bluuebunny/crossref_metadata_2025_split huggingface dataset:
Correlation of Malnutrition Inflammation Score and Highly Sensitive C-reactive Protein with Mortality and Morbidity in Patients on Maintenance Hemodialysis in a Tertiary Care Center from South India – A Prospective Study
Authors: Prabhu Pooja Prakash , Siddini Vishwanath , Bonu Ravishankar , Prakash G. K. , Sundar Sankaran , Ballal Sudarshan 
Published: August 2024

ABSTRACT

Background:
Patients undergoing maintenance hemodialysis have a high prevalence of protein energy malnutrition and inflammation. There are very few Indian studies which have looked into the utility of malnutrition inflammation score (MIS) in assessing the prognosis in dialysis patients. The objectives of this study were to assess the correlation of MIS with mortality and morbidity among hemodialysis patients and to compare it with highly sensitive C-reactive protein (hs-CRP).

Methodology:
MIS and hs-CRP were calculated for each patient at the beginning of the study and at the end of 12 months. Patients were followed up for 1 year and assessed for hospitalization rates, infection rates, erythropoietin requirements, cardiovascular events, cerebrovascular events, and mortality.

Results:
A very high mortality of 50% was noted with those who had MIS ≥10. MIS score of >7 was a strong predictor of 1-year mortality. There was an increased rate of hospitalization and infections noted in patients with higher MIS scores. There was a good correlation between MIS scores and hs-CRP among dialysis patients. Upon follow-up, there was a statistically significant difference in terms of serum albumin, hs-CRP, and hospitalization rates among those patients who continued to be in the low-risk group MIS (1–4) when compared to those who had worsening of their MIS scores at the end of 1 year.

Conclusion:
MIS is a good indicator of mortality and morbidity among dialysis patients. Periodic assessment of MIS score in the dialysis unit will enable us to risk stratify the patients and take necessary measures to improve their quality of life. By providing adequate dialysis, vascular access care, and nutritional support, it is possible to reduce the MIS and decrease the mortality and morbidity among hemodialysis patients.
A randomized, open-label, multicentered parallel-group clinical study to evaluate the efficacy and safety of Joint Core™ compared to Jointace DN™ in osteoarthritis patients
Authors: Kannan Ramesh , Bakthavatchalam Sriram , Murugesan Sakthibalan , Kumar B. Aravinda , Deb Bijoy , Marimuthu Chandramohan , Rajendran Priya 
Published: August 2024

Background:
Osteoarthritis (OA) is one of the most common musculoskeletal diseases worldwide, with pain, joint stiffness, fatigue associated with disability, and loss of physical activity. There is a need for an effective and safer alternative medication for the management of OA knee in elderly patients as the current medications possess severe risks to the patient compromising the quality of life.

Methodology:
The study design and setting were phase 3, randomized, open-label, multicentered, active-controlled parallel-group interventional trial conducted at secondary care centers in Puducherry. Fifty patients (50) patients with OA knee were enrolled as per study criteria and randomized to receive Joint Core™ and Jointace DN™ for 12 weeks. The outcomes were assessed using various pain scales and subscales, Short-Form Health-12 (SF-12) questionnaire, and inflammatory markers. The data obtained at baseline and weeks 4, 8, and 12 were compared and statistically analyzed.

Results:
Joint Core™ showed continuous reduction in the Visual Analog Scale pain scores at 4, 8, and 12 weeks and improvement in Western Ontario and McMaster Universities OA Index subscale and pain global assessment scales and good response rate in the Outcome Measures for Rheumatology Committee and OA Research Society International Standing Committee for Clinical Trials Response Criteria Initiative scores proving it to be efficacious in the treatment of OA knee compared to Jointace DN™. The safety assessed showed that Joint Core™ produces minimal gastrointestinal side effects and does not affect any organs as assessed by the laboratory parameters.

