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1.
Journal of Neonatal Surgery ; 11, 2022.
Article in English | Scopus | ID: covidwho-2206632

ABSTRACT

Background: Esophageal atresia (EA) with distal trachea-esophageal fistula (TEF), the most common variety of EA, is managed by primary end-to-end anastomosis. Recurrent TEF constitutes the most difficult-to-manage complication of the primary repair and has an incidence of 2% to15%. Case Presentation: We present a case of rare recurrent TEF after primary repair of EA. The difficulties faced in view of the COVID pandemic and difficult diagnosis are discussed. We share our experience in the successful management of acquired TEF and lessons learned. Conclusion: Recurrent trachea-esophageal fistula is one of the rare and challenging complications to manage. The surgical option carries the best overall prognosis. © 2022 Manchanda et al.

2.
Dalton Transactions ; 19:19, 2023.
Article in English | MEDLINE | ID: covidwho-2186144

ABSTRACT

The highly contagious COVID-19, caused by the outbreak of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), is commonly diagnosed using reverse transcription polymerase chain reaction (RT-PCR). However, despite being highly sensitive, RT-PCR is also time consuming and quite complex, which limits its use for point-of-care (POC) testing. We have developed a simple single-step fluorescence assay for SARS-CoV-2 RNA detection based on the principle of aggregation-induced emission (AIE) using iridium complexes. Our smartly designed iridium probes fluorescently "turn-on" in the presence of SARS-CoV-2 RNA and give specific results at room temperature within 10 min. The lower limit of detection (LOD) is 1.84 genome copies per reaction, and the sensitivity and specificity of the assay in 20 clinical samples are found to be 90% and 80%, respectively.

3.
Journal of Clinical and Diagnostic Research ; 16(9):OC21-OC24, 2022.
Article in English | EMBASE | ID: covidwho-2067195

ABSTRACT

Introduction: The clinical diagnosis of COVID-19 is supplemented by clinical severity indices. These indices are the National Early Warning Score (NEWS, which aids in risk stratification), CT severity score (radiological severity score), and Reverse Transcription-Polymerase Chain Reaction (RT-PCR) cycle threshold (Ct value, which provides a semi-quantitative measure of viral load). Aim(s): To assess the correlation between NEWS at admission, RT-PCR Ct value and CT severity score in mild and moderate COVID-19 patients. Methods and Materials: This prospective cohort study was conducted in Maulana Azad Medical College and Lok Nayak hospital, New Delhi, from January to June 2021. The study included 50 subjects (25 with mild COVID-19 and 25 with moderate COVID-19). NEWS was calculated at admission and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) Ct value was estimated using real-time RT-PCR. CT severity score was calculated based on High Resolution Computed Tomography (HRCT) chest findings. The correlation among the parameters was determined using Pearson correlation formula. Result(s): The mean age of subjects in the mild and moderate COVID-19 groups were 49.52 years and 51.84 years, respectively. The mean RT-PCR Ct value of E gene was 24.48 and Rdrp gene was 24.56 in the mild COVID-19 group;while in the moderate group it was 23.72 for both E gene and Rdrp genes. The correlation between NEWS and Ct value of E gene (r-value=-0.06, p-value=0.68), Ct value of Rdrp gene (r-value=-0.03, p-value=0.79) and the correlation between CT severity score and Ct value of E gene (r-value=-0.05, p-value=0.73), Ct value of Rdrp gene (r-value=-0.06, p-value=0.68) was negative and insignificant. The mean CT severity score in mild COVID-19 group was 3.92, and in moderate COVID-19 group was 9.88. A significant positive correlation was found between the CT severity score and NEWS at admission. Conclusion(s): The clinical severity of COVID-19 as estimated by NEWS corroborates with CT severity score while the relationship between RT-PCR Ct value and clinicoradiological severity needs to be ascertained by further research. Copyright © 2022 Journal of Clinical and Diagnostic Research. All rights reserved.

