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Delta and Omicron variants of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) are remarkably contagious, and have been recognized as variants of concern (VOC). The acquisition of spontaneous substitutions or insertion–deletion mutations (indels) in the spike protein-encoding gene substantially increases the binding affinity of the receptor binding domain (RBD)-hACE2 complex and upsurges the transmission of both variants. In this study, we analyzed thousands of genome sequences from 30 distinct SARS-CoV-2 variants, focusing on the unique nucleic acid signatures in the spike gene specific to the Delta and Omicron variants. Using these variant-specific sequences, we synthesized a range of oligonucleotides and optimized a multiplex PCR (mPCR) assay capable of accurately identifying and differentiating between the Delta and Omicron variants. Building on this mPCR assay, we developed a dipstick format by incorporating a tag linker sequence at the 5′ end of the forward primer and adding biotin to the 3′ end of the oligonucleotides, enhancing the assay’s usability and accessibility. Streptavidin-coated latex beads and the dipstick imprinted with a probe for the tag linker sequence in the test strips were used for the detection assay. Our dipstick-based assay, developed as a rapid point-of-care test for identifying and differentiating SARS-CoV-2 variants has the potential to be used in low-resource settings and scaled up to the population level.

Introduction: Prescription audit is a type of vigilance activity, which is beneficial in clinical practice in terms of reducing the burden of disease because of medication errors. The aim of the audit was to study the prescribing practices of the outpatient department of an ophthalmic tertiary care public sector hospital. The objectives were to assess the drug use pattern and to recommend suggestions, if any, to improve the prescribing practices. This was a prospective, cross-sectional descriptive study. Materials and Methods: A study was conducted over a period of 1 month (February) to audit the ophthalmic prescriptions received at free generic pharmacy of the tertiary hospital. Data was collected using a predetermined sample size (625) and random sampling strategy. Audit of prescriptions was done and WHO drug prescription and usage indicators were analyzed. Statistical Analysis Used: The data was analyzed using Microsoft Excel 2010 and Strata 11. Results: Out of randomly selected 625 prescriptions, patient identification details were not properly mentioned in 23% of prescriptions. Some errors were, missing name in 8 (1.28%), missing age in 68 (10.88%), and missing gender in 65 (10.4%) prescriptions. Regarding drug prescription indicators, the doses and correct strength of drug was mentioned in 7 (1.12%) prescriptions and the route of administration of drug was not written in 17 (2.72%) prescriptions. Out of the total 1543 drugs prescribed, only 134 (8.68%) drugs were prescribed in generic form. One hundred (6.48%) drugs were prescribed from the WHO Essential Drug Formulary (EDF), 115 (7.45%) drugs were prescribed from the National EDF, and a total of 129 (8.36%) drugs were prescribed in the form of fixed-drug combinations. An average of 2.47 ± 1.51 drugs were prescribed per patient. Polypharmacy was not significant as more than five drugs were prescribed in only 4% of prescriptions. Conclusions: Prescription writing errors were common which include incorrect mention of patient details, route of administration, and correct dose and strength of drugs. Awareness against polypharmacy was high. Efforts should be taken to promote the usage of generic form of drugs. Standardization of prescription writing and regular conduct of audits is the way forward.

Abstract SARS-CoV-2 infection is known for causing broncho-alveolar inflammation. Interleukin 9 (IL-9) induces airway inflammation and bronchial hyper responsiveness in respiratory viral illnesses and allergic inflammation, however, IL-9 has not been assigned a pathologic role in COVID-19. Here we show, in a K18-hACE2 transgenic (ACE2.Tg) mouse model, that IL-9 contributes to and exacerbates viral spread and airway inflammation caused by SARS-CoV-2 infection. ACE2.Tg mice with CD4+ T cell-specific deficiency of the transcription factor Forkhead Box Protein O1 (Foxo1) produce significantly less IL-9 upon SARS-CoV-2 infection than the wild type controls and they are resistant to the severe inflammatory disease that characterises the control mice. Exogenous IL-9 increases airway inflammation in Foxo1-deficient mice, while IL-9 blockade reduces and suppresses airway inflammation in SARS-CoV-2 infection, providing further evidence for a Foxo1-Il-9 mediated Th cell-specific pathway playing a role in COVID-19. Collectively, our study provides mechanistic insight into an important inflammatory pathway in SARS-CoV-2 infection, and thus represents proof of principle for the development of host-directed therapeutics to mitigate disease severity.

