Assessing The Anxiety Levels Among Mbbs Students During Covid-19 Lockdown

Introduction: The outbreak of COVID-19, which started in China in December 2019, has spread around the entire world. Due to the COVID-19 pandemic, lockdowns have been implemented in numerous countries around the world. On 23 March 2020, India went into Nation-wide lockdown. Schools, Colleges & Universities were closed nationwide. The disruption in academics, daily routines and isolation had a deeply negative impact on students, making them extremely vulnerable to mental health issues like mood and anxiety disorders and depression. The main aim of this study is toAim: assess the level of anxiety among MBBS students during the COVID-19 lockdown. A cross-sectionalMethodology: online survey was conducted on 632 MBBS Students. A survey invitation through Google Forms was sent to students via WhatsApp & was assured regarding the confidentiality of their responses. Anxiety levels were assessed using Zung's self-rating anxiety scale (SAS). Results: Out of 632 Students, 24.07% of students experienced mild to moderate levels of Anxiety, 6.48% of students experienced Marked to Severe Levels of Anxiety and 0.92% of Students experienced Extreme levels of Anxiety. Gender wise nearly 46.54% of female students and 16% of male students experienced different levels of anxiety. Academic Year wise 57.13% 1st MBBS, 7.69% 2nd MBBS, 11.53% Final MBBS Part 1 & 53.56% Final MBBS Part 2 students experienced different levels of anxiety. Gender, Academic Year wereConclusion: significantly associated with anxiety levels. Predominant stressors were online learning & uncertainty related to their academic performance.

Development & validation of scales to assess stigma related to COVID-19 in India

Background & objectives: COVID-19 pandemic has triggered social stigma towards individuals affected and their families. This study describes the process undertaken for the development and validation of scales to assess stigmatizing attitudes and experiences among COVID-19 and non-COVID-19 participants from the community. Methods: COVID-19 Stigma Scale and Community COVID-19 Stigma Scale constituting 13 and six items, respectively, were developed based on review of literature and news reports, expert committee evaluation and participants’ interviews through telephone for a multicentric study in India. For content validity, 61 (30 COVID-19-recovered and 31 non-COVID-19 participants from the community) were recruited. Test–retest reliability of the scales was assessed among 99 participants (41 COVID-19 recovered and 58 non-COVID-19). Participants were administered the scale at two-time points after a gap of 7-12 days. Cronbach’s alpha, overall percentage agreement and kappa statistics were used to assess internal consistency and test–retest reliability. Results: Items in the scales were relevant and comprehensible. Both the scales had Cronbach’s ? above 0.6 indicating moderate-to-good internal consistency. Test–retest reliability assessed using kappa statistics indicated that for the COVID-19 Stigma Scale, seven items had a moderate agreement (0.4-0.6). For the Community COVID-19 Stigma Scale, four items had a moderate agreement. Interpretation & conclusions: Validity and reliability of the two stigma scales indicated that the scales were comprehensible and had moderate internal consistency. These scales could be used to assess COVID-19 stigma and help in the development of appropriate stigma reduction interventions for COVID-19 infected, and mitigation of stigmatizing attitudes in the community.

Incidence of hypoplastic posterior communicating artery and fetal posterior cerebral artery in Andhra population of India: a retrospective 3-Tesla magnetic resonance angiographic study / 대한해부학회지

The posterior communicating arteries (PCoA) are important component of collateral circulation between the anterior and posterior part of circle of Willis (CW). The hypoplasia or aplasia of PCoA will reflect on prognosis of the neurological diseases. Precise studies of the incidence of hypoplastic PCoA in Andhra Pradesh population of India are hitherto unreported, since the present study was undertaken. Two hundred and thirty one magnetic resonance angiography (MRA) images were analyzed to identify the hypoplasia of PCoA and presence of fetal type of posterior cerebral artery (f-PCA) in patients with different neurological symptoms. All the patients underwent 3.0T MRI exposure. The results were statistically analysed. A total of 63 (27.3%) PCoA hypoplasia and 13 cases with f-PCA (5.6%) cases were identified. The hypoplastic PCoA was noted more in males than females (P<0.05) and right side hypoplasia was common than the left (P<0.04); bilateral hypoplasia of PCoA was seen in 37 cases out of 63 and is significant. The hypoplastic cases of the present study also were associated with variations of anterior cerebral arteries and one case was having vertebral artery hypoplasia. Incidence of PCoA as unilateral or bilateral with other associated anomalies of CW is more prone to develop stroke, migraine and cognitive dysfunction. Knowledge of these variations in the PCoA plays a pivotal role in diagnoses of neurological disorders and in neurovascular surgeries and angiographic point of view.

