Positive Contact History Research Articles

Thrombocytopenia and Coagulopathy in Covid-19 Manifesting as Upper Gastrointestinal Bleed and Epistaxis

COVID-19 is an acute febrile illness and the common manifestations are cough, flu and fever. COVID19 infection with severe thrombocytopenia and coagulopathy is a rare life threatening presentation. We are presenting a case of a gentleman in 20's with history of positive animal contact, who presented to emergency department (ED) with history of fever of more than a week and nasal bleed. Relevant examination showed unstable vitals, anterior nasal packing in place, left lower zone crackles and ongoing black stool. Laboratory workup revealed bicytopenia with platelet count of (6X109), low hemoglobin, deranged INR, low fibrinogen levels. The patient was managed for viral hemorrhagic fever leading to disseminated intravascular coagulation (DIC). He was managed with antipyretics, antibiotics. resuscitated with blood products, admitted to inpatient facility. His blood counts started improving favoring the possibility of thrombocytopenia secondary to viral illness, and later discharged in stable condition. COVID-19 is acute viral infection. Any patient with fever and bleeding should be kept on high suspicion for other viral illness as well. Treatment approach can be conservative. Thrombocytopenia and coagulopathy with 2 organ bleed is the first case reported to the best of our knowledge.

Demography, Clinical Profile and Outcome of COVID-19 Patients in the east-southern region of Bangladesh

Introduction: In Bangladesh, the first confirmed case of COVID-19 was detected on March 8 2020, about 3 months after the initial outbreak in late December 2019 in Wuhan, China. Both affected cases and deaths have increased exponentially during this global pandemic. Demographic and clinical data on COVID-19 in Bangladesh is still deficient. Our study aims to evaluate the demographic, clinical profile and outcome of COVID-19 Patients in the east-southern region of Bangladesh. Methodology: It was a cross sectional study. All RT-PCRpositive patients who tested in the RT-PCR lab of Comilla Medical College on 10 days of each month from July to December 2020 were included in this study. Ten days in each month were selected by lottery. After getting the verbal consent, selected patients were interviewed over the telephone by the investigator team, and their information was recorded accordingly in a preformed data sheet. Results: A total of 606 COVID-19 RT-PCR-positive patients were interviewed. The mean age was 40.39 ± 15.42 years; 62.8% were male, and 17.3% of patients had positive contact history with COVID-19 patients. Predominant presenting symptoms were fever (71.8%), cough (41.3%), breathlessness (22.8%), fatigue (18.3%), anorexia (26%) and diarrhea (4.1%). Hypertension (13.1%), diabetes mellitus (16.1%), ischemic heart disease (IHD) (2.8%) and chronic kidney disease (CKD) (0.4%) were frequent comorbidities. 72% of the patients were mild, 16% moderate , 7% severe, and 5% critically ill. 78% took home treatment and 5% were in ICU. 97.2% recovered and 2.8% died. Older age (p= 0.001), male sex (p= 0.007), smoking (p= 0.001), breathlessness (p=0.001) and presence of comorbidities (p= < 0.05) were significantly associated with mortality. 33.8% had post- COVID symptoms, including fatigue 26.7% and shortness of breath 13.2%. Conclusion: Younger age groups were more affected than older age groups. Majority of the patients did not have a history of contact with COVID-19 patients. Most of the patients had mild symptoms. About one fourth were hospitalized, among them 5% got treatment in ICU. Most of the patients recovered, and 2.8% died. Death was more common in patients with multiple comorbidities. One third of recovered patients had post-COVID symptoms. J Bangladesh Coll Phys Surg 2023; 41(4): 298-304

Primary hydatid cyst of the thyroid glands: two case reports and a review of the literature

IntroductionAlthough hydatid cyst remains one of the prevalent parasitic infections in humans, hydatid cyst of the thyroid is extremely rare, even in endemic areas. Here we present two cases of thyroid hydatid cysts.Case presentationA 35 and a 50 year-old Iranian female with a positive history of animal contact were presented with a neck lump without any compressive symptoms. A physical exam revealed neck masses that elevated with swallowing. Thyroid gland ultrasonography showed cystic thyroid lesions, and fine needle aspiration (FNA) suggested a thyroid hydatic cyst. Thyroid lobectomy and isthmectomy were done for the first patient, and near-total thyroidectomy was done for the other. The pathology report confirmed the diagnosis of a hydatid cyst. None of the patients had hydatid cysts in other sites. Patients were discharged without an antiparasitic drug, and no recurrence was detected at the six-month follow-up.ConclusionIt is necessary to consider hydatid cysts in the differential diagnosis of cystic lesions of the thyroid gland in endemic areas, especially in people with a positive history of animal contact.

