bluuebunny/crossref_metadata_2025 huggingface dataset:
MALDI-TOF mass spectrometry
Authors: Gautam Vikas , Sharma Megha , Singhal Lipika , Kumar Sunil , Kaur Parvinder , Tiwari Rupinder , Ray Pallab
Published: December 2024

Background & objectives:

Matrix-assisted laser desorption ionization-time-of-flight mass spectrometry (MALDI-TOF MS) has been instrumental in revolutionizing microbiological identification, especially in high-throughput laboratories. It has enabled the identification of organisms like non-fermenting Gram-negative bacilli (NFGNB), which has been a challenging task using conventional methods alone. In this study an attempt was made to validate MALDI-TOF MS for the identification of clinical isolates of each of the three most common NFGNB, other than Pseudomonas spp., taking molecular methods as the gold standard.

Methods:

One hundred and fifty clinical isolates of NFGNB, confirmed by molecular methods such as Acinetobacter baumannii[oxa-51 polymerase chain reaction (PCR)], Burkholderia cepacia complex (expanded multilocus sequence typing) and Stenotrophomonas maltophilia (species-specific PCR), were taken. Isolated colonies from fresh cultures of all 150 isolates were smeared onto ground steel plate, with and without formic acid extraction step. The identification was carried out using MALDI-TOF MS Biotyper database.

Results:

A concordance of 100 and 73.33 per cent was found between the molecular techniques and MALDI-TOF MS system in the identification of these isolates up to genus and species levels, respectively. Using a cut-off of 1.9 for reliable identification, rate of species identification rose to 82.66 per cent. Principal component analysis dendrogram and cluster analysis further increased discrimination of isolates.

Interpretation & conclusions:

Our findings showed MALDI-TOF MS-based identification of NFGNB as a good, robust method for high-throughput laboratories.
Zika virus
Authors: Bhardwaj Sumit , Gokhale Mangesh D. , Mourya Devendra T.
Published: December 2024

With confirmation of Zika virus (ZIKV) presence in India, screening of a large number of febrile illness samples yielded only four positive cases. In this review, we address the current concern with context to India. The possible reasons for low level of Zika prevalence in India have been discussed, by extracting some probable explanations from previous experience of chikungunya virus-vector model/studies. In the current context, it is hypothesized that Indian mosquito strains have lower susceptibility gradient/threshold for ZIKV. The very low positivity in the humans also indicates low levels of mosquito-human-mosquito transmission cycle. There is also a need to look for the existence of any such animal cycle/sylvatic involvement in India. The recently detected four cases in India show local transmission of ZIKV suggesting that ZIKV might have been present in India since long time. The earlier vector-virus relationship studies with chikungunya suggested that in due course of time, ZIKV might become a major public health concern in the future.
Prognostic & predictive factors for planning adjuvant chemotherapy of early-stage breast cancer
Authors: Esbah Onur , Oksuzoglu Berna
Published: December 2024

Breast cancer is a heterogeneous disease and may present with different clinical and biological characteristics. At present, breast cancer is divided into molecular subgroups besides its histopathological classification. Decision for adjuvant chemotherapy is made based on not only histopathological characteristics but also molecular and genomic characteristics using indices, guidelines and calculators in early-stage breast cancer. Making a treatment plan through all these prognostic and predictive methods according to risk categories aims at preventing unnecessary or useless treatments. In this review, an attempt to make a general assessment of prognostic and predictive methods is made which may be used for planning individualized therapy and also the comments of the guidelines used by the oncologists worldwide on these methods.
Research priorities in Maternal, Newborn, & Child Health & Nutrition for India
Authors: Arora Narendra K. , Swaminathan Soumya , Mohapatra Archisman , Gopalan Hema S. , Katoch Vishwa M. , Bhan Maharaj K. , Rasaily Reeta , Shekhar Chander , Thavaraj Vasantha , Roy Malabika , Das Manoja K. , Wazny Kerri , Kumar Rakesh , Khera Ajay , Bhatla Neerja , Jain Vanita , Laxmaiah Avula , Nair M.K.C. , Paul Vinod K. , Ramachandran Prema , Ramji Siddharth , Vaidya Umesh , Verma I.C. , Shah Dheeraj , Bahl Rajiv , Qazi Shamim , Rudan Igor , Black Robert E.
Published: December 2024

In India, research prioritization in Maternal, Newborn, and Child Health and Nutrition (MNCHN) themes has traditionally involved only a handful of experts mostly from major cities. The Indian Council of Medical Research (ICMR)-INCLEN collaboration undertook a nationwide exercise engaging faculty from 256 institutions to identify top research priorities in the MNCHN themes for 2016-2025. The Child Health and Nutrition Research Initiative method of priority setting was adapted. The context of the exercise was defined by a National Steering Group (NSG) and guided by four Thematic Research Subcommittees. Research ideas were pooled from 498 experts located in different parts of India, iteratively consolidated into research options, scored by 893 experts against five pre-defined criteria (answerability, relevance, equity, investment and innovation) and weighed by a larger reference group. Ranked lists of priorities were generated for each of the four themes at national and three subnational (regional) levels [Empowered Action Group & North-Eastern States, Southern and Western States, & Northern States (including West Bengal)]. Research priorities differed between regions and from overall national priorities. Delivery domain of research which included implementation research constituted about 70 per cent of the top ten research options under all four themes. The results were endorsed in the NSG meeting. There was unanimity that the research priorities should be considered by different governmental and non-governmental agencies for investment with prioritization on implementation research and issues cutting across themes.
Impact of regulatory spin of pioglitazone on prescription of antidiabetic drugs among physicians in India
Authors: Goyal Aman , Singh Harmanjit , Sehgal Vijay Kumar , Jayanthi C.R. , Munshi Renuka , Bairy K. Laxminarayana , Kumar Rakesh , Kaushal Sandeep , Kakkar Ashish Kumar , Ambwani Sneha , Goyal Chhaya , Mazumdar Goutameswar , Adhikari Anjan , Das Nina , Stephy Divya John , Thangaraju Pugazhenthan , Dhasmana D.C. , Rehman Shakil U. , Chakrabarti Amit , Bhandare Basavaraj , Badyal Dinesh Kumar , Kaur Inderpal , Chandrashekar K. , Singh Jagjit , Dhamija Puneet , Sarangi Sudhir Chandra , Gupta Yogendra Kumar
Published: December 2024