Conclusion:
Joint Core™ is effective and safe in the treatment of OA knee when compared to its comparator Jointace DN™. Joint Core™ can be an alternative treatment option in the patients with OA knee who are intolerant to diacerein-based combinations available to treat OA.
The role of cascade reporting integrated with breakpoint to minimum inhibitory concentration quotient (minimum inhibitory concentration therapeutic index) and minimum inhibitory concentration guiding table on clinical microbiology reporting of culture-proven bloodstream infections
Authors: Dhandapani Sarumathi , Priyadarshi Ketan , Rajshekar Deepashree , Sivaradjy Monika , Madigubba Haritha , Sastry Apurba Sankar 
Published: August 2024

Abstract

Background:
The breakpoint to minimum inhibitory concentration (MIC) quotient (BMQ) of an antimicrobial agent is the ratio of susceptible breakpoint divided by MIC of the test isolate. The higher the BMQ, the better is the therapeutic efficacy. The reporting of BMQ and MIC guiding table (MGT) when integrated with cascade reporting is more useful, especially in bloodstream infections.

Methodology:
The study period was of 2 years (June 2019–May 2021). The blood culture (BC) isolates were subjected to susceptibility testing by VITEK® 2 automated antimicrobial susceptibility test (AST) system for all the antimicrobials at a time but reported only selectively (cascade reporting). The BMQ of the susceptible antibiotics was calculated and the MGT was developed by using a specialized “clinical microbiology reporting software.” Both the BMQ and MGT were included in the clinical microbiology report along with the suggested “drug of choice” (DOC) based on the highest BMQ.

Results:
A total of 2644 out of 56,663 BC episodes were included. Of all the AST results, 57.0% (1, 508) were found to be susceptible to ≥1 first-line antimicrobials tested and 8.7% (230) were found to be resistant to all antimicrobials tested. Overall in about 16.7% of episodes, BMQ-DOC reported was found to be different compared to the raw MIC-DOC, and the difference was found to be maximum for Pseudomonas aeruginosa (50.3%).

Conclusion:
Reporting of BMQ and MGT is impactful only when it is integrated with cascade reporting as BMQ can only be taken into consideration while comparing the agents of similar spectrum.
COVID-19-associated pulmonary aspergillosis
Authors: Singh Priyanka , Kakkar Aanchal 
Published: August 2024

Abstract
Invasive pulmonary aspergillosis (IPA) is now been recognized as a possible secondary infection affecting COVID-19 recovery and increasing mortality. It can be explained due to factors such as direct epithelial injury, hypercoagulable and hyperinflammatory states, and the use of immunosuppressive treatment. We managed five such cases in a post-COVID intensive care unit facility at a tertiary care institute in North India. All patients had high oxygen demand, positive serum galactomannan (GM) index, and significant chest X-ray changes. All patients showed an initial improvement after receiving intravenous antifungal treatment with voriconazole. Systemic markers were suboptimal for the diagnosis of COVID-19-associated pulmonary aspergillosis (CAPA) with a sensitivity of less than 50%. GM assay has been validated in BAL and serum in numerous studies. Serum GM is a sensitive marker for IPA in patients with neutropenia; however, in nonneutropenic critically ill patients, serum GM exhibited a sensitivity of 25%, although a negative serum result cannot exclude the diagnosis of CAPA. The diagnosis of CAPA is challenging, and in patients with severe COVID-19 pneumonia may be associated with a worse prognosis. GM levels can be used for the diagnostic purpose of probable CAPA cases and administration of prophylactic treatment with voriconazole is still under debate.
Copious white leathery tenacious froth in a case of hanging – An arcane presentation
Authors: Narayan Gaurang , Bharathi O. Murugesa , Rathinam Rajesh Duraisamy , Ravitchandrane Revanth , Suvvari Tarun Kumar 
Published: August 2024

