Insights from establishing a high throughput viral diagnostic laboratory for SARS-CoV-2 RT-PCR testing facility: challenges and experiences.

Background: The World Health Organization declared the coronavirus disease 2019 (COVID-19) a global pandemic on 11 March 2020. Identifying the infected people and isolating them was the only measure that was available to control the viral spread, as there were no standardized treatment interventions available. Various public health measures, including vaccination, have been implemented to control the spread of the virus worldwide. India, being a densely populated country, required laboratories in different zones of the country with the capacity to test a large number of samples and report test results at the earliest. The Indian Council of Medical Research (ICMR) took the lead role in developing policies, generating advisories, formulating guidelines, and establishing and approving testing centers for COVID-19 testing. With advisories of ICMR, the National Institute of Cancer Prevention and Research (NICPR) established a high-throughput viral diagnostic laboratory (HTVDL) for RT-PCR-based diagnosis of SARS-CoV-2 in April 2020. HTVDL was established during the first lockdown to serve the nation in developing and adopting rapid testing procedures and to expand the testing capacity using "Real-Time PCR." The HTVDL provided its testing support to the national capital territory of Delhi and western Uttar Pradesh, with a testing capacity of 6000 tests per day. The experience of establishing a high-throughput laboratory with all standard operating procedures against varied challenges in a developing country such as India is explained in the current manuscript which will be useful globally to enhance the knowledge on establishing an HTVDL in pandemic or non-pandemic times.

Association of funding and conflicts of interest on outcomes reported in published studies of Covid-19.

BACKGROUND: An outbreak of the Covid-19 has led to substantial mortality globally. The entire world is carrying out studies to understand the pathophysiology, clinical features, diagnosis and treatment of Covid-19. We investigated the possible association of type of funding, corporate or academic, and conflict of interests on the outcomes reported in clinical trials on Covid-19.
Methods: Studies containing the keywords "clinical trial" AND "Covid 19" or "Corona" were located by a search on PubMed published between September 2019 to August 2021. Filters were used to select only papers in the English language and on "humans". The data were analysed using descriptive statistics and the Chi-square test.
Results: We found a significant association between the existence of a conflict of interest and reporting of a positive outcome (X2 value = 18.751, p<0.001). We also found a significant association between industry funding and reporting of a positive outcome (X2 value = 18.041, p<0.001).
Conclusion: We conclude from this study that the presence of conflict of interest and pharmaceutical industry funding is associated with reporting a positive outcome.
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Outcomes of Standard Operating Procedures Instituted for Non-COVID Outpatient Department During COVID-19 Pandemic in Rural India.

Introduction: COVID-19 has emerged as a major health care problem during 2020. The risk of infection and transmission led to imposition of a severe lockdown by the government. The diversion of health care machinery towards the control of transmission, treatment of the infected individuals led to a compromise in delivery of care towards non-COVID ailments. This is truer in rural and unapproachable areas where the health facilities were already in jeopardy. Study Design: A prospective observational study was conducted from May 2020 to November 2020 at PGIMER satellite center, Sangrur. Methods: Standard operating procedures (SOP) were instituted for physical consultation during the COVID-19 pandemic at PGIMER satellite center, Sangrur, a branch of PGIMER, Chandigarh. These were approved by the committee constituted for this purpose. The effectiveness of these SOPs was reported as percentage of healthcare workers who contracted infection for non-COVID OPD. Results: A total of 9963 patients attended the Out Patient Department (OPD). Male to female ratio of the patients was 1.2:1. Maximum (6141) consultations were sought for general physician followed by ophthalmologist (1464). Majority of the consultation were for benign non-communicable disorders. Seventy patients who visited the OPD were referred for COVID-19 testing as they had symptoms of infection. A total of 5 (3.8%) incidents of COVID-19 infection were reported among the healthcare workers at the center. Conclusions: The SOPs proved effective in the delivery of physical care with low occupational hazard to the healthcare workers (HCW).

A Regional Pooling Intervention in a High-Throughput COVID-19 Diagnostic Laboratory to Enhance Throughput, Save Resources and Time Over a Period of 6 Months.

