Background
The emergence of the COVID-19 pandemic has affected the lives of many people, including medical students. The present study explored internet addiction and changes in sleep patterns among medical students during the pandemic and assessed the relationship between them.
Methods
A cross-sectional study was carried out in seven countries, the Dominican Republic, Egypt, Guyana, India, Mexico, Pakistan, and Sudan, using a convenience sampling technique, an online survey comprising demographic details, information regarding COVID-19, the Pittsburgh Sleep Quality Index (PSQI), and the Internet Addiction Test (IAT).
Results
In total, 2749 participants completed the questionnaire. Of the total, 67.6% scored above 30 in the IAT, suggesting the presence of an Internet addiction, and 73.5% scored equal and above 5 in the PSQI, suggesting poor sleep quality. Internet addiction was found to be significant predictors of poor sleep quality, causing 13.2% of the variance in poor sleep quality. Participants who reported COVID-19 related symptoms had disturbed sleep and higher internet addiction levels when compared with those who did not. Participants who reported a diagnosis of COVID-19 reported poor sleep quality. Those living with a COVID-19 diagnosed patient reported higher internet addiction and worse sleep quality compared with those who did not have any COVID-19 patients in their surroundings.
Conclusion
The results of this study suggest that internet addiction and poor sleep quality are two issues that require addressing amongst medical students. Medical training institutions should do their best to minimize their negative impact, particularly during the current COVID-19 pandemic.
Rationale:
Miller Fisher syndrome (MFS) is a rare variant of Guillain-Barre syndrome, classically diagnosed based on the clinical triad of ataxia, areflexia, and ophthalmoplegia. MFS is usually preceded by viral infections and febrile illness; however, only a few cases have been reported after vaccinations.
Patient concerns:
A 53-year-old hypertensive male presented with a 2-day history of progressive ascending paralysis of the lower limbs along with diplopia and ataxia, 8 days after the first dose of the Sinovac–Coronavac coronavirus disease 2019 (COVID-19) vaccination, with no prior history of any predisposing infections or triggers.
Diagnoses:
Physical examination showed moderate motor and sensory loss with areflexia in the lower limbs bilaterally. Routine blood investigations and radiological investigations were unremarkable. Cerebrospinal fluid analysis showed albuminocytologic dissociation and nerve conduction studies revealed prolonged latencies with reduced conduction velocities. The diagnosis of MFS was established based on the findings of physical examination, cerebrospinal fluid analysis, and nerve conduction studies.
Interventions:
A management plan was devised based on intravenous immunoglobulins, pregabalin, and physiotherapy. However, due to certain socioeconomic factors, the patient was managed conservatively with regular physiotherapy sessions.
Outcomes:
Follow-up after 6 weeks showed remarkable improvement, with complete resolution of symptoms 10 weeks after the discharge.
Lessons:
This case suggests that MFS is a rare adverse effect after COVID-19 vaccination and additional research is required to substantiate a temporal association. Further studies are needed to understand the pathophysiology behind such complications to enhance the safety of COVID-19 vaccinations in the future.
The coronavirus disease 2019 (COVID-19) pandemic has significantly impacted healthcare systems across the globe and rapidly transformed healthcare delivery. As the pandemic continues, international health organisations, governments and hospitals grapple to contain the spread. The current public health disruption has compelled authorities to prevent overcrowding of healthcare services and depletion of medical supplies and resources. Telemedicine offers a solution to conserve healthcare resources by eliminating the need for hospital visits during this time of necessary social distancing, and has a potential to establish itself permanently within the healthcare system. 1 Pakistan, like other lower-middle-income countries, has a weak healthcare system. Approximately 64% of Pakistan's population reside in rural areas, and only 30% of its rural population has access to the necessary health facilities. 2 Pakistan's health sector is faced with challenges of poor infrastructure, shortage of healthcare human resources, and inadequate medical facilities in rural areas. As of January 2020, there are 164.9 million mobile connections in Pakistan-a 6.2% increase from the previous year-making up to 75% of the total population. Clearly, electronic health (e-health) may prove to be the critical solution to healthcare access in rural and remote areas of Pakistan, as mobile usage rises.Like many other countries, Pakistan openly adopted telehealth in the wake of the COVID-19 pandemic. 3 It was the first country to launch a free telehealth service through WhatsApp. The initiative was made possible by Digital Pakistan and the Ministry of National Health Services, Regulations and Coordination, and has enabled people to connect with domestic and overseas doctors to address COVID-19 related health concerns. The federal government of Pakistan has also launched a COVID-19 emergency response telemedicine service "Yaran-e-Watan", which allows overseas Pakistani health professionals to offer medical services to patients in Pakistan.Telemedicine initiatives like "Sehat-Kahani", "Oladoc", "Marham", "ring a doctor" and "eDoctor" are some examples of successful telehealth interventions in Pakistan. "Sehat-Kahani" has provided more than 150,000 online consultations with over 1.05 million beneficiaries
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