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   Table of Contents - Current issue
October-December 2019
Volume 10 | Issue 4
Page Nos. 111-137

Online since Tuesday, April 14, 2020

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Online videos as a supplement tool to train II MBBS students in drug administration skills p. 111
Sharmila V Jalgaonkar, Raakhi K Tripathi, Pankaj V Sarkate, Santosh B Salagre, Shobha M Itolikar, Nirmala N Rege
Objective: To evaluate the effect of online videos along with traditional teaching on learning pharmacotherapeutic skills. Materials and Methods: Eight videos illustrating skills required for drug administration by parenteral and inhalational routes were developed and uploaded along with additional resource materials on a dedicated website. Following an online pretest, two practicals on routes of drug administration were conducted for 181 II MBBS students. They were then allowed to voluntarily watch the videos. Video usage, change in knowledge (pre- and post-video observation test score), and performance (Objective Structured Clinical Examination [OSCE] scores of two internal assessments) and perceptions (using prevalidated questionnaire) were recorded. Results: The average number of videos watched/student was 7.50 ± 1.30, whereas the average number of times each video watched was 1.50 ± 0.094. Only 39 students watched the videos before the first internal assessment were found to have statistically higher OSCE score compared to others who failed to watch (P = 0.006). The latter group watched the videos subsequently and showed improvement in their OSCE scores in the second internal assessment as compared to the first one (14.28 ± 3.26; P = 0.001). Students (93.10%) perceived the online videos as useful teaching tools, which helped them to understand and retain the sequence of procedural steps of the skills better. Conclusion: Drug administration skills when taught using a blend of traditional teaching methods and online videos, improved the performance with added reinforcement. Student acceptability was high indicating online videos can serve as a supplementary tool.
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Assessment of aromatase inhibitor-induced bone loss and appropriateness of supportive therapy in postmenopausal breast cancer patients at a tertiary care center p. 118
Rashmi Kumari, Emmanuel James, Wesley M Jose
Objective: To assess aromatase inhibitor-induced bone loss (AIBL) and its management in postmenopausal women (PMW) with breast cancer (BC). Materials and Methods: A cohort of 350 PMW with BC receiving aromatase inhibitors (AIs) during a span of 4 years was evaluated retrospectively. Bone mineral density (BMD) of the patients at lumbar spine (LS) and dual femur was monitored at baseline and annually for 2 years. Baseline fracture risk was evaluated using WHO fracture risk assessment tool. Results: At baseline, only 35.4% of the patients received supportive therapy such as calcium and Vitamin D supplements ± bisphosphonates. Significant decrease of mean BMD occurred at LS, left femur, and right femur (LF and RF) at 1 year (P < 0.001) in 64.6% of patients who did not receive supportive therapy at baseline. Those who received supportive therapy at baseline had a significant elevation of their mean BMD at LS, LF, and RF; (P < 0.001) at 1 year, and this increase in BMD persisted at 2 years. Ten-year fracture risk at baseline was 'high' for 3.14% of patients, while 35.43% had 'moderate risk' of major osteoporotic fracture and 26.6% had 'high risk' of hip fracture. Overall incidence of fractures was 1.1% in patients who did not receive supportive therapy from baseline to 1 year. Conclusion: Majority of BC patients on AIs were not prescribed supportive therapy at baseline. Since AI monotherapy caused significant loss of LS and dual femur BMD at 1 year of treatment, up-front supportive therapy should be started concurrently with AIs from baseline for the prevention of AIBL.
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A comparative study of intrathecal isobaric 0.5% bupivacaine and intrathecal isobaric 0.75% ropivacaine in elective lower segment cesarean section p. 126
Akshay Kishore Gadre, Kasturi Hossain Bandyopadhyay, Chumki Dutta, Tulsi Nag
Objective: To compare the anesthetic efficacy of isobaric 0.75% ropivacaine with isobaric 0.5% bupivacaine in patients undergoing elective lower segment cesarean section (LSCS) under spinal anesthesia (SA) with respect to the nature of sensory block, motor block, and duration of analgesia. Materials and Methods: In this prospective, randomized, double-blinded study, sixty full-term parturients of American Society of Anesthesiologists Grade I–II, aged 20–35 years, scheduled for elective LSCS, were randomized into two groups namely B and R (n = 30). Preoperative medication regimen and anesthesia protocol followed, were uniform for all patients. Patients received 2.5 ml of either local anesthetic agent intrathecally. Hemodynamic parameters, onset and duration of sensory and motor blockade, level achieved, and side effects were compared between the two groups. Postoperative analgesia was assessed using the Visual Analog Scale scoring and also by noting the time of requirement of the first dose of rescue analgesic. Qualitative data were analyzed by Chi-square test and quantitative data were analyzed by independent sample t-test. Results: All the thirty patients in each arm completed the study without any dropouts. Baseline demographic variables, hemodynamic parameters, characteristics of sensory block (onset, time to reach peak sensory level, and duration), postoperative analgesia, and neonatal outcome were similar in both groups. However, intrathecal isobaric 0.75% ropivacaine demonstrated delayed onset (P = 0.005), and a significantly shorter duration (P = 0.001) of motor block. Conclusion: In view of the shorter duration of motor blockade, with similar duration of sensory blockade, hemodynamics, and postoperative analgesia, 0.75% isobaric ropivacaine (18.75 mg) is an efficient and safe alternative to bupivacaine for SA in elective LSCS.
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A comparative study between sublingual misoprostol (PGE1) versus intracervical dinoprostone Gel (PGE2) in the induction of labor:- A prospective observational study p. 132
TH Deepika, H Nagabushan, R Manohar
Objective: To compare the efficacy of sublingual misoprostol tablet and intracervical dinoprostone gel for induction of labor and also to assess the maternal and fetal outcome after induction. Methodology: A prospective observational study was conducted over a period of 6 months. Of 200 cases, 100 received sublingual misoprostol tablet (Group 1) and remaining received intracervical dinoprostone gel (Group 2). The time required from induction to delivery interval (IDI), and maternal and fetal outcome were assessed by the mode of delivery, Apgar score, and need for neonatal intensive care unit (NICU) admission. Data were analyzed using descriptive statistics, Student's t-test, and Chi-square test. Results: Induction to delivery time was 14.1 h in Group 1, whereas 13.9 h in Group 2. Stage II of labor was 2.3 h and 3.1 h in Group 1 and 2 (P < 0.05) respectively. Normal vaginal delivery occurred in 66 cases in Group 1 and 56 cases in Group 2. Apgar score (≥7) at 1 min was observed in 91 and 93 cases of Group 1and Group 2, respectively. Augmentation of labor by artificial rupture of the membrane was needed in 17 cases in Group 1 and 39 cases in Group 2 (P < 0.05). The need of NICU admission was 20 in Group 1 and 19 in Group 2 (P < 0.05). Conclusion: The misoprostol group showed shorter IDI, more number of vaginal deliveries, and reduced need of cesarean section, compared to dinoprostone group. There was a significant difference in the post induction Bishop's score, Stage II process of labor and reduction in the requirement of augmentation (ARM) between the two groups. Misoprostol was found to be more efficacious when compared to dinoprostone.
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