Knowledge, Attitudes, and Practices Regarding Organ Donation Among Medical Students in India: A Mixed Methods Study.

BACKGROUND: Deceased organ donation rates are extremely low in India. As future physicians, medical students can advocate organ donation in society. However, their knowledge, attitudes, and practices regarding organ donation remain understudied in India. Therefore, the present study aimed to assess the knowledge, attitudes, and practices related to deceased organ donation among undergraduate medical students in India using a mixed methods approach. MATERIALS AND METHODS: This is a mixed-method study with a cross-sectional survey conducted among 400 randomly selected medical students at a medical college in India using a pretested questionnaire. Additionally, 20 in-depth interviews were conducted to gain qualitative insights. RESULTS: Knowledge was high regarding organ donation (90%) but lower for brain death (27.5%). Most had positive attitudes, but only 11% were registered donors, and 10% had discussed organ donation with family. Multivariate regression revealed that having third- and fourth-year-old students, urban upbringing, good knowledge, and positive attitudes were associated with increased willingness to donate. Qualitative findings revealed gaps in brain death understanding, religious myths, lack of conviction, and family disapproval as barriers. CONCLUSION: Despite good awareness, gaps in the comprehension of brain death persist among students. However, the registration and family discussion rates are very low. Targeted strategies such as integrating ethical issues into medical curricula, public awareness campaigns busting myths, simplifying donor registration, and promoting family conversations are strongly recommended. This can empower students to become physician advocates driving organ donation uptake in India.

Sarcopenia, Eosinophil-to-Platelet Ratio, and C-reactive Protein as Predictors of Adverse Events in Patients With Acute Exacerbations of Chronic Obstructive Pulmonary Disease: A Prospective Observational Study.

BACKGROUND: Biomarkers such as sarcopenia, eosinopenia, and C-reactive protein (CRP) may predict adverse events in chronic obstructive pulmonary disease (COPD) exacerbations. We aimed to determine their prognostic utility and accuracy versus conventional measures. METHODS: This was a prospective analysis of COPD patients hospitalized for acute exacerbations for more than one year. Patients with primary diagnoses other than COPD were excluded. A total of 200 participants were screened, and 50 experienced adverse events, including mortality, rehospitalization, prolonged stay, hypoxemia, or hypercapnia. Data on demographics, lung function, symptoms, nutrition, frailty, sarcopenia, the eosinophil-to-platelet ratio (EPR), and CRP were extracted. Differences between groups were analyzed using t-tests and regression modeling. RESULTS: Elevated CRP and a low EPR were significant predictors of adverse events after adjustment, with CRP having an area under the curve (AUC) of 0.71 (0.64-0.80) and EPR having an AUC of 0.76 (0.61-0.79) for composite outcomes. According to the multivariate logistic regression analysis, sarcopenia (adjusted Or (aOR)-1.97 (1.87-4.44)), EPR (aOR-2.33 (1.02-5.32)), and CRP (aOR-2.09 (1.01-3.18)) remained significant. CONCLUSION: The EPR and CRP levels are useful prognostic markers of in-hospital morbidity and mortality during COPD exacerbations. However, multidimensional assessments incorporating other treatable traits may further optimize risk prediction and reduce adverse outcomes.

Outcomes and Morbidities in Low-Birth-Weight Neonates: A Retrospective Study From Western India.

