Tertiary Care Hospital In India Research Articles

Association of Epstein-Barr virus (EBV) with nasopharyngeal carcinoma: Experience from a North Indian tertiary care hospital

Nasopharyngeal carcinoma (NPC), arising from nasopharyngeal epithelium is caused by Epstein-Barr virus (EBV). It is common in South China, South East Asia and North East India. The aim and objectives of this study were to determine the prevalence of EBV in formalin-fixed paraffin-embedded (FFPE) tissue sections of clinically suspected NPC patients, correlate the results of polymerase chain reaction (PCR) with histopathology findings, and to determine the utility of tissue EBV DNA as a diagnostic bio-marker. 31 FFPE tissue samples were collected from clinically suspected NPC patients from April 2018-December 2019. Histopathological diagnosis was done by examination of Hematoxylin and Eosin stained slides. Presence of EBV was detected by EBNA-1 PCR. IHC was performed using EBV Latent Membrane Protein 1. Of the 31 clinically suspected NPC cases, 15 (48.4%) were histopathological confirmed NPC. Of these15, 13 (86.6%) were non-keratinizing undifferentiated NPC, and one each were keratinising NPC and non-keratinising differentiated NPC respectively. EBV EBNA1 PCR was positive in 35.5% (11/31) of clinically suspected NPC cases. Of the 11 PCR positive cases, 9 (81.8%) were histopathological confirmed NPC. Of the 31 clinically suspected NPC cases, IHC was indicated in 23 biopsies. Of which, 12 (52.2%) were positive for LMP1 in the abnormal cells. Of the 12 IHC positive samples, 10 were NPC cases. EBV DNA as an indicator towards NPC among clinically suspected cases had a sensitivity of 60% and specificity of 87.5%. In this study, addition of EBV DNA detection by PCR from FFPE tissue sections could confirm EBV association in 20% of cases where it was not detected by EBV LMP1 IHC, thus helped in increasing the detection of EBV positivity in NPC cases. Early diagnosis of NPC will improve the cure rate and hence reduce the morbidity and mortality rates.

Perceptions, Attitudes, and Behaviors Related to Hepatitis Among the General Population Attending a COVID-19 Vaccination Center in a Tertiary Care Hospital in India

Perceptions, Attitudes, and Behaviors Related to Hepatitis Among the General Population Attending a COVID-19 Vaccination Center in a Tertiary Care Hospital in India

Real-world study on the effect of nab-paclitaxel treatment on clinical outcomes and laboratory parameters in patients across metastatic tumor sites

Objectives: PacliALLTM is the first and only indigenously developed brand of nab-paclitaxel in India that has shown bioequivalence to the global reference (Abraxane®). However, real-world Evidence is scarce about the use of it in different tumor sites beyond approved indications. This study assessed the effects of nab-paclitaxel (PacliALLTM) on clinical outcomes in patients diagnosed with different metastatic cancers in a tertiary care hospital in India. Material and Methods: In this retrospective study, data on demographics, medical history, and laboratory investigations were collected from medical records of patients with metastatic cancer. Patients on nab-paclitaxel were included, and data on laboratory findings, including hematological, liver, and kidney function tests and prognostic outcomes, were evaluated. Results: The study population consisted of 73 patients with metastatic cancer (mean age- 54.6 years). Primary sites of cancer in most patients were the oral cavity (40.8%), followed by breast and ovary (15.3%, each). The Eastern Cooperative Oncology Group score was 0 in 84.3% and 1 in 14.3% of patients. Weekly analyses showed no significant differences in hemoglobin, neutrophil, creatinine, random blood glucose (RBG), and serum glutamic-oxaloacetic transaminase levels. A significant proportion of patients reported anemia and RBG >125 mg/dL at baseline (97.1% and 63.4%, respectively) and week 17 (85.1% and 88.1%, respectively). Most patients had a partial response at week 17 (76.8%), respectively. No serious adverse reactions were reported, requiring a change in treatment. Conclusion: Nab-paclitaxel showed manageable tolerability and favorable response rates in metastatic cancer patients. It is widely used beyond approved indications in a significant proportion of patients across various tumor sites.

