Indian Council Of Medical Research Research Articles

Development of Indian Council of Medical Research (ICMR) Standard Treatment Workflows for Skin Diseases: A Step Toward Universal Health Coverage

Abstract Background: Skin conditions form a major bulk of diseases in the community. With a disproportionately low number of dermatologists in the country, and a greatly unequal distribution between urban versus rural areas, ineffective treatment and mismanagement of skin conditions are, however, commonplace. Objective: To develop standard treatment workflows (STWs) for certain skin diseases for use by clinicians at primary, secondary, and tertiary care centers. Methodology: Seven members, from various academic institutes across the country, were selected for formulation of the STWs. They were provided logistic and technical support by the ICMR, Department of Health Research (DHR), and WHO India office. Multiple rounds of online and physical discussions were performed to identify topics that would be most useful in the management of skin diseases for the health care personnel (HCP) and subsequently to frame the STW content. Results: The selected diseases included acne and rosacea, alopecia, bacterial skin infections, cutaneous adverse drug reactions, dermatophytosis, eczema/dermatitis, immunobullous dermatoses, psoriasis, scabies, varicella and herpes, vitiligo, and urticaria. There was one separate module on rational use of topical corticosteroids. The STWs for these conditions have been finalised and are available as physical posters in health centers and can also be accessed online and through mobile applications. Conclusion: Thirteen STW modules have been prepared with a view to optimize management of skin diseases at various levels of health care system of the country.

A review on the crisis of antibiotic resistance and the strategies to combat resistance

Abstract The discovery of antibiotics has caused a huge impact on the history of the entire health-care system. The irrational and excessive use of antibiotics has become futile and has given rise to another serious issue known as antibiotic resistance, which is now a threat to the health-care sector. Due to this, millions of deaths are occurring worldwide every year as infections are becoming difficult to treat as a result of resistance to the antibiotics that are used to treat them. Thus, the confidence of the global health-care system is ruined. The WHO has recognized antibiotic resistance as a serious issue that needs to be addressed and has declared tackling it a high priority. Even though complete eradication of antibiotic resistance is not possible, the spread and the incidence of resistance can be reduced by taking adequate measures. Combating antimicrobial resistance is, therefore, a prime need of the and various strategies have been adopted globally. This article primarily focuses on the phenomenon of antibiotic resistance, the mechanisms of resistance, various reasons that contribute to it, and the strategies adopted to combat the global crisis. Here, we have reviewed articles on antibiotic resistance from scientific websites such as PubMed Central, NCBI, Science Direct, and Google Scholar, and the strategies have been taken from the official website of the WHO, Indian Council of Medical Research, and the guidelines issued on this by the Ministry of Health and Family Welfare Government of India and Government of Kerala.

Groundwater Chemistry in Jind District: Physiochemical Appraisal and Drinking Water Quality Assessment

It is essential to have access to safe drinking water, particularly in rural regions where groundwater is the primary water source. The physicochemical quality of the groundwater in Jind District, Haryana, India, has been evaluated in this research. Six hundred samples were collected from thirty different places, and the following physiochemical characteristics were measured: pH, total dissolved solids, total hardness, alkalinity, electrical conductivity, calcium, magnesium, sodium, potassium, nitrate, fluoride, and sulfate. The World Health Organization, the Bureau of Indian Standards, the Indian Council of Medical Research, and other regulatory bodies' standards were compared to these results. Most of the necessary criteria were found to be within acceptable levels; however, total hardness, calcium, and magnesium were found to be greater than recommended in certain areas. The Water Quality Index states that the declining quality of the groundwater in certain areas makes it unfit for human consumption. In addition to providing critical information to assist mitigation measures and ensure the provision of sustainable and clean water resources for the population of the Jind district in the state of Haryana, this research highlights the need of regular monitoring

Groundwater Chemistry in Jind District: Physiochemical Appraisal and Drinking Water Quality Assessment

