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To compare the change in serum vitamin D levels and to compare the changes in serum levels of calcium, phosphate, alkaline phosphatase and parathyroid hormone in vitamin D supplemented and unsupplemented groups after 3 mo.In this randomized, parallel group, nonblinded, controlled trial, 40 children, 2-12 y of age with newly diagnosed epilepsy, and vitamin D sufficient status, and started on valproate monotherapy, were randomized into the intervention group (n = 20), which was given daily oral 600 IU vitamin D supplementation, and the control group (n = 20), which was not given any supplementation. Changes in the biochemical parameters was measured in the two groups after 3 mo.There was a significant reduction in the median (IQR) vitamin D levels in the control group as compared to an increase seen in the intervention group [-6.64 (-8.4, -2.65) vs. 5.66 (1.81, 7.12); p 0.001]. In the control group, 37.5% children developed vitamin D insufficiency and 12.5% developed deficiency whereas only 5% of the intervention group developed vitamin D insufficiency (p = 0.005). There was a significant decrease in ionized calcium (p = 0.02), increase in serum phosphate (p = 0.02), and alkaline phosphatase level (p = 0.003) in the unsupplemented group as compared to the supplemented group.Vitamin D supplementation can reduce the valproate-associated decline in vitamin D levels and the negative impact on other markers of bone mineral metabolism.TCTR20200621002, 19.06.2020, retrospectively registered.

Background and Aims: With the implementation of the COVID-19 lockdown, conventional teaching had to be replaced with online teaching, to ensure the continuity of medical education. This has impacted the clinical training of medical undergraduates. We aimed to explore their perceptions and differences before and during the COVID-19 lockdown. Methods: A cross-sectional online survey using a self-administered, retrospective pre-post questionnaire, was conducted among students from pre-final and final year between December 2020 and March 2021. Agreement scores with 15-items about the various domains of clinical training were recorded. Open-ended question was asked to know about the reasons for the students’ preferences. Chi-square test and Wilcoxon signed rank test were used to compare the proportion and medians respectively. Results: We received 1000 responses from students of 191 medical colleges {Median (IQR): 6 (2,10) per college}. Most (81.6%) opined that their experience with clinical training was better before COVID-19 lockdown, irrespective of the mode of teaching in clinical skills (P

In this population-based study, the authors constructed age-specific and sex-specific hemoglobin percentiles from values reported for a defined healthy population in the Comprehensive National Nutrition Survey (CNNS). Age-specific and sex-specific 5th percentiles of hemoglobin derived for this healthy population was used as the study cut-off to define anemia. These were compared with the existing WHO cut-offs to assess significant differences between them at each year of age and sex for quantifying the prevalence of anemia in the entire CNNS sample. From the CNNS survey 41210 participants had a hemoglobin value, 8087 of whom were included in this study and comprised the primary analytical sample. Compared with existing WHO cut-offs, the study cut-offs for hemoglobin were lower at all ages, usually by 1–2 g/dL, but more so in children of both sexes aged 1–2 years and in girls aged 10 years or older. Anemia prevalence with the study cut-offs was 19·2 percentage points lower than with WHO cut-offs in the entire CNNS sample with valid hemoglobin values across all ages and sexes (10·8% with study cut-offs vs 30·0% with WHO cut-offs). The authors concluded that these findings support the re-examination of WHO hemoglobin cut-offs to define anemia.

All study designs in medical research, barring descriptive studies, involve comparative analysis to achieve its objective/s. Comparisons between groups based on outcomes, or risk factors, or interventions, are the basis of hypotheses in evidence-based medicine. Statistical tests support in making criterion-based decisions about the validity of the hypothesis. A basic knowledge of statistical comparisons helps medical researchers to apply valid statistical tests. Novice medical researchers struggle to decide when, and which statistical test must be applied. There is a need to further reduce the mathematical jargon in statistics related publications for medical researchers. In this article, we aim to provide the readers with practical pointers about the applied aspects of basic statistical comparisons in medical research.