Incidence of hypoplastic posterior communicating artery and fetal posterior cerebral artery in Andhra population of India: a retrospective 3-Tesla magnetic resonance angiographic study / 대한해부학회지

The posterior communicating arteries (PCoA) are important component of collateral circulation between the anterior and posterior part of circle of Willis (CW). The hypoplasia or aplasia of PCoA will reflect on prognosis of the neurological diseases. Precise studies of the incidence of hypoplastic PCoA in Andhra Pradesh population of India are hitherto unreported, since the present study was undertaken. Two hundred and thirty one magnetic resonance angiography (MRA) images were analyzed to identify the hypoplasia of PCoA and presence of fetal type of posterior cerebral artery (f-PCA) in patients with different neurological symptoms. All the patients underwent 3.0T MRI exposure. The results were statistically analysed. A total of 63 (27.3%) PCoA hypoplasia and 13 cases with f-PCA (5.6%) cases were identified. The hypoplastic PCoA was noted more in males than females (P<0.05) and right side hypoplasia was common than the left (P<0.04); bilateral hypoplasia of PCoA was seen in 37 cases out of 63 and is significant. The hypoplastic cases of the present study also were associated with variations of anterior cerebral arteries and one case was having vertebral artery hypoplasia. Incidence of PCoA as unilateral or bilateral with other associated anomalies of CW is more prone to develop stroke, migraine and cognitive dysfunction. Knowledge of these variations in the PCoA plays a pivotal role in diagnoses of neurological disorders and in neurovascular surgeries and angiographic point of view.

Childhood Leprosy in the Light of Global Leprosy Strategy 2016-2020

Achieving zero grade 2 disability among children diagnosed with leprosy was one of key targets identified in Global Leprosy Strategy (2016–2020). Considering this we decided to study the clinico-epidemiological features of childhood leprosy in the post elimination era, with special reference to disabilities, over a period of 10 years (2006 to 2015 ). These childhood cases were among the patients attending the leprosy clinic of Govt. Medical College Thrissur, a tertiary care hospital in South India. Data from the case records of all patients with leprosy aged < 15 years registered in our leprosy clinic were compiled and analysed. Out of 409 leprosy patients registered, 24 (5.9% ) were children < 15 years. In the first half of the study period (2006-2010) there were 13 childhood cases (6.2%) and in the second half (2011-2015) there were 11 (5.5%). Males (10) out numbered females (3) in the first half of study period where as in the second half, the sex ratio was almost equal (M=5, F=6). The commonest age group affected was 6 - 10 years during both halves of the study period. In both halves of the study period, majority had skin lesions of less than one year duration at the time of presentation. The commonest type of leprosy was borderline tuberculoid (n=19; 79%). All patients were smear negative for acid fast bacilli. Four patients (16.7%) had peripheral nerve thickening but none had visible deformity. Percentage of childhood leprosy (5.9%) in our study is lower than the national (8.94%) and state (6.97%) NLEP figures for the year 2015-2016. Absence of Grade 2 disability is a unique feature of our study. Zero Grade 2 deformity observed in our study is consistent with the Kerala and Tamil Nadu state NLEP data for the year 2016-2017. Zero Grade 2 disability in all our patients possibly points to the early treatment seeking behaviour of population in Kerala leading to early diagnosis and prompt management of lepra reactions.

A study of maternal mortality in a teritiary care hospital in North Coastal Andhra

Background: Pregnancy, although being considered a physiological state, carries risk of morbidity and at times death. Maternal mortality is an indicator for health care provided to the women. The major causes of maternal mortality are preventable through regular antenatal check-ups, early diagnosis and management of complications. Aim: The aim of this study was to focus on incidence of various causes of maternal mortality, and about avoidable factors that can prevent maternal deaths. Materials and methods: A hospital record based study of maternal deaths over a period of 2 years from January 2017 to December 2018 was done. The information regarding demographic profile and reproductive parameters were collected and results were analyzed. Results: MMR over a period of 2 years (2017 and 2018) was 962 per 100000 live births. Most maternal deaths occurred in the age group 20-24years. Majority were multi parous and unbooked cases. Hypertension, hemorrhage, sepsis are major direct causes. Febrile illness, respiratory disorders, cardiovascular disorders, anemia being indirect causes. Conclusion: Majority of maternal deaths were preventable by proper antenatal care, early detection of high risk pregnancies and their timely referral to tertiary care centre.

