Evaluation of hybrid problem-based learning in large classrooms: a qualitative and quantitative analysis

Background: Problem Based Learning (PBL) for teaching preclinical sciences has been proposed in curricular reform by Medical Council of India. PBL is a student-centred approach, enabling deep and transformative student learning. A 'hybrid' approach to PBL uses a range of class-based teaching methods; delivering a mode of PBL which is less resource intensive and more flexible than ‘pure’ PBL. In hybrid PBL, problems are solved in groups, but lectures are used to present the fundamental concepts and difficult topics. Our institution follows a traditional lecture-based curriculum. The present cohort study was undertaken to determine student and faculty perceptions for hybrid PBL as well as impact on student engagement.Methods: Hybrid PBL method was implemented for one cohort of hundred first year medical students. Previous batch was used as control taught by traditional lecture-based curriculum alone. Methodological triangulation design was employed for impact of hybrid PBL on student engagement (attendance scores-Chi square) and student and faculty perception to hybrid PBL (reflections- grounded theory)Results: The mean attendance score of MBBS batch 2016 was significantly better than batch 2015 (p=0.0001). The emerging themes in student reflections were innovative method, collaborative learning, quest for knowledge, promote long term retention and links to real-life scenario. Acquisition of soft skills (social and moral responsibility) was novel emerging theme in student reflections. Active student participation and improved critical thinking were themes expressed in faculty perceptions.Conclusions: Hybrid PBL with small groups is successful in large classrooms. Introduced at the initial phase of undergraduate medical education, it can assist robust self-appraisal in students and strengthen soft skills

Retracted Article Occupational Stress Psychological Well being and Quality of Life among Indian Army Personnel

Retraction Note: The article was published, it is retracted due to sensitivity of the study, the author and co-author has requested that the published paper should be withdrawn

Cell culture manufacturing of accelerated projects - Lessons from life in the fast lane

The possibility of promising molecules receiving Breakthrough Therapy Designation (BTD) early in their clinical lifecycle encourages accelerated development strategies to decrease approval timelines. The speed that these projects move through the pipeline has required Genentech’s manufacturing organization to push the limits of their manufacturing flexibility in order to support a streamlined approach to scale-up. Recent accelerated development product manufacturing presented several new operational, logistical and technical challenges which required creative solutions to overcome, in order to achieve tight in-process control while maintaining agility. This poster will discuss the lessons learned by the manufacturing site while executing that Cell Culture manufacturing campaign, including The benefits and challenges associated with: Process qualification with limited small scale data Operating within a narrow design space Leveraging a clinical facility for process qualification activities Supporting new strategies in an existing facilit

Integrin alpha 11 in the regulation of the myofibroblast phenotype: implications for fibrotic diseases

Tissue fibrosis, characterized by excessive accumulation of aberrant extracellular matrix (ECM) produced by myofibroblasts, is a growing cause of mortality worldwide. Understanding the factors that induce myofibroblastic differentiation is paramount to prevent or reverse the fibrogenic process. Integrin-mediated interaction between the ECM and cytoskeleton promotes myofibroblast differentiation. In the present study, we explored the significance of integrin alpha 11 (ITGA11), the integrin alpha subunit that selectively binds to type I collagen during tissue fibrosis in the liver, lungs and kidneys. We showed that ITGA11 was co-localized with α-smooth muscle actin-positive myofibroblasts and was correlatively induced with increasing fibrogenesis in mouse models and human fibrotic organs. Furthermore, transcriptome and protein expression analysis revealed that ITGA11 knockdown in hepatic stellate cells (liver-specific myofibroblasts) markedly reduced transforming growth factor β-induced differentiation and fibrotic parameters. Moreover, ITGA11 knockdown dramatically altered the myofibroblast phenotype, as indicated by the loss of protrusions, attenuated adhesion and migration, and impaired contractility of collagen I matrices. Furthermore, we demonstrated that ITGA11 was regulated by the hedgehog signaling pathway, and inhibition of the hedgehog pathway reduced ITGA11 expression and fibrotic parameters in human hepatic stellate cells in vitro, in liver fibrosis mouse model in vivo and in human liver slices ex vivo. Therefore, we speculated that ITGA11 might be involved in fibrogenic signaling and might act downstream of the hedgehog signaling pathway. These findings highlight the significance of the ITGA11 receptor as a highly promising therapeutic target in organ fibrosis

