Indian Journal of Medical Research最新文献

Background & objectives Depression and anxiety are known sequelae in women who undergo hysterectomy. This study aims to assess and screen the prevalence of depression, anxiety, and quality of life (QoL) in women who underwent hysterectomy for benign gynaecological conditions and compare it across different age groups (15-29, 30-39, and 40-49 yr). Methods This hospital-based cross-sectional study was conducted on 125 women who underwent hysterectomy in their reproductive age. Depression, anxiety, and QoL were assessed and screened using structured tools and analysed using JAMOVI software. Results Moderate to severe depression and anxiety were present in 38 (30.4 per cent), and 35 (28 per cent) women, respectively. Comorbidities were significantly associated with higher anxiety prevalence (P=0.035), but not with depression. Urban residents and those above the poverty line had better QoL scores. Depression and anxiety showed strong positive correlations with each other (r=0.949, P<0.001). They also showed significant negative correlations with poorer QoL, particularly in physical, and psychological domains and the total QoL. The different age groups (15-29, 30-39, 40-49 yr) showed no significant differences in the prevalence of both depression and anxiety as well as with the total and domain-wise QoL scores. Interpretation & conclusions We found no significant difference in QoL outcomes based on the age at which the surgery was performed but identified a strong link between higher depression and anxiety scores and poorer QoL.

Background & objectives Language concordance-the ability of doctors to communicate with patients in their preferred language-is known to improve clinical outcomes and patient satisfaction. Medical undergraduates often face communication barriers with patients. This study aimed to assess the perceptions of undergraduate medical students regarding native language proficiency in clinical settings and its impact on doctor-patient relationships. Methods A descriptive, questionnaire-based cross-sectional study was conducted among 409 MBBS students across various academic years in Karnataka, to assess students' views on language use in clinical interactions, its benefits, and barriers, using a 5-point Likert scale. Responses were analysed using descriptive statistics and the Kruskal-Wallis test for inter-year comparison. Open-ended responses underwent thematic analysis. Results Of the 409 participants, 26.2 per cent were non-native Kannada speakers. A majority agreed that language concordance enhances empathy, rapport, and effective communication with patients. Most students supported the inclusion of local language learning in the curriculum and recognised its role in improving clinical skills such as history-taking. Thematic analysis highlighted key concerns, including patient interaction challenges, clinical skill development, and student-led strategies to overcome language barriers. Interpretation & conclusions Medical students perceive language concordance as a vital component of effective clinical communication and patient care. There is strong support for structured, longitudinal local language training within the MBBS curriculum.

Background & objectives India faces the highest rehabilitation need in South East Asia. Rehabilitation research is essential to define the gap between the need and available rehabilitation services at all levels of healthcare in both urban and rural settings for individuals across life span. Methods A comprehensive rapid literature search was conducted in two scientific databases namely - PubMed and Cumulative Index to Nursing and Allied Health Literature (CINAHL); and two scientific registries, namely - Clinical Trials Registry India and Shodhganga, to report the current status of rehabilitation research in India. Articles published in English (1801 till 2024), reporting studies pertinent to rehabilitation services such as physiotherapy, occupational therapy, speech rehabilitation, audiology rehabilitation, prosthetics and orthotics and clinical trials and doctoral theses pertinent to rehabilitation were included. Results A total of 10,692 and 546 research articles were identified in PubMed and CINAHL, respectively. Findings of rapid literature search suggested that the volume and level of research evidence pertinent to rehabilitation are considerably low vis-a-vis the huge and diverse need for rehabilitation services in rural-tribal and urban settings in India. Secondly, the spectrum of rehabilitation research is largely clinical research. Interpretation & conclusions Present findings underscore an urgent need to prioritize context-specific rehabilitation research in India. The results highlight the need for encompassing a wider focus of rehabilitation research including health system and health policy research, extending beyond clinical research. A strategic research framework is proposed which presents a multi-level approach to prioritize, execute and accelerate rehabilitation research for accessible and effective rehabilitation services for all individuals in need, across life-span, at all healthcare levels.

