Preferential Impairment of Auditory Working Memory in Long COVID: An Observational Study of Undergraduate Medical Students.

Background Long COVID is a multisystem condition with prolonged symptoms that develop after recovery from the COVID-19 infection, often following a mild infection. Few studies have been conducted on cognitive function among medical students after recovery from mild COVID-19. This study aimed to assess the attention span and working memory (WM) capacity of medical students after six months of recovery. Methods A cross-sectional study was performed on 17 young adult medical students who had suffered a mild COVID-19 infection at least six months prior. Eighteen age-matched healthy medical students served as the controls. Audio-visual WM tasks and attention spans were assessed using computerized software for both the cases and controls. Results The mean ages of the case and control were 19.67±1.6 and 20.0±1.2 years, respectively. The most common symptoms among cases were fatigue (33%), weight loss (26%), and nasal stuffiness (13%). The overall proportion of correct responses across all visual and auditory WM tasks (p=0.085) and reaction times (p=0.609) did not differ between the cases and controls. However, the overall target hit rate of the auditory WM task was significantly lower in cases than in controls (p=0.002). This difference was not observed in the visual WM task (p=0.374). Conclusion In the current study, the overall WM functions (visual and auditory combined) and attention span did not differ between cases and controls. However, auditory WM performance was significantly impaired in patients compared with controls, indicating selective impairment of auditory WM in patients with long COVID.

Change in auditory and visuospatial working memory with phases of menstrual cycle: A prospective study of three consecutive cycles.

The menstrual cycle is a well-known physiological model used to study working memory (WM) function. The present study examined auditory and visuospatial WM during proliferative and secretory phases of three consecutive menstrual cycles.Forty young adult females with a mean age of 23.4 ± 4.2 years and a history of regular menstrual cycle were selected for this study. Computerized software-based dual-task n-back WM tasks were performed by each participant during the proliferative (day 10th - 14th) and secretory phases (day 21st - 25th) of the menstrual cycle. The above tasks were repeated for three consecutive menstrual cycles during follow-up.Data from the three menstrual cycles were pooled and compared between the proliferative and secretory phases. Significant differences were observed in the hit rate (p = 0.006), Z score (p = 0.004) and parametric sensitivity (p = 0.005) of visuospatial targets and Z score (p = 0.037) and parametric sensitivity (p = 0.028) of auditory targets with better performance during the secretory phase. However, no significant differences were found across the three proliferative or three secretory phases, indicating that the results were consistent across consecutive cycles.This study concluded that visuospatial and auditory WM skills were significantly improved during the secretory phase compared to the proliferative phase of the menstrual cycle.

Pre-pandemic autonomic function as a predictor of the COVID clinical course in young adults.

Long coronavirus disease (COVID) is emerging as a common clinical entity in the current era. Autonomic dysfunction is one of the frequently reported post-COVID complications. We hypothesize a bi-directional relationship between the autonomic function and the COVID course. This postulation has been inadequately addressed in the literature. A retrospective cohort (pre and post-comparison) study was conducted on 30 young adults whose pre-COVID autonomic function test results were available. They were divided into case and control groups based on whether they tested reverse transcription polymerase chain reaction positive for COVID-19. Autonomic function tests were performed in both the case and control groups. COVID infection in healthy young adults shifts the sympatho-vagal balance from the pre-disease state. Postural orthostatic tachycardia syndrome was present in 35% of the COVID-affected group. COVID course parameters were found to be associated with parasympathetic reactivity and the baroreflex function. Baseline autonomic function (parasympathetic reactivity represented by Δ heart rate changes during deep breathing and 30:15 ratio during lying-to-standing test) was also associated with the COVID course, the post-COVID symptoms and the post-COVID autonomic function profile. Additionally, multiple regression analysis found that the baseline parasympathetic reactivity was a very important determinant of the clinical course of COVID, the post-COVID symptoms and the post-COVID autonomic profile. Sympatho-vagal balance shifts to parasympathetic withdrawal with sympathetic predominance due to COVID infection in healthy young adults. There is a bi-directional relationship between the autonomic function and the COVID course.

Cancer-associated fibroblasts: Is it a key to an intricate lock of tumorigenesis?

The past few decades have witnessed a major leap in knowledge relating to the role of tumor microenvironment (TME) in carcinogenesis and evolving behavior of the tumor. Multiple factors within the TME modulate the cancer cells and the associated therapies. Stephen Paget first asserted that the microenvironment plays an important role in the growth of tumor metastasis. The most important player in the TME is cancer-associated fibroblast (CAF) which significantly participates in the proliferation, invasion, and metastasis of tumor cells. CAFs show phenotypic and functional heterogeneity. Mostly CAFs originate from quiescent resident fibroblast or mesoderm-derived precursor cells (mesenchymal stem cells), although several alternate sources of origin have been noted. However, due to lack of specific fibroblast-restricted markers, it is very difficult to trace lineage and identify the biological origin of distinct subtypes of CAFs. CAFs are predominantly shown by several studies to mainly act as tumor-promoting agents, however, tumor-inhibiting actions are also being validated by several studies. A more objectified and comprehensive functional and phenotypic classification of CAF is required, which will help in better way for tumor management. Here, in this review, we have tried to review the current status of CAF origin, along with phenotypic and functional heterogeneity, and recent progress in CAF research.

Flipped Classroom (FCR) as an Effective Teaching-Learning Module for a Large Classroom: A Mixed-Method Approach.

