From competence based dynamic ontology to a static ontology for medical education

Please refer to our previous post on competence based education that was more to do with creating a competence based dynamic ontology here: https://medicinedepartment.blogspot.com/2022/07/cbme-general-medicine-topics-and.html?m=0, 

although the topics and subtopics below can still be utilized to create a dynamic user driven ontology that we shall share in another post with links to all the user driven projects that are ongoing in medicine department. 

IM1.1

Topic: Heart Failure

Subtopic: Describe and discuss the epidemiology, pathogenesis clinical evolution and course of common causes of heart disease including: rheumatic/ valvular, ischemic, hypertrophic inflammatory

IM1.2

Topic: Heart Failure

Subtopic: Describe and discuss the genetic basis of some forms of heart failure

IM1.3

Topic: Heart Failure

Subtopic: Describe and discuss the aetiology microbiology pathogenies and clinical evolution of rheumatic fever, criteria, degree of rheumatic activity and rheumatic valvular heart disease and its complications including infective endocarditis

IM1.4

Topic: Heart Failure

Subtopic: Stage heart failure

IM1.5

Topic: Heart Failure

Subtopic: Describe, discuss and differentiate the processes involved in R V & LV  heart failure, systolic vs diastolic failure

IM1.6

Topic: Heart Failure

Subtopic: Describe and discuss the compensatory mechanisms involved in heart failure including cardiac remodelling and neurohormonal adaptations

IM1.7

Topic: Heart Failure

Subtopic: Enumerate, describe and discuss the factors that exacerbate heart failure dietary factors drugs etc.

IM1.8

Topic: Heart Failure

Subtopic: Describe and discuss the pathogenesis and development of common arrythmias involved in heart failure particularly atrial fibrillation

IM1.9

Topic: Heart Failure

Subtopic: Describe and discuss the clinical presentation and features, diagnosis, recognition and management of acute rheumatic fever

IM1.10

Topic: Heart Failure

Subtopic: Elicit document and present an appropriate history that will establish the diagnosis, cause and severity of heart failure including: presenting complaints, precipitating and exacerbating factors, risk factors exercise tolerance, changes in sleep patterns, features suggestive of infective endocarditis

IM1.11

Topic: Heart Failure

Subtopic: Perform and demonstrate a systematic examination based on the history that will help establish the diagnosis and estimate its severity including: measurement of pulse, blood pressure and respiratory rate, jugular venous forms and pulses, peripheral pulses, conjunctiva and fundus, lung, cardiac examination including palpation and auscultation with identification of heart sounds and murmurs, abdominal distension and splenic palpation

IM1.12

Topic: Heart Failure

Subtopic: Demonstrate peripheral pulse, volume, character, quality and variation in various causes of heart failure

IM1.13

Topic: Heart Failure

Subtopic: Measure the blood pressure accurately, recognise and discuss alterations in blood pressure in valvular heart disease and other causes of heart failure and cardiac tamponade

IM1.14

Topic: Heart Failure

Subtopic: Demonstrate and measure jugular venous distension

IM1.15

Topic: Heart Failure

Subtopic: Identify and describe the timing, pitch quality conduction and significance of precordial murmurs and their variations

IM1.16

Topic: Heart Failure

Subtopic: Generate a differential diagnosis based on the clinical presentation and prioritise it based on the most likely diagnosis

IM1.17

Topic: Heart Failure

Subtopic: Order and interpret diagnostic testing based on the clinical diagnosis including 12 lead ECG, Chest radiograph, blood cultures

IM1.18

Topic: Heart Failure

Subtopic: Perform and interpret a 12 lead ECG

IM1.19

Topic: Heart Failure

Subtopic: Enumerate the indications for and describe the findings of heart failure with the following conditions including: 2D echocardiography, brain natriuretic peptide, exercise testing, nuclear medicine testing and coronary angiogram

IM1.20

Topic: Heart Failure

Subtopic: Determine the severity of valvular heart disease based on the clinical and laboratory and imaging features and determine the level of intervention required including surgery

IM1.21

Topic: Heart Failure

Subtopic: Describe and discuss and identify the clinical features of acute and subacute endocarditis, echocardiographic findings, blood culture and sensitivity and therapy

IM1.22

Topic: Heart Failure

Subtopic: Assist and demonstrate the proper technique in collecting specimen for blood culture

IM1.23

Topic: Heart Failure

Subtopic: Describe, prescribe and communicate non pharmacologic management of heart failure including sodium restriction, physical activity and limitations

IM1.24

Topic: Heart Failure

Subtopic: Describe and discuss the pharmacology of drugs including indications, contraindications in the management of heart failure including diuretics, ACE inhibitors, Beta blockers, aldosterone antagonists and cardiac glycosides

IM1.25

Topic: Heart Failure

Subtopic: Enumerate the indications for valvuloplasty, valvotomy, coronary revascularization and cardiac transplantation

IM1.26

Topic: Heart Failure

Subtopic: Develop document and present a management plan for patients with heart failure based on type of failure, underlying aetiology

IM1.27

Topic: Heart Failure

Subtopic: Describe and discuss the role of penicillin prophylaxis in the prevention of rheumatic heart disease

IM1.28

Topic: Heart Failure

Subtopic: Enumerate the causes of adult presentations of congenital heart disease and describe the distinguishing features between cyanotic and acyanotic heart disease

IM1.29

Topic: Heart Failure

Subtopic: Elicit document and present an appropriate history, demonstrate correctly general examination, relevant clinical findings and formulate document and present a management plan for an adult patient presenting with a common form of congenital heart disease

IM1.30

Topic: Heart Failure

Subtopic: Administer an intramuscular injection with an appropriate  explanation to the patient

IM 2.1

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:-Discuss and describe the epidemiology, antecedents and risk factors for atherosclerosis and ischemic heart disease

IM 2.2 

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:-Discuss the aetiology of risk factors both modifiable and non modifiable of atherosclerosis and IHD

IM2.3 

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:-Discuss and describe the lipid cycle and the role of dyslipidemia in the pathogenesis of atherosclerosis

IM2.4 

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:-Discuss and describe the pathogenesis natural history, evolution and complications of atherosclerosis and IHD

IM 2.5 

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:-Define the various acute coronary syndromes and describe their evolution, natural history and outcomes

IM 2.6 

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:-Elicit document and present an appropriate history that includes onset evolution, presentation risk factors, family history, comorbid conditions, complications, medication, history of atherosclerosis, IHD and coronary syndromes

IM 2.7 

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:-Perform, demonstrate and document a physical examination including a vascular and cardiac examination that is appropriate for the clinical presentation 

IM 2.8 

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:-Generate document and present a differential diagnosis based on

The clinical presentation and prioritise based on “cannot miss”, most

Likely diagnosis and severity

IM 2.9 

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:- Distinguish and differentiate between stable and unstable angina and Ami based on clinical presentation 

IM 2.10

Topic:-Acute Myocardial Infarction/ IHD

Subtopic:-Order, perform and interpret an ECG

IM 2.11

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:- order and interpret a Chest X-ray and markers of acute myocardial infarction

IM 2.12 

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:-

Choose and interpret a lipid profile and identify the desirable lipid profile in the clinical context

IM 2.13

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:-

Discuss and enumerate the indications for and findings on echocardiogram, stress testing and coronary angiogram

IM 2.14

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:- 

Discuss and describe the indications for admission to a coronary care unit and supportive therapy for a patient with acute coronary syndrome

IM 2.15

Topic:-Acute Myocardial Infarction/ IHD

Subtopic:-

Discuss and describe the medications used in patients with an acute coronary syndrome based on the clinical presentation

IM 2.16 

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:- Discuss and describe the indications for acute thrombolysis, PTCA and CABG

IM 2.17 

Topic:-Acute Myocardial Infarction/ IHD

Subtopic:-Discuss and describe the indications and methods of cardiac rehabilitation

IM 2.18

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:- Discuss and describe the indications, formulations, doses, side effects and monitoring for drugs used in the management of dyslipidemia

IM 2.19 

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:- Discuss and describe the pathogenesis, recognition and management of complications of acute coronary syndromes

Including arrhythmias, shock, LV dysfunction, papillary muscle

Rupture and pericarditis

IM 2.20 

Topic:-Acute Myocardial Infarction/ IHD

Subtopic:-Discuss and describe the assessment and relief of pain in acute

Coronary syndromes

IM 2.21 

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:-

Observe and participate in a controlled environment an ACLS program

IM 2.22

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:- Perform and demonstrate in a mannequin BLS

IM 2.23

Topic:-Acute Myocardial Infarction/ IHD

Subtopic:-Describe and discuss the indications for nitrates, anti platelet agents, gpIIb IIIa inhibitors, beta blockers, ACE inhibitors etc in the management of coronary syndromes