Background & objectives:

Pioglitazone was suspended for manufacture and sale by the Indian drug regulator in June 2013 due to its association with urinary bladder carcinoma, which was revoked within a short period (July 2013). The present questionnaire-based nationwide study was conducted to assess its impact on prescribing behaviour of physicians in India.

Methods:

Between December 2013 and March 2014, a validated questionnaire was administered to physicians practicing diabetes across 25 centres in India. Seven hundred and forty questionnaires fulfilling the minimum quality criteria were included in the final analysis.

Results:

Four hundred and sixteen (56.2%) physicians prescribed pioglitazone. Of these, 281 used it in less than the recommended dose of 15 mg/day. Most physicians (94.3%) were aware of recent regulatory events. However, only 333 (44.8%) changed their prescribing pattern. Seventeen of the 416 (4.1%) physicians who prescribed pioglitazone admitted having come across at least one type 2 diabetes mellitus patient (T2DM) who had urinary bladder carcinoma, and of these 13 said that it was in patients who took pioglitazone for a duration of more than two years. Only 7.8 per cent of physicians (n=58) categorically advocated banning pioglitazone, and the rest opined for its continuation or generating more evidence before decision could be taken regarding its use in T2DM.

Interpretation & conclusions:

Majority of the physicians though were aware of the regulatory changes with regard to pioglitazone, but their prescribing patterns were not changed for this drug. However, it was being used at lower than the recommended dose. There is a need for generating more evidence through improved pharmacovigilance activities and large-scale population-based prospective studies regarding the safety issues of pioglitazone, so as to make effectual risk-benefit analysis for its continual use in T2DM.
A novel approach for characterizing variations in serum peptides in rheumatic heart disease
Authors: Wu Xiaochen , Yue Qin , Jia Weikun , Zhang Jinbao , Ouyang Hui , Xin Dong , Xiao Yingbin
Published: December 2024

Background & objectives:

Acute rheumatic fever and rheumatic heart disease (RHD) are important public health problems in developing countries. In this study, peptidomic analyses on RHD patients and healthy individuals were performed to characterize variations in serum peptide levels using label-free quantitation approaches.

Methods:

Blood samples were obtained from 160 healthy controls and 160 RHD patients. Of the 448 identified peptides, 272 were analyzed by two label-free mass spectrometry methods, the spectral count and spectral index.

Results:

There were 38 proteins and 95 peptides with significant (adjusted P<0.001) differences in the abundance of peptides between healthy controls and RHD patients, including multiple peptides derived from histone H2B, villin-like protein, complement C4-B and motile sperm domain containing protein-2. The levels of 10 peptides were upregulated, and 85 peptides were downregulated in patients compared to controls. In addition, in patients, the levels of four proteins were upregulated and 34 were downregulated compared to controls.

Interpretation & conclusions:

This study shows that detection of significant changes in serum peptides reflects the difference between RHD patients and healthy controls. This label-free method may be helpful for clinicians to treat RHD patients during the perioperative period.
Current status of lupus nephritis
Authors: Jaryal Ajay , Vikrant Sanjay
Published: December 2024

Systemic lupus erythematosus (SLE) is a systemic disease of unknown aetiology with variable course and prognosis. Lupus nephritis (LN) is one of the important disease manifestations of SLE with considerable influence on patient outcomes. Immunosuppression therapy has made it possible to control the disease with improved life expectancy and quality of life. In the last few decades, various studies across the globe have clarified the role, dose and duration of immunosuppression currently in use and also provided evidence for new agents such as mycophenolate mofetil, calcineurin inhibitors and rituximab. However, there is still a need to develop new and specific therapy with less adverse effects. In this review, the current evidence of the treatment of LN and its evolution, and new classification criteria for SLE have been discussed. Also, rationale for low-dose intravenous cyclophosphamide as induction agent followed by azathioprine as maintenance agent has been provided with emphasis on individualized and holistic approach.
Coverage of childhood vaccination among children aged 12-23 months, Tamil Nadu, 2015, India
Authors: Murhekar Manoj V. , Kamaraj P. , Kanagasabai K. , Elavarasu G. , Rajasekar T. Daniel , Boopathi K. , Mehendale Sanjay
Published: December 2024

Background & objectives:

District-Level Household Survey-4 (DLHS-4) indicated that during 2012-2013, only 56 per cent of children aged 12-23 months in Tamil Nadu were fully vaccinated, which were lesser than those reported in earlier national surveys. We, therefore, conducted cluster surveys to estimate coverage of childhood vaccination in the State, and also to identify the factors associated with low coverage.

