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   Table of Contents - Current issue
Coverpage
May-August 2022
Volume 36 | Issue 2
Page Nos. 39-90

Online since Wednesday, November 16, 2022

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REVIEW ARTICLE  

Promoting active learning and student engagement in undergraduate medical education p. 39
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jms.jms_140_21  
Medical student is expected to acquire a significant amount of knowledge during their training period and this becomes major stress for them. The purpose of the current review was to understand the need for active learning and student engagement and identify the various tools or strategies to promote student engagement. An extensive search of all materials related to the topic was carried out on the PubMed search engine, and a total of 21 articles were selected based on their suitability with the current review objectives. Keywords used in the search include student engagement and medical education in the title alone only. Student engagement is a crucial aspect to ensure active learning as it aids in stimulating and enhancing the ability of students to comprehend the concepts and apply them. As we envisage interactive teaching should be the new norm in medical education delivery, it becomes a crucial factor that medical teachers should use appropriate tools/vignettes to ensure student engagement. To conclude, considering the complexities in medical education, ensuring student engagement during the teaching–learning session is of paramount importance. It becomes the responsibility of the teachers to employ various strategies and tools to engage students in the class, as it will help them to acquire knowledge and skills better and will eventually prepare them for their future competent medical practitioner.
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ORIGINAL ARTICLES Top

Prevalence of nonadherence to iron and folic acid supplementation among pregnant women in Bishnupur district of Manipur p. 43
Bikash Debbarma, Shantibala Konjengbam, Vijaya Elangbam, Soubam Christina, Brogen Singh Akoijam
DOI:10.4103/jms.jms_82_21  
Context: Iron and folic acid (IFA) supplementation is an important strategy to reduce the prevalence of iron-deficiency anemia (IDA) during pregnancy. Consequently, it reduces risk of maternal mortality, neonatal mortality, and poor birth outcomes. Nonadherence to IFA supplementation is a challenging factor in combating IDA. Aims: The aim of this study was to determine the prevalence of nonadherence to IFA supplementation among pregnant women and identify the factors associated with it. Subjects and Methods: A cross-sectional study was conducted among pregnant women attending public health facilities of Bishnupur district, Manipur. Pregnant women with ≥20 weeks of period of gestation were recruited consecutively from the antenatal care clinics of the selected public health facilities. Face-to-face interviews were conducted using a pretested semi-structured interview schedule. Association between nonadherence to IFA supplementation and background characteristics and antenatal profile was analyzed using Chi-square test. Results: The mean age of the participants was 28 ± 5.7 years, and 69% were multigravida. Among 396 women who were currently consuming IFA tablets, 25% were nonadherent. Bad taste, side effects, and inadequate supply were cited as the main reasons for irregular intake. The presence of comorbidities (P < 0.001), government supply as source of IFA tablets (P = 0.001), and adequate knowledge about IFA tablets (P = 0.04) were found to be significantly associated with nonadherence. Other associated factors were religion, education, socioeconomic status, and period of gestation. Conclusions: The prevalence of nonadherence was high among pregnant women in Bishnupur district. The importance of IFA supplementation and its adherence should be emphasized to pregnant women.
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Epidemiological survey of fatal road traffic accident in Imphal, Manipur p. 48
Pabitramala Nandeibam, Khangembam Pradipkumar, Supriya Keisham, Huidrom Nabachandra
DOI:10.4103/jms.jms_43_22  
Background: Approximately 1.3 million people die each year as a result of road traffic accidents (RTAs). According to the National Crime Record Bureau, a total of 368,828 traffic accidents were reported in the country in 2020, and out of these, 96% of the cases were due to RTAs with 354,796 cases and 37% fatality. Objectives: The objective is to study the demographic profile of victims of fatal road accidents. Materials and Methods: A cross-sectional study was carried out in the department of forensic medicine of a tertiary care teaching hospital in Imphal on all cases of fatal RTA brought in between October 2015 and September 2018. All data including the postmortem findings were analyzed and presented. Results: Out of 478 medicolegal autopsies conducted during the study period, 159 (33.3%) were vehicular accident fatalities. The majority of the victims were males in the age group of >20–30 years (22.64%) and pedestrians (30.82%). Most of the accidents (40.88%) occurred during the afternoon period between 12 Noon and 6 PM and in the winter months (50.9%), with maximum cases occurring on national highways (55.3%). The cause of death of the victims was due to head injuries in 42.14%. Conclusions: Several factors are responsible for RTAs. There is clearly a need for road safety education among road users. The licensing authorities should adopt stricter, more comprehensive, and scientifically based test.
