Stress perception among the elderly and its effect on some muscle strength parameters

Background: With improvement in living conditions in the population and the availability of treatments for various communicable and non-communicable diseases, the life expectancy and consequently the elderly population have increased. Stress leads to mental and physical problems. Aim and Objective: The aim of this study was to assess the effect of stress on muscle functions in the elderly. Materials and Methods: One hundred apparently healthy persons (50 males and 50 females) took part in the study. Perceived stress scale was used to measure their level of stress. Maximum voluntary contraction (MVC) and endurance time were measured with the help of a handgrip dynamometer. Results: The elderly population sample in our study showed a moderate level of stress, but there was no significant difference between the three age groups under study. Conclusion: A significant positive correlation between MVC and stress level was observed in our study subjects.

Awareness, Practice and Level of Anxiety using Coronavirus Anxiety Scale among the Indian Population regarding COVID -19 Pandemic

Abstract: The most important aspect of Public Health Emergency Preparedness (PHEP) involves the circulation of trustworthy and accurate information in the public health interest domain. Strict stringency measures such as nationwide lockdown impacted people's mental health. Hence, this study was planned to assess the knowledge, practice, and anxiety among the Indian population about the ongoing pandemic in the initial phase. Methods: A web-based cross-sectional study was conducted between August 1, 2020, to October 5, 2020. Coronavirus Anxiety Scale was used to determine dysfunctional anxiety. Results: Among 553 participants, 73.6% had overall good knowledge of COVID-19 with mean correct score of 6.9±1.1. Majority of participants (97%) wore mask regularly, and 93% of respondents regularly washed their hands with soap and water. Only 14 participants scored ?9 on CAS, suggesting probable cases of dysfunctional anxiety associated with the COVID19 crisis. Conclusion: The knowledge and practices of citizens in a nation reflect their preparedness and ability to deal with a pandemic of such proportion. Good knowledge translates to good practices and therefore reduces anxiety among the population. It is deemed necessary that people's knowledge and habits, including the mental impact, be accessed at periodic intervals to track their adaptation to pandemics over time

A suspected case of COVID-19 vaccine (Covishield) induced Guillain Barre syndrome-a case report

Guillain Barre syndrome (GBS)is a collection of clinical syndromes that manifest as an acute inflammatory poly radiculopathy. It usually presents as an acute, non-febrile, monophonic, post infectious illness manifesting as ascending weakness and areflexia. It is an autoimmune disorder characterized by production of antibodies against the myelin and is often triggered by bacterial and viral infections, vaccines against rabies, flu and COVID-19. Here we present a case of 31 years old male with characteristic signs and symptoms of GBSpossibly triggered by Covishield vaccine.

RISK OF MUCORMYCOSIS IN COVID-19 PATIENTS: A REVIEW

India is trying to maintain stability in the current circumstances; another immediate threat has developed in the shape of coronavirus disease- associated mucormycosis. Mucormycosis is uncommon but lethal disease, caused by a group of molds known as mucormycetes. If not treated properly, an infection might be fatal. The most ordinary risk factor is diabetes mellitus, followed by hematological malignancies. Patients with postpulmonary tuberculosis and persistent renal diseases are further probable to extend mucormycosis in India. Trauma increases the risk of cutaneous mucormycosis. Despite a rise in illness awareness among treating physicians, disease-related morbidity and mortality remain high, as patients seek medical attention late in the disease process and medication is expensive. Despite the fact that it has been present since the beginning of the pandemic, the cause of this fungal infection remains unknown. In this review we aimed to summarize about mucormycosis and its epidemiology, pathogen, and treatment options in context to COVID-19.

