Prophylactic Medications Taken by Healthcare Workers for COVID-19; A Mixed Methods Study from South India.

BACKGROUND: COVID-19 is an unprecedented pandemic that has taken the modern world under seize. In spite of lack of solid evidence, certain federal governments had recommended the use of hydroxychloroquine (HCQ), chloroquine, and azithromycin as prophylactic medications either for contacts or for healthcare providers in particular. The objective of this study is to assess the issues related to intake of prophylactic medications in view of COVID-19 and the proportion and pattern of side effects. METHODS: A descriptive cross-sectional study was conducted using mixed methods approach among healthcare workers in Puducherry, India. RESULTS: HCQ was the prophylactic drug taken by all the participants (n = 26). Of the 26, 15.4% had a baseline ECG, 26.9% took HCQ based on the recommended Day 1 dose of 800 mg and 61.5% of the participants had the drug provided by the hospital where they work. Reasons for taking prophylaxis were sense of vulnerability (due to co-morbidities, lack of PPE kits) and peer practice. However, the participants did not recommend prophylactic medication to others due to lack of evidence, death claims related to prophylactic drugs in media, hospitals not taking responsibility of baseline monitoring and need for long follow-up. CONCLUSIONS: The data on assessment of HCQ prophylaxis indicates only minor side-effects, though limited by sample size. Evidence-based recommendations on prophylactic drugs for COVID-19, effective risk communication, peer education and support, accountability, ease of baseline, and follow-up investigations were the need of the hour to improve intake and adherence to prophylactic regime for COVID-19.

Giant Cell Tumor of Intermediate Cuneiform Evolving into Aneurysmal Bone Cyst: A Rare Case Report.

Introduction: Giant cell tumor (GCT) most commonly involves distal femoral condyles, distal end of radius, proximal tibial plateau, and proximal humerus. GCT is uncommon to occur in small bones of hand and feet. 2% of GCT occur in hand. The incidence of GCT in foot is 1.2-1.8%. Only a few cases have been reported in literature worldwide. GCT is the most common cause of secondary ABC. We report a case of GCT of intermediate cuneiform in a 25-year-old female evolving into aneurysmal bone cyst (ABC). Case Report: A 25-year-old female presented to us with complaints of pain and swelling over the dorsum of right foot for a period of 1 year. On examination, there was a localized ovoid-shaped swelling of 2 by 2 cm over the dorsum of right foot. Radiographs revealed a well-defined osteolytic lesion in the intermediate cuneiform. T2 MRI showed hyper-intense lesion in intermediate cuneiform. The patient was taken up for surgery, and the intermediate cuneiform was excised completely. Removed bone was sent for histopathological examination which confirmed it to be GCT evolving into secondary ABC. The patient was followed for 1 year and had no complaints. The patient was able to weight bear and walk without any difficulty. There was no recurrence of lesion. Conclusion: GCT of the cuneiform evolving into ABC is a very rare presentation. The treatment of choice is excision of the tumor with or without bone grafting. Any osteolytic lesion in the small bones must be evaluated and should be intervened in the early stage.

Tribal population in India: A public health challenge and road to future.

India with 8.6% of tribal population is finding it difficult to bridge the gap that exists between tribal and non-tribal population in regards to healthcare. Tribal population suffers triple burden of disease; in fact it is quadruple, namely, communicable diseases, non-communicable diseases, malnutrition, mental health, and addictions complicated by poor health seeking behavior. With increasing needs, an Expert committee on Tribal health has given recommendations with the goal to bridge the current gap in the health status of tribal people latest by the year 2027. An entirely parallel health system has been proposed with key focus areas, governance, and financing. To summarize and report the present scenario in terms of disease burden, health-seeking behavior, healthcare delivery system, and a roadmap for the future along the importance of primary healthcare in achieving it. Mere establishment of more health facilities cannot overcome the poor health of tribal population and so the role of trained manpower to deliver quality healthcare, in which case the role of traditional healers, local Tribal boys and girls comes in handy. It is high time and states should act swiftly to assess the needs, priorities of their own tribal population and set goals, targets to achieve the same through proven public health strategies.

COVID-19 reinfection: Linked Possibilities and future outlook.

SARS-CoV-2 is the third major coronavirus epidemic to affect humans. There had been multiple instances of patients turning positive after recovering from SARS-2-CoV infection. Though many different theories emerge, false positive RT-PCR is logically the foremost cause and there is a general consensus that during quarantine re-infection from outside seems unlikely when strictly adhered to. As many new strains emerge worldwide during the course of on-going pandemic, the chances of re-infection cannot be ignored as it may contribute to false negative RT-PCR test results. SARS-2-CoV though a novel virus, is phylogenetically similar to SARS-like CoV with around 79% similarity. Studies on immunological response to these infections suggest that antibodies formed after infection confers immunity only for a short period of time before it starts to wane. Also studies on SARS-CoV-2 suggest that antibody formation and longevity of immunity in an individual is dependent on the strain of coronavirus, its severity and age of the person infected. All these considerations demand reviewing the treatment duration, discharge criteria, appropriate use of imaging techniques and importance of risk communication and health education to those recovered.

