Serosurveillance among COVID-19 Cases in Ahmedabad Using SARS-COV2 IgG Antibodies

Background: Serosurveillance study focusing on antibodies against SARS-CoV2 among the Covid19 cases can add value in the scientific knowledge & help in formulating valid predictions regarding immunity status in the post-covid period. Objectives: To estimate seropositivity among covid19 cases and to identify various factors affecting seropositivity. Methods: During second half of October 2020, a population based serosurvey on Covid19 cases was carried out in Ahmedabad. Covid-Kavach test kits were used and estimated seroprevalence was compared with available demographic and covid19 case related parameters to identify factors affecting seropositivity in the post-covid period. Simple proportions and Z-test were used as appropriate. Results: As on October 2020, the sero-positivity among Covid19 cases in Ahmedabad was 54.51% [95% Confidence Interval (CI) 52.14-56.86%]. Females have higher positivity (54.78%) as compared to males (54.30%) but the difference was statistically not significant (Z=0.19, P=0.84). Among children and elderly, the positivity is high and from young adults to elderly the seropositivity has an increasing trend. Severity of clinical illness and longer duration of hospitalization are associated with higher seropositivity. Conclusion: With 54.51% seropositivity among covid19 cases, it is clear that all the covid19 cases may not have developed IgG antibodies, have undetectable level or might have disappeared during the post-covid period. Comparison of seropositivity with age group and clinical case details clearly suggest close correlation with the severity of clinical symptoms. The seronegative cases indicate the need for further in-depth scientific research to identify the factors affecting immunity and to uncover the reasons behind the same

Risk factors for early mortality on antiretroviral therapy in advanced HIV-infected adults.

CAPRISA, 2017.Abstract available in pdf

Effect of angiotensin-converting enzyme inhibitor and angiotensin receptor blocker initiation on organ support-free days in patients hospitalized with COVID-19

IMPORTANCE Overactivation of the renin-angiotensin system (RAS) may contribute to poor clinical outcomes in patients with COVID-19. Objective To determine whether angiotensin-converting enzyme (ACE) inhibitor or angiotensin receptor blocker (ARB) initiation improves outcomes in patients hospitalized for COVID-19. DESIGN, SETTING, AND PARTICIPANTS In an ongoing, adaptive platform randomized clinical trial, 721 critically ill and 58 non–critically ill hospitalized adults were randomized to receive an RAS inhibitor or control between March 16, 2021, and February 25, 2022, at 69 sites in 7 countries (final follow-up on June 1, 2022). INTERVENTIONS Patients were randomized to receive open-label initiation of an ACE inhibitor (n = 257), ARB (n = 248), ARB in combination with DMX-200 (a chemokine receptor-2 inhibitor; n = 10), or no RAS inhibitor (control; n = 264) for up to 10 days. MAIN OUTCOMES AND MEASURES The primary outcome was organ support–free days, a composite of hospital survival and days alive without cardiovascular or respiratory organ support through 21 days. The primary analysis was a bayesian cumulative logistic model. Odds ratios (ORs) greater than 1 represent improved outcomes. RESULTS On February 25, 2022, enrollment was discontinued due to safety concerns. Among 679 critically ill patients with available primary outcome data, the median age was 56 years and 239 participants (35.2%) were women. Median (IQR) organ support–free days among critically ill patients was 10 (–1 to 16) in the ACE inhibitor group (n = 231), 8 (–1 to 17) in the ARB group (n = 217), and 12 (0 to 17) in the control group (n = 231) (median adjusted odds ratios of 0.77 [95% bayesian credible interval, 0.58-1.06] for improvement for ACE inhibitor and 0.76 [95% credible interval, 0.56-1.05] for ARB compared with control). The posterior probabilities that ACE inhibitors and ARBs worsened organ support–free days compared with control were 94.9% and 95.4%, respectively. Hospital survival occurred in 166 of 231 critically ill participants (71.9%) in the ACE inhibitor group, 152 of 217 (70.0%) in the ARB group, and 182 of 231 (78.8%) in the control group (posterior probabilities that ACE inhibitor and ARB worsened hospital survival compared with control were 95.3% and 98.1%, respectively). CONCLUSIONS AND RELEVANCE In this trial, among critically ill adults with COVID-19, initiation of an ACE inhibitor or ARB did not improve, and likely worsened, clinical outcomes. TRIAL REGISTRATION ClinicalTrials.gov Identifier: NCT0273570

4. Study of Metallo-beta lactamase production in imipenem-resistant gram-negative bacteria in surgery and ICUs in tertiary care hospital.

Broad spectrum antimicrobial resistance, where resistance to multiple, or even all available antibiotic classes, is a key global healthcare problem. Gram negative bacilli account for the majority of bacterial pathogens isolated from clinical specimens. The incidence of infections is due to gram negative bacilli resistant to β lactam agents. Metallo beta lactamase (MBL) producing gram negative bacteria have been recognized to be among the most important nosocomial pathogens. MBLs have been identified with increasing frequency to cause serious infections. Aim: This study was conducted to identify phenotypically for the presence of metallo-betalactamase producing isolates in surgery and ICUs. Materials and Methods: A total of 134 imipenem resistant microorganisms were isolated in Surgery and various ICUs. All the isolates were tested for anti-microbial susceptibility (Hi-Media Mumbai) for Imipenem by Kirby-Bauer disk diffusion method on Muller-Hinton agar. Imipenem resistant isolates were further tested for Metallo-betalactamase production by Combined disc diffusion test. Results: Out of 134 isolates, 67 (50%) were Klebsiella spp., 26(19.4%) E.coli, 33 (24.6%) Pseudomonas spp., 8(5.9%) were Acinetobacter spp. 77 isolates shows MBL production. Among 77 MBL producing isolates Klebsiella spp. comprised of 40/77 (51.9%), Pseudomonas spp. 21/77(27.2%), E.coli11/77(14.2%), Acinetobacter spp. 5/77(6.4%). Out of 77 MBL producers, 31 were isolated from ICUs and 46 were from Surgical ward. Conclusion The detection of MBL resistant organism showed importance of hospital environment in the ICUs and surgical wards are vicious due to their invasive procedures and enormous usage of antibiotics

Effect of Antiplatelet Therapy on Survival and Organ Support–Free Days in Critically Ill Patients With COVID-19

International audienc