk for cancer in postmenopausal women was obesity and in premenopausal women was parity. Postmenopausal women with BMI (overweight: OR=0.39, 95% CI 0.17-0.92, p=0.03; obese: OR= 0.26, 95% CI 0.13-0.52, p=0.00), WC (OR=0.17, 95% CI 0.05-0.52, p=0.00) and WHtR (p=0.02) had highr risk. Premenopausal women with 3 or less than 3 children had a higher risk (OR=5.54, 95 % CI 2.75-11.19, p=0.00) than postmenopausal women when compared to women with more than 3 children. Binary logistic regression analysis revealed that low parity (≤3) substantially increased the risk for breast cancer (OR=4.80, 95% CI 2.34-9.85, p=0.00) in premenopausal women. CONCLUSION: Obesity, parity associated breast cancer risk and reduced breastfeeding cumulatively predispose the premenopausal women of this region to higher risk of breast cancer.
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Study of adrenal function in patients with tuberculosis.

BACKGROUND: Although subclinical adrenal insufficiency has been documented in tuberculosis but it has been neglected in mainstream management of TB due to inconclusive data on its prevalence in TB. The fact that adrenal insufficiency may result not only in poor general condition of the patient but also sudden death due to adrenal crisis, makes it all the more important to address this issue seriously. In this non-randomized interventional study comprising of 100 cases of TB, our aim was to assess the adreno-cortical functions in patients with pulmonary TB (50 cases) and extra-pulmonary TB (50 cases) in an attempt to determine if there is any compromise of adrenal function. METHODS: In this study, 100 cases of active TB were investigated for adrenal insufficiency by measuring morning fasting basal serum cortisol levels, followed by low dose ACTH stimulation test using 1µg synacthen (synthetic ACTH analog). The post-stimulation serum cortisol levels were estimated. Basal serum cortisol levels<220nmol/L or post-stimulation test serum cortisol level increment<200nmol/L or post-stimulation serum cortisol levels<500nmol/L were suggestive of adrenal insufficiency. RESULTS: Basal serum cortisol level was low in 16% cases and after low dose ACTH stimulation test, cortisol response was subnormal in 76% cases. Incidence of adrenal insufficiency in pulmonary TB (74%) and extra-pulmonary TB (78%) were comparable. The number of females having adrenal insufficiency in both the groups was higher than the males (67.3% males and 83.3% females) but the difference was statistically significant only in extra-pulmonary TB group (p=0.011). On analysing the data, the sensitivity of basal serum cortisol level estimation in diagnosing adrenal insufficiency was observed to be 21.05% and its specificity was 100%. Positive predictive value was 100% and negative predictive value was 28.57%. Diagnostic accuracy of basal serum cortisol level estimation was observed to be 40%. CONCLUSION: The incidence of subclinical adrenal insufficiency in TB cases attending chest department at a tertiary care hospital was significantly high but comparable in both pulmonary and extra-pulmonary type of TB. Females in general and particularly those with extra-pulmonary TB were observed to be at increased risk of adrenal insufficiency. The low dose ACTH stimulation test was able to identify cases with adrenal insufficiency which had normal basal serum cortisol levels. Screening all TB cases for adrenal insufficiency by measuring both morning basal serum cortisol levels and low dose ACTH stimulation test can help identify cases at risk of fatal adrenal crisis and institute timely management, thus improving disease prognosis.

Introducing Mentoring to 1st-year Medical Students of a Private Medical College in North India: A Pilot Study.

BACKGROUND: The stress of complex medical course, emotional immaturity, and adaptations to new surroundings are the challenges faced by the new medical entrants. Therefore, mentorship program was introduced to support them for their academic and personal development. AIM AND OBJECTIVES: The aim of this study is to introduce and to assess the perception of mentors and mentees on mentorship program. MATERIALS AND METHODS: A mentorship program was designed for Bachelor of Medicine and Bachelor of Surgery (MBBS) First Professional students. A 1-day workshop was conducted to sensitize the faculty. Seventeen faculty members from various departments volunteered to be mentors. After sensitization, 150 MBBS First Professional students were divided among these faculty members by lottery system. A regular visit of mentees was scheduled with the mentor. At the end of mentorship program, the perception of mentors and mentees was taken using a validated and semi-structured feedback questionnaire. A focus group discussion of students was also conducted. RESULTS: A total of 112 students and 16 faculty members completed the feedback questionnaire. The mentors considered this program helpful in their self-improvement, teaching, and communication skills. Most of the mentees felt that this program helped them emotionally and academically. It was a good way to develop a strong student-teacher relationship. All the mentors and mentees were satisfied with the mentorship program. CONCLUSIONS: The newly introduced mentorship program helped in the overall development of mentors and mentees. Both mentors and mentees were extremely satisfied with this program and considered this as a successful intervention.

Team-based Learning Strategy in Biochemistry: Perceptions and Attitudes of Faculty and 1st-Year Medical Students.

