Search

Background & Objective: Oral examinations or viva is a common mode of assessment for medical students. It is not possible to cover the entire syllabus and students often feel that the “luck factor” plays a major role in deciding their performance. Efforts have been made to address these shortcomings associated with traditional viva exams, mainly by attempting to formulate a format which is both objective as well as structured. With this background, aim of the present study was to create an objective structured viva questions in cardiovascular physiology as a prototype of viva voce in physiology. Materials & Methods: The study included creation of an Objective Structured Viva Examination (OSVE) question bank in cardiovascular physiology. The first year medical (MBBS) students were randomized by use of random number table and attended all three formats of theory viva (OSVE, traditional & blended) on designated dates and time slots. Feedback was obtained from the participants using standard format and the feedback from faculty involved in the study was collected in a qualitative format at the end of the assessment. Results: There was significant difference in the mean value of marks obtained by the students in the OSVE format when compared to traditional and blended format (p < 0.05). No correlation was observed between marks scored between the three formats of viva. Student’s feedback revealed that OSVE format was well structured and easy to score marks when compared to other formats. Faculty feedback revealed that OSVE format was less time consuming as compared to the other formats. Conclusion: Since there was no correlation between performance of students in the three formats of viva, each type of viva format can be used as a separate assessment tool for the students. Further studies of this kind can help to reorganize the viva assessment and also can give a platform for innovation of newer assessment method in medical education which can be extrapolated to other streams.

Telepsychiatry, which refers to the delivery of mentalhealth services throughvideo-based conferencing, has immense potential to resolve the mental health disparities. Era of telepsychiatry came into full force during the COVID -19 pandemic in the year 2020 in India. The literature on profile of patients attending a telepsychiatry unit is limited as the official guidelines for Telemedicine was released by the government of India in March 2020. This article provides a state-of-art analysis on the profile, telehealth usability, diagnosis, drug treatments of patients attending a telepsychiatry unit in a Union Territory in south India. 1. To profile the telepsychiatry usability by using standard questionnaire. 2. To compare the telepsychiatry usage between 2020 and 2021 (during lockdown 1 & lockdown 2). A retrospective analysis of the profile of patients attending a telepsychiatry unit in south India during the consecutive years of 2020 and 2021 was made. Demographic data regarding the age, sex, marital status, occupation, location, number of online consultations made were collected. Diagnosis was made in accordance with the International Classification of diseases tenth edition. Various groups of drugs used like antidepressants, antipsychotics, mood stabilisers, benzodiazepines. Comparison of data between the two years was made. In the year 2020, 147 teleconsultations were made and in the year 2021 46 consultations were done. Among the study participants, 62% were female. In the year 2020, psychosis was found to be the reported more(34%) and in 2021, adjustment disorder was higher (35%). Among the medications, antidepressants (35%) were the commonly prescribed group followed by antipsychotics(13%). Telepsychiatry is a budding phenomenon in India and this study is the first of its kind to throw light on the profile, drug treatment of patients attending a telepsychiatry set up.

Background: A novel nanosomal paclitaxel lipid suspension (NPLS), free from Cremophor EL (CrEL) and ethanol, was developed to address the solvent-related toxicities associated with conventional paclitaxel formulation. Objective: To evaluate the efficacy and safety of NPLS versus CrEL-based paclitaxel (conventional paclitaxel) in patients with metastatic breast cancer (MBC). Design: A prospective, open-label, randomized, multiple-dose, parallel, phase II/III study. Methods: Adult (18–65 years) female patients with MBC who had previously failed at least one line of chemotherapy were randomized (2:2:1) to NPLS 175 mg/m 2 every 3 weeks (Q3W, n = 48, arm A), NPLS 80 mg/m 2 every week (QW, n = 45, arm B) without premedication or conventional paclitaxel (Taxol ® , manufactured by Bristol-Myers Squibb, Princeton, NJ, USA) 175 mg/m 2 Q3W ( n = 27, arm C) with premedication. In the extension study, an additional 54 patients were randomized (2:1) to arm A ( n = 37) or arm C ( n = 17). Results: Pooled data from the primary study and its extension phase included 174 patients. The primary endpoint was the overall response rate (ORR). As per intent-to-treat analysis, ORR was significantly better in the NPLS QW arm as compared to conventional paclitaxel [44.4% (20/45) versus 22.7% (10/44), ( p = 0.04)]. An improvement in ORR with NPLS Q3W versus conventional paclitaxel arm [29.4% (25/85) versus 22.7% (10/44)] ( p = 0.53) was observed. Disease control rates observed were improved with NPLS Q3W versus conventional paclitaxel Q3W (77.7% versus 72.7%, p = 0.66) and with NPLS QW versus conventional paclitaxel Q3W (84.4% versus 72.7%, p = 0.20), although not significant. A lower incidence of grade III/IV peripheral sensory neuropathy, vomiting, and dyspnea was reported with NPLS Q3W versus conventional paclitaxel Q3W arms. Conclusion: NPLS demonstrated an improved tumor response rate and a favorable safety profile versus conventional paclitaxel. NPLS 80 mg/m 2 QW demonstrated a significantly better response versus conventional paclitaxel 175 mg/m 2 Q3W. Trial registration: Clinical Trial Registry-India (CTRI), CTRI/2010/091/001344 Registered on: 18 October 2010 (https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MjEzNQ==&Enc=&userName=CTRI/2010/091/001344), CTRI/2015/07/006062 Registered on: 31 July 2015 (https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=MTE2Mjc=&Enc=&userName=CTRI/2015/07/006062)

