Utility of Platelet Indices as a Predictive Marker in Sepsis: An Observational Study From North East India.

Background Unraveling sepsis remains the holy grail of clinical medicine and the commonest cause of in-hospital mortality worldwide. Various newer biomarkers have emerged in recent years that aid in the diagnosis and prognostication of sepsis. However, the widespread use of these is limited by availability, cost, and long turnaround times. Considering the crucial role of hematological parameters in infectious conditions, the present study aimed to evaluate the association of various platelet indices with the severity and outcomes in patients diagnosed with sepsis. Methods This was a single-center, prospective, observational study comprising 100 consecutive patients who fulfilled the selection criteria in the emergency department of a tertiary care hospital from June 2021 to May 2022. All patients underwent history taking, physical examination, and necessary laboratory investigations, including complete blood counts, biochemistry panel, and radiographic and microbiological tests. A detailed assessment of various platelet indices (platelet count, mean platelet volume, and platelet distribution width) was performed, and its association with outcomes was derived. The Sequential Organ Failure Assessment (SOFA) score was recorded for all patients. Results The majority of the study population was male (52%) with a mean age of 48.05±19.27 years. Respiratory infection (38%) was the most common origin of sepsis followed by genitourinary infections in 27%. The mean platelet count on admission was 1.83±1.21 lakhs/mm3. The incidence of thrombocytopenia (<1.5 lakhs/ mm3) in our study sample was 35%. The overall in-hospital mortality of the study group was 30%. Thrombocytopenia was significantly associated with a higher SOFA score (7.4±3 vs. 3.7±1.9, P<0.05), longer hospital stays (10.8±4.6 vs. 7.8±3.9; p<0.05), and mortality (17 vs. 13; p<0.05). The change in platelet count, platelet distribution width, and mean platelet volume from Day 1 to Day 3 also correlated with outcomes. There was a decrease in platelet count among the non-survivors compared to an increase in platelet count among survivors from Day 1 to Day 3 (p<0.05). Similarly, the change in platelet distribution width showed a decreasing trend among the survivors compared to an increasing trend among the non-survivors (p<0.05). The mean platelet volume of non-survivors increased from Day 1 to Day 3 compared to a downward trend among the survivors (p<0.05). Conclusion Septic patients with thrombocytopenia on admission had a higher SOFA score and were associated with worse outcomes. Additionally, platelet indices, such as platelet distribution width and mean platelet volume, serve as important prognostic markers among sepsis patients. Change in these parameters from Day 1 to Day 3 also correlated with outcomes. These indices are simple and affordable, allowing for their serial assessment to aid in the prognosis of sepsis.

Rationality of Prescriptions by Rational Use of Medicine Consensus Approach in Common Respiratory and Gastrointestinal Infections: An Outpatient Department Based Cross-Sectional Study from India.

BACKGROUND: Drug utilisation studies are relevant for the analysis of prescription rationality and are pertinent in today's context of the increasing burden of antimicrobial resistance. Prescriptions for patients with diarrhoea or Acute Respiratory Infection (ARI) have been analysed in this study to understand the prescription pattern among various categories of prescribers in two tertiary care centers. METHODS: This cross-sectional study was conducted from August 2019 to December 2020 in the medicine and pediatrics outpatient departments of two government teaching hospitals in West Bengal, India. A total of 630 prescriptions were evaluated against WHO standards. Prescriptions were assessed by a 'Rational Use of Medicine Consensus committee' approach. RESULTS: The Fixed Dose Combination (FDC) was used in half of the patients (51%). Both the generic prescription (23.3%) and adherence to hospital formulary rates (36.5%) were low. The antibiotics prescription rate was high (57%), and it was higher for diarrhoea than ARI. Deviations from the standard treatment guidelines were found in 98.9% of prescriptions. Deviations were commonly found with prescriptions written by the junior doctors (99.6%). CONCLUSION: Irrational prescribing patterns prevail in tertiary care centers and indicate the necessity of awareness generation and capacity building among prescribers regarding AMR and its unseen consequences.

Vertical Transmission Rate of Human Immunodeficiency Virus Exposed Twin Pregnancies and Associated Factors in West Bengal, India: a Retrospective Cohort Study.

Twin pregnancies are often associated with adverse obstetric outcomes. The mother-to-child transmission of the human immunodeficiency virus (HIV) in twin pregnancies has been less explored. Therefore, the present study aimed to determine the risk of vertical transmission of HIV in HIV-exposed twin pregnancies compared with that of singleton pregnancies and to explore the associated factors. We conducted a retrospective cohort study involving 348 HIV-exposed babies (58 twins and 290 singletons) through a systematic sampling from the program database of West Bengal, India, from April 2016 to March 2021. HIV vertical transmission rates were compared between single and twin live births. The effects of factors such as maternal age, timing of maternal HIV diagnosis, duration of antiretroviral treatment, mode of delivery, birth weight, and the sex of the baby were determined. The HIV transmission rate for twin pregnancies (15.5%) was significantly higher than that for single live births (5.5%) (adjusted odds ratio [OR] = 3.38 [1.17-9.69]). Among twin deliveries, maternal HIV diagnosis during the intrapartum and postpartum period was associated with HIV transmission (crude OR = 11.0, [2.2-54.9]). Perinatal HIV transmission is more common in twin pregnancies and is associated with the time of detection of maternal HIV. Therefore, early HIV detection and additional antiretroviral regimens should be considered for twin pregnancies.

