ABSTRACT
Introduction: Community acquired acute kidney injury (CA-AKI) in low income settings is different from that in the high income settings. Infections, poisoning, toxic envenomations and pregnancy related AKI are common. Kidney biopsy is seldom performed in these patients unless atypical clinical course or features are present. We have established a prospective cohort of patients with CA-AKI at the Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh in India. We present the spectrum of kidney biopsies in patients who underwent kidney biopsy in this cohort. Method(s): The study is a single centre, prospective, observational cohort study of patients with CA-AKI at PGIMER. Patients aged >12 years and with a diagnosis of CA-AKI are eligible for enrolment. Patients with underlying CKD, urinary tract obstruction, COVID 19, malignancy or heart failure are excluded. Clinical and laboratory data are recorded at baseline. Follow up visits are scheduled at 1 and 4 months after hospital discharge. Kidney biopsies are done only in those patients who have atypical clinical course or features (e.g. persistent kidney dysfunction despite other clinical improvement, strong clinical suspicion of dominant glomerular involvement or interstitial nephritis etc.). We present the spectrum of histopathological diagnoses that were recorded in such patients till date. Result(s): Till now, 646 patients have been included in the cohort. The leading causes of CA-AKI are sepsis (52%), obstetric complications (14%), envenomation (8%), nephrotoxic drugs (6%) and poisons (3%) (figure 1). 18.4% patients had died after CA-AKI. At >=3 months after CA-AKI, 16.3% patients had not recovered completely with persistent eGFR <60 ml/min/1.73m2. 44 patients had undergone kidney biopsy in this cohort. Incomplete recovery, and clinical or diagnostic dilemmas were indications for doing kidney biopsy. The leading clinical diagnoses in this subgroup were sepsis (23%), nephrotoxic drugs (23%), envenomation (9%), obstetric causes (6.8%) and others (25%). Acute interstitial nephritis, acute tubular necrosis and acute cortical necrosis were most common histologic diagnoses (table 1). Combinations of various histologic features were not uncommon. Pigment casts were recorded in 13 patients. 4 patients had acute cortical necrosis, 2 being after post-partum AKI and one each due to acute gastroenteritis and unknown animal bite. Glomerular involvement were recorded in 8 patients (table 1). Thrombotic microangiopathy was present in 4 patients. In this subgroup of patients who underwent kidney biopsy, 3 (7%) had died and 8 (18%) had eGFR <60 ml/min/1.73m2 at >=3 months. Figure 1: Causes of CA-AKI in patients [Formula presented] Table 1: Histologic diagnoses in kidney biopsies in CA-AKI cohort. [Formula presented] Conclusion(s): Acute interstitial nephritis and acute tubular necrosis, alone or in combination with other findings, were the most common histologic diagnoses in indication kidney biopsies in CA-AKI. Adverse outcomes (mortality or progression to CKD) are common after CA-AKI. No conflict of interestCopyright © 2023
ABSTRACT
COVID 19 pandemic has gradually established itself as the worst pandemic in the last hundred years around the world after initial outbreak in China, including India. To prevent the spread of the infection the Government implemented lockdown measure initially from 24th March to 14th April, 2020 which was later extended to 3rd May, 2020. This lockdown imposed restrictions in human activities, vehicular movements and industrial functioning;resulting in reduced pollution level in the cities. This study was initiated with the objective to identify the change in the air quality of seven megacities in India and to determine any correlation between the active COVID cases with the air quality parameters. Air quality dataset of the most common parameters (PM2.5, PM10, SO2, NO2, NH3, CO and Ozone) along with air quality index for 70 stations of seven megacities (Delhi, Mumbai, Kolkata, Bengaluru, Hyderabad, Chennai and Chandigarh) were analysed. Comparison was made between AQI of pre lockdown and during lockdown periods. The results obtained indicate sufficient improvement in air quality during the period of the lockdown. For the next part of the study active COVID cases during the lockdown were compared to the air quality change of that period. A significant correlation between active COVID case and change in the air quality was observed for Delhi and Kolkata with 0.51 and 0.64 R2 values respectively. A positive correlation was also observed between air pollutant parameters and incidents of COVID cases in this study. Thus from the analysis it was identified that air quality index improved considerably as a result of the nationwide lockdown however, there was no significant impact of this improvement on the infection rate of the prevailing pandemic.