Aim: To evaluate the accuracy of four intraocular lens (IOL) prediction formulae (Hoffer Q, Holladay 1, SRK/T and Barrett Universal II) in paediatric cataract. Methods: A prospective study was conducted among all children under 15 years of age, undergoing uncomplicated cataract surgery with in-the-bag IOL implantation at a tertiary care centre. Following detailed evaluation and after obtaining informed consent, the children underwent surgery and the IOL was implanted as per a modification of Wilson and Trivedi recommendation. Prediction error (PE) and absolute prediction error (APE) were computed with each of the formulae, and it was compared across the various subgroups of age (24 mm. The PE of Holladay I (rho = -0.16, P value = 0.044) and Barrett II (rho = -0.16, P value = 0.046) formula was negatively correlated with age, while no correlation was found between PEs of any formula with AL. Conclusion: Barrett II and Hoffer Q formulae appear to provide the most accurate results in the younger age groups, with shorter eyes. Further prospective studies on larger samples of younger children with longer follow-ups are required, to explore the applications of Barrett II formula in the younger age group.

Sensing and responding to environmental water deficiency and osmotic stresses are essential for the growth, development, and survival of plants. Recently, an osmolality-sensing ion channel called OSCA1 was discovered that functions in sensing hyperosmolality in Arabidopsis Here, we report the cryo-electron microscopy (cryo-EM) structure and function of an OSCA1 homolog from rice (Oryza sativa; OsOSCA1.2), leading to a model of how it could mediate hyperosmolality sensing and transport pathway gating. The structure reveals a dimer; the molecular architecture of each subunit consists of 11 transmembrane (TM) helices and a cytosolic soluble domain that has homology to RNA recognition proteins. The TM domain is structurally related to the TMEM16 family of calcium-dependent ion channels and lipid scramblases. The cytosolic soluble domain possesses a distinct structural feature in the form of extended intracellular helical arms that are parallel to the plasma membrane. These helical arms are well positioned to potentially sense lateral tension on the inner leaflet of the lipid bilayer caused by changes in turgor pressure. Computational dynamic analysis suggests how this domain couples to the TM portion of the molecule to open a transport pathway. Hydrogen/deuterium exchange mass spectrometry (HDXMS) experimentally confirms the conformational dynamics of these coupled domains. These studies provide a framework to understand the structural basis of proposed hyperosmolality sensing in a staple crop plant, extend our knowledge of the anoctamin superfamily important for plants and fungi, and provide a structural mechanism for potentially translating membrane stress to transport regulation.

Introduction Combined soft tissue and vascular injuries of the upper extremity pose several challenges at once to the plastic surgeon. Many decisions have to be taken urgently that will influence the salvage or amputation of the affected extremity. The aim of this article was to provide an evidence-based outline for the management of such injuries. Learning objectives of this article are as follows: (1) approach to a patient with upper extremity composite tissue and vascular injury presenting to the emergency, (2) decision-making as to when to salvage and when to go for amputation of the traumatized upper extremity, (3) role of imaging in emergency situation, (4) role of fasciotomy, (5) intraoperative sequencing of steps, and (6) options for vascular reconstruction and the flaps used for coverage. After reading this article, the reader should have a clear understanding of the management of vascular injury in a patient with composite defects of upper extremity.