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Comparison of effectiveness and safety of epsilon-aminocaproic acid and tranexamic acid in adult patients undergoing cardiac surgery Highly accessed article p. 52
Langpoklakpam Chaoba Singh, Sanjeev Singh, Isaac Okyere, Anbarasu Annamalai, Arti Singh
DOI:10.4103/jms.jms_149_21  
Objective: The objective of the study is to evaluate the effectiveness and safety of epsilon-aminocaproic acid (EACA) and tranexamic acid (TXA) in reducing bleeding, re-exploration, and blood transfusion in patients who underwent a cardiac surgical procedure for mitral valve replacement on cardiopulmonary bypass. Methods: A single-center, prospective, randomized, and double-blind clinical comparison study was conducted after obtaining institutional ethical approval; sixty patients of either gender between 18 and 60 years of age were randomly divided into two batches: EACA batch (n = 30) given 100 mg/kg EACA as a bolus during induction of anesthesia and then infused at 20 mg/kg/h during surgery and 6 h after surgery and TXA batch (n = 30) given TXA 20 mg/kg/h as a bolus during induction of anesthesia and then infused at 2 mg/kg/h during surgery and 6 h after surgery. The patient parameters, blood loss, transfusion requirements in the first 24 h, and other complications were recorded. Results: Blood loss per hour through the chest tube drain was significantly lower for the first 6 postoperative hours in the TXA than in the EACA (P < 0.05). The total postoperative blood loss was 416 ± 47.74 ml and 489 ± 42.12 ml in 24 h (P = 0.0001), and the blood transfusion requirement was 0.45 ± 0.62 units and 0.86 ± 0.87 units (P = 0.0481) in the TXA and EACA, respectively. The re-exploration rate was 3.34% and 13.34% in TXA and EACA (P = 0.0629). Five percent of the patients reported seizures in the study (P > 0.05). The findings of this study suggested that prophylactic therapy with EACA or TXA was effective and safer in reducing perioperative blood loss in cardiac surgical procedures with mitral valve replacement. Furthermore, TXA was significantly more effective than EACA.
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Effect of COVID-19 on sleep pattern, mobile usage, and serum melatonin level among 1st-year medical students p. 60
Lalmalsawma Hnamte, Jayshree Phurailatpam, Memeeka Laishram
DOI:10.4103/jms.jms_150_21  
Background: The COVID-19 pandemic has enforced a new norm in the world with maximum dependence on technology in day-to-day living as well as the academic atmosphere. Globally, students are profoundly affected but more specifically medical students are subjected to immense stress, which is bound to affect their sleep and thus the sleep-regulating hormone, melatonin. Young medical students right at the entry to their professional career have, therefore, been hit by the changing scenario with most classes becoming online and increasing dependence on technological gadgets such as smartphones and laptops. Aims and Objectives: The purpose of the study was to determine the sleep pattern of 1st-year medical students, survey their mobile phone use, and to estimate their serum melatonin levels during the COVID-19 pandemic. Materials and Methods: This cross-sectional study was done in a Northeast India Medical Institute using standard questionnaires, Pittsburgh's Sleep Quality Index (PSQI) and Problematic Mobile Phone Usage Questionnaire among medical students and estimating their early morning serum melatonin level by ELISA assay. Statistical Analysis: Data collected were entered in SSPS version 21 and analyzed using descriptive measures, and statistical significances were set at P < 0.05. Results: One hundred and one students (Male: 49 and Female: 52) in the age range of 18–23 years responded to the study which recorded poor sleep quality in 53.5% and good sleep in 46.5%. Poor sleep quality as indicated by PSQI score >5 was reported in 63.5% of females and 42.9% of males which was statistically significant (P = 0.04). Out of these poor sleepers, 66.7% of males and 54.5% of females reported mobile phone usage for more than 2 up to 6 h. Comparatively, poor sleep quality was reported in only 19% of male students as compared to 27% of females among those using mobiles beyond 6 h. Besides, 14% of males and 18% of females among poor sleepers reported using mobiles <2 h. Further, in 80 respondents (Male: 40 and Female: 40) randomly selected for estimation of their early morning sample, serum melatonin level was estimated as 99.25 ± 72.07 pg/ml in males and 109.76 ± 84.54 pg/ml in females. Conclusion: Nearly 2/3rd of poor sleeper, 1st-year medical male students use mobiles for 2–6 h daily during the pandemic while Only ½ of the females do. However, among those poor sleepers using mobiles beyond 6 h daily, females outnumbered males. Estimated Serum smelatonin levels were also relatively higher than those reported in nonpandemic studies.
