Hyperglycemia and steroid use increase the risk of rhino-orbito-cerebral mucormycosis regardless of COVID-19 hospitalization: Case-control study, India.

BACKGROUND: In the ongoing COVID-19 pandemic, an increased incidence of ROCM was noted in India among those infected with COVID. We determined risk factors for rhino-orbito-cerebral mucormycosis (ROCM) post Coronavirus disease 2019 (COVID-19) among those never and ever hospitalized for COVID-19 separately through a multicentric, hospital-based, unmatched case-control study across India. METHODS: We defined cases and controls as those with and without post-COVID ROCM, respectively. We compared their socio-demographics, co-morbidities, steroid use, glycaemic status, and practices. We calculated crude and adjusted odds ratio (AOR) with 95% confidence intervals (CI) through logistic regression. The covariates with a p-value for crude OR of less than 0·20 were considered for the regression model. RESULTS: Among hospitalised, we recruited 267 cases and 256 controls and 116 cases and 231 controls among never hospitalised. Risk factors (AOR; 95% CI) for post-COVID ROCM among the hospitalised were age 45-59 years (2·1; 1·4 to 3·1), having diabetes mellitus (4·9; 3·4 to 7·1), elevated plasma glucose (6·4; 2·4 to 17·2), steroid use (3·2; 2 to 5·2) and frequent nasal washing (4·8; 1·4 to 17). Among those never hospitalised, age ≥ 60 years (6·6; 3·3 to 13·3), having diabetes mellitus (6·7; 3·8 to 11·6), elevated plasma glucose (13·7; 2·2 to 84), steroid use (9·8; 5·8 to 16·6), and cloth facemask use (2·6; 1·5 to 4·5) were associated with increased risk of post-COVID ROCM. CONCLUSIONS: Hyperglycemia, irrespective of having diabetes mellitus and steroid use, was associated with an increased risk of ROCM independent of COVID-19 hospitalisation. Rational steroid usage and glucose monitoring may reduce the risk of post-COVID.

Incorporating Digital Interventions into Mental Health Clinical Practice: a Pilot Survey of How Use Patterns, Barriers, and Opportunities Shifted for Clinicians in the COVID-19 Pandemic.

Although many digital mental health interventions are available, clinicians do not routinely use them in clinical practice. In this pilot survey, we review the factors that supported the rapid transition to televisits during the COVID-19 pandemic, and we explore the barriers that continue to prevent clinicians from using other digital mental health interventions, such as mindfulness applications, mood trackers, and digital therapy programs. We conducted a pilot survey of mental health clinicians in different practice environments in the USA. Survey respondents (n = 51) were primarily psychiatrists working in academic medical centers. Results indicated that systemic factors, including workplace facilitation and insurance reimbursement, were primary reasons motivating clinicians to use televisits to provide remote patient care. The shift to televisits during the pandemic was not accompanied by increased use of other digital mental health interventions in patient care. Nine clinicians reported that they have never used digital interventions with patients. Among the 42 clinicians who did report some experience using digital interventions, the majority reported no change in the use of digital applications since transitioning to televisits. Our preliminary findings lend insight into the perspective of mental health clinicians regarding the factors that supported their transition to televisits, including institutional support and insurance reimbursement, and indicate that this shift to virtual patient care has not been accompanied by increased use of other digital mental health interventions. We contend that the same systemic factors that supported the shift toward virtual visits in the COVID-19 pandemic may be applied to support the incorporation of other digital interventions in mental healthcare. Supplementary Information: The online version contains supplementary material available at 10.1007/s41347-022-00260-8.

Sero-epidemiological survey of SARS-Cov2 in urban slums of a capital city: A cross- sectional study.

