Symptoms and psychosocial effects following hospitalization for Covid-19: A sequential, mixed-methods study from northern India

BACKGROUND It is reported that patients who have recovered from Covid-19 continue to experience various symptoms and adverse outcomes. However, this aspect has not been studied well. We aimed to evaluate these variables and the perceived impact of Covid-19 among patients discharged from a Covid hospital in northern India. METHODS We conducted this study among patients discharged from a Covid-19 hospital in northern India in June 2020. As per the official policy at that time, patients detected to have Covid-19 (symptomatically or via contact tracing) were mandatorily admitted. A sequential, mixed-methods design was followed. Patients discharged from the hospital were contacted telephonically, and the cross-sectional prevalence of symptoms, the prevalence of depression and anxiety and the social consequences of admission were assessed. A subgroup of patients was interviewed for qualitative assessment of their experience. RESULTS A total of 274 patients provided consent and were assessed, of which 8 patients underwent detailed interviews. The prevalence of somatic symptoms was 3.4%; 36.2% of the patients had depressive and 12% of the patients had anxiety symptoms. A majority of patients experienced adverse social and economic consequences of hospitalization for Covid-19. These themes were reinforced by a qualitative analysis of in-depth interviews. CONCLUSIONS Our study population experienced a high prevalence of adverse psychosocial consequences of Covid-19. These included depression and anxiety symptoms, stigma and economic and occupational consequences. These deserve more recognition and study.

Detection of ocular hypertelorism among Indian children

Background & objectives: Ocular hypertelorism constitutes an important component of many clinical syndromes. It is typically recommended to use inter-pupillary distance (IPD) for objective evaluation of ocular hypo/hypertelorism. Barring infancy, there is a scarcity of data on this anthropometric parameter relating to the ocular apparatus. This study aims to study auxological dynamics of IPD in children of Indian origin. Methods: A total of 3622 ( 2239 males and, 1383 females) normal, healthy Indian children of North-western origin, aged one month to 14 yr comprised the sample for this study. Inner and outer-canthal distance were measured using standardized anthropometric techniques. None of the children who participated in this study had craniofacial dysmorphism or any body deformity. Mean (standard deviation SD) and percentiles were calculated for IPD in male and female subjects at different age levels. Results: IPD increased from 4.68±0.21 to 6.19±0.36 cm in males and from 4.59±0.26 to 6.08±0.25 cm in females between one month and 14 yr of age. Boys in general, possessed larger IPD than girls, however, the gender differences became significant (P?0.05) at 10, 11, 16-18 and 22-24 months, respectively, and five and 10 yr of age, respectively. Interpretation & conclusions: The results of this study suggest that the patients having IPD less than the 3rd percentile should be treated as cases of hypotelorism while, those exceeding 97th percentile as cases of hypertelorism. The use of percentile grids presented for IPD may be used to detect ocular hypotelorism and hypertelorism in male and female children to corroborate diagnosis of different syndromes

A Pre-Experimental Study On Effectiveness Of Structured Teaching Programme On Knowledge Of Osteoporosis Among Menopausal Women In Selected Rural Community, Of District-Tarn Taran, Punjab. 2021

