Knowledge, Attitudes, and Practices regarding Oral Fluid, Electrolyte, and Energy Management in Acute Nondiarrheal Illnesses among Physicians in India.

BACKGROUND: Fluid, electrolytes, and energy (FEE) management is important in the treatment of acute nondiarrheal illnesses. However, the use of FEE drinks in managing such illnesses is not well-documented. OBJECTIVE: This study aimed to understand physicians' knowledge, attitude, and practices (KAP) and perceived patient outcomes in treating FEE deficits in acute nondiarrheal illnesses using FEE drinks in India. MATERIALS AND METHODS: A cross-sectional respondent-blinded survey was designed and administered among practicing physicians across various specialties and prescribing statuses in India. KAP among groups of physicians was assessed, and the correlations between knowledge- attitudes, knowledge-practice, and knowledge-perceived outcomes were explored. RESULTS: A total of 494 physicians participated in the study from September to October 2021. Overall, knowledge scores were moderate. Prescribers had a higher average knowledge score and more proactive attitudes and practices as compared to nonprescribers. Most physicians agreed that FEE management recommendations could improve patients' recovery speed. There were significant positive correlations between knowledge scores and physicians' attitudes toward the importance of FEE management awareness, the importance of FEE management for patient recovery, and a physician's perception that FEE drinks improved patients' recovery time. There was no significant correlation between knowledge score and practices. CONCLUSION: There may be benefits from improving the knowledge of physicians in India in FEE management and developing guidelines for the use of FEE drinks in acute nondiarrheal illnesses. Further research exploring the knowledge-practice gap and evaluating the clinical benefit of FEE drinks in acute nondiarrheal illnesses should also be undertaken to develop such guidelines.

Comparing the Knowledge, Attitude, and Practices on Oral Fluids, Electrolytes, and Energy Management in Non-diarrheal Illnesses across Different Physician Specialties in India.

Background: The management of non-diarrheal illnesses requires careful attention to maintaining the proper balance of fluids, electrolytes, and energy (FEE). Nevertheless, there is a limited amount of information accessible regarding the utilization of oral FEE formulations in the treatment of these conditions. Objective: The objective of this study was to assess and contrast the levels of knowledge, attitude, and practices (KAP) among various medical specialties in India when it comes to addressing FEE imbalances in non-diarrheal illnesses through the use of oral FEE formulations, as well as to examine how these approaches influence perceived patient outcomes. We also present a subgroup analysis of KAP in healthcare personnels (HCPs) whose practices include 25% or more diabetic or geriatric patients. Materials and methods: A cross-sectional online assessment was created and conducted among physicians (n = 494) representing different medical specialties in India, which include general practitioners (GPs) (n = 128), MD physicians (n = 121), gynecologists (n = 122), and pediatricians (n = 123). Results: A total of 494 physicians across specialties, including GPs, MDs (MD internal medicine physicians), obstetrics and gynecologists (OB-GYN), and pediatricians, participated in the online assessment from September to October 2021. Knowledge scores were moderate across specialties, and there was no significant difference in knowledge level across specialties. More pediatricians and GPs than other HCPs consider FEE deficit to have a high impact on recovery. Further, pediatrician prescribers consider FEE management to be of high importance compared to other specialties. A significantly higher percentage of pediatricians assess all their patients (100%) for hydration levels, and significantly more gynecologists spend >5 minutes providing hydration advice to their patients. Among all specialties, MD and gynecologist prescribers are more likely to recommend oral FEE for patient recovery. HCPs with diabetes practices agree slightly more than HCPs with geriatric practices that oral FEE management recommendations facilitate the speed of the recovery process from non-diarrheal illnesses in their patients. However, only approximately 30% of them recommend FEE to 70% of their eligible patients, of which approximately 70% of these HCPs give formal (written/electronic) prescriptions of ready-to-drink (RTD) fluids to their patients. Conclusion: Enhancing the understanding of physicians across diverse specialties in India regarding oral FEE management and formulating recommendations for the utilization of oral FEE formulations in non-diarrheal conditions could lead to better outcomes. While knowledge and awareness of oral FEE management are similar across specialties, their practice behaviors vary. Additional research into this disparity and the assessment of the clinical advantages of oral FEE formulations in non-diarrheal illnesses among various specialties should be conducted. How to cite this article: Sathe P, Chakravarty P, Tesado C, et al. Comparing the Knowledge, Attitude, and Practices on Oral Fluids, Electrolytes, and Energy Management in Non-diarrheal Illnesses across Different Physician Specialties in India. J Assoc Physicians India 2023;71(10):19-30.

Thermal ablation of tumor cells with antibody-functionalized single-walled carbon nanotubes.

