The novel Coronavirus COVID-19 is wrecking a havoc across the globe and has been declared as a pandemic by WHO. Apart from transmission and shedding of the virus through respiratory secretions in the form of droplets (mainly), several studies have shown the presence of the virus in various samples such as stool, urine and occasionally in blood, semen, tears and breastmilk. Whereas government authority guidelines consider a person as cured from COVID-19 when along with clinical improvement no more virus can be detected primarily on respiratory samples along with clinical improvement; the persistence of the virus in these body fluids even after clinical recovery and negative RT-PCR test results on respiratory samples, has raised many questions about the elusive nature of this novel virus along with the possibility of other routes of transmission of this virus in the community. Although studies performed till now across the globe on persistence of SARSCOV-2 in various body fluids are sparse, in this review we would like to present and analyse the results of those studies performed globally on the aforesaid topic to get a better insight of this side of the COVID-19 story.
SARSCoV-2, a coronavirus that causes COVID-19, is spreading rapidly. By the middle of August-2021, it has affected over 3 million confirmed cases in India. The main aim of this study was to examine the clinical profile of COVID-19 patients and their length of stay during treatment in a hospital.It was a hospital-based retrospective study conducted by using a total enumeration technique in July-August 2021 at Nehru Hospital, Postgraduate Institute of Medical Education and Research (PGIMER) in India. The present study was conducted on 72 COVID-19 patients who took treatment in 4C and 5C wards. Structured questionnaires were used to collect data, which included bio-demographic factors and questions about their treatment and length of stay.The majority of the 72 COVID-19 positive patients were men (62%), belonged to the age group of 41-60 years (35%), had SpO2 levels ranging from 91%-95% (45%), and received room air O2 therapy (63%) during their treatment in the hospital. Female patients had a longer length of stay (7.33 days), patients under the age of 20 years had the longest hospital stay (11.5 days), patients with SpO2 less than 70% had the longest hospital stay (8 days), and patients who received oxygen using a non-rebreathing mask had the longest hospital stay (11 days).To avoid panic situations, regular admission and discharge of patients was essential due to the considerable increase in cases during the second wave. Patient length of stay was reduced as a consequence of collaboration and cooperation among all physicians, residents, staff nurses, and paramedics, with the goal of discharging the patient after a room air trial and follow up if needed.
Urinary tract infections (UTI) can vary from simple cystitis to pyelonephritis with severe sepsis. The objective of this study is to provide information about the clinical and microbiological profile of admitted patients of urinary tract infection, patterns of organisms isolated, antibiotic sensitivity pattern and antibiotics use. It was a prospective observational study conducted on 40 patients age >14 years admitted with diagnosis of UTI based on clinical and microbiological criteria over 8 months at a tertiary care hospital in North India. Data was collected for the clinical, microbiological profile, empirical and definite antibiotics use with duration of stay and outcome of patients. Among 40 cases of UTI; male to female ratio was 1:1 with mean age of 51.3± 16.32 years. Fever was present in almost all (97.5%) of the patients and three-fourth (75%) of them had dysuria. Type-2 Diabetes Mellitus was most common (55%) underlying condition and mean HbA1c was 9.37±2.27 followed by obstructive uropathy (17.50%). Most of cases (82.5%) were of complicated UTI; where Pyelonephritis was 42%, Emphysematous Pyelonephritis 12.5% and Renal Abscess 7.5%. Most common (37.5%) organism isolated from urine/ pus culture was Escherichia coli. More than half of the patients (55%) were given empirical antibiotics injection piperacillin tazobactam and carbapenems was used in more than one third (35%) of patients. The mean duration of antibiotics use was 14.55±4.94 days. Two (5.0%) patients expired out during the study period. Uncontrolled Diabetes Mellitus remains the major underlying condition in cases of complicated UTI. E coli is the most common organism isolated from urine/ pus culture. Most of the patients had favourable outcome with guided antibiotics and interventions. Bangladesh Med J. 2023 May; 52(2): 15-19
The aim of this study was to analyze the clinical features of patients attending the screening clinic of a dedicated COVID-19 hospital (DCH), including COVID-19 RT-PCR test positivity rate, symptom predictors for COVID-19 positivity, the proportion of recovery, and the mortality among COVID-19 positive cases.We conducted a cross-sectional study of the patients who reported in the screening clinic of a DCH. Data were retrieved from medical records. Step-wise binary logistic regression was applied to determine the symptom predictors for determining the likelihood of the suspects turning out to be COVID-19 positive.A total of 573 patients reported to the screening clinic were enrolled, and their median age was 36 ± 14 years. Of the total patients, 237 (41%) were females and 112 (20%) patients were COVID-19 suspects. Fifty (45%) suspects tested COVID-19 positive. The majority of the positives had complaints of cough, fever, and sore throat. Running nose (OR = 7.951) and history of contact with a COVID-19-positive case (OR = 169.9) were found to be statistically significant symptom predictors for COVID-19 positivity. All patients recovered with nil case fatality.Running nose and history of contact with COVID-positive patients were significant predictors for COVID-19 positivity. In this pandemic state, patients who present with any of the upper respiratory infection (URI) symptoms such as cough, sore throat, running nose, headache, and loss of taste/smell should be tested for COVID-19 for early identification and isolation to break the chain of transmission. The public should be encouraged to undergo COVID-19 testing if they develop any of the URI symptoms.