Abstract
The presence of froth during autopsy in cases of asphyxial death has been widely studied and attributed to drowning. Although hanging is the most common cause of mechanical asphyxia in comparison to drowning, frothing observed in cases of hanging has not been reported. Herein, we describe a case of an 18-year-old married pregnant woman who attempted suicide by hanging. During the postmortem examination, the presence of copious, white, tenacious, leathery froth forming a mushroom-like mass was observed. Furthermore, internal examination and histopathological evaluation revealed noncardiogenic pulmonary edema to be the likely cause of death. Although the development of postobstructive pulmonary edema has been effectively studied in sublethal cases of hanging, with appropriate ventilation management, mortality associated with such cases has drastically reduced. Thus, the incidence of frothing noted in such cases of hanging has not been described. Pulmonary edema, which subsequently develops in patients with hanging, is an unfamiliar and unusual cause of death. Hence, we conclude that autopsy surgeons must watch out for other causes of frothing and must investigate for evidence of its differentials, not limited to only cases of drowning. This finding also becomes important for emergency physicians to consider the development of interstitial edema in the setting of nonlethal hanging.
Knowledge and practice of hand hygiene among health-care workers in a tertiary care hospital
Authors: Joseph Sharon , Kuruvilla Thomas S. , D’Souza Rose Meroline 
Published: August 2024

Abstract

Background:
A good awareness and application of hand hygiene (HH) among health-care personnel form a solid foundation for any health-care center to prevent nosocomial infections. The objective of this study was to gauge the expertise and execution of HH among various health-care professionals in a tertiary care teaching hospital.

Methodology:
This analytical cross-sectional study was conducted over 2 months. A self-administered online questionnaire adapted from the WHO’s “Hand Hygiene Knowledge Questionnaire for Healthcare Workers” was sent to 217 participants. Their answers were scored based on the level of knowledge and practice of HH among them.

Results:
All age groups practiced HH to a fair extent, although respondents over the age of 31 (94.1%) showed significantly higher levels of understanding of HH in comparison to younger adults. There was no statistical difference in the knowledge level between male and female gender; however, females (91.2%) showed a better practice of HH than males. Although doctors (87.8%) had a higher degree of knowledge than nurses (70%), nurses (98%) had better HH practice than doctors. Overall, knowledge of HH was adequate with good practice.

Conclusion:
The adoption of excellent HH habits is thought to be predicted by greater knowledge about HH. However, to foster better HH habits that can significantly contribute to maintaining compliance with good practices, it is crucial to convey lacunae in knowledge during routine training sessions.
Let’s pause and think… Do we follow the right steps in developing a research questionnaire – Is it an art or a science? Insights gained from a study investigating an outbreak of hepatitis B in Central Kerala, India
Authors: Varghese Sangeetha Merrin , Abraham Jithin Mathew , Chacko Thomas Vengail , Benjamin Anoop Ivan , Chandy George Mateethra 
Published: August 2024

Abstract

Background:
Medical research utilizes a lot of questionnaires, but their quality is highly variable and lacks consistent, rigorous standards such as the use of conceptual framework or any other systematic process for its development. Our aim was to apply an insight obtained from medical education to describe the process of designing and developing a questionnaire, through an exploratory process to capture various risk factors and determinants that are valid and relevant in construct, to improve the health of the community.

Methodology:
We followed a seven-step systematic process of questionnaire development following the Association of Medical Education of Europe Guidelines (Guide 87) with a few modifications, to explore the factors responsible for an outbreak of hepatitis B in the Pathanamthitta district, Kerala.

Results:
About half of the questions (51.1% [23/45 questions]) were obtained via literature review, 37.7% (17/45 questions) were obtained via focus group discussions, 11.1% (5/45 questions) were included, and 6.6% (3/45) questions were also omitted based on expert advice. Cognitive interviewing helped in clarifying questions related to electromyography, the appearance and bite – characteristic of a deerfly, and also the explanation of contact sports, in the transmission of hepatitis B.

Conclusion:
A well-designed questionnaire developed following a systematic process helps to achieve the research objectives, is easy for both interviewers and respondents to complete, provides complete and accurate information, and is designed with the very purpose of making sound analysis and interpretation possible. This project helped in dispelling the myths and bringing forth the facts associated with the hepatitis B outbreak.
Knowledge, attitude, and Practices of telemedicine among the health-care practitioners during COVID pandemic
Authors: Petimani Mahalaxmi S. , Bhat Nagapati P. , Preethishree P. , Adake Prabhakar 
Published: August 2024

Introduction:
COVID pandemic created a difficult situation for the medical fraternity. Many health-care practitioners achieved their work through telemedicine. For delivering better patient care, especially during the pandemic, the present study was conducted to assess the Knowledge, Attitude, and Practices (KAP) of telemedicine among healthcare practitioners of our institution.

