Indian Journal of Medical Research最新文献

{"title":"Improving completeness & reducing errors in medical certification of cause of death: The impact of electronic mortality software in a tertiary care centre in South India.","authors":"Abinavsharvesh Thanigasalam, Ramadoss Ramu, Kanagarethinam Rajarethinam","doi":"10.25259/IJMR_1394_2024","DOIUrl":"https://doi.org/10.25259/IJMR_1394_2024","url":null,"abstract":"<p><p>Background & objectives Mortality statistics are crucial for understanding public health. Accurate medical certification of cause of death (MCCD) is essential for good mortality statistics. However, the quality of MCCD form-filling remains a concern. Based on the learnings from the ICMR-National Centre for Disease Informatics and Research (ICMR-NCDIR), e-Mortality software implementation project, our institute developed and used a new in-house mortality software for MCCD from January 2021. This study compared MCCD forms before and after implementation of the mortality software. Methods The study was conducted from March 2024 to July 2024 in the department of Medicine at a tertiary care teaching institute in Puducherry. We analysed 105 hand-written forms from the year 2020 and 105 software-generated forms from the year 2021, focusing on completeness, errors, and International Classification of Diseases-10 (ICD-10) compatibility. We checked 13 items for completeness. Errors were categorised as major or minor, depending on how they affected ICD-10 coding. Results The proportion of completeness improved from 4 to 19 per cent after software introduction (P<0.001). Minor errors significantly decreased from 96 to 81 per cent (P<0.002). About 88 per cent of hand-written forms had major errors, which was significantly reduced to 42 per cent in software-generated forms (P<0.001). Compatibility of the underlying cause of death for generating ICD-10 coding improved from 73 to 96 per cent (P<0.001). Interpretation & conclusions The findings of this study suggest that our mortality software significantly improved completeness and modestly reduced errors. Other institutions may consider adopting an electronic format for MCCD to improve completeness and accuracy. We emphasise regular training of doctors and auditing of MCCD forms to further improve the quality of death certification.</p>","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 4","pages":"420-424"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325568","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Understanding the pro- & anti-inflammatory cytokine profile in Japanese encephalitis & their implications in survival outcome.","authors":"Pinku Mani Talukdar, Dharitree Sonowal, Ajanta Sharma, Deepak Upadhyaya, Sachin Kumar, Harpreet Kaur","doi":"10.25259/IJMR_1410_2024","DOIUrl":"https://doi.org/10.25259/IJMR_1410_2024","url":null,"abstract":"<p><p>Background & objectives We aimed to conduct a comprehensive analysis of the cytokine profile in Japanese encephalitis (JE) patients and healthy individuals. Additionally, the correlation between the cytokines and the disease outcome in terms of survival or non-survival was also studied. Methods The study included 72 laboratory-confirmed JE cases and 50 healthy controls. Plasma levels of cytokines viz., GM-CSF, IFN-γ, IL-2, IL-4, IL-5, IL-10, IL-12, IL-13, and TNF-α were analysed using Bio-plex200 (Bio-Rad) following manufacturer's guidelines and compared between JE patients and healthy control group. Additionally, quantitative real-time PCR (qRT-PCR) was done for the quantification of expression of the above-mentioned cytokine genes. Results Except IL-4 and IL-13, the levels of GM-CSF, IFN-γ, IL-2, IL-5, IL-10, IL-12, and TNF-α were significantly higher in JE patients in comparison to healthy controls. Significantly upregulated expression of IL-12, IL-10, and TNF-α was observed in the JE group as compared to that in healthy controls. Additionally, significantly downregulated expression of IL-4and IL-13 was observed in the JE group compared to the control group. Interpretation & conclusions A higher level of several pro-inflammatory cytokines and downregulation of a few anti-inflammatory cytokines were observed in JE patients compared to the healthy controls indicating co-association of inflammation with disease severity. Hence, a regulator of these pro and anti-inflammatory cytokines may stand out as a potential candidate for therapy in JE.