Surat Municipal Institute of Medical Education and Research (SMIMER) is a medical college and teaching hospital in Surat, Gujarat, India, which is the fourth-fastest-growing city in the world. It was established in 2000 and has been affiliated to the Veer Narmad South Gujarat University. The institute is spread over a floor area of 18,427 square metres (198,350 sq ft) for the medical college, and 75,217 square metres (809,630 sq ft) for the hospital section. It was developed with a total expenditure of Rs. 484.29 million by the Surat Municipal Corporation.The medical college admits 150 undergraduate students each year. The college campus has an area of 25 acres (100,000 m2). SMIMER is owned and run by the Surat Municipal Corporation and is approved by the Medical Council of India under MCI Act 10 A.The college has its own hospital located next to the medical college complex with 500 beds, out of which 90% are free beds and 10% are paying beds in the special wards. Dr. Vandana Desai is the Administrative Medical Superintendent. The casualty department i.e. emergency medicine or trauma center is available 24 hours a day and an average of 100–125 patients are treated every day. The hospital is a non-profit organisation run by Surat Municipal Corporation.
Introduction: The practical teaching of neuroanatomy is challenging because of the fragility of brain tissues, scarcity of specimens, and the need for visualisation of minute structural details. This requires an upgrade in teaching methodology to enhance learning and overcome problems in neuroanatomy practical teaching. Incorporating prerecorded videos of neuroanatomy specimens into practical teaching could help bridge this gap. Aim: To evaluate the prerecorded neuroanatomy specimen videos as a supplementary tool in teaching the practical aspect of neuroanatomy. Materials and Methods: This crossover educational interventional study was conducted at SMIMER Medical College, Surat, Gujarat, India from October 2024 to September 2025. All 250 first year MBBS students who volunteered were assigned to two groups using computer-generated sampling. The study was conducted in two phases with two different neuroanatomy topics. In phase I, after the theory lecture on Topic 1, Group A was exposed to prerecorded videos of neuroanatomy specimens, and Group B was taught directly using conventional cadaveric specimens in the dissection hall by the same faculty. In phase 2, after the theory lecture on Topic 2, both groups were flipped, and the same procedure was repeated. At the end of each phase, students were provided with Multiple Choice Questions (MCQs) (to assess topic-related knowledge) and a Likert scale-based questionnaire (to assess their perception of the teaching method they were exposed to). After completing both phases, a dichotomous response questionnaire was administered to gather final feedback on the preferences and effectiveness of the two teaching modalities. The collected data were analysed using both between-group and crossover comparisons, including unpaired and paired statistical tests for MCQ score, the Chi-square test for the Likert Questionnaire, and the Z-test for dichotomous responses. Results: In this study, of the 250 students, 108 were male, and 142 were female, with a mean participant age of 17.18±0.63 years. The mean MCQ Score for Topics 1 and 2 was 5.11±1.44 and 4.90±1.62 in the prerecorded video teaching method, and 4.11±1.46 and 3.65±1.80 in the dissection hall teaching method, respectively, and were found statistically significant. Analysis of Likert-scale questionnaire data showed statistically significant results for the prerecorded video teaching method in terms of overall satisfaction, better visualisation of specimen details, audibility of information, achievement of learning objectives, and enhancement of neuroanatomy knowledge (p-value <0.001). Conclusion: The present study analysed students’ perceptions of practical teaching methodologies in neuroanatomy and found that prerecorded videos of neuroanatomy specimens can serve as a supplementary tool alongside conventional dissection hall teaching.
Background:There is evolving evidence regarding whether pre-emptive transjugular intrahepatic portosystemic shunt (p-TIPS) improves outcomes in patients with acute variceal bleeding. This meta-analysis is aimed at evaluating the effectiveness of p-TIPS compared with standard care in reducing mortality and rebleeding in high-risk patients with cirrhosis. Methods:We systematically searched CENTRAL, MEDLINE, Embase, and ClinicalTrials.gov to identify randomized controlled trials (RCTs) comparing p-TIPS placed within 72 h of admission with standard care. All statistical analyses were performed using RevMan Version 5.4. Results:Six RCTs (n = 424 participants) met inclusion criteria. p-TIPS significantly reduced all-cause mortality (RR 0.54, 95% CI 0.39-0.76; ARR 14.9%; NNT ≈ 7) and rebleeding (RR 0.29, 95% CI 0.16-0.55; ARR 28.4%; NNT ≈ 4) compared with standard care, with consistent effects across variceal subtypes and degrees of hepatic decompensation. p-TIPS also significantly reduced new or worsening ascites (RR 0.51, 95% CI 0.35-0.74), hepatorenal syndrome (RR 0.37, 95% CI 0.15-0.92), liver-related mortality (RR 0.56, 95% CI 0.34-0.94), and serious adverse events (RR 0.72, 95% CI 0.59-0.88), without increasing hepatic encephalopathy (RR 1.01, 95% CI 0.72-1.43). Conclusions:p-TIPS significantly reduced mortality and rebleeding risk in high-risk patients with acute variceal bleeding, without increasing encephalopathy risk. These findings support its broader integration into clinical practice guidelines. Further large-scale RCTs with extended follow-up are warranted to define optimal patient selection, particularly in gastric variceal subgroups. PROSPERO: CRD420261329675.
