Illness wellness scale: novel grading system for performance status of patients under surgical care.

BACKGROUND: Grading the illness using clinical parameters is essential for the daily progress of inpatients. Existing systems do not incorporate these parameters holistically. The study was designed to internally validate the illness wellness scale, based upon clinical assessment of the patients requiring surgical care, for their risk stratification and uniformity of communication between health care providers. METHODS: Prospective observational study conducted at a tertiary care hospital. An expert panel devised the scale, and it was modified after feedback from 100 health care providers. A total of 210 patients (150 for internal validation and 60 for inter-observer variability) who required care under the department of surgical disciplines were enrolled. This included patients presenting to surgery OPD, admitted to COVID/non-COVID surgical wards and ICUs, aged ≥16 years. RESULTS: The response rate of the final illness wellness scale was 95% with 86% positive feedback and a mean of 1.7 on the Likert scale for ease of use (one being very easy and five being difficult). It showed excellent consistency and minimal inter-observer variability with the intra-class correlation coefficient (ICC) above 0.9. In the internal validation cohort (n = 150), univariate and multivariable analysis of factors affecting mortality revealed that categorical risk stratification, age ≥ 60 years, presence or absence of co-morbidities especially hypertension and chronic kidney disease significantly affect mortality. CONCLUSIONS: The Illness wellness scale is an effective tool for uniformly communicating between health care professionals and is also a strong predictor of risk stratification and mortality in patients requiring surgical care.

Review of Online Teaching Platforms in the Current Period of COVID-19 Pandemic.

Online teaching platforms have become a core appealing option for education and information delivery in current pandemic of Coronavirus disease 2019 (COVID-19) among medical professionals. This editorial aims to understand perspective of usability and practicality of audio and video conferencing platforms in the current situation. Review of various available online platforms was done, namely Zoom, Google Meet, Google Classroom, Microsoft Teams, Cisco Webex, Go ToMeet, and Say Namaste highlighting and comparing their essential features, their benefits, the system and operating system in which they are supported, user interface, number of individuals who can participate, price packages, security, customer support, and limitations. Based on this, educational implications are discussed and are a guide to choose a suitable platform as well as suggestion for future research.

A cross-sectional questionnaire-based study to assess anxiety among healthcare professionals in india during COVID-19 pandemic

Background and Aims: Coronavirus has resulted in unique challenges to the healthcare professionals. The pandemic has affected the mental health of healthcare professionals, which may impact their ability to provide care to patients. We aimed to assess anxiety among healthcare professionals, and its relation to selected parameters. Methods: This online questionnaire-based study recruited Indian healthcare workers through convenience sampling. Anxiety was measured using the Generalized Anxiety Disorder 7 scale. The reasons of emotional distress were also ascertained. Results: The sample comprised of 677 healthcare professionals including resident doctors, consultants, interns, nursing personnel, and others. Moderate/severe anxiety was present in 24.4% of the respondents. Moderate/severe anxiety was more likely to occur among those who had a friend or family member affected by COVID-19 (odds ratio [OR] 2.74, 95% confidence intervals [CI] 1.61–4.69), or who themselves had a psychiatric disorder in the past (OR 2.44, 95% CI 1.36–4.38). Those who reported long working hours and inadequate sleep, fear of being infected by the virus, concerns about transmitting the virus to a family member, mob violence against doctors, and shortage of personal protective equipment had significantly higher odds of moderate/severe anxiety. Conclusion: A considerable proportion of healthcare professionals suffering from anxiety suggests the need for addressing their mental health concerns.

Negative Emotions, Triggers, and Coping Strategies Among Postpartum Indian Women During Second Wave of COVID-19 Pandemic: Lessons for the Subsequent Waves and Beyond.

