Sequential Observation of Antibody Response Pattern at 3 and 6 Months Following ChAdOx1 nCoV-19 Vaccination Among Health Care Workers-A Prospective Single Cohort Study

Background: The duration of the immune response induced by ChAdOx1 nCoV-19 vaccination in a real-world setting is unknown. Objectives: This study is aimed to estimate the 6-month trend of SARS-CoV-2 antibody titer after Covishield vaccination among Health Care workers (HCW) and their associated factors. Materials & Methods: A prospective single cohort study of health care workers was done in a tertiary care-teaching institute of central Kerala from January 2021 to October 2021. HCWs who have given pre-vaccination serum sample for SARS-CoV-2 antibody estimation and negative for SARS-CoV-2 antibody were included. They were followed up and their blood samples to check for antibody levels were taken 28 days after first dose, 2 weeks after second dose, and 3 and 6 months after first dose of ChAdOx1 nCoV-19 vaccine. Samples taken from 102 HCW were sent for SARS-CoV-2 IgG antibody testing. Results: Mean age of the study participants was 39.3 (age range:19 - 71) yrs. and 71.6% were females. Antibody levels of participants at 3rd month ranged from 0.28 S/C to 21.2 S/C with a mean of 8.01. Only 34 (33.3%) HCW had IgG antibody levels >9.5 S/C. Mean antibody level further declined to 6.09 S/C at 6th month. Only 19 (28.4%) had antibody levels more than 9.5 S/C at 6th month. HCW with aged less than 50 years and those who had COVID disease during the study period had a significantly higher level of IgG antibody titres. Quantitative results were reported as signal to cut-off (S/C) value. Conclusion: The study found that after vaccination with Covishield vaccine IgG levels peaked at 14 days following second dose of vaccine, then getting decreased in the third month and further in sixth month confirming the need for a booster dose. COVID antibody levels were significantly higher in COVID infected HCW and in young age participants

Physical and mental health impact of COVID-19 on children, adolescents, and their families: The Collaborative Outcomes study on Health and Functioning during Infection Times - Children and Adolescents (COH-FIT-C&A)

BACKGROUND

The COVID-19 pandemic has altered daily routines and family functioning, led to closing schools, and dramatically limited social interactions worldwide. Measuring its impact on mental health of vulnerable children and adolescents is crucial.

METHODS

The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT - www.coh-fit.com) is an on-line anonymous survey, available in 30 languages, involving >230 investigators from 49 countries supported by national/international professional associations. COH-FIT has thee waves (until the pandemic is declared over by the WHO, and 6-18 months plus 24-36 months after its end). In addition to adults, COH-FIT also includes adolescents (age 14-17 years), and children (age 6-13 years), recruited via non-probability/snowball and representative sampling and assessed via self-rating and parental rating. Non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to promote health and prevent mental and physical illness in children and adolescents will be generated by COH-FIT. Co-primary outcomes are changes in well-being (WHO-5) and a composite psychopathology P-Score. Multiple behavioral, family, coping strategy and service utilization factors are also assessed, including functioning and quality of life.

RESULTS

Up to June 2021, over 13,000 children and adolescents from 59 countries have participated in the COH-FIT project, with representative samples from eleven countries.

LIMITATIONS

Cross-sectional and anonymous design.

CONCLUSIONS

Evidence generated by COH-FIT will provide an international estimate of the COVID-19 effect on children's, adolescents' and families', mental and physical health, well-being, functioning and quality of life, informing the formulation of present and future evidence-based interventions and policies to minimize adverse effects of the present and future pandemics on youth.

The collaborative outcomes study on health and functioning during infection times in adults (COH-FIT-Adults): Design and methods of an international online survey targeting physical and mental health effects of the COVID-19 pandemic

BACKGROUND

. High-quality comprehensive data on short-/long-term physical/mental health effects of the COVID-19 pandemic are needed.

