Teaching Learning Methodology in Times of COVID-19 Pandemic: A Case Study

The Education system in India underwent a major change due to the sudden lockdown announced by the Government in view of COVID – 19 pandemic. Both teachers and students had to shift to online mode in a very short time period. The present study analysis the positive and negative aspect of this online mode of education and measures adopted by teachers to maintain the flow of education along with attendance. The sur- vey was conducted at JSS Academy of Technical Education, Noida. More than 100 teachers and students participated in the survey conducted. Also experienced faculty came up with sug- gestions and ideas to improve the online mode of education in view of such pandemic situations. Two teachers who were also teaching kids at an NGO school running in the campus prem- ises shared their view on what efforts they took to let education reach the kids at the NGO as digital divide was the main prob- lem there. Such findings will help in designing a future teach- ing model to cope with pandemic situations and not let educa- tion suffer.

NT-ProBNP as a Potential Marker of Left Atrial Dysfunction in Rheumatic Mitral Stenosis: Correlation with Left Atrial Function after PBMV

BACKGROUND

Rheumatic heart disease is a common reason for cardiovascular morbidity and mortality. Plasma levels of N-terminal pro-brain natriuretic peptide (NT-proBNP) are known to rise in patients with MS, but the role of this compound as a non-invasive marker of left atrial (LA) dysfunction is yet to be established. The study aim was to correlate levels of NT-proBNP in patients with rheumatic mitral stenosis (MS), with echocardiographic parameters of LA function including tissue Doppler-derived strain/strain rate (S/Sr) indices, hemodynamic parameters of LA function, before and after percutaneous balloon mitral valvotomy (PBMV) for a follow up of one year.

METHODS

The study included 51 patients with severe MS and 10 age- and gender-matched controls. All patients and subjects underwent detailed clinical and echocardiographic evaluation (including LA S/Sr indices) prior to PBMV and at 12 h, one month and one year after PBMV. Venous blood samples were withdrawn to monitor NT-proBNP levels during the same period. LA functions were assessed echocardiographically, using conventional parameters, while S/Sr indices were calculated at mid-LA segments (septal, lateral, anterior and inferior) during ventricular systole, and at early and late diastole. The LA appendage contraction velocity was calculated using transesophageal echocardiography (TEE) and correlated with NT-proBNP levels. The cardiac output (CO) was calculated invasively. The pulmonary capillary wedge pressure (PCWP), pulmonary artery pressure (PAP) and other parameters were correlated with NT-proBNP levels before and after PBMV.

RESULTS

The mean NT-proBNP level before PBMV was 761.76 ± 213.6 pg/ml, and was 425 pg/ml, 300 pg/ml and 50 pg/ml at one day, one month and one year, respectively (p <0.01). The S/Sr indices at each mid-LA segment (septal, lateral, anterior, and inferior) during ventricular systole (LAs), at early (LAe) and late diastole (LAa) were each significantly lower in patients than in controls (p <0.001). The S/Sr values were improved significantly (p <0.05) in most segments at one day and at one month after PBMV, but after one year the values were increased by >50%, in relation to the NT-proBNP level. There were significant falls in mean PAP and PCWP and a rise in CO, each of which correlated significantly with NTproBNP levels.

CONCLUSIONS

NT-proBNP levels correlated significantly with LA dysfunction, and can predict improvements in LA function following PBMV in rheumatic MS for up to one year. Tissue Doppler-derived S/Sr indices may be used to detect fine variations over and above conventional echocardiography, and this may be clinically valuable in the prognosis of MS patients.

Clinical performance of biodegradable polymer-coated sirolimus-eluting stents in unselected real-world population with coronary artery disease: results from the multicenter CORE Registry

BACKGROUND

The main aim of the CORE Registry was to evaluate clinical performance of the Supralimus-Core® biodegradable polymer-coated sirolimus-eluting cobalt-chromium stent (Sahajanand Medical technologies Pvt. Ltd., Surat, India) in unselected real-world patients.