Background: The COVID-19 pandemic is an unexpected event that has led to a drastic shift in the practice of medicine around the world. Currently, not many studies are available in India regarding the role of telepsychiatry and no study has been done to assess the usability and satisfaction scores of patients who undergo a telepsychiatric consultation. Aim: The aim of the study is to find the profile of patients attending the telepsychiatry Unit and its usability and satisfaction during the pandemic in South India. Setting and Design: The study was conducted on patients attending telepsychiatric consultation from a period of March 25, 2020, to September 2020. Materials and Methods: A retrospective chart analysis of patients attending telepsychiatry consultation from March 25, 2020, to September 2020 was made. Patients who underwent video consultation were asked to fill out the telehealth usability questionnaire scale through Google Forms. The usability of the telehealth system was assessed using a Likert Scale and scoring was done. Statistical Analysis: Descriptive statistics were used to characterize the study population. Statistical significance was set at P < 0.05. The design and findings of this study were written in accordance with SQUIRE 2.0 guidelines. Results: Twenty-two percent of the study population had consultation for more than fourtimes. Around 78% of the study population had online consultation for less than four times. More than 74% of the study population had video consultation and 26% of the study population had audio consultation. The total average Telehealth Usability Questionaire score was 5.3. The usefulness score summary was found to have a low score of 5.2 ± 0.6, whereas the satisfaction scale summary was found to have the highest score of 5.3 + 0.9. Conclusion: Profile of patients who attend a telepsychiatry unit during the crisis and their satisfaction helped us to know the pros and cons of online consultation and the ways to improve telemedicine in regard to psychiatric patient care. Our study shows that majority are satisfied with telepsychiatric consultation.

Perturbation-based balance training (PBT) improves reactive stepping in older adults and people with neurological disorders. Slip-induced falls are a threat to older adults, leading to hip fractures. Fall-prone individuals must be trained to regain balance during a fall in the posterolateral direction. This study aims to analyze the characteristics of the reactive step induced by a laterally inclined platform. This cross-sectional study included 46 healthy participants who performed a “lean and release” backward fall using a platform with two inclined angles on each side. Kinovea software was used to analyze the step width. Reactive steps, characterized by crossover or medial foot placement, are preventive measures against posterolateral falls. The first objective was on the narrowed step width that was subjected to analysis using analysis of variance (ANOVA) and Tukey’s post hoc assessment, indicating a tendency toward posterolateral falls. As part of our second objective, the inclined platform resulted in uneven loading between the legs, with a preference for the unloaded leg as the reactive leg (p

Akathisia is a term used for motor restlessness along with subjective feelings of tension and discomfort. It requires both subjective and objective aspects, and these behaviors are attributed to the inner feelings of tension. It is due to antipsychotic drug exposure. Treatment involves lowering the dosage of the antipsychotic medications, adding propranolol, benzodiazepines like diazepam or clonazepam, clonidine, or mirtazapine. Here, we present a case of akathisia which we found novel as the patient did not respond to the forementioned conventional methods and developed adverse effects but responded only to cyproheptadine syrup.

Background. Coronavirus Disease 2019 (COVID-19, also known as 2019-nCoV), a cluster of acute respiratory illness with unknown causes, has occurred in India since January 2020. Over the past several months, the entire world is struggling to cope with and contain the virus spread. Several studies showed that mental health problems could occur in both healthcare workers and SARS survivors during the SARS epidemic. Considering the geographical variation, dense population, multi-strata health care structure, and rising COVID cases in South India, we have a reason to speculate that the burden on the frontline doctors is high and their psychological condition may also be affected during COVID-19 outbreak. Aims. The aim of the study is to estimate the anxiety and depression among front line doctors during COVID 19 duty in south India and also the impact of the various strata of health care on the depression and anxiety scores. Methods. An online form was created which included personal details of COVID 19 duty, Beck’s anxiety and depression questionnaire. Results. Severity of anxiety and depression scores was significantly higher among front line doctors working in primary health centers when compared to medical college and private hospital doctors (P

Health research plays an integral part in scientific and academic innovation in health care. India, a rapidly developing country, showed a tremendous increase in the number of health research projects and publications in recent years. Given the broad spectrum of health research areas and a vast number of funding agencies that fund specific areas, it is difficult to gain knowledge about them from a single source. Hence, we scanned the various funding opportunities which exist in India for healthcare research. Various agencies fund health-care research on their thrust areas of national importance. Choosing the funding agency depending on the area of interest and following the guidelines given by them ensures a successful proposal for funding. This article enlists various funding agencies and gives overall information about the nature of support and fund provided for health research in India.

