Introduction: In the UK, the number of people diagnosed with renal disease is on the increase. As a result, there will be more people in need of renal replacement therapy (RRT). Despite the mounting evidence showing that home hemodialysis (HHD) treatment is clinical and cost-effective as well as amendable to suit patients' lifestyle, the number of patients choosing this dialysis modality is low. The aim of this study is to explore factors influencing decision-making process in the selection of HHD treatment for adult patients with end-stage renal disease in the UK. Methods: A systematic literature review methodology was utilized to review, critique, and synthesize the literature on the low uptake of HHD among adult patients. Systematic searches involving the databases Google Scholar, EMBASE, MEDLINE, PsycINFO, and CINAHL were carried out for articles published from 2008 to 2021. A search was conducted from June 1 through December 23, 2020. Eight articles met the study inclusion criteria. We followed preferred Reporting Items for Systematic Reviews and Meta-analyses in designing the research and reporting. Results: This systematic review revealed that patient information needs, dialysis education, training and support, and patient decision-making preference were the major factors influencing decision-making of adult patients. Conclusion: Deciding over which dialysis modality to choose can be challenging for many adult patients. Dialysis education, training, and support should not stop at the predialysis stage but should continue during treatment.

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A pandemic named SARS-COV2 COVID 19 affected many people's life in different ways globally. The normal life is still far away, lockdown rules have been relaxed in many countries. Morbidity and mortality increased a lot after the first wave. COVID-19 has affected medical education in a significant way. Most of the patients were asymptomatic during the second wave and some had symptoms such as myalgia, fever, and cough, which complicated to pneumonia, respiratory distress, and thromboembolic complications. There have been the development of many vaccines such as Covaxin, Pfizer–BioNTech, Covishield, Sputnik V, and Moderna, and these vaccinations have been given to frontline medical workers, people with comorbidities, aged people, etc., with high priority and then the general population. Many pregnant and peripartum women were put on Extracorporeal Membrane Oxygenation (ECMO) in severe to critical cases. A new black fungus was found in post-COVID 19 infections. It was named mucormycosis which usually affected immunocompromised people. There is a high importance in the examination of all the different epidemiological variables of all the places in all the regions across the world, to understand the mutations, and severity of the disease and also to be prepared. Many studies done on COVID-19 in first and the second wave was reviewed in detail and were compared for this review.

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Background and Objectives: Upper urinary tract infections (UTIs) that require in-patient care can be expensive. Comorbid conditions such as diabetes as well as UTI due to extended-spectrum beta-lactamase (ESBL) producing bacteria may affect costs. The quality of life of patients with this condition has not been described. Methods: This was a cost of illness study that prospectively evaluated patients admitted with upper UTI to a medical ward in a tertiary care hospital. Direct medical and nonmedical costs, indirect costs were collected to make the total cost per admission. Quality of life was assessed using the World Health Organization Quality of Life-BREF score. We also compared costs between those with and without diabetes or ESBL infection. Results: Between March 2016 and July 2017, 92 eligible patients were included in the study. The average age was 55.8 years; two thirds were diabetics. The mean overall cost of a single admission for upper UTI was INR.88, 330.2 (1370.4 USD). This was INR.96, 193.0 (1492.6 USD) and INR.1, 03,154.9 (1600.4 USD) among those with diabetes mellitus and ESBL infection, respectively. The cost was higher among those with diabetes and ESBL than those without; this difference reached statistically significance for the ESBL group. The quality of life was affected in all domains; the psychological being most affected among diabetics and ESBL infected. Conclusions: The mean total cost of admission for an upper UTI in a tertiary care hospital in South India was INR 88,330 (1370.4 USD). This is higher if the patient has diabetes or ESBL organism causing the UTI. Quality of life is clearly reduced especially in the psychological domain.

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Background: Convulsion during the first few weeks of life in a newborn is a frequent problem. Such disturbances may have many causes contributing to their etiology and have prognostic significance as well. Objective: This study aimed to determine the etiology, effect of gestational age, onset, types, and mortality of neonatal convulsions. We also aimed to evaluate the clinical parameters, computed tomography (CT) brain scan, neurosonogram, metabolic profile, and cerebrospinal fluid analysis as well as the response of antiepileptic drugs and outcome in these babies. Materials and Methods: A retrospective cross-sectional study was done at the neonatal intensive care unit of a tertiary care teaching hospital. The study group comprised 358 neonates with neonatal seizures (163 inborn and 195 referred) admitted over 2 years. Data were entered in Microsoft Excel and analyzed in SPSS version 12 (Chicago, Illinois, USA). Results: Out of 10,232 live births, 163 had seizures in the neonatal period, giving an incidence of 15.9/1000 live births. The most common type of seizure was tonic accounting for 33.2%. The most common etiology was perinatal asphyxia – 50.8%, followed by central nervous system infection – 20.1%. One hundred and twenty-six out of 358 patients expired contributing to mortality of 35.1%. All the newborns with perinatal asphyxia had seizures within the first 7 days. Conclusions: Improvement in antenatal and perinatal care with early identification of high-risk mothers will reduce the incidence of birth asphyxia and thereby of neonatal convulsions. Subtle seizures are most common and should not be missed. CT brain scan and neurosonogram are useful in the early detection of cerebral edema, ischemic hypodensities, and hemorrhage which contributes to prognostic significance.

