Indian Council Of Medical Research Research Articles

चिंता का योग अभ्यासी समूह एवं गैर योगाभ्यासी समूह पर प्रभाव

Psychosis means a disorder occurring in the mind. It can also be said that this is a condition of a person's mental health which cannot be called normal as compared to a healthy person. The behavior of people who suffer from mental illness is determined to be abnormal or maladaptive and involves significant distress or disability. We all know them as psychiatry, mental illness, mental illness or mental disorder. In India, almost one person suffers from mental illness every year, although the severity of the disease can be more or less. Although the disease may be more or less, the Indian Council of Medical Research (ICMR) conducted a comprehensive study for the first time in 2017 regarding the burden of mental illness on India. This study revealed that 4.57 crore people suffer from mental disorders. 4.49 crore people suffer from depression and anxiety. Research has also revealed that mental illness is the biggest problem in India. Depression, anxiety, schizophrenia, anxiety, illness, conduct disorder etc. are types of mental illness. Even in this, those who worry are the most troubled. In this research, I tried to do research on both those who do yoga and those who do not do it, through various dimensions of yoga like asana, pranayama, meditation etc. I found that the people who practice yoga daily have less anxiety levels. Whereas the level of anxiety of those who do not do yoga was found to be very high. This proves that a person practicing yoga has very little anxiety, stress, etc.

Situational Analysis of Healthcare and Medical Diagnostic Testing Facility Availability in Selected Blocks of Muzaffarpur District, Bihar, India: A Cross-Sectional Study.

This study presents a comprehensive assessment of healthcare facilities, focusing on workforce composition, operational dynamics, diagnostic laboratory services, and accessibility considerations. The comparison between government and private healthcare sectors provides insights into service delivery and potential disparities. The study's rationale, objectives, and methodology are explored in the context of the Indian healthcare landscape. A cross-sectional analysis was conducted in Muzaffarpur district, Bihar, targeting selected urban and rural blocks. The study employed geolocation data to analyze accessibility to healthcare facilities. Data collection involved on-site visits, structured questionnaires, and consultation of the Indian Council of Medical Research (ICMR)'s framework. The assessment concentrated on the availability of tests offered by the LaBike platform, and workforce compositions were compared. Government healthcare facilities exhibited a balanced distribution of doctors, nurses, and grassroot workers, reflecting comprehensive healthcare provisions. Private facilities, although featuring moderate doctor and nurse presence, lacked grassrootworkers. Diagnostic test prevalence was evident, with core tests, such as CBC and blood glucose, available in over 85% of facilities. Government facilities provided tests free of charge, while private facilities showcased a diverse cost spectrum. Proposed interventions received strong support from both sectors, indicating the potential for innovative healthcare solutions. Accessibility analysis: Urban intervention and control sites demonstrated comparable accessibility, with facilities located within 2 km. In rural intervention and control sites, distances varied significantly. Mushahari, a rural intervention site, required participants to travel 6 km to the nearest facility, impacting healthcare access. By contrast, Marwan, a rural control site, featured a shorter distance of 3 km. This study's comprehensive evaluation of healthcare facilities offers valuable insights into workforce dynamics, diagnostic services, and healthcare interventions in the context of government and private sectors. The findings underscore the significance of addressing workforce gaps and promoting equitable access to diagnostics. By informing evidence-based decision-making, this study contributes to the optimization of healthcare service delivery, aiming to enhance healthcare quality and accessibility for all.

SARS-CoV-2 Screening on the Multiplex Real-Time RT-PCR Gene Cycle Threshold - A Machine Learning Approach

Early diagnosis of the lethal SARS-CoV-2 virus determines a patient’s survival rate. Highly transmissible novel coronavirus prevention is possible with effective, rapid diagnostic strategies. The reverse transcription polymerase chain reaction (RT-PCR), a globally adopted SARS-CoV-2 detection technique, provides better diagnosis results. The output of the RT-PCR test produces the amplified gene scores of ORF1a/b, S, N, E and RdRp. This study intends to evaluate the performance of the RT-PCR-based COVID-19 diagnosis using machine learning models. The confirmatory genes ORF1b, E and RdRp and their cycle threshold (Ct) values are the main parameters used to build the machine learning model for SARS-CoV-2 screening. The real-time dataset collected from the Indian Council of Medical Research (ICMR) database containing missing, redundant information is processed and eliminated. Statistical interpretations are performed with demographic information to understand the dynamics of the disease prevalence in India. Binary classification models delivered promising results in discriminating the samples of two classes. The models were examined further to scrutinize their performance via evaluation metrics such as balanced accuracy, f1-score, ROC curve, precision and recall. This algorithmic assessment exhibits a better outcome on the RT-PCR-based SARS-CoV-2 disease diagnosis.

