Anxiety and Depression in COVID Survivors - A Cross-Sectional Study Six Months Past the Acute Illness.

Background Studies exploring the long-term psychiatric sequelae of COVID-19 are sparse. We aimed to assess depression and anxiety six months after recovery and the association between disease severity and psychiatric sequelae. Material and methods Our study was a comparative study conducted on COVID-19 disease survivors at a tertiary hospital. We compared Hamilton Depression Rating Scale (HDRS) scores and Hamilton Anxiety Rating Scale (HAM-A) scores between mild (n=50), moderate (n=50), severe cases (n=50), and controls (n=50). We assessed the severity of depression and anxiety using the HDRS and the HAM-A. Cases: First-time COVID-19 survivors six months post-recovery. Cases were healthy pre-COVID. To the study date, controls were negative for COVID-19 reverse transcription polymerase chain reaction (RT-PCR). Results Our study of 200 subjects indicated that mean (mean, SD) HAM-A scores in cases (14.7, 5.6) were higher than controls (7.9, 1.7), and HDRS scores in cases (17.3, 6.3) were higher than controls (7.5, 1.9). HAM-A scores in severe cases (19.5, 4.8) were higher than in moderate cases (17.0, 3.9), and scores in moderate cases were higher than in mild cases (10.6, 2.4). HDRS scores in severe cases (22.5, 5.9) were higher than in moderate cases (16.4, 3.2), and scores in moderate cases were higher than in mild cases (14.4, 2.5). Among the cases, there was a positive correlation between the Hamilton Anxiety Rating Scale (HAM-A) and Hamilton Depression Rating Scale (HDRS) scores and the duration of hospital stay, ICU stay, and use of invasive oxygen. These parameters were not applicable to the controls; hence, they were not included in the comparative analysis. Conclusions Patients, even after six months of recovery from COVID-19, had symptoms of anxiety and depression. The severity of anxiety and depression in survivors correlates with the severity of the COVID-19 disease.

Super-rapid race for saving lives by developing COVID-19 vaccines.

The pandemic of coronavirus disease 2019 (COVID-19) caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has affected millions of people and claimed thousands of lives. Starting in China, it is arguably the most precipitous global health calamity of modern times. The entire world has rocked back to fight against the disease and the COVID-19 vaccine is the prime weapon. Even though the conventional vaccine development pipeline usually takes more than a decade, the escalating daily death rates due to COVID-19 infections have resulted in the development of fast-track strategies to bring in the vaccine under a year's time. Governments, companies, and universities have networked to pool resources and have come up with a number of vaccine candidates. Also, international consortia have emerged to address the distribution of successful candidates. Herein, we summarize these unprecedented developments in vaccine science and discuss the types of COVID-19 vaccines, their developmental strategies, and their roles as well as their limitations.

Cognitive assessment in asymptomatic COVID-19 subjects.

Neurological features of COVID-19 have been reported in addition to the respiratory manifestations, but cognitive dysfunction has been scarcely described. And cognitive assessment has not been studied in asymptomatic subjects. We compared the cognitive assessment scores between asymptomatic SARS-CoV-2 infected subjects with that of controls to detect mild cognitive impairment by the Montreal Cognitive Assessment test. Asymptomatic COVID-19 subjects secured lower scores in certain domains of the MoCA in comparison with the controls. The domains were visuoperception (2.4 ± 0.7 vs2.8 ± 0.7, p = 0.032), naming (3.6 ± 0.5 vs3.9 ± 0.2, p = 0.016) and fluency (0.9 ± 0.6 vs1.6 ± 0.7, p = < 0.001). Also, older aged COVID-19 positive subjects scored lower in the MoCA when compared to the younger people. Our study shows that even otherwise asymptomatic COVID-19 subjects have cognitive deficits in certain subdomains and suggests the need for a detailed psychometric assessment especially in the elderly population. SUPPLEMENTARY INFORMATION: The online version of this article (10.1007/s13337-021-00663-w).

Gene Expression Analysis Identifies Cholesterol Metabolism Dysregulation in Hippocampus of Phenytoin-Resistant Pentylenetetrazol-Kindled Epileptic Mice.

