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Nosocomial spread of adenovirus infection has been reported in neonatal, pediatric and adult medical units. This nonenveloped and hardy virus is resistant to numerous disinfectants thus posing a challenge for control and prevention of adenovirus infections in health care settings.An epidemiologic outbreak investigation revealed an adenoviral outbreak in the neonatal nursery as well as in the neonatal screening outpatient department for Retinopathy of Prematurity (ROP). All suspected cases (94 neonates) underwent adenoviral conventional polymerase chain reaction (PCR) and representative samples underwent sequencing by Sanger's method. The clinical features and disease course were studied. Infected babies were started on tobramycin eye drops. Topical steroid eye drops were added for those who developed pseudomembranes.We found 58 cases of laboratory-confirmed neonatal adenovirus conjunctivitis (between July 10 and October 24, 2019). Redness (96%) was the most common presentation followed by discharge (68.9%) and lid edema (51.7%). Pseudomembrane were seen in 77.5% of the infected neonates. Prior ROP examination was carried out in 38 (65.5%) neonates. Respiratory symptoms were present in 7 (12.06%) neonates. Sequencing revealed serotype 8 as the cause of the outbreak. Control measures were strictly implemented. Standard Operating Procedures (SOPs) for ROP screening were revisited, revised and reinforced to prevent future outbreaks.We observed ROP screening as a risk factor for the development of adenoviral conjunctivitis in neonatal care units. Neonates present with different clinical manifestations as compared with adults. Prompt control measures were implemented to control the adenoviral outbreak.

Background: The 550th Birth Anniversary (Parkash Utsav) celebrations of Shri Guru Nanak Dev Ji, the first Sikh Guru, was celebrated with great devotion and fervor at Sultanpur Lodhi, Punjab, India, from November 1 to 14, 2019. The authors aimed to shed light on the planning and management of the event and the factors that led to its success. Methods: The researchers conducted key informant interviews with authority figures, resource mapping, and observations. The researchers focused on the event’s medical lounge. Open-ended questions were asked to gather information regarding various measures taken to organize and execute the event. The data were entered and analyzed using Microsoft Excel 7.0 and SPSS 20.0 (Trial version).Results: About three million people attended the Parkash Utsav 550 celebrations. Three tent cities were set up in Sultanpur Lodhi with the consideration for incoming road traffic. The state government deployed 820 medical personnel, including 150 doctors, 470 paramedics, and 200 volunteers. A total of 19,521 patients were seen in the outpatient department of the Medical Lounge. The government made sufficient arrangements for various services, such as drinking water, langar (or community kitchens), sanitation, and security. Approximately 37 langar halls were constructed in the town to provide healthy food to the devotees. An integrated command and control center was set up for surveillance and monitoring. For the convenience of the devotees, 1,908 toilets, 1,476 urinals, and 132 bathing units were installed. The District Administration of Kapurthala launched an event-specific mobile application, “Parkash Utsav 550,” for the use of pilgrims as well as government officials. No stampedes, outbreaks, and fire incidents were reported.Conclusions: Parkash Utsav 550 was successfully celebrated. Studying the Parkash Utsav 550 presented a unique opportunity to generate an evidence base for the development of solutions and recommendations for the prevention, management, and control of infectious diseases, stampedes, and fire incidents during mass gatherings. In-depth studies of the Parkash Utsav in the future are required to produce evidence for context-specific measures for addressing the complex health challenges of mass gatherings.

In its wake, the COVID‐19 pandemic has ushered in a surge in the number of cases of mucormycosis. Most cases are temporally linked to COVID‐19; hence, the entity is described as COVID‐19‐associated mucormycosis (CAM). The present systematic review was undertaken to provide an up‐to‐date summary of the hitherto available literature on CAM. PubMed, Scopus and Google Scholar databases were systematically searched using appropriate keywords till 14 May 2021, to identify case reports/case series pertaining to mucormycosis in patients with COVID‐19. Relevant data extracted included demographic characteristics, comorbidity profile, clinical category of mucormycosis, glucocorticoid use, treatment offered and patient outcome. We identified 30 case reports/case series, pooling data retrieved from 99 patients with CAM. Most cases were reported from India (72%). The majority of the patients was male (78%) and had diabetes mellitus (85%). A prior history of COVID‐19 was present in 37% patients with mucormycosis developing after an initial recovery. The median time interval between COVID‐19 diagnosis and the first evidence of mucormycosis infection or CAM diagnosis was 15 days. Glucocorticoid use was reported in 85% of cases. Rhino‐orbital mucormycosis was most common (42%), followed by rhino‐orbito‐cerebral mucormycosis (24%). Pulmonary mucormycosis was observed in 10 patients (10%). The mortality rate was 34%; the use of adjunct surgery, which was undertaken in 81% of patients, was associated with better clinical outcomes (p

