National Early Warning Score 2 (NEWS2) to predict poor outcome in hospitalised COVID-19 patients in India

Background While several parameters have emerged as predictors of prognosis of COVID-19, a simple clinical score at baseline might help early risk stratification. We determined the ability of National Early Warning Score 2 (NEWS2) to predict poor outcomes among adults with COVID-19. Methods A prospective study was conducted on 399 hospitalised adults with confirmed SARS-CoV-2 infection between August and December 2020. Baseline NEWS2 score was determined. Primary outcome was poor outcomes defined as need for mechanical ventilation or death within 28 days. The sensitivity, specificity and Area under the curve were determined for NEWS2 scores of 5 and 6. Results Mean age of patients was 55.5 ± 14.8 years and 275 of 399 (68.9%) were male. Overall mortality was 3.8% and 7.5% had poor outcomes. Median (interquartile range) NEWS2 score at admission was 2 (0–6). Sensitivity and specificity of NEWS 2 of 5 or more in predicting poor outcomes was 93.3% (95% CI: 76.5–98.8) and 70.7% (95% CI: 65.7–75.3) respectively [area under curve 0.88 (95% CI: 0.847–0.927)]. Age, baseline pulse rate, baseline oxygen saturation, need for supplemental oxygen and ARDS on chest X ray were independently associated with poor outcomes. Conclusions NEWS2 score of 5 or more at admission predicts poor outcomes in patients with COVID-19 with good sensitivity and can easily be applied for risk stratification at baseline. Further studies are needed in the Indian setting to validate this simple score and recommend widespread use.

Development of a community orientation program (COP) as a community-based medical education method for undergraduate medical students: an experience from India

Background Intra-regional cultural and linguistic differences are common in low- and middle-income countries. To sensitise undergraduate medical students to the social and contextual determinants of health to achieve the ‘health for all’ goal, these countries must focus on innovative teaching methods. The early introduction of a Community Orientation Program (COP) as a Community-based Medical Education (CBME) method could be a game changing strategy. In this paper the methods, evaluation, and implication of the COP in an Indian setting are described. Methods The curriculum of the COP was developed based on the analysis, design, development, implementation, and evaluation (ADDIE) model for educational intervention. In this learner-centric and supervised educational program, the key aim was to focus on developing students’ communication skills, observation power and enhancing their motivation for learning through collaborative learning. To meet the objectives of the COP, a situated learning model under the constructivism theory was adopted. Results Between 2016 and 2019, 557 students were trained through the COP by visiting more than 1300 households in ten villages. To supplement the students’ observations in the community, more than 150 small group discussions, a health education programme for the community and summary presentations were conducted. The students’ feedback indicated the need to improve the clinical examinations demonstration quality and increase the number of instruments for clinical examinations. More than 80% of students felt that the program would assist them to improve their communication skills, their understanding of the various socio-demographic factors associated with the common diseases, and it will enable them to respect the local culture during their clinical practice. Conclusions Early initiation of the COP as a CBME method in the undergraduate medical curriculum in an Indian setting has shown promising results. Further evidence is required to adopt such a program routinely for under-graduate medical teaching in the low- and middle- income settings.

Lived Experiences of Women with Dissociative Disorder: An Interpretative Phenomenological Analysis

Background: In the Indian setting, several studies have documented that dissociative disorders (DDs) are more common in females, and the most commonly elicited stressors are interpersonal. However, much of the research up to now has been quantitative. There is a notable paucity of qualitative studies exploring the subjective experiences of women with DD. Therefore, the present study sought to explore and gain an in-depth understanding of the lived experiences of women diagnosed with DD. Methods: Five women were recruited who were seeking psychological treatment for dissociative symptoms at a tertiary care neuropsychiatric institute in North India. In-depth interviews were conducted with each, and the transcripts were analyzed using the analytic method of interpretative phenomenological analysis. Results: Three superordinate themes that emerged were: patients’ illness perspectives, the salience of relationships, and dealing with relationship conflicts. Conclusions: Our findings highlight the role of culture in influencing the participants’ illness perspectives. Women with DD tend to define their self in relational terms and, thus, inhibit the expression of one’s needs and opinions, to avoid conflict and to maintain harmony in relationships.

