Central Kerala Research Articles

Adverse Events Following Equine Rabies Immunoglobulin Administration among Category 3 Animal Bite Exposures

Abstract Introduction: Rabies is known to be 100% fatal. Equine rabies immunoglobulin (ERIG) recipients are prone to hypersensitivity reactions following administration. This study aims to estimate the adverse events following ERIG among category 3 animal exposures reported in a tertiary care centre in Kerala during the year 2022. Materials and Methods: A record-based descriptive study. Results: Among the 1504 cases, 557 (37.03%) developed sensitivity following the test dose of ERIG, of which 478 were administered with a full dose of ERIG after desensitisation. Human rabies immunoglobulin was given to 26 patients, and monoclonal antibodies were given to 53 patients. Among 1425 who received a full dose of ERIG, 21 (1.5%) developed sensitivity reaction during the observation period, of which 14 had developed sensitivity to the test dose. Of the 21 who developed sensitivity to full dose, 18 patients required only symptomatic management while 3 patients required admission. Conclusion: Testing for sensitivity to test dose will help to identify those in need of premedication with anti-allergic drugs, thereby reducing the risk of hypersensitivity to full dose of ERIG.

Evaluation of Cyclin D1 protein and its association with the clinicopathological characteristics and prognosis of lung cancer: A retrospective study from Southern Kerala, India.

Cyclin D1 is a protein that can enhance the proliferation of cancer cells and has been detected in various malignancies, including lung cancer. However, routine examinations for Cyclin D1 in lung cancer cases have not been conducted in Kerala. This study sought to evaluate the links between cyclin D1 expression, clinicopathological characteristics, and 2-year survival rates in lung cancer. This retrospective cohort study used medical records and paraffin blocks of lung cancer patients at the Regional Cancer Centre in Kerala, India, between 2015 and 2018. The data were collected from 61 subjects, comprising of lung adenocarcinoma (18%), lung squamous cell carcinoma (27.9%), non-small-cell lung carcinoma (18%), poorly differentiated carcinoma (19.7%), and negative for malignant cells (16.4%). Data analysis was conducted using SPSS. The study revealed that 31.10% of the lung cancer patients exhibited overexpression of cyclin D1. A significant correlation was observed between cyclin D1 expression and histopathological results (P = 0.002), indicating that the level of cyclin D1 might be linked to specific histopathological subtypes of lung cancer. Despite this significant finding, cyclin D1 expression did not show any association with the clinical stage of the cancer or other clinical characteristics of the patients. Furthermore, when examining the 2-year survival rates of the patients, the study found no significant difference between those who had overexpression of cyclin D1 and those who did not (P = 0.145). Cyclin D1 expression was associated with histology type of lung cancer with no significant association to prognosis.

Clinical and radiological profile of cervical spine injuries in maxillofacial trauma patients reporting to a tertiary trauma centre in central Kerala

The aim of the study was to determine the clinical and radiological profile of patients with cervical spine injuries in maxillofacial trauma patients following road traffic accidents in central Kerala. Percentage of cervical spine injuries associated with maxillofacial injuries, age and sex distribution, frequency of the type of cervical spine injury were studied. A descriptive cross sectional study was conducted on two hundred and fifty patients with maxillofacial trauma who reported to the Department Of Oral and Maxillofacial surgery, Government Dental College, Kottayam between July 2023 and June 2024 and who gave the consent for the study.Clinical evaluation of cervical spine was undertaken as the part of the initial assessment of all trauma patients. Neck pain was assessed with visual analog scale of 1-10 and altered sensations in upper limbs were evaluated. Lateral neck x-ray was taken to rule out cervical injury in all patients without C.T scan. The data was entered into MS excel spread sheet and analysed using SPSS version 20. Proportions were used to study categorical variables, mean and standard deviation were used for quantitative variables. Chi square test was used to test the difference in proportions of categorical variables. p values less than 0.05 was considered statistically significant in the data. The study has shown that there is a statistically significant occurrence of cervical spine injuries in maxillofacial trauma victims in road traffic accidents. The presence of maxillofacial trauma with cervical spine injury mandates prompt management with immediate reference to neurosurgeon to reduce morbidity.

