Implementation of positive psychology to surmount demoralization caused by a cataclysm in select works of Svetlana Alexievich.

BACKGROUND: Cataclysm refers to a large-scale and violent event involving disaster, catastrophe, calamity, and tragedy. The recent surge of a pandemic (coronavirus disease 2019 (COVID-19)), humanitarian crisis in Sudan, civil unrest, and war, such as the attacks in Syria and Ukraine, reiterate the need to address the trauma attached to such catastrophes. This study focuses on adapting positive psychology, one of the newest branches of psychology to emerge, to help human beings prosper and lead healthy, happy lives. It also explores post-traumatic stress disorder (PTSD) and means to overcome traumatizing psychological dejection caused by such mishaps. MATERIALS AND METHODS: Demoralization is the immediate effect caused on victims and survivors of such devastations. A comprehensive study of cataclysm and demoralization is concomitant with the suffering produced by various factors pertaining to mass annihilation. A deductive methodology is incorporated into the qualitative data to analyze the oral testimonies of war and disaster survivors in Svetlana Alexievich's works titled Zinky Boys: Soviet Voices from the Afghanistan War, Second Hand Time, The Unwomanly Face of War and Chernobyl Prayer. RESULTS: Interpretation of the polyphonic voices in the oral sagas of interviewees in Alexievich's works reveals an increased level of anxiety, stress, and trauma post-catastrophic events. CONCLUSION: The implementation of positive psychology has been identified as an appropriate psychological intervention to address the issues related to psychological devastation.

In Vitro Activity of Two Cefepime-Based Novel Combinations, Cefepime/Taniborbactam and Cefepime/Zidebactam, against Carbapenemase-Expressing Enterobacterales Collected in India.

In recent times, discovery efforts for novel antibiotics have mostly targeted carbapenemase-producing Gram-negative organisms. Two different combination approaches are pertinent: ß-lactam-ß-lactamase inhibitor (BL/BLI) or ß-lactam-ß-lactam enhancer (BL/BLE). Cefepime combined with a BLI, taniborbactam, or with a BLE, zidebactam, has been shown to be promising. In this study, we determined the in vitro activity of both these agents along with comparators against multicentric carbapenemase-producing Enterobacterales (CPE). Nonduplicate CPE isolates of Escherichia coli (n = 270) and Klebsiella pneumoniae (n = 300), collected from nine different tertiary-care hospitals across India during 2019 to 2021, were included in the study. Carbapenemases in these isolates were detected by PCR. E. coli isolates were also screened for the presence of the 4-amino-acid insert in penicillin binding protein 3 (PBP3). MICs were determined by reference broth microdilution. Higher MICs of cefepime/taniborbactam (>8 mg/L) were linked to NDM, both in K. pneumoniae and in E. coli. In particular, such higher MICs were observed in 88 to 90% of E. coli isolates producing NDM and OXA-48-like or NDM alone. On the other hand, OXA-48-like-producing E. coli or K. pneumoniae isolates were nearly 100% susceptible to cefepime/taniborbactam. Regardless of the carbapenemase types and the pathogens, cefepime/zidebactam showed potent activity (>99% inhibited at ≤8 mg/L). It seems that the 4-amino-acid insert in PBP3 (present universally in the study E. coli isolates) along with NDM adversely impact the activity of cefepime/taniborbactam. Thus, the limitations of the BL/BLI approach in tackling the complex interplay of enzymatic and nonenzymatic resistance mechanisms were better revealed in whole-cell studies where the activity observed was a net effect of ß-lactamase inhibition, cellular uptake, and target affinity of the combination. IMPORTANCE The study revealed the differential ability of cefepime/taniborbactam and cefepime/zidebactam in tackling carbapenemase-producing Indian clinical isolates that also harbored additional mechanisms of resistance. NDM-expressing E. coli with 4-amino-acid insert in PBP3 are predominately resistant to cefepime/taniborbactam, while the ß-lactam enhancer mechanism-based cefepime/zidebactam showed consistent activity against single- or dual-carbapenemase-producing isolates including E. coli with PBP3 inserts.

A comprehensive study and extensive review of morphological variations of liver with new insights.

