Determinants of substance use among young people attending primary health centers in India.

Background: Substance use is a complex condition with multidimensional determinants. The present study aims to find the prevalence and determinants of substance use among young people attending primary healthcare centers in India. Methods: A multicentric cross-sectional study was conducted across 15 states in India on 1,630 young people (10-24 years) attending primary health centers. The Alcohol, Smoking, and Substance Involvement Screening Test (ASSIST) was used to capture data on substance use. The degree of substance involvement was assessed and multivariate regression analysis was conducted to determine the risk factors of substance use. Results: The prevalence of substance use was 32.8%, with a median substance initiation age of 18 years. Among the substance users, 75.5% began before completing adolescence. Tobacco (26.4%), alcohol (26.1%) and cannabis (9.5%) were commonly consumed. Sociodemographic determinants included higher age, male gender, urban residence, positive family history, northeastern state residence and lower socioeconomic class. Over 80% of users had moderate or high involvement. Conclusions: High substance use prevalence among young people in Indian healthcare centers underscores the urgency of targeted intervention. Insights on determinants guide effective prevention strategies for this complex public health issue.

Anti-SARS-CoV-2 antibody kinetics up to 6 months of follow-up: Result from a nation-wide population-based, age stratified sero-epidemiological prospective cohort study in India.

Repeated serological testing tells about the change in the overall infection in a community. This study aimed to evaluate changes in antibody prevalence and kinetics in a closed cohort over six months in different sub-populations in India. The study included 10,000 participants from rural and urban areas in five states and measured SARS-CoV-2 antibodies in serum in three follow-up rounds. The overall seroprevalence increased from 73.9% in round one to 90.7% in round two and 92.9% in round three. Among seropositive rural participants in round one, 98.2% remained positive in round two, and this percentage remained stable in urban and tribal areas in round three. The results showed high antibody prevalence that increased over time and was not different based on area, age group, or sex. Vaccinated individuals had higher antibody prevalence, and nearly all participants had antibody positivity for up to six months.

Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials

Abstract Objective: To evaluate the efficacy and safety of trans-nasal Sphenopalatine Ganglion (SPG) block over other treatments for Post-Dural Puncture Headache (PDPH) management. Methods: A systematic literature search was conducted on databases for Randomized Controlled Trials (RCTs) comparing trans-nasal SPG blockade for the management of PDPH over other treatment modalities. All outcomes were pooled using the Mantel-Haenszel method and random effect model. Analyses of all outcomes were performed as a subgroup based on the type of control interventions (conservative, intranasal lignocaine puffs, sham, and Greater Occipital Nerve [GON] block). The quality of evidence was assessed using the GRADE approach. Results: After screening 1748 relevant articles, 9 RCTs comparing SPG block with other interventions (6 conservative treatments, 1 sham, 1 GON and 1 intranasal lidocaine puff) were included in this meta-analysis. SPG block demonstrated superiority over conservative treatment in pain reduction at 30 min, 1 h, 2 h, 4 h after interventions and treatment failures with "very low" to "moderate" quality of evidence. The SPG block failed to demonstrate superiority over conservative treatment in pain reduction beyond 6 h, need for rescue treatment, and adverse events. SPG block demonstrated superiority over intranasal lignocaine puff in pain reduction at 30 min, 1 h, 6 h, and 24 h after interventions. SPG block did not show superiority or equivalence in all efficacy and safety outcomes as compared to sham and GON block. Conclusion: Very Low to moderate quality evidence suggests the superiority of SPG block over conservative treatment and lignocaine puff for short-term pain relief from PDPH. PROSPERO Registration: CRD42021291707.

Neonatal, Infant, and Child Mortality in India: Progress and Future Directions.

