Cross-sectional study on prevalence and consequences of screen time on physical and mental health in children in the era of COVID-19

Background: With the ongoing growth and expansion of digital media and COVID-19 pandemic, children are inclining more and more toward spending time on digital media as compared to outdoor sports, leading to poor physical and mental growth. Developed nations have already set up a screen time guideline which is yet to be established in developing nations. This study was conducted with the objectives of identifying the needs of screen time guidelines and to study the impact of screen time on mental and physical health in children. Aims and Objectives: This study aims to check the screen time in children aged 2–18 and find the health consequences both physical and psychological in those children. Materials and Methods: A cross-sectional study on children aged 2–18 years was conducted between 2019 and 2020. Parents were asked to fill a pre-structured questionnaire. Impact on health physical and mental were assessed by pediatrician and psychologist. Results: A total of 155 children were enrolled in the study. Mean child hours in children aged 2–5 years, 5–10 years, and 10–18 years were 4 h, 5.83 h, and 6.29 h on week days and 5.64 h, 5.76 h, and 7.69 h on weekends, respectively. More than one-third of children had age of onset of screen time below 2 years of age. About 70% of children had malnutrition. Only 18% of parents were aware of concept of screen free days. Screen time had negative impact on health (P=0.0001) and on behavior of child (P=0.001). Average increase in screen time during COVID-19 was nearly 3 times the pre-COVID era. Conclusion: This study has paved the way for the need of larger study and development of guidelines on impact of screen time on children in developing nations where screen time guidelines is yet to be set more so in era of COVID 19 pandemic.

Impact of body mass index on critically ill COVID-19 patients admitted in a tertiary care hospital : a retrospective observational study

Background: Increased body mass index (BMI) is a known risk factor for respiratory infection and is being recognized as a predisposing factor in the COVID‐19 pandemic caused by the severe acute respiratory syndrome coronavirus‐2. Aims and Objectives: This study aimed to assess the association between different body mass index categories with severe COVID-19 patients leading to death. Materials and Methods: This retrospective study of six months included the laboratory-confirmed COVID-19 patients admitted to an ICU of a tertiary care academic health care organization. The medical records were reviewed at least 14 days after admission. Results: 484 patients were included, and BMI data were available for 306 patients. 40.19% had a normal weight, 26.79% were overweight, 17.97% had BMI 30-34.9 Kg/m2 and 15.03% had BMI ≥ 35 Kg/m2. Overall, 58 patients (18.95%) died within 14 days of ICU admission, 50.98% were discharged alive or referred from the hospital within 14 days, and 30.06% remained hospitalized at 14 days. After controlling for all covariates, there was a significantly increased risk of mortality in the patients with obesity class I (RR 2.03, 95% CI 1.07-3.85, P = 0.030) and patients with obesity class II & III (RR 2.83, 95% CI 1.54–5.22, P <0.001) compared with those with normal BMI. Conclusions: Obesity was associated with an unfavorable outcome among patients with COVID-19. Patients with obesity should be more closely monitored when hospitalized for COVID-19 as there is increasing evidence of relation of severity of COVID-19 and obesity which appears to be a factor in the health risks.

A study on the demographic, clinical, and radiological profile of lineage B.1.1.7 (United Kingdom) strain Covid-19 patients at Telangana institute of medical sciences and research, Hyderabad

