Clinical State Research Articles

PS-R07-8: A CASE OF PRIMARY ALDOSTERONISM CAUSED BY BILATERAL ALDOSTERONE-PRODUCING MICROTUMORS WITH A UNILATERAL ADRENAL MASS

Introduction: Primary aldosteronism (PA) is defined as a disease in which overproduction of aldosterone causes various complications such as hypertension, cardiovascular disorder and kidney disease. We herein report a case of PA caused by bilateral aldosterone-producing microtumors with a unilateral adrenal mass. Case presentation: A 54-year-old man was referred to our hospital with a clinical suspicion of PA. He had a history of hypertension and chronic kidney disease for 10 years and had experienced paresthesia that was caused by putaminal hemorrhage in the past. In the initial examination, he exhibited hypertension (150/90 mmHg), high aldosterone (pg/mL)-to-renin (ng/mL/h) ratio (1,744), and overt hypokalemia (K, 2.9 mEq/L). The serum creatinine level was 1.89 mg/dL. The captopril challenge test showed no changes in his blood pressure or plasma aldosterone concentration. These results led to a clinical diagnosis of PA. Computed tomography (CT) revealed the presence of left adrenal mass, so that we suspected that the mass should be responsible for overproduction of aldosterone. We performed adrenal venous sampling. Unexpectedly, the adrenal venous sampling highly suggested the presence of aldosterone-producing microtumors in bilateral adrenal glands (lateralized ratio, 1.3; left contralateral ratio, 0.2). After evaluation, we decided that there was no indication for the removal of left adrenal mass. Then, a low dose of a mineralocorticoid receptor (MR) antagonist was started. Although the dose of an MR antagonist could not be increased sufficiently due to poor renal function, he exhibited an improved control of blood pressure and was followed up thereafter. Discussion and Conclusion: Although PA is one of the most common causes of secondary hypertension, making an accurate diagnosis and appropriate treatment is sometimes problematic due to the difficulty in assessing the site of aldosterone overproduction. The Japanese Endocrine Society clinical guideline states that PA with unilateral adrenal tumor in young patients may not require adrenal venous sampling. From the current case, however, we should always consider the possibility of bilateral microtumors or hyperplasia even in the presence of a unilateral adrenal mass.

Interpreting decision-analytic modelling-based economic evaluations in orthopaedics.

Economic evaluation provides a framework for assessing the costs and consequences of alternative programmes or interventions. One common vehicle for economic evaluations in the healthcare context is the decision-analytic model, which synthesizes information on parameter inputs (for example, probabilities or costs of clinical events or health states) from multiple sources and requires application of mathematical techniques, usually within a software program. A plethora of decision-analytic modelling-based economic evaluations of orthopaedic interventions have been published in recent years. This annotation outlines a number of issues that can help readers, reviewers, and decision-makers interpret evidence from decision-analytic modelling-based economic evaluations of orthopaedic interventions.Cite this article: Bone Joint J2023;105-B(1):17-20.

Comparison of 3% Hypertonic Saline and Mannitol in the Management of Children with Raised Intracranial Tension: A Research Protocol

