A comparative study of cord blood lipid profile in term, pre term and small for gestational age - appropriate for gestational age neonates

Background: Cord blood lipid profile in neonates helps to screen for neonatal dyslipidaemia which is associated with long term morbidity mainly cardiovascular disease.Methods: The present study is a observational study done in government medical college, Chidambaram for a period of 2 years from October-2020 till September-2022 with 222 term and pre-term small or appropriate for gestational age (AGA) neonates using cord blood lipid profile.Results: In the present study of above mentioned 222 neonates, preterm accounts for 30.1% and term neonates accounts for 69.9%. AGA was 63.1% and SGA was 36.9%. Term AGA was 38.2%, term SGA 31.5%, preterm AGA was 24%, preterm SGA was 5.4%. Conclusions: Preterm AGA had higher cord lipid profile values compared to the term AGA neonates. Preterm SGA neonates had lower cord lipid profile of HDL, and LDL as compared to preterm AGA neonates. SGA neonates had higher total cholesterol, triglycerides and VLDL compared to AGA neonates. SGA neonates had lower LDL and HDL as compared to AGA neonates.

A successful conservative management of cervical ectopic pregnancy

Cervical ectopic pregnancy is a rare life-threatening condition with an incidence of less than 1% among all ectopic pregnancies. A 27-year-old primigravida presented with spotting per vaginum following 4 weeks 5 days of amenorrhea. Transvaginal ultrasound done at 4 weeks 5 days showed a gestational sac located in the anterior wall of cervix, diagnosis of cervical ectopic pregnancy was made. Initial serum beta hCG titre was 4106 mIU/ml. Serial monitoring of serum beta hCG done showed increasing values. Hence, decided for medical management with single dose of injection methotrexate, as the diagnosis was made at an early gestation and patient was hemodynamically stable. On follow up, serum beta hCG did not fall significantly, hence multidose methotrexate regimen was initiated. She responded to it, but she continued to have persistent bleeding per vaginum with fall in hemoglobin levels, hence sorted for surgical management which included suction and evacuation, after ligation of descending cervical artery and subsequently cervical tamponade. Intraoperative period was uneventful. On follow-up, patient was asymptomatic and vitals stable. Serum beta hCG done 2 weeks post procedure was below 5 mIU/ml and resumed spontaneous cycles after a month. Thus, early detection and accurate diagnosis of cervical ectopic pregnancy using ultrasound and serial beta hCG titre monitoring becomes a cornerstone of management. We present this case as it was her index pregnancy, with a need to preserve future fertility, successful conservative management of Cervical ectopic pregnancy with combination of medical and surgical intervention.

Efficacy of pulmonary telerehabilitation on exercise tolerance, fatigue, perceived exertion, depression, and quality of life in COVID-19 survivors / Eficácia da telereabilitação pulmonar na tolerância ao exercício, fadiga, percepção de esforço, depressão e qualidade de vida em sobreviventes de COVID-19

INTRODUCTION: Telerehabilitation advanced significantly with the emergence of COVID-19 and the recommendation of limiting physiotherapist-patient contact time whenever practicable. The effectiveness of telerehabilitation on those who had a longer stay in hospital and on oxygen support following discharge is still under question. OBJECTIVES: To evaluate the effects after six weeks of pulmonary telerehabilitation on exercise tolerance, fatigue level, perceived exertion, symptoms of depression and quality of life in patients surviving COVID-19. MATERIALS AND METHODS: A quasi-experimental study was conducted on 25 post-COVID-19 patients following discharge in a home environment setting. The participants were advised to prepare equipment such as oxygen concentrator, B-type oxygen cylinder (backup), lengthy oxygen tubes, finger pulse oximeter, mini static pedal exerciser, incentive spirometry, weight cuffs or water bottles and sandbags. After six weeks of telerehabilitation, the patients underwent assessments including initial oxygen saturation (SPO2), heart rate, peak oxygen demand during exercise to maintain baseline SPO2, peak heart rate, maximum drop in SPO2, recovery time to baseline SPO2 measured with a pulse oximeter and stopwatch, peak perceived exertion using the Borg Dyspnea Scale, peak fatigue score using the visual analog scale (VASF), quality of life assessed with the SF-36 questionnaire, and mental health status evaluated with the Hamilton Depression Scale (HAMD). One-way repeated measure ANOVA and paired t-test were used. RESULTS: Significant improvements following the intervention on the initial SPO2 (F (2.12, 23.13) = 21.0, p< 0.05) and quality of life also showed significant improvement (mean difference =29.92, p< 0.05). CONCLUSION: Six weeks of comprehensive pulmonary telerehabilitation with simple equipment improved tolerance to exercise, fatigue, perceived exertion, symptoms of depression and quality of life for post-COVID-19 patients.

