Introduction: Health Care Workers are major influencers in vaccination, thus their acceptance or hesitancy to the covid-19 vaccine would either aid its acceptance among the populace. Materials and Methods: The study was a cross-sectional survey using a self-administered questionnaire from December 15, 2020 to January 10, 2021 among healthcare providers living in Nigeria. The questionnaire was made up of segments that include demographics information, knowledge of the COVID-19 vaccine, its acceptance or hesitancy. The questionnaire was fashioned using Likert scale multiple questions of three options: YES, NO, and I Don’t know (No opinion) and Aware, Somewhat aware, and Not aware. Data collected were entered into the spreadsheet using IBM SPSS version 22.0 statistical software and analyzed with descriptive statistics. The results were presented as percentages, frequency, tables, and figures. Results: A total of 1094 responses were retrieved. The majority are males (56.67%) with 36.93% of the respondents aged 30–39 years. PHC Worker forms 14.90% of the respondents and social media was the greatest source of information. A percentage of 45.74% have no confidence in the vaccine and 39.68% rejecting, the majority been males (47.38%). The reasons for hesitancy are concerns of effectiveness, side effects, fear of the unknown, and safety. The highest rejection was by Dental Technicians (53.03%) while the highest acceptance was Medical consultants (72.22%). Conclusion: The study shows that about 3 out of every 10 health workers showed COVID-19 vaccine hesitancy for various reasons. The study recommends effective education, training, and public enlightenment to change the narrative.

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Background: Hearing impairment and tinnitus are common otological manifestations found in the outpatient Department of Otorhinolaryngology. Hearing loss and tinnitus have been documented among coronavirus disease-2019 (COVID-19) patients. However, these clinical manifestations were rarely investigated among pediatric patients with COVID-19 infections. Objective: This study aims to evaluate the prevalence of hearing impairment and tinnitus among children with COVID-19 infection at a teaching hospital. Materials and Methods: This is a prospective and descriptive study where 192 children with COVID-19 infections were evaluated for hearing loss and tinnitus. There were 44 (22.91%) children with COVID-19 infections presenting with hearing loss and tinnitus. All of the children were confirmed as COVID-19 infection with the help of reverse transcription-polymerase chain reaction of the nasopharyngeal swab. Detailed history taking and clinical examination of the ear were done for the assessment of hearing loss and tinnitus and its outcome was analyzed. Results: Out of 44 children, 20 (45.45%) were presented with tinnitus, 16 (36.36%) were presented with hearing loss, and 8 (18.18%) were presented with both hearing loss and tinnitus. Out of 44 pediatric patients with hearing loss and/or tinnitus, 26 (59.09%) were males and 18 (40.90%) were females with a male child to female child ratio of 1.44:1. The mean age of the participants was 9.16 years with an age range from 5 to 18 years. The sporadic type of tinnitus is more common than any other type. Conclusion: This study showed that the presence of subjective neurological features like hearing loss and tinnitus can be found in children with COVID-19 infection. More studies are required to confirm the exact pathophysiology mechanism underlying this subjective symptom in pediatric patients with COVID-19 infection.

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Introduction: Most serious patients among the poorest of the poor class are treated in the hospitals attached to medical colleges. Although there are senior and experienced doctors available, there is no denying the fact that resident doctors are the backbone of medical care. We cannot even dream of running these hospitals without them especially when coronavirus disease-2019 (COVID-19) is spreading like a wildfire across the globe. As far as the mental health of the resident doctors is concerned, often there are complaints of burnouts, depression, medical error, suicidal ideation, and leaving the course halfway, among them. We carried out a small questionnaire-based study to find out the viewpoint of the residents. Materials and Methods: An anonymous survey in respect of work hours and call schedules was administered to 50 junior residents. The results were analyzed. The faculty viewpoint, regulations in different countries, and regulatory bodies were also taken into account to present a balanced view and recommendations. Results: A total of 50 residents were surveyed. 64% of the residents worked for around 81–100h per week. 58%residents get 6h of uninterrupted sleep per day. 86% of the residents felt that extended working hours do not improve patient care. 82% of residents felt that there is no gain of skills with extended working hours; also, it does not leave them any spare time to study. 64% of the residents (mostly first-year postgraduate [PG] students) felt that most of their time is used for paperwork, which has no bearing on their skill development or knowledge. 16%–24% of residents felt that the extended working hours are affecting their mental health. Some of the residents felt that their relationship with coresident also affects their work. 74% of the residents admitted that they were asked to work more than 24h continuously quite often. 84% of the residents felt that they should get more time for leisure activities. Conclusion: There is a need to formalize working hours and to reduce paperwork for the residents to keep them in good mental health. A structured and supervised work schedule for the residents especially for the first-year PG students is the need of the hour. We need to balance education, patient care, and health of the young resident doctors while considering their work schedule.

