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   Table of Contents - Current issue
Coverpage
July-September 2021
Volume 7 | Issue 3
Page Nos. 135-201

Online since Tuesday, September 28, 2021

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EDITORIAL  

What's new in academic international medicine? Redefining our purpose, setting new goals, and refocusing our efforts p. 135
Taryn Clark, Stanislaw P Stawicki
DOI:10.4103/ijam.ijam_114_21  
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ACADEMIC PROGRAMS AND DEVELOPMENT Top

Fostering East-West and North-South bidirectional collaborations: Experiences from the First International Congress on Ecology and Evolution of Global Communicable Diseases held in Quito and the Galapagos Islands, Ecuador p. 137
Nicole K Le, Sarita Panchang, Andres Izurieta, Miguel Reina Ortiz, Ismael Hoare, Eknath Naik, Mauricio Espinel, Enrique Teran, Ricardo Izurieta
DOI:10.4103/IJAM.IJAM_42_21  
Communicable disease is a challenge that is widely recognized to be a consequence of globalization. Infectious disease threats such as SARS-CoV-2, Ebola, Zika, malaria, and yellow fever are easily transmissible through mass global processes such as migration and trade. Scholars are increasingly recognizing the value of international cooperation and transdisciplinary research to meet these infectious disease challenges and even to anticipate future challenges. However, international collaboration is not an easy process given the often-uneven relationships between the Global North and South due to histories of resource disparities. In the International Congress on Ecology and Evolution of Global Communicable Diseases held in Quito and Galapagos Islands, Ecuador in 2016, researchers developed a concrete framework for international, interdisciplinary collaboration toward tackling infectious disease challenges. We share the insights from the congress here in hopes of enabling other scientific researchers to engage in similar research partnerships and to forge collective progress toward a more efficient infectious disease research agenda. The following core competencies are addressed in this article: Medical knowledge, Interpersonal and communication skills, and Professionalism.
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REVIEW ARTICLE Top

A literature survey on the biomarkers of cardiovascular disease p. 141
Ravindran Pavithra, Thangavelu Sangeetha, Shanmugam Velayuthaprabhu, Arumugam Vijaya Anand
DOI:10.4103/IJAM.IJAM_80_20  
Biomarkers of any condition will help in predicting the disease that can help in improvised treatment and medication. Due to lack of symptoms and precursors, cardiovascular disease (CVD) is one of the leading reasons for death in population all over the world. To reduce the death rate and improve the therapeutic approach, biomarkers related to CVD can be helpful. The study of the levels of biomarkers in the body can help in predicting the chances of CVD. The literature study of biomarkers of CVD is to analyze the biomarkers and their role and levels in causing CVD. Among the various analyzed lipid-related markers like apolipoprotein B, apolipoprotein A1, lipoprotein (a), high-sensitivity cardiac troponin, high-sensitivity C-reactive protein, lipoprotein-associated phospholipase A2, coronary artery calcification, cystatin C, it has been identified that the cystatin C is the biomarker for not only the chronic kidney disease but also a predictor of major CVD events. The following core competencies are addressed in this article: Medical knowledge, Patient care, Systems-based practice.
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ORIGINAL ARTICLES Top

