Exercise for Mental Health Sir: In this era of exponential growth of the "metabolic syndrome" and obesity, lifestyle modifications could be a cost-effective way to improve health and quality of life. Lifestyle modifications can assume especially great importance in individuals with serious mental illness. Many of these individuals are at a high risk of chronic diseases associated with sedentary behavior and medication side effects, including diabetes, hyperlipidemia, and cardiovascular disease. 1 An essential component of lifestyle modification is exercise. The importance of exercise is not adequately understood or appreciated by patients and mental health professionals alike. Evidence has suggested that exercise may be an oftenneglected intervention in mental health care. 2 Aerobic exercises, including jogging, swimming, cycling, walking, gardening, and dancing, have been proved to reduce anxiety and depression. 3 These improvements in mood are proposed to be caused by exercise-induced increase in blood circulation to the brain and by an influence on the hypothalamic-pituitaryadrenal (HPA) axis and, thus, on the physiologic reactivity to stress. 3 This physiologic influence is probably mediated by the communication of the HPA axis with several regions of the brain, including the limbic system, which controls motivation and mood; the amygdala, which generates fear in response to stress; and the hippocampus, which plays an important part in memory formation as well as in mood and motivation. Other hypotheses that have been proposed to explain the beneficial effects of physical activity on mental health include distraction, self-efficacy, and social interaction. 4 While structured group programs can be effective for individuals with serious mental illness, lifestyle changes that focus on the accumulation and increase of moderate-intensity activity throughout the day may be the most appropriate for most patients. 1 Interestingly, adherence to physical activity interventions in psychiatric patients appears to be comparable to that in the general population. Exercise improves mental health by reducing anxiety, depression, and negative mood and by improving selfesteem and cognitive function. 2 Exercise has also been found to alleviate symptoms such as low self-esteem and social withdrawal. 3 Exercise is especially important in patients with schizophrenia since these patients are already vulnerable to obesity and also because of the additional risk of weight gain associated with antipsychotic treatment, especially with the atypical antipsychotics. Patients suffering from schizophrenia who participated in a 3-month physical conditioning program showed improvements in weight control and reported increased fitness levels, exercise tolerance, reduced blood pressure levels, increased perceived energy levels, and increased upper body and hand grip strength levels. 5 Thirty minutes of exercise of moderate intensity, such as brisk walking for 3 days a week, is sufficient for these health benefits. Moreover, these 30 minutes nee...

Background COVID‐19 pandemic is a global health crisis. Very few studies have reported association between obesity and severity of COVID‐19. In this meta‐analysis, we assessed the association of obesity and outcomes in COVID‐19 hospitalized patients. Methods Data from observational studies describing the obesity or body mass index (BMI) and outcomes of COVID‐19 hospitalized patients from December 1, 2019, to August 15, 2020, was extracted following PRISMA guidelines with a consensus of two independent reviewers. Adverse outcomes defined as intensive care units (ICU), oxygen saturation <90%, invasive mechanical ventilation (IMV), severe disease and in‐hospital mortality. The odds ratio (OR) and 95% confidence interval (95%CI) were obtained and forest plots were created using random‐effects models. Results A total of 10 studies with 10,233 confirmed COVID‐19 patients were included. The overall prevalence of obesity in our study was 33.9% (3473/10,233). In meta‐analysis, COVID‐19 patient with obesity had higher odds of poor outcomes compared to better outcomes with a pooled OR of 1.88 (95%CI:1.25–2.80; p=0.002), with 86% heterogeneity between studies (p<0.00001). Conclusion Our study suggests a significant association between obesity and COVID‐19 severity and poor outcomes. Our results findings may have important suggestions for the clinical management and future research of obesity and COVID‐19. This article is protected by copyright. All rights reserved.

Highlights In this meta-analysis of 24 studies with 12882 confirmed COVID-19 patients, we assessed the association of comorbid liver disease, acute liver injury, and elevated liver enzymes with outcomes in COVID-19 hospitalized patients. Overall prevalence of pre-existing chronic liver disease and COVID-19-associated acute liver injury were 2.6% and 26.5%, respectively and elevated AST and ALT were 41.1% and 29.1%, respectively. In our study, COVID-19-associated acute liver injury was having 1.7 folds higher risk of poor outcomes. Elevated AST and ALT were also independently associated with higher odds of poor outcomes. These findings may help in early triage, close monitoring of the occurrence of liver injury, and careful use of drugs which can cause liver toxicity in COVID-19 patients.

Antibiotic prescribing was common at both hospitals. The antibiotic prescriptions at the TH had higher compliance to WHOLEM and NLEMI. However, there is a need to develop appropriate interventions to improve antibiotic prescribing at both hospitals.

The peak prescribing rates during the summer and rainy season probably reflect the higher diagnostic and follow-up uncertainties faced by the treating physicians. The method used in this study could be used in busy outpatient settings.

