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1.
Gender and Development ; 30(1-2):17-33, 2022.
Article in English | Scopus | ID: covidwho-2050950

ABSTRACT

As women across the globe continue to be overburdened with child-care responsibilities owing to the closure of institutional child-care facilities due to the COVID-19 pandemic, this paper attempts to posit a viable disaster-resilient model through the idea of community-based care infrastructure. Based on research conducted among parents from low-income groups, whose children attended child-care centres run by Sangini Co-operative of Self-employed women's association (SEWA) in Gujarat in western India, this paper wants to highlight the spontaneity with which the Cooperative responded to the pandemic, underlining the efficacy of community-based interventions in times of crisis. This paper argues that solidarity between care workers and the larger community is only likely to increase during times of crisis, which makes community-based solutions an integral part of addressing future care emergencies. © 2022 Oxfam KEDV.

2.
Journal of the Indian Medical Association ; 118(6):84, 2020.
Article in English | Scopus | ID: covidwho-1787330
3.
Journal of Association of Physicians of India ; 69(12):100-108, 2021.
Article in English | Scopus | ID: covidwho-1696178

ABSTRACT

Coronavirus disease 2019 (COVID-19) is a highly hypercoagulable viral infection complicated as COVID-inflicted coagulopathy (CIC), that is associated with increased risk of morbidity and mortality. International guidelines recommend low molecular weight heparin (LMWH) to treat CIC in both in-hospital and in-home settings. However, in India, using subcutaneous LMWH may not be a feasible option for a vast majority of patients under home management. Additionally, while some evidence advocates the use of novel oral anticoagulants (NOACs), in hospitalized settings, most guidelines find no role of NOACs in hospital settings. On the other hand, the resource crunch faced in recent COVID-19 pandemic in India forced physicians to treat many patients in home settings. These patients had been usually prescribed NOACs for ease of administration and adherence. Therefore, there is a need to form a consensus on the use of NOACs to manage CIC in India. © 2021 Journal of Association of Physicians of India. All rights reserved.

4.
Clinical Trials ; 18(SUPPL 5):23-24, 2021.
Article in English | EMBASE | ID: covidwho-1582540

ABSTRACT

The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) causes a respiratory disease called coronavirus disease (COVID)-19 in infected individuals. Since its first outbreak at the end of 2019, COVID-19 has rapidly evolved into a global pandemic and has infected more than 85 million (M) people worldwide and has resulted in over 1.85 M deaths. The pandemic has led to the race for finding therapeutics and vaccines, and to date, there have been two vaccines approved within the United States and the potential for more to follow in the coming months. In addition, this has also forced clinical researchers to look into the impact this may have on ongoing trials, given the risk of COVIDrelated complications confounding with the efficacy and safety outcomes and necessitating the collection of additional data and evaluating alternate ways of analyzing trial results. This is of particular concern in patients with cancer who are often immunosuppressed as a result of both their disease and the treatment they receive, which puts them at increased risk of severe complications from COVID-19. In this session, we will focus on two important but very distinct topics that have emerged due to the onset of the pandemic: (1) the issues and challenges related to vaccine development including trial design, rapid execution, real-time regulatory feedback, and overall interpretation of trial results and (2) understanding potential impact of COVID-related deaths in Oncology trials, on time to event endpoints of overall survival and progression-free survival. Topic 1: Challenges with COVID-19 Vaccine development The SARS-CoV-2, first identified in December 2019, has caused a worldwide pandemic leading to widespread morbidity and mortality. There was no Food and Drug Administration-approved vaccine for the prevention of the coronavirus disease 2019 (COVID-19), the disease caused by SARS-CoV-2. The urgent need for safe and effective interventions to mitigate the global spread of SARS-CoV-2 has prompted international efforts to develop antivirals and vaccines. Numerous vaccine candidates based on traditional and new platforms are currently being evaluated including nucleic acid (DNA and RNA), viral vector (replicating and non-replicating), virus-like particles, peptide-based, recombinant protein, and live attenuated and inactivated virus modalities. COVID-19 vaccines are in various stages of clinical development, with several candidates in pivotal phase 3 clinical trials, including mRNA-based vaccines, of which two vaccines, one developed by Pfizer and the other by Moderna recently received the emergency use authorization from the Food and Drug Administration in December 2020. In this session, we will share experiences and challenges in the development of these two vaccines. We will share the practical and statistical challenges and considerations when designing COVID-19 vaccine studies, such as target population(s), endpoint selection and assessment, statistical analysis method, timing of interim analyses, and questions continuously to be answered after receiving the emergency use authorization and/or during the Biologics License Application review. We show that, when planning a vaccine pivotal study against a novel virus causing ongoing worldwide pandemic, special consideration needs to be given for the designing of interim analyses related to efficacy, so that a vaccine with favorable benefit-risk profile can be made available as early as possible;special attention also needs to be given for an independent data safety monitoring board for vaccine-associated enhanced respiratory disease and other safety signal monitoring to mitigate the risk for trial participants during an ongoing pandemic. Topic 2: Impact of COVID-19 on Oncology trial outcomes using overall survival or progression-free survival Simulations were conducted to assess (1) the impact of the COVID-19-related death and (2) missed RECIST visits on the statistical analysis of time-to-event outcomes in randomized phase 3 oncology trials and explore mitigation options for this r sk when COVID- 19 cohort is well-defined. Two simulated case studies of Phase 3 randomized controlled trials ongoing during the pandemic outbreak were used to evaluate five approaches (1, ITT approach;2, modified ITT excluding COVID-19-related deaths;3, censoring COVID-19- related deaths with target number of non-COVID-19- related deaths;4, censoring COVID-19-related deaths with original date-cut-off;5, Fine & Gray modeling of competing risk approach to treat COVID-19-related death and non-COVID-19-related death separately), at presence of COVID-19-related deaths with different pandemic onsets relative to timing of analysis and varying pandemic durations, the impact of COVID-19- related death due to pandemic, on the primary endpoints of overall survival and/or progression-free survival in terms of type 1 error, power, and hazard ratio estimates. It was found that COVID-19-related deaths would impact time-to-event analysis in terms of type 1 error and power for log rank test, and provide biased treatment effect estimation from Cox model if ITT approach is used;impact would be more severe if there was an imbalance in COVID-19-related deaths mainly in experimental arm. With same number of COVID-19- related deaths, the earlier the timing of the pandemic window, will lead to greater loss in power. Approaches censoring COVID-19-related deaths would minimize impact on power loss and bias in hazard ratio estimation, particularly if data cut-off was extended to mitigate for events loss due to censoring. The simulations conducted in this analysis provide a framework to help understand how to mitigate the risk to the randomized oncology trials in which COVID-19- related deaths are observed in the blinded assessment during the COVID-19 pandemic.

