Comparison of rapid antigen testing and RT-PCR in the diagnosis of COVID-19 in Kashmir division

Background:Accurate diagnosis and widespread use of diagnostic tests with easy accessis important to contain the spread of SARS-CoV-2. A Real-time reverse transcription polymerase chain reaction (RT-PCR) has high cost and can be performed in special laboratories. There have been several easy to perform rapid antigen detection tests developed and recommended to use at point of care for timely detection of positive patients and their isolation to limit the spread of infection. The aim of the study was to compare the cost effectiveness and the role of RT-PCR and rapid antigen testing in diagnosing different suspects of COVID-19.Methods:In this cross-sectional study the data of all the suspected cases who underwent COVID-19 testing over a period of seven weeks at divisional level was used for analysis.Results:The widespread use of rapid antigen testing makes it more cost effective in detecting COVID-19 cases than the highly sensitive and specific RT-PCR testing. Conclusions:Rapid antigen tests can be used as a screening testing tool in high-risk groups to identify the infected persons quickly and for preventing the transmission of infection particularly in low resource settings.

Adverse outcomes in SAR-CoV-2 (COVID-19) and SARS virus related pregnancies with probable vertical transmission

The global severe acute respiratory syndrome-related coronavirus SARS-CoV-2 (COVID-19) pandemic has had an unprecedented impact on all aspects of daily life and healthcare. Information on the infection risks for pregnant women and their offspring have so far been limited to small case series, until a large UK report on 427 SARS-CoV-2 infected pregnant women was published. Previous SARS epidemic experiences were drawn upon. Diagnostic use of real time polymerase chain reaction (RT-PCR) and IgG and IgM antibody tests are fraught with concerns of non-validation and false negative results, as are sampling methodologies. Virtually no information on controls accompany these reports. Infection of the mother and baby has serious implications for obstetric and neonatal care. Information on early and late stage pregnancy infection and the relationship to severity of infection on fetal development is both useful and clearly warranted. An increasing number of reports centre around mildly infected women showing no evidence of fetal infection while a few reports suggesting vertical transmission require further validation. Vertical transmission from mother to baby however small would have profound health implications for obstetric and neonatal care and fetal abnormalities. Some data suggesting intrapartum vertical transmission from mother to baby cannot be dismissed given the lack of controls and limitations of diagnostic viral tests. This analysis covers some key early reports addressing pregnancy outcomes following SARS-CoV-2 infection. (AU)

Smoking behaviour among young doctors of a tertiary care hospital in North India.

Background: Tobacco use is one of the biggest public health threats the world has ever faced. There are more than one billion smokers in the world. Almost half of the world's children breathe air polluted by tobacco. Aim of current study was to study the smoking trends among young doctors in a tertiary care institute in north India. Methods: A descriptive observational cross-sectional epidemiological study was conducted among 250 doctors of a tertiary care Hospital in Jammu & Kashmir (Sheri Kashmir Institute of Medical Sciences, SKIMS) during the two months of February-March, 2014. The predesigned tool adopted during data collection was a questionnaire that was developed at the institute with the assistance from the faculty members and other experts. Results: Among 250 participants, (20%) were smokers; among smokers, (76%) were regular smokers and (24%) were occasional smokers. Majority of smokers were in the age group of 21-30 years (80%) & started smoking between 11-20 years (70%). All of them were male (100%). No significant difference was observed among urban and rural students. Among smokers, majority (60%) was in the practice of smoking for last 6 months to 1 year and 26% smoked for <6 months; & (14%) smoked for more than 5 years .It was found more than half of the responding (60%) students used to smoke 5-9 cigarettes per day; 14% is <5 and 26% consumed 10 or more per day .Among smokers, peer pressure was found in 80% cases. (χ2 = 107, P <0.001). Among smokers, almost 20% had other addiction and among non-smokers only 5% had .Effect of parental smoking was significantly higher in smokers than non-smoker (χ2 = 66.2, P <0.001) .It was seen that peer pressure was the most important risk factor (60%) of initiation of smoking habit followed by parental influence (20%). Majority (78.4%) had no intention to quit in the next 6 months. Lack of Incentive (36.36%) and Addiction (27.27%) were the main reasons for not quitting. Conclusion: We need to create more awareness regarding hazards of smoking in general population especially in medical students, and afterwards provide psychological and pharmacological support for those who intend to quit, as medical students can themselves become a tool to fight this hazard at all levels.

An outbreak of influenza B in an isolated nomadic community in Jammu & Kashmir, India.

Background & objectives: Community outbreaks of disease amongst nomadic populations generally remain undocumented. Following a reported increase in acute respiratory tract infections (ARI) in May 2011 in a nomadic population of Sangerwini in Jammu & Kashmir, India, we examined the patients with ARI symptoms and their nasal swabs were tested for influenza virus. Methods: Patients with ARI (n=526) were screened from May 14 to 23, 2011 and nasopharyngeal swabs collected from 84 with Influenza like illness (ILI) for bacterial cultures and influenza virus testing. Samples were tested for influenza A and influenza B by real time (RT)-PCR. Results: Twelve (14.3%) of the 84 patients tested positive for influenza B, compared to only one (0.9%) of 108 patients with ILI in a parallel survey performed in Srinagar during the same period, suggesting a localized outbreak in the isolated nomadic community. All presented with respiratory symptoms of less than seven days. Familial clustering was seen in 40 per cent (25% of influenza B positives). Average daytime temperatures ranged from 15-16oC compared to 22oC in Srinagar. Four patients developed pneumonia whereas others ran a mild course with a total recovery with oseltamivir and symptomatic therapy. Interpretation & conclusion: Our report of confirmed influenza B in this underprivileged nomadic population argues for routine surveillance with efforts to improve vaccination and infection control practices.

