Indian Journal of Medical Research最新文献

{"title":"Prenatal hemoglobinopathy screening & prevention in India: A cross-sectional study.","authors":"Rajat Kumar Agarwal, Rakesh Dhanya, Lalith Parmar, Amit Sedai, George Mani, Aniruddha Dhar, Santhosh Hegde, Sundar Periyavan, Nagaraj Erappa, Anusha S, Sudha Kumar, Balasubramani Rengaraj, Mamatha G N, Manjunatha N, R N Prasad, Rashmi Fernandes, Adinarayan Makkam, Lawrence Faulkner","doi":"10.25259/IJMR_1003_2024","DOIUrl":"https://doi.org/10.25259/IJMR_1003_2024","url":null,"abstract":"<p><p>Background & objectives India carries a significant burden of hemoglobinopathies, with beta-thalassemia and sickle cell disease (SCD) carrier rates ranging from 3-40 per cent by region. Despite the importance of universal screening, widespread prevention is challenging due to socio-cultural stigma, low awareness, and poor follow up. Sankalp's thalassemia prevention program used targeted prenatal screening rather than mass or cascade screening. The aim of this study was to assess the efficacy and feasibility of a targeted antenatal screening strategy for the prevention and management of severe hemoglobinopathies in India. Methods A cross-sectional study was conducted in 36 districts across five Indian States between April 2023 and March 2024. Pregnant women within 20 wk gestation attending public hospitals were screened for hemoglobinopathies using high-performance liquid chromatography (HPLC). If a woman was identified as a carrier, her partner was tested. At-risk couples received molecular confirmation, followed by prenatal testing and counselling to support informed decisions. Results Of the total 34,647 enrolled women, 33,270 (96%) were screened, identifying 2,268 (6.8%) carriers, 903 (2.7%) beta thalassemia, 1,176 (3.5%) SCD, and 189 (0.6%) other hemoglobinopathies. Partners of 1,959 women (86.4%) were tested, identifying 339 at-risk couples. Testing was unnecessary in five cases due to benign mutations. Fetal testing was completed in 246 pregnancies, identifying 65 affected foetuses. Among these, 44 families (68%) chose to discontinue pregnancy. One affected birth was prevented for every 787 families enrolled. Interpretations & Conclusions The Sankalp program for hemoglobinopathies prevention demonstrates that targeted antenatal screening within public healthcare is a feasible, effective, and scalable strategy for hemoglobinopathy prevention in socio-economically disadvantaged populations.</p>","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 5","pages":"441-448"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952307","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":"Efficacy & safety of high-dose rifampicin in pulmonary tuberculosis: A systematic review & meta-analysis.","authors":"Bhavani Perumal Kannabiran, Jayanthi Arthanari, Adhin Bhaskar, Mukesh Kumar Sathya Narayanan, Leeberk Raja Inbaraj","doi":"10.25259/IJMR_1673_2024","DOIUrl":"https://doi.org/10.25259/IJMR_1673_2024","url":null,"abstract":"<p><p>Background & objectives Evidence suggests that higher doses of rifampicin aid in faster culture conversion, but its effects on unfavourable outcomes are unclear. We aimed to synthesise evidence on the efficacy and safety of high-dose rifampicin (>15 mg/kg) containing anti-tuberculosis regimen compared to a regimen with standard dose of rifampicin in adults with pulmonary tuberculosis. Methods We searched for studies from MEDLINE, Embase, Web of Science, Google Scholar, and the Cochrane Library without geographical restriction. We included randomised controlled trials that evaluated high-dose rifampicin (>15 mg/kg for 8 wk) with a six-month duration. Our outcomes of interest were sputum conversion at eight wk, mortality, treatment failure at six months, Grade 3 and Grade 4 hepatotoxicity, and adverse events leading to treatment discontinuation. Two authors independently screened titles, abstracts, and full texts and extracted data. We performed a meta-analysis using the RevMan web software as per the Cochrane Handbook for Systematic Reviews of Interventions. Results Out of 3950 articles screened, we included nine for meta-analysis. High-dose rifampicin (≥15 mg/kg) showed little benefit compared to the standard dose for sputum conversion at eight wk [(83% vs. 78%, Relative risk (RR) 1.05 (95% confidence interval (CI): 1.0-1.09), Number needed to treat (NNT)-24)] and this benefit was higher as the rifampicin dose increased [20-30 mg RR: 1.07 (95% CI 1.02-1.14), NNT-17]; >30 mg RR: 1.12 (95% CI 1.04 -1.20) NNT-9]. However, treatment failure and mortality showed no benefit with high-dose rifampicin. Grade 3 and 4 hepatotoxicity and treatment discontinuation due to toxicity had a dose-response relationship and were significantly higher in the more than 30 mg/kg