RETINA ON CORNEA IN CASE OF MECHANICAL OCULAR INJURY: A CASE REPORT

Ocular injuries are one of the major factors for mono-ocular blindness in adult population. Majority of mechanical ocular injuries occurs in factories. Our patient had injury with grinder blade. On examination, vision was no perception of light in right eye, corneoscleral tear along with lens and vitreous in the wound. Ocular trauma score was 1 with chances of visual recovery nil. After primary treatment, when we had taken patient under general anaesthesia, we found whole retina lying over cornea which was a rare event. We excised that tissue and tear repair was done. None of the factors which can lead to expulsive haemorrhage was observed in patient. We have seen many patients with extensive corneoscleral tear but never seen retina coming out of the wound. We recommend to use all protective equipments for workers to prevent industrial ocular injuries.

Effects of glenohumeral corticosteroid injection on stiffness following arthroscopic rotator cuff repair: a prospective, multicentric, case-control study with 18-month follow-up

Background@#This study aimed to analyze the efficacy of single-dose corticosteroid injection (CSI) administered at 6 weeks postoperative to treat stiffness following arthroscopic rotator cuff repair (ARCR). @*Methods@#In this prospective, multicentric, case-control study, post-ARCR stiffness at 6 weeks was treated with either a single dose of intra-articular CSI (CSI group) or physical therapy with oral analgesics (non-CSI group). Pain intensity according to visual analog scale (VAS), functional outcome using the Constant Murley Shoulder Score, time to return to activities of daily living (ADLs), and retear rate were recorded at 6 weeks, 9 weeks, 12 weeks, 6 months, 12 months, and 18 months postoperatively in both groups. @*Results@#A total of 149 patients (54.5%) in the CSI group and 124 patients (45.5%) in the non-CSI group were included in this study. Pain and function were significantly better in the CSI group at 9-week, 12-week, and 6-month (P<0.001) follow-up, whereas they were not significantly different when the groups were compared at 12- and 18-month follow-up. The mean duration to return to ADLs was significantly shorter (P<0.001) in the CSI group. The incidence of retears was not significantly different (P=0.36) between groups at the end of 18 months of follow-up. @*Conclusions@#Single-dose intra-articular CSI administered at 6 weeks postoperative to treat post-ARCR stiffness significantly improved pain, function, and duration of return to ADLs without increasing the risk of retears compared to patients who did not receive intra-articular CSI.

Demographic profile of patients seeking teleophthalmology consultations through e-Sanjeevani: Retrospective analysis of 5138 patients from North India

Purpose: To report the demographic profile of patients registered through e?Sanjeevani OPD seeking teleophthalmology services. Methods: This was a cross?sectional data analysis of patients with ocular complaints registered through the e?Sanjeevani platform at a tertiary care center. It was a doctor?to?doctor consultation, where teleophthalmology consultants provided teleconsultation services at subcenters (SCs), primary health centers (PHCs), and community health centers (CHCs). Data regarding the patient’s age, gender, residential address, provisional diagnosis, and treatment prescribed were recorded from May 2021 to February 2022 (9 months). Results: In total, 5138 patients were teleconsulted from the mean age of the patients was 37.64 ± 19.34 years. Among these patients, 44% were males and 56% were females. Most of the teleconsultation calls were made from Palwal district (19.8%), followed by Hisar (14.5%) and Sonipat. The most common provisional diagnosis was dry eyes (21%), followed by allergic conjunctivitis (18%), refractive error (15%), and cataract (14%). These constituted approximately 70% of the diagnosis made through teleconsultations. The rest of the eye problems were diagnosed as stye, blepharitis, nasolacrimal duct obstruction, pterygium, subconjunctival hemorrhage, etc., The majority of the patients were managed medically (56.6%) and approximately 11.6% of the patients were referred for surgical intervention. Conclusion: e?Sanjeevani is an effective way to provide teleconsultations to patients in remote locations. The majority of the patients seeking ophthalmology consultations can be managed conservatively. Patients requiring surgical intervention can be referred timely, thus avoiding any delay in treatment

