A Cross-Sectional Study on Anxiety Due to COVID-19 and its Predictors among Undergraduate Medical Students in a Tertiary Care Teaching Hospital of Kolkata, West Bengal

Background: Medical education is recognized as stressful globally. COVID‑19 pandemic is an additional source of anxiety to the medical students. Objectives: This study was conducted to assess the prevalence and to identify the factors associated with anxiety due to COVID‑19 among undergraduate medical students in a teaching hospital of Kolkata, West Bengal. Methods: An observational cross‑sectional study was conducted among 363 undergraduate medical students using the stratified random sampling of a medical college from June to July 2021. Data were collected using a predesigned, pretested, and structured online questionnaire, including “Coronavirus Anxiety Scale.” Descriptive statistics were used to estimate the prevalence of anxiety. Pearson’s Chi‑square test was performed to find out the factors associated with anxiety due to COVID‑19. Results: About 25.6% of the medical students were found to have anxiety due to COVID‑19. About 28.9% of them reported COVID‑19 infection in family in recent past and 11.0% had themselves tested positive. Nearly 20% reported loss of family members, relatives, and close friends due to COVID‑19. The factors associated with anxiety due to pandemic were socioeconomic status, social stigma, sleep disturbances, history of COVID‑19 in family, loss of job. and vaccination status of family members missing practical classes and exam‑related anxiety. Conclusion: The study found that one‑fourth of the medical students had anxiety due to COVID‑19. Social stigma due to COVID‑19 and loss of job of parents were the most significant predictors. It is recommended that targeted psychological and clinical interventions need to be taken to alleviate students’ anxiety due to COVID.

Comparison Of In-Hospital Mortality Of COVID-19 Patients Between Those Who Were Vaccinated And Who Were Not

Background:We compared the mortality rate of patients with moderate to severe COVID-19 who were vaccinated and who were not. Material And Methods:In this retrospective observational study, we collected data of patients who were admitted with moderate to severe COVID-19.The vaccination status and co morbidities of the patients were documented. The incidence and in-hospital mortality of COVID-19 patients was assessed.Univariate analysis was performed to determine the risk factors of in-hospital mortality.Result:Of 294 patients, 5.1% (n=15) received Covaxin™and 26.5% (n=78) received Covishield™;68.4%(n=201) patientswere unvaccinated.Of patientswho were vaccinated and contracted COVID-19, 24.8%(n=73) had taken the first dose and 6.8%(n=20) had taken the second dose of either vaccine.The in-hospital mortality rate was 13.6% (n=40). No significant association was found with the type of vaccine and the in-hospital mortality (p=0.23). Significant associations with in-hospital mortality were found with the interval before COVID-19 disease andvaccination (OR, 3.02; p=0.01); and the presence ofdiabetes mellitus (OR, 2.13; p=0.02), cardiovascular diseases (OR, 2.11; p<0.001), and malignancy (OR: 2.33; p=0.0325).Conclusion:The mortality rate of unvaccinated patients with moderate to severe COVID-19 was high. There was no significant difference in the effectiveness of Covaxin™ and Covishield™ in terms of the incidence of COVID-19 and in-hospital mortality. Diabetes mellitus, cardiovascular diseases, and malignancies had a significant association with in-hospital mortality in patients with moderate to severe COVID-19.

Antimicrobial resistance: Causes and impact on public health in developed and developing countries

Antibiotic-resistance (AR) has become an alarming issue, posing threats to public health in terms of mortality and economic loss. The drivers of AR include environmental contamination from varied sources, ultimately making its way into our drinking water and food. Other factors include reckless use of antibiotics by the uneducated health workers, unhygienic situation of the hospitals, overconsumption and careless discharge of medicines by the general populace, injudicious use of antibiotics in the livestock, and indiscriminate disposal of untreated pharmaceutical wastes into the municipal water have caused several health hazards, such as “AR in infants,” respiratory disorders, and cancer. Furthermore, the sewage treatment process itself augments the antimicrobial resistance crisis. Hence, it is an alarming issue which must be taken care at the global level as well as the national level.

Study of 'patterns of care' of ovarian cancer patients in a specialized cancer institute in Kolkata, eastern India.

