Delivering care with competence on the Covid-19 frontline

By replacing bedside clinical training with online lectures and simulation-based case scenarios, the Covid-19 pandemic has transformed the healthcare and medical education system of India. The compromise in clinical competency, patient interaction, coping strategies, and lack of resources and preparedness were the major constraints in delivering quality healthcare services during the pandemic. The pandemic taught us key lessons on empathy, preparedness and patience. Here is my experience as a student from the batch of MBBS students who had received their final year training through online lectures and then, as an intern having my first hospital posting amidst the second wave of Covid-19.

A retrospective study on COVID-19 in a tertiary care rural hospital

Background: Coronavirus disease 2019 (COVID-19) has rapidly become a worldwide concern ever since first being reported from Wuhan, China in December 2019. With no known cure, there is widespread fear-provoking interest in studying the factors contributing to mortality. Aim and Objectives: The current study was undertaken with a view to try to understand the cause of morbidity and mortality. Materials and Methods: A retrospective study done in our Institution on COVID-19 patients admitted over a course of 3 months after approval from Institutional Ethics Committee. Results: We had 17 deaths over the period under consideration whereas 73 patients improved (mortality = 19%, n = 90). Most of the patients were in the 41–80 years age group (>70%). No gender preponderance was found with mortality in each being around 20%. A clear correlation between co-morbidities and mortality was found with no person without any comorbidity succumbing to the disease. Respiratory and Heart conditions were found to contribute most to mortality with patients presenting with shortness of breath being most at risk. Similarly, a Neutrophil: Lymphocyte ratio greater than 12 was found to significantly increase the mortality. Conclusion: Patients with comorbidities need to be monitored closely with treatment being directed at improving the respiratory outcome.

A comparative study of reticulocyte count in healthy young adult and elderly age group subjects.

Introduction: Aging process has been viewed as progressive decline in physiological process necessary for maintenance of a constant milieu interior and death as the ultimate failure to sustain homeostasis. Reticulocytes are juvenile red cell. It is flat non-nucleated disc shaped, slightly larger than mature erythrocyte .The number of reticulocyte present in the peripheral blood is a fairly accurate reflection of erythropoitic activity of bonemarrow. Normal values in young adult- 0.5 to 2.5% of total RBC count. The present study was conducted to find out changes in the reticulocyte count in the elderly subject. Aims: to uncover the effect of aging on reticulocyte count. Material and method: 90 subjects were divided into two groups, normal control group (n=30, mean age 35.83yrs) and elderly group (n=60, mean age62.55yrs). Reticulocyte counts were done by new Methylene Blue method. Result & Observations: significant decrease in reticulocyte count was observed in elderly group as compare to normal control group. Conclusion: our data suggests that aging may alter haematological parameters including reticulocyte count.

Cemento-ossifying fibroma--a rare case.

The concept of 'fibro-osseous lesions' of bone has evolved over the last several decades and now includes two major entities: fibrous dysplasia and ossifying fibroma, as well as the other less common lesions such as florid osseous dysplasia, periapical dysplasia, focal sclerosing osteomyelitis, proliferative periostitis of garrie, and ostitis deformans. The cemento-ossifying fibroma is a central neoplasm of bone as well as periodontium which has caused considerable controversy because of confusion regarding terminology and the criteria for its diagnosis. The cemento-ossifying fibroma is odontogenic in origin, whereas ossifying fibroma is of bony origin. This article reports a rare case of an 11-year-old male who came to us with the history of swelling in the maxillary anterior region causing difficulty in closing of mouth as well as in mastication.

Delayed replantation of avulsed teeth.

Dental injuries are very common and their extent has been classified by Ellis. Avulsion of tooth is a grievous injury and ranges from 1-16% among the traumatic injuries, of which maxillary anterior are commonest. Reimplantation of avulsed teeth is a standard procedure. However, it has certain limitations. Most often their management is very challenging. In this case report we are presenting the management of maxillary incisors by replantation after 36 hrs in a 12 year old girl.

Serological study of hepatitis A virus infection amongst the students of a medical college in Delhi & evaluation of the need of vaccination.

BACKGROUND & OBJECTIVES: Recent seroepidemiological studies have demonstrated a decrease in the seroprevalence of hepatitis A virus (HAV) infection, thereby increasing the pool of susceptible adult population. Health care workers, especially those working in paediatric wards and nurseries, are at an increased risk of developing HAV infection. The present study was undertaken to determine the prevalence of antibody against HAV (IgG anti-HAV) among a batch of medical students of the Maulana Azad Medical College, New Delhi, so as to identify the proportion of students who would be susceptible to HAV infection and hence would benefit from a vaccination programme against HAV. METHODS: A total of 91 medical students were enrolled and divided into groups on the basis of sex. The serum samples were evaluated for the presence of immunoglobulin (IgG) against HAV (IgG anti-HAV) using a commercially available enzyme linked immunosorbent assay (ELISA) kit. RESULTS: The mean age of all the subjects was 19.9 +/- 1.5 yr and the male: female ratio was 1.2: 1. Fifty seven (62.6 +/- 5.1%) students were positive for IgG anti-HAV while 34 (37.4%) were seronegative and hence susceptible to HAV infection. No statistically significant difference was observed in the seroprevalence of HAV between males and females [64 +/- 6.7% (32/50) versus 60.9 +/- 7.6% (25/41)]. INTERPRETATION & CONCLUSION: our results indicate that more than one-third of the medical students were seronegative for IgG anti-HAV and hence at an increased risk of developing HAV infection as a result of occupational exposure. Therefore, we suggest that students in a health care set up should undergo vaccination against HAV after pre-vaccination immunity screening.

Effect of some drugs on human appendix in vitro.

Muscarinic action of acetylcholine was demonstrated in the human isolated appendix. Histamine-induced contractions seemed to the mediated by H1 receptors. Nicotine and DMPP-induced contractions were mediated through their action on ganglion cells. Experiments with adrenergic drugs suggested the presence of beta receptors.

Some photoresponses of isolated tissue preparations to ultraviolet light in the presence of photosensitizers.

Responses of isolated tissue preparations to ultraviolet (UV) light were studied with and without the presence of photosensitizers like eosin, fluorescein and sodium nitrite. Exposure to UV light in the presence of sodium nitrite induced consistent relaxation of rat duodenum. The photorelaxation was found to be related to the concentration of sodium nitrite. Adrenergic or cholinergic mechanisms do not seem to be involved. The isolated rat duodenum preparation exhibited quantitatively consistent photoresponse for 3 to 4 hr at its normal tone obviating the need for additional spasmogens as needed with other preparations. The preparation is a suitable test model for the study of photobiologic response evoked by UV light.

A preliminary report on the antiarrhythmic action of some newly synthesized glutarimide compounds.

The effects of a new series of glutarimide compounds have been studied in acetylcholine induced auricular fibrillation in anaesthetized cats and epinephrine induced ventricular arrhythmmias in conscious pigeons. Some of the compounds showed varying degree of protective action against experimental arrhythmias. However these compounds were found to be less potent than quinidine. The mechanism of antiarrhythmic action has been discussed.