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

SummaryBackground Azithromycin has been proposed as a treatment for COVID-19 on the basis of its immunomodulatoryactions. We aimed to evaluate the safety and efficacy of azithromycin in patients admitted to hospital with COVID-19.Methods In this randomised, controlled, open-label, adaptive platform trial (Randomised Evaluation of COVID-19Therapy [RECOVERY]), several possible treatments were compared with usual care in patients admitted to hospitalwith COVID-19 in the UK. The trial is underway at 176 hospitals in the UK. Eligible and consenting patients wererandomly allocated to either usual standard of care alone or usual standard of care plus azithromycin 500 mg once perday by mouth or intravenously for 10 days or until discharge (or allocation to one of the other RECOVERY treatmentgroups). Patients were assigned via web-based simple (unstratified) randomisation with allocation concealment andwere twice as likely to be randomly assigned to usual care than to any of the active treatment groups. Participants andlocal study staff were not masked to the allocated treatment, but all others involved in the trial were masked to theoutcome data during the trial. The primary outcome was 28-day all-cause mortality, assessed in the intention-to-treatpopulation. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936.Findings Between April 7 and Nov 27, 2020, of 16 442 patients enrolled in the RECOVERY trial, 9433 (57%) wereeligible and 7763 were included in the assessment of azithromycin. The mean age of these study participants was65·3 years (SD 15·7) and approximately a third were women (2944 [38%] of 7763). 2582 patients were randomlyallocated to receive azithromycin and 5181 patients were randomly allocated to usual care alone. Overall,561 (22%) patients allocated to azithromycin and 1162 (22%) patients allocated to usual care died within 28 days(rate ratio 0·97, 95% CI 0·87–1·07; p=0·50). No significant difference was seen in duration of hospital stay (median10 days [IQR 5 to >28] vs 11 days [5 to >28]) or the proportion of patients discharged from hospital alive within 28 days(rate ratio 1·04, 95% CI 0·98–1·10; p=0·19). Among those not on invasive mechanical ventilation at baseline, nosignificant difference was seen in the proportion meeting the composite endpoint of invasive mechanical ventilationor death (risk ratio 0·95, 95% CI 0·87–1·03; p=0·24).Interpretation In patients admitted to hospital with COVID-19, azithromycin did not improve survival or otherprespecified clinical outcomes. Azithromycin use in patients admitted to hospital with COVID-19 should be restrictedto patients in whom there is a clear antimicrobial indication

Convalescent plasma in patients admitted to hospital with COVID-19 (RECOVERY): a randomised controlled, open-label, platform trial

Background: Many patients with COVID-19 have been treated with plasma containing anti-SARS-CoV-2 antibodies. We aimed to evaluate the safety and efficacy of convalescent plasma therapy in patients admitted to hospital with COVID-19. Methods: This randomised, controlled, open-label, platform trial (Randomised Evaluation of COVID-19 Therapy [RECOVERY]) is assessing several possible treatments in patients hospitalised with COVID-19 in the UK. The trial is underway at 177 NHS hospitals from across the UK. Eligible and consenting patients were randomly assigned (1:1) to receive either usual care alone (usual care group) or usual care plus high-titre convalescent plasma (convalescent plasma group). The primary outcome was 28-day mortality, analysed on an intention-to-treat basis. The trial is registered with ISRCTN, 50189673, and ClinicalTrials.gov, NCT04381936. Findings: Between May 28, 2020, and Jan 15, 2021, 11558 (71%) of 16287 patients enrolled in RECOVERY were eligible to receive convalescent plasma and were assigned to either the convalescent plasma group or the usual care group. There was no significant difference in 28-day mortality between the two groups: 1399 (24%) of 5795 patients in the convalescent plasma group and 1408 (24%) of 5763 patients in the usual care group died within 28 days (rate ratio 1·00, 95% CI 0·93–1·07; p=0·95). The 28-day mortality rate ratio was similar in all prespecified subgroups of patients, including in those patients without detectable SARS-CoV-2 antibodies at randomisation. Allocation to convalescent plasma had no significant effect on the proportion of patients discharged from hospital within 28 days (3832 [66%] patients in the convalescent plasma group vs 3822 [66%] patients in the usual care group; rate ratio 0·99, 95% CI 0·94–1·03; p=0·57). Among those not on invasive mechanical ventilation at randomisation, there was no significant difference in the proportion of patients meeting the composite endpoint of progression to invasive mechanical ventilation or death (1568 [29%] of 5493 patients in the convalescent plasma group vs 1568 [29%] of 5448 patients in the usual care group; rate ratio 0·99, 95% CI 0·93–1·05; p=0·79). Interpretation: In patients hospitalised with COVID-19, high-titre convalescent plasma did not improve survival or other prespecified clinical outcomes. Funding: UK Research and Innovation (Medical Research Council) and National Institute of Health Research

