Musculoskeletal Comorbidities among known Diabetes Patients, their Quality of Life, and Healthcare Costs: A Comparative Study From a Tertiary Care Hospital in Uttarakhand.

Introduction: Diabetes is a chronic disorder with long-term sequelae and multisystem manifestation. Burden of diabetes in on the rise. Presence of other morbidities can not only have a detrimental effect on the disease treatment and recovery course, but also on the financial burden and quality of life. Present study aims to investigate how musculoskeletal conditions affect individuals with diabetes compared to those without the condition. Material and Methods: A comparative study was conducted among patients attending the outpatient department of a tertiary care hospital in North India to assess the burden of musculoskeletal disorders in people with and without diabetes. A total of 195 diabetes patients and an equal number of individuals without diabetes were sequentially enrolled from the outpatient department (OPD). Results: Burden of musculoskeletal comorbidities was significantly higher (46.2%) among people with diabetes than the comparison group (25.1%). The overall odds ratio (OR) for comorbidities of musculoskeletal system was 2.5 times higher in diabetes cases as compared to individuals without diabetes. The OR for rheumatoid arthritis, chronic backache, and osteoarthritis was found to be 3.6, 2.9, and 1.7 respectively. Poor quality of life and higher direct cost of treatment were found among diabetes cases with musculoskeletal comorbidities as against those without these comorbidities. Conclusion: Presence of musculoskeletal comorbidity is high among diabetes patients, and it has an impact on the quality of life and treatment cost. Screening for musculoskeletal comorbidities should be included as part of the diabetes complication assessment to allow for early detection and treatment.

Program management challenges of clinical studies: A qualitative critical assessment.

Background: Organization, coordination, and discipline are required to complete any intricate operation, conducting a clinical experiment is no different. There are usually many moving components, from designing a plan, to conveying changes, to calculating risk, and excellent project management which are necessary to guarantee the study works successfully. Past evidence suggested that roadblock at any level hampers the progress of the clinical research. Understanding program management challenges hence becomes the key for timely and effective completion of clinical research. Methods: A cross-sectional qualitative enquiry involving stakeholders in clinical research program management. We used problem tree-based approach wherein we documented views of various stakeholders to understand the interaction, interdependence, and related interventional needs of bottlenecks for long-term research gains using modern management methods applicable in clinical settings. The best fit approach was also explored to augment maximum benefit in limited resource settings. Results: Non-alignment with state policy aims, a lack of effective coordination and communication among members, challenging logistic management, limited use of technology, a need for training, and an inefficient monitoring mechanism were among the major issues highlighted, and solutions were proposed. Conclusion: Study concludes that an Integrated Process-cum-Timeline-Based Management strategy with multisectoral emphasis is ideal for program management of clinical projects.

COVID-Somnia: A Multicentric Study on Sleep Disturbances During the COVID-19 Pandemic With Spatial Mapping of Hotspots.

Objective The purpose of this study was to document sleep quality and assess its sociodemographic, behavioral (i.e., tobacco use, alcohol use, and screen time), and mental-health-related indicators (i.e., anxiety and depression) in adults aged 30-59 years across three states of India, and to geo-locate state and district-level findings of sleep quality during the ongoing coronavirus disease 2019 (COVID-19) pandemic. Methods From October 2020 to April 2021, residents (aged 30-59 years) of Kerala, Madhya Pradesh, and Delhi completed a web-based survey that included sociodemographic and behavioral factors, clinical history of COVID-19, and mental health screening instruments for anxiety and depression, namely the Generalized Anxiety Disorder 2-item (GAD-2) and Patient Health Questionnaire-2 (PHQ-2). The Pittsburgh Sleep Quality Index (PSQI) was used to evaluate the quality of sleep. Average PSQI scores were geo-mapped. Results Of the 694 participants who responded, 647 completed the PSQI. The mean (SD) global PSQI score was 5.99 (3.2), with approximately 54% of participants reporting poor sleep quality (PSQI Score>5). Eight hotspot districts with severe sleep disturbances (mean score PSQI>6.5) were identified. Multivariable logistic regression analysis showed that compared to Madhya Pradesh, participants from Kerala and Delhi had 62% and 33% lower chances of having poor sleep quality, respectively. Those who screened positive for anxiety had higher odds of having poor sleep quality (adjusted odds ratio {aOR}=2.4, P=0.006*). Conclusion Overall, sleep quality was poor during the early stages of the COVID-19 pandemic (October 2020-April 2021), especially among those who reported high levels of anxiety. Among the three included states, there were differences in sleep quality.

Efficacy and Safety of Thrombolysis in COVID-19 Related ARDS.

