Prevalence and Predictors of Depression, Anxiety and Stress among Elderly during COVID-19: A Cross-sectional Study from Central India.

During the COVID-19 pandemic, elderly people have been more prone to depression, anxiety and stress. During these trying times, they require more attention and support for their mental health. This cross-sectional study was performed with the duration of 06 months from March 2021 to August 2021 in AIIMS, Bhopal in the state of Madhya Pradesh, in central India. And the participants recruited by systematic random sampling from a population aged more than 60 years, those who were able to read and write Hindi or English and having at least one family member; who reported to AIIMS, Bhopal during the second wave of COVID-19 in India. Those who were confirmed COVID-19 cases and undergoing treatment for the same, with diagnosed mental health disorders and who didn't give consent were excluded. A Google form based online semi-structured questionnaire along with DASS-21 scale was completed by participants. Elderly (>=60 years) will be selected. Of the 690 participants 7.25% reported mild to moderate depression, whereas 0.58 percent had severe or extremely severe depression. Mild to moderate anxiety were found in 9.56% of people, while 2.46% had severe or extremely severe anxiety. Mildly or moderately were stressed 4.78%, while 0.42% was severely or extremely anxious. Alcoholism and depression were found to have a statistically significant relationship (p=0.028). During the COVID-19 pandemic, elderly subjects who napped during the day were substantially less depressed (p=0.033). The older the respondents were, the more nervous they were during the pandemic (p=0.042). There is a link between alcohol consumption and stress (p=0.043) and it was seen that females were more stressed as compared to males (p=0.045). There was a strong correlation between participants' alcohol addiction and depressive symptoms. Psychological therapies for the elderly are thought to be necessary to enhance their psychological resilience and mental health. We need to tackle the stigma related to the COVID-19 and mental health issues.

KNOWLEDGE OF DENTISTS REGARDING PRACTICES OF DENTAL LABORATORY PERSONNEL IN COVID 19 ERA: A QUESTIONNAIRE STUDY

Background: To curb the spread of the coronavirus disease 2019 (COVID- 19), severalguidelines for dental practice were proposed by dental practice regulating bodies. Assesing thecompliance with these guidelines is important at every step including the communication withthe dental laboratory personnel. Aim: To assess the knowledge of dentists regardingpractices of dental laboratory personnel in COVID19 era Methodology: This was adescriptive cross- sectional study conducted among dentists inNorthern India using a self- administeredQuestionnaire. Results: A total of 256 dentists aged between 20 and 56 years participated in this study. Statistically significant results were seen on comparison between laboratory personnel who wear a mask and disinfect his/her hands before entering the clinic and the dentists who were effected by covid recently(p<0.05). Conclusion: More such studies are the need of the hour to make an effort regarding the awareness of dental laboratory personnel regarding COVID 19.

Knowledge and Anxiety of Pregnant Women towards COVID-19 Pandemic in the Prevaccination Phase

Introduction: Coronavirus Disease-2019 (COVID-19) pandemic has led to devastating and unprecedented health crises especially in the vulnerable population, ever since its origin in 2019. COVID-19 management in pregnant women had been a matter of controversy before the introduction of the standard protocols by the various international bodies. A lot of concern still prevails around the adverse foeto-maternal outcomes such as preterm birth, stillbirth, increased caesarean rates, maternal morbidity and mortality. Furthermore, uncertainty about the duration of the COVID-19 pandemic had also increased anxiety among pregnant women, particularly during the first wave. Aim: To find out the knowledge and beliefs of pregnant women towards the COVID-19 infection in first wave and to know whether it had increased anxiety among non infected pregnant women before the advent of the COVID-19 vaccination. Materials and Methods: A cross-sectional study was conducted on the 280 asymptomatic pregnant women attending the Department of Obstetrics and Gynaecology, All India Institute of Medical Sciences, Bhopal, Madhya Pradesh, India, over four months (10th October 2020 to 10th February 2021). These women were provided with a questionnaire and a Generalised Anxiety Disorder Score-7 (GAD-7) chart. Statistical analysis was performed using the Pearson Chi-square analyses with p<0.05 considered statistically significant. Results: The total number of participants were 280. Majority of them were in their 20s and were primigravida. The mean GAD-7 score for the study population was 4.642 and the overall prevalence of anxiety in this study was 34.3% (n=96). GAD-7 score chart showed 65.7% (n=184) had 0-4 levels (minimal) while severe scores ≥15 were noted in 2.9% (n=8). In the current study, greater anxiety scores were found in the homemakers. A high prevalence of anxiety was seen in primigravida and during the third trimester. About 37.5% of the participants believed that COVID-19 could transmit to the foetus-in-utero, if infected and 50.36% felt being pregnant could increase the risk of contracting COVID-19 infection. Conclusion: The present findings suggest that pregnant women showed a lot of concerns and significant anxiety due to COVID-19 during the study period.

