Progress and challenges in achieving tuberculosis elimination in India by 2025: A systematic review and meta-analysis.

BACKGROUND: Tuberculosis (TB) continues to pose a significant public health challenge in India, which is home to one of the highest TB burdens worldwide. This systematic review and meta-analysis will aim to synthesize the anticipated progress and potential challenges in achieving TB elimination in India by 2025. METHODS: A comprehensive search will be conducted across multiple databases, including PubMed, Scopus, and Web of Science, to identify relevant studies. The eligibility criteria will encompass individuals diagnosed with TB in India, interventions targeting TB treatment, prevention, or control, and various comparator groups. Outcomes of interest will include incidence reduction, mortality rate, treatment success rate, barriers to TB care, and more. Both quantitative and qualitative data will be synthesized, and the risk of bias will be assessed using established tools. OUTCOMES: The review is expected to provide a holistic understanding of the TB landscape in India, highlighting the effective interventions and potential challenges in the journey towards TB elimination. CONCLUSIONS: While it is anticipated that significant progress will be made in the fight against TB in India, challenges are likely to persist. This review will offer a comprehensive roadmap for researchers, policymakers, and healthcare professionals, emphasizing the importance of continued efforts, innovative strategies, and a multi-pronged approach in achieving the goal of TB elimination in India by 2025.

Case series on Trichomonas vaginalis infections: impact of proper sample collection and diagnostic stewardship.

This paper elucidates the transformative impact of a strategic shift in diagnostic practices in the detection of Trichomonas vaginalis. It explores five cases where the implementation of a specific diagnostic protocol led to effective identification of the infection. In-depth discussions and a comprehensive literature review underline the necessity for precise diagnosis and the paramount importance of diagnostic stewardship in managing sexually transmitted infections.

Advancing Solar Energy for Primary Healthcare in Developing Nations: Addressing Current Challenges and Enabling Progress Through UNICEF and Collaborative Partnerships.

This comprehensive document explores the intersection of Sustainable Development Goals (SDGs) and the global transition to renewable energy, with a particular focus on solar energy. The text emphasizes the critical role of reliable and sustainable energy, especially solar power, in achieving health-related SDGs, particularly in low- and middle-income countries (LMICs). It discusses the challenges faced by healthcare facilities in these regions, emphasizing the importance of uninterrupted electricity for critical medical equipment and services. The document highlights the increasing significance of solar energy globally and its potential to address challenges in the healthcare sector. The International Energy Agency's (IEA) estimation that solar photovoltaic (PV) energy has become the cheapest source of electricity is discussed, along with the World Bank's active role in supporting solar energy projects in developing countries. The document presents the current status of solarization, emphasizing the exponential growth of solar capacity and generation. It also discusses global initiatives such as Mission Innovation and the contribution of various international aid organizations, including Sustainable Energy for All (SEforALL), Power Africa, Lighting Global, SolarAid, UNDP - Solar for Health (S4H), and the World Bank. A significant portion of the document focuses on the role of solar energy in healthcare, detailing successful solarization projects in India, sub-Saharan Africa, and other regions. It addresses the challenges of implementing solar PV projects in healthcare facilities, emphasizing the importance of maintenance and proper management. The document also provides insights into the contributions of United Nations Children's Fund (UNICEF) in advancing solar-powered health systems, emphasizing its support to over 80 countries in solarization and off-grid energy solutions for healthcare. In conclusion, this article emphasizes the need for collaboration among international aid organizations, governments, and development partners to ensure universal access to reliable and sustainable electricity, particularly in healthcare facilities. It underscores the importance of long-term planning, sustainability, innovative business models, and awareness campaigns to achieve scalable and impactful results in the intersection of solar energy and healthcare delivery.

Transforming clinical virology with AI, machine learning and deep learning: a comprehensive review and outlook.

