Perceptions and factors associated with COVID Appropriate Behavior (CAB) obedience among general public in India: A mixed methods research.

BACKGROUND: The purpose of the study was to analyze the public perception toward COVID Appropriate Behavior (CAB) obedience and to identify the factors associated with declining CAB. MATERIALS AND METHODS: It is a mixed methods study conducted from November 2021 to September 2022 in Pune city, India. A set of 15-CAB guidelines published by the Ministry of Health and Family Welfare, Government of India (GoI), were used as a base document to design the instruments of qualitative and quantitative study. Using a one-sample Kolmogorov-Smirnov test, CAB scores were tested for normality and distribution. Comparisons of various parameters were done using z test for proportion and paired t-test (statistical significance level was 0.05). Thematic content analysis was conducted for qualitative data analysis and verbatims are reported where applicable. RESULTS: The main motivation for people to get vaccinated was family and personal safety and a higher proportion of people felt safer post-vaccination which was linked to a reduced likelihood of CAB obedience. Qualitative results showed that people's lack of empathy and concern for others leads to undesirable personal behaviors such as spitting in public places, not wearing masks, etc., The need for socialization is high but discomfort with the use of masks/face shields and habituation with the disease were prominent causes of CAB disobedience. CONCLUSION: We conclude that reduced fear and gradual habituation have led to reduced CAB obedience. There is a need to reinforce empathy and concern for others to improve adherence to CAB like maintaining social distancing and wearing masks in public places for personal and social safety from the disease.

Dengue-chikungunya infection in the tertiary care hospital of northern India: Cross-sectional latent class cluster analysis in viral infection.

Cases of dengue and chikungunya fever are escalating all over India. Both viruses share a common vector, the "Aedes" mosquito. Due to similar clinical symptoms, both the dengue (DENV) and chikungunya (CHIKV) virus can circulate as co-infection. There is very limited data available on dengue-chikungunya co-infection in Uttarakhand, India. The purpose of this study was to determine the seroprevalence of dengue and chikungunya virus infections, as well as their co-infection, in patients presenting with clinical symptoms. Serum samples of clinically suspected patients from the tertiary care hospital of Uttarakhand were collected, and Latent Class Cluster Analysis was performed for clinical profiling. ELISA was performed for DENV and CHIKV. 279 cases were enrolled, out of which 222 (79.5%) came positive for dengue NS1 Ag, 143 (51.2%) for dengue IgM, 98 (35.1%) for IgG followed by 16 (5.7%) of CHIKV IgM, and 4 (1.4%) were NS1 Ag with CHIKV IgM. Among the clinical features, fever (n = 270, 96.8%) was the most common symptom in all suspected dengue and chikungunya cases. Other symptoms like chills (n = 254, 91.0%), arthralgia (n = 241, 86.4%), and headache (n = 240, 86.0%) were present in a significant number. Results showed fewer odds of getting both DENV and CHIKV infection simultaneously, but the risk is still not negligible. This study explores the clinical presentation of the suspected dengue-chikungunya case. The increasing incidence of dengue and chikungunya and their co-infection necessitate the authorities' active surveillance of endemic regions and effective patient care management.

Comprehensive structured training on occupational health hazards and vaccination: A novel initiative toward employee safety.

Introduction: Healthcare providers are vulnerable to occupational health hazards. However, they do not appropriately apprehend the serious health consequences of occupational exposures. This study was conducted to assess the effectiveness of "Occupational health hazards and vaccination" workshop organized periodically in institute. Material and Methods: We validated the questionnaire prior to assess the effectiveness of workshop. Expert performed "key check" of questionnaire. Item analysis of one best item questions was performed using difficulty index (p value), discrimination indices (DI), distractor efficiency (DE), and reliability using Kuder-Richardson 20 coefficients (KR20). Pre-test and post-test scores of study participants were compared. Effectiveness of workshop was determined using class average normalized gain. Result: The 14 item one-best questions had acceptable difficulty level (60.35 ± 9.46%) and ideal discriminating power (0.75 ± 0.17) with mean DE 73.81 ± 22.46%. The test was found highly reliable with KR20 as 0.90. Mean score in pre-test and post-test were 6.47 ± 3.38 and 13.69 ± 1.51, respectively, and significant improvement in post-test score was found compared to pre-test score. Class average normalized gain was 0.84. Conclusion: The Occupational health hazards and vaccination workshop effectively improved healthcare providers' knowledge regarding workplace safety protocols. Questionnaire was found to be valid and reliable. Low baseline knowledge highlights the fact that implementation of such training on regular basis is the need of hour.