It is essential to have access to safe drinking water, particularly in rural regions where groundwater is the primary water source. The physicochemical quality of the groundwater in Jind District, Haryana, India, has been evaluated in this research. Six hundred samples were collected from thirty different places, and the following physiochemical characteristics were measured: pH, total dissolved solids, total hardness, alkalinity, electrical conductivity, calcium, magnesium, sodium, potassium, nitrate, fluoride, and sulfate. The World Health Organization, the Bureau of Indian Standards, the Indian Council of Medical Research, and other regulatory bodies' standards were compared to these results. Most of the necessary criteria were found to be within acceptable levels; however, total hardness, calcium, and magnesium were found to be greater than recommended in certain areas. The Water Quality Index states that the declining quality of the groundwater in certain areas makes it unfit for human consumption. In addition to providing critical information to assist mitigation measures and ensure the provision of sustainable and clean water resources for the population of the Jind district in the state of Haryana, this research highlights the need of regular monitoring

Compliance Among Healthcare Workers on Hydroxychloroquine Prophylaxis in a Tertiary Care Teaching Hospital during COVID-19 Pandemic

Background: The Indian Council of Medical Research (ICMR), under the Ministry of Health and Family Welfare, recommended chemoprophylaxis with Hydroxychloroquine (HCQ) for asymptomatic healthcare workers treating patients with suspected or confirmed COVID-19 disease during the initial period of the pandemic. Compliance remains a major determining factor behind the success of any Community prophylaxis program. Objective: The study aimed to assess the extent of compliance with the Hydroxychloroquine (HCQ) prophylaxis schedule as per ICMR guidelines among healthcare workers and to find out the factors associated with compliance. Methods: Informed consent was obtained from the study participants, and a questionnaire on parameters and associated factors affecting compliance were filled out by every study participant upon completion of their HCQ prophylaxis. Results: A total of 160 participants were enrolled in the study. The majority of the staff enrolled was the nursing staff (34%). 66% of the total participants were involved in the care of the suspected or confirmed case of COVID-19. The major source of information about HCQ prophylaxis for COVID- 19 infection among all the participants was from the Institutional circular (56%). 10% of healthcare workers believed that HCQ could give them 100% prevention against COVID-19 infection. 56% of the enrolled healthcare workers consumed the medicine on the same day of collection throughout the schedule. 24% of enrolled healthcare workers completed the full course as per ICMR guidelines. The most motivating factor for compliance was the presence of cases of COVID-19 in the hospital. The most common factor for lack of compliance among enrolled healthcare workers was cited to be no contact with COVID-19-positive patients. Conclusion: In our study, 24% of healthcare workers enrolled for HCQ prophylaxis completed the full course of the prescribed regimen as per ICMR guidelines. The main reason for the lack of compliance was the absence of direct contact with COVID-19-positive patients, followed by fear of ADRs.

Community perspective and healthcare assessment in malaria endemic states of India: a cross-sectional study protocol

IntroductionIndia’s contribution to the malaria burden was highest in South-East Asia Region in 2021, accounting for 79% of the estimated malaria cases and 83% of malaria-related deaths. Intensified Malaria Control...

Which test results to believe? Comparison of different ELISA kits for detection of SARS-CoV-2-neutralizing antibody among COVID-vaccinated individuals

BackgroundIn the context of SARS-CoV-2, infection and immunization lead to varied levels of neutralizing antibodies (NAbs) crucial for protective immunity. In the lack of universal availability of plaque reduction neutralization tests, the gold standard centers rely on surrogate kits, for which performance standards and validation are lacking. Hence, we assessed three NAb kits available in India to determine their agreement and concordance. MethodsIt's a single-center cross-sectional observation study conducted during the third wave of the pandemic starting in January 2022 amongst individuals (n: 247) who received the first two doses of CovishieldTM. Samples were analysed using kit-A (Indian Council of Medical Research (ICMR) approved NAb microlisa kit, J. Mitra & Co. Pvt. Ltd), kit-B (Food and Drug Administration–approved NAb surrogate virus neutralisation test, GenscriptTM), and kit-C (NARI- and ICMR-approved anti–SARS-CoV-2 IgG antibodies kit using indirect ELISA principle, ErbaLisa® COVID-19 IgG). Cohen's kappa and concordance were analyzed using JMPver20.0.0. ResultsNAb was detected in 80.4%, 82.9%, and 21% samples using the three different kits. Discordance was observed in 19.68%, 65.7%, and 62.6% between Kit A-B, A-C, and B-C, respectively. The agreement was fair between Kit A-B (κ-0.35; p: 0.06) and Kit B-C (κ-0.09; p: 0.0005). Kit-B showed higher mean percentage inhibition (74.6 ± 32.1%) than Kit-A (68.1 ± 35.7%) (p: 0.0347). The correlation between kit-A and kit-B was moderate (r: 0.57; p < 0.0001). ConclusionThere is significant discordance between various commercials, which raises questions about their validity. The research underscores the need for robust validation and standardization of NAb tests to ensure their reliability and effectiveness in guiding public health strategies.