Epidemiological drivers of mother to child HIV transmission in West Bengal, India: A retrospective cohort study.

BACKGROUND: HIV transmission through vertical route can be reduced to a large extent with combination of medical interventions. Apart from maternal HIV status several other epidemiological attributes determine this transmission dynamics.Objective: The objective of this study was to identify various associated factors that determine and modify the risk of HIV transmission from a mother living with HIV to her child.Materials and method: A retrospective cohort-study was conducted with 518 HIV-positive pregnant women with delivering live babies between April 2016 - September 2018. The HIV status of the children was ascertained with polymerase chain reaction. A number of socio-demographic and medical attributes were compared between HIV-positive (41) and HIV-negative babies (477) using bivariate and multivariate methods to identify disease modifying factors. RESULTS: Maternal HIV detection during the postnatal period (AOR = 11.2; 5.2 - 23.8), low birth weight (AOR = 2.7; 1.2 - 5.9), and vaginal delivery (AOR = 2.8; 1.01 - 7.7) were significantly associated with vertical transmission of HIV. Lower duration of maternal antiretroviral treatment and higher maternal age (>25 years) were also associated in bivariate analysis. CONCLUSION: The battery of PPTCT (Prevention of Parent to Child Transmission) interventions should be tailored in such a way to address all the epidemiological attributes influencing vertical transmission.

Socio-Demographic Correlates of HIV Sero-Discordance among Couples in West Bengal, India: a Cross Sectional Analysis.

Serodiscordant couples serve as potential sources of human immunodeficiency virus (HIV) transmission. Understanding the demographic dynamics of serodiscordant couples plays an important role in tailoring interventions to eliminate HIV infection. We conducted this cross-sectional analysis among 314 integrated counseling and testing centers in West Bengal, India, from April 2016 to March 2020. General individuals who were detected as HIV-reactive and whose spouses were also tested for HIV comprised the study population, in which a total of 8,740 couples were included. Sociodemographic variables were compared across concordant and discordant arms, as well as between male positive (M+ F-) and female positive (F+ M-) subgroups of serodiscordant couples. Among the couples studied, 35.2% (95% CI: 34.2-36.2%) were serodiscordant. Among serodiscordant couples, the proportion of M+ F- (86.1%) was significantly higher than that of F+ M- (13.9%). We observed that higher mean ages of couples, higher education, business and service occupations, and urban residence were significantly associated with the serodiscordance relationship (P < 0.05). A high mean age of couples and a low proportion of housewives were associated with the F+ M- subgroup. As approximately 35% of serodiscordant couples carry the risk of transmission to negative spouses, particularly in older age and urban residence, reorientation of HIV programs may be required to avert transmission in the future.

High Stillbirth Rate among Human Immunodeficiency Virus-Infected Pregnant Women in West Bengal, India: a Retrospective Cohort Study.

Human immunodeficiency virus (HIV) infection in pregnancy may result in adverse obstetric outcomes, such as stillbirth. The present study aimed to compare the stillbirth rate (SBR) in HIV-infected pregnant women with that in the general population, observing the year-wise trends of HIV infection-associated SBR and identifying possible associated exposures. A retrospective cohort study was conducted through the analysis of secondary data from 314 integrated counseling and testing centers across the state of West Bengal, India, from 2012 to 2020. A total of 3,478 HIV-infected pregnant women were followed up, and year-wise SBR trends were compared with that among all pregnancies of the state as per the latest available Sample Registration System report in India. A linear regression analysis of the year-wise trend in SBR was performed. T-test of two means and the relative risk (RR with 95% confidence interval) was conducted to identify the associations between different exposures and stillbirth. The SBR was significantly higher (26.7/1,000) in HIV-infected pregnancies than in all pregnancies (5/1,000) and was significantly reduced after the initiation of antiretroviral treatment (RR = 0.09: 0.05-0.16). Spouse testing for HIV (surrogate marker for familial involvement) (RR = 0.35: 0.20- 0.61) and maternal literacy (RR = 0.62: 0.40-0.97) were also found to be significantly effective in preventing stillbirth.

Exploring Repurposing Potential of Existing Drugs in the Management of COVID-19 Epidemic: A Critical Review.

