Safety attitudes, burnout and well-being among healthcare workers during the COVID-19 pandemic: an Indo-Pacific regional cross-sectional study

INTRODUCTION@#The coronavirus disease 2019 (COVID-19) pandemic has had an unprecedented impact in Asia and has placed significant burden on already stretched healthcare systems. We examined the impact of COVID-19 on the safety attitudes among healthcare workers (HCWs), as well as their associated demographic and occupational factors, and measures of burnout, depression and anxiety.@*METHODS@#A cross-sectional survey study utilising snowball sampling was performed involving doctors, nurses and allied health professions from 23 hospitals in Singapore, Malaysia, India and Indonesia between 29 May 2020 and 13 July 2020. This survey collated demographic data and workplace conditions and included three validated questionnaires: the Safety Attitudes Questionnaire (SAQ), Oldenburg Burnout Inventory and Hospital Anxiety and Depression Scale. We performed multivariate mixed-model regression to assess independent associations with the SAQ total percentage agree rate (PAR).@*RESULTS@#We obtained 3,163 responses. The SAQ total PARs were found to be 35.7%, 15.0%, 51.0% and 3.3% among the respondents from Singapore, Malaysia, India and Indonesia, respectively. Burnout scores were highest among respondents from Indonesia and lowest among respondents from India (70.9%-85.4% vs. 56.3%-63.6%, respectively). Multivariate analyses revealed that meeting burnout and depression thresholds and shifts lasting ≥12 h were significantly associated with lower SAQ total PAR.@*CONCLUSION@#Addressing the factors contributing to high burnout and depression and placing strict limits on work hours per shift may contribute significantly towards improving safety culture among HCWs and should remain priorities during the pandemic.

THE ESSENCE OF GANDHARVA SANGITA

The different between Desi and Gandharva Sangita is the capacity of the latter to produce or spiritual fruit. The fruit which is the result of pleasing the gods or heavenly beings who are unseen or unperceivable. This bene?t is not possible through Desi Sangita. The Svara-Sannivesaor speci?c pattern of Svaras would have to incorporate the ten characteristics of the Jati as prescribed by Bharata. BHARATA in his Natyasastra refers to Gandharva Sangita or the music for divine beings. But he lays certain conditions. This was also called Margi Sangita. Bharata describes the Jatis as they applied to drama. But there were obviously Jatis under different situations and circumstances. For example, the epic Ramayana was supposed to have been sung in the form of a ballad before Rama by Lava and Kusa, his two sons in the different Jatis

In-Silico Analysis of Chromatin Modifiers and Profiling of Histone Deacetylases (HDAC’s) in Human Oral Cancer / 전남의대학술지

Histone modifications have been demonstrated to play a significant role in oral squamous cell carcinoma (OSCC) epigenetic regulation. An in-silico analysis of The Cancer Genome Atlas (TCGA) of various histone acetyl transferases (HATs) and histone deacetylases (HDACs) suggested that HATs do not differ between normal and tumor samples whereas HDAC2 and HDAC1 change maximally and marginally respectively between normal and tumor patients with no change being noted in HDAC6 expression. Hence, this investigation was carried out to validate the expression states of HDAC 1, 2 and 6 mRNAs in buccal mucosa and tongue SCC samples in an Indian cohort. Buccal mucosa and tongue squamous cell carcinoma tissues with intact histopathology were processed for RNA isolation followed by cDNA synthesis which was then subjected to q-PCR for HDACs. The average RNA yield of the tongue tissue sample was ∼2 μg/mg of tissue and the A260/280 ratios were between 2.03 and 2.06. The average RNA yield of buccal mucosa tissue sample was ∼1 μg/mg of tissue and the A260/280 ratio were between 2.00 and 2.08. We have demonstrated that HDAC2 was overexpressed in tongue and buccal mucosa samples. Over-expression of HDAC2 imply potential use of HDACi along with standard chemotherapeutic drug in oral cancer treatment.

