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1.
Global Health ; 16(1): 45, 2020 05 12.
Artículo en Inglés | MEDLINE | ID: mdl-32398137

RESUMEN

The recent pandemic caused by the 2019 outbreak of novel coronavirus (2019-nCoV or COVID-19) has affected more than 3.0 million people resulting ~ 212,000 deaths across 215 countries/territories as on 28th April 2020. The importation of the cases owing to enormous international travels from the affected countries is the foremost reason for local cycle of transmission. For a country like India, the second most populous country in the world with ~ 1.35 billion population, the management and control of 2019-nCoV domestic spread heavily relied on effective screening and strict quarantine of passengers arriving at various international airports in India from affected countries. Here, by extracting the data from FLIRT, an online airline database for more than 800 airlines, and scanning more than 180,000 flights and 39.9 million corresponding passenger seats during 4th - 25th March, we show that India experienced the highest risk index of importing the passengers from middle eastern airports. Contrary to perception, travelers from China imposed lowest risk of importing the infected cases in India. This is clearly evident form the fact that while the number of infected cases were on the peak in China India was one of the least affected countries. The number of cases in India started exhibiting a sharp increase in the infected cases only after the European countries and USA recorded large number of infected cases. We further argue that while the number of cases in middle eastern countries may still be very low, the airports in middle eastern countries, particularly Dubai, being one of the largest transit hubs for international passengers, including arriving in India, might have posed a higher risk of getting infected with 2019-nCoV. We suggest that any future travel related disease infection screening at the airports should critically assess the passengers from major transit hubs in addition to affected country of origin.


Asunto(s)
Enfermedades Transmisibles Importadas , Infecciones por Coronavirus/transmisión , Brotes de Enfermedades/prevención & control , Pandemias , Neumonía Viral/transmisión , Medición de Riesgo/métodos , Viaje , Aeronaves , Aeropuertos , China/epidemiología , Infecciones por Coronavirus/epidemiología , Humanos , India/epidemiología , Tamizaje Masivo/métodos , Neumonía Viral/epidemiología , Cuarentena , Enfermedad Relacionada con los Viajes
2.
Indian J Med Ethics ; V(2): 168-169, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32393441

RESUMEN

Early last month, the Italian Society of Anaesthesia was forced to publish the above guideline (1) for the country's hospitals. Besides the rising cases of infection, the doctors realised that patients required up to 15-20 days of intensive care as the disease progressed (2). In the face of medical resource scarcities, the guideline established that everyone could not be saved from the coronavirus. And a massive death toll ensued.


Asunto(s)
Infecciones por Coronavirus , Servicios Médicos de Urgencia , Asignación de Recursos para la Atención de Salud , Pandemias , Neumonía Viral , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Toma de Decisiones , Servicios Médicos de Urgencia/ética , Asignación de Recursos para la Atención de Salud/ética , Humanos , India/epidemiología , Italia/epidemiología , Neumonía Viral/epidemiología , Guías de Práctica Clínica como Asunto
3.
Indian J Med Ethics ; V(2): 103-105, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32393447

RESUMEN

It is now well established that non-communicable diseases (NCD), like diabetes mellitus, hypertension,, respiratory and heart disease, particularly among the elderly, increase the susceptibility to COVID-19 disease. Mortality in 60%-90% of the COVID-19 cases is attributed to either one or more of these comorbidities. However, healthcare management for control of COVID-19 involves public health and policy decisions that may critically undermine the existing health needs of the most vulnerable NCD patients. Temporary closure of outpatient health facilities in some secondary and tertiary care hospitals have deprived millions of NCD patients of their regular medication and diagnostic health needs. The lack of robust primary healthcare facilities in most states, and the failure to maintain physical distancing norms due to inadequate infrastructure is also problematic. In the absence of effective public health interventions, socioeconomically vulnerable patients are likely to become non-adherent increasing manifold their risk of disease complications. In this context, the feasibility of dispensing longer than usual drug refills for chronic NCD conditions at functional government health facilities, home delivery of essential drugs, running dedicated NCD clinics at PHCs, and utilisation of telemedicine opportunities for care and support to patients warrant aggressive exploration. Keywords: Covid-19, NCDs, Medical ethics, epidemic, India.


