Aim: To study the efficacy of intravenous vitamin C in management of moderate and severe COVID-19. Objective: To determine the efficacy of intravenous vitamin C in reducing in-hospital mortality in moderate and severe cases of COVID-19. Design: Parallel, double-blinded randomized controlled trial with placebo. Ethical clearance was obtained from the institutional ethics committee, AIIMS Patna. The trial was registered with the Clinical Trials Registry – India (registration number- CTRI/2020/11/029230.) Setting: A tertiary care centre in Bihar, India Participants: All patients above the age of 18 years both males and females, admitted in ICU with a diagnosis of moderate and severe COVID-19 (on the basis of a positive reverse transcriptase polymerase chain reaction (RT–PCR) report) at our facility during the study period (01/10/2020–31/12/2020) not having any of the exclusion criteria. Intervention: The patients in the intervention arm were given 1 gram (2 ampoules of 2 ml each containing 500 mg of vitamin C mixed in 100 ml normal saline) intravenous vitamin C 8 hourly for four days. The patients in the placebo arm received similar looking ampoules (2 ampoules of 2 ml sterile water for injection mixed in 100 ml normal saline) intravenously 8 hourly for four days. The rest of the treatment was given as per the standard operating procedure (SOP) of the institute with adjustments as per treating team’s judgement. Outcome Measures: Primary outcome was reduction in in-hospital mortality. Secondary outcomes were improvement in qSOFA score, pO2/fiO2 ratio, fall in inflammatory markers, need for mechanical ventilation and vasopressors. Results: Regarding primary outcome, 10 (33.3%) patients died in intervention group compared to 13 (43.3%) in placebo. Worth noting from baseline characteristics is that 86.7% in intervention arm were of severe category compared to 66.7% severe category patients in placebo group. Though number of severe cases were more in intervention arm there has been comparatively less mortality in this group. Regarding secondary outcomes, amongst 30 patients in vitamin C group, 11 (36.7%) required invasive mechanical ventilation compared to 14 (46.7%) out of 30 in placebo group but the difference was not statistically significant. Although there were a greater number of moderate cases in placebo group, invasive ventilation requirement (and NIV requirement) was more in this group, thus it could be considered that vitamin C might have a role in reducing the severity of disease. The need for vasopressor therapy was higher in intervention arm 33.3% compared to 26.7% in placebo but not significant statistically. The secondary outcomes of the study such as improvement in organ failure score (qSOFA Score), fall in level of inflammatory markers, improvement in respiratory index (pO2/fiO2 ratio), need...

INTRODUCTIONGlobally 325 million people are HBsAg positive hence carriers of hepatitis B Virus (HBV).1 This is a public health challenge as majority of them have poor access to testing and treatment facilities. With a prevalence of 3 -4.2%, India is in the intermediate endemic zone but has around 40 million HBV carriers.2 Annually around 7,80,000 people die due to consequences of chronic HBV.2 Among those with infection, chances of becoming HBV carriers are 90% in infants, 30% in early childhood and upto 5% in adults.2 In persons with chronic HBV infection, risk of dying prematurely due to liver cirrhosis and hepatocellular carcinoma (HCC) is 15-25%; one in every 26 infants born run the life-time risk of developing chronic HBV infection.3 Chronic infection with HBV is responsible for 80% of cirrhosis , and about 60% of HCC in India. 4 HBV is resilient and can survive outside the body for at least 7 days at room temperature without losing its infectivity. This virus is 100 times more infectious than HIV. 3 The risk of infection with HBV after single needle-stick injury is 30%. 5 ABSTRACTBackground: Chronic infection with heptitis B virus (HBV) leading to cirrhosis, cancer, premature death and consequent economic burden is a global problem. Prevention is a public health challenge especially in unvaccinated and disadvantaged populations with unknown risk factors. Majority of Bihar's population is rural, whose risk factors have not been studied earlier. The objective was to study the risk factors of HBV infection in the rural adult population of Bihar with aim of identifying target group for prevention. Methods: Analytic case-control study in which health camps were organized in villages of Phulwarisharif block of Patna district to screen adults and identify cases and controls. Results: H/o jaundice 6 months or more (p=0.00, OR=3.58); contact with HBV (p=0.00, OR=4.17), family H/o HBV (p=0.00 OR=5.41); blood transfusion (p=0.00, OR=6), H/o hospitalization (p=0.001, OR=2.36), surgery (p=0.003, OR=2.17) and migration (p=0.018, OR=1.95) were significant risk factors. Lack of knowledge about HBV was significant (p<0.030). About 40% and 20% of both cases and controls were aware of parenteral and sexual transmission respectively; 4% cases vs. 13% controls knew about preventive vaccination. Logistic regression revealed that H/o jaundice, family H/o hepatitis B, blood transfusion, hospitalization and migration were independent risk factors for HBV transmission (OR=4.69, 6.55, 3.89. 2.49 and 2.76 respectively) Conclusions: Screening and awareness programs for rural adults necessary to identify and follow up those with H/o jaundice, HBV + contacts and migrant population. Infection control and biomedical waste management need strengthening.

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In a prospective analytical cohort study or a study involving a longer follow up, changing age of participants influence the relationship between exposure and outcome. Usually age at entry is incorporated in the regression model to adjust for age. However, this fails to fully explain and adjust for changing age. For this Lexis expansion, a concept by Wilhelm Lexis, allows the analyst to expand the observations as per age bands and check for confounding and interaction by changing age. Lexis expansion assumes the rates to be constant within an age band.