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   Table of Contents - Current issue
Coverpage
November 2022
Volume 15 | Issue 8 (Supplement)
Page Nos. 139-367

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EDITORIAL  

COVID-19 pandemic: Need for timeout to revive the science p. 139
Amitav Banerjee
DOI:10.4103/mjdrdypu.mjdrdypu_843_22  
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GUEST EDITORIALS Top

Dramatic reduction in COVID-19 testing: Is it an epidemiologically sensible approach that can benefit tuberculosis control? p. 140
Sachin R Atre, Jitendra S Bhawalkar
DOI:10.4103/mjdrdypu.mjdrdypu_674_22  
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COVID-19 and climate p. 142
Viroj Wiwanitkit
DOI:10.4103/mjdrdypu.mjdrdypu_666_20  
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A critical take on sustaining precautionary behaviors for COVID-19 p. 143
Madhumita Dobe, Arista Lahiri, Monalisha Sahu, Sweety Suman Jha
DOI:10.4103/mjdrdypu.mjdrdypu_362_21  
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REVIEW ARTICLES Top

Mild COVID- 19 infection: Do we have any effective drugs? A narrative review p. 146
Deependra K Rai, Pramod K Manjhi
DOI:10.4103/mjdrdypu.mjdrdypu_131_22  
Coronavirus disease (COVID-19) is an infectious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The clinical spectrum of SARS-CoV-2 infection ranges from asymptomatic infection to critical illness. About 80% of COVID-19 infections are mild or asymptomatic, 15% are associated with severe infection requiring oxygen and 5% are critical infections, requiring ventilation support. Patients with mild illness usually recover at home, with supportive care and isolation. But most of the mild COVID-19 patients have been prescribed off-label medication such as Hydroxychloroquine, Azithromycin, Ivermectin, Doxycycline, Favirapivir, Vitamin C, Vitamin D, an oral and inhaled corticosteroid. Literature showed that the sale of all these medications increased in this pandemic The newer cocktail regimen which is a combination of monoclonal antibody Bamlanivimab and Etesevimab showed very promising results. The newer oral antiviral drug Molnupiravir is also showing very good efficacy in terms of reduction in hospitalization and death. This narrative review looked at evidence regarding each drug for its effect on recovery time, viral clearance, and the risk of progression or hospitalization. Among all these, Ivermectin only shows a promising result. The newer cocktail antibody and antiviral drug Molnupiravir is effective in reducing hospitalization and may be a game changer for the patient with mild-moderate COVID-19 infection. There is a lack of evidence for the use of other drugs in the mild case of COVID 19. Only symptomatic treatment with antipyretic with hydration is enough to combat mild COVID-19 infection.
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Impact of COVID-19 pandemic and lockdown on physical, psychological, and social well-being of persons with disabilities: A systematic review p. 154
Amruta P Chutke
DOI:10.4103/mjdrdypu.mjdrdypu_1031_21  
Knowing that coronavirus disease 2019 (COVID-19) pandemic and the resultant lockdowns severely curtailed the mobility and accessibility to healthcare services for people with disability (PWD); the objective was to explore the impact and challenges faced by different disabling conditions among PWDs. A systematic review was conducted using online databases on impact or effect of COVID-19 on people with disabilities. Forty-three articles were included. Studies on different disability conditions reported reduced access to healthcare and rehabilitative services due to lockdown during the pandemic. There was reduction in physical activity; increased behavioral problems; poor compliance to preventive measures; and they experience anxiety, fear, depression, stress, loneliness, social isolation, and financial crisis. Their families and caregivers also experienced adverse emotional, economic, and social consequences of the pandemic. The study highlights need for mass sensitization, mobilization of services and creating awareness for adaptation and implementation of comprehensive disability inclusive guidelines.
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Mucormycosis and COVID-19: A systemic review p. 163
Ankit Kaushik, Anamika Jaiswal, Hari S Pandey, Paramjeet Singh
DOI:10.4103/mjdrdypu.mjdrdypu_359_21  
COVID-19 presents severely in persons with immunocompromised states such as diabetes mellitus. Steroids are used in the management of COVID-19. The use of steroids in immunocompromised persons increases the chances of opportunistic infections. Mucormycosis infects immunocompromised individuals. The aim of this systemic review was to study the clinico-epidemiological features of mucormycosis in patients of COVID-19. PubMed, Medline, Embase, and Google Scholar were searched for “mucormycosis”, “COVID-19”, and “SARS-Cov 2”. A total of 30 studies were included in this study, which included 22 case reports and 8 original articles. The median age of patients was 54.80 years; 79.56% (74/93) were diabetic. Steroid administration history was present in 74.19% (69/93) of patients. Rhino-orbital mucormycosis constituted 46.98% (39/83) of the cases, rhino-orbital-cerebral type in 37.35% (31/83) cases, pulmonary mucormycosis in 10.84% (9/83) cases, 1 case of gastric mucormycosis, 1 case of cutaneous mucormycosis, 1 case of palatal mucormycosis, and 1 case of disseminated mucormycosis. The median duration of presentation of mucormycosis was 14 days after hospital admission. The total number of deaths was reported in 32.26% (30/93) of the cases. The most common species found was Rhizopus, and amphotericin B was the most common antifungal administered. The COVID-19 pandemic is creating a massive pool of susceptible patients having poorly controlled diabetes mellitus and receiving steroids for COVID-19 management, thus creating an unholy alliance with mucormycosis. Mucormycosis started as a new epidemic in India, which is an otherwise rare opportunistic fungal infection.
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COVID-19 pandemic and contagion laws and policies in international and national perspectives p. 176
MZ M. Nomani
DOI:10.4103/mjdrdypu.mjdrdypu_465_22  
There is a settled statute concerning health rights and qualifications in emergency and normalcy. The current dash of legal advancement addresses novelty in the comprehension of India's epidemic and disaster administration. India has crossed 43,144,820 positive cases and 524,525 deceased persons due to COVID-19 until May 26, 2022. India has never spent over 2% of its gross domestic product on medical services. The probability of a principal statute of general health under these conditions needs a new generation of public laws and policies. The pre-constitution vintage of the Epidemic Diseases Act, 1897, contradicts Entry 29 of the accompanying rundown of the Constitution of India, 1950, and fighting the bordering nature of COVID-19 in India. Therefore an investigation into the legal approach to the scourge of pandemic in the global and national purview appears to be entrancing in extending our comprehension of contagion control, the State's role, and citizen's freedom. The privilege of health and life is a vital concern of the State, particularly amid pestilence and pandemics. The cross-country lockdown and COVID-19 have seen a progression of legal intervention in health rights and entitlement in broader goals of COVID-19 pandemic and contagion laws and policies in India.