Sedimentary records of liquefaction from central Kerala (southwestern India), as earthquake indicators in a cratonic area

Sedimentary records of liquefaction from central Kerala (southwestern India), as earthquake indicators in a cratonic area

ANALYTICAL STUDY ON FACTORS AFFECTING THE ATTITUDE AND PERSPECTIVES OF FEMALE PATIENTS ON THE USE OF ARTIFICIAL INTELLIGENCE IN THE ASSESSMENT OF SCREENING MAMMOGRAMS

Background: Breast cancer is one of the most common cancers among Indian women, with an incidence of 25.8 per 100,000 women according to the Ministry of Health and Family Welfare. Late detection is responsible for poor quality of life (QOL), and it is the leading cause of death. Studies have shown that people are positive towards AI performing assessment tasks in healthcare in general and in mammography screening. Moreover, it is challenging to implement strategies based on self-breast inspection or do mammography in rural regions or low and middle income nations for a variety of reasons. Objective: This study was conducted to assess the perception and attitude of various female patients reporting to the radiology unit of a tertiary care centre regarding the use of Artificial Intelligence in routine mammogram screening. Study Design: A cross sectional questionnaire based study was conducted female patients attending the radiology unit of a tertiary Care Centre in Central Kerala. Methods: After obtaining, informed written consent was taken from the study participants. A predesigned, pretested, validated checklist was used to collect the required data. The Knowledge, attitude and practice was ascertained through Likerts scale and scoring done accordingly. Statistical tests of significance was employed to assess the possible associations between various variables with the knowledge, attitude and perceptions regarding Artifical Intelligence based Mammogram Results: Among the 170 study subjects analysed, 68.6% had a satisfactory knowledge about Artificial intelligence. Among the 170 study subjects analysed, 86% had a good attitude about being screened through AI enabled mammogram techniques. 92% of the total study subjects registered for mammogram had done it based on self choice. The association between age and willingness to get screened was found to be statistically significant. It was also seen that there was a statistically very high significance between Knowledge regarding AI and the independent decision to get screened. There was also a statistically significant association between age and scores >60% regarding knowledge and attitude regarding the vaccination among the study subjects. Conclusions: Majority of the study population was having a satisfactory knowledge regarding AI usage in healthcare.

Intra Arterial Tirofiban in the Peri Operative Priming for Intracranial Stent Deployment in Aneurysms – A cross Sectional Study

Introduction: Tirofiban is a glycoprotein IIb/IIIa receptor antagonist that inhibits platelet aggregation. Primary and secondary objectives of this study were to determine the efficacy and to determine the safety profile of intra arterial tirofiban in the peri operative priming for intracranial stent deployment in aneurysms respectively. Materials and methods: This was a cross sectional study in a tertiary care centre in Kerala. Patient admitted with sub arachnoid haemorrhage/aneurysm posted for endovascular stent associated procedures and willing for the study were selected. The pre procedure assessment of neurological status was done. Patient underwent the procedure where peri operative priming with intraarterial tirofiban was given. The development of any neurological deficits within 24 hours was assessed using Glasgow coma scale and National Institute Health Stroke Scale. Laboratory blood parameters before and after procedure were also reviewed. Results: Study involved 58 patients with aneurysm who were given intraarterial tirofiban. No significant difference (p value 0.521) in Glasgow coma scale on admission (14.89 ± 0.462) and on discharge (14.74 ±1.650). Analysis was done using SPSS version 20.00. Paired samples T test and Wilcoxon Signed Rank Test were used. Conclusion: Results showed that intra arterial tirofiban is effective and the procedure was uneventful with no complications. Patients recovered well and the hospital stay was of minimum duration.

