Indian Journal of Medical Research最新文献

Background & objectives Endometriosis, a chronic inflammatory condition, affects approximately 10 per cent of reproductive-age women in India. This study aimed to explore the experiences of women with endometriosis and their partners. Methods A qualitative exploratory study was conducted in two Indian States. In-depth interviews were conducted with 21 women (18-49 yr) with laparoscopically diagnosed endometriosis and 10 of their male partners. Interviews were conducted in local languages and English, with informed consent. Recordings were transcribed, coded, and analysed using Braun and Clarke's thematic analysis. Results The study revealed significant impacts of endometriosis on both women and men, including decreased quality of life, psychological effects, financial distress, strained intimate relationships and burden of infertility. Women experienced greater impacts, particularly in life opportunities and employment, social life and mental health. Delayed diagnosis and treatment exacerbated women's suffering, compromising their well-being and quality of life. Interpretation & conclusions This study emphasises the need for improved early diagnosis and treatment of endometriosis to mitigate its impact on women and their partners.

Background & objectives With limited funding and vast array of research ideas, setting priorities becomes essential to ensure effective and efficient use of resources. This study aims to systematically identify key research questions in cancer through stakeholder engagement using the Child Health and Nutrition Research Initiative method which is a new concept in the Indian context. Methods The Indian Council of Medical Research held a research priority-setting exercise on May 7-8, 2024 at All India Institute of Medical Sciences-National Cancer Institute, Jhajjar, Haryana, engaging 84 participants across India using CHNRI methodology. Experts were divided into four thematic groups. In Step I, each group proposed research questions, which were scored based on five predefined criteria (answerability, efficacy, relevance, deliverability, equity) and arranged in descending order. In Step II, the highest-scoring questions were further validated through full-house voting. Questions receiving a consensus of more than two-third were finalised as priorities. Results In Step I, 99 questions were generated which covered descriptive (n=10), development (n=65), discovery (n=14), and delivery research (n=10). Development group questions were subcategorised as Technologies (diagnostics/devices/digital) (n=17), Therapeutics (n=16), Prevention and screening (n=20), and Palliative care and survivorship (n=12). During validation (Step II), 36 questions across all domains received >66 per cent scores, resulting in research priorities. Interpretation & conclusions The priority setting exercise helped in short listing research questions in area of cancer in India and provided actionable guidance to policymakers and funders enabling appropriate usage of limited funds.

Background & objectives Review of tissue diagnosis is indispensable for any comprehensive tertiary cancer care centre, because a significant bulk of cases are primarily diagnosed peripherally and referred in a hub-and-spoke model. The primary objective of the study was to estimate the proportion of diagnostic discrepancies of the review cases over a period of one year and to identify the probable factors behind these discrepancies. Methods An observational descriptive retrospective cross-sectional study was planned in the department of Laboratory Medicine in a regional cancer institute of Eastern India encompassing all the cases undergoing review (both slides and tissue blocks) in the period between June 2023 and May 2024. Results Total 2551 cases were submitted for review within the study period. Among them 24 caused extreme diagnostic difficulty only because of poor processing. Total 171 cases among 2551 were found to carry significant diagnostic discrepancy (6.7%). A re-biopsy was advised in 69 cases, as essential. Interpretation & conclusions Although many a times the cost of review or the time consumed may pose a problem, a second opinion or a pathologic review is a patient safety mechanism, especially in the setting of cancer.

Background & objectives The prevalence of mental health disorders in India is a growing public health concern, yet there is a dearth of initiatives and consensus on prioritising mental health research areas at the national level. This paper presents the findings from the modified Delphi-based exercise undertaken by the Indian Council of Medical Research (ICMR) to address this gap. By engaging key stakeholders from diverse sectors-including mental health professionals, State programme officers, health care providers, policymakers, researchers, and civil society representatives-the exercise aimed to identify critical mental health research gaps and develop a blueprint to guide public mental health research in the country. Methods A comprehensive methodology consisting of four steps was followed, including the initial conceptualisation and desk review, a national level brainstorming meeting, restructuring and finalisation of the questions, and prioritisation process. Results Through a rigorous, iterative process of prioritisation and consensus, the top three mental health research questions were identified. These included (i) implementing suicide prevention interventions in schools and colleges, (ii) integrating mental disorder screening and treatment into non-communicable disease care, and (iii) reducing the treatment gap for mental disorders. Conclusion The outcomes of this exercise shall provide valuable insights for mental health research, policy, and resource allocation strategies at the national level.

Background & objectives Brucellosis, an occupational zoonosis, poses notable difficulties in diagnosis because of the need for secure facilities and the risk of exposure when using culture-based methods. Conventional serological tests often suffer from cross-reactivity, highlighting the need for more specific diagnostic markers. The purpose of this study was to understand the differences in whole-cell protein expression of Brucella melitensis isolates from patients with acute and chronic brucellosis and to identify immunodominant proteins that could serve as potential diagnostic markers. Methods The study included 16 blood culture-confirmed patients with acute or chronic brucellosis from a cohort of 185 individuals. Clinical isolates of B. melitensis were subjected to two-dimensional gel electrophoresis (2-DE) and PDQuest software analysis to compare proteomic profiles. Differentially expressed proteins were identified using western blotting with infected human serum samples. Further identification of the protein spots was conducted using Matrix-Assisted Laser Desorption/Ionization - Time-of-flight Mass Spectrometry (MALDI-TOF MS). Results The proteomic analysis of B. melitensis identified an average of 249 protein spots. PDQuest software revealed 65 differentially expressed spots, with 17 of these spots successfully identified via MALDI-TOF MS. Western blot assays demonstrated that human sera containing anti-Brucella antibodies reacted with seven immunodominant protein spots. Among these, the outer membrane porin protein (omp25), aldehyde dehydrogenase, and universal stress protein showed potential for differentiating acute from chronic brucellosis. Interpretation & conclusions The findings indicate that omp25, aldehyde dehydrogenase, and universal stress protein are highly specific to B. melitensis infections and could serve as valuable targets for serodiagnosis.

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.