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Introduction : Coronavirus disease 2019 (COVID-19) saw an overhaul in the biomedical waste management (BMWM) practices. Waste handlers were at the brunt of these changes. If the challenges pertaining to BMWM at the ground level are better understood, more effective measures to overcome them can be formulated. Objectives: 1. To identify myths and concerns regarding BMWM in the context of COVID-19 pandemic. 2. To explore the challenges faced in BMWM amidst the COVID-19 pandemic. 3.To explore opportunities and future perspectives of BMWM. Method: In-depth interviews were conducted among 17 purposively selected Class IV health care workers during August to November 2021 in a tertiary care institute in Mumbai. Data was reported using thematic analysis. Results: Three major themes - challenges and concerns faced by BMW handlers, enablers/motivators, opportunities and future practices were generated from the transcripts. Various challenges faced by waste handlers were- difficulties in segregation and transport of BMW, exhaustion from PPE usage and fear of acquiring and spreading COVID-19 from work, stigma faced from public, and handling COVID-19 deaths. Support from family and colleagues, incentives and a positive change in public perception enabled them to work. Forming redressal committees, addressing job security concerns and timely provision of good quality equipment can improve hospital waste management measures in the future. Conclusion: It is of utmost importance to address challenges faced by waste handlers in BMWM. Onus should also be on periodic training in BMWM.
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Background: In March 2020, the world health organization declared COVID-19 a world wide pandemic. Countries introduced public health measures to contain and reduce its spread. The effect of mandated societal lockdown to reduce the transmission of corona virus disease 2019 (COVID-19) on road traffic accidents is not known. For this we performed an in-depth analysis singdata of emergency and trauma centre UPUMS, Saifai. As most of the manpower was involved in managing Covid patients directly or indirectly, it was a challenge to manage these mass casualty patients who require intensive care as well as Medicolegal documentation, record keeping, Consent for life saving procedures in absence of Relatives. Material(s) and Method(s): We reviewed data on total 2876 road traffic accident records in UPUMS, Saifai from January 1, 2020 through September 30, 2020. We treated March 20th as the first day of mandated societal lock down and 1st July as the first day of re-opening. Result(s): We have found that the reis increase in road traffic accidents resulting in serious or fatal injuries during lockdown and post-lockdown period. There was increased Medicolegal burden in spite of the decreased medical resources, manpower as most of manpower and resources were being utilized for covid patients. Conclusion(s): Road traffic accidents are a prominent contributor to hospitalization and may negatively impact the existing hospital resources directed towards COVID-19.Copyright © 2023, World Informations Syndicate. All rights reserved.
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Introduction: The use of telemedicine in surgical care quickly increased due to the COVID-19 pandemic. However, uptake among surgical specialties has not been consistent. We aimed to characterize surgical provider perceptions of barriers and facilitators to telemedicine use. Method(s): Surgeons and nurses within the gastrointestinal surgery division at a high-volume, tertiary care academic center were contacted for participation in this study. Individual semi-structured interviews explored barriers and facilitators to telemedicine use. Qualitative analysis was conducted by multiple coders using NVivo12 software. Result(s): Six surgeons and three nurses participated in this study. Among the 9 participants, 44% identified as female and 33% were over age 50. Three themes were identified as facilitators to provider utilization of telemedicine: increased accessibility for rural patients due to decreased travel time and cost, enhanced provider productivity from reduced transition time between visits, and the ability of video telemedicine to facilitate non-verbal communication and visual examination. Three themes were identified as barriers to provider utilization of telemedicine: unreliable broadband connection, negative impacts on workflow due to scheduling challenges and insufficient IT support, and the inability to conduct a physical exam and immediately manage certain complications. Conclusion(s): As telemedicine becomes highly integrated into routine care, best practice guidelines to surgeon-patient telemedicine encounters should be established. This will improve virtual communication and consistency across providers, as well as provider satisfaction with telemedicine. Future interventions should address concerns with workflow logistics and technical support by developing comprehensive training and troubleshooting strategies for healthcare providers.
