The Coronavirus disease 2019 (COVID-19) pandemic is a major threat to public health and has had a significant impact on all aspects of life. Vaccinations have their largest potential to end the CODID-19 pandemic if they are widely accepted and used.The present study is an attempt to assess the COVID 19 Vaccination status of patients and hospital staff at a Tertiary care hospital. A Hospital based prospective study was carried out in admitted COVID wards of a tertiary care hospital for a period of 6  months (1^st June to 30^th November 2021). Each patient was inquired about vaccination history in detail and subsequently outcome of Covid positive patients {Discharged, DAMA (Discharge against medical advice or Death}was noted. In addition, vaccination data of 1501 heath care workers including teaching, non-teaching staff and medical students was also gathered. It was concluded that admitted Covid vaccinated patients had high cure rate 91.6%. Whereas the proportion of deaths among Covid vaccinees was found to be 8.4%. Thus both the vaccines has high potential to mitigate a severely damaging COVID-19 infection. Moreover, 90.7% hospital staff including students was found to be vaccinated against Covid 19 with preponderance among postgraduate students 98.6% and undergraduate students 97.7% followed by teaching staff 96.8%. This reflects greater acceptance of vaccine in younger population.

One of the most significant contributions of the Indian sub continent to the human kind is the gift of Oral Rehydration Therapy/Solution to deal with Cholera & other diarrheal diseases. The current article examines the contribution of Homoeopathy to deal with diarrheal diseases. The article traces the development of ORS both at global & the national level. Thereafter, it deals with the subject of diarrhoea through the dimension of how, why, when, where and whom of diarrhoea. Following that the burden of the disease as such is explained along with the intervention of OZ (ORS &Zinc) duo to deal with the disease. Interventions are also seen through the lens of prevention and protection as well. Taking cue from one of the elaborate & established books in the Homoeopathic world, it deals with what Homoeopathy had offered, is offering & the potential to offer in the future to deal with this water borne disease.

The emergence of new lineages of corona virus over the different continents has illustrated a significant public health concern. These new strains have a higher rate of transmissibility and have become dominant within a short period of time. The virus strains were also witnessed with an extensive range of mutations in the spike (S) protein, particularly in the receptor-binding domain (RBD) and amino-terminal domain (NTD). The studies concerning the genomic epidemiology of the COVID-19 virus have assisted the scientific community to unveil the evolutionary aspect of viruses and track the transmission dynamics over the world. At present all the mutations are vaccine sensitive, but vaccine-resistant variety may emerge at any time. It is very important that we should close the door quickly, although, strategic problems are there. Mutations are more possible in partially vaccinated areas rather than fully vaccinated areas. The present policy of vaccinating on an age structure leaves many non-vaccinated in the same home. In a population with very few vaccinated people there are viruses in many hosts and the chances of mutation is high. If the population is fully vaccinated, the virus is eradicated from that community and hence mutation chances are less. This locality specific fast and total vaccination will curtail the mutagenesity of the virus, lead to its eradication and to be preferred rather than vaccinating based on age structure.

Background: Low fruit, vegetable and Water consumption as well as increased Tea and Junk Food consumption remains a global health challenge. This study was done to evaluate the pattern of fruit, vegetable, water, tea and junk food consumption among adult population of District Shimla. Methods: A descriptive cross-sectional survey was conducted amongst the participants in the age group of 18 to 60 years, using google forms. The questionnaire was circulated among residents of district Shimla for responses. Results: A total of 400 respondents including 194(48.5%) females and 206(51.5%) males from district Shimla were participated in the study. Among the participants of the majority 189(47.3%) were in age group of 31-40 years, 159(39.8%) were in Govt Job,338(84.5%) were graduate and above, 235(58.8%) were from urban area and 387(96.8%) were belong to Hindu Religion. Among the total 400 study participants, majority 233(58.3%) were taking fruits only one time a day while 206(51.5%) were taking vegetables only one time a day. Majority 130 (32.5%) were taking 2 cups of tea /coffee in a day while 122(30.6%) were taking 3 or more cups of tea /coffee in a day. Majority 69(17.3 %) were taking 5 glasses of water in a day while 291(72.75%) were taking less than 8 glasses of water in a day. Majority 175 (43.8%) were taking junk food /fast food one time in a week and 58(14.5%) were taking junk food /fast food 3 or more times in a week. Conclusion: Health promotion campaigns emphasizing health hazards of lower intake of fruit, vegetable and Water as well as increased Tea and Junk Food consumption needs to be organized by the health care workers in this area to encourage the creation of favorable environment. 

