Vol 13, Issue 1, Jan-Mar, 2023

The COVID-19 pandemic has caused significant morbidity and mortality worldwide. One of the most persistent and debilitating consequences of COVID-19 is long-COVID, a condition characterized by prolonged symptoms and organ damage that can last for months after the acute phase of the infection has resolved. Vaccination against COVID-19 has been shown to be effective in preventing severe disease and hospitalization, but its impact on long-COVID remains unclear. In this comprehensive review, we discuss the pathological mechanism and prevalence of long-COVID and the role of COVID vaccination in preventing and treating this condition. We examine the protective effects of vaccines against COVID-19 and long- COVID, including their efficacy within populations. We also explore breakthrough infections with long-COVID, reviewing studies on their incidence and the differences among vaccine brands. Finally, we summarize current research progress and limitations, and we provide future perspectives on this important topic. Our findings suggest that COVID vaccination may play a crucial role in preventing long-COVID, and further research is needed to fully understand its impact and to develop effective prevention and treatment strategies. Keywords: Long-COVID, Pathological mechanism, Breakthrough infections.

A Myocardial Infarction (MI), commonly known as a heart attack, occurs when blood flow decreases or stops to the coronary artery of the heart, causing damage to the heart muscle. This investigation is a pioneering effort to depict the scientific output of myocardial infarction research especially in China using the data downloaded from Scopus database for a period from 2001 to 2020. The study proved that Chinese scholars are interested in collaborative research rather than solo research. The study deviates Bradford’s law of scattering. The highest productive journal in this field, as chosen by Chinese scholars is Chinese Medical Journal followed by International Journal of Cardiology (United States) and Medicine (United States). Wang, Y ranks first with 922 publications followed by Zang, Y and Li, Y having 849 and 739 publications respectively. More than one third of the references are of less than 5 years old. Keywords: Myocardial infarction, Scientometrics, China, Heart Attack, Cardiovascular diseases.

Objectives: The study took place at a central Queens Hospital and answered a total of three research questions. The research wanted to know whether the patients differed in the medications that they took, whether they were placed on a ventilator, and their survival based on their ethnicity while controlling for covariates such as the patients age, gender, and comorbidities while being managed and treated for COVID-19. Materials and Methods: Data was collected from 1188 patient charts from January 1, 2020 to January 1, 2021, and binary logistic regression was used to test hypotheses. Results: The analysis showed non-statistically significant differences in medication use, intubations, or mortality outcomes by ethnicity. The p-values for all the ethnic groups was far greater than 0.05 which indicated that for all the ethnic groups there were no differences that were statically significant for medication use, ventilator use, or survival for all ethnicities thus the null hypothesis must be considered. Conclusion: Ethnicity had no bearing on treatment modalities or mortality among patients admitted and diagnosed with COVID-19 symptoms. Patients at this hospital received equitable care despite ethnic differences that can help alleviate the ill-effects of treatment disparities. Keywords: COVID-19, Intubation use, Medication use, Mortality, Urban Hospital.

Introduction: Responding to raised demand for health services during the COVID-19 pandemic, many countries turned to private healthcare providers to augment public capacities. In India, to deal with price inflation by private hospitals, many state governments implemented regulation of rates for COVID-19 treatment. Materials and Methods: In Maharashtra which pioneered the hospital rate regulation among Indian states, we conducted a mixed-methods study to examine the impact of rate regulation. Using purposive sampling, we interviewed 100 previously hospitalised COVID patients or their relatives, along with 12 health sector stakeholders. Results: Analysis shows that in 82.5% of hospitalisation episodes, patients were overcharged compared to official packages The majority of private hospitals utilised diverse stratagems to circumvent rate regulations, including double charging on items included in official packages. Conclusion: With a background of commercialisation of healthcare and pre-existing regulatory hiatus in India, gaps in design and implementation of COVID-period regulatory measures and state’s inadequate regulatory capacity formed the context for the limited effectiveness of regulatory measures. India and other LMICs with large private healthcare sectors should develop comprehensive yet pragmatic frameworks for regulating private healthcare, including standardisation of rates, which can strengthen regulatory efforts, enabling equitable and affordable access to healthcare for all. Keywords: Regulation, Profiteering, Health policy, Policy implementation, Private sector accountability.

