Treatment outcomes of digital nasoalveolar moulding in infants with cleft lip and palate: A systematic review with meta-analysis

The aim of this systematic review was to compare the treatment outcomes of digital nasoalveolar moulding (dNAM) technique with conventional nasoalveolar moulding (cNAM) or non-presurgical intervention protocol in infants with unilateral (UCLP) or bilateral (BCLP) cleft lip and palate. A bibliometric search by MEDLINE (via Ovid), Embase, Cochrane Library, grey literature and manual method was conducted without language restriction until November 2023. Literature screening and data extraction were undertaken in Covidence. The risk of bias was evaluated using the Newcastle-Ottawa Scale and RoB-2. Pooled effect sizes were determined through random-effects statistical model using R-Software, and the certainty of evidence was assessed using the GRADE approach. Among 775 retrieved articles, nine studies were included for qualitative synthesis (6-UCLP, 3-BCLP), with only three eligible UCLP studies for meta-analysis. In the UCLP group, very low certainty of evidence indicated no difference in alveolar cleft width (SMD, 0.13 mm; 95% CI, -0.31 to 0.57; I2, 0%), soft tissue (lip) cleft gap, nasal width, nasal height, and columellar deviation angle changes between dNAM and cNAM. In the BCLP group, qualitative synthesis suggested similar changes in alveolar, lip, and nasal dimensions with dNAM and cNAM. In both cleft groups (UCLP, BCLP), reduced alveolar cleft width was observed in the dNAM group compared to the non-presurgical intervention protocol, along with fewer clinical visits and reduced chairside time for dNAM compared to cNAM. It can be concluded that the treatment outcomes with dNAM were comparable to cNAM in reducing malformation severity and were advantageous in terms of chairside time and clinical visit frequency. However, the overall quality of evidence is very low and standardization is needed for the virtual workflow regarding the alveolar movements and growth factor algorithms. Registration: PROSPERO-database (CRD42020186452).

The risk of bonded fragment loss in crown-fractured anterior teeth managed by fragment reattachment: a systematic review and meta-analysis

PURPOSE

To identify the factors affecting the risk of bonded fragment loss in crown-fractured anterior teeth managed by fragment reattachment.

METHODS

The study protocol followed the best practices of evidence-based medicine and was registered in PROSPERO. A comprehensive literature search was performed electronically in six databases (PubMed, Embase, SCOPUS, Web-of-Science, Lilacs, and Cochrane) on 18-09-2023. It was saved in EndNote-online and duplicates were removed. Selection of articles was performed in two stages, followed by data-extraction, risk of bias assessment, data-analysis, and meta-analysis. The quality of evidence for the outcomes was assessed by the GRADE-approach.

RESULTS

The study included six articles that had similar selection protocols with variations in duration from trauma to treatment and the observation period. Only one study employed pre-attachment fragment preparation and three performed post-attachment reinforcements. Overall loss of fragment was 20% (95%CI-13,30%). When the risk ratio for loss of restoration or fragment was compared, it was found to be 2.21 (95%CI-1.52,3.21) in uncomplicated crown fractures, 2.54 (95%CI-1.35,4.79) in complicated crown fractures. The risk of bias was found to be low in two and moderate in four studies. Grade of evidence for all the outcomes was very low.

CONCLUSION

Fragment loss was lowest in uncomplicated crown fractures where reinforcement had been performed, and highest when bonding was done in complicated crown fractures without reinforcement. The risk of fragment loss was higher than the loss of composite restorations.

Risk of pulp necrosis and related complications in the permanent anterior teeth with lateral luxation: A systematic review and meta-analysis

This systematic review aimed to evaluate the evidence related to the occurrence of pulp necrosis and related complications in permanent anterior teeth with lateral luxation. It was envisaged to address the ambiguity related to the recommendation for pulp extirpation in teeth with mature root apex. An a priori protocol was formulated as per the best practices of evidence-based medicine and registered in PROSPERO. A comprehensive search was performed electronically in PubMed, LILACS, Web of Science, EMBASE, Scopus, and Cochrane on July 10,2023 without any restriction of language or year of publication. The screening of titles and abstracts and later the full-text articles were performed. Later, the data extraction was performed by using a self-designed sheet, risk of bias (ROB) assessment was done, meta-analysis was performed, and the GRADE approach was used to assess the quality of evidence. The qualitative synthesis was performed on 13 studies done from 1985 to 2020 in hospital settings. There was variability in the minimum and total observation periods, sample sizes, and characteristics of the sample population. The overall pooled prevalence of pulp necrosis was found to be 57% (95% CI: 42, 72%). It was 12% (95% CI: 8%, 18%, I2 = 0%) in immature teeth, and 58% (95% CI: 42, 73%, I2 = 86%) in mature teeth. The pooled prevalence of EIRR was found to be 11% (95% CI: 4, 27%, I2 = 95%) with greater risk in teeth with mature root apex (RR: 1.26, 95% CI: 1.12, 1.42, I2 = 0%). The ROB was moderate or high in nine studies and the GRADE of evidence was very low in 14 of 15 outcomes. There are greater chances of pulp necrosis in teeth with lateral luxation, especially with mature apex. However, it can still be less than 60% in most cases with the prevalence of EIRR less than 20%. Hence, an absolute recommendation for endodontic intervention in mature teeth with lateral luxation must be interpreted with slight caution.

Effectiveness of targeted intervention program under the national AIDS control program among Hijra and transgender population: Evidence from Integrated Biological and Behavioral Surveillance, 2014-15

INTRODUCTION

The hijra and transgender (H/TG) population in India is vulnerable to HIV/AIDS. India had instituted a targeted intervention (TI) program to reduce this vulnerability. We aimed to measure the effectiveness of the TI program for H/TG.

MATERIALS AND METHODS

The National Integrated Behavioral and Biological Survey (IBBS) was carried out in 2014-15. H/TG data from IBBS was analyzed. Bivariate and multivariate logistic regression were used to calculate the unadjusted and adjusted odds ratios with 95% confidence interval. Condom use during the last sexual intercourse, and the consistent condom use in the last one month were considered as indicators of program effectiveness. The Propensity Score Matching (PSM) method was used to assess the effectiveness.

RESULTS

We found that the participants who had received condoms from peer educator/outreach worker were 1.74 and 1.40 times more likely to use condoms in the last sexual intercourse (aOR: 1.74, CI: 1.35 - 2.26) and consistent condom use in the last one month (aOR: 1.40, CI: 1.12 - 1.74) respectively compared to the participants who did not receive the condom. The matched-samples estimate (i.e., average treatment effect on treated) for the condom use during the last sexual intercourse increased by 13.0%, i.e., 0.13 (CI; 0.08 - 0.18) and consistent condom use in the last one month increased by 5.0%, i.e., 0.05 (CI; 0.00 - 0.10) among those who had received condoms from the peer educator/outreach worker compared with those who had not received condom, respectively.

CONCLUSIONS

The TI program intervention for H/TG was effective in reducing HIV risk behavior as evidenced by increase in use of condom during last sexual intercourse, and consistent condom use in the last one month.

Risk factors associated with traumatic dental injuries in individuals with special healthcare needs-A systematic review and meta-analysis

BACKGROUND/AIM

Individuals with special healthcare needs (SHCN) are more likely to sustain traumatic dental injuries (TDIs) due to distinct risk factors. The aim of this review was to assess various risk factors associated with TDIs in individuals with SHCN.

MATERIALS AND METHODS

The protocol was designed according to the recommendations of the Cochrane-handbook, Joanna Briggs Institute, and the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines and registered in PROSPERO (CRD42022357422). A comprehensive search was performed in PubMed, LILACS, Web of Science, EMBASE and Scopus using a pre-defined strategy without any limitation of language and year of publication. It was last updated on 25 April 2023. Studies addressing the TDIs in individuals with SHCN were included. Data extraction and analyses were performed, risk of bias (ROB) assessment was done using the Joanna Briggs Institute's critical appraisal tool, and a meta-analysis was performed using random-effects model.

RESULTS

A total of 21 studies were included in the review. They were categorized according to the target disease/condition: cerebral palsy (n = 5), ADHD and autism spectrum disorders (n = 5), visually impaired (n = 4), and multiple disorders (n = 7). The studies showed variability in the design and methods; however, 17 out of 21 studies showed moderate to low ROB. Increased overjet and lip incompetence were the main risk factors reported in the studies. The commonest injuries were observed to be enamel and enamel and dentine fractures.

CONCLUSION

The overall pooled prevalence of TDI in individuals with special healthcare needs was 23.16% with 20.98% in males and 27.06% in females. Overjet >3 mm and inadequate lip coverage were found to be associated with a higher risk of TDI in all the categories of individuals with special healthcare needs except ADHD and ASD. Falls at home in cerebral palsy, falls while walking and self-harm in ADHD and ASD, falls at home and collision in visual impairment, and unspecified falls in multiple disorders could be identified as the most common cause of TDI.

