Journal of Clinical and Diagnostic Research, ISSN - 0973 - 709X

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Dr Mohan Z Mani

"Thank you very much for having published my article in record time.I would like to compliment you and your entire staff for your promptness, courtesy, and willingness to be customer friendly, which is quite unusual.I was given your reference by a colleague in pathology,and was able to directly phone your editorial office for clarifications.I would particularly like to thank the publication managers and the Assistant Editor who were following up my article. I would also like to thank you for adjusting the money I paid initially into payment for my modified article,and refunding the balance.
I wish all success to your journal and look forward to sending you any suitable similar article in future"



Dr Mohan Z Mani,
Professor & Head,
Department of Dermatolgy,
Believers Church Medical College,
Thiruvalla, Kerala
On Sep 2018




Prof. Somashekhar Nimbalkar

"Over the last few years, we have published our research regularly in Journal of Clinical and Diagnostic Research. Having published in more than 20 high impact journals over the last five years including several high impact ones and reviewing articles for even more journals across my fields of interest, we value our published work in JCDR for their high standards in publishing scientific articles. The ease of submission, the rapid reviews in under a month, the high quality of their reviewers and keen attention to the final process of proofs and publication, ensure that there are no mistakes in the final article. We have been asked clarifications on several occasions and have been happy to provide them and it exemplifies the commitment to quality of the team at JCDR."



Prof. Somashekhar Nimbalkar
Head, Department of Pediatrics, Pramukhswami Medical College, Karamsad
Chairman, Research Group, Charutar Arogya Mandal, Karamsad
National Joint Coordinator - Advanced IAP NNF NRP Program
Ex-Member, Governing Body, National Neonatology Forum, New Delhi
Ex-President - National Neonatology Forum Gujarat State Chapter
Department of Pediatrics, Pramukhswami Medical College, Karamsad, Anand, Gujarat.
On Sep 2018




Dr. Kalyani R

"Journal of Clinical and Diagnostic Research is at present a well-known Indian originated scientific journal which started with a humble beginning. I have been associated with this journal since many years. I appreciate the Editor, Dr. Hemant Jain, for his constant effort in bringing up this journal to the present status right from the scratch. The journal is multidisciplinary. It encourages in publishing the scientific articles from postgraduates and also the beginners who start their career. At the same time the journal also caters for the high quality articles from specialty and super-specialty researchers. Hence it provides a platform for the scientist and researchers to publish. The other aspect of it is, the readers get the information regarding the most recent developments in science which can be used for teaching, research, treating patients and to some extent take preventive measures against certain diseases. The journal is contributing immensely to the society at national and international level."



Dr Kalyani R
Professor and Head
Department of Pathology
Sri Devaraj Urs Medical College
Sri Devaraj Urs Academy of Higher Education and Research , Kolar, Karnataka
On Sep 2018




Dr. Saumya Navit

"As a peer-reviewed journal, the Journal of Clinical and Diagnostic Research provides an opportunity to researchers, scientists and budding professionals to explore the developments in the field of medicine and dentistry and their varied specialities, thus extending our view on biological diversities of living species in relation to medicine.
‘Knowledge is treasure of a wise man.’ The free access of this journal provides an immense scope of learning for the both the old and the young in field of medicine and dentistry as well. The multidisciplinary nature of the journal makes it a better platform to absorb all that is being researched and developed. The publication process is systematic and professional. Online submission, publication and peer reviewing makes it a user-friendly journal.
As an experienced dentist and an academician, I proudly recommend this journal to the dental fraternity as a good quality open access platform for rapid communication of their cutting-edge research progress and discovery.
I wish JCDR a great success and I hope that journal will soar higher with the passing time."



Dr Saumya Navit
Professor and Head
Department of Pediatric Dentistry
Saraswati Dental College
Lucknow
On Sep 2018




Dr. Arunava Biswas

"My sincere attachment with JCDR as an author as well as reviewer is a learning experience . Their systematic approach in publication of article in various categories is really praiseworthy.
Their prompt and timely response to review's query and the manner in which they have set the reviewing process helps in extracting the best possible scientific writings for publication.
It's a honour and pride to be a part of the JCDR team. My very best wishes to JCDR and hope it will sparkle up above the sky as a high indexed journal in near future."



