Vaccination coverage and breakthrough infections of COVID-19 during the second wave among staff of selected medical institutions in India.

India experienced the second wave of SARS-CoV-2 infection from April 3 to June 10, 2021. During the second wave, Delta variant B.1617.2 emerged as the predominant strain, spiking cases from 12.5 million to 29.3 million (cumulative) by the end of the surge in India. Vaccines against COVID-19 are a potent tool to control and end the pandemic in addition to other control measures. India rolled out its vaccination programme on January 16, 2021, initially with two vaccines that were given emergency authorization-Covaxin (BBV152) and Covishield (ChAdOx1 nCoV- 19). Vaccination was initially started for the elderly (60+) and front-line workers and then gradually opened to different age groups. The second wave hit when vaccination was picking up pace in India. There were instances of vaccinated people (fully and partially) getting infected, and reinfections were also reported. We undertook a survey of staff (front line health care workers and supporting) of 15 medical colleges and research institutes across India to assess the vaccination coverage, incidence of breakthrough infections, and reinfections among them from June 2 to July 10, 2021. A total of 1876 staff participated, and 1484 forms were selected for analysis after removing duplicates and erroneous entries (n = 392). We found that among the respondents at the time of response, 17.6% were unvaccinated, 19.8% were partially vaccinated (received the first dose), and 62.5% were fully vaccinated (received both doses). Incidence of breakthrough infections was 8.7% among the 801 individuals (70/801) tested at least 14 days after the 2nd dose of vaccine. Eight participants reported reinfection in the overall infected group and reinfection incidence rate was 5.1%. Out of (N = 349) infected individuals 243 (69.6%) were unvaccinated and 106 (30.3%) were vaccinated. Our findings reveal the protective effect of vaccination and its role as an essential tool in the struggle against this pandemic.

Impact of long duration wearing of N95 masks on cardiorespiratory system and subjective sensations of health-care workers during COVID-19 era.

Background and Aims: N95 mask being an essential element of personal protective equipment to be worn by health-care workers (HCWs) may lead to adverse effects and physiological stress as HCWs have to wear it for prolonged hours. Therefore, we planned to conduct a study in our intensive care unit staff to look for the effects of N95 masks on their health as well as to plan recommendations to ease them. Material and Methods: We conducted this study on our intensive care unit nursing staff and HCWs. We noted their oxygen saturation and heart rate at baseline as well as after 1 h, 2 h, 3 h, and 6 h of duty along with their subjective sensations. Institutional ethical clearance for the same was taken. Collected data were entered in MS Excel database and analyzed using SPSS version 20.0. Fisher's Z test was applied for comparing proportion and analysis of variance for comparing two means. Results: One hundred and nine HCWs participated in this, out of which 93 (85.3%) were females and 16 (14.7%) were males. Eighty-four (77.1%) participants were below 40 years. Twenty-three participants (21.1%) were overweight and 37 (33.9%) were obese. There was no significant drop in saturation and rise in heart rate during these hours. Conclusions: On comparing subjective sensations of HCWs, our study found that feeling of uneasiness was found more in less than 40 years age group as compared to more than 40 years. N95 masks were found to have no impact on cardiovascular system and do not lead to hypoxia while working routinely even for prolonged hours.

Prevalence, overlap, and risk factors for Rome IV functional gastrointestinal disorders among college students in northern India.

BACKGROUND/PURPOSE: There is scarcity of data on prevalence, overlap, and risk factors for functional gastrointestinal disorders (FGID) by Rome IV criteria. We evaluated these factors among medical, nursing, and humanities students. METHODS: Rome IV Diagnostic Questionnaire (for all FGIDs), Rome III questionnaire (for irritable bowel syndrome [IBS], functional diarrhea [FDr], and functional constipation [FC]), and questionnaires assessing demography, physical activity, anxiety, and depression were used. RESULTS: A total of 1309 college students were included (medical 425, nursing 390, humanities 494; mean age 20.5 ± 2.1 years; 36.5% males). Prevalence of Rome IV FGIDs was 26.9% (n = 352), significantly higher among females compared with males (32.3% vs. 17.6%; p < 0.001) and significantly higher among medical (34.4%) and nursing students (29.2%) compared with humanities students (18.6%) (p < 0.05). Most common FGIDs were functional dyspepsia (FD) (15.2%), IBS (6.2%), reflux hypersensitivity (3.5%), FDr (2.9%), FC (2.1%), and unspecified functional bowel disorder (2.1%). FGID overlap was present in 9.3%, most common being FD-IBS overlap (4.4%). With Rome III criteria, prevalence of IBS was higher (9.5%), while that of FDr (0.92%) and of FC (1.3%) were lower. On multivariate analysis, independent predictors for FGIDs were female gender, medical student, non-vegetarian diet, junk food, tea/coffee, poor physical activity, anxiety, and insomnia. CONCLUSION: Rome IV FGIDs were present among one-fourth of college students with preponderance among females and medical students. FD, IBS, and reflux hypersensitivity were the most common FGIDs. Rome IV criteria led to a reduction in IBS prevalence and increase in FDr and FC prevalence. Dietary factors, physical activity, anxiety, and insomnia affected FGID prevalence.

