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Background: Vitamin B12 deficiency is widely prevalent in all age groups which is of major concern. However, there is no valid Food Frequency Questionnaire (FFQ) for dietary vitamin B12 estimation. Hence, we aimed to develop and validate an FFQ for the estimation of dietary intake of Vitamin B12. Materials and Methods: Commonly consumed B12-rich food items were selected from literature and filtered using a market survey. For concordant and discriminant validation, B12 and homocysteine levels were estimated. To establish convergent validity, the Cobalamin Intake in North Indians by Food Frequency Questionnaire (COIN-FFQ) and 72-hour dietary recall (72HrDR) were both administered to the same subjects. The COIN-FFQ was readministered after initial administration for test-retest reliability. Internal consistency of the FFQ was then tested using Cronbach's alpha. Results: We enrolled 115 adults with a mean age and weight of 31.9 ± 8.7 years and 66.0 ± 11.8 kg, respectively. In total, 19.1% were vegetarian. The dietary B12 using COIN-FFQ (n = 60; mean = 4.3 ± 1.8 µg/d) was significantly correlated (r = 0.255; P = 0.049) with serum levels (mean = 120.1 ± 62.6 pmol/L) establishing concordant validity. A significant difference was noted between the dietary, serum B12, and homocysteine levels of vegetarians versus nonvegetarians establishing discriminant validity (mean diff 1.4 (0.5-2.4), P = 0.004; Z-statistic -2.182, P value 0.029, and Z-statistic -2.438; P value 0.015), respectively. FFQ was strongly correlated with 72HrDR and test--retest FFQ (n = 27; r = 0.814, P < 0.001 and r = 0.869, P < 0.001, respectively) establishing convergent validity and test--retest reliability. The internal consistency with Cronbach's alpha was in the acceptable range, 0.631 (n = 115). Conclusion: The newly developed COIN-FFQ is valid and reliable in estimating dietary B12 intake. [ABSTRACT FROM AUTHOR]

Background: There is ongoing debate around rate versus rhythm control strategies for managing atrial fibrillation (AF), however, much of the data comes from Western cohorts. Kerala‐AF represents the largest prospective AF cohort study from the Indian subcontinent. Objectives: To compare 12‐month outcomes between rate and rhythm control strategies. Methods: Patients aged ≥18 years with non‐transient AF were recruited from 53 hospitals across Kerala. Patients were stratified by rate or rhythm control. The primary outcome was a composite of all‐cause mortality, arterial thromboembolism, acute coronary syndrome or hospitalization due to heart failure or arrhythmia at 12 months. Secondary outcomes included bleeding events and individual components of the primary. Predictors of the composite outcome were analysed by logistic regression. Results: A total of 2901 patients (mean age 64.6 years, 51% female) were included (2464 rate control, 437 rhythm control). Rates of the primary composite outcome did not differ between groups (29.7% vs 30.0%; p =.955), nor did any component of the primary. Bleeding outcomes were also similar (1.6% vs 1.9%; p =.848). Independent predictors of the primary composite outcome were older age (aOR 1.01; p =.013), BMI <18 (aOR 1.51; p =.025), permanent AF (aOR 0.78; p =.010), HFpEF (aOR 1.40; p =.023), HFrEF (aOR 1.39; p =.004), chronic kidney disease (aOR 1.36; p <.001), and prior thromboembolism (aOR 1.31; p =.014). Conclusion: In the Kerala‐AF registry, 12‐month outcomes did not differ between rate and rhythm control cohorts. [ABSTRACT FROM AUTHOR]

Objectives: This study aimed to evaluate cardiac autonomic modulation using short‐term heart rate variability (HRV) and compare it among frailty statuses in older Indian adults. Methods: A total of 210 subjects aged 60 years and above were recruited into three groups: frail (n = 70), pre‐frail (n = 70), and non‐frail (n = 70) from the outpatient department of Geriatric Medicine at a tertiary care hospital in India. Frailty status was assessed using the Rockwood frailty index (FI) criteria. HRV was derived from a 5‐min ECG recording of standard limb leads and assessed using time domain, frequency domain, and nonlinear analysis of cardiac interval variability. Results: The HRV parameters indicative of parasympathetic modulation such as SDNN, SDSD, rMSSD, NN50, pNN50, absolute HF power, and SD1 were significantly lower in frail subjects compared with both pre‐frail and non‐frail subjects (P < 0.05). Absolute LF power and SD2 were also lower in frail subjects compared with pre‐frail and non‐frail subjects (P < 0.05). Measures of sympatho‐vagal balance (LF/HF and SD1/SD2 ratios) did not show statistical significance. The FI demonstrated negative correlations with all HRV parameters. Conclusions: Frail individuals exhibit decreased sympathetic and parasympathetic modulation compared with pre‐frail and non‐frail individuals, although maintaining a balanced sympatho‐vagal state. Furthermore, autonomic modulation declines progressively with increasing frailty. [ABSTRACT FROM AUTHOR]

Background and Aim: Depression is a widespread mental health condition with a significant global impact. Recent research has explored the gut--brain axis, emphasizing the role of microbiota in neurotransmitter production. This study aims to explore the effectiveness of two complementary probiotic interventions: probiotic-rich curd and probiotic capsules, used in combination with the antidepressant escitalopram over 4 weeks. The primary objectives include assessing their impact on reducing the severity of depression, comparing their effectiveness, and discussing the clinical implications of findings. Materials and Methods: We conducted a 4-week prospective observational study at the Department of Psychiatry, MGM Medical College, and the associated Mental Hospital in Indore. Ninety individuals aged 18-60, diagnosed with depression (International Classification of Diseases-10) and assessed using the Hamilton Depression Rating Scale, participated. Subjects were divided into three groups: escitalopram 10 mg (n = 30), escitalopram 10 mg + 120 mL curd (n = 30), and escitalopram 10 mg + probiotic capsule (n = 30). Assessments were conducted on days 0, 14, and 28 using the Hamilton Depression Rating Scale. Results: All treatment groups exhibited a significant reduction in mean Hamilton Depression Rating Scale scores over the study duration (P < 0.001). Notably, the probiotic group showed a slightly greater reduction in scores between day 0 and day 28 compared to the curd and escitalopram-only groups. Conclusion: The study demonstrates the potential for slightly better outcomes with probiotic interventions alongside the antidepressant escitalopram over 4 weeks. Beyond symptom relief, this approach may offer lower side effects, potentially enhancing patient adherence. Future research should investigate long-term effects and specific probiotic strains in a larger, diverse population. [ABSTRACT FROM AUTHOR]

Background and Aim: Adults with acne have been found to have a higher incidence of anxiety, depression, and suicidal ideation as compared to the general population. To the best of our knowledge, there is a dearth of studies assessing the quality of life among males with acne. This study explores the clinical patterns of acne with special emphasis on quality of life among adult males with acne vulgaris. Materials and Methods: All male patients visiting the dermatology outpatient department with acne were included after obtaining informed consent. Demographic data were recorded. Clinical assessment was done based on Global Acne Grading System (GAGS) and qualitative global acne scar grading. Assessment of quality of life was done using Dermatological Life Quality Index (DLQI) and Cardiff Acne Disability Index (CADI) in each patient. Results: Among 322 patients recruited in this study, 293 patients (91.3%) had mild acne, followed by 29 patients (8.7%) who had moderate acne as per GAGS score. The mean DLQI and CADI scores were 5.07 ± 5.0 and 4.0 ± 2.8, respectively. GAGS was found to have a significant correlation with CADI but not with DLQI. Conclusion: CADI score is an important tool which can enable dermatologists to assess the psychosocial burden of the disease in men with acne. This can enable the development of a comprehensive management plan which will enable better treatment and better quality of life in men with acne. [ABSTRACT FROM AUTHOR]

Aims and background: Acute poisoning is one of the most common emergencies in India and around the world. Understanding the factors associated with mortality can aid us in devising appropriate preventive strategies to curtail deaths due to poisoning. Purpose of this study is to find various factors that determine the mortality among acute poisoning cases admitted in a tertiary care center. Materials and methods: A retrospective hospital records-based study was conducted at Chengalpattu Medical College Hospital. The study included 2,123 cases of various poisoning cases admitted for a year from January to December 2022. Cases of bites, stings, drowning, and hanging were excluded. Information on sociodemographic profile, type of poison, time since ingestion and admission, and treatment outcome were collected using a structured pro forma. Results: The mean age of the study population was 29.90 ± 14.98 years. Poisoning was found to be predominantly among males (56.42%) and residents of rural areas (58%). Insecticide consumption (27.0%) was the most common modality, followed by oleander poisoning (20%), corrosive poison (17%), rat poison (15%), tablet poison (13%), and other poisons. The overall case fatality rate (CFR) was 5.2%, with the highest CFR of 12.25% with insecticide poisoning. In multivariate analysis, Glasgow coma scale (GCS) score at admission is the only parameter showing a statistically significant association with mortality (adjusted odds-ratio 0.271(0.2-0.38, p-value < 0.01). Conclusion: Acute poisoning primarily affects the young and economically productive population. In the south Indian population, pesticides are still the major contributor though corrosives are a major contributor among children. Mortality is still significant, and GCS status admission is the only predictor of mortality. [ABSTRACT FROM AUTHOR]