Impact of COVID-19 pandemic on adolescent health in India.

SARS CoV2 is an emerging infectious pandemic. The preemptive measures taken to curtail the spread has its effects far and wide across different sectors and all age groups. The most unspoken sufferers are adolescents. In this article, we have reflected on how adolescent issues addressed by the government's dynamism, have had collateral damage due to the COVID initiatives. Globally, around 89% are currently not in school because of COVID-19. They will pave a way to unforeseen collateral effects on the physical, social, psychological health, and future of the young minds. From an increase in school drop-outs, interrupted learning, worsening of the gender gap in education to technology dependence and addictions, this pandemic is going to unravel the uninvited social evils. The regular benefits of adolescents from the government have not been paid heed to. Supply of IFA tablets, sanitary napkins, provision of supplementary nutrition, health education, and implementation of immunization activities are a few of the services to mention which are being hampered. We have recommended a few strategies like establishing the peer educator system in disseminating COVID-related awareness, engaging them in a smooth public distribution system, and act as a potential linkage for the families in distress. We have proposed a few modus operandi like direct cash transfer or food supplements as take-home rations will be able to sustain the nutrition of the adolescents to keep the flow of uninterrupted amenities to adolescents in education, nutrition, mental health, personal hygiene, and other such sectors.

A Rare Case of Melioidosis Causing Multifocal Osteomyelitis in an Uncontrolled Diabetic Host.

INTRODUCTION: Melioidosis caused by Gram-negative bacterium Burkholderia pseudomallei. It usually causes abscesses in lung, liver, spleen, skeletal muscle, and parotids in patient with risk factors such as diabetes mellitus, heavy alcohol use, smoking, chronic lung disease, and corticosteroid use. Musculoskeletal melioidosis is not common in India even though sporadic cases have been reported mostly involving soft tissues. CASE REPORT: A 45-year-old gentleman, farmer by occupation, belong to state of TamilNadu, type 1 diabetes mellitus with poor glycemic control, presented to us with complaints of multiple joint spain which includes severe pain over left elbow followed by mild pain over bilateral knee and right ankle for past 3 months and on and off fever for past 10 days. Clinically, patient was toxic (shows features of infection). On further investigation (Magnetic resonance imaging and X-ray left elbow, bilateral knee, and right ankle), it was found to be consistent with multifocal osteomyelitis. On arthrotomy and surgical debridement of the left elbow joint followed by intra-operative pus culture shows Staphylococcus aureus growth and patient was started on intravenous cefoperazone-sulbactam 1.5 g for 2 weeks, following which symptoms reappear. 2-d echo was done to rule out infective endocarditis. Technetium 99-methyl diphosphonate (MDP) whole-body scintigraphy shows increase uptake in the left elbow, bilateral knee, and right ankle. Now heunderwent bilateral knee and right ankle arthrotomy and surgical debridement. Polymerase chain reaction for melioidosis was positive. Gram-stain shows growth of B.pseudomallei. Serial blood cultures grew Gram-negative bacilli, later identified as B. pseudomallei, and diagnosed to have melioidosis, following which he was started on injection ceftazidime 2 g TDS (Q8 hourly) for 4 weeks followed by oral cotrimoxazole for next 6 months. The patient was followed up for a period of 2 years (1, 3, 6, and 12 months) and he was found to be recovered completely with no recurrences.. CONCLUSION: Diagnosis of melioidosis missed in many parts of the world due to lack of awareness of this infection caused by B.pseudomallei. Delay in diagnosis or treatment against melioidosis can worsen the outcome. Initial therapy with intravenous antibiotics followed by oral maintenance therapy and appropriate surgical intervention remains vital in the management.

Content Validation of Total Knee Replacement Rehabilitation Protocol in Indian Population.

