Purpose:Quality assurance data worldwide suggests that the current healthcare system is providing inadequate care for the dying. Current health care education focuses entirely on cure and care is almost compromised or nonexistent in end-of-life settings. The purpose of this study was to determine palliative care awareness among Indian undergraduate health care students and assess the need for incorporating palliative medicine education into undergraduate health education.Materials and Methods:A non-randomized population based study was conducted using 39-point questionnaire. Undergraduate medical, nursing and allied health students of Manipal University were the target population.Results:326 students participated in the study. 61.7% of students feel that resuscitation is appropriate in advanced metastatic cancer. 67.5% feel that all dying patients need palliative care and most of the students think that palliative care is equivalent to pain medicine, geriatric medicine and rehabilitation medicine. 89% of students think that Morphine causes addiction in palliative care setting. 60.7% of students feel that prognosis should only be communicated to the family.Conclusion:The outcomes of the study showed that the basic knowledge of palliative care among students was inadequate, and students are unprepared and uncertain in their approach of delivering end-of-life care.

Idiopathic calcinosis cutis is a condition involving the deposition of calcium salts in the skin and subcutaneous tissue. The disease is a pathological condition of unknown origin and hence is idiopathic. The salt deposition is confined to areas such as the breast and vulva in females and scrotum and penis in males. Diffuse calcification with multiple complications in an adult is a rare entity. Only one such case has been reported in literature. A 59-year-old female presented to us with swelling of the right elbow, multiple calcific nodular lesions all over her fingers approximately 0.5x0.5 cm in size, and ulcers on her left great toe and right thumb with pain for the past two months. The ulcers were 2x2 cm and were observed to be healing without active discharge or signs of inflammation. The elbow was diffusely swollen and tender. Flexion deformity was present at the elbow. X-ray of hand and feet revealed calcinosis of the elbow and interphalangeal joints of the foot and hand. Blood tests revealed elevated C-reactive protein levels of 24 mg/dL, elevated Erythrocyte Sedimentation Rate (ESR) of 52 mm/hr., serum calcium of 9.7 mg/dL and a serum phosphorous of 5 mg/dL. Cultures from the foot ulcer were positive for methicillin-resistant staphylococcus aureus (MRSA). Workup for collagen vascular disease was negative. Histopathology confirmed calcinosis cutis. Treatment involved a conservative approach, including physiotherapy for the flexion deformity, antibiotics for MRSA, analgesics for pain relief and daily dressings. This case demonstrates that if a patient presents with multiple chalky nodular lesions with or without ulceration, pain and discharge involving areas of the upper limb or lower limb, diagnosis of idiopathic calcinosis cutis could be considered as a differential, despite its common confinement to the scrotum, breast, vulva and penis.

A 57-year-old male with a past surgical history of a transhiatal oesophagectomy which was done for oesophageal carcinoma, presented with the complaint of dysphagia. Multiple bougie dilatations had already been done in the past, to relieve a stricture. A provisional diagnosis of a recurring stricture oesophagus was made. An upper gastrointestinal endoscopy was obtained and narrowing was observed at the anastomotic site; a diagnosis of a postoperative oesophageal stricture was confirmed and he underwent a bougie dilatation.Post-operative pain management was achieved by giving an IV injection of Fortwin (pentazocin). During its administration, he complained of a "hot flush sensation" as well as pain in the right hand at the IV line site. Two days later, redness and swelling was noted around the injection site. A right hand arterial Doppler was obtained and it showed radial artery thrombosis with complete occlusion, as well as a monophasic waveform in the proximal half of the ulnar artery, along with a trickle of flow in its distal half. A diagnosis of right arterial thrombosis which was secondary to an inadvertent IA injection was made. A CVTS consult advised that the patient be started on low molecular weight heparin. Despite this, blackish discolouration of the fingertips developed and gangrene ensued, compelling debridement under a brachial plexus block. A repeat Doppler was done, which showed a persistent thrombus in the right radial artery. LMWH was changed to oral Acitrom (nicoumalone), after which he was discharged and was told to return when the dry gangrene showed a clear line of demarcation.He returned two weeks later, and unfortunately the gangrene had progressed from his fingertips (which were now black and shriveled) to his entire palm, which was blackish and oedematous. Signs which were indicative of an extensive tissue injury were present: a right hand that was cold to touch, absence of sensation at the fingertips and decreased sensation over the palm, and absence of right radial and ulnar arterial pulsations. This quickly progressed to loss of all sensations over the right hand, and a clear line of demarcation was noted [Table/ Fig-1,2]. Wrist disarticulation was done eventually. Post-operatively, the amputation stump appeared healthy and he was advised regular follow-ups upon discharge. Surgery Section ABStRACtObtaining an intravenous (IV) access is a simple procedure which can be done in almost any hospital setting. One of the most dreaded complications of this procedure is an inadvertent intra-arterial cannulation. This can result in an accidental injection of medications intraarterially, which can potentially lead to life altering consequences. In the hope that these types of events can be prevented, we are presenting a case of a 57-year-old male who underwent bougie dilatation for an oesophageal stricture and was accidentally given medication for pain management intra-arterially through an improperly placed IV line, which resulted in ischaemia, gangrene and subsequent loss of the hand. Those wh...

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