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   Table of Contents - Current issue
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January-April 2022
Volume 49 | Issue 1
Page Nos. 1-87

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EDITORIAL  

COVID-19 vaccination in India p. 1
Shridhar C Ghagane, Rajendra B Nerli
DOI:10.4103/jss.jss_47_22  
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REVIEW ARTICLES Top

Strengthening the process of self-directed learning in medical education by targeting teachers and students p. 3
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.jss_148_21  
The range of knowledge and skills expected of a medical student upon completion of their course is vast. There is an immense need to encourage self-directed learning (SDL) among medical students, which in turn will help the medical institutions to attain the core competency of transforming students into lifelong learners. Medical teachers have to play crucial roles and they should be looked upon as one of the sources for skills and not a source of content. The success of SDL depends upon the extent of involvement of the students in the entire process and this has to begin with, being aware of SDL, accepting the fact that SDL is the way to go into the field of medical education and to enable practicing of evidence-based medicine. To conclude, SDL is an effective and vital strategy to expedite learning among medical students. The need of the hour is to give SDL adequate importance and the success of the initiative will eventually depend on the facilitation role of the teacher and the active engagement of the student.
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Convalescent plasma for coronavirus disease 2019: A boon or bane p. 6
L V Simhachalam Kutikuppala, Nijora Deka, Mohd Umar Farooq, Aisha Abeer Abdul Gaffar, Anna Mary Jose
DOI:10.4103/jss.jss_138_21  
Coronavirus disease 2019 (COVID-19) pandemic emergence has re-evaluated the functionality of the notable convalescent plasma transfusion (CPT). It is a source of neutralising antibodies, which when transfused into severe acute respiratory syndrome coronavirus 2 infected patients are believed to employ an antiviral effect, suppressing the replication of virus before the patients regain their own effective humoral immune responses. The major accepted mode of action of the CPT therapy is viremia clearance, that happens mostly between 10 and 14 days after infection. Hence, CPT has been administered to the recipients typically after the emergence of early symptoms for anticipating maximize the efficacy of the therapy. CPT has been used in treating viral diseases including measles, mumps, poliomyelitis, and influenza in the pre-vaccine era. More recently, it has been used as a treatment approach for influenza, Ebola virus disease, and severe acute respiratory syndrome coronavirus epidemics, with varying success. The available evidence till date suggests that convalescent plasma which is collected from the COVID 19 survivors contains “receptor binding domain specific antibodies” possessing potent antiviral activity. Multicentred and well-designed clinical trial studies in establishing the efficacy of CPT among COVID-19 patients are being conducted globally. PubMed, EMBASE, and Medline databases were screened till November 01, 2020. This is an attempt to review studies of convalescent plasma on clinical outcomes in patients with COVID-19. From the outcomes of some of the completed studies, it is suggested that CPT therapy among COVID-19 patients seems to be safe and clinically efficacious to some extent.
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Role and significance of ghrelin and leptin in hunger, satiety, and energy homeostasis p. 12
Charu Kharbanda, Savita Bansal, Prachi Saffar Aneja
DOI:10.4103/jss.jss_126_21  
Hunger is a set of internal experiences that lead a human or animal to seek food. Satiety is a desire to limit further food intake or the state of being gratified after completing a meal. The objective of this review article is to discuss the influence of ghrelin and leptin in hunger, appetite, satiety, and long-term energy homeostasis. The data for this review were collected through an extensive journal search. Electronic databases (Medline and PubMed) were thoroughly consulted, and few articles were obtained from the website: Google Scholars (http://scholar.google.com). Ghrelin and leptin are concerned with food intake and energy homeostasis. Ghrelin increases food intake and affects food patterns, whereas leptin induces satiety. Circulating leptin levels are directly proportion to the amount of body fat, thereby reflecting the status of long-term energy stores. Recent work suggests that leptin plays a more important role in the maintenance of weight loss than weight loss per se and ghrelin increases appetite, adjusts energy balance, and enhances the release of growth hormone from the pituitary gland
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Inclusion of sexual health-related competencies in undergraduate medical education p. 17
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.jss_91_21  
Sexual health has been recognized as an essential component of the overall health of humans. The purpose of current review is to explore the need and opportunities for the incorporation of sexual health-related competencies in the undergraduate medical curriculum. An extensive search of all materials related to the topic was carried out in the PubMed search engine, and a total of 9 articles were selected based upon the suitability with the current review objectives and analyzed. Keywords used in the search include sexual health and medical education in the title alone only. In general, the health professionals are not ready for this role on their own, and this establishes the need that undergraduate medical students should be exposed to competencies pertaining to sexual health during their training period. In the current setup, we cannot ignore the fact that not many teaching hours are assigned to sexual health, there is absence of standard competencies, lack of plans for teaching-learning or assessment of the same, and the discomfort among both doctors and patients to openly talk about the same. The competencies for sexual health should be formulated, and subsequently, a thorough curriculum mapping should be done. In conclusion, regardless of the specialty branch which an undergraduate medical student might opt in the future, there is an indispensable need to expose them to competencies pertaining to the maintenance of sexual health and well-being.
