Goiter prevalence and iodine deficiency disorder among school-age children (6-12 years) in district Ganderbal of Kashmir valley.

BACKGROUND: Iodine deficiency is a major cause of brain damage in childhood which can be prevented. Dietary deficiency of iodine is mainly responsible for iodine deficiency. This study was done to determine the prevalence of goiter among school-aged group of 6-12 years in district Ganderbal. MATERIALS AND METHODS: This was a cross-sectional study done among children of 6-12 years in district Ganderbal. RESULTS: Out of 2700 children examined, Grade 1 goiter was found in 90 (3.3%) children and Grade 2 goiter was found in 6 (0.3%) with a total goiter rate (sum of grade first and grade second) of 3.6%. On analyzing the urine samples, about 19.1% of the children had mild to moderate iodine deficiency. CONCLUSION: The study showed mild goiter prevalence in school-aged children of 6-12 years in the Ganderbal district of Kashmir valley. Continuous periodic surveys to assess the magnitude of the iodine deficiency disorders (IDD) should be undertaken to ensure that we achieve sustainable elimination of IDD in India.

Seroprevalence of SARS-CoV-2-specific anti-spike IgM, IgG, and anti-nucleocapsid IgG antibodies during the second wave of the pandemic: A population-based cross-sectional survey across Kashmir, India.

Background: Within Kashmir, which is one of the topographically distinct areas in the Himalayan belt of India, a total of 2,236 cumulative deaths occurred by the end of the second wave. We aimed to conduct this population-based study in the age group of 7 years and above to estimate the seropositivity and its attributes in Kashmir valley. Methods: We conducted a community-based household-level cross-sectional study, with a multistage, population-stratified, probability-proportionate-to-size, cluster sampling method to select 400 participants from each of the 10 districts of Kashmir. We also selected a quota of healthcare workers, police personnel, and antenatal women from each of the districts. Households were selected from each cluster and all family members with age 7 years or more were invited to participate. Information was collected through a standardized questionnaire and entered into Epicollect 5 software. Trained healthcare personnel were assigned for collecting venous blood samples from each of the participants which were transferred and processed for immunological testing. Testing was done for the presence of SARS-CoV-2-specific anti-spike IgM, IgG antibodies, and anti-nucleocapsid IgG antibodies. Weighted seropositivity was estimated along with the adjustment done for the sensitivity and specificity of the test used. Findings: The data were collected from a total of 4,229 participants from the general population within the 10 districts of Kashmir. Our results showed that 84.84% (95% CI 84.51-85.18%) of the participants were seropositive in the weighted imputed data among the general population. In multiple logistic regression, the variables significantly affecting the seroprevalence were the age group 45-59 years (odds ratio of 0.73; 95% CI 0.67-0.78), self-reported history of comorbidity (odds ratio of 1.47; 95% CI 1.33-1.61), and positive vaccination history (odds ratio of 0.85; 95% CI 0.79-0.90) for anti-nucleocapsid IgG antibodies. The entire assessed variables showed a significant role during multiple logistic regression analysis for affecting IgM anti-spike antibodies with an odds ratio of 1.45 (95% CI 1.32-1.57) for age more than 60 years, 1.21 (95% CI 1.15-1.27) for the female gender, 0.87 (95% CI 0.82-0.92) for urban residents, 0.86 (95% CI 0.76-0.92) for self-reported comorbidity, and an odds ratio of 1.16 (95% CI 1.08-1.24) for a positive history of vaccination. The estimated infection fatality ratio was 0.033% (95% CI: 0.034-0.032%) between 22 May and 31 July 2021 against the seropositivity for IgM antibodies. Interpretation: During the second wave of the SARS-CoV-2 pandemic, 84.84% (95% CI 84.51-85.18%) of participants from this population-based cross-sectional sample were seropositive against SARS-CoV-2. Despite a comparatively lower number of cases reported and lower vaccination coverage in the region, our study found such high seropositivity across all age groups, which indicates the higher number of subclinical and less severe unnoticed caseload in the community.

Testosterone Replacement Options.

The treatment of male hypogonadism is complicated by the multitude of treatments available, the lack of a clear understanding of the differences between treatment modalities, barriers to treatment, and patient misperceptions, unrealistic expectations, and anxieties. This article is intended to help the practitioner better understand the challenges of testosterone replacement options in order to better counsel and treat their patients with hypogonadism.