According to Global human immunodeciency virus and acquired immunodeciency disease syndrome statistics, 38.4 million(33.9 million-43.8 million) people live globally with HIV in 2021, and 1.5 million people became newly infected with HIV in 2021(1). As per India HIV estimation report 2020, national adult (15–49 years) HIV prevalence was estimated at 0.22% (0.17%–0.29%) in 2020, 0.23% (0.18%–0.31%) among males and 0.20% (0.15%– 0.26%) among females(2). HIV is a condition which can progressively affect almost all body organs and systems due to immune system failure. Infection with HIV is well known to cause peripheral neuropathy and other neurological complication thus affecting the quality of life(3). Autonomic nervous system involvement can affect heart rate, vasomotor tone, sexual function, gastrointestinal motility, urination, thermoregulation and production of tears and saliva. This can lead to diverse symptoms like postural syncope, impotence, sweating, diarrhea/constipation, dry eyes and mouth, urinary incontinence and changes in skin temperature. Abnormalities in cardiac autonomic function occur at all CD4 levels(4,5). The aim of our study is to assess autonomic dysfunction in HIV-positive patients and to show the correlation between decreasing CD4 + T cell counts with increasing severity of disease in the form of autonomic dysfunction.
Since the detection of the new Omicron (B.1.1.529) variant of the SARS-CoV-2 virus, there has been a rapid rise in the number of patients being sampled. SARS-CoV-2 has been detected in the tissues within and in the vicinity of the oral cavity. During toothbrushing, oral fluids like saliva and gingival crevicular fluid, along with dental plaque find their way deep into the bristles of the brush, and as the SARS-CoV-2 viral RNA has been detected in all three, it is reasonable to conclude that a toothbrush could harbour it too (Gaur et al., 2021; Gomes et al., 2021; Gupta et al., 2021). Besides these three, SARS-CoV-2 has also been detected in dental calculus (Berton et al., 2021). An attempt was made to detect the presence of SARS-CoV-2 viral RNA in toothbrushes. The study was carried out by the Unit of Periodontics, Oral Health Sciences Centre, in collaboration with the Department of Internal Medicine and Department of Virology, Postgraduate Institute of Medical Education and Research, Chandigarh, India. Following due approval from the Institute Ethics Committee (INT/IEC/2021/SPL-636 dated 8 April 2021), 25 patients presenting to the Communicable Diseases Ward on the 5th day of infectivity between 26 May 2021 and 9 July 2021 were recruited into the study after their COVID-19 status was confirmed by nasopharyngeal swab (NPS) testing. The recruited subjects ranged in age from 2 to 72 years. All 25 patients were symptomatic at the time of enrolment. Soft toothbrushes with end-rounded bristles and flexible neck (Anchor comfy grip®) were given to all the participants, and they were instructed to perform toothbrushing in their usual manner for 2 min using pea size toothpaste also provided by the researchers (Colgate Total®). After toothbrushing, the toothbrush head was cut and put into a vial containing 3 ml of viral transport media. The presence of SARS-CoV-2 RNA was detected by real-time reverse transcriptase-polymerase chain reaction (rRT-PCR) using Real-time Fluorescent RT-PCR kit for detecting SARS-CoV-2 kit, BGI Genomics Co. Ltd, China. As per the manufacturer's instructions, cycle threshold (Ct) value >38 of target genes (ORF1ab and human β–actin) was considered as negative while Ct ≤38 with sigmoid graph was considered as positive. SARS-CoV-2 viral RNA was detected in 15 out of 25 toothbrush samples. Considering NPS to be gold standard, the current study found the sensitivity of toothbrushes to be to the tune of 60%, which is comparable to the sensitivities reported with saliva (64.52%), gingival crevicular fluid (63.64%) and buccal swab sampling (58.9%) (Gaur et al., 2021; Gupta et al., 2021). The sensitivity is bound to increase if toothbrushes are checked on the first day of symptoms itself. The mean cycle threshold (Ct) value of NPS was 21.52 ± 5.82 and that of brush heads was 32.1 ± 3.04. There was a significant difference of 8–9 Ct change in brush heads