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Aim: To determine the frequency of ear, nose and throat related disorders of covid disease in PCR proven positive Covid-19 patients. Method(s): This prospective study included 320 Covid-19 positive patients and was conducted at ENT Department of MTI Hayatabad Medical Complex, Peshawar from May 1, 2021 to April 30, 2022. The acute phase of covid-19 was taken as the time interval between the onsets of symptoms as day 1 today 30th post infection. Questions were asked about the following symptoms;flu, sore throat, sinus involvement, taste disturbances, smell disturbances, hoarseness and hearing loss. Clinical examination and relevant investigations were carried out to make a diagnosis. The data was documented on a proforma & analyzed using SPSS 26.0 for windows to determine the frequencies of signs & symptoms related to ENT. Result(s): A total of 320 patients were included in the study. The ages ranged from 18-50 years with mean age of 33.96 years. The age group 18-25 years mostly presented with symptoms related to ENT. Upper respiratory tract infection was the commonest symptom (60.6%) followed by sore throat (57.5%). Smell and taste disturbances accounted for in 46.3% & 15.3 % of the patients respectively. Fungal rhinosinusitis was observed in 6.9% of the patients. As there is a wide variation of the ENT symptoms in covid disease, it is important to know the predictive symptoms so that appropriate measures can be adopted. Identification & isolation of patients will prevent spread of disease and focused therapy and investigations. Practical implication Conclusion(s): The portal of entry for the SARS-CoV-2 is through the upper airway. It is important to know the symptoms related to ENT to make an early diagnosis and therefore, institute measures for management and prevention of further spread of the disease.Copyright © 2023 Lahore Medical And Dental College. All rights reserved.
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Introduction: Covid-19 was classed as a global pandemic by the World Health Organization (WHO) in March 2020. This had an overwhelming effect on the National Health Services (NHS) in the United Kingdom resulting in the disruption and subsequent prioritization of the elective recovery services. Despite the various limitations of delivering services during a pandemic, Barts Neuromodulation Centre maintained the importance of multidisciplinary assessment in the selection of patients suitable for this form of therapy. We present the data on our continued activity through pandemic, dependent on the performance feasibility. The aim of this effectiveness project was to evaluate the post SCS outcome data during covid-19 pandemic. Method(s): This was a telephone and in person data collection of patient responses to standardized and validated pain outcome questionnaires following SCS implant performed at St Bartholomew's Hospital, London during January-December 2021. Data was collated from a tertiary Neuromodulation center at Barts Health NHS Trust, UK. Patients completed the questionnaires prior to SCS implant and post implant 1, 3, 6, and 12 month follow- up appointments with our neuromodulation specialists Results: Two hundred and fifteen patients underwent face to face or telephonic consultation during January to December 2021 for the follow ups. Total 178 patients registered their responses with F:M being 63%:37% and the average age 55 years. At each time point, the following number of patients completed: baseline n= 52;1 month n= 27;3 months n=28;6-month n= 21 and 12 months, n= 26. We demonstrate that NRS pain scores reduced by 43%, ODI disability improved by 35%, HADS anxiety reduced by 45%, depression reduced by 46%, PSQ sleep improved by 77% and EQ5D quality of life improved by 66% at 12 months when compared to baseline. There were no serious adverse events reported through this time. Conclusion(s): To our knowledge, this is one of the first reported real-world post SCS outcome data of prospective follow ups. We demonstrate safe delivery of services and data collection feasibility through pandemic. Moreover, our patient cohort showed improvement in the all dimensions of chronic refractory pain following SCS therapy despite clinical burden of COVID-19. Disclosure: Alia Ahmad: None, Angie Alamgir, PHD: None, Sanskriti Sharma: None, Joanne Lascelles, Clinical nurse specialist: None, Amin Elyas, FRCS: None, Helen Bonar: None, Serge Nikolic, MD: None, Habib Ellamushi: None, Vivek Mehta: None, Kavita Poply, PHD: NoneCopyright © 2023
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Background: Coronavirus is a highly infectious novel virus we are in urge to know more about their clinical characteristics and laboratory findings for the characterization and selection of treatment protocol. Methods: Prospective, single centre study. Two months data was collected, clinical characteristics data from patient case sheet and the laboratoryvalues from the Hospital Information System (HIS) for the month of July and August 2020. Results: Of 462 patients, 55 (11.9%) are falls under asymptomatic category, 194 (42%) are in mild category, 167 (36.1%) are in moderate category and 46 (10%) in severe category. Fever 230 (49.8%) and cough 211 (45.7%) was most common clinical symptom with p value < 0.01. Non-severe vs severe, 340 (73.6%) and 201 (43.5%) showed decreased in eosinophil count and absolute eosinophil count, 125 (27.1%) and 80 (17.3%) patient showed decrease in lymphocyte count and absolute lymphocyte count, 200 (43.3%) showed increase in neutrophil count with a significance of p value >0.05.186 (40.3%) patients had one or more co-morbidities. Laboratory findings between Asymptomatic VS symptomatic, showed significance changes in neutrophil, lymphocyte, Aspartate aminotransferase, Alkaline phosphatase, globulin values (p value <0.05). Conclusion: Clinical severity categorization at the time of admission was very helpful for the treating doctors in proper understanding of disease progression and appropriate treatment of the patient. Presence of co-morbidity, abnormal laboratory values, old age group patients, higher Computed Tomography score, higher mortality rate are seen more in patients who were in clinical severity grade severe category than in non-severe category patients.