In-Silico Analysis of Chromatin Modifiers and Profiling of Histone Deacetylases (HDAC’s) in Human Oral Cancer / 전남의대학술지

Histone modifications have been demonstrated to play a significant role in oral squamous cell carcinoma (OSCC) epigenetic regulation. An in-silico analysis of The Cancer Genome Atlas (TCGA) of various histone acetyl transferases (HATs) and histone deacetylases (HDACs) suggested that HATs do not differ between normal and tumor samples whereas HDAC2 and HDAC1 change maximally and marginally respectively between normal and tumor patients with no change being noted in HDAC6 expression. Hence, this investigation was carried out to validate the expression states of HDAC 1, 2 and 6 mRNAs in buccal mucosa and tongue SCC samples in an Indian cohort. Buccal mucosa and tongue squamous cell carcinoma tissues with intact histopathology were processed for RNA isolation followed by cDNA synthesis which was then subjected to q-PCR for HDACs. The average RNA yield of the tongue tissue sample was ∼2 μg/mg of tissue and the A260/280 ratios were between 2.03 and 2.06. The average RNA yield of buccal mucosa tissue sample was ∼1 μg/mg of tissue and the A260/280 ratio were between 2.00 and 2.08. We have demonstrated that HDAC2 was overexpressed in tongue and buccal mucosa samples. Over-expression of HDAC2 imply potential use of HDACi along with standard chemotherapeutic drug in oral cancer treatment.

Pregnancy Outcomes in COVID-19: A Prospective Cohort Study in Singapore

INTRODUCTION@#Pregnant women are reported to be at increased risk of severe coronavirus disease 2019 (COVID-19) due to underlying immunosuppression during pregnancy. However, the clinical course of COVID-19 in pregnancy and risk of vertical and horizontal transmission remain relatively unknown. We aim to describe and evaluate outcomes in pregnant women with COVID-19 in Singapore.@*METHODS@#Prospective observational study of 16 pregnant patients admitted for COVID-19 to 4 tertiary hospitals in Singapore. Outcomes included severe disease, pregnancy loss, and vertical and horizontal transmission.@*RESULTS@#Of the 16 patients, 37.5%, 43.8% and 18.7% were infected in the first, second and third trimesters, respectively. Two gravidas aged ≥35 years (12.5%) developed severe pneumonia; one patient (body mass index 32.9kg/m2) required transfer to intensive care. The median duration of acute infection was 19 days; one patient remained reverse transcription polymerase chain reaction (RT-PCR) positive >11 weeks from diagnosis. There were no maternal mortalities. Five pregnancies produced term live-births while 2 spontaneous miscarriages occurred at 11 and 23 weeks. RT-PCR of breast milk and maternal and neonatal samples taken at birth were negative; placenta and cord histology showed non-specific inflammation; and severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-specific immunoglobulins were elevated in paired maternal and umbilical cord blood (n=5).@*CONCLUSION@#The majority of COVID-19 infected pregnant women had mild disease and only 2 women with risk factors (obesity, older age) had severe infection; this represents a slightly higher incidence than observed in age-matched non-pregnant women. Among the women who delivered, there was no definitive evidence of mother-to-child transmission via breast milk or placenta.

Serum zinc level: a prognostic marker for severe pneumonia in children

Background: Pneumonia is one of the leading causes of under 5 mortality among children in developing countries. Zinc deficiency is postulated as cause of severe pneumonia, but evidences shows conflicting results on whether serum zinc levels predicts the severity of pneumonia. So prospective study was undertaken to study the relationship between serum zinc levels and severity of pneumonia in children with community acquired pneumonia.Methods: Fifty cases of pneumonia (group 1) and 50 cases of severe pneumonia (group 2) according to WHO classification were enrolled into the study. Demography, anthropometry and immunization status were recorded. A single zinc measurement was performed for all the patients within 24 hours of admission. The severity, clinical course including recovery to discharge was compared between two groups with respect to their serum zinc levels.Results: Mean ('SD) age group of the study population was 22 months'16.05 and 21.88 months'15.97 months in boys and girls respectively. Pneumonia was high in girls (59%) and children between 2 to <12 months had higher (36%) infection rate. Mean zinc level in pneumonia and severe pneumonia group were 68.69'g/dl'28.77 and 68.08'g/dl'27.55 respectively. There was no difference in the nutritional status (weight for height and height for age) of the study group. Serum Zn level was low in 56 % and 52% of pneumonia and severe pneumonia group respectively. Comparison of serum zinc levels between the ARTI groups did not achieve statistical significance (p=0.430). However, the duration of recovery is earlier than 1 week in pneumonia cases when compared to severe pneumonia patients (p<0.001, OR 1.375).Conclusions: Normal zinc levels was associated with early recovery in simple pneumonia patient, so study of serum zinc levels in severe pneumonia patients has prognostic value.

