Mapping malaria vectors and insecticide resistance in a high-endemic district of Haryana, India: implications for vector control strategies.

BACKGROUND: Achieving effective control and elimination of malaria in endemic regions necessitates a comprehensive understanding of local mosquito species responsible for malaria transmission and their susceptibility to insecticides. METHODS: The study was conducted in the highly malaria prone Ujina Primary Health Center of Nuh (Mewat) district of Haryana state of India. Monthly entomological surveys were carried out for adult mosquito collections via indoor resting collections, light trap collections, and pyrethrum spray collections. Larvae were also collected from different breeding sites prevalent in the region. Insecticide resistance bioassay, vector incrimination, blood meal analysis was done with the collected vector mosquitoes. RESULTS: A total of 34,974 adult Anopheles mosquitoes were caught during the survey period, out of which Anopheles subpictus was predominant (54.7%). Among vectors, Anopheles stephensi was predominant (15.5%) followed by Anopheles culicifacies (10.1%). The Human Blood Index (HBI) in the case of An. culicifacies and An. stephensi was 6.66 and 9.09, respectively. Vector incrimination results revealed Plasmodium vivax positivity rate of 1.6% for An. culicifacies. Both the vector species were found resistant to DDT, malathion and deltamethrin. CONCLUSION: The emergence of insecticide resistance in both vector species, compromises the effectiveness of commonly used public health insecticides. Consequently, the implementation of robust insecticide resistance management strategies becomes imperative. To effectively tackle the malaria transmission, a significant shift in vector control strategies is warranted, with careful consideration and adaptation to address specific challenges encountered in malaria elimination efforts.

Prevalence and Correlates of Malnutrition in Nuh District, Haryana State, India.

India has a substantial burden of undernutrition coupled with overweight and obesity at the other end of the spectrum of malnutrition. Nuh district, in the Haryana State in northern India, is an impoverished district in India. With an aim to investigate the problem of malnutrition in the community, a cross-sectional study was conducted in four villages of the Nuh district. Height/length, weight, and age data of children under 5 years were used to calculate three indices: weight-for-age, height-for-age, and weight-for-height. The body mass index was calculated for individuals older than 6 years. Associations between malnutrition and other factors were assessed using simple and multiple logistic regression to get adjusted coefficients. The total surveyed population comprised 11,496 individuals. Over 51% were female, and 13.2% of the surveyed population were children under 5 years. Almost half of the population was illiterate and unemployed. The prevalences of underweight, stunting, and wasting in children under 5 years were 37%, 53%, and 21%, respectively. The prevalences of underweight and stunting in the 6- to 19-year-old age group were 29% and 38%, respectively. The prevalence of overweight was 36% in the 20- to 40-year-old and > 60-year-old age groups, and 44% in the 41- to 60-year-old age group. Our findings reveal a considerable burden of undernutrition among children under 5 years and a dual burden of undernutrition and overnutrition in adults, highlighting the need to map these areas and sharpen our responses to mitigate the overwhelming and long-term consequences of malnutrition in the Nuh district.

Homeopathic Medicines in Third (Omicron) Wave of COVID-19: Prognostic Factor Research.

BACKGROUND: With the emergence of new variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, such as the Omicron variant, during the third wave of the coronavirus disease 2019 (COVID-19) pandemic, there was a need to identify useful homeopathic medicines. This study aimed to identify such medicines and their indications using prognostic factor research (PFR). METHODS: This was an open-label, multi-centred observational study conducted in January 2022, on confirmed COVID-19 cases. The data were collected from integrated COVID Care Centres in Delhi, India, where homeopathic medicines were prescribed along with conventional treatment. Only those cases that met a set of selection criteria were considered for analysis. The likelihood ratio (LR) was calculated for the frequently occurring symptoms of the frequently prescribed medicines. An LR of 1.3 or greater was considered meaningful. RESULTS: Out of the 362 COVID-19 cases, 263 cases were selected for analysis after applying selection criteria. Common symptoms included fatigue, cough, sore throat, myalgia and headache. Twenty-one medicines were prescribed, of which nine medicines - Gelsemium sempervirens, Bryonia alba, Hepar sulphuris, Rhus toxicodendron, Pulsatilla nigricans, Arsenicum album, Belladonna, Nux vomica and Phosphorus - were frequently used. By calculating LRs, the study identified meaningful indications for these medicines. CONCLUSION: Homeopathic medicines have shown promising results in the third wave of COVID-19 as an adjunct therapy. The medicines that were used in the first and second waves were found useful in the third wave also, and their indications were analogous to those found in the earlier waves. Certain new indications of some medicines were elicited in this wave, which warrant further research. However, it is important not to restrict to these medicines only and to continue data collection on COVID-19 in future waves for the improvement of the COVID-19 mini-repertory.