BACKGROUND: Ovarian cancer is one of the leading cancers in Indian women. The current standard of care is a combination of surgical staging, maximal surgical effort to achieve cytoreduction, and judicious use of chemotherapy. Multimodality therapy can reduce mortality, but the practice and uptake of such therapy in Indian Institutions are not up to the desired level. OBJECTIVES: To study the protocol adherence for ovarian cancer management along with patient compliance and evaluate their effects on survival. MATERIALS AND METHODS: The retrospective study obtained and analyzed data from records of patients operated for ovarian cancer at a Regional Cancer Center in eastern India between January 2002 and December 2006. RESULTS: The records of 202 patients were evaluable. None of the patients who had primary surgery outside the institute had staging information. A substantial number of patients operated at the institute had incomplete surgical staging, inadequate information on residual disease after surgery, and incomplete histology report. Only 20.3% patients could have optimal cytoreduction after surgery. Compliance to chemotherapy was poor. The median overall survival time and disease-free survival time were 24 months and 5 months, respectively. The residual disease after surgery significantly affected the overall survival, but not the disease-free survival. Incomplete chemotherapy was found to adversely affect survival after adjusting for advanced stage and bulky residual disease. CONCLUSION: Management of ovarian cancer is suboptimal even in the specialized cancer institute. Poor patient compliance to chemotherapy is one of the major factors adversely affecting survival from advanced ovarian cancer.

Assessment of the need for a training course in rational use of drugs: a cross-sectional pilot study.

Rational use of drugs means need-based use of them keeping in mind the pathological status, therapeutic indices, drugs interactions and adverse drug reactions. Lacunae in the existing undergraduate curriculum cause irrational use of drugs. The present study was undertaken among 2,200 fresh medical graduates from all over the country with a list of questionnaire distributed among them and analysing the answers. The aim was to ascertain the adequacy of present undergraduate curriculum on pharmacology in equipping the doctors on rational use of drugs and to assess the need and feasibility of Refresher's course. More than half (55%) replied prescriptions were not truly rational. Ninety-eight per cent opened Refresher's course is beneficial in rational prescribing. This cross-sectional survey could provide a glimpse of existing undergraduate pharmacology curriculum and its impact on rational prescribing practice. The Refresher's course in the early internship period involving the clinical departments and department of pharmacology is suggested.

Surrogate endpoints: do they really contribute in therapeutic decision making?

Surrogate endpoints are substitutes for the true endpoints and measured in any clinical research to relate in some way to the outcome of primary interest. Inappropriate selection of surrogate markers may lead to controversies during clinical trials or therapeutic interventions. Use of surrogate markers depends upon thorough understanding of the pathophysiology of the disease and pharmacology of drugs. Results obtained with surrogates should be regarded as preliminary and necessitates definitive studies.

Cytological study of serous effusions with the aid of tumour markers.

Clinicocytological evaluation with the help of tumour markers was done in 25 cases presenting with serous effusions. The main aim was to differentiate between reactive mesothelial cells and malignant cells, type the tumour cells in effusions with the aid of tumour markers--carcino-embryonic antigen (CEA), epithelial membrane antigen (EMA), cytokeratin and vimentin. It was observed that immunocytochemistry has complemented conventional cytology in diagnosis of carcinoma specially in cases labelled as suspicious of malignancy. EMA was found to be the most reliable epithelial marker and very useful in differentiating carcinoma cells from reactive mesothelial cells.

Periodic syphilis profile in a New Delhi hospital.

The study reports the prevalence of syphilis determined at intervals of ten years amongst attendees of the Sexually Transmitted Diseases Centre (STD), in New Delhi, from 1954, to 1994. It was observed that the number of STD cases increased by about eight times in 1984 as compared to 1954. The prevalence of STDs had risen from 5.5 per cent in 1964 to 14.7 per cent in 1994. However, the syphilis load has been decreasing since 1974. Childhood syphilis has decreased from 12.6 per cent in 1954 to 0.5 per cent in 1994. However in adult males it increased from 62.3 per cent in 1954 to 80.4 per cent in 1984. Cardiovascular syphilis was last reported in 1954. The prevalence of syphilis was approximately three times higher in males than in females.

Sero surveillance of HIV infection in high risk groups and in suspected AIDS cases in a New Delhi hospital.

A total of 17,824 sera were screened for the presence of HIV 1 + 2 antibodies by Enzyme Immuno Assay (EIA) to determine (i) seroprevalence of HIV infection in hospital high risk groups (ii) time trend of HIV seroprevalence in STD clinic attendees (both STD patients and non STD patients), over a period of six years, (iii) relationship of the STD's with HIV seropositivity (iv) clinical profile and epidemiological characteristics of the AIDS cases. A progressive increase in the HIV seropositive STD patients showing a five fold rise over six years was seen. Most gave history of multipartner sex especially with female CSW's. The most common STD associated with HIV seropositivity was Syphilis followed by Chancroid and Gonorrhoea. All had HIV-1 infection. The AIDS cases (20) presented mainly with tuberculosis, both pulmonary and extrapulmonary. The mode of infection, both in the HIV seropositive and AIDS cases, was mainly heterosexual relationship followed by blood transfusion. In a few cases, infection was perinatally transmitted. In the limited number of HIV positive contacts studied, seven were confirmed as Western Blot positive. HIV infection, although a later introduction in Delhi compared to the coastal cities, has shown a clear increasing trend in the STD patients.

