Background: Obstructive sleep apnea (OSA) syndrome is characterized by partial or complete cessation of airflow and oxygen desaturation during sleep owing to upper airway collapse. This study assesses the OSA parameters in nasal polyposis patients before and after functional endoscopic sinus surgery (FESS) with the help of peripheral arterial tonometry (PAT) device. Methodology: This was a prospective study done in the months of April 2015 to June 2016. Patients with bilateral nasal polyps with Lund Mackay Scoring marking equal to and more than two of both sides. Thirty patients willing to undergo PAT sleep study before and after FESS were recruited. The sleep parameters thus obtained in the pre- and postoperative period were analyzed. Results: Out of 30 patients, 22 patients were male and eight patients were female. The mean age was 43.17 with standard deviation of 10.06 years. The mean body mass index was 29.12 with a standard deviation of 5.76. All patients underwent FESS. The PAT study was done before and after surgery. Snoring grading and Epworth Sleepiness Scale scoring improved in the majority of patients after surgery. The mean respiratory disturbance index (RDI) in the preoperative period was 32.7 which decreased to 11.34 in the postoperative period. The mean apnea hypopnea index (AHI) in the preoperative period was 22.85 which decreased to 6.34 in the postoperative period. The mean oxygen desaturation index (ODI) in the preoperative period was 16.8 which decreased to 4.4 after surgery. Significant correlation (P < 0.001) was found between pre- and postoperative RDI, AHI, ODI, and oxygen desaturation events. Conclusion: The OSA parameters before and after endoscopic sinus surgery in nasal polyposis patients got improved. The PAT device, which is the newest novel plethysmograph, proved to be a reliable device for the assessment of sleep apnea parameters in nasal polyposis in the pre- or postoperative period.

Background: Delirium is characterized by decline in cognitive performance and is associated with various medical and psychiatric comorbidities. Each of these may be further associated with deranged clinical investigations. Objectives: To determine the clinical profile of delirium in patients referred to the department of psychiatry in a tertiary care hospital from October 2019 to October 2020. Methodology: This was a cross-sectional study which was conducted in a tertiary care teaching hospital among 48 in-patients who satisfied the criteria for delirium as per ICD-10, over a period of 1 year after obtaining clearance from the institutional ethics committee. A specialized pro forma was used to record demographic, medical, psychiatric, and other relevant clinical data. Results: The mean age of all participants was found to be 56.73 years ± 17.2 years. Among 48 patients with delirium, 45 had hepatic risk factors and 34 patients had multiple risk factors. Results of electrolytes between patients with and without encephalopathy were found to be statistically significant for sodium and chloride. Conclusions: Delirium continues to be a clinical diagnosis without any specific laboratory parameters and hence it becomes quite difficult to predict its onset and poses a threat for its management. Therefore, the awareness of such risk factors that increase the risk for developing delirium will lead to a better understanding of this complex syndrome which is crucial for its prevention and management.

In head-and-neck cancer (HNC), it is imperious to assess changes in health-related quality of life (HRQoL) for a comprehensive evaluation of patient needs and treatment outcomes. Currently, there is limited literature about HRQoL measures used in the Indian context. This lack of information may make it difficult for clinicians to understand their patients' overall well-being and hamper their ability to contrive the appropriate treatment plans. Several questionnaires are currently available and used to assess HRQoL in HNC. The objective of this review is to briefly reflect upon the available questionnaires in HNC, their availability in Indian regional languages and conceivable improvement in the design of the questionnaires, and their clinical use. This will allow the head-and-neck clinical team to compare and contrast the available questionnaires and make an informed choice about the most appropriate measure based on their study design or clinical workflow.

Background: It has always been suggested that sleep deprivation has a deleterious effect on the ability of health workers who are involved in multitude of life-saving tasks, which often require more attention and concentration. The Centers for Disease Control and Prevention and the national health portal (Government of India) have now recognized sleep deprivation as a public health epidemic. Materials and Methods: A cross-sectional study was done including health-care professionals working night shifts on rotation at a tertiary level health-care facility, using a semi-structured questionnaire to test the status of their sleep deprivation, cognitive ability, and quality of life as a pilot study. Stratified random sampling was used to select the study participants and health-care professionals with other factors which may interfere with sleep deprivation testing were excluded. Data were analyzed using IBM-SPSS, and required statistical tests were applied (Pearson Chi-square, Fisher exact, Spearman correlation, and Wilcoxon signed-rank test). Results: About 95.12% of participants reported < 6 h of sleep post night shifts, of which 51.2% were found to show signs of sleep deprivation. Of this 51.2%, 28.57% were also found to have lower cognitive function scores, and statistically significant lower cognitive scores were observed during night shifts than during day shifts. The median value of the Montreal cognitive assessment (MOCA) score during the night shift was 27 (interquartile range [IQR] = 4) and the median value of MOCA score during the day shift was 29 (IQR = 1). A poor QOL was observed in 17.07% of the study participants, and it was found to have a significant positive correlation with hours of sleep obtained. Conclusion: The results from the present study points towards a significantly high burden of sleep deprivation among health-care professionals working rotational shifts (51.2%). This warrants a need for further evaluation on larger populations and adoption of comprehensive measures including preventive and promotive aspects like sleep counselling and yoga/meditation for management.