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ORIGINAL ARTICLES Top

An evaluation of persistence of postdischarge symptoms in survivors of COVID-19 infection Highly accessed article p. 181
Ilankumaran Mookkiah, Mandeep Kaur, Arun Kumar Yadav, Saurabh Bobdey, Prabhakar Teli, Dharamjeet Singh Faujdar, S Vijay Bhaskar, Saibal Adhya, SK Kaushik
DOI:10.4103/mjdrdypu.mjdrdypu_729_21  
Background: The COVID-19 pandemic has affected almost 100 million people worldwide. Although the disease spectrum has still not been fully understood, there have been the reports of the persistence of symptoms well beyond the acute stage or after discharge from the hospital. Therefore, there is a need to document the persistence of symptoms to identify and provide physical as well as psychosocial support for ensuring the complete recovery of COVID-19 survivors. The present study examines the postacute stage persistence of symptoms in severe acute respiratory syndrome-coronavirus-2 patients. Materials and Methods: A longitudinal follow-up study was conducted on 1170 patients discharged from COVID hospital. All the study participants were contacted after discharge and at 7-day intervals for 42 days, and details of the persistence of symptoms were sought from them. Results: It was found that 43.8% of patients had persistence of symptoms, and 12.4% had symptoms even after 30 days of discharge from the hospital. Among symptoms, the most common persisting symptom was found to be fatigue (26%) followed by respiratory difficulty. The presence of comorbidity (odds ratio 1.61, 95% confidence interval 1.56–2.25, P < 0.01) and moderate/severe disease were found to be independent risk factors for the persistence of COVID-related symptoms. Conclusion: The findings of the study indicate that a large number of COVID-19 survivors continue to suffer from COVID-19 symptoms well after the recovery from the acute stage (discharge from hospital). Therefore, there is a genuine need for instituting measures for the monitoring of patients postdischarge and if required providing treatment to those having persistent symptoms of COVID-19.
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Impact of quarantine on lifestyle and psychological state of people during the COVID-19 pandemic Highly accessed article p. 187
Mithun Sharma, Vivek Anand, Vijay Bhaskar, Arun Kumar Yadav, Surinder Kumar, Swati Bajaj
DOI:10.4103/mjdrdypu.mjdrdypu_211_21  
Objectives: The objective of the study was to assess impact of quarantine on lifestyle behavior and the psychological state of persons during the COVID-19 pandemic. Study Design: This study was a cross-sectional study. Methods: A questionnaire-based cross-sectional study was conducted among 216 persons quarantined during the COVID-19 pandemic at home or in selected facilities set up by various tertiary care hospitals and administrative authorities in various parts of India. The questionnaire was distributed among participants using electronic media. Psychological state during quarantine was assessed using the DASS 21 questionnaire. Results: Out of 57.4% of responders who gave a history of physical exercise before quarantine, 52.7% reported a reduction in physical activity. 18.5% of study participants brought about dietary changes towards healthy diet during quarantine, while 24.5% took up some new activities or hobbies. 62.9% of respondents reported any degree of psychological stress (depression, stress, or anxiety) during the quarantine. Conclusions: Quarantine impacted psychological state of individuals and brought about changes in lifestyle with both positive attributes such as dietary modification toward healthy diet or negative attributes such as reduction in physical activity. IEC activities have a positive impact in terms of reducing negative attributes and increasing the compliance toward quarantine.
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Mental health impact of COVID-19 pandemic in India: A web-based community survey Highly accessed article p. 193
Mamta Singh, Nitin Raut, Shipra Singh
DOI:10.4103/mjdrdypu.mjdrdypu_655_21  
Background: The coronavirus pandemic has impacted the globe, altering lives of people in all domains, and added insecurity, thereby taking a toll on their mental health. Addressing the parallel surge of psychological problems and identifying the vulnerable population is of equal concern. This study aims at assessing the symptoms of anxiety and depression in the population during the coronavirus pandemic. Methodology: It was a cross-sectional methodological web-based survey to assess psychological influence of the coronavirus pandemic. A sociodemographic pro forma, validated questionnaire consisting questions about awareness regarding coronavirus, and Goldberg Anxiety and Depression Scale were included in the survey. Results: A total of 1027 participants completed the survey questionnaire. Clinically significant anxiety and depressive symptoms were found in 17.9% and 40.7%, respectively. There was statistically significant difference in prevalence of anxiety symptoms by gender (P = 0.009), age group (P = 0.030), marital status (P = 0.001), and occupation (P = 0.012). Depressive symptoms also significantly differed across age group (P = 0.001), marital status (P = 0.000), education (P = 0.020), occupation (P = 0.009), income group (P = 0.038), and place of living (P = 0.039). A significant difference of knowledge (about COVID-19) was seen between the groups with and without clinically significant depressive symptoms. Distress was noted mostly with information overload and the fear of contracting coronavirus infection. Conclusion: More than one-third of participants had clinically significant psychological symptoms. This suggests the requirement of more structured and long-term studies, and the need for appropriate mental health services to masses.
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Exploring community's perceptions and behavior toward people presumptive or treated for COVID-19: An online cross-sectional survey in Tamil Nadu, India p. 200
Geetha Mani, Subashchandrabose Varatharajan, Hariharan Mohan
DOI:10.4103/mjdrdypu.mjdrdypu_57_21  
Background: The unprecedented morbidity and mortality associated with COVID-19 pandemic and its unique epidemiological features have contributed to stigmatizing and discriminating attitudes among people. Success of prevention efforts depends on identifying and acting upon population perceptions toward the disease and those with the disease. Hence, this study was planned to assess perceptions and behavior of people toward those presumptive or treated for COVID-19 and to identify the influence of sociodemographic characteristics and basic knowledge about COVID-19 on population perceptions and behavior. Materials and Methods: A descriptive, cross-sectional, Google Forms-based online survey was conducted among eligible population of Tamil Nadu, India, during January 2021. A pretested, semi-structured questionnaire was used to collect basic sociodemographic characteristics, knowledge on COVID-19, attitude, and behavior toward people presumptive or treated for COVID-19 on a Likert scale. Descriptive statistics and Pearson's correlation coefficient test were employed for statistical analysis. P ≤ 0.05 was considered statistically significant. Results: Among 300 respondents, 59.3% had adequate knowledge on COVID-19. Twenty-nine percent of respondents expressed favorable attitude and 31.7% reported favorable behavior toward those presumptive or treated for COVID-19. The perceived attitude or reported behavior did not vary significantly across sociodemographic characteristics. An approximate one-third of respondents with adequate knowledge expressed favorable attitude and favorable behavior (P < 0.001); 54% of respondents with favorable attitude reported favorable behavior (P < 0.001). A weak but significant positive linear correlation was identified between attitude and behavior scores (r = 0.386; P < 0.01). Conclusion: Equipping people with appropriate knowledge and resources could promote positive population attitudes and behaviors toward those symptomatic or treated for COVID-19 and hence crucial in the control efforts against the pandemic.
