bluuebunny/crossref_metadata_2025_split huggingface dataset:
Evaluation of prescriptions from tertiary care hospitals across India for deviations from treatment guidelines & their potential consequences
Authors: Shetty Yashashri , Kamat Sandhya , Tripathi Raakhi , Parmar Urwashi , Jhaj Ratinder , Banerjee Aditya , Balakrishnan Sadasivam , Trivedi Niyati , Chauhan Janki , Chugh Preeta Kaur , Tripathi C. D. , Badyal Dinesh Kumar , Solomon Lydia , Kaushal Sandeep , Gupta Kanchan , Jayanthi M. , Jeevitha G. , Chatterjee Suparna , Samanta Kalyan , Desai Chetna , Shah Samidh , Medhi Bikash , Joshi Rupa , Prakash Ajay , Gupta Pooja , Roy Atanu , Chandy Sujith , Ranjalkar Jaya , Bright Heber Rew , Dikshit Harihar , Mishra Hitesh , Roy Sukalyan Saha , Kshirsagar Nilima 
Published: April 2024

Abstract

Background & objectives:
Irrational prescribing practices have major consequences on patient safety and also increase the economic burden. Real-life examples of impact of irrational prescription have potential to improve prescribing practices. In this context, the present study aimed to capture and evaluate the prevalence of deviations from treatment guidelines in the prescriptions, potential consequence/s of the deviations and corrective actions recommended by clinicians.

Methods:
It was a cross-sectional observational study conducted in the outpatient departments of tertiary care hospitals in India wherein the 13 Indian Council of Medical Research Rational Use of Medicines Centres are located. Prescriptions not compliant with the standard treatment guidelines and incomplete prescriptions with respect to formulation, dose, duration and frequency were labelled as ‘prescriptions having deviations’. A deviation that could result in a drug interaction, lack of response, increased cost, preventable adverse drug reaction (ADR) and/or antimicrobial resistance was labelled as an ‘unacceptable deviation’.

Results:
Against all the prescriptions assessed, about one tenth of them (475/4838; 9.8%) had unacceptable deviations. However, in 2667/4838 (55.1%) prescriptions, the clinicians had adhered to the treatment guidelines. Two thousand one hundred and seventy-one prescriptions had deviations, of which 475 (21.9%) had unacceptable deviations with pantoprazole (n=54), rabeprazole+domperidone (n=35) and oral enzyme preparations (n=24) as the most frequently prescribed drugs and upper respiratory tract infection (URTI) and hypertension as most common diseases with unacceptable deviations. The potential consequences of deviations were increase in cost (n=301), ADRs (n=254), drug interactions (n=81), lack of therapeutic response (n=77) and antimicrobial resistance (n=72). Major corrective actions proposed for consideration were issuance of an administrative order (n=196) and conducting online training programme (n=108).

Interpretation & conclusions:
The overall prevalence of deviations found was 45 per cent of which unacceptable deviations was estimated to be 9.8 per cent. To minimize the deviations, clinicians recommended online training on rational prescribing and administrative directives as potential interventions.
Evaluation of molecular diagnostic test for detection of adult pulmonary tuberculosis: A generic protocol
Authors: Jayaprakasam Madhumathi , Pandey Ravindra Mohan , Choudhary Hansraj , Shanmugam Sivakumar , Sivaramakrishnan Gomathi N. , Gupta Nivedita 
Published: April 2024

Abstract

Background & 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.
Survey of the present health & nutritional status of Shompen tribe of Great Nicobar Island
Authors: 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. 
Published: April 2024

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.
Long-term clinical outcomes of combined modality therapy for advanced-stage Hodgkin lymphoma in the PET era: A retrospective study
Authors: 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. 
Published: April 2024

Abstract

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.
Characteristics & outcomes of tribal & non-tribal neonates admitted to a special newborn care unit in rural Gujarat, India
Authors: Lusk Rachel , Desai Tushar , Modi Dhiren , Desai Shrey , Donda Jignesh Kumar , Raulji Nirav Kumar , Shah Pankaj , Desai Gayatri 
Published: April 2024

Background & 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.
Incidence of needlestick injury among healthcare workers in western India
Authors: Naidu Raji T , Toal Pratibha , Mishra Satish Chandra , Nair Beena , Shejul Yogesh K. 
Published: April 2024

Background & objectives:
Injuries occurring from contaminated sharps are a major occupational health hazard. It carries a risk of transmitting blood-borne diseases such as human immunodeficiency virus (HIV), hepatitis B and hepatitis C. Healthcare workers (HCWs), including personnel handling biomedical waste, are at risk. The objective of this study was to determine the incidence and details of needlestick injury (NSI) among HCWs.

