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A retrospective study of patients with orbital fractures had 48% patients in the age group of 20 – 40 years with male : female ratio of 10:1. Road traffic accidents (71.43%) were the most common cause followed by injury due to fall (20%). Eighty five percent of patients had normal visual acuity at presentation and 65.57% patients had no ocular complaints. Diplopia was present in 14.2% of patients. Of the orbital fractures infraorbital rim was involved in 43.13%, floor in 19.6%, lateral wall in 13.7%, pure blow out in 14.28% and the roof in 2.9%. Important ocular findings were extraocular movements restriction in 9 (10.3%), infraorbital dysaesthesia in 3 (3.4%), enophthalmos in 2, RAPD and globe rupture in 1 patient each. 32 patients underwent surgical management. At the end of 4 months of follow up, 3 had restriction of EOM, 1 patient had vision loss due to globe rupture, 2 had RAPD (optic nerve compression), 1 had lagophthalmos, 1 had exotropia and 1 had atrophic bulbi.

Background: An Indian medical graduate needs to be competent in the diagnosis and management of human immunodeficiency virus (HIV) patients. This is crucial in terms of occupational safety. A participatory learning approach could be a possible way to change behavior and improve HIV risk assessment skills among medical students for better occupational safety and health care. The present study was planned to identify the need, provide different learning experiences for acquiring competency, and compare the effectiveness of participatory learning over traditional in developing HIV risk assessment skills., Materials and Methods: An educational interventional (randomized controlled trial) was carried out at GEMS and Hospital. Needs assessment survey was conducted, which identified HIV risk assessment as a key competency. For which the outcome-specific learning objectives were defined, two different learning experiences were employed. A pretest was conducted to assess the baseline knowledge and attitude ( n = 92); they were then divided into two equal groups (A and B). "A" group was taught by participatory approach, whereas "B" by traditional techniques followed by posttest and objective structured clinical examination (OSCE) to assess their HIV risk assessment skills. Statistical analysis: Paired t -test for assessing knowledge and attitude within the same group and unpaired t -test for assessing skills between the two groups were used in this study., Results: Statistically significant improvement ( P < 0.001) in knowledge and attitude scores was noticed that OSCE scores were significantly higher in the intervention group "A" ( P < 0.001) as compared to "B" taught by traditional techniques., Conclusion: Participatory learning effectively builds upon existing knowledge and attitude to develop better HIV risk assessment skills., Competing Interests: There are no conflicts of interest., (Copyright: © 2021 Journal of Education and Health Promotion.)

The electrocardiogram (ECG) is the primary diagnostic tool in cardiovascular diseases. Hence its interpretation is a core competency in medicine, where obvious deficiencies have been reported among learners. The aim of this study was to introduce the fundamentals of ECG knowledge and interpretation through early clinical exposure (ECE) based on a six-step approach for preclinical students ( n = 110) and to study its influence on their knowledge and interpretation skills thereafter. The first step employed a blended learning format using didactic lectures on normal and pathological ECGs, each preceded by preinstructional videos. The second step focused on psychomotor skills and utilized laboratory exercises for ECG recording and interpretation. The third step focused on vertical integration, where the clinical relevance of the procedure was established with integrated lectures. The fourth step used the Moodle platform, where opportunities for peer interactions and clarifications by clinical faculty were made available. The fifth step incorporated clinical and diagnostic reasoning through cardiology ward visits and interpretation of patient ECGs. The sixth step was designed for critical thinking and problem solving through case-based discussions with peers and faculty. Students were assessed with multiple-choice questions and objective structured practical examination. Learner perceptions of the approach were evaluated with a feedback questionnaire and focus group discussion. Statistical analysis showed that ECE through a six-step approach significantly enhanced knowledge and interpretation of ECG as evidenced by the pre- and posttest scores. Analysis of the focus group data revealed that learner engagement and skills of critical thinking were enhanced along with diagnostic and clinical reasoning.

The present study reports perceptions of first-year undergraduate medical students ( n = 120), regarding modified directed self-learning (DSL) sessions in physiology. Students were provided with prereading assignments (faculty developed PowerPoint slides containing diagrams with incomplete labeling/flowcharts with missing steps) pertaining to the DSL topic 1 wk before the scheduled small-group DSL presentations. During DSL presentation sessions, which were facilitated by teachers, a few students individually presented learning objectives in the specified topic. Apart from that, students discussed answers for the questions in the prereading assignment. Students were also given an opportunity to use technology to support DSL, by way of involving them in Pecha Kucha (PK) talks. The impact of the modified DSL method was determined by requesting students to respond to a validated questionnaire. Frequency analysis of the responses revealed that >60% of students were positive about the modified DSL sessions improving their DSL, presentation, collaborative learning, and information retrieving skills. Students agreed that PK talks helped them to learn how to organize content (65%), present concise information (65.8%), and apply creativity (72.5%). Even though small in number, there were comments that the prereading assignments were useful for learning. The present study revealed that, even though students actively participated in modified DSL sessions, their perceptions on satisfaction and usefulness of the same toward achievement of various skills were not encouraging. The study generated significant results, which implies that undergraduate medical students should be oriented on the relevance of active learning strategies in their future studies.

