Psychological response and perception to lockdown among keralites during the COVID-19 pandemic: a cross-sectional study

Background: Kerala, which has a population density of 860 people per square kilometre, has been able to significantly curb the spread of COVID-19. This was a result of people in the State, politics, and social settings. Previous outbreaks showed that psychological symptoms could be severe and last longer than physical illness. This study examines the sources of information as well as the peritraumatic distress, attitude towards lockdown. Methods: 2335 individuals under lockdown were given a 32-item questionnaire over the internet from March to August 2020. This covers demographic data, days spent in quarantine, attitude, and awareness, adherence to lockdown procedures, and PDI for measuring psychological distress. Overall score was calculated and associations found using the Chi-square test in SPSS 20. Results: The average quarantine period lasted 10.12 days. 77.9% of individuals reported high stress, with a mean PDI score of 47.73. The psychological distress was more severe for those who were female and were placed in quarantine. The PDI score has associations with gender, education, health care access, loneliness, and the propensity to not adhere to lockdown measures. 89% of the responders expressed concern for their safety. We discovered that being in quarantine had a significant association with loneliness, concern about getting medical care, and resource accessibility. Conclusions: The population had high levels of perceived stress during the pandemic. The detrimental effects of COVID-19 do not just fit into morbidity and mortality but have wider implications for mental health issues that require proper attention.

Academic passion, perceived stress and sleep quality evaluated among medical students of private medical colleges in North Kerala

Background: Passionate doctors are required for a better health care system. Increased professional and academic requirements increase risk of developing stress and sleep disruption. This study aims to determine the academic passion, stress and sleep quality among medical students and explore the associations among them, which helps to create awareness to improve the mental and physical health of future doctors. Methods: This cross-sectional study among 649 MBBS students was done at 3 private medical colleges in North Kerala during 2019-2020 using a semi-structured 31-item questionnaire containing 4 sections: socio-demographic information, academic passion, perceived stress, and sleep quality. Data collected in 30 minutes from study participants in campus setting was entered in MS excel and analyzed using SPSS-20. Result: A 61.6% were women and 38.4% were men. 48% had chosen the profession because of parental pressure, relatives and friends. 51% were passionate about the medical profession. 69% of students were under high perceived stress (mean PSI score 33.54±8.71 SD). 48% of students were poor sleepers (mean PSQI score 6.11±3.45). A 15.6% of participants relied on medication for sleep at least once a month. Passion showed a significant association with stress (p<0.001) and sleep (p<0.001). Passionate students had less perceived stress and lower sleep quality. Conclusions: Apart from one's own desire, other factors influenced students to choose MBBS. Only half of the participants were passionate. There is a high prevalence of stress and poor sleep quality among medical students. Passion has an imperative role in one’s life quality.

Relationship between quality of life and postpartum depression among women in North-Central, Nigeria

Background: Postpartum depression is a problem of public health interest and impacts negatively on the perception of quality of lifer of sufferers. Quality of life' (QoL) as an outcome measure, is scantly used on women with postpartum depression in Nigeria. The current study was designed to assess the QoL of women with postpartum depression (PPD) in a tertiary hospital in North-Central, Nigeria.Method: A two-stage cross sectional procedure was used to recruit 550 participants 6 to 8 weeks postpartum in Jos, Northcentral, Nigeria. The Edinburgh Postnatal Depression Scale (EPDS), the World Health Organization Quality of Life-BREF-26 (WHOQoL-BREF-26) questionnaire and the Depression Module of the Structured Clinical Interview for DSM-IV axis I Diagnosis (SCID) were used.Results: The studied participants were 531 out which 21.8% with postpartum depression had significantly poor perception in all the four domains of the WHOQoL-BREF-26 i.e., in the physical health (p<0.001), psychological (p<0.001), social relationships (p<0.001) and environmental (p<0.001) domains. On the whole, the overall rating of quality of life (p=0.002) and satisfaction with general health (p<0.001) were also perceived to be poor when compared to those without depression. However, regression model analysis showed that the presence of postpartum depression in a participant predicts a significant negative perception on physical and environmental domains of quality of life, but a positive prediction on the general satisfaction with health. Conclusion: Postpartum depression as a disorder of public health importance impacts on the perception of quality of life of women who suffer from it. Early detection and treatment will improve the quality of life of women with postpartum depression

