Background Healthcare workers (HCWs) stand the risk of acquiring infection directly, while attending to patients or indirectly while handling and testing patient specimens. Considering this, the present study was planned to assess Personal Protective Equipment (PPE) breaches and exposures among HCWs working in COVID-19 wards/ screening areas and to evaluate their COVID-19 positivity rates post-exposure concerning the level of exposure, type of PPE breach, and the cadre of HCWs exposed in COVID-19 wards. Methods This retrospective cross-sectional study involved the analysis of all instances of PPE breaches which occurred during a period of nine months from June 2020 to February 2021 at a tertiary care level hospital in Central India. The analysis included all exposures involving any cadre of HCWs that occurred while handling the patients or while doffing the contaminated PPE in COVID -19 wards. Results A total of 347 PPE breaches were analyzed from the available records of the Hospital Infection Control team repository. Amongst the 347 breaches, 268 (77.2%) were classified as low-risk exposures and 79 (22.8%) as high-risk exposures. Cadre wise distribution of high and low-risk exposures revealed that, PPE breaches occurred most commonly in the category of nursing officers (n = 174, 50.1%). Among all of the breaches, 15.2% of high-risk exposures and 2.6% of low-risk exposures resulted in COVID-19 positivity with a cumulative positivity of 5.4%. Collectively, non-mask related breaches accounted for the majority (63.2%) of the positive COVID-19 cases. Conclusion Appropriate use of PPE by HCWs is vital for their protection. However, breaches in the use of PPE may occur while managing COVID-19 patients due to physical and mental exhaustion among HCWs resulting from work overload. Early identification and appropriate management of HCWs with high-risk exposures can help prevent transmission to other hospital staff and patients, thus preserving resources and workforce.

Context: Cognitive impairment is linked to thyroid dysfunction in various studies; however, the evidence is mixed. Aims: To determine cognitive function in the working population with abnormal thyroid function tests. Settings: Outpatient department of Medicine in a tertiary care hospital located in Central India. Design: Hospital-based, cross-sectional study. Methods and Material:100 patients between 15-64 years of age with different patterns of thyroid dysfunction were subjected to cognitive function testing via the Mini-Mental Status Examination (MMSE) questionnaire. Statistical analysis used: The data obtained was coded in a Microsoft Excel Worksheet and analyzed by SPSS software version 21. Results: 100 patients (11 % men and 89 % women) were included in the present study. The mean age of the study population was 37.11±8.76 years. 87 % had overt hypothyroidism, 6 % had subclinical hypothyroidism, 6 % had overt hyperthyroidism. The mean MMSE score of patients with abnormal thyroid function tests was 27.62 ±2.04 (Range 23-30). The mean MMSE score in patients with overt hypothyroidism was 27.54 ± 2.07, that of overt hyperthyroidism 28.33 ±1.03, and that of subclinical hypothyroidism was 27.67 ± 2.50. MMSE scores among different patterns of thyroid dysfunction were not found to be statistically significant. The MMSE scores between newly and previously diagnosed patients with thyroid dysfunction were not statistically significant. (28.3 ± 1.06 vs 27.54 ± 2.12). Conclusions: The results suggest no association between cognitive function and abnormal thyroid function tests in the working population.

The COVID-19 pandemic had imposed a city-level quarantine, local lockdown, and border closures for patient-level isolation to control virus spread. There is a lack of studies on the health-related quality of life (HRQoL) in the elderly in countries like India during COVID-19. After obtaining written informed consent from the elderly patients, data was recorded in the case record form-cum-questionnaire. The quality of life was assessed with the help of Centers for disease control and prevention (CDC) HRQoL-14 measures, which are based on general health improvement, physical and mental health, and its effect on usual activities like self-care, work, or play, sadness, depression, worry, tension, or anxiety, and rest or sleep. A total of 331 patients were screened and 234 were enrolled in this study, with 220 patients completing their follow-up. Among them, 55.43% were retired elderly, 31.82% were unemployed and 21.36% were living alone. After one month, 49 patients had days of poor physical health which was significantly below baseline (70 patients). More patients had poor mental health in the first 15 days as compared to the time of recruitment. At end of 1 month, self-care, work, and recreational activities were affected in 11 patients, with a significant reduction from baseline in 21 patients. Elderly patients felt sad and depressed and did not get enough sleep in the first 7 days and were worried, tense and anxious in the initial 15 days, which improved after 1 month. A significant number of patients had improved activity limitations because of the COVID-19 pandemic at the end of 1 month. The COVID-19 pandemic had made a significant impact on physical and mental health. A system of mental and psychological health support for the elderly during isolation should be developed. Engaging the elderly in cognitively stimulating mental exercises through apps, limiting exposure to social media, and setting up helplines for the elderly may be helpful in this regard.

A BSTRACT Background: Polypharmacy and inappropriate prescribing are risk factors for adverse clinical outcomes in older people. Screening tools can identify potential medicine-related patient safety incidents for the elderly on multiple medicines and with chronic diseases. Methods: In this prospective observational study, details of demography, diagnosis, history of constipation/peptic ulcer disease, over-the-counter medications, and clinical and laboratory findings were noted. Information obtained was reviewed and analyzed with the help of STOPP/START and Beers 2019 criteria. At 1 month follow-up, improvement was assessed with the help of a structured questionnaire. Results: As per the criteria, modification in drugs was recommended for 213 drugs; it was actually performed for 27.73% and 48.71% drugs as per Beers and STOPP/START criteria, respectively. Glimepiride was replaced with short-acting sulfonylureas because of hypoglycemia, and angiotensin receptor blockers were stopped because of hyperkalemia as per Beers criteria. Statins were started in 19 patients by START criteria. Overall general health improvement was observed at 1 month, but an increase in anxiety, tension, worry, depressed feel, and insomnia was observed in initial days of the coronavirus disease 2019 pandemic. Conclusions: In view of polypharmacy in the prescriptions, the combination of prescribing criteria need to be considered while prescribing medications to the elderly to get optimum therapeutic benefits and improvement in the quality of life. The quality of primary care of the elderly can also be improved by use of screening tools such as STOPP/START and Beers criteria by a primary/family physician. Prescription evaluation by a trained pharmacologist/physician for possible drug/food/disease interactions and for therapy modification can be incorporated for routine geriatric care at a tertiary care center. Clinical trial registry of India registration number: CTRI/2020/01/022852

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