INTRODUÇÃO: A telereabilitação avançou significativamente com o surgimento da COVID-19 e a recomendação de limitar o tempo de contato entre fisioterapeutas e pacientes sempre que possível. A eficácia da telereabilitação em pacientes que permaneceram mais tempo no hospital e necessitaram de suporte de oxigênio após a alta ainda está em questão. OBJETIVO: Para avaliar os efeitos após seis semanas de telereabilitação pulmonar na tolerância ao exercício, nível de fadiga, percepção de esforço, sintomas de depressão e qualidade de vida em pacientes sobreviventes de COVID-19. MATERIAIS E MÉTODOS: Foi realizado um estudo quase-experimental com dezesseis pacientes pós-COVID-19 selecionados de um hospital multispecializado. Os participantes foram orientados a preparar equipamentos como concentrador de oxigênio, cilindro de oxigênio tipo B (reserva), tubos de oxigênio longos, oxímetro de pulso, exercitador de pedal estático, espirômetro incentivador, pesos de tornozelo ou garrafas d'água e sacos de areia. Após seis semanas de telereabilitação, os pacientes foram submetidos a avaliações, incluindo saturação inicial de oxigênio (SPO2), frequência cardíaca, demanda máxima de oxigênio durante o exercício para manter a SPO2 basal, frequência cardíaca máxima, queda máxima na SPO2, tempo de recuperação para SPO2 basal medido com um oxímetro de pulso e cronômetro, esforço percebido máximo usando a Escala de Dispneia de Borg, pontuação máxima de fadiga usando a escala analógica visual (VASF), qualidade de vida avaliada com o questionário SF-36 e estado de saúde mental avaliado com a Escala de Depressão de Hamilton (HAMD). RESULTADOS: Melhorias significativas após a intervenção foram observadas na SPO2 inicial (F (2,12, 23,13) = 21,0, p <0,05) e na frequência cardíaca (F (1,839, 20,23) = 43,73, p <0,05), demanda máxima de oxigênio durante o exercício para manter a SPO2 basal (F (1,487, 16,36) = 8,96, p <0,05), esforço percebido máximo (F (5, 55) = 112,51, p <0,05), pontuação máxima de fadiga (F (1,755, 19,30) = 67,44, p <0,05), frequência cardíaca máxima (F (1,798, 19,78) = 50,99, p <0,05), queda máxima na SPO2 (F (2,467, 27,14) = 41,46, p <0,05) e tempo máximo de recuperação para alcançar a SPO2 basal (F (5, 55) = 78,89, p <0,05). A análise de seis semanas pós-intervenção nos sintomas depressivos (diferença média = 11,25, p <0,05) e na qualidade de vida também mostrou melhoria significativa (diferença média = 29,92, p <0,05). CONCLUSÃO: Seis semanas de telereabilitação pulmonar abrangente com equipamentos simples melhoraram a tolerância ao exercício, a fadiga, a percepção de esforço, os sintomas de depressão e a qualidade de vida em pacientes pós-COVID-19.

Magnitude, risk factors and immediate outcome of external congenital anomalies in neonates in government Cuddalore medical college and hospital: an observational study

Background: Despite the enormous incidence of congenital malformations in developing countries, there are presently few thorough data on these disorders because there are no birth defect registries. This study was conducted with objectives to determine the magnitude, risk factors and outcomes of external congenital anomalies in neonates born in government Cuddalore medical college and hospital.Methods: The present study is an observational study. All the neonates born during the study period were included in our study and risk factors and outcome of 201 babies born with external congenital anomalies were analyzed in detail.Results: The incidence of external congenital anomalies is 5.68% with 33% having major and 63% having minor anomalies. Among the major anomalies cleft lip and/or palate is the most common anomaly (5%) in our study. Overall sacral dimple is the most commonly observed external congenital anomaly (9.50%). Four-fifths of the newborns with external congenital anomalies were discharged. About 13% of the newborns with congenital anomalies expired.Conclusions: A comprehensive package that includes preventive services, diagnostic, surgical or medical intervention, financial assistance, counselling, and psychosocial support, as well as follow-up treatments like rehabilitation, is required in combating the incidence of congenital anomalies.

