Necrotizing fasciitis is on the right end of the spectrum with associated high morbidity and mortality. Although the descriptions of this can be dated to the times of Hippocrates, the mortality associated with the disease remained high. Early surgical debridement without any controversy is accepted as the single best prognostic indicator, but due to the masked and overlapped clinical findings relying on the clinical prowess of the treating surgeon is questionable. Due to which we need to have an objective method of assessment, many researchers have assessed the use of various biochemical, imaging, and histopathological investigation, which has been reviewed in the same.
Background: To know the effects of chewing gum and its effects on recovery on different types of surgeries.
Objectives: Several strategies and interventions have been tested to prevent or reduce postoperative ileus (POI), both pharmacological and non-pharmacological. One of these strategies is gum chewing, a new and simple modality, which can accelerate complication-free recovery of gastrointestinal (GI) function. Here we review several studies on chewing gum and its effects on recovery after different types of surgeries.
Methods: Studies from commonly searched databases like PubMed, Google Scholar, Scopus, Lilacus, and Cochrane Library with the following search terms, ‘chewing gum’ and ‘postoperative ileus’. A total of 49 articles were obtained in total and only 15 were taken for review after taking into account the study criteria.
Conclusion: Gum chewing is reducing the time for flatus, time for bowel movement, and the length of hospital stay. Its role in various surgeries has different results.
Assessment methods in competency-based medical education play a very vital role in imparting learning to learners. The assessment tools include formative and summative assessments. Based upon the milestones in the stepwise development of competencies, assessment methods are framed. The basis for an effective method of assessment is framing questions in alignment with the learning outcomes of the curriculum designed for the student. There is the active participation of students in formative assessment for their feedback drives the engine of learning and teaching. In this short communication, different methods of assessments are described.
Antony John Charles
Skillful airway management is an essential prerequisite for orotracheal intubation both in emergencies and elective surgeries requiring general anesthesia. Both Miller and Macintosh blades are very commonly and widely used for intubations in all patient age groups, though the Macintosh blade is more commonly recommended in the adult population and the Miller blade in the pediatric population as evidenced in the existing literature. A better view of the glottis is obtained with the adult straight Miller blade as it has a narrow tip and hence gives a wider working space to negotiate an endotracheal tube that leads to an improved line of sight to the glottis. A review of the literature was conducted to summarize existing evidence of the adult Miller on ease of orotracheal intubation, glottic view, time taken for intubation, and hemodynamic changes, and there is very little literature comparing the Miller blade and Macintosh blade use in the adult population.
Traditionally, progress of labor and the prediction of vaginal delivery is done by clinical assessment. There is a lot of subjectivity in assessment and increased interobserver variability, especially with digital vaginal examination. For the past two decades, many ultrasonographic parameters were developed, and their utility was studied objectively. Of the ultrasound (USG) parameters, head position is the easiest to recognize. The descent and station of the head are determined indirectly by angle of progression (AOP) and head perineal distance (HPD). Cervical dilatation does not correlate well with digital vaginal examination, and it is difficult to visualize cervical rim beyond 8-cm dilatation. Midline angle and head-up position are other parameters in the second stage of labor that are determined to predict difficult vaginal delivery. Angle of progression of >110° and HPD <4 cm are good predictors of vaginal delivery. “Sonopartogram” may replace the traditional partogram as it is more objective, noninvasive, and women-friendly. Intrapartum apps are incorporating USG parameters with other patient characteristics to develop models for predicting vaginal delivery.