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Introduction: As a part of prophecy by WHO nearly half of the population of Globe will be facing problem of refractive errors by 2050. In India by the mid of this century these diseases will flourish in Indian continent with frightening velocity. Amblyopia is one of the basic reason for refractive errors in childhood with maximum global prevalence of 4.7% averaging 2% school going children. "Amblyopia" is a disorder in retinal image foundation because of decline in the value of central, adjusted vision which most commonly happens during first decade of life. Hence we have undertaken the present study to know the status of amblyopic status in school going children during and in Post Covid sessions. Methodology: In this hospital-based observational cross-sectional study we examined (optometry, retinoscopy along with Auto-refractometer) 639 school going students from our tertiary care institutes who were facing problem in their vision. Results and discussion: Amongst the participants during COVID period 331 (52.73%) were girls and 308 (48.2%) were boys learning in different classes having refractive errors. Out of these total participants 27 students were found to have amblyopia. Affecting a greater number of females that is 16 (4.8%) and 11 boys (3.5%) of the total participating population. While in post covid period out of 437 boys students 3.4% were having amblyopia with statistical significant difference between the two groups depicting more number of boys having amblyopia during COVID period. Refractive errors are mostly caused by prolonged focusing on the screen, that children should take a break from the screen every half an hour to avoid possible eye problems. Conclusion(s): We conclude that if detection of amblyopia is possible in earlier phases of life then nationwide campaign or programme should be initiated and implemented for prevention of mortality of vision.Copyright © 2023, Dr Yashwant Research Labs Pvt Ltd. All rights reserved.
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Introduction: Rise of major Healthcare associated infections (HAIs) can be mitigated by inculcating good infection control practices which can only be possible by proper and timely educational training of healthcare workers. Aim: To reinforce infection prevention and control knowledge and practices of nursing staff through proper training program- To conduct the training in multiple sessions, to assess the immediate outcome of training program by conducting Pre and Post test (in written format only) Materials and Methods: This study was done in a tertiary care hospital in Davangere, Karnataka over a period of 2 years. Healthcare workers including 144 nurses and 12 doctors underwent training in four sessions where knowledge on how to identify, audit and conduct surveillance of major healthcare associated infections, management of needlestick injuries were imparted through interactive lectures and video demonstrations followed by hands on hand hygiene, proper use and disposal of personal protective equipments. Pre and Post test were given to know their basal knowledge and effect of our training intervention. Data was collected, analyzed and tabulated. Results: Out of four sessions covering a total of 144 nurses, 84 were trained before the onset of COVID-19 and remaining 60 were trained in the latter half of 2021, when the lockdown was relaxed in our region. The mean total Knowledge score in pre test and post test was 5.93 +or- 1.336 and 7.95 +or- 1.040. The mean difference was -2.021 and it was statistically significant by paired test. (p - 0.001). The mean total practice pretest and post test score was 3.57 +or- 1.48 and 4.56 +or- 1.114. Paired t test showed significant mean difference between the pretest and post test score. (p - 0.001). Conclusion: Our training intervention was effective in increasing their awareness on proper infection prevention and control practices. Repeated training and retraining of healthcare care workers have to be carried out to prevent and control healthcare associated infections.