Emerging trends in antimicrobial resistance in bloodstream infections: multicentric longitudinal study in India (2017–2022)

BackgroundAntimicrobial resistance (AMR) has escalated to pandemic levels, posing a significant global health threat. This study examines the patterns and trends of AMR in Bloodstream Infections (BSIs) across India, aiming to inform better surveillance and intervention strategies. MethodsSix-year data from 21 tertiary care centers in the Indian Council of Medical Research's AMR Surveillance Network (IAMRSN) were retrospectively analyzed to estimate cluster-robust trends in resistance. Time-series analysis was used to discern lead/lag relationships between antibiotic pairs and the directional influence of resistance in community and hospital-acquired BSIs(CA/HA BSIs). A data-driven Bayesian network ensemble averaged over 301 bootstrap samples was modelled to uncover systemic associations between AMR and Sustainable Development Goals (SDGs). FindingsOur findings indicate significant (p<0.001) monthly increases in Imipenem and Meropenem resistance for Klebsiella, E. coli, and Acinetobacter BSIs. Importantly, Carbapenem resistance in HA-BSIs preceded that in CA-BSIs for Klebsiella and Acinetobacter (p<0.05). At a national level, Cefotaxime resistance emerged as a potential early indicator for emerging Carbapenem resistance, proposing a novel surveillance marker. In Klebsiella BSIs, states with higher achievement of SDG3 goals showed lower Imipenem resistance. A model-based AMR scorecard is introduced for focused interventions and continuous monitoring. InterpretationThe identified spatiotemporal trends and drug resistance associations offer critical insights for AMR surveillance aligning with WHO GLASS standards.The escalation of carbapenem resistance in BSIs demands vigilant monitoring and may be crucial for achieving SDGs by 2030. Implementing the proposed framework for data-driven evidence can help nations achieve proactive AMR surveillance. FundingNo specific funding was received for this analysis.

For Malaria Elimination, India Needs to Integrate Its Research and Control Arms.

India has targeted malaria elimination by 2030. The national malaria control program has positioned its strategies in this direction. Substantial support in the form of dynamic research inputs leading to policy formulation and change is needed to steer the country towards malaria elimination. Indian Council of Medical Research (ICMR), India's nodal research body, has been generating evidence and helping to frame several policies ranging from malaria management to vector control operations. Since the country is preparing for malaria elimination, the connection between the programmatic needs and the research agenda needs further strengthening. Typically, the national malaria control program handles the implementation of programmatic activities, while the national research body, ICMR, conducts research studies to generate evidence. We propose a virtual integration of the activities conducted by these two entities to maximize the potential for translating research findings into programmatic policies. Joint monitoring of drug and insecticide resistance, codevelopment and utilization of more innovative surveillance systems, data-backed mitigation responses, and overcoming last-mile challenges are reasons for the virtual amalgamation of the two bodies. Timely translation of research outputs into policy, co-opting of workforce and material resources, joint capacity building, and synergistic advocacy are benefits of the proposed new alliance for more efficient operations. The close functioning will provide impetus to narrow down current gaps and disrupt traditional barriers, galvanizing the country toward malaria elimination.