Prevalence and Antimicrobial Susceptibility Pattern of MRSA amongst Patients from an Indian Tertiary Care Hospital: An Eye Opener

Staphylococcus aureus (S. aureus) is a very common human pathogenic microorganism that can cause a variety of infectious diseases, including skin and soft tissue infections, endocarditis, osteomyelitis, bacteremia, and lethal pneumonia. About one-third of the common population is colonized with S. aureus. MRSA is a formidable pathogen known to cause high mortality & morbidity, that poses a significant threat to public health worldwide. Presence of MRSA strains, resistant to multiple antibiotics especially in hospital stay, has complicated the management of infections caused by this bacterium. The aim of this study was to shed light on the prevalence and antimicrobial sensitivity pattern of MRSA among patients in a tertiary care center located in Faridabad, Haryana. This cross-sectional observational study was conducted in the Department of Microbiology, ESIC Medical College & Hospital, a 510 bedded tertiary care teaching hospital in Faridabad, Haryana, India. All wound samples including pus, exudates, wound swab and tissue samples received for aerobic culture and antimicrobial sensitivity from various clinical departments from January 2019 to July 2019 were included in this study. A total of 747 samples were received from January 2019-July 2019. Mean age of this study population was found to be 50.7 ± 14.8 years. Out of 747 samples, 226 (30.25%) were culture positive. Among the S. aureus isolates, methicillin resistance was seen amongst 39 (58.2%). Antibiotic Susceptibility results of S. aureus showed 100% resistance to Penicillin along with 100% resistance to Fluoroquinolones in both MRSA and MSSA. High prevalence of MRSA amongst patients highlights the importance of continued surveillance and implementation of antimicrobial stewardship program to control the menace of antimicrobial resistance. Strict adherence to Infection Control practices its regular follow up to assess the effectiveness of any hospital infection control measures taken is the key.

ANA Profile in Population of West Bengal

Antinuclear antibodies (ANA) are significant biomarkers that are used to detect and classify autoimmune connective tissue disorders more efficiently. This paper provides a thorough overview of all the ANA profiling procedures, their testing advancements, clinical significance, and future directions. This study aimed to analyze the ANA profiles along with the prevalence of specific antibodies in patients presumed to have been diagnosed with autoimmune disorders in an Eastern Indian tertiary care hospital. The results were correlated with demographic data to conclude. ANA profiles of 48 patients from Peerless Hospitex Hospital, Kolkata were evaluated between January 24 to June 15, 2024. Out of them, 13 patients (27%) had positive ANA profiles. The most prevalent autoantibodies detected were SS-A and SS-B, which occurred in 7 patients (53.85%), followed by PM-Scl in 4 patients (30.77%). The study demonstrates how the ANA profile varies among different age groups, with the highest prevalence of 6 patients (46.15%) seen in the 60–75 age range. The clinical symptoms of diseases like autoimmune hepatitis, polymyositis, dermatomyositis, PSS (progressive systemic sclerosis), SLE (Systemic Lupus Erythematosus), and Sjogren's syndrome align with the ANA profile findings. This study offers insights into the distribution of autoantibodies targeting antigens present in ANA profiles, using clinical samples collected from a 550-bed tertiary care hospital in Eastern India. The findings underscore the need for comprehensive diagnostic approaches to autoimmune disorders.

Development of a machine learning-based model for the prediction and progression of diabetic kidney disease: A single centred retrospective study

BackgroundDiabetic kidney disease (DKD) is a diabetic microvascular complication often characterized by an unpredictable progression. Hence, early detection and recognition of patients vulnerable to progression is crucial. ObjectiveTo develop a prediction model to identify the stages of DKD and the factors contributing to progression to each stage using machine learning. MethodologyA retrospective study was conducted in a South Indian tertiary care hospital and collected the details of patients diagnosed with DKD from January 2017 to January 2022. Bayesian optimization-based machine learning techniques such as classification and regression were employed. The model was developed with the help of an optimization framework that effectively balances classification, prediction accuracy, and explainability. ResultsOf the 311 patients diagnosed with DKD, 227 were selected for the study. A system for predicting DKD has been created for a patient dataset utilizing a variety of machine-learning approaches. The eXtreme gradient (XG) Boost method excelled, achieving 88.75% accuracy, 88.57% precision, 91.4% sensitivity,100% specificity, and 89.49% F1-score. An interpretable data-driven method highlights significant features for early DKD diagnosis. The best explainable prediction model uses the XG Boost classifier, revealing serum uric acid, urea, phosphorous, red blood cells, calcium, and absolute eosinophil count as the major predictors influencing the progression of DKD. In the case of regression models, the gradient boost regressor performed the best, with an R2 score of 0.97. ConclusionMachine learning algorithms can effectively predict the stages of DKD and thus help physicians in providing patients with personalized care at the right time.