Covid-19 is a respiratory disease caused by coronavirus 2 (SARS-CoV-2) first identified in Wuhan, China (December 2019). The disease rapidly crossed the barrier of countries, continents and spread globally. Non-pharmaceutical measures such as social distancing, face mask, frequent hand washing and use of sanitizer remained the best available option to prevent the spread of disease. OPD, IPD admissions, elective O. Ts were curtailed. Orthopedic care was only limited to emergency and semi-urgent procedures like necrotizing fasciitis, open fracture, and compartment syndrome. These measures were taken to preserve infrastructure and manpower to manage covid-19 pandemic. The children were thought to have a low susceptibility to covid-19 as compared to an adult. Deferring the patient during pandemic has led to high orthopedic disease burden, morbidity and disease-related sequelae, hence elective care must be resumed with modified hospital infrastructure. Resumption of elective/emergent orthopedic care should be slow, phasic and strategic, much similar to unlocking. Cases must be stratified depending on covid status and severity. Dedicated O.Ts with neutral/negative pressure and HEPA filter for covid positive and suspected patients are to be used. All symptomatic and suspected patients should be investigated for covid-19 by RT-PCR, blood counts and CT scan. Regional anaesthesia should be preferred to General anaesthesia. Power drill/saw/burr/pulse lavage should be minimized to avoid aerosol generation. Postoperatively continuous surveillance and monitoring to be done for covid related symptoms. Medical institutes rapidly shifted to the online mode of education. Blended learning (virtual & physical) and imparting skills have to be continued in post covid phase with equitable distribution of teaching hours to students of different years.

Background: Multiple-choice question (MCQ) is frequently used assessment tool in medical education, both for certification and competitive examinations. Ill-constructed MCQs impact the utility of the assessment and thus the fate of examinee. We conducted this study to ascertain whether a short training session for faculty on MCQ writing results in desired improvement in their item-writing skills. Methods: A 1-day workshop on constructing high-quality MCQs was conducted for the faculty as a before-after design, following training session of 3 h duration. 28 participants wrote preworkshop (n = 133) and postworkshop (n = 137) MCQs, which were analyzed and compared for 17 item-writing flaws. A mock test of 100 MCQs (selected by stratified random sampling from all the MCQs generated during the workshop) was conducted for MBBS-passed students for item analysis. Results: Item-writing flaws reduced following the training (15% vs. 27.7%, P < 0.05). Improvement mainly occurred in quality of options; heterogeneity dropped from 27.1% prior to the workshop to 5.8% postworkshop. The proportion of MCQs failing the cover test remained similarly high (68.4% vs. 60.6%), and there was no improvement in writing of the stem before and after the workshop. The item analysis did not reveal any significant improvement in facility value, discriminating index, and proportion of nonfunctioning distractors. Conclusion: A single, short-duration faculty training session is not good enough to correct flaws in writing of the MCQs. There is a need of focused training of the faculty in MCQ writing. Courses with a longer duration, supplemented by repeated or continuous faculty development programs, need to be explored.

Introduction: Faculty development to implement competency-based medical education (CBME) is urgently needed as the Medical Council of India has implemented the competency-based curriculum this year onwards. Objectives: To evaluate a 2-day faculty development workshop in terms of: (a) increase in knowledge about CBME terminology and concepts, (b) self-reported capacity to develop and implement a competency-based module in their respective disciplines, and (c) satisfaction of the participants. Methodology: A single arm interventional study using mixed methods was carried out in which faculty members were purposively identified and requested to volunteer for a two-day faculty development workshop on the development and implementation of CBME. The workshop was evaluated (open-ended and Likert scored items) by the participants for self-reported gain in knowledge, gain in their confidence to develop and implement CBME, and level of satisfaction with respect to the components of the workshop. Quantitative data was analyzed by Wilcoxon signed rank test and Kruskal–Wallis test. Qualitative data was analyzed by doing content analysis and emerging themes have been presented. Results: Eleven faculty members attended a capacity building workshop for developing and implementing a competency-based curriculum for medical undergraduates. There was a significant improvement in their self-reported knowledge and attitude regarding the competency-based curriculum. New concepts learned fell into four domains: modification of the existing curriculum toward competency-based curriculum, knowledge of CBME, teaching-learning and assessment methods, and beneficial to the students. The participants were highly satisfied with the workshop in its current form. Conclusion: A two-day faculty development workshop can increase the knowledge and understanding of competency-based medical education and can be an important first step in the journey to more specialized training.

