Amir Maroof Khan

Determinants of delay in initiating post-exposure prophylaxis for rabies prevention among animal bite cases: hospital based study.

BACKGROUND India is highly endemic for rabies. Although fatal, rabies is a preventable disease. Several factors interfere with the timely utilization of post exposure prophylaxis (PEP) in the population. There is a need to explore the factors leading to delay in PEP initiation. OBJECTIVE To study the factors associated with delay in initiation of PEP among animal bite cases attending anti-rabies clinic in the out-patient department (OPD) of a hospital in Delhi. MATERIALS AND METHODS A cross-sectional hospital based study was conducted among 200 patients attending the anti-rabies clinic. After obtaining informed consent, the patients were interviewed using a pre-tested, semi-structured questionnaire to find out the delay in initiation of PEP and the factors associated with it. RESULTS Most common biting animal was found to be dog (96%). Out of the studied subjects (n=200), 134 (67%) were males, 123 (61.5%) were from rural areas and 61 (30.5%) were illiterate. Delay in initiation (vaccine initiation in more than or equal to 48 h) of PEP was found among 41% of the studied subjects. The mean time spent during each visit by the study subjects were 3.46 h (SD 1.60). Delay was more likely in people living at a distance of more than 10 km from the vaccination centre (p<0.001) and with a monthly family income less than 5000 INR (p=0.004). Delay showed an increasing trend with age (p=0.041). Most commonly cited reasons by the respondents (n=82) for the inability to come early for vaccination included work related barriers (42.68%), anti-rabies clinic being closed on Sundays/national holidays (36.59%) and unawareness about timely PEP (31.71%). CONCLUSION Accessibility and lower economic status were the major factors associated with delay in initiation of PEP for rabies prevention.

Filtered Sunlight for Treatment of Neonatal Hyperbilirubinemia.

In this randomized, controlled non-inferiority trial, filtered sunlight was compared with conventional phototherapy for the treatment of hyperbilirubinemia in term and latepreterm neonates. The primary end point was efficacy, which was defined as a rate of increase in total serum bilirubin of less than 0.2 mg/dL/h for infants up to 72 hours of age or a decrease in total serum bilirubin for infants older than 72 hours of age who received at least 5 hours of phototherapy. Authors pre-specified a non-inferiority margin of 10% for the difference in efficacy rates between groups. The need for an exchange transfusion was a secondary end point. Safety, which was defined as the absence of the need to withdraw therapy because of hyperthermia, hypothermia, dehydration, or sunburn, was also assessed. Of the total 447 infants, 224 were randomly assigned to filtered sunlight and 223 to conventional phototherapy. Filtered sunlight was efficacious on 93% of treatment days that could be evaluated, as compared with 90% for conventional phototherapy, and had a higher mean level of irradiance (40 vs. 17 μW/cm2/nm; P<0.001). No infant met the criteria for withdrawal from the study for reasons of safety or required an exchange transfusion. Authors concluded that filtered sunlight was non-inferior to conventional phototherapy for the treatment of neonatal hyperbilirubinemia.

Types of observational studies in medical research

Study design forms a core component of research, mainly determined by the study objectives, and it in turn further decides the type of statistical analyses to be carried out. Observational studies are devoid of the investigator′s control over assignment of a subject to the treated or control group, in contrast to interventional studies Even though randomized controlled trials are seen as the best study design, evidence shows that properly conducted observational studies give similar results, and is relevant in medical research where ethics and feasibility concerns assume great significance. Observational studies point out towards possible causal associations, are less resource intensive than trials and have a better external validity. This review article discusses various types of observational study designs such as case reports, cross sectional, cohort, case-control and nested case-control studies with real literature examples.

Fine needle aspiration biopsy: An entrustable professional activity in cytopathology postgraduate training

Context: In the context of competency-based medical education being advocated worldwide, fine needle aspiration biopsy (FNAB) is considered as an entrustable professional activity (EPA). There is no information regarding how much time and training are required to achieve a “competent level” for performing and documenting FNAB in the Indian context. Aim: To determine the time taken by an average postgraduate pathology trainee to become competent in performing FNAB with respect to history taking, clinical examination, and fine needle aspirate adequacy. Settings and Design: A descriptive, retrospective, chart-based audit was conducted in the Department of Pathology. Materials and Methods: FNAB chart records documented during 3 years of postgraduate training by a cohort of 13 postgraduate (PG) resident trainees admitted in 2010 were included in the study. Adequacy rates and criteria for adequacy were defined for the purpose of the study. Statistical analysis: Data was entered in MS Excel and analyzed using the Statistical Package for the Social Sciences version 20.0. The adequacy rates are presented as percentages and time taken to achieve adequacy rates as median values. Results: A total of 3272 charts were audited. Median time taken to achieve 85% adequacy rate for history taking, for clinical examination by the first and the second criteria, and for FNAB were 1 month, 1 month and 3.5 months, and 1 month, respectively. Conclusions: Although the mean time taken to achieve 85% adequacy rates for FNAB was 1 month, there was wide variation in the time durations between the residents to achieve this level.

Reporting statistics in biomedical research literature: The numbers say it all

AMIR MAROOF KHAN AND *SIDDARTH RAMJI From the Department of Community Medicine, University College of Medical Sciences and GTB Hospital, and *Department of Neonatology, Maulana Azad Medical College and associated Lok Nayak Hospital; New Delhi, India. Correspondence to: Dr. Amir Maroof Khan, Associate Professor, Department of Community Medicine, University College of Medical Sciences and GTB Hospital, Dilshad Garden, Delhi, India. khanamirmaroof@yahoo.com

Data entry skills in a computer-based spread sheet amongst postgraduate medical students: A simulation based descriptive assessment

Background: In India, research work in the form of a thesis is a mandatory requirement for the postgraduate (PG) medical students. Data entry in a computer-based spread sheet is one of the important basic skills for research, which has not yet been studied. This study was conducted to assess the data entry skills of the 2nd year PG medical students of a medical college of North India. Materials and Methods: A cross-sectional, descriptive study was conducted among 111 second year PG students by using four simulated filled case record forms and a computer-based spread sheet in which data entry was to be carried out. Results: On a scale of 0-10, only 17.1% of the students scored more than seven. The specific sub-skills that were found to be lacking in more than half of the respondents were as follows: Inappropriate coding (93.7%), long variable names (51.4%), coding not being done for all the variables (76.6%), missing values entered in a non-uniform manner (84.7%) and two variables entered in the same column in the case of blood pressure reading (80.2%). Conclusion: PG medical students were not found to be proficient in data entry skill and this can act as a barrier to do research. This being a first of its kind study in India, more research is needed to understand this issue and then include this yet neglected aspect in teaching research methodology to the medical students.