Patient Safety Attitude among Indian Medical Students — A Comparative Cross-sectional Questionnaire Study

Introduction : Medical errors in Healthcare is now a global concern and patient safety is become a significant priority. Despite the escalating need for patient safety curriculum in Medical Education, few Medical Schools have a structured training in place. We did this study to evaluate the attitudes of Indian Medical Students towards patient safety. Methods : This was a descriptive, cross-sectional, questionnaire based study done over 6 months among cohorts of 2nd and 3rd year Medical Students. The Attitudes to Patient Safety Questionnaire-III was used. The responses were noted using a 7-point Likert scale. Mean scores were analysed for 9 domains consisting of 26 items and compared for the two groups using Students 't' test. The sample was set at 95% confidence interval. p < 0.05 was considered statistically significant. Results : Total of 190 students participated, 70 second year and 120 third year students with response rate of 46.6% and 80% respectively. Both groups showed positive response for domains of working factors as an error cause, team functioning and error inevitability. Lowest score was received for professional incompetence as an error and disclosure responsibility. There was a significant difference between the two groups in one domain and 6 individual items. Discussion : The results of the study reveal that there is a need to include structured patient safety curriculum in Undergraduate Medical Education which was strongly acknowledged by the participants. Non-technical skill training would help student develop positive attitudes towards teamwork, error reporting and disclosure responsibility

Breakthrough Infection with SARS-CoV-2 Delta Variant in Old-Age Homes in a Southern District of Kerala, India

Background: The incidence of breakthrough infection with the emergence of new variants of concern of SARS?CoV?2 is posing a threat, and it is pertinent to understand the role of vaccines in protecting the elderly and people with comorbidities. Objective: The present study was undertaken to understand the natural history of SARS?CoV?2 infection in a closed cohort of the elderly population in an old?age home who have received two doses of COVID?19 vaccination. The study has also undertaken genomic sequencing to identify SARS?CoV?2 variants of concern from an academic perspective. Materials and Methods: A prospective observational study was conducted from March to August 2021 among residents of 11 old?age homes in Kerala who were vaccinated with 2 doses of the COVID?19 vaccine, from 2 weeks following vaccination. Samples with a threshold cycle value of <25 were subjected to targeted sequencing of the spike protein receptor?binding domain coding region. Results: Among the 479 vaccinated individuals, 86 (17.95%) turned positive during the follow?up period. The mean duration of symptoms was 3–5 days, and no hospitalization was required. A phylogenetic analysis of the nucleotide sequences from the samples indicated B.1.617.2 lineage representing the Delta strain. Conclusion: The evidence supports maximizing the vaccine coverage among vulnerable groups to prevent hospitalization and death rate on the verge of the emergence of new variants of SARS?CoV?2.

ANSA PECTORALIS – ANATOMY AND APPLIED ASPECTS

Ansa pectoralis is the loop of communication between medial and lateral pectoral nerves, seen anterior to the second part of axillary artery. It carries C7 ?bres from the lateral cord to the medial pectoral nerve and supplies sternocostal part of pectoralis major muscle. Its damage can cause weakness of the sternocostal part of pectoralis major muscle. Section of the ansa pectoralis is done as a treatment modality to reduce spasm of pectoralis major after strokes. It is also used as nerve graft. There are only few articles which describe the anatomy of Ansa pectoralis. We conducted a dissection study in 36 pectoral regions of embalmed human cadavers to ?nd out the number, location, formation and branches of Ansa pectoralis. During dissection of the pectoral region, the formation of Ansa was seen to be of four different types. 72.2%(26 out of 36) was either between inferior or deep branch of lateral pectoral nerve and medial pectoral nerve or between the inferior lateral pectoral nerve and medial pectoral nerve (type A). In 6 cases (16.7%) it was between trunk of the lateral pectoral nerve and medial Pectoral nerve (type B). In 3 cases (8.3%), it was arising from lateral cord itself (Type C). In one case (2.7%) it was found to be arising from trunk and inferior branch of lateral pectoral nerve (Type D). The communicating loop was on the axillary artery in about 52.8% percentage of specimens, distal and plastered to the deep surface of pectoralis minor muscle in the 30.5% and multiple in 16.7%. The anatomy of Ansa pectoralis shows many variations. These are important while planning surgeries in pectoral region like breast augmentation, pectoral nerve blocks and harvesting pectoral nerve grafts.

Epilepsy in Southeast Asia, how much have we closed the management gap in past two decades?