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ORIGINAL ARTICLES Top

Clinical characteristics and risk factors for mortality in 1048 Health care workers hospitalised with COVID 19 in a Tertiary care hospital, India p. 20
Prasad Tukaram Dhikale, Smita Santosh Chavhan, Balkrishna Adsul, Chinmay Gokhale, Aniket Ingale, Kirti Kinge
DOI:10.4103/jss.jss_99_21  
Objectives: We aim to study the clinical characteristics and risk factors for mortality of doctors and nurses hospitalized with COVID-19. Materials and Methods: This was a hospital-based cross-sectional study. All doctors and nurses positive on reverse transcriptase–polymerase chain reaction test of nasopharyngeal or/and oropharyngeal samples for COVID-19 who were admitted in this designated COVID hospital from April 2020 to January 2021 and with a definite outcome (death or discharge) till the end of January 2021 were included in this study. To explore the risk factors associated with mortality of health-care workers (HCWs), bivariate and multivariate logistic regression analysis was done. Results: Out of 1048 HCWs, 846 (80.7%) were doctors and 202 (19.3%) were nurses. Majority (619, 59.15%) of the HCWs were young (18–30 years). Most (185, 91.6%) of the nurses were female, while majority (533, 63%) of the doctors were male. The 11 (1%) HCWs who died were all doctors, but the difference was not statistically significant. Total 121 (11.54%) HCWs had comorbidities, and hypertension 70 (6.7%) and diabetes 62 (5.9%) were most common. Age >60 years (adjusted odds ratios [AOR] [confidence interval (CI)] = 36.01 [3.45–375.5]) and suffering from diabetes mellitus (AOR [CI] = 10.4 [1.82–59.51]) were found to be significant predictors for the death of HCWs after adjusting for potential confounders. Conclusion: The mortality rate due to COVID-19 in doctors and nurses was lower (1%) as compared to the general population as most of the HCWs were young and with a low prevalence of comorbidities. Age >60 years and diabetes mellitus were risk factors for death; such HCWs should avoid contact with COVID-19 patients. Screening of HCWs for COVID-19 is important to reduce its transmission.
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Evaluation of pulmonary function tests in allergic rhinitis patients attending a rural tertiary care hospital in South India p. 25
S Waheeda, S Syed Liyakath Ali, K Sathyamurthy
DOI:10.4103/jss.jss_17_22  
Background: Pulmonary function tests (PFTs) include a variety of tests such as spirometry, the volume of lung measurement, and diffusing capacity of lung quantification. Allergic rhinitis (AR) is a kind of rhinitis related to complex symptomatology characterized by rhinorrhea, obstruction of the nasal cavity, attacks of sneezing, and irritation of the nose, palate, and eyes. PFT could be deranged in AR patients, as they sustain anomalous airway function, determined by obstruction. Hence, assessing PFT's are a crucial part of the patient workup with AR. Aim: The current study evaluated the variations in pulmonary function among AR patients. Materials and Methods: A sum of 100 people were included in the study, of which 50 people were with AR meeting inclusion criteria, whereas the same age- and gender-matched 50 persons were regarded as a “control group.” PFTs were performed after getting informed consent from both groups. Data were charted and analyzed for statistical significance by the Student's t-test. Results: P value of maximal voluntary ventilation (MVV) has been observed to be the most significant, pointing toward a marked reduction of MVV in the AR patients in comparison to the control group. The P value of forced expiratory volume 1 (FEV1) is moderately significant, depicting a mild decrease in FEV1 among the study group. The P value of FEV1% has been highly significant, pointing toward a marked decrease in FEV1% among the study group participants. The P value of peak expiratory flow rate (PEFR) has been highly significant, denoting a substantial decrease in PEFR in the study group. Conclusion: Alterations in the pulmonary function were evaluated by applying the PFT's among the AR patients of Salem. It was observed that PFT values such as “FEV1, FEV1%, MVV, and PEFR” demonstrated a notable reduction in the allergic patients compared to control.