Background: Physical inactivity is one of the leading risk factors for non-communicable diseases mortality. People who are insufficiently active have a 20% to 30% increased risk of death compared to people who are sufficiently active. This study was done to evaluate the pattern of Yoga, Walking, Sleep & Screen hours among adult population of District Shimla. Methods: A descriptive cross-sectional survey was conducted amongst the participants in the age group of 18 to 60 years, using google forms. The questionnaire was circulated among residents of district Shimla for responses. Results: A total of 400 respondents including 194(48.5%) females and 206(51.5%) males from district Shimla were participated in the study. Among the participants of the majority 189(47.3%) were in age group of 31-40 years, 159(39.8%) were in Govt Job,338(84.5%) were graduate & above, 235(58.8%) were from urban area and 387(96.8%) were belong to Hindu Religion. Majority 213(53.3%) were doing exercise/yoga for one hour a day while 161(40.3%) were not doing exercise/yoga at all in a day. Majority 165 (41.3%) were walk for at least 30 minutes in a day while 101(25.6%) were walk for ≥at least 150 minutes in a day. Majority 332 (83.1%) were sleeping 6-8 hours in a day while 37 (9.5%) were sleeping <6 hours & 31(7.8%) were sleeping > 8 hours in a day. Among the total 400 study participants, majority 82 (20.5%) were using mobile, Laptop, TV for 3 hours and 370 (92.7%) were using mobile, Laptop, TV for ≥2 hours. Conclusion: Majority of study participants do not meet the physical activity, screen hour and sleeping pattern recommended by the World Health Organization. This puts a large Indian population at risk of developing various NCDs

Background: Interstitial lung diseases (ILDs) comprise a heterogeneous group of acute and chronic lung diseases that cause progressive scarring of the lung tissue, compromising respiratory function and blood oxygenation. The present study was done to evaluate the Pulmonary Function Test (PFT) and 6 Minutes Walk Test Findings of Interstitial Lung Diseases (ILDs) patients. Material & Methods: This cross-sectional study was conducted at Indira Gandhi Medical College, Shimla from July 2018 to June 2019. All consecutive patients of all types of ILDs, attending the outpatient services of the Department of Pulmonary Medicine, IGMC Shimla were enrolment and subjected to focused socio-demographic, Pulmonary Function Test (PFT) and 6 Minutes Walk Test Findings history. Data was analyzed using Epi info V7 software by applying appropriate statistical tests. Results: The present study includes 50 patients of different types of ILD. Among these, 27 (54%) were female and 23 (46%) were male. The mean age of the study population was 57.821+5.03years. The mean duration of symptoms of ILD was 3.034+2.62 years. The mean six minutes walk distance was 311.4±122.5meters. The mean six minutes walk distance was significantly higher in males than in females, 350.19±110.41 meter and 277.77±124 meter respectively, (p = 0.034). Thirty (60%) patients walked less than 350 meters. The restrictive pulmonary function abnormality was the commonest form observed in 30 (60%) patients, followed by obstructive pulmonary dysfunction 5 (10%) while small percentage had mixed abnormality 3(6%) There was no significant male-female difference with regards to Pulmonary Function Test. Conclusion: The restrictive pulmonary function abnormality was the commonest form observed in most of ILD patients and mean six minutes walk distance was significantly higher in males than in females.

Cardiovascular disease (CVD) is the leading cause of morbidity and mortality, accounting for 17.3 million deaths globally each year and this figure is expected to grow to 23.6 million by the year 2030; 80 per cent of these deaths occur in lower- and middle-income countries. It is the largest contributor to non-communicable diseases (NCDs) that are now responsible for the largest share of morbidity and mortality worldwide. The incidence of CVD, including coronary heart dis- ease, heart failure, and stroke, as well as the prevalence of key risk factors, varies greatly according to geographical region, gender, and ethnic background. In this article we discuss the different risk factors that are responsible cardiovascular diseases.

