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   Table of Contents - Current issue
May-August 2022
Volume 3 | Issue 2
Page Nos. 19-44

Online since Tuesday, May 24, 2022

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Evolving pharmacotherapeutics for the Covid-19 pandemic p. 19
Harish Gupta
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Psychological antecedent of Coronavirus vaccination: An observational study in India Highly accessed article p. 21
Renu Bala, Amit Srivastava, Ashish Kumar Dixit, Meenakshi Shriwas, Ravi Bhaskar
Background: In December 2019, severe acute respiratory syndrome coronavirus 2, was identified as the causative agent of coronavirus disease 2019 (COVID-19). As a part of control measures against COVID-19, vaccination started in India from January 16, 2021. People's hesitancy may become an important challenge in the immunization campaign against COVID-19. This study aimed to assess the confidence of the general public and acceptance of the vaccines in India. Materials and Methods: A web-based cross-sectional survey was conducted between February 21, 2021, and March 10, 2021, by Google Forms utilizing a snowball sampling method. The psychological antecedents of vaccination for COVID-19 in India were assessed using a 15-item (3 items per antecedent) 5C scale. Results: The study received 720 responses, out of which 466 (64.72%) participants were willing to accept the CoV vaccines. Data were analyzed using STATCRAFT online statistical software version 2.0 (Bangalore, Karnataka, India). The participants who expressed more confidence in vaccines (odds ratio [OR] =1.818, P < 0.001) and who took a calculated decision (OR = 1.183, P = 0.001) were more likely to accept CoV vaccines while the participants who were complacent (OR = 0.852, P < 0.001) and who took collective responsibility (OR = 0.891, P = 0.033) were less likely to accept CoV vaccines. Conclusion: The findings of this study point to the importance of confidence, constraints, and calculation for vaccines among the Indian population, so that policymakers can monitor the acceptance for the vaccines and can plan future strategies to address hesitancy issues more effectively.
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Training in management of COVID-19 cases among first responders before deployment to makeshift COVID hospital p. 28
Arun Kumar Yadav, Anuj Singhal, Kiran K Kompella, Anand S Menon, Saurabh Mahajan
Background: The COVID-19 pandemic commenced in China in December 2019 and has since become a major public health problem. India, as a country, faced many challenges in preparing for the coronavirus pandemic. Due to the novelty of the disease, high infectivity rates, and constant risk of health-care workers (HCWs) getting infected, the training of the first responder, including primary care physicians, in the management of COVID-19 is paramount importance. This study analyses the benefits of a short training session imparted to HCWs involved in a makeshift COVID-19 hospital. Methodology: A structured training program consisting of lectures and workshops was formed for the HCWs detailed for the COVID-19 hospital. A questionnaire was prepared and administered to HCWs pre- and post-training sessions. Paired t-test was used to determine the mean difference, and P < 0.05 was taken as statistically significant. Results: A total of 260 HCWs participated in the study. The doctors gained the most in the critical care aspect, especially in oxygen requirement for the patient and knowledge of oxygen delivery by various apparatuses. The nurses showed a significant improvement in knowledge regarding recommended drugs for severe COVID cases (P < 0.05). Conclusion: HCWs are required to man the COVID facility at very short notice. The article showed the utility of short, structured, and quick training for HCWs. Regular training sessions are important in this regard, and there is a requirement for standardization of the training program and curriculum.
