International Journal of Medical Sciences and Education (IJMSE)
Vol. 7 Issue: 6 (Nov-Dec. 2020), Date of Publication: 01.01.2021

Table of Contents
Editorial

1.    MEDICAL EDUCATION IN INDIA – RECENT SCENARIO                                                                               1-4
       Siriesha Patnaik, Naveen Kumar. B, Simmi Oberoi, Gul Kalra, Patnaik V.V. Gopichand     PDF FULL TEXT

ABSTRACT

​Background: Medical Education at under graduate level has been under constant control and vigil of the Medical Council of India. But in spite of additions, deletions and modifications effective implementation of curricular changes have not seen the light. The graduate Medical Education Regulations was given shape in 1997 from the initial form of 1957. Changes were envisaged in 2008. Despite lot of additions in 2008 effective implementation didn’t materialize. Vision 2015 document had detailed suggested changes but unfortunately not implemented. Now this year the all new competency based medical education (CBME) is in for proper implementation through a well-designed support program with supervision and feedback (CISP) of the academic cell of MCI (Medical Council of India). Backdrop, Finer details, feedback are viewed and analyzed. Conclusion: The present CBME has clear definitions, ways to implementation and active feedback mechanisms. So success can be assured and the Indian Medical Graduate under CBME can be better wholesome and doctor of first contact not only at local levels primary secondary or tertiary levels but also with preparedness to face international competition.
Keywords: India; Medical Education; CBME; MCI.

2.    INTRODUCTION OF PREVIEW OF CLINICAL EXAMINATION VIDEO ON YOUTUBE IN PHYSIOLOGY
       PRACTICAL - A PILOT STUDY                                                                                                                        5-7
       Kshitija Patkar, Umesh Patkar                                                                                                  PDF FULL TEXT

ABSTRACT

Background: It is observed that clinical examination skills in first year occupational therapy and physiotherapy students are poor in spite of hard efforts by teachers in Physiology. So, this method of preview of clinical examination video on YouTube before attending revision class was introduced by Department of Physiology to improve their clinical examination skills. Materials and methods: This pilot study was conducted in 18, first year occupational therapy and physiotherapy students. They were asked to study a video on clinical examination at home before coming for revision practical on the same topic. The revision practical class was conducted, in which maximum time was given to practice the skills under guidance of the teachers. Students’ and teachers’ feedback was obtained after revision practical. Result: 100 % of students agreed that preview of video on clinical examination was helpful to them during revision class and wanted more topics to be covered by this method. Conclusion: The preview of video on clinical examination before revision practical is preferable method to improve clinical examination skills.
KEYWORDS: Clinical examination skills, Clinical examination video, Teaching-learning tool, YouTube

3.    EFFECTIVENESS OF JIGSAW TECHNIQUE IN ADDITION TO LECTURE FOR TEACHING MEDICAL
       UNDER GRADUATES                                                                                                                                     8-11
       Sreenivasulu.K, S. Sarah Nightingale, D.Sarada, Y. Sudha Sree, Ravi, Anitha Ramesh      PDF FULL TEXT

ABSTRACT

Background: it is One of the best innovative methods of interactive teaching. It breaks classes into groups and breaks assignments into pieces that the group assembles to complete the (jigsaw) puzzle.  Students will be able to learn the concept by analyzing the difficult tasks with group discussion. Objectives: to understand and analyze the topics through that motivating them towards self-directed and peer assisted learning. Methodology: study was conducted for 25 students, with division into A, B, C, D, E groups each comprising 5 members. We choose five difficult topics from weekly test and was assigned to groups. Initially discussion within the group as A1, A2, A3, A4 and A5 and later in between the groups as A1, B1, C1, D1 and E1. Here, teacher being a facilitator to interpret the information and its application. Similarly, four other faculty involving in the study making the input as 100. Results: pre-jigsaw failure rate was 45% and post-jigsaw it is reduced to 10%. 75 % of students showed more than 20% improvement in the performance in the form of scoring marks. Conclusions: Students will be able to correct their mistakes from self-evaluation and learning from others. Is improves the positive attitude in students by introspecting themselves which reflects in the improvement of academic performance. Jigsaw helps in understanding the non-core topics with self-evaluation and correction which leads them in abstract thinking making them as self-directed learners reflects in doing research projects.
KEY WORDS: self-evaluation, group, self-directed learning, academic performance, facilitator, abstract thinking