Background: Interstitial lung diseases (ILDs) include more than 200 disorders, characterized by a variable degree of inflammation and fibrosis leading to an often-irreversible loss of lung function. The present study was done to evaluate the Pulmonary hemodynamics and RV systolic function profile of Interstitial Lung Diseases (ILDs) patients. Material & Methods: This cross-sectional study was conducted at Indira Gandhi Medical College, Shimla from July 2018 to June 2019. All consecutive patients of all types of ILDs, attending the outpatient services of the Department of Pulmonary Medicine, IGMC Shimla were enrolment and subjected to focused socio-demographic, Pulmonary hemodynamics and RV systolic function profile history. Data was analyzed using Epi info V7 software by applying appropriate statistical tests. Results: The present study includes 50 patients of different types of ILD. Among 50 patients, 24 (48%) patients had TR. The mean value of TRV among 24 patients was 3.7±0.7 meters/sec. The mean value of PASP was 66.29±23.61mmHg. Out of 24 patients who were having TR, the mean value of Mean pulmonary artery pressure (MPAP) was 42.96±14.52mmHg. Out of 24 patients who had TR, twenty ((83.33%) had Pulmonary artery hypertension (PAH.). The mean value of mean PAP was 43.85±12.42mmHg. Out of 50 patients, 44 (88%) had PAH. The mean value of PVR was 4.11±1.41 WU. Majority of patients 79% had PVR of >3 WU. The mean IVC diameter was 14.95±4.1 mm.The IVC diameter was significantly increase (>21 mm) in 4(8%) of patients. Patients with IVC collapsibility with inspiration >50% were 31(62%) and <50% were 19(38%) respectively. The mean value of RA pressure was 5.36±3.63 mmHg. The mean value of Pulmonary flow acceleration time (PFAT) was 77.99±21. 61msec.Majority of (78%) patients had PFAT < 105 msec. The mean value of Tricuspid annular peak systolic excursion (TAPSE) was 17.67±3.08mm. Majority of patients (58%) had TAPSE of < 17mm. Conclusion: Majority of ILD patients, had TR, PAH, PVR of >3 WU, IVC collapsibility with inspiration >50%, PFAT < 105 msec and TAPSE of < 17mm.

Background- Currently, very few data is available on Day Care Single Incision Laparoscopic Cholecystectomy (SILC). Hence, in this study we aimed to evaluate the epidemiological study of patients for day care single incision laparoscopic cholecystectomy surgery. Material and Methods: This study was done in a single unit of the Department of General Surgery at Indira Gandhi Medical College and Hospital, Shimla w.e.f. July 2018 to June 2019 on patients admitted for surgery. Results: The age ranged between 20 years to 76 years. Mean age was 33.8 years. Most of our patients were females. Body Mass index (BMI) ranged between 18 and 30 with Mean BMI 24.03 Kg/m2. Conclusion: We conclude that most of patients were young female.

Background: Currently, very few data is available on Day Care Single Incision Laparoscopic Cholecystectomy (SILC). Hence, in this study we aimed to evaluate the duration of surgery for Day Care Single Incision Laparoscopic Cholecystectomy surgery. Methods: This study was done in a single unit of the Department of General Surgery at Indira Gandhi Medical College and Hospital, Shimla w.e.f July 2018 to June 2019 on patients admitted for surgery. Results: Mean duration of surgery was 48.57 minutes. 20% patients’ duration of surgery more than 50 minutes. Conclusion: We conclude that most of patient’s duration of surgery was 30-50 mint.

The most common complication of IV therapy is phlebitis, which leads to much patient discomfort and requires the removal of the catheter, the insertion of a new catheter in a different site, and, often, local treatment and analgesic drugs. During prolonged hospitalization, repeated episodes of phlebitis can lead to difficulties with venous access and may result in more invasive procedures, such as central venous catheter placements or cutdowns, being performed. Consequently, prophylaxis has been instituted by using short cannulation times, adding buffers, and using in-line membrane filters to remove microparticulate components present in the infusion fluids. This article discusses the important pathogenic determinants of catheter related blood stream infections (CRBSI) recognised routes of contamination of cannula and guidelines for insertion of cannula to prevent peripheral vein infusion phlebitis.

Thrombophlebitis is the inflammation of the vessel wall due to the formation of blood clot. Clinical signs of phlebitis are localized redness, warmth, swelling and palpable venous cord. Over the last two decades, studies about phlebitis have divided the risk factors into four main groups: patient characteristics, therapy administered health professional practices and cannula characteristics. Phlebitis is an important and ongoing problem in medical practice. Studies have found that patients on IV medications were at higher risk of developing complications than patients on hydration alone. Variations of the grading system for peripheral thrombophlebitis have evolved during the past 20 years, including the Mad

Adjuvants are commonly found to be used with the local anaesthetics. The purpose is to provide a synergistic effect by increasing the duration of sensory and motor blocks, thus limiting the overall dose requirement of the anaesthetic to a minimal. Current research is directed to search the steroidal agents that would prolong the local anaesthetic action. Dexamethasone is one such steroid that is commonly used as an adjuvant to the local anaesthetics.  The concern regarding its safety profile of dexamethasone as an adjuvant is limited due to its potentially lower neurotoxicity and neurological complications which necessitates further research in this direction.