Asunto(s)
Infecciones por Coronavirus , Prestación de Atención de Salud , Accesibilidad a los Servicios de Salud , Enfermedades no Transmisibles , Pandemias , Neumonía Viral , Poblaciones Vulnerables , Instituciones de Atención Ambulatoria , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Accesibilidad a los Servicios de Salud/ética , Necesidades y Demandas de Servicios de Salud , Humanos , India/epidemiología , Enfermedades no Transmisibles/terapia , Neumonía Viral/epidemiología , Atención Primaria de Salud , Telemedicina
4.
Indian J Med Ethics ; V(2): 1-3, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32393453

RESUMEN

The lockdown of the country, imposed by the government of India, has resulted in additional suffering for the poor without any tangible benefit. The germ theory of disease is an important contribution to human welfare. However, disease has social determinants. Responses to infectious epidemics should be based on social conditions, not only from considerations of equity, but also because they are important for success. Advice from the World Health Organisation has to be tailored to the social realities in India. Current response by the government of India has confined the poor to ghettos. They have lost the means of livelihood without a proper social security net. It is not possible for them to practise social distancing or proper hygiene. The lockdown has the effect of making conditions worse for the poor. Keywords: Covid-19 pandemic, resource allocation, social origins of disease, unplanned lockdown, diversion of resources, lack of social security.


Asunto(s)
Infecciones por Coronavirus , Accesibilidad a los Servicios de Salud , Pandemias , Neumonía Viral , Pobreza , Cuarentena , Betacoronavirus , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/epidemiología , Humanos , India/epidemiología , Pandemias/economía , Neumonía Viral/economía , Neumonía Viral/epidemiología , Aislamiento Social , Poblaciones Vulnerables
5.
Indian J Med Ethics ; V(2): 1-4, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32393458

RESUMEN

China reported cases of a severe form of pneumonia in December 2019 from Wuhan city, Hubei province. The virus causing this illness was identified as the novel Coronavirus 2019, which has now been christened Covid-19. The illness is characterised by fever, cough, body pain and in a few cases, progression to acute respiratory distress syndrome (ARDS) which marks very serious damage to the lungs (1-4). Apart from Wuhan, China, the virus has spread to 26 other countries as on February 18, 2020. Of these 26 countries, the cases of Covid-19 have been exported directly from China in 23 of them. As on February 23, 2020, a total of 78,811 confirmed cases, 2445 deaths have been reported globally. The World Health Organization declared this as a Public Health Emergency of International Concern (PHEIC) on January 30, 2020 (5).


Asunto(s)
Gestión Clínica , Infecciones por Coronavirus , Prestación de Atención de Salud , Recursos en Salud , Pandemias , Neumonía Viral , Betacoronavirus , Defensa Civil , Humanos , India/epidemiología
6.
JMIR Public Health Surveill ; 6(2): e19368, 2020 05 07.
Artículo en Inglés | MEDLINE | ID: mdl-32365045

