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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.
  82,652 4,843 56
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
  56,900 1,884 19
REVIEW ARTICLES
The 2019 novel coronavirus disease (COVID-19) pandemic: A review of the current evidence
Pranab Chatterjee, Nazia Nagi, Anup Agarwal, Bhabatosh Das, Sayantan Banerjee, Swarup Sarkar, Nivedita Gupta, Raman R Gangakhedkar
February & March 2020, 151(2):147-159
DOI:10.4103/ijmr.IJMR_519_20  PMID:32362642
A novel coronavirus (nCoV) spillover event, with its epicenter in Wuhan, People's Republic of China, has emerged as a public health emergency of international concern. This began as an outbreak in December 2019, and till February 28, 2020, there have been 83,704 confirmed cases of novel coronavirus disease 2019 (COVID-19) globally, with 2,859 deaths, resulting in an overall case fatality rate of 3.41 per cent (95% confidence interval 3.29-3.54%). By this time (February 28, 2020) 58 countries or territories and one international conveyance (Diamond Princess Cruise Ship) were affected. As a part of the global response to manage and contain the pandemic, major emphasis was placed on generating research intelligence to guide evidence-based responses to contain the virus, which was named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), owing to its genetic similarities with the SARS virus. This review summarizes the emerging evidence which can help guide the public health response, particularly in India. Key areas have been identified in which research needs to be conducted to generate critical intelligence for advising prevention and control efforts. The emergence of SARS-CoV-2 has once again exposed the weaknesses of global health systems preparedness, ability to respond to an infectious threat, the rapidity of transmission of infections across international borders and the ineffectiveness of knee-jerk policy responses to emerging/re-emerging infectious disease threats. The review concludes with the key learning points from the ongoing efforts to prevent and contain COVID-19 and identifies the need to invest in health systems, community-led response mechanisms and the need for preparedness and global health security.
  52,106 6,170 29
A brief history of vaccines & vaccination in India
Chandrakant Lahariya
April 2014, 139(4):491-511
PMID:24927336
The challenges faced in delivering lifesaving vaccines to the targeted beneficiaries need to be addressed from the existing knowledge and learning from the past. This review documents the history of vaccines and vaccination in India with an objective to derive lessons for policy direction to expand the benefits of vaccination in the country. A brief historical perspective on smallpox disease and preventive efforts since antiquity is followed by an overview of 19 th century efforts to replace variolation by vaccination, setting up of a few vaccine institutes, cholera vaccine trial and the discovery of plague vaccine. The early twentieth century witnessed the challenges in expansion of smallpox vaccination, typhoid vaccine trial in Indian army personnel, and setting up of vaccine institutes in almost each of the then Indian States. In the post-independence period, the BCG vaccine laboratory and other national institutes were established; a number of private vaccine manufacturers came up, besides the continuation of smallpox eradication effort till the country became smallpox free in 1977. The Expanded Programme of Immunization (EPI) (1978) and then Universal Immunization Programme (UIP) (1985) were launched in India. The intervening events since UIP till India being declared non-endemic for poliomyelitis in 2012 have been described. Though the preventive efforts from diseases were practiced in India, the reluctance, opposition and a slow acceptance of vaccination have been the characteristic of vaccination history in the country. The operational challenges keep the coverage inequitable in the country. The lessons from the past events have been analysed and interpreted to guide immunization efforts.
  45,365 1,689 -
SYSTEMATIC REVIEW
Epidemiology of childhood overweight & obesity in India: A systematic review
Harish Ranjani, TS Mehreen, Rajendra Pradeepa, Ranjit Mohan Anjana, Renu Garg, Krishnan Anand, Viswanathan Mohan
February 2016, 143(2):160-174
DOI:10.4103/0971-5916.180203  PMID:27121514
Background & objectives: Childhood obesity is a known precursor to obesity and other non-communicable diseases (NCDs) in adulthood. However, the magnitude of the problem among children and adolescents in India is unclear due to paucity of well-conducted nationwide studies and lack of uniformity in the cut-points used to define childhood overweight and obesity. Hence an attempt was made to review the data on trends in childhood overweight and obesity reported from India during 1981 to 2013. Methods: Literature search was done in various scientific public domains from the last three decades using key words such as childhood and adolescent obesity, overweight, prevalence, trends, etc. Additional studies were also identified through cross-references and websites of official agencies. Results: Prevalence data from 52 studies conducted in 16 of the 28 States in India were included in analysis. The median value for the combined prevalence of childhood and adolescent obesity showed that it was higher in north, compared to south India. The pooled data after 2010 estimated a combined prevalence of 19.3 per cent of childhood overweight and obesity which was a significant increase from the earlier prevalence of 16.3 per cent reported in 2001-2005. Interpretation & conclusions: Our review shows that overweight and obesity rates in children and adolescents are increasing not just among the higher socio-economic groups but also in the lower income groups where underweight still remains a major concern.