ABSTRACT
With a remarkable increase in industrialization among fast-developing countries, air pollution is rising at an alarming rate and has become a public health concern. The study aims to examine the effect of air pollution on patient's hospital visits for respiratory diseases, particularly Acute Respiratory Infections (ARI). Outpatient hospital visits, air pollution and meteorological parameters were collected from March 2018 to October 2021. Eight machine learning algorithms (Random Forest model, K-Nearest Neighbors regression model, Linear regression model, LASSO regression model, Decision Tree Regressor, Support Vector Regression, X.G. Boost and Deep Neural Network with 5-layers) were applied for the analysis of daily air pollutants and outpatient visits for ARI. The evaluation was done by using 5-cross-fold confirmations. The data was randomly divided into test and training data sets at a scale of 1:2, respectively. Results show that among the studied eight machine learning models, the Random Forest model has given the best performance with R2 = 0.606, 0.608 without lag and 1-day lag respectively on ARI patients and R2 = 0.872, 0.871 without lag and 1-day lag respectively on total patients. All eight models did not perform well with the lag effect on the ARI patient dataset but performed better on the total patient dataset. Thus, the study did not find any significant association between ARI patients and ambient air pollution due to the intermittent availability of data during the COVID-19 period. This study gives insight into developing machine learning programs for risk prediction that can be used to predict analytics for several other diseases apart from ARI, such as heart disease and other respiratory diseases. © 2022 Elsevier B.V.
ABSTRACT
Introduction: Fear and uncertainty are the 2 ingredients of psychological challenges brought about by coronavirus (COVID-19). Fear and intolerance of uncertainty can affect decision-making. Because of the pandemic and owing to their phase of cognitive development, adolescents are more susceptible to such influence. Objective(s): To explore and understand the effects of COVID-19 on emotion and cognition by investigating the association between fear of COVID-19, intolerance for uncertainty, and decision-making in Indian adolescents. Method(s): The sample constituted 136 Indian adolescents aged 15 to 19 years. The sampling technique used was a nonprobability sampling technique called snowball sampling. The sample was collected through an online platform, ie, WhatsApp, Facebook, and most responses were received from Delhi, Sirsa (Haryana), and Chandigarh. The tools administered were the fear of COVID-19 scale (FCVS-19), the Intolerance of Uncertainty Scale (IUS-12), and the adolescent decision-making questionnaire (ADMQ). Correlational, regression, and mediational analyses were conducted to study the associations and interactions between the 3 study variables. Result(s): The sample consisted of 51.5% females and 48.5% males. The correlational analysis reported significant positive relationships between fear of COVID-19, intolerance of uncertainty, and maladaptive decision-making. Further, mediation analysis reported: (a) the intolerance of uncertainty mediates the relationship between fear of COVID-19 and maladaptive decision-making patterns and (b) fear of COVID-19 mediates the relationship between intolerance of uncertainty and maladaptive decision-making patterns. Conclusion(s): The findings indicated that emotions experienced by adolescents during the COVID-19 pandemic could have a negative and significant effect on their decision-making. Thus, it is necessary to mitigate these effects to ensure optimal development of their cognitive skills during calamities such as the COVID-19 pandemic. Copyright © 2022 Indian Association for Child and Adolescent Mental Health, unless otherwise noted. Manuscript content on this site is licensed under Creative Commons Licenses.
ABSTRACT
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.
ABSTRACT
Introduction: With the changing trends of teaching methodologies in COVID-19 pandemic era, medical teachers need to adapt to the advancing technologies available for teaching as well as assessment. The present study, an online Anatomy quiz was conducted for MBBS first year students from different Medical Colleges of Punjab and Chandigarh with the help of an app called 'Mentimeter' as a part of 'The World Anatomy day' celebrations. Aims: 1.To assess the efficacy of the mentimeter app as a teaching aid for assessments. 2.To objectively assess the quality of MCQs. Material and Methods: An Multiple Choice Question (MCQ) quiz of gross Anatomy was prepared on Mentimeter app. Through a google form link shared with the students of Medical Colleges of Punjab and GMCH Chandigarh, the students registered for the quiz. Quiz was conducted through an online quiz app 'Mentimeter' on 11t h October 2021. Students' feedback was analyzed using Microsoft excel. Results: The result was immediately displayed on the screen. An excel sheet was obtained later, on the registered email from the software used and the results were then analyzed objectively to see the difficulty level and discrimination score of the MCQs. Overall, the difficulty level was perceived as moderate by majority of the students subjectively. Conclusion: Although having few limitations, this study proved that the tool used for quiz was quite useful in quick assessment of students.
