Indian Journal of Medical Research
Permanent URI for this collection
Browse
Recent Submissions
Item Clinical outcomes of rhabdomyolysis & validation of McMahon Score for risk prediction(Wolters Kluwer – Medknow, 2024-01) Mathew, Manju; Pillai, Subhash Chandran BhaskaranBackground & objectives: Rhabdomyolysis in tropics has a unique aetiology and clinical profile. The objective of this study was to determine the aetiology and clinical outcomes of rhabdomyolysis and validate the McMahon risk prediction score in affected individuals from south India. Methods: A retrospective study of affected individuals with rhabdomyolysis admitted to a tertiary care hospital in south India, between January 2015 and June 2020, was undertaken. In-patients who were ?15 yr in age and had creatinine phosphokinase ?5000 U/l were included in the study. Cardiac, stroke, chronic muscular diseases and chronic kidney disease on maintenance haemodialysis were excluded. The incidence of acute kidney injury (AKI) in this group was calculated. Other clinical outcomes determined were 28-day mortality, proportion of individuals who required renal replacement therapy (RRT), intensive care unit (ICU) admission, vasopressors, mechanical ventilation (MV), number of days on mechanical ventilator and length of stay in ICU and hospital. Validation of McMahon risk prediction score for the requirement of RRT and mortality was performed. Results: Major aetiologies identified in the 75 study participants included were infections, trauma and seizures. Twenty eight-day mortality was 24 per cent (n=18). AKI incidence was 68 per cent, out of which 43.1 per cent had RRT. AKI in all survivors became dialysis independent. Vasopressors, MV and ICU requirement were 30.7, 32 and 77.3 per cent, respectively. Receiver operator characteristic curve for RRT and mortality risk prediction based on the McMahon Score showed a sensitivity of 71.4 per cent and specificity of 77.8 per cent for a cut-off ?7.8. Interpretation & conclusions: Rhabdomyolysis in tropics is associated with significant organ dysfunction and mortality. Although the incidence of AKI and RRT is high, the overall renal outcome is good among survivors. The wide confidence intervals for the area under curve for McMahon Score limit its predictability for RRT and mortality.Item Correlation of severity & clinical outcomes of COVID-19 with virus variants: A prospective, multicentre hospital network study(Wolters Kluwer – Medknow, 2024-01) Wadhwa, Komal; Malik, Shilpa; Balaji, Srinigila; Thiruvengadam, Ramachandran; Bashyam, Murali Dharan; Bhattacharya, Prasanta Kumar; Behera, Bijayini; Bhardwaj, Pankaj; Biswas, Nidhan K.; Das, Asim; Dey, Anindya; Dhotre, Dhiraj; Dias, Mary; Dubey, Pankaj; Dutta, Shreelekha; Gadepalli, Ravisekhar; Gosain, Mudita; Goud, Kalal Iravaty; Gupta, Neeraj Kumar; Gupta, Nitesh; Jana, Pradipta; Jena, Deepak; John, Elizabeth; Karunanidhi, Arunkumar; Khan, S. Muhammad Salim; Khattar, Sahil; Paul, Abhilash Prabhakar Kundavaram; Kumar, Shakti; Maitra, Arindam; Modi, Nikhil; Moorthy, Mahesh; Nagaraj, Savitha; Palakodeti, Dasaradhi; Pandey, Anil Kumar; Pandey, Aparna; Raghav, Sunil Kumar; Ramasubban, Suresh; Raghavan, Sreevatsan; Harikrishnan, S.; Krishnamoorthy, S.; Selvamurugan, Selvaraj; Sardana, Raman; Shouche, Yogesh; Singh, Akanksha; Singh, Arvind Kumar; Ramasubramaniyan, V.; Yadav, Monika; Zahoor, Danish; Narreddy, Suneetha; Bhatnagar, Shinjini; Wadhwa, Nitya; Das, Bhabatosh; Garg, Pramod KumarBackground & objectives: The clinical course of COVID-19 and its prognosis are influenced by both viral and host factors. The objectives of this study were to develop a nationwide platform to investigate the molecular epidemiology of SARS-CoV-2 (Severe acute respiratory syndrome Corona virus 2) and correlate the severity and clinical outcomes of COVID-19 with virus variants. Methods: A nationwide, longitudinal, prospective cohort study was conducted from September 2021 to December 2022 at 14 hospitals across the country that were linked to a viral sequencing laboratory under the Indian SARS-CoV-2 Genomics Consortium. All participants (18 yr and above) who attended the hospital with a suspicion of SARS-CoV-2 infection and tested positive by the reverse transcription–PCR method were included. The participant population consisted of both hospitalized as well as outpatients. Their clinical course and outcomes were studied prospectively. Nasopharyngeal samples collected were subjected to whole genome sequencing to detect SARS-CoV-2 variants. Results: Of the 4972 participants enrolled, 3397 provided samples for viral sequencing and 2723 samples were successfully sequenced. From this, the evolution of virus variants of concern including Omicron subvariants which emerged over time was observed and the same reported here. The mean age of the study participants was 41 yr and overall 49.3 per cent were female. The common symptoms were fever and cough and 32.5 per cent had comorbidities. Infection with the Delta variant evidently increased the risk of severe COVID-19 (adjusted odds ratio: 2.53, 95% confidence interval: 1.52, 4.2), while Omicron was milder independent of vaccination status. The independent risk factors for mortality were age >65 yr, presence of comorbidities and no vaccination. Interpretation & conclusions: The authors believe that this is a first-of-its-kind study in the country that provides real-time data of virus evolution from a pan-India network of hospitals