Expectations of healthcare personnel from infection prevention and control services for preparedness of healthcare organisation in view of COVID-19 pandemic.

BACKGROUND: During infectious outbreaks like COVID-19, it is essential that every healthcare personnel (HCP) strictly adheres to infection prevention and control (IPC) policies. To boost IPC measures, training to reinforce preventive practices, which are pertinent to needs and encompass the expectations of the HCP, is indispensable. Thus, these expectations of the HCP should be explored. METHODS: In this cross-sectional descriptive survey, we used convenience sampling technique to ask the participants to list their expectations on of covid-19 IPC training paper based forms. Using the category construction approach, we organised the expectations and grouped the participants on the basis of their work and place of work to analyse the association using the chi-square test. RESULTS: Many participants expected to learn about the use of PPE and masks, hand hygiene, physical distancing, cleaning and disinfection, basic precautions for personal protection during the training. Expectations also included various administrative queries, sample collection and clinical skills for diagnosis and management. There was significant association of many categories of expectations with the nature and place of work in the hospital. CONCLUSION: When planning IPC training, these expectations of the HCP may be carefully addressed. Information about causative agent, transmission and clinical aspects may will give a contextual meaning to IPC training. Some important preventive measures, which few participants expected to learn must be analysed in detail to understand the attitude of the HCP towards them. Efforts to appraise the HCP for the importance of these measures and promoting its practice may play a vital role to curb the spread of infectious diseases.

Evaluation of Sensitization Program on Occupational Health Hazards for Nursing and Allied Health Care Workers in a Tertiary Health Care Setting.

Background: Occupational health hazard pertaining to health care providers is one of the neglected areas that need serious attention. Any compromise in their safety would result in reduction in workforce, which may affect patient care, keeping in mind the wide gap between the required number and actual health care workers (HCWs) available in the world over. Aim: This study was undertaken to evaluate the change in knowledge through a sensitization training program on occupational health hazards and vaccination for HCWs. Materials and Methods: Participants of the study included nursing and allied HCWs of a tertiary care health institute in Uttarakhand, India. Multiple training sessions, each of around 180 min, were held periodically in small groups with 20-40 participants over 2 years. Participants were assessed with pretest and posttest questionnaires, and feedback was taken. Questionnaires comprised three categories: general safety and ergonomics, biological hazards, and chemical and radiation hazards. Data of incident reporting for needlestick injury from 2017 to 2019 were retrieved. All data were compiled in Excel sheet and analyzed. Results: A total of 352 participants were included in the study. Mean ± SD for pretest and posttest scores were 5.3 ± 2.13 and 11.22 ± 2.15, respectively. There was considerable improvement in knowledge, which was found to be statistically significant with p-value of 0.001 for all categories. Participants in their feedback suggested for inclusion of psychosocial aspect in further training programs. Conclusion: Low baseline knowledge prior to attending the course highlights a need for an intervention through such structured sensitization program to create awareness and educate HCWs on common occupational health hazards and vaccination. Statistically significant improvement in posttest knowledge highlights effectiveness of the training program. A drastic rise in incident reporting for needlestick injury reflects fairly good impact of training program. Regular and appropriate form of training can reduce injuries resulting from occupational hazards and ensure healthy workforce contributing toward a positive impact on national economy.

Effectiveness of video modules in infection control trainings during COVID-19 pandemic: A quasi-experimental study in tertiary care institute.