Summary: Non-alcoholic fatty liver disease (NAFLD) is an emerging global health problem and a potential risk factor for metabolic diseases. The bidirectional interactions between liver and gut made dysbiotic gut microbiome one of the key risk factors for NAFLD. In this study, we reported an increased abundance of Collinsella aerofaciens in the gut of obese and NASH patients living in India. We isolated C. aerofaciens from the fecal samples of biopsy-proven NASH patients and observed that their genome is enriched with carbohydrate metabolism, fatty acid biosynthesis, and pro-inflammatory functions and have the potency to increase ethanol level in blood. An animal study indicated that mice supplemented with C. aerofaciens had increased levels of circulatory ethanol, high levels of hepatic hydroxyproline, triglyceride, and inflammation in the liver. The present findings indicate that perturbation in the gut microbiome composition is a key risk factor for NAFLD.

Objective: One or more inexcitable motor (IM) nerves are common during electrodiagnostic (EDx) study in Guillain–Barré syndrome (GBS). This study assessed the dose–effect relationship of IM nerves on outcome in patients with acute inflammatory demyelinating polyneuropathy (AIDP) and acute motor and/or sensory axonal neuropathy (AMAN and AMSAN). Materials and Methods: Eighty-eight GBS patients admitted during May 2018–June 2023 underwent detailed clinical evaluation and EDx study. Admission and follow-up disability were assessed on a 0–10 Clinical Grading Scale (CGS). Outcome was recovery at 6 months, defined as good (CGS

Visceral leishmaniasis (VL) is a vector-borne protozoan disease, which can be fatal if left untreated. Synthetic chemical insecticides are very effective tools for controlling of insect vectors, including the sand fly Phlebotomus argentipes, the vector of VL in the Indian subcontinent. However, repeated use of the same insecticide with increasing doses potentially can create high selection pressure and lead to tolerance and resistance development. The objective of this study was to determine the lethal concentrations and assess levels of susceptibility, diagnostic doses and times to death of laboratory-reared P. argentipes to five insecticides that are used worldwide to control vectors. Using the Center for Disease Control and Prevention (CDC) bottle bioassay, 20-30 sand flies were exposed in insecticide- coated 500-ml glass bottles. Flies were then observed for 24 hours and mortality was recorded. Dose-response survival curves were generated for each insecticide using QCal software and lethal concentrations causing 50%, 90% and 95% mortality were determined. A bioassay was also conducted to determine diagnostic doses and diagnostic times by exposing 20-30 flies in each bottle containing set concentrations of insecticide. Mortality was recorded at 10-minute intervals for 120 minutes to generate the survival curve. Phlebotomus argentipes are highly susceptible to alpha-cypermethrin, followed by deltamethrin, malathion, chlorpyrifos, and least susceptible to DDT. Also, the lowest diagnostic doses and diagnostic times were established for alpha-cypermethrin (3μg/ml for 40 minutes) to kill 100% of the flies. The susceptibility data, diagnostic doses and diagnostic times presented here will be useful as baseline reference points for future studies to assess insecticide susceptibility and resistance monitoring of field caught sand flies and to assist in surveillance as VL elimination is achieved in the region.

Plant identification and classification are critical to understand, protect, and conserve biodiversity. Traditional plant classification requires years of intensive training and experience, making it difficult for others to classify plants. Plant leaf classification is a challenging issue as similar features appears in different species of plant. With the development of automated image-based classification, machine learning (ML) is becoming very popular. Deep learning (DL) methods have significantly improved plant image identification and classification. In the last decade, convolutional neural networks (CNN) have entirely dominated the field of computer vision, showing outstanding feature extraction capabilities and significant identification and classification performance. The capability of CNN lies in its network. The primary strategy to continue this trend in the literature relies on further scaling networks in size. However, costs increase rapidly, while performance improvements may be marginal when the number of net-works increases. Hence, there is a need to optimize the CNN network to get the best possible result with the minimum number of networks and other parameters such as the number of epochs, number of layers, batch size and number of neurons. The paper aims to evolve the optimal architecture of CNN using PB3C algorithm for plant leaf classification. For this, we use the nature-inspired computing technique parallel big bang–big crunch to evolve a CNN's optimal architecture automatically. Current study validated the proposed approach for plant leaf classification and compared it with 11 other machine learning-based approaches. From the results obtained it was found that the proposed approach was able to outperforms all 11 existing state-of-the-art techniques.