closely linked to the genome sequencing laboratories. The severity of COVID-19 could be correlated with virus variants with Omicron being the milder variant.Item Survey of the present health & nutritional status of Shompen tribe of Great Nicobar Island(Wolters Kluwer – Medknow, 2024-01) Vijayachari, Paluru; Awaradi, S.; Siddaraju, H. M.; Nithin, K.; Veerendra, S.S.; Babu, U. Suresh; Chander, M. Punnam; Kartick, C.; Anwesh, M.; Sugunan, A. P.Background & objectives: Shompens are one of the two mongoloid tribes of Nicobar district. There is little information about their recent health status since the last survey which was conducted in 1998. Hence, a comprehensive health and nutritional survey was conducted in March 2017 to assess the changes. The survey was carried out by a joint team of various organizations including the ICMR-Regional Medical Research Centre and Tribal Welfare and Health Department both located in Port Blair. Methods: A detailed health and nutrition survey of the Shompen community was planned by deputing a field research team. The survey included demographic data, anthropometric data, clinical examination, screening for the markers of infectious diseases, respiratory pathogens, tuberculosis and haemoglobinopathies. Results: About half of the Shompen adults (both males and females) had a body mass index (BMI) of ?23. However, Shompen children had a good nutritional status with no child suffering from undernutrition. As per BMI for age, none of the children <5 yr were under-nourished, while in the 5-17 yr group, 12 per cent of children were undernourished. Anaemia prevalence was about 48.3 per cent, with 54 per cent prevalence in females and 43.8 per cent in males. Fungal infection of the skin, acute respiratory infection and abdominal pain were the common morbidities observed. None had active pulmonary tuberculosis. Of 38 Shompens screened for IgG (immunoglobulin G) antibodies, 42.1 and 18.4 per cent were positive for measles and rubella, respectively. Seroprevalence of Leptospira was 35.5 per cent. The prevalence of hypertension was 13.2 per cent, whereas another 28.9 per cent were pre-hypertensive. Interpretation & conclusions: The population structure of the Shompen is not skewed and under nutrition was not widely prevalent among the children of <5 yr. The other positive observations were the absence of malaria, filariasis and dengue. However, there was natural infection of measles and rubella. Fungal skin infection and intestinal parasitic infestations were widely prevalent. Although cardiovascular risk profile was low, there were signs of emerging risk of over-weight, hypertension and dyslipidaemia. These together with the high prevalence of smokeless tobacco use may have a serious effect on the cardiovascular disease susceptibility of the Shompen population in the future.Item Evaluation of molecular diagnostic test for detection of adult pulmonary tuberculosis: A generic protocol(Wolters Kluwer – Medknow, 2024-02) Jayaprakasam, Madhumathi; Pandey, Ravindra Mohan; Choudhary, Hansraj; Shanmugam, Sivakumar; Sivaramakrishnan, Gomathi N.; Gupta, NiveditaBackground & objectives: Tuberculosis (TB) continues to be the second most-leading cause of death due to a single infectious agent as of 2022 after COVID-19. Many affordable new molecular diagnostic tools are being developed for early and more accurate diagnosis, especially for low-resource settings in low- and middle-income countries. In this context, there is a need to develop a standardized protocol for validation of new diagnostic tools. Here, we describe a generic protocol for multi-centric clinical evaluation of molecular diagnostic tests for adult pulmonary TB. Methods: This protocol describes a cross-sectional study in TB reference laboratories in India. Adults (>18 yr) visitng the chest clinics or outpatient departments with symptoms of TB need to be enrolled consecutively till the required sample size of 150 culture positives and 470 culture negatives are met. Mycobacterium tuberculosis (Mtb) culture (mycobacteria growth indicator tube liquid culture) to be used under this protocol as the gold standard and Xpert MTB/RIF molecular test will be used as the comparator. The sputum samples will be tested by smear microscopy, Mtb culture, Xpert MTB/RIF and index molecular test as per the proposed algorithm. The specificity sensitivity, and positive/ negative predictive values are to be calculated for the index test with reference to the gold standard. Discussion: TB diagnosis poses many challenges as it differs with type of disease, age group, clinical settings and type of diagnostic tests/kits used. Globally, different protocols are used by several investigators. This protocol provides standard methods for the validation of molecular tests for diagnosis of adult pulmonary TB, which can be adopted by investigators.Item Clinical effectiveness of ferric carboxymaltose (iv) versus iron sucrose (iv) in treatment of iron deficiency anaemia in pregnancy: A systematic review and meta-analysis(Wolters Kluwer – Medknow, 2024-01) Srimathi, G.; Revathy, R.; Bagepally, Bhavani Shankara; Joshi, BeenaBackground & objectives: Iron deficiency anaemia (IDA) during pregnancy is treated with oral and parenteral iron. The objective of this review was to compare the clinical effectiveness, safety, pregnancy and neonatal outcomes of intravenous (iv) ferric carboxymaltose (FCM) and iv iron sucrose (IS) in treating IDA in pregnancy. Methods: