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BackgroundCOVID-19 was declared as a Public Health Emergency of International Concern on 30th January 2020. Compared to the general population, healthcare workers and their families have been identified to be at a higher risk of getting infected with COVID-19. Therefore, it is crucial to understand the risk factors responsible for the transmission of SARS-CoV-2 infection among health workers in different hospital settings and to describe the range of clinical presentations of SARS-CoV-2 infection among them.MethodologyA nested case–control study was conducted among healthcare workers who were involved in the care of COVID-19 cases for assessing the risk factors associated with it. To get a holistic perspective, the study was conducted in 19 different hospitals from across 7 states (Kerala, Tamil Nadu, Andhra Pradesh, Karnataka, Maharashtra, Gujarat, and Rajasthan) of India covering the major government and private hospitals that were actively involved in COVID-19 patient care. The study participants who were not vaccinated were enrolled using the incidence density sampling technique from December 2020 to December 2021.ResultsA total of 973 health workers consisting of 345 cases and 628 controls were recruited for the study. The mean age of the participants was observed to be 31.17 ± 8.5 years, with 56.3% of them being females. On multivariate analysis, the factors that were found to be significantly associated with SARS-CoV-2 were age of more than 31 years (adjusted odds ratio [aOR] 1.407 [95% CI 1.53–1.880]; p = 0.021), male gender (aOR 1.342 [95% CI 1.019–1.768]; p = 0.036), practical mode of IPC training on personal protective equipment (aOR 1. 1.935 [95% CI 1.148–3.260]; p = 0.013), direct exposure to COVID-19 patient (aOR 1.413 [95% CI 1.006–1.985]; p = 0.046), presence of diabetes mellitus (aOR 2.895 [95% CI 1.079–7.770]; p = 0.035) and those received prophylactic treatment for COVID-19 in the last 14 days (aOR 1.866 [95% CI 0.201–2.901]; p = 0.006).ConclusionThe study was able to highlight the need for having a separate hospital infection control department that implements IPC programs regularly. The study also emphasizes the need for developing policies that address the occupational hazards faced by health workers.

Background India has a high burden of invasive fungal infections. Although invasive aspergillosis was also reported during the COVID-19 pandemic, the real world data on the risk factors and outcome of CAPA are limited. Our aim is to determine risk factors and clinical outcomes of CAPA and develop a prediction model for patient stratification. Methods A retrospective, case-control study was conducted at a 1300-bedded South Indian tertiary care academic centre from June 1st, 2020 to May 31st, 2021. CAPA cases were defined by 2020 ECMM/ISHAM consensus criteria as possible, probable, and proven infection. Age and admission period matched control group with COVID-19 but without aspergillosis was selected in a 1:1 ratio. A risk scoring stratification for CAPA was developed based on the significant CAPA risk factors using logistic regression model. Figure 1:Receiving operating characteristic curve of CAPA incidence score for predicting CAPA in the study cohort Results 95 CAPA cases, of which 75(79%) were probable and 20(21%) possible, were diagnosed during the study period. 84(88.4%) patients had moderate to severe COVID-19, and 75(78.9%) were treated with steroids, most commonly dexamethasone (Table 1). The time from COVID-19 diagnosis to CAPA was 13 days (IQR 12). 40(42.1%) of patients were on mechanical ventilation at CAPA diagnosis. Outcome measures (MV, NIV and hospital/ICU stay) were significantly higher in CAPA patients compared to controls(Table 2). Neutropenia, use of steroids, broad spectrum antibiotic use, fluconazole prophylaxis and absence of co-infecting pathogen were found to be significant factors associated with CAPA(p< 0.05) (Table 3). An optimal risk score of ≥10.00 predicted CAPA with a sensitivity of 84.2% and a specificity of 59% with an area under the curve of 0.77 (PPV=67.23%, NPV=78.87%)(Fig 1). 75(78.9%) patients had positive serum aspergillus galactomannan with an average value of 1.89±1.65. 28-day (41.1% vs 33.7%, p=0.13) and 6-week all cause-mortality (48.4% vs 37.9%, p=0.07) were higher, but not statistically significant, for CAPA. Table 1:Baseline characteristics and risk factorsTable 2:Primary and secondary outcomesTable 3:CAPA incidence scoring table Significant univariate variables were included in the multivariate logistic regression model and predicted probabilities based on the beta co-efficients of the significant variables in the model were transformed to generate CAPA incidence score for patients. Conclusion Risk factors of CAPA in Indian were similar to those reported previously in other countries. CAPA can be seen in severe COVID-19 patients who are not mechanically ventilated. A CAPA risk scoring system, that needs external validation, is a simple and feasible tool that could be useful in stratification of patients suspected of CAPA. Disclosures All Authors: No reported disclosures.