Introduction: Slums are the most vulnerable settlements for COVID-19 infection due to overcrowding and unsanitary conditions. Thus, this study was undertaken to determine the level of seroprevalence for SARS-CoV-2 infection among slum dwellers. Material and Methods: A community-based cross-sectional seroepidemiological survey was conducted at several slums of Patna over four weeks, that is, January 20-February 20, 2021. A total of 650 participants were recruited in the study by applying a two-stage random sampling technique. Results: Seroprevalence for SARS-CoV-2-specific IgG antibody was found to be 31.5% (95% Confidence Interval (CI): 27.9-35.1). The seropositivity prevalence was found to be statistically higher among participants belonging to the age group of 18-30 years (41.1%), male gender (67.9%), high-risk occupation (70%), below poverty line (BPL) economic status (62.1%), and residing in a hut (51.2%) and kutcha house (42.4%). Further, 262 participants reported having COVID-like symptoms in the preceding 1 month of the survey, which was found to be significantly associated with the seropositivity status. Conclusion: The finding of the study reflects that a moderate seroprevalence level of COVID-19 infection was acquired in the slum settings of Bihar. Unchecked spread in these informal communities will pose a serious threat to the rest of the bigger sections of urban populations. This indirectly calls for early intervention in the form of preference in the roadmap of COVID-19 vaccination.

The Effects of COVID-19 Hospital Practices on Breastfeeding Initiation and Duration Postdischarge.

Background: Early in the COVID-19 pandemic, many birth hospitals separated SARS-CoV-2-positive mothers from their newborn infants and advised against breastfeeding to decrease postnatal SARS-CoV-2 transmission. Information on how these practices impacted breastfeeding postdischarge is limited. Objectives: In a statewide sample of SARS-CoV-2-positive mothers, we aimed to determine the extent to which (1) mother-infant separation and (2) a lack of breastfeeding initiation in-hospital were associated with breast milk feeding postdischarge. Design/Methods: From 11 birthing hospitals in Massachusetts, we identified 187 women who tested positive for SARS-CoV-2 from 14 days before to 72 hours after delivery (March 1-July 31, 2020) and their newborn infants. We abstracted chart data from the delivery hospitalization on main exposure variables (mother-infant separation, in-hospital breast milk feeding [expressed milk feeding and/or direct breastfeeding]) and from outpatient visits until 30 days postdischarge. We evaluated associations of in-hospital practices with outcomes up to 30 days postdischarge, adjusting for confounders using multivariable logistic and linear regression. Results: Mother-infant separation in-hospital was associated with a shorter duration of any breast milk feeding (regression coefficient estimate -5.29 days, 95% confidence intervals [CI] [-8.89 to -1.69]). Direct breastfeeding in-hospital was associated with higher odds of any breast milk feeding (adjusted odds ratios [AOR] 5.68, 95% CI [1.65-23.63]) and direct breastfeeding (AOR 8.19, 95% CI [2.99-24.91]) postdischarge; results were similar for any breast milk feeding in-hospital. Conclusions: Perinatal hospital care practices implemented early in the COVID-19 pandemic, specifically mother-infant separation and prevention of breast milk feeding initiation, were associated with adverse effects on breast milk feeding outcomes assessed up to 1 month postdischarge.

Impact of Lockdown due to COVID-19 on lifestyle and diet pattern of college students of Eastern India: A cross-sectional survey.

Background: The emergence of the COVID-19 pandemic and lockdown measures to confine it has disrupted the routine of the public. The impact of such long-term confinements on the lifestyle and diet of students are not known and hence this study was designed to assess the impact of lockdown due to the COVID-19 pandemic on the lifestyle and diet of university students. Methods: An online cross-sectional survey among 622 university students across various educational institutes of east India using a pre-designed questionnaire about lifestyle-diet before and during the lockdown. Results were tabulated and statistical tests like Paired t-test, Wilcoxon Rank sign test, and Mc-Nemar tests were applied and overall significance was attributed to P<0.05. Results: During the lockdown a total of 2.4% (95% CI: 1.4-3.8%) decrease in prevalence of tobacco use, 8.7% (95% CI: 6.6-11%) decrease in physical activity and a 0.8 hour (95% CI: 0.6-0.9 hour) increase in the mean sleep duration was observed. There was a significant increase in use of fresh fruits consumption [Median(IQR)-before:2(1-5);during:3(1-5) days] and a decrease in meat-poultry[Median(IQR)-before: 2(0-3);during: 1(0-3)days] and junk food[Median(IQR)-before:1(0-2);during:0(0-2)days] consumption during the lockdown. Conclusion: A significant proportion of changes in lifestyle and frequency of consumption of certain food items in the dietary pattern during the lockdown.

