Psychiatric Symptoms and Fatigue in COVID-19 Survivors.

INTRODUCTION: Psychiatric symptoms and fatigue are common after the coronavirus disease 2019 (COVID-19) illness. The cause of these symptoms is direct neuronal injury and indirect injury with immune-mediated inflammation. In addition, social factors also affect mental health. OBJECTIVE: We aim to compare psychiatric symptoms and fatigue between COVID-19 survivors and healthy controls. MATERIAL AND METHODS: We prospectively evaluated 100 COVID-19 survivors for anxiety, depression, positive affect, and behavior control using the Mental Health Inventory (MHI). Fatigue is assessed using the Modified Fatigue Impact Scale (MFIS) score. We compared them with 100 healthy controls. RESULTS: There was a significant statistical difference between the MHI score and individual components of MHI. Overall, MHI scores in cases and controls were 79.41 and 93.31, respectively, with a P value of less than 0.0001. Computed scores for anxiety, depression, behavior control, and positive affect of COVID-19 survivors showed statistically significant differences as compared to healthy controls. There was a weak association between hospital stay duration and poor MHI scores. Fatigue was significantly worse in COVID-19 survivors, with a mean score of 6.93 in cases and 5.35 in controls, with a P value of 0.0001. This was a cross-sectional study evaluating psychiatric symptom scores, but not establishing the diagnosis. It is suggested that appropriate treatment and counseling for these symptoms should be done. CONCLUSIONS: Psychiatric symptoms and fatigue were significantly more common in COVID-19 patients after recovery from acute illness. It is a major contributing cause of morbidity other than organic complications of COVID-19 and requires attention in management.

People's Perspective on Out-of-Pocket Expenditure for Healthcare: A Qualitative Study From Pune, India.

Background Out-Of-Pocket Expenditure (OOPE) directly reflects the burden of health expenses that households bear. Despite the availability of social security schemes providing healthcare benefits, a high proportion of Indian households are still incurring OOPE. In order to recognize the reasons behind OOPE, a comprehensive understanding of people's attitudes and behavior is needed. Methodology By purposive sampling, 16 in-depth interviews were conducted using an interview guide in the catchment area of urban and rural health centers of a tertiary healthcare hospital. Interviews were conducted in Marathi and Hindi and were audio tape-recorded after taking informed consent. The interviews were transcribed and translated into English, followed by a thematic analysis. Results Although most participants knew that government hospitals provide facilities and experienced doctors, inconvenience and unsatisfactory quality deter them from utilizing government facilities. A few had experiences with government schemes; almost all concur that the formality and procedure of claiming insurance are cumbersome and all have had bad experiences. Cost of medications and consultation accounted for the majority of the healthcare expenditures. While some participants had benefitted from insurance, few regretted not enrolling in one. Conclusion The awareness regarding government schemes was derisory. Government-financed health insurance schemes and their utilization are crucial to reducing OOPE. Efforts should be made to increase accessibility to public healthcare services. Nevertheless, there is potential to redress the barriers to improve scheme utilization.

Real-world utilization patterns of intravenous immunoglobulin in adults with generalized myasthenia gravis in the United States.

OBJECTIVE: To evaluate real-world utilization patterns of intravenous immunoglobulin (IVIg) among patients with generalized myasthenia gravis (gMG) over 3 years post-IVIg initiation. METHODS: Patients with gMG who initiated IVIg treatment were identified from a United States claims database (Symphony Health's Integrated Dataverse [IDV]®, January 1, 2014 - December 31, 2019). The frequency of subsequent IVIg treatment and associated cost during the year post-IVIg initiation were analyzed. Usage patterns of IVIg and concomitant gMG treatments during the year preceding and 3 years post-IVIg initiation were compared. RESULTS: Among 1225 patients with gMG who initiated IVIg treatment, 706 patients (57.6%) received 1 to 5 IVIg treatment courses (intermittent IVIg users), and 519 patients (42.4%) received ≥6 IVIg treatment courses (chronic IVIg users) within the subsequent year. Mean annual medical cost per patient was nearly 2.5-fold higher for chronic vs. intermittent IVIg users ($161,478 vs. $64,888, p < 0.001). The proportion of patients using corticosteroids and nonsteroidal immunosuppressive treatments (NSISTs) was not reduced over the 3-year follow-up period following IVIg initiation, even for patients who continued annual chronic IVIg for 3 consecutive years post-initiation. CONCLUSIONS: Nearly half of patients with gMG received chronic and multiple IVIg treatment courses within the first year once initiating IVIg treatment, indicating higher usage than expected. For all IVIg initiators, the proportion of patients using corticosteroids and NSISTs did not decrease over 3 years despite IVIg initiation.