Seroepidemiological and Molecular Survey for the Detection of SARS-CoV-2 Infection among Children in Iran, September 2020 to June 2021: 1-Year Cross-Sectional Study.

A population-based seroepidemiological and molecular survey on severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) was performed to detect induced antibodies to prior exposure and active infection of children aged 14 years or less in Tehran between 19 September 2020 and 21 June 2021. Moreover, correlations between the children's demographic data and coronavirus disease 2019 (COVID-19) symptoms with the infection status were investigated. Out of 1517 participants, cardinal symptoms of COVID-19 (fever > 38 °C and/or cough and/or diarrhea) were detected in 18%, and serological history of SARS-CoV-2 infection and polymerase chain reaction (PCR) positivity were confirmed in 33.2% and 10.7% of the weighted population, respectively. The prevalence of SARS-CoV-2 infection was significantly higher among 10-14-year-old children. Active infection was significantly higher in symptomatic children and during autumn 2020 and spring 2021. The quantitative reverse transcription real-time PCR (RT-qPCR) positivity was significantly higher among families with a lower socioeconomic status, whereas no association between RT-qPCR or seropositivity was determined with household size, underlying diseases, or gender. In conclusion, high SARS-CoV-2 infection prevalence and seroprevalence were detected in children in Tehran in different seasons. Infection prevalence was significantly higher in older children and in those with a positive history of close contact with infected cases and/or lower socioeconomic status.

Serological Profile of SARS-CoV-2 in Unvaccinated Blood Donors: A Nationwide Study During the Fifth Wave of the Pandemic in Iran

Background: Serological studies can demonstrate pathogen circulation in regional populations and reflect public health measures' effectiveness during different pandemic phases. By late November 2021, coinciding with the third pandemic wave, the seroprevalence of SARS-CoV-2 spike IgG antibodies among the Iranian population was 32.63%. Objectives: This study aimed to assess the Iranian population's seroprevalence during the fifth pandemic wave by analyzing donated blood samples. Methods: This population-based cross-sectional study was conducted on Iranian blood donors referred to all 31 main provincial capitals between August 2021 and September 2021. The participants selected through quota sampling were asked to complete a questionnaire on socio-demographics and coronavirus disease 2019 (COVID-19)-related information. Also, SARS-CoV-2 spike IgG antibodies were measured in serum samples using SARS-CoV-2 enzyme-linked immunosorbent assay (ELISA) kits. The seroprevalence was weighted based on the gender and age groups of the population and then adjusted for test performance. Results: Totally 3,339 blood donors participated in this study. The overall population-weighted seroprevalence adjusted for test performance was 52.67% (95% confidence interval (CI): 50.14 - 55.21). Seroprevalence was higher among participants with a high school diploma (55.45%, 95% CI 50.61 - 60.29), a positive history of close contact with COVID-19 patients (65.23%, 95% CI 60.83 - 69.63), and previous positive COVID-19 PCR tests (86.51%, 95% CI 82.32 - 90.7). Conclusions: More than half of the study population was exposed to SARS-CoV-2, indicating a 1.7-fold increase in the seroprevalence between late November 2020 and mid-September 2021. Our finding illuminated the pattern of Iran's fifth wave of the pandemic.

Demographic characteristics, clinical presentation and in-hospital outcome among patients with Covid-19 in a Nigerian tertiary hospital.

