Human to Humanoid: An Evolving Concept; Issues and Concerns of Neuroethics.

Background: Neuroethics is a subsection of ethics which allows us to express our concerns with advances in neurotechnology, threat to human race, our freedom of expression, autonomy, and justice. Objectives: Aim of the review is to familiarize readers about the concept of neuroethics and alarming threats with newer neurotechnology and to sensitize them about our responsibilities as neuroscientists. Materials and Methods: Systematic literature search was conducted from 2010 to 2021 in PubMed to look at previously published review articles related to neuroethics. Relevant filters were added addressing autonomy and consent. Of the 426 articles, only 12 addressed the issue of autonomy and neuroethics and two on consent and neuroethics. Results and Conclusions: International literature has expressed limited concern on the scope of neuroethics. Newer threats are getting added on with advancing technology, and as neuroscientists, we all need to understand and educate neuroscientists about our social responsibilities in curtailing an out-of-reach situation for the mankind.

Transesophageal echocardiography probe induced recurrent VF in a child with severe RV dysfunction: Report of a rare case.

The safety of transesophageal echocardiography (TEE) probes has been documented in pediatric patients (neonates, infants, and small children even < 2.5 kg). The overall safety profile of TEE probe is quite favorable with a reported incidence of complications of 1%-3%. However, insertion of the TEE probe can induce vagal and sympathetic reflexes such as hypertension or hypotension, nonsustained ventricular and supraventricular tachyarrhythmias, or bradyarrhythmias (third degree heart block), and even angina and myocardial infarction. We hereby document a repeated intraoperative ventricular fibrillation precipitated by TEE probe in a 2-year-old, 10 kg pediatric patient diagnosed with ostium secundum-atrial septal defect, supravalvular pulmonary stenosis, and severe right ventricular dysfunction. The international review board approval or waiver and clinical trial registrations are not applicable for this case report publication.

Students' satisfaction to hybrid problem-based learning format for basic life support/advanced cardiac life support teaching.

BACKGROUND AND AIMS: Students are exposed to basic life support (BLS) and advanced cardiac life support (ACLS) training in the first semester in some medical colleges. The aim of this study was to compare students' satisfaction between lecture-based traditional method and hybrid problem-based learning (PBL) in BLS/ACLS teaching to undergraduate medical students. METHODS: We conducted a questionnaire-based, cross-sectional survey among 118 1st-year medical students from a university medical college in the city of New Delhi, India. We aimed to assess the students' satisfaction between lecture-based and hybrid-PBL method in BLS/ACLS teaching. Likert 5-point scale was used to assess students' satisfaction levels between the two teaching methods. Data were collected and scores regarding the students' satisfaction levels between these two teaching methods were analysed using a two-sided paired t-test. RESULTS: Most students preferred hybrid-PBL format over traditional lecture-based method in the following four aspects; learning and understanding, interest and motivation, training of personal abilities and being confident and satisfied with the teaching method (P < 0.05). CONCLUSION: Implementation of hybrid-PBL format along with the lecture-based method in BLS/ACLS teaching provided high satisfaction among undergraduate medical students.

Percutaneous Nephrolithotomy: Current Clinical Opinions and Anesthesiologists Perspective.

Percutaneous nephrolithotomy (PCNL), a minimally invasive method for removal of renal calculi, was initially started in the 1950s but gained popularity about two decades later and has now become standard practice for management. There has been an immense improvement in technique and various guidelines have been established for treatment of renal stones. However, it has its own share of complications which can be attributed to surgical technique as well as anesthesia related complications. PubMed and Google search yielded more than 30 articles describing the different complications seen in this procedure, out of which 15 major articles were selected for writing this review. The aim of this review article is to describe the implications of the complications associated with PCNL related to the anesthesiologist. The anesthesiologist is as much responsible for the management of the patient perioperatively as the surgeon. Therefore, it is mandatory to be familiar with the various complications, some of which may be life threatening and he should be able to manage them efficiently. The paper also analyses the advantages and drawbacks of the available options in anesthesia, that is, general and regional, both of which are employed for PCNL.

Technological advances in perioperative monitoring: Current concepts and clinical perspectives.

Minimal mandatory monitoring in the perioperative period recommended by Association of Anesthetists of Great Britain and Ireland and American Society of Anesthesiologists are universally acknowledged and has become an integral part of the anesthesia practice. The technologies in perioperative monitoring have advanced, and the availability and clinical applications have multiplied exponentially. Newer monitoring techniques include depth of anesthesia monitoring, goal-directed fluid therapy, transesophageal echocardiography, advanced neurological monitoring, improved alarm system and technological advancement in objective pain assessment. Various factors that need to be considered with the use of improved monitoring techniques are their validation data, patient outcome, safety profile, cost-effectiveness, awareness of the possible adverse events, knowledge of technical principle and ability of the convenient routine handling. In this review, we will discuss the new monitoring techniques in anesthesia, their advantages, deficiencies, limitations, their comparison to the conventional methods and their effect on patient outcome, if any.