Objective: The present study aims to assess pregnancy-associated plasma protein-A (PAPP-A) and beta human chorionic gonadotropins (β-hCG) as predictive markers to diagnose Gestational Diabetes Mellitus (GDM) in the first trimester of pregnancy in a population of India. Material and Methods A retrospective observational study was conducted, wherein the cohort of 975 pregnant women were enrolled. All the patients had first trimester aneuploidy screen and 171 pregnancies were diagnosed with GDM during pregnancy. Glucose challenge or tolerance test was carried out in each trimester for detection of GDM. Results The incidence of GDM was 17.4% in the cohort. The PAPP-A value (1.2 ± 0.69 vs 1.39 ± 0.80), age (30.1 ± 3.8 vs 28.4 ± 3.7 (years)), and Body Mass Index (24.09 ± 5.1 vs 21.71 ± 4.04) were significantly different in GDM group and non-GDM group respectively. The Receiver Operating Characteristic (ROC) curve provided the value of 0.57 as an area under the curve for the exclusion of GDM. A cutoff value of PAPP-A ≤0.95 MoM was found to have a sensitivity of 45% and a 70% specificity value for the diagnosis of GDM. The β-hCG values were statistically identical between GDM and non-GDM groups. Conclusion: This study demonstrates that PAPP-A MoM is inversely proportionate to GDM. The low normal value is associated with GDM. Hence, it can be a part of the early screening GDM tool but not sufficient as an individual screening test. Hence, glucose tolerance test is recommended for diagnosis of GDM. Pregnancies with GDM have decreased β-hCG, however, it was not significant. [ABSTRACT FROM AUTHOR]

Background: Suicide is a primary health concern worldwide, and has a negative impact on the individual, family, and society. The literature suggests that females are more prone to attempt suicide and have more suicidal inclinations; however, males are more serious suicide attempters compared to females. Objective: The objective of this study was to assess the sociodemographic and clinical profile of patients admitted to acute care with the current suicide attempt. Materials and Methods: One hundred consecutive patients, aged between 18 and 60 years, who were medically stable and presented to the emergency or medical wards at the hospital with suicidal attempt, were included in this study. Beck's Suicide Intent Scale (SIS), Beck Scale for Suicidal Ideation, Beck Hopelessness Scale, and Beck Depression Inventory--II were administered to assess the current suicidal intent and ideation, depression, and hopelessness. Results: The diagnostic breakup was -- 69% mood (affective) disorders, 21% adjustment disorders, 4% schizophrenia, and 6% other disorders. Most suicide attempters were female (66% vs. 34%) and belonged to a younger age group (28.30 ± 10.08 years vs. 34.73 ± 13.97 years) compared to males (P < 0.05). Although both genders displayed high suicide intent, a significant difference in the SIS score was noted between females and males (36.53 ± 7.68 vs. 41.47 ± 8.82; P < 0.05). Conclusion: There is a difference in the clinical and demographic profile among male and female suicide attempters. Hence, appropriate interventions can be devised to prevent the future suicide attempts as per the demographic and clinical characteristics specific to the study population. [ABSTRACT FROM AUTHOR]

Background: Tuberculosis and diabetes both diseases are present in large numbers in the country and we are major contributors to both globally. With the objective to understand the various traits of patients having both tuberculosis and diabetes and to ascertain various possible predictors for such occurrence based on the public health database we carried out this study. We seek answers to questions like they have any effects? Are they having any additive role to play? Methods: One-year data from the NIKSHAY portal of both districts were analyzed to look for possible associations and other variable traits. Data were analyzed using standard methods to express data in frequency and percentage. Chi-square test was used to establish association, while step-wise approach was used to calculate univariate and multivariate logistic regression analysis for knowing various predictors. P-value of <0.05 was considered statistically significant. Results: Concurrent diabetes in tuberculosis patients was close to 294 (6%) in the 4933 individuals. In total, 65.2% of the study population were male. Diagnosis of tuberculosis was made most of the time by chest X-ray (49.4%) followed by Microscopy ZN staining and cartridge-based nucleic acid amplification test (CBNAAT). Death was more among diabetics (4.4%) as compared to nondiabetics (3.5%). Conclusion: Diabetes is increasing in tuberculosis patients; improvement in data quality is needed. More research is required to reveal various other reasons that make tuberculosis patients more prone to develop diabetes. [ABSTRACT FROM AUTHOR]

Male participation in reproductive and child health improves breastfeeding rates. The role of fathers in breastfeeding may be crucial in improving exclusive breastfeeding (EBF) rates. This study explored the fathers' attitudes and support and its association with EBF in mothers with infants attending a rural primary health center in Karnataka. A cross-sectional descriptive study was conducted on mothers with infants visiting a rural primary health center between December 2020 and February 2021. A pretested semi-structured questionnaire was used to collect data to ascertain the exclusivity of breastfeeding and other sociodemographic factors. The fathers' attitudes and support toward mothers during and after pregnancy were measured on a 5-point Likert scale. Quantitative variables were expressed in median and interquartile ranges, and qualitative variables were expressed using percentages and proportions. The association was determined using the Chi-square test and Spearman's correlation test. The data were collected using Epi Data and analyzed using Epi info v 3. A total of 169 mothers participated in the study. The self-reported EBF was 148 (87.1%). The fathers' attitudes and support to the mothers were found to be more favorable during the antenatal period in 97% of the women. The fathers' attitudes and support in the antenatal period and after delivery were not associated with the mothers' exclusivity in breastfeeding. The present study concluded that there is no association between the fathers' attitudes and support before and after the delivery of the infant and mothers' exclusivity in breastfeeding. [ABSTRACT FROM AUTHOR]

Background: Cancer has been the leading cause of death worldwide, and palliative care is an approach that improves the quality of life (QoL) of patients and their families facing the problem associated with life-threatening illness. Hospice care helps patients and their family to cope with the change from treating the cancer to living life as fully as possible through their final days. This study aimed to (1) assess the sociodemographic and clinical profile of terminally ill cancer patients, (2) assess the QoL among terminally ill cancer patients receiving palliative care, and (3) study various determinants affecting their QoL. Material and Methods: A cross-sectional study was conducted among terminally ill cancer patients receiving palliative care at the Hospice Centre, Community Oncology Centre, Ahmedabad. Based on previous years' admission data, a sample size of 360 was taken. Patients who are seriously ill up to the extent that they were unable to respond and had a previous positive history of psychiatric illness before the diagnosis of cancer were excluded. Institutional ethical committee (IEC) permission was obtained before the study. Statistical analysis was performed using the Chi-square test in Statistical Package for the Social Sciences (SPSS) software. Results: The mean age of participants was 48.1 ± 13.0 years. The gender distribution of participants was males and females (226 (62.8%) and 134 (37.2%)), respectively. On studying, the involvement of various anatomical sites as "primary site of cancer" revealed that head and neck carcinoma had the highest (63.3%) involvement and hematological cancer had the lowest (0.6%) involvement. Of total, 62% of participants had "below-average QoL," followed by 34.9% of participants having "significantly poor QoL." There was a significant association between different age groups, time lag in cancer diagnosis, and treatment initiation and QoL. Conclusion: Spearman's rank correlations between the majority of factors fell in "low partially positive" category except for the physical well-being (factor 2) and psychosocial well-being (factor 3) with optimism and belief (factor 7), where they were in "low partially negative" category. [ABSTRACT FROM AUTHOR]

Background: Immunization is a cost-effective weapon against vaccine preventable diseases. Children of migrant workers suffer from lack of immunization because of frequent shift of places, poor knowledge, and low socioeconomic status. To assess the immunization status of children 12--36 months of age of migrant workers and factors associated it. To identify the reasons for non-immunization or partial immunization among these children. Material and Methods: A cross-sectional study was conducted among 500 migrant workers' children aged 12--36 months residing in Urban Bangalore east from February 2019 to August 2020. A cluster sampling method was incorporated. The data were collected using pre-tested semi-structured questionnaire. Data were analyzed using Epi-info™ Version 7.2.1 and SPSS version-21. Data were summarized in percentages, mean, standard deviation, and logistic regression. Results: The mean age of the children was 25.2340 ± 8.42 months. Out of 500 children, 88.60% were fully immunized, 11.40% were partially immunized, and no child was unimmunized. Significant predictors of immunization status of children were education of father and immunization card. Common reasons for dropout were inconvenient time (80.70%), unaware of need (77.19%), and busy schedule of parents (75.44%). The dropout rate of BCG to MR-1, Penta-1 to Penta-3, and Penta1to MR-1 was 6.49%, 0.85%, and 2.12%, respectively. Conclusions: Immunization coverage in the present study was 88.60%. Inconvenient time was the main reason behind partial immunization. [ABSTRACT FROM AUTHOR]

