Performance & clinical utility of oropharyngeal versus nasopharyngeal swabs in COVID-19.

Background & objectives: The oropharyngeal (OP) and nasopharyngeal (NP) swab samples are the most recommended clinical specimens for detecting SARS-CoV-2 in an individual through the quantitative real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR) method. The primary objective of this study was to compare the performance of NP and OP swabs for the diagnosis of COVID-19 among 2250 concomitant samples (1125 NP + 1125 OP) using rRT-PCR test. Methods: This study was conducted at a tertiary care hospital in southern India. The study compared the specificity and efficacy of the two samples (NP & OP swabs) in 1125 individuals suspected having COVID-19 infection. The rRT-PCR values from all the samples were compared based on gender, age group and viral load. The differences between unmatched proportion and matched proportion were analysed. Agreement between the two methods was assessed using Kappa statistic. Absolute sensitivity, specificity, positive and negative predictive values (PPV and NPV) for OP and NP swabs were analysed. Results: The study identified a fair degree of agreement between OP and NP swabs in diagnosis of COVID-19 (kappa = 0.275, P <0.001). There was also a fair degree of agreement between NP and OP swabs irrespective of gender, age or duration of symptoms. NP swabs had better sensitivity and NPV as compared to OP swabs, however, specificity and PPV were 100 per cent for both. Interpretation & conclusions: The present study showed that both OP and NP swabs had similar sensitivity and specificity for predicting the presence of SARS-CoV-2.

In-hospital mortality of intermittent vs daily antitubercular regimen in patients with meningeal tuberculosis--a retrospective study.

INTRODUCTION: The Revised National Tuberculosis Control Programme (RNTCP), the State-run Tuberculosis Control Initiative of the Government of India, recommends intermittent thrice a week Directly Observed Treatment Short course (DOTS) both during intensive phase and continuation phase for a total of nine months for tubercular meningitis. However, most recent guidelines recommend daily regimen. OBJECTIVE: Assessment of the in-hospital mortality in patients with meningeal tuberculosis. MATERIAL AND METHODS: We retrospectively analyzed the data of patients (n = 98) admitted with a diagnosis of meningeal tuberculosis from January 1st 2006 to December 31st 2009 in a tertiary care centre in South India. Thwaites index score of four or less was used for diagnosis of meningeal tuberculosis which is a weighted diagnostic index score for dichotomised clinical variables including age, blood white cell count, duration of illness, CSF total white cell count, and CSF neutrophil percentage. We compared in-hospital treatment outcome of patients on thrice weekly intermittent DOTS regimen with daily regimen patients. RESULTS: The inhospital mortality was same (27%) in the two treatment regimens (p 0.944). However, there was less incidence of hepatic dysfunction in the intermittent DOTS regimen, even though it was not statistically significant (p 0.148). CONCLUSIONS: In the short-term, both regimens have similar mortality outcomes and no statistically significant difference in hepatic dysfunction during the hospital stay.

Impact of antiretroviral therapy on vocational rehabilitation.

This study evaluates the impact of a free antiretroviral therapy (ART) programme on the employment status of people living with HIV/AIDS. Patients on ART were interviewed regarding the employment status before and after ten months of enrollment into therapy. We included patients who were started on the free ART program of Kerala state at the Medical College, Thrissur. We documented the demographic details, indication for starting ART, disease status, WHO staging and CD4 count (whenever available) and the job status at the time of enrollment into the study. We collected data about the patient's job status at the end of ten months of ART. We excluded patients below 20 years of age, those who died during the study period and those lost for follow-up before the end of ten months from the analysis. We looked at factors associated with having employment at the end of ten months of ART using logistic regression. At the end of ten months of therapy the employment status improved significantly (p<0.01) to 74% (77 patients). We found that 96.4% of those previously employed are at present employed, while 65.8% of those previously unemployed are employed at present. A history of previous employment (p=0.014) was associated with acquisition of employment; sex, duration on ART, stage of disease or age does not significantly influence the present employment status. This study suggests that the provision of free ART by the state can significantly improve the employment status of PLWHA.

Usefulness of the Rowland Universal Dementia Assessment scale in South India.

BACKGROUND: The number of older people with cognitive impairment being seen in out patient settings is increasing. A brief screening test, which is culturally and educationally fair, would be very useful for clinicians for identifying dementia in these settings. OBJECTIVES: To examine the new cognitive screening test, the Rowland Universal Dementia Assessment Scale (RUDAS), and to compare it with the Mini-Mental State Examination (MMSE). METHOD: We administered MMSE and RUDAS to 116 subjects, consisting of 58 patients with mild to moderate dementia and 58 age and sex matched controls. The two screening tests were compared with regard to sensitivity and specificity. We looked at the correlation of both tests with years of formal education among the controls. RESULT: RUDAS had a similar sensitivity but better specificity than MMSE, but did have an educational bias. CONCLUSIONS: RUDAS is a useful brief screening test in clinical settings.