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Background: To plan suitable policy against COVID-19 pandemic, it is important that the nurses have updated knowledge related to prevention, diagnosis, treatment, and management of COVID-19 and have an optimistic attitude and good practices in managing the patients during the pandemic crisis. Thus, we conducted a study on the knowledge, attitude, and practices (KAP) related to COVID-19 among Indian nursing professionals. Methodology: A cross-sectional study was conducted from April 22 to May 22, 2020 using a pretested 37-item-self-reported e-questionnaire among nursing professionals above 18 years of age, working in health-care setting across 25 states. The questionnaire consisted of four sections: demographic details, knowledge (26 items), attitude (6 items), and practice (5-itmes). KAP questionnaire was shared through e-mail, SMS, and WhatsApp groups. Results: A total of 1182 participants responded to the online survey with 94% completion rate. The study analyzed the data for 1110 nurses with a mean age of 30 ± 6.7 years and 68% being females. The mean KAP score was 16.82 ± 3.3, 9.77 ± 2.03, and 18.37 ± 3.29, respectively. Knowledge was significantly correlated with attitude (r = 0.1316) and practice (r = 0.1526). Practice and attitude were also found to be positively correlated (r = 0.4398). Good knowledge related to COVID-19 was significantly affected by age, gender, location, and type of facility (<0.01). Conclusion: The study raised concerns regarding poor knowledge, anxiety, and fear from COVID-19 duty affects the health-care workers (HCWs) performance and provides resistance in working. A comprehensive training program for HCWs focuses more in terms of infection, prevention, control, and management and maintaining good mental health is required.

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Celiac disease is an autoimmune disease triggered by presence of gluten in diet which precipitates symptomsof celiac disease causing malnutrition. A narrative review on diet in Celiac diseasewas taken up, which was very much required for health care providers in day-to-day clinical care. Thirty six research studies were identified from 105 potentially relevant articles. Studies were selected on: firstly; all protocols of celiac disease among published literature were meticulously searched. Secondly, nutritional considerations about celiac disease were explored from relevant articles, Thirdly, published reports from apex bodies of global importance like World Health Organization (WHO), Centre for disease control (CDC), Atlanta USA and others were given due weightage for their multi-authored authenticity. In this review the correlation between celiac disease and gluten free diets have been discussed with prognosis, complications, and clinical outcomes of patients reported by different research groups. In spite of substantial growth in healthcare, no researchers have yet suggested any other management except elimination of gluten from diet of celiac disease cases. Though there is abundant literature on celiac disease about its aetiology, signs and symptoms and diet models, there is no specific treatment and management protocol available, other than gluten free diet. Researchers have to do further studies to suggest treatment modalities.

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COVID-19 is known to involve multiple organs and physiological systems in all age group humans. There are a growing number of patients worldwide who have survived COVID-19 but continue to battle the symptoms of the illness, long after they have clinically tested negative for the disease. This narrative review summarizes current clinical evidence regarding post COVID health issue specially post COVID pulmonary fibrosis, post COVID thrombosis, post COVID syndrome, and post COVID ICU syndrome. Many aspects regarding post COVID sequelae remain answered, necessitate hot area for research.

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Hepatitis B virus (HBV) infection is a global public health challenge as roughly a quarter of the world's population has serological evidence of past or present hepatitis B virus (HBV) infection. Healthcare personnel, who work in healthcare settings, represent a high-risk population for serious, potentially life-threatening Hepatitis B Virus infections. Needle stick injuries pose a serious risk for occupational transmission of hepatitis B virus and may occur during various procedures such as needle recapping, operative procedures, blood collection, intravenous line administration, blood sugar monitoring, and due to improper sharps/needle disposal. Infections acquired through occupational exposure are largely preventable through strict control measures such as the use of safe devices, proper waste disposal, immunization and prompt management of exposures including the use of Post Exposure Prophylaxis. The current review highlights the first aid management, reporting, baseline investigations as well as post exposure prophylaxis for Hepatitis B following needle stick injury.

