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Introduction: Inflammatory bowel disease (IBD) is a chronic multisystem inflammatory condition with associated endothelial dysfunction and dysregulated coagulation. Although deep venous thrombosis (DVT) in IBD has been well described, arterial thrombosis and thromboembolism are less commonly appreciated. Methods: A 63-year-old male with a known history of Crohn disease presented with acute-onset right arm pain. His past vascular history was significant for left lower extremity DVT with an existing inferior vena cava filter and acute ischemia of the right lower extremity requiring a below-knee amputation a year ago. Imaging revealed acute brachial, ulnar, and radial artery thrombosis. Results: Patient underwent an open right brachial, radial, and ulnar thrombectomy to restore vascular flow. He required multiple exploration and thrombectomy for reocclusion of the vessels in the early postoperative period. He later developed a rapidly deteriorating clinical status, flank ecchymosis and swelling concerning for soft tissue ischemia, and compartment syndrome heralding an eventual hemodynamic collapse. On exploration, he was found to have chronic fibrosis of his left femoral vein and femoral artery occlusion. Clinically, the patient deteriorated rapidly, which resulted in his demise. Conclusion: The inflammatory reaction in IBD leads to arterial stiffening and hypercoagulability, which should theoretically increase the risk for vascular disease. Although the link between IBD and DVT is well established, arterial thrombosis and thromboembolism remain widely debated, with some implications for therapeutic intervention. The link between vascular thrombosis and IBD must be examined further, as the treatment and prevention of vascular complications in IBD depends on our understanding of this relationship.

Small group discussions are used in medical education to reinforce learning and to promote the application of knowledge. Small group discussions can involve a variety of tasks, such as critical thinking, self-directed learning, problem-solving, and brainstorming. The objective of this study is to find out if small group discussions can improve students' learning of specific pharmacology topics and students' performance on assessments. In the present study, small group discussions were utilized for six unique topics in the pharmacology course, and knowledge-based tests were administered before and after small group discussions to examine their efficacy. Statistically significant improvement in knowledge gains was observed for antimicrobials and neuropharmacology topics, but not for anticancer agents. Students' performance in topics that had group discussions was better on summative assessments compared with the overall performance on the summative assessment in the pharmacology (study group; summer 2018). Students' (study group; summer 2018) overall grade on the summative assessment of the pharmacology course was better than overall pharmacology grade on the summative assessment of students who had no group discussions (control group; winter 2018). Students' perceptions of the small group discussions were satisfactory, suggesting group discussions may be an enjoyable way to improve students' performance in some pharmacology topics.

Introduction: Emotional intelligence (EI) impacts many different aspects of daily life, such as the way one behaves and interacts with others. Empathy, one of the five elements of EI, is considered to be the most important psychosocial factor of inpatient care. An assessment of EI and empathy would help health-care professionals give better patient-centered care. Aims and Objectives: This study aims to assess the various components of EI among medical students and professionals and study its relation with personal and social factors. Materials and Methods: This is a cross-sectional study conducted with a sample that consists of 200 participants in Mamata Medical College, Khammam and Pratima Medical College, Karimnagar, Telangana during a period of 6 months (2018). A semi-structured pro forma is used to collect sociodemographic profile and the emotional quotient self-assessment checklist by Sterrett is used to measure EI and empathy. Results: There is a significant negative correlation between work hours and empathy, individuals with lesser work hours scored higher on empathy and social competence. There is also a significant negative correlation between motivation and sleep hours, individuals with more number of sleep hours scored lesser on motivation. Those who exercised scored higher on self-awareness and social competence as compared to those who never exercised. Individuals with a greater number of friends in the workplace scored significantly higher in confidence and motivation. Conclusion: The current study supports that good work relations, empathy, and exercise have a positive correlation with various domains of EI.

