Several studies have compared the basal-bolus (BB) and premixed (PM) insulin regimens with varying results. This study aimed to evaluate the glycemic control and occurrence of hypoglycemia with these regimens in insulin-naïve patients with type 2 diabetes mellitus (T2D) in the Indian subpopulation. This was a 12-week (wk) prospective, observational study in 60 adult patients (distributed 1:1) with >7 years of T2D and uncontrolled with three oral drugs. Changes in glycemic parameters at wk4 and wk12 were assessed, and hypoglycemia events were also recorded. The PM insulin showed a significant decrease in fasting plasma glucose (FPG) at wk4 from baseline (P = 0.02) and at wk12 (P < 0.001), while in the BB insulin group, the change was significant only at wk12 (P < 0.0001). There were greater reductions in the PM group in FPG at wk4 (PM vs. BB: P = 0.04) and wk12 (P = 0.03) compared to the BB group. The post-prandial plasma glucose in both groups significantly reduced from baseline at wk4 (PM group P = 0.034; BB group; P = 0.034) and wk12 (PM group P < 0.0001 and BB group: P < 0.0001). However, there were no between-group differences at wk4 (P = 0.12) but only at wk12 (P = 0.009) with greater reductions in the PM group. The PM group showed a slightly greater reduction in glycated hemoglobin versus the BB group (9.18% vs. 7.08%; P = 0.39). There was no significant difference (P = 0.49) in the incidence of hypoglycemia. Both treatments significantly improved glycemic control and were not associated with any severe episodes of hypoglycemia. Therefore, the choice should instead be guided by the insulin-related (posology, complexity) and patient-related (dietary habits, adherence levels) factors.
{"title":"Glycemic control and adverse effects in patients with type 2 diabetes receiving basal-bolus insulin regimen versus premixed insulin regimen: An observational study","authors":"Prithwis Mitra, Sattik Siddhanta, Nafisha Yasmin, Gairik Sengupta","doi":"10.25259/ijms_204_2023","DOIUrl":"https://doi.org/10.25259/ijms_204_2023","url":null,"abstract":"\u0000\u0000Several studies have compared the basal-bolus (BB) and premixed (PM) insulin regimens with varying results. This study aimed to evaluate the glycemic control and occurrence of hypoglycemia with these regimens in insulin-naïve patients with type 2 diabetes mellitus (T2D) in the Indian subpopulation.\u0000\u0000\u0000\u0000This was a 12-week (wk) prospective, observational study in 60 adult patients (distributed 1:1) with >7 years of T2D and uncontrolled with three oral drugs. Changes in glycemic parameters at wk4 and wk12 were assessed, and hypoglycemia events were also recorded.\u0000\u0000\u0000\u0000The PM insulin showed a significant decrease in fasting plasma glucose (FPG) at wk4 from baseline (P = 0.02) and at wk12 (P < 0.001), while in the BB insulin group, the change was significant only at wk12 (P < 0.0001). There were greater reductions in the PM group in FPG at wk4 (PM vs. BB: P = 0.04) and wk12 (P = 0.03) compared to the BB group. The post-prandial plasma glucose in both groups significantly reduced from baseline at wk4 (PM group P = 0.034; BB group; P = 0.034) and wk12 (PM group P < 0.0001 and BB group: P < 0.0001). However, there were no between-group differences at wk4 (P = 0.12) but only at wk12 (P = 0.009) with greater reductions in the PM group. The PM group showed a slightly greater reduction in glycated hemoglobin versus the BB group (9.18% vs. 7.08%; P = 0.39). There was no significant difference (P = 0.49) in the incidence of hypoglycemia.\u0000\u0000\u0000\u0000Both treatments significantly improved glycemic control and were not associated with any severe episodes of hypoglycemia. Therefore, the choice should instead be guided by the insulin-related (posology, complexity) and patient-related (dietary habits, adherence levels) factors.\u0000","PeriodicalId":13277,"journal":{"name":"Indian journal of medical sciences","volume":"23 63","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-15","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"139000850","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Vikram Khan, A. Sanghai, D. Zala, Manjula J Babariya, V. K. Das
This retrospective observational study conducted in the district of Dadra and Nagar Haveli, Western India, over the past 9 years aimed to comprehensively investigate the epidemiology of chickenpox. The objectives were to analyze demographic and clinical characteristics, examine temporal trends, identify outbreak locations, assess outbreak intensity and duration, determine laboratory-confirmed cases, and provide insights for public health interventions. The study employed a retrospective approach, gathering data on chickenpox cases in the region. Demographic information, clinical profiles, and outbreak details were analyzed. Temporal variations and seasonal trends were assessed. Laboratory confirmation was achieved through serology and molecular methods. Locations of outbreaks were identified, and their characteristics were evaluated. The study revealed that the 6–10 age groups were most vulnerable, with mild-to-moderate symptoms predominantly observed. Significant variations in cases occurred year round, with peaks between November and February. Out of 25 recorded outbreaks and three early warning signals, Aganwadis, play schools, and schools were common outbreak locations. Most outbreaks were low intensity, and laboratory confirmation identified Clade-1 Varicella-Zoster virus as the causative agent. These findings provide essential insights for public health officials. Identifying the vulnerable age group and high-risk locations allows for targeted vaccination campaigns. Moreover, the study underscores the need for continuous monitoring and surveillance to detect outbreaks early and mitigate their spread effectively, emphasizing the importance of proactive prevention and control measures for chickenpox in the region.
