Multistation exercises: a combination of problem-based learning and team-based learning instructional design for large-enrollment classes.

To introduce active learning session for a large group of 250 students, we combined the strengths of problem-based learning and team-based learning to promote a structured active learning strategy with less faculty involvement. For the implementation of this strategy, a case on anemia was selected based on the module already covered in classes. Structured exercises were preplanned on six different concepts that a student should possess for solving the problem. The large group of 250 students was divided into groups of 41 or 42 each. The groups were facilitated by one faculty member for one structured exercise. At the station, the group of 41 or 42 was further broken down into 6 smaller groups comprising 7 students each. After completion of the exercise, students cycled to the next exercise station facilitated by another faculty member. The case was solved in a plenary session. The effectiveness of the method was assessed by comparing the academic performance of the group with other similar groups from the previous year. The intervention group performed significantly better than the nonintervention group on the related item. Quartile subanalysis found that the effect was present in the performance of average and higher quartile groups, but not in the lower quartile group.

An Unusual Content in a Congenital Hernia - Complete Spleno -gonadal Fusion Band.

Six years old boy underwent elective inguinal exploration for left congenital hernia. Per- operatively, an elongated, purplish-red, fleshy band of tissue was found inside the sac, adherent to the upper pole of testis. Biopsy was taken and the wound closed. An MRI done after 4 weeks proved the origin of the band from spleen. Laparotomy and excision of the band was done. The histo-pathology of the specimen was reported as normal splenic tissue. The above features are consistent with a diagnosis of spleno - gonadal fusion (SGF).

Handgrip strength and endurance as a predictor of postoperative morbidity in surgical patients: can it serve as a simple bedside test?

Postoperative morbidity is related to preoperative nutritional status. Current methods of assessing this are cumbersome, lack sufficient accuracy to completely separate all those at risk from others, and require a laboratory backup. This study was done to evaluate handgrip manometry, a simple bedside test as an indicator of preoperative nutritional status to predict risk of postoperative complications. Normal values for maximal grip strength and endurance times were established in 496 controls. Similar values were recorded in 100 patients undergoing elective surgery preoperatively. Postoperative variables studied included complication rate and hospital stay. The efficacy of four parameters, serum albumin, clinical nutritional score based on subjective global assessment, maximal grip strength (MGS), and grip endurance time, in predicting complications were studied. It was found that age and presence of co-morbidity increased risk of complications. Of the four predictive parameters studied, it was found that MGS is better than serum albumin. Clinical scoring was superior to MGS in predicting risk of complications. MGS is a simple bedside test, which can be easily performed. It can be used as a complimentary test to clinical scoring in identifying patients at risk of complications after surgery. Patients with abnormal MGS require urgent preoperative correction to reduce the risk of complications.

Unimicrobial appendicitis due to non-vaccine serotype of streptococcus pneumoniae: Implications for and management and prevention.

The aetiology of appendicitis is usually polymicrobial. We report a rare case of appendicitis caused by Streptococcus pneumoniae as the only causative organism. The case assumes significance because it occurs in the absence of any predisposing factor for invasive pneumococcal infection, it is unimicrobial, it may lead to the misdiagnosis of primary peritonitis due to pneumococcus, and it undermines the efficacy of polyvalent pneumococcal vaccine.