Experience of rigorous practice of antimicrobial stewardship program and its impact on antibiotic consumption

Objectives: Antimicrobial resistance (AMR) is the next pandemic with a huge global economic burden. A customized antimicrobial stewardship program (AMSP) is a well-recognized tool for containment of AMR. The current study was undertaken to identify the impact of AMSP measures on the trends of antibiotic consumption rates, e.g., defined daily dose (DDD) and days of therapy (DOT) per 100 patient days in pre-identified areas of the hospital. Materials and Methods: The present study was a case-record-based extended cross-sectional study carried out in a tertiary care institute in central India from January 2021 to September 2021. Time-bound feasible sampling was undertaken, and all cases were included without any exclusion criteria. The study was approved by the Ethics Committee of the Institute and funded by the Indian Council of Medical Research (ICMR). Statistical Analysis: The data was entered into a spreadsheet. The calculation of DDD and DOT was performed individually for each antibiotic as per WHO tool per 100 patient days. Results: In high-priority areas such as intensive care unit and high dependency unit, the top three DDD/100 days were meropenem (77.9), colistin (41.4), and piperacillin-tazobactam (13.5) versus the top 3 DOT/100 patient days were meropenem (40.5), colistin (20.9), and piperacillin-tazobactam (15.7). In low-priority areas such as general wards, the top 3 DDD/100 patient days were meropenem (45.4), piperacillin-tazobactam (22.6), and cefoperazone (5.0) versus the top three DOT/100 patient days were meropenem (45.4), cefoperazone (44.9), and piperacillintazobactam (22.6). There was a downward trend of consumption of almost all these antibiotics when measured at baseline and the next two quarters. DDD and DOT per 100 patient days had a positive linear correlation during the study period. Conclusions: The present study demonstrates about 50% reduction in consumption of ICMR priority antibiotics with a yearlong AMSP. DDD and DOT per 100 patient days can be calculated with minimal effort, even in extremely busy hospitals. DOT tools are less labor-intensive and, hence, should be the pivotal tool for antibiotic exposure measurement.

Adherence to weekly iron folic acid supplementation and associated factors among adolescent girls – A mixed-method study

ABSTRACT Context: Despite the Weekly Iron folic acid supplementation (WIFS) program, the prevalence of anaemia among adolescent girls remains high. Phase 1 Indian Council of Medical Research (ICMR) task force study conducted in 2016 in Kallur showed that the IFA provision rate for adolescent girls was 72% but the consumption rate was only 15% in the Kallur area. The present study was done to identify the gaps for the difference between provision and consumption rate of weekly IFA tablets among adolescent girls using the WHO conceptual framework in home-based settings. Materials and Methods: This crosssectional study with a mixedmethod design was conducted from October 2020 to December 2021. Quantitative data were collected from 972 adolescent girls and their parents using a structured pretested questionnaire, whereas qualitative exploration was done by focus group discussions. Descriptive analysis and bivariate analysis were used to analyse the quantitative data. Qualitative data were analysed and integrated with quantitative results. Results: The overall number of girls who were aware of Iron Folic acid therapy (IFAT) was 704 (72%). However, only 132 (13%) adolescent girls were found to be adherent to IFA therapy. Multivariable regression analysis revealed that side effects encountered on intake of IFAT (Odds ratio (OR) =0.5, P = 0.009) were associated with higher rates of nonadherence, whereas regular supply (OR = 13.6, P = 0.000), health education to parents (OR = 2.76, P = 0.002), and experiencing benefits (OR = 1.72, P = 0.006) were associated with higher rates of adherence. These were substantiated by qualitative findings. Conclusions: Ignorance on the impact of anaemia on adolescent health, fear of side effects, unpleasant effects experienced on intake of Iron folic acid (IFA), and inadequate counselling determines the adherence to weekly IFA supplements among adolescent girls.

Effectiveness of video-assisted teaching on prevention of constipation among postpartum women admitted in postnatal ward at a tertiary care hospital: a randomised controlled trial

BackgroundThe postpartum period is a vital phase for a mother as she undergoes a role transition in her life, in addition to physiological changes. Among all discomforts experienced during this...

