Lived Experiences of Bereaved Family Members During COVID-19 Pandemic in a Tertiary Care Hospital With Special Reference to Imposed Restrictive COVID Guidelines-a Qualitative Study.

This study aimed to understand the experiences of bereaved family members in view of restrictive COVID guidelines using qualitative approach. 10 Hindu, Gujarati bereaved family members who lost their loved ones during the first wave were interviewed telephonically after a month of their loss. Findings were difficulty in proper communication during hospitalization, disrupted end-of-life and funeral rituals and accepting harsh realities related to the changes imposed by using content analysis. Most of the family members felt that there was a need of staying with the patients. Telephonic mode of communication was not sufficient for them and created doubts related to death. Most of them felt remorseful as they were not able to see or bring their loved one home during their last moments and felt deprived of the traditional rituals. Also, they had to deal with their grief by themselves.

Prevalence and predictors of suicide ideation among undergraduate medical students from a medical college of Western India.

BACKGROUND: Looking at the background vulnerability and increasing incidence of suicides among medical students, more information on its burden and causes is needed. METHODS: A cross-sectional study was conducted at a medical college to assess prevalence of suicide ideation and associated factors among medical students. Data were collected through a web-based survey questionnaire using Patient Health Questionnaire-9 and items on suicide cognitions, suicide attempt history and risk factors. Bivariate and multivariate analyses were performed in SPSS. RESULTS: A total of 506 students (69.2%) responded to the survey questionnaire. The 2-week prevalence of depression and suicide ideation was 14% (73/506) and 9% (44/506). Proportion of participants reporting suicidal cognitions in preceding 1 month: life not worth living-13%; death wish-6%; suicidal ideas-4%; and suicide plan-1%. The significant predictors of suicide ideation were female gender (adjusted odds ratio [AOR] = 3.2, 95% confidence interval [CI] 1.6-49.1), alcohol use (AOR = 3.2, 95% CI 1.1-9.7), history of facing any type of abuse (AOR = 3.9, 95% CI 1.2-11.9), academic stress (AOR = 3.3, 95% CI 1-10.9), family-related stress (AOR = 5.6, 95% CI 1.8-17) and relationship-related stress (AOR = 3.5, 95% CI 1.1-10.8). Half of the students reported presence of academic stress as important life stressor. Three-fourth students preferred friends as their source of help in times of need. Web-based survey method for screening was acceptable to students. CONCLUSION: The prevalence of suicide ideation is alarmingly high among medical students. Academic stress, previous experience of abuse, stress originating from family expectations and strained relationship with friends and peers were found to be risk factors or predictors for suicidal ideation.

Prevalence and pattern of antipsychotic induced movement disorders in a tertiary care teaching hospital in India - a cross-sectional study.

OBJECTIVES: To assess prevalence and pattern of movement disorders among patients taking antipsychotic medications. METHODS: This cross-sectional, intensive monitoring (patient interview, case record form review and clinical examination) study was conducted in patients taking antipsychotic drugs irrespective of duration for the development of movement disorders. The psychiatrist used Modified Simpson-Angus Scale score (10-item scale), Barnes' rating scale and Abnormal Involuntary Movement Scale to diagnose parkinsonism, akathisia and tardive dyskinesia, respectively. We assessed movement disorders for the preventability and seriousness. RESULTS: The overall prevalence of antipsychotic induced movement disorders was 5.67% (95% CI: 4.19-7.62). The prevalence of parkinsonism, akathisia and tardive dyskinesia was 5.10% (95% CI: 3.71-6.98), 0.85% (95% CI: 0.39-1.84) and 0.57% (95% CI: 0.22-1.45), respectively. There was a trend of high proportions of movement disorders in extreme of age group, female gender, patients treated with conventional antipsychotics, on poly therapy, patients of epilepsy with psychosis, schizophrenia and bipolar mood disorder. The movement disorder was lowest with quetiapine (2.02%). CONCLUSIONS: The higher use of atypical antipsychotics had reduced the occurrence of movement disorders in our setup.

Effectiveness of Diode Laser in Intraoral Soft Tissue Surgeries - An Evaluative Study.

