Ritesh G Menezes

Suicidal ideation among medical students of Pakistan: A cross-sectional study

Few studies have investigated suicidal ideation among medical students in the developing world. We found only one report on suicidal ideation among medical students in Pakistan published in the year 2005. The present cross-sectional survey on suicidal ideation conducted in July 2013 involved 331 medical students of Dow University of Health Sciences, Karachi, Pakistan. In the past one year, suicidal ideation was found in 118 (35.6%) students. Forty-six (13.9%) of all the students had made a plan in their life time to commit suicide while 16 (4.8%) of the 331 students tried to commit suicide at some point of time in their life. More females than males pondered suicide while first year medical students formed the majority of those with suicidal ideation. The single greatest risk factor predisposing to suicidal ideation was substance abuse. This was followed jointly by parental neglect and previous psychiatric disorder. Campaigns against substance abuse and counseling of vulnerable students will help in eradicating suicidal intent.

Parents in Pakistan arrested for polio vaccine refusal: a necessary step?

Pakistan’s vaccination drive against polio has encountered many adversities in the past few years. The vaccination drive received hostility from militant groups when it was used as cover to spy on Taliban hideouts. In retaliation, extremist groups have killed about 60 polio vaccine workers, which further hindered progress of the vaccine drive. Additionally, some in the general population have misconceptions about the vaccine. Until now, the government has not taken a hard line, which is necessary to control this issue. On March 2, 2015, police in Khyber– Pakhtunkhwa province, Pakistan, arrested more than 450 parents after they refused to vaccinate their children against polio virus because of some religious fears and myths associated with vaccination (such as sterilisation). The parents later signed an agreement to cooperate in administration of the polio vaccine to their children. The police felt the need to intervene because the number of polio cases in the province had increased by 96% in the previous year. In Khyber–Pakhtunkhwa She previously received paclitaxel, trastuzumab, plus pertuzumab, and lapatinib plus capecitabine regimens. She started taking ado-trastuzumab emtansine (T-DM1) at 3·6 mg/kg every 3 weeks. After five cycles of treatment, she developed severe desquamation of her palms and soles with oral mucositis. Additionally, she had characteristic yellow–orange discolouration of her palms (fi gure). Laboratory examin ations showed no abnormalities in whole blood cell count, lipid profile, aspartate aminotransferase and alanine aminotransferase, blood urea nitrogen and creatinine, total bilirubin, direct and indirect bilirubin. The diagnosis was carotenoderma with hand-foot syndrome. A

Endosulfan poisoning: An overview

Endosulfan, an organochlorine (OC) insecticide, is a widely used agricultural pesticide, despite its life threatening toxic effects. In this review, the pharmacokinetics of endosulfan, mechanism of endosulfan toxicity, clinical presentations and management, histopathological findings, and toxicological analysis are described, in addition to its environmental toxicity. The toxic effects of endosulfan can affect many organs and systems presenting in a wide array of signs and symptoms. Although termed a restricted OC-classed pesticide, it continues to be used, especially in the developing world, owing to its beneficial effects on agriculture. Several cases of endosulfan poisoning have been reported from different regions of the world. Whether accidental or intentional, endosulfan ingestion proves to be fatal unless immediate, aggressive treatment is initiated. Management is mainly supportive as no antidote exists for endosulfan poisoning as yet. The use of endosulfan needs to be strictly regulated and eventually banned worldwide altogether to lower the current morbidity and mortality resulting from this pesticide. Additionally, monitoring biological samples, using non-invasive techniques such as breast milk sampling, can provide an effective method of observing the elimination of this environmentally persistent organic pollutant from the general population.

Undergraduate teaching of forensic medicine in Saudi Arabia.