Methods:

Cross-sectional surveys were conducted in 15 strata [municipal corporation non-slum (n=1), municipal corporation slum (n=1), hilly (n=1), rural (n=6) and urban (n=6)]. From each stratum, 30 clusters were selected using probability proportional to the population size linear systematic sampling; seven children aged 12-23 months were selected from each cluster and their mothers/care-takers were interviewed to collect information about vaccination status of the child. A child was considered fully vaccinated if he/she received bacillus Calmette-Guérin (BCG), three doses of pentavalent, three doses of oral polio vaccine and one dose of measles vaccine, and appropriately vaccinated if all vaccine doses were given at right age and with right interval. Further, coverage of fully vaccinated children (FVC) as per vaccination cards or mothers’ recall, validated coverage of FVC (V-FVC) among those having cards, and coverage of appropriately vaccinated children (AVC) were estimated using survey data analysis module with appropriate sampling weights.

Results:

A total of 3150 children were surveyed, of them 2528 (80.3%) had vaccination card. The weighted coverage of FVC, V-FVC and AVC in the State was 79.9 per cent [95% confidence interval (CI): 78.2-81.5], 78.8 per cent (95% CI: 76.9-80.5) and 69.7 per cent (95% CI: 67.7-71.7), respectively. The coverage of individual vaccine ranged between 84 per cent (measles) and 99.8 per cent (BCG). About 12 per cent V-FVC were not vaccinated as per the vaccination schedule.

Interpretation & conclusions:

The coverage of FVC in Tamil Nadu was high, with about 80 per cent children completing primary vaccination. Efforts to increase vaccination coverage in the State need to focus on educating vaccinators about the need to adhere to the national vaccination schedule and strengthening supervision to ensure that children are vaccinated appropriately.
Impact of embryo co-culture with cumulus cells on pregnancy & implantation rate in patients undergoing in vitro fertilization using donor oocyte
Authors: Bhadarka Harsha K. , Patel Nayana H. , Patel Niket H. , Patel Molina , Patel Kruti B. , Sodagar Nilofar R. , Phatak Ajay G. , Patel Jagdish S.
Published: December 2024

Background & objectives:

Cumulus cell co-culture of embryo had been found to be beneficial for achieving better pregnancy and implantation rate (IR). The present study was aimed to evaluate efficiency of cumulus co-culture technique over simple culture of embryo in terms of pregnancy rate (PR) and IR in patients undergoing treatment for infertility using donor oocytes fertilized by intracytoplasmic sperm injection.

Methods:

This was a quasi-experimental study between control and study groups. The primary endpoint was achievement of pregnancy. Control group included 508 women who underwent embryo development without cumulus cell co-culture and study group included 394 women who underwent embryo development with cumulus cell co-culture using donor's cumulus cells.

Results:

The present study demonstrated a significant increase in the IR (37.2 vs 24.2%, P<0.001) and in PR (45.7 vs 37.8%, P<0.05) in study group than in control group. The PR and IR were found to be higher in study group, among all groups of women, grouped on the basis of different indications for use of donor oocytes.

Interpretation & conclusions:

Cumulus cell co-culture technique was found to be more effective than simple culture technique for embryo development in women undergoing treatment for infertility using donor oocytes fertilized by intracytoplasmic sperm injection.
Extensively drug-resistant tuberculosis in India
Authors: Prasad Rajendra , Singh Abhijeet , Balasubramanian Viswesvaran , Gupta Nikhil
Published: December 2024

Emergence of extensively drug-resistant tuberculosis (XDR-TB) has significantly threatened to jeopardize global efforts to control TB, especially in HIV endemic regions. XDR-TB is mainly an iatrogenically created issue, and understanding the epidemiological and risk factors associated with it is of paramount importance in curbing this menace. Emergence of this deadly phenomenon can be prevented by prompt diagnosis and effective treatment with second-line drugs in rifampicin-resistant TB (RR-TB) as well as multidrug-resistant TB (MDR-TB) patients. Optimal treatment of RR-TB, MDR-TB and XDR-TB cases alone will not suffice to reduce the global burden. The TB control programmes need to prioritize on policies focusing on the effective as well as rational use of first-line drugs in every newly diagnosed drug susceptible TB patients so as to prevent the emergence of drug resistance.
Spectrum of prenatally detected central nervous system malformations
Authors: Siddesh Anjurani , Gupta Geetika , Sharan Ram , Agarwal Meenal , Phadke Shubha R.
Published: December 2024

Background & objectives:

Prenatal diagnosis of malformations is an important method of prevention and control of congenital anomalies with poor prognosis. Central nervous system (CNS) malformations amongst these are the most common. The information about the prevalence and spectrum of prenatally detected malformations is crucial for genetic counselling and policymaking for population-based preventive programmes. The objective of this study was to study the spectrum of prenatally detected CNS malformations and their association with chromosomal abnormalities and autopsy findings.

Methods:

This retrospective study was conducted in a tertiary care hospital in north India from January 2007 to December 2013. The details of cases with prenatally detected CNS malformations were collected and were related with the foetal chromosomal analysis and autopsy findings.