Background: Self-management of diabetes is essential for proper control of blood sugars and prevention of complications. Persons with disabilities face challenges in adopting self-management behaviours. Objectives: To assess diabetes self-management behaviours among persons with disabilities. Materials and Methods: We searched PubMed with a comprehensive search strategy to retrieve epidemiological studies that reported the diabetes self-management behaviours among persons with disabilities in English language journals between 1990 – 2022. We did a step-wise screening of the retrieved articles and synthesized the findings of the selected papers. Results: Of the 992 papers that were obtained, 981 did not meet our inclusion criteria and were excluded at the stage of title and abstract screening. Eleven papers were retrieved and read in detail, and 8 of them were excluded at this stage. Finally, three papers two from China and one from Iran were included in the review. The studies revealed poor diabetes self-management behaviours among persons with disabilities, especially in the domains of diet and physical activity. Conclusion: There is a dearth of studies exploring diabetes self-management behaviours among persons with disabilities. Even the few reported studies show low levels of self-management behaviours. Keywords: Diabetes self-management, Disabilities, Glycemic control, Diet, Exercise, Monitoring, Medication adherence.

Introduction: Vaccination is one of the important solution to control the COVID-19 pandemic. Considering the vaccine hesitancy in India, a study about an experience of COVID-19 vaccination is planned. Materials and Methods: A cross-sectional, self-administered interview-based study was performed at a vaccination centre in Mumbai. Individuals who have taken at least one vaccine dose were interviewed at the vaccination centre between August 2021 and December 2021. The self-administered questionnaire consists of 23 items which include questions about demographic details, history of COVID-19 infection and the details of the vaccine, followed their beliefs and confidence regarding the vaccine, their experience with the vaccination centre, and the side effects of the vaccine if any. Results: A total of 400 individuals responded to the survey. Among them, 50.3% were males. About 77% of participants depended on digital media for the vaccination program awareness. Only 19.3% of respondents expressed hesitancy regarding vaccine side effects and felt difficulty taking a vaccine. A majority (94.5%) of the responders were in favor of recommending vaccination to their peers. Most of the participants were satisfied with the services at the vaccination centre. The Adverse Events Following Immunization (AEFI) reported by individuals were minor. Conclusion: Side effects of the vaccination, trust, risk perception, personal experience, and earlier vaccine experiences are some factors that reduce people’s willingness to vaccination. The current study reports an overall high willingness for vaccination. It also reflects the acceptance of booster doses with the organized vaccination drives and awareness among the people. Keywords: COVID-19 vaccination, Community health, Vaccination experiences, Adverse events following immunization.

To address these issues, it is essential to prioritize comprehensive menstrual health education in schools and communities. By providing accurate information about menstruation, its biological processes, and emotional aspects, we can empower young girls with the knowledge they need to navigate this significant milestone in their lives. It is equally important to debunk myths and break the silence surrounding menstruation, encouraging open dialogue and creating a safe space for girls to seek guidance and support. Furthermore, schools and parents should play an active role in providing emotional support to girls experiencing early menstruation. Counseling services can be made available to help them cope with the psychological challenges they face. Teachers and parents should also be trained to recognize signs of distress and mental health issues among these girls, ensuring timely intervention and support. Additional measures that can be taken to address the impact of early menstruation on the mental health of teens in India:

Since the first reported case of COVID-19 in India, the virus has spread rapidly, challenging the capacity and resilience of our healthcare infrastructure. As the number of infections surged, hospitals were overwhelmed, with shortages of beds, medical equipment, and essential supplies. The grim scenes of patients gasping for breath, struggling to find adequate care, and families devastated by loss have left an indelible mark on our collective consciousness. One of the most significant consequences of the pandemic has been the strain on healthcare workers. Doctors, nurses, and other frontline workers have selflessly put their lives at risk to save others, working tirelessly under immense pressure. However, the prolonged exposure to the virus, coupled with the emotional toll of witnessing so much suffering, has taken a severe toll on their mental and physical well-being. Many healthcare professionals have faced burnout, leaving the profession altogether, leading to a potential shortage of skilled personnel in the future.1

