Active Symptom-Based Surveillance of Adverse Events Following Immunization Among Individuals Vaccinated with ChAdOx1 nCoV-19 Coronavirus Vaccine in a Tertiary Hospital of Kerala.

BACKGROUND: The reports on adverse experiences following vaccination are scanty from India. It is important to know the real-world post-vaccination experience outside of clinical trial conditions. OBJECTIVES: The study aims to estimate the incidence of adverse events following immunization with the ChAdOx1 nCoV-19 coronavirus vaccine and to identify the predictors for the development of vaccine adverse events. METHODS: A prospective observational study was conducted among health care workers who received the ChAdOx1 nCoV-19 coronavirus vaccine. Study participants were monitored at the site for 30 min following vaccination and were followed up for 7 days after receiving the second dose, with a purpose-specific designed online surveillance form to enquire about any adverse events following vaccination. We used the Chi-squared test for categorical variables and multivariate regression analysis to identify predictors for the development of vaccine adverse effects. RESULTS: Of 411 participants, the mean age was 30.77 ± 12.5 years and 76.2% were females. Overall, 207 (50.4%) respondents reported at least one post-vaccination symptom receiving either dose of coronavirus vaccination. Fever (34.8%), local pain at the injection site (28.0%), tiredness (25.5%), chills (20%), myalgia (18.7%), headache (17.8%), injection site stiffness (5.4%), joint pain (4.6%) and nausea-vomiting (3.8%) were the most prevalent symptoms following the first dose. Adverse reactions reported after the second dose were milder and less frequent. Postvaccination symptoms were more likely in the younger age group, those with comorbidity particularly, bronchial asthma , and a history of allergy to food/drugs. CONCLUSION: All the adverse reactions were of a minor type and non-serious. Side effects were less common in older adults (>60 years). Reactions to the second dose were lesser in intensity and frequency. Younger age, history of allergy, and comorbidities, particularly asthma, were found to be major predictors for the development of adverse events and require more watchful vaccine administration.

The gaps in undergraduate medical education due to the ongoing pandemic: An experience from a private medical college in Kerala.

The Covid-19 pandemic affected undergraduate medical education worldwide. By March 2020, colleges in India had to close following a national lockdown. Most of the colleges including ours started using e-platforms. Our earlier studies highlighted concern for lack of patient examination in clinical settings and successes of the online teaching programmes were limited to didactic teaching. The year 2020 also was the year in which the National Medical Commission (NMC) introduced a competency-based system, which was new to all stakeholders. We assessed the impact of Covid-19 on the ongoing teaching pattern in our institute. Actual coverage of theory classes and practical/clinical teaching sessions were gathered from departments across all years of undergraduate medical education and the gap percentage was calculated against the NMC/ Medical Council of India requirements. The gap percentage was calculated as missing classes divided by required classes multiplied by hundred. The heads of departments were consulted, and details of theory, practical and clinical classes taken for each batch before and after lockdown were gathered using a questionnaire. These were compared against the mandated teaching by the NMC guideline for theory, practical and clinics. The results showed a gap ranging from 2% to 83% for theory classes, the least being in anatomy and the highest being in medicine. As there were no practical or clinical sessions during the lockdown, the gap was zero. Various challenges were faced due to online medical education. There was a dilemma over choosing the type of training that would produce adequate numbers with low quality or a delayed training but of assured quality. Various solutions including suspending the ongoing course and converting it to short-term skill training sessions to deal with pandemic care and strategies to improve online teaching were considered.

Clinicoepidemiological and laboratory findings of COVID positive patients presenting to a tertiary care centre in South India: A retrospective analysis.