Results:

Amongst 6044 prenatal ultrasonographic examinations performed; 768 (12.7%) had structural malformations and 243 (31.6%) had CNS malformations. Neural tube defects (NTDs) accounted for 52.3 per cent of CNS malformations and 16.5 per cent of all malformations. The other major groups of prenatally detected CNS malformations were ventriculomegaly and midline anomalies. Chromosomal abnormalities were detected in 8.2 per cent of the 73 cases studied. Foetal autopsy findings were available for 48 foetuses. Foetal autopsy identified additional findings in eight foetuses and the aetiological diagnosis changed in two of them (4.2%).

Interpretation & conclusions:

Amongst prenatally detected malformations, CNS malformations were common. NTD, which largely is a preventable anomaly, continued to be the most common group. Moreover, 60 per cent of malformations were diagnosed after 20 weeks, posing legal issues. Chromosomal analysis and foetal autopsy are essential for genetic counselling based on aetiological diagnosis.
Stem cells survive oncotherapy & can regenerate non-functional gonads
Authors: Bhartiya Deepa
Published: December 2024

A large proportion of patients who survive cancer are rendered infertile as an unwanted side effect of oncotherapy. Currently accepted approaches for fertility preservation involve banking eggs/sperm/embryos or ovarian/testicular tissue before oncotherapy for future use. Such approaches are invasive, expensive, technically challenging and depend on assisted reproductive technologies (ART). Establishing a gonadal tissue bank (for cancer patients) is also fraught with ethical, legal and safety issues. Most importantly, patients who find it difficult to meet expenses towards cancer treatment will find it difficult to meet expenses towards gonadal tissue banking and ART to achieve parenthood later on. In this review an alternative strategy to regenerate non-functional gonads in cancer survivors by targeting endogenous stem cells that survive oncotherapy is discussed. A novel population of pluripotent stem cells termed very small embryonic-like stem cells (VSELs), developmentally equivalent to late migratory primordial germ cells, exists in adult gonads and survives oncotherapy due to their quiescent nature. However, the stem-cell niche gets compromised by oncotherapy. Transplanting niche cells (Sertoli or mesenchymal cells) can regenerate the non-functional gonads. This approach is safe, has resulted in the birth of fertile offspring in mice and could restore gonadal function early in life to support proper growth and later serve as a source of gametes. This newly emerging understanding on stem cells biology can obviate the need to bank gonadal tissue and fertility may also be restored in existing cancer survivors who were earlier deprived of gonadal tissue banking before oncotherapy.
Development & standardization of an in-house IgM indirect ELISA for the detection of parvovirus B19 infections
Authors: Vadivel Kumaran , Ramamurthy Mageshbabu , Sankar Sathish , Jain Amita , Srikanth Padma , Ghosh Asit Ranjan , Nandagopal Balaji , Nair Aravindan , Sridharan Gopalan
Published: December 2024

Background & objectives:

Parvovirus B19 infections occur worldwide; the infection is acquired early in childhood but could occur later. B19 is reported to cause infection in childhood febrile illnesses, and arthropathies in adults and children and in end-stage renal disease (ESRD) seen in adults. This study was designed to develop an in-house IgM indirect ELISA for serological screening among patients and controls, and to compare ELISA results with those of nested polymerase chain reaction (nPCR) assay.

Methods:

An in-house IgM indirect ELISA was standardized using peptide sequence of VP1/VP2 region of parvovirus B19. A total of 201 children and adult with febrile illnesses, 216 individuals with non-traumatic arthropathies, 201 cases of chronic anaemia associated with ESRD and 100 healthy controls were tested. Serum was separated from the blood and subsequently used for DNA extraction. The nested polymerase chain reaction (nPCR) for the detection of B19V DNA was performed using primers targeting the overlapping region of VP1/VP2 capsid protein genes.

Results:

A total of 618 samples were tested for parvovirus B19 by an in-house IgM indirect ELISA. Among these samples, six were positive by in-house ELISA. The inter-rater agreement between ELISA and PCR assays was calculated using kappa coefficient analysis. The value of κ was 0.77 and the strength of agreement was ‘good’ (P<0.001).

Interpretation & conclusions:

The in-house IgM indirect ELISA was found to be simple with high sensitivity and specificity when compared with nPCR and could be used as an alternative to expensive commercial kits in resource-poor settings.
Action-oriented colour-coded foot length calliper for primary healthcare workers as a proxy for birth weight & gestational period
Authors: Pratinidhi Asha K. , Bagade Abhijit C. , Kakade Satish V. , Kale Hemangi P. , Kshirsagar Vinayak Y. , Babar Rohini , Bagal Shilpa
Published: December 2024

Background & objectives:

Foot length of the newborn has a good correlation with the birth weight and is recommended to be used as a proxy measure. There can be variations in the measurement of foot length. A study was, therefore, carried out to develop a foot length calliper for accurate foot length measurement and to find cut-off values for birth weight and gestational age groups to be used by primary healthcare workers.

Methods:

This study was undertaken on 645 apparently healthy newborn infants with known gestational age. Nude birth weight was taken within 24 h of birth on a standard electronic weighing machine. A foot length calliper was developed. Correlation between foot length and birth weight as well as gestational age was calculated. Correctness of cut-off values was tested using another set of 133 observations on the apparently healthy newborns. Action-oriented colour coding was done to make it easy for primary healthcare workers to use it.