4.    A STUDY OF EFFECT OF SPACED EDUCATION METHOD IN SUBJECT PATHOLOGY FOR UNDER-
       GRADUATE STUDENT IN MEDICAL COLLEGE                                                                                         12-16
       Jalaly Farah, Namdev Garima                                                                                                   PDF FULL TEXT

ABSTRACT

Background: Spaced education is a learning method in which knowledge is provided with repetition over a longer time period. Medical students struggle to retain academic pearls and often forget with time. By spaced education method, student is reminded for academic pearls for longer time. This is an innovative learning method that can be delivered electronically on a mobile smartphone. This study investigated whether online spaced education could prospectively improve students retention of medical knowledge. Aim & Objective: To know the effect of spaced education upon learning of the medical students. Method: This cross-sectional analytical study was carried out on IInd Prof MBBS student studying pathology subjects. Four topics related to “liver” pathology were taught to them through didactic lectures. Than one group was spaced educated on two topics via WhatsApp group for one month. In the same way other group was spaced educated on other two topics. After completion of one month of ‘spaced education’ of each individual topic, learning of each topic on both groups was assessed by 20 validated multiple-choice questions. Results: 54 students met the criteria of the study. The obtained grades were divided in likert scales. Unpaired t-test was applied for comparing the mean of obtained marks. It showed a high statistical significant association with spaced education (t=7.85, p-value = 0.00001) Conclusion: The present study found highly significant effect of spaced education upon learning of students. Most topics proved to be successful in enhanced learning of students through intervention of spaced education.
Keyword: Academic - pearls, Learning, Spaced Education, WhatsApp,

5.    E-LEARNING TOOLS FOR ONLINE PROBLEM BASED LEARNING IN MEDICAL EDUCATION            17-24
        Srikumar Chakravarthi, Barani Karikalan                                                                                 PDF FULL TEXT

ABSTRACT

PBL is an instructional student-centred method that uses meticulously built real-world problems within the context of learning objectives. PBL in medical education was first introduced at McMaster University in Canada by Howard Barrows in the 1960s. PBL encourages learners to actively participate not only in the construction of knowledge and but also enhance competencies across multiple principles essential to solve a problem. PBL has become a major contributor to teaching and learning methods in medical education. PBL is an instructional framework that encourages active and collaborative learning based on the principle that effective learning occurs when learners learn and co-learn knowledge by means of interactions and directed self-learning. Traditional PBL is face to face where a facilitator guides students’ learning, especially in the problem understanding phase and problem-solving phase of the PBL, as well as facilitating students’ inquiry by discussion and sharing learning resources. Synchronous PBL sessions conducted through online communication platforms allow learners to communicate and also to share content and learning resources. Studies show that online learning encourages individualised student-centred learning. While many communication systems allow synchronous conversation, the facility to record and summarise ideas and facts of all students is missing. We shall be discussing two video conferencing apps in this article that has a synchronous whiteboard facility to record ideas and facts.
Keywords: Problem Based Learning, Online PBL, ePBL, Videoconference, Collaborative whiteboard

6.   UNDERSTANDING SELF-DIRECTED LEARNING FOR SALVAGING MEDICAL EDUCATION DURING
      COVID-19 LOCKDOWN                                                                                                                                   25-29
      Pushpa, Neelanjali Kumari, Vidya Sagar, Vivek Kashyap, Dewesh Kumar                             PDF FULL TEXT

