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Antimicrobial resistance (AMR) is a serious threat to global public health. It increases morbidity and mortality, and is associated with high economic costs due to its health care burden. Infections with multidrug-resistant (MDR) bacteria also have substantial implications on clinical and economic outcomes. Moreover, increased indiscriminate use of antibiotics during the COVID-19 pandemic will heighten bacterial resistance and ultimately lead to more deaths. This review highlights AMR's scale and consequences, the importance, and implications of an antimicrobial stewardship program (ASP) to fight resistance and protect global health. Antimicrobial stewardship (AMS), an organizational or system-wide health-care strategy, is designed to promote, improve, monitor, and evaluate the rational use of antimicrobials to preserve their future effectiveness, along with the promotion and protection of public health. ASP has been very successful in promoting antimicrobials' appropriate use by implementing evidence-based interventions. The \"One Health\" approach, a holistic and multisectoral approach, is also needed to address AMR's rising threat. AMS practices, principles, and interventions are critical steps towards containing and mitigating AMR. Evidence-based policies must guide the \"One Health\" approach, vaccination protocols, health professionals' education, and the public's awareness about AMR.

The current study aimed to determine the clinical-epidemiological profile, patterns, and HIV seropositivity among STI patients attending the Suraksha Clinic by the National AIDS Control Organization in southern Rajasthan, India. This cross-sectional study was performed among 300 STI patients via a questionnaire. The proportions of STI patients with various clinical-epidemiological backgrounds were expressed as frequencies and percentages. The associations between the sex distributions of the clinical parameters of STI patients were assessed via the chi-square test. Among the 300 STI patients, nearly three-fourths (74%) were males. Only 85 (28.3%) used condoms. Nearly half of them (51%) had their first sexual contact at approximately 15–19 years of age, and more than half (52.7%) had more than one sexual partner. The most common STIs were herpes genitalis (56.8%) in males and vaginal discharge (58.9%) in females. Overall, HIV seropositivity was observed in 7.7% (95% CI: 5.2–11.2%) of patients. HIV seropositivity was more common among the bridge population (17.2%) than among the other populations (4.2%). Only one out of four STI patients used condoms. One out of two had more than one sexual partner. Almost one in ten STI patients were HIV seropositive. The bridge population were more likely to be HIV seropositive than the other populations were.

Background Various evidence-based and student-centered strategies such as team-based learning (TBL), case-based learning (CBL), and flipped classroom have been recently applied to anatomy education and have shown to improve student engagement and interaction. These strategies shift the focus of teaching from knowledge transmission to knowledge construction by students and encourage the use of tasks. This study discusses the use of an active and engaging learning strategy to teach the musculoskeletal system to Year 1 MBBS students (Faculty of Medical Sciences, The University of the West Indies, Cave Hill, Barbados) and examines the correlation between assessment modalities and student performance. Methods The “Active and Engaging Learning Strategy” was used to assess student learning in the form of oral presentations. Students had presentations on muscle attachments, muscle actions, blood and nerve supply, and applied anatomy of the limb musculature. Questions on the limbs (Locomotor System) were included in pre and post-presentation spotters, in-course assessments, and final examinations. Percentages, paired t-test, independent sample t-test, and zero-order correlations were performed to confirm the results for the different objectives of the study. Results The main modes of presentation chosen were poems (37.1%), followed by stories (21.2%), songs (11.4%), and skits (10.6%). The majority of students (84%) found the strategies beneficial and recommended such sessions for future cohorts (92%). Students achieved significantly better scores in post-presentation spotters ( p  < 0.01) and the marks of in-course and final examinations also showed significant improvement ( p  < 0.01). Conclusion Our study highlighted that the active and engaging learning strategy can be used as an effective learning tool in anatomy. Students were proactive in preparing the muscle presentations by utilizing their own creativity, curiosity, and intelligence. Further studies should be conducted using randomized controlled trials to assess the effectiveness of various learning strategies which could open a new door to medical education.