In the rapidly evolving field of clinical virology, technological advancements have always played a pivotal role in driving transformative changes. This comprehensive review delves into the burgeoning integration of artificial intelligence (AI), machine learning, and deep learning into virological research and practice. As we elucidate, these computational tools have significantly enhanced diagnostic precision, therapeutic interventions, and epidemiological monitoring. Through in-depth analyses of notable case studies, we showcase how algorithms can optimize viral genome sequencing, accelerate drug discovery, and offer predictive insights into viral outbreaks. However, with these advancements come inherent challenges, particularly in data security, algorithmic biases, and ethical considerations. Addressing these challenges head-on, we discuss potential remedial measures and underscore the significance of interdisciplinary collaboration between virologists, data scientists, and ethicists. Conclusively, this review posits an outlook that anticipates a symbiotic relationship between AI-driven tools and virology, heralding a new era of proactive and personalized patient care.

Prevalence and Predictors for Respiratory Viral Infections among Liver Disease Patients.

Aim and background: Respiratory viral infections (RVIs) cause significant hospitalizations every year. Also, RVIs caused by either influenza or noninfluenza group of viruses can have adverse outcomes, especially among immunosuppressed patients. Regular and timely supervision is needed for accurate etiological identification, to prevent inappropriate use of antibiotics in patients with nonbacterial etiology. This study aimed to identify the spectrum of RVIs and clinical characteristics among liver disease patients with influenza-like illness (ILI). Materials and methods: In this study, medical records of patients with ILI, whose requests for respiratory viral testing came from September 2016 to December 2022 were retrospectively reviewed. Respiratory viruses were identified using FilmArray 2.0 respiratory panel (BioFire Diagnostics, USA). Results: Of the 1,577 liver disease patients with ILI, the overall prevalence of RVI was 28% (n = 449). Infection by noninfluenza viruses (NIVs) was detected in 329 patients (73%), higher than those infected with influenza viruses. In multivariable logistic regression analysis, female gender [odds ratio (OR): 2.5, 95% confidence interval (CI): 1.5-4.2], infection with influenza B (OR: 3.3, 95% CI: 1.09-9.9) and decompensated cirrhosis (OR: 3.9, 95% CI: 1.7-8.5) were independent risk factors for mortality. Regarding seasonality, influenza peaked in monsoons and winters, whereas NIVs circulated throughout the year. Conclusion: Overall, this study adds new knowledge regarding the incidence of RVI and the distribution of respiratory viral etiologies among liver disease patients with ILI. The findings highlight that female gender, decompensated cirrhosis, and influenza B infection are independently associated with poor clinical outcomes. Early etiological identification of viral causes of ILI could aid in an enhanced understanding of the prevalence of ILI and the timely management of the patients. Clinical significance: Respiratory viral infections can cause severe illness in individuals with underlying liver disease. Accurate diagnosis and risk stratification is crucial in mitigating the adverse health effects. How to cite this article: Samal J, Prabhakar T, Prasad M, et al. Prevalence and Predictors for Respiratory Viral Infections among Liver Disease Patients. Euroasian J Hepato-Gastroenterol 2023;13(2):108-114.

Circulation of DENV-3 Genotype 3 during 2017 to 2018 in Delhi: A Single-Center Hospital-Based Study.

Introduction Delhi is hyperendemic for dengue virus (DENV) where all the four DENV have previously been reported. A constant vigilance of circulating DENV serotypes is important in surveillance, since the introduction of a new variant to areas affected by preexisting serotypes constitutes a risk factor for dengue hemorrhagic fever and dengue shock syndrome. Objectives This retrospective study was performed with an objective to determine the circulating serotype and genotype of DENV in acute phase blood samples of patients who have reported to a tertiary liver care hospital in New Delhi during the last 2 years (2017-2018). Methods The data of clinician-initiated testing for dengue nonstructural protein 1 (NS1) antigen (Ag) was searched in the institutional hospital information system. The serum sample of dengue NS1 Ag-positive cases confirmed by enzyme-linked immunosorbent assay (ELISA; PANBIO, Gyeonggi-do, ROK) and a fever duration of less than 5 days were retrieved from the laboratory archive. The DENV serotyping on these sample was performed by reverse transcriptase polymerase chain reaction (RT-PCR). Sequencing and phylogenetic analysis was done for the capsid premembrane (CprM) region to determine the genotype. Results A total of 440 acute-phase samples were received. Twenty one (4.77%) were positive for dengue NS1 Ag with a mean age of 35.1 years and male-to-female ratio of 1.1:1. Eight cases (38.09%) were positive by dengue RT-PCR and all belonged to DENV-3 serotypes. Phylogenetic tree analysis revealed DENV-3 clustered to genotype III with 100% homology with 2008 Indian subcontinent strain. Conclusion This study revealed circulation of DENV-3, genotype III in Delhi from 2017 to 2018, similar to the 2008 viral type. Virological surveillance is an important exercise to be done for viral infections with public threat and outbreak potential.

