Exploring cyberchondria and its associations in dental students amid COVID-19 infodemic.

BACKGROUND: Adverse psychological effect of pandemic includes not only increased levels of stress, anxiety, and depression but also cyberchondria - the problematic online health research behavior. It is thought that the distress and uncertainty of pandemic clubbed with information overload and its ambiguity have paved the way for cyberchondria. Students being the vulnerable population, the present study was an effort at understanding cyberchondria in students. AIM: The aim of the study is to assess cyberchondria and its association with depression, anxiety, stress, and quality of life (QOL) in dental students during the pandemic. MATERIALS AND METHODS: An online questionnaire-based survey was carried out on dental students. The survey tool comprised a semi-structured pro forma, General Health Questionnaire-12, Depression Anxiety and Stress Scale 21, Cyberchondria Severity Scale 15, and European Health Interview Survey QOL 8. RESULTS: The study revealed that 98.7% of the students were affected by one of the constructs of cyberchondria, viz., "excessiveness" (93.7%), followed by "distress" (84.3%) and "reassurance"-seeking behavior (83.7%). Cyberchondria affected girls more than boys and shared robust positive correlation with depression, anxiety, and stress but not QOL. Factors such as stress, anxiety, QOL, and changes in appetite were associated with higher severity of depression. Family financial losses, preexisting psychiatric illness, and media adverse effect shared robust positive associations with severity of depression, anxiety, and stress and an inverse association with QOL. 76.0% of the students expressed excessive worries regarding missing out on clinical exposure, and nearly half of the students were dissatisfied with eLearning. 78.3% of the students experienced changes in sleep; 68.7% had changes in appetite; and 89.0% reported reduction in the level of physical activity. CONCLUSION: Cyberchondria is affecting the large majority of students. Educational institutions must put efforts to sensitize students about cyberchondria.

COVID-19 pandemic and its aftermath: Knowledge, attitude, behavior, and mental health-care needs of medical undergraduates.

BACKGROUND: The undeniable impact of the COVID-19 pandemic on the educational sector has left the students perplexed and uncertain. Infection-related fears, inevitable loneliness, disturbed routine making way for adverse lifestyle habits, stressors such as financial crisis faced by their families, and many more further accentuate their vulnerability to mental health issues. AIM: The aim was to assess the knowledge, attitude, and behavior of medical undergraduate students about the COVID-19 outbreak, and to assess their stress, anxiety, depression, and quality of life (QOL). The study also explored the correlation between the knowledge, attitude, and behavior of the medical undergraduate students about the pandemic and their mental health issues. MATERIALS AND METHODS: An online questionnaire-based survey was carried out on medical undergraduate students. The survey tool comprised a semi-structured proforma; General Health Questionnaire-12 items; Depression, Anxiety, and Stress scale-21 items; and European Health Interview Survey-Quality of Life-8 items. RESULTS: Nearly 61.8% of the students seemed well read and had good knowledge about the medical aspects of the pressing issue of COVID-19, and majority of the students had adaptive attitudes and behaviors toward the pandemic. Almost 23.2% of the students had depression, 20.7% had anxiety, and 13.0% had stress ranging from mild to extremely severe. Nearly 75.1% of the students experienced changes in appetite and 53.6% had changes in appetite. Nearly half of the students expressed excessive worries regarding studies. The mean score of QOL of students was 3.9 ± 0.6. Students with adaptive attitudes and behavior experienced relatively less severe depression, anxiety, and stress compared to their counterparts. CONCLUSION: A significant portion of the medical undergraduates are experiencing mental health issues and study related concerns due to the adversity brought by the pandemic. The concerned educational bodies and institutes must take up necessary steps to mitigate the adverse effects of the pandemic on students.

A Case Report on Varenicline Induced Delirium in an Alcohol and Nicotine Dependent Patient.

