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Introduction: Germ cell tumors, including germinomas, account for 10% of pediatric chronic Diabetes Insipidus (DI) cases. Delays in diagnosis of germinomas are generally longer than six months, however, no reported cases of suprasellar germinomas causing chronic DI and precocious puberty have been known to exceed a 5-year delay in both treatment of DI symptoms and a definitive diagnosis. Case Description: A 10-year-old Hispanic male presented with a 5-year history of polydipsia and polyuria. He underwent evaluation in Venezuela, where DI was reportedly 'ruled out';however, no head MRI was performed. After two years in the US struggling to acquire insurance, he presented to his pediatrician with worsening symptoms. A head MRI, ordered to evaluate dilute high-volume urine output, revealed a suprasellar mass. He was admitted for diagnostic evaluation and met the criteria for DI. Notably, he had an elevated Beta-Human Chorionic Gonadotropin (B-HCG) level. Biopsy confirmed the diagnosis of a Central Nervous System (CNS) germinoma. He was treated with DDAVP and proton therapy with subsequent remission of his tumor. Discussion: Throughout the patient's disease course, there were multiple delays in seeking and receiving care. These include a 5-year delay in seeking care despite worsening symptoms, a one-month delay in completing a 24-hour urine collection, a one-month delay in consulting pediatric nephrology, and another month delay before completing a retroperitoneal ultrasound. Multiple medical and socio-economic factors led to these delays. The patient did not present with symptoms more typical of CNS Germinomas like headaches, nausea, and vomiting. He had no visual disturbances despite mass effect on his optic chiasm. His increased stretched penis length and Tanner staging, which were identified later in his disease course, were contradicted by his pre-pubertal testicular volume and bone age. The patient is from a Spanishspeaking/Limited English Proficiency (SSLEP) household. While Spanish interpreters were present at each appointment, the language barrier proved to be a consistent issue. Initially, the child's mother indicated that the diagnosis of DI was 'ruled out' in Venezuela. In reality, the recommended imaging was never performed. Mychart messages left by his father further highlighted communication difficulties. Without access to an interpreter, he was forced to use broken English to relay his concerns. These frantic messages indicated misunderstandings regarding scheduling with various services and completing vital labs. Care only proceeded after significant physician intervention. Poverty in Venezuela, lack of insurance, and anxiety regarding COVID-19 also contributed to these delays. Conclusion: To our knowledge, this is the first case report of a pediatric patient presenting with a 5-year history of untreated polyuria and polydipsia due to undiagnosed DI with a B-HCG secreting CNS germinoma, without spinal metastasis. This study also illustrates the importance of supporting SSLEP families as they grapple with the complicated process of navigating our healthcare system. Sagittal T1 post gadolinium contrast image (A) and axial T2 FLAIR image (B) show an enigmatic, homogeneous, briskly enhancing mass in the suprasellar cistern (red arrow) with mass effect on the optic chiasm which is displaced upward and anteriorly (green arrow).
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Methods: In this ongoing randomized waitlist-controlled trial, we assessed changes in sleep,HRV & vitals, recorded overnight using a Ballistocardiography based health monitoring device. Outcomes were measured before (Day 0) & after (Day 4) a four-day online breath meditation workshop (OBMW) involving Sudarshan Kriya Yoga. 90 MPs from a tertiary care hospital in northern India were randomized equally (1:1) (45 participants each) to experimental (mean age 27.4±3.6) & waitlist-control (28.8±3.48) groups using computer-generated sequentially numbered opaque sealed envelopes. Results: All outcomes were found comparable at baseline. The between-groups analysis showed a highly significant increase in total sleep duration (p=0.000), duration of deep sleep (p=0.034), light sleep (p=0.000) & rapid eye movement sleep (p=0.000) with a significant reduction in respiration rate (p=0.015) for the Experimental group when compared to Controls. Within-group analysis showed highly significant improvements in HRV outcomes of SDNN (p=0.000) & RMSSD (p=0.000) & reduction in heart rate (p=0.006) for the experimental group alone. Background: Medical professionals (MPs) are facing tremendous stress, sleep deprivation & burnout due to COVID related high patient inflow& continuouswork shifts. Lowheart rate variability (HRV) & poor sleep regimes are associated with cardiomyopathy & diabetes in the long run. Yoga has strong evidence for its multifold mental & physical health benefits, yet no previous study has determined its acute effects on objective sleep measures & HRV among MPs during a pandemic. Conclusion: Maintaining a good sleep routine & high HRV result in greater cardiovascular fitness & vagal tone. Four days of OBMW might help induce psycho-physical relaxation & prove to be a feasible, cost-effective, & well-accepted tool to help build stress resilience. As the stakeholders in patient care i.e., MPs are healthy, it might further improve patient care & reduce the chance of medical errors. Further research is warranted to determine long-term effects in this regard.