Though severe side effects were not found in Ali’s investigation [1] and were not reported previously in adolescents following vaccinations with the mRNA-1273 SARS-CoV-2 vaccine(Moderna), there are several reports of severe adverse reactions to this vaccine in adults. 

 In a 22yo male with a history of mild COVID-19 6m prior, peri-myocarditis developed 3d after the first dose of the Moderna vaccine [2]. The patient markedly benefited from aspirin and colchicine [2].

A 77yo male developed immune encephalitis, myoclonus, and Sweet-syndrome 1d after the first Moderna dose [3]. He profited significantly from methyl-prednisolone.[3]

A 60yo male with a history of hepatitis-C, renal insufficiency, hypertension, and heart failure, presented with purpuric rash and thrombocytopenia (84000/µL) without major bleeding 2d after the first Moderna dose [4]. 

A 66yo male developed a large-area, painful blistering rash 1d after the second Moderna dose [5]. He benefited from mupirocin and prednisone.

One day after the second Moderna dose, a 34yo male developed myocarditis. Aspirin, colchicine, bisoprolol and rampiril were beneficial.

Though severe adverse reactions to Moderna are rarely reported, they might be harmful to those experiencing them.

Anaesthesia is an ever-evolving branch. In order to understand the function of an anaesthetic drug, it is imperative to assess the pharmacodynamic and pharmacokinetic properties of the inducing agent. Levobupivacaine is one such local anaesthetic drug that is commonly used in day care operative procedures. The success of the surgery mainly depends on the safety and efficacy of the drug, that is usually dose responsive. Levobupicavaine is about 97% bound to plasma proteins. Half-life of levobupivacaine is 3.3 hours. The volume of distribution is estimated at 66.91 ± 18.23. It is found to have stable effect on the central nervous system, respiratory system, autonomic nervous system as well as it provides hemodynamic stability as well. The most common adverse drug reactions reported are: hypotension (31%), nausea (21%), vomiting (14%), headache (9%), procedural pain (8%), dizziness (6%). It is concluded that levobupivacaine can be used safely as an anaesthetic drug.

With interest we read the article by Aksoy et al. about a 46 years old female with myasthenia gravis (MG) due to antibodies against the acetyl-choline receptor (AchR) being treated with 120mg pyridostigmine per day in whom MG exacerbated in the course of an infection with SARS-CoV-2 (COVID-19) [1]. It was concluded that early immune-modulatory therapy may be more effective in terms of preventing permanent lung damage than standard first-line treatments in patients with MG [1]. We have the following comments and concerns.

A shortcoming of the study is that AchR antibody titers were not determined during hospitalisation and were not compared with pre-hospitalisation titers. Knowing AchR antibody titers during hospitalisation would allow assessing if MG truly exacerbated. Missing in this respect are results of nerve conduction studies (NCSs), such as repetitive nerve stimulation or single-fiber EMG to document exacerbation of MG during the viral infection. Since clinical manifestations of COVID-19 may mimic clinical manifestations of MG, differentiation between deterioration due to the viral infection or due to MG is often not possible upon clinical investigations alone. The presented data are not convincing with regard to exacerbation of MG. Symptoms and signs could be simply explained by the severe SARS-CoV-2 infection. 

A dosage of 120mg/d pyridostigmine is very low according to the recommendations of international neurological societies for treating MG [2]. We should know the reason why the patient was treated with such a low dosage. Was this due to the low body weight of the patient or due to only mild symptoms during the last 4y since onset of MG?

Certain drugs may exacerbate MG, such as chloroquine [3] or azithromycin [4]. We should know why the patient nonetheless received these drugs on admission. Missing is the complete list of drugs the patient was regularly taking prior to admission.

We do not agree with the statement that corticosteroids should be used with caution in MG patients. Steroids are the mainstay of generalised MG treatment particularly before immune-suppressive treatment becomes effective or during exacerbations. Steroids may not only improve clinical manifestations of MG but may also lower AchR antibody titers [5]. 

