Background:Communication is a key component in medical practice. The area of pediatric palliative care is emotionally distressing for families and healthcare providers. Inadequate communication can increase the stress and lead to mistrust or miscommunication.Materials and Methods:Reviewing the literature on communication between physicians, patients, and their family; we identified several barriers to communication such as paternalism in medicine, inadequate training in communication skills, knowledge of the grieving process, special issues related to care of children, and cultural barriers. In order to fill the gap in area of cultural communication, a study questionnaire was administered to consecutive families of children receiving chemotherapy at a large, north Indian referral hospital to elicit parental views on communication.Results:Most parents had a protective attitude and favored collusion; however, appreciated truthfulness in prognostication and counseling by physicians; though parents expressed dissatisfaction on timing and lack of prior information by counseling team.Conclusion:Training programs in communication skills should teach doctors how to elicit patients’ preferences for information. Systematic training programs with feedback can decrease physicians stress and burnout. More research for understanding a culturally appropriate communication framework is needed.

Treatment of spine surgeries has evolved from traditional surgeries to open surgeries. Endoscopic spine surgeries (ESS) and endoscope assisted surgeries along with microscopic and tubular surgeries has developed significantly over the last three decades. With improvement in the diagnostic methods it is now possible to find and differentiate the spinal pathologies. ESS was initially limited to the lumbar disc herniations (DH). But, now it can be used for cervical and thoracic DH. Minimized technical problems has been brought by evolutions in endoscopy, better optics, instruments, access, and safety. Similarly acquired knowledge and skills are being extrapolated to advanced indications in different spinal pathologies. Due to the further advantages of ESS within the ambit of minimal invasive spine surgeries, many misnomers are as well getting added. This confuses the new learners and potential patients as well. ESS should be classified for uniformity in reporting and common nomenclature like FESS (Full endoscopic spine surgery) should be used. It specifically refers to surgery through one working channel under irrigation with incorporated optics. This will make easier understanding for novice surgeons and general population. It will lead to standardised reporting of high quality clinical studies, trials, and meta-analysis for the publications. Rising misnomers and complex nomenclature of endoscopy is suggesting along with the exponential publications in last decade that ESS is entering into its golden era. This review is undertaken to throw light on the techniques, advances and literature review of only FESS and clear the misnomers. This review also describes the evolution of different techniques and goals that led to impeccable advances in the field of FESS. Further improvement of technologies and techniques in future will soon establish FESS as the Gold Standard in spine surgery.

No abstract

Study Design: Retrospective observational analysis. Objectives: Spinal tuberculosis accounts for about 50% of cases among extra pulmonary osteoarticular tuberculosis. Resistance to drugs in spinal tuberculosis patients is on a rise and there is inadequate literature concentrating on the precise pattern of resistance in Indian subcontinent which harbors 24% of global prevalence. The aim was to study the pattern of drug resistance in spinal tuberculosis among first- and second-line drugs. Drug resistance is common in spinal tuberculosis and we intended to find the prevalence of various drug resistance patterns. Methods: Patients with spinal tuberculosis visiting a tertiary center were assessed. Samples were taken from the affected vertebrae and sent for BACTEC mycobacterium growth indicator tube (MGIT) 960 culture. Patients with a positive growth in MGIT were included in the study. All previously treated patients (relapse, treatment after failure, treatment after loss to follow-up and other previously treated patients) were excluded. Results: A total of 150 patients with a positive growth in MGIT report were included in the study, of whom 43 patients had some kind of drug resistance. Seven were multidrug resistant (MDR), 9 had preextensive drug resistance (pre-XDR), and 4 had extensive drug resistance (XDR). Seventeen patients had mono-drug resistance, which was most frequently for isoniazid. Resistance among second-line drugs was common in the fluoroquinolone group. Conclusion: Drug resistance in spinal tuberculosis was found to be 28.6%. Of these, MDR was in 16.2%, pre-XDR in 20.9%, and XDR in 9.3% patients.

No abstract

No abstract

Os odontoideum (OO) was first described by Giacomini in 1886 as separation of the odontoid process from the body of the axis. Instability can consequently occurs at this level due to the failure of the transverse atlantal ligament (TAL) and this atlantoaxial instability can be a cause of progressive neurological deficits. It is considered a rare anomaly of the odontoid process. It is a disease with controversial etiology, debatable incidence, and only a partly known natural history owing to the paucity of the literature on this topic. There are insufficient demographic data about the occurrence of the disease, and most of the management is dictated by the isolated case reports and few studies which have been carried out at handful of institutes. OO is classified into two types by Fielding et al. based on the anatomic location: orthotopic and dystopic. Orthotopic OO consists of an ossicle that moves with the anterior arch of the atlas, whereas the dystopic type presents as an ossicle near the basion or one that is fused with the clivus. In one magnetic resonance imaging (MRI) study of odontoid morphology, a 0.7% (1 case of 133 patients) incidence was reported. The spectrum of the clinical presentation varies from completely asymptomatic individuals to patients presenting with features of cervical myelopathy. Here, we present a case of 35-year-old-male with dystopic OO who presented to us with features of gradually progressing cervical myelopathy without any obvious history of neck trauma. On investigations, he was found to have atlantoaxial instability with wide atlanto-dens interval. He was treated with the posterior C1-C2 stabilization and reduction of atlantoaxial instability.

No abstract