Results:

There was a significant correlation of foot length with birth weight (r=0.75) and gestational age (r=0.63). Cut-off values for birth weight groups were 6.1, 6.8 and 7.3 cm and for gestational age of 6.1, 6.8 and 7.0 cm. Correctness of these cut-off values ranged between 77.1 and 95.7 per cent for birth weight and 60-93.3 per cent for gestational age. Considering 2.5 kg as cut-off between normal birth weight and low birth weight (LBW), cut-off values of 6.1, 6.8 and 7.3 were chosen. Action-oriented colour coding was done by superimposing the colours on the scale of the calliper, green indicating home care, yellow indicating supervised home care, orange indicating care at newborn care units at primary health centres and red indicating Neonatal Intensive Care Unit care for infants.

Interpretation & conclusions:

A simple device was developed so that the primary health care workers and trained Accredited Social Health Activist workers can identify the risk of LBW in the absence of accurate weighing facilities and decide on the type of care needed by the newborn and take action accordingly.
Devising a method towards development of early warning tool for detection of malaria outbreak
Authors: Verma Preeti , Sarkar Soma , Singh Poonam , Dhiman Ramesh C.
Published: December 2024

Background & objectives:

Uncertainty often arises in differentiating seasonal variation from outbreaks of malaria. The present study was aimed to generalize the theoretical structure of sine curve for detecting an outbreak so that a tool for early warning of malaria may be developed.

Methods:

A ‘case/mean-ratio scale’ system was devised for labelling the outbreak in respect of two diverse districts of Assam and Rajasthan. A curve-based method of analysis was developed for determining outbreak and using the properties of sine curve. It could be used as an early warning tool for Plasmodium falciparum malaria outbreaks.

Result:

In the present method of analysis, the critical Cmax (peak value of sine curve) value of seasonally adjusted curve for P. falciparum malaria outbreak was 2.3 for Karbi Anglong and 2.2 for Jaisalmer districts. On case/mean-ratio scale, the Cmax value of malaria curve between Cmax and 3.5, the outbreak could be labelled as minor while >3.5 may be labelled as major. In epidemic years, with mean of case/mean ratio of ≥1.00 and root mean square (RMS) ≥1.504 of case/mean ratio, outbreaks can be predicted 1-2 months in advance.

Interpretation & conclusions:

The present study showed that in P. falciparum cases in Karbi Anglong (Assam) and Jaisalmer (Rajasthan) districts, the rise in Cmax value of curve was always followed by rise in average/RMS or both and hence could be used as an early warning tool. The present method provides better detection of outbreaks than the conventional method of mean plus two standard deviation (mean+2 SD). The identified tools are simple and may be adopted for preparedness of malaria outbreaks.
Food significantly reduces plasma concentrations of first-line anti-tuberculosis drugs
Authors: Kumar Agibothu Kupparam Hemanth , Chandrasekaran Vedachalam , Kumar Angadi Kiran , Kawaskar M. , Lavanya J. , Swaminathan Soumya , Ramachandran Geetha
Published: December 2024

Background & objectives:

Concomitant feeding and anti-tuberculosis (TB) drug administration are likely to reduce nausea and enhance compliance to treatment. However, food could lower plasma drug concentrations. This study was undertaken to examine the effect of food on two-hour plasma concentrations of rifampicin (RMP), isoniazid (INH) and pyrazinamide (PZA), and pharmacokinetics of these drugs in adult TB patients.

Methods:

Newly diagnosed adult TB patients were recruited from the Revised National Tuberculosis Control Programme (RNTCP) treatment centres in Chennai Corporation, Chennai, India. Two-hour post-dosing plasma concentrations were determined in 25 patients, and a semi-intensive pharmacokinetic study was undertaken in six patients. RMP, INH and PZA concentrations were determined by high-performance liquid chromatography.

Results:

The geometric mean two-hour concentrations with food and under fasting conditions were 2.2 and 5.5 μg/ml for RMP (P<0.001), 3.9 and 11.3 μg/ml for INH (P<0.001), and 18.0 and 28.2 μg/ml for PZA (P<0.001), respectively. Drug administration with food caused the plasma concentration to decrease by 50, 45 and 34 per cent for RMP, INH and PZA, respectively. Significant decreases in peak concentrations and exposures of drugs and delay in time to attain peak concentrations of drugs when taken with food were also observed.

Interpretation & conclusions:

Our findings showed that food lowered anti-TB drug concentrations significantly and delayed absorption. Patients may be explained the beneficial effects of taking anti-TB drugs in a fasting state and advised to do so. There is a need for more research on optimization of dosing to maximize efficacy and safety of currently used drugs.
A meta-analysis to assess usefulness of procalcitonin-guided antibiotic usage for decision making
Authors: Shafiq Nusrat , Gautam Vikas , Pandey Avaneesh Kumar , Kaur Navjot , Garg Shubha , Negi Harish , Kaur Sharonjeet , Ray Pallab , Malhotra Samir
Published: December 2024

Background & objectives:

Development of antibacterial resistance and its association with antibiotic overuse makes it necessary to identify a specific and sensitive biomarker for the diagnosis of bacterial infection and guiding antibiotic therapy. Procalcitonin (PCT), as a sepsis biomarker, may play a role in guiding antibiotics treatment in hospital settings. The aim of the current meta-analysis was to analyze the utility of PCT on various outcomes of interest in inpatients.

Methods:

Different databases were searched for randomized controlled trials comparing PCT-guided therapy with standard therapy in admitted patients with bacterial infections. Twenty six articles were found suitable for full text search and of these, 16 studies were considered finally for data extraction.

