poorest in the depressed-distressed group and best in the depressed group [8.0 (7.3-9.8) vs. 6.5 (5.6-7.4) vs. 7.7 (6.7-8.6); P = 0.01].Comparison of glycaemic control in all depressed individuals (with and without concomitant diabetes-related distress) with that in symptom-free individuals revealed no differences in either baseline or follow-up HbA 1c ( P = 0.51 and P = 0.96, respectively).These results suggest that depression alone does not predict poorer glycaemic control than in the symptom-free individuals. Rather than mere depression, it is the interaction between depression and diabetes-related distress that compromises the ability of Type 2 diabetic patients to successfully control their diabetes. Thus, measuring interactive effects of depressive symptoms and other psychological factors on diabetes-related outcomes may have advantages over investigating individual psychological effects in future research. Letters DIABETIC Medicine
Central nervous system (CNS) involvement in SARS-CoV-2 is now a known fact, likely due to viral transmission through the olfactory nerve and high brainstem viral load, which also suggests dissemination in the ambiguus and solitary nuclei from the respiratory tract via the vagus nerve. 1 Anosmia and ageusia findings are justified by a potential large cohort study. It may only be an interesting coincidence that hyposmia disorders are normal in premature Parkinson's disease (usually only in the prodromal phase) and the olfactory system is an early favored site for alpha-synuclein linked diseases. 2 Chorea is a hyperkinetic movement disorder characterized by involuntary brief, sudden and irregular movements. 3 Chorea patients may not recognize irregular movements immediately since they are discreet, and some gestures can be temporarily blocked by parakinesia. The inability to maintain voluntary contraction, as observed during the milkmaid grip test and in individuals with persistent tongue protrusion, is a characteristic of chorea. Chorea can cause irritability and gaucheness. Chorea can be hereditary or acquired, generalized or localized and can have several etiologies, such as viral infection and acute stroke. A 58-year-old male, with known hypertension and no travel history, was brought to the emergency room (ER) at 1:00 pm with complaints of abnormal movements of the hands and feet with an inability to talk properly. The patient was very irritable during the initial ER visit, and intravenous (IV) midazolam was given to control movements. Consultation with the neurology department was requested (Supplementary Video 1 in the online-only Data Supplement). The neurology resident on duty re
Background. There is insufficient data in Pakistan and in South Asia regarding paediatric COVID-19 demographics and related parameters. The main aim of this study was to assess the paediatric population exposed to SARS-CoV-2 infection, their clinical parameters, risk factors, and outcome. Methods. This was a descriptive retrospective study conducted at the Pakistan Institute of Medical Sciences and Federal General Hospital Islamabad from 23rd July 2020 to 22nd August 2020. All paediatric contacts (≤13 years) of one hundred adult COVID-19 patients were included. Data of the index cases was taken from the medical records. Paediatric data was collected on the phone using a predesigned proforma. Results. There were 137 paediatric contacts of 100 adult COVID-19 index cases. The index cases were predominantly males (67%) and belonged to the middle socioeconomic class (89%), and 14% succumbed to the disease. Females had more paediatric contacts. The mean age of contacts was 6.6 years, and the majority (80%) developed no symptoms. Among the symptomatic contacts, fever and cough were the most common symptoms. None of the contacts developed dyspnoea or required hospitalization. Majority of the contacts had been vaccinated with the BCG vaccine. Testing for COVID-19 was done in only 77 (56%) contacts, 25 (32%) by the government team, and 52 (67%) privately. A higher number of symptomatic contacts were positive (15/17 (88%)) as compared to that of the asymptomatic contacts (6/60 (10%)) ( p = 0.002 ). Development of symptoms in the contacts was associated with the history of respiratory illnesses, recurrent infections, use of hematinics, a positive COVID-test result, and health professionals being index cases ( p ≤ 0.01 ). Parents with higher education and in the health profession and the families of symptomatic contacts reported better compliance with quarantine regulations. Conclusion. A significant number of children were exposed to adult COVID-19 patients. Most paediatric contacts remained asymptomatic. Children with preexisting medical conditions and with parents in health profession were susceptible to infection.
Background: Pre-exposure prophylaxis (PrEP) is a promising strategy to break the chain of transmission of novel coronavirus (2019-nCoV). Aims: This trial aimed to evaluate the safety and efficacy of PrEP with various doses of HCQ against a placebo among high-risk healthcare providers (HCPs). Methods: A phase II, randomized, placebo-controlled trial was conducted at a tertiary care hospital. A total of 228 HCPs were screened, we included 200 subjects with no active or past SARS-CoV-2 infection. Subjects of experimental groups 1-3 received HCQ in various doses and those in the control group received placebo. The study outcomes in terms of safety and efficacy were monitored. Participants exhibiting COVID-19 symptoms were tested for SARS-CoV-2 during the study and also by the end of the 12th week, with PCR or IgM and IgG serology. Results: Overall, 146 of 200 participants reported exposure to a confirmed COVID-19 case in the first month, 189 in the 2nd month and 192 were exposed by the 12th week of the study. Moreover, the precautionary practices, i.e. use of personal protective equipment (PPE), significantly varied; initially more than 80% of the exposed HCPs weren't ensuring the PPE used by the patients treated by them. However, it gradually developed with the increasing knowledge of the virus. As far as safety is concerned, mild treatment-related side effects were observed among the interventional and placebo arm patients. While none of the participants were critical, and a few had mild illness by the end of the 12th week, requiring only outpatient observation with no hospitalization. There was no significant clinical benefit of PrEP with HCQ as compared to placebo (p>0.05). Conclusion: It is concluded from the study findings that the PrEP HCQ does not significantly prevent illness compatible with COVID-19 or confirmed infection among high-risk HCPs.
This trial aimed to evaluate the safety and efficacy of pre-exposure prophylaxis (PrEP) with various hydroxychloroquine (HCQ) doses against a placebo among healthcare personnel (HCP) with high-risk exposure to coronavirus disease 2019 (COVID 19). MethodsA phase II, randomized, placebo-controlled trial was conducted including 200 subjects with no active or past severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (antibody testing and reverse transcription-polymerase chain reaction (RT-PCR) were taken at the time of enrollment). Subjects of experimental groups one to three received HCQ in various doses and the control group received a placebo. The study outcomes in terms of safety and efficacy were monitored. Participants exhibiting COVID-19 symptoms were tested for SARS-CoV-2 during the study and by the end of week 12 with RT-PCR or serology testing (COVID-19 IgM/IgG antibody testing). ResultsOut of the total participants, 146 reported exposure to a confirmed COVID-19 case in the first month, and 192 were exposed by week 12 of the study. Moreover, the precautionary use of personal protective equipment (PPE) significantly varied; initially more than 80% of the exposed HCPs were not ensuring PPE being used by the patients treated by them, which gradually developed over time. Mild treatment-related side effects were observed among the interventional and placebo arm patients. There was no significant clinical benefit of PrEP with HCQ as compared to placebo (p>0.05). ConclusionIt is concluded that the PrEP HCQ does not significantly prevent COVID-19 among high-risk HCPs.
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