Background of the study:- Osteoporosis is a major health and economic problem. An international consensus development conference has stated that osteoporosis is a systemic skeletal disease characterized by low bone mass and micro architect deterioration of bone tissue, with a consequent increase in bone fragility and susceptible to fracture. During menopause estrogen level become significant lowered. Estrogen hormone help to control the osteoclasts, which are the bone cell producers. When estrogen level decrease in menopausal women that can ultimately leads to osteoporosis. The investigator while working in the field of community and hospital setting found that menopausal women had very little knowledge regarding osteoporosis. The lack of awareness about osteoporosis reflects the need to impart educational programs to menopausal women regarding prevention of disease. Hence, the present study was undertaken to assess the effectiveness of structured teaching programme regarding osteoporosis. Method:- the research design was selected for the study of a pre-experimental one group pre test and post test. The setting was selected in rural community of district, Tarn Taran. The sample includes 60 menopausal women and Non- probability convenience sampling technique was used. Only menopausal women were included for conducting the study. The pilot study was conducted with 10 menopausal women. The reliability of tool was obtained by split half method on samples participating in the pilot study and correlation was done by Karl's Pearson coefficient of correlation. The reliability of tool was 0.98. Results and interpretation:-The data was analyzed by applying descriptive and inferential statistics. The findings showed that the mean post test knowledge score (21.23) was higher than the mean pre test score(16.3) and found to be . highly significant with a calculated 't' value of 7.51 thus the results have validated and structured teaching programme devised. There was statistical significant existing relation between Education, occupation and marital status with the knowledge about osteoporosis among menopausal women. But has no significant relation with knowledge between Age, dietary pattern, monthly family income and source of information with the knowledge of osteoporosis among menopausal women. Conclusion:- The results of the study indicated that menopausal women were having less knowledge regarding osteoporosis and structured teaching programme had helped them to increase their knowledge.

Comparative Analysis of Leucocyte Count (Total and Differential) in Patients with Leucocytosis using Sysmex XN550-L Series (5 Part) Automated Analyzer and Conventional Manual Technique in a Tertiary Care Hospital in Rural Haryana

Normal concentration of WBCs in blood varies between 4000 and 11,000 per microliter and are classified intotwo variants namely granulocytes and agranulocytes on the basis of presence and absence of granules.Manual methods of calculation of TLC include- Neubauer chamber and estimating WBC on leishman stainedslides whereas automated methods are based on impedance or light scattering technology. The study comparedthe efficacy of both these methods in statistical terms using Chi Square test. 100 cases of leucocytosisanalyzed over a period of 1 year at MMIMSR, Mullana, Haryana revealed leucocytosis prevalent in 4-6 decadeof life with slight male predominance. The pearson coefficient for TLC came out to be p value =0.215 (notsignificant) but for DLC, calculations revealed p values for polymorphs, lymphocytes, eosinophils andmonocytes to be significant (p value =0.000 each). To conclude, standard manual methods should be advocatedas special practice where there is definite need of morphological and quantitative evaluation of WBCs and tovalidate the automated methods by which the laboratories can optimize patient care and not as a replacement

Protective efficacy of Chlorophytum borivilianum root extract against murine visceral leishmaniasis by immunomodulating the host responses

Background: The available drugs for treating visceral leishmaniasis are limited. Moreover, the disease isassociated with suppression of immune function. Therefore, therapies with effective immunomodulatoryagents are needed which can decrease parasitic burden and enhance adaptive immunity.Objectives: The present study was planned to evaluate the antileishmanial efficacy of crude ethanolicextract of roots of Chlorophytum borivilianum (CBREE) against murine visceral leishmaniasis throughimmunomodulation.Materials and methods: The in vitro studies were carried out to check leishmanicidal activity againstpromastigote form and cytotoxicity against HeLa cells. The parasite load in liver smears, immunologicaland biochemical changes induced by 500 and 1000 mg/kg b.wt. of CBREE were assessed on 1, 7, 14 and 21post treatment days in infected and treated BALB/c mice.Results: CBREE showed inhibitory effect on growth of promastigotes with IC50 of 28.25 mg/mL andnegligible cytotoxicity. The extract was toxicologically safe in BALB/c mice when administered orally with5 g/kg b.wt. of extract. A significant reduction in parasite load was observed along with active immunomodulation through enhanced Th1 type of immune responses and suppressed Th2 type of immuneresponses.Conclusion: The treatment with both doses showed no toxic effect as evidenced by normal liver andkidney function tests and normal histological observations of liver and kidney. Therefore, it should befurther explored for its active components in pursuit of the new effective antileishmanial agents in theplant kingdom.© 2017 Transdisciplinary University, Bangalore and World Ayurveda Foundation. Publishing Services byElsevier B.V. This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