Background and Aim: Kidney dysfunction is reported in significant number of beta thalassemia major children. The aim of this study was to determine the prevalence of glomerular dysfunction in beta-thalassemia major children on regular blood transfusion (BT) and chelation therapy, and to find the correlation between glomerular filtration rate (GFR) estimated by Schwartz formula and Technetium 99m diethylenetriaminepentaacetic acid (99mTc-DTPA) renogram with ferritin level and cumulative transfusion load. Materials and Methods: An observational cross-sectional study conducted was done on 110 children diagnosed with beta-thalassemia major receiving regular BT and chelation therapy. Clinical examination, biochemical investigations (serum creatinine, ferritin) and DTPA renal scan were done. Estimated GFR calculation was done by Schwartz method and 99mTc-DTPA scan. The normal values of GFR were taken from the standard value as per KDIGO guidelines. P < 0.05 was considered statistically significant. Results: The prevalence of glomerular dysfunction by Schwartz formula and DTPA renogram was 44% and 24%, respectively. The GFR calculation (Schwartz formula and DTPA renogram) were weakly positively correlated (r = 0.126, P = 0.547). There was significant association between GFR Schwartz and duration of iron chelation, as children with abnormal GFR had significantly more duration of iron chelation >5 years (28% vs. 4%, P = 0.003). GFR (Schwartz formula and DTPA renogram) showed no association with cumulative transfusion load and disease duration (P > 0.05). GFR Schwartz formula and GFR-DTPA showed no correlation with serum ferritin with r = 0.179, (P = 0.392) and r = 0.278 (P = 0.178). Conclusion: There is a significant derangement in the renal function of children of beta-thalassemia major on chronic BT and iron chelation therapy. GFR holds a direct correlation with the increasing duration of iron chelation. [ABSTRACT FROM AUTHOR]

India is a land of unity in diversity and it is not only true about its sociocultural but also holds residential areas too. Rural and urban areas associated with different sociostructural characteristics may contribute variation in behavioural adaptation. We studied the impact of rural-urban differences on the acceptance level and meaning of life among breast cancer patients in India. The present analytical descriptive cross-sectional study was conducted under superspecialty hospital, West Bengal, India. We compared the acceptance capability and meaning in life in breast cancer patients from rural areas (N = 122) and urban areas (N = 99). Patient-reported data concerning selected psychological (acceptance ability and the meaning of life), sociodemographic, and biological factors were collected by using validated tools. To identify the impact of sociocultural variation, descriptive statistics were calculated as the mean ± standard deviation of the score of validated tools based on acceptance and meaning of life. Patients from urban areas perceived meaning of life significantly worse than rural individuals (33.1 ± 2.44 vs. 24.2 ± 1.02). Education (p = < 0.01), family per capita income (p = 0 < 0.01), and family structure (p = 0.004) factors were evaluated for being predictors of acceptance levels, whereas the educational level (p = < 0.01) has significantly interacted with the meaning of life among both areas' patients. Disease acceptance levels were found to be significantly higher in urban area's patients than rural ones (38.6 ± 1.9 vs. 32.7 ± 1.92). The current study demonstrates that the patients of rural background and low education are more likely than their respective counterparts to have a lower level of acceptance capability and meaning of life. [ABSTRACT FROM AUTHOR]

Background: Amputation of a limb is equivalent to loss of a person's life. Psychological aspects are essential factors in dealing with the disability and functional outcome is a significant concern. Longitudinal studies have not examined the experience and determinants of common mental health problems and functional outcome in lower limb amputees. Materials and Methodology: A total of 103 lower limb amputees were recruited and followed up for 6 months. Patients were assessed on Hospital Anxiety and Depression Scale (HADS) and Social Functioning (SF-36) Quality of life, semi-structured clinical interview for psychiatric disorders and phantom limb at baseline (in hospital), at 2 weeks, 3 months and 6 months, respectively after discharge. Holistic care was provided through psychological counselling, supportive sessions, medications if required, rehabilitation counselling, prosthesis implantation, and treatment as usual. Results: Holistic care resulted in a statistically significant reduction in anxiety, depression and overall psychiatric morbidity as measured on HADS (p < 0.001). There was a significant improvement in all the domains of SF-36 (p -< 0.001) except the role of limitation due to physical activity. The intervention also resulted in a statistically significant reduction in the presence of phantom limbs. Conclusion: Amputees should be provided holistic care under one roof, which was found to be very useful in treating psychiatric morbidity, social functioning and quality of life. [ABSTRACT FROM AUTHOR]

Background. This cross-sectional study investigated root caries prevalence among older adults in Miraj, India. Methods. Stratified cluster sampling was used; 891 (5%) of households were randomly selected in each of the nine wards in Miraj. Between January and June 2022, individuals aged ≥55 years from the selected households were invited to undergo oral examination. Root caries status was determined using the root caries index. Periodontal status was determined using the Community Periodontal Index. Sugar intake was determined using the sweet score. Data on the use of tobacco products and oral hygiene practices were collected using a self-administered questionnaire. Results. Of 1756 participants, 493 (28.1%) had root caries. The mean root caries index was 1.72±0.44, and the prevalence of recession with decay was 2.0%. The prevalences of periodontal pockets and loss of attachment were 10.5% and 92.6%, respectively. Caries was present in 82.0% of participants with a sugar score in the ‘watch out zone’ and 13.3% of participants with a ‘good’ sugar score. Conclusions. 28.1% of older adults in Miraj had root caries. No root caries had fillings, which suggests low emphasis on oral health. Caries prevention measures should be implemented for older adults. [ABSTRACT FROM AUTHOR]

Context: Kidney transplant recipients (KTRs) represent a high-risk population but were grossly underrepresented in COVID-19 vaccination trials. Aims: The aim was to study the immunogenicity of two COVID-19 vaccines (Covaxin and Covishield) among KTRs. Subjects and Methods: We conducted a prospective observational study among KTRs who consented to receive two doses of the COVID-19 vaccine – either Covaxin or Covishield. Patients who underwent kidney transplant during the previous 6 months or had received antirejection therapy during the previous 1 month were excluded from the study. Antibody titers to the spike protein of COVID-19 were measured at baseline and at 4 weeks after the second dose of the vaccine. Statistical Analysis: A univariate analysis was performed in the subgroup of patients who were seronegative at baseline, to identify factors that were associated with seroconversion. The Chi-square test or the Fisher's exact test was used to compare categorical variables, and the Mann–Whitney U-test was used to compare continuous variables. P < 0.05 was considered statistically significant. Results: A total of 150 KTRs were studied, of whom 98 received Covaxin and 52 received Covishield. At baseline, even before vaccination, 63.3% of patients (n = 95) were found to be seropositive. Among those who were seronegative (n = 55) at baseline, seroconversion was noted in 34.5% of patients (n = 19), of which 15.7% (n = 3) had a robust response with antibody titers >250 U/mL. Conclusions: Among KTRs who were seronegative at baseline, a seroconversion rate of 34.5% was demonstrated after two doses of Covaxin or Covishield. [ABSTRACT FROM AUTHOR]

Introduction: Being diagnosed with breast cancer or receiving surgery, radiation or chemotherapy as a treatment modality in itself is seen as a traumatic experience for many women. This emotional distress is in turn associated with reduced quality of life and can pose a negative influence on compliance with treatment. Ultimately leading to an elevated risk of mortality which is also seen as the sixth vital sign in cancer care. Aim & Objectives: The purpose of our study is to estimate the prevalence of depression and anxiety in breast cancer patients and their correlation with socio-demographic factors. Materials and Methods: A cohort of 140 breast cancer patients registered in the Department of Radiation Oncology, SMS medical College, Jaipur from January 2022 to December 2022 were recruited and interviewed with a structured questionnaire including socio-clinical and demographic factors and PHQ-2 and GAD-2 scales. Results: Prevalence of depression among patients were 37.9% (53/140) and almost one third (33.6%, 47/140) of cases had anxiety. Around two thirds (69.3%, 97/140) cases had stage III breast cancer, followed by stage II in 23 (16.4%) cases and 20 (14.3%) cases had IV stage breast cancer. The place of residence, educational status, employment status, accompanying person and marital status emerged as significant predictors of depression risk, while age group, marital status and financial status were found to have statistically significant association with elevated anxiety symptoms. Conclusion: This study shows that prevalence of anxiety and depression in breast cancer patients is high and patients from rural areas, single, low monthly income, younger age group and low education level were more prone. Therefore, special care and support and often referral to psychiatry department may be required in such group of patients. [ABSTRACT FROM AUTHOR]

Context: Loneliness is a psychosocial problem that can affect anyone at any age in any circumstances, but it has become a serious issue of concern among the elderly. Aim: The present study aims to examine the overall and state and union-territories-wise prevalence of loneliness among India's elderly population and exploring the correlates of loneliness in old age. Method: The study is based on secondary data from Longitudinal Ageing Study in India (LASI) Wave-1 (2017-2018) data collected from a total of 30,394 older adults aged 60 and above excluding missing responses. Frequent loneliness was measured using a single question asking how often you feel alone. Statistical Analysis Used: Descriptive statistics, the Chi-square test, and bivariate logistic regression were used to meet the objectives. The statistical significance was set at <0.05. Results: 13.4% of elderly reported frequent loneliness. The prevalence of loneliness among elderly was found to be maximum in Andaman and Nicobar Island and minimum in Tripura. Age, current marital status, region, religion, MPCE quintile, number of chronic conditions, number of Activities of Daily Living (ADL), and Instrumental Activities of Daily Living (IADL) difficulties, involvement in physical activity, involvement in yoga/meditation, number of social networks, participation in social activities, and involvement in leisure activities like reading books, watching TV, or using computer were found to be significantly associated with loneliness. Conclusion: Not being in a marital union, having more than two chronic conditions, more than two ADL and IADL difficulties, being physically inactive, non-involvement in Yoga/Meditation, and small social network are associated with higher loneliness. [ABSTRACT FROM AUTHOR]