5.
Journal of the Indian Medical Association ; 119(5):21-27, 2021.
Article in English | EMBASE | ID: covidwho-1471427

ABSTRACT

Background: The declining trend of COVID-19 infection in India has made healthcare personnel (HCP) and general public lenient about personal-protective-measures. Serosurveys to estimate the prevalence of SARS-CoV2 IgG antibodies, particularly in high-risk-zones like hospitals can give the real scenario and risk-factors can help prioritise the target population for urgent, effective vacccination. Methods: 1470 consecutive HCP from 4 tertiary-care-hospitals in Kolkata filled a questionnaire and were tested for serum SARS-CoV2-IgG by Enzyme-linked Immunosorbent Assay (ELISA). The prevalence of SARS-CoV2-IgG among asymptomatic HCPs was studied and the work environment, clinical comorbidities, personal habits and protective measures and pharmacologic prophylaxes were compared between those with and without SARS-CoV2-IgG. Parameters of asymptomatic seroconverters were also compared to those with personal history of COVID-19-Infection. Logistic regression was done to identify independent risk-factors. Results: Prevalence of asymptomatic seroconversion was 15.8%. Asymptomatic seroconverters (n=208) were mostly working in mixed hospitals (having both COVID-19 and non-COVID-19 wards, 57.7%), were non-doctors by profession (nurses-25.1%, others–51.4%). Among asymptomatic HCP, indepedendent positive risk factors for SARS-CoV2 IgG-positivity were Diabetes Mellitus (DM) and multiple comorbidities (pboth <0.001) and prophylactic use of Hydroxychloroquine and Famotidine (pboth < 0.03). However, for symptomatic COVID-19 infection, working in COVID-19 dedicated hospitals, and personal h/o COPD were positive risk-factors and Ivermectin prophylaxis a negative risk-factor (pall < 0.03). Conclusion:In our study conducted i n the i mmedi ate pre-i mmuni sati on peri od, rate of asymptomati c seroconversion among HCPs is too low to presume herd immunity. Those working in mixed hospitals and DM, multiple comorbidities are at particularly high risk.