Abdominolabial Hydrocele Of The Canal Of Nuck: A Rare Entity

Hydrocele of the canal of Nuck also called the “female hydrocele” is a rare entity in females. The processus vaginalis peritonei is a tubular fold of peritoneum that invaginates into the inguinal canal along with the round ligament. It usually gets obliterated by birth or during early infancy, but if this communication remains patent, it may lead to the development of an indirect inguinal hernia or hydrocele. Here, we present the case of a 32-year-old female who complained of swelling in the right inguinal region. Contrast-enhanced computed tomography scan of abdomen and pelvis was suggestive of a cystic lesion in the right inguinal region which was seen extending from mons pubis up to the right iliac fossa in the retroperitoneum likely suggestive of hydrocele of the canal of Nuck. Surgical excision of the cyst was done

A Functional Domain Based Approach in Neurocognitive Rehabilitation with Transcranial Direct Current Stimulation: A Case Report

Transcranial direct current stimulation (tDCS) is a novel brain stimulation technique which has kindled hope in alleviating motor, language as well as cognitive deficits in neuronal injury. Current case report describes application of tDCS in two phases using two different protocols in a patient with hypoxic injury. In the first phase anodal stimulation of dorsolateral prefrontal cortex improved the language fluency. Subsequently, after 6 months second phase application of anodal stimulation over posterior parietal region targeted arithmetic and working memory deficits. Individualising the treatment protocols of brain stimulation, based on the lesion and the functional deficits, for neuro-rehabilitation is emphasised.

Liver Abscess: A Retrospective Analysis

Liver abscess (LA) is defined as a collection of purulent material in the liver parenchyma which can be due to bacterial, parasitic, fungal, or mixed infection. Here, we report a retrospective analysis with an aim to evaluate the clinical presentation, etiology, manifestations, comorbidities, and different treatment options in patients with LA. This retrospective study was conducted to collect and analyze information from patients diagnosed with LA who were admitted to a tertiary care academic hospital.

Does utilization pattern of antennal care & early neonatal practices improved by close supervision and support intervention among primigravidae in the tribal area? - Community based interventional study.

Pregnancy related complications are among the leading causes of death and disability for women aged 15-49 in India. The National Rural Health Mission (NRHM) is contributing to the various health needs still the antenatal care utilization and neonatal practices are very poor especially in the tribal pockets of Maharashtra. Our aim was to assess the impact of close supervision and support intervention (CSSI) among primigravidae as compared to non-intervened primigravidae. Community based interventional study done in the tribal rural health training centre (RHTC) which is field practice area of tertiary health care institute.Total of 120 registered primigravidae mothers were enrolled in the study and were divided into two groups interventional group (N=30) and non- interventional group (N= 90).The CSSI was given to interventional group. Only 57 (42.50%) & 59(49.17%) women had taken two doses of TT immunization and ≥100 IFA tablets respectively. Regular CSSI helped to increase the ANC visits 25(83.33%), helped to confine delivery either at the RHTC or private hospital 29(96.70%).Maximum mothers i.e. 17(90%) and 30(100%) initiated breast feeding within 1 hour and fed colostrums to their baby respectively.

Determinants of delays in diagnosis and treatment of pulmonary tuberculosis in a new urban township in India: A cross-sectional study.

Background: The period of infectiousness of a new sputum smear-positive pulmonary tuberculosis case is important in determining the risk of exposure faced by the community. Early detection and effective treatment of TB case reduces the period of transmission and the risk of exposure of the community. It is for this reason that the delay in TB diagnosis and treatment should be minimal to control disease transmission and patient suffering. Aims & Objective: To measure delays in diagnosis and treatment of pulmonary tuberculosis, and to identify and assess the risk factors associated with these delays. Material and Methods: A cross-sectional study was conducted of all new smear-positive pulmonary TB patients diagnosed between January 2012 and June 2013 at RNTCP clinic. The time from the onset of symptoms to first health care consultation (patient delay) and the time from first health care consultation to the date of TB diagnosis (health system delay) were analysed. Bivariate and logistics regression were applied to analyse the risk factors of delays. Results: A total of 122 patients with a mean age of 29.9 years were included in the study. Mean total delay between the onset of symptoms and treatment initiation was 53.42 days (median 50, range 14-128), with a mean patient delay of 29.24 days (median 25, range 5-94) and mean health system delay of 21.7 days (median 17, range 3–93). The mean treatment delay was 2.48 days (median 2, range 1-6). Factors independently associated with total delay were cough symptom (OR 3.36, P = 0.038), completed secondary school (OR 0.41, P = 0.018), good knowledge of TB symptoms (OR 0.39, P = 0.011), first visit to a public health facility (OR 0.45, P = 0.044), sputum testing at first health care consultation (OR 0.46, P = 0.048) and stigma attached to TB disease (OR 2.89, P = 0.021). Those associated with patient delay were male sex (OR 0.42, P = 0.020), large family size (OR 2.30, P = 0.027), completed secondary school (OR 0.43, P = 0.025) and good knowledge of TB symptoms (OR 0.45, P = 0.029); while those associated with health system delay were first visit to a public health facility (OR 0.31, P = 0.006), sputum testing at first health care consultation (OR 0.22, P = 0.001), number of health care consultations (OR 4.41, P < 0.001) and pre-diagnosis health care cost (OR 3.35, P = 0.001). Conclusion: Health system delay was an important problem in the area studied, with patient delay being of most concern.

