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People suffering from severe mental illness (SMI) have a significant negative impact on their communities as compared to the normal population. There are a variety of factors that contribute to the majority of this excess mortality. It is reported in this paper on a study that was conducted to explore the impact on mental health among psychiatric patients all over the world. We were able to determine the prevalence rates as well as the factors that contributed to the elevated morbidity and mortality rates. There is evidence that increased risk for the majority of physical diseases is caused by a combination of lifestyle variables as well as treatment-specific risk factors. There is also adequate data to imply that people with SMI are less likely than the general population to obtain normal levels of care for the majority of illnesses than the general population. The current period of Covid 19 demonstrates the enormous amount of mental stress experienced by health practitioners all across the world. A range of mental health disorders are caused by the pandemic, which is particularly widespread among psychiatric patients due to the unusual nature of the outbreak. Psychiatric patients are frequently affected by anxiety, depression, burnout, insomnia, and other stress-related diseases, according to the American Academy of Family Physicians (Freudenberger, H). It is the purpose of this study, as well as other low-resource countries, to draw attention to the mental health aspects of the pandemic among psychiatric patients.
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COVID-19, also known as coronavirus, has spread throughout the world and changed all facets of lives drastically. Though the vaccines are being distributed, the situation is still miserable in many countries. To slow down the spread of this virus, social distancing is required to be maintained. This paper proposes a smart door system that helps in fast temperature scanning of people and ensures social distancing at public places. The proposed system also automatically opens or closes the doors at public places and switches the appliances on the basis of the number of people present. The system design is based on Internet of things (IoT) and is embedded using Arduino Uno. This is an efficient and low-cost model to control the spread of infectious disease. © 2022, The Author(s), under exclusive license to Springer Nature Singapore Pte Ltd.
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Background: Infections contribute to an early mortality risk of 15 percent in newly diagnosed multiple myeloma(NDMM) cases. There is a limited literature on the type of infections in fully vaccinated NDMM patients. Aims: To study epidemiology, clinical profile and predictors of infection in NDMM who are immunised against pneumococci and influenza. Methods: NDMM patients were prospectively studied for 6 months for the pattern of infections . All patients were vaccinated with pneumococcal and Influenza vaccine at diagnosis. PJP prophylaxis and fluconazole prophylaxis was given for patients receiving high dose steroids while acyclovir was given to all. Infections were classified as microbiologically defined, clinically defined and fever of unknown focus according to definitions published by the International Immunocompromised Host Society. Severity of infections were graded according to the NCI CTCAE Ver5. Results: Forty-eight NDMM patients with a median age 55 years comprising of 26 males and 22 females were enrolled. Renal involvement was noted in 42% of enrolled patients and two third of them required renal replacement therapy. ISSIII and R-ISS III were 70.8 % and 62.5 % respectively. 85% had poor performance status(ECOG ≥2) at baseline. RVD was the most common regimen (37%)used. 6 patients received daratumumab based regimen. Treatment response of atleast VGPR was seen in 97 % of NDMM patients. A total of 19 episodes of infections were observed during 6 months. All episodes of infections were reported in the first 45 of myeloma diagnosis(Median 6 days;Range 0-45). Ten of these episodes of infection were diagnosed during the initial evaluation for myeloma defining events. Microbiological diagnosis was possible in 63 %. Commonest infectious agent was COVID 19(n=8) followed by Gram negative bacteria (n=5) viz E.coli and Klebsiella pneumoniae . None of the eight patients who developed COVID 19 infection had received COVID vaccine as they antedated the operationalisation of national guidelines for immunisation. Respiratory and the urinary tract were the most common focus of infection. All critically ill COVID patients succumbed to progressive respiratory failure and all patients with mild and moderate COVID illness recovered uneventfully. Early mortality in our cohort of forty eight patients was twenty percent(n=10). Three fourths of infections in our cohort were Grade≥3 severity. A total of seven deaths were attributable to infectious diseases in this cohort of NDMM patients. Imune paresis was seen in eighty four percent of patients at diagnosis. On follow up at 6 months;immune paresis had persisted in only thirty seven percent. Regression analysis of variables with odds of infection is shown in Table 1 Baseline BMI<18.5 kg/m2;albumin<3g/dl and ISS or R-ISS stage ≥ 2 was found to be have statistically significant odds of predicting infection risk in the cohort of patients. The choice of myeloma regimen, presence of high risk cytogenetics and response to therapy did not correlate with increased odds of infection in our cohort. Summary/Conclusion: Conclusion In this prospective study of NDMM patients vaccinated against pneumococci and influenza at baseline;infection attributable early mortality was 14.5 %. Advanced stage of presentation, hypoalbuminemia and baseline BMI < 18.5 kg/m2 correlated with increased odds of infection. COVID vaccination and COVID appropriate behavioural practices may mitigate COVID related outcomes including deaths in myeloma patients.
