Fiction contract: its importance in simulation-based medical education

Simulation-based education has become an integral part of education and training in high-risk professions and disciplines such as aviation, aerospace, military, nuclear power plants, medicine and healthcare. In the last decade, medical simulation has globally emerged as a powerful instructional technique across various specialties and disciplines. Despite its increasing popularity and various advantages, simulation-based medical education (SBME) poses a unique challenge, that is, realism. This is where the concept of fiction contract or suspension of disbelief comes into the picture. In this article we provide an overview of fiction contract in SBME including how can it be effectively addressed during training

COVID-19 and concerns related to self-medication

The practice of self-care through self-medication is not uncommon. Self-medication is not just a problem of one country, the phenomenon is global. A systematic review has highlighted this wide spread problem. Self-medication can be based on self-belief, advice of a pharmacist or another person instead of consultation with a qualified healthcare professional. In the settings of poor access to health care services and issues related to affordability of paying for medical services, people practice self-medication as the righteous approach. Some people may consume medications without consultation of a healthcare professional citing reason of time saving. Certain drugs available as prescription medicine in one country may be available over the counter in another country. Furthermore, with digitalisation, people now have an easy access to the internet where they simply explore their symptoms and find the perceived suitable treatment for the same. Thus, the reasons and pattern of self-medications may differ based on different factors including type of population affordability, and country

Comparison of stressful life events among family caregivers of cancer, mental retardation and schizophrenia patients leading to stress, anxiety and depression and its effect on quality of life

Background: Mental retardation (MR), schizophrenia and cancer are chronic disorders, requiring long term treatment along with family support. Principal caregiver is usually nonprofessional family person who play a pivotal role in supporting the patient medically, emotionally and financially which in turn affects their own health and quality of life. To identify stressful life events, level of anxiety, stress, depression and Quality of life in these family caregivers (FC), this study was planned.Methods: After gaining consent, the FC were assessed on Presumptive Stressful Life Events Scale (PSLE), Depression Anxiety Stress Scale (DASS) and WHO Quality of Life -Bref Scale (WHOQOL-Bref). Data so gained was analyzed by SPSS-21 and results were drawn.Results: 66 FC of cancer patients, 39 FC of MR patients and 53 FC of Schizophrenia patients were assessed. All three groups were found to be matched socio-demographically. On PSLE Mean of total stressful life events for cancer FC was 7±1.5, for MR 6.02±1.5 and for schizophrenia FC was 5.75±1.70 and this difference was statistically significant. Mean of total undesirable life events was 5.31±1.3, 4.33±1.34 and 3.86±1.46 respectively and this difference was also statistically significant. Similarly difference in mean stress score of total life events and for undesirable events was also statistically significant. On DASS scale no statistically significant difference was found within the groups. Quality of life was significantly low depicting high impact on physical health and social life of these care givers.Conclusions: Family Caregivers of cancer, mental retardation and schizophrenia groups are highly affected and there is urgent need to address these issues for early diagnosis and treatment

Crystalline Lens Staining with Intracameral Phenylephrine During Cataract Surgery

This is a Photo Essay and does not have an abstract. Please download the PDF or view the article in HTML

Massive collision tumor of ovary in pregnancy: rare successful perinatal outcome

A collision tumor is the co-existence of two adjoining but histologically distinct tumors without histological admixture in the same tissue or organ. The most common histological combination of collision tumor in the ovary is the coexistence of mature teratoma with mucinous cystadenomas. The incidence of adnexal mass in pregnancy is 0.05-2.4% of which 94-99% are benign. The 1-6% maybe malignant requiring more extensive surgical procedures that increases likelihood of pregnancy loss. Ovarian tumors first diagnosed during pregnancy often present a challenge for diagnosis and management. Hence accurate knowledge of tumor characteristics, especially the ultrasound appearance and gestational age at diagnosis, are the key prerequisites for establishing the most effective plan of management for the pregnant women. To the best of our knowledge this report of huge collision tumor with successful pregnancy outcome is first of its kind

Association of pro/anti-inflammatory cytokine gene variants in renal transplant patients with allograft outcome and cyclosporine immunosuppressant levels

T-helper (Th) type 1/Th2 cytokines are key mediators in induction/effecter phases of all immune and inflammatory responses playing role in acute/chronic renal allograft rejection. Association studies lead to identification of patient risk profiles enabling individualization of level of immunosuppressions. We investigated the association of allograft rejection with interleukin-2 (IL-2), IL-4, IL-6, tumor necrosis factor-α (TNF-α) −308, transforming growth factor-β (TGF-β) (C-del, codon 10 and 25) gene variants in 184 renal transplant recipients and 180 controls. These cytokine genotypes were also evaluated with cyclosporine levels (C2) at one month in 135 stable recipients. High producing genotypes B1B1 of IL-4 and AA of TNF-α α308 showed significant association with rejection of allograft. The dose-adjusted C2 levels were significantly lower in patients with the high producing genotype T/T of IL-2 and heterozygous G/C of TGF-β codon 25 (P = 0.012 and 0.010, respectively). Haplotype frequencies were comparable in subjects for TGF-β codon-10 and 25. Combined inter-gene interaction showed high risk for rejection in recipients with high producing genotype B1B1 of IL-4 and AA of TNF-α and high TNF-α (AA) with low TGF-β (CC or Pro/Pro). In conclusion, association of IL-4 VNTR and TNF-α −308 suggested the involvement of these cytokines contributing to pathogenesis of allograft rejection. Recipients with TT genotype of IL-2 and GC of TGF-β codon 25 having low C2 levels may require higher cyclosporine dosage. Combined analysis of gene-gene interaction demonstrated synergistic effect of cytokines increasing risk for rejection. Thus, this information may help in pre-assessment of allograft outcome and to optimize cyclosporine therapy in post-transplant patients

Curcumin Induces Cell Death in Esophageal Cancer Cells through Modulating Notch Signaling

Curcumin inhibits the growth of esophageal cancer cell lines; however, the mechanism of action is not well understood. It is becoming increasingly clear that aberrant activation of Notch signaling has been associated with the development of esophageal cancer. Here, we have determined that curcumin inhibits esophageal cancer growth via a mechanism mediated through the Notch signaling pathway.In this study, we show that curcumin treatment resulted in a dose and time dependent inhibition of proliferation and colony formation in esophageal cancer cell lines. Furthermore, curcumin treatment induced apoptosis through caspase 3 activation, confirmed by an increase in the ratio of Bax to Bcl2. Cell cycle analysis demonstrated that curcumin treatment induced cell death and down regulated cyclin D1 levels. Curcumin treatment also resulted in reduced number and size of esophagospheres. Furthermore, curcumin treatment led to reduced Notch-1 activation, expression of Jagged-1 and its downstream target Hes-1. This reduction in Notch-1 activation was determined to be due to the down-regulation of critical components of the γ-secretase complex proteins such as Presenilin 1 and Nicastrin. The combination of a known γ-secretase inhibitor DAPT and curcumin further decreased proliferation and induced apoptosis in esophageal cancer cells. Finally, curcumin treatment down-regulate the expressions of Notch-1 specific microRNAs miR-21 and miR-34a, and upregulated tumor suppressor let-7a miRNA.Curcumin is a potent inhibitor of esophageal cancer growth that targets the Notch-1 activating γ-secretase complex proteins. These data suggest that Notch signaling inhibition is a novel mechanism of action for curcumin during therapeutic intervention in esophageal cancers