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BACKGROUND: Dermatology being a visual branch, there is a need to add a visual element in learning and assessment of dermatology. This study compares the utility of image-based assessment (IBA) as a new tool compared to routinely used semi-structured viva (SSV) in dermatology formative assessment at undergraduate level. METHODS: Comparison was made between batches of students in year 2018 who underwent clinical posting term ending assessment by IBA with the retrospective cohort of batch of students in year 2015 who underwent assessment by SSV. The students' marks in this assessment and their attendance were collected. Feedback was taken from batch of students who had undergone IBA assessment. Faculty feedback was also taken. RESULTS: Correlation of attendance with marks was higher in IBA batch compared to SSV. IBA is better able to assess the diagnostic skills which requires visual element and prescription writing skill. SSV can do an authentic assessment of clinical reasoning skills. IBA had higher variability in marks allotted to students suggesting that it was more objective tool whereas with narrow range of marks SSV was found to be more subjective. Both IBA and SSV had similar acceptability by students and faculty. IBA was more resource intensive at preparation stage while SSV was so in conduction stage. IBA had better educational impact, as it promoted learning through exposure to actual patients. CONCLUSION: IBA fared better in terms of validity, reliability, acceptability, and educational impact. In terms of feasibility IBA and SSV had differing challenges.
RESUMO
BACKGROUND: The epidemiological data based on intensive monitoring studies are limited for the cutaneous adverse drug reactions (CADRs) in terms of incidence. Most of earlier Indian studies focused only on types and causative drugs of CADRs. AIM: The aim of this study is to analyze the CADRs with reference to the incidence, its subgroup analysis, causative drugs, and other clinical characteristics in Indian population. METHODOLOGY: Intensive monitoring study was carried out over a period of 3 years in the dermatology outpatient and inpatient department. CADRs due to only systematically administered drugs were considered. The WHO definition for CADR, the WHO causality definitions, modified Schumock and Thornton's criteria for preventability, and International Conference on Harmonisation E2A guidelines for seriousness were considered. Incidence was expressed in percentage and its 95% confidence interval. The incidence was analyzed on basis of characteristics of study population and CADRs. RESULTS: A total of 171 CADRs were observed from 37,623 patients. The CADR incidence was 0.45% (95% CI: 0.39-0.53). The incidence did not significantly differ in different age groups and gender. Commonly observed CADRs were maculopapular rash (23.98%), urticaria (21.64%), and fixed drug eruptions (FDEs) (18.13%). Antimicrobials (35.18%) and nonsteroidal anti-inflammatory drugs (NSAIDs) were suspected in all common CADRs. Anti-infective and NSAIDs were most commonly suspected drugs in overall CADRs, maculopapular rash, urticaria, FDEs, and erythema multiforme. The exact nature of drugs remained inaccessible in one-fourth cases due to use of the over-the-counter self-medications. The incidence of preventable and serious and fatal CADRs was 0.08% (95% CI: 0.05-0.11), 0.04% (95% CI: 0.02-0.06), and 0.003% (95% CI: 0.000-0.001), respectively. CONCLUSION: Ethnic characteristics should be considered while interpreting incidence from the international studies. The demographic characteristics of study population do not affect the incidence of CADRs. Indian patients should be sensitized about hazards of self-medications.
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CONTEXT: Diabetes mellitus (DM) is the most common of the endocrine disorders. Mucocutaneous manifestations of diabetes mellitus are many and vary from trivial to life-threatening. Sometimes, mucocutaneous disorders may herald the onset of diabetes. AIMS: To study the pattern of mucocutaneous manifestations in diabetics and role of it in diagnosing diabetes mellitus and its complications. SETTINGS AND DESIGN: It was a longitudinal observational study of patients having diabetes with skin complaints attending skin outdoor department or admitted in wards for any reason in a tertiary care hospital. MATERIALS AND METHODS: Total 300 patients were included in the study. Detailed history, clinical examination, and relevant investigations were done to diagnose the mucocutaneous disorders, diabetes, and diabetic complications. STATISTICAL ANALYSIS USED: The data was analyzed by using Epi info software. RESULTS: Demographic profile shown majority of cases (78.66%) in more than 40 years of age with almost equal male and female preponderance. Mucocutaneous manifestations as presenting feature of diabetes were observed in 21.67% cases. Infections were most common in 119 (39.66%) cases, followed by acanthosis nigricans in 46 (15.33%) cases. Various associated complications like hypertension, retinopathy, hyperlipidemia, coronary artery disease, neuropathy, nephropathy, and diabetic ketoacidosis were observed in 160 (53.3%). CONCLUSIONS: Skin is the mirror, which reflects internal diseases; this aptly applies to skin and diabetes mellitus. Through awareness about cutaneous manifestations of DM, dermatologist can not only take credit for detecting DM but also facilitate early diagnosis of systemic complications of DM. This is immensely beneficial to patients in long run.