Background: Emergence of variants with specific mutations in key epitopes in the spike protein of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) raises concerns pertinent to its severity. Aims and Objectives: To assess the demographics, clinico-radiological pattern, and outcome of reverse transcription-polymerase chain reaction (RT-PCR) positive isolated coronavirus disease 2019 (COVID-19) patients arrived from the United Kingdom (UK). Materials and Methods: A cross-sectional, observational study was conducted in RT-PCR positive COVID-19 patients arrived from the UK, from December 2020 to February 2021. Nasopharyngeal samples of all patients were sent for whole-genome sequencing of SARS-CoV-2. The aimed parameters were compared between the B.1.17 positive and non-B.1.1.7 groups, among the people, arrived from the UK. All statistical tests with P<0.05 were considered significant. Results: A total of 59 SARS-CoV2 infected patients, who arrived from the UK, were isolated from December 2020 to February 2021 at Telangana Institute of Medical Sciences hospital, Hyderabad, were enrolled in the study. Of these, 27 patients (mean age-31.81±11.28 years) were infected with the B.1.1.7, diagnosed by whole genomic sequencing. Males were predominant in our study. Personal habits such as smoking, alcohol intake were higher among the sequenced group with a significant P<0.05. The most common symptoms observed in the sequenced group were cough (22.22%), sore throat (22.22%), cold (11.11%), fever (11.11%), and in the unsequenced group were cough (22.22%), cold (6.25%), fever (6.25%). In the sequenced group, chest X-ray posteroanterior view was normal in 74%, patchy ground-glass opacities was observed in 25.92% patients, whereas in the unsequenced group it was 84.37% and 15.62%, respectively. Asymptomatic patients, observed in the sequenced and unsequenced group were 48.18% and 78.12%, respectively, and symptomatic patients were 51.85% and 21.87%, respectively. We found a statistically significant difference between sequenced and unsequenced patients in the asymptomatic group with a significant P<0.05. In the sequenced and unsequenced group, mild cases were 48.18% and 18.75%, moderate cases were 3.7% and 3.12%, respectively. We found no evidence of an association between disease severity and lineage B.1.17. Conclusion: Our data, within the context and limitations of a real-world study, provide initial reassurance that severity in hospitalized patients with B.1.1.7 is not markedly different from severity in those without B.1.1.7.

Non-descent vaginal hysterectomy surgery associated with less complications and good prognosis

Background: Removal of the uterus through vagina when performed in a case without uterine descent or prolapse is known as “non-descent vaginal hysterectomy” or NDVH. Vaginal route is preferred as compared to laparoscopic and abdominal methods. The advantages of vaginal hysterectomy being fewer complications, less post-operative stay, cost effective, and useful in bulky uterus. Aims and Objectives: The aims of the study were as follows: (1) To study the intraoperative and post-operative complications encountered during NDVH and their management. (2) To assess the intraoperative blood loss, the operative time, and post-operative hospital stay. (3) To study and check the feasibility of vaginal route as the primary route for all hysterectomies in the absence of uterine prolapse. Materials and Methods: A total of 50 patients were included in the study. Detailed history was taken including obstetric history and menstrual history and clinical examination was performed. After taking written, informed consent and doing proper pre-operative preparation, the patient was posted for NDVH. Post-operative complications were noted. Patients were asked to come for follow-up after 15 days. Results: In 92% of cases operated, no intraoperative complications were found suggesting low morbidity associated with the procedure. Hemorrhage requiring blood transfusion was found in 4% of cases. Average operative time was 61.2 ± 27.89 min, average blood loss was 170 ± 81.44 ml, and average hospital stay was 5.94 ± 4.95 days. On histopathological examination, 40% were having leiomyoma and dysfunctional uterine bleeding was seen in 22% of cases. Pain was the most common complication seen in 30% of cases while vaginal discharge was seen in just 4% of cases. About 80% of patients were discharged on post-operative day 5. Conclusion: In 92% of NDVH cases, no intraoperative complications were found suggesting low morbidity associated with the procedure. The post-operative hospital stay was restricted to 5 days in 80% of cases which indicates early discharge of the patient. Post-operative complications such as vaginal discharge and fever were seen only in 4% of cases. NDVH should, therefore, be considered as the primary route for all hysterectomies unless contraindicated in the absence of prolapse.