Long-Term Kinetics of SARS-CoV-2 Neutralizing and Anti-Receptor Binding Domain Antibodies among Laboratory-Confirmed COVID-19 Cases in Delhi National Capital Region, India: A Prospective, One-Year Follow-Up Study

Background: This study was conducted with the objective of measuring the neutralizing and anti-receptor binding domain antibody levels against SARS-CoV-2 among laboratory-confirmed COVID-19 cases and exploring its long-term kinetics over a period of 1 year. Methods: One hundred laboratory-confirmed COVID-19 cases were recruited. Serum samples of the participants were collected within three months from the date of the positive COVID-19 report. The participants were prospectively followed up every three months for symptoms and the collection of blood samples for three additional rounds. The presence of anti-SARS-CoV-2 antibodies (IgA, IgG, and IgM antibodies), anti-receptor binding domain antibodies (anti-RBD), and neutralizing antibodies were measured. Findings: Median plaque reduction neutralization test (PRNT) titers showed a rising trend in the first three rounds of follow-up. The quantitative anti-receptor binding domain ELISA (QRBD) values showed a declining trend in the initial three rounds. However, both the PRNT titers and QRBD values showed significantly higher values for the fourth round of follow-up. Total antibody (WANTAI) levels showed an increasing trend in the initial three rounds (statistically significant). Interpretation: Neutralizing antibodies showed an increasing trend. The anti-receptor binding domain antibodies showed a decreasing trend. Neutralizing antibodies and anti-RBD antibodies persisted in the majority.

IMPETUS Stroke: Assessment of hospital infrastructure and workflow for implementation of uniform stroke care pathway in India

BACKGROUND

India accounts for 13.3% of global disability-adjusted life years (DALYs) lost due to stroke with a relatively younger age of onset compared to the Western population. In India's public healthcare system, many stroke patients seek care at tertiary-level government-funded medical colleges where an optimal level of stroke care is expected. However, there are no studies from India that have assessed the quality of stroke care, including infrastructure, imaging facilities, or the availability of stroke care units in medical colleges.

AIM

This study aimed to understand the existing protocols and management of acute stroke care across 22 medical colleges in India, as part of the baseline assessment of the ongoing IMPETUS stroke study.

METHODS

A semi-structured quantitative pre-tested questionnaire, developed based on review of literature and expert discussion, was mailed to 22 participating sites of the IMPETUS stroke study. The questionnaire assessed comprehensively all components of stroke care, including human resources, emergency system, in-hospital care, and secondary prevention. A descriptive analysis of their status was undertaken.

RESULTS

In the emergency services, limited stroke helpline numbers, 3/22 (14%); prenotification system, 5/22 (23%); and stroke-trained physicians were available, 6/22 (27%). One-third of hospitals did not have on-call neurologists. Although non-contrast computed tomography (NCCT) was always available, 39% of hospitals were not doing computed tomography (CT) angiography and 13/22 (59%) were not doing magnetic resonance imaging (MRI) after routine working hours. Intravenous thrombolysis was being done in 20/22 (91%) hospitals, but 36% of hospitals did not provide it free of cost. Endovascular therapy was available only in 6/22 (27%) hospitals. The study highlighted the scarcity of multidisciplinary stroke teams, 8/22 (36%), and stroke units, 7/22 (32%). Lifesaving surgeries like hematoma evacuation, 11/22 (50%), and decompressive craniectomy, 9/22 (41%), were performed in limited numbers. The availability of occupational therapists, speech therapists, and cognitive rehabilitation was minimal.

CONCLUSION

This study highlighted the current status of acute stroke management in publicly funded tertiary care hospitals. Lack of prenotification, limited number of stroke-trained physicians and neurosurgeons, relatively lesser provision of free thrombolytic agents, limited stroke units, and lack of rehabilitation services are areas needing urgent attention by policymakers and creation of sustainable education models for uniform stroke care by medical professionals across the country.

Quantification of COX-2 Level in Alzheimer's Disease Patients to Develop Potential Blood-Based Biomarker for Early Diagnosis and Therapeutic Target

Background

Alzheimer's disease (AD) is a progressive neurodegenerative disease and symptoms develop gradually over many years. The current direction for medication development in AD is focused on neuro-inflammation and oxidative stress. Amyloid-β (Aβ) deposition activates microglia leading to neuro-inflammation and neurodegeneration induced by activation of COX-2 via NFκB p50 in glioblastoma cells.

Objective

The study aimed to evaluate the concentration of COX-2 and NFκB p50 in serum of AD, mild cognitive impairment (MCI), and geriatric control (GC) and to establish a blood-based biomarker for early diagnosis and its therapeutic implications.

Methods

Proteins and their mRNA level in blood of study groups were measured by surface plasmon resonance (SPR) and quantitative polymerase chain reaction (qPCR), respectively. The level of protein was further validated by western blot. The binding study of designed peptide against COX-2 by molecular docking was verified by SPR. The rescue of neurotoxicity by peptide was also checked by MTT assay on SH-SY5Y cells (neuroblastoma cell line).

Results

Proteins and mRNA were highly expressed in AD and MCI compared to GC. However, COX-2 decreases with disease duration. The peptide showed binding affinity with COX-2 with low dissociation constant in SPR and rescued the neurotoxicity of SH-SY5Y cells by decreasing the level of Aβ, tau, and pTau proteins.

Conclusions

It can be concluded that COX-2 protein can serve as a potential blood-based biomarker for early detection and can be a good platform for therapeutic intervention for AD.

Anti-SARS-CoV-2 antibody kinetics up to 6 months of follow-up: Result from a nation-wide population-based, age stratified sero-epidemiological prospective cohort study in India

Repeated serological testing tells about the change in the overall infection in a community. This study aimed to evaluate changes in antibody prevalence and kinetics in a closed cohort over six months in different sub-populations in India. The study included 10,000 participants from rural and urban areas in five states and measured SARS-CoV-2 antibodies in serum in three follow-up rounds. The overall seroprevalence increased from 73.9% in round one to 90.7% in round two and 92.9% in round three. Among seropositive rural participants in round one, 98.2% remained positive in round two, and this percentage remained stable in urban and tribal areas in round three. The results showed high antibody prevalence that increased over time and was not different based on area, age group, or sex. Vaccinated individuals had higher antibody prevalence, and nearly all participants had antibody positivity for up to six months.

Association of obstructive sleep apnea and sleep quality with cognitive function: a study of middle-aged and elderly persons in India

INTRODUCTION

Symptoms of obstructive sleep apnea (OSA) and poor sleep quality affect around one in ten people in India. We aimed to determine if OSA symptoms and poor sleep quality are independently associated with cognition in middle-aged and elderly urban Indian populations.

METHODS

We studied the cross-sectional association between OSA symptoms (by Berlin Questionnaire), poor sleep quality (by Pittsburgh Sleep Quality Index), and cognitive function in adults ≥ 50 years. Using a standard neuropsychological battery for cognitive function, a G-factor was derived as the first rotated principal component assessing domains of information processing, memory, and executive function. The associations of exposures with cognitive measures were modeled using linear regression, adjusted for metabolic risk factors, lifestyle factors, and psychosocial problems, followed by stratified analysis by decadal age group.

RESULTS

A total of 7505 adults were enrolled. Excluding those with MMSE < 26 (n 710), of 6795 individuals (49.2% women), mean (SD) age 64.2 (9.0) years, 38.3% had high risk of OSA symptoms, and 15.9% had poor sleep quality. OSA symptoms were negatively associated with cognitive domains of information processing (adjusted beta coefficient of z-score - 0.02, p-value 0.006), memory (- 0.03, 0.014), and G-factor (- 0.11, 0.014) in full-model. Stratified analysis by age group showed significant adverse effects of OSA symptoms on cognition for middle-aged people (50-60 years) (- 0.26, 0.001), but not in later age groups. Poor sleep quality was also associated with lower cognitive scores for G-factor (- 0.48, < 0.001), memory (- 0.08, 0.005), and executive domains (- 0.12, < 0.001), but not with information domain.

CONCLUSION

The findings suggest that both symptoms of OSA and poor sleep quality have a direct adverse impact on cognition in an Indian setting. A modest effect of age on the relationship of OSA and cognition was also observed.

Effect of endovascular therapy in large anterior circulation ischaemic strokes: A systematic review and meta-analysis of randomised controlled trials

INTRODUCTION

The benefit of endovascular treatment in large anterior circulation ischaemic strokes with low ASPECTS score (<6) is uncertain. Recent randomised studies have demonstrated the benefit of endovascular treatment (EVT) in large ischaemic strokes. The present meta-analysis aims to assess the combined effect of these studies on efficacy and safety of endovascular treatment in this group of patients.

MATERIALS AND METHODS

We conducted a systematic review and meta-analysis according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses statement. Databases MEDLINE, PubMed, EMBASE, SCOPUS, Google Scholar, Tripdatabase were searched for randomised controlled trials with at least 50 participants from inception until February 16, 2023. The primary efficacy outcome analysed was the relative risk of functional independence defined as mRS - 0-2 at 90 days. Secondary efficacy outcomes included early neurological improvement, death due to any cause at 90 days and proportion of patients requiring decompressive hemicraniectomy. The primary safety outcome was the risk of developing symptomatic intracerebral haemorrhage (sICH).

RESULTS

A total of three studies (RESCUE Japan-LIMIT, SELECT 2 and ANGEL ASPECTS) involving 1011 patients; 510 in the EVT arm and 501 in the medical management (MM) arm met the defined criteria (ASPECTS-3-5). The combined RR for the primary outcome of mRS 0-2 was 2.53 [1.84-3.47] (p = <0.0001) favouring EVT over MM. The primary safety outcome of sICH was not significant in the EVT arm with a combined RR of 1.84 [0.94-3.60] (p = 0.5157). Mortality rates were similar in both arms (26.67% in EVT arm vs 27.94% in MM arm) with a combined RR of 0.95 [0.78; 1.16] (p = 1.000).