4.
Indian Journal of Medical Microbiology ; 39:S69, 2021.
Article in English | EMBASE | ID: covidwho-1734503

ABSTRACT

Background:In the wake of Covid-19 pandemic, there has been a growing concern over the various modes of spread of virus. While airborne droplet transmission must be considered, and is a critical component to the safety of healthcare workers, it is also important to consider the role of surfaces. Knowing the extent of environmental -contamination of SARS-CoV-2 will play a significant role in improving the safety practices in hospital-settings as well as in answering ques- tions about virus-transmission among the public. Methods: Swab samples were collected from surfaces in Covid-19 wards and laboratory. Sterile premoistened swabs were used to collect samples from high-contact surfaces like door-handles, light-switches, faucet-handles, flushing- buttons, slabs, biosafety-cabinets etc. A total of 48 samples were tested with an RT-PCR test kit, targeting the envelope (E) and RNA dependent RNA polymerase (RdRp) of SARS-CoV-2. A cycle threshold (Ct) ≤36 was considered as positive for SARS-CoV-2 RNA and Ct >36 was considered as negative. Results:Among the 48 samples, RT-PCR analysis showed SARS-Cov2 RNA (E-gene positive, RdRp positive) in three sites (6.25%), while six samples (12.5%) were screen-positive (E-gene positive, RdRp negative) despite routine decontamina- tion of the surfaces. SARS-CoV-2 RNA was detected in samples collected from the electric-switches and door-handles in the Covid-19 ward and testing-area. Conclusions:The routine decontamination protocol must include previous mapped high touch surfaces in the area. De- spite decontamination standard precautions must be followed in healthcare settings.

5.
Indian Journal of Medical Microbiology ; 39:S69, 2021.
Article in English | EMBASE | ID: covidwho-1734502

ABSTRACT

Background: In the absence of effective treatment or vaccine, the current strategy for the prevention of further trans- mission of severe acute respiratory syndrome (SARS) CoV-2 (COVID-19) infection is early diagnosis and isolation of cas- es. The diagnosis of SARS-CoV-2 is done by detecting viral RNA in the nasopharyngeal and throat swabs by real-time polymerase chain reaction (PCR). Many commercial assays are now available for performing the PCR assay. The aim was to evaluate the performance of the SD Biosensor nCoV real-time detection kit with the real-time PCR kit provided by the Indian Council of Medical Research-National Institute of Virology (ICMR-NIV), Pune (NIV Protocol). Methods:A total of 253 pairs of nasopharyngeal-oropharyngeal swabs combined in a single viral transport medium were tested for viral RNA by both the protocols. The sensitivity and specificity of the SD Biosensor were calculated consider- ing the ICMR-NIV kit as the gold standard. Matched pairs of recorded cycle threshold values (Ct values) were compared by Pearson’s correlation coefficient. Results:Concordant COVID-19 negative and positive PCR results were reported for 113 and 77 samples, respectively. The SD Biosensor kit additionally detected 62 cases, which were found negative by the NIV protocol. In all discordant positive results by the SD Biosensor kit, the average Ct values were higher than the concordant positive results. A total of forty samples tested positive for E gene by SD Biosensor and having Ct values <25 had 100% concordance with NIV protocol results and 39 samples tested positive for E gene by SD Biosensor having Ct value >32 were all found negative by the NIV protocol. Conclusions:The results highlight the need for careful evaluation of commercial kits before being deployed for screening of COVID-19 infections