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Medical Profession in the 21st Century. Is it Still Alluring?? p. 28
Savita Bansal, Prachi Saffar Aneja, Manish Aneja, Ravi Bansal, Jyoti Arora
DOI:10.4103/jss.jss_144_21  
Introduction: The world, particularly India, is in the midst of one of the worst pandemics ever. The second wave of the COVID-19 pandemic has hit the country like a tsunami, taking a toll on life. A robust health-care industry with competent, productive, and positive manpower is needed like never before. The productivity of doctors is directly related to the fulfillment they experience in their jobs. Aims and Objectives: The study will try to explore the satisfaction level of doctors working in Haryana. It will also delve into major determinants of satisfaction and dissatisfaction. Materials and Methods: The cross-sectional survey-based analysis was conducted in FMHS SGTU on doctors employed in Haryana. The prevalidated questionnaire was administered via Google Forms. Results: A total of 515 filled pro forma were obtained. 71.6% of doctors were found to be satisfied in their chosen profession. Discussion: The discontentment among doctors is now globally acknowledged. It stems from a wide array of issues such as the growing incidents of workplace violence, lack of security measures, deteriorating doctor–patient relationship, erratic work hours, monumental workload in stressful environment, inadequate infrastructure, and pitiful pay. Conclusion: There is marked diminution in doctors' morale who regret being in this profession more and more. However, with the joint efforts of society and competent authorities, this grim situation can be rectified. Steps should be taken to build a strong doctor–patient relationship based on trust and boost infrastructure so that medical profession can be made alluring in the 21st century.
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A comparative study to assess mental health literacy, impact of event, depression, anxiety, and stress levels of medical and other students during the second wave of the COVID-19 pandemic p. 35
Arunima Chaudhuri, Suhrita Paul, Enakshi Saha
DOI:10.4103/jss.jss_143_21  
Background: COVID-19 pandemic is negatively affecting the mental health of medical professionals as well as medical students, as they stand in the frontline. Medical education is recognized as stressful across the globe and in the hour of present crisis, students have to stay back home and continue their studies online. Aims: The aim of the study is to compare the emerging evidence of the effects of the COVID-19 outbreak on mental health and assess mental health awareness of medical students and other students studying in a Medical College of Eastern India. Materials and Methods: This cross-sectional observational study was conducted in a period of 3 months after taking Institutional ethical clearance and informed consent of the subjects. 212 medical students and 101 students of other courses studying in the college participated in the study. The present survey was conducted online using Google Forms. In the first section of the form, purpose of the study was explained and informed consent was taken from the participants. In the second part of the form, participants were asked to fill up demographic details and relevant history; in the third part, participants had to fill up three scales: Depression, Anxiety and Stress Scale-21, Impact of Event Scale-Revised (IRE-R), Mental Health Literacy Scale. Results: There was no significant difference in depression scores between the two groups. Anxiety scores and stress scores were significantly higher among medical students as compared to the other group with P = 0.0017 and 0.008, respectively. Group A: Anxiety scores 12.34 ± 8.5; Stress scores - 13.07 ± 8.01. Group B: Anxiety scores 9.34 ± 7.34; Stress scores - 10.55 ± 7.62. There was no significant difference in mental health literacy scores between the two groups. Mental Health literacy scores of Group A: 96.84 ± 17.29; Mental health literacy score of Group B: 99.86 ± 13.39; P = 0.09. No difference in IRE-R scores between the two groups was observed. Group A: Total score - 21.81 ± 14.34; Avoidance scale - 9.43 ± 6.1; intrusion scale 8.58 ± 5.12; Hyperarousal scale - 3.79 ± 2.94. Group B: Total score - 20.39 ± 14.34; Avoidance scale - 9.06 ± 6.5; Intrusion scale - 7.84 ± 5.95; Hyperarousal scale - 3.49 ± 3.21. Conclusions: Mental health literacy scores and impact of event score were similar in medical and other students studying in the same medical institution. Medical students had significantly higher levels of anxiety and stress as compared to the other group, though depression scores of both groups were comparable. Hence, it may be concluded that medical students perceived higher levels of anxiety and stress during the second wave of the present COVID-19 pandemic.
