Highlights This is the first review determining psychological morbidities amidst COVID-19 pandemic. Almost half of the general public had a significant mental health impact. Poor sleep quality was the commonest problem followed by stress, psychological distress. The burden was highest among the COVID-19 patients followed by healthcare workers.

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Introduction Pre-existing comorbid conditions in COVID-19 patients are risk factors for developing severe disease and death. We aimed to determine the association of chronic liver disease (CLD), a comorbid condition, with severity of disease and death among COVID-19 patients. Methods We searched for studies reporting COVID-19 outcomes among CLD and non-CLD patients in databases including Medline, EMBASE, ScienceDirect, Google Scholar, and Cochrane Library from inception of the pandemic until February 2022. Risk of bias assessment was conducted by using the Newcastle-Ottawa Scale for assessing the quality of nonrandomized studies in meta-analyses. We conducted a meta-analysis with a random-effects model and reported pooled odds ratios (ORs) with 95% CIs. Results We included 40 studies with 908,032 participants. Most studies were conducted in China and the US. COVID-19 patients with CLD had significantly higher odds of having a severe form of COVID-19 (pooled OR = 2.44; 95% CI, 1.89–3.16) and death (pooled OR = 2.35; 95% CI, 1.85–3.00) when compared with COVID-19 patients without CLD. Conclusion The presence of CLD is significantly related to adverse clinical outcomes among COVID-19 patients in terms of severity and mortality. Clinicians should develop a comprehensive intervention plan to manage these high-risk patients and reduce COVID-19–related deaths.

Despite widespread dissemination of cancer to multiple organs, muscle metastasis remains a rare occurrence. Limiting factors in this regard include, among others, repetitive muscle contraction, increased lactic acid, and decreased pH as well as protease metabolism. With the approval of hospital's research committee, a 10-yr review of histopathologic and imaging studies of patients diagnosed as having muscle metastasis was attempted. A review of the literature dealing with this phenomenon was also initiated. The review of the literature with reference to muscle metastasis highlighted its rare occurrence, which in turn correlated with our own 40-yr clinical experience (M.M.L.). As a potential target, muscle tissue remains an "infrequent soil" for metastasis because of its unique mechanical and metabolic qualities.

Introduction:Shock wave lithotripsy has become first line treatment modality for renal calculi due to its noninvasiveness. However, the destructive forces like dispersion of cavitation bubbles can cause trauma to thin-walled vessels and renal parenchyma during fragmentation of the stones. Antioxidants are our first line of defense against oxidative stress. The aim of this study was to investigate whether oral administration of Vitamin C and E help in a reduction of the serum level of inflammatory mediator by serial measurement of high sensitivity C-reactive protein (hs-CRP) and by this reduction in the risk of renal damage.Patients and Methods:A total of 107 subjects were recruited in three groups. Group A served as a control group, and Group B and Group C received oral medication of Vitamin E 800 mg/day and Vitamin C 1000 mg/day respectively, start from 2 days prior the lithotripsy and continued for total 7 days. The level of hs-CRP was used as a mediator of the inflammatory response following lithotripsy and thus for long term renal injury. Serum level of hs-CRP was measured on 2 days prior the lithotripsy and day 2, 7 and 28 after the lithotripsy.Results:Patients who were given either Vitamin C or Vitamin E showed a significant reduction of serum level of hs-CRP when compared to control the group.Conclusion:Oral administration of Vitamin C and E helps in reduction of serum levels of the inflammatory marker for acute renal injury and thus they can be useful in minimizing the kidney injury following lithotripsy for renal stone disease.

