Perception of health care students towards lectures as a teaching and learning method in the COVID era - A multicentric cross-sectional study from India

The sudden precipitation of the pandemic forced undergraduates to take refuge at home, deserting the campus. Consequently, the age-old classroom in person teaching-learning (T-L) method shifted and lessons had to be conducted online. In previous decades, archetypical classroom lectures survived a lot of criticism in the face of the quasi-passive nature of T-L  methodology. There are very few studies that reflect undergraduate students' perceptions of lectures. This study aimed to evaluate undergraduate students' perceptions of lectures using an online questionnaire with 13 items, which was circulated to undergraduate students of medical, physiotherapy, and nursing courses in three settings at different locations of private and public health schools. There was a total of 877 responses. The surveyed students were in favor of lectures and considered them indispensable for undergraduate learning. They preferred it as a kind of organized learning through the teacher's own experiences. Our study suggests that it is not the 'lecture' that requires mending but possibly teachers require better training, application of effective audio-visual aids, and innovative techniques to sustain students' interest in the class.

Evaluation of Preclinical Task Based Learning program in Medical Education

The conventional curriculum in preclinical medical education has a need for early clinical exposure programs that help in correlation of basic science data with clinical skills. This is helpful to develop clinical reasoning skills, problem-solving abilities, team work, communication skills and overall attitudes and behaviour relevant for a healthcare provider. Preclinical task based learning (TskBL) is an active learning strategy in which the focus for the first year medical student is a real task done by a doctor. In this strategy the student-doctors undergo a standardized patient encounter and discuss the learning issues related to the task in the first year of medical school. The current study is focussed on the student perception of the effectiveness of task based learning module.The TskBL was conducted among first year medical students for nine topics that are commonly encountered in the clinics. After TskBL was planned and implemented the evaluation of the modules was done using focus group discussions. The students highlighted the importance of standardized patients in the TskBL strategy in providing early clinical exposure in preclinical medical education. They reported its usefulness gaining essential knowledge, skills and attitudes for medical learning. They reported positive outcomes of module design and processes and activities in TskBL. Based on the negative aspects of the modules, future improvement was suggested in improving the usefulness of standardized patient encounter. This study showed the novice learners' outlook of the potency of TskBL for several other topics of clinical relevance to provide early clinical exposure in medical schools.

A task-based learning strategy in preclinical medical education

Preclinical task-based learning (TskBL) is a simulated learning approach in which the focus for students is a real task done by a medical professional. TskBL includes standardized patient encounters and is helpful to provide early clinical exposure. Our study aimed at planning, implementing, and assessing TskBL among first-year medical students and comparing it to the conventional method of tutorials in the physiology MBBS curriculum. This is a nonequivalent group quasi-experimental study approved by the institutional ethics committee. TskBL was conducted for seven topics among first-year medical students of Kasturba Medical College, Mangalore for three academic years. Participants were divided into a TskBL group and a control group. Both groups attended the theory classes in physiology, practical sessions, and clinical examinations concerning the tasks. After this, the TskBL group underwent TskBL, and the control group underwent tutorials. Pretest and posttest assessments were conducted by using a multiple choice question (MCQ) test and objective structured clinical examinations (OSCEs).The mean TskBL scores for MCQ (exception: hypertension, myasthenia gravis, and chronic obstructive pulmonary disease) and OSCE (exception: anemia and hypertension) were significantly higher than the tutorial group. Pretest and posttest scores revealed significantly higher MCQ and OSCE scores for TskBL (exception: MCQ score for hypertension and chronic obstructive pulmonary disease). The tutorial group did not show a significant improvement in test scores for all the tasks. The TskBL strategy could be used for topics that are likely to be encountered by the students during clinical attachments. Small group teaching can include TskBL in preference to tutorials to provide early clinical exposure in medical schools.

