The unprecedented second wave of SARS-CoV-2/COVID-19 pandemic has caught an already weak public health system unaware in India. The rising number of COVID-19 afflicted patients, shortage of testing strategy, disorganized vaccination drive, lack of oxygen-supported beds, and overwhelmed medical facilities in cities across India has led to a quintessential crisis never experienced before. Physicians, doctors, and other healthcare workers (HCWs) still recovering from the socioeconomic and adverse impact of the first wave, now face a further whirlpool of unfavorable mitigating factors including shortage of personnel, stretched resources, inadequate medical equipment, facilities, and the ever-existent occupational risk of contracting of SARS-CoV-2 viral infection and mortality. Exhibiting exemplary dedication, public health effort, and resilience in the health care management of COVID-19 patients in the first wave, they face an uphill task against the second deadlier wave. We explore the mounting challenges confronting these HCW and strategic solutions that can be undertaken to support them.

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Background: Obesity is almost pandemic, affecting millions of humans worldwide. Etiology is multifactorial. It's the root cause of diseases that can cause significant morbidity and mortality. Despite this, sadly, no “magic bullet” exists for this ailment. In fact, strangely enough, there has been no concrete effort by modern medicine to wage a concentrated war against obesity, leading to quacks and unqualified people to “take control” of this ailment, leading to disastrous consequences. We at Apollo Hospital Navi Mumbai have initiated a novel department to fight obesity- Department of Bariatric Medicine. To the best of our knowledge, no such dedicated department exists anywhere. Materials and Method: We recruited 39 patients with high BMI (Body Mass Index) for this two month program. They were assessed in details by BCA (Body Composition Analyser) and a plethora of physical evaluations and lab tests. This done, they were sent for consultations with Dietician, Exercise physiologist, clinical psychologist and physiotherapist. Previous medications (if any) were altered (to be weight neutral). Results: Most of the Patients had a significant weight loss. Besides, there was a gain in exercise capacity, fitness and confidence.Discussion: Obesity is a vexatious problem. It's difficult to reduce weight and irritatingly easy to gain it. Obesity predisposes to a lot of diseases and therefore it must be reversed. Surprisingly, There aren't too many effective medications against Obesity. Conclusion: We describe an encouraging account of a successful intervention in 39 obese patients. This needs to be replicated on a much broader scale in the interest of Indian health in particular and humanity in general.These sort of structured programs will be very helpful in the battle against obesity. A dedicated speciality (Bariatric Medicine) is the need of the hour.

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A cutaneous horn is an uncommon condition in human beings and it mimics the horn of an animal. It usually occurs in sun-exposed areas such as the face and the scalp. It is very rarely documented in nonsun exposed areas such as the penis, chest, and shoulder. An umbilical horn is one of the nonsun exposed areas and it is not documented in the literature till now. Here, we report a case of the umbilical cutaneous horn with a review of the literature. The management of the umbilical horn is like the management of other cutaneous horns. Excision of the horn along with its base is the recommended treatment for the horn.

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Carotid artery disease is typically the result of atherosclerosis at the bifurcation of the common carotid artery or in the origins of either the internal or external carotid artery. Chronic kidney disease (CKD) has been associated with increased morbidity and mortality after carotid revascularization. In contrast, there are only limited and conflicting data on the impact of CKD in patients undergoing carotid revascularization. Hemodynamic depression which occurs between 7% and 42% of patients undergoing carotid artery stenting might also have an important role in the pathogenesis of associated acute kidney injury. We hereby report two cases of carotid stenting in patients with underlying renal impairment.

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Nocardiosis is a life-threatening disease in solid organ transplant recipients. It is an uncommon but important infection in these patients. Nocardiosis is caused by a Gram-positive, weakly acid fast, branching filamentous aerobic bacteria belonging to the order Actinomycetales. It causes pulmonary and systemic infections in immunocompromised patients. The common species of Nocardia causing infections are Nocardia asteroids, Nocardia brasiliensis, Nocardia farscinica, and Nocardia nova. Here, we report a case of a 32-year-old female postrenal transplant recipient developing pulmonary nocardiosis by a rare species of Nocardia called Nocardia asiatica. A modified Ziehl–Neelsen stain using 1% H₂SO₄ in the endotracheal (ET) secretion revealed numerous acid fast branching filamentous organisms morphologically resembling Nocardia spp., and the culture grew Nocardia and it was confirmed as N. asiatica by MALDI TOF. Our patient had cytomegalovirus co-infection. The patient was started on trimethoprim-sulfamethoxazole. This case shows the importance of keeping nocardiosis as a differential diagnosis in immunocompromised patients.

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Major curricular reforms have been reported on the delivery of undergraduate and postgraduate medical education across the world in different medical institutions. The purpose of the present review was to explore the use of evaluation of teaching quality in the field of medical education. An extensive search of all materials related to the topic was carried out on the PubMed search engine. Keywords used in the search include evaluation, teaching quality, teacher, faculty, and medical education in the title alone only. A total of 12 studies were selected based upon the suitability with the current review objectives and analyzed. Evaluation of the teaching quality is an important aspect of maintaining the quality of the delivered training and thereby the vision to produce a competent medical graduate. It is being envisaged that the faculty evaluation with regard to teaching quality should not be restricted to only once in a year, but preferably on much better frequency. The ideal approach to ensure seamless implementation of evaluation of teaching quality will be to plan the same as an institutional policy. In conclusion, teaching quality evaluation is an essential aspect of maintaining the quality of curriculum delivery in medical college settings. Thus, specific steps should be taken to ensure that evaluation of teaching quality becomes a regular practice and that helps both the teachers to grow professionally and the students to learn in a more effective manner.