Campylobacteriosis is an Allied Disease in the Elderly

In this study we analysed campylobacteriosis cases in a tertiary care hospital of India to find out this is an isolated disease or an allied disease with comorbidities in elderly people. In all the four elderly cases, acute gastroenteritis by Campylobacter appears to be a contributory condition of the disease besides other associated diseases. Perceptive the link between this disease and comorbidities is crucial for effective prevention, early detection, and thorough care, in elderly populations with underlying health problems.

Analysis of mcr family of colistin resistance genes in Gram-negative isolates from a tertiary care hospital in India.

Colistin serves as the drug of last resort for combating numerous multidrug-resistant (MDR) Gram-negative infections. Its efficacy is hampered by the prevalent issue of colistin resistance, which severely limits treatment options for critically ill patients. Identifying resistance genes is crucial for controlling resistance spread, with horizontal gene transfer being the primary mechanism among bacteria. This study aimed to assess the prevalence of plasmid-mediated mcr genes associated with colistin resistance in Gram-negative bacteria, utilizing both genotypic and phenotypic tests. The clinical isolates (n=913) were obtained from a tertiary care center in Chennai, India. Colistin resistance was seen among Gram-negative isolates. These strains underwent screening for mcr-1, mcr-3, mcr-4, and mcr-5 genes via conventional PCR. Additionally, mcr-positive isolates were confirmed through Sanger sequencing and phenotypic testing. The bacterial isolates predominantly comprised Klebsiella pneumoniae (62.43%), Escherichia coli (19.71%), Pseudomonas aeruginosa (10.73%), and Acinetobacter baumannii (4.81%), along with other species. All isolates exhibited multidrug resistance to three or more antibiotic classes. Colistin resistance, determined via broth microdilution (BMD) using CLSI guidelines, was observed in 13.08% of the isolates studied. Notably, mcr-5 was detected in K. pneumoniae in PCR, despite its absence in Sanger sequencing and phenotypic tests (including the combined-disk test, colistin MIC in the presence of EDTA, and Zeta potential assays). This finding underscores the importance of employing multiple diagnostic approaches to accurately identify colistin resistance mechanisms.

Assessing Quality of In-Patient Care and Patients's Expectations Using A SERVQUAL Approach in A Tertiary Care Hospital in India

Background: Patient satisfaction is a key indicator of healthcare service quality and has implications for the growth and success of healthcare organizations. However, there is often a gap between patients’ expectations and perceptions of service quality, which can vary depending on various sociodemographic factors. This study aimed to assess the expectations, perceptions and service quality gap in a tertiary care hospital using SERVQUAL model. Materials and Methods: A cross-sectional study was conducted among 120 adult inpatients using a semi-structured questionnaire based on the five dimensions of the SERVQUAL model. The quality gap was calculated as the difference between perception and expectation scores. Results: The study found a significant negative quality gap across all five dimensions, with the largest gaps observed in reliability and responsiveness. The study also revealed that gender, age, and education influenced patients’ perception of service quality, while type of specialty, residence, monthly income, and occupation did not have a significant effect. Conclusion: The study highlighted the need for improving the service quality in the tertiary care hospital, especially in terms of reliability and responsiveness. The study also suggested that healthcare managers and providers should consider the diverse expectations and needs of patients based on their sociodemographic characteristics.