Varenicline is a smoking cessation agent. Varenicline acts as a partial agonist of α4ß2 neuronal nicotinic acetylcholine receptor and prevents nicotine binding to the same. It also causes dopamine (DA) stimulation that decreases craving and symptoms of dependence. A 40-year-old male diagnosed with alcohol and nicotine dependence syndrome was treated with 1 mg of varenicline for 3 days. Patient developed episodes of transient delirium within 15-30 min after administration of varenicline. Patient was disoriented and did not respond relevantly. Patient would have disorientation and would respond irrelevantly and was unable to recall the event completely. There were no features suggestive of seizures. The episodes resolved after the medication was stopped. Varenicline, with its partial agonistic effect on nicotinergic receptors, stimulates the release of multiple neurotransmitters including DA. DA dysregulation is probably responsible for the development of neuropsychiatric adverse reactions due to varenicline. This is the first case report to the best of our knowledge reporting varenicline induced dilirium. In this case, the adverse event was found in an alcohol and nicotine dependent patient undergoing treatment. It is essential to monitor uncommon adverse effects as this can cause significant morbidity.

Voriconazole-induced psychosis in a case of acute myeloid leukemia with febrile neutropenia.

Voriconazole-induced psychosis is a rare side effect. It is important that clinicians are made aware of voriconazole-induced potential psychosis. We report a case of voriconazole-induced psychosis that responded to haloperidol.

Efficacy of pulsed electromagnetic field therapy in healing of pressure ulcers: A randomized control trial.

BACKGROUND: Pressure ulcers are one of the most common complications in health care settings. Still there are no optimal protocols to manage the pressure ulcers. AIM: To assess the effectiveness of pulsed electromagnetic field therapy (PEMF) in healing of pressure ulcers in patients with neurological disorders. DESIGN: Randomized double blind control trial. SETTING: Neurological rehabilitation department in a university research hospital. PARTICIPANTS: Twelve patients (M:F, 9:3) having neurological disorders, with age between 12-50 years (mean 30.166 +/- 11.32 yrs) and 24 pressure ulcers. INTERVENTION: Six patients with 13 ulcers received PEMF therapy and the remaining 6 patients with 11 ulcers received sham treatment, for 30 sessions (45 minutes each) using the equipment 'Pulsatron'. The frequency of PEMF was set at 1 Hz with sine waves and current intensity of 30 mili ampere. Whole body exposure was given in both the groups. OUTCOME MEASURES: Bates-Jensen wound assessment tool (BJWAT) score was used as main outcome measure and scores at the end of session were compared with initial scores and analyzed. Similarly National Pressure Ulcer Advisory Panel (NPUAP) scores were compared and analyzed as secondary outcome measure. RESULTS: Thirteen ulcers were in stage IV and 11 were in stage III at the start of the study. Significant healing of ulcers was noted, BJWAT scores, in both the treatment and sham groups (P < 0.001 and 0.003 respectively) at the completion of the study. However, when comparing between the groups, healing was not significant (P = 0.361). Similarly trend was noted with NPUAP scores with no significant difference between the treatment and sham groups (P = 0.649) at the completion of study. CONCLUSIONS: No significant difference in pressure ulcer healing was observed between PEMF treatment and sham group in this study.

Urodynamic profile in myelopathies: A follow-up study.

AIMS: To study the significance of filling cystometry in assessment and management of neurogenic bladder in myelopathies and correlate neurological recovery and bladder management in the follow up. STUDY DESIGN: Retrospective analysis of reports of filling cystometry in patients with traumatic and non-traumatic myelopathy. SETTING: Neuro-rehabilitation unit of a tertiary care university hospital. METHODS: The study was carried out between September 2005 and June 2006 and included all subjects with myelopathy who underwent filling cystometry. ASIA impairment scale was used to assess neurological status during admission as well as in the follow up. Bladder management was advised based on the cystometric findings. Neurological recovery and mode of bladder management were correlated during the follow up after a minimum of 6 months. RESULTS: Fifty-two subjects (38 males, 14 females), mean age 33.26 +/- 14.66 years (10-80) underwent filling cystometry. Twenty patients had cervical, 24 had thoracic and 8 had lumbar myelopathy. Cystometric findings were overactive detrusor observed in 43 patients, (21 had detrusor sphincter dyssynergia (DSD), 22 without DSD) and areflexic/underactive detrusor in 9. Post-void residual (>15% of voided urine) was significant in 27 patients. Twenty-three patients (44%) reported for follow up (16 males, 7 females) after a mean duration of 9.04 +/- 2.44 months (6-15 months). Neurological recovery was seen in 61% cases, while 1 patient showed deterioration. Only 26% patients reported change in bladder management during follow up. Correlation between neurological recovery and bladder management was found to be insignificant (P > 0.05) using spearman correlation co-efficient. CONCLUSIONS: Filling cystometry is valuable for assessment and management of neurogenic bladder after myelopathy. No significant relationship was observed between neurological recovery and neurogenic bladder management in the follow up in the present study.

