Our Fight Against the Rapidly Evolving COVID-19 Pandemic: A Review of India's Actions and Proposed Way Forward.

A new strain of coronavirus named severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has overwhelmed the world with its rapid spread and high number of cases. SARS-CoV-2 causes COVID-19 disease which may present with mild, moderate, or severe illness. In severe cases, pneumonia, acute respiratory distress syndrome, sepsis, and septic shock can occur. Individuals above 60 years and people with preexisting comorbidities are at higher risk for developing serious complications. The incubation period of this new pathogen ranges from 1 to 14 days and there is no preexisting immunity to the disease. Countries across the globe have adopted various prevention and control measures to minimize negative health impacts. India has adopted various public health measures which include social distancing measures, nationwide lockdown to reduce risk of exposure, widespread IEC messaging regarding hand-washing, usage of masks, and recommending avoidance of unnecessary travel to combat the spread of disease. This manuscript reviews the global situation, contextualizes India's disease control efforts, and outlines the possible way forward by identifying specific actions under the following headings: enhancing district preparedness, enabling care for patients, and broadening community and stakeholder engagement for India.

Diagnostic Methods for Detection of Cotinine Level in Tobacco Users: A Review.

The greatest disease-producing product known to man is tobacco. It is a cause of many oral diseases and adverse oral conditions. In India, tobacco is available in smokeless and smoking form. Tobacco contains nicotine which metabolises to form a toxic alkaloid i.e. cotinine. It stimulates autonomic ganglia and central nervous system. Cotinine is the best indicator of tobacco smoke exposure. Various methods are used to measure cotinine level in blood, saliva and urine such as high performance liquid chromatography, colorimetric assay, gas chromatography, NicAlert saliva test, etc. Thus such wide range of methods for cotinine detection in tobacco users requires a detailed discussion regarding their utility. This review will help readers to compare various methods for cotinine detection and enable them to make scientifically informative decision.

Association of occupational stress factors on nicotine dependence among patients visiting dental care unit of Indo-Tibetian border police force station in India.

BACKGROUND: Tobacco use is the foremost preventable cause of death and disease in the world today and work strain might be related with nicotine dependence by its provoking effect. OBJECTIVE: To assess the association between occupational stress and nicotine dependence. MATERIAL AND METHODS: A cross sectional survey was conducted among 200 subjects visiting a satellite dental clinic of Swami Devi Dyal Hospital and Dental College, Barwala, Panchkula, India. Nicotine dependence was measured using the Fagerstrom Test for Nicotine Dependence (FTND). The extent of the stress factors experienced at work was assessed using the Effort-Reward Imbalance scale (ERI). Chi-square test and multiple logistic regression analysis were employed for statistical analysis. Confidence level and level of significance were set at 95% and 5% respectively. RESULTS: The results of bivariate analysis revealed association of occupational stress with age, marital status, educational status, level of nicotine dependence, frequency of cigarette smoking and religious attendance. However, multivariate analysis elicited the significant association of occupational stress with only two variables, level of nicotine dependence and frequency of smoking. CONCLUSION: Occupational stress was found to be associated with nicotine dependence in the present study implying a need of other tranquil measures to be incorporated for the relief of work related stress.

Effectiveness of oral health education versus nicotine replacement therapy for tobacco cessation- a parallel randomized clinical trial.

BACKGROUND: India has millions of tobacco users. It is the leading cause of deaths due to oral cancer and hence needs effective strategies to curb it. Hence the aim of present study was to evaluate and compare the effectiveness of Oral Health Education (OHE) and Nicotine Replacement Therapy (NRT) in tobacco cessation. MATERIAL AND METHODS: The clinical trial consisted of Manohar Lal Kapoor (MLK) factory workers (n= 40) giving history of tobacco consumption (smoking/smokeless) within past 30 days. They were randomized into OHE (n=20) and NRT (n=20) groups. Baseline evaluation (demographic, smoking/ smokeless behaviour) was done. Fagerstrom test was used for Nicotine Dependence (FTND) and to assess nicotine addiction level. Follow up was done at an interval of 1week, 2 weeks, 1 month, 2 months and 3 months to assess the reduction in the mean FTND score. "Nano-CheckTM Rapid Nicotine test" was used for the qualitative detection of cotinine in human urine. Appropriate statistical analysis was performed (Paired and Unpaired t test). RESULTS: In both OHE and NRT group there was a significant reduction (p< 0.00001) in mean Fagerstrom score at every follow up but when both the groups were compared mean Fagerstrom score reduction was more in NRT than OHE at all time interval though it was not statistically significant (p>0.05). CONCLUSIONS: NRT is better than OHE when both the groups were compared. However, it was found that any intervention given to tobacco users either NRT or OHE is helpful for the patients in the process of quitting tobacco. KEY WORDS: Tobacco cessation, nicotine replacement therapy, oral health education, fagerstrom test, urine cotinine.

Cognitive Behavioural Therapy versus Basic Health Education for Tobacco Cessation among Tobacco Users: A Randomized Clinical Trail.

INTRODUCTION: Tobacco is the greatest disease-producing product which is known to man and it is a primary cause of many oral diseases and adverse oral conditions. This study was conducted to bring the behavioural changes and to educate individuals about the harmful effects of tobacco. METHOD: Subjects reporting to the tobacco cessation centre of the Department of Public Health Dentistry and giving a history of tobacco consumption (smoking/smokeless) within past 30 day period were randomized into 2 groups: cognitive behavioural therapy (CBT) group (study group) and Basic health education (BHE) group (control group). Baseline evaluation (of demographic parameters, smoking/ smokeless behaviour) was done and Fagerstrom's test for Nicotine Dependence (FTND) was used to assess subjects' nicotine addiction levels. Follow up was done at intervals of 2 weeks and 4 weeks to assess the reduction in the mean FTND score. Appropriate statistical analysis was performed (Paired and Unpaired t-test). RESULTS: Of all the subjects who reported to the department, 40 subjects were recruited in the study. A majority of the subjects were males who belonged to rural areas, who had completed high school and most of them had consumed more than 10 sachets of pan masala daily, for an average of 10 years. In both CBT and BHE groups, significant reductions in mean Fagerstrom scores at 1st and 2nd follow ups from baseline and between 1st and 2nd follow ups were seen. But when both groups were compared, reductions in mean Fagerstrom scores were found to be more in CBT group than in BHE group at all time intervals, though it was not statistically significant. CONCLUSION: Any intervention given to tobacco users from either CBT or BHE groups, helped the patients in quitting habit of tobacco.