Background: Pandemics harm mental health by inducing stressors such as frustration, boredom, financial loss, self-isolation, fear of infection, and stigmatization. Students are vulnerable and at risk of ill effects of these stressors. Aim: The objective of this study was to determine the mental health status and associated social risk factors among dental students in Malaysia during the coronavirus disease 2019 pandemic. Materials and Methods: This was an online cross-sectional study done using the Depression Anxiety Stress Scale-21 questionnaire. The study was carried among the undergraduate dental students in Malaysia, during the period of compulsory self-quarantine. The prevalence of depression, anxiety, and stress (DAS) and their median scores were computed and analyzed with sociodemographic factors using Mann–Whitney U test, Kruskal–Wallis test, odds ratio, and Chi-square test. Results: The prevalence of DAS was 33.5%, 28.7%, and 7.3%, respectively, with no gender differences. Depression increased with increasing age (P = 0.043) and year of study (P = 0.015). The prevalence of depression was the highest in the students of Indian ethnicity (44%; P = 0. 018). Students from public universities reported a higher prevalence of anxiety (34%; P = 0.019) and stress scores (P = 0.013). A family's financial crisis increased the risk of DAS (P < 0.05). Being quarantined with family increased the odds of anxiety by 2.8 times (P < 0.05). Conclusion: Students were found to be vulnerable to the negative psychological impact of self-quarantine as measured by their mental health status. The study also identified demographic and social risk factors contributing toward this vulnerability.

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Background: Continuing Medical education during the COVID-19 Pandemic has been a great challenge to Medical educators, especially teaching clinical skills online. Aims: The study aims too study the efficacy of teaching ECG in online mode to first MBBS students in the Department of Physiology. Materials and Methods: There are 200 students in the first MBBS batch at Burdwan Medical College. Our method of teaching was flipped classroom-assisted self-directed learning. For teaching ECG to our students we had first arranged for presession MCQ to assess the initial level of knowledge. We had then provided the students with PowerPoint presentations with voice narrations for their self-study, following which the students were divided into batches of twenty and each batch had a team leader and a facilitator. These small batches were shown videos of instruments, methods of recording ECG, normal and abnormal ECG along with explanations in multiple sessions (10). Doubt clearing sessions were arranged for each batch and these sessions were brainstorming. The students were assessed with MCQs (10 marks each Session), oral questions, short answer type questions, spots, and problem-based questions. We also took a feedback survey from the students and provided the students with feedback regarding their performance. Results: MCQ assessments of students in Pre and Posttest session on ECG teaching classes were 50.39 ± 19.41 vs. 65.25 ± 9.14; P ≤ 0.001**. Students performed significantly better in MCQ assessments of students on Normal parameters of ECG assessment as compared to Abnormal ECG parameters: 67.25 ± 10.98 vs. 63.157 ± 7.399; P = 0.000424**. Results of Written Examination and Viva Examination of students in ECG classes were 64.844 ± 9.923 vs. 71.89 ± 10.49; P ≤ 0.001**. Conclusions: The online method of teaching ECG was a success in the institution as observed in this study as observed in the assessment. Students performed better in viva in online exam for ECG and students were satisfied with online delivery.

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Background: Health-care workers at all levels are putting their best efforts to contain the COVID-19 pandemic. In resource-poor country like India, the community health workers are given primary responsibility for prevention and control measures at the village level. Learning from their experiences and addressing constraints will ensure improved service delivery in the face of further waves of pandemic. Aim: The aim of the study is to explore the field level experiences of Accredited Social Health Activists (ASHAs), working in Bhatar block of Purba Bardhaman district, West Bengal, while delivering COVID-19 response services and to elicit the nature of constraints faced by them. Materials and Methods: This was a qualitative study with phenomenological approach conducted among ASHA workers from December 2020 to January 2021. Convenient sampling was done to select 8 participants for data collection by focused group discussion (FGD) using FGD guide. A total of four FGDs with 32 participants were conducted. Data were analyzed using thematic framework approach to identify codes and themes. Results: The experiences are presented under five broad themes and in subthemes. ASHAs were engaged in extensive work amidst various challenges, though they received ample support and cooperation from society and general administration. ASHAs faced issues with inadequate supply of protective equipment and were in need for refresher trainings. Events of social stigma and ostracizations had also surfaced. Limited financial incentives, increased susceptibility to COVID-19, and detachment from family were the main source of stress among ASHAs. Conclusion: The issues identified in this study can be addressed to further utilize ASHAs in delivering services in pandemic context.