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Factors affecting compliance to quarantine and its psychological effects during the COVID-19 pandemic: A cross-sectional study from aspirational district of India p. 40
Amanjot Kaur Chauhan, Abhishek Singh, Rajesh Ranjan, Vikas Gupta, Pawan Kumar Goel
DOI:10.4103/jss.jss_123_21  
Background: COVID-19 has caused pandemic during 2019–2020 and has presented with illnesses ranging from the usual mild flu to serious respiratory problems/complications, even leading to considerable mortality. Recent literatures have suggested that the health (especially psychological) impacts of quarantine are substantial and can be long lasting. Aim: The purpose of this study was to assess the mental health status (psychological distress) of experienced quarantine and compliance to quarantine during the outbreak of COVID-19 in Nuh district. Methods: The study included 543 subjects (adults aged 18 years or more) who were sent for quarantine at home or state-run facilities and included “Flu corner” screened patient and health-care staff working in COVID-19 outpatient and wards. The psychological impact was assessed using the Kessler Psychological Distress Scale (K10). Categorical data were presented as percentages (%), and bivariable logistic regression was applied to find out the association, and it was considered significant if the P < 0.05. Results: The doctors and nursing staff were among two-fifth of the subjects (217/543, 40.1%), and only 11.6% of quarantined subjects (63/543) were compliant with all protective measures. The mean score obtained on Kessler Psychological Distress Scale (K10) subjects was 18.69 ± 4.88, whereas out of 543 subjects, 152 (27.9%) had a score of 20 or more, and it has a significant association with the elderly age group, female gender, and workplace as exposure setting (P < 0.05). Conclusion: Given the developing situation with coronavirus pandemic, policymakers urgently need evidence synthesis to produce guidance for the public. Thus, the outcomes of this study will positively help authorities, administrators, and policymakers to apply quarantine measures in a better way.
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Drug utilization pattern at the cardiac surgical outpatient clinic in a tertiary care hospital at Goa p. 47
Jagannath Kolwalkar, Dhanya Jose, Shirish Borkar, Vijay Madhan, PV Rataboli, Jagdish A Cacodcar, Nitin Y Dhupdale
DOI:10.4103/jss.jss_92_21  
Background: Drug utilization research encourages rational drug prescribing practices and thus contributes to the contemporary use of drugs in the society. This study assesses the drug utilization pattern (DUP) at the cardiac surgical outpatient department of Goa Medical College hospital. We used the World Health Organization (WHO)-prescribing indicators to analyze the National List of Essential Medicines (NLEM) implementation as recommended in the National Drug Policy. Methods: We used a cross-sectional study design to analyze the DUP. We randomly selected 103 prescriptions dispensed to patients at the cardiac surgical outpatient during the study period. We critically examined these prescriptions for their consistency with WHO core drug use indicators. Results: The average number of drugs prescribed per person was 4.95. The most commonly prescribed top three drugs were antiplatelets (21.46%), beta-blockers (14.76%), and statins (13.78%). Most drugs were prescribed as single drugs (90.98%), whereas 9.02% were fixed-dose drug combinations (FDC). The combination of aspirin and clopidogrel was the most common prescribed FDC. The majority (72.44%) of the drugs prescribed were as per the NLEM 2015 list, whereas the generic name was low (2.8%). We measured Patient-Care Indicators and Facility-Specific Indicators also. The average consultation time and dispensing time were 7.76 and 3.23 min, respectively. The in-house pharmacy dispensed 82% of drugs. 93.75% of the key drugs were available in the facility. A copy of the essential drugs list was readily available in the facility. 96.67% of the patients knew the correct dosage of drugs. Conclusions: Anti-platelets and statins were the most commonly prescribed drugs. There was a high prescribing trend from the NLEM; however, the inclination to prescribe generic names was less. Patient-care and facility-specific indicators were also far from the optimal values except that of the average dispensing time.