Effect on Mental Health among Undergraduate College Students of India during the COVID-19 Pandemic: A Cross-Sectional Multicentric Study.

BACKGROUND: College students show higher prevalence of mental health issues as compared to the general population. Unfortunately, this year, students all over the world have to face, added pressure due to COVID-19. This study aimed to estimate the effect of COVID-19 pandemic and lockdown on the mental health of Medical and Engineering Students. SUBJECTS AND METHODS: The study was carried out at different medical and engineering colleges in Bihar, Delhi and Maharashtra, and Tamil Nadu. 699 responses were collected and analyzed during the study period. Data was collected by email/ online platform through Google form via non- probability Sampling Technique. Mental health status was determined by using Corona virus anxiety screening (CAS), GHQ (General Health Questionnaire)-12, GAD (General Anxiety Disorder)-7 scale and PHQ (Patient Health Questionnaire)-9 scales.369 (53%) MBBS and 330 (47%) Engineering students participated in the study. RESULTS: Maximum participants in both groups did not have anxiety related to COVID-19 (MBBS (96.8%) and Engineering (95.2%). About two-third participants secured above cut off score i.e., MBBS (62.3%) and Engineering (64.8%) in GHQ-12. Approximately comparable proportion in both groups were found to have severe anxiety and depression (16% vs 20%), when applied GAD-7 and PHQ-9. Uncertainty in the timing of the exams/ Academic delay was found to be the most worrying factor (MBBS, 41.19% vs Engineering 31.82%). CONCLUSIONS: About two-thirds of medical and engineering students psychologically equally affected by current pandemic in our study. A student wellness clinic is the need of hour in current scenario, which is supported by mental health experts (Psychiatrists, Clinical Psychologists) and residents on rotation basiswhere all psychological problem including Stress, Anxiety, Interpersonal crisis, Relationship issues and Personality problems of the students are dealt effectively in institute campus near to student residential area.

Clinical Profile and Outcome of Haemodialysis in Patients With COVID-19 - A Single Centre Experience.

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causing COVID-19 disease is the third coronavirus to have emerged in the last 20 years. The COVID-19 infection causes more severe illness in patients with comorbid diseases, especially in patients with diabetes, hypertension and kidney failure. Methods This is a retrospective study using electronic records and laboratory data of adult patients hospitalised at All India Institute of Medical Sciences (AIIMS), Patna between May 1st, 2020 and March 31st, 2021, who were diagnosed with COVID-19 and needed haemodialysis. The demographic characteristics, co-morbidities, symptoms, clinical course, laboratory parameters, and treatments were recorded. The aim of this study is to evaluate the clinical profile and outcome of patients on hemodialysis with COVID-19 infection. Results The study included 261 COVID-19 patients who needed haemodialysis. The most common symptoms on admission were fever (72.8%), cough (64.3%) and dyspnoea (46.6%). The mean age was 58.4 +/-15 years. A total of 195 patients (74.7%) were male. The most common co-morbid condition was hypertension (85.1%) followed by diabetes (71.9%). A total of 118 (45.2) patients had acute on chronic kidney disease (CKD), 40 (15.3) were on maintenance haemodialysis (MHD) and 103 (39.5) were having acute kidney injury (AKI). Eight patients were renal transplant recipients. At presentation, 183 (70.1%) patients were having mild to moderately severe infection and 78 (29.9%) patients were having severe disease. A total of 213 patients required ICU admissions, 186 (75.3%) of whom required invasive ventilation. Overall mortality was 66% (172/261) and the rest were discharged. Conclusion The study suggests that COVID-19 disease has a significantly more severe course and poorer outcome in patients requiring haemodialysis.

