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The coronavirus pandemic brought with it a wide range of clinical presentations. Earlier, the respiratory symptoms comprised most of the clinical picture. However, as more and more people got infected, many atypical presentations came into the limelight, especially the neurological manifestations. Spinal cord complications are widely reported, with COVID-19 associated myelitis constituting a big part. Through this report, we bring you a series of cases of COVID-19 associated myelitis to add to the already available data. We report four patients, two of whom developed longitudinally extensive myelitis (three or more vertebral segments). The other two suffered from multisegmented short-segment myelitis (less than three vertebral segments). COVID-19 myelitis can be seen during COVID-19 illness and post COVID. We aim to familiarize the medical community with this entity so that there is a minimum delay between the onset of the symptoms in the patient and the management of this complication, as the treatment is often gratifying.
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Purpose: The International Council of Ophthalmology?Small Incision Cataract Surgery (ICO?SICS) rubric is a tool to grade SICS steps from novice to competent. The study aimed to evaluate the progress of residents’ surgical skills by using the ICO?SICS rubric and the perceptions of residents and faculties about its use. Methods: This prospective educational interventional study, done in the Ophthalmology department between September 2019 and February?2020 included 14 residents and five faculties. Faculties scored residents’ SICS by ICO?SICS?rubric (four sessions/resident) and helped them identify three steps as “area of focus” to work upon. Feedback was taken using a semi?structured pretested questionnaire. Focus group discussion was done for residents. Data were entered in MS Excel and analyzed using SPSS. Perception analysis presented as percentage of written responses. Results: Step?wise rubric score showed improvement for initial SICS steps and wound closure (P < 0.05). Critical surgical steps and scores for three areas of focus steps showed no statistically significant improvement. Three steps as an area of focus changed partly for 11 residents and completely for three residents at the end of 6 months. Perception analysis of faculty and residents showed that the ICO?SICS rubric is a good tool to record surgical performance, identify steps needing improvement and provide structured feedback hence opined to continue it. Residents considered it as an effective learning and assessment tool. Conclusion: ICO?SICS rubric is a good teaching tool and helps to assess the progress of surgical skills. Identification of areas of poor performance and feedback given motivates them to focus on those areas leading to continuous professional development, resulting in competent surgeons performing SICS surgery independently at the end of the residency
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Chronic periaortitis is a rare inflammatory condition predominantly affecting the abdominal segment of the aorta. This can present as IgG4 related inflammatory disease, idiopathic retroperitoneal fibrosis, perianeurysmal retroperitoneal fibrosis andinflammatory abdominal aortic aneurysm (IAAA). Aortitis can also be a manifestation of a number of rheumatological large vessel vasculitides such as Takayasu arteritis and giant cell arteritis (GCA). We present three interesting cases of chronic periaortitis and a literature review. The first case showsa classic picture ofIgG4 periaortitis. The second case illustrates periaortitis with retroperitoneal fibrosis, ureteric involvement and hydronephrosis, following abdominal aortic aneurysmal stenting. The final case presents as widespread periaortitis due to Takayasu's disease involving the entire aorta including the arch and root of the subclavian artery
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Ossicular defect is although more common in squamosal type of chronic suppurative otitis media, it can also occur in mucosal type of the disease. Its preoperative knowledge not only helps surgeon to plan for ossicular reconstruction in a better way but also to counsel the patient accordingly. We wanted to determine the prevalence of ossicular chain defect and preoperative identification of clinical and audiological factors as indicators of ossicular defects in patients with Mucosal CSOM.METHODSThis is a hospital based cross sectional study of 2 years. Patients 15 to 60 years of age, having inactive mucosal type of Chronic Suppurative Otitis Media, posted for Tympanoplasty were included in the study. Findings on history, clinical, audiological and intraoperative otomicroscopic examination were recorded and analysed.RESULTSOssicular necrosis was noted in 21 (23.33%) of total 90 patients. On statistical analysis, patients of age >30 years (p=0.019, duration of ear discharge >10 years (p=0.003), those having large and subtotal perforation (p<0.001), adhesion of tympanic membrane edges to promontory (p=0.04), incudostapaedial joint area exposure (p=0.01) and air-one gap >40 dB (p <0.001) were found to be statistically significantly associated with ossicular erosion.CONCLUSIONSAll patients of mucosal type of chronic suppurative otitis media should be assessed in detail so as to get a clue of ossicular defects to be prepared for its repair and will not come as a surprise during surgery.
