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Context: The coronavirus disease 2019 (COVID-19) pandemic is still a cause of worldwide health concern. Diabetes and its associated comorbidities are risk factors for mortality and morbidity in COVID-19. Selecting the right antidiabetic drug to achieve optimal glycemic control might mitigate some of the negative impacts of diabetes. Metformin continues to be the most widely administered antidiabetic agent. There is evidence of its beneficial outcome in COVID-19 independent of its glucose-lowering effect. Evidence Acquisition: A thorough literature search was conducted in PubMed, Google Scholar, Scopus, and Web of Science to identify studies investigating metformin in COVID-19. Result(s): Several overlapping mechanisms have been proposed to explain its antiviral properties. It could bring about conformational changes in the angiotensin-converting enzyme-2 receptor and decrease viral entry. The effects on the mammalian target of the rapamycin pathway and cellular pH have been proposed to reduce viral protein synthesis and replication. The immunomodulatory effects of metformin might counter the detrimental effects of hyperinflammation associated with COVID-19. Conclusion(s): These findings call for broader metformin usage to manage hyperglycemia in COVID-19.Copyright © 2023, International Journal of Endocrinology and Metabolism.
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Anxiety and depression are the two most prevalent mental health problems throughout the globe. They may present either suddenly or persistently, with a broad range of symptoms, many of which are often asymptomatic. This need is a direct outcome of the mental illness-related economic and healthcare insurance service burden. The expansion of the COVID-19 pandemic and the resulting increase in the incidence of mental health concerns have both contributed to the rising need for mental health care. In response to these demands, a substantial amount of research is examining alternatives to the usual methods used to treat mental health issues. According to research, digital games include cognitive benefits such as attention management, cognitive flexibility, and information processing. This study dissects and analyses the game 'Space Invaders' in terms of its design and implementation. The game has enormous potential as a resource for the mitigation of some mental health issues in lieu of or in addition to established therapeutic therapies. The resource is inexpensive, readily accessible, globally accessible, beneficial, and not connected with shame. © 2022 IEEE.
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Aim/Introduction: Although 18F-Fluorodeoxyglucose (FDG) Positron Emission Tomography/Computed Tomography (PET/ CT) is not routinely used for diagnosis of COVID- 19 infections, we incidentally detected lung lesions in few patients, who were referred for some other indications. The study aimed to explore a cut off value of standardized uptake values (SUV) of 18F-FDG PET/ CT in predicting active COVID-19 infection in both symptomatic and asymptomatic patients referred to our department for various oncologic indications. Material(s) and Method(s): We retrospectively analysed PET/CT studies performed from March 2020 to August 2021 done at our department, who underwent 18F-FDG PET/CT for various oncological indications. PET/CT scans were reviewed by 2 experienced nuclear medicine physicians. At first, only HRCT chest was reviewed to ascertain inclusion of the patient. CT severity score and COVID-19 Reporting and Data System (CORADS) criteria were calculated from HRCT chest. PET/CT images were reviewed and SUVmax were recorded in lung parenchyma and mediastinal blood pool and SUV ratios (SUVR) between them were calculated. Result(s): A total of 85 patients were identified and divided into 3 groups based on clinical symptoms and reverse transcription-polymerase chain reaction (RT-PCR) results * Group A- patients with symptoms of COVID- 19 and positive RT-PCR- (n=51) * Group B- patients with symptoms of COVID-19 and a negative RT-PCR- (n=13) * Group Cpatients with no symptoms of COVID-19 - (n=21). SUVR of these 3 groups (2.67+/-1.21 vs 1.86+/-0.8 vs 1.42+/-0.53 respectively) showed significant statistical difference (p<0.05). Moderate correlation was obtained between SUVR and CT severity score (r= 0.43, p<0.05), thereby correlating towards prognosis. The area under the curve (AUC) obtained for different cut-off values of SUVR was 0.74 (95% CI- 0.55-0.97, p<0.05). A SUVR cut-off value of 1.87 yielded a specificity of at least 74.3% and a sensitivity of at least 68%. Conclusion(s): An SUVR cut off value of 1.87 can yield a specificity of at least 74.3% and a sensitivity of at least 68%. HRCT chest and 18F-FDG PET/CT plays a complementary role in determining active COVID-19 infection. SUVR of pulmonary lesions can be considered as an important prognostic indicator for active COVID-19 infections.
