Prevalence of Flu-like Symptoms and COVID-19 in Healthcare Workers from India.

BACKGROUND: The current COVID-19 pandemic is unprecedented. As the numbers expand exponentially, a paucity of data regarding health care workers (HCWs), who are at the forefront of this disaster, exists. Hence we decided to conduct a study amongst the HCWs to determine the prevalence and risk factor stratification. METHODS: This was an online questionnaire-based survey of healthcare workers conducted at Max Super Speciality Hospital, Saket, New Delhi, India from 23rd March to 30th April 2020. Data on flu-like symptoms, travel history, posting in high-risk or low risk zones, and prophylactic drugs was collected. RESULTS: Out of the 18000 HCWs who were approached 4403 responded and adequate data of 3667 was available for analysis. 14.7% had flu-like symptoms. 1.8% (20/1113) of the participants tested were positive for the virus. HCWs posted in the high-risk zones had more symptoms than those working in low-risk zones (169/539, 31.4% vs 679/3128, 21.7%), p<0.001; but no difference in COVID-19 positivity rates (p=0.849). Symptomatic HCWs had higher positivity (10/193, 5.2%) than the asymptomatic ones (10/920, 1.1%), p=0.001. HCQ was taken by 755/1113 (67.8%) people and 14 (1.9%) of these reported positive for the virus. CONCLUSION: This is the first study on healthcare workers from India to the best of our knowledge. Our findings suggest that posting in a high-risk zone with adequate PPE does not pose higher risk to the HCWs. Moreover, HCQ as a prophylactic has no use. CLINICALTRIALS.GOV IDENTIFIER: NCT04339608.

Outcome Predictors of Acute-on-Chronic Liver Failure: A Narrative Review.

Complications of acute-on-chronic liver failure (ACLF) include increased short-term mortality. Extrahepatic organ failures result from chronic liver disease and acute hepatic injury. This combination characterizes end-stage liver disease. Its rapid progression makes it challenging for hepatologists and intensivists to treat. The varied definitions of this condition lead to varied clinical presentations. Hepatic or extrahepatic failures are more prevalent in chronic hepatitis B or cirrhosis patients who receive an additional injury. Numerous intensity parameters and prognosis ratings, including those for hepatitis B virus (HBV), have been developed and verified for various patients and causes of the disease. Liver regeneration, liver transplantation (LT), or antiviral therapy for HBV-related ACLF are the main treatment aims for various organ failures. LT is the best treatment for HBV-ACLF. In some HBV-related ACLF patients, nucleos(t)ide analogs and artificial liver assistance may enhance survival. Combining epidemiological and clinical studies, this review updates our understanding of HBV-ACLF's definition, diagnosis, epidemiology, etiology, therapy, and prognosis.

Guarding Health: A Comprehensive Review of Nosocomial Infections in Sickle Cell Anemia, a Multifaceted Approach to Prevention.

This comprehensive review explores the complex dynamics of nosocomial infections in individuals with sickle cell anemia (SCA) and advocates for a collaborative strategy to enhance prevention. SCA patients, marked by compromised immunity and susceptibility to infections, face unique challenges that necessitate tailored preventive measures. The review underscores the importance of vaccination, antibiotic prophylaxis, education, and environmental hygiene in mitigating the risk of nosocomial infections. Addressing socioeconomic factors, healthcare system limitations, patient-related issues, and cultural considerations is imperative for effective prevention. The call to action emphasizes the pivotal roles of healthcare professionals, policymakers, researchers, and community engagement in implementing targeted interventions. By fostering a collective effort, this review envisions an improved landscape for infection prevention in SCA patients, enhancing their overall health outcomes and quality of life.

Navigating Perinatal Challenges: A Comprehensive Review of Hepatitis B Viral Infection and Pregnancy Outcomes.

Hepatitis B viral infection poses a significant challenge during pregnancy, as the risk of vertical transmission carries serious consequences for both maternal and neonatal well-being. This comprehensive review delves into the intricacies surrounding hepatitis B infection during the perinatal period, shedding light on its impact on pregnancy outcomes and stressing the necessity of addressing it within the broader framework of perinatal care. By scrutinizing current evidence, diagnostic methodologies, management techniques, and preventive measures, this review emphasizes the urgent need for enhanced screening protocols, timely interventions, and augmented public health initiatives. Notably, key findings underscore the elevated likelihood of chronic hepatitis B virus (HBV) infection in infants and its enduring implications for the health of both mothers and newborns. The imperative call to action advocates for a multifaceted approach, engaging healthcare professionals, policymakers, and public health agencies to optimize strategies for management and prevention, thereby striving for improved outcomes for pregnant women and their infants affected by hepatitis B viral infection.