IM 2.24 

Topic:- Acute Myocardial Infarction/ IHD

Subtopic:- Counsel and communicate to patients with empathy lifestyle changes in atherosclerosis / post coronary syndromes

TOPIC 3 – PNEUMONIA 

IM3.1

Topic : pneumonia

Subtopic : community acquired pneumonia, nosocomial pneumonia and aspiration pneumonia

IM3.2

Topic : pneumonia

Subtopic : aetiologies of various kinds of pneumonia and their microbiology depending on the setting and immune status of the host

IM3.3

Topic : pneumonia

Subtopic : pathogenesis, presentation, natural history and complications of pneumonia

IM3.4

Topic : pneumonia

Subtopic : evolution, risk factors including immune status and occupational risk

IM3.5

Topic : pneumonia

Subtopic : physical examination including general examination and appropriate examination of the lungs that establishes the diagnosis, complications and severity of disease

IM3.6

Topic : pneumonia

Subtopic : differential diagnosis based on the clinical features, and prioritise the diagnosis based on the presentation

IM3.7

Topic : pneumonia

Subtopic : interpret diagnostic tests based on the clinical presentation including: CBC, Chest X ray PA view, Mantoux, sputum gram stain, sputum culture and sensitivity, pleural fluid examination and culture, HIV testing and ABG

IM3.8

Topic : pneumonia

Subtopic : arterial blood gas examination

IM3.9

Topic : pneumonia

Subtopic : pleural fluid analysis

IM3.10

Topic : pneumonia

Subtopic : blood culture

IM3.11

Topic : pneumonia

Subtopic : HRCT, Viral cultures, PCR and specialised testing

IM3.12

Topic : pneumonia

Subtopic : aetiology, an appropriate empirical antimicrobial based on the pharmacology and antimicrobial spectrum

IM3.13

Topic : pneumonia

Subtopic : culture and sensitivity appropriate empaling antimicrobial based on the pharmacology and antimicrobial spectrum

IM3.14

Topic : pneumonia

Subtopic :  sputum gram stain and AFB

IM3.15

Topic : pneumonia

Subtopic : the indications for hospitalisation in patients with pneumonia

IM3.16

Topic : pneumonia

Subtopic : the indications for isolation and barrier nursing in patients with pneumonia

IM3.17

Topic : pneumonia

Subtopic : the supportive therapy in patients with pneumonia including oxygen use and indications for ventilation

IM3.18

Topic : pneumonia

Subtopic : counsel patient on family on the diagnosis and therapy of pneumonia

IM3.19

Topic : pneumonia

Subtopic : indications and communicate to patients on pneumococcal and influenza vaccines

IM4.1

Topic: Fever and febrile syndromes

Describe and discuss the febrile response and the influence of host immune status, risk factors and comorbidities on the febrile response

IM4.25 Communicate to the patient and family the diagnosis and treatment

IM5.1

TOPIC- LIVER DISEASE

The physiologic and biochemical basis of hyperbilirubinemia 

IM5.2

TOPIC- LIVER DISEASE

SUBTOPIC  - the aetiology and pathophysiology of liver injury 

IM5.3

TOPIC- LIVER DISEASE

SUBTOPIC – the pathologic changes in various forms of liver disease 

IM5.4

TOPIC- LIVER DISEASE

SUBTOPIC  - Epidemiology, microbiology, immunology and clinical evolution of infective (viral) hepatitis 

IM5.5

TOPIC- LIVER DISEASE

SUBTOPIC -  The pathophysiology and clinical evolution of alcoholic liver disease

IM5.6

TOPIC- LIVER DISEASE

SUBTOPIC – The pathophysiology, clinical evolution and complications of cirrhosis and portal hypertension including ascites, spontaneous bacterial peritonitis, hepatorenal syndrome and hepatic encephalopathy

 IM5.7

TOPIC- LIVER DISEASE

SUBTOPIC- The causes and pathophysiology of drug induced liver injury 

 IM5.8

TOPIC- LIVER DISEASE

SUBTOPIC- The pathophysiology, clinical evolution and complications cholelithiasis and cholecystitis 

IM5.9

TOPIC- LIVER DISEASE

SUBTOPIC – Elicit document and present a medical history that helps delineate the aetiology of the current presentation and includes clinical presentation, risk factors, drug use, sexual history, vaccination history and family history 

IM5.10 

TOPIC- LIVER DISEASE

SUBTOPIC – systematic examination that establishes the diagnosis and severity that includes nutritional status, mental status, jaundice, abdominal distension ascites, features of portosystemic hypertension and hepatic encephalopathy 

IM5.11

TOPIC- LIVER DISEASE

SUBTOPIC-  Generate a differential diagnosis and prioritise based on clinical features that suggest a specific aetiology for the presenting symptom 

IM5.12 

TOPIC- LIVER DISEASE

SUBTOPIC- Choose and interpret appropriate diagnostic tests including: CBC, bilirubin,function tests.

IM5.13 

TOPIC- LIVER DISEASE

SUBTOPIC -  Enumerate the indications for ultrasound and other imaging studies including MRCP and ERCP and describe the findings in liver disease 

IM5.14

TOPIC- LIVER DISEASE

SUBTOPIC-  Outline a diagnostic approach to liver disease based on hyperbilirubinemia, liver function changes and hepatitis serology

IM.15

TOPIC- LIVER DISEASE

SUBTOPIC- Assist in the performance and interpret the findings of an ascitic fluid analysis

IM5.16 

TOPIC- LIVER DISEASE

SUBTOPIC- The management of hepatitis, cirrhosis, portal hypertension, ascites spontaneous, bacterial peritonitis and hepatic encephalopathy 

IM5.17  

TOPIC- LIVER DISEASE

SUBTOPIC- Enumerate the indications, precautions and counsel patients on vaccination for hepatitis

IM5.18

TOPIC- LIVER DISEASE

SUBTOPIC – Enumerate the indications for hepatic transplantation

Topic: HIV

IM6.1 Describe and discuss the symptoms and signs of acute HIV seroconversion

Topic: Rheumatologic problems

IM7.1 Describe the pathophysiology of autoimmune disease

IM 8.1

Topic:- HYPERTENSION

Subtopic:-Describe and discuss the epidemiology, aetiology and the prevalence of primary and secondary hypertension

IM 8.2

Topic:- HYPERTENSION 

Subtopic:-Describe and discuss the pathophysiology of hypertension

IM 8.3

Topic:- HYPERTENSION 

Subtopic:-Describe and discuss the genetic basis of hypertension

IM8.4

Topic:- HYPERTENSION 

Subtopic:-Define and classify hypertension

IM 8.5 

Topic:- HYPERTENSION

Subtopic:-Describe and discuss the differences between primary and

Secondary hypertension

IM 8.6

Topic:- HYPERTENSION 

Subtopic:-Define, describe and discuss and recognise hypertensive urgency

IM 8.7

Topic:- HYPERTENSION 

Subtopic:-Describe and discuss the clinical manifestations of the various aetiologies of secondary causes of hypertension

IM 8.8 

Topic:-HYPERTENSION 

Subtopic:-Describe, discuss and identify target organ damage due to hypertension

IM 8.9

Topic:- HYPERTENSION 

Subtopic:-Elicit document and present a medical history that includes: duration and levels, symptoms, comorbidities, lifestyle, risk factors, family history, psychosocial and environmental factors, dietary assessment, previous and concomitant therapy

IM 8.10

Topic:- HYPERTENSION 

Subtopic:- Perform a systematic examination that includes : an accurate of measurement of blood pressure, fundus examination, examination of vasculature and heart

IM 8.11

Topic:- HYPERTENSION 

Subtopic:-Generate a differential diagnosis and prioritise based on clinical features that suggest a specific aetiology

IM 8.12

Topic:- HYPERTENSION 

Subtopic:-Describe the appropriate diagnostic work up based on the presumed aetiology

IM 8.13

Topic:- HYPERTENSION 

Subtopic:- Enumerate the indications for and interpret the results of : CBC, Urine routine, BUN, Cr, Electrolytes, Uric acid, ECG

IM 8.14

Topic:- HYPERTENSION 

Subtopic:- Develop an appropriate treatment plan for essential hypertension

IM 8.15

Topic:- HYPERTENSION

Subtopic:-Recognise, prioritise and manage hypertensive emergencies

IM 8.16

Topic:- HYPERTENSION 

Subtopic:- Develop and communicate to the patient lifestyle modification

Including weight reduction, moderation of alcohol intake, physical

Activity and sodium intake

IM 8.17

Topic:- HYPERTENSION 

Subtopic:-Perform and interpret a 12 lead ECG

IM 8.18

Topic:- HYPERTENSION

Subtopic:-Incorporate patient preferences in the management of HTN

TOPIC 09 - ANEMIA

TOPIC : ANEMIA 

SUBTOPIC : 

IM9.1 Define, describe and classify anemia based on red blood cell size and reticulocyte count ? 