BACKGROUND: Low birth weight (LBW) increases infant morbidity and mortality and is a major public health concern, especially in resource-constrained settings. The purpose of this retrospective study was to assess the outcomes and morbidities related to LBW neonates referred to a neonatal intensive care unit (NICU) in Western India. METHODS: The present study examined the medical records of newborns weighing less than 2 kg at birth who were admitted to the NICU between September 15, 2016, and September 15, 2017. Data on long-term outcomes, clinical manifestations, morbidities, mortality, and demographic variables were gathered and analyzed. Descriptive statistics were used to present continuous variables as mean and standard deviation (SD), while categorical variables were presented as frequencies and percentages. Bivariate and multivariate logistic regression analyses were carried out to find the association between gestational age and major morbidities among LBW babies. RESULTS: Of 4710 births, 327 (6.9%) were LBW. The leading morbidities of LBW babies were respiratory distress syndrome (RDS) 153 (46.8%), neonatal jaundice 92 (28%), and septicemia 81 (25%), contributing to 58 (17.7%) deaths. Lower gestational age was associated with significantly higher adjusted odds of RDS (<28 weeks: reference; 28-32 weeks: adjusted odds ratio (AOR) 0.07, 95% confidence interval (CI) 0.01-0.33; ≥37 weeks: AOR 0.001, 95% CI 0.00005-0.02) and RDS-related mortality (28-32 weeks: AOR 0.26, 95% CI 0.06-1.13; ≥37 weeks: AOR 0.07, 95% CI 0.01-0.43). Among 250 successfully discharged cases, at 12 months, 18 (13.7%) had a weight below the 3rd percentile, and 9 (6.8%) failed the neurodevelopmental screening. CONCLUSION: LBW infants in this setting experience significant morbidities, mortality, and long-term growth and developmental effects. To alleviate the burden associated with LBW, improved neonatal care facilities, infection control protocols, and focused interventions are essential.

Exploring the association between depression and diabetes among type 1 and type 2 diabetic mellitus patients: A cross-sectional study in Gujarat, India.

Background: Depression and anxiety are common among patients with diabetes mellitus and it affects the control of diabetes negatively. Depression is the third leading reason for the most disability-adjusted life years. Once depression coexists with diabetes mellitus, it is related to major health consequences and ends up in poor health outcomes. Aim: The study aimed to estimate the prevalence of depression in diabetes mellitus people and to find an association of depressive symptoms with sociodemographic and clinical predictors among patients with diabetes mellitus attending follow-ups at the general public hospital, in western Gujarat. Materials and Methods: It is an institutional-based cross-sectional study conducted among people living with diabetes mellitus at Tertiary Hospitals, Urban Health Training Center, and Rural Health Training Center. The study period was from January 2023 to May 2023. Data were collected using a structured questionnaire. Depression was assessed by the Patient Health Questionnaire 9. The collected data were cleaned, edited, entered into MS Excel (2006), and analyzed using SPSS software (version 26). A P value of <0.05 was considered statistically significant. Results: A total of 380 study participants were included in this study. Among 380 participants, 282 (74%) were having depressive symptoms. Of 282, 61 (21.6%) have mild depressive symptoms, 106 (37.5%) have moderate symptoms, 111 (39%) have moderately severe symptoms, and four (1.4%) have severe symptoms. Of 380 participants, 221 (58%) have clinical depression (moderate, moderately severe, and severe symptoms). Variables significantly associated with depression were marital status, number of family members, socio-economic status, type of diabetes mellitus, treatment given, presence of comorbidities, and duration of diabetes more than 5 years. Conclusion: The present study has shown a considerably higher amount of depression in diabetic participants. So, healthcare professionals should consider screening for depression using the Patient Health Questionnaire 9 or other validated tools in all diabetic patients, especially in those who are at a higher risk.

Mental Health Impacts of Multidrug-Resistant Tuberculosis in Patients and Household Contacts: A Mixed Methods Study.

