Background On 16 Jan 2021, India launched its immunization program against COVID-19. Among the first recipients were 1.59 million Health Care Workers (HCWs) and Frontline Workers (FLWs) of the Indian Armed Forces, who were administered COVISHIELD (Astra Zeneca). We present an interim analysis of vaccine effectiveness (VE) estimates till 30 May 2021. Methods The VIN-WIN cohort study was carried out on anonymized data of HCWs and FLWs of Indian Armed Forces. The existing surveillance system, enhanced for COVID-19 monitoring, was sourced for data. The cohort transitioned from Unvaccinated (UV) to Partially Vaccinated (PV) to Fully Vaccinated (FV), serving as its own internal comparison. Outcomes studied in the three groups were breakthrough infections and COVID related deaths. Incidence Rate Ratio (IRR) was used to compare outcomes among the three groups to estimate VE. Results Data of 1,595,630 individuals (mean age 27.6 years; 99% male) over 135 days was analysed. Till 30 May 21, 95.4% and 82.2% were partially and fully vaccinated. The UV, PV and FV compartments comprised 106.6, 46.7 and 58.7 million person-days respectively. The number of breakthrough cases in the UV, PV and FV groups were 10061, 1159 and 2512; while the deaths were 37, 16 and 7 respectively. Corrected VE was 91.8–94.9% against infections. Conclusion Interim results of the VIN-WIN cohort study of 1.59 million HCWs and FLWs of Indian Armed Forces showed a ∼93% reduction in COVID-19 breakthrough infections with COVISHIELD vaccination.

Within the next few decades, we will see an extraordinary increase in the number of older people worldwide. The public health benefit of preventive medicine in old age comes from the compression of the time spent in dependency to a minimum. A community-based, cross-sectional study was conducted to assess the morbidity profile of the geriatric population in a rural area of Maharashtra. A total of 214 subjects, of age 60 years and above, were examined. Data were collected by structured interviews and clinical and laboratory examinations. Out of the total of 214 subjects, 190 were suffering from some or the other diseases and the major morbidities were visual (56%), musculoskeletal (38.3%), respiratory (32.7%), and hypertension (28%). Anemia was present in 62.6%, 5.61% had Diabetes Mellitus and 22.5% were found to be overweight. The average morbidity load was 2.61. The rising morbidities clearly showed that a regular, complete health checkup of the elderly should be embedded in the essential elements of the Primary Health Care. This would reduce the morbidity, improve the quality of life, and facilitate 'Active Aging'.

No abstract

AM Al-Takroni, KBL Mendis, I Reddy, S Agrawal, Indomethacin for Treatment of Fetofetal Transfusion Syndrome. 1995; 15(3): 284-285 Acute severe fetofetal transfusion syndrome, with presentation in the midtrimester, complicates 1% of monochorionic twin pregnancies and until recently was associated with near 100% mortality.1 Aggressive therapeutic amniocentesis changed this grim situation and improved survival rates to between 69% and 79% 2 but only when begun before the onset of uterine activity.1 However, the midtrimester fetofetal transfusion syndrome presenting with uterine activity remains a therapeutic dilemma. We present a case of severe twin transfusion syndrome admitted in midtrimester with uterine activity in which the indomethacin therapy led to a successful outcome. We are not aware of any previous report of successful use of indomethacin in acute severe fetofetal transfusion syndrome. Case ReportA 28-year-old gravida 5, para 4 Saudi, known to be carrying twins and with a normal past obstetric history, was admitted with mild to moderate uterine activity and shortness of breath at 24 weeks' gestation. Her cardiovascular and respiratory systems were normal. The abdomen was grossly distended and tense. The symphysis-fundal height was 43 cm. The cervix was effaced and the cervical os was dilated to 2 cm.The laboratory investigations were within normal limits; ultrasonography performed with ALOKA SSD 630 real time scanner demonstrated two structurally normal male fetuses and a single placental mass located in the fundus of the uterus. Twin A was occupying the dependent portion of the uterus and moved freely, whereas twin B was lying longitudinally in the left superior part of the uterus with its head very close to the placenta. Though it showed good gross activity, it remained fixed in relation to the uterine wall, even when the maternal position was changed. The biometric assessment revealed discordance of growth between the fetuses, which corresponded to a difference of three weeks in favor of twin A.Very careful ultrasonographic examination failed to reveal a separating membrane between the twins. However, the "stuck" appearance of twin B pointed to the presence of a membrane which was invisible, probably because of its thinness and close apposition to the body parts of twin B. Therefore, we inferred that twin A was residing in a polyhydramniotic sac and that twin B was in a sac with reduced liquor. The estimation of the amniotic fluid volume in each sac was made by measuring the depth of the maximal pool. On admission, the depth of the maximal pool in sac A was 15 cm. and that in sac B was 3 cm. All the ultrasonic examinations were carried out by one investigator (S.A.). On the above findings, a diagnosis of twin pregnancy complicated by acute severe fetofetal transfusion syndrome, where twin A was the recipient and twin B the donor, was made.Treatment with indomethacin 50 mg q. 8 h. was started on the day of admission. Within 24 hours, uterine activity ceased. However, we planned to continue indomet...

No abstract