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Clinical profile and outcome of pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 series in Eastern India Highly accessed article p. 210
Bonny Sen, Mihir Sarkar, Dibyendu Raychaudhuri, Priyankar Pal, Satyabrata Roychowdhoury, Amitabha Chattopadhyay, Avijit Hazra, Rakesh Mondal
DOI:10.4103/mjdrdypu.mjdrdypu_15_21  
Objective: The objective of this study is to delineate the characteristics and outcome of Pediatric Inflammatory Multisystem Syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARSCoV2) infection (PIMS-TS) in Eastern Indian settings. Materials and Methods: We conducted a prospective observational multicentric study from May 2020 to August 2020, collecting data on clinical profile, investigation findings, and outcome of the children aged 1 month–12 years admitted with the features of coronavirus disease 2019 (COVID-19) related hyperinflammation satisfying criteria for PIMS-TS from three tertiary care hospitals of Kolkata. Results: A total of 38 patients fulfilling the criteria of PIMS-TS were recruited. The median age of the study population was 5 years (1.9–8 years). Gastrointestinal symptoms were present in 33 (86.6%) of patients. Nasopharyngeal swab for COVID-19 reverse transcriptase-polymerase chain reaction was positive in 19 (50%) of patients, and immunoglobulin G antibody against COVID-19 was found in 12 (66.6%) of patients, whereas 19 (50%) of patients had a positive contact history of SARS-Co-V2 exposure. The features of Kawasaki, like illness with coronary changes, were seen in 12 (32%) cases, whereas myocarditis with ejection fraction <55% was reported in 17 (45%) of patients. Intensive care admissions were needed in 27 (71%) patients, and inotropes were given in 18 (47%), whereas four patients required mechanical ventilator support. Immunotherapy was used in 32 (84%) of patients. The outcome was good, with one death. Conclusions: PIMS TS has varied clinical presentation ranging from milder cases to severe cardiac dysfunction with shock. However, timely intervention and prompt initiation of immunomodulators can improve the prognosis.
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Knowledge, attitude, and practices toward COVID-19 during pandemic among Indian adults: An online cross-sectional study p. 215
Vaishali Praful Bansod, Mayavati Nannaware, Shradhha Kulkarni, Samir Singru, PS Chawla, Khyati Kalra
DOI:10.4103/mjdrdypu.mjdrdypu_554_20  
Background: People's adherence to recommended control measures is influenced by their Knowledge, attitude and practices they are following in COVID-19 Pandemic. So study was carried out to assess Knowledge, attitude and practices regarding COVID-19 among Indian citizens. Methods: A cross-sectional study was carried out among Indian citizens above 18 years of age using snowball sampling method. Data were collected through Google Forms containing structured questionnaire. Results: Totally 678 citizens responded across 20 states of India. More females reported fever, dry cough, tiredness, difficulty in breathing, headache as most common symptoms of covid-19 and sneezing, coughing as way of its transmission than male. This difference was statistically significant. Most of the study participants had favorable attitude and behavior toward COVID-19 infection. Conclusion: Majority of the participants have good knowledge, favorable attitude, and practices regarding COVID-19 during this ongoing pandemic situation. Still, continuous awareness with regard to new evidence gathered is needed to break chain of transmission to contain COVID-19 disease. Individual's attitude toward health-care worker and police personnel needs to be improved through behavior change communication activities that enable health-care workers and frontline workers to work proficiently to win the fight against COVID-19.
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Media consumption during COVID-19 and its impact on psychological well-being p. 223
Saloni Kumari, Saloni Bhagat, Shikha Surbhi, Mamta Singh
DOI:10.4103/mjdrdypu.mjdrdypu_623_20  
Introduction: Media have never been as essential as it has become during the time of pandemic. Every information related to disease, prevention, and precaution was on media. Since most of the people confined to their homes, they used media not only to get the information about pandemic but also used media as companion, which enhanced the overall consumption of media significantly. This study aims to assess the changed consumption pattern of media in Indian population before and during the pandemic and its relation to the psychological well-being. Materials and Methods: It was a cross-sectional web-based survey. Four hundred and five respondents participated in it. Data analysis was done using descriptive and inferential statistics. Results: It was found that media consumption pattern and duration both have changed during the pandemic. There was a significant difference between before and after usage of all types of media. There was also significant difference for viewing media category in demographic subgroups, age (P = 0.000), marital status (P = 0.000), occupation (P = 0.000), and place of living (P = 0.036). Females (odds ratio [OR] =2.045, 95% confidence interval [CI]: 1.305, 3.203) and retired (OR = 0.039, 95% CI: 0.003, 0.470) were significantly associated with poor mental well-being. Respondents consumed media for sometimes (OR = 2.045, 95% CI: 1.557, 4.012) and frequently (OR = 4.946, 95% CI: 1.995, 12.264) were also associated with poor mental well-being. Conclusion: The study demonstrates the existence of poor mental well-being among women and retires more. It also demonstrates that people who preferred watching news more during the pandemic had the chance of suffering from poor mental well-being.
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Psychological impact on health-care workers at a Tertiary Hospital in South India during the COVID-19 pandemic p. 229
Ajay Christopher, Abigail Ruth Gojer, Aparna Lohanathan, Anju Kuruvilla, Rajesh Gopalakrishnan, Kundavaram Paul Prabhakar Abhilash
DOI:10.4103/mjdrdypu.mjdrdypu_251_21  
Background: The COVID-19 pandemic has overwhelmed the health-care infrastructure in the country. The steadily increasing number of cases and workload, inadequacy of healthcare infrastructure, and perceived lack of support contribute to psychological stress among health-care workers (HCWs). Aims: This cross-sectional survey estimated the prevalence and factors associated with depressive, anxiety, and stress symptoms among HCWs during the COVID-19 pandemic at a tertiary care hospital in South India. Methodology: Randomly chosen HCWs who provided informed consent were recruited to the study and administered the Depression Anxiety and Stress Scale-21, Clinical Interview Schedule-Revised, and the revised stigma scale to assess for depressive, anxiety, and stress symptoms, common mental disorders, and stigma, respectively. Sociodemographic details were also recorded. Bivariate and multivariate statistics were obtained. Results: One hundred and twenty-seven participants completed the survey questionnaire. The overall prevalence of significant depressive, anxiety, and stress symptoms was 31.5%, 26%, and 16.5%, respectively. Depressive symptoms were associated with younger age, being single, presence of medical illness in the family, current nicotine, and alcohol use. Anxiety symptoms were associated with younger age, being single, and working in a clinical area with potential for exposure to COVID-19 patients. The presence of children at home was associated with lower depressive or anxiety scores. Nearly 15.7% of the participants had a primary psychiatric diagnosis. Conclusions: HCWs are at risk of experiencing psychological distress during the ongoing COVID-19 pandemic. Our findings suggest that a supportive environment is essential to protect and promote the psychological well-being of HCWs during and after the outbreak. Early psychological interventions for those who require it can prevent long-term sequelae in this vulnerable group.
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Coronavirus anxiety and cyberchondria among undergraduate medical students during the COVID-19 pandemic in a Tertiary Care Hospital: A cross-sectional study Highly accessed article p. 240
D Sravani, C Gowtham Reddy, PS Murthy, Suprakash Chaudhury
DOI:10.4103/mjdrdypu.mjdrdypu_614_20  
Background: Despite widespread rise in anxiety due to the COVID-19 pandemic, there is a paucity of studies of coronavirus anxiety and cyberchondria, which is searching for more health-related information, among medical students. Aim: The aim of the study is to assess the prevalence of coronavirus anxiety and cyberchondria in the context of COVID-19 in undergraduate medical students. Materials and Methods: This is a cross-sectional study done between August 24, 2020 and September 5, 2020. A total of 280 students have given consent to participate in the study by filling online self-designed questionnaire, coronavirus anxiety scale, and cyberchondria severity scale-12. Data analysis was done by SPSS version 20 using appropriate statistical tests. Results: Coronavirus-related anxiety was present in 55% of the students. Moderate and severe cyberchondria were seen in 39% and 50% of the students, respectively. Association between coronavirus anxiety and severity of cyberchondria was statistically significant (P < 0.001). Majority of the students spent >2 h in watching or reading COVID-19 related news. Conclusions: As significant number of medical students had anxiety and cyberchondria related to COVID-19, medical colleges have to implement necessary psychological interventions to safeguard the students' mental health.