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A retrospective analysis of drowning deaths in Imphal p. 65
K Supriya, N Pabitramala, Khangembam Pradipkumar Singh, D W. S. James, C Deepen
DOI:10.4103/jms.jms_46_22  
Background: Drowning is a major cause of death worldwide and it is the third leading cause of unintentional injury deaths accounting for 7% of all injury-related deaths. Different factors are responsible for causing death due to drowning. Objectives: The objective of this study was to find out the prevalence of death due to drowning in relation to epidemiological factors and to find out postmortem examination findings and manner of death of such cases. Materials and Methods: A retrospective study of drowning deaths brought to the Department of Forensic Medicine and Toxicology of a tertiary care teaching hospital in Imphal was conducted for 10 years. Data obtained were entered in a pro forma and later analyzed statistically. Results: In this study period, there were 110 cases of drowning cases. Male: female ratio was 10:1. The highest number of victims was observed in the age group of 21-30 years and the maximum number occurred in rivers, i.e., 54.54%. In 67.27% of the cases, there were signs of asphyxia and in 40% of the cases, froth was present around the mouth and nostrils. Cadaveric spasm which was considered the surest sign of antemortem drowning was observed in only 2.72%. Lungs were found to be voluminous in 77.27% of the cases. Maximum occurred in the rainy season. Conclusion: The manner of death could not be ascertained in the present study however from history, most of the cases seem to be accidental. Public awareness and water safety measures need to be improved to prevent drowning deaths.
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Phytochemical analysis and potential applications of the ethanol and aqueous-ethanol extracts of some selected plant in family Zingiberaceae plants for cosmeceutical and health-promoting food p. 69
Pannapa Powthong, Warangkana Lektrakul, Bajaree Juntrapanukorn, Chitradee Luprasong, Chaowalit Monton
DOI:10.4103/jms.jms_145_21  
Background: The rhizomes of the Zingiberaceae family are a vegetable widely used in many Asian nations, and their therapeutic properties have been acknowledged in many traditional recipes. Aims and Objectives: Investigate the in vitro biological effect of the aqueous-ethanol and ethanol crude extract received from three medicinal plants in the family Zingiberaceae. Materials and Methods: Three species of Zingiberaceae plants including Curcuma longa L., Curcuma zedoaria (Christm.) and Curcuma aromatica Salisb.were gathered and evaluated for their phytochemical contents, anti-inflammatory and anti-oxidant characteristics using the aqueous-ethanol (30:70%) and ethanol (95%) extraction and varying according to single and mixed extracts (1:1:1 and 2:1:1 ratio respectively) for determining the synergistic effects. Results: It was indicated that extracts of the three selected plant contained at least 5 from 13 phytochemical constituents. The single aqueous-ethanol extract of C. aromatica Salisb. and synergy achieved at 1:1:1 ratio of aqueous-ethanol extract showed the highest effective anti-inflammatory activity. The greatest antioxidant activity was found in a single ethanol extract of C. zedoaria (Christm.) and synergistically obtained at a 1:1:1 ratio of aqueous-ethanol extract. Furthermore, we discovered that combination extract produced greater outcomes than utilizing the mono extract alone. Conclusion: Our results demonstrate that screening for chosen Zingiberaceae plant extracts is a favorable representation of the value of screening for cosmetically and medicinal purposes.
