Conquering maternal mortality: skill development in medical curriculum

Background: Maternal Mortality Rate remains to be high in developing countries despite the advances made in the modern world. A medical student needs to understand the basic clinical subjects and in a short span of one year translate it into patient care. A skill development method was initiated in the final year curriculum of medical students to integrate the basic knowledge of labor with the final outcome of reducing maternal mortality rate.Methods: The skills were demonstrated on mannequins and simulation models of difficult situations in labour were provided. The study was conducted in Saveetha Medical College in the Department of Obstetrics and Gynaecology in May 2015 as a one day hands on workshop for medical undergraduate students. One hundred and fourteen medical students conducted normal labor, applied forceps and ventouse, sutured episiotomies and perineal tear and performed a drill on active management of third stage of labor on training mannequins. All the basic didactic teaching and its translation into clinical skills were tested pertaining to the problem of parturition. Plenary discussion of each demonstrable skill was done by a galaxy of experts. This was followed with Mind Mapping of concepts developed. Pretest and posttest helped the teaching faculty to assess the impact of knowledge generated. Feedback was obtained to improvise the existing teaching method and develop new teaching tools.Results: The students were able to comprehend Conduct of Labor from its basics and decide on the relevant clinical implications. The case based skill demonstrations done on instrumental delivery, episiotomy suturing, clinical pelvimetry, active management of third stage of labor and monitoring of labor using partogram gave students hands on experience and improved their practical knowledge.Conclusion: Skill Development in conduct of labour helps medical students to understand the clinical implications better. A well trained medical student can thus help to reduce maternal mortality rate in developing countries

Cross sectional study on analysis of reasons for refusal of PPIUCD at GIMS, Gadag

Background: Women are highly motivated and receptive to accept Family Planning (FP) methods during the postpartum period. Intrauterine Contraceptive Device (IUCD) is one of the commonly used reversible methods of contraception and provide very effective, safe and long-term protection against pregnancy and the health risks associated with the method are negligible. Taking advantage of the immediate postpartum period for counselling on family planning and IUCD insertion, overcomes multiple barriers to service provision. The increased institutional deliveries are opportunity to provide women easy access to immediate PPIUCD services. Objective-The aim of the study was to determine proportion of women accepting postplacental intrauterine contraceptive device insertion, and to describe the factors associated with acceptability and non-acceptance.Methods: Cross-sectional study conducted from September 2021 to October 2021 in 250 women admitted for delivery at Gadag institute of medical sciences, Gadag. The respondents were interviewed using structured interviewer administered questionnaire.Results: In the study, it is found that overall awareness regarding PPIUCD in the study population is only 32% which is comparable with the study findings of Rajasthan where the 8 awareness was 20.2%. The readiness rate for PPIUCD insertion after the counselling in present study was 8% which is similar the study report from Government Medical College, Trissur, Kerala where the acceptance rate 1 was 10.5%. The major factors associated with nonacceptance were refusal by patient (50%) and relatives.Conclusions: The emerging factors for less acceptance of PPIUCD are low literacy rate among women and infrequent counselling and education during antenatal period. Integration of a PPIUCD counselling service at every delivery point with provision of couple counselling can improve the success of this programme

Screening of cancer cervix: Pap smear in rural India

Background: The incidence of cervical premalignant lesions in rural India is likely to be high due to presence of several risk factors like early marriage, early coitarche and multiparity. Hence prospective cross sectional study was conducted to find the incidence of pre-invasive state and cancer of cervix in women between the age group 30 and      60 years, visiting Thirumazhisai health centre by Pap’s smear method.Methods: Cervical mucosa is scraped, using Ayre spatula a 360° turn is made at the transition zone and smeared on a slide and papanicolaou stain is applied and the slide is examined under microscope. If Pap’s smear confirms low/high grade lesion, biospy is done to confirm the finding. The result is analysed for pre-invasive state.Results: Out of the cases (107) examined with in the study period, 36.45% were normal. Out of the rest 47.05% had an inflammatory smear, 14.7% had active bacterial infection, 17.65% had active candida infection and 5.88% had high-grade intraepithelial lesion (CIN 3).Conclusions: The incidence of high-grade lesion for cervical cancer is high among the rural population and they are susceptible to develop the cancer. Regular screening for cancer of uterine cervix is of need among people of lower socio economic status. Awareness should be created on cervical cancer and its complications

Prevention of cancer cervix: developing a task force

Background: Cancer cervix is the most common cancer in women of the developing countries where screening facilities are inadequate. Cancer cervix is a preventable cancer due to its long pre invasive stage and availability of screening methods. Colposcopy is an in situ clinical examination of cervix with magnification and illumination. It is a clinical method that complements the laboratory method of cytology in identifying the site of origin of dysplastic cells. Developing a task force for prevention of cancer cervix requires training of medical and paramedical staff.Methods: The study was conducted as a one-day live demonstration workshop on screening of cancer cervix in the department of obstetrics and gynecology in Saveetha Medical College, Chennai. Colposcopy Reid’s index calculation was demonstrated on twelve women. Sixty-four medical and paramedical health workers identified the pre-invasive lesion under magnification and green filter application. Acetic acid and Lugol’s iodine staining was done. Pretest and posttest helped the teaching faculty to assess the level of competency achieved.Results: The colposcopy-training workshop equipped the health workers to detect and treat the preinvasive cancers. Primary prevention by elimination of risk factors and HPV vaccination is difficult and expensive but secondary prevention by means of mass screening and treatment of precancerous lesion can reduce the progression to cancer cervix. The strategy, however is not to lower the incidence of cancer cervix, but to minimize cancer death due to early detection.Conclusions: A women with a preinvasive lesion of cancer cervix can be asymptomatic. This requires a task force for mass screening of all women in the community. Community health workers begin screening of all women from 21 years onwards with Pap smear and colposcopy. The trained heath workers can be used for downstaging of cancer cervix leading to a dramatic reduction in the incidence of invasive carcinoma. Even when a colposcopist detects the invasive carcinoma, it is so early that an 85-100% five-year survival rate can be achieved