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Sixteen novel active pharmaceutical ingredients, namely Urea stibamine, Methaqualone, Enfenamic acid, Hamycin, Centimizole, Centbutindole, Ormiloxifene, Centpropazine, Centbucridine, Alpha-beta-arteether, Bulaquine, Chandonium Iodide, Sintamil, Amoscanate, Saroglitizar, and Diperoxochloric Acid (DPOCL), were discovered from India. Six formulations, namely of Ormiloxifene, Alpha-beta-arteether, Bulaquine, Sintamil, Saroglitizar, and DPOCL, are in the market. The Indian pharmaceutical industry uses nearly 2200 active pharmaceutical ingredients (APIs) for the manufacture of nearly 60,000 branded generic and generic formulations from its nearly 3000 manufacturing units. The industry manufactures nearly 1000 APIs locally and imports about another 1200 APIs; the manufacture of generic APIs as well as formulations is heavily dependent on imports. To remain a dominant manufacturer, India needs to invest in the discovery of novel APIs.

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By the end of September 2021, worldwide there were 22 approved SARS-CoV-2 vaccines of which nine were inactivated whole virus-based, six were replication-deficient viral vectored, four protein subunit based, one DNA vaccine, and two mRNA vaccines. Developmental efforts were also to manufacture the whole virus attenuated vaccines, viral vector replicating vaccines, bacterial vector-based vaccines, and viral particle-based vaccines. Host-cell-based vaccines were also being explored. As of October 05, 2021, there were 318 novel vaccine development approaches of which124 had entered into the clinical development stage, the rest 194 were in the preclinical stage. As of October 22, 2021, there were 243.44 million COVID-19 patients worldwide, of which 220.6 million recovered, and about 4.95 million died. The largest deaths per one million population were recorded at 5659 in Peru, and the smallest of 3 were in China. The total vaccine doses deployed worldwide were 6795 million, with 38% of the world population fully vaccinated, and 50% partly. India had taken multiple proactive steps, which included the development of local capabilities in various aspects including manufacturing of vaccines, testing methods and devices development, mass vaccination, mass testing, and production of personal protective equipment and materials. India had lost 324 people per one million, which was much lower than those witnessed in several countries like the Czech Republic, Brazil, Argentina, Spain, Columbia, Romania, the USA, Belgium, Mexico, and Italy. The virus is anticipated to stay in nature and people would have to live with it. Mass vaccination of people all over the world as fast as possible, and deploying booster doses on vulnerable people including those aged 60 years and above, are thought to be most protective for the people against the disease.

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The World Health Organization declared COVID-19 disease as a pandemic after the first cases from China were reported in December 2020. COVID-19, caused by SARS-CoV2 (severe acute respiratory syndrome), spreads by contact with infected droplets. The incubation period ranges from 2 to 14 days with initial symptoms of fever, sore throat, cough, fatigue, malaise, and breathlessness. In patients with co-morbidities and the elderly, it progresses to pneumonia, acute respiratory distress syndrome, and multi-organ failure. Regarding the impact of the environment on the spread of the corona virus, more research is going on. Environmental factors including atmospheric temperature, ventilation, climate change, and humidity have been studied to understand the effect of these factors on COVID-19 spread. We have evaluated studies to date related to the environmental effect on COVID-19 and summarized them for better understanding.

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The severe acute respiratory syndrome coronavirus 2 (SARS CoV2) also called human coronavirus 2019 (HCoV-19) causing COVID-19 flu originated from China. The complete nucleotide sequence of SARS CoV2 was revealed in January 2020 by Chinese scientists, opening up opportunities for developing therapeutic agents and vaccines. The Chinese people were late in declaring the onset of the disease; only during January 2020, it was revealed that this disease was spreading like an epidemic from man to man contact. The spread of the disease and deaths, in the meantime, were very high in a short period all over the world from man to man contact. To prevent these, use of masks, social distancing among the noninfected and maintaining isolation in houses for a period to allow the surroundings to get absolved from infection, and locking down the infected in hospitals or at home with supportive therapy were effective to prevent the spread. Current country-wise world data on diseased individuals and the deaths reveal that the developing countries having a preponderance of tuberculosis perform better in comparison, to resist the disease with concomitant lesser deaths. The efforts of developing an effective vaccine would require a painstaking, precise understanding of the manner the virus mutates and mount vaccination strategies to effectively neutralize and opsonize.