Methods:
We analyzed data of all HCWs who reported NSI over the past three years. Demographic details, type and source of injury, use of personal protective equipment (PPE), immediate post-exposure measures, hepatitis B vaccination status and HCWs and source’s HIV, hepatitis B and hepatitis C serological status were studied.

Results:
Fifty-six cases of NSI were recorded over three years, accounting for an incidence of 10.4/100 occupied beds per year. Maximum cases (73.2%) occurred between the 20 and 40 yr age group. The distribution among the work category was doctors (37.5%), nursing staff (26.8%), phlebotomy technicians (12.5%), housekeeping/subordinate staff (12.5%) and others (10.7%). Appropriate PPE was donned by 66 per cent of the HCWs. The majority of cases (46.4%) occurred in wards and operating rooms (23.2%). Phlebotomy (35.7%), followed by procedures, such as hemoglucotest (HGT) measurement, intravenous cannula insertion and operative procedures (33.9%), were the most common situation during which HCWs suffered NSI. While 64.2 per cent HCWs were vaccinated for hepatitis B, only 5.4 per cent of the HCWs completed post-exposure anti-retroviral regimen.

Interpretation & conclusions:
We conclude that a relative lack of awareness towards preventive measures and inexperience among HCWs may be contributory to high occurrence of NSI events. This study emphasizes upon ensuring active hospital-wide hepatitis B vaccination of all HCWs and supportive therapy to improve compliance towards post-exposure prophylaxis.
A neural network framework based on ConvNeXt for side‐channel hardware Trojan detection
Authors: Gao Yuchan , Su Jing , Li Jia , Wang Shenglong , Li Chao 
Published: April 2024

AbstractResearchers in the field of hardware security have been dedicated to the study of hardware Trojan detection. Among the various approaches, side‐channel detection methods are widely used because of their high detection accuracy and fewer constraints. However, most side‐channel detection methods cannot make full use of side‐channel information. In this paper, we propose a framework that utilizes the continuous wavelet transform to convert time‐series information and employs an improved ConvNeXt network to detect hardware Trojans. This detection framework first converts one‐dimensional time‐series information into a two‐dimensional time–frequency map using the continuous wavelet transform to leverage frequency information in electromagnetic side‐channel signals. Then, the two‐dimensional time–frequency map is fed into the improved ConvNeXt network, which increases the weight of the informative parts in the two‐dimensional time–frequency map and enhances detection efficiency. The results indicate that the method proposed in this paper significantly improves the accuracy of hardware Trojan detection.
Predictive model for non-malignant portal vein thrombosis associated with cirrhosis based on inflammatory biomarkers
Authors: Nie Guo-Le , Yan Jun , Li Ying , Zhang Hong-Long , Xie Dan-Na , Zhu Xing-Wang , Li Xun 
Published: April 2024

BACKGROUND
Portal vein thrombosis (PVT), a complication of liver cirrhosis, is a major public health concern. PVT prediction is the most effective method for PVT diagnosis and treatment.
AIM
To develop and validate a nomogram and network calculator based on clinical indicators to predict PVT in patients with cirrhosis.
METHODS
Patients with cirrhosis hospitalized between January 2016 and December 2021 at the First Hospital of Lanzhou University were screened and 643 patients with cirrhosis who met the eligibility criteria were retrieved. Following a 1:1 propensity score matching 572 patients with cirrhosis were screened, and relevant clinical data were collected. PVT risk factors were identified using the least absolute shrinkage and selection operator (LASSO) and multivariate logistic regression analysis. Variance inflation factors and correlation matrix plots were used to analyze multicollinearity among the variables. A nomogram was constructed to predict the probability of PVT based on independent risk factors for PVT, and its predictive performance was verified using a receiver operating characteristic curve (ROC), calibration curves, and decision curve analysis (DCA). Finally, a network calculator was constructed based on the nomograms.
RESULTS
This study enrolled 286 cirrhosis patients with PVT and 286 without PVT. LASSO analysis revealed 13 variables as strongly associated with PVT occurrence. Multivariate logistic regression analysis revealed nine indicators as independent PVT risk factors, including etiology, ascites, gastroesophageal varices, platelet count, D-dimer, portal vein diameter, portal vein velocity, aspartate transaminase to neutrophil ratio index, and platelet-to-lymphocyte ratio. LASSO and correlation matrix plot results revealed no significant multicollinearity or correlation among the variables. A nomogram was constructed based on the screened independent risk factors. The nomogram had excellent predictive performance, with an area under the ROC curve of 0.821 and 0.829 in the training and testing groups, respectively. Calibration curves and DCA revealed its good clinical performance. Finally, the optimal cutoff value for the total nomogram score was 0.513. The sensitivity and specificity of the optimal cutoff values were 0.822 and 0.706, respectively.
CONCLUSION
A nomogram for predicting PVT occurrence was successfully developed and validated, and a network calculator was constructed. This can enable clinicians to rapidly and easily identify high PVT risk groups.
Computed tomography-based radiomics diagnostic approach for differential diagnosis between early- and late-stage pancreatic ductal adenocarcinoma
Authors: Ren Shuai , Qian Li-Chao , Cao Ying-Ying , Daniels Marcus J , Song Li-Na , Tian Ying , Wang Zhong-Qiu 
Published: April 2024

