Outcome of Therapies for Membranous Glomerulonephritis During Three Waves of COVID Pandemic.

There is lack of clarity on immunosuppressive therapy in glomerular diseases and concomitant corona-virus infection. We retrospectively evaluated 36 patients with primary membranous nephropathy from January 2020 to December 2021 who had received immunosuppression during this period. Diagnosis of COVID-19 was made based on self-reported history of being COVID positive. History of hospitalization and oxygen therapy was noted. Four patients developed COVID-19 in this cohort, and all were infected only once. Two patients had asymptomatic disease and two were hospitalized for severe COVID-19 and had complete recovery. In immunocompromised patients, there is a high risk of infection. This observational study is an attempt to bridge the gap that immunosuppression can precipitate COVID-19 infection.

Economic burden estimation associated with dengue and chikungunya in Gujarat, India.

Background: Dengue and chikungunya have been emerging as major vector-borne diseases. The global burden of the diseases is rising as a public health problem. The complexity of disease is governed by multiple constraints including only symptomatic treatment and inflicts heavy social and economic burden on society. The present study is designed to assess the economic burden of dengue and chikungunya infection by calculating cost per patient in Gujarat, India. Methods: A total of 210 patients were enrolled in the study from Ahmedabad and Kheda district of Gujarat from May 2018 to December 2019 of which 150 had dengue and 60 chikungunya infections, subject to the willingness of participation in the survey. Information on wage loss days, cost associated with medicines, diagnosis, special food and travel cost, etc., for the calculation of the direct and indirect costs associated with dengue and chikungunya were collected from these participants using a structured questionnaire. Informed consent was taken before including any participant in the study. Results: In the dengue sample, 86 were males (57.3%) and the rest were females, and in the chikungunya sample, 31 were males (51.7%) and the rest females. The median age of the participants with dengue and chikungunya was 18 (p25 to p75: 8 to 26) and 30 (p25 to p75: 21 to 45) years respectively. Median family income was recorded as Rs 15,000 (p25 to p75: 9000 to 25500) and Rs 12,000 (p25 to p75: 9000 to 18500) for the dengue and chikungunya cases, respectively. The average duration of the illness was observed to be higher in chikungunya (median days (P25 to p75): 15 (7-45)) than dengue (median days (P25 to p75): 10 (5-15)). The median indirect cost in the case of dengue was Rs 1,931 (p25 to p75: 300 to 4500) while Rs 2,550 (p25 to p75: 0 to 5250) was observed for chikungunya cases. Two types of direct cost, namely, direct cost related to medical expenses and direct cost related to other expenses were calculated. Direct cost related to medical expenses was observed to be higher in dengue (Md (P25 to p75): Rs 2,450 (400-5000)) than chikungunya (Md (P25 to p75): Rs 1,500 (150-5200)) while indirect cost related to other expenses were comparable between dengue (Md (P25 to p75): Rs 1,575 (1300-2600)) and chikungunya (Md (P25 to p75): Rs 1500 (850-2850)). The average total cost for one dengue episode was estimated to be Rs 6,860 (3700-12525) whereas it was Rs 7,000 (2550-14000) for one episode of Chikungunya. Conclusions: Overall, patients have to bear high costs while suffering from dengue and chikungunya infections. Furthermore, the duration of illness while suffering from viral diseases also contributes to the substantial economic burden. Improved knowledge about the impact of the cost and the economic burden associated with dengue and chikungunya will help policymakers allocate and appropriate resources accordingly.

First report on genome wide association study in western Indian population reveals host genetic factors for COVID-19 severity and outcome.

Different human races across the globe responded in a different way to the SARS-CoV-2 infection leading to different disease severity. Therefore, it is anticipated that host genetic factors have a straight association with the COVID-19. We identified a total 6, 7, and 6 genomic loci for deceased-recovered, asymptomatic-recovered, and deceased-asymptomatic group comparison, respectively. Unfavourable alleles of the markers nearby the genes which are associated with lung and heart diseases such as Tumor necrosis factor superfamily (TNFSF4&18), showed noteworthy association with the disease severity and outcome for the COVID-19 patients in the western Indian population. The markers found with significant association with disease prognosis or recovery are of value in determining the individual's response to SARS-CoV-2 infection and can be used for the risk prediction in COVID-19. Besides, GWAS study in other populations from India may help to strengthen the outcome of this study.

Decision-Making Skills: An Assessment among Adolescents in Surat City.

INTRODUCTION: This study assessed the process of decision-making among adolescents and the factors affecting it and also explored the styles of decision-making among adolescents. METHODOLOGY: A cross-sectional study using purposive sampling was carried out involving 1177 college-going students aged between 17 and 19 years. General Decision-Making Style (GDMS) and semi-structured questionnaire was used to collect data. Data were analyzed with the help of SPSS and AMOS. Exploratory and confirmatory factor analyses were run. RESULTS: Good decision-making process was seen among 76.9% of the students. Kaiser-Meyer-Olkin verified that sampling adequacy was 0.8. Scree plot and Monte Carlo parallel analysis were suggestive of four factors which were logically intuitive, avoidant, dependent, and spontaneous styles of making decisions. Cronbach's alpha was 0.7 for GDMS. Staying arrangement, paternal education, fantasy scale score, perspective-taking score, personal distress score, problem-solving, self-esteem, creative thinking, and coping with stress were found statistically significant with decision-making process. While, on confirmatory factor analysis, a five-factor model was found to be fit with minimum discrepancy/degrees of freedom value of 2.68, root mean square error of approximation: 0.038, Comparative Fit Index (CFI): 0.927, Normed Fit Index (NFI): 0.890, parsimony CFI: 0.66, and parsimony NFI: 0.634. A high correlation was observed between rational and intuitive styles. CONCLUSION: The process of decision-making was found to be good, but styles of making decisions were overlapping.