  36,221 2,215 74
REVIEW ARTICLES
Hand hygiene: Back to the basics of infection control
Purva Mathur
November 2011, 134(5):611-620
DOI:10.4103/0971-5916.90985  PMID:22199099
Health care associated infections are drawing increasing attention from patients, insurers, governments and regulatory bodies. This is not only because of the magnitude of the problem in terms of the associated morbidity, mortality and cost of treatment, but also due to the growing recognition that most of these are preventable. The medical community is witnessing in tandem unprecedented advancements in the understanding of pathophysiology of infectious diseases and the global spread of multi-drug resistant infections in health care set-ups. These factors, compounded by the paucity of availability of new antimicrobials have necessitated a re-look into the role of basic practices of infection prevention in modern day health care. There is now undisputed evidence that strict adherence to hand hygiene reduces the risk of cross-transmission of infections. With "Clean Care is Safer Care" as a prime agenda of the global initiative of WHO on patient safety programmes, it is time for developing countries to formulate the much-needed policies for implementation of basic infection prevention practices in health care set-ups. This review focuses on one of the simplest, low cost but least accepted from infection prevention: hand hygiene.
  30,995 4,027 96
SPECIAL SECTION - TB DIAGNOSTICS - REVIEW ARTICLES
Challenges in the diagnosis & treatment of miliary tuberculosis
Surendra K Sharma, Alladi Mohan, Abhishek Sharma
May 2012, 135(5):703-730
Miliary tuberculosis (TB) is a potentially lethal disease if not diagnosed and treated early. Diagnosing miliary TB can be a challenge that can perplex even the most experienced clinicians. Clinical manifestations are nonspecific, typical chest radiograph findings may not be evident till late in the disease, high resolution computed tomography (HRCT) shows randomly distributed miliary nodules and is relatively more sensitive. Ultrasonography, CT and magnetic resonance imaging (MRI) are useful in discerning the extent of organ involvement by lesions of miliary TB in extra-pulmonary locations. Fundus examination for choroid tubercles, histopathological examination of tissue biopsy specimens, conventional and rapid culture methods for isolation of Mycobacterium tuberculosis, drug-susceptibility testing, along with use of molecular biology tools in sputum, body fluids, other body tissues are useful in confirming the diagnosis. Although several prognostic markers have been described which predict mortality, yet untreated miliary TB has a fatal outcome within one year. A high index of clinical suspicion and early diagnosis and timely institution of anti-tuberculosis treatment can be life-saving. Response to first-line anti-tuberculosis drugs is good but drug-induced hepatotoxicity and drug-drug interactions in human immunodeficiency virus/acquired immunodeficiency syndrome (HIV/AIDS) patients pose significant problems during treatment. However, sparse data are available from randomized controlled trials to define the optimum regimen and duration of treatment in patients with drug-sensitive as well as drug-resistant miliary TB, including those with HIV/AIDS.