Early onset ACS: An age based clinico-epidemiologic and angiographic comparison.

BACKGROUND AND AIMS: Acute coronary syndrome (ACS) in the very young is a rare entity, with limited data. We aimed to study patterns and profile of ACS in patients aged 20-30 years in comparison with those above 30 years. METHODS: In this retrospective record-based study, the demographic and clinical profile of all patients with ACS in the last 12 years (n = 35259) was analysed: group I (20-30 years) and group II (above 30 years). Patients in group II were selected by systematic sampling. Age, gender, domicile, body mass index (BMI), serum cholesterol, smoking, alcohol use, drug abuse, diabetes, hypertension, family history, type of ACS, angiographic findings and management strategies were recorded. Chi-square test and Fischer's exact test were used for data analysis. RESULTS: Of 35,259 patients, 0.32% (n = 114) were from the younger age group, with a rising trend of prevalence over 12 years. Obesity, overweight, urban living, smoking, alcohol and drug abuse were significantly higher in group I (p < 0.05). Diabetes mellitus and hypertension were more prevalent in group II (p = 0.001). STEMI in group I (76.3%) and NSTEMI in group II (47.1%) were the common modes of presentation (p = 0.001). 42.1% of group I patients had recanalized coronaries with conservative management in comparison to 3% in group II (p = 0.001). CONCLUSIONS: There is a rising trend in prevalence of ACS in very young patients. Overweight, obesity, urbanization and drug abuse are potential risk factors. The younger subset of ACS patients is different from the older population due to their thrombotic milieu, which could be more amenable to intensive pharmacologic management.

Multidimensional impact on families of children with steroid-sensitive nephrotic syndrome.

AIM: Children with nephrotic syndrome (NS) have prolonged disease course with relapses requiring frequent visits and prolonged steroid therapy with their long-term concerns. All these factors affect the child and their families in many domains of functioning. The objective of this study was to assess multidimensional impact on families of children with nephrotic syndrome using (PedsQL) Family Impact Module (FIM). METHODS: This cross-sectional study was conducted in a paediatric nephrology clinic of a tertiary care hospital. Fifty cases of steroid-sensitive nephrotic syndrome between age group of 2-18 years were included, and equal age-sex matched healthy children were taken as controls. Baseline demographic factors including age, gender and education status, modified Kuppuswamy's socio-economic status were collected and clinical variables of NS cases were recorded. FIM is a parent-reported instrument that measures the impact of paediatric chronic health conditions on care giver's HRQOL and their family function. Mean FIM scores were compared among the cases and controls, and different predictive factors affecting family impact (FI) were analysed. RESULTS: The FI total score showed significantly lower scores in cases (mean score: 60.76 ± 15.66) as compared to controls (mean 100). Among the individual groups, lowest scores were found in two domains, namely 'worry' and 'emotional function' with mean scores of 46.20 ± 20.66 and 46.80 ± 24.61, respectively, although other domains were also significantly affected. CONCLUSION: FI score should be evaluated in all cases of NS as parenting such children may significantly affect all domains of family functioning.

Parental stress in a paediatric intensive care unit in Punjab, India.

AIM: Paediatric intensive care is a fast-growing specialty in India. There are studies on parental stress in paediatric intensive care unit (PICU) in developed countries, but limited data from developing countries, where many factors may be different, are available. This paper describes various stressors in Indian parents. METHOD: One hundred parents were interviewed using the Parental Stress Scale (PSS: PICU), which rates 22 factors on a scale from 1 (not stressful) to 5 (extremely stressful). RESULTS: The average parental stress score was 3.0. The main causes of extremely stressful situations were: the parents' child having breathing difficulty; their child suffering pain; their child being unresponsive; crises in other children in the PICU. Factors least associated with stress included: not being alone with baby; and the presence of monitors and equipment. Nearly all parents (99) felt that prayer was of help. The majority (67) felt stressed during procedures, and 59 parents felt stressed by the sights and sounds of the PICU. Factors significantly related to increased stress included: the severity of illness as measured by higher paediatric risk of mortality scoring (P = 0.0136); for mothers rather than fathers (P = 0.0054): for parents <30 years (P = 0.0114); and parents of a male child (P = 0.0482). CONCLUSIONS: It is concluded that there is significant stress among parents of children admitted to an Indian PICU, and stress factors are different from studies done in developed countries. Mothers and young parents were more stressed. Type of family, income, education, number and age of children did not affect level of stress.

A Simple Clinical Score "TOPRS" to Predict Outcome in Pediatric Emergency Department in a Teaching Hospital in India.