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History taking and clinical interviewing is usually the start of medical contact with patients with chronic diseases like diabetes mellitus in primary care. The current novel corona virus-19 epidemic has limited our ability to conduct in-person consultations with patients as before and most of us limit physical contact to the minimum. This has made the process of history taking either by virtual consultations or physically in our offices but by maintaining appropriate physical distance more important than even before. This review summarizes an easy-to-understand hierarchy of questioning to help us in maximizing the information obtained by history taking. We initiate the clinical interview with a warm welcome and first focus on the primary felt need of the patient. Then we interview the patient about his duration and current control of his diabetes. The second part of the interview focuses on current clinical status including reviewing for complications and co-morbidities. The third part focuses on current ongoing management including life style, diet, glucose lowering and other drugs and the use of complementary and alternative medicines. The fourth part of the interview focuses on emotional status including religious and cultural beliefs about diabetes management and presence of diabetes related distress. Special attention should be paid to the financial status of patients who are paying for their treatment out of pocket. The interview should conclude with summarization of current issues with regards to diabetes management and a therapeutic plan individualized for the patient.
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Introduction: Severe acute respiratory syndrome coronavirus 2 has caused a worldwide pandemic. This study was aimed to describe the clinico-demographic, hematological, and comorbidity profile in a group of coronavirus disease 2019 (COVID-19) patients at a tertiary care center in north India. Materials and Methods: We conducted a prospective, single-center collection of data regarding clinico-epidemiological, hematological parameters, and comorbidity profile of COVID-19 patients admitted at a tertiary care facility. Results: Data from 200 patients with COVID-19 were collected and analyzed. The median age of the patients was 48 years, with 63% males, and 78% patients were from urban area. Ten patients were smokers while 11 patients were alcoholic. The occupation of 20.6% of patients was related directly or indirectly with medical or allied professions. The most common mode of transmission of COVID-19 was direct close contact with microbiologically confirmed patients. Fever (n = 93;46.5%) was the most common presenting symptom and the median duration of onset of symptoms before admission were 3.5 days (range 2-6 days). In hematological profile, lymphopenia (n = 48;24%) had been the most common documented finding. Comorbidities were present in 39 (19.5%) patients, of which diabetes mellitus (n = 25;12.5%) was the most common. Furthermore, the case fatality rate in our study was 1.5%. Conclusion: Among all patients of COVID-19 at our center, the characteristic findings included high proportion of male patients with younger to middle-age group, diabetes as most common comorbidity and people who were directly or indirectly in contact with the health-care system were more prone for developing the disease.
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The interplay between pulmonary and endocrine systems modify and influence the pathogenesis and manifestation of several disease processes. Endocrine dysfunctions predispose to numerous pulmonary disorders, including various respiratory infections. On the other hand, pulmonary conditions like chronic obstructive pulmonary disease and obstructive sleep apnoea can produce critical metabolic and endocrine derangements. Varied manifestations such as primary adrenal insufficiency, hypophysitis and hypercalcaemia can result from chronic granulomatous conditions like tuberculosis and sarcoidosis. Various endocrine consequences of coronavirus disease 2019 are also getting apparent during the pandemic. Tumours of the lung can secrete different hormones that give rise to several endocrine paraneoplastic syndromes. This review focuses on the clinically relevant interaction between these two diverse but interrelated systems. We suggest the portmanteau term "pulmocrinology" to delineate the multifaceted relationship evident in pathophysiology, clinical features and therapeutics of various pulmonary and endocrine disorders.
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The humankind is facing one of the worst nightmares in the form of the ongoing Corona crisis. The pandemic has spread all across the globe and we are struggling to deal with its might. All nations have made their own strategies to deal with this situation and mainly a phase of lockdown has been the savior in most countries, especially India, where it was enforced early and well in time. After a successful lockdown, there is a phase of unlocking, which is equally important. One should exercise caution in that this should be done gradually and phased, with all the precautions in place and without any complacency. Neurosurgeons are faced with a situation pertaining to those afflicted by posterior fossa lesions with hydrocephalus. They are treated with ventriculoperitoneal shunt, but sometimes they develop reverse tentorial herniation. This needs prompt evaluation and intervention and carries a poor prognosis if untreated. Another situation is where bifrontal contusions need decompressive surgery;some patients develop encephaloceles and extradural hematomas following successful surgery and complicate the prognosis. Both situations emerge due to sudden decompression, leading to quick changes in brain pressure and perfusion. The solution is slow and careful decompression, with all precautions in place despite the temptation of eureka moments. A similar response could be desirous over the course of our unlocking period. Hope this wisdom brings us good results in these Corona times.