Comparison of Three Nursing Positions for Reducing Gastric Residuals in Preterm Neonates: A Randomized Crossover Trial

Objective: To compare left lateral, right lateral, and pronenursing positions of neonate for reducing pre-feed gastricresiduals among ?34 weeks neonates.Design: Randomized crossover trial.Setting:Level-III NICU.Participants: Neonates ?34 weeks, receiving 50-150 mL/kg/day feeds through oro-gastric route.Intervention: Neonates were randomized to left lateral, rightlateral and prone positions. Intervention position was given foreight hours (4 feeds, 9AM to 5PM) followed by a wash-off period of16 hours. After 24 hours, each neonate crossed over to nextposition as per randomization card to complete three positions inthree consecutive days. Gastric residuals were collected justbefore next feed.Main outcome:Pre-feed gastric residuals.Results:Sixty three neonates were randomized. Fewer neonatesin right lateral position had gastric residuals compared to leftlateral position [OR 0.09 (95% CI 0.04, 0.21), P<0.001]. Neonatesin right lateral and prone positions had comparable gastricresiduals [OR 0.90 (95% CI 0.36, 2.22), P=0.82]. Gastricresiduals, as a proportion of last feed, were highest in left lateral[6% (2, 10), maximum 28%] position. Significantly higherproportion of neonates in right lateral position had episodes ofregurgitation compared to other positions. Oxygen saturation,heart rate, time to full feeds and duration of hospital stay werecomparable in the three groups.Conclusions: Left lateral position was associated with higher butclinically non-significant pre-feed gastric residuals as comparedto right lateral position. Right lateral position was associated withsignificantly increased regurgitation episodes

Validation of ICMR index for identification of dental fluorosis in epidemiological studies.

Background & objectives: The Indian Council of Medical Research (ICMR) formulated a Task Force on dental fluorosis and recommended the subgroup to develop a simplified index for identification and grading of dental fluorosis to be used by the health workers. This study was conducted to pre-test the ‘ICMR Index for Dental Fluorosis’ in the field to check its reliability and reproducibility. Methods: A total of 600 photographs were taken, 150 in each grade of fluorosis by screening 14-17 yr school children from eight schools of Hisar (Haryana) and South west Delhi. Eighty photographs were finalized (20 in each grade) before calibration to be used for training of field workers. Calibration exercise was conducted involving the five member survey team on 100 diagnosed cases of dental fluorosis. The members again screened 74 children with dental fluorosis in the field to categorize in to different grades of fluorosis for assessment of inter-examiner reliability. Results: The ICMR criteria showed more difference in agreement in very mild and mild categories during calibration. The inter-examiner reliability (κ) ranged from 0.59-1. The criteria was further modified and inter- examiner reliability (κ) found to be 0.83-0.98 which was almost perfect agreement. Interpretation & conclusions: The tool developed by the ICMR to assess dental fluorosis can be used in a field set up by non-dental personnel reliably with high degree of reproducibility.

Reed–Sternberg Cells in Pericardial Effusion - Rare Finding in a Case of Nodular Sclerosis Classical Hodgkin Lymphoma.

Causes of malignant pericardial eff usion include metastatic carcinomas, acute leukemias, chronic leukemias, non-Hodgkin lymphoma, and rarely Hodgkin lymphoma. We report here a case of nodular sclerosis classic Hodgkin lymphoma presenting with massive pericardial eff usion. Cytological fi ndings of the pericardial fl uid and histopathology of the lymph node are presented. A 13-year-old girl came with complaints of a cough and progressive breathlessness for 5 months. She also had B symptoms. Imaging showed massive pericardial eff usion, along with mediastinal, cervical, and abdominal lymphadenopathy. Pericardiocentesis was done. A cytology of the pericardial fl uid showed large atypical Reed–Sternberg (RS) - like cells in a background of lymphocytes, eosinophils and plasma cells – suggestive of Hodgkin lymphoma. Cervical lymph node biopsy and immunohistochemistry confi rmed the diagnosis of classical Hodgkin lymphoma – nodular sclerosis subtype. Th e institution of chemotherapy resulted in signifi cant decrease in pericardial eff usion, and the patient was discharged in a satisfactory condition. Hodgkin lymphoma presenting clinically with massive pericardial eff usion and showing RS cells in the pericardial fl uid is very rare. A cytopathologist needs to be aware of this possibility which will facilitate early diagnosis and treatment.

