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

Seroprevalence of Immunoglobulin G Antibody among Contacts of COVID19 Cases: A Study from India

Objective: To estimate Covid19 seropositivity among contacts of cases and to compare the seropositivity among different types of contact for assessing the differential risk & transmission dynamics. Material and Methods: A large-scale population-based serosurvey was carried out among the general population of Ahmedabad during the second half of October 2020. The contacts of cases were selected based on the population proportion and enrolled as an additional category. The seropositivity among the contacts was estimated using the enzyme-linked immunosorbent assay and compared with different types of contact and available demographic factors. Results: As of October 2020, the seropositivity against Severe Acute Respiratory Syndrome Coronavirus-2 (SARS-CoV2) among contacts of cases in Ahmedabad was 26.0% [95% confidence interval 24.2–28.0]. The seropositivity among family contacts was significantly higher (28.8%) compared to other contacts (24.4%) (Z=2.19, p-value=0.028). This trend was seen across all age groups and both sexes. The seropositivity was higher among females (27.7%) compared to males (24.5%) but the difference was statistically not significant (Z=1.64, p-value=0.101). In terms of age groups, the positivity had an increasing trend up to 60 years but declined after that. Conclusion: A seropositivity of 26.0% among contacts indicates that a large proportion of contacts demonstrated Immunoglobulin-G antibodies. This highlights asymptomatic transmission and/or low sensitivity of the diagnostic tests. The current strategy for contact tracing and testing among contacts is justified based on the significantly higher seropositivity among family contacts

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

STUDY OF CANDIDA SPECIES AND ITS ANTIFUNGAL SUSCEPTIBILITY PATTERN IN A TERTIARY CARE HOSPITAL

Introduction: Opportunistic infections by Candida spp are becoming quite common in hospitals today with antifungal resistance, an increasing problem in many wards. Candida albicans has been the commonest species causing infection for many years but indiscriminate use of azole group of drugs has led to increase in NCA infection and resistance to antifungal drugs in Candida species Methodology: Duration of the study was from7th June- 2018 to 12th Mar 2019. Candida species isolated from various clinical specimens were subjected to speciation using standard yeast identification protocol and CHROM agar. Antifungal susceptibility testing was performed and interpreted for all the isolates of Candida using disc diffusion method as recommended by Clinical and Laboratory Standards Institute (CLSI) M44-A document guidelines. The inoculum was prepared by suspending five colonies of growth in 5 ml of sterile saline and compared the turbidity to 0.5 McFarland Standard. A cotton swab was dipped into the inoculum suspension and evenly streaked onto Mueller–Hinton agar supplemented with 2% glucose and 5 μg/ml methylene blue against Amphotericin B and Azole group of antifungals like Fluconazole, Itraconazole, Clotrimazole and Voriconazole. Results: Among the 268 culture positive isolates 152(56.7%) were C. albicans and 116 (43.2%) were non candida albicans. Among NCA, 53(19.7%) were C. tropicalis followed by other species. Susceptibility pattern showed that Azole group 73.0% sensitive among C. albicans and 67.9% sensitive among C. tropicalis while in Amphotericin B sensitivity varies from 50 % to 100% to all isolated spp. of candida. Conclusion: In this study C.albicans was the most common yeast isolated from all the clinical samples. The C. albicans and NCA showed highly susceptible to Amphotericin B, followed by Voriconazole

Covid-19 Serosurveillance Positivity in General Population: Comparison at Different Times

Introduction: Serological surveys estimating the cumulative incidence of the disease are powerful and effective tools for monitoring the epidemic and in determining the immunity status. Objectives: To compare the percentage sero-positivity for IgG antibodies against SARS-CoV2 at two different time period in the same population to understand the pandemic and predict about the immunity status of the population. Methods: As a part of Covid19 pandemic management, two separate population based sero-survey within a gap of 1½ months were carried in Ahmedabad city to scientifically document the progress of the Covid19 pandemic. Various demographic factors and other parameters from both the survey were compared with seropositivity for valid and precise estimation of disease situation as well as immunity status of the population. Results: The study documents an increase in seropositivity by 5.32% (from 17.92% to 23.24%). The seropositivity shows increasing trend with increase in the age group and the seropositivity is significantly higher among females. Overall higher seropositivity against the reported cases in the first sero-survey and the narrow increase in the seropositivity during the subsequent sero-survey inspite of high number of cases may indicate temporary status of the antibodies. This may also be due to the difference in the level of stigma, health care service delivery, service utilization and related field level situation affecting the asymptomatic/unreported case positivity. Conclusion: The result of seropositivity comparison indicates the scopes for further research to confirm and generate greater evidences regarding the factors affecting seropositivity

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

International audienc