Background: Safe and effective use of colistin requires robust pharmacokinetic (PK) and pharmacodynamic (PD) data to guide dosing. Aim: To evaluate the pharmacokinetics of colistimethate sodium and colistin in critically ill patients and correlate with clinical efficacy and renal function. Materials and Methods: Twenty critically ill adult patients with colistin-susceptible multidrug-resistant (MDR) infections and normal renal function treated with intravenous colistimethate sodium – at a 9 million units (270 mg CBA) loading dose followed by maintenance (MD) of 3 million units t.i.d, 24 hours later – were evaluated for clinical cure (CC) at the end of therapy. Patient characteristics and plasma colistin levels at 0, 0.5, 1, 2, 4, 8 and 12 hours after the loading dose and at 1, 2 and 8 hours after the eighth and ninth infusion of MD were evaluated. Colistimethate sodium and colistin levels were measured by high-performance liquid chromatography and tandem mass spectrometry (HPLC-MS/MS). Results: Among the 20 patients who were evaluated, 60% had pneumonia. Predominant pathogens were Klebsiella pneumoniae and Acinetobacter spp. Clinical cure was 50% (10/20). Mean peak loading dose concentrations were 3 ± 1.1 mg/L (1.75–5.14) and 2.37 ± 1.2 mg/L (1.52–5.54) for ‘cure’ and ‘failure’ groups, respectively (p = 0.13), while mean steady-state (Cssavg) concentrations were 2.25 ± 1.3 mg/L and 1.78 ± 1.1 mg/L in ‘cure’ and ‘failure’ groups, respectively (p = 0.19). Nephrotoxicity was 5% on day 7 of therapy. However, bacteriological cure could not be correlated with PK/PD. Conclusions: Subtherapeutic Cssavg with clinical failure and lower efficacy without significant nephrotoxicity highlights the need for therapeutic drug monitoring to guide colistin dosing.

Background Antimicrobial resistance is a major public health threat internationally but, particularly in India. A primary contributing factor to this rise in resistance includes unregulated access to antimicrobials. Implementing antimicrobial stewardship programs (ASPs) in the acute hospital setting will help curb inappropriate antibiotic use in India. Currently, ASPs are rare in India but are gaining momentum. This study describes ASP implementation in a large, academic, private, tertiary care center in India. Methods An ASP was established in February 2016 consisting of an administrative champion, hospitalist, microbiologist, intensivist, and pharmacists. Antimicrobial stewardship program interventions included postprescriptive audit and establishment of institutional guidelines. The ASP tracked appropriate drug selection including loading dose, maintenance dose, frequency, route, duration of therapy, de-escalation, and compliance with ASP recommendations. Defined daily dose (DDD) of drugs and cost of antimicrobials were compared between the pre-implementation phase (February 2015–January 2016) and post-implementation phase (February 2016–January 2017). Results Of 48 555 patients admitted during the post-implementation phase, 1020 received 1326 prescriptions for restricted antibiotics. Antibiotic therapy was appropriate in 56% (742) of the total patient prescriptions. A total of 2776 instances of “inappropriate” antimicrobial prescriptions were intervened upon by the ASP. Duration (806, 29%) was the most common reason for inappropriate therapy. Compliance with ASP recommendations was 54% (318). For all major restricted drugs, the DDD/1000 patient days declined, and there was a significant reduction in mean monthly cost by 14.4% in the post-implementation phase. Conclusions Implementation of a multidisciplinary antibiotic stewardship program in this academic, large, Indian hospital demonstrated feasibility and economic benefits.