Oromotor Stimulation for Transition from Gavage to Full Oral Feeding in Preterm Neonates: A Randomized controlled trial.

Objective: To assess the effect of additional oromotor stimulation along with routine care on transition from gavage to full oral feeding in preterm neonates. Method: 51 neonates (28-34 weeks) randomized to receive either oromotor stimulation along with routine care (n=25, intervention), or routine care alone (n=26, control) (which included Kangaroo mother care and non-nutritive sucking). Results: Median (IQR) days to reach partial and full spoon feed were significantly lesser [5(3-9.5) vs 10(5-15) P=0.006; and 7(5-14.5) vs 12.5(7-21); P=0.03] in intervention than in control group, respectively. A significantly higher number (56%) in intervention group as compared to control group (31%) achieved partial direct breast feeding at discharge (P=0.01). Conclusion: Oromotor stimulation along with routine care reduces the duration of gavage feeding in preterm neonates.

Presurgical Antibiotic Prophylaxis Pattern In An Indian Tertiary Care Teaching Hospital.

The present study was performed to study the antibiotic prophylaxis pattern in patients admitted in Surgery and Obstetrics and Gynaecology wards of a Tertiary Care Teaching hospital in North India. It was an observational, non interventional and analytical study used to evaluate the patients undergoing surgery through period of one and half years. Information concerning demographic data, type of surgery, and parameters of antibiotic therapy (selection of antibiotic, dose, route and duration of therapy as well as cost) was collected from case records of 400 patients. Third generation cephalosporins were the most commonly prescribed class of antibiotics. No consistency was noted in the timing of administration of prophylactic antimicrobials agents which were prescribed 30 minutes to 6 hours before surgery. The dose was not repeated during surgery. Majority of antibiotics were prescribed from Essential Medicines List. Surgical prophylaxis was inappropriate in terms of choice of antimicrobial agent, timing of administration as well as the total duration of prescription, in majority of the cases. Interventions are warranted to promote the development, dissemination and adoption of evidence based guidelines for antimicrobial prophylaxis.

Comparative study: Efficacy and tolerability of vildagliptin vs. pioglitazone as an add-on therapy to metformin in poorly controlled type 2 diabetes mellitus patients in Punjab.

Introduction: The incidence of diabetes in urban Punjab is on the rise and the number of diabetics is increasing year by year. Material and methods: This 24 week study was designed to compare vildagliptin versus pioglitazone as an add-on therapy in patients of type 2 diabetes mellitus inadequately controlled with metformin alone in Punjabi population. Sixty patients were randomized in two groups to receive either vildagliptin 100 mg (group 1) or pioglitazone 30 mg (group 2) in addition to metformin 1000 mg. The primary efficacy end point was change in FBG, PPG and HbA1c. Secondary end point included lipid profile, body weight and peripheral edema. Results: There was no significant difference between mean reduction in FBG, PPG and HbA1c in both groups. There was significant decrease in mean body weight in group 1 in contrast to significant increase in group 2. Both the treatment groups reported a significant decrease in TG, TC, LDL and increase in HDL. Conclusion: Vildagliptin displays robust efficacy with the added benefits of a much lower risk of peripheral edema, hypoglycemia and no weight gain, making it a promising alternative to pioglitazone as an add-on therapy to metformin in Punjabi population.

tem Cell and Cloning Research in Farm Animals: A Special Focus on Buffalo.