Advanced integrative molecular platform for high-throughput screening of drug-resistant tuberculosis

A real time-polymerase chain reaction-based test in lyophilized form, was developed to simultaneously identify Mycobacterium tuberculosis complex (MTC) by targeting IS6110, rrs as dual markers, as well as mutations causing rifampicin and isoniazid resistance. The test was evaluated for pulmonary and non-pulmonary specimens from sample isolation to PCR analysis. The test demonstrated limit of detection of 25 CFU/mL for MTB, 200 CFU/mL for rpoB and inhA/katG targets with >95 % CI. The specificity for MTC was supported by a comprehensive clinical validation (n = 100). This load-and-go molecular platform, with features of high throughput, long shelf-life, room temperature storage provides simultaneous detection of MTC and its drug-resistant mutations in minimal time. The test named “PathoDetect TM MTB-RIF and INH resistance detection kit” has been approved by Central Drugs Standard Control Organisation, Indian Council of Medical Research and would have implications for tuberculosis elimination programs.

Effectiveness of Gerontechnology Empowerment Program on Awareness and Use of Mobile Apps Among Older Adults for Instrumental Activities of Daily Living: Protocol for a Cluster Randomized Controlled Trial.

Instrumental activities of daily living (iADLs) are crucial for older adults to live independently. Health care and technological advancements will increase the older adult population and life expectancy globally. Difficulties with iADLs impact older adults' quality of life. Mobile apps can assist older adults, but many require help due to limited awareness. Lack of awareness is a barrier to app use. Existing literature mainly covers health care and app design, needing more focus on iADL apps for older adults. The study objectives encompass 2 main aspects: first, to evaluate the awareness, use, and factors influencing the use of apps among older adults for iADLs; and second, to create and assess the effectiveness of a gerontechnology empowerment program (GEP) for older adults on the awareness and use of apps for iADLs. This research uses a quantitative approach divided into 2 distinct phases. In phase 1, we conduct a descriptive survey to assess the level of awareness and use of mobile apps for iADLs and identify the factors that influence the use of such apps among older adults. To ensure clarity and comprehension among participants, we provide them with a subject information sheet in both Kannada and English. The data collected during this phase enable us to gain insights into awareness levels, use patterns, and factors that shape older adults' use of apps for iADLs. The results serve as the foundation for designing the GEP. In phase 2, a cluster randomization method will be used to select older adults aged 60 to 75 years in Udupi district, Karnataka, India, who are active smartphone users. These participants will be divided into 2 groups: the experimental and the control groups. The experimental group will join the GEP. The sample size for phase 1 is 554, and phase 2 is 50. To assess the effectiveness of this program, we will measure the outcomes before and after its implementation using the same assessment tools used in phase 1. This study is funded by the Indian Council of Medical Research (Adhoc/193/2022/SBHSR on November 18, 2022). Phase 1 data collection is expected to be completed by November 2023, and phase 2 is scheduled to commence in the upcoming months. Phase 1 and 2 findings will be analyzed and discussed in the main paper, which we intend to submit to a high-quality peer-reviewed journal for publication. The research protocol, informed consent forms, and associated documentation received approval from institutional ethics committees (214/2020). Upon the successful testing of the GEP, it can be recommended that welfare departments encourage older adults to use mobile apps for iADLs and establish training programs to provide support to older adults in using these apps. Clinical Trials Registry - India CTRI/2020/09/027977; https://ctri.nic.in/Clinicaltrials/pmaindet2.php?EncHid=NDUxMzM=&Enc=&userName=027977. DERR1-10.2196/53587.

Assessment of the Internet Addiction Disorder and its Association with Anxiety and Depression in Young Indian Adults: A Cross Sectional Study

