Assessment of Knowledge, Attitude, and Practices (KAP) Toward Hepatitis B Infection, Its Prevention, and Vaccination Among Health Care Workers.

BACKGROUND: Health Care workers (HCWs) have an approximate four-fold increased risk of contracting hepatitis B infection than the normal population. A lack of knowledge and practices regarding precautions has been frequently observed. We aimed to do a knowledge, attitude, and practices (KAP) study regarding hepatitis B prevention measures among HCWs. METHODS: The study enrolled 250 HCWs. A questionnaire-based proforma regarding KAP towards hepatitis B, its causation, and prevention was filled out by each participant. RESULTS: Mean age (SD) of participants was 31.8 ± 9.1 years with 83 males and 167 females. Subjects were divided into two groups: Group I (House Surgeons and Residents) and Group II (Nursing staff, Laboratory Technicians, Operation Theatre Assistants). All Group I and 148 (96.7%) of Group II subjects had adequate knowledge regarding the professional risk of hepatitis B virus transmission. Knowledge regarding different modes of transmission was less in Group II subjects (Blood (96.1%), Sex (84.3%), percutaneous route (85.6%), and During Birth (83%)) as compared to Group I (100% in all). All subjects in Group I and 134 (90.9%) Group II subjects knew about vaccination as a preventive measure. There was a slight discordance between attitude and practices towards universal precautionary measures in Group II subjects (Use of gloves 96.1% vs 94.8%; Safe needle disposal 96.7% vs 96.1%; Vaccination 94.8% vs 67.9%). Of the subjects in Group I, 94.8% were vaccinated and 67.9% were vaccinated in Group II, with complete vaccination rates being 76.3% and 43.1%, respectively, and the difference was statistically significant (P < 0.001). CONCLUSION: Better knowledge and attitude led to more adoption of preventive practices. But, still, there is a gap in the KAP towards hepatitis B preventive practices and knowledge is not getting transformed into practices. We recommend that all HCWs should be questioned about their vaccination status. In addition, vaccination coverage, various preventive campaigns, and the hospital infection control committee (HICC) need to be strengthened.

Changing pattern of admissions for acute myocardial infarction in India during the COVID-19 pandemic.

AIM: Studies on the changes in the presentation and management of acute myocardial infarction (AMI) during the COVID-19 pandemic from low- and middle-income countries are limited. We sought to determine the changes in the number of admissions, management practices, and outcomes of AMI during the pandemic period in India. METHODS & RESULTS: In this two-timepoint cross-sectional study involving 187 hospitals across India, patients admitted with AMI between 15th March to 15th June in 2020 were compared with those admitted during the corresponding period of 2019. We included 41,832 consecutive adults with AMI. Admissions during the pandemic period (n = 16414) decreased by 35·4% as compared to the corresponding period in 2019 (n = 25418). We observed significant heterogeneity in this decline across India. The weekly average decrease in AMI admissions in 2020 correlated negatively with the number of COVID cases (r = -0·48; r2 = 0·2), but strongly correlated with the stringency of lockdown index (r = 0·95; r2 = 0·90). On a multi-level logistic regression, admissions were lower in 2020 with older age categories, tier 1 cities, and centers with high patient volume. Adjusted utilization rate of coronary angiography, and percutaneous coronary intervention decreased by 11·3%, and 5·9% respectively. CONCLUSIONS: The magnitude of reduction in AMI admissions across India was not uniform. The nature, time course, and the patient demographics were different compared to reports from other countries, suggesting a significant impact due to the lockdown. These findings have important implications in managing AMI during the pandemic.

Pattern of acute MI admissions in India during COVID-19 era: A Cardiological Society of India study - Rationale and design.

BACKGROUND: COVID-19 pandemic has affected around 20million patients worldwide and 2.0 million cases from India. The lockdown was employed to delay the pandemic. However, it had an unintentional impact on acute cardiovascular care, especially acute myocardial infarction (AMI). Observational studies have shown a decrease in hospital admissions for AMI in several developed countries during the pandemic period. We aimed to evaluate the impact of COVID-19 on the AMI admissions patterns across India. METHODS: In this multicentric, retrospective, cross-sectional study, we included all AMI cases admitted to participating hospitals during the study period 15th March to 15th June 2020 and compared them using a historical control of all cases of AMI admitted during the corresponding period in the year 2019. Major objective of the study is to analyze the changes inthe number of hospital admissions for AMI in hospitals across India. In addition, we intend to evaluate the impact of COVID-19 on the weekly AMI admission rates, and other performance measures like rates of thrombolysis/primary percutaneous interventions (PCI), window period, door to balloon time, and door to needle time. Other objectives include evaluation of changes in the major complications and mortality rates of AMI and its predictors during COVID-19 pandemic. CONCLUSIONS: This CSI-AMI study will provide scientific evidence about the impact of COVID-19 on AMI care in India. Based on this study, we may be able to suggest appropriate changes to the existing MI guidelines and to educate the public regarding emergency care for AMI during COVID-19 pandemic.

Antiphospholipid syndrome in a pregnant female presenting with severe thrombocytopenia and bleeding.

The antiphospholipid antibody syndrome (APS) is defined by the persistent presence of antiphospholipid antibodies in patients with recurrent venous or arterial thromboembolism or pregnancy morbidity. Antithrombotic therapy is the mainstay of treatment given the high risk of recurrent thromboembolism that characterizes this condition. Despite the prothrombotic nature of APS, thrombocytopenia is present in a proportion of patients, which can complicate management and limit the use of antithrombotic therapy. The mechanism of APS-associated thrombocytopenia is multifactorial and its relation to thrombotic risk is poorly characterized. The presence of thrombocytopenia does not appear to reduce thrombotic risk in patients with APS, who can develop thromboembolic complications necessitating antithrombotic treatment. In these cases, treatment of the thrombocytopenia may be necessary to facilitate administration of antithrombotic agents. We present such a pregnant lady with history of recurrent pregnancy losses who presented with severe thrombocytopenia and bleeding manifestations, who was subsequently diagnosed to have antiphospholipid antibody syndrome. She was initially managed with steroids and when her platelet counts improved, antithrombotic therapy was started. She delivered an uneventful and successful pregnancy outcome without any complications during follow-up.