Pubertal Labial Fusion: A Case Study.

Labial fusion, though rare, can present during puberty, or even adolescence leading to challenges in diagnosis and management. This case report offers a detailed examination of the clinical manifestation, diagnostic process, and therapeutic approach in an adolescent girl with labial fusion. This report emphasizes the importance of early intervention to improve patient outcomes for this complex medical condition.

Uncommon Cause, Critical Consequence: Vertebral Artery Aneurysm Resulting in Intraventricular Hemorrhage.

The vertebrobasilar system is made up of the two vertebral arteries that unite to form the basilar artery near the base of the skull. Aneurysms in the vertebrobasilar system are distinct from other cerebral aneurysms due to their unique morphologic characteristics. They can be large and bulging (massive), pressing on the brainstem. Alternatively, they might be weak and splitting apart (dissecting) or have an elongated shape (fusiform). On the other end of the spectrum, Vertebral artery aneurysms (VAAs) can also be small and rounded (saccular). These aneurysms can occur at the vertebral artery itself or where it joins the posterior inferior cerebellar artery (PICA). Anatomically, they are situated near the brainstem and cranial nerves, deep within the posterior fossa. The cerebrospinal fluid is kept in transit and flux by the ventricular system's chambers circulating the fluid within themselves. An intraventricular hemorrhage (IVH) can occasionally result from vertebral artery aneurysmal ruptures that result in bleeding into the subarachnoid space and then extravasate into the ventricles. Persistent and poorly controlled hypertension affects about 50% of individuals with IVH. In this case report, we study a 74-year-old woman who complained of a sudden onset headache that had been bothering her for three days at the medical emergency room. She had been diagnosed with systemic hypertension eight years prior and had not taken her medicines as prescribed. She was discovered to have rigidity in her neck and a blood pressure reading of 170/100 mmHg, which had been followed by an episode of vomiting. Radiological investigations revealed a VAA that had a high risk of rupturing and causing an IVH.

Strategies for Cardiovascular Disease Prevention in Type 1 Diabetes: A Comprehensive Review.

Cardiovascular disease (CVD) is a leading cause of morbidity and mortality among individuals with type 1 diabetes (T1D), necessitating effective prevention strategies. This comprehensive review consolidates current knowledge and evidence on preventing CVD in T1D patients. It begins by exploring the pathophysiological mechanisms that link T1D to an increased risk of CVD, highlighting factors such as chronic hyperglycemia, hypertension, dyslipidemia, and inflammation. The review also examines the epidemiology and specific risk factors for CVD in this population, emphasizing the need for rigorous risk assessment and screening. Lifestyle modifications, including dietary interventions, regular physical activity, and smoking cessation, are evaluated for their effectiveness in reducing CVD risk. Additionally, the review discusses pharmacological interventions, such as insulin therapy for glycemic control, antihypertensive medications, lipid-lowering agents, and antiplatelet therapy, underscoring their critical role in CVD prevention. Emerging therapies and future research directions are explored, focusing on novel pharmacological agents, advances in insulin delivery systems, and personalized medicine approaches. The importance of integrated care models involving multidisciplinary teams and the use of technology is highlighted as essential for comprehensive management. Challenges and barriers to implementing these strategies, including healthcare system limitations, patient adherence, and socioeconomic factors, are also addressed. This review provides a detailed synthesis of current strategies and future directions for preventing CVD in individuals with T1D, serving as a valuable resource for clinicians, researchers, and policymakers dedicated to improving cardiovascular outcomes in this high-risk population.

An Unforeseen Complication: Intestinal Prolapse After Total Abdominal Hysterectomy.

After total abdominal hysterectomy (TAH), intestinal prolapse is uncommon. We report an instance of a 48-year-old woman who had TAH and then intestinal prolapse. Two weeks after the operation, symptoms started to show up, and the vaginal vault developed a bulging bulge. The problem was satisfactorily treated with an urgent laparotomy. The significance of being vigilant for unusual complications following TAH is shown by this example.

Unraveling Neurological Shades: Vitamin D Toxication and Central Pontine Myelinolysis Exposed.

This case report is about a middle-aged female who presented with complaints of pain in the abdomen with intractable vomiting for three months, pain and weakness in bilateral lower limbs for two months, and irritability for three days. She was previously treated for lumbar disc bulge and severe narrowing of the spinal cord whose treatment also included vitamin D supplements. After taking high doses of a vitamin D supplement daily for approximately four months, it resulted in vitamin D toxicity. The sodium level of the patient was in the normal range throughout the treatment. Her magnetic resonance imaging brain revealed features of central pontine myelinolysis. The development of central pontine myelinolysis due to vitamin D toxicity, with normal sodium levels, makes this a rare case for discussion.