Simplified Guide to MR Elastography in Early Detection of Hepatic Fibrosis with Case Reports

The current unhealthy diets and sedentary lifestyle have led to increase in the prevalence of diabetes and metabolic syndrome globally. Fatty liver is a common occurrence in metabolic syndrome. The liver health is often ignored due to delayed warning signs. Fatty changes of the liver is one of the common findings in ultrasonography. Ultrasound does not detect fibrosis except when cirrhosis is developed. Early stages of fibrosis are asymptomatic with no significant laboratory or preliminary imaging findings. With fibrosis, the elasticity of the liver is reduced and becomes stiffer. Over the years, many techniques have developed to assess the stiffness of the liver, starting from palpation, ultrasonography, and recently developed magnetic resonance elastography (MRE). In this article, we have tried to simplify the concepts of MRE to detect fibrosis and present few case reports. The basic steps involved in generating elastograms and interpretation with some insight on how to incorporate it into the clinical workflow are discussed. MRE is superior to various other available techniques and even offers certain advantages over biopsy. MRE is FDA approved for liver fibrosis since 2009, yet it is hardly used in the Indian setting. MRE is a safe and noninvasive technique to evaluate a large volume of the liver and can be a new norm for the evaluation of fatty liver. Magnetic resonance imaging (MRI)-based elastography techniques hold an exciting future in providing mechanical properties of tissues in various organs like spleen, brain, kidney, and heart.

CLINICAL EFFECTIVENESS OF FIXED DOSE COMBINATION OF EMPAGLIFLOZIN AND LINAGLIPTIN (EMPA/LINA) IN PATIENTS WITH TYPE 2 DIABETES MELLITUS UNWILLING TO CONTINUE BASAL INSULIN THERAPY: A REAL-WORLD EXPERIENCE IN INDIAN SETTING

Many T2DM patients are reluctant to continue injectable insulin therapy affecting medication adherence. The objective was to investigate the clinical effectiveness with empagliozin/linagliptin (EMPA/LINA) combination in patients unwilling to continue insulin therapy. In this retrospective assessment, a total of 60 patients [(41 men, 19 women); age (± S.D.) 53.38 ± 8.49 years and disease duration 5.67±1.89 years; baseline HbA1c: 7.1±0.58%; BMI: 28.25±4.07 kg/m2 were initiated with EMPA/LINA (25/5 mg) after thorough assessment. During 12-week period, there was modest improvements in glycemic prole [baseline vs. endpoint; HbA1c: 7.1±0.58% versus 7.1±0.55% (p < 0.63), FPG 129±14 mg/dl versus 125±9.3 mg/dl, PPG 154±18 mg/dl versus 143±11 mg/dl (p=0.01), proportion of patients achieving A1C goal with no major hypoglycemia was improved from 37% to 81.48%. The incidence of overall hypoglycemia was reduced. These ndings suggest that patients with stable glycemic status reluctant to continue insulin may have effective transition to EMPA/LINA therapy

Advancing Dynamic Proficiency Skills into Teaching English as a Second Language in Indian Setting

This research article entitled “Advancing Dynamic Proficiency Skills in Teaching English as a Second Language in Indian Setting” is devoted to deliberate the uniqueness of Communication Skills in English for special as well as secondary purpose. It is in short about refining the speaking skill in English as a second language in India. In the course of its deliberation it would point out the central insights of the topic, and would elucidate the outcomes of the research. Some recommendations will also be stated in this article. Teaching and learning English, in addition to the vernacular language, is highly essential for communicative purposes so as to cope with the ever increasing regional, national and the global demands for communication skills in English. In India, English is the official language, and is used for the purposes of education, employment and for wider communication within and among the states as well for traveling to foreign countries. To cope up with the national and global demand, innumerable efforts have been made to the Indian educational system to enhance the learners English speaking skills.

A Critical Study of the Man-Eater of Malgudi from Ecofeminist Perspectives

This article attempts to analyze how R.K. Narayan’s The Man-Eater of Malgudi draws a polyphonic picture about woman, life, and the nature of Malgudi from an ecofeminist perspective. It attempts to explore how the theory of ecofeminism that was originally hypothesized in the West is echoed in Narayan’s novel The Man-Eater of Malgudi (1961) based on an Indian setting. This work is an attempt to evaluate and analyze the roles and positions of women and nature that philosophically and phenomenally resembles each other in The Man-Eater of Malgudi with an ecofeminist approach. Ecofeminism or ecological feminism is now very valid in the academic and literary world. The present paper examines the selected novel under the lens of oriental view towards woman and nature where both are closely associated with each other. Women are victims of degradation, domination, and exploitation, yet they play the role to bring ecological harmony and sustainability. The way Rangi, though oppressed by patriarchy, attempts to save the elephant; Kumar mirrors the purpose of eco-feminism; to create a balance in nature by establishing an inter-cooperative, consistent and unbiased relationship with all creatures of the world irrespective of gender, class, and color. The interrelationship and inter-connectivity between woman and nature are strongly highlighted in this paper through the character Rangi who dismisses Vasu’s anti-ecological ventures.