BackgroundWearing a mask is one of the simplest ways to reduce the spread of COVID-19. Studies reported poor mask compliance in Greater Chennai Corporation, India. Hence, we described the knowledge, attitude, and practice regarding mask use among adults (≥18 years) in Greater Chennai Corporation, Tamil Nadu, India.MethodsWe conducted a cross-sectional survey among residents of Greater Chennai Corporation in March 2021. We estimated the sample size to be 203 per strata (slum and non-slum). We used a simple random sampling technique to select 20 locations using a digital map in the slum and non-slum areas. After reaching the location chosen, we selected 10 consecutive households and one adult (≥18 years of age) from each household. We used a validated, semi-structured questionnaire for collecting data regarding knowledge, attitudes, and practices for mask use. We estimated proportions and 95% CI for key variables and compared the variables between slums and non-slums.ResultsOf 430 participants included in the study, 51.4% were males. The mean (S.D.) age of the participants is 41.1 (14.6) years. The majority (86.7%) of the participants felt that wearing a mask helped in reducing the spread of coronavirus and the knowledge differed (p-value < 0.05) between the slum (81.4%) and non-slum (92.3%). Nearly half (46.5%) of the participants did not like being forced to wear the mask. About 63.9% of the participants reported the practice of mask use while going out which was similar across slums and non-slums.ConclusionAlthough the knowledge regarding mask use was good among the public, the attitude was unfavorable. We suggest continuous reinforcement by spreading awareness and educating the community on the appropriate use of the mask.

Background Different combinations of lifestyle interventions have been studied with varying results on hypertension control. Hence, this review was done to compare multiple combined lifestyle intervention in reducing blood pressure (BP) among patients with prehypertension or hypertension. Methods We conducted systematic search in the following databases: MEDLINE, PubMed Central, CENTRAL, ScienceDirect, Google Scholar from 1964 until November 2020. Estimates of comparative intervention effect from network meta-analyses (random-effects model) were represented as mean difference (MD) with 95% confidence interval. Results In total, 14 studies with 2451 participants were included. Almost all the studies had high risk of bias. Healthy diet (HD) and physical activity (PA) combination showed highest mean reduction in systolic BP (−9.88 mmHg) and diastolic BP (−6.28 mmHg) followed by HD + PA + smoking cessation + alcohol restriction combination (systolic BP = −6.58 mmHg, diastolic BP = −4.09 mmHg) compared with usual care. HD and PA combination had the highest probability of being the best intervention (82.8% for SBP and 81.7% for DBP). Conclusion We found that HD and PA are the most important combination of lifestyle modifications for prehypertensive and hypertensive patients. Hence, a coordinated approach is required from the clinicians by integrating beneficial effect of these modifications through education, counselling and support. Summary Box What is already known on this topic? Various combinations of these multiple lifestyle interventions have been studied with varying results. Hence, it would be beneficial to find out the intervention combination with maximum effectiveness in controlling the blood pressure among prehypertensive or hypertensive patients. What is added by this report? We found that healthy diet and physical activity are the most important combination of lifestyle modifications required to achieve maximum reduction in SBP and DBP amongst HTN patients. What are the implications for public health practice? Our study has several implications for the clinicians and public health professionals. A coordinated approach is required from the clinicians by integrating the beneficial effect of these modifications through education, counselling and support. Public health professionals and policy makers should make use of these findings to design the policy, programme or scheme to tackle the burden of HTN or improve the control status amongst the established patients.

Obesity has been associated with increased risk of adult asthma, however, not all studies have found a clear association between overweight and the incidence of asthma, and data on other adiposity measures have been limited. Hence, we aimed to summarize evidence on association between adiposity and adult asthma. Relevant studies were retrieved through searches conducted in PubMed, and EMBASE up to March 2021. A total of sixteen studies (63,952 cases and 1,161,169 participants) were included in the quantitative synthesis. The summary RR was 1.32 (95% CI 1.21–1.44, I2 = 94.6%, pheterogeneity < 0.0001, n = 13) per 5 kg/m2 increase in BMI, 1.26 (95% CI 1.09–1.46, I2 = 88.6%, pheterogeneity < 0.0001, n = 5) per 10 cm increase in waist circumference and 1.33 (95% CI 1.22–1.44, I2 = 62.3%, pheterogeneity= 0.05, n = 4) per 10 kg increase in weight gain. Although the test for nonlinearity was significant for BMI (pnonlinearity < 0.00001), weight change (pnonlinearity = 0.002), and waist circumference (pnonlinearity = 0.02), there was a clear dose-response relationship between higher levels of adiposity and asthma risk. The magnitude of the associations and the consistency of the results across studies and adiposity measures provide strong evidence that overweight and obesity, waist circumference and weight gain increases asthma risk. These findings support policies to curb the global epidemic of overweight and obesity.