Students’ perception of the learning environment in a new medical college by means of the DREEM inventory

Background: The educational environment in a college is one of the most important factors in determining the success of the curriculum and the student. The DREEM inventory is a validated global instrument for measuring the educational environment in undergraduate medical education. A study was undertaken to assess the educational environment as perceived by the students of a new medical college established in India in 2008.Objectives: To compare the quality of the educational environment in preclinical years as perceived by the first two batches of students in a new medical college so that appropriate remedial measures could be taken, and also to identify gender differences, if any in the students’ perception.Methods: The DREEM questionnaire was administered to 156 students (2008 batch, n=56 and 2009 batch, n=100) on different occasions after a lecture class. Purpose of the study was explained to the students before administering the questionnaire. Confidentiality was maintained. Statistical analysis used: Cronbachs alpha for internal consistency and reliability. Unpaired t test was used for comparison.Results: The response rate was 100% (256 /256 students). The overall DREEM score was 126.3/200 indicating that perception of the educational environment of the medical school was more positive than negative. However, the study revealed some problem areas within the educational environment.Conclusion: A large number of diverse and hidden factors influence the way students perceive their educational environment. It should be a continuous process to monitor the feedbacks from the students to identify problem areas so that necessary remedial measures can be instituted at the earliest

Primary Ovarian Pregnancy - A Rare Case Report

We report the rare case of a 27-year-old female who presented to the emergency department with severe pain in the lower abdomen. She gave a history of a spontaneus pregnancy of 5 weeks gestation with a history of irregular spotting on and off. The total leukocyte count was 25,000/cmm and β-human chorionic gonadotropin level was 984.7 IU/mL. Ultrasound showed an adnexal mass with hemoperitoneum. An ovarian wedge resection was done. She made good postoperative recovery and was discharged on the third postoperative day. Histology confirmed a ruptured ovarian ectopic pregnancy. Ovarian ectopic pregnancy is a rare condition and is associated with the use of assisted reproductive techniques. This case is unusual as it was a spontaneous pregnancy with no history of use of any assisted reproductive techniques

Thyroid FNAC Reporting Post-Bethesda - Problems and Challenges Faced in Our Center - A Preliminary Study

Aims and Objectives: The Bethesda system for reporting thyroid cytopathology (TBSRTC) was proposed to standardize the reporting of thyroid cytopathology for more effective clinical communication and patient management. This study was undertaken to see the challenges, if any, faced in our center post the implementation of the new system.Materials and Methods: Retrospective analysis of 250 thyroid aspirates was done wherein all slides were reviewed and reclassified as per TBSRTC.Results: The mean age of patients was 40.2 years and females comprised 86.4% of the study group. Histological follow-up was available in 19.6% of cases. On reclassification, 6% of cases were put in the category of atypia of unknown significance/follicular lesion of unknown significance (AUS/FLUS). The benign category comprised 80.6% down from 87.6% reported earlier. The non-diagnostic group also increased marginally from 8% to 8.8%. No changes were observed in the following categories: Follicular/Hurthle cell neoplasm, suspicious for malignancy and malignant.Conclusion: TBSRTC was useful in achieving the goal of improving thyroid cytopathology reporting by adopting a standardized format. However, due to the heterogeneity of the AUS/FLUS category, more cases than warranted were put in this category, which did not correlate with a higher risk of malignancy. More stringent criteria for inclusion of patients in the AUS/FLUS group and further stratification of these patients into high-risk and low-risk categories are suggested

A Cross-Sectional Study of prevalence of Prostate lesions and inter-Observer Variability in Histopathological Reporting

Introduction: To report the prevalence of various prostate lesions in the general population through cadaver prostates and to determine the interobserver variability for reporting high-grade lesions of the prostate. Materials and Methods: The cross-sectional study was carried out on 110 autopsy specimens of healthy prostate with deceased age over 40 years. The specimens were grossed, sectioned, stained and reported independently by the primary investigator resident and the senior professor. The lesions were categorized into prostatitis, benign prostate hypertrophy (BPH), prostate intraepithelial neoplasia (PIN) further graded as low grade (LGPIN) and high grade (HGPIN) and prostate cancer (PCa). Inter-rater kappa agreement was used to find the strength of agreement between the pathologists. Results: Among 110 prostate specimens, only 8(7.27%) cases had normal prostate with 72 (65.4%) having BPH and 12(10.9%) cases having prostatitis. There were 17 cases of PIN with 11 cases of HGPIN and 6 cases of LGPIN. Malignancy was seen in only a single case (95% Confidence Interval: 0% - 2.71%). The primary resident missed 4 cases of HGPIN and 2 cases of LGPIN. Interobserver agreement between the resident and senior pathologist was fair (Kappa 0.282, p value=0.335). Conclusion: In conclusion, prostate lesions remain latent and show high prevalence in general population without causing any symptoms. The study depicts a high interobserver variability of reporting the high-grade lesions of prostate since they cause a diagnostic dilemma with PCa. The consultation with uropathologists and use of molecular markers must be included in the diagnostic panel while reaching a final diagnosis. &nbsp