TOPIC : ANEMIA 

SUBTOPIC : 

IM9.2 Describe and discuss the morphological characteristics, aetiology and prevalence of each of the causes of anemia

TOPIC : ANEMIA 

SUBTOPIC : 

IM9.3 Elicit document and present a medical history that includes symptoms, risk factors including GI bleeding, prior history, medications, menstrual history, and family history

TOPIC : ANEMIA 

SUBTOPIC : 

IM9.4 Perform a systematic examination that includes : general examination for pallor, oral examination, DOAP session of hyper dynamic circulation, lymph node and splenic examination

TOPIC : ANEMIA

SUBTOPIC : 

IM9.5 Generate a differential diagnosis and prioritise based on clinical features that suggest a specific aetiology

TOPIC : ANEMIA

SUBTOPIC : 

IM9.6 Describe the appropriate diagnostic work up based on the

Presumed aetiology

TOPIC : ANEMIA 

SUBTOPIC : 

IM9.7 Describe and discuss the meaning and utility of various components

Of the hemogram

TOPIC : ANEMIA 

SUBTOPIC : 

IM9.8 Describe and discuss the various tests for iron deficiency

TOPIC : ANEMIA 

SUBTOPIC : 

IM9.9 Order and interpret tests for anemia including hemogram, red cell

Indices, reticulocyte count, iron studies, B12 and folate

TOPIC : ANEMIA

SUBTOPIC : 

IM9.10 Describe, perform and interpret a peripheral smear and stool occult

Blood

TOPIC : ANEMIA

SUBTOPIC : 

IM9.11 Describe the indications and interpret the results of a bone marrow aspirations and biopsy

TOPIC : ANEMIA

SUBTOPIC : 

IM9.12 Describe, develop a diagnostic plan to determine the aetiology of anemia

TOPIC : ANEMIA 

SUBTOPIC : 

IM9.13 Prescribe replacement therapy with iron, B12, folate

TOPIC : ANEMIA

SUBTOPIC : IM9.14 Describe the national programs for anemia prevention

TOPIC :ANEMIA

SUBTOPIC : IM9.15 Communicate the diagnosis and the treatment appropriately to patients

TOPIC : ANEMIA 

SUBTOPIC : 

IM9.16 Incorporate patient preferences in the management of anemia

TOPIC : ANEMIA 

SUBTOPIC: 

IM9.17 Describe the indications for blood transfusion and the appropriate use of blood components

TOPIC : ANEMIA 

SUBTOPIC : 

IM9.18 Describe the precautions required necessary when performing a blood transfusion

TOPIC : ANEMIA

SUBTOPIC : 

IM9.19 Assist in a blood transfusion

TOPIC : ANEMIA 

SUBTOPIC : 

IM9.20 Communicate and counsel patients with methods to prevent

Nutritional anemia

TOPIC : ANEMIA 

SUBTOPIC : IM9.21 Determine the need for specialist consultation

Topic: Acute Kidney Injury and Chronic renal failure

IM10.1 Define, describe and differentiate between acute and chronic renal 

failure

TOPIC 11 – DIABETES MELLITUS

IM11.1

Topic:- DIABETES MELLITUS

 

Subtopic:- Define and classify diabetes

IM 11.2

Topic:- DIABETES MELLITUS

Subtopic:-Describe and discuss the epidemiology and pathogenesis and risk factors and clinical evolution of type 1 diabetes

IM 11.3

Topic:- DIABETES MELLITUS

Subtopic:- Describe and discuss the epidemiology and pathogenesis and risk

factors economic impact and clinical evolution of type 2 diabetes

IM 11.4

Topic:-DIABETES MELLITUS

Subtopic:- Describe and discuss the genetic background and the influence of

the environment on diabetes

IM 11.5

Topic:- DIABETES MELLITUS

Subtopic:-Describe and discuss the pathogenesis and temporal evolution of

microvascular and macro-vascular complications of diabetes

IM 11.6

Topic:- DIABETES MELLITUS

Subtopic:- Describe and discuss the pathogenesis and precipitating factors,

recognition and management of diabetic emergencies

IM 11.7

Topic:-DIABETES MELLITUS

Subtopic:- Elicit document and present a medical history that will differentiate the aetiologies of diabetes including risk factors, precipitating factors, lifestyle, nutritional history, family history, medication history, co-morbidities and target organ disease

IM 11.8

Topic:- DIABETES MELLITUS

Subtopic:-Perform a systematic examination that establishes the diagnosis and severity that includes skin, peripheral pulses, blood pressure measurement, fundus examination, detailed examination of the foot (pulses, nervous and deformities and injuries)

IM 11.9 

Topic:- DIABETES MELLITUS

Sub topic :- Describe and recognise the clinical features of patients who present with a diabetic emergency

IM 11.10 

Topic:- DIABETES MELLITUS

Subtopic:- Generate a differential diagnosis and prioritise based on clinical features that suggest a specific aetiology

IM 11.11

Topic:- DIABETES MELLITUS

Subtopic:-Order and interpret laboratory tests to diagnose diabetes and its complications including: glucoses, glucose tolerance test,glycosylated hemoglobin, urinary micro albumin, ECG, electrolytes ABG, ketones, renal function tests and lipid profile

IM 11.12

Topic:- DIABETES MELLITUS 

Sub topic:- Perform and interpret a capillary blood glucose test

IM 11.13 

Topic :- DIABETES MELLITUS

 

Subtopic:-Perform and interpret a urinary ketone estimation with a dipstick

IM 11.14

Topic:- DIABETES MELLITUS 

Subtopic:-Recognise the presentation of hypoglycaemia and outline the

principles on its therapy

IM 11.15

Topic:- DIABETES MELLITUS

Subtopic :- Recognise the presentation of diabetic emergencies and outline the

principles of therapy

IM 11.16

Topic:- DIABETES MELLITUS

Subtopic:- Discuss and describe the pharmacologic therapies for diabetes their

indications, contraindications, adverse reactions and interactions

IM 11.17 

Topic:- DIABETES MELLITUS 

Subtopic:-Outline a therapeutic approach to therapy of T2Diabetes based on

presentation, severity and complications in a cost effective manner

IM 11.18

Topic:- DIABETES MELLITUS 

Subtopic:-Describe and discuss the pharmacology, indications, adverse reactions and interactions of drugs used in the prevention and treatment of target organ damage and complications of Type II Diabetes including neuropathy, nephropathy, retinopathy, hypertension, dyslipidemia and cardiovascular disease

IM 11.19

Topic:- DIABETES MELLITUS 

Subtopic:- Demonstrate and counsel patients on the correct technique to administer insulin

IM 11.20 

Topic:- DIABETES MELLITUS

Subtopic:-Demonstrate to and counsel patients on the correct technique of self monitoring of blood glucoses

IM 11.21 

Topic:- DIABETES MELLITUS

Subtopic:- Recognise the importance of patient preference while selecting therapy for diabetes

IM 11.22

Topic:- DIABETES MELLITUS 

Subtopic:-Enumerate the causes of hypoglycaemia and describe the counter hormone response and the initial approach and treatment

IM 11.23

Topic:- DIABETES MELLITUS

Subtopic:-Describe the precipitating causes, pathophysiology, recognition, clinical features, diagnosis, stabilisation and

management of diabetic ketoacidosis

IM 11.24

Topic:- DIABETES MELLITUS 

Subtopic:- Describe the precipitating causes, pathophysiology, recognition, clinical features, diagnosis, stabilisation and management of Hyperosmolar non ketotic state

TOPIC 12 - THYROID

IM 12.1

Topic : Thyroid

Subtopic : epidemiology and pathogenesis of hypothyroidism and hyperthyroidism including the influence of iodine deficiency and autoimmunity in the pathogenesis of thyroid disease

IM 12.2

Topic : Thyroid

Subtopic: Genetic basis of some forms of thyroid dysfunction

IM12.3

Topic : Thyroid

Subtopic : Physiology of the hypothalamopituitary – thyroid axis, principles of thyroid function testing and alterations in physiologic function

IM12.4 

Topic : Thyroid

Subtopic : Principles of radio iodine uptake in the diagnosis of thyroid disorder

M12.5

Topic : Thyroid 

Subtopic : Document and present an appropriate history that will establish the diagnosis cause of thyroid dysfunction and its severity

IM12.6

Topic : Thyroid 

Subtopic : Perform and demonstrate a systematic examination based on the history that will help establish the diagnosis and severity including systemic signs of thyrotoxicosis and hypothyroidism, palpation of the pulse rate and rhythm abnormalities neck palpation of thyroid and lymph nodes and cardiovascular findings.