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Background: Medical students are already under extreme academic pressure which causes disruption in their sleep patterns. Due to the COVID-19 pandemic, though they have been relieved of their hectic schedules this has also led to complete lack of hands-on training and bedside clinical teaching which might have given rise to increased anxiety in this population. Aims: To assess the sleeping pattern and determinants of poor sleep quality among medical students during the COVID-19 pandemic. Materials and Methods: A cross-sectional study was conducted among 343 undergraduate medical students of a tertiary care teaching hospital from August 17, 2020, to September 17, 2020, via an online questionnaire containing questions on sociodemographic parameters, lifestyle factors, Pittsburgh Sleep Quality Index, COVID-19-related stress and academic delay-related stress. Statistical Analysis: Analysis was done with the Statistical Package for the Social Sciences (SPSS) Version 20.0. Results: About 52.47% had a poor sleep quality; 92.4% had a high level of academic uncertainty-related stress and 64.7% experienced a high level of COVID-19-related stress. Significant association was found between Poor Sleep Quality (PSQI score) and urban residence, nuclear family, smoking, excessive caffeine consumption, and high levels of COVID-19 stress. Conclusion: Although poor sleepers had decreased in number from before the COVID-19 pandemic, they were still much higher than the general population. This might be due to high levels of academic delay-related stress present virtually in the entire population. This can be circumvented by proper counseling of the students and sensitive planning of the academic activities once the pandemic will over.

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The coronavirus disease-2019 outbreak in the Wuhan city of China has been declared as a public health emergency of international concern and as a pandemic, and it is a marker that the caseload of the disease is increasing at a rapid pace. It has been recommended that the suspect cases need to be isolated and monitored in healthcare establishments, keeping in mind the quality of care and security of the general population. However, in special circumstances such as lack of isolation wards or lack of infrastructure/human resources to provide healthcare or even in situations, wherein the existing hospitals refuse admission of suspects due to their own limitations, it becomes quite essential to think about home-based management. However, such a decision should be taken only after thorough clinical evaluation, after thorough assessment of the safety of the home environment, and after healthcare personnel is assigned the responsibility to act as a bridge between hospital and home care till the patient completely recovers. In conclusion, provision of home-based care for asymptomatic contacts or potential suspect with mild symptoms is a crucial domain in settings with limited healthcare infrastructure. However, considering the magnitude of the cases and lack of preparedness, it becomes very much essential to strengthen home-based care.

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The coronavirus disease-2019 (COVID-19) outbreak, which was first detected in the Wuhan city of China has been considered eligible to meet the requirements of the Public Health Emergency of International Concern. It is a fact that healthcare workers constitute the first line of defense against the infection and are involved in patient care related activities by compromising their own safety and quality of life. The current available disease trends neither indicate about the extent of the infection in hospital settings nor about the potential risk factors among health workers. In an attempt to bridge this gap, a protocol has been formulated to assess the extent of the infection and the risk factors which can facilitate the acquisition of the infection. Further, based on the proposed protocol, we can get vital insights about transmissibility and routes of transmission by periodically analyzing laboratory specimens as a part of follow-up. In conclusion, health workers are at the forefront in containing the COVID-19 outbreak amidst all uncertainty and thus it is our responsibility to adopt a standard protocol not only to safeguard them, but also simultaneously generate adequate evidence for better prevention and control of the disease.

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Introduction: COVID-19 is a global pandemic that has led to crisis in the supply of essential goods and services and personal protective equipments including face masks. Aim: The aim of the study is to compare Adi's five-layered cotton face masks with N95 masks and surgical face masks with regard to cost and efficacy. Materials and Methods: After IEC approval, a sample size of 10 was randomly selected. In a closed chamber made up of glass, three plates of blood agar, chocolate agar, and MacConkey Agar (MCA) were kept and at four different times, first without mask (Group D), second with N95 mask (Group N), third with surgical mask (Group S), and finally with Adi's face mask (Group A). Participants at first coughed three times then sang for 3 min and finally spoke for 2 min for each group. Plates were observed for growth after 24 h. Inclusion Criteria: Age 18–40 years of either sex, with no comorbidities. Exclusion Criteria: Anyone having cough, cold, or fever. Results: Group A (Adi's face mask with filter) showed no growth all ten times, Group N (N95 Mask) showed no growth of colonies four times, and one colony growth six times. As far as Group D (Direct speech without mask) is concerned, it showed multiple colonies all ten times and Group S (Surgical mask) showed one colony growth all ten times. Conclusion: Adi's mask is almost equivalent to wearing an N95 mask. It is easy to use, innovative, simple, scientific, and cost-effective.