METHODS

This was a multicenter, retrospective, non-randomized, single-arm study. A total of 376 consecutive patients treated with the Supralimus-Core® between April 2010 and June 2014 were enrolled. The primary-end point of the registry was major adverse cardiac events (MACE), which is a composite of cardiac death, target lesion revascularization (TLR), target vessel revascularization (TVR), myocardial infarction (MI) and stent thrombosis (ST). Clinical follow-up were scheduled at 30-day and 6-month.

RESULTS

The mean age of enrolled patients was 54.6±10.3 years. A total of 444 lesions were treated successfully with 457 stents (1.0±0.2 per lesion). The average stent length and diameter was 24.0±8.0 mm and 3.0±0.33 mm, respectively. Out of total patients, 300 (79.8%) were male. Diabetes, hypertension and chronic totally occluded lesions were found in 95 (25.3%), 102 (27.1%) and 125 (28.2%) patients, respectively, reflecting high-risk patients involvement. The incidence of MACE at 30-day and 6-month was found to be in 4 (1.1 %) and 4 (1.1%) patients, respectively. The TLR and ST was found in 1 (0.3 %) and 1 (0.3 %) patient respectively at 6-month follow-up.

CONCLUSIONS

The lower incidence of MACE, TLR and ST clearly delineates safety and efficacy of Supralimus-Core sirolimus-eluting stent in "real-world" patients with complex coronary lesions.

Giant pulmonary artery aneurysm in a patient with rheumatic mitral stenosis

Pulmonary artery (PA) aneurysm is a rare condition, frequently associated with pulmonary hypertension. However, the evolution and treatment of this pathology is still not clear. We report a case of a 45-year-old female patient with giant PA aneurysm associated with rheumatic mitral stenosis and severe pulmonary arterial hypertension. The patient had undergone balloon mitral valvotomy around 7 years back; aneurysm was first identified 3 years back during routine follow-up. The PA aneurysm size, however, had remained almost unchanged with associated severe pulmonary regurgitation. Surgical correction was advised but denied by the patient. To our knowledge, this is the first case report of such a large PA aneurysm in association with rheumatic heart disease. Although medical therapy for pulmonary hypertension was started, surgical correction of the aneurysm was advised in order to prevent the future complications.

Idiopathic aneurysmal giant right atrial enlargement with thrombus formation

A 12-year-old boy presented to our outpatient department with progressive dyspnoea and palpitations of 6-month duration. Cardiovascular system examination revealed a short ejection systolic murmur at the left lateral heart border. Chest X-ray showed gross cardiomegaly. Two-dimensional ECHO revealed massive aneurysmal right atrial (RA) enlargement, low-pressure tricuspid regurgitation and dysplastic tricuspid valve with compression of the left atrium (LA) and left ventricle (LV). Cardiac CT showed grossly enlarged RA compressing the LA, LV, right pulmonary artery and right upper lobe pulmonary vein. Initially, the patient refused surgery. On follow-up, a thrombus was seen in the giant RA and the patient agreed to and underwent successful surgery. Absence of pericardium was specifically excluded on cardiac MRI and on surgery. Resected atrial tissue showed wall thinning and focal fibrosis establishing idiopathic dilation of the RA. The patient is on regular follow-up.

Retinopathy in Newly Diagnosed Type 2 Diabetics with a special stress on the importance of glycemic control

Background: Diabetes mellitus (DM) is a major health problem with long-term microvascular and macrovascular complications responsible for the majority of its mortality and morbidity. The development and progression of diabetic complications are strongly related to the degree of glycemic control. The purpose of this study was to study, the incidence of retinopathy in newly diagnosed diabetics and its association with various risk factors with a special stress on role of HbA1c levels. Methods: We analysed 300 newly diagnosed type2 diabetics (diagnosed within 6 months). Patients were subject to detailed history, examination (including retinal examination), and investigations including serum creatinine, urinary micro-albumin, 24 hours urinary protein, HbA1c and ultrasonography. Results: Incidence of retinopathy in newly diagnosed type 2 diabetics was 30% (91/300). With increase in HbA1c, the incidence of retinopathy increased. All results were statistically proven. Conclusion: Incidence of retinopathy in newly diagnosed type2 diabetics is as high as 30%. Glycemic control is the an important factor contributing to development of this microvascular complications in diabetic patients. DOI: http://dx.doi.org/10.3329/bjms.v14i1.16535 Bangladesh Journal of Medical Science Vol.14(1) 2015 p.39-42

