Depression, anxiety, stress and resilience among undergraduate health sciences students of a rural tertiary healthcare centre in Maharashtra during the Covid-19 lockdown: A cross-sectional, online survey

BACKGROUND The Covid-19 pandemic caused a rapidly evolving and confused situation. Health sciences students (HSSs) are not immune to depression, anxiety and stress during such a pandemic. We aimed to assess the relation between depression, anxiety, stress and resilience among undergraduate HSSs during the Covid-19 lockdown. METHODS We conducted a cross-sectional, online survey at a rural tertiary healthcare centre in Maharashtra. Data were recorded from study participants on sociodemographic details using the 21-item Depression, Anxiety and Stress Scale (DASS-21) and the Brief Resilience Scale (BRS). Data were analysed using SPSS software version 15.0. RESULTS A total of 381 students participated in the online survey. The prevalence of depression, anxiety and stress were 7.6%, 6.3% and 1.0%, respectively. There was a positive correlation between all three sub-scales of DASS-21. On BRS, 5 (1.3%) participants had high resilience, 216 (56.7%) had normal resilience and 160 (42.0%) had low resilience. Those respondents who had high resilience had lower rates of depression, anxiety and stress on DASS-21 sub-scales. CONCLUSION A proportion of HSSs had anxiety, depression and stress during the Covid-19 outbreak and lockdown. Respondents with high resilience had less frequent depression, anxiety and stress. In the long run, strengthening resilience of HSSs may be useful.

Association between Glutathione-S-Transferase and Gastric Carcinoma: A Case Control Study

Gastric carcinoma is the fourth most common cancer type and the second leading cause of cancer deaths worldwide. Every year, around 1 million new cases and 0.7 million deaths are caused due to gastric carcinoma. Gastrointestinal tract is involved in absorption and metabolism of toxic or potentially carcinogenic compounds which may be present in the food we eat. In this context, digestive tract may be considered as a major site of cancer in humans. Glutathione-S-Transferase (GST) is an important metabolizing enzyme, present in the epithelial cells of human GIT. As nearly all reactive, ultimate carcinogenic forms of chemicals are electrophiles, GST is substantially important as a mechanism for carcinogen detoxification. The present study was conducted to evaluate the role of GST in gastric carcinoma and analyse the level of serum GST in patients suffering from gastric carcinoma. METHODSThis is a case control study, conducted among 50 cases of gastric carcinoma and 50 age sex matched controls. Patients included in this study were diagnosed with gastric carcinoma, after clinical and histological examination. Circulating levels of GST were assayed in the in the serum of control group and in patients with gastric carcinoma, using standardized method. RESULTSMean GST activity in serum was significantly higher (p < 0001) in gastric carcinoma patients (8.24 ± 1.94) as compared to control (5.47 ± 0.52). After chemotherapy (12.34 ± 1.05) the activity of GST was significantly higher (p < 0001) than before chemotherapy (10.23 ± 2.12). The generation of free radicals is as reflected by increased GST and GST-π activity in carcinoma cases. CONCLUSIONSSerum GSTs measurement in plasma may be a useful tumour marker in stomach cancer and serum GSTs activity might be helpful in predicting the response of chemotherapy in advanced stages of cancer. GST values are helpful in predicting the radiation response. Overexpression of GST in neoplasia may be causal, allowing replicative advantage, or casual, accompanying clonal expansion. The major limitation to its widespread use is the time needed for doing the assay and until this is overcome it will remain primarily a research tool.

Predicting difficulties during laparoscopic cholecystectomy by preoperative ultrasound.

BACKGROUND: The aim of this study was to determine whether the preoperative USG finding can predict the risk of conversion or difficulty during the laparoscopic cholecystectomy. MATERIALS AND METHODS: 200 patients undergoing Laparoscopic cholecystectomy at Kathmandu Medical College Teaching Hospital were included. Sonographic parameters like size of gall bladder, wall thickness, distance between hepaticoduodenal ligament and Hartmann's pouch and the size of stone were taken into consideration and difficulties in terms of adhesions around gall bladder, anatomy of calot's triangle and difficulty in peeling off gall bladder from the bed and retrieval were analyzed. RESULT: In 8 of 200 patients (4%), LC was converted to open procedure. In univariate analysis all the sonographic parameters we had included in this study were statically significant (p value <0.05). CONCLUSION: Preoperative sonographic signs can predict the difficulty in laparoscopic cholecystectomy.

Acute respiratory failure and oxygen therapy.

Acute Respiratory Failure (ARF) results in an inability to maintain gas exchange at a rate commensurate with the demands of the body and results in hypoxemia and/or hypercarbia, the mechanisms of which may be different. Hypoxemia commonly occurs due to Ventilation Perfusion (V/Q) mismatching, intrapulmonary shunt, diffusion defect or hypoventilation. Hypercarpnic respiratory failure may also be multifactorial but is usually due to inhibited central respiratory drive or inefficient respiratory muscle pump. Hypercapnia may occur in upper and lower airways obstruction, respiratory muscle fatigue and occasionally due to excess CO2 production (burns and excessive glucose administration). Issues in management centre around assessment of severity, determining the need for intervention, establishing diagnosis and etiology and institution of specific treatment. Diagnosis of respiratory failure may be made clinically and confirmed by blood gas analysis. Calculation of oxygenation indices will delineate extent of hypoxemia. When evaluating a child with respiratory failure, one should be aware that a child with prominent respiratory symptoms may have non-respiratory disease (i.e. metabolic acidosis, DKA) and conversely, advanced respiratory failure may be present in a child with no respiratory distress (central hypoventilation secondary to drugs, infection) careful assessment of history, complete physical examination and evaluation of lab parameters may clarify the diagnosis. Serial assessment of sensorium, respiratory symptoms, ABG and response to treatment will provide valuable clues to determine the need for intervention. Oxygen, like any drug, must be administered in a prescribed dose, only when indicated with the potential risks borne in mind. A variety of oxygen delivery devices are available; which ever device is used, the resulting FiO2 and devisable end points must be clearly determined. Hazards of oxygen therapy range from retinal damage in premature infants, damage to the alveolar capillary membrane with resultant hypoxemia) atelectasis and decreased mucociliary activity.