Current Clinical Opinions, Attitudes and Awareness of Interns Regarding Post-operative and Cancer Pain Management in A Tertiary Care Centre.

AIM: This prospective study was aimed to assess the opinion, awareness and attitude of interns regarding pain assessment, pain management and common barriers in effective pain therapy for patients experiencing pain. MATERIALS AND METHODS: A questionnaire including demographic details, knowledge of the tools of pain assessment, choice of drugs used, side effects, lacunae in existing knowledge and barriers in pain management was designed. A total of 160 interns were approached, out of which 149 returned the completed questionnaire. Only a few of them had a chance exposure to cancer pain management but none of them had undergone any formal training, teaching or classes in this field. RESULTS: Most respondents knew that the pain can be measured and the ways to do it. A significant number considered morphine as the preferred drug for managing cancer pain and thought morphine is responsible for addiction and respiratory depression. About 72% interns knew about transdermal preparation of fentanyl and its usage in malignancy but only a few were aware of buprenorphine transdermal patch. Though they were enthusiastic about relieving the cancer patients from suffering, they had limited knowledge of how to achieve this. The common barriers identified by them were lack of adequate knowledge and training and limited availability of opioids. CONCLUSIONS: The results of this study emphasize the need of special training programs pain management in order to change the current prevailing situation and improve the quality of analgesia provided to the patients.

Status of problem based learning in postgraduate anesthesia teaching: A cross-sectional survey.

BACKGROUND: Anesthesia is a specialized branch of medicine with a very narrow margin of error. Incorporation of problem-based learning (PBL) in anesthesia post-graduate (PG) teaching enhances the critical thinking and problem-solving skills. It also helps in developing a broader prospective of clinical case scenarios. Case based discussions (CBD) are most widely practiced out of all PBL methods in anesthesia PG teaching. MATERIALS AND METHODS: We conducted an anonymous questionnaire based, cross-sectional survey among 62 anesthesia residents from various medical institutions in a city of Delhi, India. We aimed to assess the current status of PBL by assessing the student satisfaction with CBD in anesthesia PG teaching, educational objectives accomplished with CBD and effectiveness of teaching curriculum in PG teaching with suggested modifications, if any. RESULT AND CONCLUSION: We observed that CBD is lacking in many important key areas of PBL e.g., formulation of objectives, communication on the content and direction of PBL, facilitation skills, supplementation of inadequacies of CBD. However, CBD seems to be a valid method of PBL in terms of the educational objectives accomplished with it but increased motivation for learning is required. Majority of the students felt that PG teaching curriculum should be centralized, with increased emphasis on open interactive sessions regarding its effectiveness.

Delayed traumatic diaphragmatic hernia mimicking hydropneumothorax.

Traumatic diaphragmatic hernia (TDH) is generally a consequence of thoraco-abdominal trauma. Anaesthetic problems arise due to herniation of abdominal contents into the thoracic cavity causing diaphragmatic dysfunction, lung collapse, mediastinal shift and haemodynamic instability. Diagnosis depends on history, clinical signs and radiological investigations. Sometimes, it may be misdiagnosed as hydropneumothorax due to the presence of air and fluid in the viscera lying in the pleural cavity. We report a case of TDH mimicking hydropneumothorax on radiological investigations and subsequent surgical management, which led to serious complications.

Solitary lymphangioleiomyoma of pancreas mimicking pancreatic pseudocyst--a case report.

INTRODUCTION: Lymphangioleiomyomatosis (LAM) is a rare disease characterized by proliferation of morphologically distinguishable smooth muscle cells in the lymphatics and lymph nodes of the pulmonary parenchyma in most cases. Extrapulmonary LAM is a rare condition and is found to occur concurrently, before or after pulmonary LAM, and show strong association with tuberous sclerosis. DISCUSSION: The literature regarding extrapulmonary LAM without associated pulmonary LAM is limited due to the extreme rarity of the cases. We hereby describe clinical, pathological and radiological features of primary pancreatic LAM presenting clinicoradiologically as pseudocyst of pancreas in a 43-year-old lady. CONCLUSION: The present case is unique as LAM in pancreas without associated pulmonary LAM has never been reported in the literature before.

Student assessment of teaching effectiveness of "bundle of changes"-A paired, controlled trial.