Introduction: The clinical application of the diode laser seems to have beneficial effects in surgery. The laser provides precise and rapid tissue dissection, excellent haemostasis and lessens post-operative inflammation. This study was done to assess the clinical effectiveness of diode laser in the management of different varieties of intraoral soft-tissue lesions. Materials and Methods: After applying exclusion criteria, a total of 50 samples were selected with benign intraoral soft-tissue lesions treated with a diode laser under local anaesthesia between September 2017 and September 2020. Each patient was followed up on the 3rd, 7th and 15th post-operative days for healing, pain, infection and swelling. Results: From all patients, a total of 50 were evaluated in the study; out of all, 60% of patients had no pain on the 2nd follow-up. As per the Landry Index of Healing, 54% of patients had excellent healing. None of the cases had post-operative bleeding, infection was present in 4% at the 1st-2nd follow-up, and in 2% of cases, post-operative swelling was present. The efficacy of diode lasers was tested using the Chi-square test and P < 0.01, which was statistically significant. Discussion: Diode laser seems to be superior over conventional treatment modalities as it provides a bloodless dry field and increases patient comfort during surgery. It also lessens the post-operative pain and swelling. Diode laser can safely and effectively be used as a treatment modality for benign soft-tissue lesions, without any complication and without compromising the health and function of patients.

Limitations of access to antipsychotics in Canada: loss of the old and unavailability of the new options.

Schizophrenia is a severe, debilitating disorder that is associated with a significant burden of illness. Antipsychotic medications remain the mainstay of treatment for schizophrenia and related disorders. In recent years, a number of new psychotropic medications have been introduced to the market, with some potential differences in the mechanism of action compared to the previous ones. In this paper, we discuss the issue of lack of access to the newer antipsychotics in Canada, and the discontinuation of some of the older options from the market, leaving clinicians and patients with a limited number of available options. While the aim of this paper is to increase awareness of the current state of availability and accessibility of options, we further discuss some potential solutions.

Analysis of change in knowledge, attitude, and practices about COVID-19 following and awareness session in rural population of Western India.

BACKGROUND: Beginning of the pandemic showed our limitations in our understanding of the spread of the dreaded coronavirus-19 that had sprung from China and spread through thick and thin across the world. The measures to contain the spread of virus in the absence of specific treatment protocol had everyone grope for the solutions in a very short time frame. One such is the knowledge, attitude, and practice in the rural setup. AIM: The aim of the study is to measure the change in knowledge, attitude, and practices (KAP) regarding COVID-19 following an awareness session in rural population. MATERIALS AND METHODS: A cross-section interventional study was carried out in January 2021. An interactive awareness session was conducted with the help of audiovisual aids following MOHFW guidelines for COVID-19, and the change in KAP about COVID-19 was measured by pre- and posttest standardized questionnaire. RESULTS: Of all the participants, statistically significant change in knowledge was seen from 43% to 52%. The villagers were educated about preventive steps and a positive change was measured in the practice of changing masks regularly (84%-100%), maintaining social distancing (44%-64%), frequent handwashing (52%-64%). No change was seen in wearing of masks (92%) and negative change was seen in avoiding handshakes (32%-28%). The preventive practices regarding COVID-19 pandemic changed significantly from 50% to 58%. Our study measured positive attitude change toward getting vaccinated from 64% to 72%. CONCLUSION: A single, short awareness session led to significant change in KAP about COVID-19 in rural population.

Efficacy of Collagen Membrane Graft in Intraoral Surgery - An Evaluative Study.

INTRODUCTION: Bovine-derived collagen membrane is usually and regularly used as a temporary cover or dressing for extraoral wounds and burns. It has wide applications because of its usefulness and biocompatibility. This has provoked us to do a study with the use of collagen membrane even for minor intraoral surgical defects. The aim of this evaluative study was to evaluate the clinical efficacy of collagen membrane in intraoral wounds created by removal of various soft tissue lesions. MATERIALS AND METHODS: A total of 25 healthy patients (16 males and 9 females) were taken for this study. This study was confined to secondary defects of the oral mucosa, which occur after excision of premalignant lesions and other conditions, such as benign lesions, reactive proliferations, and incisional biopsy wounds. Only those lesions that were sufficiently large and could not be closed primarily were included in the study. RESULTS: The results were evaluated on the day of surgery and in the postoperative period. The usefulness of collagen membrane as an intraoral temporary wound dressing material to promote haemostasis, relieve pain, induce granulation, and assist in rapid epithelialization at the wound site and prevent infection, contracture, scarring, and donor-site morbidity was evaluated, and finally, the efficacy of collagen membrane was tested by the use of Chi-square test and P < 0.001, which is a statistically and clinically significant value. DISCUSSION: Collagen membrane was observed as both biological dressing material and drug carrier. It was found to be a suitable alternative to other graft materials mentioned for the repair of defects in the mucous membrane created by surgical excision of lesions. Therefore, when used judiciously in a controlled clinical situation, collagen membrane is biologically acceptable in nature. It is an alternative to autologous grafts rather than a replacement of other grafts used in the oral cavity.