Introduction: The study aimed to evaluate COVID-19 associated psychological distress among pregnant and postpartum women during the second wave of COVID-19 in India. Methods: A cross-sectional survey was done using a pre-validated tool involving 491 participants attending a tertiary-care hospital during the second wave of COVID-19 in India. Results: Three-fourths of participants experienced negative emotions such as fear and various features of depression. Participants (75%) reported COVID-related news on TV/Radio/Newspapers including social media as the major trigger for these negative emotions. Loss of social support mainly affected postpartum women (p < 0.001) and working women (p < 0.001). Inability to access healthcare services had negative associations with age (p < 0.001), education (p < 0.001), and socioeconomic class (p < 0.001). Various coping strategies being followed by participants included watching TV/Videos or reading books (93%), resorting to social media (77%), spending more time praying and meditating (86%), and engaging in hobbies (56%). Conclusion: During the second wave, the COVID-19 pandemic had a significantly high negative impact on the psychological and social well-being of pregnant and postpartum women. Hence, it is important to initiate appropriate preventive and corrective steps by the policymakers for any future waves of the pandemic.

Rapid Real-time Squiggle Classification for Read until using RawMap

ReadUntil enables Oxford Nanopore Technology's (ONT) sequencers to selectively sequence reads of target species in real-time. This enables efficient microbial enrichment for applications such as microbial abundance estimation and is particularly beneficial for metagenomic samples with a very high fraction of non-target reads (> 99% can be human reads). However, read-until requires a fast and accurate software filter that analyzes a short prefix of a read and determines if it belongs to a microbe of interest (target) or not. The baseline Read Until pipeline uses a deep neural network-based basecaller called Guppy and is slow and inaccurate for this task (~60% of bases sequenced are unclassified). We present RawMap, an efficient CPU-only microbial species-agnostic Read Until classifier for filtering non-target human reads in the squiggle space. RawMap uses a Support Vector Machine (SVM), which is trained to distinguish human from microbe using non-linear and non-stationary characteristics of ONT's squiggle output (continuous electrical signals). Compared to the baseline Read Until pipeline, RawMap is a 1327X faster classifier and significantly improves the sequencing time and cost, and compute time savings. We show that RawMap augmented pipelines reduce sequencing time and cost by ~24% and computing cost by 22%. Additionally, since RawMap is agnostic to microbial species, it can also classify microbial species it is not trained on. We also discuss how RawMap may be used as an alternative to the RT-PCR test for viral load quantification of SARS-CoV-2.

How Indian obese population managed their lifestyle during first and second lockdown during COVID-19 pandemic? - A comparative study.

Background: People from all over the world have been affected by the COVID-19 (SARS-CoV-2) pandemic. The lockdown during the pandemic has impacted the lifestyle of most of the population. The aim of the present study is to compare the effect of COVID lockdown-1 and lockdown-2 on the lifestyle of the obese Indian population. Methods: This was a cross-sectional study conducted during the COVID-19 lockdown on obese adults. A well-structured questionnaire was developed and administered among the study population. The study was conducted in two phases (lockdown-1 and lockdown-2). A total of 390 subjects were included in the study (260 subjects in the lockdown-1 phase and 130 subjects in the lockdown-2 phase). Data on diet, sleep, stress, and physical activity were obtained and analyzed. Results: The mean age of the participants of phase-1 in the study was 41.7 ± 10.2 years and the participants of phase-2 were 44.5 ± 9.2 years. Statistically significant differences were observed between lockdown-1 and lockdown-2 in terms of monitoring of weight and other comorbid conditions, changes in the consumption of refined flour and processed foods, sugar and sugar-sweetened foods, oils and ghee, duration of physical activity, changes in the duration of sleep, and the stress levels related to COVID-19 (P < 0.001). Conclusion: The impact of the lockdowns on health was very significant and different areas of lifestyle were affected in both the lockdowns. Weight gain was reported in both phases of the lockdown. The monitoring of health parameters, eating frequency, diet, and stress levels were affected during lockdown-1, whereas during lockdown-2, sleep duration and physical activity were affected. A comprehensive lifestyle modification plan is required to be developed to avoid these effects in the future.

Indian medical student perspectives on online mode of education.