Unraveling the Predictive Power: Placenta Growth Factor and Pregnancy-Associated Plasma Protein A in Pre-eclampsia.

This review provides a comprehensive exploration of the roles of placenta growth factor (PlGF) and pregnancy-associated plasma protein A (PAPP-A) in the context of pre-eclampsia, a pregnancy-related hypertensive disorder with significant implications for maternal and fetal health. The background elucidates the clinical significance of pre-eclampsia, highlighting its prevalence and impact. The review delves into the biological importance of PlGF and PAPP-A, emphasizing their critical roles in normal placental development and their dysregulation in pre-eclampsia. Notably, altered levels of these biomarkers emerge as potential diagnostic indicators, offering insights into the pathophysiology of the disorder. The exploration of pathophysiological mechanisms, including angiogenic imbalance and placental dysfunction, provides a nuanced understanding of pre-eclampsia's molecular landscape. The therapeutic implications of targeting PlGF and PAPP-A open avenues for future research, aiming at effective intervention strategies. The conclusion summarizes key findings, outlines implications for future research, and underscores the crucial role of PlGF and PAPP-A in understanding and managing pre-eclampsia, with the ultimate goal of improving outcomes for both mothers and infants.

In the Shadows of Motherhood: A Comprehensive Review of Postpartum Depression Screening and Intervention Practices.

This comprehensive review delves into the multifaceted landscape of postpartum depression (PPD), exploring its prevalence, impact on maternal and infant well-being, and the efficacy of existing screening and intervention practices. PPD emerges as a critical concern, with implications extending beyond individual mental health to encompass the dynamics of mother-infant relationships and societal well-being. The analysis underscores the complexity of addressing PPD, emphasizing the challenges associated with screening tools and the importance of evidence-based interventions. A call to action resonates throughout, urging healthcare providers, policymakers, and stakeholders to prioritize mental health support for new mothers through enhanced screening protocols and improved accessibility to interventions. Furthermore, the review highlights the need for destigmatization and awareness campaigns to foster a supportive environment. Future research directions are outlined, emphasizing the refinement of screening tools, developing innovative interventions, and exploring cultural and socioeconomic influences on PPD outcomes. The review envisions a collaborative effort to dispel the shadows of PPD, striving for a future where mothers receive comprehensive support, ensuring optimal mental health and overall well-being.

Timely Management of Simultaneous Bilateral Spontaneous Pneumothorax: A Near-Death Experience.

Simultaneous bilateral spontaneous pneumothorax is a situation that rarely occurs. The patient can have various presentations, from dyspnoea and chest pain to significant respiratory failure. Although it causes lung collapse in nearly two thirds of cases, early diagnosis and treatment are of the utmost importance. Here, we present the case of an 18-year-old boy who presented with complaints of sudden onset respiratory distress. He was immediately put on mechanical ventilation. He was diagnosed with simultaneous bilateral spontaneous pneumothorax on chest X-ray. He needed bilateral intra-thoracic drainage, following which a video-assisted thoracoscopy was done on the left side.

Navigating Nasal Surges: Understanding Catamenial Epistaxis.

Catamenial epistaxis is a rare form of epistaxis (nosebleed) that occurs in women during menstruation due to hormonal changes. There are numerous hypotheses on the cellular mechanisms and pathophysiology of endometriosis. Endometriosis may present a wide range of symptoms depending on where endometrial tissue was implanted. This entity's diagnosis is neither simple nor difficult. There are numerous clinical and laboratory diagnostic techniques in use, but none of them is considered to be the best. Every woman who experiences recurrent symptoms (such as epistaxis and hemoptysis) of extrapelvic organs should be clinically suspicious of endometriosis because of its multipotent location and the variety of clinical manifestations of the condition. This case report demonstrates that periodic epistaxis may infrequently be the root cause of the extra pelvic endometrium in the nasal septum in a woman who has had treatment for recurrent pelvic discomfort and dysmenorrhea.

Role of Apparent Diffusion Coefficient in Evaluating Degeneration of the Intervertebral Disc: A Narrative Review.