Rare blood group registry in India-current challenges and future perspectives.

Patients who require blood from rare blood group donors present great challenges even to the most advanced healthcare delivery system. It is most challenging to supply blood for a patient with an antibody to an antigen of high prevalence. The blood donor lacking the corresponding antigen would have an occurrence rate of less than one in 1,000. The International Rare Donor Panel was established in 1965, but since then there has been gross underrepresentation of South Asian countries, including India. There are several challenges to starting a rare blood group donor program in India that include technical, logistical, and administrative limitations. But the main limiting factors are poor availability of trained resources, lack of awareness, absence of antibody screening, inadequate number of laboratories with blood group genotyping facilities, and the decentralized nature of blood transfusion services. Despite that, there were several rare blood groups identified by Indian immunohematologists in the recent past. Recently, a transfusion genomic group has been established in collaboration with the clinical transfusion medicine specialists in India under the GUaRDIAN (Genomics for Understanding Rare Disease in India Alliance Network) initiative to address the domain of rare blood group genomics. Similarly, the National Institute of Immunohematology, Mumbai under the directive of the ICMR (Indian Council of Medical Research) has taken a step to start the RDRI (Rare Donor Registry of India). In this context, we explore the current challenges of setting-up a rare blood group registry in India and future goals from a developing nation's perspective.

Development of the Indian Reference Case for undertaking economic evaluation for health technology assessment.

Health technology assessment (HTA) is globally recognised as an important tool to guide evidence-based decision-making. However, heterogeneity in methods limits the use of any such evidence. The current research was undertaken to develop a set of standards for conduct of economic evaluations for HTA in India, referred to as the Indian Reference Case. Development of the reference case comprised of a four-step process: (i) review of existing international HTA guidelines; (ii) systematic review of economic evaluations for three countries to assess adherence with pre-existing country-specific HTA guidelines; (iii) empirical analysis to assess the impact of alternate assumptions for key principles of economic evaluation on the results of cost-effectiveness analysis; (iv) stakeholder consultations to assess appropriateness of the recommendations. Based on the inferences drawn from the first three processes, a preliminary draft of the reference case was developed, which was finalised based on stakeholder consultations. The Indian Reference Case provides twelve recommendations on eleven key principles of economic evaluation: decision problem, comparator, perspective, source of effectiveness evidence, measure of costs, health outcomes, time-horizon, discounting, heterogeneity, uncertainty analysis and equity analysis, and for presentation of results. The recommendations are user-friendly and have scope to allow for context-specific flexibility. The Indian Reference Case is expected to provide guidance in planning, conducting, and reporting of economic evaluations. It is anticipated that adherence to the Reference Case would increase the quality and policy utilisation of future evaluations. However, with advancement in the field of health economics efforts aimed at refining the Indian Reference Case would be needed. This research received no specific grant from any funding agency, commercial, or not-for-profit sectors. The research was undertaken as part of doctoral thesis of Sharma D, who received scholarship from the Indian Council of Medical Research (ICMR), New Delhi, India.

“75/25” Initiative for Hypertension: Setting Priority for Action

The epidemiological shift and the increase in noncommunicable diseases (NCDs) have been of concern in recent times. Hypertension is the primary cause of 10.8% of all fatalities in India. The rapid increase in cardiovascular diseases, spurred on by poor lifestyle choices, is a serious concern. The increasing burden of chronic diseases is shown by data from the Indian Council of Medical Research, which assigns 61.8% of fatalities in 2016 to NCDs. According to data from the World Health Organization, NCDs account for 63% of fatalities in India, whereas CVDs account for 27% of fatalities. The National Program for Prevention and Control of Noncommunicable Diseases and the India Hypertension Control Initiative are the main initiatives being used by India to tackle hypertension and NCDs. Effective management is hampered by low levels of awareness in rural regions, treatment compliance issues, health disparities, and challenges with data collection and monitoring. Government programs and active youth participation are acknowledged as vital components to lower hypertension and pave the road for a healthier future. The Indian government also supports expanding outreach to underserved communities, encouraging better lives, providing telemedicine options, and enhancing data gathering and research for battling hypertension.

Stop antibiotic resistance - A roller coaster ride through "antibiotic stewardship," "prescription auditing" and "AWaRe" assessment tool.