group [RR: 4.01 (95%CI 1.75-9.19), Number needed to harm -20]. Interpretation & conclusions High doses of rifampicin (≥15 mg/kg) increased the rate of sputum culture conversion after two months of the intensive phase. There was no difference in mortality and treatment failure between high-dose rifampicin and standard arms. In the subgroup analysis, the 20-30 mg/kg dose exhibited a beneficial effect in sputum conversion with no significant risk of hepatotoxicity and adverse drug reactions (ADR) leading to treatment discontinuation. This dose could be administered with close monitoring of adverse events and hepatotoxicity. There is an urgent need for adequately powered trials that assess long-term treatment outcomes, including recurrence.</p>","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 5","pages":"449-460"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952551","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":"High prevalence of metabolic obesity in India: The ICMR-INDIAB national study (ICMR-INDIAB-23).","authors":"Deepa Mohan, Rajendra Pradeepa, Ulagamadesan Venkatesan, Prabha Adhikari, Hiranya Kumar Das, Kalpana Dash, Jatinder Kumar Mokta, Somorjit Ningomban, Rosang Luaia, Richard O Budnah, Anil Bhansali, Lobsang Jampa, Vizolie Suokhrie, Sunil M Jain, Prashant P Joshi, Shashank Joshi, Anil J Purty, Karma Jigme Tobgay, Taranga Reang, Sri Venkata Madhu, Elangovan Nirmal, Radhakrishnan Subashini, Sudha Vasudevan, Arumugam Muruganathan, Krishna G Seshadri, Ranjit Unnikrishnan, Ashok Kumar Das, Tanvir Kaur, Rupinder Singh Dhaliwal, Viswanathan Mohan, Ranjit Mohan Anjana","doi":"10.25259/IJMR_328_2025","DOIUrl":"https://doi.org/10.25259/IJMR_328_2025","url":null,"abstract":"<p><p>Background & objectives While obesity usually produces cardio-metabolic dysfunction, some obese individuals are metabolically healthy, and conversely, some nonobese individuals have significant metabolic dysfunction. This study aims to assess the national prevalence of various obesity subtypes and their association with type 2 diabetes (T2D), coronary artery disease (CAD), and chronic kidney disease (CKD) in the Indian Council of Medical Research-India Diabetes (ICMR-INDIAB) study. Methods The ICMR-INDIAB study is a nationally representative cross-sectional survey of 1,13,043 individuals aged ≥20 yr from urban and rural areas across 31 Indian States and Union Territories. In every fifth individual (n=19,370), venous blood glucose and lipids were measured. A body mass index (BMI) ≥25 kg/m2 was defined as being obese, and metabolic obesity was diagnosed if two risk factors, out of the following: high waist circumference, high blood pressure, elevated blood glucose, raised serum triglycerides, or low HDL cholesterol, were present. Four subgroups were identified: Metabolically Healthy Non-Obese (MHNO), Metabolically Healthy Obese (MHO), Metabolically Obese Non-Obese (MONO), and Metabolically Obese Obese (MOO). Results The prevalence of various obesity subtypes was as follows: MONO: 43.3 per cent [95% confidence interval (CI): 42.6-44%], MOO: 28.3 per cent (27.7-28.9%), MHNO: 26.6 per cent (26-27.2%), and MHO: 1.8 per cent (1.6-2%). MONO was more prevalent in rural areas [Rural vs. Urban: MONO: 46 per cent (45-46.9%) vs. 39.6 per cent (37.8-41.3%), P<0.001]. MOO showed the highest risk for T2D and CAD, while MONO showed the highest risk of CKD, especially among females. Interpretation & conclusions Individuals with MONO have a distinct phenotype with adverse metabolic consequences, highlighting the need to shift from body weight-focused approaches to broader strategies to identify and tackle non-communicable diseases (NCDs) in India.</p>","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 5","pages":"461-472"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952278","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":"The syndemic of structural vulnerabilities & HIV risk among men who inject drugs in India: Reflections from a population-based study.","authors":"Akash Nagar, Vaibhavi Singh","doi":"10.25259/IJMR_1368_2025","DOIUrl":"https://doi.org/10.25259/IJMR_1368_2025","url":null,"abstract":"","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 5","pages":"575-576"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952338","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":"Venkatesan Chakrapani, Lakshmi P V M, Alexander C Tsai, Vijin Pandara Purayil, Pradeep Kumar, Rajesh Kumar, Chinmoyee Das, Shobini Rajan","doi":"10.25259/IJMR_1573_2025","DOIUrl":"https://doi.org/10.25259/IJMR_1573_2025","url":null,"abstract":"","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 5","pages":"576-578"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952414","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":"Awareness