Purpose: The coronavirus pandemic has led to drastic changes in the education system globally. The medical education curriculum has also undergone a significant drift from traditional or physical classes to online classes. The study aims to explore the viewpoints of the Indian medical students toward online classes, their ramifications, and suggestions for improvement. Methods: The self-administered online questionnaire using the Google form was developed, validated, and circulated among students of All India Institute of Medical Sciences (AIIMS), New Delhi. The data of the survey were systematically analyzed by descriptive statistics. Results: A total of 223 students filled the Google form. After applying the inclusion and exclusion criteria, 171 students were finalized, and the analysis was done. The data suggested that 49.7% of the participants were facing technical glitches, poor Internet connectivity being the commonest. Eye straining (56.7%) was the major physical health hazard, whereas lack of concentration (53.8%) was the major psychological issue reported by the students. The major advantage of online classes reported was its accessibility (93%) at any time and place, whereas students also reported that the traditional learning method is more interactive and motivating (72.5%). Overall, 72.5% of the students wanted to continue both modes of education after the coronavirus disease (COVID-19) pandemic. Conclusion: As per the analysis of the results, it is concluded that, since both online and offline modes of education have advantages and disadvantages, henceforth, mixed or blended method of learning is the best form of learning medical science.

Negative Emotions, Triggers, and Coping Strategies Among Postpartum Indian Women During Second Wave of COVID-19 Pandemic: Lessons for the Subsequent Waves and Beyond

Introduction The study aimed to evaluate COVID-19 associated psychological distress among pregnant and postpartum women during the second wave of COVID-19 in India. Methods A cross-sectional survey was done using a pre-validated tool involving 491 participants attending a tertiary-care hospital during the second wave of COVID-19 in India. Results Three-fourths of participants experienced negative emotions such as fear and various features of depression. Participants (75%) reported COVID-related news on TV/Radio/Newspapers including social media as the major trigger for these negative emotions. Loss of social support mainly affected postpartum women (p < 0.001) and working women (p < 0.001). Inability to access healthcare services had negative associations with age (p < 0.001), education (p < 0.001), and socioeconomic class (p < 0.001). Various coping strategies being followed by participants included watching TV/Videos or reading books (93%), resorting to social media (77%), spending more time praying and meditating (86%), and engaging in hobbies (56%). Conclusion During the second wave, the COVID-19 pandemic had a significantly high negative impact on the psychological and social well-being of pregnant and postpartum women. Hence, it is important to initiate appropriate preventive and corrective steps by the policymakers for any future waves of the pandemic.

Risk Factors of Severity and Mortality Among COVID-19 Patients: A Prospective Observational Study From a Tertiary Care Center.

Introduction The COVID-19 pandemic has been a major public health threat for the past three years. The RNA virus has been constantly evolving, changing the manifestations and progression of the disease. Some factors which impact the progression to severe COVID-19 or mortality include comorbidities such as diabetes mellitus, hypertension, and obesity. In this study, we followed a cohort of patients to evaluate the risk factors leading to severe manifestations and mortality from COVID-19. Methodology We conducted a prospective observational study of 589 COVID-19 patients to assess the risk factors associated with the severity and mortality of the disease. Results In our cohort, 83.5% were male, with a median age (p25, p75) of 39.71 (30-48) years. The most common comorbidities included diabetes mellitus (7.8%) and hypertension (7.9%). About 41.7% had an asymptomatic disease, and of the symptomatic, 45% were mild, 6% moderate, and 7% severe. The mortality rate was 4.1%. Risk factors for severity included breathlessness (p=0.02), leukocytosis (p=0.02), and deranged renal function (p=0.04). Risk factors for mortality included older age (p=0.04), anemia (p=0.02), and leukocytosis (p=0.02). Conclusions COVID-19 commonly leads to asymptomatic or mild illness. The major factors we found that were associated with severity include breathlessness at presentation, leukocytosis, and deranged renal functions. The factors associated with mortality include older age, anemia, and leukocytosis.

Novel Scoring Systems to Predict the Need for Oxygenation and ICU Care, and Mortality in Hospitalized COVID-19 Patients: A Risk Stratification Tool.

