Navigating the Pandemic: An Exploration of Medical Practitioners' Preparedness, Concerns, Adaptations, and Practices During the COVID-19 Epidemic in India.

Introduction The coronavirus disease 2019 (COVID-19) pandemic, caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus, has had profound health and societal impacts, and healthcare providers from diverse backgrounds had to continuously adapt and update to manage patient care, prevent morbidity-mortality, and minimize transmission of the infection. Methodology A cross-sectional survey was conducted among 218 doctors in western India. A structured questionnaire was used to gather data on demographic characteristics, patient consultations, infection prevention practices, COVID-19 diagnosis, management, vaccination attitudes, and healthcare program disruptions. Multistage probability sampling was undertaken to select 161 (64%) private and 57 (26%) public sector doctors from the list of clinics and hospitals reporting COVID-19 cases in the urban municipal corporation area of South Gujarat. Private sector doctors were contacted through the network of public administrative staff and caregivers of their area. They were provided the choice of date, time, and mode (telephonically, face to face, or online) of interview. Descriptive measures of central tendency and variation were calculated. Inferential statistics was applied to test the significance of the difference between sub-groups. For ratio and interval variables, t-test (for two groups) and ANOVA (for more than two groups) were applied while for nominal and ordinal variables, chi-square and appropriate tests were applied. Results The mean age of the 218 doctors included in the study was 43.6 ± 11.1 years while the mean duration of practice was 16.9 ±10.8 years. During the pandemic, patients' consultation frequencies decreased at the clinics while telephonic and residential consultancies increased, which was statistically significant (P=0.000). Social distancing (n= 187; 85%), isolation (n=157; 72%), and consultation reduction (n=65; 30%) were adopted by doctors. Both public and private doctors preferred government-recognized COVID-19 centers for testing (n=167; 76.7%) and reverse transcriptase-polymerase chain reaction (RT-PCR) as the standard diagnostic test (n=196; 90%). A combination of antipyretics, favipiravir, and antibiotics was used to manage symptomatic cases. Concerns and emotional stress for personal and family safety were prominent among this group of frontline medical doctors (94%). Delivery of healthcare programs for chronic conditions like hypertension and tuberculosis was negatively affected (n=102; 47%). Despite these challenges, doctors managed cases and advised vaccination to control the pandemic. Conclusion This study among over 200 qualified medical practitioners during the pandemic attempts to fill gaps in COVID-19 management, prevention, and safety measures. To the best of our knowledge, this is one of the few studies providing genuine insights into the practice of private doctors with a large sample size. Findings show the established treatment, prophylaxis, and vaccination protocols among private and public practitioners. It highlights the need for adaptable healthcare strategies and collaboration between public and private sectors for managing future global health emergencies.

Effect of degeneration on bone mineral density, trabecular bone score and CT Hounsfield unit measurements in a spine surgery patient population.

This study investigated the impact of spinal degeneration on bone mineral density (BMD), trabecular bone score (TBS), and CT Hounsfield units in an at-risk population. We found that BMD was increased by degeneration, whereas TBS and HU were unaffected. These findings support that TBS is not adversely affected by spinal degeneration. INTRODUCTION: This study evaluated the impact of spinal degeneration on BMD and TBS measured by dual-energy x-ray absorptiometry (DXA) and on CT HU in a spine surgery patient population. METHODS: A retrospective study of 63 patients referred for consideration of spine surgery or with history of spine surgery was performed. Patients were included if a DXA scan and a CT containing the lumbar spine were obtained within 18 months of each other. DXA data were collected and analyzed by vertebral level. Individual vertebrae were assessed for degenerative changes by qualitative evaluation of the anterior and posterior elements using CT. Degeneration scores were compared to BMD T-scores, TBS and CT HU at individual vertebral levels L1-4, and after applying International Society for Clinical Densitometry (ISCD) criteria for excluding vertebrae from diagnostic consideration. RESULTS: Mean patient age and BMI were 67.2 years and 27.8 kg/m2, respectively; 79.4% were female. Mean (SD) lowest T-scores of the hip, spine, and lowest overall T-score were - 1.3 (1.4), - 1.7 (0.9), and - 1.9 (1.0), respectively. Osteoporosis was present by T-score in 38% and osteopenia in 52%; 10% had a history of osteoporotic fracture. The mean degeneration score of individual vertebrae was 4.1 on a 0-6 scale. T-score correlated moderately with degeneration score (Spearman's rho 0.484, p < 0.001), whereas TBS and HU were unrelated. ISCD excluded vertebrae had a higher degeneration score than included vertebrae (p = < 0.001). CONCLUSIONS: In a spine surgery population, TBS and CT HU values are unrelated to degeneration score and thus appear unaffected by lumbar vertebral degenerative changes. Additionally, these data support the ISCD criteria for vertebral exclusion.