In India, considerable progress has been made in reducing child mortality rates. Despite this achievement, wide disparities persist across and socio-economic strata, and persistent challenges, such as malnutrition, poor sanitation, and lack of clean water. This paper provides a comprehensive review of the state of child health in India, examining key risk factors and causes of child mortality, assessing the coverage of child health interventions, and highlighting critical public health programs and policies. The authors also discuss future directions and recommendations for bolstering ongoing efforts to improve child health. These include state- and region-specific interventions, prioritizing social determinants of health, strengthening data systems, leveraging existing programs like the National Health Mission (NHM) and Ayushman Bharat Pradhan Mantri Jan Arogya Yojana (PM-JAY), and the proposed Public Health Management Cadre (PHMC). The authors argue that reducing child mortality requires not only scaled-up interventions but a comprehensive approach that addresses all dimensions of health, from social determinants to system strengthening.

Risk of secondhand smoke exposure and severity of COVID-19 infection: multicenter case-control study.

Introduction: Exposure to secondhand smoke (SHS) is an established causal risk factor for cardiovascular disease (CVD) and chronic lung disease. Numerous studies have evaluated the role of tobacco in COVID-19 infection, severity, and mortality but missed the opportunity to assess the role of SHS. Therefore, this study was conducted to determine whether SHS is an independent risk factor for COVID-19 infection, severity, mortality, and other co-morbidities. Methodology: Multicentric case-control study was conducted across six states in India. Severe COVID-19 patients were chosen as our study cases, and mild and moderate COVID-19 as control were evaluated for exposure to SHS. The sample size was calculated using Epi-info version 7. A neighborhood-matching technique was utilized to address ecological variability and enhance comparability between cases and controls, considering age and sex as additional matching criteria. The binary logistic regression model was used to measure the association, and the results were presented using an adjusted odds ratio. The data were analyzed using SPSS version 24 (SPSS Inc., Chicago, IL, USA). Results: A total of 672 cases of severe COVID-19 and 681 controls of mild and moderate COVID-19 were recruited in this study. The adjusted odds ratio (AOR) for SHS exposure at home was 3.03 (CI 95%: 2.29-4.02) compared to mild/moderate COVID-19, while SHS exposure at the workplace had odds of 2.19 (CI 95%: 1.43-3.35). Other factors significantly related to the severity of COVID-19 were a history of COVID-19 vaccination before illness, body mass index (BMI), and attached kitchen at home. Discussion: The results of this study suggest that cumulative exposure to secondhand cigarette smoke is an independent risk factor for severe COVID-19 illness. More studies with the use of biomarkers and quantification of SHS exposure in the future are needed.

Trans-nasal sphenopalatine ganglion block for post-dural puncture headache management: a meta-analysis of randomized trials.

OBJECTIVE: To evaluate the efficacy and safety of trans-nasal Sphenopalatine Ganglion (SPG) block over other treatments for Post-Dural Puncture Headache (PDPH) management. METHODS: A systematic literature search was conducted on databases for Randomized Controlled Trials (RCTs) comparing trans-nasal SPG blockade for the management of PDPH over other treatment modalities. All outcomes were pooled using the Mantel-Haenszel method and random effect model. Analyses of all outcomes were performed as a subgroup based on the type of control interventions (conservative, intranasal lignocaine puffs, sham, and Greater Occipital Nerve [GON] block). The quality of evidence was assessed using the GRADE approach. RESULTS: After screening 1748 relevant articles, 9 RCTs comparing SPG block with other interventions (6 conservative treatments, 1 sham, 1 GON and 1 intranasal lidocaine puff) were included in this meta-analysis. SPG block demonstrated superiority over conservative treatment in pain reduction at 30 min, 1 h, 2 h, 4 h after interventions and treatment failures with "very low" to "moderate" quality of evidence. The SPG block failed to demonstrate superiority over conservative treatment in pain reduction beyond 6 h, need for rescue treatment, and adverse events. SPG block demonstrated superiority over intranasal lignocaine puff in pain reduction at 30 min, 1 h, 6 h, and 24 h after interventions. SPG block did not show superiority or equivalence in all efficacy and safety outcomes as compared to sham and GON block. CONCLUSION: Very Low to moderate quality evidence suggests the superiority of SPG block over conservative treatment and lignocaine puff for short-term pain relief from PDPH. PROSPERO REGISTRATION: CRD42021291707.

A Review on Autonomic Functional Assessment in Diabetic Patients.

