COVID-19 and tinnitus-a tertiary care Centre experience

Background: COVID-19 outbreak was declared a global pandemic in March 2020 by WHO. Due to person-to-person transmission of this infection, majority of countries of world introduced lockdown to ensure people stay at home. A complex bidirectional interaction exists between tinnitus and emotional distress, as they can exacerbate one another. Also, COVID-19 infection can cause damage to outer hair cells. The aim of this study is to find out relationship between COVID-19 and initiation or exacerbation of tinnitus. Method(s): The present retrospective study, after approval by Institutional Ethics Committee, was conducted in Department of ENT, GMC Jammu, from June 2020 to March 2021 on 90 patients with primary complaint of tinnitus. All 90 patients were asked to complete the Tinnitus Handicap Inventory. Also, all patients were asked COVID-19-related questions (history of contracting virus/history of grief/anxiety/depression/stress/nervousness/financial status/ physical exercise/sleep routine/ social interactions). Result(s): Out of 90 patients, 72 patients (80%) had chronic longstanding tinnitus and 18 patients (20%) experienced tinnitus during pandemic. Out of 72 patients who gave history of longstanding tinnitus, 41 patients (56.9%) reported tinnitus to be stable during COVID-19 pandemic, 26 patients (36.1%) reported it to become more bothersome and 5 patients (6.9%) reported that tinnitus was improved. Out of 90 patients, 21 patients (23.3%) were diagnosed as COVID-19 positive. Of these 21 patients experiencing COVID-19 symptoms, 16 patients (76.2%) gave history of exacerbation of tinnitus, 4 patients (19%) gave history of tinnitus remaining stable and 1 patient (4.7%) said that tinnitus was improved. Out of 90 patients, history of negative psychological impact due to COVID-19 restrictions was seen in 65 patients (72.2%). Conclusion(s): With our study, we concluded that ENT specialists should be fully aware that not only pre-existing tinnitus may be exaggerated due to COVID-19 infection, but also, there can be development of new-onset tinnitus due to COVID-19 infection and the negative psychological impact due to COVID-19 pandemic.Copyright © 2022, The Author(s).

CLINICAL, LABORATORY PROFILE, TREATMENT AND OUTCOME OF PRIMARY AMYLOIDOSIS IN THE ERA OF NOVEL AGENTS: AN EXPERIENCE FROM A TERTIARY CARE HOSPITAL IN INDIA

Background: Diagnosis of AL amyloidosis requires demonstration of amyloid in affected tissues along with clonal plasma cells in bone marrow or presence of monoclonal light chains in blood. With increasing awareness among physicians and availability of proper diagnostics, more cases of AL amyloidosis are being diagnosed. Here we present our experience of AL amyloidosis diagnosis and treatment in the era of modern diagnostics and therapy with novel agents. Aims: We aimed to describe the clinical presentations, laboratory features and outcomes of patients with AL amyloidosis in a single center using standard diagnostic tests and treatment with novel agents. Methods: A retrospective analysis of AL amyloidosis patients, diagnosed in our hospital, a tertiary care center in India from January 2016 to December 2021. The data was collected from departmental database. All statistical analyses were done by SPSS version 17. Results: Diagnosis of AL amyloidosis was done in 27 patients. Median age of presentation was 59 years. 22 (81.5%) were males. Major symptoms were pedal edema (37%), shortness of breath (22.2%), frothy urine (11.1%) and fatigue (11.1%). Twenty two (81.5%) presented with ECOG PS ≥ 2. Most common system involved was renal in 16 (59.2%), followed by cardiac in 13 (48.1%) and gastro-intestinal in 9 (33.3%). Fifteen (55.6%) had two or more system involvement while 12 (44.4%) had single system involvement. Lambda monoclonal light chain was present in 22/27 (81.5%) and kappa monoclonal light chain was present in 5/27 (18.5%). Median Hb was 11.6 g/dl (range 6.7- 14.8 g/dl), median M-protein was 0.69 g/dL (range 0-2 g/dL) and median bone marrow plasma cells were 7% (range- 1-18%). Fourteen patients were treated;cyclophosphamide, bortezomib and dexamethasone (CyBORD) in 10/14 (71.4%) and bortezomib + dexamethasone in 4/14 (28.6%). Among 14 patients followed up with median follow up of 13 months (range 6-60 months), 5 expired;3 due to COVID, one due to cardiac arrhythmia (during first cycle) and one due to relapse and rest 9 were alive. Among the 9 patients who were alive 6 were in complete hematological response and 3 were in partial response after 6 cycles of therapy. Summary/Conclusion: Our study presents the spectrum of clinical manifestations, management and outcomes of primary amyloidosis in Indian context. There is a need to increase the awareness among the physicians about amyloidosis so that early diagnosis can be made and timely treatment can be done with novel agents to improve the dismal historical results.