ABSTRACT
Introduction: Studies have linked lower vitamin D levels with cardiovascular disease (CVD) and mortality in general population and chronic kidney disease (CKD). The preliminary evidence of vitamin D supplementation is encouraging but there is a huge void with respect to good quality long term data supporting the use of this promising intervention for translation into better outcomes for CVD in CKD. This study is exploring the effect of cholecalciferol supplementation on cardiovascular disease, markers of inflammation and bone metabolism in CKD. We present the baseline characteristics of feasibility phase of the trial. Methods: The study is a multicentric, prospective, randomized, placebo controlled, double blind trial in two parallel groups and feasibility phase is being done at Postgraduate Institute of Medical Education and Research, Chandigarh, India. The trial is registered at Clinical Trials Registry of India (CTRI/2019/05/019211). After a run-in period of 2 weeks, the enrolled subjects are randomized in 1:1 to receive either 60,000 IU/2 weeks of cholecalciferol or matching placebo. The subjects will be then followed up every three month till 3 years. The primary outcome of the study is a composite of major adverse cardiac events (MACE). Secondary outcome measures include all-cause mortality, need of RRT, change in hsCRP, IL-6, iPTH, FGF-23, bone specific alkaline phosphatase, and CTX-1. Results: A total of 720 subjects have been screened till date. Out of 119 enrolled, 86 subjects have been randomized over 24 months period. 76% subjects have completed annual follow up at 12 months, 66% subjects - 15thmonths follow up, 40%- 18 months follow up, 26% subjects - 21 months follow up, 6% subjects – 24 months follow up. Baseline characteristics and serum biomarkers levels has been analysed in 80 subjects. Mean age of the subjects were 51.3 ± 12.2 years and 58.8 % were males. Serum haemoglobin levels were 11.6 ±1.7 g/dl. Mean eGFR was 26.3 (17.4, 35.1) ml/min/1.73m2. Outcome events were;MACE: 1 (due to CVD), death other than due to MACE: 1 (due to COVID 19), subjects with composite of all-cause death and non-fatal MACE: 2, subject with need of RRT:1 and subjects with composite of 50% decline in GFR or need of RRT: 3. 2 serious adverse events unrelated to study drug were reported during the course of study. Table: Baseline levels of various serum biomarkers [Formula presented] Conclusions: Despite COVID 19 related restrictions being in place for most of the last 18 months, the study has been able to screen and enrol participants. The follow ups have been ensured either through physical or remote (mobile/telephonic) means. Once in the multi-centric phase, the study will be able to test a relatively inexpensive intervention in the form of vitamin D supplementation for CVD in CKD. No conflict of interest
ABSTRACT
Aim: Patients with Covid-19 are theoretically at a higher risk of ACS, as respiratory infections can often lead to coronary endothelial damage and plaque rupture. Initial reports during start of pandemic suggested decrease in STEMI patients, however this has been explained by iatrophobia rather than actual decrease. Data on pathophysiology and outcome of patients presenting with ACS is scarce. We did a prospective observational study to study epidemiology and outcomes of Covid-19 patients with ACS. Methods: A total of 654 patients were admitted with Covid-19 at PGIMER, Chandigarh from August 2020 to February 2021, 35 (5.3%) consecutive patients of ACS were enrolled into the study. Acute myocardial infarction was defined as per fourth universal definition of myocardial infarction. Diagnosis of Covid-19 was established using RT-PCR from nasopharyngeal swab. Angiographic assessment was done by two interventional cardiologists. Results: Mean age of patients was 59.5±11.8 years, males comprised majority (80%) of study group. Most common risk factor was hypertension seen in around 70% followed by DM in 57% patients. Most common symptom at presentation was rest angina seen >90% while history of fever was present in only 31.4%. STEMI was most common ACS seen in 45.7% followed by USA in 23% patients. CS was present in 15% patients at presentation while another 5% developed shock in hospital. Oxygen requirement was required in over half the patients while 25% patients succumbed to illness in hospital.Thrombolysis was done in half the patients of STEMI. In view of Covid-19 disease 71.4% required dexamethasone and remdesivir. Coronary angiography was done in around 20% patients, which revealed obstructive CAD in 83% patients with 60% patients having 100% occlusion of IRA. Percutaneous intervention was done in 66% patients. Hypoalbuminemia was commonly seen patients with mean albumin of 3.3 gm/dL. Low T3 syndrome was most common thyroid function abnormality seen in 37.1%.On univariate analysis age, BNP levels and albumin were able to predict 30-day mortality. Conclusion: ACS can be first presentation of patients with Covid-19 as shown by our study only 30% patients had prior history of fever. Our data reaffirms that patients with Covid-19 and ACS have worse prognosis. Interestingly mortality in our study was comparable to western study, despite low rate of angiography and intervention thus underscoring individualization of therapy. We believe Type-2 myocardial infarction is common in pathophysiology of patients who benefit most from medical therapy.