ABSTRACT

Today self-directed learning is a standard norm in institutions of repute for developing professional apprentices into lifelong learners. Medical education being a lifelong process compels the doctors to learn throughout their professional career as the practice of medicine and its underlying knowledge base changes very rapidly. In the present settings, SDL is also essential for medical students to help them develop self-regulating learning skills, more accountability, decisiveness and responsibility which are the pillars of a medical profession. In the available literature, SDL has been linked closely with Problem based learning(PBL) and often they are used interchangeably as SDL is initiated only after a problem or educational challenge. Medical education stresses upon patient care mainly, where learning from patients becomes utmost important. In this lockdown due to COVID19, medical education has suffered a lot but there have been attempts to compensate through virtual classes. So, the quest of learning and the need of continuous dissemination of knowledge in medical education have paved the way for SDL during this COVID-19 pandemic time. This way of learning will always be part of our system without any coercive action for its inclusion in the curriculum, but for transforming our education to a better level, SDL needs to be part of our curriculum. This paper highlights the importance of SDL in adult learning with special reference to medical education and its relevance during COVID 19 time.
Keywords: Self-directed learning, problem based learning, medical education

7.   STUDY OF ASSOCIATION IN BETWEEN MODIFIABLE RISK FACTORS AND  HYPERTENSION AMONG                 ADULT MALES IN AN URBAN SLUM IN  PUNE                                                                                           30-36
       R.K. Gaur, Swapnil Jain, D K Shukla, Pradeep Tewari                                                             PDF FULL TEXT

ABSTRACT

Background: It is well-established fact now that high blood pressure is a major risk factor for coronary, renal, and peripheral vascular diseases. If we compare the male adults of rural areas, the urban males living in poor socio-economic conditions are more prone to develop hypertension due to the presence of various modifiable risk factors. This study was carried out to study certain factors/ determinants, which are modifiable and their association with elevated blood pressure. Material and Methods: This cross-sectional study was carried out in an urban slum in Pune. It covered six month period from Jan 2019 to Jun 2019.  The data collection procedure consisted of a physical examination by measuring the blood pressure, measurement of height, weight, hip, and waist. Besides these, a personal interview was undertaken by using a predesigned Performa. Results: Hypertension was found to be significantly linked with extra salt intake, alcohol consumption, lack of physical exercise, high BMI, and high WHR.Conclusion: There was a significant association observed between elevated blood pressure and extra salt intake, alcohol consumption, lack of regular physical exercise, and obesity.
 
Keywords: Blood pressure, urban male adult, risk

8.    A COMPARATIVE STUDY BETWEEN CT COLONOGRAPHY AND CONVENTIONAL COLONOSCOPY IN
       DETECTING THE COLORECTAL LESIONS                                                                                                37-42
       Hariom Sharma, Kuldeep Mendiratta, Meenu Bagarhatta, Poornima Sharma                      PDF FULL TEXT

ABSTRACT

Background: Colorectal cancer is one of the most common cancers globally with a long interval of disease progression. Timely diagnosis and early interventions decrease the morbidity and mortality significantly. The current study was planned with an aim to compare CT colonography and conventional colonoscopy in detecting colorectal lesions. Materials and methods: A hospital-based comparative study was conducted on 90 patients in the department of radiodiagnosis, SMS medical college, Jaipur, Rajasthan in which CT colonography and conventional colonoscopy was performed on the same day. Results: A total of 72 lesions were detected in 63 patients. Entire colon was visible in 100% patients in CT colonography and 87.77% patients in conventional colonoscopy. Conventional colonoscopy detected lesions more in rectum, descending colon, transverse colon, and ascending colon while CT colonography detected lesions better in sigmoid colon and caecum. Conventional colonoscopy detected more lesions for size ≤5mm while lesions 6-9 mm were better detected on CT colonoscopy. For lesions of ≥10 mm, lesion detection was same on both the modalities.  Conclusions: Further prospective studies with a larger sample size and complete follow-up of the patients with the suggestive interventions are recommended for future references.
Keywords: Colorectal cancer, CT colonography, Conventional colonoscopy, colonic polyps

9.    AGE DETERMINATION BY RADIOLOGICAL EPIPHYSEAL FUSION OF ELBOW AND WRIST IN
       ADOLESCENT POPULATION IN MALWA REGION OF MADHYA PRADESH                                            43-50
       Ravindra Kumar, Pragya Gupta, Raman Grover, Jaswant Goyal, Naveen Meena, Devendra Kumar                
                                                                                                                                                             PDF FULL TEXT

