Impact of COVID-19 Pandemic on Dermatology Teaching Program in India: A Survey on the Faculty and Residents' Perspective

Background

Impact of COVID-19 pandemic has been immense. An innocent casualty of this disaster is medical education and training. Dermatology, which primarily deals with out-patient services, medical and surgical interventions, and in-patient services, was one of the worst hit. The National Medical Commission of India has implemented competency-based medical education (CBME) in Dermatology, Venereology, and Leprosy since 2019. The new curriculum relies on acquiring practical and procedural skills, training skills in research methodology, professionalism, attitude, and communication.

Objectives

The study was undertaken to understand the implications of the COVID-19 pandemic on postgraduate dermatology CBME training in India.

Materials and Methods

A questionnaire-based survey was carried out on postgraduate dermatology teachers and residents in India after obtaining ethics committee approval. An online semi-structured English questionnaire was administered by Google Forms. The calculated sample size was 366 dermatology faculty and 341 postgraduate students. Validity (Content validity ratio (CVR) ≥0.56) and reliability (Cronbach's alpha coefficient 0.7249) of the questionnaire were determined.

Results

Among the 764 responses received, 51.4% reported that their institutes were converted to exclusive COVID hospitals. Domains of dermatology education affected were procedural training (n = 655), bedside clinical teaching (n = 613), outpatient department-based clinical teaching (n = 487), bedside laboratory procedures (n = 463), research activities (n = 453), histopathology (n = 412), and theory classes (n = 302). To keep up with the teaching-learning process, online platforms were mostly utilized: Zoom Meeting (n = 379), Google Meet (n = 287), and WhatsApp Interaction (n = 224). Teaching during ward rounds was significantly more affected in exclusively COVID institutes than non-exclusive COVID institutes (P < 0.001). Psychomotor skill development suffered a major jolt with 26.7% of respondents reporting a standstill (P < 0.001). Communication skills among students suffered due to social distancing, mask, and poor attendance of patients. According to 23.84% of respondents, formative assessment was discontinued.

Conclusion

Online seminars, journal clubs, and assessments have been incorporated during the pandemic. Online modalities should be used as a supplementary method as psychomotor skills, communication skills, research work, and bedside clinics may not be replaced by the e-learning.

Patterns and Trends of Tribal Leprosy: An Overview from a Tertiary Care Leprosy Clinic of Choto Nagpur Plateau of Eastern India

Background

Leprosy is a chronic granulomatous disease mainly affecting the peripheral nerves and skin. Any communities including the tribals are susceptible to leprosy. Very few studies on clinico-epidemiological patterns of leprosy have been reported in the tribal population, especially in the Choto Nagpur plateau.

Aims

To observe clinical types of newly diagnosed leprosy cases among the tribal population and demonstrate bacteriological index, frequency of deformity, and lepra reaction at presentation.

Methods

An institution-based cross-sectional study was conducted with consecutive newly diagnosed tribal leprosy patients attending the leprosy clinic of a tribal-based tertiary care center of Choto Nagpur plateau of eastern India, from January 2015 to December 2019. Thorough history taking and clinical examination were done. A slit skin smear for AFB was performed to demonstrate the bacteriological index.

Results

There was a steady rise in total leprosy cases from 2015 to 2019. Borderline tuberculoid (BT) was the commonest form of leprosy (64.83%). Pure neuritic leprosy was not uncommon (16.26%). Multibacillary leprosy was noted in 74.72% of cases and childhood leprosy was observed in 6.70% of cases. The commonest nerve involved was the ulnar nerve. Garde II deformity was noted in around 20% of cases. AFB positivity was observed in 13.73% of cases. A high bacteriological index (BI ≥3) was noted in 10.65% of cases. Lepra reaction was observed in 25.38% of cases.

Conclusion

BT leprosy, pure neuritic leprosy, childhood leprosy, grade II deformity, and higher AFB positivity were prevalent in this study. The tribal population required special attention and care for the prevention of leprosy amongst them.

Distribution of norm and 137Cs in soils of the Visakhapatnam region, Eastern India, and associated radiation dose

The specific activity of naturally occurring radioactive materials and (137)Cs in surface soils around the new Bhabha Atomic Research Centre site at Visakhapatnam region, Eastern India, has been determined using high-resolution gamma-ray spectrometry as part of a baseline radiological survey. Radiation hazard for the samples was assessed by radium equivalent activity (Raeq) and absorbed gamma dose rate (D). The mean absorbed gamma dose rate was found to be 104.9 nGy h(-1). The average annual effective dose equivalent was found to be 0.13 mSv y(-1).

Distribution of radionuclides in surface soils, Singhbhum Shear Zone, India and associated dose

Gamma emitters were estimated in surface soils from a mineralized zone in Eastern India using high purity Germanium detector-based high resolution gamma spectrometry system. Activities of (238)U, (226)Ra, (232)Th, (235)U, (227)Th, (234 m)Pa, (210)Pb, (40)K, and (137)Cs were 79 ± 50, 81 ± 53, 65 ± 23, 4 ± 2, 5 ± 4, 92 ± 50, 97 ± 45, 517 ± 201, and 4 ± 2 Bq/kg, respectively. Most radionuclides were observed to follow log-normal distribution. The correlation between physicochemical properties of the samples, like pH, organic matter content, particle size, and moisture content were also studied. Activity ratios of (226)Ra/(238)U, (210)Pb/(226)Ra, and (227)Th/(235)U indicated deviation from secular equilibrium in some samples. The associated annual effective dose ranged from 0.07 to 0.24 mSv and the mean was calculated to be 0.12 ± 0.04 mSv for this region, indicating it to be one of normal natural background radiation.