The emergence of superbugs and highly resistant organisms like methicillin-resistant staphylococci, vancomycin-resistant enterococci, carbapenem-resistant enterobacteriaceae demands the monitoring of antibiotic prescription and usage in various domains. The impact of antibiotic resistance is huge that it increases mortality, morbidity, and economic costs. The issue has to be addressed at various levels and that is why regulatory bodies implement antibiotic stewardship programs. These programs give a list of guidelines like infection control, tracking antibiotic use, prescription auditing, and involvement of health professionals like pharmacists, nurses, etc., A comparison of the list of guidelines given by the Centre for Disease Control and Prevention and Indian Council of Medical Research gives an idea about the measures to be taken at various levels to reduce the burden of antibiotic resistance. Prescription auditing is one of the major components of antibiotic stewardship. The auditing can be done either prospectively or retrospectively using WHO core prescribing indicators and antibiotic-specific indicators. An AWaRe assessment tool was also used to evaluate antibiotic consumption in countries and hospitals. The antibiotics are classified into access, watch and reserve categories. The aim of implementing the AWaRe tool is to increase the rational use of access antibiotic and reduce the consumption of watch and reserve antibiotics. This review focuses on the importance of prescription auditing, AWaRe tool and antibiotic stewardship in decreasing the threat of antibiotic resistance.

Assessment of thermal and temporal stability of SARS-CoV-2 samples using real-time qRT-PCR.

As per the guidelines of the Indian Council of Medical Research, nasopharyngeal and oropharyngeal swabs in viral transport medium (VTM) are to be stored at 4°C for less than 5 days and for more than 5 days at -70°C. Samples are not transported or stored as per prescribed conditions because of the limitations, resulting in an apprehensive diagnosis. The aim of the study was to test the stability of the SARS-CoV-2 sample stored in VTM at different temperatures. In this study, the stability of 21 positive and 9 negative samples for SARS-CoV-2 was evaluated in commercial VTM at different temperatures (-80°C, -20°C, 4°C, and 25 to 30°C). Stability was checked for up to 50 days in the above storage conditions at different intervals. PathoDetect™ and Hi-PCR® kits were used for the detection of the four genes of SARS-CoV-2. The Cycle Threshold (Ct) value for determining the positivity of samples for PathoDetect™ was < 40 and for Hi-PCR® was < 38. The SARS-CoV-2 confirmatory genes (RdRp and E genes) and the internal housekeeping gene remained detectable even on the 50th day of the study. The Ct of the RdRp and E genes were found to increase with storage duration, but all positive samples remained positive till the end of the study, or the Ct value remained below the cut-off level. The negative samples gave consistent results until the end of the study. When the differences in Ct values were compared between the days in a set of experiments, they were not significantly different except in a few samples. The SARS-CoV-2 genetic materials in commercial VTM were stable at room temperature to -80°C for 50 days.

Ethics in Research and Publications.

The purpose of this study is to present a comprehensive overview of the ethical issues and the processes involved in research and publishing in India. The study examines the present ethical norms, guidelines, frameworks and developments in India, providing insights into the nation's current status of research and recommendations for publication. This document will be a useful starting point and reference document for those embarking on research and publication in Orthopaedics in India. A survey of the literature was done, which included scholarly papers, reports, rules, and policies pertaining to Indian publishing norms and research ethics. the document starts with a general introduction to ethics, followed by the evolution of ethics in research and the current International as well as Indian codes of ethics. Subsequently, the discussion is divided into two broad headings of ethics in research and ethics in publishing. Under each heading, there are many specific areas in orthopaedics that would require the application of a unique set of ethics. These areas are discussed separately as subheadings. The review draws attention to the complexity of ethical issues in Indian and international research and publishing in orthopaedics. Where available, specific guidelines about the topic in India or international guidelines are discussed. The importance of informed consent, data integrity, plagiarism, authorship disputes, and conflicts of interest are only a few of the key results. It is obvious that ethical norms and regulations, such as those offered by the University Grants Commission (UGC), the Indian Council of Medical Research (ICMR), and the Council of Publication Ethics (COPE) are crucial in determining how research is conducted and how papers are published. The types of studies discussed include research in humans and animals, research with stem cells, metal implants and devices, orthobiologics, Artificial Intelligence, Robotics, computer modelling, virtual reality, 3D printing and bioprinting, tissue banking and data management. The roles of different personnel in research and publications are discussed. Ethics in research and publishing play a crucial role in establishing the authority and standard of scholarly work in India. This study underlines the key concepts of ethics that guide various types of studies and the publication process. It also highlights the requirement for frameworks and guidelines for certain unique areas of research in orthopaedics.