The Department of Health Research funded this study. PubMed, Cochrane Library, EMBASE and Scopus were searched to include studies published till November 2022. The protocol was registered in PROSPERO (CRD42022306092). Pregnant women (15-49 yr) in second and third trimesters, diagnosed with moderate-to-severe iron deficiency anaemia, treated with either of the drugs were included. The included studies were critically assessed using appropriate tools. We conducted a qualitative synthesis of the studies and meta-analysis for improvement in haematological parameters and incidence of adverse events. Results: A total of 18 studies were included. The risk of bias was low to moderate. A rise in haemoglobin up to four weeks was higher with FCM than IS by 0.57 (0.24, 0.9) g/dl. Intravenous FCM is associated with fewer adverse events than IS [pooled odds ratio: 0.5 (0.32, 0.79)]. The included studies had limited evidence on pregnancy and neonatal outcomes after iv iron treatment. Interpretation & conclusions: Intravenous FCM is effective and safer than intravenous IS in terms of haematological parameters, in treating IDA in pregnancy. Further research is required on the effects of iv FCM and iv IS on the pregnancy and neonatal outcomes when used for treating IDA in pregnancy.Item Determinants of depression in Indian tribal adults: Evidence from the Longitudinal Ageing Study in India Wave-I survey(Wolters Kluwer – Medknow, 2024-01) Deepani, Vijit; Nayak, Itishree; Rani, Manju; Taneja, N. K.; Sahu, Damodar; Rao, M. Vishnu Vardhana; Sharma, Ravendra KumarBackground & objectives: The tribal populations are vulnerable to mental health issues owing to various reasons. However, limited research has been conducted to assess depression and related determinants among tribal adults aged ?45 yr (45 years and older). The present study aimed to assess the prevalence and sociodemographic and health determinants of depressive symptoms among the scheduled tribe (ST) population aged ?45 yr in India. Methods: The present study analyzed the Wave I data of the Longitudinal Ageing Study in India conducted between April 2017 to December 2018. The outcome variables in the present study were self-reported depressive symptoms. Two internationally recognised tools, the Centre for Epidemiologic Studies Depression scale (CES-D) and Composite International Diagnostic Interview-Short Form (CIDI-SF), were used to obtain the data, however, only the CES-D data are utilized in this study. The present study focused on 12,215 ST individuals aged ?45 yr from whom information about depressive symptoms was collected and analyzed. Results: Nearly 25 per cent ST population aged 45 yr or older experienced depressive symptoms. The likelihood of experiencing depressive symptoms among the ST population aged ?45 yr was negatively associated with 10 or more years of education and living with children and others and positively associated with experiencing multiple morbidity conditions. Interpretation & conclusions: Given the substantial burden of depression among the adult ST population, the present study lays emphasis on raising the awareness about depressive symptoms and strengthen the availability of mental health services among the ST community through intensive campaigns and engagement of ST individuals along with other key stakeholders. Higher education, living with spouse and children and a physically active lifestyle can play a crucial role in limiting depressive symptoms among the tribal adults (?45 yr). It is paramount to regularly screen depressive symptoms and conduct more microlevel studies to evaluate socioeconomic and health determinants of depressive symptoms among ST communities living in different geographic regions.Item Evaluation of liver segmental dose threshold for hepatocyte regeneration following liver stereotactic body radiation therapy(Wolters Kluwer – Medknow, 2024-02) George, Karishma; Chopra, Supriya; Rajamanickam, Karthick; Joshi, Kishore; Swamidas, Jamema; Shetty, Nitin; Engineer, ReenaBackground & objectives: There is limited evidence studying the relationship of liver segmental dose and segmental volume changes. The segmental dose thresholds could potentially allow for segmental regeneration after liver stereotactic body radiation therapy (SBRT). Given improved survival in hepatocellular cancer (HCC) and liver metastases and more salvage therapy options, this has become an important clinical question to explore. This study assesses the impact of liver segmental dose on segmental volume changes (gain or loss) after SBRT. Methods: Liver segmental contours were delineated on baseline and serial follow up triphasic computed tomography scans. The volumes of total liver and doses to total liver, uninvolved liver and individual segments were noted. A correlation was evaluated between liver/segmental volume and dose using Pearson’s correlation. Furthermore, receiver operator’s curve (ROC) analysis was performed to find the segmental dose, i.e. predictive for liver volume loss. Results: A total of 140 non-tumour liver segments were available for analysis in 21 participants. Overall, 13 participants showed loss of overall liver volume and eight showed gain of overall liver volume. The median dose in segments reporting an increase in volume was 9.1 Gy (7-36 Gy). The median dose in segments losing volume was 15.5 Gy (1-49 Gy). On ROC analysis, segmental dose >11 Gy was associated with volume loss. On univariate analysis, only