We described the demographic/clinical characteristics and in-hospital outcome of patients with COVID-19 at the University of Nigeria Teaching Hospital (UNTH) during the first wave to inform evidence-based responses during subsequent waves in Africa. We conducted retrospective cohort analyses of adult patients ≥18 years with PCR or GeneXpert-confirmed SARS-CoV-2 infection. Data was extracted from patients' medical records from 1st May to 30th September 2020. Based on disease severity, patients were either hospitalized (82) or managed at home (90). Logistic regression and cox-proportional hazard models were used to determine predictors of severe COVID-19 disease and in-hospital mortality, respectively. Of 172 cases, 113 (65.7%) were males, and the mean age was 45 ± 19 years. The majority were urban dwellers (72.1%), 19.8% had a positive history of contact with a confirmed/suspected case, 15.7% were healthcare workers while 68 (39.5%) had co-morbidities. Symptomatic patients comprised 73.3% of cases. Fever (p=0.02) and breathlessness (p=0.03) were commoner in males while diarrhoea (p<0.01) was predominant in females. On multivariate analysis, severe COVID-19 was predicted by the presence of co-morbidity (AOR= 14.44, 95% C.I= 4.79- 43.58, p <0.001)and prior antibiotic/antimalarial use (AOR= 6.35, 95% C.I= 2.24- 18.05, p =0.001) while being a non-healthcare worker (AOR= 0.18, 95% C.I= 0.04-0.78, p=0.02) was protective. However, none of the variables assessed predicted in-hospital mortality. Our findings underscore the contributions of demographic variables in COVID-19 transmission and gender differences in clinical presentation. Underlying comorbidity likewise prior antimicrobial use increased the likelihood of severe COVID-19. The absence of mortality predictors in our study may be related to the relatively small number of deaths. Further studies are recommended to unravel the predominance of severe disease in healthcare workers.

A Critical Appraisal of Clinicopathological, Imaging, and GeneXpert Profiles of Surgical Referrals with Pediatric Abdominal Tuberculosis.

To study the clinicopathological, imaging, and GeneXpert profiles of surgical referrals with abdominal tuberculosis (TB) and to compare the utility of GeneXpert versus conventional diagnostic armamentarium. This cohort study which was conducted over a study period of 8 years (2011-18) included seventy-seven children operated with a provisional diagnosis of abdominal TB and those who had either histological (n = 58; 75.3%) or GeneXpert (n = 9) confirmation or had miliary tubercles on exploration with supportive clinical and imaging findings (n = 17; 22.1%). GeneXpert testing was added to the diagnostic armamentarium only in the latter half of the study (2016-18, n = 31). Demographic details, symptomatology, prior antitubercular treatment, GeneXpert positivity, imaging, operative, and histological findings were recorded and analyzed using mean, standard deviation, and range for continuous variables and proportion for categorical variables. Perforation peritonitis (n = 26; 33.8%) and unrelieved obstruction (n = 51; 66.2%) were the main surgical indications. The mean age at presentation was 9.5 ± 3.6 years with a distinct female preponderance. The presence of right lower abdomen lump (n = 23; 29.9%), alternate diarrhea and constipation (n = 34; 44.1%), tubercular toxemia (n = 38; 49.4%), positive history of contact (n = 20; 25.9%), tuberculin positivity (n = 38; 49.4%), fibrocavitary pulmonary lesion (5.2%), clumped bowel loops with pulled-up cecum (n = 23; 29.9%), septated ascites (n = 17), mesenteric lymphadenopathy and omental thickening (n:18; 23.4% each) were the supportive tell-tale signs of the disease. The hallmark of pathological diagnosis was caseous necrosis with epithelioid granulomas (n = 43; 55.8%), nongranulomatous caseation (n = 15; 19.5%), and acid-fast bacilli positivity in 27.3% of patients. GeneXpert was positive in only nine patients with an overall sensitivity of 29% as compared to 75.3% for histopathology. Bacteriological and histological confirmation of the disease eluded us in a significant proportion of patients, requiring a very high index of clinical suspicion to clinch the diagnosis. The current version of GeneXpert has low sensitivity in diagnosing pediatric abdominal TB.

Clinical Profile and Outcome of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with Severe Acute Respiratory Syndrome Coronavirus 2 Series in Eastern India

Objective: The objective of this study is to delineate the characteristics and outcome of Pediatric Inflammatory Multisystem Syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARSCoV2) infection (PIMS-TS) in Eastern Indian settings. Materials and Methods: We conducted a prospective observational multicentric study from May 2020 to August 2020, collecting data on clinical profile, investigation findings, and outcome of the children aged 1 month–12 years admitted with the features of coronavirus disease 2019 (COVID-19) related hyperinflammation satisfying criteria for PIMS-TS from three tertiary care hospitals of Kolkata. Results: A total of 38 patients fulfilling the criteria of PIMS-TS were recruited. The median age of the study population was 5 years (1.9–8 years). Gastrointestinal symptoms were present in 33 (86.6%) of patients. Nasopharyngeal swab for COVID-19 reverse transcriptase-polymerase chain reaction was positive in 19 (50%) of patients, and immunoglobulin G antibody against COVID-19 was found in 12 (66.6%) of patients, whereas 19 (50%) of patients had a positive contact history of SARS-Co-V2 exposure. The features of Kawasaki, like illness with coronary changes, were seen in 12 (32%) cases, whereas myocarditis with ejection fraction &lt;55% was reported in 17 (45%) of patients. Intensive care admissions were needed in 27 (71%) patients, and inotropes were given in 18 (47%), whereas four patients required mechanical ventilator support. Immunotherapy was used in 32 (84%) of patients. The outcome was good, with one death. Conclusions: PIMS TS has varied clinical presentation ranging from milder cases to severe cardiac dysfunction with shock. However, timely intervention and prompt initiation of immunomodulators can improve the prognosis.