Effectiveness of Self-Instructional Module (SIM) on Knowledge Regarding Breast Cancer among Women

Women are blessed with a kind heart, a sea of love, and a bundle of affection. They are, undoubtedly, a symbol of love and a pillar of strength. They are always there, like a beacon in the night. A woman is not only beautiful, but, a woman is a companion to a man, family and society given by God Almighty. Yes, women are indeed God’s most beautiful creation. Every woman should know this, and should live up to it. Women should respect themselves. Today, sadly, things have changed. Many women have no sense of their health and their wellness. Cancer has become one of the ten leading causes of death in India. According to Indian Council of Medical Research there are nearly 1.5-2 million cancer cases at any given point of time. Over 7 lakh new cases of cancer and 3 lakh deaths occur annually due to cancer. Nearly 15 lakh patients require facilities for diagnosis, treatment and follow up at a given time.3 The incidence of breast cancer is rising in every country of the world especially in developing countries such as India. This is because more and more women in India are beginning to work outside their homes which allow the various risk factors of breast cancer to come into play. These include late age at first childbirth, fewer children and shorter duration of breast-feeding.4 Breast cancer has increased incidence of among women residing in metropolitan cities. Statistically, breast cancer is supposed to be more common among unmarried women; those who are married, but have not had children; and those who have had children, but did not breast feed their babies. It is also related with smoking, alcohol drinking and high fat intake to the causation of breast cancer and this probably explains its etiological relationship to a modern lifestyle and environment.5 Materials and Methods: Descriptive survey design is selected using convenient sampling and 60 working women were selected as sample. A structured questionnaire is used to assess the knowledge of the working women regarding breast cancer. The questionnaire consisted of two parts: Part –A to collect the demographic data, Part-B consisting of questions regarding the various aspects of knowledge about breast cancer. Results: Major findings of the study revealed that the majority of 50%women belonged to the age group of 41-50 yrs, 75% women are married 50% are graduate, majority (40%) of women had two children and 40 never breast fed majority of women (40%) had a family monthly income of Rs. 20001-30000, and had no history of breast cancer running in the family. The mean knowledge score was 5.7 (SD  2.47) and 22% of the study population had poor knowledge regarding breast cancer. Demographic variables like age, marital status educational status, duration of breast feeding and family history were associated with the level of knowledge. A self-instructional module was prepared for use as a teaching aid and found effective with‘t’ value 17.77 at p&lt;0.01 level. Conclusion: After the detailed analysis of the study findings showed that the earlier studies done on the knowledge of women regarding breast cancer. There is lack of knowledge even in the educated women regarding breast cancer. It is the responsibility of all the nursing educators, administrators and policy makers to find out the barriers in the gain of knowledge and should try to remove them and to develop strategies which can make emphasis on prevention and early detection of diseases

Developing Standard Treatment Workflows-way to universal healthcare in India.

Primary healthcare caters to nearly 70% of the population in India and provides treatment for approximately 80-90% of common conditions. To achieve universal health coverage (UHC), the Indian healthcare system is gearing up by initiating several schemes such as National Health Protection Scheme, Ayushman Bharat, Nutrition Supplementation Schemes, and Inderdhanush Schemes. The healthcare delivery system is facing challenges such as irrational use of medicines, over- and under-diagnosis, high out-of-pocket expenditure, lack of targeted attention to preventive and promotive health services, and poor referral mechanisms. Healthcare providers are unable to keep pace with the volume of growing new scientific evidence and rising healthcare costs as the literature is not published at the same pace. In addition, there is a lack of common standard treatment guidelines, workflows, and reference manuals from the Government of India. Indian Council of Medical Research in collaboration with the National Health Authority, Govt. of India, and the WHO India country office has developed Standard Treatment Workflows (STWs) with the objective to be utilized at various levels of healthcare starting from primary to tertiary level care. A systematic approach was adopted to formulate the STWs. An advisory committee was constituted for planning and oversight of the process. Specialty experts' group for each specialty comprised of clinicians working at government and private medical colleges and hospitals. The expert groups prioritized the topics through extensive literature searches and meeting with different stakeholders. Then, the contents of each STW were finalized in the form of single-pager infographics. These STWs were further reviewed by an editorial committee before publication. Presently, 125 STWs pertaining to 23 specialties have been developed. It needs to be ensured that STWs are implemented effectively at all levels and ensure quality healthcare at an affordable cost as part of UHC.

Computer-Aided Diagnosis and Analysis of Skin Cancer from Dermoscopic Images in India.

