Prevalence of psychological stress among health care workers during COVID-19 pandemic – A cross-sectional questionnaire-based survey in a tertiary care teaching hospital

Background: Health care workers (HCWs) exposed to COVID-19 are at increased risk of developing mental health problems. This study aims to access the prevalence of psychological stress among HCWs during COVID-19 pandemic. Aims and Objectives: The aim of the study was to assess the prevalence of psychological stress among HCWs during COVID-19 pandemic. Materials and Methods: A cross-sectional study was conducted among HCWs working in a tertiary care teaching hospital. A total of about 100 HCWs who participated in the study were randomly distributed prestructured questionnaire pertaining to sociodemographic parameters and variables related to psychological stress and their responses were graded accordingly. Results: It was found that HCWs showed significant rise in psychological distress with moderate-to-severe elevated levels of anxiety (69%), depression (21%), and insomnia (41%). Nurses were significantly more likely to experience anxiety than other HCWs in our present study and the most of the participants were engaged in some form of stress reduction activities. Conclusion: The high levels of psychological distress were reported in HCWs in hospital dealing with COVID-19 patients. Increase efforts are needed for promotion of mental health well-being of HCWs exposed to COVID-19

Complementary and alternative medicines use among adults with migraine in a tertiary care hospital: An observational study

Background: The use of Complementary and Alternative Medicine (CAM) dates back to being quite pervasive amongst patients suffering from chronic ailments such as cancer, diabetes, hypertension, and migraine. While data pertaining to the use of CAM among adults with migraine is limited and mostly undercover thereby veiling their effects. Hence, this analysis was taken up to project the paradigm of CAM usage among sufferers of migraine in our domain. Aim and Objectives: To examine various attributes of CAM utility in patients of migraine. Materials and Methods: Following the approval by the Institutional Ethics Committee vide order no. IEC/GMC/2019/767 dated November 26, 2019, this study was performed in migraine patients visiting Medicine out patient department of Government Medical College and Hospital, Jammu over a span of 3 months. After receiving their consent, they were confronted with a prevalidated questionary consisting of two sections viz. socio-demographic profile and CAM use aspects. Results: A total of 100 patients were inducted in our research, of which 64 agreed to use various CAM modalities alongwith ongoing conventional migraine therapy. Females (73.43%) belonging to rural setting (57.81%) depicted quite high use of CAM than their male (26.56%) counterparts. Ayurvedic balm/oil massage (56.25%) was the most common type of CAM used with family/friends (59.37%) being major informants about various CAM practices. The less educated patients (46.87%) showed relatively more use of CAM than in illiterates (9.37%). 53.12% of those on CAM proclaimed about its safety, being less costly (18.75%) yet effective (14.06%). Only 29.68% of patients disclosed about their CAM use to their treating doctor while the majority (70.31%) were non-revealers. Conclusion: CAM is prevalent in patients suffering from migraine with more propensity among females of rural strata. Ayurvedic balm/oil massage was the most extensively practiced CAM. Ironically, a vast chunk of patients did not reveal regarding CAM usage to their treating physician. As such there’s a dire need to embolden such patients to divulge regarding CAM to their treating doctor so as to thwart any impending undesired interplay.

An Audit Investigating the Usefulness of a Hospital-Based 4-Week First Postoperative Review Following Routine Cataract Surgery.

Aim: Timing of postoperative review after routine phacoemulsification cataract surgery in the English National Health Service is not specified in the Royal College of Ophthalmologists Cataract Surgery Guidelines. There are wide variations in when the first postoperative review occurs in routine practice. This audit assesses the usefulness of a 4-week first postoperative review in the hospital setting, in the context of high volume routine cataract surgery. Setting: Manchester Royal Eye Hospital cataract treatment centre based at Withington Hospital, UK. Methods: Retrospective review of 200 consecutive sets of case notes of patients undergoing routine phacoemulsification cataract surgery with standard 4-week postoperative review using a proforma. Results: 88% of patients were discharged at the 4-week review for this episode. 4.5% of patients required earlier unplanned review. 16.5% of patients experienced a postoperative problem, anterior uveitis was the commonest complication. 15% of patients were referred from the postoperative clinic for investigation or continuing management of co-existing ocular disease. Conclusions: A four-week hospital-based first post-operative review following routine cataract surgery does not serve the purpose of treating sight-threatening complications. A substantial proportion of routine cataract surgery patients (88%) were discharged at this review. A routine 4-week follow-up review may therefore not be required within a hospital setting in many cases. It would be a reasonably safe option to consider early discharge of such patients to an accredited community optometrist for routine postoperative review and refraction in the presence of careful patient selection and good access to emergency eye care facilities.

Salvage surgery in variceal bleeding due to portal hypertension.