liver segmental dose contributed to a significant segmental volume loss. Interpretation & conclusions: We propose from the findings of this study that in SBRT for large hepatocellular cancer or liver metastases, liver segments should be individually delineated. Furthermore, 3-5 liver segments may be preferentially subjected to <9 Gy to facilitate hepatocyte regeneration. Preferential sparing of uninvolved liver segments may improve outcomes in liver stereotaxyas lower segmental doses were associated with liver regeneration. This may have implications on future liver SBRT planning where segmental doses may be as important as the mean dose.Item Does Lake Louise questionnaire interpret high-altitude headache as acute mountain sickness? Experience in the western Himalayas(Wolters Kluwer – Medknow, 2024-02) Unnikrishnan, Abhilash; Shekhar, Atul; Kumar, Dharmendra; Jaipurkar, Raksha; Sikri, Gaurav; Singh, Krishan; Manral, RahulBackground & objectives: High-altitude headache (HAH) and headache in acute mountain sickness (AMS) are common among lowlanders ascending to the high altitude and are often confused with one another. A pilot study was undertaken to analyze HAH and AMS cases in Indian lowlanders ascending to Leh city (3500 m) in western Himalayas. Methods: A total number of 1228 Indian lowlanders, who ascended (fresh and re-inductees) by air and acclimatized, participated in this pilot study. The intensity of headache was assessed by the Visual Analogue Score. The parameters of HAH as per the International Classification of Headache Disorders-3 and 2018 Revised Lake Louise Questionnaire (LLQ) were used to differentiate HAH and AMS. Results: Out of 1228 cases, 78 (6.4%) cases had headache, of which 24 (1.95%) cases were HAH only, 40 (3.25%) cases AMS only and 14 (1.14%) cases were defined as both HAH and AMS. There was a significant difference in heart rate [F (2,51) = (4.756), P=0.01] between these groups. It also showed a difference in the correlation between the parameters within the groups. The Odd’s Ratio of AMS in fresh and re-inductees was found to be 4.5 and for HAH it was 4.33. Interpretation & conclusions: The findings of this study suggest that LLQ has a tendency of overestimating AMS by including HAH cases. Furthermore differential parameters exhibit differences when AMS and HAH are considered separately. Re-inductees showed a lower incidence of HAH and AMS.Item Recent updates on laboratory diagnosis of rabies(Wolters Kluwer – Medknow, 2024-01) Ashwini, M. A.; Pattanaik, Amrita; Mani, Reeta S.Rabies is a lethal viral disease transmitted through the bite of rabid animals. India has a high burden of rabies, contributing to a significant proportion of the global deaths. However, under-reporting of the disease is prevalent due to lack of laboratory confirmation. Laboratory diagnosis of rabies plays a crucial role in differentiating the disease from clinical mimics, initiation of appropriate care, implementing infection control measures and informing disease surveillance. This review provides an overview of the recent advancements in laboratory diagnosis of rabies, aimed at updating physicians involved in diagnosis and management of rabies cases in India.Item Characteristics & outcomes of tribal & non-tribal neonates admitted to a special newborn care unit in rural Gujarat, India(Wolters Kluwer – Medknow, 2024-01) Lusk, Rachel; Desai, Tushar; Modi, Dhiren; Desai, Shrey; Donda, Jignesh Kumar; Raulji, Nirav Kumar; Shah, Pankaj; Desai, GayatriBackground & objectives: This study aimed to compare the admission characteristics and outcomes of tribal and non-tribal neonates admitted to a level II special newborn care unit (SNCU) in rural Gujarat. Methods: This was a retrospective observational study that looked at all neonates admitted to a high- volume SNCU between 2013 and 2021. A series of quality improvement measures were introduced over the study period. Admission characteristics, such as birth weight, gestational age, gender and outcomes for tribal and non-tribal neonates, were compared. Results: Six thousand nine hundred and ninety neonates [4829 tribal (69.1%) and 2161 (30.9%) non- tribal] were admitted to the SNCU. Tribal neonates had lower mean birth weight (2047 vs. 2311 g, P<0.01) and gestational week at birth (35.8 vs. 36.7 weeks, P<0.01) compared to non-tribal neonates. Common causes of admissions were neonatal jaundice (1990, 28.4%), low birth weight (1308, 18.7%) and neonatal sepsis (843, 12%). Six hundred and thirty-eight (9.1%) neonates died during the treatment in the SNCU. The odds of death among tribal neonates was similar to non-tribal neonates [adjusted odds ratio: 1.12 (95% confidence interval [CI]: 0.89, 1.42)]. The tribal neonates had significantly higher cause-specific case fatality rate from sepsis [relative risk (RR): 2.18 (95% CI: 1.41, 3.37)], prematurity [RR: 1.98 (95% CI: 1.23, 3.17)] and low birth weight [RR: 1.83 (95% CI: 1.17, 2.85)]. The overall case fatality rate in the SNCU decreased from 18.2 per cent during the year 2013-2014 to 2.1 per cent in the year 2020-2021. Interpretation & conclusions: There was a reduction in the case fatality rate over the study period. Tribal and non-tribal neonates had similar risk of death. Sepsis prevention and management, mechanical respiratory support and timely referral to a higher centre might help further reduction in mortality for these neonates.Item ABDpred: Prediction of active antimicrobial compounds using