Silent epidemic of silicotuberculosis in India and emergence of multidrug-resistant tuberculosis?

OBJECTIVES: India's projected silica-dust-exposed workers will be 52 million at the end of 2025. The elimination of tuberculosis (TB) is also targeted in India by 2025. Scientists in India have already pointed out that unless silicosis is controlled, the said elimination will be difficult to achieve. METHODS AND RESULTS: This study provides evidence of an increasing incidence of tuberculosis (TB) including multidrug-resistant TB (MDR-TB) with mortality owing to treatment failure among the silica dust-exposed workers compared to their unexposed counterpart. It was also observed that TB as well as MDR-TB were directly proportional to the dose and/or duration of silica dust exposure (progression of silica-dust induced lung damage). This means the occurrence of both TB and MDR-TB is lowest in the unexposed group, moderate in the radiologically negative but silica dust-exposed group (subradiological silicosis owing to moderate exposure), and highest in the radiologically confirmed silicotic workers (maximally exposed group). Because India has a huge burden of silicosis cases, the said cases are vulnerable to pulmonary TB, including MDR-TB. The study indicates there will be an emergence of MDR-TB among the silica dust-exposed workers unless appropriate intervention measures are initiated with immediate effect. Failure to do so, it will probably lead to a silent epidemic of silicotuberculosis in India shortly. CONCLUSIONS: It is important to have tools to detect silicosis cases quickly and at an early stage to identify a vulnerable population and adopt an effective intervention measure.

Assessing Health Seeking Behaviors and Economic Consequences of Morbidity in Indian Construction Workers: A Multicenter Study.

Background: Construction laborers succumb to poor health due to the inherent workplace health hazards and poor socio-economic living conditions. With rising healthcare expenses, the increased risk of poor health may aggravate their economic status, pushing them deeper into poverty. Settings and Design: The current cross-sectional multicenter study comprehensively investigated the determinants of health, health-seeking behavior, and poor economic impact regarding catastrophic health expenditure (CHE) among construction laborers. Methods and Material: We collected details on illnesses among self and family members of the construction laborers that required healthcare visits during the previous year and their approximate expenses. Among the 1110 participants with complete data, 37% reported illness requiring a healthcare visit either for self or a family member. Results: Regression models to ascertain demographic and living condition determinants of perceived illness revealed an increased risk of illness when the kitchen is shared with the living space (OR = 1.87) and use unhygienic smoky cooking fuels (OR = 1.87). More than 25% of those who reported illness incurred CHE. Conclusion: We conclude that the frequency of perceived illness and the economic impact, i.e., CHE is relatively higher among the construction laborers. Our results demonstrate that poor living conditions add to the burden of morbidity in construction workers and families. Providing healthcare coverage for this population and engaging and educating them about affordable healthcare are necessary future steps to prevent the worsening of the economic situation.

A cluster onset of acute and accelerated silicosis cases in workers of ramming mass industries in Jharkhand, Eastern India.

Introduction and Methodology: A cross-sectional study was conducted among workers of ramming mass industries in the East Singhbhum district of Jharkhand, eastern India. Workers had occupational exposure to respirable crystalline silica dust of varied duration between 1 and 6 years. A total of 122 subjects participated in it. Relevant epidemiological information was collected from them. All were x-rayed using 300 mA radiation for the detection of the presence of silicotic opacities if any as described by the International Labour Organisation (ILO) for the detection of silicosis. Results: The study revealed that 61.4% (n = 75) of subjects had silicosis. Of them, 19 had acute silicosis (having a duration of silica dust exposure of 2 years or lesser) and 56 had accelerated silicosis (a duration of occupational exposure of > 2 to 6 years). The offending agent was clouds of respirable crystalline silica dust from the ramming mass industries. Epidemiological Interpretation: To the best of our knowledge, this is the first report of an outbreak of acute and accelerated silicosis cases because of occupational inhalational exposure to ramming mass in India with a sizable portion of female workers with silicosis. Regional as well as national authorities need to take appropriate interventional measures in a programmatic mode as soon as possible. Conclusion: An in-depth investigation on the existence and magnitude of the problem of silico-tuberculosis is needed to be performed in them as silicosis increases the vulnerability of pulmonary tuberculosis among the affected workers.