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Background: Severe acute respiratory illness caused by SARS-CoV-2 has been a health emergency of great concern in the year 2020. This study was undertaken to identify characteristics of hospitalized patients with Coronavirus Disease 19 (COVID-19) and hypoxia in the form of disease course and outcome with special reference to the presence or absence of comorbidities. Materials and Methods: A prospective observational study was conducted at a tertiary hospital recognized as Dedicated COVID Hospital during the period of June 2020 to September 2020. The study included a total of 249 patients of COVID-19 with hypoxia who required oxygen or noninvasive ventilation/invasive ventilation. Patients were divided into two groups as per the presence or absence of comorbidity (175 and 74 patients, respectively). Their clinical and laboratory findings, course in the hospital, and outcomes were noted. Data were analyzed using SPSS software. Results: Among all the study patients, more patients from comorbidity group presented with a N:L ratio >3.5 and raised inflammatory markers (like serum ferritin) than patients in the no comorbidity group. In patients with comorbidities, 47.43% required noninvasive or invasive ventilation as against 18.92% in those without any comorbidities. Development of deranged renal function was noted in 32.57% of patients in the comorbidity group and only 9.46% in the noncomorbid group. All except one death during the study period were in the patients with comorbidities. Conclusion: COVID-19 patients with hypoxia and the presence of comorbidities in this study had more complications and a worse outcome.

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Rapid antigen test has a very important value as one of tools to address the Covid pandemic. Though this test is not as accurate as polymerase chain reaction (PCR) testing. As viral antigen appears before antibody formation in infected person. It is a specific marker of virus. Therefore, for detection of this highly infectious disease at an early stage, viral antigen testing can be a useful strategy in scenario of community transmission to prevent further spread. In India an advisory was issued by ICMR (on 14th June 2020) regarding usage of RAT for quick detection of COVID-19 positive patients. During second wave, Rapid antigen testing was advised only in symptomatic individuals and immediate contacts of laboratory confirmed positive cases. Though no test is perfect when it comes to the attributes of accuracy, accessibility, affordability, and timeliness of results. However, Rapid antigen test can be used as a useful test in public health that can benefit the larger population in breaking the chain of transmission if used wisely in different settings and according to the timeline of symptoms.

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COVID-19 is an important coronavirus infection. The detection of SARS-CoV-2-specific antibodies is important in laboratory medicine. Several serological tests are available. Some serological tests such as ELISA IgG versus CMIA IgG are used as standard references for rapid diagnostic immunoassay. Here, the authors reappraised on the diagnostic property of ELISA IgG versus CMIA IgG for the detection of SARS-CoV-2-specific antibodies in COVID-19 patients. According to the analysis, CMIA IgG has a higher sensitivity and ELISA IgG has a higher specificity. Therefore, CMIA IgG is more appropriate for screening purpose.

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Classical high-resolution computed tomography (HRCT) pattern in nCOVID-19 pneumonia is bilateral, basal, peripheral, subpleural, bronchopneumonia. Ground-glass opacities and consolidation are the most common initial radiological findings. However, chest computed tomography (CT) should not be used as an independent diagnostic tool to exclude or confirm COVID-19. CT is not a standard diagnostic tool for the diagnosis of COVID-19, but CT findings help to suggest the diagnosis in the appropriate setting. Chest CT findings should be correlated with epidemiologic history, clinical presentation, and reverse transcriptase–polymerase chain reaction (RT-PCR) test results. Many other diseases can mimic nCOVID-19 in HRCT and vice versa. We report an atypical radiological feature in RT-PCR-confirmed nCOVID-19 pneumonia case. HRCT showed unilateral peripheral ground-glass opacity. Atypical HRCT features in nCOVID-19 described in literature include central involvement, peribronchovascular involvement, isolated upper lobe involvement, nodular opacities, lobar consolidation, solitary opacity, unilateral lung involvement, mediastinal adenopathy, cavitory lesions, pleural and pericardial effusion, and subpleural sparing. When radiological manifestations are atypical, diagnosis of nCOVID-19 pneumonia should be by exclusion of other causes for the radiological abnormality.