An effective and rapid diagnosis has great importance in tackling the ongoing COVID-19 pandemic through isolation of the infected individuals to curb the transmission and initiation of specialized treatment for the disease. It has been proven that enhanced testing capacities contribute to efficiently curbing SARS-CoV-2 transmission during the initial phases of the outbreaks. RT-qPCR is considered a gold standard for the diagnosis of COVID-19. However, in resource-limited countries expenses for molecular diagnosis limits the diagnostic capacities. Here, we present interventions of two pooling strategies as 5 sample pooling (P-5) and 10 sample pooling (P-10) in a high-throughput COVID-19 diagnostic laboratory to enhance throughput and save resources and time over a period of 6 months. The diagnostic capacity was scaled-up 2.15-folds in P-5 and 1.8-fold in P-10, reagents (toward RNA extraction and RT-qPCR) were preserved at 75.24% in P-5 and 86.21% in P-10, and time saved was 6,290.93 h in P-5 and 3147.3 h in P-10.

Psychosocial determinants of adherence to public health and social measures (PHSMs) in 18 African Union Member States during the early phase of the COVID-19 pandemic: results of a cross-sectional survey.

OBJECTIVE: The objective of this study was to gain a better understanding of the psychosocial and sociodemographic factors that affected adherence to COVID-19 public health and social measures (PHSMs), and to identify the factors that most strongly related to whether citizens followed public health guidance. DESIGN: Cross-sectional study. SETTING AND PARTICIPANTS: Nationally representative telephone surveys were conducted from 4-17 August 2020 in 18 African Union Member States. A total of 21 600 adults (mean age=32.7 years, SD=11.4) were interviewed (1200 in each country). OUTCOME MEASURES: Information including sociodemographics, adherence to PHSMs and psychosocial variables was collected. Logistic regression models examined the association between PHSM adherence (eg, physical distancing, gathering restrictions) and sociodemographic and psychosocial characteristics (eg, risk perception, trust). Factors affecting adherence were ranked using the Shapley regression decomposition method. RESULTS: Adherence to PHSMs was high, with better adherence to personal than community PHSMs (65.5% vs 30.2%, p<0.05). Psychosocial measures were significantly associated with personal and community PHSMs (p<0.05). Women and older adults demonstrated better adherence to personal PHSMs (adjusted OR (aOR): women=1.43, age=1.01, p<0.05) and community PHSMs (aOR: women=1.57, age=1.01, p<0.05). Secondary education was associated with better adherence only to personal PHSMs (aOR=1.22, p<0.05). Rural residence and access to running water were associated with better adherence to community PHSMs (aOR=1.12 and 1.18, respectively, p<0.05). The factors that most affected adherence to personal PHSMs were: self-efficacy; trust in hospitals/health centres; knowledge about face masks; trust in the president; and gender. For community PHSMs they were: gender; trust in the president; access to running water; trust in hospitals/health centres; and risk perception. CONCLUSIONS: Psychosocial factors, particularly trust in authorities and institutions, played a critical role in PHSM adherence. Adherence to community PHSMs was lower than personal PHSMs since they can impose significant burdens, particularly on the socially vulnerable.

Circumferential Scar on Wrist of Children: an Explicit Warning Sign of Rubber Band Syndrome.

"Common habits develop into rare syndromes." This idiom holds true when one such colorful rubber band put on the wrist of a child gets forgotten, burrows through the skin, and presents with a swollen paralyzed hand with a circumferential scar on the wrist. We present two cases of rubber band syndrome (Dhaga syndrome) who presented with painful, swollen, complete claw hand. Until 2019, only 15 cases were reported with predominance of Indian children. MRI is the gold standard investigation where a high degree of clinical suspicion is diagnostic. Surgical exploration with removal of the constricting band and excision of neuroma in continuity of ulnar and median nerves for preventing neurological deficit and tenolysis of tendons depending on the depth of the band is unambiguous treatment of choice. Where history is not forthcoming, a circumferential scar on the wrist of a child demands exploration.

Tocilizumab plus standard care versus standard care in patients in India with moderate to severe COVID-19-associated cytokine release syndrome (COVINTOC): an open-label, multicentre, randomised, controlled, phase 3 trial.

