Medical ethics teaching in the new undergraduate physiology competency-based curriculum in medical institutions in Delhi: A pilot, feasibility study.

BACKGROUND: Medical ethics teaching has received little attention in India's undergraduate medical curriculum, so the National Medical Commission's formal inclusion of medical ethics in the new competency-based curriculum (CBME) is creditable. However, the policymakers have left out the most crucial stakeholders - the teachers. This study was conducted to find out how physiology educators in Delhi felt about the implementation of ethics teaching in physiology in the CBME. METHODS: This was a pilot, cross-sectional, observational, feasibility study conducted using a questionnaire, involving faculty and senior residents (post-MD) in the departments of Physiology at nine medical colleges in Delhi, conducted over the period from February to October 2020. RESULTS: The response rate was 76% (60/79), of which 40% (24/60) were senior residents and 60% (36/60) were faculty. Around 55% (n=33) felt bioethics and clinical ethics are not synonymous; 53% (n=32) believed ethics education can be accomplished in a large group setting; 75% (n=45) believed it should be the responsibility of the physiology faculty, rather than the clinical faculty, and 61.7% (n=37) wanted it to be included in the formative assessment. The respondents shared ethical concerns that should be included in the physiology curriculum and the best candidates to teach them to achieve integration. Despite the challenges, the majority 65% (n=39) felt ethics in the physiology CBME should be an inseparable part of teaching in all instructional modalities. CONCLUSION: Early clinical exposure was considered preferable to the Attitude, Ethics, and Communication (AETCOM) programme. Using the five W's and one H method, we talk about how our findings can be used as a road map to help physiologists teach ethics to medical students in the new CBME.

Development and implementation of a sustainable COVID-19 training package for healthcare workers: Experience from a teaching hospital of North India.

Background: With the impending threat of future COVID-19 waves, it is imperative that teaching hospitals develop, implement, and evaluate a systematic training program to render HCW elastic in delivering COVID-19 related services. We present our experience in developing, implementing, and evaluating a sustainable and scalable COVID-19 patient management training package for healthcare workers. Materials and Methods: A mixed-methods study design was used. Rapid assessment to understand the need of the trainees and identify the available resources was done followed by planning of the training module and its implementation. The program was evaluated for effectiveness and sustainability. Data analysis was done using descriptive statistics and qualitative data generated from open-ended questions in the feedback forms and the discussions were analyzed using rapid content analysis. Results: A total of 66.8% of the doctors and 18.9% of the nurses were trained by online synchronous mode while 55.0% of the nursing officers and 47.1% of the nursing orderlies and paramedical staff were trained in onsite skill development sessions. Need assessment identified that healthcare workers were ill-prepared to use medical devices such as Bipap machines, ventilators, and oxygen delivery devices. The participants mentioned that the multidisciplinary approach and video-based demonstrations facilitated their online learning while the incremental learning approach, easy-to-understand terminology and hands-on experience facilitated their onsite skill development sessions. Conclusion: The COVID-19 training package developed was multidisciplinary, effective, sustainable, and scalable in a resource-limited setting. We suggest that this model can be adapted by healthcare organizations to develop and implement such training packages for their healthcare workers.

Rapid transition to online practical classes in preclinical subjects during COVID-19: Experience from a medical college in North India.

BACKGROUND: COVID-19 pandemic compelled medical schools to opt for online mode in medical education. The competency-based curriculum started in India last year onwards allotted more hours to practical teaching than lectures. As the lockdown extended, there was a need to shift laboratory teaching to online mode. We describe our experience of developing and implementing a framework to rapidly shift practical lab teaching of preclinical subjects to online mode. METHODS: A mixed method study was conducted during the COVID-19 lockdown period in a public funded medical institute of India. A framework utilizing the principles of small group teaching using the available resources was developed and implemented. Online feedback was obtained from students, while in-depth telephonic interview was conducted for teachers. RESULTS: A Demonstrate-Engage-Assess framework for online Practical teaching of Preclinical subjects (DEAPP) was developed and implemented. Feedback was obtained from 103 first year students and six teachers from preclinical subjects. Around 62%-80% students were satisfied with online practical teaching or agreed with benefits of various online tools used in the teaching sessions. Teachers found the framework more planned, and resource efficient, while students found it to be more engaging, enjoyable, and motivated for learning. No face-to-face interaction, non-experiential learning, and adaptation to newer technology were the main barriers perceived in online practical laboratory teaching. CONCLUSION: DEAPP framework was found to be feasible for rapid online transition of practical lab teaching and reported by the students and teachers as engaging, enjoyable and motivated learning.

