Performance and preference of problem-based learning (PBL) and lecture-based classes among medical students of Nepal

Background: PBL (problem based learning) is new active learning educational strategy that has been extensively tested and used in recent years. Patan Academy of Health Sciences (PAHS) is one of medical schools from Nepal, a Low Income Country (LIC) implementing PBL for undergraduate medical education. This study aims to compare PAHS students' understanding and knowledge retention when taught through PBL and lecture-based classes and compare students' perceptions of PBL and lectures in medical education. Methods: This is a cross-sectional study of medical students of a PBL based medical school in Nepal, a non-Western low-income country. Ethical approval was given by the institutional research committee of the Patan Academy of Health Sciences. Understanding and knowledge retention was assessed with 50 vignette-based multiple-choice questions, half of which were taught through PBL sessions, and the remaining half were taught in didactic lectures during basic science years of medical school. A separate pre-validated perception questionnaire was used to assess students' preferences regarding PBL and lectures. Results: Out of 107 students, 99 participated in the understanding and knowledge retention questionnaires and 107 completed perception questionnaires. Understanding and knowledge retention of students was found to be the same for topics taught by PBL and lectures, with median scores of 17 and s16, respectively. PBL were mostly preferred for the physiology (59.81%), pathology (51.40%) and pharmacology (53.27%) concepts, and lectures were mostly preferred for the anatomy (78.50%), biochemistry (45.79%), and microbiology (42.99%) topics. Students wanted the same concepts to be taught through both PBL and lectures, especially for anatomy. Conclusions: Understanding and knowledge retention is the same for topics taught by either PBL or lectures during the basic science years of undergraduate medical education. Students prefer PBL for physiology, pathology, and pharmacology-related concepts, conventional didactic lecture for physiology and microbiology, and a combination of lecture and PBL sessions for anatomy.

Lichenoid drug reaction to isoniazid presenting as exfoliative dermatitis in a patient with acquired immunodeficiency syndrome

Human immunodeficiency virus-infected patients are at increased risk of drug reactions because of immune dysregulation and multiple drug intake. Lichenoid drug reactions to isoniazid have been reported previously in the literature. However, for lichenoid drug reaction to isoniazid to be so extensive to present as exfoliative dermatitis is rare. We report here a rare case of lichenoid drug reaction to isoniazid presenting as exfoliative dermatitis in a patient with acquired immunodeficiency syndrome.

Histological pattern of esophageal cancer at BP Koirala memorial cancer hospital in Nepal: a three year retrospective study

Background: The incidence of esophageal adenocarcinoma is increasing in trends. Squamous cell carcinoma is associated with tobacco and alcohol consumption. Adenocarcinoma is often associated with a history of gastroesophageal reflux disease and Barrett's esophagus. The aim of this study was to find out the histological pattern of esophageal cancer in one of the largest Cancer center in Nepal.Materials and Methods: Between January 2008 and December 2011, a total of 106 cases of esophageal cancer were received in the department of pathology, BP Koirala Memorial Cancer Hospital. Relevant clinical data were retrieved from computer database of the hospital.Results: A total of 106 cases of esophageal carcinomas were diagnosed during a three years period. There were 68 (64.15%) cases of squamous cell carcinoma, 33 (31.13%) cases of adenocarcinoma including signet ring cell carcinoma, 4 (3.76%) cases of undifferentiated carcinoma and 1 (0.94%) case of small cell carcinoma. The esophageal cancer was most common in the age group of 61-70 years of age. Distal third of esophagus was the most common site for esophageal carcinoma, followed by middle esophagus and proximal esophagus.Conclusion: The most frequent type of esophageal carcinoma is squamous cell carcinoma followed by adenocarcinoma. Distal esophagus is the most common site with male preponderance.Journal of Pathology of Nepal (2012) Vol. 2, 277-281DOI: http://dx.doi.org/10.3126/jpn.v2i4.6877

Orthotopic neobladder urinary diversion for carcinoma of urinary bladder

BACKGROUND

Invasive cancers of urinary bladder need radical cystectomy as an optimal treatment. Urinary diversions of different types are available after the procedure. Orthotopic neo-bladder reconstruction is an emerging technique of diversion in suitable patients. The aim of this study was to see the outcome of this procedure in our set up.

METHODS

The patient with carcinoma of urinary bladder who underwent radical cystectomy and orthotopic neo- bladder reconstruction during five year period were included in the study from department of surgical oncology in a hospital. Studer type ileal pouches were made in all the patients and their outcomes were studied.

RESULTS

There were 30 patients among which 28 were male and 2 female. Age ranged from 38-60 years with mean age of 49.6 years. Average operative time was 330 minutes. Average hospital stay was 16 days (range 14-30 days). Majority of patients were transitional cell carcinoma 26 (86.7%) in histology. Majority of cases presented in stage II (53.3%). Post-operative complications were ileus in 30%, urinary leak in 26.6% and pneumonia in 13.3% of patients. Mortality was 1 (3.3%) on 29th postoperative day. Patients were able to micturate with satisfactory stream postoperatively.

CONCLUSIONS

Orthotopic neobladder has similar complication rates compared with other forms of continent diversions. This method gives less psychological trauma to the patients with higher acceptance. So we recommend transforming the technique from ileal conduits to neobladder in well-established pelvic reconstruction set ups.

SURGICAL TREATMENT OF CARCINOMA OESOPHAGUS AT B P KOIRALA MEMORIAL CANCER HOSPITAL, BHARATPUR

To review resectability, lymph node status and post-operative complications in cases of carcinoma ofoesophagus treated surgically at B P Koirala memorial cancer hospital (BPKMCH), we reviewed the medicalrecords of 16 surgically treated cases of carcinoma oesophagus from January 2001 to March 2002. Therewere 5 patients in stage IIa and 9 patients in stage III. Tumor was resectable in 14 out of 16 patients (87.5%).There was no perioperative mortality. Anastomotic leak was seen in one case. Out of 14 resected specimens,7 (50%) of them had lymph node metastasis. Oesophagectomy is a safe procedure if done in a well-selected group of patients. Resectability is considerably high with minimal perioperative complications.Key Words: Carcinoma oesophagus, surgical therapy, lymphnode metastasis.

Recurrent "unexplained" scalp swelling in an eighteen-month-old child: an atypical presentation of angioedema causing confusion with child abuse

In this article, we demonstrate that angioedema may atypically present with noninflammatory scalp or facial swelling without recurrence on other parts of the body and without urticaria. In a young child, such a presentation exclusively with recurrent "unexplained" swellings over different parts of the scalp could erroneously be misconstrued as child abuse (blunt head trauma).