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Serum homocysteine in intracerebral hemorrhage: A savior or a destroyer? p. 33
Debabrata Chakraborty, Sadanand Dey, Sanjay Bhaumik, Aditya Choudhary, Kishalaya Karan, Pradipta Bhattacharjee, Priyanjita Sen, Mohuya Mukherjee, Gobinda Pramanick, Nirmalya Ray, Payel Biswas, Jayanta Roy, Satya Narayan Singh, Binod Kumar Singhania, Biswajit Sengupta, Kajal Das, Gopal Acharya, Bhaskar Ukil, Rahul Ghosh
Objectives: Intracerebral hemorrhage (ICH) is more common in the Indian subcontinent compared to the Western world and associated with significant morbidity and mortality. Hence, all possible modifiable factors should be searched and steps taken so that a single opportunity is not missed in preventing such a catastrophe. The aim of the study is to find out whether homocysteine and Vitamin B12 are related to ICH. Materials and Methods: We included acute ICH patients of 18 years and above who came to our institute and got admitted in 5 months (September 2021–January 2022). Our team noted the demographics, National Institutes of Health Stroke Scale (at admission and discharge) and other clinical parameters. Volume and site of the intracerebral hematoma (from the initial computed tomography [CT] scan of the brain) were noted. The outcome and prognostic markers like Modified Rankin Scale (mRS) at discharge, MRS at 3 months (also MRS at admission) and ICH score were calculated. The blood parameters, including serum homocysteine and Vitamin B12 level, were noted post admission in hospital. Results: We found out of 44 ICH patients; ten patients had hyperhomocysteinemia (HHcy): 22.72%. We detected significant correlation between HHCy with ICH score (inverse relationship) and dyslipidemia (direct relationship). Conclusion: We found an inverse correlation between serum homocysteine level and ICH score, which shows a short-term (1 month) prognosis. This might hint that homocysteine might have a protective role to play in ICH. However, we probably need larger study population to find a correlation strong enough so that we can make a stronger conclusion.
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Is COVID-19 infection also a silent killer?: A case of acute stroke p. 40
Debabrata Chakraborty, Prakash Chandra Mondal, Kaushik Sundar, Sanjib Kumar Dingal
A 59-year-old male had multiple comorbidities such as diabetes, dilated cardiomyopathy, hypertension, ischemic heart disease, and chronic obstructive pulmonary disease. He presented with dyspnea and had ground-glass opacity in the lungs. It was during the pandemic of COVID-19 so repeated Reverse transcription polymerase chain reaction (RT-PCR) was done, but all were negative. He got stabilized within 5 days and we planned discharge. Suddenly, he had right hemiplegia and developed altered sensorium. He had NIH Stroke Scale/Score of 28 and computed tomography-Alberta Stroke Program Early Computed Tomography Score of 10. We used tenecteplase (0.25 mg/kg bodyweight) for thrombolysis within 20 min of onset and planned mechanical thrombectomy for the occlusion of internal carotid artery and beyond. However, in magnetic resonance imaging of the brain, he had an established infarct in the left middle cerebral artery (MCA) territory (within this short time) without significant DWI/FLAIR mismatch. Hence, we continued conservative management. We incidentally detected him to have COVID-19 infection positivity on that day, but all inflammatory and coagulation parameters were normal on that day and later. His monitor did not reveal arrhythmia (during the event and later) and echocardiography failed to reveal evidence of culprit lesion. He had a rapid clinical decline, required hemicraniectomy but expired within 2 days. COVID-19 infection may have negative reports initially, but malignant MCA infarct with normal inflammatory markers makes our case special. The rapidity with which stroke developed underscores the severe nature of the disease process, the absence of arrhythmias (in this in-house stroke), and normal coagulation parameters hints that the exact mechanism of stroke in this type of infection is still an enigma.
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When doom is invincible and not easily perceptible: A case of diffuse nodular disease p. 43
Debabrata Chakraborty, Asok Sengupta, Ranajoy Chanda, Sagar Sen, Samit Goenka, Sanjay Bhaumik
A 47-year-old -lady without known co-morbidity had presented with a one-month history of respiratory distress and headache. Someone incidentally started her with antitubercular drugs and steroids outside our hospital. Her routine CT scan of brain was unremarkable. She had a partial response to the same, but she presented to us with an increased headache after a month. We found her to have diffuse nodular pulmonary involvement with bilateral pleural effusion. The pleural fluid diagnostic evaluation revealed adenocarcinoma of the lung. The MRI of the brain revealed multiple nodular involvements consistent with the rare intracranial miliary metastasis. Our case underscores the importance of careful history taking and evaluation of patients with respiratory distress along with headaches (our patient lacked a classical history of miliary tuberculosis). We may overlook the silent brain metastasis on routine CT scans of the brain and cause an important delay in diagnostic evaluation and intervention in life-threatening diseases, like our case.
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