Aim: To assess the outcomes of drug therapy (DT) followed by pancreatic endotherapy for continuing painful episodes in recurrent acute pancreatitis., Methods: DT comprised of pancreatic enzymes and anti-oxidants failing which, endotherapy (ET; pancreatic sphincterotomy and stent placement) was done. The frequency of pain, its visual analogue score (VAS), quality of life (QoL), serum C peptide and faecal elastase were compared between baseline and after 1 year of follow up in all patients and in the two subgroups on DT and ET. Response was defined as at least 50% reduction in the severity of pain to below a score of 5., Results: Of the thirty nine patients analysed, 21 (53.9%) responded to DT and 18 (46.1%) underwent ET. The VAS for pain (7.0 ± 2.0 vs 1.3 ± 2.5, P < 0.001) and the number of days with pain per month decreased [1.0 (1.0, 2.0) vs 1.0 (0.0, 1.0), P < 0.001], and the QoL scores [55.0 (44.0, 66.0) vs 38.0 (32.00, 51.00), P < 0.01] improved significantly during follow up. Similar significant improvements were seen in patients in the subgroups of DT and ET except for QoL in ET. The serum C-peptide ( P = 0.001) and FE ( P < 0.001) levels improved significantly in the entire group and in the two subgroups of patients except for the C peptide levels in patients on DT., Conclusion: A standardised protocol of DT, followed by ET decreased the intensity and frequency of pain in recurrent acute pancreatitis, enhanced QoL and improved pancreatic function., Competing Interests: Conflict-of-interest statement: The authors have no conflict of interest to declare.

Aim: To compare two tests for exocrine pancreatic function (EPF) for use in M-ANNHEIM staging for pancreatitis., Methods: One hundred and ninety four consecutive patients with acute pancreatitis (AP; n = 13), recurrent acute pancreatitis (RAP; n = 65) and chronic pancreatitis (CP; n = 116) were enrolled. EPF was assessed by faecal elastase-1 (FE-1) estimation and stool fat excretion by the acid steatocrit method. Patients were classified as per M-ANNHEIM stages separately based on the results of the two tests for comparison. Independent Student's t -test, χ 2 test, Kruskal-Wallis test, Mann-Whitney U test and McNemar's test were used as appropriate., Results: Sixty-one (52.5%) patients with CP had steatorrhoea when assessed by the acid steatocrit method; 79 (68.1%) with CP had exocrine insufficiency by the FE-1 test (χ 2 test, P < 0.001). The results of acid steatocrit and FE-1 showed a significant negative correlation (Spearman's rho = -0.376, P < 0.001). A statistically significant difference was seen between the M-ANNHEIM stages as classified separately by acid steatocrit and the FE-1. Thirteen (6.7%), 87 (44.8%), 89 (45.8%) and 5 (2.5%) patients were placed in M-ANNHEIM stages 0, I, II, and III respectively, with the use of acid steatocrit as against 13 (6.7%), 85 (43.8%), 75 (38.6%), and 21 (10.8%) respectively by FE-1 in stages 0, I, II, and III thereby altering the stage in 28 (14.4%) patients ( P < 0.001, McNemar's test)., Conclusion: FE-1 estimation performed better than the acid steatocrit test for use in the staging of pancreatitis by the M-ANNHEIM classification since it diagnosed a higher proportion of patients with exocrine insufficiency., Competing Interests: Conflict-of-interest statement: The authors have no conflict of interest to declare.