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Background: The ubiquitous elixir for mortality and morbidity inflicted by severe acute respiratory syndrome virus (SARS-CoV-2) has been a vaccine. These vaccines were approved for emergency use authorization by health authorities based on limited data from clinical trials. Hence, there was a need for active surveillance of vaccinees to monitor for safety. Objective(s): This study reports adverse events following immunization with Oxford-AstraZeneca's COVID-19 vaccine (COVISHIELD). Material(s) and Method(s): The present study is an observational follow- up study to assess any adverse event occurrence following immunization (AEFI) within 7 days of vaccination among all eligible participants who were vaccinated. A structured safety surveillance questionnaire was administered consecutively to 714 participants. Vaccinees were observed for thirty minutes and followed telephonically for adverse events. Result(s): The overall incidence of any AEFI within 7 days was found to be 136/1000 vaccinations for the first dose. Out of total, 97 recipients reported with adverse events, 76.3% had AEFI within 24 h with fever as the most common symptom reported. The incidence of AEFI's was found to be associated with gender (P<0.02), age group (P<0.05) and occupation (P<0.05). No cases of hospitalization, disability or death were reported. Conclusion(s): Most of the adverse events were short-lived and observed in the first 24 h of vaccination. Incidence decreased in subsequent days and as no significant life-threatening adverse event was observed, this study might help reduce hesitancy for vaccination among the population and thus help reduce transmission of this highly contagious disease.
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INTRODUCTION AND OBJECTIVE: Overactive bladder (OAB) is highly prevalent, affecting millions of Americans, and poses a significant symptom burden. The purpose of this study was to understand patient experiences with OAB and the impact of these experiences on OAB treatment. METHOD(S): People with symptoms of OAB were recruited from a tertiary care clinic and from an online health research portal to complete semi-structured interviews regarding their OAB experiences. The interviews were recorded, transcribed, coded, and inductively analyzed to identify emerging themes. RESULT(S): We performed 19 interviews and identified several key themes central to the patient experience, including symptom impact and severity, knowledge, stigma, self-efficacy, and regret. We considered these themes along the following stages of the patient's OAB journey. Symptom Development and Awareness: The routine of self-care is insidious and normalized, making realization of a lifestyle that is centered around voiding less obvious to patients, leading to a delay of care-seeking. Participants noted restrictions on all aspects of life. Adjectives used to describe symptom impact included "annoyance, depression, humiliation and desperation." Care-Seeking: Participants expressed coping behaviors during onset and gradual worsening of symptoms, however many recounted a "sentinel event" that heightened their severity perception and served as a cue to action. Routine primary care visit screenings and friend recommendations were additional cues to action. Reasons for careseeking delay included lack of OAB knowledge, stigma, and embarrassment. Experiences with Therapy: Participants recognized that treatment outcomes depended on their engagement. Some individuals regretted their lack of self-advocacy and self-efficacy. Participants highlighted internal barriers (forgetfulness, doubting treatment effectiveness) and external barriers (comorbidities, COVID- 19) to therapy adherence. Among those with high self-efficacy, fear of treatment failure, calendar tools, and social support networks facilitated treatment compliance (Figure 1). CONCLUSION(S): Living with OAB affects patients physically, mentally, and socially. Gaining a better understanding of OAB experiences can help physicians tailor their practice to meet patients' needs.
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Objective: The primary objective was to assess the difference in rates of hypoglycemia (blood glucose (BG) <=70 mG/dL) when using reduced-dose (5 units) vs. standard-dose (10 units) of IV regular insulin for hyperkalemia treatment in renal insufficiency. Secondary objectives include the efficacy of insulin dose on potassium reduction and evaluating the difference in rates of severe hypoglycemia (BG <=54 mG/dL) between the groups. Method(s): This was a retrospective chart review of patients with renal insufficiency treated with IV regular insulin for hyperkalemia at a tertiary care teaching hospital from June 2020 to June 2021, with institutional review board approval. Inclusion criteria encompassed patients aged 18 years and older with elevated baseline potassium (>=5.5 mEq/L), estimated glomerular filtration rate < 30 mL/min/1.73m2, end stage renal disease, or presence of acute kidney injury, having received either 5 or 10 units of IV regular insulin for hyperkalemia, and had documented glucose and potassium levels after insulin administration. Patients who were pregnant, had diabetic ketoacidosis, or a baseline BG <=70 mG/dL were excluded. Data collection included patient demographics, diabetes history, relevant labs at time of elevated potassium, doses of insulin and dextrose administered for hyperkalemia treatment, presence of coronavirus-19 infection, glucose levels within 6 hours and first potassium level within 24 hours following insulin administration, concurrent use of potassium-lowering agents, insulin outside of hyperkalemia treatment, or steroids, and mortality. Result(s): Out of 409 patients included, 92 were in the 10-unit group and 317 in the 5-unit group. The rate of hypoglycemia in the 5-unit arm vs. the 10-unit arm was 6.9% vs. 8.7% (p=0.649), respectively. The rate of severe hypoglycemia between the 5-unit arm and the 10-unit arm was 3.2% vs 