Seroprevalence of cytomegalovirus antibodies in patients attending STD and antenatal clinics.

Sera from 368 patients attending sexually transmitted disease (STD) and antenatal clinics were screened for cytomegalovirus (CMV) specific IgG and IgM by indirect ELISA. IgG was detected in 94% of patients tested. CMV IgM seropositivity was found in 8.5% of normal pregnant females and in none of the normal asymptomatic males. CMV-IgM was detected in higher number of patients with STD than in those without STD. There was slightly higher association of CMV IgM antibodies mainly with syphilis in males and chlamydial endocervicitis in females.

Usefulness of immunoperoxidase test for serodiagnosis of genital chlamydial infections.

An immunoperoxidase test detecting Chlamydia trachomatis specific serum IgG and IgA antibodies, was carried out to determine its efficacy in establishing chlamydial etiology in 104 clinically diagnosed patients attending a major STD Clinic in Delhi. The patients consisted of 58 with nonspecific urethritis/cervicitis (NSU/NSC), 11 with pelvic inflammatory disease (PID), 23 with primary infertility in either male or female and 12 with lymphogranuloma venereum (LGV). IgG antibodies were tested at a dilution of 1:64 and 1:128 and IgA antibodies at 1:16. Although 27.7 per cent (5 of 18) of the controls had IgG antibodies (> or = 1:128), none had IgA, showing the IgA marker as 100 per cent specific. In 80.8 per cent of all the patients, active infection was detected, 81.0 per cent in NSU/NSC, 81.8 per cent in PID, 76.9 per cent in female infertility, 80 per cent in male infertility and 83.3 per cent in LGV patients. The immunoperoxidase test was found to be an extremely simple and rapid test especially suited for laboratories where facilities are limited.

Frusemide-induced diabetes mellitus in insulin pretreated rabbits as an experimental model.

Single dose of frusemide 0.1 mg/kg orally was administered in 10 rabbits pretreated with soluble insulin 4 IU intravenously. Induction of diabetes after 24 h was confirmed by an increase in blood sugar and glucosylated haemoglobin and a decrease in serum insulin levels. Ten diabetic rabbits which received only frusemide without insulin pretreatment were used as controls, whereas equal number of insulin-pretreated rabbits receiving hydrochlorothiazide 250 mg/kg orally served as the positive control group. All biochemical parameters remained unaltered in the frusemide-treated test group as well as the positive control group after two weeks. The pancreatotoxic effect of frusemide may induce a stable hyperglycaemic state in rabbits which could lead to a useful diabetic model.

Ocimum sanctum Linn--a study on gastric ulceration and gastric secretion in rats.

The antiulcerogenic property of Ocimum sanctum Linn (Tulsi) was studied in pyloric ligated and pyloric ligated & aspirin treated rats. The extract of OSL reduced the ulcer index, free & total acidity on acute and chronic administration. Seven days pretreatment with the drug increased the mucous secretion also. It may be concluded that OSL extract has antiulcerogenic property against experimental ulcers, and it is due to its ability to reduce acid secretion and increase mucous secretion.

Effects of trichloroethylene anaesthesia on salivary paracetamol elimination.

The effect of trichloroethylene (Trielene) anaesthesia was studied in 10 young male patients undergoing short surgical procedures. Equal number of males operated upon for the same indication under epidural anaesthesia, served as a control group. Paracetamol concentrations in saliva were measured at hourly intervals on the day before and after surgery. Paracetamol half life (t1/2) significantly decreased (from 2.5 to 0.84 h) and clearance rate (CL) significantly increased (from 8.0 to 14.0 ml/min/kg) as compared to preoperative values. The control also showed significant but smaller alterations in these parameters. Our result suggests that trielene exposure may accelerate the hepatic metabolism of paracetamol.

Detection of malaria antigen in blood by inhibition ELISA.

Demonstration of parasite associated antigen in blood by inhibition ELISA in malaria patients and controls is described. The test was negative in all the healthy controls and positive in 90 per cent of the Plasmodium vivax malaria cases. The test was found to be quite sensitive, being able to detect 5 parasites/10(6) RBC in a case of natural P. falciparum infection. There was 95.3 per cent agreement between the results of this test and IgM-IIF test.