RESUMEN

BACKGROUND: The World Health Organization has declared the novel coronavirus disease (COVID-19) to be a public health emergency; at present, India is facing a major threat of community spread. We developed a mathematical model for investigating and predicting the effects of lockdown on future COVID-19 cases with a specific focus on India. OBJECTIVE: The objective of this work was to develop and validate a mathematical model and to assess the impact of various lockdown scenarios on COVID-19 transmission in India. METHODS: A model consisting of a framework of ordinary differential equations was developed by incorporating the actual reported cases in 14 countries. After validation, the model was applied to predict COVID-19 transmission in India for different intervention scenarios in terms of lockdown for 4, 14, 21, 42, and 60 days. We also assessed the situations of enhanced exposure due to aggregation of individuals in transit stations and shopping malls before the lockdown. RESULTS: The developed model is efficient in predicting the number of COVID-19 cases compared to the actual reported cases in 14 countries. For India, the model predicted marked reductions in cases for the intervention periods of 14 and 21 days of lockdown and significant reduction for 42 days of lockdown. Such intervention exceeding 42 days does not result in measurable improvement. Finally, for the scenario of "panic shopping" or situations where there is a sudden increase in the factors leading to higher exposure to infection, the model predicted an exponential transmission, resulting in failure of the considered intervention strategy. CONCLUSIONS: Implementation of a strict lockdown for a period of at least 21 days is expected to reduce the transmission of COVID-19. However, a further extension of up to 42 days is required to significantly reduce the transmission of COVID-19 in India. Any relaxation in the lockdown may lead to exponential transmission, resulting in a heavy burden on the health care system in the country.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Modelos Teóricos , Pandemias/prevención & control , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Infecciones por Coronavirus/epidemiología , Humanos , India/epidemiología , Neumonía Viral/epidemiología , Reproducibilidad de los Resultados
11.
JMIR Public Health Surveill ; 6(2): e18795, 2020 04 16.
Artículo en Inglés | MEDLINE | ID: mdl-32287038

RESUMEN

The coronavirus disease pandemic requires the deployment of novel surveillance strategies to curtail further spread of the disease in the community. Participatory disease surveillance mechanisms have already been adopted in countries for the current pandemic. India, with scarce resources, good telecom support, and a not-so-robust heath care system, makes a strong case for introducing participatory disease surveillance for the prevention and control of the pandemic. India has just launched Aarogya Setu, which is a first-of-its-kind participatory disease surveillance initiative in India. This will supplement the existing Integrated Disease Surveillance Programme in India by finding missing cases and having faster aggregation, analysis of data, and prompt response measures. This newly created platform empowers communities with the right information and guidance, enabling protection from infection and reducing unnecessary contact with the overburdened health care system. However, caution needs to be exercised to address participation from digitally isolated populations, ensure the reliability of data, and consider ethical concerns such as maintaining individual privacy.


Asunto(s)
Infecciones por Coronavirus/prevención & control , Coronavirus , Brotes de Enfermedades/prevención & control , Pandemias/prevención & control , Neumonía Viral/prevención & control , Vigilancia en Salud Pública , Betacoronavirus , Investigación Participativa Basada en la Comunidad , Infecciones por Coronavirus/epidemiología , Humanos , India/epidemiología , Neumonía Viral/epidemiología , Salud Pública
12.
Monaldi Arch Chest Dis ; 90(1)2020 Apr 10.
Artículo en Inglés | MEDLINE | ID: mdl-32290644

RESUMEN

COVID-19 has now become a pandemic. It has spread from Wuhan, China, in December 2019 to a large number of countries within three months. The objective of this work is to report the initial experience with epidemiologic and clinical features, as well as with the management of COVID-19 patients in India. This is a descriptive case series of the first 21 COVID-19 infected patients confirmed with polymerase chain reaction (PCR) and admitted to a tertiary care centre in India from 01.02.2020 to 19.03.2020. Clinical, laboratory, and radiologic data were collected, including age, sex, nationality, travel history, symptoms, duration of stay, and comorbidities. The mean age of the population was 40.3 years with a male preponderance. Thirteen (62%) patients had recent travel history outside India in the previous 30 days, two thirds of whom had travelled to Italy. The most common symptoms were fever and cough (42.9%) followed by sore throat, headache and breathlessness. Vital and laboratory parameters were preserved in all patients and none of them required ventilatory support. Among the first 21 patients diagnosed with COVID-19 infection in India, the typical clinical presentation consisted in a mild upper respiratory tract infection predominantly affecting the young male population. One patient required supplemental oxygen. All patients recovered with no residual symptoms.   *The Safdarjung Hospital COVID 2019 working group: Nitesh Gupta, Sumita Agrawal, Pranav Ish, Suruchi Mishra, Rajni Gaind, Ganapathy Usha, Balvinder Singh, Manas Kamal Sen, Shibdas Chakrabarti (Consultant and Head, Pulmonary Medicine); NK Gupta (Professor, Pulmonary medicine); Dipak Bhattacharya (Consultant, Pulmonary medicine); Rohit Kumar (Assistant Professor, Pulmonary Medicine); Siddharth R. Yadav (Assistant Professor, Pulmonary Medicine); Rushika Saksena (Specialist, Microbiology); Rojaleen Das (Assistant Professor, Microbiology); Vikramjeet Dutta (Assistant Professor, Microbiology); Anupam Kr Anveshi (Senior Resident, Microbiology); Santvana Kohli (Assistant Professor, Anaesthesiology); Naveen KV (Assistant Professor,  Anaesthesiology); Amandeep Jaswal (Assistant Professor, Anaesthesiology).