Urodynamics post stroke in patients with urinary incontinence: Is there correlation between bladder type and site of lesion?

OBJECTIVE: Assessment of bladder by urodynamic study (UDS) in patients with urinary incontinence following stroke, and correlation with site of lesion. STUDY DESIGN AND SETTING: Retrospective cross-sectional study in the neurological rehabilitation unit of a tertiary care institute. MATERIALS AND METHODS: Forty patients (22 males) with arterial or venous, ischemic or hemorrhagic stroke, with urinary incontinence in the acute phase following the event, underwent UDS. Seventeen patients had right hemiplegia, 18 had left hemiplegia, and five had posterior circulation stroke with brainstem/cerebellar features. Bladder type was correlated with age, side, and site of lesion. RESULTS: The mean age was 46.80 +/- 16.65 years (range: 18-80 years). Thirty-six patients had arterial stroke and four had cortical venous thrombosis. UDS was performed after a mean of 28.32 +/- 10.27 days (range: 8-53 days) after the stroke. All but one patient had neurogenic bladder dysfunction, with 36 patients (90%) having overactive detrusor (OD) and three having underactive/areflexic detrusor. Among the 36 patients with OD, 25 patients (62.5%) had OD without detrusor-sphincter dyssynergy (DSD) and 11 (27.5%) had OD with DSD. Bladder management was advised based on the UDS findings. No significant correlation (P > 0.05) was found between type of bladder and age or side and site of lesion. CONCLUSIONS: UDS is a useful tool to assess and manage the bladder following stroke with urinary incontinence. In this study, no significant correlation was found between UDS findings and site of lesion.

Quality of life and psychological problems in patients undergoing neurological rehabilitation.

AIM: To assess the quality of life (QoL) and prevalence of psychological problems (PP) in patients with neurological illness, and their correlation with functional abilities. MATERIALS AND METHODS: Prospective cross-sectional study conducted in the neurological rehabilitation unit of tertiary research hospital in 30 consecutive hospitalized patients (21 men), age 16-55 years (34.63+/-11.87). OUTCOME MEASURE: WHOQoL-BREF was used to assess QoL. The prevalence of PP was recorded using Hospital Anxiety Depression Scale (HADS) and General Health Questionnaire (GHQ-12). QoL and HADS scores were correlated with functional abilities using mean Barthel Index (BI) Score. RESULTS: The duration of illness was three to 30 months (10.63+/-7.83) and their primary diagnoses were stroke 12, traumatic spinal cord injury seven and non-traumatic spinal cord lesion 11. Twenty-two patients qualified for GHQ-12 caseness, with 15 patients having distress (score >/=15) and seven having severe problem and psychological distress (score>/=20). Twenty five patients had abnormal anxiety and 17 had abnormal depression on HADS (abnormal = 8-21), with moderate to severe anxiety and depression (scores>/=11) in nine and three patients respectively. The mean WHOQoL-BREF transformed scores (on WHOQoL 0-100 scale) were (38.83+/-8.02), (50.76+/-9.79), (48.53+/-18.46) and (49.13+/-10.63) in physical, psychological, social, and environmental domains respectively. The social domain of QoL had significant correlation (P<.05) with functional abilities. CONCLUSION: Patients with neurological disorders requiring inpatient rehabilitation have impaired QoL that affects all domains of life. There is high prevalence of psychological problems, including anxiety and depression. The social domain of QoL adversely affected functional abilities, but the correlation between PP and functional abilities was insignificant.