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SARS-CoV-2 is highly infectious and has ability to mutate into newer, more contagious, and lethal strains. Moreover, presence of comorbidities and low immunity increases the COVID-19 susceptibility and severity. Thus, COVID-19 is challenging to treat and eradicate globally. This increase stress and anxiety among the patients, worsening their condition. Even health care workers (HCWs) are distressed and anxious while managing the COVID-19. Mental stress and depression increases risk of COVID-19. Yogic breathing techniques may be beneficial in improving immunity and reducing stress and anxiety. The present study investigated the effectiveness of short and controlled Yoga-based breathing protocols in COVID-positive, COVID-recovered and HCWs. Study subjects were recruited from Postgraduate Institute of Medical Education and Research, Chandigarh, India from 13th October, 2020 to 7th January 2021. Each group was randomly divided into intervention or yoga group and non-intervention or control group. COVID-positive practiced a 5-min routine and COVID-recovered and HCW practiced 5-min and 18-min routines for 15 days. Pre-post estimation of neuropsychological parameters and heart rate variability and baseline, 7th and 15th day estimation of biochemical parameters, 6-minute walk and 1-minute sit-stand tests were conducted. Based on Ayurveda, Prakriti-type was assessed. WBC count was elevated in COVID-positive intervention (p<0.001) and control groups (p=0.003). WBC count (p=0.002) and D-dimer (p=0.002) was decreased in COVID-recovered intervention. A non-significant reduction in perceived stress and tension was noted in COVID-positive intervention. Tension was reduced and quality of life improved in HCW intervention (p>0.05). The Kapha Prakriti (48.9 %) was dominant among COVID-19 infected (positive and recovered) subjects. Distance covered in 6-min increased after intervention in COVID-positive (p=0.01) and HCW (p=0.002). The covered distance was more after intervention in all groups than control sub-group. COVID-positive intervention group shows reduced heart rate (p>0.05) and high-frequency power (p=0.01). The interventions were capable of improving exercise capacity in patients and HCW and reduced cardiovascular risk in COVID-19. The studied breathing protocol can be integrated for the management of COVID-19 and is beneficial to HCWs.
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Gradual lockdown as a measure was forced into action in India for more than 4 weeks after the beginning of Covid-19 pandemic, as a measure to flatten the epidemic curve. Through our study we are trying to interpret the changes in air quality level during the period of lockdown in Delhi by collecting and evaluating the data of pollutants from 3 major hotspots through updated data of DPCB (Delhi Pollution Control Board). It has noted that after a week and more there was a significant decline in air pollutant level in these areas which lead to improvement in air quality, major decline was noted in PM2.5 (-28.37%,-25.37% and-25.43%), and NO2 a traffic emission related pollutant (-91.29%,-13.29% and-55.26%) respectively whereas slight improvement in ozone has been recorded an association of major pollutant (PM2.5,10, NO2) has shown significant association with impact of lockdown during covid-19 in their decline, whereas further improvement might come in forthcoming days as GOI is going to put more measures to combat the virus spread which came into force from 23rd March 2020. Still there are lots of efforts need to be done to understand impact of lockdown on major polluted level and how a single lockdown could give great result after spending crores of money on project related to same, so it’s our recommendation to GOI to look into this impact and plan measure accordingly in future so that Delhites can breathe a easy air than they used to breathe earlier. © EM International.