Asunto(s)
Infecciones por Coronavirus/epidemiología , Neumonía Viral/epidemiología , Adulto , Betacoronavirus , Femenino , Humanos , India/epidemiología , Masculino , Pandemias , Centros de Atención Terciaria
14.
Trop Doct ; 50(2): 108-110, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32316857

RESUMEN

The emergence of COVID-19 has impacted orthopaedic surgery worldwide. India, with its large population and limited health resources, will be overwrought over the coming days due to the number of cases of critically ill patients with COVID-19. It is important to understand the challenges for orthopaedic (and other) surgeons in India when dealing with patients during the COVID-19 pandemic. This article highlights the challenges in the triaging of patients, care in dealing with a patient with COVID-19 in orthopaedic surgery, and the effects on academics and research activities; it also suggests immediate measures and recommendations that also apply to other specialties.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Procedimientos Ortopédicos , Cirujanos Ortopédicos/psicología , Pandemias , Neumonía Viral/epidemiología , Humanos , India/epidemiología
16.
Indian J Ophthalmol ; 68(5): 725-730, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32317434

RESUMEN

Purpose: In early 2020, the World Health Organization declared the outbreak of the disease COVID-19, caused by a new variant of coronavirus 2019-nCoV as a global pandemic. The government of India ordered a nationwide lockdown for 21 days, limiting movement of people as a preventive measure. This survey was designed and conducted during the lockdown period to assess its effect on ophthalmic practice and patient care in India. Methods: An online survey was sent across to practicing Indian ophthalmologists across through various social media platforms. All valid responses were tabulated and analyzed. Results: A total of 1260 ophthalmologists responded to the survey. Most of the respondents (775/1260; 61.5%) were in private practice and 14.8% (187/1260) were affiliated to ophthalmic institutes. At the time of taking the survey, 72.5% of the respondents (913/1260) were not seeing any patients due to the lockdown. Of those who were still examining patients, 82.9% (287/347) were only seeing emergency cases, based on their own clinical judgement. The proportion of ophthalmologists in ophthalmic institutes, government and municipal hospitals (126/253;49.8%) who were still seeing patients was significantly higher (P < 0.0001) than those in private practice (174/775;22.4%). Apart from emergencies such as trauma, retinal detachment, and endophthalmitis (81.8%), other surgeries that were still being performed included intravitreal injections (9.1%) and cataract surgeries (5.9%). Approximately, 77.5% (976/1260) of the respondents had begun telephonic/e-mail/video consultations or consultations over social media applications since the lockdown began. In addition, 59.1% (745/1260) felt that ophthalmologists were potentially at a higher risk of contracting COVID-19 compared to other specialties while examining patients. When asked about the resumption of practice upon easing off of the restrictions, 57.8% (728/1260) of the respondents said they were unsure of when to resume elective surgeries; furthermore, 62.8% (791/1260) were unsure about the preferred screening strategy or precautionary approach prior to resuming surgeries and were awaiting guidelines. Conclusion: Our survey shows that majority of ophthalmologists in India were not seeing patients during the COVID-19 lockdown, with near-total cessation of elective surgeries. Emergency services were still being attended to by 27.5% of ophthalmologists who responded. A large proportions of ophthalmologists had switched over to telephonic advice or other forms of telemedicine to assist patients. Most of the responding ophthalmologists were unclear about when and how to resume surgeries upon easing off of the COVID-19 related restrictions. Regulatory bodies should take note of this and issue appropriate guidelines regarding the same.