Materials and Methods:
A prevalidated questionnaire form containing 13 questions on KAP of telemedicine was circulated to health-care practitioners through Google Form by snowball technique. A total of 96 responses were collected. Descriptive statistical method was applied and results are expressed in percentages.

Results:
Out of 96 responses, 61 (63.5%) were from men and 35 (36.5%) from women. About 63.5% of health-care practitioners were aware of the term telemedicine, 22.9% were aware but not practising, and 13.5% were aware and currently practising telemedicine. Regarding the mode of telemedicine, 42.7% preferred video calling (Skype/hangout/WhatsApp), followed by 27.1% personalized website (HODO/Healzapp), 17.7% by text message (SMS/Email/Fax), and 12.5% for an audio phone call. With respect to taking consent, 59.4% expressed that consent is required and 40.6% expressed that consent is implied when the patient initiates the call. Regarding challenges in telemedicine, 83.3% expressed that clinical examinations cannot be done, 76% for connectivity issues, 55.2% worried about patient safety, and 54.2% for medico-legal issues. 53.1% of health-care practitioners would like to charge the same fees for telemedicine, followed by 27.1% lower fees, 12.5% no fees, and 7.3% would like to charge higher fees than routine.

Conclusion:
Telemedicine is essential for patient care, especially during a pandemic. Hence, National Medical Commission should incorporate telemedicine modules in the undergraduate curriculum for better patient care.
Impact of COVID-19 lockdown on characteristics of unnatural deaths autopsied at a tertiary care center in Pondicherry
Authors: Subramanyam Sunil , Janardhanan Joshima , Das Udit B. , Ravichandran Kandasamy 
Published: August 2024

Abstract

Background:
The number of reported unnatural deaths showed an observable decline during the lockdown imposed to curb COVID-19. In this study, we aimed to analyze the characteristics of unnatural deaths autopsied at our center during this 3-month period of lockdown and compared it with statistics of the same 3-month period in the 3 years before 2020.

Methodology:
The statistics of unnatural cases autopsied during the lockdown period were analyzed and compared with the statistics of cases autopsied in the same period of the previous 3 years (2017–2019). The data for this study were obtained from autopsy reports and police inquest reports of the cases autopsied at a tertiary care center in Pondicherry.

Results:
There was a reduction in homicidal and accidental deaths during lockdown when compared to previous years while suicides had doubled during the lockdown period. Unnatural deaths, where the presence of alcohol was either the instigator or a major contributor to the fatality, were also reduced.

Conclusion:
This study reveals the indirect and unexpected consequences of lockdown in relation to unnatural deaths and the findings can help in the implementation of social reform policies.
The commonly used adult generic quality of life instruments for chronic diseases with merits and demerits
Authors: Ravindra B. N. , Chonari Thanveer Ahammed , Kumar B. P. Satish , Dahim Muhammed , Mohan Akshay 
Published: August 2024

Abstract
A chronic condition is a physical or emotional wellness condition that endures over a year, causes utilitarian limitations, or requires progressing checking or treatment. The aging of the population has caused a high prevalence of chronic illnesses, such as diabetes, cardiovascular diseases, and cancer. Even though individuals live longer, they often live with disabilities and constant illnesses. Quality of life (QOL) has become a critical idea and focus for examination and practice in the fields of well-being and medication. During the previous years, more examination has focused on patients’ QOL, and the utilization of QOL evaluations has expanded. Health-related QOL (HRQOL) is now mandatory in assessing health outcomes. Searches were conducted using PUBMED, Google Scholar, Web of Science, and Google to find the studies published in peer-reviewed journals. Key search terms included HRQOL, QOL, SF-36, MQOL, COOP chart, SIP, NHP, QWB, EQ-5D, and EuroQol Instrument. Relevant articles were chosen from the search results. This review provides researchers and clinicians with up-to-date practical and comparative information on adult generic QOL instruments to help them decide which the instrument is best suited for their study. It examines the Medical Outcomes Study 36-Item Short Form (SF-36) Health Survey, the McGill QoL Questionnaire – Original (MQOL – Original), the Dartmouth Primary Care Cooperative Information Project (COOP) Charts, Sickness Impact Profile (SIP), Nottingham Health Profile (NHP), Quality of Well-Being (QWB) scale, and the EuroQOL 5-Dimension Instrument (EQ 5-D). This paper looks at 7 HR-QOL instruments and finds that there are no consistently “best” or “worst” instruments. The choice to use the generic QOL measure is driven by the reason for the assessment.
Meta-analysis of differential expression of sex-biased and common drug metabolism enzymes and transporters genes in blood transcriptomics of mental disorders
Authors: Mohandoss Anusa Arunachalam , Kumar S. Ananda Krishna 
Published: August 2024