Late onset isotretinoin resistant acne conglobata in a patient with acromegaly

A 55 year-old male presented with multiple pus-discharging abscesses and sinuses and mutilating scarring on the gluteal region and back prevalent for the last ten years with exacerbations and remissions. Physical examination revealed acromegaly with frontal bossing, prognathism, a barrel chest and acral hypertrophy. Dermatological examination revealed cutis verticis gyrata, thick eyelids, a large triangular nose, a thickened lower lip, macroglossia, widely spaced teeth and widened skin pores with wet and oily skin. Hair was fine and nails were flat and wide. There were multiple inflammatory papules, tender nodules, draining sinuses, and grouped, polyporous comedones as well as multiple and extensive depressed and keloidal scars localized predominantly over the gluteal region with a few scattered lesions over the back. A computed tomography (CT) scan showed widened sella turcica. His basal fasting growth hormone (GH) levels were markedly raised (230 ng/mL; normal 1-5 ng/mL) while the prolactin levels were moderately raised (87 ng/mL; normal 2-5 ng/mL). These findings were consistent with a diagnosis of acromegaly. The patient was put on antibiotics, nonsteroidal antiinflammatory drugs and isotretinoin at a dose of 1 mg/kg/day, which was increased to 1.5 mg/kg/day. Except for an initial mildly beneficial response, the skin lesions were largely resistant to high doses of isotretinoin at the end of four months

Effect of Fastened Ankle Multidirectional Jumping Exercise Program on Jumping Performance among Athletes with Chronic Ankle Instability: A Randomised Controlled Trial

Introduction: Chronic ankle instability leads to alterations of ankle joint function, especially during jumping and running leading to diminished athletic performance. Multidirectional jumping exercise program with fastened ankle are required to be explored to overcome the challenges faced by the clinicians for management of ankle injuries, as well as, early return of athletes to sports. Aim: To find out the effect of fastened ankle multidirectional jumping exercise program on jumping performance among athletes with chronic ankle instability. Materials and Methods: This single-blinded randomised controlled trial was conducted at Amity Institute of Physiotherapy, Amity University, Noida, Uttar Pradesh, India in June 2022, and included 30 athletes with ≥6 months of Grade I and II ankle sprain, with instability and history of two or more episodes of injury. All subjects were distributed into three groups of 10 each. Pain and ankle disability were assessed using Numerical Pain Rating Scale (NPRS), vertical jump test and Foot and Ankle Disability Index tool (FADI-sports module). Therefore, recorded at baseline, 3rd week, and 5th week of intervention. Group 1 received ankle active range of motion exercises, while Group 2 received multidirectional jumping exercises, and Group 3 received multidirectional jumping exercise program with fastened ankle. Before exercise the involved ankle was taped with rigid tape. One-way Analysis of Variance (ANOVA) was used for between group analysis and ANOVA using repeated measure were used for within group analysis. Results: There was improvement in experimental group (group 2 and 3) from baseline to 5th week. Group 3 showed significant improvement in pain (NPRS) with mean difference of 5.4 from baseline to 5th week, Vertical jump height (vertical jump test) with mean difference of 24.7 from baseline to 5th week, ankle disability (FADI-sports module) with mean difference of 42.80 from baseline to 5th week with p<0.001. whereas group 2 showed improvement in pain with mean difference of 5.2 from baseline to 5th week, vertical jump height with mean difference of 18.5 and ankle disability with mean difference of 44.9 from baseline to 5th week with p <0.001. Conclusion: The study concluded that, five weeks of fastened ankle multidirectional exercise program improved the jumping performance, among athletes with chronic ankle instability