Background: Medical colleges are accountable for training medical students to have sound knowledge and ability before they take up the professional responsibilities. Therefore, medical colleges typically use a curriculum of orations, simulations supervised practice, mentoring, and hands-on experience to enhance undergraduate's skill. In such a process unfortunately few areas of the training process have unintentional negative effects on student's physical and mental health. Aims and Objectives: The aim of this study is to assess stressors among medical undergraduate students. The objectives of this study are i. To compare stressors among government medical college. Undergraduates and private medical college undergraduates. ii. To compare stressors among gender. iii. To compare stressors among various years of study. Materials and Methods: This cross-sectional study consisted a sample size of 1568 participants who are undergraduate students from various medical colleges across India. The samples were drawn using convenience sampling method. The Medical Student Stressor Questionnaire (MSSQ) was the tool used to collect data for this study. Results: Academic Related Stressors (Mean score = 2.156) was higher in medical college undergraduates followed by teaching and learning related stressors, group activities related stressor, Interpersonal and intrapersonal related stressors, social related stressors and Drive and desire related stressors with mean scores of 1.711, 1707, 1.599, 1.385 and 1.243 respectively. Conclusions: Academic stress was the most broadly source of stress found and thus most often contributed to overall stress scores. Females show more stress as compared to males. Private medical college undergraduates had more medical stress compared to government medical undergraduates. Final year undergraduates had more medical stress followed by first year. This needs attention towards curriculum change process in medical education.

Aims and Objectives: The aim and objective of this study are to study the major barriers to seeking mental health care among medical undergraduates and to understand the correlation between barriers and demographic factors. Materials and Methods: This was a cross-sectional study that was conducted with a sample that consists of 100 participants in Mamata Medical College, Khammam and Pratima Medical college, Telangana, India, during the period of 6 months (2019). A semi-structured pro forma was used to collect the sociodemographic details, and the Barriers to Access to Care Evaluation Scale was used to assess the reasons for not seeking mental health services. Results: This study found that 26% of the participants did not seek any kind of mental health care despite needing it. The analysis revealed that stigmatizing beliefs, difficulty in sharing one's concerns, preference for self-reliance, and difficulty in accessing help were the prominent barrier themes among responders. Conclusions: This study highlights the vast discrepancy in the number of individuals in need of mental health care and the actual number of people seeking it. The present findings indicate that interventions are required to improve mental health literacy and knowledge of local services.

Background: Caribbean graduates contribute significantly to the US healthcare workforce. The accreditation requirements of local governments vary from one Caribbean island to another island. The Educational Commission for Foreign Medical Graduates (ECFMG) requirement that all future applicants be graduates from accredited medical schools drove Caribbean medical schools to seek accreditation. Accreditation has been found to significantly impact the educational processes of Canadian medical schools. Our study aims at investigating Caribbean medical school leaders’ perceptions of the impact of accreditation on their school’s processes.Methods: This qualitative study and data analysis were done using a framework analysis. Academic leaders and faculty members from three different types of Caribbean medical schools (accredited, denied-accreditation schools, never applied for accreditation) were interviewed using semi-structured interviews.Results: A total of 12 participants from six different Caribbean medical schools participated in the interview process. Themes of processes influenced by accreditation at Caribbean medical schools were similar to those found in the Canadian context and align with best practices of Continuous Quality Improvement (CQI).Conclusions: Caribbean medical schools are changing their educational processes as a result of accreditation requirements. Some processes are not maintained in a continuous manner, raising questions about the development of a true CQI culture., Contexte : Les diplômés des Caraïbes contribuent de manière significative au personnel de santé Américain. Les exigences des gouvernements Caraïbes en matière d’agrément varient d’une île à l’autre. L’Educational Commission for Foreign Medical Graduates, ECFMG (Commission de l’éducation pour les diplômés en médecine étrangers), exige que les candidats soient diplômés de facultés de médecine agréées, ce qui a incité les facultés de médecine des Caraïbes à solliciter l’agrément. Il a été démontré que l’agrément affectait de manière importante les processus éducatifs des écoles de médecine canadiennes. Notre étude vise à examiner les perceptions des directions des facultés de médecine des Caraïbes quant aux répercussions de l’agrément sur leurs processus.Méthodes : La présente étude qualitative et l’analyse des données ont été réalisées selon la méthodologie du cadre logique. Les responsables universitaires et les membres du corps professoral de facultés de médecine des Caraïbes se trouvant dans trois cas de figure différents (facultés agrées, facultés auxquelles l’agrément a été refusé et facultés n’ayant jamais sollicité l’agrément) ont été interrogés par le biais d’entretiens semi-structurées.Résultats : Douze participants de six facultés de médecine de la région des Caraïbes ont participé aux entretiens. Des thèmes similaires se dégagent en ce qui concerne les processus influencés par l’agrément dans les facultés de médecine caribéennes et canadiennes, en particulier l’adoption des pratiques exemplaires en matière d’amélioration continue de la qualité (ACQ).Conclusions : Les facultés de médecine des Caraïbes modifient leurs processus éducatifs afin de remplir les exigences d’agrément. Certains processus ne sont pas maintenus de manière continue, ce qui soulève des interrogations quant à l’implantation d’une véritable culture de l’ACQ.

