Indian Journal of Medical Research最新文献

Background & objectives Current options for treating tuberculosis (TB) that is resistant to rifampicin (RR-TB) are limited and available regimens are often lengthy and poorly tolerated. However, following recent evidence from the TB PRACTECAL trial, countries are considering programmatic adoption of six-month, all-oral treatment regimen such as bedaquiline, pretomanid, linezolid (BPaL) and BPaL with moxifloxacin (BPaLM). We conducted an economic evaluation to assess whether the introduction of BPaL/BPaLM regimen under National Tuberculosis Elimination Programme (NTEP) for the treatment of multi-drug resistant (MDR)/RR-TB is a cost-effective strategy. The idea was to estimate the incremental cost incurred from BPaL/BPaLM regimen in comparison with the current mix of standard of care (SoC) regimen. Methods We used an economic model comprising a Markov analysis. The study estimated the incremental costs, life years gained and quality adjusted life years (QALYs) gained by the introduction of BPaL/BPaLM regimen for MDR/RR-TB patients. A scenario analysis for different proportions of shorter and longer SoC regimen compared with BPaL/BPaLM was also done. Cost threshold analysis was done to assess the ideal cost at which the drug BPaL/BPaLM turns into cost-saving. Budget impact analysis was conducted to assess the financial implications of adopting BPaL/BPaLM compared to mix SoC, supporting informed decision-making alongside cost-effectiveness analysis for one year. Results The base case analysis showed the total discounted costs by health system perspective for the BPaL, BPaLM and the current mixed SoC were INR 2515, INR 2644 and INR 2630 million, respectively. The ICER for BPaL was INR -379 which indicates that we have to spend INR 379 less per patient for BPaL than the mixed SoC to gain one QALY. The ICER for BPaLM was INR 37 which indicates that we have to spend INR 37 additionally per patient for BPaLM than the mixed SoC to gain one QALY. Interpretation & conclusions Our findings indicate that BPaL based regimens are likely to be cost-saving and more effective than the current mixed SoC in a range of settings. Countries should consider programmatic uptake of BPaL based regimens to treat MDR/RR-TB.

Background & objectives Hepatitis B virus (HBV) infection continues to pose a major public health challenge, especially among rural and tribal communities where access to healthcare services is often limited. The present study aimed to assess the status of HBV infection among children between 1 to 5 yr of age and to evaluate vaccination coverage in the Mayurbhanj district of Odisha. Methods A cross-sectional study was conducted among children aged 1-5 yr. Blood samples were tested for Hepatitis B surface antigen (HBsAg), antibody to Hepatitis B surface antigen (anti-HBs) and other serological markers to determine infection status and vaccination coverage. Results HBsAg seropositivity, indicating active HBV infection, was detected in 0.6 per cent [95% confidence interval (CI): 0.3-0.9] of the samples. Similarly, anti-HBc was tested positive in 0.4 per cent (95% CI: 0.2-0.8) of children. The combined prevalence of HBV infection-based on positivity for either HBsAg or anti-HBc-was 0.8 per cent (95% CI: 0.5-1.2). Vaccination data were collected for 2,647 (98.0%) children of which 90.9 per cent received the birth dose of Hepatitis B vaccine. A total of 98.1 per cent received pentavalent 1 (Penta 1), whereas 97.3 per cent and 96.1 per cent of children received Penta 2 and Penta 3. However, 72.6 per cent (1,961) had protective levels of antibody (anti-HBs) above the threshold, signifying adequate immune protection and 27.4 per cent had sub-protective anti-HBs levels (<10 IU/mL), indicating insufficient immunity. Interpretation & conclusions The results of this study highlighted the need for targeted interventions-such as improving timely administration of the birth dose, enhancing follow-up for subsequent doses including digital or paper-based tools, implementing a robust tracking and reminder system to ensure HBV vaccination series and increasing awareness through community-based health education-to strengthen acceptance of HBV vaccination in rural and tribal communities.

Background & objectives Sudden death, defined as death occurring within one hour of symptom onset in witnessed cases or within 24 h of last being seen alive in unwitnessed cases, remains a major public health concern. This study aimed to evaluate the incidence, causes, and risk factors associated with sudden death in young adults. Methods A cross-sectional study was conducted over one year at a tertiary care centre in New Delhi. Cases meeting the definition of sudden death were included, excluding trauma, suicide, homicide, and drug abuse. Each case underwent whole-body imaging, autopsy, and histopathological examination. A multidisciplinary team comprising forensic experts, pathologists, radiologists, and clinicians determined the cause of death. Comparative analysis was performed between sudden death in young adults (18-45 yr) and older adults (46-65 yr). Results Out of 2214 autopsies, 180 cases (8.1%) met the criteria for sudden death. Sudden death in young accounted for 103 (57.2%) cases. Mean age was 33.6 yr in sudden death in young (IQR=10) and 53.8 years in sudden death in old, with male predominance in both. Cardiovascular causes were most common in young (n=40, 42.6%), followed by respiratory causes (n=20, 21.3%) and sudden unexplained deaths (n=20, 21.3%), where no pathology was identified. Other causes included gastrointestinal, central nervous system, and genitourinary pathologies. Smoking and alcohol intake was equally prevalent in those who died young and at old age. Interpretation & conclusions Sudden death in young adults is a significant concern requiring targeted public health strategies. Coronary artery disease remains the leading cause. Respiratory and unexplained deaths warrant further investigation.

