Social stigma and discrimination faced by COVID-19 patients in an industrial unit: Findings of survey from rural Maharashtra.

Introduction: Uncertain situation of the coronavirus disease 2019 (COVID-19) pandemic has led to fear, stigma, and discrimination across all strata of society in varying proportions. Stigmatization increases the suffering of people or those who are at risk of getting the disease and make it harder for public health authorities to control the disease. Material and Methods: The present study is a questionnaire-based cross-sectional survey conducted over a period of four weeks in the month of July 2021 in a food industry in rural region of western Maharashtra among COVID-19 positive patients. A total of 152 participants were included in the study. The data was analyzed using SPSS software (version 20). Descriptive statistics were used which included frequencies and percentages. Results: 64.5% of the participants were males and 35.5% were females. Approx. 85% of the participants were in age group 15-58 years. 100% of them reported to have faced fear on being tested COVID-19 positive. However, only approx. 2-5% individuals hid their illness from family and friends and 7.9% of them were afraid of getting hospitalized. Conclusion: It was found that fear was prevalent among all survivors but stigma was found to be minimal which is likely due to widespread awareness through media, IEC campaigns, and active involvement of administration in implementing policies.

Findings of second multicentric follow-up serosurvey among Health Care Workers in government hospitals.

Background: The change in serological status of community may be used as input for guiding the public health policy. Hence, the present study was conducted to determine change in seroprevalence of COVID-19 among healthcare workers (HCWs). Methods: From the baseline multicentric study sample, a subsample was followed up, and a seroepidemiological study was conducted among them between 6 and 22 weeks after the second dose of the vaccination. Multistage population proportion to size sampling was performed for the selection of subsample of HCWs. The serosurvey was conducted using the enzyme-linked immunosorbent assay-based IgG antibody test (COVID KAVACH). Results: Follow-up serological testing was done in subsample of 1122 participants of original 3253 participants. The mean age of the participants was 34.6 (8.13) years. A total of 300 (26.7%) participants were females. The seroprevalence was 78.52, (95%CI:76-80.1). Among those who were seronegative at initial test, 708 (77.04%) were seroconverted. Those who were not seroconverted (241 (21.5%)) have longer duration from the second dose of the vaccination (93 (31.4) vs. 56 (38.4); p value < 0.001). The COVID-19 infection was significantly associated with seropositive status and being a medical staff was associated with remaining seronegative on follow-up. The higher age (≥50 years) was found to be significantly associated with seroreversion. Conclusion: Four in five HCWs had detectable antibodies. Seroepidemiological studies carry vital information to control the public health response in the course of the pandemic. The study can also further help as a platform to study the seroconversion and effect of vaccination among HCWs for newer variants of SARS-CoV-2.

Epidemiological analysis of SARS-COV-2 B.1.617.2 (delta variant) transmission in an educational institute.

Background: Despite having an effective COVID-19 vaccine, the COVID-19 pandemic is far from over and the delta variant continues to cause havoc across several continents. The present study was conducted to analyze and describe the occurrence of COVID-19 cases among completely vaccinated individuals. Methods: In an educational institute in Western Maharashtra, we analyzed a cluster of RTPCR positive COVID-19 cases among fully vaccinated students which occurred in 12 days. The cases were linked to a series of curricular and co-curricular events in the institute. A detailed epidemiological investigation and genome sequencing of cases were conducted. IgG antibodies against S1 protein of novel SARS-CoV-2 were estimated for cases and age, sex, and vaccination status matched controls. Results: All 37 identified cases were mild COVID. 188 high risk (HR) contacts of the cases were identified. The overall secondary attack was 9.5%. Out of 31 cases and 50 controls, 09 (29%) cases and 08 (16%) controls were found to have IgG antibodies against S1 protein of novel SARS-CoV-2 titer of more than 60 U/ml. Whole-genome sequencing of 15 samples of the cluster showed the presence of the Delta variant of SARS-CoV-2. No correlation was observed between Ct value and IgG S1 antibody titers. Conclusion: The study provides significant evidence that only vaccination alone does not completely protect against SARS-CoV-2 B.1.617.2 (Delta) variant infection. An all-encompassing multicomponent strategy involving implementation of NPIs, robust contact tracing, early identification and isolation of cases, and high vaccination coverage is the way forward for the prevention of COVID-19.