Researchers have made several advancements in this field, including automatic segmentation techniques, computer-aided diagnosis, mobile-based technology, deep learning methods, hybrid methods etc. All these techniques are beneficial in diagnosing melanoma or segregating skin lesions into different categories. This paper aims to define different types of skin cancers, diagnosis procedures and statistics. This paper presents skin cancer statistics over a period of time in India. The increment in the number of skin carcinoma and melanoma cases from 1990 to 2020 as well as the mortality rates, has been presented in this paper. Also, this paper provides a review of different technologies used by researchers in detecting melanoma. The rise in the number of cases by 2040 and mortality rates are compared. The statistics that are used in this paper are as per hospital-based cancer registries (HBCR) 2021 prepared by the Indian Council of Medical Research - National Centre for Disease Informatics and Research, Bengaluru (ICMR-NCDIR) and from World Health Organization (WHO).

A Review of Community-Oriented Program for Control of Rheumatic Diseases Studies from India

Abstract Background: Community-Oriented Program for Control of Rheumatic Diseases (COPCORD) is a global community-based program, emphasizing prevalence data. In India, it has been headed by the World Health Organization (WHO), the International League of Associations for Rheumatology (ILAR), and the Bone and Joint Decade (BJD), India. The Indian Council of Medical Research (ICMR) also utilized the COPCORD methodology. This study aimed to review Indian COPCORD data. Methods: PubMed, COPCORD website, conference proceedings, and citations were searched from inception to 2022. Search terms included WHO-ILAR, COPCORD, and India. Studies conducted in India and available in English were included. Abstracts from journal supplements or conference proceedings were included if they studied the Indian population. Results: Bhigwan, Pune, Bikaner, Lucknow, Calicut, and Trivandrum studies were published as full-length articles. Soft-tissue rheumatism showed a higher prevalence than most diseases everywhere. The appraisal checklist found a few lacunae in the description of the study setting and statistical analysis clarity. Bhigwan had a high prevalence of “ill-defined diagnosis” (6.25%). Osteoarthritis (OA) knee had a prevalence of 10.6% in Lucknow urban. RA prevalence was 2.54% in Bikaner. Pune exhibited the highest OA prevalence (6.25%). Age and gender were important risk factors in the Calicut study. Trivandrum found that functional impairment impacted workability and finances. Malappuram reported higher rheumatic musculoskeletal disease (RMSD) in women (70%). Conclusion: COPCORD studies were the first to highlight the burden of RMSD in India. Nonclinical aspects such as architecture and living conditions have been described. Further research regarding functional ability, work disability, and psychosocial factors is recommended. Future scope to look at economic aspects and environmental risk factors remains.

Nutritional support for adult patients with microbiologically confirmed pulmonary tuberculosis: outcomes in a programmatic cohort nested within the RATIONS trial in Jharkhand, India

Undernutrition is a common comorbidity of tuberculosis in countries with a high tuberculosis burden, such as India. RATIONS is a field-based, cluster-randomised controlled trial evaluating the effect of providing nutritional support to household contacts of adult patients with microbiologically confirmed pulmonary tuberculosis in Jharkhand, India, on tuberculosis incidence. The patient cohort in both groups of the trial was provided with nutritional support. In this study, we assessed the effects of nutritional support on tuberculosis mortality, treatment success, and other outcomes in the RATIONS patient cohort. We enrolled patients (aged 18 years or older) with microbiologically confirmed pulmonary tuberculosis across 28 tuberculosis units. Patients received nutritional support in the form of food rations (1200 kcal and 52 g of protein per day) and micronutrient pills. Nutritional support was for 6 months for drug-susceptible tuberculosis and 12 months for multidrug-resistant tuberculosis; patients with drug-susceptible tuberculosis could receive an extension of up to 6 months if their BMI was less than 18·5 kg/m2 at the end of treatment. We recorded BMI, diabetes status, and modified Eastern Cooperative Oncology Group (ECOG) performance status at baseline. Clinical outcomes (treatment success, tuberculosis mortality, loss to follow-up, and change in performance status) and weight gain were recorded at 6 months. We assessed the predictors of tuberculosis mortality with Poisson and Cox regression using adjusted incidence rate ratios (IRRs) and adjusted hazard ratios (HRs). The RATIONS trial is registered with the Clinical Trials Registry of India (CTRI/2019/08/020490). Between Aug 16, 2019, and Jan 31, 2021, 2800 patients (mean age 41·5 years [SD 14·5]; 1979 [70·7%] men and 821 [29·3%] women) were enrolled. At enrolment, 2291 (82·4%) patients were underweight (BMI <18·5 kg/m2), and 480 (17·3%) had a BMI of less than 14 kg/m2. The mean weight and BMI were 42·6 kg (SD 7·8) and 16·4 kg/m2 (2·6) in men and 36·1 kg (7·3) and 16·2 kg/m2 (2·9) in women. During the 6-month follow-up, treatment was successful in 2623 (93·7%) patients, 108 (3·9%) tuberculosis deaths occurred, 28 (1·0%) patients were lost to follow-up, and treatment failure was experienced by five (0·2%) patients. The median weight gain was 4·6 kg (IQR 2·8-6·8), but 1441 (54·8%) of 2630 patients remained underweight. At 2 months, 1444 (54·0%) of 2676 patients gained at least 5% of baseline weight. Baseline weight (adjusted IRR 0·95, 95% CI 0·90-0·99), BMI (0·88, 0·76-1·01), poor performance status (ECOG categories 3-4; 5·33, 2·90-9·79), diabetes (3·30, 1·65-6·72), and haemoglobin (0·85, 0·71-1·00) were predictors of tuberculosis mortality. A reduced hazard of death (adjusted HR 0·39, 95% CI 0·18-0·86) was associated with a 5% weight gain at 2 months. In this study, nutritional support was provided to a cohort with a high prevalence of severe undernutrition. Weight gain, particularly in the first 2 months, was associated with a substantially decreased hazard of tuberculosis mortality. Nutritional support needs to be an integral component of patient-centred care to improve treatment outcomes in such settings. India Tuberculosis Research Consortium, Indian Council of Medical Research.

