ABSTRACT
ObjectivesConvalescent plasma (CP) as a passive source of neutralizing antibodies and immunomodulators is a century-old therapeutic option used for the management of viral diseases. We investigated its effectiveness for the treatment of COVID-19. DesignOpen-label, parallel-arm, phase II, multicentre, randomized controlled trial. SettingThirty-nine public and private hospitals across India. ParticipantsHospitalized, moderately ill confirmed COVID-19 patients (PaO2/FiO2: 200-300 or respiratory rate > 24/min and SpO2 [≤] 93% on room air). InterventionParticipants were randomized to either control (best standard of care (BSC)) or intervention (CP + BSC) arm. Two doses of 200 mL CP was transfused 24 hours apart in the intervention arm. Main Outcome MeasureComposite of progression to severe disease (PaO2/FiO2< 100) or all-cause mortality at 28 days post-enrolment. ResultsBetween 22nd April to 14th July 2020, 464 participants were enrolled; 235 and 229 in intervention and control arm, respectively. Composite primary outcome was achieved in 44 (18.7%) participants in the intervention arm and 41 (17.9%) in the control arm [aOR: 1.09; 95% CI: 0.67, 1.77]. Mortality was documented in 34 (13.6%) and 31 (14.6%) participants in intervention and control arm, respectively [aOR) 1.06 95% CI: -0.61 to 1.83]. InterpretationCP was not associated with reduction in mortality or progression to severe COVID-19. This trial has high generalizability and approximates real-life setting of CP therapy in settings with limited laboratory capacity. A priori measurement of neutralizing antibody titres in donors and participants may further clarify the role of CP in management of COVID-19. Trial registrationThe trial was registered with Clinical Trial Registry of India (CTRI); CTRI/2020/04/024775.
ABSTRACT
Expanding mobile telephony in India has prompted interest in the potential of mobile-telephone health(mHealth) in linking health workers in rural areas with specialist medical advice and other professionalservices. In 2012, a toll-free helpline offering specialist medical advice to community-based healthworkers throughout Maharashtra was launched. Calls are handled via a 24 h centre in Pune, staffed byhealth advisory officers and medical specialists. Health advisory officers handle general queries, whichinclude medical advice via validated algorithms; blood on-call services; grievance issues; and mentalhealth support – the latter calls are transferred to a qualified counsellor. Calls requiring more specialistadvice are transferred to the appropriate medical specialist. This paper describes the experienceof the first 4 years of this helpline, in terms of the services used, callers, nature of calls, types ofqueries serviced and lessons learnt. In the first 4 years of the helpline, 669265 calls were serviced.Of these calls, 453373 (67.74%) needed medical advice and were handled by health advisoryofficers. Specialist services were required to address 199226 (29.77%) calls. Blood-bank-relatedservices accounted for 7919 (1.18%) calls, while 2462 (0.37%) were grievance calls. Counselling formental health issues accounted for 6285 (0.94%) calls. The large-scale mHealth professional supportprovided by this helpline in Maharashtra has reached many health workers serving rural communities.Future work is required to explore ways to expand the reach of the helpline further and to measure itseffectiveness in improving health outcomes.
Subject(s)
India , TelemedicineABSTRACT
OBJECTIVE: To evaluate smile in different age groups and to detect gender differences in smile. MATERIALS AND METHODS: Digital videographic records of 241 randomly selected subjects were obtained for smile analysis. The subjects were divided into four groups by age (15-20 years, 21-30 years, 31-40 years, and 41-50 years). Each group was further subdivided by gender. After 41 subjects were excluded, the smile dimensions of 200 subjects were analyzed by two-way multivariate analysis of variance (MANOVA) with Duncan's multiple range post hoc test. RESULTS: All dynamic measurements (change in upper lip length, upper lip thickness, commissure height, and intercommissural width from rest to smile) decreased with age in both males and females. Changes in upper lip length and commissure height on smiling were greater in males as compared with females of the same age groups. Changes in intercommissural width on smiling were greater in females as compared with males in all age groups. CONCLUSION: Smile changes with increase in age, and the changes differ between males and females. Females had a wider smile as compared with males of similar age groups.