Comparison of Londrina activities of daily living protocol and Glittre ADL test on cardio-pulmonary response in patients with COPD: a cross-sectional study

Background

In COPD patients it is very important to assess the activities of daily living (ADL) due to an impairment of independence and quality of life. There is a lack of retrievable data regarding the cardio-pulmonary response to Londrina ADL protocol in patients with COPD. The aim of the present study was to assess the cardio-pulmonary response to Londrina ADL protocol in patients with COPD and to compare this with responses to the Glittre ADL test.

Methods

This cross-sectional study was done on 30 COPD subjects. Each subject was taken to perform the Londrina ADL protocol, Glittre ADL test, twice each, on subsequent days. The Londrina ADL protocol comprises 5 activities representing ADL, involving upper limbs, lower limbs, and trunk movements. The Glittre ADL test consists of completing a circuit while carrying a weighted backpack (2.5 kg for women, 5.0 kg for men). The better value of the two was taken into consideration. For the Londrina ADL protocol and Glittre ADL test the outcome of primary interest was time and for the six-minute walk test was the distance walked. The secondary outcomes for all tests were heart rate, systolic blood pressure, diastolic blood pressure, respiratory rate, saturation of oxygen in blood and dyspnea.

Results

The COPD subjects of age group 63.27±11.07 years took 5.94±0.36 min to complete trial 2 of the Londrina ADL protocol. Significant physiological increases in heart rate (p≤0.01), respiratory rate (p≤0.01), blood pressure (p≤0.01) and severity of dyspnea (p≤0.01) were observed, whereas saturation of oxygen in blood (p≤0.01) was reduced at the end of the Londrina ADL protocol and Glittre ADL test. There was a positive, non-significant correlation between the six-minute walk test distance and the Londrina ADL protocol time (r=0.236) (p=0.209). A positive, not significant correlation was observed between the Glittre ADL test (time) and the Londrina ADL protocol (time) (r=0.194) (p=0.304) and a negative but not significant correlation between the six-minute walk test (distance) and the Glittre ADL test (time) (r= -0.184) (p=0.330).

Conclusion

The Londrina ADL protocol can be used as an assessment tool for the evaluation of functional performance and activities of daily living in COPD along with other test protocols in pulmonary rehabilitation.

Reference value for the six-minute peg board and ring test. A cross sectional study

Introduction

In our daily life, arm activities, whether supported or unsupported play a major role. Both simple and complex activities require the muscles, namely trapezius, pectoralis minor, scalene, and intercostals, to participate in arm positioning. These muscles also enact as the accessory respiratory muscles. Therefore, arm elevation increases the load on these muscles and they fail to perform dual activities, resulting in arm fatigue and a feeling of dyspnoea in healthy individuals as well as in chronic obstructive pulmonary disease patients. Various upper limb exercise tests were designed to measure this impairment, one of them being the six-minute peg board and ring test. The aim of the study is to derive a reference value for the six-minute peg board and ring test among healthy Indian population (Mangalore) from the age of 20-70 years of either gender. Also, to find a correlation among the number of rings and body mass index, arm length, arm and forearm circumference, the strength of shoulder and elbow flexors-extensors, grip strength of both sides and level of physical activity.

Methods

Participants performed two tests, thirty minutes apart. They were asked to load as many rings as possible in 6 minutes. Arm length, arm and forearm circumference were measured with a measuring tape. Shoulder and elbow flexors-extensors were assessed using a handheld push-pull dynamometer. Grip strength was measured with the Jamar hand-held dynamometer. Level of physical activity was assessed using International Physical Activity Questionnairelong form.

Results

The samples consisted of 450 healthy individuals between the age of 20-70 years. Reference values for each age group for both genders were reported. We found that age was correlated with the six-minute peg board and ring test score (p<0.05). We also found a correlation between the strength variables and the test results (p=0.001). However, no correlation was found between the arm length, arm and forearm circumference and the level of physical activity with the number of rings.

Conclusion

In this study, we derived a reference value for the six-minute peg board and ring test. There was a correlation among age, strength variables and the number of rings.

Reference Values for Glittre Activities of the Daily Living Test in Healthy Subjects Among Indian Population- A Cross-Sectional Study

Background:

The Glittre ADL test was done to assess the functional capacity of patients with COPD. 6 MWT was used to check for functional capacity, but there was a limitation of upper limb work or activities other than walking.

