Background: Major depressive psychosis (MDP) is a severe psychiatric condition characterized by symptoms of major depression accompanied by psychotic features such as hallucinations or delusions. Treatment remains a challenge, especially in developing countries where resource constraints affect therapeutic approaches. Objective: This study explores the clinical profiles, treatment modalities, and outcomes of patients diagnosed with MDP at a tertiary care hospital in Bangalore, India. Methods: This hospital-based, prospective observational study included patients diagnosed with MDP between April 2018 and December 2018. Data were collected using structured clinical interviews, hospital records, and follow-up assessments. Results: Among 92 patients (mean age 35.2 ± 11.4 years), 61% were female. Atypical antipsychotics combined with selective serotonin reuptake inhibitors (SSRIs) showed the highest efficacy. Electroconvulsive therapy (ECT) was used in 18% of severe cases. 78% achieved significant symptomatic improvement within 12 weeks. Conclusion: Early diagnosis and a combination of pharmacological therapies are effective in managing MDP. The study highlights the need for accessible mental health services in tertiary hospitals.

Introduction: Central neuraxial blockade is very popular for lower abdominal and lower limb surgeries. The cost effectiveness, ease of administration, rapidity of onset, adequacy of muscle relaxation and profound analgesia during the operative as well as during the post-operative period provide excellent operating conditions and make it an indispensable technique to provide anaesthesia for the surgeries below umbilicus. Materials and method: In this study, we compared epidural dexmedetomidine and magnesium sulphate as adjuvants to ropivacaine for lower abdominal and lower limb surgeries in relation to characteristics of sensory block, motor block and sedative effect. The changes in hemodynamic parameters and side effects were also observed. This double blind, prospective, randomized controlled study was conducted on 90 adult patients of ASA physical status I-II of either sex, in the age group of 18-55 years. Patients were allocated to either of the three groups according to computer generated random numbers. Result: GROUP (R) (n =30): received bolus of 19 ml epidural injection of 0.75% ropivacaine plus 1ml normal saline.  GROUP (D) (n =30): received bolus of 19 ml epidural injection of 0.75% ropivacaine plus injection dexmedetomidine 25 mcg (25 mcg/ml). GROUP (M) (n =30): received bolus of 19 ml epidural injection of 0.75% ropivacaine plus injection magnesium sulfate 50 mg (50mg/ml). Each of the solution was made to a total volume of 20 ml. The observations were made on the basis of the data collected, and were compiled in the form of master chart. Discussion: Epidural anaesthesia can be used as sole anaesthetic for procedures involving the lower abdomen and lower limb. The major advantages of epidural anaesthesia are the ability to titrate the extent and duration of anaesthesia thus making it suitable for procedures of long duration, lesser complication of haemodynamic changes than that seen with comparable levels of spinal block and puncture of durameter associated with sub-arachnoid block. Conclusion: Onset of the sensory and motor block was earliest in dexmedetomidine followed by magnesium and longest in control (ropivacaine) group. Time to two segment regression, time to first rescue analgesic of sensory block and duration of motor block was found to be longest in dexmedetomidine followed by magnesium and then in control (ropivacaine alone) group with statistically significant difference among all the three groups. The haemodynamic parameters (PR, SBP, DBP and MAP) decreased in all the groups after injecting the study drug.

Objective: To explore the perception of undergraduate medical students in developing world regarding teaching and learning of various basic clinical skills, identifying their learning needs and directing resources of the university accordingly. Design / Setting: A questionnaire study implemented at the time of completion of voluntary clinical skills course for four weeks at the attached Liaquat University of Medical and Health Sciences, Hyderabad, Pakistan. Participants: All students who went through the course during consecutive sixteen months commencing from October 2008 and ending in January 2010. Results: History taking and laboratory investigations were deemed least important by students, perhaps because these are taught to them during normal attachments in all wards. The Friedmans mean rank was highest for passing of a naso-gastric tube (12.24) and catheterisation of urinary bladder (11.66). The students felt the greatest need to learn these two invasive procedures because they are not taught elsewhere, followed by equipments and drugs used in anaesthesia, sterilization and inserting an intravenous cannulation. The students ranked the learning of the following skills in the middle: giving intra- venous and intra-muscular injections, taking blood, providing pre- or post-operative care (mainly pre-operative fitness assessment and monitoring heamo- dynamic stability post operatively), and being able to identify surgical instruments. Asymptotic as well as Monte-Carlo significance was very high. (p<0.000) Conclusions: Student’s views should form a key part of design when considering development of a skills course and resources should be geared to meet these student learning needs.

Informed consent is an important part of good medical practice. Potentially, added, but not essential procedures may only become obvious during surgery. Therefore, comprehensive consent to cover such a situation is advisable. In this report, we illustrate the value of a standardized consent form which addresses the issue.

A 44-year-old man, previously in good health, presented with congestive heart failure, the onset of which was probably four weeks previously. A diagnostic label of community acquired pneumonia led to delay in the diagnosis of type A aortic dissection. This required surgical management which resulted in a good outcome. The absence of chest pain may have contributed to the delay in diagnosis. Aortic dissection should form part of the differential diagnosis of unexplained acute congestive heart failure.

The Theophylline concentration was reported as 41.6mcg/ml (NR 10-19.9mcg/ml), more than twice the upper safe therapeutic concentration. A search of the laboratory system revealed that this patient’s Theophylline concentration had been within the therapeutic range when last checked 2 months prior to admission, while she was still smoking. Theophylline has largely fallen out of favour as a treatment for airways disease due to its very narrow therapeutic index. Even within the therapeutic range, side effects frequently occur. These side effects range from mild, including tremor and gastrointestinal disturbance, to serious and potentially life threatening, such as seizures and cardiac arrhythmias. Following acute overdose, hypokalemia, hyperglycemia, hypercalcemia, hypophosphatemia, and acidosis commonly occur.