Ashok K Shenoy

Assessment of Learning Styles of Undergraduate Medical Students Using the VARK Questionnaire and the Influence of Sex and Academic Performance.

While there are several tools to study learning styles of students, the visual-aural-read/write-kinesthetic (VARK) questionnaire is a simple, freely available, easy to administer tool that encourages students to describe their behavior in a manner they can identify with and accept. The aim is to understand the preferred sensory modality (or modalities) of students for learning. Teachers can use this knowledge to facilitate student learning. Moreover, students themselves can use this knowledge to change their learning habits. Five hundred undergraduate students belonging to two consecutive batches in their second year of undergraduate medical training were invited to participate in the exercise. Consenting students (415 students, 83%) were administered a printed form of version 7.0 of the VARK questionnaire. Besides the questionnaire, we also collected demographic data, academic performance data (marks obtained in 10th and 12th grades and last university examination), and self-perceived learning style preferences. The majority of students in our study had multiple learning preferences (68.7%). The predominant sensory modality of learning was aural (45.5%) and kinesthetic (33.1%). The learning style preference was not influenced by either sex or previous academic performance. Although we use a combination of teaching methods, there has not been an active effort to determine whether these adequately address the different types of learners. We hope these data will help us better our course contents and make learning a more fruitful experience.

Study of risk factors and prevalence of invasive candidiasis in a tertiary care hospital

Introduction: The frequency of invasive mycoses has increased dramatically during the past two decades owing to medical advances such as intensive cancer chemotherapy, broad-spectrum antimicrobial therapy, invasive medical devices, organ transplantation, human immunodeficiency virus (HIV) disease epidemic and an expanding aging population. There were few Indian studies regarding the incidence and risk factors for candidemia. Hence the aim of this work was to evaluate the changes in the prevalence of candidemia and invasive candidiasis in a tertiary care hospital and also to assess the risk factors and predictors of mortality Materials and Methods: Nonsystematic review of patients with candidemia/invasive candidiasis was done during the period 1999 to 2004. All in-patients who had shown signs and symptoms of nosocomial blood stream infection were screened for candidial infection. Among these, 29 patients had candidemia/invasive candidiasis. Demographic and clinical data of these patients were recorded on a standardized form, which included age, sex, site of isolation, infectious diagnosis, underlying conditions, predisposing factors, catheter status and clinical outcome. The data were collected during the years of 1999 to 2004, which is divided into two time periods (1999-2001 and 2002-2004). Data collected during these different time spans are compared with each other. Results: A total of 255 patients were screened during the study period. Among these, 100 patients were screened during the period 1999-2001 and 155 patients were screened during the year 2002-2004. Out of these patients, 29 showed positive cultures in blood or other sterile site (ascitic fluid, bronchial aspirate and urine from suprapubic puncture). Out of these, 24 were males and five were females. The most common risk factor was use of intravenous canulae (62.1%), followed by prolonged use of antibiotics (34.5%) and HIV infection (24.1%). There were no statistically significant differences in the risk factors during the two different study periods. Candida was mainly isolated from blood (75.9%). Other sources included ascitic fluid (10.4%), bronchial aspirate (3.4%), sputum (3.4%) and urine (6.9%). Distributions of sources were comparable during the two study periods. Candida albicans, Candida tropicalis and Candida parapsilosis caused 89.7%, 3.4%, 6.9% of the candidemia episodes respectively. The overall mortality was 51.7%. Conclusion: The present study emphasizes the importance of candidemia among hospitalized patients. Continued surveillance of candidemia will be important to track trends of this serious infection and to document changes in its epidemiological features. More active screening in high-risk groups should be done to avoid diagnostic delay. Risk factors like prolonged use of multiple antibiotics, central venous catheters, mechanical ventilation and prolonged hospital stay should be restricted whenever possible. Timely use of antiretroviral drugs and other measures to improve the immunity of HIV patients may help to decrease the incidence of candidemia in this patient population.