Medico-legal tasks are not exclusive to forensic medical experts –any physician may face medico-legal issues in his career. Hence, the practice of medicine requires education in legal issues. In Saudi Arabia, there are 30 universities with medical colleges, but we do not know how they teach undergraduate forensic medicine and medico-legal issues. The aim of this study was to discover undergraduate training courses in forensic medicine in Saudi universities. We conducted a cross-sectional study involving all colleges of medicine in Saudi Arabia. A structured, self-administered questionnaire containing 13 items relating to the undergraduate forensic medicine course was distributed. Out of a total of 30 universities, 27 universities responded. Of these 27 universities, 16 (59.26%) teach forensic medicine to undergraduate medical students, and 11 (40.74%) do not teach forensic medicine in their undergraduate curriculum. Of the 27 universities that responded, none has a department of forensic medicine. Eleven universities that do not teach forensic medicine have no forensic medicine unit/division or faculty at all. Forensic medicine belongs to the pathology department in 11 universities, while it belongs to different departments in five universities. There is variation in teaching methods, years where the course is taught and length of the course. Practical and morgue visits take place in 7/16 (43.8%) universities, while 9/16 (56.3%) universities only teach the theoretical aspects of forensic medicine. All 16 universities teach forensic medicine only to medical students and do not teach it to students in other colleges such as dentistry and nursing.

Paying to publish: Should we?

First, the author has concluded that under the pay-for-publication system, the quality of the papers accepted for publication can no longer be guaranteed. This statement unfairly undermines the quality of online publications. In fact, over the years, the quality of research publications has been augmented from many perspectives: (a) When compared with non-paid journals, the electronic interface provided to interact with these journals are user-friendly and one seldom has problems in submitting or reviewing the manuscript; (b) After submission, the responses by the journal to the manuscript in terms of acceptance or rejection or reviewers’ comments are rapid and swift (not like other non-paid journals); (c) Many of the international online journals, though paid journals, graciously waive off the processing and publication charges if the author expresses and justifies inability to pay; (d) Being reviewers for online international paid journals, in our experience, there is no flexibility for a paid journal manuscript to get published without contesting a reviewer’s comments; (e) The journals are judged by their “impact factor”, where every journal tries to maximize its impact factor irrespective of its paid and non-paid factor. As in any business, the producer always looks for top class platforms to showcase his or her work, and it can come with substantial cost. Overall, it is ridiculous to attribute publication charges to improper scrutiny and publication. In “In the News”, the author has viewed the word “pay-to-publish” negatively. In the long run, only those journals with top quality services tend to survive while lesser quality journals keep improving. We welcome the open access movement across the globe.

Student's perspectives on objective structured practical examination (OSPE) in Forensic Medicine - a report from India.

The objective of the present study was to know the perceptions of students regarding objective structured practical examination (OSPE) as a tool for assessment in Forensic Medicine. The present study was conducted in the Department of Forensic Medicine and Toxicology, Mahatma Gandhi Medical College and Research Institute (MGMCRI), Pondicherry, India. Undergraduate medical students of the 4th semester were enrolled in the study to know their perceptions regarding OSPE. The students were briefed regarding OSPE with a PowerPoint presentation and interaction. An examination was conducted using OSPE with10 stations and a total of 74 students participated in the study. The feedback was collected using a preformed proforma consisting of 12 items and analyzed. Most of the participants (82.4%) agreed that OSPE is a better method of examination than the conventional/traditional practical examination. The majority of the participants (77.0%) said that the OSPE covered wide range of knowledge than the conventional practical examination. A large number of students (63.5%) were of the opinion that the OSPE may be exhausting and stressful if number of stations are increased. Overall a larger proportion of the participants preferred OSPE over the conventional practical examination considering the various attributes examined in the study.

Evaluation of the mastoid triangle for determining sexual dimorphism: A Saudi population based study

Demographic assessment of skeletal remains in forensic investigations includes identification of sex. The present study aimed to develop population-specific, sex-discriminating anthropometric standards for the mastoid triangle of a documented Saudi population using computed tomographic (CT) images of the lateral aspect of the skull. The present study was performed on 206 CT images of a documented Saudi population of known sex and age. The clinical CT images of subjects visiting the Department of Radiology, Dammam Medical Complex, Dammam, Saudi Arabia (KSA) were evaluated to know the validity of the metric assessment of the mastoid triangle for identification of sex in a Saudi population. The distance between asterion to porion (AP), asterion to mastoidale (AM), porion to mastoidale (PM) were measured and the area of the mastoid triangle (AMT) was calculated using these measurements. Discriminant function procedure was used to analyze the data for sexual dimorphism. In conclusion, the results of the present study indicate that all the 3 sides of the mastoid triangle and AMT were sexually dimorphic in the sampled Saudi population with PM being the best individual parameter in discriminating sex with an accuracy of 69.4%. Whereas, all the parameters combined showed the highest accuracy (71.4%).

