Learner’s perspectives on competency-based medical education in pharmacology at a tertiary care teaching hospital in South India

Background: Competency based medical education (CBME) was implemented recently in India. The study was conducted to evaluate the perspectives of undergraduate medical students towards CBME curriculum in pharmacology at a tertiary care medical college in South India.Methods: After the completion of the curriculum, feedback was taken in a semi-structured, validated questionnaire. It was based on Kirkpatrik’s level 1 model of evaluation. Majority of the questions were framed on a 5-point Likert's scale (1 being poor to 5 being excellent). Qualitative data was collected by open ended question on additional comments.Results: The response rate was 72.8%. Majority of the participants rated the theory classes, practical classes, small group discussions, self-directed learning, integration, and assessments as good and excellent. More than 80% participants rated role play as an innovative and worthwhile concept towards mastering prescription communication. They felt that role play ignites team work, and provides confidence. Close to 90% of the participants rated the overview on emergency use authorization, orientation on drug regulators, perspectives on hydroxychloroquine prophylaxis as effective and excellent. More than 85% participants felt that AETCOM provided them insight on ethical issues, patient communication, and perspective of doctors as caregivers. 9.8% (16) participants provided comments to open ended question for feedback.Conclusions: The study provided an insight of medical undergraduates towards CBME curriculum. Further studies can be designed to look into the effectiveness of teaching learning methods based on the performance of the students, perspective of faculties with focus faculty development, and role of various stakeholders

Synthesis and pharmacological evaluation of chlorin derivatives for photodynamic therapy of cholangiocarcinoma

Photodynamic therapy (PDT) has been developed as a promising therapeutic method in cancer treatment. The discovery of effective photosensitizer, which is the key factor of PDT, is highly desired. This paper reports the synthesis of novel chlorin derivatives, 5,10,15,20-tetraphenyl-[2:3]-[(methoxycarbonyl, carboxy)methano] chlorin I and 5,10,15,20-tetraphenyl-[2:3]- {[methoxycarbonyl, (2-hydroxyethyl)amide]methano}chlorin II. Their structures were characterized with UV–vis, 1HNMR, 13CNMR and HRMS spectroscopies. Photophysical and photochemical experiments results showed that compound I and II had an absorption maximum around 650 nm, with molar extinction coefficients of 1 × 104 M−1 cm−1. They had strong fluorescence emission in 650–660 nm upon excitation with 419–422 nm light. ESR showed that singlet oxygen was produced upon irradiation of compounds with 650 nm light in the presence of molecular oxygen. The photo-bleaching test indicated that the structure of compounds was stable. These new compounds exhibit excellent anti-tumor effects and lower toxicity compared to m-THPC in vitro and in vivo. Compound I and II had high tumor selectivity, which could induced tumor cells shrinkage and necrosis under 650 nm laser irradiation. Flow cytometry revealed that the compounds might mediate PDT effect at late apoptotic phase. These results make these compound I and II promising candidates for future study in photo-diagnosis and photodynamic therapy of cholangiocarcinoma

Birth asphyxia and neurodevelopmental outcome

Thirty six neonates with severe birth asphyxia (Apgar score less than or equal to 3 at 1 min), 32 with moderate birth asphyxia (Apgar score 4 to 6 at 1 min) and 35 controls (Apgar score greater than or equal to 7 at 1 min) matched for weight and gestation were followed up prospectively for neurodevelopmental outcome. Fetal distress occurred more frequently in babies with severe birth asphyxia when compared to controls (p less than 0.05). Six neonates with severe birth asphyxia had abnormal neurological signs such as delayed sucking, hypo or hypertonia, apneic spell or seizures. Of these, only two had delayed developmental milestones (Developmental Quotient less than 70) and features of cerebral palsy. Both of these babies developed seizures during first 24 hours, did not suck and required gavage feeding. The study highlights the fact that a vast majority of survivors of birth asphyxia enjoy good quality of life thus emphasizing the need for vigorous management of asphyxiated babies at birth

The state of India's neonatal units in the mid-nineties

Background: A previous study in 1987 showed that neonatal care facilities in major hospitals in the country were of a very poor standard. The present study was done to reassess their status. Design: A survey. Methods: A pretested structured questionnaire was sent to 48 centers in 1994-95. The responses were analyzed. Results: A total of 37 centers returned the questionnaire duly filled. Of them, 22 belonged to the government sector, the rest 15 to the private sector. A nursery bed: nurse ratio of less than 1.0 was reported by only 4 centers. Majority of the centers cited inadequate nursing strength and frequent transferring out of nurses as a major problem. Twenty nine (78%) centers had ventilation facilities. Most of them had 1 or 2 ventilators. Blood gas facility was available with 29 centers and parenteral nutrition was undertaken at 20 (54%) centers. Resuscitation bag(s) were available at all the centers and incubators at all except one. In quantitative terms, the following equipment was available in satisfactory numbers: resuscitation bags, resuscitation bassinet, incubators/open care systems, vital sign monitors, infusion pumps and pulse oximeters in 78.3%, 43.2%, 72.9%, 56.7%, 64.8% and 43.5% centers, respectively. Indigenous products of the following categories were reasonably well accepted: resuscitation bags, resuscitation bassinets, incubators, open care systems and dextrometers. Conclusion: The newborn care facilities, particularly the ventilation facilities, have improved in recent years. Almost 10 units were operating at or near level III standard of newborn care. Indigenous equipment of selected categories is replacing the imported equipment. However, most units continue to face problems of shortage of nursing personnel

