The genesis of the second wave and the probable way forward for India

An unprecedented pandemic affecting 210 countries emerged in the watershed year of 2020 and involved India as well (1). We mined the number of daily cases of three equal periods of importance during the evolution of the pandemic in India, namely 1) initial lockdown (March-April 2020), 2) early days of unlocking (June-July 2020), and 3) second wave (March April 2021). Notice the March 2020 series in [Figure 1] and country-wise cases in [Figure 2], and we can observe that India was able to sustain itself against the first wave of the SARS Coronavirus-2 in a much better way compared to other developed countries. Social lockdown and other preventive strategies paid off even in the face of criticisms regarding lack of preparedness and economic slowdown due to strict enforcement of harsh measures. Soon, there were demands of decentralized control measures with more testing and local containment measures than the centrally dictated regimen. Lockdown was suggested for only local clusters with high positivity rather than a general clampdown (2). The June-July series in [Figure 1] represents the increasing numbers of cases resulting from suspicions, fear-mongering, and resultant relaxation in social restrictions as part of the phase-wise unlocking across the country

Concept maps in immunology: A metacognitive tool to promote collaborative and meaningful learning among undergraduate medical students

Introduction: Concept maps are graphical representations of knowledge that connect concepts, ideas, and relationships. The present study aims at assessing the perception of medical students in utilization of concept maps as a tool to foster their lifelong learning skills in immunology.Methods: The current study was approved by Institutional Ethics and Review Committee. Third-year undergraduate (MD3) medical students of the academic year 2021-22 were sensitized about the concept map study and included after obtaining their informed consent. The students worked in teams to find answers and link the different words or phrases of the concept maps. At the end of the immunology course, students’ perception on concept map-based learning strategy was assessed. A pre-designed, selfadministered questionnaire, pre-validated by subject experts for relevance and feasibility, was used for the study. The questionnaire included some quantitative questions assessed by using 3-pointLikert Scale and an open-ended question to receive students’ comments on concept map-based learning strategy. The responses were collected and analyzed using SPSS version 22. Descriptive statistics was used for the quantitative variables, tabulated as numbers and percentages while the qualitative data was analyzed by thematic analysis. The quantitative data results were prioritized but supported by students’ comments on open ended question. Results: Out of 133 eligible participants, 109 students who volunteered and completed the study were included. Majority of our participants (>80%) welcomed the concept map-based learning strategy. Almost 4 out of 5 expressed that concept maps are interesting and enjoyable, encourage active participation, peer discussion, and enhance critical thinking and problem-solving skills. More than 80% of the students agreed that concept maps promoted deep understanding of the topic and lifelong learning. Nearly 3 out of 4 students suggested including concept maps in many immunology topics in future. Majority of students penned down positive comments indicating concept map tool facilitates metacognitive skills.Conclusion: From the study, it can be concluded that concept maps are effective active learning strategies to improve themetacognitive domain of medical students in immunology course, thus assisting them to become better lifelong learners

Prescription to practice in hypertension: a community experience in central Kerala

Background: Control of blood pressure is a global challenge and non-adherence to hypertension medications is a public health concern. Patient, medication and system related factors can contribute to non-adherence. The study was to determine adherence to hypertension medications and to understand the barriers to adherence in an adult group in Pathanamthitta District of Central Kerala.Methods: A cross sectional study was conducted in a community setting in 2016, among 139 adults aged 30 years and above on treatment for hypertension for at least six months. Those with gestational hypertension, those having serious comorbid conditions and those unwilling to participate were excluded. The data sheet included basic demographic information and history related to hypertension. A content validated eight item questionnaire was used to assess reported adherence and scores classified level of adherence as good (8), moderate (6-<8) and poor (<6). The data was analyzed using SPSS. Chi square test of significance and multivariate regression analysis were done. P<0.05 was considered statistically significant.Results: The participants were in the age group 34-91 years, 50.4% belonging to 50-69 years, and 75.5% were females. Adherence to hypertension medications was good in 49.6%, moderate in 31.7% and poor in 18.7%. The most common factors reported to contribute to non-adherence were forgetfulness (70.5%), high cost of medications (51.8%), and symptom-free state (27.3%).Conclusions: Adherence was good in less than half the study participants and poor in almost one-fifth. Forgetfulness and high medication costs were the most commonly reported barriers. These findings highlight the importance of individuals, families and health service, joining hands to tackle the public health problem of non-adherence to hypertension medications