Determinants of mortality in COVID-19 infection in western Uttar Pradesh, India: A Retrospective Study

A new disease SARS-COV -2 popularly known as COVID-19 had become global pandemic taking toll of many lives in short time. India is among the most severely affected countries with on-going COVID-19 pandemic. It is very crucial to determine the factors related to mortality in COVID-19 infected cases to reduce the further deaths. The aim of the study is to assess the determinants related with COVID-19 mortality. Objectives: 1.To study the socio demographic profile of deceased from COVID-19 infection. 2. Assessment of factors related to mortality from COVID-19 infection. Methodology: An observational retrospective study was conducted by telephonic interview of family members of all deceased provided in the line-list of deaths in the Meerut district, Uttar Pradesh, India on pre-designed pretested validated questionnaire during study period. The detailed information regarding progress of the disease and hospitalization was also obtained from the death summary of the hospital deaths and data collected was entered and analyzed in Epi info7.2.3.1 software. Result: The case fatality ratio is around 2%.Increasing age, male gender ,urban population, delay in investigation and hospitalization ,poor health seeking behaviour are the determining factors in increasing mortality. Breathlessness followed by fever, cough are the most common presenting symptoms. Diabetics with Hypertension are at very high risk as compared to isolated non communicable diseases. Conclusion: Though the COVID-19 disease is highly infectious but the mortality is not very high in first wave and vulnerable population needs more focus with proper planning and strategies. IEC needs to be promoted for early investigation and treatment.

A CASE OF IDIOPATHIC HEMORRHAGIC PERICARDIAL EFFUSION: NO CLUES LEFT BEHIND

Background: Hemorrhagic pericardial effusion (HPE) is an infrequently encountered entity. We present here a challenging case of HPE. Case: A 67-year-old woman with history of hypothyroidism presented with dyspnea, chest discomfort, chills since 2 weeks. She had received mRNA-1273 vaccine 7 days prior to presentation. Vitals were notable for a heart rate of 136/min, otherwise she was hemodynamically stable. Physical exam was notable for muffled heart sounds. Decision-making: Labs showed a hemoglobin of 9.6 g/dL, C reactive protien(CRP) of 93.80 mg/L, normal thyroid profile and troponin, and a negative COVID-19 PCR. ECG was suggestive of sinus tachycardia. An Echocardiogram showed ejection fraction of 55-60% and large pericardial effusion with tamponade physiology. Emergent pericardiocentesis was done, removing 940 mL of sanguineous fluid. Pericardial fluid showed predominantly red blood cells;cytology was negative for malignant cells. Infectious workup for fungal, viral, tuberculosis and bacterial infections, and antibody testing as a part of rheumatologic workup was negative. A CT of the chest, abdomen and pelvis did not show any evidence of malignancy. She remained hemodynamically stable and was discharged on colchicine and ibuprofen. The patient did well on follow up at one month. Conclusion: Despite extensive workup, underlying etiology of HPE was not identified. As the symptoms preceded vaccination, the likelihood of vaccine-induced pericarditis and HPE was deemed low. [Formula presented]

Pharmaceutical Aspects and Clinical Evaluation of COVID-19 Vaccines.