Single-walled carbon nanotubes (CNTs) emit heat when they absorb energy from near-infrared (NIR) light. Tissue is relatively transparent to NIR, which suggests that targeting CNTs to tumor cells, followed by noninvasive exposure to NIR light, will ablate tumors within the range of NIR. In this study, we demonstrate the specific binding of antibody-coupled CNTs to tumor cells in vitro, followed by their highly specific ablation with NIR light. Biotinylated polar lipids were used to prepare stable, biocompatible, noncytotoxic CNT dispersions that were then attached to one of two different neutralite avidin-derivatized mAbs directed against either human CD22 or CD25. CD22(+)CD25(-) Daudi cells bound only CNTs coupled to the anti-CD22 mAb; CD22(-)CD25(+) activated peripheral blood mononuclear cells bound only to the CNTs coupled to the anti-CD25 mAb. Most importantly, only the specifically targeted cells were killed after exposure to NIR light.

Specific thermal ablation of tumor cells using single-walled carbon nanotubes targeted by covalently-coupled monoclonal antibodies.

CD22 is broadly expressed on human B cell lymphomas. Monoclonal anti-CD22 antibodies alone, or coupled to toxins, have been used to selectively target these tumors both in SCID mice with xenografted human lymphoma cell lines and in patients with B cell lymphomas. Single-walled carbon nanotubes (CNTs) attached to antibodies or peptides represent another approach to targeting cancer cells. CNTs convert absorbed near-infrared (NIR) light to heat, which can thermally ablate cells that have bound the CNTs. We have previously demonstrated that monoclonal antibodies (MAbs) noncovalently coupled to CNTs can specifically target and kill cells in vitro. Here, we describe the preparation of conjugates in which the MAbs are covalently conjugated to the CNTs. The specificity of both the binding and NIR-mediated killing of the tumor cells by the MAb-CNTs is demonstrated by using CD22+CD25- Daudi cells, CD22-CD25+ phytohemagglutinin-activated normal human peripheral blood mononuclear cells, and CNTs covalently modified with either anti-CD22 or anti-CD25. We further demonstrate that the stability and specificity of the MAb-CNT conjugates are preserved following incubation in either sodium dodecyl sulfate or mouse serum, indicating that they should be stable for in vivo use.

Risk Factors for Symptomatic Atrial Fibrillation-Analysis of an Outpatient Database.

Atrial fibrillation (AF) is the most common sustained arrhythmia encountered in practice and is the leading cause of debilitating strokes with significant economic burden. It is currently not known whether asymptomatic undiagnosed AF should be treated if detected by various screening methods. Currently, United States guidelines have no recommendations for identifying patients with asymptomatic undiagnosed AF due to lack of evidence. The American Heart Association Center for Health Technology & Innovation undertook a plan to identify tools in 3 phases that may be useful in improving outcomes in patients with undiagnosed AF. In phase I we sought to identify AF risk factors that can be used to develop a risk score to identify high-risk patients using a large commercial insurance dataset. The principal findings of this study show that individuals at high risk for AF are those with advanced age, the presence of heart failure, coronary artery disease, hypertension, metabolic disorders, and hyperlipidemia. Our analysis also found that chronic respiratory failure was a significant risk factor for those over 65 years of age and chronic kidney disease for those less than 65 years of age.

Cow's Milk-related Symptom Score as a predictive tool for cow's milk allergy in Indian children aged 0-24 months.

BACKGROUND: Cow's milk protein causes an unfavorable and unwanted reaction in some individuals called cow's milk protein allergy (CMPA). It is more often imprecise and easily missed in primary care settings. Cow's Milk-related Symptom Score (CoMiSS) was developed as a screening and awareness tool to suggest the presence of CMPA using general, dermatological, gastrointestinal, and respiratory symptoms. OBJECTIVE: Assess the utility of CoMiSS in the diagnosis of CMPA in Indian children aged between 0 and 24 months. METHODS: A pilot multicentric, observational, longitudinal study was conducted over a period of 4 months among infants aged 0-24 months with symptoms suggestive of CMPA to measure the positive and negative predictive value of CoMiSS. A predesigned questionnaire was used to record the information via CoMiSS. The patients were confirmed of having CMPA via oral food challenge/skin prick test or ImmunoCAP test. RESULTS: A total of 83 children were enrolled in the study and majority of them had gastrointestinal complaints (61%, 51 of 83) followed by respiratory (41%, 34 of 83) and skin complaints (33%, 27 of 83). CoMiSS was >12 in 72.3% of the infants and amongst them 84.3% were confirmed via oral food challenge/ImmunoCAP test. The positive and negative predictive values for CoMiSS were 93% and 33% respectively. CONCLUSION: CoMiSS can help predict CMPA in children aged less than 2 years in the Indian primary care setting, aiding in early diagnosis. Prospective randomized studies are needed to evaluate the use of CoMiSS further.

The Immunogenicity of Peptoid-Protein Conjugates.

We demonstrate that a peptoid composed of five monomers and attached via a maleimide linker to a carrier protein elicits anti-peptoid, anti-linker and anti-carrier antibodies in rabbits. Specific anti-peptoid antibodies were affinity purified and used to reproducibly retrieve three specific peptoid-coupled beads from 20,000 irrelevant peptoid-beads using magnetic screening.