  30,033 2,645 -
ORIGINAL ARTICLES
Full-genome sequences of the first two SARS-CoV-2 viruses from India
Pragya D Yadav, Varsha A Potdar, Manohar Lal Choudhary, Dimpal A Nyayanit, Megha Agrawal, Santosh M Jadhav, Triparna D Majumdar, Anita Shete-Aich, Atanu Basu, Priya Abraham, Sarah S Cherian
February & March 2020, 151(2):200-209
DOI:10.4103/ijmr.IJMR_663_20  PMID:32242873
Background & objectives: Since December 2019, severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has globally affected 195 countries. In India, suspected cases were screened for SARS-CoV-2 as per the advisory of the Ministry of Health and Family Welfare. The objective of this study was to characterize SARS-CoV-2 sequences from three identified positive cases as on February 29, 2020. Methods: Throat swab/nasal swab specimens for a total of 881 suspected cases were screened by E gene and confirmed by RdRp (1), RdRp (2) and N gene real-time reverse transcription-polymerase chain reactions and next-generation sequencing. Phylogenetic analysis, molecular characterization and prediction of B- and T-cell epitopes for Indian SARS-CoV-2 sequences were undertaken. Results: Three cases with a travel history from Wuhan, China, were confirmed positive for SARS-CoV-2. Almost complete (29,851 nucleotides) genomes of case 1, case 3 and a fragmented genome for case 2 were obtained. The sequences of Indian SARS-CoV-2 though not identical showed high (~99.98%) identity with Wuhan seafood market pneumonia virus (accession number: NC 045512). Phylogenetic analysis showed that the Indian sequences belonged to different clusters. Predicted linear B-cell epitopes were found to be concentrated in the S1 domain of spike protein, and a conformational epitope was identified in the receptor-binding domain. The predicted T-cell epitopes showed broad human leucocyte antigen allele coverage of A and B supertypes predominant in the Indian population. Interpretation & conclusions: The two SARS-CoV-2 sequences obtained from India represent two different introductions into the country. The genetic heterogeneity is as noted globally. The identified B- and T-cell epitopes may be considered suitable for future experiments towards the design of vaccines and diagnostics. Continuous monitoring and analysis of the sequences of new cases from India and the other affected countries would be vital to understand the genetic evolution and rates of substitution of the SARS-CoV-2.
  24,770 4,945 13
REVIEW ARTICLES
Parasitic infections in HIV infected individuals: Diagnostic & therapeutic challenges
Veeranoot Nissapatorn, Nongyao Sawangjaroen
December 2011, 134(6):878-897
DOI:10.4103/0971-5916.92633  PMID:22310820
After 30 years of the human immunodeficiency virus (HIV) epidemic, parasites have been one of the most common opportunistic infections (OIs) and one of the most frequent causes of morbidity and mortality associated with HIV-infected patients. Due to severe immunosuppression, enteric parasitic pathogens in general are emerging and are OIs capable of causing diarrhoeal disease associated with HIV. Of these, Cryptosporidium parvum and Isospora belli are the two most common intestinal protozoan parasites and pose a public health problem in acquired immunodeficiency syndrome (AIDS) patients. These are the only two enteric protozoan parasites that remain in the case definition of AIDS till today. Leismaniasis, strongyloidiasis and toxoplasmosis are the three main opportunistic causes of systemic involvements reported in HIV-infected patients. Of these, toxoplasmosis is the most important parasitic infection associated with the central nervous system. Due to its complexity in nature, toxoplasmosis is the only parasitic disease capable of not only causing focal but also disseminated forms and it has been included in AIDS-defining illnesses (ADI) ever since. With the introduction of highly active anti-retroviral therapy (HAART), cryptosporidiosis, leishmaniasis, schistosomiasis, strongyloidiasis, and toxoplasmosis are among parasitic diseases reported in association with immune reconstitution inflammatory syndrome (IRIS). This review addresses various aspects of parasitic infections in term of clinical, diagnostic and therapeutic challenges associated with HIV-infection.
  22,363 2,680 30
Emerging/re-emerging viral diseases & new viruses on the Indian horizon
Devendra T Mourya, Pragya D Yadav, PT Ullas, Sumit D Bhardwaj, Rima R Sahay, Mandeep S Chadha, Anita M Shete, Santosh Jadhav, Nivedita Gupta, Raman R Gangakhedkar, Pradeep Khasnobis, Sujeet K Singh
April 2019, 149(4):447-467
DOI:10.4103/ijmr.IJMR_1239_18  PMID:31411169
Infectious diseases remain as the major causes of human and animal morbidity and mortality leading to significant healthcare expenditure in India. The country has experienced the outbreaks and epidemics of many infectious diseases. However, enormous successes have been obtained against the control of major epidemic diseases, such as malaria, plague, leprosy and cholera, in the past. The country's vast terrains of extreme geo-climatic differences and uneven population distribution present unique patterns of distribution of viral diseases. Dynamic interplays of biological, socio-cultural and ecological factors, together with novel aspects of human-animal interphase, pose additional challenges with respect to the emergence of infectious diseases. The important challenges faced in the control and prevention of emerging and re-emerging infectious diseases range from understanding the impact of factors that are necessary for the emergence, to development of strengthened surveillance systems that can mitigate human suffering and death. In this article, the major emerging and re-emerging viral infections of public health importance have been reviewed that have already been included in the Integrated Disease Surveillance Programme.