METHODS

. The Collaborative Outcomes study on Health and Functioning during Infection Times (COH-FIT) is an international, multi-language (n=30) project involving >230 investigators from 49 countries/territories/regions, endorsed by national/international professional associations. COH-FIT is a multi-wave, on-line anonymous, cross-sectional survey [wave 1: 04/2020 until the end of the pandemic, 12 months waves 2/3 starting 6/24 months threreafter] for adults, adolescents (14-17), and children (6-13), utilizing non-probability/snowball and representative sampling. COH-FIT aims to identify non-modifiable/modifiable risk factors/treatment targets to inform prevention/intervention programs to improve social/health outcomes in the general population/vulnerable subgrous during/after COVID-19. In adults, co-primary outcomes are change from pre-COVID-19 to intra-COVID-19 in well-being (WHO-5) and a composite psychopathology P-Score. Key secondary outcomes are a P-extended score, global mental and physical health. Secondary outcomes include health-service utilization/functioning, treatment adherence, functioning, symptoms/behaviors/emotions, substance use, violence, among others.

RESULTS

. Starting 04/26/2020, up to 14/07/2021 >151,000 people from 155 countries/territories/regions and six continents have participated. Representative samples of ≥1,000 adults have been collected in 15 countries. Overall, 43.0% had prior physical disorders, 16.3% had prior mental disorders, 26.5% were health care workers, 8.2% were aged ≥65 years, 19.3% were exposed to someone infected with COVID-19, 76.1% had been in quarantine, and 2.1% had been COVID 19-positive.

LIMITATIONS

. Cross-sectional survey, preponderance of non-representative participants.

CONCLUSIONS

. Results from COH-FIT will comprehensively quantify the impact of COVID-19, seeking to identify high-risk groups in need for acute and long-term intervention, and inform evidence-based health policies/strategies during this/future pandemics.

Active Symptom-Based Surveillance of Adverse Events Following Immunization among Individuals Vaccinated with ChAdOx1 nCoV-19 Coronavirus Vaccine in a Tertiary Hospital of Kerala

BACKGROUND

The reports on adverse experiences following vaccination are scanty from India. It is important to know the real-world post-vaccination experience outside of clinical trial conditions Objectives: To estimate the incidence of adverse events following immunization with ChAdOx1 nCoV-19 coronavirus vaccine and to identify the predictors for development of vaccine adverse events.

MATERIALS AND METHODS

A prospective observational study was conducted among health care workers who received the ChAdOx1 nCoV-19 coronavirus vaccine. Study participants were monitored at the site for 30 min following vaccination and were followed up for 7 days after receiving the second dose, with a purpose-specific designed online surveillance form to enquire about any adverse events following vaccination. We used the Chi-squared test for categorical variables and multivariate regression analysis to identify predictors for the development of vaccine adverse effects.

RESULTS

Of 411 participants, the mean age was 30.77 ± 12.5 years and 76.2% were females. Overall, 207 (50.4%) respondents reported at least one post-vaccination symptom receiving either dose of coronavirus vaccination. Fever (34.8%), local pain at the injection site (28.0%), tiredness (25.5%), chills (20%), myalgia (18.7%), headache (17.8%), injection site stiffness (5.4%), joint pain (4.6%) and nausea-vomiting (3.8%) were the most prevalent symptoms following the first dose. Adverse reactions reported after the second dose were milder and less frequent. Post-vaccination symptoms were more likely in the younger age group, those with comorbidity particularly, bronchial asthma and who had a history of allergy to food/drugs.

CONCLUSION

All the adverse reactions were of a minor type and non-serious. Side effects were less common in older adults (>60 years). Reactions to the second dose were lesser in intensity and frequency. Younger age, history of allergy, and comorbidities, particularly asthma were found to be major predictors for the development of adverse events and require more watchful vaccine administration.