Checklist-based training for essential clinical skills in 3 term MBBS students p. 150
Smitha Bhat
DOI:10.4103/IJAM.IJAM_141_20  
Background: Undergraduate students find the correct sequence & method of eliciting clinical signs is ambiguous, leading to confusion & reluctance to demonstrate. The 3-term posting is the introduction to clinical skills & it is essential that bedside teaching is organized & delivered well. Studies have shown that a structured clinical training improves students' examination skills. This study aimed to estimate the difference in competence in basic physical examination in students taught by checklist-based training and those taught by standard clinical teaching. Materials and Methods: This was a randomized crossover trial conducted on 3 term MBBS students posted to medicine. Checklists for general physical examination (GPE) and vital sign examination were framed, piloted. Students were divided in to control & test groups by simple randomization. In phase 1, the control group learnt measurement of vital signs by standard clinical teaching in the units. The test group learned using checklist-based demonstration. In phase 2, the groups were interchanged and GPE was taught by checklist method in the test group .Skills were assessed by OSCE after each training. OSCE scores between control & test groups were compared and analysed. Results: Students showed significantly higher scores when GPE was taught by checklist-based method (Test 1.49, control 0.6. P – 0.000). There was no significant difference in OSCE scores in vital sign examination (Test – 1.15, Control 1.19 P – 0.378). Students found the checklist-based method systematic and easy to remember Conclusion: Checklist-based training improves student clinical learning in GPE, though not in vital sign examination. The following core competencies are addressed in this article: Medical knowledge, Patient care, Practice-based learning and improvement.
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The perception of the medical faculty and undergraduate students regarding online teaching in the era of COVID-19 p. 156
Meeta Gupta, Manish Singh, Rajesh Gupta, Shalini Sobti, Puneeta Gupta, Vanita Gupta, Aditya Gupta
DOI:10.4103/IJAM.IJAM_27_21  
Introduction: In this COVID-19 epidemic, most of the countries are facing issues regarding health care from the points of management, academic, and treatment. Online medical education as an alternate source has been utilized, but it entails certain solutions to the problems encountered in this new methodology of medical education. The study was conducted to enhance the knowledge about the barriers and the concurrent solutions and help improve online medical education in COVID era. Materials and Methods: A prospective, cross-sectional study was conducted on 336 undergraduate medical students 61 medical faculty members of ABVMS, Jammu. The two online intake forms in the form of a voluntary, self-administered questionnaires were used to collect the data; whose link was made active from May 15, 2020, to May 30, 2020. The questionnaire was designed with 10 questions for faculty and 7 for students. The questions encompassed different subjects related to their preferences and perception of online learning. The data were entered in MS Excel and analyzed using the SPSS software version 20.0. P <0.05 was considered statistically significant. Results: The medical faculty perceived online class discussions and assessments of the students as difficult barriers (27.87% and 40.99%, respectively) and access to books/images for teaching and lectures making and delivering as easy (50.82% and 52.46%, respectively). The students felt that the ease of theoretical learning was best with downloadable AV lectures (54.46%). A total of 48.15% students and 31.15% faculty members supported the use of online education in future (P < 0.0001). Conclusion: The coronavirus pandemic appears to be an inflection point that is forcing disruption in how we teach medicine. While in the midst of this COVID-19 crisis, the medical faculty and the students are willing for a favorable change from offline to online medical education in view of an online instructional support/training, and infrastructural change. The following core competencies are addressed in this article: Interpersonal and communication skills, Practice-based learning and improvement.
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Safely managing pain in hospitalized older adults: Implementation of a geriatric acute pain management order set p. 166
Heather L Alban, Heather E Krasa, Peter W Deringer, Kushee-Nidhi Kumar
DOI:10.4103/IJAM.IJAM_67_21  
Introduction: Opioid pain medications carry serious risks when not used properly. Tools should be used to establish individualized, multimodal pain treatment plans that use opioids judiciously and effectively.This study aimed to explore outcomes of older adult patients who experience acute pain and determine if implementation of a Geriatric Acute Pain Management Order Set reduces opioid consumption during hospitalization, length of stay, unnecessary readmissions, and discharges to skilled nursing facilities. Materials and Methods: This was a retrospective chart review over 12 months at a Level I trauma center.Implementation of Geriatric Acute Pain Management Order Set on adults ≥70 years admitted to services diagnosed with long bone, rib, vertebral, or pelvic fracture. Exploratory analysis using the order set was compared to standard pain management practices. Results: Nonsignificant association was found between order set usage and average oral morphine equivalents (OMEs), consumption per day (P = 0.08), length of stay (P = 0.45), and number of days to readmission (P = 0.70). Hip/femur/pelvic fractures showed higher median OME/day (14.2 mg) compared to patients with humerus/scapula/clavicle fracture(s) (8.9 mg). Median OME/day was statistically different between types of service lines (P < 0.01), with orthopedics having the highest daily OME (30.4 mg). Most patients were discharged to skilled nursing facilities (n = 277) and homes (n = 114) with no demonstrated correlation between the amount of opioids consumed and discharge disposition. Conclusions: Order set integration into practice guides safe and effective care of older adults experiencing pain. Optimization of pain management modalities in the hospital serves to restore mobility and function, reduce patient harm, and improve quality of life. The following core competencies are addressed in this article: Practice-based learning and improvement, Patient care and procedural skills, and Systems-based practice.
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CASE REPORTS Top

