Ethical Issues in the Planning and the Conduct of Escape Rooms in Medical Education.

Escape rooms in medical education are relatively a novel approach to facilitate critical thinking and decision-making in simulated realistic clinical scenarios among the medical students. The success of escape rooms in the attainment of specified competencies depends on several factors that must be given due consideration for optimizing the overall outcome. Further, there might be multiple ethical concerns that must be given due attention before, during, and after the conduct of such sessions. There is an immense need to integrate ethical considerations while designing and implementing escape rooms in medical schools, as it will aid in the creation of a respectful and encouraging learning atmosphere for the students. In conclusion, escape rooms provide a great learning opportunity for medical students to critically think, engage in teamwork, and learn the art of adaptation depending on the given clinical scenario. However, the successful conduct of such sessions is determined by a wide range of factors, including ethical considerations, and all of them need to be systematically analyzed and measures should be taken to reduce their impact on students.

Implications of Human Chorionic Gonadotropin (hCG) Therapy in a Varicocele Patient and Its Effect on In Vitro Fertilization (IVF) Outcome.

This case study pertains to a 32-year-old male and a 29-year-old female who sought treatment at a fertility clinic due to their primary infertility, which had persisted for over four years. Both individuals underwent comprehensive physical and hormonal examinations; while all reports for the female partner indicated normal findings, the test reports for the male partner revealed the presence of azoospermia and varicocele. The standard surgical protocol for varicocelectomy was followed. However, no improvement in the semen parameters was observed. Subsequently, microsurgical testicular sperm extraction was performed on the male patient in an attempt to retrieve sperm from testicular tissues, but the outcomes were negative. In response to these findings, the patient was advised to undergo intramuscular injections of human chorionic gonadotropin (hCG) at a dosage of 3,000 IU on alternate days, in conjunction with the daily administration of clomiphene citrate at 30 mg. Improvement in sperm parameters was seen after six months, leading to the successful intracytoplasmic sperm injection and the development of six blastocysts. The use of hCG significantly improved the semen quality, and frozen embryo transfer resulted in clinical pregnancy after endometrial preparation, highlighting the utilization of hCG therapy in varicocele cases for enhanced sperm retrieval and pregnancy success.

Gender-specific reference values of dynamometric and non-dynamometric trunk performance in individuals with different body fat percentages: A preliminary study.

Trunk muscles maintain steady effort with adequate strength and endurance. When the muscle performance is subpar, it might cause lower back discomfort. No reference for trunk strength and endurance has been established previously. The aim of this study was to determine the normative reference values for dynamometric and non-dynamometric tests in people with various body fat percentages. Two hundred sixty-four participants aged 19-40 years old were recruited in this cross-sectional study. The Siri equation was used to calculate the individuals body fat proportions, which were divided into normal, high, and very high body fat for men and women. The Modified Sorenson's and the Back-Leg-Chest Dynamometric tests were utilized to measure muscular performance. The means of strength in females with normal, high, and very high body fat percentages were 27.39, 25.75, and 25.37 N/m2, respectively. The males in the same category had the means of 56.48, 51.79, and 60.17 N/m2, respectively. The highest mean of endurance in females was in those with normal body fat percentage (42.28), so did males (71.02). Our findings suggest that males had higher trunk muscle strength and endurance than females, and normal-body-fat individuals had the greatest endurance regardless of gender.

Sickle Cell Anomaly Meets Leukemic Challenge: A Case Report.

This case report delves into the rare occurrence of sickle cell disease (SCD) and acute myeloid leukemia (AML) coexisting in a 36-year-old patient. The initial presentation, marked by escalating fatigue, pallor, and recurrent episodes initially attributed to sickle cell disease, unveiled an unexpected discovery of AML upon bone marrow examination. The diagnostic hurdles stemming from overlapping clinical features necessitated a thorough approach incorporating hematological, molecular, and imaging studies. Managing both conditions concurrently entailed navigating complexities addressed by a multidisciplinary team, tailoring chemotherapy regimens, and implementing personalized strategies to tackle complications associated with SCD. This case underscores the significance of tailored and comprehensive approaches in diagnosing and managing patients with overlapping hematological disorders. The insights gleaned from this instance contribute to the evolving comprehension of such intricate interplays, guiding future research endeavors and enhancing the care provided to patients simultaneously grappling with SCD and acute myeloid leukemia (AML). This case study investigates the unusual medical history of a 36-year-old male patient who concurrently has acute myeloid leukemia and sickle cell disease. Since childhood, the patient has endured severe anemia, necessitating frequent red blood cell transfusions or exchange blood therapy. Additionally, the patient was prescribed hydroxyurea (HU) for approximately 26 months.