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Comparison of trends of monsoon-related diseases during COVID-19 pandemic in a Tertiary Care Center: A retrospective study p. 248
Reema L Wankar, Smita S Chavhan, Balkrishna B Adsul, Prasad T Dhikale
DOI:10.4103/mjdrdypu.mjdrdypu_587_22  
Introduction: With the arrival of the monsoons, people living in coastal regions are at an increased risk of contracting water-borne and vector-borne illnesses like dengue, malaria, leptospirosis, hepatitis, typhoid, chikungunya, and acute gastroenteritis. With proper hygiene and sanitation practices, several monsoon-related illnesses may have been averted during the COVID-19 pandemic. Objective: To analyze the trend of monsoon-related diseases from January 2018 to December 2019 and compare the trends of these diseases during the COVID-19 pandemic, that is, from January 2020 to December 2021. Material and Method: A retrospective observational study was conducted in the tertiary care center using secondary data of monsoon-related diseases available from the Integrated Disease Surveillance Programme (IDSP). Results: The overall number of cases of monsoon-related illnesses was low in 2020 and 2021 compared to that in 2018 and 2019. Percentage change of diseases depicts that in the year 2020, all monsoon prevalent diseases were reported less compared to 2019, with the highest change being in dengue and acute febrile illness (AFI). In 2021, a majority of the disease incidence, except dengue and typhoid, had increased compared to that of 2020. Conclusion: There have been fewer incidences of monsoon-related illnesses as a result of efforts to stop the COVID-19 pandemic. This study emphasizes the significance of widespread sanitary practices and their value in the long-term decline of diseases associated with the monsoon season.
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Usefulness of CRP as a prognostic marker in the clinical course of Covid-19 infection during the three waves: A retrospective study p. 253
Shailaja Alapaty, Suhas Dhulipala, Jyothi A Natikar, H Ajit, Mangala Sirsikar, Umalakshmi Annavarapu, Deepthi Mahendrakar
DOI:10.4103/mjdrdypu.mjdrdypu_437_22  
Introduction: COVID-19 is an emerging public health problem. It comprises of a large virus family causing varying infection ranging from common cold to more severe infection. Classification of cases into mid, moderate, severe helps for effective management and treatment. CRP is a highly sensitive biomarker for inflammation, tissue damage. Materials and Methods: A retrospective cohort study was done during March 2020 to Feb 2021. Total 2,239 patients were included in the study. CRP levels were measured in hospitalized patients on the day of admission. Statistical Analysis: Continuous variables are presented as Mean ± standard deviation and Median (Q1, Q3). Qualitative variables are presented as frequency and percentage. The continuous variables were compared using independent t test, one-way analysis of variance or Kruskal–Wallis test. Receiver operating characteristic curves (ROC) were constructed to identify the predictability and best cut-offs of variables to differentiate moderate illness from severe–critical illness, severe illness from critical illness, and survivors from non-survivors. A two-tailed P value <0.05 was considered statistically significant. Results: We found a significant increase in CRP values in patients with critical illness in wave-1 and wave-2. The levels of CRP increased as the severity of disease progressed. The CRP had a sensitivity of 71.3% and specificity of 59.8% in critically ill patients in wave-1. In wave-2, the sensitivity of 70.10% and specificity of 56% in critically ill patients. In wave-3, the sensitivity of 75% and specificity of 20.3% in severely ill patients. This indicates that CRP can be used as a marker for disease progression. The Youden index J is 0.3978 and the association criterion is >1.85. Conclusion: CRP is a simple test that helps in initiating primary care. It indicates the severity of disease in COVID-19 infection. CRP can be used as a marker for disease progression and also indicates the severity of lung involvement.
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A study to evaluate the effect of the COVID-19 pandemic on the mental health of junior doctors of a Government Medical College in West Bengal p. 259
Shouvik Das, Arunima Chaudhuri, Parthasarathy Sinha, Daniel Saldanha
DOI:10.4103/mjdrdypu.mjdrdypu_467_22  
Background: The COVID-19 pandemic had posed huge challenges to junior doctors as they had to work as frontline health workers during this emergency. Objectives: To evaluate the mental health status of junior doctors during the present pandemic using Depression, Anxiety, Stress Scale-21 (DASS-21) and impact of even scale-revised (IES-R) scale scores. Methods and Participants: This longitudinal study was conducted over a time period of 8 months after taking Institutional Ethical Clearance and informed consent of 220 participants. This online survey was conducted using Google Forms and DASS-21 and IES-R scores were evaluated twice in an interval of 6 months. Results: Depression scores, anxiety scores, and stress scores were significantly increased on the second assessment. Gradation of depression, anxiety, and stress in month 1 among participants were as follows: Depression scores (normal; mild; moderate; severe; extremely severe): 82; 40; 52; 33; 13. Anxiety scores (normal; mild; moderate; severe; extremely severe): 113; 21; 55; 16; 15. Stress scores (normal; mild; moderate; severe; extremely severe): 137; 33; 41; 8; 1. ISE-R scores: <24 = 98; 24–32 = 39; 33–36 = 15; ≥37 = 68. Gradation of depression, anxiety, and stress in month 6 were the following: Depression scores (normal; mild; moderate; severe; extremely severe): 50; 19; 63; 26; 62. Anxiety scores (normal; mild; moderate; severe; extremely severe): 34; 5; 67; 25; 89. Stress scores (normal; mild; moderate; severe; extremely severe): 61; 12; 42; 38; 67. ISE-R Scores: <24 = 73; 24–32 = 34; 33–36 = 11; ≥37 = 102. Conclusions: Junior doctors working during the COVID-19 pandemic developed increased levels of stress, anxiety, and depression with the progression of the pandemic. They were the major frontline health workers to combat COVID-19 which may be the cause of their decreased psychological resilience resulting in mental health issues. Psychological counseling sessions can be used among these young doctors to build up their mental resilience.
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Breakthrough Sars-Cov-2 infection after Covid-19 vaccination – A retrospective observational clinico-epidemiological study from North-Western India p. 265
Shilpi Gupta, Shweta Singh Rathore, Umesh Kapoor, Ankush Gupta, Ved Prakash Mamoria
DOI:10.4103/mjdrdypu.mjdrdypu_541_22  
Introduction: Mass vaccination is considered one of the most crucial weapons in fighting against the ongoing COVID-19 pandemic. However, the occurrence of breakthrough infections (BTIs) has questioned the vaccine effectiveness of the currently available vaccines. The present study aimed to determine the breakthrough SARS-CoV-2 infections in the vaccinated population and to compare the clinic-epidemiological profile and outcomes between breakthrough cases and unvaccinated SARS-CoV-2 positive cases. Methods: This retrospective case-control study was conducted between April 15, 2021, and June 15, 2021, in a zonal military hospital in Jaipur. We evaluated individuals with BTI as cases which were SARS-CoV-2 positive after 14 days of the second dose of vaccine and unvaccinated SARS-CoV-2-positive individuals as control. The clinical and demographic data was collected from the Indian Council of Medical Research and specimen referral forms were filled out for all persons who had undergone testing for SARS-CoV-2. The outcome of positive cases in terms of discharge and deaths were collected from hospital records. Results: A total of 162 breakthrough COVID 19 infections and 925 unvaccinated positive confirmed controls were recorded within the study duration. The majority of cases presented with mild infection in both case (80.2%) and control groups (72.4%). The risk of hospitalization and occurrence of moderate to severe disease was 2.3 and 4 times more in the non-vaccinated group as compared to the vaccinated group, respectively. No mortality was reported among the breakthrough cases. Interpretation and Conclusions: Despite the occurrence of BTIs, the benefits of vaccines are far greater. Our findings suggest that vaccination is associated with a lower risk of hospital admission, severe disease, and mortality against COVID-19.