Results:

There were no significant differences found in total mortality [pooled odds ratio (OR) 1.04, 95% confidence interval (CI) 0.89-1.22, P=0.63], 28-day mortality (pooled OR 0.97, 95% CI 0.80-1.19, P=0.79), need of Intensive Care Unit admission (OR=0.80, 95% CI 0.59-1.09, P=0.16) and duration of stay in hospital (pooled mean difference −0.01, 95% CI −0.50-0.49, P=0.98) between treatment and control groups. PCT-guided treatment significantly decreased the duration of antibiotic treatment (pooled mean difference −2.79, 95% CI −3.52-−2.06, P<0.00001).

Interpretation & conclusions:

PCT-guided therapy significantly decreased antibiotics exposure and thus treatment cost. However, the hard endpoints did not demonstrate any significant benefits, possibly due to low power to detect differences and/or the presence of comorbidities.
Evolution of technology for molecular genotyping in blood group systems
Authors: Gorakshakar Ajit , Gogri Harita , Ghosh Kanjaksha
Published: December 2024

The molecular basis of the blood group antigens was identified first in the 1980s and 1990s. Since then the importance of molecular biology in transfusion medicine has been described extensively by several investigators. Molecular genotyping of blood group antigens is one of the important aspects and is successfully making its way into transfusion medicine. Low-, medium- and high-throughput techniques have been developed for this purpose. Depending on the requirement of the centre like screening for high- or low-prevalence antigens where antisera are not available, correct typing of multiple transfused patients, screening for antigen-negative donor units to reduce the rate of alloimmunization, etc. a suitable technique can be selected. The present review discusses the evolution of different techniques to detect molecular genotypes of blood group systems and how these approaches can be used in transfusion medicine where haemagglutination is of limited value. Currently, this technology is being used in only a few blood banks in India. Hence, there is a need for understanding this technology with all its variations.
Adaptive Mechanisms of Mycobacterium tuberculosis: Role of fbiC Mutations in Dormancy and Survival
Authors: Farnia Parissa , Maleknia Mohsen , Farnia Poopak , Ghanavi Jalaledin
Published: December 2024

This review examines the impact of F420 biosynthesis protein C (fbiC) mutations in Mycobacterium tuberculosis (Mtb) and their influence on the bacterium’s dormancy mechanisms. The potential role of fbiC mutations and functional impairments in the persistence of Mtb is emphasized. Tuberculosis (TB) bacilli can enter a dormant state with minimal metabolic activity, allowing them to conserve resources and survive in low-nutrient, low-oxygen environments for extended periods. While the fbiC gene contributes to dormancy, Mtb can achieve this state through multiple genetic and metabolic pathways, suggesting that it may still undergo dormancy even with functional impairments in fbiC. In this review, we utilized several scientific databases, including PubMed, Web of Science, and Google Scholar, and set of key search terms including “fbiC gene,” “F420 Biosynthesis,” “Mycobacterium tuberculosis,” “Dormancy,” and “Drug Resistance” to highlight the significance of the fbiC gene in regulating dormancy and explore how Mtb compensates for fbiC dysfunction through various metabolic adaptations.
A Challenging Case of Miliary Tuberculosis in Pregnancy
Authors: Singh Anuja , Siddiqui Farha , Maurya Anand Kumar , Purwar Shashank , Saigal Saurabh
Published: December 2024

Miliary tuberculosis (TB) is an uncommon yet severe condition that can pose substantial risks to pregnant women and their unborn child. This case study describes a 22-year-old pregnant female at 23 weeks of gestation presented with breathlessness, fever accompanied by chills, dry cough, and loss of appetite. With no significant comorbidities, her initial symptoms were inconclusive, leading to her initial diagnosis as a case of pyrexia of unknown origin. Despite receiving iron supplements for anemia and broad-spectrum antibiotics, her health continued to decline, prompting her transfer to a specialized medical center where advanced molecular testing ultimately confirmed a diagnosis of miliary TB. Upon admission, she was promptly started on anti-TB therapy and managed in the intensive care unit, where her clinical course included the development of acute respiratory distress syndrome (ARDS) requiring ventilatory support. Through meticulous monitoring and multidisciplinary intervention, the patient stabilized and ultimately delivered a healthy baby girl through normal vaginal delivery. Miliary TB, though rare, is challenging to diagnose during pregnancy due to overlapping symptoms with other conditions. This case underscores the critical importance of recognizing the atypical presentations of miliary TB in pregnant women, particularly in the context of previous exposure. It highlights the need for high clinical suspicion, timely diagnosis, and comprehensive management strategies to ensure favorable outcomes for both mother and child in the face of such challenging clinical scenarios.
TcPO2 as a Predictor of Limb Salvage or Amputation in Patients of Critical Limb Ischemia
Authors: Merkhed Rahul , Patra Vikram , Dhillon Rishi , Mehra Rohit , Dattatreya CVNM , Kaur Ramandeep , Vohra Gagandeep Singh , Dwivedi Surjeet
Published: December 2024

Introduction:

Critical limb-threatening ischemia presents a significant challenge in clinical management, often necessitating lower limb amputation if not managed promptly and effectively. A crucial aspect of managing CLTI involves determining the optimal level of amputation to maximize post-surgical healing and functional outcomes. Among various non-invasive diagnostic tools, Transcutaneous Oximetry (TcPO2) has garnered attention, yet a consensus on predictive cutoff levels remains elusive in the literature.

Aim and Objective:

This study addresses this gap by investigating the predictive utility of TcPO2 in assessing healing outcomes following amputation or ulcer management, aiming to provide valuable insights for clinical practice and enhance patient outcomes in CLTI management.