Disease pattern is based on socio-demographic characteristics, comprehensive health care services, and environmental variables like water supply, basic sanitation and housing, illness behavior like quick decision to arrive at health care facility, and treatment behavior like the modality of treatment they receive. The descriptive cross-sectional study was conducted during the period of January 2014 to December 2015. The study was carried out among 310 purposively selected children attended at Pediatric Outpatient department of Community Based Medical College Hospital, Bangladesh. Data were collected by face to face interview of the parents and clinical examination and anthropometric measurement of children using case record form. Mean age of the children was 4.11 years with a SD of 4.35 years, male-female ratio was 1.25:1 with predominance 201(64.84%) of under-five children. The common diseases were 121(39.03%) with Acute Respiratory Infections (ARI), while 43(13.87%) diarrheal diseases, 25(8.06%) each with bronchial asthma and helminthiasis. Other diseases 96(30.97%) include anemia 17(5.48%), urinary tract infection 15 (4.84%), peptic ulcer disease 9(2.90%), enteric fever, oral candidiasis, apthous ulcer of mouth, scabies and vulvovaginitis. Average number of children per family was 2.2 including 251(80.97%) children having sanitary latrine in the family, 297(95.81%) with safe drinking water facilities and 270(87.10%) were fully vaccinated under EPI. More than three fourth 76(24.52%) of the children were underweight, 114(36.77%) were from poor families and 136(43.87%) lived in Kancha house. With the improvement of safe water supply and use of sanitary latrine diseases like diarrhoeal disease and helminthiasis are showing a decreasing trend.

This article reports observational evidence of Black Carbon (BC) induced cloud burning effect (Semi direct effect) for the first time over a mountainous location in North east India. Simultaneous aircraft observations of Black Carbon (BC) mass concentrations and cloud microphysical parameters were carried out over Guwahati, in Northeast India during Cloud Aerosol Interactions and Precipitation Enhancement Experiment (CAIPEEX) Phase-I in 2009. Elevated pollution layers of BC (concentration exceeding 1 μg m−3) were observed over the site up to 7 km on different experimental days (August 30, September 4 and 6 in 2009) in the cloud regime. The vertical heating rate and radiative forcing induced by elevated BC layers in the cloud regime were estimated using an optical model along with a radiative transfer model. The instantaneous vertical heating rate induced by BC in cloud layers is found to be as high as 2.65 K/day. The instantaneous vertical heating by BC is found to be inducing a significant reduction in the measured cloud liquid water content (LWC) over the site. Subsequently, the BC stimulated heating has been found to be reducing the cloud fraction (CFR) and thus inducing a “cloud burning effect (Semi direct effect)”, over the region. The estimated instantaneous BC induced radiative forcing in the cloud regime is found to be +12.7–+45.1 W m−2 during the experimental periods. This large warming and reduction in cloudiness can decrease the precipitation over the region. However, more simultaneous BC-cloud observations and further research are necessary to establish a stable “semi-direct effect” over the region.

Background In India, Candida bloodstream infections have a reported incidence of 1–12 per 1,000 admissions and a mortality rate of up to 60%. Antimicrobial stewardship programs (ASP) can improve quality of care and clinical outcomes. This study evaluates the impact of a comprehensive candidemia ASP bundle in a hospital in southern India with an established stewardship program. Methods A single-center, pre-post quasi-experimental study was conducted at a tertiary-care center in southern India to analyze the impact of an ASP care bundle for the management of adults with candidemia. During the intervention period (October 2017–December 2018), the ASP provided recommendations to providers in accordance with the 2016 IDSA Guidelines for the Management of Candidemia, which included the following bundle: (1) appropriate selection and dosing of antifungal therapy; (2) repeat blood cultures every 48 hours until clearance; (3) removal of central venous catheters and other potential removable foci of infection; (4) echocardiogram; (5) ophthalmologic evaluation; and (6) appropriate duration of therapy. The primary outcome was initiation of appropriate antifungal therapy. Additional clinical outcomes were also compared with a historical cohort. Results One hundred and four patients with candidemia were included: 52 in the pre-intervention and 52 in the post-intervention group. Overall, baseline demographics were similar between the two groups (Table 1). Candida tropicalis (26.9%) and Candida parapsilosis (29.8%) were the most common causes of candidemia in the cohort. Following intervention, administration of appropriate antifungal therapy improved by 40.4% (28.8% pre vs. 69.2% post, P < 0.01). Average time to effective treatment initiation following culture positivity decreased from 57.6 hours to 12 hours in the post-intervention group (P < 0.01). Thirty-day all-cause mortality was similar between the two groups (34.6% 38.4%, P = 0.84). Conclusion Implementation of a comprehensive candidemia care bundle by the ASP significantly improved the use and timing of initiation of appropriate antifungal therapy. Disclosures All authors: No reported disclosures.