Opportunistic Use of Lumbar Magnetic Resonance Imaging for Osteoporosis Screening.

Magnetic resonance imaging (MRI) is a routine assessment before spine surgery. We found that the opportunistic use of MRI with the vertebral bone quality (VBQ) score has good diagnostic ability, with a threshold value of VBQ > 3.0, in recognizing patients who may need further osteoporosis evaluation. INTRODUCTION: The purpose of this study was to determine whether the opportunistic use of magnetic resonance imaging (MRI) is useful for identifying spine surgical patients who need further osteoporosis evaluation. METHODS: This retrospective study evaluated 83 thoracolumbar spine surgery patients age ≥ 50 who received T1-weighted MRI. Opportunistic MRI was evaluated with the vertebral bone quality (VBQ) score, VBQ (fat) score, and signal-to-noise ratio (SNR). Each uses the median L1-L4 vertebral body signal intensities (SI) divided by either the L3 cerebrospinal fluid (CSF) SI, average SI of the L1 and S1 dorsal fat, or standard deviation (SD) of the background SI dorsal to the skin. Single-level VBQ was calculated as the ratio of the L1 vertebral body and L1 CSF SIs. Receiver-operator curve analysis was performed to determine diagnostic ability. RESULTS: The mean age was 70.10, 80% were female, and 96% were Caucasian. The mean ± SD VBQ, single-level VBQ, VBQ (fat), and SNR were 3.39 ± 0.68, 3.56 ± 0.81, 3.95 ± 1.89, and 113.18 ± 77.26, respectively. Using area under the curve, the diagnostic ability of VBQ, single-level VBQ, VBQ (fat), and SNR for clinical osteoporosis were 0.806, 0.779, 0.608, and 0.586, respectively. Diagnostic threshold values identified with optimal sensitivity and specificity were VBQ of 2.95 and single-level VBQ of 3.06. CONCLUSION: Opportunistic use of MRI is a simple, effective tool that may help recognize patients who are at risk for complications related to bone disease. A VBQ > 3.0 can identify patients who need additional diagnostic evaluation.

Clinical features and outcome of COVID-19 among PLHIV in Gujarat, India: A case series.

Information on people living with HIV (PLHIV) and current COVID-19 pandemic is still scarce in Indian setting. This case series of PLHIV with COVID-19 describes clinical characteristics and outcome in this special group of patients. This case series included 11 confirmed cases of COVID-19 among PLHIV admitted at a tertiary care hospital in Gujarat, India during April-December 2020. This retrospective study was conducted by doing secondary data analysis from case records of patients for various variables including demographic, clinical characteristics, HIV-related parameters, and outcome (discharged/death). The mean age of patients was 39.2 years ranging from 20 to 55 years. Nearly, 18% (2/11) of patients had major comorbidities like diabetes and hypertension. All were taking antiretroviral therapy drugs with >95% drug adherence and had CD4 count ranging from 79/cu.mm. to 1189/cu.mm. Majority (91%) of patients recovered and were discharged while only one patient (9%) died during course of COVID-19 treatment. COVID-19 showed a similar clinical and epidemiological profile among PLHIV like other group of people. Further studies with large-sample size are recommended to find risks of COVID-19 among PLHIV and its impact on treatment outcomes.

Influence of Dodecylsulfate Adsorption on the Stability of Cerium Oxide Nanoparticle-Based Colloidal Aqueous Dispersions.

In this contribution, the influence of the adsorption of dodecylsulfate, an anionic surfactant, on the stability of colloidal aqueous dispersions containing ceria (CeO2) nanoparticles (NPs) was investigated using zetametry, UV-visible spectrophotometry, and potentiometry involving an ionic surfactant-selective electrode (ISSE). In particular, thanks to absorbance follow-ups carried out as a function of time, aqueous dispersions containing a given loading of CeO2 NPs were found simultaneously to stabilize more quickly with time and to adopt a higher opacity and a more pronounced light-yellow color as the sodium dodecylsulfate (SDS) concentration increased. Knowing that this absorbance was attributed undoubtedly to CeO2 NPs, the fact that the measured absorbance is lower for a higher amount of CeO2 NPs in suspension, as revealed by a higher opacity of the studied dispersions, is somewhat counterintuitive. Besides the higher opacity of the dispersions, a shield effect of the adsorbed SDS layer toward UV-visible light may also explain this observation. The adsorption of dodecylsulfate on CeO2 NPs was indeed demonstrated using zetametry measurements in the presence of SDS and the potentiometric method combined with an ISSE. This latter method did not only allow the accurate determination of impoverishment in freely diffusing dodecylsulfate (DS) anions resulting from DS adsorption on CeO2 NPs but it also showed that this latter obeys a Freundlich isotherm.