Multipotent mesenchymal stromal/stem cell-based therapies for acute respiratory distress syndrome: current progress, challenges, and future frontiers

Acute respiratory distress syndrome (ARDS) is a critical, life-threatening condition marked by severe inflammation and impaired lung function. Mesenchymal stromal/stem cells (MSCs) present a promising therapeutic avenue due to their immunomodulatory, anti-inflammatory, and regenerative capabilities. This review comprehensively evaluates MSC-based strategies for ARDS treatment, including direct administration, tissue engineering, extracellular vesicles (EVs), nanoparticles, natural products, artificial intelligence (AI), gene modification, and MSC preconditioning. Direct MSC administration has demonstrated therapeutic potential but necessitates optimization to overcome challenges related to effective cell delivery, homing, and integration into damaged lung tissue. Tissue engineering methods, such as 3D-printed scaffolds and MSC sheets, enhance MSC survival and functionality within lung tissue. EVs and MSC-derived nanoparticles offer scalable and safer alternatives to cell-based therapies. Likewise, natural products and bioactive compounds derived from plants can augment MSC function and resilience, offering complementary strategies to enhance therapeutic outcomes. In addition, AI technologies could aid in optimizing MSC delivery and dosing, and gene editing tools like CRISPR/Cas9 allow precise modification of MSCs to enhance their therapeutic properties and target specific ARDS mechanisms. Preconditioning MSCs with hypoxia, growth factors, or pharmacological agents further enhances their therapeutic potential. While MSC therapies hold significant promise for ARDS, extensive research and clinical trials are essential to determine optimal protocols and ensure long-term safety and effectiveness.

Mechanical Thrombectomy for In-Hospital Onset Stroke: A Comparative Systematic Review and Meta-Analysis / 대한뇌졸중학회지

Background@#and Purpose In-hospital onset stroke (IHOS) accounts for a significant proportion of large vessel occlusion acute ischemic strokes, leading to worse outcomes due to delays in evaluation and treatment. Limited data is available on the effectiveness of mechanical thrombectomy in IHOS patients. This study aims to assess the safety and efficacy of mechanical thrombectomy for patients with IHOS and compare the outcomes with those of community-onset strokes (COS). @*Methods@#We conducted a systematic review and meta-analysis following established guidelines, by searching PubMed, Scopus, Web of Science, and Embase databases up to April 11, 2023. Eligible studies reporting outcomes of interest were included, and relevant data was extracted and analyzed using Stata software version 17.0. @*Results@#In a meta-analysis of nine studies, comprising 540 cases of IHOS and 5,744 cases of COS, IHOS cases had a significantly lower rate of good functional outcomes on follow-up (35.46% vs. 40.74%, P<0.01) and a higher follow-up mortality rate (26.29% vs. 18.08%, P<0.01) compared to COS patients. Both groups had comparable successful recanalization rates (IHOS: 79.32% vs. COS: 81.44%, P=0.11), incidence rates of periprocedural complications (IHOS: 15.10%, COS: 12.96%, P=0.78), and symptomatic intracranial hemorrhage (IHOS: 6.24%, COS: 6.88%, P=0.67). It is worth noting that much of the observed effect size for mortality and good functional outcomes on follow-up was derived from only one and two studies, respectively. @*Conclusion@#While the current literature suggests that mechanical thrombectomy is a safe and effective treatment for IHOS, further research is necessary to comprehensively evaluate its impact, particularly during follow-up.

Impact of childbirth preparation sessions towards the willingness and ability of husbands to accompany their wives during childbirth in the delivery room