Impaired Glucose Tolerance and its Association to Oral Cancer

Background: Diabetes mellitus is a serious and leading health problem worldwide and is associated with severe acute and chronic complications that negatively influence both the quality of life and survival of affected persons. Growing epidemiologic evidence suggests that people with diabetes are at significantly greater risk for cancer in general and recent studies also demonstrated that glucose intolerance was associated with a higher risk of oral cancer death, beginning in the prediabetic range of glucose intolerance. Aim: We undertook this study with the aim of finding out an association between impaired glucose tolerance and oral cancer along with finding out prevalence of other risk factors for oral cancer. Subjects and Methods: 45 cases and 45 controls were selected for the study. Oral glucose tolerance was performed on subjects who satisfied inclusion criteria and were willing to sign informed consent form. Results and Conclusion: Fifty three percent of the cases had abnormal glucose tolerance as compared to Thirty one percent of the controls. It was statistically significant with a p value of 0.032. To conclude, hyperglycemia (which includes IFG, IGT and diabetes) increase the risk of oral cancer two folds, however Impaired Glucose tolerance alone as defined by ADA does not appear to play a role.

The pain management in orthodontics.

Pain and discomfort are the frequent side-effects of the orthodontic therapy with fixed appliances. The people who experience orthodontic pain are likely to self-medicate with nonprescription pain relievers before seeing the dentist. It is imperative for an orthodontist to address questions that might arise in a clinical setting from the viewpoint of the clinicians and the patients/parents. This article will provide an overview of the current management strategies which are employed for alleviating orthodontic pain.

Serum C peptide level and renal function in diabetes mellitus.

C peptide is an active peptide hormone with potentially important physiological effects. C peptide has the capacity to diminish glomerular hyperfiltration and reduce urinary albumin excretion in both experimental and human type 1 diabetes. The present study is aimed at correlating the serum C peptide level with that of renal clearance, urinary albumin excretion and duration of diabetes. This is a prospective cross sectional study. Patients with diagnosis of type 2 diabetes mellitus were evaluated for their baseline clinical and laboratory profile. Both males and females above the age of 18 years were included in the study. The laboratory investigations include fasting serum C peptide, HbA1C, serum creatinine, blood urea nitrogen, urine albumin and creatinine. Creatinine clearance was calculated using modification of diet in renal disease formula from serum creatinine value. A total of 168 patients were included in the study, among them 90 were females (53.57%) and 78 males (46.43%). Mean age of the patients was 57.64 years. Pearson correlation test showed negative correlation of serum C peptide level with creatinine clearance, though statistically not significant. Negative correlation was also seen between serum C peptide, and urine albumin, urine albumin creatinine ratio, HbA1C and duration of diabetes. Mean urine albumin was higher in patients with subnormal C peptide level. Duration of disease was more in patients with lower serum C peptide level. The study has shown weak association of serum C peptide level with microalbuminuria and creatinine clearance. Risk of albuminuria is more in patients with low serum C peptide level.

Effects of botropase on clotting factors in healthy human volunteers

Objective: To evaluate the effects of botropase on various clotting factors in human volunteers. Materials and Methods: It was a prospective open label study conducted on human healthy volunteers. After the baseline screening, subjects fulfilling inclusion criteria were enrolled. On the study day, 1 ml of botropase was administered intravenously and after an hour same dose of botropase (1 ml) was given by intramuscular (IM) route. The efficacy and safety parameters were monitored up to 72 h from the time of intravenous (IV) administration. Results: A total of 15 volunteers, belonging to 24-35 years of age were included in the study. Botropase significantly reduced the plasma level of fibrinogen and fibrin degradation products after 5 min of IV administration (P < 0.05). In addition, factor X was observed to reduce constantly by botropase administration suggesting enhanced turnover between 5 and 20 min of IV administration. Although botropase reduced clotting and bleeding time in all the volunteers, the data remains to be statistically insignificant. Conclusion: Present study demonstrated the safety and efficacy of botropase in human healthy volunteers. The study has shown that it is a factor X activator and reduces effectively clotting and bleeding time.