Cognitive deterioration in association with teeth loss in elderly population: A study from Eastern India

Background: With the global increase in cognitive impairment and dementia, the need to investigate into the possible ways that can be used to prevent or delay such occurrence has been growing. Maintenance of dental care and oral hygiene has been promoted as one such aspect. Aims and Objectives: To study the association between cognitive impairment in patients without registered diagnosis of dementia with tooth loss and chewing ability. Materials and Methods: It was a cross-sectional hospital-based study where consenting elderly persons attending Dental outpatient department over 1½ years were included. Data obtained on socio-demographic details, number of tooth loss, number of remaining teeth, subjective chewing ability, cognitive assessment as per mini-mental state examination (MMSE), and Clock Drawing Test were analyzed statistically to check correlational association. Results: In this study 96 eligible elderly persons of mean age of 68.30±6.28 years showed increased cognitive impairment among females (P=0.003), increased age (P=0.009), rural background (P=0.033) and low income groups (P=0.001). Positive correlation was found between chewing capacity (P=0.348), number of remaining teeth (r=0.418) with MMSE scores. Conclusion: Our study population showed positive correlation between impaired cognition and the number of extracted tooth and chewing capacity. With further study on wider and representative population, we hope to project the role of maintaining good oral hygiene and dental care as a possible preventive strategy among many others to combat the increased burden of cognitive impairment.

A study on outcome of controlled ovarian hyperstimulation and intrauterine insemination (husband) in a medical college in Kolkata

Background: A combination of controlled ovarian hyperstimulation and intrauterine insemination (IUI) remains an important treatment option for couple having infertility. Success rate of IUI with ovulation induction ranges from 8-20% depending on many factors. Aims and Objectives: To assess the factors affecting the success rate of IUI and to evaluate the success of ovulation Induction by different methods of controlled stimulation protocol. Materials and Methods: It is a duration-based prospective cross-sectional study where total of 67 couples were included by inclusion and exclusion criteria. They underwent 90 cycles of IUI with each couple having a maximum of three cycles. Ovulation induction was done by clomiphene citrate or letrozole or gonadotrophins. Semen preparation was done by density gradient method. The outcomewas measured by positive urine pregnancy test. Range, percentage, confidence interval, mean with standard deviation, median, range, and P-value were calculated. P<0.05 was taken as statistically significant. Results: Out of 90 IUI cycles 8 were successful resulting in a success rate of 8.8% per cycle and 11.9% per couple. Factors that had a positive impact were follicle size >21 sqmm, endometrial thickness >9 mm, post wash count >15 million/ml, >2 cycles of IUI and on the number of follicles 2 or more on the day of trigger. Conclusion: The study concluded that IUI after ovulation induction can be a simple and safe cost-effective procedure in selected group of infertile couple. Clinical significance IUI following ovulation induction can be a successful approach for specific indications in a low-resource setting where options for other ART interventions are absent or limited.

A comparative prospective observational study on the use of ulipristal acetate versus mifepristone in reduction of the size of uterine leiomyoma

Background: Fibroid or uterine leiomyoma is the most common benign tumor of the uterus in the reproductive age group and found in one out of every four women. They are symptomatic in 50% of women, with the peak incidence occurring among women in their 30s or 40s. Fibroid can cause a variety of symptoms which include menstrual disturbances commonly menorrhagia and dysmenorrhea. It is a common indication of hysterectomy in Indians. An effective medical treatment option may reduce hysterectomy-associated morbidity and mortality. This study is undertaken to evaluate the efficacy and safety of medical management of myoma and contribution in the reduction of myoma size comparing the two drugs ulipristal and mifepristone. Aims and Objectives: The study was conducted to compare reduction of menorrhagia (By pictorial blood loss assessment chart score), reduction of fibroid size (using transvaginal ultrasonography), and improvement of hemoglobin (Hb) level. We are also evaluating safety or side effects using these drugs. Materials and Methods: The study includes 210 patients who are divided into two groups. Group A includes 105 patients who are treated with tablet Ulipristal Acetate 5 mg daily for 3 months and Group B includes 105 patients who are treated with tablet mifepristone 25 mg daily for 3 months. Results: Ulipristal and mifepristone both are effective in reduction of menorrhagia and improvement of Hb levels, but Ulipristal is more effective in reduction of size of uterine myoma than mifepristone after 3 months of treatment. Conclusion: Multicentric study over a larger population is required to reach a valid conclusion.

