Role of Gene Xpert in smear negative pulmonary tuberculosis.

BACKGROUND: Tuberculosis is a major health problem contributing to significant morbidity and mortality. Early diagnosis and treatment is the key for TB control. Sputum microscopy is a rapid and inexpensive test but due to low and variable sensitivity, many cases can be missed. Culture is considered to be the gold standard but is time consuming. Gene Xpert is a novel and rapid cartridge based nucleic acid amplification test (CBNAAT) that can be used for prompt diagnosis. AIM: To compare the sensitivity, specificity, positive predictive value (PPV) and negative predictive value (NPV) of Gene Xpert with culture in diagnosing tuberculosis in sputum smear negative patients. METHODS: The study is a prospective observational study conducted from December 2017 to January 2019 on 189 patients, who were sputum smear negative but had signs and symptoms suggestive of tuberculosis. Their respiratory samples were taken (either sputum or bronchoalveolar lavage) and sent for Gene Xpert. The results were compared with culture, which was taken as the gold standard, and diagnostic accuracy was assessed. RESULT: A total of 189 patients were included in the study. In 25 patients sputum was taken and in 164 patients BAL was taken (which included 22 patients in whom sputum Gene Xpert was negative but there was high clinical suspicion of tuberculosis). The sensitivity, specificity, PPV and NPV of Gene Xpert in diagnosing smear negative pulmonary tuberculosis was found to be 96.3%, 81.3%, 87.5% and 94.2% respectively. CONCLUSION: Gene Xpert can be used as a rapid diagnostic tool in patients who are sputum smear negative but have clinical features highly suggestive of tuberculosis. It additionally helps in detecting rifampicin resistance. But every Gene Xpert positive case does not necessarily mean an active disease, therefore, past history of tuberculosis along with radiological signs of disease activity are to be considered. In case of negative Gene Xpert but high clinico-radiological suspicion of TB, patients should be followed up on regular intervals, while awaiting their culture.

Clinical characteristics among patients with COVID­19: A single­center retrospective study.

The aim of the present study was to investigate the clinical features and laboratory parameters of hospitalized patients with coronavirus disease 2019 (COVID-19) and assess the characteristics between severe and non-severe cases. The study retrospectively analyzed the clinical data of 1,096 patients, of which, 626 (57.11%) and 470 (42.89%) were categorized into severe and non-severe groups, respectively. Clinical parameters such as signs and symptoms, comorbidities, levels of D-dimer, C-reactive protein (CRP), interleukin 6 (IL-6) and lactate dehydrogenase were analyzed. The data are presented as frequencies, means and standard deviations. The chi-square test and Mann-Whitney U test were used to assess any significant differences between the severe and non-severe COVID-19 groups. The clinical symptoms in severe COVID-19 cases included anosmia (P≤0.01), sore throat (P≤0.01), fatigue (P≤0.01), headache (P≤0.01), and shortness of breath (P≤0.01). Laboratory findings showed a significant increase in CRP (21.90±40.23 vs. 16.13±21.82; P≤0.01) and IL-6 levels (58.92±55.07 vs. 41.41±38.30; P≤0.01). Patients with severe COVID-19 had significant lymphopenia compared with that in non-severe cases. Among the comorbidities, hypertension (P≤0.01) was significantly more frequent in patients with severe COVID-19. In conclusion, major derangements in laboratory parameters were observed in patients with severe COVID-19 infection.

Managing COPD exacerbation at home- Teleconsultations amid COVID-19.

Background: Due to an enormous health care crisis arising out of COVID-19 pandemic, alternate methods of seeking treatment like tele-consultation proved useful to patients. We assessed the role of teleconsultation in managing COPD exacerbations at home in the times of COVID-19 crisis. Materials and Methods: A prospective study of 527 diagnosed cases of COPD seeking treatment for exacerbation of their illness telephonically because of difficulty in visiting the hospitals created by the COVID-19 lockdown. Data were collected telephonically and via social media platforms from April 7,2020 to October 29, 2020.The patients were treated for exacerbation and followed telephonically at day 3,5,7, 14 and day 30. Patients who turned to be COVID-19 positive were referred to COVID health facility centers. Results: 509 patients out of 527 patients were treated for exacerbation of COPD, 18 patients tested positive for COVID-19. Out of 509, 13 patients did not improve and had to be referred to hospital. All of them had acute respiratory failure (Type 2) as documented by their arterial blood gas analysis. 2 out of them did not survive. 496 out of 509 (97.4%) patients of COPD exacerbation were successfully treated via teleconsultations and with a follow-up of 4 weeks period minimum for all the patients. Conclusion: Teleconsultation provided excellent means to manage COPD exacerbation remotely with equally effective outcome as seen in hospital care in the times of health care crises due to COVID-19 pandemic.

Evaluation of Olfactory Acuity in Patients with Coronavirus Disease 2019 (COVID-19).

