Pushpagiri Medical College

BACKGROUND:Social anxiety is common among medical students because of academic pressure and frequent evaluations. Low self-esteem may contribute to the development of social anxiety. This study assessed the prevalence of social anxiety and low self-esteem and examined their association among medical students. OBJECTIVES:This study aimed to determine the prevalence of social anxiety and low self-esteem among medical students and to evaluate the association between social anxiety and low self-esteem, as well as their relationship with gender. METHODS:A cross-sectional analytical study was conducted among MBBS students at Believers Church Medical College Hospital, Thiruvalla, Kerala, India, between 2019 and 2021. All MBBS students from the 2016-2021 admission batches were invited to participate through a self-administered online questionnaire (Google Forms, Google LLC, California, USA). Of 600 eligible students, 507 responded (84.5%). Social anxiety was assessed using the Social Interaction Anxiety Scale (SIAS) and self-esteem using the Rosenberg Self-Esteem Scale (RSES). Social anxiety was defined as an SIAS score ≥35 and low self-esteem as an RSES score <20. Data were analyzed using IBM SPSS Statistics for Windows, version 25 (IBM Corp., Armonk, NY, USA). Chi-square tests, odds ratios (ORs), Pearson correlation, and multivariable logistic regression were performed. RESULTS:Social anxiety was identified in 201 (39.64%) participants, while low self-esteem was present in 134 (26.43%). Low self-esteem was significantly associated with social anxiety (χ² = 67.41, p < 0.001; OR =5 .57, 95% confidence interval (CI): 3.62-8.56). Female participants had significantly higher odds of low self-esteem (OR = 2.31, p < 0.001), whereas gender was not independently associated with social anxiety. SIAS and RSES scores showed a significant negative correlation (r = -0.595, p < 0.001). Low self-esteem remained an independent predictor of social anxiety after adjustment for gender (adjusted OR = 5.76, 95% CI: 3.71-8.93; p < 0.001). Most participants reported symptom onset between 15 and 19 years. CONCLUSIONS:Social anxiety and low self-esteem are highly prevalent among medical students. Low self-esteem is independently associated with social anxiety, highlighting the importance of early screening and interventions aimed at improving psychological well-being in this population.

Abstract Contrecoup brain injury involves a contusion opposite to the actual site of impact to the head. In a coup injury, the brain strikes the skull at the site of the direct impact; a contrecoup injury occurs opposite to the site of the external force. These injuries occur when the moving head strikes a stationary object and coup injury occurs when a moving object impacts a stationary head. This type of injury has been studied and debated regarding its aetiology and significance. Four theories have been proposed for the development of contrecoup injury. They are positive pressure theory, negative pressure theory, rotational shear stress theory and angular acceleration theory. According to the current hypothesis, due to relative buoyancy of the brain in the cerebrospinal fluid (CSF), when the skull is abruptly stopped, the denser CSF continues forward, displacing the brain in the opposite direction leading to contrecoup injury. No single hypothesis can explain every facet of contrecoup damage, and a combination of mechanisms contributes to ultimately cause contrecoup injury. The concept of contrecoup injuries can also be applied to fractures in the maxillofacial region where an impact on one side produces a fracture on the opposite side. These injuries are frequently missed in cases, as clinicians focus on the fracture side and hence may be underreported.

Although more than 30 case reports of eosinophilic meningitis have been attributed to Angiostrongylus cantonensis ( A. cantonensis ) in India, only three have been microbiologically confirmed (via polymerase chain reaction [PCR] or immunoblot testing). In seven ocular infections and two brain abscesses reported, A. cantonensis was identified on the basis of the morphology of recovered worms. Here, five cases of Angiostrongylus eosinophilic meningitis (AEM) in children and adults are reported, diagnosed via the detection of A. cantonensis DNA in cerebrospinal fluid using the AcanR3990 quantitative PCR (National Institutes of Health, Bethesda, MD). All patients responded to management with steroids and albendazole. When AEM cases reported from India were reviewed and mapped, the majority were reported from southern Indian states. Managing and preventing this emerging zoonosis in these areas requires 1) access to accurate and timely diagnostics, 2) increasing awareness among clinicians, and 3) risk assessment with public health officials on acquiring infections from water and food contaminated by gastropods and other paratenic hosts.

Purpose: To compare the efficacy of retromandibular approach (RM) to transmasseteric anteroparotid approach (TMAP) in open reduction and internal fixation of mandibular condylar fractures using various clinical parameters. The parameters evaluated include duration (time taken from incision to reach the fractured site, accessibility to reach the fractured site (intraoperative), facial nerve palsy, sialocele, and scarring (post-operative). Materials and Methods: The sample size was 26 (13 per group). The study was conducted in patients with condylar fractures planned for open reduction and internal fixation. The choice of approaches was RM and TMAP. The post-operative parameters were analyzed during the first week, first month, and third month. The study was done between 2018 and 2020. Patients were randomly assigned to the groups. Group I contained RM and Group II had TMAP. Results: On comparing efficacy, each approach was versatile in its own way. Considering duration no statistically significant difference was observed. In terms of accessibility there was no statistically significant difference but TMAP offered a better access compared to RM. A very minimal difference was observed in post-operative features like facial nerve palsy, sialocele, and scarring but none reached statistical significance. Only scaring pertaining to the length of the incision in TMAP was statistically significant. Considering RM, it was the fastest, easiest to reach the fractured site and more suitable for reducing medially displaced condyle fractures. TMAP credits with respect to direct access to the fracture site, placement of screws perpendicular to the fractured site, less chance of facial nerve palsy but resulted in inconspicuous scar. It was observed that both approaches had their own versatility, including good exposure and accessibility to fracture site. The choice depends on the type of condyle fracture and convenience of the surgeon. Conclusion: Currently, very little has been published pertaining to the comparison between RM and TMAP for condyle fractures. RM resulted in less scarring, providing a better convenience and accessibility for reducing medially displaced subcondyle fracture. TMAP offered a more direct exposure of the fracture site with a better direct reduction, ease of placement of plate and screws with a favorable access.