6.
Journal of Association of Physicians of India ; 69(10):17-23, 2021.
Article in English | Scopus | ID: covidwho-1469268

ABSTRACT

Background: There is more than twofold rise in prevalence of mucormycosis cases in India during the COVID-19 pandemic which needs to be evaluated. Aims: The study aimed to document the spectrum of cases of mucormycosis seen at our Institute during COVID-19 times. Methods: The study is a retrospective observational study carried out at our Institute from May 2021 to mid-June 2021. All patients with biopsy-proven mucormycosis were enrolled in the study. The patients were subjected to complete history taking, ophthalmological examination, and imaging studies. The patients were treated with a multidisciplinary approach with antifungal therapy as well as surgical intervention when needed. Results: Ten patients (n=10) were seen, with a mean age of 50.3 years. The major risk factors included recent use of steroids, uncontrolled diabetes, and CKD. The most common presentation was swelling of unilateral eye and ptosis, followed by loss of vision. Inflammatory marker (CRP) and d-dimer were raised at presentation in all cases. Imaging showed the spread of infection from paranasal sinus to orbit and brain via cavernous sinus, which was a poor prognostic factor. Intravenous Amphotericin-B was given to all patients for at least 4 weeks. Two patients were discharged after completion of treatment and mortality was seen in three patients. Conclusion: We present an array of COVID-associated-mucormycosis (CAM) cases from Eastern India. CAM is presenting with rhino-orbito-cerebral involvement. There is poor outcome with cerebral involvement and high incidence of adverse effects with deoxycholate formulation of amphotericin-B. The causal association of COVID-19 with mucormycosis needs to be unearthed but possible preventive role of anticoagulation should be evaluated. © 2021 Journal of Association of Physicians of India. All rights reserved.

7.
Spat Stat ; 49: 100537, 2022 Jun.
Article in English | MEDLINE | ID: covidwho-1386627

ABSTRACT

At the very outbreak of a pandemic, it is very important to be able to assess the spreading rate of the disease i.e., the rate of increase of infected people in a specific locality. Combating the pandemic situation critically depends on an early and correct prediction of, to what extent the disease may possibly grow within a short period of time. This paper attempts to estimate the spreading rate by counting the total number of infected persons at times. Adaptive clustering is especially suitable for forming clusters of infected persons distributed spatially in a locality and successive sampling is used to measure the growth in number of infected persons. We have formulated a 'chain ratio to regression type estimator of population total' in two occasions adaptive cluster successive sampling and studied the properties of the estimator. The efficacy of the proposed strategy is demonstrated through simulation technique as well as real life population which is followed by suitable recommendation.

8.
Journal of Clinical and Diagnostic Research ; 15(5):AC01-AC05, 2021.
Article in English | EMBASE | ID: covidwho-1227171

ABSTRACT

Introduction: Coronavirus Disease 2019 (COVID-19) pandemic has necessitated closure of physical classroom for maintaining social distancing norms, prompting learning environment to shift from offline to online. Medical education has also undergone similar changes, and online education and assessment methods had to be implemented. Student's perception regarding the same was assessed through this study. Aim: To assess the perception of first year MBBS students about the online education and assessment during the lockdown period of two months. Materials and Methods: A descriptive cross-sectional study was carried out on the first year MBBS students of North Bengal Medical College (NBMCH) during the COVID-19 Lockdown period. All first year MBBS students of NBMCH were added in WhatsApp groups created for academic purposes by Department of Anatomy, NBMCH during the lockdown period. Respective teachers in the academic groups carried out sharing of Digital Education Material (DEM), holding Online Interaction (OI) and correspondence with students, and taking Online Assessments (OA) through sharing questions framed in Google Forms. After two months, the perception of the students was assessed through a voluntary participation based online survey designed in google forms, the results of which were tabulated later and analysed. Results: A total 95 students (54 Male, 41 Female) out of 200 had participated in the survey. Most students were reliant on smartphones (n=90, 94.7%) and mobile internet (n=78, 82%). Most agreed on DEM being relevant (83.2%) and informative (80.7%) but showed diverging opinion on ease of understanding, revision and overall fulfillment of learning objective. On OI majority students responded positively on promptness, relevancy, informative and helpfulness but only 46.8% considered DEM and OI fulfilled the overall learning objective. Regarding OA students had an overall positive opinion. Comparing the online mode with offline, students mostly preferred the latter, though agreeing that online method of education was effective and it was easier to score in OAs. Conclusion: While most students accepted online education, interaction and assessment positively, at the end most of them still preferred offline mode of education and assessment. This could reflect lack of student-student interaction and indicated need of further studies to explore the matter, to help us approach online education better.

9.
Journal of the Indian Medical Association ; 118(6):84, 2020.
Article in English | EMBASE | ID: covidwho-682995
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