A Rare and Unusual Case of Hypernatremic Dehydration in a Newborn Presenting With Adrenal Haemorrhage and Leading to Acute Kidney Injury.

Adrenal haemorrhage, although a rare entity in the neonatal period, is a known complication of birth asphyxia. Adrenal haemorrhage progresses differently depending on the type and extent of the glands involved. Adrenal haemorrhage can cause persistent jaundice, fever, dehydration, scrotal swelling, abdominal wall discolouration, septicemia, and a shock-like state. Here, we report the case of a four-day-old male infant who presented with jaundice, poor feeding, and hypernatremic dehydration. The patient developed acute kidney injury and, eventually, renal failure due to adrenal haemorrhage. He had an abdominal lump with deranged renal parameters along with hyperbilirubinemia. Abdominal ultrasonography and contrast computed tomography scan showed left suprarenal enlargement with evidence of adrenal haemorrhage. The patient was managed well with ventilatory support and peritoneal dialysis and discharged successfully. A subsequent follow-up showed complete resolution of the adrenal haemorrhage. Single ultrasonography is a good modality for diagnosis but not sufficient, so serial ultrasonography at subsequent follow-up is a must.

Exploring the Association Between Age Groups and Success Patterns in Platelet-Rich Plasma Therapy: A Cohort Study.

Objective This study aimed to comprehensively examine the correlation between success trends in platelet-rich plasma (PRP) therapy and the advancing age of patients undergoing fertility interventions. Methods Female participants were categorized randomly into five age groups undergoing PRP or conventional hormone replacement therapy. Procedures included controlled ovarian stimulation, escalating estrogen dosage, gonadotrophin injections, and embryo transfer post-ovulation trigger. A pivotal PRP intervention was provided to half of the age sub-groups, and endometrial thickness was assessed 24 hours prior to embryo transfer. Statistical analysis employed SPSS 26.0 for Windows Student Version (IBM Inc., Armonk, New York), incorporating descriptive statistics, one-way analysis of variance (ANOVA), Tukey's honestly significant difference (HSD) test to explore age-PRP success relationships (p<0.05). Results The study, involving 60 participants, revealed a balanced patient distribution across age groups, with 20-30 age groups contributing 23.33% each. Baseline characteristics showed no significant differences between PRP and hormone replacement therapy (HRT) groups. Post-intervention, PRP demonstrated consistently higher endometrial thickness (p<0.001) and clinical pregnancy rates (63.33%) compared to HRT (40%). These findings suggest a positive association between PRP therapy and improved outcomes, particularly in younger age cohorts. Conclusion The study challenges traditional perspectives on hormonal influences in fertility, highlighting a potential link between PRP therapy and favorable outcomes among younger age groups. Improved endometrial thickness and clinical pregnancy rates in the PRP group emphasize the need for further exploration of PRP's mechanisms and applications in reproductive medicine.

Revitalizing Recovery: Unveiling the Transformative Impact of Physiotherapy in Rehabilitating a Neglected Case of Shoulder Hemiarthroplasty.