The use of retrievable inferior vena cava filters is on the rise, but there is an inadequate number of these filters being removed even if their use as a prophylactic for venous thromboembolism is no longer indicated. Complications with retrievable filters that remain in the patient for an extended duration include examples such as filter tilt and embedding into the caval wall. This raises concerns for whether the filter is properly functioning and for consequent sequelae, including recurrent thrombosis, stenosis, or inferior vena cava perforation. With these complications, there are also challenges to retrieving these filters via the standard techniques and thus more advanced techniques are required. Both standard and advanced techniques, their uses, and possible risks of these methods are also discussed.

Retention, stability & support are three important factors which determine the basic objectives, success and comfort of any removable prosthesis.In acquired surgical maxillary defects; the degree of impairment, size and location of the defect influences the outcome of the overall prosthetic overhaul.Prosthetic therapy with obturator closes the defect by re-establishing the oro-nasal separation, thereby, improving deglutition, speech and hypernasality. After maxillectomy, 3-6 months after surgery,patients with class 4 maxillary defects complains of frequent loosening of temporary prosthesis due to more amount of tissue changes, dimensional stabilization of surgical site, more loss of mucogingival support and rapid healing changes. As a result, there is an every chance of endangerment with the use of temporary prosthesis and allow the patients in seeking the definitive prosthesis over interim prosthesis. In this regard, designing of cast partial metal frame work with linear configuration for class 4 maxillary defects enhances the quality and comfort of the definitive prosthesis over conventional acrylic prosthesis. This article mainly describes the fundamental designing technique in improving the retention, stability and support of the definitive prosthesis with cast retainers.

Introduction: Nasotracheal intubation (NTI) is the method of choice when orotracheal intubation is not feasible (Patients with limited mouth opening), where orotracheal intubation is predicted to be difficult and in patients having airway related mechanical issues (angioedema, Ludwig’s angina, tongue haematomas, jaw fracture etc.).A common problem facing anaesthetist while performing nasotracheal intubation is bleeding which might affect the course of intubation, surgery and recovery of the patient.Oxymetazoline is a selective ?1 and a partial ?2 adrenergic receptors agonist. Since vascular beds widely express ?1 receptors, the action of oxymetazoline results in vasoconstriction. The mechanism of action of ephedrine is shown to be increasing the effects of NE by mobilizing and releasing the NE from the mobile pool.Aims: To evaluate and compare the effect of using prophylactic nasal drops of oxymetazoline versus ephedrine on the incidence of nasal bleeding when nasotracheal intubation is performed.Materials and Methods: This interventional randomized single blinded controlled study was conducted in Khartoum Dental Hospital during the period from September to October 2017. Sixty patients undergoing dental surgery were selected and were randomly assigned into two groups to receive either 1 ml of oxymetazoline 0.05% nasal drops (30 patients) or 1 ml of Ephedrine 1% nasal drops (30 patients) 5 minutes before induction. The incidence and severity of epistaxis, the incidence of the commonest complications related to nasal bleeding and the mode of recovery were assessed following NTI.Data was collected through predesigned data collection sheet then analyzed using a statistical package for the social sciences version and presented as tables and figures.Results: Among 60 participants, 53.3% had no bleeding with oxymetazoline application compared to 30% with those who used ephedrine. Fair recovery was reported in 96.7% patients who received oxymetazoline compared to 63.3% from those who received ephedrine. Complicated recovery was significantly more in patients who received ephedrine (36.7%)) compared to a single patient 3.3% from oxymetazoline group.Conclusion: the study concluded that patients undergoing NTI had no or minimal bleeding and lower rate of complications with the use of oxymetazoline 0.5% compared to ephedrine nasal drops.