Prevalence of panic disorder among patients with non-cardiac chest pain attending cardiology outpatient department in a tertiary care centre in Kerala – A cross-sectional study

Prevalence of panic disorder among patients with non-cardiac chest pain attending cardiology outpatient department in a tertiary care centre in Kerala – A cross-sectional study

Socio-demographic factors and life events associated with high suicidal intent in youth with intentional self-harm: A cross-sectional study at a tertiary care centre in Kerala, India

Socio-demographic factors and life events associated with high suicidal intent in youth with intentional self-harm: A cross-sectional study at a tertiary care centre in Kerala, India

Investigating the response of groundwater and streamflow to rainfall in a tropical catchment using non-parametric methods

The present study investigates the monthly and seasonal patterns of groundwater levels and streamflow in response to rainfall in a humid tropical catchment in central Kerala, India. The trends were investigated at a temporal scale using data from eight groundwater-level observation wells, four stream-gauging stations and rainfall records of three subcatchments, viz. Cheripad, Pala and Kidangoor. The exercise of trend detection was carried out using two widely adopted non-parametric tests, viz. the Mann–Kendall (MK) test, Spearman's Rho (SR) test and a relatively new visual graphical approach, innovative trend analysis (ITA). The results revealed predominantly rising trends (monthly and seasonal scale) within the catchment, across all three hydrological components examined. Notably, the ITA test identified specific changes in the trend direction within the time series (positive to negative or vice versa), which were not observable in the MK or SR tests. Data published in the Groundwater Book of Kerala for 2021–22 corroborated this increasing trend, showing, on average, a rising trend in well water levels throughout the watershed across pre-monsoon and post-monsoon seasons. This trend was further confirmed using ITA by pairing the observations from the groundwater-level monitoring station at KTM-OW-11 with rainfall data from the nearby gauging station at Erattupettah.

Role and Function of Frontline Health Workers During the COVID-19 Pandemic in a Rural Health Center in Kerala: A Qualitative Study.

Introduction Accredited Social Health Activists (ASHAs) are community health workers established under the National Rural Health Mission (NRHM). ASHAs have played a crucial role in responding to the COVID-19 pandemic. The COVID-19 pandemic has prompted ASHAs to adapt their strategies and methods to effectively address the challenges and ensure the well-being of the communities they serve. Objectives This study was done to explore the impact of the COVID-19 pandemic on the duties and performance of ASHAs. Methods A qualitative study was conducted over one month in the rural Primary Health Center (PHC) area of Thrissur district, Kerala. Focus group discussions (FGDs) were conducted among ASHAs and in-depth interviews with a Junior Health Inspector (JHI) and a Junior Public Health Nurse (JPHN). Results During the COVID-19 pandemic, the healthcare system shifted its focus toward managing the virus, leading to changes in the responsibilities of ASHA workers. They were assigned additional duties, and their routine services were disrupted due to lockdown measures. Despite the challenges, several factors played a crucial role in facilitating their services, including social support, teamwork, and personal satisfaction. However, there were several barriers that affected their effectiveness, such as inadequate and inconsistent remuneration, lack of recognition, transportation difficulties, safety concerns, and out-of-pocket expenses. Conclusion ASHAs effectively managed the challenging situation during the COVID-19 pandemic by taking diligent measures and showing a high level of commitment to their duties. It is essential to prioritize regular evaluations of their performance to ensure ongoing quality and effectiveness.

New Evidence on the Sixteenth-Century East Syriac Missions in the Malabar Coast: The Muttuchira Inscription (1581 CE) in Context

The present study deals with an inscription on a granite stele in the township of Muttuchira, Kottayam District, Kerala, India. The inscription was written in Malayalam, in the ancient Dravidian vaṭṭeḻuttu script, in 1581. It commemorates the erection of a series of open-air crosses, as well as the placement of a Persian Cross, called the Bleeding Cross. The first cross was erected in 1528 and the last one in 1581. The inscription was first published in 1930 and, ever since, several concurrent interpretations thereof have been proposed. However, all the previous transcriptions and interpretations were based on a poorly executed estampage, which gave rise to a series of misunderstandings. This study is based on a new, clearly readable estampage and gives a transcription in vaṭṭeḻuttu Unicode fonts and in Modern Malayalam characters as well as a Modern Malayalam and an English translation, together with a detailed historical interpretation permitted by new material collected in Kerala in the last two and a half decades. The new deciphering of the inscription sheds light on the role of Muttuchira, one of the main centres of the anti-Portuguese and anti-Latin resistance of the local Christians in the sixteenth century, on the origin of the open-air crosses defining the landscape of Central Kerala, and on the vicissitudes of Christian epigraphy in Kerala.