Introduction: A correct histopathological diagnosis is dependent on an array of technical variables. The quality and completeness of a histological section on a slide is extremely prudent for correct interpretation. However, this is mostly done manually and depends largely on the expertise of histotechnician. In this study, we analysed the application of digital image analysis for quality control of histological section as a proof-of-concept. Material and methods: Images of 1000 histological sections and their corresponding blocks were captured. Area of the section was measured from these digital images of tissue block (Digiblock) and slide (Digislide). The data was analysed to calculate DigislideQC score, dividing the area of tissue on the slide by the tissue area on the block and it was compared with the number of recuts done for incomplete section. Results: Digislide QC score ranged from 0.1 to 0.99. It showed an area under curve (AUC) of 98.8%. A cut-off value of 0.65 had a sensitivity of 99.6% and a specificity of 96.7%. Conclusion: Digiblock and Digislide images can provide information about quality of sections. DigislideQC score can correctly identify the slides which require recuts before it is sent for reporting and potentially reduce histopathologists’ slide screening effort and ultimately turnaround time. These can be incorporated in routine histopathology workflows and lab information systems. This simple technology can also improve future digital pathology and telepathology workflows.

The present experimental investigation is dealt with the formation of composite cladding on Ti6Al4V alloy using laser melting and deposition (LMD) technique. The reinforcement consisting of ilmenite (Fe-TiO3), CeO2, La2O3, cubic boron nitride (cBN) and Ti6Al4V in different compositions ratio are considered as cladding materials to fabricate a dense composite clad surface. Single tracks are formed using 15.92 × 104 w/cm2 laser power density and three different laser scanning speeds of 200,400 and 600 mm/min to analyze the clad height, aspect ratio, dilution rate and average contact angle of the track. Further, area clads are fabricated for different powder compositions of the cladding materials. The clad layer thickness are found to be decreases with increase in laser scanning speed and rise in the percentage of ilmenite (Fe-TiO3). The formation of different microstructure in the clad as well as interface zone are observed. With the increase in the percentage composition of ilmenite with cerium and lanthanum leads to the refined and coarser grain microstructure with unique structure are found which enhance mechanical properties like wear and hardness of the clad. Some of the important microstructure like dendritic, lamellar, flower, grit type and long needle type are found on the clad surface. The formation of unique chemical compound such as Ti3O, La2O3, Ti2B5, LaTi21O38, Ce3B2N4, Fe4N, TiN, La3BO6, and Fe-TiO3 are observed through the XRD analysis. Micro hardness of the clad surface are found to be increases approximately five times to the substrate at the clad with the increase in percentage composition of RE element, but found to be decrease drastically as passing through the intersection zone due to intermixing phenomena of clad and the substrate. It is observed that with higher percentage composition of RE result decrease in the reduction of the coefficient of friction approximately thrice to that of the cladded sample as compare to base (Ti6Al4V), which improve the wear resistance of the clad material. However there are minor amount of defects like micro crack are found on the clad and wear at the disk are occurred due to ploughing and cutting observed through track analysis.

