Visualization in Anatomical Sciences for Effective Teaching and Learning

Anatomy is one of the basic subjects of medical science. Medical students gain detailed knowledge of human body by dissecting cadavers. Hence, cadaveric dissection has become an essential tool in teaching and learning anatomy. In anatomy, visualization plays an important role in understanding the spatial orientation of structures. Due to technological advancement and a shortage of cadavers, there is a need to look for various complementary tools which can provide an adequate visualization of bodily structures. This issue was very well understood and reflected during the recent pandemic when cadaveric dissection was substituted by experimenting with various teaching tools. In this paper, we have tried to briefly describe the various options that can complement/supplement dissection and assist in self-directed learning

Online Learning Modules in Anatomical Sciences: Effective Sources for Continued Learning for Medical Undergraduates During the Unprecedent COVID-19 Pandemic

Introduction. During the COVID-19 pandemic-induced lockdown, the selection of simple and authentic online material among plethora of web content is difficult for both students and teachers. This forces students and teachers to explore various avenues of learning. The objective of this research was to evaluate free open-access anatomy e-learning resources in accordance with required standard learning outcomes for medical students. Methods. During February 2021, an extensive search for online modules for learning anatomy across six Massive Open Online Courses, including edX, Coursera, Udemy, Khan Academy, Canvas and FutureLearn, along with Google and YouTube was conducted. Courses or modules on e-learning platforms, YouTube channels, standalone videos, anatomy atlases, 3D models were considered as learning resources and evaluated. Online materials were classified as structured learning resources if they had a defined syllabus, time duration and instructional design. Resources lacking these characteristics were considered as unstructured ones. Results. Twenty structured learning courses were identified on the Udemy (6 courses), Coursera (3 courses), edX (2 courses), FutureLearn and Khan academy platforms. Learning resources available through Swayam Prabha were aligned with the defined syllabus and video lectures. The content hosted within Clinical Anatomy, Medvizz and Kenhub was eye-catching. Thirty-two YouTube channels offering standalone learning material were identified. Seven resource materials, other than YouTube channels, offered anatomy learning material in the form of charts and tables. Four websites noted to have 3D interactive learning content regarding gross anatomy. Conclusions. During the pandemic-induced lockdown, the list presented in the study may act as guide in selection of the simplest and best materials for those teaching and learning anatomy in medical undergraduate courses. However, in most cases, there is no alignment with standard learning outcomes as defined by medical education regulatory authorities

Omicron and vaccine booster dose – an update

Mutations in coronavirus is not unheard off. The variant, Omicron B.1.1.529 has overall 50 mutations and is considered as a variant of concern. Though the new variant has shown changes throughout its genome, S gene changes predominate. Significant changes in the S encoding gene, S gene, influences not only the transmissibility properties of SARS-CoV-2 but also the efficacy of existing vaccines. Increased transmissibility and ability of this variant to evade host immune responses conferred either due to past infections or due to vaccination driving increase in number of infections. However, the severity of the infections is low in comparison to its predecessors. A meta-analysis of ten studies analyzing the effect of COVID-19 vaccine booster dose, it was found studies report 10-to-42-fold increase in omicron neutralization. COVID appropriate behaviors, if followed rigidly can bring a meaningful change in the viral spread and resultant health impacts

Allelic variants of DYX1C1 are not associated with dyslexia in India

Dyslexia is a hereditary neurological disorder that manifests as an unexpected difficulty in learning to read despite adequate intelligence, education, and normal senses. The prevalence of dyslexia ranges from 3 to 15% of the school aged children. Many genetic studies indicated that loci on 6p21.3, 15q15-21, and 18p11.2 have been identified as promising candidate gene regions for dyslexia. Recently, it has been suggested that allelic variants of gene, DYX1C1 influence dyslexia. In the present study, exon 2 and 10 of DYX1C1 has been analyzed to verify whether these single nucleotide polymorphisms (SNPs) influence dyslexia, in our population. Our study identified 4 SNPs however, none of these SNPS were found to be significantly associated with dyslexia suggesting DYX1C1 allelic variants are not associated with dyslexia

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

Background: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. Methods: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. Findings: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96–1·28). Interpretation: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. Funding: National Institute for Health Research Health Services and Delivery Research Programme

Effectiveness of a national quality improvement programme to improve survival after emergency abdominal surgery (EPOCH): a stepped-wedge cluster-randomised trial

