IT-based activity in physiology education: an experience from a developing country

Information technology (IT)-based components are included as active learning activities in medical curricula that have been shown to be more effective than most passive learning activities. In developing countries, these activities are not popular compared with developed countries. In this study, an IT-based assignment was carried out in physiology for undergraduates in Sri Lanka. We assessed certain basic IT capabilities before the assignment and found that the capability of using MS Word, e-mail, and the internet was limited to 68.3%, 62.0%, and 49.2% of students, respectively, with 40.8% of students having some other IT capabilities. We found a considerable variation in IT capabilities among the students, which depended on IT learning at schools and the geographical locations where students came from. The main source of IT knowledge for students was an introductory IT course given in the medical school with the second source being private IT learning centers. Response to the IT-based assignment was very poor. The reasons for poor participation included a lack of time due to parallel subjects, poor IT knowledge, and poor IT resource availability. However, students were willing to have optional IT-based components and were aware that IT knowledge is important for medical students as well as doctors. This study shows the importance of improving IT knowledge in students and the need of improving IT resources in medical schools. With these improvements, physiology education can be enriched with more interactive IT-based learning activities, which help students to acquire knowledge more efficiently and effectively in developing countries like Sri Lanka.     

A prospective study on elderly patients with facial fractures in a developing country

Background: This paper describes the incidence, aetiology, treatment and complications of facial fractures seen among the elderly in a developing country. Methods: A prospective study evaluated 85 patients over 60 years of age who were diagnosed with facial fractures over a period of 12 months in 23 public hospitals nationwide. Results: The elderly accounted for 4.5% of the total number of patients seen with facial fractures during the study period. Elderly men outnumbered women by a ratio of 4.31:1. Of the elderly patients, 35.3% had at least one medical condition, the commonest of which was hypertension. Road traffic accidents were the main cause of injury. The fractures were treated in only 26.2% of cases. Complications were uncommon. Conclusions: With a low incidence, and conservative treatment often being practised, the healthcare burden of treating facial fractures among the elderly in Malaysia is at present still low.     

Seasonality of births: stability and change in a developing country

A marked seasonality of births for the two main ethnic groups of peninsular Malaysia, far exceeding the cyclic fluctuations in births in the United States and Canada, was reported for the 1960s. A 36% excess of births over the average monthly number was observed among Malays each January. Among the ethnic Chinese in Malaysia a regular periodicity in the numbers of births was also found, but it was far less marked and the peak occurred in October or November. The peaks in both groups were due in large measure to conceptions that correlate with religious observances or holidays. Here I report on cyclic birth patterns in peninsular Malaysia for the period 1970-1985. Rapid economic development has occurred during this time and has brought with it demographic changes, such as a massive rise in contraceptive use and a decline in birth rates. These demographic changes have been accompanied by the loss of the pronounced seasonal pattern of births among the Malays. The seasonality of Malay births is now of roughly the same magnitude as the seasonality in the United States and Canada, whereas seasonality of births among the Chinese in Malaysia remains essentially unchanged.     

Telemedicine in plastic surgery: E-consult the attending surgeon

Telemedicine has evolved into a valuable but underused resource for the delivery of health care to patients at a distance, particularly where patient transport is impractical, expensive, complicated, and/or urgent. Today, over 250,000 telemedicine consults are generated annually, involving various specialties in both military and civilian health delivery systems. The ability to evaluate and triage plastic surgery patients through the use of telemedicine has not been widely explored. We have designed, developed, and tested a "store-and-forward" solution at UMass Memorial Hospital and Beth Israel Deaconess Hospital whereby the plastic surgery residents who responded to a consult request transmitted digital photographs by means of the Internet to the attending physician on call. The customary telephone call between resident and attending physician benefited from the additional photographic data, and patient management resulted in a clear, concise, and unambiguous treatment plan. The initial management suggested by the resident was modified on some occasions, particularly with complex problems. The use of digital images was especially helpful for evaluation of radiographs and complex wounds of the hand and face. The solution proved to be very valuable for both attending physicians and residents in plastic surgery. The photographs provide rich detail and resolution comparable to high-quality prints. The mechanics of obtaining images and the process of sending them electronically was readily mastered. Images reached their destination in only a few minutes over standard telephone lines. No problems were encountered while sending or viewing images on Macintosh or Windows platforms. Determining course of action with a complete clinical history now includes a level of visual detail previously not available. As this application expands into wider use, data integrity and safety will have to be more formally secured and monitored. Our model of telemedicine has broad-reaching ramifications for the improvement of health-care delivery locally, nationally, and internationally.     