ABSTRACT

Background: Law crime and punishment is entirely based on the criminal responsibilities and age of the person. In modern society, the crime against the children and adolescent and crime by the children and adolescent are increasing enormously. Hence, estimation of age has gained much importance, especially in medico legal cases. In the present study, we determine the bone age based on fusion of epiphysis of long bones around elbow and wrist for apparently normal adolescent between the age group of 12-20 years for the population of Malwa region of Madhya Pradesh. Materials and Method: The study was carried out on adolescent population of Malwa region of Madhya Pradesh. The study was done from August, 2007 to September, 2008. In this study, we take normal healthy adolescents between age group of 12-20 years. We consider their document evidence for their age like date of delivery details, birth certificates, school records etc. We only consider the population of Malwa region. Results: On the basis of our criteria, our study was done on 500 subjects with 265 males and 235 females between the 12-20 age groups from Malwa region of Madhya Pradesh. The history of all the subjects was including name, sex, socioeconomic status, religion and dietary habits. Majority of the subjects in the study were males and the sex ratio were similar to the sex ratio of Madhya Pradesh. Conclusion: There was no difference in age of fusion in individuals of different religions in Malwa region. There is difference of 1-3 years in age of fusion from Western population. Fusion occurs earlier than Western population suggesting climatic, dietetic and hereditary factors as aetiology. Similar differences can see in other studies in India. There was no variation on the basis of diet and occupation seen in study group. There was no appreciable difference in the age of complete union of epiphysis on both right and left side of body. The results are showed in the tables.
Keyword: elbow and wrist, children and adolescent, plain X-ray

10.   PREVALENCE OF SYMPTOMATIC GASTROESOPHAGEAL REFLUX DISEASE IN CHRONIC
        OBSTRUCTIVE PULMONARY DISEASE PATIENTS IN NORTH INDIAN POPULATION                        51-57
        Pankaj Singh Jadon, Pragya Gupta, Jaswant Goyal, Aryak Singh                                     PDF FULL TEXT

ABSTRACT

Background: Our aim to this study is to evaluate a possible relation between GERD and COPD. We see the prevalence of symptomatic gastroesophageal reflux disease in COPD patients. Material and Method: The present study is a cross sectional study. In this study, consecutive 100 patients of COPD (chronic obstructive pulmonary disease) were selected by questionnaire method and spriometry. Population which comprised of 100 COPD patients, 91 was males and 9 were females. Performa contained 8 questions for COPD patients. The questionnaire was written at a fourth grade reading level and easily understood by all patients. The person with more than 35 age have selected for the COPD. Results:  In the present study, GERD symptoms were found in 9 patients of 35-44 years age group, 16 patients of 45-54 years age group, 23 patients of 55-64 years age group, 18 patients of 65-74 years age group and 8 patients of more than 75 years age group. Overall, 38% (n=38) patients of total study population had GERD symptoms, who were taking treatment for COPD is 25% (n=25) patients of total study population, who were not taking any treatment. Conclusion: In present study, we have studied the prevalence of GERD in COPD group. In our study, majority of patients (66.2%) were from elderly age group which is more than 55 years age group had symptomatic GERD. Higher prevalence of GERD symptoms was found in male patients (76.9% of total males) as compare to female patients (44.4% of total females). High prevalence of GERD symptoms was found in those subjects who were taking treatment for COPD (drugs like inhaled Beta-2 agoinst/inhaled steroid/oral theophylline). Higher prevalence of hiatus hernia (40.9%) and lax LES (27.3%) was found in those patients, who had symptomatic reflux in COPD group.
Keywords: Chronic obstructive pulmonary disease, Gastroesophageal, Endoscopy, Treatment, Reflux

11.  KNOWLEDGE, ATTITUDE AND PRACTICES REGARDING BIOMEDICAL WASTE MANAGEMENT AMONG             HEALTHCARE PERSONNEL IN JAIPUR, INDIA                                                                                      58-63              Dr. Dinesh Kumar Jain, Dr. Monika Gupta, Dr. Parul Sinha,
      Dr. Sandeep Gupta, Dr. Jaishree Jain                                                                                     PDF FULL TEXT