Background and Objective: Most Fathers-to-be within Indian setting find it difficult to cooperate with their spouse抯 labour and encounter a great deal of stress during the journey of Childbirth. The study objective is to assess the impact of Childbirth preparation sessions (CPS) in a private maternity centre at Chennai towards shaping the willingness and attitudes of fathers-to be regarding their willingness and ability to accompany their wives during childbirth in the delivery room and to compare the attitudes with those fathers who did not attend the Childbirth preparation sessions. Materials and methods: A pilot study was conducted between October 2022 to January 2023 at a tertiary maternity hospital in a metropolitan city (Chennai) with a convenient sample of fathers-to-be who attended (Group 1, n=30) CPS and those who did not attend (Group 2, n =30). A questionnaire was given to fathers who had less than 2 year old child to analyze the difference in willingness and ability to go to the labour room among those who attended child birth preparation sessions and those who did not. Results: All men were well educated Indians and the mean age of men who attended childbirth preparation sessions were 33 years and most of them were fathers-to-be for the first time. The results showed that fathers-to-be who attended the childbirth preparation sessions were more likely to express willingness to attend labour room. Though majority of men (51 men out of 60) were willing to go to the labour room, only 47 men were able to go to the labour room out of which 28 had attended the CPS. There was a high significance in their ability to go to the labour room among those who attended the CPS (P-value - 0.010). Conclusions: The preliminary results of this pilot study indicated that a well-structured and delivered CPS could not only enhance the shared role of fathers-to-be in the critical childbirth journey but also provide them with adequate psychosocial support.

A study of microbial pattern and antibiotic susceptibility in blood cultures among children aged upto thirty six months

Background: Sepsis is the most common cause of high morbidity and mortality among newborn, infants and young children. The organisms implicated in these infections vary with geographical alteration.so antibiotics used should be decided by local prevalence of microbial pathogen, and its bacterial susceptibility pattern. Methods: a prospective observational study among the different neonates and children aged 0 to 36 months. Blood samples are taken under aseptic precaution. Inocluted onto blood culture media (brain heart infusion broth). It is incubated at 37°C. Turbidity is observed daily and it is sub cultured on alternate days. If there is growth, the organism is identified by routine biochemical reactions and the antibiotic susceptibility test was done on the Muller Hinton agar using appropriate antibiotic discs. For testing antibiotic susceptibility, criteria defined by the clinical and laboratory standards institute (CLSI) were followed. Results: Among 148 subjects 102 found to be culture positive with positive rate of 69%. Gram negative organism is more prevalence in this study, most common isolates from gram negative sepsis was Klebsilla species (22.2%) followed by E. coli (18.1%). Conclusions: Gram negative organism form the majority of isolates in our setup with Klebsilla as the most common species among them, which was least sensitive to most of the drugs. Among gram positive organism MRSA as the most common isolates in our setup. Most of the antibiotic were sensitive. Limited and objective use of antibiotic therapy is a much-needed statergy and the new guidelines.

A Morphometric Study of Typical and Atypical Lumbar Vertebrae in South Indian Population

Introduction:The lumbar vertebrae are affected in conditions such as congenital defects, degenerative diseases, accidents, and cancer metastasis. A thorough knowledge of the morphometry of typical and atypical lumbar vertebrae in adults of South Indian population is needed for lumbar spine surgeries. MaterialsandMethods: Adescriptive study was done on 200 dry lumbar vertebrae, of which 100 were typical and 100 were atypical lumbar vertebrae. The following dimensions of both typical and atypical lumbar vertebrae were measured with digital vernier calipers: anteroposterior and transverse diameters of the body; anterior and posterior body heights; anteroposterior and transverse diameters of vertebral foramen; height, breadth, and width of the laminae; length, height, and width of the pedicles; transverse processes and spinous process; distance between the two superior articular processes; and the distance between the two inferior articular processes. All the measurements were tabulated. The mean and standard deviation were calculated for each of the parameters and the results were statistically analyzed. Results: The anteroposterior and transverse diameters of the body, the height of the laminae on both sides, the length and height of the spinous process, and the distance between the superior articular facets were significantly longer in atypical lumbar vertebrae than that of typical lumbar vertebrae (P < 0.05). There was no significant difference in measurements between both sides. Conclusion: The dimensions of vertebral foramen, transverse processes, spinous processes, and distance between articular processes were different from the dimensions of previous studies. The morphometric data obtained will be useful for orthopedic procedures on the lumbar vertebrae in South Indian population

Study on the effect of severe acute malnutrition on various echocardiographic parameters of the heart