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Introduction: COVID-19 was a public health emergency and declared it as a pandemic by WHO. During this pandemic every branch of health care delivery system was negatively affected including Blood Transfusion Services (BTS). The main objective of this study is to compare the blood donations, issued and wasted units of blood and their components during pre-COVID and COVID period. Materials and Methods: It was a retrospective cross-sectional study and data of all voluntary and replacement donations, issue and wastage of blood and blood components were collected from 1st April 2019 to 31st March 2021. This duration was divided into pre COVID period from April 2019 to March 2020 and COVID period from April 2020 to March 2021 for this study purpose. Results: During the study period total 2818 blood donation were observed. Out of this 1818 donations were in pre COVID and 1000 donation occurred in COVID period. The mean with SD of collected blood units per month in pre COVID was 151.5±73.46, while during COVID 19 it was 83.33±36.79 (p value 0.0088). A total 4036 units of blood and blood products were issued during study period. In pre COVID period 2592 units (mean/month 216±108.46) were issued, and 1444 units (mean/month 120.33±57.97) were issued during COVID period (p value 0.0132). Conclusion: To maintain stable reserve and ensure availability of safe blood to the patients an emergency preparedness plan is necessary and blood banks must follow the guidelines given by national and international authorities.
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Due to a lack of data on various parameters with COVID-19 in the Indian population, this study was carried out to understand the relation among gender, age and comorbidities in Indian population. The data was collected using a questionnaire-based survey form that included questions on demographic characteristics, infection and any pre-underlying conditions (n=1146). The data showed that the male patients had suffered more from COVID-19 (58.6%). Also, the patients suffering from comorbidity are more likely to suffer from a severe form of COVID-19 and obesity/overweight was identified as the most prevalent (n=69) comorbid condition, followed by diabetes (n=35), thyroid (n=19) and hypertension (n=11). In severe COVID-19 cases, 85% of patients had a comorbid condition. In another study of COVID-19 hospitalized-cases, about 97% of patients were found to have an underlying medical condition. Among these, diabetes (55.9%) was identified as the most prevalent comorbidity. Males and older people are at a higher risk of developing COVID-19 infection in Indian population. The comorbid conditions also predisposed individuals to COVID-19 and aggravated the infection. © 2022. ScienceIN.
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Introduction: To statistically compare the trends of epidemiological indicators of COVID-19 in India with Italy, the UK, and the US. Methodology: In this descriptive analysis, epidemiological indicators were calculated and their trends were plotted and compared statistically. Regression analysis was done to predict the fatalities. Results: The trends of total and active cases per million populations are rising in India and US, while Italy has achieved the plateau in the total cases per million populations, and active cases have been sharply declining with time. The UK is about to achieve the same. India has remained far behind the other three countries in the number of tests per million populations (p<0.05). In the initial phase, the test positivity rate of India was quite lower but has overtaken Italy and UK. India has always reported a higher recovery rate than US and lower than Italy. CFRs have achieved a plateau in Italy and UK, in US it is declining, while it remained almost constant in India throughout the pandemic. Testing was a significant covariate in predicting the fatalities. Conclusions: India was able to manage the initial phase of this pandemic due to early and strict government interventions and strong public health responses. @ 2022 The Journal retains the copyrights of this article.