ROLE OF PERSONALIZED MEDICINE IN THYROID CANCER LATEST ASPECTS

Thyroid cancer is the prevalent endocrine cancers, and its incidence is growing all over the world, according to the World Health Organization. About 5–10 per cent of individuals with differentiated thyroid carcinoma may experience destructive behavior and metastasis, and their disease will be refractory to therapeutic techniques such as radiation therapy for an unknown cause, despite the favorable prognosis. Most aggressive, deadly, and unresponsive type of the cancer is thyroid carcinoma. Regrettably, existing treatments are not specific and are thus considered poor in treating thyroid malignancies. Consequently, mortality in this malignancy despite progress in diagnosis and treatment is a prominent issue in medicine. evidence linking cellular, molecular, and genetic to a diagnostic and therapeutic simplification. With the new idea of personalized therapy for thyroid cancer diagnosis, arranging the treatment, discovering the success of the treatment and assessing the visualization has improved in the last ten years. Personalized medicine treatment for thyroid cancer is supported by these studies. According to the findings of this review, cellular and molecular processes of cancer will lay concrete on the way for the development of narrative biomarkers for personalized medicine that take individual variations into account

Predicting pregnancy outcomes from homocysteine level: an evidence from a North Indian study

Background: Hypertensive disorders of pregnancy are a major cause of adverse pregnancy outcomes. Though the etiology of spectrum of vascular disorders of pregnancy is still not understood completely, yet abnormally elevated homocysteine level has been implicated in the causal pathway and pathogenesis. Hyperhomocysteinemia has been significantly associated with increased risk of poor maternal and foetal outcomes in terms of PIH, abruption, IUGR, recurrent pregnancy loss, intrauterine death and prematurity.Methods: The present prospective study was conducted among 180 pregnant women (57 exposed and 123 non exposed) in Kamla Nehru State Hospital for Mother and Child, IGMC Shimla, Himachal Pradesh with an objective of determining association of abnormally elevated homocysteine level in pregnancy and adverse pregnancy outcomes. Socio-demographic, clinical, biochemical including homocysteine level, laboratory, ultrasonographic parameters and foeto-maternal outcomes of pregnancy of all the participants were documented.Results: The mean homocysteine level of exposed group (23.26±10.77 µmol/L) was significantly higher than the unexposed group (8.99±2.47 µmol/L). Among hyperhomocysteinemic subjects, 10.5% had abruption, 15.8% had PRES and 8.7% PPH which was significantly higher than normal subjects. Similarly, patients with homocysteinemia had significantly higher proportion (21.3%) of poor Apgar score, more (41.9%) NICU admissions and higher frequency (4.7%) of meconium aspiration syndrome.Conclusions: The present study generates necessary evidence for associating abnormally elevated homocysteine levels with pregnancy related hypertensive ailments and adverse pregnancy outcomes. It further demands the need of robustly designed studies and trials to further explore the phenomenon. Moreover, it emphasizes on a simple and timely intervention like estimating the much-neglected homocysteine levels during pregnancy which can definitely contribute in predicting and preventing adverse perinatal outcomes.

Use of ocular biomarkers as a potential tool for early diagnosis of Alzheimer's disease

Alzheimer's disease (AD) is the most common neurodegenerative disease worldwide which unfortunately has no known effective cure to date. Despite many clinical trials indicating the effectiveness of preclinical treatment, a sensitive tool for screening of AD is yet to be developed. Due to multiple similarities between ocular and the brain tissue, the eye is being explored by researchers for this purpose, with utmost attention focused on the retinal tissue. Besides visual functional impairment, neuronal degeneration and apoptosis, retinal nerve fiber degeneration, increase in the cup-to-disc ratio, and retinal vascular thinning and tortuosity are the changes observed in the retinal tissue which are related to AD. Studies have shown that targeting these changes in the retina is an effective way of reducing the degeneration of retinal neuronal tissue. Similar mechanisms of neurodegeneration have been demonstrated in the brain and the eyes of AD patients. Multiple studies are underway to investigate the potential of diagnosing AD and detection of amyloid-? (A?) levels in the retinal tissue. Since the tissues in the anterior segment of the eye are more accessible for in vivo imaging and examination, they have more potential as screening biomarkers. This article provides a concise review of available literature on the ocular biomarkers in anterior and posterior segments of the eye including the cornea, aqueous humour (AH), crystalline lens, and retina in AD. This review will also highlight the newer technological tools available for the detection of potential biomarkers in the eye for early diagnosis of AD.