Dr. Arunava Biswas
MD, DM (Clinical Pharmacology)
Assistant Professor
Department of Pharmacology
Calcutta National Medical College & Hospital , Kolkata




Dr. C.S. Ramesh Babu
" Journal of Clinical and Diagnostic Research (JCDR) is a multi-specialty medical and dental journal publishing high quality research articles in almost all branches of medicine. The quality of printing of figures and tables is excellent and comparable to any International journal. An added advantage is nominal publication charges and monthly issue of the journal and more chances of an article being accepted for publication. Moreover being a multi-specialty journal an article concerning a particular specialty has a wider reach of readers of other related specialties also. As an author and reviewer for several years I find this Journal most suitable and highly recommend this Journal."
Best regards,
C.S. Ramesh Babu,
Associate Professor of Anatomy,
Muzaffarnagar Medical College,
Muzaffarnagar.
On Aug 2018




Dr. Arundhathi. S
"Journal of Clinical and Diagnostic Research (JCDR) is a reputed peer reviewed journal and is constantly involved in publishing high quality research articles related to medicine. Its been a great pleasure to be associated with this esteemed journal as a reviewer and as an author for a couple of years. The editorial board consists of many dedicated and reputed experts as its members and they are doing an appreciable work in guiding budding researchers. JCDR is doing a commendable job in scientific research by promoting excellent quality research & review articles and case reports & series. The reviewers provide appropriate suggestions that improve the quality of articles. I strongly recommend my fraternity to encourage JCDR by contributing their valuable research work in this widely accepted, user friendly journal. I hope my collaboration with JCDR will continue for a long time".



Dr. Arundhathi. S
MBBS, MD (Pathology),
Sanjay Gandhi institute of trauma and orthopedics,
Bengaluru.
On Aug 2018




Dr. Mamta Gupta,
"It gives me great pleasure to be associated with JCDR, since last 2-3 years. Since then I have authored, co-authored and reviewed about 25 articles in JCDR. I thank JCDR for giving me an opportunity to improve my own skills as an author and a reviewer.
It 's a multispecialty journal, publishing high quality articles. It gives a platform to the authors to publish their research work which can be available for everyone across the globe to read. The best thing about JCDR is that the full articles of all medical specialties are available as pdf/html for reading free of cost or without institutional subscription, which is not there for other journals. For those who have problem in writing manuscript or do statistical work, JCDR comes for their rescue.
The journal has a monthly publication and the articles are published quite fast. In time compared to other journals. The on-line first publication is also a great advantage and facility to review one's own articles before going to print. The response to any query and permission if required, is quite fast; this is quite commendable. I have a very good experience about seeking quick permission for quoting a photograph (Fig.) from a JCDR article for my chapter authored in an E book. I never thought it would be so easy. No hassles.
Reviewing articles is no less a pain staking process and requires in depth perception, knowledge about the topic for review. It requires time and concentration, yet I enjoy doing it. The JCDR website especially for the reviewers is quite user friendly. My suggestions for improving the journal is, more strict review process, so that only high quality articles are published. I find a a good number of articles in Obst. Gynae, hence, a new journal for this specialty titled JCDR-OG can be started. May be a bimonthly or quarterly publication to begin with. Only selected articles should find a place in it.
An yearly reward for the best article authored can also incentivize the authors. Though the process of finding the best article will be not be very easy. I do not know how reviewing process can be improved. If an article is being reviewed by two reviewers, then opinion of one can be communicated to the other or the final opinion of the editor can be communicated to the reviewer if requested for. This will help one’s reviewing skills.
My best wishes to Dr. Hemant Jain and all the editorial staff of JCDR for their untiring efforts to bring out this journal. I strongly recommend medical fraternity to publish their valuable research work in this esteemed journal, JCDR".



Dr. Mamta Gupta
Consultant
(Ex HOD Obs &Gynae, Hindu Rao Hospital and associated NDMC Medical College, Delhi)
Aug 2018




Dr. Rajendra Kumar Ghritlaharey

"I wish to thank Dr. Hemant Jain, Editor-in-Chief Journal of Clinical and Diagnostic Research (JCDR), for asking me to write up few words.
Writing is the representation of language in a textual medium i e; into the words and sentences on paper. Quality medical manuscript writing in particular, demands not only a high-quality research, but also requires accurate and concise communication of findings and conclusions, with adherence to particular journal guidelines. In medical field whether working in teaching, private, or in corporate institution, everyone wants to excel in his / her own field and get recognised by making manuscripts publication.


