The rapid emergence of coronavirus disease 2019 (COVID-19) as a global pandemic affecting millions of individuals globally has necessitated sensitive and high-throughput approaches for the diagnosis, surveillance, and determining the genetic epidemiology of SARS-CoV-2. In the present study, we used the COVIDSeq protocol, which involves multiplex-PCR, barcoding, and sequencing of samples for high-throughput detection and deciphering the genetic epidemiology of SARS-CoV-2. We used the approach on 752 clinical samples in duplicates, amounting to a total of 1536 samples which could be sequenced on a single S4 sequencing flow cell on NovaSeq 6000. Our analysis suggests a high concordance between technical duplicates and a high concordance of detection of SARS-CoV-2 between the COVIDSeq as well as RT-PCR approaches. An in-depth analysis revealed a total of six samples in which COVIDSeq detected SARS-CoV-2 in high confidence which were negative in RT-PCR. Additionally, the assay could detect SARS-CoV-2 in 21 samples and 16 samples which were classified inconclusive and pan-sarbeco positive respectively suggesting that COVIDSeq could be used as a confirmatory test. The sequencing approach also enabled insights into the evolution and genetic epidemiology of the SARS-CoV-2 samples. The samples were classified into a total of 3 clades. This study reports two lineages B.1.112 and B.1.99 for the first time in India. This study also revealed 1,143 unique single nucleotide variants and added a total of 73 novel variants identified for the first time. To the best of our knowledge, this is the first report of the COVIDSeq approach for detection and genetic epidemiology of SARS-CoV-2. Our analysis suggests that COVIDSeq could be a potential high sensitivity assay for the detection of SARS-CoV-2, with an additional advantage of enabling the genetic epidemiology of SARS-CoV-2.
The rapid emergence of coronavirus disease 2019 (COVID-19) as a global pandemic affecting millions of individuals globally has necessitated sensitive and high-throughput approaches for the diagnosis, surveillance and for determining the genetic epidemiology of SARS-CoV-2. In the present study, we used the COVIDSeq protocol, which involves multiplex-PCR, barcoding and sequencing of samples for high-throughput detection and deciphering the genetic epidemiology of SARS-CoV-2. We used the approach on 752 clinical samples in duplicates, amounting to a total of 1536 samples which could be sequenced on a single S4 sequencing flow cell on NovaSeq 6000. Our analysis suggests a high concordance between technical duplicates and a high concordance of detection of SARS-CoV-2 between the COVIDSeq as well as RT-PCR approaches. An in-depth analysis revealed a total of six samples in which COVIDSeq detected SARS-CoV-2 in high confidence which were negative in RT-PCR. Additionally, the assay could detect SARS-CoV-2 in 21 samples and 16 samples which were classified inconclusive and pan-sarbeco positive respectively suggesting that COVIDSeq could be used as a confirmatory test. The sequencing approach also enabled insights into the evolution and genetic epidemiology of the SARS-CoV-2 samples. The samples were classified into a total of 3 clades. This study reports two lineages B.1.112 and B.1.99 for the first time in India. This study also revealed 1,143 unique single nucleotide variants and added a total of 73 novel variants identified for the first time. To the best of our knowledge, this is the first report of the COVIDSeq approach for detection and genetic epidemiology of SARS-CoV-2. Our analysis suggests that COVIDSeq could be a potential high sensitivity assay for the detection of SARS-CoV-2, with an additional advantage of enabling genetic epidemiology of SARS-CoV-2.
Background: Infants and children suffer from frequent but usually non serious illnesses and are more vulnerable to various adverse events related to drugs and poor understanding of instructions on prescription by the patient or caretakers were likely to cause medication error. The correct identification of an illness and its management with medications is a vital aspect of patient care, especially for paediatric population. So, prescribing pattern studies are very helpful in promoting the appropriate use of drugs in population. Objectives: It aims to obtain data on the current prescribing pattern in pediatric OPD at a tertiary care teaching hospital with ultimate goal to promote appropriate use of drugs. Methods: This study was conducted in 62 pediatric patients of either sex visiting Pediatric out-patient department over a period of three months at NMCH and RC, Raichur, Karnataka. Results: Prescription analysis showed that the average number of drugs per prescription was 3.32. Drugs were mostly prescribed by brand name (98.06%), Injections (4.83%) were least prescribed, drugs prescribed from Essential Drug List was 48.54%. Antibiotics were most prescribed class of drugs (33.9%). Conclusion: The study concludes that polypharmacy was slightly seen in prescriptions. Diagnosis of the patient was recorded for most of the prescriptions. There is need to conduct many such studies at regular interval as it is useful for auditing large number of prescriptions to find out early signals of the irrational drug use. Our study evaluated drug use pattern only from the outpatients hence prescription pattern may vary among inpatients. Keywords: Prescribing pattern, Infants, WHO core prescribing indicators, Polypharmacy, Generic name
A 50-year-old healthy male farmer was admitted in department of emergency, PBM hospital Bikaner 2 hour after accidental inhalation of unknown poison during spraying; with the chief complain of several episode of vomiting. The identity of the poison was confirmed by the family. As they had brought an empty pack of "Gramaxone".There was no evidence or history of any prior psychological disorders or any medications and addiction. After it patient has discomfort of mouth, nasal irritation, irritation of eyes, dyspnoea, nausea, vomiting. Patient was drowsy but conscious and cooperative. On examination blood pressure was 110/80 mmHg, heart rate 94/minute, regular, respiratory rate 18 per minute regular abdomino-thorasic and oxygen saturation 95% on room air. Temperature was 98.8 degree Fahrenheit by axilla. Cardiac examination was absolutely normal. Both lung fields were clear on auscultation. Other systemic examinations were normal.Gastric lavage was performed, and repeated doses of charcoal were given in the emergency department. Patient was shifted to intensive care unit for further management. Initially Blood Cell Line, Renal Function Test, Liver Function Test, Electrolytes and Arterial Blood Gas was within normal limits. ECG showed sinus tachycardia. Chest X-ray was normal [Table/ Fig-1].After shifting to ICU patient was managed with IV fluid and supportive measure. Steroid (methylprednisolone 15-20 mg/ kg/day) was started from first day. Patient was managed conservatively for two days. Patient becomes unstable on third day with the feature of adult respiratory distress syndrome. He became severely hypoxic (SpO 2 50) Venturi Mask was used. ABG showed PaO 2 of 50mmHg with mild respiratory alkalosis. Intubation was performed and placed on mechanical ventilation. Broad spectrum antibiotics (Pipracillin-Tazobectam 4.5 mg and metronidazole 100mg IV 8 hour) were started prophylactic after intubation. Blood Internal Medicine SectionParaquat Poisoning: A Case Report Paraquat is commonly used herbicide by farmers in North West Rajasthan. Despite its easy availability, poisoning of its not common. Fatal dose of paraquat is so small that >10 ml poison can damage lungs permanently. Diagnosis is often difficult without proper history, absence of specific clinical feature and lack of diagnostic test. Inhalation exposures represent one of the most important routes of poisoning. We are reporting a case of inhaled paraquat poisoning with complication of irreversible acute kidney, liver and lung injury.
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