Breakthrough COVID-19 Infection Among the General Community, Frontline Workers, and Healthcare Workers During the Second and Third Wave in North India: A Longitudinal Study.

BACKGROUND: Vaccination is among the most important public health tools for preventing the harm caused by communicable diseases. This was particularly true in the case of COVID-19 vaccination during the COVID-19 pandemic. However, no vaccine is 100% effective, and all carry the risk of breakthrough infection in vaccinated individuals. METHODOLOGY: This longitudinal observational study was done on COVID-19-vaccinated individuals at a vaccination site in a tertiary care hospital. The study participants were categorized into the general community, frontline workers, and healthcare workers and were followed up during the study period from June 2021 to May 2022 post-vaccination. They were interviewed by telephone regarding adverse effects and breakthrough infections post-vaccination during the second and third wave of the COVID-19 pandemic in India. Incidence of breakthrough infection was calculated in all three categories after they received their first, second, and booster doses of vaccination. RESULTS: Fever was the most common adverse effect among all the categories of participants after the first and second doses. Incidence of breakthrough infection after the second dose of vaccination among frontline workers (RR: 5.7, 95% CI: 0.7-44.2) and healthcare workers (RR: 18.9, 95% CI: 2.6-138.6) was observed to be higher compared to the general community, but no such difference was observed among the three categories after the first dose of vaccination. CONCLUSIONS: The incidence of breakthrough infection was found to be the highest in healthcare workers, followed by frontline workers compared to the general community, justifying their work profile and the risk associated with it.

Epidemiological correlates of hepatitis C infection- A case control analysis from a tertiary care hospital.

Background: Hepatitis C virus (HCV) infection is considered one of the growing public health problems. Identification of HCV-associated risk factors is pivotal for developing appropriate prevention strategies. Objectives: To determine the epidemiological variables of HCV infection in a tertiary care hospital. Methods: This hospital-based case-control study was conducted in a tertiary care hospital in Punjab on 320 subjects, including 160 cases and controls each. Cases and controls were matched by age (±5 years), gender, and residence. A patient ≥18 years of age fulfilling the biomarker criteria with or without clinical criteria diagnosed in the last 1 month was considered as a case. The information on socio-demographic characteristics and previous exposures to selected risk factors was collected through detailed interviews of the subjects. Analysis was performed using SPSS 20 statistical software. Odds ratio (OR) with 95% confidence interval (CI) was calculated to measure the strength of association between cases and controls for each risk factor. Results: Odds of having HCV infection was significantly higher among those with a history of blood transfusion (OR: 2.30, 95%CI: 1.14-4.63), dental procedure (OR: 4.82, 95%CI: 2.38-9.77) and intravenous injection/infusion from quacks (OR: 3.26, 95%CI: 1.47-7.19), injectable drug use (OR: 26.69, 95%CI: 3.55-200.24), non-injectable drug use (OR: 2.37, 95%CI: 1.44-3.90), tattooing (OR: 7.91, 95%CI: 2.31-27.08), and piercing from street hawkers (OR: 2.25, 95%CI: 1.18-4.29). Multivariate analysis identified history of blood transfusion, dental procedure, intravenous injection/infusion from quacks, injecting drug use, and piercing as independent risk factors for HCV infection. Conclusion: The study identified multiple risk factors for acquiring HCV infection and suggest appropriate interventions targeting high-risk populations.

From rapid antigen testing for COVID-19 to final outcome: An experience from industrial city of Ludhiana.

Context: The ongoing corona pandemic has created medical crises all over the world. An increased surge in the number of COVID-19 cases was observed in the month of August, September and October 2020. Punjab has around 10 Lakh migrant workers. Intensive rapid antigen testing was done during this surge among factory workers. With this background, the study aims to find out the positivity rate of rapid antigen testing and to find out the final outcome of the COVID positive cases in terms of morbidity. Materials and methods: Screening of factory workers working in various factories was done for COVID-19 by rapid antigen testing from 26th august to 31st October 2020. Those who tested positive were clinically examined, counseled, and followed up telephonically to get information regarding their course of illness. The collected information was entered in Microsoft excel sheet and analyzed using SPSS. Results: A total of 11045 factory workers were screened using the rapid antigen test. The mean age of subjects was 33.37 ± 10.97 years. The majority of them were males (88.3%) and migrants (who did not belong to Punjab) (97.3%). The majority of the subjects (97.3%) had no symptoms at the time of screening. COVID-19 positivity rate increased with age, was found to be higher in males (2.3%) as compared to females. Conclusion: The positivity rate was higher in asymptomatic males and local resident workers. Rapid antigen testing is an important public health measure to prevent the further spread of the disease during a pandemic due to its quick results and detection of asymptomatic patients.