P25 Healthcare associated candiduria in ICU patients: experience from a surveillance network in India, 2017–22

Abstract Background Urinary tract infections (UTI) are common healthcare associated infections (HAI) in low-and-middle-income countries including India, with limited information on Candida UTI. An ICU-based HAI surveillance network of tertiary care hospitals across India, coordinated by the All-India Institute of Medical Sciences, New Delhi and the Indian Council of Medical Research, modified the US CDC’s National Healthcare Safety Network (NHSN) case definitions to record UTI. Unlike NHSN, India surveillance includes fungal pathogens, such as Candida spp., as eligible pathogens causing HAI-UTI. We describe the epidemiology, microbiology and antimicrobial resistance (AMR) profile of candiduria cases reported to this network to address the knowledge gap on Candida UTI in India. Methods Patients with at least one UTI symptom and a positive urine culture with Candida sp. who had spent at least 2 calendar days in a participating ICU were included as candiduria events. All candiduria events reported by participating sites from 1 November 2017 to 31 May 2022 were extracted from overall UTI reported for all pathogens. The distribution of events by age, gender, ICU type, urinary catheterization, pathogen and drug resistance profile were performed. UTI rate and device utilization ratio (DUR) were calculated. Network sites performed antifungal susceptibility testing (AST) on Candida isolates using MIC-based method as per CLSI guidelines. Results Data was reported by 131 ICUs in 39 hospitals. Overall network UTI events including all pathogens were 3600; UTI rates were 2.6 (adult ICUs) and 1.3 (paediatric ICUs); DUR was 0.8 (adult ICUs) and 0.4 (paediatric ICUs). There were 1111 candiduria events, 95% were classified as catheter-associated UTI (CAUTI), and the median age of patients was 65 years (IQR 32–74 years) and 58% were male. Among 739 Candida isolates speciated, Candida tropicalis (37%), Candida albicans (36%), Candida glabrata (6%) and Candida auris (6%) were the top four species isolated. Among 220 C. tropicalis isolates tested with AST, 6.9% were fluconazole resistant and 2% of 140 were caspofungin resistant; 7% of 177 C. albicans isolates were fluconazole resistant and 6.5% of 92 isolates were caspofungin resistant; and 48% of 28 C. glabrata isolates were fluconazole resistant and 44% of 18 isolates were caspofungin resistant. Conclusions Candiduria events reported from ICUs to the HAI surveillance network-India are common and the majority are classified as CAUTI. Most of the species isolated are susceptible to fluconazole and caspofungin. Additional work is needed to understand the clinical significance of candiduria events reported to the network.

Prevalence and determinants of delays in care among premature deaths due to acute cardiac conditions and stroke in residents of a district in India.

