Effectiveness of Simulation-Based Training of Undergraduate Medical Students Regarding the Management of Eclampsia: A Randomized Controlled Educational Trial.

Introduction Obstetric emergencies, like eclampsia, need a quick and accurate response from the treating physician coming into first contact with the patient. Therefore, all doctors, even primary care physicians, interns, and resident doctors, need training to handle such cases proficiently, leaving minimal chances of error. Providing training for the management of these critical conditions on actual patients is not practically feasible. Clinical simulation in obstetrics can be used for the improvement of these skills for undergraduate and postgraduate students. We conducted a non-blinded randomized controlled trial with the primary aim of developing and implementing a module for training undergraduate medical students on the assessment and management of eclampsia and to evaluate and compare it with traditional didactic lectures or case-based learning. Methods The present randomized controlled educational trial was conducted in the Department of Obstetrics and Gynecology, All India Institute of Medical Sciences, Bibinagar, Hyderabad, India. The undergraduate medical students (Phase 3, Part 1) posted in the department during their clinical postings or tutorials were randomized into two groups. A total of 62 students were randomly divided into two groups, Group A and Group B, each consisting of 31 students. However, only 24/31 (77.42%) in Group A and 19/31 (61.3%) in Group B finally agreed to participate in the study. One group (Group A, with 24 participants) was taught the diagnosis and management of antepartum eclampsia through simulation-based training, and the other group (Group B, with 19 participants) was taught the same topic through conventional teaching, which consisted of didactic lectures through PowerPoint presentations and case-based discussion. Learning objectives were kept identical for both groups. Pre- and post-test scores were compared for both groups. Results The mean pre-test score of the simulation group was 6.13 ± 1.39, and that of the conventional teaching group was 6.05 ± 1.54. The post-test score of the simulation group was 9.17 ± 1.34, and that of the conventional teaching group was 7.37 ± 1.70. The simulation group showed an extremely significant (two-tailed p < 0.0001) improvement in their post-test scores when compared to their scores before the module was taught. The difference in the scores of simulated teaching (Group A) and conventional teaching (Group B) was also statistically significant (p = 0.005). Simulation-based learning was found to be more interactive, helpful in providing real-life-like experiences, led to better retention and understanding, and motivated the students for self-directed learning. Conclusion Although both conventional and simulation-based teaching were useful, simulation-based training was more effective in teaching undergraduate medical students regarding the diagnosis and management of eclampsia. Simulation-based learning is more interactive, provides real-life-like experiences, leads to better retention and understanding, and motivates the students for self-directed learning.

Ovarian Cystadenofibroma: An Innocent Tumor Causing Early Postoperative Small Bowel Obstruction and Perforation Peritonitis.

Ovarian serous cystadenofibroma (CAF) is a relatively uncommon variant of benign epithelial tumors of the ovary. It is frequently misdiagnosed as malignant ovarian mass, on both ultrasound (USG) and computed tomography (CT). Although most cases are easily treatable by surgery, some cases can present with life-threatening complications increasing patient morbidity and mortality. The present case report briefs about a 69-year-old female, P4 L4, who presented to the gynecology outpatient department with a complaint of pain in the lower abdomen for 2-3 months. USG and CT were suggestive of a suspicious-looking ovarian mass favoring malignancy. A staging laparotomy with pelvic and para-aortic lymphadenectomy with omental biopsy was done. Although the tumor was benign, extensive surgery, due to the suspicion of malignancy led to the patient developing early postoperative small bowel obstruction, mandating a re-exploration. CAF is a specific type of ovarian tumor that exhibits a combination of benign characteristics. This tumor presents as a partly cystic (containing fluid-filled sacs) and partly solid (composed of fibrous tissue) growth within the ovary, displaying a diverse architectural pattern. Mostly the diagnosis is incidental, on USG done for some other indication. CAF of the ovary needs a very high index of suspicion for diagnosis as these are frequently misdiagnosed as malignant ovarian masses. Although an innocent tumor, extensive surgery done for CAF, under suspicion for malignancy, can sometimes lead to serious complications.