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Prevalence and risk factors of COVID-19 vaccine hesitancy among healthcare workers at a Tertiary Care Center: A cross-sectional study p. 271
Prashant R Kokiwar, Varun Vijay Gaiki
DOI:10.4103/mjdrdypu.mjdrdypu_450_22  
Background: Vaccine hesitancy is hesitancy to take vaccine. Studies are required to identify prevalence of coronavirus disease 2019 (COVID-19) vaccine hesitancy. It is equally important to recognize factors responsible for this hesitancy. This data will help to plan health education measures so that healthcare workers can overcome the barriers for vaccine hesitancy. Objective: The objective of this article is to study prevalence and factors associated with COVID-19 vaccine hesitancy among healthcare workers. Methods: This was a single-center, cross-sectional study carried out over a period of two months among 1063 healthcare workers. Those with missing information, not consenting and absent on the day of survey were excluded. Healthcare workers included doctors including postgraduates, nurses, para-medical staff, admin staff, and housekeeping staff either working in hospital or medical college. Results: Prevalence of vaccine hesitancy was 15.1%. On logistic regression, as age increased odds of vaccine hesitancy decreased significantly (OR = 0.95; 95%CI = 0.92-0.98; P < 0.05). Patient contact of <10/day was associated with the decreased odds of vaccine hesitancy compared to those with patient contact of >40/day. Odds of vaccine hesitancy among those with poor knowledge was 2.84 (95%CI = 1.91-4.21; P < 0.05) times more compared to those with good knowledge. Odds of vaccine hesitancy was 3.22 (95%CI = 1.09-9.48; P < 0.05) times and 3.31 (95%CI = 1.05-10.48; P < 0.05) times more among educated up to primary and illiterate respectively compared to higher educated persons. Conclusion: We conclude that low levels of education, poor knowledge, and young age were independently and significantly associated with vaccine hesitancy among healthcare workers. Prevalence of vaccine hesitancy was still high at 15.1%.
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Peripheral blood morphology and hemogram in COVID-19 patients correlates with disease severity: Insights from a Tertiary Care Center p. 278
Priyanka Mishra, Samir Agarwal, Preeti Patni, Sukant Pathak, Mandeep Kaur, Nidhin Rehman
DOI:10.4103/mjdrdypu.mjdrdypu_185_22  
Context: Coronavirus Disease 2019 (COVID-19) has profound hematopoietic manifestations reflected in complete blood count (CBC) parameters and peripheral blood morphology. Aims: We aimed to evaluate CBC and peripheral blood morphology in COVID-19 patients and correlated them with severity, progression, and mortality. Settings and Design: Prospective observational study. Methods and Materials: Baseline and sequential blood samples were collected in 197 hospitalized COVID-19 patients, and CBC and morphology were assessed and compared with severity, progression, and survival. Statistical Analysis Used: Independent samples t-test for parametric continuous and Chi-Square and Fisher Exact for categorical variables. Results: Of the 197 patients, 84 (42.6%) were non-severe and 113 (57.4%) severe. The severe group displayed higher mean Total leukocyte count (TLC) (mean 11,772/μL SD 5445 vs. mean 7872/μL SD 3789, P < 0.0001), neutrophils (mean 81.2% SD 17.01 vs. mean 59.8% SD 14.55, P < 0.0001), and Red Cell Distribution Width-Standard Deviation (RDW-SD) (mean 30.04 SD 17.1 vs. mean 16.95 SD 6.63, P < 0.0001) with lymphopenia (mean 12.86% SD 15.41 vs. mean 30.64% SD 13.23, P < 0.0001) and monocytopenia (mean 4.62% SD 3.56 vs. mean 7.23% SD 3.06, P < 0.0001). The severe group had significantly more pseudo Pelger-Huet (62.8% (71/113) vs. 22.9% (14/61), P < 0.0001), abnormal nuclear projections (27.4% (31/113) vs. 3.3% (2/61), P < 0.0001), elongated nucleoplasm (17.7% (20/113) vs. 3.3% (2/61), P = 0.0073), shift to left (100% (113/113) vs. 21.3% (13/61), P < 0.0001), prominent granules (100% (113/113) vs. 85.2% (52/61), P < 0.0001), cytoplasmic vacuolations (100% (113/113) vs. 50.8% (31/61), P < 0.0001), ring (8.3% (3/113) vs. 4.9% (3/61), P = 0.0117), fetoid (15.04% (17/113) vs. 1.6% (1/61), P = 0.039), and nucleolated forms (53.9% (61/113) vs. 21.3% (13/61), P < 0.0001) with red cell agglutination (8.8% (10/113) vs. 0% (0/61), P = 0.0154) than non-severe patients. The non-severe group showed lympho-plasmacytoid (98.4% (60/61) vs. 37.2% (42/113), P < 0.0001), monocytoid (96.7% (59/61) vs. 25.7% (29/113), P < 0.0001), apoptotic (100% (61/61) vs. 17.6% (20/113), P < 0.0001), and nucleolated lymphocytes (78.7% (48/61) vs. 5.3% (6/113), P < 0.0001) with prominent granules (80.3% (49/61) vs. 12.4% (14/113), P < 0.0001), cytoplasmic vacuolations (83.6% (51/61) vs. 30.1% (34/113), P < 0.0001), and plasma cells (45.9% (28/61) vs. 19.5% (22/113), P = 0.0004). The progressors (9/84) had baseline leukocytosis (TLC mean 15,889/cu mm SD 4163.96 vs. mean 6940.27/cu mm SD 2381.59, P < 0.0001) and lymphopenia (lymphocyte% mean 18.11% SD 10.75 vs. mean 32.1% SD 12.75, P = 0.0022) with elevated RDW-SD (P = 0.032) at 7th to 10th day of illness. The 14 non-survivors had significant thrombocytopenia (mean 63.35 × 103/μL SD 30.72 vs. mean 230.77 × 103/μL SD 98.77, P < 0.0001) with lymphocytes nadir at day 9 without recovery versus day 7 to 8 nadir before recovery in survivors. Conclusions: The peripheral blood morphological features are distinct in severe and non-severe COVID-19 patients and baseline leukocytosis, lymphopenia, and elevated RDW-SD at day 7 of illness are useful indicators of disease progression.