CONCLUSION

In patients with Large vessel occlusion (LVO) and low ASPECTS (3-5), EVT was associated with higher likelihood of achieving functional independence and early neurologic improvement but did not provide any mortality benefit.

Global Trends in Knowledge, Attitude, and Awareness of Orthodontists Regarding the Management of Patients with Cleft lip and/or Palate: A Systematic Review

The aim of the present systematic review was to assess the trends in knowledge, attitude, awareness, and practice among orthodontists regarding the management of patients with cleft lip and/or palate.

An a priori protocol was developed as per the best practices of evidence-based medicine and registered in Prospero (CRD42022306107). The literature search was conducted electronically, using MeSH-terms, keywords, and Boolean-operators "AND" and "OR" in different combinations in multiple databases and screening of titles and abstracts followed by full-text evaluation was performed. The risk of bias (ROB) was assessed using Joanna Briggs Institute critical appraisal checklist.

Five studies were included in the qualitative synthesis and three of them showed a high ROB. When participants were questioned about which other specialists worked in the cleft team in addition to the orthodontists, 84% of them in one study reported it to be general dentists. Furthermore, the absence of an interdisciplinary team was reported in two studies from Africa. When asked about the percentage of their practice devoted to the care of patients with cleft lip and palate (CLP) one study reported that 52% of orthodontists had treated <10 such patients in their entire career.

The present systematic review highlights the lack of knowledge and experience among orthodontists and orthodontic residents regarding the management of patients with CLP. Efforts must be made to design validated questionnaires and conduct methodologically sound studies in different geographical locations to develop adequate modules for improving the knowledge of orthodontists in this domain.

Description of HIV risk behavior among adolescent female sex workers: Findings from the nationwide cross-sectional integrated biological and behavioral surveillance (IBBS) 2014-15 survey for HIV in India

Introduction

Adolescent female sex workers are at high risk of acquiring human immunodeficiency virus (HIV)/acquired immunodeficiency syndrome (AIDS) infection. There was paucity of information regarding their sexual practices. The main objective of this study was to study the sexual behavior, condom use practices, and physical and sexual violence experienced by adolescent female sex workers (FSWs).

Materials and Methods

This study was a secondary data analysis of the data collected during the nationwide IBBS 2014-15 survey. All adolescent FSWs aged 15 to 19 years were included in the analysis. The primary outcome variable was HIV serostatus, and independent variables included sexual behavior and condom use practices and socio-demographic variables. Descriptive analyses were performed to estimate the prevalence of independent variables. Ethical approval of the original IBBS study was obtained by the Ethics Committee of National AIDS Control Organization.

Results

A total of 948 adolescent FSWs were included in the final analysis. The prevalence of HIV in adolescent FSWs was 1.2% [95% confidence interval, 0.1-1.9%]. The mean age [standard deviation (SD)] of FSWs was 18.2 (0.9) years. The mean (SD) age at first sexual intercourse was 15.6 (1.7) years, and the mean (SD) age of starting sex work was 16.6 (1.5) years. The majority of the FSWs (94%) had used condom during the last sexual intercourse with a commercial partner, and about one-thirds (66%) had consistently used condom with a commercial partner. About a quarter (26%) of the FSWs had anal intercourse with a commercial partner in the last 1 month. About one in five FSWs (21%) had experienced physical violence in the last 1 year.

Conclusion

Almost one-third of FSWs had high-risk sexual behavior like multiple clients, anal intercourse, inconsistent condom use, and so on. These behaviors in turn increase their vulnerability to HIV infection.

Cell-Mediated Immunity (CMI) for SARS-CoV-2 Infection Among the General Population of North India: A Cross-Sectional Analysis From a Sub-sample of a Large Sero-Epidemiological Study

Background Cell-mediated immunity (CMI), or specifically T-cell-mediated immunity, is proven to remain largely preserved against the variants of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), including Omicron. The persistence of cell-mediated immune response in individuals longitudinally followed up for an extended period remains largely unelucidated. To address this, the current study was planned to study whether the effect of cell-mediated immunity persists after an extended period of convalescence or vaccination. Methods Whole blood specimens of 150 selected participants were collected and tested for Anti-SARS-CoV-2 Interferon-gamma (IFN-γ) response. Ex vivo SARS-CoV-2-specific interferon-gamma Enzyme-linked Immunospot (IFN-γ ELISpot) assay was carried out to determine the levels of virus-specific IFN-γ producing cells in individual samples. Findings Out of all the samples tested for anti-SARS-CoV-2 T-cell-mediated IFN-γ response, 78.4% of samples were positive. The median (interquartile range) spots forming units (SFU) per million levels of SARS-CoV-2-specific IFN-γ producing cells of the vaccinated and diagnosed participants was 336 (138-474) while those who were vaccinated but did not have the disease diagnosis was 18 (0-102); the difference between the groups was statistically significant. Since almost all the participants were vaccinated, a similar pattern of significance was observed when the diagnosed and the never-diagnosed participants were compared, irrespective of their vaccination status. Interpretations Cell-mediated immunity against SARS-CoV-2 persisted, irrespective of age and sex of the participant, for more than six months of previous exposure. Participants who had a history of diagnosed COVID-19 infection had better T-cell response compared to those who had never been diagnosed, in spite of being vaccinated.

Low awareness but high acceptability of pre-exposure prophylaxis for HIV among men who have sex with men and transgender persons in Delhi, India

Background: HIV pre-exposure prophylaxis (PrEP) is part of India's HIV prevention policy. We aimed to determine awareness of and willingness-to-use PrEP among men-who-have-sex-with-men (MSM) and transgender-persons (TG) in Delhi, India.Methods: A cross-sectional study was conducted at five purposively selected targeted-intervention projects in Delhi. Participants included self-identified MSM/TG aged ≥18 years, with negative/unknown HIV serostatus. A structured interview schedule, developed using formative research, was used. Primary outcomes were awareness of, and willingness-to-use PrEP. Socio-demographic and behaviour variables included age, living situation, education, anal-sex, condom-use and experiences of physical-violence. Determinants of outcome were identified in univariable logistic regression; variables associated at p < .25 were included in multivariable regression models.Results: Of 400 (224 MSM, 176 TG), mean ± SD age 25.7 ± 7.2 years, 14.5% (95% CI 11.0, 18.0) were aware of PrEP, while 63.3% (95% CI: 58.6, 68.1) reported willingness-to-use PrEP. PrEP-awareness was independently associated with formal-education (adjusted odds ratio; AOR = 1.20), professional occupation (AOR = 5.45) and condom-use (AOR = 3.07). Willingness-to-use PrEP was higher if participants had recent anal-sex (AOR = 2.29), had used condoms during anal-sex (AOR = 2.09), or recently experienced physical-violence (AOR = 3.65).Conclusions: PrEP awareness was low, but most were willing to use PrEP, implying that communication is key to PrEP awareness and uptake.

Metabolic risk factors and psychosocial problems independently explain poor sleep quality and obstructive sleep apnea symptoms among adults in urban India

STUDY OBJECTIVES

To determine if metabolic risk factors are associated with poor sleep quality and obstructive sleep apnea-like symptoms (OSA symptoms) independent of psychosocial problems and demographic and lifestyle factors in older Indian adults.

METHODOLOGY

We analyzed baseline data from adults (≥ 50 years) from a population-based cohort, the LoCARPoN study, in India. Variables were grouped as (a) demographic and lifestyle factors such as smoking, alcohol use, and physical activity; (b) psychosocial problems including symptoms of depression, anxiety, and perceived stress; and (c) metabolic risk factors including glycated hemoglobin, high-density lipoprotein, low-density lipoprotein, total cholesterol, body mass index, and hypertension. Variables were examined as predictors of poor sleep quality and OSA symptoms. Groups of variables were added stepwise to a logistic regression. Variance explained by nested models was quantified using McFadden's pseudo R2, and change was formally tested with the log-likelihood ratio test.

RESULTS

Among 7505 adults, the prevalence of poor sleep quality was 16.9% (95% CI: 16.0, 17.7), and OSA symptoms were present in 7.0% (95% CI: 6.4, 7.6). Psychosocial problems had a strong independent association with both poor sleep quality (pseudo R2 increased from 0.10 to 0.15, p < 0.001) and more OSA symptoms (pseudo R2 increased from 0.08 to 0.10, p < 0.001). Metabolic risk factors had a modest independent association with sleep quality (pseudo R2 increased from 0.14 to 0.15, p < 0.01), but a strong association with OSA symptoms (pseudo R2 increased from 0.08 to 0.10, p < 0.001).

CONCLUSION

Psychosocial and metabolic risk factors were independently associated with sleep quality and OSA symptoms. This fact implied that OSA symptoms may affect both mental health and physical health. Our findings have public health implications because the number and proportion of the elderly in India is increasing, while the prevalence of metabolic risk factors and psychosocial problems is high already. These facts have the potential to exacerbate not only the burden of sleep disorders and OSA symptoms but also associated cardiovascular and neurologic sequelae, further stretching the Indian health-care system.

Prevalence of HIV among inmates in four states of north India: findings from the 16th round of HIV sentinel surveillance

PURPOSE

Prisoners are at a higher risk of HIV infection compared to the general population. The purpose of this study is to estimate the prevalence of HIV and related risk behaviours among inmates of the Central Prisons in four states of North India.

