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2020| May | Volume 151 | Issue 5
Online since
June 20, 2020
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ORIGINAL ARTICLES
Healthcare workers & SARS-CoV-2 infection in India: A case-control investigation in the time of COVID-19
Pranab Chatterjee, Tanu Anand, Kh Jitenkumar Singh, Reeta Rasaily, Ravinder Singh, Santasabuj Das, Harpreet Singh, Ira Praharaj, Raman R Gangakhedkar, Balram Bhargava, Samiran Panda
May 2020, 151(5):459-467
DOI
:10.4103/ijmr.IJMR_2234_20
PMID
:32611916
Background & objectives
:
Healthcare workers (HCWs) are at an elevated risk of contracting COVID-19. While intense occupational exposure associated with aerosol-generating procedures underlines the necessity of using personal protective equipment (PPE) by HCWs, high-transmission efficiency of the causative agent [severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)] could also lead to infections beyond such settings. Hydroxychloroquine (HCQ), a repurposed antimalarial drug, was empirically recommended as prophylaxis by the National COVID-19 Task Force in India to cover such added risk. Against this background, the current investigation was carried out to identify the factors associated with SARS-CoV-2 infection among HCWs in the country.
Methods
:
A case-control design was adopted and participants were randomly drawn from the countrywide COVID-19 testing data portal maintained by the ICMR. The test results and contact details of HCWs, diagnosed as positive (cases) or negative (controls) for SARS-CoV-2 using real-time reverse transcription-polymerase chain reaction (qRT-PCR), were available from this database. A 20-item brief-questionnaire elicited information on place of work, procedures conducted and use of PPE.
Results
:
Compared to controls, cases were slightly older (34.7 vs. 33.5 yr) and had more males (58 vs. 50%). In multivariate analyses, HCWs performing endotracheal intubation had higher odds of being SARS-CoV-2 infected [adjusted odds ratio (AOR): 4.33, 95% confidence interval (CI): 1.16-16.07]. Consumption of four or more maintenance doses of HCQ was associated with a significant decline in the odds of getting infected (AOR: 0.44; 95% CI: 0.22-0.88); a dose-response relationship existed between frequency of exposure to HCQ and such reductions (χ
[2]
for trend=48.88;
P
<0.001). In addition, the use of PPE was independently associated with the reduction in odds of getting infected with SARS-CoV-2.
Interpretations & conclusions
:
Until results of clinical trials for HCQ prophylaxis become available, this study provides actionable information for policymakers to protect HCWs at the forefront of COVID-19 response. The public health message of sustained intake of HCQ prophylaxis as well as appropriate PPE use need to be considered in conjunction with risk homoeostasis operating at individual levels.
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72,601
3,738
33
CORRESPONDENCES
First confirmed case of COVID-19 infection in India: A case report
MA Andrews, Binu Areekal, KR Rajesh, Jijith Krishnan, R Suryakala, Biju Krishnan, CP Muraly, PV Santhosh
May 2020, 151(5):490-492
DOI
:10.4103/ijmr.IJMR_2131_20
PMID
:32611918
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18,823
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3
ORIGINAL ARTICLES
Laboratory surveillance for SARS-CoV-2 in India: Performance of testing & descriptive epidemiology of detected COVID-19, January 22 - April 30, 2020
ICMR COVID Study Group, COVID Epidemiology & Data Management Team, COVID Laboratory Team, VRDLN Team
May 2020, 151(5):424-437
DOI
:10.4103/ijmr.IJMR_1896_20
PMID
:32611914
Background & objectives
:
India has been reporting the cases of coronavirus disease 2019 (COVID-19) since January 30, 2020. The Indian Council of Medical Research (ICMR) formulated and established laboratory surveillance for COVID-19. In this study, an analysis of the surveillance data was done to describe the testing performance and descriptive epidemiology of COVID-19 cases by time, place and person.
Methods
:
The data were extracted from January 22 to April 30, 2020. The frequencies of testing performance were described over time and by place. We described cases by time (epidemic curve by date of specimen collection; seven-day moving average), place (area map) and person (attack rate by age, sex and contact status), and trends were represented along with public health measures and events.