A neonatal pneumococcal conjugate vaccine trial in Papua New guinea: study population, methods and operational challenges

Infants in Papua New Guinea (PNG) are at a high risk of invasive pneumococcal disease, and a substantial burden of this falls on children less than six months old. PNG is planning to introduce a pneumococcal conjugate vaccine for infants in the near future, but to make the maximum impact neonatal immunization will have to be considered. To provide evidence on safety and immunogenicity for neonatal and early infant immunization, we undertook an open randomized controlled trial of 7-valent pneumococcal conjugate vaccine (7vPCV). 318 children received 7vPCV at ages 0, 1 and 2 months or at 1, 2 and 3 months or not at all. All children received 23-valent pneumococcal polysaccharide vaccine at age 9 months. This was a large and complex trial: village reporters visited participants weekly during the first year and fortnightly for a further 6 months and nurses monitored self-reported morbidity and collected many thousands of biological samples. The study team was remarkably successful in achieving the study aims, with 18-month follow-up completed on 77% of enrolled children and over 80% of scheduled samples collected. While the results of the trial will be reported elsewhere, this paper discusses the design of the study and dissects out some of the main reasons for its successful completion. Strong community engagement was an essential factor in success and the principles of equitable partnership and service provision led to a strong research partnership. A two-stage consent process, comprising primary assent followed by later informed consent, led to a high drop-out before initial enrolment, but an outstanding retention of those enrolled in the study. We conclude that factors such as strong community participation, reciprocity and a good relationship between the study team and participants are just as important as the technical elements of laboratory testing and data handling in ensuring the success of a vaccine trial in PNG.

Determinants of Extramarital Sex by Men in Tanzania: A Case Study of Mbeya region

This paper attempts to identify some factors associated with extramarital sex by men in the Mbeya region of Tanzania using data from a survey conducted in 2003/2004. The choice of Mbeya region was prompted by the fact that it has been found by previous studies to be one of the regions with the highest HIV prevalence rate in Tanzania. Correlates of extramarital sex that were considered include current age; education; residence; age at first sexual intercourse; age at first marriage and sex before marriage. A bivariate analysis of the survey data; which comprised a sample size of 568 married men aged between 15 and 62 years revealed statistically significant association between extramarital sex with current age; education; age at first intercourse and sex before marriage. The effect of these variables was tested through a multivariate logistic regression analysis and all the four independent variables were found to be statistically significant predictors of extramarital sex in Mbeya region

Transmission of Human African Trypanosomiasis in the Komo-Mondah focus; Gabon

Knowledge about transmission of sleeping sickness in a given focus is of a great importance since it governs the efficacy and the cost-effectiveness of control strategy. The Komo-Mondah focus is the most endemic sleeping sickness focus of Gabon. This focus has hardly been investigated and available publications are more than thirty years old. In order to update transmission features of sleeping sickness in that focus; we have conducted epidemiological and entomological surveys in March-April 2008. Methods: Epidemiological investigation relied on a case-control study using a quantitative and qualitative methodology (a structured questionnaire). Cases were affected people (parasitological positive) diagnosed by the national control program from 2004 to 2007; controls were those found disease-free after clinical examination and biological tests in the same period. They were asked to respond to a standard questionnaire concerning their activities after having signed a written consent. An unvaried analysis was first performed and then a multivariate analysis using the conditional logistic regression for matching method. Traps were then set out for four days in areas where people were working. Tsetse flies captured were identified and dissected; their density and human-fly contact points were determined. Results: A risk of infection was associated with fishing activities (Odds-ratio: 5.69; CI95: 3.38-9.57). Three species of Glossina were captured: Glossina palpalis palpalis; Glossina fuscipes fuscipes and G. Caliginea. Human-fly contact points were mainly landing stages. Conclusion: A combined strategy of case-detection and vector control targeted at landing stages should be efficient against the disease

Spontaneous splenic rupture in a patient receiving thrombolytic therapy / Ruptura esplênica espontânea em paciente submetida a terapia trombolítica

We describe the case of a 67-year-old female patient with a history of femoral-distal bypass graft with sudden onset of unremitting leg pain, who had recently received tissue plasminogen activator (t-PA). The patient reported non-compliance with her warfarin regimen. Angiography revealed occlusion of the bypass graft. Infusion of t-PA was performed via a right femoral artery approach. On hospital day two, the patient developed nausea and abdominal pain with associated hypotension. A CT scan showed a massive intra-abdominal and pelvic free fluid consistent with blood. The spleen was enlarged and fluid noted around the liver. At laparotomy, a grade III splenic laceration at the hilum was identified and a splenectomy performed. The patient recovered completely. Although rare, spontaneous splenic rupture should be considered in the differential diagnosis of patients undergoing thrombolytic therapy who develop signs of hemodynamic instability.

