Deciphering the interdependent labyrinth between gut microbiota and the immune system.

The human gut microbiome interacts with each other and the host, which has significant effects on health and disease development. Intestinal homeostasis and inflammation are maintained by the dynamic interactions between gut microbiota and the innate and adaptive immune systems. Numerous metabolic products produced by the gut microbiota play a role in mediating cross-talk between gut epithelial and immune cells. In the event of an imbalance between the immune system and microbiota, the body becomes susceptible to infections and homeostasis is compromised. This review mainly focuses on the interplay between microbes and the immune system, such as T-cell- and B-cell-mediated adaptive responses to microbiota and signalling pathways for effective communication between the two. We have also highlighted the role of microbes in the activation of the immune response, the development of memory cells and how the immune system determines the diversity of human gut microbiota. The review also explains the relationship of commensal microbiota and their relation to the production of immunoglobulins.

[Retrosternal goiter in thoracic surgical practice]. / Zagrudinnyi zob v torakal'noi khirurgicheskoi praktike.

OBJECTIVE: To evaluate and optimize surgical approaches to the management of retrosternal goiter. MATERIAL AND METHODS: A cohort retrospective single-center study included 56 patients aged 68.3±9.8 years with retrosternal goiter who underwent surgery between 2004 and 2019. Right-sided goiter was diagnosed in 16 cases, left-sided goiter in 21 patients, bilateral goiter in 19 patients. Palpable neck mass was found in 17 (30.4%), stridor in 16 (28.6%), thyrotoxicosis in 4 (7.1%) and recurrent laryngeal nerve palsy in 2 (3.6%) cases. X-ray signs of tracheal compression were detected in 43 (76.8%) patients, deviation in 26 (46.4%) patients. Resection through cervical collar incision was performed in 40 (71.4%) patients. Additional sternotomy was required in 11 (19.6%) patients, 1 (1.8%) patient required collar incision and right anterior mediastinotomy. Right-sided posterolateral thoracotomy without collar incision was performed in 1 (1.8%) patient with a suspected mediastinal teratoma. Three patients underwent median sternotomy only because of preoperative diagnosis of teratoma in one and thymoma in two patients. RESULTS: There was no perioperative mortality. Transient vocal changes occurred in 3 (5.4%) patients, recurrent laryngeal nerve palsy in 3 (5.4%), atrial fibrillation in 2 (3.6%), wound complications in 2 (3.6%), left phrenic nerve palsy in 1 (1.8%), transient hypocalcaemia in 1 (1.8%) and persistent hypothyroidism in 1 (1.8%) patient. Hospital-stay ranged from 2 to 12 (5.5±2.0) days. Multinodular goiter was found in 53 (94.6%) patients, diffuse goiter in 1 (1.8%), ectopic thyroid in 1 (1.8%) and oncocytic tumor in 1 (1.8%) patient. One (1.8%) patient underwent simultaneous resection of RSG via a collar incision and right-sided VATS upper lobectomy for primary lung cancer. One (1.8%) patient also underwent simultaneous resection of RSG via collar incision and right-sided VATS subcarinal lymph node biopsy for coexistent lymphoma. Mean vertical length of goiter in the collar incision group was 7.6 cm compared to 10.6 cm in the sternotomy group. Mean weight of specimens was 162.3 g in patients with collar incisions and 312.5 g in the sternotomy group. Sternotomy was required in 14 (25%) patients. CONCLUSION: Resection of retrosternal goiter is more commonly performed via cervical collar incision with mandatory availability of sternotomy. Radiological measurement of craniocaudal length may predict the need for sternotomy. Surgical outcomes are not affected by surgical approach. Simultaneous thoracic interventions for a coexistent pathology in patients with RSG may be considered. Further research of minimally invasive interventions for RSG resection is required.

Validation of International Classification of Disease Ninth Revision codes for atopic dermatitis.