Effectiveness of Behavioral Counseling in Smokeless Tobacco Cessation Among Adult Users Reporting to a Dental Hospital in Pune: A Randomized Controlled Trial.

Aim To assess the effectiveness of behavioral counseling for smokeless tobacco cessation among adult users in a dental hospital setting. Methods A total of 200 patients visiting a dental hospital who were exclusively using smokeless tobacco (SLT) were enrolled in the study. A randomized controlled trial with a concurrent parallel study design, which consisted of two arms, was conducted. Fagerstrom test for nicotine dependence level and the transtheoretical stage of change was assessed at the baseline. Behavioral cessation counseling and motivational interviewing were provided in the study arm and brief advice was given to those in the control arm. The counseling was provided at baseline and followed up till six months through telephone to assess the change in the frequency of use of SLT products and abstinence from SLT use. A biochemical validation with a urine cotinine test was done to confirm abstinence. Results At six months, there was a significant difference within and between the study and control groups, indicating the role played by behavioral tobacco cessation in reducing the frequency of consumption. About 24.4% of participants in the study group and 10% in the control group abstained from the habit at the sixth month, with an odd's ratio (OR)=2.91 and with a loss to follow-up of 10% in each of the groups. The cotinine test, which was used for validation, revealed a significant difference between the study and the control group. The number needed to treat (NNT) shows that to motivate one additional person to give up the SLT habit, we need to intervene with about seven people. Conclusion Behavior intervention with motivational interviewing was considered an effective method in promoting smokeless tobacco cessation among adults. Transtheoretical stages of change have proven to be an effective model to assess the stage of behavior change of the population toward SLT use and was also helpful for changing the behavior.

Severe acute respiratory syndrome-coronavirus-2 seroprevalence study in Pimpri-Chinchwad, Maharashtra, India coinciding with falling trend - Do the results suggest imminent herd immunity?

BACKGROUND: COVID-19 is a public health concern currently demanding continuous efforts to understand its epidemiology. Pimpri-Chinchwad township with a population of over 25 lakhs is located in Maharashtra, one of the worst affected states in India. After the incidence peaked in the township in mid-September 2020, cases started declining even as lockdown restrictions were eased. OBJECTIVES: A seroprevalence study was conducted to understand the transmission dynamics of the pandemic in this region. METHODS: We carried out a population-based seroprevalence study for IgG antibodies for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) among 5000 residents 12 years and above selected by the cluster random sampling. We selected 50 clusters in slums, 80 clusters in tenements, and 70 clusters from housing societies. The field work for collection of samples was carried out from October 07 to October 17, 2020. We used kit from Abbott (SARS-CoV-2 IgG), which employs chemiluminescent microparticle immunoassay technology. The prevalence of IgG antibodies was expressed as point estimates with 95% confidence intervals (CIs). These were weighted for areas and cluster effect and further adjusted for test performance. RESULTS: The overall seropositivity for IgG was 34.04% (95% CIl 31.3%-36.8%). Slum dwellers had 40.9% positivity rate (95% CI 37.0%-44.7%), those in tenements 41.2% (95% CI 37.7%-44.8%) and people living in housing societies had 29.8% positivity (95% CI 25.8%-33.8%). CONCLUSION: A considerable proportion of population had encountered the novel coronavirus approaching partial, if not complete, herd immunity, which may partly explain the declining trend in spite of easing of lockdown restrictions.

