Psychological impact of COVID-19 pandemic and mental health problems of Indian medical health workers: a cross sectional study

Background: The COVID-19 pandemic had burdened tremendously health, economic and social status of all. Populations across globe and MHW are also affected physically, economically and mentally too. The primary aim of this study was to assess the psychiatric and mental health issues. Methods: A face-to-face interview and cross-sectional study were carried out in hospitals associated to Dr. SNMC Jodhpur from April 2020 to July 2021. Evaluation and assessment of insomnia, anxiety and depression was done using insomnia severity scale (ISI); generalized anxiety disorder (GAD-7) and depression on patient health questionnaire (PHQ-9) scale. A total number of 218 persons participated. Results: Compared with non-medical health workers (n=82); medical health workers (n=136) had higher score for insomnia (8.26±7.28 verses 6.35±5.29; p=0.039); generalized anxiety (8.26±6.25 verses 6.32±4.76; p=0.016) and depression (8.45±5.96 verses 6.18±4.72; p=0.035). Similarly higher prevalence rate in medical health workers was found for insomnia (23.3% versus 14.6%); generalized anxiety 31% versus 19%) and depression (14.7% versus 3.66%). These psychiatric symptoms were found in higher intensity (moderate to severe type) in all groups. Conclusions: During COVID-19 pandemic medical health workers are exposed to severe type of insomnia, generalized anxiety and depression. It requires more attention and recovery programs to combat the symptoms.

Prevalence of Thyroid Disorders in Type 2 Diabetes Mellitus.

Background: Diabetes mellitus and thyroid diseases are the two common endocrine diseases. Thyroid disorder is found commonly in most forms of diabetes and is associated with advanced age particularly in type 2 diabetes. The aim of the study is to know the prevalence and profile of thyroid disorders as assessed by thyroid hormone assay in hospital based cross section study in patients of type 2 diabetes mellitus and to know the prevalence of sub clinical hypothyroidism in type 2 diabetes mellitus and its effect on dyslipidemia in a rural setting. Methods: This is an observational, cross-sectional study done during the period from February 2013 to December 2014. Study population consists of 100 diabetic patients. Blood samples from all patients were collected in a standardized manner and were subjected for routine and special investigations including FBS, PP2BS, TSH, T3, T4. Fisher exact test was used for analysis of nominal variables presented in two (2×2) tables and chi-square test was used for distributions are presented in two by two tables. P-value<0.05 was taken as significant. Results: The prevalence of hypothyroidism was high in individuals with type 2 diabetes mellitus. It was 13% in this study and it was statistically significant. It was also concluded that subclinical hypothyroidism was more common in diabetics. Conclusion: Diabetes and thyroid disorders are co-related with each other. In patients of diabetes, subclinical hypothyroidism is commonly found.

Solitary fibrous tumour of lung.

Fibrous tumours arising entirely within the substance of the lung are rare. We report one such rare case in whom the diagnosis was established after surgical removal.

Correlation of gallstone characteristics with mucosal changes in gall bladder.

Background and aim: Gallstones are known to produce diverse histopathological changes in the gall bladder. Our aim was to correlate various gallstone characteristics (number, size, weight, volume and morphological type) with the type of mucosal response in gall bladder (inflammation, hyperplasia, metaplasia and carcinoma). Methods: The study was conducted on 330 open cholecystectomy specimens with complete gallstones. The stones were assessed for various parameters i.e. number, size, weight, volume and morphological type. For microscopy, sections were obtained from the fundus, body and neck of the gallbladder. Additional sections were taken from abnormal looking areas. Results: Out of the 330 cases, 194 (59%) had mixed stones, 84 (25%) combined, 30 (9%) pigment and 22 (7%) had cholesterol stones. Number of stones varied from a single calculus in 131 (39.6%) cases, double in 29 (8.8%) and multiple in the remaining 170 (51.6%) cases. Cholecystitis, hyperplasia, metaplasia and carcinoma were more commonly seen with mixed and multiple stones. The average weight of calculi in cholecystitis was 2.551 gm, in hyperplasia 3.619 gm, metaplasia 4.549 gm and 17.96 gm in cases with carcinoma. Similarly, average volume of the stone(s) was 2.664 ml in cholecystitis, 3.742 ml in hyperplasia, 4.532 ml in metaplasia and 19.178 ml in carcinoma. The average calculus size (2.147 cm) was found to be maximum in cases with carcinoma, followed by hyperplasia (1.187 cm), metaplasia (1.145 cm) and cholecystitis (1.136 cm). Conclusion: As the weight, volume and size of the stone increases the changes in the gall bladder mucosa changes from cholecystitis, hyperplasia, metaplasia, dysplasia, to carcinoma.

Fetus-in-fetu presenting as acute intestinal obstruction.