Validation of Gender Friendly Breastfeeding Knowledge scale among young adults

Introduction: Breastfeeding is the most effective intervention to improve child health. Young adults, both genders play an important role in society supporting breastfeeding as they will be stepping towards parenthood in the near future. Bringing awareness and busting the myths among them is essential. This study aimed to develop a Gender Friendly Breastfeeding Knowledge scale based on a conceptual framework that reflected the knowledge of young adults and evaluates its validity and reliability. Methodology:&nbsp; Development of the questionnaire for Conceptual framework and item generation was done using PubMed, Google Scholar, other sources and expert opinion. The type of measurement was structured as a 5-point Likert scale. The Lawshe technique to assess the content validity ratio. A cross-sectional survey in graduation colleges situated in Mangalagiri or within the radius of 30 km of Mangalagiri, Andhra Pradesh, India was conducted in 2020. 1400 Adult males and females aged 20-25 years and perusing full-time graduation course were recruited. For each item in the Gender Friendly Breastfeeding Awareness scale, we assessed individual item characteristics and item-test correlation. To check to construct validity, we performed exploratory factor analysis and confirmatory factor analysis. Results: Expert panel retained 23 items from initially 30 items. The content validity index score for the each of 23-items in the scale was more than 0.80. A four-factor structure perfectly fitted the data and illustrated 54 percent of the variation in knowledge of breastfeeding. Four stages of CFA were completed. The chi-square = 860.534 was significantly above the 0.01 level. &nbsp;Cronbach's a = 0.787 based on standardized items reflected the overall internal consistency of the gender-friendly breastfeeding awareness scale. Conclusion: Gender-friendly breastfeeding knowledge scale is a valid and reliable tool, it is recommended that this scale be used in communities, educational institutions, and in relevant research to assess breastfeeding knowledge among young adults of both genders, thereby promoting breastfeeding practices in the future

A single strand RNA impacts global DNA

An editorial in the recent edition of The Lancet (April 25th 2020), was a focussed review on India’s lockdown during the pandemic. (1) While the editorial gave only back-handed credit to Indian performance, the world’s largest lockdown, it did not give a balanced comment on India’s accomplishment.&nbsp; The initial lapses of migrant labourers issue were played up along with several other inconsistencies noticeable in the review.&nbsp; In order to present a more balanced critique of India’s accomplishment, we herein compare the status of the response to the pandemic among the nations that had first exposure to the virus in January 2020, serving as a comparison among the first cohort of countries. India is one of the countries to have recorded the first case of COVID-19 in January 2020 and hence, is among the nations, most vulnerable to coronavirus epidemic.&nbsp; It was quick to close the international borders and enforce lockdown early. These and other actions have been lauded by WHO. (2

Medication adherence to oral hypoglycemic drugs among individuals with Type 2 diabetes mellitus : A community study

Context: Control of diabetes mellitus is a global challenge and nonadherence to diabetic medications is a public health concern. Factors related to patients, medications, and system can contribute to nonadherence. Aims: We aimed to determine self-reported adherence to oral hypoglycemics and to understand the determinants of medication adherence in a group of adult diabetics in South Kerala. Methods: A cross-sectional survey was conducted among 218 diabetic individuals. An eight-item questionnaire to assess the level of adherence and a structured interview schedule were administered to meet the objectives. Adherence was categorized as poor, moderate and high, based on k-means cluster analysis. Results: The proportion of good adherence was 60.09%. Higher age, male gender, nonalcoholic, higher family income, higher frequency of blood glucose monitoring, and controlled blood sugar level were independent predictors of good adherence. Conclusion: The proportion of individuals with poor medication adherence is low. Focus must be on determining factors influencing medication nonadherence.publishedVersionPeer reviewe

Netiquette and Ethics Regarding Digital Education Across Institutions: A Narrative Review

Information Technology (IT) has made rapid advancement since the turn of this century. Ergo the scope and extent of IT has also grown, resulting in increase in the number of internet users, who have differing reasons for using the IT resources. The users of this IT revolution include students worldwide; who interact with technology based on their needs, with relative ease and have found the whole experience enriching. Progress in IT has not only changed the way humans interact with technology but has also influenced the way of interaction between the people. The interaction online is mostly informal and comes without set guidelines and compounded with the relative anonymity provided by internet, also it has complicated an individual’s ability to interact in a respectful and responsible way. The problems relating to internet safety arise from such interactions. Flame wars and cyberbullying are some of the other risky behavioural interactions displayed online and can lead to severe consequences. The unethical use of IT resources in the form of plagiarism, piracy, identity theft etc also questions the moral of an individual. Whilst there may be some idea, multitude of issues regarding Netiquette and ethical use of IT resources are often poorly understood and the knowledge imparted is also fragmented. Moreover, contemporary educators are much in need of such information. Thus, there is a need to include and summarise current priority areas that relate to etiquette and ethics in digital education

Cranioplasty Using Autoclaved Autologous Skull Bone Flaps Preserved at Ambient Temperature