BACKGROUND: Evaluation of large-scale data sets is needed to better understand the epidemiology, cost, and burden of atopic dermatitis (AD). We sought to validate the use of ICD-9-CM codes for identifying AD. METHODS: Patients from a large metropolitan quaternary care medical center with a diagnostic code of either 691.8 (AD) or 692.9 (eczema and contact dermatitis) were queried. Medical records were reviewed for demographics, Hanifin & Rajka (H&R) and United Kingdom Working Party (UKWP) criteria. Sensitivity, specificity, and positive predictive values (PPV) of the codes were calculated. RESULTS: Of 43 278 patients identified with associated ICD-9 codes of 691.8 or 692.9, 519 and 253 with 691.8 and 692.9 were randomly selected for chart review. There was extensive overlap: 34.3% had ≥1 occurrences of 691.8 and 692.9 and 25.6% had multiple occurrences of both codes. Among patients with ≥1 occurrence of 691.8, 29.9% and 30.8% met the H&R and UKWP criteria, respectively. Similarly, among patients with ≥1 occurrence of 692.9, 33.7% and 32.2% met the H&R and UKWP criteria. Increased PPV was associated with concomitant diagnoses of asthma, hay fever, and food allergy and increased disease severity. CONCLUSIONS: In the outpatient setting, the ICD-9-CM codes 691.8 and 692.9 alone have poor PPV. Incorporation of diagnoses of asthma, hay fever, and food allergy improves PPV and specificity. In the inpatient setting, a primary discharge diagnosis of 691.8 had excellent PPV. Although ICD-10 has been adopted in Europe and more recently in the USA, the same systematic errors would likely occur unless providers standardize their coding.

Impact of calcineurin-inhibitor conversion to mTOR inhibitor on renal allograft function in a prednisone-free regimen.

Traditionally, chronic calcineurin inhibitor (CNI) nephrotoxicity has been considered to be one of the main nonimmune mechanisms causing chronic renal allograft dysfunction. CNI minimization and withdrawal strategies have yielded inconsistent results. Few studies address the feasibility of CNI elimination in a prednisone-free regimen. We report a prospective, randomized trial in 200 patients evaluating the impact on renal function and incidence of acute rejection after conversion from tacrolimus (Tac) to sirolimus (SRL). Patients with recent (<3 months) acute rejection episodes or with >0.5 g/day of proteinuria were excluded. All were induced with alemtuzumab, underwent rapid steroid elimination and were maintained on mycophenolate mofetil and Tac. At 12 months posttransplant, patients were randomized 2:1 to SRL (n = 123) or maintained on Tac (n = 64). Mean follow-up was 41.1 ± 15.8 months in the SRL group and 40.7 ± 14.4 months in the Tac group. Biopsy-proven acute rejection at 24 months postrandomization was similar between the groups. Patient survival, graft survival and estimated GFR were also not statistically different. Our study demonstrates that in a prednisone-free immunosuppressive regimen, conversion from Tac to SRL at 12 months posttransplantation is not associated with increased rates of acute rejection and graft loss. However, despite CNI elimination, renal allograft function is equally maintained in both groups.

Spin-based logic in semiconductors for reconfigurable large-scale circuits.

Research in semiconductor spintronics aims to extend the scope of conventional electronics by using the spin degree of freedom of an electron in addition to its charge. Significant scientific advances in this area have been reported, such as the development of diluted ferromagnetic semiconductors, spin injection into semiconductors from ferromagnetic metals and discoveries of new physical phenomena involving electron spin. Yet no viable means of developing spintronics in semiconductors has been presented. Here we report a theoretical design that is a conceptual step forward-spin accumulation is used as the basis of a semiconductor computer circuit. Although the giant magnetoresistance effect in metals has already been commercially exploited, it does not extend to semiconductor/ferromagnet systems, because the effect is too weak for logic operations. We overcome this obstacle by using spin accumulation rather than spin flow. The basic element in our design is a logic gate that consists of a semiconductor structure with multiple magnetic contacts; this serves to perform fast and reprogrammable logic operations in a noisy, room-temperature environment. We then introduce a method to interconnect a large number of these gates to form a 'spin computer'. As the shrinking of conventional complementary metal-oxide-semiconductor (CMOS) transistors reaches its intrinsic limit, greater computational capability will mean an increase in both circuit area and power dissipation. Our spin-based approach may provide wide margins for further scaling and also greater computational capability per gate.

