Advanced Concepts in Medicine and Medical Research Vol. 6

All teaching and learning styles address how students view themselves as learners and their realization of the learning experiences for skill development in the activities which define them. A qualitative research approach was used, to explore the learning approaches of students on a hospital-based midwifery training model for better understanding of their learning needs and facilitate their readiness to competence and confidence development. The Grounded theory design facilitated for exploring participants’ characteristics, learning orientations and readiness through in-depth interviews. Data saturation was achieved with 30 Participants through purposive and theoretical sampling and theoretical sensitivity. Constant comparative analysis concurrent with data collection was used. The main category ‘Individualistic- Collectivistic Learning Styles’ and its four subcategories ‘Bio psychosocial individualities’, ‘Time and Being’, ‘Dexterity Attainment promptness’ and ‘Learning orientations’ emerged when the students were describing their reasons for enrolling into the midwifery programme, their characteristics and their approach towards learning. ‘Time and Being’ emerged when participant described the students’ previous status and related working experience and relationship building in training. The Biopsychosocial individualities emerged from their demographic data (age, gender) and social problems and the psychological support they received in the process. Whilst ‘Skill Acquisition Readiness’ emerged when the participants were describing the rate at which they assimilated the subject matter and requisite skills and their approach towards learning.

In conclusion in this study, it has emerged that: Students are individuals who should be treated with respect and dignity irrespective of their gender and background to allow wholesome development of a qualified midwife in an enabling. Based on the findings from study it could be recommended that: Learning styles in midwifery education should take into account the ‘Bio Psychosocial Uniqueness’, ‘Time and Being’, ‘Dexterity Acquisition Promptness’ and ‘Learning Orientation’, of individual student in order to address each student’s unique learning needs. Finally, further research be conducted to give more insight into the ever-changing characteristics of students to better accommodate their individualistic nature.

The aim of this chapter is to assess the position of the patella by measuring the insall salvati and modified insall salvati ratio among the south indian population. The Insall-Salvati ratio for the assessment of patellar height was the first widely used index to be relatively independent of knee flexion. Despite the subsequent publication of other indices, it remains the most widely used index. This study included 200 people seen on a OP basis in Sri Ramachandra medical college and research institute between January 2016 to June 2016, chosen randomly, splitting up the study population by 100 males and 100 females to avoid gender based bias with no previous history of trauma, surgeries or any pathologies in and around the knee joint.

The mean Insall Salvati ratio for 100 males were found to be 1.41 and for 100 females were found to be 1.28. The mean modified Insall Salvati ratio for 100 males were 1.81 and for 100 females were 1.75. The use of the Insall Salvati ratio to determine the patellar position is less applicable to Indian populations in which squatting, sitting cross-legged, and kneeling are customs. 

Based on the above study it is conclude that majority of South Indian population had patella baja with female predominance.

This chapter aimed to assess the presence of SARC-CoV-2 in semen and its effect on semen quality, thereby providing insights into the early impact on male reproductive function. Viral infections have been a part of human existence to date, though viruses have posed a huge threat with various outbreaks lately. These threats are associated with reproductive health challenges, especially male infertility. Testicular tissue has abundant angiotensin-converting enzyme-2 receptors, which explains how coronavirus disease (COVID-19) can cause harm to multiple organ systems. However, little is known about how spermatogenesis and reproductive potential are affected by the shedding of SARS-CoV-2, or severe acute respiratory syndrome coronavirus-2, in semen. 

A total of Thirty COVID-19 male patients aged 19-45 registered to AIIMS Patna hospital participated in the survey between October 2020 and April 2021.  For every sample of semen, we performed a real-time reverse transcriptase assay. At the initial sampling, which took place during COVID-19, a thorough examination of the semen was performed, including the sperm DNA Fragmentation Index. We got the second sampling 74 days after the first sampling and carried out the aforementioned tests once again.