BACKGROUND: Continuous pertinent trainings for infection prevention and control (IPC) measures are essential to ensure quality health-care services along with the safety of the health personnel. Amid the COVID-19 pandemic, the current study focusses on the utilization of explicated video modules training of all health-care personnel of the institute and assessment of the effectiveness of video training for IPC practices during COVID-19 pandemic. MATERIALS AND METHODS: A quasi-experimental study, one group pre- and posttest design, using Google Questionnaire forms was conducted at a tertiary care center. The training was assisted by trained tutors, and three in-house videos were demonstrated to the participants regarding specific IPC measures; "Do's and Don'ts;" "Hand hygiene and personal protective equipment's (PPE)" and "Environmental cleaning and disinfection." SPSS software version 23 (IBM Corp., N. Y., USA) was used for the analysis using the descriptive statistics, Chi-square test, Fisher's t-test, ANOVA, and post hoc Tukey's test. RESULTS: The level of knowledge increased significantly by 16% in the posttest. Statistically significant association between the levels of knowledge in pretest as well as posttest scores and age (P < 0.001), designation (P < 0.001), and years of experience (P < 0.001) was identified. The participants were satisfied with the video-assisted trainings and willing to use videos for revision. CONCLUSIONS: Video-assisted training modules similar to this study may be utilized to enhance the knowledge of various cadres of health-care staff regarding IPC practices.

Assessment of cognitive and psychomotor domains regarding biomedical waste management and hand hygiene among various categories of health-care professionals at a tertiary care center in Northern India.

BACKGROUND: Health care-associated infections (HAIs) are associated with high morbidity, mortality, and costs in the health-care sector. Large proportions of HAIs are preventable by following infection prevention activities such as hand hygiene (HH) and biomedical waste management (BMWM). AIM: The aim was to evaluate the effectiveness of a structured teaching session on the cognitive and psychomotor domains of BMWM and HH practices in a tertiary health-care institute. MATERIALS AND METHODS: Every participant was evaluated for pretest knowledge assessment using a prestructured format along with skill demonstration. The training included interactive sessions, open discussion, and demonstration of various skills with the active participation of various participants by trained faculty and infection control nursing officers. On completion, every participant underwent posttest evaluation. RESULTS: During 11-month study period, 450 health-care professionals (HCPs) participated in the training program. Cognitive domain score increased from 16.3 ± 2.4 to 21.3 ± 2.0 from pre- to post-test, respectively. In psychomotor domain, pre- and post-test scores for HH were 8.3 ± 3.5 and 14.3 ± 1.4, for BMWM, the corresponding values were 8.6 ± 2.1 and 9.8 ± 0.7, respectively. Overall change in the mean (± standard deviation) score between pre- and post-test for various domains of assessment was 5.0 (±2.7), 6.0 (±3.5), 1.1 (±1.8), and 12.2 (±5.3) for knowledge, HH skill demonstration, BMW segregation skill, and cumulative assessment, respectively. CONCLUSION: The initiation of a structured training program can result in a significant increase in participants' cognitive and psychomotor domains of learning, which may have an indirect impact on the prevention of HAIs.

Corona health-care warriors in India: knowledge, attitude, and practices during COVID-19 outbreak.

BACKGROUND: COVID-19 has become a global health emergency after its first case in Wuhan city, China. An increasing number of cases and deaths are challenging the health-care system globally. This study aims to assess knowledge, attitude, and practice toward COVID-19 disease among health personnel in rapid outbreak in India. MATERIALS AND METHODS: A cross-sectional survey was conducted using Google Forms through Google platform on-line. A total of 713 health personal allied health-care staff, working in different public and private health-care facilities, was conducted in the mid of April 2020. A structured knowledge, attitude, and practice questionnaire used to assess health personnel's knowledge, attitude, and practice toward COVID-19. All instruments were validated and pretested before use. Chi-square test, followed by binary logistic and multivariate regression, was applied to determine factors associated with knowledge scores. RESULTS: Seven hundred and thirteen health personnel participated, and 703 (98.6%) participants responded were analyzed for final results. 95.9% of the health personnel were aware about route of transmission and clinical symptoms (95.3%) of COVID-19. 63.7% believed that virus outbreak would be controlled globally and followed standard precautions (81.8%), including wearing the mask. Further, majority (98.3%) of the participants avoided social contact by not going to crowded places and not calling people to their homes (82.2%) during the advisory of the government. In binary logistic regression analyses, the adequate knowledge score found significantly associated with MBBS/bachelor's degree (odds ratio [OR]: 2.309, confidence interval [CI]: 1.232-4.324, P < 0.009) and master's degree (OR: 2.944, CI: 1.485-5.835, P < 0.002), working with government health-care facility (OR: 3.662, CI: 1.624-8.285, P < 0.002), and holding a post of a physician (OR: 7.735, CI: 2.210-27.091, P < 0.001) during outbreak. CONCLUSIONS: The level of education is associated with adequate knowledge scores among the health personnel. Type of health-care facility and post held in a health-care facility are significant predictors of adequacy of knowledge.

