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Background: The year 2019 witnessed major curricular reforms in terms of launching Foundation Course (FC) by National !Medical Commission (NMC) asapartofCBME (Competency Based Medical Edttcation). Feedback from various stakeholders in medical education can register ite merits and demerits. This study aimed to explore perceptions of students and faculties of 1• year MBBS, regarding implementation of FC. Methods! A mixed-method study was employed immediately as post implementation of FC using a structured questionnaire and a focus group interview to report perception of students and faculties. Study was conducted in Government medical college & Hospital, Ratlam, Madhypradesh India in September montit of 2019. Results: Majority of students i.e. 92.15 % felt, that FC orientation module helped them acclimatize to new environment and helped them engage with peers and faculties. 91.01% were sensitized to importance of professionalism and etilics in medicine.92.68% reported an enhancement in their communication sldlls, 85.70% mentioned its help in stress management, 88.19% to 92.69% found reflective writing as an interesting exercise. Overall 87.00% graded FC as beneficial and a good program. Besides these sessions, an essential computer learning skill, community health care visit, sports, and extracurricular activities were appreciated. In addition, medical students gave mixed reviews on problems like duration of FC, didactic teaching, and language barriers in terms of English and local. Conclusions: FC provides a roadmap from a knowledge centric curriculum towards a competency based performance centric curriculum. Facilitating and nurturing such programs can pity a pivotal role in fostering holistic development of students. [ABSTRACT FROM AUTHOR]

Introduction: Numerous doctors have been infected while treating the patients of Coronavirus Disease (COVID-2019). Expecting doctors to treat without any regard to their safety is an extreme and unrealistic approach. Apart from professional obligations, doctors have personal obligations to their families too. Aim: To understand the barriers of willingness and ability to serve during pandemics for Indian doctors. Materials and Methods: In this cross-sectional study, Peertested web-based questionnaire, along with informed consent form incorporated into Google form, was posted on a WhatsApp group. Study was conducted from April 2020 to June 2020. The group included 400 Indian medical practitioners, selected randomly. It comprised of total 49 questions, including open and close ended type, in English language. Out of these, 14 questions were pertaining to the present study. The exploratory data analysis was used to analyse and interpret the data. Results: Responses were submitted by 256 doctors (64% response rate) out of which 121 were from males, 134 from females and 1 person preferred not to disclose the gender. Majority (64.8%) of the responses were obtained from doctors in age group of 20-40 years and 49% of the total responses were from faculty in government medical college. It was revealed that 9% doctors were willing to quit medical profession and 23%doctors preferred not to serve patients during pandemic of contagious disease. As many as 58.6% expressed that incidences of doctors facing public harassments abuse and social discrimination dissuaded them from serving COVID-19 patients. A 59.4% and 58.2% of doctors had responsibility of child-care and elderly-care respectively which was acting barrier to ability to serve during the pandemic. As many as 49.2% brought it to light that the infrastructure at their workplace was not up to the mark to deal with COVID-19 patients. Conclusion: This study has brought into light that fear of contracting the disease due to lack of Personal Protective Equipment (PPE), risking one's family for getting infected, responsibility of child-care and elderly-care along with social ostracism as untouchables are the major deterrents for willingness to work. Distance from workplace, one's illness and lack of proper infrastructure at workplace are barriers to ability to work during COVID-19 for Indian doctors. [ABSTRACT FROM AUTHOR]

Isolated cases of subacute thyroiditis exist in the early period of COVID‐19 vaccination, largely after mRNA vaccines. Here we report late onset thyroid disturbances and persistent health issues in patients of thyroid disorders after COVID‐19 vaccination. Seventy‐five patients with post COVID‐19 vaccination thyroid disturbances were identified. Among these, 41 had flare of underlying thyroid illness, majority occurring at a median time lag of 28.4 weeks since 2nd dose. Thirty‐one cases of new onset hypothyroidism and three of new onset hyperthyroidism were reported, with a median time lag respectively of 17.2 and 22.6 weeks since 2nd dose. Most cases occurred after ChAdOx1‐nCoV‐19, which was the commonest vaccine employed in mass roll out in India. Significant improvement was observed in majority, after a median follow up of 22–26 weeks. New onset health issues persisting for ≥4 weeks were reported in 37.3% and were common in individuals with history of COVID‐19 before vaccine. New onset metabolic, musculoskeletal, and reproductive disorders were the common health complaints. Active monitoring is warranted for late onset adverse events after COVID‐19 vaccines of all types. Larger studies with involvement of unvaccinated individuals are required to understand the incidence and causality of late onset thyroid disturbances after COVID‐19 vaccines. [ABSTRACT FROM AUTHOR]