Introduction: Raised Intracranial Tension (ICT) is a common medical emergency with varied aetiology. Immediate medical or surgical intervention is mandated in most cases. Conservatively, osmotherapy with 3% Hypertonic Saline (HTS) or Mannitol is the mainstay to reduce raised ICT. Additionally, the patient may also need surgical intervention along with osmotherapy. The need for the study: Cerebral oedema and raised ICT in children and its treatment protocol are under-estimated and need further research and study in terms of identification of the condition and the choice of osmotherapy, which is the cornerstone in treating raised ICT among others. Aim: To analyse the role of 3% HTS and mannitol and their individual efficacy in reducing intracranial pressure in children. Materials and Methods: An open-labeled, prospective study, where alternately patients between the age group of one month to 16 years admitted to the Pediatric Intensive Care Unit (PICU) of a designated tertiary care hospital situated in the state of Maharashtra, in India from November 2020 to October 2022, diagnosed to have or showing signs and symptoms of raised ICT will be given 3% HTS or Mannitol after considering the exclusion criteria for each if any will be conducted. The patient will be treated with a fixed dose of either drug as pre-decided by the principal investigator and the secondary investigator and the patient will be monitored within the next hour for immediate effects and improvement in the clinical state of the patient as well as the immediate general outcome in terms of vitals and sensorium and final outcome in terms of discharge rate with neuromorbidity, if any, or resulting death in patients treated with either drug will be noted. The chi-square test, Fischer’sexact test for categorical data, and independent t-test for continuous data with normal distribution will be used to assess the relationship between various demographic, clinical, and aetiological characteristics and outcomes. The parameters that will be compared are sensorium, heart rate, respiratory rate and pattern, and Blood Pressure (BP) at admission. The above parameters will be monitored immediately after infusion of osmotherapy and the final outcome, as mentioned above, of patients on either of the drugs will be noted. The p-value of less than 0.05 will be considered significant.

Investigating the Role of T-bet+ B Cells (ABCs/DN) in the Immunopathogenesis of Systemic Lupus Erythematosus.

Age-associated B cells (ABCs) constitute a B cell subset, defined as CD19+CD21-CD11c+, that expands continuously with age and accumulates strongly in individuals with autoimmune and/or infectious diseases. In humans, ABCs are principally IgD-CD27- double-negative (DN) B cells. Data from murine models of autoimmunity, implicate ABCs/DN in the development of autoimmune disorders. T-bet, a transcription factor which is highly expressed in these cells, is considered to play a major role in various aspects of autoimmunity, such as the production of autoantibodies and the formation of spontaneous germinal centres. Despite the available data, the functional features of ABCs/DN and their exact role in the pathogenesis of autoimmunity remain elusive. This project focuses on the investigation of the role of ABCs/DN in the pathogenesis of systemic lupus erythematosus (SLE) in humans, as well as the effects that various pharmacological agents may have on these cells. Samples from patients with active SLE will be used to enumerate and immunophenotype - via flow cytometry - the ABCs/DN found in the peripheral blood of the patients. Transcriptomic analysis and functional assays for the cells, both before and after in vitro pharmacological treatments, will also be performed. The results of the study are expected to allow characterization of the pathogenetic role of ABCs/DN in SLE and could probably contribute, following careful association with the clinical state of the patients, towards the discovery and validation of novel prognostic and diagnostic markers of disease.

Radiation Protection Issues in Clinical Research Involving X-Ray Diagnostic Radiology Procedures

Aim: To review radiation protection issues in clinical diagnostic studies that involves the use of x-rays. The Issue: X-rays imparting low dose have some dominance in the use of ionising radiation (IR) in clinical radiological investigations. In good clinical diagnostic practice, with radiation effects anticipated to be wholly stochastic, it is simply not possible to be specific about risks to health other than to acknowledge an anticipated increase in probability with dose. Difficulties in making an assessment of risk can be further compounded given possible cumulative effects from previous exposures and from varying clinical state. Scientific Considerations: Clinically focused research involving IR and subjects (reviewed by ethics committees and other parties) necessarily involves assessment of the study protocol. In addition to the embodiment of radiation protection principles, the protocol must conform to the general ethical principles of beneficence, prudence, justice and dignity, all of which are important. The protection aspects arising from the use of radiation needs to be assessed by radiation experts, the safety of study participants needing to be weighed against the necessity for the study. This information must be fully explained to the participant as part of the process of seeking consent. In obtaining consent, the participant information sheet must be of an appropriate quality of language and possible specific risks provided in a transparent manner. Conclusion: In clinical studies that involve the use of IR, the study protocol must contain all relevant radiation protection measures. It is important that review of the protocol should involve IR experts.

An Interpretable Deep Learning Approach for Biomarker Detection in LC-MS Proteomics Data.