INTRODUCTION: Total knee replacement (TKR) surgery has become the most successful surgery for patients with severe debilitating arthritis. The guidelines for rehabilitation progression should be tailored respecting the tissue healing parameters. Hence, the current literature states a need for protocol to mitigate these impairments and ultimately result in improved functional outcomes. OBJECTIVE: The present study aimed to validate the content of TKR rehabilitation protocol in Indian population. MATERIALS AND METHODS: The process of content validation involves development stage and expert judgment stage. The protocol was designed into three stages with extensive review of literature. After designing the protocol, nine experts in field of musculoskeletal Physiotherapy performed the judgemental process. The process of validation includes rating of experts in a 5 point likert grading on two parameters namely relevance and ease of performance. Based on expert's inputs on TKR protocol, the level of agreement, content validation index and kappa value was calculated. RESULTS: The three staged TKR protocol almost exhibited an excellent agreement on all stages. However, muscle activation exercises (except Vastus medialis obliques activation), stretching, strengthening program and functional training showed 100% agreement than other stages. CONCLUSION: The structured TKR protocol exhibited excellent content validity to its use in Indian population.

Early active motion protocol following triple Kessler repair for flexor tendon injury.

PURPOSE: To evaluate outcome of 6-strand triple Kessler repair for flexor tendon injuries, followed by early active motion rehabilitation. METHODS: 25 men and one woman (36 fingers) underwent 6-strand triple Kessler repair for flexor tendon injuries in zones 2 to 5, followed by early active motion rehabilitation. Rehabilitation was started at days 3 to 5. Patients were instructed to passively flex all the fingers with the uninjured hand and to actively retain this position for 10 seconds. Active extension within the confines of the splint was allowed. At the end of week 8, strength training was commenced until a satisfactory range of motion was regained. Outcome measures included total active motion, grip strength, and the Disabilities of the Arm, Shoulder and Hand (DASH) score. Complications such as infection and wound dehiscence were recorded. RESULTS: The mean follow-up was 1.2 (range, 1-2) years. Outcome was excellent in 24 digits, good in 4, and poor in 8. The mean grip strength was 80% (range, 60-100%) of normal in dominant hands and 60% (range, 50-65%) of normal in non-dominant hands. The mean DASH score was 15 (range, 0-52). One patient had wound dehiscence and superficial infection. CONCLUSION: Six-strand triple Kessler repair for flexor tendon injuries, followed by early active motion rehabilitation yields satisfactory results.

Recurrent solitary osteochondroma of the metacarpal: a case report.

Osteochondromas are the most common benign bone tumours and account for 20 to 50% of benign bone tumours and 10 to 15% of all bone tumours. They usually occur in long bones; 40% occur around the knee joint, but in the hand they are uncommon and usually affect the proximal phalanx. The metacarpal is rarely involved. We report a 32-year-old man with a recurrent solitary osteochondroma of the metacarpal.

Effect of ethanolic extract of Eugenia jambolana seeds on gastric ulceration and secretion in rats.

Eugenia jambolana (Jamun) fruit has been reported to give soothing effect on human digestive system. Present study includes the effect of ethanolic extract of seeds of E. jambolana (EJE) against gastric ulcers induced by 2 h cold restraint stress (CRS), aspirin (ASP, 200 mg/kg, 4 h), 95% ethanol (EtOH, 1 ml/200 g, 1 h) and 4 h pylorus ligation (PL) in rats. To ascertain the mechanism of action of EJE, its effect was studied on mucosal offensive acid-pepsin secretion, lipid peroxidation (LPO, free radical) and defensive mucin secretion, cell proliferation, glycoprotein and glutathione (GSH, an antioxidant). Acute and subacute toxicity studies were also conducted for the safety profile of Eugenia jambolana. EJE 200 mg/kg, when administered orally for 10 days in rats was found to reduce the ulcer index in all gastric ulcer models. It tended to decrease acid-pepsin secretion, enhanced mucin and mucosal glycoprotein and decreased cell shedding but had no effect on cell proliferation. It showed antioxidant properties indicated by decrease in LPO and increase in GSH levels in the gastric mucosa of rats. Acute toxicity study indicated LD50 to be more than 10 times (>2000 mg/kg) of the effective ulcer protective dose while subactue toxicity study (>1000 mg/kg) indicated no significant change in the general physiological and haematological parameters, liver and renal function tests. The result of the present study indicates that E. jambolana seed has gastro-protective properties mainly through promotion of mucosal defensive factors and antioxidant status and decreasing lipid peroxidation.

Effect of aqueous extract of neem (Azadirachta indica) leaves on offensive and diffensive gastric mucosal factors in rats.