The psychological impact of COVID-19 duty among resident doctors working in a COVID-hospital: A short-term follow-up study.

Background: There is a dearth of longitudinal research that measures the impact of the pandemic on the mental health of resident doctors. Aim: This study aimed to estimate depression, anxiety, stress, burnout, and sleep disturbances (insomnia and nightmares) among resident doctors after COVID-19 duty. The study was a prospective longitudinal study among resident doctors posted in COVID-19 wards in a tertiary hospital in North India. Methods: The participants were assessed at two points of time, two months apart, on a semistructured questionnaire and self-rated scales for depression, anxiety, stress, insomnia, sleep quality, nightmare experience, and burnout. Results: A significant proportion of resident doctors working in a COVID hospital had symptoms of depression (29.6%), anxiety (28.6%), stress (18.1%), insomnia (22%), and burnout (32.4%), even after two months of being off COVID duty. It was seen that these psychological outcomes had a strong positive correlation with each other. Compromised sleep quality and burnout significantly predicted depression, anxiety, stress, and insomnia. Conclusion: The current study has added to the psychiatric aspects of COVID-19 among resident doctors and the changes in these symptoms with time and highlights the need for targeted interventions to decrease these adverse outcomes.

Psychosocial functioning among current noninjecting opioid users: Is there any difference between methadone maintenance treatment and treatment as usual?

Background: Patients with opioid use disorder (OUD) have a significant problem in psychosocial functioning domains, which are not systematically studied in India. This study aimed to evaluate the psychosocial functioning in current noninjecting opioid users on Methadone Maintenance Treatment (MMT) versus Treatment as Usual (TaU: Chlordiazepoxide, Zolpidem, Trazodone, Tramadol, Tapentadol, and Buprenorphine). Materials and Methods: It is a cross-sectional study on patients of current noninjecting OUD on MMT or TaU for at least in the past month. Comorbidities and illness severity were assessed with the help of Mini-International Neuropsychiatric Interview 7.0.2 and World Health Organization-The Alcohol, Smoking, and Substance Involvement Screening Test 3.0, respectively. Social and occupational functioning assessment scale (SOFAS), WHO Quality of Life (WHOQoL-BREF), and Client Satisfaction Questionnaire (CSQ-8) assessed the sociooccupational functioning and QoL and client satisfaction. A total of 67 participants (37 on MMT and 30 on TaU) were included in the study. Results: A significant difference between the two groups (MMT better than TaU) was based on SOFAS scores, CSQ-8, and WHOQoL-BREF. In the TaU group, there was a significant negative correlation between risk of addiction severity with sociooccupational functioning (r = -0.5; P = 0.0046), physical health (r = -0.48; P = 0.0087) and social relationship (r = -0.47; P = 0.0087) domain of QoL. In the MMT group, the association between risk of addiction severity with sociooccupational functioning, domains of QoL, and client satisfaction were insignificant. Conclusion: Sociooccupational Functioning, Client Satisfaction, and QoL of patients maintained on MMT are better than those on TaU.

Executive functioning in early and middle age adult patients operated for epidural hematoma: A comparative study.