BACKGROUND:Human papillomavirus (HPV)-associated oropharyngeal squamous cell carcinoma is biologically and clinically distinct from conventional tobacco- and alcohol-related head and neck squamous cell carcinoma. Indian data remain heterogeneous because oral cavity and oropharyngeal tumors are often analyzed together despite their different etiologic patterns. This study evaluated p16INK4a (p16) expression and high-risk HPV DNA detection in oral cavity and oropharyngeal squamous cell carcinoma and assessed their association with clinicopathologic variables. MATERIALS AND METHODS:This cross-sectional observational study included 100 adult patients with biopsy-proven squamous cell carcinoma of the oral cavity or oropharynx treated at a tertiary care center in Surat, Gujarat, India. Demographic characteristics, tobacco-related habits, tumor site, clinical presentation, and histopathological findings were recorded. All cases underwent hematoxylin and eosin examination and p16 immunohistochemistry. Fresh tissue was available for high-risk HPV DNA testing in 89 cases and was analyzed for HPV genotypes 16, 18, and 45 using multiplex real-time polymerase chain reaction. Associations were tested using the chi-square test or Fisher's exact test, as appropriate, and effect size was estimated using Cramer's V. RESULTS:p16 positivity was identified in six of 100 cases (6.0%), and HPV DNA was detected in five of 89 tested cases (5.6%). All p16-positive and HPV DNA-positive patients were male. p16 positivity was significantly more frequent in oropharyngeal tumors than in oral cavity tumors (5/24, 20.8% vs. 1/76, 1.3%; p=0.0028). The base of the tongue was the most common p16-positive subsite (4/6, 66.7%). p16 expression was significantly associated with HPV DNA detection, with five of six p16-positive tumors showing HPV DNA positivity and no HPV DNA detection among p16-negative tumors (Fisher's exact p < 0.001). Most p16-positive cases had no documented history of tobacco chewing, smoking, or alcohol consumption. CONCLUSION:p16 expression and HPV DNA detection were uncommon in this Western Indian cohort, likely reflecting the predominance of oral cavity tumors and traditional risk-factor-associated disease. Biomarker-positive cases were concentrated in male patients with oropharyngeal tumors, particularly tumors involving the base of the tongue. Because HPV DNA testing was performed in 89 cases and was limited to genotypes 16, 18, and 45, these findings should be interpreted as a site-aware assessment of common high-risk HPV types rather than a comprehensive estimate of all HPV-driven disease. Combining p16 expression with HPV DNA testing may provide a more balanced assessment of HPV involvement than either test alone, particularly in resource-limited settings.
BACKGROUND:Heart failure with reduced ejection fraction (HFrEF) remains a major global health burden despite advances in guideline-directed medical therapy (GDMT). Device-based therapies-including baroreflex activation therapy (BAT), cardiac contractility modulation (CCM), and cardiac resynchronization therapy (CRT)-target distinct autonomic, contractile, and electrical mechanisms. However, their comparative effectiveness across structural, functional, and clinical outcomes remains uncertain. METHODS:We performed a systematic review and network meta-analysis of randomized controlled trials in accordance with PRISMA-NMA guidelines (PROSPERO CRD420251087472). PubMed, Embase, Scopus, and Google Scholar were searched for trials enrolling adults with HFrEF and left ventricular ejection fraction (LVEF) ≤40%. Random-effects frequentist models were used, with GDMT as the reference comparator. Outcomes included change in LVEF, health-related quality of life (HRQoL), exercise capacity, New York Heart Association (NYHA) functional class, heart failure-related hospitalization, and all-cause mortality. Treatment rankings were estimated using the surface under the cumulative ranking curve (SUCRA). RESULTS:Nineteen trials involving 10,125 participants were included. BAT ranked highest for improvement in LVEF, HRQoL, six-minute walk distance, and NYHA class. CRT demonstrated the greatest improvement in peak oxygen consumption, whereas CCM ranked best for reducing heart failure-related hospitalization. None of the device therapies significantly reduced all-cause mortality. Between-study heterogeneity was low to moderate, and sensitivity analyses confirmed the robustness of the findings. CONCLUSIONS:BAT, CCM, and CRT provide complementary benefits beyond GDMT, supporting a phenotype-guided approach to device therapy in patients with HFrEF.