Elimination of tuberculosis requires prior control of silicosis including sub-radiological silicosis.

India is committed to the elimination of tuberculosis by 2025. But its achievement appears to be difficult as India has a huge burden of silicosis as well as sub-radiological silicosis, which was never given its required attention. Silicotic subjects are highly vulnerable to pulmonary tuberculosis due to the progressive decline of lung immunity. A study among vulnerable glass factory workers in Firozabad, Uttar Pradesh, revealed that silicotic workers were 7.5 times more at risk of pulmonary tuberculosis compared to non-silicotic subjects. Since India has a huge burden of silicosis and sub-radiological silicosis, the elimination of tuberculosis needs prior attention on silicosis. This article may be viewed as an eye-opener for understanding the necessity of dual control of both silicosis as well as tuberculosis by integrating both together.

Occupational exposure of vehicular emissions and cardiorespiratory risk among urban metropolitan bus drivers: A cross-sectional comparative study.

BACKGROUND: Vehicular emissions on long-term exposure predispose metropolitan bus drivers to cardiorespiratory ailments. OBJECTIVE: To evaluate the cardiorespiratory risk of urban metropolitan bus drivers related to vehicular emission exposure. METHODS: Bus drivers (with service >5 years, n = 254) and their administrative controls (primarily engaged in indoor white collared jobs, n = 73) were recruited. Demographic, occupational and clinical details were collected through pre-validated standardized format. Pulmonary Function Test (PFT) and lipid profile were carried out with standard protocol. Risk for cardiovascular events for preceding 10-years was estimated with WHO/ISH risk prediction chart and QRISK3 score. Exposure assessments for particulate matter (PM) were performed for both groups while duty hours. RESULTS: Exposure of drivers to PM2.5 six times and PM10 five times higher in comparison to administration staff (PM2.5- 970.9 v/s 145.0µg/m3 TWA and PM10- 1111.7 v/s 233.8µg/m3 TWA). Bus drivers exhibited significantly higher prevalence of respiratory symptoms (dyspnea-25% v/s 6.8% and cough-20.1% v/s 9.8%) and compromised PFT (obstructive-21% v/s 5.7% and restrictive-4.2% v/s 2.9%) in comparison to controls. Multivariate regression statistics reveal a significant decline for FEV1/FVC and FEV25-75 % among bus drivers compared to controls, controlling the influence of physiological and environmental factors. The difference between predicted cardiac age and their respective chronological age was twice higher (8.3 v/s 4.3 years) among drivers compared to their administration staff. CONCLUSION: Bus drivers were exposed to high levels of outdoor air pollutants. Further, the drivers exhibited higher risk for ischemic attack and obstructive airway diseases as compared to administration staff.

Susceptibility of male reproductive system to bisphenol A, an endocrine disruptor: Updates from epidemiological and experimental evidence.

Bisphenol A (BPA) is an omnipresent environmental pollutant. Despite being restrictions in-force for its utilization, it is widely being used in the production of polycarbonate plastics and epoxy resins. Direct, low-dose, and long-term exposure to BPA is expected when they are used in the packaging of food products and are used as containers for food consumption. Occupationally, workers are typically exposed to BPA at higher levels and for longer periods during the manufacturing process. BPA is a known endocrine disruptor chemical (EDC), that causes male infertility, which has a negative impact on human life from emotional, physical, and societal standpoints. To minimize the use of BPA in numerous consumer products, efforts and regulations are being made. Despite legislative limits in numerous nations, BPA is still found in consumer products. This paper examines BPA's overall male reproductive toxicity, including its impact on the hypothalamic-pituitary-testicular (HPT) axis, hormonal homeostasis, testicular steroidogenesis, sperm parameters, reproductive organs, and antioxidant defense system. Furthermore, this paper highlighted the role of non-monotonic dose-response (NMDR) in BPA exposure, which will help to improve the overall understanding of the harmful effects of BPA on the male reproductive system.

A Comparative Health Assessment of Occupationally Lead Exposed Individuals with Blood Lead Levels Range across Upper Acceptable Limit.