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Since the COVID-19 eruption in December 2019, the investigation has been focused on its treatment and preventing the disease spread. Currently, there is no biomarker available that can predict the predisposition and severity of COVID-19 infection. In the present study, we have used the cross-sectional survey study data to decipher the association between the ABO blood group and susceptibility, severity and breakthrough COVID-19 infections. Further, we have also investigated the association between antibody class and the risk of contracting COVID-19 infection. Our results indicated that individuals with blood group B had higher susceptibility to acquire COVID-19 infection. In contrast, blood group A was found to be associated with a low risk of acquiring severe COVID-19. In addition, we did not find any correlation between ABO blood group and breakthrough COVID-19 infections. Further, we examined the association of antibodies;anti-A (blood groups B and O) and anti-B (blood groups A and O) with COVID-19 infection. The analysis of antibody classes showed that anti-A antibody associated with a high predisposition to acquire COVID-19 infection. The present study indicates that blood group B and anti-A antibodies are associated with proneness to COVID-19 infection and severity. © ScienceIN.
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Context: In India, COVID-19 pandemic has limited the utilization and access to dental services owing to the risk of infections transmission. In this context, tele-dentistry could be useful but there is paucity of literature which provides guidance on the scope and challenges for using tele-dentistry in India. Aims: To identify challenges, scope and assessment approaches of tele-dentistry from an Indian perspective. Settings and Design: Scoping Review. Methods and Material: Scoping review was conducted using the Arksey and O’Malley framework. Databases were searched in July from April to August 2020. Studies concerning challenges and scope of tele-dentistry in India were included. Additionally, literature about assessment approaches used for tele-dentistry programs were also reviewed Results: A total of 64 studies were reviewed, out of which 26 articles were included in the final review. Scoping review reveled that tele-dentistry could act as a seamless tool for diagnosing, training and screening. Few studies suggested the relevance of smartphone technology for specialist consultations and proper diagnosis. Majority of studies revealed shortage of basic infrastructure as a major challenge for tele-dentistry in India. Assessment studies were mainly focused on economic perspective and cost-effectiveness of the programs. Conclusions: This review provide guidance for using tele-dentistry in India. It is also reflected that there is a need for further research about the assessment of tele-dentistry in terms of safety, clinical outcomes, and patient perception. © 2021, Indian Association of Preventive and Social Medicine. All rights reserved.
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Background: Palliative care has an irrefutable part to play in oncologic management. Due to the ongoing COVID-19 pandemic, where many patients are unable to visit hospitals, tele-palliative care has become an attractive option. We conducted this study intending to assess the impact of tele-palliative care on the quality of life (QOL) of cancer patients in the setting of this pandemic. Methods: 60 patients of advanced stages of cancer on supportive care were prospectively recruited into the study. Each patient was assessed by physicians at baseline and every 2 weeks thereafter for 6 weeks and analysed for the difference in score. The baseline assessment was in-person and the subsequent assessments were made over the phone and utilizing teleconferencing services when needed. At each assessment, patients received supportive care, symptomatic medication, and counselling as required. The quality of life at baseline and at 6 weeks of receiving tele-palliative care was assessed using the functional assessment of chronic illness therapy- palliative care (FACIT-Pal) version 4 questionnaire. The questionnaire had 5 sub-scales which are used to calculate three quality of life indices, FACIT-Pal Trial Outcome Index (TOI), FACT-G, and FACIT-Pal Total score. The higher the score of the indices, the better is the QOL. Results: At 6 weeks, all the sub-scale scores and indices showed a significant improvement improved when compared to baseline except for the emotional well-being subscale. Among the indices, the improvement in the mean scores was the highest (8.01%) for TOI and the least (6.03%) for the FACIT-PAL total score. The mean of TOI at 6 weeks was 88, standard deviation (SD) of 16.69,95% CI 83.69-92.31) compared to mean at baseline 77.43(SD-16.52, 95% CI 73.16-81.70) with a p-value of <0.0001. The mean of FACIT-Pal total at baseline was 112.08(SD-20.45, 95% CI 106.79-117.36) and at 6 weeks, the mean was 123.17(SD-20.58, 95% CI-117.86-128.49) with a p-value of <0.0001. Conclusions: Tele-palliative care in the background of the COVID-19 has resulted in improved QOL of symptomatic cancer patients. This study reiterates the importance of palliative care and encourages us to devise ways to provide this invaluable service. Legal entity responsible for the study: The authors. Funding: Has not received any funding. Disclosure: All authors have declared no conflicts of interest.