Methodology:

It was conducted at a tertiary care centre in North India . Our study of 128 patients examines TcPO2 as a predictor for ulcer or amputation stump healing. By applying a cutoff of 40 mmHg, informed by previous retrospective studies suggesting its predictive efficacy, our approach seeks to standardise decision-making and optimise tissue oxygenation to improve clinical outcomes.

Results:

We found that a TcPO2 cutoff of 40 mmHg or higher significantly correlated with increased healing likelihood, whereas values below this threshold, particularly in patients with diabetes mellitus (DM) and chronic kidney disease (CKD), posed greater risks of non-healing outcomes.

Discussion And Conclusion:

This underscores the critical role of TcPO2 in assessing vascular compromise, especially in cases where conventional methods like ankle-brachial pressure index (ABPI) may be unreliable due to arterial calcifications. In our analysis, CKD and TcPO2 < 40 emerged as independent predictors of non-healing ulcers or stump in univariate regression. Interestingly, DM did not show a significant association with non-healing outcomes in this context. Moreover, in multivariate analysis, DM, CKD, and TcPO2 < 40 retained their significance as predictors of poor healing, with TcPO2 < 40 demonstrating the strongest association. Further prospective studies are warranted to validate these findings and establish robust correlations between TcPO2 values and clinical outcomes. Additionally, exploring the influence of various comorbidities and demographic factors could refine predictive models, offering tailored interventions for patients with CLTI.
Accuracy of Lone Three-dimensional Transthoracic Echocardiography in Tricuspid Valve Function and Geometry Assessment: Implication for Preoperative Evaluation of Transcatheter Tricuspid Valve Therapies
Authors: Bruno Noemi , Russo Marco , Pergolini Amedeo , Cammardella Antonio Giovanni , Musumeci Francesco , Ranocchi Federico
Published: December 2024

Introduction:

Tricuspid regurgitation (TR) is associated with high rate and poor prognosis in patient undertreated. In recent years, transcatheter tricuspid valve interventions (TTVI) appears like a valuable option in high risk surgical candidates in presence of suitable anatomy. Screening phase with transthoracic, thansoesophageal echocardiography, and cardiac computed tomography (CT) are necessary select patients.

Purpose:

The aim of the study is to compare different imaging modalities as three-dimensional (3D) transthoracic echocardiography (TTE), transesophageal echocardiography (TOE) and ECG-gated cardiac CT for the definition of tricuspid valve (TV) function and geometry assessment.

Materials and Methods:

Twenty-one (age 79 ± 7 years, female 72%) patients under screening for transcatheter treatment of TR were prospectively enrolled in the study and underwent TTE, TOE, and cardiac CT. All measurements were performed in double blind by three different operators and compared.

Results:

In the comparison between 2D/3D TTE and 2D/3D TOE, no statistically significant differences were found regarding the evaluation of the valve anatomy, the site of regurgitation, and the underlying mechanism (TTE vs. TOE: 3D septo-lateral diam 45.8 ± 4,92 vs. 45.87 ± 4,98 mm, P = 0.87; 3D antero-posterior diam 43.5 ± 4,58 vs. 43.5 ± 4,53 mm, P = 0.59; Circularity index 0,75 ± 0,08 vs. 0,76 ± 0,08, P = 0.98). When comparing 3D TTE and cardiac CT, no differences were recorded in terms of TV area 17.58 ± 3 versus 17.71 ± 4,3 cm2, P = 0.1; perimeter 14.89 ± 1,6 versus 14.29 ± 1 cm, P = 0.5 and diameters. Similarly, in the study of right ventricular dimensions, obtained through 3D volumetric reconstruction, TTE was not statistically different to Cardiac CT.

Conclusions:

The present series shows how a lone 3D TTE has a good reliability in the definition of TV function, leaflet characteristics, and geometry when compared with second level imaging modalities and may be safely used to select optimal candidates for complex TTVI.
Investigating the Impact of Voxel Size and Postfiltering on Quantitative Analysis of Positron Emission Tomography/Computed Tomography: A Phantom Study
Authors: Mohymen Ahmed Abdel , Farag Hamed Ibrahim , Reda Sameh M. , Monem Ahmed Soltan , Ali Said A.
Published: December 2024

Aim:

This study aims to investigate the influence of voxel size and postfiltering on the quantification of standardized uptake value (SUV) in positron emission tomography/computed tomography (PET/CT) images.

Materials and Methods:

National Electrical Manufacturers Association phantom with the spheres of different sizes were utilized to simulate the lesions. The phantom was scanned using a PET/CT scanner, and the acquired images were reconstructed using two different matrix sizes, (192 × 192) and (256 × 256), and a wide range of postfiltering values.

Results:

The findings demonstrated that postfiltering significantly affected SUV measurements. The changes in postfiltering values can result in overestimation or underestimation of SUV values, highlighting the importance of carefully selecting appropriate filters. Increasing the matrix size improved SUVmax and SUVmean values, particularly for small-sized spheres. Smaller voxel reconstructions slightly reduced partial volume effects and partially enhanced SUV quantification.