Epidural Hematoma (EDH) is a common condition of traumatic brain injury. It has a good prognosis if prompt surgical intervention is conducted. There is a dearth of studies on neuropsychological assessment of executive functioning exclusively in post-operative EDH patients. Moreover, age as a variable in determining executive functions in patients post-head injury, has been studied mostly in the older adults. This cross-sectional case-control study assessed Executive Functions (EF) in 62 post-surgery patients with EDH and compared 57 healthy controls (HC) using standardized assessment tools of sustained attention, speed, working memory, fluency, set-shifting, perseveration, planning, and response inhibition. Further, executive functions in two phases of adulthood, viz. Early Adulthood (20-39 years) and Middle Adulthood (40-60 years) were compared in the EDH group (E-EDH and M-EDH) and HC (E-HC and M-HC). A two-way Analysis of Variance (ANOVA) and correlational analysis was conducted. Results showed a trend where the M-EDH group performed significantly poorer on executive function tests (viz a viz., time taken, errors, and correct responses), followed by E-EDH, M-HC, and E-HC. The main effect of age was found significant on Digit Symbol, Color Trail 1, N-Back 2, Animal Naming, and Stroop Effect (p < 0.01 level) while N-Back 1, WCST-PE, and Tower of London (p < 0.05 level). The findings have significant clinical and therapeutic implications. In addition, it gives guidance regarding planning specific neuropsychological tests and rehabilitation targeting specific areas of executive functions decline due to age in EDH post-surgery patients.

Depression in patients of myocardial infarction--a cross-sectional study in northern India.

OBJECTIVES: To assess the prevalence of major depressive disorder and subsyndromal depression in patients with first episode of myocardial infarction (MI) and to compare the socio-demographic, clinical and coronary risk factors in patients with and without depression. METHODS: Patients of acute MI (n = 101) attending OPD at 4 to 6 weeks after the index event were the subjects. Diagnoses of Major Depressive Disorder were established according to Diagnostic and Statistical Manual for Mental Disorders fourth edition Test Revision (DSN-IV-TR) criteria. Schedule for Affective Disorder and Schizophrenia changed version modified for Bipolar disorder (SADS-CB) was applied to detect cases with depressive symptoms not amounting to major depressive disorder (sub-syndromal). It was a single point cross sectional study. RESULTS: No depressive symptoms (Group-A) were found in 56 patients (55.4%). Major Depressive Disorder (Group-B) was found in 24 patients (23.8%) and subsyndromal symptoms (Group-C) in 21 patients (20.8%). Sociodemographic and clinical variables were similar amongst three groups except, more patients in Group-C were from nuclear family (p = 0.01) and were educated (p = 0.03). More patients in Group-B had hypertension (p = 0.001), diabetes (p = 0.03) or were overweight (p = 0.02) as compared to Group-A. Similarly higher number of Group-C patients had hypertension (p = 0.04), diabetes (p = 0.01) and were current smokers (p = 0.01) as compared to Group-A. CONCLUSION: Unrecognized and untreated major depressive disorder and sub-syndromal symptoms were frequent in patients of MI. Established coronary factors were more commonly present in these groups as compared to no depressive symptom group. This emphasizes the need for routine screening for depression in post MI phase in our population.

Microbe defines the efficacy of chemotherapeutic drug: a complete paradigm.

The human body harbors a diverse microbiome that regulates host physiology and disease development. Several studies have also been reported where the human microbiome interferes with the efficacy of chemotherapeutics. Reports have also suggested the use of microbes in specific targeting and drug delivery. This review mainly focuses on the alteration in the efficacy of the drug by human microbiota. We have also discussed how the diversity in microbes can determine the therapeutic outcomes of a particular drug. The pathways involved in the alteration are also focused, with some highlights on microbes being used in cancer therapy.

Sexual functioning during the lockdown period in India: An online survey.