about the symptoms & risk factors of ovarian cancer among women in North Urban Bengaluru: A cross-sectional study.","authors":"Surabhi Sai P Raghavendra, Mackwin Kenwood Dmello, Anjusha Alex, Priya Nandimath","doi":"10.25259/IJMR_1351_2024","DOIUrl":"https://doi.org/10.25259/IJMR_1351_2024","url":null,"abstract":"<p><p>Background & objectives In low or medium Human Development Index (HDI) nations, late-stage ovarian cancer diagnosis in 75 per cent of women is known to hinder treatment outcomes. However, knowledge and awareness can significantly impact disease progression and outcomes. This study was conducted to determine ovarian cancer awareness, risk factors, and symptoms among women in a community-based setting. Methods This study was conducted in Yelahanka, North Urban Bengaluru, between October 2023 and July 2024. A validated questionnaire, Ovarian Cancer Awareness Measure (OCAM), was used to interview the women. Household data were collected through systematic sampling using the Epicollect-5 mobile application and analysed with Jamovi software version 2.3.28. Results A total of 375 women were interviewed during the study, of which 28.5 per cent were aware of ovarian cancer. With median scores of 4 out of 10 for symptoms and 5 out of 12 for risk factors, there was a general lack of awareness of symptoms and risk factors. Commonly identified symptoms included extreme fatigue (61.7%), pelvic pain (54.2%), abdominal enlargement (51.4%), and back pain (43.9%). The socioeconomic class was significantly associated with symptom awareness (P<0.05). On identifying risk factors of ovarian cancer, the most recognised were a history of ovarian cysts (71%), smoking (64.48%), age >50 yr (55.54%), and being overweight (47.6%). Age, marital status, education, and socioeconomic class (P<0.05) influenced awareness of risk factors. Interpretation & conclusions This study found low ovarian cancer awareness among women in North Urban Bengaluru, emphasising the necessity for focused awareness programmes to enhance early diagnosis and improve health outcomes.</p>","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 5","pages":"502-509"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952572","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":"Genotypic distribution & clinical profile of chronic hepatitis B cases: insights from a tertiary care hospital in North India.","authors":"Pooja Pandey, Juhi Taneja, S Zafar Abbas, Praveen Malik, Ashwini Kumar Setya","doi":"10.25259/IJMR_644_2024","DOIUrl":"https://doi.org/10.25259/IJMR_644_2024","url":null,"abstract":"<p><p>Background & Objectives India is considered a region with intermediate to high endemicity for the carriage of Hepatitis B surface antigen (HBsAg). Epidemiological updates are crucial to monitor the progress towards the global commitment to eliminate hepatitis by 2030. This study was designed to analyse the demographic, epidemiological, laboratory, virological, clinical, and genotypic characteristics of the patients with Chronic Hepatitis B (CHB) in North India. Methods One hundred and eighty-three HBsAg-positive patients were enrolled in the study between October 2019 and October 2022. Inclusion criteria required patients to have HBsAg detectable in serum for more than six months. The genotype of Hepatitis B virus (HBV) was determined by using polymerase chain reaction (PCR)- based method. To validate the findings, 20 samples were selected for HBV DNA polymerase genes (S/POL) sequencing, which is crucial for accurately classifying of the virus and its genotypic characteristics. Sequences were manually edited with the BioEdit Sequence Editor (version 7.2.5) and analysed via BLAST. Results Among 183 HBsAg-positive chronic liver disease patients, 77.5 per cent clinically presented as HBeAg negative chronic hepatitis. The identified genotypes were predominantly D (170; 92.2%), followed by A (11; 6%) and C (2; 1.1%). Of the total patients, 102 (55.7%) were male, with the majority within the 0-45 years age group (83.4%). The most common risk factor was surgical intervention (77; 42.1%), followed by tattooing and body piercing (39; 21.3%), blood transfusion (14; 7.7%), dialysis (33; 18%), mother-to-child transmission (4; 2.2%), IV drug abuse (10; 5.5%), and dental procedures (3; 1.6%). Familial transmission was observed in 11.8 per cent of spouses. Interpretation & conclusions The study highlighted that genotype D was the most prevalent and acquired commonly through the parenteral routes, with severe disease phase, while genotype A was the next frequent genotype associated with vertical or familial spread, with the most patients seen in the immune-tolerant phase.