Asunto(s)
Betacoronavirus , Infecciones por Coronavirus , Pandemias , Atención al Paciente , Neumonía Viral , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Infecciones por Coronavirus/transmisión , Humanos , India/epidemiología , Oftalmólogos , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Neumonía Viral/transmisión , Encuestas y Cuestionarios
18.
Int J Antimicrob Agents ; 55(4): 105946, 2020 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-32199877

RESUMEN

It has been 2 months since the first case of coronavirus disease 2019 (COVID-19) was reported in Wuhan, China. So far, COVID-19 has affected 85 403 patients in 57 countries/territories and has caused 2924 deaths in 9 countries. However, epidemiological data differ between countries. Although China had higher morbidity and mortality than other sites, the number of new daily cases in China has been lower than outside of China since 26 February 2020. The incidence ranged from 61.44 per 1 000 000 people in the Republic of Korea to 0.0002 per 1 000 000 people in India. The daily cumulative index (DCI) of COVID-19 (cumulative cases/no. of days between the first reported case and 29 February 2020) was greatest in China (1320.85), followed by the Republic of Korea (78.78), Iran (43.11) and Italy (30.62). However, the DCIs in other countries/territories were <10 per day. Several effective measures including restricting travel from China, controlling the distribution of masks, extensive investigation of COVID-19 spread, and once-daily press conferences by the government to inform and educate people were aggressively conducted in Taiwan. This is probably the reason why there was only 39 cases (as of 29 February 2020) with a DCI of 1 case per day in Taiwan, which is much lower than that of nearby countries such as the Republic of Korea and Japan. In addition, the incidence and mortality were correlated with the DCI. However, further study and continued monitoring are needed to better understand the underlying mechanism of COVID-19.


Asunto(s)
Infecciones por Coronavirus , Pandemias , Neumonía Viral , Betacoronavirus , China/epidemiología , Infecciones por Coronavirus/economía , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/mortalidad , Infecciones por Coronavirus/prevención & control , Geografía Médica , Recursos en Salud , Humanos , Incidencia , India/epidemiología , Irán/epidemiología , Italia/epidemiología , Japón/epidemiología , Pandemias/economía , Pandemias/prevención & control , Neumonía Viral/economía , Neumonía Viral/epidemiología , Neumonía Viral/mortalidad , Neumonía Viral/prevención & control , República de Corea/epidemiología , Taiwán/epidemiología
19.
BMC Med Genet ; 21(1): 50, 2020 03 12.
Artículo en Inglés | MEDLINE | ID: mdl-32164556

