Melaka Manipal Medical College

The following Joint Position Statement represents a collective contribution of emergency and acute care experts from the World Academic Council of Emergency Medicine and the American College of Academic International Medicine Task Force on Telemedicine for COVID-19 Pandemic. Over the past 3 months, the world witnessed historic and dramatic developments related to the rapid emergence of a novel coronavirus. Real-time, detailed global media coverage brought live updates on the infection to every corner of the planet. Social media outlets are abuzz with minute-to-minute alerts, reflections, witness accounts, and personal reactions. We are witnessing stories of human suffering, including overwhelmed health-care systems, limited access to emergency care, vacationing passengers stranded on cruise ships, large-scale evacuations, overnight economic shutdown, and empty streets in China and Italy.[123] The imagery is comparable to an epic movie depicting martial law with large populations confined to their homes in the wake of a deadly virus. This time, it is a novel coronavirus, and the associated disease has been named COVID-19. Moreover, the current world-wide event has now been declared a pandemic by the World Health Organization (WHO).[45] Pneumonia of unknown cause detected in Wuhan, China, was first reported to the WHO on December 31, 2019. In turn, the WHO declared the event a Public Health Emergency of International Concern (PHEIC) on January 30, 2020.[5] Soon, there was a total shutdown of free travel between China and the rest of the world, expanding the human and medical dimensions of the outbreak into the economic and political spheres.[67] The epicenter of the current outbreak was the city of Wuhan in China's Hubei province. In an attempt to contain the spread of COVID-19, the Chinese government has implemented metropolitan-wide quarantine of Wuhan and several nearby cities, effectively forcing millions of people to remain indoors and avoid unnecessary outdoor travel.[8] In a record period of 10 days, a massive 1000-bed hospital was built to help cope with the rapidly increasing number of cases.[9] Despite these efforts, as of February 25th, there were 78,064 confirmed infections, 8752 patients in serious condition, and 2715 reported mortalities in Mainland China alone. Moreover, Chinese authorities estimate a total of 647,406 people who had close contact/proximity with infected people, and more than 79,000 individuals who are under medical observation.[10] There is also a case of a Chinese person who may face a jail sentence for lying about his movements in Singapore during the mandatory quarantine period.[11] Finally, there is a real possibility that the Federal Emergency Management Agency in the United States (US) may declare emergency over the COVID-19 infection.[12] At the time of this commentary, COVID-19 has spread throughout the world and has infected 37,371 confirmed cases in 113 countries with 1130 deaths outside of China.[5] A sudden increase in cases has been reported in Iran, Italy, and South Korea. Cases linked to travel to/from Iran have been found in Bahrain, Iraq, Kuwait, and Oman. Similarly, cases related to Italy have been found in Algeria, Austria, Croatia, Germany, Spain, and Switzerland.[513] Most recently, Nigeria confirmed its first case in Sub-Saharan Africa, whereas the US reported its first coronavirus-related death in Washington state.[1415] Thus, COVID-19 has established itself outside of China and now appears to be spreading across new regions, countries, and continents. The geographic diversity of the above locations suggested that a pandemic was imminent and ultimately, on 11th of March, 2020 WHO declared COVID-19 a pandemic.[516] In the meanwhile, various international and regional authorities are following the footsteps of China to impose movement restrictions on their populations with an aim to curb the human-to-human spread of the virus. Few health-care systems around the world are equipped to deal with the potentially massive numbers of infections, acutely ill patients, as well as population-level anxiety related to both COVID-19 and the restrictions put into place to help contain its spread.[171819] In China, COVID-19 infections escalated quickly and without warning, with little time for emergency procedures or other mitigation efforts. Other provinces in China have not shown similar massive increase in infections and deaths as seen in the Hubei province. However, this was achieved at a great cost for the 40–60 million residents of Wuhan and 15 other surrounding cities within Hubei Province who were subjected to community containment measures.[1320] The human movement restrictions may be prolonged for now as approximately 14% of recovered coronavirus patients in China's Guangdong have tested positive again after being declared virus free and there is no consensus on the optimal length of the quarantine.[21] Like any other defining challenge in human history, the current emergence of COVID-19 comes with its own unique opportunities and innovative solutions. Technological advances provide humanity with new, previously unavailable options. Although the ultimate solution to the COVID-19 infection will be multifaceted, one important avenue that has not yet been explored fully is to leverage existing technologies to facilitate optimal care delivery while minimizing the risk of direct human-to-human exposure. In this context, telemedicine represents an attractive, effective, and affordable option. Moreover, this technology is of critical importance when one considers the consequences of health-care providers contracting COVID-19 as a result of direct exposure; something that can be especially devastating in low-resource areas or under the circumstances of massive stress to the existing health-care infrastructure and staff.[22] When movement is restricted throughout the world and entire cities are quarantined, affected populations are susceptible to increased stresses of daily life, unexpected economic burdens, communicable and noncommunicable diseases, and various mental health sequelae.[232425] Consequently, unique and innovative solutions are called for to help address the critical needs of not only those acutely ill with COVID-19 but also all others who may require medical attention but are unable to receive it due to limited access or lack of resources. Under such conditions, telemedicine services (TMSs) become a critical asset, with important implications across the entire health-care delivery spectrum. The use of TMS offers several advantages, especially in the setting of nonurgent/routine care and in situations where services do not require direct provider–patient interaction, such as focused/abbreviated medical consultations or mental health visits.[262728] This, in turn, reduces resource use across the already stressed health-care infrastructure, improves access to care, and at the same time minimizes the risk of direct person-to-person transmission of the infectious agent.[29303132] Furthermore, the associated reduction in resource consumption due to the lower need for personal protective equipment can amount to substantial financial savings when considered at national, continental, or global scale.[3334] Based on the above rationale, the availability of TMS can become a critical need for populations and patients affected by the COVID-19 infection, especially when under active quarantine. Enabling patients to consult a health-care provider via teleconferencing, in real-time, to allay one's fear and anxiety, seek advice regarding their routine health problems, and learn self-care, all become critically important in the setting of hospitals and clinics being overwhelmed with more acute complaints.[353637] Using tailored approaches, TMS providers can remotely identify patients who may require further escalation of care. Thus, TMS can be a powerful gate-keeping and coordination mechanism to ensure more appropriate use of provider offices, emergency departments (EDs), and hospitals, as understood within the above broader context.[36383940] The overall emergency implementation of TMS can also be augmented by the addition of point-of-care clinical assessment and diagnostic testing, further strengthening the efficacy of the emergency response infrastructure.