Objective:

To develop reference equations for Glittre ADL test on the basis of anthropometric and demographic variables in healthy individual among Indian population.

Methods:

This cross-sectional study was conducted with 423 healthy participants of either gender between 20-70 years. Participants were divided into 5 groups based on age. Each participant underwent anthropometric assessment & two glitter ADL tests. Two out of the best performance out of two was considered and the minimum time spend was taken.

Results:

The mean time spent by males in different age groups was 20-30 years 3.18±0.56, 30-40 years 3.36±0.17, 40-50 years 3.46±0.18, 50-60 years 3.53±0.15, 60-70 years 4.02±0.27.For females in different age groups the mean time was 20-30 years 3.31±0.14, 30-40 years 3.41±0.13, 40-50 years 3.48±0.13, 50-60 years 3.75±0.28, 60-70 years 4.30±0.19. Equation 1 : Glittre ADL-test predicted =3.399+(0.018×age years)+(-0.004×height cm), Equation 2 : Glittre ADL-test predicted =2.805+(-0.002× BMI)+(0.018×age year).

Conclusion:

The reference equations for the time to complete the Glittre ADL-test were based on age, BMI, height as independent variables and can be useful for predicting the performance of adult individuals.

Microplastics along the beaches of southeast coast of India

Occurrence of microplastics (plastic debris <5 mm) along the coast is a growing concern worldwide, due to increased input of discarded wastes from various sources. In order to evaluate the extent of microplastic pollution on the sandy beaches (25 locations) along Tamil Nadu coast (1076 km), India, microplastic debris were quantified and categorized into four different size classes. The beaches were classified according to potential sources of pollution i.e. riverine, tourism and fisheries. Beach samples collected from the high tide line contained significantly higher abundance of microplastic than at the low tide line. Beaches adjacent to rivers exhibited relatively higher microplastic abundance compared to those influenced by tourism and fishing activities. Out of the total detected debris, plastic fragments were the maximum (47-50%), followed by line/fibres (24-27%) and foam (10-19%) materials. Fourier Transform Infrared Spectroscopy (FTIR) analysis revealed that polyethylene, polypropylene, and polystyrene were the main types of microplastics present in these beaches. Gut content analysis of commercially important fishes, collected from the coastal waters, revealed microplastics ingestion in 10.1% of fishes. The results indicate that microplastics accumulation in the coastal environment, especially close to the river mouths, may be a serious concern, due to its ability to enter into the marine food web and highlights the necessity of microplastics screening from estuarine, coastal waters and other potential sources.

Risk and Triggering Factors Associated with Bronchial Asthma Among School-Going Children in an Urban City of Coastal Karnataka

Introduction: Asthma is common in childhood and is a major public health issue. The objectives of this study were to identify risk and triggering factors associated with asthma among school children.Material and Methods: A prospective cross sectional study was conducted among 6-15 years old children, over two months in two private schools at Mangalore city. Trigger factors were assessed as per asthma trigger inventory (ATI). Responses were graded from 0-5 score based on ‘never’,’ rarely’, ‘sometimes’, ‘most of the time’ and ‘always’. A predesigned questionnaire suiting the city environment was prepared and used to assess the risk and triggering factors. Analysis was done using SPSS version 16.Results: Asthma and allergic rhinitis in parents (34.1%,40.7%), smoking at home(24.2%), exclusive breast feeding absence (27.5%),early weaning(24.2%), living in a flat (37.4%) and pets at home(37.4%) were risk factors noted. As per ATI, it was found that ‘having a cold’ was the most frequently selected trigger at 94.5% (47.3% ‘sometimes’, 2.2% ‘always’), followed by ‘running’ at 79.1% (27.5% ‘sometimes’, 13.2% ‘always’), and ‘house dust’ at 69.2% (31.9% ‘sometimes’, 6.6% ‘always’). The highest mean was for infections, (2.228, SD=0.546), followed by physical exercise (2.167, SD=0.331). Animal allergens had lowest mean (1.527, SD=0.104), followed by psychological triggers at second lowest (1.579, SD=0.181). However none of the risk and trigger factors had statistical significance with asthma.Conclusion: Avoiding exposure to probable triggers and identifying risk factors would aid in planning effective strategic measures with better quality of life.