{"title":"A deep dive into chickenpox epidemiology and outbreaks: A retrospective study in a tribal-dominated district of Western India","authors":"Vikram Khan, A. Sanghai, D. Zala, Manjula J Babariya, V. K. Das","doi":"10.25259/ijms_196_2023","DOIUrl":"https://doi.org/10.25259/ijms_196_2023","url":null,"abstract":"\u0000\u0000This retrospective observational study conducted in the district of Dadra and Nagar Haveli, Western India, over the past 9 years aimed to comprehensively investigate the epidemiology of chickenpox. The objectives were to analyze demographic and clinical characteristics, examine temporal trends, identify outbreak locations, assess outbreak intensity and duration, determine laboratory-confirmed cases, and provide insights for public health interventions.\u0000\u0000\u0000\u0000The study employed a retrospective approach, gathering data on chickenpox cases in the region. Demographic information, clinical profiles, and outbreak details were analyzed. Temporal variations and seasonal trends were assessed. Laboratory confirmation was achieved through serology and molecular methods. Locations of outbreaks were identified, and their characteristics were evaluated.\u0000\u0000\u0000\u0000The study revealed that the 6–10 age groups were most vulnerable, with mild-to-moderate symptoms predominantly observed. Significant variations in cases occurred year round, with peaks between November and February. Out of 25 recorded outbreaks and three early warning signals, Aganwadis, play schools, and schools were common outbreak locations. Most outbreaks were low intensity, and laboratory confirmation identified Clade-1 Varicella-Zoster virus as the causative agent.\u0000\u0000\u0000\u0000These findings provide essential insights for public health officials. Identifying the vulnerable age group and high-risk locations allows for targeted vaccination campaigns. Moreover, the study underscores the need for continuous monitoring and surveillance to detect outbreaks early and mitigate their spread effectively, emphasizing the importance of proactive prevention and control measures for chickenpox in the region.\u0000","PeriodicalId":13277,"journal":{"name":"Indian journal of medical sciences","volume":"23 5","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-14","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138974756","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The current case–control study was conducted to investigate the relationship of iron deficiency anemia and calcium levels with febrile seizures (FSs) in children. The study included 200 children ranging in age from 6 to 60 months. One hundred cases had FSs, including simple FSs and rest; 100 controls had a short history of febrile illness (<3 days) without seizures. A statistical analysis of the data was carried out using Statistical Package for the Social Sciences version 23. The mean weight, height, and head circumference of cases and controls are 9.73 ± 2.51 kg and 10.63 ± 3.34 kg, 79.66 ± 11.08 cm and 85.43 ± 15.55 cm, and 46.37 ± 2.79 cm and 46.83 ± 3.72 cm, respectively. As per the Indian Academy of Pediatrics, 27% of cases and 37% of controls had protein energy malnutrition (PEM). In cases and controls, the mean hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, and red cell distribution width values were 9.23 ± 1.30 and 10.78 ± 1.60 gm/dL, 68.83 ± 8.86 and 78.59 ± 9.82 fl, 25.40 ± 3.47 and 28.50 ± 3.60 pg, and 18.73 ± 1.77 and 16.44 ± 1.76, respectively, and are statistically significant. Patients had lower serum ferritin levels than controls. The mean blood calcium levels in cases and controls were 9.13 ± 0.64 and 9.05 ± 0.93 mg/dL, respectively (P = 0.507). Iron deficiency anemia was found in 26% of cases and 7% of controls (P value <0.001). Hypocalcemia was reported in only 18% of patients and 23% of controls (P = 0.38). There is a clear correlation between FSs and iron deficiency. The majority of data suggests that hypocalcemia is unlikely to be the cause of FSs. Early detection and intervention of iron deficiency in children could help in the prevention and recurrence of FSs.