Authors are the souls of any journal, and deserve much respect. To publish a journal manuscripts are needed from authors. Authors have a great responsibility for producing facts of their work in terms of number and results truthfully and an individual honesty is expected from authors in this regards. Both ways its true "No authors-No manuscripts-No journals" and "No journals–No manuscripts–No authors". Reviewing a manuscript is also a very responsible and important task of any peer-reviewed journal and to be taken seriously. It needs knowledge on the subject, sincerity, honesty and determination. Although the process of reviewing a manuscript is a time consuming task butit is expected to give one's best remarks within the time frame of the journal.
Salient features of the JCDR: It is a biomedical, multidisciplinary (including all medical and dental specialities), e-journal, with wide scope and extensive author support. At the same time, a free text of manuscript is available in HTML and PDF format. There is fast growing authorship and readership with JCDR as this can be judged by the number of articles published in it i e; in Feb 2007 of its first issue, it contained 5 articles only, and now in its recent volume published in April 2011, it contained 67 manuscripts. This e-journal is fulfilling the commitments and objectives sincerely, (as stated by Editor-in-chief in his preface to first edition) i e; to encourage physicians through the internet, especially from the developing countries who witness a spectrum of disease and acquire a wealth of knowledge to publish their experiences to benefit the medical community in patients care. I also feel that many of us have work of substance, newer ideas, adequate clinical materials but poor in medical writing and hesitation to submit the work and need help. JCDR provides authors help in this regards.
Timely publication of journal: Publication of manuscripts and bringing out the issue in time is one of the positive aspects of JCDR and is possible with strong support team in terms of peer reviewers, proof reading, language check, computer operators, etc. This is one of the great reasons for authors to submit their work with JCDR. Another best part of JCDR is "Online first Publications" facilities available for the authors. This facility not only provides the prompt publications of the manuscripts but at the same time also early availability of the manuscripts for the readers.
Indexation and online availability: Indexation transforms the journal in some sense from its local ownership to the worldwide professional community and to the public.JCDR is indexed with Embase & EMbiology, Google Scholar, Index Copernicus, Chemical Abstracts Service, Journal seek Database, Indian Science Abstracts, to name few of them. Manuscriptspublished in JCDR are available on major search engines ie; google, yahoo, msn.
In the era of fast growing newer technologies, and in computer and internet friendly environment the manuscripts preparation, submission, review, revision, etc and all can be done and checked with a click from all corer of the world, at any time. Of course there is always a scope for improvement in every field and none is perfect. To progress, one needs to identify the areas of one's weakness and to strengthen them.
It is well said that "happy beginning is half done" and it fits perfectly with JCDR. It has grown considerably and I feel it has already grown up from its infancy to adolescence, achieving the status of standard online e-journal form Indian continent since its inception in Feb 2007. This had been made possible due to the efforts and the hard work put in it. The way the JCDR is improving with every new volume, with good quality original manuscripts, makes it a quality journal for readers. I must thank and congratulate Dr Hemant Jain, Editor-in-Chief JCDR and his team for their sincere efforts, dedication, and determination for making JCDR a fast growing journal.
Every one of us: authors, reviewers, editors, and publisher are responsible for enhancing the stature of the journal. I wish for a great success for JCDR."



Thanking you
With sincere regards
Dr. Rajendra Kumar Ghritlaharey, M.S., M. Ch., FAIS
Associate Professor,
Department of Paediatric Surgery, Gandhi Medical College & Associated
Kamla Nehru & Hamidia Hospitals Bhopal, Madhya Pradesh 462 001 (India)
E-mail: drrajendrak1@rediffmail.com
On May 11,2011




Dr. Shankar P.R.