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Background: Coronavirus disease 2019 (COVID-19) is an infectious respiratory illness caused by a novel corona virus. Being at higher risk of contracting COVID-19, knowledge of disease among health care workers (HCWs) can influence their attitudes and practices towards infection control measures. Aims and objectives: This study aimed to evaluate the knowledge towards COVID-19 among the HCWs through an online survey. Material and Methods: An online cross-sectional survey was conducted among the HCWs in various health facilities of India in May, 2020. The HCWs included nurses, physicians, Lab technicians, Physiotherapists and Pharmacists. A 20-item structured knowledge questionnaire was developed by the researchers after extensive review of literature and experts inputs. The main domains of the questionnaire included structure of the virus, general symptoms of COVID-19 infection and infection prevention and control measures. Results: A total of 189 HCWs participated in the survey. Majority of participants were in the age group of 18–30 years (82%). About two third (63%) of HCWs were nurses and only 14% were physicians. A large proportion (70%) of the participants was found to have poor levels of knowledge on COVID-19 and infection control measures. Conclusions: Since the HCWs are at a higher quantum of being infected with COVID 19, it is therefore of paramount importance that HCWs must have adequate knowledge about all aspects of the disease including clinical presentation, diagnosis, management and infection control practices

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Background: Various studies have shown that polycystic ovary syndrome (PCOS) patients have sleeping problems and disturbances associated with depression, anxiety, stress, drowsy driving, and other clinical symptoms. This study was taken to investigate the sleep status in POCS women according to the Rotterdam criteria. Aim: This was a pilot study to analyze the quality of sleep by Pittsburgh Sleep Quality Index (PSQI) in patients with poly ovary cystic disease in Bhopal. Materials and Methods: Sixty-two PCOS patients (mean age-24.54 ± 2.63 years) and 31 healthy controls (mean age: 23.20 ± 3.9 years) were recruited from AIIMS, Bhopal, who were evaluated for specific sleep quality by means of PSQI questionnaires. A PSQI global score of ≥5 confirmed the presence of poor quality of sleep. Results: The POCS patients have a global score of 7.97 ± 3.61 than the non-POCS control group 5.42 ± 2.73, thereby indicating that POCS patients have poor sleep quality. Among the seven components, “sleep latency” has a maximum mean score of 1.85 ± 0.99 (control = 1.23 ± 0.85) and a minimum mean score of 0.32 ± 0.82 (control = 0.21 ± 0.75) was attributed to the “use of sleeping Medicine” component. The PSQI mean scores of POCS patients were 1.44 ± 1.44, 1.39 ± 0.61, and 0.89 ± 1.10 for “Subjective sleep quality,” “sleep disturbance,” and “sleep duration,” respectively, and the results were statistically significantly (P < 0.05) when compared to other components and control. Conclusion: This study on the basis of substantiation data found evidence that PCOS women have a relatively poor quality of sleep when compared with the normal control group.

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Illicit drug use and gambling are global problem, and multiple stakeholders are involved in it. This often leads to devastating physical, mental, and socioeconomic consequences for the family. In this case study, we describe our experience with an urban poor family from north India that was disintegrated by illicit drug and gambling use by one of its members. In this case, the family and school failed to recognize and act on the early warning signs of drug addiction and gambling. Health system failed to retain and follow him up. Law enforcement was also inadequate. It was a multisystem failure. For managing an illicit drug use case, we have also to address the cultural and social complexities that are part of the poverty subculture. Adequate involvement of multiple sectors and optimal follow-up can not only help the patient but also it prevents the collateral damage to a large extent in the affected families.

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Introduction: Noncommunicable diseases (NCD) is responsible for 52% of the demises and 38% of the total disease burden in the South-East Asia Region. Eighty percent of total deaths from NCD occur in poor countries. It is projected that cardiovascular diseases (CVD) will be the major killer in India by 2020. Methodology: This cross-sectional study will be carried out in staff clinic for one year in PGIMER, India. A scoring for risk prediction of CVD mortality in next ten years will be calculated by the tools to be tested (WHO CVD Risk Prediction Chart, QRISK2-2017 and by Framingham point scores). We will use simple random sampling using a sample size of 400. Results: During statistical analysis, proportions will be calculated for nominal data, and continuous data were given as mean and standard deviation, while categorical variables were compared using the Chi-square test for difference of proportion. Kappa statistics will be used to measure inter-rater reliability. All analyses will be two-tailed, and P < 0.05 was considered as statistically significant. Discussion: Those patients who will fall under the high-risk scores, counselling (food behavior change, lifestyle modification) will be given in the staff clinic OPD. It will be extremely helpful to the staffs according the risk score they can modify their lifestyle through individualized tailor-made counselling. There may be reduction in mortality among the staff members, and disease burden on staff clinic may be reduced. We can also inculcate health promoting behavior within the hospital setting. It will also increase job satisfaction; improved administration- employee relations; and they will perform better.