Evaluation of the Auditory Pathway in Traffic Policemen.

BACKGROUND: Traffic policemen working at heavy traffic junctions are continuously exposed to high level of noise and its health consequences. OBJECTIVE: To assess the hearing pathway in traffic policemen by means of brainstem evoked response audiometry (BERA), mid-latency response (MLR), and slow vertex response (SVR). METHODS: In this observational comparative study, BERA, MLR, and SVR were tested in 35 male traffic policemen with field posting of more than 3 years. 35 age-matched men working in our college served as controls. RESULTS: Increase in the latencies of waves I and III of BERA, and IPL I-III were observed. Compared to controls, the MLR and SVR waves showed no significant changes in studied policemen. CONCLUSION: We found that chronic exposure of traffic policemen to noise resulted in delayed conduction in peripheral part of the auditory pathway, ie, auditory nerve up to the level of superior olivary nucleus; no impairment was observed at the level of sub-cortical, cortical, or the association areas.

Is Metformin-Induced Vitamin B12 Deficiency Responsible for Cognitive Decline in Type 2 Diabetes?

INTRODUCTION: Diabetes mellitus has its deleterious effects on various aspects of cognition such as memory function, executive function, and information-processing speed. The present study aims to assess cognition in diabetes patients and also tries to find its association with Vitamin B12 deficiency induced by metformin. MATERIALS AND METHODS: Thirty diabetics taking metformin and thirty nondiabetic controls were enrolled. Event-related potentials (ERPs) and serum Vitamin B12 levels were evaluated in them. RESULTS: Vitamin B12 levels were found to be deficient, and latencies of waves P200 and P300 were prolonged in the diabetics as compared to the controls. The dose and duration of metformin had no association with the ERPs. CONCLUSIONS: Although the Vitamin B12 levels were deficient in diabetics on metformin, this is not the reason behind the cognitive impairment found in them.

Does chronic exposure to mobile phones affect cognition?

Mobile phones form an integral part of our modern lifestyle. Following the drastic rise in mobile phone use in recent years, it has become important to study its potential public health impact. Amongst the various mobile phone health hazards, the most alarming is the possible effect on the brain. The aim of the present study was to explore whether chronic exposure to mobile phones affects cognition. Ninety subjects aged 17-25 years with normal hearing were recruited for the study and divided into three groups according to their duration of mobile phone use. No significant differences in N100, P200, N200, P300 latencies or N2-P300 amplitude were observed. Our results suggest that chronic mobile phone exposure does not have detrimental effects on cognition.

Event-related potentials study in children with borderline intellectual functioning.

BACKGROUND: Low general cognitive ability is a common cause for learning and academic difficulties. The present study was undertaken to objectively investigate the cognitive functioning of children having borderline intelligence using electrophysiological measures. MATERIALS AND METHODS: The study was conducted on children having borderline intelligence (IQ: 70-85). The cognitive functioning of children was assessed using event-related potentials. RESULTS: Significant prolongation of the latency of P200, N200, and P300 with no significant difference in the amplitudes was seen in the children having borderline intelligence as compared to controls. CONCLUSIONS: Brain systems that are important for stimulus discrimination and using cognitive representation to guide cognition and behavior are impaired in children with borderline intelligence.

Functional status of auditory pathways in children with borderline intellectual functioning: evoked potential study.

The present study was undertaken to determine whether impairment of sensory conduction in the auditory pathway is one of the contributory factors of performance in children with borderline intelligence. The study was conducted on children having borderline intelligence (IQ 71-84). The functional integrity of the central auditory pathway was assessed using Auditory Evoked Responses i.e. Auditory Brainstem response (ABR), Mid Latency Response (MLR) and Slow Vertex Response (SVR). The recordings were done using a computerized evoked potential recorder by 10-20 electrode placement system. There was no significant difference in the absolute peak latencies, the interpeak latencies and amplitude of ABR in the subjects as compared to controls. There was prolongation of the latency of MLR and SVR waves in subjects though not statistically significant indicating no conduction abnormality in the auditory pathway of the study subjects. Electrophysiological methods reveal underlying immaturity or abnormal brainstem timing and may serve as reliable tool in individuals with learning difficulties.