The Effects of Social Media on the Well-being of Youth: An Empirical Evidence from Central Kerala

The Effects of Social Media on the Well-being of Youth: An Empirical Evidence from Central Kerala

Characterisation of carbapenemase-producing Gram-negative bacilli among clinical isolates in a tertiary care centre in Kerala, South India

Background: Infections caused by carbapenem-resistant Gram-negative bacteria are a cause for concern due to the limited choice of antibiotics available for their treatment. Aims, Settings and Design: This study screened multidrug-resistant (MDR) Gram-negative bacilli isolated from clinical samples over a period of one year, for carbapenem resistance and characterised them using phenotypic methods such as combined disc diffusion test (CDDT), modified Hodge test (MHT), E-test for metallo-beta-lactamase (MBL) and molecular method, PCR. Materials and Methods: Two hundred and ten MDR Gram-negative bacilli were screened for carbapenem resistance using Imipenem and Meropenem disc diffusion. These were further checked for carbapenemase production by CDDT, MHT and E-test for MBL. Those positive by E-test were subjected to PCR. Uniplex PCR for New Delhi metallo-beta-lactamase-1 was used for Escherichia coli and Klebsiella pneumoniae , and multiplex PCR for Imipenemase and Verona imipenemase was used for Pseudomonas aeruginosa and Acinetobacter baumannii isolates. Results: Twenty-three (11%) isolates were found to be carbapenem-resistant and included E. coli (six) K. pneumoniae (three), P. aeruginosa (five) and A. baumannii (nine). Seventeen (74%) isolates were positive by phenotypic methods and were subjected to PCR. Out of eight Enterobacteriaceae isolates subjected to PCR, all were positive for bla NDM gene. All were negative for bla KPC gene. All five A. baumannii isolates subjected to PCR were found to contain bla VIM gene. Two out of four P. aeruginosa isolates were positive for bla IMP , one was positive for bla VIM gene. One P. aeruginosa isolate was positive for both bla IMP and bla VIM gene. Conclusions: In view of the increasing resistance of Gram-negative bacilli to carbapenems, rational use of antibiotics needs to be emphasised.

Clinical profile and outcome of pediatric autoimmune hepatitis: ten year experience from a single centre in Kerala

Clinical profile and outcome of pediatric autoimmune hepatitis: ten year experience from a single centre in Kerala

Etiological profile of cirrhosis in patients admitted in a tertiary care centre in kerala

Etiological profile of cirrhosis in patients admitted in a tertiary care centre in kerala

Bile duct tumors masquerading as cholangiocarcinoma: case reports from a tertiary care center in Kerala

Bile duct tumors masquerading as cholangiocarcinoma: case reports from a tertiary care center in Kerala

Molecular Characteristics of Cephalosporin Resistant Escherichia coli and Klebsiella pneumoniae Isolated from Children in a Tertiary Care Centre of Central Kerala, India