A comprehensive study on jaundice in pregnancy with emphasis on fetomaternal outcome

Background: Jaundice affects a small percentage (1-4 per 1000) of pregnant women, yet it is an important medical disorder especially in developing countries like India. Jaundice in pregnancy carries adverse outcomes for both the fetus and the mother. It accounts for 60% perinatal and 14% of maternal deaths. The aim of the study is to know the incidence of jaundice, to evaluate the causes of jaundice and to know the effect of jaundice during pregnancy on maternal and fetal outcome. Materials and methods: All pregnant women with jaundice admitted in the Department of Obstetrics and Gynecology, King George Hospital, Visakhapatnam between September 2015 and August 2017 were taken up for study. Results: The incidence of jaundice was 7.22 per 1000 deliveries. Since 92.54% of patients were between 20-35 years of age, maximum number of cases was Primi gravidae. The most common cause of jaundice was HELLP syndrome, hepatitis being the second most common cause. Maternal mortality was 12.74%, the perinatal mortality was 35.71%, prematurity being the commonest cause. Conclusions: Jaundice in pregnancy has adverse fetomaternal outcome. It should be managed as a team in collaboration of obstetrician, physician, gastroenterologist, anesthetist and neonatologist. Improvement in health education, regular antenatal check-ups and early referrals result in early diagnosis and treatment of jaundice during pregnancy thus reducing maternal and fetal morbidity and mortality.

Hemangioblastoma in the Setting of Von Hippel Lindau Disease: A Case Report

A 21-year-old Chinese gentleman with no known medical illness, presented with a history of right painless blurring of vision with central scotoma of two weeks duration. He also had a history of multiple episodes of seizures prior to presentation. Visual acuity was 1/60 with unremarkable anterior segment findings and no relative afferent pupillary defect. Fundus examination of the right eye revealed dilated and tortuous retinal veins with multiple retinal capillary hemangiomas and sub retinal hard exudates at the macula with edema. A diagnosis of Von Hippel Lindau disease was made when a posterior fossa mass suggestive of hemangioblastoma with obstructive hydrocephalus was seen on computed tomography of the brain. Craniotomy with nodule excision was performed. The retinal capillary hemangiomas were treated with the combination of laser photocoagulation and intravitreal Ranibizumab injections. Visual acuity subsequently improved to 6/36.

Declining prevalence of pulmonary paragonimiasis following treatment & community education in a remote tribal population of Arunachal Pradesh, India

Background & objectives: In India, human pulmonary paragonimiasis is an important public health problem in the northeastern (NE) region. In 2005 we reported a hyperendemic focus of paragonimiasis in a remote tribal village in the hills of Changlang district in Arunachal Pradesh. The community was made aware of the disease and all active cases were treated. This study was aimed to assess the decline in the prevelance of paragonimiasis in the same area after a re-survey done in 2011 after a gap of six years. Methods: Re-surveys were carried to determine the reduction in the prevalence of paragonimiasis. Community education was given to the villagers to raise their awareness about paragonimiasis. A total of 624 individuals including 301 children (age < 15 yr) were included in the study. Sputum and stool samples were examined for eggs of lung flukes. Serum samples were screened for IgG antibodies against lung fluke antigen by ELISA. Results: A significant (P<0.001) decline in the prevalence of paragonimiasis was found. There was decline in both ELISA positivity and egg positivity. Antibody positivity against excretory-secretary (ES) antigen in children (age < 15 yr) fell down from earlier 51.7 to 15.9 per cent and in individuals 16 - 30 yr of age the serological prevalence fell down from 22.4 to 8.2 per cent and in individuals aged > 31 yr, the decline in prevalence was from 15.3 to 3.7 per cent. Gender-wise analysis revealed that the decline in ELISA positivity was similar in both genders and fell down from 33.9 to 11.5 per cent in males and from 29.8 to 10.7 per cent in females. Similarly, there was a significant decline rate in egg positivity also. Interpretation & conclusions: The strategy of hotspot targeted active paragonimiasis case detection and treatment of infected cases together with community education appears to be feasible methods to achieve control of paragonimiasis in this region.