Attention and information processing in end stage renal disease and effect of hemodialysis: a bedside study.

The neurobehavioral syndrome of uremia in chronic kidney disease affects the functioning of the central nervous system. Cognitive impairment is one of the most important manifestations of this dysfunction. The process of hemodialysis is known to bring about conflicting changes in the cognitive status of patients. In the present study an assessment of cognitive status of patients with end stage renal disease was done in comparison to controls before and after a session of hemodialysis using simple bedside paper-pencil tests. Thirty patients of end stage renal disease on maintenance dialysis for at least one month with MMSE score >24 were assessed one hour before and one hour after hemodialysis using Digit Symbol Substitution Test, One Letter and Three Letter Cancellations tasks. Their results were compared to age and sex matched healthy controls. The patients with end stage renal disease had significantly lower performance in cognitive tests in comparison to controls. The performance improved 1 hour after hemodialysis in comparison to pre-dialysis values. However, the values after dialysis were significantly lower than in controls, thereby indicating that though the cognitive functions improved after hemodialysis, they did not reach the control levels. There was also a significant change in the biochemical parameters after dialysis. We conclude that patients with end stage renal disease suffered from cognitive impairment which improved on hemodialysis due to removal of metabolic waste products.

Psychomotor performance of medical students: effect of 24 hours of sleep deprivation.

CONTEXT: Sleep deprivation is known to have detrimental effects on attentional resources and cognitive functions. AIM: The aim of this study is to assess the changes in performance, due to 24 h of sleep deprivation, in medical students MATERIALS AND METHODS: The performance was assessed using simple paper-pencil tasks, such as digit symbol substitution test, digit vigilance test, and letter cancellation tasks. RESULTS: The results revealed an increase in the number of errors in letter cancellation tasks and digit vigilance test, with a significant decrease in the number of correct responses on the letter cancellation task. The time taken to complete the tests increased with lack of sleep, with the digit symbol substitution test being affected the most. DISCUSSION: This study infers that sleep deprivation for 24 h affected the judgment ability more than the response speed. CONCLUSION: Sleep deprivation might lead to compromised performance of medical students in examinations.

Effect of caffeine on information processing: evidence from stroop task.

BACKGROUND: Caffeine is a pyschostimulant present in various beverages and known to alter alertness and performance by acting on the central nervous system. Its effects on central nervous system have been studied using EEG, evoked potentials, fMRI, and neuropsychological tests. The Stroop task is a widely used tool in psychophysiology to understand the attention processes and is based on the principle that processing of two different kinds of information (like the word or colour) is parallel and at different speeds with a common response channel. AIM: To study the effect of caffeine on classical color word Stroop task. MATERIALS AND METHODS: This study was conducted on 30 male undergraduate students by performing a test before and 40 minutes after consuming 3 mg/Kg caffeine and evaluating the effect of caffeine on Stroop interference and facilitation. RESULTS: The results revealed that practice has no effect on the performance in a Stroop task. However, there was reduction in Stroop interference and increase in facilitation after consumption of caffeine as was evident by changes in the reaction times in response to neutral, incongruent, and congruent stimuli. CONCLUSION: We hypothesize that caffeine led to faster processing of relevant information.

Oxidative status in workers engaged in recycling of plastic: occupational hazard.

Recycling plastic industry is on rise. Plastic waste in environment is a pollutant so recycling of it can save environment and is economical too. However its recycling is associated with harmful effects on workers engaged in it. The present study was designed to elucidate the role of free radicals and cytochrome c in pathogenesis of polypropylene associated diseases. Thirty workers from plastic recycling factory occupationally exposed to polypropylene between the age of 18-40 years and working for atleast 8 hours a day for more than a year but less than 10 years were selected for the study. A trend in increase of FRAP and decrease of MDA was observed but they could not reach the level of significance. The level of serum cytochrome c, which is an indirect marker of oxidative stress, was also detectable in only two subjects. Since the number of subjects in the study was less, the result needs to be confirmed on larger number. More over cause of pulmonary dysfunction and carcinomas in these workers needs to be investigated.