Online survey on practice patterns in the treatment of corneal ulcer during COVID-19 pandemic.

PURPOSE: To evaluate practice patterns in the treatment of corneal ulcer by ophthalmologists during COVID-19 pandemic in the Indian subcontinent. METHODS: This was an online questionnaire-based survey circulated via google form to reach ophthalmologists practising cornea as a subspeciality between January 4, 2021 and February 3, 2021. The survey comprised of 21 questions to evaluate the prevailing practice patterns in corneal ulcer management during pandemic. RESULTS: In total, 39.3% of government ophthalmology clinics and 41.5% of private ophthalmology clinics reported an average delay of 2 weeks in presenting to the hospital after the onset of symptoms. Totally, 60.5% of participants reported that the clinical outcomes of infectious keratitis cases during the COVID-19 pandemic were worse than before. In total, 61.3 and 41.1% of ophthalmologists in private and government sectors, respectively, were routinely performing corneal scrapings for corneal ulcer patients. The procedures were performed with adequate protective measures. In total, 68.5% participants mentioned decreased availability of donor cornea during the pandemic, and 44.4% reported compromised cornea practice due to the limited availability of essentials (tissue adhesives, BCLs, medications, etc.). A statistically significant difference of effect of pandemic on cost of services was noted between government and private hospitals. In total, 51% participants from private hospitals reported hike in outpatient department services and surgical charges, and 78.6% from government hospitals mentioned no hike in the charges (P value <0.001). CONCLUSION: This study provides an overview on modified strategies in corneal ulcer management during pandemic without compromising patient safety and quality care.

Tobacco use pattern and quitting behaviour among healthcare professionals during the COVID-19 pandemic: Insights from a pan India online survey.

BACKGROUND: Healthcare professionals (HCPs) have a definite role in tobacco control and can help immensely by setting examples. The current study aimed to study the tobacco use pattern and quitting behaviour among HCPs of India during the COVID-19 pandemic. METHODS: We addressed the research objective using a cross-sectional, anonymous online survey using 'google form" among 687 HCPs of India during December 2020. Descriptive and inferential statistics were performed using SPSS. RESULTS: Overall, 32.6% of the HCPs were ever tobacco user while 23.4% and 16.9% were current and daily tobacco user. During the COVID-19 pandemic, 51.7% and 43.1% of HCPs cut down the frequency and amount of tobacco use respectively while for 24.1% COVID-19 pandemic exerted no effect on their tobacco use. Presence of vulnerable population at home [ adjusted odds ratio (AOR): 17.5 (95% confidence interval (CI): 3.3-92.2)], ever tobacco quit attempt [AOR: 13.5 (95% CI:2.7-67.7)] and history of COVID-19 disease [AOR: 5.1 (95% CI:1.3-20.7)] significantly determined reduced tobacco use (60.3%) during the pandemic. Similarly, reduced tobacco use during the pandemic [AOR: 4.8 (95% CI:1.7-13.5)] and perception of both smoking and smokeless tobacco form to be harmful for COVID-19 [AOR: 4.8 (95% CI:1.7-13.5)] were the independent correlates of tobacco quit attempt (50.0%) during the pandemic. CONCLUSION: Tobacco use was quite rampant among the HCPs with every fourth and sixth being a current and daily tobacco user respectively. During the COVID-19 pandemic three in every five HCPs surveyed reduced tobacco use while every second HCP made a quit attempt.

Leveraging the Massachusetts perinatal quality collaborative to address the COVID-19 pandemic among diverse populations.