First case of Paragonimus westermani infection in a female patient in India.

Paragonimiasis is a foodborne parasitic zoonosis caused by lung fl uke species of the genus Paragonimus. The Paragonimus westermani is the most common human pathogen in Asian countries. In northeast India, Paragonimus heterotremus has been documented as the only human pathogen in the earlier literature. In India, P. westermani infection in humans remained undetermined. Herein, we report a case of pulmonary paragonimiasis due to P. westermani in an adult female in Manipur. The diagnosis was made by morphological and molecular characterisation of the eggs in the sputum. This is the fi rst confi rmed case of paragonimiasis due to P. westermani in India.

Microfilaria in Fine Needle Aspiration Cytology Smear of Mixed Parotid Tumor - A Case Report

Filariasis is a major public health disease in India especially at coastal areas of Andhra Pradesh, India. Microfilaria is some time seen as an incidental finding during fine needle aspiration cytology smear (FNAC). But it is very rare to find microfilaria in cytological smears of parotid lesions. This is unique finding not reported till to date at our institute. Microfilaria is seen mainly in peripheral blood smear. Wuchereria bancrofti is the most common parasite which causes lymphatic filariasis in India. Here we reported a case in which microfilaria is seen in cytological smears of parotid lesion, first time at our institute of Gandhi Medical College, Telangana, India.

Pharmacodynamic interaction of Boerhaavia diffusa with omeprazole in experimentally induced ulcers in rats .

The study evaluates the possible gastro protective of combination therapy of Omeprazole and Boerhaavia diffusa using three different gastric ulcer models. Gastric Ulcers in SD rats were induced by Indomethacin (25mg/kg), Pyrolus ligation model and stress-induced Ulcer. Various parameters like free acidity and total acidity, ulcer index, ulcer score, pepsin and mucin content, anti oxidant parameters like super oxide dismtase and catalase were evaluated. Omeprazole (2mg/kg) was used as the standard drug. Boerhaavia diffusa was administered at two dose levels, 200mg/kg and 400 mg/kg body weight. Statistical analysis was done by ANOVA followed by Dunnet’s Multiple Comparision test. P<0.05 was considerable statistically significant.Oral administration of combination of Omeprazole and Boerhaevia diffusa at 200 and 400 mg/kg produced significant (p<0.01 & p<0.001) decrease in acidity, ulcer index and severity of ulceration in the pylorus ligation model as well as protection against stress and Indomethacin induced ulcerations compared to control. It also shows significant (p<0.001) decrease pepsin content and significant (p<0.001) increase in mucin content compared to control pylorus ligation model. In Indomethacin induced model combination therapy at high level shows significant increase (p<0.001) in antioxidant parameters like SOD and catalase compared to control. The anti ulcer effects of combination of Omeprazole and Boerhaavia diffusa at both the dose levels were significantly higher than that of omeprazole alone. Combination therapy was found to be an effective anti ulcerogenic agent, minimizing any possible side effects. The result of the study suggests that combination therapy causes an inhibitory effect on release of gastric hydro chloric acid and protects gastric mucosal damage.

Bilateral Profound Visual Loss As a Consequence of Leukaemia – A Case Report

An 18-year-old Malay gentleman was noted to have profound bilateral blurred vision for one month duration, associated with loss of weight, appetite, low grade fever and abdominal distension. Visual acuity on presentation was 6/60 on the right, counting finger on the left with no afferent pupillary defect. Anterior segments were unremarkable. Vitreous cells were occasional bilaterally. Fundus revealed multiple choroidal and sub-retinal Roth spots with areas of pre-retinal and intra-retinal haemorrhages, involving the macula in the left eye. Vessels were dilated and tortuous in all quadrants of the right eye. Many areas of capillary fall out at peripheral retina were demonstrated in fundus fluorescein angiogram. Further systemic and laboratory review confirmed the diagnosis of CML and chemotherapy was initiated. Both eye ischaemic retinopathy secondary to CML was confirmed and scatter pan retinal photocoagulation was performed bilaterally. Good improvement in vision noted during subsequent follow up to 6/24 on the right, 6/60 on the left. High levels of suspicion and accurate early recognition of fundus changes are vital in these types of cases to ensure the institution of prompt treatment.