Medical ethics during armed conflicts: Dilemmas of a physician soldier.

A Military Physician is expected to fulfill the dual role of a humane physician and a patriotic soldier. But both these professions are principally very different from each other, a soldier above all is supposed to have utmost loyalty towards his country and protect national security at all costs. Whereas a doctor has moral obligations towards his patients and is required to treat ill or wounded irrespective of caste, creed, or nationality. Military physicians bridge these two professions based on the principles of humanity, impartiality, and neutrality. The present paper attempts to explore the challenges faced by military physicians in adhering to professional ethos especially during an armed conflict and provides an overview of various regulations and declarations in vogue for guiding military physicians in times of ethical and obligatory dilemmas.

Association of personality traits with performance in military training.

BACKGROUND: In today's era of asymmetric and unconventional warfare, psychological fitness is equally important as physical fitness. Personality assessment of soldiers, and more so officers who are leaders of men is essential in deciding what makes a good "War asset" The present study was conducted to explore the correlation between personality traits of cadets undergoing training in an Armed Forces Training Academy and their performance in terms of their military and academic pursuits. METHODS: Personality traits of 607 cadets determined using Revised Neuroticism-Extraversion-Openness Personality Inventory (NEO PI-R) were compared and correlated with their performance in terms of Officer Like Qualities (OLQ), Outdoor activities (ODT), Academics, and Extracurricular Activities (ECA). RESULTS: Cadets with high personality traits scores in Neuroticism and low scores in Conscientiousness (Work ethics) had performed poorly in all the domains/criteria for evaluation of performance viz Officer like qualities, Outdoor activities, Academics, and Extracurricular Activities. Further, a significant negative correlation was observed between facets of Neuroticism and Academics, ODT, and OLQ. In contrast, personality facets of Conscientiousness (Work ethic) were found to be positively correlated with performance in Academics, ODT, and OLQ. Extracurricular activities were found to be positively correlated with Modesty and Intellectual Curiosity. CONCLUSION: The present study represents the first-ever attempt in Indian Armed Forces to correlate and identify personality traits most suited for military training. The findings of the study indicate that cadets with low scores of neuroticism and high scores of conscientiousness perform well in the military academy. However, more such studies are required to reaffirm the findings of the present study and to conclusively recommend personality traits most conducive for military training.

Effectiveness of ChAdOx1 nCOV-19 Vaccine: Experience of a tertiary care institute.

BACKGROUND: The first dose of the ChAdOx1 nCoV- 19 Corona Virus Vaccine (Covishield) was administered to the eligible beneficiaries of tertiary care institute of Western Maharashtra on 16 Jan 21 and in the past three months almost 97% of the staff has been vaccinated. The present study analyses the incidence of COVID cases in the unvaccinated and vaccinated population of the institute. METHODS: All Covid 19 infections (RT-PCR positive) from 01 February 21 to 25 April 21 were included in the study and analyzed as per their vaccination status. To assess the COVID 19 transmission in contacts, Secondary Attack Rates (SAR) of the pre-vaccination period (Jun-Oct 20) was compared with the present SAR. RESULTS: A total of 113 cases occurred in the study period (01 Feb to 25 Apr 21). Lower number of infections were observed among the fully vaccinated as compared to partially vaccinated and non-vaccinated. The overall vaccine effectiveness was found to be 88.6% (81.55-92.37) and 44.1% (4.55-67.3) in completely and partially vaccinated individuals respectively. Hazard Ratios for getting infected dropped significantly after 28 days of the second dose. The SAR in high risk contacts (HRCs) was found to be 4.25%, which was lower than SAR (20.6%) of pre-vaccination period. CONCLUSION: This is one of the earliest studies in India to report the impact of COVID-19 vaccination. The results indicate that the vaccine provides effective protection against COVID-19 infection. However, given the complex dynamics of vaccination, the role of NPIs and implementation of COVID appropriate behavior cannot be undermined.