Unilateral Condylar Fracture with Review of Treatment Modalities in 30 Cases - An Evaluative Study.

INTRODUCTION: The treatment of subcondylar mandible fractures is a topic of debate and can be variable even though these fractures are commonly seen. The present study aimed at evaluation of various treatment modalities for unilateral condylar fracture in adults. MATERIALS AND METHODS: Thirty patients with unilateral condylar fractures between the age of 18 and 60 years were evaluated. Treatment protocol included closed reduction for 15 patients and open reduction for 15 patients. RESULTS: Assessment was done functionally for maximum interincisal mouth opening, deviation on maximum interincisal mouth opening, occlusion and facial nerve function, and radiologically for ramus height shortening. In general, there were no statistically significant differences between closed and open methods. DISCUSSION: Both the treatment options for condylar fractures of the mandible yielded acceptable results. Closed treatment appears to be a safe and appropriate modality for most unilateral condylar fractures. Although the open group, in general, showed similar outcomes, this treatment should be reserved for limited indications. The present study has confirmed that both treatment options can yield acceptable results. On clinical examination, there was no significant difference in mouth opening measures, the incidence of occlusal disturbances or in the degree of pain perception.

Angioleiomyoma of the Lower Lip.

Leiomyoma is a benign smooth muscle tumor that occurs most frequently in the uterine myometrium, gastrointestinal tract, skin, and lower extremities. Leiomyoma rarely affects the oral cavity. Angioleiomyoma (vascular leiomyoma) is a histological subtype of the leiomyoma. The diagnosis is commonly determined by histopathological studies. This case report shows a 57-year-old male patient with a lesion of the lower lip. After laser excision, hematoxylin and eosin and smooth muscle actin staining confirmed the diagnosis of angioleiomyoma.

Adenomatoid Odontogenic Tumor Associated with Impacted Mandibular Canine - A Case Report.

Adenomatoid odontogenic tumor (AOT) is a relatively rare, benign, hamartomatous, and cystic odontogenic neoplasm that was first described more than a century ago. It accounts for 2-7% of all odontogenic tumors. The lesion still continues to intrigue experts with its varied histomorphology and controversies regarding its development. The present article describes a case of cystic AOT with an unusual histomorphology associated with an impacted 43 in a 15-year-old male.

Ectopically Positioned Tooth Piercing the Philtrum.

A variety of eruption disturbances arise during the transitional dentition period, which can be broadly classified as disturbances related to time and disturbances related to position. The occurrence of ectopic eruption is relatively common, but ectopically positioned tooth piercing the philtrum is a rare clinical presentation. This is a case report of a 70-year-old female who presented with the chief complaint of an abnormally positioned tooth piercing out from the upper lip to the Department of Oral and Maxillofacial Surgery, Karnavati School of Dentistry, Uvarsad, Gandhinagar, Gujarat, India. As per the patient's history, labially erupted tooth was piercing the philtrum for 60 years and it was visible extraorally from the philtrum and was painful.

Attitudes of undergraduate medical students toward mental illnesses and psychiatry.

BACKGROUND: Worldwide, studies show negative attitude among medical students toward psychiatry and mental illness. The knowledge of the attitude and awareness of the undergraduate medical students toward psychiatry, mental health, and psychiatric disorders are most important as they are going to be involved in the care of these patients either directly or indirectly during the later years of their careers. AIM: This study aims to assess attitude toward psychiatry and mental illness among undergraduate medical students. METHODOLOGY: The responses of 67 medical students from the 6th semester (third professional year) batch who completed their 2-week clinical posting of psychiatry in 4th semester (i.e., second professional year) were collected using validated questionnaires, attitude towards mental illness (AMI), and attitude towards psychiatry (ATP) that assessed their attitudes to psychiatry and mental illness. Double data entry and validation were done using EpiData and analysis using Epi Info software. RESULTS: Median AMI score was 54 (out of maximum 100) showing a neutral AMI. Median ATP score was 82 (out of maximum 150) also showing a neutral ATP. The theme-wise analysis showed that the attitude of students toward psychiatrist and psychiatry branch was relatively better compared to their AMI. CONCLUSION: Undergraduate students have a neutral attitude to psychiatry and mental illness. More efforts are needed to change the attitude to favorable side.