Degeneration of the lumbar intervertebral disc is the most common cause of lower back pain. It is directly related to daily activities, mechanical stress, and other biological factors. We use imaging modalities to assess the degree of disc degeneration, out of which magnetic resonance imaging (MRI) is the most popular non-invasive modality. It is believed that early changes in disc degeneration are due to the biochemical events in the disc and can be evaluated by sequences in MRI involving the diffusion of water molecules. The apparent diffusion coefficient (ADC) is one such sequence that captures the signals based on the diffusion of water molecules. Ten articles were chosen from PubMed and Google Scholar using the MeSH terms 'lumbar spine degeneration' and 'apparent diffusion coefficient'. This review article has summarized various studies intending to gain a better understanding of the biochemical events leading to the development of disc degeneration. This study has also gathered the role of various sequences in MRI that can quantitatively assess disc degeneration.

The Spectrum of Shoulder Pathologies on Magnetic Resonance Imaging: A Pictorial Review.

Patients present to the orthopedic outpatient department with complaints of shoulder pain on movement or restriction of movement in the shoulder joint and are referred for magnetic resonance imaging (MRI) of the shoulder joint. Almost all the patients have similar complaints but may have a wide range of pathology affecting the joint and causing pain. Rotator cuff tears or tendinopathy are the most common causes of shoulder pain. Ultrasound (USG) and MRI are the most commonly used imaging modalities for assessing rotator cuff pathologies. There is a wide range of pathologies affecting the shoulder joint, other than rotator cuff tendinopathies or tears, for which USG is less sensitive and specific in detecting accurate pathology. MRI is the choice of imaging for shoulder joint pathologies. We present a pictorial review discussing and depicting MRI features of a wide list of pathologies of the shoulder joint complex that should be kept in mind when the patient presents with shoulder pain.

Lightning Strike-Induced Myocarditis.

Lightning strikes are frequently encountered and are a major cause of morbidity and mortality. It could impair several organs, but the effects of electric current on the cardiovascular system contribute to the primary cause of cardiorespiratory arrest. These effects can be either transient or persistent, ranging from benign or life-threatening arrhythmias, ischemic injury, myocardial contusion, aortic injury, cardiomyopathy, and ventricular failure. Myocarditis has been an important but not very well-understood cause of cardiac dysfunction. Fulminant myocarditis is defined as patients presenting with severe heart failure, having a duration of <2 weeks of symptoms, and requiring inotropic or mechanical circulatory support. This condition can rapidly lead to hemodynamic instability and death. Resuscitation for a longer time increases the probability of favorable outcomes in young and previously healthy patients. This case report accounts for a case of a healthy young male who was struck by lightning while working on the farm and developed electrocardiographic changes along with positive cardiac biomarkers.

Supernumerary Kidney (Triple Kidney) With Horseshoe Malformation: A Case Report.

The presence of an extra (third) kidney is an unusual congenital anomaly of the urinary system (US), having less than a hundred cases reported globally. Owing to the rare occurrence of this complex anomaly, the fused supernumerary kidney and horseshoe portion is very scarcely reported with unknown incidence. This paper presents a rare renal anomaly case of a fused supernumerary kidney with a horseshoe portion in a 41-year-old male who presented with fever, abdominal pain, and burning micturition. CT of the kidney urinary bladder showed non-rotation of the right kidney with a supernumerary malrotated horseshoe-shaped kidney and malrotated left kidney with features of acute pyelonephritis. The patient was managed with double J stenting and appropriate antibiotics till discharge.

HCQ prophylaxis in COVID-19 did not show any QTc prolongation in Healthcare workers.

BACKGROUND: HCQ is a commonly recommended drug for the prophylaxis of COVID-19. One of its rare side-effect includes QTc prolongation. METHODS: This was a prospective, cross sectional and observational study conducted on Hydroxychloroquine (HCQ) among Healthcare Workers (HCWs) at Max Super Speciality Hospital, Saket, New Delhi, India. A 3-lead ECG (only limb leads, it does not require chest leads) was performed. The QTc cut offs were pre decided, QTC < 470 ms for males and <480 ms for females was considered within the normal limits and anything above this was regarded as QTc prolongation. RESULTS: There were 274 HCWs enrolled into the study, including 175 males and 99 females. Majority of the HCWs were young and had a mean age of 32.19 ± 9.29 years. Out of these, 218 were taking HCQ as per the Indian Council of Medical Research (ICMR) guidelines. The median cumulative dose being taken was 1600 mg and the median QTc of these participants was 390 ms in males and 391.5 ms in females. Subsequently, 33 participants were followed-up and found to have a median QTc of 389 ms and a cumulative dose of HCQ as 2000 mg. CONCLUSION: In conclusion, ours is a first study in the middle of the pandemic which showed that HCQ prophylaxis in young HCWs without comorbidities did not show any QTc prolongation.