Search

Introduction: Early Clinical Exposure (ECE) has been shown to be an effective method in teaching history-taking, physical examination and communication to pre-clinical students. Medical students in their preclinical years at IOM, MMC have been undergoing two year ECE course since 1978, but there is no provision of formative and summative assessment to check its effectiveness. This cross-sectional study was undertaken to fill this gap in evidence. Methods: A 17-station Objective Structured Clinical Examination was administered to 17 pre-clinical students. Of the 17 stations, seven, six and four stations were designed to test their skills in history-taking, clinical-examination and communication domains respectively. Modified borderline regression method was used to calculate the pass-marks for each station. The pass-marks of all the stations were averaged to determine the pass-marks for the entire OSCE. Results: One student passed the entire OSCE whereas four and eight students passed the history taking and communication skills domains; while none could pass the physical examination skills domain. Repeated measure one-way Analysis Of Variance (ANOVA) and post-hoc test using the Bonferroni correction showed that scores in history taking (M = 44.36, SD = 11.09) and communication skills (M = 44.40, SD = 12.12) were significantly better than in physical examination (M = 29.35, SD = 10.50), (p < 0.001 and p = 0.007, respectively). Conclusions: Despite enormous teaching hours allocated to the ECE course, pre-clinical students' performance in an OSCE did not meet the expectation of the curriculum suggesting that the ECE course at MMC, IOM is not fulfilling its objectives. [ABSTRACT FROM AUTHOR]

Introduction: Endometrial cancer (EC) is the most common malignancy of the female genital tract. It is now the fourth most common gynecological cancer among women and the sixth worldwide cancer in Western countries. It is the most curable of the 10 most common cancers in women and the most frequent and curable of the gynecologic cancers. The incidence is increasing when life expectancy rise. This study was carried out to evaluate the prognostic factors of Endometrial Cancer. Methods: Clinico-pathological characteristics and follow-up cases of endometrial cancer were analysed retrospectively between January 2000 to December 2007 with its prognostic factors influence were statistically analysed. During the study period total 180 patients were taken. Univariate model revealed that the menopausal status, the FIGO stage, grade, histological type, myometrial invasion, ER, PR, peritoneal cytology, lymph node metastases, adjuvant therapy, and the method of operation were related with the prognosis significantly. The multivarite analysis Cox proprotion hazards regression model showed that the ER (P=0.004), PR (P=0.000), myometrial invasion (P=0.006) and lymph node metastases (P=0.049) were related with the prognosis significantly. Conclusion: The clinico- pathological character of endometrial cancer is responsible for patient's better survival. If the patients had early detection and treated in proper modalities, this might improve the good prognosis. [ABSTRACT FROM AUTHOR]

Organophosphorus (OP) compounds are widely used for agriculture, domestic pest-control and chemical warfare. Pesticide self-poisoning accounts for one-sixth to one-eighth of the world's suicides and a third of suicide deaths in rural Asia each year. OP pesticides inhibit cholinesterase enzymes leading to overstimulation of cholinergic receptors. Clinical features depend on the types of receptors stimulated at various sites of the body. The diagnosis of OP poisoning is made on the basis of history of poisoning, smell of pesticides, the characteristic clinical signs and reduced cholinesterase activity. Measurement of plasma cholinesterase is useful for diagnosis of OP poisoning although it may not directly correlate with severity of the poisoning. Atropine remains the main stay of treatment of OP poisoning with clear evidence of benefit if administered effectively. Atropine therapy should be monitored to maintain systolic blood pressure > 80 mmHg, pulse > 80 beats/min and clear chest on auscultation. Oximes reactivate cholinesterase enzymes and help to overcome even the nicotinic effects of OP poisoning. However, evidence for its effectiveness after self-poisoning is weak. Although several newer adjuvant therapies are tried to achieve better outcome, their potential benefits are not yet established.