{"title":"Association of serum iron and serum calcium levels in children with febrile seizures","authors":"Himanshu Gupta, Bhoopendra Sharma, Manisha Verma, Vijay Kumar Singh, Rajeev Verma","doi":"10.25259/ijms_136_2023","DOIUrl":"https://doi.org/10.25259/ijms_136_2023","url":null,"abstract":"\u0000\u0000The current case–control study was conducted to investigate the relationship of iron deficiency anemia and calcium levels with febrile seizures (FSs) in children.\u0000\u0000\u0000\u0000The study included 200 children ranging in age from 6 to 60 months. One hundred cases had FSs, including simple FSs and rest; 100 controls had a short history of febrile illness (<3 days) without seizures. A statistical analysis of the data was carried out using Statistical Package for the Social Sciences version 23.\u0000\u0000\u0000\u0000The mean weight, height, and head circumference of cases and controls are 9.73 ± 2.51 kg and 10.63 ± 3.34 kg, 79.66 ± 11.08 cm and 85.43 ± 15.55 cm, and 46.37 ± 2.79 cm and 46.83 ± 3.72 cm, respectively. As per the Indian Academy of Pediatrics, 27% of cases and 37% of controls had protein energy malnutrition (PEM). In cases and controls, the mean hemoglobin, mean corpuscular volume, mean corpuscular hemoglobin, and red cell distribution width values were 9.23 ± 1.30 and 10.78 ± 1.60 gm/dL, 68.83 ± 8.86 and 78.59 ± 9.82 fl, 25.40 ± 3.47 and 28.50 ± 3.60 pg, and 18.73 ± 1.77 and 16.44 ± 1.76, respectively, and are statistically significant. Patients had lower serum ferritin levels than controls. The mean blood calcium levels in cases and controls were 9.13 ± 0.64 and 9.05 ± 0.93 mg/dL, respectively (P = 0.507). Iron deficiency anemia was found in 26% of cases and 7% of controls (P value <0.001). Hypocalcemia was reported in only 18% of patients and 23% of controls (P = 0.38).\u0000\u0000\u0000\u0000There is a clear correlation between FSs and iron deficiency. The majority of data suggests that hypocalcemia is unlikely to be the cause of FSs. Early detection and intervention of iron deficiency in children could help in the prevention and recurrence of FSs.\u0000","PeriodicalId":13277,"journal":{"name":"Indian journal of medical sciences","volume":"122 41","pages":""},"PeriodicalIF":0.0,"publicationDate":"2023-12-02","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"138606990","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Evelyne Kantarama, Dieudonne Uwizeye, Annette Uwineza, Claude Mambo Muvunnyi
Objective: Depot medroxyprogesterone acetate (DMPA) injectable contraceptive is a widely used hormonal method that offers reversible and effective birth control for women worldwide. However, various studies have raised concerns regarding its potential association with increased cardiovascular disease risk, attributed to its influence on cardiometabolic risk factors. While previous studies have primarily focused on lipid profile, weight gain, blood pressure, and blood glucose, important aspects such as central obesity, glycated hemoglobin (HbA1C), and systemic inflammation have remained under-investigated. Thus, this study aimed to explore the influence of DMPA injectable contraceptives on lipid panel, HbA1C, visceral fat deposition, blood pressure, and inflammatory markers among women of childbearing age in Rwanda. Materials and Methods: The study was a prospective cohort and recruited an equal number of DMPA users (45) as the study group and users of nonhormonal (NH) contraceptives (45) as the control group. We recruited participants from two selected family planning centers in Kigali and collected data at baseline, 6 months, and 12 months. We measured the waist circumference, blood pressure, lipids profile (high-density lipoprotein cholesterol [HDL], low-density lipoprotein cholesterol [LDL], total cholesterol [TC], and triglycerides [TG]), HbA1C, and high-sensitivity C-reactive protein (hs-CRP). We run the Mann–Whitney to compare the median (MD) change between DMPA and NH users. Data were presented as MD (interquartile range), with a significance level of 5%. Results: After a follow-up of 12 months, DMPA users experienced a significant increase in waist circumference, TG, LDL, TC, hs-CRP, and HbA1C ( P < 0.05), whereas they experienced a significant decrease in HDL than controls ( P < 0.05). However, our data did not indicate a significant difference in blood pressure changes between DMPA and NH users ( P > 0.05). Conclusion: The effect of DMPA injectable on cardiometabolic parameters was minimal in the first 6 months of use; however, it manifested statistically significant at 12 months of follow-up. It is recommended to initiate a follow-up with users at least 12 months of use and repeat every 6 months to check the status of cardiometabolic markers and intervene where necessary.