Role of Physical Therapy and Virtual Rehabilitation during and after COVID-19 Disease

Early physical therapy rehabilitation protocols have shown improved functional outcomes and a reduction in mortality rates. Virtual rehabilitation (VR) has allowed practitioners to provide safe treatment without any risk of viral contamination. This review aimed to evaluate the importance of physical therapy and rehabilitation during and after the infection of coronavirus (COVID-19). To do so, four electronic databases such as PubMed, ResearchGate, Science Direct, and Google Scholars were searched to retrieve articles published after the outbreaks of the COVID-19 pandemic. Six studies were included in the final review. It is a compilation and examination of physical therapy treatments provided by various hospitals and organizations during and after CO-VID-19. The present review throws light on physical therapy, going hand in hand with VR, to play a promising role in patients with mild to moderate symptoms, thus improving their quality of life. The necessary references, as well as the statistics gathered from the published articles, are available. A total of 12 046 patients were included. Of the total patients, 3085 (25.6%) had fatigue symptoms and 1866 (15.5%) had arthralgia/myalgia. Within an hour of being in the prone position, patients were found to have an increase in the oxygen saturation (SpO2) level from 94% to 98%. The pace of breathing also improved, dropping from 31 to 22 per minute. Physical therapy and VR have improved daily activities while assisting in the recovery of health, lifestyle, and lowering post-illness physical and mental deficiencies. ©Copyright 2022 by Anatolian Journal of Family Medicine

Mental health problems in health-care workers of tertiary level COVID-19 care centers in Central India

Background: The health-care workers (HCWs) who are overburdened during the COVID-19 pandemic are at increased risk of developing psychological disorders. Aim: The aim of this study was to assess the magnitude of psychological problems such as depression, anxiety, and fear of COVID-19 among the HCWs and to study their correlates. Material and Methods: The study is an online multicentric cross-sectional survey of mental health problems in the HCWs of three tertiary level COVID care centers in Central India. HCWs were assessed using the Patient Health Questionnaire-9 (PHQ-9), Generalized Anxiety Disorder Scale-7 (GAD-7), and Fear of COVID-19 Scale. Results: Out of 467 HCWs assessed, 25.5% of the participants had depression (defined by PHQ-9 score of more than 5), whereas anxiety was present in 24.4% of the study subjects (defined by GAD-7 score of more than 5). Forty-six percent of the participants had medium-to-high levels of fear of COVID-19. Female gender, working in the nonclinical department, direct involvement in care of COVID-19 patients, perceived worsening of physical health status following the pandemic outbreak, and past history of psychiatric problem were the factors significantly associated with presence of depression as well as anxiety. Age of the participant had a positive correlation with fear of COVID-19 and a negative correlation with depression and anxiety levels. Conclusion: HCWs serving in COVID hospitals are vulnerable to develop mental health problems and appropriate screening measures and interventions should be designed so as to preserve mental health of this vital task force.

Has the COVID-19 Pandemic Exacerbated India's Mental Health Issues?: A Narrative Review

Purpose: Presently, the COVID-19 second wave is creating havoc with extensive surges in active cases and fatality in India. The country witnessed lockdowns, various prevention strategies including quarantine and social isolation for the first time in the history. Rippling impact on economy, socio cultural atmosphere, migration, sports, agriculture was observed. The drastic change affected mental health of people as well. The objective was to document pandemic's effect on the mental health of people of India. Methodology: "COVID-19", "mental health", "psychology", "lockdown", "quarantine" was searched in PubMed in different orders. The final selection constituted 17 articles. Findings: The review revealed symptoms of depression, anxiety, stress in adults. Quarantine children and young adults showed negative symptoms of mental health, health care professionals reflected high prevalence of depression, anxiety and stress and low Quality of Life (QoL). Gender, age, education, occupation, marital status, parenthood and income were found to be the predictors of mental illness. Insomnia, fear, worry other negative mental health symptoms were documented. Research Limitations: Review of literature in this area is restricted. So, all types of research articles were selected in the review. Originality/Value: The article recognizes the symptoms of mental health experienced, vulnerable population and predictors. Country's large size, diversity, constrained healthcare resources, makes it challenging to deal the pandemic including protection of mental health. The review would be constructive to researchers, psychiatrists, psychologists, policymakers. Together they could strategize holistic interventions for the problems.