6.
Indian Journal of Medical Microbiology ; 39:S68-S69, 2021.
Article in English | EMBASE | ID: covidwho-1734501

ABSTRACT

Background:SARS CoV-2 is a novel coronavirus, the causative agent of COVID-19. Airborne respiratory droplet transmis- sion is well recognized;however, transmission by methods, such as ocular secretions, is yet to be proven. The objective of the study was to investigate the presence of SARS-CoV-2 RNA in tears of patients with moderate to severe coronavirus disease 2019. Methods:Tears were collected within 48 hours of laboratory confirmation using 3 methods: conjunctival swab plus Schirmer’s test strips (group 1), conjunctival swab (group 2), and Schirmer’s test strips (group 3). Samples from both the eyes of each patient were transported in a single viral transport media for real-time RT- PCR. Demographic profiles, sys- temic symptoms, comorbidities, and ocular manifestations were noted. Viral load of a sample was determined using cycle threshold (Ct) value of E gene. Results:Out of 75 patients 48% (36) had moderate disease, while 52% (39) had severe disease. RT -PCR analysis of tears showed positive results in 18 patients (24%). Positive results were found in 11 (14.7%), 11 (14.7%), and 7 (9.3%) patients in groups 1, 2, and 3, respectively (P=0.3105). Mean Ct values in groups 1, 2, and 3 were 28.36+6.15, 29.00 +5.58, and 27.86+6.46 (P= 0.92), respectively. Five patients showed positive RT-PCR results by all 3 methods (mean Ct value, 25.24+6.33), and 12 patients showed positive results by any of the 3 methods (mean Ct value, 32.16+1.94), the differ- ence in Ct values being statistically significant (P=0.029). The median value of symptomatology in patients with positive RT-PCR results from tears was 5 days (range, 4-9 days). Conclusions:SARS-CoV-2 RNA was detected in tears of 24% of patients with laboratory-proven moderate to severe COVID-19. Conjunctival swab remains the gold standard of tear collection for RT-PCR assay. A significantly higher possi- bility of viral transmission exists through tears in patients with moderate to severe COVID-19.

7.
Indian Journal of Medical Microbiology ; 39:S68, 2021.
Article in English | EMBASE | ID: covidwho-1734500

ABSTRACT

Background:COVID-19 is a respiratory disease caused by novel coronavirus SARS CoV -2 and has been declared as pan- demic by WHO. The timely detection of cases and their contacts is crucial to help curtail the pandemic. Introduction of antigen based RDT has been able to bridge the time gap of detection and tracing as these tests are timely and easy to perform. However the real world performance of these assays is uncertain and the sensitivity of the test is claimed to be between 50% to 87%. This study was conducted to evaluate the currently used antigen -based RDT for the detection of SARS CoV-2 virus in respiratory specimens. Methods:This prospective study included patients who were seeking healthcare in Ophthalmology department for eye ailments and were subjected to SARS CoV-2 antigen based RDT. Regardless of results of RDT, nasopharyngeal swabs were collected from these patients and were tested for SARS CoV-2 RNA by real-time RT PCR using commercial assay (SD Biosensor). The evaluation of antigen-based RDT for the detection of SARS CoV-2 virus was performed with real time RT-PCR as gold standard. Results:A total of 564 patients were tested by both antigen based RDT and real time RT -PCR. The antigen based RDT exhibited analytical sensitivity and specificity of 37.5% and 99.79% respectively. Positive predictive value and negative predictive value of RDT were 96.4% and 91.6% respectively. Negative correlation was found between antigens based RDT’s positivity and Ct values of E and RdRp genes. Conclusions:Overall poor sensitivity of RDT does not allow adopting it as point of care test in screening for COVID -19 and it only serves as an additional test to RT-PCR because of potential false negative results.