BACKGROUND: Multidrug-resistant tuberculosis (MDR-TB) patients experience disproportionately worse mental health, with implications for adherence, outcomes, and families. Comprehensive assessments of comorbid depression/anxiety and related factors remain limited. OBJECTIVE: This study aimed to assess the prevalence, predictors, and qualitative experiences of depression and anxiety in MDR-TB patients and household contacts. METHODS: A sequential explanatory mixed methods study was conducted in Gujarat, India, with 403 smear-positive MDR-TB patients and 403 contacts. The quantitative phase administered structured questionnaires on sociodemographic factors, clinical history, depression/anxiety symptoms, and psychosocial stressors (like stigma and social support). Logistic regression models were used. The qualitative phase included in-depth interviews with 30 purposively sampled patients for thematic content analysis. Results were integrated to contextualize quantitative findings. RESULTS: High rates of depression (37.5%, n = 151) and anxiety (45.2%, n = 182) were documented among the MDR-TB patients, significantly greater than household contacts (20.1%, n = 81 and 25.1%, n = 101, respectively). For depression, older age (adjusted odds ratio (AOR) 2.03, 95% CI 1.01-4.05), female gender (AOR 2.5, 95% CI 1.1-6.0), divorced/widowed status (AOR 3.8, 95% CI 1.1-8.0), financial constraints, substance abuse (AOR 1.7, 95% CI 1.1-2.7), greater disease severity (AOR 1.8, 95% CI 1.5-2.2), medication side effects (AOR 2.4, 95% CI 1.2-4.6), and perceived stigma (AOR 3.2, 95% CI 1.1-5.3) emerged as significant risk factors. For anxiety, significant predictors were less social support (AOR 0.81, 95% CI 0.71-0.86), higher perceived stigma (AOR 2.2, 95% CI 1.1-6.3), greater disease severity (AOR 2.6, 95% CI 1.3-4.0), and more medication side effects (AOR 3.3, 95% CI 1.1-5.5). Prominent themes included psychological impacts like depression and anxiety, experiences of stigma and caretaking challenges, and recommendations for comprehensive patient support services. CONCLUSION: MDR-TB patients experience a substantially higher dual disease burden of depression and anxiety, elevating the risk for adverse outcomes and transmission. Improving psychosocial support is vital to patient-centric care pathways for vulnerable groups. Mixed methods provide comprehensive evidence to inform integrated physical and mental health services.

Knowledge, Attitudes, and Preventive Practices Regarding Tuberculosis Among Healthcare Workers and Patients in India: A Mixed-Method Study.

BACKGROUND: Tuberculosis (TB) remains a major public health challenge in India. Healthcare workers (HCWs) and TB patients are critical to disease transmission and prevention. This study evaluated and compared knowledge, attitudes, and practices related to TB infection control. MATERIALS AND METHODS: This was a mixed-method study that included a cross-sectional survey conducted among 167 HCWs and 346 patients with TB at tertiary hospitals in western Gujarat using a validated questionnaire. Additionally, 20 HCWs and 20 patients were interviewed to gain qualitative insights. Between-group analyses were performed, and multivariate regressions identified predictors of knowledge and compliance, while thematic analysis explored qualitative insights. RESULTS: A total of 142/167 (85.0%) HCWs had good knowledge, whereas 208/346 (60.1%) patients had good knowledge. A total of 151/167 (90.4%) HCWs had positive attitudes, whereas 242/346 (69.9%) patients had positive attitudes. A total of 159/167 (95.2%) HCWs practiced good preventive behaviors, whereas 225/346 (65.0%) patients did. HCWs demonstrated significantly higher mean knowledge scores (9.2 vs. 7.1, p<0.001) and higher median attitude scores (ranging from 5 with IQR 4-5 to 5 with IQR 5-5) compared to patients (ranging from 4 with IQR 3-5 to 5 with IQR 4-5) across all attitude statements assessed using the Likert scale (p<0.001). Being an HCW was associated with good knowledge (adjusted odds ratio (AOR) 2.5, 95% CI 1.5-4.1), positive attitudes (AOR 2.2, 95% CI 1.4-3.6), and good practices (AOR 3.1, 95% CI 1.8-5.2). The qualitative themes highlighted the need for accessible education, clear communication, adequate resourcing, and personal responsibility. CONCLUSION: This study identified gaps in TB prevention knowledge and practices among patients compared to those among HCWs in India. Tailored educational initiatives, optimized health communication, improved infrastructure, and accessible messaging can help individuals assimilate appropriate infection control behaviors among healthcare system actors and communities toward ending TB.

