Development and use of low-fidelity, low-cost, animal tissue-based simulators for surgical training during the Covid-19 pandemic

BACKGROUND The Covid-19 pandemic severely affected surgical training as the number of surgeries being done was reduced to a bare minimum. Teaching and training of clinical skills on a simulator are desirable as they may have an even larger role during the Covid-19 pandemic. Commercially available simulators with optimum fidelity are costly and may be difficult to sustain because of their recurring cost. The development of low-cost simulators with optimum fidelity is the need of the hour. METHODS We developed animal tissue-based simulators for imparting skills training to surgical residents on some basic and advanced general surgical procedures. Porcine tissue and locally available materials were used to prepare these models. The models were pilot-tested. Standard operating procedures were developed for each skill that was shared with the participants well before the ‘hands-on’ exercise. An online pre-test was conducted. The training was then imparted on these models under faculty guidance adhering to Covid-19-appropriate behaviour. This was followed by a post-test and participant feedback. The entire exercise was paperless. RESULTS Sixty residents were trained in 10 sessions. Most of the participants were men (44; 73%). The mean pre-test and post-test scores were 40.92 (standard deviation [SD] 6.27) and 42.67, respectively (SD 4.06). Paired sample t-test suggested a significant improvement in the post-test score (p<0.001). The activity and the models were well appreciated by the residents. CONCLUSION The animal tissue-based indigenous models are easy to prepare, cost-effective and provide optimum fidelity for skill training of surgical residents. In addition to skill acquisition, training on such modules may alleviate the stress and anxiety of the residents associated with the loss of surgical training during a time-bound residency period.

Role of biomarkers in risk stratification of acute coronary syndrome.

Diagnosis of acute coronary syndrome (ACS) encompasses a wide spectrum of myocardial ischaemia varying from assuredly benign to potentially fatal. Cardiac biomarkers have had a major impact on the management of this disease and are now the cornerstone in its diagnosis and prognosis. In this review we discuss both the established and the newer emerging biomarkers in ACS and their role in highlighting not only myocardial necrosis but also different facets of the pathophysiology of ACS. The future of cardiac biomarker testing may be in multimarker testing to better characterize each patient of ACS and thus tailor both short-term and long-term therapy accordingly. This novel concept, however, needs to be tested in clinical trials for its incremental value and cost-effectiveness.

Impact of current knowledge on CVD prevention.

As the cardiovascular disease (CVD) epidemic ebbs from the Western countries its impact shift towards developing nations. CVD has already emerged as the leading cause of mortality in India and other developing countries. However, the knowledge in CVD prevention gained from the West provides an opportunity to reduce the morbidity and mortality due to these diseases. The stress needs to be on the implementation of current knowledge and to eliminate barriers at various levels in CVD prevention. This article discusses the role of high risk-strategy for CVD prevention, the hurdles in its implementation, and how to overcome them.

Use of Amplatzer duct occluder to close severely hypertensive ducts: utility of transient balloon occlusion.

BACKGROUND: The dividing line between a patent ductus arteriosus with severe but reversible pulmonary artery hypertension and an Eisenmenger duct remains elusive. Increasing experience with the Amplatzer duct occluder has made non-surgical closure of even large patent ductus arteriosus simple and safe. However, data on the use of this device in severly hypertensive ducti is sparse. METHODS AND RESULTS: There were six patients (2 males, 4 females), wherein transient ductal occlusion was done with an embolectomy balloon catheter. The post-occlusion hemodynamics along with overall clinical and hemodynamic assessment was used to decide the likelihood of benefit of closure and the choice of the device. In four of six patients of patent ductus arteriosus with severe pulmonary artery hypertension (pulmonary vascular resistance index> 8.0 U/m2) the duct was successfully closed using the Amplatzer duct occluder, while in two an Amplatzer ventricular septal defect occluder was used. CONCLUSIONS: Transient balloon occlusion is quite helpful for assessing patients with patent ductus arteriosus with severe pulmonary hypertension, and short-term non-invasive follow-up has shown this strategy to be safe and useful.

An infant with "dying spells".

A 45-day-old infant presented with the unusual and intriguing symptom of episodic crying and loss of consciousness. The infant was discovered to have a vascular compression of the trachea by the innominate artery, almost serendipitously. He was cured of his symptoms by anterior suspension of the innominate artery.

Isolation of the left subclavian artery.

Two cases of isolation of the left subclavian artery from the aortic arch are reported for the rarity of this lesion. One patient was diagnosed clinically, the other after angiography. The isolated left subclavian artery was reimplanted in one patient. This rare anomaly has clinical and surgical relevance and should be diagnosed by diligent clinical and angiographic evaluation.