No auditory conduction abnormality in children with attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder (ADHD) is a neurobehavioral developmental disorder characterized by lack of sustained attention and hyperactivity. It has been suggested that asymmetrical conduction of the auditory stimulus in the brainstem plays a role in the pathophysiological process of ADHD. In the present study, the functional integrity of the central auditory pathway was assessed using the auditory brainstem response (ABR), mid-latency response (MLR) and slow vertex response (SVR). Twenty ADHD children and twenty controls were recruited for the study and recordings were done on a computerized evoked potential recorder using the 10-20 system of electrode placement. There emerged no significant difference in absolute peak latencies, interpeak latencies and amplitude of ABR or latency of MLR in the ADHD children as compared with the controls. Prolongation of the SVR latency was found in the children with ADHD versus the controls, but the difference was statistically insignificant. The present study does not suggest any auditory conduction abnormality as a contributory factor in ADHD.

Pulmonary function and oxidative stress in workers exposed to styrene in plastic factory: occupational hazards in styrene-exposed plastic factory workers.

Styrene is a volatile organic compound used in factories for synthesis of plastic products. The pneumotoxicity of styrene in experimental animals is known. The aim of the present study was to study the effect of styrene on lung function and oxidative stress in occupationally exposed workers in plastic factory. Thirty-four male workers, between 18 and 40 years of age, exposed to styrene for atleast 8 hours a day for more than a year were studied, while 30 age- and sex-matched healthy subjects not exposed to styrene served as controls. Assessment of lung functions showed a statistically significant reduction (p < 0.05) in most of the lung volumes, capacities (FVC, FEV(1), VC, ERV, IRV, and IC) and flow rates (PEFR, MEF(75%), and MVV) in the study group (workers) as compared to controls. Malondialdehyde (MDA) was observed to be significantly high (p < 0.05) while ferric-reducing ability of plasma (FRAP) was significantly low (p < 0.05) in styrene-exposed subjects. Reduced glutathione (GSH) level was significantly depleted in exposed subjects as compared to control group. The mean value of serum cytochrome c in styrene-exposed subjects was found to be 1.1 ng/ml (0.89-1.89) while in control its levels were under detection limit (0.05 ng/ml). It shows that styrene inhalation by workers leads to increased level of oxidative stress, which is supposed to be the cause of lung damage.

Pulmonary functions in plastic factory workers: a preliminary study.

Exposure to long term air pollution in the work environment may result in decreased lung functions and various other health problems. A significant occupational hazard to lung functions is experienced by plastic factory workers. The present study is planned to assess the pulmonary functions of workers in the plastic factory where recycling of pastic material was done. These workers were constantly exposed to fumes of various chemicals throughout the day. Thirty one workers of plastic factory were assessed for their pulmonary functions. Parameters were compared with 31 age and sex matched controls not exposed to the same environment. The pulmonary function tests were done using Sibelmed Datospir 120 B portable spirometer. A significant decrease in most of the flow rates (MEF 25%, MEF 50%, MEF 75% and FEF 25-75%) and most of the lung volumes and capacities (FVC, FEV1, VC, TV, ERV, MVV) were observed in the workers. Smoking and duration of exposure were not affecting the lung functions as the non smokers also showed a similar decrement in pulmonary functions. Similarly the workers working for less than 5 years also had decrement in pulmonary functions indicating that their lungs are being affected even if they have worked for one year. Exposure to the organic dust in the work environment should be controlled by adequate engineering measures, complemented by effective personal respiratory protection.

Event-related potentials study in attention deficit hyperactivity disorder.

Attention deficit hyperactivity disorder (ADHD) is a childhood disorder characterized by lack of sustained attention, hyperactivity and impulsivity. Children with ADHD have functional impairment occurring at multiple levels. In the present study, cognitive status was assessed using auditory event-related potentials (ERPs). Twenty ADHD children and 20 controls were recruited for the study and ERPs were recorded on a computerized evoked potential recorder, using the international 10-20 system of electrode placement. The ADHD children showed a statistically significant N200 latency prolongation and amplitude decrease compared with the controls; the latencies of the other waves, i.e. N100, P200, P300, were prolonged in the ADHD children but the difference versus the controls was statistically insignificant. Reaction time was significantly longer in the ADHD subjects as compared with the controls. The above findings are suggestive of dysfunctions in the discrimination of task-relevant stimuli and a slower motor response in ADHD children.