In our study, the semen parameters, such as sperm vitality and total motility, were decreased below the normal limits during the first sampling. In contrast, values of semen agglutination, sperm DFI, semen viscosity, and semen leukocytes were above their normal limits during the second sampling. All semen samples collected in the first and second sampling tested with real-time reverse transcription-polymerase chain reaction (RT-PCR) were negative for SARS-CoV-2. In the first sampling, semen volume, vitality, total motility, sperm concentration, total sperm count, % normal morphology, % cytoplasmic droplet, and fructose were significantly lower. Conversely, there was an increase in leukocytes, liquefaction time, semen viscosity, DNA Fragmentation Index, % head defect, and semen agglutination. At the second sampling, these results were reversed, though not to the best extent possible. Every single one of these results was statistically significant (p < 0.05). Thus, COVID-19 negatively affects semen parameters, including sperm DNA fragmentation index. One of the primary symptoms of COVID-19 is a high-grade fever, which may disrupt the blood-testis barrier, exposing the sperm cells and testicular tissues to circulating cytokines and other inflammatory mediators generated in the body. This may result in a systemic inflammatory state and immune response against the seminiferous epithelium and accessory glands resulting in low semen quality. This study suggests that assisted reproductive technology (ART) clinics and sperm banking facilities should consider assessing detailed semen analysis of males with a history of COVID-19.

This chapter discusses about IgA Vasculitis (Henoch- Schönlein purpura) among children. The IgA vasculitis, a primary vasculitis that mostly affects small blood vessels, is diagnosed based on the presence of characteristic purpura or petechiae, abdominal discomfort, and renal abnormalities. The Ig A vasculitis is an acute multisystemic disease with signs and symptoms of purpura or petechiae, arthralgia or arthritis, and abdominal pain. Approximately 50% to 75% of children have gastrointestinal symptoms, such as colicky abdominal discomfort, vomiting, paralytic ileus, and GI bleeding, often occurring between 1-4 weeks. An incomplete presentation of IgAV, particularly if the skin symptoms are initially missing or there is an atypical presentation, the diagnosis becomes very difficult. Under these conditions, it is necessary to take into account alternative factors that may contribute to purpura, arthritis, abdominal discomfort, and renal illness. Disease recurrence can occur in patients with IgA Vasculitis even after renal transplantation. But despite recent advances in molecular understanding and healthcare facilities over the last few decades, the renal complication of IgA vasculitis remains a concern and the outcome has not changed over time.

This chapter present the clinical, laboratory, radiological features, and management of MAC empyema in an elderly patient. The study also provides a brief overview of cases of MAC associated pleurisy and empyema that have been reported in literature. Non-tuberculous mycobacteria (NTM) called Mycobacterium avium complex (MAC) is known to produce cavitary or fibro-cavitary pneumonia and subacute or chronic nodular bronchiectasis in individuals with chronic structural lung pathology, such as emphysema, chronic bronchitis, and bronchiectasis. Additionally, it is an etiological agent linked to disseminated infections and extrapulmonary infections in immunocompromised individuals, including transplant recipients, as well as acquired immune deficiency syndrome (AIDS). Empyema brought on by MAC is an uncommon occurrence that is seldom ever documented in the media. We report about a 72 yrs. old caucasian male with past medical history of chronic obstructive pulmonary disease (COPD), atrial fibrillation, gastroesophageal reflux disease, arterio-venous malformation of ascending colon, abdominal aortic aneurysm, stable left lower lobe lung mass (noticed on imaging 2 years ago) was admitted with chief complaints of progressively worsening shortness of breath associated with left sided pleuritic chest pain and productive cough with yellowish sputum for 2-3 weeks. Later in his course, he presented to us with a large mass and pleural effusion complicated by a bronchopleural fistula, that was diagnosed as MAC empyema. To our knowledge, this is the first case of MAC empyema, that presented as a chronic lung mass, complicated by a bronchopleural fistula and empyema.  High clinical suspicion, suitable NTM tests, and prompt medical and surgical therapies are essential for effective therapy that would lower morbidity and death.