BACKGROUND: Team-based learning (TBL) strategy has been widely adapted by medical schools all over the world, but the reports regarding the perceptions and the attitudes of faculty and undergraduate medical students towards TBL approach have been conflicting. AIM: The study aimed to introduce TBL strategy in curriculum of Biochemistry after evaluating its effectiveness through perceptions and attitudes of faculty and 1st-year medical students. MATERIALS AND METHODS: One hundred and fifty students of first professional M.B.B.S and five faculty members participated in the study. Their responses regarding perceptions and attitudes towards TBL strategy were collected using structured questionnaires, focus group discussions, and in-depth interviews. Data were analyzed using Wilcoxon signed-rank test, paired sample t-test, and Mann-Whitney U-test. RESULTS: Majority of the students expressed satisfaction with team approach and reported improvement in the academic scores, learning styles, and development of problem-solving, interpersonal, and professional skills. The faculty, however, recommended a modified TBL approach to benefit all sections of the students for the overall success of this intervention. CONCLUSION: TBL is an effective technique to enable the students to master the core concepts and develop professional and critical thinking skills; however, for the 1st-year medical students, a modified TBL approach might be more appropriate for the effective outcomes.

Correlation of the serum insulin and the serum uric Acid levels with the glycated haemoglobin levels in the patients of type 2 diabetes mellitus.

BACKGROUND: Type 2 Diabetes mellitus (DM) is a heterogeneous disease which is characterized by variable degrees of insulin resistance and impaired insulin secretion. Insulin is a hormone that regulates the body's use of glucose. The present study was undertaken to find the correlation of the serum uric acid levels in the patients of Type 2 Diabetes mellitus. MATERIAL AND METHOD: This was a case control study. The subjects who were included in the study were divided into two groups. Group A included 50 normal healthy individuals who were in the age group of 40-65 years, who were of either sex and with no family history of Diabetes mellitus. Group B included 50 newly diagnosed patients of Type 2 Diabetes Mellitus, who were in the age group of 40-65 years, who were of either sex, from the same population. Fasting blood samples were drawn and they were investigated for the serum insulin, serum uric acid, fasting blood sugar and the HbA1C levels. The values were compared with those of normal healthy subjects. RESULTS: All the three parameters, HbA1C, serum insulin and serum uric acid were found to be increased in the patients of Type 2 Diabetes Mellitus as compared to their levels in the controls (p<0.001). CONCLUSION: In the present study, it was concluded that the serum uric acid levels linearly increased with increasing serum insulin levels, in newly diagnosed diabetic patients. Therefore, uric acid serves as a potential biomarker of the glucose metabolism.

Evaluation of nested polymerase chain reaction for rapid diagnosis of clinically suspected tuberculous pleurisy.

BACKGROUND: Early diagnosis of tuberculosis is important in its control. The conventional techniques like smear microscopy and culture suffer from low sensitivity for diagnosis of extra-pulmonary tuberculosis like Pleural Tuberculosis (PTB) due to paucibacillary nature of the fluid. Polymerase Chain Reaction (PCR) is presently seen as a promising alternative to conventional techniques. In this study we have evaluated IS6110 sequence based nested PCR (nPCR) for the detection of Mycobacterium tuberculosis (MTB) DNA directly from clinical samples. The results of PCR were compared with the results of conventional methods like smear, culture and Adenosine Deaminase (ADA) activity. MATERIAL AND METHODS: A total of 50 pleural fluid samples from the patients with history suggestive of tuberculosis were taken. All the samples were processed for Ziehl-Neelsan (ZN) staining for Acid Fast Bacilli (AFB), culture ADA activity and PCR with primers targeting 123bp fragment of IS6110 of MTB complex. RESULTS: A significant difference was seen in the sensitivities of conventional methods and PCR (p<0.05). Out of these 50 samples 3 were positive by smear, culture was positive in 5 samples, 21 samples showed high ADA activity and 29 were positive by PCR with overall 100% sensitivity of PCR using culture on LJ media as gold standard. CONCLUSIONS: The combined analysis of nPCR, ADA activity and other lab investigations can be very useful in the rapid diagnosis in cases of PTB.

The oxidative stress in cataract patients.

BACKGROUND: The recent studies on cataract formation focus on the primary role of the systemic oxidative stress which is generated outside the lens. Our research was directed to assess the oxidative stress by measuring the lipid peroxidation products in the form of the Thiobarbituric Acid Reactive Substances (TBARS) and the antioxidant enzyme levels in the blood. The antioxidant therapy may have a role to play in delaying the onset and the progression of age related cataracts. MATERIAL AND METHOD: This was a case control study. It comprised of 100 age matched subjects (50 with cataracts and 50 controls) with their ages ranging from 45- 75 years. Oxidative stresses such as the Thiobarbituric Acid Reactive Substances (TBARS) and the antioxidant enzymes, Superoxide Dismutase (SOD) and Glutathione Peroxidase( GPX ) were investigated in all the patients and the controls. RESULTS: Significantly increased levels of serum lipid peroxide in the form of Malondialdehyde (MDA) (p<0.001) were observed in the cataract patients as compared to the controls. Significantly decreased blood levels of SOD and GPX were observed in all the patients. CONCLUSION: In the present study, it was concluded that oxidative stress plays an important role in the onset and the progression of cataracts. The pro-oxidant i.e. serum malondialdehyde (MDA) levels were increased in the cataract patients. The blood levels of the enzymatic anti-oxidants, SOD and GPX were decreased. The plasma TBARS can be used as biomarkers of the degeneration in the lens.