BACKGROUND
One of the primary reasons for the dismal survival rates in pancreatic ductal adenocarcinoma (PDAC) is that most patients are usually diagnosed at late stages. There is an urgent unmet clinical need to identify and develop diagnostic methods that could precisely detect PDAC at its earliest stages.
AIM
To evaluate the potential value of radiomics analysis in the differentiation of early-stage PDAC from late-stage PDAC.
METHODS
A total of 71 patients with pathologically proved PDAC based on surgical resection who underwent contrast-enhanced computed tomography (CT) within 30 d prior to surgery were included in the study. Tumor staging was performed in accordance with the 8th edition of the American Joint Committee on Cancer staging system. Radiomics features were extracted from the region of interest (ROI) for each patient using Analysis Kit software. The most important and predictive radiomics features were selected using Mann-Whitney U test, univariate logistic regression analysis, and minimum redundancy maximum relevance (MRMR) method. Random forest (RF) method was used to construct the radiomics model, and 10-times leave group out cross-validation (LGOCV) method was used to validate the robustness and reproducibility of the model.
RESULTS
A total of 792 radiomics features (396 from late arterial phase and 396 from portal venous phase) were extracted from the ROI for each patient using Analysis Kit software. Nine most important and predictive features were selected using Mann-Whitney U test, univariate logistic regression analysis, and MRMR method. RF method was used to construct the radiomics model with the nine most predictive radiomics features, which showed a high discriminative ability with 97.7% accuracy, 97.6% sensitivity, 97.8% specificity, 98.4% positive predictive value, and 96.8% negative predictive value. The radiomics model was proved to be robust and reproducible using 10-times LGOCV method with an average area under the curve of 0.75 by the average performance of the 10 newly built models.
CONCLUSION
The radiomics model based on CT could serve as a promising non-invasive method in differential diagnosis between early and late stage PDAC.
Application of texture signatures based on multiparameter-magnetic resonance imaging for predicting microvascular invasion in hepatocellular carcinoma: Retrospective study
Authors: Nong Hai-Yang , Cen Yong-Yi , Qin Mi , Qin Wen-Qi , Xie You-Xiang , Li Lin , Liu Man-Rong , Ding Ke 
Published: April 2024

BACKGROUND
Despite continuous changes in treatment methods, the survival rate for advanced hepatocellular carcinoma (HCC) patients remains low, highlighting the importance of diagnostic methods for HCC.
AIM
To explore the efficacy of texture analysis based on multi-parametric magnetic resonance (MR) imaging (MRI) in predicting microvascular invasion (MVI) in preoperative HCC.
METHODS
This study included 105 patients with pathologically confirmed HCC, categorized into MVI-positive and MVI-negative groups. We employed Original Data Analysis, Principal Component Analysis, Linear Discriminant Analysis (LDA), and Non-LDA (NDA) for texture analysis using multi-parametric MR images to predict preoperative MVI. The effectiveness of texture analysis was determined using the B11 program of the MaZda4.6 software, with results expressed as the misjudgment rate (MCR).
RESULTS
Texture analysis using multi-parametric MRI, particularly the MI + PA + F dimensionality reduction method combined with NDA discrimination, demonstrated the most effective prediction of MVI in HCC. Prediction accuracy in the pulse and equilibrium phases was 83.81%. MCRs for the combination of T2-weighted imaging (T2WI), arterial phase, portal venous phase, and equilibrium phase were 22.86%, 16.19%, 20.95%, and 20.95%, respectively. The area under the curve for predicting MVI positivity was 0.844, with a sensitivity of 77.19% and specificity of 91.67%.
CONCLUSION
Texture analysis of arterial phase images demonstrated superior predictive efficacy for MVI in HCC compared to T2WI, portal venous, and equilibrium phases. This study provides an objective, non-invasive method for preoperative prediction of MVI, offering a theoretical foundation for the selection of clinical therapy.