  21,599 2,182 17
Female genital tuberculosis: Revisited
Jai Bhagwan Sharma, Eshani Sharma, Sangeeta Sharma, Sona Dharmendra
December 2018, 148(7):71-83
DOI:10.4103/ijmr.IJMR_648_18  PMID:30964083
Female genital tuberculosis (FGTB) is caused by Mycobacterium tuberculosis (rarely Mycobacterium bovis and/or atypical mycobacteria) being usually secondary to TB of the lungs or other organs with infection reaching through haematogenous, lymphatic route or direct spread from abdominal TB. In FGTB, fallopian tubes are affected in 90 per cent women, whereas uterine endometrium is affected in 70 per cent and ovaries in about 25 per cent women. It causes menstrual dysfunction and infertility through the damage of genital organs. Some cases may be asymptomatic. Diagnosis is often made from proper history taking, meticulous clinical examination and judicious use of investigations, especially endometrial aspirate (or biopsy) and endoscopy. Treatment is through multi-drug antitubercular treatment for adequate time period (rifampicin, isoniazid, pyrazinamide, ethambutol daily for 60 days followed by rifampicin, isoniazid, ethambutol daily for 120 days). Treatment is given for 18-24 months using the second-line drugs for drug-resistant (DR) cases. With the advent of increased access to rapid diagnostics and newer drugs, the management protocol is moving towards achieving universal drug sensitivity testing and treatment with injection-free regimens containing newer drugs, especially for new and previously treated DR cases.
  22,023 1,499 -
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
  22,320 1,059 10
COMMENTARIES
Intimate partner violence against women in slums in India
Bushra Sabri, Jacquelyn C Campbell
June 2015, 141(6):757-760
DOI:10.4103/0971-5916.160693  PMID:26205018
  22,186 476 4
ORIGINAL ARTICLES
Prevalence of SARS-CoV-2 infection in India: Findings from the national serosurvey, May-June 2020
Manoj V Murhekar, Tarun Bhatnagar, Sriram Selvaraju, Kiran Rade, V Saravanakumar, Jeromie Wesley Vivian Thangaraj, Muthusamy Santhosh Kumar, Naman Shah, R Sabarinathan, Alka Turuk, Parveen Kumar Anand, Smita Asthana, Rakesh Balachandar, Sampada Dipak Bangar, Avi Kumar Bansal, Jyothi Bhat, Debjit Chakraborty, Chethana Rangaraju, Vishal Chopra, Dasarathi Das, Alok Kumar Deb, Kangjam Rekha Devi, Gaurav Raj Dwivedi, S Muhammad Salim Khan, Inaamul Haq, M Sunil Kumar, Avula Laxmaiah, Madhuka , Amarendra Mahapatra, Anindya Mitra, AR Nirmala, Avinash Pagdhune, Mariya Amin Qurieshi, Tekumalla Ramarao, Seema Sahay, YK Sharma, Marinaik Basavegowdanadoddi Shrinivasa, Vijay Kumar Shukla, Prashant Kumar Singh, Ankit Viramgami, Vimith Cheruvathoor Wilson, Rajiv Yadav, CP Girish Kumar, Hanna Elizabeth Luke, Uma Devi Ranganathan, Subash Babu, Krithikaa Sekar, Pragya D Yadav, Gajanan N Sapkal, Aparup Das, Pradeep Das, Shanta Dutta, Rajkumar Hemalatha, Ashwani Kumar, Kanwar Narain, Somashekar Narasimhaiah, Samiran Panda, Sanghamitra Pati, Shripad Patil, Kamalesh Sarkar, Shalini Singh, Rajni Kant, Srikanth Tripathy, GS Toteja, Giridhara R Babu, Shashi Kant, JP Muliyil, Ravindra Mohan Pandey, Swarup Sarkar, Sujeet K Singh, Sanjay Zodpey, Raman R Gangakhedkar, DC S. Reddy, Balram Bhargava
July & August 2020, 152(1):48-60
DOI:10.4103/ijmr.IJMR_3290_20  PMID:32952144
Background & objectives: Population-based seroepidemiological studies measure the extent of SARS-CoV-2 infection in a country. We report the findings of the first round of a national serosurvey, conducted to estimate the seroprevalence of SARS-CoV-2 infection among adult population of India. Methods: From May 11 to June 4, 2020, a randomly sampled, community-based survey was conducted in 700 villages/wards, selected from the 70 districts of the 21 States of India, categorized into four strata based on the incidence of reported COVID-19 cases. Four hundred adults per district were enrolled from 10 clusters with one adult per household. Serum samples were tested for IgG antibodies using COVID Kavach ELISA kit. All positive serum samples were re-tested using Euroimmun SARS-CoV-2 ELISA. Adjusting for survey design and serial test performance, weighted seroprevalence, number of