An analysis of mortality and survival of COVID 19 patients admitted to a tertiary care hospital in Maharashtra, India.

BACKGROUND: After nine months of responding to the coronavirus disease-19 (COVID-19) pandemic, the scientific fraternity is yet to unravel the mystery of those who are at most risk from mortality. Despite resistance to wear masks, the global public health response has beaten the grimmer projections of millions of deaths. The present study seeks to analyze the survival of COVID-19 patients at a tertiary care hospital and identify the risk factors of mortality. METHODS: Medical records of 1233 RT PCR confirmed COVID-19 patients admitted in a tertiary care hospital between 01 April and 30 September 2020 were retrospectively analyzed for calculating overall survival and to investigate the independent predictors of survival of COVID-19 patients. RESULTS: There were 72 (5.8%) deaths; which occurred in 24.9% of the elderly (age > 60yrs) people (P < 0.001), 76.0% in people with multiple comorbidities (having more than one comorbidity) (P < 0.001), 75.6% in people with diabetes (P < 0.001), and 75.5% in people with hypertension (P < 0.001). A significantly higher risk of mortality was observed in elderly patients, patients with comorbidities, and patients requiring oxygen while admitted in the hospital. CONCLUSION: Survival reflects the cure rates and is used by health professionals and policymakers to plan and implement disease control measures. The insights provided by the study would help facilitate the identification of patients at risk and timely provision of specialized care for the prevention of adverse outcomes in the hospital setting.

Seroconversion among COVID-19 patients admitted in a dedicated COVID hospital: A longitudinal prospective study of 1000 patients.

BACKGROUND: The immune response after SARS-CoV-2 is complex and may be affected by severity of the disease, race, etc. The present study was conducted to assess the serial antibody response among the COVID-19 patients admitted in the hospital. METHODS: The study was conducted between July and October 2020 in a dedicated COVID-19 hospital. All consented patients underwent serial testing of antibodies using a rapid chromatographic immunoassay-based qualitative IgG/IgM kit every third day until their discharge or death. The data about age, sex, severity of disease, length of stay, onset of symptoms, date of molecular testing were also collected. Appropriate statistical tests were used. RESULTS: The mean age of 1000 COVID-19 patients was 47.5 ± 17.9 years. Out of the total, 687 (68.7%) were males. With respect to severity, 682 (68.2%) were asymptomatic/mild, 200 (20%) were moderate and 118 (11.8%) were severe cases. The seroconversion percentage increased from 12.8% to 97.9% and 16.3% to 80.9% for IgG and IgM respectively in 21 days. The median time for seroconversion was 10 days (IQR:6-12 days) for IgG and eight days (IQR: 6-11 days) for IgM. At the time of discharge (median nine days), detectable IgG and IgM antibodies were present in 502 (52.46%) and 414 (43.26%) participants respectively. Seroconversion was associated with days after the symptoms, increasing severity of the disease and the presence of co-morbidity. CONCLUSION: Seroconversion increased during the period of observation. The severe/moderate cases of COVID-19 tend to have an early seroconversion as compared to the asymptomatic/mild cases. Only half of the patients were seroconverted at discharge.

Overweight: A risk factor for COVID-19 --- A medical conundrum or a reality?

INTRODUCTION: Obesity may contribute to the initiation, progression, transmission, and deterioration of COVID-19. However, there was lack of such studies carried out by Indian workers. MATERIALS AND METHODS: Data of cumulative cases of COVID-19 of various countries as on the day the peak incidence were reported in each country during the first and second waves of the pandemic was obtained from the internet. Data on prevalence of overweight were obtained by doing a thorough search of existing literature. The data so collected were tabulated and analyzed using SPSS version 20 to establish a correlation coefficient between overweight and COVID-19. Data pertaining to overweight status and age profile and COVID-19 status as on 28 Feb 2021 was collated as part of routine surveillance from the Health Department in an urban area. The total population for which the above data was obtained was 1107. The data so collected were subject to statistical analysis using SPSS version 20, to find out the odds ratio of overweight as a risk factor for COVID-19 after adjusting for age. RESULTS: Correlation coefficient between overweight and COVID-19 for data pertaining to the first wave and the second wave 0.95 and 0.94, respectively. Odds ratio of overweight as a risk factor for COVID-19 after adjusting for age works out to 2.95 (95% confidence interval 2.30- 3.78). Mean age of the study subjects was 32.61 years (median 32 years, minimum 19 years, maximum 54 years, standard deviation 6.62). LIMITATIONS: The limitation of the present study is that the workers could only obtain retrospective data, carry out a case-control study and calculate odd ratio for overweight as a risk factor for COVID-19.

