Depression and Anxiety among COVID-19 Indian Intensive Care Unit Survivors: A Prospective Observational Study.

Background: Long-lasting physical, cognitive, and mental health sequelae including depression and anxiety are common in intensive care unit (ICU) survivors. Aim: This study was aimed to assess the immediate and medium-term mental health sequelae-depression and anxiety among coronavirus disease-2019 (COVID-19) ICU survivors. Materials and methods: The COVID-19 ICU survivors of a tertiary level ICU were recruited into this study from 1 July 2020 to 31 October 2020. Willing participants were circulated with an electronic questionnaire. It consisted of demographics and questionnaires related to COVID-19 disease, comorbidities, and a patient health questionnaire (PHQ-9) scale for depression, and generalized anxiety disorder (GAD-7) scale for anxiety. Responses were collected at the time of discharge. Follow-up was done at 2 weeks and 6 months. Results: Among the 133 COVID-19 ICU survivors contacted, 91 survivors submitted the baseline data at the time of discharge. Fourteen and another 11 survivors were lost to follow-up at 2 weeks and at 6 months. The median age was 52.75 and 68.1% (n = 62/91) were male. The median PHQ-9 and GAD-7 scores showed a statistically significant decrease at 2 weeks and a non-significant decrease at 6 months compared to baseline scores. The GAD-7 score was the same or worse between baselines to 2 weeks, but it reduced between baseline to 6 months for all variables and their subgroups. Conclusion: This study revealed a high prevalence of anxiety and depression in the immediate post-discharge period. These findings suggest the need for better mental rehabilitation strategies to deal with the well-being of critically ill survivors in future pandemics. How to cite this article: Gunjiganvi M, Rai S, Awale RB, Mishra P, Gurjar M, Gupta D, et al. Depression and Anxiety among COVID-19 Indian Intensive Care Unit Survivors: A Prospective Observational Study. Indian J Crit Care Med 2022;26(12):1267-1274.

Organizational resilience and social-economic sustainability: COVID-19 perspective.

COVID-19 has affected the global economy like no other crisis in the history of mankind. It forced worldwide lockdown and economic shutdown to the point from where the recovery process has been very difficult. It has affected demand, supply, production and consumption in such a way that the entire economic development cycle has gone to its lowest levels. COVID-19 has also affected the social and economic sustainability structure which has led from one crisis to another and the developing countries have been the worst hit. Economic crisis resulted in unemployment leading to labour migrations, inevitable casualties and rising poverty etc. However, at a certain level, a few industries and organizations have shown resilience with better anticipation and survivability which may lead them to a quicker recovery. The current study aims at presenting a holistic view of organizational resilience which leads to the overall sustainable development. The study considers three aspects of organizational resilience as crisis anticipation, organizational robustness and recoverability. It assesses the impact of the aspects of resilience on social sustainability and economic sustainability. The study uses empirical analysis of primary data which is analysed to verify the hypothesized relationships by using a structural equation modelling approach. The study finds out that predicting the crisis and disruptions, building robustness and recoverability have a positive effect on both the social and economic aspects of sustainability. Findings of the study have their practical implications for industry, researchers and society.

Prospective analytical study of assessment of off loading by Total Contact Cast in treatment of non healing plantar ulcers in anaesthetic foot.

BACKGROUND: Chronic planter ulcer, also known as trophic ulcer, shows no tendency towards healing. It is usually seen in sensory deficient foot. The clinical result of a sensory, motor or autonomic loss of a nerve function is frequently the same--ulceration, although the exact cause may vary. The treatment principle involves dressing and avoiding pressure on the ulcerated site called 'offloading' and patient education for prevention. AIM OF THE STUDY: To determine the outcome of non-healing planter ulcers in an anaesthetic foot treated with offloading, total contact casting (TCC), in terms of rate and duration of healing and percentage of ulcers healed based on improvement of Wagner's grading with respect to the clinical profile of the patient. METHOD: Detailed examination of the patients was done, and neuropathic foot confirmed. Surgical debridement of the ulcer was done to take off all the necrotic tissues, periwound callus, and infected material down to viable tissues. Once the ulcer became clean, a total contact cast was applied with a walking iron for ambulation. TCC was renewed every 2 weeks and rate of healing was assessed. RESULT: 80% of the cases healed within 8 weeks, healing defined by complete re-epithelisation of wound. Average duration of healing of an ulcer was 6.73 ±1.92 weeks. LIMITATIONS OF THE STUDY: Small sample size and the lack of control subjects for comparison. CONCLUSION: Offloading with total contact casts is believed to be the gold standard method with better and faster healing rates.