Awareness and perceptions of anganwadi workers about female feticide and girl child discrimination in district Ludhiana, Punjab.

BACKGROUND: It is a matter of grave concern that a girl child continues to be insecure and vulnerable in the state of Punjab. To ingrain gender equality in social system, it is very important to make community an important stakeholder to deal with the situation. This study focuses on the awareness and perceptions of anganwadi workers regarding girl child discrimination and female feticide. MATERIALS AND METHODS: A total of 2206 anganwadi workers between the age group of 20-70 years of different blocks of Ludhiana district, Punjab, were enrolled. They had come for Anganwadi Worker (AWW) Training Workshop, organized at Urban Health Centre, Ludhiana, Punjab. Data were analyzed in terms of proportions. RESULTS: Study subjects showed high level of awareness about female feticide (98.8%). A majority of the subjects (93.3%) agreed to the fact that practice of discrimination is being followed between boys and girls. They were also of the opinion that this practice is harmful and it should be stopped (98.9%). Various contributing factors enumerated by them included sons are intelligent, carry on family lineage, and they take care of their parents in old age. Regarding perception of anganwadi workers for curbing this social evil, 70.7% of subjects were of the view that by giving equal opportunities, equal status to girls, and empowering girls, this practice can be stopped, while 42.4% of the subjects were of the view that increasing awareness among the rural women, parents, and family is the solution to stop this practice. CONCLUSION: The anganwadi workers had optimum level of awareness about female feticide and almost all of them strongly felt that this harmful practice should be stopped altogether.

Peripheral Vascular Disease in Patients with Diabetic Foot Ulcers - An Emerging Trend: A Prospective Study from North India.

BACKGROUND: Diabetic foot ulcer is one of the chronic complications of diabetes mellitus (DM) with 25% of patients with diabetes developing a foot ulcer during their lifetime leading to amputation. Diabetic foot is classified into 2 main types: neuropathic ulcers (NPU) and neuro-ischemic ulcer (NIU) where in addition to neuropathy peripheral vascular disease (PVD) is also present. AIMS: We aimed to a) assess the prevalence of Peripheral vascular disease (PVD) in patients of type 2 diabetes mellitus (T2DM) presenting with New Diabetic Foot ulcers (DFU). b) To compare the clinical profile and risk factors responsible for development of NPU and NIU in North Indian population. SETTING AND DESIGN: Cross sectional study conducted on first 100 T2DM patients presenting with new DFU in tertiary referral institute for one year period from August 2012 to July 2013. METHODS AND MATERIAL: Detailed relevant clinical history including age, sex and duration of diabetes, history of smoking and hypertension (HTN) and prevalence of other complications like retinopathy, nephropathy, coronary artery disease (CAD) and stroke was obtained. Patients were examined for neuropathy, loss of pulsations, ankle brachial pressure index (ABI) and investigated for HbA1C, blood urea nitrogen (BUN) and serum creatinine. Statistical analysis used: t test, Fisher exact test and univariate analysis. RESULTS: NIU was present in 30 and NPU in 70 out of 100 patients. NIU were commoner among males as compared to females (21/64 males vs 9/36 females). Strong association of smoking (20/30 patients), hypertension (24/30 patients) and longer duration of DM (14 vs 8 years) with NIU was found. Even other complications of DM like CAD (8/30 patients), stroke (4/30 patients), retinopathy (24/30 patients) and nephropathy (15/30 patients) were more prevalent in patients with NIU. CONCLUSIONS: Prevalence of PVD is 30% in our study which is more than previous studies showing an increasing trend. NPU are two times more common than NIU. Hypertensive male patients with smoking habits and longer duration of T2DM are most prone to develop NIU. NIU share the similar risk factors with CAD and coexist with other complications of DM which should be looked for and treated.