In today's world, science has progressed significantly, yet most people are still unaware of diabetes. Lack of obesity, physical work, and lifestyle changes are the main factors. Diabetes is becoming more common all around the globe. Type 2 diabetes may go unnoticed for years, resulting in serious consequences and high healthcare expenses. The goal of this study is to look at a wide range of studies in which the autonomic function of diabetic people has been studied with the help of various autonomic function tests (AFTs). AFT is a non-invasive approach to assessing patients for testing sympathetic and parasympathetic responses to stimuli. AFT findings give us comprehensive knowledge of the autonomic physiology reactions in normal and in autonomic diseases like diabetes. This review will concentrate on AFTs that are scientifically valid, trustworthy, and clinically beneficial, according to experts.

Dexmedetomidine versus clonidine as an adjuvant to local anaesthetic in brachial plexus blocks: a meta-analysis of randomised controlled trials.

OBJECTIVE: This meta-analysis aimed to compare the efficacy and safety of dexmedetomidine and clonidine as an adjuvant to local anesthetics in BPBs. METHODS: Two investigators independently searched databases to identify all RCTs comparing the efficacy and/or safety of dexmedetomidine and clonidine as an adjuvant to local anesthetics in BPBs. All outcomes were pooled using the inverse variance method with a random-effect model. An I2 test was used to assess heterogeneity. The source of heterogeneity was explored through meta-regression. The quality of the evidence was assessed using the GRADE approach. RESULTS: Out of 123 full texts assessed, 24 studies (1448 patients) were included in the analysis. As compared to clonidine, dexmedetomidine groups showed significantly longer sensory block duration (MD = 173.31; 95% CI 138.02‒208.59; I2 = 99%; GRADE approach evidence: high); motor block duration (MD = 158.35; 95% CI 131.55‒185.16; I2 = 98%; GRADE approach evidence: high), duration of analgesia (MD = 203.92; 95% CI 169.25‒238.58; I2 = 99%; GRADE approach evidence- high), and provided higher grade quality of block (RR = 1.97; 95% CI 1.60‒2.41; I2 = 0%; GRADE approach evidence: moderate). The block positioning technique (regression coefficient: 51.45, p = 0.005) was observed as a significant predictor of the heterogeneity in the case of sensory block duration. No significant difference was observed for the risk of hypotension (RR = 2.59; 95% CI 0.63‒10.66; I2 = %). CONCLUSION: Moderate to high-quality evidence suggests dexmedetomidine is a more efficacious adjuvant to local anesthetic in BPBs than clonidine.

Impact of suspected adverse drug reactions on mortality and length of hospital stay in the hospitalised patients: a meta-analysis.

PURPOSE: To estimate the risk of mortality and length of stay in hospitalised patients who have experienced suspected adverse drug reactions (ADRs) as compared to patients who did not experience suspected ADRs. METHODS: A systematic literature search was conducted on databases for observational and randomised controlled studies conducted in any inpatient setting that reported deaths and/or length of hospital stay in patients who had suspected ADRs and did not have suspected ADRs during hospitalisation. PRISMA guidelines were strictly followed during the review. The methodological quality of included studies was assessed using a tool designed by Smyth et al. for the studies of adverse drug reactions. The meta-analytic summary of all-cause mortality was estimated using odds ratio-OR (95% CI) and length of stay using mean difference-MD (95% CI). Both outcomes were pooled using a random effect model (DerSimonian and Laird method). Subgroup and meta-regression were performed based on study variables: study design, age group, study ward, study region, types of suspected ADRs (ADRAd-suspected ADRs that lead to hospitalisation and ADRIn-suspected ADRs that occur following hospitalisation), study duration, sample size and study period. The statistical analysis was conducted through the 'Review manager software version 5.4.1 and JASP (Version 0.14.1)'. RESULTS: After screening 475 relevant articles, 55 studies were included in this meta-analysis. Patients having suspected ADRs had reported significantly higher odds of all-cause mortality [OR: 1.50 (95% CI: 1.21-1.86; I2 = 100%) than those patients who did not have suspected ADRs during hospitalisation. Study wards, types of suspected ADRs and sample size were observed as significant predictors of all-cause mortality (p < 0.05). Patients having suspected ADRs had reported significantly higher mean difference in hospital stay [MD: 3.98 (95% CI: 2.91, 5.05; I2 = 99%) than those patients who did not have suspected ADRs during hospitalisation. Types of suspected ADRs and study periods were observed as significant predictors of length of stay (p < 0.05). CONCLUSION: Suspected ADRs significantly increase the risk of mortality and length of stay in hospitalised patients. SYSTEMATIC REVIEW REGISTRATION: CRD42020176320.