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Introduction: COVID-19 pandemic has threatened the safety of both donors and recipients thus negatively impacting the blood donation process. Home confinement limits the ability of donors to attend blood services and the staff to take part in collection teams as well. The restrictions and limitations of large gatherings also reduce the number of large blood drives and campaigns. Aim: The current survey was undertaken soon after the official announcement of nationwide lockdown to assess the COVID-19-related knowledge and expressed practices about precautions among blood donors visiting blood bank. Materials and Methods: This was a cross-sectional survey conducted on 109 blood donors visiting blood bank in the month of March–April 2020. Data were collected using structured knowledge questionnaire and expressed practice checklist. After collecting data, the donors were provided with information related to COVID-19, and its precautions as per the guidelines from the Ministry of Health and Family Welfare, India. The obtained data were analyzed using the SPSS software version 22. Results: In terms of knowledge, it was found that 51.3% donors had very good knowledge, 42.3% had good knowledge, whereas 6.4% donors had poor knowledge about COVID-19. With regard to practices related to COVID precautions, it was noticed that most (90.82%) of the donors followed best practices, 9.18% donors followed good practices, whereas none of the donor followed poor practices. A significant positive correlation (P ≤ 0.01) was found between knowledge and practice score of blood donors. Significant association was seen in knowledge with educational status (P = 0.003) and practice with place of residence (P = 0.010). Conclusion: Based on the findings, it was concluded that 51.3% donors had very good knowledge, whereas 6.4% donors had poor knowledge about COVID-19. With regard to the practices related to COVID precautions, most (90.82%) of the donors followed best practices, 9.18% donors followed good practices, whereas none of the donor followed poor practices. Hence, the health-care professionals must take active steps to disseminate correct and updated information to blood donors regarding COVID-19 and related precautions.

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Background: Conflict is an inevitable and integral part of any work environment including nursing. Unresolved conflicts among nurses may lead to increased errors in patient care, affect their morale, and even increase turnover. Objective: The objective of the study is to determine the conflict-handling styles practiced by newly joined nursing staff working in a tertiary care hospital. Materials and Methods: This descriptive cross-sectional study was conducted on newly joined 297 nurses. Standardized Thomas-Kilmann Conflict Mode Instrument was used to collect the data. Nurses were asked to give answers that characterized their dominant response in a conflict situation. Results: A total of 34.7% nurses used accommodating style for conflict management whereas 30.3% used collaborating style. It was followed by compromising, competing, and avoiding styles of conflict management. Conclusion: There is a need to enhance nurses' conflict management skills which in long run may lead to improvement in the quality of work as well as job satisfaction among nurses.

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Background: Serum levels of Vitamin D have been linked to some complications in pregnancy such as diabetes mellitus and premature rupture of membranes (PROM). While some studies suggest inverse relationship between serum Vitamin D levels and poor pregnancy outcomes, others report a J-shaped (curvilinear) or U-shaped relationship. Objective: The objective of the study is to determine the relationship between serum Vitamin D and some selected pregnancy complications among pregnant Nigerian Igbo women. Subjects and Methods: A prospective, cross-sectional study conducted on 256 consecutive consenting antenatal women in Anambra state, Southeastern Nigeria. Maternal blood obtained was assayed for 25 hydroxyvitamin D3 using high-pressure liquid chromatography. A pro forma was used to elicit information with respect to the biosocial characteristics of the subjects. Data obtained were analyzed using SPSS version 23, and the relationship between Vitamin D levels and antenatal complications was determined using Chi-square at P < 0.05 at 95% confidence interval being considered statistically significant. Results: The overall results showed that no participant had hypovitaminosis D. It also showed that there is maximum safe limit for serum Vitamin D beyond which the prevalence of hypertensive disorders/preeclampsia, preterm labor, and PROM rises. However, higher serum Vitamin D appears to be protective against clinical and laboratory-diagnosed malaria and malaria parasitemia. The study showed an inverse relationship between the degree of malaria parasitemia and serum Vitamin D levels. Conclusion: Despite the importance of Vitamin D in both skeletal and extra-skeletal health, there appears to be a safe upper limit. Therefore, Vitamin D supplementation should be reserved for proven cases of hypovitaminosis in pregnancy, especially in our locality where there is abundance of sunshine and low prevalence of hypovitaminosis D.