Leishmaniasis on the Indian subcontinent is thought to have an anthroponotic transmission cycle. There is no direct evidence that a mammalian host other than humans can be infected with Leishmania donovani and transmit infection to the sand fly vector. The aim of the present study was to evaluate the impact of sand fly feeding on other domestic species and provide clinical evidence regarding possible non-human reservoirs through experimental sand fly feeding on cows, water buffalo goats and rodents. We performed xenodiagnosis using colonized Phlebotomus argentipes sand flies to feed on animals residing in villages with active Leishmania transmission based on current human cases. Xenodiagnoses on mammals within the endemic area were performed and blood-fed flies were analyzed for the presence of Leishmania via qPCR 48hrs after feeding. Blood samples were also collected from these mammals for qPCR and serology. Although we found evidence of Leishmania infection within some domestic mammals, they were not infectious to vector sand flies. Monitoring infection in sand flies and non-human blood meal sources in endemic villages leads to scientific proof of exposure and parasitemia in resident mammals. Lack of infectiousness of these domestic mammals to vector sand flies indicates that they likely play no role, or a very limited role in Leishmania donovani transmission to people in Bihar. Therefore, a surveillance system in the peri-/post-elimination phase of visceral leishmaniasis (VL) must monitor absence of transmission. Continued surveillance of domestic mammals in outbreak villages is necessary to ensure that a non-human reservoir is not established, including domestic mammals not present in this study, specifically dogs.

Background: An outreach (OR) health-care facility providing broad specialty outpatient services was started by All India Institute of Medical Sciences (AIIMS), New Delhi, in rural area of district Jhajjar, Haryana. Objectives: This study aimed to ascertain the resource requirement for establishing an OR health-care facility and patient satisfaction with regard to the services being provided. Methods: A cross-sectional study was conducted in 2017 at an OR Outpatient Department (OPD) of AIIMS, New Delhi, at Jhajjar. Service delivery model adopted for health-care delivery was hub and spoke. Traditional method of costing was used for economic evaluation. Feedback pro forma of 400 patients who attended OPD services was analyzed to measure health service accessibility. Results: Capital expenditure to set up the facility was calculated to be approximately INR 17,57,49,074/- ($ 2,703,832) and operational cost per year was approximately INR 8,73,86,370/- ($ 1,344,406). Approximate per-patient cost for single OPD consultation was calculated to be INR 874 ($13.45) which included medicines and investigations. High scores for all domains of accessibility of health care were observed. Conclusion: The study provides a preliminary evidence that OR health-care facilities can be instrumental in increasing access to health-care delivery with lesser capital outlays, however, large-scale multicentric studies are needed to arrive at any conclusion. The services have been very well accepted by the local community members being quality medical care with highly subsidized health-care services.

Background and Aim: Psoriasis is an immunologically mediated chronic inflammatory skin disease. Altered platelets in psoriasis patients may have a role in predisposition to cardiovascular complications. The aim of this study is to study the platelet count (PLT) and indices in patients with psoriasis and to correlate platelet indices with Disease Area Severity Index score. Materials and Methods: The study was done in a tertiary care hospital. It was performed on 42 psoriasis patients (study group) and twenty healthy controls. Lifestyle factors, PLTs, and platelet indices were compared between psoriasis cases and controls. Correlation between these parameters and Psoriasis Area Severity Index (PASI) score was also studied in psoriasis patients. Chi-square test was applied to compare the categorical data from patients and controls. Spearman's rank correlation was used to correlate lifestyle factors with the severity of disease. Pearson's correlation coefficient was used to find the correlation between PASI and platelet parameters. Results: We found that PASI correlated with smoking (P = 0.042) and levels of psychological stress (P = 0.002). PLT (P = 0.043) and plateletcrit (P = 0.043) were significantly higher in the study group, whereas platelet distribution width (PDW) (P = 0.05) was lower in the study group. We found a significant correlation of PASI with PDW (P = 0.031), mean platelet volume (P = 0.050). and PLCR (0.028). Conclusion: Lifestyle factors such as smoking and levels of psychological stress play a significant role in psoriasis disease severity. There is a correlation of PLT and platelet indices with the pathogenesis and manifestation of disease.