infections, infection to case ratio (ICR) and infection fatality ratio (IFR) were calculated. Logistic regression was used to determine the factors associated with IgG positivity. Results: Total of 30,283 households were visited and 28,000 individuals were enrolled. Population-weighted seroprevalence after adjusting for test performance was 0.73 per cent [95% confidence interval (CI): 0.34-1.13]. Males, living in urban slums and occupation with high risk of exposure to potentially infected persons were associated with seropositivity. A cumulative 6,468,388 adult infections (95% CI: 3,829,029-11,199,423) were estimated in India by the early May. The overall ICR was between 81.6 (95% CI: 48.3-141.4) and 130.1 (95% CI: 77.0-225.2) with May 11 and May 3, 2020 as plausible reference points for reported cases. The IFR in the surveyed districts from high stratum, where death reporting was more robust, was 11.72 (95% CI: 7.21-19.19) to 15.04 (9.26-24.62) per 10,000 adults, using May 24 and June 1, 2020 as plausible reference points for reported deaths. Interpretation & conclusions: Seroprevalence of SARS-CoV-2 was low among the adult population in India around the beginning of May 2020. Further national and local serosurveys are recommended to better inform the public health strategy for containment and mitigation of the epidemic in various parts of the country.
  18,433 2,623 41
REVIEW ARTICLES
National Iron Plus Initiative: Current status & future strategy
Umesh Kapil, Radhika Kapil, Aakriti Gupta
September 2019, 150(3):239-247
DOI:10.4103/ijmr.IJMR_1782_18  PMID:31719294
Anaemia is a severe public health problem amongst all vulnerable age groups in India. The National Nutritional Anaemia Prophylaxis Programme initiated in 1970, was revised and expanded to include beneficiaries from all age groups namely children aged 6-59 months, 5-10 yr, adolescents aged 10-19 yr, pregnant and lactating women and women in reproductive age group under the National Iron Plus Initiative (NIPI) programme in 2011. The dose of iron, frequency and duration of iron supplementation and roles and responsibilities of the functionaries were described. At present, the coverage of beneficiaries with iron and folic acid has been poor at the national level. The prevalence of anaemia has continued to remain high during the last 60 years, and there has been no significant change in the scenario due to various reasons. The constraints in implementation and measures to improve the NIPI programme are discussed in the current article.
  19,992 890 7
Body composition techniques
Rebecca Kuriyan
November 2018, 148(5):648-658
DOI:10.4103/ijmr.IJMR_1777_18  PMID:30666990
Body composition is known to be associated with several diseases, such as cardiovascular disease, diabetes, cancers, osteoporosis and osteoarthritis. Body composition measurements are useful in assessing the effectiveness of nutritional interventions and monitoring the changes associated with growth and disease conditions. Changes in body composition occur when there is a mismatch between nutrient intake and requirement. Altered body composition is observed in conditions such as wasting and stunting when the nutritional intake may be inadequate. Overnutrition on the other hand leads to obesity. Many techniques are available for body composition assessment, which range from simple indirect measures to more sophisticated direct volumetric measurements. Some of the methods that are used today include anthropometry, tracer dilution, densitometry, dual-energy X-ray absorptiometry, air displacement plethysmography and bioelectrical impedance analysis. The methods vary in their precision and accuracy. Imaging techniques such as nuclear magnetic resonance imaging and computed tomography have become powerful tools due to their ability of visualizing and quantifying tissues, organs, or constituents such as muscle and adipose tissue. However, these methods are still considered to be research tools due to their cost and complexity of use. This review was aimed to describe the commonly used methods for body composition analysis and provide a brief introduction on the latest techniques available.