{"title":"Effect of depot medroxyprogesterone acetate on cardiometabolic risk factors among women of reproductive age in Rwanda: A prospective cohort study","authors":"Evelyne Kantarama, Dieudonne Uwizeye, Annette Uwineza, Claude Mambo Muvunnyi","doi":"10.25259/ijms_205_2022","DOIUrl":"https://doi.org/10.25259/ijms_205_2022","url":null,"abstract":"Objective: Depot medroxyprogesterone acetate (DMPA) injectable contraceptive is a widely used hormonal method that offers reversible and effective birth control for women worldwide. However, various studies have raised concerns regarding its potential association with increased cardiovascular disease risk, attributed to its influence on cardiometabolic risk factors. While previous studies have primarily focused on lipid profile, weight gain, blood pressure, and blood glucose, important aspects such as central obesity, glycated hemoglobin (HbA1C), and systemic inflammation have remained under-investigated. Thus, this study aimed to explore the influence of DMPA injectable contraceptives on lipid panel, HbA1C, visceral fat deposition, blood pressure, and inflammatory markers among women of childbearing age in Rwanda. Materials and Methods: The study was a prospective cohort and recruited an equal number of DMPA users (45) as the study group and users of nonhormonal (NH) contraceptives (45) as the control group. We recruited participants from two selected family planning centers in Kigali and collected data at baseline, 6 months, and 12 months. We measured the waist circumference, blood pressure, lipids profile (high-density lipoprotein cholesterol [HDL], low-density lipoprotein cholesterol [LDL], total cholesterol [TC], and triglycerides [TG]), HbA1C, and high-sensitivity C-reactive protein (hs-CRP). We run the Mann–Whitney to compare the median (MD) change between DMPA and NH users. Data were presented as MD (interquartile range), with a significance level of 5%. Results: After a follow-up of 12 months, DMPA users experienced a significant increase in waist circumference, TG, LDL, TC, hs-CRP, and HbA1C ( P < 0.05), whereas they experienced a significant decrease in HDL than controls ( P < 0.05). However, our data did not indicate a significant difference in blood pressure changes between DMPA and NH users ( P > 0.05). Conclusion: The effect of DMPA injectable on cardiometabolic parameters was minimal in the first 6 months of use; however, it manifested statistically significant at 12 months of follow-up. It is recommended to initiate a follow-up with users at least 12 months of use and repeat every 6 months to check the status of cardiometabolic markers and intervene where necessary.","PeriodicalId":13277,"journal":{"name":"Indian journal of medical sciences","volume":"8 2","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-28","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136233240","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Role of regional antibiograms: Acting before the blast","authors":"Charu Singh, Naveen Bansal, Ashish Gulia","doi":"10.25259/ijms_197_2023","DOIUrl":"https://doi.org/10.25259/ijms_197_2023","url":null,"abstract":"","PeriodicalId":13277,"journal":{"name":"Indian journal of medical sciences","volume":"12 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135729665","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Introduction: Obesity is defined for the Asian population as a body mass index (BMI) >25 kg/m 2 , while overweight is a BMI between 23 kg/m 2 and 24.9 kg/m 2 . Both obesity and type 2 diabetes are major independent risk factors for cardiovascular disease according to previous literature. The data on the risk of obesity on diabetic complications are scarce, which is why this study was conducted. This study is designed to study the hypothesis that complications of diabetes are more in obese/overweight than in non-obese patients. Materials and Methods: We conducted an observational cross-sectional study in a tertiary care center. Patients with known type 2 diabetes mellitus admitted to our center were serially selected and BMI was calculated and patients were divided into non-obese/overweight and obese/overweight categories according to the World Health Organization recommendations for the Asian population. Patients were assessed for diabetes control and duration of diabetes. Each patient was also evaluated for microvascular and macrovascular complications of diabetes according to the American diabetes association guidelines. Complications in obese/overweight diabetics and diabetics with normal BMI were compared. SPSS version 23 software was used for statistical analysis. Results: A total of 84 admitted diabetics were included, of the 84 patients 45 (53.57%) were women, and 56 (66.67%) were overweight and obese. About 10.71% of diabetics with normal BMI and 26.79% of overweight/obese diabetics had retinopathy. 8 (28.57%) patients in the normal BMI group, while 26 (46.42%) patients in the overweight/obese group had ischemic heart disease (IHD) ( P < 0.05). Conclusion: Obesity and overweight are associated with a high risk of complications of diabetes, especially retinopathy and IHD. Glycemic control is also poor among obese/overweight diabetics. Microvascular complications occur earlier in obese/overweight diabetics.