A retrospective observational insight into COVID-19 exposures resulting from personal protective equipment (PPE) breaches.

BACKGROUND: Healthcare workers (HCWs) stand the risk of acquiring infection directly, while attending to patients or indirectly while handling and testing patient specimens. Considering this, the present study was planned to assess Personal Protective Equipment (PPE) breaches and exposures among HCWs working in COVID-19 wards/ screening areas and to evaluate their COVID-19 positivity rates post-exposure concerning the level of exposure, type of PPE breach, and the cadre of HCWs exposed in COVID-19 wards. METHODS: This retrospective cross-sectional study involved the analysis of all instances of PPE breaches which occurred during a period of nine months from June 2020 to February 2021 at a tertiary care level hospital in Central India. The analysis included all exposures involving any cadre of HCWs that occurred while handling the patients or while doffing the contaminated PPE in COVID -19 wards. RESULTS: A total of 347 PPE breaches were analyzed from the available records of the Hospital Infection Control team repository. Amongst the 347 breaches, 268 (77.2%) were classified as low-risk exposures and 79 (22.8%) as high-risk exposures. Cadre wise distribution of high and low-risk exposures revealed that, PPE breaches occurred most commonly in the category of nursing officers (n = 174, 50.1%). Among all of the breaches, 15.2% of high-risk exposures and 2.6% of low-risk exposures resulted in COVID-19 positivity with a cumulative positivity of 5.4%. Collectively, non-mask related breaches accounted for the majority (63.2%) of the positive COVID-19 cases. CONCLUSION: Appropriate use of PPE by HCWs is vital for their protection. However, breaches in the use of PPE may occur while managing COVID-19 patients due to physical and mental exhaustion among HCWs resulting from work overload. Early identification and appropriate management of HCWs with high-risk exposures can help prevent transmission to other hospital staff and patients, thus preserving resources and workforce.

Mapping the footprints of COVID-19 pandemic.

The new member of the coronavirus family created havoc in the world in few days of its discovery and was declared as a pandemic by March 2020. The enveloped, single-stranded RNA virus was first identified in a patient with dry cough, pain, and weakness for the past1 week with unknown etiology in Wuhan. The coronavirus soon spread across the globe in the next few weeks. To curb the spread of coronavirus, stringent measures such as lockdown and social distancing were enforced resulted in a declining of cases in various countries. However, unlocking, relaxation of preventive measures, and changing human behaviors led to a drastic increase in the number of COVID-19 cases resulting in the second wave of transmission. This resulted in reimposing of lockdown measures in countries such as Nepal, Italy, France, Netherland, and Germany. At present, the virus has affected over 110.7 million peoples and over 2.4 million deaths across the world, with India having the second-highest number of COVID-19 cases, following the United States of America. Furthermore, a cross-sectional view of the disease states several new strains being reported across the globe at one end and at another end there is rolling out of vaccine against COVID-19. There is still uncertainty related to curbing of the pandemic as effect of vaccine on new strains is undetermined. Thus, it is important to understand the transforming epidemiology of the virus as it helps in planning necessary steps for physicians and policymakers. The present review summarizes the updated information primarily about the epidemiology of COVID-19, from initiation to the present scenario.

Pooled nasopharyngeal swab collection in a single vial for the diagnosis of SARS CoV-2 infection: An effective cost saving method.

