AN EXPLORATORY STUDY EVALUATING EXPERIENCED STIGMA AMONG DOCTORS IN A DEDICATED COVID-19 HOSPITAL OF NORTH INDIA

Objective: Doctors may experience stigma and discrimination from community, friends and even family due to their association with COVID-19 patients. The present study was planned to assess actual stigma experienced by doctors because of working in COVID-19 wards. Methods: A cross-sectional study was conducted in the Department of Psychiatry of a dedicated COVID-19 Hospital of North India. A Google Survey Form which measured Experienced Stigma was circulated through WhatsApp groups in October-November 2020 among all the doctors working in COVID-19 ward. Data collected was analyzed statistically. Results: Around 250 doctors participated in the study and 70% of them experienced stigma in one or more ways. Approximately, 60% doctors had stopped socializing because of people’s reactions, they felt that people were afraid of them and that people avoided touching them because they were treating patients with COVID-19. 110 (44%) respondents were denied social exchanges/friendships, 88 (35.2%) felt neglected by family or friends, and 71 (28.4%) lost friendships because they worked with patients with COVID-19. Stigma was experienced significantly higher in younger age (p=0.012*), resident doctors (p=0.001**) and those with longer working hours (p=0.01*). Conclusion: Doctors experience stigma from friends, family and general public due to their contact with COVID-19 patients. Experienced stigma is higher in young age and resident doctors

Antidepressants-a possibly risk factor for cataract development: a cross-sectional study

Background: Few studies have reported the role of antidepressants as cataractogenic in humans.Methods: It’s a hospital based descriptive, cross-sectional study. 45 Patients were screened for antidepressant use and diminution of vision, 6 were dropped out. 39 patients with 78 eyes were finally enrolled. They were divided into two goups i.e., Group-I, with cataract (N=53) and Group-II, without cataract (N=25). Three clusters of antidepressants were assessed e.g., SSRI, SNRI and TCA with therapeutic dose (TD) and non-therapeutic dose (NTD) range. Psychiatric illness was diagnosed on DSM-5 and severity of depression on HAM-D. Best corrected visual acuity (BCVA) was converted from Snellen units to logarithm of minimal angle of resolution (log MAR) for statistical analysis. Cataract changes in eyes were seen on slit-lamp and classified on Lens opacities classification system-III (LOCS-III) criteria.Results: A total 78 eyes of thirty-nine (39) patients were evaluated. Thirty (38.46%) and forty-eight (61.53%) eyes belonged to males and females, respectively. Mean age of males (n=7) was 41.8±2.3 years and females (n=32) 40.2±1.0 years. In Group-I, out of (N=53) eyes that developed cataract 33 were females (62.26%) as compared to males 20 (37.7%). Group -II, out of (N=25) eyes, females without cataract were 15 (60%) as compared to males 10 (40%).  Therapeutic dose (TD) of antidepressants (AD) in Group-I had more cataract 37 (69.81%) as compared to non-therapeutic dose (NTD) 16 (30.1%). Most of the eyes with cataract 35 (66.03%) had AD exposure of more than 1 year that was possibly associated with increased risk of cataract development (OR 2.10; 95% CI, 0.79-5.55). Amongst users of antidepressants, SSRI was associated with increased risk of cataract development (OR 2.4; 95% CI, 0.72–7.94) with a female preponderance (OR 1.1; 95% CI, 0.41–2.91). Maximum number of eyes 34 (64.15%) that developed cataract had BCVA of ≥6/12 and minimum of 2 (3.77%) eyes had BCVA of ≤6/36. LOCS-III revealed 38 (71.69%) eyes (71.69%) having peripheral cortical cataract and 15 (28.30%) posterior sub-capsular cataract.Conclusions: There is a possible risk of association of cataract amongst user of antidepressants. The AD use of more than 1 year or longer had increased risk for development of cataract with a female preponderance. The highest risk was observed in the users of SSRI as compared to SNRI and TCA. Treatment exposure with antidepressant was longer for mild depression having more than two episodes

Barrett’s Esophagus: An update

Barrett’s esophagus is premalignant condition in which the stratified squamous epithelium is replaced by metaplastic intestinal epithelium. The cause is usually long-standing gastro-esophageal reflux. Infection with Helicobacter pylori is also believed to play a role in this. The most significant complication is development of dysplasia with an increase in relative risk for development of adenocarcinoma 40–120 times

IMPACT OF FAMILY STIGMA AND CAREGIVER BURDEN ON QUALITY OF LIFE AMONG WIVES OF PATIENTS WITH ALCOHOL AND OPIOID USE DISORDER