[4142] Spatiotemporal analyses of telehealth data, specifically those focusing on calls regarding the complaint of “fever,” have in the past provided a timely and useful picture of the evolution of a national influenza outbreak in the United Kingdom (UK).[43] The high burden of seasonal influenza outbreaks prompted the implementation of innovative TMS-based solutions as first-line approaches to reduce patient visits to the ED.[44] Taking a cue from the fight against influenza, a robust and responsive health-care system should consider adopting similar innovative TMS-based approaches in the setting of COVID-19. For countries and regions with limited or no identified transmission of COVID-19, rapid adoption of TMS and appropriate training of the health-care workforce in use of TMS should be considered among the top priorities. The level of urgency increases further in the presence of active and/or accelerating viral spread. When evaluating options for rapid mass-scale implementation of TMS capabilities across the entire regions, countries, or even continents, important logistical issues must be taken into consideration. With the rapid evolution and miniaturization of portable electronic devices, most households own at least one digital device that is capable of rudimentary TMS patient–provider interactions.[454647] Moreover, most regions of the world have some form of connectivity, even if intermittent, thus enabling the use of patient- or community-owned devices over the existing infrastructure. During the current COVID-19 pandemic, the WHO has asked nations to increase their preparedness, suggesting the following three priorities:[13] First, all countries must prioritize protecting health-care workers Second, communities must actively work on ways to protect people who are most at risk of severe disease, particularly the elderly and individuals with pre-existing health conditions Third, the global community must protect the most vulnerable countries, by doing everything possible to effectively contain the epidemic and/or minimize its spread. Within the context of the above WHO priorities, TMSs are perfectly positioned to help achieve the objectives for all three priorities, as follows: First, TMS use actively protects health-care workers by reducing nonacute patient-provider interactions, thus minimizing the risk of COVID-19 transmission involving infected but mildly symptomatic individuals Second, TMS will assist communities with protecting high-risk individuals (i.e., elderly and those with co-morbid health conditions) by reducing their exposure to hospitals and other health-care locations that may be frequented by those with acute COVID-19 infection Third, countries or regions with ample health-care staffing and resources will be able to help countries or regions with limited access to staffing and/or resources by providing TMS-based services within an established, agreed-upon framework. One of the Israel's medical centers has reported the use of TMS to more effectively care for the 12 Israeli COVID-19 patients received from the cruise ship that was quarantined in Japan for several weeks.[148] The various TMS platforms and modalities tested include remote patient examination without medical staff presence, robotic telemedicine cart equipped with a camera, screen and medical equipment controlled by doctors and nurses, and remote monitoring using a thermometer, blood pressure instruments and pulse oximetry, without additional human presence.[48] Approximately 1700 health-care personnel have been reported infected with COVID-19 in China and 14.8% have been classified as severe or critically ill, with a total of 5 associated deaths.[49] Fortunately, infection rates appear to be lower than the 2002–2003 severe acute respiratory syndrome (SARS) outbreak where 30% of infections occurred in health-care workers; furthermore, the case fatality rate among health-care workers for SARS was 11% and with COVID-19 it is 0.3%.[50] COVID-19 is demonstrating an estimated reproduction number of 2.2, which signifies that, on average, every patient with COVID-19 will infect just over 2 other individuals.[5152] Until the reproduction number is below 1, the pandemic will continue to escalate unless transmission strategies (i.e., containment or technological innovations like TMS) prevail. In Italy as on March 5 more than 3000 positive cases have been reported, 50% of whom are hospitalized, including 10% in intensive care units with severe respiratory manifestations. Also the mortality in Italy is somewhat higher (107 cases) at around 3.5% and this is probably due to the primary infection clusters that are located in small towns in remote part of North of Italy, far from larger hospitals where the availability of testing for COVID-19 detection is greater.[53] On planetary scale, as the number of documented cases of COVID-19 continues to rise, health officials and providers are exploring virtual care delivery to screen patients for infection away from crowded EDs and provide a safer care alternative for those in isolation after a positive diagnosis. In addition to TMS being beneficial by keeping unaffected individuals safe, including the general public, patients and health workers, another crucial advantage is its ability to provide a powerful “force multiplier” that dramatically extends the reach of caregivers. Medical professionals such as triage nurses and emergency medical technicians can quickly screen larger numbers of patients and lessen the burden on physicians and specialists who can perform remote consults when needed. This is not the first time that telemedicine has been considered as an adjunct in the treatment of infectious disease outbreak, but growing concerns over the emergence of a pandemic are certainly pushing TMS to the forefront. Health organizations can employ digital health in a number of ways in preparation for COVID-19 cases – ranging from transitioning patients with cold and flu symptoms into virtual appointments, installing telemedicine stations in isolation units, to setting up dedicated triage units off-site to send patients for screening and specialist consults. Decision-making algorithms incorporating telemedicine, designed through the utilization of artificial intelligence tools, could also be used in order to assist with definitive disposition of the evaluated patients by remote analysis. Our working group believes that innovative TMS solutions need to be adopted and promoted worldwide to safeguard health-care workers and high-risk patient populations, as well as to provide supplemental care for nations and regions where resources are insufficient to cope with cumulative burdens of the COVID-19 pandemic. Based on the current reports from around the world, the management of COVID-19 infections should be based on multidisciplinary team approaches. The number and causes of mortality are somewhat variable, with multiple organ failure and myocarditis featuring prominently on the list. Moreover, the left ventricular ejection fraction is affected negatively and cardiac biomarkers have been significantly elevated in a substantial number of cases.[54] Such complex scenarios necessitate collaborative strategies involving multi-specialty teams. In addition to bringing much needed expertise to the patient, the adoption of TMS based consultations for such cases also helps reduce direct COVID-19 exposure among health-care experts. The real risk of COVID-19 extends well beyond the current period. In fact, the true game changer scenario would be the transition of COVID-19 from a one-time pandemic event into an endemic phenomenon, circulating permanently within the human population.[54] Under such as yet hypothetical circumstances, the endemic coronavirus would co-exist with seasonal influenza, leading to potentially permanent new equilibrium state. In this context, TMS in conjunction with point-of-care testing will become an important asset, allowing early differentiation between influenza and coronavirus infections and facilitating targeted therapeutic approaches while reducing viral transmission risk.[55] In summary, the WHO and other global health care organizations should take into account and issue directions to countries to adopt and strengthen TMS services that will augment and optimize the planetary effort to extinguish the COVID-19 pandemic.

