Medical student’s perception and feed-back on virtual classes during COVID-19 pandemic: a multi-centric questionnaire based study

Introduction: The quick turn to online platforms from contact learning during COVID-19 remained challenging for both teachers as well for students. This study was done with the aim to know the perception and feed back of under-graduate medical students on virtual classes during the pandemic. Material & Methods: This was a cross-sectional questionnaire based multi-centric study.  Questionnaire in the form of Google form was distributed to the undergraduate medical students from various MBBS professionals studying in various medical colleges across North India. The completed questionnaire was collected and data was analyzed. Results: 40% students were from government, 52% from private medical colleges and 8% from AIIMS/ SGPGI. Majority of students were using mobile (63.7%) for e learning, using 4G internet (70.6%). Mostly the private medical colleges (73%) and only 4.5% government colleges were conducting the live video classes. Rest of them was providing the soft copy of the study material to the students. Based on the feedback by the students, about one third of the students (36.7%) appreciated the online platform in the current scenario as well for future in the combination with traditional classroom teaching. Discussion: The e-learning was the need of the hour as every day is important for a medical student and the learning has to be uninterrupted. Although helpful, e-learning alone is a far cry from face‐to‐face interaction between students and teachers. Finding the right balance of class-room teaching combined with e-learning should become the norm for future students.   &nbsp

SERUM HOMOCYSTEINE AS A RISK FACTOR FOR STROKE: A PROSPECTIVE STUDY FROM A RURAL TERTIARY CARE CENTRE

Objective: Stroke is one of the leading causes of mortality and long-term disability in both developed and developing countries. Serum homocysteine level is one of the emerging modifiable risk factors for atherosclerosis which may result into a cerebrovascular accident. This study was designed to study the association of Serum Homocysteine level with the development of acute stroke at a rural tertiary care centre in North India.Methods: The present study was a prospective cross-sectional study conducted in the Department of Medicine, Maharishi Markandeshwar Institute of Medical Sciences and Research, Mullana, Ambala. The study population included 100 patients presenting with Stroke (either ischemic or hemorrhagic) in the indoor and outdoor facilities in the Department of Medicine. 50 age and sex-matched healthy individuals were taken as controls. Serum total Homocysteine level was measured in all the cases and controls.Results: Majority of the patients suffered from ischemic stroke (78%), while only 22% patients had hemorrhagic stroke. The mean Serum Homocysteine level in stroke patients (19.88±8.78 μmol/l) was significantly higher than in controls (10.48±4.39 μmol/l) (p<0.01). In a subgroup analysis, stroke patients with a positive history of smoking had significantly higher homocysteine level as compared to non-smokers (p<0.05).Conclusion: Increased level of Serum Homocysteine is significantly associated with risk of cerebrovascular accident, which is independent of the risk attributed to traditional risk factors.Â

A comparative study of the C-reactive protein and the ST-score (ECG) as prognostic indicators in acute myocardial infarction in a rural resource-constrained hospital setting in central India: A cross-sectional study

Context: The electrocardiogram remains a crucial tool in identification of acute myocardial infarction (AMI). High sensitivity C-reactive protein (hs-CRP) has been found to be strong predictor of coronary artery disease (CAD) and future cardiovascular events. Aims: The aim of the present study was to compare hs-CRP and ST-Score (STS) as prognostic indicator in acute ST segment elevated myocardial infarction (STEMI) in central rural India. Settings and Design: Cross sectional study, rural hospital in central India. Material and Methods: In all patients of STEMI, STS, ST index and hs-CRP were measured on admission and serially. The Primary outcome was all cause mortality at 30 days. Secondary outcome were heart failure, life threatening arrhythmia, cardiogenic shock, re-infarction, hospital stay and re-admission. Statistical analysis used: We used Student′s t test to compare means, Chi-square test to compare proportions and Mann Whitney test to compare medians. P value <0.05 will be considered significant. Crude odds ratios were computed to assess the strength of association between risk factors and independent variable along with 95% confidence intervals. Results: STS was significantly higher in patients with poor outcome, when compared with good outcome (20.27mm vs.12.47mm, P = 0.002). On multivariate regression model STS was significant predictor of composite outcome events (OR = 2.74; 95% [CI], 1.46 to 5.17; P = 0.002). The area under the ROC curve was 0.70, with sensitivity of 73.5%, specificity of 58.7%; PPV of 68.3% and NPV of 64.2%. hs-CRP in patients with poor outcome vs. good outcome (6mg/L vs. 3.74mg/L, P = 0.003) and (P = 0.06, 0.85 and 0.12) respectively. Conclusions: STS on admission is independent predictor while hs- CRP is not in resource constrained settings

Utility of ST score on admission as a marker for outcome in acute myocardial infarction in a resource constrained setting

Introduction: An early and specific indicator is needed to prognosticate acute myocardial infarction (MI). This indicator should be simple, quick, reliable, non-invasive, inexpensive, and easily applicable to all the patients especially in a resource-constrained setting. The present study tried to evaluated efficacy of ST score on electrocardiography as a prognostic indicator in acute ST-elevated MI (STEMI). Materials and Methods: A prospective study was conducted on consecutive thrombolysed patients of STEMI admitted in teaching hospital. ST score defined as sum of ST-segment elevation in all leads related to infarct location was calculated in standard 12-lead electrocardiographic tracings immediately on admission and then serially postthrombolysis at 90 min, 6 h, 24 h, and day 3 and 5 of admission. Primary end-point was all-cause mortality at 30 days. Results: The mean ST score between survivor and nonsurvivor was 19.27 mm and 16.16 mm, respectively. The score on admission in patients who had poor outcome was significantly higher than those who had good outcome (poor = 20.27 mm vs. good outcome = 12.47 mm; P = 0.002). This difference persisted throughout but was maximum at 90-min postthrombolysis (13.82 mm vs. 7.39 mm; P = 0.0001). The optimal cutoff point maximizing sensitivity and specificity was found at 11 mm for both anterior- and inferior wall MI (IWMI) with a sensitivity of 73% and specificity of 58%. Conclusion: This study concludes that an increase of 1 mm in ST score increased the odds of complications by 1.06 (95% confidence interval [CI], 1.01–1.2) for anterior-wall MI and by 1.09 (95% CI, 0.96–1.2) for IWMI. In a resource-constrained health facility where electrocardiography may be the only available equipment, ST score can easily and effectively be used to stratify patients into high-risk and low-risk categories