Clinico-epidemiological presentations and management of Nipah virus infection during the outbreak in Kozhikode district, Kerala state, India 2023

India experienced its sixth Nipah virus (NiV) outbreak in September 2023 in the Kozhikode district of Kerala state. The NiV is primarily transmitted by spillover events from infected bats followed by human-to-human transmission. The clinical specimens were screened using real-time RT-PCR, and positive specimens were further characterized using next-generation sequencing. We describe here an in-depth clinical presentation and management of NiV-confirmed cases and outbreak containment activities. The current outbreak reported a total of six cases with two deaths, with a case fatality ratio of 33.33%. The cases had a mixed presentation of acute respiratory distress syndrome and encephalitis syndrome. Fever was a persistent presentation in all the cases. The Nipah viral RNA was detected in clinical specimens until the post-onset day of illness (POD) 14, with viral load in the range of 1.7-3.3 × 104 viral RNA copies/mL. The genomic analysis showed that the sequences from the current outbreak clustered into the Indian clade similar to the 2018 and 2019 outbreaks. This study highlights the vigilance of the health system to detect and effectively manage the clustering of cases with clinical presentations similar to NiV, which led to early detection and containment activities.

Influence of Religious Affiliations on Attitudes Toward Homosexuality Among Physicians: A Cross-Sectional Study From India

Objective: To examine the attitudes among practicing physicians of various specialties toward homosexuality and its association with participants' religious affiliations in India.

Methods: A cross-sectional descriptive study was conducted among physicians about their attitudes toward homosexuality between December 2018 and January 2019. Participants completed a survey anonymously in hardcopy form or online. The survey was developed based on the Attitude Toward Homosexuality Scale for Indians (AHSI). A higher AHSI score indicates less homonegativity. It was modified by adding demographic details, career status, and personal experience with homosexual individuals.

Results: The study results showed that among 106 respondents, 81 were men with a mean (SD) age of 32.2 (7.3) years. Of the participants, 40 (37.7%) were MBBS graduates with no specialization, while 34 (32.1%) and 32 (30.2%) respondents were from medical and surgical specialties, respectively. The majority of the respondents were Muslim (43.4%), followed by Hindu (35.8%), Christian (10.4%), those not conforming to any religion (5.7%), and other religions (4.7%). The mean ± SD total score on the AHSI was 69.6 ± 17.7, which was higher than the mean neutral score of 60. The AHSI total score was significantly higher among women (P < .001). The total AHSI score was highest among the no religion category followed by Hindus, with the lowest for biblical religions; the difference was statistically significant (P < .001). No significant difference was seen between Muslims and Christians.

Conclusions: This study showed an overall positive attitude among the respondents toward homosexuality; however, those belonging to Abrahamic religions, especially Muslims, had more negative attitudes. The results highlight the need for antistigma campaigns and educational interventions targeting the physician population of India to reduce negative attitudes toward homosexuality and improve their knowledge of this topic.

Side Effect Profiles of Selective Serotonin Reuptake Inhibitors: A Cross-Sectional Study in a Naturalistic Setting

Background: Side effects of selective serotonin reuptake inhibitors (SSRIs), the most commonly used antidepressants, are usually underreported in clinical trials. Systematic evaluation of side effects associated with SSRIs with structured instruments in a naturalistic setting is an important design to fully understand the side effect profile of various SSRIs. We examined the frequencies of the side effects induced by 3 commonly used SSRIs, sertraline, escitalopram, and fluoxetine, by using a self-rating instrument designed to measure the subjective symptoms of patients in a naturalistic treatment setting.

Methods: The subjects were outpatients recruited from the psychiatry department of a tertiary care hospital. The subjects were aged ≥ 18 years; were diagnosed with depression, anxiety spectrum disorders, adjustment disorder, hypochondriasis, or impulse control disorder according to ICD-10 criteria; and were on SSRI monotherapy. The assessment instrument included 42 items and was devised using drug package insert data on the most commonly observed side effects of antidepressants released by the US Food and Drug Administration.

Results: A total of 100 patients participated in the study. Among them, 70% were women. The most common diagnosis was depression (49%). Of the patients, 53% were taking sertraline, 38% escitalopram, and 8% fluoxetine. The common side effects reported by patients were flatulence (64%), somnolence (59%), memory impairment (51%), decreased concentration (50%), yawning (47%), fatigue (45%), dry mouth (45%), weight gain (45%), light headedness (43%), and sweating (38%). Patients treated with escitalopram had significantly higher incidence of headache, pruritus, memory impairment, decreased concentration, and dizziness. Patients treated with sertraline had significantly decreased appetite.

Conclusions: The study results highlight the prevalence and pattern of side effect profiles of 3 commonly used SSRIs and provide baseline data for comparison with other similar studies.

Depression, Anxiety, and Coping During the COVID-19 Pandemic Among Indian Expats in the Middle East: A Survey Study

Objective

There are multiple studies indicating that the Indian expat population working in the Middle East is at a significantly high risk for developing anxiety, depression, and suicidal thoughts. The coronavirus disease 2019 (COVID-19) pandemic can precipitate or exacerbate psychological distress among the expat population. The objective of this study was to evaluate psychological distress and coping mechanisms among Indian expats working in the Middle East during the COVID-19 pandemic.

Methods

An online survey was conducted with a semistructured questionnaire using a nonprobability snowball sampling technique. In addition to demographic data, a list of COVID-19 pandemic-related questions, the Brief COPE, the 9-item Patient Health Questionnaire (PHQ-9), and the 7-item Generalized Anxiety Disorder Questionnaire (GAD-7) were also utilized.

Results

A total of 94 responses were received. Of the respondents, 52% reported clinically significant anxiety levels, and 41% reported clinically significant depression levels. Both the PHQ-9 and GAD-7 scores were significantly associated with the level of concern with air traffic restriction (P < .05).

Conclusions

Our findings show that governments of both Indian and Middle Eastern countries should pay more attention to the mental health of the expat population while combating COVID-19.

Dose-dependent L-dopa/carbidopa-induced hyponatremia presenting with hiccups

Levodopa (L-dopa) is the most effective antiparkinsonian agent and is well tolerated at all stages of the disease. However, both motor and nonmotor adverse events are reported with the use of L-dopa. Electrolyte imbalances such as hyponatremia and hiccups with L-dopa/carbidopa are very rare. For the first time, we are reporting a case of L-dopa/carbidopa-induced hyponatremia and hiccup cooccurring in a 75-year-old male. He symptomatically improved after reducing the dose of levodopa/carbidopa, indicating a dose-dependent nature of these adverse events. Clinicians who prescribe L-dopa/carbidopa should be mindful of the potential for precipitating SIADH and hiccups, especially in elderly patients.