Evaluating the Use of E-Learning in Indian Emergency Medicine Residency Programs During the COVID-19 Pandemic: A National Cross-Sectional Survey.

OBJECTIVE: The coronavirus disease (COVID-19) pandemic has necessitated e-learning strategies in academic emergency medicine (EM) programs. A study was conducted during the COVID-19 pandemic to understand e-learning in the Indian EM context. METHODS: After IEC/IRB approval, we conducted a multicenter national survey validated by experts and underwent multiple reviews by the research team. The final survey was converted into Google Forms for dissemination via email to National Medical Commission (NMC) approved EM residency program as of 2020-2021. Data were exported into Excel format and analyzed. RESULTS: Residents and faculty comprised 41.5% and 58.5% of 94 respondents. The COVID-19 pandemic's second wave in India significantly impacted response rates. Internet connectivity was cited as a significant barrier to e-learning, while flexible timings and better engagement were facilitators identified by the survey. The attitude among residents and faculty toward e-learning was also evaluated. CONCLUSION: This survey reveals a significant positive shift in medical education from conventional teaching strategies toward e-learning, specifically during the pandemic. It also shows the need for all stakeholders (learners/educators) to better understand e-learning and adapt to its requirements. We need more data on the efficacy of e-learning compared to traditional methods. Until then, innovative hybrid/blended strategies would be the way forward.

Modus Operandi: Irrigation of the Modified Eloesser Flap in Heterogeneous Suppurative Lung Pathologies.

BACKGROUND: Refractory empyemas with collapsed lung and persistent bronchopleural fistulas pose significant problems to thoracic surgeons and impose a substantial burden in terms of morbidity and mortality. The modified Eloesser flap procedure is a useful palliative option for clearing infections. Herein, we present our experiences with the modified Eloesser flap procedure in mixed suppurative lung pathologies with a new technique of irrigation for persistent infection. METHODS: A retrospective review was carried out of 56 patients who underwent the modified Eloesser flap with continuous irrigation at Katurba Medical College. These patients had severe morbidities and were not suitable for major thoracic resection surgery, and electively underwent modified Eloesser flap surgery. Regular follow-up was done at 1, 3, 6, and 12 months. Patients with persistent infections were treated with our continuous irrigation technique. RESULTS: The most important finding was that all patients with active sputum acid-fast bacilli-positive findings became sputum smear-negative during the first month of follow- up. Half (50%) of the patients had a patent stoma. Eleven patients had persistent infections, necessitating continuous irrigation. The infection was fully cleared after 1 month in 9 patients, while 2 patients required second irrigation and continued to receive follow-up. In the remaining 50% of the patients, the stoma closed completely, and the lung expanded fully. CONCLUSION: The modified Eloesser flap is a simple procedure. In suppurative pathologies, infections were well controlled and the general condition of the patients improved. Our continuous irrigation method showed promising results in patients with persistent purulent discharge.

Every hill has its leopard: patterns of space use by leopards (Panthera pardus) in a mixed use landscape in India.

Understanding abundance and distribution of species is often necessary for wildlife conservation. However, elusive species such as the leopard (Panthera pardus) that have wide geographical distribution and typically low abundance pose a constant challenge to conservationists due to logistical and methodological constraints. Although leopard abundance has been estimated at the scale of protected areas or other smaller regions, reliable information describing leopard distribution over large spatial scales remains largely unavailable. Knowledge about space use by leopards within landscapes could help improve conservation management, reduce human-wildlife conflict, and also facilitate population status monitoring. We carried out occupancy surveys across c. 24,000 km2 in southern India in a landscape that consisted a mosaic of leopards' natural habitats and highly human-dominated areas. We investigated the effects of key ecological and anthropogenic variables in determining leopard space use patterns. We addressed imperfect detections obtained using sign surveys conducted on spatially replicated transects within sampling units by modeling detection as a function of spatial auto-correlation and covariates. Our results show that the probability of site-use by leopards across the landscape varied between 0.02 (95% CI [0.01-0.09]) and 0.99 (95% CI [0.99-1.0]) across the study area. The best model (AIC weight = 0.97) showed that the probability of leopard space use was affected by the proportion of natural habitats and the presence of large wild prey in the sampling unit. Given that India is undergoing rapid modifications due to economic changes and demand for natural resources, we emphasize the need for landscape-based approach for conserving and monitoring leopards. We argue that leopards are an indicator of functional ecosystems represented by scrub, deciduous forest and rocky outcrops that do not always get prioritized for conservation, unlike densely forested habitats. Similarly, conservation of natural large wild prey, especially outside the protected area system, should assume greater importance, which could also have a positive impact on reducing human-leopard conflict.

Clinical variables responsible for early and late diagnosis of foreign body aspiration in pediatrics age group.

BACKGROUND: Incidence of foreign body aspiration has been noticed predominantly in age group ranging from 12 months-3 years. Foreign body in the trachea is a medical emergency as presentation is in respiratory distress. Obstruction of only one main or distal bronchus, leads to severe cough, choking sensation and breathlessness. Without early intervention, it can lead to collapse, consolidation and pneumonia of the affected lung. METHODS: We retrospectively analyzed 37 pediatric case records who presented from January 2014-December 2018 with foreign body aspiration. Our primary aim was to assess the parameters responsible for early and late diagnosis of foreign body aspiration. We concluded with a diagnostic algorithm for management of foreign body aspiration on the basis of this outcome. RESULTS: Around 32.5% came with a history of aspiration, 43% were referred from the primary centers with a suspicion for the same and the rest came to our tertiary care hospital directly. Those who presented within a week came with complaints of wet cough, wheeze and tachypnea. Furthermore, those who came in after a week had a dry cough and fever as their main complaint. Majority of ingested foreign bodies was a vegetative type (80%) as compared to the non -vegetative. CONCLUSION: Unlike adults, foreign body aspiration in children is most commonly diagnosed on history, suspicion and clinical findings. Chest x ray has been the primary investigation of choice but in the majority of the cases it was normal with subtle changes. Early diagnosis is the key to avoid complication.