BACKGROUND: A proportion (10%-15%) of patients with variceal bleeding do not respond to medical management and require surgical intervention. METHODS: Retrospective analysis of 82 consecutive patients (median age 31 years, range 3-71; 60 male) who underwent salvage surgery for variceal bleeding between 1989 and 2005. RESULTS: Immediate control of variceal bleeding was achieved in 78 (95%) patients. Four patients (cirrhosis 3, portal vein block 1) continued to bleed in the postoperative period following gastro-esophageal devascularization (3) or portacaval shunt (1). Twelve (15%) patients died in hospital; the commonest cause of death (n=7) was liver failure and sepsis leading to multi-system organ failure. The mortality rate was higher among patients who had undergone emergency surgery for active bleeding than among those who had been adequately resuscitated and evaluated prior to surgery (12/45 vs. 0/37; p< 0.001). Mortality rate tended to be higher in patients with cirrhosis (overall 10/45 [22%]; Child A 1/9 [11%], Child B 4/20 [20%], Child C 5/16 [31%]) than in those with non-cirrhotic portal hypertension (3/37 [8%]; p=ns). CONCLUSIONS: Our data suggest that salvage surgery is justified in patients with variceal bleed in whom non-surgical measures fail.

Xanthogranulomatous cholecystitis: differentiation from associated gall bladder carcinoma.

Xanthogranulomatous cholecystitis (XGC) is a destructive form of chronic cholecystitis. In some patients it coexists with gall bladder carcinoma (GBC) and is often difficult to differentiate between the two. Present study was performed with an aim to identify differentiating features of XGC and those of XGC with associated Gall bladder carcinoma (XGC ass. GBC). A retrospective analysis of prospectively maintained data of 4800 cholecystectomies performed from January 1988 to December 2003 was carried out. On histopathology 453 cholecystectomy specimens revealed XGC. These patients were divided into two groups, those with associated GBC (n=26) and those without GBC (n=427). Clinical, radiological and operative findings were compared in these two groups. P value of < 0.05 was considered statistically significant. The incidence of associated GBC in present series was 6%. XGC patients with associated GBC, at presentation were older than those with XGC alone and there was male preponderance. XGC patients with associated GBC were more likely to present with anorexia, weight loss, palpable lump and jaundice. Gall stones were present in majority of patients in both the groups. GB wall thickening, GB mass, enlarged abdominal lymph nodes may be found on imaging in both the groups but more so in patients with associated GBC. Both preoperative FNAC and peroperative FNAC/imprint cytology failed to reveal the associated GBC with XGC in some patients.

Surgical management of corrosive strictures of stomach.

BACKGROUND: Corrosive injuries of the upper aero-digestive tract are a frequent cause of morbidity in India. We report here our institution's experience in managing patients with corrosive strictures of the stomach. METHODS: Records of 28 patients who underwent definitive surgery for corrosive strictures of the stomach in our institution over a 15-year period were reviewed. RESULTS: The main presenting complaints were vomiting (75%), dysphagia (46%) and significant weight loss (100%). Pre-operative evaluation included barium and endoscopic studies. Most patients had antro-pyloric strictures (n=22); in 6 patients, however, near-total or total gastric involvement was observed. Thirteen (46%) patients had associated strictures of the esophagus; of these, 7 responded to esophageal dilation. Strictures of the stomach were managed with resectional procedures like distal gastrectomy (n=16), subtotal gastrectomy (1) or total gastrectomy (3) and esophagogastrectomy (1) in 21 (75%) patients. The remaining 7 patients underwent bypass procedures like gastrojejunostomy (5), stricturoplasty (1), and colonic bypass of esophagus and stomach (1). Three patients had entero-cutaneous fistulae in the postoperative period. One patient died in hospital of septicemia and malnutrition. CONCLUSIONS: In patients with corrosive strictures of the stomach, surgery, tailored according to the extent of gastric involvement and presence of associated esophageal strictures, gives excellent results.

Spontaneous perforation--a rare complication of choledochal cyst.

We report a 2-year-old girl with spontaneous perforation of choledochal cyst. Preoperative diagnosis was possible by hepatobiliary scintigraphy. In view of emergency presentation and bile peritonitis, management was a staged procedure with peritoneal lavage and T-tube drainage of the biliary system, followed by excision of the cyst and Roux-en-Y hepatico-jejunostomy 3 months later.

Morphological changes in bile ducts following preoperative biliary stenting.

OBJECTIVES: To analyze the morphological changes in bile ducts following endobiliary stent insertion, and consequent technical problems encountered at surgery. METHODS: Data on bile duct morphology--gross (luminal diameter and wall thickness) and microscopic (histological changes in bile duct wall graded semiquantitatively)--and operative parameters related to bile duct dissection (grade of difficulty in dissection) were collected prospectively in 31 consecutive patients undergoing pancreatico-duodenectomy. These data were compared between patients who had undergone preoperative endoscopic biliary stent placement (n=17) and those who had not (n=14). RESULTS: Mean duration of stenting before surgery was 34 (range 10-120) days. Stented ducts were significantly narrower (luminal diameter 9 [7-12] mm vs. 17.5 [8-23] mm; p=0.0001) and had thicker walls (2.3 [1.3-3.5] mm vs. 1.85 [0.8-2.2] mm; p=0.004) compared to non-stented ones. On microscopy, stented ducts had advanced grades of submucosal gland hypertrophy, fibrosis and inflammatory cell infiltrate. Difficulty in bile duct dissection was encountered more often in patients who had been stented than in those without stents, though the difference was not statistically significant. CONCLUSION: Endobiliary stent placement results in significant morphological and fibroproliferative inflammatory changes in bile ducts, making dissection difficult.