AIM: This study aimed to evaluate the impact of lockdown on sexual functioning in India. In addition, impact of lockdown on relationship with the partner and mental health was evaluated. MATERIALS AND METHODS: An online survey was conducted using changes in sexual functioning questionnaire, Patient Health Questionnaire-4, and a self-designed questionnaire. RESULTS: The mean age of the participants was 41.5 (standard deviation: 11.2; range: 22-77; median: 39.5) years, with the majority being males 385 (85.6%). The participants reported that lockdown led to reduction in the frequency of sexual intercourse and also touching the partner (fondling, caressing, touching, or kissing) when not indulging in sexual intercourse. Majority of the participants reported improvement in the overall relationship, communication with the partner, and interpersonal conflicts. About two-fifths of the participants reported engaging in sexual intercourse more than twice a week or more. About one-fifth screened positive for psychiatric morbidity, with 14.2% screened positive for anxiety, 14.8% screened positive for depression and 8.7% screened positive for both. In both genders, presence of depression and anxiety were associated with lower sexual functioning in all the domains. CONCLUSION: Lockdown led to a reduction in the frequency of sexual intercourse, and reduction in the frequency of intimacy in the form of fondling, caressing, touching, or kissing partner when not doing sexual intercourse. However, lockdown led to the improvement in overall relationship and communication with the partners and a reduction in interpersonal conflicts.

Evaluation of Psychological Impact of COVID-19 on Health-Care Workers.

BACKGROUND: Little information is available from India about the psychological impact of COVID-19 on helath-care workers. AIM: The current study aimed to evaluate the psychological issues among the health-care workers (HCW) during the COVID-19 pandemic. MATERIALS AND METHODS: An online survey using Survey Monkey® platform was carried out to evaluate depression (using Patient Health Questionnaire-9), anxiety (using Generalized Anxiety Disorder Questionnaire-7), and other psychological issues (using a self-designed questionnaire). RESULTS: The study sample comprised 303 participants with a mean age of 41.2 (standard deviation: 11.1) years. A majority of them were male (69%) and married (79.9%). Nearly half (46.2%) of the participants had either anxiety disorder or depression or both and 12.9% of HCW had suicidal behavior. Higher level of anxiety and depression scores were associated with being female, having undergone quarantine, directly involved in the care of COVID-19 patients, and younger age (<30 years). Higher prevalence of depression and anxiety disorder was seen in younger (<30 years) age group, being a doctor (compared to paramedics). In addition, higher prevalence of depression was seen in those who were directly involved in the care of patients with COVID-19 infection. CONCLUSION: About half of the HCWs are suffering from psychiatric morbidity, specifically anxiety, in the wake of the COVID-19 pandemic. There is a need to assess all the HCWs for psychiatric morbidity and provide them with psychological support.

Emerging mental health issues during the COVID-19 pandemic: An Indian perspective.

The current global health crisis, the COVID-19 pandemic, has posed an unprecedented challenge to our health systems, economy, socio-political organizations, and the infrastructure of most countries and the world. This pandemic has affected physical health as well as mental health adversely. Several recent evidence suggests that health systems across the world have to improve their preparedness in context to infectious pandemics. The research on mental health aspects of COVID-19 and other related pandemics is lacking due to obvious reasons. This narrative review article, along with our personal views, is on various current and future mental health issues in the context of the COVID-19 pandemic focusing on various challenges and suggested solutions. The aim is also to update mental health strategies in the context of such rapidly spreading contagious illness, which can act as a resource for such a situation, currently and in future. We recommend that there is a need to facilitate mental health research to understand the psychiatric aspects of the COVID-19 pandemic, include psychiatrists in the task force, and make available psychotropic and other medications with special attention to the deprived sector of the society.

Data and debriefing observations on healthcare simulation to prepare for the COVID-19 pandemic.