ABSTRACT

Background: Biomedical waste is an emerging issue of concern to hospitals, institution authorities, and the environment. There is a large amount of probably infectious and dangerous waste generating within the health care hospitals and facilities around the world. Aims and objective: To assess the levels of knowledge and practices among doctors, postgraduates, interns, staff nurses, laboratory technicians, lab attendants, and sanitary workers in the different departments. Methodology: The descriptive observational hospital-based study. Total of 300 health care personnel participated. Results: Total of 83% of participants knew about BMW, only 77% have heard about the rules of BMW 2016 and only 40% knew about new amendments done in 2019. Among all the health personals 69% were having detailed knowledge of the categories of BMW, 74% were able to identify the correct color of bag for different categories,76% had awareness regarding the transmission of disease by BMW and 77% were knowing the use of the puncture-proof bag. Conclusion: Observations and results are emphasizing the importance of training regarding biomedical waste management. Lack of information about biomedical waste management cannot be attributed to an ideal practice of appropriate waste disposal. Together with the training; medical wastes should be classified and segregated at the source level first. There should be a series of scientific management of hugely growing biomedical waste using innovative and radical measures of cleaning up the waste.
Keywords: BMW, BMWM, Healthcare personnel, Knowledge, Practice.

12.   ROLE OF STEROIDS IN PREVENTING RECURRENCE OF CHRONIC SDH                                           64-68              Dr.Ranjeet  Kumar Jha                                                                                                                PDF FULL TEXT

ABSTRACT

Biomedical Chronic subdural hematoma is a neurological disorder, mainly in older patients. The treatment is mainly surgical intervention, with various modalities used among neurosurgeons. Over the time, growing evidence that inflammatory changes play a main role in the pathology of CSDH. In that favor, the role of corticosteroids has been boon treatment to surgery. However, this practice remains very ancient and we need for high-quality-of-clearance studies to clear the effectiveness of corticosteroids in the management of CSDH. Methods: We did a double-blind, randomized controlled trial for comparison of methylprednisolone and placebo in the management of CSDH without clinical along with radiological signs of severity. The management will be given daily for the duration of 3 weeks. The study assessment will be conducted at 1, 3 and 6 months. 202 study participants enrolled for the present study. Results: Time for surgical management of the chronic subdural hematoma is 1 month to compared between the two study groups with the log-rank test. Two interim analyses after inclusion of one third and two thirds of the study participants and one final analysis will be conducted. The cumulative result in terms of value of alpha for each analysis are: 0.00021 for first analysis, 0.01202 for second analysis and 0.04626 for final analysis (Statistical Solutions Ltd., Cork, Ireland, nTerim, V 1.1,). The trial will be stopped when the significance values of the log-rank test will be reported below to these alpha values. Conclusion: Observations This study started in June 2016; its outcome may be interesting as alternatives to surgery in the treatment of patients harboring a chronic subdural hematoma, and result may insights into the natural history of its pathology
Keywords:  Corticosteroids, Chronic subdural hematoma, Elderly patients.

13.   COMPARISON OF GASTROESOPHAGEAL REFLUX DISEASE IN CHRONIC OBSTRUCTIVE
        PULMONARY DISEASE AND BRONCHIAL ASTHMA PATIENTS                                                            69-78              Pankaj Singh Jadon, Jaswant Goyal, Pragya Gupta, Aryak Singh                                          PDF FULL TEXT

ABSTRACT

Background: In this paper, we defined the prevalence of symptomatic gastroesophageal reflux disease in COPD and bronchial asthmatics patients and evaluate the possible relationship between GERD and bronchial asthma and COPD present. Materials and Method: The present study is a cross sectional study. In this study, a total of 200 patients selected for COPD and bronchial asthma group were selected by questionnaire method and spriometry. Each group contained 100 patients. Age, sex, diet, economic, addiction and treatment wise study were done in the present study. The result was tabulated and wherever possible, statistically method was applied. Results: Overall, 38% (n=38) patients of COPD study population had GERD symptoms, who were taking treatment for COPD is 25% (n=25) patients of total study population, who were not taking any treatment. Overall 42% (n=42) patients of total study population had GERD symptoms, who were taking treatment for bronchial asthma (either inhaled β-.2 agonist / inhaled steroid / oral theophylline /all) as compare to 27% (n=27) patients of total study population, who were not taking any treatment. Conclusion: High prevalence of GERD symptoms was found in those subjects who were taking treatment for COPD and bronchial asthma. Higher prevalence of hiatus hernia (40.9%) and lax LES (27.3%) was found in those patients, who had symptomatic reflux in COPD group. Higher prevalence or both hiatus hernia plus lax LES (19%) was found in those patients, who had symptomatic GERD in bronchial asthma group.
Keywords: Gastroesophageal reflux, Chronic obstructive pulmonary disease, Bronchial asthma