compared to NPS. Hence, within the limitations of the small sample size of the study, we conclude that toothbrushes can act as sampling methodology for the detection of SARS-CoV-2. They can be utilized as an alternative sampling methodology for patients in whom NPS sampling is not amenable, especially in the paediatric population. Not only is toothbrush sampling cost effective and painless but is also a self-collectable modality which requires no technical skill or mandate to follow special instructions on part of the patient. Future studies should aim to corroborate these findings further. The authors report no conflict of interest with respect to the research, authorship and/or publication of this article. Shipra Gupta: Conceptualization; data curation; investigation; methodology; project administration; visualization; writing–original draft; writing–review and editing. Ritin Mohindra: Data curation; investigation; methodology; resources; writing–review and editing. Akanksha Jain: Investigation; methodology; resources; writing–review and editing. Mohita Singla: Investigation; methodology; resources; writing–review and editing. Timo Sorsa: Conceptualization; supervision; writing–review and editing. Ismo Räisänen: Conceptualization; formal analysis; writing–review and editing. Meenakshi Malhotra: Investigation; methodology; writing–review and editing. Roop K. Soni: Investigation; methodology; resources; writing–review and editing. Amit Kumar: Conceptualization; visualization; writing–review and editing. Poonam Kanta: Investigation; methodology; writing–review and editing. Krishan Gauba: Conceptualization; supervision; resources; writing–review and editing. Mini P. Singh: Conceptualization; investigation; supervision; writing–review and editing. Arnab Ghosh: Investigation; writing–review and editing. Vikas Suri: Resources; supervision; writing–review and editing. The peer review history for this article is available at https://publons.com/publon/10.1111/odi.14122. The peer review history for this article is available at https://publons.com/publon/10.1111/odi.14122.
Inappropriate antimicrobial prescribing is considered to be the leading cause of high burden of antimicrobial resistance (AMR) in resource-constrained lower- and middle-income countries. Under its global action plan, the World Health Organization has envisaged tackling the AMR threat through promotion of rational antibiotic use among prescribers. Given the lack of consensus definitions and other associated challenges, we sought to devise and validate an Antimicrobial Rationality Assessment Tool—AmRAT—for standardizing the assessment of appropriateness of antimicrobial prescribing. A consensus algorithm was developed by a multidisciplinary team consisting of intensivists, internal medicine practitioners, clinical pharmacologists, and infectious disease experts. The tool was piloted by 10 raters belonging to three groups of antimicrobial stewardship (AMS) personnel: Master of Pharmacology (M.Sc.) (n = 3, group A), Doctor of Medicine (MD) residents (n = 3, group B), and DM residents in clinical pharmacology (n = 4, group C) using retrospective patient data from 30 audit and feedback forms collected as part of an existing AMS program. Percentage agreement and the kappa (κ) coefficients were used to measure inter-rater agreements amongst themselves and with expert opinion. Sensitivity and specificity estimates were analyzed comparing their assessments against the gold standard. For the overall assessment of rationality, the mean percent agreement with experts was 76.7% for group A, 68.9% for group B, and 77.5% for group C. The kappa values indicated moderate agreement for all raters in group A (κ 0.47–0.57), and fair to moderate in group B (κ 0.22–0.46) as well as group C (κ 0.37–0.60). Sensitivity and specificity for the same were 80% and 68.6%, respectively. Though evaluated by raters with diverse educational background and variable AMS experience in this pilot study, our tool demonstrated high percent agreement and good sensitivity and specificity, assuring confidence in its utility for assessing appropriateness of antimicrobial prescriptions in resource-constrained healthcare environments.
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