Livelihood Challenges and Mitigation Strategies Adopted During COVID-19 Lockdown Period

Over the past century, apart from COVID-19, human civilization has seen five other significant pandemics such as the H1N1 outbreak in 2009, Ebola outbreak in West Africa in 2014, and subsequent outbreak in Congo in 2019, Zika outbreak in 2016, etc. However, of all these outbreaks, perhaps the COVID-19 pandemic is unparalleled due to the global proportions that it has assumed. The severity of the epidemic can be seen in terms of the number of lives lost and the multi-dimensional impact that COVID-19 has had upon the economies of nations and lives of people. Beyond the physical sphere of human life, COVID-19 has also impacted human life's social, mental, and economic aspects. This study was conducted to understand the livelihood challenges faced by the residents of 5 villages in Mulshi taluka during the lockdown period. In-depth interviews were conducted with three respondents from each village (15 respondents). The study drew upon the insights given by key opinion leaders in the towns such as Sarpanch and elected members of the gram panchayat, ASHA workers, ration shop owners etc. Identify the livelihood challenges faced by the people during the lockdown imposed due to COVID-19. Describe the strategies adopted by the people to overcome the challenges to livelihood faced by the people. The residents of the village's studies faced various challenges related to agriculture such as lack of manpower to harvest produce, lack of transportation facilities to transport produce to markets, lack of storage facilities to store agricultural produce etc, loss of employment faced by daily wage laborers due to non-operational status of small businesses during the lockdown period and challenges due to reverse migration.

Awareness and Usage of 'Aarogya Setu' Mobile Phone Application in Mulshi Block of Pune District: A Clinic-based Study

Background: The 'Aarogya Setu' mobile phone application (app) is designed to inform people regarding the potential risk of COVID-19.Alimited amount of information is available about awareness and usage of the app. Objective: To assess awareness, opinions, and usage of the 'Aarogya Setu' app amongst out patients of three clinics in Mulshi taluka of Pune district. Methods: Convenient sampling technique was used. A total of 234 patients were interviewed who visited the clinics over five months. The interviews were conducted on phone using a pre-tested questionnaire. Additionally, 15 indepth interviews were conducted with the participants who had previously used the app. on the telephone using an interview schedule. Quantitative data were analyzed by calculating frequencies and associations. An inductive approach was used to analyze qualitative information. Results: Around one-third of the participants (33.8%) were aware that the 'Government of India' (Gol) has developed an app named 'Aarogya Setu' to fight against the pandemic. A significantly higher percentage of awareness was observed in the participants less than 35 years of age. The app was mostly known and used for 'obtaining the number of nearby COVID-19 patients'. Overall, the participants believed in the purpose of the app. Concerns were raised about the reliability of the data gained from the app. Conclusion: Awareness of the 'Aarogya Setu' app needs to be enhanced amongst all age groups. Trust building in the app must be strengthened simultaneously.

Imaging findings using a combined MRI/CT protocol to identify the "entire iceberg" in post-COVID-19 mucormycosis presenting clinically as only "the tip".

AIM: To analyse combined computed tomography (CT) and magnetic resonance imaging (MRI) characteristics of invasive rhino-orbital mucormycosis (IROM) in post-COVID-19 infection patients for accurate diagnosis and delineation of the extent of involvement. MATERIALS AND METHODS: A retrospective analysis was undertaken of 50 patients who developed IROM post-COVID-19 infection who underwent combined CT/MRI evaluation. RESULTS: The age range of the 50 affected patients was 23-73 years. Out of these, 41 were diabetic. CT/MRI showed predominant involvement of the maxillary (n=26) and ethmoid (n=19) sinuses. Extension of disease to the orbit (n=35), cavernous sinus (n=18), hard palate (n=15), skull base (n=8), and intracranial involvement (n=3) was seen. Perineural spread of the disease was analysed along all divisions of the trigeminal nerve and its branches. MRI showed T2-hypointense soft-tissue thickening with heterogeneous contrast enhancement with corresponding hyperdensities on CT diagnosing the presence of fungal elements. CONCLUSION: Clinicians should be aware of the possibility of IROM post-COVID-19 infection. Conjunctive use of CT, which depicts bone destruction and other reactive bony changes along with MRI, which reveals characteristic findings of soft-tissue thickening of the involved sinuses with extension of disease to the orbits, cavernous sinus, dura, hard palate, skull base, and intracranial structures. Accurate diagnosis and early recognition of the disease and its extension with appropriate use of these techniques helps to initiate appropriate and timely treatment, which is vital to prevent a fatal outcome.