BACKGROUND: Global randomised controlled trials of the anti-IL-6 receptor antibody tocilizumab in patients admitted to hospital with COVID-19 have shown conflicting results but potential decreases in time to discharge and burden on intensive care. Tocilizumab reduced progression to mechanical ventilation and death in a trial population enriched for racial and ethnic minorities. We aimed to investigate whether tocilizumab treatment could prevent COVID-19 progression in the first multicentre randomised controlled trial of tocilizumab done entirely in a lower-middle-income country. METHODS: COVINTOC is an open-label, multicentre, randomised, controlled, phase 3 trial done at 12 public and private hospitals across India. Adults (aged ≥18 years) admitted to hospital with moderate to severe COVID-19 (Indian Ministry of Health grading) confirmed by positive SARS-CoV-2 PCR result were randomly assigned (1:1 block randomisation) to receive tocilizumab 6 mg/kg plus standard care (the tocilizumab group) or standard care alone (the standard care group). The primary endpoint was progression of COVID-19 (from moderate to severe or from severe to death) up to day 14 in the modified intention-to-treat population of all participants who had at least one post-baseline assessment for the primary endpoint. Safety was assessed in all randomly assigned patients. The trial is completed and registered with the Clinical Trials Registry India (CTRI/2020/05/025369). FINDINGS: 180 patients were recruited between May 30, 2020, and Aug 31, 2020, and randomly assigned to the tocilizumab group (n=90) or the standard care group (n=90). One patient randomly assigned to the standard care group inadvertently received tocilizumab at baseline and was included in the tocilizumab group for all analyses. One patient randomly assigned to the standard care group withdrew consent after the baseline visit and did not receive any study medication and was not included in the modified intention-to-treat population but was still included in safety analyses. 75 (82%) of 91 in the tocilizumab group and 68 (76%) of 89 in the standard care group completed 28 days of follow-up. Progression of COVID-19 up to day 14 occurred in eight (9%) of 91 patients in the tocilizumab group and 11 (13%) of 88 in the standard care group (difference -3·71 [95% CI -18·23 to 11·19]; p=0·42). 33 (36%) of 91 patients in the tocilizumab group and 22 (25%) of 89 patients in the standard care group had adverse events; 18 (20%) and 15 (17%) had serious adverse events. The most common adverse event was acute respiratory distress syndrome, reported in seven (8%) patients in each group. Grade 3 adverse events were reported in two (2%) patients in the tocilizumab group and five (6%) patients in the standard care group. There were no grade 4 adverse events. Serious adverse events were reported in 18 (20%) patients in the tocilizumab group and 15 (17%) in the standard care group; 13 (14%) and 15 (17%) patients died during the study. INTERPRETATION: Routine use of tocilizumab in patients admitted to hospital with moderate to severe COVID-19 is not supported. However, post-hoc evidence from this study suggests tocilizumab might still be effective in patients with severe COVID-19 and so should be investigated further in future studies. FUNDING: Medanta Institute of Education and Research, Roche India, Cipla India, and Action COVID-19 India.

Understanding patterns of COVID infodemic: A systematic and pragmatic approach to curb fake news.

Amid the flood of fake news on Coronavirus disease of 2019 (COVID-19), now referred to as COVID-19 infodemic, it is critical to understand the nature and characteristics of COVID-19 infodemic since it not only results in altered individual perception and behavior shift such as irrational preventative actions but also presents imminent threat to the public safety and health. In this study, we build on First Amendment theory, integrate text and network analytics and deploy a three-pronged approach to develop a deeper understanding of COVID-19 infodemic. The first prong uses Latent Direchlet Allocation (LDA) to identify topics and key themes that emerge in COVID-19 fake and real news. The second prong compares and contrasts different emotions in fake and real news. The third prong uses network analytics to understand various network-oriented characteristics embedded in the COVID-19 real and fake news such as page rank algorithms, betweenness centrality, eccentricity and closeness centrality. This study carries important implications for building next generation trustworthy technology by providing strong guidance for the design and development of fake news detection and recommendation systems for coping with COVID-19 infodemic. Additionally, based on our findings, we provide actionable system focused guidelines for dealing with immediate and long-term threats from COVID-19 infodemic.

Gaucher's Disease in an Adult Female: A Rare Entity.

Gaucher's disease is a rare inborn error of metabolism with an autosomal recessive pattern of inheritance. With over 26 million births occurring per annum, extrapolation of this figure would give us an estimated burden of 17,000 babies born with lysosomal storage disorder (LSD). Given the large population of India and the high rates of consanguineous marriage that takes place in the subcontinent, LSD might not be as rare as we perceive it to be. We report a rare occurrence of type-1 Gaucher's disease in an adult female patient born of a non-consanguineous marriage, belonging to the tropical area of Chhattisgarh, India where there is a predominance of malaria, thalassemia, and sickling. The diagnosis was challenging in this case since we needed to work out all the differential diagnoses of pancytopenia with hepatomegaly and massive splenomegaly. The key part was her medical history where there was documentation of her elder brother's death due to some mental illness of undiagnosed etiology. Being a difficult time due to coronavirus disease 2019 ( COVID-19) , we were able to diagnose the patient with a bone marrow biopsy followed by glucocerebrosidase enzyme level suggestive of Gaucher's disease.