Background & objectives Tribal communities in Pune district of India have relatively high burden of low birth weight and preterm babies. The 'Pradhan Mantri Surakshit Matritva Abhiyan' (PMSMA), categorises pregnant women according to risk and provides intensive care to high-risk pregnant women until delivery. This study aimed to identify barriers, challenges and supporting mechanisms to implementing the PMSMA programme for the management of high-risk pregnancies and report recommendations in adapting these guidelines. Methods We used the consolidated framework for implementation research (CFIR), to guide the qualitative assessment of the implementation context and identify factors that could influence intervention implementation and effectiveness of PMSMA. Due to COVID-19 pandemic-induced delays in the study implementation, we conducted a rapid qualitative analysis of 20 in-depth interviews and two focussed group discussions. Results The study highlights challenges faced by high-risk mothers in accessing private sonography centres, including untimely ambulance services, connectivity issues, and out-of-pocket expenses. The lack of diagnostics at primary centres adds to these issues. Culturally, pregnancy is kept secret until the first 12 wk, causing delayed intimation and loss of crucial healthcare days. The tribal community perceives large babies as risks during delivery, depriving pregnant women of healthy food and iron supplements. Interpretation & conclusions The study suggests that health systems should utilize a government-funded food supplementation program and ensure proper coordination between departments for better implementation, recommending community awareness, staff training, and collaboration with local governments.

Background & objectivesFollowing surgical treatment and subsequent immobilisation of one limb, physiological reductions in blood flow are expected due to limited or no movement. This study was designed to investigate the change in perfusion index in a resting limb when the contralateral limb exercises (active and passive). MethodsThis was a two-arm comparative study with 39 healthy participants (22 males, 17 females) with a mean (SD) age of 23.4 (5.2) years. One limb was set to exercise (active and passive in different sessions), and another limb rested with a pre-designed exercise protocol. We measured perfusion index in exercising and non-exercising limbs after 3, 4, 5, and 6 min of exercise. ResultsIn resting upper limbs, there was an increase in the perfusion index during both active and passive exercise of the contralateral limb (achieved at 3 min in active and 4 min in passive exercise). In resting lower limbs, in active exercise, the increase in perfusion index occurred at 4 min and 6 min of exercise. In passive exercise, there was no significant change in perfusion index. Interpretation & conclusionsActive exercise of one limb significantly increases blood flow in the opposite, resting limb. This effect is not found in passive exercise in the lower limb. Hence, when one limb undergoes surgery, for a higher perfusion on that limb, an active exercise or passive exercise in the upper limb, or active exercise in the lower limb may be beneficial.

Background & objectives The COVID-19 pandemic came up with distinct challenges for patients with rheumatoid arthritis indicating higher risk of infection and severity due to SARS-CoV-2. In this study, we performed the immunotyping of humoral and cell-mediated responses in patients with rheumatoid arthritis to assess characteristics and durability of Covid vaccine-induced immune memory. Methods We enrolled 50 individuals with rheumatoid arthritis who had received SARS COV-2 vaccine (Covaxin/Covishield). Of these 26 were assessed within six months of the second vaccine dose (T1) and 24 were evaluated 6-9 months after the third dose (T2). Serum IgG titres were measured using chemiluminescent microparticle immunoassay (CLIA), and lymphocyte immunophenotyping. In vitro challenge with the SARS-CoV-2 spike protein was performed using flow cytometry. Results Patients vaccinated with Covishield showed significantly higher IgG titres and elevated levels of cytokines such as TNFα and IFNγ compared to those vaccinated with Covaxin. The Covishield group also exhibited a higher percentage of antigen-specific and inflammatory T cell subsets, contributing to the overall cytokine pool in patients with rheumatoid arthritis. In vitro stimulation with the SARS-CoV-2 spike protein further activated lymphocytes in Covishield-vaccinated individuals. Interpretation & conclusions Our study presents the increased effectiveness of Covishield in initiating responses compared to Covaxin. Covishield vaccinated patients with rheumatoid arthritis show higher antigen specificity and T cell activation indicating a shift of the immune system towards a Th1 phenotype, which makes it imperative to focus on development of safe and durable vaccines with a continuous follow up for the patients with rheumatoid arthritis to control disease severity.