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We report a familial cluster of 24 individuals infected with SARS-CoV-2. The index case had a travel history &spent twenty four days in the house before being tested and was asymptomatic. Physical overcrowding in the house provided a favourable environment for intra-cluster infection transmission. Restriction of movement of family members due to countrywide lockdown limited the spread in community. Among the infected, only 4 individuals developed symptoms. The complete genome sequences of SARS-CoV-2 was retrieved using next-generation sequencing from eight clinical samples which demonstrated a 99.99% similarity with reference to Wuhan strain and the phylogenetic analysis demonstrated a distinct cluster, lying in the B.6.6 pangolin lineage.
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Background: Hydroxychloroquine(HCQ), one of the repurposed drugs in COVID-19, has several known cardiovascular(CVS) toxicities. Methods: VigiBase data were used to analyze the reported ADEs linked to HCQ. The data were analyzed based on age, gender, and seriousness of ADEs at the System Organ Classification level and the individual Preferred Term level. Results: The majority were above 18 years(91.6%) and from Europe(41.6%). A total of 5,315 ADEs were associated with HCQ use in COVID-19. Of these, 918 ADEs were attributed to CVS and reported from 773 patients. Grossly, CVS ADEs were associated with concomitant use of HCQ and azithromycin(AZM), and only 40 ADEs were solely due to HCQ. The majority were serious (69.3%) and resolved afterward (51%). In CVS ADEs, there were 366 cardiac disorders, 38 vascular disorders, and 514 ADEs under investigation. Among the cardiac disorders, palpitation was the most typical (N=65), followed by bradycardia(N=44) and tachycardia(N=33). Among arrhythmias, QT prolongation (N=469), atrial fibrillation (N=25), and ventricular tachycardia(N=16) were common. The odds of developing serious CVS ADEs increased with age, patients aged 45-64 years(OR=1.75;p=0.015) and >65 years(OR=1.93, p=0.003) as compared to younger ones. Conclusion: Hydroxychloroquine with known CVS toxicities and increased risk with co-administering AZM makes physicians cautious while prescribing in COVID-19 patients.
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The covid-19 virus changed everything suddenly, the lockdown was imposed, and social distancing became the new normal. This pandemic has affected the routine operations of every business organisation overall industries globally in the year 2020. With the lockdown in place, billions of people, excluding the essential workers, have been forced to work from home. Corporate authorities around the world have no other alternative than providing flexible worksetting including work from home. This research was an attempt to explore the relationships/impact of work from home on employee performance under descriptive research design.The research was aimed to test the relationship between the variables affecting employee performance while working from home during the lockdown, based on the hypothecated model of the theory of planned behaviour. Hypothetical relations among the variables were tested using parametric statistical analysis with the help of AMOS model testing. It was found that employee’s performanceduring their tenure of work from home is dependent on their attitude towards work from home and home atmosphere. © 2021, Ashwin Anokha Publications and Distributors. All rights reserved.
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The COVID-19 pandemic gave an opportunity to adopt many appropriate changes in the behavior of the people in India. The major gears of those behavior changes were the enforcement by the government, fear, motivation (self and induced), and self-experiences or realizations with time. If those changes are fitted in the Trans-Theoretical Model, Indian people have passed through the "Pre-Contemplation" to "Action" stage of behavior changes during different phases of this pandemic. Frequent hand hygiene, maintaining physical distancing, use of face mask, cough etiquettes, avoid greetings through physical contacts, fear in spitting and urination at public places, refrain from gatherings and avoiding outside food are some of the examples of those appropriate behaviors which were enforced or learnt during the COVID pandemic. The continuous lockdown made people understand the difference between "want" and "need," the importance of local production, and the significance of social media and technology in routine life. The work-from-home strategy gave a chance to appreciate the work--life balance in a more applied way. The first-ever lifetime experience of unbelievable rejuvenating nature because of lack of human play taught people to appreciate nature. Although the current focus is on responding to the pandemic and on coping with its immediate effects, yet this is the time when there is an urgent need to create an enabling environment to support and sustain these COVID-19 appropriate behaviors (maintenance stage) to reap the maximum benefits out of them. Sustaining these appropriate behaviors is also important considering the bimodal distribution of the COVID-19 and possibility of advent of the second wave of COVID-19 in near future.