The phenomenon of involuntary engagement with internet devices, accompanied by a sense of emptiness in their absence, characterizes internet addiction disorder. A comprehensive meta-analysis spanning 80 studies worldwide from 1996 to 2012, involving 89,281 participants across 31 countries, revealed a 6% prevalence of this disorder among young individuals globally. A separate study funded by the Indian Council of Medical Research (ICMR) investigated 2,755 participants aged 18-65 in India, finding a prevalence rate of 1.3% for internet addiction. Notably, this disorder has not yet been recognized as Internet Addiction Disorder (IAD) in the Diagnostic and Statistical Manual of Mental Disorders (DSM). Numerous studies have examined the prevalence of internet addiction in the Indian population. This current study aimed to assess the prevalence, impact, and available treatment options for internet addiction among Indian adults. Utilizing a cross-sectional, close-ended online survey questionnaire distributed among the general public and experts, a total of 303 responses were collected. The findings revealed that 33.3% of Indian adults were addicted to the internet, with varying degrees of severity: severely (1.7%), moderately (10.2%), and mildly (20.8%) addicted. Notably, most severely addicted individuals (80%) fell within the 26-35 years age range. Male participants exhibited a higher prevalence of internet addiction compared to females (57.1% vs. 42.9%), with males also displaying a greater propensity for addiction (71.9% vs. 28.1%). Further analysis indicated that 11.2% of addicted individuals experienced symptoms of anxiety and/or depression, with males affected at a rate 50% higher than females.

A Cross Sectional Study in Indian Adult Population to Assess the Internet Addiction and its Effect on the Quality of Sleep

A Cross Sectional Study in Indian Adult Population to Assess the Internet Addiction and its Effect on the Quality of Sleep

The Indian multiple sclerosis and allied demyelinating disorders registry and research network (IMSRN): Inception to reality

BackgroundDemyelinating disorders of the CNS are a set of chronic, inflammatory, autoimmune conditions. To improve understanding of epidemiology, population characteristics and disease behaviour, an Indian, hospital-based registry has been established to serve as a platform for fostering collaborative research. The following article outlines the development, governance and current status of the Indian Multiple Sclerosis and Allied Demyelinating Disorders Registry and Research Network (IMSRN), the country's first scientific database and dedicated expert research network of these disorders. MethodsMultiple reviews and stakeholder meetings were held to set up the registry. The IMSRN was formally initiated in August 2021 across 26 tertiary care centres. The registry is governed by the Indian Council of Medical Research (ICMR), New Delhi and its task force committee. The online secure database captures detailed clinical and imaging patient details at baseline and periodic follow up. Periodic meetings of the task force and collaborators are held to discuss the progress, improvements and research proposals. ResultsThe IMSRN is currently active and recruiting patients following an informed consent. As of current, more than 3336 patients including RIS (N = 8), CIS (N = 134), MS (N = 1674), NMOSD (N= 561), MOGAD (N = 404), ADEM (N = 46), CRION (N = 21), CLIPPERS (N = 2), and GFAP (N =1) have been enrolled. 340 patients, not meeting the diagnostic criteria for any of the aforementioned disease phenotypes are in the others category. Various research proposals are being developed to study different aspects of these disorders. ConclusionThe IMSRN has been established with a vision to strengthen our understanding about MS, NMOSD, MOGAD, and other demyelinating disorders. This would help answer important questions related to disease profiles and long-term outcomes of patients in the Indian setting. From the standpoint of clinical practice, therapeutics, patient management, research, and national policy building, IMSRN shall serve as a synergising platform for bridging the gap in the aforementioned areas and guiding future research through national and international collaboration.

Analysis of informed consent documents for compliance with ICMR guidelines for biomedical and health research