Diving ranula- A case report and review

Pathologies developing on the floor of the mouth create difficulty for the patient and pose a challenge to oral physicians both clinically and surgically as this area manifests numerous vital structures. While diagnosing, an accurate differential diagnosis should be established to rule out other lesions that usually occur on the floor of the mouth such as ranula, lipoma, salivary gland tumours, dermoid cyst, and vascular lesions. Cystic lesions developing from the salivary glands are commonly known as "mucoceles", these lesions develop mostly in relation to the minor salivary glands and rarely, in relation to the major salivary glands. Mucoceles basically are of two types: Mucous retention cyst and Mucous extravasation cyst. A Ranula is a form of mucous extravasation cyst which commonly occurs on the floor of the mouth. Deep seated lesions when herniate through mylohyoid muscle give rise to a clinical variant; plunging or cervical Ranula. Various treatment modalities for ranula has been suggested that include excision of lesion with or without excision of ipsilateral sublingual salivary gland, marsupialization, aspiration of cystic fluid, sclerotherapy, incision and drainage and many more. Those various treatments have shown diverse results. Here we present a case report and review of Sublingual Ranula in a 47-year-old female patient, treated with the excision of the Ranula. A follow-up of 3 months revealed no recurrence.

Insulating frontline COVID warriors from moral and mental distress during COVID pandemic- An Evidence based review

The commencement of Covid-19 pandemic has bothered moral and mental health of frontline Covid warriors. Scarcity of personal protective equipments, protracted working hours, improper hydration, hostile healthcare system, unprecedented settings and hurdles in provision of quality care have constituted a deterioration of mental health in healthcare workers. Frontline health care workers often experience burnout, anxiety, depression, insomnia and stress-related disorders. Moral distress rearing from baffl ing decisions regarding issuance of scarce resources and care to Covid-19 positive patients further amplify to strain health worker loads. Therefore, it is vital to admonish mental health of health care workers consistently using collaborative strategies at individual, system and organisational level. This article reviews the moral distress and mental health problems confronted by frontline health care workers and explores various strategies which ought to be executed to cope with them.

GROSS CHARACTERIZATION OF NEOPLASTIC LYMPHADENOPATHY.

Background: Neoplastic lesions are one ofthe causes of lymphadenopathy, which harbors a wide spectrum of diseases.It is essential to conduct a lymph node biopsy and histopathological examination of the enlarged nodes. Histological processing begins with noticing down the gross features.Itis possible torecognize thediseaseprocess bygross lyexamining lymphnodes. Objectives: The objective of thisstudy isto characterize the neoplastic lymph node grossly on the premise of itssize,shape, cutsection appearance and pattern of in volvement whether presentingas single,multipleormatted. Methods: The study used cross-sectional, quantitative methods, conducted in a hospital over a one-year period from 30thApril 2018 to 29thApril 2019 at Department of Pathology, TUTH. Ourstudy included participants with neoplastic lymph nodes who underwent excisional and lymph node biopsynodedissection, along with other radical procedures. Wenoted the grossfeatures of aneoplastic lymphnode. Results: The mean diameter of the largest lymph node with a neoplastic lesion was 2.02± 0.86 cm. The majority of neoplastic lymph nodes were round.Matted lesionswere found in seven cases, discretemultiple lymph nodesinvolved in 16 cases, and single lymph nodewasinvolved in 16 cases. Metastasisinvolving lymph nodes was most common in invasive carcinoma of the breast, NST.Among primary tumors of lymph nodes, most were Hodgkin lymphomas.Typically, lymphnodes were irregular and showed homogenous brown and irregular grey white areas on cut sections. Conclusion: Neoplastic lymph nodes are characterized by different gross characteristics depending on theirshape, cutsection, and location. Pattern oflymph nodesinvolved is associatedwith origin of cancer(metastatic or primary tumor oflymph node).For amore complete understanding of gross features of lymph nodes, a rigorous study is recommended to identify whether the gross appearance of lymph nodes correlates with neoplastic pathology and to do similar studies with larger sample sizes.

Inflammatory infiltrates in melanocytic lesions / Infiltrados inflamatorios en lesiones melanocíticas

SUMMARY: Inflammatory infiltrates are frequently present in melanocytic lesions, with different distribution and composition. Much attention has been devoted to tumor-infiltrating lymphocytes (TIL) in the tumor microenvironment, establishing their prognostic and predictive value in many malignancies, including melanoma. However, lymphocytes, albeit the most numerous and consistent presence, constitute only part of the immune microenvironment. Other inflammatory cells, including neutrophils, plasma cells, eosinophils and mast cells, are found in melanoma and other melanocytic lesions.Few studies offer a detailed count of these inflammatory infiltrates across the spectrum of melanocytic lesions. By using whole slide image analysis and open source software, in the present study we report the enumeration of different inflammatory infiltrates in benign melanocytic nevi, dysplastic nevi, melanoma in situ and invasive malignant melanomas. Significant higher numbers of plasma cells and neutrophils were observed in melanoma. These results indicate that composition of the inflammatory infiltrate may contribute to the diagnostic algorithm of melanocytic lesions.

