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BACKGROUND Implementing the new competency based medical education is quite challenging for medical educators while teaching newly admitted undergraduate medical students. We wanted to compare the role of interactive lecture classes with self-directed sessions among first MBBS students in the Department of Physiology during implementation of competency based medical education. METHODS The present study was conducted in the Department of Physiology among two hundred undergraduate medical students after obtaining Institutional Ethical Clearance. Ten interactive lecture classes were compared with ten self-directed learning sessions using pre-test and post-test MCQS. Students’ feedback was collected following the sessions and students were provided with feedback following each session. Feedbacks from facilitators were also taken following the sessions. SPSS version 16 was used to analyse the data. T test was done to compare the different teaching methods. RESULTS Students were more satisfied with the SDL sessions. According to the teachers, students participated and interacted in SDL sessions better when compared to traditional classes. Teachers had to put much more effort to the SDL sessions as compared to traditional lecture sessions to make these sessions effective. There was no difference in performance between traditional lecture classes and self-directed learning sessions in pre-test sessions (50.39 ± 19.41 vs. 52.84 ± 16.01; p value 0.17). Students performed better in post-test sessions (50.39 ± 19.41 vs. 63.38 ± 12.79; p value < 0.0001**) as compared to pretest sessions in interactive lecture classes. Students performed better in posttest sessions (52.84 ± 16.01 vs. 69.79 ± 12.4; p value < 0.0001**) as compared to pre-test sessions during assessment of self-directed learning sessions. Performances of students were also better in SDL sessions as compared to interactive lecture classes in post-test sessions. (69.79 ± 12.4 vs. 63.38 ± 12.79; p value < 0.0001**). CONCLUSIONS Self-directed learning sessions were more effective than interactive lecture classes for teaching physiology to undergraduate medical students and for implementation of competency based medical education. Successful implementation of SDL sessions requires a greater number of teachers as compared to interactive lecture sessions. KEYWORDS Traditional Lecture Classes, Self-Directed Learning, Competency Based Medical Education

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Introduction:Carbon dioxide pneumoperitoneum (PP) for laparoscopic surgery increases arterial pressure, heart rate, and systemic vascular resistance. In this randomized, double blind, prospective clinical study; we investigated the efficacy of magnesium sulfate to prevent adverse hemodynamic response associated with PP in patients undergoing laparoscopic cholecystectomy.Materials and Methods:Sixty patients, of either sex (18-65 years of age), undergoing elective laparoscopic cholecystectomy were randomly allocated in one of the two groups containing 30 patients each. Group M received magnesium sulfate 30 mg/kg intravenously as a bolus before PP. Group C received same volume of 0.9% saline.Results:Mean arterial pressure and heart rate were significantly less throughout the period of pneumoperitoneum in patients of group M. Intravenous labetalol was required in 40% (12 out of 30) of the patients in group C to control intraoperative hypertension and it was clinically significant in comparison to group M.Conclusion:Magnesium sulfate administered before PP attenuates adverse hemodynamic response and provides hemodynamic stability during PP created for laparoscopic surgery.

Introduction: Aceclofenac, a NSAID is widely used in the treatment of pain and infl ammation associated with osteoarthritis. Nabumetone, a recently developed preferential cyclo-oxygenase 2 inhibitor has also proved to be equally effective. The present study was undertaken to evaluate the ‘real better’ drug, amongst these with better effi cacy and gastro-intestinal tolerability as well.Methods:Four hundred and twenty-three patients of either sex, aged 40-64 years with uncomplicated osteoarthritis of knee joint were randomly allocated into three equal groups receiving aceclofenac, nabumetone or placebo. A baseline pain measurement was done with Visual Analogue Scale (VAS: 0-10 scale) and Investigator Global Assessment of Disease status (IGADS: 0-4 point scale). Code was broken at the end of two weeks or earlier to eliminate any real fatal outcome. Final evaluation of efficacy was done at the end of four weeks. The signifi cance of difference between the treatment outcomes was analyzed using one way ANOVA test. Results:During the active comparator controlled period, the most common reason for discontinuation was unacceptable adverse events. While 108 (76.6%) participants could take the full course of treatment with aceclofenac, 118 (83.7 %) of the nabumetone group completed the study. Drop outs were highest in the placebo group (33.9%) followed by the aceclofenac group (12.1%) and nabumetone group (8.5%). Discontinuation due to G.I. intolerance was least in the placebo group (2.1%) followed by the nabumetone group (5%) and aceclofenac group (7.8%). Conclusions:The preferential inhibition of cyclo-oxygenase 2 by nabumetone was postulated to afford better clinical effi cacy and gastrointestinal tolerability in osteoarthritis as compared to aceclofenac.Key Words: aceclofenac, nabumetone, osteoarthritis

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Background:Carbon dioxide pneumoperitoneum for laparoscopic surgery increases arterial pressures, heart rate (HR), and systemic vascular resistance. In this randomized, single-blind, placebo-controlled clinical study, we investigated and compared the efficacy of esmolol and dexmedetomidine to provide perioperative hemodynamic stability in patients undergoing laparoscopic cholecystectomy.Methods:Sixty patients, of either sex undergoing elective laparoscopic cholecystectomy, were randomly allocated into three groups containing twenty patients each. Group E received bolus dose of 500 μg/kg intravenous (IV) esmolol before pneumoperitoneum followed by an infusion of 100 μg/kg/min. Group D received bolus dose of 1 μg/kg IV dexmedetomidine before pneumoperitoneum followed by infusion of 0.2 μg/kg/h. Group S (control) received saline 0.9%.Results:Mean arterial pressure and HR in Group E and D were significantly less throughout the period of pneumoperitoneum in comparison to Group S. IV nitroglycerine was required in 45% (9 out of 20) patients in Group S to control intraoperative hypertension, and it was clinically significant in comparison to Group E and D.Conclusion:Both esmolol and dexmedetomidine attenuate the adverse hemodynamic response to pneumoperitoneum and provide hemodynamic stability during laparoscopic surgery.