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Background: Mannitol is a commonly used drug in general medicine and neuro medicine wards. Mannitol reduces intracerebral pressure by redistributing water from the brain parenchyma. Renal failure is cited as one of the most common side effects and concern over this often limits the use of Mannitol. This study is intended to find out whether the use of Mannitol, in the doses commonly used in our setting, is associated with derangement of renal function and if so what are its determinants. Materials and Methods: We did a prospective observational study on 151 consecutive patients. The duration of the study was for one year from January to December 2020. Mannitol was used in the usual dose of 100 ml of 20% solution 8 hourly. Acute kidney injury was diagnosed based on the KDIGO criteria. Results: The study population included 103 males (68%) and 48 females (32%). The age group ranged from 14 years to 98 years. A total of 42 patients (27.8%) developed acute kidney injury of which 26 were males (62%) and 16 were females (38%). By multiple regression analysis, age more than 65 years and diastolic blood pressure more than 100 mm of Hg were the two significant predictors for the occurrence of acute kidney injury. Conclusion: Mannitol is a safe drug that can be used to reduce intracerebral pressure, provided the dose of the drug is carefully monitored, especially in those with risk factors such as advanced age and high diastolic blood pressure. An equally important aspect is the early recognition of the renal impairment because stopping the drug will in most situations reverse the damage. Since any renal impairment, however small and short-lasting, can have adverse long-term effects, such insults must be avoided as far as possible.

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Background and Objectives: Pregnancy-induced hypertension (PIH) is a challenging obstetric condition that can result in grave complications. The retina is a unique site where the vasculature in the human body is visualized directly with the help of an ophthalmoscope. Progression of retinal changes generally correlates with the progression of PIH. The purpose of this study was to determine the prevalence and association of retinal changes with the progression of PIH. Materials and Methods: This is a hospital-based, prospective, observational study. A total of 100 admitted cases diagnosed with PIH was included in the study. Ocular and systemic history, age, blood pressure, and proteinuria were noted. A dilated indirect ophthalmic examination was done at the bedside of the patient. Results: A total of 100 patients with PIH were examined. The mean age of the patients was 24.8 years; the mean gestational age was 36.5 weeks. Out of the total 100 patients with PIH who were examined, retinal changes were noted in 43 patients. The prevalence of retinopathy changes was more pronounced among patients with severe preeclampsia (76.5%) and eclampsia (88.9%). As the severity of the PIH increased, the odds of women developing retinopathy also increased substantially and this association between the severity of PIH and the development of retinopathy changes was found to be statistically significant. A significant correlation was also seen between albuminuria and the severity of retinopathy. Conclusion: Cases of severe preeclampsia and eclampsia showed higher grades of retinal changes. Thus fundus examination plays an important role in assessing the severity of PIH.

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Objective: This study aimed at the synthesis and application of selenium nanoparticles (SeNPs) against biofilm formation by multidrug-resistant (MDR) Staphylococcus aureus isolated from the domestic sewage treatment plant. Materials and Methods: Chemically synthesized SeNPs were characterized using Ultraviolet–visible spectroscopy, X-ray diffraction, and high resolution scanning electron microscopy (HR-SEM).. Bacteria were isolated from domestic sewage water samples and characterized and identified using standard techniques. The drug resistance pattern of the isolates was determined using a disk diffusion assay. Biofilms of this MDR isolate were established (microtiter plate method—colorimetric assay and a slide method). Minimum inhibitory concentrations (MIC) of selenium nanorods (SeNRs) and their effect on biofilm formation were established using a colorimetric method. Results: The HR-SEM analysis of nanomaterials revealed its shape (rod), size (between 85 nm and 275 nm), and purity of the material. The disk diffusion assay attributed MDR status to an isolate that was identified and found to be S. aureus, a pathogenic bacterium isolated from an environmental sample. The MICs of antibiotics against biofilm were found to be at least threefold higher than those against the planktonic state. In the presence of SeNRs, biofilm formation was inhibited. Conclusion: SeNRs synthesized using wet chemical method showed antibacterial activity against MDR S. aureus and inhibited biofilm formation by this organism. These SeNRs can be further developed as an alternate drug lead to combat the challenge posed by the MDR bacteria. The study has a future prospectus in investigating the mechanism of inhibition of biofilm formation and its action on preformed biofilm by this isolate.