IM12.7 

Topic : Thyroid 

Subtopic :  The correct technique to palpate the thyroid

IM12.8

Topic : Thyroid

Subtopic : Generate a differential diagnosis based on the clinical presentation and prioritise it based on the most likely diagnosis

IM12.9

Topic : Thyroid 

Subtopic : Order and interpret diagnostic testing based on the clinical diagnosis including CBC, thyroid function tests and ECG and radio iodine uptake and scan

IM12.10

Topic : Thyroid

Subtopic : Identify atrial fibrillation, pericardial effusion and bradycardia on ECG

IM12.11

Topic : Thyroid

Subtopic :  Interpreting thyroid function tests in hypo and hyperthyroidism

IM12.12

Topic : Thyroid

Subtopic : The iodisation programs of the government of India

IM12.13

Topic : Thyroid

Subtopic : Pharmacology, indications, adverse reaction, interactions of thyroxine and antithyroid drugs

IM12.14

Topic : Thyroid

Subtopic : Write and communicate to the patient appropriately a prescription for thyroxine based on age, sex, and clinical and biochemical status

IM12.15

Topic : Thyroid

Subtopic: The indications of thionamide therapy, radio iodine therapy and surgery in the management of thyrotoxicosis

IM13.1

Topic: COMMON MALIGNANCIES

Subtopic:- Describe the clinical epidemiology and inherited & modifiable risk factors for common malignancies in India

IM13.2

Topic: COMMON MALIGNANCIES

Subtopic:- Describe the genetic basis of selected cancers

IM13.3

Topic: COMMON MALIGNANCIES

Subtopic:- Describe the relationship between infection and cancers

IM13.4

Topic: COMMON MALIGNANCIES

Subtopic:- Describe the natural history, presentation, course, complications and cause of death for common cancers

IM13.5

Topic: COMMON MALIGNANCIES

Subtopic:- Describe the common issues encountered in patients at the end of life and principles of management

IM13.6

Topic: COMMON MALIGNANCIES

Subtopic:- Describe and distinguish the difference between curative and palliative care in patients with cancer

IM13.7

Topic: COMMON MALIGNANCIES

Subtopic:- Elicit document and present a history that will help establish the aetiology of cancer and includes the appropriate risk factors, duration and evolution 

IM13.8

Topic: COMMON MALIGNANCIES

Subtopic:- Perform and demonstrate a physical examination that includes an appropriate general and local examination that excludes the diagnosis, extent spread and complications of cancer

IM13.9

Topic: COMMON MALIGNANCIES

Subtopic:- Demonstrate in a mannequin the correct technique for performing breast exam rectal examination and cervical examination and Pap smear 

IM13.10

Topic: COMMON MALIGNANCIES

Subtopic:- Generate a differential diagnosis based on the presenting symptoms and clinical features and prioritise based on the most likely diagnosis

IM13.11

Topic: COMMON MALIGNANCIES

Subtopic:- Order and interpret diagnostic testing based on the clinical diagnosis including CBC and stool occult blood and prostate specific antigen 

IM13.12

Topic: COMMON MALIGNANCIES

Subtopic:- Describe the indications and interpret the results of Chest X Ray, mammogram, skin and tissue biopsies and tumor markers used in common cancers

IM13.13

Topic: COMMON MALIGNANCIES

Subtopic:- Describe and assess pain and suffering objectively in a patient with cancer

IM13.14

Topic: COMMON MALIGNANCIES

Subtopic:- Describe the indications for surgery, radiation and chemotherapy for common malignancies 

IM13.15

Topic: COMMON MALIGNANCIES

Subtopic:- Describe the need, tests involved, their utility in the prevention of common malignancies 

IM13.16

Topic: COMMON MALIGNANCIES

Subtopic:- Demonstrate an understanding and needs and preferences of patients when choosing curative and palliative therapy

IM13.17

Topic: COMMON MALIGNANCIES

Subtopic:- Describe and enumerate the indications, use, side effects of narcotics in pain alleviation in patients with cancer

IM13.18

Topic: COMMON MALIGNANCIES

Subtopic:- Describe and discuss the ethical and the medico legal issues involved in end of life care

IM13.19

Topic: COMMON MALIGNANCIES

Subtopic:- Describe the therapies used in alleviating suffering in patients at the end of life 

Topic: Obesity

IM14.1 Define and measure obesity as it relates to the Indian population

Topic: GI bleeding

IM15.1 Enumerate, describe and discuss the aetiology of upper and lower 

GI bleeding

IM 16   Diarrheal disorder  

IM16.1

Topic: Diarrheal disorder  

Subtopic : Describe and discuss the aetiology of acute and chronic diarrhea including infectious and non infectious causes

IM16.2

Topic: Diarrheal disorder  

Subtopic : Describe and discuss the acute systemic consequences of diarrhea including its impact on fluid balance

IM16.3

Topic: Diarrheal disorder  

Subtopic : Describe and discuss the chronic effects of diarrhea including malabsorption

IM16.4

Topic: Diarrheal disorder  

Subtopic : Elicit and document and present an appropriate history that includes the natural history, dietary history, travel , sexual history and other concomitant illnesse

IM16.5

Topic: Diarrheal disorder  

Subtopic :Perform, document and demonstrate a physical examination based on the history that includes general examination, including an appropriate abdominal examination

IM16.6

Topic: Diarrheal disorder  

Subtopic :Distinguish between diarrhea and dysentery based on clinical features

IM16.7

Topic: Diarrheal disorder  

Subtopic : Generate a differential diagnosis based on the presenting symptoms and clinical features and prioritise based on the most likely diagnosis

IM16.8

Topic: Diarrheal disorder  

Subtopic : Choose and interpret diagnostic tests based on the clinical diagnosis including complete blood count, and stool examination

IM16.9

Topic: Diarrheal disorder  

Subtopic :Identify common parasitic causes of diarrhea under the microscope in a stool specimen

IM16.10

Topic: Diarrheal disorder  

Subtopic : Identify vibrio cholera in a hanging drop specimen

IM16.11

Topic: Diarrheal disorder  

Subtopic :Enumerate the indications for stool cultures and blood cultures in patients with acute diarrhea

IM16.12

Topic: Diarrheal disorder  

Subtopic :Enumerate and discuss the indications for further investigations  including antibodies, colonoscopy, diagnostic imaging and biopsy in the diagnosis of chronic diarrhea

IM16.13

Topic: Diarrheal disorder  

Subtopic :Describe and enumerate the indications, pharmacology and side effects of pharmacotherapy for parasitic causes of diarrhea

IM16.14

Topic: Diarrheal disorder  

Subtopic :Describe and enumerate the indications, pharmacology and side effects of pharmacotherapy for bacterial and viral diarrhea

IM16.15

Topic: Diarrheal disorder  

Subtopic  : Distinguish based on the clinical presentation Crohn’s disease from Ulcerative Colitis

IM16.16

Topic: Diarrheal disorder  

Subtopic : Describe and enumerate the indications, pharmacology and side effects of pharmacotherapy including immunotherapy

IM16.17

Topic: Diarrheal disorder  

Subtopic :Describe and enumerate the indications for surgery in inflammatory bowel disease

IM17.1

TOPIC- HEADACHE

Define and classify headache and describe the presenting features,  precipitating factors, aggravating and relieving factors of various kinds of headache

IM17.2

TOPIC- HEADACHE

SUBTOPIC  - Elicit and document and present an appropriate history including  aura, precipitating aggravating and relieving factors, associated symptoms that help identify the cause of headaches 

IM17.3

TOPIC- HEADACHE

SUBTOPIC -  Classify migraine and describe the distinguishing features between  classical and non classical forms of migraine

IM17.4

TOPIC- HEADACHE

SUBTOPIC  - Perform and demonstrate a general neurologic examination and a  focused examination for signs of intracranial tension including neck  signs of meningitis

IM17.5

TOPIC-HEADACHE

SUBTOPIC-Generate document and present a differential diagnosis based on  the clinical features and prioritise the diagnosis based on the presentation.