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Background: Although hydroxychloroquine (HCQ) lacks benefit in patients with moderate-to-severe COVID-19, its role in asymptomatic and mildly symptomatic disease needs better elucidation. Methods: This multi-centre cohort study included asymptomatic and mildly symptomatic, RT-PCR confirmed COVID-19 cases between 30 March and 20 May, 2020. Patients were categorized into two groups (HCQ-treated and untreated) based on exposure to HCQ. Dose of HCQ used was 400 mg twice daily (day one) followed by once daily for seven days. HCQ-untreated patients were managed supportively without any active antiviral or immunomodulatory therapy. Nasopharyngeal SARS-CoV-2 clearance by RT-PCR (primary outcome) was compared between HCQ-treated and untreated patients using Kaplan-Meier analysis and Cox proportional-hazards regression. Clinical efficacy and safety profile of HCQ were assessed (secondary outcomes). Results:162 patients [84 (51·9%) males;mean age 38·2 (15·2) years] were included. Forty-four (27·2%) patients had mild disease, rest 118 (72·8%) were asymptomatic. Seventy-five (46·3%) patients received HCQ. Median time to virological negativity was lesser in HCQ-treated (13 days) versus untreated patients (15 days) (log-rank<0·001) in both asymptomatic and mildly symptomatic patients. Treatment with HCQ was the only independent predictor of virological negativity (hazard-ratio=2·24;adjusted p-value<0·001). Two (5·4%) mildly symptomatic patients progressed to severe disease within 24 hours (two doses) of HCQ initiation, compared to none in the HCQ-untreated group. Five HCQ-treated patients developed minor gastrointestinal side effects, not requiring drug discontinuation. Conclusion: HCQ reduced the time to virologic negativity (by 2 days) in asymptomatic and mildly symptomatic COVID-19, without any serious adverse events. However, no obvious clinical benefit was noted. © 2022 Journal of Association of Physicians of India. All rights reserved.
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Introduction: Acute lymphoblastic leukemia in adults represent amajor therapeutic challenge even in modern era. Constantly evolvinggenomics has led to a better risk stratification and prognostication.Aims &Objectives: Here we present a novel mutation in calreticulingene in a patient with Precursor B lineage Acute lymphoblasticleukemia.Materials &Methods: A 19 year old boy presented with fever,jaundice and pancytopenia. Initial investigation revealed a hemoglobin of 5.8 g/dl with a total leukocyte count of 700 cells/mm3 andplatelet count of 11,000/mm3. Differential count showed 95% lymphocytes and 5% neutrophils and no blasts with mildanisopoikilocytosis on PBF. Bone marrow biopsy demonstartedreduction granulocytic and erythroid lineage with adequatemegakaryocytes and occasional collections of immature appearingcells, whose charcter was not able to be definitely ascertained. PETCT showed FDG avid lymph nodes on both sides of diaphragm, withPET guided biopsy was suggestive of non specific lymphocyticinflammatory infiltrate. A diagnosis of hemophagocytic lymphohistiocytosis (HLH) was made according to HLH 2004 criteria (Fever,cytopenias, hypertriglyceridemia, splenomegaly and elevated serumferritin levels). However workup for primary HLH and primaryimmune deficiencies were negative.Clinical exome sequencing forprim was postive for mvk transcript (c.808G >A). He was treatedwith IVIG and short course steroids. Repeat bone marrow was normocellular with mild erythroid prominence and adequaterepresentation of granulocytic and megakaryocytic lineage elements.He was under regular follow up thereafter.Result: He developed mild Covid illness a month after discharge. Amonth after recovery from illness, he presented with easy fatiguabilityand pancytopenia (Hb: 7.1 g/dl, TLC: 900 cells/mm3 and Plateletcount: 1.46 lakhs) with presence of occasional blast in PBF. Repeatbone marrow was markedly hypercellular with 76% blast.Megakaryocytes were relatively preserved. On flow cytometry, blastswere positive for CD 10, CD 19, CD 20, cyto CD 79a, CytoCD22, CD34, CD 45, HLA DR and TDT and negative for MPO CD 2 CD 3 CD13 aand CD 33 consistent with Precursor B Lineage acute lymphoblastic leukemia. Multiplex RT-PCR for recurrent geneticabnormalities (ALL) were negative. A never reported CALR (TYPE1) mutation was found in this patient. CALR plays an important rolein cell proliferation, apoptosis and immune responses. Patient wastreated with modified BFM regimen and Rituximab, attained CR postinduction and currently in consolidation phase of therapy.Conclusions: CALR mutation has never been reported before in acase of acute lymphoblastic leukemia. Long term follow up of patient is required to conclude whether the novel mutation has prognostic andtherapeutic implications.