supervised machine learning techniques(Wolters Kluwer – Medknow, 2024-01) Jana, Tanmoy; Sarkar, Debasree; Ganguli, Debayan; Mukherjee, Sandip Kumar; Mandal, Rahul Shubhra; Das, SantasabujBackground & objectives: Discovery of new antibiotics is the need of the hour to treat infectious diseases. An ever-increasing repertoire of multidrug-resistant pathogens poses an imminent threat to human lives across the globe. However, the low success rate of the existing approaches and technologies for antibiotic discovery remains a major bottleneck. In silico methods like machine learning (ML) deem more promising to meet the above challenges compared with the conventional experimental approaches. The goal of this study was to create ML models that may be used to successfully predict new antimicrobial compounds. Methods: In this article, we employed eight different ML algorithms namely, extreme gradient boosting, random forest, gradient boosting classifier, deep neural network, support vector machine, multilayer perceptron, decision tree, and logistic regression. These models were trained using a dataset comprising 312 antibiotic drugs and a negative set of 936 non-antibiotic drugs in a five-fold cross validation approach. Results: The top four ML classifiers (extreme gradient boosting, random forest, gradient boosting classifier and deep neural network) were able to achieve an accuracy of 80 per cent and above during the evaluation of testing and blind datasets. Interpretation & conclusions: We aggregated the top performing four models through a soft-voting technique to develop an ensemble-based ML method and incorporated it into a freely accessible online prediction server named ABDpred (https://clinicalmedicinessd.com.in/abdpred/).Item Molecular detection of Orientia tsutsugamushi in ectoparasites & their small mammal hosts captured from scrub typhus endemic areas in Madurai district, India(Wolters Kluwer – Medknow, 2024-02) Govindarajan, R.; Sankar, S. Gowri; Kumar, M. Senthil; Rajamannar, V.; Krishnamoorthi, R.; Anand, A. Alwin Prem; Kumar, Ashwani; Samuel, P. PhilipBackground & objectives: Scrub typhus, caused by Orientia tsutsugamushi present in small mammals harbouring the ectoparasites. A study was undertaken to detect the pathogen present in small mammals and its ectoparasites in the scrub typhus-reported areas. Methods: The small mammals (rodents/shrews) and its ectoparasites were screened for O. tsutsugamushi using nested PCR amplification of the groEL gene. Small mammals were collected by trapping and screened for ectoparasites (mites, ticks and fleas) by combing method. Results: All the chigger mites collected were tested negative for O. tsutsugamushi. Interestingly, adult non- trombiculid mites (Oribatida sp., Dermanyssus gallinae), fleas (Xenopsylla astia, X. cheopis, Ctenophalides felis and Ctenophalides sp.) and ticks (Rhipicephalus sanguineus, R. haemaphysaloides) screened were found to be positive for O. tsutsugamushi, which the authors believe is the first report on these species globally. Bandicota bengalensis with O. tsutsugamushi infection is reported for the first time in India. The O. tsutsugamushi groEL sequences from the positive samples were similar to the reference strains, Karp and Ikeda and phylogenetically clustered in clade IV with less evolutionary divergence. The blood samples of Rattus rattus, Suncus murinus and B. bengalensis collected from this area were tested positive for O. tsutsugamushi; interestingly, the sequence similarity was much pronounced with their ectoparasites indicating the transmission of the pathogen to host or vice versa. Interpretation & conclusions: The outcome of the present investigations widened our scope on the pathogens present in ectoparasites and rodents/shrews from this area. This will help to formulate the required vector control methods to combat zoonotic diseases.Item Geographic information system-aided evaluation of epidemiological trends of dengue serotypes in West Bengal, India(Wolters Kluwer – Medknow, 2024-02) Baskey, Upasana; Verma, Priya; Mondal, Palash; Dutta, Supradip; Biswas, Aritra; Bakshi, Sagnik; Das, Raina; Bhaduri, Sudipta; Maji, Dipankar; Dutta, Shanta; Sadhukhan, Provash ChandraBackground & objectives: West Bengal is a dengue-endemic State in India, with all four dengue serotypes in co-circulation. The present study was conceived to determine the changing trends of circulating dengue virus (DENV) serotypes in five consecutive years (2015-2019) using a geographic information system (GIS) during the dengue season in West Bengal, India. Methods: Molecular serotyping of dengue NS1 sero-reactive serum samples from individuals with ?5 days of fever was performed using conventional nested reverse transcriptase-PCR. GIS techniques such as Getis-Ord Gi* hotspot analysis and heatmap were used to elucidate dengue transmission based on the received NS1-positive cases and vector data analysis was used to point out risk-prone areas. Results: A total of 3915 dengue NS1 sero-positive samples were processed from most parts of West Bengal and among these, 3249 showed RNA positivity. The major circulating serotypes were DENV 3 (63.54%) in 2015, DENV 1 (52.79%) in 2016 and DENV 2 (73.47, 76.04 and 47.15%) in 2017, 2018 and 2019, respectively. Based on the NS1 positivity, dengue infections were higher in males than females and young adults of 21-30 yr were mostly infected. Getis-Ord Gi* hotspot cluster analysis and heatmap indicate