Evaluating a research methodology workshop among postgraduate students using Kirkpatrick's model

BACKGROUND

In this era of evidence-based medicine, only systematic research can help in providing judicious and precise healthcare to individual patients based on updated knowledge and skills. However, many medical professionals do not feel competent and confident enough to conduct research. One of the reasons could be the lack of a research-based curriculum in undergraduate courses. The National Medical Council has also stressed the need for formal training in research methodology for healthcare professionals. The research methodology workshops help to familiarize the participants with basic, clinical, and translational research required to impart optimum patient care. The objective of our study was to evaluate a research methodology workshop conducted for postgraduate students by assessing the participant's knowledge, feedback, and expected impact using Kirkpatrick's evaluation model.

MATERIALS AND METHODS

A quasi-experimental, single-group study was conducted among 132 first-year postgraduate students. The four levels of Kirkpatrick's model were applied for evaluation. Feedback forms, scores of the pretest and posttest, quality of the research proposal drafted by the postgraduates for their thesis, and finally successful submission of the research proposal were the components used to evaluate the four levels of outcome of Kirkpatrick's model.

STATISTICAL ANALYSIS

Data collected were compiled and tabulated into MS Excel. Proportions were calculated for categorical variables and mean and standard deviation (SD) for scores. A comparison of means between pre- and postworkshop scores was made with paired t-test. A value of P < 0.05 was considered statistically significant. Statistical analysis was done using IBM SPSS Statistics version 20.0 software.

RESULTS

Out of 132 participants, 29% (38) were males and 71% (94) were females. The mean ± SD pretest and posttest scores at a 95% confidence interval were 10.55 ± 2.537 and 12.43 ± 2.484, respectively. The difference was found to be statistically significant by paired sample t-test (P < 0.001).

CONCLUSION

Participant feedback is vital for improving research methodology workshops. The workshop met the overall requirements of the participants. There was a significant improvement in the knowledge of participants after the workshop completion.

Evaluation of 'Normal' Cognitive Functions and Correlation With MRI Volumetry: Towards a Definition of Vascular Cognitive Impairment

Introduction It is important to establish criteria to define vascular cognitive impairment (VCI) in India as VCI is an image-based diagnosis and magnetic resonance imaging (MRI) changes resulting from age with prevalent vascular risk factors may confound MRI interpretation. The objective of this study was to establish normative community data for MRI volumetry including white matter hyperintensity volume (WMHV), correlated with age-stratified cognitive scores and vascular risk factors (VRFs), in adults aged 40 years and above.  Methods We screened 2651 individuals without known neurological morbidity, living in Mumbai and nearby rural areas, using validated Marathi translations of Kolkata Cognitive Battery (KCB) and geriatric depression score (GDS). We stratified 1961 persons with GDS ≤9 by age and cognitive score, and randomly selected 10% from each subgroup for MRI brain volumetry. Crude volumes were standardized to reflect percentage of intracranial volume.  Results MRI volumetry studies were done in 199 individuals (F/M = 90/109; 73 with body mass index (BMI) ≥25; 44 hypertensives; 29 diabetics; mean cognitive score 76.3). Both grey and white matter volumes decreased with increasing age. WMHV increased with age and hypertension. Grey matter volume (GMV) decreased with increasing WMHV. Positive predictors of cognition included standardized hippocampal volume (HCV), urban living, education, and BMI, while WMHV and age were negative predictors. Urban dwellers had higher cognitive scores than rural, and, paradoxically, smaller HCV.  Conclusion In this study of MRI volumetry correlated with age, cognitive scores and VRFs, increasing age and WMHV predicted lower cognitive scores, whereas urban living and hippocampal volume predicted higher scores. Age and WMHV also correlated with decreasing GMV. Further study is warranted into sociodemographic and biological factors that mutually influence cognition and brain volumes, including nutritional and endocrine factors, especially at lower cognitive score bands. In this study, at the lower KCB score bins, the lack of laboratory data pertaining to nutritional and endocrine deficiencies is a drawback that reflects the logistical limitations of screening large populations at the community level. Our volumetric data which is age and cognition stratified, and takes into account the vascular risk factors associated, nevertheless constitutes important baseline data for the Indian population. Our findings could possibly contribute to the formulation of baseline criteria for defining VCI in India and could help in early diagnosis and control of cognitive decline and its key risk factors.

