Nepal Journal of Epidemiology 2021-09-30T16:29:57+00:00 Dr. Brijesh Sathian Open Journal Systems <p>The official journal of the International Nepal Epidemiological Association (INEA). Content also available on the journal's own <a title="NJE" href="" target="_blank" rel="noopener">website</a>. It is indexed in PubMed,PubMed Central, EMBASE, Web of Science, Thomson and Reuters, CABI. 2019 <a href="">impact facor</a> is 1. </p> Clinical and Molecular facets of Dengue Virus infection from Bengaluru, South India 2021-08-01T13:56:55+00:00 Shantala Gowdara Basawarajappa Ambica Rangaiah Shwetha Jinnahalli Venugopal Chakrakodi N Varun Vijay Nagaraj Shashiraja Padukone Sathyanarayan Muthur Shankar <p><strong>Background: </strong>Dengue virus (DENV) continues to be an epidemic with high mortality rates. The clinical features, especially in the early phase of infection, are nonspecific and there is no single marker that can be reliably deployed for diagnostics. Further, serotype and genotype diversity is not clearly understood. This study was conceived to understand the performance characteristics of various diagnostic markers; serotype and genotype distribution is thus a vital requirement.</p> <p><strong>Methods: </strong>A subset of blood samples was obtained for all the clinically suspected Dengue cases during the period January to December 2017. The samples were tested for IgM and IgG antibodies and NS1 antigen by both ELISA and rapid tests. Real-time PCR, Conventional PCR and sequencing was performed based on the serology results. Correlation of the data with demographic and clinical details was used to analyze the performance characteristics of various tests.</p> <p><strong>Results</strong>: Clinical signs and symptoms could not predict dengue positivity due to lack of specific symptoms. The performance of IgM rapid test was found to be lower than the ELISA method (53.5% agreement). The NS1 rapid and NS1 ELISA tests were comparable (89.2% agreement). Majority of the infections were caused due to DEN-2 serotype and phylogenetic analysis revealed all the sequenced DEN-2 serotypes belong to Genotype IV. Three sequences with were deposited into NCBI GenBank (GenBank accession number MW583116, MW579054 and MW579053).</p> <p><strong>Conclusion</strong>: Our comprehensive data suggests that NS1 ELISA and PCR are best used in the early phase of dengue infection (&lt; 5 days post-onset of fever), whereas IgM antibody detection is reliable only in the late phase. We also highlight the unreliable performance of rapid tests.</p> <p> </p> <p> </p> 2021-09-30T00:00:00+00:00 Copyright (c) 2021 CEA & INEA Polycystic ovary syndrome among Indian adolescent girls – A systematic review and metanalysis 2021-08-18T17:18:11+00:00 Megha Sharma Meenakshi Khapre Vartika Saxena Pawna Kaushal <p><span class="fontstyle0"><strong>Background:</strong> </span><span class="fontstyle2">Polycystic ovary syndrome (PCOS) is a common endocrine disorder in the progenitive age group and the leading cause of infertility. The worldwide prevalence of PCOS in women varies between 2.2% to 26%. Due to limited literature on burden of PCOS among adolescent girls, its significance is still unfathomed as a research is few and far between in the present time. We conducted Systematic review and metanalysis to estimate the pooled prevalence of PCOS among Indian adolescent girls (14-19 years).<br /></span><strong><span class="fontstyle0">Methods: </span></strong><span class="fontstyle2">With the help of a search strategy, two authors searched Scopus, Embase and Pubmed independently. We screened studies considering eligibility criteria and extracted data. Selected studies were assessed for quality and risk biases using the NIH tool. R software was used for analysis.<br /></span><strong><span class="fontstyle0">Results: </span></strong><span class="fontstyle2">Twelve studies were included in the meta-analysis. The total number of participants in the study was 4473. All studies scored average and above as per the NIH quality assessment tool. The prevalence of PCOS among adolescents based on the Rotterdam criteria was 17.74 per 100 (CI = 11.77-23.71) with I² =97 %. Hospital-based studies had a comparatively higher prevalence of PCOS as compared to community-based.<br /></span><strong><span class="fontstyle0">Conclusion: </span></strong><span class="fontstyle2">Pooled prevalence of PCOS among Indian adolescents' girls was high, approximately one in five.</span></p> 2021-09-30T00:00:00+00:00 Copyright (c) 2021 CEA & INEA COVID-19 airborne transmission: a new frontier of infection 2021-09-26T16:50:07+00:00 Indrajit Banerjee Jared Robinson <p>COVID-19 has spread around the globe and infections are still rising despite the development of vaccinations and protocols. Various mutations of the SARS-CoV-2 virus have arisen with a greater rate of transmission and increased virulence. New found research has proven that the new strains of the virus are more virulent and use airborne aerosolized transmission to enable long range spread of the virus.