Vacuolar malic acid accumulation largely determines fruit acidity, a key trait for the taste and flavor of apple and other fleshy fruits. Aluminum‐activated malate transporter 9 (ALMT9/Ma1) underlies a major genetic locus, Ma, for fruit acidity in apple, but how the protein transports malate across the tonoplast is unclear. Here, it is shown that overexpression of the coding sequence of Ma1 (Ma1α) drastically decreases fruit acidity in "Royal Gala" apple, leading to uncovering alternative splicing underpins Ma1's function. Alternative splicing generates two isoforms: Ma1β is 68 amino acids shorter with much lower expression than the full‐length protein Ma1α. Ma1β does not transport malate itself but interacts with the functional Ma1α to form heterodimers, creating synergy with Ma1α for malate transport in a threshold manner (When Ma1β/Ma1α ≥ 1/8). Overexpression of Ma1α triggers feedback inhibition on the native Ma1 expression via transcription factor MYB73, decreasing the Ma1β level well below the threshold that leads to significant reductions in Ma1 function and malic acid accumulation in fruit. Overexpression of Ma1α and Ma1β or genomic Ma1 increases both isoforms proportionally and enhances fruit malic acid accumulation. These findings reveal an essential role of alternative splicing in ALMT9‐mediated malate transport underlying apple fruit acidity. [ABSTRACT FROM AUTHOR]

Management of composite defects of leg following trauma requires a planned ortho-plastic approach right from the outset. Timely, planned intervention results in reduced amputation rates and improved limb salvage and function. Right from the time of presentation of the patient to the emergency with such injury, the process of decision making in terms of salvage or amputation, local flap cover/free flap cover, bone reconstruction first or soft tissue or both combined, come into play. Guidelines on management are unclear for such defects, a literature search yielding various methods being used by different authors. This article is a review of current literature on management of composite leg defects. A summary of the literature search in terms of various management options given by various authors including the rationale, advantages and disadvantages of each strategy has been provided in this article. The management protocol and method followed by the author in his institute for management of such composite defects have been described in detail. The article seeks to provide readers with an understanding of the management strategies so that appropriate method could be chosen to provide best result.

Since the advent of microsurgery, and expanding expertise in the field, extensive traumatic wounds of leg have been managed successfully with free tissue transfer. Various patient-related factors may preclude the use of free flaps even in units with available expertise and infrastructure. It is in such situations that the “cross-leg flap” comes into play. In these cases, instead of attempting complicated anastomotic techniques or anastomosis in the zone of trauma, it is better to perform the simpler and more reliable cross-leg flap. In this study, we try to show the utility of a cross-leg flap based on a retrospective study of 198 patients who underwent cross-leg flap in our institute over a period of 15 years extending from November 2003 to March 2018. Materials and methods: Case sheets of all patients who underwent cross-leg flap from November 2003 to March 2018 were reviewed. The location of defect in the leg, the indication for cross-leg flap, the pattern of cross-leg flap, and perioperative complications were noted. Results: A total of 198 patients underwent cross-leg flap for traumatic soft tissue injury of leg during this period. The most common reason for performing cross-leg flap was poor pulsatility of the recipient artery as seen intraoperatively, followed by the economics of the procedure wherein the initial cost of free flap was found significantly higher compared with cross-leg flap. All flaps survived with partial necrosis occurring in 23 patients. All flaps settled well by 2 years’ time. Bony union/fracture healing evaluation was not a part of this study. Conclusion: Cross-leg flap is still a useful tool for leg wound coverage even in microsurgical unit in situations precluding free flap coverage.

