Poor Vaccine Effectiveness against Influenza B-Related Severe Acute Respiratory Infection in a Temperate North Indian State (2019–2020): A Call for Further Data for Possible Vaccines with Closer Match

Background: Influenza vaccine uptake in India is poor, and scant data exist regarding the effectiveness of influenza vaccine against hospitalization. Methods: From October 2019 to March 2020, vaccination status of 1219 patients (males n = 571, aged 5–107 years; median, 50 years) hospitalized with severe acute respiratory illness (SARI) was assessed. The patients were tested for influenza viruses and their subtypes by RT PCR. Sequencing of the HA gene was performed. Vaccine effectiveness (VE) against influenza subtypes was estimated by the test negative design. Results: A total of 336 (27.5%) patients were influenza-positive, with influenza B/Victoria accounting for 49.7% (n = 167), followed by influenza A/H1N1 (47.6%; n = 155) and influenza A/H3N2 (4.4%; n = 15). About 6.8% and 8.6% of the influenza-positive and influenza-negative patients, respectively, had been vaccinated. Adjusted VE for any influenza strain was 13% (95% CI −42 to 47), which for influenza B was 0%. HA sequencing revealed that influenza B samples mainly belonged to subclade V1A.3/133R with deletion of residues 163–165, as against the 2-aa deletion in influenza B/Colorado/06/2017 strain, contained in the vaccine. VE for influenza A/H1N1 was 55%. Conclusions: Poor VE due to a genetic mismatch between the circulating strain and the vaccine strain calls for efforts to reduce the mismatch

Effectiveness, acceptance and feasibility of home-based intervention model for tuberculosis contact tracing in Kashmir

Background: As long as one case of tuberculosis is replaced by another, elimination of tuberculosis cannot be achieved. Contact tracing is an important strategy for detection of more TB cases early. The present study is concerned with an innovative method of contact tracing. Methods: A quasi randomized interventional study was conducted in two TB Units of Kashmir for evaluation of newly designed interventional model for its effectiveness, acceptance and feasibility. Data was collected from 1st Jan 2014 to 30th June 2015. Results: In interventional group of 598 eligible household contacts, total 27 (4.51%) contacts were detected as suffering from active pulmonary TB cases. Out these, 21 (3.51%) cases were diagnosed during initial home visit and 6 (1.04%) cases were diagnosed at 6th monthly follow up visit. In controlled group 593 eligible household contacts, total 7 (1.18%) contacts were found suffering from active pulmonary —TB during routine practice under RNTCP for contact screening. In interventional group, during initial home visit by the investigator, 423 (70.74%) of household contacts participated for study and during follow up visit at 6th month, 356 (59.53%) household contacts participated. Conclusion: Newly designed “home-based intervention model” for active-case finding among household contacts of index pulmonary-TB case has been found an effective method for contact tracing. This intervention has adequate acceptance by the community and feasible for implementation under existing revised national tuberculosis control programme. Keywords: Household contacts, Contact tracing, Tuberculosis Active case finding, Intervention mode

Diagnosing sputum/smear-negative pulmonary tuberculosis: Does fibre-optic bronchoscopy play a significant role?

<b>Background</b> : Diagnosis of sputum/smear-negative pulmonary tuberculosis patients can be both challenging and time consuming with many patients being put on empirical anti-tubercular treatment. Fibreoptic bronchoscopy may provide a confirmative and early diagnosis in such patients. <b> Aims:</b> To assess the role of fibreoptic bronchoscopy in the diagnosis of sputum /smear-negative pulmonary tuberculosis. <b> Materials and</b> <b> Methods:</b> The study was conducted on 75 suspected sputum / smear-negative pulmonary tuberculosis cases attending Pulmonary Medicine Department of Mamata Medical College and Hospital, Khammam, AP. Fibreoptic bronchoscopy was performed; culture of sputum and bronchial washings for <i>Mycobacterium tuberculosis</i> was done by BACTEC method. <b> Results:</b> A final diagnosis of sputum /smear-negative pulmonary tuberculosis was made in 60 patients. Bronchial washings smear for acid-fast bacilli (AFB) was positive in 21 patients while culture of bronchial washings was positive in 39 patients. In 29 patients, smear or culture of bronchial washing alone contributed to the final diagnosis. Total yield of bronchoscopy in diagnosis of sputum smear negative pulmonary tuberculosis was 83.33&#x0025; (50/60); bronchoscopy was the only diagnostic method in 66&#x0025; cases (40/60) with bronchial washings being the only diagnostic method in 48.33&#x0025;. Bronchial washings smear for AFB and histopathological evidence of caseating granuloma made immediate diagnosis possible in 48.33&#x0025; (29/60) patients. <b> Conclusion:</b> Our study suggests that fibreoptic bronchoscopy can provide excellent material for diagnosis of suspected cases of Pulmonary Tuberculosis in whom smears of expectorated sputum do not reveal mycobacteria