An assessment of perceived social support among naval personnel.

BACKGROUND: Studies from the Indian Navy have found junior sailors to have higher occupational stress than senior sailors. Positive social support can provide protection against detrimental effects of stress and facilitate in development of individual resilience. Therefore, the present study was conducted to explore the level of perceived social support among naval personnel. METHODS: A cross-sectional survey was conducted using "Interpersonal Support Evaluation List" (Cohen and Hoberman, 1983) among personnel posted on a capital ship of the Indian Navy. Five hundred sixty-eight sailors voluntarily participated in the study. RESULTS: Personnel living on board (in-living) were found to have significantly lower overall perceived social support score (76.14 ± 13.72) than personnel living in family accommodation (79.40 ± 14.14). In addition, in-living personnel were also found to have lower subscale scores viz "appraisal support", "self-esteem support", and "belonging support" (p < 0.05) but not "tangible support" score (p > 0.05). CONCLUSION: Our study brings out that young in-living sailors lack perceived social support. These young in-living sailors, being away from their families, often feel isolated and fall prey to social media, which in turn aggravates feeling of isolation and leads to psychological distress. Therefore, it is important for these individuals to have confidence in his mess mates and belief in commanders who form their primary sources of social support. To ensure this, it is the need of the hour to revitalize the age old divisional system by introduction of concepts of "Keep Your Mates Safe", "promotion of psychological resilience", and so on.

Work-rest pattern, alertness and performance assessment among naval personnel deployed at sea: A cross sectional study.

BACKGROUND: The combat naval vessels require continuous operational preparedness for guarding the vast coastline. Sailors onboard these ships are at risk for sleep deprivation. Sailors may be vulnerable to chronic fatigue; and decreased performance, vigilance, and cognitive functioning owing to sleep debt, which may affect safety during tactical operations and while transportation of ships. In this study we assessed the work-rest pattern and level of alertness during sailing and non sailing days. METHODS: Thirty-two male participants maintained a 24-h sleep and activity log for 5 days. Furthermore, qualitative gross motor activity was recorded using an actiwatch during these 5 days. Participants also completed four test sessions of personal digital assistant (PDA) based psychomotor vigilance task (PVT) test: pre-sleep, post-sleep, pre-work, and post-work. A comparison of data was performed using the Wilcoxon signed-rank test. RESULTS: Sailors received approximately 1 h less of rest while sailing. There was a significant difference in bedtime, wake-up time, total sleep time, sleep onset latency (SOL), wake up after sleep onset (WASO), and the number of awakenings during the non-sailing and the sailing days. PVT data showed significantly higher reaction times during the sailing days on pre-work and post-sleep sessions. CONCLUSION: Our study shows that although the sailors are not getting sufficient restorative sleep while sailing as compared to non-sailing days, this is not affecting their cognitive functioning while working.

A Nomogram based prognostic score that is superior to conventional TNM staging in predicting outcome of surgically treated T4 buccal mucosa cancer: Time to think beyond TNM.