Clinico-Histopathological Spectrum of Infectious Granulomatous Dermatoses in Western India- A Representative Study from Mumbai.

INTRODUCTION: Infectious Granulomatous Dermatoses (IGDS) have various aetiological factors with a considerable overlap in the histopathological and clinical features, thus posing a diagnostic dilemma for dermatologists and pathologists. AIM: We aimed at determining the histopathological profile of IGDS correlating it with clinical features with an attempt to find the aetiology. MATERIALS AND METHODS: In a cross-sectional study conducted in a tertiary referral center of Mumbai over two years, out of 1872 skin biopsies received, 239 histopathologically diagnosed cases of IGDS were studied for histopathological features of granuloma. A clinico-histopathological correlation was attempted. Chi-square test was used for comparison of proportions of different groups. RESULTS: Leprosy (211 cases) and tuberculosis (28 cases) were the commonest histopathologically diagnosed IGDS. Leprosy spectrum included BT (30.33% cases), followed by TT (21.32%), BL and LL and 21.79% cases of lepra reactions. Skin TB biopsies on histopathology showed lupus vulgaris (53.85% cases), scrofuloderma (15.38%), TBVC and papulonecrotic tuberculid (11.54% each). In leprosy maximum clinico-pathological agreement was seen at tuberculoid pole (TT 72.7% and BT 56.6%). Among tuberculosis cases, scrofuloderma (100%) and lupus vulgaris (53.8%) showed maximum agreement. CONCLUSION: Leprosy and skin TB are the commonest IGDS in Mumbai region though difficult to diagnose and subcategorize with certainty during initial stages. Histopathology plays the important role to elucidate the dilemma. This being a single center study, more such studies with a larger sample size are recommended to get more elaborate data and regional prevalence of these IGDS for a better overall approach to prevention, treatment and control.

Malaria Diagnosis Using Automated Analysers: A Boon for Hematopathologists in Endemic Areas.

BACKGROUND: Haematological abnormalities are common in acute febrile tropical illnesses. Malaria is a major health problem in tropics. In endemic areas especially in the post monsoon season, it is not practical to manually screen all peripheral blood films (PBF) for malarial parasite. Automated analysers offer rapid, sensitive and cost effective screening of all samples. AIM: The study was done to evaluate the usefulness of automated cell counters analysing their histograms, scatter-grams and the flaggings generated in malaria positive and negative cases. The comparison of other haematological parameters were also studied which could help to identify malaria parasite in peripheral blood smear. MATERIALS AND METHODS: The blood samples were analysed using Beckman coulter LH-750. The abnormal scatter grams and additional peaks in WBC histograms were observed diligently & compared with normal controls. Haematological abnormalities were also evaluated. STATISTICAL ANALYSIS: Statistical analysis was done by using software Epi-Info version 7.1.4 freely available from CDC website. Fisher exact test was applied to calculate the p-value and value < 0.05 was considered as significant. Final identification of malarial parasite species was done independently by peripheral blood smear examination by two pathologists. RESULTS: Of all the 200 cases evaluated abnormal scatter grams were observed in all the cases of malaria while abnormal WBC histogram peaks were noted in 96% cases demonstrating a peak at the threshold of the histogram. The difference between number of slides positive for abnormal WBC scatter gram and abnormal WBC histogram peaks were statistically highly significant (p=0.007). So abnormal WBC scatter gram can better give idea of malarial parasite presence. Of the haematological parameters thrombocytopenia (92% cases) emerged as the strongest predictor of malaria. CONCLUSION: It is recommended for haematopathologists to review the haematological data and the scatter plots on the analyser along with peripheral blood smear examination.

What are we drinking? Assessment of water quality in an urban city of Punjab, India.