COVID-19 Mortality in the Delta Wave in India: A Hospital-Based Study From Ramanagara District, Karnataka

INTRODUCTION

Coronavirus 19 (COVID-19) disease spread rapidly over the world since its inception in December 2019 in Wuhan, China. India too was crippled by the burden of high caseloads and deaths. The first death caused by COVID-19 in Karnataka was reported on March 13, 2020. There is a plethora of information on the descriptive statistics, epidemiology, and management of COVID-19 cases. However, there has not been an in-depth and extensive exploration of COVID-19 mortality data in terms of published research from India. The study area was a 300 bedded tertiary care center in Ramnagara district, Karnataka. During the second wave, 150 beds were dedicated to COVID-19 cases referred from government centers. This study was carried out to assess the in-hospital mortality at this institute during the second wave. The expected outcome of this study was to shed light on co-morbidities associated with mortality, the age and sex distribution in mortality, and any other significant factors influencing mortality due to COVID-19.

METHODOLOGY

A hospital-based, retrospective, and observational-analytical study was carried out during April-August 2021, the second wave of COVID-19. The data included all deaths recorded in-hospital during the dedicated COVID-19 referral center status. Data were collected from case sheets and mortality audit forms that included basic demographics, symptoms, co-morbidities, admission pathway, transfer to ICU, oxygen therapy, ventilator requirement, duration of hospitalization, laboratory profile, and management modalities prior to death. Data were compiled into Microsoft Excel and were analyzed with JASP software (open source). Data were interpreted in terms of frequencies, averages with standard deviation, and bivariate and multivariate analysis.

RESULTS

 We analyzed mortality audits of 91 adult patients and one neonate. The male-to-female ratio was 1.67:1 (> 60% male), with an average age of 53.4 years (standard deviation 15.4 years). Most of the patients fell in the age range of 36 to 65 years (65%). The average duration was 5.6 days (range 0-35 days). The most common symptom was fever (84, 92.31%), followed by breathlessness (77, 84.62%) and fatigue (65, 71.43%). Only 10 had a positive contact history and only one patient reported travel to a containment zone. The source of infection was indeterminate in the majority of cases. Diabetes mellitus and hypertension were the commonest associated comorbidities. Almost three-quarters of the patients were tachypneic at admission and nearly 90% had low levels which included 43 patients with critically low SpO2. The inflammatory indicators, such as WBC count, CRP, and d-dimer, were raised in many patients (WBC count raised in 40% and d-dimer, CRP raised in > 50% of cases). A striking 83% of the patients had hyperglycemia. The most common immediate cause of death pertained to the respiratory system (ARDS, refractory hypoxia, respiratory) in more than half of the patients.

CONCLUSION

 This study reported the clinical and laboratory characteristics of 91 adult COVID-19 mortality cases at a teaching hospital at the peak of the Delta wave in Karnataka. While inflammatory indicators such as WBC count, CRP, and d-dimer were raised in many patients, our most remarkable finding was the high frequency of hyperglycemia. The findings of our study would contribute to enhancing the understanding of the clinical correlates and progression of COVID-19.

A cross-sectional study of anthropometry and immunization coverage of Anganwadi children in a rural area of Karnataka

Background

Children are a supreme asset to a nation. Beginning six years of life is pivotal for the social, emotional, cognitive, physical, motor, and psychological upbringing of the child. National Family Health Survey (NFHS) 5 data shows 41.9% of children die before the age of five years, with greater mortality in the rural areas (45.7%). The present study was conducted to assess the anthropometric profile and immunization status of children in Anganwadi centers.

