Background: Psychologic behavior plays a key role in the outcome of any treatment or therapy. It was recommended to assess the psychologic status of the patient along with the clinical examination and also counsel him with adequate management therapies. Ragas have a high impact on mental well-being. Listening to ragas was reported to be highly effective in regulating the blood pressure and heart rate. Methods: The present study involved 30 (10 males and 20 females) preoperative patients who will be undergoing cataract surgery in 2 days and within the age group of 55 to 60 years from the ophthalmology department. The patients were subjected to listen to Raga Bhairavi for 30 minutes for 2 days. Results: There is a significant decrease in depression anxiety and stress levels followed by raga therapy. Conclusion: There is a significant decrease in depression anxiety and stress levels followed by raga therapy. There is a strong need for further studies with multiple centers and a higher sample size to recommend raga therapy in the management of mental health problems in the patients.

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Brain tumors are the second most common malignancy and the most common solid tumors in the pediatric population. Most brain tumors in the pediatric population are primary in origin contrary to the adult population. The various factors useful for establishing the diagnosis include the age of the patient, imaging characteristics, and location of the tumor. Infratentorial tumors are more common between 4 and 10 years of age, whereas supratentorial tumors are common in neonates and infants up to 3 years. Conventional computed tomography and magnetic resonance imaging are of paramount importance in the diagnostic evaluation of these tumors which help in their characterization and allow accurate assessment of their extent. The updated World Health Organization classification of brain tumors has incorporated various genetic and molecular parameters. It is essential for the radiologists to be familiar with the imaging features of genetic tumor subtypes as it plays a role in patient management and prognostication. Advanced neuroimaging provides additional information regarding the metabolism and physiology of these lesions, thereby aiding in their diagnosis and follow-up.

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Background: Increased use of computers over prolonged hours leads to a decrease in tear film breakup time (TBUT), resulting in dry eye. This study was carried out to find out the variations in TBUT according to hours of daily computer usage. Methods: Computer users were grouped into five groups as group A <2 hours, group B >2 hours to ≤4 hours, group C >4 hours to ≤6 hours, group D >6 hours to ≤8 hours, and group E >8 hours according to their hours of computer exposure per day. All the participants were subjected to TBUT. Chi-squared test and analysis of variance test was used to compare mean values, find P-values, and ensuring statistical significance. Results: In our study, the mean age of the study population was 32.18 ± 5.38 years. The mean TBUT in the various groups was found to be 25.83, 21.20, 18.62, 12.40, and 9.43 seconds in the right eye and 26.05, 21.19, 18.57, 12.31, and 9.41 seconds in the left eye in groups A, B, C, D, and E, respectively. Conclusion: It seems there is significant decrease in TBUT with increasing duration of computer use per day. TBUT can be performed quickly, easily, and be used to screen and support diagnosis of dry eye.

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Background and objective: Osmotic demyelination syndrome (ODS) refers to a spectrum of clinicoradiologic syndrome which occurs due to pontine and extrapontine involvement due to myelinolysis. It is well described in association with rapid correction of hyponatremia and in alcoholics. In this case series, we have reviewed clinical presentation, neuroimaging features, and clinical outcomes of five patients diagnosed with ODS. Methods: The hospital medical records of all patients diagnosed with ODS between September 2018 and May 2020 at our hospital were analyzed retrospectively. Patients’ relevant clinical details and laboratory findings were recorded and magnetic resonance imaging (MRI brain) was reviewed. Those cases having imaging or clinical picture not clearly consistent with diagnosis were excluded. Results: Patients included in the study were 49 to 69 years old. All patients were treated as a case of hyponatremic encephalopathy in local hospitals. All patients had initial improvement followed by neurologic deterioration for which they were referred to our hospital. Possible etiologies of hyponatremia were recurrent vomiting and diuretic induced in two patients each and alcohol induced in one patient. Three out of five patients showed isolated extrapontine involvement on MRI. All patients showed improvement on dopaminergic drugs, whereas one patient had residual pseudobulbar symptoms which improved on follow-up. Conclusion: This series represents cases with clinical, etiopathogenic and radiologic spectrum of the ODS. ODS is a potentially treatable condition and rewarding results can be obtained by prompt diagnosis and management of associated secondary complications.

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Workplace-based assessment (WPBA) is a method of assessment which measures working of a healthcare professional when performing his duties. The shift in undergraduate medical education to competency-based medical education in curriculum of India makes this WPBA a very attractive option of evaluation, as it measures competency outcomes in real-time scenarios on patients. This article discusses the strengths of WPBA, its lacunae, its essential components of direct observation, conduction at workplace, and constructive, immediate feedback. It also details the methodology, types, utility index, strengths, and lacunae of WPBA along with strategies to improve implementation.