INTRODUCTION: Ground water is the ultimate and most suitable fresh water resource for human consumption in the urban areas of India. Studies regarding ground water quality have shown that the higher rate of exploration as compared to the rate of recharging, inappropriate dumping of solid, as well as liquid waste, lack of strict enforcement of law has led to the deterioration of ground water quality. The present study was thus, carried out to evaluate physicochemical, as well as a microbiological profile of tap water, and filtered water in urban areas of Patiala, Punjab. MATERIALS AND METHODS: The three zones under Municipal Corporation and two areas under Public Health Department were chosen according to the simple random sampling from Patiala city. From each area, 10 houses were chosen according to the systematic random sampling technique (n = 50). Water was taken from two sources, tap water, and from the water filter. Two samples were taken from each source one for the physicochemical analysis and another for bacteriological analysis. The samples which were sent for bacteriological assessment were collected in a sterile container. RESULTS: The number of water samples found to be within desirable limits with respect to physicochemical parameters were significantly more with the filter water sample than the tap water samples. Suspicious/unsatisfactory microbiological quality of water was observed in 28% and 4% of tap and filter water samples, respectively. CONCLUSION: The results indicate that certain chemical parameters such as hardness, chloride, and fluoride levels were beyond the permissible limits. Therefore, we recommend that home filters should be installed, serviced appropriately, and their water quality should be checked routinely. Also, any leak from sewage pipes should be promptly repaired to prevent contamination of drinking water.

Depression and anxiety among middle-aged women: A community-based study.

BACKGROUND: Anxiety and depressive disorders constitute a substantial proportion of the global burden of disease and are projected to form the second most common cause of disability by 2020. OBJECTIVE: To assess the level of depression and anxiety among middle age women and the possible factors behind it. MATERIALS AND METHODS: A total of 180 women aged 40-60 years were selected by proportionate sampling technique. Age, education, marital status, socioeconomic status, age at marriage, age at menopause, weight and height were noted. Zung-self-rating scales were used for calculating levels of depression and anxiety in these women. The data were analyzed by using statistical software SPSS. RESULTS: The level of syndromal depression and anxiety was found to be 86.7% and 88.9%, respectively. Most of the subjects had the moderate type of depression (49.5%) followed by mild (29.4%) and severe depression (7.8%). While in case of anxiety, most of the subjects (69.4%) had a mild form of anxiety and 17.8% had moderate anxiety level. A significant difference was observed in the level of depression with respect to marital status (P = 0.009) and in the level of anxiety with respect to age (P = 0.021) in the study subjects. On applying logistic regression, none of the factors studied were found to be significant variables for anxiety or depression in the study population. CONCLUSION: Depression and anxiety are prevalent among the middle-aged women in rural Punjab. Provision of mental health services in this group is essential.

Comprehensive Evaluation of Drug De-addiction Centres (DDCs) in Punjab (Northern India).

BACKGROUND: Drug addiction is on the rise in Punjab,India. There are 15 DDCs which are supported by the Indian Red Cross Society. There is alleged mushrooming of private Drug De-addiction Centres (DDCs) in the smaller towns, villages and cities of Punjab. OBJECTIVE: This study aimed to evaluate DDCs in Punjab. MATERIALS AND METHODS: A total of 10 DDCs were included in the study and scheduled visits were made to collect data by using a pre-tested questionnaire. RESULTS: The duration of treatment was 1 month at the Red Cross DDCs and it was approximately 6 months at private DDCs. The staff at the private DDCs were inadequate. The major drugs which were abused by patients were Propoxyphene, Alcohol, Bhukki and Cannabis. Patients were usually referred to the DDCs either by family members (35.3%) or social workers (29.8%). About 72.5% of patients were married, 36.3% had passed 10th standard and 54.4% were employed. A majority dropped out of the DDCs due to personal reasons and lack of family support. On comparison, more patients were found to be treated at Red Cross centres (75.3%) than at private centres (65.8%). All DDCs had conducted regular sessions of individual, group and family counseling for patients. Red Cross DDCs ensured that ex-clients received follow-ups and home visits. More patients were satisfied with the services which were provided by the Red Cross DDCs. On the contrary, more patients at the private DDCs complained about harassment fromstaff personnel (p>0.05). CONCLUSION: It is recommended that all DDCs should be checked regularly, and that the private centres should be provided with additional support from the government, to help run them more efficiently.