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A study of type of aphasia in cortical and subcortical strokes p. 55
Zulkifli Misri, Amruta A Jhawar, Jayashree Bhat, Berton Craig Monteiro, Safwan Ahmed
DOI:10.4103/jss.jss_88_21  
Context: In the elderly stroke or stroke-related injury often results in cortical dysfunction termed as aphasia. This affects language usage and multiple aspects of communication. Comparative studies between cortical and subcortical lesions in aphasia are lacking. Aim: To study the type of aphasia in cortical and subcortical strokes. Settings and Design: Prospective observational. Subjects and Methods: Subjects with cortical and subcortical strokes of the dominant cerebral hemisphere were included in the study and divided into various aphasia types. Bedside language tests and distribution according to educational qualifications were performed. The subjects were assessed for aphasia scores and its association was performed with other baseline characteristics. Statistical Analysis Used: Data was expressed as a percentage and mean ± standard deviation. Kolmogorov-Smirnov analysis and Fischer's exact test or Chi-square test were used. Results: Significant difference was noted between the type of aphasia and age group in study subjects (P < 0.001). A severe form of language dysfunction like global aphasia was noted in subjects with a comparatively low level of education, with subcortical bleed, or those with left perisylvian infarcts. Subjects with diabetes and dyslipidemia had a higher risk of developing anomic aphasia (P = 0.02). Conclusions: This study showed the type of aphasia in subjects with cortical and subcortical strokes and it revealed that age at onset, level of education, and site of the lesion were associated with the outcome of patients of aphasia.
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Impact of social media on young bank employees during COVID-19 pandemic: A cross-sectional study p. 61
Saloni Prabhu, Arif Maldar, Pooja S Dhagavkar, Ashwini Narasannavar, Mubashir Angolkar
DOI:10.4103/jss.jss_111_21  
Background: During the COVID-19 pandemic, social media (SM) use saw a sharp raise, especially for obtaining information regarding COVID-19 during the lockdown. SM platforms also led to misinformation about the disease which caused negative psychological effects on individuals. Bank employees (BE) are special workgroups who experience various levels of mental stress at their workplace due to workload. During lockdown and till date many of the BE work from home which enabled them to use SM accordingly. Objective: The study was conducted to assess the stress levels and anxiety levels due to usage of SM in young BE during the COVID-19 pandemic. Materials and Methods: In this cross-sectional study, an online Google form questionnaire was distributed to the participants using convenient and snowball sampling method. The final sample consisted of 126 Goan young BE. Statistical analysis was performed using descriptive analysis. Results: The results of the study revealed that SM use had significant impact on the BE, with a potential negative effect on developing stress and anxiety. 10.3% (13) of the participants experienced low stress and 89.7% (113) experienced moderate stress. 51.6% (65) of the participants had mild anxiety, 10.3% (13) had moderate anxiety, and 38.1% (48) had severe anxiety. Conclusion: The present study concludes that increased SM use among the BE was associated with negative psychological outcomes. Anxiety and stress were associated with the time spent on using SM sites.
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Comparative study of fine-needle aspiration cytology and needle core biopsy in the diagnosis of breast lumps with histopathological correlation p. 70
Rizia Siddique, Anuradha Sinha, Moumita Adhikary, Jyoti Prakash Phukan
DOI:10.4103/jss.jss_81_21  
Introduction: Diseases of breast constitute a large proportion of cases in surgical practice and need to be differentiate between benign from malignant lesions prior to definite treatment. Aims and Objective: The aim is to determine the accuracy with the benign and malignant lesions can be differentiated by fine-needle aspiration cytology (FNAC) and needle core biopsy (NCB) and to correlate the findings of NCB with histopathological diagnosis. Materials and Methods: It is a prospective study for one and half years comprising of 104 patients of breast lumps who underwent FNAC, NCB, and surgical excision followed by histopathological examination. Data have been collected and analyzed regarding sensitivity, specificity, positive predictive value (PPV), and negative predictive value (NPV) of FNAC and NCB in comparison with histopathology (HP). Results: Out of 104 patients, the most common age group is 41–50 years (35 cases, 33.7%). The most common HP diagnosis was infiltrating ductal carcinoma followed by ductal carcinoma in situ (50 cases and 12 cases, respectively). In our study, we found FNAC has sensitivity 94.3%, specificity 100%, PPV 100%, NPV 87.9%, diagnostic efficiency 95% while NCB has sensitivity 97.3%, specificity 100%, PPV 100%, NPV 81.8% and diagnostic accuracy 97.6% in diagnosing breast lumps. Conclusion: NCB is better in comparison to FNAC in diagnosing breast lumps. However, the role of FNAC cannot be ignored in our settings especially in the diagnosis of benign breast conditions. NCB should be considered as second-line method of investigation in case of any doubt to rule out missed diagnosis of breast carcinoma.