In recent years, oxidative stress and free radicals have been implicated in impaired wound healing. Ocimum sanctum (O. sanctum), a plant widely used in Ayurveda, possesses anti-inflammatory and antioxidant properties. The present study was undertaken to assess the potential of alcoholic and aqueous extracts in wound healing in Wistar albino rats. The rats were divided into five groups of six animals each. Group 1 is normal wounded control and the other four groups were treated with two different doses each of alcoholic and aqueous extract of O. sanctum. The wound healing parameters were evaluated by using incision, excision and dead space wounds in extract-treated rats and controls. Both the doses of alcoholic and aqueous extract significantly increased wound breaking strength, hydroxyproline, hexuronic acid, hexosamines, superoxide dismutase, catalase, reduced glutathione and significantly decreased percentage of wound contraction and lipid peroxidation when compared with the control group. The results suggest that O. sanctum has antioxidant properties, which may be responsible and favorable for faster wound healing and this plant extract may be useful in the management of abnormal healing and hypertropic scars.

BACKGROUND: Learning environment in any medical school is found to be important in determining students' academic success. This study was undertaken to compare the perceptions of first year and clinical phase students regarding the learning environment at Melaka Manipal Medical College (MMMC) (Manipal Campus) and also to identify the gender wise differences in their perceptions. METHODS: In the present study, the Dundee Ready Education Environment Measure (DREEM) inventory was used. DREEM was originally developed at Dundee and has been validated as a universal diagnostic inventory for assessing the quality of educational environment. In the present study, DREEM was administered to undergraduate medical students of first year (n = 118) and clinical phase (n = 108) and the scores were compared using a nonparametric test. RESULTS: Among the two batches, first year students were found to be more satisfied with the learning environment at MMMC (as indicated by their higher DREEM score) compared to the clinical batch students. Gender wise, there was not much difference in the students' perceptions. CONCLUSION: The present study revealed that both groups of students perceived the learning environment positively. Nevertheless, the study also revealed problematic areas of learning environment in our medical school which enabled us to adopt some remedial measures.

Ethanol is a testicular toxin and it causes fertility abnormalities with low sperm count and impaired sperm motility in men. The present study was designed to investigate plasma testosterone level and hypothalamic pituitary gonadal (HPG) axis function in alcoholic men and also effect of ethanol on systemic oxidative stress. Forty six male alcohol abusers in the age group 20-40 years were selected. Fifty five, males in the same age group served as control. Alcohol abusers had significantly low plasma testosterone with low luteinizing hormone and follicle stimulating hormone. In addition they had significantly high thiobarbituric acid reactive substances (TBARS), superoxide dismutase and glutathione S-transferase, and low glutathione, ascorbic acid, catalase, glutathione reductase and glutathione peroxidase. Moreover, serum testosterone level in alcoholics negatively correlated with duration of alcohol abuse, and TBARS. Duration dependent decreased serum testosterone level in alcohol abusers might be due to 1) increased oxidative stress which can damage Leydig and supporting Sertoli cells and 2) impaired HPG axis.