Predictors of co-morbidities in chronic obstructive pulmonary disease patients at a tertiary care centre in north India

Background: Chronic obstructive pulmonary disease (COPD) is a common preventable and treatable disease that is characterised by persistent respiratory symptoms and airflow limitation. COPD is characterised by an intense inflammatory process in the airways, parenchyma, and pulmonary vasculature. It is possible in some cases that the inflammatory process may overflow into the systemic circulation, promoting a generalised inflammatory reaction. Patient with COPD often have concomitant chronic illness (co-morbidities). The aim of this study is to know the pattern of co-morbidities in COPD patients.Methods: This study was a cross sectional observational study conducted on 172 COPD patients (IPD and OPD) diagnosed on the basis of GOLD guideline 2017. Co morbidities were diagnosed as per standard defined criteria laid down in the respective guidelines.Results: 55.3% of the patients with COPD had co morbidities. 18/88(20.5%) patients presented with multiple co-morbidities. 49/88, 55.7% COPD patients were affected with cardiac (either only cardiac or had multiple organs affected besides cardiac), the commonest co-morbidity. Amongst cardiac, hypertension and congestive heart failure (CHF) was the commonest (n=19/49, 38.8% each) followed by CAD/CSA/IWMI/IHD/AF. Others were metabolic (n=14/88, 15.9%), GERD (n=13/88, 14.8%), Depression (n=11/88, 12.5%). Less prevalent co-morbidities were Osteoporosis (n=8/88, 9.1%), Lung cancer (n=6/88, 6.8%), Bronchiectasis (n=5/88, 5.6%) and OSA (n=3/88, 3.4%).Conclusions: Urban indwelling, advancing age and duration of illness, presentation with low mood, loss of pleasure/ interest, appetite disturbances and heart burn with relief on taking proton pump inhibitor can be predictors of co-morbidities in COPD patients. Chance of finding co-morbidities may be multifactorial. Thus, it is important to look out for co morbidities in each and every COPD patients.

Role of adipokines in obstructive airway disease and diabetes mellitus

This review summarizes the state of the current literature relating to the associations of lung disease and adipokines (proteins produced by adipose tissue) in humans. The mechanistic basis for these associations in humans is not established, although a possible role for adipokines has been invoked. Leptin, a pro-inflammatory adipokine, and adiponectin, an anti-inflammatory adipokine, are causally associated with asthma in mice. Although human studies are currently inconclusive, high-serum leptin and low-serum adiponectin concentrations predict asthma, independent of obesity, in select population groups, such as premenopausal women in the United States. In contradistinction, low-serum leptin and high-serum adiponectin concentrations are associated with stable COPD, although these associations are likely confounded by fat mass. Interestingly, leptin may promote systemic and airway inflammation in stable COPD patients. On the other hand, COPD may upregulate systemic and lung adiponectin expression. The precise mechanism and significance of the associations between these adipokines and lung disease at the current stage are confusing and frankly paradoxical in places. It is now known that adipose tissue is not an inert organ simply for energy storage, but regulates systemic inflammation via a variety of secreted proteins (called adipokines). While the associations of obesity and adipokines with cardiovascular, endocrine, and rheumatological diseases are well described, the respiratory effects of obesity and adipokines are less well known. This review will focus on the effect of obesity and adipokines on asthma and chronic obstructive pulmonary disease (COPD) in humans. This area of research needs additional study that may open up novel therapeutic strategies for these lung diseases.