Fraser syndrome with limb reduction defect: a rare and unique anatomic variation.

INTRODUCTION: Fraser syndrome, named after George Fraser, is an autosomal recessive disorder showing a highly variable interfamilial phenotypic variation, with malformations ranging from minor symptoms to lethal anomalies like renal agenesis, incompatible with survival. Limb reduction defects have not been reported to be associated with it. CASE PRESENTATION: A 21-year-old primigravida presented to the antenatal outpatient department with a level two targeted anomaly scan report suggestive of severe oligohydramnios with suspected renal agenesis. The cranial vault bones were compressed, and orbital globes and lenses could not be visualized. Renal agenesis was confirmed due to sleeping adrenals sign, non-visualization of the urinary bladder, and Doppler of renal arteries. A detailed examination of the fetal head in the sagittal section showed the absence of an eye globe and lens, arousing suspicion of Fraser syndrome. After pregnancy termination, a complete fetal autopsy was done to look for any additional findings. CONCLUSION: Patients who have a syndromic mix of acrofacial and urogenital abnormalities with or without cryptophthalmos should be evaluated for Fraser syndrome, which can be diagnosed by clinical examination and perinatal autopsy.

Oxidative stress responses in Puntius sarana collected from some environmentally contaminated areas of River Mahananda, Malda, West Bengal.

Environmental contaminant-induced aquatic pollution threatens the aquatic biota and causes oxidative stress in the aquatic organisms. Mahananda River, the lifeline of Malda district, West Bengal, India is presently experiencing environmental crisis due to increasing level of contaminants which deteriorate the water quality along with its biota. Puntius sarana is an economically important edible fish species in the River Mahananda that seems to be declining, owing to environmental pollution. Therefore, the present study aimed to investigate the health status of Puntius sarana by evaluating different oxidative stress biomarkers. The sampling sites were selected according to population density and possible anthropogenic activities around the River Mahananda. Significantly higher concentration of Zn2+ (p < 0.01), Cu2+ (p < 0.05) in different sampling sites has been observed, compared to the control site. Results of the water quality index and water pollution index confirmed the pollution status of different sampling sites. Significant decreases were observed in superoxide dismutase and catalase activity, compared to the control. The decreased values of reduced and oxidized glutathione ratio also indicate the increased oxidative stress of Puntius sarana. The principal component analysis showed that total hardness, calcium hardness, nitrate, manganese, zinc, copper, iron and arsenic were the main descriptors of the aquatic pollution. Therefore, findings of the present study demonstrate the ecotoxicological impacts of various anthropogenic activities which necessitates the need for continuous monitoring of the fresh water resources and its ecosystem from further contamination.

Toxicological assessment of Diplazium esculentum on the reproductive functions of male Swiss albino mouse.

CONTEXT: Diplazium esculentum, a commonly consumed seasonal vegetable, has been reported to have some pathological effects in some animals. But, its effect on the male reproductive function has not yet been studied. OBJECTIVE: To investigate the effects of boiled D. esculentum (BDE), the form which human consumes, on male reproductive functions of Swiss albino mice. MATERIALS AND METHODS: Male (120 in no.) and female (80 in no.) Swiss albino mice (6-8 weeks of age) were fed orally with 80, 160 and 320 mg/kg bw of BDE within a span of 180 d. After the treatment, body weight, absolute- and relative-testis weight, relative-weight of other organs, their biochemical parameters, hypo-osmotic swelling test (HOST) of spermatozoa, testis histology and fertility and fecundity tests were performed to justify the toxic effects of D. esculentum on male reproductive functions. RESULTS: Significant dose- and time-dependent decreases were observed in body weight, absolute- and relative-testis weight, relative-weights of other organs and their biochemical parameters, percentage of live spermatozoa and percentage of fertility and fecundity in BDE fed mice. Significant decreases were observed in diameter, perimeter and area of the seminiferous tubules of mice treated for 180 d. The percentage of empty seminiferous tubules was increased significantly in BDE treated mice when compared to the controls. DISCUSSION AND CONCLUSION: These results suggest that the intake of D. esculentum, even after cooking, may induce infertility by altering the male reproductive function, and therefore, should be evaluated further as a potential antifertility agent.