RESUMEN

BACKGROUND: Noonan syndrome (NS), an autosomal dominant developmental genetic disorder, is caused by germline mutations in genes associated with the RAS / mitogen-activated protein kinase (MAPK) pathway. In several studies PTPN11 is one of the genes with a significant number of pathogenic variants in NS-affected patients. Therefore, clinically diagnosed NS individuals are initially tested for pathogenic variants in PTPN11 gene to confirm the relationship before studying genotype-phenotype correlation. METHODS: Individuals (363) with clinically diagnosed NS from four hospitals in South India were recruited and the exons of PTPN11 gene were sequenced. RESULTS: Thirty-two previously described pathogenic variants in eight different exons in PTPN11 gene were detected in 107 patients, of whom 10 were familial cases. Exons 3, 8 and 13 had the highest number of pathogenic variants. The most commonly identified pathogenic variants in this series were in exon 8 (c.922A > G, c.923A > G), observed in 22 of the affected. Congenital cardiac anomalies were present in 84% of the mutation-positive cohort, the majority being defects in the right side of the heart. The most common facial features were downward-slanting palpebral fissures, hypertelorism and low-set posteriorly rotated ears. Other clinical features included short stature (40%), pectus excavatum (54%) and, in males, unilateral or bilateral cryptorchidism (44%). CONCLUSION: The clinical features and mutational spectrum observed in our cohort are similar to those reported in other large studies done worldwide. This is the largest case series of NS-affected individuals with PTPN11 mutations described till date from India.


Asunto(s)
Síndrome de Noonan/genética , Polimorfismo de Nucleótido Simple , Proteína Tirosina Fosfatasa no Receptora Tipo 11/genética , Adolescente , Adulto , Niño , Preescolar , Estudios de Cohortes , Análisis Mutacional de ADN , Familia , Femenino , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Mutación de Línea Germinal , Cardiopatías Congénitas/epidemiología , Cardiopatías Congénitas/genética , Humanos , India/epidemiología , Lactante , Recién Nacido , Masculino , Síndrome de Noonan/epidemiología , Fenotipo , Adulto Joven
20.
BMC Med Genet ; 21(1): 53, 2020 03 14.
Artículo en Inglés | MEDLINE | ID: mdl-32171272

RESUMEN

BACKGROUND: Adolescence is a distinctive stage of various changes and is noted as peak age for onset of many psychiatric disorders, especially linked to stress and depression. Several genetic variations are being increasingly known to be linked with stress and depression. The polymorphisms in two such genes, the BDNF and SLC1A3, have been reported to be linked with either depression/stress or with suicidal behaviour. These genes have not been validated in Indian population, and therefore there is a need to investigate these genes in Indian population. The present study was undertaken to test whether the known polymorphisms SLC1A3 C3590T, SLC1A3 C869G and BDNF G196A are associated or not with stress or depression in an eastern Indian population. METHODS: A case-control association study was performed with 108 cases having variable levels of stress and depression and 205 matched controls. Detection of stress and depression was done by using standard instruments as PSS and CES-D, respectively and demographic profile was obtained for each individual on the basis of personal data sheet. Genotyping for the selected polymorphisms was performed by PCR followed by restriction digestion. RESULTS: The SNP SLC1A3 C3590T was found to be associated with stress and depression (p = 0.0042, OR = 2.072). Therefore, the T allele increases the risk by more than two folds for stress and depression in the present population. The other allele of SLC1A3, G869C, as well as BDNF G196A were not associated with stress or depression in the population studied. CONCLUSION: SLC1A3 C3590T is a predisposition factor for stress and depression in an eastern Indian population, whereas SLC1A3 G869C and BDNF G196A were not found to be a risk factor. Therefore, presence of T allele of SLC1A3 C3590T, may predict the development of stress and depression in an individual. This may also help in the understanding of pathophysiology of the disease. However, these findings warrant a wider study in Indian populations and would be of significance in understanding the predisposition of stress and depression in this population.


Asunto(s)
Factor Neurotrófico Derivado del Encéfalo/genética , Depresión/genética , Transportador 1 de Aminoácidos Excitadores/genética , Polimorfismo de Nucleótido Simple , Estrés Psicológico/genética , Adolescente , Grupo de Ascendencia Continental Asiática/genética , Grupo de Ascendencia Continental Asiática/estadística & datos numéricos , Estudios de Casos y Controles , Depresión/epidemiología , Femenino , Estudios de Asociación Genética , Predisposición Genética a la Enfermedad , Humanos , India/epidemiología , Masculino , Psicología del Adolescente , Factores de Riesgo , Estrés Psicológico/epidemiología , Adulto Joven
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