Objectives: Spouses of patients with alcohol use disorder (AUD) and opioid use disorder (OUD) suffer from burden, stigma, and low quality of life (QoL). The present study assessed the impact of stigma and burden on QoL among wives of patients with AUD and OUD. Methods: 90 wives of in-patients with severe AUD (n=54) and OUD (n=36) as per DSM-5 were assessed using socio-demographic pro forma, WHO QoL Bref Hindi, Hindi family stigma scale and Family Burden Interview Schedule. Statistical Package for the Social Sciences Inc., Chicago, IL, version 25.0 for Windows was used for analysis. Appropriate statistical tests including Kolmogorov–Smirnov tests of normality, Mann–Whitney test, and Kruskal–Wallis test were used. To see the relationship between two variables Pearson Correlation coefficient was calculated. All statistical tests were two-sided and performed at a significance level of α=.05. Results: Majority of the wives were more than 30 years old, literate and belonged to rural areas. Higher financial burden reduced overall QoL (p=0.001**), satisfaction with physical health (0.006**), psychological health (p=0.032*), and environment (p=0.001**). There was a negative correlation of satisfaction with environment with disruption of family interaction (p=0.003**), burden on mental health (p=0.001**), overall burden (p=0.000**), and discrimination (p=0.032*). Conclusion: QoL of spouses of patients with AUD and OUD reduces significantly due to stigma and burden. Enhancing QoL of spouses should be a part of management of AUD and OUD

Fixed-Time Stable Proximal Dynamical System for Solving MVIPs

In this paper, a novel modified proximal dynamical system is proposed to compute the solution of a mixed variational inequality problem (MVIP) within a fixed time, where the time of convergence is finite, and is uniformly bounded for all initial conditions. Under the assumptions of strong monotonicity and Lipschitz continuity, it is shown that a solution of the modified proximal dynamical system exists, is uniquely determined and converges to the unique solution of the associated MVIP within a fixed time. As a special case for solving variational inequality problems, the modified proximal dynamical system reduces to a fixed-time stable projected dynamical system. Furthermore, the fixed-time stability of the modified projected dynamical system continues to hold, even if the assumption of strong monotonicity is relaxed to that of strong pseudomonotonicity. Connections to convex optimization problems are discussed, and commonly studied dynamical systems in the continuous-time optimization literature follow as special limiting cases of the modified proximal dynamical system proposed in this paper. Finally, it is shown that the solution obtained using the forward-Euler discretization of the proposed modified proximal dynamical system converges to an arbitrarily small neighborhood of the solution of the associated MVIP within a fixed number of time steps, independent of the initial conditions. Two numerical examples are presented to substantiate the theoretical convergence guarantees.Comment: 12 pages, 5 figure

Comparison of Nitroglycerin versus Lignocaine Spray to Attenuate Haemodynamic Changes in Elective Surgical Patients Undergoing Direct Laryngoscopy and Endotracheal Intubation: A prospective randomised study

Objectives: This study aimed to compare the effects of nitroglycerin (NTG) versus lignocaine spray in blunting the pressor response during direct laryngoscopy and endotracheal intubation. Methods: This study was conducted between January and June 2018 in the Department of Anesthesiology, Teerthankar Mahaveer Medical College, Moradabad, India. A total of 90 elective surgical patients of American Society of Anesthesiologists physical status grades I or II were divided into three groups, comprising two treatment groups and one control group. Patients in the treatment groups received either one puff (1.5 mg/kg) of lignocaine 10% spray or one puff (400 μg) of NTG spray in the oropharynx one minute prior to the induction of anaesthesia. Haemodynamic variables and mean rate pressure product at baseline and one, two, three, four and five minutes post-induction were compared. Results: There was a significant reduction in mean heart rate at 3–5 minutes in both treatment groups compared to the control group (P <0.050), as well as lower increases in mean arterial pressure at 1–3 minutes (P <0.050). However, at 2–4 minutes, there was a significantly greater decrease in mean systolic blood pressure in the NTG group compared to both the lignocaine and control groups (P <0.050). Moreover, a greater decrease in mean rate pressure product response at 1–5 minutes was observed in the NTG group compared to the lignocaine and control groups (P = 0.001). Conclusion: The NTG spray was more effective than lignocaine in attenuating blood pressure increases and rate pressure product during elective laryngoscopy and intubation.Keywords: Endotracheal Anesthesia; Intubation; Laryngoscopy; Lignocaine; Nitroglycerin; Comparative Effectiveness Research; India

EFFECT OF ETHANOLIC FRUITS EXTRACT OF EMBELIA RIBES BURM ON DEXAMETHASONE INDUCED INSULIN RESISTANCE IN MICE

This study was designed to examine the effect of ethanolic fruits extract of Embelia ribes Burm on dexamethasone-(1mg/kg, intramuscular, 22 days) induced Insulin resistance in Mice. Twenty two  days of oral feeding the extract (100 mg/kg and 200 mg/kg) to induced mice resulted in significant (P < .01) decrease in blood glucose, triglyeride, Insulin, HOMA-IR index and  increase in body weight  levels as compared to dexa control mice. Further, the extract also significantly (P < .01) decreased the MDA levels and significantly (P < .01) increased the superoxide dismutase, catalase, and glutathione levels as compared to above levels in Hepatic tissue of dexa control  mice and also increased glucose uptake by skeletal muscle. The results of test drug were comparable to pioglitazone (2 mg/kg, i.m , 22 days), a standard antihyperglycemic agent. The study concludes that Embelia ribes enhances the antioxidant defense against reactive oxygen species produced under hyperglycemic condition and Embelia ribes may prove to be effective in the treatment of Type-II Diabetes mellitus owing to its ability to decrease insulin resistance