Publications

BACKGROUND: The growing threat of antimicrobial resistance (AMR) poses a significant challenge globally in the treatment of respiratory tract infections (RTIs). The PERCEPT survey aimed to capture Indian healthcare practitioners' (HCPs) perspectives on the prevalence of RTIs, AMR patterns, AMR diagnosis, and clinical evaluation of cefpodoxime and its combination with clavulanic acid in managing RTIs.

MATERIALS AND METHODS: A structured questionnaire was used to conduct a cross-sectional survey among 1,000 healthcare professionals (HCPs) who manage RTIs in Indian adults and children, with 842 participants responding. The collected data were compiled and thoroughly analyzed.

RESULTS: Most HCPs reported RTIs in 26-50% of adult and pediatric patients, with the most common RTIs including pharyngitis/tonsillitis, bronchitis, and common cold. Streptococcus pneumoniae and Staphylococcus aureus were reported as the prevalent antibiotic-resistant microorganisms causing upper respiratory tract infections (URTIs) and lower respiratory tract infection (LRTIs). Antibiotic susceptibility testing (AST) is a common method to detect AMR in patients with RTIs. Among antibiotics, amoxicillin was the most common linked with resistance to microorganisms causing RTIs. Cefpodoxime alone or in combination with clavulanic acid was the most preferred drug for managing RTIs due to its high efficacy, broad-spectrum activity, safety, and better tolerability.

CONCLUSION: Indian practitioners find cefpodoxime monotherapy and its combination with clavulanic acid effective in managing RTIs compared to earlier-generation cephalosporins and amoxicillin.

BACKGROUND: Edaravone is recommended for amyotrophic lateral sclerosis (ALS) based on a study showing an effect on a defined subset of patients.

AIM: To document the effect of edaravone in a cohort of ALS patients from India to find out if, after starting edaravone, there is a plateau period or significant slowing from baseline to compare results with existing literature.

METHODS: This was a single-center, prospective observational study with no control arm (due to ethical reasons). ALS patients >18 years of age, not requiring respiratory support or tube feeding, were included. All patients were given edaravone infusion in addition to standard of care and oral riluzole 50 mg twice daily. This consisted of giving the drug in monthly cycles over 6 months. The first cycle consisted of daily infusion of the drug for 14 days followed by a drug-free interval for the remaining part of the month. From cycle 2 to cycle 6, the patients received the drug for the first 10 days of the month followed by a drug-free interval for the remaining part of the month. The primary outcome was a significant change in Revised Amyotrophic Lateral Sclerosis Functional Rating Scale (ALSFRS-R) score from baseline at 6 months. Secondary outcomes were monthly change in ALSFRS-R scores when compared with the previous month and baseline, change in the first 3 months compared to the change in the next 3 months, adverse drug effects, and number of deaths. The study was registered with the Indian Council of Medical Research Clinical Trial Registry of India with the trial number CTRI/2019/11/021838. Paired t-test was used for statistical analysis.

RESULTS: Thirty patients received the drug along with riluzole. Twenty-three patients completed all six monthly infusions. Two died (3 months), two developed adverse reactions (3 months) and did not want further infusions (one had breathing difficulty and the other had hypotension during infusion). Two withdrew consent due to perceived poor effectiveness of the drug. The mean ALSFRS-R at baseline was 35.17 [standard deviation (SD) 8.01; range 20-46]. The primary outcome showed a significant decline in the mean last available ALSFRS-R score 6 months by -4.9 (SD 1.21) (p < 0.01). For the secondary outcome measure, mean monthly ALSFRS-R score was calculated before each infusion after excluding dropouts. There was a significant monthly decline in ALSFRS-R score: -0.93 (SD 0.58), -1.0 (-0.52), -0.90 (SD 0.71), -0.87 (SD 0.61), -0.82 (SD 0.57), -0.95 (SD 0.63), respectively (p < 0.001). There was also a progressive monthly decline when compared to baseline. The rate of decline in the first 3 months was the same as in the remaining 3 months: -2.5 (SD 0.73) vs -2.6 (SD 0.98) (p = 0.3).

CONCLUSION: Edaravone infusion does not stop or significantly slow progression of disease from baseline but is safe.