Evaluation of Microbiological, Epidemiological and Clinical profile of Enterococcal infectionsat a Tertiary Care Hospital in India

Evaluation of Microbiological, Epidemiological and Clinical profile of Enterococcal infectionsat a Tertiary Care Hospital in India

A Questionnaire Based Study to Assess the Antimicrobial Stewardship Practices in the Tertiary Care Hospitals in India

A Questionnaire Based Study to Assess the Antimicrobial Stewardship Practices in the Tertiary Care Hospitals in India

Palliative Right Ventricular Outflow Tract Stenting in Tetralogy of Fallot with Severe Cyanosis: Experience from a Single Center in Southern India

Background: This study conducted at an Indian tertiary care hospital aimed to characterize the clinical profile of tetralogy of Fallot (ToF) patients undergoing right ventricular outflow tract (RVOT) stenting and assess their immediate postprocedural outcomes until discharge. Methods: In this retrospective analysis, the clinical and procedural outcomes were analyzed for 20 patients who underwent palliative stenting in the RVOT for severe cyanosis associated with ToF during 2021–2023. Results: The median age for the patients was 2.3 years (range 3 months–21 years), two being adults (>18 years). Fourteen (70%) patients underwent elective RVOT stent and 30% underwent emergency stenting. The most common indication of RVOT stenting was hypoplastic branch pulmonary arteries (PAs) (n = 11, 78.6%) and cyanotic spell (n = 4, 66.7%) for elective and emergency surgeries, respectively. The average improvement in SpO2 was 27.2% (95% confidence interval 23.4–31.0, P < 0.001). Six (30%) patients had complications including reperfusion injury of lungs (n = 2, 33.4%) sepsis (n = 1, 16.7%), stent embolization (n = 1, 16.7%), re-stenting (n = 1, 16.7%), transient complete heart block (n = 1, 16.7%) during the procedure, and. One child went through RVOT stent postoperative due to severe residual stenosis and child developed severe tricuspid regurgitation and succumbed to death due to culture positive sepsis with multi-organ dysfunction. Rest (n = 19, 95%) were discharged with an average 6.7 days of hospital stay. Conclusion: ROVT stenting is a safe and effective palliative management in ToF enhancing oxygen saturation prior to definitive surgical repair.

Leveraging Lean Six Sigma principles in an Indian tertiary care hospital: a case study

PurposeWorkflow optimisation is crucial for establishing a viable acute stroke (AS) intervention programme in a large tertiary care centre. This study aims to utilise Lean Six Sigma (LSS) principles to enhance the hospital's workflow.Design/methodology/approachThe Action Research methodology was used to implement the project and develop the case study. The study took place in a large tertiary care academic hospital in India. The Define-Measure-Analyse-Improve-Control approach optimised the workflow within 6 months. Lean tools such as value stream mapping (VSM), waste audits and Gemba were utilised to identify issues involving various stakeholders in the workflow. Sigma-level calculations were used to compare baseline, improvement and sustainment status. Additionally, statistical techniques were effectively employed to draw meaningful inferences.FindingsLSS tools and techniques can be effectively utilised in large tertiary care hospitals to optimise workflow through a structured approach. Sigma ratings of the processes showed substantial improvement, resulting in a five-fold increase in clinical outcomes. Specifically, there was a 43% improvement in outcome for patients who underwent acute stroke revascularisation. However, certain sigma ratings deteriorated during the control and extended control (sustainment) phases. This indicates that ensuring the sustainability of quality control interventions in healthcare is challenging and requires continuous auditing.Research limitations/implicationsThe article presents a single case study deployed in a hospital in India. Thus, the generalisation of outcomes has a significant limitation. Also, the study encounters the challenge of not having a parallel control group, which is a common limitation in quality improvement studies in healthcare. Many studies in healthcare quality improvement, including this one, are limited by minimal data on long-term follow-up and the sustainability of achieved results.Originality/valueThis study pioneers the integration of LSS methodologies in a large Indian tertiary care hospital, specifically targeting AS intervention. It represents the first LSS case study applied in the stroke department of any hospital in India. Whilst most case studies discuss only the positive aspects, this article fills a critical gap by unearthing the challenges of applying LSS in a complex healthcare setting, offering insights into sustainable quality improvement and operational efficiency. This case study contributes to the theoretical understanding of LSS in healthcare. It showcases its real-world impact on patient outcomes and process optimisation.