Immunization with ovarian autoantigens leads to reduced fertility in mice following follicular dysfunction.

Immunoproteomics using sera of women with ovarian autoimmune diseases such as primary ovarian insufficiency and IVF embryo transfer recruits led to identification of three proteins namely alpha actinin 4 (α-ACTN4), heat-shock 70 protein 5 (HSPA5), and actin beta (ACTB). This study deals with the establishment of a peptide ELISA for screening sera of antiovarian antibody (AOA)-positive patients and further delves into understanding the role of these three proteins in ovarian autoimmunity in a mouse model. Using in silico approach, antigenic peptides of these proteins were identified and used for peptide ELISA. ELISA results indicated that AOA-positive sera showed reactivity with only specific peptides. The functional significance of the dominant peptides was studied by active immunization of female mice with these peptides. All immunized mice generated high antibody titers and profound effect on ovaries with few primordial (2.4±0.1, 2.4±0.2, and 2±0.1), primary (2.4±0.5, 1.7±0.3, and 2.4±0.3), preantral (2.3±0.5, 3.4±0.3, and 2.9±0.3), antral (0.9±0.2, 1.6±0.8, and 2.3±0.6) follicles, and corpora lutea (2.8±0.8, 2.9±1.7, and 4.6±2.3), and increased number of atretic follicles (5.5±0.4, 4.9±1.8, and 7.5±1.0) in ACTN4-, HSPA5-, and ACTB-immunized mice compared with control animals (3.0±0.2, 3.5±0.6, 3±0.1, 3.6±0.2, 4.7±0.3, and 1.5±0.3) respectively. These mice when mated with fertile male mice showed an overall 25-43% reduction in fertility compared with controls. The data clearly suggest that the dominant antigenic epitopes of the three proteins play critical role in fertility and could possibly be the key autoimmune targets. These epitopes could be used to develop a more specific and sensitive diagnostic test for women with ovarian autoimmune diseases and to design therapy for disease management for reinstatement of ovarian function.

Evaluation of contraceptive potential of a novel epididymal sperm protein SFP2 in a mouse model.

PROBLEM: Sperm flagellar protein 2 (SFP2), which was earlier identified using a novel combinatorial approach, was evaluated for its contraceptive potential in mice. METHOD OF STUDY: Male mice were actively immunized with two synthetic peptides of SFP2. Antipeptide antibody was characterized by Western blot and indirect immunofluorescence. Immune response was monitored, and mating studies were performed 6 and 22 weeks post-immunization. RESULT: Antibodies to the SFP2 peptide 1 recognized a doublet at 220- to 230-kDa region only in the epididymal protein extract. Peptide 1 antibody recognized the cognate protein on spermatozoa from mouse, rat, and human. Histological analysis of testis and epididymis of the immunized mice indicated no deleterious effect. Incubation of sperm with the immune sera of peptide 1 caused significant reduction in motility and viability but did not agglutinate sperm. Only synthetic peptide 1 gave rise to high-level antibodies in all the immunized mice, which on mating resulted in reduced fertility rate (20%) when compared with PBS control animals (100%). The antibody levels in the immunized males declined by 22 weeks post-immunization, resulting in 100% reinstatement of fertility. CONCLUSION: These data provide an experimental basis for the development of effective contraceptive vaccine based on new epididymal target.

Study of susceptibility towards varicella by screening for the presence of IgG antibodies among nursing and medical students of a tertiary care teaching hospital in pune, India.