Background: Little data exist on the progression of recurrent acute (RAP) and chronic pancreatitis (CP) from regions from where the entity of tropical chronic pancreatitis was originally described. The study aimed to follow up patients with RAP and CP seen at a southern Indian centre for progression of disease over time., Methods: Prospectively enrolled patients with RAP and CP were followed up, and the alcoholic and idiopathic subgroups were assessed for progression of structural and functional changes in the organ., Results: One hundred and forty patients (RAP = 44; 31.4 %, CP = 96; 68.5 %) were followed up over a median 12.2 (interquartile range 12.0-16.8) months. The cause was alcohol in 31 (22.1 %) and not evident in 109 (77.8 %). The disease progressed from RAP to CP in 7 (15.9 %), 6 (16.2 %) out of 37 in the idiopathic and 1 (14.2 %; p = 1.00) out of 7 in the alcoholic subgroups. Three (42.8 %) and 1 (14.2 %) developed steatorrhea and diabetes mellitus (DM), respectively, and 2 (4.5 %) developed calcification. Established CP progressed in 19 (19.7 %), 1 (1.0 %), 5 (5.2 %), 2 (2.0 %) and 11 (11.4 %) newly developed DM, steatorrhea, calcification and duct dilation during follow up. Among the idiopathic and alcoholic CP, disease progression was seen in 15 (20.8 %) out of 72 and 4 (16.6 %) out of 24 respectively., Conclusions: Idiopathic RAP and CP progressed during the short-term follow up. This is similar to other etiological forms of pancreatitis, as described from elsewhere in the world.

Background: The undergraduate curriculum at our institution is divided system-wise into four blocks, each block ending with theory and objective structured practical examination (OSPE). The OSPE in Physiology consists of 12 stations, and a conventional minimum score to qualify is 50%. We aimed to incorporate standard setting using the modified Angoff method in OSPE to differentiate the competent from the non-competent student and to explore the possibility of introducing standard setting in Physiology OSPE at our institution., Methods: Experts rated the OSPE using the modified Angoff method to obtain the standard set cut-off in two of the four blocks. We assessed the OSPE marks of 110 first year medical students. Chi-square test was used to compare the number of students who scored less than standard set cut-off and conventional cut-off; correlation coefficient was used to assess the relation between OSPE and theory marks in both blocks. Feedback was obtained from the experts., Results: The standard set was 62% and 67% for blocks II and III, respectively. The use of standard set cut-off resulted in 16.3% (n=18) and 22.7% (n=25) students being declared unsuccessful in blocks II and III, respectively. Comparison between the number, who scored less than standard set and conventional cut-off was statistically significant (p=0.001). The correlation coefficient was 0.65 (p=0.003) and 0.52 (p<0.001) in blocks II and III, respectively. The experts welcomed the idea of standard setting., Conclusion: Standard setting helped in differentiating the competent from the non-competent student, indicating that standard setting enhances the quality of OSPE as an assessment tool.

Background: Diagnostic parameters that can predict the presence of chronic pancreatitis (CP) in patients with recurrent pain due to pancreatitis would help to direct appropriate therapy. This study aimed to compare the serum levels of monocyte chemoattractant protein-1 (MCP-1), transforming growth factor-beta1 (TGF-beta1), nerve growth factor (NGF), resistin and hyaluronic acid (HA) in patients with recurrent acute pancreatitis (RAP) and CP to assess their ability to differentiate the two conditions., Methods: Levels of serum markers assessed by enzyme-linked immunosorbent assay (ELISA) were prospectively compared in consecutive patients with RAP, CP and in controls, and stepwise discriminant analysis was performed to identify the markers differentiating RAP from CP., Results: One hundred and thirteen consecutive patients (RAP=32, CP=81) and 78 healthy controls were prospectively enrolled. The mean (SD) age of the patients was 32.0 (14.0) years; 89 (78.8%) were male. All markers were significantly higher in CP patients than in the controls (P<0.001); MCP-1, NGF and HA were significantly higher in RAP patients than in the controls (P<0.001). Stepwise discriminant analysis showed significant difference (P=0.002) between RAP and CP for resistin with an accuracy of 61.9%, discriminant scores of ≤-0.479 and ≥0.189 indicating RAP and CP, respectively. The other markers had no differential value between RAP and CP., Conclusion: Serum resistin is a promising marker to differentiate between RAP and CP and needs validation in future studies, especially in those with early CP.

Aim: To assess the intraocular penetration of 0.5% moxifloxacin hydrochloride into aqueous humour after oral and topical administration., Methods: A prospective, interventional study of 42 patients scheduled to undergo cataract surgery was carried out. Out of the 42 subjects, 21 were randomly categorised into Group I and received one drop of 0.5% topical moxifloxacin four times, at 15 min intervals starting 75 min before the surgery. Another 21 subjects were categorised into Group II and all subjects in this group were administered a single tablet of 400 mg of moxifloxacin, 12 h before the surgery. Estimation of moxifloxacin in aqueous samples was carried out using high-performance liquid chromatography. Results were analysed using Student unpaired 't' test and analysis of variance. The value of p<0.05 was considered to be significant., Results: Mean aqueous concentration of moxifloxacin attained in the oral group (n=21) was 0.504±0.30 μg/mL while that in the topical group (n=21) was 2.04±0.72 μg/mL, and this difference in levels was statistically significant (p<0.005). The levels attained by both the groups well exceeded the MIC90 (minimum inhibitory concentration of antibiotic required to inhibit growth of 90% of bacteria strains) levels for most of the organisms causing endophthalmitis. Penetration of moxifloxacin in aqueous in both the groups was not affected by gender, intraocular pressure or comorbidities significantly. However, aqueous levels were found to be higher among the younger subjects within the topical group., Conclusions: Moxifloxacin has an impressive spectrum of coverage and this pharmacokinetic study reinforces its potential as a prophylactic drug against intraocular infections, given the high aqueous levels post topical administration., (Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.)