INTRODUCTION: A rapid surge in cases during the COVID-19 pandemic can overwhelm any healthcare system. It is imperative to triage patients who would require oxygen and ICU care, and predict mortality. Specific parameters at admission may help in identifying them. METHODOLOGY: A prospective observational study was undertaken in a COVID-19 ward of a tertiary care center. All baseline clinical and laboratory data were captured. Patients were followed till death or discharge. Univariable and multivariable logistic regression was used to find predictors of the need for oxygen, need for ICU care, and mortality. Objective scoring systems were developed for the same using the predictors. RESULTS: The study included 209 patients. Disease severity was mild, moderate, and severe in 98 (46.9%), 74 (35.4%), and 37 (17.7%) patients, respectively. The neutrophil-to-lymphocyte ratio (NLR) >4 was a common independent predictor of the need for oxygen (p<0.001), need for ICU transfer (p=0.04), and mortality (p=0.06). Clinical risk scores were developed (10*c-reactive protein (CRP) + 14.8*NLR + 12*urea), (10*aspartate transaminase (AST) + 15.7*NLR + 14.28*CRP), (10*NLR + 10.1*creatinine) which, if ≥14.8, ≥25.7, ≥10.1 predicted need for oxygenation, need for ICU transfer and mortality with a sensitivity and specificity (81.6%, 70%), (73.3%, 75.7%), (61.1%, 75%), respectively.  Conclusion: The NLR, CRP, urea, creatinine, and AST are independent predictors in identifying patients with poor outcomes. An objective scoring system can be used at the bedside for appropriate triaging of patients and utilization of resources.

Effect of intensive weight-loss intervention on metabolic, ultrasound and anthropometric parameters among patients with obesity and non-alcoholic fatty liver disease: an RCT.

BACKGROUND: Lifestyle intervention is the mainstay therapy for Non-Alcoholic Fatty Liver Disease (NAFLD). We aimed to assess the efficacy of an intensive (9 contact points in 6 months) weight-loss intervention among patients with obesity (BMI 25-39.9 kg/m2) and NAFLD in north India. METHODS: A total of 140 patients (18-60 years) with obesity and NAFLD were randomized into intervention (n = 70) and control (n = 70) groups, at a tertiary-care hospital. Weight, anthropometric parameters, Controlled Attenuation Parameter (CAP), Liver Stiffness Measurement (LSM), liver enzymes, grade of fatty liver and HOMA-IR were measured at baseline (T0) and 6 months (T6). There was a high drop-out, exacerbated by the Covid-19 pandemic. Completers comprised of 59 participants (n = 30 intervention, n = 29 control). Intention to treat analysis was done. RESULTS: At T6, ALT normalized in significantly higher (p = 0.03) number of cases in the intervention arm (66.7%) versus control arm (18.2%). No significant improvement was seen in other metabolic, ultrasound or anthropometric outcomes. Weight (p < 0.001), AST (p = 0.01), ALT (p = 0.02), body fat% (p < 0.001), WC (p < 0.001) and CAP (p < 0.001) significantly improved within the intervention arm along with a trend of improvement in steatosis and HOMA-IR. Control group showed significant decrease in weight (p < 0.001), WC (p < 0.001) and CAP (p = 0.02). Twice the number of patients in intervention arm (46.7%) lost ≥5% weight, compared to control arm (24.1%) (p = 0.07). CONCLUSION: The intensive weight-loss intervention was not effective in improving the treatment outcomes among patients with obesity and NAFLD. However, given the potential of our intervention, we recommend larger trials with more intensive weight-loss interventions.

A cross sectional survey of 504 women regarding perceived risk factors and barriers to follow healthy lifestyle and association with sociodemographic factors and menopausal symptoms.

BACKGROUND AND AIMS: Midlife women undergoing menopausal transition are predisposed to weight gain. Weight gain in midlife is driven by two modifiable risk factors: menopausal symptom's severity and lifestyle practices. The independent and interactive nature of menopausal symptoms and lifestyle practices as risk factors of weight gain has not been investigated yet. This study was undertaken to study menopausal symptoms and lifestyle practices as risk factors for weight gain in midlife women and identify midlife -related barriers in managing corrective lifestyle practices. METHODS: In this cross-sectional study, menopausal symptom severity and lifestyle practices such as diet, exercise, and sleep were assessed using a pre-validated and reliable questionnaire on a convenience sample of midlife women (43-55 years) via an interview schedule. The association of lifestyle practices and its barriers with socio-demographics and menopausal symptoms were analysed. RESULT: A total of 504 women (mean age: 47.3 ± 4.1 years) were recruited. More than half of them followed corrective dietary practices, but only one-fourth engaged in moderate-intensity exercises. Total menopausal symptom severity was associated with increased food intake (P < 0.001), joint pain with limited physical activity and hot flashes and emotional volatility with sleep disturbances (P < 0.01). Demographic variables such as education, economic and employment status were associated with unhealthy lifestyle practices. CONCLUSION: Assessment of menopausal symptoms and lifestyle practices as risk factors and associated barriers must be the pivotal component to devise comprehensive women-centric weight management modules. Similar studies should be carried out in future when there is no clear effect of COVID19 on lifestyle factors.