Restructuring the Modified Faine's Criteria for the Diagnosis of Leptospirosis in Monsoon: A Study from South Gujarat.

CONTEXT: Clinical and epidemiological variables in the modified Faine's criteria offered low validity in our study setting. AIMS: Restructuring and validating modified Faine's criteria for leptospirosis to better suit health scenario of south Gujarat. SUBJECTS AND METHODS: Clinical, epidemiological, and laboratory features of derivation cohort (1216 suspected leptospirosis cases) admitted at a tertiary care hospital of south Gujarat (2007-2015) that significantly correlated with confirmed leptospirosis were used in binary logistic regression to derive scoring models and receiver operating characteristic to determine cutoff values. Validity and net reclassification improvement (NRI) were estimated in validation cohort (82 cases, 2016-2017) and algorithm for diagnosis was prepared. RESULTS: Screening model consisted of the presence of conjunctival suffusion, calf tenderness, raised serum creatinine, headache with conjunctival suffusion and/or jaundice, and dyspnea/meningism. Area under curve (AUC) for screening model was 0.590 (standard error [SE] ±0.017) and cutoff score ≥9 gave sensitivity 79.16%, specificity 50%. The confirmatory model consisted of laboratory parameters, namely polymerase chain reaction, immunoglobulin M ELISA, and microscopic agglutination test and gave AUC 0.998 (SE ± 0.001), sensitivity 89.58%, specificity 85.29%, positive predictive value 89.58%, and negative predictive value 85.29% at cutoff score ≥100. Net sensitivity of algorithm was 98.27% at the point of screening (screening model and rapid test) and net specificity 87.89% at the point of confirmation (screening followed by confirmatory model) in validation cohort. CONCLUSIONS: Simultaneous use of screening model and rapid test gave NRI 81.25% and sequential use of confirmatory test gave NRI 47.18% compared to corresponding parts of the modified Faine's criteria.

Double outbreak of measles in the talaja block of bhavnagar district, gujarat, India 2011: a need for improving the vaccine coverage and the community participation.

BACKGROUND: Two outbreaks of measles were reported from an urban and a village area of Bhavnagar District, Gujarat, India in January and March 2011 respectively. AIM: The present study was conducted to investigate and to assess various epidemiological features which were associated with the measles outbreak. SETTINGS AND DESIGN: The present study was designed as a cross sectional study, which was conducted in an urban and a rural area of the Talaja block of the Bhavnagar district of Gujarat, India from December 2010 to April 2011. METHODS AND MATERIAL: The suspected cases were detected through an active case finding in the community. We defined a case clinically by the WHO criteria as the occurrence of a febrile rash with or without cough, coryza and conjunctivitis in a resident of the Talaja-urban and the Gorkhi village of the Talaja block, in the period from 1(st) December 2010 to 30(th) April 2011. Blood samples from 10 case patients were collected for the IgM antibody detection. A community based, retrospective, cohort design was carried out to find the vaccine efficacy in the Gorkhi village. STATISTICAL ANALYSIS: We entered and analyzed the data by using an MS-Excel sheet. RESULTS: This study identified 27 confirmed cases of measles in the urban area of Talaja and 78 cases in Gorkhi village. All the 105 case patients belonged to the age group of 3 months-15 years. According to their mothers' statements, out of the 105 measles cases in the two areas, 40 (38%) case patients were immunized. Ten sera from five case-patients each from both the areas were tested; all were found to be positive for the IgM/IgG antibodies by ELISA. CONCLUSIONS: The outbreaks occurred due to a poor community participation and the poor vaccine coverage levels.

Epidemic investigation of the jaundice outbreak in girdharnagar, ahmedabad, gujarat, India, 2008.

BACKGROUND: Since 1976, seven outbreaks of hepatitis E occurred in Ahmedabad. Clusters of jaundice cases were reported on June 19, 2008, by a civic center, Girdharnagar ward, Ahmedabad. OBJECTIVES: THE OBJECTIVES WERE AS FOLLOWS: (1) to identify the etiological agent, source of outbreak, and mode of transmission; (2) to propose a control measure based on the outbreak investigation. MATERIALS AND METHODS: We defined a case as an acute illness with (a) a discrete onset of symptoms and (b) jaundice or elevated serum aminotransferase levels, from March to September 2008 in the households of the Girdharnagar ward. We collected data through a door-to-door survey and hospital records. We described the outbreak in terms of time, place, and person. We collected laboratory investigation reports of case patients admitted to the civil hospital. To test our hypothesis we conducted a retrospective cohort study to find out the relative risk for hepatitis. We conducted environment investigation to find out the source of contamination of water supply. RESULTS: A total 233 case patients of hepatitis were identified with the attack rate of 10.9/1000 population. Cases were reported in all the age groups with a higher attack rate in the age group of 20-29 years (18.5/1000). Out of 17 case patients, 16 were positive for the hepatitis E IgM antibody. The attack rate was two times more among those who were exposed to the leaking pipeline than the non-exposed (RR=2.3, 95% CI 1.76, 2.98). Environmental investigation also confirmed the sewage contamination of drinking water in the distribution system. CONCLUSION: The outbreak was due to hepatitis E virus. We recommended a temporary alternative water supply, repair of the leakages, and water quality surveillance.