This chapter describes an invasive Aspergillus induced brain abscess in an immunocompetent/ immunocompromised patient with no history of trauma. With the global growth of immunocompromised patients, the incidence rate of aspergillus infections in central nervous system increased accordingly. Aspergillus abscess is a typical phenotype of aspergillus infections in central nervous system, and is tended to be confused with tumors. Neuroimaging features with careful observation and detailed history-taking can help to make final diagnosis. Aspergillus is an omnipresent fungus in the natural world. In a healthy individual, spore inhalation can result in a localized illness. These fungi have the potential to produce invasive infections in immunocompromised patients, which can be fatal and have a high morbidity rate. The prognosis for invasive aspergillosis is not good. An exceedingly uncommon sign of invasive aspergillosis in immunocompetent people is intracranial aspergillosis. A case of 60-year-old immunocompetent male is reported who had multiple Aspergillus brain abscess. CNS aspergillosis particularly invasive aspergillosis is rarely observed in immunocompetent patients. The brain is remarkably resistant to fungal infections due to its abundant blood supply and the relatively impermeable blood-brain barrier. The signs of Aspergillus-induced brain abscesses should thus be known to medical personnel, as prompt detection and suitable treatment are essential for ensuring the best possible outcome for patients.

Testicular extirpation is conducted for medical reasons namely testicular cancer or prostate cancer. An orchiectomy is conducted if the blood supply can not be restored to save the testicle. Testis extirpation is happened in certain medical conditions include sterilization as well as population control, behavior modifications, gender transition in transgender animals, reproductive disorders, regulatory as well as legal requirements. Complications and considerations of extirpation of testes include testosterone replacement therapy (TRT), bone health, muscle mass as well as fat distribution, impact fertility, psychological as well as emotional effects and hot flashes. Procedure of testis extirpation include pre operative preparation, anesthesia, surgical incision, isolation of testis, ligation of blood vessels, dissection as well as isolation, hemostasis, post operative care and follow-up. Precautions to be taken to ensure after testicle extirpation include wound care, pain management, scrotal support, activity limitation, hygiene, medication compliance, follow-up appointment, swelling as well as bruising, pain as well as discomfort, emotional support and fertility preservation based on application. Finally it is concluded that testicular extirpation is a procedure that carries both physical and psychological implications for men.

This chapter evaluates the CAUTI rate and the predominant organisms in the hospital with their susceptibility patterns. Catheter-associated urinary tract infection (CAUTI) is a prevalent healthcare-associated infection that affects various parts of the urinary system, including the urethra, bladder, ureters, and kidney. CAUTIs account for up to 40% of all health-related infections and are the most common type of infection after catheterization, with a rate of 1.41 per 1000 catheter days. It is estimated that 4% of patients with bacteriuria will eventually develop clinically significant bacteriuria, resulting in a death rate of 13-30%. The risk of acquiring bacteriuria increases over time after catheterization, with a daily risk ranging from 3% to 10%.

To gain insights into the prevalence of CAUTIs and the susceptibility patterns of organisms, a study was conducted in a 330-bed tertiary care teaching hospital in Hyderabad, South India. The study focused on five intensive care units (ICUs) and medical wards catering to various surgical and medical specialties. Over a period of 24 months, 1258 cases of Foley's catheterization were followed up. The cases were confirmed based on the NABH Standards and Centers for Disease Control and Prevention guidelines. Out of the 1258 catheterized individuals, 46 cases of CAUTI were confirmed, with 29 cases in 2018 and 17 cases in 2019. The most common isolate was Escherichia coli, accounting for 41.86% of the cases. The isolates exhibited reduced susceptibility to other urinary antibiotics and resistance to cotrimoxazole, fluoroquinolones, and second and third-generation cephalosporins.

It is crucial to avoid unnecessary catheter insertion as it can lead to increased patient expenses, longer hospital stays, and higher morbidity rates. In cases where Foley catheter insertion is necessary, it is essential to follow aseptic precautions during the insertion process and remove the catheter as soon as possible. Additionally, health worker training and surveillance by infection control teams play a significant role in improving practices and reducing infections.