Can serum homocysteine predict hypertensive disorders of pregnancy?: an evidence from a case control study in a North Indian tertiary health care institution

Background: Hypertensive disorders of pregnancy are a major cause of both maternal and foetal morbidity and mortality. Although pregnancy induced hypertension (PIH) is still regarded as a disease of theories and unknown etiology, elevated homocysteine level has been hypothesized as a key risk factor. Abnormally raised homocysteine has been significantly associated with increased risk of PIH, abruption, intrauterine growth restriction, recurrent pregnancy loss, intrauterine death and prematurity.Methods: The present case control study was conducted among 180 pregnant women (90 cases and 90 controls) in Kamla Nehru State Hospital for Mother and Child, IGMC Shimla, Himachal Pradesh with an objective of ascertaining the role of homocysteine in pregnancy related hypertensive disorders. Socio-demographic, clinical, biochemical including homocysteine level, laboratory and ultrasonographic parameters of all the participants were documented.Results: The mean homocysteine level of cases (18.30±10.81) was significantly higher than the controls (8.70±2.64).  About 62.2% cases had abnormally raised homocysteine level (>15 µmol/L), while only 1.1% controls had such level. The odds of a case having abnormally elevated homocysteine level were 146.6 (CI: 19.52-1101) times to that of controls. Eclamptics had the highest homocysteine level followed by preeclamptics and controls.Conclusions: The present study significantly associates the abnormally elevated homocysteine levels with pregnancy related hypertensive ailments and demands much needed robustly designed studies to further explore the phenomenon. A simple intervention like estimating the much neglected homocysteine levels prior to pregnancy can definitely aid in predicting and preventing perinatal outcomes.

To Assess the Correlation between Bone Marrow Morphology and Immunophenotypic Findings in Patients of Chronic Lymphoproliferative Disorders (CLPD’s) and to Assess the Role of Flowcytometric Immunophenotyping in Diagnosis and Subclassification of CLPD’s

Introduction: Chronic lymphoproliferative disorderrepresent clonal proliferation of morphologically andimmunophenotypically mature B or T cells characterized by alow proliferation rate and prolonged cell survival. Study aimedto assess the correlation between bone marrow morphologyand immunophenotypic findings in patients of ChronicLymphoproliferative Disorders (CLPD’s) and to assess therole of flowcytometric immunophenotyping in diagnosis andsubclassification of CLPD’s.Material and Methods: 48 newly diagnosed cases ofCLPD were included. After complete clinical evaluation theyunderwent marrow aspiration, biopsy and immunophenotypingby flowcytometry with selected panel of monoclonalantibodies.Results: On morphology 47.9% cases were CLL. In 52.1%non CLL cases , 4.2% were PLL , 2% case as LPL and45.8% cases were CLPD-unclassifiable. Commonest patternof marrow infiltration noted on trephine biopsy was diffuse inCLL, HCL-V, B-PLL and T-CLPD. On immunophenotyping95.8% cases were B-CLPD and 4.25% T-CLPD. CD5, CD22,CD23, FMC7 and SmIg were used as first line markersfollowed by CD 10, CD 25, CD103, CD38, CD138 andCyclin D1 (on biopsy sections) as second line markers. Finalimmunophenotypic diagnosis was CLL (54.2%), B-CLPDunclassified (29.2%), 4.1% each of LPL, MCL, T-CLPD and2% each of B-PLLand HCL-V.Conclusion: Concordance rate between morphologicaldiagnosis and immunophenotypic diagnosis was 79.17%.Hence, Flowcytometry is necessary for confirmationof diagnosis and to classify the CLPD cases which areunclassifiable by morphology

Positioning of a morbidly obese patient during retinal surgery

A body mass index (BMI) ?35 kg/m2 is classified as obese, and a BMI ?40 kg/m2 is classified as morbidly obese. Obese people are at a higher risk for developing cardiovascular complications like ischemic heart diseases, congestive cardiac failure, hypertension, type 2 diabetes mellitus and obstructive sleep apnea (OSA) among other health issues. Central obesity can also increase the pleural pressure and cardiac filling pressures, thus increasing the intracranial (ICP) and intraocular pressure (IOP). These clinical co-morbidities can make retina surgeries, which require patient in supine position for 45-90 minutes, a challenging task. We present our experience in the intraoperative positioning of such a patient who underwent surgery for retinal detachment.