Dynamic contact effects: Individuals' positive and negative contact history influences intergroup contact effects in a behavioral game.

Positive contact between members of different groups reduces prejudice and increases cooperation, findings known as intergroup contact effects. Yet in real-world settings not only positive, but also negative intergroup contact occurs, which have opposing effects. To date little is known about whether and how an individual's valenced history of intergroup contact influences contact effects and how this dynamic change happens during specific instances of intergroup contact. A pilot study examined the psychological impact of a novel paradigm to assess intergroup contact using a behavioral game. We then conducted two studies, which allowed us to observe a sequence of up to 23 in- and outgroup interactions and their behavioral outcomes in a continuous prisoner's dilemma behavioral game (N = 116, 2,668 interactions; N = 89, 1,513 interactions). As expected, participants showed a clear ingroup bias in expectations and cooperation. Furthermore, the quality of contact history moderated contact effects. Specifically, intergroup contact following a positive history of intergroup contact had a stronger effect on intergroup expectations than contact following a negative history thereof. Findings are discussed in view of the importance of considering the valenced history of intergroup contact, as well as new research questions on intergroup contact that can be addressed with this novel contact paradigm. (PsycInfo Database Record (c) 2022 APA, all rights reserved).

Spectrum of COVID-19 infection in children in Southern Nigeria

Background: Corona virus disease 2019 (COVID-19) is a global pandemic that affects all age groups. Infected asymptomatic children can transmit the disease to vulnerable adults with co-morbidities resulting in severe disease in the latter. There are few reports of COVID-19 in children in Sub-Saharan Africa in general and in Nigeria in particular.Aim: To determine the prevalence, symptoms and risk factors for COVID-19 in Southern Nigerian children.Methods: This was a one-year retrospective cross-sectional study between April 2020 and March 2021. Data of all children tested for COVID-19 was extracted from the Epidemiology unit of Akwa Ibom state ministry of health. All patient identifiers were omitted and data was analyzed using STATA version 13.Results: Two hundred and fifty five children (2.25%) out of a total of 11,289 people were tested for COVID-19. Fifty -four children (0.47%) of the total number of persons tested for COVID-19 were positive. Twenty one percent of the 255 children tested were positive for COVID-19. Two hundred and fifty- four (99.6%) of children that were tested had a positive history of contact with a confirmed COVID-19 case. Five (9.3%) of COVID-19 positive children were symptomatic. The commonest symptoms seen were Fever (90.9%), Anosmia (63.6%) and Aguesia (36.4%). Increasing age (15 years and above) was significantly associated with COVID-19 positivity (p=0.000). In addition, the presence of symptoms was significantly associated with COVID-19 positivity (p=0.04).Conclusion/Recommendation: The prevalence of COVID-19 in Southern Nigerian children is low. Majority of the children have asymptomatic disease. Increasing age is significantly associated with COVID-19 positivity. We recommend increased COVID-19 testing in the general children population.

Evaluation of Pediatric COVID-19 Screening Process in a Tertiary Hospital of Indonesia.

Objectives To identify parameters that can improve the effectiveness of COVID-19 screening in the pediatric population according to the demographic, clinical, and epidemiological characteristics of pediatric patients screened for COVID-19 at our hospital. Methods A cross-sectional study of suspected and confirmed pediatric patients (0–18 years old) with COVID-19 using data from the electronic medical records of Dr. Cipto Mangunkusumo Central Hospital from March to December 2020. Results From 1,018 data of suspected COVID-19 pediatric patients, there were 94 (9.2%) confirmed cases of COVID-19. The proportions of children with travel history (p=0.022), positive contact history (p < 0.001), fever ≥38°C (p=0.034), cough (p=0.038), and abdominal pain (p=0.022) were significantly higher in the confirmed COVID-19 group compared to the non-COVID-19 group. Conclusions A majority of the confirmed COVID-19 pediatric patients have travel and positive contact history, along with symptoms of fever, cough, and abdominal pain. However, these are nonspecific symptoms that may also be misdiagnosed as other diseases. Improving access and turnaround time of the RT-PCR test is mandatory, as no specific screening variables have been identified.

