Performance & clinical utility of oropharyngeal versus nasopharyngeal swabs in COVID-19

Background & objectives: The oropharyngeal (OP) and nasopharyngeal (NP) swab samples are the most recommended clinical specimens for detecting SARS-CoV-2 in an individual through the quantitative real-time reverse-transcriptase-polymerase chain reaction (rRT-PCR) method. The primary objective of this study was to compare the performance of NP and OP swabs for the diagnosis of COVID-19 among 2250 concomitant samples (1125 NP + 1125 OP) using rRT-PCR test. Methods: This study was conducted at a tertiary care hospital in southern India. The study compared the specificity and efficacy of the two samples (NP & OP swabs) in 1125 individuals suspected having COVID-19 infection. The rRT-PCR values from all the samples were compared based on gender, age group and viral load. The differences between unmatched proportion and matched proportion were analysed. Agreement between the two methods was assessed using Kappa statistic. Absolute sensitivity, specificity, positive and negative predictive values (PPV and NPV) for OP and NP swabs were analysed. Results: The study identified a fair degree of agreement between OP and NP swabs in diagnosis of COVID-19 (kappa = 0.275, P<0.001). There was also a fair degree of agreement between NP and OP swabs irrespective of gender, age or duration of symptoms. NP swabs had better sensitivity and NPV as compared to OP swabs, however, specificity and PPV were 100 per cent for both. Interpretation & conclusions: The present study showed that both OP and NP swabs had similar sensitivity and specificity for predicting the presence of SARS-CoV-2.

Communication Skills Appropriate to Context: Our Approach to Meeting the Training Needs of Interns.

Objectives: To identify the core competency areas for teaching and training interns in communication skills followed by evaluating effectiveness of the training subjectively, based on student perception. Methods: At the outset we identified five key areas where doctors faced difficulty in communication in their routine clinical practice. This was followed by a two day training programme to 160 interns consisting of videos, hand-outs, lectures and role plays with emphasis on deliberate practice of skills. At the end of the training, Intern‘s perception about the effectiveness of the programme and their selfperceived improvement in skills were assessed. Results: The core competency areas listed by the doctors were: breaking bad news; dealing with a parent resistant to immunisation; communicating with the distressed patient and irritated bystander in casualty, explaining risks and procedures; and dealing with a patient with psychosomatic complaints. Interns responses to the training methodology based on the core competencies were overwhelming with 91% rating the training as effective. Role play was the most appreciated learning technique. Increased self-perceived immediate improvement in Communication skills was reported by 85% of Interns. Conclusions: This exercise has helped us identify the key areas to be focused in communication skills training for interns in our setting, as well as design appropriate teaching learning methods to achieve the objectives. A systematic approach in developing a teaching-learning methodology stressing on the content and process of communication skills training relevant to the local context using a mix of experiential problem based and didactic methods should be stressed while framing a communication skill curriculum.

Cutaneous manifestations of chikungunya during a recent epidemic in Calicut, north Kerala, south India.

Background: There was a recent epidemic of chikungunya (CKG) in Calicut and other northern districts of Kerala, South India, affecting thousands of people. Aims: To study the cutaneous manifestations of CKG and to have a serological and histopathological correlation. Methods: A total of 162 patients (63 males and 99 females) with cutaneous manifestations of CKG were enrolled in the study and serological confirmation was done with capture IgM ELISA for CKG. Skin biopsy was done in all representative cases. Results: Cutaneous manifestations were found more in females. There were 23 children, the youngest being 39 days old. Generalized erythematous macular rash was the most common finding. Vesicles and bullae were also common especially in infants. Localized erythema of the nose and pinnae, erythema and swelling of the pre existing scars and striae and toxic epidermal necrolysis-like lesions sparing mucosae were the other interesting findings. Different types of pigmentation were observed with a striking nose pigmentation in a large number of patients, by looking at which even a retrospective diagnosis of CKG could be made. Hence we suggest this peculiar pigmentation may be called "chik sign". There was flare up of existing dermatoses like psoriasis, lichen planus and unmasking of Hansen's disease with type 1 reaction. Serological tests were positive in 97%. Some hitherto unreported histopathologic findings like melanophages in the erythematous rashes were observed. Conclusion: A spectrum of cutaneous manifestations of CKG with a wide variety of unusual presentations with confirmed serological and histopathological evidence was encountered.

Contamination of community water sources by potentially pathogenic vibrios following sea water inundation.

Potentially pathogenic members of the Vibrionaceae family including Vibrio cholerae and Vibrio parahemolyticus were isolated from domestic sources of drinking water in coastal villages following sea water inundation during the tsunami in Southern India. Phenotypic and genotypic studies were done to confirm the identity and detection of toxins. Vibrio-gyr (gyrase B gene) was detected in all sixteen vibrio isolates. Toxin regulating genes i.e.: ctx gene, tdh gene, and trh gene, however were not detected in any of the strains, thereby ruling out presence of toxins which could endanger human life. Other potentially pathogenic bacteria Aeromonas and Plesiomonas were also isolated from hand pumps and wells, in a few localities. There was no immediate danger in the form of an outbreak or sporadic gastroenteritis at the time of the study. Timely chlorination and restoration of potable water supply to the flood affected population by governmental and nongovernmental agencies averted waterborne gastroenteritis. Assessment of quality of water and detection of potential virulent organisms is an important public health activity following natural disasters. This work highlights the importance of screening water sources for potentially pathogenic microorganisms after natural disasters to avert outbreaks of gastroenteritis and other infectious diseases.

Impact of feeding ethanolic extract of root bark of Cananga odorata (Lam) on reproductive functions in male rats.

The 50% ethanolic extract of the root bark of C. odorata administered orally at the dose of 1g/kg body weight/day for 60 days resulted in decreased epididymal sperm motility and sperm count in male albino rats. Morphological abnormalities were also observed in the sperms. The testicular glycogen, the activities of 3beta hydroxy steroid dehydrogenase, glucose 6-phosphate dehydrogenase, malic enzyme, sorbitol dehydrogenase in seminal vesicle, fructose in seminal plasma and serum testosterone were significantly decreased in treated group. While testicular cholesterol level, the concentration of the fecal bile acids, urinary excretion of 17 ketosteroids, the activities of 17beta hydroxy steroid dehydrogenase, epididymal lactate dehydrogenase and that of testicular HMG CoA reductase were increased in treated group when compared to control. The results suggest that the ethanolic extract of C. odorata possesses the spermatotoxic effects in male albino rats.

Colitis due to Ancylostoma duodenale.

The larva of hookworm matures into the adult stage in the small intestine, causing chronic intestinal blood loss and iron-deficiency anemia. Hookworm infestation of colon has not been reported previously. We report a 35-year-old man who presented with diarrhea with blood and mucus in stools. Colonoscopy revealed several hookworms in the colon firmly adherent to the mucosa, with oozing of blood and surrounding mucosal erosions. He was treated with mebendazole and symptoms recovered completely.