A rare case of Weil’s disease with alveolar haemorrhage

Leptospirosis, a disease of protean manifestations occurs sporadically throughout the year with a peak seasonal incidence during the rainy season mimicking other febrile viral illness. In the rare case, the disease leads to renal and hepatic involvement with hemorrhage which may be associated with multisystem organ dysfunction in form of pulmonary, cardiac and central nervous system, when it is known as Weil’s disease. Rarely haemorrhagic manifestations are assosciated. Early diagnosis is important as sometimes the disease may be life threatening. Proper antibiotics results in dramatic improvement. We hereby presented a case that had clinical features of Weil’s disease with cough, dyspnoea and haemoptysis. Leptospirosis was detected on ELISA testing. Patient was cured rapidly with antibiotics.

case of zosteriform verrucous epidermal nevus at an unusual location

Verrucous epidermal nevus is a common type of keratinocyte hamartoma present at birth or occurring later in life. It affects about one in every thousand live births. It is seen at any site, usually found on the lower extremities but is less common on the head and neck. We present a unique case of a female patient aged 12 years affected by zosteriform verrucous epidermal nevus over neck, a rare presentation

A rare case of Weil's disease with alveolar haemorrhage

Leptospirosis, a disease of protean manifestations occurs sporadically throughout the year with a peak seasonal incidence during the rainy season mimicking other febrile viral illness. In the rare case, the disease leads to renal and hepatic involvement with hemorrhage which may be associated with multisystem organ dysfunction in form of pulmonary, cardiac and central nervous system, when it is known as Weil's disease. Rarely haemorrhagic manifestations are assosciated. Early diagnosis is important as sometimes the disease may be life threatening. Proper antibiotics results in dramatic improvement. We hereby presented a case that had clinical features of Weil's disease with cough, dyspnoea and haemoptysis. Leptospirosis was detected on ELISA testing. Patient was cured rapidly with antibiotics.

Sexual behaviour, knowledge, attitude and practices regarding HIV/AIDS amongst female sex workers (FSWs) in red light area of Mumbai city.

Background: HIV/AIDS is not only a public health problem but also a social, political and economic challenge. The key concern with HIV infection is not only about infected person, but also about the chain of people infected by that individual and that h/she will probably infect in the future. The prevalence of HIV infection in India has been steadily increasing over the past few decades. Commercial sex workers and their clients are at highest risk for HIV infection and transmission. Objective: The present study describes the sexual behaviour, knowledge, attitude and practices in context to HIV/AIDS amongst female sex workers (FSWs) in red light area of Mumbai city. Materials and Methods: A cross-sectional community based study was conducted among female sex workers in red light area of Mumbai city during period of October 2008 to September 2009. A total 103 female sex workers were selected and interviewed. The statistical analysis was performed using SPSS software (version 13.0). Results: In the present study, the mean age of the FSWs was 26.4 ± 5.2 years and 43.8% belonged to lower middle class socio-economic status. Most of the FSWs responded poverty (84%) and broken family (76%) as the main reasons for resorting to the sex trade. Majority of the FSWs (72.8%) were illiterate and more than half (67%) did not have any children. Most of the FSWs (84.5%) were aware about HIV/AIDS but only 33% were aware of the status of their partner. Only 13.6% FSWs knew that HIV could be transmitted to the child through breast feeding from an infected mother. Conclusion: Misconception about HIV was very high. Most of the FSWs in the present study had first sexual debut at a very young age. Routine screening and periodic surveys are warranted in order for early detection of infections including HIV and other STDs.