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Background: With the increasing use of magnetic resonance imaging (MRI) in diagnostic radiology, the problem of anxiety is also encountered more often in patients undergoing MRI. Anxious patients may not co-operate well with the procedure resulting in poor image quality. Repetition of sequences to acquire the images of better quality prolongs the total scan time and precludes optimal patient experience. For satisfactory completion and clinical usefulness of the scan, patient compliance is vital. Aim: The aim of this study is to assess the effectiveness of video-based education (VBE) versus music therapy (MT) on anxiety, experience, and co-operation among patients undergoing MRI. Materials and Methods: Randomized controlled trial pre- and posttest-based study was carried out among 90 patients undergoing MRI who were randomly allocated to VBE group (30), MT group (30), and control group (30). The data on anxiety, experience, and cooperation were collected using the appropriate tools. Patients in VBE group were provided with VBE, patients in MT group received MT and control group received routine procedural instructions. Results: No significant differences were found in VBE group, MT group, and control group in terms of posttest anxiety scores. With regard to mean experience scores, the VBE group had better experience (81.70 ± 3.153) as compared to the control group (77.27 ± 6.817). A significant strong positive correlation was found between experience and co-operation of patients in VBE group (r = 0.860, P < 0.001) and MT group (r = 0.640). All of the patients (100%) agreed that VBE was easy to understand and also suggested to use VBE for all patients undergoing MRI procedure. Most of the patients (96.7%) found MT effective during the waiting time of MRI procedure and useful for diverting the mind. Conclusions: Both VBE and MT were effective in improving the experience and co-operation of patients undergoing MRI as compared to routine procedural instructions in the control group.

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Background: Malignant pleural effusion missed routinely because of less diagnostic yield of conventional fluid cytology. Materials and Methods: Prospective multicentric study conducted during January 2014 to June 2016 in Venkatesh chest hospital, and Pulmonary Medicine, MIMSR medical college Latur, to find diagnostic yield of conventional pleural fluid cytology and pleural fluid “cell block” in malignant pleural effusion and compare yield of pleural fluid cell block with conventional cytology technique. The study included 200 cases of unexplained, exudative pleural effusion with Adenosine deaminase (ADA) ≤30/IU/l and pleural fluid cytology is either positive for malignant cell with or without cell type differentiation, or cytology suspicious for malignant cell. All cases were subjected to cell block preparation. Statistical analysis was done by using Chi-test. Observation and Analysis: In study of 200 cases, mean age of group was 68 ± 9.5 years and adenocarcinoma was predominant malignancy in 72% cases, mesothelioma in 10% cases, squamous cell carcinoma in 7% cases and 9% cases were having primary tumor outside the thoracic cavity. In study cases, pleural fluid cytology was positive in 42% cases (84/200), and pleural fluid cell block was positive in 96% cases (192/200) in detecting malignant pleural effusion (P < 0.0001). Remaining six and two cases were diagnosed by using image-guided and thoracoscopy-guided pleural biopsies, respectively. Immunohistochemistry (IHC) was done in all pleural fluid cell block preparation for calretinin, cytokeratin, and epidermal growth factor receptor. Conclusion: Pleural fluid cell block is sensitive, superior, cost-effective, and specific diagnostic method over conventional pleural fluid cytology. “Cell block” specimens are enough for primary diagnosis and IHC analysis necessary for cell typing. It will decrease the need for more invasive and costlier diagnostic methods like thoracoscopy and image-guided pleural biopsies. We recommend cell block for every exudative pleural fluid samples with ADA <30 IU/l.

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Immune Thrombocytopenic purpura (ITP) is an autoimmune disorder characterized by a platelet count of <100 × 10⁹/L in the absence of other underlying causes of thrombocytopenia and increased risk of bleeding. Glucocorticoids are the mainstay drugs of treatment for ITP. The response rate to steroids is around 60%–70% in adults, but only 10%–15% of these patients will have a durable response. If patients do not respond to steroids by 4 weeks, they are considered to have steroid-resistant ITP. Some patients though they respond, need frequent courses of steroids to maintain a platelet count above 30 × 10⁹/L or to avoid bleeding and are considered nonresponders to steroids. A number of potential mechanisms for this resistance to steroids have been suggested, including receptor downregulation by glucocorticoid exposure and negative inhibition by the beta-isoform of the glucocorticoid receptor. The available treatment options for these patients include various drugs including rituximab, thrombopoietin receptor agonists, fostamatinib, danazol, immunosuppressive drugs, and biological therapies including intravenous immunoglobulin, Rh immunoglobulins, and immunoadsorption. Splenectomy has been performed surgically, by radiation, or chemoembolization. Supportive treatment includes screening for osteoporosis and management, vaccination, and platelet therapy. Newer therapies such as veltuzumab, belimumab, and toralizumab which deplete B-cells have been tried. Nearly 70% of adult chronic ITP patients failing to respond to splenectomy still achieve stable remission with additional therapies.