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Background: The impact of COVID-19 pandemic has been highly heterogeneous across the globe and different regions within the country. The differences in the outcome of these patients is related to their demographic profile, genetics, socio-economic conditions, and government health policies. Prior to the COVID-19 pandemic, the Healthcare Access and Quality (HAQ) Index for hematological malignancies (HAQ index <30) in a low-middle socio-demographic index(SDI) country like India was less than the mean HAQ index for all other diseases (HAQ index 41) with a significant regional disparity.(1)Several national and international registries from high socio-demographic Index (SDI) countries have reported worse short-term outcomes of coronavirus disease (COVID-19) in patients with hematologic as compared to other solid cancers. The outcomes of COVID-19 in patients with hematologic malignancies from a low-middle SDI country are yet unknown. The COVID-19 Hematologic Cancer registry of India reports these outcomes from India. Methods: Ten tertiary referral hospitals across India reported the demographic, clinical, laboratory, treatment, and outcomes of COVID-19 infection in patients with hematological malignancies. The registry was retrospective from March 21, 2020, and prospective from November 1, 2020, till March 20, 2021. Risk factors associated with severity and mortality were evaluated using the penalised logistic regression and Cox proportional hazards model. Findings: Data from 565 patients was included in this study. Among these, 429 (76%) patients were hospitalized, 186 (33%) patients had moderate/severe COVID-19.There were 116 (20.5%) non-survivors at a mean follow up of 147 (95% CI : 142-153) days. Age >60 years (HR 2·55, 1·23 - 5·27), diagnosis of acute myeloid leukemia (HR 2·85, 1·58 - 5·13), interruption or alteration of anticancer therapy (HR 2·78, 1·65 - 4·68), and post hematopoietic cell transplant status (HR 3·68, 1·82 - 7·45) predicted mortality. In contrast, increasing age [20-40 years (OR 2·54, 1·32 - 4·90), 41-60 years (OR 3·51, 1·84 - 6·71), >60 years (OR 6·04, 3·01 - 12·10), comorbidities such as diabetes mellitus (OR 1·89, 1·18 - 3·04), hypertension (OR 1·94, 1·17 - 3·19), diagnosis of AML (OR 3·70, 2·06 - 6·67), indolent non-hodgkin lymphoma (OR 3·20, 1·68 - 6·09), multiple myeloma (OR 2·88, 1·64 - 5·05), malignancy not being in remission (OR 1·71, 1·12 - 2·60)were significantly associated with severe COVID-19 on univariate analysis. Of these, only increasing age [20-40 years (OR 2·60 (1·31 - 5·15), 40-60 years (OR 3·44, 1.60 - 7·41), more than 60 years (OR 5·70, 2·43 - 13·35)], AML (OR 2·73, 1·45 - 5·12), and malignancy not being in remission (OR 1·85, 1·18 - 2·89) were significantly associated with severe COVID-19 on multivariable analysis Conclusion: The overall mortality from COVID-19 infection of the entire cohort was 20.5%;the mortality was 46.2% in patients who had moderate to severe disease COVID-19 illness. Similar to previous studies, age, diagnosis of acute myeloid leukemia and a post stem cell transplant status was associated with mortality. In addition, interruption or de-escalation of anticancer therapy during Covid-19 infection was identified as an important factor associated with higher mortality on follow up in the current study. References 1. Measuring performance on the Healthcare Access and Quality Index for 195 countries and territories and selected subnational locations: a systematic analysis from the Global Burden of Disease Study 2016. Lancet (London, England)2018;391(10136): 2236-71.Lee AJX, Purshouse K. COVID-19 and cancer registries: learning from the first peak of the SARS-CoV-2 pandemic. Br J Cancer 2021;124(11): 1777-84. [Formula presented] Disclosures: No relevant conflicts of interest to declare.