Dexmedetomidine versus clonidine as an adjuvant to local anaesthetic in brachial plexus blocks: a metaanalysis of randomised controlled trials

Abstract Objective: This meta-analysis aimed to compare the efficacy and safety of dexmedetomidine and Clonidine as an adjuvant to local anesthetics in BPBs. Methods: Two investigators independently searched databases to identify all RCTs comparing the efficacy and/or safety of dexmedetomidine and Clonidine as an adjuvant to local anesthetics in BPBs. All outcomes were pooled using the inverse variance method with a random-effect model. An I2 test was used to assess heterogeneity. The source of heterogeneity was explored through meta-regression. The quality of the evidence was assessed using the GRADE approach. Results: Out of 123 full texts assessed, 24 studies (1448 patients) were included in the analysis. As compared to Clonidine, dexmedetomidine groups showed significantly longer sensory block duration (MD = 173.31; 95% CI 138.02-208.59; I2 = 99%; GRADE approach evidence: high); motor block duration (MD = 158.35; 95% CI 131.55-185.16; I2 = 98%; GRADE approach evidence: high), duration of analgesia (MD = 203.92; 95% CI 169.25-238.58; I2 = 99%; GRADE approach evidence-high), and provided higher grade quality of block (RR = 1.97; 95% CI 1.60-2.41 ; I2 = 0%; GRADE approach evidence: moderate). The block positioning technique (regression coefficient: 51.45, p = 0.005) was observed as a significant predictor of the heterogeneity in the case of sensory block duration. No significant difference was observed for the risk of hypotension (RR = 2.59; 95% CI 0.63-10.66; I2 = %). Conclusion: Moderate to high-quality evidence suggests dexmedetomidine is a more efficacious adjuvant to local anesthetic in BPBs than Clonidine.

Urban-rural disparities in blood pressure and lifestyle risk factors of hypertension among Indian individuals.

Objectives: This study aims to assess the urban-rural difference in prevalence of hypertension (HT) and to explore the disparities in lifestyle risk factors of HT among urban and rural individuals aged 15-49 years in India. Study Design: The cross-sectional data collected as a part of the fourth round of National Family Health Survey (NFHS-4) was analysed in this observational study. NFHS-4 was conducted between January 2015 and December 2016 amongst men aged 15-54 years and women aged 15-49 years. In order to maintain uniformity, age group of 15-49 years was considered. Descriptive analyses were performed for sociodemographic and lifestyle factors. Binary logistic regression was conducted to assess the predictors of HT in men and women in urban and rural settings. The presence of HT was considered as the outcome variable. Results: The overall age adjusted prevalence of HT was 17.2% and was greater in urban (18.3%) than in rural population (15.5%). The age adjusted prevalence was also higher in males (18.2%) as compared to females (16.1%). Age and wealth were associated with HT in both urban and rural population. Education and dietary habits played a role in all except rural men. Alcohol consumption, diabetic status and marital status were significantly associated with HT in both urban and rural women. Occupation was associated with HT only in urban women. Conclusions: The study has shown higher HT prevalence in urban areas despite higher prevalence of lifestyle risk factors in rural settings. This calls for more robust screening and health education in the entire population, especially in rural areas.

Prevalence and associated factors for awareness of hypertension in India: Findings from national survey-4.