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Prospective clinical study to evaluate role of centchroman in regression of mastalgia in rural population p. 78
Shashi Prakash Mishra, Somendra Pal Singh, Shailendra Pal Singh, Vipin Gupta, Prashant Gupta, Anil Kumar Sharma, Shesh Kumar, Manish Agarwal
DOI:10.4103/jms.jms_115_21  
Background: Mastalgia in the reproductive age group is common among women. Treatment is not yet standardized for these conditions. The majority of treatments used for mastalgia is costly and have side effects. The aim of our study was to find the efficacy of centchroman for regression of mastalgia in a predominantly rural population, measured by the visual analog scale (VAS). Materials and Methods: A total of 140 patients were randomized into two groups: Group 1 (n = 70) patients treated with centchroman and Group 2 (n = 70) patients treated with placebo for 12 weeks. The main outcomes are evaluated after one week to look for any intolerance, followed by repeated follow-ups at four, twelve, and twenty-four weeks to evaluate the treatment response using the VAS score and the side effects. Results: The mean age of patients in Group 1 was 29.63 ± 9.67 years and 32.32 ± 9.74 years in Group 2. The baseline mean VAS score was 6.40 ± 1.65 and 5.83 ± 1.69, respectively. After 2, 4, 8, 12, and 24 weeks of follow-up, the mean VAS score was significantly decreased in patients treated with centchroman. On intragroup comparison, the mean VAS score was significantly decreased at baseline to 2, 4, 8, 12, and 24 weeks of follow-ups. In both the groups, gastritis and headache were comparable, and delayed menstruation was significantly more in patients treated with centchroman. Conclusion: Centchroman has substantial efficacy, with a marginal effect on regression, of mastalgia in women of the reproductive age group, and it can be used as the first line of treatment.
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Serosurveillance of hepatitis C Infection among health-care workers in RIMS, Imphal p. 83
Yumlembam Bishwabati Devi, Olisha Sumer, Bidyarani Kongbrailatpam, Laitonjam Lalit Kumar, Prahllad Debnath, Robertson Sawian, Ranjana Devi Khuraijam
DOI:10.4103/jms.jms_128_21  
Background: Alarming increase of hepatitis C infection among the general population has put a significant risk among health-care workers (HCWs). This study aims to find the prevalence of hepatitis C infection among HCWs and its importance for surveillance. Objective: The objective of this study was to assess the prevalence of hepatitis C infection among HCWs in a tertiary care hospital. Materials and Methods: A retrospective study was conducted in the Department of Microbiology, RIMS, Imphal, among healthy volunteer HCWs in October 2020 regardless of their COVID-19 status where blood samples were collected and tested for anti-hepatitis C virus (HCV) antibodies using enzyme-linked immunosorbent assay (Merilisa HCV). Results: A total of 378 nonconsecutive blood samples were obtained from volunteers aged between 21 and 65 years. The majority of samples were from Imphal West district with a female preponderance of 66.93%. Two positive cases were detected with a prevalence of 0.53% belonging to occupational Category II and III. Maximum prevalence was seen in the age group of 30–39 years, with both positive cases falling in this group. One case was newly detected, while the other was known as a case of hepatitis infection. Conclusion: Hepatitis C infection among HCWs is common. Infection control should be prioritized when dealing with patients directly or indirectly. Since no vaccine is available, HCWs require periodic screening. Thus, routine surveillance will help combat such infections among HCWs as a result of occupational exposure.
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CASE REPORT Top

A complex odontoma of the anterior maxilla associated with an unerupted maxillary central incisor: A rare entity p. 88
Abhishek Shukla, Bhagavandas Rai, Himanshu Gupta, Viral Gadhiya, Kunjan Patel
DOI:10.4103/jms.jms_46_21  
Odontomas are the most common odontogenic tumors. They are usually asymptomatic and are often discovered during routine radiography. We report a case of complex odontoma in the maxillary anterior region that caused pain and prevented the eruption of a maxillary central incisor. This case is significant as there are very few reports of complex odontoma erupting in the maxillary anterior region of the oral cavity.
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