Neurodevelopmental outcome of ‘at risk’ nursery graduates

A cohort study at a tertiary care neonatal service was undertaken to determine the neurodevelopmental outcome of heonates who required intensive care. One hundred and nineteen nursery graduates were enrolled for follow up if they fulfilled any of the following risk factors : birth weight less than 1500g, Apgar score less than 4 at 5 minutes, seizure(s), and required assisted ventilation for more than 24 hours. They were subjected to periodic clinical evaluation and administered the Bayley Scales of Infant Development in early childhood. Of the total infants enrolled, 101 completed the required follow up. They included 55 infants with birth weight < 1500g, 45 with low Apgar scores, 12 with seizure(s) and 28 who received assisted ventilation. An overwhelming majority of subjects (85%) had normal neurodevelopmental outcome. The adverse outcome in the remaining 15 included mental retardation in all, subnormal motor development in 14, microcephaly in 1, hearing loss in 2 and visual impairment in 4. Among the neonatal risk factors, seizures, sepsis and hypoxic ischemic encephalopathy had a significant association with adverse outcome. Despite serious neonatal morbidity, the early neurodevelopmental outcome of nursery graduates was reasonably good. The association of neonatal sepsis with neurodevelopmental sequelae merits a prospective evaluation

Symptomatic neonatal polycythemia: Comparison of partial exchange transfusion with saline versus plasma

A prospective study to evaluate efficacy and safety of partial exchange blood transfusion (PEBT) with normal saline or plasma was conducted in 30 symptomatic polycythemic newborns. Babies were randomly assigned to receive PEBT either with normal saline or plasma. Both groups were comparable in terms of birth weight, gestational age, preexchange hematocrit and viscosity. A significant fall in hematocrit and viscosity was noticed at 6 hours following PEBT which persisted even at 24 hours (P < 0.001). Hematocrit and viscosity were comparable in the two groups at 6 and 24 hours (p > 0.05 for both). Majority of babies became asymptomatic after 24 hours of PEBT, but one baby in the saline group remained polycythemic and symptomatic requiring repeat PEBT. No complications related to the procedure were encountered in the two groups. Partial exchange with normal saline was as effective and safe as plasma in symptomatic polycythemic newborns

A new transport incubator for primary care of low birth weight babies

A new portable, cheap and indigenous incubator made of polystyrene has been devised for delivery of primary health care services to the newborn babies in the community. Twenty six babies with a mean weight of 1726 g (range 1388-1981g) and gestational age of 35.3 weeks (range 34-38 wks) were continuously evaluated for 2 hours observation period, in naked and clothed conditions. Rectal, abdominal skin, foot, ambient air and nursery temperatures were recorded. The baseline core temperature of the babies was 36.58 (+/- 0.21) degrees C; after incubator care it was recorded s 36.80 (+/- 0.10) degrees C in naked infants. The baseline core temperature of the clothed babies was 36.63 (+/- 0.21) while it was 37.01 (+/- 0.18) after 2 hours of incubator care. An ambient air temperature of 33-34 degrees C in the incubator (thermoneutral temperature range for these babies being 31.0-33.8 degrees C) was achieved within 30-60 minutes of incubator stay (nursery temperature being 28 +/- 0.6 degrees C). No evidence of carbon dioxide narcosis, hypoxia, acidosis, or adverse thermoregulatory behavior was observed. One baby had hypoglycemia (blood sugar less than 35 mg/dl) and another had sweating. There is a scope for providing additional facilities like administration of oxygen, phototherapy, X-rays through the incubator without disturbing the baby

Perinatal outcome in hypertensive disease of pregnancy

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Correlates of mortality among hospital-born neonates with birth asphyxia

Background: Birth asphyxia is a major cause of neonatal mortality. An understanding of the determinants of mortality among asphyxiated neonates will help formulate effective management protocols. Methods: One hundred and fifty consecutive neonates with birth asphyxia (apnoea or gasping respiration at 1-minute of age) were prospectively studied. The association of the outcome variable, namely, mortality before discharge, was documented in relation to a number of clinically important risk factors. Results: The neonatal mortality of 24.7% (37/150) among asphyxiated neonates was 34.5-times compared to that of the non-asphyxiated population (p < 0.001). The mortality rates in preterm-and term-asphyxiated neonates were 47.8% and 6%, respectively (p < 0.0001). The relative risk of mortality increased progressively with increased birth-weight. On univariate analysis, prematurity, low birth-weight, respiratory distress, severity of asphyxia, hypoxic-ischaemic encephalopathy, apnoea, acidosis and seizures were found to be significant risk factors of death. However, on step wise regression analysis, prematurity emerged as the most significant determinant of mortality. The highest positive predictive value (58.3%) for mortality was documented for hypoxic-ischaemic encephalopathy. Conclusion: A significant reduction in mortality among asphyxiated neonates will require aggressive management of prematurity-related neonatal complications and hypoxic-ischaemic encephalopathy

Persistent pulmonary hypertension in the neonate

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