Background: This research aimed to evaluate the clinico-epidemiological profile and short-term outcomes of patients admitted to the emergency department of a tertiary hospital. Materials and Methods: This prospective observational cross-sectional study was conducted between January 1, 2021, and June 30, 2022, in the Emergency Department of a tertiary hospital. Patients of either gender of any age attending the emergency department with acute poisoning were included. These cases were analyzed for their epidemiological profiles, poisoning characteristics, and various clinical variables influencing patient outcomes. Results: Out of a total of 236 patients, 190 patients (80.5%) were aged more than 18 years. Comorbidities were present in 32 (13.5%) patients, and psychiatric illness was the most common comorbidity. The intention of poisoning was suicidal in 185 patients (78.4%) and accidental in 51 patients (21.6%). Organophosphate was the most common poisoning seen in 55 patients (23.3%), followed by drug ingestion seen in 44 patients (18.6%). Twenty-eight patients (11.8%) were transferred to the intensive care unit. Nineteen patients (8.1%) required mechanical ventilation. There were ten deaths (4.2%) in the study population. Aluminum phosphide poisoning was associated with the highest mortality rate, followed by organophosphate poisoning. Conclusions: This study indicates that most poisoning cases involved young people, mainly males. Organophosphorus poisoning was one of the most common poisonings, followed by the ingestion of drugs in this part of the world. Aluminum phosphide had the highest fatality rate. [ABSTRACT FROM AUTHOR]

Background Tuberculosis (TB) is well-known for causing wasting. Patients on treatment gain weight and weight loss is associated with unfavorable treatment outcomes. There is limited description of weight loss and its predictors during intensive treatment phase. The objective of this study was to assess the predictors of weight loss during intensive phase and to see if there is any association exists with sputum conversion at the end of intensive phase of treatment. Methods Data collected as a part of the prospective TB cohort (Regional Prospective Observational Research for TB India Phase 1) conducted in Pondicherry, Cuddalore and Viluppuram districts of Tamil Nadu were used for this study. Sputum smear and body weight comparison were made in the baseline and at the end of second month of treatment. Results In all, 726 participants had weight measurements at the two time points and 18.7% had weight loss; mean weight lost being 2.3 kg (SD 3.05). Mean weight loss was more among males (2.4 kg, SD 3.2), diabetics (2.8 kg, SD 3.9) and alcoholics (2.1 kg, SD 2.4). Alcohol consumption was the only predictor of weight loss after adjusting for age, diabetes, marital status and BMI (aRR 1.52, P 0.02). Weight loss was not associated with sputum conversion at the end of second month. Conclusions Alcohol use emerged as the major predictor for weight loss during intensive phase. [ABSTRACT FROM AUTHOR]

Background: Estimating the morbidity and mortality in the emergency department (ED) only allows the pediatricians to assess the prognosis of the patient and plan therapies accordingly. This study was conducted to develop and validate a simple scoring system and establish a correlation between clinical parameters and the outcome of the patient. Subjects and Methods: Nine parameters, i.e., body temperature, respiratory rate, heart rate, blood pressure (BP), pulse oxygen saturation (SpO2), capillary refill time, level of sensorium, presence of seizure, and random blood sugar level, were documented, at the time of admission. Parameters were assigned a score of "0" if it is normal. An abnormality in the above parameters were indicated by a score ranging from 1 to 3. The primary outcome was assessed in terms of death/survival. Results: Out of the total, 57.2% required critical care, and mortality was reported in 14.75% of cases. On univariate analysis, seven clinical parameters were significantly associated with mortality. In multivariate logistic regression analysis, abnormalities in BP, SpO2, and temperature were independent predictors of mortality (P < 0.05). The receiver operating characteristic was 0.798 (95% confidence interval, 0.755-0.836; P < 0.0001) for the outcome of mortality (the predictive ability of score of 79.8%). The patients with scores 1-5, 6-10, and >10 had 4.923, 23.143, and 112.0 higher odds of mortality, respectively. Conclusions: This scoring system predicts the severity of illness and outcome with a sensitivity of 71.19% and specificity of 72.14%, respectively, in the ED. Higher scores predict unfavorable outcomes in these children. [ABSTRACT FROM AUTHOR]

Background: The co-infection of human immunodeficiency virus-tuberculosis (HIV-TB) is a serious public health concern and aptly called the 'deadly duo'. Recognising the determinants of the co-infection will help target the vulnerable population for prevention and reduce mortality. Aims: The objective of this study was to estimate the proportion of HIV-TB co-infection among adults attending the antiretroviral therapy (ART) centre at a tertiary healthcare facility and associated clinico-epidemiological determinants. Patients and Methods: A cross-sectional analytical research that lasted for 6 months was conducted at the ART Centre of Medical College, Gwalior, Madhya Pradesh. According to the inclusion criteria, 251 newly diagnosed HIV patients were enrolled in the study. The pro forma administered by the interviewer was utilised to collect the socio-demographic information at the time of enrolment by face-to-face interviews. To gather the clinical details, records were reviewed. A Chi-square test of significance was used to determine the difference between proportions after descriptive analysis. Variables found significant in bivariate analysis were put in multivariate logistic regression to predict HIV-TB co-infection. The odds ratio was estimated at 95% confidence interval (CI). Results: Among the participants, 27.5% of the 251 people had both TB and HIV. Males who were employed as labourers (X2 = 25.5, df = 4 and P = 0.001) were epidemiologically more likely to get co-infection. In comparison to the other group of HIV-only patients, the CD4+ count of co-infected individuals was considerably lower (X2 = 6.37, df = 3 and P < 0.01). Clinical staging of HIV (adjusted odds ratio [aOR] =4.70, 95% CI 2.34–9.43; P = 0.001), body mass index (aOR = 0.46, 95% CI 0.013; P = 0.25–0.85) and CD4+ count (aOR = 0.22, 95% CI 0.08–0.60; P = 0.003) were found to predict HIV-TB co-infection among people living with HIV (PLHIV). Conclusion: The study concludes, being underweight with an advanced clinical staging (World Health Organisation Clinical Stage III or IV of HIV) and a CD4+ count equal to or below 300 cells/μL increase the vulnerability of HIV-TB co-infection among adult PLHIV. [ABSTRACT FROM AUTHOR]

Background: Peripherally inserted central catheters (PICCs) are central venous catheters inserted peripherally but terminate in great vessels. PICCs are widely used for patients requiring long-term intravenous therapy in both in-patient and out-patient settings. Aim: This study was carried out to understand PICC-related complications, specifically infections and causal pathogens, in a tertiary care hospital in Kerala, South India. Methods: A retrospective analysis of PICC insertions and follow-up during a 9 years period to look at patient demographics and infections related to PICC was carried out. Results: The overall PICC-related complication rate is 28.1% (4.98 per 1000 PICC days). Commonest complication was thrombosis followed by infection, either PICC-associated bloodstream infection (PABSI) or local infection (LI). PABSI noted in this study was 1.34 per 1000 catheter days. The majority (85%) of PABSI were due to Gram-negative rods. The average duration of PICC days for occurrence of PABSI was 14 days and the majority occurred in in-patients. Conclusion: Thrombosis and infection were the commonest PICC-related complications. PABSI rate was comparable to that of previous studies. [ABSTRACT FROM AUTHOR]

Introduction: India has a huge burden of HIV/AIDS infection. Tenofovir-based first-line therapy is the preferred treatment for newly diagnosed cases of HIV infection. Materials and Methods: The present prospective study was done among newly diagnosed cases of HIV infection. The patients were followed up for 6 months from the day of enrollment. Sociodemographic parameters, CD4 counts, and adverse drug reactions (ADRs) were analyzed at baseline and after 6 months. Bivariate and multivariate logistic regression was performed with the occurrence of ADRs as outcome variable. Results: In this study, 67 patients were enrolled with a mean age of 32.75 (±14.39) years. Mean CD4 count at the start of treatment was 241.5/mm3. The mean difference in CD4 count was 383.05/mm3 (standard deviation = 274.9). Dizziness, tingling, numbness of extremities, and muscle cramps were the most common adverse effects. On multivariate logistic regression, the occurrence of ADRs was seen to be significantly higher only in illiterate patients. Conclusion: The present study highlights the importance of long-term follow-up of the patients on antiretroviral therapy. Adequate monitoring of the treatment parameters is of utmost importance. [ABSTRACT FROM AUTHOR]

