Identifying gaps in maternal knowledge and care-seeking for neonatal health: A mixed methods study in rural pregnant women.

BACKGROUND: Knowledge of neonatal danger signs is crucial for timely care-seeking and improved newborn survival. This study assessed this knowledge among pregnant women in rural western Gujarat. MATERIALS AND METHODS: A mixed methods study was conducted among 390 pregnant women selected through a two-stage sampling procedure. Quantitative data were collected using a structured questionnaire. Qualitative data were gathered via in-depth interviews with 20 purposively sampled women. Logistic regression identified determinants of knowledge. Thematic analysis was done for qualitative data. RESULTS: The majority of women were young (220, 56.5% ≤25 years), literate (333, 85%), and from rural backgrounds (320, 82%). Overall, 232 (59.5%) knew about cord care, and 301 (77.2%) correctly identified breastfeeding initiation time. Recognition of key danger signs such as fever (311, 79.7%), vomiting (292, 74.8%), and jaundice (275, 70.5%) was high, but only 70 (18%) identified chest in-drawing. Multiparity (adjusted odds ratio (AOR): 1.4, 95% confidence interval (95% CI): 1.2-3.9), lower age (AOR: 3.8, 95% CI: 2.4-5.8), education (AOR: 3.1, 95% CI: 1.5-6.4), inadequate counseling (AOR: 2.2, 95% CI: 1.82-5.190), and normative delivery (AOR: 2.4, 95% CI: 1.16-5.006) were associated with poor knowledge. Qualitative findings revealed reliance on informal sources, family elders, and financial constraints as key barriers along with limited comprehension of some danger signs. CONCLUSION: Focused interventions via health workers, family members, and community platforms are needed to increase neonatal danger signs awareness among vulnerable women in the region to enable timely care-seeking.

Unraveling the Tapestry of Depression: A Cross-Sectional Study.

BACKGROUND: An often-occurring and severely disabling mental illness that mostly affects older people living in urban slums is depression. Developing successful therapies requires an understanding of the complex interactions between the different factors that contribute to depression in this susceptible population. OBJECTIVES: This study aimed to find the prevalence of depression and identify the factors associated with depression in the geriatric population aged ≥60 years in the study area during the study period in Gujarat, India. METHODS: This study was carried out among 450 participants aged ≥60 years. Face-to-face interviews and standardized assessment tools, including the Geriatric Depression Scale (GDS) for depression and the Mini-Cog test for cognitive impairment, were used to collect data on depression levels, sociodemographic characteristics, behavioral factors, medical conditions, life events, and psychiatric history. Statistical analyses, including chi-squared tests, were performed to assess the associations. RESULTS: Significant associations were found between various factors and depression levels, which were lower education (11.11% severe depression among non-literate vs. 2.11% among literate, p<0.001) and widowhood (11.56% severe depression among widowed vs. 4.53% among married, p<0.001), which were linked to higher depression severity. Behavioral risk factors like short sleep duration (<6 hours at night: 21.71% severe depression, p<0.001), tobacco snuffing (16.24% severe depression, p<0.001), and lack of physical activity (28.71% severe depression, p<0.001) were strongly associated with increased depression. Medical conditions such as hypertension (10.36% severe depression, p<0.001) and stressful life events like family conflicts (16.67% severe depression, p<0.001) exhibited strong associations. A personal history of depression (38.82% severe depression, p<0.001) was a potent predictor. CONCLUSIONS: The study highlights the multifaceted nature of depression in the geriatric population of the study area, underscoring the necessity of all-encompassing measures to tackle the recognized possible risk factors. The results provide valuable insights for developing targeted prevention strategies, healthcare policies, and support systems to enhance the mental well-being of this vulnerable population.

Bridging the Artificial Intelligence (AI) Divide: Do Postgraduate Medical Students Outshine Undergraduate Medical Students in AI Readiness?