Clinicoepidemiological and laboratory findings of COVID positive patients presenting to a tertiary care centre in South India: A retrospective analysis

BACKGROUND

SARS CoV2 continues to pose a threat to human race even after one year of its outset in China. Observational studies from across the world have shown huge disparity in the clinicoepidemiological and laboratory features of this disease. In this study we attempt to assess the clinical, epidemiological and laboratory parameters of COVID 19 positive patients in this geographic location.

METHODS

This is a descriptive retrospective study of patients who were tested positive for SARS-CoV-2 at a tertiary care centre in central Kerala, India between July 16, 2020 and November 30, 2020. The clinicoepidemiological and laboratory parameters of the confirmed patients were collected from the laboratory and hospital records and analysed.

RESULTS

A total of 1051 patients were tested positive during the study period. The mean age of the patients was 45.7 years ± Standard Deviation (SD): 8.68; 51.76% were male. Among them 658 (62.61%) were symptomatic and 393(37.39%) were asymptomatic; males (54.7%) were more symptomatic than females (45.3%). The common presenting symptoms were fever (43.58%), cough (21.50%), myalgia or fatigue (10.28%). Lymphocytopenia was more in males than females. Laboratory parameters such as Serum Ferritin, Alanine Transferase, Aspartate Transferase, Sodium level were elevated in males compared to female.

CONCLUSION

The common symptoms in our study could emphasize on identifying potential patients in this geographic area. Asymptomatic patients should be monitored and investigated for effective control of the disease. A knowledge about the disease presentation in each geographic area is important in planning the effective management strategies since the features are varied from place to place.

Biomarker Signatures to Monitor Alcohol Consumption and Induced Organ Damage

The difficulty to differentiate long duration alcoholic behaviours is a major obstacle in the diagnosis and its treatment. Biomarkers in alcoholism are indicative of recent alcohol consumption or alcohol-induced organ damage. They are broadly divided into two; state markers, which are tools indicative of acute or chronic alcohol consumption, and trait markers, which are markers indicative of a genetic predisposition responsible to develop alcohol dependence. This review aimed to sensitise the practitioners on different alcohol state markers available now-a-days. An electronic search in Google Scholar, MEDLINE, and PubMed was conducted by using following keywords: Alcohol biomarkers, State markers, Trait markers, Alcohol consumption test. Studies on alcohol biomarkers published in English language were included in this review. Reviews and studies with free access to only abstract have been excluded. The state markers mostly used to identify chronic alcohol exposure are the Gamma-Glutamyltransferase (GGT), Aspartate and Alanine Aminotransferase (AST and ALT) which are routine serum liver function panels and Mean Corpuscular Volume (MCV) which is a haematological marker. The available non-conventional state biomarkers are Phosphatidylethanol (PEth), Fatty Acid Ethyl Esters (FAEE) and 5-Hydroxytryptophol (5-HTOL). The novel state markers which have been developed in recent research context are still awaiting validation and possible introduction to commercial settings are Plasma Sialic Acid Index of Apolipoprotein J (SIJ), Total Serum Sialic Acid (TSA), Acetaldehyde, Acetaldehyde adducts, anti-adduct antibodies and β-Hexosaminidase. Conventional alcohol biomarkers are routinely used in clinical practice. Non-conventional biomarkers seem to be promising for its estimation. Novel biomarkers are at various stages of research and development.

Serosurveillance of SARS-CoV-2 among the Healthcare Workers of a Tertiary Care Teaching Institution during the Post Lockdown Phase in Central Kerala, India