  17,104 2,810 29
ORIGINAL ARTICLES
Current antibiotic use in the treatment of enteric fever in children
Sushila Dahiya, Rooma Malik, Priyanka Sharma, Archana Sashi, Rakesh Lodha, Sushil Kumar Kabra, Seema Sood, Bimal Kumar Das, Kamini Walia, VC Ohri, Arti Kapil
February 2019, 149(2):263-269
DOI:10.4103/ijmr.IJMR_199_18  PMID:31219092
Background & objectives: Antimicrobial resistance is a major challenge in the treatment of typhoid fever with limited choices left to empirically treat these patients. The present study was undertaken to determine the current practices of antibiotic use in children attending a tertiary care hospital in north India. Methods: This was a descriptive observational study in children suffering from enteric fever as per the case definition including clinical and laboratory parameters. The antibiotic audit in hospitalized children was measured as days of therapy per 1000 patient days and in outpatient department (OPD) as antibiotic prescription on the treatment card. Results: A total of 128 children with enteric fever were included in the study, of whom, 30 were hospitalized and 98 were treated from OPD. The mean duration of fever was 9.5 days at the time of presentation. Of these, 45 per cent were culture positive with Salmonella Typhi being aetiological agent in 68 per cent followed by S. Paratyphi A in 32 per cent. During hospitalization, the average length of stay was 10 days with mean duration of defervescence 6.4 days. Based on antimicrobial susceptibility ceftriaxone was given to 28 patients with mean duration of treatment being six days. An additional antibiotic was needed in six patients due to clinical non-response. In OPD, 79 patients were prescribed cefixime and additional antibiotic was needed in five during follow up visit. Interpretation & conclusions: Based on our findings, ceftriaxone and cefixime seemed to be the first line of antibiotic treatment for typhoid fever. Despite susceptibility, clinical non-response was seen in around 10 per cent of the patients who needed combinations of antibiotics.
  18,705 1,096 5
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.
  16,676 2,571 24
SYSTEMATIC REVIEW
Incidence & prevalence of stroke in India: A systematic review
Sureshkumar Kamalakannan, Aashrai S. V. Gudlavalleti, Venkata S. Murthy Gudlavalleti, Shifalika Goenka, Hannah Kuper
August 2017, 146(2):175-185
DOI:10.4103/ijmr.IJMR_516_15  PMID:29265018
Background & objectives: There has been more than 100 per cent increase in incidence of stroke in low- and middle-income countries including India from 1970-1979 to 2000-2008. Lack of reliable reporting mechanisms, heterogeneity in methodology, study population, and small sample size in existing epidemiological studies, make an accurate estimation of stroke burden in India challenging. We conducted a systematic review of epidemiologic studies on stroke conducted in India to document the magnitude of stroke. Methods: All population-based, cross-sectional studies and cohort studies from India which reported the stroke incidence rate or cumulative stroke incidence and/or the prevalence of stroke in participants from any age group were included. Electronic databases (Ovid, PubMed, Medline, Embase and IndMED) were searched and studies published during 1960 to 2015 were included. A total of 3079 independent titles were identified for screening, of which 10 population-based cross-sectional studies were considered eligible for inclusion. Given the heterogeneity of the studies, meta-analysis was not carried out. Results: The cumulative incidence of stroke ranged from 105 to 152/100,000 persons per year, and the crude prevalence of stroke ranged from 44.29 to 559/100,000 persons in different parts of the country during the past decade. These values were higher than those of high-income countries. Interpretation & conclusions: A paucity of good-quality epidemiological studies on stroke in India emphasizes the need for a coordinated effort at both the State and national level to study the burden of stroke in India. Future investment in the population-based epidemiological studies on stroke would lead to better preventive measures against stroke and better rehabilitation measures for stroke-related disabilities in the country.
