Outcome of combination of methods of educational interventions in physiology for first-year MBBS students

Background: This comparative, before and after study (without controls) was conducted in a municipal medical college to compare the cognitive domain scores obtained by first-year MBBS students after didactic lectures with that obtained after an educational intervention that combined integrated teaching with clinical scenarios.Methods: After obtaining prior permissions, the purpose of the study was explained to first-year MBBS students and written informed consent was obtained. After attending curriculum-based didactic lectures on the alimentary system, the students (n=62, females: n=29, 46.77% and males: n=33, 53.23%) took a pre-test comprising ten questions (total 20 marks). After the pre-test, the participants attended an educational intervention that combined integrated teaching with clinical scenarios on the same topic. Subsequently, the post-test was administered using a questionnaire that was identical to that of the pre-test.Results: The mean overall marks obtained in the pre-test was 14.73±1.87 (95% CI: 14.26-15.19), while that obtained in the post-test was 17.16±1.73 (95% CI: 16.73-17.59), exhibiting highly significant (p <0.00001) difference. The gender difference in scores was significant (p=0.011) for only question no. 1 in the pre-test and there was no significant gender difference in the post-test.Conclusions: A combined method of educational intervention was found to enhance the cognitive domain scores of students. Though a larger study would be needed to generalize the findings, male students seem to need an additional educational intervention to improve their cognitive domain scores. Despite time limitations in the teaching schedule for the first-year MBBS course, integrated teaching with case scenarios can be implemented to impart early clinical exposure

Feasibility of breast crawl in a tertiary care teaching institute

Background: Early initiation of breastfeeding has many beneficial effects for both the mother and the baby. The breast crawl has been&nbsp;established as the ideal method for promoting early skin-to-skin contact and early initiation of breastfeeding. Objective: The objective&nbsp;of the study was to assess the feasibility of breast crawl in a busy tertiary care institute. Materials and Methods: An observational&nbsp;study was performed including 50 mother-baby pairs, admitted to the labor room of Sassoon General Hospital, Pune, from January2018 for 6 months. Observations were made on patient and nurse attitude and behavior and were further analyzed. Results: Of the&nbsp;total subjects, 23 (46%) mothers had not received any counseling about breastfeeding during the antenatal period and none of them&nbsp;were familiar with the idea of breast crawl from the antenatal period. Of the 50 mothers, 27 mothers (54%) were concerned about&nbsp;privacy, 8 (16%) were concerned about environmental cold, 6 (12%) were worried about exposure, and 9 mothers (18%) were&nbsp;concerned about the baby, whereas 6 mothers (12%) had no concerns and 6 mothers had more than one concern. The attitude of the&nbsp;nursing staff was favorable (enthusiastic) 19 times, indifferent 23 times, reluctant 6 times, and unfavorable (uncooperative) 2 times.&nbsp;Conclusion: While it is highly desirable to implement breast crawl as a routine practice, there are several roadblocks such as lack&nbsp;of antenatal counseling, lack of awareness and motivation, lack of specific guidelines and instructions, skewed staff-to-patient and&nbsp;bed-to-patient ratio, and lack of privacy

Cohort for Tuberculosis Research by the Indo-US Medical Partnership (CTRIUMPH): protocol for a multicentric prospective observational study

INTRODUCTION: Tuberculosis disease (TB) remains an important global health threat. An evidence-based response, tailored to local disease epidemiology in high-burden countries, is key to controlling the global TB epidemic. Reliable surrogate biomarkers that predict key active disease and latent TB infection outcomes are vital to advancing clinical research necessary to ‘End TB’. Well executed longitudinal studies strengthening local research capacity for addressing TB research priorities and advancing biomarker discovery are urgently needed. METHODS AND ANALYSIS: The Cohort for Tuberculosis Research by the Indo-US Medical Partnership (CTRIUMPH) study conducted in Byramjee Jeejeebhoy Government Medical College (BJGMC), Pune and National Institute for Research in Tuberculosis (NIRT), Chennai, India, will establish and maintain three prospective cohorts: (1) an Active TB Cohort comprising 800 adults with pulmonary TB, 200 adults with extrapulmonary TB and 200 children with TB; (2) a Household Contact Cohort of 3200 adults and children at risk of developing active disease; and (3) a Control Cohort consisting of 300 adults and 200 children with no known exposure to TB. Relevant clinical, sociodemographic and psychosocial data will be collected and a strategic specimen repository established at multiple time points over 24 months of follow-up to measure host and microbial factors associated with (1) TB treatment outcomes; (2) progression from infection to active TB disease; and (3) Mycobacterium tuberculosis transmission among Indian adults and children. We anticipate CTRIUMPH to serve as a research platform necessary to characterise some relevant aspects of the TB epidemic in India, generate evidence to inform local and global TB control strategies and support novel TB biomarker discovery. ETHICS AND DISSEMINATION: This study is approved by the Institutional Review Boards of NIRT, BJGMC and Johns Hopkins University, USA. Study results will be disseminated through peer-reviewed journals and research conferences. FUNDING: NIH/DBT Indo-US Vaccine Action Programme and the Indian Council of Medical Research