</p>","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 4","pages":"386-393"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325572","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A machine learning approach to predict hypertension using cross-sectional & two years follow up data from a health & demographic cohort of Assam, North East India.","authors":"Krishnarjun Bora, Natarajaseenivasan Kalimuthusamy, Ananya Jyoti Gogoi, Namita Garh, Manisha Rabidas, Gargi Chanda, Rajshree Das, Prasanta Kumar Borah","doi":"10.25259/IJMR_881_2024","DOIUrl":"https://doi.org/10.25259/IJMR_881_2024","url":null,"abstract":"<p><p>Background & objectives Hypertension affects a sizable section of the world population and is being recognised as a growing problem. Its prediction using machine learning (ML) algorithms, will add to its control and prevention. The objective of the present investigation was to check the applicability of ML approaches in the prediction and detection of hypertension. Methods We included 53,301 participants at baseline from a health and demographic surveillance system in Dibrugarh, Assam (Dibrugarh-HDSS). We constructed two models, one at baseline and the other after two years of follow-up. Of the total participants (baseline: 29,402; follow up: 4,400), 70 per cent were randomly selected to fit seven popular classification models namely decision tree classifier (DTC), random forest classifier (RFC), support vector machine (SVM), linear discriminant analysis (LDA), logistic regression, Ada-boost classifier, and XG boost classifier. The data from the remaining 30 per cent were used to evaluate the performance of the models. Results In the baseline data, the Ada-boost classifier could identify hypertension with a maximum accuracy score of 87.02 per cent (CI: 86.01-88.03). The maximum area under the curve (AUC) score of 98.37 per cent (CI: 97.36-99.38) was obtained under RFC. For the prediction of risk at two years, the maximum average accuracy score of 77.57 per cent (CI: 76.6-78.54) was achieved under X-G Boost followed by RFC (77.2%, CI: 76.15-78.25) and a maximum AUC of (85.82%, CI: 84.88-86.76) was obtained under RFC. Interpretation & conclusions In both the identification and prediction of hypertension, RFC was found to be better than the other classifiers. 'Waist circumference' followed by 'body mass index' (BMI) were found to have maximum relative importance in the identification of hypertension, while in the case of two-year risk prediction, the baseline 'systolic blood pressure' (SBP), diastolic blood pressure (DBP), and 'BMI' had the maximum relative importance. The findings revealed the potential of predictive models in accurately identifying high-risk individuals, enabling timely interventions, and optimising clinical decision-making.</p>","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 4","pages":"394-405"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325494","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Fast pacing India's fight against viral hepatitis: Targets & action points.","authors":"Ekta Gupta, Shiv Kumar Sarin","doi":"10.25259/IJMR_743_2025","DOIUrl":"https://doi.org/10.25259/IJMR_743_2025","url":null,"abstract":"","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 4","pages":"321-326"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325506","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Preparedness of public & private health facilities for management of diabetes & hypertension in 19 districts in India.","authors":"Vani Srinivas, Vinay Urs, Suresh Kumar N, Narendra Kumar Arora, Pankaja Raghav, Sarangi Das, Abhiruchi Galhotra, Praveen Kulkarni, Binod Kumar Patro, Ananth Ram, R Swetha, Saurabh Singh, Pradeep Joshi, Ravivarman Lakshmanasamy, Prashant Mathur","doi":"10.25259/IJMR_755_2024","DOIUrl":"https://doi.org/10.25259/IJMR_755_2024","url":null,"abstract":"<p><p>Background & objectives India has the second highest number of adults with diabetes in the world, and more than one-fourth of adults have hypertension. This article describes the preparedness of public and private health facilities for type 2 diabetes mellitus and hypertension management. Methods A cross-sectional survey of the health facilities was conducted in 19 districts of seven States in India, which included an assessment of both public and private health facilities. We used the Indian Public Health Standards and other relevant guidelines for assessment. The service domain score for four domains: equipment, medicine, diagnostics capacity, staff, including the availability of guidelines, and overall readiness score, was calculated following the Service Availability and Readiness Assessment manual of the World Health Organisation. The study considered a readiness score of ≥70 per cent to classify a facility as prepared for providing hypertension and diabetes services. Results Out of 415 health facilities covered in the survey, 75.7 per cent were public facilities. Most were primary care facilities (57.6%) and were located in rural areas (53.3%). The overall readiness score for providing hypertension