Efficacy and safety of polyherbal formulation as an add-on to standard-of-care in mild-to-moderate COVID-19: A randomized, double-blind, placebo-controlled trial.

Background: Novel corona virus disease-2019 (COVID-19) pandemic is a significant contributor to morbidity and mortality in affected individuals. Modulating the immune response in COVID-19 is now an established treatment approach. Polyherbal formulations have long been assessed for their potential immune modulating effects and are expected to be beneficial on COVID-19. Methods: This study aims at assessing the efficacy and safety of polyherbal formulation (referred as IP) in comparison to placebo, as add on to the standard of care (SOC), in patients with mild to moderate COVID-19 patients. Hospitalized RT-PCR positive patients were randomized to either SOC + IP or SOC + Placebo arm. The viral load (VL) was assessed using quantitative reverse transcription-polymerase chain reaction (qRT-PCR). Immunological parameters were also assessed. The clinical improvement was assessed using a numeric rating scale (NRS) and WHO ordinal scale, and follow-up period was 30 days. Results: Seventy-two patients were randomized to SOC + IP (n = 39) and SOC + Placebo (n = 33) arms. There was significant reduction in VL in SOC + IP arm from day 0-4 (p = 0.002), compared to SOC + Placebo arm (p = 0.106). Change in the NRS score and WHO score was significant in both arms, however, the difference between the two arms was statistically significant in favour of IP arm. The increase in Th1 response was significant in SOC + IP arm (p = 0.023), but not in SOC + Placebo arm. COVID-19 specific antibodies were numerically higher in the SOC + IP arm. Conclusion: The study finds that polyherbal formulation significantly reduces VL and contributes to immunomodulation and improvement in clinical conditions without side effects.

Epidemiological Pattern and Trend Analysis of Animal Bite Cases of Anti-Rabies Clinic of Tertiary Care Hospital of Delhi.

Background: Animal bites to humans are a public health problem. Rabies is caused by rhabdovirus which is present in the saliva of rabid animals like dogs, cats, monkeys, and wild animals like fox and jackals. Objective: To find the epidemiological pattern and trend analysis of animal bite cases registered in Anti-rabies clinic of tertiary care hospital of Delhi. Materials and Methods: A retrospective cross-sectional study was planned in Anti-rabies clinic of Hindu Rao Hospital, Delhi, and data from January 2010 to December 2018 was taken. Data were analyzed by SPSS software version 21.0. Results: After interpretation of data from 2010 to 2018, it was found that maximum number of animal bite cases belonged to category 3 (91.0%) and majority (93.6%) were due to dog bite. On analysis of year and season wise trend, it was found that the frequency of cases showed a rising trend from the year 2010, with highest number of cases in the year 2014, while animal bite cases were maximum with arrival of spring season (month of April). Conclusion: This study concludes that animal bite cases are rising over the years and dog bites are most common animal bite cases in Delhi. Most of the animal bite cases occurred during spring season followed by autumn season of the year. So, there is dire need of strengthening the preventive measures for controlling animal bites in the study area.

HIV Treatment with the Two-Drug Regimen Dolutegravir Plus Lamivudine in Real-world Clinical Practice: A Systematic Literature Review.

The two-drug regimen dolutegravir plus lamivudine demonstrated durable efficacy for up to 3 years in phase III studies and a high barrier to resistance in treatment-naive and virologically suppressed people with HIV (PWH). This systematic literature review summarizes real-world evidence evaluating effectiveness and safety of dolutegravir plus lamivudine. We searched Ovid MEDLINE®, Embase®, PubMed, Cochrane library, and relevant international conference proceedings from 2013 to 2020. Qualitative synthesis of virologic suppression at Week 48, treatment-emergent resistance, discontinuation rates, and comorbidities was undertaken, with no statistical analyses conducted. Linked publications and potential for duplication in reporting of outcomes for cohorts and populations were identified, and the publication reporting the highest number of PWH receiving dolutegravir plus lamivudine was included in the analysis. Thirty-four studies reporting on cohorts of PWH not suspected to be linked or to include duplicate data receiving dolutegravir plus lamivudine were identified (N = 5017). Of 3744 virologically suppressed PWH who switched to dolutegravir plus lamivudine, 603 (16%) reported history of virologic failure. Nineteen studies included effectiveness data (n = 3558), four of which included data from treatment-naive PWH (n = 69). In studies with > 100 PWH, high rates of virologic suppression (Week 48, 97-100%) were maintained with dolutegravir plus lamivudine, with low rates of virologic failure (0-3.3 per 100 person-years of follow-up); one instance of emergent integrase strand transfer inhibitor resistance was reported in a complex treatment-experienced individual. Rates of discontinuation due to adverse events were low and consistent with previously observed trial data. Dolutegravir plus lamivudine minimally impacted renal function and had minimal impact on or improved lipid profiles and bone mineral density. This systematic review demonstrates that effectiveness and safety of dolutegravir plus lamivudine in clinical practice support data from randomized controlled trials with regard to high rates of virologic response, low rates of discontinuation, and a high barrier to resistance.