{"title":"Microvascular and macrovascular complications in non-obese/overweight and obese/overweight type 2 diabetes mellitus","authors":"Digvijay Chavan, Nilesh Lomte, Meenakshi Bhattacharya, Akash Singh, Ramachandra Sonavale","doi":"10.25259/ijms_82_2022","DOIUrl":"https://doi.org/10.25259/ijms_82_2022","url":null,"abstract":"Introduction: Obesity is defined for the Asian population as a body mass index (BMI) >25 kg/m 2 , while overweight is a BMI between 23 kg/m 2 and 24.9 kg/m 2 . Both obesity and type 2 diabetes are major independent risk factors for cardiovascular disease according to previous literature. The data on the risk of obesity on diabetic complications are scarce, which is why this study was conducted. This study is designed to study the hypothesis that complications of diabetes are more in obese/overweight than in non-obese patients. Materials and Methods: We conducted an observational cross-sectional study in a tertiary care center. Patients with known type 2 diabetes mellitus admitted to our center were serially selected and BMI was calculated and patients were divided into non-obese/overweight and obese/overweight categories according to the World Health Organization recommendations for the Asian population. Patients were assessed for diabetes control and duration of diabetes. Each patient was also evaluated for microvascular and macrovascular complications of diabetes according to the American diabetes association guidelines. Complications in obese/overweight diabetics and diabetics with normal BMI were compared. SPSS version 23 software was used for statistical analysis. Results: A total of 84 admitted diabetics were included, of the 84 patients 45 (53.57%) were women, and 56 (66.67%) were overweight and obese. About 10.71% of diabetics with normal BMI and 26.79% of overweight/obese diabetics had retinopathy. 8 (28.57%) patients in the normal BMI group, while 26 (46.42%) patients in the overweight/obese group had ischemic heart disease (IHD) ( P < 0.05). Conclusion: Obesity and overweight are associated with a high risk of complications of diabetes, especially retinopathy and IHD. Glycemic control is also poor among obese/overweight diabetics. Microvascular complications occur earlier in obese/overweight diabetics.","PeriodicalId":13277,"journal":{"name":"Indian journal of medical sciences","volume":"17 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135779458","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Aqeel S Mahmood, Enam Azez Khalel Altameemi, Ahmed A Shakir, Samer Sabri, Mustafa Ismail
This article illuminates the changing landscape of managing multifocal (MF) breast cancer, specifically within the context of Iraq. Conventionally, MF breast cancer, characterized by multiple tumors within the same quadrant, has been deemed unsuitable for breast-conserving surgery (BCS) due to the perceived risk of local recurrence. However, data from our two centers in Baghdad may challenge this perspective. Of the 239 patients diagnosed with MF breast cancer in 2020, 73 underwent BCS, with only one local recurrence (1.37%), comparable to the recurrence rate in the mastectomy group (1.20%). Despite ongoing debates regarding MF breast cancer’s management and its association with higher local recurrence rates, our findings support emerging consensus on the effectiveness of BCS. Our experience from Iraq offers a unique perspective, suggesting equivalent local recurrence rates for BCS and mastectomy, necessitating a re-evaluation of surgical approaches and potentially endorsing less invasive treatments.