INTRODUCTION: COVID-19 causes significant pulmonary microthrombi in some individuals, leading to ARDS and death. Thrombolysis could be an effective approach in some patients with severe ARDS. We describe our experience with the usage of thrombolytic agents in critically ill COVID-19 patients who were in worsening respiratory failure. METHODS: Retrospective chart analysis was done in patients who were thrombolysed between May 2020-Sept 2020. Analysis was done to find out factors associated with improvement in oxygenation and survival. RESULTS: Twenty-seven patients with severe ARDS [all had respiratory rate >30, FiO2 >0.6 (on NIV/HFNC) and PiO2/FiO2 ratio <120] were thrombolysed in our ICU for COVID19 causes. C.T. Pulmonary Angiography could not be done in any of the 27 patients due to poor general condition, but 2D echo was normal in most (5 had dilated RA, RV), and none of the patients was in shock. So, there was no conventional indication of thrombolysis in these patients, yet after thrombolysis, we observed dramatic changes in oxygenation (defined by a decrease in FiO2 by ≥0.2) in twenty patients. Five patients had a major bleed. Eleven patients survived (survival rate of 40.7%) and the survival rate was high {66% (8/12)} in patients who were thrombolysed within 2 days of oxygen requirement. CONCLUSION: In this unprecedented pandemic with high mortality rates, efficacy of early thrombolysis needs to be further explored in randomised controlled trials.

Gender inequalities in prevalence, pattern and predictors of multimorbidity among geriatric population in rural West Bengal.

Context: Multimorbidity is considered as a priority for global health research. It is defined as the coexistence of two or more chronic health conditions in an individual. It is increasingly being recognized as a major concern for primary care physicians due to its huge impact on individual, family, and societal level. Aim: The aim of this study was to find the quantum of gender-related inequalities and determinants of multimorbidity among the elderly people in a rural part of West Bengal. Materials and Methods: This is a cross-sectional study carried out among 246 elderly people (60 years and above) in a community setting from Oct 2017 to Sep 2018. Logistic regression analysis was done to find out the predictors of multimorbidity. Data were analyzed using the SPSS software (version 16.0. Chicago, SPSS Inc.). Results: Approximately 82% of the study subjects were suffering from multi-morbidity with a significant difference between males (80.9%) and females (88.5%). In binary logistics, people of both the genders aged >70 years, who had less than primary level education, had more than three children, whose source of income was from their children (sons/daughters), were dependent on others for daily routine were at high risk of being multimorbid; whereas depression was a significant predictor of multimorbidity in females and not in males. In multivariable analysis, age remained the only significant predictor for both the gender and for females; depression remained significant after adjusting with significant variables in binary logistics. Conclusion: Morbidity screening at each visit, individual as well as family counseling and lifestyle modifications help to cope with the rising burden of multimorbidity at the primary care level. More insight into the epidemiology of multi-morbidity is necessary to take steps to prevent it, lower its burden and align health-care services as per needs.

Clinical profile and spectrum of bacteriuria in patients with diabetes: An analytical study.

Introduction: Diabetes is one of the modern-day epidemics with a spectrum of complications. Urinary tract infections (UTI) are common among patients with diabetes, and often it goes unnoticed in the initial period, which can later lead to complications. This study was planned to find out the magnitude of the problem of bacteriuria among diabetics and to look for its associated factors in diabetics. Methodology: A hospital-based study recruiting 100 eligible diabetics consecutively over a period of one year. Socio-demographic data were collected using a semi-structured questionnaire, and clinical examinations with relevant investigations were done. Informed written consent was taken. Results: Bacteriuria was found in 43 out of 100 participants. Prevalence was significantly more among females (54%) as compared to males (32%). Factors like poor glycaemic control, complications like neuropathy, diabetic foot were significantly associated with bacteriuria. E Coli was the most common bacterial isolate. Conclusion: Urinary tract infection is common in diabetic patients, especially females, and other clinical factors like uncontrolled sugar levels also play a role.

Depression and its socio-demographic correlates among urban slum dwellers of North India: A cross-sectional study.

Background: Depression is a common mental health disorder that is characterized by loss of interest or pleasure, feelings of guilt or low self-worth, disturbed sleep or appetite, low energy, and poor concentration, insomnia or hypersomnia, and occasionally suicidal thoughts. Apart from biological factors, sociocultural factors also play a key role in development of depression. Objectives: To determine the prevalence of depression in the study population and to study various socio-demographic correlates of depression in the study population. Methods: A community based cross-sectional study was carried out in an urban slum area of Rohtak city during 2016-2017. A total of 600 study participants were selected and interviewed by using PHQ-9 depression scale. The collected data were entered in MS Excel spread sheet and analysed using SPSS software version 20.0. Results: Mean age of the study participants was 37.91 ± 11.75 years. Almost all (97.5 %) study subjects were Hindu. Majority (52 %) belonged to General category. Overall prevalence of depression was found to be 16.2%. The distribution for factors like gender, marital status, education, occupation, socioeconomic status, type of family, living arrangement, smoking habit and death of close relatives were found to be statistically significant with depression (P<0.05). Logistic regression analysis showed that female gender, divorce/separation, illiteracy, unemployment, lower socioeconomic class nuclear family living alone, smoking habit, presence of chronic morbidity and death of close relative in past one year, as independent predictors of depression. Conclusions: The prevalence of depression among adults in an urban slum of north India was found to be 16.2%. Our findings indicate that depression in urban slum is significantly associated with determinants such as gender marital status, education, occupation, SE class, family type, smoking, living arrangement, death of close relative, chronic morbidities like neurological disorders, diabetes and hypertension.