Background: Despite the fact that hypertension is increasing, merely 50% are aware of the disease. Being aware of hypertension is important to control it. Aim: The study's objective was to estimate the level of hypertension awareness in India and explore its associated sociodemographic factors. Materials and Methods: The data collected in National Family Health Survey 4 (2015-2016) among men aged 15-54 years and women aged 15-49 years were analyzed. Taking awareness of hypertension as an outcome variable, descriptive analysis, and multivariable logistic regression model were performed, by gender. Results: Of 1,41,215 hypertensive individuals analyzed, 34.7% of men and 53.6% of women were aware of being hypertensive. The control among those aware was 67.1% in men and 74.6% in women. The awareness varied among states ranging from 29.6% in Chhattisgarh to 75.6% in Tamil Nadu. The multivariable logistic regression model explained the awareness of hypertension in males increased with age (odds ratios [OR]: 0.226 for 95% confidence interval [CI]: 0.139-0.366 for 25-29 years of age increased to 0.599 for 95% CI: 0.48-0.74 for 40-44 years of age), education (OR of 0.66 for 95% CI: 0.51-0.85 for primary increased to 0.69 for 95% CI: 0.54-0.89 for secondary school level), and wealth status (OR of 0.407 for 95% CI: 0.309-0.535 for poor wealth quintile increased to 1.030 for 95% CI: 0.863-1.230 for the richest wealth quintile). For women, the awareness increased with age (OR of 0.306 for 95% CI: 0.119- 0.791 for the age of 20-24 years increased to 0.736 for 95% CI: 0.570-0.951 for the age of 45-49 years) and wealth status (OR of 0.28 for 95% CI: 0.18-0.44 for poor wealth quintile increased to 1.262 for 95% CI: 0.859-1.855 for the richest wealth quintile). Conclusion: Improving access to hypertension screening and awareness especially among men, with lower wealth and younger age is needed.

Serological prevalence of SARS-CoV-2 antibody among children and young age group (between 2 and 17 years) in India: An interim result from a large multicentric population-based seroepidemiological study.

Background: Estimating seroepidemiolgical prevalence of SARS-CoV-2 antibody is an essential public health strategy. There is insufficient evidence of prevalence among those belonging to young age population in India. Objective: To compare the SARS-CoV-2 seropositivity rate between children and adults in selected sites from India. Materials and Methods: This was a multicentric population-based seroepidemiological study conducted in selected urban and rural areas of five sites selected from four states (Delhi, Odisha, Uttar Pradesh, Tripura) of India. Participants aged ≥1 year were included from different clusters of each area. Total serum antibody against SARS-CoV-2 virus was assessed qualitatively by using a standard enzyme-linked immunosorbent assay (ELISA) kit. Results: Data collection period was from 15 March 2021 to 10 June 2021. Total available data was of 4509 participants, of whom 700 were <18 years of age and 3809 were ≥18 years of age. The site-wise number of available data among those aged 2-17 years was 92, 189, 165, 146 and 108 for the sites of Delhi urban, Delhi rural, Bhubaneswar rural, Gorakhpur rural and Agartala rural area, respectively. The seroprevalence was 55.7% in the <18 years age group and 63.5% in the ≥18 years age group. The prevalence among female children was 58% and among male children was 53%. Conclusion: SARS-CoV-2 seropositivity rate among children was high and comparable to that of the adult population. Hence, it is unlikely that any future third wave by prevailing SARS-CoV-2 variant would disproportionately infect children 2 years or older.

The Impact of Mobile Health Interventions on Antenatal and Postnatal Care Utilization in Low- and Middle-Income Countries: A Meta-Analysis.