Introduction: The hallmark of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection is high infectivity, pre symptomatic transmission and asymptomatic prevalence which could result in high cumulative numbers of infections, hospitalisations, and deaths. Kerala was the first state to confirm community transmission in July 2020. Healthcare Workers (HCWs) being in the forefront in the war against Coronavirus Disease-2019 (COVID-19) are more prone to acquire the infection and could possibly be asymptomatic sources for cluster formation. Knowing the development of immunity as shown by the presence of anti COV-2 antibodies in the population contributes to the epidemiological understanding of the disease. Aim: To determine the pattern of seropositivity of SARS-CoV-2 among the HCWs at Jubilee Mission Medical College and Research Institute, Thrissur, Kerala, India, six months after revoking the lockdown. Materials and Methods: This cross-sectional study was carried out among 423 HCWs of the medical college from September 5th to December 15th, 2020. Multistage sampling was done with the hospital block as the first stage and departments as the second stage. Blood sample was collected and Anti SARS COV-2 IgG antibody testing which targets the Spike Protein 1 (SP1) was done using the vitros chemiluminescence platform (Orthoclinical diagnostics, USA). For the summary of demographic characteristics, continuous variables were summarised as mean values and Standard Deviation (SD) while categorical variables were summarised as proportions. The χ2 test was used for comparing the epidemiological features between positive and negative cases. Chi-square test for trend analysis was done for exploring the relationship of the degree of severity with test positivity. All analyses were conducted using Statistical Package for the Social Sciences (SPSS) version 25.0. Results: Jubilee Mission Medical College had 2785 working staff at the time of study. A total of 423 staff consented and their samples were tested. Thirty seven staff members tested positive for COVID-19 antibody, yielding an overall prevalence of 8.75% (95% CI, 6.23-11.86). A 86.5% (32/37) of them were having a history of COVID-19 Antigen/Reverse Transcriptase Polymerase Chain Reaction (RT-PCR) Positivity. A statistically significant linear trend (p-value=0.00001) was observed, between seropositivity and the degree of severity of COVID-19. Among the various factors which increase the risk of seroconversion, history of undergoing quarantine (p-value <0.001), contact with a confirmed case (p-value=0.002), contact with a caregiver for COVID-19 (p-value=0.001) and history of upper respiratory symptoms (p-value=0.001), were found to be significantly associated with positive serology. Conclusion: The pattern of seropositivity across the different category of HCWs observed in the present study showed a higher prevalence among nurses. Being an educational institution, it was obligatory to train all the elements of care delivery to the future generation of HCWs. Acquiring experience from a small but relevant sample was expected to facilitate larger community study envisaged in peripheral areas Jubilee Mission Hospital served.

Concerns and confidences expressed by teaching staff about the shift of medical education to online mode in South India during the COVID 19 pandemic

Background: Online education is prevalent in the country since the beginning of the 21st century. The outbreak of COVID-19, the government declared lockdown, and subsequent closing of institutions was unexpected, and it forced medical colleges to launch online programs for undergraduate courses. Due to the sudden shifting to online mode, most teaching staff members face the challenges of lacking online teaching experience, early preparation, or support from educational technology teams. This institution was in touch with the teachers and students through online mode, enquiring about their welfare and wellness. The present study focuses on concerns and confidences presented by the medical teaching staff on online medical education.  Method: This study was conducted at Jubilee Mission Medical College & Research Institute, a medical college in central Kerala in south India. This institution conducted online classes for undergraduate (UG) medical students through Google classroom and YouTube platforms. There was 186 teaching staff from 21 departments involved in undergraduate (MBBS) teaching in this Institute. In this study, we collected information from the teaching staff about the online classes that they handled. A 27-point survey form was designed using a Google survey and mailed to them. The responses were collected in a week. The data collected was analyzed. Result: Fifty-one members responded. All responding teachers preferred regular classroom teaching due to the provision for better teacher-student interaction. However, one-third of respondents wanted the continuation of online classes, even after resuming classroom teaching. Out of 51 responses, 24 teachers graded the success of the programs more than 90%. The major suggestions received for further improvement of the program were that the departments provided their hardware and software, centralized online sessions for practical purposes, and collected regular feedback from students. Conclusion: The successes of our online teaching programs were limited to didactic teaching only. It could not replace the actual patient examination in a clinical setting, which involves communication skills and emotional relationships. This adversary must be converted into an opportunity to develop e-learning programs. This pandemic should open our eyes, so we learn from it and be better prepared for the future.