A study to predict fracture risk using bone mineral density and FRAX score in patients on chronic maintenance haemodialysis.

Introduction: Disturbances in mineral and bone metabolism are prevalent in chronic kidney disease (CKD) and are important causes of morbidity also their diagnosis often delayed and require a spectrum of investigations. The current study attempts to predict and correlate, the fracture risk using simple tools like BMD and FRAX (Fracture Risk Assessment Tool) score in CKD patients. Methods: A cross-sectional study among 50 CKD patients age more that 40 years attending OPD (Out Patient Department) at a tertiary care Hospital in north India. Results: There is a negative correlation between BMD (NOF) and FRAX score for hip fracture risk and major osteoporotic fracture risk. Conclusion: The 10-year fracture risk in these patients, as predicted by FRAX score using FRAX (Indian) calculator, was significantly higher in CKD patients. Recommendation: FRAX can be useful tool for early screening of fracture risk in such situations for timely interventions.

Comparison of standard dose with high dose of methylprednisolone in the management of COVID-19 patients admitted in ICU.

CONTEXT: The pathological progression in severe Coronavirus Disease 2019 (COVID-19) includes an excessive and unregulated pro-inflammatory cytokine storm. Though the efficacy of corticosteroids like methylprednisolone (MPS) in severe COVID-19 is proven now, its dose and duration are not precise. AIMS: Our study aimed to compare the effect of a standard dose (SD) of MPS (60-120 mg/day) to a high dose (HD) of MPS (>120 mg/day) on the outcome of hospitalized COVID-19 patients. SETTINGS AND DESIGN: This study was a cross-sectional study. Patients admitted to AIIMS, Bhopal's intensive care unit (ICU) from July 2020 to March 2021 were enrolled in the study. METHODS AND MATERIAL: The patient's medical records were extracted from the medical record section of the hospital. The primary endpoint was the all-cause mortality during the hospital stay. The secondary endpoints were the need for mechanical ventilation, the use of vasopressors, the occurrence of acute kidney injury (AKI), and secondary infections. STATISTICAL ANALYSIS USED: Data were entered in the MS Excel spreadsheet and coded appropriately. RESULTS: Our data showed that survival, the need for mechanical ventilation, the occurrence of AKI, and secondary bacterial infection are comparable among the two groups with no significant difference. The logistic regression analysis showed that there is a slightly higher risk of death for patients with an acute respiratory distress syndrome (ARDS) receiving HD of corticosteroids compared to SD, though these results were found to be statistically non-significant. CONCLUSIONS: In hospitalized patients suffering from severe COVID-19 pneumonia, an SD of MPS is as effective as an HD of MPS in terms of reduction in mortality and need for mechanical ventilation.

Assessment of Poor Functional Status and its Predictors among the Elderly in a Rural Area of West Bengal.

CONTEXT: Functional ability considered a proxy for healthy aging, not only related to mental and physical health but it also determines social well-being. Eliciting the determinants of functionality components among the elderly will assist in evolving with appropriate plans at both domiciliary and facility level to eliminate their sufferings and disabilities. AIM: The aim of this study is to find out the magnitude of poor functional status among the elderly and its predictors. MATERIALS AND METHODS: This is a community-based cross-sectional study conducted among 246 geriatric people in a rural area of West Bengal from August 2017 to December 2017; data were analyzed using the SPSS software (version 16.0. Chicago, SPSS Inc.). Logistic regression analysis was performed to find out the factors associated with poor functional status (activities of daily living [ADL] and instrumental ADL [IADL]). RESULTS: The study concluded that 32.4% and 59.3% were dependent for basic ADL and IADL, respectively. Binary logistics showed people aged >70 years, female gender, less than primary level education, widowed/separated, who lived in the joint family, poorest percentile of economic status, who were depressed and who suffered from multimorbidity had increased odds of dependency for ADL and IADL. In multivariate logit regression, age >70 years and depression remained significant for ADL; in addition, marital status, education, and family type remained significant for IADL. CONCLUSION: There should be a provision for community-based comprehensive geriatric health and disability assessment, as it enables older people to avert the illness at the early stage, to delay the onset of disabling diseases. This will ensure their participation in the upliftment of the society, and they thus will be less dependent on their progeny.