Results
:
Between January 22 and April 30, 2020, a total of 1,021,518 individuals were tested for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). Testing increased from about 250 individuals per day in the beginning of March to 50,000 specimens per day by the end of April 2020. Overall, 40,184 (3.9%) tests were reported positive. The proportion of positive cases was highest among symptomatic and asymptomatic contacts, 2-3-fold higher than among those with severe acute respiratory infection, or those with an international travel history or healthcare workers. The attack rate (per million) by age was highest among those aged 50-69 yr (63.3) and was lowest among those under 10 yr (6.1). The attack rate was higher among males (41.6) than females (24.3). The secondary attack rate was 6.0 per cent. Overall, 99.0 per cent of 736 districts reported testing and 71.1 per cent reported COVID-19 cases.
Interpretation & conclusions
:
The coverage and frequency of ICMR's laboratory surveillance for SARS-CoV-2 improved over time. COVID-19 was reported from most parts of India, and the attack rate was more among men and the elderly and common among close contacts. Analysis of the data indicates that for further insight, additional surveillance tools and strategies at the national and sub-national levels are needed.
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12
CORRESPONDENCES
Evaluation of
RdRp
&
ORF-1b-nsp14
-based real-time RT-PCR assays for confirmation of SARS-CoV-2 infection: An observational study
K Alagarasu, ML Choudhary, KS Lole, Priya Abraham, Varsha Potdar
May 2020, 151(5):483-485
DOI
:10.4103/ijmr.IJMR_1256_20
PMID
:32474555
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5
PERSPECTIVE
Impact of COVID-19 pandemic on health system & Sustainable Development Goal 3
Sonalini Khetrapal, Rajesh Bhatia
May 2020, 151(5):395-399
DOI
:10.4103/ijmr.IJMR_1920_20
PMID
:32611910
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6
REVIEW ARTICLE
Clinical management of COVID-19
George M Varghese, Rebecca John, Abi Manesh, Rajiv Karthik, OC Abraham
May 2020, 151(5):401-410
DOI
:10.4103/ijmr.IJMR_957_20
PMID
:32611911
The novel coronavirus disease 2019 (COVID-19) with its early origin from Wuhan city in China has evolved into a global pandemic. Maximal precautionary measures and resources have been put forward by most nations in war footing to mitigate transmission and decrease fatality rates. This article was aimed to review the evidence on clinical management and to deal with the identification of high-risk groups, warning signs, appropriate investigations, proper sample collection for confirmation, general and specific treatment measures, strategies as well as infection control in the healthcare settings. Advanced age, cardiovascular disease, diabetes, hypertension and cancer have been found to be the risk factors for severe disease. Fever lasting for >five days with tachypnoea, tachycardia or hypotension are indications for urgent attention and hospitalization in a patient with suspected COVID-19. At present, reverse transcription-polymerase chain reaction (RT-PCR) from the upper respiratory tract samples is the diagnostic test of choice. While many drugs have shown
in vitro
activity against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), there are insufficient clinical data to promote or dissuade their usage. Among the currently available drugs, hydroxychloroquine and lopinavir/ritonavir may be considered for patients with severe COVID-19 infection, awaiting further clinical trials. Stringent droplet and contact precautions will protect healthcare workers against most clinical exposures to COVID-19.
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5
PROTOCOL
National sero-surveillance to monitor the trend of SARS-CoV-2 infection transmission in India: Protocol for community-based surveillance
Muthusamy Santhosh Kumar, Tarun Bhatnagar, Ponnaiah Manickam, V Saravana Kumar, Kiran Rade, Naman Shah, Shashi Kant, Giridhara R Babu, Sanjay Zodpey, CP Girish Kumar, Jeromie Wesley Vivian Thangaraj, Pranab Chatterjee, Suman Kanungo, Ravindra Mohan Pandey, Manoj Murhekar, Sujeet K Singh, Swarup Sarkar, JP Muliyi, Raman R Gangakhedkar, D.C.S Reddy
May 2020, 151(5):419-423
DOI
:10.4103/ijmr.IJMR_1818_20
PMID
:32611913
Conducting population-based serosurveillance for severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2) will estimate and monitor the trend of infection in the adult general population, determine the socio-demographic risk factors and delineate the geographical spread of the infection. For this purpose, a serial cross-sectional survey would be conducted with a sample size of 24,000 distributed equally across four strata of districts categorized on the basis of the incidence of reported cases of COVID-19. Sixty districts will be included in the survey. Simultaneously, the survey will be done in 10 high-burden hotspot cities. ELISA-based antibody tests would be used. Data collection will be done using a mobile-based application. Prevalence from the group of districts in each of the four strata will be pooled to estimate the population prevalence of COVID-19 infection, and similarly for the hotspot cities, after adjusting for demographic characteristics and antibody test performance. The total number of reported cases in the districts and hotspot cities will be adjusted using this seroprevalence to estimate the expected number of infected individuals in the area. Such serosurveys repeated at regular intervals can also guide containment measures in respective areas. State-specific context of disease burden, priorities and resources should guide the use of multifarious surveillance options for the current COVID-19 epidemic.