RESUMEN: Los infiltrados inflamatorios están presentes con frecuencia en las lesiones melanocíticas, con diferente distribución y composición. Se ha prestado mucha atención a los linfocitos infiltrantes de tumores (TIL) en el microambiente tumoral, estableciendo su valor pronóstico y predictivo en muchas neoplasias malignas, incluido el melanoma. Sin embargo, los linfocitos de presencia más numerosa y constante, constituyen solo una parte del microambiente inmunológico. Otras células inflamatorias, incluidos neutrófilos, células plasmáticas, eosinófilos y mastocitos, se encuentran en el melanoma y otras lesiones melanocíticas. Pocos estudios ofrecen un recuento detallado de estos infiltrados inflamatorios en todo el espectro de lesiones melanocíticas. Mediante el uso de análisis de imágenes de diapositivas completas y software de código abierto, en el presente estudio informamos la enumeración de diferentes infiltrados inflamatorios en nevos melanocíticos benignos, nevos displásicos, melanoma in situ y melanomas malignos invasivos. Se observaron números significativamente más altos de células plasmáticas y neutrófilos en el melanoma. Estos resultados indican que la composición del infiltrado inflamatorio puede contribuir al algoritmo diagnóstico de las lesiones melanocíticas.

Protection of palmitic acid treatment in RAW264.7 cells and BALB/c mice during Brucella abortus 544 infection

Background@#We previously elucidated the protective mechanism of Korean red ginseng oil (RGO) against Brucella abortus infection, and our phytochemical analysis revealed that palmitic acid (PA) was an abundant component of RGO. Consequently, we investigated the contribution of PA against B. abortus. @*Objectives@#We aimed to investigate the efficacy of PA against B. abortus. infection using a murine cell line and a murine model. @*Methods@#Cell viability, bactericidal, internalization, and intracellular replication, western blot, nitric oxide (NO), and superoxide (O2 - ) analyses and flow cytometry were performed to determine the effects of PA on the progression of B. abortus. infection in macrophages. Flow cytometry for cytokine analysis of serum samples and bacterial counts from the spleens were performed to determine the effect of PA in a mouse model. @*Results@#PA did not affect the growth of B. abortus.. PA treatment in macrophages did not change B. abortus. uptake but it did attenuate the intracellular survivability of B. abortus.. Incubation of cells with PA resulted in a modest increase in sirtuin 1 (SIRT1) expression.Compared to control cells, reduced nitrite accumulation, augmented O2 - , and enhanced pro-inflammatory cytokine production were observed in PA-treated B. abortus.-infected cells.Mice orally treated with PA displayed a decreased serum interleukin-10 level and enhanced bacterial resistance. @*Conclusions@#Our results suggest that PA participates in the control of B. abortus. within murine macrophages, and the in vivo study results confirm its efficacy against the infection. However, further investigations are encouraged to completely characterize the mechanisms involved in the inhibition of B. abortus. infection by fatty acids.

Protection of palmitic acid treatment in RAW264.7 cells and BALB/c mice during Brucella abortus 544 infection

