Clinical Course and Outcomes of COVID-19 Patients Admitted to the ICU of a Tertiary Care Hospital in Central India: A Cross-Sectional Study.

BACKGROUND: Coronavirus disease 2019 (COVID-19) rapidly spread globally, leading to a pandemic significantly impacting individuals, communities, and economies worldwide. Public health measures such as social distancing, mask-wearing, and hand hygiene have been implemented globally to mitigate the spread of the virus. Many people recovered from COVID-19, but some cases needed intensive care unit (ICU) care, among whom most required mechanical ventilation (MV). MATERIALS AND METHODS: This hospital-based cross-sectional study was done among 75 clinical or reverse transcriptase-polymerase chain reaction (RT-PCR) test-confirmed cases of COVID-19 infection admitted to the ICU of a tertiary care unit in India. RESULTS: A maximum number of patients, i.e. 47 (63%), were male, and 26 (35%) belonged to the age group of 41-60 years. The most common symptom was fever at the time of admission to the hospital. Comorbidity was reported in 21 (28%) patients. The majority of patients recorded a combination of hypertension and diabetes. The majority (n =34, 45%) of the patients stayed for ≤ 3 days in the ICU, and 46 (61%) deaths were recorded in the ICU during this period. CONCLUSION: Delayed medical intervention, advanced age, male gender, and underlying health conditions like cardiovascular disease and diabetes can contribute to worse outcomes and increased mortality in COVID-19 patients.

A Clinical Comparative Study of Rectus Sheath Closure Techniques in Emergency Exploratory Laparotomy: Evaluating "Far-Near-Near-Far" vs. Conventional Closure Approach.

BACKGROUND: Midline exploratory laparotomy is essential in emergency surgery, and effective closure of the abdominal wall is crucial for optimal healing and reduced complications. The far-near-near-far technique for rectus sheath closure has gained attention due to potential advantages over conventional closure due to the fact that even if one suture gives way it does not affect the nearby suture and the rectus sheath is still held in place. This study aims to compare these techniques in emergency exploratory laparotomy. METHODS: This single-center prospective observational study included all patients undergoing emergency exploratory laparotomy at a tertiary care hospital. Patients were categorized into two groups based on the closure technique used: conventional closure or far-near-near-far technique. Sociodemographic data and comorbidities were collected. Operative time, closure time, and postoperative complications were assessed. Statistical analysis was performed using IBM SPSS Statistics 22.0 (IBM Corp., Armonk, NY). RESULTS: The study included patients with a mean age of 42.14 years. Operative and closure times did not significantly differ between the groups. There was no significant difference in comorbidities between the two techniques. The incidence of wound infection, dehiscence, burst abdomen, incisional hernia, and sinus formation did not significantly differ between the groups. Late complications were also similar. CONCLUSION: The far-near-near-far technique for rectus sheath closure in emergency exploratory laparotomy showed comparable outcomes to conventional closure methods. No significant differences were found in operative time, closure time, or postoperative complications. This study contributes to the understanding of different closure techniques, allowing surgeons to make informed decisions.

Assessing the Risk Perception and Knowledge Regarding Cardiovascular Diseases in Patients With Hypertension and Diabetes in Central India: A Mixed-Methods Study.

Background Cardiovascular diseases (CVDs) are a major cause of morbidity and mortality worldwide. The perceptions of patients can be important in health-related behaviors and disease prognosis. Thus, this study aimed to determine the risk perception and knowledge of hypertensive and diabetic patients. Methodology The study was conducted among 264 patients with diabetes and/or hypertension. A sequential exploratory mixed-methods design was used, which initially identified themes related to risk perception about CVDs among patients. Knowledge and risk perception about CVDs were quantified using a survey derived from predefined themes. CVD knowledge scores were categorized into low, intermediate, and high scores, and the trends of risk perception were studied across this spectrum of cardiovascular knowledge. Results The age of the participants ranged from 30 to 78 years. Overall, 57.19% of the participants were males, whereas 42.80% were females. The qualitative results revealed that the sources of knowledge about CVDs, physical activity, and maintaining a nutritious diet included family, friends, and media. On the other hand, doctors played a significant role in influencing perceptions related to medications. The observation of complications related to CVDs and the fear of mortality played a pivotal role in shaping the perception regarding the seriousness of the condition. Perceived susceptibility was low if there was unawareness of protection through medications and lifestyle changes, but it was high with stress or heredity. The analysis of CVD knowledge and risk perception survey data revealed the median CVD knowledge score to be 12 (interquartile range = 7.5-13), which showed a significant association with education and socioeconomic status (p < 0.05). The distribution of risk perception scores across the spectrum of CVD knowledge scores depicted that participants with higher scores agreed more with CVDs being serious and their susceptibility to them. Conclusions Despite having high knowledge scores regarding CVDs, the study population had average risk perception. Patient risk perceptions should be evaluated as it affects the health-seeking behavior and prognosis of the disease.

Quantum of Stress Hyperglycemia at the Time of Initial Diagnosis of Tuberculosis.