BACKGROUND AND OBJECTIVES: T4 squamous cell carcinomas of the buccal mucosa is known to have ominous outcome. The aim of this study was to develop a nomogram for T4 buccal mucosa cancer patients and demonstrate the difference in survival based on prognosticators beyond those covered by the traditional TNM staging system. METHODS: We examined medical records of treatment naïve 205 T4 buccal mucosa cancer patients operated between January 1, 2009, and December 31, 2014. A nomogram was developed using multivariate cox-regression. The nomogram was validated internally by bootstrapping and externally in an independent validation set. RESULTS: The nomogram for predicting 3-year overall survival was built using Tumor differentiation, Pathological Lymph node involvement, Bone and Perineural invasion. Based on nomogram, a score was assigned to each patient and they were divided into two groups based on Youden derived cut-off value (13.5). These two groups in training and validation set showed significant difference in survival. CONCLUSION: We developed a high performance, accurate and efficient nomogram to predict the probability of 3-year survival in T4 buccal mucosa cancer patients. Intensification of adjuvant treatment in these advanced cancer patients with poorer score might improve their survival.

Comparison of tumor volume, thickness, and T classification as predictors of outcomes in surgically treated squamous cell carcinoma of the oral tongue.

BACKGROUND: As per TNM classification, superficial tumors with a favorable prognosis are fallaciously clubbed together with unfavorable, deeply infiltrating lesions in the same classification. METHODS: This is a retrospective study of 588 patients with treatment-naive oral tongue cancers. Binary logistic regression was used to identify predictors of nodal metastasis and extracapsular spread (ECS) using tumor volume and thickness as separate models. The C-index was generated to quantify predictive accuracy of T classification, thickness, and tumor volume for survival. RESULTS: Compared to T classification, tumor volume and thickness were better predictors of nodal metastasis and ECS. Predictive accuracy for disease-free survival (DFS) and overall survival (OS) given by C-index was equal and better for thickness (0.60 and 0.69) and tumor volume (0.61 and 0.69) as compared to T classification (0.59 and 0.64, respectively). For early-stage T1 to T2 oral tongue cancer, thickness is a better predictor of nodal metastasis as compared to tumor volume and T classification. CONCLUSION: Concordance between the tumor thickness and volume proves that tumor thickness can be taken as a surrogate and reliable predictor of outcomes instead of calculating the tumor volume.

Squamous cell carcinoma of buccal mucosa: An analysis of prognostic factors.

INTRODUCTION: Carcinoma of the buccal mucosa is the most common oral cavity cancer in the Indian subcontinent. The aim of this study was to analyze the outcome and evaluate prognostic factors in surgically treated buccal mucosa squamous cell carcinoma (BMSCC) patients. MATERIALS AND METHODS: A retrospective study was performed by reviewing the medical records of 409 pathologically proven buccal mucosa cancer patients, who were diagnosed and surgically treated in Tata Memorial Hospital between January 1, 2006, and December 31, 2008. RESULTS: The overall 5-year survival of the cohort was found to be 54.1%. The stage-wise survival rate for tumor, node, metastasis (TNM) Stage I, II, III, and IV patients was found to be 85.2%, 82.9%, 56.3%, and 42.6% (P < 0.00), respectively. On multivariate Cox proportional hazard analysis, the presence of comorbidity, histological tumor size, pathological lymph node status, tumor differentiation, perineural invasion, and extracapsular spread were found to be independently associated with overall survival. CONCLUSION: BMSCC is an aggressive malignant tumor. In addition to TNM classification, other clinical and pathological factors also have a significant role in BMSCC prognostication. Hence, there is a need to move beyond TNM and develop a more inclusive, flexible, and easy to use prognostic system.

Sociodemographic Factors and Late-stage Diagnosis of Breast Cancer in India: A Hospital-based Study.

