Anxiety and depression during post covid-19 lockdown period among medical students, and it's relation with stress and smartphone addiction in India.

OBJECTIVES: Medical profession, a competitive and ever-updating field which requires great commitment, imposes a stressful environment for students. Our study aimed to find the prevalence and factors associated with psychological illness. METHODS: A cross-sectional analytical study was done among medical students in Puducherry. A stratified random sampling strategy was incorporated to achieve a calculated sample size of 384. The presence of anxiety and depression, perceived stress and addiction to the phone were assessed using the Hospital Anxiety and Depression Scale, Perceived Stress Scale, and Smartphone Addiction Scale - short version. Prevalence of anxiety and depression was summarized as a proportion with a 95 % confidence interval (CI). The prevalence ratio (PR) for the factors associated was estimated using log-binomial regression. RESULTS: With the response from 383 students, the prevalence of anxiety and depression was 39.4 % (95 %CI: 34.5-44.3 %) and 26.6 % (22.2-31.1 %). Perceived stress was moderate in 68.2 % and high in 14 % of students. Higher age (aPR=1.49), female gender (aPR=1.22), tobacco or alcohol use (aPR=1.24), smartphone addiction (aPR=2.09) and high stress (aPR=1.93) were the predictors of anxiety among medical students in our study. Use of tobacco or alcohol (aPR=2.07), smartphone addiction (aPR=1.96) and high stress (aPR=1.72) were the predictors of depression. CONCLUSIONS: Anxiety was more prevalent than depression among the medical students. Use of tobacco or alcohol, smartphone addiction and stress increase the risk of psychological morbidity. Medical training should have a module on coping mechanisms to overcome psychological illness and have better mental well-being.

Association between domestic violence and unintended, terminated pregnancy and complications during pregnancy among Indian women: Findings from nationally representative survey.

Background: Women experiencing domestic violence might have restrictions in the pregnancy-related decision-making and care-seeking process leading to adverse pregnancy outcomes. We explored the association between domestic violence and undesirable pregnancy events. Methods: 63,796 women aged 18-49 years covered under the domestic violence module of National Family Health Survey-5, 2019-21. Stratification and clustering in the complex sampling design of the survey were accounted in analysis. Using Poisson regression, prevalence ratio (PR) was reported to provide association of domestic violence with undesirable pregnancy events. Results: Prevalence of undesirable pregnancy events was 25.0% (95%CI: 24.4%-25.7%) amongst women aged 18-49 years. Prevalence of unintended, terminated pregnancy and complications during pregnancy was 3.2%, 5.1% and 20.9%, respectively. Women aged ≥35 years, educated, unemployed, primi or multi parity, intimate partner/husband being uneducated, facing problem with access to healthcare, belonging to large number of household members (≥4) and poorest or poorer quintile had significantly higher chance of having undesirable pregnancy events. Sexual violence (aPR: 1.11, p = 0.02) had higher chance of having undesirable pregnancy events. Conclusion: One-fourth of reproductive-age group women had undesirable pregnancy events. Sexual violence was significantly associated with these events. Effective policy should protect women from domestic violence to promote maternal well-being.

Burden, trend and determinants of various forms of domestic violence among reproductive age-group women in India: findings from nationally representative surveys.

BACKGROUND: Violence, a notable human rights concern, has a public health impact across the globe. The study aimed to determine the prevalence and determinants of domestic violence among ever-married women aged 18-49 years in India. METHODS: Secondary data analysis with National Family Health Survey 5, 2019-21 data (NFHS-5) was conducted. The complex sampling design of the survey was accounted-for during analysis. The primary outcome was domestic violence. Prevalence was reported with 95% confidence interval (CI). Prevalence ratio was reported to provide the factors associated with domestic violence using Poisson regression. RESULTS: About 63 796 ever-married women aged 18-49 years covered under domestic violence module of NFHS-5 survey were included. Prevalence of domestic violence (12 months preceding the survey) was 31.9% (95% CI: 30.9-32.9%). Physical violence (28.3%) was the most common form followed by emotional (14.1%) and sexual violence (6.1%). Women with low education, being employed, husband being uneducated or with coercive behavior had significantly higher prevalence of domestic violence. CONCLUSIONS: One-third of the reproductive age-group women were facing some form of domestic violence. Target group interventions like violence awareness campaigns, women supportive services and stringent law enforcement should be implemented to eliminate domestic violence by year 2030.