BACKGROUND: Titanium has been the most popular material of choice for dental implantology over the past few decades. Its properties have been found to be most suitable for the success of implant treatment. But recently, zirconia is slowly emerging as one of the materials which might replace the gold standard of dental implant, i.e., titanium. MATERIALS AND METHODS: Literature was searched to retrieve information about zirconia dental implant and studies were critically analyzed. PubMed database was searched for information about zirconia dental implant regarding mechanical properties, osseointegration, surface roughness, biocompatibility, and soft tissue health around it. The literature search was limited to English language articles published from 1975 to 2015. RESULTS: A total of 45 papers met the inclusion criteria for this review, among the relevant search in the database. CONCLUSION: Literature search showed that some of the properties of zirconia seem to be suitable for making it an ideal dental implant, such as biocompatibility, osseointegration, favourable soft tissue response and aesthetics due to light transmission and its color. At the same time, some studies also point out its drawbacks. It was also found that most of the studies on zirconia dental implants are short-term studies and there is a need for more long-term clinical trials to prove that zirconia is worth enough to replace titanium as a biomaterial in dental implantology.

BACKGROUND: Nardostachys jatamansi DC is a Himalayan medicinal herb that has been described in various traditional systems of medicine for its use in cancer. In view of its traditional claims, and chemical constituents, antioxidant and anticancer activities were evaluated in breast carcinoma. METHODS: Petroleum ether (NJPE), methanol extract (NJM) and subsequent diethyl ether (NJDE), ethyl acetate (NJEA) and aqueous (NJAQ) fractions of roots and rhizomes of N. jatamansi were prepared. Total phenolic, flavonoid content, and antioxidant activities were determined using suitable methods. Antiproliferative activity was assessed in estrogen receptor (ER)-positive (MCF-7) and ER-negative breast carcinoma (MDA-MB-231) cells by MTT and SRB assay. Cell cycle analysis, Hoechst staining, and clonogenic assay were employed to determine the mode of antiproliferative and pro-apoptotic activity in MDA-MB-231 cells. RESULTS: NJM/fractions exhibited prominent antioxidant activity with significant correlation between phenolic content and ABTS (IC50) scavenging (R = -0.9680, P < 0.05), and total antioxidant capacity (R = 0.8396, P > 0.05). In MTT assay, NJM exhibited the highest antiproliferative activity (IC50: 58.01 ± 6.13 and 23.83 ± 0.69 μg/mL in MCF-7 and MDA-MB-231 respectively). Among the fractions, NJPE and NJDE were found to be most potent in MCF-7 (IC50: 60.59 ± 4.78 μg/mL) and MDA-MB-231 (IC50: 25.04 ± 0.90 μg/mL) cells respectively. Statistical analyses revealed NJM and NJDE exhibited significantly higher (P < 0.05) cytotoxicity in MDA-MB-231 cells. Cell cycle analysis demonstrated that NJM, NJPE and NJEA caused G2/M arrest while NJDE caused G0/G1 phase arrest in MDA-MB-231 cells. Further, NJM/fractions induced significant (P < 0.001) cell death by apoptosis characterized by apoptotic morphological changes in Hoechst staining and inhibited long-term proliferation (P < 0.001) of MDA-MB-231 cells in clonogenic assay. Lupeol and β-sitosterol were identified as anticancer principles in NJM/fractions by HPTLC. CONCLUSION: Our results suggest that NJM/fractions possess significant antiproliferative potential which is mediated through cell cycle perturbation and pro-apoptotic effects in MDA-MB-231 cells. Moreover, this study highlights the antioxidant potential of NJM/fractions which can be attributed to the presence of phenols. NJDE emerged as the most potent fraction and further mechanistic and phytochemical investigations are under way to identify the active principles.

OBJECTIVES: The present study was undertaken to study the maternal risk factors for preterm birth (PTB) and low birth weight (LBW) with a special emphasis on assessing the proportions of maternal genitourinary and periodontal infections among Indian women and their association with adverse pregnancy outcomes. METHODS: A hospital-based prospective study comprising 790 pregnant women visiting the obstetrics clinic for a routine antenatal check-up was undertaken. Once recruited, all study participants underwent clinical and microbiological investigations for genitourinary infections followed by a dental check-up for the presence of periodontitis. The study participants were followed up until their delivery to record the pregnancy outcomes. Infectious and non-infectious risk factors for PTB and LBW were assessed using univariate and multivariate Cox regression analysis. Independent risk factors for PTB and LBW were reported in terms of adjusted relative risk (ARR) with the 95% confidence interval (CI). RESULTS: Rates of PTB and LBW in the study population were 7.6% and 11.4%, respectively. Previous preterm delivery (ARR, 5.37; 95% CI, 1.5 to 19.1), periodontitis (ARR, 2.39; 95% CI, 1.1 to 4.9), Oligohydramnios (ARR, 5.23; 95% CI, 2.4 to 11.5), presence of Nugent's intermediate vaginal flora (ARR, 2.75; 95% CI, 1.4 to 5.1), gestational diabetes mellitus (ARR, 2.91; 95% CI, 1.0 to 8.3), and maternal height <1.50 m (ARR, 2.21; 95% CI, 1.1 to 4.1) were risk factors for PTB, while periodontitis (ARR, 3.38; 95% CI, 1.6 to 6.9), gestational hypertension (ARR, 3.70; 95% CI, 1.3 to 10.8), maternal height <1.50 m (ARR, 2.66; 95% CI, 1.3 to 5.1) and genital infection during later stages of pregnancy (ARR, 2.79; 95% CI, 1.2 to 6.1) were independent risk factors for LBW. CONCLUSIONS: Our study findings underscore the need to consider screening for potential genitourinary and periodontal infections during routine antenatal care in developing countries.

