Perception of students and teachers regarding the attributes of an effective clinical teacher in dentistry: A cross-sectional analytical study.

Objective: To compare the perception of dental students and faculty members regarding the attributes of effective clinical teachers. METHODS: This cross-sectional study was conducted at the Dow University of Health Sciences, Karachi, from August 2021 to November 2021, and comprised of third and final year dental students and associated clinical faculty members from three dental colleges in the city. Data was collected using the modified version of a pre-validated questionnaire. Data was analysed using SPSS 25. RESULTS: Of the 200 students approached, 169(84.5%) responded; 135(79.9%) females and 34(20.1%) males with mean age 21.78±1.099 years (range: 19-26 years). Of the 59 teachers approached, 49(83%) responded; 33(67.3%) females and 16(32.7%) males with mean age 31.59±5.041 years (range: 23-49 years). The students found record-keeping a tiresome task 69(42%), while teachers regarded it essential for clinical development. Unlike teachers, the students were unable to identify the relevance of clinical objectives and they also did not appreciate teachers' involvement in clinical procedures. For other domains regarding personal traits, teaching methods and clinical skills, both groups had similar responses. Conclusion: There was generally a similarity of opinions among students and teachers regarding the essential qualities of effective dental clinical teaching.

Impact of Postoperative Antibiotic Prophylaxis on Surgical Site Infections Rates After Mastectomy with Drains but Without Immediate Reconstruction: A Multicenter, Double-Blinded, Randomized Control Superiority Trial.

BACKGROUND: There is no consensus on the use of postoperative antibiotic prophylaxis (PAP) after mastectomy with indwelling drains. We explored the utility of continued PAP in reducing surgical site infection (SSI) rates after mastectomy without immediate reconstruction and with indwelling drains. PATIENTS AND METHODS: A multicenter, two-armed, randomized control superiority trial was conducted in Pakistan. We enrolled all consenting adult patients undergoing mastectomy without immediate reconstruction. All patients received a single preoperative dose of cephalexin within 60 min of incision, and postoperatively were randomized to receive either continued PAP using cephalexin (intervention) or a placebo (control) for the duration of indwelling, closed-suction drains. The primary outcome was the development of SSI within 30 days and 90 days postoperatively. Secondary outcomes included study-drug-associated adverse events. Intention-to-treat analysis was performed using multivariable Cox regression. RESULTS: A total of 369 patients, 180 (48.8%) in the intervention group and 189 (51.2%) in the control group, were included in the final analysis. Overall cumulative SSI rates were 3.5% at 30 days and 4.6% at 90 days postoperatively. PAP was not associated with SSI reduction at 30 (hazard ratio, HR 1.666 [95% confidence interval CI 0.515-5.385]) or 90 (1.575 [0.558-4.448]) days postoperatively, or with study-drug-associated adverse effects (0.529 [0.196-1.428]). CONCLUSIONS: Continuing antibiotic prophylaxis for the duration of indwelling drains after mastectomy without immediate reconstruction offers no additional benefit in terms of SSI reduction. There is a need to update existing guidelines to provide clearer recommendations regarding use of postoperative antibiotic prophylaxis after mastectomy in the setting of indwelling drains.

INTRA OPERATIVE FROZEN EXAMINATION OF SENTINEL LYMPH NODE IN BREAST CANCER.

BACKGROUND: Sentinel node (SN) biopsy is the standard of care for the assessment of axilla in early breast cancer patients with clinically node negative disease. Confirmed absence of tumour deposit in node on intra operative frozen section (FS) examination saves the patient from complete axillary dissection. However controversies arise when inconsistencies occur in results of frozen and permanent section. Reported sensitivity of frozen examination of sentinel node in literature ranges from 70-95%.The purpose of this study was to determine the sensitivity of frozen examination of sentinel node in breast cancer. The frozen section examination of sentinel node is not a reliable technique for accurate pathological assessment of node. METHODS: Data was collected prospectively on patients with sentinel node procedure from May to December 2013. All SNs removed at surgery were submitted for frozen section and the results were compared with permanent sections. RESULTS: Of 50 patients 16 were true positive while 32 were true negative. Two patients reported negative on FS were confirmed to be positive on permanent section. The accuracy of frozen section was 96%, with sensitivity of 89%. In false negative cases the size of nodal metastasis was significantly smaller than that of true positive, i.e., 1-2 mm. The false negative cases were further classified for assessment into technical and interpretative error. CONCLUSION: The intra operative frozen section examination is a reliable technique for the assessment of Sentinel node with a high accuracy rate to detect metastasis size of >2 mm. It spares the patient from complete axillary dissection and its subsequent morbidity of lymphedema and shoulder pain.

Impact of duration of antibiotic prophylaxis on rates of surgical site infection (SSI) in patients undergoing mastectomy without immediate reconstruction, comparing a single prophylactic dose versus continued antibiotic prophylaxis postoperatively: a multicentre, double-blinded randomised control trial protocol.