BACKGROUND: Sepsis results from the body's extreme response to pathogens and is associated with high mortality rates. Autoimmune diseases, treated with immunosuppressive medications, can weaken immune responses and increase susceptibility to sepsis. While older studies linked autoimmune disease and immunosuppressive treatment with higher mortality and longer hospital stays in sepsis patients, recent research suggests that these patients may not always have worse outcomes, in fact, they might have better outcomes, highlighting the need for further investigations.

OBJECTIVES: (1) To investigate predictive factors of sepsis outcomes in individuals with underlying autoimmune diseases. (2) To quantify the severity of sepsis in the context of autoimmune diseases using the Sequential Organ Failure Assessment (SOFA) scoring system. (3) To evaluate the influence of autoimmune disease therapy on sepsis outcomes.

MATERIALS AND METHODS: A 6-month prospective, observational cohort study was conducted with 83 participants at a single center. Patients were nearly evenly divided into autoimmune and nonautoimmune groups. Key variables including SOFA score at admission, sex distribution, mortality, and effect of autoimmune treatment regimens were analyzed using statistical methods such as Chi-squared tests, t-tests, analysis of variance (ANOVA), and post hoc Bonferroni tests.

RESULTS: A comparison between patients with autoimmune conditions and those without revealed a significant difference in sex distribution, with 73.2% of autoimmune patients being female compared to 42.9% in the nonautoimmune group (χ2 = 7.818, p = 0.005). Analysis of the SOFA scores showed that the nonautoimmune group had significantly higher mean scores (6.05) compared to autoimmune group (4.15) (p = 0.006). Septic shock occurred less frequently in the autoimmune group (26.8%) than in the nonautoimmune group (42.9%) but was not statistically significant (χ2 = 2.345, p = 0.126). Mortality was lower in individuals with autoimmune diseases (14.6%) compared to those without (23.8%), but lacked statistical significance (χ2 = 1.122, p = 0.289). Different treatment types for autoimmune diseases did not significantly affect mean SOFA scores (F = 1.918, p = 0.144), indicating no major impact on sepsis outcomes. However, post hoc analyses suggested that untreated autoimmune patients had higher average SOFA scores than those on disease-modifying antirheumatic drugs (DMARDs), warranting further investigation into treatment effects.

CONCLUSION: Our study showed significantly low SOFA scores and better sepsis outcomes in patients with autoimmune diseases, highlighting the mitigating effects of autoimmune diseases and their treatment in sepsis. Even though many observed differences, including mortality, septic shock, and autoimmune disease treatment effects on sepsis, were not statistically significant, it highlights the need for further research to confirm these trends and understand the underlying mechanisms.

AIMS AND BACKGROUND: The King's Brief Interstitial Lung Disease (K-BILD) questionnaire, used to evaluate health-related quality of life (HRQoL) in interstitial lung diseases (ILDs), has been translated and validated in multiple languages. However, there is currently no validated Hindi translation available.

METHODS: This study aimed to translate and validate the K-BILD questionnaire into Hindi for ILD patients. Using a forward-backward translation method after approval from the original developers, we created the Hindi version and provided it to patients alongside the St George's Respiratory Questionnaire (SGRQ). We evaluated the Hindi K-BILD's reliability and validity by examining internal consistency, concurrent validity, and effect size (ES).

RESULTS: About 86 patients completed the Hindi version of the K-BILD questionnaire, demonstrating good internal consistency in the total score, breathlessness and activities, and psychological domains (Cronbach's α = 0.939, 0.916, and 0.928, respectively) and acceptable consistency in the chest symptoms domain (Cronbach's α = 0.732). Concurrent validity with the SGRQ domains and total scores was strong to very strong (p < 0.001). The K-BILD score also distinguished disease severity, notably in forced vital capacity (FVC) Z score (0.257) and diffusion capacity of lung for carbon monoxide (DLCO) Z score (0.181).

CONCLUSION: The Hindi language-translated K-BILD questionnaire was well accepted by patients and showed excellent validity, comparable to the original version of K-BILD in English language.

CLINICAL SIGNIFICANCE: The validated Hindi K-BILD enhances patient care, communication, and research for Hindi-speaking ILD patients by providing a reliable, culturally relevant tool for assessing health status and disease severity.

BACKGROUND: Healthcare practitioners (HCPs) face high stress levels at work due to the demanding nature of their profession, making them more susceptible to burnout. The objective of the study is to assess the prevalence of burnout among HCPs in India and to examine its relationship with age, gender, and working hours.