Alcoholic extract of the stems of Coscinium fenestratum, a medicinal plant indigenous to India and Sri Lanka used in ayurveda and siddha medicine for treating diabetes, was studied for its carbohydrate metabolism effect and antioxidant status in streptozotocin-nicotinamide induced type 2 diabetic rats. Oral administration of C. fenestratum stem extract in graded doses caused a significant increase in enzymatic antioxidants such as catalase, superoxide dismutase, glutathione synthetase, peroxidase, and glutathione peroxidase and in the nonenzymatic antioxidants ascorbic acid, ceruloplasmin and tocopherol. Effects of alcoholic extract on glycolytic enzymes such as glucose-6-phosphate dehydrogenase, lactate dehydrogenase and hexokinase showed a significant increase in their levels, whereas a significant decrease was observed in the levels of gluconeogenic enzyme, glucose-6-phosphatase and alanine aminotransferase in treated diabetic rats. Serum creatinine and urea levels also declined significantly. This investigation demonstrates significant antidiabetic activity of C. fenestratum.

During the COVID-19 pandemic, a countrywide lockdown of nearly twelve weeks in India reduced access to regular healthcare services. As a policy response, the Ministry of Health & Family Welfare which exercises jurisdiction over telemedicine in India, rapidly issued India's first guidelines for use of telemedicine. The authors argue that: guidelines must be expanded to address ethical concerns about the use of privacy, patient data and its storage; limited access to the internet and weaknesses in the telecom infrastructure challenge widespread adoption of telemedicine; only by simultaneously improving both will use of telemedicine become equitable; Indian medical education curricula should include telemedicine and India should rapidly extend training to practitioner. They determine that for low- and middle-income countries (LMIC), including India, positive externalities of investing in telemedicine are ample, thus use of this option can render healthcare more accessible and equitable in future.

OBJECTIVE: To evaluate the anti-arthritic potential of the plant Justicia gendarussa using two different rat models. MATERIALS AND METHOD: The anti-arthritic potential of the alcoholic extract of the plant Justicia gendarussa was evaluated using the Freund's adjuvant-induced and collagen-induced arthritic rat models. The rats were treated with the ethanolic extract of Justicia gendarussa and with standard aspirin. RESULTS: The ethanolic extract of Justicia gendarussa showed significant anti-arthritic activity that was statistically similar to that of aspirin. Our results suggest that the alcoholic extract of Justicia gendarussa exhibits significant anti-arthritic potential.

BACKGROUND: Krishna Tulsi, a member of Lamiaceae family, is a herb well known for its spiritual, religious and medicinal importance in India. The common name of this plant is 'Tulsi' (or 'Tulasi' or 'Thulasi') and is considered sacred by Hindus. We present the draft genome of Ocimum tenuiflurum L (subtype Krishna Tulsi) in this report. The paired-end and mate-pair sequence libraries were generated for the whole genome sequenced with the Illumina Hiseq 1000, resulting in an assembled genome of 374 Mb, with a genome coverage of 61 % (612 Mb estimated genome size). We have also studied transcriptomes (RNA-Seq) of two subtypes of O. tenuiflorum, Krishna and Rama Tulsi and report the relative expression of genes in both the varieties. RESULTS: The pathways leading to the production of medicinally-important specialized metabolites have been studied in detail, in relation to similar pathways in Arabidopsis thaliana and other plants. Expression levels of anthocyanin biosynthesis-related genes in leaf samples of Krishna Tulsi were observed to be relatively high, explaining the purple colouration of Krishna Tulsi leaves. The expression of six important genes identified from genome data were validated by performing q-RT-PCR in different tissues of five different species, which shows the high extent of urosolic acid-producing genes in young leaves of the Rama subtype. In addition, the presence of eugenol and ursolic acid, implied as potential drugs in the cure of many diseases including cancer was confirmed using mass spectrometry. CONCLUSIONS: The availability of the whole genome of O.tenuiflorum and our sequence analysis suggests that small amino acid changes at the functional sites of genes involved in metabolite synthesis pathways confer special medicinal properties to this herb.

AIM: There is strong evidence to suggest vertical and horizontal modes of transmission of human papilloma virus (HPV), an established etiologic agent of cervical cancer. Infants, children, and adults can acquire both high-risk and low-risk infections by birth or by close contact even though HPV is mainly transmitted sexually. A thorough review of the literature was performed to assess the possible non-sexual modes of transmission of HPV. METHODS: An electronic search of databases for review articles, cross-sectional studies, cohort studies, and case reports on non-sexual modes of transmission among sexually unexposed women and children was carried out using search terms such as "human papilloma virus, HPV, transmission, horizontal transmission, vertical transmission, and fomites". Articles published between 1983 and 2015 were retrieved. RESULTS: Epidemiological and clinical data support various non-sexual modes of transmission especially at the time of birth and by close contact. Even though the role of fomites in the transmission of HPV is not well established, HPV-DNA positivity has been reported in transvaginal ultrasound probes and colposcopes after routine disinfection. CONCLUSION: Awareness needs to be spread among the public about alternate modes of transmission. For a proper understanding of the exact natural history of HPV infection acquired via the non-sexual route, long-term prospective studies need to be undertaken.