Timely education about CAUTI, as well as other complications of urinary catheterization and alternatives to indwelling catheters, is crucial. Continuous education and training of health workers, along with monitoring by infection control teams, are vital in improving practices and reducing the incidence of infections.

CAUTI is a significant healthcare burden, with high rates of antibiotic resistance. Preventive measures, such as avoiding unnecessary catheter insertion and implementing infection control practices, can help reduce morbidity, hospital stays, and patient costs. By raising awareness and providing education, healthcare professionals can contribute to the prevention and management of CAUTIs effectively.

This chapter is unique in regard to its unusual presentation as there was involvement of almost entire breast skin along with its nipple-areola complex. The clinical appearance of the Paget's disease is usually a thickened, sometimes pigmented, eczematoid, erythematous weeping or crusted lesion with irregular borders. It is rare type of cancer with tumors inside the same breast which may be either ductal carcinoma in-situ or invasive breast cancer. We report a 78 year old women (with no comorbidity & prior history of laparoscopic cholecystectomy for gall stones) presented with gradually progressive eczematous lesion over nipple, areola and left breast skin for last 15 years. Histology may reveal hyperkeratosis, parakeratosis or acanthosis of the epidermis and infiltration with classical Paget cells that are large, ovoid, have pale vacuolated cytoplasm and hyperchromatic nuclei.

Deprescribing is a multifaceted approach to optimize patient care by reducing unnecessary or potentially harmful medications, minimizing polypharmacy, and adhering to the "first, do no harm" ethos in medical ethics. Its goals include improving medication safety, adherence, therapy, and overall quality of life. Challenges like healthcare professionals' reluctance and patient resistance are addressed through shared decision-making and comprehensive medication reviews. Implementing deprescribing relies on interprofessional collaboration and robust monitoring strategies. Case studies and best practices offer practical insights for clinical pharmacists. The chapter concludes by emphasizing the crucial role of clinical pharmacists in enhancing medication safety, patient outcomes, and healthcare quality through deprescribing.

The aim of this chapter is to compare the assessment of the cervix through transvaginal sonography and digital examination in predicting the outcome of labor induction. Digital assessment is limited to measuring the length from the external cervical os to the cervical-vaginal junction, and discomfort associated with this assessment can further affect its accuracy. This prospective observational study was conducted in the Department of Obstetrics and Gynecology at tertiary care centre in New Delhi over a span of 17 months, from November 2009 to March 2011. Regarding the relationship between cervical length and the outcome of labor, women with longer sonographically measured cervical lengths had a decreased chance of vaginal delivery and an increased likelihood of caesarean section. Sonographic cervical length was significantly related to the mode of delivery. The approach, especially in high-risk pregnancies, enhances the prediction of successful labor induction, providing valuable insights for obstetricians and improving the ability to assess outcomes in high-risk cases.

Objective: To summarize the main tools for social function assessment of schizophrenia in the past 30 years both domestically and internationally.

Methods: Relevant literature review was conducted to organize and analyze commonly used social function assessment scales for schizophrenia patients both domestically and internationally.

Results: The research results abroad are relatively rich: From the perspective of content structure, there are single and multi-dimensional; From the perspective of application fields, it can be divided into daily functional assessment and comprehensive (combined daily functional with professional ability) assessment; From the perspective of construction foundation, there are diagnostic standards based on the "Handbook of Mental Disorder Statistics and Diagnosis", as well as clinical experience. There are few research results in China, mainly revisions of foreign scales or simplified scales developed by referring to foreign methods, and their psychometric performance needs to be verified and improved.

Conclusion: The social function assessment of schizophrenia is of great significance for the rehabilitation of patients, family harmony, and social stability. Due to the strong cultural dependence of social functions, we should strengthen the development and promotion of localized evaluation tools.