COVID-19 pandemic is inducing acute respiratory distress syndrome, multi-organ failure, and eventual death. Respiratory failure is the leading cause of mortality in the elderly population with pre-existing medical conditions. This group is particularly vulnerable to infections due to a declined immune system, comorbidities, geriatric syndrome, and potentially inappropriate polypharmacy. These conditions make the elderly population more susceptible to the harmful effects of medications and the deleterious consequences of infections, including MERS-CoV, SARS-CoV, and SARS-CoV-2. Chronic diseases among elderlies, including respiratory diseases, hypertension, diabetes, and coronary heart diseases, present a significant challenge for healthcare professionals. To comply with the clinical guidelines, the practitioner may prescribe a complex medication regimen that adds up to the burden of pre-existing treatment, potentially inducing adverse drug reactions and leading to harmful side-effects. Consequently, the geriatric population is at increased risk of falls, frailty, and dependence that enhances their susceptibility to morbidity and mortality due to SARS-CoV-2 respiratory syndrome, particularly interstitial pneumonia. The major challenge resides in the detection of infection that may present as atypical manifestations in this age group. Healthy aging can be possible with adequate preventive measures and appropriate medication regimen and follow-up. Adherence to the guidelines and recommendations of WHO, CDC, and other national/regional/international agencies can reduce the risks of SARS-CoV-2 infection. Better training programs are needed to enhance the skill of health care professionals and patient’s caregivers. This review explains the public health implications associated with polypharmacy on the geriatric population with pre-existing co-morbidities during the COVID-19 pandemic.

Studies focusing on the safety and common side effects of vaccines play a crucial role in enhancing public acceptance of vaccination. Research is scarce regarding the usage of COVID-19 vaccines and the side effects experienced by health professions students in India and other countries. This study aimed to document self-reported side effects associated with COVID-19 vaccination among medical and dental students of six medical and dental colleges and teaching hospitals in four states (Tamil Nadu, Madhya Pradesh, Gujarat, and West Bengal) of India. A cross-sectional survey using purposive sampling of medical and dental students was conducted from 26 April to 26 May 2021. Data was collected using a Google Forms questionnaire capturing information regarding receiving COVID-19 vaccines, side effects and symptoms, onset and duration of symptoms, use of treatment to alleviate symptoms, awareness of haematologic risks associated with vaccination, and side effects from previous (non-COVID-19) vaccinations. The majority (94.5%) of participants received both doses of the Covishield/AstraZeneca COVID-19 vaccine. Among participants ( n  = 492), 45.3% ( n  = 223) reported one or more side effects. The most frequently reported side effects were soreness of the injected arm (80.3%), tiredness (78.5%), fever (71.3%), headache (64.1%), and hypersomnia (58.7%). The two most common severe symptoms were fever (14.8%) and headache (13%). Most side effects appeared on the day of vaccination: soreness of the injection site (57%), fever (43.1%), and tiredness (42.6%). Most reported symptoms persisted for one to three days–soreness of the injection site (53%), fever (47.1%), and headache (42.6%). Logistic regression showed that women were almost 85% less likely to report side effects. The study’s findings corroborate the safety of the Covishield/AstraZeneca vaccine’s first dose, evidenced by the relatively minor and transient nature of the side effects. However, the study underscores the necessity for ongoing research to assess the long-term impacts of COVID-19 vaccines, especially in the context of booster doses, thereby contributing to the global understanding of vaccine safety and efficacy.