Centella asiatica is a reputed medicinal plant used in the treatment of various skin diseases in the Indian system of medicine. The objective of the study presented in this article was to evaluate the wound-healing potential of the ethanolic extract of the plant in both normal and dexamethasone-suppressed wound healing. The study was done on Wistar albino rats using incision, excision, and dead space wounds models. The extract of C asiatica significantly increased the wound breaking strength in incision wound model compared to controls (P < .001). The extract-treated wounds were found to epithelize faster, and the rate of wound contraction was significantly increased as compared to control wounds (P < .001). Wet and dry granulation tissue weights, granulation tissue breaking strength, and hydroxyproline content in a dead space wound model also increased at statistically significant levels as shown. The extract of the leaves had the effect of attenuating the known effects of dexamethasone healing in all wound models (P < .001, P < .05). The results indicated that the leaf extract promotes wound healing significantly and is able to overcome the wound-healing suppressing action of dexamethasone in a rat model. These observations were supported by histology findings.

The free radical scavenging potential of the plant S. indicus was studied by using different antioxidant models of screening. The ethanolic extract at 1000 microg/ml showed maximum scavenging of the radical cation, 2,2-azinobis-(3-ethylbenzothiazoline-6-sulphonate) (ABTS) observed upto 41.99% followed by the scavenging of the stable radical 1,1-diphenyl, 2-picryl hydrazyl (DPPH) (33.27%), superoxide dismutase (25.14%) and nitric oxide radical (22.36%) at the same concentration. However, the extract showed only moderate scavenging activity of iron chelation (14.2%). Total antioxidant capacity of the extract was found to be 160.85 nmol/g ascorbic acid. The results justify the therapeutic applications of the plant in the indigenous system of medicine, augmenting its therapeutic value.

Thiols are the organic compounds that contain a sulphydryl group. Among all the antioxidants that are available in the body, thiols constitute the major portion of the total body antioxidants and they play a significant role in defense against reactive oxygen species. Total thiols composed of both intracellular and extracellular thiols either in the free form as oxidized or reduced glutathione, or thiols bound to proteins. Among the thiols that are bound to proteins, albumin makes the major portion of the protein bound thiols, which binds to sufhydryl group at its cysteine-34 portion. Apart from their role in defense against free radicals, thiols share significant role in detoxification, signal transduction, apoptosis and various other functions at molecular level. The thiol status in the body can be assessed easily by determining the serum levels of thiols. Decreased levels of thiols has been noted in various medical disorders including chronic renal failure and other disorders related to kidney, cardiovascular disorders, stroke and other neurological disorders, diabetes mellitus, alcoholic cirrhosis and various other disorders. Therapy using thiols has been under investigation for certain disorders

Ethanol extract (FRE) and water extract (FRW) of Ficus racemosa (family: Moraceae) were subjected to free radical scavenging both by steady state and time resolved methods such as nanosecond pulse radiolysis and stopped-flow spectrophotometric analyses. FRE exhibited significantly higher steady state antioxidant activity than FRW. FRE exhibited concentration dependent DPPH, ABTS(*-), hydroxyl radical and superoxide radical scavenging and inhibition of lipid peroxidation with IC(50) comparable with tested standard compounds. In vitro radioprotective potential of FRE was studied using micronucleus assay in irradiated Chinese hamster lung fibroblast cells (V79). Pretreatment with different doses of FRE 1h prior to 2 Gy gamma-radiation resulted in a significant (P < 0.001) decrease in the percentage of micronucleated binuclear V79 cells. Maximum radioprotection was observed at 20 mug/ml of FRE. The radioprotection was found to be significant (P < 0.01) when cells were treated with optimum dose of FRE (20 mug/ml) 1 h prior to 0.5, 1, 2, 3 and 4 Gy gamma-irradiation compared to the respective radiation controls. The cytokinesis-block proliferative index indicated that FRE does not alter radiation induced cell cycle delay. Based on all these results we conclude that the ethanol extract of F. racemosa acts as a potent antioxidant and a probable radioprotector.

Centella asiatica (CeA) is a creeping plant growing in damp places in India and other Asian countries. The leaves of CeA are used for memory enhancement in the Ayurvedic system of medicine, an alternative system of medicine in India. In this study, we have investigated the effect during the rat growth spurt period of CeA fresh leaf extract treatment on the dendritic morphology of hippocampal CA3 neurons, one of the regions of the brain concerned with learning and memory. Neonatal rat pups (7 days old) were fed with 2, 4 or 6 ml kg(-1) body weight of fresh leaf extract of CeA for 2, 4 or 6 weeks. After the treatment period the rats were killed, their brains were removed and the hippocampal neurons were impregnated with silver nitrate (Golgi staining). Hippocampal CA3 neurons were traced using a camera lucida, and dendritic branching points (a measure of dendritic arborization) and intersections (a measure of dendritic length) were quantified. These data were compared with data for age-matched control rats. The results showed a significant increase in the dendritic length (intersections) and dendritic branching points along the length of both apical and basal dendrites in rats treated with 4 and 6 ml kg(-1) body weight per day of CeA for longer periods of time (i.e. 4 and 6 weeks). We conclude that the constituents/active principles present in CeA fresh leaf extract have a neuronal dendritic growth stimulating property; hence, the extract can be used for enhancing neuronal dendrites in stress and neurodegenerative and memory disorders.