IM17.6

TOPIC- HEADACHE

SUBTOPIC -Choose and interpret diagnostic testing based on the clinical  diagnosis including imaging

 IM17.7

TOPIC- HEADACHE

SUBTOPIC-Enumerate the indications and describe the findings in the CSF in 

Patients with meningitis

 IM17.8

TOPIC- HEADACHE

SUBTOPIC-Demonstrate in a mannequin or equivalent the

Correct technique for performing a lumbar puncture

IM17.9

TOPIC- HEADACHE

SUBTOPIC – Interpret the CSF findings when presented with various parameters  of CSF fluid analysis

IM17.10 

TOPIC-HEADACHE

SUBTOPIC -  Enumerate the indications for emergency care admission and  immediate supportive care in patients with headache

IM17.11

TOPIC- HEADACHE

SUBTOPIC-Describe the indications, pharmacology, dose, side effects of  abortive therapy in migraine

IM17.12 

TOPIC- HEADACHE

SUBTOPIC- Describe the indications, pharmacology, dose, side effects of  prophylactic therapy in migraine

IM17.13 

TOPIC- HEADACHE

SUBTOPIC – Describe the pharmacology, dose, adverse reactions and regimens  of drugs used in the treatment of bacterial, tubercular and viral meningitis.

IM17.14

TOPIC- HEADACHE

SUBTOPIC-Counsel patients with migraine and tension headache on lifestyle  changes and need for prophylactic therapy

Topic: Cerebrovascular accident

IM18.1 Describe the functional and the vascular

anatomy of the brain

Topic: Movement disorders

IM19.1 Describe the functional anatomy of the locomotor system of the 

brain

Topic: Envenomation

IM20.1 Enumerate the local poisonous snakes 

and describe the distinguishing marks of each

IM21.1

Topic: Poisoning

Subtopic : Describe the initial approach to the stabilisation of the patient who presents with poisoning. 

IM21.2

Topic: Poisoning

Subtopic :Enumerate the common plant poisons seen in your area and describe their toxicology, clinical features, prognosis and specific approach to detoxification 

IM21.3

Topic: Poisoning

Subtopic : Enumerate the common corrosives used in your area and describe their toxicology, clinical features, prognosis and approach to therapy

IM21.4

Topic: Poisoning

Subtopic : Enumerate the commonly observed drug overdose in your area and describe their toxicology, clinical features, prognosis and approach to therapy

IM21.5

Topic: Poisoning

Subtopic : Observe and describe the functions and role of a poison center in suspected poisoning

IM21.6

Topic: Poisoning

Subtopic : Describe the medico legal aspects of suspected suicidal or homicidal poisoning and demonstrate the correct procedure to write a medico legal report on a suspected poisoning

IM21.7

Topic: Poisoning

Subtopic : Counsel family members of a patient with suspected poisoning about the clinical and medico legal aspects with empathy

IM21.8

Topic: Poisoning

Subtopic : Enumerate the indications for psychiatric consultation and describe the precautions to be taken in a patient with suspected suicidal ideation / gesture

IM22 Mineral, Fluid Electrolyte and Acid base Disorder   

IM22.1

Topic: Mineral, Fluid Electrolyte and Acid base Disorder   

Subtopic : Enumerate the causes of hypercalcemia and distinguish the features of PTH vs non PTH mediated hl

IM22.2

Topic: Mineral, Fluid Electrolyte and Acid base Disorder

Subtopic  : Describe the aetiology, clinical manifestations, diagnosis and clinical approach to primary hyperparathyroidism

IM22.3

Topic: Mineral, Fluid Electrolyte and Acid base Disorder

Subtopic :Describe the approach to the management of hypercalcemia

IM22.4

Topic: Mineral, Fluid Electrolyte and Acid base Disorder

Subtopic : Enumerate the components and describe the genetic basis of the multiple endocrine neoplasia syndrome

IM22.5

Topic: Mineral, Fluid Electrolyte and Acid base Disorder

Subtopic :Enumerate the causes and describe the clinical features and the correct approach to the diagnosis and management of the patient with hyponatremia

IM22.6

Topic: Mineral, Fluid Electrolyte and Acid base Disorder

Subtopic :Enumerate the causes and describe the clinical and laboratory features and the correct approach to the diagnosis and management of the patient with hyponatremia

IM22.7

Topic: Mineral, Fluid Electrolyte and Acid base Disorder

Subtopic : Enumerate the causes and describe the clinical and laboratory features and the correct approach to the diagnosis and management of the patient with hypokalemia

IM22.8

Topic: Mineral, Fluid Electrolyte and Acid base Disorder

Subtopic :Enumerate the causes and describe the clinical and laboratory features and the correct approach to the diagnosis and management of the patient with hyperkalemia

IM22.9

Topic: Mineral, Fluid Electrolyte and Acid base Disorder

Subtopic : Enumerate the causes and describe the clinical and laboratory features of metabolic acidosis

IM22.10

Topic: Mineral, Fluid Electrolyte and Acid base Disorder

Subtopic :Enumerate the causes of describe the clinical and laboratory features of metabolic alkalosis

IM22.11

Topic: Mineral, Fluid Electrolyte and Acid base Disorder

Subtopic : Enumerate the causes and describe the clinical and laboratory features of respiratory acidosis

IM22.12

Topic: Mineral, Fluid Electrolyte and Acid base Disorder

Subtopic : Enumerate the causes and describe the clinical and laboratory features of respiratory alkalosis

IM22.13

Topic: Mineral, Fluid Electrolyte and Acid base Disorder

Subtopic : Identify the underlying acid based disorder based on an ABG report and clinical situation

TOPIC 23 – NUTRITION AND VITAMINE DEFICIENCIES 

IM23.1

Topic : Nutrition and vitamin deficiencies Subtopic :Discuss and describe the methods of nutritional assessment in an adult and calculation of caloric requirements during illnesses .

IM23.2 

Topic :Nutrition and Vitamin deficiencies 

Subtopic :Discuss and describe the causes and consequences of protein caloric malnutrition in the hospital KK  

IM23.3

Topic : Nutrition and Vitamin deficiencies Subtopic : Discuss and describe the aetiology, causes, clinical manifestations, complications, diagnosis and management of common vitamin deficiencies .

 IM23.4

Topic : Nutrition and Vitamin deficiencies Subtopic :Enumerate the indications for enteral and parenteral nutrition in critically ill patients 

IM23.5

Topic : Nutrition and Vitamin deficiencies

Subtopic :Counsel and communicate to patients in a simulated environment with illness on an appropriate balanced diet.

Topic: Geriatrics

IM24.1 Describe and discuss the epidemiology, pathogenesis, clinical evolution, presentation and course of common diseases in the elderly

25.1 Topic: Miscellaneous Infections :

immune status, risk factors and comorbidities on zoonotic diseases (e.g. Leptospirosis, Rabies) and non-febrile infectious disease (e.g. Tetanus)

26.1 Topic: The role of the physician in the community

IM26.2 Describe and discuss the commitment to lifelong learning as an important part of physician growth IM26.3 Describe and discuss the role of non maleficence as a guiding principle in patient care IM26.4 Describe and discuss the role of autonomy and shared responsibility as a guiding principle in patient care IM26.5 Describe and discuss the role of beneficence of a guiding principle in patient care IM26.6 Describe and discuss the role of a physician in health care system

IM26.7 Describe and discuss the role of justice as a guiding principle in patient care IM26.8 Identify discuss medicolegal, socioeconomic and ethical issues as it pertains to organ donation IM26.9 Identify, discuss and defend medicolegal, sociocultural, economic and ethical issues as it pertains to rights, equity and justice in access to health care IM26.10 Identify, discuss and defend medicolegal, socio-cultural and ethical issues as it pertains to confidentiality in patient care

IM26.49 Administer informed consent and approriately adress patient queries to a patient

Current state of Case Report PaJR poem (2 States)

Stole this from a song linked at the bottom. Majority of our current case reports here: https://medicinedepartment.blogspot.com/2022/02/?m=0

can be described in the lines below : 

Adhoori adhoori adhoori kahaani, 

Incomplete, incomplete! Oh the case report story is incomplete! 

adhoora alvida

(the discharge summary is incomplete) 

Yunhi yunhi raina jaaye adhoore sadaa

Let's hope it doesn't stay incomplete forever! 

Gal sun le raaz ki

Listen to this secret 

Jism ye kya hai, khokhli seepi

The body is just an empty snail's chassis 

Rooh da moti hai tu

While you are the shining star of the soul

Garaz ho jitni teri

Your user requirements 

Badle mein jindadi meri

Drive my soul 

Mere saare bikhre suron se geet piroti hai tu

With all my scattered music 

You make your body sing again! 

To listen to the entire song click here: https://youtu.be/h-zueoz5yF0

Medicine CUBE -- Nail growth conversational learning in the CBBLE PaJR group

Medicine CUBE is a positive cross connection toward a broader collaboration. 