Use and Accuracy of Inpatient CGM During the COVID-19 Pandemic: An Observational Study of General Medicine and ICU Patients.

BACKGROUND: Continuous glucose monitoring (CGM) is widely used in the outpatient setting for people with diabetes and has been limited to investigational use only for the inpatient population. In April 2020, the US FDA exercised enforcement discretion for the temporary use of inpatient CGM during the pandemic, thus hospitals were presented the opportunity to implement this technology. METHODS: We sought to investigate the accuracy of CGM in hospitalized patients on general care floors and the intensive care unit (ICU) in attempts to decrease healthcare professional exposure to COVID-19 and ultimately improve glycemic management of patients affected by COVID-19. Point of care (POC) and laboratory (Lab) glucose values were matched with simultaneous CGM glucose values and measures of accuracy were performed to evaluate the safety and usability of CGM in this population. Our data are presented drawing a distinction between POC and Lab as reference glucose sources. RESULTS: In 808 paired samples obtained from 28 patients (10 ICU, 18 general floor), overall mean absolute relative difference (MARD) for all patients using either POC or Lab as reference was 13.2%. When using POC as the reference glucose MARD was 13.9% and using Lab glucose as reference 10.9%. Using both POC and Lab reference glucose pairs the overall MARD for critical care patients was 12.1% and for general floor patients 14%. CONCLUSION: We determined, with proper protocols and safeguards in place, use of CGM in the hospitalized patient is a reasonable alternative to standard of care to achieve the goal of reducing healthcare professional exposure. Further study is necessary to validate safety, accuracy, and efficacy of this technology. Investigation and analysis are necessary for the development of protocols to utilize CGM trend arrows, alerts, and alarms.

The burden of SARS-CoV-2 among healthcare workers across 16 hospitals of Kashmir, India-A seroepidemiological study.

SARS-CoV-2 pandemic has greatly affected healthcare workers because of the high risk of getting infected. The present cross-sectional study measured SARS-CoV-2 antibody in healthcare workers of Kashmir, India. METHODS: Serological testing to detect antibodies against nucleocapsid protein of SARS-CoV-2 was performed in 2003 healthcare workers who voluntarily participated in the study. RESULTS: We report relatively high seropositivity of 26.8% (95% CI 24.8-28.8) for SARS-CoV-2in healthcare workers, nine months after the first case was detected in Kashmir. Most of the healthcare workers (71.7%) attributed infection to the workplace environment. Among healthcare workers who neither reported any prior symptom nor were they ever tested for infection by nasopharyngeal swab test, 25.5% were seropositive. CONCLUSION: We advocate interval testing by nasopharyngeal swab test of all healthcare workers regardless of symptoms to limit the transmission of infection within healthcare settings.

Seroprevalence of SARS-CoV-2-specific IgG antibodies in Kashmir, India, 7 months after the first reported local COVID-19 case: results of a population-based seroprevalence survey from October to November 2020.

OBJECTIVES: We designed a population-based survey in Kashmir to estimate the seroprevalence of SARS-CoV-2-specific IgG antibodies in the general population aged 18 years and above. SETTING: The survey was conducted among 110 villages and urban wards across 10 districts in Kashmir from 17 October 2020 to 4 November 2020. PARTICIPANTS: Individuals aged 18 years and above were eligible to be included in the survey. Serum samples were tested for the presence of SARS-CoV-2-specific IgG antibodies using the Abbott SARS-CoV-2 IgG assay. PRIMARY AND SECONDARY OUTCOME MEASURES: We labelled assay results equal to or above the cut-off index value of 1.4 as positive for SARS-CoV-2-specific IgG antibodies. Seroprevalence estimates were adjusted for the sampling design and assay characteristics. RESULTS: Out of 6397 eligible individuals enumerated, 6315 (98.7%) agreed to participate. The final analysis was done on 6230 participants. Seroprevalence adjusted for the sampling design and assay characteristics was 36.7% (95% CI 34.3% to 39.2%). Seroprevalence was higher among the older population. Among seropositive individuals, 10.2% (247/2415) reported a history of COVID-19-like symptoms. Out of 474 symptomatic individuals, 233 (49.2%) reported having been tested. We estimated an infection fatality rate of 0.034%. CONCLUSIONS: During the first 7 months of the COVID-19 epidemic in Kashmir Valley, approximately 37% of individuals were infected. The reported number of COVID-19 cases was only a small fraction of the estimated number of infections. A more efficient surveillance system with strengthened reporting of COVID-19 cases and deaths is warranted.