Coronavirus (COVID-19) pandemic spread in India is steeply rising A 21-day lockdown has been imposed by the Government of India, to curtail its spread This has impacted all walks of life, including availability of food and nutrition related services which would affect nutritional status of children throughout India The two major schemes, i e Integrated Child Development Services Scheme and Mid-day Meal Scheme have been affected leading to risk of worsening of child nutrition Some states have evolved their own strategies to mitigate the effect of lockdown Here we discuss the challenges and way forward for ensuring availability of food for child nutrition during this health crisis No single, optimal response to a public health emergency exists The government and non-government partners must coordinate and scale up child nutrition services in the community through strengthening of public distribution system and home delivery of food parcels wherever feasible for beneficiaries of child nutrition programs © 2020, Indian Association of Preventive and Social Medicine All rights reserved

Routine immunizations (RI) keep the infectious diseases under control in the community However, during the coronavirus pandemic, to prevent the associated exponential rise in the number of cases, it became necessary to stop routine health services across the country Routine Immunization also had to be discontinued It is to be realized however that the risk of vaccine-preventable diseases is gradually increasing in direct proportion to the delay in administering vaccinations to eligible children It’s likely that we will face outbreaks of VPD if we keep RI halted for weeks together Various dimensions of RI need to be examined from the perspective of the COVID-19 pandemic ranging from vaccine hesitancy to operationalization of services In this article, we highlight this hidden problem, which has the potential to further challenge our already challenged health and healthcare-related situation The domains which deserve careful consideration are discussed to supporting policymakers in making informed decisions in this regard © 2020, Indian Association of Preventive and Social Medicine All rights reserved

Coronavirus (COVID-19) pandemic has been declared by the World Health Organization after it has gripped many countries of the world The exponential increase in the number of cases has resulted in panic and confusion among healthcare workers and the vulnerable population Pregnant and lactating mothers are a vulnerable group and need evidence-based advice to protect the health of the mother and the child Healthcare workers can play an important role in dispelling the myths and misconceptions among pregnant and lactating mothers regarding COVID-19, if they are equipped with scientific information on antenatal care, care at birth, and breastfeeding This review attempts to summarize the published evidence related to antenatal care, care at birth and breastfeeding during the COVID-19 pandemic © 2020, Indian Association of Preventive and Social Medicine All rights reserved

The role of plasma therapy in the management of the COVID-19, pandemic has been speculated. However, in view of the varied response regarding its effectiveness from various multicenter studies, there is a need to conduct more single center population-specific studies. We, thus, aimed to assess the role of convalescent plasma therapy in COVID-19 patient management in a single -center.This retrospective study was conducted using records of all COVID-19 patients who received plasma therapy over a period of 6 months in a dedicated COVID-19 hospital in Delhi. Information pertaining to transfusion, disease severity, associated comorbidities, the treatment given and patient outcome were recorded. Data was analyzed using SPSSv23.Of the141 patients who received plasma therapy, 62% were discharged after treatment. Mortality was found to be significantly higher in patients 60 years of age (p 0.001), those with severe COVID-19 infection (p 0.05) and pre-existing renal disease (p 0.05). The admission-transfusion interval was significantly correlated to mortality and was a sensitive parameter for predicting outcome at cut off value of 5 days (p 0.001). There was no significant association of mortality with patient blood group, plasma antibody levels or donor hemoglobin levels.We report improvement and recovery in a large number of patients who received convalescent plasma within the first 5 days of hospitalization with moderate to severe disease. Further research to compare dosage and administration protocols to delineate role of CCP in survival of COVID-19 patients is needed before it is prematurely shelved.

