COVID-19 vaccination: Immune response in healthcare workers-A study with review of literature.

Background: As the world has been going through a pandemic of coronavirus disease 2019 (COVID-19) for the past two years, a safe and effective vaccine was urgently needed. Vaccination against the disease was launched in India on January 16, 2021 with healthcare workers, frontline workers, and the elderly above 60 years being the first beneficiaries. Vaccines being used in India are Covishield and Covaxin. Materials and Methods: Fifteen healthcare workers (HCWs) who were vaccinated with Covishield or Covaxin were included in the study, and T cell, B cell and antibody response of the HCWs were analyzed. Blood samples collected from every subject were sent for antibody analysis, hematological workup for cell counts, and flow cytometry was performed for various subsets of lymphocytes. Hematological variables in naïve HCWs (who never had any natural infection) and recovered HCWs (those recovered from natural infection) were compared. Results: Antibody index among recovered HCWs was significantly higher than the naïve HCWs. All the leucocyte parameters showed a higher median value in the recovered group except total leucocyte count (TLC), T helper cell count (Th cell), T helper cell to T cytotoxic cell (Th cell: CTL) ratio and natural killer (NK) cell. But only Th: CTL ratio showed a statistically significant difference. Conclusion: This study shows that the antibody index among individuals who had both vaccination and COVID-19 infection is significantly higher than those who just had vaccination. T helper cell to T cytotoxic cell ratio is lowered in the recovered HCWs as compared to the naïve HCWs and this finding is statistically significant.

Primary oral histoplasmosis in an immunocompetent host masquerading as malignancy.

Histoplasma capsulatum is known to cause deep mycotic infections, the primary site being pulmonary, and may disseminate in immunosuppressed patients. Oral presentation is usually a part of disseminated disease however may rarely occur as an isolated event. Extensive literature search has shown that only 17 cases of primary oral histoplasmosis in immunocompetent hosts have been reported from India to date. We hereby report a rare case of primary oral histoplasmosis in a middle-aged, non-diabetic, and HIV-negative patient masquerading as malignancy.

Proportion of syphilis and hepatitis B and C virus infections among the Integrated Counselling and Testing Centre attendees of a tertiary care hospital.

Introduction: Human Immunodeficiency Virus (HIV) affects the immune system of the body, causing a breakdown in its normal defenses and leaving it vulnerable to a host of life-threatening diseases. High-risk behaviors and routes of transmission for sexually transmitted infections such as syphilis, hepatitis B and hepatitis C are identical with HIV. This study was conducted to assess the proportion of syphilis and hepatitis B and C virus infections in HIV-positive and HIV-negative individuals, and their association with socioeconomic and other factors in Integrated Counselling and Testing Centre (ICTC) attendees, and to determine the association of absolute CD4+ T-lymphocyte count with these co-infections in HIV-positive individuals. Materials and Methods: The study was conducted in the Department of Microbiology of a tertiary care hospital. It included 100 HIV-positive individuals and 100 matched HIV-negative controls attending the ICTC. HIV-positive patients on antiretroviral therapy and patients with history of current/past treatment for chronic hepatitis infection were excluded from the study. Blood samples were tested for HIV, syphilis, and hepatitis B and C infections. Results: The prevalence of syphilis, hepatitis B, and hepatitis C was observed in 3.5%, 2%, and 10% of patients, respectively. The frequency of hepatitis B virus (HBV) infection in HIV-positive and HIV-negative individuals was 1% and 3%, respectively. Hepatitis C virus (HCV) infection among HIV-positive and HIV-negative patients was 16% and 4%, respectively. Syphilis was seen in 7% of the HIV-infected patients. The mean CD4+ count for the HIV-positive patients with either syphilis, HBV, or HCV infections was 252 ± 137.5 cells/µl. Significant associations between HIV infection and education below high school, IV drug abuse, and multiple sexual partners were observed. Conclusions: The HIV-infected patients were observed to be at an increased risk of acquiring syphilis and HCV co-infections through the shared routes of transmission. Routine screening of these patients for concurrent syphilis and viral hepatitis may aid in prompt diagnosis and treatment with improved outcomes, which in turn may decrease the further spread of these infections.

Dynamic responses of a damaged double Euler-Bernoulli beam traversed by a 'phantom' vehicle.