DESIGN/METHODOLOGY/APPROACH

The HIV sentinel surveillance was conducted in seven Central Prisons in four states of North India from February to April 2019. Four hundred inmates were included from each prison. The interviews were conducted at the Integrated Counselling and Testing Centre located within the prison premises. The Ethics Committee of the National AIDS Control Organization, New Delhi, granted ethical approval before the start of the surveillance.

FINDINGS

Overall, 2,721 inmates were enrolled in this study. The mean (SD) age was 38.9 (13.9) years. One-third of prison inmates had comprehensive knowledge about HIV/AIDS. The proportion of convict (54%) and undertrial (46%) inmates was almost equal. The overall prevalence of HIV infection among inmates was 0.96% (95% CI 0.65-1.40). The odds of being HIV positive were significantly higher in never married inmates, undertrials, inmates who were in the prison for more than three months to one year, inmates incarcerated for multiple times, inmates with history of injecting drug use and inmates with history of intercourse with a commercial sex worker.

ORIGINALITY/VALUE

The findings from the very first HIV sentinel surveillance in central prisons in North India have been presented in this paper. This has huge implications for future policy decisions.

Effect of Imatinib Mesylate on Growth in Pediatric Chronic Myeloid Leukemia: A Systematic Review and Meta-analysis

The outcomes of pediatric chronic myeloid leukemia (CML) have improved with the use of imatinib mesylate (IM). Multiple reports of growth deceleration with IM have raised concerns, necessitating careful monitoring and evaluation in children with CML. We systematically searched the databases of PubMed, EMBASE, Scopus, CENTRAL, and conferences-abstracts, reporting the effect of IM on growth among children with CML, and published in the English language from inception till March 2022. For observational studies, the modified Newcastle Ottawa Scale was used to assess the risk of bias. Pooled estimates were derived using a random-effects meta-analysis, and heterogeneity was assessed using Cochrane Q statistic test of heterogeneity and I2 statistic. Of the 757 studies identified through electronic search, 15 (n=265) were included in the final analysis. Six studies (n=178) were included in the meta-analysis of the primary outcome. There was a significant deleterious effect of IM on height-standardized mean difference (SMD): -0.52 (95% CI: -0.76; -0.28) ( I2 =13%). The adverse effect of IM on height was significant among studies with a follow-up period <3 years [SMD: -0.66 (95% CI: -0.93, -0.40), I2 =0%, P =0.59] but not in studies with follow-up period ≥3 years [SMD: -0.26 (95% CI: -0.63, 0.11), I2 =0, P =0.44], indicating that the effect of IM on height is a short-term effect. The effect of IM on height was not dependent upon pubertal status at the initiation of therapy. Prospective studies with adequate sample size are required to confirm the findings of the effect of IM on height in children with CML.

Global status of knowledge of parents for emergency management of traumatic dental injuries: a systematic review and meta-analysis

RESEARCH PROTOCOL

The protocol was developed as per the recommendations of the Cochrane-handbook and PRISMA and was registered in PROSPERO.

LITERATURE SEARCH

Search was performed by using MeSH-Terms and keywords in PubMed, Scopus, Embase, Web of Sciences, Lilacs, and Cochrane databases and gray literature sources 15th July 2022. There were no limits regarding the year of publication and language. Hand-searching of included articles was also performed. Titles and abstracts and later full texts were screened as per strict inclusion and exclusion criteria.

DATA EXTRACTION

Self-designed pilot-tested form was used.

QUALITY APPRAISAL

Risk of bias was analyzed through Joanna-Brigg's-Institute's-critical appraisal checklist. The evidence analysis was done by using the GRADE approach.

DATA ANALYSIS

Qualitative synthesis was performed for describing the study characteristics, details of sampling, and results of various questionnaires. It was discussed by the expert group and presented using KAP heat map. Meta-analysis was done by using Random Effects Model.

RESULTS AND INTERPRETATION

The risk of bias was found to be low in seven and moderate in one study. It was observed that >50% of parents knew about the urgency to seek professional advice after TDI. Only <50% of parents were confident of their ability to identify the injured tooth, clean the soiled avulsed tooth, and perform the replantation. Appropriate responses regarding immediate action after tooth avulsion were given by 54.5% (95% CI: 50.2-58.8, p = 0.042) of parents. The knowledge of the parents regarding the emergency management of TDI was found to be inadequate. The majority of them were interested in obtaining information about dental trauma first aid.

Predictors of Out-of-Pocket Expenditure on Health Incurred by Elderly Persons Residing in a Rural Area of Faridabad District

BACKGROUND

A significant portion of India's 1.2 billion population consists of elderly individuals, accounting for approximately 8.6%, who incur substantial out-of-pocket (OOP) healthcare expenses. Any policy for the elderly should encompass financial protection from illness-related expenditures. However, the lack of comprehensive information on OOP expenditure and its determinants precludes such action.

METHODS

We conducted a cross-sectional study of 400 elderly persons residing in the rural town of Ballabgarh. The participants were randomly selected using the health demographic surveillance system. We utilized questionnaires and tools to assess the costs associated with outpatient and inpatient services in the previous year, as well as gather information on socio-demographics (individual characteristics), morbidity (motivation for seeking care), and social engagement (health-seeking).

RESULTS

A total of 396 elderly persons participated, with a mean (SD) age of 69.4 (6.7), and 59.4% females. Nearly 96% and 50% of the elderly availed of outpatient and inpatient services, respectively, in the preceding year. The mean (IQR) annual OOP expenditure, as per the consumer price index 2021, was INR 12,543 (IQR, INR 8,288-16,787), with a median of INR 2,860 (IQR, INR 1,458-7,233), explained significantly by sex, morbidity status, social engagement, and mental health.

CONCLUSION

In low-middle-income countries like India, policymakers may consider pre-payment mechanisms like health insurance for the elderly, using such prediction scores.

Prevalence and determinants of heterosexual anal-intercourse among female sex workers in India: Findings from nationwide cross-sectional biological and behavioural survey

BACKGROUND

The vulnerability of female sex workers (FSWs) to HIV infection increases if unprotected heterosexual anal intercourse (HAI) is practiced.

OBJECTIVES

To estimate the prevalence of HAI among FSWs, and associated factors, and prevalence of consistent condom use (CCU) during HAI and associated factors.

METHODS

Analysis of cross-sectional data from nationwide biological and behavioural survey, conducted at 73 randomly selected domains with sample size of 27,000 in India.

RESULTS

A total of 25,932 FSWs were included in the analysis, after excluding 1075 (3.9%) FSWs for which the data were incomplete. The prevalence of HAI was 29.9% (95% CI, 29.3, 30.4); The CCU during HAI in the last one month was 58.9%. Younger age at the start of sex work, use of mobile phone/internet for soliciting client, home as a place of sex work, consumption of alcohol/drug, and physical violence against FSWs were associated with higher odds of HAI. Frequent contact with outreach workers, awareness of sexually transmitted infection, and older age at the start of sex work was associated with CCU.

CONCLUSION

Prevalence of HAI was high among FSW in India. The national program could target those factors that reduce the odds of HAI and/or promote CCU.

Does dental trauma have impact on the oral health-related quality of life of children and adolescents?

RESEARCH QUESTION

Does dental trauma have impact on the oral health-related quality of life of children and adolescents?

RESEARCH PROTOCOL

Protocol was designed as per the best practices of evidence-based medicine, guidelines for umbrella reviews and registered in PROSPERO.

LITERATURE SEARCH

PubMed, Scopus, Embase, Web of Sciences and Lilacs were searched for studies meeting the inclusion criteria from start of databases to 15th July 2021. Grey literature and registries of systematic review protocols were also searched. Hand searching of the references of included articles was also performed. The literature search was updated on 15th October 2021. Scrutiny of the titles and abstracts and later full text was done as per the inclusion and exclusion criteria.

DATA EXTRACTION

Self-designed pre-piloted form was used by two reviewers.

QUALITY APPRAISAL

AMSTAR-2 was used to assess the quality of systematic reviews, PRISMA was used to check reporting-characteristics and citation-matrix was used to evaluate study-overlap. Quality of evidence was assessed by using Kohler's-criteria.

DATA ANALYSIS

Qualitative synthesis was performed for describing the study characteristics, details of sampling and the tool of OHRQoL used. The meta-analytic data was used for evaluating the evidence and its strength for each of the outcomes.

RESULTS AND INTERPRETATION

A significant impact of all types of TDI on OHRQoL in children and adolescents was observed. The effect of uncomplicated TDI on OHRQoL in children and all ages showed no difference from controls. Though the quality of evidence in these interpretations was weak.