Sensory, cognitive and motor assessment of children with poor academic performance: an auditory evoked potential study.

The present study aims to evaluate the auditory sensory process in the brainstem, thalamocortical and cortical areas by using auditory evoked potentials [auditory brainstem response (ABR), mid latency response (MLR) and slow vertex response (SVR)], cognitive functions by P300 and motor response by reaction time in children with poor academic performance. Thirty children between 6-12 years of age were selected as subjects on the basis of poor academic school records. While thirty children with good academic performance served as controls. The recordings were done using a computerized evoked potential recorder by 10-20 electrode placement system. There was no difference in the anthropometric parameters and IQ of the two groups. There was a significant increase in latency of waves II, III, IV and V, and Inter-peak latency I-V of ABR in poor performer females. All the component waves of MLR and SVR showed increased latency in the subjects but could not reach the level of significance. There was a significant increase in latencies of P300 at Cz and Pz electrode positions with no change in amplitude in poor performer females. The reaction time was also increased in the poor performer females as compared to the controls. The latencies of all the waves of ABR, P300 and reaction time are also increased in male poor performers as compared to male controls but could not reach the level of significance. The conduction of impulses is slower in pontine and midbrain auditory pathway along with inefficient cortical processing of task relevant stimuli and motor response in female children having poor academic performance.

Visual evoked potential study in slow learners.

Slow learners are individuals with low achievement and comparably low IQ scores. It may be a symptom reflecting a larger underlying problem in them. Sensory neural processing of visual information can be one of the contributory factors for their underachievement. The present study was undertaken to examine the integrity and function of visual pathway by means of Visual Evoked Potential (VEP). Pattern reversal VEP was performed on seventeen slow learners. Fifteen age and sex matched children with good school performance and normal IQ were taken as controls. There was significant prolongation of N75 component of VEP in slow learners. The latencies of P100 and N145 were also increased but could not reach the level of significance. Our findings are suggestive of the presence of a weaker VEP response in slow learners indicative of a deficit early in the visual processing. There is some abnormality in the geniculate afferents to V1 which is consistent with a defect in the magnocellular pathway at the level of Visual Area 1 or earlier.

Evaluation of cognitive brain functions in caffeine users: a P3 evoked potential study.

Caffeine is one of the most widely consumed stimulant drugs of the modern world. It brings about a feeling of well-being, relaxation, increased alertness and concentration. Its effects have been studied on brain function and behavior using mood questionnaires, reaction time tests, memory tests, EEG and of late Event Related Potentials (ERPs). This study evaluates the response of caffeine on ERPs and Reaction Time (RT) using auditory "oddball" paradigm. Forty undergraduate medical students volunteered for the study and their ERPs and RT were recorded before and after 40 minutes of ingestion of caffeine. There was a non-significant decrease in latency of N1, P2, N2 and P3 and a significant decrease in Reaction Time after caffeine consumption. The amplitude of P3 showed a significant increase after intake of caffeine. The results of this study indicate that caffeine leads to facilitation of information processing and motor output response of the brain.

Effect of caffeine on central auditory pathways: an evoked potential study.

Caffeine is consumed in various forms like tea, coffee, chocolates and colas. The present study evaluated the effect of caffeine on auditory brainstem response (ABR), mid latency response (MLR) and slow vertex response (SVR) in 40 male volunteers. The recordings were done using a computerized evoked potential recorder by 10-20 electrode placement system. The subjects consumed 3mg/kg body weight of caffeine after 12h abstinence from caffeine in any form. The data obtained revealed that latencies of waves IV and V along with I-V interpeak interval of ABR decreased significantly. This was accompanied with significant increase in amplitude of wave V. MLR latencies and latency of P1 wave of SVR was significantly decreased following caffeine ingestion. The results indicated that caffeine improves transmission in the peripheral and central brain auditory pathways.