BackgroundCOVID-19 pandemic has required a major and rapid shift in teaching and training methods across health professions education. Physical distancing and closure of campuses required online teaching to replace face-to-face teaching. This study aims to investigate if online teaching implemented in the first two years of the medical school at Avalon University School of Medicine is serving the purpose during the COVID-19 pandemic. MethodsThis is a concurrent mixed research method. The quantitative data collected are course evaluations and students’ performance in assessments between the two semesters September 2019 and May 2020, which had on-campus and online teaching, respectively. Qualitative data were collected using individual interviews of 19 faculty members and students. The quantitative data were analyzed for p-values and statistical significance using a t-test. The qualitative data were analyzed using thematic analysis. ResultsResults have shown no statistically significant difference (pConclusionsOnline teaching is serving the purpose in the first two years of the medical school during the COVID-19 pandemic. The advantages of online teaching are flexibility and comfort, and students can save time. The disadvantages are technical challenges, students lacking motivation, lack of personal interaction, and limitations on lab and hands-on experiences.

Introduction: The COVID-19 pandemic has caused a significant toll on healthcare across the globe. The pandemic caused many other consequences, including economic implications and teaching consequences, notably in higher education throughout the world. COVID-19 and the resulting closure of university campuses have had many impacts on Health Professions Education (HPEd), affecting all aspects, including teaching methods, assessment methods, curricula, student-teacher relationships, student selection processes, and student well-being. It has had significant effects on the setting in which students are required to learn more skills such as psychomotor skills. This manuscript aims to investigate the changes implemented in medical education during the pandemic and describe one medical school's response to medical education changes during the pandemic. Methods: This study was a combination of a case study done by in-depth investigation of the current context at one medical school during the pandemic and action research done by gathering information to change a condition in a particular place. Results: Many changes were implemented in medical education, including online teaching for basic science courses (first two years of the program) and online assessments (video-based remote proctoring) in the program's first two years. Such courses as Clinical Skills are using telemedicine/telehealth concepts in training. There were changes such as video-based remote proctoring of NBME shelf-examinations even in the assessments of clerkships/clinical rotations. Conclusions: Adaptations of medical education during this pandemic is highly dependent on technology. Most of the changes will be practiced until the campuses are open. We need to understand that these changes were made over this unprecedented period, i.e. the pandemic as an emergency rather than as a normal change process.

We present a case of a 49-year-old male with complaints of back pain and not being able to urinate. The patient was suffering from back pain for the last four days and followed up with the chiropractor, but the pain persisted. The patient took eight ibuprofen tablets (1600 mg) within those four days to relieve the pain. Lab workup showed a blood urea nitrogen (BUN) of 175 mg/dL, creatinine level of 32.87mg/dL, and an anion gap metabolic acidosis. With close monitoring and dialysis in the hospital, the creatinine came down to 11.92mg/dL. Ultrasound-guided renal biopsy showed that the patient developed acute interstitial nephritis. The patient was treated with prednisone and later discharged with a creatinine level of 8.60mg/dL. Before he was discharged, he was declared to have end-stage renal disease and placed on outpatient dialysis. Only a few case reports are recorded in the literature with such a high elevation of creatinine levels.

Background Coronavirus disease 2019 (COVID-19), originally, from Wuhan, China, has now spread to most countries across the globe and devastated global healthcare systems. The impact of this disease has, however, shown baffling variations in prevalence in different regions of the world. The aim of this short review is to identify differential national COVID-19 prevalence of COVID-19, as well as to suggest these epidemiological differences. Methods A review of studies was conducted using PubMed and Google Scholar search engines. Search tactics were centered on COVID-19 ("COVID-19" AND "coronavirus") and BCG vaccination ("BCG vaccination" OR "Bacillus Calmette-Guerin" OR "vaccine") Results It is found that national prevalence differences may be linked with BCG childhood immunization history. A statistically insignificant difference was observed in COVID-19 prevalence when comparing countries with a BGC policy and countries without it (P> 0.05). This inconclusivity suggests the influence of confounders in this study. Conclusions National differences in COVID-19 cases can be attributable to immunologic regulations, such as BCG vaccination protocols. Caution should be taken in establishing a correlation between COVID-19 prevalence and BCG vaccination, partly due to the weak quality of statistical data on COVID-19 related to poor testing rates in countries with BCG vaccination policy. Nonetheless, the analysis of the epidemiological aspects of COVID-19 will shed light on future efforts towards effective control and prevention.