Efficacy and safety of vemurafenib in Langerhans cell histiocytosis (LCH): A systematic review and meta-analysis

Almost half of the patients with Langerhans cell histiocytosis (LCH) are refractory to primary induction chemotherapy or undergo reactivation. The ideal treatment modality for refractory/relapsed LCH is yet not evidenced. This review aimed to determine the efficacy and safety of vemurafenib (a BRAF pathway inhibitor) in LCH, particularly the refractory/relapsed cases. The literature search was conducted using PubMed, Embase, CENTRAL, and abstracts published in the SIOP meetings. Studies that described the outcome of patients of LCH being treated with vemurafenib, alone or in combination, were included. A total of 416 studies were screened, and after applying exclusion criteria, 22 studies (n = 107) were included in the final analysis. The first-line therapy was prednisolone plus vinblastine for most patients (n = 92, 86%), and vemurafenib was started upfront in 3 patients (3%). The median time to first clinical response with vemurafenib was one week. The median time to best response was 5.25 months. Out of 107 patients, 62 patients (58%) had ultimately no active disease (NAD) while 39 (36%) had active disease better (ADB), making the overall response rate (ORR) of 101/107, ie, 94.4% (CI 0.88; 0.98). The main adverse effects of vemurafenib were rash or photosensitivity (47%) and other cutaneous adverse events (15%). Vemurafenib is highly efficacious and safe in the treatment of refractory LCH; however, the timing of its commencement and duration of therapy is yet to be established. Larger prospective collaborative trials are needed to answer the appropriate treatment duration and effective maintenance therapy approach.

Test concordance and diagnostic accuracy of three serological assays for detection of anti-SARS-CoV-2 antibody: result from a population-based sero-epidemiological study in Delhi

BACKGROUND

Several methodological tests are available to detect SARS-CoV-2 antibody. Tests are mostly used in the aid of diagnosis or for serological assessment. No tests are fully confirmatory and have variable level of diagnostic ability. We aimed at assessing agreement with three serological tests: quantitative anti receptor binding domain ELISA (Q-RBD), qualitative ELISA (WANTAI SARS-CoV-2 Ab) and qualitative chemiluminescence assay (CLIA).

METHODS

This study was a part of a large population based sero-epidemiological cohort study. Participants aged 1 year or older were included from 25 randomly selected clusters each in Delhi urban (urban resettlement colony of South Delhi district) and Delhi rural (villages in Faridabad district, Haryana). Three type of tests were applied to all the baseline blood samples. Result of the three tests were evaluated by estimating the total agreement and kappa value.

RESULTS

Total 3491 blood samples collected from March to September, 2021, out of which 1700 (48.7%) from urban and 1791 (51.3%) from rural. Overall 44.1% of participants were male. The proportion of sero-positivity were 78.1%, 75.2% and 31.8% by Wantai, QRBD and CLIA tests respectively. The total agreement between Wantai and QRBD was 94.5%, 53.1% between Wantai and CLIA, and 56.8% between QRBD and CLIA. The kappa value between these three tests were 0.84 (95% CI 0.80-0.87), 0.22 (95% CI 0.19-0.24) and 0.26 (95% CI 0.23-0.28).

CONCLUSIONS

There was strong concordance between Wantai and QRBD test. Agreement between CLIA with other two tests was low. Wantai and QRBD tests measuring the antibody to same S protein can be used with high agreement based on the relevant scenario.

Sexual dysfunction and sexual concerns among persons with disability due to myelopathy: A cross-sectional study

Objectives

We have very little information about sexual activity and concerns of patients with myelopathy from India. The objectives of this study were to assess the sexual dysfunction and sexual concerns among patients with myelopathy due to spinal cord lesion (SCL).

Materials and Methods

This study was a single-center, cross-sectional, and hospital-based study among male and female patients in the age-group 18-50 years, with disability due to myelopathy due to SCL. The data were collected using a self-designed, pretested, and semi-structured questionnaire by face-to-face interview.

Results

Eighty participants were recruited in the study, of which 62 (77.5%) were men. The mean standard deviation (SD) age of the participants was 33.7 (8.6) years, and mean (SD) age at time of illness was 31.4 (8.6) years with median duration of 17 months. Among 62 males, psychogenic erection was impaired in 77.2%, reflex erection was impaired in 78.9%, and ejaculation was affected in 70.7%. Orgasm was absent or reduced in 66.1% males. Among 18 female participants, psychogenic genital arousal was reduced in 66.5%, reflex genital arousal was impaired in 55.5%, and orgasm was absent in 38.8% subjects. Sexual desire in these patients was unchanged in 41 (51.2%) and decreased or absent in 39 (48.8%). Sexual activity involvement was there in 46 (57.5%) and 34 (42.5%) had not involved in any kind of sexual activity after injury/illness. The main reasons of non-involvement in sexual activity were bladder and bowel accidents, spasticity, and difficulty in positioning.

Conclusion

Comprehensive neurological rehabilitation should address sexual function of affected individual to allow them highest level of function and quality of life.

Impact of inpatient rehabilitation on quality of life among stroke patients

Objective

Despite remarkable progression in the treatment of stroke, the life quality and social related events caused by stroke have received limited attention in our country. Quality of life (QOL) assessment is an important part of the evaluation of stroke patients and their management. The objective of this study was to assess QOL in patients with stroke at the time of admission in rehabilitation unit and to assess the impact of inpatient rehabilitation on change in QOL in these patients.

Materials and Methods

Adult patients with first arterial stroke of any duration, with presentation as hemiplegia, were recruited. The clinical outcome scales and 36-Item Short Form Health Survey (SF-36) parameters for QOL were assessed at both admission and discharge. The scales used were Scandinavian stroke scale (SSS), Barthel Index (BI), and modified Rankin Scale. SF-36 scores were assessed after 6 weeks of discharge also.

Results

Ten patients with median age of 36.5 years and median duration of stroke 75 days were recruited. There was significant improvement in functional scores of BI and SSS scales at the time of discharge. Majority of the components of both physical and mental domains of QOL SF-36 questionnaire showed significant improvement. The QOL scores after 6 weeks of discharge did not show significant change except for the emotional well-being.

Conclusion

The QOL in patients with stroke improves with inpatient rehabilitation along with motor and functional scores. Improved functional independence leads to better emotional state after discharge also.

Comparing the Effects of Oral HIV Self-Testing With Those of Standard HIV Testing for Men Who Have Sex With Men (MSM): A Systematic Review and Meta-Analysis

The WHO recommends HIV self-testing (HIVST) as an innovative strategy and an additional testing approach to attain UNAIDS targets to end HIV by 2030. HIVST is a process whereby a person collects his or her own specimen (either oral fluid or blood), performs an HIV test, and interprets the result. It has been described as a discreet and convenient way to reach the hidden, unreached key populations (KPs) who do not know their HIV status or do not get tested. Among the KPs, men who have sex with men (MSM) is one such group that by far remains hidden due to feared stigma and discrimination associated both with their sexuality and HIV. Fear of pain and blood while HIV testing also deters MSM from getting tested. In this review, we assessed the effect of oral HIVST on the uptake and frequency of testing and risk behavior as compared to standard HIV testing.

For this review, we systematically searched various electronic databases for clinical trials comparing HIVST to standard HIV testing from January 1, 2011, to December 31, 2021. A meta-analysis of studies was conducted using a random-effects model for relative risks (RRs) and 95% confidence intervals (CIs). The protocol was registered with PROSPERO, and PRISMA guidelines for systematic reviews and meta-analyses were followed. The quality of the clinical trials was assessed using Cochrane’s risk of bias tool version 2.0 (RoB 2.0).

We identified eight studies comparing HIVST to standard HIV testing services (HTSs). The eight randomized controlled trials (RCTs) enrolled 5,297 participants, of which 5,212 were MSM and 85 were transgender (TG) women. Seven RCTs were conducted in high-income countries (HICs): four in the USA, two in Australia, and one in Hong Kong. One was conducted in a low-middle-income country (LMIC) in Myanmar.In all the studies, HIVST intervention was provided with oral HIVST kits, except for one study in which both blood-based and oral HIVST kits were used. Meta-analysis (five RCTs) showed that HIVST increased the uptake of HIV testing by 1.43 times compared to standard of care (SoC) (RR = 1.43; 95% CI = 1.25, 1.64). Meta-analysis (four RCTs) found that HIVST increased the mean number of HIV tests by 2.34 during follow-up (mean difference = 2.34; 95% CI = 1.66, 3.02). Meta-analysis (four RCTs) showed that HIVST doubled the detection of new HIV infections among those tested (RR = 2.10; 95% CI = 1.35, 3.28) and reported higher repeat testing as compared to the control arm (RR = 2.04; 95% CI = 1.22, 3.42). A meta-analysis of three trials found no significant difference in risk behavior in respect of condomless anal intercourse (CAI) (odds ratio (OR) = 0.90; 95% CI = 0.67, 1.22) and multiple male partnership (RR = 0.89; 95% CI = 0.83, 0.94).

Oral HIVST could increase the HIV testing and detection of new HIV infections among MSM who may not otherwise test, as compared to standard testing services alone. However, further research from low-middle-income countries is required for generalizability.

Antibody Response to SARS-CoV-2 among COVID-19 Confirmed Cases and Correlates with Neutralizing Assay in a Subgroup of Patients in Delhi National Capital Region, India

Background: The plaque reduction neutralization test (PRNT) is the gold standard to detect the neutralizing capacity of serum antibodies. Neutralizing antibodies confer protection against further infection. The present study measured the antibody level against SARS-CoV-2 among laboratory-confirmed COVID-19 cases and evaluated whether the presence of anti-SARS-CoV-2 antibodies indicates virus neutralizing capacity. Methods: One hundred COVID-19 confirmed cases were recruited. Their sociodemographic details and history of COVID-19 vaccination, contact with positive COVID-19 cases, and symptoms were ascertained using a self-developed semi-structured interview schedule. Serum samples of the participants were collected within three months from the date of the positive report of COVID-19. The presence of anti-SARS-CoV-2 antibodies (IgA, IgG and IgM antibodies), receptor binding domain antibodies (anti-RBD), and neutralizing antibodies were measured. Findings: Almost all the participants had anti-SARS-CoV-2 antibodies (IgA, IgG and IgM) (99%) and anti-RBD IgG antibodies (97%). However, only 69% had neutralizing antibodies against SARS-CoV-2. Anti-RBD antibody levels were significantly higher among participants having neutralizing antibodies compared with those who did not. Interpretation: The present study highlights that the presence of antibodies against SARS-CoV-2, or the presence of anti-RBD antibodies does not necessarily imply the presence of neutralizing antibodies.