"On looking back through my Gmail archives after being requested by the journal to write a short editorial about my experiences of publishing with the Journal of Clinical and Diagnostic Research (JCDR), I came across an e-mail from Dr. Hemant Jain, Editor, in March 2007, which introduced the new electronic journal. The main features of the journal which were outlined in the e-mail were extensive author support, cash rewards, the peer review process, and other salient features of the journal.
Over a span of over four years, we (I and my colleagues) have published around 25 articles in the journal. In this editorial, I plan to briefly discuss my experiences of publishing with JCDR and the strengths of the journal and to finally address the areas for improvement.
My experiences of publishing with JCDR: Overall, my experiences of publishing withJCDR have been positive. The best point about the journal is that it responds to queries from the author. This may seem to be simple and not too much to ask for, but unfortunately, many journals in the subcontinent and from many developing countries do not respond or they respond with a long delay to the queries from the authors 1. The reasons could be many, including lack of optimal secretarial and other support. Another problem with many journals is the slowness of the review process. Editorial processing and peer review can take anywhere between a year to two years with some journals. Also, some journals do not keep the contributors informed about the progress of the review process. Due to the long review process, the articles can lose their relevance and topicality. A major benefit with JCDR is the timeliness and promptness of its response. In Dr Jain's e-mail which was sent to me in 2007, before the introduction of the Pre-publishing system, he had stated that he had received my submission and that he would get back to me within seven days and he did!
Most of the manuscripts are published within 3 to 4 months of their submission if they are found to be suitable after the review process. JCDR is published bimonthly and the accepted articles were usually published in the next issue. Recently, due to the increased volume of the submissions, the review process has become slower and it ?? Section can take from 4 to 6 months for the articles to be reviewed. The journal has an extensive author support system and it has recently introduced a paid expedited review process. The journal also mentions the average time for processing the manuscript under different submission systems - regular submission and expedited review.
Strengths of the journal: The journal has an online first facility in which the accepted manuscripts may be published on the website before being included in a regular issue of the journal. This cuts down the time between their acceptance and the publication. The journal is indexed in many databases, though not in PubMed. The editorial board should now take steps to index the journal in PubMed. The journal has a system of notifying readers through e-mail when a new issue is released. Also, the articles are available in both the HTML and the PDF formats. I especially like the new and colorful page format of the journal. Also, the access statistics of the articles are available. The prepublication and the manuscript tracking system are also helpful for the authors.
Areas for improvement: In certain cases, I felt that the peer review process of the manuscripts was not up to international standards and that it should be strengthened. Also, the number of manuscripts in an issue is high and it may be difficult for readers to go through all of them. The journal can consider tightening of the peer review process and increasing the quality standards for the acceptance of the manuscripts. I faced occasional problems with the online manuscript submission (Pre-publishing) system, which have to be addressed.
Overall, the publishing process with JCDR has been smooth, quick and relatively hassle free and I can recommend other authors to consider the journal as an outlet for their work."



Dr. P. Ravi Shankar
KIST Medical College, P.O. Box 14142, Kathmandu, Nepal.
E-mail: ravi.dr.shankar@gmail.com
On April 2011
Anuradha

Dear team JCDR, I would like to thank you for the very professional and polite service provided by everyone at JCDR. While i have been in the field of writing and editing for sometime, this has been my first attempt in publishing a scientific paper.Thank you for hand-holding me through the process.


Dr. Anuradha
E-mail: anuradha2nittur@gmail.com
On Jan 2020

Important Notice

Original article / research
Year : 2022 | Month : October | Volume : 16 | Issue : 10 | Page : FC01 - FC05 Full Version

Effectiveness of Prophylactic Drugs for COVID-19 among Healthcare Professionals- A Cross-sectional Observational Study


Published: October 1, 2022 | DOI: https://doi.org/10.7860/JCDR/2022/55564.16949
Namrata Krishna Jaiswal, Veena Rani Vemuri

1. Student, Department of Pharmacology, Terna Medical College, Nerul, Navi Mumbai, Maharashtra, India. 2. Associate Professor, Department of Pharmacology, Terna Medical College, Nerul, Navi Mumbai, Maharashtra, India.

Correspondence Address :
Dr. Namrata Krishna Jaiswal,
3/301, Vidyut Nagar, Masoli, Dahanu, Maharashtra, India.
E-mail: namratajaiswal0113@gmail.com

Abstract

Introduction: The risk of Coronavirus Disease 2019 (COVID-19) infections among healthcare workers are far greater than those in the general population. A number of prophylactic drugs were being studied during this time for use by the Healthcare Professionals (HCP) who were the first contacts of an infested patient, more so than the general population

Aim: To evaluate the drugs used for pre-exposure prophylaxis for COVID-19 and their efficacy and safety among healthcare workers.

Materials and Methods: A cross-sectional survey was conducted among two hundred and thirty seven healthcare professionals after taking requisite permission from the Institutional Ethics Committee (IHC). A prevalidated survey questionnaire containing 21 questions and an inbuilt consent form was prepared using the Google form. The responses were presented using descriptive statistics of frequency and percentage.

Results: Out of total, 112 (47.26%) participants were on a pre-exposure prophylactic drug, while 125 (52.74%) had not taken any prophylaxis. A total of 19 (16.96%) had used alternative medicine (Ayurveda and Homeopathy). Participants who had taken pre-exposure prophylaxis of modern medicine (n=93), 56 (60.21%) had received Hydroxychloroquine (HCQ) alone or with another drug, and in total 27 (81.8%) had tested negative for COVID-19 infection while on HCQ. Ivermectin which seems to be the other drug which was preferred was taken by 16 participants, three were tested for COVID-19 and two were positive. Only four participants had reported experiencing an adverse drug reaction. Three of them experienced acidity, while on HCQ and one experienced headache, while on ivermectin.