8.
Indian Journal of Medical Microbiology ; 39:S66, 2021.
Article in English | EMBASE | ID: covidwho-1734494

ABSTRACT

Background:Droplet transmission is the main mode of transmission for SARS-CoV-2. Contact transmission through fom- ites is another important mode of transmission. Amongst fomites, currency notes carry a high risk of SARS-CoV-2 trans- mission because of frequent handling. They also provide ample surface area to harbor micro -organisms. As there is lim- ited data currently available on this subject, the study was planned to determine the presence of SARS -COV-2 on com- monly circulating currency notes by detecting viral RNA using real time PCR. Methods:A total of 71 creased and visibly well circulated notes of monetary value Rs. 10, 100 and 500 were included in the study, collected through normal monetary transaction from the busy shops in designated areas in Delhi (inside and outside containment zones). Two nylon flocked swabs moistened with viral transport medium were rubbed on the ob- verse and reverse sides of the notes and then kept in screw capped tubes containing 1 ml of VTM till further processing at 2-8. RNA extracted was tested for the presence of SARS-CoV-2 by real time PCR as per NIV protocol. Results:Among the 71 currency notes tested for the presence of SARS-CoV-2 RNA by RT-PCR, three samples tested posi- tive for SARS-CoV-2 RNA (4.2%). All the three positive samples were collected from containment zones. Conclusions:Currency notes may be a potential mode of human-to-human transmission. Considering the widespread magnitude of the pandemic and the remarkable stability of the virus on smooth surfaces, caution is warranted while handling currency notes. Hence, contactless transactions/ digital transactions should be recommended as the best op- tions in the ongoing pandemic

9.
Indian Journal of Medical Microbiology ; 39:S66, 2021.
Article in English | EMBASE | ID: covidwho-1734493

ABSTRACT

Background:Past one year has set in an unprecedented and rather disturbing situation in the entire world especially for the medical community as the COVID-19 pandemic engulfed the world. In all this chaos, the first and foremost step in curbing the spread of infection is detection of infection by with the best sensitivity RT -PCR kit. This led to mass produc- tion of plethora of kits for real time PCR. This on one hand helps and empowers but at the same time can cause confu- sion in results and reporting. This study compares most commonly available RT-PCR kits in hope to form some sort of standardisation and develop a clarity about their sensitivities and make decision accordingly. Methods:A total of 104 samples (42 positive and & 62 negative) processed by GeneXpert™ for detection of SARS -CoV- were included in the study. These were analysed using 8commonly available SARS-CoV-2 diagnostic RT-PCR kits in India. Cartridge based NAT was used as it minimizes the observer variation. The CT values were compared with respect to different kits. Sensitivity, Specificity, PPV and NPV were calculated for each kit. Agreement of different kits was evaluat- ed using Kappa analysis. Results: Variable positivity rates were recorded by different kits. Maximum agreement was seen with SD -Biosensor. Positivity of these samples by various kits ranged from 38.4% to 9.6%. Conclusions:Use of different kits can lead to variable results causing change in reporting. As the targets for each kit and reporting threshold is different, it becomes important to adhere to kit instructions and mention kit in reports.

10.
Indian Journal of Medical Microbiology ; 39:S63, 2021.
Article in English | EMBASE | ID: covidwho-1734482

ABSTRACT

Background:The clinical presentation of COVID-19 varies from range of clinical symptoms to being completely asympto- matic. The country's case fatality rate in July was at 2.41% though the mortality has remained at a lower level in the Indian subcontinent. The present study aims at reviewing detailed demographic, systemic symptoms, comorbidities and its association with cycle threshold (Ct) values Methods:It is a retrospective study. The patients who died with the disease in the dedicated covid care hospital be- tween March 2020 through October 2020 were included in the study. Records from Medical Records Department were retrieved with data entered in Microsoft excel sheet. The analysis was done in percentage and average values as re- quired. Results:A total of 10383 patients of confirmed COVID-19 were admitted to the hospital. Among these patients, 1321 patients died (12.72 deaths per 100 admissions). Among these death cases 83 patients had undergone RT PCR testing at MAMC at the time of admission. Out these 38 (45%) were females and 45 (54%) males. Crude death rate is calculated 127 per 1000 admissions. Deaths were highest in the month of June (21.5 per 100 admissions) followed by May (14.3) and August (10.2). Maximum comorbidities observed in death cases was hypertension (39%), Diabetes (33%), Coronary Artery disease (16%) and Chronic kidney disease (16%). Among these deaths 34% occurred within 24 hours of admission and additional 11% occurred in next 24 hrs. The lowest average Ct value (20) was observed in older patients (>60 years) indicating higher viral RNA burden. Conclusions:Mortality was highest in >60 year old males, correlating with average lower Ct values suggesting higher viral load. Mortality was highest in the month of June. As close to 50% deaths occurred within 48hrs of admission indi- cating that patients arrived to the hospital in late stages of illness minimizing their chance of survival.