{"title":"The challenges of breast conservative surgery in multifocal breast cancer: The first insights from Iraq experience","authors":"Aqeel S Mahmood, Enam Azez Khalel Altameemi, Ahmed A Shakir, Samer Sabri, Mustafa Ismail","doi":"10.25259/ijms_146_2023","DOIUrl":"https://doi.org/10.25259/ijms_146_2023","url":null,"abstract":"This article illuminates the changing landscape of managing multifocal (MF) breast cancer, specifically within the context of Iraq. Conventionally, MF breast cancer, characterized by multiple tumors within the same quadrant, has been deemed unsuitable for breast-conserving surgery (BCS) due to the perceived risk of local recurrence. However, data from our two centers in Baghdad may challenge this perspective. Of the 239 patients diagnosed with MF breast cancer in 2020, 73 underwent BCS, with only one local recurrence (1.37%), comparable to the recurrence rate in the mastectomy group (1.20%). Despite ongoing debates regarding MF breast cancer’s management and its association with higher local recurrence rates, our findings support emerging consensus on the effectiveness of BCS. Our experience from Iraq offers a unique perspective, suggesting equivalent local recurrence rates for BCS and mastectomy, necessitating a re-evaluation of surgical approaches and potentially endorsing less invasive treatments.","PeriodicalId":13277,"journal":{"name":"Indian journal of medical sciences","volume":"22 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135778552","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
{"title":"Rapid incorporation of technology in health-care management – Blessing or curse?","authors":"Purvish M. Parikh","doi":"10.25259/ijms_200_2023","DOIUrl":"https://doi.org/10.25259/ijms_200_2023","url":null,"abstract":"","PeriodicalId":13277,"journal":{"name":"Indian journal of medical sciences","volume":"42 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135779299","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
The advent of artificial intelligence (AI) has brought about significant changes in the fields of pathology and radiology, particularly in the area of diagnostic accuracy. Although AI has enormous potential for enhancing the precision and effectiveness of diagnosis, it also presents an array of challenges. This review article examines the diagnostic challenges of AI in pathology and radiology. The article begins by giving a general review of AI and its potential applications in pathology and radiology. It then discusses the challenges posed by AI in the areas of data quality, generalization, interpretability, and hardware limitations. The article also explores the ethical and regulatory implications of AI in diagnostic settings, including issues of bias and transparency. Finally, the article offers potential solutions to address these challenges, such as standardization of AI algorithms, data sharing initiatives, saliency mapping, adversarial training of algorithms, cloud computing, edge computing, hybrid approaches, and increased collaboration between human experts and AI systems. Overall, this review highlights the critical importance of addressing the diagnostic challenges of AI in pathology and radiology to make sure AI is able to achieve its potential to enhance patient care.
{"title":"Overcoming diagnostic challenges of artificial intelligence in pathology and radiology: Innovative solutions and strategies","authors":"Rajendra M. Shah, Rupali Gautam","doi":"10.25259/ijms_98_2023","DOIUrl":"https://doi.org/10.25259/ijms_98_2023","url":null,"abstract":"The advent of artificial intelligence (AI) has brought about significant changes in the fields of pathology and radiology, particularly in the area of diagnostic accuracy. Although AI has enormous potential for enhancing the precision and effectiveness of diagnosis, it also presents an array of challenges. This review article examines the diagnostic challenges of AI in pathology and radiology. The article begins by giving a general review of AI and its potential applications in pathology and radiology. It then discusses the challenges posed by AI in the areas of data quality, generalization, interpretability, and hardware limitations. The article also explores the ethical and regulatory implications of AI in diagnostic settings, including issues of bias and transparency. Finally, the article offers potential solutions to address these challenges, such as standardization of AI algorithms, data sharing initiatives, saliency mapping, adversarial training of algorithms, cloud computing, edge computing, hybrid approaches, and increased collaboration between human experts and AI systems. Overall, this review highlights the critical importance of addressing the diagnostic challenges of AI in pathology and radiology to make sure AI is able to achieve its potential to enhance patient care.","PeriodicalId":13277,"journal":{"name":"Indian journal of medical sciences","volume":"44 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-10-19","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"135729660","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