Pharmaco-resistant Epilepsy has been a major challenge for medical interventions in controlling seizures. To date, up to 33% of the patients with epilepsy do not show adequate response to anti-epileptic drugs even after prolonged combinatorial drug usage. Using microarray, this study explores the changes in hippocampal gene expression in the phenytoin-resistant pentylenetetrazol (PTZ)-kindled mouse model of epilepsy. Our results from mRNA microarray analysis show distinct gene expression profiles in the hippocampus of phenytoin-resistant and sensitive mice. Pathway enrichment analysis showed differential expression of genes involved in cholesterol biosynthesis in phenytoin-resistant and sensitive mice.

Gender and occupation predict Coronavirus Disease 2019 knowledge, attitude and practices of a cohort of a South Indian state population.

CONTEXT: Coronavirus disease 2019 (CoViD 19) pandemic has induced the government to initiate strict control measures. Improvements to these measures and shortcomings could be gleaned with the understanding of the knowledge, attitude and practices (KAP) of the public. AIMS: The aim of this study the CoViD 19 KAP of a south Indian state population. SETTINGS AND DESIGN: This was a Cross-sectional observational study. SUBJECTS AND METHODS: We conducted an online survey to elicit this information. STATISTICAL ANALYSIS USED: Mean, Standard deviation, Binomial and Multinomial logistic regression. RESULTS: Of the 1837 subjects who answered the survey, 70% were youth (16-29 years), 54% were postgraduates and 47.8% were desk jobholders. The mean knowledge score was 9.92 ± 2.37/14 and 94.44% secured at least above-average score. The subjects had a positive (70%) attitude towards the CoViD 19 situation and 77% of subjects followed good preventive practices. However, we found that women, people with low education and nonmedical background were associated with poor knowledge and practices. The attitude was poor in subjects occupant in physical works. CONCLUSIONS: The health policy would better serve the purpose of the groups with poor scores are targeted.

Hyperargininemic Encephalopathy with Unique Clinical Presentation and Novel Genetic Mutations.

Hyperargininemia is a urea cycle disorder that has rarely been reported in adults. We present a case of arginase deficiency disorder in a 32-year man with metabolic encephalopathy. He presented with progressive limb spasticity, changes in personality, cognitive decline (impaired judgement, executive and language dysfunction) and pseudo-bulbar affect. He deteriorated to an akinetic mute and rigid state. MRI brain was suggestive of a metabolic disorder. Hyperammonemia was present, blood arginine levels were elevated, and serum arginase levels were reduced. The standard argI gene mutations were absent but rs2781666 (G/T) and rs2608897 (C/T) variations were noted in this patient. Hyperargininemic encephalopathy may present in adults and with atypical features. It should be kept in the differential diagnosis of metabolic encephalopathy in adults. Key Words: Metabolic encephalopathy, Pseudobulbar affect, Arginase deficiency, Hyperammonemia, Urea cycle.

A Novel Mutation in Neurodegeneration with Brain Iron Accumulation - A Case Report.

Neurodegeneration with brain iron accumulation (NBIA), previously called Hallervorden Spatz disease, is a group of disorders which share the hallmark of iron deposition in the brain. They are collectively characterized by extrapyramidal movement disorders, particularly those of parkinsonism, dystonia, cognitive regression, neuropsychiatric abnormalities, pyramidal features, optic atrophy, and retinal abnormalities. There is aberrant brain iron metabolism, with large amounts of iron deposited in the globus pallidus and the substantia nigra pars reticulata. NBIA displays a marked genetic heterogeneity, and 10 genes have been associated with different NBIA subtypes at present. We present a 12-year-old boy with a one and a half-year history of a slow, progressive gait disturbance. An MRI of his brain revealed T2, FLAIR bilateral symmetrical hypointensities in globus pallidus and substantia nigra s/o NBIA. His genetic analysis revealed a novel homozygous missense variation in exon 2 of the C19orf12 gene (chr19:30199203; A>C) that results in the amino acid substitution of valine for phenylalanine at codon 51 (p.F51V; ENST00000392278). This is consistent with the MPAN (mitochondrial membrane protein-associated neurodegeneration) subtype.

Mobile phones and seizures: drug-resistant epilepsy is less common in mobile-phone-using patients.