Embryonic stem (ES) cell lines constitute a special class of cell lines derived from the inner cell masses of preimplantation embryos. They are special owing to their unique capability of self renewal and differentiation and propagation in culture for indefinite periods of time. Unlike cancerous cells, they maintain stable chromosomal content and have potential to differentiate into any of the 200 cell type, under appropriate culture conditions. Embryonic stem cell research has gained a tremendous momentum owing to their promises and hopes in regenerative medicine, stem cell therapy, biopharming, and usefulness as in vitro models for studying embryonic development and differentiation. ES cell research in farm animals provides strong incentives for precise genetic manipulation for better health, increased disease resistance, increased milk production and desired composition, increased growth rate with improved carcass composition, enhanced reproductive performance and prolificacy. The potential benefits of using ES cells as donor cells in somatic cell nuclear transfer would boost transgenic animal production. However, with all the promises and hopes, need for more rigorous research and evidence-based therapy is the need of the time, before we could successfully embark on exploitation of ES cells in regenerative medicine. In the current review, establishment, characterization, applications and future challenges of farm animal ES cells are discussed in detail with a special focus on bubaline ES cell lines.

Protective effect of Lannea coromandelica Houtt. Merrill. against three common pathogens.

Background: Ayurvedic text reports suggested Lannea coromandelica is used in various microbial origin disorders like dysentery, sore eyes and leprosy, genital wounds. Objective: The present study was designed to investigate the antimicrobial effect of L. coromandelica Houtt. Merrill. (Anacardiaceae) on microbes which cause female reproductive tract infection. Materials and Methods: Ethanolic and aqueous bark extract (Ext.) of L. coromandelica were screened against strains of Streptococcus pyogens, Staphylococcus aureus, and Candida albicans. Antimicrobial assay had been done with agar well diffusion method. Results: Ethanolic extracts [100% (16 mg), 75% (12 mg) and 50% (8 mg)] of L. coromandelica exhibited zone of inhibition (ZI) 19.21 mm, 18.45 mm, 16.41 mm and 18.12 mm, 17.35 mm, 16.35 mm against S. aureus and S. pyogens, respectively. However, only 100% and 75% ethanolic extract showed (ZI-19.18 mm, 16.29 mm) activity against C. albicans. Nevertheless, aqueous extract (100%) showed higher antifungal activity (ZI-16.97 mm). Ciprofl oxacin and amphotericin B were used as a standard drugs in the present study. Conclusion: The results demonstrated that L. coromandelica Houtt. Merrill. have antibacterial activity against S. pyogens, S. aureus and antifungal property against C. albicans. Our fi ndings corroborate the ethnobotanical use of L. coromandelica in traditional medicine system (Ayurveda) of India.

Experience with Kangaroo mother care in a neonatal intensive care unit (NICU) in Chandigarh, India.

OBJECTIVE: To study the feasibility and acceptability of Kangaroo mother care (KMC) on the low birth weight infants (LBWI) in the neonatal intensive care unit (NICU) by the mothers, family members and health care workers (HCW) and to observe its effect on the vital parameters of the babies. METHOD: A observation in the NICU. RESULTS: A total of 135 babies (74 boys and 61 girls) who completed minimum of 4 hrs of KMC/day, were included. The mean birth weight and gestation were 1460 gm and 30 week respectively. 47% babies started KMC within first week of age. Mean duration of KMC was 7 days (3-48) days. The O(2) saturation improved by 2-3%, temperature ( degrees C) rose from 36.75 +/- 0.19 to 37.23 +/- 0.25, respiration stabilized (p<0.05 for all) and heart rate dropped by 3-5 beats. No episodes of hypothermia or apnea were observed during KMC. KMC was accepted by 96 % mothers, 82% fathers and 84% other family members. 94% HCW considered it to be safe and conservative method of care of LBWI. Benefits of KMC on the babies' behavior and on maternal confidence and lactation were reported by 57%, 94% and 80% respectively. A decline in use of heating devices in the NICU was reported by 85% and 79% said it did not increase their work load. CONCLUSION: KMC was found to be safe, effective and feasible method of care of LBWI even in the NICU settings. Positive attitudes were observed in mothers, families and HCW.