Consequences of antepartum hemorrhage and its maternal and perinatal outcome

Background: Antepartum haemorrhage, a life-threatening event, is defined as bleeding per vaginum occurring after the fetus has reached the period of viability, considered to be 20 weeks in developed countries and 28 weeks in countries with low resource settings. We evaluated the consequences of antepartum haemorrhage, their maternal and perinatal outcome so as to outline the proper management of patient in order to improve both maternal and perinatal morbidity and mortality.Methods: This one-year prospective study totaled 133 cases of APH fulfilling the inclusion criteria were studied. Data was recorded on the MS excel sheet for further analysis and processing.Results: Total 6693 deliveries were conducted out of which 133 presented as APH and incidence of APH was found out to be 1.98%. Placenta previa was most common. APH was commonly associated with multigravida and most cases were in age group of 26-30 years. Most of the PP and abruption cases were admitted at 34-37 weeks and 31-33 weeks respectively. High risk factors included previous LSCS and D and C, hypertension, multiple pregnancies and malpresentations. Most of the patients underwent preterm LSCS. Most fetal complications were due to prematurity. 58.6% patients were transfused blood. Overall perinatal mortality was 20.1% and maternal mortality was zero.Conclusions: Early diagnoses, timely referrals and transfusion facilities along with trained team of doctors with well-equipped ICU facility goes a long way in avoiding APH related maternak and fetal complications.

A study to assess the knowledge regarding practices of menstrual hygiene and reproductive tract infections among school going adolescent girls

Background: Poor menstrual hygiene and inadequate self-care are major determinants of morbidity and other complications among adolescent age groups. Some of these problems include urinary tract infections, scabies in the vaginal area, abnormal abdominal pain, and absence from school. Due to the silence prevailing in developing countries related to the topic of menstruation and related issues, many young girls lack appropriate information on menstrual hygiene. Learning about menstrual hygiene is a vital part of health education for adolescent girls so that they can continue to work and maintain hygienic habits throughout their adult life. Objectives: The objectives of this study were (1) to assess the knowledge of students about menstrual hygiene and the diseases contracted if the standards of hygiene are not maintained and (2) to educate and increase the awareness of the students about the proper hygiene to be maintained during the cycle and about the risks. Materials and Methods: This was a two-point cross-sectional study, carried out during October–December 2017 among 200 adolescent school going girl students of Government Hamidia Girls School, Bhopal. MS Excel and Epi info version 6 were used for statistical analysis. The study population was interviewed through pre-tested and pre-designed questionnaire, and intervention in the form of audiovisual presentations was given. Results: Of 200 students studied, majority, i.e., 71% of the girls was aged between 15 and 17 years. Only 38% of the girls were aware of menstruation before menarche. The main source of information about menstruation and menstrual hygiene was their mother in about 54% of girls. 76% of the girls used sanitary pads during menstruation. Conclusion: The present study shows the need for adolescent girls to have accurate and adequate information about menstruation. The study revealed that the knowledge on menstruation is poor and the hygiene practiced is often suboptimal. Awareness among adolescent girls regarding menstruation has increased in recent times, but lot more can be done to improve menstrual health management awareness among adolescent girls for addressing those problems.

A Report on Bilaterally Elongated Superior Cervical Ganglion

Superior cervical ganglion (SCG), the largest of the three cervical sympathetic ganglia, is formed by the fusion of first four cervical ganglia. Bilaterally elongated superior cervical ganglion was observed in a female cadaver during dissection. On the right side, it was 63.74 mm long and 5.75 mm wide and on the left side, it was 62.88 mm and 5.84 mm respectively. Histological analysis of the ganglion done with toluidine blue staining confirmed the structure of sympathetic ganglion. Superior cervical ganglion is the preferred ganglion for sympathetic block in conditions like trigeminal neuralgia, atypical facial pain,and post-herpetic neuralgia. Even though superior cervical ganglion has been reported to be at the safest location, thetension of sympathetic trunk while retracting the carotid sheath during surgeries might result in Horner’s syndrome. Furthermore, a large ganglion may also be confused with deep cervical lymph nodes or retropharyngeal mass during imaging studies. Understanding the variant anatomy of the superior cervical ganglion might serve as a guide for imaging studies, cervical spine surgeries,and sympathetic block.