Context: Lead (Pb) smelting workers are exposed to high lead levels and its adverse health effects. Despite no biological role, regulatory bodies regard blood lead levels (BLL) ≤40 µg/dL as upper acceptable limit in occupationally lead exposed population. Objective: To explore the differences in general health status of individuals with BLL ≤40 µg/dL and >40 µg/dL. Methods: All workers (n = 803) of age >18 years employed in a Pb smelting plant were interviewed with a semi-structured questionnaire to obtain sociodemographics, occupational details, followed by detailed clinical examination. 5 ml of venous blood was collected and BLLs were determined as per standard NIOSH method using GF-AAS technic. A complete general health status was performed including hemoglobin and blood pressure (BP). Results: About 47.7% of the participants exhibited high BLL (>40 µg/dL), while the rest 52.3% were identified to have ≤40 µg/dL. Both groups were grossly similar in the majority of demographic and occupational parameters. Interestingly, both groups had substantially higher fraction of workers with elevated BP. Conclusions: Lead exposed workers with BLL ≤40 µg/dL are at equal risk of health hazards as those with BLL >40 µg/dL. There is a need to revisit the current guidelines on the BLL for workers to protect from the hazards of chronic lead exposure.

Occupational lead exposure is an independent modulator of hypertension and poor pulmonary function: A cross-sectional comparative study in lead-acid battery recycling workers.

Blood lead level (BLL) is the primary biomarker for lead-exposure monitoring in occupationally exposed workers. We evaluated occupational lead-exposure (OE) impact on cardiopulmonary functions in lead-acid battery recycling unit workers. Seventy-six OE cases and 30 control subjects were enrolled for questionnaire-based socio-demographic, dietary, tobacco usage, and medical history data. Anthropometric measurements, systolic and diastolic blood pressure (SBP and DBP), and pulmonary function tests were performed. Venous blood was collected for BLL, hematological analysis, and biochemical analysis. OE caused a significant increase in BLL, SBP, DBP, and small airways obstruction in lung function tests. It also impaired platelet indices, affected renal and liver biochemical measurements, and promoted oxidative stress and DNA damage. Multilinear regression analysis suggested that BLL affected SBP (ß = 0.314, p = .034) and increased small airways obstruction (FEV1/FVC, ß = -0.37, p = .05; FEV25-75%, ß = -0.351, p = .016). Higher BLL appears to be an independent modulator of hypertension and poor pulmonary function upon occupational lead exposure in lead-acid battery recyclers.

Intra-Familial Transmission Patterns of COVID-19 Infection among the Rural Residents of Ahmedabad, Gujarat, during an Epidemic of SARS-CoV-2 in India.

We are yet to completely understand the transmission dynamics of coronavirus disease 2019 (COVID-19), a highly infectious disease, and research exploring the same is currently lacking. Hence, a community-based cross-sectional study was conducted to assess the intra-familial transmission pattern of COVID-19 among the rural residents of Ahmedabad, Gujarat, in relation to possible determinants, with a special focus on the viral load as an important factor. This cross-sectional study included visiting 195 families. We interviewed families with at least one case of COVID-19 infection. We recorded information about sociodemographic profiles and secondary transmission of cases. Out of the 195 families, 114 confirmed having at least one infected case within the family. Approximately 38.6% (44/114) of the index cases were asymptomatic, which was much higher than the low viral load index cases. Index cases with high, moderate, and low viral loads had transmitted the infection with an average of 3.3, 1.5, 0.4 secondary cases per index case, respectively. Approximately one-third of the COVID-19 cases were asymptomatic, and the affected individuals were capable of transmitting the disease within families. Moreover, index cases with a higher viral load had a higher transmission potential to generate more secondary cases, as compared to those with a low viral load.

A rapid point of care CC16 kit for screening of occupational silica dust exposed workers for early detection of silicosis/silico-tuberculosis.