@#The last review on epilepsy in Southeast Asian (SEA) countries was reported in 1997. This review aimed to update the understanding of epilepsy management in this region over the past 23 years. There has been significant increase in the epidemiological studies which reported a prevalence of 4.3-7.7 per 1,000 populations in this region. Reversible aetiologies of epilepsy such as head injury, birth trauma, cerebrovascular disease, and intracranial infections (neurocysticercosis or meningoencephalitis) are still prevalent, with a surge in autoimmune encephalitis. There was a surge in genetic studies which suggest ethnic variation. Treatment gap is still high especially in the rural and less developed areas, and the availability and affordability of newer anti-epileptic drugs (AEDs) is still a major challenge in SEA. Alternative medicine is a common practice but varies among different ethnic groups. AEDs hypersensitivity especially on the association between HLA-B*1502 and carbamazepine-related severe cutaneous reaction had been extensively studied and proven in nearly all SEA countries. However, HLA-B*1502 screening is not widely available in SEA and the cost-effectiveness of the screening is questionable. Stigma and its psychosocial consequences are still a major concern despite enormous efforts to study the public attitudes towards epilepsy and change of epilepsy naming in a few countries. The number and complexity of epilepsy surgery are progressing, but it is still under-utilized in many SEA countries, related to cost, cultural perception and lack of facilities. More resources should also be channelled in training adequate number of epileptologists who can spearhead epilepsy care around the region, as well as public education and research in epilepsy. In conclusion, there is an increase in epilepsy research in this region, gradual increase in trained neurologists and facilities, and efforts to reduce the knowledge and treatment gap, but the epilepsy management gap is still a battle to fight.

Narrow gene pool can threaten the survival of Calamus nagbettai R. R. Fernald & Dey: a highly, endemic dioecious rattan species in the Western Ghats of India

Rattans, the spiny climbing palms of Arecaceae (Palmae) family exhibit high endemism to the biodiversity hot spots in India. Of the five rattan genera, Calamus is the only genus found in peninsular India with 15 of 21 species, endemic to the Western Ghats. The extensive utilization of rattans owing to their strength, durability and huge demand has resulted in depletion of their natural resources. Ofthe 15 endemic species, C. nagbettai is the most affected species on account of endemism, low population size and restricted distribution with fragmented populations. The present study revealed high amount of genetic diversity in the surviving scattered populations of the species using microsatellite markers. High gene flow (Nm = 1.498) observed across the populations resulted in low genetic differentiation (14%). A clear genetic admixture could be seen in Kerala as well as one of the Karnataka’s populations while the remaining two populations were genetically distinct. UPGMA, PCoA and STRUCTURE analyses showed significantly different genetic composition in Kerala population compared to other populations. Kerala and Karnataka populations of C. nagbettai were also unique in their genetic structure and allelic composition. Therefore, effective management and conservation strategies have to be implemented to preserve the rarealleles with adaptive potential to protect this economically valuable Calamus species from endangerment. Overexploitation, low seed set and poor regeneration, as well as habitat fragmentation can further threaten the survival of this endemic, narrowly distributed dioecious rattan species in the Western Ghats region.

Complex coronary intervention outcomes: real world left main coronary artery angioplasty experience from a tertiary care center in South India

Background: Left Main Coronary Artery (LMCA) Disease is among the most complex forms of the coronary artery stenosis, the leading cause of mortality in the world.Methods: In this analysis, 102 patients with elective angioplasty for LMCA stenosis with PCI from 6/2013 to 5/2016, 3 years (70 in GenxSync™ arm and 32 in other devices arm; 100 DES and 2 BMS) were included. RADHIKa Analysis compared post-hoc subgroups of GenxSync™ and control groups.Results: Mean population age was 59.99±12.03 years; 60.27±10.49 years in GenxSync™ arm, and 58.31±14.32 years in control arm. A significant population (44, 43.14%) had diabetes, renal impairment (14, 13.73%) and hypertension (25, 24.51%). The MACCE in GenxSync™ arm was 17 13(18.58%) Versus 5(15.63%) [RR=0.93, RR’=-0.07, ?=-14.01. p=0.3). Most patients presented with unstable Angina (41, 40.20%) in all, 31(44.29%) in GenxSync™ and 10 (31.25%) in Control arm. AWMI and IWMI were 18, 17.65% each, attributed to 12 (17.14%) in GenxSync™ 6 (18.75%) in Control. Effort angina was 15(21.43%) in GenxSync™ and 10 (31.25%) in Control and NSTEMI was 25,24.51% (18 (25.71%)- GenxSync™ 7(21.88%) Control). The MACE in GenxSync™ arm at 24, 12 and 6 months was 12(17.15%), 8(11.43%) and 4(5.71%) respectively versus corresponding MACE in the control arm as 5(15.63%), 2(2.86%) and 2(6.25%) respectively. The TVR was present only in GenxSync™ Arm, which was contributed by 2 CABGs and 12 months and 1 additional PCI at 24 months.Conclusions: In real-world scenario of LMCA cases, performance and safety of various stents were similar. GenxSync™ Sirolimus Eluting Stent, in the post-hoc bifurcation had results similar to other real-world cases, based upon RADHIKa analysis.