Background: Few observational studies have shown a beneficial effect of dipeptidyl peptidase-4 inhibitors (DPP4i) in patients with coronavirus disease 2019 (COVID-19), although results are not consistent. The present systematic review and meta-analysis was undertaken to provide a precise summary of the effect of DPP4i use (preadmission or in-hospital) and mortality in COVID-19 patients with diabetes mellitus (DM). Methods: PubMed and Google Scholar databases were systematically searched using appropriate keywords to 4 January 2021, to identify observational studies reporting mortality in COVID-19 patients with DM using DPP4i versus those not using DPP4i. Preadmission and in-hospital use of DPP4i were considered. Study quality was assessed using the Newcastle–Ottawa Scale. Unadjusted and adjusted pooled odds ratio (OR) with 95% confidence intervals (CIs) were calculated. Subgroup analysis was performed for studies reporting preadmission and in-hospital use of DPP4i. Results: We identified nine observational studies of high quality pooling data retrieved from 7008 COVID-19 patients with DM. The pooled analysis of unadjusted and adjusted data did not show any significant association between DPP4i use and mortality in COVID-19 patients with DM. However, on subgroup analysis, we found that in-hospital (and not preadmission) DPP4i use was associated with reduced mortality (unadjusted OR 0.37, 95% CI 0.23, 0.58, p 2 = 0% and adjusted OR 0.27, 95% CI 0.13, 0.55, p = 0.0003, I2 = 12%). Conclusions: In-hospital use of DPP4i is associated with a significant reduction in COVID-19 mortality. Hence, it would be prudent to initiate or continue DPP4i in COVID-19 patients with DM if not contraindicated.

ObjectivesHealthcare personnel (HCP) are at an increased risk of acquiring COVID-19 infection especially in resource-restricted healthcare settings, and return to homes unfit for self-isolation, making them apprehensive about COVID-19 duty and transmission risk to their families. We aimed at implementing a novel multidimensional HCP-centric evidence-based, dynamic policy with the objectives to reduce risk of HCP infection, ensure welfare and safety of the HCP and to improve willingness to accept and return to duty.SettingOur tertiary care university hospital, with 12 600 HCP, was divided into high-risk, medium-risk and low-risk zones. In the high-risk and medium-risk zones, we organised training, logistic support, postduty HCP welfare and collected feedback, and sent them home after they tested negative for COVID-19. We supervised use of appropriate personal protective equipment (PPE) and kept communication paperless.ParticipantsWe recruited willing low-risk HCP, aged ResultsBetween 31 March and 20 July 2020, we clinically screened 5553 outpatients, of whom 3012 (54.2%) were COVID-19 suspects managed in the medium-risk zone. Among them, 346 (11.4%) tested COVID-19 positive (57.2% male) and were managed in the high-risk zone with 19 (5.4%) deaths. One (0.08%) of the 1224 HCP in high-risk zone, 6 (0.62%) of 960 HCP in medium-risk zone and 23 (0.18%) of the 12 600 HCP in the low-risk zone tested positive at the end of shift. All the 30 COVID-19-positive HCP have since recovered. This HCP-centric policy resulted in low transmission rates (ConclusionA multidimensional HCP-centric policy was effective in ensuring safety, satisfaction and welfare of HCP in a resource-poor setting and resulted in a willing workforce to fight the pandemic.

Health care workers are the most exposed and worst affected in this recent pandemic worldwide. Here we narrate an incident where one of our healthcare workers (HCW) contracted COVID 19 infection. The HCW was actively involved in blood donation camps organized by the institute and might have caught infection there. Another HCW, brother of the index case is associated in the office of the authors and was quarantined at home with his family. Families of two brothers were living in a two storey house. All the members of the families living there took all the precautions as per the guidelines of Government of India and when the rest of family members were screened for COVID19 on day twelve; all the members of the household were negative for the dreaded COVID-19. The younger brother joined office after completing the quarantine period following all the precautions meticulously.

Background: Health care personnel (HCP) are at an increased risk of acquiring COVID infection during this pandemic especially in developing countries like India, where they work in resource restricted healthcare settings and return to homes, unfit for safe self-isolation. Thus, many HCP were reluctant to accept COVID-19 duty as they were apprehensive about their safety and concerned about carrying the infection home to their families. Methods: We describe a novel multidimensional HCP-centric evidence-based, dynamic policy to address the expressed concerns of HCPs. The hospital was divided into three zones: high, medium, and low risk zones. In the high risk and medium risk zones, we organized pre-duty holistic training, provided on-duty support, ensured post duty HCP welfare, and send them all home after they tested negative for COVID-19. To minimize transmission, we provided appropriate PPE, ensured its proper use, kept all communication paperless. To reduce morbidity, we recruited only willing low risk HCP, aged