The Pedagogical Shift During COVID 19 Pandemic: Online Medical Education, Barriers and Perceptions in Central Kerala

Owing to COVID 19 pandemic, all educational institutions including medical colleges were closed by the second week of March 2020 in Kerala, India. This college started online classes using various e-platforms by the third week of March. In this study, we report the barriers and perceptions of undergraduate students by an online questionnaire after 2.5 months of e-classes. The study participants were 364 students who responded in a week's time. Most of the faculty used platforms like Google class room or recorded YouTube videos. The department of Physiology used the Impartus platform. Among the respondents 72.8% were using mobile data and 17.8% were using broadband facilities. Among network providers Jio was the most used. Only first year students were exposed to 3 different online platforms. Among those students, 63.6% reported in favor of Impartus, followed by YouTube and Google class room. Most of the students preferred recorded classes (69.2%) over live classes (33.5%). Submissions were mainly through the online platform itself (69.5%), email submission to the department (17%) or to the faculty (13.5%). Forty seven percent of the students wanted the classes to be of 30 to 45 minutes duration and 42% felt that the classes should be short and below 30 minutes. Only 28.3% of the students favored centralized online class by the university. Providing education to students cannot be discontinued for long. In the present study students are able to follow the online classes and have good learning experience on in the Didactic part. The medical educators could rise up to the challenge of continuing to teach even in times of crisis.

The Phenomenon of Family Suicides: An Explorative Study into Consecutive 32 Incidents in Kerala

BACKGROUND

Suicides rank high as the cause of human deaths. But research on whole family ending life is scanty. This study explored the family suicides in Kerala.

METHODOLOGY

All the family suicides reported from four central districts of Kerala State during the year 2000 were included. Cases were prospectively located from different sources. A research associate systematically gathered information, from survivors, family and key persons in the locality.

RESULTS

84 lives lost in 32 incidents involving 99 persons. No report from Muslim dominated district. Largest age group was 19 and below, others progressively decreased. Poisoning formed most frequent method; drowning, burns, hanging and wrist slashing followed. Suicide notes were left in half. Mental illness and physical illness were noted in five and eight incidents respectively. Financial crisis reported as the main reason. The SES of the deceased and their parents were same but half of the families were leading a life at a higher level than could be afforded. Warning signals noted in 12 incidents. Decision was taken by father and mother (17), mother (10) or father alone (5). The incidents came to the attention of others without long delay.

DISCUSSION

Firm stand of the religion against suicides on individual reasons could explain absence of family suicides from Muslim dominated district. Selection of sure method and flawless execution explains high lethality. Presence of victims explains more loss of young lives and profile difference from reported suicide attempts. Opening up of avenues for higher dreaming due to globalisation and wider visual media could be a reason for living unaffordable standard of life and resulting financial difficulty. The warning signals were recognised, but not responded by others. Social support was strong within the family but was non-existing with outside. Strong social support could be pathological if it is narrow.

Psychosocioeconomic study of medically unexplained physical symptoms

BACKGROUND

There is a paucity of studies done on medically unexplained physical symptoms (MUPS) in Kerala, India. The objective of this study was to examine the sociodemographic and other clinical variables associated with this condition.

MATERIALS AND METHODS

The clinical sample was taken from the General Medicine Clinic of a tertiary care hospital, in Kerala. The referred cases meeting the criteria (N=48) for medically unexplained physical symptoms were enrolled for this cross-sectional study. The medical doctor with experience in psychiatry completed the questionnaire.

RESULTS

Most of the patients were middle-aged females from rural areas. The most common symptom reported was headache. Most of the patients had symptoms for five years or more and had seen two-to-five consultants. A majority of the patients had undergone special investigations and a few had expensive and invasive investigations. Cluster C personality disorders were the most common associated personality disorders with medically unexplained physical symptoms.