Background. There is lack of data on feasibility and safety of kidney transplants from living donors who recovered from COVID-19. Methods. Here, we present a retrospective cohort study of 31 kidney transplant recipients (KTR) from living donors who recovered from polymerase chain reaction confirmed COVID-19 across 19 transplant centers in India from July 3, 2020, to December 5, 2020. We detailed demographics, clinical manifestations, immunosuppression regimen, treatment, and outcomes. Donors with a previous diagnosis of COVID-19 were accepted after documenting 2 negative polymerase chain reaction tests with complete symptom resolution for at least 28 days and significant social distancing for 14 days before surgery. Results. COVID-19 clinical severity in donors ranged from completely asymptomatic (71%, n = 22) to mild infection (29%, n = 9). None progressed to moderate or severe stages of the disease in the entire clinical course of home treatment. Patient and graft survival was 100%, respectively, with acute cellular rejection being reported in 6.4% (n = 2) recipient. All recipients and donors were asymptomatic with normal creatinine at median follow-up of 44 days after surgery without any complications relating to surgery and COVID-19. Conclusions. Our data support safety of proceeding with living donation for asymptomatic individuals with comprehensive donor, recipients screening before surgery, using a combination of clinical, radiologic, and laboratory criteria. It could provide new insights into the management of KTR from living donors who have recovered from COVID-19 in India. To the best of our knowledge, this remains the largest cohort of KTR from living donors who recovered from COVID-19.

The increasing COVID-19 cases in the USA have led to overburdening of healthcare in regard to invasive mechanical ventilation (IMV) utilization as well as mortality. We aim to identify risk factors associated with poor outcomes (IMV and mortality) of COVID-19 hospitalized patients. A meta-analysis of observational studies with epidemiological characteristics of COVID-19 in PubMed, Web of Science, Scopus, and medRxiv from December 1, 2019 to May 31, 2020 following MOOSE guidelines was conducted. Twenty-nine full-text studies detailing epidemiological characteristics, symptoms, comorbidities, complications, and outcomes were included. Meta-regression was performed to evaluate effects of comorbidities, and complications on outcomes using a random-effects model. The pooled correlation coefficient ( r ), 95% CI, and OR were calculated. Of 29 studies (12,258 confirmed cases), 17 reported IMV and 21 reported deaths. The pooled prevalence of IMV was 23.3% (95% CI: 17.1–30.9%), and mortality was 13% (9.3–18%). The age-adjusted meta-regression models showed significant association of mortality with male ( r : 0.14; OR: 1.15; 95% CI: 1.07–1.23; I 2 : 95.2%), comorbidities including pre-existing cerebrovascular disease ( r : 0.35; 1.42 (1.14–1.77); I 2 : 96.1%), and chronic liver disease ( r : 0.08; 1.08 (1.01–1.17); I 2 : 96.23%), complications like septic shock ( r : 0.099; 1.10 (1.02–1.2); I 2 : 78.12%) and ARDS ( r : 0.04; 1.04 (1.02–1.06); I 2 : 90.3%), ICU admissions ( r : 0.03; 1.03 (1.03–1.05); I 2 : 95.21%), and IMV utilization ( r : 0.05; 1.05 (1.03–1.07); I 2 : 89.80%). Similarly, male ( r : 0.08; 1.08 (1.02–1.15); I 2 : 95%), comorbidities like pre-existing cerebrovascular disease ( r : 0.29; 1.34 (1.09–1.63); I 2 :93.4%), and cardiovascular disease ( r : 0.28; 1.32 (1.1–1.58); I 2 : 89.7%) had higher odds of IMV utilization. COVID-19 patients with comorbidities including cardiovascular disease, cerebrovascular disease, and chronic liver disease had poor outcomes. Diabetes and hypertension had higher prevalence but no association with mortality and IMV. Our study results will be helpful in right allocation of resources towards patients who need them the most. Electronic supplementary material The online version of this article (10.1007/s42399-020-00476-w) contains supplementary material, which is available to authorized users.

Background:There is limited data on the prevalence of impulse control disorder and related behaviors (ICD-RBs) in Indian patients with Parkinson's Disease (PD). In the context of potential genetic and environmental factors affecting the expression of ICD-RBs, studying other multiethnic populations may bring in-sights into the mechanisms of these disorders.Objectives:To ascertain point prevalence estimate of ICD-RBs in Indian PD patients, using the validated “Questionnaire for Impulsive-Compulsive Disorders in Parkinson's disease (QUIP)” and to examine their association with Dopamine replacement therapy (DRT).Materials and Methods:This was a hospital based observational cross-sectional study. After taking informed consent, patients and their informants (spouse, or primary caregiver) were made to complete the QUIP, and were instructed to answer questions based on behaviors that occurred anytime during PD that lasted at least four consecutive weeks.Results:Total of 299 patients participated in the study. At least one ICD-RB was present in 128 (42.8%), at least one Impulse control disorder (ICD) was present in 74 (24.75%) and at least one Impulse control related compulsive behaviour (ICRB) was present in 93 (31.1%) patients. Punding was the most frequent (12.4%) followed by hyper sexuality (11.04%), compulsive hobbyism (9.4%), compulsive shopping (8.4%), compulsive medication use (7.7%), compulsive eating (5.35%), walkabout (4%) and pathological gambling (3.3%). ≥ 2 ICD-RBs were observed in 15.7% of patients. After multivariate analysis, younger age of onset, being unmarried were specifically associated with presence of ICD. Longer disease duration was specifically associated with presence of ICRB. Whereas smoking and higher dopamine levodopa equivalent daily doses (DA LEDD) were associated with both presence of ICD and ICRB. Higher LD LEDD was specifically associated with presence of ICD-RB.Conclusions:Our study revealed a relatively higher frequency of ICD-RBs, probably because of the use of screening instrument and because we combined both ICDs and ICRBs. Also high proportion of DA use (81.6%) among our patients might be responsible. The role of genetic factors that might increase the risk of developing ICD-RBs in this population needs further exploration.