Glossary :

CUBE : Collaboratively Understanding Biology Education .More here : https://www.hbcse.tifr.res.in/research-development/collaboratively-understanding-biology-education-cube

Conversational learning : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4117104/

CBBLE : https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6163835/

PaJR : https://userdrivenhealthcare.blogspot.com/2022/09/current-pajr-workflow-and-how-to-make.html?m=1

[9/18, 7:55 AM] MBBS 2019 Batch: Saw about Collasmart capsules adv. does it help for my knees?

[9/18, 7:56 AM] MBBS 2019 Batch: Question from patient

[9/18, 8:12 AM] Rakesh Biswas: Type collagen extract efficacy in osteoarthritis and share what you learn. 

However the more important question earlier asked (and still unanswered) here is : does she have arthritis at all? 

Does she have any feature of swelling, restriction of movement and deformity in any of the joints?

[9/18, 8:12 AM] MBBS 2019 Batch: No sir, she doesn't have any of those

[9/18, 8:12 AM] MBBS 2015 Batch: Doesn't she eat chicken?

[9/18, 8:13 AM] MBBS 2019 Batch: No sir, vegetarian

[9/18, 8:14 AM] Rakesh Biswas: Is the incidence of any disease higher in vegetarians (provided they don't indulge in hogging simple carbohydrates)?

[9/18, 8:15 AM] MBBS 2015 Batch: Not sure sir..

But if she's non vegetarian,there's no requirement to take anymore supplements,I feel

[9/18, 8:17 AM] Rakesh Biswas: Why put non vegetarians on a pedestal. I guess even vegetarians eating healthy also shouldn't need any supplements

[9/18, 8:18 AM] MBBS 2015 Batch: Yep agree

[9/18, 8:31 AM] MBBS 2015 Batch: @⁨MBBS 2019 Batch⁩ However if she feels she needs some collagen,try recommending her some good vegetarian sources of collagen.

Google and also share here what are good vegetarian sources of collagen

[9/18, 8:36 AM] MBBS 2019 Batch: In food, collagen is naturally found only in animal flesh like meat and fish that contain connective tissue. However, a variety of both animal and plant foods contain materials for collagen production in our own bodies.

https://www.hsph.harvard.edu/nutritionsource/collagen/

[9/18, 8:37 AM] MBBS 2019 Batch: This also says that all the collagen sources are animal based. Plant based sources only provide raw material for collagen synthesis and not collagen itself

[9/18, 8:38 AM] MBBS 2015 Batch: How are we sure that she isn't synthesizing enough collagen though?

[9/18, 8:57 AM] Rakesh Biswas: 👍Good research question

[9/18, 8:57 AM] MBBS 2019 Batch: Hair, skin and nails, sir?

[9/18, 8:58 AM] MBBS 2015 Batch: Share your findings after you examine hair,skin and nails.

And also,which type of collagen is present on hair,skin and nails.And which type is present in cartilage and bone.

(NEET PG que)

[9/18, 9:00 AM] MBBS 2019 Batch: Hair, skin, nails -type 1

Cartilage - type 2 (mixed with other types)

[9/18, 9:14 AM] Rakesh Biswas: @⁨MBBS 2019 Batch⁩ These are the learning conversations that need to be published and a correlation between the student's learning outcomes shown with the patient's health outcomes. That's the gist of the CBBLE PaJR project

[9/18, 9:14 AM] MBBS 2019 Batch: Ok sir

[9/18, 9:16 AM] Rakesh Biswas: Awaiting similar learning conversations in your neurodegenerative PaJR groups

[9/18, 9:17 AM] MBBS 2015 Batch: Which one is that group?

[9/18, 9:18 AM] Rakesh Biswas: Find out. You are there in those too

[9/18, 9:47 AM] MBBS 2019 Batch: Skin change again since 4 to 6 weeks

[9/18, 9:47 AM] MBBS 2019 Batch: Hair fall is normal and never checked nail brittleness

[9/18, 9:47 AM] MBBS 2019 Batch: But growth of nails has become slow

[9/18, 9:48 AM] Rakesh Biswas: How? What was the usual time she had earlier noted for her nail growth and what is the current time?

[9/18, 9:49 AM] MBBS 2019 Batch: Not sure of the correct time sir, but while regularly cutting nails, she noticed that they were not growing kuch

[9/18, 9:49 AM] MBBS 2019 Batch: *much

[9/18, 9:50 AM] MBBS 2015 Batch: Recall bias

[9/18, 9:51 AM] MBBS 2019 Batch: I didn't ask about nail growth sir, i asked about nail brittleness and she mentioned they growth

[9/18, 9:51 AM] Rakesh Biswas: So let's say earlier she needed to cut them in a week or 7 days and after how many days does she need to cut it now?

[9/18, 9:52 AM] Rakesh Biswas: She was more correct

[9/18, 9:52 AM] MBBS 2019 Batch: I'll ask sir

[9/18, 9:54 AM] MBBS 2019 Batch: 2 weeks or a little long

[9/18, 9:54 AM] Rakesh Biswas: And previously? 1 week?

[9/18, 9:55 AM] MBBS 2019 Batch: Yes sir

[9/18, 9:55 AM] Rakesh Biswas: Since when has she noticed this?

[9/18, 9:57 AM] MBBS 2019 Batch: Around 2 months

[9/18, 10:00 AM] MBBS 2015 Batch: 

@⁨Rakesh Biswas⁩ Is slow growing nails a serious sign?

We can do one thing to confirm if they are growing really slow.

@⁨MBBS 2019 Batch⁩ Can u ask your patient to trim nails today and share pics on day 7 and day 14 from now?

Let's compare it with our nails and also @⁨ might help us sharing picture of her patient's(another 47F) nails,today,at day 7 and at day 14

[9/18, 10:05 AM] Rakesh Biswas: Also review the literature to see if someone else has already done this experiment

[9/18, 10:05 AM] MBBS 2015 Batch: Sure sir

[9/18, 10:30 AM] MBBS 2019 Batch: Will do sir, but is it a serious concern? I think we're deviating from the question on whether she needs collagen supplements?

[9/18, 10:34 AM] MBBS 2015 Batch: She's doesn't need any collagen supplements because she doesn't have arthritis.

It is not a serious concern.However,we don't even know if her nails are really growing slow.If we confirm that her nails are growing too slow(as compared to others),we evaluate it further.

[9/18, 10:35 AM] MBBS 2015 Batch: Nail brittleness and slow growth of nails is commonly seen in water soluble vitamins,zinc deficiency.She is already on mvt supplements as you mentioned earlier.

[9/18, 10:37 AM] Rakesh Biswas: This factual statement needs to be supported by some literature

[9/18, 10:38 AM] Rakesh Biswas: We don't yet know if she has or doesn't have arthritis till we have the clinical examination findings and images

[9/18, 10:39 AM] Rakesh Biswas: Seriousness of concern is very subjective and is a variable of how the individual patient perceives seriousness and that is again perhaps dependent on his her worldview? @⁨Psychologist⁩

[9/18, 10:40 AM] Rakesh Biswas: We still need to evaluate her ourselves if there is no clinical video evidence

[9/18, 10:43 AM] Psychologist: Yes Sir, from her perspective it can be understood that she has been going through pretty tough period since march. She agrees to the fact that her physical symptoms have a direct correlation with her life situation

[9/18, 10:44 AM] Psychologist: It might be a definite possibility that as her life situation improves, her physical symptoms too would subside

[9/18, 3:17 PM] Rakesh Biswas: Check out the CUBE STEM discussion on nail growth here : https://metastudio.org/t/s4e78-cube-chatshaala-analysis-of-nail-data/11940 

Will also archive ours as "Medicine CUBE conversational learning session on "nail growth."

Two cases for the Monday clinico diagnostic meet

Presenter : Dr Sai Charan PGY2 Medicine 

Discussant : Dr Aditya Samitinjay SR Medicine 

Case 1:

OBG request referral : We have a long distance current inpatient, 33F with chronic pelvic pain since last three years. She had a tubal ligation five years ago. 

Would it be possible to review her for a diagnostic Laparoscopy for endometriosis or PID? 

More details of the patient in her deidentified case report here 👇

https://113riyagupta.blogspot.com/2022/09/case-of-29-years-old-female-with.html?m=1

Case 2:

Dermatology and Pathology  request referral :

We have a 51M inpatient of left foot drop due to left peroneal mononeuropathy and a perforating plantar ulcer who has been biopsied in the earlobes as well as planter skin. 

More details about the patient here :

https://113riyagupta.blogspot.com/2022/09/case-of-51-years-old-man-with-loss-of.html?m=1

Will be looking forward to the presentation also from the dermatologists and pathologists tomorrow. 