We report on data and debriefing observations in the context of an immersive simulation conducted to (a) train clinicians and (b) test new protocols and kits, developed in table-top exercises without prior clinical experience to fit anticipated clinical encounters in the setting of the rapidly expanding COVID-19 pandemic. We simulated scenarios with particular relevance for anesthesiology, perioperative and critical care, including (1) cardiac arrest, (2) emergency airway management, (3) tele-instruction for remote guidance and supervision, and (4) transporting an intubated patient. Using a grounded theory approach, three authors (MHA, DLR, EHS) developed emergent themes. First alone and then together, we sought consensus in uncovering overarching themes and constructs from the debriefings. We thus performed an informal qualitative thematic analysis based in a critical realist epistemological position - the understanding that our findings, while real, are affected by situational variables and the observer's perspective[1,2]. We compared data from videos and triangulated the data by member checking. All participants and course instructors volunteered to participate in this educational project and contributed as co-authors to this manuscript. During debriefing, we applied crisis resource management concepts including situation awareness, prioritization of tasks, and clear communication practices, conducting the debriefing with emphasis on current TeamStepps 2.0 terminology and concepts. [3,4] In addition, we re-evaluated formerly familiar processes, as shortcomings of protocols, kits, and interdisciplinary cooperation became apparent. The data provide detailed observations on how immersive simulation and debriefing among peers mitigated the unfamiliarity of individual clinicians and the organization at large with the demands of an unprecedented healthcare crisis. We also observed and report on the anxiety caused by resource constraints, risk to clinicians in the face of limited personal equipment, and the overall uncertainty surrounding COVID-19. We began to summarize, interpret, critique, and discuss our data and debriefing observations in a rapid co-publication in the Journal of Clinical Anesthesia. [Healthcare Simulation to Prepare for the COVID-19 Pandemic][5].

Impact of COVID-19 pandemic and lockdown on the state of mental health services in the private sector in India.

BACKGROUND: No information is available about the impact of lockdown and COVID-19 pandemic on the mental health services in the private practice in India. AIM: The current study is aimed to assess the impact of the COVID-19 pandemic and lockdown on the state of Mental Health Services in the Private Sector in India. MATERIALS AND METHODS: An online survey was carried out using the Survey Monkey platform during the period of 1st to 15th May 2020 among the members of the Indian Psychiatric Society. RESULTS: Three hundred and ninety six responses were analysed. There was a reduction in revenue generation by about 70%. All kinds of services, including outpatient services, inpatient services, psychotherapy services, consultation-liaison, and electroconvulsive therapy (ECT) services, were severely affected. One-third of the participants were using the teleservices during the pandemic. The most common problem faced in running the services included modifying the psychological treatment to maintain social distancing, and managing the staff. Besides providing clinical care to the patients, the majority of the mental health professionals reported that they were involved in increasing awareness about the mental health consequences of pandemic and the lockdown and addressing myths related to the spread of infection. CONCLUSION: The pandemic and the lockdown have markedly impacted mental health services in the private sector. ECT services, inpatient services, psychotherapy services and outpatient services are the most affected. However, the COVID-19 pandemic and lockdown have led to the expansion of teleconsultation services.

State of mental health services in various training centers in India during the lockdown and COVID-19 pandemic.

BACKGROUND: There is some information from different developed coutries that mental health services have been badly affected by the COVID-19 pandemic. Little information is available from India. AIM: The aim of this study was to evaluate the impact of lockdown and COVID-19 pandemic on mental health services in India's various training centers. MATERIALS AND METHODS: In an online survey, information was collected from various training centers of India through E-mail or WhatsApp. RESULTS: Responses were received from 109 institutes. The majority of the responses were received from state-funded government medical colleges and private medical colleges. Since the lockdown and COVID-19 pandemic, brain stimulation treatments have completed stopped. Other, most affected services included electroconvulsive therapy, inpatient services, outpatient services, and psychotherapy services. However, there was an expansion of teleconsultations services because of the lockdown and the COVID-19 pandemic. In three-fourth of the centers mental health services were being provided to the patients with COVID-19 infection. In most of the institutes, mental health professionals were involved at different levels in the COVID-19 responsibilities. These included providing helpline services to the general public, screening people in quarantine for mental health issues, providing clinical care to COVID-19 patients, screening health care workers (HCWs) for mental health issues, and training the HCWs. CONCLUSION: COVID-19 pandemic and lockdown have led to the collapse of regular mental health services. The present study also shows that mental health professionals are playing a significant role in addressing the prevailing psychiatric morbidity, specifically related to the COVID-19 related issues, and taking care of the HCWs.