INTRODUCTION: As artificial intelligence (AI) transforms healthcare, medical education must adapt to equip future physicians with the necessary competencies. However, little is known about the differences in AI knowledge, attitudes, and practices between undergraduate and postgraduate medical students. This study aims to assess and compare AI knowledge, attitudes, and practices among undergraduate and postgraduate medical students, and to explore the associated factors and qualitative themes. METHODS: A mixed-methods study was conducted, involving 605 medical students (404 undergraduates, 201 postgraduates) from a tertiary care center. Participants completed a survey assessing AI knowledge, attitudes, and practices. Semi-structured interviews and focus group discussions were conducted to explore qualitative themes. Quantitative data were analyzed using descriptive statistics, t-tests, chi-square tests, and regression analyses. Qualitative data underwent thematic analysis. RESULTS: Postgraduate students demonstrated significantly higher AI knowledge scores than undergraduates (38.9±4.9 vs. 29.6±6.8, p<0.001). Both groups held positive attitudes, but postgraduates showed greater confidence in AI's potential (p<0.001). Postgraduates reported more extensive AI-related practices (p<0.001). Key qualitative themes included excitement about AI's potential, concerns about job security, and the need for AI education. AI knowledge, attitudes, and practices were positively correlated (p<0.01). CONCLUSIONS: This study reveals a significant AI knowledge gap between undergraduate and postgraduate medical students, highlighting the need for targeted AI education. The findings can inform curriculum development and policies to prepare medical students for the AI-driven future of healthcare. Further research should explore the long-term impact of AI education on clinical practice.

Beyond the screen: Examining the associations between cyberbullying, social media addiction, and mental health outcomes among medical students: A cross-sectional study.

Background: Cyberbullying and excessive social media use are emerging issues among medical students, with potential implications for mental health. This study aimed to investigate the prevalence of cyberbullying, social media addiction, and their associated mental health conditions, as well as to explore the associated factors among medical students. Methods: A cross-sectional study was conducted among 418 medical students in Gujarat using a self-administered questionnaire. Cyberbullying was assessed using the Revised Cyberbullying Inventory (RCI-R), social media addiction was measured using the Bergen Social Media Addiction Scale (BSMAS), and mental health issues were evaluated using the Depression Anxiety Stress Scale (DASS-21). Descriptive statistics and binary logistic regression analyses were performed. A P value of <0.05 was considered significant. Results: The prevalence of cyberbullying, social media addiction, depression, anxiety, and stress among participants was 27.5% (95% CI: 23.4%-31.9%), 32.1% (95% CI: 27.8%-36.7%), 37.6% (95% CI: 33.1%-42.2%), 41.9% (95% CI: 37.3%-46.6%), and 46.2% (95% CI: 41.6%-50.9%), respectively. Factors associated with increased risk of being a cyber victim included older age, female gender, later years of study, increased daily mobile and social media usage, social media as the preferred mobile usage, and social media addiction. Factors associated with being a cyberbully were similar, except for the male gender. Both cyber victimization and social media addiction were significantly associated with higher odds of depression [aOR-2.5 (1.6-3.9) and 2.1 (1.4-3.2)], anxiety [aOR-2.2 (1.4-3.4) and 1.9 (1.3-2.8)] and stress [aOR-2.8 (1.8-4.3) and 2.4 (1.6-3.6)]. Conclusions: Cyberbullying, social media addiction, and mental health issues are prevalent among medical students. Targeted interventions addressing excessive social media use, promoting responsible online behaviour, and supporting mental well-being are crucial for this population. Further research is needed to establish causal relationships and develop effective prevention and support strategies.

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.

Association of serum ferritin trends with liver enzyme patterns in ß-thalassemia major: A longitudinal correlational study.

Background: ß-Thalassemia major patients require lifelong blood transfusions, leading to iron overload and liver injury. This study examines the longitudinal association between serum ferritin and liver function over 5 years in pediatric patients. Methods: This retrospective study included 582 transfusion-dependent thalassemia patients aged 1-18 years. Serum ferritin, aspartate aminotransferase (AST), alanine aminotransferase (ALT), and albumin were measured annually. Correlation and linear regression analyses assessed associations between ferritin trajectories and liver enzymes. Results: Mean ferritin rose from 1820 ± 960 ng/mL at baseline to 4500 ± 1900 ng/mL at year 5, indicating worsening iron overload. AST and ALT levels also steadily climbed over follow-up, whereas albumin declined slightly. Ferritin correlated positively with AST (r = 0.675, P < 0.01) and ALT (r = 0.607, P < 0.01), but not with albumin (r = -0.143, P = 0.153) annually. The regression interaction term showed within-patient ferritin increases over time were independently associated with escalating AST and ALT (P < 0.05), after adjusting for confounders. Conclusion: Rising ferritin levels predict progressive liver injury in regularly transfused pediatric thalassemia patients. Tighter control of iron overload may help preserve hepatic function.