The need of generating power is increasing to a greater extent in the present day world. The conventional energy power plants like Thermal, diesel, hydro and nuclear etc., were in the position of reaching the power demand in the world but due to the extinguishment of fossil fuels and other necessary conventional energy suppliers, the entire world is waiting for a big alternative solution to overcome the above power crisis problem. Solar energy systems are best among the renewable energy resources in the world. The major problem of extracting maximum power from the solar systems has been resolved by different conventional MPP techniques. But to enhance the solar panel's effectiveness, an intelligent controller has been used as a MPPT system. As the solar Irradiation changes with respect to the change in weather conditions, the output power fluctuates a lot. This problem can be overcome by placing an intelligent controller in the MPP system and the proposed intelligent controller was simulated in MATLAB/SIMULINK software for different Irradiation levels., {"references":["Vinodh Kumar G, Reena J, Sasikumar M (2012), \"Performance enhancement in PV system using intelligent controller based MPPT controller\", IOSR Journal of Engineering, Volume 2, Issue 2, pp. 284–287.","Roshan Rajiv, Yadav Yatendra, S Uma Shankar, DP Kothari (2013), \"Modeling and simulation of incremental conductance MPPT algorithm based solar photovoltaic system using Cuk converter\", Energy Efficient Technology for Sustainability (ICEETS), International conference on, IEEE, ISBN: 978-1-4673-6150-7 DOI:10.1109/ICEETS.2013.6533450.","Mirbagheri SZ, Mekhilef S, Mirhassani SM (2013), \"MPPT with Inc. Conductance Method Using Conventional Interleaved Boost converter\", Energy Procedia, Volume 42, Issue 2013, pp. 24–32.","Ratnalka P, M Rita I (2011), \"Maximum power point tracking control for photovoltaic using neural fuzzy\", International Journal of Computer and Electrical Engineering, Volume 4, Issue 1, pp. 75–81.","Qin Shihong, Wang Min, Chen T, Yao X (2011), \"Comparative analysis of incremental conductance and perturb –and-observation methods to implement MPPT in photovoltaic system\", Electrical and Control Engineering (ICECE), International Conference on, IEEE, ISBN: 978-1-5090-6287-4.","IH Altas, A M Sharaf (2008), \"A novel maximum power fuzzy logic controller for photovoltaic solar energy systems\", Renewable Energy, Volume 33, pp. 388−399.","G Walker, \"Evaluating MPPT converter topologies using a Matlab PV Model\", Journal of Electrical & Electronics Engineering, Australia, Volume 21, Issue 1. (2001), pp. 49−56.","J Surya Kumari1 et al. (July-Aug. 2012), \"Design and Analysis of P&O and IP&O MPPT Techniques for Photovoltaic System\", International Journal of Modern Engineering Research (IJMER), Volume 2, Issue 4, pp. 2174–2180.","Roberto Faranda SL (June 2008), \"Energy comparison of MPPT Techniques for PV Systems\", WSEAS Trans. on Power Systems, Volume 3, Issue 6,","M Abdulkadir, AS Samosir, AHM Yatim (May 2012), \"Modeling and simulation based approach of photovoltaic system in Simulink model\", ARPN Journal of Engineering and Applied Sciences Volume 7, Issue 5, pp. 616–623.","Trishan Esram, Patrick L Chapman (June 2007), \"Comparison of photovoltaic array maximum power point tracking techniques\", IEEE Transactions on energy conversion, Volume 22, Issue 2, pp. 439–449.","Pongsakor Takun, Somyot Kaitwanidvilai, Chaiyan Jettanasen (March 2011), \"Maximum Power Point Tracking using Fuzzy Logic Control for Photovoltaic System\", Proceedings of the International Multi Conference of Engineers and Computer Scientists 2011, Volume 2, pp. 1–5, ISSN: 2078-0966.","N Pandiarajan, Ranganath Muthu (35 Jan, 2011), \"Mathematical Modeling of Photovoltaic Module with Simulink\", International Conference on Electrical Energy Systems (ICEES 2011), IEEE, ISBN: 978-1-61284-379-7.","\"Photovoltaic Modeling\" Power Analytics Corporation 168720 West Bernardo Drive, Suite 330 San Diego, CA 92127, U.S.A.","Prince Jose, Priya Rani Jose (February 2014), \"Grid connected photovoltaic system with fuzzy logic control based MPPT\" International Journal of Engineering and Innovative Technology (IJEIT), Volume 3, Issue 8, pp. 142–148, ISSN: 2277-3754."]}