2009H1N1 Infection in a 1-day-old neonate

A full-term female neonate was delivered with meconium stained amniotic fluid by cesarean section by a 2009H1N1 positive 22-year-old second gravida mother, who developed symptoms 8 days prior to delivery. The neonate was completely and immediately isolated from the mother after delivery. Oseltamivir was started at birth to the neonate who had a potential possibility of 2009H1N1 infection. At 5 hours of life, the neonate developed respiratory distress. The neonate′s throat swab sent for 2009H1N1 by real-time polymerase chain reaction (RT-PCR) assay was positive. The neonate required oxygen by hood for 3 days and made an uneventful recovery. The mother developed acute respiratory distress syndrome after delivery, requiring ventilatory care for 14 days and was discharged after 25 days stay in hospital. 2009H1N1 infection, although rare, needs a high index of suspicion and prompt therapy in neonates. Clinicians should be alert about the possibility of perinatal transmission of 2009H1N1

D-transallethrin: An unusual agent for accidental poisoning

D-trans allethrin, a pyrethroid, is commonly used as a coil mosquito repellant. There are very few reports of human toxicity due to D-trans allethrin. We present the case of an 11-month-old boy who presented to us with excessive salivation, altered sensorium and convulsions following alleged accidental ingestion of a coil containing D-transallethrin. He required mechanical ventilation for a brief period and made a full recovery. Although rare, the possibility of pyrethroid poisoning should be kept in mind in children who present with sudden onset unconsciousness or convulsions

Infant and young child feeding indicators and determinants of poor feeding practices in India : secondary data analysis of National Family Health Survey 2005-06

In India, poor feeding practices in early childhood contribute to the burden of malnutrition and infant and child mortality. The objective of this study was to estimate infant and young child feeding indicators and determinants of selected feeding practices in India. The sample consisted of 20,108 children aged 0 to 23 months from the National Family Health Survey India 2005–06. Selected indicators were examined against a set of variables using univariate and multivariate analyses. Only 23.5% of mothers initiated breastfeeding within the first hour after birth, 99.2% had ever breastfed their infant, 89.8% were currently breastfeeding, and 14.8% were currently bottle-feeding. Among infants under 6 months of age, 46.4% were exclusively breastfed, and 56.7% of those aged 6 to 9 months received complementary foods. The risk factors for not exclusively breastfeeding were higher household wealth index quintiles (OR for richest = 2.03), delivery in a health facility (OR = 1.35), and living in the Northern region. Higher numbers of antenatal care visits were associated with increased rates of exclusive breastfeeding (OR for ≥ 7 antenatal visits = 0.58). The rates of timely initiation of breastfeeding were higher among women who were better educated (OR for secondary education or above = 0.79), were working (OR = 0.79), made more antenatal clinic visits (OR for ≥ 7 antenatal visits = 0.48), and were exposed to the radio (OR = 0.76). The rates were lower in women who were delivered by cesarean section (OR = 2.52). The risk factors for bottle-feeding included cesarean delivery (OR = 1.44), higher household wealth index quintiles (OR = 3.06), working by the mother (OR=1.29), higher maternal education level (OR=1.32), urban residence (OR=1.46), and absence of postnatal examination (OR=1.24). The rates of timely complementary feeding were higher for mothers who had more antenatal visits (OR=0.57), and for those who watched television (OR=0.75). Revitalization of the Baby Friendly Hospital Initiative in health facilities is recommended. Targeted interventions may be necessary to improve infant feeding practices in mothers who reside in urban areas, are more educated, and are from wealthier households

Additional file 1: of A randomized controlled trial of hospital versus home based therapy with oral amoxicillin for severe pneumonia in children aged 3 – 59 months: The IndiaCLEN Severe Pneumonia Oral Therapy (ISPOT) Study

Standard operating procedures that were used to train the physicians in assessing clinical signs. (PDF 240 kb

Additional file 2: of A randomized controlled trial of hospital versus home based therapy with oral amoxicillin for severe pneumonia in children aged 3 – 59 months: The IndiaCLEN Severe Pneumonia Oral Therapy (ISPOT) Study

Details of contributorship of the ISPOT study group. (PDF 288 kb