Anti-SARS-CoV-2 Antibody Screening in Healthcare Workers and Its Correlation with Clinical Presentation in Tertiary Care Hospital, Kathmandu, Nepal, from November 2020 to January 2021.

Background Antibody titer and the life span of antibodies against SARS-CoV-2 have been found to be associated with the clinical presentation in individuals. The extent of exposure of healthcare workers and the general public to SARS-CoV-2 needs to be assessed to monitor the COVID-19 pandemic. Thus, this study is an attempt in assessing the anti-SARS-CoV-2 antibody in health care workers. Methods This laboratory-based cross-sectional study was performed in Manmohan Memorial Medical College and Teaching Hospital, Kathmandu from November 2020 to January 2021. A total of 185 HCWs were enrolled in this study. Their serum samples were screened for anti-SARS-CoV-2 antibodies, and a structured questionnaire was administered to collect further information. Anti-SARS-CoV-2 antibody screening was performed using lateral flow immunoassay. The data were analyzed using SPSS version 20. Results Among 185 HCWs that participated in the study, 41 (22.2%) tested positive for the anti-SARS-CoV-2 antibody. Of these 41 HCWs, 37 tested positive for IgG only and 4 of them tested positive for both IgM and IgG antibodies. The presence of the previous history of SARS-CoV-2 infection (p < 0.001), the presence of flu-like symptoms within the last 6 months (p < 0.001), and the presence of positive contact history (p=0.002) were statistically significant with the presence of the antibody among HCWs. Conclusion Healthcare workers carry a high burden of SARS-CoV-2 infection and are at risk of acquiring infection from their workplace. Anti-SARS-CoV-2 antibody screening among healthcare workers is highly recommended in multiple healthcare settings as it can help in monitoring transmission dynamics and evaluation of infection control policies.

Role of Remdesivir in Covid-19 Patients: A Study from the Capital City of Pakistan

Background Coronavirus disease 2019, caused by SARS-COVID-19 has emerged as a pandemic. It usually causes severe respiratory disease. Characteristically it undergoes genetic variability and newer strains emerge as a result of genetic mutations or environmental factors. It makes it difficult to be treated. We used remdesivir in our hospital to treat covid-19 patients. The aim of our study was to evaluate the role of remdesivir in COVID-19 patients. Patients and Methods We conducted a descriptive cross sectional study on the patients admitted in the department of Medicine, Capital hospital, Islamabad, Pakistan from November 2020 to October 2021. All patients aged 14 years and above were included. Both SARS-CoV-2 positive patients by molecular biology and COVID suspected cases, selected on the basis of low oxygen saturation, deranged inflammatory markers, positive contact history and radiological findings with negative COVID19 PCR testing were included in the study. The data was compiled using Microsoft Excel and later was analyzed on SPSS version 24. Results Among 669 patients, 375 (56.1 %) were males and 294 (43.9%) were females. Median age of patients was 58.2 years. 349 (52.2%) were COVID PCR positive and 320 (47.8%) were PCR negative. Out of 669 patients 573 (85.7%) were discharged and 96 (14.3%) expired. Inflammatory markers before and after the treatment were measured with overall significant decrease (P-value 0.000) after treatment. Patients were divided into two groups, remdesivir given (n=436) and remdesivir not given (n=233). Hospital stay was of shorter duration among 249(57.6%) in remdesivir given group than in remdesivir not given group 183(42.4%). While evaluating outcome 370(64.6%) patients were discharged and 66(68.7%) expired in remdesivir given group and 203 (35.4%) patients were discharged and 30 (31.3%) expired in second group. Lactic dehydrogenase (LDH) level was raised (&gt;480 U/L) in 378(68.5%) patients before taking remdesivir and was raised only in 209(47.9%) patients after taking remdesivir (P-0.027). Conclusion Our study revealed that Hospital stay was shorter (P-value 0.000) in remdesivir given group. There was no significant effect of remdesivir on patient’s outcome and mortality (P-value 0.250). Only Lactic dehydrogenase was significantly decreased (p-value 0.027) in remdesivir given group. Key words COVID-19, Remdesivir, outcome, Inflammatory markers