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Background: Varicose veins and their associated symptoms/complications constitute the most common chronic vascular disorders, affecting 20% of the adults, leading to surgical treatment. In general, this does not cause major life-threatening illness, yet the morbidity of venous ulceration places a substantial burden on community health care. Aim: The aim of our study was to evaluate various clinical presentations, management, and outcome in 50 patients who presented with varicose veins at tertiary center. Materials and Methods: This study is a descriptive review of clinical data of 50 patients diagnosed and treated for varicose veins at our tertiary center over 2 years. Results: Most commonly affected age-group was 41–60 years. Majority of patients were males, dilated veins being the most common presenting symptom. Increased incidence was observed in left leg (32%) as compared to right (26%). In unilateral leg involvement, great saphenous vein (GSV) was most commonly affected (62.06%), whereas in bilateral leg involvement, 73.8% had perforator incompetence. Patients with advanced disease had both saphenofemoral and perforator incompetence. Majority underwent Trendelenburg’s procedure with stripping of GSV and subfascial perforator ligation. Postoperative complications were minimal, and no patient developed recurrence at subsequent follow-ups. Conclusion: The use of color Doppler is an essential investigation along with clinical examination for effective treatment of varicose veins, to prevent recurrence and reduce morbidity. Operative treatment is the primary procedure in the management with minimal chance of recurrence.

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Context: Prevalence of musculoskeletal disorders (MSDs) in India is 90%, leading to loss of working hours, poor quality of life (QoL), and reduction in productivity of the life of the employers. Housekeeping profession, considered a major workforce industry, requires manual labor demanding awkward postures and repetitive movements, leading to MSDs and impacting QoL. Objectives: The objective of this study was to find the prevalence of the symptoms of MSDs and QoL in the housekeeping workers of the hospital. Settings and Design: A descriptive study was carried out among housekeeping workers of MGM Hospital, Kamothe, Navi Mumbai, Maharashtra, India. Materials and Methods: With Cornell Musculoskeletal Discomfort Questionnaire (CMDQ) and WHO-QOL-BREF scale, 82 housekeeping workers were contacted, and an interview-based session was held. Statistical Analysis: Descriptive analysis and graphical representation were carried out using MS Excel. Results: Of the participants, 68.29% were females with a mean age of 42.28 ± 7.4 years, and 31.70% were males with a mean age of 42.04 ± 8.3 years. The prevalence of the symptoms of MSDs was higher in knees followed by lower back and lower leg. Females (80.36%) were affected more than males (61.54%). WHOQOL-BREF for QoL showed a moderate impact without much gender difference. Conclusion: The study concluded that there is a high prevalence of the symptoms of MSDs in housekeeping staff, more likely in the lower back, knee, and lower leg, and WHO QOL-BREF shows comparable mean scores among males and females.

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Background: Cholelithiasis is a common disease and notable advances have been made in studying the possible causes and mechanisms involved. It is not only important to study the prevalence of gallstone disease regionally, but also to explore the demographic and biological markers related to the development of gallstone disease, so that appropriate preventive measures may be undertaken. Many previous studies have shown a positive correlation between altered lipid profile and formation of gallstones, whereas some show no definite correlation between the two. Objective: This work aimed to study the association of lipid profile with cholelithiasis in our geographic region. Materials and Methods: This was a retrospective study of cases who underwent cholecystectomy for cholelithiasis, obtained from the archives of the Department of Pathology. The lipid profiles of these patients were retrieved from the laboratory records and analyzed. Results: The number of patients with mixed stones (cholesterol and pigment) accounted for 85% and pure cholesterol stones were seen 15% of the cases. Deranged lipid profile was observed in 57 (95%) of the cases. The most common abnormality was increased levels of low-density lipoprotein /very low density lipoprotein with decreased high-density lipoprotein. Conclusion: In this study, it was found that a significant number of patients with cholesterol-containing stones had a deranged lipid profile. This suggests that hyperlipidemia plays an important role in the lithogenesis of cholesterol-rich gallstones.