A rare case of coexisting tuberculosis with hydatid disease from North India with review of literature.

Coexisting tuberculosis (TB) and hydatid disease in an immunocompetent individual is an extremely rare occurrence. Given the similarities in the clinical manifestations and morbidities of both, specific diagnosis in individuals coinfected with these is difficult. We, hereby present a case of a 17-year-old adolescent man diagnosed to be a coinfection of pulmonary TB with pulmonary and cardiac hydatid disease, with the review of cases having a similar presentation. The coexistence of these infections should be considered in endemic areas. Management can only be done by a multidisciplinary approach including surgical, microbiological, histopathological and radiological facilities. Complete surgical excision of the cyst is the treatment of choice and medical therapy for both aetiologies should be appropriate to achieve cure.

Actinomycotic Osteomyelitis of the Hand and Wrist Treated with Pharmacotherapy Alone: A Case Report.

CASE: Primary infection by Actinomyces is uncommon because susceptibility to infection requires breakdown of the normal protective mucosal barrier. Furthermore, involvement of the upper extremity is rare. This case report presents clinical, radiological, and pathological findings in a 26-year-old patient with actinomycosis of the hand that was treated successfully by pharmacotherapy alone without any surgical debridement. CONCLUSION: Primary actinomycoses of the hand and upper extremity present as a challenging condition. It requires a high index of clinical suspicion and histopathologic diagnosis to guide treatment, typically involving antimicrobial therapy. This case highlights the usefulness of conservative treatment with antimicrobial therapy without surgical debridement.

Evaluation of existing knowledge, attitude, perception and compliance of hand hygiene among health care workers in a Tertiary care centre in Uttarakhand.

BACKGROUND AND AIMS: To evaluate existing knowledge, attitude and perception and compliance of hand hygiene activity among various healthcare workers in a tertiary care centre in Uttarakhand. METHODS: A cross sectional study was done for a period of two months. WHO hand hygiene and compliance form with slight modification were used to study knowledge, attitude, perception and compliance (overt and covert) by direct observational technique. Statistical analysis was done using Microsoft Excel 2010 and IBM SPSS 23.0 version software. RESULTS: A total of 220 participants were given questionnaire out of which 172 participated in study. 159 (92.4%) had already received training in HH in the past 3 years and were using alcohol based hand rub routinely. The overall correct knowledge score of various professional categories of HCW was good i.e. 71.6% Most of the healthcare workers knew the importance of adhering to this simple practice in prevention of healthcare associated infections. Most of them were aware of the conditions before or after when HH activity has to be performed. Poor compliance of hand hygiene was noted among healthcare workers on covert observation. For given hand hygiene opportunities the HH was started in 53.2% and 15.7% of overt and covert observations, respectively. However, HH compliance decreased drastically among HCW, which was 15.7% and 1.6% of overt and covert observations, respectively. INTERPRETATION AND CONCLUSIONS: The acceptance of the fact by most of the HCW that direct vigilance over this activity helped them performed better, suggested the demand of regular surveillance and several other promotional activities in the centre.

Rational use of face mask in a tertiary care hospital setting during COVID-19 pandemic: An observational study.