Image source : Laparoscopy Wikipedia 

Medicine department current stance on LORs

Introduction :

LORs are frequently necessary for residency applications globally and it's important for the LOR seeker and LOR giver to do justice to this process. 

The problem statement below in  

Conversational learning transcripts :

[6/3, 9:09 AM] LOR Seeker: Hi sir 

Good morning

[6/3, 9:10 AM] LOR Seeker: 

Hope you are doing good 

Myself ... 

I am from 2Kxy batch.

I did my internship under you.

I was with xyz mam, abc sir..PGs 

[6/3, 9:12 AM] LOR Seeker: I gave my step exams and currently working as a research fellow currently at ...US 

I need your support for the residency application. 

I am so sry I am very informal texting you.

I am currently in US,so couldn't meet you in person to request you an LOR.

[6/3, 9:13 AM] LOR Seeker: Could you please send me your email address so that I can send my eras portal request to upload an LOR.

Thank you.

Hope you consider my request. 

Sincerely, 

[6/3, 9:14 AM] Medicine Department: 

Can you share some links to your work to let me assess you for the LOR?

[6/3, 9:17 AM] LOR Seeker: Sir,I will send few cases which I worked on and presented.

The mortality and morbidity meets which I attended.

Amma Nana ashram visits.

But in that year,we didn't create an online portal for our patients which was started 2 years later...

[6/3, 9:19 AM] Medicine Department : Currently we are providing LORs only to our students who are working with us in our current projects here 👇

http://medicinedepartment.blogspot.com/2022/06/linking-students-to-our-departmental.html?m=0

[6/3, 9:27 AM] LOR Seeker: Ok sir 

Thank you ...

I will try uploading my cases if I can.

[6/3, 9:31 AM] Medicine Department : 

No we may have a better project role for you. 

Can you share the deficiencies in the current case reports posted by the current batches listed here 👇

https://medicinedepartment.blogspot.com/2022/02/?m=0

We can add you to our current 2017 case discussion group for the same

[6/3, 9:33 AM] LOR Seeker: Yes sir

Sure will do

[6/3, 9:42 AM] LOR Seeker: It was so good and helpful.

I could have asked you and joined the group long back..

I have my deadline to upload my LOR in 10 days.

Still,I will do my best and be in touch base with my juniors and provide my input.

[6/3, 9:43 AM] Medicine Department : Better get that LOR from the college Principal office as per protocol

[9/3, 9:45 AM] LOR Seeker: Most of the program's are asking from the chair of Internal Medicine sir.

I have submitted my MSPE from principal sir.

I worked under you during my internship.So,thought I would take from you

[6/3, 9:47 AM] Medicine Department : 

Should have thought about it earlier. We don't do 10 days.  10 months is the least we can do although most of our LOR students are 5 years

[6/3, 9:49 AM] LOR Seeker: Yes sir .I even regret that.

I didn't knew that,my friends last year have taken like that.

So I am not sure of the process.

I am really sorry for that.

Thank you for adding me to the group.

[6/3, 9:51 AM] Medicine Department : 

Many of your friends didn't get our LOR as they couldn't live up to these requirements we set for them

Previous stance on LORs from Medicine department :

http://medicinedepartment.blogspot.com/2021/07/evidence-based-letter-of-recommendation.html?m=1

Probable solution 

In conversational learning transcripts :

[6/5, 8:11 AM] LOR Seeker: Sir 

U will definitely remember me.

We saw bud-charie syndrome(icu 1st bed)young female 

PSVT

Acute necrotising fascitis

In mortality meet we presented Pulmonary embolism and hypokalemia cases 

Old male with back pain-later turned out to be spinal Mets (we referred him to cancer centre)

Dengue 

Sydenham chorea 

Malaria

HIV-i have been to lab to check stool for cyclospora,isospora,.(ART was given)

Stroke cases.

Hyponatremia.

I even worked for ashram cases.

[6/5, 8:15 AM] Medicine department : Alright write up all your experiences with our unit in your blog and that will be good evidence for us to provide the LOR.

[6/5, 8:32 AM] Medicine department

: In your write talk more in detail about the patients you saw and the problems they had and the way our unit tackled their problems

[6/5, 8:35 AM] LOR Seeker: Ok sir 

Sure will do that 👍

Thank you so much.

[6/12, 7:03 AM] LOR Seeker: Sir ,this was my experience with the patients.

I wrote it .

[6/12, 7:05 AM] LOR Seeker: Should I post it like a blog how my juniors are doing the case presentations?

[6/12, 7:07 AM] Medicine department

: Yes. That would be considered an open access publication submitted for post publication peer review 👍

[6/12, 7:56 AM] Medicine department

: Also we would need yours and everyone of the past and current batch students permission for this "LOR driven reflective learning" project and will be subjecting your current reflective-narrative publication to a global post publication peer review (as in with the other 1000 students in our dashboard) in which case would you like to remove the identifiers in your write up and also realistically point out the shortcomings in your internship instead of just painting a pretty picture as you have done currently as that would immediately be labeled skewed if not totally unrealistic

[6/12, 8:06 AM] Medicine department

: Let me share another interns write up to give you a better idea

[6/12, 8:09 AM] Medicine department

: Yours is a generalized incident narrative while this one here https://chandanavishwanatham19.blogspot.com/2022/05/a-day-in-life-of-medicine-pg.html?m=1 is a particular incident narrative by one of our current interns/residents (I guess you know that in US their interns are PGY1s)

[6/12, 10:11 AM] LOR Seeker: http://yyyy1234567.blogspot.com/2022/09/transitioning-from-text-book-approach_11.html

[6/12, 10:13 AM] LOR Seeker: I have changed the URL also sir

[6/12, 9:04 PM] Rakesh Biswas: Thanks. I shall get this peer reviewed and let's see if we can have a suitable LOR for you, going by your self testimony in this blogged write up.

2021 MD batch Formative assessment

 

DEPARTMENT OF GENERAL MEDICINE

This is a blended, formative assessment of the learning competencies of PG 2021, MD batch in the department of Medicine. The formative assessment is from each PG's logged competency around patients evaluated regularly from date of joining till date.

The formative assessment has been divided into non-verbal which assesses their competency in procedural domains including empathic communication and body language and verbal which assesses their ability to communicate their work through their day to day E logs.

PG  (2021 Batch)
1	Dr. K. Prem Sai Pavan Kumar	Formative Assessment from May 2022 to Aug 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://kpremsaipavankumar96.blogspot.com/?m=1	51
2	Dr. Deepika Raga	Formative Assessment from May 2022 to Aug 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://deepikaraga97.blogspot.com/?m=1	50
3	Dr. Kranthi	Formative Assessment from May 2022 to Aug 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: http://drkranthimenmula.blogspot.com	52
4	Dr. Narsimha Reddy	Formative Assessment from May 2022  to Aug 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://drbnr.blogspot.com/?m=1	51
5	Dr. Nishitha Alla	Formative Assessment from May 2022 to August 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://nishithaalla95.blogspot.com/?m=1	51
6	Dr. Haripriya	Formative Assessment from  May 2022 to August 2022 Subjective Non Verbal:  https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://jharipriya.blogspot.com/?m=1	51
7	Dr. Venkat Sai	Formative Assessment from May 2022 to August 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://venkatsaitodupunoori.blogspot.com/?m=1	51
8	Dr. Bharath Kumar	Formative Assessment from May 2022 to August 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://drbharath79.blogspot.com/?m=1	52
9	Dr. Pavani	Formative Assessment from May 2022 to Aug 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://pavani2021.blogspot.com/?m=1	50
10	Dr. Keerthi	Formative Assessment from May 2022 to Aug 2022 Subjective Non Verbal: https://youtube.com/playlist?list=PLvYjjuT_hEEQDtlHSAvFdRpCb5EBszwgR Objective Verbal: https://drkeerthimadireddy.blogspot.com/?m=1	50

 

Plasma exchange as an intervention toward longevity: a journal club in our global CBBLE

Conversational learning transcripts below that reflects the online journal club interactions and selective sampling and critical appraisal of the journal published study content and the camaraderie:

[8/27, 1:19 AM] Sumit Global CBBLE: 

https://twitter.com/davidasinclair/status/1562830261171421185?t=8zzZZcYjD4ejZ3qUIgy0TQ&s=19

Context: David is one of the pioneers of longevity research.

[8/27, 5:53 AM] Rakesh Biswas: Any links to the real paper for a proper appraisal in the PICO format?