Silicosis is an irreversible, incurable and progressive occupational disease caused by prolonged exposure to crystalline-silica dust while working in the relevant industries. Conventionally diagnosis is done by chest radiology, often in an advanced stage as early symptoms often go unnoticed. Early detection and necessary intervention (secondary prevention) could be a realistic possible control strategy for controlling silicosis as no effective treatment is available to stop and/or reverse the pathological process. Additionally, these patients are also vulnerable to pulmonary tuberculosis, which often becomes difficult to treat and with uncertain treatment outcome. Considering India has a huge burden of silicosis and silico-tuberculosis, a rapid and inexpensive screening method was realized to be an urgent need for early detection of silicosis among silica dust exposed workers. Serum club cell protein 16 (CC16) is evidenced to be a useful proxy screening marker for early detection of silicosis as evidenced from the recent research work of ICMR-National Institute of Occupational Health (ICMR-NIOH), India. In this study a lateral-flow assay for semi-quantitative estimation of serum CC16 level was developed. The detection was performed using gold nanoparticles conjugated anti-CC16 monoclonal antibodies. A sum of 106 serum samples was tested to do the performance evaluation of the assay. A concentration of 6 ng/ml or less produced one band, 6.1-9 ng/ml produced two bands, while more than 9 ng/ml produced all the three bands at the test zone. The sensitivity of the assay was 100% while the specificity was 95%. This assay may be used as a sensitive tool for periodic screening of silica dust exposed vulnerable workers for early detection of silicosis in them.

Merits and Demerits of Selective Isolation of Superspreaders: A Mathematical Modeling Study Based upon West Bengal (India) SARS-COV 2 Data.

CONTEXT: All COVID cases and their contacts are considered highly infectious requiring isolation, which blocks the COVID isolation beds and disrupts life in the community. AIM: To find out the effect of selective isolation and contact tracing of superspreaders as compared with the conventional ongoing protocol. SETTINGS AND DESIGN: A mathematical model was designed to look at the effect of isolation and contact tracing of only those with high viral loads (superspreaders) on COVID-19 bed occupancy and overall mortality, in comparison with conventional protocol of isolation and contact tracing of all cases. MATERIALS AND METHODS: An agent-based model, calibrated to the ongoing West Bengal COVID-19 data, was run for a total of 178 days to find out the effect of the interventions on COVID-19 bed occupancy and mortality. RESULTS: There is an impressive reduction in the occupancy of COVID isolation beds, even with the preintervention testing rate with no negative impact on mortality. CONCLUSIONS: Strict isolation of superspreaders only, maybe highly effective in reducing the burden on health care and solving the COVID isolation bed crises if the testing rate is significantly increased.

Designing, fabrication and evaluation of a rapid, point-of-care and noninvasive system for the detection of lead (Pb2+).

Non-invasive collection of biological sample such as sweat, urine, saliva, hairs and, stool and onsite detection of anlaytes in those samples is an interesting and viable approach for rapid screening of various toxicants in body. Environmental exposure/presence of lead (82Pb) and its rapid detection provide one such opportunity. A chemical spot based colorimetric method and a transdermal patch device based on this spot test, is developed for rapid and qualitative assessment of inorganic lead (Pb2+) in non-coloured biological or environmental liquid samples. The transdermal patch system contains two important parts, a chemical spot prepared on a thin glass sheet and, an absorbent paper (11 µm pore size). A one step colour development reaction is able to identify the presence or absence of Pb2+. In-vitro evaluation for sensitivity and cut-off value determination, within run and between run precision testing, specificity testing were done. In-vivo evaluation of the developed patch system was performed in occupationally lead-exposed subjects and in control volunteers. In-vivo field testing results were further validated with gold standard test for lead detection. Blood lead levels and patch lead levels were found to be positively correlated (r = 0.57, P < 0.0001). In addition, the sensitivity and specificity of device in identification of Pb2+ was found to be 75.93% (95% CI = 62.36%-86.51%) and 95.24% (95% CI = 76.18%-99.88%). The developed system appears as a reliable, non-invasive rapid test with minimum step involve for identification of Pb2+ in a given system.

Secondary prevention of silicosis and silico-tuberculosis by periodic screening of silica dust exposed workers using serum club cell protein 16 as a proxy marker.