Lack of timely care is a predictor of poor outcomes in acute cardiovascular emergencies including stroke. We assessed the presence of delay in seeking appropriate care among those who died due to cardiac/stroke emergencies in a community in northern India and identified the reasons and determinants of this delay. We conducted a social audit among all civil-registered premature (30-69 years) deaths due to acute cardiac event or stroke in the district. The three-delays model was used to qualitatively classify the delays in care-seeking-deciding to seek care, reaching the appropriate health facility (AHF) and initiating definitive treatment. Based on the estimated time from symptom onset to reaching AHF, we classified patients as early (reached within one hour) or delayed arrivers. We used mixed-effect logistic regression with postal code as a random effect to identify determinants of delayed arrival. Only 10.8% of the deceased reached an AHF within one hour. We noted level-1 delay in 38.4% (60% due to non-recognition of seriousness); level-2 delay in 20% (40% due to going to an inappropriate facility) and level-3 delay in 10.8% (57% due to lack of affordability). Patients with a monthly family income of >270US$ (aOR 0.44; 95% CI 0.21-0.93) were less and those staying farther from AHF (aOR 1.12; 95% CI 1.01-1.25 for each Km) were more likely to have delayed arrival in AHF. A small proportion of patients with cardiac and stroke emergencies reach health facility early with delays at multiple levels. Addressing the reasons for delay could prevent these deaths. : Indian Council of Medical Research, New Delhi, India.

Analysis of Predictors and Outcomes of COVID-19 Patients Requiring ICU Admission from COVID-19 Registry, India.

Patients admitted to intensive care units (ICUs) with severe coronavirus disease (COVID-19) are associated with high mortality. The present retrospective, multicenter study describes the predictors and outcomes of COVID-19 patients requiring ICU admission from COVID-19 Registry of Indian Council of Medical Research (ICMR), India. Prospectively collected data from participating institutions were entered into the electronic National Clinical Registry of COVID-19. We enrolled patients aged >18 years with COVID-19 pneumonia requiring ICU admission between March 2020 and August 2021. Exclusion criteria were negative in RT-PCR report, death within 24 hours of ICU admission, or incomplete data. Their demographic and laboratory variables, ICU severity indices, treatment strategies, and outcomes were analyzed. A total of 5,865 patients were enrolled. Overall mortality was 43.2%. Non-survivors were older (58.2 ± 15.4 vs 53.6 ± 14.7 years; p = 0.001), had multiple comorbidities (33.2% vs 29.5%, p = 0.001), had higher median D-dimer (1.56 vs 1.37, p = 0.015), higher CT severity index (16.8 ± 5.2 vs 13.5 ± 5.47, p = 0.001) and longer median hospital stay (10 vs 8 days, p = 0.001) and ICU stay (5 vs 4 days, p = 0.001), compared with survivors.On multivariate analysis, high CRP (HR 1.008, 95% CI: 1.006-1.010, p = 0.001) and high D-dimer (HR 1.089, 95% CI: 1.065-1.113, p < 0.001) were associated with invasive mechanical ventilation while older age (HR 1.19, CI: 1.001-1.038, p = 0.039) and high D-dimer (HR-1.121, CI: 1.072-1.172, p = 0.001) were independently associated with mortality and while the use of prophylactic low molecular weight heparin (LMWH) (HR 0.647, CI: 0.527-0.794, p = 0.001) lowered mortality. Among 5,865 COVID-19 patients admitted to ICU, mortality was 43.5%. High CRP and D-dimers were independently associated with the need for invasive mechanical ventilation while older age and high D-dimer were associated with higher mortality. The use of prophylactic LMWH independently reduced mortality. Kajal K, Singla K, Puri GD, Bhalla A, Mukherjee A, Kumar G, et al. Analysis of Predictors and Outcomes of COVID-19 Patients Requiring ICU Admission from COVID-19 Registry, India. Indian J Crit Care Med 2023;27(8):552-562.

The Underutilization of Forensic Microbiology: A Narrative Review

AbstractOne of the main reasons of death in India is infection. At many centers, determining the infectious cause of death during autopsy is not regularly done. Although it is still a neglected field, postmortem microbiology has the potential to be a crucial tool for identifying the reason and circumstances of unexpected death. In addition to its use in forensic autopsies and medicolegal investigations, this tool can help with the detection of novel pathogen presentations, estimation of drug resistance, identification of bioterrorism agents, and a better understanding of infectious diseases like toxic shock syndrome, Human Immunodeficiency Virus (HIV), and Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2). In India, there has not been much use of microbiology in postmortem, and there is a dearth of specific guidelines or recommendations by regulatory agencies.In an effort to highlight the value of microbiology in postmortem, this narrative review focusses on suggestions made by a group of academicians from Europe in February 2016 and how they may be used in an Indian context. Based on the Indian Council of Medical Research and the Centers for Disease Control and Prevention standards, we have briefly discussed about postmortem in coronavirus disease 2019 related deaths.

Prognostic factors for COVID-19 infected inpatients with chronic diseases: Author's response.