Background: The present study was aimed to find the correlation of electrocardiographic changes with epicardial thrombolysis in myocardial infarction (TIMI) flow grade and TIMI myocardial perfusion grade (TMPG) after reperfusion in ST-elevation myocardial infarction (STEMI). Methods: One hundred and fifty patients with STEMI were included. Reperfusion was done either by thrombolysis or primary percutaneous coronary intervention. The summed absolute ST-segment deviation and summed relative ST-segment deviation were calculated. TIMI and TMPG were assessed. The primary outcome measures were to study the correlation of summed absolute ST deviation and summed relative ST deviation with TIMI flow grade and TMPG after reperfusion. The secondary outcome measures were to compare TIMI flow grade and TMPG with respect to time since symptom onset to treatment and T-wave inversion after reperfusion. Results: There was a significant positive correlation between relative ST-segment deviation that occurred after reperfusion with TIMI flow grade (r = 0.475) and TMPG (r = 0.376). There was a significant negative correlation between absolute ST-segment deviation that occurred after reperfusion with TIMI flow grade (r = -0.194) and TMPG (r = -0.288). A significantly higher percentage (87.4%) of patients who got treatment within 1 h showed TMPG 2 and 3. A significantly higher percentage of patients who had T-wave inversion after reperfusion had TIMI flow Grade 3 and TMPG 2 and 3. Conclusions: There was a significant positive correlation between relative ST-segment deviation and significant negative correlation between absolute ST-segment deviation after reperfusion with TIMI flow grade and TMPG. [ABSTRACT FROM AUTHOR]

Background: Compared to a healthy population, sexual dysfunction is higher in major depressive disorder (MDD). Identification and management of sexual dysfunction profoundly impact marital satisfaction, quality of life, and compliance with treatment in patients with depression. Aims and Objectives: The primary objective was to determine the proportion of sexual dysfunction among women suffering from MDD attending the psychiatry department of a tertiary care center. The secondary objectives were (1) to study the correlation between the severity of depression and sexual dysfunction in women with MDD and (2) to study the relationship between sociodemographic and clinical variables with sexual dysfunction. Settings and Design: This was a cross-sectional study carried out among 40 women diagnosed with MDD attending the psychiatry department of our tertiary care institute. Materials and Methods: After taking informed consent, relevant sociodemographic details and clinical variables were recorded using a semi-structured questionnaire. MDD was diagnosed according to the Diagnostic Statistical Manual of Mental Disorders-Fifth Edition, and its severity was assessed using Hamilton rating scale for depression. Sexual dysfunction was measured using the Arizona sexual experience scale. Statistical Analysis: Spearman's correlation coefficient was used to assess the correlation between the severity of depression and sexual dysfunction. The Chi-square test was used to test the relationship between categorical variables. Analysis of data was done using appropriate statistical software. Results: The proportion of sexual dysfunction among women with MDD was 65%. The most common sexual dysfunction was low sexual desire (57.5%). There was a positive correlation between the severity of depression and the presence of sexual dysfunction, with Spearman's correlation coefficient (rho = 0.765, P = 0.000). Age, attainment of menopause, history of alcohol and tobacco use in the spouse, and severity of depression were significant with sexual dysfunction using the Chi-square test. Conclusions: The proportion of sexual dysfunction was high among women suffering from MDD. The severity of depression and the presence of sexual dysfunction are positively correlated. [ABSTRACT FROM AUTHOR]

Background: Psychological impact of COVID-19 is an emerging area of interest among researchers worldwide. We aimed to study the prevalence of anxiety and depression among COVID-19 survivors and its association with individual characteristics including demographic variables. Methods: One hundred and fifty COVID-19 survivors from a tertiary care hospital were contacted to collect information regarding anxiety and depression using the Generalized Anxiety Disorder-7 (GAD-7) scale and Patient Health Questionnaire-9 (PHQ-9). The Pearson's Chi-square was used for univariate analysis of categorical variables. The Mann–Whitney test was used to check the significance between group medians. Results: 21.3% of the survivors (n = 32) reported postdischarge COVID-19 anxiety. Mild, moderate, and moderately severe anxiety was reported by 17.3%, 3.3%, and 0.7% of the patients, respectively, on using the GAD-7 questionnaire. PHQ-9 revealed that 29.3% (n = 44) had depression. Minimal, mild, moderate, and moderately severe depression was reported by 19.3%, 24.0%, 2.0%, and 3.3% of the respondents, respectively. None of the survivors had severe anxiety or depression. In both the questionnaires, variation in median scores was statistically significant with age, whereas for GAD-7 scores, the difference in median scores was statistically significant only for gender. On analysis, age above 40 years was a statistically significant determinant for both anxiety (P = 0.041) and depression (P = 0.018) while male gender showed a statistically significant association in case of anxiety (P = 0.028). The correlation between age and respective scores and GAD-7 scores and PHQ-9 scores was also found to be significant (P < 0.001). Conclusion: These preliminary screening results provide convincing evidence of anxiety and depression among COVID-19 survivors, thus reiterating the need of timely detection and management of mental health issues through formulation of strategies to tackle the concurrent psychological comorbidities amid the ongoing pandemic. [ABSTRACT FROM AUTHOR]

Introduction: General trust and trust in various social institutions/agents are argued to positively influence the outcome, more so, in a crisis. Mitigating a crisis requires actions from individuals, family, friends, co-workers, various policymaking, and implementing agencies, media, and other agencies with whom people interact. In the COVID-19 situation, people individuals did not have a choice but to access essential services even with the risk of infection. Personal experiences also guide individuals’ trust in various social groups and are responsible for taking individual action of protecting themselves in the pandemic. To what extent people trusted various social groups and observed appropriate behavior is investigated in this research. Methods: Responses were collected through a structured, web-based questionnaire where respondents self-reported their trust in various social agents and the extent to which they observed COVID-appropriate behavior. Respondents primarily belonged to the eastern part of India. Results: This study finds significant demographic differences in observing appropriate behavior leading to an identification of a vulnerable group. Second, trust in the inner group (family, friends, neighbors, and co-workers among others) is least important whereas trust in professionals and administrative institutions is the most important. Trust in the central government, media, and politicians among others is counterproductive to observing the appropriate behavior. Conclusion: People repose higher trust in professionals and administrative institutions in a crisis situation. Professional and administrative leadership helps in more effective crisis management leading to better behavioral compliance of the public. Any other leadership may be ineffective or counter‑productive. [ABSTRACT FROM AUTHOR]

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Aim: To find out the normal mean oral temperature in the Indian population as per a longitudinal study. Background: 98.6°F is generally accepted as normal body temperature as defined by Wunderlich (1868) and later challenged by Mackowiak (1992) and Protsiv (2020) who concluded it as 98.2°F based on cross-sectional studies. Hence, the normal body temperature at present needs quantification as per a longitudinal study in Indians. Patients and Methods: A longitudinal study on the healthy population of Northern India was followed-up over 1 year. Participants were advised for self-monitoring of oral temperature with a standard digital thermometer in either left or right sublingual pocket and record it in the thermometry diary. The study was considered complete if the participant had all three phases of the study (i.e., non-febrile, febrile and post-febrile phases) or completed the duration of the study. Results: The mean oral temperature of the participants (n = 144) during the non-febrile and post-febrile phases (temperature readings = 6543) were 98.0°F (standard deviation [SD], 0.61) and 98.01°F (SD, 0.60), respectively (P < 0.001). With the diurnal variability, the morning (am), noon (an) and afternoon (pm) mean temperatures were 97.91°F, 98.08°F and 98.27°F (P < 0.001), respectively, during the non-febrile phase. Similar trends were observed in variability among men and women, seasons and across post-febrile phase. Conclusions: The mean oral temperature was 98.0°F (SD, 0.61). The temperature was as low as 96.9°F and as high as 99.1°F. The temperature during the post-febrile phase was found to be higher than the non-febrile phase temperature such as pm over an and am, women over men, summer over other seasons in the non-febrile phase and spring over others in the post-febrile phase. [ABSTRACT FROM AUTHOR]

Introduction: Isavuconazole is an emerging therapeutic option for invasive infections caused by molds, especially aspergillosis and mucormycosis. Isavuconazole has predictable pharmacokinetics and good bioavailability. These attributes have led to some doubts regarding the need for therapeutic drug monitoring (TDM). There are no data from India regarding TDM for isavuconazole. Methods: A retrospective analysis of 50 patients who received oral isavuconazole for therapeutic purposes. Plasma isavuconazole levels were measured using a reversed phase high-performance liquid chromatography (HPLC) and UV detector with acetonitrile (ACN) as protein precipitating solvent. Results: Of the 50 cases, 5 (10.0%) patients had subtherapeutic levels, while 45 (90.0%) had therapeutic levels. Higher body weight and solid organ transplantation (SOT) were significantly associated with subtherapeutic levels of isavuconazole (p-value < 0.05 for all). Receipt of a SOT was the only independent and statistically significant factor which was associated with subtherapeutic levels of isavuconazole (p-value < 0.05). Conclusion: Our study reemphasizes the need of TDM for isavuconazole and adds to the growing evidence for the need to obtain drug levels. Factors associated with subtherapeutic levels of isavuconazole need to be assessed in larger studies to help identify those patients who are at risk of having subtherapeutic drug levels. [ABSTRACT FROM AUTHOR]