Background: Fascia iliaca compartment nerve block (FICB) is a commonly preferred pain management technique in femoral fractures. The duration of analgesia is prolonged with the addition of an adjuvant to the Fascia iliaca compartment nerve block. Aims and Objectives: To compare the duration of analgesia and VAS scores between 4mg and 8mg of dexamethasone given as an adjuvant to Levobupivacaine in Fascia iliaca block. Materials and Methods: 100 American Society of Anaesthesiologists (ASA) I and II patients of either sex, scheduled for proximal femoral nail surgery under spinal anaesthesia were randomly allocated to two groups. Group A (n=50) received ultrasonography (USG) guided fascia iliaca block with 28ml of 0.25% levobupivacaine combined with 1ml of 4mg dexamethasone and 1ml of normal saline. Group B (n=50) received USG guided fascia iliaca block with 28ml of 0.25% levobupivacaine combined with 2ml of 8mg dexamethasone. Following fascia iliaca block, spinal anaesthesia was administered in both the groups. Postoperative visual analogue scale (VAS) score, duration of analgesia and haemodynamic parameters were recorded. Results: The duration of analgesia in Group A was 715.60 + 42.48 minutes and in Group B was 836 + 35.91 minutes (p <0.0001) and the VAS score was lower in the 8mg dexamethasone group than 4 mg dexamethasone at 12 hours postoperatively. Conclusion: 8 mg dexamethasone, in comparison to 4 mg dexamethasone as an adjuvant to 0.25% levobupivacaine for FICB significantly prolongs postoperative analgesia and reduces need for rescue analgesia in patients undergoing proximal femoral nailing under spinal anaesthesia. Keywords: Fascia iliaca block, Levobupivacaine, Dexamethasone, analgesia.

Background: Alpha-2agonists like clonidine and dexmedetomidine are used as neuraxial adjuvants. They potentiate the effect of local anaesthetics and allow a decrease in required doses. They prolong the duration of both motor and sensory spinal blockade. Aims & Objectives: This study is designed to compare the onset, duration of sensory and motor block and haemodynamic characteristics and side effects of addition of clonidine (35µg) and dexmedetomidine (5µg) to intrathecal 0.5% bupivacaine. Materials and Methods: Sixty American Society of Anesthesiologists (ASA) grade I and II patients were randomized into two groups, 30 patients in each.: Group C (n=30) received 3.5 ml [3ml (15mg) of 0.5% bupivacaine + 0.5ml (35µg) of clonidine] and Group D received 3.5ml [3ml (15mg) of 0.5% bupivacaine + 0.5ml(5µg) of dexmedetomidine] of study drug. All the drugs used in this study were preservative free. The intrathecal injections were prepared by an anaesthesiologist who was not involved in the study. The investigator performing the block and recording the observations of the study parameters was blinded to the intrathecal drug administered. Lumbar puncture was performed in lateral position at L3-L4 intervertebral space using a 25 gauge, Quincke Babcock’s spinal needle and intrathecal injection was administered after aspiration of cerebrospinal fluid. Results: The two groups were comparable with respect to age, weight, height, gender, ASA status. The mean times of onset of sensory block (loss of cold sensation at T10), maximum height of block, time to reach maximum height and regression time to S1 were comparable in between the 2 groups. The motor block onset and duration of block were comparable in between the 2 groups. Haemodynamic parameters were well maintained in both the groups. Heart rate was compared between the groups at regular intervals. The results did not show any statistical significant difference. Mean arterial pressure compared in between the 2 groups. A statistically significant difference was observed at 2min, 60min and 3hr. No statistical significant difference in the incidence of adverse events is observed between 2 groups. The mean doses of ephedrine and atropine and total amount of I.V fluid given to the patients were comparable between the groups. Conclusion: In our study we concluded that addition of clonidine 35µg or 5µg dexmedetomidine produced similar characteristics of sensory and motor block with maintenance of haemodynamic stability. Keywords: Clonidine, Dexmedetomidine, Bupivacaine, Subarachnoid block.