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Background: Objective structured practical examination (OSPE) has ended up being a decent choice to beat traps of customary technique for evaluation. OSPE is not typically used in medical colleges in India in view of requirements of assets. Consequently, the two teachers and students are very little mindful of the OSPE model. Consequently, we led this examination to make mindfulness on the OSPE strategy and break down Student’s assessment with respect to the technique. Aims and Objectives: This study was conducted to know how the subjectivity of conventional practical methods of evaluation in medical education is overcome in OSPE. Materials and Methods: A total of 130 second-year professional MBBS students were included in the study. The skills of the medical students were assessed on the basis of their performance. Four stations were formed, of which two were procedure stations and other response stations. Students were evaluated using the OSPE model. OSPE additionally broke down to see the lacuna in any progression or any inquiry with respect to students. Traditional techniques and procedural and response stations in OSPE were investigated to learn the knowledge, skill, and competency of students in this subject. Student’s opinion about the new method was collected through a questionnaire and analyzed. Results: A total of 130 students from MBBS’ second professional year were included in the study. Of which, 91.54% of students felt that they were given adequate time at each station adequate, 71.54% responded that they were prior sensitized about OSPE, 93.08% responded that the exam was not stressful, 94.62% said that the OSPE was very much organized, applicable, and uniform, 80.77% said that the exam covers the appropriate knowledge than the traditional examination, and 76.15% opined that such type of exams should be included in the future as a method of formative assessment in practical examination. Conclusion: It was proved in this study that OSPE had overcome the subjectivity in conventional methods. The students showed lacunae in some steps of the exercise, which were informed to the teachers for more concentration on those steps. The students had good knowledge and skills but less competency, our study highlights the implementation of OSPE for formative assessment in the curriculum of undergraduate medical education, so that students can achieve more skills and knowledge to improve their competency.

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Introduction: India is the second most populous country in the world. Intrauterine contraceptive device (IUCD) is a very effective, reversible, and economical family planning method. In India, the acceptance rate of IUCD is very low, only 3% of the women in the reproductive age group are using IUCD. Aims: The study was conducted to assess the knowledge and attitude regarding the postpartum intrauterine contraceptive device (PPIUCD) among women. Materials and Methods: A descriptive approach with a non-experimental research design was used for the study. The subjects were 180 women selected by the non-probability convenience sampling technique. The study was conducted among the women admitted in antenatal and postnatal wards at Doon Medical College Female Hospital, Dehradun, Uttarakhand. Results: The study showed that 54.44% (98) of the women have average knowledge about PPIUCD, 21.11% (38) have poor knowledge, 23.33% (42) did not know, and only 1.11% (2) was having good knowledge about it. The study revealed that favorable and unfavorable attitudes toward PPIUCD of women were 43.33% and 56.67%, respectively. The present study communicated that there was no correlation (−0.113) between knowledge and attitude toward PPIUCD among women. The finding suggested that women had average knowledge and unfavorable attitude toward the PPIUCDs. The χ² value showed that demographic variables such as age, family income, and education status were having an association with the level of knowledge regarding the PPIUCD. No association was found between attitude and selected demographic variables. Conclusion: Findings stress the need for teaching programs, which in turn may enhance the knowledge and attitude of women regarding the PPIUCD. It will also helpful in improving the health status of women. It may reduce maternal morbidity and mortality.

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Background: Opioids have been used as additives to bupivacaine in spinal block to enhance their action and analgesia. The aim of the study was to assess the effectiveness of adding intrathecal nalbuphine or fentanyl as an adjuvant to bupivacaine in spinal anesthesia for patients undergoing the transurethral resection of the prostate (TURP). This is a single-center, prospective, double-blind, randomized study. Materials and Methods: Sixty men (40–80 years) undergoing TURP received an intrathecal injection with 2.5 mL of 0.5% hyperbaric bupivacaine with fentanyl 25 µg (Group 1) or nalbuphine hydrochloride 0.8 mg (Group 2) in this prospective, randomized, double-blind study. The onset and duration of sensory and motor block, hemodynamic parameters, and incidence of adverse effects were compared between the groups. Results: Patients in the nalbuphine group reported significantly prolonged sensory block (198.60 ± 16.8min) compared to patients in the fentanyl group (185.40 ± 22.2min), (P < 0.001). Similarly, patients in the nalbuphine group had a longer motor block (210.60 ± 19.8min) in comparison to those in the fentanyl group (194.40 ± 21min; P < 0.001). Intraoperative hemodynamic variability was comparable in both the groups. Postoperative pain was significantly higher in the fentanyl group (80%) as compared to the nalbuphine group (13.3%) (P < 0.001). Conclusion: Intrathecal nalbuphine is a safe and valuable alternative to intrathecal fentanyl for spinal anesthesia.