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Correlation between severe acute respiratory syndrome Coronavirus-2 and cytomegalovirus p. 286
Ahmed Danbous Obayes Al-Hussainy, Falah Hasan Obayes AL-Khikani, Aliaa Zaraa Allah Hussein, Rasha Salih Mahdi Alshamary
DOI:10.4103/mjdrdypu.mjdrdypu_433_22  
Background: Severe acute respiratory syndrome coronavirus-2 (SARS-CoV2), which causes the novel betacoronavirus 2019 disease (COVID-19), has become the first global pandemic in 100 years. Cytomegalovirus (CMV) is a prevalent herpesvirus that affects 40%–70% of the general population. This study aimed to see how CMV affected the presentation of COVID-19 infections as a prospective risk factor. Material and Methods: This study was conducted in Babylon, Iraq, from January to March, 2022. A total of 120 people were engaged in this study divided into four groups: mild, moderate, severe, and control group, 30 individuals in each group. Ninety patients identified with SARS-CoV-2 by PCR testing and 30 people serving as a control group. IgG antibody titer in blood samples were detected by mini vidas biomerieux. The samples were processed with the complete blood count (CBC) and ABO blood group. Independent T and Chi-square tests were used to examine the data using SPSS 21 software. Results: COVID-19 infection was more frequent in females than males. The COVID-19 patients were detected to have increased white blood cell count (p < 0.0001) and decreased lymphocytes compared to the healthy persons (p < 0.0001). No significant correlation between CMV and COVID-19 was discovered. CMV titer was not associated with disease severity. Blood group A is the most predominant type in patients compared to healthy persons. Conclusion: This study revealed no significant correlation between the severity of COVID-19 and CMV in spite of slightly increased in severe patients at mean 66.53 compared to the control group 58.80 (p = 0.26). Reactivation of CMV in COVID-19 patients may be associated with complications, so more attention should be taken into consideration regarding this virus, especially in severe patients.
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A study on correlation of hematological parameters with computed tomography severity score in COVID-19 patients in a Tertiary Care Center p. 291
Jayanthi Chandran, Umamageswari Amirthalingam, S Abinizha, R Sindhuri
DOI:10.4103/mjdrdypu.mjdrdypu_874_21  
Background: COVID-19 is a rapidly spreading infectious pandemic. Increase in the level of systemic inflammatory markers is known to play fugitive role in the prognosis of the patients. This study retrospectively correlates the various hematological parameters with computed tomography severity score in COVID-19 patients. Method: The demographic, hematological, and radiological parameters of 150 patients were collected and analyzed. The performance of complete blood count (CBC) indexes for monitoring and predicting the severity of COVID-19 in patients was evaluated by analyzing and comparing CBC results with radiological severity score. Results: Neutrophil lymphocyte ratio (NLR) and platelet lymphocyte ratio (PLR) correlated positively while lymphocyte correlated negatively with chest computed tomography severity score. Neutrophil, lymphocyte, eosinophil, monocyte, NLR, and PLR showed a significant difference between radiologically mild and severe COVID-19 cases (P < 0.05). Conclusion: The prognostic value of NLR in predicting the severity of illness is well established in our study. Increased NLR should prompt the clinicians to predict increased lung involvement by COVID-19 and should cater the treatment accordingly.
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A study on psychological distress among pregnant women during COVID-19 pandemic in a rural area of West Bengal p. 297
Biswadip Chattopadhyay, Bobby Paul, Lina Bandyopadhyay, Madhumita Bhattacharyya, Pritam Ghosh, Ankush Banerjee
DOI:10.4103/mjdrdypu.mjdrdypu_830_21  
Background and Objectives: Pregnancy, an altered physiological state, is specifically vulnerable to psychological distress (PD), more so during the coronavirus disease 2019 (COVID-19) pandemic. This can impart detrimental consequences to both mother and child. This study assessed the magnitude of PD and associated factors among pregnant women in rural West Bengal. The proportion of pregnant women with COVID-19 symptomatology and its relationship with PD was also determined. Methods: This cross-sectional study was done among 130 pregnant women availing antenatal care in health centers during August–October 2020. Patient Health Questionnaire (PHQ-4) was used to assess PD and a “Perception on COVID-19 Pandemic” (PCP) Scale was used to assess the perception of the COVID-19 pandemic (Cronbach's alpha = 0.75). Statistical analyses were done in SPSS Inc., SPSS for Windows, Chicago, USA. Results: The proportion of study participants with PD was 49.2%. Unsatisfactory antenatal care (AOR = 19.4, CI = 2.5-152.7), COVID-19 case within family/neighborhood (AOR = 6.3, CI = 1.2-34.9), strenuous spousal relationship (AOR = 7.3, CI = 1.1-50), increasing score in perceived susceptibility domain of PCP Scale (AOR = 1.3, CI = 1.1-1.6), and decreased daily sleep duration (AOR = 2.8, CI = 1.6-4.9) were found to be associated with PD. 38.5% of participants reported COVID-19 related symptoms. Conclusion: The magnitude of PD among pregnant women in the study area is high. Thus, proper counseling of pregnant mothers during antenatal visits by public health nursing personnel to alleviate fears about the pandemic would go a long way to reduce the negative impact of PD on mother and child.
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Evaluation of stress score and correlation of stress score with heart rate, blood pressure and serum cortisol levels among health care workers in DCH and DCHC hospitals during Covid-19 duty Highly accessed article p. 306
Sanjay Wasnik, Jagdish Hundekari, Rahul Mittal, Lokendra S Kot
DOI:10.4103/mjdrdypu.mjdrdypu_75_22  
Introduction: In the basic setting of the Coronavirus pandemic, medical care workers are at the forefront, participating directly in the consideration, determination, and therapy of patients with Coronavirus from the last two years. This exposes them to a higher danger of creating ongoing pressure, mental misery, and some other psychological wellness side effects. Objective: To evaluate stress, serum cortisol level, and blood pressure in a health workers population and, in addition, to measure serum cortisol concentration as a current biomarker of stress. Materials and Methods: Sixty health workers (22 men & 38 women) from Dedicated Covid Hospital and Dedicated Covid health Centre were included in this study. In these participants, after obtaining the data of socio-demography and perceived stress, serum cortisol was measured by automated chemiluminescent method. This is a hospital-based cross-sectional study. The studied population was divided into two groups: Group A (workers in direct contact with Covid patients) and Group B (workers not in direct contact with patients). Stress scores, serum morning cortisol levels, systolic and diastolic BP and heart rate of all the participants were measured and compared with controls using a Student's t-test. Stress scores of HCW in direct contact with patients were correlated with heart rate, systolic and diastolic BP, and serum morning cortisol levels and Pearson correlation coefficient (r) were calculated. Results: Stress scores are significantly increased whereas serum morning cortisol levels, heart rate and systolic and diastolic BP were non-significantly increased in Group A as compared with controls that is, Group B (P < 0.05). Stress scores of HCW in direct contact with patients were found to correlate strongly with serum morning cortisol levels, heart rate and systolic and diastolic BP with r values 0.397 (P < 0.0001), 0.322 (P < 0.001), 0.717 (P < 0.001), and 0.810 (P < 0.0001), respectively. Conclusion: Stress scores were elevated in HCW in direct contact with patients and were strongly correlated with serum cortisol levels, heart rate, and BP. It is the responsibility of the health authorities to implement strategies to manage this psychological stress.