Background: There are various factors including inflammation that have been studied in bipolar disorder. NLR (Neutrophil to lymphocyte ratio) and PLR (platelet to lymphocyte ratio) are one of them. Various psychotropic drugs can affect the inflammatory state. Aim: This study was planned to find NLR and PLR in bipolar disorder (mania) and psychotropic drug naïve 1st episode mania. Materials and Methods: Total of 120 subjects were chosen including, 40 bipolar mania, 40 drugs naïve 1st episode mania, and 40 healthy controls. The severity of mania was assessed by the Young Mania Rating Scale. Blood samples were collected in the morning hours in order to get blood counts. Results: A significantly higher values of neutrophil counts and NLR, while the significant lower values of lymphocyte counts in both 1st episode and bipolar mania compared to healthy control were observed. The first episode mania group had significantly higher neutrophil counts and NLR in comparison to bipolar mania. Conclusion: Results suggest a possible inflammatory pathophysiology of mania. Psychotropic medicines may have an anti-inflammatory effect, signified by the fact that 1st episode mania group has a greater level of inflammation in comparison to bipolar mania. [ABSTRACT FROM AUTHOR]

Objectives: Hypertension is one of the essential modifiable risk factors in causing stroke, renal disease, cardiovascular diseases, and peripheral artery disease. Epicardial fat tissue is regarded as endocrine organ and is metabolically active as it produces angiotensinogen and free fatty acids which are proinflammatory cytokines and are atherogenic. The presence of microalbuminuria has been associated with endothelial dysfunction that predisposes to cardiovascular events. The aim of this study is to determine the association of epicardial fat tissue with age, sex, serum creatinine, left ventricular (LV) mass, serum albumin, low-density lipoprotein (LDL), and triglycerides in patients with essential hypertension. Materials and Methods: One hundred patients with essential hypertension were divided into two groups each having 50 patients. Group A included urinary albumin creatinine ratio (UACR) <30 mg/g. Group B included UACR >30 mg/g. Age, body mass index, blood pressure, creatinine, urea, albumin, LDL, triglycerides, and epicardial adipose tissue thickness (EAT) were evaluated and compared between two groups. All patients underwent UACR, transthoracic echocardiography to determine EAT, LV mass, and ejection fraction. Results: In our study, EAT ranged from 2 mm to 6.9 mm, with mean value of 3.21 mm and 5.12 mm in Groups A and B, respectively. Mean EAT values were found to be higher in Group B compared to A and was found to be statistically significant. Similarly, LDL, triglycerides, serum albumin levels, and LV mass showed significant difference among two groups. Serum albumin level in Group B was significantly reduced than the patients with normal urine albumin creatinine ratio. Conclusion: EAT serve as an important indicator in patients with essential hypertension to determine target organ damage and to stratify high risk group. [ABSTRACT FROM AUTHOR]

Introduction: Mental disorders are quite common in association with human immunodeficiency virus (HIV). Mental disorders are more prevalent in people living with HIV/AIDS (PLWHA) than the general population. The aim of this study was to evaluate depression, anxiety and insomnia in PLWHA and its correlation with socio-demographic factors and cluster of differentiation-4 (CD4) count. Material and methods: This was a cross sectional study conducted in Pt. BD Sharma PGIMS, Rohtak on 500 PLWHA in India. Hospital Anxiety and Depression Scale-Depression (HADS-D), Hospital Anxiety and Depression Scale-Anxiety (HADS-A) and Pittsburgh Sleep Quality Index (PSQI) scale were used to assess depression, anxiety and insomnia respectively in PLWHA. Five groups were designed on the basis of CD4 count: Group A (< 100 cells/µl), Group B (100-199 cells/µl), Group C (200-349 cells/µl), Group D (350-499 cells/µl) and Group E (> 500 cells/µl). Results: Prevalence of anxiety, depression and insomnia was found to be 59.6%, 61.2% and 56.4% respectively. Males had higher prevalence of depression and insomnia which are 64.2% and 57.4% respectively, whereas female had higher prevalence of anxiety (63%). There was a positive correlation between each score i.e. HADS-A, HADS-D and PSQI scale. There was a weak negative correlation between CD4 and each score. Conclusions: Despite higher prevalence, psychiatric illnesses remains underdiagnosed most of the time. Thus clinicians at the anti-retroviral therapy centre should screen these patients for depression, anxiety and depression for improvement in morbidity and mortality in PLWHA. [ABSTRACT FROM AUTHOR]

Background: Acute kidney injury (AKI) following severe trauma is common. However, the requirement of renal replacement therapy (RRT) in these patients is rare and is associated with high morbidity and mortality. The primary objective of this study was to the identify odds of risk factors, in particular, hypotension at presentation, for the requirement of RRT in patients with AKI following trauma. Methods: We performed a case-control study involving patients who were admitted to the intensive care unit (ICU) at a level I trauma center for at least 24 hours. The primary outcome measure was a study of the odds of risk factors associated with the requirement of RRT in such patients. Univariate comparisons and multiple logistic regression analyses were done to identify other risk factors. Results: The presence of crush injury, sepsis, and elevated serum creatinine (sCr) on arrival were identified to be independent risk factors for RRT requirement. Hypotension and exposure to radiocontrast or nephrotoxic antimicrobials were not found to be associated with the need for RRT. Acute kidney injury requiring RRT was associated with significantly increased ICU length of stay (15 days vs 5 days; p < 0.001) and higher mortality (83% vs 35%; p < 0.001). Conclusion: The presence of crush injury, sepsis, and elevated sCr on presentation were identified to be independent risk factors while hypotension association was insignificant for AKI requiring RRT in our investigation. [ABSTRACT FROM AUTHOR]

Introduction: Renal transplant recipients (RTRs) show increased mortality after 1st year of undergoing renal transplantation. Cardiovascular disease (CVD) is the major cause of mortality in these patients. Oxidative stress (OS), inflammation, and endothelial dysfunction (ED) represent a key triad for the onset and progression of atherosclerosis. The present study was undertaken to assess OS, inflammatory biomarkers, and ED as a surrogate marker of atherosclerosis in stable RTRs. Materials and Methods: Thirty stable post-RTRs along with 30 healthy individuals as controls were included in the study conducted at a tertiary care teaching hospital in south India. Lipid profile; OS markers; malondialdehyde (MDA), ischemia-modified albumin (IMA), and ferric reducing ability of plasma (FRAP); inflammatory marker high-sensitivity C-reactive protein and interleukin 6 (IL-6); ED markers nitric oxide (NO) and P-selectin were estimated using standard methods. Lipid indices were calculated. Carotid intima-media thickness, two-dimensional echocardiogram, and renal Doppler scans were done. Results: No difference in lipid profile was observed between the RTRs and the control groups. RTRs had significantly higher oxidant markers (MDA and IMA), inflammatory marker (IL-6), marker of ED (NO), and lower antioxidant marker (FRAP) (P < 0.05) compared to the control group. RTRs had significantly more number of carotid plaques compared to the control group. A positive correlation was observed between number of carotid plaque and OS, ED, and inflammatory markers. Conclusion: RTRs have increased CVD risk despite undergoing renal replacement therapy. This can be attributed to the increased OS and inflammation which is seen in these patients. [ABSTRACT FROM AUTHOR]

Background: Acceptance of vaccines has been on a decline in recent times, with vaccine hesitancy being listed as one of the top 10 global health threats. This study analysed vaccine hesitancy and belief towards vaccination among caregivers of children aged below 5 years. Methods: In this cross-sectional study, 196 caregivers of children aged 6 months to below 5 years who had attended an immunization clinic at a tertiary care institute of Eastern India from March to May 2019 were surveyed. Consecutive sampling was used to recruit eligible study participants. The survey assessed the attitudes of parents towards childhood vaccination by using the Vaccine Hesitancy Scale and their beliefs towards vaccination. Univariate analysis was performed to assess the association of various sociodemographic factors with vaccine hesitancy. Results: Among the caregivers, most (48%) mothers were aged 26–35 years, literate and homemakers. Vaccine hesitancy was observed in 9.18% of the participants. Only the age of the child was significantly associated with vaccine hesitancy. Nearly half (48.5%) of the participants were concerned about the serious adverse effects of vaccines, and a third (30.6%) agreed that newer vaccines are associated with higher risks than the older ones. Caregivers felt that vaccines are no longer required for uncommon diseases. Conclusion: Concerns regarding vaccine hesitancy are prevalent even among caregivers attending a tertiary care institute. Thus, additional studies are required to assess hesitancy in urban, rural, remote and inaccessible areas. Policymakers ought to conduct periodic assessments and implement necessary remedial measures for the long-term sustenance of the benefits of the national immunization programme. [ABSTRACT FROM AUTHOR]