Are the Newer Antidiabetic Agents Worth the Cost

Type 2 Diabetes Mellitus (T2DM) is a multisystem metabolic disease that requires lifelong medical management. While the burden of T2DM to society can be measured in dollars and rupees, the cost of T2DM to the patient may be immeasurable, reflecting the daily challenges of this chronic disease and uncertain quality of life. Citizens of the 21st century are experiencing a pandemic of T2DM which has motivated development of an armamentarium of new antidiabetic drugs. The new antidiabetic medicines, classified by mechanism of action, include: (i) the glucagon like polypeptide (GLP-1) analogues exenatide and liraglutide; (ii) the renal sodium glucose transport-2 (SGLT-2) inhibitors canagliflozin and dafagliflozin; (iii) the dipeptidyl peptidase-4 (DPP-4) inhibitor sitagliptin; (iv) the amylin analogue pramlinitide; and (v) the insulin analogues: aspart, lispro, and glargine. The older, conventional antidiabetic medicines such as glibenclamide, glimepiride, metformin, pioglitazone, and the insulin preparations are, largely, much less expensive and therefore more affordable to the diabetic patient than the newer drugs. Furthermore, it is known that patient compliance with antidiabetic treatments, almost exclusively, depends on the direct cost to the patient [1]. This problem of compliance is magnified by the fact that antidiabetic treatments are lifelong and, hence, present the diabetic patient with substantial financial, behavioral and emotional challenges which must be overcome. Another challenge is that patients may not have health insurance, but even if they do, health insurance policies often do not cover drugs for outpatient use. Zhang et al., analysed the benefits and harms of antihyperglycaemic treatment regimens considering clinical effectiveness, quality of life, and cost. They found that older agents like sulfonylureas were associated with greater benefit in terms of both life-years, quality adjusted life years, and less expensive compared with newer glucose lowering agents like, sitagliptin and exenatide. Monthly medication cost (USD) of metformin 81.75, sulfonylurea 54.85, whereas newer medications like GLP-1 agonist 325.97, DPP-4 inhibitor 232.84 [2]. Limited knowledge of the longterm safety of the newer antidiabetic agents is another important issue. For example, it has been reported that, a 51-year-old woman with longstanding T2DM developed liraglutide induced acute pancreatitis. Her symptoms resolved after withdrawal of this GLP-1 analogue [3]. GLP-1 agonists are contraindicated in patients with histories of pancreatitis, glomerular filtration rate < 30 mL/min, or gastroparesis. Another report demonstrates a significant risk of subclinical pancreatic inflammation, pancreatic cancer, and neuroendocrine tumours in users of exenatide [4]. The DPP-4 inhibitors are commonly associated with nasopharyngitis, headache, and respiratory infections, but pancreatitis, pancreatic cancer, elevation of hepatic enzyme activity; skin reactions and severe joint pain are also reported in users of DPP-4 inhibitors [5]. The SGLT-2 inhibitors are known to cause urinary and genital tract infections, dehydration, and hyperkalaemia. As per a recent report of a 60-year-old man with T2DM treated with glimepiride, metformin, insulin, and canagliflozin developed hypercalcaemia due to intestinal and urinary calcium absorption possibly due to inhibition of SGLT by the canagliflozin [6]. These are but a few examples of why more research is needed to support the safe use of these novel antidiabetic agents. Apart from the financial challenges faced by diabetic patients there is substantial uncertainty about the safety of the newer antidiabetic drugs—newer is not necessarily better.

Evaluation of adverse drug reactions in HIV positive patients in a tertiary care hospital.