CONCLUSIONS

To our knowledge this is the first psychosocioeconomic study on medically unexplained physical symptoms, done in Kerala, India. Medically unexplained physical symptoms cause loss of productivity and economic burden and are a major public health problem. Future studies are warranted focusing on non-pharmacological treatment, psycho-education on mind-body association, and medical models on specific cytokines associated with medically unexplained physical symptoms for personalized management, and to examine the effect of a combination of pharmacotherapy and cognitive behavioral therapy.

User Satisfaction among Inpatients in a Tertiary Care Hospital

User satisfaction is an important factor which should guide the running of any establishment. In the field of healthcare delivery, taking feedback is rare at least in the state of Kerala. Due to paucity of reports in scientific journals, a survey was conducted at a Government Medical College to assess the level of user satisfaction.

Using a pre-designed proforma, trained social workers gathered information from the discharged patients during a period of two weeks. The coverage was 31.6 per cent of all discharged patients. About two-thirds of the respondents gave positive results on registration for-malities, accommodation facilities, water supply and lighting facilities, general cleanliness, bathrooms and toilets, availability of medicines, service of doctors, services of different wings of the hospitals and fee structure. There were reports about corruption among staff. However the majority of patients preferred to suggest this hospital to friends and relatives and for future consultations.

The development of a guideline and its impact on the media reporting of suicide

CONTEXT

A causal association between media reporting of suicides and the subsequent actual suicides has been observed. There are no studies from India regarding media reporting of suicide. This study examines whether educating media professionals about responsible reporting of suicides can change the quality of reporting.

AIMS

To study the impact of a guideline on the reporting style of suicides by journalists.

SETTINGS AND DESIGN

Newspaper reports in the local language examined by psychiatrists.

MATERIALS AND METHODS

The Department of Psychiatry of a Teaching Hospital conducted a workshop for journalists, with the collaboration of media and mental health professionals and came out with a guideline about responsible reporting of suicide. Using this, a proforma was designed for assessing newspaper reports of suicides. All the suicide reports in the leading newspapers in Kerala were analyzed for one year prior to the workshop, the immediate next year, the second year, and six years later, using the 15 item proforma and whether each report was concordant or discordant to each item in the proforma was noted.

RESULTS

The total concordant responses were 43.7% in the year prior to the workshop, 45.2% during the first year following the workshop, 46.2% in the next year, and 45.7% after six years. When the trend of each item was examined, the concordance rates were increasing in each item, except two. There was no statistical significance.

CONCLUSIONS

A workshop for journalists could bring about positive changes in the media reporting of suicides. The changes persisted over the years, although they did not reach statistical significance.

A study of an antipsychotic prescription pattern of patients with schizophrenia in a developing country

BACKGROUND

Though there are several recommended guidelines for treating schizophrenia, in routine clinical practice, these are not followed.

AIM

To conduct an audit of the prescription pattern of antipsychotic drugs in patients with schizophrenia, in a tertiary care centre in India, during a period of 1 year and compare it with Maudsley guidelines and Clinical practice guidelines for Psychiatrists in India (IPS guidelines).

MATERIALS AND METHODS

Data were collected from the case records, compiled, and analyzed. The concordance or discordance with Maudsley and IPS guidelines were studied.

RESULTS

The demographic variables of the patients and the prescription pattern of drugs were analyzed. The correlations between supramaximal and sub-threshold dosage of drugs to the gender, age, duration of illness, and combination of drugs were examined.

CONCLUSIONS

Polypharmacy of antipsychotics is common. 31% of patients were on combination of typical and atypical antipsychotics. 4% of patients were receiving supramaximal dose of antipsychotics and all of them were on combination (P =<0.03, x(2)). 24% of patients were on sub-threshold doses. 83% were not on anticholinergic drugs.