The shoulder joint has a complex anatomy and biomechanics. It is a ball and socket joint made by the articulation surface of the humeral head (ball) and glenoidal fossa (socket) of the scapula. Shoulder arthroplasty is done when parts of the shoulder joint are severely affected and damaged beyond repair. The damaged parts are replaced with artificial parts. Prosthetic implants are typically made of metal or plastic material. Implants come in various sizes and shapes. There are three types of surgical arthroplasty: total shoulder arthroplasty, partial shoulder arthroplasty, and reverse arthroplasty. Indications of shoulder arthroplasty may include osteoarthritis, fractures, rotator cuff injuries, osteonecrosis, and rheumatoid arthritis. This case study aims to provide a case of anteroinferior dislocation of the left shoulder with humeral head comminuted fracture confirmed by an investigation like radiograph and CT scan operatively managed by left shoulder hemiarthroplasty. In this case study, a 58-year-old male cannot lift his arm and perform actions of the shoulder joint independently after the operative procedure, thus reducing the functional status and quality of life. After the left shoulder hemiarthroplasty repair post due to inadequate rehabilitation, there was a failure in achieving the ranges and gaining back the strength of the muscles. The patient has a combined plan of action, which consists of pharmacological interventions along with physiotherapy rehabilitation. The physiotherapy protocol consists of goals like using electrical muscle stimulation, activation exercises of muscles, strengthening protocol, stretches, and counselling. By the end of the physiotherapy treatment, the patient showed significant progress in re-establishing the ranges and enhanced muscle strength, which resulted in a positive self-boost along with improved functional independence quotient, thereby increasing quality of life.

Minimally Invasive Colorectal Surgery Techniques.

Colorectal surgery has witnessed a transformative shift with the advent of minimally invasive techniques, offering patients reduced postoperative discomfort, shorter hospital stays, and accelerated recovery compared to conventional open surgery. This comprehensive review aims to assess the current state of minimally invasive approaches in colorectal surgery, encompassing various techniques such as single-incision laparoscopic surgery, robot-assisted surgery, and conventional laparoscopic surgery. The article meticulously explores the benefits and drawbacks of each technique, delves into the established criteria for their application, delineates cautious circumstances, and analyzes the outcomes of minimally invasive colorectal surgery. Additionally, the integration of virtual reality and augmented reality for surgical planning and training is discussed, shedding light on the future trajectory of this field. Surgeons and researchers striving to enhance patient care and surgical outcomes in colorectal surgery will find this review article an invaluable resource, presenting crucial components of minimally invasive colorectal surgery and paving the way for continued advancements in the field.

A Rare Case of Achondroplasia With Bilateral Developmental Cataract.

Enchondral ossification disorders of autosomal dominant congenital origin include achondroplasia, among others. Low stature, craniofacial deformity, and spinal abnormality are its clinical hallmarks. Some of the associated ocular characteristics are telecanthus, exotropia, angle abnormalities, and cone-rod dystrophy. A 25-year-old female presented to the Ophthalmology outpatient department (OPD) with the classical clinical signs of achondroplasia and developmental cataracts in both eyes. She also had associated esotropia in the left eye. Achondroplasia patients should be screened for developmental cataracts to enable timely intervention and management.

An Incidental Finding of Butterfly Vertebrae in a Case of Vertebral Defects, Anal Atresia, Cardiac Defects, Tracheo-Esophageal Fistula, Renal Anomalies, and Limb Abnormalities (VACTERL).

Butterfly spine is a rare benign congenital abnormality. The onset of a minimum of three of the congenital malformations of vertebral defects, anal atresia, cardiac defects, tracheo-esophageal fistula, renal anomalies, and limb abnormalities often characterises the VATER/VACTERL relationship. Recognising this anomaly is crucial for diagnosis, although this rare aberration is thought to be asymptomatic most of the time. Here we are describing a case of a one-year-old female child who has tetralogy of Fallot, congenital anal atresia, vesicovaginal fistula, and butterfly vertebrae which were found as an incidental finding. Furthermore we suggest screening all the children with any one abnormality of VACTERL, usually vertebral anomalies are screened.

Postpartum Depression and Maternal Care: Exploring the Complex Effects on Mothers and Infants.