Vertical teaching principles: pregnancy induced hypertension

Background: The methodology of teaching is of three types. “Adhyapana” refers to “act of teaching” or the “teacher reads”.  “Adhyayan” is “self-learning” or the “student reads”. “Sambhasa” or “Tatva vidya” refer to “discussion”. Types of learning are again of three types: informative learning, formative learning and transformative learning. Informative learning produces experts. Formative learning produces professionals. Transformative learning in the context of health education produces leaders with global connection. Millers pyramid of competence evolves the steps in learning as knows, knows how, does and teaches how. The aim of the vertical integrated teaching programme on pregnancy induced hypertension was to enable students to comprehend and teach (sambhasa) pregnancy induced hypertension with firm and reinforced understanding of pathophysiology, biochemical markers, radiological predictors, pharmacotherapy and anesthetic consideration. Neonatal problems specific to pregnancy-induced hypertension were also discussed.Methods: Problem based and peer instruction approach was followed. The study was conducted as a one-day teaching-learning programme for final year students (168) of Saveetha Medical College, Chennai, India. All the basic sciences and their translation into clinical skills were explained pertaining to the problem of hypertension in pregnancy. Plenary discussion of each clinical case of hypertension and convulsion in pregnancy was done in a galaxy of experts from each department.The teaching faculty of the department of biochemistry, pathology, pharmacology, radiology, general medicine, anesthesia and obstetrics and gynecology and neonatal medicine provided a learning module in the web forum of university website for the final year medical undergraduate students. The students were able to comprehend pregnancy-induced hypertension (PIH) from its basics and decide on the relevant clinical implications. A case based discussion was done with the constellation of experts from all disciplines of medicine. This was followed with mind mapping of concepts developed. Pretest and posttest helped the teaching faculty to assess the impact of knowledge generated. Feedback was obtained to improvise the existing teaching method sand develop new teaching tools.Results: The median, the 25th percentile, the 75th percentile and extreme values in pretest and posttest group were plotted using Sigma plot. An improvement in scores was observed.Conclusions: Vertical integration of medical disciplines helps medical students to understand a clinical problem in the light of basic sciences. The modules beginning with the pathophysiology of pregnancy induced hypertension and concluded with anesthetic considerations.  An elaborate module helps to translate an understanding of pharmaco therapeutics of hypertension in pregnancy. A well-trained medical student can help to reduce maternal mortality due to preeclampsia

High frequency Agrobacterium mediated genetic transformation in rubber tree via. vacuum infiltration

In a tree species like Hevea brasiliensis, genetic transformation offers a viable approach for crop improvement within a short period. Hevea being highly recalcitrant to in vitro culture, an efficient transformation protocol is necessary for generating large number of transgenic plants with stable foreign gene expression. After several modifications in the initial transformation protocol, the transformation frequency was increased to 14 per cent using proliferated anther callus. Therefore, vacuum infiltration was attempted for enhancing the transformation frequency. In the present work the conditions for vacuum infiltration viz. vacuum pressure and period of infiltration were standardized. Vacuum infiltration at 30 psi pressure for 10 minutes was found to be ideal for getting high frequency transformation in H. brasiliensis. Irrespective of the gene constructs experimented, transformation frequency was significantly improved by adopting vacuum infiltration. Employing this technique, the transformation efficiency of MnSOD gene construct with FMV34S promoter could be enhanced from 14 to 50 percent

Development of cost-effective SNP assays for chickpea genome analysis and breeding

A total of 1499 ESTs generated from 26 different Cicer species, available in the public domain at the time of analysis, were used for in silico identification of SNPs using the bioinformatic tools developed at the International Crops Research Institute for the Semi-Arid Tropics (ICRISAT) (http://hpc.icrisat.org/PBSWeb). Cluster analysis provided a total of 118 clusters, of which 11 clusters contained sequences from more than one Cicer species. Further, these clusters were assembled into 19 contigs and 184 putative SNPs were identified in 15 contigs. However, only 73 SNPs involved restriction enzyme sites for development of the CAPS assays as identified through the SNP2CAPs program. Primer pairs were designed for only 8 contigs (CL3a, CL3c, CL3d, CL3e, CL4a, CL10, CL20 and CL99) which had SNPs, resulting in putative recognition sites to commonly used restriction enzymes. Results of the demonstrates the utility of Cicer EST resources and the availability of bioinformatics analysis pipelines for the large-scale identification of SNPs on the HPC (High Performance Computer) at ICRISAT and the development of costeffective CAPS assay for SNP genotyping. It is anticipated that the availability of large number of ESTs from more than one genotype of cultivated chickpea (C. arietinum) in the near future will make it possible to develop larger number of SNPs in cultivated chickpea germplasm for genome analysis and breeding application

Perl module and PISE wrappers for the integrated analysis of sequence data and SNP features

This is an Open Access article distributed under the terms of the Creative Commons Attribution Licens