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Plasma-cell myeloma (PCM) is a monoclonal gammopathy (MGM) characterized by proliferation of abnormal clone of plasma cells infiltrating the bone marrow with consequent end-organ damage. The clonal plasma cells secrete a single clone of immunoglobulins (Igs) leading to presence of M-protein in the serum and/or urine. The M-protein is appreciated as a discrete band on serum protein electrophoresis (SPE) in the gamma globulin region, also called the M-band. Biclonal gammopathy (BGM) occurs due to neoplastic transformation of a plasma-cell clone undergoing Ig class switching or due to an independent neoplastic transformation event yielding proliferation of unrelated plasma-cell clones, therefore resulting in two distinct M-bands on SPE. It is, however, vital to distinguish a true BGM from an apparent one (MGM presenting with two distinct bands on SPE) so as to make an accurate diagnosis. Hereby, we report a case of a 61-year-old man, diagnosed with PCM and presenting with two discrete bands on SPE (simulating a BGM) which turned out to be monoclonal in nature.

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Background: Thrombocytopenia is the second most common hematologic abnormalities in pregnancy next to anemia. Its etiology is not well understood in the pregnant females. Aim: To find out the prevalence of thrombocytopenia (hospital based) in pregnant women and the various etiologic factors responsible for thrombocytopenia in pregnant Indian women. Setting and Design: This was a prospective, cross-sectional study. Materials and Methods: One thousand pregnant registered females attending the antenatal clinic were studied with detailed history, examination, hemogram on Sysmex KX-21 hematology analyzer (Transasia: Mumbai, India Diamed, Switzerland) five part differential analyzer in blood collected in ethylenediaminetetraacetic acid vials, liver and kidney function tests, and other relevant special hematologic tests depending upon the clinical diagnosis. Statistical Analysis: By using the Chi-squared test, values of P < 0.05 being considered statistically significant. Results: The prevalence of thrombocytopenia in pregnancy was 134/1000 (13.4%). Moderate thrombocytopenia was observed in 72/134 (53.7%) and severe thrombocytopenia in 14/134 (10.4%). About 125/134 (93.3%) of the thrombocytopenic patients were in the third trimester. Majority of them belonged to 21 to 25 years of age and had B+ blood group. Most common etiology was gestational thrombocytopenia (GT) in 46/134 (34.3%). Anemia was found in 27/134 (20.1%) patients. Conclusion: In Indian thrombocytopenic female, most common cause is GT but lesser than western world. The prevalence of associated anemia is higher in this part of world.

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In December 2019, a new type of coronavirus, severe acute respiratory syndrome coronavirus 2 was detected in Wuhan, Hubei province, China. It is currently a pandemic, with more than 185 million cases and roughly 4 million deaths globally as of July 9, 2021, with the United States and India leading the way. Coronavirus disease 2019 (COVID-19) may show multisystem involvement with significant impact on hematopoietic system and hemostasis. Blood count abnormalities, that is, lymphopenia (83.2%) and neutrophilia (34.5%), are of prognostic significance. Changes in hemostatic biomarkers represented by increase in D-dimer (23.3%) and associated thrombocytopenia (36.3%) indicate the essence of coagulopathy reported in these patients leading to fatal implications such as disseminated intravascular coagulation and serious thrombotic complications. Hence, accurate evaluation of laboratory indicators at the beginning and during COVID-19 can help health professionals in adjusting appropriate treatment and providing special and prompt care for those who need it. This study aims to highlight these abnormalities and appropriate interventions aimed to reduce the associated mortality of the disease. The effect of COVID-19 in patients with hematologic abnormalities and role of vaccination are also outlined.