Postpartum depression (PPD) is a common and debilitating mental health condition affecting many mothers worldwide. This review article aims to explore the complex effects of PPD on mothers and infants, focusing on maternal care. The transition to motherhood is a critical period characterized by numerous physical, psychological, and social changes, making women vulnerable to the onset of PPD. Consequently, PPD can significantly impact a mother's ability to provide optimal care for her infant, leading to potential adverse consequences for both parties. The article synthesizes existing research literature on the topic, encompassing studies from various disciplines, including psychology, psychiatry, obstetrics, and pediatrics. It begins by providing an overview of the prevalence and risk factors associated with PPD, emphasizing the importance of early detection and intervention. The impact of PPD on maternal caregiving behaviors, such as bonding, sensitivity, and responsiveness, is then examined, highlighting the potential disruptions in the mother-infant relationship. Furthermore, the article delves into the potential consequences of impaired maternal care on infant development, including emotional, cognitive, and social domains. Several factors contributing to the complex interplay between PPD and maternal care are discussed, including hormonal changes, psychosocial stressors, and the influence of social support networks. The review also addresses the bidirectional nature of the mother-infant relationship, whereby infant characteristics and behaviors can exacerbate or mitigate the effects of PPD on maternal care. Moreover, the article explores the role of healthcare providers and the importance of implementing effective screening, assessment, and treatment strategies for PPD to promote optimal maternal-infant outcomes. By consolidating current knowledge on the topic, this review article provides valuable insights into the multifaceted effects of PPD on both mothers and infants. Recognizing the significance of maternal care and understanding the mechanisms through which PPD disrupts it can inform the development of targeted interventions to promote early detection, effective treatment, and supportive interventions for mothers experiencing PPD. Ultimately, improving maternal mental health and enhancing maternal-infant relationships can yield long-term positive effects on mothers' and infants' well-being and development.

Understanding the Impact of Menopause on Women With Schizophrenia-Spectrum Disorders: A Comprehensive Review.

Menopause is a physiological event in women's lives that typically transpires in midlife, denoting the cessation of ovarian function and ultimately leading to the end of reproductive capacity. However, women with schizophrenia-spectrum disorders may encounter unique challenges during this period because of the interaction between hormonal changes and their pre-existing mental health conditions. This literature review aims to investigate the consequences of menopause on women with schizophrenia-spectrum disorders, including modifications in symptomatology, cognitive function, and quality of life. Potential interventions will also be examined, including hormone replacement therapy and psychosocial support. The study findings suggest that menopause can worsen symptoms, such as hallucinations and delusions, and may also impair cognitive function, resulting in memory and executive function difficulties. Nevertheless, hormone replacement therapy and psychosocial support could offer potential avenues to manage symptoms and improve the quality of life for women with schizophrenia-spectrum disorders during menopause.

High-Dose Prophylactic Anticoagulation for COVID-19 Pneumonia: A Review of Benefits and Risks.

The COVID-19 pandemic has had a devastating impact on a global scale, causing significant morbidity and mortality. The virus affects multiple organ systems, including the respiratory, cardiovascular, and coagulation systems, leading to severe pneumonia in some patients. Moreover, COVID-19 patients with severe pneumonia have a high incidence of thrombotic events, which can result in significant morbidity and mortality. Given the potential benefits of anticoagulation therapy in COVID-19 patients with thrombotic complications, recent studies have proposed high-dose prophylactic anticoagulation (HD-PA) therapy as a potential treatment option. In fact, some studies have suggested that HD-PA therapy may be more effective in reducing thrombotic events and mortality rates than other treatment options. This review aims to provide a comprehensive overview of the benefits and risks of HD-PA therapy for COVID-19 pneumonia patients. By synthesizing and analyzing the latest available research, we highlight patient selection criteria and discuss the optimal dosage, duration, and timing of therapy. Additionally, we review the potential risks associated with HD-PA therapy and provide recommendations for clinical practice. Ultimately, this review provides valuable insights into the use of HD-PA therapy in COVID-19 pneumonia patients and paves the way for further research in this critical area. By exploring the benefits and risks of this treatment option, we hope to provide healthcare professionals with the information they need to make informed decisions about the best course of treatment for their patients.

A Bibliometric Analysis of Scientific Research Publications Related to Pesticide Poisoning in the South Asian Countries.

Pesticide self-intoxication leading to suicide is a widespread phenomenon in India. Implementing regulations prohibiting the use of highly toxic pesticides in agriculture has proven effective in reducing the overall suicide rate in various South Asian countries without compromising agricultural production. In this study, we conducted a bibliometric analysis of scientific publications on pesticide poisoning in South Asian countries using various databases, including PubMed, Scopus, and Web of Science, using relevant Medical Subject Heading (MeSH) terms. To analyze the data, we employed R Studio and Microsoft Excel 2019, which enabled us to collect information on the number of scientific publications, citation frequency, and keyword trends. Our analysis involved 417 articles, and the results indicated a crucial need for greater awareness and improved management of pesticide poisoning in South Asian countries. Our findings provide valuable insights for policymakers and offer guidelines for pesticide control.