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Maternal and perinatal outcome in Covid-19 complicated pregnancies in a Level-3 Covid facility of North India Highly accessed article p. 311
Neelima Agarwal, Manisha Gupta, Alpana Agrawal
DOI:10.4103/mjdrdypu.mjdrdypu_846_21  
Background: Due to its physiologic immune suppression, pregnancy is a vulnerable time for severe respiratory infections including COVID-19. However, information regarding the effect of COVID-19 during pregnancy is limited. Objectives: To study the clinical profile of patients suffering from coronavirus disease-2019 (COVID-19) during pregnancy and to evaluate the effect of COVID-19 on maternal, perinatal, and neonatal outcomes. Methodology: This is a cross-sectional observational study over a period of one year from June 2020 to May 2021, in Level-3 Covid facility in Ghaziabad. All pregnant females with confirmed positive for Corona virus infection admitted to the covid ward under the department of Obstetrics & Gynecology were included in the study. Results: A total of 233 pregnant women were included in the study. Maximum patients were from age group 21-30 years (53.2), multigravida (62.7%), and presented in the third trimester (80.7%). On admission, 198 patients (85%) had no covid related symptoms and only three patients had severe symptoms requiring ICU care. Total 102 patients delivered (43.77%), out of whom 40 had a normal vaginal delivery and 62 had a cesarean section. The incidence of preterm birth was 22.5% and maternal death was in three patients (1.3%). Conclusion: The common presentation of COVID-19 during pregnancy is either a mild disease or even asymptomatic. The maternal outcomes observed in late pregnancy and fetal and neonatal outcomes appear good in most cases. Further studies are required to know long-term outcomes and potential intrauterine vertical transmission.
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Study of clinical features, laboratory and radiological findings, morbidity, and mortality in COVID-19 patients with controlled and uncontrolled diabetes mellitus Highly accessed article p. 317
Prashant Gopal, Pradnya Diggikar, Nelabhotla Sai Satya Saranya
DOI:10.4103/mjdrdypu.mjdrdypu_753_21  
Introduction: Coronavirus disease 19 (COVID-19) is a pandemic caused by a novel coronavirus, the Severe Acute Respiratory Syndrome Coronavirus 2. Diabetes and its complications are major causes of morbidity and mortality. Patients with uncontrolled diabetes may be associated with poorer outcomes as compared with patients with good glycemic control. Methodology: A total of 120 patients with type 2 diabetes mellitus with COVID-19 were taken from a tertiary care center in Pune, Maharashtra, and included in the study following their voluntary informed consent. Results: It was observed that patients with poor glycemic control had a greater prevalence of symptoms including fever (64.9% vs 55.4%), cough (51.3% vs 42.2%), and dyspnoea (40.5% vs 27.7%). C-reactive protein (9.40 vs 5.66), D-dimer (668.2 vs 457.9), and ferritin levels (352 vs 238) were observed to be greater in patients with poor glycemic control. Chest X-Ray changes (45.9% vs 17.2%) and CT severity score (9.32 vs 5.79) were significantly greater in patients with poor glycemic control. Patients with poor glycemic control also had an increased incidence of O2 requirement, increased mortality, and a longer duration of hospital stay. Poor glycemic control was also associated with an increased incidence of complications like acute respiratory distress syndrome (35.1% vs 18.0%), sepsis with or without septic shock (18.9% vs 9.6%), acute coronary syndrome (13.5% vs 8.4%), acute kidney injury (18.9% vs 3.6%), acute hepatic injury (13.5% vs 2.4%), and other complications like diabetic ketoacidosis, pulmonary thromboembolism, and cerebrovascular accident (10.8% vs 6.0%).Conclusion: On the basis of our findings, we concluded that patients with poor glycemic control were associated with poorer outcomes and increased complications.
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COVID-19 knowledge, attitudes and practices survey among population of Western Maharashtra p. 325
B Thomas Asha, K Vaidya Bhalchandra, R Chandani Sneha, Kawade Anand, S Chitlange Sohan, S Sarode Varsha, Arya Manish, Sharma Dharmendra
DOI:10.4103/mjdrdypu.mjdrdypu_914_21  
Background: In wake of COVID-19 pandemic in India, basic knowledge of mode of transmission of the disease, precautionary hygiene practices to be adopted to contain the infection and specific dietary modifications to be made as per government advisories are critical from public health and safety viewpoint. Objective: The objective is to find out the perception of population in Maharashtra state, India with specific emphasis on their knowledge, attitudes, and practices (KAP) during the pandemic. Methods: KAP was assessed through a systematic survey employing a structured questionnaire and was carried out through online-platform among the Indian population in Maharashtra state. The questionnaire was designed as per WHO guidelines. Data were collected from 1770 respondents across Maharashtra state, India from April 1, 2021, to April 30, 2021. Data were systematically analyzed using correlation and ordinal logistic regression models. Results: Data collected from 1648 participants across Maharashtra state indicated that 82.9% of respondents had high level of knowledge about the disease. However, it alarming to observe that 78.7% of respondents still demonstrated low COVID-19 related practices score. The pandemic also affected the psychological well-being of 81% of respondents; with major socio-economic implications (55%). The regression analysis showed that female participants displayed higher knowledge than males. Also, educational qualification had an impact on practices-1 (general) while both gender and educational qualification affected practices-2 (COVID-19 related). Conclusion: Findings of this KAP survey demonstrated good knowledge of the average population but relatively lower levels of attitudes and practices toward the pandemic. This highlights the need of training/counseling programs that can impart positive attitudes and improved practices to Indian citizens to fight the COVID-19 pandemic.
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A longitudinal study to estimate adverse events following two doses of COVID-19 vaccination Highly accessed article p. 334
Saurabh Bobdey, Rajesh Sahu, Arun Kumar Yadav, SK Kaushik, KS Sreekanth, Niharika Nagari, Kunal Koundinya
DOI:10.4103/mjdrdypu.mjdrdypu_722_21  
Background: On March 30, 2020, coronavirus disease 19 was declared pandemic and many countries of the world started working on the development of vaccine soon after China released the genetic structure of severe acute respiratory syndrome coronavirus 2. Drugs Controller General of India on January 3, 2021, accorded emergency use authorization to Oxford-AstraZeneca's ChAdOx1 nCoV-19 vaccine and vaccination drive commenced in India on January 16, 2021. The present study was conducted to determine the incidence adverse event following immunization (AEFI) among recipients of the first and second dose of the vaccine. Materials and Methods: A longitudinal descriptive study was conducted among 2529 vaccine beneficiaries who were asked about the side effects at 24 and 72 h after the first dose and second dose of vaccination with ChAdOx1 nCoV-19 vaccine. Passive surveillance was also done for 4 months. Results: AEFI was reported in 27.59%, 38.4%, and 19.96% of vaccines after both doses, first dose, and second dose, respectively. 14% did not report any AEFI with either dose of vaccine. Younger people had higher rates of AEFIs with both the doses. Pain at injection site and fever <102°F were the most common symptoms. Only three patients required admission after first dose and nil required admission after second dose, all three were discharged after 24 h observation without any complication or sequelae. Conclusion: The results of our study indicate that the vaccine has good safety profile and is recommended for use among 18–60 years. However, since majority of individuals in our study were young, studies may be undertaken in more than 60 years of age, persons with a history of allergy, and comorbidities to further evaluate safety profile of the vaccine among these groups of people.