MATERIALS AND METHODS: A descriptive cross-sectional, pan India study was conducted from October 6 to 26, 2022. A total of 763 Indian HCPs participated in the study. The prevalence of burnout among HCPs was assessed using the Copenhagen Burnout Inventory (CBI). The CBI is a validated instrument that measures three dimensions of burnout: personal, work-related, and patient-related burnout. Data collected from the survey responses were analyzed using the Statistical Package for the Social Sciences (SPSS) version 18. Descriptive statistics were calculated to summarize the participants' demographic characteristics and burnout levels, including means, standard deviations (SD), frequencies, and percentages. A Chi-squared test was employed to examine associations and predictors of burnout among Indian HCPs.

RESULTS: Out of the 763 HCPs, 577 (76%) were males and 186 (24%) were females. The average age of the HCPs was 43.4 years. The prevalence of personal, work-related, and patient-related burnout was 47, 31, and 35%, respectively, with 24.9% experiencing all three types of burnout. Burnout was more common among female and younger practitioners. HCPs who spent longer hours a day treating patients and those with night duties and night calls reported higher burnout levels. A larger proportion of smokers reported work-related burnout. Regular exercise of at least 45 minutes and 6 hours of sleep was associated with lower burnout levels. Additionally, HCPs with anxiety as a medical condition were more likely to experience all three types of burnout.

CONCLUSION: This study reveals a significant prevalence of burnout among HCPs, with approximately 25% experiencing all three types of burnout. This raises concern, as burnout can have negative implications for the healthcare system. Further research is necessary to understand the impact of physician burnout on healthcare delivery and outcomes.

BACKGROUND: The diagnosis of hypertension (HTN) is best achieved by ambulatory blood pressure monitoring (ABPM) as it helps differentiate sustained hypertension (SH) from white coat hypertension (WCH).

AIM: To diagnose SH and WCH in newly diagnosed hypertensive patients.

MATERIALS: All newly diagnosed hypertensive patients with office blood pressure measurement (OBPM) ≥140/90 mm Hg, attending the medical outpatient department and not on any antihypertensive treatment, were included in the study.

OBJECTIVES: To evaluate the clinical utility of ABPM in newly diagnosed hypertensive subjects by comparing OBPM with ABPM readings.

METHODS: This descriptive cross-sectional study was carried out on 196 newly diagnosed HTN patients over a period of 18 months. All hypertensive patients were subjected to ABPM. Patients with persistent HTN on ABPM were labeled as SH, whereas those with normal blood pressure on ABPM were labeled as WCH.

RESULTS: SH was diagnosed in 143 out of 196 (73%) patients. WCH was detected in 53 patients (27%). Patients with SH had a significant family history of HTN compared to patients with WCH (82.5 vs 45.3%, p = 0.00), higher office diastolic blood pressure (DBP) compared to WCH (96.56 ± 4.63 vs 94.13 ± 3.23, p = 0.000), and significant nondipping pattern compared to WCH (37.1 vs 18.9%, p = 0.015).

CONCLUSION: ABPM should be performed in all newly diagnosed hypertensive patients, especially if they have no family history of HTN and DBP is <95 mm Hg, to rule out WCH.

INTRODUCTION: In recent times, neutrophil-to-lymphocyte ratio (NLR) has garnered interest from all over the world as a multisystemic marker for ongoing inflammatory processes. It has been found to be independently related to poor clinical outcomes among patients with liver cirrhosis due to any cause.

AIM: To determine any significant correlation between NLR with Child-Turcotte-Pugh (CTP) score and model for end-stage liver disease (MELD)-Na score among patients with decompensated liver cirrhosis in a tertiary referral center in Ahmedabad, India.

MATERIALS AND METHODS: The cross-sectional study involved patients diagnosed with liver cirrhosis at SMS Multispeciality Hospital, Dr. M.K. Shah Medical College and Research Centre in March 2023. The study enrolled 16 cirrhotic patients, regardless of the etiologic agent. The CTP score was fulfilled by using two methods; bilirubin, albumin and international normalized ratio (INR) were noted from medical record registry, while ascites and encephalopathy were assessed using interview and physical examination on the day of patient admission. MELD-Na score was calculated by an online calculator after collecting data on all the patient's serum bilirubin, creatinine, sodium levels, and INR on the day of admission. The Spearman correlation test was performed to determine the correlation between two sets of variables, while the demographic characteristics were presented in a single table with mean or median and standard deviations.