Context: The advancement and development of new drugs and treatment strategies increase the risk of unusual Adverse Events (AEs) in HIV patients. Aims: The objective of our study was to assess the incidence, types and nature of AEs in HIV positive subjects. Settings and Design: Patients with WHO stage IV disease irrespective of the CD4 cell count, or WHO stage III disease with a CD4 cell count <350 cell/cu. Mm, or, WHO stage I or II disease with a CD4 cell count of <200 cells/cu. mm, and on prior anti-retroviral therapy for not more than six months preceding the observation date, were included in the study. After initiation of therapy, the patients were examined for the occurrence any adverse events including the type and severity, or any other abnormal laboratory findings. Causality assessment of the adverse events was done using the Naranjo′s scale. Results: Out of 327 patients studied prospectively, 43 patients developed AEs. Out of these, 23 (53.5%) were males and 20 (46.5%) were females. A total of 53 (16.21%) AEs were reported. Antitubercular drugs caused the maximum AEs (28.3%) followed by zidovudine (20.7%), nevirapine (15.0%) and efavirenz (5.6%). Stavudine, ethambutol, sulfamethoxazole and trimethoprim, and atazanavir were also responsible for 3.7% of AEs individually. Causality assessment done according to the Naranjo′s scale revealed that 66.04% AEs were ′probable′ and 33.96% were ′possible′. Conclusions: Anemia, hepatitis and dermatological adverse effects are the most common AEs. Antitubercular drugs contributed significantly for the incidence of AEs in these patients. Frequency of AEs was slightly more in males compared to females.

Incidence of Opportunistic Infections among HIV-Positive Adults on Highly Active Antiretroviral Therapy in a Teaching Hospital, India: Prospective Study:

Oral manifestations in HIV infections are numerous and some of these are acknowledged as being of great importance in the early diagnosis of the disease. Many HIV-associated oral infections occur early in HIV disease, not infrequently as the presenting sign or symptom. Thus, early detection of the associated oral opportunistic infections should, in many cases, result in earlier diagnosis of HIV infection. Cytology, a simple, painless, and inexpensive method, has become a preferred method and was used in our study for early diagnosis of certain lesions. To determine the effect of highly active antiretroviral therapy on incidence rate of opportunistic infections among HIV-positive adults in a teaching hospital in India, a prospective study was conducted and the required sample size was 40. Study participants were selected randomly from the outpatient department of an HIV clinic who were currently on for antiretroviral therapy (ART). Data on age, gender, form of contagion, antiretroviral therapy at the time of review, number of CD4 lymphocytes per milliliter, and viral load were collected. Oral cytologic investigation was carried out and then stained for histopathological examination. A total of 40 individuals were examined and the incidence of opportunistic infections was 66.7% in individuals with CD4 counts less than 200, 55.6% in individuals with CD4 counts of 200 to 499, and 40.0% in individuals with CD4 counts more than 500. The incidence of opportunistic infection was higher in individuals with low CD4 counts in spite of being on ART.

Quit Tobacco: Are We Prepared?

Background: The pattern of tobacco consumption survey among the students in a private dental college in Mangalore helps us to assess the awareness and pattern of tobacco consumption among the dental students and also to assess the preparedness for tobacco control among the future health care professionals in India. Aim: To study the awareness and pattern of tobacco use among undergraduate dental students of a private dental College, at Dakshina Kannada, Karnataka. Materials and Methods: A Cross-sectional study was conducted among 100 dental students using a predesigned and pretested, semi-structured self-administered anonymous questionnaire. Data was analyzed by Microsoft excel and SPSS v 16.Statistical analysis comprised calculating proportion and the chi-square (χ2) test with Yates correction. Results: Among 100 participants, of which 52 students were males and 48 females, out of which 49% believed that the minimum number of cigarettes a person can smoke without causing harm to one’s health. About 89% of the students believe that it is the doctor’s duty to advice patients not to smoke or chew tobacco. 81% believe that health professional intervention would help the patient quit the habit. Conclusion: Awareness about harmful effects of tobacco abuse was good and the students feel that tobacco cessation modules should be incorporated in the dental curriculum. Given their important future role as exemplars, more effective measures to help reduce tobacco smoking among dental students are clearly needed worldwide.