Olfactory dysfunction as a screening tool for mild and moderate cases of COVID-19: a single-center prevalence study of 646 patients in flu clinic

BackgroundTo evaluate the prevalence of olfactory dysfunction (OD) in the Indian population and to establish olfactory dysfunction as a screening tool in COVID-19-positive patients. Data was collected using a questionnaire from laboratory-confirmed COVID-19 patients. The patient’s demographic and clinical details were analyzed to calculate the prevalence of olfactory dysfunction, general symptoms like fever, cough, malaise, diarrhea, along with the sinonasal symptoms. All the symptoms were self-reported, and no objective tests were carried out.ResultsOut of 646 laboratory-confirmed cases of COVID-19 infection, olfactory dysfunction was self-reported by 465 (72%) patients and gustatory dysfunction (GD) was seen in 406 (62.8%) patients. The affected males (416) were proportionately more than females (230), with the mean age of our study population being 39.47 ± 13.85 (range 18–85 years). The most common symptoms were myalgia (n = 494, 76.5%), cough (n = 471, 72.9%), and fever (n = 444, 68.7%). Out of 465 patients with olfactory dysfunction, only 108 (23.2%) reported nasal obstruction. Five hundred thirty-three (82.5%) RT-PCR-positive patients did not give a history of smoking; however, co-morbidity was reported by 163 patients, of which 117 were found to have olfactory dysfunction. One hundred seventy (26.3%) patients gave a positive contact history.13.6% reported olfactory dysfunction as their first symptom. A positive association was seen between olfactory dysfunction and gustatory dysfunctionConclusionsOur study demonstrates a high prevalence of 72% in the Indian population. We recommend that anosmia be used as a screening tool to identify mild to moderate cases of COVID-19.

Tracing the Children in Contact of Sputum Smear Negative Adults is the Need of the Hour to Achieve WHO “Stop TB Strategy”

Tuberculosis has been a public health issue affecting a large number of population world wide. 1According to 2019 report, approximately 10 million of people fell ill by the disease around the globe. A considerable proportion of TB affected cases is constituted by paediatric patients solely. The WHO estimates that about 1 million children endure the disease each year of which a significant figure harbours the latent form of infection. Since, the accurate diagnostic test to confirm the tuberculosis in children has not been unrolled, a positive history of contact is regarded as the foremost feature for authenticating the diagnosis in children. A large proportion of children with tuberculosis lives under the same roof with sputum smear positive adults, tracing out the childhood TB cases in sputum smear negative contacts is equally important and needs to be diagnosed timely. This category of children left undiagnosed acts as a pool for further transmission of the disease from where new TB cases arise. Therefore, the early diagnosis of children of this group is the need of the hour and a challenge to “STOP TB Strategy”.

The Diagnostic Value of Urinary Secretory Antigen Target of 6 kDa in Childhood Pulmonary Tuberculosis

Introduction. Childhood tuberculosis (TB) is difficult to diagnosed and is based together on clinical and microbiology examinations. Since in children signs and symptoms of TB are not typical and sputum is difficult to be obtained, Mycobacterium tuberculosis (Mtb) antigen detection could be considered as a non invasive method for early detection of childhood TB. ESAT-6 is a low molecular weight specific protein that plays an important role in Mtb virulence. Aim. To determine the diagnostic value of urinary ESAT-6 for the diagnosis of childhood tuberculosis. Methodology.This was a cross-sectional study, with consecutive sampling collection . in children aging between 0-14 years suspected for pulmonary TB based on the clinical presence of :cough lasting more than 2 weeks, fever without clear ethiology, loss of body weight or poor weight gain, fatigue, malaise with positive history of contact with sputum smear from adult TB patients. Diagnosis of pulmonary TB was based on clinical presentation plus tuberculin positive skin test, chest x-ray, AFB staining and/or sputum culture. Subjects who met the inclusion criteria but unconfirmed by clinical and microbiological were considered as control (non-TB group). Urinary ESAT-6 level was analyzed by using ELISA. Cut off value and AUC was determined using ROC Statistical Analysis (SPSS 20.0). Sensitivity and specificity was measured from 2x2 crosstable. Result. Between the 61 studied children with suspected TB, 46/61 (75%) were finally diagnosed with TB, with 34/46 (74%) microbiologically confirmed cases either by sputum microscopy 31/34 (91%) or culture 3/34 (9%), whereas 15/61 (25%) subjects were not-confirmed cases (non-TB group). The mean value of urinary ESAT-6 level was higher in TB than non-TB group, Mean (SD) [4.855(6.714)] ng/mLvs [1.503(0.946)] ng/mL; p=&lt;0.001(Mann-Whitney test). At ROC curve analysis ,the cut off value of urinary ESAT-6 in subjects TB confirmed both with clinical plus microbiology evaluation as reference standard was 1,91 ng/mL, with sensitivity 72% and specificity 67%. While the cut off value of ESAT-6 in TB subjects confirmed group only by clinical signs was 2.45 ng/mL, with sensitivity 65% and specificity 67%. Conclusion. For TB Diagnosis in Children, Urinary ESAT-6 urine could be considered of value when utilized in addition to microbiological tests and clinical examination.