Background: Use of sunscreens on the face is becoming popular, and patients with melasma are prescribed sunscreen for use on the face. Results of a few Western studies on the effect of sunscreen use on serum vitamin D concentration are not applicable to Indian conditions.Aims: To examine the effect of use of a high sun protection factor (SPF 50+, PA++++) sunscreen on face in patients with melasma on serum concentration of 25-hydroxyvitamin D.Methods: Forty-five Indian patients (Fitzpatrick skin types III and IV) with melasma were advised to use a sunscreen with SPF 50 + for 3 months, 43 (33 female, 10 male; age 32.9 ± 8 years) completed the study. Patients staying outdoor for <4 hours applied sunscreen once daily after bath. Patients staying outdoors for >4 hours reapplied sunscreen 4 hours after first application. Patients were provided a container to measure the amount of sunscreen for use, which was approximately equal to recommended thickness. Compliance was tested by weighing the used tubes and tubes in use during monthly visits. Serum concentration of 25-hydroxyvitamin D was tested before and after the study period.Results: Amount of sunscreen advised (100.5 ± 29.2 ml) and the actual amount used (96.6 ± 27.9 ml) were similar (P = 0.53, t-test). The difference between serum concentrations of 25-hydroxyvitamin D at the baseline (19.20 ± 9.06 ng/ml) and at 3 months (18.91 ± 8.39 ng/ml) was not significant (P = 0.87, paired t-test, 95% confidence interval of difference -3.33 to 3.92). No correlation was found between the amount of sunscreen used and the percentage change in serum 25-hydroxyvitamin D concentration at 3 months (rho = 0.099, P = 0.528, Spearman's rank correlation).Limitations: Longer duration of application and a larger sample size may detect minor differences in vitamin D concentration.Conclusion: Using a high SPF sunscreen on the face, along with physical photoprotection advice, in patients with melasma for 3 months does not influence serum 25-hydroxyvitamin D concentration in Indian conditions. [ABSTRACT FROM AUTHOR]

Study Question: Do methylation changes in sperm DNA correlate with infertility?Study Answer: Loss of spermatogenesis and fertility was correlated with 1680 differentially-methylated CpGs (DMCs) across 1052 genes.What Is Known Already: Methylation changes in a number of genes have been correlated with reduced sperm count and motility.Study Design, Size, Duration: This case-control study used spermatozoal DNA from 38 oligo-/oligoastheno-zoospermic infertile patients and 26 normozoospermic fertile men.Participants/materials, Settings, Methods: Genome-wide methylation analysis was undertaken using 450 K BeadChip on spermatozoal DNA from six infertile and six fertile men to identify DMCs. This was followed by deep sequencing of spermatozoal DNA from 32 infertile patients and 20 fertile controls.Main Results and the Role Of Chance: A total of 1680 DMCs were identified, out of which 1436 were hypermethylated and 244 were hypomethylated. Classification of DMCs according to the genes identified BCAN, CTNNA3, DLGAP2, GATA3, MAGI2 and TP73 among imprinted genes, SPATA5, SPATA7, SPATA16 and SPATA22 among spermatogenesis-associated genes, KDM4C and JMJD1C, EZH2 and HDAC4 among genes which regulate methylation and gene expression, HLA-C, HLA-DRB6 and HLA-DQA1 among complementation and immune response genes, and CRISPLD1, LPHN3 and CPEB2 among other genes. Genes showing significant differential methylation in deep sequencing, i.e. HOXB1, GATA3, EBF3, BCAN and TCERG1L, are strong candidates for further investigations. The role of chance was ruled out by deep sequencing of select genes.Large-scale Data: N/A.Limitations, Reason For Caution: Genome-wide analyses are fairly accurate, but may not be exactly validated in replication studies across all DMCs. We used the 't' test in the genome-wide methylation analysis, whereas other tests could provide a more robust and powerful analysis.Wider Implications Of the Findings: DMCs can serve as markers for inclusion in infertility screening panels, particularly those in the genes showing differential methylation consistent with previous studies. The genes validated by deep sequencing are strong candidates for investigations of their roles in spermatogenesis.Study Funding/competing Interest(s): The study was funded by the Council of Scientific and Industrial Research (CSIR), Govt. of India with grant number BSC0101 awarded to Rajender Singh. None of the authors has any competing interest to declare. [ABSTRACT FROM AUTHOR]