BACKGROUND: SARS CoV2 continues to pose a threat to human race even after one year of its outset in China. Observational studies from across the world have shown huge disparity in the clinicoepidemiological and laboratory features of this disease. In this study we attempt to assess the clinical, epidemiological and laboratory parameters of COVID 19 positive patients in this geographic location. METHODS: This is a descriptive retrospective study of patients who were tested positive for SARS-CoV-2 at a tertiary care centre in central Kerala, India between July 16, 2020 and November 30, 2020. The clinicoepidemiological and laboratory parameters of the confirmed patients were collected from the laboratory and hospital records and analysed. RESULTS: A total of 1051 patients were tested positive during the study period. The mean age of the patients was 45.7 years ± Standard Deviation (SD): 8.68; 51.76% were male. Among them 658 (62.61%) were symptomatic and 393(37.39%) were asymptomatic; males (54.7%) were more symptomatic than females (45.3%). The common presenting symptoms were fever (43.58%), cough (21.50%), myalgia or fatigue (10.28%). Lymphocytopenia was more in males than females. Laboratory parameters such as Serum Ferritin, Alanine Transferase, Aspartate Transferase, Sodium level were elevated in males compared to female. CONCLUSION: The common symptoms in our study could emphasize on identifying potential patients in this geographic area. Asymptomatic patients should be monitored and investigated for effective control of the disease. A knowledge about the disease presentation in each geographic area is important in planning the effective management strategies since the features are varied from place to place.

The Pedagogical Shift During COVID 19 Pandemic: Online Medical Education, Barriers and Perceptions in Central Kerala.

Owing to COVID 19 pandemic, all educational institutions including medical colleges were closed by the second week of March 2020 in Kerala, India. This college started online classes using various e-platforms by the third week of March. In this study, we report the barriers and perceptions of undergraduate students by an online questionnaire after 2.5 months of e-classes. The study participants were 364 students who responded in a week's time. Most of the faculty used platforms like Google class room or recorded YouTube videos. The department of Physiology used the Impartus platform. Among the respondents 72.8% were using mobile data and 17.8% were using broadband facilities. Among network providers Jio was the most used. Only first year students were exposed to 3 different online platforms. Among those students, 63.6% reported in favor of Impartus, followed by YouTube and Google class room. Most of the students preferred recorded classes (69.2%) over live classes (33.5%). Submissions were mainly through the online platform itself (69.5%), email submission to the department (17%) or to the faculty (13.5%). Forty seven percent of the students wanted the classes to be of 30 to 45 minutes duration and 42% felt that the classes should be short and below 30 minutes. Only 28.3% of the students favored centralized online class by the university. Providing education to students cannot be discontinued for long. In the present study students are able to follow the online classes and have good learning experience on in the Didactic part. The medical educators could rise up to the challenge of continuing to teach even in times of crisis.

The Phenomenon of Family Suicides: An Explorative Study into Consecutive 32 Incidents in Kerala.

BACKGROUND: Suicides rank high as the cause of human deaths. But research on whole family ending life is scanty. This study explored the family suicides in Kerala. METHODOLOGY: All the family suicides reported from four central districts of Kerala State during the year 2000 were included. Cases were prospectively located from different sources. A research associate systematically gathered information, from survivors, family and key persons in the locality. RESULTS: 84 lives lost in 32 incidents involving 99 persons. No report from Muslim dominated district. Largest age group was 19 and below, others progressively decreased. Poisoning formed most frequent method; drowning, burns, hanging and wrist slashing followed. Suicide notes were left in half. Mental illness and physical illness were noted in five and eight incidents respectively. Financial crisis reported as the main reason. The SES of the deceased and their parents were same but half of the families were leading a life at a higher level than could be afforded. Warning signals noted in 12 incidents. Decision was taken by father and mother (17), mother (10) or father alone (5). The incidents came to the attention of others without long delay. DISCUSSION: Firm stand of the religion against suicides on individual reasons could explain absence of family suicides from Muslim dominated district. Selection of sure method and flawless execution explains high lethality. Presence of victims explains more loss of young lives and profile difference from reported suicide attempts. Opening up of avenues for higher dreaming due to globalisation and wider visual media could be a reason for living unaffordable standard of life and resulting financial difficulty. The warning signals were recognised, but not responded by others. Social support was strong within the family but was non-existing with outside. Strong social support could be pathological if it is narrow.