Impact of the COVID-19 pandemic on psychosocial health and well-being in South-Asian (World Psychiatric Association zone 16) countries: A systematic and advocacy review from the Indian Psychiatric Society.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has emerged as a global health threat. The South-Asian (SA) countries have witnessed both the initial brunt of the outbreak as well as the ongoing rise of cases. Their unique challenges in relation to mental health during the pandemic are worth exploring. MATERIALS AND METHODS: A systematic review was conducted for all the original studies on the impact of COVID-19 and lockdown on psychological health/well-being in the SA countries of the World Psychiatric Association Zone 16. PubMed, Google Scholar, PSYCHINFO, EMBASE, and SCOPUS were searched till June 2020. Studies conducted in the age group of 18-60 years with a minimum sample size of 10, and statistically significant results were included. RESULTS: Thirteen studies were included in the review. They showed increase prevalence in nonpsychotic depression, preanxiety, somatic concerns, alcohol-related disorders, and insomnia in the general population. Psychological symptoms correlated more with physical complaints of fatigue and pain in older adults and were directly related to social media use, misinformation, xenophobia, and social distancing. Frontline workers reported guilt, stigma, anxiety, and poor sleep quality, which were related to the lack of availability of adequate personal protective equipment, increased workload, and discrimination. One study validated the Coronavirus anxiety scale in the Indian population while another explored gaming as a double-edged sword during the lockdown in adolescents. Another study from Bangladesh explored psychosexual health during lockdown. Most studies were cross-sectional online surveys, used screening tools and had limited accessibility. CONCLUSION: The ongoing COVID-19 crisis and its impact serve as an important period for adequate mental healthcare, promotion, research, and holistic biopsychosocial management of psychiatric disorders, especially in vulnerable groups. Mental healthcare and research strategies during the pandemic and preparedness for postpandemic aftermath are advocated subsequently.

Psychological impact of COVID-19 lockdown: An online survey from India.

BACKGROUND: The COVID-19 pandemic has led to a complete shut-down of the entire world and almost all the countries are presently in a "lockdown" mode. While the lockdown strategy is an essential step to curb the exponential rise of COVID-19 cases, the impact of the same on mental health is not well known. AIM: This study aimed to evaluate the psychological impact of lockdown due to COVID-19 pandemic on the general public with an objective to assess the prevalence of depression, anxiety, perceived stress, well-being, and other psychological issues. MATERIALS AND METHODS: It was an online survey conducted under the aegis of the Indian Psychiatry Society. Using the Survey Monkey platform, a survey link was circulated using the Whatsapp. The survey questionnaire included perceived stress scale, Patient Health Questionnaire-9, Generalized Anxiety Disorder-7, Warwick-Edinburgh Mental Well-being Scale to assess perceived stress, anxiety, depression, and mental well-being, respectively. The survey link was circulated starting from April 6, 2020 and was closed on April 24, 2020. RESULTS: During the survey, a total of 1871 responses were collected, of which 1685 (90.05%) responses were analyzed. About two-fifth (38.2%) had anxiety and 10.5% of the participants had depression. Overall, 40.5% of the participants had either anxiety or depression. Moderate level of stress was reported by about three-fourth (74.1%) of the participants and 71.7% reported poor well-being. CONCLUSIONS: The present survey suggests that more than two-fifths of the people are experiencing common mental disorders, due to lockdown and the prevailing COVID-19 pandemic. This finding suggests that there is a need for expanding mental health services to everyone in the society during this pandemic situation.

Population-based stroke survey in Mumbai, India: incidence and 28-day case fatality.