This chapter provides a brief review of how wars in recent history have shaped the development of rheumatology as a medical specialty. Rheumatology was a field well documented in the ancient world by various systems of medicine, including those of India, China and Ancient Greece. This history seems to have been forgotten and is not well known in the modern medical community. Nonetheless, in a civilian setting, it is significant for the fields of rheumatology and military medicine. Due to doctors treating soldiers' arthritis during World Wars I and II, many rheumatic disorders were identified for the first time. Doctors treating soldiers for a variety of musculoskeletal complaints during WWI and WW2 lead to the identification of new rheumatic diseases, not previously recognised in Western medicine. Chemical Weapons in both wars lead to the discovery of many Disease Modifying Anti Rheumatic Drugs (DMARDS) still commonly used today in rheumatology. This chapter seeks to reveal information from military history important to the field of rheumatology history. There were 93,000 documented cases of arthritis in US soldiers during World War I. The government was providing $10,000,000 annually to around 35,000 former service members for disabilities resulting from chronic arthritis ten years after World War I concluded in the US, indicating the significance of arthritis in military history. Many rheumatic illnesses were discovered for the first time as a result of physicians treating soldiers' arthritis during World Wars I and II. This history is important for the disciplines of rheumatology and military medicine in times of peace.

Background and Objectives: Intraoperative Nausea and Vomiting (IONV) can be distressing for patients, obstetricians, and anesthetists, and it may increase the risk of visceral injury during surgery due to involuntary uncontrolled abdominal movements. This study aimed to compare the antiemetic efficacy of low-dose Ketamine versus Dexamethasone in reducing the incidence of IONV during Cesarean Section (C/S) under spinal anesthesia.

Materials and Methods: The study included 135 full-term parturient women, aged between 18 and 40 years, who were candidates for cesarean section under spinal anesthesia in the operating room. The participants were randomly allocated to three groups using a randomized blocking method. Group I (n = 45) received 8 mg Dexamethasone with a total syringe volume of 5 ml, while group II (n = 45) received 20 mg Ketamine with a total syringe volume of 5 ml, and control group III (n = 45) received 5 ml normal saline. An anesthetist, blinded to the drug administered to the patient, recorded the number of nausea, retching, and vomiting episodes during the intraoperative period. Intraoperative hypotension and bradycardia were also recorded. The patients were asked to report any symptoms of nausea, vomiting, and shivering that occurred at intervals. Vomiting was managed by administering Metoclopramide 10 mg slowly intravenously. A standardized surgical technique was used in all cesarean sections. Statistical analysis was performed using the Statistical Package for the Social Sciences version 21 program (SPSS21).

Results: The study included 135 parturient women divided into three groups, with 45 members in each group (the first group received Dexamethasone, the second and third groups received Ketamine and Placebo, respectively). The average age was 30.35 ± 5.94 years in the Dexamethasone group, 29.97 ± 6.18 years in the Ketamine group, and 29.6 ± 6.03 years in the control group (P = 0.840). The study found a statistically insignificant increase in the rate of successful prevention of IONV (P = 0.062) and shivering (P = 0.550) using preoperative Ketamine and Dexamethasone. However, there was a statistically significant decrease in the rate of IONV in the Ketamine group compared to the Dexamethasone group (P=0.023). The studied groups were comparable in terms of mean arterial blood pressure (Table 7) and heart rate (Table 9), and there was no statistically significant difference between the groups during the study period. Additionally, there was no statistically significant difference in hypotensive episodes (P = 0.885), the total amount of Ephedrine administered (average amount in those who experienced hypotension and received Ephedrine) (P = 0.623), and bradycardia (P = 0.146) between the studied groups during the intraoperative period. However, there was a statistically significant decrease in the incidence of bradycardia in the Ketamine group compared to the Dexamethasone group(P=0.049).

Conclusion: This study demonstrates that there was no statistically significant difference between the groups receiving Dexamethasone and low-dose Ketamine compared to the control group regarding the decrease in the rate of nausea and vomiting(P=0.062), hypotension (P=0.885), and shivering (P=0.550) during the operation period.