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6,314
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2
EDITORIAL
Lessons learnt during the first 100 days of COVID-19 pandemic in India
Rajesh Bhatia, Priya Abraham
May 2020, 151(5):387-391
DOI
:10.4103/ijmr.IJMR_1925_20
PMID
:32611909
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5,658
1,941
3
ORIGINAL ARTICLES
Analysis of RNA sequences of 3636 SARS-CoV-2 collected from 55 countries reveals selective sweep of one virus type
Nidhan K Biswas, Partha P Majumder
May 2020, 151(5):450-458
DOI
:10.4103/ijmr.IJMR_1125_20
PMID
:32474553
Background & objectives
:
SARS-CoV-2 (Severe acute respiratory syndrome coronavirus-2) is evolving with the progression of the pandemic. This study was aimed to investigate the diversity and evolution of the coronavirus SARS-CoV-2 with progression of the pandemic over time and to identify similarities and differences of viral diversity and evolution across geographical regions (countries).
Methods
:
Publicly available data on type definitions based on whole-genome sequences of the SARS-CoV-2 sampled during December and March 2020 from 3636 infected patients spread over 55 countries were collected. Phylodynamic analyses were performed and the temporal and spatial evolution of the virus was examined.
Results
:
It was found that (
i
) temporal variation in frequencies of types of the coronavirus was significant; ancestral viruses of type O were replaced by evolved viruses belonging to type A2a; (
ii
) spatial variation was not significant; with the spread of SARS-CoV-2, the dominant virus was the A2a type virus in every geographical region; (
iii
) within a geographical region, there was significant micro-level variation in the frequencies of the different viral types, and (
iv
) the evolved coronavirus of type A2a swept rapidly across all continents.
Interpretation & conclusions
:
SARS-CoV-2 belonging to the A2a type possesses a non-synomymous variant (D614G) that possibly eases the entry of the virus into the lung cells of the host. This may be the reason why the A2a type has an advantage to infect and survive and as a result has rapidly swept all geographical regions. Therefore, large-scale sequencing of coronavirus genomes and, as required, of host genomes should be undertaken in India to identify regional and ethnic variation in viral composition and its interaction with host genomes. Further, careful collection of clinical and immunological data of the host can provide deep learning in relation to infection and transmission of the types of coronavirus genomes.
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9
An overview of mobile applications (apps) to support the coronavirus disease 2019 response in India
Abhinav Bassi, Sumaiya Arfin, Oommen John, Vivekanand Jha
May 2020, 151(5):468-473
DOI
:10.4103/ijmr.IJMR_1200_20
PMID
:32474557
Background & objectives
:
The potential benefits of mobile health (mHealth) initiatives to manage the coronavirus disease 2019 (COVID-19) pandemic have been explored. The Government of India, State governments, and healthcare organizations have developed various mobile apps for the containment of COVID-19. This study was aimed to systematically review COVID-19 related mobile apps and highlight gaps to inform the development of future mHealth initiatives.
Methods
:
Google Play and the Apple app stores were searched using the terms 'COVID-19', 'coronavirus', 'pandemic', and 'epidemic' in the first week of April 2020. A list of COVID-19-specific functions was compiled based on the review of the selected apps, the literature on epidemic surveillance, and national and international media reports. The World Health Organization guideline on Digital Health Interventions was used to classify the app functions under the categories of the general public, health workers, health system managers, and data services.