Fetal mummification complicating a dichorionic twin gestation: Clinical pearls for medical education p. 172
Olusoji Edward Jagun, Oluwaseyitan Adesegun
DOI:10.4103/IJAM.IJAM_164_20  
Fetus papyraceous is a complication of multiple gestation characterized by single intrauterine fetal death of a twin, co-existing with a normal twin. It can present without problems to the mother and surviving twin but it increases the risk of death to the surviving twin, preterm delivery, dystocia, and other fetomaternal complications. This case aims to draw attention to the rare finding of a mummified twin coexisting with a normal twin, as well as the clinical management of such presentation. We present a case of a 32-year-old multigravida with no living children, who spontaneously conceived a twin pregnancy that was complicated by fetus papyraceous and eventual (inevitable) preterm delivery. The pregnancy was managed conservatively by frequent fetomaternal monitoring to allow for adequate fetal lung maturity. The surviving twin and mother remained stable postpartum. Frequent ultrasonographic monitoring along with conservative management to prolong pregnancy until fetal lung maturity is ascertained, are useful strategies in managing such a case, and the management of each case should be individualized. The following core competencies are addressed in this article: Medical knowledge, Patient care.
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An ambiguous periapical cyst: A case report and literature review p. 176
Rinisha Sinha, P Pranave, Pramod Waghmare
DOI:10.4103/IJAM.IJAM_40_21  
Periapical cyst or radicular cyst is the most common inflammatory odontogenic cyst of the jaws, but its association with the over-retained deciduous teeth is unusual. This case reports a 24-year-old male patient who complained of swelling in the upper right back tooth region of the mouth. It was tentatively diagnosed as an odontogenic keratocyst because of its radiographic appearance. However, after histopathological examination, it was identified as an infected periapical cyst whose etiology was an over-retained deciduous root piece. We have reported this case due to its uniqueness in terms of etiology, clinical and radiographic findings, and management. The literature review is discussed in comparison with the current case's findings as well as the indications for guided bone regeneration after a follow-up of 6 months. This article highlights that the art of clinical diagnosis lies in the ability to perform a thorough examination, followed by proper investigations that may defy the provisional diagnosis. Sometimes, it lies as a disguise and only a detailed thorough investigation can reveal its true identity. The following core competencies are addressed in this article: Practice-based learning and improvement, Medical knowledge, Patient care.
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FUTURE TRENDS Top

Choose your own adventure: Psychiatric advanced directives coming soon to an ED near you p. 181
Nidal Moukaddam, Veronica Theresa Tucci
DOI:10.4103/IJAM.IJAM_22_21  
Psychiatric advanced directives (PADs) are utilized by mental health patients to direct their psychiatric care including assigning surrogates for medical decision-making, listing preferred inpatient psychiatric/treating facilities, preferred medication regimens to stabilize acute psychiatric condition and to facilitate the patient's overall interaction with the mental health system. This article reviews the rationale behind PADs, how they can be utilized to reduce the need for de-escalation techniques, restraints and chemical anxiolysis by partnering with patients in the delivery of their care. This paper will also briefly address some of the practical limitations that Emergency Physicians and allied health care providers might face in attempting to honor PADs including the inability to admit to preferred facilities due to staff shortages or other issues associated with the global COVID-19 pandemic. The following core competencies are addressed in this article: Patient care, Interpersonal and communication skills, and Systems-based practice.
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CONFERENCE ABSTRACTS AND REPORTS Top

The 2021 St. Luke's University Health Network Annual Research Symposium: Event highlights and scientific abstracts p. 185
Anna Ng Pellegrino, Rachel Birk, Kushee-Nidhi Kumar
DOI:10.4103/2455-5568.326811  
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