Objectives: Urinary tract infection (UTI) remains a significant concern in diabetic patients due to associated morbidity and mortality. The innate immune response against UTI is controlled by the Toll like receptors (TLRs) expressed on urinary bladder epithelium. Previous studies in non diabetic patients showed that TLR4 mutations increase susceptibility to UTIs. The present study evaluated the association of single nucleotide polymorphisms (SNPs) of TLR4. A (896) G (corresponding to an Asp299Gly substitution mutation; SNP ID: rs 4986790) and TLR4 C (1196) T (corresponding to a Thr399Ile substitution mutation; SNP ID: rs 4986791) with risk of UTIs in the patients of type 2 diabetes mellitus. Materials and Methods: A total 446 type 2 diabetic patients (224 with UTI and 222 without infection) and 270 healthy control subjects were examined for TLR4 A(896)G and C(1196)T polymorphisms by means of polymerase chain reaction and restriction fragment-length polymorphism. Results: In diabetic UTI patients TLR4 896AG genotype and TLR4 896G allele has higher prevalence than healthy control. [896AG versus control p = 0.0004 (OR 2.1 95% CI 1.428-3.312), 896G P = 0.005 (OR 2.5 95% CI 1.173-2.24). TLR4 1196CT genotype and 1196T allele has also higher prevalence than control. [1196CT versus control P = 0.0001 (OR 2.5 95% CI 1.618-3.826), 1196T P = 0.0001 (OR 2.16 95% CI 1.472-3.173). No statistically significance correlation was detected in between control and diabetic patients without infection [OR 0.9 P = 0.75]. Conclusion: TLR4 A(896)G and C(1196)T polymorphisms are associated with the development of UTI in type 2 diabetes. [ABSTRACT FROM AUTHOR]

Oxidative stress is a well known phenomenon under hyperthyroid condition that induces various physiological and neural problems with a higher prevalence in females. We, therefore investigated the antioxidant potential of melatonin (Mel) on hyperthyroidism-induced oxidative stress and neuronal cell death in the hippocampus region of brain (cognition and memory centre) of aged female golden hamster, Mesocricetus auratus . Aged female hamsters were randomly divided into four experimental groups (n = 7); group-I: control, group-II: Melatonin (5 mg kg − 1 day − 1 , i.p., for one week), group-III: Hyperthyroid (100 μg kg − 1 day − 1 , i.p., for two weeks) and group-IV- Hyper + Mel. Hormonal profiles (thyroid and melatonin), activity of antioxidant enzymes (SOD, CAT and GP X ), lipid peroxidation level (TBARS) and the specific apoptotic markers (Bax/Bcl-2 ratio and Caspase-3) expression were evaluated. A significant increase in the profile of total thyroid hormone (tT3 and tT4) in hyperthyroidic group as compared to control while tT3 significantly decreased in melatonin treated hyperthyroidic group. However, Mel level significantly decreased in hyperthyroidic group but increased in melatonin treated hyperthyroidic group. Further, the number of immune-positive cells for thyroid hormone receptor-alpha (TR-α) decreased in the hippocampus of hyperthyroidic group and increased in melatonin treated hyperthyroidic group. Profiles of antioxidant enzymes showed a significant decrease in hyperthyroidic group with a simultaneous increase in lipid peroxidation (TBARS). Melatonin treatment to hyperthyroidic group lead to decreased TBARS level with a concomitant increase in antioxidant enzyme activity. Moreover, increased expression of Bax/Bcl-2 ratio and Caspase-3, in hyperthyroidic group had elevated neuronal cell death in hippocampal area and melatonin treatment reduced its expression in hyperthyroidic group. Our findings thus indicate that melatonin reduced the hyperthyroidism-induced oxidative stress and neuronal cell death in the hippocampus region of brain, suggesting a novel therapeutic approach of melatonin for management of cognition and memory function in females under hyperthyroid condition. [ABSTRACT FROM AUTHOR]