According to a recent review of SARS-CoV-2 infected patients with MG [6], there is no increase in the prevalence of MG since the outbreak of the COVID-19 pandemic, MG not necessarily deteriorates in SARS-CoV-2-infected patients, there is no increase in the frequency of complications, and there is no general need to modify the anti-myasthenic treatment in asymptomatic SARS-CoV-2-positive MG patients [6]. In symptomatic SARS-CoV-2 infected MG patients, however, there may be a need to modify and adapt immune-modulating treatment depending on the clinical presentaiton and disease course.

Overall, this interesting study has a number of shortcomings which should be addressed before drawing final conclusions. There is a need for confirmation of MG exacerbation by non-clinical investigations, to differentiate between manifestations of MG and COVID-19. Immuno-suppression should be considered in all COVID-19 patients given the often severe immune-response with lymphocyte depletion and chemokine and cytokine elevation in these patients.

Various local anaesthetic agents like bupivacaine, levobupivacaine, ropivacaine and lignocaine have been used with safety and efficacy in performing such blocks. Out of various agents which are used for brachial plexus block, levobupivacaine is the agent which not only prolongs motor and sensory blockade but is also less cardiotoxic and neurotoxic. The study was done with an objective to estimate the duration of analgesia and the requirement of rescue analgesia post operatively after inducing the patient with 0.5% levobupivacaine in comparison to 0.25% of levobupivacaine. There were a total of 60 participants of which there were 14 male patients in group L50 and 15 in group L25 as compared to female patients being 16 and 15 in groups L50 and L25. The mean duration of surgery in group L50 was 58.83± 27.41 minutes and 40.93 ±17.90 minutes in group L25 (P=0.05). The duration of analgesia was significantly longer in L50 group. (P=0.001).The number of demands for rescue analgesia were lower in group L50 compared to group L25. There was no significant change in the vital parameters of all the patients under study both intraoperatively and postoperatively. 0.5 % levobupivacaine has better therapeutic profile as compared to 0.25% levobupivacaine without any significant side effects.

Various local anaesthetic agents like bupivacaine, levobupivacaine, ropivacaine and lignocaine have been used with safety and efficacy in performing such blocks. Out of various agents which are used for brachial plexus block, levobupivacaine is the agent which not only prolongs motor and sensory blockade but is also less cardiotoxic and neurotoxic. The study was done with an objective to estimate the duration of analgesia and the requirement of rescue analgesia post operatively. We also intended to study the intra-operative cardiovascular stability by assessing the heart rate and mean arterial pressure of the study participants. There were 30 study participants who were provided with 0.5% Levobupivacaine plus dexamethasone 4 mg. The mean duration of the surgery was 58.83 (SD=27.41) minutes. The mean duration of the pain free period was 567 minutes (95% Confidence Interval: 513.0-592.25). Our study also observed that requirement of rescue analgesia was 2 with a range from 1.0-2.0. In conclusion, the use of 0.5% levobupivacaine with dexamethasone (4 mg) as adjuvant in USG guided supraclavicular brachial plexus block resulted in smooth induction of analgesia, with a pai free period of over 10 hours. The requirement for rescue analgesia is delayed. This anaesthetic has also been found to maintain cardiovascular stability. Further studies are required to assess the relative efficacy of this anaesthetic.

Various local anaesthetic agents like bupivacaine, levobupivacaine, ropivacaine and lignocaine have been used with safety and efficacy in performing such blocks. Out of various agents which are used for brachial plexus block, levobupivacaine is the agent which not only prolongs motor and sensory blockade but is also less cardiotoxic and neurotoxic. The study was done with an objective to estimate the duration of analgesia and the requirement of rescue analgesia post operatively. We also intended to study the intra-operative cardiovascular stability by assessing the heart rate and mean arterial pressure of the study participants. There were 30 study participants who were provided with 0.25% Levobupivacaine plus dexamethasone 4 mg. The mean duration of the surgery was 41.6 (SD=11.64) minutes. The mean duration of the pain free period was 229 minutes (95% Confidence Interval: 222.75 -243.5). Our study also observed that requirement of rescue analgesia was 4 with a range from 3.0-4.0. In conclusion, the use of 0.25% levobupivacaine with dexamethasone (4 mg) as adjuvant in USG guided supraclavicular brachial plexus block resulted in smooth induction of analgesia, with a pain free period of nearly 4 hours. The requirement for rescue analgesia is delayed. This anaesthetic has also been found to maintain cardiovascular stability. Further studies are required to assess the relative efficacy of this anaesthetic.