Background Ensuring objectivity and maintaining reliability are necessary in order to consider any form of assessment valid. Evaluation of students in Problem-Based Learning (PBL) tutorials by the tutors has drawn the attention of critiques citing many challenges and limitations. The aim of this study was to determine the extent of tutor variability in assessing the PBL process in the Faculty of Medical Sciences, The University of the West Indies, St Augustine Campus, Trinidad and Tobago. Method All 181 students of year 3 MBBS were assigned randomly to 14 PBL groups. Out of 18 tutors, 12 had an opportunity to assess three groups: one assessed 2 groups and 4 tutors assessed one group each; at the end each group had been assessed three times by different tutors. The tutors used a PBL assessment rating scale of 12 different criteria on a six-point scale to assess each PBL Group. To test the stated hypotheses, independent t-test, one-way ANOVA followed by post-hoc Bonferroni test, Intra Class Correlation, and Pearson product moment correlations were performed. Result The analysis revealed significant differences between the highest- and lowest-rated groups (t-ratio = 12.64; p  < 0.05) and between the most lenient and most stringent raters (t-ratio = 27.96; p  < 0.05). ANOVA and post-hoc analysis for highest and lowest rated groups revealed that lenient- and stringent-raters significantly contribute ( p  < 0.01) in diluting the score in their respective category. The intra class correlations (ICC) among rating of different tutors for different groups showed low agreement among various ratings except three groups (Groups 6, 8 and 13) ( r  = 0.40). The correlation between tutors’ PBL experiences and their mean ratings was found to be moderately significant ( r  = 0.52; p  > 0.05). Conclusion Leniency and stringency factors amongst raters affect objectivity and reliability to a great extent as is evident from the present study. Thus, more rigorous training in the areas of principles of assessment for the tutors are recommended. Moreover, putting that knowledge into practice to overcome the leniency and stringency factors is essential.

Introduction There is a need to assess and strengthen reproductive rights-based family planning and abortion services in Indian medical schools that play a key role in medical education and service delivery. This study presents the findings of baseline assessment across nine schools in two states and one union territory with objective to assess, identify the gaps and improve the status of reproductive rights and evidence-based family planning and abortion services in Indian medical schools. Methods A convergent parallel mixed methods study was conducted in nine medical schools in Rajasthan, Gujarat, and Chandigarh a Union territory in India from October 2018 to June 2019. In-depth interviews with 33 faculty from the Department of Obstetrics and Gynaecology were conducted. The COM-B (Capability, Opportunity, and Motivation) model of behaviours was used to qualitatively identify barriers and facilitators of reproductive rights-based family planning and abortion services. Reproductive health services provided to 104 women for family planning and abortion were observed quantitatively using a pre-tested checklist. Findings Providers’ preference bias in recommending contraceptive methods to specific clients (wherein sterilisation was offered to women with two or more children and IUCD to women with one child) was observed as barrier to reproductive rights. The facilitators of rights based reproductive services included well-informed faculty regarding providing dignified and respectful care. Barriers included infrastructure gaps, high workload, insufficient human resources affecting privacy, and lower awareness and decision-making power of clients. Family planning counselling using the cafeteria approach was offered in 69.4% of cases, 31.6% of women seeking abortion services were offered counselling on both family planning and abortion. Sterilisation or IUD insertion was a pre-condition in 36.8% of women requesting an abortion. Conclusions Right-based reproductive services around family planning counselling and abortion services were delivered partially despite the medical schools’ trained faculty, mainly due to provider bias, high workload, and less autonomy and lower awareness of reproductive rights among women.

Efficacy and safety are fundamental for the development of successful COVID-19 vaccines. Vaccine-associated side effects influence vaccine hesitancy. This study investigated the prevalence, severity, and onset of side effects following the first dose of COVID-19 vaccines among physicians and dentists working in various healthcare settings across India. A cross-sectional survey collected self-report data from April to June 2021 on side effects following the first dose of the vaccine. An online validated questionnaire using the Google Docs platform was circulated via email and social media platforms. More than 40% of participants experienced at least one side effect after the first dose of vaccination; the most common were mild and resolved within three days after vaccination. More than 91% of respondents received the Covishield (AstraZeneca) vaccine; the most prevalent adverse effects were soreness of the injected arm (78.9%), tiredness (71.1%), and fever (54.9%). Logistic regression showed that women were almost 60% less likely to report side effects. Findings supported the safety of the first dose of the COVID-19 vaccine based on relatively few self-limiting side effects, mainly soreness of the injected arm and tiredness. Further research is needed to determine the long-term safety of COVID-19 vaccines, especially after booster doses.