In this paper, the dynamic response of a damaged double-beam system traversed by a moving load is studied, including passive control using multiple tuned mass dampers. The double-beam system is composed of two homogeneous isotropic Euler-Bernoulli beams connected by a viscoelastic layer. The damaged upper beam is simulated using a double-sided open crack replaced by an equivalent rotational spring between two beam segments, and the lower primary beam is subjected to a moving load. The load is represented by a moving Dirac delta function and by a quarter car model, respectively. Road surface roughness (RSR) is classified as per ISO 8606:1995(E). The effect of vehicle speed of the moving oscillator and variable RSR profiles on the dynamics of this damaged double Euler-Bernoulli beam system for different crack-depth ratios (CDRs) at various crack locations is studied. It is observed that coupling of two beams leads to a vehicular effect on the damaged beam, even when no vehicle on it is present. The effects of single and multiple tuned mass dampers to control the vibrational responses of the primary beam due to damage on the secondary beam is studied next. The performance of tuned mass dampers to reduce the transverse vibrations of the damaged double-beam system and of the quarter car is investigated. The paper links the coupling between the two levels of double beam with the inertial coupling of the vehicle to the double-beam system.

The seroprevalence of severe acute respiratory syndrome coronavirus 2 in Delhi, India: a repeated population-based seroepidemiological study.

BACKGROUND: Three rounds of a repeated cross-sectional serosurvey to estimate the change in seroprevalence of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) were conducted from August to October 2020 in the state of Delhi, India, in the general population ≥5 y of age. METHODS: The selection of participants was through a multistage sampling design from all 11 districts and 280 wards of the city-state, with multistage allocation proportional to population size. The blood samples were screened using immunoglobulin G (IgG) enzyme-linked immunosorbent assay kits. RESULTS: We observed a total of 4267 (N=150 46), 4311 (N=17 409) and 3829 (N=15 015) positive tests indicative of the presence of IgG antibody to SARS-CoV-2 during the August, September and October 2020 serosurvey rounds, respectively. The adjusted seroprevalence declined from 28.39% (95% confidence interval [CI] 27.65 to 29.14) in August to 24.08% (95% CI 23.43 to 24.74) in September and 24.71% (95% CI 24.01 to 25.42) in October. On adjusted analysis, participants with lower per capita income, living in slums or overcrowded households and those with diabetes comorbidity had significantly higher statistical odds of having antibody positivity (p<0.01). CONCLUSIONS: Nearly one in four residents in Delhi, India ≥5 y of age had the SARS-CoV-2 infection during August-October 2020.

Positive QuantiFERON test and the severity of COVID-19 disease: A prospective study.

BACKGROUND: A strong negative correlation is reported between the Bacille Calmette Guerin (BCG) index and COVID-19 mortality. The present study explored if frequent exposure to strong Th1 antigens like Mycobacteria or Salmonella have any effect on the progression of the disease in COVID-19 patients. METHODS: This prospective comparative study comprised of 3 groups of 20 each of mild or asymptomatic COVID-19 patients (A), severely ill patients (S) and healthy volunteers with a COVID Negative report (H). RESULTS: QuantiFERON TB Gold (QFT) which is interferon gamma release assay (IGRA) against Mtb antigen was used to quantify immunity status of patients against the tuberculosis. Group S showed positive QFT in only 15% patients as against 50% QFT positive patients in group A and H. All fourteen patients in group S with QFT negative report died while 5 of six survived patients showed positive QFT report either on initial or repeat testing done at 6 weeks. The sixth survived patient was QFT negative but showed high antibody titre against H antigen (TH) on Widal test. All severely ill group S patients showed huge reduction of IGRA even to the mitogen stimulus thus suggesting gross general unresponsiveness of T cells. Presence of BCG scar showed no correlation with prevalence or progression of the disease. CONCLUSION: Population in an endemic area of tuberculosis and typhoid with good community exposure to these antigen is likely to withstand COVID -19 better and show reduced mortality following it.

Seroprevalence of antibodies to SARS-CoV-2 and predictors of seropositivity among employees of a teaching hospital in New Delhi, India.

OBJECTIVE: Healthcare workers (HCWs) are at a high risk of contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) due to the increased likelihood of clinical exposure during patient management. The study objective was to determine the seroprevalence of antibodies to SARS-CoV-2 and its predictors among hospital employees. METHODS: The cross-sectional study was conducted at a teaching hospital from August 2020 to September 2020 among 1,401 employees, including 1,217 HCWs, in New Delhi, India. The serum samples were examined for immunoglobulin G (IgG) antibodies to SARS-CoV-2 using the COVID Kavach-Anti-SARS-CoV-2 IgG Antibody Detection enzyme-linked immunosorbent assay kit. Data were collected electronically using the EpiCollect mobile platform. A p < 0.05 was considered to indicate statistical significance. RESULTS: A total of 169 participants (12.1%) had detectable IgG antibodies to SARS-CoV-2. The highest seropositivity rate was observed in the administrative staff (20.1%), while it was lowest among medical doctors (5.5%, p < 0.001). Male sex and ever having lived in a containment zone were independently associated with past infection with SARS-CoV-2. CONCLUSION: The seroprevalence of SARS-CoV-2 infection in health workers may be lower than in the general population in New Delhi. However, nonpharmaceutical interventions were not associated with a reduction in the risk of acquisition of SARS-CoV-2.

