Psychological impact of COVID-19 on medical interns - Findings from a nationwide survey.

BACKGROUND: The COVID-19 pandemic has negatively impacted the mental health of health-care workers worldwide. This study aimed to estimate the prevalence of psychological distress in medical interns during the pandemic and examine the factors influencing it. MATERIALS AND METHODS: A cross-sectional online survey was conducted using snowball sampling among 764 medical interns across India, who were evaluated using the Kessler Psychological Distress Scale, Fear of COVID-19 Scale, and semi-structured questionnaires. Univariate analysis was done using Chi-square test, unpaired t-test, and ANOVA, while multivariate analysis was conducted using binary logistic regression. RESULTS: 57.5% of the interns reported psychological distress, with 39.8% having moderate-to-severe distress. Past consultation with a mental health professional (odds ratio [OR]: 2.15; 95% confidence interval [CI]: 1.42-3.26) and perceived lack of support from friends (OR: 2.33; 95% CI: 1.33-3.99) and faculty (OR: 2.15; 95% CI: 1.41-3.28) were the most significant predictors of distress. Fear of COVID-19 was higher in interns who were female, were medically ill, were dissatisfied with the pandemic preparedness at the hospital, and perceived the faculty to be less approachable and supportive. Majority of the interns felt that the pandemic had hampered their learning and were worried about an extension to their internship and their performance in the postgraduate entrance examinations. CONCLUSIONS: Psychological distress was highly prevalent among interns, with several workplaces and personal factors affecting the distress levels. Most interns perceived a negative impact of the pandemic on their learning and career. Addressing these issues could help alleviate the distress and bolster the mental health of interns.

A Rare Case of Complicated Opioid Withdrawal in Delirium Without Convulsions.

Opioids are one of the commonly abused substances in India. Opioid withdrawal symptoms classically include severe muscle cramps, bone aches, autonomic symptoms, anxiety, restlessness, insomnia, and temperature dysregulation. However, reports of cases with delirium during withdrawal are few. A 25-year-old male with severe opioid withdrawal symptoms developed delirium. Investigations were normal. There were no comorbidities, no significant past history and family history. Patient treated for opioid dependence with tapering doses of lorazepam and clonidine. He was discharged with naltrexone. Patient lapsed 3 months later with similar presentation. Complications such as convulsions and delirium are recognized in alcohol withdrawal. However, these are rare as a feature of opioid withdrawal. This case illustrates the need for psychiatrists and physicians to be aware of the possibilities of delirium with opioid withdrawal and monitoring for the same is important because of its complications.

Supportive CSF biomarker evidence to enhance the National Institute on Aging-Alzheimer's Association criteria for diagnosis of Alzheimer's type dementia--a study from Southern India.

The present study was undertaken to validate the measurement of biomarkers as a supplement to the latest diagnostic criteria for Alzheimer disease (AD) dementia by National Institute on Aging-Alzheimer's Association (NIA-AA) work group using a sample attending a tertiary care center in Southern India. A total of 20 subjects diagnosed clinically as Alzheimer's dementia according to the NIA-AA criteria for AD were included in the study. The CSF biomarkers Aß42, t-tau, and p-tau181 were assessed. The biomarker results were compared among mild and moderate to severe AD as defined in the NIA-AA work group guidelines. The results revealed that the amount of Aß42 was very low in all the 20 samples (<50pg/ml) collected from mild AD cases with CDR score of 1 (n=8), and moderate to severe AD cases with CDR >1 (n=12). t-tau and p-tau levels were in the range of 39.45±5.09pg/ml and 13.06±7.32pg/ml for CDR 1 group. t-tau and p-tau levels were in the range of 49.9±11.28pg/ml and 33.94±15.13pg/ml for moderate to severe cases. Analysis of the data revealed statistically significant differences in the p-tau/t-tau ratio and p-tau/Aß ratio between CDR 1and CDR >1 AD cases (p<0.001) suggesting that p-tau/t-tau and p-tau/Aß ratio are good indicators of severity of dementia with discriminative value in differentiating mild AD from moderate to severe AD.