Despite many efforts, the utilization of full antenatal and postnatal care remains a significant concern in low- and middle-income countries (LMICs). We planned to retrieve the relevant literature and pooled the data for meta-analysis to evaluate the impact of mobile health (mHealth) intervention on antenatal and postnatal care utilization in low- and middle-income countries. We searched the literature through major electronic databases such as PubMed, MEDLINE, Embase, Cochrane, Scopus, CINAHL, Clinical key, Google Scholar, and Ovid with selected keywords and explored the reference list of articles. Meta-analysis was performed using the RevMan software version 5.4; p-value < 0.05 was considered statistically significant. The effect of variables was measured in odds ratio (OR) with a fixed-effects model. Six published interventional studies were selected as per the eligibility and participants, intervention, comparison, and outcome (PICO) framed for systematic review and meta-analysis. The search was restricted to articles in the English language, articles published online, and preprinted articles until September 2020. Outcome variables include antenatal and postnatal care utilization by pregnant and delivered mothers. The results have been presented in the form of a forest plot. The findings of this meta-analysis depicted the significant increase in four or more antenatal care (ANC) attendance (OR = 1.81, 95% confidence interval (CI) = 1.49-2.19), tetanus toxoid (TT) immunization (OR = 1.63, 95% CI = 1.17-2.27), compliance to iron supplementation (OR = 1.88, 95% CI = 1.18-3.00), and postnatal care attendance (OR = 2.54, 95% CI = 2.15-2.99) among those pregnant mothers who received mHealth intervention compared with the control group. This meta-analysis creates evidence for the effectiveness of mHealth with pooled data of interventional studies with limited sample sizes. Technology is changing, but even with limited support such as short messaging service (SMS), there was an improvement in antenatal and postnatal service utilization. This meta-analysis concluded that mHealth has the potential to increase the utilization of antenatal and postnatal care compared to standard care, although the level of evidence is moderate.

Perspectives of women on availing antenatal services in urban poor areas of Rishikesh, Uttarakhand.

Background Antenatal care (ANC) is the essential regular care of women that prevents potential health problems during pregnancy. In India, the proportion of women who received four or more antenatal visits was only 51% (National Family Health Survey, 2015-2016). An even worse situation prevails in urban areas where women from poor communities face greater health risks. We assessed various barriers women residing in these areas come across in availing ANC services. Methods This study is a part of a mixed-methods, community-based study, and we report its qualitative component. We conducted the study at the residence of the study participants in September-October 2019. The study participants were women who had less than four antenatal visits throughout the pregnancy. Twelve in-depth interviews were conducted based on data saturation. Data were transcribed and themes were drawn concerning the gender analysis framework. Results Through this study, we found how gender relations affect the utilization of antenatal services concerning access to resources, division of labour, social norms including the belief of husband and other family members towards pregnancy and decision-making power of women. Conclusion Our findings underline the importance of making the urban health system gender-sensitive and responsive to the needs of women during pregnancy. There is a need to educate men regarding maternal health so as to allay such social norms that label pregnancy as a woman's responsibility and encouraging them to accompany their wives during pregnancy visits, thus making men a part of antenatal services.

Burden of ocular morbidities and color blindness among school-attending children in a foothill town of Uttarakhand State.

PURPOSE: To estimate prevalence of common ocular morbidities including color blindness among school-attending children of an urban foothill town of Uttarakhand State in Northern India. METHODS: A cross-sectional study was conducted among school-going children of age group 6-16 years of standard I-XII. Schools were selected using population proportionate to the size sampling technique. Detailed ocular examination including color vision and unaided or aided visual acuity for various ocular morbidities was done. Data was entered into MS excel with statistical analysis using SPSS version 23 with significant P value <0.05. RESULTS: In total, 13,492 students (mean age 10.9 ± 2.7 years) with almost equal male to female ratio were screened. Overall prevalence of ocular morbidity was 23.2%, with refractive error (18.5%) on top, followed by color blindness (2.2%). The later was observed more among males (3.0%) as compared to females (1.4%) with significantly higher odds, OR = 2.3 (1.7-2.9) (P < 0.001). CONCLUSION: Refractive error has been the most common ocular morbidity, followed by color blindness. Earliest detection can prevent permanent disability and disappointment among youngsters when rejected from entering certain professions due to color vision defect.

Drug-related deaths among inpatients: a meta-analysis.

