Short-acting β2-agonists over-prescription in patients with asthma: an Indian subset analysis of international SABINA III study

OBJECTIVE

The SABINA (SABA use IN Asthma) program was initiated to describe short-acting β2-agonists (SABA) prescription patterns and assess the impact of its over-prescription on exacerbation risk and asthma control. We evaluated SABA prescription patterns in patients with asthma in the Indian cohort of SABINA III.

METHODS

This multi-centre, observational, cross-sectional study included retrospective and real-time electronic data collection. Data were extracted from medical records of patients with asthma (aged >12 years) having >3 consultations with the same healthcare practitioners between March 2019 and January 2020. The data included prescriptions of SABA and other asthma treatments and over-the-counter (OTC) purchases of SABA. SABA prescriptions were categorized by the number of SABA canisters prescribed in the 12 months preceding the study visit.

RESULTS

A total of 510 patients with asthma were included from specialist care (mean age 49.1 years; 57.65 females), with 8.2% classified with mild asthma and 91.8% with moderate-to-severe asthma. SABA as monotherapy and add-on to maintenance therapy was prescribed to 4.5% (n = 23) and 44.9% (n = 229) of patients, respectively. While ICS monotherapy and ICS/LABA were prescribed to 5.1% (n = 26) and 93.3% (n = 476) of patients, respectively. SABA was found to be over-prescribed (≥3 SABA canisters/year) among 23.9% of patients (n = 122). Additionally, 8% of patients (n = 41) purchased SABA OTC without prescription.

CONCLUSIONS

Nearly one-fourth of patients with asthma in India were over-prescribed SABA. Educational programmes targeted at national and regional levels should be expanded to raise greater asthma awareness and encourage the adoption of guideline-directed asthma treatment plans among healthcare practitioners.

Postcode based participatory disease surveillance systems : a comparison with traditional risk-based surveillance and its application in the COVID-19 pandemic

BACKGROUND

Background: The SARS-Cov-2 infection has rapidly saturated health systems and traditional surveillance networks are finding hard to keep pace with its spread. We designed a participatory disease surveillance (PDS) system, to capture symptoms of Influenza-like illness (ILI) to estimate SARS-CoV-2 infection in the community. While data generated by these platforms can help public health organisations find community hotspots and effectively direct control measures, it has never been compared to traditional systems.

OBJECTIVE

Methods and Objectives: A completely anonymised web based PDS system, www.trackcovid-19.org was developed. We evaluated the symptomatic responses received form the PDS system to the traditional risk based surveillance carried out by the Bruhat Bengaluru Mahanagara Palike over a period of 45 days in the South Indian city of Bengaluru.

METHODS

Methods and Objectives: A completely anonymised web based PDS system, www.trackcovid-19.org was developed. We evaluated the symptomatic responses received form the PDS system to the traditional risk based surveillance carried out by the Bruhat Bengaluru Mahanagara Palike over a period of 45 days in the South Indian city of Bengaluru.

RESULTS

Results: The PDS system recorded 11062 entries from 106 Postal codes. A healthy response was obtained from 10863 users while 199 (1.8%) reported symptomatic. Subgroup analysis of a 14 day symptomatic window recorded 33 (0.29%) responses. Risk based surveillance was carried out covering a population of 605,284 with 209 (0.03%) individuals identified symptomatic.

CONCLUSIONS

Conclusion: Web PDS platforms provide better visualisation of community infection when compared to traditional risk based surveillance systems. They are extremely useful by providing real time information in the extended battle against this pandemic. When integrated into national disease surveillance systems, they can provide long term community surveillance adding an important cost-effective layer to already available data sources.

