A cross sectional study on Emotional status and Behavioral Changes of school going children during the COVID-19 outbreak

Background: The current threat of Covid-19 pandemic is not only disrupting the economy but also creating psychological impact on the people. As a measure to control the spread, India imposed lockdown on various occasions. During this period only essential services were operational, while educational institutions remain closed. Due to social distance norms and restricted recreational activities, children are more prone to behavioural changes and it can also cause anxiety and depression. The current study focusses upon this aspect among school going children due to Covid-19.. Methodology: A cross sectional study was done on school going children, currently restricted to home. A semi-structured questionnaire which included (RCADS-25 scale for depression and anxiety) was administered to the parents through online platform. Bivariate logistic regression was used to test the significance of association between changes Impact of covid-19 and emotional status of Children and also between behavioural changes in children and presence of at least one sibling. Results: Majority of respondents were males (59%) and mean age was 9.9yrs. Majority (47.2%) belong to Middle school. Mean score of RCADS-25 scale was 15.61±9.4 for the study population. Worry was seen in 67.3% and frustration was seen in 32.4% for conduction of online classes. Irritability was seen 31.91% and restriction of outdoor activities caused loss of temper in 56.9% of the study population. Insomnia was often seen in 20% while 50% had sadness/empty feeling at some point of time. Lack of confidence was seen in 52.7% children. Majority (69.5%) were scared to sleep alone at night. Chi-square test for significance showed significant association between Parent’s behaviour and mood changes in Children (O.R- 2.43(1.1-5.33 - 95%C. I) p=0.04). Bivariate logistic regression showed significant association between Impact of covid-19 and emotional status of Children (O.R=2.967,95% C.I(1.582-5.564), p=0.001) and also between behavioural changes during pandemic and presence of at least one sibling(O.R =0.578,95% C.I 0.345-0.971,p=0.038). Conclusion: The behavioural changes of children due to Covid -19 is evident and necessary measures like counselling the parents are necessary

Study of spectrum of sepsis and prediction of its outcome in patients admitted to ICU using different scoring systems

Background: Although sepsis is one of the leading causes of mortality in hospitalized patients, information regarding early predictive factors for mortality and morbidity is limited. The aim was to identify reliable and early prognostic variables predicting mortality in patients admitted to ICU with sepsis.Methods: Patients fulfilling the Surviving Sepsis Campaign 2012 guidelines criteria for sepsis within the ICU were included over two years. Apart from baseline haematological, biochemical and metabolic parameters, APACHE II, SAPS II and SOFA scores were calculated on day 1 of admission. Patients were followed till death or discharge from the ICU. Chi-square test, student t-test, receiver operating curve analyses were done.Results: 100 patients were enrolled during the study period. The overall mortality was 35% (68.6% in males and 31.4% in females). Mortality was 88.6% and 11.4% in patients with septic shock and severe sepsis and none in the sepsis group, respectively. On multivariate analysis, significant predictors of mortality were APACHE II score greater than 27, SAPS II score greater than 43 and SOFA score greater than 11 on day the of admission. On ROC analysis APACHE II had the highest sensitivity (92.3%) and SAPS II had the highest specificity (82.9%).Conclusions: All three scores performed well in predicting the mortality. Overall, APACHE II had highest sensitivity, hence was the best predictor of mortality in critically ill patients. SAPS II had the highest specificity, hence it predicted improvement better than death. SOFA had intermediate sensitivity and specificity.

Comparison of prediction of outcomes in upper GI bleed using non-endoscopic scoring systems

Background: Several scoring systems have been designed for risk stratification and prediction of outcomes in upper GI bleed. Endoscopy plays a major role in the diagnostic and therapeutic management of UGIB patients. However not all patients with UGIB need endoscopy. The objective of the present study was compared the prediction of mortality using different scoring systems in patients with upper GI bleed. A decision tool with a high sensitivity would be able to identify high and low risk patients and for judicious utilization of available resources.Methods: 100 patients were assessed with respect to their clinical parameters, organ dysfunction, pertinent laboratory parameters and five risk assessment scores i.e. clinical Rockall, Glasgow Blatchford, ALBI, PALBI and AIMS65 were calculated.Results: For prediction of outcomes, AIMS65 was superior to the others (AUROC of 0.889), followed by the GBS (AUROC of 0.869), followed by clinical Rockall score (AUROC 0.815), followed by ALBI score (AUROC of 0.765), followed by PALBI score (AUROC of 0.714) all values being statistically significant.Conclusions: The AIMS65 score is best in predicting the mortality in patients with upper GI bleed. The optimum cut off being >2. Though GBS may be better in predicting the need for intervention, it is inferior in predicting the mortality. The newer scores like ALBI and PALBI are inferior to AIMS65 and GBS in predicting mortality.