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Background: Research on smartphone and Internet addiction has increased rapidly, indicating its clinical and social significance. This study aimed at exploring the possible relationship between smartphone addiction, self-esteem, and social anxiety. Materials and Methods: A total of 464 young college-going adults participated in this study [male = 175 (37.71%), female = 289 (62.3%)] between the ages of 18 and 28 years old. The study participants were asked to complete a survey having three different questionnaires, namely “Smartphone Addiction Scale,” “Rosenberg’s Self-Esteem Scale,” “and the Interaction Anxiousness Scale.” This study also focuses on gender and age differences regarding smartphone addiction. Karl Pearson’s correlation coefficient and unpaired t-test were used to test the significance of the relationship among study variables. Regression analysis was performed to predict smartphone addiction by using Age, Rosenberg’s Self-Esteem Score, and Interaction Anxiousness Score. Results: The mean smartphone addiction scale (SAS) total score was higher in males as compared with females (P = 0.01). No significant difference was observed in RSE total score and IAS total score among males and females (P > 0.05). Significant correlations were observed among SAS total, RSE total, IAS total, and Age (in years) (P < 0.05). Regression analysis was applied to predict SAS total score by using independent variables such as age, RSE total, and IAS total. The coefficients for age and RSE total score were significant (P < 0.01), and the IAS total was not significant (P > 0.05). Conclusion: Males reported having higher smartphone addiction levels as compared with females. A positive correlation was observed between Social Anxiety and Smartphone addiction. A negative correlation was observed between self-esteem and smartphone addiction, which indicates that the lower the self-esteem, the higher will be the smartphone addiction. Age was negatively correlated with smartphone addiction score and social anxiety score, whereas age was positively correlated with self-esteem.

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China is presently the most populous country; the annual birth rate is estimated at above 18 million each year over the next 5 years. The number of the aged population is also increasing. Continuous in-country demand for vaccines will, therefore, be maintained, providing opportunities for the manufacturers. China produces a large number of vaccines, presently estimated at 55 different types, which are used to protect against 28 types of individual infectious microbial diseases. The country has presently a total of 41 vaccine manufacturing companies, of which 21 are the major ones. The manufacturing capacity appears to be over 1000 a million doses per annum and the annual production in 2019 was over 700 million doses. Chinese imports of vaccines have remained low. The major government establishment, the China National Biotec Group (CNBG) companies are the leading manufacturer of vaccines in China and supply more than 50% of all the vaccines consumed in the country. CNBG is a research-driven biotech establishment and is engaged in R&D, manufacturing, marketing, and distribution of vaccines and blood products. CNBG has six institutes of biological products besides other assets; the six institutes are also engaged in the manufacture, distribution, and sale of vaccines through their manufacturing companies and establishments in China. CNBG has seven vaccine manufacturing units. CNBG is a subsidiary of China National Pharmaceutical Group Corporation (Sinopharm). Sinopharm infrastructure shoulders the social responsibility of Chinese national medical and pharmaceutical reserve on a sustainable long-term basis, including handling of emergency situations. Sinopharm is under the State-owned Assets Supervision and Administration Commission (SASAC) of the State Council of China and is engaged in 10 core business activities that cover biopharmaceutical products, including vaccines.

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Elastic compliance of the blood vessels contributes high-frequency components in the peripheral pulse, which are analyzed with the help of the power spectral density of the signal. The frequency corresponding to heart rate in a subject is called his fundamental harmonic or first harmonic, frequency twice the heart rate is called second harmonic, and so on. The contribution of these harmonics is assessed by performing Fourier transform on the peripheral blood volume or flow pulse signal for sufficient duration, which yields power spectral density of the peripheral pulse. Dedicated software, known as pulse harmonic analyzer, has also been developed for performing harmonic analysis of the peripheral signal. It not only yields a contribution of higher harmonics in the pulse but also subharmonics (frequencies smaller than the heart rate of the subject). Researchers have observed suppression of second harmonics in subjects aging more than 30 years, suppression of high-frequency components in the power spectral density of the pulse in the coronary artery disease and enhancement of the first harmonic in hypertensives and subjects susceptible to diabetes during the past four decades. Subharmonic components are observed to be related to variability in heart rate, pulse volume, and pulse morphology, which has the potential to become a method of choice for continuous real-time variability monitoring in intensive care units. These observations are reviewed in this paper briefly.