Background India has a high burden of both tuberculosis (TB) and diabetes mellitus (DM). The National TB Elimination Program recommends testing for glycemic status at the initiation of therapy; however, some individuals with elevated sugar levels might have stress hyperglycemia (SH) instead of true DM. Our aim was to perform a longitudinal glycemic assessment of individuals with TB to identify those with true newly diagnosed DM and those with SH. Methods We identified newly diagnosed adults with TB and abstracted information about demography, co-morbidities, disease severity, and glucose-lowering agents. A glycemic assessment was performed at baseline and at the end of six months. Results We included 150 patients with TB, and based on their initial HbA1c values, 82 (54.6%, 95% CI: 46-62%) had dysglycemia (30% had HbA1c levels above 6.4% and 24.6% had values between 5.9% and 6.4%) and 31 (20.7%, 95% CI: 14-18%) had SH. Among individuals with both baseline and follow-up glycemic values, 30% of the individuals previously defined as DM were characterized as SH. The proportion of true SH was 43% (95% CI: 33-60%). Conclusion Most individuals who have dysglycemia at the time of their TB diagnosis have SH. A close follow-up of such individuals will identify those who really require long-term glucose-lowering therapy.

How to make services adolescent friendly? A cross-sectional study on awareness of adolescent friendly health clinics in Central India.

Background: India's flagship program on adolescent health - Rashtriya Kishor Swasthya Karyakram (RKSK) emphasises the importance of strengthening Adolescent Friendly Health Clinics (AFHCs) under its facility-based approach for improving the health of adolescents. AFHCs are intended to provide targeted intervention in six domains - nutrition, injuries & violence (including gender-based violence), mental health, sexual & reproductive health, substance abuse and noncommunicable diseases. Objective: The current study was conducted to assess the determinants of awareness and utilisation of AFHC services in districts with RKSK services in Madhya Pradesh. Subjects: In total, 1605 adolescents (both males and females) within the age group of 10-19 years were included in the study. Methods: Multistage stratified random sampling was employed to enrol participants from three districts of Madhya Pradesh, where AFHC services have been launched. Results: The mean age of the participants was 15.07 ± 2.32 years. Only 153 (9.5%) adolescents were aware of AFHC services. On multivariate logistic regression, awareness of AFHC was seen to be associated with being aware of RKSK, being a part of the peer educator-led peer group, having had adolescent health days organised in the village and belonging from one of the financially better off districts. Utilisation rate of AFHC services was lower still - at 2.74%. Conclusion: Both awareness and utilisation of AFHC services remain very low among adolescents. There is a pressing need to focus on awareness generation campaigns - via mass media, but more importantly, through community health workers and peer educators - in order to sensitise target beneficiaries about the available services.

Do Patients of Chronic Low Back Pain have Psychological Comorbidities?

Background Individuals with chronic pain have been reported to have an increased incidence of psychological morbidities. We aimed to examine the prevalence of anxiety, depression, disability, alexithymia, insomnia, and sleep quality in patients having chronic low back pain (LBP) and study their association with the severity of pain and any disability arising from it. Methods This descriptive study was conducted in a tertiary care teaching hospital setting. Fifty adults with nonspecific LBP of > 6-week duration were included. Study instruments employed were patient health questionnaire-9 for depression, generalized anxiety disorder-7 for anxiety, visual analogue scale (VAS) score for pain, Oswestry disability index (ODI) to assess disability, Toronto alexithymia scale-20 for alexithymia, and insomnia severity index and Pittsburgh sleep quality index for insomnia. Descriptive results were expressed as numbers, means, and proportions. Association study between variables was performed using Fisher's exact test. Results Mean ODI score was 31.54% (95% CI, 26.09-36.99); mean VAS score was 6.08 (95% CI, 5.35-6.81). Insomnia of varying severity was found in 29 patients. Sleep quality was reported as good by 23 patients. One patient had alexithymia. There was significant association between the level of disability and depression, anxiety, insomnia, and sleep quality. The severity of pain had significant association with insomnia but the association with anxiety, depression, alexithymia, and sleep quality was not significant. Conclusions Patients with chronic LBP do have associated psychological comorbidities of varying extent. A "patient-centric" approach when treating patients with chronic LBP is necessary, so that appropriate evaluation of psychiatric and psychosocial comorbidities, sleep problems, and quality of life is done as part of their routine management to ensure the desired outcomes.

A Primer on Persistent Homology of Finite Metric Spaces.

Topological data analysis (TDA) is a relatively new area of research related to importing classical ideas from topology into the realm of data analysis. Under the umbrella term TDA, there falls, in particular, the notion of persistent homology PH, which can be described in a nutshell, as the study of scale-dependent homological invariants of datasets. In these notes, we provide a terse self-contained description of the main ideas behind the construction of persistent homology as an invariant feature of datasets, and its stability to perturbations.

Adult-onset unilateral disabling pansclerotic morphea.

Disabling pansclerotic morphea (DPM) is a rare, severe, and mutilating form of morphea, involving the dermis, subcutaneous tissue, fat, muscle, and even bone. It is usually seen before the age of 14 years, with the patient complaining of arthralgia and stiffness at the time of onset. We report a case of unilateral adult-onset DPM with sparing of the face. Within a few months of onset, painful contracture deformities of the hand, elbow, and shoulder joints developed, impairing the patient's normal daily activities. We are reporting this case because of the unusual presentation: DPM in an adult, with history of trauma in childhood and rapid onset of complications, is rare.

Fusarium skin infection: a case report.

A 65-year-old man presented with an irregular ulcer with a black eschar on his forehead associated with severe headache. A subcutaneous nodule with a necrotic center was present on the left knee. The diagnosis of Fusarium infection was made and confirmed by biopsy and culture. The patient had a history of bronchial asthma for which he was on inhalational steroids for 5 years. It is unclear if this treatment was related to the disseminated Fusarium infection. The patient received oral itraconazole for 3 months with good improvement but met with an unexpected sudden death.