Evaluation of an Instrument to Assess Students' Personal and Professional Development During the Faculty Advising Process.

Objective. To evaluate a tool designed to assess Doctor of Pharmacy (PharmD) students' personal and professional development prior to beginning advanced pharmacy practice experiences (APPEs).Methods. A five-item instrument, entitled the Faculty Advisor's Assessment of the Advisee (FAAA) tool, was developed to assess and monitor pharmacy students' progress over the three-year didactic curriculum. Question anchors were created to describe characteristics exhibited by the student that matched categories of not engaged, beginning, emerging, or engaged. Possible FAAA composite scores ranged from 7 to 20. Using the FAAA tool, faculty advisors assessed their advisees' values, engagement, self-awareness, professionalism, and leadership in 2017, 2018, and 2019. Individual and aggregate cohort reports were run and data for each of the three years were matched with students. To determine if the FAAA showed progression in assessed dimensions in the students during the first, second, and third professional (P1, P2, and P3) years, a Friedman test was performed. Cronbach alpha was used to assess the reliability of the instrument.Results. The data of 93 students were matched for the P1 through the P3 years. Median (IQR) for the FAAA composite score levels for the P1, P2, and P3 were 13 (12-16), 17 (15-19) and 18 (16-20), respectively. Significant differences existed at all timepoints compared, including from the P1 to P2, P2 to P3, and P1 to P3 years. The reliability of the FAAA scale was strong across all three years (winter 2017, α=0.87; winter 2018, α=0.89; and winter 2019, α=0.87). All items appeared worthy of retention as removal did not significantly increase their reliability.Conclusion. A five-item tool which assesses pharmacy students' personal and professional development during the first three years of a PharmD program could be used by faculty advisors to assess student's progress across the didactic curriculum.

Generics and Biosimilars; A Step Towards Sustainable and Low Cost Health Care.

Millions of people across the globe go without essential medicines resulting in many avoidable deaths each year. It's no secret that the cost of prescription drugs, including the life-saving ones has been rising far faster than inflation over the last few years. If we take the example of diabetes and as India has the largest number of patients with the condition in the world; it has been shown that patients belonging to the low income group in urban India were spending. 27% of their annual income and those in rural India 34% of their annual income on diabetes care; most of which was spent on purchase of medicines. This raises the question of whether current pricing of drugs is based on reasonable expectation of return on investment or whether it is based on what prices the market can bear. The price of pharmaceuticals has become an issue of great concern for people and governments around the world. Thus governments across the globe must make efforts to correct the present distortions around the concept of generic drugs.

Microangiopathic Hemolytic Anemia and Fulminant Renal Failure: A Rare Manifestation of Pheochromocytoma.

Pheochromocytoma is a rare adrenal tumor that is classically associated with the triad of paroxysmal tachycardia, diaphoresis, and headaches. However, it can have myriad manifestations. We present a case of a 31-year-old male who presented with abdominal pain, hypertensive emergency, and renal failure. Abdominal imaging demonstrated a left adrenal mass. Plasma metanephrines (153 pg/ml, n < 57) and normetanephrines (1197 pg/ml, n < 148) were noted to be elevated, leading to the diagnosis of pheochromocytoma. Intravenous antihypertensives were utilized to control his blood pressure. Hemodialysis was initiated given the degree of renal dysfunction. The patient subsequently developed hemolytic anemia, requiring the transfusion of multiple units of packed red cells. He developed acute respiratory failure leading to intubation, but was thereafter liberated from the ventilator following clinical stabilization. Uncontrolled hypertension precipitated by pheochromocytoma can cause microangiopathic hemolytic anemia and renal insufficiency. This case is notable not only for the occurrence of this rare presentation, but also for the severity of manifestations in a young male with no known significant comorbidities.