OBJECTIVE: To develop a simple clinical scoring system for severity of illness to help prioritize care and predict outcome in emergency department. METHODS: Prospective hospital based observational study. Out of a total of 874 children who attended emergency department in one year, 777 were included in the study. Data was collected at the time of admission in emergency department. The baseline information like age, gender, etc and variables of 'toprs' score viz temperature, oxygen saturation, pulse rate, respiratory rate, sensorium and seizures were recorded. Variables were categorized as normal (score zero) or abnormal (score 1) based on systemic inflammatory response syndrome (SIRS) criteria and criteria mentioned in advanced pediatric life support (APLS) and the total scores were computed for each child. The outcome (death/discharge) was correlated with the study variables and total score. The predictive ability of score was calculated using receiver operating characteristic (ROC) curve analysis. FINDINGS: Of the six variables, temperature, oxygen saturation and respiratory rate were found to be significantly associated with mortality. Mortality increased with the increase in the number of abnormal variables. Based on the regression coefficients, maximum possible score was 6.68. The predictive ability of score was 81.7 calculated using ROC curve. Maximum discrimination was observed at a score of 2.5. CONCLUSION: For triage in emergency, any patient with 2 or more abnormal variables should be closely monitored and evaluated. These patients require admission as they have a potential risk of death.

Corticosteroid plus pentoxifylline is not better than corticosteroid alone for improving survival in severe alcoholic hepatitis (COPE trial).

BACKGROUND: Corticosteroids and pentoxifylline reduce short-term mortality in severe alcoholic hepatitis (SAH), but not to the extent desired. Combining both drugs may lead to better survival, but has not yet been studied. AIM: To compare the efficacy of corticosteroids plus pentoxifylline with that of corticosteroids alone in improving survival of SAH patients. METHODS: Of the 111 patients screened, 70 patients with SAH (Maddrey discriminant function (MDF) ≥ 32) were enrolled. Patients with active infection, bleeding, renal failure, or pancreatitis were excluded. Treatment was given for four weeks to group A (n = 36; prednisolone 40 mg/day plus pentoxifylline 400 mg thrice/day) and group B (n = 34; prednisolone 40 mg/day). Patients were followed up for 6 months. Data are expressed as median (range) or percentage. RESULTS: Baseline characteristics of the two groups were similar (MDF group A 78.5 (36.8-140.9), group B 74.9 (45.6-140.2)). Four-week and six-month survival in groups A and B were not significantly different (four-week 72.2 and 73.5%, respectively, p = 1.00; six-month 30.6 and 23.5%, respectively, p = 0.417). At seven days, 55.6% of patients in group A and 64.7% in group B had a Lille score <0.45 (p = 0.473). Six-month survival was significantly higher for patients with a Lille Score <0.45 than for those with a Lille score ≥0.45 (group A 55.5 vs. 0%, p = 0.0006; group B 36 vs. 0%, p = 0.0304). Biological improvement at 28 days was significant for both groups; however, the difference between the groups was not significant. CONCLUSIONS: For patients with severe alcoholic hepatitis, a combination of corticosteroids and pentoxifylline has no additional survival advantage compared with corticosteroids alone.

Rifaximin improves psychometric performance and health-related quality of life in patients with minimal hepatic encephalopathy (the RIME Trial).

OBJECTIVES: Cirrhotics with minimal hepatic encephalopathy (MHE) have a poor health-related quality of life (HRQOL). Treatment of MHE is still evolving. The aim of this double-blind randomized pilot study was to assess the efficacy of rifaximin in improving neuropsychometric (NP) test performance and HRQOL in patients with MHE. METHODS: MHE was diagnosed if any two NP tests (number and figure connection tests, picture completion, digit symbol, and block design tests) were deranged beyond 2 s.d. of normal. HRQOL was assessed using the sickness impact profile (SIP) questionnaire. RESULTS: A total of 486 patients with cirrhosis were screened and 284 were found eligible. Out of these 115 (40.9%) had MHE, of which 21 refused consent and 94 were randomized to receive placebo (n=45) and rifaximin (n=49; 1200 mg/day) for 8 weeks. At the end of treatment, significantly more number of patients in rifaximin group showed reversal of MHE (75.5% (37/49) vs. 20% (9/45) in placebo group; P<0.0001). Rifaximin group also showed significant reduction in mean number of abnormal NP tests (baseline, 2.35 (95% confidence interval (CI), 2.17-2.53); 2 weeks, 1.29 (95% CI, 1.02-1.56), P=0.002; 8 weeks, 0.81 (95% CI, 0.61-1.02), P=0.000), compared with placebo group (baseline, 2.31 (95% CI, 2.03-2.59); 2 weeks, 2.03 (95% CI, 1.74-2.31); 8 weeks, 1.97 (95% CI, 1.69-2.25), P>0.05). The mean total SIP score also improved significantly in rifaximin group (baseline, 11.67 (95% CI, 10.31-13.03); 8 weeks, 6.45 (95% CI, 5.59-7.30); P=0.000) compared with placebo group (baseline, 9.86 (95% CI, 8.66-11.06); 8 weeks, 8.51 (95% CI, 7.35-9.67); P=0.82). Improvement in HRQOL correlated with improvement in NP tests. Rifaximin was well tolerated. CONCLUSIONS: Rifaximin significantly improves both cognitive functions and HRQOL in patients with MHE.