Conclusions:

Careful consideration of postfiltering values and matrix size selection can lead to better SUV quantification. These findings emphasize the need to optimize the reconstruction parameters to enhance the clinical utility of PET/CT in detecting and evaluating malignant lesions.
Evaluation of the Effect of Nanosilver and Bismuth oxide on the Radiopacity of a Novel Hydraulic Calcium Silicate-based Endodontic Sealer: An In vitro Study
Authors: Dsouza Teena Sheethal , Shetty Aditya , Pais Kelvin Peter , Chikkanna Meenakumari , Almutairi Fahad Hamoud , Alharbi Yazeed Abdulaziz , Babu J. Suresh , Swarnalatha C. , Nayyar Abhishek Singh
Published: December 2024

Background and Aim:

A wide range of dental materials have incorporated the concept of nanotechnology into their composition to enhance their physical and antimicrobial properties. In this pretext, silver nanoparticles (AgNPs) are among the most commonly used nanoparticles which are exceptionally noteworthy for their role in medical applications as an antibacterial agent. Another essential, desirable physical characteristic of all endodontic cements is their radiopacity, while in similar context, various radiopacifying agents such as bismuth oxide, barium sulfate, and even AgNPs have been incorporated in endodontic sealers to enhance their physical properties. The aim of the present study was to assess whether the incorporation of AgNPs and 10% bismuth oxide imparted the required radiopacity to the novel cement material (Nano CS) as per the requirement and standards laid by the International Organization for Standardization (ISO) guidelines and whether it complied with the ISO 6876:2001 specifications to achieve the necessary norms.

Materials and Methods:

The structural characteristics of the novel cement material (Nano CS) were observed using energy-dispersive X-ray analysis under a Zeiss Gemini 500 Field Emission Scanning Electron Microscope, while radiopacity of the test material (Nano CS) was assessed with the help of an aluminum (Al) step‐wedge using a nondestructive testing method following ISO guidelines. The optical density of the test material (Nano CS) was tested with the specimens of mineral trioxide aggregate (MTA) as the standard cement material along with the specimens of enamel and dentin that were 1 mm thick, and Al of appropriate thickness with the desired and equivalent radiopacity.

Results:

The findings of the present study suggested MTA to have higher radiopacity index equivalent to 4.56 ± 0.00 mm thickness of Al when compared to the test material (Nano CS) (2.78 ± 0.01 mm thickness of Al) and enamel (4.09 ± 0.01 mm thickness of Al) and dentin (2.01 ± 0.01 mm thickness of Al) specimens. Furthermore, the radiopacity index of test material (Nano CS) was found to be more when compared to dentin, though, less when compared to the enamel specimens with the results being statistically highly significant (P < 0.001).

Conclusion:

The addition of nanosilver and bismuth oxide to the test material (Nano CS) imparted characteristic radiopacity, though the required specifications laid down by the ISO standards were not achieved. Increasing the concentration of the additives used might be considered to bring in the required radiopacity without having a significant impact on the physical and biological properties of the test material (Nano CS) intended to be used for endodontic applications.
Evaluating the Utilization of the National Cancer Institute Computed Tomography Program for Calculating Size-specific Dose Estimate and Effective Dose in Computed Tomography in Thai Pediatric Patients
Authors: Sookpeng Supawitoo , Martin Colin J. , Rattanarungruangchai Natch , López-Gonzalez M. Rosario
Published: December 2024

The objectives of this study were to assess the feasibility of utilizing computational calculations and the simulation of the National Cancer Institute computed tomography (NCICT) dosimetry system to obtain size-specific dose estimate (SSDE) and effective dose values resulting from the most common CT examinations in Thai pediatric patients and to evaluate age- and size-specific k conversion factor. For the calculation methods, SSDEs were calculated using the American Association of Physicists in Medicine Report No. 220 and 293 methodologies. The results revealed that SSDEs derived from CT scans of the body, obtained through the two different methods, varied by within 10%. The size of the patient and the scanning distance had an impact on the variability of E values derived from NCICT. Age- and size-specific k conversion factors may be used as a first line to estimate risk for the pediatric patients.
Multifaceted Characterization and Therapeutic Evaluation of Co-precipitated Cobalt Ferrite Nanoparticles for Magnetic Hyperthermia Cancer Therapy
Authors: Reena R. Jafrin , Raj N. Arunai Nambi
Published: December 2024

Aim:

Magnetic-mediated hyperthermia has emerged as a promising therapeutic approach for treating cancer. This technique employs the heat dissipated by the magnetic nanoparticles when subjected to an external varying magnetic field, to bring about localized hyperthermia in tumor tissues. Owing to their conducive and tuneable “physical, chemical, and magnetic” characteristics, cobalt ferrite (CoFe2O4) nanoparticles are recognized as emerging contenders. The aim of the present work was to enhance the magnetic characteristics and guarantee the efficacy of CoFe2 O4 nanoparticles in targeting and eliminating cancer cells.

Methods:

CoFe2O4 nanoparticles were synthesized using the chemical co-precipitation route and underwent rigorous structural, morphological, and magnetic characterization techniques. The synthesized particles were then subjected to in vitro studies to evaluate their cytotoxicity and antimicrobial susceptibility.

Results:

The characterization techniques confirmed the cubic structure, ferrite phase, and spherical and magnetic nature of CoFe2O4 nanoparticles. The zeta potential was found to be − 0.0048V (4.8 mV). Cytotoxicity analysis exhibited decreased cell viability with increasing concentrations of CoFe2O4 nanoparticles. Antimicrobial studies displayed good inhibiting properties.

Conclusion:

The zeta potential of the synthesized CoFe2O4 nanoparticles was found to be higher than that of the breast cancer cells (MCF-7) which proves the synthesized drug to be effective. The in vitro studies also disclose the efficacy of the drug over cancer cells.