OBJECTIVES: The aims of this study were (1) to establish a prospective community-based stroke registry in Mumbai of subjects having 'first-ever stroke' (FES) and (2) to collect standardized data on annual incidence, stroke subtypes, and case fatality rate at 28 days during the years 2005 and 2006. BACKGROUND: An estimated 5.8 million people died from stroke (cerebrovascular disease) in 2005, two thirds of them were from low-/middle-income countries but reliable population-based studies are scarce. METHODS: The manual on WHO STEPwise approach to stroke surveillance (STEPS Stroke; http://www.who.int/chp/steps/Manual pdf) was the operational protocol. We selected a well-defined community (H-district) having verifiable census data and being representative of the population structure of Mumbai (Bombay). Of 337,391 permanent residents, 156,861 persons between the age of 25 and 94+ years who were eligible for survey were screened. The responses to a predefined questionnaire (version 2.0) were entered in coded data sheets for analysis. RESULTS: During the 2-year study period (January 2005 to December 2006), 456 (238 males and 218 females) had FES, indicating an annual incidence in subjects of 25 years and above of 145/100,000 persons (CI 95%: 120-170); for males it is 149/100,000 persons (CI 95%: 120-170) and for females it is 141/100,000 persons (CI 95%: 120-160). The age-standardized rate for study population (both sexes) by the direct method using Segi's 1996 world population is 152/100,000/year (CI 95%: 132-172). Stroke diagnosis was supported by computed tomography in 407 (89.2%) of 456 FES cases: 366 (80.2%) had ischemic stroke, 81 (17.7%) had hemorrhagic stroke and 9 (1.9%) were in the unspecified category. The mean age was 66 +/- (SD) 13.60 years, women were older as compared to men (mean age 68.9 +/- 13.12 years vs. 63.4 +/- 13.53 years). Case fatality: at 28 days, 320 (70%) of 456 FES cases were still alive and 136 (29.8%) had died. Of the 320 surviving patients 38.5% had moderate to severe disability by the modified Rankin scale. CONCLUSIONS: The results of Mumbai stroke study, using uniform definitions and methodologies, show that the annual standardized incidence rates, stroke subtypes and case fatality rate are very similar to those reported from developed nations. To plan effective intervention and prevention strategies, standardized data in representative samples of regional populations are urgently needed.

Mumbai stroke registry (2005-2006)--surveillance using WHO steps stroke instrument--challenges and opportunities.

BACKGROUND: India will face enormous socioeconomic burden because life expectancy is increasing placing larger numbers of older people at risk of stroke and other chronic diseases. In order to plan prevention strategies, reliable information on stroke epidemiology is required. For uniform data collection (population based), WHO recommends use of STEPS Stroke instrument. STUDY: A well-defined community (H-ward) with verifiable census data, and representative of population structure of Mumbai (Bombay), was selected. The manual on WHO STEPwise approach to stroke surveillance (STEPS; http://www.who.int/chp/steps/Manual.pdf) was the operational protocol. RESULTS: During the two year study period (Jan 2005 to Dec 2006), 521 new stroke (CVD) cases (males--275 and females--246) were identified; of which 456 (238 males and 218 females) had "first ever stroke"(FES) indicating an annual incidence of 145 per 100,000 persons (CI 95%: 120-170); age adjusted Segi rate: 152/100,000/year (CI 95% 132-172). Two thirds of the FES cases were admitted to health care facilities (Step I: "in-hospital" cases), the remaining 150 (32.8%) either died outside of hospital or were treated at home or nursing homes (Step II: Fatal events in community and Step III: Non-fatal events in community). CVD Diagnosis was supported by CT (Computed Tomography) in 407 (89%) of 456 FES cases: 366 (80.2%) had Ischaemic CVD, 81 (17.7%) had hemorrhagic CVD and 9 (1%) were of unspecified category. The mean age was 66 yrs SD +/- 13.60 and women were older compared with men (mean age 68.9 yrs SD +/- 13.12 versus 63.4 yrs SD +/- 13.53). Hypertension (BP more than 140/90 mm Hg) alone or in various combinations was present in 378 ( 82.8%) cases. Case fatality at 28 days after the FES stroke was 29.8%. Of 320 surviving patients 38.5% had moderate to severe disability. CONCLUSIONS: WHO STEPs stroke surveillance Instrument is simple to use and, practical for community surveys. The data are useful for planning stroke prevention campaigns on public awareness and education with regard to diet, exercise, blood pressure control and early symptoms of minor strokes.