INTRODUCTION: In breast surgeries, prophylactic antibiotics given before the surgical incision as per Joint Commission Surgical Care Improvement Project guidelines have been shown to decrease the rate of postoperative infections. There is, however, no clear consensus on postoperative antibiotic prophylaxis in patients undergoing mastectomy with indwelling drains. This trial protocol proposes to study the difference in rates of surgical site infection (SSI) with or without continuation of postoperative antibiotics in patients undergoing mastectomy without immediate reconstruction and with indwelling drains. METHODS AND ANALYSIS: In this multicentre, double-blinded clinical trial, all patients undergoing mastectomy (without immediate reconstruction) will receive a single prophylactic dose of preoperative antibiotics at induction of anaesthesia and will then get randomised to either continue antibiotic prophylaxis or a placebo postoperatively, for the duration of indwelling drains. The primary and secondary outcomes will be development of an SSI and antibiotic-associated adverse effects, respectively. Data will be collected through a standard questionnaire by wound assessors. Intention-to-treat analysis will be carried out using STATA V.12. For categorical variables, frequencies and percentages will be assessed by χ2 test/Fisher's exact test as appropriate. The quantitative variables will be computed by their mean±SD or median (IQR) and will be assessed by independent t-test/Mann-Whitney test as appropriate. Unadjusted and adjusted relative risk with their 95% CI will be reported using Cox proportional regression. A p value of <0.05 will be considered statistically significant. ETHICS AND DISSEMINATION: Ethical approval has been obtained from each site's Ethical Review Board. The study background and procedure will be explained to the study participants and informed consent will be obtained. Participation in the study is voluntary. All data will be deidentified and kept confidential. The study findings will be published in scientific media and authorship guidelines of International Committee of Medical Journal Editors will be followed. TRIAL REGISTRATION NUMBER: NCT04577846. (patient recruitment).

Crushed Confluence with Significant Tissue Loss: A Case Report of a Rare Biliary Tract Injury following Blunt Trauma Abdomen.

Traumatic extrahepatic biliary tract injuries are rare occurrences because they are a relatively small target of injury following trauma. They are almost always associated with injuries to surrounding structures, which take precedence during initial management. The management of extrahepatic biliary tract injuries depends on the extent and level of the injury. This may include primary repair to high-level biliary-enteric anastomoses. We report a case of injury to the biliary confluence that occurred after blunt trauma abdomen. The injury was associated with an extensive liver injury that was the focus of initial treatment. We discuss the possible mechanisms that led to injury of this relatively hidden area and describe the various treatment options that can be applicable in such cases.

Efferent Loop Syndrome in a Post-pancreatoduodenectomy Patient Due to Exuberant Foreign Body Giant Cell Reaction Mimicking Cancer: A Case Report.

Efferent loop syndrome has been rarely reported after pancreatoduodenectomy. In those cases that have been reported, the majority presented late and recurrence or peritoneal metastases were found to be the usual causes. Foreign body giant cell reactions (FBGCR) also rarely develop into masses that are large enough to cause problems or mimic malignancy. This report presents a case of a middle-aged female who underwent completion extended cholecystectomy for carcinoma of the gallbladder. Whipple's pancreatoduodenectomy was also performed at the same surgery due to presence of a hard mass at the cystic duct stump that was densely adherent to the common bile duct and duodenal cap. This was later found to be FBGCR. The patient underwent re-exploration just three weeks later for efferent loop syndrome, the cause of which was again found to be a mass due to FBGCR that was not previously present. Despite a difficult initial treatment phase, the patient is disease free and doing well after two and half years of completing treatment for the carcinoma gallbladder.

Organophosphate induced delayed polyneuropathy.

Organophosphate induced delayed polyneuropathy (OPIDP) is a rare sensory-motor distal axonopathy, which usually occur after ingestion of large doses of certain organophosphate insecticide. The clinical picture is characterized by the distal paresis in lower limb associated with sensory symptoms. Electrodiagnostic studies show a motor axonal neuropathy. This case occurred in a 14 years old girl who developed cramping pain in both calves associated with lower limbs paresis 6 weeks after accidental organophosphate poisoning. After another week, she also developed weakness in both hands. Electrophysiological study was characterized by an axonal polyneuropathy pattern. Patient improved upon oral multivitamin therapy and physiotherapy.

Delayed obstructive jaundice secondary to bullet in common hepatic duct.

A young male presented with obstructive jaundice and recurrent attacks of acute cholangitis. He had sustained gunshot wound in abdomen 9 years back. Laparotomy was done at that time and the bullet was found left within right lobe of liver, as it was inaccessible and possible benefit to take it out was considered less than leaving it in-situ. The patient recovered and did well for 7 years. After 7 years of latency, he developed recurrent attacks of acute cholangitis. The reason of this delayed presentation was probably the migration of the bullet from its original place to the biliary tree i.e. common hepatic duct.