A Cross-Sectional Study of Psychological Distress and Fear of COVID-19 in the General Population of India during Lockdown

Context: With relatively high transmission rate and fatal potential, the COVID-19 pandemic is responsible for widespread fear and psychological distress all over the world, including India. Aim: Assessment of these problems in the general population is the first step to address this problem. Settings and Design: We did an online survey using snowball sampling strategy through various social media communication platforms. Materials and Methods: Semi-structured format was used to collect sociodemographic data and COVID-19-related information. The Kessler's Psychological Distress Scale (K10) and the Fear of COVID-19 Scale were used for assessment psychological distress and fear, respectively. Results: A total of 530 study respondents had adequate participation from all socioeconomic strata, diverse educational and professional backgrounds, and from all parts of the country. Majority of the participants were from red zone districts of lockdown (72.8%) and considered the imposed lockdown as essential (98.7%), although many of them reported negative impact on their psychological state (38.9%). A substantial number (38%) of people reported psychological distress significantly (P < 0.05) associated with females, unmarried, students, lower socioeconomic status (SES), caretakers of COVID-19 patients, poor perceived physical health, and higher score on the Fear of COVID-19 Scale. Female participants and those belonging to lower SES and a red zone district also reported significantly (P < 0.05) higher degree of fear of COVID-19. Despite this, only about 10.9% of the respondents sought help through telephonic or online counseling and most (91.4%) of them found it helpful. Conclusions: The impact of COVID-19 pandemic on psychological health is catastrophic. Planned measures at local as well as national level are essential to avert this crisis.

Typically ''atypical'': A case series of atypical chronic myeloid leukemia

Aims & Objectives: Atypical Chronic myeloid leukemia (aCML) is a rare subtype of MDS/MPN. The diagnosis of aCML has evolved over years with more evidence from cytogenetic and molecular studies. We report here a case series of three patients with aCML that was picked up based on morphology and molecular workup. Patients/Materials & Methods: Case 1: A 68-year male with incidental detection of leukocytosis on routine hemogram without organomegaly with Hb11.6 g/dL,TLC 35X103/μl,platelets 41X103/ ll,DLC My30MM5N53L8E3Baso1%. Bone marrow was hypercellular with M:E ratio7.7:1, severe dysgranulopoiesis, 07% blasts,and dysmegakaryopoiesis (>50%). His extended MPN reflex panel (BCR-ABL1, JAK2, CALR, MPL) was negative. Provisional diagnosis of aCML was made. NGS panel revealed multiple mutations in ZRSR2, ASXL1, RUNX1, SF3B1, EZH2, TET2 genes. He has completed 6 cycles of Azacytidine and remains stable for 8 months since the diagnosis. Case 2: A 76-year old male with suspected CML presented with mild hepatosplenomegaly with Hb 8.9 g/dL,TLC 46X103/μl, platelets 75X103/μl, DLC Blast3My12MM8 N66Ly8 Mono2Baso1% and 2nRBC/100 WBCs. Bone marrow was hypercellular with M:E 6.3:1, significant dysgranulopoiesis 03% blasts, and dysmegakaryopoiesis. His extended MPN reflex panel was negative. NGS revealed mutations in ASXL1 and KRAS genes. After diagnosing aCML he was started on hydroxyurea and remains stable after 6 months of diagnosis. Case 3: A 71-year old female with suspected CML based on moderate splenomegaly and hemogram showed Hb 8.9 g/dL,TLC 65.94X103/μl, Platelets 45X103/μl with DLC Blast1My29MM22N38Ly5Eo4Baso2% Bone marrow was hypercellular with M:E 5.8:1, prominent left shift in granulocytic series, 01% blasts, no dysgranulopoiesis. There was significant dysmegakaryopoiesis. A provisional diagnosis of CML vs MDS/MPN was kept and was advised molecular workup. BCR-ABL1 and JAK2 mutation were negative. NGS panel revealed ASXL1 and SF3B1 gene mutations. Finally diagnosed as aCML and treated with Hydroxyurea. She developed undiagnosed fever during COVID19 lockdown and succumbed to her illness. Discussion & Conclusion: Atypical CML is a very rare entity with close differential diagnoses of accelerated phase of CML or MDS/ MPN-U. However as more awareness of this entity has emerged, more patients are subjected to NGS evaluation, thus contributing to the knowledge about this under-reported diagnosis from the third world.