Prevalence of anaemia among school going adolescent girls attending Test, Treat and Talk (T-3) camp under Anaemia Mukt Bharat in Delhi.

BACKGROUND: Adolescent period is signalized by marked physical activity and rapid growth spurt; therefore, they need additional nutritional supplements and are at utmost risk of developing nutritional anaemia. Anaemia play a major role in affecting the adolescents especially girls. On September 2019, Ministry of Health and Family welfare, Govt. of India directed to all state and district health authority to conduct Test, Treat and Talk (T-3) anaemia camps for celebration of nutrition month (Poshan Maah) in all government schools and colleges. The present study aimed to assess prevalence of anaemia and factors associated with it among school going adolescent girls attending T-3 camp in Delhi. METHODS: A cross-sectional study was conducted among 203 adolescent girls in government girls' school in central district of Delhi. Hb estimation was done by HemoCue 201 and data regarding socio-demographic details, deworming, dietary preferences were collected. Clinical examination and anthropometric measurements were done by resident doctors. Data was analysed using STATA vs. 13. RESULTS: The prevalence of anaemia was found to be 59% with mean (±SD) Hb of 11.3 gm/dl (±1.55) among 203 participants. The majority (48%, n = 119) of anaemic girls had mild degree of anaemia. Among 203 girls, 65% participants were of age 14-15 years with mean (±SD) age of 14.6 years (±1.18). There was a significant relationship between anaemia and diet, deworming status, and BMI (P < 0.05). CONCLUSION: The study revealed that anaemia was highly prevalent among adolescent girls. Among anaemic girls, majority had mild anaemia. Factors like vegetarian diet, underweight, deworming and presence of pallor were found to be associated with anaemia. There is need to conduct T-3 camps at regular interval in all schools to curb the problem of adolescent anaemia.

Internet Addiction, Sleep Quality and Depressive Symptoms Amongst Medical Students in Delhi, India.

Today, the internet has become an important element in people's lives, and owing to internet access becoming widespread, it has resulted in internet addiction. It is a major concern amongst medical students aiming to develop into health professionals. The implications of this addiction as well as its association with sleep and depression affects their studies, impacts their career goals and has detrimental consequences for society as a whole. The objectives of this study were to assess the proportion of medical undergraduate students and interns with internet addiction (IA), depressive symptoms and poor sleep quality and to study the association of IA with sleep quality and depressive symptoms. A cross-sectional questionnaire-based study was carried out in a medical college in Delhi. Universal sample consisting of all the medical students from first to final year (n = 185) and interns (n = 37) enrolled during the time of the study were included. Sleep quality, internet addiction and depressive symptoms in these students was assessed using Pittsburgh Sleep Quality Index (PSQI) Young's Internet Addiction Test (YIAT) and Patient Health Questionnaire-9 (PHQ) respectively. The average YIAT score was 33.16 ± 15.68. Overall 18%, 59.9%, 46.8% of students scored above validated cutoff scores for internet addiction, poor sleep quality and depression respectively. Prevalence of IA among males and females were 20.4% and 12.9% respectively. Significant correlations were found between potential IA, sleep quality and depression (p < 0.001). The study concluded a strong correlation between IA, disturbed sleep quality and depression. Identifying medical students with potential IA is important because this addiction often coexists with other psychological problems. Thus timely remedial actions and tailored interventions are required to combat IA among medical students.

Integrating screening for non-communicable diseases and their risk factors in routine tuberculosis care in Delhi, India: A mixed-methods study.