Background: Malnutrition is a major cause for morbidity and mortality in children below 5 years of age in developing countries. According to National family health survey-5 (NFHS-5), stunting has reduced from 38.4% to 35.5%. Wasting has reduced from 21.0% to 19.3% and underweight prevalence has reduced from 35.8% to 32.1%. Acute malnutrition can lead to biochemical changes based on metabolic, hormonal and glucoregulatory mechanisms and can affect various organ systems. This study aims to determine the effect of malnutrition on various cardiac parameters by M mode echocardiography.Methods: A cross sectional observational study was conducted in 50 severe acute malnutrition children selected by convenient sampling between 6 months and 5 years of age of Government Cuddalore medical college for a period of 2 years and M mode echocardiography was done to assess various parameters of cardiac wall dimensions and cardiac mass and compared with age/body surface area specific values.Results: Among SAM children, 74% had decreased end diastolic diameter, 80% had decreased end systolic diameter and 88% had decreased posterior wall dimension. Ejection fraction and fractional shortening was in normal range for all children. 64% had decreased left ventricular mass and 56% had decreased left ventricular mass index.Conclusions: Dimensions of the heart and cardiac mass was reduced in majority of malnourished children. Systolic function of the heart was relatively preserved as demonstrated by normal ejection fraction and fractional shortening. Thus, echocardiography can serve as a valuable tool in detecting changes in cardiac structure and function in malnourished children.

A randomised controlled trial on effect of topical anaesthetics on injection pain during immunization in infants of 6 weeks to 6 months of age with pentavac vaccine

Background: Pain is a both a sensory and an emotional experience when untreated and unrecognized, it extracts a significant physiological, biochemical and psychological toll on both the children and family members. Vaccine injections are considered to be the most common cause of iatrogenic pain in childhood. Positive experience during vaccine injection like reducing injection pain with local anaesthetics can avoid pre procedural anxiety in future, needle phobias, healthcare avoidance behaviors and maintain trust in healthcare providers.Methods: This randomized controlled trial was done at immunization clinic of Rajah Muthiah Medical College Hospital over a period of 2 years.100 infants of age group 6 weeks to 6 months brought for Pentavac (DPT-Hib-Hepatitis B) combination vaccine were taken for study and allocated into control, intervention group (receiving local anaesthetic cream/lidocaine spray) and pain score was compared using modified behavioral pain score (MBPS).Results: Among the three groups studied, the mean pain scores after vaccine injection were minimum in group A (infants with topical occlusive EMLA cream), followed by group B (infants with topical LA spray), whereas control group of infants who did not receive any local anaesthesia exhibited higher pain scores values.Conclusions: Our study showing that topical occlusive EMLA cream significantly decreases injection pain in infants has applicability in clinical practice, where it can be routinely used in infants before administering intramuscular vaccine injections in settings where resources are not a constraint.

Perspectives of Teachers at Medical Colleges Across India regarding the Competency based Medical Education Curriculum – A Qualitative, Manual, Theoretical Thematic Content Analysis

Background: Competency-based medical education (CBME) curriculum has been implemented in India since 2019 with a goal to create an “Indian Medical Graduate” (IMG) possessing requisite knowledge, skills, attitudes, values, and responsiveness. Objectives: To explore teachers’ perceptions across India at medical colleges on the newly implemented competency-based medical education curriculum. Methods: This was a qualitative cross?sectional study conducted among teachers working at medical colleges across India, between February and April 2022 (n = 192). The data collection was done using Google forms online survey platform on teachers’ perception regarding CBME, its specific components, and perceived bottlenecks. We analyzed this qualitative data using manual, theoretical thematic content analysis following the steps endorsed in Braun and Clarke’s six-phase framework. Results: The majority of the teachers (64.1%) have positively responded to the CBME curriculum’s implementation. However, it came with a caution that the curriculum should continuously evolve and adapt to regional demands. The foundation course, early clinical exposure, and the family adoption program were the specific components of CBME curriculum over which the teachers raised concerns. The need for additional teachers in each department (department-specific teacher or faculty per hundred students ratio to be worked out) and the need for enabling faculty preparedness through adequate training was highlighted. Concerns were also raised regarding implementing CBME with teachers without a medical background (especially in preclinical departments). Conclusion: It is the need of the hour for the curriculum to incorporate a systematic feedback mechanism built into the system, though which such critical appraisals can be meaning collated and acted upon, to ultimately evolve, thereby creating an “Indian Medical Graduate” for the needs of todays’ society.