Conclusion: HCQ given in the dose as recommended by Indian Council of Medical Research (ICMR) had significantly reduced the number of infections among HCP.

Keywords

Coronavirus disease 2019, Healthcare workers, Hydroxychloroquine, Pre-exposure prophylaxis

The first human case of COVID-19, caused by the novel coronavirus, subsequently named Severe Acute Respiratory Syndrome (SARS-CoV-2), was first reported by officials in Wuhan City, China, in December 2019 (1). Coronavirus disease-2019 (COVID-19), was declared as a pandemic by the World Health Organisation (WHO) on March 11, 2020 (2). More than 204 million people have been infected by the coronavirus whereas more than 2 million people have lost their lives (3). COVID-19 has exposed health workers and their families to unprecedented levels of risk. Healthcare workers (HCWs) play an essential role, providing care for patients. In the context of COVID-19 and during routine health services, they provide critical care to patients and ensure that infection prevention and control (IPC) measures are implemented and adhered to, in healthcare facilities to limit healthcare-associated infections (4). The vaccines against COVID-19 have become available but their efficacy and safety was an open question (5). No definitive treatment was available at that time and the only way to combat this disease was prevention. WHO had issued interim guidance on 19 March 2020 recommending the use of contact and droplet precautions by HCWs caring for patients with COVID-19. WHO encouraged the use of fabric face masks in public places where there is community transmission (6) and where other prevention measures, such as physical distancing, was not possible (7). Fabric masks, if made and worn properly, can serve as a barrier to droplets expelled from the wearer into the air and environment (7).

Study had shown that coronaviridae infect their target cells by an endocytic pathway. This pathway can be inhibited by chloroquine by reducing their replication. The inhaled virus SARS-CoV-2 likely binds to nasal cavity epithelial cells and replicates here. ACE2 is the main receptor for SARS-CoV-2 as well as SARS-CoV. The virus propagates and migrates down the respiratory tract along the conducting airways, and a final innate immune response is triggered (8).

The authors in a study had given evidence that chloroquine is effective in preventing SARS-CoV-2 infection in cell culture if the drug is added to the cells 24 hour prior to infection. Chloroquine blocks virus infection by increasing endosomal pH required for virus and cell fusion. It also interferes with the glycosylation of cellular receptors of SARS-CoV-2. In addition to this, chloroquine was significantly effective even when the drug was added 3-5 hour after infection. This suggested an antiviral effect even after the establishment of infection and therefore a possible prophylactic and therapeutic use (9). Studies also suggested that chloroquine/hydroxychloroquine can impair the replication of several viruses other than SARS-CoV-2 by interacting with the endosome-mediated viral entry or by inhibiting the late stages of replication of enveloped viruses (10),(11).

It was noted that the clinical worsening of individuals with SARS in week two is related to immunopathological damage and not due to uncontrolled SARS coronavirus replication (11). Chloroquine/hydroxychloroquine was shown to accumulate in lymphocytes and macrophages resulting in anti-inflammatory properties, and therefore its use in rheumatoid arthritis, lupus erythematosus, and sarcoidosis. An overproduction of tumour necrosis factor α (TNFα) by the alveolar macrophages is the main character of sarcoidosis. Chloroquine (CQ)/hydroxychloroquine (HCQ) reduces the secretion of the proinflammatory cytokines and in particular TNFα, as shown in a murine macrophage cell line seen in a study (11).

Along with Chloroquine, there were other drugs which were also considered for prophylaxis, among these azithromycin, a macrolide antibiotic, Ivermectin an Anthelminthic were found to be likely candidates. Azithromycin is used to treat a very wide range of bacterial and mycobacterial infections of respiratory tract and also skin infections. It had also shown to have antiviral and anti-inflammatory properties. It has been used as a treatment in previous coronavirus diseases during the epidemics of Severe Acute Respiratory Syndrome (SARS) in 2003 and Middle East Respiratory Syndrome (MERS) in 2012. It was also investigated as a potential candidate treatment for viruses including SARS-CoV-2 (12). Azithromycin was found to reduce Rhino Virus replication and release during in-vitro infection of Primary Human Bronchial Epithelial Cells (PBEC) (13). Azithromycin has also been shown to be active in-vitro against Zika virus (14). Azithromycin and other macrolides also have a number of immuno-modulatory properties and have proven clinical efficacy in a broad range of respiratory diseases including asthma, Chronic Obstructive Pulmonary Disease (COPD), and Diffuse Pan Bronchiolitis (DPB) (15).