Analyzing mass spectrometry-based proteomics data with deep learning (DL) approaches poses several challenges due to the high dimensionality, low sample size, and high level of noise. Additionally, DL-based workflows are often hindered to be integrated into medical settings due to the lack of interpretable explanation. We present DLearnMS, a DL biomarker detection framework, to address these challenges on proteomics instances of liquid chromatography-mass spectrometry (LC-MS) - a well-established tool for quantifying complex protein mixtures. Our DLearnMS framework learns the clinical state of LC-MS data instances using convolutional neural networks. Based on the trained neural networks, we show how biomarkers can be identified using layer-wise relevance propagation. This enables detecting discriminating regions of the data and the design of more robust networks. One of the main advantages over other established methods is that no explicit preprocessing step is needed in our DLearnMS framework. Our evaluation shows that DLearnMS outperforms conventional LC-MS biomarker detection approaches in identifying fewer false positive peaks while maintaining a comparable amount of true positives peaks. Code availability: The code is available from the following GIT repository: https://github.com/SaharIravani/DlearnMS.

CARDIOVASCULAR CHANGES IN SUBCLINICAL HYPOTHYROIDISM: DESCRIPTIVE OBSERVATIONAL STUDY

Thyroid disorders are the most common endocrine disorders in India. Reduced production of thyroid hormone is central feature of clinical state termed as “hypothyroidism”. Iodine deciency remains a common cause of hypothyroidism worldwide. In areas of iodine sufciency, autoimmune disease (Hashimoto's thyroiditis) and iatrogenic causes (treatment of hyperthyroidism) are most common. By denition, subclinical hypothyroidism refers to biochemical evidence of thyroid hormone deciency in patients who have few or no apparent clinical features of hypothyroidism. Subclinical Hypothyroidism is an asymptomatic state in which reduction in thyroid activity is compensated by elevated thyroid stimulating hormone to maintain euthyroid state. Evidence seems to indicate subclinical hypothyroidism is quite prevalent in presumably normal population. Subclinical hypothyroidism is found in 6–8% of women (10% over the age of 60) and 3% of men8. Prevalence increases with age. Methods- This was an observational study done in medical college and hospital. The study was carried out in the duration of 2 years. All OPD and IPD patients of Hospital, diagnosed with subclinical hypothyroidism, during this period, who fullled the inclusion criteria, were included in this study. This study included 54 newly diagnosed patients with subclinical hypothyroidism attending Hospital. Results- In this study maximum patients belong to age group ranging from 18-30 (33.33%). Next to it is age group involving 31-40 (31.48%). While least number of patients comes in age group ranging from 61-70 (9.26%) . Female (74.07%) preponderance compared to males (25.93%). With male having (25.93%). Male to Female ratio is 1:3. Showing female predominance in hypothyroidism. Conclusion- Quite a signicant number of patients were in the prehypertension group. Various life style modications can be advised to prevent them from going to stage I hypertension. Skin changes, Facial pufness, Hoarseness of Voice, cold intolerance, limbs swelling and weight gain these are the symptoms in decreasing order in patients with subclinical hyperthyroidism

Promoting patient self-management following cardiac rehabilitation using a web-based application: A pilot study.

The use of health-related mobile apps has become an important component of healthcare. Patients can use a range of tools to strengthen their health literacy and promote disease management. The aim of the project was to develop a web-based application for use on smartphones, tablets and computers for patients with cardiovascular diseases (cardio-app). A semi-standardized written survey was conducted among rehabilitation patients with cardiovascular diseases (n = 158). The usability of the cardio-app was assessed using the System Usability Scale (SUS). The usage behaviour was conducted with a self-developed questionnaire. The study enrolled 158 eligible rehabilitation patients. The SUS of the cardio-app determined was 74.4 (SD ± 17.4). For 86%, the menu navigation was self-explanatory and logical. The visual presentation appealed to 92% of respondents. The content of the texts used in the app was understandable for 95%, and 93% found the technical terms used in the glossary well explained. For 57%, the app was helpful in planning their physical activities. 83% of the rehabilitation patients would recommend the app to others. The main criticisms of the app were the lack of synchronization options with other apps. Of those who did not use the app, the following reasons for non-use were most frequently cited: too much effort (43%), lack of time (29%) and pandemic-related reasons (29%). The cardio-app revealed high agreement values. Whether the use of the app is associated with improved clinical state and outcome would have to be verified in further studies.