IlluminationsSELF-DIRECTED LEARNINGReem Rachel Abraham, Subramanya Upadhya, and K. RamnarayanReem Rachel AbrahamDepartment of Physiology Melaka Manipal Medical College (Manipal Campus) International Centre for Health Sciences Manipal 576 104 Karnataka, India E-mail: , Subramanya UpadhyaDepartment of Physiology Melaka Manipal Medical College (Manipal Campus) International Centre for Health Sciences Manipal 576 104 Karnataka, India E-mail: , and K. RamnarayanDepartment of Pathology Melaka Manipal Medical College (Manipal Campus) International Centre for Health Sciences Manipal 576 104 Karnataka, India E-mail: Published Online:01 Jun 2005https://doi.org/10.1152/advan.00008.2005MoreSectionsPDF (211 KB)Download PDF ToolsExport citationAdd to favoritesGet permissionsTrack citations This paper describes self-directed learning (SDL) sessions in teaching physiology for undergraduate medical students. It is important that a student become aware of how he or she is learning (2). When students are given the opportunity to learn by themselves, they develop learning skills to become self-directed learners (3). SDL is a process in which students take the initiative with or without the help of others in diagnosing their learning needs, formulating learning goals, identifying human and material resources for learning, choosing and implementing appropriate learning strategies, and evaluating learning outcomes (1).The undergraduate medical program (Bachelor of Medicine and Bachelor of Surgery; MBBS) at Melaka Manipal Medical College (MMMC) (Manipal Campus), India is a 5-yr, intense academic program. In MMMC, the first-year MBBS physiology curriculum is divided into four blocks.Block 1: Basic concepts, blood, nerve, and muscle physiology.Block 2: Cardiovascular, respiratory, and gastrointestinal physiology.Block 3: Endocrine, reproductive, and renal physiology.Block 4: Central nervous system and special senses.In each block, students had six SDL sessions of 2.5 h each, which included 2 h of presentation session, followed by 0.5 h of evaluation of the topic covered in the presentation. During presentation sessions, the class of 136 students were divided into four groups according to their roll numbers and each group was led by a faculty member. Students were asked to present the learning objectives individually. Due to time constraints, it was not possible for all students to present in all SDL sessions. But it was ensured that all students presented at least once in the entire block. For every learning objective presented, students were encouraged to go into discussion sessions to create group dynamics. The subject experts guided the students to focus on learning objectives whenever they deviated from it and also clarified their misconceptions. Two days after the presentation session, the evaluation was administered, which consisted of true or false questions, fill in the blanks, and short-answer questions. To determine the effectiveness of SDL, the average score obtained by the students for all of the six SDL evaluations in block 3 were compared with block 3 lecture exam scores using Student's paired t-test. Lecture exam scores were significantly lower than SDL exam scores (72 ± 0.40 vs. 76 ± 0.21). These results suggest that SDL may be an effective learning tool. Furthermore, feedback from the students (Table 1 showed more of a positive approach to this strategy, even though a few students were negative. Based on the comments and performance, we consider that SDL helps students realize that learning is a life-long process and that they are responsible for acquiring knowledge in the vast field of medicine. Table 1. Student opinions on self-directed learningIt gives me an opportunity to spend more time in self study.2.3 ± 0.08It makes me to know whether my understanding of a topic is correct or not.2.2 ± 0.08It prepares me to speak, discuss, and share my knowledge in physiology with my friends.2.3 ± 0.09It helps me to gain more confidence in studying physiology.2.4 ± 0.09It motivates me to learn physiology better.2.6 ± 0.1It helps me to be more responsible in studies.2.3 ± 0.09Values are means ± SE; n = 136 students. A scale of 1 –5, ranging from strongly agree to strongly disagree was used (1 = strongly agree; 2 = agree; 3 = uncertain; 4 = disagree; 5 = strongly disagree). References1 Knowles M. Self-Directed Learning –A Guide for Learners and Teachers. Englewood Cliffs, NJ: Prentice Hall, 1975.Google Scholar2 Kopelman P. Learning skills and the acquisition of clinical skills. Med Educ 31, Suppl 1: 17–19, 1997.Google Scholar3 Seale JK, Chapman J, and Davey C. The influence of assessments in students' motivation to learn in a therapy degree course. Med Educ 34: 614–621, 2000.Crossref | ISI | Google Scholar Download PDF Previous Back to Top FiguresReferencesRelatedInformation Cited ByDo learning style preferences influence the cumulative gross point average and self directed learning hours in dental students: a preliminary study24 June 2022 | BMC Medical Education, Vol. 22, No. 1COMPARATIVE STUDY OF CASE BASED LEARNING WITH TRADITIONAL TEACHING METHODS IN BIOCHEMISTRY FOR FIRST YEAR MEDICAL STUDENTS1 April 2022 | INDIAN JOURNAL OF APPLIED RESEARCHDeveloping Self-Directed Learners12 December 2019 | American Journal of Pharmaceutical Education, Vol. 84, No. 3Prediscussion and Postdiscussion Assessment Scores in a Self-directed learning module implemented in the department of biochemistry: A comparative studyIndian Journal of Medical Specialities, Vol. 11, No. 2The Term "Self-Directed Learning"—Back to Knowles, or Another Way to Forge Ahead?10 May 2019 | Journal of Research on Christian Education, Vol. 28, No. 1LEVEL OF KNOWLEDGE GAINED BY SELF-DIRECTED LEARNING AND INTERACTIVE LECTURES FOR TEACHING BIOCHEMISTRY AMONG FIRST YEAR MEDICAL STUDENTS IN GOVERNMENT MEDICAL COLLEGE, IDUKKI, KERALA- A COMPARATIVE STUDY16 April 2018 | Journal of Evidence Based Medicine and Healthcare, Vol. 5, No. 16Modified directed self-learning sessions in physiology with prereading assignments and Pecha Kucha talks: perceptions of studentsReem Rachel Abraham, Sharmila Torke, James Gonsalves, Sareesh Naduvil Narayanan, M. Ganesh Kamath, Jay Prakash, and Kiranmai S. Rai4 January 2018 | Advances in Physiology Education, Vol. 42, No. 1A COMPARISON OF DIDACTIC LECTURES TO SELF-DIRECTED LEARNING IN MEDICAL EDUCATION9 January 2017 | Journal of Evidence Based Medicine and Healthcare, Vol. 4, No. 3Students' perceived value of physiology course activities in a Sudanese medical facultyLamis Kaddam, and Mustafa Khidir Mustafa Elnimeiri1 December 2012 | Advances in Physiology Education, Vol. 36, No. 4An Experimental Teaching-Learning Program in HistologyJournal of Veterinary Medical Education, Vol. 38, No. 4Promoting a special learning environment for second language learning in a Chinese rural primary schoolProcedia - Social and Behavioral Sciences, Vol. 12Application of web-based periodical self-directed learning modePhysiology teaching and learning experience in a new modular curriculum at the National University of RwandaJean Bosco Gahutu1 March 2010 | Advances in Physiology Education, Vol. 34, No. 1Self-directed Learning in Health Professions Education15 July 2008 | Annals of the Academy of Medicine, Singapore, Vol. 37, No. 7 More from this issue > Volume 29Issue 2June 2005Pages 135-136 Copyright & Permissions© 2005 American Physiological Societyhttps://doi.org/10.1152/advan.00008.2005PubMed15905163History Published online 1 June 2005 Published in print 1 June 2005 Metrics