Clinical characteristics with inflammation profiling of long COVID and association with 1-year recovery following hospitalisation in the UK: a prospective observational study

BACKGROUND

No effective pharmacological or non-pharmacological interventions exist for patients with long COVID. We aimed to describe recovery 1 year after hospital discharge for COVID-19, identify factors associated with patient-perceived recovery, and identify potential therapeutic targets by describing the underlying inflammatory profiles of the previously described recovery clusters at 5 months after hospital discharge.

METHODS

The Post-hospitalisation COVID-19 study (PHOSP-COVID) is a prospective, longitudinal cohort study recruiting adults (aged ≥18 years) discharged from hospital with COVID-19 across the UK. Recovery was assessed using patient-reported outcome measures, physical performance, and organ function at 5 months and 1 year after hospital discharge, and stratified by both patient-perceived recovery and recovery cluster. Hierarchical logistic regression modelling was performed for patient-perceived recovery at 1 year. Cluster analysis was done using the clustering large applications k-medoids approach using clinical outcomes at 5 months. Inflammatory protein profiling was analysed from plasma at the 5-month visit. This study is registered on the ISRCTN Registry, ISRCTN10980107, and recruitment is ongoing.

FINDINGS

2320 participants discharged from hospital between March 7, 2020, and April 18, 2021, were assessed at 5 months after discharge and 807 (32·7%) participants completed both the 5-month and 1-year visits. 279 (35·6%) of these 807 patients were women and 505 (64·4%) were men, with a mean age of 58·7 (SD 12·5) years, and 224 (27·8%) had received invasive mechanical ventilation (WHO class 7-9). The proportion of patients reporting full recovery was unchanged between 5 months (501 [25·5%] of 1965) and 1 year (232 [28·9%] of 804). Factors associated with being less likely to report full recovery at 1 year were female sex (odds ratio 0·68 [95% CI 0·46-0·99]), obesity (0·50 [0·34-0·74]) and invasive mechanical ventilation (0·42 [0·23-0·76]). Cluster analysis (n=1636) corroborated the previously reported four clusters: very severe, severe, moderate with cognitive impairment, and mild, relating to the severity of physical health, mental health, and cognitive impairment at 5 months. We found increased inflammatory mediators of tissue damage and repair in both the very severe and the moderate with cognitive impairment clusters compared with the mild cluster, including IL-6 concentration, which was increased in both comparisons (n=626 participants). We found a substantial deficit in median EQ-5D-5L utility index from before COVID-19 (retrospective assessment; 0·88 [IQR 0·74-1·00]), at 5 months (0·74 [0·64-0·88]) to 1 year (0·75 [0·62-0·88]), with minimal improvements across all outcome measures at 1 year after discharge in the whole cohort and within each of the four clusters.

INTERPRETATION

The sequelae of a hospital admission with COVID-19 were substantial 1 year after discharge across a range of health domains, with the minority in our cohort feeling fully recovered. Patient-perceived health-related quality of life was reduced at 1 year compared with before hospital admission. Systematic inflammation and obesity are potential treatable traits that warrant further investigation in clinical trials.

FUNDING

UK Research and Innovation and National Institute for Health Research.

Impact of Inpatient Rehabilitation on Quality of Life Among Stroke Patients

Background Despite remarkable progression in the treatment of stroke, the quality of life (QoL) and social-related events caused by stroke have received limited attention in our country. The assessment of QOL is an important part of the evaluation of stroke patients and their management.

Objective To assess the QoL in patients with stroke at the time of admission in the rehabilitation unit and assess the impact of inpatient rehabilitation on change in QoL in these patients.

Materials and methods Adult patients with first arterial stroke of any duration, with presentation as hemiplegia were recruited. The clinical outcome scales and SF-36 parameters for QOL were assessed at both admission and discharge. The scales used were Scandinavian Stroke Scale (SSS), Barthel Index (BI), modified Rankin Scale (mRS). SF-36 scores were assessed after 6 weeks of discharge also.

Results Ten patients with a median age of 36.5 years and a median duration of stroke 75 days were recruited. There was significant improvement in functional scores of BI and SSS scales at the time of discharge. Majority of the components of both physical and mental domains of QOL SF-36 questionnaire showed significant improvement. The QOL scores after 6 weeks of discharge did not show significant change except for the emotional well-being.

Conclusion The QOL in patients with stroke improves with inpatient rehabilitation along with motor and functional scores. Improved functional independence leads to better emotional state after discharge also.

Sexual Dysfunction and Sexual Concerns among Persons with Disability Due to Myelopathy: A Cross-Sectional Study

Background We have very little information about sexual activity and concerns of patients with myelopathy from India.

Objectives This article assesses the sexual dysfunction and sexual concerns among patients with myelopathy due to spinal cord lesion (SCL).

Materials and Methods Single-center, cross-sectional, hospital-based study among male and female patients in the age group of 18 to 50 years, with disability due to myelopathy due to SCL. The data were collected using a self-designed, pretested, semistructured questionnaire by face-to-face interview.

Results Eighty participants were recruited in the study, of which 62 (77.5%) were men. The mean (standard deviation [SD]) age of the participants was 33.7 (8.6) years, and mean (SD) age at time of illness was 31.4 (8.6) years with median duration of 17 months. Among 62 males, psychogenic erection was impaired in 77.2%, reflex erection was impaired in 78.9%, and ejaculation was affected in 70.7%. Orgasm was absent or reduced in 66.1% males. Among 18 female participants, psychogenic genital arousal was reduced in 66.5%, reflex genital arousal was impaired in 55.5%, and orgasm was absent in 38.8% subjects. Sexual desire in these patients was unchanged in 41 (51.2%), and decreased or absent in 39 (48.8%). Sexual activity involvement was there in 46 (57.5%) and 34 (42.5%) had not involved in any kind of sexual activity after injury/illness. The main reasons of noninvolvement in sexual activity were bladder and bowel accidents, spasticity, and difficulty in positioning.

Conclusion Comprehensive neurological rehabilitation should address sexual function of affected individual to allow them highest level of function and quality of life.

Test concordance of three serological assays for detection of anti-SARS-CoV-2 antibody: Result from a population-based sero-epidemiological study in Delhi.. [DOI: 10.21203/rs.3.rs-1720417/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background Several methodological tests are available to detect SARS-CoV-2 antibody. Tests are mostly used in the aid of diagnosis or for serological assessment. No tests are fully confirmatory and have variable level of diagnostic ability. We aimed at assessing agreement with three serological tests: quantitative anti receptor binding domain ELISA (Q-RBD), qualitative ELISA (WANTAI SARS-CoV-2 Ab) and qualitative chemiluminiscence assays (CLIA). Methods This study was a part of a large population based sero-epidemiological cohort study. Participants aged 1 year or older were included from 25 randomly selected clusters each in Delhi urban (urban resettlement colony of South Delhi district) and Delhi rural (villages in Faridabad district, Haryana). Three type of tests were applied to all the baseline blood samples. Result of the three tests were evaluated by estimating the total agreement and kappa value. Results Total 3491 blood samples collected from March to September, 2021, out of which 1700 (48.7%) from urban and 1791 (51.3%) from rural. Overall 44.1% of participants were male. The proportion of sero-positivity were 78.1%, 74.1% and 31.8% by Wantai, QRBD and CLIA tests respectively. The total agreement between Wantai and QRBD was 94.2%, 53.1% between Wantai and CLIA, and 56.6% between QRBD and CLIA. The kappa value between these three tests were 0.84 (95% CI: 0.80–0.87), 0.22 (95% CI: 0.19–0.24) and 0.26 (95% CI: 0.23–0.28). Conclusions There was strong concordance between Wantai and QRBD test. Agreement between CLIA with other two tests was low. Wantai and QRBD may be used interchangeably.

Antibody response to SARS-CoV2 among COVID-19 confirmed cases, and correlates with neutralizing assay in a subgroup of patients in Delhi National Capital Region, India.. [DOI: 10.1101/2022.05.17.22275193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0]

Background

Plaque reduction neutralization test (PRNT) is the gold standard to detect neutralizing capacity of the serum antibodies. Neutralizing antibody confers protection against further infection. The present study was done with the objective to measure the antibody level against SARS-CoV2 among laboratory confirmed COVID-19 cases and to evaluate whether the presence of anti-SARS-CoV2 antibodies indicate virus neutralizing capacity.

Methods

One hundred COVID-19 confirmed cases were recruited. Sociodemographic details and history of COVID-19 vaccination, contact with positive COVID-19 cases, and symptoms were ascertained using a self-developed semi-structured interview schedule. Serum samples of the participants were collected within three months from date of the positive report of COVID-19. The presence of anti-SARS-CoV-2 antibodies (IgA, IgG and IgM antibodies), receptor binding domain antibodies (anti-RBD), and neutralizing antibodies were measured.