Return to Sports in Stress Reaction and Stress Fractures in Indian Athletes: A Case Series.

Introduction: A stress fracture is a painful condition which occurs when the adaptive ability of the bone is unbalanced. This imbalance predominantly occurs due to increased intensity, frequency, or duration of training. Identifying the etiology of stress fracture and its proper treatment prevents recurrence. Besides, evidence-based and supervised rehabilitation is indispensable for permanent remission of pain and return to sports to preinjury functional levels. The case series discusses the continuum of stress reaction to stress fracture in athletes, causes of stress fractures, their management, and return to sport. The paper aims to give a clear discussion about the management with rehabilitation guidelines for metabolic causes of stress fractures. Case Report: This study was a case series of five cases coming to Sports Medicine outpatient clinic of Sports Injury Centre, VMMC and Safdarjung Hospital, New Delhi, and physical medicine and rehabilitation outpatient clinic of Sanjay Gandhi Post Graduate Institute of Medical Sciences, Lucknow over a period of 1 year. The discussed cases are young Indian athletes, both male and females, who have presentation along the continuum of medial tibial stress syndrome (MTSS) to stress reactions and stress fracture. Conclusion: The findings of the paper highlight the significance of rehabilitation for individuals suffering from MTSS. Accurate diagnosis with targeted rehabilitation leads to quicker return to sports. The rehabilitation program comprises of identifying and treating the cause of stress fracture, removing any risk factors, biomechanical correction wherever indicated, structured exercise program, training in underwater treadmill, cyclical increase in loading, reducing activity every 3rd week.

Impact of COVID-19 Pandemic on People with Locomotor Disability in North India: A Cross-Sectional Analysis.

OBJECTIVE: To assess, analyse, and infer the impact of the coronavirus disease 2019 (COVID-19) pandemic on people living with locomotor disability in North India. METHODS: Patients with locomotor disabilities who met the inclusion criteria received a questionnaire that had already undergone testing and validation. It covered topics highlighting the effect of the pandemic on general health, financial burden, psychological and mental health, social life and behaviour, disability and comorbidity management, transportation, and healthcare accessibility during the pandemic. In order to gauge the pandemic's effects on the population of people with locomotor disabilities, the answers to the questions were collected and analyzed. RESULTS: The COVID-19 pandemic has adversely affected people living with locomotor disability, ranging from loss of wages and financial crisis to anxiety, depression and lack of sleep. People with disabilities had limited reach to health and community services that were vital for them, including basic life and functional needs, besides risks of mistreatment and other psychological consequences. CONCLUSION: This analysis suggests that the root cause of pandemic disparities is the lack of disability-inclusive planning and, more significantly, the pre-existing socioeconomic disparities and challenges that disabled people have been experiencing for a long time. We suggest that unambiguous public health and policy responses should be incorporated, and health, social participation, and socioeconomic disparity causes for disabled people should be addressed in tandem.

Role of Autologous Platelet-Rich Fibrin in Chronic Non-healing Ulcers With Various Etiologies in a Tertiary Care Rehabilitation Centre: A Case Series.