Morphometric Study Of Femoral Neckshaft Angle And Its Applied Aspects

Background and Aims:Fractures involving the neck and trochanter of the femur are very common. Internal fixation with implants for these fractures is important for rehabilitation and early mobilization of the patients. Depending upon the dimensions of the upper end of the femur, the implants are designed. Currently most of the orthopaedic surgeons need notifications in the dimensions of the implants that suit the Indian standards.This study is designed to find out whether there is any significant difference between right and left femur for the purpose of modelling orthopaedic implants as the femoral fractures are very important health burden in India. Materials and methods:This study done with 90 dry adult femur bones of both sides from the department of anatomy at Sree Mookambika Institute of Medical Sciences, Kulasekharam, Tamil Nadu. By using a coloured thread, axis of the neck of femur was determined. The thread divides the anterior surface of the neck into two equal halves. In the mid sagittal plane over the anterior surface, the axis of the shaft was marked using same thread.Then the angle between the neck and shaft is measured using the goniometer. The measurement was subjected to statistical analysis to evaluate the significance. Result:We observed that the mean neck shaft angle of the left side was 126.15±4.22 degrees and the mean value of the right side was 127.20±2.43 degrees.

Assessment of dental caries experience among 5-16 year old school going children of Mangalore, Karnataka, India: A cross-sectional study

Background: Health in school children requires unique attention since they are the future goals in every country. Their disease prevalence and prevention should be updated for the betterment of the society. Materials and Methods: A cross-sectional study was carried out in 6198 children in different areas of Mangalore city in age group 5–16 years. The dental caries status was assessed by Decayed, Missing, and Filled Teeth (DMFT)/dmft index using the World Health Organization criteria 1997. Collected data from each subject was statistically analyzed to know the prevalence of dental caries using two sample T test and Chi square test. Results: The overall dental caries prevalence among school children were 63.5%. In males the entire decayed, filled and missed tooth was 63.9%, 7.05%, 7.02% and in females decayed, missed and filled tooth percentage was 63%, 6.02%, 6.13% respectively. The mean DMFT score among males and female’s population were 2.54 ± 2.84 and 2.50 ± 2.85 respectively. The highest caries prone group was between 5-7 years old (71.8%) and lowest was among 14-16 years old (56.71%). Conclusion: The present study revealed that caries is more prevalent among preschool children compared to other school going age groups.

Sclerosing mucoepidermoid carcinoma with eosinophilia of thyroid gland: Not so indolent a neoplasm?

A 58-year-old female, a known diabetic and hypertensive, presented with left-sided swelling on the anterior aspect of the neck of 1-year duration, which was rapidly increasing in size for the past 6 months. She was on Eltroxin for hypothyroidism for the past 1 year. Computed tomography study of the neck showed a nodule in the left lobe of thyroid which on fine-needle aspiration was suspicious for malignancy. Total thyroidectomy with left posterolateral lymph node dissection was done. Histopathological examination showed sclerosing mucoepidermoid carcinoma with eosinophilia (SMECE) of the thyroid gland with lymph node metastasis. SMECE of the thyroid was initially thought to be a low-grade malignancy with indolent clinical behavior. However, our case showed extra thyroidal spread with lymph node metastasis, necessitating adjuvant therapy for our patient. Such aggressive behavior has been noted in few earlier case reports also.