A rare case of congenital complex pulmonary AV fistula

A 15-year-old boy presented with central cyanosis with clubbing and dyspnoea on exertion. Cardiovascular examination did not reveal any abnormality. ECG was normal. Chest X-ray showed a normal sized heart with rounded opacities of variable size in the left upper lung field. Two-dimensional echocardiographic examination was normal. CT angiography showed a large complex lesion composed of serpiginous tubular structures involving the left upper and lingular lobe, suggestive of racemose tangle of blood vessels. A diagnosis of large complex arteriovenous (AV) fistula involving the left upper and lingular lobe was performed. This case reports a rare case of complex pulmonary AV fistula.

Pentology of Fallot's presenting with complete heart block

A 17-year-old male patient presented with cyanosis, repeated squatting since childhood and haemoptysis since the past 1 month. He had central cyanosis with clubbing. Cardiovasular examination revealed ejection systolic murmur in the pulmonary area with single S2. ECG showed right ventricular hypertrophy (RVH) with right atrial enlargement and first-degree heart block. Two-dimensional echo showed ventricular septal defect, overriding aorta, RVH, right ventricular enlargement (RVE) and right atrial enlargement with infundibular and valvular pulmonary stenosis and 1.9 cm ostium secondum atrial septal defect. There was no evidence of atrioventricular canal defect. The patient was diagnosed with pentology of Fallots. Follow-up ECG showed complete heart block (CHB) that again reverted to first-degree heart block. A diagnosis of pentology of Fallot with intermittent CHB was made with an awake heart rate of 50/min. This case report shows association of CHB with tetralogy of Fallot.

Nonlocal effect of plasma resonances on the electron energy-distribution function in microwave plasma columns

Spatially resolved trace rare gases optical emission spectroscopy was used to analyze the electron energy-distribution function (EEDF) in low-pressure argon plasma columns sustained by surface waves. At frequencies >1 GHz, in the microwave-sustained region, the EEDF departs from a Maxwellian, characterized by a depletion of low-energy electrons and a high-energy tail, whereas in the field-free zone, the EEDF is Maxwellian. Abnormal behavior of the EEDF results from the acceleration of low-energy electrons due to the conversion of surface waves into volume plasmons at the resonance point where the plasma frequency equals the wave frequency and their absorption by either collisional or Landau damping.

Mining the adenovirus virome for oncolytics against multiple solid tumor types

Although there are 55 serotypes of adenovirus (Ad) that infect humans, Ad serotype 5 (Ad5) is the most widely studied because of the availability of commercial kits for its genetic manipulation. In fact, engineered Ad 5 is currently being used in all of the 87 global clinical trials utilizing Ad for the treatment of cancer. Unfortunately, Ad5 is one of the most seroprevalent serotypes, meaning that this virus has to confront additional immunological barriers to be effective in Ad5-immune patients. In this work, we compare Ad5 to 13 other adenoviral serotypes from species B, C, D and E for oncolytic potential in both immunodeficient mouse and immunocompetent hamster models. Our results indicate that species D Ads are not effective oncolytics against most solid tumors. Conversely, lower seroprevalent Ad6 and Ad11 had anti-cancer activity comparable to Ad5. This work strongly supports the consideration of Ad6-based oncolytic therapies for the treatment of breast, ovarian, kidney and liver tumors.