Epidemiology and Risk Factors of COVID-19-Related Mortality.

Introduction During the coronavirus disease 2019 (COVID-19) pandemic in India, several characteristics of hospitalized COVID-19 patients, based on demographics, mortality predictors, and presence of comorbidities, were found to be associated with poor outcomes. The objective of this study was to identify such epidemiological and clinical characteristics among the patients admitted at a tertiary-care center in India that may have predisposed them to COVID-19-related mortality. Methods This retrospective observational study conducted at the Department of Medicine, All India Institute of Medical Sciences, New Delhi, in May 2021 included 141 COVID-19 confirmed patients. The medical history, demographic characteristics, comorbidities, clinical findings, and laboratory data of each patient were obtained. The data were analyzed to identify significant clinical and laboratory parameters that led to the adverse final outcomes. Results Hypertension was the most common comorbidity and the presence of diabetes with hypertension led to poorer final outcomes. Lower oxygen saturation and requirement of oxygen supplementation at admission along with worse prognostic scores during admission led to poorer outcomes. Twenty-seven patients needed non-invasive ventilation (NIV) during the hospital course, and all ultimately landed up among the 56 patients who were managed on invasive mechanical ventilation (IMV). Multivariate logistic regression analysis performed identified COVID-19 severity at admission, co-existence of hypertension and diabetes mellitus, systolic blood pressure less than 90 mm Hg, and serum creatinine greater than 1.2 mg/dL to be associated with higher COVID-19 mortality. Conclusion COVID-19 patients having the co-existence of diabetes and hypertension constitute a high-risk group and may be targeted by prompt vaccination strategies. The presence of severe disease along with a need for oxygen therapy and other intensive care interventions ultimately led to unfavorable outcomes.

Pilot study on burden of fungal contamination in face masks: need for better mask hygiene in the COVID-19 era.

Risk factors which led to the outbreak of COVID-19 associated Mucormycosis still remains elusive. Face masks can become contaminated by fungal spores that are present ubiquitously in the environment. However the exact burden of such contamination is not known. Fifty masks of patients who attended the Employees Health Scheme COVID-19 facility of a tertiary healthcare centre in India were sampled by direct impression smears on Sabouraud Dextrose Agar. Agar plates were screened for any growth within five days after incubation. Growth was identified by microscopy on the Lactophenol Cotton Blue mount. Mask hygiene practices of participants was assessed using a pre-designed proforma. Out of 50 masks, fungal contamination was seen in 35/50 (70%) masks, with Aspergillus sp. being isolated from 26/50 (52%) masks and Mucorales being isolated from 9/50 (18%) of the masks. Aspergillus niger, Rhizopus a rrhizus and Syncephalastrum sp. were the most common species isolated. Same mask was worn for a median duration of 8 days (2-30 days) at a stretch with or without washing. Thirty one patients washed and re-wore their masks, with median time duration since last wash being 12 hours (4-72 hours). None of the factors assessed for mask hygiene were associated with fungal contamination. High rates of fungal contamination observed in our study emphasizes the need for better mask hygiene in the COVID-19 era.

Dynamics of Inflammatory Markers in Predicting Mortality in COVID-19.