Assessment of Serum Vitamin D Status and Its Associated Health Problem Among Children With Protein Energy Malnutrition: A Cross-Sectional Research Study in Central Rural India.

Background Protein energy malnutrition (PEM) is a condition that results from inadequate intake of both macronutrients and micronutrients, leading to a lack of energy. The condition can manifest quickly or gradually, ranging from mild to severe. It predominantly affects children in low-income countries who do not receive enough calories and proteins. In developed nations, it is more prevalent among older individuals. PEM is more common in children as they consume less protein. In rare cases in developed countries, it may result from fad diets or a lack of knowledge about children's nutritional requirements, especially in cases of milk allergy. Vitamin D plays a critical role in bone growth and development by facilitating the absorption of calcium and phosphorus from food and supplements. Additionally, vitamin D has been linked to a reduced risk of infections, immune system disorders, diabetes, high blood pressure, and heart disease. Aims and objectives The primary objective of this study is to evaluate serum vitamin D levels and their relationship with health complications in children affected by PEM. The specific aim is to estimate the serum vitamin D levels in children with PEM who exhibit symptoms of being underweight, stunting (limited linear growth), wasting (abrupt weight loss), or edematous malnutrition (kwashiorkor). Additionally, this study seeks to analyze the correlation between serum vitamin D levels and the associated health problems in children with PEM. Materials and methods This cross-sectional study employed an analytical research approach. A total of 45 children with PEM participated in the study. Data were collected through a venipuncture method, and serum vitamin D level was assessed using an enhanced chemiluminescence method. The children's pain was assessed using a visual analogue scale, and developmental delay was evaluated using an assessment chart. Data were analyzed using SPSS Version 22 (IBM Corp., Armonk, NY). Results The study's results indicate that a considerable proportion of children, specifically 46.6%, were deficient in vitamin D, whereas 42.2% exhibited insufficiency and only 11.2% had sufficient levels of the vitamin. Pain assessment using the visual analogue scale classification revealed that 15.6% of children reported no pain, 60% reported mild pain, and 24.4% reported moderate pain. The mean and standard deviation of vitamin D levels correlated with developmental delay were 4.22±0.212 and 5.34±0.438, respectively. Similarly, the mean and standard deviation of vitamin D levels correlated with pain were 4.22±0.212 and 2.98±0.489, respectively. The Pearson correlation coefficient for vitamin D levels and pain was 0.010, with a significant level of 0.989, significantly lower than the tabulated value at a 5% significance level. Conclusion Based on the study's findings, it was concluded that children who suffer from PEM are at a risk of developing vitamin D deficiency, which can result in adverse health outcomes, including developmental delay and pain.

Endometrial Receptivity During the Preimplantation Period: A Narrative Review.

Endometrial receptivity is a complex and critical process fundamental to achieving a successful pregnancy. While researchers have made significant strides in understanding the underlying mechanisms governing endometrial receptivity, effective diagnostic and therapeutic strategies remain scarce. This review article aims to elucidate the various factors that contribute to endometrial receptivity, including the hormonal regulation and molecular mechanisms that govern this process, as well as potential biomarkers for assessing endometrial receptivity. One of the major challenges in identifying reliable biomarkers for endometrial receptivity is the intricate nature of the process itself. Nonetheless, recent advances in transcriptomic and proteomic technologies have identified several candidate biomarkers that could potentially enhance our ability to predict endometrial receptivity. Furthermore, emerging technologies such as single-cell RNA sequencing and mass spectrometry-based proteomics hold great promise for providing novel insights into the molecular mechanisms underlying endometrial receptivity. Despite the lack of reliable biomarkers, various therapeutic strategies have been proposed to improve endometrial receptivity. One promising approach involves the transplantation of mesenchymal stem cells (MSCs), which have been shown to increase endometrial thickness and receptivity in both animal models and clinical trials. Growth factors, cytokines, and exosomes derived from MSCs and other cell types may also have therapeutic potential for addressing endometrial dysfunction.