BACKGROUND: It is believed that all suffer from chickenpox infection in their childhood. Many studies abroad and some in India clearly indicate that many individuals escape the infection in childhood, and thus, remain susceptible in adulthood. Adulthood chickenpox is a more serious infection than childhood. Prior screening of health care workers for the presence of IgG antibodies against Varicella will not only prevent hospital outbreaks but also economic and academic loss faced by the students. This will also have an important implication in terms of patient care as there is a threat of spreading Varicella to immuno-compromised patients. Definite history of prior infection of chickenpox is considered as an indicator for immunity towards the same. However, the reliability of this needs to be tested. AIM: A study to assess the susceptibility of nursing and medical students towards Varicella infection by screening for IgG antibodies against Varicella virus and to identify any risk factors for the same. SETTINGS AND DESIGN: A hospital-based cross-sectional study in nursing and medical students. MATERIALS AND METHODS: Total 78 nursing and medical students participated in the study. They were given prestructured and pretested questionnaires. After obtaining informed consent, blood sample was collected and screened for the presence of IgG antibodies against Varicella by Enzyme Linked Immunosorbent Assay (ELISA) by using a commercial kit. STATISTICAL ANALYSIS: Epi_info 2002 was used for analysis. Age of the study subjects were summarized as mean age and standard deviation. Susceptibility was analyzed as percentage with 95% confidence interval and Chi Square test was used to find association of susceptibility status with sex and region of residence in childhood. Relevance of definite history as an indicator for immunity was assessed by calculating sensitivity, specificity, positive and negative predictive values with 95% confidence interval. RESULTS: Twenty males (25.6%) and 58 females (74.4%) participated in the study from medical and nursing students. The mean age ± standard deviation of mean was 19.4 ± 1.42 years for female students and 20.8 ± 2.13 years for male students. Total 20 (25.6%) students were found to be susceptible to Varicella with the confidence interval ranging from 15.8% to 35.4%. With respect to the gender of the students, the difference between the susceptibility percentage in female students (32%) and in male students (14.3%) was only a numerical difference and not statistically significant (χ(2) = 2.098, P=0.147, d.f. = 2). Also, the susceptibility was seen significantly more among Keralite students (Pearson Chi-Square=16.736, d.f=6, P=0.008; Likelihood Ratio=15.086, d.f=6, P=0.035; Fisher's Exact Test=13.569, p=0.022). The sensitivity of definite history of prior chickenpox infection as an indicator of immunity was only 55.17%, with C.I ranging from 43.9% to 66.4%, specificity was 80%, with C.I. ranging from 70.9% to 86%, and positive predictive value was 88.8% with C.I of 81.7% to 89% and negative predictive value of history of 66.6% with C.I. of 56% to 77.2%. CONCLUSION: Total 20 (25.6%) students were found to be susceptible to Varicella with the confidence interval ranging from 15.8% to 35.4%. Thus, there is a need for vaccination of all susceptible individuals. Definite history of prior chickenpox infection is not a reliable indicator of immunity against the same. The investigators recommend screening for IgG antibodies against Varicella of all students selected for the M.B.B.S. (Bachelor of Medicine and Bachelor of Surgery) and nursing course, and vaccination for susceptible individuals to prevent institutional outbreak and academic loss.

Identification of novel immunodominant epididymal sperm proteins using combinatorial approach.

Functionally immature spermatozoa leave the testis mature during epididymal transit. This process of maturation involves either addition of new proteins or modification of existing proteins onto the sperm domains that are responsible for domain-specific functions. Epididymal proteins are preferred targets for immunocontraception. In an attempt to identify epididymis-specific sperm proteins, we used a novel combinatorial approach comprising subtractive immunization (SI) followed by proteomics. Following SI, sera of mice were used for immunoproteomics, which led to the identification of 30 proteins, of which four proteins namely sperm head protein 1, sperm flagella protein 2 (SFP2), SFP3, and SFP4 are being reported for the first time on sperm. Another group of four proteins namely collagen alpha-2 (I) chain precursor, homeodomain-interacting protein kinase 1, GTP-binding protein Rab1, and ubiquinol cytochrome c reductase core protein II although reported earlier in testis are being reported for the first time in epididymal sperm. Furthermore, seven out of these eight novel proteins could be validated using peptide ELISA. These data are a useful repository, which could be exploited to develop targets for post-testicular immunocontraception or biomarkers for infertility diagnosis and management.