Results
:
The search yielded 346 potential COVID-19 apps, of which 50 met the inclusion criteria. Dissemination of untargeted COVID-19-related information on preventative strategies and monitoring the movements of quarantined individuals was the function of 27 (54%) and 19 (32%) apps, respectively. Eight (16%) apps had a contact tracing and hotspot identification function.
Interpretation & conclusions
:
Our study highlights the current emphasis on the development of self-testing, quarantine monitoring, and contact tracing apps. India's response to COVID-19 can be strengthened by developing comprehensive mHealth solutions for frontline healthcare workers, rapid response teams and public health authorities. Among this unprecedented global health emergency, the Governments must ensure the necessary but least intrusive measures for disease surveillance.
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6
Development of indigenous IgG ELISA for the detection of anti-SARS-CoV-2 IgG
Gajanan Sapkal, Anita Shete-Aich, Rajlaxmi Jain, Pragya D Yadav, Prasad Sarkale, Rajen Lakra, Srikant Baradkar, Gururaj Rao Deshpande, Deepak Mali, Bipin N Tilekar, Triparna Majumdar, Himanshu Kaushal, Yogesh Gurav, Nivedita Gupta, Sreelekshmy Mohandas, Ketki Deshpande, Ojas Kaduskar, Malvika Salve, Savita Patil, Shivshankar Gaikwad, AP Sugunan, M Ashok, Sidhartha Giri, Jayanthi Shastri, Priya Abraham, Raman R Gangakhedkar, COVID Support Team
May 2020, 151(5):444-449
DOI
:10.4103/ijmr.IJMR_2232_20
PMID
:32611915
Background & objectives
:
Since the beginning of the year 2020, the pandemic caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) impacted humankind adversely in almost all spheres of life. The virus belongs to the genus
Betacoronavirus
of the family
Coronaviridae
. SARS-CoV-2 causes the disease known as coronavirus disease 2019 (COVID-19) with mild-to-severe respiratory illness. The currently available diagnostic tools for the diagnosis of COVID-19 are mainly based on molecular assays. Real-time reverse transcription-polymerase chain reaction is the only diagnostic method currently recommended by the World Health Organization for COVID-19. With the rapid spread of SARS-CoV-2, it is necessary to utilize other tests, which would determine the burden of the disease as well as the spread of the outbreak. Considering the need for the development of such a screening test, an attempt was made to develop and evaluate an IgG-based ELISA for COVID-19.
Methods
:
A total of 513 blood samples (131 positive, 382 negative for SARS-CoV-2) were collected and tested by microneutralization test (MNT). Antigen stock of SARS-CoV-2 was prepared by propagating the virus in Vero CCL-81 cells. An IgG capture ELISA was developed for serological detection of anti-SARS-CoV-2 IgG in serum samples. The end point cut-off values were determined by using receiver operating characteristic (ROC) curve. Inter-assay variability was determined.
Results
:
The developed ELISA was found to be 92.37 per cent sensitive, 97.9 per cent specific, robust and reproducible. The positive and negative predictive values were 94.44 and 98.14 per cent, respectively.
Interpretation & conclusions
:
This indigenously developed IgG ELISA was found to be sensitive and specific for the detection of anti-SARS-CoV-2 IgG in human serum samples. This assay may be used for determining seroprevalence of SARS-CoV-2 in a population exposed to the virus.
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4,116
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3
REVIEW ARTICLE
COVID-19 pandemic from an ophthalmology point of view
Parul Chawla Gupta, M Praveen Kumar, Jagat Ram
May 2020, 151(5):411-418
DOI
:10.4103/ijmr.IJMR_1369_20
PMID
:32611912
Coronavirus disease 2019 (COVID-19) is caused by a highly contagious RNA virus termed as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Ophthalmologists are at high-risk due to their proximity and short working distance at the time of slit-lamp examination. Eye care professionals can be caught unaware because conjunctivitis may be one of the first signs of COVID-19 at presentation, even precluding the emergence of additional symptoms such as dry cough and anosmia. Breath and eye shields as well as N95 masks, should be worn while examining patients with fever, breathlessness, or any history of international travel or travel from any hotspot besides maintaining hand hygiene. All elective surgeries need to be deferred. Adults or children with sudden-onset painful or painless visual loss, or sudden-onset squint, or sudden-onset floaters or severe lid oedema need a referral for urgent care. Patients should be told to discontinue contact lens wear if they have any symptoms of COVID-19. Cornea retrieval should be avoided in confirmed cases and suspects, and long-term preservation medium for storage of corneas should be encouraged. Retinal screening is unnecessary for coronavirus patients taking chloroquine or hydroxychloroquine as the probability of toxic damage to the retina is less due to short-duration of drug therapy. Tele-ophthalmology and artificial intelligence should be preferred for increasing doctor-patient interaction.