BACKGROUND: Epilepsy is a condition where patients have seizures due to abnormal nerve impulses in the brain. The effect of mobile phone radiation on patients with seizures is not known. OBJECTIVE: To compare the seizure profile of patients not using mobile phones with that of their peers using mobile phones. METHODS: In a retrospective cohort study performed at the neurology outpatient department of Guntur Medical College Hospital, Guntur, India from September 2014 to September 2015, we included 178 consecutive epileptic patients aged 16-65 years, who had had seizure disorder for 1 year or more. On the basis of their possession and usage of mobile phones, patients were divided into three groups: no mobile group (NMG), home mobile group (HMG) and personal mobile group (PMG). We obtained data on seizure frequency and recorded details of mobile phone usage and their antiepileptic drug (AED) treatment. RESULTS: 107 NMG, 3 HMG and 68 PMG patients were finalised for the analysis. There was no significant difference in the number of seizures in the past year between the three groups. The PMG (3.7%) contained a clinically significant lower proportion of patients with drug-resistant epilepsy than the NMG (28.2%). Patients with drug-responsive epilepsy were 7.4 (95% CI 1.4 to 39.9) (p=0.01) times more likely to be found in the PMG than in the NMG after adjustment for differences in sex and occupation. CONCLUSIONS: Although the experimental data remain inconclusive, our clinical study suggests that patients who use mobile phones are less likely to have drug-resistant epilepsy.

Stroke: Changing Risk Factor Profile and Unaltered Mean Age in a Developing Country. A Retrospective Study and Literature Review.

BACKGROUND: The rapid changes in the lifestyles of people in the developing countries such as India are known to increase the incidence of risk factors for stroke like hypertension (HTN), diabetes mellitus and dyslipidemia. Tobacco smoking and alcoholism are on the rise. Hence, stroke might occur in younger age groups when compared to the earlier generations. We compared data of age at stroke in India across a decade. METHODS: Data from medical case records of 299 stroke patients from our tertiary referral Government General Hospital, Guntur, from January 2012 to December 2014 are collected and compared with previous studies of stroke in India. RESULTS: The mean age at stroke was 55 (14) years with 32.3% women. The prevalence of smoking was 43%, HTN 46%, diabetes 17% and dyslipidemia 54.6%. A previous medical diagnosis of coronary artery disease was reported in 0.01% cases. When compared to previous studies, there was no significant change in mean age of stroke (p = 1.0). While smoking and dyslipidemias have increased, HTN and diabetes were more in earlier decades. CONCLUSIONS: The age at stroke has remained constant over the last 4 decades in India. The profile of risk factors for stroke has changed over the years.

Pulse Oximetry Overestimates Oxygen Saturation in COPD.

BACKGROUND: Measurement of oxygen saturation with a handheld pulse oximeter is widely practiced as a surrogate to invasive arterial blood gas analysis. Oxygen saturation is an important parameter in cases of COPD, but there are insufficient data on the role of pulse oximetry in patients with COPD, moreso in diseases across its spectrum, such as chronic bronchitis and emphysema. We assessed the performance of pulse oximetry in acute respiratory failure of patients with COPD. METHODS: This was a cross-sectional, observational study. We studied 50 subjects with COPD admitted to the Government General Hospital, a 1,000-bed tertiary referral center in Guntur, India, from June 2013 to July 2013. Simultaneous reading of S(pO2) by a handheld pulse oximeter and S(aO2) by an automated arterial blood gas analyzer were taken. RESULTS: Pulse oximetry was sufficiently sensitive (84.60%) to hypoxemia in respiratory failure to be used in clinical situations. The mean difference (bias) between SaO2 and S(pO2) was -3.98 (95% CI -4.68 to 3.28). There was less sensitivity (82% vs. 85%) and positive predictive value (69% vs. 85%) of the pulse oximeter to respiratory failure in subjects with chronic bronchitis versus emphysema. CONCLUSIONS: Pulse oximetry performed poorly in comparison with the invasive arterial blood gas analysis. The variability of the readings was greater in the subjects with chronic bronchitis than in those with emphysema.

Vanishing Weakness and Persistent Cardiac Dysrhythmia: Are We Dealing with Andersen Tawil Syndrome?

Andersen Tawil Syndrome (ATS) is a very rare type of periodic paralysis; the authors present a case report from South India with features that have not been reported earlier. This case suggests many unexplored hypotheses for the disease and argues the need for physician sensitization of this entity.