BACKGROUND: Pool testing is one of the strategy to expedite testing capacities while simultaneously conserving various diagnostic kits, reagents and consumables and time. In the present study, we investigated potential role of combined specimen collection technique for the diagnosis of SARS-CoV-2 virus infection where five nasopharyngeal swabs were collected from different individuals and pooled together in a single viral transport medium (VTM). MATERIAL AND METHODS: This pilot study was conducted on different cohorts of Delhi state. Two nasopharyngeal swabs were collected from each enrolled individual. One swab was put into VTM vial to be further used for individual swab testing (ID). The other swab was put into a fresh VTM for pool swab collection. Each pool comprised five swabs collected from five different patients in one VTM vial. Both IDs and pools were tested in parallel for the detection of SARS-CoV-2 using real time PCR. RESULTS: A total of 46 pools were collected from 230 enrolled individuals.Among 230 ID tested, 60 were found to be positive for both E and RdRp gene. Among 46 pools, 25 pools included all negatives samples and remaining 21 pools included one or more positives. Comparing ID with pool results, overall concordance was seen in 42 pools (91.3%). Four pools showed false positive results as all included samples on ID testing were found to be negative. Considering ID results as reference, swab pool showed 100% sensitivity, 84% specificity, 84% positive predictive value and 100% negative predictive value. CONCLUSION: The pooling of swab strategy could be beneficial only among asymptomatic in low prevalence areas.

Pooled RNA sample reverse transcriptase real time PCR assay for SARS CoV-2 infection: A reliable, faster and economical method.

BACKGROUND: Corona virus disease 2019 (COVID-19) which initially started as a cluster of pneumonia cases in the Wuhan city of China has now become a full-blown pandemic. Timely diagnosis of COVID-19 is the key in containing the pandemic and breaking the chain of transmission. In low- and middle-income countries availability of testing kits has become the major bottleneck in testing. Novel methods like pooling of samples are the need of the hour. OBJECTIVE: We undertook this study to evaluate a novel protocol of pooling of RNA samples/elutes in performance of PCR for SARS CoV-2 virus. STUDY DESIGN: Extracted RNA samples were randomly placed in pools of 8 on a 96 well plate. Both individual RNA (ID) and pooled RNA RT-qPCR for the screening E gene were done in the same plate and the positivity for the E gene was seen. RESULTS: The present study demonstrated that pool testing with RNA samples can easily detect even up to a single positive sample with Ct value as high as 38. The present study also showed that the results of pool testing is not affected by number of positive samples in a pool. CONCLUSION: Pooling of RNA samples can reduce the time and expense, and can help expand diagnostic capabilities, especially during constrained supply of reagents and PCR kits for the diagnosis of SARS-CoV-2 infection.

Optimal size of sample pooling for RNA pool testing: An avant-garde for scaling up severe acute respiratory syndrome coronavirus-2 testing.

Background and Objectives: Timely diagnosis is essential for the containment of the disease and breaks in the chain of transmission of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2). The present situation demands the countries to scale up their testing and design innovative strategies to conserve diagnostic kits and reagents. The pooling of samples saves time, workforce and most importantly diagnostic kits and reagents. In the present study, we tried to define the pool size that could be applied with acceptable confidence for testing. Materials and Methods: We used repeatedly tested positive clinical sample elutes having different levels of SARS CoV 2 RNA and negative sample elutes to prepare seven series of 11 pools each, having pool sizes ranging from 2 to 48 samples to estimate the optimal pool size. Each pool had one positive sample elute in different compositions. All the pools were tested by SARS CoV 2 reverse transcriptase quantitative polymerase chain reaction. Results: Out of the 77 pools, only 53 (68.8%) were found positive. The sensitivity of pools of 2-48 samples was decreased from 100% (95% confidence interval [CL]; 98.4-100) to 41.41% (95% CL; 34.9-48.1). The maximum size of the pool with acceptable sensitivity (>95%) was found to be of six samples. For the pool size of six samples, the sensitivity was 97.8% and the efficiency of pooling was 0.38. Conclusions: The pooling of samples is a practical way for scaling up testing and ultimately containing the further spread of the CoV disease 2019 pandemic.