Invasive Fungal Infection Presenting as Early-Onset Neonatal Sepsis

In neonatal intensive units, invasive fungal infection remains a significant cause of morbidity and mortality, although an unusual cause of early-onset neonatal sepsis. In this report, we present a case of Candida parapsilosis infection presenting as early-onset bacterial sepsis. The patient was a 6-day-old male preterm neonate (estimated gestational age of 32 weeks) admitted to our neonatal unit on account of fever, refusal to feed, and vomiting which started during the first 24 h of life. Initially, he was managed for early-onset neonatal sepsis. However, his clinical state deteriorated within the 1st week of admission and his blood culture yielded C. parapsilosis. His clinical condition subsequently improved significantly following the administration of intravenous amphotericin. He spent a total of 25 days on admission before discharge. Our report reiterates the need to raise the index of suspicion for invasive fungal infection in cases of early-onset neonatal sepsis with poor response to appropriate and potent antibiotics.

Study of serum iron and Vitamin B12 status in primary hypothyroidism at a tertiary care hospital in eastern region of India

Background: Reduced production of thyroid hormone is central feature of the clinical state termed as hypothyroidism. In approximately 99% of cases of hypothyroidism, the pathology lies in the gland itself, rest due to thyroid stimulating hormone deficiency, or other causes. The prevalence of hypothyroidism is 11% in India. There are various metabolic abnormalities associated with hypothyroidism. The literature has revealed alteration of various micronutrients in hypothyroidism in different parts of the world. In this background, the serum levels of iron and Vitamin B12 in primary hypothyroidism have been studied in tertiary care hospital in eastern region of India. Aims and Objectives: The aim of the study was to delineate if there is any significant association between serum iron and Vitamin B12 levels with primary hypothyroidism cases belonging to the eastern India. Materials and Methods: It was an observational, noninterventional, hospital-based, and cross-sectional study with 160 cases and same number of controls based on inclusion and exclusion criteria. Serum levels of iron and Vitamin B12 were analyzed in both cases and controls with the help of Erba EM-600 Autoanalyzer and ADVIA Centaur CP (Siemens). Statistical analysis was performed by Microsoft excel and Statistical Package for the Social Sciences software; P < 0.05 had been taken as significant. Results: There was statistically significant difference in serum iron and Vitamin B12 levels in cases compare to controls with P = 0.0001. Conclusion: Routine estimation of serum iron and Vitamin B12 should be mandatory in primary hypothyroidism for early detection and intervention if required.

Short-Term Results of Simpson Grade 2 Resection in Spinal Meningiomas

Spinal meningiomas are benign and slow-growing intradural tumors. Surgery is the choice of treatment. In this retrospective study, results of minimally invasive Simpson grade 2 resection and its impact on recurrence in 44 spinal meningiomas are reviewed. Clinical data of 44 cases who underwent surgery for spinal meningiomas between 2010 and 2020 have been reviewed retrospectively. Demographics, preoperative and postoperative clinical states, pathologic type, location of the meningioma relative to the spinal cord, resection amount of the tumor according to Simpson's grading scale, postoperative complications, recurrence rate, and correlation between preoperative and intraoperative data and recurrence were analyzed. The tumor was located in the thoracic spine in 31 cases, in the cervical spine in 12 cases, and in the lumbar spine in one case. Dural attachment of tumor was ventral to the spinal cord in 15 cases, lateral to the spinal cord in 15 cases, and posterior to the spinal cord in 14 cases. All cases underwent microsurgical Simpson grade 2 resection. Two cases were recurrent and reoperated. Recurrences were observed in cases younger than 18 years old, in cervical spines and in cases with long dural tails. Simpson grade 2 resection is safe and effective in spinal meningiomas. Patients younger than 18 year old, and those with cervical location and long dural tail may be under risk of recurrence after Simpson grade 2 resection.