Background & objectives Diuretics are among the most cost-effective therapies for hypertension, yet uncertainty remains regarding the comparative efficacy and safety of chlorthalidone versus hydrochlorothiazide. Methods A search was conducted in PubMed, Cochrane, Scopus, and Embase. RCTs involving hypertensive patients were included, with chlorthalidone as the intervention and hydrochlorothiazide as the comparator. Risk of bias was assessed using the ROB 2 tool. The mean difference (MD) and relative risk (RR) were used as summary estimates. Safety outcomes were assessed by pooling the incidence of hypokalaemia, using RR. Results Ten RCTs (n = 1,182) were included. Chlorthalidone achieved greater reductions in 24-h ambulatory systolic blood pressure (BP)[MD: -4.21 mmHg, 95% confidence interval (CI): -4.73 to -4.05] and diastolic BP (MD: -2.23 mmHg, 95% CI: -3.13 to -1.32; both P< 0.01). Office systolic BP was also lower with chlorthalidone (MD: -4.10 mmHg, 95% CI -6.11 to -2.08; P< 0.01), whereas office diastolic BP showed no significant difference (MD: -1.70 mmHg, 95% CI -3.40 to 0; P= 0.05). The risk of hypokalaemia did not differ significantly (RR: 1.51, 95% CI 0.83-2.72; P= 0.17). Hypokalaemia was numerically more frequent with chlorthalidone. Interpretation & conclusions Chlorthalidone lowers systolic and diastolic BP more effectively than hydrochlorothiazide without significantly increasing the risk of hypokalaemia. These findings support chlorthalidone as the more efficacious thiazide option, particularly where cost-effective BP control is critical. Larger, long-term RCTs are needed to determine whether these BP benefits translate into superior cardiovascular outcomes.

Background & objectives Little data exist on population-based incidence of diabetes related complications in developing countries. We assessed sex-specific incidence of complications among Asian Indians with type 2 diabetes (T2D) based on follow up assessments from a community-based cohort. Methods We evaluated incident complications among individuals with T2D identified in the Chennai urban rural epidemiological study (CURES) conducted in 2001-03, who were complication-free at baseline and re-assessed once during a follow up survey in 2012-14. Diabetic retinopathy was assessed using retinal photography, diabetic peripheral neuropathy using biothesiometry, diabetic kidney disease using urinary albumin excretion and estimated glomerular filtration rate (eGFR), peripheral artery disease by ankle-brachial index, and coronary artery disease using medical history of coronary artery disease and/or Minnesota coding of ECGs. Cumulative incidence reflected the proportion developing each complication during a specified period of time, and relative risk analysis identified associated risk factors. Results Among 1,053 participants [men= 453(43%)], assessed in a cross-sectional manner about a decade later, the cumulative incidence rates differed by sex: women showed higher rates of diabetes kidney disease (36.1 vs. 31.4%) and peripheral artery disease (35.4 vs. 23.9%) whereas men had higher rates of diabetic retinopathy (37.0 vs. 27.3%) and coronary artery disease (36.2 vs. 34.5%). The incidence of peripheral neuropathy was comparable between men (63%) and women (62.7%). After adjusting for confounding variables compared to men, women had higher risk for peripheral artery disease [range (RR:1.62, 95% confidence interval (CI):1.20-2.17] but a lower risk for diabetic retinopathy (RR:0.75,95% CI:0.59-0.97) and coronary artery disease (RR:0.60, 95% CI:0.49-0.75). Interpretation & conclusions Women have a higher risk of peripheral arterial disease and lower risk of diabetic retinopathy and coronary artery disease, while there were no sex differences for developing kidney disease and peripheral neuropathy.