BACKGROUND AND OBJECTIVES: Silicosis is a neglected and widely prevalent occupational disease in India and several other countries such as China, South Africa, Brazil, etc. It is an irreversible, incurable, and progressive disease with high morbidity and mortality, which is mostly caused by occupational exposure to silica dusts. Silicosis is usually detected at an advanced stage, when effective intervention is not possible. But early detection appears to be a cost-effective way to control it. There is a need for some suitable biomarker, which could detect silicosis at an early stage for further necessary intervention. This study aimed to estimate the lung damage in silicotic subjects and its relationship with serum CC16 as a proxy marker. The ultimate objective was to explore whether CC16 could be used as a screening tool for early detection of silicosis. METHODOLOGY: Radiographs of 117 workers having radiological evidences of silicosis were evaluated in accordance with International Labour Organisation (ILO) Classification of chest radiographs and were categorized as mild, moderate, and severe lung damage using a lung damage scoring system, made for the purpose of this study. The concentration of CC16 in serum was determined by enzyme-linked immunosorbent assay. RESULT: It was observed that serum CC16 values were significantly decreased in relation to increasing lung damage. The mean ± standard deviation (SD) serum CC16 value in mild lung damage group was 8.4 ± 0.87 ng/mL as compared to 4.0 ± 2.10 ng/mL in moderate and 0.7 ± 0.21 ng/mL in high lung damage groups. On the other hand, CC16 value of control (healthy) population was found to be 16.3 ± 3.8 ng/mL. CONCLUSION: Result of the study concluded that serum CC16 might be used as a periodic screening tool for early detection of silicosis and for it's secondary prevention. It may be viewed as a new approach toward control of silicosis, and an appropriate policy may be adopted.

Silicosis, progressive massive fibrosis and silico-tuberculosis among workers with occupational exposure to silica dusts in sandstone mines of Rajasthan state: An urgent need for initiating national silicosis control programme in India.

CONTEXT: Silicosis is a progressive, irreversible and incurable respiratory morbidity and often becomes a cause for pre-mature mortality among occupationally silica dust-exposed workers in India and similar countries. It has a dual problem of associated silico-tuberculosis as a co-morbidity. The present study was done to assess the respiratory morbidity caused by silicosis in sandstone mine of Rajasthan, India. METHODS: The chest X-rays of 529 subjects having history of employment in stone mines with respiratory morbidity were subjected for this study and evaluated in accordance with ILO Classification 2000. The X-rays were classified into various categories of silicosis and progressive massive fibrosis (PMF) in relation to years of work in stone mines. RESULTS: Out of 529 chest radiographs evaluated, 275 (52%) showed radiological evidence of silicosis. Of them, 40 (7.5%) subjects showed large opacities suggestive of progressive massive fibrosis. Both silicosis and progressive massive fibrosis were associated with increasing duration of work in stone mines. Sixty-one (12.4%) subjects with silicosis also had associated pulmonary tuberculosis, termed as silico-tuberculosis. CONCLUSION: The present study showed a high prevalence of silicosis, progressive massive fibrosis and silico-tuberculosis among stone mine workers. It appears that that unless silicosis is controlled, elimination of tuberculosis is far from reality in the country. Hence, states and central authorities must work together towards control of both silicosis as well as silico-tuberculosis. Similarly, there is an urgent need of initiation of national silicosis control programme, similar to existing national tuberculosis control programme, considering the huge burden of silicosis in India.

Viral load could be an important determinant for fomites based transmission of viral infections.

BACKGROUND AND OBJECTIVE: Fomites are common sources of transmission of certain infections. Infectious pathogens, such as viruses known to cause respiratory tract infections, are common examples of being transmitted by fomites. However, the load of the particular pathogen on these inanimate surfaces is a crucial factor for the transmission. The current study aims at investigating the load of one such viral pathogen on the surfaces of commonly used materials. METHODS: Based on the cycle threshold (Ct) values in the diagnostic system using gene amplification for the considered viral pathogen, we categorized the positive samples for high (17 to < 24), moderate (24 to < 31), or mild (31 to < 38) viral load. Five randomly selected samples from each of these category were smeared on commonly used cardboard surface (absorbent surface) and stainless steel (non-absorbent surface). After an observation duration of 90 min, samples from the surfaces were analyzed again for gene amplification using RT-PCR. RESULTS: Viral load/titter positively correlated with the viral material on either of these investigated surfaces post-observation duration. Higher viral load (low Ct) samples exhibited higher probability of being detected on the surfaces than those samples with lower/moderate (high Ct) viral load. INTERPRETATION AND CONCLUSION: Common inanimate surfaces are potential source of the viral transmission, however the viral load on these surfaces are key determinant of such transmission.