Introduction A cytokine storm is an important cause of morbidity and mortality in patients with coronavirus disease 2019 (COVID-19). The objective of the study was to determine the prognostic significance of pro-inflammatory cytokines with the overall final outcome of patients with COVID-19. Methods We conducted a retrospective study of 142 patients admitted with COVID-19 in the Department of Medicine at All India Institute of Medical Sciences, New Delhi, from May 2021 to June 2021. We obtained their demographic, clinical, and biochemical characteristics at baseline and 48-72 hours prior to the terminal event (survival/death). The data were analyzed to determine the prognostic significance of these markers on the final outcome. Results Higher levels of inflammatory markers were associated with a worse final outcome (ferritin p-value <0.001, c-reactive protein (CRP) p-value <0.001, interleukin 6 (IL-6) p-value 0.007, procalcitonin p-value 0.005, and lactic acid p-value 0.004). Optimal probability cut-offs for these markers for predicting mortality were: ferritin: 963 ng/mL (sensitivity - 67.35%, specificity - 67.50%), CRP: 66.3 mg/L (sensitivity - 78.43%, specificity - 74.12%), IL-6: 46.2 pg/mL (sensitivity - 59.26%, specificity - 59.57%), procalcitonin: 0.3ng/mL (sensitivity - 65.38 %, specificity - 66.67%), lactic acid: 1.5 mg/dL (sensitivity - 59.26%, specificity - 58.57%). Multivariate logistic regression analysis was done, which showed that pre-terminal event CRP was associated with a statistically significant higher risk of mortality (Unadjusted OR 18.89, Adjusted OR 1.008, p=0.002, 95% CI 6.815 - 47.541). Conclusion Inflammatory markers have a prognostic significance in patients with COVID-19, with higher levels being associated with worse outcomes.

Psycho-social and behavioral impact of COVID-19 on middle-aged and elderly individuals: A qualitative study.

BACKGROUND: COVID-19 may seem to have an impact on middle-aged and elderly people. However, not much is known about the lived experiences of middle-aged and elderly people during this pandemic. The study aims to explore psychosocial and behavioral impact of COVID-19 on the lives of these individuals. MATERIALS AND METHODS: Three focus group discussions and seven in-depth interviews were conducted. A format to guide discussions and interviews was made to bring uniformity across groups and participants. Participants were recruited through purposive and snowball sampling techniques. Discussions were recorded and transcribed verbatim. Thematic analysis method was used to extract key conceptual themes. RESULTS: There were 12 male and 10 female participants included, with a mean age of 62.2 years. Five subcategories identified were: Fear and anxiety, household confinement, lifestyle modification, preventive practices, and coping strategies. These sub-categories formed three major categories-psychological, social, and behavioral which ultimately led to the emergence of the main theme that is, COVID-19 effects on the life of middle-aged and older individuals. CONCLUSION: Middle-aged and elderly people are affected in many ways due to COVID-19. Addressing the psycho-social and behavioral problems can help in the better adjustment to tide over the pandemic.

Evaluation of the dose-effect association between the number of doses and duration since the last dose of COVID-19 vaccine, and its efficacy in preventing the disease and reducing disease severity: A single centre, cross-sectional analytical study from India.

AIMS: To evaluate the dose-effect association between COVID-19 vaccination and probability of turning RT-PCR positive and to assess the correlation between disease severity and vaccination status. METHODS: A single centre cross-sectional study was conducted amongst 583 individuals presenting to COVID-19 testing clinic and 55 hospitalized COVID-19 patients. Vaccination status was assessed by the number of doses and duration since the last dose. Disease severity was evaluated by the requirement of hospitalisation and ICU admission/death. The association between the vaccination status and development of disease and its severity were statistically analyzed. RESULTS: The mean age of the population was 36.6 years and 82.6% had no comorbidities. The odds of turning RT-PCR positive was 0.17(95% CI: 0.11-0.27) among the clinical suspects who had taken both doses of the vaccine at least 14 days before (fully vaccinated). The odds of hospitalisation was 0.12(95% CI: 0.03-0.45) and ICU admission/death was 0.07(95% CI: 0.01-0.36) among fully vaccinated individuals. The protective role of vaccination was observed to start 14 days after receiving the first dose. CONCLUSIONS: COVID-19 vaccination provides dose-dependent protection against the development of the disease. It also lowers the risk of hospitalisation and ICU admission/death in RT-PCR positive patients in a dose-dependent manner.

Association of Sociodemographic Parameters With Depression, Anxiety, Stress, Sleep Quality, Psychological Trauma, Mental Well-Being, and Resilience During the Second Wave of COVID-19 Pandemic: A Cross-Sectional Survey From India.