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The coronavirus disease-2019 (COVID-19) pandemic is a global health crisis. COVID-19 is a highly contagious disease caused by severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) which spread human-to-human by respiratory droplets. It was declared as a public health emergency by the World Health Organization. The clinicians particularly otorhinolaryngologists and head and neck surgeons are at increased occupation risk for getting infections of the SARS-CoV-2. A large group of patients those have no overt signs and symptoms, yet pose a high risk to the health care workers particularly otolaryngologist sand head and neck surgeons those deal frequently ear, nose, throat and respiratory airway. All the procedures which have the potential for aerodigestive secretions must be avoided or done only if mandatory. Any intervention in the upper aerodigestive region irrespective of the setting and confirmation of the COVID-19, the health care personnel should wear personal protective equipment such as N95, gown, cap, face shield, eye protection, and gloves. The procedures such as nasal endoscopy, flexible laryngoscopy, tracheostomy, and procedures of the oral cavity and oropharynx need safety of the health care professionals during COVID-19 pandemic. In particular, otorhinolaryngologists, head and neck, and maxillofacial surgeons have the greatest risk toward to get infections from COVID-19-positive patients and their protections should be considered as a priority in the current dreaded pandemic.

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During the period of medical training, a medical student is expected to be competent in multiple subject-specific competencies and, at the same time, make significant progress toward noncognitive attributes. However, apart from teaching, it is extremely important that all the core and noncore competencies need to be assessed. In order to help the faculty members to monitor the learning progression of students and to provide them with appropriate feedback, the reporter-interpreter-manager-evaluator (RIME) framework has been employed. This framework can be used to describe the progress of medical students and also by the students to monitor their own progress. Although the proposed framework is an effective approach to assessment of learning, the implementation of the same has some inherent challenges. In conclusion, the RIME framework is a valid and feasible approach to assess the clinical performance of the medical students. Considering the multiple benefits attributed to the same, it will be ideal to employ the framework in all medical institutions and help the students to monitor their own learning and also encourage the same via constructive and immediate feedback.

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Respiratory tract foreign bodies are most dangerous emergencies in children. There are various types of foreign bodies removed from airway like-peanuts, metallic foreign bodies, sharp foreign bodies, led bulbs and different part of toys. Most commonly they present with proper history of aspiration and symptoms of respiratory distress, but not always. It should be diagnosed immediately either with the history and clinical examination or with the help of radiological investigations. High resolution computed tomography of chest gives the exact location of the foreign body. These patients should be managed promptly to reduce the morbidity and mortality. Rigid bronchoscopy with optical forceps under general anaesthesia is the procedure of choice to retrieve the foreign bodies. We are presenting a case of 2 months old child which has aspirated a safety pin into her airway accidentally. The location was confirmed by HRCT chest and it was removed using optical forceps. Child was discharged under stable conditions.

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Balo's concentric sclerosis (BCS) is a variant of multiple sclerosis which differs in terms of clinical presentation, neuroimaging, and neuropathology. It is known for its characteristic “concentric ring” appearance on radioimaging. We present an interesting case of BCS with bilateral cerebral hemisphere involvement.

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Children have several worries concerning the coronavirus disease 2019 (COVID-19) pandemic, such as fear of contracting COVID-19, play deprivation and lack of recreational activities. Anxieties about COVID-19 and its containment measures have adversely affected the mental health and well-being of children. Moreover, parents' economic hardship/financial distress, school closures, lack of peer interactions, loneliness, and home confinement may affect a child's mood state and emotional well-being in the COVID-19 era. Setting up lifestyle intervention as early as possible might mitigate the long-term mental health consequences of the COVID-19 pandemic among children. A Lifestyle intervention comprising various types of physical activity (PA) designed for improving cognitive functioning, and mood states are required to improve mental health and well-being among children in the era of the COVID-19 pandemic. There is a need to emphasize the association between PA, which is an avenue for social interactions, and mental health among children in the era of COVID-19. PA has a positive impact on child mental health and well-being. On the other hand, sedentariness and loneliness are detrimental to a child's mental health and psychological well-being in the era of the COVID-19 pandemic. There is a need for various community health agencies to promote PA among children through family-based intervention. Parents should encourage their children to engage regularly in moderate-intensity PA at home or in a safe green space (e.g. parks and community gardens).

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We present the case of a 29-year-old male from the southern part of India presenting with renal stones, pancytopenia with leukoerythroblastic blood picture, diagnosed on bone marrow (BM) aspiration smears as BM oxalosis. Although it is a rare disorder, BM oxalosis should be considered and BM aspiration and biopsy should be performed in patients presenting with renal stones, pancytopenia with leukoerythroblastic blood picture. Early diagnosis of patients affected by hyperoxaluria is associated with improved long-term survival.

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