Background@#We previously elucidated the protective mechanism of Korean red ginseng oil (RGO) against Brucella abortus infection, and our phytochemical analysis revealed that palmitic acid (PA) was an abundant component of RGO. Consequently, we investigated the contribution of PA against B. abortus. @*Objectives@#We aimed to investigate the efficacy of PA against B. abortus. infection using a murine cell line and a murine model. @*Methods@#Cell viability, bactericidal, internalization, and intracellular replication, western blot, nitric oxide (NO), and superoxide (O2 - ) analyses and flow cytometry were performed to determine the effects of PA on the progression of B. abortus. infection in macrophages. Flow cytometry for cytokine analysis of serum samples and bacterial counts from the spleens were performed to determine the effect of PA in a mouse model. @*Results@#PA did not affect the growth of B. abortus.. PA treatment in macrophages did not change B. abortus. uptake but it did attenuate the intracellular survivability of B. abortus.. Incubation of cells with PA resulted in a modest increase in sirtuin 1 (SIRT1) expression.Compared to control cells, reduced nitrite accumulation, augmented O2 - , and enhanced pro-inflammatory cytokine production were observed in PA-treated B. abortus.-infected cells.Mice orally treated with PA displayed a decreased serum interleukin-10 level and enhanced bacterial resistance. @*Conclusions@#Our results suggest that PA participates in the control of B. abortus. within murine macrophages, and the in vivo study results confirm its efficacy against the infection. However, further investigations are encouraged to completely characterize the mechanisms involved in the inhibition of B. abortus. infection by fatty acids.

An experimental study to evaluate the role of aspirin and metformin in prevention of depression in rats

Background: Depression was seen to be associated with an increased level of inflammatory biomarkers along with the disturbance in the monoamine neurotransmitter system. Current therapies are mostly focussed on the neurotransmitters imbalance but due to increasing cases of treatment failure there is a need to shift our treatment focus to other potential therapies. This study aimed to evaluate the preventive role of aspirin and metformin in stress induced model of depression in wistar rats.Methods: Fifty four wistar rats were randomly divided into nine groups as normal control, experimental control, aspirin (30 mg/kg, 60 mg/kg), metformin (50 mg/kg, 100 mg/kg), two combination groups and imipramine (15 mg/kg). Depression model was created by the induction of chronic unpredictable mild stress (CUMS) for consecutive 28 days. Behavioural assessment was done by evaluating immobility time in forced swim test (FST) and sucrose preference ratio (SPR) in sucrose preference test. The data were analysed by analysis of variance (ANOVA) test using SPSS software. P<0.05 was considered to be statistically significant.Results: The CUMS led to an increase in immobility time and decrease in SPR. Aspirin and Metformin alone and their combinations showed statistically significant response in preventing the immobility time to increase (p<0.001) and SPR to decrease (p<0.001). However the response of Aspirin was comparable with Imipramine but the response of Metformin was not as significant as of Imipramine (p>0.05).Conclusions: Aspirin and metformin might have a potential role in the prevention of depression.

Cost comparison of commonly used antidepressant drugs with drug price control order in India

Background: Price of a drug is an important factor for compliance to the treatment. So, to overcome the high prices of drugs, National Pharmaceutical Pricing Authority (NPPA) under government of India has issued Drug Price Control Order (DPCO) list containing commonly used drugs. Pharmaceutical companies can be punished if they keep their prices higher than the ceiling price mentioned in the DPCO. To find out the price variations of commonly used antidepressant drugs included in DPCO list of 29th April 2019.Methods: A list of all oral antidepressant drugs included in DPCO of 29th April 2019 and available in Indian market was procured from medguide India. Analysis of number of total brands following as well as not following DPCO ceiling price was done.Results: Author found 17 formulations of four antidepressant drugs included in DPCO. Total 556 brands found out of which 84.6% were following the DPCO and 15.4% of brands prices were higher than the ceiling price of DPCO.Conclusions: Though large number of companies are following the DPCO but still strict regulation is needed to further increase the compliance of guidelines.

Effectiveness of Two Types of Photostimulable Phosphor Plate Plastic Barrier Envelopes for Prevention of Microbiological Contamination

Abstract Objective: To compare the effectiveness of two types of commercially available photostimulable phosphor plate (PSP) protective barrier envelopes to prevent microbiological contamination. Material and Methods: In this cross-sectional study, 80 barrier envelopes were tested in 40 volunteers. The PSP plates were placed individually in Asia Teb and Soredex protective barrier envelopes and were placed in the mouth for two minutes, similar to periapical films. The protective barrier envelopes were then removed under sterile conditions, and the sensors were placed on different culture media. The number of colonies on each plate was counted. Data were analyzed using SPSS via McNemar and Wilcoxon tests. Results: Bacterial growth was noted in 17.5% of PSPs with Soredex, and 32.5% of PSPs with Asia Teb barrier envelopes. Gram-positive bacilli were the most commonly isolated bacteria. The difference between the Asia Teb and Soredex barrier envelopes for the protection of microbiological contamination was not significant (p>0.05). Conclusion: The use of different types of protective barrier envelopes was not sufficient for prevention of microbiological contamination of PSP plates, and some adjunct modalities were required to decrease microbiological contamination of PSP plates.