Fetus-in-fetu is a rare condition in which a fetiform calcified mass is often present in the abdomen of its host; a newborn or infant. We present the case of a three-month-old male baby with acute intestinal obstruction and abdominal mass. X-ray abdomen and ultrasonogram revealed a cystic mass with calcification. On laparotomy, a well encapsulated retroperitoneal mass causing high intestinal obstruction was identified. Total excision of the mass was done. Diagnosis of fetus-in-fetu was confirmed on histopathology. Postoperative recovery was uneventful.

Adenolipoma of the thyroid gland.

Thyrolipoma or adenolipoma of the thyroid gland is defined as a thyroid adenoma containing mature fat tissue. It is a rare encapsulated lesion. A case of a 35-year-old female presenting with swelling in the neck that was diagnosed as adenolipoma is described because of its extreme rarity.

Testicular granulosa cell tumor, adult type.

Granulosa cell tumor (GCT) of the adult type is a rare and slow-growing neoplasm in the testis. This tumor may be associated with endocrine manifestations and resemble classic GCT of the ovary morphologically. It has a potential for distant metastasis or recurrence late in the clinical course. We report a case of granulose cell tumor of the testis, adult type.

Acute renal failure in the intensive care unit.

BACKGROUND: Acute renal failure (ARF) in the intensive care unit (ICU) is associated with high mortality. A thorough understanding of the clinical spectrum of the disease is needed in order to devise methods to improve the final outcome due to this problem. AIMS AND OBJECTIVES: The aim of the present study was to analyze the clinical spectrum, causes, risk and prognostic factors and final outcome of ARF in the setting of ICU. METHOD: This prospective study involved patients admitted to ICU during the period between September 2003 to January 2005 (17 months). Patients who developed ARF during the ICU stay were included in the study. The clinical and laboratory data were collected at admission and then on daily basis. Data recorded included; patient characteristics, underlying medical conditions responsible for ICU admission, dialytic status, need for ventilation, total duration of ICU stay, APACHE-III score and final outcome, and these data were analyzed for predicting survival using univariate and multivariate analysis. RESULTS: Twelve hundred and fifteen (1215) patients were admitted to ICU from September 2003 to January, 2005 and 46 (3.79%) patients developed ARF after admission to ICU. Mean age of patients was 44.9 +/- 17 years and 56.5% were males. Comorbidity was seen in 24 (52%) patients; hypertension (34.7%), diabetes mellitus (28.3%), coronary artery disease (30.4%) and chronic kidney disease (13%). ARF had developed complicating medical and surgical conditions in 33 (71.7%) and 11 (23.7%) patients respectively. The etiology of ARF was multifactorial and included; hypotension (71.74%), volume depletion (17.4%), nephrotoxic drugs (67.39%), and sepsis (69.5%). Multiple organ system failure (MOSF) was noted in 63% of cases and dialysis was required in 25 (54.3%) patients. Mortality occurred in 63% of patients. MOSF and sepsis were found to be significant adverse prognostic factors when multiple logistic regression analysis was done. CONCLUSIONS: ARF was seen in 3.79% of cases in our ICU and associated with poor prognosis. Presence of sepsis, MOSF, higher APACHE--III scores and ventilation need were correlated with higher mortality in ARF patients in the intensive care unit.

Extraskeletal chondroma of the hand--a case report.

Extraskeletal chondroma is a rare entity. A fairly benign condition, it is usually seen in adults. It presents as an enlarging mass, most commonly in the hand. Local excision is the treatment of choice. We present a case of extraskeletal chondroma of hand in a 12 year male child. Its variable histological appearance not infrequently leads to a mistaken diagnosis of chondrosarcoma.

Malignant Brenner tumour--a case report.

Malignant Brenner tumour is a rare pathological entity. Apart from identification of typical benign, metaplastic and/or proliferating components, stromal invasion must be observed for diagnosis of Brenner tumour. A case of malignant Brenner tumour is described along with a brief review of strict criteria of diagnosis and its biological behaviour.

Cystic lymphangioma of the spleen--a case report.

Splenic cystic lymphangioma is a very rare condition. It occurs commonly in children in whom it is often an incidental imaging finding. In the absence of histologic confirmation, it usually mimics hydatid disease and other cystic vascular proliferations of the spleen. We present a case of cystic lymphangioma of the spleen in 15 years old female.

Pancreatoblastoma (infantile pancreatic carcinoma)--a case report.

Pancreatoblastoma or infantile pancreatic carcinoma is a rare pancreatic tumor with distinct acinar and squamoid cell differentiation that generally affects infants and young children. Ultrasound and CT scan may be useful but preoperative diagnosis is often quite difficult. The outcome is generally favourable. A such case of 10 years old boy with an abdominal mass is being presented.