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Introduction: The emergence of methicillin resistance among staphylococcal infections has led to increasing demand for the use of safe and effective agents to treat such infections. Clindamycin is one such drug which is gaining the interest of clinicians because of its excellent pharmacokinetic properties. However, the widespread use of macrolide–lincosamide–streptogramin B antibiotics has led to inducible or constitutive resistance which is a major concern. In vitro routine tests for clindamycin, susceptibility may fail to detect inducible clindamycin resistance leading to treatment failure, thus requiring a simple D test to detect such resistance on a routine basis. Aim of the Study: The aim of this study was to find the prevalence of inducible clindamycin resistance in Staphylococcus aureus isolates from various clinical samples. Materials and Methods: One thousand isolates isolates of S. aureus obtained from various clinical samples were subjected to routine antibiotic susceptibility testing including cefoxitin (30 μg) using the Kirby–Bauer disk diffusion method. Inducible clindamycin resistance was tested by the “D test” as per CLSI guidelines. Results and Conclusion: Out of 1000 isolates of S. aureus, 556 (55.6%) were methicillin-sensitive S. aureus and 444 (44.4%) were methicillin-resistant S. aureus (MRSA). The total percentage of inducible clindamycin resistance was found to be 21.9%. Inducible clindamycin resistance was found to be higher among MRSA making treatment of such infections more difficult. D test is a simple test which can be included in routine testing of antibiotic susceptibility for staphylococcal isolates to detect inducible clindamycin resistance so as to avoid treatment failure and aid in the judicious use of this drug.

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Background: Adopting interactive teaching in dermatology will encourage the students to acquire a deeper understanding of the subject, increase attention span and retention of knowledge, and enhance self-directed learning. Aim and Objectives: To introduce Quiz as an Interactive teaching tool in dermatology and assess the perception of the undergraduate students and faculty about using quizzes in dermatology. Methodology: This prospective study was conducted in the department of dermatology. Participants are the 2^nd year MBBS students. After sensitizing the students and taking informed consent, quizzes were conducted on four topics, at appropriate time intervals using the “POLL EVERYWHERE” software. During the lecture, a quiz was conducted as follows: At the beginning of the lecture (a), after 20 min (b) and at the end of the lecture (c). At the end of the 4 interactive lectures, questionnaires were provided to the students and faculty to get feedback on their perception regarding the interactive teaching sessions. The responses of the feedback forms were graded using a 5-point Likert's scale. Statistical Analysis: The data were entered in Microsoft Excel and analyzed using SPSS (Statistical Packages for the Social Sciences, software version 21.o. Armonk, NY: IBM corp). Open-ended questions were analyzed by thematic qualitative analysis and expressed as percentages. Results: About 44.6% agreed that quizzes do make dermatology more interactive. Around 53% students agreed that interactive learning helps in better retention of knowledge. All faculty perceived that interactive learning is an appropriate motivator for the undergraduate students to do self-directed learning and that quiz is an effective tool. Conclusions: Interactive teaching learning methods such as quizzes will encourage the students in the better understanding of dermatology.

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Goiter is defined as abnormal (either nodular or diffuse) growth of the thyroid gland. The normal thyroid gland is located in neck, caudal to larynx in anterolateral portion of the trachea. Intrathoracic goiter, defined as growth of more than 50% of the thyroid gland below the thoracic operculum, mostly located in anterior mediastinum and is seen in only 8%–15% of all goiters. Posterior mediastinal goiters (PMGs) are rare and accounts for only 2% of intrathoracic goiters. Patients usually present with a cervical mass and local pressure symptoms due to tracheal, esophageal, or superior vena cava compression. The diagnosis is established by chest X-ray, computed tomography scan, and fine-needle aspiration cytology. A combined cervicothoracic approach is the procedure of choice as it provides easy access, better visualization, and optimal control of blood vessels. We, hereby, describe a case of giant PMG, which was managed successfully at our center.