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CASE SERIES Top

Clinicopathological spectrum of gastrointestinal stromal tumors: A case series p. 76
Padmanaban Krishnan Govindaraman, U Aravindan, Rajiv Michael
DOI:10.4103/jss.jss_96_21  
Gastrointestinal stromal tumor (GIST) is the most common primary mesenchymal neoplasm of the gastrointestinal tract, and they are potentially malignant tumors with varied biological behavior. The objective of this study was to investigate the clinicopathological characteristics and prognostic factors of GISTs in our institution. Medical records of nine cases of GISTs diagnosed during January 2018 to March 2021 were reviewed. Details of patient demographics, clinical presentation, treatment details, and gross and histopathological features were noted. GISTs were commonly seen in stomach in 50–60-year age group with slight male preponderance. Abdominal pain was the most common symptom. Other sites encountered were colon, mesentery, peritoneum, and omentum. Most of the gastric GISTs were in low-risk group. Mean size of the tumor was 9.3 cm. Spindle cell type was the most common histological pattern with diffuse hypercellularity subtype. All cases were positive for CD117 (c-kit). One case was inoperable due to dissemination in abdominal cavity, surgery was done in all other cases, and imatinib therapy was given for high-risk cases postoperatively. GIST is uncommon with diverse clinical presentation. CD117 is a very sensitive marker for making a diagnosis of GIST. Successful management of GISTs requires complete surgical resection and adjuvant imatinib therapy for intermediate- and high-risk patient.
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CASE REPORTS Top

A giant tonsillolith: An unusual cause for longstanding foreign body sensation in throat p. 81
Santosh Kumar Swain
DOI:10.4103/jss.jss_40_21  
Foreign body sensation in throat is a common complaint by patients at the outpatient department in routine clinical practice. Long-standing tonsillolith is an uncommon cause for foreign body sensation in throat. Tonsilloliths are also called as tonsillar calculi or tonsillar stones or throat stone which form in the crypts of the faucial or palatine tonsils. They are usually small in size. The exact etiopathogenesis for the formation of tonsillolith is not known. It may protrude out of the tonsillar crypt and provide foreign body sensation in throat and usually not harmful to the body. It is a common cause for bad breath or halitosis in adult patients with tonsillolith. Finding giant tonsilloliths is rare in clinical practice. Here, we report a case of a giant tonsillolith in left palatine tonsil which was associated with long standing foreign body sensation in throat. Here, we report a 62-year-old man presenting for giant tonsilloliths with complaint of long-standing foreign body sensation in throat.
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SHORT COMMUNICATION Top

Challenges encountered by teachers in medical education p. 84
Saurabh RamBihariLal Shrivastava, Prateek Saurabh Shrivastava
DOI:10.4103/jss.jss_153_21  
In general, it is expected from medical teachers that they should transform fresh learners into competent medical graduates upon completion of their training period. However, a lot goes into this, as the delivery of medical education is quite different and complicated in comparison to any other graduate courses available. Teachers play an instrumental role in helping the students acquire various noncognitive attributes essential for successful medical practice. A number of challenges have been identified from the teachers' perspective in medical training. In conclusion, the job profile of medical teachers is extremely demanding as they have to simultaneously perform on various domains. There is an immense need to support the medical teachers in their assigned roles so that their overall outcomes can be significantly enhanced.
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LETTER TO EDITOR Top

Preloading of the suction catheter on I-gel: A stitch in time saves nine!! p. 86
Kaminder Bir Kaur, Davinder Jit Singh, Debashish Paul, Vishal Mangal
DOI:10.4103/jss.jss_120_21  
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