5.4% (p=0.682), respectively. The percent normalization of potassium was not statistically different between the 5-unit group and the 10-unit group (59% vs. 68%;p=0.115), with the same mean reduction in potassium from baseline (0.8 mEq/L (p=0.947)). Administration of concurrent treatments for hyperkalemia was similar between the groups, with dialysis being the only one with statistical significance in normalization of potassium. Patient characteristics that could have an impact on risk of hypoglycemia were studied and analyzed, including pre-treatment BG, history of diabetes mellitus, insulin naive, and patient weight. In patients with hypoglycemia (n=30) vs. those without hypoglycemia (n=379), there was a significantly different mean pre-treatment BG (113 mG/dL vs. 178 mG/dL, p<0.001). Discussion/Conclusion: There was no significant difference in rates of hypoglycemia and severe hypoglycemia between the 5-unit vs. 10-unit groups. There was no significant change in potassium normalization between the two insulin doses. Because of the small number of hypoglycemia events, larger studies are needed to better understand if 5 units of regular insulin is a safer option for the treatment of hyperkalemia in renal insufficiency.Copyright © 2023
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Objective: Government of India (GOI) has allowed vaccination for age group of 15-18 y. It is a positive step toward boosting immunization rates across the nation. As per guidelines, BBV152 vaccine, Bharat Biotech's "Covaxin" is approved for adolescents. The study was designed to evaluate adverse events following immunization (AEFI) among adolescents. Method(s): A prospective, observational survey was carried out among the first 315 beneficiaries (adolescents of age 15-18 y) for a period of 5 mo at Osmania medical college and hospitals. Within 24 h, 48-72 h, and two weeks following the first and second doses of Covaxin, active and passive surveillance using telephonic inquiry and documentation relating to adverse events was conducted. The prevalence of AEFI and its association with demographic factors have been identified. Collected data were analyzed using SPSS 25. Result(s): The first 315 beneficiaries (Adolescents between the ages of 15 and 18) who received Covaxin were identified. All AEFIs reported were within the first 24-72 h of vaccination. AEFI incidence was higher in 1st dose (16.6%) when compared to 2nd dose (3.5%). No AEFIs were noted after 2 w. We found no association of AEFI with sex, age group, and past history of Covid as this finding is not significant (p>0.05). Conclusion(s): Overall, Covaxin has a good safety profile in adolescents. Symptoms were transient and of low intensity. There were no documented severe and serious AEFI. It is obligatory for documentation as the AEFI profile will encourage vaccine adoption and lessen reluctance.Copyright © 2023 The Authors. Published by Innovare Academic Sciences Pvt Ltd.
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Purpose of Study: Between September 2020 and November 2021, a survey was developed in partnership with children, youth, and community members experiencing vulnerabilities in a Vancouver Inner City Neighbourhood (ICN) to explore challenges encountered during the COVID-19 pandemic. In the survey, participants were asked questions about their financial status, housing security, food accessibility, and other social determinants of health. Other equity-seeking groups in Vancouver, including youth experiencing developmental and/or other medical diversity, wished to adapt the ICN COVID-19 survey to explore the impact of the pandemic in their community. These youth are active members of the province's pediatric tertiary care teaching hospital's Youth Advisory Committee (YAC), and in sharing their lived experience as patients, they strive to improve the quality of healthcare for children and youth throughout British Columbia. The objectives of this study were to: 1) adapt the COVID-19 survey to capture the views and needs of youth experiencing developmental and/or other medical diversity;and 2) identify how the COVID-19 pandemic impacted this group's social determinants of health. Methods Used: Ethics board approval was obtained for this observational, cross-sectional study (H20-00987). The research team and YAC co-constructed an adapted COVID-19 survey via Zoom dialogues. YAC members completed the survey online via Qualtrics from May 2022-August 2022. Demographic information and survey results were analyzed using descriptive statistics. Summary of Results: In total, 12 participants completed the survey, including 11 youth and 1 staff member. The median age of the youth participants was 23 years (n=11, min=14, max=29). During the COVID-19 pandemic, 82% (9/11) of youth reported changes in their ability to attend work or school, 36% (4/11) reported concern around reliable and affordable access to medications/medical treatment, and 46% (5/11) reported difficulty in caring for themselves. 46% (5/11) of youth also reported difficulty in caring for older adults or people in their families with disabilities. Many youth (6/11;55%) reported they had less than five people to turn to for support in times of stress, and 46% (5/11) of youth reported the pandemic changed their ability to connect with these people. Furthermore, 82% (9/11) of youth reported experiencing some level of distress related to the pandemic. 73% (8/11) of youth reported heightened anxiety, 82% (9/11) reported worsened mood, 55% (6/11) reported difficulty sleeping, and 64% (7/11) reported difficulty exercising. Conclusion(s): Youth with developmental and/or other complex medical diversity experienced difficulties accessing work and education, reliable and affordable medical care, and social support due to the COVID-19 pandemic. The pandemic negatively impacted the social, emotional, and physical wellbeing of these youth, indicating a need for future dialogue and advocacy to ensure the views and voices on rights of children and youth are honoured.