PULMONARY CANDIDIASIS PRESENTING AS MYCETOMA

Candida is a saprophytic yeast that is frequently recovered from the respiratory tract. Most mycetoma lesions are due to Aspergillus species growing inside an existing cavity. The saprophytic nature of the Candida species in the human respiratory tract obscures diagnosis of Candida pulmonary infections. Only a few cases of mycetoma due to Can-dida have been reported. We report a case of mycetoma caused by Candida albicans in a diabetic immunocompromised tuberculous patient. Diagnosis was confirmed by biopsy and certain points strongly favoured the diagnosis. The patient was immunocompromised due to uncontrolled diabetes mellitus. Candida albicans was grown from bronchial and repeatedly from sputum samples and Candida antigen was positive from blood in high titre. There was a good clinical as well as radiological response to antifungal therapy and Candida antigen became negative. We emphasize that in the immunosuppressed host, a mycetoma-like lesion may be caused by Candida pulmonary infection

Pulmonary candidiasis presenting as mycetoma

Candida is a saprophytic yeast that is frequently recovered from the respiratory tract. Most mycetoma lesions are due to Aspergillus species growing inside an existing cavity. The saprophytic nature of the Candida species in the human respiratory tract obscures diagnosis of Candida pulmonary infections. Only a few cases of mycetoma due to Can-dida have been reported. We report a case of mycetoma caused by Candida albicans in a diabetic immunocompromised tuberculous patient. Diagnosis was confirmed by biopsy and certain points strongly favoured the diagnosis. The patient was immunocompromised due to uncontrolled diabetes mellitus. Candida albicans was grown from bronchial and repeatedly from sputum samples and Candida antigen was positive from blood in high titre. There was a good clinical as well as radiological response to antifungal therapy and Candida antigen became negative. We emphasize that in the immunosuppressed host, a mycetoma-like lesion may be caused by Candida pulmonary infection

One-year descriptive analysis of patients treated at an anti-rabies clinic-A retrospective study from Kashmir.

Dog bites in humans are a major public health problem in India in general and Kashmir in particular. Canine rabies is almost non-existent in developed countries and exists mainly in the poorer, low socioeconomic strata of society in the developing world. The objective of this study was to determine the characteristics, pattern, and burden of dog bite injuries in the Kashmir valley. Data from Anti-Rabies Clinic of a tertiary care hospital in Srinagar, the summer capital of the state of Jammu & Kashmir, was collated and analyzed. Analysis of records of all the patients who had reported between April 2016 and March 2017 was done. A total of 6172 patients had reported to the Anti-Rabies Clinic for management of animal bites from 1st April 2016 to 31st March 2017. Most of the patients were young males. Almost half (47.7%) of the patients were bitten in the afternoon. Lower limbs were the most common site of bite (71.7%). Most of the bites were of Category III (57.6%) followed by Category II (42.3%); only one case of Category I was recorded. Almost all (98.0%) cases reported being bitten by dogs. Conclusions: Category III dog bites on lower limbs were the most common type of animal bites presenting to the Anti-Rabies Clinic of a tertiary care hospital. Children have more chances of a bite on head and neck region. Serious and workable efforts have to be made to reduce the incidence and consequences of animal bites

Proposing melasma severity index: A new, more practical, office-based scoring system for assessing the severity of melasma