Journal Article Accepted manuscript Prognostic factors for COVID-19 infected inpatients with chronic diseases: Author's response Get access Aparna Mukherjee, PhD, Aparna Mukherjee, PhD Indian Council of Medical Research, New Delhi, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Gunjan Kumar, MD, Gunjan Kumar, MD Indian Council of Medical Research, New Delhi, India Search for other works by this author on: Oxford Academic PubMed Google Scholar Samiran Panda, MD Samiran Panda, MD Indian Council of Medical Research, New Delhi, India Corresponding Author: Dr. Samiran Panda, ICMR-Dr AS Paintal Distinguished Scientist Chair, Indian Council of Medical Research (ICMR), New Delhi, India-110029, Telephone: +91-9830908475 (Mobile), email: pandasamiran@gmail.com Contact Number: 0091 9830908475 Search for other works by this author on: Oxford Academic PubMed Google Scholar QJM: An International Journal of Medicine, hcad128, https://doi.org/10.1093/qjmed/hcad128 Published: 19 June 2023 Article history Received: 15 May 2023 Published: 19 June 2023

Sequential Shifting in T-helper and T-cytotoxic Subset Cell Population in Mild and Severe COVID-19 Patients Infected With Variant B.1.61.

Severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) modulates antiviral immunity via T cells, but whether these cells are active or abundant in coronavirus disease 2019 (COVID-19) patients is unknown. The present study aimed to investigate the temporal shifting in the T-cell population and their subsets, T-Helper (Th) cell (CD4) and T-Cytotoxic (Tc) cell (CD8) in COVID-19 patients. Thirty confirmed COVID-19 patients (nasal swab reverse transcription-polymerase chain reaction (RT-PCR) confirmed) were enrolled. On the basis of oxygen saturation (SpO2) levels, patients were stratified into two categories: (i) mild (n=11) having fever and SpO2 level >95%, and (ii) severe (n=19) on the ventilator, and in the intensive care unit (ICU)as per the Indian Council of Medical Research (ICMR) guidelines. Thirty age-sex-matched controls without infectious diseases unrelated to COVID-19 were also enrolled in the study. Patients with inflammatory diseases and severe comorbidities that compromise immunity were excluded from the study. Immunophenotyping flow cytometry assay was used to evaluate T-cell viability, Th, and Tc cells population in mild and severe COVID-19 patients on day 1 (at admission) and day 4 (decreasing the infection load) in the second COVID-19 wave (variant: B.1.61). Categorical variables were expressed as frequency and percentage andp-values were calculated by Chi-square test. All the variables were represented in median and Q1 (25 percentile) and Q3 (75 percentile). The Mann-Whitney test was used to compare the study groups. The Δ mean differences were calculated by using the Paired samples t-test. The statistically significant level was taken as p<0.05. Hemoglobin, total leukocyte count (TLC), lymphocytes, monocytes, and eosinophils were significantly reduced in patients (p<0.05). A significant decrease of CD4 and CD8 cells in severe COVID-19 patients vs. controls (CD4, median 49; CD8, 40.12; p>0.05) was seen. Th-EM (effector memory)-Tim-3 (T-cell immunoglobulin domain and mucin domain 3)+ was significantly higher (p=0.002) however, Tc-EMRA (effector memory cells re-expressing)-Tim-3+, Tc-Naive-Tim-3+, Tc-EM-PD1+ and Tc-CM (central memory)-Tim-3+ significantly reduced (p<0.05) in mild COVID-19 patients than controls. Similarly, in severe COVID-19 patients, Th-EMRA-Tim-3+, Th-Naive-PD1+, Th-EM-PD1+, Th-EM-Tim 3+ and Th-CM-Tim-3+ showed a significant reduction (p<0.05) and Tc-EMRA-Tim-3+, Tc-Naive-Tim-3+, Tc-EM-PD1+, and Tc-CM-Tim-3+ showed similar results. In mild vs. severe group, decreased T-cells (p=0.001), Th-EMRA-Tim-3+ (p=0.024), and Th-Navie-Tim-3+ (p=0.005), and significantly increased (p<0.05) Tc-Naive-Tim3+ (p=0.001), Tc-EM-Tim-3+ (p=0.031), and Tc-CM-Tim-3+ (p=0.08) were observed. Severe COVID-19 patients showed a significant increase in Th-Naive-Tim3+ (day 4-day 1; δ43, p=0.019), Th-EM-Tim3+ (δ 16.24, p=0.033), and Th-CM-Tim3+ (δ 13.57, p=0.041). T-cell populations and CD8 subset help to differentiate the mild and severe COVID-19 patients. Monitoring T cells, especially CD8 subset changes, has important implications for diagnosing and treating mild and severe patients being critically ill.