Nephropathy in newly diagnosed type 2 diabetics with special stress on the role of hypertension

OBJECTIVE

Nephropathy is a common complication in diabetes mellitus (DM), with significant morbidity and mortality. The aim of the present study is to study the incidence of nephropathy in newly diagnosed type 2 diabetics and to study the relationship of development of nephropathy with various risk factors associated with DM, like age, sex, blood pressure, blood sugar, body mass index (BMI).

MATERIAL AND METHODS

We analysed 300 newly diagnosed type 2 diabetics (diagnosed within 6 months), between Jan 2008 to August 2009. Presence of urinary microalbuminuria in two samples in a period of six months was taken as criteria for detecting nephropathy.

RESULTS

Incidence of nephropathy in newly diagnosed type 2 diabetics was 17.34% (52/300). It increased significantly with increase in age and was 30% in age group >60 years. It also has significant correlation with male sex and blood pressure with incidence of nephropathy being as high as 66.67% at BP> 160/100 mmHg. The incidence also increased with increase in BMI as well as HbA1C. Dyslipidemia also has significant effect. All results were statistically proven. Family history of DM has only little effect.

CONCLUSION

Incidence of nephropathy in newly diagnosed type 2 diabetics is as high as 17.34%. Hypertension is the most important associated factor contributing to development of nephropathy in these patients. Poor glycemic control (high HbA1C), high BMI, dyslipidemia, age, male sex also play significant role. Family history of DM seems to have little effect.

Treatment of neglected elbow dislocations with combination of speed V-Y muscleplasty and intra-articular injection of hydrocorticosone

Neglected dislocations of the elbow are not uncommon in developing countries. We report case series of 3 cases of neglected dislocations of elbow. All the three cases were treated by combination of Speeds procedure and intraarticular injection of 25mg of hydrocorticosone acetate in 5 ml of distilled water. Mean time from injury was 5 months and mean follow-up was 10 months. According to Mayo Elbow Performance Index, 2 outcomes were excellent and 1 outcome was good.

Feasibility of a palmtop-based interactive education to promote patient safety

Institute of Medicine defines "patient safety" as a set of measures taken by healthcare professionals to prevent adverse outcomes from medical errors. Kohn estimated that medical errors are likely to result in a death of 44,000 to 98,000 people in U.S. hospitals each year, making it almost the fifth leading cause of death. The costs of medical errors, made by healthcare professionals, amount to $29 billions annually. Recent studies showed that current system of medical training and continuous education has limited capability in promoting and sustaining awareness of patient safety and medical error issues. Use of Personal Digital Assistants (PDA) has been increasingly widespread among clinical students and residents. Despite significant improvement in PDA functionality, current literature does not provide systematic assessment of potential use of hand-held computing for interactive clinician education. To address these issues, we assessed the feasibility of a PDA-based interactive multimedia tool aimed to provide self-paced patient safety education for clinicians.

Feasibility and patients' acceptance of Home Automated Telemanagement of oral anticoagulation therapy

We developed the Home Automated Telemanagement (HAT) system for patients on oral anticoagulation therapy. It consists of a home unit, HAT server, and clinician unit. Patients at home use a palmtop or a laptop connected with a prothrombin time (PT) monitor. Each HAT session consists of self-testing, feedback, and educational components. The symptom data and PT/INR from patient homes are automatically sent to the HAT server and analyzed by the system. Patients who were seen in the Anticoagulation Clinic (N=29) were asked to use HAT in a laboratory setting. Semi-structured, in-depth interviews were used for the evaluation of HAT acceptance. 93% claimed that they would use such a tool at home and would advise other patients to use HAT for self-management and disease-specific education. Twelve patients used HAT at home for eight weeks. Compared to baseline, patients completing the home study showed statistically significant improvement in disease-specific quality of life dimensions of general satisfaction, self-efficacy, daily hassles, and distress. The Client Satisfaction Questionnaire demonstrated significant improvement in patient satisfaction with the treatment process. Our results demonstrated high acceptance of the HAT system by patients receiving long term anticoagulation therapy regardless of their previous computer experience or socioeconomic background.