Vaccination coverage and breakthrough infections of COVID-19 during the second wave among staff of selected medical institutions in India.

India experienced the second wave of SARS-CoV-2 infection from April 3 to June 10, 2021. During the second wave, Delta variant B.1617.2 emerged as the predominant strain, spiking cases from 12.5 million to 29.3 million (cumulative) by the end of the surge in India. Vaccines against COVID-19 are a potent tool to control and end the pandemic in addition to other control measures. India rolled out its vaccination programme on January 16, 2021, initially with two vaccines that were given emergency authorization-Covaxin (BBV152) and Covishield (ChAdOx1 nCoV- 19). Vaccination was initially started for the elderly (60+) and front-line workers and then gradually opened to different age groups. The second wave hit when vaccination was picking up pace in India. There were instances of vaccinated people (fully and partially) getting infected, and reinfections were also reported. We undertook a survey of staff (front line health care workers and supporting) of 15 medical colleges and research institutes across India to assess the vaccination coverage, incidence of breakthrough infections, and reinfections among them from June 2 to July 10, 2021. A total of 1876 staff participated, and 1484 forms were selected for analysis after removing duplicates and erroneous entries (n = 392). We found that among the respondents at the time of response, 17.6% were unvaccinated, 19.8% were partially vaccinated (received the first dose), and 62.5% were fully vaccinated (received both doses). Incidence of breakthrough infections was 8.7% among the 801 individuals (70/801) tested at least 14 days after the 2nd dose of vaccine. Eight participants reported reinfection in the overall infected group and reinfection incidence rate was 5.1%. Out of (N = 349) infected individuals 243 (69.6%) were unvaccinated and 106 (30.3%) were vaccinated. Our findings reveal the protective effect of vaccination and its role as an essential tool in the struggle against this pandemic.

Homeopathic Medicines in Second Wave of COVID-19: Prognostic Factor Research.

BACKGROUND: The clinical profile and course of COVID-19 evolved perilously in a second wave, leading to the use of various treatment modalities that included homeopathy. This prognostic factor research (PFR) study aimed to identify clinically useful homeopathic medicines in this second wave. METHODS: This was a retrospective, multi-centred observational study performed from March 2021 to May 2021 on confirmed COVID-19 cases who were either in home isolation or at COVID Care Centres in Delhi, India. The data were collected from integrated COVID Care Centres where homeopathic medicines were prescribed along with conventional treatment. Only those cases that met a set of selection criteria were considered for analysis. The likelihood ratio (LR) was calculated for the frequently occurring symptoms of the prescribed medicines. An LR of 1.3 or greater was considered meaningful. RESULTS: Out of 769 confirmed COVID-19 cases reported, 514 cases were selected for analysis, including 467 in home isolation. The most common complaints were cough, fever, myalgia, sore throat, loss of taste and/or smell, and anxiety. Most cases improved and there was no adverse reaction. Certain new symptoms, e.g., headache, dryness of mouth and conjunctivitis, were also seen. Thirty-nine medicines were prescribed, the most frequent being Bryonia alba followed by Arsenicum album, Pulsatilla nigricans, Belladonna, Gelsemium sempervirens, Hepar sulphuris, Phosphorus, Rhus toxicodendron and Mercurius solubilis. By calculating LR, the prescribing indications of these nine medicines were ascertained. CONCLUSION: Add-on use of homeopathic medicines has shown encouraging results in the second wave of COVID-19 in integrated care facilities. Further COVID-related research is required to be undertaken on the most commonly prescribed medicines.