A novel approach to suicide prevention - Educating when it matters.

BACKGROUND: Looking at the burden of suicide, there is a dire need for medical schools to incorporate suicide prevention training. Effective communication helps in early detection and management of suicidal behavior. Medical students can act as a GATEKEEPER if they receive adequate training. METHODOLOGY: This was an educational intervention study done at tertiary care teaching hospital to assess the knowledge and attitude of medical students toward depression and suicide and to impart and assess communication skills for suicide prevention in one of the four batches of students in 4th semester. Pretest was conducted to assess knowledge and attitude toward depression and suicide, followed by training using interactive lectures, demonstration of interview, and hands-on training with patients and role-plays. The posttest and objective structured clinical examination (OSCE) were administered for skill assessment. Feedback was taken regarding this intervention. RESULTS: The mean marks of the pre- and post-test were 8.96 (8.3-9.6) and 14.58 (13.8-15.3), respectively, out of 25. The difference was statistically significant (t = 13.24, P ≤ 0.0001) which suggests improvement in knowledge. We found mixed responses in attitude statements showing limited change. Mean obtained marks on OSCE examination out of 66 was 42.7. Among various components of OSCE, students scored high on rapport building. The most useful components of trainings were role-play, OSCE, and interaction with patients as per their feedback. CONCLUSION: The intervention was found effective in increasing knowledge, changing attitude, and enhancing communication skills of medical students toward suicide prevention. Training of communication skills for suicide prevention in depressed person should be given to every medical student as suggested by feedback.

Pharmacists' perceptions of pay for performance versus fee-for-service remuneration for the management of hypertension through pharmacist prescribing.

OBJECTIVES: As pharmacists expand their roles as patient care providers, remuneration must be offered for patient care activities apart from dispensing. Most jurisdictions paying for such services utilize the fee-for-service (FFS) model, while little is known about the role of pay for performance (P4P) within the pharmacy profession. This study aimed to elicit the experience of pharmacists practicing under both models within the Alberta Clinical Trial in Optimizing Hypertension (RxACTION) study in Alberta, Canada. METHODS: Pharmacist participants in RxACTION caring for at least one patient under FFS and under P4P were interviewed about their experiences until data saturation was reached. Interviews were conducted in June-July 2015, with responses audio recorded, transcribed and coded to identify key themes. KEY FINDINGS: Eight pharmacists were interviewed, with three key themes identified: a perceived comfort with the existing FFS model particularly due to its ease related to business planning, the transformative effect of the study on their practices and a preference for future models to consider a blend of both service count- and performance-driven metrics. The degree of influence pharmacists feel they can have on outcomes achieved by patients, the perceptions of patients and other healthcare professionals on outcome-based payment, and concerns with the impact of variable remuneration on the pharmacy business model are concerns raised with P4P in pharmacy practice. CONCLUSIONS: This study reveals a hesitation to radically transform payment for pharmacists' patient care services towards a P4P model. Efforts to implement P4P should therefore be gradual and accompanied with a robust evaluation plan.

Impact of Quality Rights Gujarat program on dropout rate of patients visiting outpatient psychiatry department of tertiary care hospital.

