Narratives of endurance and the ethics of listening.

This is a commentary on the ethics of listening as can be gleaned from two narratives drawn from real-life encounters and crafted in the mode of fiction. "The Spiral" by Rakhi Ghoshal and "The Liquid Miscreant" by Aiswarya Sasi are narratives of the indignities inflicted by alcoholism on families and individuals. The narrators in both instances are outsiders who have to listen and bear witness to the suffering and resistance that they witness. This commentary argues that both narratives offer readers an opportunity to reflect on what is entailed in the ethics of listening. It is hence suggested that the components of an active, dynamic and ethical listening entail empathetic presence, non-intrusive reception, and bearing witness with compassion.

Ethical dilemmas in mental health resources for college students: A reflective case study.

Poised to have the highest number of young people in the world, India will have the onus of providing adequate mental health resources to a demographic considered among the most vulnerable with regard to mental well-being. While the Mental Healthcare Act 2017 pushed for greater accountability and care in supporting individuals with mental illness, these directions were specific to services provided by the state and did not address the care required in non-hospital settings. Since many manifestations and repercussions of mental health issues in young people occur in educational institutions, it becomes vital to address ways in which we can formulate ethical mental health services at those sites. This article is a reflective case study of the ethical dilemmas and challenges around issues of confidentiality and quality of care in relation to demand, contributing to a larger mental health ecology involved in providing mental health resources at the Student Support Centre, Manipal, that caters exclusively to students in an Indian campus town.

Efficacy of choline and DHA supplements or enriched environment exposure during early adult obesity in mitigating its adverse impact through aging in rats.

INTRODUCTION: The aim of this study was to assess the efficacy of choline and DHA or exposure to environmental enrichment in obese adult and aging rats on alterations in body mass index, serum lipid profile and arterial wall changes, despite stopping high fat diet consumption and interventions during adulthood. METHODS: 21 day old male Sprague Dawley rats were assigned as Experiment-1 & 2 - PND rats were divided into 4 groups with interventions for 7 months (n = 8/group). NC- Normal control fed normal chow diet; OB- Obese group, fed high fat diet; OB + CHO + DHA- fed high fat diet and oral supplementation of choline, DHA. OB + EE- fed high fat diet along with exposure to enriched environment .Experiment-2 had similar groups and interventions as experiment 1 but for next 5 months were fed normal chow diet without any interventions. Body mass index was assessed and blood was analyzed for serum lipid profile. Common Carotid Artery (CCA) was processed for Haematoxylin and eosin, Verhoff Vangeison stains. Images of tissue sections were analyzed and quantified using image J and tissue quant software. RESULTS: In experiment.1, mean body mass index (p < 0.001), serum lipid profile (p < 0.01), thickness of tunica intima (p < 0.05), tunica media (p < 0.01) and percentage of collagen fibers (p < 0.01) of CCA were significantly increased in OB compared to NC. These were significantly attenuated in OB + CHO + DHA and OB + EE compared to OB. In experiment.2, mean body mass index (p < 0.01), serum lipid profile (p < 0.05) and thickness of tunica media of CCA (p < 0.01) were significantly increased in OB compared to NC. In OB + CHO + DHA and OB + EE, significant attenuation was observed in mean body mass index and mean thickness of tunica media compared to same in OB. CONCLUSION: Adult obesity has negative impact on body mass index, serum lipid profile and arterial wall structure that persists through aging. Supplementation of choline and DHA or exposure to enriched environment during obesity attenuates these negative impacts through aging.

Hippocampal neural cell degeneration and memory deficit in high-fat diet-induced postnatal obese rats- exploring the comparable benefits of choline and DHA or environmental enrichment.