Substance Use Disorder: A Case of Alcohol Withdrawal in a 40 Year Old Man

Alcohol withdrawal is a clinical state characterized by symptoms such as tremors, tachycardia, sweating, nausea and vomiting, headache, malaise, insomnia, grand mal convulsions amongst others. Patients typically present acutely with a history of recent cessation or reduction of heavy alcohol use after a long period of repeated, persistent use. It may feature perceptual disturbances such as illusions or hallucinations. It may present with delirium in a condition known as delirium tremens, which typically occurs after recent cessation or reduction of very heavy alcohol use in patients with a long-standing history of alcohol dependence syndrome, who may also have coexisting medical conditions. We herein report a case of a 40 year old man, with a 12-month history of persistent alcohol use, who presented with classical symptoms of alcohol withdrawal including inability to sleep, excessive sweating, tachycardia, vomiting, and hallucinations. There is no associated history of convulsions or co-morbid medical conditions. Features of this case are discussed, as well as evaluation and treatment of alcohol withdrawal.

A review on hypothalamo-pituitary- adrenal axis

The effector hormones of the hypothalamic-pituitary-adrenal axis neuroendocrine system are the glucocorticoid hormones cortisol and corticosterone.The level of corticosterone, a systemic intercellular signal, changes dynamically with environmental and psychological stressors and predictably varies with time of day. A wide range of physiological and mental health issues are linked to irregularities in the typical HPA axis activity profiles. Despite several investigations that have uncovered molecular, cellular, and systems-level glucocorticoid actions to date, more glucocorticoid actions, and connections with clinical state, need to be discovered. Hypothalamic-pituitary-adrenal (HPA) axis feedback regulation may be compromised due to reduced mineralocorticoid receptor (MR)-mediated feedback in the brain. Medicinal herbs and their compounds have been shown to have a preventative impact against depression through a variety of ways. Medicinal plants can provide fresh ideas for antidepressant medication research.

Combined arthroscopic release with corticosteroid hydrodilatation versus corticosteroid hydrodilatation only in treating freezing-phase primary frozen shoulder: a randomized clinical trial

BackgroundThere has been no ideal treatment for freezing-phase frozen shoulder to rapidly relieve pain and improve joint mobility. No any other team directly compared the effectiveness of combination of arthroscopic release and corticosteroid hydrodilatation with corticosteroid hydrodilatation only in treatment of freezing-phase frozen shoulder.MethodsSeventy-two patients with freezing-phase frozen shoulder were randomly assigned to combined arthroscopic release with corticosteroid hydrodilatation (group A) or corticosteroid hydrodilatation only (group B). Clinical states were examined at baseline and periodically (Weeks 1, 4, 12, 24 and 1 year) after intervention by passive ROM; visual analog scale (VAS); UCLA and Disabilities of the Arm, Shoulder, and Hand (DASH) score.ResultsThe passive ROM, VAS, UCLA and DASH scores always improved along the time points (all p < 0.01). The passive abduction (pAB), passive forward flexion (pFL), passive external rotation (pER), passive internal rotation (pIR) were better in group A than in group B at Week 1, 4, 12, 24 (all p < 0.01). At 1 year post-operation, the pFL and pIR were better in group A than in group B (all p < 0.01). VAS scores of group A were similar with those of group B (all p > 0.01), the differences between group A and group B were all lower than minimal clinically important difference (MCID). At Week 12, the UCLA sores and DASH scores were 26.8 ± 3.8, 14.2 ± 2.0 in group A versus 22.3 ± 3.4, 22.5 ± 3.1 in group B (all p < 0.01). At Week 24 post-operation, there were 32.7 ± 2.0, 9.8 ± 1.5 in group A versus 26.3 ± 3.6, 17.5 ± 3.5 in group B (all p < 0.01). At 1 year post-operation, there were 34.5 ± 0.8, 1.7 ± 1.5 in group A versus 32.1 ± 2.3, 8.8 ± 2.8 in group B (all p < 0.01), the differences of UCLA scores between group A and group B at Week 24 was higher than the MCID. There were no complications such as infection, nerve or vascular injury.ConclusionsCombined arthroscopic release with corticosteroid hydrodilatation would yield better results in passive ROM and function than corticosteroid hydrodilatation only.Trial registrationChiCTR1900024235, July 2, 2019 (Retrospectively registered).