Introduction: Type I diabetes Mellitus (T1DM) is caused by autoimmune destruction of β-cells of pancreas. Two forms of T1DM are known called as 1A (autoimmune) and 1B (idiopathic). Aim: Aim was to study the prevalence of Anti-TTG IgA, Anti- TPO, GADA, ZnT8 and IA-2 autoantibodies and HLA DR and DQ genes and its diagnostic value in T1DM. Materials and Methods: Thirty four T1DM patients, 59 type 2 diabetes mellitus (T2DM) patients and 28 healthy controls were included in study. Antibodies levels were estimated by ELISA and HLA typing was performed by SSP-PCR method. Result: The prevalence of various autoantibodies in T1DM were Anti-TTG 14.7%, Anti-TPO 17.65%, GADA 38.23%, ZnT8 11.76% and IA-2 5.88%. Only GADA and ZnT8 were significantly positive in T1DM. GADA (66.67%) and ZnT8 (33.33%) positivity was more in patients below 15 years age while levels of other antibodies were higher after 15 years age. All autoantibodies were detected in higher frequency in T1DM than in T2DM and controls. HLA DR and DQ typing showed highly significant increase in DRB1*0301 (61.76%, p=0.00) and DQB1*0201 (64.71%, p=0.00) in T1DM. Subjects with HLA DRB1*0301 and DQB1*0201 had 80-100% positive prevalence of GADA, ZnT8, IA-2, Anti-TTG and Anti-TPO autoantibodies. Conclusion: Combination of GADA antibody with DRB1 and DQB1 estimation improved diagnosis of T1A than insulin antigen specific antibodies alone. [ABSTRACT FROM AUTHOR]

Background: There was an unprecedented increase in COVID-19-associated-Mucormycosis (CAM) cases during the second pandemic wave in India.Methods: This observational study was done to know the epidemiological profile of CAM cases andincluded all patients admitted with mucormycosis between May 2021 and July 2021.Results: Out of the enrolled 208 CAM cases (either SARS-CoV-2 RT-PCR or serology positive), 204, three and one had rhino-orbital-cerebral, pulmonary and gastrointestinal mucormycosis, respectively. 95.7 % of the patients had diabetes, out of which 42.3 % were recently diagnosed. Mean HbA1c was 10.16 ± 2.56 %. 82.5 % of the patients were unvaccinated. During their COVID-19 illness, 86.5 % were prescribed antibiotics, 84.6 % zinc preparations, 76.4 % ivermectin, and 64.9 % steroids, while only 39.5 % required oxygen therapy. The frequency of blood groups A, B, O and AB in our CAM patients was 29.5 %, 18.9 %, 38.9 % &12.6 %, respectively. At three months follow up, 60 (28.8 %) patients died, four (1.9 %) stopped antifungal treatment, and 144(69.23 %) were on antifungal treatment. 55 % (n = 33) of deaths occurred within 15 days of admission. Mortality was significantly associated with higher age, RT-PCR positive for SARS-CoV-2, raised serum creatinine and alkaline phosphatase during treatment. At 6 months follow-up, eight more patients died, three due to chronic kidney disease, four patients who had stopped treatment and one patient who was on a ventilator due to COVID-19 associated pneumonia and the rest 140(67.3 %) survived.Conclusion: Uncontrolled hyperglycemia, SARS-CoV-2 infection, rampant use of antibiotics, zinc supplementation and steroids were some of the risk factors for mucormycosis. Despite the overwhelming number of patients with an uncommon disease like mucormycosis, the six months mortality was much lower than expected. [ABSTRACT FROM AUTHOR]