and diabetes services was lowest for Sub-Centres (SCs; 61%) and Community Health Centres (CHCs; 59%), compared to other facilities. The readiness score for public Primary Health Centres (PHCs) and private primary care facilities (level 2) was 73 and 57 per cent, respectively. The readiness score of district hospitals, government private medical colleges, and other private tertiary care facilities was above 70 per cent, and they were considered prepared for services. Interpretations & conclusions PHCs were better prepared for diabetes and hypertension care than SCs, CHCs, and SDHs. By ensuring adequate human resources availability and uninterrupted supply of essential medicines, programme managers can further improve the preparedness of all public health facilities.</p>","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 4","pages":"327-335"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325571","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Authors' response.","authors":"Bashir Ahmad Laway, Arun S Viswanath, Mohammad Salem Baba, Nisar Ahmad Tramboo, Zaffar Amin Shah, Ajaz Ahmad Lone, Imran Hafeez","doi":"10.25259/IJMR_1307_2025","DOIUrl":"https://doi.org/10.25259/IJMR_1307_2025","url":null,"abstract":"","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 4","pages":"428-429"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325497","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"A qualitative study on the barriers to tuberculosis treatment adherence using digital adherence technologies (DATs).","authors":"Madhuvarshne Sivashanmugam, Rajalakshmi Mahendran","doi":"10.25259/IJMR_1644_2024","DOIUrl":"https://doi.org/10.25259/IJMR_1644_2024","url":null,"abstract":"<p><p>Background & objectives In order to meet the ambitious aim set by the Government of India as well as the sustainable development goals (SDG) target for eliminating tuberculosis in 2030, it is important for the healthcare providers to follow and support the patients throughout the treatment for its successful completion. For monitoring the tuberculosis treatment compliance, Digital Adherence Technologies (DATs) play a major role. DATs are digital tools that use mobile phone, computer, or sensor technologies to support the capture of detailed, daily, patient-specific adherence information. DATs provide opportunities for a more patient-centred care model and also help healthcare workers while treating tuberculosis (TB) patients when compared to traditional directly observed therapy. Hence, in this study explored the acceptance and barriers to the use of DATs for monitoring compliance with TB treatment and its possible solutions. Methods A community-based qualitative study was done in two PHCs in Puducherry, India among TB patients who completed treatment, healthcare providers such as tuberculosis health visitors, staff nurses, and respective medical officers. Thirty participants were interviewed using purposive sampling to explore TB treatment outcomes over two months (Oct-Nov 2023). In-depth interviews were conducted with the help of a separate interview guide consisting of broad, open-ended questions with two primary stimulus questions based on the acceptance and barriers for use of DATs for capturing adherence to TB treatment. The possible solutions for the barriers to the use of DATs were also explored by the healthcare providers. Manual content analysis was done for the qualitative data. Results Benefits of the use of DATs included saving time, identification of loss to follow up patients, information on NIKSHAY, and other direct benefit transfers. Barriers include financial constraints, level of education, family issues, and difficulty in the use of gadgets (tab). Some of the solutions to the barriers were cooperation from family members, distribution of mobile phones, appointment of ASHA workers, and linking of NIKSHAY IDs with Aadhaar card numbers to avoid duplication. Interpretation & Conclusions Identification of barriers and potential solutions in DATs can help in the successful monitoring and completion of tuberculosis treatment which are crucial towards achieving the tuberculosis elimination goal set by the Government of India as well as the SDG target for elimination by 2030.