</p>","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 5","pages":"552-558"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952556","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":"Integrating rehabilitation into health systems.","authors":"Shankar Ganesh","doi":"10.25259/IJMR_1737_2024","DOIUrl":"https://doi.org/10.25259/IJMR_1737_2024","url":null,"abstract":"","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 5","pages":"437-440"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952379","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":"Effectiveness of pulmonary rehabilitation on functional exercise capacity & health related quality of life (HRQOL) among individuals with post tuberculosis lung disease: A multicentric pre & post-interventional study.","authors":"Sanjeev Sinha, Renuka Titiyal, Pallati Mounika, Anuj Ajayababu, Palanivel Chinnakali, Nalini Ghanate, Prashantha Bettappa, Ravish Kshatriya, Prashanth Chikkahonnaih, Suman Shil, Manju Rajaram, Sadhana Subramanian, Karthik Velimala, Palvai Rajesh Kumar, Sravan Kumar G, Geetika Madan Patel, Shivam Pandey","doi":"10.25259/IJMR_1643_2024","DOIUrl":"https://doi.org/10.25259/IJMR_1643_2024","url":null,"abstract":"<p><p>Background & objectives Pulmonary rehabilitation (PR) has been extensively studied and proven beneficial in various respiratory conditions such as chronic obstructive pulmonary disease (COPD) and interstitial lung disease (ILD). Individuals with post-tuberculosis lung disease (P-TBLD) have limited exercise tolerance and a significant disability affecting daily living, much like those with COPD. Hence, they appear to be good candidates for PR. This study aimed to determine the effectiveness of an outpatient PR protocol on functional exercise capacity and health-related quality of life (HRQOL) in individuals with P-TBLD. Furthermore, the effectiveness of adherence to the PR protocol among the participants as well as identifying the gaps and barriers in accessing PR were also determined. Methods This is a multicentric pre- and post-interventional study conducted across five centres in India. 260 individuals with P-TBLD were included if they could complete more than 80 per cent of the physiotherapist's training sessions at the time of enrollment had previously received treatment for pulmonary tuberculosis and were negative for acid fast bacilli (AFB) on sputum examination. Individuals were excluded if they had preexisting lung disease other than P-TBLD or suffered from any mental, neurological, musculoskeletal, or unstable cardiovascular disease that could impair their performance during the exercise training sessions. Pre- and post-intervention assessments included clinical symptoms, exercise intolerance, pulmonary function test (PFT), 6-minute walk test (6MWT), muscle strength testing, and St. George Respiratory Questionnaire (SGRQ) score for HRQOL. Participants received PR training at first visit in OPD and were advised to follow it at home and telephonic follow up was done for a duration of 12 wk. Results Out of the 260 participants who were enrolled, 246 patients completed the post-intervention evaluation following 12 wk of the PR protocol. Clinical parameters, the 6MWT, the functional balance test, and the muscle strength test all showed significant improvement after PR. Significant improvement was observed across all domains of the SGRQ score. Pulmonary function measures showed significant improvement in FEV1 and FVC parameters post intervention. Interpretation & conclusions This study provides compelling evidence that PR is beneficial for post-TB patient, leading to notable improvements in the exercise capacity, symptom management as well as the overall quality of life. The findings support the implementation of PR protocol on a larger scale within national health frameworks, particularly in countries with high TB prevalence. By integrating PR into the National Tuberculosis Elimination Programme, it is possible to offer a comprehensive care approach that sets standard indicators for the surveillance of P-TBLD and addresses the long-term health needs of TB survivors.</p>","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 5","pages":"540-551"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952482","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":"Nipah virus infection in humans in Kerala, India: Hypothesis of air-borne transmission.","authors":"Thekkekara Jacob John, Nivedita Gupta, Manoj Vasant Murhekar","doi":"10.25259/IJMR_2180_2024","DOIUrl":"https://doi.org/10.25259/IJMR_2180_2024","url":null,"abstract":"","PeriodicalId":13349,"journal":{"name":"Indian Journal of Medical Research","volume":"161 5","pages":"567-571"},"PeriodicalIF":2.5,"publicationDate":"2025-05-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"144952359","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}