This study is aimed at explaining the change process followed for the implementation of the new curriculum at Avalon University School of Medicine and its evaluation.Self-evaluation at Avalon University School of Medicine identified the need for a change in the curriculum. The main reasons for the change are isolated disciplines and overcrowded curriculum leading to less self-study time for students. The new curriculum is aimed to have an integrated curriculum and to avoid redundancies. The new curriculum is designed, implemented, and evaluation of the same is in place. Evaluation methods and materials: After implementation, quantitative (results from exams) and semi-quantitative (self-administered questionnaire) evaluation methods are being used to evaluate the new curriculum. Feedback is also taken by having discussions with teachers and students to find out what they like and where modifications are needed. In this article, we are presenting the results of course evaluations (semi-quantitative methods) for two courses. The course evaluations were taken from the sample class size of 30 students.The course evaluations demonstrated an improvement. The main reason for the improvement is due to collaborative efforts of the faculty members from different disciplines in teaching, assessments, and providing feedback to the students.The well-approached change process is required for the successful implementation of the new curriculum. The idea of ownership among all stakeholders is required for a well-managed change process.

Aims and Objectives: The aim of this study was to assess the knowledge of psychiatric aspects of alcohol use disorders (AUDs) in medical students. Materials and Methods: A cross-sectional study conducted in Mamata Medical College, Khammam, Telangana, from June 2014 to May 2015. The study sample consisted of 180 medical students (115 final year and 65 interns), who agreed to answer the Knowledge of Psychiatric Aspects of Alcohol Questionnaire (KPAAQ) anonymously, indicating their gender, year of study and whether they had attended any lecture or workshop on alcohol. KPAAQ consists of 50 questions of 6 clinically relevant categories. Each response to 50 questions of the KPAAQ was assessed. Each correct response was awarded 2 points, thereby, yielding a possible range from 0 to 100 points. Results: The mean knowledge score in medical students was 44.53 (standard deviation = 11.23) without any significant differences (t = 1.171; P > 0.05) between final year students and interns, while the mean knowledge score was significantly more in 74 male students when compared to 106 female students (46.62 ± 10.58; 43.07 ± 11.49) (t = 2.103; P < 0.037). Conclusions: Irrespective of their year of study. Knowledge of psychiatric aspects of AUDs in medical students was inadequate.

Durability plays important role in structures that replicates the service life of the structure. Most of the structures are built by using concrete as main construction material. We can improve the service life of structures by substituting cement with secondary materials which contain cementitious property such asGGBS (Ground Granulated Blast Furnace Slag). In this concept we determine the chloride content in reinforced concrete structure which leads to deterioration, when exposed to 3.5% of NaCl solution by using immersion test. Firstly, we cast cubes (150x150x150mm) for conventional mix and mixes with different percentages of GGBS (30%, 50% and70%). Present in this paper we considered 0.30, 0.40 and 0.50 water binder ratio (w/b). Later on, we find the percentage of chloride ion penetrated is tested at 6 weeks and 12 weeks. We determine the compressive strength for 28 days, 56 days and 90 days and the chloride content (%) at 5mm, 10mm, 15mm, 20mm and 25mm depths of specimens, by using an empirical formula of Fick’s 2nd law. Service life prediction can be helpful to estimate prevailing the life of structure and can plan the better repair strategies and to make critical decisions in practice. We can design new structures such that life cycle cost can be optimized.