Bioavailable turmeric extract for knee osteoarthritis: a randomized, non-inferiority trial versus paracetamol.

BACKGROUND: To compare the efficacy and safety of bioavailable turmeric extract versus paracetamol in patients with knee osteoarthritis (OA). METHODS: In this randomized, non-inferiority, controlled clinical study, patients of knee OA were randomized to receive bioavailable turmeric extract (BCM-95®) 500 mg capsule two times daily or paracetamol 650 mg tablet three times daily for 6 weeks. The primary outcome measure was Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) pain subscale. The secondary outcome measures were WOMAC total, WOMAC stiffness, and WOMAC physical function scores. Responder analysis of individual patients at different levels (≥ 20%, ≥ 50%, and ≥ 70%) for WOMAC score was calculated. TNF alpha and CRP levels were evaluated and adverse events (AE) were also recorded. RESULTS: Seventy-one and seventy-three knee OA patients, respectively in bioavailable turmeric extract and paracetamol groups, completed the study. Non-inferiority (equivalence) test showed that WOMAC scores were equivalent in both the groups (p value < 0.05) in all the domains within the equivalence limit defined by effect size (Cohen's d) of 0.5 whereas CRP and TNF-α were better reduced with turmeric extract than paracetamol. After 6 weeks of treatment, WOMAC total score, pain, stiffness, and function scores got a significant improvement of 23.59, 32.09, 28.5, and 20.25% respectively with turmeric extract. In the turmeric extract group, 18% of patients got more than 50% improvement and 3% of patients got more than 70% improvement in WOMAC pain and function/stiffness score and none of the patients in the paracetamol group met the criteria. CRP and TNF-α got significantly reduced (37.21 and 74.81% respectively) in the turmeric extract group. Adverse events reported were mild and comparatively less in the turmeric extract group (5.48%) than in the paracetamol group (12.68%). CONCLUSION: The results of the study suggest that bioavailable turmeric extract is as effective as paracetamol in reducing pain and other symptoms of knee osteoarthritis and found to be safe and more effective in reducing CRP and TNF-α. TRIAL REGISTRATION: Clinical Trials Registry - India CTRI/2017/02/007962 . Registered on 27 February 2017.

Seroprevalence of SARS-CoV-2 and Risk Assessment Among Healthcare Workers at a Dedicated Tertiary Care COVID-19 Hospital in Delhi, India: A Cohort Study.

Background Healthcare workers (HCWs) have a substantially higher risk of Covid-19 infection but there is a paucity of information on the risk factors of disease transmission in high-burden real-world settings. The study objective was to determine the seroprevalence of SARS-CoV-2 among healthcare workers in a high-burden Covid-19 setting and to estimate the incidence and identify the risk factors of infection. Methods This was a prospective observational cohort study amongst doctors and nurses working at a dedicated Covid-19 tertiary care government hospital in Delhi, India. A baseline blood sample (2-3ml) was collected from all the participants to test for the presence of total SARS-CoV-2 antibodies. The HCWs that were seronegative (non-reactive) at baseline were followed-up for ≥21≤28 days with the collection of a second blood sample to assess for the incidence of SARS-CoV-2 infection. Results A total of 321 (51.3%, 95% C.I 47.4, 55.3) HCWs were detected with SARS-CoV-2 antibodies on baseline examination. The seroprevalence, when adjusted for assay characteristics, was 54.5% (95% C.I 50.3, 58.6). On bivariate analysis, SARS-CoV-2 antibody positivity lacked statistically significant association with either age, sex, occupation, cumulative duty duration, and smoking status. The incidence of seroconversion in the baseline seronegative cohort on follow-up after 21-28 days was observed in 35 (14.9%) HCWs (n=245). Furthermore, the self-reported adherence to infection prevention and control measures did not show a statistically significant association with antibody positivity in the HCWs, neither at baseline nor on follow-up. Conclusions  The high risk of SARS-CoV-2 transmission in HCWs may be substantially reduced by adherence to Infection Prevention Control (IPC) and protective measures.

Localized cutaneous infection caused by Scedosporium apiospermum: Report of a case diagnosed on cytology.

Scedosporium apiospermum (also known as Pseudallescheria boydii) is a ubiquitous filamentous fungus. This fungus is known as a cause of mycetoma, which may occur in a normal immune host following trauma and nonmycetoma-localized skin infections without grain production which are much rarer. However, in an immunocompromised host, S. apiospermum may cause a life-threatening infection. We describe a case of S. apiospermum infection of the left middle finger in an immunocompetent patient, which was diagnosed on cytology and later confirmed on culture.

Phaeohyphomycosis breast masquerading as fibroadenoma in a young teenage girl.