Work-related musculoskeletal disorders and associated risk factors among urban metropolitan hairdressers in India.

OBJECTIVES: Ergonomic hazards account for a substantial proportion of work-related diseases and injuries among hairdressers. Awkward posture during work, repetitive movements, prolonged standing, and long working periods to carry out work activities cause mechanical load on the joints and work-related musculoskeletal disorders (WMSDs). This study investigated the musculoskeletal problems among urban hairdressers and associated risk factors. METHODS: This study investigates the prevalence of WMSDs among 768 study subjects (384 hairdressers and control subjects each) from Ahmedabad and New Delhi metropolis in India. Univariate statistical analysis was carried out along with 95% confidence interval for effect estimates. RESULTS: Findings reveal that the nearly half of the hairdressers suffered from knee and foot pain (49.5%), followed by lower back pain (39.8%) and upper back pain (38.8%). The neck pain and shoulder pain were reported by more than 25% hairdressers. The odds of developing neck pain (OR = 2.04; 95% CI 1.37-3.06) and shoulder pain (OR = 1.85; 95% CI 1.25-2.73) were significantly higher than control. The female hairdressers were more likely to experience work-related musculoskeletal disorder (OR = 2.63; 95% CI 1.18-5.86) than male counterparts. Hairdressers within the age of 18-35 years had significantly higher occurrence of musculoskeletal disorders with longer duration of working hours at the workplace. Longer daily work hours (>12 hours) posed significantly higher risk (OR = 2.47; 95% CI 1.39-4.38) of experiencing MSD for hairdressers. CONCLUSION: A very large proportion of hairdressers suffered with work-related musculoskeletal disorders. The long daily working hours and gender of the hairdresser are associated with increased risk of developing WMSDs.

Initial Viral Load of a COVID-19-Infected Case Indicated by its Cycle Threshold Value of Polymerase Chain Reaction Could be used as a Predictor of its Transmissibility - An Experience from Gujarat, India.

BACKGROUND: Transmission dynamics of the infectious disease Corona Virus Disease - 19 (COVID-19) is yet to be understood fully. The study aimed at exploring whether quantitative viral load of COVID-19-infected case indicated by cycle threshold (Ct) value of real-time reverse transcription polymerase chain reaction could predict about transmission pattern in the community. MATERIALS AND METHODS: An observational study was conducted involving 1976 individuals, suspected to be suffering from COVID-19 and contacts, of laboratory confirmed cases from selected districts of Gujarat, India. A total of 138 persons were detected to be positive. Weekly positivity showed an overall increasing trend during the studied weeks. It was observed that only 7% had high, 9% as moderate and rest, 84% had low viral load based on Ct values of real-time RT-PCR. RESULTS: Most secondary cases clustered around index cases with high viral load whereas fewer secondary cases clustered around index cases with low viral load. Each index high viral load case transmitted an average of 6.25 secondary cases whereas the same of low viral load transmitted an average of 0.8 case. CONCLUSION: If cases with higher viral load are selectively isolated on detection from the rest of the community along with contact tracing of all individuals, who came in contact with them during the previous 5 days, the quantum of transmission will reduce subsequently. Moreover, health-care workers often get infected while working, probably due to the fact that they often handle cases with higher viral load. The Ct value of all may be provided along with test report to safeguard everybody's health including health-care workers.

Club cell protein 16 as a biomarker for early detection of silicosis.