A multidisciplinary approach to restoration of severely worn dentition: a case report

Severe caries, attrition and developmental anomalies of anterior teeth lead to loss of anterior guidance. This in turn causes attrition of posterior teeth and loss of occlusal vertical dimension of occlusion . To gain the space for esthetic rehabilitation in these cases is challenging task. The required space can be achieved by crown lengthening and increasing the vertical dimension of occlusion within physiologic limits..We, hereby have presented a case report showing the treatment procedure of a patient with severely worn dentition in a simple and systematic multidisciplinary approach to improve the function as well as aesthetics , that also remains in harmony with the entire gnathostomatic system.

A multidisciplinary approach to restoration of severely worn dentition: a case report

Severe caries, attrition and developemental anomalies of anterior teeth lead to loss of anterior guidance. This in turn causes attrition of posterior teeth and loss of occlusal vertical dimension of occlusion. To gain the space for esthetic rehabilitation in these cases is challenging task. The required space can be achieved by crown lengthening and increasing the vertical dimension of occlusion within physiologic limits. We hereby have presented a case report showing the treatment procedure of a patient with severly worn dentition in a simple and systematic multidisciplinary approach to improve the function as well as aesthetics, that also remains in harmony with the entire gnathostomatic system.

Transcatheter aortic valve replacement: a review article

Transcatheter aortic valve replacement [TAVR] is a novel therapeutic intervention for the replacement of severely stenotic aortic valves in high-risk patients for standard surgical procedures. Since the initial PARTNER trial results, use of TAVR has been on the rise each year. New delivery methods and different valves have been developed and modified in order to promote the minimally invasive procedure and reduce common complications, such as stroke. This review article focuses on the current data on the indications, risks, benefits, and future directions of TAVR. Recently, TAVR has been considered as a standard-of-care procedure. While this technique is used frequently in high-risk surgical candidates, studies have been focusing on the application of this method for younger patients with lower surgical risk. Moreover, several studies have proposed promising results regarding the use of valve-in-valve technique or the procedure in which the valve is placed within a previously implemented bioprosthetic valve. However, ischemic strokes and paravalvular leak remain a matter of debate in these surgeries. New methods and devices have been developed to reduce the incidence of post-procedural stroke. While the third generation of TAVR valves [i.e., Edwards Sapien 3 and Medtronic Evolut R] addresses the issue of paravalvular leak structurally, results on their efficacy in reducing the risk of paravalvular leak are yet to be obtained. Furthermore, TAVR enters the field of hybrid methods in the treatment of cardiac issues via both surgical and catheter-based approaches. Finally, while TAVR is primarily performed on cases with aortic stenosis, new valves and methods have been proposed regarding the application of this technique in aortic regurgitation, as well as other aortic pathologies. TAVR is a suitable therapeutic approach for the treatment of aortic stenosis in high-risk patients. Considering the promising results in the current patient population, recent studies have been conducted to evaluate the efficacy of this approach as a standard-of-care procedure

Re-emergence of dengue virus serotype 2 strains in the 2013 outbreak in Nepal.

Background & objectives: Epidemiological interventions and mosquito control are the available measures for dengue control. The former approach uses serotype and genetic information on the circulating virus strains. Dengue has been frequently reported from Nepal, but this information is mostly lacking. The present study was done to generate a comprehensive clinical and virological picture of a dengue outbreak in Nepal during 2013. Methods: A hospital-based study involving patients from five districts of Nepal was carried out. Demographic information, clinical details and dengue serological status were obtained. Viral RNA was characterized at the molecular level by reverse-transcription polymerase chain reaction (RT-PCR), nucleotide sequencing and phylogenetic analysis. Results: From among the 2340 laboratory-confirmed dengue cases during the study period, 198 patients consented for the study. Clinically they had fever (100%), headache (59.1%), rashes (18.2%), retro-orbital pain (30.3%), vomiting (15.1%), joint pain (28.8%) and thrombocytopenia (74.3%). Fifteen (7.5%) of them had mucosal bleeding manifestations, and the rest were uncomplicated dengue fever. The patients were mostly adults with a mean age of 45.75 ± 38.61 yr. Of the 52 acute serum samples tested, 15 were positive in RT-PCR. The causative virus was identified as DENV serotype 2 belonging to the Cosmopolitan genotype. Interpretations & conclusions: We report here the involvement of DENV serotype 2 in an outbreak in Nepal in 2013. Earlier outbreaks in the region in 2010 were attributed to serotype 1 virus. As serotype shifts are frequently associated with secondary infections and severe disease, there is a need for enhancing surveillance especially in the monsoon and post-monsoon periods to prevent large-scale, severe dengue outbreaks in the region.

A 'pen' in the neck: An unusual foreign body and an unusual path of entry.