Effect of smoking on myocardial enzymes and some haematological parameters

Effects of cigarette smoking on healthy and cardiac ptients were evaluated by studying myocardial enzyme profiles and some selected haematological parameters. The smokers, whether normal or cardiac patients, had relatively higher values of Hb. conc., [13.90g/dL], ESR [11.05 mm/hr] and TLC [7102 per cu mm]. Similarly, Neutrophil and Eosinophil counts [65% and 2.6% respectively] were found elevated in smokers. Myocardial enzymes, such as, LDH, CK-MB, GOT were found maximally raised [mean as 295.68, 68.21, 21.08, 35.86 and 68.92 U/L respectively] in exclusively the cardiac patients who also smoked. Moreover, cholesterol levels were also highest for cardiac smoker patients. The statistical analysis revealed the evaluation as significant [P<0.01, P < 0.05] Thus, the smoking was identified as a significant risk factor among normal individuals as well as those with myocardial complaints

Ultrasonic evaluation of hepatic metastasis

To assess the sensitivity of ultrasound in Hepatic Metastatic lesion in co-relation with clinical examination and history. Prospective study of 64 indoor patients with suspected Hepatic metastasis. Department of Radiology and Imaging, Liaquat Medical College Hospital Jamshoro from January 1996 to April 1996 in whom satisfactory follow up was possible. Ultrasound is the most sensitive imaging modality for detection of metastasis is co-relation with proper clinical examination and history, without any help from CT scan or MRI. The metastatic patterns were variable in liver, it was Hyperechoic, Hypoechoic, necrotic or target lesion, the primary was diagnosed clinically with their past and present history and also with ultrasonography. The most common primary carcinoma was found to be in bronchus 4.77% followed by colon 4.24%. the hyperechoic pattern was the most commonly seen hepatic metastatic lesion [13.15%] followed by hypoechoic mass [8.48%]. The bulls'eye appearance which was from urinary bladder was 2.65% conclusion ultrasound is the low cost, easy, quick and non-invasive imaging modality for the detection of Hepatic Metastasis without help from CT Scan or MRI

Role of gray scle ultrasonography in vesical haematuria

The importance of Gray Scale Ultrasonography in detecting the cause of haematuria within urinary bladder. DESIGN: Prospective study of 156 patients complaining of haematuria from 01 June 97 to 31 December 97. SETTING: Department of Radiology and Imaging, Liaquat Medical College Hospital, Jamshoro. MAIN OUTCOME: Gray scale ultrasonography is still one of the important imaging modality for the diagnosis of the cause of haematuria within urinary bladder. Vesical calculus was found to be the commonest cause of haematuria detecting on ultrasonography. 52.5% were complaining of haeinaturia and had vesical calculus. The male to female ratio was 74.8 with age variation. 53 patients [33.9%] were having BPH [Benign Prostatic Hypertrophy], between 50 and 60 year followed by the patient above 70 year and below 80 year. 5.7% [9 cases] of new growth were noted within urinary bladder. The male to female ratio was 8: 1. The age were between 20 to 70 years. No evidence of growth was noted between 1 to 20 year. Mucosal oedema and additional inflammation was present in 14 cases where male to female ratio was equal. 1 patient shows blood clot with history of catheterisation and another was diagnosed as diverticular with impacted calculus within it. Foreign body within the urinary bladder was not seen in this study, though reported in various text and papers. Gray scale and B mode ultrasonography is the one of the important imaging modality in our Govt. Hospitals for the quick, less expensive diagnosis of the causes of haematuria within urinary bladder

Retrospective study on different focal masses in liver as diagnosed on ultrasonography

Retrospective study of 1052 patients with focal masses of liver, diagnosed on ultrasonography, was carried out from 1990 to 94. Focal masses were abscess, carcinoma, cyst [simple], hydatid cyst, polycystic disease of liver, haemangioma and haematoma. The involvement of males and female were studied. Relationship of abscess month-wise and age factor in liver haematoma were abserved. Among all the focal masses, abscess was the most common lesion [83%]

review of 100 cases of appendicectomy

Over a period of six months appendicectomies were performed at Civil Hospital Karachi [n=61] and Karachi National Hospital [n=39],. Of these 49 cases were dealt with by open conventional surgery, 12 by laparoscopic method and 39 by laparoscopic directed techniques. There were 58 male and 42 female patients while maximum number of cases were seen in the 3rd decade of life. Our study conclude that appendicectomy by laparoscopic technique has distinct advantages over the conventional open method, as it results in less post operative pain, shorter hospital stay, low complication rate and better cosmetic results