Structural insights for neutralization of Omicron variants BA.1, BA.2, BA.4, and BA.5 by a broadly neutralizing SARS-CoV-2 antibody.

In this study, by characterizing several human monoclonal antibodies (mAbs) isolated from single B cells of the COVID-19-recovered individuals in India who experienced ancestral Wuhan strain (WA.1) of SARS-CoV-2 during early stages of the pandemic, we found a receptor binding domain (RBD)-specific mAb 002-S21F2 that has rare gene usage and potently neutralized live viral isolates of SARS-CoV-2 variants including Alpha, Beta, Gamma, Delta, and Omicron sublineages (BA.1, BA.2, BA.2.12.1, BA.4, and BA.5) with IC50 ranging from 0.02 to 0.13 µg/ml. Structural studies of 002-S21F2 in complex with spike trimers of Omicron and WA.1 showed that it targets a conformationally conserved epitope on the outer face of RBD (class 3 surface) outside the ACE2-binding motif, thereby providing a mechanistic insights for its broad neutralization activity. The discovery of 002-S21F2 and the broadly neutralizing epitope it targets have timely implications for developing a broad range of therapeutic and vaccine interventions against SARS-CoV-2 variants including Omicron sublineages.

A cross-sectional study to assess the utilization pattern of maternal health services and associated factors in aspirational district of Haryana, India.

BACKGROUND: In India mother related mortalities and morbidities are still significantly higher even after having various maternal program and schemes at regional and national level which reflects that such services are being under-utilized. AIM: The current study focused in assessing utilization pattern of maternal health services and associated factors in Nuh (Mewat). METHODS: This present cross-sectional study was done for one year (2015-16) among mothers (15-49 years) under field practice area, PHC Taoru with minimum calculated sample as 645. The selection of participants was made using simple random sampling technique from available randomized list of villages. Data was collected by home-to-home visits using pretested, predesigned, standardized questionnaire and during analysis an association between variables was considered as significant if P < 0.05. RESULTS: Out of 645 participants, 632 provided consent for inclusion into study. Any ANC and full ANC services was made by only 58.3% and 11.7% of participants respectively. More than half of the participants (52.7%) had suffered from pregnancy related complications. Variables such as lower age group, low decision-making capacity were significantly associated with not obtaining full ANC services (P < 0.05). CONCLUSION: In the present study major determinants of a women which influence utilization of maternal health care service includes their age, literacy status, parity, socioeconomic status and occupation. Such determinants shall be considered for upcoming intervention aiming to bring attitudinal changes and concurrently leading to improved and enhanced usage of maternal health care services.

Clinico-pathological features in fatal COVID-19 infection: a preliminary experience of a tertiary care center in North India using postmortem minimally invasive tissue sampling.

OBJECTIVES: To study the histopathology of patients dying of COVID-19 using post-mortem minimally invasive sampling techniques. METHODS: This was a single-center observational study conducted at JPNATC, AIIMS. Thirty-seven patients who died of COVID-19 were enrolled. Post-mortem percutaneous biopsies were taken from lung, heart, liver, kidney and stained with hematoxylin and eosin. Immunohistochemistry was performed using CD61 and CD163. SARS-CoV-2 virus was detected using IHC with primary antibodies. RESULTS: The mean age was 48.7 years and 59.5% were males. Lung histopathology showed diffuse alveolar damage in 78% patients. Associated bronchopneumonia was seen in 37.5% and scattered microthrombi in 21% patients. Immunopositivity for SARS-CoV-2 was observed in Type II pneumocytes. Acute tubular injury with epithelial vacuolization was seen in 46% of renal biopsies. Seventy-one percent of liver biopsies showed Kupffer cell hyperplasia and 27.5% showed submassive hepatic necrosis. CONCLUSIONS: Predominant finding was diffuse alveolar damage with demonstration of SARS-CoV-2 protein in the acute phase. Microvascular thrombi were rarely identified in any organ. Substantial hepatocyte necrosis, Kupffer cell hypertrophy, microvesicular, and macrovesicular steatosis unrelated to microvascular thrombi suggested that liver might be a primary target of COVID-19.