Pattern of CYP3A5 and MDR-1 single nucleotide polymorphism and its impact on Tacrolimus levels and clinical outcomes in living renal allograft recipient

Abstract Introduction Renal transplant is best form of renal replacement therapy. Most favored immunosuppression includes Tacrolimus, mycophenolate mofetil and steroids. Tacrolimus has narrow therapeutic index and requires therapeutic drug monitoring (TDM). However, there is wide variation in tacrolimus level with weight based fixed dosage regimens. This variability is due to polymorphism of major pathways of metabolism ie CYP3A5 and MDR1 genes. Fast metabolizer require higher dosage and slow metabolizer require lower dosage. Genotype based dosing strategy may be useful to achieve early therapeutic level and reduce infections and rejections. Methodology 160 transplant patients at tertiary care hospital in India were included in this study from 2016 to 2018. Genetic polymorphism analysis in CYP3A5 and MDR1 gene was carried out at time of transplant. All patients were given a fixed weight-based dosage of Tacrolimus. Data was analyzed in relation to genotype polymorphism. Results and discussion 69.2% of Wild variants of CYP 3A5 (Fast metabolizers) have low initial tacrolimus levels. 51.5% of Homo variants (Slow metabolizers) have high initial tac levels. However, all variants achieve optimum tacrolimus levels at same time (mean 12.4 days). There were higher number of infections among slow metabolizers. Conclusion A fixed dosing regimen with TDM result in high and low initial tacrolimus levels in slow and fast metabolizers respectively and more infections in slow metabolizers. However, graft rejections being fewer in number, were not different. A larger sample with genotype based dosing is required to test such a strategy.

Insights into Urinary Tract Infection Bacteriology and Antimicrobial Sensitivity: A Study from a Central Indian Tertiary Care Hospital

Insights into Urinary Tract Infection Bacteriology and Antimicrobial Sensitivity: A Study from a Central Indian Tertiary Care Hospital

Comprehensive Analysis of Dementia Types and Risk Factors: A Study From a Tertiary Care Center in India.

Background and objective Dementia is a prevalent clinical syndrome characterized by memory impairment and cognitive dysfunction. Its global burden is expected to rise significantly, particularly in low- and middle-income countries. Understanding the spectrum of dementia types and associated risk factors is crucial for effective management. This study aims to elucidate the demographic profiles, clinical types, and risk factors of newly diagnosed dementia cases at a tertiary care hospital in India. Methods and materials A cross-sectional, hospital-based observational study was conducted on 81 patients at the Department of Medicine, Dr. D. Y. Patil Medical College, Hospital, and Research Centre, Pimpri, Pune, from February 2022 to January 2024. Ethical approval was obtained, and written consent was obtained from participants. Clinical diagnosis was based on the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V) criteria, supported by cognitive assessment tools and laboratory/radiological investigations. Inclusion criteria encompassed individuals aged 18 years or older, presenting with clinical symptoms suggestive of dementia, having a Mini-Mental State Examination (MMSE) score of less than 24 and Montreal Cognitive Assessment (MoCA) score of less than 25, according to DSM-V criteria for dementia. Exclusion criteria included individuals with a history of head trauma or those below 18 years of age. Results Of the 81 participants, the majority (74.1%) were over 60 years old, with females comprising 59.3% of the sample. Alzheimer's disease was the most prevalent dementia subtype (34.5%), followed by vascular dementia (19.7%) and mixed dementia (13.5%). Other causes included Lewy body dementia (2.46%), Parkinson's dementia (4.9%), frontotemporal dementia (4.9%), and Creutzfeldt-Jakob disease (1.2%). Reversible causes accounted for a significant proportion of cases: alcohol-associated dementia (6.1%), hypothyroid-associated dementia (3.7%), HIV-associated dementia (2.46%), herpes simplex dementia (1.2%), neurosyphilis-associated dementia (1.2%), and normal pressure hydrocephalus (NPH)-associated dementia (2.4%). Analysis of risk factors revealed distinct patterns among different dementia types, emphasizing the role of cardiovascular and metabolic health. Conclusion This study provides insights into the demographic profiles, clinical types, and dementia risk factors in India. Addressing causes and managing cardiovascular/metabolic health is crucial for dementia prevention and management. Comprehensive care strategies and ongoing research efforts are essential for improving dementia outcomes and enhancing the quality of life for affected individuals and their families.

