Indian Journal of Medical Research最新文献

Background & objectives To evaluate the progressive changes in the antibiotic resistance gene (ARG) profile by investigating their presence at different time points in the gut of infants during early life. Methods Stool samples of 54 full-term healthy infants at birth at 6, 14, and 36 wk were processed to examine the presence of 20 antibiotic-resistance genes. McNemar's test was used to check the statistical significance of the change in prevalence of genes across various time points. Chi-square test and logical regression were performed to evaluate the influence of clinical and demographic factors on the carriage of ARGs during early life. Results Infants predominantly carried genes that conferred resistance to beta-lactams (80.6%), macrolides (MSLB) (70%), and the sulphonamide (61%) class of antibiotics. ARG carriage peaked at 6 wk and 14 wk with a significant increase in the proportion of genes like blaTEM, catB, oqxA, sul1, ermB, tet, blaSHV (P: <0.05) from birth to 6 wk. Caesarean-section [P = 0.001; odds ratio (OR): 6.93; confidence interval (CI): 2.06-23.26] and maternal exposure to cephalosporins postpartum (P value = 0.013; OR: 4.16; CI: 1.31-13.17) had a significant influence on the increased carriage of the blaCTX-M gene at 6 wk of life. Interpretation & conclusions Our findings demonstrate that infants carry a diverse range of ARGs, with peak prevalence observed at 6 and 14 wk. Delivery mode and maternal antibiotic exposure significantly impact ARG carriage, emphasising the need for targeted interventions to reduce antibiotic resistance in early life.

Background & objectives Immune checkpoint inhibitor (ICI) therapy is an emerging therapeutic strategy for several malignancies, including gastric cancer, that hinges on immune checkpoint expression by the tumour infiltrating lymphocytes (TILs). Cytotoxic T lymphocyte associated antigen-4 (CTLA-4) is a well-known inhibitory T-cell co-receptor that functions as an immune checkpoint. CTLA-4 has also been found to be expressed by tumour cells making it a potential area of research for targeted therapy. We attempted to explore tumour cell CTLA-4 expression, and its correlation with programmed cell death receptor-1 (PD-1) and CD8 expression by the TILs and their correlations with histopathological parameters in gastric carcinoma. Methods A retrospective study carried out on archived paraffin blocks from 50 cases of gastric adenocarcinoma. Immunohistochemical (IHC) staining was performed and interpreted by grading the marker expression on the basis of its intensity and proportion of tumour cells stained. The relationship between tumour cell CTLA-4 expression, PD-1, CD8 expression in TILs and the histopathological features of gastric carcinoma was evaluated statistically. Results Most patients (n=37, 74%) were males and aged >60 yr (n=22, 44%). A statistically significant association was noted between high CTLA-4 expression in tumour cells and higher tumour stage (P=0.017). All cases with high CTLA-4 expression in tumour cells demonstrated nodal metastasis. CTLA-4 did not show a statistically meaningful association with other histopathological parameters. Positive PD-1 expression in TILs did not show a significant association with tumour aggression in terms of tumour grade, histologic type, nodal metastasis, lymphovascular and perineural invasion. Most TILs were found to be CD8+ T-cells. Interpretation & conclusions A higher CTLA-4 expression in tumour cells is linked to advanced tumour stage in our study. These findings can trigger research to elucidate a likely role of these markers as independent prognostic and therapeutic factors in determining overall outcome in gastric carcinoma.

Background & objectives Though sexual dysfunction are common in individuals with opioid dependence, the relative contribution of hormonal and psychological determinants remains unclear. Studies assessing sexual functioning and sex hormone levels together in this population remain limited. This study aimed to evaluate self-reported sexual dysfunction and sex hormone alterations, and their association with demographic, psychosocial, and hormonal factors in men with opioid dependence, primarily using heroin. Methods In this cross-sectional study, 143 sexually active males (aged 18-50 yr) with opioid dependence were recruited. Sexual functioning was assessed using the international index of erectile function (IIEF-15). Hormonal assays included total testosterone, prolactin (PRL), luteinising hormone (LH), follicle-stimulating hormone (FSH), gonadotropin-releasing hormone (GnRH), sex hormone-binding globulin (SHBG), and dehydroepiandrosterone sulphate (DHEA-S). Descriptive statistics, Spearman's rank correlation with FDR (false discovery rate) correction, and hierarchical multiple regression with bootstrapped confidence intervals (1000 samples) were conducted. A sensitivity analysis restricted to married participants (n=78) allowed inclusion of intimate partner violence as predictor. Results The median age of participants (n=143) was 26 yr [Interquartile range (IQR):24-30], with 93 per cent identifying as heterosexual. Erectile dysfunction (93.7%, n=134), orgasmic dysfunction (95.1%, n=136), low sexual desire (94.4%, n=135), dissatisfaction with sexual intercourse (99.3%, n=142), and premature ejaculation (72%, n=103) were highly prevalent. Hormonal analysis showed low testosterone in 7.7 per cent (n=11), high PRL in 8.4 per cent (n=12), and elevated GnRH in 57.3 per cent (n=82) of participants. Median hormone levels were: Testosterone 20.5 (15.0-27.3) nmol/L, PRL 5.8 (3.5-11.2) ng/mL, and GnRH 160.3 (132.2-178.1) pg/mL. No significant correlations were observed between hormone levels and sexual function. In regression analysis, demographic and psychosocial variables predicted sexual functioning, while hormonal measures did not contribute independently. The final model explained 17 per cent of variance (adjusted R2 = 0.17). Interpretation & conclusion Sexual dysfunction in men with opioid dependence primarily using heroin was driven more by psychosocial and demographic determinants than by hormonal changes. Endocrine alterations were not sufficient to explain the high burden of dysfunction. Addressing sexual health in opioid dependence requires a multifactorial approach, with attention to social and psychological contributors alongside biological assessment.