Penetrating injuries to head and neck region with varying objects have been reported in the literature. [1],[2],[3],[4],[5],[6],[7],[8],[9],[10] Majority of these injuries occur in interpersonal violence or bomb blasts or road traffic accidents. Despite the improvement in imaging technologies and surgical methods, penetrating injuries to head and neck with impacted foreign bodies are very challenging due to the proximity to vital structures and/or difficulties in accessing them for the removal. [1] Following injury the normal anatomy could be altered because of edema or tissue destruction, which makes the diagnosis or retrieval more difficult. [3] Parapharyngeal or prevertebral space is an unusual place for lodgment of foreign bodies and in these cases the usual point of entry is the oral cavity, cheek or neck. Here, we report a case of a ball point pen extending to the prevertebral region at the level of C1-C2 vertebrae from point of entry at the suprazygomatic region in the temporal fossa.

Comparison of New Ballards Score and Parkins Score for Gestational Age Estimation.

This prospective analytical study was done to compare the accuracy of New Ballards score (NBS) and Parkins score (PS) in assessing the gestational age (GA) in newborns. The GA of 284 babies was assessed by the NBS and PS within 24 hours of birth. The two methods of assessment were compared using the Bland Altmann Plot. The mean difference between the two measurements was 1.530576. 95% of the values lay within the limits of agreement which are -1.82982 and 4.890974. The two methods are found to be in acceptable agreement. Parkins score enables us to easily assess the gestational age of babies within ±12 days, especially in sick and preterm babies.

Bovine carriers of Anaplasma marginale and Anaplasma bovis in South India

Carriers of bovine anaplasmosis in Northern Kerala, South India were detected using conventional microscopical and molecular techniques. PCR-RFLP and nested PCR techniques were used for detection of Anaplasma marginale and Anaplasma bovis respectively and the PCR products were confirmed by sequencing. Out of 150 samples tested, 25 were detected positive for A. marginale and five for A. bovis based on molecular tests. The inclusion bodies of A. marginale could be detected by microscopy in two blood smears after staining by giemsa while acridine orange staining detected three smears positive. The data clearly suggest the higher sensitivity of molecular techniques for diagnosis of these diseases.

Endovascular Treatment of Aneurysm of Splenic Artery Arising from Splenomesentric Trunk Using Stent Graft

We report a rare case of aneurysm of splenic artery arising anomalously from the superior mesenteric artery (SMA). The aneurysm was treated successfully by coil embolization of the splenic artery distal to aneurysm and then deploying a stent graft in the SMA. A combination of stent graft and coil embolization for the treatment of aberrant splenic artery aneurysm has been reported only once. We describe the imaging findings and the endovascular procedure in this patient.

Comparison of the roles of serratiopeptidase and dexamethasone in the control of inflammation and trismus following impacted third molar surgery.

Introduction: Surgical extraction of lower 3 rd molar is the most frequent intervention in oral surgery. This procedure is often associated with significant post operative swelling that may have both biological and social implications. Various studies have been done using different anti inflammatory drugs to study their impact on inflammation. Material and Methods: This study was conducted on 110 patients who had undergone surgical removal of mandibular third molar. The subjects were divided into two groups by double blind method. In addition to post operative swelling and pain , trismus was evaluated using two different groups of drugs. Results: One group was administered 1 mg of dexamethazone every 8 hours for 3 days post operatively. The other group was administered 10 mg of serratiopaptidase every 8 hours for 3 days post operatively. Swelling, pain and trismus were assessed on the 1 st , 3 rd , 5 th and 7 th post operative days. The results of the studies were statistically analysed. Conclusion: The results showed dexamethazone was more effective in reduction of swelling and pain in comparison with serratiopaptidase. Both dexamethazone and serratiopaptidase had the same effect on trismus.

Organ transplantation: bridging the technology-ethics gap.

Ever since the first organ transplant was successfully performed in the 1950s, controversies surrounding the scope and consequences of this medical intervention have attracted more attention than its potential human benefit. While the medical world finds in it the potential to provide effective treatment for end state organ failure, the various steps involved in the treatment? selection of donor and recipient, the process and stages of decision making, the diverse cultural and religious practices and beliefs – raise complex ethical challenges. Religious institutions often view the very idea of organ transplantation skeptically. Yet it has evolved as a widely accepted medical practice and continues to give hope to millions of patients, across the world, who suffer from potentially life-threatening ailments.