Atmospheric aerosols alter the radiation balance by absorption/scattering of solar radiation, and indirectly by modifying the cloud microphysical properties. Observations during the Cloud Aerosol Interaction and Precipitation Enhancement Experiment (CAIPEEX) provide a unique opportunity to investigate the aerosol–cloud interaction in a dry to wet transition phase prior to the onset of southwest monsoon. It is observed that aerosol loading increased over the central Indian region in spite of the increase in surface rainfall. This aerosol loading was observed mainly in the 2–5 km level above surface. The origin and influence of elevated aerosol layer have been investigated with the help of WRF-Chem simulations by conducting sensitivity experiments for dust emissions, modified based on the satellite observations. To enhance the dust emissions, the erodible fraction over the Thar Desert region is enhanced to an average factor of 1.7 based on TOMS aerosol index (AI) and USGS land use category, which contributed to enhanced dust emissions by a factor of 1.25 over the study region. This enhancement of dust emission from Thar Desert can result in an increased radiative heating due to elevated aerosol layers, which leads to an increase in the ice mixing ratio and ice water content in the regions of dry to wet transition. It is shown that even natural dust emissions (without changes in anthropogenic emissions) may also influence the spatial and temporal distribution of cloud and precipitation and the hydrological cycle.

Sediment quality data provide essential information for evaluating ambient environmental quality conditions. Sediments are important carriers of trace metals in the environment and reflect the current quality of the system. In the present study, distribution of mercury, lead, cadmium, copper, zinc, chromium and manganese in Cochin estuary were studied. The distribution of oxides of metals and textural quality were also studied in detail. It was found that the concentration of metals in the sediments near the industrial belt was extremely high. Correlation of different metals and metal oxides were analysed. It was found that all the alloys were correlated significantly (α

Constructed wetlands are artificial wastewater treatment systems consisting of shallow ponds or channels which have been planted with aquatic plants and which rely upon natural microbial, biological, physical and chemical process to treat wastewater and are gaining acceptance in the recent years as a viable option for the treatment of industrial effluents and removal of toxic components. In this study, an attempt was made to compare the efficiency of aquatic macrophytes like Typha sp., Eichhornia sp., Salvinia sp., Pistia sp., Azolla sp. and Lemna sp. to treat the effluents from dairy factory, under laboratory conditions in constructed wetlands. The biological oxygen demand and chemical oxygen demand of dairy effluent were reduced up to 65.4–83.07% and 70.4–85.3%, respectively, after treatment with constructed wetland technology.

This paper discusses the extent of Black Carbon (BC) radiative forcing in the total aerosol atmospheric radiative forcing over Pune, an urban site in India. Collocated measurements of aerosol optical properties, chemical composition and BC were carried out for a period of six months (during October 2004 to May 2005) over the site. Observed aerosol chemical composition in terms of water soluble, insoluble and BC components were used in Optical Properties of Aerosols and Clouds (OPAC) to derive aerosol optical properties of composite aerosols. The BC fraction alone was used in OPAC to derive optical properties of BC aerosols. The aerosol optical properties for composite and BC aerosols were separately used in SBDART model to derive direct aerosol radiative forcing due to composite and BC aerosols. The atmospheric radiative forcing for composite aerosols were found to be +35.5, +32.9 and +47.6 Wm−2 during post-monsoon, winter and pre-monsoon seasons, respectively. The average BC mass fraction found to be 4.83, 6.33 and 4 μg m−3 during the above seasons contributing around 2.2 to 5.8% to the total aerosol load. The atmospheric radiative forcing estimated due to BC aerosols was +18.8, +23.4 and +17.2 Wm−2, respectively during the above seasons. The study suggests that even though BC contributes only 2.2–6% to the total aerosol load; it is contributing an average of around 55% to the total lower atmospheric aerosol forcing due to strong radiative absorption, and thus enhancing greenhouse warming.

Aerosol indirect effect (AIE) was estimated over six Indian regions, which have been identified as main source regions of absorbing aerosol emissions, for four successive contrasting monsoon years, 2001 (normal monsoon rainfall year), 2002 (drought year), 2003 (excess monsoon rainfall year) and 2004 (below normal rainfall year). The AIE has been estimated both for fixed cloud liquid water path (CLWP) and for fixed cloud ice path (CIP) bins, ranging from 1 to 350 gm−2 at 25 gm−2 intervals obtained from Moderate resolution imaging spectroradiometer (MODIS). In 2002 and 2004, AIE found to be of positive (Twomey effect) in majority of the fixed CLWP and CIP bins, while in 2001 and 2003 majority of the bins were found to be showing negative indirect effect (Anti-Twomey effect). Changes in circulation patterns during contrasting monsoon seasons, bringing up air mass containing aerosols of different source origins may be the main reason for this positive and negative AIE. The study suggests that AIE could be one of the factors in modulating Indian summer monsoon. However, further research on this topic is to be carried out to establish the relationship between AIE and Indian monsoon rainfall and also AIE values may be parameterized in climate models for better prediction of monsoon.