RESULTS: A significant correlation between NLR and CTP score was obtained (p = 0.002), and it was positively correlated (r = 0.722). No significant correlation between NLR and MELD-Na could be established with a p-value = 0.149 and r = 0.378.

CONCLUSION: The NLR ratio may be used as an independent parameter to prognosticate the severity of decompensated liver disease. However, it still needs further study to acknowledge its potential.

BACKGROUND: Iron deficiency anemia (IDA) is the most common cause of anemia and represents a significant global health problem. While the role of endoscopy in diagnosing IDA is well-established, the frequency and types of lesions identified vary widely across different regions. Factors such as symptomatology, complications, age, and geographic location significantly influence diagnostic outcomes. This study was conducted to evaluate the diagnostic yield of various endoscopic techniques in patients with IDA in an Indian cohort.

METHODS: This retrospective analysis included all patients evaluated for IDA in the Department of Gastroenterology and Hepatology from January 2016 to March 2023. Data collection included patient demographics, clinically significant endoscopic findings, and laboratory parameters such as hemoglobin levels, serum ferritin, total iron-binding capacity, and serum iron concentrations.

RESULTS: A total of 554 patients were initially enrolled, of whom 435 underwent upper gastrointestinal (GI) endoscopy, and 309 underwent colonoscopy after applying exclusion criteria. The diagnostic yield for detecting clinically significant lesions via upper endoscopy was 43.6%, while colonoscopy demonstrated a yield of 52.4%. Dual lesions were identified in 2.4% of all patients. The most common finding on upper endoscopy was peptic ulcer disease (13.3%), followed by esophageal varices (8.3%). On colonoscopy, colonic ulcers were the most prevalent finding (25.24%), followed by colonic malignancies (12%). Symptom presence was significantly associated with higher endoscopic diagnostic yield (p < 0.05).

CONCLUSION: GI endoscopy should be considered an essential diagnostic tool for all patients with IDA. The selection of the initial endoscopic modality should be guided by the presence of symptoms. Given the favorable risk-benefit ratio, GI evaluation is recommended across all age groups, including premenopausal women.

Maturity-onset diabetes of the young (MODY) was first described by Tattersall and Fajans in their classic paper published in 1975.1 At that time, the classification of diabetes was based purely on the age at onset of diabetes. Those diagnosed with diabetes below 40 years of age were labeled as "growth onset diabetes," while those with onset at or above the age of 40 years were referred to as "maturity onset diabetes." At that time, these types were believed to be equivalent to what are known as type 1 diabetes (T1D) and type 2 diabetes (T2D) today.

PURPOSE: The purpose of this study was to investigate the field of fluidic effect (FOE) at the vitrectomy port in a range of artificial vitreous solutions (AVS) with varying rheological characteristics to add insight into the effects surgeons observe during vitrectomy and how they change with a variety of console settings.

METHODS: Laboratory-based investigation using in vitro testing was carried out at Newcastle University, United Kingdom. Testing was conducted using an Eva Nexus Vitrectomy system (D.O.R.C. Dutch Ophthalmic Research Center [International] B.V., Zuidland, The Netherlands) using dual cutting action vitrectomy probes in 3 gauge sizes (23G, 25G, and 27G). Using AVS, particle image velocimetry (PIV) measurements were conducted for various console settings and AVS concentrations.

RESULTS: Rheological analysis of AVS with varying hyaluronic acid concentrations showed shear thinning and viscoelastic properties, resembling the liquid component of human vitreous humour. PIV during vitrectomy revealed that a dual cutting probe created a focused, elongated jet stream in AVS, contrasting with the symmetrical flow in balanced salt solution (BSS). Key findings included peak fluid velocity magnitude in AVS was 0.5 to 1 mm from the port, broadening with increased vacuum, higher vacuum led to inferior jet deviation, cut rates increased peak velocities, with viscoelasticity influencing fluid flow dynamics, and increasing hyaluronic acid concentration transitioned flow from BSS-like to elongated jet profiles.

CONCLUSIONS: Using an AVS with similar rheological properties to the liquid component of human vitreous and a high-speed PIV technique, we evaluated the FOE around vitrectomy probes with a range of surgical relevant variables. Further research into the influence of different vitreous substitutes and surgical parameters is crucial to enhance our understanding and refine vitrectomy procedures.

TRANSLATIONAL RELEVANCE: Our findings provide valuable insights into the fluid dynamics during vitrectomy, helping to optimize surgical techniques and improve patient outcomes.