14.  AGE AND HBA1C IN PREDICTING MAJOR ADVERSE OUTCOME IN INDIAN HOSPITALISED PATIENTS               WITH COVID-19 INFECTION: A PROGNOSTIC CLUE                                                                                79-87           Dr Srishti Jain, Dr. Rajeev Kasaliwal, Dr. Naveen Gupta, Dr. Rajat Vohra ,
       Dr Nimish Mathur, Dr Saket Yadav, Dr. Ashish Jain, Dr. Puneet Rijhwani                              PDF FULL TEXT

ABSTRACT

Background: In Following rapid spread of COVID-19, WHO on March 11, 2020, declared COVID-19 a global pandemic. Many earlier studies outside India have shown more aggressive course of COVID-19 pneumonia in diabetic patients. Material and methods: A observational study was carried out at Mahatma Gandhi Medical College and Hospital, Jaipur. Data from electronic medical records of seven thirty-one patient admitted from 15 October 2020 to 30 November 2020 were reviewed and analysed. Results: Patients with diabetes had significantly high risk of suffering from major adverse events (composite of Oxygen requirement, mechanical ventilation, and death) compared to those without diabetes. No significant difference in mortality rates was observed between two groups in our cohort. No significant difference in mortality rates was observed between two groups in our cohort.  ROC analysis has shown that Hba1c > 5.77 % at the time of admission and age > 50 years have sensitivity of 89 % sensitivity of major adverse events in Covid 19 pneumonia. Conclusion: Indian diabetic patients with or without pre-existing comorbidity had more severe illness from COVID-19 than those without diabetes during hospital admission. Covid 19 pneumonia patient with HBA1c ≥5. 77 % and age ≥ 50 years have higher risk of suffering from adverse events.
Keywords: Diabetes, Age, HbA1C, COVID-19, Major adverse outcome

15.   MORPHOMETRIC ANALYSIS OF THE PATELLA BONE AS ASSESSED BY MAGNETIC RESONANCE
        IMAGING IN NORTH INDIAN POPULATION                                                                                              88-92              Ravindra Kumar, Raman Grover, Jaswant Goyal, Pragya Gupta,
        Naveen Meena, Devendra Kumar                                                                                              PDF FULL TEXT

ABSTRACT

Background: Anatomic variations based on ethnicity and gender play an important role in designing of prosthesis for knee surgeries and commercially available prostheses are majorly based on Caucasian morphometry. The present study aimed to assess the patella bone by magnetic resonance imaging in North Indian population. Materials and Method: The present retrospective study comprised of axial magnetic resonance images of the knee joint of 60 North Indian adults (35 males, 25 females; aged between 20–70 years). The patellar width, thickness, lateral facet width, facet thickness, ratio of the lateral facet, the relative thickness and ratio of facet thickness were measured in the by using the digital ruler. The statistical analysis was done by unpaired t test and performed by using the R statistical software. Results: Patellar width, thickness and lateral facet width demonstrated statistically highly significant gender wise variations suggesting sexual dimorphism (P≤0.001). The mean value was higher in males than females except for patella relative thickness and patella facet thickness ratio. It was observed that the males exhibit increased variance than females in all the measurements of patella except patella lateral facet ratio. Conclusion: The present study provides an important reference guide for designing gender specific prosthetic implants for North Indian population and lead to successful treatment planning in cases of anterior knee pain and patellofemoral joint disorders requiring surgical procedures such as arthroplasty of the total knee, patellofemoral arthroplasty, resurfacing of patella, and designing the prosthetic implant.
Keyword: Morphometric analysis, Patellar width, Patellar thickness, Patellar lateral facet width