PURPOSE: To estimate the prevalence of drug-related deaths with regard to total hospital mortality and to explore the heterogeneity in its estimation through subgroup analysis, univariate and multivariate analysis. METHODS: Two investigators independently searched the PubMed and Google Scholar databases with appropriate key terms to identify observational and randomised studies assessing drug-related problems. The prevalence of drug-related deaths was estimated using a double arcsine method. The heterogeneity was explored through subgroup and univariate analysis for the following study characteristics: study design, age group, study ward, study region, types of drug-related problems, study duration, sample size and study period. The study variables showing significant effects were further explored through a multivariable regression model. The percentage of preventable drug-related deaths was explored as a secondary objective. RESULTS: Of the 480 full-text articles assessed, 23 studies satisfying the selection criteria were included. The mean percentage of drug-related deaths was 5.6% (95% CI: 3.8-7.6%; I2 = 96%). The univariable analysis showed study design (regression coefficient: 4.31) and study wards (regression coefficient: - 6.37) as heterogeneity modifiers. In the multivariable model, only the study ward was considered a significant predictor of drug-related deaths (regression coefficient: - 5.78; p = 0.04). The mean percentage of preventable drug-related deaths was 45.2% (95% CI: 33.6-57.0%; I2 = 60%). CONCLUSION: Drug-related problems are an important cause of mortality. The variability in its estimation could be explained by admission wards.

Comparison of the Rapid Antigen Testing Method With RT-qPCR for the Diagnosis of COVID-19.

BACKGROUND: Coronavirus disease 2019 (COVID-19) has till now affected about 110 million people globally. It has not spared any country and has led to 24 lakh deaths. As a result, the testing had to be increased manifold leading to depletion in the number of the quantitative reverse transcription polymerase chain reaction (RT-qPCR) kits. Point-of-care rapid antigen-based tests were developed in order to meet the increasing demands. The objective of this study was to compare the performance of a rapid chromatographic test (index test) with a gold standard test (RT-qPCR). METHODS: A retrospective analysis was done at a tertiary care teaching hospital in Eastern Uttar Pradesh, India. Paired samples were taken from all patients reporting to the clinic for antigen-based rapid diagnostic testing (RDT) and RT-qPCR. The sensitivity and specificity were calculated to evaluate the performance of the RDT. RESULTS: The overall sensitivity and specificity of the RDT were observed to be 53.6% (39.7-67.0) and 97.35% (94.6-98.9), respectively. In symptomatic individuals, the sensitivity was higher 61.0% (44.5-75.8). The test positivity rates of RDT were found to be higher at a ​​cycle threshold value ≤20. CONCLUSION: RDT can be used as a screening test to rule in the infection especially in symptomatic patients who are more prone to spread the disease. It is an important weapon in the armamentarium of public healthcare for the containment of COVID-19.

Comparison of Positivity Rates of Rapid Antigen Testing and Real-Time Polymerase Chain Reaction for COVID-19 During the First and Second Waves of the Pandemic in Eastern Uttar Pradesh, India.

Background The advent of the second wave of coronavirus disease 2019 (COVID-19) in India caused a new range of challenges in diagnosing the virus. Various point-of-care tests have been introduced for rapid diagnosis. Although rapid antigen tests are the most commonly used, the false-negative rates are high. Therefore, the purpose of this study was to compare the positivity rate of real-time polymerase chain reaction (RT-PCR) testing in rapid antigen-negative cases of COVID-19 during the first and second waves of the COVID-19 pandemic. Methodology This was an observational study conducted in the Department of Microbiology, All India Institute of Medical Sciences, Gorakhpur. Results In total, 2,168 patients were tested. The percentage positivity rate of the RT-PCR tests among the antigen-negative samples was 4.34% in the first wave of the pandemic whereas it was 8.08% in the second wave. Conclusions The main conclusion of this study was that antigen tests should never be used alone for the diagnosis of COVID-19. Instead, they should be confirmed with a RT-PCR test.

Is it time to consider shreds of epidemiological and environmental evidence associated with high transmission of COVID-19?

Novel coronavirus named COVID-19 that emerged in late December from Wuhan affected almost the entire globe. Recent studies provided new insight into the high transmission of the disease. This review explores the current evidence of epidemiological and environmental factors associated with high transmission of COVID-19. Even transmission and symptoms found among cats, dogs, ferrets, and tiger suggested low species barrier of the virus. The airborne transmission was found even up to 4 m, and fecal transmission with virus particles and RNA in sewage and wastewater suggests rethinking containment strategies. However, temperature, humidity, and pollution were also associated with transmission and mortality trends of COVID-19. To better mitigate and contain the current pandemic, it is a need of hours to consider the recent shreds of evidence to prevent further spread and require detailed investigations of these evidences by extensive epidemiological and meteorological studies.