COVID-19, the disease caused by the novel severe acute respiratory syndrome-associated coronavirus 2 (SARS-CoV-2), was first detected in December 2019 and has since morphed into a global pandemic claiming over 2.4 million human lives and severely impacting global economy. The race for a safe and efficacious vaccine was thus initiated with government agencies as well as major pharmaceutical companies as frontrunners. An ideal vaccine would activate multiple arms of the adaptive immune system to generate cytotoxic T cell responses as well as neutralizing antibody responses, while avoiding pathological or deleterious immune responses that result in tissue damage or exacerbation of the disease. Developing an effective vaccine requires an inter-disciplinary effort involving virology, protein biology, biotechnology, immunology and pharmaceutical sciences. In this review, we provide a brief overview of the pathology and immune responses to SARS-CoV-2, which are fundamental to vaccine development. We then summarize the rationale for developing COVID-19 vaccines and provide novel insights into vaccine development from a pharmaceutical science perspective, such as selection of different antigens, adjuvants, delivery platforms and formulations. Finally, we review multiple clinical trial outcomes of novel vaccines in terms of safety and efficacy.

Mhealth based mental health support counselling service for covid-19 suspect and positive patients in isolation facilities

Introduction: Psychological issues of COVID-19 suspect and positive patients in isolation and quarantine facilities can be addressed using mHealth. Methodology: mHealth telecounselling framework for COVID-19 inpatients was established using existing manpower and standardised operating procedures. Separate WhatsApp groups were used to obtain contact data of consenting patients, allocate patients to counsellors, and clinical discussion. Telecounselling was documented in real-time in a Google form database and remotely monitored for adherence to the standard of care. Pilot anonymised scale based client satisfaction feedback was obtained from discharged patients using a Google form link shared on WhatsApp. Results: 2918 telecounselling sessions were conducted between 21 March and 25 June 2020 for 643 inpatients (280 COVID-19 positive and 363 COVID suspect but later determined negative;mean age 49.57 years ± 15.23;male: female = 404: 239). Psychological issues included anxiety (43.54%), low mood (9.79%), irritability (9.33%), insomnia (8.39%) boredom (8.24%), frustration (7.46%), fearfulness (3.57%) anger (1.24%) and Delusion of pregnancy in one non-compliant psychotic patient. Interventions provided were supportive psychotherapy (57.69%), psychoeducation (52.72%), counselling regarding testing protocol (41.21%), sleep hygiene (20.06%), relaxation techniques (14.61%), activity scheduling (6.22%). Only 9 (1.39%) patients needed pharmacotherapy. Most respondents expressed satisfaction on pilot anonymised feedback (n = 115: M: F = 73: 42) with 83% recommending the programme for other COVID-19 settings despite concerns for possible lack of privacy and confidentiality (31.1%). Conclusion: Telemental Health Counselling Programme is a low cost, feasible, culturally acceptable, and sustainable mHealth initiative which can be easily transposed in other COVID-19 settings. © 2021, Indian Academy of Clinical Medicine. All rights reserved.

Post covid-19 symptoms: A neglected domain

Background: COVID -19 is the most important public health problem of recent time. Most people who have COVID-19 recovers completely within a few weeks but some people continue to have symptoms after initial recovery. Objective: To assess the prevalence of Post COVID symptoms, to assess requirement of treatment and to make recommendation for Post COVID care. Methods: Present cross sectional study was done among patients who recovered from COVID-19 in Meerut district. Mobile numbers of COVID patients were obtained from records, Total 100 randomly selected patients were contacted using google form and information regarding post covid symptoms in between 6 weeks to 12 weeks after recovery from COVID was obtained. Result: 87%patients developed one or more post covid symptoms. Weakness was reported to be most common problem (55%), followed by body ache (26%) and neuropsychiatric symptoms such as difficulty in concentration and insomnia (22%). Every fifth patient reported that symptoms persisted for more than 1 month. Though most of the respondents classified their symptoms as mild and moderate (52.5% and 37.9% respectively), 47% of the symptomatic patients have to take some treatment for these symptoms. Conclusion: Post COVID symptoms are common but usually less severe. Some form of treatment was required to deal with problem. Almost one in five patients reported that symptoms persisted for more than one month. The results highlight the need for post Covid care for COVID recovered patients. © 2021, Indian Association of Preventive and Social Medicine. All rights reserved.