Descrevemos o caso de uma paciente de 67 anos com histórico de enxerto fêmoro-distal com início súbito de dor repetitiva em membro inferior e que havia recebido ativador de plasminogênio tecidual (AP-t) recentemente. A paciente relatou não adesão ao seu tratamento com warfarina. A angiografia revelou oclusão do enxerto. O AP-t foi administrado via artéria femoral direita. No segundo dia de hospitalização, a paciente apresentou náuseas e dor abdominal com hipotensão associada. Uma tomografia computadorizada revelou a existência de um fluido pélvico e intra-abdominal livre em grande quantidade, com suspeita de que fosse sangue. O baço estava crescido, e o fluido foi observado em torno do fígado. A laparotomia identificou uma laceração grau III no hilo esplênico, e uma esplenectomia foi realizada. A paciente teve recuperação completa. Embora rara, a ruptura esplênica espontânea deve ser considerada no diagnóstico diferencial de pacientes submetidos a terapia trombolítica que apresentem sinais de instabilidade hemodinâmica.

Isolation of cryptococcus, candida, aspergillus, rhodotorula and nocardia from meningitis patients in Egypt

Meningitis occurs throughout Egypt and is largely attributed to bacterial pathogens, but there is little information on fungal etiologies of meningitis. We, therefore, investigated fungal infections among Egyptian patients with acute and subacute meningitis who tested negative for bacterial and viral agents. A total of 1000 cerebrospinal fluid [CSF] samples collected from nine governorates of Egypt during 1998-2002 were initially stained with Gram's, India ink, and lacto-phenol cotton-blue stains, and examined under light microscope to detect fungal elements. All CSF samples were cultured on brain heart infusion, Wickerham and Staib agar media for fungus isolation. CSF with suspected Cryptococcus neoforntans infections were also tested by latex agglutination test for antigen detection. Species identification of selected isolates was carried out at the Mycotic Diseases Branch, CDC, Atlanta, Georgia, USA. Fungal agents were detected microscopically and by culture in 17 of 1000 [1.7%] CSF samples tested. Ten of 17 were identified as C. neoformans var grubii [serotype A], 4 as Candida albicans, and one each of Aspergillus candidus, Rhodotorula mucilaginosa [rubra] and Nocardia spp [actinomycetes]. Out of the 17 cases with fungal CSF infection, 8 died [Cryptococcus-3. Candida-2, AspergiUus, Rhodotorula and Nocardia] and 2 suffered neurological sequelae. Of the 10 cryptococcal meningitis patients, 4 were HIV positive and one was diagnosed with lymphoma. To our knowledge, this is the first study on isolation of fungi other than Cryptococcus from CSF of Egyptian patients with acute/subacute meningitis. Consideration must now be given to cryptococcosis and candidiasis as potential etiologies of meningitis in Egypt

Rapid enzyme-linked immunosorbent assay for the diagnosis of human brucellosis in surveillance and clinical settings in Egypt

To optimize and standardize an enzyme-linked immunosorbent assay [ELISA] for rapid diagnosis of human brucellosis in clinical cases identified during a surveillance study for acute febrile illness [AFI]. Serum samples from patients presenting with AFI at 13 fever hospitals across Egypt between 1999 and 2003 were kept frozen at NAMRU-3 and used in this study. The assay was evaluated in 5 subject groups: brucellosis cases confirmed by blood culture [group I, n=202] 87% positive by standard tube agglutination test [TA], brucellosis cases exclusively confirmed by TA [group II, n=218], blood cultures from AFI cases positive for bacterial species other than Brucella [group III, n=103], AFI cases with unexplained etiologies [group IV, n=654], and healthy volunteers [group V, n=50]. All members of groups III-V were negative for brucellosis by TA. Sensitivity and specificity of ELISA for total specific antibodies were >=96% versus 87% for TA as compared to microbial culture, the current gold standard method for Brucella identification. Assessment of Brucella antibody classes by ELISA in random subsets of the 5 groups showed significantly high [p>0.001] levels of anti Brucella IgG [>=81%] and IgM [>=90%] in groups I and II only. The obtained sensitivity and specificity results indicate that our ELISA is more suitable for AFI surveillance and clinical settings than blood culture and TA. The developed assay is also cost-effective, easier to use, faster, and the coated plates can be stocked for at least 8 months, providing a potential for field use and automation