that Kolkata has become a hotspot for dengue outbreaks and serotype plotting on maps confirms a changing trend of predominant serotypes during 2015-2019 in West Bengal. Interpretation & conclusions: Co-circulation of all the four dengue serotypes was observed in this study, but only one serotype became prevalent during an outbreak. Representation of NS1-positive cases and serotype distribution in GIS mapping clearly showed serotypic shift in co-circulation. The findings of this study suggest the need for stringent surveillance in dengue-endemic areas to limit the impact of dengue and implement better vector-control strategies.Item Urinary lipoarabinomannan in individuals with sputum-negative pulmonary tuberculosis(Wolters Kluwer – Medknow, 2024-02) Ajantha, P.; Puri, Man Mohan; Tayal, Devika; Khalid, U.Background & objectives: Tuberculosis (TB) is a major global cause of ill health. Sputum microscopy for confirmation of presumptive pulmonary TB (PTB) has a reportedly low sensitivity of 22-43 per cent for single smear and up to 60 per cent under optimal conditions. National TB Elimination Programme in India recommends the use of cartridge-based nucleic acid amplification test (CBNAAT) and culture for microbiological confirmation in presumptive PTB individuals with sputum smear negative test. The use of lateral flow urine lipoarabinomannan (LF-LAM) is usually recommended for the diagnosis of TB in HIV-positive individuals with low CD4 counts or those who are seriously ill. The objective of this study was to detect urinary LAM using cage nanotechnology that does not require a physiologic or immunologic consequence of HIV infection for LAM quantification in human urine in 50 HIV-seronegative sputum smear-negative PTB individuals. Methods: To study the diagnostic value of urinary LAM in sputum smear negative PTB individuals, a cage based nanotechnology ELISA technique was used for urinary LAM in three different groups of participants. Fifty smears negative PTB clinically diagnosed, 15 smear positive PTB and 15 post TB sequel individuals. Sputum was tested by smear, CBNAAT, and culture along with urine LAM before treatment. The results were interpreted by ROC curve in comparison to the standard tests like CBNAAT and culture. Results: The mean urinary LAM value was 0.84 ng/ml in 37 culture-positive [Mycobacterium tuberculosis (M.tb)] and 0.49 ng/ml in 13 culture-negative (M.tb) smear-negative individuals with PTB, respectively. In 47 smear-negative PTB cases with microbiologically confirmed TB by CBNAAT, the mean urinary LAM was 0.76 ng/ml. The mean urinary LAM in post-TB sequel individuals was 0.47 ng/ml. As per the receiver operating characteristic curve, cut-off value of urinary LAM in individuals with smear-negative PTB microbiologically confirmed by: (i) CBNAAT was 0.695 ng/ml and (ii) culture was 0.615 ng/ml. Interpretation & conclusions: The findings of this study suggest that individuals with smear-negative PTB and a urinary LAM value of >0.615 ng/ml were most likely to have microbiological confirmed TB while those with a LAM value <0.615 ng/ml >0.478 ng/ml are less likely and those with a value <0.478 ng/ml are unlikely to have microbiological confirmed TB.Item Long-term clinical outcomes of combined modality therapy for advanced-stage Hodgkin lymphoma in the PET era: A retrospective study(Wolters Kluwer – Medknow, 2024-02) Chugh, Swati; Panda, Goutam; Mokal, Smruti; Jain, Hasmukh; Bagal, Bhausaheb; Khanna, Nehal; Epari, Sridhar; Punatar, Sachin; Nayak, Lingaraj; Gokarn, Anant; Khattry, Naveen; Sengar, Manju; Laskar, Siddhartha; Goda, Jayant S.Background & objectives: The role of consolidation radiation therapy (CRT) after complete metabolic response to chemotherapy in advanced-stage (stage III and IV) Hodgkin lymphoma (HL) is controversial. This study was undertaken to assess the clinical outcomes in terms of event free survival, local failure free survival and overall survival in individuals with advanced HL treated with chemotherapy and CRT. Methods: A retrospective review was conducted to study the long-term clinical outcomes in individuals diagnosed with HL and treated with chemotherapy and CRT from 2012 to 2016 at a tertiary cancer care hospital in India. Results: Data from 203 study participants with advanced-stage HL were analyzed. Positron emission tomography-computed tomography (PET-CT) was done at baseline and after 2 cycles for response assessment. The median age at presentation was 32 yr [interquartile range (IQR): 26-46]. Early metabolic response (after 2 cycles) and delayed metabolic response (after 4 or 6 cycles) were observed in 74.4 and 25.6 per cent of individuals, respectively. With a median follow up of 52 months (IQR: 40-67), the five-year event- free survival (EFS), local failure-free survival (LFFS) and overall survival (OS) were 83.2, 95.1 and 94.6 per cent, respectively. On univariate analysis, extranodal disease was associated with inferior EFS (P=0.043). Haemoglobin <10.5 g/dl (P=0.002) and Hasenclever index >3 (P=0.00047) were associated with poorer OS. Relapses were observed in 28/203 (13.8%) study participants with predominance at central nodal stations. The median time to relapse was 19.4 months (IQR: 13-33). Local relapse alone (at the irradiated site) was observed in 5/28 study participants, systemic (distant) relapse in 14/28 individuals, while both systemic and local relapse was observed in 9/28 participants. Extranodal disease (P=0.05), bulky