Introduction Post-exposure prophylaxis using rabies immunoglobulin (RIG) is universal recommendation for category III exposures. This study was conducted to determine quantity of RIG used to infiltrate animal bite wounds in relation to longest dimension and area of wound. Methods Children aged 2–18 years reporting within 7 days of category III animal bite were included. eRIG (300 IU/ml) was used in all subjects. A predesigned proforma was filled for clinical and epidemiological details of subjects. Maximum length and width of wounds was measured by using non-stretchable measuring tape. RIG was infiltrated in wounds as per WHO recommendations and volume infiltrated was noted. Results and conclusion A total of 100 subjects were enrolled. The mean (±SD) volume of RIG infiltrated in wounds per unit length was 0.75 (±0.21) ml/cm and per unit area was 3.18 (±1.75) ml/cm2. Regression equations were calculated. Proposed equations y = 0.6x + 0.3, where y is the volume of RIG (ml) and x is the length of the wound (cm) and y = 0.9x + 1.1, where y is the volume of RIG (ml) and x is the area of the wound (cm2) can prove to be a useful tool in RIG volume calculation for primary health care providers.

Background COVID-19 pandemic compelled medical schools to opt for online mode in medical education. The competency-based curriculum started in India last year onwards allotted more hours to practical teaching than lectures. As the lockdown extended, there was a need to shift laboratory teaching to online mode. We describe our experience of developing and implementing a framework to rapidly shift practical lab teaching of preclinical subjects to online mode. Methods A mixed method study was conducted during the COVID-19 lockdown period in a public funded medical institute of India. A framework utilizing the principles of small group teaching using the available resources was developed and implemented. Online feedback was obtained from students, while in-depth telephonic interview was conducted for teachers. Results A Demonstrate-Engage-Assess framework for online Practical teaching of Preclinical subjects (DEAPP) was developed and implemented. Feedback was obtained from 103 first year students and six teachers from preclinical subjects. Around 62%–80% students were satisfied with online practical teaching or agreed with benefits of various online tools used in the teaching sessions. Teachers found the framework more planned, and resource efficient, while students found it to be more engaging, enjoyable, and motivated for learning. No face-to-face interaction, non-experiential learning, and adaptation to newer technology were the main barriers perceived in online practical laboratory teaching. Conclusion DEAPP framework was found to be feasible for rapid online transition of practical lab teaching and reported by the students and teachers as engaging, enjoyable and motivated learning.

CONTEXT: Currently, self-directed learning (SDL) is emphasized in medical institutions all over the world. The skills of SDL enable one to be a lifelong learner, a necessity to cope up with fast-expanding medical knowledge. AIMS: This study aims to develop and implement an “SDL” module for medical undergraduates and find out their perception about the same. SETTINGS AND DESIGN: A cross-sectional study using a mixed-method design (having both qualitative and quantitative components) was conducted in the Department of Community Medicine, UCMS, Delhi, India. METHODS: A module was developed following an extensive literature review and focus group discussions with the teaching staff of the institute. First-semester undergraduate students were invited to participate in the study and asked for feedback using a semi-structured questionnaire. STATISTICAL ANALYSIS: Quantitative data were expressed in mean, range, and frequency. For qualitative data, thematic analysis was performed. RESULTS: The module was implemented with 160 students, in November for 10 hour distributed over 5 weeks. Feedback could be obtained from 130 students. Sixty-seven percent of students were satisfied and 66% reported as motivated to study the allotted topic further. Qualitative analysis showed that though the students liked the learning process based on this module, they also felt facilitators could have been more active in imparting knowledge and skills. CONCLUSIONS: To make learners equipped with the ability to learn throughout a professional learning course, SDL as a learning tool should be introduced in the medical undergraduate curriculum.