Clinical and angiographic profiles and six months outcomes of smokers with acute ST segment elevation myocardial infarction undergoing primary percutaneous coronary angioplasty

Background Outcomes of primary percutaneous coronary intervention (PCI) for acute STEMI (ST-segment elevation myocardial infarction) in smokers are expected to be better than non-smokers as for patients of acute STEMI with or without fibrinolytic therapy. Objectives This comparative study was designed to evaluate the outcomes of primary PCI in patients with acute STEMI in smokers and non-smokers. Clinical and angiographic profile of the two groups was also compared. Methods Over duration of two year, a total of 150 consecutive patients of acute STEMI eligible for primary PCI were enrolled and constituted the two groups [Smokers (n = 90), Non-smokers (n = 60)] of the study population. There was no difference in procedure in two groups. Results In the present study of acute STEMI, current smokers were about a decade younger than non-smokers (p value = 0.0002), majority were male (98.9% vs 56.6%) were male with a higher prevalence of hypertension and diabetes mellitus (61.67% vs 32.28% and 46.67% vs 14.44%, p = 0.001) respectively. Smokers tended to have higher thrombus burden (p = 0.06) but less multi vessel disease (p = 0.028). Thirty day and six month mortality was non-significantly higher in smokers 4.66% vs 1.33% (p = 0.261) and 5.33% vs 2.66% (p = NS) respectively. Rate of quitting smoking among smokers was 80.90% at 6 months. Conclusion The study documents that smokers with acute STEMI have similar outcomes as compared to non smokers with higher thrombus burden and lesser non culprit artery involvement. Smokers present at much younger age emphasizing the role of smoking cessation for prevention of myocardial infarction.

Antimicrobial And Phytochemical Evaluation Of Cissus Quadrangularis L.

The present investigation involves antimicrobial and phytochemical evaluation of Cissus quadrangularis L. The antibacterial activity of Cissus quadrangularis was performed using disk diffusion method. The Results of study proved prompt efficacy of herbal extract against S. aureus and E. coli. The concentration dependent antibacterial activity of extract was observed against both organisms. Study also involves phytochemical investigation of herbal extract using HPTLC, IR and UV-Visible spectrophotometer. The result of study indicated that the methanolic extract possessed most potent antibacterial activity as compared to other extract. The antibacterial activity increases with the concentration and results indicated that the diameters of zone inhibition of the extract were comparable with the standard drug. The antimicrobial potential of plant extract may be attributed to the presence of specific phytoconstituents.

Mobile phone addiction among MBBS students of a Medical College leading to Sleep Cycle Disturbances

Introduction: Mobile phone has become such a daily routine essential part of our life causing good and adverse effects both in our performance. The aim of the present study is to see the effects of mobile addiction and sleep cycle disturbances in today’s life among medical students. Methods: The study was carried out among 218 MBBS students age group of 18 to 25 years, out of which 108 (49.5%) were females &110 (50.5%) were male. Internet addiction Test and PSQI Scale was used to assess the subjects and Chi square test was done for statistical analysis and p value (<0.05) is taken as significant. Result: The results are as follows: 218 undergraduate medical students participated in the study out of which 108 (49.5%) were females and 110 (50.5%) were male's age group between 18 to 25 years. Majority of them 204 (93.6%) were smart mobile phone users and 75 (34.4%) uses phone for near 2 hours per day, (34.4%) slept for less than 5 hours at night, 61(28%) reported ringxiety, ie, false perception of ring. Conclusion: We conclude that mobile use in present scenario affects sleep disturbances of the students. Identifying it early in life and motivating the students to indulge more in out-door sports and activities to refresh them.