Prevalence of bronchial asthma among school-going children in Mangalore, South India

Background: Asthma in childhood is a major public health issue. Objective: To estimate prevalence and associated housing environment factors of asthma among school children. Material & Methods: We conducted a cross sectional study among school children aged six to fifteen years. Standard ISAAC (International Study of Asthma and Allergies in Children) Core Questionnaire for Asthma was used for determining the prevalence of wheezing and asthma. Demographic, housing and indoor pollution factors were collected. Data were analyzed by SPSS version 15. Results: Prevalence of ‘wheeze ever’ and ‘current wheezers’ was 10% and 9% respectively.  Physician diagnosed asthma was seen in 6.3 %. Severe asthma was noted in 28.6% of current wheezerswith 84.6% and 8.8% having one to two and four to 12 wheezing attacks per year respectively. Wheezing was present post exercise in 5.4%, nocturnal cough in 6.1%, sleep disturbance less than one night/week (40.7%), one or more nights/week (3.3%) and wheezing limiting speech to few words between breaths (20.9%). Prevalence was greater among boys (9.8%) than girls (7.5%) and maximal in age group eight to nine years. On multiple logistic regression presence of overcrowding and absence of smoke outlet were significantly associated with current wheeze. Socio-economic status, beedi rolling practices and absence of separate kitchen was statistically significant with severe asthma. Conclusions: Current wheezer prevalence was9% and more in boys. Adoption of improved housing conditions and avoiding environmental tobacco exposure may aid in reducing childhood asthma attacks in this developing city.

Comparison of Flow and Volume Incentive Spirometry on Pulmonary Function and Exercise Tolerance in Open Abdominal Surgery: A Randomized Clinical Trial

INTRODUCTION

Surgical procedures in abdominal area lead to changes in pulmonary function, respiratory mechanics and impaired physical capacity leading to postoperative pulmonary complications, which can affect up to 80% of upper abdominal surgery.

AIM

To evaluate the effects of flow and volume incentive spirometry on pulmonary function and exercise tolerance in patients undergoing open abdominal surgery.

MATERIALS AND METHODS

A randomized clinical trial was conducted in a hospital of Mangalore city in Southern India. Thirty-seven males and thirteen females who were undergoing abdominal surgeries were included and allocated into flow and volume incentive spirometry groups by block randomization. All subjects underwent evaluations of pulmonary function with measurement of Forced Vital Capacity (FVC), Forced Expiratory Volume in the first second (FEV1), Peak Expiratory Flow (PEF). Preoperative and postoperative measurements were taken up to day 5 for both groups. Exercise tolerance measured by Six- Minute Walk Test during preoperative period and measured again at the time of discharge for both groups. Pulmonary function was analysed by post-hoc analysis and carried out using Bonferroni's 't'-test. Exercise tolerance was analysed by Paired 'T'-test.

RESULTS

Pulmonary function (FVC, FEV1, and PEFR) was found to be significantly decreased in 1(st), 2(nd) and 3(rd) postoperative day when compared with preoperative day. On 4(th) and 5(th) postoperative day the pulmonary function (FVC, FEV1, and PEFR) was found to be better preserved in both flow and volume incentive spirometry groups. The Six-Minute Walk Test showed a statistically significant improvement in pulmonary function on the day of discharge than in the preoperative period. In terms of distance covered, the volume- incentive spirometry group showed a greater statistically significant improvement from the preoperative period to the time of discharge than was exhibited by the flow incentive spirometry group.

CONCLUSION

Flow and volume incentive spirometry can be safely recommended to patients undergoing open abdominal surgery as there have been no adverse events recorded. Also, these led to a demonstrable improvement in pulmonary function and exercise tolerance.