Long-term pulmonary and extra-pulmonary consequences of COVID-19: A comprehensive review of current evidence and future perspectives.

The global impact of the coronavirus disease 2019 (COVID-19) pandemic has been significant, affecting countless individuals worldwide. The existence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has led to considerable levels of illness and mortality. While considerable attention has been devoted to the immediate handling of COVID-19, there is a growing concern about the long-term effects of this disease. The recent studies have brought to light various complexities associated with COVID-19, encompassing both respiratory and non-respiratory problems such as lung scarring, heart diseases, neurological effects, and psychological consequences. The purpose of this review is to provide a comprehensive understanding of the persistent repercussions of COVID-19. It presents a summary of recent studies that have examined the frequency and severity of these complications, as well as an exploration of the potential mechanisms that contribute to their development. Specifically, it delves into the role of immune dysregulation, prolonged inflammation, and dysfunction of blood vessel linings in the origin of these complications. Moreover, the clinical significance of these long-term consequences is discussed, including their potential impact on healthcare systems and society as a whole. Our review highlights the necessity for continuous monitoring and management of patients diagnosed with COVID-19, along with the importance of conducting follow-up studies over an extended period to determine the most effective strategies for prevention and treatment of these complications.

Posterior Circulation Stroke Secondary to Basilar Artery Thrombosis With a Fatal Outcome.

Stroke is a regularly encountered emergency by emergency physicians, categorized based on the culprit artery and diagnosed based on non-contrast computerized tomography (CT) brain, which is supported by clinical examination that can be treated intravenously by thrombolytic agents or mechanical thrombectomy. Here we present one such case, which was brought to the emergency room with symptoms of posterior circulation stroke within 8 hours and underwent mechanical thrombectomy.

Surprising Diagnosis of Myxedema Crisis In-Patient Who Presented With Altered Sensorium.

Hypothyroidism, a disorder of decreased thyroid hormone secretion diagnosed by increased thyroid stimulating hormone (TSH) and low free triiodothyronine (FT3) and free thyroxine (FT4) levels, is classified as primary and secondary hypothyroidism, depending on the pathology. Raised TSH levels are associated with primary hypothyroidism, while decreased levels of TSH are seen in secondary hypothyroidism. With the easy availability of diagnostic tests, hypothyroidism can be detected and managed early but can be life-threatening if not treated within time. Manifestations of hypothyroidism are dry skin, hoarseness of voice, weight gain, constipation, cold intolerance, fatigue, and lethargy; however, the clinical presentation can differ as per age and sex and person to person. Here, we present one such case, which was brought to the emergency room with a history of altered sensorium, hypotension, and swelling over the bilateral lower limbs and face, with a surprise diagnosis of myxedema crisis. The uniqueness of this case is the omnipresent availability of early diagnosis and treatment in this era. still got a female patient with altered sensorium who was diagnosed to be a myxedema crisis which was given a lesser thought in our provisional diagnosis.

A Rare Case of Infantile Cortical Hyperostosis (ICH) of the Bilateral Tibia or Caffey Disease.

An inflammatory collagenopathy of infancy characterized by subperiosteal bone hyperplasia is known as infantile cortical hyperostosis (ICH) or Caffey disease. A 10-day male infant presented to the hospital with leg swelling, excessive crying, and irritability since birth. He was born with the swallowed part of his tibia bone. The X-ray suggested hyperostosis of the bilateral tibia bone involving the anterior cortex, which is more prominent on the right side. The infant was clinically monitored and treated and discharged after the swelling was reduced. Again, he was admitted to the hospital at 10 weeks of life, and a similar thickening appeared on his left tibia. He was administered analgesics and non-steroidal anti-inflammatory drugs (NSAIDs) and discharged under a follow-up schedule. The infant was monitored in the pediatric ward for the next seven days. The swelling and pain completely subsided one and a half weeks after hospitalization, and continued follow-up was suggested until the complete correction of the disease on an outpatient basis. This disease must be recognized and understood, and the clinical-radiological correlation is significant.