Association of Social Capital With Tuberculosis: A Community-Based Cross-Sectional Analytical Study in South India.

BACKGROUND: Social capital denotes the relationships, networks, norms and values in the community. A high level of social capital positively improves health through a supportive social system. Illnesses affect health and social relationships. One such disease is tuberculosis (TB), known for its social stigma. India has the highest burden of morbidity and mortality due to TB. The assessment of social capital would highlight the importance of a supportive environment in reducing the disease burden and bringing better treatment outcomes. METHODS: A cross-sectional exploratory analytical study was conducted in two primary health centers in Puducherry between February 2020 and March 2021. Considering the feasibility and resource constraints, we assessed the social capital between 50 newly diagnosed pulmonary tuberculosis (PTB) patients, their age- and gender-matched 50 household contacts (HHCs) and 50 PTB patients who completed treatment a year before. The HHC was either the marital partner or sibling of the newly diagnosed PTB patients selected for comparison as their exposure to infection would be similar to those diseased but did not develop the illness. Social capital and its domains were assessed using the World Bank's social capital questionnaire. Sociodemographic characteristics and social capital domains were compared using a chi-squared test. Mean standardized Z-scores of the domains were compared using one-way analysis of variance (ANOVA). A p-value of <0.05 is taken as significant. RESULTS: Most participants from each group belonged to lower socioeconomic strata and were males (80%). The overall level of social capital was low among the newly diagnosed PTB patients, especially the group and network and trust and solidarity domains. The mean standardized Z-scores of social capital were the highest among the HHCs, followed by the treatment-completed PTB patients. There was no consistent pattern, but the trust and solidarity domain showed a statistically significant difference. CONCLUSION: A low level of social capital and its domains were seen among the newly diagnosed PTB patients. However, better scores among the HHCs and the treatment-completed patients infer a negative association between social capital and TB. Thus, higher social capital preserves and improves health. Therefore, caregivers and disease-cured patients can be utilized as a social support system for current diseased patients and improve their health status.

Association of Selected Cardiovascular Markers With Tuberculosis: Community-Based Exploratory Cross-Sectional Analytical Study in Puducherry.

Introduction India accounts for one-fourth of the global tuberculosis (TB) burden and also faces a rising burden of non-communicable diseases. Only a few have studied the association between the infective pathogenesis of TB and cardiovascular diseases (CVD). Methods A cross-sectional exploratory analytical design was used to compare CVD risk factors and immunological and radiological parameters. This was a pilot study conducted in two primary health centers in urban Puducherry between February 2020 and March 2021. Household contacts (HHC) were either spouses or siblings of the newly diagnosed pulmonary tuberculosis (PTB) patients selected for comparison as their exposure to infection would be similar to those who were diseased yet did not develop illness. Assuming a difference of 5% in CVD risk between the general population and TB patients, with a 95% confidence interval, the sample size calculated was 153 in each group by nMaster v2.0. Considering the feasibility and resource constrain, we recruited 50 newly diagnosed PTB patients, their age- and gender-matched 50 HHC and 50 PTB patients who completed treatment a year before. CVD risk factors were compared using chi-square or Fisher exact test. Interleukins-6 (IL-6), interferon-gamma (INF-γ), highly specific - C reactive protein (hs-CRP), and carotid intima-media thickness (CIMT) were compared using ANOVA or Kruskal-Wallis test. Results Most participants from each group belonged to lower socio-economic strata and were males (40/50). Alcohol intake was higher among newly diagnosed and treatment-completed PTB patients (82.5% vs 72.5%). Excess salt intake (58%) was present more in newly diagnosed PTB patients. General and abdominal obesity were seen more among HHC (64% and 84%) and treatment-completed PTB patients (50% and 74%). IL-6 was higher in newly diagnosed PTB patients, whereas INF-γ and hs-CRP were higher in treatment-completed PTB patients. The largest proportion of those having high CIMT values was also in the treatment-completed PTB patients. Conclusion Levels of immune markers hint at the role of inflammation due to TB disease being related to the high CIMT values among the newly diagnosed and treatment-completed PTB patients. CVD risk was higher among TB patients even if they had completed treatment and were declared cured.

