Background: The circle of Willis (CW) encircles the pituitary stalk and is considered an anastomotic vascular system that links the forebrain and hindbrain. Because morphology varies between races, it was reasonable to do research on the anatomy of the CW. The purpose of this study was to determine the anatomical variations in the arteries composing the CW on computed tomography (CT angiography) in the adult Kashmiri population. Materials and Methods: This was a cross-sectional descriptive study conducted to assess the structural characteristics of CW and to estimate the prevalence of anatomical variations of CW in the adult Kashmiri population among those who were permanent residents of Kashmir Valley, aged 20 years or older, and who were referred for CT angiography from the Department of Medicine or Surgery with the diagnosis of CW. Results: A total of 50 (23.1%) studied CT angiography were having the presence of any anatomical variations, while 166 (76.9%) had normal anatomical origins. Arteries forming the CW (polygon) were found to be absent among 9 (4.16%) and 5 (2.3%) had fetal origin of arteries forming the CW. Trifurcation of arteries was found among only 2 (0.9%), hypoplastic arteries were found among 34 (15.7%), and complete circles were present in 207 (95.8%) CT angiographs. Right and left internal carotid artery, right and left anterior cerebral artery, the right middle and left middle cerebral artery, and the anterior communicating artery were all present. Conclusion: Hypoplasia was more prevalent in a posterior circle, absent arteries in the anterior circulation, while accessory vessels were common in the anterior portion of the circle.

Objectives: This study aimed to identify the areas of strength and areas needing improvement in the internal medicine residency curriculum in a developing country - Sudan. Materials and Methods: This qualitative study was conducted at six major teaching hospitals in Sudan. Purposive sampling was used to select 48 residents who participated in six focus group discussions (FGDs). All FGDs were audio taped and lasted between 60 and 90 min. Data collection continued until theoretical saturation took place. The transcribed data were analyzed using the content analysis technique, and codes were generated and categorized into subthemes. Three emerging themes were identified: training curriculum, training in research, and assessment of residents. Results: The residents were generally satisfied with the curriculum at the planning level. They reported that the structure of the program is suitable and the duration of the curriculum appropriate; the number of patients and theoretical training in the research were considered optimum. They suggested that training in research should begin earlier in the curriculum, with time reserved for conducting research, and that assessment needs improvement. Conclusion: This study highlighted the utility of the qualitative approach in identifying residents' perspectives of their educational programs. However, the residents provided suggestions for improvement in the following areas: training curriculum, research training, and assessment. The practical recommendations from this study could be used to improve the quality of postgraduate medical training in Sudan and elsewhere.

Background and Objectives: The assessment of general movements (GMs), particularly fidgety movements, helps identify preterm infants likely to suffer from Neurodevelopmental deficits; less is known about preterm GMs. This study evaluates the predictive value of preterm GMs for normal fidgety movements. Methods: This prospective cohort study included 131 very preterm infants (gestational age - M (standard deviation) - 29.7 (1.3) weeks) who underwent 3 GM assessments in the preterm period (31–37 weeks postmenstrual age [PMA]), term age (38–44 weeks PMA) and fidgety movement age (48–58 weeks PMA). Results: The sensitivity of preterm GMs in predicting fidgety movements was 67.21%, the specificity was 44.4%, the positive predictive value was 94.25% and negative predictive value was 9.09%. The proportion of abnormal GMs decreased with increasing age, with 33.8% in the preterm age, 20% in the term age, and 7% in the fidgety movement age. Conclusion: This study confirms findings of other studies-specificity values of preterm GMs are poor, implying a high rate of false positives. Preterm GMs may be inadequate in predicting future Neurodevelopmental outcomes.

Background: Perception of higher stress may lead to insomnia which can adversely affect the mental and physical well-being of health professionals and patient care. The aim of the study was to compare the correlation of perceived stress and insomnia among health professionals and other employees in a Government Medical College of Eastern India. Materials and Methods: This online survey was conducted using two Google forms in a span of 18 months. In the first section of the document, the relevance was explained, and informed consent was taken. In the second part of the form, participants were asked to fill up demographic details and relevant history. In the third part of the form, participants had to fill up the following four scales: Perceived Stress Scale (PSS) of Sheldon Cohen, Pittsburgh Sleep Quality Index (PSQI), Insomnia Severity Index (ISI), and Job Satisfaction Scale (JSS). Results: Participants were divided into two groups: Group A: Health Professionals and Group B: Other Employees. JSS scores were significantly higher among Group A (38.29 ± 6.34) as compared to Group B (35.47 ± 6.98) with a P = 0.0008**. Participants having higher JSS scores also had higher PSS scores (Group A with an r = 0.12; Group B with an r = 0.007). ISI scores were significantly higher in Group A (10.53 ± 3.43) as compared to Group B (6.21 ± 2.77) with a P < 0.001**. Participants having higher PSS scores also had higher scores for ISI (Group A with an r = 0.167 and Group B with an r = 0.333). PSQI scores were significantly higher among Group A (11.52 ± 2.05) as compared to Group B (6.37 ± 2.69) with a P < 0.0001**. PSS scores also positively correlated to PSQI scores (Group A, r = 0.963 and Group B r = 0.959). Participants having higher PSS scores also had higher scores for PSQI (Group A with an r = 0.963 and Group B with an r = 0.959). Conclusions: Perceived stress scores positively correlated to both severities of insomnia and poor quality of sleep among study participants. This suggests that higher perceived stress levels may be a significant contributor to insomnia and poor sleep quality among health professions as they are constantly exposed to higher professional stress in the present health-care system.