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Background: Inappropriate reporting of animal studies has been a serious issue. The Animals in Research: Reporting in Vivo Experiments (ARRIVE) guidelines were published to improve design, analysis, and reporting of animal studies. Methods: The present study is a retrospective observational study of published original research using small laboratory animals. Studies published between the year 2015 and 2020 in Indian Journal of Medical Research (IJMR), Indian Journal of Pharmacology (IJP), Indian Journal of Experimental Biology (IJEB), and Journal of Pharmacology and Pharmacotherapeutics (JPP) were reviewed in accordance with ARRIVE guidelines. Results: Three hundred and seventy-seven studies (JPP n = 15, IJMR n = 37, IJEB n = 157, IJP n = 167) were analyzed. A statement regarding ethics approval was reported in 90.2% of studies. Information regarding randomization and blinding was reported in 20.4% and 0.53% of studies, respectively. Only nine studies mentioned sample-size calculation. Macroenvironmental information such as room temperature/humidity were detailed in 87.5% and light/dark cycle in 96.5% of studies. Concerning microenvironmental conditions, access to food and water was reported in 75% of studies. Only 6.3% studies mentioned the details of adverse events. Information regarding humane endpoint was missing in all studies. Conclusion: Inappropriate and inadequate reporting in some areas of animal research need to be curbed by adhering to ARRIVE guidelines.

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Head and neck wounds account for a large majority of gunshot and firearm-related injuries. The morbidity and mortality associated with such injuries are high due to the presence of various vital structures in the vicinity, such as trachea, esophagus, carotid and vertebral artery, brachial plexus, and so on. Damage to any of these can lead to devastating results. However, in rare cases, there can be unusual trajectories of the bullet bypassing these structures. Here, we present one such case of a 35-year-old man where the bullet got lodged in the infratemporal fossa and it was successfully removed by trans-maxillary endoscopic approach. Transmaxillary endoscopic approach for infratemporal fossa is a minimally invasive technique with low morbidity, better acceptability, and quicker postoperative recovery than traditional approaches.

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Background and objective: The objective of the present study was to determine the effectiveness of erector spinae plane block (ESPB) for pain relief in patients undergoing percutaneous nephrolithotomy. Methods: Sixty-four patients of either sex, American Society of Anaesthesiology (ASA) Grade I/II for surgery were enrolled. After informed consent, all participants received subarachnoid block with 3 ml of 0.5% injection heavy bupivacaine. Participants in the block group received ultrasound-guided ESPB with 30 ml of 0.5% ropivacaine, whereas participants in the control group received routine analgesia as per our hospital’s protocol for percutaneous nephrolithotomy procedure which is tramadol 100 mg intravenously. This prospective, single-blind, randomized, controlled study was conducted after approval from the institutional ethics committee (SRHU/HIMS/RC/2019/291) and written informed consent was obtained for surgery under spinal anesthesia. Pain score (visual analog scale, VAS) was evaluated by the anesthesiologist who was not involved in the study at 30 minutes and 2, 4, 6, 8, 12, 18, and 24 hours postoperatively and patient was monitored with electrocardiogram, noninvasive blood pressure, heart rate, and pulse oximetry. Unpaired t test was used for comparison between the groups. Results: Both the groups were appropriately matched for age, ASA physical status, weight, and duration of surgery. The total dosing of rescue analgesia, that is, tramadol was considerably more in the control group in comparison with the ESPB group in the first postoperative day (P = 0.000; 218.75 ± 82.06 mg vs. 103.12 ± 47.41 mg, respectively). Similar results were obtained in the VAS pain score. Conclusion: ESPB helped in providing considerable postoperative pain relief in patients undergoing percutaneous nephrolithotomy.

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Background: Emergence and recovery have been found to be common problems after general anesthesia, especially in children. Both sevoflurane and desflurane have fast emergence and recovery from anesthesia which results in emergence delirium (ED). This study aims to compare the incidence of ED and rate of recovery in pediatric patients under sevoflurane and desflurane anesthesia. Materials and Methods: Seventy children aged 1 to 10 years belonging to American Society of Anesthesiologists physical status I or II were enrolled and randomly allocated into two groups. Group D (n = 35) received inhalational desflurane, whereas Group S (n = 35) received inhalational sevoflurane at 1.3 minimum alveolar concentration with oxygen and nitrous oxide for maintenance of anesthesia in both the groups. Rate of recovery from anesthesia (emergence time and recovery time) and incidence of ED were assessed in both the groups. Postanesthesia care unit (PACU) discharge time, hemodynamic changes, and side effects were also noted. Results: Emergence and recovery times were significantly shorter in Group D than Group S: (4.50 ± 1.53 minutes versus 6.25 ± 1.64 minutes) and (6.79 ± 1.52 minutes versus 9.12 ± 2.32 minutes), respectively (P < 0.001). No significant difference was observed in the incidence of ED in the two groups (P = 0.782). Mean PACU discharge time was significantly shorter in Group D than Group S (P < 0.001). No significant hemodynamic changes and side effects were noted in both the groups (P > 0.05). Conclusion: The incidence of ED was found to be similar with both sevoflurane and desflurane. Although the rate of recovery was significantly faster with desflurane, it was clinically insignificant. Hence, we inferred that both agents can be used safely in children, but sevoflurane should be preferred owing to its properties and cost-effectiveness particularly in our setup.