Background Disability competencies were included, for the first time, in India's new undergraduate competency-based curriculum as a result of physician-led advocacy in 2019; the regulatory body also recommended the use of the humanities in medicine. Objective To use tools from the health humanities to impart disability competencies and help students appreciate the social and human rights issues associated with disability. Methods A module was developed and piloted in the foundation course on the new cohort of students. The tools included storytelling, visual art, poetry, narratives, and Forum Theatre; many facilitators were doctors and patients with disabilities. Learners were introduced to the concept of universal design through a field visit. Quantitative and open-ended feedback was taken from learners after module delivery; reflections were sought after four months. Results The data revealed that the humanities tools used in the module had the potential to help learners explore struggle and oppression and to expose discriminatory attitudes. Learners were able to think beyond the hegemony of normalcy, and show an understanding of diversity, dignity, autonomy, disableism, social inclusion, equity, and universal design. They admitted to the misconceptions they carried and showed keenness to advocate for change. Conclusion This study piloted a novel disability competencies module using tools from the health humanities and found that learners were able to engage with and show an understanding of the social and human rights issues associated with disability. Conversations by, for, and with people with disabilities must be part of such interventions in developing and delivering disability courses.

Conventional algorithms for selecting study designs are difficult to use for a novice researcher, especially the postgraduate students. An inherent limitation of using the existing algorithms is the requirement of a priori knowledge of the characteristics of various study designs. We propose a simple and novel 3-question approach to select study designs. The questions are asked in a stepwise manner with answers in 'yes' or 'no'. The responses to each of these questions lead the researcher towards choosing the appropriate study design. We believe that this 3-question approach would be useful for unexperienced researchers in selecting study designs, besides serving as a tool to teach-learn selection of study designs.

Context: In the context of competency-based medical education being advocated worldwide, fine needle aspiration biopsy (FNAB) is considered as an entrustable professional activity (EPA). There is no information regarding how much time and training are required to achieve a “competent level” for performing and documenting FNAB in the Indian context. Aim: To determine the time taken by an average postgraduate pathology trainee to become competent in performing FNAB with respect to history taking, clinical examination, and fine needle aspirate adequacy. Settings and Design: A descriptive, retrospective, chart-based audit was conducted in the Department of Pathology. Materials and Methods: FNAB chart records documented during 3 years of postgraduate training by a cohort of 13 postgraduate (PG) resident trainees admitted in 2010 were included in the study. Adequacy rates and criteria for adequacy were defined for the purpose of the study. Statistical analysis: Data was entered in MS Excel and analyzed using the Statistical Package for the Social Sciences version 20.0. The adequacy rates are presented as percentages and time taken to achieve adequacy rates as median values. Results: A total of 3272 charts were audited. Median time taken to achieve 85% adequacy rate for history taking, for clinical examination by the first and the second criteria, and for FNAB were 1 month, 1 month and 3.5 months, and 1 month, respectively. Conclusions: Although the mean time taken to achieve 85% adequacy rates for FNAB was 1 month, there was wide variation in the time durations between the residents to achieve this level.

Background: In spite of the decline observed in total fertility rate (TFR) in India during the last few decades, the unintended pregnancy rates continue to remain the same. With increasing employment levels of women, there has been an increase in the contraceptive usage rates, but evidence among the working women regarding the emergency contraceptive pills is lacking. The Objectives of the study was to assess, among the working women regarding the emergency contraceptive pills (ECP). Methods: A cross sectional survey was conducted among the reproductive age group working women attending the obstetrics and gynecology outpatient department clinic of a private hospital in Delhi. Face to face interviews were conducted using a sem-structured questionnaire. Results: Out of the 206 participants studied, around one-third (35.0%) were not aware about ECPs. Amongst the aware, 81.3% and 44.8 % did not know about the correct indication and correct timing of ECP use respectively. Amongst those who were aware about ECPs, 91.8% had never used it. Conclusions: Even though the awareness about ECPs is not low, the correct knowledge about its indications and correct timing is poor. More emphasis on increasing the awareness about ECPs is required to increase its correct use thereby reducing TFR further.

There is a lack of awareness about the guidelines for standardized and transparent reporting of biomedical research, among the medical professionals. This paper aims to familiarize the clinical researchers and practitioners regarding the issues related to transparency and the evolving guidelines for standardizing them, in the reporting of biomedical research. A narrative review method is adopted here, primarily based on the EQUATOR and SAMPL guidelines for reporting studies and statistical analyses. As study methods and statistical approaches support each other, their reporting practices as per the standardized guidelines have been dealt here in a congruous manner.