Ultrasound-Guided Manipulation does not Prevent Malalignment Over Landmark-Based Fracture Reduction in Distal Radius Fracture (Colles).

Introduction: This systematic review aims to determine the relative risk of distal radius (Colles) fracture (DRF) malalignment between ultrasound (USG)-guided and conventional/landmark guided/blind manipulation and reduction (M&R). Methods: We searched 3932 records from major electronic bibliographic databases on USG-guided manipulation of DRF. Studies with randomized, quasi-randomized, and cross-sectional study designs meeting the inclusion criteria were included in this review. USG and landmark-guided DRF manipulations were named cases and controls, respectively. The Newcastle-Ottawa Scale was used to assess the quality of included studies. Results: Thirteen and nine studies were analysed for qualitative and quantitative analysis in this review. Nine hundred fifty-one DRF patients (475 cases and 476 controls) from 9 studies with mean ages of 51.52 ± 11.86 (22-92) and 55.82 ± 11.28 (18-98) years for cases and controls were pooled for this review. The pooled relative risk estimate from the studies included in the meta-analysis was 0.90 (0.74-1.09). There was a 10% decrease in the risk of malalignment with USG than the landmark guided M&R of DRF. The I2 statistic estimated a heterogeneity of 83%. Sensitivity analysis revealed a relative risk of 1.00 (0.96-1.05). Conclusion: The USG-guided manipulation does not prevent malalignment over the landmark-based manipulation of DRF. The risk of bias across the included studies and heterogeneity of 83% mandates further unbiased, high-quality studies to verify the findings of this review.

Prevalence of Phantom Vibrations and Ringing Syndrome, and its Association with Smartphone Addiction among Medical Students of Teaching Hospital, South India.

INTRODUCTION: Phantom vibration syndrome (PVS) and phantom ringing syndrome (PRS) is a false sensation of phone vibration and ringing when it is not. This study aimed to estimate the prevalence of PVS/PRS among medical students and to determine factors including level of smartphone usage associated with the development of phantom sensations. METHODS: Using cross-sectional analytical design, sociodemographic details, information on phantom sensations and phone usage among medical students in our institution in Puducherry, India, was obtained. Stratified random sampling strategy was incorporated to achieve a sample size of 369. Also, overuse of phone was assessed using Smartphone Addiction scale - short version (SAS-SV). Prevalence of PVS and PRS was summarized as a proportion with a 95% confidence interval (CI). Prevalence ratio for the factors associated with the phantom syndrome (PVS/PRS) was estimated using log-binomial regression. RESULTS: Using data from 383 students, the prevalence of phantom syndrome (PVS/PRS) was 44.9% (39.9-50.0%). PVS was more prevalent than PRS (27.9% vs 21.2%). There was a significant difference in SAS-SV scores between those with the phantom syndrome and those without. Students who stay in hostel (aPR = 1.88; 95% CI: 1.46 to 2.43), self-reported overuse of phone (aPR = 1.96; 95% CI: 1.56 to 2.45) and higher smartphone addiction score (aPR = 1.26; 95% CI: 1.04 to 1.53) were found to be significant determinants to have PVS/PRS. CONCLUSION: Overall, one in two medical students had either PVS or PRS in our institution, Puducherry. Higher smartphone usage was a significant predictor of the presence of PVS/PRS.

Venom induced consumption coagulopathy and performance of 20-min whole blood clotting test for its detection in viperid envenomation.

