Introduction: Competency-based medical education (CBME) is being implemented across India in medical colleges from the 2019 batch. The new aspects of this curriculum are introduction of a foundation course (FC); early clinical exposure; longitudinal program on attitudes, ethics, and communication; electives; emphasis on small group learning methods; assessment changes; and most importantly, a horizontally aligned and vertically integrated method of teaching–learning. The faculty members of medical colleges are the prime movers for implementing the CBME. The Medical Council of India (MCI) is imparting training about the new curriculum to the faculties of all medical colleges across India. All faculty members have not been able to get the requisite training in the latest changes as required for the new curriculum. This study is an attempt to analyze the awareness and perceptions of the faculty and the challenges envisaged in the implementation of CBME.
Materials and methods: All faculty members of our college were e-mailed a self-structured, prevalidated Google questionnaire. The results were analyzed by the inbuilt available Google statistical software.
Results: A total of 58 faculty members responded to the questionnaire. Of the 58 faculty members, 87.9% were aware about the CBME but only 51.7% felt that better doctors would be produced as a result of its implementation. Eighty-one percent were aware that small group teaching needs to be two-thirds of the total teaching hours in a particular subject but the small group teaching methods only few could enlist. Around 86.2% agreed that students should have early clinical exposure. Around 41.4% were not aware of the changes in internal assessment as proposed by CBME.
Conclusion: The faculty lacked uniformity in awareness and there was ambiguity on various aspects and constituents of CBME as proposed by the MCI. The proper implementation of CBME would require more clarity and continuous efforts by Medical Education Units (MEU) under guidance of the MCI to update their faculty in the form of Curriculum Implementation Support Programs (CISPs), Revised Basic Course Workshops (RBCWs), and advanced courses in medical education.
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Ravishanker R, Niharika D. Incidence, Etiopathogenesis, and a Preventive Protocol of Deep Vein Thrombosis in Severe Burns Patients at a Tertiary Care Teaching Hospital. Journal of Medical Academics 2019; 2 (1):6-10.
Deep vein thrombosis (DVT) a consequence of thromboembolism can lead to life threatening pulmonary embolism. A study was carried over 4 years from January 2014 to January 2018 to determine the incidence of DVT in severe burns cases admitted to the Burns Unit of a 1200 bed tertiary care medical college teaching hospital. In the retrospective study of 100 consecutive cases of severe burns the incidence of DVT was found to inordinately high. This study was carried out to determine the causes of DVT in these patients and formulate a protocol for the prevention of DVT. A further prospective study of 116 cases were studied following the introduction of the protocol. A dramatic decrease in the incidence was found. This protocol is recommended to be followed in all burns centres especially in teaching institutions.
Background: Domestic accidents leading to injuries form a major burden of morbidity in the population. Injuries, like other causes of morbidity, have their own environmental and individual risk factors.
Materials and methods: The study was conducted among 520 individuals belonging to 234 households of a suburban colony of Delhi. Environmental risk factors and occurrence of injuries due to domestic accidents in the last one year of the study were assessed.
Results: The prevalence of injuries was very high in the present study. A total of 418 injuries were reported (803 per 1000 person years). Cuts and falls were the most common injuries. Females, children, and elderly had suffered more injuries.
Conclusion: Most of the households are unsafe and hence the occurrence of injuries is very high. Majority of the injuries were mild and hence preventive education and knowledge for first aid may reduce the burden of injuries in the study population.
Sourya S Mohakuda
Background: Indian soldiers serve in extreme climatic conditions at uninhabitable altitudes. Only few studies and case reports have described various thrombotic disorders in soldiers serving in high altitude (HA). It is postulated that there is activation of intravascular coagulation cascade and factors such as low temperatures, dehydration, polycythemia, stress, and hypoxia have been implicated.
Aim: To study the spectrum of thrombotic disorders occurring in soldiers serving in high-altitude areas (>10,000 feet).
Setting: The study was conducted at a tertiary-level referral centre for troops deployed in HA regions. The study involved a retrospective analysis of records of patients presenting with thrombotic disorders while being posted to HA. The duration of the study was between February 2012 and March 2014.
Materials and methods: Diagnosis, patient particulars, all investigations (including the thrombophilia workup), and treatment given were recorded. Patients with any pre-existing diseases were excluded from the study. Descriptive statistics were used for data analysis.
Results: Totally, 69 male patients were presented with thrombotic disorders during the study period. Only 30 (43.4%) patients had pulmonary embolism, 18 (26%) cerebral venous thrombosis, 9 (13%) acute coronary syndrome, 7 (10.1%) deep vein thrombosis, 4 (5.7%) arterial stroke, and 1 (1.4%) had retinal vein thrombosis. An estimated 14 (20.2%) were smokers and 3 (4.3%) patients were highlanders. The procoagulant workup was positive in 10 (14.4%) patients, and 34 (49.2%) patients had polycythemia. The mean duration of stay at HA was 5 ± 2 months. There was no mortality.