Standardized aqueous extract of Neem (Azadirachta indica) leaves (AIE) has been reported to show both ulcer protective and ulcer healing effects in normal as well as in diabetic rats. To study the mechanism of its ulcer protective/healing actions, effects of AIE (500 mg/ kg) was studied on various parameters of offensive acid-pepsin secretion in 4 hr pylorus ligation, pentagastrin (PENTA, 5 microg/kg/hr)-stimulated acid secretion and gastric mucosal proton pump activity and defensive mucin secretion including life span of gastric mucosal cells in rats. AIE was found to inhibit acid-pepsin secretion in 4 hr pylorus ligated rats. Continuous infusion of PENTA significantly increased the acid secretion after 30 to 180 min or in the total 3 hr acid secretion in rat stomach perfusate while, AIE pretreatment significantly decreased them. AIE inhibited the rat gastric mucosal proton pump activity and the effect was comparable with that of omeprazole (OMZ). Further, AIE did not show any effect on mucin secretion though it enhanced life span of mucosal cells as evidenced by a decrease in cell shedding in the gastric juice. Thus, our present data suggest that the ulcer protective activity of AIE may be due to its anti-secretary and proton pump inhibitory activity rather than on defensive mucin secretion. Further, acute as well as sub acute toxicity studies have indicated no mortality with 2.5 g/kg dose of AIE in mice and no significant alterations in body or tissues weight, food and water intake, haematological profile and various liver and kidney function tests in rats when treated for 28 days with 1 g/kg dose of AIE.

Teratogenicity of Asparagus racemosus Willd. root, a herbal medicine.

Asparagus racemosus (AR) is a herb used as a rasayana in Ayurveda and is considered both general and female reproductive tonic. Methanolic extract of A. racemosus roots (ARM; 100 mg/kg/day for 60 days) showed teratological disorders in terms of increased resorption of fetuses, gross malformations e.g. swelling in legs and intrauterine growth retardation with a small placental size in Charles Foster rats. Pups born to mother exposed to ARM for full duration of gestation showed evidence of higher rate of resorption and therefore smaller litter size. The live pup showed significant decrease in body weight and length and delay of various developmental parameters when compared to respective control groups. AR therefore, should be used in pregnancy cautiously as its exposure during that period may cause damage to the offspring.

Gel purified LipL32: a prospective antigen for detection of leptospirosis.

BACKGROUND: Leptospirosis, a zoonosis, is a re-emerging disease, affecting populations across the globe. However, the current methods of diagnosis are time- consuming, cumbersome, imprecise or expensive. AIM: To develop an assay for differential and early diagnosis of Leptospirosis. METHODS AND MATERIAL: IgG based ELISA for evaluation of three antigens, namely, a gel-purified recombinant protein (rLipL32), secreted proteins and whole organism sonicates of Leptospira spp. The antigens were evaluated using, rabbit polyclonal antiserum and human sera samples. RESULTS: Studies with a rabbit polyclonal antiserum indicated the utility of these antigens in differentiating Leptospira from other common pathogenic organisms. Evaluation of these antigens with fifteen representative human serum samples indicated gel-purified rLipL32 to be a potentially useful antigen for detection of leptospirosis. The results obtained with IgG ELISA were correlated with the results of microscopic agglutination test (MAT). CONCLUSION: Gel-purified rLipL32 is a valuable antigen for early and accurate diagnosis of leptospirosis. Further evaluation of this assay in field conditions and larger sera samples will indicate its suitability in case of an epidemic.

Anticonvulsant and neurotoxicity evaluation of some 6-substituted benzothiazolyl-2-thiosemicarbazones.

Various 6-substituted benzothiazolyl-2-thiosemicarbazones were synthesized and screened for anticonvulsant activity in maximal electroshock induced seizure (MES) and subcutaneous pentylenetetrazole (scPTZ) induced seizure models in mice. The neurotoxicity was assessed using the rotorod method. The 6-methyl benzothiazolyl-2-thiosemicarbazones showed anticonvulsant activity in both mice i.p. and rat oral MES screen. The 6-nitro benzothiazolyl thiosemicarbazone derivative 1a emerged as the most promising one with anti-MES activity in mice i.p., rat i.p. and rat p.o. evaluations. All the compounds exhibited lesser or no neurotoxicity compared to phenytoin. The isatinimino derivatives had shown better activity when compared to the benzylidene or acetophenone derivatives.

Synthesis and anticonvulsant and neurotoxicity evaluation of N4-phthalimido phenyl (thio) semicarbazides.

The phenyl (thio) semicarbazide derivatives of phthalimido pharmacophore were synthesized and evaluated for their anticonvulsant and neurotoxic properties. Initial anticonvulsant screening was performed using intraperitoneal (i.p.), maximal electroshock-induced seizure (MES), subcutaneous pentylenetetrazole (scPTZ) and subcutaneous strychnine (sc STY)-induced seizure threshold tests in mice. Compound 2c afforded protection in all the three screens. Compounds except 1d, 2a and 2d showed no neurotoxicity up to 300 mg/kg. Compounds 1a, 1b, 2c, 2d, 2g and 2i were found to show oral MES activity. The compounds exhibited CNS depression and behavioral despair side effects, lesser than the conventional antiepileptic drugs.