Morphometric evaluation of the foramen magnum for sex determination: A study from Saudi Arabia

The present study provides a database of various morphometric dimensions of the foramen magnum region in the Saudi population. The objective of this study was to evaluate various measurements of the foramen magnum region for sex determination in the Saudi population by using computed tomography (CT) images. The various radiological measurements of the foramen magnum region were measured in a total of 200 adult subjects of Saudi origin including 100 males and 100 females. Sexual dimorphism was observed in five parameters related to the foramen magnum, namely length of the right occipital condyle (LROC), length of the left occipital condyle (LLOC), width of the foramen magnum (WFM), area of the foramen magnum (AFM) and length of the foramen magnum (LFM). The accuracy to discriminate sex ranged from 65.5% to 62.5% when LROC, LLOC, WFM, AFM, and LFM were considered as individual parameters. When multiple parameters were combined to discriminate sex, the highest accuracy of 71% was achieved.

Aluminium phosphide poisoning: Need for revised treatment guidelines

Sir, Exothermic reactions, fumes, flames and thermal injuries observed in aluminium phosphide (ALP) poisoning have been brought out by Mirakbari.[1] All know well that ALP when comes in contact with water, air or hydrochloric acid (HCL) (as in stomach), toxic phosphine gas is liberated. Potassium permanganate (KMnO4) solution (1 in 10,000) used as gastric lavage in ALP poisoning, oxidizes phosphine to non-toxic phosphate. Here, we would like to mention the limitations of KMnO4, usefulness of vegetable oil and gastric ventilation, certain matters related to education and research and patient safety aspects of ALP poisoning. Nasrabadi and Marashi[2] have observed that phosphine a hard nucleophile and the free oxygen radicals released from the resolution of KMnO4 do not interact with each other. Hence, there is no well-established basis for the use of KMnO4 solution in ALP poisoning. Moreover, an exothermic reaction while using it was noticed in the case described.[1] In view of these facts, one has to find alternatives instead of KMnO4. Vegetable oil administered orally or through a nasogastric tube in those cases of ALP poisoning inhibits phosphine release due to physiochemical properties of ALP and non-miscibility with fat.[3,4] For example, coconut oil used in ALP poisoning inhibits the breakdown of phosphide, reduces the toxicity of phosphides, protects gastric mucosa, prevents the absorption of phosphine gas and dilutes gastric acid to some extent. Bajwa et al.[4] used coconut oil with sodium bicarbonate for gastric lavage, where sodium bicarbonate neutralizes HCL. As a result, it reduces the catalytic reaction of phosphide with HCL and inhibits the release of phosphine. Medicated liquid paraffin available in the emergency department can also be used to inhibit the phosphine release. Interestingly, Hassanian-Moghaddam and Shahbazi[5] had shown the usefulness of gastric ventilation in ALP poisoning. Medical students and practitioners have to be sensitised on the changing trends in the treatment modalities of ALP poisoning. Having seen the limitations of KMnO4 and usefulness of vegetable oil, it is the time to undertake research on early diagnosis, treatment modalities and prevention of ALP poisoning. It is also suggested to conduct a clinical audit of ALP poisoning cases and update the treatment modalities so as ensure patient safety. It is worth to recall John Eisenbergs statement ‘globalize the evidence, localize the decision’.

Research publication in India faces new challenges

1484 www.thelancet.com Vol 382 November 2, 2013 (table). This is strikingly (and perhaps disappointingly) consistent with the 82% reported by Sackett and colleagues. It is also consistent with other studies in North America, Sweden, and the UK, which report that 73–84% of patients received evidence-based care. 22% of our patients’ treatments were based on evidence from randomised controlled trials, and 61% were treated according to convincing non-experimental evidence. Sackett and colleagues reported 53% of treatments were supported by randomised controlled trial evidence and 29% were based on convincing non-experimental evidence. This possibly represents the ongoing importance of logic and common sense in medical decision making, and not a failure of evidence. There seems to have been very little change in the percentage of decisions based on good evidence during the past 15 years, despite more trials and a much wider appreciation of evidencebased medicine. Medicine appears to have grown older, but no better educated.