BACKGROUND: Inching toward optimum patient safety by training personnel is the prime aim of the ongoing medical education. AIMS: To assess whether lectures targeted to improve quality care in ICU could improve ICU practitioners' knowledge levels and to evaluate the effectiveness of teaching. SETTINGS AND DESIGN: In this paired controlled trial, 50 ICU practitioners, i.e., anesthesia and medicine residents and nursing staff of our hospital attended a series of four lectures. MATERIALS AND METHODS: Participants enrolled in the study attended lectures on bundles of changes in ICU, namely, introduction, ventilator bundle, central line bundle, and catheter-related blood stream infections and severe sepsis bundle. They were given a questionnaire of 15 multiple choice questions prior to and after the lectures. We evaluated their immediate knowledge acquisition and retention recall. Subsequently, they evaluated the effectiveness of the teaching programme by a questionnaire of 10 multiple choice questions. STATISTICAL ANALYSIS USED: Data for statistical analysis were tabulated and analyzed using SPSS-Pc 11.5 version software. RESULTS: Fifty study participants completed all three questionnaires. There was an increase in the overall mean score in the post-lecture test (4.58 + 1.51 SD) (P < 0.001). Overall mean score increased significantly from 8.30 + 1.34 SD in THE pre-lecture test - to 12.02 + 1.61 SD in the postlecture re-test (3.72 + 1.39 SD) (P < 0.001). In the evaluation of teaching effectiveness 88% respondents agreed to most of the questions, signifying the effectiveness of the lectures. However, there were 10% who disagreed to the questions and only 2% strongly disagreed to all the questions. CONCLUSIONS: Teaching programmes such as the "bundle of changes" are effective in improving immediate knowledge acquisition and retention recall of the participants if designed keeping the target audience in mind.

Pleural puncture with thoracic epidural: A rare complication?

Freedom from pain has almost developed to be a fundamental human right. Providing pain relief via epidural catheters in thoracic and upper abdominal surgeries is widely accepted. Pain relief through this technique not only provides continuous analgesia but also reduces post-operative pulmonary complications and also hastens recovery. But being a blind procedure it is accompanied by certain complications. Hypotension, dura puncture, high epidural, total spinal, epidural haematoma, spinal cord injury and infection are some of the documented side effects of epidural block. There are case reports eliciting neurological complications, catheter site infections, paresthesias, radicular symptoms and worsening of previous neurological conditions. Few technical problems related to breakage of epidural catheter are also mentioned in the literature. The patient had no sequelae on long term follow up even when a portion of catheter was retained. We present a case report where epidural catheter punctured pleura in a patient undergoing thoracotomy for carcinoma oesophagus.

Secondary malignant fibrous histiocytoma of thigh with surface ulceration following radiotherapy for carcinoma cervix.

INTRODUCTION: Radiotherapy is known to cause rarely various malignancies including leukemia, sarcoma, and thyroid and lung carcinoma. Post-radiation sarcomas account for 0.5-5.5% of all sarcomas; and include extra skeletal osteosarcoma, fibrosarcoma leiomyosarcoma, and malignant fibrous histiocytoma. Reports on post radiotherapy malignant fibrous histiocytoma in cervical cancer patients are rare. CASE REPORT: We present a case of 45-years-old female diagnosed with squamous cell carcinoma of the uterine cervix stage IIB; she underwent a radical hysterectomy with pelvic lymphadenectomy and postoperative radiotherapy and chemotherapy. Five years later, she presented with ulcerated nodular masses in right and left medial aspect of thigh. Cytological and histological diagnosis of the masses was malignant fibrous histiocytoma which was further confirmed by immunohistochemistry. CONCLUSION: Post-irradiation sarcoma must be considered in patients of carcinoma cervix treated with radiotherapy, when soft tissue mass is seen in the previously irradiated area. It should be differentiated from metastasis from primary tumor with the help of appropriate markers as it has a grave prognosis.

Signet ring carcinoma parotid gland: a case report.

BACKGROUND: Signet ring adenocarcinoma is a recently characterized entity occurring in the minor salivary glands. All reported cases have occurred in minor salivary gland. Pure signet ring adenocarcinoma of a major salivary gland has not been reported in the literature. METHODS: A 38-year-old woman presented with a mass in the parotid region. Microscopy showed signet ring cells positive for mucicarmine. Immunohistochemistry showed cytokeratin and focal smooth muscle actin (SMA) positivity; an exhaustive search for primary elsewhere did not reveal any suspicious focus. RESULTS: A diagnosis of low-grade signet ring adenocarcinoma of the parotid gland was made. On 6-month follow-up the patient was alive and well. CONCLUSIONS: The present case highlights a rare occurrence of this tumor in the parotid gland, which until now was labeled as a tumor exclusive to minor salivary glands. Thus this entity should be kept as a differential while investigating mucinous tumors of parotid.

Role of amino acid infusion in delayed recovery from neuromuscular blockers.

This case report highlights the anaesthetic management of a patient who had residual muscle paralysis following neuromuscular blockade, which was attributed to hypothermia and corrected by administration of amino acid solution. The various causes of residual neuromuscular blockade should be considered when treating such a patient. Amino acid infusion has been found to hasten the recovery from neuromuscular block due to vecuronium bromide aggravated by hypothermia.