Background: Melasma Area and Severity Index (MASI), the scoring system in melasma, needs to be refined. Aims and Objectives: To propose a more practical scoring system, named as Melasma Severity Index (MSI), for assessing the disease severity and treatment response in melasma. Materials and Methods: Four dermatologists were trained to calculate MASI and also the proposed MSI scores. For MSI, the formula used was 0.4 (a × p 2 ) l + 0.4 (a × p 2 ) r + 0.2 (a × p 2 ) n where "a" stands for area, "p" for pigmentation, "l" for left face, "r" for right face, and "n" for nose. On a single day, 30 enrolled patients were randomly examined by each trained dermatologist and their MASI and MSI scores were calculated. Next, each rater re-examined every 6 th patient for repeat MASI and MSI scoring to assess intra- and inter-rater reliability of MASI and MSI scores. Validity was assessed by comparing the individual scores of each rater with objective data from mexameter and ImageJ software. Results: Inter-rater reliability, as assessed by intraclass correlation coefficient, was significantly higher for MSI (0.955) as compared to MASI (0.816). Correlation of scores with objective data by Spearman′s correlation revealed higher rho values for MSI than for MASI for all raters. Limitations: Sample population belonged to a single ethnic group. Conclusions: MSI is simpler and more practical scoring system for melasma

Prevalence of common ocular morbidities in adult population of Aligarh

Aims and Objectives: To determine the prevalence of common ocular morbidities (cataract, refractive errors, glaucoma, and corneal opacities) and their demographic and sociocultural correlates. Settings and Design: The present cross-sectional study was conducted in the field practice areas of the Department of Community Medicine, JNMC, AMU, Aligarh, for a period of one year, from September 2005 to August 2006. Materials and Methods: Systematic random sampling was done to select the required sample size. All adults aged 20 years and above in the selected households were interviewed and screened using a 6/9 illiterate &#x2032;E&#x2032; chart. Those who could not read the &#x2032;E&#x2032; chart were referred to the respective health training center for a complete eye examination by an ophthalmologist. Statistical Analysis: Chi- square test. Results: The prevalence of visual impairment, low vision, and blindness, based on presenting visual acuity was 13.0, 7.8, and 5.3&#x0025;, respectively. The prevalence of cataract was 21.7&#x0025;. Bilateral cataract was present in 16.9&#x0025; of the population. Cataract was significantly associated with age, education, and fuel use. The prevalence of myopia, hypermetropia, and astigmatism was 11.5, 9.8, and 3.7&#x0025;, respectively. Glaucoma was diagnosed in six patients, giving a prevalence rate of 0.9&#x0025;. All the six patients of glaucoma were aged above 40 years. The prevalence of corneal opacity was 4.2&#x0025;. Conclusion: There is a high prevalence of treatable or preventable morbidities such as cataract, refractive errors, and corneal opacity

Goiter Survey among School Children (6–12 Years) in Northern Himalayan Region

Background: Deficiency of iodine results in impairment of thyroid hormone synthesis and abnormalities grouped under the heading of “iodine deficiency disorders (IDDs).” Goiter surveys are conducted to estimate the region's iodine status. In view of this, we conducted this goiter survey among school-going children of district Baramulla, Kashmir division, to see the prevalence of IDD. Materials and Methods: This cross-sectional study was conducted among 6–12 years children in district Baramulla during the month of March and April 2017. The sample size of 2700 was calculated. The assessment of goiter was performed clinically by inspection and palpation of the thyroid gland. Results: In this study, we studied a total of 2700 school children in the age group of 6–12 years from district Baramulla with a mean age of 9 ± 1.86 years. 50.07% were boys. The age distribution prevalence of goiter among school children (6–12 years) in district Baramulla was observed to be 15.29%. The prevalence of Grade 1 goiter was more than twentyfold higher than Grade 2 goiter. The highest prevalence of Grade 1 and 2 goiter was seen among school children of 12 years age (25.19% and 1.81%, respectively). Females have higher prevalence of Grade 1 and Grade 2 goiter (17.58%). The relationship of goiter prevalence with gender and age was statistically significant. Conclusion: The present study showed mild goiter prevalence in school-aged children of 6–12 years in the district Baramulla of Kashmir valley. There is a dire need of periodic surveys to assess the magnitude of the IDD in the future