Findings

Almost all participants had Anti-SARS-CoV2 antibodies (IgA, IgG and IgM) (99%) and Anti-RBD IgG antibodies (97%). However, only 69% had neutralizing antibodies against SARS-CoV2. Anti-RBD antibody levels were significantly higher among participants having neutralizing antibodies compared to those who didn’t.

Interpretation

The present study highlights that presence of antibodies against SARS-CoV2, or presence of anti-RBD antibody doesn’t necessarily imply presence of neutralizing antibodies.

Funding

World Health Organisation

Effectiveness of Peripheral Median, Radial, and Ulnar Nerve Block at Wrist along with Intra-Articular Steroid Injection in Shoulder Joint in Management of Complex Regional Pain Syndrome of Upper Limb: 1-Week Follow-Up Study

BACKGROUND

Complex regional pain syndrome (CRPS) of upper limbs is one of the under-recognized painful disabling condition seen in many neurological conditions.

OBJECTIVE

To see the effectiveness of peripheral nerve blocks (PNB) along with intra-articular injection in shoulder joint in the improvement of pain, swelling and range of motion (ROM) of the upper limb in CRPS.

METHODS

It was a single-center, prospective study in male and female patients between 18 and 70 years with CRPS of the upper limb due to any etiology, within one year of illness. Single-dose of the intra-articular shoulder joint injection and peripheral nerve blocks at the wrist with steroid, 2% lignocaine, and sterile water was given. The primary outcome measure was a reduction in pain in the upper limb, assessed with a visual analog scale (VAS). Secondary outcome measures were an improvement in passive ROM of joints and a decrease in swelling of the hand. The significance of the P value was adjudged against an alpha of 0.05.

RESULTS

Thirty-three patients (25 men), with a mean (SD) age of 55.2 (9.4) years, and mean (SD) duration of illness of 101.9 (76.8) days were included. After 1 week, there was a significant improvement (P < 0.05) in the ROM of joints. The decrease in pain scores on VAS [mean difference -5.1 (CI -5.7, -4.5)] and reduction in hand swelling [mean difference -0.9 (CI -1.1, -0.7)] was also significant.

CONCLUSION

Peripheral median, radial, and ulnar nerve block at wrist along with intra-articular steroid injection in the shoulder joint is an effective method of management of CRPS of the upper limb.

Effectiveness of Intravenous Iron Sucrose Therapy in Routine Antenatal Care for the Treatment of Moderate to Severe Anemia Among Pregnant Women Attending a Secondary Care Hospital in North India: A Retrospective Analysis

Introduction: Anemia during pregnancy is an important public health problem and is associated with a number of maternal and fetal complications. Intravenous iron sucrose (IVIS) has been reported to be safe and efficacious in raising the hemoglobin (Hb) level among pregnant women. However, most of the studies were conducted in controlled research settings, and there is a paucity of data on the effectiveness when IVIS is given as routine therapy in public health facilities. The objective of this study was to estimate the change in mean Hb level four weeks after the last dose of IVIS infusion in pregnant women with moderate to severe anemia in a public healthcare setting.

Methods: Records of pregnant women having moderate anemia (Hb level: 7.0-9.9 gm/dL), who received IVIS in calculated dose during routine antenatal care between 1 January 2018 and 31 July 2018, were reviewed. Data were analyzed using STATA version 13 software (StataCorp LLC, College Station, TX). Hb levels before the start of the therapy (baseline) and four weeks after the last infusion (endline) were compared. A value of p < 0.05 was considered statistically significant.

Results: The mean (±SD) Hb level increased from 8.5 (±0.88) gm/dL at baseline to 10.3 (±1.24) gm/dL four weeks after the last dose of IVIS infusion. The mean (±SD) increase in Hb level was 1.7 (±1.29) gm/dL (95% CI: 1.57, 1.87). The change from moderate and severe anemia to normal Hb levels was observed in 28.4% and 28.6% of women, respectively.

Conclusion: IVIS therapy is effective in improving Hb levels when given as routine therapy in a secondary level public healthcare facility.

An effective method to summarise the outcomes of questionnaire-based studies in systematic reviews

With an increased number of questionnaire-based knowledge, attitude, practice and other types of studies, there is a need to perform evidence-based research in such designs as well. The systematic reviews (SR) and meta-analyses (MA) of the questionnaire-based studies are difficult to conduct and summarise due to the wide variations in the questions included in each of them. The presentation of these reviews often leads to ambiguous conclusions, and meta-analysis is not possible due to wide heterogeneity. This paper aims to highlight a method known as the 'Knowledge-Attitude-Practice' or 'KAP' Heat Map, which was developed and validated for the effective presentation of the outcomes of varied questionnaires in systematic reviews.

Study protocol: IMPETUS: Implementing a uniform stroke care pathway in medical colleges of India: IMPETUS Stroke

Introduction:

In India, a national program for stroke (national programme for the control of cardiovascular diseases, diabetes, cancer, and stroke) and stroke management guidelines exist. Its successful implementation would need an organized system of stroke care in practice. However, many challenges exist including lack of awareness, prehospital notification systems, stroke ready hospitals, infrastructural weaknesses, and rehabilitation. We present here a protocol to investigate the feasibility and fidelity of implementing a uniform stroke care pathway in medical colleges of India.

Methods and Analysis:

This is a multicentric, prospective, multiphase, mixed-method, quasi-experimental implementation study intended to examine the changes in a select set of stroke care-related indicators over time within the sites exposed to the same implementation strategy. We shall conduct process evaluation of the implementation process as well as evaluate the effect of the implementation strategy using the interrupted time series design. During implementation phase, education and training about standard stroke care pathway will be provided to all stakeholders of implementing sites. Patient-level outcomes in the form of modified Rankin Scale score will be collected for all consecutive patients throughout the study. Process evaluation outcomes will be collected and reported in the form of various stroke care indicators. We will report level and trend changes in various indicators during the three study phases.

Discussion:

Acute stroke requires timely detection, management, and secondary prevention. Implementation of the uniform stroke care pathway is a unique opportunity to promote the requirements of homogenous stroke care in medical colleges of India.

Prevalence of serum cobalamin and folate deficiency among children aged 6–59 months: A hospital-based cross-sectional study from Northern India

Context:

Cobalamin and folate are essential for the synthesis of nucleic acids and in the maintenance of myelin. They are required during the period of the rapid growth of infancy and childhood. Their deficiency may result in nutritional anemia and neurological manifestations. There is paucity of literature regarding the prevalence of cobalamin and folate deficiency among North Indian children aged 6–59 months.

Aim:

The aim of this study was to estimate the prevalence of serum cobalamin and folate deficiency among children aged 6–59 months, attending a secondary care hospital.

Settings and Design:

Children were recruited from pediatrics OPD of the sub-district hospital (SDH), Ballabgarh, Haryana, through systematic random sampling. Hemoglobin was measured by an automated analyzer. Serum cobalamin and serum folate were estimated using enhanced chemiluminescence based immunoassay.

Results:

A total of 420 children were recruited, of which 392 provided a blood specimen. Prevalence of cobalamin, folate deficiency, and anemia were 22.3% (95% CI: 18.3–26.7), 10.9% (95% CI: 8.2–14.6), and 81.9% (95% CI 77.7–85.4), respectively. The proportion of children with cobalamin deficiency who had anemia was 97.7% compared to 95.7% among those with no cobalamin deficiency (P = 0.396). Similarly, the proportion of children with folate deficiency who had anemia was 95.2% compared to 96.2% among those with no folate deficiency (P = 0.765).

Conclusion:

We found that almost one in five children aged 6–59 were deficient in cobalamin, and one in ten were deficient in folate.

Serological prevalence of SARS-CoV-2 antibody among children and young age group (between 2 and 17 years) in India: An interim result from a large multicentric population-based seroepidemiological study

Background:

Estimating seroepidemiolgical prevalence of SARS-CoV-2 antibody is an essential public health strategy. There is insufficient evidence of prevalence among those belonging to young age population in India.

Objective:

To compare the SARS-CoV-2 seropositivity rate between children and adults in selected sites from India.

Materials and Methods:

This was a multicentric population-based seroepidemiological study conducted in selected urban and rural areas of five sites selected from four states (Delhi, Odisha, Uttar Pradesh, Tripura) of India. Participants aged ≥1 year were included from different clusters of each area. Total serum antibody against SARS-CoV-2 virus was assessed qualitatively by using a standard enzyme-linked immunosorbent assay (ELISA) kit.

Results:

Data collection period was from 15 March 2021 to 10 June 2021. Total available data was of 4509 participants, of whom 700 were <18 years of age and 3809 were ≥18 years of age. The site-wise number of available data among those aged 2–17 years was 92, 189, 165, 146 and 108 for the sites of Delhi urban, Delhi rural, Bhubaneswar rural, Gorakhpur rural and Agartala rural area, respectively. The seroprevalence was 55.7% in the <18 years age group and 63.5% in the ≥18 years age group. The prevalence among female children was 58% and among male children was 53%.

Conclusion:

SARS-CoV-2 seropositivity rate among children was high and comparable to that of the adult population. Hence, it is unlikely that any future third wave by prevailing SARS-CoV-2 variant would disproportionately infect children 2 years or older.