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Clinical profile of SARS-CoV-2 infection-associated pediatric Multisystem Inflammatory Syndrome (MIS-C): A case series from Western Maharashtra p. 339
Vipulkumar V Gandhi, Sandeep Kavade, Shankar Gore, Komal Chopra
DOI:10.4103/mjdrdypu.mjdrdypu_353_22  
Background and Objectives: Multisystem inflammatory syndrome (MIS-C) is a SARS-COV-2 infection-associated dreaded clinical sequelae in pediatric patients. Its epidemiology is complex and differs from severe acute COVID-19 infection in children. The present case-series report describes the various clinical features, laboratory markers, and interventions among 222 pediatric patients from one of the states in India with the highest prevalence of COVID-19 infection. Methods: An observational study was conducted at one of the tertiary healthcare institutes in the western region of Maharashtra state of India. Twenty-two children were hospitalized with diagnosed MIS-C, aged from 2 months to 18 years, from January to June 2021. Demographic and clinical characteristics and diagnostic and treatment parameters were collected from each subject. Statistical Package for Social Sciences version 21 software was used as a data analysis tool. Results: Clinical assessment revealed high-grade fever, non-purulent conjunctivitis, and abdominal complaints, which were the leading presentations of MIS-C. In inflammatory markers, serum IL-6 levels and D-dimer levels took a longer duration for normalization in the severe MIS-C group. Almost half of the mild–moderate MIS-C patients were managed with only systemic corticosteroids. All remaining patients recovered with the dual therapy of intravenous immunoglobulins (2 g/kg) and systemic corticosteroids with an improved clinical and biological response. Conclusions: The present clinical case-series report concluded that almost all MIS-C cases have a favorable prognosis with dual therapy of corticosteroids and immunoglobulins. With the principle of early diagnosis and prompt treatment, it is possible to manage patients without any critical support. However, long-term follow-up studies of these cases are warranted to validate the clinical approach.
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CASE REPORTS Top

Acute onset bilateral ptosis in an asymptomatic COVID patient p. 345
Kathyayini Vijayalekshmi Revivarman, Arun Kumar Krishnan, KP Gireeshkumar, TP Sreekrishnan, Manna Maria
DOI:10.4103/mjdrdypu.mjdrdypu_423_21  
Sixty-five-year old man, known hypertensive with previous history of cerebrovascular accident presented to the Emergency Department with complaints of acute onset ptosis for the last 7 h. Onset of ptosis was sudden and was not associated with waxing and waning of symptoms. Examination revealed bilateral ptosis with no other neurological deficits. Differentials of acute cerebrovascular accident, myasthenia, and neurotoxic envenomation were considered. Magnetic resonance imaging stroke protocol was done which revealed an acute mid brain infarct. Real-time polymerized chain reaction test for corona virus disease 19 (COVID-19) done in view of the pandemic situation was positive. Acute onset bilateral ptosis is an infrequent presentation to any emergency room. Prompt diagnosis and evaluation of the various differentials is of utmost significance in improving the patient outcome. Ptosis occurs due to paresis of levator palpebrae superioris (LPS) and Mullers muscle. In this patient, isolated ptosis with papillary sparing probably occurs due to the involvement of caudal sub nucleus of oculomotor nucleus. Ischemic events especially stroke is emerging as complication of COVID-19. COVID-19 is associated with hypercoagulopathy and the elevation of d-dimer and fibrinogen, leading to potential complications like acute stroke. COVID-19 infection may not always present with the typical respiratory symptoms and atypical presentations are incrementing. However, the patient had risk factors for stroke and a causal relationship with coronavirus infection remains conjectural.
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Post-covid Multisystem Inflammatory Syndrome in children (Mis-C) with rare gastrointestinal ramifications: Case reports from a Tertiary Care Hospital in Eastern India p. 348
Sanjay Kumar Sahu, Soumya Ranjan Mohapatra, Sushant Kumar Das, Ravi Kumar, Nirmal Kumar Mohakud
DOI:10.4103/mjdrdypu.mjdrdypu_320_22  
Children with prior coronavirus disease 2019 (COVID-19) infection display an increased systemic inflammation causing multiorgan dysfunctions in the cardiovascular, respiratory, central nervous system, and gastrointestinal (GI) systems, known as MIS-C, that is, multisystem inflammatory syndrome in children. Most of the MIS-C cases have GI manifestations like pain abdomen, loose motion, vomiting or nausea, elevated liver enzymes, ileus, and bleeding. Angiotensin-converting enzyme 2 (ACE2) receptors in the terminal ileum and colon are responsible for the majority of ACE2-induced damage to these tissues. In the pandemic's second wave, a significant number of MIS-C patients with predominantly GI symptoms (around 80%) were reported. Although different molecular inflammatory mechanisms are involved, there is a significant overlap of the children's GI symptoms with those of MIS-C and other conditions of the abdomen caused by infection or inflammation, thus resulting in a diagnostic dilemma. Here, we report two cases of MIS-C with acute appendicular perforation and ileal perforation needing both medical management and surgical intervention.
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SHORT COMMUNICATIONS Top

How much can we rely on a scrambled COVID-19 vaccine? It is not the only way out! p. 353
Nikunja Kumar Das, S Prasanna, Priyanka Pandit, Vaibhav Laxmikant Dudhat
DOI:10.4103/mjdrdypu.mjdrdypu_591_20  
The COVID-19 pandemic has engulfed the world in the blink of an eye and created a state of panic. Vaccine is one of the suggested ways to counter the menace. Smallpox was an ideal vaccine candidate yet, it took about 182 years to eradicate. Vaccines are associated with incidents of mishap like the “Cutter incident”. COVID-19 vaccine has a political, commercial angle to it, with at least 62 vaccine candidates in the pipeline. Potential obstacles in development of vaccines are mutations in strains of SARS-CoV-2, lack of details of biological properties of the virus and incomplete information of pathogenicity, lack of suitable animal models. The potential side effects of the vaccine are eosinophilic infiltration, increased infectivity following challenge infections, antibody-dependent enhancement of infections. The general public has to stop anticipating that a vaccine is nearby and believe that for now, vaccine is face mask, hand wash, and social distancing and hope that either the virus goes weak or an effective vaccine arrives rather early than late.
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Computed Tomography Severity Index in nCovid19 Pneumonia: Clinicians Perspective p. 356
M Vishnu Sharma
DOI:10.4103/mjdrdypu.mjdrdypu_510_21  
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LETTERS TO THE EDITOR Top

CORONA Pandemic p. 358
Jyotsna Satish Paranjpe
DOI:10.4103/mjdrdypu.mjdrdypu_459_20  
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Conduct of online classes for medical curriculum during the COVID-19 lockdown: Our first-hand experience Highly accessed article p. 359
Nikunja Kumar Das, Shahzad Mirza, Rajashri Amar Patil, Rabindra N Misra
DOI:10.4103/2589-8302.337617  
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Coronavirus outbreak, traditional medicines, and interpathy research p. 361
Ajay Gavkare, Sachin Mumbre, Abhijit Rayate, Basavraj Nagoba
DOI:10.4103/mjdrdypu.mjdrdypu_176_21  
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Coronavirus Lexicon p. 363
Harish Gupta
DOI:10.4103/mjdrdypu.mjdrdypu_991_21  
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Barotrauma in COVID pneumonia: Our observations and clinical implications p. 365
Vishnu Sharma Moleyar
DOI:0.4103/mjdrdypu.mjdrdypu_363_21  
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