Bronchogenic carcinoma is the most common malignancy all over the world in terms of both incidence and mortality.  It also remains the most common malignancy in men worldwide.  Majority of patients having lung cancer had direct exposure to smoking. Occupational exposures and air pollution approximately accounts for 2% to 9% of lung cancers. Approximately 85% patients with lung cancer are symptomatic at presentation. Design: This record based cross sectional study was carried out in the department of Pathology, Indira Gandhi Medical College, Shimla over a period of one year from January to December 2018. Data was collected using a structured clinical Performa which included various sociodemographic and clinical variables. Result and Discussion: The mean age of presentation was 62 years with male female ratio 2.4:1. Right lung was involved (49.7%) more than left (33.1%). Majority (80.3%) of the lesions were malignant followed by benign (16.2%). Out of malignant lesions squamous cell carcinoma was most common (29.3%). These parameters were comparable to other studies. Conclusion: Among the malignant lesions, squamous cell carcinoma was most common and most of the benign lesions were granulomatous. Malignant lesions were predominant in elderly patients, narrowed gender gap with smoking being the most probable cause.

With interest we read the article by Baskaran et al. about a 22 months-old female with Leigh-syndrome (LS) due to a variant in SURF1, phenotypically manifesting with classical features of the syndrome [1]. We have the following comments and concerns.

A shortcoming of the study is that the causative SURF1 variant was not specified. Additionally, information if the variant occurred in the homo- or heterozygous form is missing.

Furthermore, we do not agree that LS is only caused by variants in genes encoding proteins responsible for the pyruvate-dehydrogenase complex, cytochrome-c oxidase, adenosine-triphosphate synthase subunit-6, or subunits of mitochondrial comples [1]. The spectrum of mutated genes causing LS is broader than mentioned in the introduction. Currently, mutations in about 75 different genes have been linked to LS [2]. 

Missing in the report is the family history. Since LS due to SURF1 mutations is usually transmitted via an autosomal recessive or dominant trait [3], we should know if other first-degree relatives were clinically affected or carried the variant. Of particular interest is the clinical presentation and genetic status of the mother and father of the index patient. 

Unfortunately, no details about seizure type, seizure frequency, type of anti-seizure drug (ASD) treatment, compliance, and effect or side effects of the AED treatment have been provided. Knowing the exact AED treatment is crucial as it may determine the outcome of these patients.

LS is usually a multisystem disease, in which not only the brain but also the eyes, ears, endocrine organs, heart, the gastro-intestinal tract, the kidney, the bones, or the skin can be affected. The index patient obviously manifested in the brain (epilepsy, hypotonia, ataxia, failure-to-thrive), the endocrine system (hirsutismus), gastro-intestinal tract (vomiting, diarrhoea, poor weight gain), the muscle (myopathy of limb and extra-ocular muscles), and other systems (dysmorphism, developmental delay). We should know if the patient was prospectively investigated for subclinical or mild involvement of other organs, such as the heart or the kidneys. Of particular interest is cardiac involvement since it may strongly co-determine the outcome of these patients [4].

Overall, the case report presented by Baskaran et al. has a number of shortcomings, which should be met before drawing final conclusions. We should know the mutation load in the index patient, the genetic status of the parents or other first-degree relatives, and the results of prospective investigations of the heart. More information about epilepsy in the index patient is warranted.

The main limitation of the study by Kanberg et al. [1] is that neurological symptoms were assessed without confirmation that neurons/glial cells were affected. No cerebral imaging studies, CSF studies, nerve conduction studies, cerebral angiographies, EEGs, or electro-myographies were provided. Missing is also a clinical neurological investigations to objectify the reported symptoms.

Fatigue may not only be a neurological symptom but may also originate from pulmonary, cardiac, psychiatric, endocrine, or renal involvement in COVID-19.[2] Thus, it is crucial to assess in how many of the included patients fatigue was non-neurological. “Changes in cognition” may not only be neurological but may occur together with fever, 

A further limitation is that the current medication and the anti-COVID-19 treatment were not included in the evaluation. From a number of drugs given for COVID-19 it is known that they can be neurotoxic or glial-toxic [3,4] why it is essential to know the treatment for COVID-19. In this respect we also need to know how many of the 100 patients required mechanical ventilation as it is usually associated with the requirement for sedation, muscle relaxation, analgesia, or anaesthesia. 