Background and Aim: Learning styles are subconscious stable traits influencing the perception and response of learners to their learning environment. Honey–Mumford classification of learning styles has been utilized and evaluated in a number of studies among students across different professional courses. Though learning style preferences of medical students have been assessed, we did not come across any study evaluating the paramedical students of Medical Laboratory Technology (MLT). Because laboratory technicians form the backbone of clinical laboratories in today's evidence-based medicine, it seems imperative to understand the basic learning styles of these students. Thus, this study aimed to identify the learning styles among students pursuing the bachelor degree of medical laboratory technology at a tertiary-level hospital. Materials and Methods: A cross-sectional observational study was undertaken among 98 students pursuing Bachelor of MLT at a tertiary-level hospital and medical college. The Honey–Mumford's learning style questionnaire was administered to each student after taking informed consent. Individual students' preference for learning style was categorized as per Mumford classification, and students were categorized according to their preferred learning style. Results: Majority of the students (60%) showed very strong preference for the activist learning style followed by reflector style. Prevalence of activist and reflector styles was found to be equal among our students followed by the theorist style. No difference was noted between male and female students. Conclusion: We demonstrated, for the first time, the learning styles of medical laboratory technology students or the future laboratory technicians. Activist and reflector styles were the most frequent among our study group. Future studies at other institutions providing similar training shall help in refining these results. Such studies are likely to help in adopting appropriate teaching methods and assessment strategies leading to better learning and consequent improvement in laboratory efficiency.

Background and Aim: Queuing theory, a discipline of operation management, has seen great utility in various service industries. Application of queuing analysis (QA) in healthcare has been largely limited to emergency room, pharmacy, and patient appointment system. Utility of QA in the hospital laboratory has not been evaluated in detail so far. This study aimed at evaluating the application of QA at a report dispatch counter in the pathology department of our tertiary-level hospital. Materials and Methods: In a cross-sectional observational study, patient arrival at the report dispatch counter in the department of pathology was noted for 5 consecutive days while service rate at the same counter was observed for 4 days. QA was performed using Poisson distribution function for patient arrival and exponential distribution function for service rate. The expected waiting time in queue as well as number of patients waiting in the queue was calculated. Results: The average arrival rate (λ) was 6.94 and service rate (μ) was 8.34 patients, both for 5-min interval periods. QA yielded the average waiting time in queue as 3.05 min. The expected number of patients in queue was estimated to be 4.26, implying that, on an average, four patients would be waiting in the queue to receive their report apart from the one being served at the a given time. Conclusion: QA can be efficiently applied to various areas of the hospital laboratory including report dispatch point. This is an extremely helpful tool to assist in staffing policy and assessing patient satisfaction at any patient contact point in the laboratory.

This article has been retracted. Please see the Retraction Notice for more detail: https://doi.org/10.1186/1476-4598-12-147.

Aims: There is limited literature on the outcome of care in intensive care units (ICUs), especially when it comes to neonatal surgical units. Hence, this study was aimed to observe the outcome of care provided in the neonatal surgery ICU (NSICU) at an apex tertiary care teaching institute of North India. Methods: A descriptive, observational study was carried out through retrospective medical record analysis of all the patients admitted in NSICU from January to June 2011. Results: In NSICU, from January to June 2011, 85 patients were admitted. More than two-third (69.9%) patients were admitted through the emergency department. Of the total admitted patients, 69.9% were male. Mean and median age of the admitted patients were 6.31 and 2 days (range 0–153 days), respectively. The most common diagnosis was esophageal atresia with tracheoesophageal fistula (36.1%).Within a day of admission at NSICU, 88% patients underwent surgical intervention. Of the total admitted patients, 56.6% required mechanical ventilation with 3.57 days (range 0–31 days) of mean duration of mechanical ventilation. Reintubation rate (within 48 h of extubation) was observed to be 15.7%, and 27.7% (23) of the patients required vasopressor support during their NSICU stay. Patients who developed postoperative complications were 34.25%, with the most common being wound infection/discharge/dehiscence. Two patients were readmitted within 72 h of their discharge/transfer out from the NSICU. Conclusion: NSICU survival rate was 85.5% and net death rate was observed to be 14.5%. Sepsis was the major reason for mortality in NSICU.