Prevalence of quadriceps muscle weakness in patients with COPD and its association with disease severity

INTRODUCTION

COPD presents with an array of extra-pulmonary symptoms of which skeletal muscle dysfunction, particularly of the quadriceps, is well recognized. This contributes to impaired quality of life and increased health care utilization. Work on the quadriceps originated from the observation that a good proportion of COPD patients stop exercise due to the feeling of leg fatigue rather than breathlessness. This study was carried out with the aim of finding the prevalence of quadriceps weakness in a population set and correlate it with severity of COPD.

METHODOLOGY

This cross-sectional study was conducted in 75 subjects suffering from COPD aged 45 years or above. COPD severity in the subjects was graded based on the GOLD staging system. A digital hand held dynamometer (HHD) was used to measure quadriceps muscle strength. Descriptive statistics were done, and Pearson's Correlation Coefficient and ANOVA analysis was used for expressing the results.

RESULTS

Ninety two percent of subjects were suffering from quadriceps muscle weakness. Quadriceps weakness was present in significantly high proportions even in those suffering from mild disease and belonging to a younger age group. The mean quadriceps muscle force value decreased with disease severity and this relation was found to be significant (P<0.01).

CONCLUSION

Majority of the COPD patients were found to be suffering from quadriceps weakness, which was also present in significant proportions in subjects belonging to younger age groups and suffering from mild disease. These findings indicate that onset of muscle weakness in COPD may precede the onset of symptoms. These findings suggest need for early remedial measure to prevent occurrence of associated systemic diseases.

Probiotic Lactobacillus rhamnosus GG and Aloe vera gel improve lipid profiles in hypercholesterolemic rats

OBJECTIVE

The effects of Lactobacillus rhamnosus GG (LGG) and Aloe vera (AV) gel on lipid profiles in rats with induced hypercholesterolemia were studied.

METHODS

Five treatment groups of rats (n = 7) were the fed experimental diets: a normal control diet, a hypercholesterolemic diet (HD), HD + LGG, HD + AV gel, and HD + LGG + AV gel.

RESULTS

Supplementation with LGG decreased serum total cholesterol by 32%; however, in combination with AV, the decrease was 43%. The decreases in triacylglycerol levels in the HD + LGG, HD + AV, and HD + LGG + AV groups were 41%, 23% and 45%, respectively. High-density lipoprotein increased by 12% in the HD + LGG + AV group, whereas very low-density and low-density lipoprotein values decreased by 45% and 30%, respectively. The atherogenic index in the HD + LGG + AV group decreased to 2.45 from 4.77 in the HD + LGG group. Furthermore, fecal Lactobacillus species counts increased significantly when LGG was fed in combination with the AV gel. The oral administration of LGG fermented milk alone or in combination with the AV gel increased cholesterol synthesis (3-hydroxy-3-methylglutaryl coenzyme A reductase expression) and absorption (low-density lipoprotein receptor expression), whereas cholesterol 7α-hydroxylase mRNA expression levels were lower in the HD + LGG and HD + LGG + AV groups compared with the control HD group.

CONCLUSION

The combination of LGG and AV gel may have a therapeutic potential to decrease cholesterol levels and the risk of cardiovascular diseases.

Photoperiod influences endogenous indoleamines in cultured green alga Dunaliella bardawil

Effect of light intensity and photoperiod on growth, indoleamines and carotenoid production was studied in unicellular green algae D. bardawil. Maximum biomass and carotenoid contents were found when cultures were grown in light (intensity of 2.0 Klux) at a photoperiod of 16/8h light and dark cycle. There was a profound influence of tested photoperiod conditions of light:dark viz. 8:16, 10:14, and 12:12 hr, continuous light on indoleamines (SER and MEL) production as estimated by HPLC and confirmed by mass spectral data obtained from LC-MS-ESI studies. Serotonin level increased from 908 to 1765 pg/g fresh wt with increase in light duration and melatonin level increased from 267 to 584 pg/g fresh wt during increase in dark phase. Carotenoids production was high in continuous light than other tested conditions.