E-learning in medical education in India

E-learning, or learning and teaching facilitated and supported through the application of technology, is presently being used widely in all fields of education, and also being utilized extensively in medical education. This narrative review aims to introduce the concept of elearning, and discuss its need and scope in medical education in India. Experience shows that students and faculty are mostly in favor of adopting e-learning side-by-side with traditional learning, and the advantages far outweigh the likely discomfort associated with adoption of this new method.     

Comparison of 300,000 and 600,000 IU Oral Vitamin-D Bolus for Vitamin-D Deficiency in Young Children

Objective

To compare the efficacy and safety of 300,000 and 600,000 IU vitamin-D single-oral dose for the treatment of vitamin-D deficiency (VDD) in young children (3 mo – 3 y).

Methods

This double-blind randomized control trial (Clinical Trail Registration-CTRI/2012/05/002621) was conducted in the Pediatric out-patient department (OPD) at a tertiary-care referral hospital. Children (3 mo – 3 y) with clinical/radiological features suggestive of VDD were screened; those found to be having 25(OH)D below 15 ng/ml and meeting inclusion and exclusion criteria’s were enrolled after taking informed consent. They were randomized into two groups, one receiving 600,000 and other 300,000 IU vitamin-D orally stat (Stoss-therapy). Primary outcome measure was proportion of children developing hypercalcemia/and hypercalciuria at day 7–10 post-therapy. Secondary outcome measures were proportion of children with hypercalciuria at day 3–5, hypercalcemia/and hypercalciuria at day 25–30 and 25(OH)D sufficiency at day 25–30 post-therapy.

Results

Sixty children, 30 in each group were randomized to two study groups. Baseline variables were comparable in two groups. Primary outcome measure (proportion of children with hypercalcemia/and hypercalciuria at 7 – 10th d) were 18.5 % (5/27) in 600,000 and 10.7 % (3/28) in 300,000 IU group (P = 0.47). Secondary outcome measures were - i) Proportion of children with hypercalciuria (3–5th d) were 18.5 % (5/27) in 600,000 and 7 % (2/28) in 300,000 group (P = 0.25). ii) Proportion of children with hypercalcemia/and hypercalciuria (25–30th d) were 18.5 % (5/27) in 600,000 and 11 % (3/28) in 300,000 group (P = 0.47). iii) All children in both groups had 25(OH)D levels in sufficiency range (25–30th d). With this sample size no significant difference in any of the group could be established.

Conclusions

The superiority of 300,000 over 600,000 IU vitamin-D single-dose oral therapy for VDD in children (3 mo – 3 y) in terms of safety could not be established with this sample size, although the prevalence of hypercalcemia/and hypercalciuria was observed more with 600,000 IU group. Both the regimens were effective for treating VDD at 25–30th d post-therapy.

     

Assessing the quality of clinical and administrative data extracted from hospitals: the General Medicine Inpatient Initiative (GEMINI) experience

ObjectiveLarge clinical databases are increasingly used for research and quality improvement. We describe an approach to data quality assessment from the General Medicine Inpatient Initiative (GEMINI), which collects and standardizes administrative and clinical data from hospitals.MethodsThe GEMINI database contained 245 559 patient admissions at 7 hospitals in Ontario, Canada from 2010 to 2017. We performed 7 computational data quality checks and iteratively re-extracted data from hospitals to correct problems. Thereafter, GEMINI data were compared to data that were manually abstracted from the hospital’s electronic medical record for 23 419 selected data points on a sample of 7488 patients.ResultsComputational checks flagged 103 potential data quality issues, which were either corrected or documented to inform future analysis. For example, we identified the inclusion of canceled radiology tests, a time shift of transfusion data, and mistakenly processing the chemical symbol for sodium (“Na”) as a missing value. Manual validation identified 1 important data quality issue that was not detected by computational checks: transfusion dates and times at 1 site were unreliable. Apart from that single issue, across all data tables, GEMINI data had high overall accuracy (ranging from 98%–100%), sensitivity (95%–100%), specificity (99%–100%), positive predictive value (93%–100%), and negative predictive value (99%–100%) compared to the gold standard.Discussion and ConclusionComputational data quality checks with iterative re-extraction facilitated reliable data collection from hospitals but missed 1 critical quality issue. Combining computational and manual approaches may be optimal for assessing the quality of large multisite clinical databases.     

Role of Superior Turbinate Pneumatisation in Chronic Rhinosinusitis

The study was designed (1) to study the prevalence of pneumatisation of the superior turbinate in patients undergoing FESS, (2) to evaluate the role of superior turbinate pneumatisation in sinusitis involving the posterior sinuses. The study involved 50 patients being evaluated for FESS. Pre-operative CT scans were done and reviewed by a single observer with specific attention to superior turbinates. Record was also made for opacification/mucosal thickness of the sinuses. Each side of nasal cavity was examined separately. Therefore 50 patients had 100 sides. Of the 100 sides, superior turbinate was identified in 70 sides on CT scan. Of the 70 sides having an identifiable superior turbinate, 18.6 % i.e. thirteen sides had turbinates which were pneumatised. Pneumatised superior turbinates were seen in higher percentage in patients with diseased posterior sinuses. Pneumatised superior turbinate may contribute to posterior sinus disease and mandates attention during FESS.     

Male genital dermatophytosis – clinical features and the effects of the misuse of topical steroids and steroid combinations – an alarming problem in India

Genital dermatophytosis has been considered rare by most Western authorities. However, to the contrary, Indian reports have shown a higher prevalence of genital dermatophytosis due to warm and humid climate, overcrowding and lack of hygiene. A review is presented for 24 cases of male genital dermatophytosis occurring in patients suffering from tinea cruris in India who have been randomly applying various broad‐spectrum steroid antifungal and antibacterial creams containing one or more antifungal and antibiotic in addition to potent corticosteroids, mainly clobetasol propionate. This is such a common phenomenon that Indian dermatologists are witnessing an epidemic of sorts of steroid‐modified dermatophytosis and we hereby share various clinical presentations of dermatophytosis of penis and/or scrotum in patients with tinea cruris who have been applying the above‐mentioned creams. The review also discusses the bleak scenario that prevails in India regarding the drug regulatory affairs that allow such dangerous and irrational combinations that are sold over the counter because of misinterpretation of the law and lax implementation of existing laws.