Background Various modalities are under study for prevention and treatment of novel coronavirus. One such modality is use of Hydroxychloroquine/Choloroquine. The objective of survey was to understand the awareness and impact of HCQ/CQ prophylaxis among the health care workers (HCWs) including surgeons and anaesthetists. Methods A web-based, cross-sectional survey was conducted for HCWs globally. Participation was voluntary and con dentiality was maintained by making participants' information anonymous. The questionnaire consisted of 28 items. Data were tabulated in excel, and descriptive statistics were performed. Results Survey was taken by 344 HCWs from all over the world. 98% participants heard about the use of HCQ/CQ prophylaxis against COVID 19 infection. 301 HCWs knew about the side effects of HCQ/CQ. 54 1% participants agree there is not adequate research done. 122 participants took HCQ/CQ prophylaxis. Out of 29 5% participants who received the medicine from hospital under hospital protocol, 66 7% were given medication without baseline investigations and 30 5% HCWs were not even briefed about the drug and its side effects by the hospitals. 36 2% participants developed side effects. 8 7% HCWs were tested for COVID19 out of 344 participants. Conclusion The drug taken by HCWs was without adequate evidence, prior investigations, supervision and followup. Most of the participants self prescribed the drug. No separate guidelines were stated for people who had comorbid conditions. Hospitals neither conducted baseline investigations and nor briefed HCWs about HCQ/CQ. These are some serious concerns we are looking into as who will be answerable in case of adverse events.
BackgroundAnaemia is a common disorder. Most health providers in resource poor settings rely on physical signs to diagnose anaemia. We aimed to determine the diagnostic accuracy of pallor for anaemia by using haemoglobin as the reference standard.Methodology/Principal FindingsIn May 2007, we enrolled consecutive patients over 12 years of age, able to consent and willing to participate and who had a haemoglobin measurement taken within a day of assessment of clinical pallor from outpatient and medicine inpatient department of a teaching hospital. We did a blind and independent comparison of physical signs (examination of conjunctivae, tongue, palms and nailbed for pallor) and the reference standard (haemoglobin estimation by an electronic cell counter). Diagnostic accuracy was measured by calculating likelihood ratio values and 95% confidence intervals (CI) at different haemoglobin thresholds and area under the receiver operating characteristic curve. Two observers examined a subset of patients (n = 128) to determine the inter-observer agreement, calculated by kappa statistics. We studied 390 patients (mean age 40.1 [SD 17.08] years); of whom 48% were women. The haemoglobin was <7 g/dL in 8% (95% confidence interval, 5, 10) patients; <9 g/dL in 21% (17, 26) patients and <12 g/dL in 64% (60, 70) patients. Among patients with haemoglobin <7 g/dL, presence of severe tongue pallor yielded a LR of 9.87 (2.81, 34.6) and its absence yielded a LR of 0. The tongue pallor outperformed other pallor sites and was also the best discriminator of anaemia at haemoglobin thresholds of 7 g/dL and 9 g/dL (area under the receiver operating characteristic curves (ROC area = 0.84 [0.77, 0.90] and 0.71[0.64, 0.76]) respectively. The agreement between the two observers for detection of anaemia was poor (kappa values = 0.07 for conjunctival pallor and 0.20 for tongue pallor).Conclusions/SignificanceClinical assessment of pallor can rule out and modestly rule in severe anaemia.
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