An Anthropometric Study on the Carrying Angle of Elbow among Young Adults of Various Ethinicities in Malaysia.

Background and Objectives: Prediction of stature from incomplete and decomposing skeletal remains is vital in establishing the identity of an unknown individual. Variety of factors such as race, gender and nutrition play an important role in determining the carrying angle of an individual. There were no study done in Malaysia to find the relationship of the carrying angle with common anthropological parameters and for comparing carrying angle among various ethnic group such as Malay, Chinese and Indians. This study was useful in finding the relationship of the discussed parameters with carrying angle among both genders and comparing between ethnics group in Malaysia. Materials and Methods: A total of 201 participants between ages of 18-25 years were included in the study. The carrying angle was measured and compared among the genders and among ethnic groups and data analysis was done using SPSS version 22. Results and Discussion: The findings indicated significant differences in the carrying angle between the genders and between left and right arm. The variation in carrying angle was significant among the males and females of various ethnicities. Conclusion: The findings in this study will be useful for clinicians, anatomists, archaeologists, anthropologists and forensic scientists when such evidence provides the investigator the only opportunity to gauge that aspect of an individual's physical description which are of value in management of arm fractures, introduction of prosthesis, evolutionary studies and forensic assessments.

A study of sister chromatid exchange in patients with dental amalgam restorations.

Study Background: Dental amalgam is still widely used as a restorative material in developing countries due to its low cost and ease of manipulation. The health risks associated with the components of this restorative material has always been a matter of concern. Our study was designed to address this question regarding dental amalgam. Objective: To study sister chromatid exchange (SCE) as an indicator of systemic genotoxicity, due to the exposure from the components of amalgam restorations during its placement and chronic use. Materials and Methods: Systemic genotoxicity in subjects exposed to amalgam during its placement (Group II; n = 5) and subjects with chronic exposure to amalgam (Group III; n = 5) were compared with controls (Group I; n = 5) by SCE assay in cultured peripheral blood lymphocytes. Result: Subjects exposed to amalgam during its placement and subjects having chronic exposure to amalgam showed an increase in the frequency of SCE, but the change was not statistically significant (P = 0.84, P = 0.123 respectively). Conclusion: Systemic genotoxicity was not observed due to the components of amalgam restorations released during its placement and chronic use. The findings of this study can be considered as preliminary information on the systemic toxicity due to the components of amalgam restorations.

Comparative evaluation of bovine derived hydroxyapatite and synthetic hydroxyapatite graft in bone regeneration of human maxillary cystic defects: A clinico-radiological study.

Introduction: Bone grafts are frequently used in the treatment of bone defects. Bone harvesting can cause postoperative complications and sometimes does not provide a sufficient quantity of bone. Therefore, synthetic biomaterials have been investigated as an alternative to autogenous bone grafts. Aim and Objectives: The aim of this study was to evaluate and compare bovine derived hydroxyapatite (BHA) and synthetic hydroxyapatite (SHA) graft material as bone graft substitute in maxillary cystic bony defects. Patients were analyzed by computerized densitometric study and digital radiography. Materials and Methods: In this study, 12 patients in each group were included randomly after clinical and radiological evaluation. The integration of hydroxyapatite was assessed with mean bone density, surgical site margin, and radiological bone formation characteristics, of the successful graft cases using computer densitometry and radio-visiograph. Statistical analysis was carried out using Mann-Whitney U-test, Wilcoxon matched pairs test and paired t-test. Results: By the end of 24 th week, the grafted defects radiologically and statistically showed similar volumes of bone formation. However, the significant changes observed in the formation of bone and merging of material and surgical site margin at 1 st week to 1 st month. The results were significant and correlating with all the parameters showing the necessity of the grafting for early bone formation. However, the bone formation pattern is different in both BHA and SHA group at 3 rd month interval with significant P value. Conclusion: Both BHA and SHA graft materials are biocompatible for filling bone defects, showing less resorption and enhanced bone formation with similar efficacy. Our study showed maximum bone healing within 12 weeks of grafting of defects. The BHA is economical; however, price difference between the two is very nominal.