The Invisible Toll: Unveiling the Prevalence and Predictors of Depression and Anxiety Among Pulmonary Tuberculosis (TB) Patients and Their Households in Gujarat, India.

BACKGROUND:  Tuberculosis (TB) imposes a substantial physical and psychological burden on patients and their families. This study aimed to investigate the prevalence and predictors of depression and anxiety among pulmonary TB patients and their household contacts in Jamnagar, Gujarat, India. MATERIALS AND METHODS:  A cross-sectional study was conducted at TB units (TUs) in Jamnagar, Gujarat. Trained research assistants interviewed 272 pulmonary TB patients and 544 household contacts using structured questionnaires. Depression and anxiety were assessed using the Patient Health Questionnaire-9 (PHQ-9) and Hamilton Anxiety Rating Scale (HAM-A), respectively. Sociodemographic, clinical, and psychosocial factors (stigma and social support) were evaluated. Logistic regression analyses were performed to identify predictors of depression and anxiety. A p-value of < 0.05 was considered statistically significant for all analyses in this study. RESULTS:  Out of 272 TB patients and 544 household contacts, the prevalence of depression was 98 (36.0%) and 135 (24.8%) (p=0.001). Anxiety was present in 85 (31.3%) of TB patients and 112 (20.6%) of household contacts (p<0.001). For TB patients, low household income (AOR=2.1, 95% CI: 1.9-4.3), low social support (AOR=0.84, 95% CI: 0.6-0.9), and high perceived stigma (AOR=2.3, 95% CI: 1.3-4.5) were independently associated with depression. Among household contacts, similar factors were identified, including low household income (AOR=1.7, 95% CI: 1.6-2.9), low social support (AOR=0.88, 95% CI: 0.6-0.9), and high perceived stigma (AOR=1.80, 95% CI: 1.1-2.3). CONCLUSION:  Depression and anxiety are highly prevalent among pulmonary TB patients and their household contacts in Gujarat, India. Low socioeconomic status, lack of social support, and TB-related stigma emerged as significant predictors of these mental health conditions, underscoring the need for integrated, multidisciplinary interventions to address the psychological impact of TB on patients and their families.

Investigating the Prevalence and Predictors of Uncontrolled Hypertension: A Cross-Sectional Study in Gujarat, India.

BACKGROUND: Uncontrolled hypertension is a major public health concern that contributes significantly to cardiovascular morbidity and mortality. Treatment of hypertension prevents and reduces cardiovascular morbidity, notably a 40% reduction in risk of stroke and a 15% reduction in risk of myocardial infarction. Understanding the prevalence and predictors of uncontrolled hypertension is crucial for developing targeted interventions. OBJECTIVE: This study aimed to determine the prevalence of uncontrolled hypertension and identify potential predictors among patients attending the Non-Communicable Disease (NCD) clinic of a tertiary care center in Gujarat, India. METHODS: A cross-sectional study involving 732 adult patients with hypertension was conducted. Sociodemographic data, lifestyle factors, anthropometric measurements, and comorbidities were assessed. Blood pressure was measured using standardized protocols, and uncontrolled hypertension was defined as a systolic blood pressure ≥140 mmHg or diastolic blood pressure ≥90 mmHg. Univariate and multivariate logistic regression analyses were performed to identify predictors of uncontrolled hypertension. RESULTS: The prevalence of uncontrolled hypertension was 60.2% (95% CI: 56.7%-63.7%). In the multivariate analysis, increasing age (adjusted OR: 1.21, 95% CI: 1.05-1.39), increased body mass index (adjusted OR: 1.49, 95% CI: 1.27-1.75), diabetes (adjusted OR: 1.68, 95% CI: 1.20-2.35), chronic kidney disease (adjusted OR: 2.11, 95% CI: 1.22-3.65), and current smoking status (adjusted OR: 1.83, 95% CI: 1.14-2.93) were identified as independent predictors of uncontrolled hypertension. CONCLUSION: This study revealed a high prevalence of uncontrolled hypertension in this tertiary care setting. Age, obesity, diabetes, chronic kidney disease, and smoking were identified as significant predictors. Targeted interventions addressing these modifiable risk factors and comorbidities are crucial for improving blood pressure control and reducing the burden of hypertension-related complications.