EPIDEMIOLOGIC PROFILE OF THE INITIAL COVID 19 PATIENTS AT A DESIGNATED COVID HOSPITAL IN SOUTH TAMIL NADU

BACKGROUND:COVID-19, caused by SARS CoV-2 has caused a worldwide pandemic since its origins in December 2019. The spectrum of the disease ranges from asymptomatic infection to severe respiratory illness causing mortality in severe cases. Person to person spread through respiratory droplets appears to be the most common route of spread. AIM &amp; OBJECTIVE:This study aims to assess the demographic prole of COVID-19 patients. In addition, measures of transmission probability are determined using travel history and contact tracing. SETTINGS AND DESIGN: This study was done at a Government medical college in South Tamil Nadu over four months among patients who were RT-PCR positive for SARS CoV-2. METHODS AND MATERIAL: Aquestionnaire from NCDC for COVID-19 patients was used for collecting demographic and clinical details. Travel history and contact tracing were obtained using telephonic interviews and in person interviews. STATISTICALANALYSIS USED: Data was entered using MS-Excel and analysed using R studio version 3.6.3. RESULTS: Majority of the patients belonged to 20 to 49 years of age. Around 14.6% were symptomatic with fever and sore throat being predominant. Diabetes and hypertension were the most associated comorbidities. A positive contact history was present among 46.58% of the cases. The secondary attack rate was 25.03% and R0 was 2.76 CONCLUSIONS: The absence of a positive contact history and the preponderance of asymptomatic cases seem to contribute to the spread of the disease and impede control efforts. Hence, a multi-pronged approach including community participation, active surveillance systems and legal measures would be of great impact in slowing disease spread.

Clinical Presentations of Brucellosis Over a Four-Year Period at Sultan Qaboos University Hospital and Armed Forces Hospital, Muscat, Oman.

ObjectivesBrucellosis is a highly contagious zoonotic disease which can have serious health implications for affected humans and livestock. This study aimed to evaluate the clinical presentation, geographical distribution and risk factors of brucellosis cases admitted over a four-year period to two hospitals in Muscat, Oman.MethodsThis observational study was conducted from January 2015 to December 2018 at the Sultan Qaboos University Hospital and Armed Forces Hospital in Muscat. All patients with probable or definitive diagnoses of brucellosis according to the diagnostic criteria of the World Health Organization were included. Relevant data were gathered from the patients’ medical records, including results from standard agglutination tests, Brucella enzyme-linked immunosorbent assays, bacterial blood or tissue/aspirate cultures and Brucella polymerase chain reaction tests.ResultsA total of 64 patients were diagnosed with brucellosis over the study period. The median age was 31.5 years and 73.4% were male. The majority (95.2%) presented with fever, followed by weight loss (51%), transaminitis (48.4%), peripheral arthritis/arthralgia (15.9%) and back pain (spondylodiscitis/sacroiliitis; 23.4%). Overall, 75.5% reported having consumed raw dairy products, while only 25.9% gave a positive history of animal contact.ConclusionPatients with brucellosis presented with a wide range of clinical features, the most predominant of which was fever. The majority of patients were residents of or had recently visited Salalah and had consumed raw dairy products. These findings highlight the need for healthcare practitioners to maintain a high index of suspicion for this diagnosis. Moreover, further regulatory measures are necessary to oversee the sale of raw/unpasteurised dairy products.

High-Resolution CT Chest Findings in Suspected COVID-19 Pneumonia Patients With Negative Real-Time Polymerase Chain Reaction Assay.