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Context: Item response theory (IRT), is a psychometric measure of trait considering each response positioned on a continuum. Aim: Assessment of item and test information Oral Health Literacy Adults Questionnaire (OHL-AQ) using IRT in the patient visiting the tertiary institution of Himachal Pradesh. Settings and Design: A descriptive cross-sectional study conducted on patients visiting the outpatient department. Methods: Data were obtained from the participant and recorded on a structured schedule using OHL-AQ. Statistical Analysis: The two-assumption essential for IRT are unidimensionality and local independence of items. Unidimensional dichotomous IRT consists of three models and three parameters of difficulty discrimination and guessing. Item response interpretation is based on item characteristic curves, test characteristic curve (TCC), and test information function, and analyses were conducted using the statistical software package STATA version 14. Results: The selection of 3PL model is based on the likelihood ratio test which is higher (χ² = 133.62, P < 0.0001) than other models (χ² = 130.41, P < 0.0001). The parameter estimate of pseudo-guessing is 0.02 indicating mild degree of guessing and represent the smallest probability of correct response. The TCC of the study shows that 95% of the randomly selected respondent scored between 3.23 and 14. The median probability of correct response is 8.16 when both difficulty and discrimination parameter is equal. Conclusion: IRT is an estimated probability of a response to a given item. Our study showed that OHL-AQ measures higher levels of OHL more precisely compared to lower levels. The OHL-AQ scale is the precise measure of both high and low levels of OHL.

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Context: Medical education. Aims: This study was an effort to sensitize students and faculty with an active learning technique known as jigsaw method and study its effectiveness and feasibility. Settings and Design: A prospective observational study was conducted for 2^nd-year medical undergraduates in a 2 h long session. Subjects and Methods: Eighty out of 100 students of entry batch 2017 during the third semester in 2018 participated in this study with the supervision of five faculty members. The session was evaluated using prevalidated anonymous questionnaires filled by faculty and students. Statistical Analysis Used: Questionnaire used comprised nine questions for students and seven for faculty questionnaire to which the responses were to be marked on a 5-point Likert scale. The percentage of students/faculty with each response was calculated and analyzed. Results: More than 85% of the class agreed that jigsaw classroom guided them to take responsibility of their own learning and was helpful in developing their information-synthesizing skills. Almost the same percentage of students was interested in participating in a similar active learning technique in future as well. Conclusions: Student-centered learning approaches like jigsaw technique aim to develop learner autonomy and independence by putting responsibility for the learning path in the hands of the student. Such techniques promote learning and foster respect among students from diverse backgrounds.

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Introduction: Respiratory infections are associated with high morbidity and mortality, especially in critically ill patients. The excessive use of broad-spectrum antibiotics has led to the development of drug resistance, thus resulting in the emergence of pathogens which are difficult to treat. Materials and Methods: A total of 632 tracheal secretions were received in the Bacteriology section of the microbiology department of a tertiary care hospital from November 2019 to February 2020. Tracheal secretions were processed for culture according to standard operating procedures. Identification, phenotype detection, and antibiotic sensitivity testing were performed by automated VITEK-2 Compact system. Results: In total, 632 tracheal secretions were received during the study period, 559 cultures yielded significant pathogens and no organisms were isolated in 73 cultures. Among the Gram-negative organism 540 (97%), Klebsiella pneumoniae (30%) was the most common isolates. Gram-positive organisms 12 (2%) and Candida spp. 7 (1%) were isolated. The most common phenotype detected in Escherichia coli and K. pneumoniae was extended-spectrum beta-lactamase producer. Conclusions: K. pneumoniae was the most common isolate from tracheal secretion among intensive care unit patients. Colistin, followed by tigecycline, was found to be the most susceptible antibiotics. K. pneumoniae was found to be sensitive to tigecycline (69%) with minimum inhibitory concentrations of ≤ 1. 0.6%. K. pneumoniae was colistin resistant.

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Background: Pacifying newborns by nonpharmacological methods during painful procedures is a frequent and difficult problem in routine practice. Purpose: The purpose of the study was to determine the analgesic effects of oral sucrose solution in comparison to placebo (sterile water) in neonates. Materials and Methods: A prospective, double-blinded study of 100 neonates who were divided into two groups after simple randomization, to give either 30% sucrose solution (group A) or sterile water (group B) during an intravenous catheterization. Assessment of pain by the Douleur Aigue Nouveau-ne scale (DAN) and changes in the heart rate (HR), respiratory rate (RR), or arterial oxygen saturation (SpO₂) during peripheral vein catheterization were analyzed. Results: The mean change of HR, RR, and SpO₂ was more in group B compared to group A. The mean DAN scores were 2.24 ± 2.026 and 6.92 ± 2.538 in group A and group B, respectively. None of these results were statistically significant (P > 0.05). Conclusion: There was a less prominent change in HR, RR, and SpO2 with response to noxious stimuli with oral sucrose administration in newborns when compared to placebo.