BACKGROUND: Venom induced consumption coagulopathy (VICC) and its underlying mechanisms have not been fully elucidated in viperid envenomation (VE), especially among Indian patients. We evaluated for VICC in VE, assessed the performance of 20-min whole blood clotting test (20WBCT) for VICC detection and also studied predictors of VICC. METHODS: This hospital-based observational study enrolled 103 consecutive patients (age ⩾ 12 years) of snakebite admitted within 24 h of bite, with features of VE. They underwent 20WBCT, prothrombin time (PT)/international normalised ratio (INR), plasma fibrinogen and D-dimer testing during first 24 h after enrolment. Overt VICC (defined by overt bleeding), subclinical VICC (INR ⩾ 1.4 and/or fibrinogen < 2g/L, without overt bleeding), disseminated intravascular coagulation (DIC) (overt/non-overt, defined based on International Society on Thrombosis and Haemostasis (ISTH) DIC score) and primary defibrination (PDF) were evaluated among patients. RESULTS: VICC overall was noted in 77 (≈75%) and overt VICC in 52 (≈50%). DIC (overt/non-overt) was noted in 59 (≈77%) and PDF in 2 (2.6%) patients with VICC. Sensitivity, specificity, positive predictive value and negative predictive value of 20WBCT for VICC detection were 98.7% (95%CI: 92.9-99.9%), 65.4% (95%CI: 44.3-82.8%), 89.4% (95%CI: 83.3-93.5%) and 94.4% (95%CI: 70.4-99.2%) respectively. Severe cellulitis in bitten limb predicted reduced VICC risk. DISCUSSION: Majority (75%) of patients with VE had VICC and 68% with VICC had overt bleeding. DIC (overt/non-overt) was the predominant contributor to VICC. Though 20WBCT is a good screening test for VICC, false positive results should be kept in mind before deciding on snake antivenom treatment.

MRI Features and Treatment for Idiopathic Chondrolysis of the Hip (ICH) in Children: Outcomes of a Systematic Review.

Background: The purpose of this paper was to review the MRI features and treatment for idiopathic chondrolysis of the hip (ICH) in patients aged 18 years or less. Methods: We included studies published in English up to August 2021. We accessed major electronic bibliographic databases on ICH that described MRI features, treatment, or both. We used the Joanna Briggs Institute (JBI) Critical appraisal checklist for case reports for Risk of bias assessment. Results: We pooled 136 hips (125 participants) from 35 studies with 11.6 ± 3.4 years mean age. We had 46, 8, and 106 hips to assess ICH's MRI, pharmacological, and operative interventions. Geometric marrow edema (GME) (P < 0.01), diffuse marrow edema (DME) (P < 0.05), diffuse cartilage loss (DCL) (P < 0.05), and joint effusion (P < 0.05), were significantly associated with time in first MRI reviews. GME (P < 0.01) and focal cartilage loss (FCL) (P < 0.01) decreased significantly between two MRI reviews at median time of 1.75 (IQR 0.93-4.25) and 12.5 (IQR 3.75-19.5) months. Diffuse cartilage loss (P < 0.01) and degenerative changes (P < 0.01) increased significantly between the two MRI reviews. Etanercept, Methotrexate, and Botulinum Neurotoxin A drugs were used by 3, 3, and 1 report to treat ICH. Capsulectomies, total hip arthroplasty, arthrodiastasis, arthrodesis, arthroscopy operations treated 45, 18, 5, 5, and 2 hips. Discussion: GME may be the most specific and early MRI feature in diagnosing ICH. GME and DME show an inverse relationship over time. So, it is with FCL and DCL. Despite reports on the efficacy of biologics, immunomodulators, and operations, early and late ICH management remains controversial due to poor quality studies. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-022-00684-7.

Corrective derotation osteotomies to treat congenital radioulnar synostosis in children: results of a systematic review and meta-analysis.