Flipped classroom (FCR) is one of the emerging active teaching-learning methods in the medical profession. Its potential for achieving learning objectives, especially in the scenario of a large classroom, especially in medical schools, has not been convincingly demonstrated. This study was designed to establish FCR model conduction and its overall utility as a teaching-learning methodology for undergraduate medical students in large classroom settings using a mixed-method approach using quantitative (assessment scores) and qualitative criteria (subjective feedback from students and teachers). FCR was conducted for a batch of 170 first-year medical students for a hematology topic. Pre- and post-assessments (based on all the cognitive learning domains) were done to quantify the objective improvement after exposure to the FCR. In addition, subjective feedback from both students and teachers was taken on a validated feedback survey to decipher the qualitative benefits of the FCR. Comparing pre- and post-assessment scores, there was a significant improvement after the FCR session, especially in the low performers. There was optimistic feedback from students and teachers regarding the utility of FCR as a teaching-learning module. FCR as a teaching-learning module was feasible and effective, and the users seemed primarily satisfied. Although there is a higher workload for students and teachers, still FCR is an effective teaching-learning module for a large classroom.

A Cross-Sectional Study of Barriers in Prevention of Anemia in Pregnancy.

Introduction Anemia in pregnancy is a significant health challenge in India and other developing countries. Various health programs aiming anemia prevention are existing in India for many decades. Despite that, anemia affects more than half of pregnant women. Our objective for performing this study was to evaluate the barriers in the prevention of anemia and to evaluate the perceptions and practices of anemic women towards their condition. Methods A cross-sectional questionnaire-based study, including 210 anemic women, was conducted in a tertiary care center in Delhi, India. In-depth interviews were conducted with 50 participants. Results Our important observations were that anemia was more prevalent in multigravida, and 43.80% of anemic patients were not taking iron supplements at the time of diagnosis. Chronic diseases were associated with 28.2% (n=59) of anemic women. Only 19% (n=40) of women sought antenatal care in the first and second trimester; the rest all booked themselves in the third trimester only. Twenty-two percent (n=48) of women reached our hospital after 36 weeks. Ignorance to anemia symptoms and the importance of consistent intake of the oral iron supplements was seen in 35.2% (n=74). One hundred and sixty-five (74.8%) women accepted that healthcare provider had informed them about iron-rich and high protein diet, but only 47.1% (n=98) actually made dietary modifications. Only 9.5% (n=20) of women were consistent in iron intake. Side effects of iron were reported by 30% (n=64) of women, and 15% (n=32) were intolerant to oral iron. Non-availability, change of residence, and forgetfulness were the main reasons behind non-compliance to oral iron. Conclusion We emphasize motivation for early registration, regular antenatal care, adequate iron supplement supply, and persistent counseling to ensure compliance to iron supplements by the antenatal care provider. Behavior-changing communication is needed at a societal level for antenatal mothers and their families aiming to prevent anemia in pregnancy instead of focussing on treatment.

A Study of Depressive Symptoms in Doctors Working at COVID-19 Hospitals: An Online Survey.

OBJECTIVE: COVID19 outbreak has put a tremendous physical and mental burden on frontline doctors. A limited amount of literature is available in this area. The present study was done to assess the depressive symptoms and depression levels in doctors working at COVID-19 Hospitals. METHOD: This study was based on an online survey that was started on May 2020 and ended on 30th June, 2020. An online questionnaire which included details such as age, gender, and 21 items to assess depressive symptoms was sent through social media to doctors from various countries. Depressive symptoms were measured by Beck's Depression Inventory-II (BDI-II). Items of a total of 220 questionnaires were responded. Out of these, only 200 responses were analyzed using SPSS software. RESULTS: Out of 200 subjects, 110 (55%) had depressive symptoms and 90 (45%) had no symptoms. Males had more depressive symptoms (42.5%) than females (12.5%). Those who worked at COVID-19 centers 75 (37.5%) had higher depressive symptoms. The number of males working at COVID-19 centers was much higher (36%) than females (12%). Depressive symptoms were significantly higher in males than females (35.35±10.25 vs 16.90±7.76; p<0.0001). CONCLUSION: Doctors, especially males working at COVID-19 centers have higher depressive symptoms than their female colleagues.Multicentric studies with larger sample sizes are needed to study the impact of COVID-19 on frontline doctors.

Hearing Sensitivity in 40-60 Years Old Hypertensive Male Adults.

Declining hearing sensitivity is appreciated as a normal age related change. However, studies reveal that health variables other than age play significant role in hearing impairment over time. Hypertension is one such variable. The objective of this study was to assess whether the hypertension has an accelerating effect on age related reduction in hearing function in males in the age group of 40-60 years. Systolic and Diastolic blood. pressure and Pure Tone thresholds in frequency range 250-8000 Hz were measured in 30 known hypertensive (HT) male subjects in the age group of 40-60 years and 30 age and sex-matched normotensive (NT) controls. There was no significant difference in hearing thresholds at various frequencies between HT and NT group and between uncontrolled HT (n = 15) and controlled HT subgroups (n = 15). However, a significantly positive correlation between the systolic blood pressure and Air conduction thresholds at 4000 Hz and 8000 Hz and Bone conduction thresholds at 4000 Hz were noted in uncontrolled HT subgroup. Results of the current study demonstrated towards the potentially negative impact of uncontrolled hypertension on the auditory function in the age group of 40-60 years.