Missing is the differentiation between primary and secondary neurological impairment in COVID-19. Not only the virus and the immunological reaction against it may lead to CNS/PNS damage but also involvement of organs other than the CNS/PNS in COVID-19. Cardiac involvement may lead to cardio-embolism or arterial hypertension, which may cause PRES, vasoconstriction syndrome, or ICB. 

Overall, the interesting study has several limitations which challenge the results and their interpretation.

The child health programme in India, under the National Health Mission, focuses on improving child survival by integrating interventions that address factors contributing to infant and under-five mortality. The programme emphasizes the concept of Continuum of Care, providing critical services at home, through community outreach, and at health facilities. The Reproductive, Maternal, Newborn, Child and Adolescent Health (RMNCH+A) strategy aims to improve child health and nutrition status. The National Health Policy targets to reduce Infant Mortality Rate to 28 per 1000 live births by 2019, Neonatal Mortality Rate to 16 per 1000 live births by 2025, and Under 5 Mortality Rate to 23 per 1000 live births by 2025. However, as per the data from the National Family Household Survey and Sample Registration System, the current rates are higher. Sustainable Development Goal 3.2 aims to reduce neonatal mortality to at least 12 per 1000 live births and under 5 mortality to at least 25 per 1000 live births by 2030. Facility-based newborn care services, such as Special New Born Care Units (SNCUs), New Born Stabilization Units (NBSUs), and New Born Baby Corners (NBCCs), have been established to address higher neonatal and early neonatal mortality rates. The Janani Shishu Suraksha Karyakram (JSSK) provides free treatment, drugs, diagnostics, diet, blood, and transport for pregnant women and sick newborns, aiming to promote institutional delivery and eliminate out-of-pocket expenses.

The global adolescent population, now comprising over a quarter of humanity, faces critical health challenges. Improved infant survival has driven demographic shifts, yet adolescent mortality remains a concern, particularly in low- and Middle-Income Countries (LMICs). The rise of Non-Communicable Diseases (NCDs) linked to adolescent behaviors-including tobacco, alcohol, obesity, and inactivity-exacerbates long-term health risks. Mental disorders, maternal conditions, and injuries significantly impact adolescent health worldwide, with variations in mortality causes across different regions. Health promotion strategies, including The Gatehouse Project, Nurse-Family Partnership (NFP) and Conditional Cash Transfer (CCT) programs, have demonstrated success in improving adolescent health and preventing risk behaviors. Addressing adolescent health demands a holistic approach, integrating policies, education, and preventive interventions to reduce morbidity and long-term disease burdens.

Kangaroo Mother Care (KMC) is a low-resource, evidence-based intervention for low-birth-weight (LBW) infants, incorporating skin-to-skin contact and exclusive breastfeeding. Proven to reduce neonatal mortality, severe infections, and hospital stays, KMC fosters thermoregulation, bonding, and neurodevelopment. It is initiated in hospitals and continued at home, with regular follow-up essential for monitoring growth and neurodevelopment. Counseling and family involvement are critical to overcoming socio-cultural barriers and ensuring adherence. While primarily for stable LBW infants, KMC can be adapted for sick neonates under clinical supervision. Feeding strategies for LBW infants emphasize fixed intervals and gradual increases in fluid and nutrient intake. Effective implementation of KMC requires hygiene practices, gradual duration adjustments, and close monitoring to address complications like inadequate weight gain or infection. Follow-up care integrates anthropometric assessments, linkage to early intervention programs, and support by community health workers.

Polycystic ovarian disease is one of the commonest cause of infertility in women it can cause menstrual problem overweight excess hair growth and acne management of PCOD include weight loss and lifestyle changes taking care of all the individual symptoms.

Background: Because of its weight-bearing function and the construction of its articulation, the ankle is the most commonly injured joint among athletes and a frequent cause of morbidity in the general population. This study was undertaken with the objective to assess the knowledge about preventive factors and practices during ankle pain among Ortho OPD patients in civil hospital Rohru. Material and Methods: This cross-sectional study was conducted between Aug- December 2020 among Ortho OPD patients in civil hospital Rohru selected by convenience sampling technique. Information regarding their socio-demographic characteristics, knowledge regarding prevention and practices during ankle pain were obtained using a self-administered, pre-tested, semi-structured questionnaire. Data was analyzed using epi info v7 software using appropriate statistical tests. Results: In the present study 35% (140) of the patients fall were below 40 years of age while 65% (260) were above 40 years. 54% (216) of patients were male and 46% (184) were female. Among the total patients maximum 347(86.75%) replied that avoiding sandals and shoes that are too loose helps in prevention of ankle injury or pain followed by minimizing wearing high heels 345(86.25%). Among the total patients maximum 339(84.75%) replied that they applied of pain relief gels upon ankle pain followed by compression and wrapping with elastic bandage 334(83.5%). Conclusion: For immediate at-home treatment of ankle pain, the Rest, Ice, Compression and Elevation of ankle (RICE) method for the first few days is recommended. OTC medication may provide some relief as well.