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Aim: The aim of the study was to correlate environmental changes with coronavirus disease 2019 (COVID-19) cases in four metropolitan cities. Methodology: Data on monthly cumulative new cases, monthly average temperatures, humidity, precipitation, and average monthly air quality index (AQI) levels for the four Indian cities – Chennai, New Delhi, Mumbai, and Kolkata, and biomedical waste (BMW) quantity at national level were abstracted for the period from March 2020 to December 2020. Results: An inverse correlation was observed between temperature and transmission of the disease in New Delhi and Kolkata which was of fair degree for New Delhi (r = 0.299, P = 0.402) and poor for Kolkata (r = 0.200, P value = 0.579). Positive correlation of fair and poor degrees was observed between temperature and transmission of the disease in Mumbai (r = 0.272, P = 0.448) and Chennai (r = 0.196, P = 0.588), respectively. A positive correlation was observed between the transmission of the disease and humidity in New Delhi, Mumbai, and Kolkata, which was of moderate-to-good degree for Mumbai (r = 0.729, P = 0.017) and poor for New Delhi (r = 0.242, P = 0.501) and Kolkata (r = 0.123, P = 0.735). A significant positive correlation was observed between the rise in COVID-19 cases and the quantity of BMW generated (r = 0.88, P = 0.009). Furthermore, significant improvement in air quality AQI in four metros and water quality biological oxygen demand/chemical oxygen demand of Yamuna river was observed. Conclusions: Understanding of the interplay of environmental meteorological factors on COVID-19 disease transmission and vice versa is necessary for better informed policy framing and future research.

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The novel coronavirus disease 2019 (COVID-19) is highly contagious and rapidly spreading all over the world. COVID-19 patients might present with higher susceptibility to fungal co-infection. Mucormycosis is a life-threatening fungal disease characterized by vascular invasion by hyphae, leading to thrombosis and necrosis. Currently, COVID-19–associated mucormycosis (CAM) is creating a threat to patient's life in the community and is considered a fatal clinical entity in the Indian subcontinent. Mucormycosis is emerging as a matter of concern in COVID-19 patients with poorly controlled diabetes mellitus and other comorbidities as risk factors. Here, a 48-year-old man previously admitted to the COVID hospital due to severe acute respiratory syndrome coronavirus 2 infection presented with foreign body sensation and was later diagnosed with primary mucormycosis at the palatine tonsils. Early diagnosis and prompt treatment with surgery followed by liposomal amphotericin B are essential for the successful management of the CAM.

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Context: The COVID-19 pandemic burdened the healthcare systems and led to unprecedented impact leading to global economic crisis. In India, the vaccines given emergency use authorization for restricted use were Covishield and Covaxin. The majority of the known adverse effects of COVID vaccine were reported to be mild but there are some serious and severe adverse events reported in COVID-19 vaccine trials including deaths. Aim: To make estimates of the adverse events following immunization (AEFI) burden in India based on Vaccine Adverse Effect Reporting System data model from the USA. Settings and Designs: The descriptive study was carried out in March–May 2022. Data were extracted from report of National AEFI Committee, Ministry of Health and Family Welfare (MOHFW), Immunization Division, Government of India. This study made different hypothesis based on assumption of levels of underreporting ranging from 0.1 to 5%. From these hypotheses, projected deaths and those requiring hospitalization because of AEFI were calculated. Results: More than half (51.34%) of adverse events following immunization were classified as coincidental by National AEFI Committee. Actual reported deaths by MOHFW were 387 but estimated deaths may be around 38,700–41,400 or even more. From the total AEFI deaths, 77.78% were labelled as coincidental deaths. A Maximum of 53.82% coincidental death were because of cardiac cause. Conclusion: Deaths reported by MOHFW are likely to represent gross underestimate of the real scenario in India.