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Amidst global lockdown due to the ongoing COVID 19 pandemic, the beginning of commercial space travel is a remarkable event in human history. While commercial air travel is shut down to prevent contagion, a paid ticket to a thrilling ride into space opens up a new chapter in transportation, aviation, and connectivity. We have to wait and see what unfolds in the future after the COVID pandemic, talks about the climate apocalypse, and now liberty of individual space travel.

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Awake repositioning has been recommended in various national and international guidelines for the management of COVID-19 as patients with moderate-to-severe acute respiratory distress syndrome appear to have responded well to treatment in the position changes. It involves moving patients' positions in such a way that led to improve the respiratory status. Awake repositioning among COVID patients improves ventilation, reduces hypoxemia, and improves secretion clearance. Nurses must be aware of the correct technique of awake repositioning and must educate the community at large on how to perform the awake positioning using mass media or telenursing services. The current review highlights the significance of awake repositioning in patients with COVID-19 along with nursing considerations.

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Background: Stroke is one of the major causes of loss of quality-adjusted life years and inflicts varying degree of physical deficits, psychological distress, and strained social relationships among stroke survivors. However, knowledge regarding risk factors, warning symptoms, and first aid management of stroke can help to minimize this burden. Aim: This study aims to assess knowledge and awareness of general population regarding risk factors, warning symptoms, and first aid management of stroke. Materials and Methods: The cross-sectional study was conducted to collect information from general population regarding risk factor, warning symptoms, and first aid management of stroke by administering a pretested questionnaire. Five hundred patients attending Outpatient Departments of Selected Hospital were selected using simple random sampling. After explaining purpose of the study and taking written consent from the participants, the participants were requested to fill the questionnaire. Results: The findings revealed that only 22.6% of participants were having good knowledge, 56.6% were having average knowledge, and rest 20.8% of them had poor knowledge regarding risk factors, warning symptoms, and first aid management of stroke. The mean knowledge score was 11.86 ± 3.651. 31.4%, 36.2%, and 33.6% of participants were not aware about even single risk factors, warning symptoms, and first aid management of stroke, respectively. Conclusion: The low level of knowledge regarding risk factor, warning symptoms, and first aid management of stroke indicates immense need of initiatives to implement stroke education.

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Background: Herpes simplex virus (HSV) infection of the brain is treated with antiviral drugs such as acyclovir. A summary of randomized control trials (RCTs) of antiviral drugs against HSV encephalitis has not been put forward yet. We aimed to determine the effect of antiviral agents in treating HSV encephalitis on mortality and neurological sequelae at approximately 2 years. The secondary objective was to assess the adverse effect of antiviral agents on the patients. Materials and Methods: RCTs were identified by searching PUBMED, European Medicines Agency ( EMA ), USFDA, US Clinical trials, Elsevier database, and Cochrane website and the reference lists of published trials. Randomized controlled trials of antiviral therapy in biologically proven HSV infection were included in the study. Results: A total of 5 studies met the criteria. The first study was published in 1980 and the latest was in 2015. All the studies used acyclovir/valacyclovir or vidarabine. Three studies compared acyclovir and vidarabine, one study was placebo-controlled vidarabine trial and another one was a placebo-controlled trial of long-term valacyclovir therapy. Acyclovir improved mortality and lowered the incidence of neurological sequelae. There was no significant reduction in the risk of mortality with vidarabine therapy. Conclusion: Trial evidence suggests that acyclovir decreases mortality and morbidity in acute HSV encephalitis.

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Shortened hospital stays for clients with an intestinal stoma have shifted the focus from institutional care in hospitals to self-care of ostomies to the home setting. Clients with intestinal ostomy experience numerous changes in physical functioning, psychosocial health, and in their sexual life after creation of stoma. This enhances the importance of a guide for home management of intestinal stoma to assist home care clinicians and stoma care nurses, who are determined to make ostomates self-reliant. This evidence-based review focused on published articles from the Medline, CINAHL, Social Sciences Citation Index, Psych INFO, a hand search through selected journals published since 2000, and from references lists, to prepare home management guide for intestinal stoma. This article provides information regarding measures to protect skin around stoma, daily care management for ostomates, and ways to prevent peristomal skin complications.

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