An update on the novel approaches towards skills assessment of ophthalmology residents in the Indian scenario

An essential part of the teaching-learning paradigm is assessment. It is one of the ways to achieve feedback for the various methods that have been used to impart a particular skill. This is true of ophthalmology training, where various clinical and surgical skills are learned as part of the residency program. In preparation for residents to become proficient ophthalmologists, both formative and summative assessments are of paramount importance. At present, assessment is primarily summative in the form of a university examination, including theory and practical examinations that are conducted at the end of the three years of residency. A formative assessment can make course corrections early on, allowing for an improved understanding of the subject and the acquisition of clinical and surgical skills. Formative assessments also allow us to customize the teaching methodology considering individual residents’ learning capabilities. In addition, formative assessments have the advantage of alleviating the stress of a “final” examination, which could sometimes result in a less-than-optimum performance by the residents. The COVID-19 pandemic has forced us to adopt new teaching methods, which has led to the adoption of changes in assessment. In this regard, we discuss the different assessment tools available, their pros and cons, and how best these tools can be made applicable in the setting of an ophthalmology residency program.     

Excitability of sensory axons in amyotrophic lateral sclerosis

Objective

To evaluate the excitability of sensory axons in patients with amyotrophic lateral sclerosis (ALS).

Prunus mume extract exhibits antimicrobial activity against pathogenic oral bacteria

International Journal of Paediatric Dentistry 2011; 21: 299–305 Objectives. Prunus mume is a common fruit in Asia, which has been used in traditional Chinese medicine. In this study, we focused on the antimicrobial properties of Prunus mume extract against oral pathogens related to dental caries and periodontal diseases. Study design. A total of 15 oral pathogens including Streptococcus mutans, S. sobrinus, S. mitis, S. sanguinis, Lactobacillus acidophilus, P. gingivalis, Aggregatibacter actinomycetemcomitans, and Candida species were included in the study. Initially, agar diffusion assay was performed to screen the antimicrobial activities of Prunus mume extract. Minimum inhibitory concentration (MIC) and minimum bactericidal concentration (MBC) were then determined for sensitive species. Effect of Prunus mume extract on human oral keratinocytes (HOK) viability was also tested. Result. In the agar diffusion assay, drug suspension of 2 g/mL was able to inhibit all the bacterial species tested, but not the fungal species. MIC and MBC range of Prunus mume extract against the oral bacteria was 0.15625–0.0003 g/mL and P. gingivalis being the most susceptible species. Prune extract did not cause any detrimental effect on HOK. Conclusion. Prunus mume extract may be a potential candidate for developing an oral antimicrobial agent to control or prevent dental diseases associated with oral pathogenic bacteria.     

One vs two applications of chlorhexidine/ethanol for disinfecting the skin: implications for regional anaesthesia

Chlorohexidine/ethanol is commonly used for skin disinfection before neuraxial procedures. Two applications of this solution have been advocated but no evidence exists to support this. Our aim was to ascertain whether two applications of chlorohexidine/ethanol solution are more effective than one for skin disinfection before neuraxial anaesthesia. A 4-cm diameter soya agar contact plate was applied to the skin of the lumbar region of 309 healthy volunteers, followed by a single spray application of chlorhexidine gluconate 0.5% w/v in 70% v/v denatured ethanol. This was allowed to dry and a second contact plate applied. The disinfectant was re-applied and after drying, a third contact plate applied. Agar plates were incubated at 37°C for 24 h. No growth occurred in any plates after the first or second spray (p < 0.0001). We feel reassured that the current practice of using a single application of chlorhexidine/ethanol solution is sufficient to disinfect the skin before regional anaesthesia, particularly in the emergency situation when waiting for a second application to dry may add needless delay and risk translocation of excess chlorhexidine into the subarachnoid space.     

Frailty Screening (FRAIL-NH) and Mortality in French Nursing Homes: Results From the Incidence of Pneumonia and Related Consequences in Nursing Home Residents Study

Objectives

To investigate the ability of the fatigue, resistance, ambulation, incontinence or illness, loss of weight, nutritional approach, and help with dressing (FRAIL-NH) tool to predict mortality.

Loss of the signaling adaptor TRAF1 causes CD8+ T cell dysregulation during human and murine chronic infection

The signaling adaptor TNFR-associated factor 1 (TRAF1) is specifically lost from virus-specific CD8 T cells during the chronic phase of infection with HIV in humans or lymphocytic choriomeningitis virus (LCMV) clone 13 in mice. In contrast, TRAF1 is maintained at higher levels in virus-specific T cells of HIV controllers or after acute LCMV infection. TRAF1 expression negatively correlates with programmed death 1 expression and HIV load and knockdown of TRAF1 in CD8 T cells from viral controllers results in decreased HIV suppression ex vivo. Consistent with the desensitization of the TRAF1-binding co-stimulatory receptor 4-1BB, 4-1BBL-deficient mice have defects in viral control early, but not late, in chronic infection. TGFβ induces the posttranslational loss of TRAF1, whereas IL-7 restores TRAF1 levels. A combination treatment with IL-7 and agonist anti-4-1BB antibody at 3 wk after LCMV clone 13 infection expands T cells and reduces viral load in a TRAF1-dependent manner. Moreover, transfer of TRAF1(+) but not TRAF1(-) memory T cells at the chronic stage of infection reduces viral load. These findings identify TRAF1 as a potential biomarker of HIV-specific CD8 T cell fitness during the chronic phase of disease and a target for therapy.