CONTEXT: Breast cancer (BC) is one of the major causes of cancer mortality in India. Late-stage diagnosis of BC is associated with poor survival. Identification of factors affecting late presentation of the disease could be an effective step to reduce BC mortality. AIMS: To study the association of sociodemographic factors with BC stage at diagnosis. SETTINGS AND DESIGN: The study is a retrospective analysis from the case records from a single institution. SUBJECTS AND METHODS: Data for the year 2008 was collected from the hospital records. A total of 1210 cases were included for the analysis. Sociodemographic factors included were age, place of residence, religion, marital status, level of education, and occupation. Other study variables were family history, presence of comorbidity, and stage at diagnosis. STATISTICAL ANALYSIS: Association between sociodemographic factors by stage at diagnosis was tested using Chi-square statistics, with odds ratios (ORs) estimated through logistic regression modeling. RESULTS: In the study cohort, 46% patients had reported at early stages and 54% at advanced stages. All factors were evaluated for being predictors of disease stage at presentation using univariate and multivariate logistic regression model. Women from urban background were less likely to present with advanced stage disease (OR = 0.64; 95% confidence interval [CI]: 0.49-0.84) as compared to rural women. Similarly, illiterate women were also more likely to present with advanced-stage disease (OR = 1.55; 95% CI: 1.16-2.09). CONCLUSIONS: This data clearly indicate that the patients of rural background and of low education status are more likely than their respective counterparts to have an advanced stage of BC diagnosis. Our results may be considered the keys to determining how stage variation may be related to patients and community characteristics and where limited resources need to be invested to ensure early diagnosis of BC.

Sociodemographic and Clinical Profile of Cervical Cancer Patients Visiting in a Tertiary Care Hospital in India.

CONTEXT: Cancer of the cervix is the most common genital tract malignancy in the female and is a major public health problem in the developing countries. Study of the sociodemographic and clinical profile of patients is the first step in planning control measures and treatment facilities. AIMS: The aims of the study were to determine the sociodemographic and clinical profile of cervical cancer patients and study their association with other tumor-related factors. SETTINGS AND DESIGN: This is a record-based retrospective study from a single institution. SUBJECTS AND METHODS: The data on sociodemographic and clinical factors of 765 cervical cancer patients visited and treated at tertiary care cancer hospital in Mumbai in 1 year period were analyzed. STATISTICAL ANALYSIS: Data were analyzed using descriptive statistics. Kruskal-Wallis and Chi-square test were used to assess relationship between variables. RESULTS: The median age of the cohort was 54 years and interquartile range was 16 years. Nearly 53.6% of patients were illiterate. About 88.10% of patient's had squamous cell carcinoma. Only 13% of cases had early stage disease and 77% of patient's had not taken any treatment before coming to the hospital. Of the total, about 26% patients also had concomitant comorbidities, of which hypertension was found to be the leading comorbid condition. Stage of disease was found to be significantly (P < 0.05) associated with age and educational status. CONCLUSION: This study highlights certain important baseline characteristics of cervical cancer patients. This basic information on profile of patients can help plan and optimum utilization of hospital services, especially in resource-poor countries like India.

Role of Monocyte Count and Neutrophil-to- Lymphocyte Ratio in Survival of Oral Cancer Patients

Abstract Introduction Inflammation seems to play a critical role in the development and progression of numerous cancers. Peripheral blood leukocyte count is an easily assessable parameter of systemic inflammatory response. Objective The aim of this study was to investigate whether the pretreatment leukocyte counts can predict the prognosis of patients with oral cavity cancer. Methods Medical records of 471 oral cavity cancer patients diagnosed between January 2007 and December 2008 were retrospectively analyzed. Receiver operating characteristic curve analysis and Cox proportional hazards analyses were applied to evaluate the associations of leukocyte counts with overall survival. Results The overall five year's survival of the cohort was found to be 49.4%. On univariate analysis, elevated monocyte count (≥500/mm3) and neutrophil-to-lymphocyte ratio (NLR) (>2.38) were associated with poor overall survival (OS) (p = 0.001 and 0.000, respectively). Multivariate Cox proportional hazard analysis showed that higher monocyte and NLR levels were significant independent predictors of worse OS (HR = 1.385, 95% CI = 1.049 - 1.829; p < 0.05 and HR = 1.392, 95% CI = 1.045 - 1.855; p < 0.05, respectively). The advanced overall stage and lymph nodal involvement were also independent indicators for poor OS. Conclusions Higher pretreatment monocyte and NLR levels are independent predictors of poor prognosis for patients with oral cavity cancer. Thus, these easily accessed variables can serve as a potent marker to predict the outcomes of oral cancer patients.