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COVID-19 epidemic severely affects the social life of people living in India. The best solution to the COVID-19 problem is the vaccination of the people. In India, COVID-19 vaccination started from January 16, 2021, mainly with the Covishield vaccine. In this study, the COVID-positive history family was selected who had taken the first and second (booster) doses residing at Pune, Maharashtra, India, was followed up to check for any side effects postvaccination. Their data were collected with participant-administered questions. The predominant side effects reported were uneasiness, pyrexia (fever), voice difference, vomiting, and headache. The side effects were started at 2–16 h postvaccination while it takes an average duration of 48–60 h to last. Analysis shows nonpresence of major and serious side effects makes the Covidshield vaccine safe for use in the COVID-positive history population.

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Introduction: Although ventilator-associated pneumonia (VAP) mostly has bacterial etiology, many cases have viral etiology. The present study aimed at determining the proportion of viral VAP and any associated factors and identifying the viral isolates in pediatric VAP. Materials and Methods: A descriptive observational study was conducted at pediatric intensive care unit of tertiary referral center including 120 VAP cases aged 1–18 years. Endotracheal aspiration samples from these patients were tested for viral etiology. Results: Most VAP cases were males (66.7%). Virus was isolated in 14.2% of cases of VAP. Human adenovirus (29%), respiratory syncytial virus (29%), and herpes simplex virus (24%) were the most common viruses identified. Viral VAP was significantly associated with age, primary disease, and total leukocyte count. Neutrophil count decreased and lymphocyte count increased significantly after viral VAP. Conclusion: Viral etiology should be considered in VAP patients, especially in patients not responding to antibiotics as proper diagnosis and timely initiation of appropriate antiviral could be lifesaving. Prevalent viruses may vary geographically; hence, hospitals should try to identify the common viruses causing VAP in their settings to guide appropriate battery of tests and antiviral drugs.

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Background: In the traditional undergraduate curriculum, majority of the hours is dedicated to passive lectures where students are mere listener. Emphasis on self-learning is restricted to reading some of the topics from the book and Internet. With reference to this, storytorial was introduced as an innovative learning method mainly concentrating on self-learning, communication skills, and retrieval of concept. A story was illustrated and enacted to a topic in physiology during tutorial hour, hence the name storytorial. Methods: This method of learning was introduced to the I MBBS 2018–2019 batch, comprising 200 students. They were divided into small groups; topics and list of students to perform storytorial were displayed in the notice board 15 days before the session. On the day of session, the selected 10 students performed a story that illustrated the physiology topic assigned to them. Time allotted for the presentation was 20–30 min. The students enacted the story, and one of them narrated how the story is linked to the topic. Later, a case study related to the topic was given, and the students solved the case in the presence of an in-charge teacher for that batch. The session lasted for 1 h. Likewise, all the students were involved in the performance with a different topic in separate sessions according to the time table. At the end of all the sessions, subjective feedback of storytorial from the students was taken using 5-point Likert scale and computed. Results: The analysis of feedback on 5-point Likert scale with point 5 as strongly agree and 1 as strongly disagree was as follows: increased confidence and learning – 4.468, better understanding of concept – 4.058, better memory retention and retrieval – 4.28, and enjoyed and liked the sessions – 4.37. 90% of the students recommended storytorial for the next batch. Conclusion: This innovative method is an extended role-play where the concepts are illustrated in the form of story which helps the students to understand and remember the medical concepts by self-learning approach.

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We report the case of a 13-month-old girl with neuroregression over 3 months and encephalopathy at presentation. Marked skin hyperpigmentation and being exclusively breastfed gave the clue to B12 deficiency secondary to maternal B12 deficiency as the possible etiology which was confirmed on investigation. Upon treatment with parenteral B12 therapy she demonstrated dramatic improvement at follow-up. Nutritional B12 deficiency is an imminently treatable cause of neurocognitive dysfunction. Better awareness, healthy complementary feeding practices in infancy and perhaps maternal B12 supplementation can help prevent this disorder.

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Lymphangioma circumscriptum is a microcystic lymphatic malformation localized to an area of the skin, subcutaneous tissue, and muscle which presents with vesiculo-papules or warty lesions, resembling a “frog spawn.” Keloids develop due to the proliferation of dermal tissue following skin injury. We present a case of lymphangioma circumscriptum with secondary infection and keloid formation treated with intralesional bleomycin.

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Coronavirus disease-2019 (COVID-19) infection, caused by severe acute respiratory syndrome coronavirus 2, is primarily a respiratory illness. The sequelae have been observed affecting multiple organ systems, adding to the morbidity and mortality of the disease. It has also been shown to have adverse effects on lipid profile in some case studies. Acute pancreatitis (AP) post-COVID-19 infection has been described previously. Hypertriglyceridemia (HTG) is a well-described cause of AP. Here, we report patients presenting with post-COVID-19 infection with HTG causing AP.

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