Undetected diabetes and the plastic surgeon

Plastic surgery candidates are generally healthy. Therefore, major postoperative complications are rare. Should they happen, the surgeon should search for possible causes, one of which is undetected diabetes mellitus. Six patients are presented who, based on the individual or family history or the unusual nature of their complications, were suspected of having diabetic tendencies. This experience necessitated our in-depth search into the role of silent or undetected diabetes. This report emphasizes the importance of positive family history of diabetes and the role of glucose tolerance tests on suspected cases. Even with normal glucose tolerance tests, however, some of these patients with a positive family history of diabetes and history of previous infections suffer from deficiencies in the chemotactic immune system. We recommend full discussion of the increased risk of infection and delayed healing with these patients, conservatism during surgical procedures, and prophylactic use of antibiotics perioperatively.     

Adolescent lifestyle and behaviour: a survey from a developing country

Introduction

Adolescents form two-thirds of our population. This is a unique group of people with special needs. Our survey aims to identify the lifestyle and behavioral patterns in this group of people and subsequently come up with issues that warrant special attention.

Methods

A survey was performed in various schools of Karachi. Data collection was done via a face-to-face interview based on a structured, pre-tested questionnaire. Participants included all willing persons between 12–19 years of age.

Results

Most adolescents with lifestyle issues fell in the age group of 16–18 years. Females were more depressed than males and had more sleep problems. Substance abuse and other addictions were documented more in males. Watching television or listening to music was stated as the most common late night activity (61.8%) and therefore was also referred to as the contributory factor for less than eight hours of sleep each day. (58.9%) of the respondents are getting less than eight hours of sleep daily. (41.5%) of the respondents who felt depressed sought treatment for it. Quite a few of them were also indulged in substance abuse and other addictions. Only (16.8%) of the respondents opined that physical activity is essential for health. Thirty-five adolescents out of all the respondents were smoking cigarettes currently, whereas 7% of the respondents chewed paan (areca nut). Peer pressure was the most common reason (37.1%) to start smoking.

Conclusion

Adolescents need to be treated as a distinct segment of our population and it is important to realize and address their health and lifestyle problems. Inadequate sleep, depression and smoking were the leading unhealthy behaviours among the respondents. Families can play an important role to help these adolescents live a healthier life. Further research studies should be carried out to highlight issues of concern and their possible solutions in this population.     

Human genomics and microarrays: implications for the plastic surgeon

The Human Genome Project was launched in 1989 in an effort to sequence the entire span of human DNA. Although coding sequences are important in identifying mutations, the static order of DNA does not explain how a cell or organism may respond to normal and abnormal biological processes. By examining the mRNA content of a cell, researchers can determine which genes are being activated in response to a stimulus.Traditional methods in molecular biology generally work on a "one gene: one experiment" basis, which means that the throughput is very limited and the "whole picture" of gene function is hard to obtain. To study each of the 60,000 to 80,000 genes in the human genome under each biological circumstance is not practical. Recently, microarrays (also known as gene or DNA chips) have emerged; these allow for the simultaneous determination of expression for thousands of genes and analysis of genome-wide mRNA expression.The purpose of this article is twofold: first, to provide the clinical plastic surgeon with a working knowledge and understanding of the fields of genomics, microarrays, and bioinformatics and second, to present a case to illustrate how these technologies can be applied in the study of wound healing.