Dystonia is a movement disorder whose main feature is a sustained or intermittent muscle contraction causing abnormal, often repetitive, movements. Cervical dystonia (CD) is a type of focal dystonia affecting cervical muscles leading to abnormal postures and movements of the head, neck, and shoulders. Pathological laughter and crying are a condition characterized by uncontrollable episodes of laughter and crying. It occurs without any apparent triggering stimulus or in response to a stimulus which had not resulted in cry or laughter before the onset of the condition. It is characterized as a disorder of emotional expression rather than a disorder of feelings. The purpose of presenting this case report is that this patient presented with pathological laughter and CD without any other neurological complications which are a very rare and unusual presentation.

Background: Many flaps have been described for reconstruction of lower extremity defects, including, Latissimus Dorsi, Rectus abdominis, Anterolateral thigh perforator flaps, each having advantages and disadvantages. The defect location, size and specific geometric pattern of defect influences the type of flap that can be used. In this case series, we describe the specific situations where the use of chimeric latissimus dorsi–serratus anterior (LD + SA) free flaps are of advantage in providing complete wound cover. Materials and Methods: Case records of all patients who underwent LD + SA free flap transfer for lower extremity trauma at Amandeep Hospital, from Feb 2006 to Feb 2017 were reviewed. Patients were categorised based on the anatomical location and size of defect. The method of usage of the chimeric segments, recipient vessels and type of anastomosis were noted. Flap complications, if any were reviewed. Result: 47 patients with lower limb defects were included in the study. All cases were post traumatic in nature. Defect size ranged from 180 sq cm to 1050 sq cm. Average defect size was 487.70 sq cm. All patients underwent soft tissue reconstruction with LD + SA flap. Complete wound cover was obtained. Conclusion: Latissimus dorsi + Serratus anterior free tissue transfer is an effective, reliable method of providing cover to extensive lower limb traumatic defects with minimal donor site morbidity, with added freedom of inset and flap positioning. Specific use is seen in patients with broad proximal defect, long defect in the leg, defects involving adjacent anatomical areas and in large defect with dead space.

A 12-year-old boy presented to us with complaints of nonprogressive diminution of vision and seeing a black spot at the center of his visual field in his right eye following exposure to a red laser pointer accidentally, while playing, 2 years ago. On examination, his best-corrected visual acuity was 6/12 OD and 6/6 OS. His anterior segment examination was clinically normal. Fundus examination revealed a well-defined, pigmented, slightly elevated, hypoautofluorescent scar involving the nasal parafoveal region of the macula in his right eye. His left fundus appeared normal. Optical coherence tomography (swept source) imaging showed an irregular, raised, hyperreflective inner layer with back-shadowing in the parafoveal region corresponding to the pigmented scar seen in his right eye. Laser pointer injuries are fairly common but under-reported health hazard.

Background: Workers laboring in steel industries in tropical settings with high ambient temperatures are subjected to thermally stressful environments that can create well-known risks of heat-related illnesses and limit workers’ productivity. Methods: A cross-sectional study undertaken in a steel industry in a city nicknamed “Steel City” in Southern India assessed thermal stress by wet bulb globe temperature (WBGT) and level of dehydration from urine color and urine specific gravity. A structured questionnaire captured self-reported heat-related health symptoms of workers. Results: Some 90% WBGT measurements were higher than recommended threshold limit values (27.2–41.7°C) for heavy and moderate workloads and radiational heat from processes were very high in blooming-mill/coke-oven (67.6°C globe temperature). Widespread heat-related health concerns were prevalent among workers, including excessive sweating, fatigue, and tiredness reported by 50% workers. Productivity loss was significantly reported high in workers with direct heat exposures compared to those with indirect heat exposures (χ2 = 26.1258, degrees of freedom = 1, p

Introduction: Cardiac axis is altered in many physiological and pathological states. Hence its measurement is important. Position and movements of diaphragm determine the position of heart because the pericardium is firmly attached to the central tendon of the diaphragm. Effect of change in body posture and breathing on cardiac axis has not been well documented. The changes in cardiac axis during deep breathing are greater in aged patients. Aim: To study the effect of deep breathing on cardiac axis of young normal subjects in various postures. Materials and Methods: This was a cross-sectional study done on 45 normal healthy volunteers. After 10 min of supine rest, with the help of INCO RMS Vesta 101 electrocardiograph, ECG was recorded in leads I and aVF during eupnea, after maximum inspiration and after maximum expiration. The measurement was repeated in sitting and standing postures. The cardiac axis was calculated from Einthoven triangle. Data was analysed using ANOVA and inter-group was analysed using post-hoc test. Results: Maximum inspiration produced a significant (p