Co-Twin Prognosis After Single Intrauterine Fetal Death at a Tertiary Care Hospital in India: A Retrospective Observational Study.

Twin pregnancy is associated with an increased risk of perinatal morbidity. Besides, if intrauterine death of a single twin occurs, it increases the morbidity of the surviving co-twin perinatally and postnatally. The objective of this study was to determine the incidence of single intrauterine fetal death (SIUFD) in a twin pregnancy and fetal outcome defined in dimensions according to the complications in the surviving co-twin. Data on twin pregnancies were collected retrospectively for a period of five years (from 2015 to 2019) from the labour room records of the Central Records Department (CRD) at the Postgraduate Institute of Medical Education and Research, Chandigarh, India. Cases with SIUFD were studied individually and neonatal follow-up was taken post delivery for up to three to eight years. Inclusion criteria were SIUFD in twin pregnancies after 14 weeks gestation, chorionicity pre-defined by early trimester ultrasonography. Exclusion criteria were higher-order pregnancy and monoamniotic twins. A total of1246 (4.273%) twin deliveries were conducted in the study period. Of these, 107 (8.587%) pregnancies had SIUFD with co-twin surviving in utero. Among these, 77 (72%) were dichorionic diamniotic (DCDA) twin pregnancies and 30 (28%) were monochorionic diamniotic (MCDA) twin pregnancies. The incidence of SIUFDwas 8.5%. Preterm birth was the most common complication observed in our study and was found in 53.5% and 58.3% of participants in DCDA and MCDA twins, respectively. Early neonatal death (within 24 hours of life) of the surviving twin was found in 29.2% monochorionic twins with SIUFD. SIUFD at < 28 weeks gestation led to a greater number of early neonatal deaths of surviving twins. The incidence of neurodevelopmental disorders (cerebral palsy, developmental delay, epilepsy) in our population after birth was 7.5% (n=93). Twin pregnancies with SIUFD have an increased incidence of preterm labour, increased neonatal death of the surviving twin, and neurodevelopmental disorders (cerebral palsy, developmental delay, epilepsy). Monochorionicity and SIUFD at <28 weeks gestation are associated with increased neonatal deaths in co-twin. The Incidence of neurodevelopmental disorders is not directly associated with chorionicity, but developmental delay is more profoundly seen in the monochorionic group.

A Study of Prevalence of Renal Function Abnormalities and Their Association with the Individual Components of Metabolic Syndrome.

Metabolic syndrome (MetS) is one of the most important emerging pandemics of the 21st century and is associated with renal dysfunction in a significant number of subjects, the association of which is shown to be of greater significance in the South Asian population. The prevalence of renal dysfunction in patients with MetS is the primary outcome. The secondary outcome is to assess the strength and significance of the association between the individual components of MetS and the presence of renal dysfunction. This is a hospital-based cross-sectional observational study conducted for 2 years in a tertiary care hospital in India. A total of 100 diagnosed subjects of MetS were taken as cases and underwent relevant blood tests. Data were collected and analyzed in a Statistical Package for the Social Sciences (SPSS) v29 sheet. Over a period of 18 months, 100 subjects with MetS were documented, among which 66% had albuminuria, with microalbuminuria being 24% and the rest being macroalbuminuria. Among the same subjects, 30% had an estimated glomerular filtration rate (eGFR) <60 mL/minute/1.73m2. Waist circumference (WC) [measured by the National Institutes of Health (NIH) protocol] had the strongest association with increased albuminuria (r = 0.540; p-value < 0.001) as well as reduced eGFR (r = 0.460; p-value < 0.001). All the components of MetS, for example, increased WC, hypertension, increased fasting glucose, raised triglyceride (TG), and low high-density lipoprotein (HDL), have statistically significant correlations with increased urine albumin-to-creatinine ratio (ACR) and decreased eGFR, signifying glomerular injury and renal dysfunction, respectively.