BACKGROUND: Dropout from an outpatient clinic is the loss of patient to the scheduled follow-up. Noncompliance in the form of treatment dropouts is a major problem across outpatient mental health settings and can range from 15% to 60%. Follow-up studies provide valuable insights into improving the quality of existing mental health facilities. Quality Rights Gujarat (QRG) is a step toward improving mental health facilities across various centers. METHODS: This retrospective observational study aims to explore follow-up pattern, predictors and any change after QRG implementation. Pre intervention Group (A) attended psychiatry OPD for 6 months before implementation of QRG project and Post intervention Group (B) attended psychiatry OPD for 3 months after implementation of QRG project. RESULTS: Total 1632 Patients consulted in group A and 926 patients consulted Psychiatry OPD in group B. The most common Psychiatric disorder were Depression (A-19.55%, B-28.62%), Schizophrenia and related disorders (A-14.15%, B-15.01%), Neuropsychiatric disorders like headache and epilepsy (A-14.52%, B-18.68%), substance use disorder (A-15.26%, B-13.71%) and Bipolar disorder (A-11.76%, B-13.17%). 59.56% patients dropped out after the first visit in pre intervention group as compared to 51.94% patients in post intervention group. Significant reduction of about 8% in loss to follow up and 16% increase in follow-ups of initial visits after implementation of Quality Rights Gujarat project. CONCLUSIONS: Much can be done to improve attendance in most services. The initiative like QRG significantly has positive results on patient's follow-up.

Adverse drug reactions in a psychiatric department of tertiary care teaching hospital in India: Analysis of spontaneously reported cases.

The epidemiological data are limited for the spontaneous adverse drug reaction (ADR) reporting system in psychiatry and its comparison with intensive monitoring studies in terms of causative drugs, seriousness, preventability and drug interactions. This spontaneous ADR reporting study was carried out over a period of three years in the psychiatry department. We adopted WHO definition for an ADR, Naranjo's algorithm for causality, WHO-ADR terminology for the labeling of involved organ-system, International conference on harmonisation (ICH) E2A guidelines for seriousness, modified Schumock and Thornton's criteria for preventability and Medscape drug interaction checker for drug interactions. Two subgroup analyses were performed to find out the risk factors for the serious and preventable reactions. A total of 97 ADRs from 67 patients were included for analysis. The incidence of 'overall' and 'serious ADRs were 0.69% (95% CI: 0.54%, 0.88%) and 0.18% (95% CI: 0.12-0.29%), respectively. The females experienced more ADRs than males. The most commonly reported ADR, incriminated pharmacology group and drug, were extrapyramidal movement disorders (22.68%), atypical antipsychotics (35.62%) and escitalopram (13.91%), respectively. One out of five and one out three reactions were considered as 'serious' and 'preventable', respectively. The drug interactions contributed in 34.02% reactions. The factors significantly associated with 'serious' reactions were typical antipsychotics [OR: 5.47 (1.68, 17.87)], central and peripheral nervous system disorders [OR: 24.00 (5.12, 112.5)] and extrapyramidal reactions [OR: 14.03 (4.43, 44.43)]. The polypharmacy [OR: 5.85 (1.90, 18.03)] was significantly associated with 'preventable' reactions. The spontaneous reporting system is efficient to detect serious reactions and preventable reactions.

Increased exposure to estrogens disturbs maturation, steroidogenesis, and cholesterol homeostasis via estrogen receptor alpha in adult mouse Leydig cells.

Deteriorated male reproductive health has been connected to overexposure to estrogens or to imbalanced androgen-estrogen ratio. Transgenic male mice expressing human aromatase (AROM(+) mice) serve as an apt model for the study of the consequences of an altered androgen-estrogen ratio. Our previous studies with AROM(+) mice showed that low androgen levels together with high estrogen levels result in cryptorchidism and infertility. In the present study, the AROM(+) mice were shown to have severe abnormalities in the structure and function of Leydig cells before the appearance of spermatogenic failure. Decreased expression of adult-type Leydig cell markers (Ptgds, Vcam1, Insl3, Klk21, -24 and -27, Star, Cyp17a1, and Hsd17b3) indicated an immature developmental stage of the Leydig cells, which appears to be the first estrogen-dependent alteration. Genes involved in steroidogenesis (Star, Cyp17a1, and Hsd17b3) were suppressed despite normal LH levels. The low expression level of kallikreins 21, 24, and 27 potentially further inhibited Leydig cell function via remodeling extracellular matrix composition. In connection with disrupted steroidogenesis, Leydig cells showed enlarged mitochondria, a reduced amount of smooth endoplasmic reticulum, and an accumulation of cholesterol and precursors for cholesterol synthesis. The results of studies with AROM(+) mice crossed with estrogen receptor alpha or beta (ERalpha and ERbeta, respectively) knockout mice lead to the conclusion that the structural and functional disorders caused by estrogen exposure were mediated via ERalpha, whereas ERbeta was not involved.