Role of Serum MRP8/14 in Predicting Response to Methotrexate in Children With Juvenile Idiopathic Arthritis

OBJECTIVE

Nearly 40% of children with juvenile idiopathic arthritis (JIA) might not respond to first-line disease-modifying antirheumatic drugs (DMARDs) including methotrexate (MTX). Hence, there is a need for a biomarker that can predict MTX response and help in tailoring initial therapy. Our objective was to study the role of serum myeloid-related protein (MRP) 8/14, and other inflammatory cytokines, as predictors of response to MTX among children with JIA.

METHODS

We did a longitudinal follow-up study among children diagnosed with JIA at our institute. All MTX-naive children with JIA requiring DMARDs were eligible for this study; those who either took corticosteroids or DMARDs for more than 6 weeks at time of presentation were excluded. The demographic and clinical information was collected using a pretested semistructured questionnaire, and selected biomarkers were collected at baseline and again at 3 months. Response at 3 months was assessed using the American College of Rheumatology (ACR) criteria; responders were children who achieved ACR50, whereas those failing to achieve ACR30 were classified as nonresponders. Multivariate binary logistic regression was done to assess determinants of being a responder.

RESULTS

We enrolled 69 children (36 boys) with JIA, of which 48 (69.5%) were responders. The baseline value of serum MRP8/14 was significantly higher in responders (median, 144.34 [interquartile range, 88.54-188.34] ng/mL) compared with the nonresponders (median, 95.34 [interquartile range, 76.54-130.28] ng/mL), p = 0.047. Being a responder was significantly associated with baseline serum MRP8/14 with adjusted odds ratio of 1.01 (95% confidence interval, 1.00-1.02).

CONCLUSIONS

The baseline levels of MRP8/14 were significantly raised in children meeting ACR50 at follow-up and suggest a prognostic value in predicting response to MTX.

Partnering for rotavirus vaccine introduction in India: A retrospective analysis

BACKGROUND

The pre-existing partner network created in India for the delivery of polio vaccines was initially used to eradicate polio and later on embedded in the health systems network to promote routine immunization and other health interventions efficiently. The experience from this network offered lessons for strengthening the health care systems and provided a well-established network that could be utilized for other vaccine initiatives. It has also been established that successful partnerships between a broad range of stakeholders provide support, strengthen the health system, and accelerate vaccine innovation, introduction, access, logistics, and communication support. However, beyond polio eradication, there have not been too many documented success stories of vaccine introduction, which could be replicated in other new vaccine introductions and allied health initiatives. The authors have reviewed the successful and time-bound introduction of rotavirus vaccine (RVV) in India in the present article.

METHODS

The review was conducted based on a partnership framework which analysed multiple factors-partnership prerequisites, partnership model, partnership process, and partnership performance, thereby providing a comprehensive insight into the successful utilization of partnership networks for rotavirus vaccine introduction under the Universal Immunization Program in India.

RESULTS & CONCLUSION

The review also highlights the role of a lead agency in creating a fertile ground for lush, efficient, and effective partnerships amongst different stakeholders. The already existing RVV partnership framework reviewed by the authors can be successfully utilized for future new vaccine introductions.

Impact of G-CSF administration post-allogeneic hematopoietic stem-cell transplantation on outcomes: a systematic review and meta-analysis

Granulocyte colony-stimulating factors (G-CSFs) have been used post hematopoietic stem cell transplant (HSCT) for earlier neutrophil engraftment. The use of G-CSFs, and their effect on other post-HSCT outcomes remains debatable. In this systematic review and meta-analysis, we searched PubMed, Embase, Cochrane library, Google Scholar, and IndMed using a predefined search strategy. We included randomized controlled trials (RCTs) and non-randomized studies (NRSs) reporting data on G-CSF administration post-HSCT, published in the English language from their inception until Jan 31, 2021. The primary outcome of this systematic review and meta-analysis was to evaluate the time to neutrophil engraftment (NE). The secondary outcomes were probability of NE, time to platelet engraftment (PE), the incidence of graft-versus-host disease (GVHD), duration of hospital stay (HS), and overall survival (OS). The review is registered with PROSPERO (CRD42020206989). Fourteen studies were extracted (n=9850), of which five were RCTs, and nine were NRSs. As per Egger's test, publication bias was not present for any outcome. After meta-analysis, we found that the duration of NE favouring G-CSF arm from RCTs was -0.94 days (SMD) [(95% CI: -1.38, -0.51); I²=35%], and from NRSs -1.2 days (SMD) [(95% CI: -1.43, -0.96); I²=74%]. For the outcome of GVHD, the relative risks (RR) of incidence for chronic GVHD and overall GVHD were not significant for the RCTs, and these were 1.11 (RR) [(95% CI: 1.00, 1.22); I²=43%] and 1.10 (RR) [(95% CI: 1.03, 1.18); I²=48%], respectively for NRSs. There was no difference in the incidence of GVHD (acute or chronic) in both arms. No significant difference was found between the two arms for the outcomes of PE, HS, and OS. For NE, there was a marginal benefit of around one day with the use of G-CSF. The use of G-CSF did not alter time to PE, the incidence of GVHD, HS, and OS in both arms.

Global status of knowledge for the prevention and emergency management of traumatic dental injuries among non-dental healthcare professionals: A systematic review and meta-analysis

OBJECTIVES

This Systematic Review was conducted to evaluate the global status of the knowledge of prevention and emergency management of traumatic dental injuries among non-dental healthcare professionals (NDHCP).

METHODS

The protocol was designed as per PRISMA guidelines and registered in PROSPERO (CRD42020192381). A broad-based search using text-words and MeSH terms was performed in established databases as per a predefined strategy without any distinction of language and year of publication. Studies without details of the questionnaire, knowledge score, validity and reliability were excluded. Data extraction was performed and risk of bias assessment was done using the Joanna Briggs Institute's critical appraisal tool and a meta-analysis was performed.

RESULTS

The qualitative synthesis included 14 studies between 2009-2020 with nine of them from Asia. Majority of the studies had low risk of bias and reported poor overall level of knowledge. Less than 40% of the NDHCP had received a dental trauma first aid training in six of the 10 studies and majority of the participants (>50%) believed that dental trauma training was required in five studies. Less than 36% of the participants were adequately aware of the correct approach towards management of avulsed permanent tooth in five studies.

CONCLUSION

The knowledge of non-dental health care professionals regarding the emergency management of traumatic dental injuries was insufficient or low in the majority of studies and the knowledge about prevention was not evaluated. There was a paucity of studies from the countries of Europe and Australia, with wide variability in the study methods, categories of the participants and questionnaire characteristics.

Single Dose of Intravenous Ferric Carboxymaltose Prevents Anemia for 6 Months among Moderately or Severely Anemic Postpartum Women: A Case Study from India

The effectiveness of intravenous ferric carboxymaltose (FCM) in quickly increasing normal hemoglobin concentration and replenishing body iron reserves up to 6-12 wk is known; however, its long-term effectiveness is unknown. In this study conducted in northern India during August 2018 to February 2019, 100 postpartum women within 48 h of delivery with a hemoglobin concentration between 5.0 and 9.9 g/dL were included. A single dose of intravenous FCM was administered. The hemoglobin and serum ferritin concentrations were measured at baseline and at 6 mo. Out of 100 women recruited, 57 (57%) returned for the follow-up visit at 6 mo. The mean (± SD) hemoglobin and serum ferritin concentrations at baseline were 8.6 ± 1.1 g/dL and 15.8 ± 17.2 ng/mL, respectively, and at 6 months were 12.5 ± 1.2 g/dL and 72.0 ± 52.0 ng/mL, respectively. The mean increase in hemoglobin concentration was 3.9 (95% CI: 3.5, 4.3) g/dL (P < 0.001) and for serum ferritin was 53.8 (95% CI: 41.8, 65.8) ng/mL (P < 0.001). The study was registered prospectively in the Clinical Trials Registry-India (CTRI) as CTRI/2018/06/014332.

Did Inclusion of informed consent affect the observed hiv prevalence rate among injecting drug users during hiv sentinel surveillance 2017 in Delhi, Uttar Pradesh, Uttarakhand, and Jharkhand States of Central Zone of India?

Background

In 2017, the sampling procedure for HIV sentinel surveillance (HSS) among all high-risk groups was changed from the consecutive sampling to random sampling along with the introduction of linked anonymous testing strategy with informed written consent.

Objective

The objective of this study was to assess whether the inclusion of informed consent affects the HIV positivity rate among the participants and nonparticipants injecting drug users (IDU) in HSS 2017 in four states of Central Zone of India.

Methods

This study was a cross-sectional study. All sentinel sites from Delhi, Uttar Pradesh, Jharkhand, and Uttarakhand located at targeted intervention facilities in 2017 were included in the study. Information about the participation and nonparticipation of each high-risk individual at the sentinel site was gathered from the master list, respective registers, and website portal of the National AIDS Control Organization. A total of 8639 individuals were included in the analysis.

Results

Overall, 16 sites in four states were included in the study. Overall, the nonparticipation rate of IDUs was 14.3%; highest being for Delhi (17.2%), followed by Uttar Pradesh (14.6%), Uttarakhand (10.9%), and Jharkhand (4.4%). Overall, the HIV-positivity rate among nonparticipants (9.6%) was significantly higher (P = 0.009) compared to the participants (6.7%).

Conclusion

Change in methodology and seeking written informed consent might have an effect on the nonparticipation in all four states. This, in turn, could have led to the underestimation of HIV-positivity rates among IDU in the states.