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Introduction: Robust data of LDH (Lactate dehydrogenase) is available in bacterial infection, and it can be utilized in this COVID-19 Pneumonia pandemic for initial assessment, planning of treatment in indoor setting in association with HRCT severity. Method(s): Prospective, observational, 12 weeks follow up study, included 2000 COVID-19cases confirmed with RT PCR. All cases were assessed with lung involvement documented and categorized on HRCT thorax, oxygen saturation, LDH at entry point and follow up.Age, gender, comorbidity and BIPAP/NIV use and outcome as with or without lung fibrosis as per CT severity. Statistical analysis is done by Chi square test. Result(s): HRCT severity score at entry point has significant correlation with LDH titer [p<0.00001] LDH titer has significant association with duration of illness (Doi) [p<0.00001] Comorbidities has significant association with LDH titer. [p<0.00001] LDH titer has significant association with oxygen saturation [p<0.00001] BIPAP/NIV requirement during hospitalization has significant association with LDH titer. [p<0.00001] Timing of BIPAP/NIV requirement has significant association with LDH titer. [p<0.00001] Follow-up LDH titer during hospitalization as compared to entry point (initial) normal and abnormal LDH has significant association in post-covid lung fibrosis [p<0.00001] Conclusion(s): LDH is easily available, and universally acceptable inflammatory marker in COVID-19 pandemic and documented very crucial role in covid-19 pneumonia in predicting severity of illness, assessing response to treatment and analyzing outcome during hospitalization.Copyright © 2023 Patil S.
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Background: Pandemics are never easy to deal with, especially this new covid pandemic which has exposed the vulnerability and multiple lacunae in our existing health care. In this midst of chaos and uncertainty delivering endoscopic services had become a nightmare, as endoscopy is a procedure done in the aero digestive tract and also an aerosol generating procedure. This led to a lot of enigma and skepticism in selection of patients and precautions to be taken while performing procedures. Objective(s): To Know the Feasibility and Utility of endoscopy as diagnostic and therapeutic services in Covid pandemic in the midst of chaos and uncertainties. Material(s) and Method(s): It is a retrospective study conducted from May 2020 to December 2020 in a Tertiary care Gastro hospital. Patients were screened clinically by Questionnaire highlighting the travel history, contact history, and residing history (hot spots for covid). X-Ray, HRCT and RT-PCR was done to exclude high risk cases. Clinical screening for symptoms, Vitals, Spo2 was done on all the patients. The procedures were performed using standard endoscopy equipment with appropriate COVID 19 protocols. Result(s): One thousand two hundred and eighty (1280) patients aged between 20 years to > 70 years were referred and undertake upper and lower GI endoscopy in a Tertiary Care gastro hospital. Majority of the cases who underwent endoscopy were in the age group 31-40 years 317 (24.8%). They comprised of 59.9% males and 40.1% females. Common endoscopic diagnoses were Gastric erosions 31.4% followed by Normal Upper gastrointestinal endoscopy (UGIE) / Lax Gastroesophageal (GE) Junction 17.4%. The most common symptom was dyspepsia seen in 725 (56.6%) of the patients, followed by dysphagia in 92 (7.2%), abdominal discomfort 64 (5%). Conclusion(s): This study highlights, with proper history and clinical screening and appropriate precautions it was possible to provide endoscopy service to the needy without a strict protocol and expensive pre-endoscopy work up like HRCT and RT-PCR for all patients, without compromising patient or staff safety. Patients with alarm symptoms like Dysphagia and GI Bleed benefited the most, many patients with functional GI Disorders also were reassured with negative endoscopy and counseling. As during these times, people were in panic mode with all negative things happening around;many of these functional patients with overlap anxiety disorders were scared to death. A positive diagnosis is very important while managing most of these GI disorders.Copyright © 2022 Dr. Yashwant Research Labs Pvt. Ltd.. All rights reserved.