Background: Adolescence is a transitional phase between childhood and adulthood, in which both physical and psychological aspects are involved in the process of growth and development. Drug dependence among adolescents is rising everywhere in the world. According to studies, adolescents who live in slums in India have a 46% of tobacco use rate. Objective: This study aims to evaluate the pattern and severity of substance use in help-seeking adolescents. Materials and Methods: On the Teen Addiction Severity Index Scale (T-ASI), 43 adolescents seeking help were interviewed to assess the severity of substance use. Results: The mean age of adolescents interviewed was 17 years. Male preponderance was noted 95.3%. The majority of the adolescents were students 76.7%, belonged to a nuclear family setup. The adolescents reported the mean age for starting substances to be 13 years. About 42% of adolescents reported the use of multiple substances during the interview. On the T-ASI scale, adolescents reported difficulty in different domains such as chemical use 6 (1.8), school status 6 (1.8), employment 3.72 (3.7), family support 12.46 (3.63), peer relations 2.9 (1.2), legal problems 0.28 (1.26), and psychiatric problem 6.44 (1.42) due to substance use. Conclusion: The present study suggests marked substance use severity in adolescents in help-seeking group. Higher severity of substance use in adolescents is associated with impairment in different domains of adolescent's lives. [ABSTRACT FROM AUTHOR]

Aim: This study aims to evaluate the prevalence of psychiatric morbidity and suicidal behavior by using a structured diagnostic interview in patients of chronic kidney disease currently on dialysis. An additional aim of the study was to evaluate the impact of psychiatric morbidity on quality of life (QOL). Methodology: One hundred and ten patients undergoing hemodialysis were evaluated, at least 24 h after the last dialysis on Mini International Neuropsychiatric Interview PLUS (MINI PLUS), Columbia Suicide Severity Rating Scale (C-SSRS), and Beck Depression Inventory Second Edition. Results: On MINI-PLUS, about two-thirds (67.3%) of the study sample fulfilled at least one-lifetime psychiatric diagnosis and half of the study participants fulfilled a current psychiatric diagnosis. More than one-fourth (29.1%) of the study participants had more than one psychiatric diagnosis. Among various psychiatric disorders, depressive disorders were the most common (45.5%). About one-third of the participants had suicidality, as assessed on MINI-PLUS and C-SSRS. Compared to those without psychiatric morbidity, those with psychiatric morbidity had a poor QOL. Conclusions: In view of the high psychiatric morbidity and its negative impact on the QOL of patients undergoing hemodialysis, there is a need for close liaison between nephrologists, transplant surgeons and mental health professionals. [ABSTRACT FROM AUTHOR]

Background: Retirement can precipitate an identity crisis through a transformation of "personal" and "professional" identity, which are prime contributors to the "self-identity" of an individual. Objective: To compare self-identity between the retirees and employees of selected nationalized banks in Kolkata, India. Materials and Methods: An analytical study with cross-sectional design was conducted on retirees and employees of selected nationalized banks in Kolkata from August, 2019, to August, 2021, by employing a self-administered predesigned, pretested, and structured e-questionnaire (Google Forms). A sample size of 185 in each arm was estimated, which was selected using two-stage random sampling technique. The data were explored using Pearson's Chi-square test, binary logistic regression, independent samples median test, Mann-Whitney U-test, Z-test for proportion, and Spearman's rho. P < 0.05 was considered statistically significant. Results: There was a significant difference between the median identity scores of retired and working employees. All the aspects of identity seemed to be more important to current employees than to retirees. The identity of retirees was influenced by the type of family. Satisfaction with different aspects of life and identity were correlated. Conclusion: Retirement might be a contributor to identity crisis in bankers. [ABSTRACT FROM AUTHOR]

Background: Multimorbidity estimates are expected to increase in India primarily due to the population aging. However, there is a lack of research estimating the burden of multimorbidity in the Indian context using a validated tool. Weestimated the prevalence and determinants of multimorbidity amongst the adult population of the rural Uddanam region, Andhra Pradesh. Methods: This community-based cross-sectional study was conducted as a part of an ongoing research program. Multistage cluster sampling technique was used to select 2419 adult participants from 40 clusters. Multimorbidity was assessed using Multimorbidity Assessment Questionnaire for Primary Care (MAQ-PC) tool, collecting information on 13 chronic diseases. Patient Health Questionnaire (PHQ-12) was used to screen for depression. Multiple logistic regression was conducted to identify the strongest determinants of multimorbidity. Results: Of the 2419 participants, 2289 completed the MAQ-PC tool. Mean age (standard deviation) of participants was 48.1 (13.1) years. The overall prevalence of multimorbidity was 58.5% (95% CI 56.5-60.6); with 30.7%, 15.6%, and 12.2% reporting two, three, and four chronic conditions, respectively. Acid peptic disease-musculoskeletal disease (44%) and acid peptic disease-musculoskeletal disease-hypertension (14.9%) were the most common dyad and triad. Among metabolic diseases, diabetes-hypertension (28.3%) and diabetes-hypertension-chronic kidney disease (7.6%) were the most common dyad and triad, respectively. Advancing age, female gender, and being obese were the strongest determinates of the presence of multimorbidity. Depression was highly prevalent among the study population, and participants with higher PHQ-12 score had 3.7 (2.5-5.4) greater odds of having multimorbidity. Conclusions: Our findings suggest that six of 10 adults in rural India are affected with multimorbidity. We report a higher prevalence of multimorbidity as compared with other studies conducted in India. We also identified vulnerable groups which would guide policy makers in developing holistic care packages for individuals with multimorbidity. [ABSTRACT FROM AUTHOR]

Background and Purpose: Vascular cognitive impairment (VCI) presents with a spectrum of cognitive impairment due to stroke and poses a huge socioeconomic burden especially in low middle income countries. There is a critical need for early recognition and identification of VCI patients. Therefore, we developed and validated culturally appropriate neuropsychological instruments, the ICMR Neuro Cognitive Tool Box (ICMR NCTB) and Montreal Cognitive Assessment (MoCA) to diagnose vascular MCI and dementia in the Indian context. Methods: A total of 181 participants: 59 normal cognition, 25 stroke with normal cognition, 46 vascular MCI (VaMCI) and 51 vascular dementia (VaD) were recruited for the study. The ICMR NCTB and MoCA were administered to patients with VCI and major cognitive domains were evaluated. Results: The ICMR NCTB was found to have good internal reliability in VaMCI and VaD. The sensitivity of the ICMR NCTB to detect VaMCI and VaD ranged from 70.8% to 72.9% and 75.9% to 79.7%, respectively, and the specificity for VaMCI and VaD ranged from 84.8% to 86.1% and 82.5% to 85.2%, respectively. The MoCA had excellent sensitivity and specificity to detect VaMCI and VaD at ideal cut off scores. Conclusion: The ICMR NCTB is a valid neuropsychological toolbox that can be used for comprehensive cognitive assessment and diagnosis of VCI in India. In addition, the Indian version of MoCA is more adept as a screening instrument to detect VCI due to its high sensitivity. The ICMR NCTB will aid in early detection and management of many patients, thereby reducing the burden of vascular MCI and dementia in India. [ABSTRACT FROM AUTHOR]

Background: To achieve the goals of the end tuberculosis (TB) strategy, strategies for management of TB infection (TBI) have to be expanded. The first step to devise policies is to understand the distribution and determinants of TBI in the community. The objectives of the study were to estimate the prevalence of TBI using Interferon Gamma Release Assay (IGRA) and its determinants among the adult population of Thiruvananthapuram district, Kerala. Materials and Methods: A community-based, cross-sectional study using the stratified cluster sampling was carried out among the adults. TBI was detected using IGRA conducted on whole blood sample. Data on determinants were collected using a structured questionnaire by the face-to-face interview. The prevalence of TBI was estimated. Univariate and multivariate analysis was conducted to identify the determinants. Results: Age standardized prevalence of TBI among 396 adults was 20.5% (95% confidence interval [CI] 16.52–24.48). On adjusting for the possible confounders, increasing age (adjusted odds ratio [OR] 1.028; 95% CI 1.008–1.048; P = 0.005), history of contact with active TB disease (adjusted OR 7.61; 95% CI 4.43–13.05; P < 0.001), childhood contact (adjusted OR 8.20; 95% CI 3.14–21.41; P < 0.001), and household contact (adjusted OR 10.12; 95% CI 5.39–18.98; P < 0.001) were found to be the determinants of TBI in this population. Conclusion: The present study observed that nearly one-fifth of the adult population in the Thiruvananthapuram district has TBI. For the programmatic management, factors such as increasing age and contact history may be considered for the elimination of TBI in the state. [ABSTRACT FROM AUTHOR]