Abstract Background: Ethical conduct of research depends on the voluntary expression of consent and adequate disclosure of information about the research in informed consent documents (ICDs). Objectives: The objective of this study was to analyze ICDs of academic studies for compliance with National Ethical Guidelines for Biomedical and Health Research laid down by the Indian Council of Medical Research (ICMR) and to determine the readability of ICDs using the Flesch–Kincaid Grade Level scale and Flesch reading-ease (FRE) score. Methodology: ICDs of academic research projects submitted during 2020–22 were retrieved from the IEC office and analyzed for compliance with ICMR 2017 guidelines. The readability of the documents was assessed by the Flesch–Kincaid Grade Level Scale and FRE score. Results: Among 177 protocols analyzed, the most common were epidemiological studies (36.72%), followed by diagnostic studies (28.81%). Vernacular translations of ICDs were present in significantly more studies in 2022 (χ 2 = 7.18, P = 0.02) as compared to 2020 and 2021. FREs score was 45.75 ± 10.76, and Flesch–Kincaid Grade Level was 8.67 ± 1.44. Content analysis of participant information sheet (PIS) revealed that significantly more PIS submitted in 2022 mentioned expected duration of participation (χ 2 = 6.95, P &lt; 0.001), benefit to patient/community (χ 2 = 26.63, P &lt; 0.001), disclosure of foreseeable risk or discomfort (χ 2 = 21.72, P &lt; 0.001), payment for participation (χ 2 = 21.72, P &lt; 0.001), and identity of research team and contact details (χ 2 = 18.58, P &lt; 0.001). Compliance score was significantly better in 2022 as compared to 2020 and 2021. Conclusion: Gradually, ICDs became more compliant with ICMR guidelines. Still, there is scope for improvement in ICDs regarding content and readability so that patients can comprehend facts easily to make informed decisions in a real sense.

Patterns of cancer at a tertiary cancer center in Kerala, India, based on 10-years of hospital-based cancer registry data: A retrospective observational study

ABSTRACT Background: The magnitude and pattern of cancer cases vary across different hospital-based cancer registries (HBCRs) in India. Currently, the clinical and epidemiological profiles of cancer cases are not available for the North Malabar region of Kerala, India. Objectives: The primary objective of this study was to evaluate the magnitude and pattern of cancer cases in the North Malabar region of Kerala, India. The secondary objective was to evaluate the trends of cancer cases based on 10-year HBCR data from a tertiary cancer center in the North Malabar region of Kerala, India. Materials and Methods: This retrospective observational study was conducted on patients who were registered at the HBCR of Malabar Cancer Center in the northern region of Kerala. The demographic and clinical profile of patients with cancer who registered at the HBCR between January 2010 and December 2019 was obtained using a prescribed format developed by the Indian Council of Medical Research (ICMR). Descriptive statistics were used to analyze the data, and a line diagram was used to represent the trends of the five most common cancers in males and females. Results: Between 2010 and 2019, 38,836 patients were registered. Among them, 20,829 (53.6%) were males and 18,017 (46.4%) were females. Lung cancer was the most common cancer among males and breast cancer was the most common cancer among females. The median age at diagnosis of lung cancer was 64 years (interquartile range [IQR], 58-70). Similarly, the median age at diagnosis of breast cancer was 52 years (IQR, 44-60). Conclusion: The five most common sites of cancer among males were the lung, mouth, stomach, tongue, and larynx. In females, the most common cancers were breast, cervix uteri, ovary, mouth, and lung. During these ten years, the common cancers in both males and females showed an upward trend.

Diabetes Mellitus and Other Comorbidities: Outcome among Covid-19 Patients in Kerala: A Retrospective Observational Study.

Covid-19 was declared by the WHO as a pandemic in 2020; India was also severely affected. Diabetes, a major lifestyle disorder, has seen its prevalence rate rising in developing countries. India is home to the world's second-largest population of diabetes. Several studies have reported greater severity and mortality of Covid-19 in diabetic patients. This was a hospital-based retrospective study done in a rural-based medical college in Kerala State. Data was collected using a semi-structured proforma and analysis was performed using Statistical Package for Social Sciences software version 25. The study was part of the STS research program of the Indian Council of Medical Research (ICMR). There were 567 patients in the study. Those with pre-existing diabetes had a worse outcome compared to those with newly detected diabetes. The presence of CKD was associated with a poor outcome. Patients admitted to the ICU, and those on assisted ventilation also had a lower survival rate; within the subgroup, those on non-invasive ventilation had a better outcome. Mortality in Covid-19 is multifactorial. Those with diabetes have a poor outcome. Comorbidities have been reported to confer a high mortality rate in Covid-19 but this was not so in our study (except for CKD). Variability in outcome with respect to comorbidities and better outcomes in those who were non-invasively ventilated calls for more research to establish the relationship between pre-existing conditions and severity of disease. The use of non-invasive ventilation could also provide succor to resource-limited communities.