Easy detection of green fluorescent protein multicopy transformants in Penicillium griseoroseum

Penicillium griseoroseum, a deuteromycete fungus producer of pectinolytic enzymes, was transformed with a gene encoding for green fluorescent protein (GFP). The selection of transformants was based on the homologous nitrate reductase gene (niaD). Protoplasts of a P. griseoroseum Nia mutant (PG63) were co-transformed with the plasmids pNPG1 and pAN52-1-GFP. The plasmid pNPG-1 carries the homologous niaD gene and pAN52-1-GFP carries the SGFP-TYG version of GFP. The highest transformation efficiency (102 transformants/µg of pNPG1) resulted from the utilization of equimolar amounts of transforming and co-transforming vectors. Analysis of pAN52-1-GFP insertions into the genomic DNA of the transformants revealed single and multiple copy integrations. The transformants possessing a single copy of the gfp gene showed a low level of fluorescence, whereas multicopy transformants displayed strong fluorescence under visualization with fluorescent light. The transformants showing high expression of the gfp gene had the normal mycelia pigmentation altered, displaying a bright green-yellowish color, visible with the naked eye on the plates, without the aid of any kind of fluorescent light or special filter set.

Insomnia: behavioural and cognitive interventions

Esta revisäo trata do diagnóstico e tratamento näo-farmacológico da insônia. Na primeira parte, säo apresentados critérios para a definiçäo de insônia e um roteiro clínico para a investigaçäo das suas várias causas (físicas, relacionadas a drogas, mentais e comportamentais). Na segunda parte, säo discutidas diferentes técnicas de relaxamentos e um programa detalhado de controle de estímulos aplicados à terapêutica da insônia.

Tratamiento de las estenosis del esófago: experiencia del Hospital General de México / Treatment of the esophageal structures: experience in the Hospital General de Mexico

Presentamos nuestra experiencia en los procedimientos de dilatación del esófago, en los últimos diez años, un número elevado de pacientes han sido tratados con resultados muy satisfactorios en las estenosis de origen péptico o inflamatorio en general, resultados regulares en las estenosis originadas por la ingesta de substancias corrosivas y aceptables en las estenosis malignas del esófago, tomando en cuenta la índole y el pronóstico del padecimiento de base. Nuestra morbimortalidad es menor a la informada en la mayor parte de la literatura y el número de pacientes y procedimientos realizados es también mayor a lo publicado en series individuales.

Regulation of sialyltransferase activity in intestinal segments of rats.

A differential distribution of sialyltransferase (ST) in different regions of intestine has been shown. Jejunum and ileum homogenates from rats showed almost exclusive presence of alpha-2-3 ST (to Gal in Gal beta-1-4GlcNAc and/or to Gal in Gal beta-1-3GalNAc). In contrast, colon homogenates showed the presence of both alpha-2-3 ST (as above) and alpha-2-6 ST. Incubation of intestinal slices in presence of heat-inactivated horse serum (HHS) showed a time- and temperature-dependent secretion of soluble ST into the medium. Both jejunum and ileum slices showed high rates of secretion of alpha-2-3 ST. Colon slices, though rich in alpha-2-6 ST, secreted only alpha-2-3 ST. Colchicine, an anti-mitotic drug, injected into rats caused about 10-fold increase of the serum ST level. Jejunum slices from colchicine-treated rats showed an increased secretion of alpha-2-6 ST, suggesting that intestine undergoes a change in the expression of normal secretion of alpha-2-3 ST to a secretion of alpha-2-6 ST. The secretion of ST from incubated intestinal slices was inhibited by heparin. Certain protein factors (anti-proteases) in HHS bind to heparin-sepharose column and these protein factors are responsible for causing the secretion of ST into the medium. It has also been found that a supernatant fraction of the colon homogenate activated ST. Gel chromatography on HPLC produced 3-4 protein fractions from the colon cytosol and one of this fraction bearing high molecular weight proteins produced the maximum activation of ST.(ABSTRACT TRUNCATED AT 250 WORDS)