Despite high morbidity and mortality of ongoing coronavirus disease 2019 (COVID-19) pandemic, no specific therapy has been established till date. Though in vitro studies identified various molecules as possible therapies against severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), these findings call for substantiation by human studies. We conducted this review aiming at reporting evidences on therapies used so far globally for management of COVID-19 in clinical settings. We searched electronic databases as PubMed, Google Scholar, EMBASE and extracted 612 possible studies as on May 31, 2020. We included original studies of any epidemiological design done on human COVID-19 patients and measured clinical outcomes. Finally, following removal of duplicates and studies meeting exclusion criteria, we derived 22 studies, of which eight were clinical trials, seven were case reports and case series, and seven were observational studies. The most reported therapies were hydroxychloroquine (HCQ) (eight studies) and lopinavir/ritonavir (four studies). We conclude from the evidence generated so far that interferon combined with antivirals, remdesivir, umifenovir and favipiravir were mostly associated with better clinical outcomes. The therapeutic effect of HCQ was established initially by two clinical trials; one of them showing a reinforcing effect by azithromycin but subsequent studies did not elicit any effectiveness rather increased rate of adverse events was reported. Lopinavir/ritonavir was found beneficial when administered with interferon and ribavirin, but one clinical trial on its sole use proved contrary. As many clinical trials are in process, we expect to get concrete evidences on repurposing of existing drugs based on less biased, high powered studies.

Motivation for adherence to antiretroviral therapy by transgender people living with hiv - A study in West Bengal, India.

The introduction of antiretroviral therapy (ART) has substantially improved the survival of persons infected with HIV. In India, the aggregated HIV prevalence among transgender (TG) community was found 7.5%. West Bengal, with over 30,000 TG population recorded HIV prevalence of 4.8%. The qualitative study was conducted in 2019 with the objective to explore the motivating factors for adherence to ART treatment among TG people living with HIV (PLHIV) in an ART center. Respondents were motivated PLHIVs on ART with suitable treatment adherence recorded. Data were inductively analyzed, using thematic analysis, to identify themes central to ART adherence. Five themes emerged with prime acknowledgment of respondents that ART medication is lifelong for their survival with receiving support. Notwithstanding the chronic nature of the disease, TG PLHIV patient stands a better chance of maintaining treatment adherence if they are involved in treatment plans with their community-based members' helping as peer navigators.

A retrospective cohort study on effect of literacy status of HIV-positive pregnant women on possibility of child getting HIV infected.

INTRODUCTION: Prevention of parent-to-child transmission (PPTCT) program aims at reduction of HIV transmission through vertical route. Although medical intervention reduces chance of HIV transmission substantially, several demographic factors are often contributory. Minimum literacy is required for HIV-infected individuals to understand the course of medicine and to ensure compliance to the treatment which may have impact on vertical transmission. The objective of this study is to analyze relationship between maternal education and possibility of her babies to get HIV infected. MATERIALS AND METHODS: A retrospective cohort study was carried out through analysis of secondary data during the period from April 13 to September 16 from all stand-alone integrated counseling and testing centers in West Bengal. A total number of 326 HIV-exposed babies, whose 6th week HIV-Polymerase Chain Reaction (PCR) reports are available and both the mother-baby received PPTCT services, were recruited in the study, and their maternal literacy status was substantiated and analyzed. RESULTS: HIV positivity among HIV-exposed babies was found to be 6.67% whose mothers were illiterate as compared to 5.55% whose mothers were literate up to primary standard and 3.93% whose mothers were educated up to secondary standard. HIV positivity among the exposed babies whose mothers studied higher secondary standard or above showed zero HIV positivity. Chi-square was done to ascertain statistical significance but result was inconclusive although the trend shows increasing chance of HIV-exposed babies to get infected with decreasing literacy. CONCLUSION: Maternal literacy status favorably influences vertical transmission of HIV.

HIV/AIDS epidemic in West Bengal: An overview.

BACKGROUND: West Bengal is a low-prevalent state with high vulnerability for HIV. The state bears around 6% of HIV burden of India. With consistent effort on preventive, diagnostic, and curative services under National AIDS Control Program, HIV prevalence is gradually coming down. Our study objective is to determine the trend of HIV positivity among different groups/population attending Integrated Counseling and Testing Centres (ICTCs) over a period of 8 years and identify the group of population needing special attention. METHODS: The study was conducted with available program data year-wise from 2008-2009 to 2014-2015 among different groups of population who attended ICTCs for HIV testing. Year-wise positivity was calculated and trend analysis was performed by linear regression method keeping year as regressor. Similar methodology was applied for different typologies among the high-risk groups (HRGs) and trend analysis was done using linear regression for the study period from 2012-2013 to 2014-2015. RESULTS: HIV positivity among general male and non-pregnant individuals, HRG population, transgender (TG) population, and pregnant women showed a significant declining trend over the past 8 financial years, but the discordance rate remained almost the same. Regarding HIV positivity trend among different typologies of HRGs, trucker group showed a significant increase in HIV positivity over the past 3 years, whereas HIV positivity among other groups like female sex workers, men having sex with men, injecting drug users, and migrant labors did not undergo significant changes over the past 3 years. CONCLUSION: HIV-preventive services among truckers need to be emphasized. HIV screening services among the TG population should be further scaled up through more number of targeted interventions.