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Coronavirus disease 2019 (COVID-19) is a highly contagious infection of the respiratory tract by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). The symptomatology of COVID-19 varies from mild symptoms such as fever and dry cough to severe acute respiratory distress syndrome (ARDS). There is an increasing number of patients with anosmia and hyposmia as the COVID-19 pandemic continues. Currently, loss of smell is a well-recognized symptom of the COVID-19 infection, and some of the patients develop long-lasting olfactory dysfunction. Some COVID-19 patients may present with olfactory dysfunction as the only symptom or with other symptoms. The exact pathogenesis of olfactory dysfunctions is still not clear. The clinical evolution of the olfactory dysfunction in COVID-19 patients is still unclear as the recovery reports vary significantly. There is no recommended standard treatment protocol to reduce anosmia or hyposmia due to COVID-19 infection. A short course of oral corticosteroids and olfactory training (OT) is a safe and effective option for managing post-COVID olfactory dysfunction. The efficacy of intranasal corticosteroid spray is still in doubt for treating olfactory dysfunction in COVID-19 patients. Currently, OT is a useful treatment option for anosmia or hyposmia in COVID-19 patients. However, there is a crucial need for further studies to get better and more effective treatment options for a complete cure of the post-COVID-19 olfactory dysfunction. This review article discusses the details of the management of olfactory dysfunction in COVID-19 patients. The literature sources included PubMed, Scopus, Google Scholar, and Medline databases and searched with word management of olfactory dysfunction in COVID-19 patients, smell disturbances, COVID-19 infections, olfactory dysfunction, and medical treatment of olfactory dysfunction.

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“Variability is the sign of life” is the principle being followed by all living beings on the earth. The study of variability came into existence in 1965 with Hon and Lee’s observation of the need for rapid delivery after a decrease in fetal heart rate variation. The field has grown phenomenally since then and has become an essential part of patient care. Heart rate variability is the most studied and explored for its physiological origin and subsequent clinical applications. It has been followed by blood pressure variability, blood flow variability, morphology index variability, and so on. These variabilities are expressed in the time domain, frequency domain, and nonlinear domain by different parameters and geometric shapes. Poincare representation is one of the nonlinear domain representations of variability. Elliptical, torpedo-like, or fan-shaped central conglomeration of points in Poincare plots are generally considered normal. The shape distorts considerably in different diseases. Not much effort has been made to classify these distortions since the time domain and frequency domain presentations have dominated most of the studies due to their numerical expression. Poincare presentation in arrhythmias is very interesting to the extent that a diagnosis can be made based on the Poincare plot. The point plots are now being extended to curve plots or line plots for better detection of arrhythmia and its understanding. Owing to large scatter in the time domain and frequency domain parameters of variability, extended Poincare plots are currently being explored as substitutes. Some of these features of Poincare plots and their clinical applications are briefly described in this article.

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A glioma is a kind of tumor that initiates in the glial cells of the brain or the spinal cord. High rates of complications and mortality are leading features of gliomas, a glioma can be treated through a surgical procedure, radiation, and chemotherapy. This short communication aimed to analyze the crucial role of epigenetic alterations in the pathogenesis of gliomas and the possible treatment of gliomas by manipulating epigenetic mechanisms. The pathogenesis of glioma is associated with key epigenetic mechanisms, which are deoxyribonucleic acid (DNA) methylation, abnormal microribonucleic acid (RNA), chromatin remodeling, and histone modifications. Alterations and mutations in genes are often seen in gliomas. Alterations and mutations in isocitrate dehydrogenase 1 (IDH1) are commonly found in gliomas; mutant IDH1 facilitates the maintenance of genomic stability in tumors by increasing the DNA damage reaction. Moreover, therapeutic modification of epigenetic alterations connected with the development of gliomas is of utmost clinical significance; comprehensive knowledge of epigenetic aberrations that lead to the formation of glioma will help in the design and development of epigenetic drugs for the treatment of gliomas. Some medications that target epigenetic alterations such as inhibitors of mutant IDH, bromodomain and extraterminal motif inhibitors, histone deacetylase inhibitor, DNA methylation inhibitors, and enhancer of zeste homolog 2 inhibitors are presently used to tackle glioma.

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