Masks play a role in the protection of health-care workers (HCWs) from acquiring respiratory infections, including coronavirus disease 2019 (COVID-19) in health-care settings. This observational study was conducted among 382 HCWs in a tertiary care setting over a period of 1 month. Descriptive analysis was done to assess the rational and recommended use of masks/respirators during COVID-19 pandemic using a structured observation checklist as a survey tool. A total of 374 HCWs were included, 64.9% of whom were using face masks rationally as mentioned per risk area categorization with a predominance of triple-layered mask during all 4 weeks. Overall, 64.1% used masks correctly. Clear guidelines and strategies can help to increase the compliance of HCWs with rational use of face masks.

A review of modern technologies for tackling COVID-19 pandemic.

OBJECTIVE: Science and technology sector constituting of data science, machine learning and artificial intelligence are contributing towards COVID-19. The aim of the present study is to discuss the various aspects of modern technology used to fight against COVID-19 crisis at different scales, including medical image processing, disease tracking, prediction outcomes, computational biology and medicines. METHODS: A progressive search of the database related to modern technology towards COVID-19 is made. Further, a brief review is done on the extracted information by assessing the various aspects of modern technologies for tackling COVID-19 pandemic. RESULTS: We provide a window of thoughts on review of the technology advances used to decrease and smother the substantial impact of the outburst. Though different studies relating to modern technology towards COVID-19 have come up, yet there are still constrained applications and contributions of technology in this fight. CONCLUSIONS: On-going progress in the modern technology has contributed in improving people's lives and hence there is a solid conviction that validated research plans including artificial intelligence will be of significant advantage in helping people to fight this infection.

Incidental Finding of Nocardia: A Case Series from a Tertiary Care Centre in Uttarakhand.

Nocardiosis is a rare bacterial infection that may lead to a severe disease. These infections are rare among normal population and are showing an increasing trend worldwide attributable to the increase in the immunosuppressed population. Most of these patients present with nonspecific clinical features such as fever, productive cough, and exertional dyspnoea as seen in our series of patients which makes it difficult to be diagnosed. Pulmonary nocardiosis is rarely clinically suspected and often diagnosed very late in the course of disease resulting in high mortality. A similar observation was made in one of our cases where the patient was being treated on the lines of pneumonia, and in the end she was diagnosed with pulmonary nocardiosis. In view of the limited literature available, we report here a case series of pulmonary nocardiosis in immunosuppressed patients diagnosed incidentally by fungal KOH mount. The most common conditions causing immunosuppression were type II DM, COPD, and pulmonary tuberculosis.

Serological evidence of human leptospirosis in patients with acute undifferentiated febrile illness from Uttarakhand, India: A pilot study.

CONTEXT: To the best of our knowledge, there are no reports of serological evidence of human leptospirosis from Uttarakhand state in India. AIMS: The aim of this study was to screen for serological evidence of leptospirosis in patients with acute undifferentiated febrile illness at a tertiary care teaching hospital in Uttarakhand. SETTINGS AND DESIGN: A pilot study was conducted from March to November 2017. SUBJECTS AND METHODS: Fifty-three adult patients who presented in Medicine outpatient Department with a history of fever of ≥7 up to 14 days duration with or without other associated symptoms such as a headache, rashes, myalgia, arthralgia, and conjunctival suffusion were enrolled in the study using convenience sampling technique. Blood samples of these patients were collected and subjected to peripheral smear examination for malaria parasites, dengue immunoglobulin M (IgM) immunochromatographic card test, IgM Typhidot, Leptospira and Scrub typhus IgM ELISA, respectively. Aerobic blood culture was performed in 24 cases. Relevant clinico-epidemiological details were obtained as per the pro forma formulated in accordance with the modified Faine's criteria. STATISTICAL ANALYSIS USED: Descriptive statistics. RESULTS: The study population consisted of 50.94% of males and 49.06% of females with a mean age ± standard deviation of 34.2 ± 15.2 years. Fifty febrile patients had additional symptoms of which myalgia was the most common (81.1%) followed by arthralgia (22.6%). Peripheral smears of all patients were negative for malaria parasites. Dengue and Typhidot IgM positivity was observed in two and eight patients, respectively. Six and five patients were tested positive by leptospira and scrub typhus IgM ELISA, respectively. Salmonella Typhi was isolated from blood sample of only one patient. Serum samples of two patients showed dual positivity. All six leptospira seropositive patients satisfied modified Faine's criteria. CONCLUSIONS: Leptospirosis is a seemingly unexplored infection in Uttarakhand and should be considered as a differential diagnosis in patients with acute undifferentiated febrile illness.