Technology-enhanced learning includes the adaptive e-learning platform, a data-driven method with computer algorithms, providing customised learning enhancing critical thinking of individual learners. \"Firecracker\" - an online adaptive e-learning platform, and assessment software, promotes critical thinking, helps prepare students for courses and high-stakes examinations, and evaluates progress relative to co-learners. The objectives of this study were to determine the usage rates of Firecracker, examine the performance of Firecracker formative quizzes, identify the correlation between Firecracker use and performance with that of performance at summative course assessments, and assess students' satisfaction with Firecracker usage. Study participants were Year-2 MBBS (Bachelor of Medicine, Bachelor of Surgery) students (n=91) of the Faculty of Medical Sciences, The University of the West Indies, Cave Hill Campus, Barbados. The Firecracker Administrator uploaded quizzes covering basic science content in the Cardiovascular System course. Access, usage, and performance on Firecracker formative quizzes were retrieved from the Firecracker dashboard. A questionnaire sought the views of study participants. Seven sets of quizzes were administered over nine weeks, with weekly student completion rates ranging from 53% to 73%. Mean quiz scores ranged from 52% to 72%. Students completing >4 quiz sessions compared to those completing ≤4 demonstrated significantly better performance in Firecracker quizzes ( <0.01), final examinations ( <0.01) and in-course assessment plus final examination ( <0.05) scores. Correlations between overall Firecracker performance and in-course assessment marks ( <0.05); between total overall Firecracker performance and final examination ( <0.01); and overall Firecracker performance and total course marks ( <0.01) were all significant. Most students (70%) were happy using Firecracker and felt it complemented coursework (78%) and prepared them for course exams (58%) ( <0.01). Overall, Firecracker was perceived very positively and welcomed by the students. Students were satisfied with the Firecracker as a formative assessment tool, and its use correlated with improved performance in the course examinations.

Background: Biomedical research and publications provide evidence-based information about the extent and burden of health-related problems of a country and help to formulate strategic and operational plans to tackle the problems. Purpose: To determine the biomedical publication rates of CARICOM full member countries. Methods: Biomedical publications of full member CARICOM countries were retrieved using PubMed (1990–2015) and SCImago Journal & Country Rank (1996–2015) databases. CARICOM countries having >50 publications in the PubMed (1990–2015) database were subject to further analysis, whereby publications of each country were adjusted by total population (million population), gross domestic product (billion-dollar), and Internet usage rate (hundred thousand population). Results: Total publications by all countries were 7281 and 8378 in PubMed and SCImago Journal & Country Rank, respectively. Jamaica produced highest number of publications (PubMed: 3928 (53.9%); SCImago Journal & Country Rank: 2850 (34.0%)). In both databases, Grenada had the highest research publications when adjusted with per million population (4721 and 10,633), per billion gross domestic product (803 and 1651), and per hundred thousand Internet users (1487 and 3387). Trend analysis revealed Jamaica produced the highest number of additional PubMed listed publications each year, averaging 4.8/year, followed by Trinidad and Tobago (4.4). According to SCImago Journal & Country Rank, Jamaica also had the highest number of citations (42,311) and h-index (76), followed by Trinidad and Tobago (29,152 and 71). Barbados had the highest number of citations per document (24.9), followed by Haiti (18.4). The publication rates determined by PubMed and SCImago Journal & Country Rank databases were significantly correlated (p < 0.001). Most publications (68% SCImago Journal & Country Rank and 85% PubMed) can be attributed to authors affiliated with Barbados, Jamaica, and Trinidad. Conclusion: Publication and citation rates varied markedly between CARICOM countries and were in general low. Most publications could be attributed to researchers affiliated with The University of the West Indies. More universities valuing biomedical research are needed in the region, and more resources needed to improve publication rates.