A clinical registry of multisystemic presentation of hypovitaminosis D in hospital attendees in Kolkata

Background: Vitamin D (Vit D) is a steroid hormone essential for maintaining functional homeostasis in the body. Hypovitaminosis D has been a recognized worldwide problem affecting all age groups and sex. Its prevalence is very high in South Asia. Aims and Objectives: Therefore, this study was aimed to determine the spectrum of presentation of biochemical levels of hypovitaminosis D in Indian population in terms of age, sex, and multisystemic disorders. Materials and Methods: A cross-sectional study carried out on selective study population attending a tertiary care hospital from July 2019 to December 2020 with clinical presentations suspected to arise due to Vit D deficiency. Serum 25OH Vit D level was estimated by chemiluminescence method. Data were analyzed using GraphPad Prism 8. Results: Of the study population (n = 685), average serum 25(OH)D level in females and males was 24.13 ng/ml and 28.59 ng/ml, respectively. Significant difference in mean value of Vit D existed in males and females in the 21–40 years age group (p = 0.0048). Females in the Vit D deficient group (Vit D level<20) mostly presented with mastalgia (20.45%), low back pain (17.61%), and joint pain (11.36%). Common clinical presentation in males with Vit D levels less than 20 ng/ml was diabetes mellitus without CKD (18.34%), non-diabetic CKD (19.27%), and low back pain (16.51%). Conclusion: Low Vit D levels manifest itself as signs and symptoms involving various multisystemic disorders involving different age groups in both sexes. Early recognition and replacement can prevent the progress of complications which Vit D deficiency makes us prone to develop.

Correlation of biofilm production with antibiotic susceptibility pattern of Pseudomonas aeruginosa from various clinical specimens

Background: Pseudomonas aeruginosa is one of the most prevalent nosocomial pathogens that cause a life-threatening infection. One of the important characteristics of P. aeruginosa is biofilm formation which leads to antibiotic resistance. Aims and Objectives: The aim of the study was to study the antibiotic resistance pattern of P. aeruginosa isolates and correlation with their biofilm-production. Materials and Methods: A total of 87 P. aeruginosa isolates from different clinical specimens were processed and confirmed by conventional microbiological methods as per standard methodology. Antibiotic sensitivity testing was done for all isolates. Biofilm producing isolates were identified by the microtiter plate method (MTPM). Results: Of 87 P. aeruginosa isolates, majority were from pus 33 (38%), followed by urine 26 (30%), sputum 19 (22%), body fluids 7 (8%), and blood 2 (2%). Biofilm producing isolates showed more resistance in comparison to non-biofilm producers. The observed difference between biofilm formation for multidrug resistant and susceptible isolates was found to be statistically significant. Conclusion: MTPM method was an effective test for detection of biofilm formation and was also able to verify biofilm production by P. aeruginosa. This indicated a higher propensity among the clinical isolates of P. aeruginosa to form biofilm and revealed a positive correlation between biofilm formation and antibiotic resistance. This indicates the need for testing of even susceptible isolates for virulence factors such as biofilm production.

Case series of maternal mortality and maternal near miss due to severe acute respiratory syndrome coronavirus 2

The severe acute respiratory syndrome coronavirus 2 (SARS-COV-2) that causes the COVID-19 pandemic has affected every household of the remotest part of North East India, Mizoram. The pregnant women do not have a higher chance of getting infected, yet the infection seems to be more severe. We are reporting five cases of maternal death and two cases of maternal near miss in ZMC of Mizoram. Case 1 to 5 were maternal death due to COVID-19. All of them were multigravida within the age group of 27–41 years with a period of gestation 24–37 weeks. The presenting complaints were fever and cough more than 3 days with an investigation report revealing raised C-reactive protein (CRP) and severe pneumonia. Case 6 (Near miss) was 20 years, primigravida at term pregnancy in labor with a history of fever for 2 days with an investigation report revealing raised CRP and severe pneumonia, the baby was delivered asphyxiated and died. Case 7 (Near miss) was 17 years old primigravida at term pregnancy admitted as asymptomatic COVID-19 positive, elective caesarean section was done for Obstetrics indication, the patient later developed fever and moderate pneumonia on 5 days of hospitalization, she also developed eclampsia on 7th hospital day, she survived after intensive care in the intensive care unit.