disease (P=0.005) and haemoglobin concentration ?10.5 g/dl (P=0.036) were significant predictors for disease relapse. Interpretation & conclusions: Individuals with advanced-stage HL treated with anthracycline-based chemotherapy (anthracycline-based chemotherapy with doxorubicin, bleomycin, vinblastine and dacarbazine regimen) and CRT had excellent long-term outcomes. As isolated infield failures are uncommon, selective consolidation with conformal RT to high-risk sites improves final disease outcomes.Item Emerging role of exosomes as a liquid biopsy tool for diagnosis, prognosis & monitoring treatment response of communicable & non-communicable diseases(Wolters Kluwer – Medknow, 2024-02) Yadav, Rajbala; Singh, Ajay Vir; Kushwaha, Shweta; Chauhan, Devendra SinghFrom an initial thought of being used as a cellular garbage bin to a promising target for liquid biopsies, the role of exosomes has drastically evolved in just a few years of their discovery in 1983. Exosomes are naturally secreted nano-sized vesicles, abundant in all types of body fluids and can be isolated intact even from the stored biological samples. Being stable carriers of genetic material (cellular DNA, mRNA and miRNA) and having specific cargo (signature content of originating cells), exosomes play a crucial role in pathogenesis and have been identified as a novel source of biomarkers in a variety of disease conditions. Recently exosomes have emerged as a promising ‘liquid biopsy tool’and have shown great potential in the field of non-invasive disease diagnostics, prognostics and treatment response monitoring in both communicable as well as non-communicable diseases. However, there are certain limitations to overcome which restrict the use of exosome-based liquid biopsy as a gold standard testing procedure in routine clinical practices. The present review summarizes the current knowledge on the role of exosomes as the liquid biopsy tool in diagnosis, prognosis and treatment response monitoring in communicable and non-communicable diseases and highlights the major limitations, technical advancements and future prospects of the utilization of exosome-based liquid biopsy in clinical interventions.Item Neutralizing antibody responses to SARS-CoV-2 Omicron variants: Post six months following two-dose & three-dose vaccination of ChAdOx1 nCoV-19 or BBV152(Wolters Kluwer – Medknow, 2024-02) Yadav, Pragya D.; Sardana, Viren; Deshpande, Gururaj Rao; Shinde, Pradnya V.; Thangaraj, Jeromie Wesley Vivian; George, Leyanna S.; Sapkal, Gajanan N.; Patil, Deepak Y.; Sahay, Rima R.; Shete, Anita M.; Joshi, Madhavi; Murhekar, Manoj; Godbole, Sheela; Gupta, Nivedita; Prakash, Satyartha; Rathore, Mamta; Ujjainiya, Rajat; Singh, Ajay Pratap; Mishra, Aastha; Dash, Debasis; Chaudhary, Kumardeep; Sengupta, Shantanu; ICMR Booster Dose Study GroupBackground & objectives: The Omicron sub-lineages are known to have higher infectivity, immune escape and lower virulence. During December 2022 - January 2023 and March - April 2023, India witnessed increased SARS-CoV-2 infections, mostly due to newer Omicron sub-lineages. With this unprecedented rise in cases, we assessed the neutralization potential of individuals vaccinated with ChAdOx1 nCoV (Covishield) and BBV152 (Covaxin) against emerging Omicron sub-lineages. Methods: Neutralizing antibody responses were measured in the sera collected from individuals six months post-two doses (n=88) of Covishield (n=44) or Covaxin (n=44) and post-three doses (n=102) of Covishield (n=46) or Covaxin (n=56) booster dose against prototype B.1 strain, lineages of Omicron; XBB.1, BQ.1, BA.5.2 and BF.7. Results: The sera of individuals collected six months after the two-dose and the three-dose demonstrated neutralizing activity against all variants. The neutralizing antibody (NAbs) level was highest against the prototype B.1 strain, followed by BA5.2 (5–6 fold lower), BF.7 (11–12 fold lower), BQ.1 (12 fold lower) and XBB.1 (18–22 fold lower). Interpretation & conclusions: Persistence of NAb responses was comparable in individuals with two- and three-dose groups post six months of vaccination. Among the Omicron sub-variants, XBB.1 showed marked neutralization escape, thus pointing towards an eventual immune escape, which may cause moreinfections. Further, the correlation of study data with complete clinical profile of the participants along with observations for cell-mediated immunity may provide a clear picture for the sustained protection due to three-dose vaccination as well as hybrid immunity against the newer variants.Item Outcome of individuals with alcoholic cirrhosis hospitalized with first decompensation and their predictors(Wolters Kluwer – Medknow, 2024-02) Giri, Suprabhat; Ingawale, Sushrut; Harindanath, Sidharth; Jain, Mohit; Garg, Pranav; Darak, Harish; Kumar, Sanjay; Kale, Aditya; Shukla, AkashBackground & objectives: Alcohol is one of most common aetiologies of cirrhosis and decompensated cirrhosis is linked to higher morbidity and death rates. This study looked at the outcomes and mortality associated risk variables of individuals with alcoholic cirrhosis who had hospitalization with their first episode of decompensation. Methods: Individuals with alcoholic cirrhosis who were hospitalized with the first episode of decompensation [acute decompensation (AD) or acute-on-chronic liver failure (ACLF)] were included in the study and were prospectively followed up until death or 90 days, whichever was earlier. Results: Of the 227 study participants analyzed, 167 (73.56%) and 60 (26.43%) participants presented as AD and ACLF, respectively. In the ACLF group, the mortality rate at 90 days was higher than in the AD group (48.3 vs 32.3%, P=0.02). In the AD group, participants who initially presented with ascites as opposed to variceal haemorrhage had a greater mortality rate at 90 days (36.4 vs 17.1%, P=0.041). The chronic liver failure-consortium AD score and the lactate-free Asian Pacific Association for the study of the Liver-ACLF research consortium score best-predicted mortality in individuals with AD and ACLF. Interpretation & Conclusions: There is significant heterogeneity in the type of decompensation in individuals with alcoholic cirrhosis. We observed significantly high mortality rate among alcoholic participants hospitalized with initial decompensation; deaths occurring in more than one-third of study participants within 90 days.Item Pharmacoeconomics of medicines used for geriatric individuals in a tertiary care hospital in Delhi(Wolters Kluwer – Medknow, 2024-02) Singh, Vikram Jit; Roy, Vandana; Singhal, Shubha; Daga, M.K.Background & objectives: Expenditure on healthcare is a major concern in the geriatric age group. The current study was carried out to assess the expenditure patterns on medicines utilized in geriatric inpatients. Methods: An observational study was conducted on 1000 geriatric inpatients, aged ?60 yr, admitted to the medicine unit. Data were collected regarding demographic characteristics, prescribed medicines, expenditure incurred on medicines, appropriateness of medicines prescribed and adverse drug reactions (ADRs). Appropriateness of the prescribed medicines was determined using the American Geriatrics Society 2015 Updated Beers Criteria. Results: Geriatric inpatients comprised 41.3 per cent of the total individuals admitted in the ward during the study period. A total of 8366 medicines were prescribed in 127 formulations. The total expenditure on prescribed medicines was INR 1,087,175 with a per capita expenditure of INR 1087.17. Parenteral medicines accounted for 91 per cent of the expenditure on medicines. Maximum expenditure (70%) was incurred on 11.9 per cent of the medicines prescribed. The per capita expenditure was significantly higher in individuals with comorbidities (P=0.03) and those who had a longer duration of hospital stay (P<0.0001). About 28.1 per cent prescriptions were inappropriate. ADRs (140) were observed in 139 (13.9%) inpatients. Individuals with inappropriate medicines prescriptions and ADRs had a longer duration of hospital stay and more number of medicines prescribed. Interpretation & conclusions: Comorbidities, prolonged hospitalization, polypharmacy, inappropriate medicines and parenteral medicines being prescribed contribute to increased expenditure on medicines in geriatric inpatients. In view of the rising number of geriatric inpatients, there is a need to frame a drug policy for them along with surveillance of expenditure on prescribed medicines. This needs to be treated as a priority.Item Clinico-epidemiological profiles & outcome of severe malaria in children under-five in the tribal area of Kalahandi, Odisha(Wolters Kluwer – Medknow, 2024-01) Edassery, Aquinas; Meher, Ajay Kumar; Gupta, Vanshika; Rodriguez, RashmiBackground & objectives: Severe malaria is a cause of excess mortality and morbidity in children in malaria-endemic areas where indigenous people live. Currently, available reports are all from secondary or tertiary care hospitals across India and some African countries. The objective of this study was to assess the clinical and epidemiological profiles of children under five years in two primary care health centres located in tribal-dominant Thuamul Rampur Block of Kalahandi district, Odisha.The outcome of management of severe malaria in these children was also assessed. Methods: A retrospective review of case records of children under five years of age diagnosed and admitted with severe malaria in two non-governmental primary care facilities between 2017 and 2022, was undertaken. Results: There was a declining trend in malaria cases documented in primary care health facilities between January 2017 and June 2022. Of the 4858 cases recorded, 242 (4.9%) had severe malaria, of whom 70.7 per cent (n=171) were children under 5 yr. The median age of the study children was 24 months (16-36). Children aged 1-2 yr had a significantly higher risk of malaria. The majority were tribals (87%), more than half the children presented with neurological manifestations (64.4%), and 49.6 per cent had respiratory manifestations, while 20.5 per cent had severe anaemia (Hb <5 g/dl). Most, 167 (97.7%) severe malaria was due to Plasmodium falciparum. Thirty-two percent of children were severely wasted (WHZ < -3 SD) and 28 per cent were moderately wasted (WHZ <-2 SD). There was no fatality among the 171 children who were managed for severe malaria in the two primary care facilities. Interpretation & conclusions: In high endemic areas severe malaria is predominantly a disease of under- five children and is caused by P. falciparum. Clinical manifestations of severe malaria in children can be varied and life-threatening. Primary health facilities can manage severe malaria successfully, thereby reducing child mortality. Effective collaboration between malaria control and nutrition intervention programmes is essential for appropriate case management.