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Outcomes: 1. Apply the knowledge about how the COVID-19 pandemic has impacted the care of patients with serious illness into daily practice. 2. Summarize current research findings in hospice and palliative care and describe its relevance to the care and treatment of patients with serious illness. Context: The urgency of the COVID-19 pandemic has brought forth an increased focus on palliative care involvement and advance care planning discussions around end-of-life preferences;however, few outcomes have been reported to date. The objective of this study was to compare characteristics of patients with advanced cancer during their terminal admission at a tertiary care comprehensive cancer center before and after the onset of the COVID-19 pandemic. Method(s): A random sample of 250 inpatient deaths from April 1, 2019 to July 31, 2019 was compared to a random sample of 250 inpatient deaths from April 1, 2020 to July 31. Sociodemographic and clinical characteristics, timing of palliative care referral, timing of DNR order, location of death, and pre-admission Out-of-Hospital DNR documentation were included. Result(s): Timing of DNR orders occurred earlier (2.9 days vs. 1.7 days prior to death, p=0.024), while the frequency of DNR orders before death did not change (94% vs. 90%, p=0.25). Palliative care referrals increased (68% vs. 60%, p=0.062) and occurred earlier (3.5 days vs. 2.5 days prior to death, p=0.037). Overall length of stay increased (9.4 days vs. 7 days, p=0.048). 36% of inpatient deaths occurred in ICU and 36% in the PCU, compared to 48% and 29% prior to the COVID-19 pandemic, respectively (p=0.01). Conclusion(s): DNR orders occurred significantly earlier after the onset of the COVID-19 pandemic, indicating a shift in early and intentional conversations with patients with advanced cancer at the time of their terminal admission. Earlier palliative care referrals and significantly fewer ICU deaths also suggest an improvement in quality end-of-life care. These findings highlight encouraging changes that have occurred as a response to the COVID-19 pandemic and may have future implications for timely integration of palliative care. Further research is needed to understand how to maintain and expand on such progress.Copyright © 2023
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Background: There are various studies on coronavirus disease-2019 (COVID-19) from globally which are mainly focused on respiratory and other medical manifestations of the disease. There are few studies on ocular manifestations in COVID-19 and post-COVID-19 patients. Objective(s): We aim to investigate the ocular manifestations of hospitalized post-COVID-19 patients at a tertiary care institute in the North Eastern part of India. Material(s) and Method(s): This cross-sectional study was conducted among hospitalized post-COVID-19 patients 18 years and above during July 1, 2021-December 31, 2021. A universal sampling method was employed. A structured pro forma was used for data collection along with detailed ocular examination. Descriptive statistics were generated from collected data. Approval of the study was obtained from the institutional ethics committee. Result(s): A total of 105 patients were included in the study with ages ranging from 18 to 85 years and males constituting 63.8%. Around two-thirds of the patients (70, 66.7%) had not received any vaccination. Chest X-ray showed bilateral moderate consolidation in 59 (56.2%) patients. Twelve (11.4%) patients developed ocular signs and symptoms. Dry eye, redness of the eye, dimness of vision, itching, blurring of vision, and discharge from the eyes are some of the symptoms encountered. Two patients developed subconjunctival hemorrhage, one patient had a retinal hemorrhage and exposure keratopathy was detected in one patient. Conclusion(s): In this study, 11.4% of hospitalized post-COVID-19 patients have ocular manifestations. Post-COVID-19 syndrome could affect the eyes thus necessitating meticulous follow-up of patients who recovered from COVID-19.Copyright © 2023 Journal of Medical Society Published by Wolters Kluwer-Medknow.