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Introduction: Addition of fentanyl to bupivacaine orropivacaine in epidural space will increase duration andquality of analgesia with similar safety profile. Study aimed tocompare epidural Inj. Bupivacaine 0.1% + Inj. Fentanyl andInj. Ropivacaine 0.1% + Inj. Fentanyl for onset, effectivenessand duration of analgesia, to study motor blockade intensity,to study hemodynamic parameters, to study technical anddrug related complications in mother and baby and to studyacceptability of technique by patient.Material and methods: A prospective interventional studywas conducted on 50 adult females with primigravida /multigravida full term pregnancy for epidural analgesia underASA 1 & 2. Unpaired Student t test was used to interpret theresults.Results: Patients got more pain relief and satisfaction withropivacaine+fentanyl as compare to bupivacaine+fentanyl.Conclusions: Addition of fentanyl to bupivacaine orropivacaine in epidural space increase duration and qualityof analgesia with similar safety profile and reduce therequirement of local anesthetic drugs during labour. It didnot hamper ambulation and bearing down of patient and hadsimilar incidence of maternal and fetal outcome, with goodpatient satisfaction.
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Objective To explore the differences of curricula setting of medical students in China and the United States,and the enlightenment for medical education in China.Methods The curriculum of the 8-year students in Grade 2010 of Peking University was compared with the schedule of medical students in the same grade at the Pittsburgh University,specifically for the number of courses,the distribution of courses,the training of innovative abilities,and the doctor-patient communication courses.All the data were analyzed by SPSS 20.0,and t test and chi-square test were used for statistical analysis.Results The total number of courses in the two medical schools was similar.The number of study weeks per year for Peking University was (41.6 ± 8.7) weeks while that of Pittsburgh University was (39.6 ± 8.5)weeks,without statistically significant difference (t =1.414,P=0.200).Courses of both universities were distributed from comprehensive courses to medical courses and from basic courses to clinical courses,and the professional courses were similar.Innovative ability training and doctor-patient communication education were reflected in the curriculum of both universities,but the training courses of the University of Pittsburgh began earlier and the form was more flexible.Among them,there was a total of 47 learning hours of the doctor-patient communication lecture in Peking University while the number of Pittsburgh University was 140 learning hours,including lectures and communication with standard patients and real patients.The difference was statistically significant (~=67.45,P=0.000).Conclusion After more than 20 years of medical education reform,the curricula of medical students in China have basically reached the level of developed countries.Professional courses are similar to those of medical schools in developed countries.However,it is still necessary to strengthen the cultivation of innovative ability and medical humanities education.
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Background: Loneliness is a common problem in relationships. The purpose of the study was to find out ifthere is a relation between loneliness and people in romantic relationship.Methods: Convenient sampling was used to collect data in the age range of 18 to 25 years. Data wascollected from 111 people out of which 37 were in a romantic relationship, 37 had been in a romanticrelationship at least once in their lives and 37 had never ever been in a romantic relationship. Tool used tomeasure loneliness was UCLA loneliness scale.Results: The data was not significant. It was found that the degree of loneliness was lowest in people whowere in a romantic relationship and highest in the people had never been in a romantic relationship whenthe survey was conducted.Conclusion:The results show that the difference between the mean reported loneliness for 3 groups is notsignificant. That is being in relationship, or not being in relationship romantically has no significant impacton feelings of loneliness reported in young adults.
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Endometrial stromal sarcoma (ESS) has a wide histopathological spectrum with CD10 as its diagnostic marker. Recently, few non-conventional ESSs have been identifi ed that lack diffuse CD10 expression. A 46-year-old, perimenopausal lady referred to us with history of vaginal bleeding. On clinical examination and radiological imaging, a polypoid endometrial tumor was identifi ed. Hysterectomy revealed a multinodular tumor in the myometrium. Microscopically, the tumor composed of rather banal oval to spindle-shaped cells in a fi bromyxoid stroma. Focal areas displayed compact cellular arrangement, unassociated with signifi cant mitoses and necrosis. Immunohistochemically, tumor cells were focally positive for CD10, estrogen receptor, progesterone receptor, p16INK4 and were diffusely positive for cyclinD1. Diagnosis of cyclinD1 and p16INK4 positive ESS was offered. This case highlights the value of additional IHC markers, especially cyclinD1 and p16INK4 in order to identify certain ESSs that lack diffuse CD10 immunoexpression; are invariably misdiagnosed as undifferentiated sarcomas, but actually form a relatively more aggressive subset of ESSs.