Influence of N95 Mask-related Hypoxemia on Headache, Stress, Anxiety, and Quality of Sleep during COVID-19 Patient Care among Frontline Health Care Professionals.

BACKGROUND: Prolonged use of N95 masks by healthcare workers might affect physical health due to mask-related hypoxia in addition to the psychological effects of N95 masks. We tried to explore the association of N95 mask-related hypoxia and headache with stress, quality of sleep, and anxiety in the current study. MATERIALS AND METHODS: The sample (N = 78) consisted of 41 doctors and 37 nurses involved in COVID-19 patient care and using N95 masks with or without PPE for at least 4 hours. Perceived stress scale (PSS), Coronavirus anxiety scale (CAS), and Pittsburgh sleep quality index (PSQI) were administered, and physical parameters like heart rate and oxygen saturation (SpO2) were measured. RESULTS: Around 42% of the study participants experienced headaches after wearing an N95 mask and had a higher increase in heart rate (mean percent:10.5% vs 6.3%) and decline in SpO2 (mean percent: 2.6% vs 1.5%) compared to those who didn't develop a headache after N95 mask use. Independent samples t-test showed a mean difference for PSS and CAS between those who experienced headaches and those who didn't. The mean PSQI scores among the study participants were 8.91 ± 5.78; the score among those participants with and without headache was 10.57 ± 3.11 and 7.68 ± 2.53, respectively. CONCLUSION: Perceived corona anxiety, poor sleep quality, and corona anxiety are associated with N95-related headaches and SpO2 drop among health professionals who wear N95 masks for at least 4 hours.

Relationship between burnout, effort-reward imbalance, and insomnia among Informational Technology professionals.

BACKGROUND: Work in informational technology (IT) professionals is highly competitive and stressful, leading to job stress. This can lead to burnout, effort-reward imbalance (ERI), and poor sleep quality. MATERIALS AND METHODS: The present study examined associations of ERI, burnout, and poor sleep quality among IT professionals using data from 200 software engineers (mean age of 29.3 ± 4 years, 32% women). ERI and overcommitment were assessed using Siegrist's "effort-reward" questionnaire. The Oldenburg Burnout Inventory (OLBI) was used to assess burnout and Pittsburgh Sleep Quality Index (PSQI) to assess sleep quality. RESULTS: ERI, burnout and poor sleep quality were present in 72%, 60%, and 70%, respectively. Females had higher ERI, burnout, and poor sleep quality compared to males. ERI is significantly associated with burnout (r = 0.45, P < 0.01) and poor sleep quality (r = 0.31, P < 0.01). Linear regression to assess the ability of ERI to predict levels of burnout yielded a statistically significant (R 2 = 0.206, P < 0.01) indicating ERI to be a unique incremental predictor of burnout (b = 0.454, t = 7.16, P < 0.01). ERI tends to be a predictive factor of poor sleep quality with Odd's ratio = 3.5, 95%CI (1.81-6.73), P < 0.01. CONCLUSION: In summary, Intervention programs both at the individual and at the organization level have to be designed to combat ERI, burnout, and poor sleep quality among IT professionals.

Effectiveness of Medical Nutritional Therapy in the Management of Type 2 Diabetes Mellitus.