In vitro assessment of anticholinesterase and NADH oxidase inhibitory activities of an edible fern, Diplazium esculentum.

BACKGROUND: Diplazium esculentum is the most commonly consumed edible fern throughout Asia and Oceania. Several studies have been performed so far to determine different functional properties of this plant, but there have been no reports on the anticholinesterase and nicotinamide adenine dinucleotide (NADH) oxidase inhibitory activities of this plant. Therefore, the present study was conducted to determine the anticholinesterase and NADH oxidase inhibitory activities of 70% methanolic extract of D. esculentum. METHODS: The D. esculentum extract was investigated for its acetylcholinesterase and NADH oxidase inhibitory activities as well as its free radical scavenging and total antioxidant activities in the linoleic acid system. The free radical scavenging activity of the extract was determined by the 2,2-diphenyl-1-picryl-hydrazyl (DPPH) method. The total antioxidant activity of the extract was evaluated by ferric thiocyanate (FTC) and thiobarbituric acid (TBA) methods. RESULTS: The D. esculentum extract inhibited acetylcholinesterase and NADH oxidase in a dose-dependent manner, with IC50 values of 272.97±19.38 and 265.81±21.20 µg/mL, respectively. The extract also showed a potent DPPH radical scavenging activity with an IC50 value of 402.88±12.70 µg/mL. Moreover, the extract showed 27.41% and 33.22% of total antioxidant activities determined by FTC and TBA methods, respectively. CONCLUSIONS: Results indicated that 70% methanolic extract of D. esculentum effectively inhibited the enzymes acetylcholinesterase and NADH oxidase and acted as a potent antioxidant and free radical scavenger. These in vitro assays indicate that this plant extract is a significant source of natural antioxidants, which may be helpful in preventing the progression of various neurodegenerative disorders associated with oxidative stress.

Assessment of the immunosuppressive and hemolytic activities of an edible fern, Diplazium esculentum.

CONTEXT: Diplazium esculentum is the most commonly consumed fern throughout Asia and Oceania. Systemic toxicity and pathological effects on its consumption have already been demonstrated. But, the immunosuppressive and hemolytic activities of the boiled Diplazium esculentum (BDE), the form in which human consumes it, have not yet been studied. OBJECTIVE: To investigate the immunosuppressive as well as hemolytic activities, if any, of BDE in Swiss albino mice. MATERIALS AND METHODS: Body weight, relative spleen weight, plaque forming cell assay, hemaggutination antibody (HA) titer assay and macrophage counting were performed in BDE treated mice and respective control groups within a span of 180 days, and in vitro assays such as counting of cultured splenocytes, splenocytes proliferation assay and hemolytic assay were performed to justify the immunomodulatory as well as hemolytic activities of D. esculentum. RESULTS: Body weight and relative spleen weight were significantly decreased in BDE fed mice. Significant decreases were observed in the number of plaques formed, HA titer value and in the number of peritoneal macrophages within a span of 180 d. Significant dose-dependent decrease was observed in the number of cultured splenocytes. Significant dose-dependent increases in the percentage inhibition of splenocyte proliferation as well as percentage of hemolysis were evident by in vitro assays. DISCUSSION: These results suggest that the intake of D. esculentum may evoke immune dysfunction as well as may cause destruction of erythrocytes even after cooking. CONCLUSION: Therefore, the consumption of D. esculentum is alarming and may act as immunosuppressive agent.