Psychosocioeconomic study of medically unexplained physical symptoms.

BACKGROUND: There is a paucity of studies done on medically unexplained physical symptoms (MUPS) in Kerala, India. The objective of this study was to examine the sociodemographic and other clinical variables associated with this condition. MATERIALS AND METHODS: The clinical sample was taken from the General Medicine Clinic of a tertiary care hospital, in Kerala. The referred cases meeting the criteria (N=48) for medically unexplained physical symptoms were enrolled for this cross-sectional study. The medical doctor with experience in psychiatry completed the questionnaire. RESULTS: Most of the patients were middle-aged females from rural areas. The most common symptom reported was headache. Most of the patients had symptoms for five years or more and had seen two-to-five consultants. A majority of the patients had undergone special investigations and a few had expensive and invasive investigations. Cluster C personality disorders were the most common associated personality disorders with medically unexplained physical symptoms. CONCLUSIONS: To our knowledge this is the first psychosocioeconomic study on medically unexplained physical symptoms, done in Kerala, India. Medically unexplained physical symptoms cause loss of productivity and economic burden and are a major public health problem. Future studies are warranted focusing on non-pharmacological treatment, psycho-education on mind-body association, and medical models on specific cytokines associated with medically unexplained physical symptoms for personalized management, and to examine the effect of a combination of pharmacotherapy and cognitive behavioral therapy.

The development of a guideline and its impact on the media reporting of suicide.

CONTEXT: A causal association between media reporting of suicides and the subsequent actual suicides has been observed. There are no studies from India regarding media reporting of suicide. This study examines whether educating media professionals about responsible reporting of suicides can change the quality of reporting. AIMS: To study the impact of a guideline on the reporting style of suicides by journalists. SETTINGS AND DESIGN: Newspaper reports in the local language examined by psychiatrists. MATERIALS AND METHODS: The Department of Psychiatry of a Teaching Hospital conducted a workshop for journalists, with the collaboration of media and mental health professionals and came out with a guideline about responsible reporting of suicide. Using this, a proforma was designed for assessing newspaper reports of suicides. All the suicide reports in the leading newspapers in Kerala were analyzed for one year prior to the workshop, the immediate next year, the second year, and six years later, using the 15 item proforma and whether each report was concordant or discordant to each item in the proforma was noted. RESULTS: The total concordant responses were 43.7% in the year prior to the workshop, 45.2% during the first year following the workshop, 46.2% in the next year, and 45.7% after six years. When the trend of each item was examined, the concordance rates were increasing in each item, except two. There was no statistical significance. CONCLUSIONS: A workshop for journalists could bring about positive changes in the media reporting of suicides. The changes persisted over the years, although they did not reach statistical significance.

A study of an antipsychotic prescription pattern of patients with schizophrenia in a developing country.

BACKGROUND: Though there are several recommended guidelines for treating schizophrenia, in routine clinical practice, these are not followed. AIM: To conduct an audit of the prescription pattern of antipsychotic drugs in patients with schizophrenia, in a tertiary care centre in India, during a period of 1 year and compare it with Maudsley guidelines and Clinical practice guidelines for Psychiatrists in India (IPS guidelines). MATERIALS AND METHODS: Data were collected from the case records, compiled, and analyzed. The concordance or discordance with Maudsley and IPS guidelines were studied. RESULTS: The demographic variables of the patients and the prescription pattern of drugs were analyzed. The correlations between supramaximal and sub-threshold dosage of drugs to the gender, age, duration of illness, and combination of drugs were examined. CONCLUSIONS: Polypharmacy of antipsychotics is common. 31% of patients were on combination of typical and atypical antipsychotics. 4% of patients were receiving supramaximal dose of antipsychotics and all of them were on combination (P =<0.03, x(2)). 24% of patients were on sub-threshold doses. 83% were not on anticholinergic drugs.