Introduction Chronic non-healing ulcers are defined as a discontinuity or break in the integrity of skin that is not healing in a reasonable period of time due to an underlying systemic etiology. Despite using conventional initial treatment and many other available dressing options, such wounds are difficult to completely heal, thus affecting the progress of rehabilitation measures and compromising functional improvement and quality of life. Materials and methods In this case series, platelet-rich fibrin (PRF) was applied to eight wounds from six patients. The patients included had various etiologies (including spinal cord injury, peripheral vascular disease, Guillain-Barré syndrome, and diabetic foot ulcer) with chronic non-healing wounds over different anatomical locations on the body. Pressure ulcer scale for healing (PUSH) score, surface area, and volume of the wounds were evaluated and monitored weekly after PRF dressing. We have applied PRF every week. On average, two PRF dressings were applied, the maximum being three applications. Results The maximum healing rate in terms of PUSH score was observed to be 3.84% per day, and the minimum was 1.19% per day. The maximum healing rate in terms of surface area was observed to be 5.89% per day, and the minimum was 1.78% per day. Three of the wounds showed complete closure. The maximum follow-up period was 10 weeks. The percentage mean Functional Independence Measure (FIM) improvement was calculated to be 15.87% ± 14.04 during the course of hospitalization after PRF application. Conclusion Based on the results, we can conclude that PRF showed accelerated improvement in the healing of chronic non-healing ulcers of various etiologies at different anatomical locations. It has proven to be a safe and effective method, thereby improving their quality of life and functional independence in performing activities of daily living. To our knowledge till date, no other study in a rehabilitation setting has been done on patients having non-healing ulcers due to various etiologies and at different anatomical locations.

Efficacy of Yoga Nidra on Depression, Anxiety, and Insomnia in Frontline COVID-19 Healthcare Workers: A Pilot Randomized Controlled Trial.

The COVID-19 pandemic has led to a surge of mental health disturbances and the subsequent use of various mind-body therapies. Although evidence supports the benefits of yoga for mental health in a variety of disease states, information on its effects among healthcare workers during the COVID-19 epidemic is scarce. Therefore, this study evaluated and compared the efficacy of relaxation to music and yoga nidra on the mental health of frontline healthcare workers during the pandemic. This open-label randomized trial was conducted at a Level III COVID-19 care center. In the Relaxation-to-Music Group, participants received deep relaxation music, whereas those in the Yoga Nidra Group performed yoga nidra practices; both interventions were delivered through a YouTube platform and were to be done daily for 30 minutes during the healthcare workers' 2-week duty periods. The primary outcomes were measured using scores of the Patient Health Questionnaire (PHQ)-9, Generalized Anxiety Disorder (GAD)-7 scale, and Insomnia Severity Index (ISI) at the end of the duty period. A total of 79 healthcare workers were randomly divided into two groups: (1) Relaxation-to-Music (n = 40) and (2) Yoga Nidra (n = 39). Demographics; clinical characteristics; and PHQ-9, GAD-7, and ISI scores of the two groups were comparable at baseline. In the Yoga Nidra Group, PHQ-9 scores decreased significantly (5.17 ± 4.25 to 3.03 ± 2.40, p = 0.002) compared to the Relaxation-to-Music Group (5.68 ± 4.73 to 4.34 ± 2.90, p = 0.064). Similarly, GAD-7 scores decreased significantly in the Yoga Nidra Group (4.93 ± 3.27 to 2.33 ± 2.56, p < 0.001) compared to the Relaxation-to-Music Group (4.84 ± 3.94 to 4.03 ± 3.56, p = 0.123). ISI scores also decreased significantly in the Yoga Nidra Group (6.10 ± 3.53 to 3.03 ± 2.88, p < 0.001) compared to the Relaxation-to-Music Group (6.09 ± 5.37 to 5.93 ± 5.95, p = 0.828). In this study, yoga nidra practice was more helpful than relaxation to music in reducing depression, anxiety, and insomnia among frontline COVID-19 healthcare workers during their duty periods.

Rehabilitation During COVID-19 Pandemic: An Indian Perspective.