Abstract

Background:
There are reports that pharmacogenomics, pharmacodynamics, and pharmacotherapeutics of psychiatric drugs differ significantly with sex. There is a dearth of literature on this aspect. The aim of this study is to identify sex-biased genes among common mental disorders and the influence of sex on the common drug metabolism enzymes and transporters (DMET) genes in blood transcriptomics data.

Methodology:
Data for this meta-analytic, in silico study, are from Gene Expression Omnibus repository with restrictions of human blood samples that measured the mRNA expression of genes of any mental disorder patients without any date limitations. The identified datasets were then entered into the online Exatlas software. Quality check of the dataset was performed and only those datasets that fulfilled were used further in this meta-analysis. DMET genes were identified from literature, and the differential expression (DE) was identified and presented.

Results:
In all, 239 patient samples with five common mental disorders formed the study group. Of them, there were 21139 genes, of which the number of significant genes (FDR <0.05) was 16989. In this meta-analysis of mental illness among either sex, 32 genes were identified as DE. Of these 32 genes, 23 (72%) belonged to sex chromosomes and the remaining mapped to autosomes. We identified 48 DEMT genes from literature and their DE reported.

Conclusion:
Within the limitation of this study, it is established that among the mentally ill, there is a measurable difference between males and females, in terms of gene expression, particularly of DMET genes. Such DE of genes can potentially alter the pharmacogenomics, pharmacodynamics, and pharmacotherapeutics of psychiatric drugs.
Utility of biomarkers in predicting the severity and mortality of coronavirus disease 2019 infection
Authors: Deshpande Sapna S. , Mestri Namrata , Halgale Mohasin J. , Chimankar Pradnya M. 
Published: August 2024

Context:
The clinical course of Coronavirus Disease 2019 (COVID-19) infection is variable and subjective. Hence, there is a dire need for objective interpretation of severity. The utilization of biomarkers categorizes these patients into nonsevere, severe, or critical categories.

Aim:
This study aims to assess the role of different biomarkers in predicting the severity and mortality of COVID 19.

Materials and Methods:
Case records of 247 patients of a designated COVID center in Kolhapur, Maharashtra, India, were included in this observational study. Biomarkers such as total leukocyte count, C-reactive protein, lactate dehydrogenase, D-Dimer, interleukin-6 (IL-6), procalcitonin, and serum ferritin were studied in different categories of severity of the disease.

Results:
The median serum ferritin levels among nonsevere cases, severe, and critical cases were 187.95 ng/mL (interquartile range [IQR] = 93.05 ng/mL to 382.50 ng/mL), 230 ng/mL (156 ng/mL to 670 ng/mL), and 412.33 ng/mL (234 ng/mL to 689 ng/mL), respectively and this difference was statistically significant (P < 0.001). The average values of IL-6 were significantly higher (P < 0.001) among the patients who died (19.12 pg/mL) when compared to those which were alive (3.74 pg/mL). Based on the receiver operating characteristic analysis, the interpretation of the severity of the disease was excellent through the evaluation of levels of serum ferritin (Area under curve = 0.755 [95% confidence interval = 0.635–0.875; P = 0.001]).

Conclusions:
Serum ferritin among the biomarker panel studied was the best test that predicted the severity of COVID-19 infection. The IL-6 levels were significantly higher among the patient who succumbed when compared to those who survived the disease.