BackgroundThe incidence of preterm birth (PTB) in India is around 13%. Specific bacterial communities or individual taxon living in the vaginal milieu of pregnant women is a potential risk factor for PTB and may play an important role in its pathophysiology. Besides, bacterial taxa associated with PTB vary across populations.ObjectiveConduct a comparative analysis of vaginal microbiome composition and microbial genomic repertoires of women who enrolled in the Interdisciplinary Group for Advanced Research on Birth Outcomes – A DBT India Initiative (GARBH-Ini) pregnancy cohort to identify bacterial taxa associated with term birth (TB) and PTB in Indian women.MethodsVaginal swabs were collected during all three trimesters from 38 pregnant Indian women who delivered spontaneous term (n=20) and preterm (n=18) neonates. Paired-end sequencing of V3-V4 region of 16S rRNA gene was performed using the metagenomic DNA isolated from vaginal swabs (n=115). Whole genome sequencing of bacterial species associated with birth outcomes was carried out by shotgun method. Lactobacillus species were grown anaerobically in the De Man, Rogosa and Sharpe (MRS) agar culture medium for isolation of genomic DNA and whole genome sequencing.ResultsVaginal microbiome of both term and preterm samples reveals similar alpha diversity indices. However, significantly higher abundance of Lactobacillus iners (p-value All_Trimesters

BackgroundIvermectin is one among several potential drugs explored for its therapeutic and preventive role in SARS-CoV-2 infection. The study was aimed to explore the association between ivermectin prophylaxis and the development of SARS-CoV-2 infection among healthcare workers.MethodsA hospital-based matched case-control study was conducted among healthcare workers of AIIMS Bhubaneswar, India, from September to October 2020. Profession, gender, age and date of diagnosis were matched for 186 case-control pairs. Cases and controls were healthcare workers who tested positive and negative, respectively, for COVID-19 by RT-PCR. Exposure was defined as the intake of ivermectin and/or hydroxychloroquine and/or vitamin-C and/or other prophylaxis for COVID-19. Data collection and entry was done in Epicollect5, and analysis was performed using STATA version 13. Conditional logistic regression models were used to describe the associated factors for SARS-CoV-2 infection.ResultsIvermectin prophylaxis was taken by 76 controls and 41 cases. Two-dose ivermectin prophylaxis (AOR 0.27, 95% CI, 0.15-0.51) was associated with a 73% reduction of SARS-CoV-2 infection among healthcare workers for the following month. Those involved in physical activity (AOR 3.06 95% CI, 1.18-7.93) for more than an hour/day were more likely to contract SARS-CoV-2 infection. Type of household, COVID duty, single-dose ivermectin prophylaxis, vitamin-C prophylaxis and hydroxychloroquine prophylaxis were not associated with SARS-CoV-2 infection.ConclusionTwo-dose ivermectin prophylaxis at a dose of 300 μg/kg with a gap of 72 hours was associated with a 73% reduction of SARS-CoV-2 infection among healthcare workers for the following month. Chemoprophylaxis has relevance in the containment of pandemic.

IgA nephropathy (IgAN) is a common cause of glomerulonephritis and end-stage renal disease. The recurrence of IgAN postrenal transplant is well documented. IgA recurrence posttransplant manifests as recurrent IgAN, de novo IgAN, and crescentic IgAN. Three cases are described in this article, representing the above-mentioned presentations of IgAN. The first case represents the manifestation of crescentic IgAN in a renal transplant recipient. The patient presented with severe graft dysfunction requiring hemodialysis. Inspite of aggressive immunosuppression and plasmapheresis, the graft kidney could not be salvaged. The second case represents recurrent IgAN. The patient was initiated on antiproteinuric measures and has maintained a stable graft function. The third case presented with de novo IgAN and acute antibody-mediated rejection (AMR). This patient was treated with immunosuppressants and plasmapheresis as per AMR treatment guidelines, following which his graft function improved.

Etiologic diagnosis of an eosinophilic pleural effusion (EPE) presents a diagnostic challenge when intrapleural air and blood have been ruled out as its proximate causes. Among the causes of EPE, those that require immunosuppression for the underlying disease include connective tissue diseases, sarcoidosis, vasculitis, and eosinophilic pneumonia. We present a case of clinically suspected Behcet's syndrome based on a 10-year history of recurrent multiple oral ulcers and human leukocyte antigen-B51 positivity who presented with only an EPE. Computed tomography pulmonary angiogram ruled out central thoracic vein thrombosis but was inconclusive in ruling out a subsegmental pulmonary embolism. The patient declined immunosuppressants and while on follow-up developed bilateral extensive acute lower limb deep venous thrombosis and pulmonary embolism. Upper infrarenal inferior vena cava demonstrated chronic thrombosis suggestive of its antecedent role in pulmonary embolism-related EPE during the first instance. Behcet's syndrome-related EPE can be associated with venous thromboembolism, and immunosuppressive therapy prevents the subsequent thrombotic episodes.