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3,537
788
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CORRESPONDENCES
Mapping the genomic landscape & diversity of COVID-19 based on >3950 clinical isolates of SARS-CoV-2: Likely origin & transmission dynamics of isolates sequenced in India
Hina Singh, Jasdeep Singh, Mohd Khubaib, Salma Jamal, Javaid Ahmed Sheikh, Sunil Kohli, Seyed Ehtesham Hasnain, Syed Asad Rahman
May 2020, 151(5):474-478
DOI
:10.4103/ijmr.IJMR_1253_20
PMID
:32474554
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2,842
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3
ORIGINAL ARTICLES
A cluster of SARS-CoV-2 infection among Italian tourists visiting India, March 2020
Jeromie Wesley Vivian Thangaraj, Manoj Murhekar, Yatin Mehta, Sushila Kataria, Megha Brijwal, Nitesh Gupta, Aashish Choudhary, Bharati Malhotra, Madhavi Vyas, Himanshu Sharma, Naveen Yadav, Tarun Bhatnagar, Nivedita Gupta, Lalit Dar, Raman R Gangakhedkar, Balram Bhargava
May 2020, 151(5):438-443
DOI
:10.4103/ijmr.IJMR_1722_20
PMID
:32474558
Background & objectives
:
A cluster of SARS-CoV-2 infection occurred among Italian tourists visiting India. We report here the epidemiological, clinical, radiological and laboratory findings of the first cluster of SARS-CoV-2 infection among the tourists.
Methods
:
Information was collected on demographic details, travel and exposure history, comorbidities, timelines of events, date of symptom onset and duration of hospitalization from the 16 Italian tourists and an Indian with laboratory-confirmed SARS-CoV-2 infection. The clinical, laboratory, radiologic and treatment data was abstracted from their medical records and all tourists were followed up till their recovery or discharge or death. Throat and deep nasal swab specimens were collected on days 3, 8, 15, 18, 23 and 25 to evaluate viral clearance.
Results
:
A group of 23 Italian tourists reached New Delhi, India, on February 21, 2020 and along with three Indians visited several tourist places in Rajasthan. By March 3, 2020, 17 of the 26 (attack rate: 65.4%) had become positive for SARS-CoV-2 infection. Of these 17 patients, nine were symptomatic, while eight did not show any symptoms. Of the nine who developed symptoms, six were mild, one was severe and two were critically ill. The median duration between the day of confirmation for COVID-19 and RT-PCR negativity was 18 days (range: 12-23 days). Two patients died with a case fatality of 11.8 per cent.
Interpretation & conclusions
:
This study reconfirms higher rates of transmission among close contacts and therefore, public health measures such as physical distancing, personal hygiene and infection control measures are necessary to prevent transmission.