Contact Tracing and Quarantine for Covid 19: Challenges in community surveillance

Covid 19 caused by SARS-coV-2 is a novel corona virus. This began in Wuhan city, China at the end of December 2019 and had spread to the rest of the world. World Health Organization (WHO) declared Covid 19 as Public Health Emergency of International Concern (PHEIC) on 30th Jan 2020 and later declared as pandemic on 11th march 2020. 1 The disease is mainly spread from human to human through small droplets from nose or mouth when a person with Covid 19 coughs or exhales and through the surface contact. Community surveillance plays significant role in prevention of spread of disease. It includes isolation of the positive case, quarantine of the high risk and low risk contacts and community disinfection.1, 2             The period of communicability is estimated with the current data to be from 2 days before the onset of symptoms and up to 2 weeks after onset. Hence the initial few asymptomatic days turns out to be crucial period in containing the spread of infection. By the time a Covid 19 patient is diagnosed and isolated, there are quite a number of primary and secondary contacts. Government of India focus has been on Community Surveillance activities which mainly comprises of Contact Tracing and Quarantine.3, 4 This article focuses on the various measures taken to trace the contacts, quarantine measures and on the challenges faced.

A Study on Respiratory Morbidities and Pulmonary Functions among Traffic Policemen in Bengaluru City

CONTEXT

Air pollution is a major public health problem in the present Indian cities, due to unplanned urbanization and increased use of vehicles. Traffic policemen, due to the nature of their job and working atmosphere, are more prone to develop respiratory problems such as asthma, chronic obstructive pulmonary disease, rhinitis, recurrent respiratory tract infections, and others.

OBJECTIVES

The objective was to find out the respiratory morbidities and to assess their pulmonary function using computerized spirometry among traffic policemen in Bengaluru city.

SETTINGS AND DESIGN

A cross-sectional study was conducted for a period of 6 months (from January 2018 to June 2018) in randomly selected traffic police stations in South Bengaluru, Karnataka.

SUBJECTS AND METHODS

A pretested, semi-structured questionnaire was used to collect information on the demographic profile, duration of exposure, smoking history, allergy/asthma history, and the use of personal protective measures. Pulmonary function test (PFT) was done to assess the lung function using computerized spirometry.

STATISTICAL ANALYSIS USED

Data were entered and analyzed using Microsoft Excel 2016 version.

RESULTS

A total of 217 traffic policemen were included in the study. The mean duration of working in the traffic department was 5.9 ± 6.6 years (mean ± standard deviation). Among them, 101 (46.5%) used personal protective measures. Allergic rhinitis was reported by 38 (17.5%) individuals, and 28 (12.9%) individuals had chest symptoms (cough and breathing difficulty). Among them, 44 (20.3%) experienced exacerbation of these symptoms at the workplace. Observed mean values of all parameters in the PFT were less than their predicted (expected) values.

CONCLUSIONS

There was increased burden of respiratory problems and lower lung volumes and flows among traffic policemen.

Sensitization to silk allergen among workers of silk filatures in India: a comparative study

Background

Sericulture plays an eminent role in development of rural economy in India. Silk filature is a unit where silk is unwound from the cocoons and the strands are collected into skeins. During the process workers are exposed to the high molecular weight proteins like Sericin and Fibroin which are potent allergens leading to sensitization over a period of time and subsequently occupational related health disorders.

Objective

To identify and compare the magnitude of silk allergen sensitization in workers of silk filatures.

Methods

A community based comparative descriptive study was conducted for a period of 1 year at Ramanagara in south India. One hundred twenty subjects working in the silk filatures formed the study group. For comparison, 2 types of controls were selected viz.120 subjects who were not working in the silk filatures but resided in the same geographical area (control A) and 360 subjects who were not working in silk filatures as well not residing in the same geographical area (control B). Skin prick test was used to identify the silk allergen sensitization.

Results

Mean age was 34.14 ± 2.84 years in the study group. Mean age was 40.59 ± 14.40 years and 38.54 ± 12.20 years in control A and control B, respectively. There were 35 males (29.16%) and 85 females (70.84%) in the study group. There were 58 (48.34%) males and 62 (51.66%) females and 152 (42.2%) males and 208 females (57.8%) in control A and control B, respectively. Sensitization to silk allergen was 35.83% in the study group and 20.83% in the control group A and 11.11% in control group B. There was difference in the allergen sensitivity between the study group and control groups and it was statistically significant (chi-square = 38.08; p < 0.001).

Conclusion

There is high burden of silk allergen sensitization among silk filature workers.