Ophthalmic Manifestations of COVID-19: A Retrospective Study on Prevalence, Characteristics, and Clinical Implications.

BACKGROUND: The coronavirus disease 2019 (COVID-19) pandemic, caused by the SARS-CoV-2 virus, has had far-reaching implications beyond the respiratory system. Mounting evidence suggests that COVID-19 can impact various organ systems, including the eyes. This study aimed to elucidate the prevalence, characteristics, and clinical implications of ophthalmic manifestations in patients diagnosed with COVID-19. METHODS: This retrospective study analyzed data from electronic medical records of adult patients hospitalized with COVID-19 between March 1, 2020, and December 31, 2020, at a large tertiary academic medical center. Ophthalmic manifestations, including conjunctivitis, dry eye symptoms, ocular pain, epiphora, ocular redness, and visual disturbances, were identified and examined for their prevalence, onset, duration, and associations with COVID-19 severity and systemic symptoms. RESULTS: Among 342 patients included in the study, 106 (31.0%) experienced at least one ophthalmic manifestation during their COVID-19 illness. Conjunctivitis was the most common manifestation in 62 patients (18.1%), followed by dry eye symptoms in 38 patients (11.1%), ocular pain/discomfort in 27 patients (7.9%), epiphora in 19 patients (5.6%), ocular redness in 14 patients (4.1%), and visual disturbances in nine patients (2.6%). Ophthalmic manifestations were significantly associated with severe COVID-19 illness (42.9% vs. 26.7%, p = 0.003) and the presence of systemic symptoms such as fever, cough, and dyspnea. The median time of onset was six days, and the median duration was 10 days. CONCLUSIONS: Ophthalmic manifestations are prevalent in COVID-19 patients, particularly in those with severe illness and systemic symptoms. The study highlights the importance of recognizing and managing ocular symptoms in affected individuals and underscores the multifaceted nature of COVID-19, necessitating interdisciplinary collaboration for comprehensive patient care.

Self-Care Practices and Health-Seeking Behaviors Among Older Adults in Urban Indian Slums: A Mixed Methods Study.

Background Effective self-care is crucial for maintaining health among older adults in resource-constrained communities. This study examined self-care practices, health-seeking behaviors, and associated factors among older adults in urban slums in India. Materials and methods A mixed methods study was conducted among 432 adults aged ≥65 years. Participants were selected through multistage random sampling from five slum areas. Self-care practices, health-seeking behaviors, demographic information, chronic conditions, self-efficacy, and health literacy were assessed through interviews. The qualitative data was explored through in-depth interviews with 30 participants. Results Inadequate health literacy (194, 45%) and low self-efficacy (162, 37.5%) were common. While 324 (75%) had an adequate diet and 378 (87.5%) took medications properly, only 86 (20%) monitored diabetes complications. Only 194 (45%) of the patients underwent recommended cancer screening, and 324 (75%) of the patients saw doctors ≥twice a year. Age, sex, education, income, comorbidities, self-efficacy, and health literacy had significant associations. Alongside facilitators such as social support, barriers such as limited healthcare access and suboptimal prevention orientation emerged. Conclusion Suboptimal prevention orientation and overreliance on secondary care instead of self-care among elderly people are problematic given the limited use of geriatric services. Grassroots health workers can improve health literacy and self-efficacy through home visits to enable self-care. Healthcare access inequities for vulnerable groups merit policy attention.