OBJECTIVE: We leveraged the Massachusetts perinatal quality collaborative (PQC) to address the COVID-19 pandemic. Our goals were to: (1) implement perinatal practices thought to reduce mother-to-infant SARS-CoV-2 transmission while limiting disruption of health-promoting practices and (2) do so without inequities attributable to race/ethnicity, language status, and social vulnerability. METHODS: Main outcomes were cesarean and preterm delivery, rooming-in, and breastfeeding. We examined changes over time overall and according to race/ethnicity, language status, and social vulnerability from 03/20-07/20 at 11 hospitals. RESULTS: Of 255 mothers with SARS-CoV-2, 67% were black or Hispanic and 47% were non-English speaking. Cesarean decreased (49% to 35%), while rooming-in (55% to 86%) and breastfeeding (53% to 72%) increased. These changes did not differ by race/ethnicity, language, or social vulnerability. CONCLUSIONS: Leveraging the Massachusetts PQC led to rapid changes in perinatal care during the COVID-19 crisis in a short time, representing a novel use of statewide PQC structures.

Association of Maternal Perinatal SARS-CoV-2 Infection With Neonatal Outcomes During the COVID-19 Pandemic in Massachusetts.

Importance: The incidence of mother-to-newborn SARS-CoV-2 transmission appears low and may be associated with biological and social factors. However, data are limited on the factors associated with neonatal clinical or viral testing outcomes. Objective: To ascertain the percentage of neonates who were born to mothers with positive SARS-CoV-2 test results during the birth hospitalization, the clinical and sociodemographic factors associated with neonatal test result positivity, and the clinical and virological outcomes for newborns during hospitalization and 30 days after discharge. Design, Setting, and Participants: This multicenter cohort study included 11 academic or community hospitals in Massachusetts and mother-neonate dyads whose delivery and discharge occurred between March 1, 2020, and July 31, 2020. Eligible dyads were identified at each participating hospital through local COVID-19 surveillance and infection control systems. Neonates were born to mothers with positive SARS-CoV-2 test results within 14 days before to 72 hours after delivery, and neonates were followed up for 30 days after birth hospital discharge. Exposures: Hypothesized maternal risk factors in neonatal test result positivity included maternal COVID-19 symptoms, vaginal delivery, rooming-in practice, Black race or Hispanic ethnicity, and zip code-derived social vulnerability index. Delivery indicated by worsening maternal COVID-19 symptoms was hypothesized to increase the risk of adverse neonatal health outcomes. Main Outcomes and Measures: Primary outcomes for neonates were (1) positive SARS-CoV-2 test results, (2) indicators of adverse health, and (3) clinical signs and viral testing. Test result positivity was defined as at least 1 positive result on a specimen obtained by nasopharyngeal swab using a polymerase chain reaction-based method. Clinical and testing data were obtained from electronic medical records of nonroutine health care visits within 30 days after hospital discharge. Results: The cohort included 255 neonates (mean [SD] gestational age at birth, 37.9 [2.6] weeks; 62 [24.3%] with low birth weight or preterm delivery) with 250 mothers (mean [SD] age, 30.4 [6.3] years; 121 [48.4%] were of Hispanic ethnicity). Of the 255 neonates who were born to mothers with SARS-CoV-2 infection, 225 (88.2%) were tested for SARS-CoV-2 and 5 (2.2%) had positive results during the birth hospitalization. High maternal social vulnerability was associated with higher likelihood of neonatal test result positivity (adjusted odds ratio, 4.95; 95% CI, 1.53-16.01; P = .008), adjusted for maternal COVID-19 symptoms, delivery mode, and rooming-in practice. Adverse outcomes during hospitalization were associated with preterm delivery indicated by worsening maternal COVID-19 symptoms. Of the 151 newborns with follow-up data, 28 had nonroutine clinical visits, 7 underwent SARS-CoV-2 testing, and 1 had a positive result. Conclusions and Relevance: The findings emphasize the importance of both biological and social factors in perinatal SARS-CoV-2 infection outcomes. Newborns exposed to SARS-CoV-2 were at risk for both direct and indirect adverse health outcomes, supporting efforts of ongoing surveillance of the virus and long-term follow-up.