Characterization of neutralizing versus binding antibodies and memory B cells in COVID-19 recovered individuals from India.

India is one of the most affected countries by COVID-19 pandemic; but little is understood regarding immune responses to SARS-CoV-2 in this region. Herein we examined SARS-CoV-2 neutralizing antibodies, IgG, IgM, IgA and memory B cells in COVID-19 recovered individual from India. While a vast majority of COVID-19 recovered individuals showed SARS-CoV-2 RBD-specific IgG, IgA and IgM antibodies (38/42, 90.47%; 21/42, 50%; 33/42, 78.57% respectively), only half of them had appreciable neutralizing antibody titers. RBD-specific IgG, but not IgA or IgM titers, correlated with neutralizing antibody titers and RBD-specific memory B cell frequencies. These findings have timely significance for identifying potential donors for plasma therapy using RBD-specific IgG assays as surrogate measurement for neutralizing antibodies in India. Further, this study provides useful information needed for designing large-scale studies towards understanding of inter-individual variation in immune memory to SARS CoV-2 natural infection for future vaccine evaluation and implementation efforts.

Community sensitization to improve acceptability of indoor residual spraying (IRS) in Mewat district of Haryana, India: A community-based interventional study.

BACKGROUND & OBJECTIVES: Indoor Residual Spraying (IRS) is an important part of malaria prevention and control strategies for villages with annual parasitic incidence (API) of more than 5, or other criteria by National Program of the country. At the time of conception of the study, i.e., in 2012, district Mewat in Haryana state, India was malaria endemic including 35 malaria high risk villages with API more than 5. The current study aimed to improve acceptability of IRS among the residents of Mewat district. METHODS: This was a community based interventional study. Out of the 14 sub-centers, there were 12 sub-centers catering the population of 79 villages, out of which 35 villages had API of more than five, and hence, fulfilled the criteria for regular IRS. Considering sub-center as the unit of randomization, out of all the 12 sub-centers which cater population of villages with API > 5, equal number of the sub-centers matched according to the population size of those villages were assigned to the intervention and non-intervention (control) groups by randomization using lottery technique. The intervention comprised community sensitization through community meetings, wall paintings and distribution of pamphlets. Baseline and post intervention acceptability of IRS was measured and compared. RESULTS: There was 21.7% (95% CI 16.12 to 27.15) increase in intention to accept IRS as per guidelines, and 15.2% (95% CI 9.50 to 20.80) increase in the actual acceptance of IRS in intervention group of villages in Mewat district. INTERPRETATION & CONCLUSION: The intervention can bring about significant increase in the acceptability of IRS which is an important component of malaria control under national programme in district Mewat, Haryana, India.

Active case finding of tuberculosis among household contacts of newly diagnosed tuberculosis patients: A community-based study from southern Haryana.

BACKGROUND: Active case-finding is provider-initiated and implies systematic searching for TB in individuals who would not spontaneously present to a health service, and bringing them into care for diagnosis and treatment. AIM: The present study was carried out with the objective to assess the yield and feasibility of active case finding strategy among household contacts of newly diagnosed pulmonary TB cases and to determine risk factors in household contact. METHODS: This community-based study with cross-sectional design was conducted among the household contacts of all newly diagnosed microbiologically confirmed pulmonary TB patients registered at Tuberculosis Unit (TU), Nuh. Investigator conducted house to house visit and met respective index case and his/her household contacts to build the rapport. RESULTS: In the present study, there were 55 sputum smear-positive index cases and 356 household contacts of index cases. The most common symptom among screening positive household contacts was cough followed by weight loss. A substantial proportion (83.8%) of symptom positive household contacts were investigated for tuberculosis and among them, 18.9% were found to be positive for tuberculosis. The overall prevalence of TB cases among household contacts was found to be 1.97%. CONCLUSION: The present study concludes that household contact screening for active case finding for TB is a feasible and efficient tool that can potentially result in earlier diagnosis and treatment of active TB, thus minimizing the severity and decreasing transmission. It can also contribute toward improving treatment outcomes, health sequelae, and the social and economic consequences of TB.