Materials and Methods

A community-based cross-sectional study was conducted in 21 Anganwadi centers in a rural area in South India. The anthropometry (height, weight, mid-upper arm circumference), morbidity profile, and immunization status of the enrolled and available children were assessed with the help of WHO growth charts, Salter scale, clinical examination, immunization cards, and data from Anganwadi registers.

Statistical analysis

Data were compiled and analyzed using SPSS software version 20. Descriptive data were interpreted as mean and percentages and associations were tested with the Chi-square test, and Fisher's exact test. A P value of <0.05 was considered to be statistically significant.

Results

Around 400 children, aged 0-6 years, participated in the study. The mean age of the study population was 42.08 ± 12.55 months. The overall prevalence of underweight, stunting, and wasting was 52%, 54%, and 47.5% respectively. The most common morbidity was upper respiratory tract infection (11.5%). A majority (97.5%) of children were found to be immunized appropriately as per age.

Conclusion

The prevalence of malnutrition was alarmingly high which warrants urgent referral and follow-up. The ICDS services, although substantially beneficial, need focal strengthening with regard to the nutritional status of enrolled children.

A Rare Case of Focused Pulling Type of Trichotillomania Presenting as Dermatological Pathomimicry

Nonhealing ulcers are defined as spontaneous or traumatic lesions, unresponsive to initial therapy, or which persist despite appropriate care. Trichotillomania (TTM) is an impulse control disorder, where severe form may cause ulcer and scarring. After extensive research, we could not find any case showing the association of TTM with large-sized factitious ulcer. Hence, we report a rare case of 30 year old female presenting with TTM and large sized factitious ulcer.

Use of POSSUM (Physiologic and Operative Severity Score for the Study of Mortality and Morbidity) and Portsmouth-POSSUM for Surgical Assessment in Patients Undergoing Emergency Abdominal Surgeries

INTRODUCTION

The POSSUM (Physiologic and Operative Severity Score for the Study of Mortality and Morbidity) and Portsmouth-POSSUM (P-POSSUM) models have been popularly recommended as appropriate for predicting postoperative mortality and morbidity in surgical practice. This study aims to evaluate the efficacy and accuracy of both scoring systems for surgical risk assessment in predicting postoperative mortality and morbidity in patients undergoing emergency abdominal surgeries.

METHODOLOGY

The study was conducted as a part of a post-doctoral fellowship program. A total of 150 patients, undergoing emergency abdominal surgery in a tertiary care hospital in Bhubaneswar, were evaluated using POSSUM and P-POSSUM. Physiological scoring was done prior to surgery and operative scoring was performed intra-operatively. Patients were followed up for 30 days after the operative period. The observed mortality rate was then compared with POSSUM and P-POSSUM predicted mortality rates.

RESULTS

POSSUM predicted a morbidity rate of 116, whereas the actual morbidity rate was 92 (p < 0.05). P-POSSUM predicted a morbidity rate of 109, whereas the actual morbidity rate was 92 (p < 0.05). POSSUM predicted a mortality rate of 23, whereas the actual mortality rate was 21 (p < 0.05). P-POSSUM predicted a mortality rate of 25, whereas the actual mortality rate was 21 (p < 0.05).

CONCLUSIONS

With a reasonably good prediction of morbidity and mortality rate, POSSUM and P-POSSUM scores are both effective scoring systems in clinical practice for use in abdominal surgery.

Geospatial Hotspot Analysis and Endemicity Trends of Missing and Unrecovered Children in India

BACKGROUND

Children constitute a nation's true asset. A country's future relies upon the proper development of its children, which necessitates a supportive environment and sufficient opportunities. Children, under the age of 18 years form a considerable percentage of India's population which imparts a huge responsibility for the nation. Everyday we come across news about a child going missing. The National Crime Record Bureau (NCRB) states that 73,138 children were reported missing overall in 2018. The prevalence increased by 8.9% in 2019, a worrisome situation. The cause behind children going missing is multi-dimensional like poverty, unemployment, loss of livelihood, natural calamities, social conflicts, and migration to urban areas. At present, missing children remain a neglected and non-urgent intervention area for everyone. Only the parents whose children are missing can feel the vacuum and sorrow of the situation. The sociologies of India's missing children merit dimensional and circumstantial examination. The sociological space into which a child goes missing is highly under-researched in India. This study helped in understanding the magnitude of missing cases across India based on existing literature and secondary sources. It also identified the potentially safe and worst areas with regard to missing children. The endemicity helped in identifying the changing trends in each of these areas of interest, which could serve as baseline data for policymakers and law enforcement alike.