Comparative study of Cu-Zn coatings electrodeposited from sulphate and chloride baths.

In this work, the effect of the nature of the salt anion (chloride and sulphate) in the Cu-Zn citrate bath was investigated, using cyclic voltammetry (CV) and chronoamperometry (CA). Experimental electrodeposition parameters (switching potential and imposed potential) were varied in order to examine their influence on the deposits. The coating microstructures were observed by scanning electron microscope (SEM-EDS), the coating phases were characterized by X-ray diffraction (XRD) analysis and the surface composition was assessed by XPS. Higher current efficiency was obtained in chloride baths compared to sulphate baths and best deposits were obtained at - 1.4 V v s . ( A g / A g C l / K C l ) compared to - 1.2 and - 1.5 V v s . ( A g / A g C l / K C l ) . Corrosion test results in 0.5 M NaCl solution show that Cu-Zn deposit produced from chloride bath exhibited the highest corrosion resistance.

Magnitude of Gestational Diabetes Mellitus, its Influencing Factors and Diagnostic Accuracy of Capillary Blood Testing for its Detection at a Tertiary Care Centre, Rajkot, Gujarat.

BACKGROUND: Gestational diabetes mellitus (GDM) occurs during pregnancy which affects mother, fetus, and outcome of pregnancy, hence early detection is necessary. The objective of this study was to ascertain the validity of glucometer over standard biochemical testing for detection of GDM and to estimate prevalence of GDM and its associated risk factors. MATERIALS AND METHODS: A hospital-based study was conducted at Antenatal clinics of Obstetrics Department, tertiary care hospital, based on the "National Guidelines for Diagnosis and Management of GDM." Totally 357 pregnant women between 21 and 28 weeks of gestational age agreed were included in the study from January to March 2016. After obtaining written consent, one step procedure was offered to pregnant women by giving 75 g of anhydrous glucose dissolving in 200-250 ml of water. After 2 h, glucose level was estimated by capillary testing with glucometer and venous glucose by glucose oxidase test. RESULTS: GDM was found in 20.4% pregnant women with capillary testing done by glucometer compare to 11.5% with venous blood testing. GDM was found higher among literates, homemakers, Hindus, people living in nuclear family, belongs to middle class, residing in urban area, primigravidae, obese and with gestational age between 21 and 24 weeks. Intermediate agreement (Kappa = 0.42) was found between two methods with sensitivity of 70.7%, specificity of 86.1%, positive predictive value 39.7%, and negative predictive value 95.8%. CONCLUSION: Intermediate agreement between two methods indicates glucometer testing can be used to screen pregnant women at an early gestational age (21 weeks), at the community level by health-care workers.

Evaluation of Integrated Child Development Services program in Gujarat, India.

OBJECTIVE: To evaluate Integrated Child Development Services (ICDS) program in terms of infrastructure of Anganwadi centers, inputs, process, coverage and utilization of services, and issues related to program operation in twelve districts of Gujarat, India. DESIGN: Facility (Anganwadi) based study. SETTING: Twelve districts of Gujarat, India (April 1, 2012 to March 31, 2013). PARTICIPANTS: ICDS service providers (60 Anganwadi workers from 46 rural and 14 urban Anganwadi centers) and their beneficiaries. MAIN OUTCOME MEASURES: Coverage of supplementary nutrition, pre-school education, immunization and referral services. RESULTS: Supplementary nutrition coverage was reported in 48.3% in children. Interruption in supply of supplementary nutrition during last six months was reported in 61.7% Anganwadi centers. Only 20% centers reported 100% pre-school education coverage among children. Immunization of all children was recorded in only 10% Anganwadi centers, while in 76.7% centers, no such records were available. Regular health checkup of beneficiaries was done in 30% centers. Referral slips were available in 18.3% Anganwadi centers and referral of sick children was done from only 8.3% centers. CONCLUSIONS: There are program gaps in coverage of supplementary nutrition in children, its regular supply to the beneficiaries, in pre-school activities coverage, recording of immunization, and regular health check-up of beneficiaries and referral of sick children.

