BackgroundPigment nephropathy represents one of the most severe complications of rhabdomyolysis or hemolysis.MethodsWe performed a retrospective observational study to analyze the etiology, clinical manifestation, laboratory profile and outcome in patients with biopsy-proven pigment-induced nephropathy between January 2011 and December 2016. History, clinical examination findings, laboratory investigations and outcome were recorded.ResultsA total of 46 patients were included with mean follow-up of 14 ± 5.5 months. Mean age was 40.15 ± 12.3 years, 65% were males (male:female, 1.8:1) and ∼37 (80.4%) had oliguria. Mean serum creatinine at presentation and peak creatinine were 7.5 ± 2.2 and 12.1 ± 4.3 mg/dL, respectively. Evidence of rhabdomyolysis was noted in 26 patients (64%) and hemolysis in 20 patients (36%). Etiology of rhabdomyolysis include snake envenomation (10 patients), seizures (7), strenuous exercise (5), wasp sting (2) and rifampicin induced (2). The causes of hemolysis include rifampicin induced (7 patients), sepsis (5), malaria (3), mismatched blood transfusion/transfusion reaction (3) and paroxysmal nocturnal hemoglobinuria (2). On renal biopsy, two patients had acute interstitial nephritis and two had immunoglobulin A deposits in addition to pigment nephropathy. All except one (97.8%) required hemodialysis (HD) during hospital stay and mean number of HD sessions was 9 ± 2. A total of three patients with sepsis/disseminated intravascular coagulation died, all had associated hemolysis. On statistical analysis, there was no difference between AKI due to rhabdomyolysis and hemolysis except for high creatine phosphokinase in patients with rhabdomyolysis and Lactate dehydrogenase level in patients with hemolysis. At mean follow-up, five patients (12%) progressed to chronic kidney disease (CKD).ConclusionsPigment nephropathy due to rhabdomyolysis and hemolysis is an important cause of renal failure requiring HD. The prognosis was relatively good and depends on the etiology; however, long-term studies and follow-up are needed to assess the true incidence of CKD due to pigment nephropathy.

IntroductionDuring a large-scale disease outbreak, one needs to respond to the situation quickly towards capacity building, by identifying areas that require training and planning a workable strategy and implementing it. There are limited studies focused on fast-track workforce creation under challenging circumstances that demand mandatory social distancing and discouragement of gatherings. This study was conducted to analyze the planning process and implementation of fast-track training during the Coronavirus disease (COVID-19) pandemic, and evaluate its effectiveness in building a rapid, skilled, and massive workforce. MethodsA cross-sectional study was conducted to evaluate rapid preparedness training delivered from March to June 2020, based on documents and data regarding the process, planning, and implementation for large-scale capacity building. Pre-test and post-test scores were compared to assess the effectiveness of training. The number of personnel trained was evaluated to determine the efficiency of the training program. Data on COVID-19 among health care workers (HCWs) were analyzed. ResultsThe Advanced Center of Continuous Professional Development acted as the central facility, quickly responding to the situation. A total of 327 training sessions were conducted, including 76 online sessions with 153 instructors. The capacity-building of 2,706 individuals (913 clinicians and 1,793 nurses, paramedics, and non-medical staff) was achieved through multiple parallel sessions on general precautionary measures and specialized skills within four months. The rate of hospital staff infected with COVID-19 was found to be 0.01% over five months. ConclusionsA fast-track, efficient, large-scale workforce can be created through a central facility even under challenging circumstances which restrict gatherings and require physical distancing. A training action plan for disease outbreaks would be a useful resource to tackle such medical emergencies affecting substantial populations in future.

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The Calman reforms in training have meant that surgical training now consists of a 2-year basic training period followed by a 6-year period of higher surgical training. This article addresses the problems faced by the new Calman surgical trainees and proposes some new measures which could be introduced for surgical training in the next millennium.

Background: Periodontitis is associates with various systemic disease one of which is PCOS. PCOS is a genetically complex endocrinopathy of uncertain etiology affecting women of reproductive age group which results in most common cause of anovulatory infertility, menstrual dysfunction and hirsutism. PCOS have close association with cardiometabolic risk profile, insulin resistance (IR), hyperinsulinemia, central obesity, dyslipidemia and increase prevalence of cardiovascular risk factors. The common pathway is the chronic low grade inflammation which is constituted by proinflammatory cytokine IL-6. Aim: To compare salivary IL-6 levels among patients with Polycystic ovary syndrome (PCOS) patients with chronic periodontitis and without Chronic Periodontitis. Materials and Methods: Newly diagnosed PCOS patients were selected for the study and the periodontal Parameters were recorded. Group A consist of 42 patients of PCOS with Periodontitis & Group B consist of 42 patients of PCOS without Periodontitis. Salivary levels of IL-6 was compared between the two groups, and was assessed by Enzyme Linked Immuno Sorbent Assay (ELISA) kit (Bioassay). Results: BOP in group A was 1.40 ± 0.40 and in group B it was 0.91.± 0.18,PPD in group A was 4.23 ± 0.134 and in group B it was 1.30 ± 0.06, CAL in group A was 4.87 ± 0.124 and in group B was 1.30 ± 0.06, CAL in group A was 4.87 ± 0.124 and in group B was 1.30 ± 0.06. The values were statistically significant (p= <.001). IL-6 level in group A is 102.59 ± 18.2 and in group B it was 51.3 ± 25.3. Which implies there is an increase salivary IL-6 level in group A (PCOS with Periodontitis) than group B (PCOS without Periodontitis). Conclusion: Salivary IL-6 levels shows a double fold increase in Group A (PCOS with Periodontitis) than in group B ( PCOS without Periodontitis).

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Background: The National Medical Commission (NMC) Act, 2019 has come into force from August 2019 with the aim of addressing the shortcomings in the process of regulating medical colleges in the country and also in the wake of allegations of corruption against the 63-year-old Medical Council of India. However, it has been criticized for various reasons viz., it is over-centralized, it would lead to increased profiteering, corruption etc. In this context the present study was undertaken to find out the perceptions and opinion of the medical students about the NMC act.Methods: This was a cross-sectional study done at a Medical College, Wayanad District, between August-January 2019. All the undergraduate medical students of the college were the study subjects. Data was collected using a predesigned and pretested self-administered questionnaire. The subjects were asked to give response to questions pertaining to NMC on a Likert scale of 1 to 5. Completed responses were obtained from a total 655 students.Results: The subjects strongly agreed with the 6 limitations of the NMC (median score 1) and agreed with 9 (median score 2) out of the total 15 limitations. The number of subjects agreeing (agree and strongly agree) was highest [574 (88.3%)] for “NMC is over-centralized”.Conclusions: The subjects agreed (strongly agree+agree) to all the limitations of the NMC. There was no disagreement to any of the limitations.

Conclusions:The majority of prostate cancer patients reported at least mild anxiety and mild depression. In this analysis of real-world evidence, cancer stage, PSA at diagnosis, treatments, and side-effects, were among the factors affecting patients in several ways. The multiple determinants of emotional wellbeing of prostate cancer patients warrant more research and offer the opportunity for personalised interventions.