BACKGROUND: Emergency abdominal surgery is associated with poor patient outcomes. We studied the effectiveness of a national quality improvement (QI) programme to implement a care pathway to improve survival for these patients. METHODS: We did a stepped-wedge cluster-randomised trial of patients aged 40 years or older undergoing emergency open major abdominal surgery. Eligible UK National Health Service (NHS) hospitals (those that had an emergency general surgical service, a substantial volume of emergency abdominal surgery cases, and contributed data to the National Emergency Laparotomy Audit) were organised into 15 geographical clusters and commenced the QI programme in a random order, based on a computer-generated random sequence, over an 85-week period with one geographical cluster commencing the intervention every 5 weeks from the second to the 16th time period. Patients were masked to the study group, but it was not possible to mask hospital staff or investigators. The primary outcome measure was mortality within 90 days of surgery. Analyses were done on an intention-to-treat basis. This study is registered with the ISRCTN registry, number ISRCTN80682973. FINDINGS: Treatment took place between March 3, 2014, and Oct 19, 2015. 22 754 patients were assessed for elegibility. Of 15 873 eligible patients from 93 NHS hospitals, primary outcome data were analysed for 8482 patients in the usual care group and 7374 in the QI group. Eight patients in the usual care group and nine patients in the QI group were not included in the analysis because of missing primary outcome data. The primary outcome of 90-day mortality occurred in 1210 (16%) patients in the QI group compared with 1393 (16%) patients in the usual care group (HR 1·11, 0·96-1·28). INTERPRETATION: No survival benefit was observed from this QI programme to implement a care pathway for patients undergoing emergency abdominal surgery. Future QI programmes should ensure that teams have both the time and resources needed to improve patient care. FUNDING: National Institute for Health Research Health Services and Delivery Research Programme

Analysis of pre-operative factors predicting difficult laparoscopic cholecystectomy

Background: Laparoscopic cholecystectomy is considered the gold standard treatment for most gallbladder diseases. It has now become one of the most common operations performed by general surgeons. At times, it is difficult and takes longer time or some complications may occur or has to be converted in to open cholecystectomy. Objective: To study pre-operative factors in the patients to predict whether the laparoscopic cholecystectomy will be easy or difficult and to co-relate the pre-operative factors predicting a difficult Laparoscopic Cholecystectomy with intra-operative findings. Methods: This prospective study was carried out in the Department of General Surgery over a period of 2 years. Total 100 patients were included in the study. All patients were evaluated for risk factors preoperatively and intraoperative findings were noted. A chi-square test has been used to find the significant association of findings of the preoperative score with postoperative outcome. Results: 11 (11%) were males and 89 (89%) were females. In this series, age range for the enrolled patients was from 15 to 60 years. Majority were in the group 20-40 years of age (80 patients, 80%)

The effect of anti-thyroid drug treatment duration and predictive for intraoperative blood loss in patients with Graves’ disease

Background: Grave’s disease frequently results in and is the most common cause of hyperthyroidism. It also often results in an enlarged thyroid. It also known as toxic diffuse goitre, is an autoimmune disease that affects the thyroid. Objective: To evaluate all the factors that cause intra-operative blood loss and how it affects the grave’s disease. Methods: This study was conducted on 200 patients with Grave’s disease, who underwent thyroidectomy during the period from May 2010 to April 2016. For a period of 14 days, all patients were administered with potassium iodide before the surgery. Conventional open surgery or neck surgery video assisted were performed. SPSS (Version 22.0) was used for analysis. Results: The majority of patients were females which constitute about 76.3% with a median age of 32 years. The median period between the onset of the disease and operation was 15 months. Weight of thyroid in grams was 40. Post-operative hospital stay was 3 days. Univariate analysis revealed that the strongest correlation of amount of intraoperative blood loss (AIOBL) was noted with the weight of thyroid (p<0.001). Additionally, AIOBL was correlated positively with the period be- tween disease onset and surgery (p<0.001) and negatively with preoperative free T4 (p<0.01).&nbsp

Evaluation of pre-operative albumin in the prediction of outcomes of emergency laparotomy

Background: Hypoalbuminemia has been established indicator of nutritional status, which may and may not be clinically apparent, but is linked to a significantly higher risk of morbidity and mortality. Objective: To assess the post-operative morbidity with relation to pre-operative albumin status in patients undergoing emergency abdominal surgery. Methods: It was a hospital based observational study, 100 patients undergoing emergency abdominal surgery at Tertiary care Hospital was included. Hypoalbuminemia was diagnosed if serum albumin level was less than 3.5 gm/dl. Study period was between May 2021 to April 2022. The Statistical software namely SPSS 11.0 and Systat 8.0 were used for the analysis. Results: Pre-operatively, 60 patients had hypoalbuminemia (serum albumin <3.5 g/dl) and 40 patients had normal albumin levels (≥3.5 g/dl). Out of 100 patients, 41 (41%) developed complications postoperatively. 32 patients (50%) out of 60 patients with hypoalbuminemia (with serum albumin<3.5 g/dl) had complications. 9 patients (17.5%) with albumin level ≥3.5 g/dl had complications. Mean length of hospital stay was found to be higher i.e. 9.70±4.75 days in patients with hypoalbuminemia, compared to 6.45±3.31 days with those having albumin level ≥3.5 g/dl. Conclusions: Preoperative albumin is a useful low-cost prognostic predictor for predicting surgery outcome