Use of ultrasonography in COVID-19: Probing for success.

The ongoing pandemic of COVID-19 has put an immense strain on healthcare facilities around the world. Unique challenges are being faced in the adequate management of rapidly increasing number of cases while ensuring adequate healthcare providers apostrophe safety. Issues related to the difficulty of examination while wearing personal protective equipment, need for objectivity in triage and testing of patients, and evidence-based management of the critically ill has resulted in reliance on longitudinal radiological assessment. There are a number of portability, disinfection and radiation exposure related problems with the use of X-rays and computerized tomography (CT). Point of care ultrasonography provides a pragmatic, safe, and repeatable approach for addressing the pertinent clinical questions that have traditionally relied on X-rays and CT scans. Here, we summarize the use ultrasound assessment can play in the triage, identification, and subsequent management of patients with COVID-19.

Barriers to childhood vaccination as perceived by accredited social health activists and multipurpose health workers in Mewat, Haryana (India): A qualitative research.

BACKGROUND: As compared to other parts of the country, vaccination coverage and literacy rate in district Mewat, State Haryana (India) had been low, that is, 20.8-27% and 54%, respectively. National immunization program of the country was being implemented primarily through the field workers, and accredited social health activists (ASHAs) were one of the key grass root level link workers. AIMS: Hence, this study was carried out with the objective to identify barriers to childhood vaccination by field staff in field practice area of SHKM Govt Medical College Nalhar, Mewat as perceived by ASHAs and health workers. METHODS AND MATERIAL: The current study was a qualitative research which was conducted in the field practice area attached to SHKM Government Medical College Nalhar Mewat. Focus Group Discussions (FGDs) were carried out among health workers (MPHW-F/M) and ASHAs. STATISTICAL ANALYSIS USED: None. RESULTS AND CONCLUSIONS: The barriers to childhood vaccination as identified in the study are pain during vaccination and other side effects, additional expenditure on treatment of side effects, worsening of interpersonal relations of the functionaries (workers/ASHAs) with the beneficiaries, extra work burden, unawareness of the benefits of vaccination, myth/belief of potential risk of impotency in adulthood, denial by elders, lack of cash benefits, inaccessibility to vaccination services due to remote work places, people's beliefs in supernatural causes of childhood diseases, delayed BCG vaccination, etc., The barriers to childhood vaccination from the perspective of ASHAs and health workers are explored and identified which can be utilized in tailoring the efforts and strategies to improve the vaccination coverage.

Atypical presentation of pyogenic iliopsoas abscess in two cases.

Iliopsoas abscess (IPA) is an uncommon diagnosis in medical wards. Herein, we present two unusual cases of IPA. First patient was an elderly diabetic patient who had gas-forming bilateral IPA caused by Escherichia coli. This infection proved fatal and patient succumbed on third day of hospital admission. Second patient was a young boy who had right sided sacroilitis with IPA. Staphylococcus aureus was isolated from the pus culture and patient was successfully treated without any sequelae.

Not so sweet; severe Sweet's syndrome presenting as SIRS and pleural effusion.

Acute febrile neutrophilic dermatosis (Sweet's syndrome) is a rare inflammatory condition which presents as abrupt onset of painful erythematous plaques or nodules, often associated with fever and leucocytosis. Many extracutaneous manifestations are described in literature, but pulmonary manifestations and systemic inflammatory response syndrome (SIRS) are rare. Here we report a case of a 35-year-old male who presented with SIRS and pleural effusion. The presence of vesiculobullous and pustular skin lesions raised the suspicion of Sweet's syndrome and it was confirmed by skin biopsy. Initiation of systemic glucocorticoids lead to complete resolution of symptoms.