PURPOSE: Liver is divided into four anatomical lobes presenting minor fissures and invisible major fissures. The prevalence of Accessory Fissures in liver ranges widely from 6 to 94%. The morphometric analysis of individual lobes is also scarce in literature. There have been instances where the surgeon has experienced some of these variations as a surprise during surgery as the existing data on the surface variations of liver is still contradictory. A sound knowledge of these variations would aid the surgeons and radiologists to circumvent the misdiagnosis and complications during surgeries. METHODS: The study was conducted in 93 cadaveric livers. Minor liver fissures, Accessory fissures and lobes were noted and measured. The livers were classified according to the Netter's classification. The morphology of caudate and quadrate lobes was studied. Any other variations in the appearance of groove for Inferior vena cava, gall bladder and its fossa were also studied. The results are tabulated. RESULTS: The study revealed several variations in the morphological features of liver. Accessory fissures were noted in 51.61% of livers, distributed on various liver surfaces. Accessory lobes were noted in 27.9%. Pons hepatis was present in 22.5%. Gall bladder variations that were noted include the Hartmann's pouch (n = 14; 15.05%) and the Phrygian cap (n = 2; 2.15%). 65.6% livers (n = 61) had the sulcus of the caudate process or fissure of Gans or Rouviere sulcus which is a normal fissure present in majority of normal healthy livers. CONCLUSION: The current study provides a complete understanding and a thorough knowledge of surface morphological variations in liver. We hope that this will be greatly helpful for surgeons and radiologists to avoid possible errors in interpretations, to plan appropriately and assist during liver surgeries and to do radiological interventions.

Perceptions of Medical Undergraduate Students on Curricular Changes in Anatomy: An Embedded Design Mixed Method Study.

INTRODUCTION: Implementation of competency-based medical education (CBME) offers challenges to the faculty and students. As a part of the new curriculum by the National Medical Council of India, we introduced certain teaching and assessment modifications in anatomy. There are few studies on the actual implementation of CBME. The current study aimed to assess the perceived usefulness of the teaching, learning, and assessment methodology (TLAM) based on written feedback from students. METHODS: All the 147 first MBBS students of the batch who had undergone the new teaching learning methodology answered the questionnaire on usefulness of the various TLAMs on a 3-point Likert scale which was taken as quantitative data. They were also asked to pen down their opinions and suggestions about the TLAM which was thematically analysed and considered as qualitative data. Face and content validity was assessed prior to administration of the questionnaire. Descriptive statistics were used for quantitative variables. Qualitative data were analysed by thematic analysis. RESULTS: 100% of the students found vertical integration and small group teaching as useful. Seminars and quizzes were reported as useful to extremely useful by 75.5% of the students. Self-directed learning and near-peer teaching was also appreciated well by 78% of students. In Embryology and Neuroanatomy, these active learning methods were not found to be useful as these topics were difficult to understand. Overall, the new TLAM introduced as per the new medical curriculum was found useful for the majority of students. CONCLUSION: This study provides valuable insights on the teaching, learning, and assessment methods as formulated by the competency-based medical curriculum. Though active learning methods are the integral principles of andragogy, the concepts which are difficult to understand need to be taught using the traditional teaching methodology.

Infusing the axioms of clinical reasoning while designing clinical anatomy case vignettes teaching for novice medical students: a randomised cross over study.

The clinical reasoning skills is often gained when the biomedical knowledge is broadened and deepened alongside exposure to patients. The 'ideal' blend of axioms of clinical reasoning and case based learning would establish the pedagogical bridges right from the first year of medical education. So this study aimed to investigate the perceived importance and efficacy of teaching clinical reasoning skills among first year medical students, as this has not previously been described. As a priori, two clinical reasoning skill sessions were conducted using clinico-anatomical case vignettes designed according to the literature regarding clinical reasoning ('serial cue' approach and hypothetico-deduction). Students were divided into intervention and control group and crossed over in subsequent sessions. Analysis was done by mixed method approach including measuring proof of benefit using post-test comparison, quantitative survey and qualitative analysis by nominal group discussion. Post test scores were compared using student's t-test. Feedbacks were analysed using descriptive statistics. The results showed that post test scores were significantly higher in intervention group than the control group in both sessions (P<0.001, 0.016). A total of 66% students felt, diagnostic skills and lateral thinking abilities were improved and It helped in developing problem-solving abilities for 67% students. clinico-anatomical case vignettes helped in understanding anatomical basis of clinical conditions for 61% students. To conclude, introducing clinical reasoning has considerable effect in improving the decision making ability of the students and if incorporated right from the first year, would better prepare the students in successful transition to clinical learning environment.