Zoonotic diseases are an important public health problem. Keeping this in way, a panel reviewed the discussion around “one health” strategy of the WHO in combating zoonotic diseases during Seventh annual conference of Consortium Against Rabies (CAR) with the theme of “Zoonoses: Thinking beyond Rabies” held on 14th and 15th June 2019. The panel came out a manuscript discussing the need, background, and rationale for basic framework of possible roadmap for one health. Background —About CAR: CAR has been established with the aim to serve as a platform for the control of the rabies menace in India. It will evolve into a full fledged struggle against rabies in the country. The association comprises of medical professionals, veterinary doctors, and public health persons. The idea behind CAR is to bring the best minds in the country for research and information dissemination in the field of rabies. About Academy of Family Physicians of India (AFPI): AFPI is the official association of family physicians in India. Dedicated to provide professional leadership, conduct healthcare advocacy, policy development and a change in health system within the domain of family medicine, and larger public health system in the country, the academy is the recipient of the Healthcare Leadership Award 2012 in the category of Healthcare Governance and Public Administration. The white paper development Process: More than 100 medical experts, veterinary doctors, and public health persons from across the country and belonging to the fields of internal medicine, family medicine, public health, veterinary sciences, nursing science and environmental science and representing reputed medical institutions, government funded research institutions, and policy making bodies participated in discussions on topic of “one health” made during 7th Annual national conference of CAR with the theme of “Zoonoses: Thinking beyond Rabies” held on 14th and 15th June 2019. The panel steering the discussion included leading expert from ICMR, medical colleges, veterinary college, family medicine, private practitioners, and health program managers. The panel committee had prepared a draft document well in advance of the conference, which was communicated to all participants for feedback and comments. The panel was steered by ICMR expert. The discussion of the panellist was presented to the consensus group and unanimously adopted. A writing group worked on the manuscript, which was again circulated by email to all for any comments and suggestions before final publication.

Janani Suraksha Yojana (JSY) was launched in April 2005, to promote institutional deliveries through provision of cash assistance, transport, escort, and referral services. An observational cross-sectional study was conducted to assess the antenatal registrations, postnatal checkups, and institutional deliveries, and to compare the various social groups. Married women of the reproductive age group, having at least two children, were interviewed regarding antenatal care, delivery, and postnatal care in both pregnancies, latest as well as previous. Post JSY implementation, antenatal registrations increased from 61.79 to 96.34%, Deliveries at the Government Health Facility increased from 25.20 to 53.25% and postnatal check-ups increased from 45.93 to 69.51%. In the post-JSY-implementation phase, the Government Health Facility was preferred more by Scheduled Castes (SC), Scheduled Tribes (ST), Other Backward Classes (OBC) (SC/ST = 56.87%, OBC = 60.2%, and general = 43.68%), educated (Illiterate = 17.39%, Primary = 88.14, and Middle or above = 81.94%) and the lower socioeconomic classes (Lower SEC 71.83% and Upper lower and above = 45.71%) for their deliveries. It appears that the socially backward groups have benefited more from JSY.

Background: In India, research work in the form of a thesis is a mandatory requirement for the postgraduate (PG) medical students. Data entry in a computer-based spread sheet is one of the important basic skills for research, which has not yet been studied. This study was conducted to assess the data entry skills of the 2 nd year PG medical students of a medical college of North India. Materials and Methods: A cross-sectional, descriptive study was conducted among 111 second year PG students by using four simulated filled case record forms and a computer-based spread sheet in which data entry was to be carried out. Results: On a scale of 0-10, only 17.1% of the students scored more than seven. The specific sub-skills that were found to be lacking in more than half of the respondents were as follows: Inappropriate coding (93.7%), long variable names (51.4%), coding not being done for all the variables (76.6%), missing values entered in a non-uniform manner (84.7%) and two variables entered in the same column in the case of blood pressure reading (80.2%). Conclusion: PG medical students were not found to be proficient in data entry skill and this can act as a barrier to do research. This being a first of its kind study in India, more research is needed to understand this issue and then include this yet neglected aspect in teaching research methodology to the medical students.