Introduction: Sleep is vital for mental and physical health of an individual. Duration of sleep influences the metabolism and regulates body weight., Objective: To assess the cross-sectional association of sleep duration with body mass index (BMI) and waist-hip ratio in Malaysian students., Methods: Eighty-nine Malaysian students of both genders, and with a mean (standard deviation) age of 21.2 (0.9) years were included. Institutional Ethics Committee clearance was obtained prior to the start of study. The subjects were interviewed regarding the average hours of sleep/day, their self-reported sleep duration was categorized as < 6hour/day (short sleep duration), 6-7hour/day and > 7hour/day. Their height (in meters), weight (in kilograms), waist and hip circumference (in centimetre) were measured. BMI and waist-hip ratio were calculated using appropriate formulas and expressed as mean (standard deviation). The duration of sleep was compared with BMI and waist-hip ratio using one way ANOVA., Results: No statistical significance was observed when sleep duration was associated with BMI (p=0.65) and waist-hip ratio (p=0.95). Duration of sleep did not affect BMI and waist hip ratio in the Malaysian students in our study. The age and healthy lifestyle of the subjects in this study may have been a reason for no significant influence of short sleep duration on the BMI and waist-hip ratio., Conclusion: No association was found between sleep duration with BMI and waist hip ratio in the Malaysian students.

Melaka Manipal Medical College (Manipal Campus; Manipal, Karnataka, India) conducts the Bachelor of Medicine and Bachelor of Surgery program, for which the admission intakes are during the months of March and September. The present study was undertaken to study the differences in learning approaches to physiology of undergraduate medical students in a partially problem-based learning (PBL)- and non-PBL-oriented curriculum. PBL was introduced as a curricular reform for the September 2006 batch of students (partially PBL group), whereas it was not incorporated for the March 2006 batch of students (non-PBL group). Learning approaches to physiology of both groups of students were compared using the short inventory of approaches to learning. Mean scores for deep and strategic approaches were found to be significantly higher for the partially PBL group compared with the non-PBL group. The results of the present study support the earlier observation that PBL promotes a deep approach to learning.

Penetration of intraorbital foreign bodies into the nose and paranasal sinuses although reported in the past are uncommon. Here we present a case of a 26 years old male who came to us with a seemingly trivial injury of his right eye due to a foreign body. Which on further investigation revealed the major part of a large foreign body impacted into the nose and bilateral sinuses, removed successfully.

Tilt table testing has long been used as a standard tool in the diagnostic evaluation of syncope. However, differences of opinion exist with regard to its utility in the evaluation of patients with only presyncopal attacks. We present the results of drug-free, 70-degree head-up tilt table tests (maximum duration of 45 minutes), conducted between May 2002 and May 2003 in the Department of Physiology at JIPMER. This series consisted of both male and female patients (age 6-79 yr) with presyncope (n = 43), unexplained syncope (n = 43) and asymptomatic healthy volunteers without a history of syncope (n = 14). 28 out of 43 patients with unexplained syncope had a history of recurrent syncope while the remaining 15 had only 1 episode. 2 out of 43 patients (4.6%) with a history of only presyncopal attacks had a positive test (induction of intense presyncope and/or syncope accompanied by hypotension and/or a relative bradycardia). 21 out of 43 patients (49%) with a history of syncope had a positive test. 7 had vasodepressor syncope due to hypotension, 6 had cardioinhibitory syncope characterized by asystole and 10 had a mixed form of the vasovagal syndrome characterized by hypotension as well as bradycardia. 18 out of 28 patients (64%) with recurrent unexplained syncope had a positive test. All fourteen healthy volunteers had a negative test. We conclude that tilt table testing is useful in the diagnostic evaluation of patients with unexplained syncope, especially those with recurrent syncope, but not in the evaluation of patients with presyncope alone.

Two cases of unilateral corneal ulcers caused by Acanthamoeba are reported. Neither of the patients had contact lenses at any time. The diagnosis was confirmed by Giemsa stain and cultures of the corneal scrapings.