Are Footedness and Lateral Postures Better Predictors of Hemispheric Dominance Than Handedness: A Cross-sectional Questionnaire-Based Clinical and Pedigree Study.

Objective Approximately 9 out of 10 individuals show right-hand dominance. The remaining 10% include left-hand dominant and mixed handed/ambidextrous individuals. Laterality, lateral postures or lateral preference is defined by various authors as the most comfortable posture that an individual prefers to assume. The current study aims at finding the distribution of these lateral postures and their correlation with handedness/dominant side. Materials and Methods The study was done in medical and nursing students in the age group 18 to 22 years. The patients were asked to fill a self-assessment questionnaire to determine handedness and footedness. The laterality traits were observed by asking the patients to do by themselves after an untailored demonstration. Statistical Analysis The relationship between study parameters was assessed using Chi-square test. Pearson's correlation test was done to assess the strength of association between comfort ratings of the various laterality postures. Results In our study, 96.5% were right handed and 79.9% of patients were right footed. Also, 50.8% preferred right-hand clasping, 53.9% preferred left-arm folding, and 60.6% preferred right-leg folding. A statistically significant correlation was seen between foot preference and lateral postures and arm folding and hand clasping (p < 0.05). A significant association was also found between handedness and positive history of retraining. Sidedness did not follow any Mendelian pattern of inheritance. Conclusions Handedness is affected by genetic and environmental factors. Since cultural and traditional practices can affect the lateral postures and handedness, it is important to know the relationship between laterality postures and sidedness and the impact of retraining on them. These postures are measures of cerebral dominance and are clinically important.

Evaluating the effectiveness of integrating radiological and cross-sectional anatomy in first-year medical students - A randomized, crossover study.

CONTEXT: Radiological anatomy (RA) knowledge is essential for the current-day clinical practice due to the rapid development in imaging technologies. As there is a long interval between learning RA in the 1st year and applying it in their clinical disciplines impedes their functional understanding, this study has been planned to provide the students with a right mix of anatomy and radiology in order to promulgate deeper medical comprehension. AIM: This study aimed to evaluate the effectiveness of integrated RA in honing the radiological reasoning abilities in 1st year medical students and to develop critical thinking skills through small-group, case-based learning experience. METHODOLOGY: All the students of 2017-2018 batch were randomized equally into study group and control group. The study group was exposed to the interactive RA module followed by posttest. The control group was exposed to traditional teaching and then given posttest. The groups were flipped for successive regions of anatomy. Feedbacks were obtained by both quantitative and qualitative methods. STATISTICAL ANALYSIS: Posttest scores were compared using Student's t-test. Feedbacks were analyzed using descriptive statistics. RESULTS: The posttest scores were significantly higher in the study group when compared to the control group. Nearly 92% of the students felt that the integrated module made them learn better and 44% of the students felt that it helped them to apply the knowledge in clinical context. CONCLUSION: For the present millennial-generation students, integrated RA lectures help develop their critical thinking and help in the subsequent clinical years.

Cytokinesis blocked micronucleus assay of peripheral lymphocytes revealing the genotoxic effect of formaldehyde exposure.