Osteoprotegerin inhibits cartilage degradation through an effect on trabecular bone in murine experimental osteoarthritis.

OBJECTIVE: To characterize bone microarchitectural changes and to test the hypothesis that disrupting local cytokine equilibrium could modify cartilage degradation in a murine model of experimental osteoarthritis (OA). METHODS: Ten-week-old male C57BL/6 mice underwent medial meniscectomy of their right knees and a sham operation of their left knees. The mice received intraperitoneal injections of osteoprotegerin (OPG) (10 mg/kg), interleukin-1 receptor antagonist (IL-1Ra) (100 mg/kg), or phosphate buffered saline for 6 weeks. The microarchitecture of the trabecular bone, the OA score, and expression of ADAMTS-4 and ADAMTS-5 were assessed. Proteoglycan release was measured in cartilage explant cultures in the presence of IL-1Ra and OPG. RESULTS: In the meniscectomized knees, bone volume/tissue volume (BV/TV) was lower, whereas trabecular separation, the OA score, and aggrecanase expression were higher than in the sham-operated knees. After treatment with OPG, BV/TV was significantly increased and trabecular separation was reduced in the knees that underwent meniscectomy. The OA score and the number of ADAMTS-positive cells were significantly decreased by treatment with OPG but were not affected by IL-1Ra. Moreover, OPG did not directly reduce the release of proteoglycans from cartilage explant cultures. CONCLUSION: In an experimental model of OA, meniscectomy induced bone loss and cartilage degradation at 6 weeks. Systemic administration of OPG prevented bone and cartilage degradation in vivo but had no effect on cartilage in vitro. These data collectively indicate that bone could be a contributor in the early stages of OA pathogenesis. They further suggest that disruption of RANKL/OPG balance might result in the degradation of cartilage subjected to mechanical loading. Specific targeting of the bone cytokine network might help to prevent OA.

Crystal quality and differential crystal-growth behaviour of three proteins crystallized in gel at high hydrostatic pressure.

Pressure is a non-invasive physical parameter that can be used to control and influence protein crystallization. It is also found that protein crystals of superior quality can be produced in gel. Here, a novel crystallization strategy combining hydrostatic pressure and agarose gel is described. Comparative experiments were conducted on hen and turkey egg-white lysozymes and the plant protein thaumatin. Crystals could be produced under up to 75-100 MPa (lysozymes) and 250 MPa (thaumatin). Several pressure-dependent parameters were determined, which included solubility and supersaturation of the proteins, number, size and morphology of the crystals, and the crystallization volume. Exploration of three-dimensional phase diagrams in which pH and pressure varied identified growth conditions where crystals had largest size and best morphology. As a general trend, nucleation and crystal-growth kinetics are altered and nucleation is always enhanced under pressure. Further, solubility of the lysozymes increases with pressure while that of thaumatin decreases. Likewise, changes in crystallization volumes at high and atmospheric pressure are opposite, being positive for the lysozymes and negative for thaumatin. Crystal quality was estimated by analysis of Bragg reflection profiles and X-ray topographs. While the quality of lysozyme crystals deteriorates as pressure increases, that of thaumatin crystals improves, with more homogeneous crystal morphology suggesting that pressure selectively dissociates ill-formed nuclei. Analysis of the thaumatin structure reveals a less hydrated solvent shell around the protein when pressure increases, with approximately 20% less ordered water molecules in crystals grown at 150 MPa when compared with those grown at atmospheric pressure (0.1 MPa). Noticeably, the altered water distribution is seen in depressurized crystals, indicating that pressure triggers a stable structural alteration on the protein surface while its polypeptide backbone remains essentially unaltered.

Prevalence of tuberculosis infection among children in slums of Ahmedabad.

Children below 15 yrs. of age without BCG scar were chosen for the tuberculin testing. Total 210 children were tested in 30 selected clusters (7 children in each cluster). Median age of the surveyed children was 6.33. Prevalence of infection in children was found to be 30.4% as 64 children out of 210 showed positive result (had induration > or = 10mm in size). Average ARI in the 0-14 yrs of age group was 5.4%. Tuberculosis is still one of the commonest problems in the urban slums. It is important to evaluate the epidemiology of tuberculosis in the changing face of century.