Background: Patient counseling is an integral part of the pharmacy services provided in community pharmacies, and it can be used as a tool to determine the quality of health care. This study aimed to evaluate the community pharmacists' counseling services and determine patients' satisfaction toward these services. Methodology: This study was a descriptive, community-based cross-sectional study in the Sudanese population from March 2020 to June 2020. One thousand nine participants responded to the questionnaire. A convenience sampling method was used to collect the data. Data were collected using an online predesigned standardized questionnaire and then analyzed using the Statistical Package for the Social Sciences. Results: It was found that most of the participants (78.4%) were from urban areas. The majority of the participants (84.8%) completed their education until the university level, and 82% of the respondents were aged between 18 and 29 years. Females were 57.1%, and 50.5% of the participants work in the medical field. About 60% (59.9%) of them have never been asked if they had an allergy to certain drugs when they visited the pharmacy and 81.6% did not receive any information about what to do if they missed a dose, whereas 71.6% have never been told about the possible side effects of the drugs they are prescribed. The average score of satisfaction among the participants was 18.24 ± 3.953. It was found that 32.1% and 11.8% of the people involved in the study were satisfied and very satisfied with the pharmacist's counseling services, respectively. Chi-square test revealed that opinion/feedback about the pharmacist and his services was significantly associated with gender, residence, and working in the medical field. Conclusion: More than two-thirds of the participants reported positive feedback toward the community pharmacists and their services. Patient satisfaction was significantly associated with gender, residence, and working in the medical field. Opinion/feedback about the pharmacist and his services was significantly associated with gender, residence, and working in the medical field.

With the SARS-CoV-2 holding the world under siege throughout the year, frontline workers who readily took up the gauntlet have been having a harrowing experience. Emergency medicine teams, among others, have been at the forefront of the herculean task of fighting this invisible foe. Our Emergency department has so far resuscitated and managed thousands of Covid suspect and confirmed patients who passed passing through our gates into the hospital. During these troubled waters, thousands of doctors, nurses, paramedics, and other healthcare workers at the frontline against COVID-19 have fallen victims to the contagion. Emergency medicine physicians, nurses and paramedics across the world are experiencing rising levels of anxiety and emotional exhaustion amid the coronavirus chaos.[1] The psychological burden of the pandemic on these valiant frontline warriors is likely to leave long-lasting scars, and the quantum of impact could perhaps be unmeasurable. Adding to the stress of working in "COVID zones" is the pan-global lockdown that has aptly been described as "the world's largest psychological experiment." Shortage of critical care beds further compound patient's misery, with the end result being thousands of patients unable to get optimal care across the country. The daily sight of patients succumbing to their illness and the helplessness to admit and treat all COVID 19 patients is quite a traumatic experience. After a long and hard days' toil where keeping the head above water is a challenge, frontline workers are faced with the worry of exposing their family members or roommates, possibly needing to self-quarantine. The mental effects of this additional isolation because of the working environment on the frontline further compound their already stressful day. Healthcare workers have not been the only frontline warriors in this pandemic battle. Controlling the spread of the virus through quarantine and lockdown required a collective effort from police officers, municipal workers, and many other government officials, who bravely stood in the line of duty and risked not only their lives but also their family members. Being thrown into the lion's den early this year, the frontline warriors collectively have been fighting this "pandemic war" with very limited preparation. The epicenter of the pandemic kept migrating from the Far East to Europe and then to the "New World."[2] The Indian subcontinent has been equally battered by the deadly virus with most of the metropolitan cities with high population density being sitting ducks. The many 'potential hopes' such as remdesivir, hydroxychloroquine, ivermectin, favipiravir, convalescent plasma and the good old dexamethasone kept giving the World glimmers of hope through this pandemic, but none proved to be the 'silver bullet' for COVID 19. Some therapeutic options even turned out to be a wild goose chase. More than 150 vaccine candidates such as the ChAdOx1 nCoV-19 and mRNA-1273 are at varying phases of efficacy and could play a pivotal role in the future of this combat.[34] The year 2020 thus far has been topsy–turvy with the bottom of the abyss still beyond sight. SARS-CoV-2 is only a sojourner on the planet Earth; however, till a rendezvouz with victory over this formidable microbe can be arranged, emergency physicians and other frontline workers would be required to continue their relentless selfless combat. In the fight against the pandemic of epic proportion, the brave frontline warriors have truly been the "calm amid this storm."