PURPOSE: Childhood obesity increases risk for neural dysfunctions causing learning and memory deficits. The objective of the study is to identify the effects of high fat diet-induced obesity in postnatal period on serum lipids, memory and neural cell survival in hippocampus and compare the role of choline and DHA or environmental enrichment in attenuating the alterations. MATERIALS AND METHODS: 21 day postnatal male Sprague Dawley rats were assigned as Normal control [NC] fed normal chow diet, Obesity-induced [OB] fed high fat diet, Obesity-induced fed choline & DHA [OB + CHO + DHA], Obesity-induced environmental enrichment [OB + EE] [n = 8/group]. Memory was assessed using radial arm maze. Subsequently blood was collected for serum lipid analysis and rats were euthanized. 5 µm hippocampal sections were processed for cresyl-violet stain. Surviving neural cells were counted using 100 µm scale. RESULTS: Memory errors were significantly higher [p < 0.001, 0.01] in OB compared to same in NC rats. Mean number of surviving neural cells in hippocampus of OB was significantly lesser [p < 0.01] compared to same in NC. Interventions in OB + CHO + DHA and OB + EE significantly attenuated [p < 0.01] memory errors and number of surviving neural cells in hippocampus [CA1, CA3 and DG] compared to same in OB. Moreover, hippocampal neural cell survival was found to be inversely related to serum lipid profile in OB group and was attenuated in OB + CHO + DHA and OB + EE rats. CONCLUSIONS: High fat diet-induced postnatal obesity in rats causes CA1/CA3 hippocampal neuro-degeneration and memory deficits. Supplementation of choline and DHA in obese rats attenuates these deficits.

The disappearing act: Humanities in the medical curriculum in India.

The field of Medical Humanities, shaped by a belief in the vitality of interdisciplinary and non-hierarchical conversations across disciplines, would only be sustainable if both components of the field - 'medical' and 'humanities' were given equal validity and weightage. The challenge for any exploration of Medical Humanities within the medical curriculum would be to take seriously the methodology and scholarship of the Humanities and its millennia-rich study of health, illness, mortality and human wellbeing. While Humanities has to work within the parameters of medical education, there needs to be more clarity on how to locate and explore subjects from the Humanities in this educational process. The Medical Council of India has made various forays in engaging with the issue. While the previous regulations (1997, last updated in 2017) were non-committal and insufficiently specific, the new guidelines of 2018 do not contain a single inclusion of the word 'Humanities'. Further, the only overture to all the non-medical components have been ossified under the umbrella of AETCOM (Attitude, Ethics and Communication) with prefabricated topics. Both curricular formulations are deeply inadequate: the earlier formulation was lost in vagueness, and the new is instrumental. This revised emphasis on capsules of information, rather than the epistemological approaches that have informed the interplay of Medicine and Humanities means the disappearing act of any possibility of a genuine engagement with the ethos of Medical Humanities. This article attempts to address this invisibility of the Humanities in contemporary formulations of medical syllabi and pedagogy in India.

My body is a lantern: Oscillopsia and an experience of Ayurveda.

February 9, 2017. The alarm on my phone was set to a pre-dawn hour. We were to leave for a holiday in the hills, a long drive that I had planned for days, eager for hours of camaraderie with the steering wheel. But the waking was a shock. The walls and ceiling of the room were swirling, my body felt as if strapped to a rotating carnival wheel. Sitting, standing, walking, nothing eased it. I threw up from the nausea. Maybe it will slow, maybe it will stop, maybe it is nothing. It is vertigo, said my cousin (a doctor) on the phone, and prescribed an over-the-counter medication. The world steadied. I made the drive, the vacation, but the condition was now with me, for several hours each day.

Rare case of median nerve and brachial artery entrapment by an abnormal musculo-fascial tunnel in the arm: possible cause of neurovascular compression syndrome.

Entrapment neuropathies of the peripheral nervous system are frequently encountered due to anatomical variations. Median nerve is the most vulnerable nerve to undergo entrapment neuropathies. The clinical complications are mostly manifested by median nerve impingement in forearm and wrist areas. Median nerve entrapment could also occur at the arm, due to the presence of ligament of Struthers. Here we report a rare case of proximal entrapment of median nerve and brachial artery in the arm by an abnormally formed musculo-fascial tunnel. The tunnel was formed by the muscle fibers of brachialis and medial intermuscular septum in the lower part of arm. Due to this, the median nerve coursed deep, below the tunnel and continued distally into the forearm, underneath the pronator teres muscle and hence did not appear as a content of cubital fossa. The present entrapment of neurovascular structures in the tunnel might lead to pronator syndromes or other neurovascular compression syndromes.

Medical themes in a literature classroom: An alternate perspective on Medical Humanities pedagogy in India.

This article examines the transferability of conversations in literary studies to a more sensitive, holistic, ethically informed, medical education. The article begins with a discussion of a class assignment on medical humanities in a literature course. The assignment enabled an immersive engagement with medical discourse by diverse students through different modes - through textual analysis, direct, and reflective encounters with communities of patients, caregivers, health professionals. The effort was to suggest that literature and medicine be studied as continuous shared strategies of reading and narrating lived experiences of health and illness. The insights of such learning should ideally be integral to the curriculum of medical students in India. Though the Medical Council of India's mandate for the humanities is inadequately sketched out, it nevertheless provides an opportunity to demand a larger citizenship and broader base of social sensitivity and knowledge for medical humanities.