Antigenicity of a Bacterially Expressed Triple Chimeric Antigen of Plasmodium falciparum AARP, MSP-311 and MSP-119: PfAMSP-Fu35.

Development of fusion chimeras as potential vaccine candidates is considered as an attractive strategy to generate effective immune responses to more than one antigen using a single construct. Here, we described the design, production, purification and antigenicity of a fusion chimera (PfAMSP-Fu35), comprised of immunologically relevant regions of three vaccine target malaria antigens, PfAARP, PfMSP-3 and PfMSP-1. The recombinant PfAMSP-Fu35 is expressed as a soluble protein and purified to homogeneity with ease at a yield of ~ 7 mg L-1. Conformational integrity of the C-terminal fragment of PfMSP-1, PfMSP-119 was retained in the fusion chimera as shown by ELISA with conformation sensitive monoclonal antibodies. High titre antibodies were raised to the fusion protein and to all the three individual components in mice and rabbits upon immunization with fusion chimera in two different adjuvant formulations. The sera against PfAMSP-Fu35 recognized native parasite proteins corresponding to the three components of the fusion chimera. As shown by invasion inhibition assay and antibody mediated cellular inhibition assay, antibodies purified from the PfAMSP-Fu35 immunized serum successfully and efficiently inhibited parasite invasion in P. falciparum 3D7 in vitro both directly and in monocyte dependent manner. However, the invasion inhibitory activity of anti-AMSP-Fu35 antibody is not significantly enhanced as expected as compared to a previously described two component fusion chimera, MSP-Fu24. Therefore, it may not be of much merit to consider AMSP-Fu35 as a vaccine candidate for preclinical development.

Correction: Phase I Clinical Trial of a Recombinant Blood Stage Vaccine Candidate for Plasmodium falciparum Malaria Based on MSP1 and EBA175.

[This corrects the article DOI: 10.1371/journal.pone.0117820.].

Phase I Clinical Trial of a Recombinant Blood Stage Vaccine Candidate for Plasmodium falciparum Malaria Based on MSP1 and EBA175.

BACKGROUND: A phase I randomised, controlled, single blind, dose escalation trial was conducted to evaluate safety and immunogenicity of JAIVAC-1, a recombinant blood stage vaccine candidate against Plasmodium falciparum malaria, composed of a physical mixture of two recombinant proteins, PfMSP-1(19), the 19 kD conserved, C-terminal region of PfMSP-1 and PfF2 the receptor-binding F2 domain of EBA175. METHOD: Healthy malaria naïve Indian male subjects aged 18-45 years were recruited from the volunteer database of study site. Fifteen subjects in each cohort, randomised in a ratio of 2:1 and meeting the protocol specific eligibility criteria, were vaccinated either with three doses (10 µg, 25 µg and 50 µg of each antigen) of JAIVAC-1 formulated with adjuvant Montanide ISA 720 or with standard dosage of Hepatitis B vaccine. Each subject received the assigned vaccine in the deltoid muscle of the upper arms on Day 0, Day 28 and Day 180. RESULTS: JAIVAC-1 was well tolerated and no serious adverse event was observed. All JAIVAC-1 subjects sero-converted for PfF2 but elicited poor immune response to PfMSP-1(19). Dose-response relationship was observed between vaccine dose of PfF2 and antibody response. The antibodies against PfF2 were predominantly of IgG1 and IgG3 isotype. Sera from JAIVAC-1 subjects reacted with late schizonts in a punctate pattern in immunofluorescence assays. Purified IgG from JAIVAC-1 sera displayed significant growth inhibitory activity against Plasmodium falciparum CAMP strain. CONCLUSION: Antigen PfF2 should be retained as a component of a recombinant malaria vaccine but PfMSP-1(19) construct needs to be optimised to improve its immunogenicity. TRIAL REGISTRATION: Clinical Trial Registry, India CTRI/2010/091/000301.