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Background & objectives: Sepsis, including neonatal sepsis, remains a prevalent cause of morbidity and mortality in low- and middle-income countries such as India, representing 85 per cent of all sepsis-related deaths globally. Early diagnosis and timely initiation of treatment is challenging due to non-specific clinical manifestations and non-availability of rapid diagnostic tests. There is an urgent need for affordable diagnostics with fast turnaround time catering to the needs of end-users. Target product profiles (TPPs) have been found instrumental in developing ‘fit-for-use’ diagnostics, thus reducing the time taken to facilitate development and improving diagnosis. Hitherto, no such guidance or criteria has been defined for rapid diagnostics for sepsis/neonatal sepsis. We propose an innovative approach for developing the diagnostics for sepsis screening and diagnosis which can be utilized by diagnostic developers in the country. Methods: Three-round Delphi method, including two online surveys and one virtual consultation, was adopted to define criteria for minimum and optimum attributes of TPPs and build consensus on characteristics. Expert panel (n=23) included infectious disease physicians, public health specialists, clinical microbiologists, virologists, researchers/scientists and technology experts/innovators. Results: We present a three-component product profile for sepsis diagnosis, (i) screening with high sensitivity, (ii) detection of aetiological agent, and (iii) profiling of antimicrobial susceptibility/resistance, in adults and neonates with an option of testing different considerations. An agreement of >75 per cent was achieved for all TPP characteristics by Delphi. These TPPs are tailored to the Indian healthcare settings and can also be extrapolated to other resource-constraint and high-disease burden settings.
RESUMO
Background : Various studies have pinned longevity of protective Immunoglobulin-G (IgG) titres at 2-5 months. The robustness and longevity of the IgG antibody response to COVID-19 infection has been gauged in a cohort of 214 single institutional health care workers by serial quantitative immunometric tests. Currently no separate guidelines exist for vaccination of COVID-survivors and this study provides data to fill this lacuna in knowledge. Methodology : Prospective longitudinal panel survey administered to the same cohort of Health Care Workers (HCW) till such time they got vaccinated under Indian Government’s free vaccination drive for HCW. Depending upon the date of contraction of infection the HCW could be longitudinally monitored for variable periods (2-9 months). The survey questionnaire comprising multiple-choice, dichotomous, matrix and Likert-scale questions was deployed to the respondents online via email/WhatsApp. Data was expressed as box-whisker plots, trendlines and trend areas. A p-value<0.05 was considered statistically significant. The composite index of ‘Effective Immunity’ was calculated. Results : The mean IgG antibody titre was 11.13±8.6AU at 1-2m, 9.68±8.9AU at 3-4m, 8.35±5.9 AU at 6-7m and 7.87±4.4 AU at 8-9m after first symptom, respectively. The lowest titre at all time points was 0 while the highest titres were 46.8 AU, 56.5 AU, 23.4 AU and 17.4 AU at 1-2m, 3-4m, 6-7m and 8-9m, respectively. Conclusion : Adaptive active immunity acquired through natural infection may last for at least 9 months post-initial exposure and lies in the moderate protection range in 77% HCW, which can be extrapolated to vaccination and immunity passports. Separate vaccination guidelines are required for COVID-survivors. The first shot of vaccine serves as a booster second exposure/booster dose in all COVID-survivors.HCW with low IgG-titre may suffer from a false sense of security. Periodic quantitative IgG-titre based serological tests can help guide timing of second shot of vaccination and predict likelihood of re-infection
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Background: Patients with diabetes has 2 fold higher chances of suffering from hypertension. Hypertension is risk factor for development of diabetes as well for complications like nephropathy, CAD and neuropathy etc. Hypertension control is vital to prevent and retard progression of microvascular and macrovascular complications. Therefore, we undertook this study to evaluate treatment patterns in diabetic patients with hypertension, those are being followed at our institute. Methods: Study group comprised of diabetic patients who had hypertension as well. All patients with diabetes reporting to medicine OPD from March 2014 to September 2014 at our institute were screened. Patients with follow up of at least 3 months and age more than 18 years of either sex were included. Results: There were 223 patients. Study group comprised of 121 males and 102 females. Mean age of group was 48.6 years. One hundred three patients (46.18%) were on monotherapy and remaining 120 patients were on combination antihypertensive drugs. There were total 398 antihypertensive drug exposures. Patient needed mean antihypertensive drug of 1.78. Angiotensin receptor blockers were the most commonly prescribed drugs. Angiotensin inhibitors (angiotensin receptor blockers and ACE inhibitors) were utilized in 158 (71%) patients. Hypertension control was achieved in 84 (37.66%) patients. One hundred eighty one patients (81.2%) knew about disease. Conclusion: Our study showed that majority of diabetic hypertensive patients needed multiple drug therapy to control hypertension. Most of the patients were on ARBs/ACE inhibitors. This was according to recommendation by ADA or JNC8.
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Background: Hantavirus infections are found all over world but there is paucity of information about clinical features of Hantavirus infection in India. Aim of current study was to study clinical profile and outcome of patients with Hantavirus infection and renal insufficiency who presented at our institute. Methods: All patients who were admitted in department of medicine with Hantavirus infection and renal insufficiency were included. Their basic demographic profile with relevant laboratory investigations was recorded. They were diagnosed with Hantavirus infection if they had positive IgM antibodies by ELISA test. Results: There were seven patients with mean age of 54 years. They had mean serum creatinine level of 4.37 ± 1.86 mg%. All had thrombocytopenia and hepatic dysfunction as well. Five patients had hypotension. There was need of dialysis in three patients. They also had hypoalbuminemia. No patient had features suggestive of acute respiratory distress syndrome. All patients had recovery of renal function and there was no mortality. Conclusion: Patients with Hantavirus infection presented like hemorrhagic fever with renal syndrome. Their outcome is good. We need to suspect Hantavirus infection in appropriate clinical scenario in India.