Voluntary donors-need for a second look.

Voluntary non-remunerated blood donation is the source of the safest blood supply to the transfusion service. In the Indian set up where voluntary donations are fewer and poorly structured, safety of blood could still be compromised. This study was carried out to find out the seroprevalence of transfusion transmitted diseases among replacement and voluntary donors. A retrospective study of replacement and voluntary donors over a three and a half year period was carried out and the seroprevalence for human immunodeficiency virus (HIV), hepatitis B, hepatitis C, syphilis and malaria was noted. A total of 41122 donors were studied comprising of 94.7% replacement and 5.3% voluntary donors. The prevalence of transfusion transmitted diseases was marginally higher among voluntary donors (3.3%) as compared to replacement donors (2.9%). All cases of HIV were seen in the replacement donors while the figures for hepatitis B and C were marginally higher in the voluntary donors (p>0.05). Voluntary donations in our study were not voluntary in the real sense. There is a need to work on building a stronger voluntary donor base and to create awareness among the populace in order to gradually abolish the replacement donations; thereby ensuring the safety of blood and its products.

Utility of white blood cell suspect flags and histogram pattern in the detection of acute leukemia by Advia-60 automated hematology analyzer.

Blood samples from patients with acute leukemia, when analyzed with automated hematology counters, tend to introduce inaccuracies in the automated differential count and can cause diagnostic confusion without providing definite clues to the presence of abnormal cells. We designed this study to assess the utility of white blood cell (WBC) flags and histogram pattern generated by Advia-60 automated hematology analyzer in the recognition and categorization of acute leukemia. Data printouts of 31 newly diagnosed cases of acute leukemia, 22 with acute myeloid leukemia (AML) and 9 with acute lymphoblastic leukemia (ALL) were reviewed. All cases of AML and ALL generated the WBC suspect blastflag M2 associated with two of the non blast suspectflags G1 and G2. Among the cases of AML, 95.5% of the WBC histogram patterns were definitive of the presence of abnormal cells and were indicative of the myeloid nature of cells. Only 44.4% of the histograms in the cases of ALL could be definitive of the presence of abnormal cells and 33.3% were indicative of their lymphoid nature. Significantly, 55.5% of the histograms in ALL were normal. The false positives for both AML and ALL were 10.5% when only WBC flagging was considered and were reduced to 0.05% when the flags were combined with histogram patterns for interpretation. Combined flagging and histogram recognition can be of aid in identifying cases of acute leukemia and the morphologist can then assess these samples further. This ensures that cases of acute leukemia, especially in high output laboratories, are not inadvertently missed.

Use of the gel-based DiaMed-ID microtyping system for crossmatching enhances sensitivity.

A host of newer techniques have been introduced over the past decade in blood bank serological testing. One such technology which has been in vogue in the west since early 1990s is the gel test. The procedures used are standardized and they provide clear and stable reactions that improve result interpretation. The principle involves the differential passage of red cell agglutinates and free red blood cells through a dextran acrylamide gel. The results are stable and may be read even after many hours. The test is easy to perform, sensitive and reproducible. We report our experience in compatibility testing with use of the DiaMed micro typing system which is based on the gel technology. Over a one year period since this technology was introduced in our blood bank, we noticed a startling 65 fold rise (p<0.0001) in the reported number of incompatible units in one year which rose from a paltry 4 (0.02%) to 260 (1.6%). We found the DiaMed system easy to use and as our findings suggest it proved to be more sensitive than the conventional tube agglutination technique.