Background & objectives Aflatoxins pose serious health risks to humans and livestock, with ingestion being the most common route of exposure. In occupational settings, workers can also be exposed through inhalation of organic dust and dermal contact. The review aimed to provide an overview of aflatoxin exposure and health effects among workers. Methods Observational studies investigating occupational exposure to aflatoxins and their health effects were systematically screened in PubMed, Embase, and Scopus till June 2024. Studies meeting inclusion criteria, were assessed for their methodological quality using the Newcastle-Ottawa Scale. Results Overall, 12,610 studies were screened of which 17 studies were included in the final review. Food-grain workers, farmers, millers, bakers, grain handlers, oil pressors, and feed mixers, are at a higher risk of occupational exposure to aflatoxins. Assessment of exposure was done by analysing biological fluids (Blood, Urine, and Bronchoalveolar lavage) and samples from the working environment (settled dust, airborne dust, and personal sampling) using enzyme-Linked Immunoassay and High-Performance Liquid Chromatography. Studies have shown an elevation of hepatic and renal enzymes, an increased risk for hepatobiliary cancer, and an increased risk for tumour markers, oxidative markers, and reduced antioxidant levels. One recent study has also found an association between aflatoxin exposure and weight for age and height among children of workers. Interpretation & conclusions Occupational exposure to aflatoxins is associated with hepatic and renal toxicity and increased carcinogenic risk. These findings highlight the need of large scale dose- response studies, workplace monitoring and regular health surveillance among workers.

Background & objectives Living at high altitudes causes chronic exposure to hypoxia, which triggers various physiological and autonomic adaptations, and many residents show successful acclimatization. Long-term exposure leads to time-dependent alterations in autonomic nervous system function, even in healthy individuals. Heart rate (HR) variability has long been a valuable tool for assessing autonomic activity, yet only a few studies have examined its association with altitude in healthy populations. This study assessed the impact of altitude on cardiac autonomic activity through HR variability analysis in healthy Sikkimese natives. Methods A cross-sectional study was conducted among the Sikkimese population residing at high, intermediate and low altitudes of Sikkim. Two areas from each altitude category were selected. Based on the population of the selected areas, the sample size was distributed using probability proportional to size, sampling. Systematic random sampling was then used to select participants. For each participant, a 5-min ECG was recorded using lead II of a Power Lab system. HR variability analysis was performed to derive time and frequency-domain indices from spectral analysis of successive R-R intervals. Results We found significantly higher values of time domain HR variability indices including standard deviation of all normal-to-normal intervals (SDNN) and root mean square of successive differences between normal heartbeats (RMSSD) among the people residing at higher altitudes in Sikkim (P<0.001). Interpretation & conclusions Residents living at high altitudes exhibit enhanced parasympathetic cardiac activity compared to those residing at lower and intermediate elevations, reflecting a possible adaptive response to chronic hypobaric hypoxia.

Background & objectives Soil-transmitted helminth (STH) infections, primarily caused by Ascarislum bricoides, Trichuris trichiura, and Ancyclostoma duodenale, significantly impact child growth and cognitive development in endemic regions. This study aimed to evaluate the effectiveness of a single 400 mg dose of albendazole in treating STH infections among children aged 1-15 yr in Nabarangpur, Odisha, India, and to assess the influence of socio-demographic factors on treatment outcomes. Methods This longitudinal study included 1246 children across 18 clusters. Among them, 203 STH-positive children received albendazole, with stool samples collected on Days 14, 28, and 42 post-treatment. Egg counts were measured using the Kato-Katz method. Cure rates and egg reduction rates (ERR) were calculated, and repeated measures ANOVA was used to assess the impact of schooling, gender, tribal status, and geography on treatment efficacy. Results Albendazole demonstrated high effectiveness in reducing egg counts, with an ERR of 96.2 per cent for A. lumbricoides and 93.8 per cent for A. duodenale. Cure rates were suboptimal, at 66.7 per cent and 52.94 per cent, respectively, falling below WHO-recommended thresholds. Gender and geographic location influenced baseline egg counts, with females and children in Nabarangpur showing higher initial burdens. Reductions were consistent across schooling and tribal groups. Interpretations & conclusions Although albendazole effectively reduced infection intensity, its lower cure rates for hookworms highlight the need for region-specific and gender-sensitive interventions. Integrating treatment with WASH (Water, Sanitation, and Hygiene) programs and health education may improve long-term control. Monitoring resistance patterns and exploring combination therapies could further enhance treatment efficacy.