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1
VIEWPOINT
Contact lens use at the time of SARS-CoV-2 pandemic for healthcare workers
Raghav Bhargava
May 2020, 151(5):392-394
DOI
:10.4103/ijmr.IJMR_1492_20
PMID
:32474559
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2,137
827
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CORRESPONDENCES
Community engagement in times of COVID-19: Lessons from neo-Vaishnavite practices
Bishwajeet Saikia, Raktim Pratim Tamuli, Dewark Sharma
May 2020, 151(5):499-500
DOI
:10.4103/ijmr.IJMR_1765_20
PMID
:32611924
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1,723
353
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Evaluation of the susceptibility of mice & hamsters to SARS-CoV-2 infection
Sreelekshmy Mohandas, Rajlaxmi Jain, Pragya D Yadav, Anita Shete-Aich, Prasad Sarkale, Manoj Kadam, Abhimanyu Kumar, Gururaj Deshpande, Shreekant Baradkar, Savita Patil, Gajanan Sapkal, Deepak Mali, Malvika Salve, Dilip Patil, Triparna Majumdar, Annasaheb Suryawanshi, Himanshu Kaushal, Rajen Lakra, Hitesh Dighe, Nivedita Gupta, Priya Abraham, Raman R Gangakhedkar
May 2020, 151(5):479-482
DOI
:10.4103/ijmr.IJMR_2235_20
PMID
:32611917
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1,576
375
1
Respiratory virus detection among the overseas returnees during the early phase of COVID-19 pandemic in India
Varsha Potdar, Manohar L Choudhary, Sumit Bhardwaj, Rohan Ghuge, AP Sugunan, Yogesh Gurav, Pragya D Yadav, Anita Shete, Shilpa Tomar, B Anukumar, Himanshu Kaushal, Gajanan Sapkal, Atanu Basu, Sarah Cherian, Priya Abraham
May 2020, 151(5):486-489
DOI
:10.4103/ijmr.IJMR_638_20
PMID
:32474556
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1,383
549
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A confirmed case of COVID-19 among the first three from Kerala, India
Raman Swathy Vaman, Mathew J Valamparampil, AV Ramdas, AT Manoj, Basil Varghese, Flory Joseph
May 2020, 151(5):493-494
DOI
:10.4103/ijmr.IJMR_2205_20
PMID
:32611919
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1,200
346
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Pandemic SARS-CoV-2 laboratory preparedness in India: An opportunity beyond diagnostics
Bhagirathi Dwibedi
May 2020, 151(5):495-496
DOI
:10.4103/ijmr.IJMR_1548_20
PMID
:32611920
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865
375
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Creation of a network of tropical medicine units to implement 'One Health'
Sunil Kumar Raina
May 2020, 151(5):497-498
DOI
:10.4103/ijmr.IJMR_1622_20
PMID
:32611922
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886
180
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Authors' response
Nivedita Gupta, Varsha Potdar, Ira Praharaj, Sidhartha Giri, Gajanan Sapkal, Pragya Yadav, Manohar Lal Choudhary, Lalit Dar, AP Sugunan, Harmanmeet Kaur, Ashok Munivenkatappa, Jayanthi Shastri, Krishnasamy Kaveri, Shanta Dutta, Bharti Malhotra, Amita Jain, Kammilli Nagamani, GB Shantala, Sharmila Raut, MM Vegad, Ajanta Sharma, Aashish Choudhary, Megha Brijwa, Anukumar Balakrishnan, Jayaswamy Manjunatha, Manish Pathak, Sivasubramanian Srinivasan, Hasina Banu, Himanshu Sharma, Parul Jain, Pakalpati Sunita, R Ambica, Babita Fageria, Disha Patel, Gitika Rajbongshi, Neetu Vijay, Jitendra Narayan, Neeraj Aggarwal, Anu Nagar, Raman R Gangakhedkar, Priya Abraham
May 2020, 151(5):496-496
DOI
:10.4103/0971-5916.286255
PMID
:32611921
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822
230
1
Infectious disease isolation facility with advanced engineering design: Need of the hour
Bhagirathi Dwibedi
May 2020, 151(5):502-503
DOI
:10.4103/ijmr.IJMR_1657_20
PMID
:32611926
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626
298
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Author's response
Rajesh Bhatia
May 2020, 151(5):500-501
DOI
:10.4103/0971-5916.286494
PMID
:32611925
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760
132
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Authors' response
Anup Agarwal, Nazia Nagi, Pranab Chatterjee, Swarup Sarkar, Devendra Mourya, Rima Rakeshkumar Sahay, Rajesh Bhatia
May 2020, 151(5):503-504
DOI
:10.4103/0971-5916.286224
PMID
:32611927
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635
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ERRATUM
Erratum: Guidance for building a dedicated health facility to contain the spread of the 2019 novel coronavirus outbreak
May 2020, 151(5):504-504
DOI
:10.4103/0971-5916.287328
PMID
:32611928
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444
148
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CORRESPONDENCES
Author's response
Rajesh Bhatia
May 2020, 151(5):498-498
DOI
:10.4103/0971-5916.286414
PMID
:32611923
[FULL TEXT]
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[EPub]
[PubMed]
459
103
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© Indian Journal of Medical Research | Published by Wolters Kluwer -
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Online since 25 February, 2011