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Introduction: Zygomycetes consisting of Mucorales order is a group of fungal infections. These species cause life threatening opportunistic fungal infections mucormycosis. This infection is highly prevalent in immunocompromised. During the 2 nd wave of Covid 19 pandemic corticosteroid treatment was used which has been linked to development of Mucormycosis. In our tertiary care teaching hospital we saw that patients suffering from Covid-19 infections developed mucormycosis. We present these cases in our study. To study the clinical, demographical,and Laboratory parameters in Covid-19 patients with Mucormycosis. Material(s) and Method(s): Retrospective Study. All biopsy proven cases of Mucormycosis (which developed after Covid-19 infection) were included. Relevant Clinical Demographics and Laboratory data was retrieved from the available case sheets. The data was tabulated in Excel sheet and further reviewed. Result(s): A total of 22 patients were diagnosed as suffering from mucormycosis majority were unvaccinated. 11 patients out of 22 (50%) started manifesting mucormycosis within one week of COVID infection. All the patients who had only single comorbidity (22.72%) suffered from mild disease and patient who had more than one comorbidity suffered from moderate (27.27%) to severe (50%) COVID infection. Conclusion(s): It is suggested that patients with Covid-19 infection are at risk for development of opportunistic fungal infections like Mucormycosis. Hence the physicians who are involved in treating such patients must be mindful of the fact that mucormycosis can develop in them. Histopathology helps in establishing a concrete diagnosis of Mucormycosis.Copyright © 2022 Wolters Kluwer Medknow Publications. All rights reserved.
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Methods: multicentric observational study, included 6000 COVID-19 RT PCR Positive cases with lung involvement on HRCT thorax at entry point & categorised as Radiological presentation phenotypes as severity assessmentmild, moderate, severe as per lung segment involvement (mild<7, moderate 8-15 and severe 16-25), Evolving and Evolved phenotype- with or without GGOs, consolidations, and crazy paving with or without spreading edges, Anatomical phenotype-Unilateral or bilateral as per lung lobe segment or lobe involvement, Clinicalradiological-pathological phenotypes-five types as classical GGOs, consolidations, Bronchopneumonia, Necrotizing pneumonia and cavitating. Response to treatment phenotypes-easy to treat and difficult to treat as per interventions required & response to treatment. Radiological outcome phenotypes as Resolving, Persistent and Progressive as per lung reticular and fibrosing lesions as with or without honeycombing and or tractional bronchiectasis. Statistical analysis by Chi test and students t test and ANOVA. Observations and analysis:In 6000 radiological assessment of covid-19 pneumonia, significant association was documented in Evolving and Evolved pneumonia phenotypes (p<0.000026), Unilateral and Bilateral pneumonia anatomical phenotypes (p<0.00001), Clinical-radiological-pathological phenotypes (p<0.00001), Easy to treat and Difficult to treat pneumonia phenotypes (p<0.00001), Radiological final outcome phenotypes-Persistent, Progressive & Resolving phenotype (p<0.00001) conclusion: Radiological phenotypes will guide in assessing severity, predicting response to therapy and final outcome in covid-19 pneumonia.
ABSTRACT
Methods: observational study, included 6000 COVID-19 indoor cases confirmed with RT-PCR. Retrospective analysis with treatment records, laboratory markers as IL-6, D-dimer, Ferritin, LDH, BSL, HBA1C. All cases undergone thorough interview in 'post covid care' outdoor setting regarding symptomatology, documnted vital signs abnormality, & workup as HBA1C, BSL, TFT, KFT, ECG, chest x-ray, HRCT thorax, BMD, Echocardiography, MRI brain whichever is necessary. Statistical analysis by using Chi square test and ANOVA. Observations: Long covid manifestations were documented in 36.06% (2517/6000) post COVID cases as- Fatigue 41.95%, dyspnea 35.98%, cough 31.96%, chest discomfort 26.95%, anosmia 8.76%, joint pain & headache 11.96% , dizziness, vertigo&insomnia 22.95% &alopecia 4.18% cases, Lung fibrosis in 16.66%, minimal lung abnormality 23.65%, pulmonary embolism 7.18% cases, palpitations 25.56%, chest pain 11.3%, arrythmias 5.53%, cardiac dysfunction 24.31%, PTSD 28%, Impaired memory with or without poor concentration (brain fog) 24.03%, Anxiety and or depression 6.33%, Reduction in quality of life 33%, Diabetes mellitus-new onset26%, transient34%, uncontrolled27%, Osteoporosis38.08%, thyroid dysfunction12.1%. CT severity score, Intensive care treatment with or without oxygen and or ventilator use & Laboratory parameters (D-dimer, IL6, LDH, Ferritin) during hospitalization has significant association with long covid manifestations (p<0.00001) Conclusion(s): Long covid in underestimated, improperly evaluated and halfheartedly treated during follow-up. All treated cases needs prompt evaluation, more awareness regrding its manifestations and its impact on quality of life is must.