ABSTRACT
Background & objectives: Chest X-ray (CXR) is an important screening tool for pulmonary tuberculosis (TB). Accessibility to CXR facilities in difficult-to-reach and underserved populations is a challenge. This can potentially be overcome by deploying digital X-ray machines that are portable. However, these portable X-ray machines need to be validated before their deployment in the field. Here, we compare the image quality of CXR taken by a newly developed handheld X-ray machine with routinely used reference digital X-ray machine through the conduct of a feasibility study. Methods: A total of 100 participants with suspected pulmonary TB were recruited from the outpatient departments of a medical college and a community health centre in Agra. Each participant underwent CXR twice, once with each machine. Both sets of de-identified images were independently read by two radiologists, who were blinded to the type of X-ray machine used. The primary outcome was agreement between image qualities produced by these two machines. Results: The intra-observer (radiologist) agreements regarding the status of the 15 CXR parameters ranged between 74 per cent and 100 per cent, with an unweighted mean of 87.2 per cent (95% confidence interval: 71.5-100). The median Cohen’s kappa values for intra-observer agreement were 0.62 and 0.67 for radiologists 1 and 2, respectively. In addition, on comparison of the overall median score of quality of the image, the handheld machine images had a higher score for image quality. Interpretation & conclusions: The current study shows that a handheld X-ray machine, which is easy to use and can potentially be carried to any area, produces X-ray images with quality that is comparable to digital X-ray machines routinely used in health facilities.
ABSTRACT
COVID-19 was declared a pandemic by the World Health Organization (WHO) on March 11, 2020. Since then, efforts were initiated to develop safe and effective vaccines. Till date, 11 vaccines have been included in the WHO’s emergency use list. The emergence and spread of variant strains of SARS-CoV-2 has altered the disease transmission dynamics, thus creating a need for continuously monitoring the real-world effectiveness of various vaccines and assessing their overall impact on disease control. To achieve this goal, the Indian Council of Medical Research (ICMR) along with the Ministry of Health and Family Welfare, Government of India, took the lead to develop the India COVID-19 Vaccination Tracker by synergizing three different public health databases: National COVID-19 testing database, CoWIN vaccination database and the COVID-19 India portal. A Vaccine Data Analytics Committee (VDAC) was constituted to advise on various modalities of the proposed tracker. The VDAC reviewed the data related to COVID-19 testing, vaccination and patient outcomes available in the three databases and selected relevant data points for inclusion in the tracker, following which databases were integrated, using common identifiers, wherever feasible. Multiple data filters were applied to retrieve information of all individuals ?18 yr who died after the acquisition of COVID-19 infection with or without vaccination, irrespective of the time between vaccination and test positivity. Vaccine effectiveness (VE) against the reduction of mortality and hospitalizations was initially assessed. As compared to the hospitalization data, mortality reporting was found to be much better in terms of correctness and completeness. Therefore, hospitalization data were not considered for analysis and presentation in the vaccine tracker. The vaccine tracker thus depicts VE against mortality, calculated by a cohort approach using person-time analysis. Incidence of COVID-19 deaths among one- and two-dose vaccine recipients was compared with that among unvaccinated groups, to estimate the rate ratios (RRs). VE was estimated as 96.6 and 97.5 per cent, with one and two doses of the vaccines, respectively, during the period of reporting. The India COVID-19 Vaccination Tracker was officially launched on September 9, 2021. The high VE against mortality, as demonstrated by the tracker, has helped aid in allaying vaccine hesitancy, augmenting and maintaining the momentum of India’s COVID-19 vaccination drive
ABSTRACT
Background & objectives: Data from the National Clinical Registry for COVID-19 (NCRC) were analyzed with an aim to describe the clinical characteristics, course and outcomes of patients hospitalized with COVID-19 in the third wave of the pandemic and compare them with patients admitted earlier. Methods: The NCRC, launched in September 2020, is a multicentre observational initiative, which provided the platform for the current investigation. Demographic, clinical, treatment and outcome data of hospitalized COVID-19 patients were captured in an electronic data portal from 38 hospitals across India. Patients enrolled during December 16, 2021 to January 17, 2022 were considered representative of the third wave of COVID-19 and compared with those registered during November 15 to December 15, 2021, representative of the tail end of the second wave. Results: Between November 15, 2021 and January 17, 2022, 3230 patients were recruited in NCRC. Patients admitted in the third wave were significantly younger than those admitted earlier (46.7±20.5 vs. 54.6±18 yr). The patients admitted in the third wave had a lower requirement of drugs including steroids, interleukin (IL)-6 inhibitors and remdesivir as well as lower oxygen supplementation and mechanical ventilation. They had improved hospital outcomes with significantly lower in-hospital mortality (11.2 vs. 15.1%). The outcomes were better among the fully vaccinated when compared to the unvaccinated or partially vaccinated.Interpretation & conclusions: The pattern of illness and outcomes were observed to be different in the third wave compared to the last wave. Hospitalized patients were younger with fewer comorbidities, decreased symptoms and improved outcomes, with fully vaccinated patients faring better than the unvaccinated and partially vaccinated ones.
ABSTRACT
Food allergy (FA) is a growing health problem in India and worldwide with notable prevalence in infants when compared with children and adults. Multiple genetic and nutritional factors play an important role in etiology of FA leading to morbidity and mortality. As general practitioners (GPs) and homeopaths are the first persons to be approached by patients with possible FA, the need for evaluating their Knowledge, Attitude and Practices (KAP) towards the same are essential to be studied.A total of 214 participants- 107 GPs with or without specialization in Internal Medicine and 107 homeopaths participated in the study. A validated questionnaire was adopted to assess their KAP. The questionnaire had 31 parameters (demographic details-5, knowledge-21 and attitude and practices-5) regarding symptoms, severity, risk factors, diagnosis and treatment of FA. The score was recorded and results with p-value ≤0.05 were considered statistically significant.A significant difference in the perception of FA was observed between GPs (42.1%) and homeopaths (10.3%) regarding the safety of administering influenza vaccines in children with egg allergy (p=0.003). 80.4% of GPs and 23.3% homeopaths believed that epinephrine is the 1st line choice for treatment of anaphylaxis (p=0.035). 64.5% GPs and 28.1% homeopaths opined that timely administration of epinephrine prevents fatal anaphylaxis which was statistically significant. (p=0.046). However no statistically significant difference (p=0.112) was found between GPs (65.4%) and homeopaths (58.9%) in their opinion regarding the reliability of positive skin prick test or radioallergosorbent test (RAST) as sufficient FA diagnostic tool. The total scores obtained regarding the knowledge in FA and anaphylaxis by GPs and homeopaths was 66.4% and 46.8% respectively which was not found to be statistically significant (p=0.172).Overall knowledge of FA in GPs and homeopaths was comparable with strengths and weakness in each domain. GPs had more precise knowledge than homeopaths, regarding the treatment schedule, in case of anaphylaxis, which in turn reflects the differences in attitude and approach in treating FA among the two groups. Periodic educational programs focused at improving the knowledge regarding food allergy and treatment options is a prerequisite among GPs and homeopaths help them to understand better as well as treat the adverse effects of FA