&nbsp;</p> <p>By virtue of the fact that the virus spreads through such means, increases the risk of transmission and contamination highly as the virus can be transmitted via long range and through common ventilation and duct systems. In light of this it is now pertinent for legislation to support the use of personal protection equipment to safeguard the health of the public.</p> 2021-09-30T00:00:00+00:00 Copyright (c) 2021 CEA & INEA Improving Last-mile Delivery of COVID-19 Vaccines: The Cluster Strategy 2021-09-02T01:29:22+00:00 Anila Varghese Surachna Sidharth Sekhar Mishra <p>Vaccination against the COVID 19 virus is the most effective way to prevent infection and save lives. It is estimated that 285 million doses per month will be needed over the next five months to vaccinate all remaining adults by the end of 2021. To accelerate the vaccination coverage for its population, the state of Uttar Pradesh, North India, has planned a cluster approach to vaccination in rural areas.</p> <p>The cluster strategy is a micro-plan for vaccination by the government of U.P involving intensive mobilisation activities followed by vaccination at centres set up in schools, <em>Panchayat Bhavan</em>s and other selected places. It is a people-centred and comprehensive approach, modelled on listening to the intended beneficiaries and stakeholders is vital. It will reduce expenses related to travel and loss of wages for those missing work while travelling far to get vaccinated. The cluster approach is also along the lines of the Near to Home COVID Vaccination Centres (NHCVC) for Elderly and Differently Abled Citizens.</p> <p>The main fear of the health workers regarding the cluster approach is concerning adverse events and their management at the peripheral level. This strategy is only practically possible if an adequate supply of vaccines is available.</p> <p>The cluster approach to vaccination ensures accessibility, includes community participation and is provided free of cost. This is thus in line with the concept of Primary Health Care (PHC) which is essential health care made universally accessible to individuals and families in the community by means acceptable to them, through their full participation and at a cost the community and country can afford. Popularising this strategy and applying it to other states in a tailored manner based on social and cultural practices can give the nation the necessary momentum to attain the target of herd immunity quickly and curb the COVID-19 pandemic.</p> 2021-09-30T00:00:00+00:00 Copyright (c) 2021 CEA & INEA Corticosteroid induced avascular necrosis and COVID-19: The drug dilemma 2021-08-23T09:34:21+00:00 Indrajit Banerjee Jared Robinson Brijesh Sathian <p>The severe and life-threatening nature of the COVID-19 infection, the ARDS (acute respiratory distress syndrome) as well as the cytokine storm induced by the infection, commands lifesaving high doses of steroid therapy. As in all pharmacological therapies adverse effects are present. One such adverse effect which is being reported is corticosteroid induced avascular necrosis of the femoral head/ osteonecrosis of the femoral head.</p> <p>It must be noted that AVN principally affects the femoral head and most commonly the anterolateral aspect thereof as it is the crux of weight bearing.&nbsp; Corticosteroids induce fat mobilization and this thus innately enhances the likelihood of fat emboli developing from the liver to occlude minor blood vessels in the femur, this thereby compromises the microvascular environment. Superadded to this the steroid therapy disrupts calcium metabolism and homeostasis which induces hypertrophy in the intramedullary fat cells, Gaucher cells and inflammatory cells; whilst increasing the activity of osteoclasts, thus increasing bone resorption and decreasing calcium uptake and deposition; ultimately leading to an insufficiency in the trabecular and cortical bone. This insufficiency thus equates to an increased intraosseous pressure which impedes intramedullary circulation and results in avascular necrosis.</p> <p><strong><sup>&nbsp;</sup></strong>It is evident that avascular necrosis is directly caused by high dose steroid therapy, however the case reports have very clearly indicated that the rapid onset of AVN post recovery from the COVID-19 infection cannot be solely attributed to steroid therapy and that another benefactor induced by the COVID-19 infection is at play. It is thus vital for treating physicians to take cognisance of this adverse effect post recovery and therefore should ensure that prophylactic bisphosphonate therapy is initiated timeously and congruently.</p> 2021-09-30T00:00:00+00:00 Copyright (c) 2021 CEA & INEA