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Spinal cord involvement in COVID-19 infections can be varied and may present as acute transverse myelitis, acute necrotizing myelitis, neuromyelitis optica spectrum disorder, Myelin oligodendrocyte-associated glycoprotein (MOG) antibody myelitis, and SARS-CoV-2 myelitis. We retrospectively analyzed eight cases of COVID-19-associated myelitis. All patients had only mild antecedent symptoms of COVID-19 infection and were admitted with clinical features of acute transverse myelitis confirmed on neuroimaging. Seven patients had longitudinally extensive transverse myelitis (LETM). Serum Aquaporin-4 antibodies (NMO), cerebrospinal fluid (CSF) oligoclonal bands, and RT PCR for COVID-19 were negative. Serum MOG antibodies were positive in three patients; out of this two had CSF pleocytosis. All patients were treated with steroids followed by plasmapheresis. Five cases showed good improvement (increase in power by grade 2 or more), while three cases that were MOG positive had poor outcomes with either minimal or no improvement. The severity of COVID-19 infection was not related to the development of myelitis. Seven cases had LETM. Response to therapy was not uniform and the presence of MOG antibodies and CSF pleocytosis was associated with poor outcomes.

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Context: COVID-19 response needs to be enlightened with representative data regarding the humoral response to the virus, and its relationship with the clinico-epidemiological profile of the general population. Aims: To estimate the titres of IgG antibodies against SARS-CoV-2 and study the factors associated with the same among the general population of the Pimpri Chinchwad Municipal Corporation area. Settings and Design: Population-based cross-sectional study was carried out among the general population aged 6 years and above in the Pimpri Chinchwad Municipal Corporation area. Methods and Material: A total of 10,082 individuals from 106 wards of the PCMC area were studied between June 16, 2021 and June 26, 2021. The survey form questionnaire included sociodemographic details, COVID-19 exposure history, symptoms, tests, and vaccination status. About 3 to 5 ml blood samples were collected from each subject. Testing of samples was done using ABBOTT CMIA, SARS-CoV-2 quant assay—sensitivity 92.7% and specificity 99.9%. Statistical Analysis Used: Frequency analysis was done for sociodemographic variables, and antibody titres. An appropriate test of association was applied to the association between antibody titres and the sociodemographic and clinical profile of participants. Results: Antibody titres were significantly higher in males, aged 45 years and above, participants of upper socioeconomic class, participants residing in elite areas, subjects with a history of COVID-like symptoms in the past, and those who were vaccinated. Conclusions: Anti-SARS-CoV-2 IgG antibodies titres were found to be significantly associated with age, sex, socioeconomic status, area of residence, vaccination status, and history of COVID symptoms.

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Introduction: The present study was conducted for vaccine effectiveness in the prevention of mortality among moderate to severe COVID-19 cases. Methods: The study was conducted in a dedicated COVID-19 hospital in Northern India from April 2021 to June 2021. Only moderate and severe COVID-19 cases were admitted to the hospital. All patients with the outcome (recovery or mortality) till 30 June 2021 constitute the study population for the study. The study is designed as a case-control study. The outcome was mortality due to COVID-19. The control group was cases who have recovered. The exposure was vaccination status. The data about the age, sex, and vaccination status including the type of vaccine was collected from the case sheets. Results: A total of 735 participants were recruited, out of which 409 patients survived and 326 patients died due to COVID-19 in the hospital. The mean age was 52.80 years (SD = 14.1 years) in the cases group and 60.92 years (SD = 14.97 years) in control group (P = 0.001). 137 (33.50%) were female and 272 (66.50%) were male in the control group while in cases 134 (41.10%) were female and 192 (58.90%) were male (P = 0.03). A total of 473 (64.35%) patients were unvaccinated, 199 (27.07%) were partially vaccinated, and 63 (8.57%) were fully vaccinated. Among the patients who survived, 101 (24.69%) were partially vaccinated and 28 (6.85%) were fully vaccinated; in the cases group, 98 (30.06%) people were partially vaccinated and 35 (10.74%) were fully vaccinated. On multiple regression analysis, there was no association between vaccination status and mortality among moderate and severe cases. Conclusion: The present study brought out that there is no association between vaccination and mortality among moderate to severe COVID-19 cases admitted to the makeshift hospital in Delhi.