Impact of COVID-19 pandemic on medical education

Background: Medicine is one of the few academic disciplines that cannot be taught in the distance education mode. Hands-on practice for clinical skills and competency is critical in medical education. Although this pandemic has offered new learning modes such as teleconsultation, videoconferencing, virtual simulations, and digital podcasts, how much actual knowledge transfer and skill gain will be achieved, is unanswered. Aims and Objectives: The present study has been planned to understand the impact of COVID on medical education and to identify the factors which promoted or hindered learning during COVID-19 pandemic. Materials and Methods: This cross-sectional study was conducted among 261 willing MBBS students from various colleges of Tamil Nadu after obtaining Institutional Ethical committee clearance using a pre-validated structured online questionnaire through Google form link in online social platforms through “Voluntary opt in” method of sampling. Results: About 22.6% of the study participants were affected by COVID-19. About 46% of the participants family members suffered from COVID and all of them accepted that it significantly affected their academics. About 71.6% experienced anxiety/depression. About 93.5% were addicted to social media during class hours. About 88.1% welcomed “flipped/blended learning”. More than 90.8% reported that they missed skill-based learning/Primary health care training. About 80.8% positively felt that they got more duration for preparing exams. About 89.3% found that practical exams were challenging. Conclusion: Not only have we witnessed the importance of having a robust health-care system, but the pandemic has created a critical need to transform various aspects of medical education especially to a model of blended learning of online and offline methods to enable a better academic environment so as to reflect the changing medical landscape.

Histopathological correlation of transvaginal sonography and hysteroscopy in women with postmenopausal bleeding

Background: Postmenopausal bleeding is defined as vaginal bleeding occurring after 12 months of amenorrhea. It is a symptom which may have benign or malignant etiology and hence prompt examination is necessary to make a correct diagnosis. This is a prospective interventional study conducted to correlate findings of transvaginal sonography (TVS), hysteroscopy/ versascopy and the final histopathological diagnosis.Methods: Prospective study was conducted in 100 patients with post-menopausal bleeding. All patients underwent TVS followed by hysteroscopy and guided biopsy, results of which were compared with the gold standard i.e., histopathology.Results: For diagnosing abnormal histopathology, the overall sensitivity and specificity for TVS was 85.96% and 34.88% respectively whereas it was 70% and 72% respectively for hysteroscopy. For diagnosing malignancy, the sensitivity and specificity of TVS was 91.6% and 25% respectively and was 91.6% and 100% respectively for hysteroscopy. On combining both modalities the sensitivity and specificity increased to 83% and 100% respectively.Conclusions: TVS can be used as screening modality with cut off endometrial thickness (ET) of 4 mm with good sensitivity. However, specificity is low, hence hysteroscopy followed by endometrial biopsy is recommended as the diagnostic modality in evaluation of postmenopausal bleeding.

CHOICE OF MEDICAL PROFESSION-PASSION OR PRESSURE: MEDICAL STUDENTS PERSPECTIVES

Objective: Medical profession is one of the most aspired career option among school students and parents. Though the profession may look so lucrative and charming, one needs to be committed a lot to become a successful doctor. Passion and interest towards the career will be the most determining option to be a successful practitioner. But there will be many external influences in a student’s life to choose this career. This study was conducted with the objective to understand the factors that influenced MBBS students to choose this career.Methods: An analytical cross-sectional study was conducted among 1060 MBBS students throughout India. A self-designed questionnaire which contained questions related to why they selected this career was prepared and validated among experts in the field and was converted into google forms and was circulated to all the medical colleges in India through social media platform.Results: Though the majority (60.4%) mentioned that passion to serve as the main reason, nearly one-fourth (25.8%) have opted the career for social status, job opportunity, good remuneration and lifestyle. Nearly one-third (32%) have regretted joining the profession. Regarding the plan after MBBS, most of them (59.2%) preferred speciality practice. Clinical subjects were the most preferred Postgraduation.Conclusion: Though passion for the medical profession was the most common reason for coming into this career, parental and few other external influences were also found as the reasons for choosing MBBS among some students.

Mandibular midline osteotomy for correction of bimaxillary transverse discrepancy: a technical note

Bimaxillary transverse width discrepancies are commonly encountered among patients with dentofacial deformities. Skeletal discrepancies should be diagnosed and managed appropriately with possible surgical corrections. Transverse width deficiencies can present in varieties of combinations involving the maxilla and mandible. We observed that in a significant proportion of cases, the maxilla is normal, and the mandible showed deficiency in the transverse dimension after pre-surgical orthodontics. We designed novel osteotomy techniques to enhance mandibular transverse width correction, as well as simultaneous genioplasty. Chin repositioning along any plane is applicable concomitant with mandibular midline arch widening. When there is a requirement for larger widening, gonial angle reduction may be necessary. This technical note focuses on key points in management of patients with transversely deficient mandible and the factors affecting the outcome and stability. Further research on the maximum amount of stable widening will be conducted. We believe that developing evidence-based additional modifications to existing conventional surgical procedures can aid precise correction of complex dentofacial deformities.