</p>","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 4","pages":"354-361"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325495","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Cardiovascular safety of gabapentinoids gabapentin & pregabalin: A systematic review.","authors":"Deep Dutta, Ritin Mohindra, Manoj Kumar, Mainak Banerjee, Meha Sharma, Satinath Mukhopadhyay","doi":"10.25259/IJMR_1990_2024","DOIUrl":"https://doi.org/10.25259/IJMR_1990_2024","url":null,"abstract":"<p><p>Background & objectives A few propensity-score-matched cohort studies have suggested increased cardiovascular events with gabapentinoids (gabapentin/pregabalin). This systematic review analysed the cardiovascular safety of gabapentin and pregabalin in clinical practice. Methods Databases were searched for articles examining the occurrence of cardiovascular events with gabapentin and pregabalin in different clinical conditions. The primary outcome was to look at the occurrence of myocardial infarction (MI) and stroke. Secondary outcomes were to look at the occurrence of deep venous thrombosis (DVT), peripheral artery disease (PAD), pulmonary thrombo-embolism (PTE), heart failure (HF) and atrial fibrillation (AF). Results Data from five cohort studies (10,85,488 patients) were analysed. Gabapentin use was associated with increased risk of MI after one year of [Hazard ratio (HR) 1.31(1.14,1.52); I2=0%; P=0.0002] use. Gabapentinoids were associated with increased risk of stroke after five years of use [HR 1.44 (1.04, 2.01); I2=86%; P=0.03]. Heart failure was not increased with the use of gabapentinoids. Their chronic use was associated with increased risk of PVD after one year [HR 1.41(1.18, 1.67); P=0.0001] and five years [HR 1.58 (1.16, 2.15); I2=83%; P=0.003] use. Gabapentinoid use was associated with increased risk of DVT after three months [HR 1.37(1.21, 1.55); P<0.00001], one-year [HR 1.42 (1.15, 1.74); P=0.0009], and five years [HR 1.78 (1.31,2.40); I2=71%; P=0.0002] use. Their use was associated with increased risk of pulmonary embolism after three months [HR 1.27 (1.09, 1.46); P=0.002], one-year [HR 1.23 (1.01, 1.40); P=0.04], and five years of [HR 1.86 (1.64, 2.09); I2=0%; P<0.0001] use. Interpretation & conclusions The use of gabapentinoids was associated with increased risks of thrombotic events as early as three months of use, and with increased risk of cardiovascular events on prolonged use of more than a year duration.</p>","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 4","pages":"363-374"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325501","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Drug utilisation patterns & clinical outcomes in hospitalised COVID-19 patients: A geospatial & machine learning approach.","authors":"Dhruva Kumar Sharma, Madhab Nirola, Mousumi Gupta, Arpan Sharma, Prasanna Dhungel, Barun Kumar Sharma","doi":"10.25259/IJMR_352_24","DOIUrl":"https://doi.org/10.25259/IJMR_352_24","url":null,"abstract":"<p><p>Background & objectives Coronavirus disease (COVID-19) caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has posed challenges in clinical management due to a lack of established treatment guidelines. This study aimed to analyse drug utilisation patterns and identify factors influencing clinical outcomes in COVID-19 patients. Methods A retrospective study was conducted on 380 confirmed COVID-19 patients admitted between April and June 2021 at a tertiary hospital in Sikkim, India. Study participants demographics, medications, comorbidities, outcomes, and geospatial data were collected with due approval from the Institutional Ethics Committee. Machine learning classification and regression models were used for analysis. Results The Random Forest classification model achieved the highest accuracy of 90.7 per cent and an AUROC score of 0.86. Methylprednisolone use was associated with an 11.4 per cent mortality rate. Geospatial analysis identified significant mortality clustering in the East district for female study participants and in the East and North districts for male study participants, with a Moran's I index of 0.125080 and a z-score of 8.642819, indicating statistically significant spatial clustering. Interpretation & conclusions The study provides insights into COVID-19 management practices and outcomes. Machine learning identified relationships between factors associated with mortality, which could be due to advanced disease state, associated co-morbidities or post-treatment issues. Further prospective studies are needed to validate findings and address limitations.</p>","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 4","pages":"375-385"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325504","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}

{"title":"Pituitary dysfunction in heart block: The need for broader insight.","authors":"Muhammad Zarrar","doi":"10.25259/IJMR_270_2025","DOIUrl":"https://doi.org/10.25259/IJMR_270_2025","url":null,"abstract":"","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 4","pages":"428"},"PeriodicalIF":2.7,"publicationDate":"2025-04-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144325570","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":4,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}