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Background: COVID-19 has caused a pandemic since the end of the year 2019. Controversy regarding the presence of the SARS-CoV-2 in tears and conjunctival sac has created suspense throughout. Moderate to severe dry eye has been observed in the patients infected with COVID-19. Material and Method: We conducted a descriptive, prospective observational study. We enrolled 16 patients fulfilling the inclusion criteria for our study. Patients affected with acute COVID-19 from 28-9-2020 to 9-10-2020 registered at our hospital and willing to participate were included. Tears and conjunctival swabs were taken at the interval of 24 h; consecutively three samples were taken from one COVID-19 infected patient. In total, 48 samples were analyzed by qRT-PCR. Result: We had 16 participants, 47% were females and 53% were males; 2/16 [12.5%] patients showed the presence of SARS-CoV-2 in tears and conjunctival swabs. Both the infected patients were females, and they did not have any obvious abnormal ocular conditions. Schirmer strip reading, however, showed a severe dry eye in both the patients. Conclusion: We identified dry eye ranging from mild to moderate to severe [Schirmer 1 reading ranged from 2 to 8 mm] in all our patients admitted to the COVID-19 ward. The SARS-CoV-2 gene seems to be mutating. More work needs to be done to find the viral load in the tears and any abnormalities in the eyes accordingly.

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Background: A high incidence of air leak syndromes (ALSs) has been reported in critically ill coronavirus disease 2019 (COVID-19) patients, which affects disease outcome. Objective: To evaluate the incidence, outcome, and risk factors associated with ALSs in critically ill COVID-19 patients receiving invasive or non-invasive positive pressure ventilation. Result: Out of 79 patients, 16 (20.2%) patients had ALS. The mean age of the ALS group was 48.6 ± 13.1 years as compared to 52.8 ± 13.1 (p = 0.260) years in the non-ALS group. The study group had a lower median body mass index (25.9 kg/m² vs 27.6 kg/m², P = 0.096), a higher D-dimer value (1179.5 vs 762.0, P = 0.024), lower saturation (74% vs 88%, P = 0.006), and a lower PF ratio (134 vs 189, P = 0.028) at presentation as compared to the non-ALS group. Patients with ALS had received a higher median positive end-expiratory pressure (PEEP) (10 cm vs 8 cm of water, P = 0.005). The pressure support, highest driving pressure, and peak airway pressure were not significantly different in the two groups. The ALS group had a significantly longer duration of hospital stay (17.5 vs 9 days, P = 0.003). Multiple logistic regression analyses indicated that patients who received inj. dexamethasone were less likely to develop ALS (OR: 12.6 (95% CI 1.6-95.4), P = 0.015). Conclusion: A high incidence of ALS is present in critically ill COVID-19 patients. High inflammatory parameters, severe hypoxia at presentation, and use of high PEEP are significant risk factors associated with ALS. The risk of developing ALS was lower in patients who received inj. dexamethasone.

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A post-COVID patient with a high D-dimer Value (>5000 IU) was posted for total knee replacement. She was on multiple anticoagulants including the novel oral anticoagulants that started to reduce thrombotic risk. This case highlights the importance of continuing the anticoagulants and provides insights on the proper timing to stop and restart various anticoagulants after surgery in post-COVID patients.

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Background: The coronavirus disease 2019 (COVID-19) pandemic has caused an unprecedented disruption in the lives of students and health care systems worldwide. Objectives: The study explored the impact of the prolonged COVID-19 pandemic among medical students in Malaysia. Methods: An online, cross-sectional survey was conducted among 397 medical students using Google forms circulated on social networking sites, like WhatsApp. Data were collected on self-reported anxiety and preventive health behaviors, challenges faced in daily activities, perception of e-learning, and changes in social and personal relationships. Results: As compared to before the advent of the pandemic, 83% of the students were more nervous and anxious, 38% washed their hands more often, and 43% bought more cleaning and hygiene supplies during the pandemic. Forty-two percent of the respondents went out less often, and 73% had lesser in-person social contact with their friends. The majority of students practiced a sedentary lifestyle; 47% snacked more often, and 58% had lesser physical activity. Conclusion: This study emphasizes the role of the provision of emotional support and strategies to enhance the well-being of medical students.

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