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In the current era, information technology has found its scope and application across all the streams and the same applies to the field of medical education and health care industry. The emergence of the coronavirus disease-2019 pandemic has significantly affected the delivery of the medical curriculum. The adoption of online learning in medical institutions has neutralized the issue of accessibility and has enabled the teachers to continue the process of facilitation of learning. Regardless of the multiple merits that can be attributed to online learning, it has its inherent limitations and thus has to be supplemented by the conventional teaching-learning. Considering the multiple competencies that a medical student should acquire and the complexity of the medicine stream, the best approach will be to use online learning as an approach to supplement learning. It will be ideal to continue online learning till conventional learning becomes a feasible option, and then integrate the best aspects of online learning with face-to-face learning to simultaneously meet the varied needs of medical students. In conclusion, online learning has its own pro and cons, and the best approach is to use the technology for ensuring effective learning among medical students. This will essentially require adequate faculty development along with the necessary support from the administration and the technical team.

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Context: The world witnessed the emergence of a new disease, coronavirus disease 2019 (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) which is now a global pandemic. Studies have shown that people with pre-existing conditions are more vulnerable to the virus compared to people with no comorbidities. Aims: The present study has been conducted to evaluate the prevalence of comorbidities among patients with COVID-19 admitted to a district hospital in Sonipat, Haryana. Materials and methods: An epidemiologic, questionnaire-based cross-sectional study was conducted on consecutive patients with COVID-19 admitted to a civil hospital in Sonipat, Haryana between May 13, 2020 to November 13, 2020 over a period of 6 months. Statistical analysis: The data were analyzed using SPSS version 20.0 (IBM Corp., Armonk, New York, USA). Results: The results show that men (65.4%) were affected more than women with maximum prevalence in the age group of 21 to 30 years (28.8%). Only 10.7% of the volunteers showed no signs of any chronic ailment in contrast to 89.3% volunteers who were already suffering from some underlying health condition. The data also revealed that people suffering from type 2 diabetes (40.9%) and hypertension (33.5%) are more susceptible to develop SARS-CoV-2. About 55.9% of the participants were asymptomatic at presentation. Conclusion: People with chronic conditions were more susceptible to COVID-19, may be due to an increased inflammation leading to weakening of the immune system. As prevention is better than cure, so by following basic principles of sanitization, social distancing, and use of proper face masks, people with comorbidities can protect themselves from the virus.

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Acknowledging the complexity of medicine and the pressure on medical students in the current era, it is the need of the hour to ensure that they are taught using effective teaching-learning strategies. Team teaching refers to the approach wherein two or more qualified teachers join their hands together with an aim to provide knowledge to the students. The adoption of team teaching offers enormous benefits to the medical students, in terms of a broader range of experience, different teaching styles, views, and better problem-solving via the development of critical thinking skills. To conclude, the adoption of team teaching can prove to be an effective learning experience for the teachers and the students. However, to maximize the outcome, a significant amount of planning and coordination is required among the team members and thus all the medical colleges should aim to implement within their settings for the benefit of the medical students.

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Operating in coronavirus disease times has become a challenge as it risks the frontline task force. Till now, no definitive and clear-cut guidelines for reducing aerosol generating procedures using the orthopedic power tools have been issued by the World Health Organization. We describe a technique to reduce aerosol generation in orthopedic procedures especially during drilling while inserting a screw or pin. We tooled a piece of polycarbonate plastic glass into a cup-shaped configuration and made two working portals, one through which a drill bit/sleeve could be advanced and the other through which a suction catheter could be inserted to suck out the dangerous fumes while drilling.

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As the ultimate aim of medical education is to produce a competent medical student who can meet the needs of the community they serve, the acquisition of clinical skills and other attributes carries immense importance in the training period. Keeping this in mind, the clinical teaching offered to the medical students is a crucial component of training and all efforts should be taken by the administrators and teachers to increase the number of opportunities available to medical students for teaching and learning. Owing to the changing dynamics in patient care, the ambulatory care settings end to neutralize all the limitations attributed to the ward teaching. In conclusion, clinical teaching in the field of medical education has gradually moved from the wards to the ambulatory settings. These settings precisely reflect the true spectrum of health and disease in the community and it is the need of the hour to expose the medical student to these wide ranges of learning opportunities and help them to become self-directed learners.

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