11.
Indian Journal of Medical Microbiology ; 39:S62-S63, 2021.
Article in English | EMBASE | ID: covidwho-1734481

ABSTRACT

Background:In resource-constrained settings, the majority of laboratories are not accredited to international standards and may only be partially implementing elements of a QMS. ICMR started an Inter -Laboratory Quality Control (ILQC) program for Covid-19 testing. Under this program, RT-PCR testing laboratories across the country send 10 Covid testing samples;five positive and five negative, quarterly to the assigned State Quality Control (SQCs) laboratories for ILQC testing. MAMC Covid-19 laboratory is one of the SQCs laboratory which receives samples for testing. We are presenting here ILQC results and experience of MAMC SQCs Laboratory. Methods:In the duration from July through to November 2020 a total of 445 anonymized samples were received from 24 various public and private linked laboratories. These samples were processed by RT -PCR tests as per NIV protocol. Results were uploaded on the ICMR QC/QA portal to keep pace with the latest technical developments and to synchro- nize with the International Standards. ICMR QC/QA portal generated a final report stating concordance of the results to individual laboratories. Results: Among 445 samples, three samples were rejected as leaked. A total of 442 samples tested. Of these samples, 317 Covid testing samples results are available till date from ICMR which were received in 25 different batches from 18 laboratories. Out of total 317 samples, 308 samples (97%) showed concordant results and 09 were discordant. A total of 19 sample batches showed complete concordance. Only 6 batches from different laboratories showed disagreement. Of these laboratories two laboratories were public and four private laboratories. A total of 12 laboratories had 100% con- cordance. Conclusions:We concluded that majority of the laboratories approved by ICMR are performing with high concordance of results despite varied usage of kits and platforms

12.
Indian Journal of Medical Microbiology ; 39:S58, 2021.
Article in English | EMBASE | ID: covidwho-1734467

ABSTRACT

Background:A calamity in Wuhan, China would reach our doorstep was never thought and we were never prepared for it. Healthcare sector in India was stretched to its limits and manual processes in place were prone to errors and time consuming. ICMR has taken initiative for data management and develop portal for tracking testing and positive cases. However, mechanisms are required to reduce double data entries from already resource constrain laboratories. There was need for a software for automated report dispatch and real time analysis based on artificial intelligence for timely dissemination of reports to patients and health authorities for prompt containment measures. Methods:Once the result for a specimen was concluded, lab facilities would enter test details into the ICMR’s portal. DAAP - Data Accumulation and Analysis Platform was designed to timely disseminate institution specific reports in en- crypted manner. Once the data is entered into the ICMR Portal, an excel is exported from the same which is uploaded to the DAAP. Every patient’s ingested data is verified by laboratory. Validated reports are published which can only be viewed by the respective collection centres from where a particular specimen was collected. The analytic dashboard provides cumulative real time data. Results:Prior to DAAP, data entry engaged 20 manhours per day to disseminate reports, which was reduced to less than two manhours due to DAAP. DAAP has not only reduced the challenges posed by the double data entry, confidentiality and security but also assisted in providing real time insights into the trends and laboratory quality systems. Conclusions:DAAP empowers the clinicians and the authorities to view data statistics real time. Data insights such as hospitalization rate, positivity rate, symptoms distribution and distribution based on various parameters like age group, gender, ward, district etc can be sought real time by DAAP.

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