Financial toxicity in the background of free health care: A cross-sectional survey in a tertiary care hospital in India.

e13685 Background: The financial toxicity of cancer treatment is a known fact in low to middle-income countries due to poverty, lack of health insurance and illiteracy. We tried to estimate the financial strain and its contributing factors in an Indian population with access to free cancer treatment. Methods: All government employees and their dependents are eligible to receive free treatment including inpatient management, investigations and medicines at our institute. All cancer patients ≥18 years were invited to participate in a survey. The survey included their demographic, cancer and therapy details, the COST-FACIT questionnaire, and information about increase in expenses since cancer diagnosis and source of additional finances. Results: 300 cancer patients completed the survey. 61.3% of the respondents were females and the mean patient age was 43.14 years. Breast cancer was the most common malignancy and stage IV was the most common stage. 44% were residents of a rural area. The average duration of treatment was 8.03 months. Prior to cancer diagnosis, 37.2% of the patients had average monthly expenses between INR 10-25,000 (USD 120 to 300). The approximate increase in monthly expenditures after cancer diagnosis was between INR 5-10,000 (USD 60 to 120) for 33.4% and between INR 10-25,000 (USD 120 to 300) for 31.4% of the population. The primary income source for 65.7% respondents was the salary of the government employee while 48% had two or more earning members in the family. Cancer treatment negatively affected the earning capacity of the patient alone in 40% of the population, while in 28% it affected the earning capacity of the patient and caregiver. 51% had to utilise their savings, 39% sold fixed assets, and 31% borrowed or took a loan to cope with the additional financial strain. Commonest expenses were travel, accommodation, and food (75.7%). 34.5% spent money on other therapy-related costs (second opinion or alternative therapy). The mean COST-FACIT score was 21.38,(20-24) demonstrating mild financial toxicity. Predictors of high financial toxicity were a single-earning member, familial discord and long duration of treatment (&gt; 6 months). Conclusions: Though all participants had access to free cancer treatment, all experienced mild financial toxicity due to non-therapeutic expenses. Despite desperate financial measures to complete treatment, most participants did not express severe financial toxicity. This may be attributed to the stigma of expected high expenditure associated with cancer treatment in India. COST-FACIT scoring may not have suitably assessed the financial strain experienced by patients with free healthcare. Additional financial information collected by the survey, (monthly expenses, earning members, source of additional funds), helped us to better understand financial impact of cancer treatment and identify gaps in our healthcare.

In vitro assessment of newer colistin-sparing antimicrobial agents for clinical isolates of carbapenem-resistant organisms

ObjectivesCarbapenem-resistant organisms (CROs) are a significant public health threat globally, particularly in countries like India with high antibiotic resistance rates. The current study investigates the prevalence of CROs, detects resistance mechanisms using phenotypic methods and assesses the efficacy of newer antibiotics against CROs. MethodsA prospective study conducted at a tertiary care hospital in India during 2021–23. Clinical specimens were processed and bacterial identification was performed using MALDI-TOF mass spectrometry followed by antimicrobial susceptibility testing using CLSI guidelines against a plethora of newer antibiotics for CROs. Carbapenemase production was detected using phenotypic methods, and the presence of the mcr-1 gene was assessed by real-time PCR. ResultsDuring the study period, predominantly (70 %) Gram-negative bacteria were isolated; amongst which 5692 strains were carbapenem-resistant, wherein resistance to different carbapenems ranged from 34.1% to 79 %. Majority of the carbapenemase producers were metallo-β-lactamases (MBL) producers (75 %). Colistin resistance was noted in 5.4 % of selected carbapenem-resistant isolates. Among newer antibiotics, cefiderocol demonstrated the lowest resistance rates (0–14 %), while resistance to newer β-lactam/β-lactamase inhibitor combinations was very high in carbapenem-resistant isolates. Fosfomycin, minocycline and tigecycline, each showing variable efficacy depending on the site of infection. Moreover, newer β-lactam/β-lactamase inhibitor combinations offer restricted benefits due to widespread prevalence of MBL in the region. ConclusionThe escalating prevalence of CROs in India underscores the urgency for alternative treatment options beyond colistin. Hence, highlighting the critical importance of developing effective strategies to combat carbapenem resistance.