Aims: The study was aimed to determine the molecular characteristics of extended-spectrum beta-lactamases (ESBL) producing cephalosporin-resistant Escherichia coli and Klebsiella pneumoniae isolated from children below ten years of age. Background: Geographically diverse variations in the prevalence of ESBL genes were reported. No data were available on the prevalence of ESBL genes in central Kerala, India, among children below 10 years of age. Methods: A cross-sectional study was performed to analyze ESBL genes in cephalosporin-re-sistant E. coli and K. pneumoniae strains isolated from samples received in the Microbiology la-boratory of a tertiary care centre during the period between May 2021 and July 2022. The strains showed that ESBL + cephalosporin resistance was subjected to PCR-based genotyping for the genes such as bla (beta-lactamase) CTX-M-1, blaCTX-M-15, blaCTX-M-U, blaTEM, blaPER and SHV. Results: Among the total 228 samples analyzed, 136 (60%) had no growth. Ninety-two (40 %) samples showed growth of E. coli and K. pneumoniae. Among the isolates that showed growth, 39 (42%) were sensitive, and the remaining 53 (57%) were resistant to third-generation cephalospor-ins. Among the isolates showed resistance, 22 (42%) were ESBL positive and 31 (58%) were ESBL negative. Among the positive ESBL, nine E. coli strains (60%) were positive for CTX-M-15 and CTX-M-1. CTX-M-15 and CTX-M-U were present in six (85%) K. pneumoniae with ESBL +. Conclusion: E. coli and K. pneumoniae isolated from specimens of children below ten years of age showed 41-42% ESBL producers. Prevalent ESBL-producing genes in E. coli were CTX-M-15 and CTX-M-1. CTX-M-15 and CTX-M-U were prevalent in ESBL-producing K. pneumoniae.

Stake Net Fishery of Central Kerala – Costs, Returns and Seasonality

Stake Net Fishery of Central Kerala – Costs, Returns and Seasonality

Investigating the Impact of Recent and Future Urbanization on Flooding in an Indian River Catchment

Socioeconomic growth in India has caused massive infrastructure development which has resulted in extensive damage to the natural environment. A consequence of this urbanization has been extensive monsoon flooding in many locations within the country. The impact of recent land use and land cover (LULC) change because of urbanization and a series of future LULC scenarios is assessed for the Meenachil river basin in central Kerala, India. This catchment flows into the Kuttanad administrative area, which has the country’s lowest elevation, an increasing population, and currently suffers from regular flooding. Hydrological modeling using SHETRAN and hydraulic modeling using HEC-RAS predicts that an extreme event will produce a 105% rise in flood depth in 2100 compared to 2005. A scenario that incorporates Nature-based Solutions suggests the rise in flood depth could be reduced by 44%. A catchment response for future development is needed but is hindered by different administrative boundaries within the river basins that flow into the Kuttanad administrative area, and so this study concludes by providing regional-scale planning recommendations that integrate hydrologic components.

Moth Biodiversity in Central Kerala: A Comprehensive Examination of Urban and High-Altitude Habitats With New Distribution Record of Palaeosetidae

The order Lepidoptera, encompassing both butterflies and moths, many species within lepidoptera plays a pivotal role in ecosystem dynamics as key pollinators. Moths, constituting the vast majority within this order, serve as essential contributors to biodiversity in the Indian subcontinent, with over 12,000 known species. Despite their ecological significance, our understanding of moth diversity in India remains incomplete. This study addresses this knowledge gap by conducting a focused survey of moths in central Kerala between May 2019 and December 2021. Utilizing a standardized methodology involving moth trapping with white cloth and mercury vapor bulbs, we recorded and analyzed 483 moth species spanning 44 families. Notably, this investigation documented the presence of the family Palaeosetidae in Kerala for the first time including two species previously reported only from the Khasi Hills. Additionally, the first-ever sighting of Corgatha semipardata in India and the presence of Cirrhochrista fuscusa in South India were reported. Temporal activity patterns of moths revealed intriguing variations, and a meticulous identification process resulted in classifications at various taxonomic levels. Erebidae emerged as the most speciose family, predominantly in urban areas, while Crambidae, Geometridae, and Noctuidae thrived in high-altitude regions, indicating habitat diversity. Furthermore, this study sheds light on the challenge of identifying moths without specimen collection, particularly for microlepidoptera, which needs further research in this area. The observation of Macroglossum genus caterpillars suggests the possibility of migration, opening avenues for future investigations into moth movement patterns. In conclusion, our research highlights the rich diversity of moths in central Kerala and emphasizes the importance of conserving ecosystems and host plants in urban areas. While providing valuable insights, this study acknowledges its limitations due to a limited duration and calls for extensive research to comprehensively assess moth species richness in the region, offering a crucial foundation for future studies focused on moth diversity.