Double pouched, sigmoid gallbladder that can cause a diagnostic dilemma to radiologists: a case report.

Gallbladder shows frequent variations in position, shape, interior, and its duct system. These variations may go unnoticed lifelong; however, they may predispose it for cholecystitis and cholelithiasis. We observed a double pouched gallbladder in an adult male cadaver. The gallbladder was folded to have a sigmoid shape. It had two broad pouches: anterior and posterior and a narrow isthmus in between. Its anterior pouch was covered by peritoneum, whereas the posterior pouch was covered by extrahepatic connective tissue. We discuss the clinical and radiological importance of the case.

Bilateral low origin of testicular artery: a case report / Origem bilateral baixa de artéria testicular: relato de caso

The testicular artery is frequently subjected to radiographic imaging techniques such as angiography for diagnosis and treatment of conditions like epididymitis, testicular torsion, tumor, hematoma, and hydrocele and in cases of undescended testis. Radiologists and surgeons should therefore be aware of testicular artery variants. Although there are numerous studies and case reports that mention testicular artery variants, this is probably the first case, reporting a bilateral low origin of the testicular artery and discussing its probable embryological etiology

A artéria testicular é frequentemente examinada por técnicas de imagem como angiografia, para o diagnóstico e tratamento de condições como epididimite, torsão testicular, tumor, hematoma e hidrocele, e também em casos de criptorquidia. Sendo assim, radiologistas e cirurgiões devem estar cientes de variantes anatômicas da artéria testicular. Embora numerosos estudos e relatos de caso mencionem variantes da artéria testicular, este provavelmente é o primeiro caso a descrever origem bilateral baixa da artéria testicular e a discutir sua provável etiologia embriológica

Bilateral low origin of testicular artery: a case report.

The testicular artery is frequently subjected to radiographic imaging techniques such as angiography for diagnosis and treatment of conditions like epididymitis, testicular torsion, tumor, hematoma, and hydrocele and in cases of undescended testis. Radiologists and surgeons should therefore be aware of testicular artery variants. Although there are numerous studies and case reports that mention testicular artery variants, this is probably the first case, reporting a bilateral low origin of the testicular artery and discussing its probable embryological etiology.

A artéria testicular é frequentemente examinada por técnicas de imagem como angiografia, para o diagnóstico e tratamento de condições como epididimite, torsão testicular, tumor, hematoma e hidrocele, e também em casos de criptorquidia. Sendo assim, radiologistas e cirurgiões devem estar cientes de variantes anatômicas da artéria testicular. Embora numerosos estudos e relatos de caso mencionem variantes da artéria testicular, este provavelmente é o primeiro caso a descrever origem bilateral baixa da artéria testicular e a discutir sua provável etiologia embriológica.

Unusual and Unique Variant Branches of Lateral Cord of Brachial Plexus and its Clinical Implications- A Cadaveric Study.

INTRODUCTION: Adequate knowledge on variant morphology of brachial plexus and its branches are important in clinical applications pertaining to trauma and surgical procedures of the upper extremity. AIM: Current study was aimed to report variations of the branches of the lateral cord of brachial plexus in the axilla and their possible clinical complications. MATERIALS AND METHODS: Total number of 82 upper limbs from 41 formalin embalmed cadavers was dissected. Careful observation was made to note the formation and branching pattern of lateral cord. Meticulous inspection for absence of branches, presence of additional or variant branches and presence of abnormal communications between its branches or with branches of other cords was carried out. RESULTS: In the present study, we noted varied branching pattern of lateral cord in 6 out of 82 limbs (7%). In one of the limb, the median nerve was formed by three roots; two from lateral cord and one from medial cord. Two limbs had absence of lateral pectoral nerve supplemented by medial pectoral nerves. One of which had an atypical ansa pectoralis. In 2 upper limbs, musculocutaneous nerve was absent and in both cases it was supplemented by median nerve. In one of the limb, coracobrachialis had dual nerve supply by musculocutaneous nerve and by an additional branch from the lateral cord. CONCLUSION: Variations of brachial plexus and its branches could pose both intraoperative and postoperative complications which eventually affect the normal sensory and motor functions of the upper limb.