Objectives: Isoniazid (INH) and second-line drug resistance (DR) detection through line probe assay (LPA) takes long in extrapulmonary (EP) specimens because culture growth needs to be obtained to perform deoxyribonucleic acid (DNA) extraction due to the paucibacillary nature of these specimens. Knowing the DR pattern at the earliest is key to success of the treatment. Delay in appropriate tuberculosis (TB) treatment in EP TB patients runs the risk of DR amplification, significant disease damage, and patient loss to follow-up. Here, LPA was attempted on truenat-derived DNA elute from EP specimens, which, in routine, is discarded after the truenat test, to determine drug sensitivity test (DST) for INH and, where necessary, for second-line drugs (Fluoroquinolones, Kanamycin, amikacin, and capreomycin). Material and Methods: Truenat, acid-fast bacilli culture, and fluorescent microscopy were performed on all EP samples that were received at the laboratory during June–September 2022. DNA elute that was left over from 59 truenat Mycobacterium tuberculosis (MTB) positive EP samples were subjected to Genotype MTBDR plus Ver 2.0 assay. Results: MTBDR plus assay (DNA elute) detected MTB and rifampicin (RIF) and INH DST in 47 samples (79.6%) having truenat MTB count of 7.8 × 10 2 colony-forming unit/milliliter and above. It also detected RIF DST in 65.2% truenat RIF indeterminate samples and DST for both RIF and INH in 60% of culture negative EP specimens. DST results by LPA (DNA elute) completely concorded with standard indirect LPA (on 21 culture isolates from smear-negative specimens). The MTBDRsl yield was however relatively low (11.1%), although second line LPA (SLLPA) was performed only on 9 first-line DR samples. Conclusions: Left-over truenat-derived DNA elute is a significant sample by-product that can significantly speed up and increase the yield of determination of MTB DST in EP samples for RIF and INH, the most critical drugs for TB treatment.
{"title":"Usefulness of truenat-derived DNA from extrapulmonary specimens in direct detection of drug resistant tuberculosis by line probe assay","authors":"Sarika Jain Agrawal, V Mamatha, N Somashekar","doi":"10.25259/ijms_40_2023","DOIUrl":"https://doi.org/10.25259/ijms_40_2023","url":null,"abstract":"Objectives: Isoniazid (INH) and second-line drug resistance (DR) detection through line probe assay (LPA) takes long in extrapulmonary (EP) specimens because culture growth needs to be obtained to perform deoxyribonucleic acid (DNA) extraction due to the paucibacillary nature of these specimens. Knowing the DR pattern at the earliest is key to success of the treatment. Delay in appropriate tuberculosis (TB) treatment in EP TB patients runs the risk of DR amplification, significant disease damage, and patient loss to follow-up. Here, LPA was attempted on truenat-derived DNA elute from EP specimens, which, in routine, is discarded after the truenat test, to determine drug sensitivity test (DST) for INH and, where necessary, for second-line drugs (Fluoroquinolones, Kanamycin, amikacin, and capreomycin). Material and Methods: Truenat, acid-fast bacilli culture, and fluorescent microscopy were performed on all EP samples that were received at the laboratory during June–September 2022. DNA elute that was left over from 59 truenat Mycobacterium tuberculosis (MTB) positive EP samples were subjected to Genotype MTBDR plus Ver 2.0 assay. Results: MTBDR plus assay (DNA elute) detected MTB and rifampicin (RIF) and INH DST in 47 samples (79.6%) having truenat MTB count of 7.8 × 10 2 colony-forming unit/milliliter and above. It also detected RIF DST in 65.2% truenat RIF indeterminate samples and DST for both RIF and INH in 60% of culture negative EP specimens. DST results by LPA (DNA elute) completely concorded with standard indirect LPA (on 21 culture isolates from smear-negative specimens). The MTBDRsl yield was however relatively low (11.1%), although second line LPA (SLLPA) was performed only on 9 first-line DR samples. Conclusions: Left-over truenat-derived DNA elute is a significant sample by-product that can significantly speed up and increase the yield of determination of MTB DST in EP samples for RIF and INH, the most critical drugs for TB treatment.","PeriodicalId":13277,"journal":{"name":"Indian journal of medical sciences","volume":"6 1","pages":"0"},"PeriodicalIF":0.0,"publicationDate":"2023-09-21","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":null,"resultStr":null,"platform":"Semanticscholar","paperid":"136154849","PeriodicalName":null,"FirstCategoryId":null,"ListUrlMain":null,"RegionNum":0,"RegionCategory":"","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":"","EPubDate":null,"PubModel":null,"JCR":null,"JCRName":null,"Score":null,"Total":0}
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