Aim and Objectives: To describe the prevalence and characteristics of olfactory dysfunction (OD) in patients with laboratory-confirmed COVID-19 infection. Materials and Methods: This monocentric study was performed at Chest Diseases Hospital during the COVID-19 pandemic and all patients testing positive for COVID-19 over a 5-month period (April to August 2020) were recruited. Detailed history was elicited from subjects and all patients were inquired about olfactory dysfunction (OD). Patients with olfactory dysfunction were asked to complete olfactory questionnaires based on the short version of the Questionnaire of Olfactory Disorders-Negative Statements (sQOD-NS). Results: 655 patients with mild to moderate COVID-19 infection were included in the study. The prevalence rate of olfactory dysfunction was 18.47% (n = 121) with contribution of 11.60% (n = 76) and 6.87% (n = 45) from anosmia and hyposmia respectively, thereby suggesting olfactory dysfunction to be a significant clinical feature in COVID-19 patients. Males were significantly more affected by olfactory dysfunctions than females. Anosmic patients had significantly reduced sQOD-NS results as compared to hyposmic patients (significant at P < 0.05). The mean duration of OD was 7.7 days (± 4.3) and >90% patients in our study showed resolution within 14 days. Conclusion: The early recognition of olfactory dysfunction should help to screen, identify and thereby quickly isolate mildly symptomatic COVID-19 patients from the general population and the existence of these dysfunctions may well be a prognostic factor in the course of the disease.

Clinico-radiological profile of COVID-19 in Kashmiri population: A descriptive study.

AIM: The purpose of our study was to assess the presentation of COVID-19 disease in terms of clinical and radiological features in our population. METHODS: 64 RT-PCR documented COVID-19 patients were included in the study. Clinical, biochemical, and radiological data were collected and analyzed retrospectively from last week of March to 30th April 2020. RESULTS: Out of the 64 patients, 38 (59.4%) were males, 44 (68.7%) had a history of contact with COVID-19 positive patient. 26.6%patients were in the age group of 21-30 years. 53.1% patients were asymptomatic while as cough and fever were the most common symptoms in 21.8 and 20.3% patients, respectively. Anosmia was present in four patients. Hypertension and hypothyroidism were the most common comorbid illnesses among the study population in 9.4% patients each. Lymphopenia was present in 38% of patients CRP was increased in 83% patients, LDH in 90.2%, and ferritin in 51.5% of patients. 17 (26.6%) patients had bilateral disease in CT. RUL was the most common lobe involved in 18 (28.1%) patients. GGO and consolidation were seen in 22 (34.45) and 13 (20.3%) patients, respectively. Vessel enlargement was observed in 11 (17.2%) patients. All five lobes were involved in 9 (14.1%) patients. Five patients developed severe disease with respiratory comprise; two of them eventually died. CONCLUSION: The clinical and radiological characteristics of COVID-19 patients vary among different populations. Although there are no radiological features which seems to be characteristic of COVID-19, but CT helps in evaluation of the patients as many asymptomatic ones have some radiological findings suggestive of viral pneumonia.

Correction: Stigma in coronavirus disease-19 survivors in Kashmir, India: A cross-sectional exploratory study.

[This corrects the article DOI: 10.1371/journal.pone.0240152.].

Stigma in coronavirus disease-19 survivors in Kashmir, India: A cross-sectional exploratory study.

BACKGROUND: Coronavirus disease-19 (COVID-19) has not only spawned a lot of stigma and discrimination towards its survivors but also to their corpses. We aimed to assess the magnitude and correlates of stigma in these survivors, on return to their communities. METHODS: This was a cross-sectional, hospital-based, exploratory study conducted by the postgraduate department of psychiatry, in collaboration with the postgraduate department of chest medicine, Govt. medical college, Srinagar. The study was performed among COVID-19 survivors, who attended the outpatient department after their discharge from the hospital. Socio-demographic characteristics were recorded through semi-structured proforma. Stigma was measured by the stigma questionnaire. Data was analyzed using descriptive statistics and regression analysis. RESULTS: A total of 91 survivors consented to participate in the study. Almost half (46.2%) of them were in the age group of 30-49 years and close to two-thirds (68.1%) were males. About three-fourths (74.7%) were from the urban background. The mean time from hospital discharge to study entry was 11.7±5.1 [Range(R) = 7-21] days. 98% of survivors provided at least one stigma endorsing response and the total mean stigma score was 28.5±7.1[R = 6-39]. The mean stigma sub-scores were highest for enacted stigma (7.6±1.8) [R = 2-9] and externalized stigma (15.0±4.1) [R = 1-20]. Enacted stigma was significantly high in males as compared to females. Enacted stigma and internalized stigma were both associated with education. Enacted stigma, externalized stigma, disclosure concerns, and total stigma was significantly associated with the occupation. Being unemployed and time since discharge were identified as independent predictors of total stigma. CONCLUSION: Our study results showed high levels of enacted and externalized stigma among COVID-19 survivors. Enacted stigma was more among males and in those who were highly educated. Survivor centered and community-driven anti-stigma programs are the need of the hour to promote the recovery and community re-integration of these survivors.