Formaldehyde (FA), which is said to be a carcinogenic agent, is commonly used in anatomy laboratories. This study used the cytokinesis blocked micronucleus assay (CBMN) to assess DNA damage due to FA exposure by measuring the frequency of micronuclei (MN) in lymphocytes. The extent of DNA damage was assessed with respect to the duration of exposure. Thirty male anatomy laboratory workers from various medical colleges involved with storing specimens and embalming were included in the study. Thirty males who were not exposed to FA were included as a comparison group. Blood samples were collected after informed consent was given. Information regarding age, duration of FA exposure and smoking habits was obtained by a questionnaire. The CBMN assay was conducted on cultured isolated lymphocytes stained with Giemsa. MN were counted in a total of 1000 binucleated lymphocytes. The effect of smoking was assessed using appropriate statistical tests. The frequency of MN in lymphocytes was significantly higher in the exposed group (P < 0.001). The duration of exposure correlated positively with the frequency of MN (r = 0.5, P = 0.02). Neither aging nor smoking correlated significantly with the formation of MN. The present study highlights significant DNA damage in people exposed to FA. The extent of damage was directly proportional to the duration of exposure.

Androgen insensitivity syndrome: ten years of our experience.

Abnormalities of secondary sexual differentiation manifest in varying degrees depending upon the severity of the underlying cause. Primary amenorrhea in phenotypic females is caused by several different factors, including hormonal imbalance, nutritional deficiency and sex differentiation abnormalities. Androgen insensitivity syndrome (AIS) accounts for a large proportion of such cases in phenotypic females but genetically male individuals. Over the past 10 years, we have collected data related to androgen insensitivity from more than 150 cases. The research identified several important but neglected facts about this syndrome; including the identification of mutations in 39% of the cases and the establishment of the cause of pathogenesis in 60% of them. The most intriguing facts were uncovered in relation to late presentation of the AIS cases, little awareness among patients and family members, no consensus on the age of performing gonadectomy, and reluctance of the patients to undergo recommended surgery. These issues need immediate attention to improve healthcare and management of AIS cases. This article summarizes our observations about AIS with an aim to spread awareness among patients and clinicians.

Pregnancy among unmarried adolescents and young adults.

OBJECTIVES: To determine the risk factors for pregnancy among unmarried adolescents and young adults. METHODS: Case-control study was done over a period of 2 years. Data collected from 181 unmarried abortion seekers and 181 unmarried non-pregnant controls (≤24 years) attending three Medical Colleges of Kerala. RESULTS: Logistic regression analysis showed a strong association between unmarried adolescent pregnancy and lack of parental supervision and control (OR 8.74, P = 0.000), poor intra-family relationship (OR 7.01, P = 0.000), family problem (OR 4.41, P = 0.000), lack of knowledge on sexual and reproductive health (OR 4.95, P = 0.0003), and non-engagement of adolescent in any productive activity (OR 4.41, P = 0.0373). CONCLUSIONS: Lack of parental control, family problem, poor intra-family relationship, lack of knowledge on sexual and reproductive health, and lack of engaging in any productive activity were found to be significant predictors for unmarried adolescent pregnancy.

Domino alkylation/oxa-Michael of 1,3-cyclohexanediones: steering the C/O-chemoselectivity to reach tetrahydrobenzofuranones.

An unprecedented domino synthesis of tetrahydrobenzofuran-4-ones is described implicating chemoselective alkylation of various 1,3-cyclohexanediones with bromocrotonate or crotonitrile followed by oxa-Michael cyclization. Further transformations of this core to reach molecular diversity are also presented.

Incidence of morphological variants of mandibular lingula.

The ligual of mandible is a tongue shaped bony projection on the medical surface of the ramus close to the posterior margin of the mandibular foramen. Since the inferior alveolar nerve enters the mandibular foramen to supply the strctures of the lower jaw, the relationship of lingula to the inferior alveolar nerve is of clinical significance to dental surgeons. It becomes a necessety to know the morphology of linguls so as to preserve the important structures during surgical interference of mandible around the lingula region. The present study was undertaken mainly to establish the frequency of various morphological types of lingula in adult human mandibles of South Indian background. The material for this study comprised of a collection of 147 (294 sides) dry adult human mandibles. In each mandible, the lingula was scored using the classification proposed by Tuli et al (2000). More frequently observed bilaterally were the Truncated and Nodular types. These two types occurred more frequently unilaterally as well. The assimilated type, whether unilateral or bilateral was more or lesws similar in frequency along with other non metric variants of the skull, morphological types of lingula can also be useful as anthropological marker to assess population and recial distances.