78 FOUR YEARS ECHOCARDIOGRAPHIC FOLLOW-UP OF A LEFT VENTRICULAR PSEUDOANEURYSM

Abstract Introduction Left ventricular pseudoaneurysm is a rare and often fatal complication of myocardial infarction. It has an incidence of 0,2-0,4% of all the STEMI and a very high mortality, particularly in the first month. Symptoms can vary from shortness of breath on exertion, orthopnea, chest pain, fatigue. At least 10% of patients do not present any symptoms and the pseudoaneurysm is diagnosed incidentally during a follow-up appointment. Signs include persistent ST elevation on EKG and its diagnosis can easily be made with a transthoracic echocardiogram and more in depth with a CT scan and a cardiac MRI. Its treatment is surgical, but the choice is up to the anesthesiologist and cardiothoracic surgeon, depending on patient's comorbidity and surgery risk. Surgical treatment has a high rate of death, reaching even the 37%. Background We present the case of a 74 years old patient with an history of chronic hypertension and cerebral vasculopathy, who sustained a STEMI in 2017. Urgent coronarography study was performed, but unfortunately the angioplasty treatment was unsuccessful and the left anterior descending artery could not be recanalized. Therefore, the patient was transferred to the cardiothoracic department in order to undergo bypass surgery: surgery was performed five days after, using left internal mammary artery to the left anterior descending artery and great saphenous vein to the first diagonal. Surgery went well with no complications; the post-operative period passed by without any complications and, after 15 days, patient was discharged with no complains. Two months later, he was admitted to intensive care unit of a hospital of our town, because of dyspnea (NYHA 3), peripheral edema, moderate-severe mitral insufficiency, moderate pleural and pericardial effusion. He underwent a CT-scan that showed “9×6,4 cm cavity with blood that seemed to have a connection with the postero-lateral wall of the left ventricle”. He also underwent a cardiac MRI that displayed a pseudoaneurysm with an endoluminal thrombus. After an accurate evaluation of the case, the Heart Team decided to do not perform surgery because of the high risk of the patient. Thence, we have been followed him with close echocardiographic exams for more than four years. Methods From March 2018 to September 2022, we have been followed the patient with complete echocardiographic follow-ups, done every three-six month. Results and conclusions Patient with left ventricle pseudoaneurysm due to an extensive myocardial infarction has been followed in our echo lab for more than 4 years. He has been stable during these years, NYHA II, in a good clinical and hemodynamical state.

Trajectories, Transitions, and Trends in Frailty among Older Adults: A Review.

Frailty is an age-related clinical state associated with deterioration across multiple physiological systems and a leading cause of morbidity and mortality later in life. To understand how frailty develops and what causes its progression, longitudinal data with repeated frailty measurements are required. This review summarizes evidence from longitudinal studies on frailty trajectories, transitions, and trends. We identified several consistent findings: frailty increases with aging and is a dynamic condition, and more recent generations of older adults have higher frailty levels. These findings have both clinical and public health relevance, including the provision of healthcare and aged care services in the coming years. Further studies are required, particularly those conducted in low- and middle-income countries and those investigating factors associated with changes in frailty. The latter may help develop better-targeted interventions to reverse or slow the progression of frailty.