Fertility preservation in young patients′ with cancer

Preservation of fertility is an important issue in the management of young cancer patients. Though embryo cryostorage is a well-established procedure, it can only be availed by couples. Recent studies have indicated increasing success rates with mature and immature oocyte cryopreservation. Cryostorage induces injuries on the human oocytes which can be minimized by slow freezing and vitrification. Selection of candiidates is crucial so that the most suitable technique can be offered without any delay in initiation of cancer therapy. Factors affecting suitability are age of patient, assessment of ovarian reserve, hormonal status and type and stage of neoplastic disease. Encouraging results have been obtained with oocyte in vitro maturation (IVM) followed by vitrification for cryostorage. Data on the use of vitrified eggs in routine in vitro fertilization (IVF) show that pregnancy rates can be comparable to those achieved with fresh oocytes

Overwhelming Post Splenectomy Infection (OPSI) in Adult – Need for Awareness and Recognition

Overwhelming Post Splenectomy infection (OPSI) is a rare but fulminant disease with high mortality. The symptoms are usually non- specific in the initial stages mimicking flu and the source of infection usually remains cryptic. In spite of aggressive management, death rapidly occurs and is usually due to overwhelming sepsis. The commonest organism implicated is Streptococcus pneumoniae and the risk for OPSI after splenectomy is present throughout the lifetime of an individual. We report a case of a young woman who had undergone splenectomy nine years back. She rapidly deteriorated and died after a non- specific infection of three days duration. This case report is being presented to highlight that awareness and recognition of this important entity among physicians along with appropriate vaccination and education of patients' at risk may help reduce the high mortality associated with this serious disease

Xanthogranulomatous endometritis presenting as pyometra and mimicking carcinoma on imaging

Xanthogranulomatous endometritis (XGE) is an uncommon but well-established histopathological entity seen affecting the kidney and gallbladder. Involvement of the endometrium is very rare, with only a few case reports in world literature till date. Histologically, it is characterized by the replacement of the endometrium by sheets of foamy histiocytes, plasma cells, lymphocytes, giant cells, and siderophages. We present a case of a 74-year-old female who presented with foul-smelling discharge and postmenopausal bleeding of a short duration. Clinical examination and imaging studies revealed a pyometra, cervical stenosis. A suspicion of carcinoma was raised. Since XGE may mimic an endometrial carcinoma clinically and pathologically, knowledge of this unusual and rare inflammatory pathology is important for both the gynecologists and the pathologists

Giant adenomatous polyp of stomach: Case report of a rare tumor with unusual features

Adenomatous polyps of the stomach are rare tumors and comprise <10% of gastric polyps. They are usually located in the antrum and arise in a background of chronic gastritis and intestinal metaplasia. These tend to remain asymptomatic, but do carry significant risk of malignant change wherein underlies their importance. The magnitude of the risk of malignancy is not precisely defined, but is considered to be in the range of 5-15%, which increases with the size of the tumor. In this case report, we would like to highlight a large adenoma of stomach measuring 9 cm. This is the first case to the best of our knowledge to have attained such a huge dimension without any associated gastric pathology. Since synchronous carcinomas are known to exist in a large percentage of adenomas greater than 4 cm in size, this association should be kept in mind by both the gastroenterologist and pathologist so that any focus of malignancy if present, is not advertently missed

Trichoadenoma of the External Auditory Canal - A Rare Lesion

Trichoadenoma of Nikolowski is a rare benign tumor with hair follicle-like differentiation. It is seen in adults as a nodular lesion on the face and buttocks. We report a case of trichoadenoma in a 57-year-old woman in the external auditory canal due to its rarity and unusual site