However, a retrospective cohort analysis conducted in 2018, of 349 patients across 14 sites in Saudi Arabia found no significant reduction in 90-day mortality or improvement in MERS-CoV RNA clearance with macrolide use (16).

A study done in 2020, using two candidate molecules, hydroxychloroquine and azithromycin, suggested a synergistic inhibition of SARS-CoV-2 replication in vero cells at 5 and 10 μM concentrations, respectively (17). An approach that this synergy would allow effective use of hydroxychloroquine at less toxic concentrations was tried in a small observational study conducted. It was done to show that these drugs were efficient in clearing viral nasopharyngeal carriage of SARS-CoV-2 in COVID-19 patients in only three to six days (18). However, there were concerns that combination therapy may enhance cardiovascular side effects as both drugs individually can cause prolongation of the QT interval (19).

In favour of Ivermectin, a meta-analysis of 15 trials found that Ivermectin reduces the risk of death compared with no ivermectin (20).

In patients with suspected COVID-19 in UK, who were at high risk of adverse outcomes, treatment with doxycycline was not associated with clinically meaningful reductions in time to recovery or hospital admissions or deaths related to COVID-19, and should not be used as a routine treatment for COVID-19 (21).

A retrospective case-control analysis at ICMR had also found that there is a significant dose-response relationship between the number of prophylactic doses taken and frequency of occurrence of SARS-CoV-2 infection in symptomatic healthcare workers who were tested for SARS-CoV-2 infection (22).

Indian Council of Medical Research, therefore recommended the use of HCQ in all asymptomatic healthcare workers involved in containment and treatment of COVID-19 and asymptomatic healthcare workers working in non COVID-19 hospitals/non COVID-19 areas of COVID-19 hospitals/blocks as well as amongst the asymptomatic frontline workers, such as surveillance workers who were deployed in containment zones and paramilitary/police personnel involved in COVID-19 related activities. Dosage recommended was 400 mg twice a day on day 1, followed by 400 mg once weekly for next seven weeks which was to be taken with meals. The experts at ICMR further recommended for its use beyond eight weeks on weekly dosage with strict monitoring of clinical and Elecrocardiogram (ECG) parameters under supervision. Further, for reducing any adverse effects ICMR had recommended that an ECG (with estimation of QT interval) to be done before prescribing HCQ prophylaxis, an ECG in case any new cardiovascular symptoms occurs (e.g palpitations, chest pain syncope) during the course of prophylaxis, an ECG (with estimation of QT interval) in those who are already on HCQ prophylaxis before continuing it beyond eight weeks. Atleast one ECG should be done anytime during the course of prophylaxis. Along with hydroxychloroquine, healthcare workers and other frontline workers on HCQ were also advised to use Personal Protective Equipmemt (PPE) in accordance with the guidelines issued by the Ministry of Health and Family welfare (22).

This study was therefore done, to understand the pattern of prophylactic drug usage, preference of the drug and effectiveness of drugs used for COVID-19 for prevention among HP.

Material and Methods

The present cross-sectional observational study was conducted in February 2021, after taking a proper informed consent, among healthcare professionals which included doctors, nurses, and interns, after requisite approvals from the Institutional Ethics Committee (Approval number–TMCHRC/IEC/003).

Inclusion criteria: HCWs including doctors, nurses, interns working in direct or indirect contact with COVID-19 infected patients.

Exclusion criteria: Janitors, pregnant staff working in direct or indirect contact with COVID-19 infected patients Incompletely filled forms.

Study Procedure

A survey questionnaire in English was developed after literature review and discussion with healthcare workers, regarding the drugs which were being used for prophylaxis. The developed questionnaire was evaluated by experts from different disciplines for content validation. It was divided into four parts:

1) Questions regarding the Sociodemographic details of the participants consisting of age, gender, place of residence and Institute/hospital, designation, whether the hospital was a tertiary care hospital or a private hospital, whether it was a dedicated COVID-19 hospital or not.
2) This part was regarding the prophylactic drugs being taken by them. These were open ended questions, where they were expected to fill out the details of the name, dose and duration of drugs. Since they were medical professionals there was a likelihood that they were taking the drugs after doing their own research or getting them from institutes which were following ICMR guidelines. Hence, the question whether the drugs were prescribed by ICMR or by the Institute or by self was added.
3) Had questions whether they experienced any adverse drug reactions.
4) In the questions regarding COVID-19 testing, whether they tested positive or negative during the period they were on the prophylactic drug was asked, along with this whether they were taking any alternative medicine (Ayuveda/Homeopathy) for prophylaxis, as these were also rampantly used. There was an open ended question to share any other information which was relevant to the present study.