BACKGROUND: During a given year, almost 30% of the people around the world are affected by mentally ill health. In India, it accounts for about 20%. Caregivers face a lot of strain, ill health, and disrupted family life, with literature suggesting an increasing concern about their ability to cope up. The needs of caregivers of the mentally ill are given low priority in the current health-care setting in India. AIM: The aim of the study was to assess the burden of caregivers of mentally ill individuals and their coping mechanisms. METHODS: A cross-sectional study was employed with a quantitative approach. A convenient sample of 320 caregivers was taken from two private tertiary care centers and one public secondary care center in Udupi taluk. This study was conducted using the Burden Assessment Schedule (BAS) and Brief Cope Scale (BCS). Statistical analysis was done on categorical variables, and they were expressed as frequencies and percentages. Continuous variables were measured using mean and standard deviation. Univariate and multivariate analysis using binomial logistic regression was done. SPSS version 15 was used to analyze the data. RESULTS: According to BAS, severe burden accounted for 40.9% and moderate for 59.1%. The highest amount of burden was seen in the areas of physical and mental health, spouse related, and in areas of external support. The BCS showed that the most frequently used coping styles were practicing religion, active coping, and planning. CONCLUSION: This study concluded that caregivers of the mentally ill individuals do undergo a lot of burden. Hence, there is a need to develop strategies that can help them such as providing them with a support structure as well as counseling services.

To determine the distribution and relationship of antimicrobial resistance determinants among extended-spectrum-cephalosporin (ESC)-resistant or carbapenem-resistant Escherichia coli isolates from the aquatic environment in India, water samples were collected from rivers or sewage treatment plants in five Indian states. A total of 446 E. coli isolates were randomly obtained. Resistance to ESC and/or carbapenem was observed in 169 (37.9%) E. coli isolates, which were further analyzed. These isolates showed resistance to numerous antimicrobials; more than half of the isolates exhibited resistance to eight or more antimicrobials. The blaNDM gene was detected in 14/21 carbapenem-resistant E. coli isolates: blaNDM-1 in 2 isolates, blaNDM-5 in 7 isolates, and blaNDM-7 in 5 isolates. The blaCTX-M gene was detected in 112 isolates (66.3%): blaCTX-M-15 in 108 isolates and blaCTX-M-55 in 4 isolates. We extracted 49 plasmids from selected isolates, and their whole-genome sequences were determined. Fifty resistance genes were detected, and 11 different combinations of replicon types were observed among the 49 plasmids. The network analysis results suggested that the plasmids sharing replicon types tended to form a community, which is based on the predicted gene similarity among the plasmids. Four communities each containing from 4 to 17 plasmids were observed. Three of the four communities contained plasmids detected in different Indian states, suggesting that the interstate dissemination of ancestor plasmids has already occurred. Comparison of the DNA sequences of the blaNDM-positive plasmids detected in this study with known sequences of related plasmids suggested that various mutation events facilitated the evolution of the plasmids and that plasmids with similar genetic backgrounds have widely disseminated in India.