The COVID-19 pandemic has caused extensive disruption to the lives of people all over the world. Aside from controlling the spread of the virus, some studies suggest that there are also other benefits of the pandemic and lockdown like a closer family relationship by spending more quality time with the family members. On the other hand, the majority of the studies concluded that the prolonged lockdown has a negative impact on the overall health of children and young individuals; ranging from poor physical health due to lack of physical activity, to severe anxiety, depression, and other psycho-socio issues. Even worse, some studies found that children with pre-existing health conditions are severely affected. This paper aims to review various literature on the effects of the Covid-19 pandemic and lockdown on the overall health of children and teenagers. It tries to study and find possible suitable recommendations or solutions to the various problems caused by the Covid-19 pandemic concerning the health issues of young individuals.

It is interesting that the Hindu Vedas introduced by Aryan invaders to India promotes a caste system that has led to the subjugation of the indigenous Dravidian population. The religion promotes racial hygiene just as the Nazis did, but because it is couched in the form of religious dogma, it has never been repudiated, unlike the case with the Nazis who made racial hygiene into a political ideology that has been roundly criticized around the world. It turns out, however, that the Hindus may have had reasons for promoting their caste system, even health reasons as it turns out. What has emerged from recent genetic studies is that certain genetic haplotypes, particularly in the Indian subcontinent as well as South Asia, have been found to be extremely vulnerable to CoViD-19, due to a weakness in the genes that leads to autoimmune dysfunction in the immune response of CoViD patients.

Background: Coronavirus disease 2019 (COVID-19) is a respiratory illness caused by Severe Acute Respiratory Coronavirus-2 (SARS-CoV-2). The disease has infected many and also causes high mortality since first case was reported in China on December 2019. Transmission of virus is very high and occurs mainly by droplet infection. Aims and objective: To find out the rate of SARS-CoV-2 positivity among individuals attending Covid testing center. Methodology: A prospective study was carried out on population attending the CTC attached to Dr. Baba Saheb Ambedkar Medical College and Hospital, New Delhi between 3^rd May 2020 and 20^th May 2020. Epidemiological, demographic and clinical data was collected and analyzed by using SPSS version 22. Consecutive sampling was done. Results: Out of 50 samples the positivity rate for SARS-CoV-2 was only 8%. The positivity rate among males was 7.40% and among females was 8.69%. The most common symptoms were cough (34%), sore throat (34%), fever (14%), breathlessness (10%), nasal discharge (10%) and chest pain (2%). Conclusion: In a single-center of New Delhi, the case positivity rate was very low. And incidents of becoming positive was higher in symptomatic cases.

Background: The estimated prevalence of HIV related eye diseases in India is reported to be between 8-45%. Dry eye occurs has been seen in later stages of HIV as common anterior segment disorder.  Aim: Present study was conducted to prevalence of dry eye in HIV seropositive patients. Material and Methods: The study was a hospital based cross – sectional study where 120 HIV-positive patients registered at the ART centre and referred to Ophthalmology OPD of a tertiary care teaching hospital in Himachal Pradesh, India for ocular complaints were included in the study. Subjects were investigated for dry eye with Rose Bengal staining, Ocular Surface Disease Index score (OSDI), Schirmers test 1 with and without anaesthesia & Tear Film Break Up Time (TBUT). Results: 25 (10.4%) eyes were found positive on rose Bengal staining while OSDI score was found to be positive for dry eye in 67 patients (55.8%). Based on TBUT Mild, moderate and severe dry eye was found in 58 (24.2%), 45(18.8%) and 13 (5.4%). Based on Schirmer-1 test with anaesthesia, dry eye was seen in 81 (33.7%) eyes.  Conclusion: Dry eye is very common in HIV patients than general population hence, routine examination of tear function should be an integral part of assessment of HIV and AIDS patients.