ObjectiveThe study was conducted with the objective of describing High-resolution computed tomography (HRCT) chest findings of clinically suspected COVID-19 patients having a negative real-time polymerase chain reaction (RT-PCR) assay as well as prevalence and distribution of the HRCT chest manifestations consistent with the diagnosis of COVID-19 pneumonia.MethodsThis descriptive cross-sectional study was conducted prospectively on a total of 48 patients with high clinical suspicion for COVID-19 and a negative RT-PCR assay that was presented to the Diagnostic Radiology Department of Capital Hospital, Islamabad from July 2020 to December 2020. These patients were included via non-probability consecutive sampling, had a positive history of contact with a known COVID-19 patient and/or any two of the following signs and symptoms; fever, cough, malaise, body aches, arthralgia, new-onset loss of taste and smell, and dyspnea or oxygen saturation less than 85%. A detailed history was sought after informed consent and all these patients underwent non-contrast HRCT chest scans that were reported by an experienced consultant radiologist. The scans showing positive features for COVID-19 pneumonia were assessed for the nature and distribution of the disease.ResultsAmongst 48 suspects with negative RT-PCR assay, 38 (79.2%) showed ground-glass opacities, a hallmark feature of COVID-19 pneumonia. A total of 22 (57.89%) of these 38 patients had ground-glass opacities with a crazy-paving pattern, nine (23.68%) mixed ground-glass opacities with consolidation, and seven (18.42%) had pure ground-glass opacities. Among these 79.2% suspects, ground-glass opacities were multifocal in 37 (97.37%), bilateral in 35 (92.10%), peripheral in 36 (94.74%), and dorsally located in 32 (81.6%) cases. Subpleural atelectatic bands were seen in 18 (47.36%) of these, bronchovascular markings were prominent in 15 (39.47%), and reverse halo sign was positive in nine (23.68%) cases. Out of the rest of the cases, three were diagnosed as interstitial lung disease, two as chronic lung disease, and one as active pulmonary tuberculosis.ConclusionThe majority of clinically suspected cases for COVID-19 showed hallmark findings on non-contrast HRCT chest scans in keeping with coronavirus disease regardless of a negative RT-PCR assay.

CLAINICO-BACTERIOLOGICAL SPECTRUMAND ANTIMICROBIAL RESISTANCE PROFILEIN BACTEREMIA COINFECTING COVID-19 PATIENTS IN A TERTIARY CARE HOSPITAL IN TRIPURA

Background- Secondary bacterial infections including bacteremia have been implicated as a major cause of morbidity and mortality in COVID-19 patients So, it is important to determine the bacteriological profile of organisms responsible for bacteremia among COVID-19 patients along with their antimicrobial resistance pattern Objectives- To determine the bacteriological profile, antimicrobial resistance pattern and clinical outcome among COVID-19 patients with bacteremia as manifestation of secondary bacterial infection. Study design- Single center, cross sectional study Methods- Blood cultures were obtained from COVID-19 patients with features of bacteremia and sepsis based on Sepsis-3 criteria and serum procalcitonin level. Identification and AST were performed and the patients were followed until final outcome or discharge from hospital. Results- Among 43 blood samples obtained. 8 were positive in culture for pathogenic bacteria (18.6%). Mean age of the patients were 53.4 ± 14.9 years with male preponderance (62.5%). Mean procalcitonin level was 6.5±5.7 ng/ml. Positive history of contact was the major risk factor (62.5%) and mean duration of hospital stay was 11.1± 3.9 days. Mortality rate was 37.5%. Gram negative bacilli were the major isolates (75%) and one case was caused by an unusual organism Erysipelothrixrhusiopathiae. Among the Gram negative bacilli, maximum resistance was against Amikacin (100%) and minimum against Meropenem (16.7%). Out of GNB isolates, one isolate of Pseudomonas aeruginosa was Metallo ? lactamase enzyme producer and another one was multidrug resistant strain. Conclusion- Bacteremia among COVID-19 patients is a serious form of bacterial co-infection, leading to increased morbidity and mortality among the patients. High degree of clinical suspicion and increasing prolactin level must be complemented with blood culture to rule out bacteremia in these patients, where timely intervention and proper antimicrobial therapy can be lifesaving. Keywords- COVID-19, SARS-CoV-2, Coronavirus, Bacterial coinfection, Bacteremia, Antimicrobial resistance.