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Objective: The coronavirus disease 2019 (COVID-19) also known as COVID-19 or severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) is a viral infection caused by severe acute respiratory syndrome coronavirus 2, emerged first in Wuhan, China, and spread all over the world. The World Health Organization on January 30, 2020, officially declared the COVID-19 epidemic as a public health emergency of international concern. There is speculation as to the origin of the infection and the objective of this narrative review is to scan the available literature to create a cohesive review. Methodology: This review article is based on a literature search of PubMed, Google, and Google Scholar using the keywords " Corona virus," "COVID-19," "COVID" "Origins," "Review," and "classification." Articles providing new information were selected. Results: The coronavirus which has caused a pandemic has a genomic structure which closely resembles that of a bat coronavirus. The region that binds angiotensin-converting enzyme 2 (ACE2), i.e., the region of the spike proteins, resembles a coronavirus found in the pangolin (a scaly anteater found in the Chinese market and used in Chinese medicine). It is possible that the coronavirus was existing initially in its natural hosts, the bat, or pangolin. It is likely that the spike proteins mutated to bind to molecules similar to the human ACE2 protein therefore allowing it to infect humans. Another possibility is that it jumped species from bat to human and then became capable of causing pathogenic disease. The mutations in the receptor-binding domain portion of the spike protein and its distinct backbone, rules out laboratory manipulation as a potential origin for SARS-CoV-2. It is not certain if the necessary mutations for causing the pandemic occurred before or after SARS-CoV-2 made the jump to humans. Conclusions: The current corona pandemic is due to the SARS-CoV-2 and there is evidence that it has spread to humans from bats. Pangolins, civet cats may be reservoirs for the virus, but as of now, there is no evidence of a laboratory origin of the virus. It is not clear whether the virus jumped species recently or was preexisting in humans and became pathogenic because of a recent mutation.
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The world is in the midst of a corona virus disease (COVID-19) pandemic. We review a case of COVID-19 myocarditis which was successfully managed and reported and also comment on the connection of COVID-19 and the heart.
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BACKGROUND: Duration of persistence of SARS-CoV-2 in the upper respiratory tract of infected individuals has important clinical and epidemiological implications. AIM: We aimed to establish the duration and risk factors for persistence of SARS-CoV-2 in the upper respiratory tract of asymptomatic infected individuals. METHODS: Data of repeat rRT-PCR (real-time reverse transcription-polymerase chain reaction) test done for SARS-CoV-2 infected individuals at our institute at Jodhpur, India were analysed from 19 March to 21 May 2020. Duration of virus persistence was estimated with parametric regression models based on weibull, log-normal, log-logistic, gamma and generalized gamma distributions. Factors associated with prolonged viral persistence were analysed with the best-fitting model. RESULTS: Fifty-one SARS-CoV-2 infected individuals with repeat rRT-PCR test were identified with 44 asymptomatics. The asymptomatic individuals had median virus persistence duration of 8.87 days (95% CI: 7.65-10.27) and 95 percentile duration of 20.70 days (95% CI: 16.08-28.20). The overall median virus persistence including both symptomatic and asymptomatic individuals was found to be 9.18 days (95% CI: 8.04-10.48). Around one-fourth asymptomatics (10/44) demonstrated SARS-CoV-2 persistence beyond 2 weeks. Age <60 years and local transmission were found to be significantly associated with longer virus persistence among asymptomatic individuals on univariate regression but not in multivariate analysis. CONCLUSION: Recommended home isolation duration for SARS-CoV-2 infected individuals in India should be extended from 17 days to at least 3 weeks. Prolonged persistence of SARS-CoV-2 in a considerable proportion of asymptomatic individuals merits attention with regard to ensuring universal infection prevention precautions irrespective of symptomatic status.