Background & objectives Persistent mild inflammation is considered as a main contributor to the altered genesis of polycystic ovary syndrome (PCOS), with numerous studies reporting elevated serum levels of inflammatory markers. This inflammatory state may be attributed to genetic variants, particularly single nucleotide polymorphisms (SNP), that alter cytokine regulation. This study investigated the association of PCOS and inflammatory SNPs including interleukin (IL) such as IL-1β rs1143634, IL-1β rs16944, IL-6 rs1800795, IL-6 rs1800797, IL-6 rs1800796, IL-1RN; and tumour necrosis factor-alpha (TNF-α). Methods A total of 250 women volunteered for the study; of which 100 were diagnosed with PCOS and 150 were healthy controls. Serum levels of IL-6, IL-1β, and TNF-α were measured using enzyme-linked immunosorbent assay (ELISA). Genotyping was analysed using polymerase chain reaction (PCR), PCR-restriction fragment length polymorphism (PCR-RFLP), or real-time PCR (RT-PCR). Genotype distributions amid groups were compared using the Chi-square test. Results Women with PCOS exhibited elevated serum levels of IL-1β than those of healthy controls which was considerably significant (P<0.001). The heterozygous genotypes of IL-1RN and IL-6 rs1800796 were seen more frequently in the control group (P=0.02), suggesting a potential inverse association. Interpretation & conclusions SNPs in IL-1 and IL-6 genes may influence susceptibility to PCOS and could confer a protective role in women of South Asian Indian origin.

Background & objectives Maternal mortality remains a major global health issue, with India, particularly Meghalaya, contributing significantly to the burden. The three delays: decision-making, reaching a healthcare facility, and receiving care are key factors contributing to maternal deaths. Birth preparedness and complication readiness (BPCR) interventions aim to address these delays by preparing women for childbirth and its complications. This study evaluated the BPCR index and the quality of antenatal care (ANC) in Meghalaya, considering the perspectives of both pregnant women and healthcare providers. Methods A mixed-methods design was employed in different blocks of East Khasi Hills District, Meghalaya. A quantitative design was used to assess the BPCR index among 200 pregnant women. Direct observations of a subset of over 10 per cent of the ANC checkups were done to assess their quality. Additionally, in-depth interviews with 14 pregnant women and eight healthcare providers explored factors influencing BPCR and the quality of ANC. Results The BPCR index from this study was 43.4 per cent. Only 5 per cent of pregnant women could identify at least one danger sign of pregnancy. Direct observations revealed that the quality of ANC concerning BPCR was poor, with none of the ANC check-ups incorporating BPCR counselling. In-depth interviews also revealed that none of the healthcare providers were aware of BPCR counselling. Interpretation & conclusion The study revealed a critical lack of awareness about danger signs, contributing to the low birth preparedness and complication readiness. The absence of related counselling during ANC visits highlights a significant gap in maternal care and preparedness in the region.

Background & objectives Telemedicine is a promising tool for the delivery of remote healthcare services in the country. This study was conducted to assess the promoters and barriers for healthcare workers (HCWs) to adopt telemedicine using hub and spoke model for health care delivery in selected rural areas. Methods A cross-sectional study was undertaken using an online questionnaire, at the Primary Healthcare Centre (PHC) at Kaiwara, district Chikkaballapur and Avathi PHC- Devanahalli Taluk, Karnataka, which are adopted by MS Ramaiah Medical College Hospital, Bengaluru as part of their hub-spoke model of telemedicine. The study was conducted among Health Care Workers (HCWs)- consultants, postgraduate residents, interns, nurses who were posted at these facilities during the study period. Results There were 86 HCWs approached and 78 participated in the study. 73 (94%) respondents considered themselves to be having knowledge for basic computer use. Total 52 (67%) participants agreed that telemedicine eased connections with specialists at the hub and majority of patients appreciated telemedicine services. Out of the total 52 respondents, 64 per cent respondents agreed that telemedicine greatly reduced travel costs and helped cover a larger patient population, making referrals and prescriptions efficient. However, 16 (20%) respondents were nervous about using telemedicine services, 46 (59%) respondents felt that telemedicine could breach patient confidentiality and 36 (46%) of respondents felt that there could be loss of jobs to telemedicine. Interpretation & conclusions The findings of this study indicates that telemedicine model is feasible and has good acceptance among the health care workers for the delivery of health care in the selected rural settings. Most respondents were positive that using telemedicine would make specialised healthcare more accessible in rural settings and improve digital health record management.