Leishmania tropica: The comparison of two frequently-used methods of parasite load assay in vaccinated mice

Objective: To compare limiting dilution assay and real-time PCR methods in Leishmania tropica parasite load measurement in vaccinated mice.Methods: BALB/c mice were vaccinated by Leishmania tropica soluble Leishmania antigen or recombinant Leishmania tropica stress-inducible protein-1 with/without adjuvant. After three vaccinations, mice were challenged by Leishmania tropica promastigotes. Two months after challenge, the draining lymph nodes of mice footpad were removed and parasite load was assayed by limiting dilution assay and real-time PCR methods. Limiting dilution assay was done by diluting tissue samples to extinction in a biphasic medium. For real-time PCR, DNA of the lymph nodes was extracted, equal dilutions of each sample were prepared and hot-start real-time PCR was done using appropriate primers. The data of the two methods were compared by appropriate statistical methods. Results: Both methods were able to measure different levels of parasite load in vaccinated/unvaccinated mice. In addition, wherever parasite load of a group was estimated high (or low) by one method, the estimated parasite load by another method was the same, although statistically significant differences were found between some groups. Conclusions: Both methods lead to approximately similar results in terms of differentiating parasite load of the experimental groups. However, due to the lower errors and faster process, the real-time PCR method is preferred.

Effect of Vigna radiata, Tamarix ramosissima and Carthamus lanatus extracts on Leishmania major and Leishmania tropica: An in vitro study / 中草药·英文版

Objective: Current therapy strategies of leishmaniasis have some problems such as high cost, toxicity and side effects. Plant extracts can be a source of drugs to control leishmaniasis. In this study, the effect of hydroalcoholic and chloroformic extracts of Vigna radiata, Tamarix ramosissima, and Carthamus lanatus on Leishmania major and L. tropica was studied. Methods: The plant samples were collected from west of Iran and their extracts were prepared. Anti-promastigote activity assay of all extracts was done using tetrazolium-dye assay. Results: Only high concentrations of V. radiata and C. lanatus were able to inhibit Leishmania, while both high and low concentrations of T. ramosissima had antileishmanial effect. No difference was observed between hydroalcoholic with chloroformic extract of each plant. Conclusion: Altogether, the results revealed the antileishmanial activity of T. ramosissima extracts against L. major and L. tropica, indicating its potential as an antileishmanial agent.

Leishmania tropica: The comparison of two frequently-used methods of parasite load assay in vaccinated mice

Objective: To compare limiting dilution assay and real-time PCR methods in Leishmania tropica parasite load measurement in vaccinated mice. Methods: BALB/c mice were vaccinated by Leishmania tropica soluble Leishmania antigen or recombinant Leishmania tropica stress-inducibleprotein-1 with/without adjuvant. After three vaccinations, mice were challenged by Leishmania tropica promastigotes. Two months after challenge, the draining lymph nodes of mice footpad were removed and parasite load was assayed by limiting dilution assay and real-time PCR methods. Limiting dilution assay was done by diluting tissue samples to extinction in a biphasic medium. For real-time PCR, DNA of the lymph nodes was extracted, equal dilutions of each sample were prepared and hot-start real-time PCR was done using appropriate primers. The data of the two methods were compared by appropriate statistical methods. Results: Both methods were able to measure different levels of parasite load in vaccinated/unvaccinated mice. In addition, wherever parasite load of a group was estimated high (or low) by one method, the estimated parasite load by another method was the same, although statistically significant differences were found between some groups. Conclusions: Both methods lead to approximately similar results in terms of differentiating parasite load of the experimental groups. However, due to the lower errors and faster process, the real-time PCR method is preferred.