Background: Headache is prevalent worldwide and it affects people in almost all age groups, irrespective of their gender, educational level, socioeconomic status, and occupation. The aim of this study was to determine the characteristics, perceived cause, and medical consultation sought by undergraduate medical students of Government Medical College, Srinagar. Materials and Methods: A descriptive cross-sectional study was conducted among undergraduate medical students of Government Medical College, Srinagar. One hundred students participated in the study. A 12-item structured questionnaire which included cause, aggravating factors, relieving factors, and frequency of headache was distributed among these students to be filled by them after a proper written consent. Results: Out of 100 participants, 60 were female. The most commonly reported cause of the headache was stress (25%), followed by disturbed sleep cycle (18%) and mobile phone use for social media in (13%) students. Aggravating factors such as less hours of sleep duration were reported by 40% of students and 27% reported having headache after not eating for several hours. Majority (51%) of the participants reported described pain as a sensation of constant pressure, which was mainly concentrated in the frontal region. Family history was found among 18% of students and only 22% had consulted doctor for headache symptoms. Conclusion: Stress was identified as the most common reported cause of headache and sleep as the most reported relieving factor among medical students of Government Medical College, Srinagar.

Introduction: Coronavirus, a worldwide pandemic today, is continuing its spread day by day. The only way that can be adopted at this stage is to control the number of cases to a minimum. Time series-forecasting models can enable the planners and administrators to foresee the picture and take timely action to control. Methodology: To forecast the daily number of COVID cases, prediction models were developed using Autoregressive-Integrated Moving Average (ARIMA) modelling techniques in the various states of India where the cases are highly reported. The main objectives included the assessment of trend and growth rates of number of COVID-19 cases confirmed and identification of the best ARIMA model for their prediction. Results: Excellent parsimonious forecasting equation for each state in India could be generated using the method. These models will be helpful for planning purposes in controlling the cases. The best model for the prediction of number of COVID cases in all over India was observed as ARIMA (0,2,1). ARIMA (0,1,0) was identified as best model for Mizoram and Puducherry. Conclusion: To predict all India cases, ARIMA (0,2,7) was identified as the best model.

Use of contraception has been recommended to prevent pregnancy, practice family planning and also to prevent the acquisition of sexually transmitted infections. It is important to advocate that regardless of geographical settings, all the women should have access to the wide range of contraceptives, so that based on their preferences or values, an appropriate and well-informed choice can be made. The revised recommendation for women at high risk of HIV advocates for the use of any form of reversible contraception, including progestogen-only injectables. In conclusion, the sexual and reproductive health needs of all women are quite variable and it becomes even more challenging for the women who are either at high risk of HIV or HIV positive. The recent recommendations to expand the range of services offered, including contraceptive methods, is an important step, but will also require strengthening of the existing services.

It is estimated that there are around 50 million people living with epilepsy (PWE) globally. Around one-sixth of this population resides in India. Around 10–12 million people with epilepsy reside in India. A significant proportion of PWE do not receive appropriate treatment, leading to a large treatment gap (TG). Poor awareness of antiepileptic drugs (AEDs), cultural practices, social stigma surrounding epilepsy, lack of accessibility to healthcare, and a severe shortage of medical professionals trained in the management of epilepsy are major contributors to the TG. Infectious diseases, particularly neurocysticercosis, form a major bulk of underlying cause for epilepsy. Certain geographical regions exhibit typical patterns of epilepsy. In this article, we attempt to provide a broad overview of the incidence, prevalence, etiology, types, mortality, and treatment of epilepsy derived from the data from Indian studies. India provides particular challenges in the management of patients with epilepsy, not only in terms of the wide spectrum of epileptic conditions but also in the demand for medical practice based on economic constraints.