Conclusion: Only 14.4% of patients showed prothrombotic states. The role of causative factors and the unknown prothrombotic condition in HA needs further investigation by trials involving a larger study population.
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Kaur G, Arora P, Maan A, Monga G, Vaidya R, Kumar A. Dietary and Lifestyle Modifications among Diabetic Patients at a Tertiary Care Hospital in Delhi: A Cross-sectional Study. Journal of Medical Academics 2019; 2 (1):20-24.
Background: Modern lifestyle changes combined with urbanization has led to increased prevalence of diabetes. To decrease the morbidity, mortality, and the complications of diabetes, comprehension of diet and physical exercise is a must.
Objectives: To assess the degree of awareness of diet, physical exercise, and lifestyle modifications among type 2 diabetics among the urban population of Delhi.
Materials and methods: The study was conducted using a pretested questionnaire among 100 type 2 diabetic patients attending the medicine outpatient department of a Tertiary Care Hospital, Delhi. Baseline parameters of the study participants were expounded and their awareness and practice regarding the lifestyle modifications were assessed.
Results: The mean age of the study population was found to be 50 ± 9.64. An estimated 74% were well aware of foods to be eluded; 54% were familiar with the quantity of food in food plate. The awareness of lifestyle modifications was good among 29% and practice was followed by 15% of diabetic patients.
Conclusion: Despite the clear attitudes of type 2 diabetes patients towards dietary pattern and healthy lifestyle modifications, the lifestyle awareness and practices were poor among the study group.
The role of luck in medical care has been acknowledged since times immemorial. Yet with more and more emphasis on evidence based medicine we tend to underplay it. This article provides many examples of how luck has been and always will be relevant in practice of medicine in the world.
Aim: The aim of the study was to highlight the diagnostic dilemma in diagnosis of right paraduodenal hernia.
Background: Internal abdominal hernias account for nearly 0.9% of all intestinal obstructions. Paraduodenal hernias (PDH) constitute nearly 50% of all internal hernias, left PDH being 3 times more common than right PDH. Initial presentation is nonspecific, but if missed can present with catastrophic outcomes (i.e., small bowel obstruction, ischemia, and bowel perforation).
Case description: A 38-years-old gentlemen was presented to emergency department with acute onset, intermittent colicky pain abdomen in the right lower quadrant with 2 episodes of vomiting of one-day duration. On examination, fullness in the right lumbar and iliac fossa region was noted and bowel sounds were found to be increased. Routine investigations were normal and USG Abdomen was inconclusive. CECT abdomen showed clustering of small bowel loops on the right side with bowel loops behind the SMA and SMV suggestive of right PDH. The patient was taken up for an emergency laparotomy. Intraoperatively, small bowel was seen herniating below the D3 of duodenum and clumped in the right iliac fossa. Superior mesenteric vessel was seen at the neck of the sac. A full Catell-Brasch maneuver was done to expose the neck of the sac to avoid a vascular injury and the sac was excised. An appendicectomy was done before placing a large bowel in the left hypochondrium.
Conclusion: With a high degree of suspicion and early radiological evaluation, we were able to clinch the diagnosis in the early stage. Prompt surgical intervention prevented the high morbidity and mortality associated with PDH in our patient.
Clinical significance: PDH remains an elusive diagnosis. A high degree of suspicion with early radiological evaluation is required for diagnosis. Prompt surgical intervention can prevent catastrophic outcomes associated with this condition.
Daya K Jha,
Partha B Mukherjee,
Introduction: Unilateral pulmonary edema can mimic as pneumonia and is often misdiagnosed.
Case description: We describe a case of cardiogenic unilateral lobar pulmonary edema in a HIV infected and diabetic patient without known history of cardiac disease.
Conclusion: Rarely, unilateral pulmonary edema can present as a lobar consolidation and be confused with pneumonia. High index of suspicion and response to treatment of heart failure can clinch the diagnosis.
Bharath N Kumar,
Irshad A Khan,
Aditya A Jha
Aim: The aim of the study was to report a case of postoperative pancreatic fistula (POPF) in the setting of a left cytoreductive nephrectomy.
Background: Pancreatic injury during nephrectomy is a rare complication with a reported incidence of 2.1% in laparoscopic left radical nephrectomy. It has not been described in the setting of cytoreductive nephrectomy (CN) and we report one such case.
Case description: A 61-years-old male underwent left CN for metastatic left renal mass. On the 5th postoperative day, there was spontaneous expulsion of the retroperitoneal drain, two days after which the patient developed a serous discharge of 25–30 mL per day from the drain site, which later became purulent. The patient was managed successfully with pigtail drainage of the collection, culture-sensitive antibiotics, and subcutaneous injection of octreotide.
Conclusion: Conservative management of POPF after nephrectomy in the form of drainage of retroperitoneal collection, antibiotics, somatostatin analogs, and discontinuing oral diet with total parenteral nutrition (TPN) (as indicated) is successful in most cases.
Clinical significance: A pancreatic injury during a left CN is a distinct possibility, which can be managed successfully by conservative means.