Survey of Usage and Type of Topical Anesthesia among Dentists of Tricity

Introduction: Local anaesthesia injection is widely acceptedas the gold standard for pain management during variousdental procedures. Intra-oral topical anaesthesia not onlyreduces the pain of injection prick but also several minordental procedures can be carried out under topical anaesthetic.Study aimed to determine the usage, type & effectiveness ofvarious topical anaesthetics used for minor dental proceduresin pediatric patients.Material and Methods: A self-structured, closed endedquestionnaire was emailed to 100 private dental practitionersin the tricity and were asked to fill and mail it back.Results: 59% dentists responded, out of them 70.7%routinely used topical anesthetic. 64.8% used Lidocaine gelfor administration of local anesthesia. 24.1% used topicalanesthetic for extraction of nearly exfoliating deciduous teeth.42.6% responded that the effect of topical anesthetic wasachieved between 30 seconds to 1 minute.Conclusion: All the dentists were aware of using topicalanesthetic and the most preferred delivery system was gel.

The use of cyclooxygenase-2 inhibitors in depression: a narrative review of the state of evidence

Multiple lines of evidence suggest that inflammation contribute to the pathophysiology of depression. Various studies have found that patients with major depression have higher levels of pro-inflammatory cytokines like interleukin-1, interleukin-6, tumor necrosis factor-alpha and C-reactive protein. As a consequence of above findings this narrative literature review was done to look for the role of cyclooxygenase (COX)-2 inhibitors in the patients of depression. A web based search was done using the keywords like antidepressants, anti-inflammatory treatment, celecoxib, depression, neuro inflammation in well recognized databases like PubMed, Google scholar from the year 2006 to 2019 to come out with data that matches our inclusion criteria that have been pooled and critically analyzed. Although the exact mechanism remains to become elucidated the results suggest that COX-2 have beneficial role in treatment of depression and it may be used as an adjunct to the anti-depressant treatment as it may hasten the response to current treatment without any serious side effects.

Role of sleep on alertness among medical students from a tertiary care hospital, Thrissur district, Kerala: cross-sectional study

Background: Alertness and ability to perform vary as functions of homeostatic factors such as sleep duration, sleep quality, and time awake. As far as medical students are concerned, alertness during the lectures is important due to their vast curriculum, and their alertness aids in the development of better doctors in their future. Though the importance of sleep is known, there is scarcity of studies on how adequate sleep among medical students affects their alertness during lecture classes. The aim was to study effect of sleep duration on alertness among medical students from a tertiary care hospital in Thrissur district, Kerala.Methods: A cross-sectional study was conducted among undergraduate medical students and alertness was assessed following afternoon lecture classes, using a Stanford sleepiness scale questionnaire. The sample size was calculated with a formula 4PQ/d2 and total 202 undergraduate students were included. The data regarding overnight sleep duration and post lunch nap was also collected using a semi-structured questionnaire.Results: Based on stanford sleepiness scale 66.3% of students were alert and responsive, 29.2% were not alert and only 4.5% of students were sleepy following afternoon lecture classes. Out of total 202 undergraduate students 43.6% of them had poor overnight sleep and only 32.7% had taken post lunch nap. There was a statistically significant association between alertness and post lunch nap (p=0.01).Conclusions: Those students who had good overnight sleep and post lunch nap had better alertness during lecture classes.

Knowledge, attitude and practice towards adverse drug reactions reporting in post graduate students of a tertiary care hospital

Background: Adverse Drug Reactions (ADRs) are a major cause of morbidity and mortality. Under reporting of ADRs by health care professionals is a very common problem worldwide. So, the present study was planned to assess the knowledge, attitude and practices of postgraduate (PG) students towards ADR reporting and suggest possible ways for improvement.Methods: It was a cross sectional questionnaire-based study conducted among 44 PG students using a questionnaire with questions on knowledge (21), attitude (13) and practices (15) of ADR reporting. The questionnaire was analyzed question wise and the percentage was calculated using Microsoft Excel spreadsheet in Microsoft Office 2010 software.Results: Most of them were aware of the term pharmacovigilance (PV) (95.45%). 54.55% agreed to be trained on how to report an ADR. 88.63% knew about the existence of pharmacovigilance committee in the institute.93% of participants knew that Central Drug Standard Control Organization (CDSCO) is responsible for monitoring of ADRs. 56.82% were aware about VIGIBASE an online software to report ADR. 81.82% of participants had agreed to witness ADRs in patients but only 38.64% reported them. The main reason behind it was non – availability of ADR forms. 42.55% opine that mobile based app would be the most preferred method to send ADR information to an ADR reporting center.Conclusions: There exists a huge gap between ADR experienced and ADR reported by PG students. Participants agreed upon necessity of reporting ADR and periodic briefing about PV.