Predictors of acceptance and willingness to pay for the COVID-19 vaccine in the general public of India: A health belief model approach

Objective:To determine the predictors of acceptance and willingness to pay(WTP)for the COVID-19 vaccine among the Indian public and to provide insights for future demand forecasts and pricing considerations.Methods:A nationwide,web-based,self-administered,crosssectional survey was conducted from 5 to 20 October 2020.The health belief model(HBM)approach was used as a theoretical framework to assess the predictors of acceptance of and WTP for the COVID-19 vaccine.Results:Of 2480 respondents,2451 completed the online survey,yielding a response rate of 98.8%.Participants who participated in the survey had diverse demographics in terms of their location,educational level,occupation type,and family income.Among 2451 respondents,the majority(89.3%)intended to receive the COVID-19 vaccine.Respondents with high perceived benefits of COVID-19 vaccination,such as reduction in worry(OR 5.87;95%CI 4.39-7.96)and sickness(OR 4.31;95%CI 3.31-5.62),showed higher intention to receive the vaccine.However,respondents with a high perception of the side effects and barriers to vaccination(OR 0.36;95%CI 0.25-0.54)and vaccine shortage(OR 0.58;95%CI 0.41-0.81)showed lower intention to receive the vaccine.The majority(2162,88.21%)of respondents were willing to pay an amount of INR:500-1000 or USD:6.81-13.62 for a dose of COVID-19 vaccine,with a median(Q1,Q3)of INR:500(500,1000)or USD:6.81(6.81,13.62).The higher marginal WTP for the COVID-19 vaccine was influenced by advanced age,marital status,female sex,intermediate educational background,high family income,fair or poor perceived health status,and no affordable barriers.Conclusions:The majority of respondents intended to receive the COVID-19 vaccine.Healthcare interventions focusing on HBM constructs and demographic predictors associated with low intention to receive the vaccine can be effective in enhancing the coverage of the COVID-19 vaccine.The findings of this study provide guidance for the future price considerations of the COVID-19 vaccine.     

The N-terminal conserved domain of rubella virus capsid interacts with the C-terminal region of cellular p32 and overexpression of p32 enhances the viral infectivity

Cellular 'defense collagens' are produced to launch virus-specific responses to clear the invading viruses. Cellular p32, the C1q binding protein is one such protein. In this report, we identified the interaction of p32 derived from a human lung diploid cell line (WI-38) with rubella virus capsid (RVCP from Therien strain) N-terminal 28-amino acid domain, which is conserved among several RV strains including the vaccine strains. We further identified that the C-terminal 69 aa of the mature p32 is sufficient to interact with the CP. In addition, we observed that in three independent Vero 76-derived cell lines constitutively overexpressing p32, the RV infectivity was enhanced. Our results suggest that RV has evolved a strategy whereby one of its proteins is recruited to interact with, and exploit the cellular defense machinery to its advantage.     

Case-based discussion: an unusual manifestation of diaphragmatic hernia mimicking pneumothorax in an adult male

Diaphragmatic hernia is an important cause of emergency hospital admission associated with significant morbidity. It usually results from congenital defect or rupture in the diaphragm due to trauma. Prompt and appropriate diagnosis is necessary in patients with this condition, as surgical intervention by either abdominal or thoracic approach may be necessary. Here, we report a case of left-sided diaphragmatic hernia presenting with sudden onset of breathlessness, respiratory distress and left-sided chest pain radiating to the abdomen, mimicking pneumothorax, treated successfully with surgical intervention.     

Liver abscess secondary to a broken needle migration- A case report

Background  

Perforation of gut by sharp metallic objects is rare and rarer still is their migration to sites like liver. The symptoms may be non-specific and the discovery of foreign body may come as a radiological surprise to the unsuspecting clinician since the history of ingestion is difficult to obtain.     

Early tracheostomy in closed head injuries: experience at a tertiary center in a developing country – a prospective study

Background

An important factor contributing to the high mortality in patients with severe head trauma is cerebral hypoxia. The mechanical ventilation helps both by reduction in the intracranial pressure and hypoxia. Ventilatory support is also required in these patients because of patient's inability to protect the airway, persistence of excessive secretions, and inadequacy of spontaneous ventilation. Prolonged endotracheal intubation is however associated with trauma to the larynx, trachea, and patient discomfort in addition to requirement of sedatives. Tracheostomy has been found to play an integral role in the airway management of such patients, but its timing remains subject to considerable practice variation. In a developing country like India where the intensive care facilities are scarce and rarely available, these critical patients have to be managed in high dependency cubicles in the ward, often with inadequately trained nursing staff and equipment to monitor them. An early tracheostomy in the selected group of patients based on Glasgow Coma Score(GCS) may prove to be life saving.Against this background a prospective study was contemplated to assess the role of early tracheostomy in patients with isolated closed head injury.

Methods

The series consisted of a cohort of 50 patients admitted to the surgical emergency with isolated closed head injury, that were not considered for surgery by the neuro-surgeon or shifted to ICU, but had GCS score of less than 8 and SAPS II score of more than 50. First 50 case records from January 2001 that fulfilled the criteria constituted the control group. The patients were managed as per ATLS protocol and intubated if required at any time before decision to perform tracheostomy was taken. These patients were serially assessed for GCS (worst score of the day as calculated by senior surgical resident) and SAPS scores till day 15 to chart any changes in their status of head injuries and predictive mortality. Those patients who continued to have a GCS score of <8 and SAPS score of >50 for more than 24 hours (to rule out concussion or recovery) underwent tracheostomy. All these patients were finally assessed for mortality rate and hospital stay, the statistical analysis was carried out using SPSS10 version. The final outcome (in terms of mortality) was analyzed utilizing chi-square test and p value <0.05 was considered significant.

Results

At admission both tracheostomy and non-tracheostomy groups were matched with respect to GCS score and SAPS score. The average day of tracheostomy was 2.18 ± 1.0038 days. The GCS scores on days 1, 2, 3, 4, 5, 10 between tracheostomy and non-tracheostomized group were comparable. However the difference in the GCS scores was statistically significant on day 15 being higher in the tracheostomy group.Thus early tracheostomy was observed to improve the mortality rate significantly in patients with isolated closed head injury

Conclusion

It may be concluded that early tracheostomy is beneficial in patients with isolated closed head injury which is severe enough to affect systemic physiological parameters, in terms of decreased mortality and intubation associated complications in centers where ICU care is not readily available. Also, in a selected group of patients, early tracheostomy may do away with the need for prolonged mechanical ventilation.     

Gastric outlet obstruction and cutaneous metastasis in adenocarcinoid tumor of stomach - unusual presentations with cytologic and ultra structural findings

Neuroendocrine tumors, including carcinoids account for less than 1% of gastric tumors. Various subtypes of gastric carcinoids have been reported earlier. The present case deals with two unusual presentations, diagnosis and course of a gastric neuroendocrine tumor in an adult patient. A 35-years-old male initially presented with gastric outlet obstruction for an antral growth in the emergency ward. He underwent radical gastrectomy and was diagnosed with a gastric carcinoid tumor, on histopathology. After 6 months, he developed hepatic along with nodular cutaneous lesions over the scalp. Aspiration cytology (FNAC) from these metastatic lesions showed two distinct cell types with rosette formation. Ultrastructural findings showed neurosecretory granules in some cells. Subsequently, he underwent 2 cycles of chemotherapy. After a total duration of 9 months, he finally succumbed to the disease. We present a case of a gastric adenocarcinoid tumor, with 2 rare presentations. The metastatic lesions exhibited neuroendocrine features on cytology and electron microscopy.