Age-dependent dose and health risk due to intake of uranium in drinking water from Jaduguda, India

Uranium is a heavy metal that is not only radiologically harmful but also a well-known nephrotoxic element. In this study, occurrence of uranium in drinking water samples from locations near the uranium mining site at Jaduguda, India, was studied by Laser-induced fluorimetry. Uranium concentrations range from 0.03 ± 0.01 to 11.6 ± 1.3 µg l(-l), being well within the US Environmental Protection Agency drinking water limit of 30 μg l(-1). The ingestion dose due to the presence of uranium in drinking water for various age groups varies from 0.03 to 28.3 μSv y(-1). The excess lifetime cancer risk varies from 4.3×10(-8) to 1.7×10(-5) with an average value of 4.8×10(-6), much less than the acceptable excess lifetime cancer risk of 10(-3) for radiological risk. The chemical risk (hazard quotient) has an average value of 0.15 indicating that the water is safe for drinking.

Ingestion dose from 238U, 232Th, 226Ra, 40K and 137Cs in cereals, pulses and drinking water to adult population in a high background radiation area, Odisha, India

A natural high background radiation area is located in Chhatrapur, Odisha in the eastern part of India. The inhabitants of this area are exposed to external radiation levels higher than the global average background values, due to the presence of uranium, thorium and its decay products in the monazite sands bearing placer deposits in its beaches. The concentrations of (232)Th, (238)U, (226)Ra, (40)K and (137)Cs were determined in cereals (rice and wheat), pulses and drinking water consumed by the population residing around this region and the corresponding annual ingestion dose was calculated. The annual ingestion doses from cereals, pulses and drinking water varied in the range of 109.4-936.8, 10.2-307.5 and 0.5-2.8 µSv y(-1), respectively. The estimated total annual average effective dose due to the ingestion of these radionuclides in cereals, pulses and drinking water was 530 µSv y(-1). The ingestion dose from cereals was the highest mainly due to a high consumption rate. The highest contribution of dose was found to be from (226)Ra for cereals and drinking water and (40)K was the major dose contributor from the intake of pulses. The contribution of man-made radionuclide (137)Cs to the total dose was found to be minimum. (226)Ra was found to be the largest contributor to ingestion dose from all sources.

An assessment of the radiological scenario around uranium mines in Singhbhum East district, Jharkhand, India

The present work deals with the prevalent radiological scenario around uranium-mining sites in the Singhbhum East district of Jharkhand state, India. The concentration of naturally occurring radioactive materials (NORMs) was estimated from 27 soil samples collected around three regions in the study area, namely Bagjata, Turamdih and Jaduguda. The mean activity concentrations of (238)U in Bagjata, Turamdih and Jaduguda regions were found to be 128.6, 95.7 and 49.2 Bq kg(-1), respectively. Similarly for (232)Th and (40)K the activity concentrations were found to be 57.3, 78.4, 68.9 and 530, 425 and 615 Bq kg(-1) in the Bagjata, Turamdih and Jaduguda regions, respectively, which are comparable with other reported values worldwide, except for some high values. The calculated gamma dose rate, obtained from the concentrations of (238)U, (232)Th and (40)K in the samples, was compared with the observed dose rate in air. A good correlation (0.96) was observed between the calculated and the observed gamma dose rate. The annual outdoor effective dose rate was estimated and the values falls between 0.04-0.3, 0.07-0.3 and 0.07-.14 mSv y(-1) with mean values of 0.14, 0.12 and 0.11 mSv y(-1) for the Bagjata, Turamdih and Jaduguda regions, respectively. The terrestrial dose rates in all the three regions are comparable with other reported values worldwide, except for a few high values in Greece, Rio Grande Do Norte (Brazil) and Kalpakkam (India).

Natural radioactivity in roadside soil along Jamshedpur-Musabani road: a mineralised and mining region, Jharkhand and associated risk

The specific activity and the gamma radiation dose rates due to naturally occurring radioactive materials ((238)U, (232)Th and (40)K) were determined in 26 roadside surface soils along Jamshedpur-Musabani road-a mineralised and mining region, using high-resolution gamma-ray spectrometry. The concentrations of (238)U, (232)Th and (40)K in the soil samples were found to be in the range of 16.6 +/- 0.6-390.5 +/- 1.6, 24.1 +/- 0.7-148.2 +/- 2.1 and 85.9 +/- 3.8-881.6 +/- 22.4 Bq kg(-1), respectively. The annual effective dose equivalent was found to be in the range of 0.04-0.32 mSv y(-1) with an average value of 0.13 mSv y(-1). The excess cancer risk is in the range of 0.16 x 10(-3)-1.22 x 10(-3) with an average value of 0.49 x 10(-3).