Objective This study was conducted to assess the traumatic impact of the second wave of coronavirus disease 2019 (COVID-19) pandemic on depression, anxiety, stress, sleep quality, mental well-being, and resilience among the general population of India. Methods An online cross-sectional survey was conducted in May-June, 2021 via Google Forms, which included adult individuals who were willing to participate in the study. The purposive and snowball sampling technique was used to ensure the principle of maximum diversity. Standardised tools [Depression Anxiety and Stress Scale (DASS), Pittsburgh Sleep Quality Index (PSQI), Impact of Event-Revised (IES-R), Short Warwick-Edinburgh Mental Well-being Scale (SWEMWBS), and the Brief Resilience Scale (BRS)] were used to collect data. Results A total of 1,109 responses were analysed for this study. Participants of different age groups (mean age: 32.98 ±14.72 years) and different sociodemographics were enrolled. The younger population group (18-34 years) was found to be the most affected among all the age groups. The findings revealed that 44.18% showed posttraumatic stress disorder (PTSD)-like symptoms. About 48.87%, 65.56%, and 22.09% of the participants had significant depression, anxiety, and stress symptoms respectively, and 11.27% had disturbed sleep patterns. Mental well-being was found to be disturbed for 74.75% of the study population, out of which only 4.15% showed high resilience capacity. Conclusion The associated collective psychological trauma mapped out by this paper is a pandemic in itself and needs to be addressed on a scale similar to the efforts being made to curb the physical symptoms of COVID-19.

Examination in the Time of COVID-19-MCh Plastic Surgery Examination: How Did We Do It?

Background Many aspects of life have been changed, after the starting of the pandemic. Modifications and improvisation in our day-to-day activities is now a new norm. During the pandemic period, continuation academic activities and conductance of examination is difficult but essential. We are sharing our experience of conductance of MCh examination during the pandemic and preparations made. This article also discussed the future of surgical assessment examination, use of technology in surgical assessment changing times. Methods Procedural flow of the examination, Logistics and arrangements were planned and checked. Reliability and validity of questions were maintained by providing a similar set of questions and stepwise objective assessment. Assessment and feedback by the examinees and examiners on the pattern and conductance of examination were assessed by a Likert scale. Results We found, 73% agreed examination patterns were able to test the knowledge fairly. While 80 % believed the pattern was the same for all the candidates. All the stakeholders agreed the examination conducted in a Safe and stress-free atmosphere and use of technology helpful. Fifty- three % agreed the case scenarios correctly simulate the clinical presentations. Lastly, 66 % felt the examination process is adequate for summative assessment. Conclusions It is vital to reflect regarding the need for a uniform module to handle changing scenarios keeping the integrity and quality of the examination. Interactive screen, mannequin, and 3D model will be useful in the examination. In future, standardized examination modules for the surgical trainees will be required to perform a comprehensive assessment.

Clinical predictors of long COVID-19 and phenotypes of mild COVID-19 at a tertiary care centre in India.

A variable proportion of patients develop persistent/prolonged symptoms of Coronavirus Disease 2019 (COVID-19) infection (long COVID). We aimed to study the clinical predictors of persistent symptoms in patients with mild COVID-19 at 30 days post discharge (long COVID-19). We also tried to identify symptom clusters among mild COVID-19 patients. Fifty-seven patients admitted at a tertiary care centre after a positive RT-PCR report over a period of 2 months, were enrolled in the study. Details of presentation, history of illness, laboratory investigations and disease outcomes were recorded from documented medical records and discharge slip. The patients were contacted (telephonically) at 30 days after discharge and enquired regarding persistent symptoms, if any. Follow up data at 30 days post-discharge was available for 53 patients. Among them, the most common persistent symptom was fatigue (22.6%), followed by cough (9.4%) and myalgias (7.5%). There was a significant association of persistent symptoms with diarrhoea at presentation [OR 14.26 (95% CI 2.30-142.47; p = 0.009] and gap between symptom onset and admission [OR 1.40 (95% CI 1.08-1.93; p = 0.020] on multivariate logistic regression analysis. On cluster analysis, three phenotypes of mild COVID-19 were identified, which may have implications on monitoring and management. There appears to be a positive association of diarrhoea as a presenting manifestation and gap between symptom onset and admission with the persistence of symptoms classified as long COVID-19, even in mild illness. We also identified multiple phenotypes of mild COVID-19 illness, which warrant further exploration.