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COVID-19 , Erythema Nodosum , Herpes Zoster , Pityriasis Rosea , COVID-19 Vaccines , Humans , India , SARS-CoV-2ABSTRACT
The 21st-century worldwide scourge is coronavirus disease or coronavirus disease 2019 (COVID-19). It is influencing more than 120 nations universally. This is basically an infection sickness that is transmitting fundamentally by droplet technique. Incubation period fluctuates from 2 days to 14 days. There is no particular treatment or vaccine accessible till now. The aim of this study is to investigate different medicinal measures to improve the resistance of a person. In this study, we followed rules of the World Health Organization and Ministry Ayurveda, Yoga and Naturopathy, Unani, Siddha, and Homeopathy give measures to improve resistance and checked information from databases such as PubMed, Google researcher, Medline, and electronic web indexes that were propelled from January 2020 to March 2021. Evidence suggested that there is a lack of literacy regarding use of the herbal product to boost immunity. Strong compliance to these guideline helps in improving immunity which ultimately leads to strong immunity strong enough to fight off novel COVID-19 infection.
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Background: Remdesivir (RDV) shortens time to recovery time in patients with severe COVID-19. Its effect in patients with moderate COVID-19 remains unclear. Methods: We conducted an open-label, phase 3 trial (NCT04252664) involving hospitalized patients with confirmed SARS-CoV-2 infection, evidence of pulmonary infiltrates, and oxygen saturation >94% on room air. Patients were randomly assigned 1:1:1 to receive up to 5d or 10d of RDV with standard of care (SoC), or SoC alone;patients could be discharged prior to completing per-protocol assigned treatment duration. RDV was dosed intravenously at 200 mg on d1, 100 mg daily thereafter. Patients were evaluated daily while hospitalized, and via telephone if discharged. The primary endpoint was clinical status on d11 assessed on a 7-point ordinal scale. Results regarding the primary endpoint are expected to be published before IDWeek 2020;we plan to present d28 results at the meeting. Results: In total, 584 patients underwent randomization and started their assigned treatment (191, 5d RDV;193, 10d RDV;200, SoC). By d11, 3 2 point improvement on the ordinal scale occurred in 70% of patients in the 5d arm, 65% in the 10d arm, and 61% in the SoC arm. Patients in the 5d RDV arm were significantly more likely to have an improvement in clinical status than those receiving SoC (odds ratio [OR], 1.65;95% confidence interval [CI], 1.09-2.48;P=0.017);OR of improvement for the 10d RDV arm compared to SoC was 1.31 (95% CI, 0.88-1.95];p=0.183). This improvement in the 5-day arm over the SOC arm was noted from d6 through d11. We observed a peak of discharges corresponding with the assigned treatment duration of RDV, with increased discharges at d6 in the 5-day arm and at d11 in the 10-day arm. A worsening of clinical status of ≥ 1 point in the ordinal scale was observed more commonly in the SoC am (n=19, 10%) versus the 5d RDV (n=7, 4%) and 10d RDV (n=9, 5%). Conclusion: RDV for up to 5 days was superior to SoC in improving the clinical status of patients with moderate COVID-19 by d11. We will report d28 outcomes at the meeting. (Table Presented).