A study on occupational asthma among workers of silk filatures in South India

Background:

The production of silk is a multidimensional and multistep process involving exposure of workers to allergens at work place. The silk allergen has been implicated in the development of bronchial asthma.

Objectives:

To identify the prevalence of occupational asthma (OA) and to identify sensitization to silk allergen and among workers in silk filature units.

Materials and Methods:

A community-based cross-sectional study was conducted in silk filature units of Ramanagara (Silk City) in Karnataka, South India, for a period of 6 months. One hundred and twenty workers of silk filature units who met the inclusion and exclusion criteria were recruited into the study group. For comparison, a control group comprising of 120 individuals not working in silk filature units was constituted. All the subjects were interviewed using the standardized International Union against Tuberculosis and Lung Diseases (IUATLD) Questionnaire and subjected to the skin prick test, which used the extracts of silk allergen.

Results:

The study group comprised of 35 males and 85 females, whereas the control group comprised of 58 males and 62 females. The prevalence of occupational asthma among workers in silk filatures was 20.83%. It was observed that 35.83% of those in the study group and 20.83% of those in the control group were found to be sensitive to silk allergen. This difference was statistically significant (χ²= 6.64; P < 0.05).

Conclusion:

There is a high burden of sensitization to silk allergen and occupational asthma among silk filature workers in South India.

Safety and immunogenicity study of a new purified chick embryo cell rabies vaccine Vaxirab-N (Pitman-Moore strain) manufactured in India

Zydus Cadila Health care, India developed a new purified chick embryo cell rabies vaccine (PCECV, Vaxirab-N; 1 mL) by adapting Pitman-Moore strain of virus on to the chick embryo fibroblast cell line in 2006. During 2007-10, a series of safety and immunogenicity studies were conducted as per ICH-GCP guidelines after obtaining permission from Drug Controller General of India. In the first study, Vaxirab-N was administered to 35 healthy adult volunteers by intramuscular (IM) route using pre exposure regimen. The geometric mean concentration (GMC) of rabies virus neutralizing antibody (RvnAb) of 7.5 IU/mL on day 35. In the second study, Vaxirab-N was administered to 35 healthy adult volunteers using simulated post- exposure prophylaxis regimen by IM route. A GMC of 6.3 IU/mL on day 14, 13.2 IU/mL on day 28 and 8.6 IU/mL on day 90 was obtained. In the third study, Vaxirab-N administered by intradermal (ID) route using Updated Thai Red Cross (TRC) regimen in 36 healthy adult volunteers showed GMC of 7.8 IU/mL on day 14, 11.5 IU/mL on day 28 and 6.0 IU/mL on day 90. The 4th study was multi centric and Vaxirab-N was administered to 129 animal bite cases by IM route using post-exposure Essen regimen. The GMC following this schedule was 8.2 IU/mL on day 14, 13.01 IU/mL on day 28, 7.92 IU/mL on day 90 and 3.72 IU/mL on day 180. Mild to moderate adverse events were reported to Vaxirab-N but no serious adverse events were reported in any of these studies. In conclusion, Vaxirab-N developed by Zydus Cadila was found to be safe and immunogenic by both intramuscular and intradermal route and is recommended for rabies prophylaxis (CTRI No. 2010/091/000055 and 2010/091/000509).

Vertical distribution of polychaetes in brackishwater pond of Nethravathi estuary, India

Vertical distribution of polychaetes in a semi-enclosed brackishwater pond of Nethravathi estuary was studied for one year from February 2004 to January 2005. The semienclosed brackishwater pond is a shallow water body with an average depth of 1-1.5 m with an area of 12 ha having direct connection with the estuary which opens into the Arabian sea. A total of nine species of polychaetes were identified. Among these, Dendronereis aestuarina and D. arborifera were most common and accounted for 65.62% of total abundance. The fauna were more abundant at 5-10 cm depth than at 0-5 cm depth and decreased beyond 10 cm depth. Species composition and the abundance of polychaetes were generally high during postmonsoon followed by premonsoon and monsoon season. Polychaete abundance showed positive significant correlation with organic carbon content at all depth layers of sediments in all the stations.