Background: The primary objective of this review is to estimate the rotational correction after corrective derotation osteotomies (CDO) for congenital radioulnar synostosis (CRUS). The secondary objective of this review is to identify the complications with CDO in CRUS. Methods: We included studies in the English literature from electronic bibliographic databases Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL, Directory of Open access journals (DOAJ), EMBASE, MEDLINE, ProQuest, PubMed, and Scopus up to December 2020 that determined the effects of CDO in CRUS for two or more cases with a mean follow-up of 1 year or more. We used the National Institutes of health quality assessment tool for case series (interventional) and Modified Coleman methodology Score for assessment of risk of bias in the included studies. Results: We pooled 383 forearms (318 participants) from 23 studies with mean age of 6.28 ± 1.75 years. The mean pronation deformity was 72.83 ± 15.64° from 22 studies. The CDO derotated forearm to 10.4 ± 5.90° of mean pronation in 12 studies and 13.47 ± 9.51° of mean supination in nine studies. One study corrected the forearms to a neutral position. The mean derotation from CDO was 73.13 ± 16.54° (35° supination to 130° pronation). The overall mean difference was - 68.26° [95% CI - 86.87, - 49.66] of correction favoring supination. There were eight transient nerve palsies and six compartment syndromes from synostosis site osteotomies (four studies). Discussion: We had poor-quality studies at a high risk of bias on the described tools of assessment. We could estimate the directional effect of CDO in CRUS favoring correction from pronation to supination; however, due to the heterogeneity among studies, we cannot comment on the most efficient and least harmful CDO techniques. The single bone osteotomies seem to be efficient, simple, and reportedly low on complications but need evaluation. We cannot define the indications for correction and expected improvement in functional outcomes from osteotomy techniques. Supplementary Information: The online version contains supplementary material available at 10.1007/s43465-021-00582-4.

Effectiveness of Covishield vaccine in preventing Covid-19 - A test-negative case-control study.

INTRODUCTION: This study aimed at assessing the vaccine effectiveness (VE) of Covishield, which is identical to AstraZeneca vaccine, in preventing laboratory-confirmed Covid-19. METHODS: Using test-negative case-control design, information on vaccination status of cases with Covid-19 among healthcare workers in our institution in Puducherry, India, and an equal number of controls matched for age and date of testing, was obtained. The groups were compared using multivariable conditional logistic regression to calculate odds ratios (OR). VE was calculated as 100*(1-adjusted odds ratio)%. RESULTS: Using data from 360 case-control pairs, VE of one dose and of two doses, in providing protection against Covid-19 was 49% (95% CI: 17%-68%) and 54% (27%-71%), respectively. Among cases with moderately severe disease that required oxygen therapy, VE following any number of vaccine doses was 95% (44%-100%). CONCLUSION: Covishield vaccine protected significantly against Covid-19, with a higher protection rate against severe forms of disease.

Association between indoor air pollution and cognitive function among nationally representative sample of middle-aged and older adults in India-A multilevel modelling approach.

We have used a nationally representative sample of middle-aged and older adults in India to study the association between indoor air pollution and cognitive function. Longitudinal aging study in India (LASI) Wave-I data was utilized for this study. A two-level mixed-effects linear regression model was used to study the association between indoor air pollution and cognitive function and interpreted as adjusted beta coefficient (ꞵ) with 95% confidence interval (CI). In total, 56,179 participants aged ≥45 years were included in the analysis. The proportion of participants living in households with indoor air pollution were 30.6% (95%CI: 30.0%-31.3%). After adjusting for all the potential confounders (age, gender, education, region, religion, separate kitchen, socioeconomic status, marital status, residence, smoking, alcohol consumption, body mass index, self-rated health, and sleep problems), participants living in households with indoor air pollution had significant decline in the cognitive function when compared to those living in households without indoor air pollution (ꞵ = -0.57; 95%CI: -0.69 to -0.45). Since the LASI survey is being conducted as a biennial panel survey, assessing the impact of indoor air pollution on cognitive decline using the follow-up data can provide further insights into the pathogenesis of condition.