Background: Subject of interest is the status of mental health of college students around the globe as they are undergoing a lot of mental stress and depression during the pandemic lockdown. Aims and Objectives: The aim of this survey is to evaluate the prevalence of depression, its determinants, and association with coping mechanisms among college students during the COVID-19 pandemic lockdown. Methodology: A cross-sectional, questionnaire-based e-survey among college students in North India using Snowball sampling technique was done. A total of 920 responses (calculated sample size) were collected for a period of 25 days from 6th to 30th October 2020. A questionnaire regarding sociodemographic characteristics, COVID-19-related experiences along with Patient Health Questionnaire-9 (PHQ-9), and Carver Brief-coping orientation to the problem experienced-28 was adapted to Google Forms and distributed to college students. Chi-square test, independent t-test, Pearson's correlation, and hierarchical multiple regression analysis were used to investigate the determinants of depression and its association with coping mechanisms. Results: On analysis of 884 qualified participants, it was revealed that 402 (45.5%) participants have depressive symptoms ranging from moderate to severe level. The mean score of PHQ-9 was 9.82 ± 6.61. Nearly 85% thought that they were lagging behind in studies. The main determinants of depression in this study were age group of 21-24 years thought of lagging behind in studies and family members/friends/relatives diagnosed with COVID-19. Adaptive coping mechanisms (emotional support, religion, and humor) were significantly associated with lower depressive symptoms and maladaptive coping mechanisms (self-distraction, denial, behavioral disengagement, and venting) were significantly associated with higher depressive symptoms among students. Conclusions: This survey revealed multiple determinants of depression, mainly including academic worries among college students. The college staff should provide a well-structured pedagogical framework to encourage them and alleviate the unpleasant psychological effects of pandemic on students. [ABSTRACT FROM AUTHOR]

Background: During the COVID-19 pandemic, Anganwadi workers (AWWs) were repositioned for community support, community surveillance, community awareness on infection prevention and mitigating stigma/discrimination entailing infection, going door to door. The job entailed good knowledge, attitude and practices (KAP) with regard to infection prevention and control (IPC). Aims: To assess the KAP of AWW with regard to IPC in context of COVID-19 in Lucknow district. Methods: A cross-sectional survey was conducted using Google form between 30 June and 28 July 2020. AWWs were recruited from Lucknow district irrespective of their training status; data analysis was done on 137 participants. The mean KAP score was calculated and student t-test was applied. Chi-square test was performed between categorical variables and KAP. Univariate and multivariate logistic regression was applied between independent and dependent variables. Results: The mean score of knowledge was 7.22 ± 2.64, attitude was 4.34 ± 1.14 and practice was 4.44 ± 1.11. There was a significant difference between good and poor score for KAP. Participants with older age, good knowledge and attitude scores were more likely to have good practices. Conclusion: AWWs had good attitude and practices, but lacked adequate knowledge on IPC measures. Ensuring training for AWW on IPC is important. [ABSTRACT FROM AUTHOR]

Background: In India, the number of occupational therapy practitioners currently working in mental health settings is lower than most other specialties. The attitudes of students influence their interest in any field and their desire for working in it. Objectives: The objective of this study was to examine the attitudes of Indian undergraduate occupational therapy students toward mental health and psychiatry, and to explore the differences in attitudes across different years of study, gender, resulting from personal experiences, and educational coursework, and to examine if the attitudes influence future career choices. Study Design: This was a cross-sectional survey. Methods: Permission was obtained from heads of institutions of 14 occupational therapy colleges and the survey link was sent. In order to obtain a representative sample, the link was also shared on social groups. The purpose of the study, voluntary participation, and confidentiality were explained on the landing page. The subsequent sections consisted of the demographic questionnaire, the Attitudes toward Psychiatry-30 (ATP-30) Questionnaire, and the Career Preference Questionnaire. A total of 402 responses were obtained within the stipulated period. Statistical analysis was performed, and the odds ratio using logistic regression and Pearson's correlation coefficient were determined. Results: Gender and contact with persons with mental illness were significant predictors of positive ATP. Females are 5.387 times more likely to have positive ATP (odds ratio [OR] = 5.387, 95% confidence interval [CI]: 2.101-13.814, P = 0.000). Furthermore, those in contact with persons with mental illness are 2.883 times more likely to have positive ATP (OR = 2.883, 95% CI: 1.076--7.724, P = 0.035). Moderately high positive correlations existed between ATP and career preference in psychiatry. Conclusions: Overall, positive attitudes were found. Significant correlations were seen across the domains of the ATP-30 and career preference in psychiatry. Female students are five times more likely to have positive attitudes than male students. Those in contact with persons with mental illness were almost thrice more likely to have positive attitudes than those without any contact. [ABSTRACT FROM AUTHOR]

Background: Literature suggests that the COVID-19 pandemic has resulted in poor sleep quality, especially among the infected population. However, literature regarding the effect of COVID-19 pandemic and SARS-CoV-2 infection on occurrence of insomnia, restless legs syndrome and dream enactment behavior is either scarce or unavailable. Methods: This study was planned to assess the effect of SARS-CoV-2 infection on the occurrence of insomnia, restless legs syndrome (RLS) and dream enactment behavior (DEB). For this cross-sectional study, a questionnaire comprising of items related to demographic details, past medical history, and information related to SARS-CoV-2 infection was distributed through social media. Insomnia was diagnosed using clinical criteria. RLS, DEB, sleep quality, depression and anxiety were assessed using a validated questionnaire. Information regarding the use of hypnotic medications was also gathered. Results: Of the 1596 respondents, 37.2% reported disturbed sleep while insomnia was reported by 22.6% respondents. 27.3% of respondents reported RLS and 17.4% suffered DEB. The odds of insomnia were greater among males (OR = 1.27; 95% CI: 1.03–1.58; P < 0.02) and among those who had SARS-CoV-2 infection (OR = 1.76; 95% CI = 1.42–2.19; P < 0.001). Similarly, SARS-CoV-2 infection was also associated with increased odds of RLS (OR = 2.48; 95% CI = 1.98–3.11; P < 0.001) and DEB (OR = 1.58; 95%CI = 1.21–2.06; P < 0.001). Insomnia, RLS and DEB were more frequent among respondents who required oxygen therapy, those who experienced loss of taste and/or smell, depression and anxiety. Prevalence of insomnia, DEB and RLS was higher than said prevalence among respondents with no history of SARS-CoV-2 infection, but lower than that of those with positive history of SARS-CoV-2 infection. 5.3% of respondents reported taking hypnotic medications before infection, 7% during infection and 5.3% after infection. Conclusion: SARS-CoV-2-infection-related factors in association with environmental factors have increased the prevalence of insomnia, DEB and RLS among subjects having infection. SARS-CoV-2-associated immunological changes, hypoxia and neurotropism may play a role in occurrence of insomnia, DEB and RLS. [ABSTRACT FROM AUTHOR]

Background and Aim: The flexibility to control the gain in different frequency regions by setting compression parameters in a larger number of compression channels in hearing aids will be advantageous to individuals with a sloping audiogram. The objective of the study was to compare the aided speech identification scores and speech quality ratings in quiet for three aided conditions (i.e. 4-channel, 8-channel, and 16-channel), with syllabic and dual compression, at two input levels (60 dB SPL and 80 dB SPL) in individuals with flat, gently sloping, and steeply sloping sensorineural hearing loss. Methods: The participants were 36 native speakers of Kannada adults with sensorineural hearing loss. In a repeated-measures design, aided speech identification score for sentences in quiet and speech quality ratings were obtained at two input levels (60 dB SPL and 80 dB SPL) with three hearing aids (having 4-, 8-, & 16-channels), programmed for dual and syllabic compression settings. Results: The results revealed that there was no significant difference in the aided speech identification scores and speech quality ratings, in different aided conditions, in the three groups. Conclusion: There was no additional perceptual benefit in quiet with an increase in the number of channels (from 4 to 16) in hearing aids, either in syllabic or dual compression, at conversation speech level or loud speech level, in individuals with different audiogram configurations. [ABSTRACT FROM AUTHOR]

Background: Prevention of early neurological deterioration (END) is becoming an important therapeutic target in acute ischemic stroke management. The aim of the study is to ascertain the causes and predictors of early neurological deterioration following thrombolysis and determine the predictive value of IScore. Methods: In this single center prospective study, we analyzed clinical, imaging and outcome data in 168 patients thrombolyzed intravenously ≤4.5 hours from onset of stroke. Early neurological deterioration was defined as worsening ≥2 points in the NIHSS score at 24 hours. Results: END occurred in 34 patients (20%) and caused significantly worse short term outcome. Ischemic END (ENDi) (n = 23) was twice as common as symptomatic hemorrhage (ENDh) (n = 11). Ischemia progression (n = 15) was the most common cause. Early malignant edema was another major cause. On multivariate analysis, significant predictors (p <.05) were proximal artery occlusion [all END (p <.001), ENDi and ENDh], previous ischemic insults (all END) and raised diastolic blood pressure (ENDh). ENDi was more common in those with carotid artery occlusion, large vessel disease and previous ischemic insults. ENDh was more common in those with raised diastolic blood pressure and NIHSS-ASPECTS mismatch. For patients with NIHSS <14, IScore >105 and for NIHSS ≥14, IScore >175 was associated with higher risk of END. Conclusion: END occurs in one fifth of patients after intravenous thrombolysis; ENDi outnumbers ENDh. Proximal artery occlusion is a major predictor for END. Potentially modifiable risk factors include admission hyperglycemia and elevated blood pressures. Distinct factors characterize ENDh and ENDi and can guide prevention and management strategies. IScore identifies patients at risk for END. [ABSTRACT FROM AUTHOR]