  16,331 2,177 37
REVIEW ARTICLES
Prevention of ventilator-associated pneumonia in the intensive care unit: A review of the clinically relevant recent advancements
Holly Keyt, Paola Faverio, Marcos I Restrepo
June 2014, 139(6):814-821
PMID:25109715
Ventilator-associated pneumonia (VAP) is one of the most commonly encountered hospital-acquired infections in intensive care units and is associated with significant morbidity and high costs of care. The pathophysiology, epidemiology, treatment and prevention of VAP have been extensively studied for decades, but a clear prevention strategy has not yet emerged. In this article we will review recent literature pertaining to evidence-based VAP-prevention strategies that have resulted in clinically relevant outcomes. A multidisciplinary strategy for prevention of VAP is recommended. Those interventions that have been shown to have a clinical impact include the following: (i) Non-invasive positive pressure ventilation for able patients, especially in immunocompromised patients, with acute exacerbation of chronic obstructive pulmonary disease or pulmonary oedema, (ii) Sedation and weaning protocols for those patients who do require mechanical ventilation, (iii) Mechanical ventilation protocols including head of bed elevation above 30 degrees and oral care, and (iv) Removal of subglottic secretions. Other interventions, such as selective digestive tract decontamination, selective oropharyngeal decontamination and antimicrobial-coated endotracheal tubes, have been tested in different studies. However, the evidence for the efficacy of these measures to reduce VAP rates is not strong enough to recommend their use in clinical practice. In numerous studies, the implementation of VAP prevention bundles to clinical practice was associated with a significant reduction in VAP rates. Future research that considers clinical outcomes as primary endpoints will hopefully result in more detailed prevention strategies.
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Epidemiology, pathogenesis, genetics & management of polycystic ovary syndrome in India
Mohammad Ashraf Ganie, Vishnu Vasudevan, Imtiyaz Ahmad Wani, Mohammad Salem Baba, Tasleem Arif, Aafia Rashid
October 2019, 150(4):333-344
DOI:10.4103/ijmr.IJMR_1937_17  PMID:31823915
Polycystic ovary syndrome (PCOS) is a common endocrine disorder predominantly affecting women of reproductive age. Clinical manifestations are diverse including hyperandrogenism, anovulation, infertility and increased risk of metabolic diseases besides psychosocial dysfunction. This review provides information on the problem of PCOS in India, its pathophysiology, genetics and an overview of current management options to instigate further research in this field. Prevalence of PCOS in India ranges from 3.7 to 22.5 per cent depending on the population studied and the criteria used for diagnosis. Abnormalities in leptin-adiponectin (adipocyte biology), oxidative stress and autoimmunity are among the mechanisms studied regarding pathogenesis of PCOS. Many candidate gene studies have shown associations with PCOS in various studies. Studies have consistently demonstrated the relationship between the well-known manifestation of hyperandrogenism among Indian PCOS women and the metabolic morbidities including insulin resistance, glucose intolerance and cardiovascular risk. Management of individual components of PCOS can be achieved by medications or surgical methods, though further clarification regarding pathogenesis of PCOS is needed to sharpen our therapeutic armamentarium.
  16,722 1,647 9
Country-specific nutrient requirements & recommended dietary allowances for Indians: Current status & future directions
Krishna Pillay Madhavan Nair, Little Flower Augustine
November 2018, 148(5):522-530
DOI:10.4103/ijmr.IJMR_1762_18  PMID:30666979
Nutrient requirements and recommended dietary allowances (RDAs) are set and revised periodically by the Indian Council of Medical Research. These are meant to guide the population and provide policy directions regarding nutrient requirements corresponding to a healthy population. This review article provides an overview of the current recommendations (RDA, 2010) and the challenges faced by the committee to contextualize RDA to the Indian scenario which has a background of double burden of malnutrition, diverse dietary habits but predominantly home-based cereal-pulse vegetarian diet with low bioavailability of several nutrients and lower consumption of packaged fortified foods. The need for country-specific requirements and harmonization of methodologies related to nutrient requirements and RDA are also discussed. The recommendations fixed for iron have been provided in detail as an example. The measures to carry forward RDA revisions to ensure its sustainability have been emphasized.