MATERIALS AND METHODS

This is a cross-sectional analytical type of study. The data of missing and unrecovered children for the past five years (2021-2017) were obtained from open government data portal (https://data.gov.in) and geospatial hotspot analysis was done using the Getis-Order-G statistics on the same using GeoPandas and PySAL libraries of python. The endemicity of missing cases was studied using hierarchical cluster analysis and self-organizing maps using Python.

RESULTS

For boys, Uttar Pradesh, Rajasthan, and Madhya Pradesh remained consistent hotspots (high risk of missing cases) across all five years of study whereas Karnataka became a hotspot for 2020 and 2021. Among the cold spots (low risk of missing cases), Andaman and Nicobar Islands remained consistent cold spot across all five years of study and has emerged as a safe haven for boys. The missing girls' data reveals that Uttar Pradesh has consistently been the worst state for girls (along with their neighbors) as it possess the risk of girls going missing all through the study period with Chhattisgarh being included from 2019 onwards. Jharkhand, Gujarat, Sikkim, and Andaman and Nicobar Islands have consistently been cold spots across the board and have emerged as areas with low risk for missing girls.

CONCLUSION

This study helps us in understanding the magnitude of missing cases across India and it also identifies which are potentially safe areas as well as worst areas with regard to missing children. The endemicity also helps us in identifying the changing trends in each of these areas of interest. This will serve as a great resource for policy makers and law enforcement alike.

Comparison of efficacy of diode laser in patients of facial hirsutism with normal dehydroepiandrosterone sulfate and dihydrotestosterone versus deranged dehydroepiandrosterone sulfate and dihydrotestosterone level - A Longitudinal study

INTRODUCTION

Hirsutism is defined as an excessive terminal hair growth in female over male pattern distribution areas. Traditional methods of hair removal have been replaced by lasers.

OBJECTIVE

To observe the effect of diode laser in hirsutism patient with normal and deranged dehydroepiandrosterone sulfate (DHEAS) and dihydrotestosterone (DHT) level.

MATERIALS & METHODS

50 patients of facial hirsutism with skin type IV and V were enrolled. 18 patients with deranged dehydroepiandrosterone sulfate and dihydrotestosterone level were allocated in group A whereas 16 patients with normal level were allocated in group B. Three sittings of diode laser was done in all subjects with varying session within a period of 6 months.

RESULT

At first follow-up visit, the percentage of hair reduction was fair in 62.5% of patients in group B and 16.7% of patients in group A, whereas at second follow-up visit, it was good in 56.3% of patients in group B and 11.1% of patients in group A. Increase in vellus hair and reduction in percentage of terminal hair were more significant in group B. Hair free interval and satisfaction level was significantly higher in group B.

CONCLUSION

Diode laser is effective mode of treatment in hirsutism patient irrespective of hormone level. But, the effect is observed to be more efficacious in patients with normal DHEAS & DHT level.