Health trajectories in older patients hospitalized for COVID-19: Results from the GeroCovid multicenter study

BackgroundCOVID-19 has disproportionately affected older adults. Yet, healthcare trajectories experienced by older persons hospitalized for COVID-19 have not been investigated. This study aimed at estimating the probabilities of transitions between severity states in older adults admitted in COVID-19 acute wards and at identifying the factors associated with such dynamics. MethodsCOVID-19 patients aged ≥60 years hospitalized between March and December 2020 were involved in the multicentre GeroCovid project–acute wards substudy. Sociodemographic and health data were obtained from medical records. Clinical states during hospitalization were categorized on a seven-category scale, ranging from hospital discharge to death. Based on the transitions between these states, first, we defined patients’ clinical course as positive (only improvements), negative (only worsening), or fluctuating (both improvements and worsening). Second, we focused on the single transitions between clinical states and estimated their probability (through multistage Markov modeling) and associated factors (with proportional intensity models). ResultsOf the 1024 included patients (mean age 78.1 years, 51.1% women), 637 (62.2%) had a positive, 66 (6.4%) had a fluctuating, and 321 (31.3%) had a negative clinical course. Patients with a fluctuating clinical course were younger, had better mobility and cognitive levels, fewer diseases, but a higher prevalence of cardiovascular disease and obesity. Considering the single transitions, the probability that older COVID-19 patients experienced clinical changes was higher within a 10-day timeframe, especially for milder clinical states. Older age, male sex, lower mobility level, multimorbidity, and hospitalization during the COVID-19 first wave (compared with the second one) were associated with an increased probability of progressing towards worse clinical states or with a lower recovery. ConclusionCOVID-19 in older inpatients has a complex and dynamic clinical course. Identifying individuals more likely to experience a fluctuating clinical course and sudden worsening may help organize healthcare resources and clinical management across settings at different care intensity levels.

Visual disturbances in recent-onset psychosis and clinical high-risk state for psychosis

Visual disturbances in recent-onset psychosis and clinical high-risk state for psychosis

A REVIEW ON THE RELATIONSHIP BETWEEN NIDRA QUALITY AND MENTAL HEALTH: A PHYSIOLOGICAL ASPECT

Ahara, nidra, and brahmacharya are the three fundamental pyramids of life according to the ancient Ayurvedic texts, and they all play an essential part in preserving human health. Nidra nourishes the body and helps us avoid sickness by reducing stress. When practised regularly, nidra may help a person to live a long and healthy life, retain their memory and intellect as they age, and improve their appearance, voice, and overall health. In addition to reversing disease processes and preventing recurrence, nidra may help boost a person's immune system so that he can avoid contracting illness. Anidra refers to the array of clinical states brought on by nidra deficiency (primary insomnia). Chronic insomnia, also known as secondary or tertiary insomnia, is a symptom of poor health that may lead to psychological difficulties such as dissociation from reality (delusions), paranoia, and hallucinations. There is an increased risk of cardiovascular illness in those with poor mental health because of its impact on the cardiovascular system. For both psychological and physical well-being, nidra is a valuable tool. This review presents a critical explanation of nidra, mental health, and their relationship with respect to cognitive and physiological aspects.

EARLY WARNING SYSTEM (PENGGUNAAN WHATSAPP BOT DI BIDANG KESEHATAN)

Social media has taken on a new function in recent years, serving as both a source of information and a way to participate and communicate. A same scenario happened with WhatsApp; many people use it to obtain updates on Covid-19's health. The goal of this project is to use a WhatsApp Bot to investigate the health sector's early warning system. This study employs a literature review method, which entails examining scholarly publications, books, and research journals. Articles from 2019 to 2021 were selected as inclusion criterion. The findings of the study demonstrate that the usage of WhatsApp Bot in the health industry is critical for early warning systems, particularly during the Covid-19 pandemic. The use of this Whatsapp bot is aimed at assisting healthcare professionals in spotting early warning signs of critically unwell patients in an inpatient hospital, before their clinical state worsens