AIM: To assess the effect of medical nutritional therapy (MNT) provided by dieticians on medical and clinical outcomes for adults with Type 2 Diabetes Mellitus. OBJECTIVE: To compare effectiveness of MNT administered monthly to MNT administered once in 03 months. METHOD: The study was conducted at the Department of Endocrinology in a tertiary care hospital. 98 men and women of the age group above 18 years were recruited in the study. 49 consenting individuals were randomly assigned to each of the 02 groups namely Group A and Group B. Group A consisted of 02 visits with dietician (including the initial visit) in the first month and thereafter every monthly. Group B consisted of initial visit with the dietician and there after every 03 monthly. An additional 49 adults with type 2 Diabetes mellitus at one site who had no facility for a contact with dietician were included as a comparison group.Medical outcome measures including fasting plasma glucose (FPG), glycated haemoglobin (HbA1c) and serum lipid levels were compared and analysed. Clinical outcomes included Body weight, Height and Body mass index (BMI).Data was collected at the entry to the study and at 03 and 06 months interval. RESULT: In our study, the baseline fasting plasma glucose (FPG), HbA1C, total cholesterol and BMI was more or less similar in all 3 groups. There was a sustained decrease in all the four parameters in Group A which received the maximum nutritional therapy over a period of 06 months (A mean decrease of FPG 15.2 mg/dL, HbA1C 0.59%, total cholesterol 19.6 mg/dL, BMI 0.5 kg/m2 from baseline at 03 months and a mean decrease of FPG 33.4 mg/dL, HbA1C 1.24%, total cholesterol 40.8 mg/dL, BMI 1.1 kg/m2 from baseline at 06 months was seen). However, in Group B which received intermitted nutritional therapy, the decrease in these parameters were observed initially but over a period of 06 months, they increased to more or less near the baseline value months (A mean decrease of FPG 12.9 mg/dL, HbA1C 0.73%, total cholesterol 16.1 mg/dL, BMI 0.5 kg/m2 from baseline at 03 months but a mean increase of FPG 3.2 mg/dL and a mean decrease of HbA1C 0.24%, total cholesterol of 4.3 mg/dL and BMI 0.15 kg/m2 from baseline at 06 months was seen). In Group C which had no means of access to nutritional therapy, there was a subtle decrease in FPG and gradual increase in HbA1C, total cholesterol and BMI at 03 months but all four parameters increased significantly higher than the baseline value at the end of 06 months months (A mean decrease of FPG 6.2 mg/dL and mean increase of HbA1C 0.31%, total cholesterol 16.0 mg/dL, BMI 0.3 kg/m2 from baseline at 03 months and a mean increase of FPG 5.9 mg/dL, HbA1C 0.73%, total cholesterol 31.1 mg/dL, BMI 0.81 kg/m2 from baseline at 06 months was seen). CONCLUSION: Our study has clearly indicated that medical nutritional therapy is of great importance in the holistic management of Type 2 Diabetes mellitus in adults. MNT has got the advantage of not only maintaining a strict glycemic control (in terms of FPG and HbA1C reduction) but also in the lowering of cholesterol and BMI which are the main contributors to cardiovascular (CVD) events among people with type 2 Diabetes mellitus. Also, people who were given frequent MNT had a clear advantage over those who received intermittent MNT in terms of all the measured parameters.

Diagnostic Value of Low Platelets in Malaria.

OBJECTIVE: To study the incidence of thrombocytopenia in adults with Plasmodium vivax infection. METHOD: An observational study comprising 84 consenting individuals with Plasmodium vivax infection was undertaken. All the individuals belong to armed forces who are from different parts of the country. Everyone had normal platelet count prior to admission to the hospital. After admission, they were subjected to routine hematological and biochemical investigations comprising complete blood count including platelet counts, urine routine, liver function test, renal function test, serum electrolytes and Chest X-ray after ruling out Dengue, concomitant sepsis and possibility of recent viral infection. Grading of thrombocytopenia was done according to NCI common terminology criteria for adverse events Version 3.0. Results were analysed and tabulated. RESULT: A total of 84 patients were studied. 82 (97.6%) patients had thrombocytopenia. Majority (68.3%) of the patients had their lowest platelet count on the 5th and 6th day of fever. There was no associated increase in risk of complication with the increase in grade of thrombocytopenia. But with increase in severity of thrombocytopenia, it took more time for the platelets to recover to normal level. CONCLUSION: Thrombocytopenia is widely present in P. vivax malaria of adults. However, the severity of thrombocytopenia does not correlate with the likely progression to complication. The chance of progressing to complicated malaria is equal among all adults of P.vivax malaria irrespective of the platelet levels. Hence, in a resource limited rural Indian set-up where the expertise to diagnose and detect malaria microscopically or reliable antigen detection method is not available, thrombocytopenia in an acute febrile illness especially on Day 5 to Day 6 of fever onset could be considered as P. vivax malarial infection with good amount of diagnostic accuracy (sensitivity of 97.6%) and empirical anti-malarial therapy could be started as per the existing treatment guidelines.