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Extended wearing of mask, which has become a part of routine life, has led to the emergence of 'mask fatigue'. Mask fatigue is defined as the lack of energy that accompanies, and/or follows prolonged wearing of a mask. This communication describes the various aspects of mask fatigue, and shares pragmatic tips on its reduction. This discussion is relevant to all health care professionals and to general public to some extent, in the present scenario.
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We are spending our days today in a nationwide lockdown. The government should be lauded for taking a firm stand and announcing this lockdown well in time. Perhaps the benefits of social distancing cannot be more emphasized to prevent the spread of the dreaded coronavirus as witnessed by some of the developed nations who missed out by announcing it very late. In this lockdown period when we are primarily confined to our home, people face this dilemma of what to do and what lies ahead. Suddenly people find themselves in a situation where they are forced to stay at home and there is fear and turmoil all around. The mindset in this situation quickly becomes negative and as is well known empty mind is devil's workshop. The need of the hour is to get constructively active and keep the positive vibes going.
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The world has been facing a global threat from the past few months from Coronavirus Disease 2019 (COVID-19). There has been a significant increase in morbidity and mortality due to this ongoing pandemic which is creating a global challenge. This pandemic is having a profound effect on all aspects of society especially the physical and mental health of the people. There has been a rising concern about the mental health of normal population, COVID-19 patients, Healthcare Workers (HCW) or doctors, children and the elderly population. Recent research has reported symptoms of anxiety, depression and other symptoms of psychological distress among these populations. The main purpose of this review was to focus on various mental health issues and the coping strategies during the COVID-19 pandemic period.
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Background: Coronavirus disease-2019 (COVID-19) poses a risk for health care workers necessitating modifications to existing medical pathways. In particular, managing patients with suspected COVID-19 represents a risk to the delivery of a primary percutaneous coronary intervention (PPCI) pathway where time-dependent revascularization is key. Methods: We sought to evaluate the effect of the COVID-19 pandemic on an established ambulance-triggered PPCI program involving 2 high-volume heart attack centers in London, United Kingdom. A systematic analysis was performed in patients with ST-segment elevation myocardial infarction undergoing PPCI comparing the COVID-19 pandemic period March 1, 2020, to April 30, 2020, with a control group from the previous year. Results: During the study period, admissions through the PPCI pathway decreased by 34%. The time from symptoms onset to first call for help (2020: 11 min vs. 2019: 12 min;p = 0.90) and from symptom onset to arrival at PPCI center (2020: 183 min vs. 2019: 178 min;p = 0.99) were comparable;however, the time from arrival at PPCI center to revascularization decreased (2020: 44 min vs. 2019: 53 min;p = 0.0004). In-hospital mortality during the study period was significantly lower (5% vs. 15%;p = 0.04). COVID-19–positive patients (n = 8) had higher rates of cardiogenic shock (25%), intensive care unit admission (50%), and inpatient mortality (38%). [Formula presented] Conclusion: Our data show that the modifications to the existing PPCI pathway were not associated with treatment delay or adverse outcome. The reduction in ST-segment elevation myocardial infarction presentations raises concern that patients may not be seeking appropriate medical attention for chest pain. Importantly, we demonstrate that PPCI can be delivered safely and efficiently during the COVID-19 pandemic. Categories: OTHER: COVID-19
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Purpose: Type 1 diabetes (T1D) requires a holistic approach and continuous care. The current COVID-19 pandemic has made the health care professionals realise its challenges even more ardently than in the normal times. In a country like India with its huge population burden and a significant number of people having T1D, the risk of COVID-19 in people having T1DM is considerably high. Methods: In this article, we are sharing our practical experiences of problems faced by children and adolescents having T1DM during the past 2 months of lockdown. Results: We have classified the challenges into 3 broad categories based on diabetes self-management, healthcare system and psychosocial aspects. We have tried to provide precise, comprehensive and region specific solutions to these challenges. Solutions briefly include maintaining the supply chain of essentials like insulin, syringes and glucose meter strips to psychological support, financial aid and support for hospitalization in case of COVID-19 itself or diabetes complications including diabetic ketoacidosis. Conclusions: Children and adolescents having T1DM require special care and attention during this period of COVID-19 pandemic because of various challenges as discussed. Our proposed solutions may help them overcome these problems and help them in better diabetes management during such emergency situations.