It has been noted that as high as 20.3% of patients hospitalized for coronavirus disease 2019 (COVID-19) require intensive care unit (ICU) admission. This has most commonly been attributed to the development of acute respiratory distress syndrome. These patients require prolonged periods of ICU stay, averaging approximately 20 days. As people recover and are discharged, there will be a new pandemic of critical illness survivors. These patients would present with impairments and disabilities arising because of prolonged ICU stay as well as consequences of severe respiratory illness. The longer the duration of ICU stay, the higher is the risk for long-term physical, cognitive, and emotional impairments needing comprehensive and early rehabilitation. This article focuses on the indispensable role of early and interdisciplinary rehabilitation in effective disaster management, restoring functions, and improving quality of life in COVID survivors. It outlines how to practically expand rehabilitation services in a resource-limited country, such as India, and lists the limitations being faced that prevent the uniform application of rehabilitation services in India. This would help to deal with the rapid increase in demand of postacute care facilities, be it in hospital services, in the form of inpatient or outpatient rehabilitation or home care facilities, including telemedicine.

Comparative assessment of fluoride release and recharge through newer fluoride releasing posterior restorative materials: An in vitro study.

AIM: This study aimed to assess and compare the fluoride release and recharge capacity of CentionN, Zirconomer and Gc Gold Label 9 Extra. METHODOLOGY: Disk-shaped specimens (n = 12) of CentionN, Zirconomer and Gc Gold Label 9 Extra were prepared according to manufacturer's instructions. After setting, each specimen was dipped in a plastic tube containing 5ml deionized water and incubated at 37°C ± 2°C. Every 24 h, the samples were placed in fresh 5 ml deionized water. Mean fluoride release (in ppm) from each material, on day 1 and day 6 was calculated using a spectrophotometer. On day 6, the specimens were recharged with 0.2% neutral NaF solution for 2 min and the fluoride release on day 7 was determined. RESULTS: Cention N released significantly greater amount of fluoride on day 1 and day 6, than zirconomer and Gc Gold Label 9 Extra (P < 0.001). Cention N showed a better recharge capacity than zirconomer and Gc Gold Label 9 Extra (P < 0.001). CONCLUSIONS: Cention N with a higher fluoride release and recharge capacity can be used as a posterior restorative material in patients with high caries risk, thereby inhibiting secondary caries.

Absence of caveolin-1 leads to delayed development of chronic lymphocytic leukemia in Eµ-TCL1 mouse model.

Chronic lymphocytic leukemia (CLL) is the most common adult leukemia in the United States. The tissue microenvironment, specifically the lymph nodes, influences the biological and clinical behavior of CLL cells. Gene expression profiling of CLL cells from peripheral blood, bone marrow, and lymph nodes revealed Cav-1 as one of the genes that might be involved in the pathogenesis of CLL. We have previously reported that the knockdown of Cav-1 in primary CLL cells exhibits a significant decrease in cell migration and immune synapse formation. However, the precise role of Cav-1 in CLL initiation and progression in vivo is not known. Therefore, we decreased the expression of Cav-1 in vivo by breeding Eµ-TCL1 with cav-1 knockout mice. We observed a significant decrease in the number of CLL cells and rate of proliferation of CLL cells in spleen, liver, and bone marrow from Eµ-TCL1-Cav1(-/+) and Eµ-TCL1-Cav1(-/-) mice as compared with Eµ-TCL1 mice. In addition, there was a significant increase in survival of Eµ-TCL1-Cav1(-/+) and Eµ-TCL1-Cav1(-/-) compared with Eµ-TCL1 mice. Mechanistically, we observed a decrease in MAPK-Erk signaling measured by p-Erk levels in Eµ-TCL1-Cav1(-/+) mice when compared with Eµ-TCL1-Cav(wt/wt). Together these results indicate that decreased Cav-1 in Eµ-TCL1 mice significantly delays the onset of CLL and decreases leukemic progression by inhibiting MAPK-Erk signaling, suggesting a role for Cav-1 in the proliferation and progression of CLL.