  16,444 1,635 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
  15,463 2,464 13
ORIGINAL ARTICLES
Modelling the spread of SARS-CoV-2 pandemic - Impact of lockdowns & interventions
Manindra Agrawal, Madhuri Kanitkar, M Vidyasagar
January & February 2021, 153(1):175-181
DOI:10.4103/ijmr.IJMR_4051_20  PMID:33146155
Background & objectives: To handle the current COVID-19 pandemic in India, multiple strategies have been applied and implemented to slow down the virus transmission. These included clinical management of active cases, rapid development of treatment strategies, vaccines computational modelling and statistical tools to name a few. This article presents a mathematical model for a time series prediction and analyzes the impact of the lockdown. Methods: Several existing mathematical models were not able to account for asymptomatic patients, with limited testing capability at onset and no data on serosurveillance. In this study, a new model was used which was developed on lines of susceptible-asymptomatic-infected-recovered (SAIR) to assess the impact of the lockdown and make predictions on its future course. Four parameters were used, namely β, γ, η and ε. β measures the likelihood of the susceptible person getting infected, and γ denotes recovery rate of patients. The ratio β/γ is denoted by R0 (basic reproduction number). Results: The disease spread was reduced due to initial lockdown. An increase in γ reflects healthcare and hospital services, medications and protocols put in place. In Delhi, the predictions from the model were corroborated with July and September serosurveys, which showed antibodies in 23.5 and 33 per cent population, respectively. Interpretation & conclusions: The SAIR model has helped understand the disease better. If the model is correct, we may have reached herd immunity with about 380 million people already infected. However, personal protective measures remain crucial. If there was no lockdown, the number of active infections would have peaked at close to 14.7 million, resulted in more than 2.6 million deaths, and the peak would have arrived by June 2020. The number of deaths with the current trends may be less than 0.2 million.
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Gargle lavage as a viable alternative to swab for detection of SARS-CoV-2
Ankit Mittal, Ankesh Gupta, Shiv Kumar, Milan Surjit, Binit Singh, Manish Soneja, Kapil Dev Soni, Adil Rashid Khan, Komal Singh, Shivdas Naik, Arvind Kumar, Richa Aggarwal, Neeraj Nischal, Sanjeev Sinha, Anjan Trikha, Naveet Wig
July & August 2020, 152(1):77-81
DOI:10.4103/ijmr.IJMR_2987_20  PMID:32820725
Background & objectives: Nasopharyngeal and oropharyngeal swab (NPS and OPS) collection is widely accepted as the preferred method for obtaining respiratory samples. However, it has certain disadvantages which may be overcome by gargling. The primary objective of this study was to assess agreement between gargle lavage and swab as an appropriate respiratory sample for the detection of SARS-CoV-2. The secondary objective was to assess the patient acceptability of the two sampling methods. Methods: It was a cross-sectional study done at a tertiary care hospital in New Delhi, India, on 50 confirmed COVID-19 patients. Paired swab (NPS and OPS) and gargle samples were taken within 72 h of their diagnosis. Samples were processed by reverse transcription-polymerase chain reaction (RT-PCR) for detection of SARS-CoV-2. Post-sample collection, a 10-point scale was administered to assess the level of discomfort with either of the collection methods. Results: All gargle samples were positive and comparable to their corresponding swab samples irrespective of the symptoms and duration of illness. The cycle threshold (Ct) values for gargle samples were slightly higher but comparable to those of swabs. Bland-Altman plot showed good agreement between the two methods. Majority (72%) of the patients reported moderate-to-severe discomfort with swab collection in comparison to 24 per cent reporting only mild discomfort with gargle collection. Interpretation & conclusions: Our preliminary results show that the gargle lavage may be a viable alternative to swabs for sample collection for the detection of SARS-CoV-2. Adoption of gargle lavage for sample collection will have a significant impact as it will enable easy self-collection, relieve healthcare workers and also lead to substantial cost savings by reducing the need for swabs and personal protective equipment.
  16,691 670 7
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