Pandemic information support lifecycle: Evidence from the evolution of mobile apps during COVID-19.

Information sharing and consumption play an important role during a pandemic in managing constrained resources and devising effective plans to minimize a pandemic's impact. The type of support extended by information also changes as a pandemic evolves. In this paper, we present a novel framework to understand the different types of information support needed during a pandemic crisis. Adapting phases from the pandemic crisis management lifecycle, we propose five different overlapping phases of our proposed Pandemic Information Support Lifecycle (PISL): awareness information support, preventive care information support, active information support, confidence-building information support and evaluation information support. To validate the proposed PISL, we examine the evolution of new mobile apps during the current COVID-19 pandemic by developing a taxonomy for mobile app-based information support. The proposed lifecycle presents future phases of information support for the ongoing COVID-19 pandemic, while identifying specific areas that need additional research and mobile-based information support development.

A real estate portfolio management risk assessment framework for nonlisted real estate funds in India

PurposeThis study provides an extensive risk assessment framework for nonlisted real estate funds' (NREFs) portfolio management in India across their life cycle;that is, the investment stage, the monitoring stage and the exit stage in an emerging market context. The study of risk across these three stages is a new addition to the literature and assumes importance in the context of real estate portfolio management for NREFs in the emerging markets (e.g. India), which are predominantly an opportunistic investment play.Design/methodology/approachThe risk assessment framework is built on the multiactor/multicriteria risk priorities, using analytical hierarchy process (AHP), obtained from 35 experts in four real estate fund management professional groups;namely, investors/fund managers, valuers, consultants and international developers.FindingsThe results demonstrate that the real estate portfolio management risk priorities change across the three life cycle stages of the fund. At the investment stage, specific risks are most critical;at the monitoring stage, it is important to concentrate on all three risks – specific, systematic and management risks;and at the exit stage, systematic risk plays a crucial role. Real estate portfolio management risk evaluation at the subfactor level shows that investee/partner and location selection needs to be critically evaluated at the time of the investment;project execution and quality of development must be monitored during the construction/monitoring period;and repatriation of the funds, currency volatility and exit risk (resale) are critical at the exit stage of the fund.Practical implicationsThe understanding of the real estate portfolio management risk transformation across the life cycle stages is crucial for NREF managers for risk minimization, transfer and mitigation strategy formulation in their real estate portfolios. Unlike previous research that evaluates investment risk, this study breaks the NREF's risks into the investment, monitoring and exit stages. The key risk factors for each stage depend on the NREF's real estate activities for that stage. These activities, in turn, give rise to a typical risk profile for that stage. The findings are crucial for the various stakeholders of real estate fund management and policymakers in an emerging market context;particularly India, one of the fastest growing major economies in the world.Originality/valueThis risk assessment framework for simultaneously assessing risk across the three life cycle stages of NREFs is a new addition to the literature.

Air quality assessment among populous sites of major metropolitan cities in India during COVID-19 pandemic confinement.

The present study aims to determine the impact of COVID-19 pandemic confinement on air quality among populous sites of four major metropolitan cities in India (Delhi, Mumbai, Kolkata, and Chennai) from January 1, 2020 to May 31, 2020 by analyzing particulate matter (PM2.5 and PM10), nitrogen dioxide (NO2), ammonia (NH3), sulfur dioxide (SO2), carbon monoxide (CO), and ozone levels. The most prominent pollutant concerning air quality index (AQI) was determined by Pearson's correlation analysis and unpaired Welch's two-sample t test was carried out to measure the statistically significant reduction in average AQI for all the four sites. AQI significantly plummeted by 44%, 59%, 59%, and 6% in ITO-Delhi, Worli-Mumbai, Jadavpur-Kolkata, and Manali Village-Chennai respectively. The findings conclude a significant improvement in air quality with respect to reduction of 49-73%, 17-63%, 30-74%, and 15-58% in the mean concentration of PM2.5, PM10, NH3, and SO2 respectively during the confinement for the studied locations. The p values for all of the four studied locations were found significantly less than the 5% level of significance for Welch's t test analysis. In addition, reduced AQI values were highly correlated with prominent pollutants (PM2.5 and PM10) during Pearson's correlation analysis. These positive results due to pandemic imprisonment might aid to alter the current policies and strategies of pollution control for a safe and sustainable environment. Graphical abstract.