Spleen preserving distal pancreatectomy for blunt abdominal trauma--a case report

The case of a 22-year-old male who underwent spleen preserving distal pancreatectomy (SPDP) for pancreatic trauma is briefly reported. SPDP was performed by preserving the splenic vessels to maintain a reliable splenic blood flow post-operatively. Although technically demanding, this procedure can be performed safely and easily in the emergency, and avoids splenectomy-related problems in the post-operative period.

Incomplete pancreas divisum with anomalous choledochopancreatic duct junction with choledochal cyst

The coexistence of incomplete pancreas divisum, an anomalous choledochopancreatic duct junction, and a choledochal cyst is an extremely rare condition, described in only 3 patients in the available medical literature. The symptoms may be similar to any of these 3 distinct pathological conditions. Magnetic resonance cholangiopancreatography or endoscopic retrograde cholangiopancreatography is usually required for diagnosis. Management of symptomatic pancreas divisum may be accomplished with open accessory duct sphincteroplasty or endoscopic papillotomy with or without stenting. Treatment of choledochal cyst is by complete excision of the cyst whenever possible, with hepaticodochoenterostomy being the treatment of choice. Here, we describe a patient with this complex disorder who was successfully managed with endoscopic minor duct papillotomy with accessory pancreatic duct stenting and resection of the choledochal cyst with hepaticodochojejunostomy.

Utilization of the Yellow Component of a Copper-Vapor Laser for Extending the Tuning Range of a Rhodamine 6G Dye Laser by Use of an Additional Dye in a Novel Coupled Resonator Scheme

We demonstrate the use of both 510.6- and 578.2-nm components and the extension of the tuning range of a Rhodamine 6G dye laser in a novel coupled resonator scheme. Rhodamine 6G is pumped by 510.6-nm light in one resonator and Sulforhodamine B is pumped by 578.2 nm in the other. The spectral tuning range of 564-609 nm of the Rhodamine 6G laser is extended up to 640 nm. A two-mirror arrangement ensures continuous tuning across the spectral ranges of the two dyes by rotation of a single plane mirror.

Molecular cloning, genomic characterization and expression of novel human alpha1A-adrenoceptor isoforms

We have isolated and characterized from human prostate novel splice variants of the human alpha1A-adrenoceptor, several of which generate truncated products and one isoform, alpha(1A-4), which has the identical splice site as the three previously described isoforms. Long-PCR on human genomic DNA showed that the alpha(1A-4) exon is located between those encoding the alpha(1A-1) and alpha(1A-3) variants. CHO-K1 cells stably expressing alpha(1A-4) showed ligand binding properties similar to those of the other functional isoforms as well as agonist-stimulated inositol phosphate accumulation. Quantitative PCR analyses revealed that alpha(1A-4) is the most abundant isoform expressed in the prostate with high levels also detected in liver and heart.

Ultrasonographic study of children suspected of hydrocephalus at the Queen Elizabeth Central Hospital in Blantyre, Malawi

Eighty Malawian children aged below 15 months who presented with rapidly enlarging head and were suspected of having hydrocephalus were investigated with anterior fontanelle ultrasonography at the Queen Elizabeth Central Hospital (QECH), Blantyre. Of the 68 (85%) who were found to have hydrocephalus, 35 (51.5%) were post infective, 14 (20.6%) were associated with lumbosacral myelomeningocele, 13(19.1%) were post haemorrhagic and the rest probably congenital or idiopathic. The remaining 12 patients with macrocephaly but without hydrocephalus comprised six children with hydranencephaly, five with subdural effusion and one with achondroplasia. Ultrasonography of the head is thus a simple, quick, non-invasive, economical diagnostic tool in the management of macrocephaly and to a limited sense as effective as CT scan. Its increased use in the investigation of infantile hydrocephalus is therefore recommended in developing countries with limited resources and without sophisticated imaging techniques.