Background: Idiopathic pulmonary fibrosis (IPF) is a form of progressive fibrosing interstitial lung disease with a poor prognosis. Pirfenidone is an oral antifibrotic agent used in the treatment of IPF, and it reduces the rate of decline of lung function. However, the tolerable dose and adverse effect profile appear to be different in the Indian population. Methodology: This prospective observational study was conducted in the Department of Pulmonary Medicine at a tertiary care center in India between January 2015 and June 2016. All adult patients diagnosed as IPF based on multidisciplinary discussion were enrolled. Subjects with active respiratory tract infection, other end-organ failures, and drugs interacting with Pirfenidone were excluded. Data collection was done with a predesigned questionnaire at baseline. Subsequently, they were followed up telephonically every week and in-person review at 3 and 6 months. Results: The cohort has 30 patients with a mean age of 60 years ± 4.5 (standard deviation 8.9). 80% did not tolerate the recommended total dose (40 mg/kg/day or 2400 mg/kg) and the median tolerated dose was 1800 mg/day (25–30 mg/kg). 75% reported adverse events, the most common being anorexia, and gastroesophageal reflux disease in gastrointestinal (GI) reaction, followed by a rash in dermatological reactions. All these adverse effects were mild to moderate and managed with supportive care or dose reduction. None of them were severe, causing cessation of therapy. Conclusion: Pirfenidone has a lower tolerable dose and predominantly GI adverse effects in our population, and if addressed early, it can prevent cessation of treatment and better quality of life for patients.

Background: Vaccination against COVID-19 among people living with HIV (PLWH) infection is crucial. At present, evidence lacks to strategize vaccinating the hesitant PLWH. This study has estimated the proportion of PLWH vaccinated till October 2021, enumerated the various adverse events following vaccination, and identified the enabling and constraining factors associated with vaccination. Methods: A cross-sectional survey was conducted among PLWH by the snowball sampling in the Chittoor district of Andhra Pradesh, India. Data were analyzed using the descriptive statistics and qualitative analyses. Results: Two-hundred and forty-seven PLWH responded, out of which 52 (20.7%) were yet to be vaccinated. Seventy-five (30%) participants reported having adverse events, out of which five (7%) had pain at the injection site, and 72 (96%) had systemic reactions. Fever (n = 51, 68%), dizziness (n = 23, 31%), and joint pain (n = 23, 31%) were the major systemic reactions. Among the vaccinated, motivation by the health-care workers and village volunteers were the major enabling factors. On the contrary, uncertainty about the vaccine effects, negative feedback from the health-care workers, and lack of self-motivation were the important constraining factors in taking the vaccines. Conclusion: Some PLWH are still hesitant to take the vaccine. Evidence generation, coupled with community mobilization, is required to upthrust the vaccination campaign in achieving the herd immunity against COVID-19.

Although eosinophilic esophagitis has been a commonly identified condition in Western countries, reports are emerging about an increasing incidence in developing countries. Multiple environmental factors and genetic susceptibility play a role in the development of this condition. Limited treatment modalities are available, and future research hopefully would guide further insights into effective management strategies of this condition.

The employment of computers for facilitating learning in the field of medicine is a known identity. The purpose of the current review is to explore the role of computer-based assessment in medical education and the potential challenges and strategies that need to be adopted to overcome them. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of 15 articles were selected based upon their suitability with the current review objectives and analyzed. The keywords used in the search include computer-based assessment and medical education. The mode of use of computers in assessment can be decided based on the purpose of the intended assessment and play an important role in helping predominantly the students to expedite their learning. Computer-based assessments offer a good option for the students to assess their knowledge and learning progression in a nonthreatening and noncompetitive environment. In conclusion, computer-based assessments can be acknowledged as an exciting prospect and have the potential to bring about reforms in the assessment in medical education. This calls for the need that each and every medical institution should gradually aim for the introduction of the same within their set-up and thus prepare students better for their future medical career.

Lesson plan is required for all medical educators as it would help in completing their teaching-learning activity within specific periods for completion of all learning goals. There are six steps and eight components in the formulation of a lesson plan. The lesson plan should include the instructional design or learning objectives. The learning activity should start with a proper set induction, i.e., induce the interest regarding the topic in the students. There should be a brief travel to the past lessons, and it should end with feedback from the students and one assessment for assessing the learning understandings of the students.