The confidentiality of the participants was maintained. The questionnaire was distributed through Gmail, WhatsApp, and Instagram as a Google form with the informed consent being the compulsory part to be answered. The time required to complete the Google form was estimated to be 4-5 minutes.

Statistical Analysis

The data collected was tabulated in an Excel sheet and the responses were presented using descriptive statistics of frequency and percentage.

Results

A total of 237 participants completed the survey. Of these 90 (37.97%) were females and 147 (62.02%) were males. As depicted in (Table/Fig 1), 76 (32.07%) participants were of the age group 41-50 years and 57 (24.05%) were between the age groups of 31-40 years. The eldest was 75 years old and the youngest was 22 years old.

(Table/Fig 2) shows the region of the participants, 209 (88.19%) participants were from Mumbai and Navi Mumbai regions. Most of our participants 201 (71.44%) were practicing doctors. About 146 (61.60%) of study participants worked in primary care clinics while 91 (38.39%) were providing service in tertiary care hospitals.

As shown in (Table/Fig 3), 135 (56.96%) were practicing in a private clinic. Out of the 237 participants, 170 (71.73%) of the participants were involved in providing direct or indirect care to the COVID-19 patients and 67 (28.27%) were not seeing COVID-19 patients on a regular basis. Of the participants, who were providing care to COVID-19 patients, 50 (29.41%) participants had provided for a period of six months, whereas 36 (21.18%) had provided for more than six months as shown in (Table/Fig 4).

In total, there were 53 (22.36%) participants with co-morbidity as shown in (Table/Fig 5), of these the most common co-morbidity was hypertension with 19 (35.85%) participants and 13 (24.53%) participants had diabetes mellitus. Information regarding the drugs used by the participants with co-morbidities is shown in (Table/Fig 6). Some other drugs like steroids, bronchodilators and anti-platelet drugs were also used, but their names were not mentioned. Also the dose of the drugs were not mentioned by the participants.

Among the participants, 112 (47.26%) had taken the pre-exposure prophylactic drug while 125 (52.74%) had not taken any prophylaxis. Among them 80 (71.43%) were taking the drug following the ICMR guidelines, 49 (43.75%) of these participants were directly following guidelines issued by ICMR, 14 (12.5%) received the prophylactic drug distributed by the hospital, and 17 (15.17%) consulted some doctor. Thirty two (28.57%) self-prescribed the drug following online research.

Among the 112 participants who had taken pre-exposure prophylaxis for COVID-19, 19 (16.96%) had used alternative medicine (Ayurveda and Homeopathy). Of the participants who had taken modern medicine (n=93), in total 56 (60.21%) had taken hydroxychloroquine in the dose of 400 mg twice a day on Day 1, followed by 400 mg once weekly for next seven weeks. Out of these, 52 (92.85%) participants had taken it alone and 3 (5.35%) responders had taken it in combination with Ivermectin (12 mg once a week) and 1 (1.78%) had taken it with azithromycin (500 mg once daily, duration not specified). Of these only three participants had said they experienced an adverse drug reaction that too only acidity and 2 among them had taken antacid for the ADR. Ten (10.75%) participants had taken ivermectin (12 mg once weekly or Ivermectin 12 mg twice a day for four days) either alone, or in combination with multivitamins (once a day), 5 (50%). Among the people who had taken ivermectin, one participant had experienced an adverse drug reaction, headache and had taken paracetamol for the same.

Seventeen (18.27%) participants said they had taken multivitamin once daily. Ten (10.75%) participants had taken azithromycin either alone, or along with other drugs like ivermectin, 3 (30%), doxycycline 1 (10%) and favipiravir 1 (10%), of these three underwent test for COVID-19 and two were positive. Most of the participants had mentioned that they had taken vitamin C, vitamin D3 and zinc along with multivitamins. They had not specified the dose of these drugs. One participant had taken favipiravir (dose not specified) along with azithromycin and one had taken it alone. One participant had taken oseltamivir 75 mg twice a day for seven days.

As shown in (Table/Fig 7), of the 112 participants who had taken the pre-exposure prophylaxis, 56 (50%) had undergone a test for COVID-19, and among them 22 (39.29%) were tested positive. Out of the 125 participants who had not taken any prophylaxis, 43 got tested for COVID-19 during their work, and 20 (46.51%) were positive for SARS-CoV-2.