In situ aircraft measurements of cloud microphysical properties and aerosol during the 1st phase of the Cloud Aerosol Interaction and Precipitation Enhancement EXperiment (CAIPEEX-I) over the Indian sub-continent provided initial opportunities to investigate the dispersion effect and its implications for estimating aerosol indirect effects in continental cumuli. In contrast to earlier studies on continental shallow cumuli, it is found that not only the cloud droplet number concentration but also the relative dispersion increases with the aerosol number concentration in continental cumuli. The first aerosol indirect effect estimated from the relative changes in droplet concentration and effective radius with aerosol number concentration are 0.13 and 0.07, respectively. In-depth analysis reveals that the dispersion effect could offset the cooling by enhanced droplet concentration by 39 in these continental cumuli. Adiabaticity analysis revealed aerosol indirect effect is lesser in subadiabatic clouds possibly due to inhomogeneous mixing processes. This study shows that adequate representation of the dispersion effect would help in accurately estimating the cloud albedo effect for continental cumuli and can reduce uncertainty in aerosol indirect effect estimates.

[1] The effect of increased aerosol concentrations on the low-level, non-precipitating, ice-free stratus clouds is examined using a suite of surface-based remote sensing systems. Cloud droplet effective radius and liquid water path are retrieved using cloud radar and microwave radiometer. Collocated measurements of aerosol scattering coefficient, size distribution and cloud condensation nuclei (CCN) concentrations were used to examine the response of cloud droplet size and optical thickness to increased CCN proxies. During the episodic events of increase in aerosol accumulation-mode volume distribution, the decrease in droplet size and increase in cloud optical thickness is observed. The indirect effect estimates are made for both droplet effective radius and cloud optical thickness for different liquid water path ranges and they range 0.02–0.18 and 0.005–0.154, respectively. Data are also categorized into thin and thick clouds based on cloud geometric thickness (Δz) and estimates show IE values are relatively higher for thicker clouds.

[1] We present results from sun/sky radiometer measurements of aerosol optical characteristics carried out in New Delhi during March–June, 2006, as part of the Indian Space Research Organization's Integrated Campaign for Aerosol Radiation Budget. For the first time at this site, derived are parameters such as aerosol optical depth (AOD), single scattering albedo (SSA), asymmetry parameter, Angstrom exponent, and real and imaginary refractive indices in five spectral channels. During the campaign, a consistent increase in aerosol loading from March to June with monthly average AOD values at 0.5μm of 0.55, 0.75, 1.22 and 1.18, respectively, was observed. Angstrom exponent gradually decreases from 1.28 (March) to 0.47 (June), indicating an increased abundance of coarse particles due to dust storms that transport desert dust from the Thar desert and adjoining regions. SSA at 0.5 μm is found to be in the range of 0.84 to 0.74 from March to June, indicating an increasing contribution from the mixture of anthropogenic and desert dust absorbing aerosols. Optical properties derived during the campaign are used in a radiative-transfer model to estimate aerosol radiative forcing at the surface and at the top-of-the atmosphere. A consistent increase in surface cooling is evident, ranging from −39 W m−2 (March) to −99 W m−2 (June) and an increase in heating of the atmosphere from 27 W m−2 (March) to 123 W m−2 (June). Heating rates in the lower atmosphere (up to 5 km) are 0.6, 1.3, 2.1, and 2.5K/d from March, April, May, and June 2006, respectively. Higher aerosol induced heating in the premonsoon period has been shown to have an impact on the regional monsoon climate.

Heavy metal pollution in soil and water is becoming a serious problem for agriculture and health. Many plant species have developed some physiological mechanisms that allow their survival in such environments. Here, comparative analysis on absorption of heavy metals and the biochemical changes in aquatic macrophytes like Typha sp. and Pistia sp. were done. The study reveals that the absorption of heavy metals was high in the emergent plant than the floating macrophytes. Different plant enzymes played an important role in withstanding adverse conditions due to the presence of heavy metals. The macrophytes used for the study were utilised for biogas production.