EVALUATION OF INAPPROPRIATE PRESCRIPTIONS IN THE GERIATRIC POPULATION OF AN URBAN SLUM IN BANGALORE

Although the over 60 years age population constitutes approximately 8% of the total population, 30% of total medication is prescribed for this age group. Chronic diseases and polypharmacy in the elderly population increase the risk of inappropriate drug use. Some physicians prescribe medications without reviewing other supplements and medications used by the elder patient. This polypharmacy results in many adverse drug interactions and reactions. The purpose of this study was to identify older patients who were prescribed inappropriate drugs, according to START/STOPP criteria. To estimate the prevalence of inappropriate prescriptions amongst the elderly residing in an urban slum under the field practice area of Urban Health and Training Center (UHTC) of a tertiary medical college; to assess polypharmacy and morbidity pattern in these elderly. A cross-sectional study was conducted among the elderly, aged 65 years and above, residing in an urban slum under the field practice area of a tertiary medical college. A total of 215 elderly were chosen from the study area by simple random sampling. Data regarding socio-demographic profile and medication usage was collected using a pre-tested semistructured questionnaire through individual interview. START/STOPP criteria were used to identify potentially inappropriate prescriptions. The prevalence of PIPs was 43.3% and of PIOs was 20.9%. Polypharmacy was found in 36.7% of elderly population. Mean number of medications used by the study population was 6.19±2.43 (range was 1-10). The most common morbidity present in the study population was Arthritis in 34.9% followed by hypertension in 13% (28) of elderly. The faulty prescription commissions and omissions have created a significant issue of polypharmacy. This study only provides a baseline data about inappropriate prescriptions and polypharmacy. A multi-pronged approach, involving healthcare workers and policy makers is required to address this issue to optimize the elderly pharmacotherapy and thus health care.

Secukinumab in Erythrodermic Psoriasis: Real World Experience of 6 Patients Successfully Treated by Injecting at Unconventional Sites

Biologics which are given subcutaneously are usually injected at certain prementioned sites such as the upper arms, thighs, or any quadrant of the abdomen. In erythrodermic patients, these conventional sites are usually affected. In our series of six patients of psoriatic erythroderma, we selected unconventional apparently spared sites to inject secukinumab subcutaneously which returned similar results as compared to injecting at conventional sites as reported by other studies.

Combination of 1064-nm Q-switched neodymium-doped yttrium-aluminum-garnet laser with Modified Jessner's peel for the treatment of Nevus of Ota: A case series of seven patients

1064-nm Q-switched Nd: YAG (neodymium-doped yttrium-aluminium-garnet) laser is widely used for the treatment of Nevus of Ota but multiple treatments are necessary for clinical improvement. Superficial chemical peeling using Modified Jessner's solution has been used for the treatment of facial pigmentation but repetitive chemical peeling can cause irritation and post-inflammatory hyperpigmentation. In this series, we evaluated seven patients who were treated with a combination of 1064-nm Q-switched Nd: YAG laser and Modified Jessner's peel for eight sessions with 85.7% patients showing more than 50% reduction in pigmentation. The added therapeutic benefit of the combination helped to achieve a significant reduction in pigmentation faster with a lesser number of sessions and reduced cost.

Study to assess internet usage patterns and prevalence of internet addiction among medical and engineering students of Bengaluru city

Background: Internet has become today, one of the most powerful tools for everybody, playing major roles in the life of adolescents. In tandem with the splurge in access to the Internet globally, with the rise of new-generation gadgets, the risk of “internet addiction” is emerging as a significant behavioral addiction pandemic to be tackled worldwide.Methods: A cross sectional study was carried out among 200 medical and engineering students, with 100 selected from each course. Data on internet usage patterns was collected by administering a semi-structured pre-tested questionnaire. Prevalence of internet addiction was estimated by using Young’s internet addiction scale.Results: The mean age of the participants was 18.85±0.197 years, among which 52% were females and 48% were males. While assessing internet usage patterns, it was found that the frequency of years of internet usage for 1-5 years was 80% (160) and that of internet use per day for 0-2 hours was 50.5% (101). Both these factors were significantly associated with internet addiction. Most common location of internet access was hostel, i.e. 51.5% (103). 93.5% (187) of students used Mobile phones and social media was found to be the main purpose for internet use which was 60% (120). Totally 67% (134) of medical and engineering students had internet addiction.Conclusions: The present study highlights the vulnerability of professional college students for internet addiction. Large scale epidemiological studies should be undertaken to assess the real problem and thereby take appropriate steps to tackle the growing problem.