Background & objectives: Clinically silicosis is diagnosed by chest X-ray showing specific opacities along with history of silica dust exposure. Diagnosis is invariably made at an advanced or end stage when it is irreversible. Moreover, silicosis patients are susceptible to develop tuberculosis. Therefore, a suitable biomarker for early detection of silicosis is needed. This study evaluated the suitability of club cell protein (CC16) as a biomarker for early detection of silicosis. Methods: This pilot study included 121 individuals from X-ray-confirmed/advanced silicosis, moderate silica dust-exposed workers and healthy controls from western India. CC16 levels were quantified in serum samples through ELISA. Sensitivity and specificity of CC16 values at different cut-off points were calculated in both non-smokers and smokers. Results: Serum CC16 level was significantly (P <0.01) decreased in X-ray confirmed advanced silicosis patients (4.7±3.07 ng/ml) followed by moderately exposed workers (10.2±1.77 ng/ml) as compared to healthy non-exposed individuals (16.7±3.81 ng/ml). Tobacco smoking also caused a significant decrease of serum CC16 concentration in both healthy (10.2±1.12 ng/ml) and advanced silicosis workers (2.6±2.28 ng/ml) compared to non-smokers. Sensitivity and specificity of CC16 values were also found to be ≥83 per cent for screening all categories of individuals. Interpretation & conclusions: Because of high sensitivity and specificity, serum CC16 could be used as predictive biomarker for suspicion and early detection of silicosis, which would help in reducing/delaying premature deaths caused by silicosis. It would also control silicotuberculosis additionally.

COVID control strategy--is there any light at the end of the tunnel?

CONTEXT: India has been witnessing a huge surge of COVID-19 cases, with increasing number of new cases and deaths daily. There is yet no effective vaccine, drug or strategy to combat this disease. Various models of COVID-19 trend and management have been put forward by different researchers, yet no prediction has yet turned out to be close to the reality. AIMS: To find an effective public health strategy against COVID control. SETTINGS AND DESIGN: Ahmedabad district in Gujarat. METHODS AND MATERIAL: Ahmedabad Model for control of COVID-19 based on Ct threshold has been put forth which stresses upon the fact that higher viral load (super-spreaders) could be an important determinant in spreading infections in the community. RESULTS: The cycle threshold (Ct)-based segregation of laboratory-confirmed positive cases along with contact tracing of all of them of previous 5 days has been found to be effective strategy and needs to be adopted for further management. The Ahmedabad model of COVID-19 control was practiced during 3rd week of June 2020 onwards. Following implementation, cases started declining in Ahmedabad district whereas it showed an increasing trend in rest of Gujarat where it was not implemented. CONCLUSIONS: Cases with low viral load may be quarantined at home with standard precaution whereas cases with higher viral load need to be quarantined in institutions (hospital or separate premises away from family).

Screening for dysglycaemia using anthropometric indices in an adult population in Oman.

BACKGROUND: A previous community-based cross-sectional survey conducted in a semi-urban community revealed that 44% of people aged 18+ years manifest dysglycaemia, which appears to echo the national trend. There is lack of studies examining the role of anthropometric indices in people with dysglycaemia. AIM: We explored the screening ability of anthropometric indices, body mass index (BMI), waist circumference (WC), waist-to-hip ratio (WHR), and waist-to-height ratio (WHtR) to detect dysglycaemia in the adult Omani population based on a community-based survey conducted in 2005. The potential of anthropometric indices to detect the presence of glycaemic disorder could aid in detection, prevention and health education. METHODS: A total of 480 male and 795 female subjects aged 18+ years were included in this study. The prevalence of dysglycaemia was analysed using the American Diabetic Association criteria. Logistic regression approach and Receiver- Operating Characteristic (ROC) curve analysis was performed. RESULTS: The analysis revealed that mean values of age, BMI, WC, WHR and WHtR increased significantly from normoglycemic to pre-diabetic and further to diabetic in both sexes (P<0.0001). Dysglycemia showed an increasing prevalence with age. WHtR showed the highest sensitivity for detecting dysglycemia in all age groups compared to other anthropometric indices with sensitivity rate of 94.4% in ≥45 years, 88.6% in (25- 44) years and 45.6% in age group <25 years. CONCLUSION: Among the anthropometric indices we investigated, WHtR was the best predictor of dysglycaemia among Omani adults aged > 25 years.