Phaeohyphomycosis is an unusual granulomatous fungal infection, observed in immunocompromised or diabetic patients; however, it is even rarer in immunocompetent patients. Cytological findings of the same have been infrequently reported. The histopathological diagnosis or fungal culture helps in definitive diagnosis to identify the exact fungal species. Hereby, we report a rare case of invasive fungal infection in a breast lump in a young female, presenting as fibroadenoma breast. Fine needle aspiration cytology from the breast lesion showed the presence of septate acute-angled branching fungal hyphae with focal pigmentation, morphologically suggestive of phaeohyphomycosis which was positive with fungal stains. This was later confirmed on biopsy as histopathology slides showed the presence of prominent pigmented fungal hyphae. The pus culture from needle aspirate also showed phaeohyphomycotic fungal organism delineating the species Exophiala dermatitidis. Aspiration cytology is crucial for the diagnosis of fungal infection in such cases. An appropriate diagnosis will help in early detection and treatment of such infections as these are usually associated with high morbidity and mortality.

Comparison of Hay's criteria with Nugent's scoring system for diagnosis of bacterial vaginosis.

Although Nugent's criterion is considered as the gold standard for the diagnosis of bacterial vaginosis (BV), the method requires an experienced slide reader and considerable time and skill. In this study, we compared the method of Hay and Ison with Nugent's scoring criteria. Vaginal specimens were collected from a total of 213 women, presenting with or without the symptoms of vaginitis. Diagnosis of BV was done using Nugent' and Hay's method. Sensitivity, specificity, and predictive values for positive and negative test were calculated for Hay's method using Nugent's method as the gold standard. We diagnosed 70 cases (32.86%) of BV by Nugent's method and 87 (40.85%) cases by the Hay's method. Sensitivity, specificity, predictive value of positive result, predictive value of negative result, and Kappa value when evaluating Hay's criteria using Nugent's criteria as the gold standard were ≥97.2%, ≥88.1%, ≥80.4%, ≥97.1%, and ≥0.830, respectively, when Hay's grade II and/or Nugent's intermediate score were considered either as negative or positive or excluded. Using Nugent score for the intermediate group is the most difficult. Hay's method shows good agreement with the gold standard method of Nugent et al. and can be used as an alternative to Nugent's criteria in busy tertiary care hospitals.

Enteric spore-forming opportunistic parasites in HIV / AIDS.

Human Immunodeficiency Virus (HIV) infection causes progressive damage to both limbs of the immune system, which results in a plethora of opportunistic infections. Among the various opportunistic infections, gastrointestinal infections are very common in HIV / Acquired Immunodeficiency Syndrome (AIDS). Opportunistic spore-forming protozoal parasites, namely, Cryptosporidium parvum, Isospora belli, Cyclospora cayetanensis, and Microsporidia, play a major role in causing chronic diarrhea, accompanied with weight loss, in patients with HIV / AIDS. The purpose of this review is to discuss the salient microbiological, clinical, and diagnostic aspects of important enteric spore-forming opportunistic parasites in HIV / AIDS.

Prevalence of bacterial vaginosis among women in Delhi, India.

BACKGROUND & OBJECTIVE: Bacterial vaginosis is the most common cause of vaginal discharge among women in reproductive age. Surveillance studies on bacterial vaginosis are mostly based on specialist clinic settings. As few population-based prevalence surveys of bacterial vaginosis have been conducted, we studied the prevalence of bacterial vaginosis in the urban and rural communities in Delhi, and to associate the presence of bacterial vaginosis with demographic profile, risk factors and presence of other reproductive tract infections (RTIs)/ sexually transmitted infections (STIs). METHODS: Vaginal specimens for Gram-stain evaluation of vaginal flora for diagnosis of bacterial vaginosis and culture of Trichomonas vaginalis and Candida spp, blood samples for HIV and syphilis serology, and urine for detection of Neisseria gonorrhoeae and Chlamydia trachomatis were collected from women (15-49 yr) from rural and urban areas. Information on demographic characteristics, risk factors and clinical symptoms was obtained. RESULTS: Bacterial vaginosis was diagnosed in 70 (32.8%) subjects. A high percentage though asymptomatic (31.2%) were found to have bacterial vaginosis. Highest prevalence was seen in urban slum (38.6%) followed by rural (28.8%) and urban middle class community (25.4%). All women with vaginal trichomoniasis were found to have bacterial vaginosis while 50 per cent of subjects having syphilis also had bacterial vaginosis.. INTERPRETATION & CONCLUSION: The study showed high prevalence of bacterial vaginosis. The asymptomatic women having bacterial vaginosis are less likely to seek treatment for the morbidity and thus are more likely to acquire other STIs. Women attending various healthcare facilities should be screened and treated for bacterial vaginosis to reduce the risk of acquisition of other STIs.