A Comparative Assessment of Comprehensive Trail Making Test and Wisconsin Card Sorting Test Among Alcohol Dependence Patients

@#Introduction: Alcohol, when used frequently, accelerates the ageing process, causes brain damage, and results in a reduced volume of grey and white matter, leading to frontal lobe abnormalities. The neurotoxicity resulting from alcohol overuse affects the higher functions of the brain. This study aimed to evaluate the effect of alcohol dependence on the executive functioning of the brain. Methods: This study was carried out as a case-control study among 60 patients with alcohol dependence and 60 controls. Assessment of executive function was carried out using the Comprehensive trail-making test (CTMT) and the Wisconsin card sorting test (WCST). Comparison between the alcohol dependence group and normal healthy controls were calculated using the Mann-Whitney U test as data followed a non-parametric distribution. Results: The mean age of the participants among the cases and controls was 38.3±5.5 years and 37.8±5.4 years, respectively. The results showed a significant difference in both WCST and CTMT between cases and controls (p<0.05). Conclusion: This study concludes that there was an impaired performance in executive functions in alcohol- dependence patients in early abstinence compared to normal controls showing frontal lobe impairment in alcohol-dependence patients.

Correlation Between Laboratory Findings and Clinical Severity among the COVID-19 Patients in the Tertiary Care Centre

Background : Coronavirus is a highly infectious novel virus we are in urge to know more about their clinical characteristics and laboratory findings for the characterization and selection of treatment protocol. Methods : Prospective, single centre study. Two months data was collected, clinical characteristics data from patient case sheet and the laboratoryvalues from the Hospital Information System (HIS) for the month of July and August 2020. Results : Of 462 patients, 55 (11.9%) are falls under asymptomatic category, 194 (42%) are in mild category, 167 (36.1%) are in moderate category and 46 (10%) in severe category. Fever 230 (49.8%) and cough 211 (45.7%) was most common clinical symptom with p value < 0.01. Non-severe vs severe, 340 (73.6%) and 201 (43.5%) showed decreased in eosinophil count and absolute eosinophil count, 125 (27.1%) and 80 (17.3%) patient showed decrease in lymphocyte count and absolute lymphocyte count, 200 (43.3%) showed increase in neutrophil count with a significance of p value >0.05. 186 (40.3%) patients had one or more co-morbidities. Laboratory findings between Asymptomatic VS symptomatic, showed significance changes in neutrophil, lymphocyte, Aspartate aminotransferase, Alkaline phosphatase, globulin values (p value <0.05). Conclusion : Clinical severity categorization at the time of admission was very helpful for the treating doctors in proper understanding of disease progression and appropriate treatment of the patient. Presence of co-morbidity, abnormal laboratory values, old age group patients, higher Computed Tomography score, higher mortality rate are seen more in patients who were in clinical severity grade severe category than in non-severe category patients.

Online Medical Education: A look into the various perceptions, among students across India

Background: The students during the Covid time had been made to adopt online education to socially distance and pursue the curriculum at the safety of their homes. This type of education is important as the future demands learning to be a hybrid of both online and offline. The study was done with an objective of identifying various perceptions about online medical education among the students. Methodology: The crosssectional study was done among 578 students across various medical colleges in India and the data was collected using online platform where the questionnaire was regarding socio-demographic details, advantages and disadvantages, teacher’s quality, hinderances and suggestions with respect to online education. The data collected was analyzed using SPSS 21. Results: Out of the 578 subjects 386 (66.8%) were females and 413 (71.5%) responses were from private college. In the study 449 (77.7%) students were from the state of Tamilnadu. The study showed a significant increase in the number of students using various learning modalities like video lectures. Power point and pre-recorded lectures/tutorials after the advent of online classes. Most of the students reported the maximum concentration time for videos and pre-recorded lectures/tutorials, and least for PDF/ MS Word document. The study showed that 314(54%) students preferred blended or hybrid learning in the future. Conclusion: In the study the students reported the need for high selfdiscipline and motivation considered necessary for the online education. The students reported more biased attention and use of video-based lectures in terms of increased time spending and concentration time. So the revised modules should be made available with importance towards visual capture and to reduce the monotony of the medical education.