Context: Decompressive craniectomy followed by cranioplasty (CP) uses autologous craniectomy flaps or synthetic materials like titanium. Sterilization and preservation methods for the autologous bone flaps continue to be the surgeon's choice. Aim: This study aimed to assess the short-term as well as long-term clinical outcomes of CP using autoclaved autologous bone grafts. Settings and Design: This retrospective observational study was performed on patients admitted in a tertiary care teaching neurosurgery department. Patients and Methods: Seventy-two patients who underwent CP with autoclaved autologous skull flaps preserved under ambient conditions with strict aseptic precautions were included in the study. Statistical Analysis Used: Frequencies and percentages of the various characteristics before and after the surgery were tabulated. Continuous variables were summarized as means and standard deviations. Results: The primary CP had a satisfactory clinical outcome in 62 cases (86.11%). Osteomyelitis was observed in four patients (5.56%) nearly 2 months after the surgery. Radiologically significant bone resorption was noted in a single patient (1.39%) after 1 year. Five patients (6.94%) developed bone fragmentation or fracture, and the mean time taken for this was about 36 months. In all these ten cases, secondary CP was successfully done using a prefabricated, patient-specific titanium mesh. Conclusions: The efficacy and safety of the studied craniectomy flaps used for cranial reconstruction showed a good patient outcome. Further retrospective studies with larger cohorts and prospective case–control studies are essential so as to issue standard guidelines for sterilization and preservation of autologous bone flaps

Stenotrophomonas maltophilia: An emerging opportunistic nosocomial pathogen in a tertiary care hospital in Al Batinah North Governorate, Oman

Objectives: Stenotrophomonas maltophilia, a Gram-negative non-fermentative bacillus, has emerged as an important nosocomial pathogen in recent years. It is intrinsically resistant to many antibiotics and has the ability to acquire antibiotic resistance by multiple mechanisms. Treating Stenotrophomonas infections, therefore, is a serious challenge for physicians. This study aimed to investigate the antibiotic susceptibility patterns and risk factors contributing to S. maltophilia infections. Methods: A retrospective cross-sectional study was conducted at Sohar Hospital in Sohar, Oman. The demographic, clinical and microbiological data of individuals from whom S. maltophilia was isolated between September 2016 and August 2019 were reviewed. Descriptive statistics were presented as frequencies and percentages. Results: A total of 41 S. maltophilia isolates from clinical specimens of 41 patients were studied. Infection occurred predominantly in males (73%) and the majority of patients (88%) were either ≤5 years old or &gt;60 years old. All inpatients had at least one comorbidity while 50% had more than one. All inpatients were exposed to various medical interventions such as intensive care (44%), mechanical ventilation (41%), haemodialysis (25%), Foley’s catheterisation (13%) and central venous lines (6%). Most patients (81%) were in hospital longer than two weeks. The susceptibility rates of S. maltophilia to minocycline (97%), trimethoprimsulfamethoxazole (93%) and levofloxacin (92%) were high; the rate was lowest for ceftazidime (50%). Conclusion: S. maltophilia was found to be an important nosocomial opportunistic pathogen. Prolonged hospital stay and exposure to various medical interventions were key factors contributing to the development of infection. Minocycline and ceftazidime were found to be the most and least susceptible drugs, respectively.   KEYWORDS Nosocomial Infection; Opportunistic Infections; Fluoroquinolones; Hemodialysis; Ventilation; Oman

Menstrual cup webinar series: A developing model of modified pre- and post-tests in the online teaching-learning of primary health care workers

Menstrual hygiene management, especially in resource-limited settings, is challenging. The acceptability of the menstrual cup is increasing recently in western countries whereas, in developing countries like India, the awareness, acceptability, and use of menstrual cups are very limited. We assessed the effectiveness of modified pre-post-test teaching-learning methodology in an online webinar series on menstrual cups using Moore's outcome assessment. An online webinar series on menstrual hygiene and the menstrual cup was conducted to raise awareness about the usage of menstrual cups among the health care workers like Auxiliary Nurse Midwife (ANMs), Accredited Social Health Activist (ASHAs), and Anganwadi Workers (AWWs) of the Guntur district, Andhra Pradesh, India. The questions of modified pre- and post-test were displayed. The questions were displayed to participants using the polling option in zoom. A total of 1597 health care workers participated in the menstrual cup webinar series. Of the total, 72.7% of participants responded to the job title question of which ASHA, ANMs, and AWWs were 16.8%, 34.2%, and 41.9%, respectively. The baseline knowledge of menstrual cups among primary health care workers for “heard of the menstrual cup” and “ever used/know anyone using menstrual cup” was 36.89% and 11.67%, respectively. After the webinar among the primary health care workers, the maximum gain in knowledge was seen for “menstrual cup can be cleaned in the home,” 94.53%, and the minimum gain in knowledge was on “unmarried girls can use menstrual cups,” 50.42%. The modified pre- and post-test model predicted an overall 50 percent rise in the knowledge of primary health care workers by the webinar series about a different aspect of the menstrual cup.As online webinar providers aim to provide more performance-based learning activities, current approaches to continuing medical education may become obsolete. The single most essential shift in online webinar planners can make is to incorporate modified pre-and post-test to allow for interactive and formative assessment during webinar activities