[8/27, 10:15 PM] Sumit Global CBBLE: It's in the tweet (the link at the end)

[8/27, 10:19 PM] Rakesh Biswas: Can someone appraise it in the PICO format? @⁨Aashita KIMS PG⁩

[8/27, 10:26 PM] Aashita KIMS SR : 

Sure sir

I’ll go through it

[8/27, 11:56 PM] Aashita KIMS SR: 

Quoting, 

To investigate the effect of TPE, we examined blood samples before and after rounds of this clinical procedure

P - 15 samples were included 

I - Samples 1, 2, 4, 6, 7, and 8 were from old individuals 

C - Samples 3 and 5 were from middle-aged people

( I’m assuming the remaining samples belong to the younger age group but they haven’t  clearly mentioned their sample numbers)

[8/27, 11:56 PM] Aashita KIMS SR: 

Quoting, 

Changes in 8-OHdG levels after TPE.Oxidative DNA damage gradually decreases and becomes statistically lower by the last round, in all patients.

[8/27, 11:56 PM] Aashita KIMS PG: R0 is before TPE, R1 is 1 month afterwards and before the next round of TPE, and so on.

[8/27, 11:56 PM] Aashita KIMS PG: 

Quoting, 

C. TPE decreases p16 levels in PBMCs of old and middle-aged people, 

D. TPE upregulates the markers of lymphoid genes (T cells, B cells, NK cells) in old PBMCs. E The lymphoid:myeloid ratio is increased by the rounds of TPE. The myeloid:NK ratio is downregulated by TPE. The ratios of lymphoid:CD68 and NK:CD68 are elevated by the rounds of TPE. 

These data show a rejuvenation of the lymphoid/myeloid balance, suggesting an improved capacity for productive immune responses

[8/27, 11:56 PM] Aashita KIMS SR: 

Quoting 

Out of 507 proteins, 72 proteins were significantly different in their levels between the old and the young groups (> 1.75 fold change, p < 0.05). These 72 proteins were analyzed further in the longitudinal TPE datasets by heat mapping, which revealed a gradual rejuvenation of the age-specific systemic proteome by subsequent rounds of TPE. Principal component analysis confirmed that each R0 proteome (before the first TPE) was closer to the old control group than to the young control group and shifted from the old toward the young group with the rounds of TPE

[8/27, 11:56 PM] Aashita KIMS SR : 

Quoting, 

We also determined whether repetitive TPE may regulate the complement system including C3 and C1q, which play a key role in immune responses and also participate in non-immune crosstalks of cell–cell signaling pathways

[8/27, 11:56 PM] Aashita KIMS PG: In our analysis, 13 proteins were related to the negative regulation of apoptosis and the levels of these proteins were higher in the old group than in the young. Consistent with better tissue homeostasis, the levels of these apoptotic inhibitors diminished over rounds of TPE, becoming closer to the young cohort

[8/27, 11:56 PM] Aashita KIMS SR: 

Quoting, 

Considering these observations, we decided to analyze systemic levels of TDP43, which is the trigger of several neurological pathologies and becomes increased in the blood of patients with ALS, Parkinson’s disease (PD), frontotemporal dementia (FTD), and AD

[8/27, 11:56 PM] Aashita KIMS SR: 

Circulating TDP43 levels are higher in old than in young individuals

[8/27, 11:56 PM] Aashita KIMS SR: 

Summary: (Quoting) 

Among 15 samples post TPE the oxidative dna damage reduces by each round of TPE.  TPE also increased the lymphoma myeloid balance basically improving the immune responses. It also regulates complement C3 and C1q.  Circulating TDP43 were found to be higher in older ages but with TPE, TDP43 reduced gradually.

[8/27, 11:56 PM] Aashita KIMS SR: 

Quoting, 

The effect of repetitive TPE on aged blood. Aged blood has the characteristics of chronic inflammation (inflammaging), increased PBMC DNA damage and senescence, and immune deregulation, all changes that promote the high risk of diseases. TPE resets the systemic milieu to a younger state by rapidly and significantly diluting the age-elevated inhibitors of the canonical signaling pathways that regulate tissue maintenance and repair.

[8/28, 8:10 AM] Rakesh Biswas: Thanks. Also please share the direct link to the paper

[8/28, 8:19 AM] Rakesh Biswas: Thanks 

So to critically appraise this @⁨Sumit Global CBBLE⁩ , David Sinclair has currently just begun to show scientists looking at certain chemical changes demonstrable on Therapeutic plasma exchange (TPE) as reflected in his obtained outcomes that simply mention the chemical changes as a result of TPE but don't tell us what actually happened in terms of longevity in the participants who received TPE. 

That may require a follow up of the same or more cohorts and one would also need to figure out the optimal frequency of TPE necessary to maintain the levels of the currently assumed healthy chemical balance. 

In essence this was a phase 2 study that shows promise but there's a long way ahead

[8/28, 8:24 AM] Sumit Global CBBLE: Interesting, thanks.

Regarding you question, as I've previously stated: DNA damage is directly linked to DNA methylation clock which is a standard ageing biomarker by now (until something cheaper and more reliable comes along).

So I guess we can say that TPE promises longevity (if this study replicates well in more trials)?

I agree regarding your points on the optimal frequency exploration.

[8/28, 8:26 AM] Sumit Global CBBLE: 

And thanks for the detailed PICO analysis @⁨Aashita KIMS PG⁩

[8/28, 8:27 AM] Sumit Global CBBLE: Thanks for simplifying the appraisal! 🙏

[8/28, 8:30 AM] Rakesh Biswas: Yes it's promising but too early to draw conclusions. 

Standard biomarkers are never standalone and have only been provided assumed causal associations in relation to more palpable clinical determinants such as morbidity, mortality, longevity and we would need to look again critically at those papers that have drawn causal association between oxidative DNA and patient outcomes

[8/28, 8:32 AM] Rakesh Biswas: Thanks for sharing the paper and this journal club, which I shall be archiving.

Please tell our audience here a little bit about yourself. 🙂

[8/28, 8:37 AM] Sumit Global CBBLE: True, promising but not 100% confirmation.

Here's the catch-22 with aging - good trials would need to run for 200 years (or atleast 150 if parallelized) to be perfectly sure of the outcomes given that the trials would need to run atleast twice the lifespan (repeating promising studies, or starting more studies in parallel that promise improvement in biomarkers to run them in their full length).

So I guess, in our lifetimes we would need to rely on best biomarkers available that improve the well being of the species in a noticeable way.

Are there other ways to be sure?

About me in the next text ➡️

[8/28, 8:40 AM] Rakesh Biswas: Got the link to the original here https://link.springer.com/article/10.1007/s11357-022-00645-w but also enjoyed the many comments in the twitter feed

[8/28, 8:52 AM] Sumit Global CBBLE: Sinclair's YouTube podcast is great!

[8/28, 8:54 AM] Rakesh Biswas: Please share that link too

[8/28, 8:55 AM] Sumit Global CBBLE: https://youtube.com/c/DavidSinclairPodcast

[8/28, 8:56 AM] Rakesh Biswas: Please share a link to your online learning portfolio. It could be a LinkedIn profile or anything. @⁨Aashita KIMS PG⁩ 's online learning portfolio is here👉https://ashiness3.blogspot.com/?m=1

[8/28, 9:01 AM] Sumit Global CBBLE: https://youtube.com/channel/UCHA5edkpRK_M7nDHvg3Jp2g

I tried doing this thing where I learnt a new field from the experts - was fun. It's limited to the design field though.

[8/28, 9:09 AM] Sumit Global CBBLE: Sure sir. I'll tell the group about myself.

Hi all, I'm Sumit Srivastava, primarily a technologist with extremely diverse interests.

Every couple of years I pick a field that I know nothing about and immerse myself into it, learning from the best.

Then overtime, I gradually accumulate knowledge in that field while also picking up new fields subsequently.

This method has worked decently over the years for learning various different things.

I've started noticing that a most problems have simple and logical solutions, even though they may seem complex at the first glance. 

I picked up the field of medicine as a challenge a few years ago after working on some interesting things in brain computer interfaces.

Now I love the field of medicine so much that I've started exploring interesting (and promising) sub fields of the vast knowledge available in medicine.

As a child I knew that the my innate nature was that of curiosity - asking a lot of questions.

I've tried to not let that die (it's super hard, because questioning everything comes at the cost of speed of doing things).

Over time, you learn to question the things that matter the most.

I've learnt that the best things to question are the things that people think are either "really obvious" or things that are "mostly unexplored".

I take my inspiration from an excellent paper called you and your research by Dr. Richard W. Hamming, a pioneer in computer science.

Even though I'm not a researcher - this is one of the most groundbreaking paper an ambitious individual can read in their lifetime (it's super long): https://medium.com/motivate-the-mind/you-and-your-research-b525e6125afd

The global CBBLE is a social network currently with 156 members and can be joined through this link : https://chat.whatsapp.com/AEovRaJe7MF2dhVKDes95Z