As seen in (Table/Fig 8), 52 participants were taking hydroxychloroquine which was the most common prophylactic drug consumed and among these participants, 33 (63.46%) got tested for COVID-19 and 27 (81.81%) were tested negative. Among the participants, who were taking ivermectin only one got tested and that person tested positive.

Discussion

Throughout the pandemic, it was seen that the previously done research by using already available drugs in the market to inhibit the virus was the first step. Most of these drugs were found to have action in-vitro, but whether this will be same in-vivo, was the question that needed to be answered.

In a study conducted by Chatterjee P et al., in 2020, they found benefits of HCQ prophylaxis in SARS-CoV-2 infection (COVID-19). It was also mentioned that simply taking HCQ prophylaxis did not reduce the number of SARS-CoV-2 infections among healthcare workers, but after the intake of four or more maintenance doses of HCQ, the protective effect was observed. The authors mentioned that in the adjusted multivariate model, a significant reduction (>80%) in the odds of SARS-CoV-2 infection in the HCWs was seen with the intake of six or more doses of HCQ prophylaxis (23). Another study conducted by Bhattacharya R et al., demonstrated that consumption of HCQ as prophylaxis among high risk individuals was associated with a significantly reduced risk of testing positive for COVID-19 (24). This was reflected in the survey done by the authors, HCQ was the major drug which was recommended and preferred by HCP. HCQ according to this paper is significantly associated with reduction in the number of positive cases (27 out of 33, 81.81%) as compared to the 43 participants out of 125, who were not taking any prophylactic drug and who underwent COVID-19 test, 23 (53.49%) were negative.

Along with potential antiviral property, HCQ is also known to have anti-inflammatory properties, together with the low cost of therapy and excellent oral bioavailability, high tissue concentrations in the lungs relative to the plasma levels and acceptable safety profile (25) make this, a drug which can be studied further for use in pandemic situations, as it requires large quantities of drug distribution.

A study done in September to October 2020 in Bhubaneshwar, the participants were selected depending on their intake of ivermectin and/or hydroxychloroquine and/or vitamin-C and/or other prophylaxis for COVID-19.They concluded that two-dose ivermectin prophylaxis at a dose of 300 μg/kg with a gap of 72 hours was associated with a 73% reduction of SARS-CoV-2 infection among healthcare workers for the following month (26). In the present study 16 participants only, in total, had taken ivermectin in the dose of 12 mg weekly alone or with other drugs, and three were tested for COVID-19 and two were positive. Ivermectin in the present study was over shadowed by HCQ which seems to be the preferred drug for prophylaxis.

Although chloroquine/hydroxychloroquine were the main recommended drugs for prophylaxis, and others like azithromycin, doxycycline and ivermectin were at that time used for treatment of mild and moderate COVID-19 disease. The participants receiving alternative therapy (Ayurveda and Homeopathy) were not included, while calculating the efficacy or safety of the drugs, as the authors do not have the required expertise in these fields.

Limitation(s)

This study had a drawback, as the preference for prophylactic drugs changes regionwise. Secondly, the population studied in this study was more of interns and residents which does not reflect the entire population of HCW.

Conclusion

HCQ given in the dose as recommended by ICMR had significantly reduced the number of infections among healthcare professionals. Ivermectin, also another promising candidate for prophylaxis requires more study as in present case, the sample was small to conclude in its favour. However, being antibiotics of relevance it is always necessary to keep in mind that there are chances of development of drug resistance.

Acknowledgement

The authors would like to thank all the HCP who had willingly participated in the study and are overwhelmed by the way they had passed on the Google form among their known professional colleagues.

Authors contribution: Namrata Jaiswal-Conceptualisation, data collection, statistical analysis, methodology, resources, writing – original draft, review and editing. Veena Rani Vemuri-Conceptualisation, data collection, statistical analysis, methodology, resources, writing – original draft, review and editing.

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DOI and Others

DOI: 10.7860/JCDR/2022/55564.16949

Date of Submission: Feb 14, 2022
Date of Peer Review: Mar 16, 2022
Date of Acceptance: Jun 23, 2022
Date of Publishing: Oct 01, 2022

AUTHOR DECLARATION:
• Financial or Other Competing Interests: None
• Was Ethics Committee Approval obtained for this study? Yes
• Was informed consent obtained from the subjects involved in the study? Yes
• For any images presented appropriate consent has been obtained from the subjects. Yes

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