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The present study was conducted to assess effectiveness and challenges of tele-dentistry and factors affecting it, during the times of COVID-19 health emergency among dental professionals. It was a cross-sectional questionnaire study conducted among dental professionals which was online. Mean age of Study participants were 32.3±3 years. Majority of study participants major challenges to practice of Tele dentistry during Covid-19 Pandemic was lack of proper infrastructure {(189 (91.3%)}, negative attitude of Dental professionals {(93 (44.9%)}, According to {172 (83.1%)} dental professionals there are many challenges for practicing Tele-dentistry. Dental professionals reported that effectiveness of Tele dentistry during Covid-19 is good but all together challenges were large to practice. Tele dentistry in India due to which its effectiveness decreases and factors effecting its effectiveness barriers were age, average number of patients seen per month before lockdown, and Practice closed due to Covid-19 outbreak.
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COVID-19 infection as described by Merriam Webster 2 as a mild to severe respiratory disease caused by a coronavirus that is mainly transmitted through interaction or contact with transmittable material such as respiratory droplets or with matter or surfaces contaminated with the virus causing it. The main aim of this article was to review Psychosocial Implications of Lockdown on Dental Professionals. Due to the lockdown situation attributed to COVID-19 infection around the world, a large number of dentists are affected in every aspect of life mentally, physically and economically. The self employed dentists were also concerned about their financial consequences personally. In a country like India, where a large number of cases are asymptomatic or with no or very little symptoms of infection have increased problems for dentists. On research front, very few studies are conducted till now to determine Psychological wellbeing of dental professionals and factors associated with it during COVID-19 health emergency.
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Can early use of corticosteroids prevent progression of Covid-19 pneumonia to full-blown ARDS, and reduce mortality? Clinical data for use of corticosteroids in severe coronavirus infections are mixed - there is a particular lack of evidence in patients in the pre-critical care stage of illness i.e. before decompensation into severe respiratory failure or other organ dysfunction necessitating a critical care admission. Early experience during the initial surge of admissions at our large teaching hospital suggested improved clinical outcomes in some patients treated with corticosteroids. We therefore carried out a rapid retrospective review of all Covid-19 related admissions (n=422) to the hospital from 12th March 2020 (when the first patient was admitted) until 28th April 2020. There was no significant difference in length of stay or total number of days on oxygen -however there was a marked, statistically significant difference in in-hospital mortality (28% in the corticosteroid group versus 65% in the standard treatment group, p=0.00013), as well as a reduction in the need for critical care admission (7.7% versus 49%). Until robust data from RCTs emerges, we suggest that treating a selected group of patients with Covid-19 pneumonia with corticosteroids at the right time is crucial. Timely treatment may attenuate the excessive host respiratory and systemic inflammatory responses, preventing progression to ARDS and death.
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Many recent studies have reported that patients infected with novel coronavirus 2019 or SARS-CoV-2 (Severe Acute Respiratory Syndrome Coronavirus 2) might have a liver injury. However, few studies have focussed on the levels of Gamma glutamyl-transferase (GGT) alone and the variations associated with it. We retrospectively analysed the GGT levels of 476 admitted patients with confirmed COVID-19 in a tertiary care centre, PGIMER (Post Graduate Institute of Medical Education and Research), Chandigarh. Out of the total 476 COVID-19 patients studied, 35% had elevated GGT levels. ICU care was required for 51.19% (P <0.0001) of these patients and their hospital stay was of longer duration as compared to the patients with normal GGT levels. The incidence of GGT elevation was found to be more pronounced in males and elderly patients. The male population displayed higher GGT levels with 52% having raised levels compared to females where only 21.6% had elevated GGT levels. Although the number of COVID-19 cases was majorly from young age groups, the elevation in GGT levels has been reported more in elderly patients. GGT levels can therefore serve as a predictor for the extent of liver injury and severity in COVID-19 patients.