BACKGROUND: Evidence supports the integration of prevention and management for tuberculosis (TB) with non-communicable diseases (NCDs). Bi-directional screening for TB and diabetes mellitus (DM) is already implemented in India, a country with a dual burden of TB and NCDs. However, very limited programmatic data are available on the feasibility of adding other NCDs and their risk factors in such screening programme. OBJECTIVE: To assess the yield, feasibility, and acceptability of a two-stage integrated screening for NCDs and risk factors for NCDs among patients with TB ≥20 years and treated in DOTS centres of two medical colleges in Delhi, between October 2016 and March 2017. METHODS: It was a mixed-methods, triangulation study with a quantitative component (cross-sectional study using questionnaires, anthropometric measurements and records review) and a qualitative component (descriptive study using interview data). RESULTS: Amongst 403 patients screened, the prevalence of hypertension was 7% (n = 28) with 20 new cases detected and 8% for DM (n = 32) with 6 new cases diagnosed. The number needed to screen to find a new case was 20 and 63 for hypertension and DM respectively. The most frequent NCD-risk factors were inadequate vegetable (80%) and fruits (72%) intake, alcohol use (34%), use of smokeless tobacco (33%) and smoking (32%). Clustering of four or more risk factors was associated with increasing age and male sex (p<0.05). Both patients and health providers considered the screening relevant and acceptable. However, waiting time and costs involved in blood tests were considered as bothersome by the patients, while health providers perceived increased workload, inadequate medical supplies and inadequate skills and knowledge as key challenges in implementation of the screening. CONCLUSION: Integrating screening for NCDs and their risk factors in the existing TB programme produces high yield and it is feasible and acceptable by patients and health providers provided the challenges are overcome.

Past, present, and future of iodine deficiency disorders in India: Need to look outside the blinkers.

Iodine deficiency disorders (IDDs) have been recognized as one of the major nutritional disorders throughout the world affecting 200 million people who are at risk and another 71 million suffering from goiter and other IDDs. These groups of disorders can affect every stage of life, but most vulnerable age group is between 6 and 12 years and these disorders together constitute the single largest preventable cause of brain damage leading to learning disabilities and psychomotor impairment. The existence of endemic goiter in an extensive belt along the southern slopes of the Himalayas, Alps, and Andes has long been described, but consistently high prevalence of IDDs outside the endemic zones and failure to attain goals set by the National Iodine Deficiency Disorder Control Program questions the strategy and achievements till date. Therefore, the present article is an attempt to critically examine the program since inception in India.

Role of traditional nonsteroidal anti-inflammatory drugs in Alzheimer's disease: a meta-analysis of randomized clinical trials.

The role of nonsteroidal anti-inflammatory drugs (NSAIDs) in prevention of Alzheimer's disease (AD) has been evaluated in many studies. We performed a meta-analysis to summarize the existing evidence on the relation between use of classical NSAIDs and AD. Randomized controlled trials (RCTs) evaluating the role of classical NSAIDs in AD was searched using different search engines. The RCTs in patients who had the degree of AD measured on Mini-Mental State Examination (MMSE) or AD Assessment Scale-Cognitive subscale (ADAS-cog) were included in the study. The RCTs and data (AD scores) were independently assessed by 2 reviewers, and data were included in meta-analysis only after a common consensus was reached. The pooled results from the ADAS-cog and MMSE scores failed to show any difference between the treatment and the placebo groups as opposed to findings from some observational studies. However, in view of heterogeneity of results, there is a need to conduct more RCTs to arrive at confirmatory findings.

Role of statins in Alzheimer's disease: a retrospective meta-analysis for commonly investigated clinical parameters in RCTs.

This review was conducted to assess the role of statins in the treatment of Alzheimer's disease (AD). We conducted meta-analysis using the randomised controlled trials (RCTs) conducted in patients who suffered from Alzheimer's disease, by conducting searches for RCTs in MEDLINE, EMBASE and Cochrane (up to 2012). An overall of five studies were included and analysed. The evaluation was done for some commonly evaluated clinical parameters like Clinical Global Impression of Change (CGIC), Mini Mental State Examination (MMSE) and Alzheimer's Disease Assessment Scale (ADAS-CoG). Statistical evaluation was done as per method described by Neyeloff et al. and forest plots were plotted for each evaluated parameter. MMSE score showed a significant difference in favour of statins. ADAS-CoG and CGIC did not show a significant advantage for statins in comparison to placebo. Highly heterogeneous distribution was seen for MMSE score. Further trials need to be conducted to arrive at more robust results.

AN EPIDEMIOLOGICAL SURVEY OF MALARIA AT AN AIR FORCE STATION.

Increased incidence of malaria in an Air Force Station in western India in 1994 was investigated by means of an epidemiological survey. The survey was conducted from 17 October to 20 October 1994. It revealed that the station had ecological conditions and topography favouring mosquito breeding. For 1994 the annual parasite incidence was 3.29 and annual blood examination rate was 26.4 per cent. Active parasitological survey revealed 2 cases of asymptomatic parasitaemia. The survey also revealed that the outbreak was due to combination of natural forces and laxity in implementing existing anti-malaria activity.