BACKGROUND: In the wake of the novel coronavirus pandemic, the closure of educational institutions has imposed a situation of potential gap in learning. Since training of medical and paramedical students is vital in creation of our army of these frontline health-care workers, this study was aimed at comparing the asynchronous and synchronous methods of online teaching for imparting training to students of medical laboratory technology (MLT). MATERIALS AND METHODS: This cross-sectional study included 33 students of the 1st-year batch of MLT course at a tertiary level hospital. Ten lectures each from the subject of biomedical statistics were delivered through asynchronous (lecture shared on WhatsApp group) and synchronous (online live lecture) methods followed by a brief examination for each topic. A short survey was designed to assess the students' perception of clarity of concepts, confidence of solving the examination, and their preference for one of these methods. Appropriate statistical tests were applied to the data. RESULTS: Synchronous method of online teaching was preferred by majority of the students (P < 0.001). Students' clarity in understanding of the concepts (P < 0.001) and confidence of the ability to solve examination questions (P < 0.05) was higher after synchronous teaching. The examination scores after synchronous online teaching were significantly higher (P = 0.0156) than those for topics covered through asynchronous method. CONCLUSION: Online teaching, especially the synchronous method, offers an opportunity of continuum of training during crisis situations such as the ongoing novel coronavirus pandemic. The wide availability of internet services and the ever-changing global situation mandates readiness for this modality of teaching, both for the teachers and the students.

High minute ventilation is required to lower intracranial pressures in patients with intracranial bleed. Respiratory acidemia consequent to ventilatory difficulty is dangerous in such patients as it further raises intracranial tension. We describe such a case. A 24-year-old man had to be intubated and mechanically ventilated after he met with a road traffic accident and sustained extensive maxillofacial injuries and intracranial bleed. A tooth was accidentally aspirated in this injury and progressively resulted in left lower lobe collapse, pneumomediastinum, and consequent difficult ventilation. Under video bronchoscope guidance, the tooth was removed with grasping forceps. Pneumomediastinum temporarily increased after the tooth removal, but by 12 h postextraction, resolution of both the pneumomediastinum and left lower lobe collapse was observed. There was a 17 h delay postadmission before the cause of ventilatory failure was realized. Aspiration of foreign bodies, in general, and teeth, in particular, should be actively looked for in patients with ventilatory difficulties in the post-trauma setting.

Context: Though intensive care units (ICUs) only account for 10% of hospital beds, they consume nearly 22% of hospital resources. Few definitive costing studies have been conducted in Indian settings that would help determine appropriate resource allocation. Aim: To evaluate and compare the cost of intensive care delivery between multi-specialty and neurosurgery ICU in an apex trauma care facility in India. Materials and Methods: The study was conducted in a polytrauma and neurosurgery ICU at a 203 bedded level IV trauma care facility in New Delhi, India from May, 2012 to June 2012. The study was cross-sectional, retrospective, and record-based. Traditional costing was used to arrive at the cost for both direct and indirect cost estimates. The cost centers included in study were building cost, equipment cost, human resources, materials and supplies, clinical and nonclinical support services, engineering maintenance cost, and biomedical waste management. Statistical Analysis: Fisher′s two-tailed t-test. Results: Total cost/bed/day for the multi-specialty ICU was Rs. 14,976.9/- and for the neurosurgery ICU was Rs. 14,306.7/-, manpower constituting nearly half of the expenditure in both ICUs. The cost center wise and overall difference in the cost among the ICUs were statistically significant. Conclusions: Quantification of expenditure in running an ICU in a trauma center would assist healthcare decision makers in better allocation of resources. Although multi-specialty ICUs are more expensive, other factors will also play a role in defining the kind of ICU that need to be designed.