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.

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.

Exploring Patterns of Medication Usage in Affective Disorder Patients: A Comprehensive Investigation at a Psychiatry Outpatient Clinic of a Tertiary Care Hospital.

INTRODUCTION: Affective disorders impose a significant burden on public health due to their high prevalence and associated suffering. This study addresses gaps in current literature and clinical practice by providing insights into medication usage trends, which can inform treatment strategies and optimize patient care. The study aims to investigate drug utilization patterns, particularly focusing on defined daily dose/1000/day, among individuals attending a psychiatric outpatient department of a tertiary care hospital. METHODS: This cross-sectional, prospective drug utilization study included 600 affective disorder patients aged 18 years and above. The study period spanned 12 months, from March 2021 to February 2022. Data on demographics, diagnosis, treatment, and counseling were collected and analyzed using descriptive statistics. RESULTS:  Among the 600 patients analyzed, bipolar mood disorder was the most prevalent (239 patients, 39.83%), followed by depressive disorder (208 patients, 34.67%). Triple therapy was the most common prescription regimen, accounting for 308 encounters (51.33%). The average number of drugs per encounter was 3.75 ± 1.01. A combination of psychotherapy and medication counseling sessions was provided to 594 patients or their relatives, representing 99% of the total encounters. CONCLUSION: The study highlights the prevalent use of triple therapy in managing affective disorders, especially bipolar mood disorder and mania disorder. Effective utilization of essential drug lists and comprehensive patient counseling underscores the importance of holistic care in psychiatric outpatient settings. RECOMMENDATION:  Given the high prevalence of triple therapy, further research into the efficacy and safety of this treatment approach is warranted. Additionally, continued emphasis on patient education and counseling can enhance treatment adherence and overall outcomes in individuals with affective disorders.

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.

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.

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.

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.

Association Between Sarcopenia and Chronic Renal Failure (Overt and Concealed) in Chronic Obstructive Pulmonary Disease (COPD) Patients: A Cross-Sectional Study.

Background Sarcopenia, a syndrome characterized by a progressive decline in skeletal muscle mass, strength, and function, is frequently associated with chronic diseases such as chronic obstructive pulmonary disease (COPD). Chronic kidney disease (CKD) is a prevalent condition among patients with sarcopenia. Reports suggest that between 15% and 55% of stable COPD patients have sarcopenia. Therefore, the present study aims to determine the association between sarcopenia and chronic renal failure (overt and concealed) in COPD patients. Methodology This institutional-based cross-sectional study was conducted on patients diagnosed with COPD. Hospitalized adult COPD patients who gave consent were included. Sociodemographic information such as age, gender, residence, and prolonged length of stay in the hospital (categorized by a median of 10 days, considering its data distribution in our sample) was obtained using electronic medical records. Skeletal muscle %, visceral fat %, and body fat % were calculated using a bio-electrical impedance analysis device (Omron Body Composition Monitor, Model HBF-702T). Additionally, the strength of the hand grip was measured using a hand dynamometer. Sarcopenia was assessed following the criteria set by the Asian Working Group on Sarcopenia (AWGS). Chronic renal failure (CRF) was assessed by calculating the glomerular filtration rate (GFR) using the Modification of Diet in Renal Disease (MDRD) Study Group equation. Quantitative data were compared using an independent sample t-test. The association was determined using chi-square and multivariate logistic regression analyses. A p-value of <0.05 was considered significant. Results The study found that the proportion of sarcopenia in COPD patients was 52%, with overt and concealed CRF prevalence rates of 31.5% and 27%, respectively. Sarcopenic individuals had significantly lower FEV1 and FEV1/FVC compared to non-sarcopenic patients. The incidence of sarcopenia significantly increased with rising BODE index (body mass index (BMI, B), airflow obstruction (O) as measured by the post-bronchodilator FEV1 (percentage of predicted value), dyspnea (D) assessed by the modified Medical Research Council (MMRC) score, and exercise tolerance (E) measured by 6-minute walking distance) and mMRC (modified Medical Research Council dyspnea scale) dyspnea scale scores. Both concealed CRF and overt CRF patients had four times higher odds of having sarcopenia (AOR=4). Conclusion The study reveals a high prevalence of sarcopenia and provides evidence for the association between sarcopenia and chronic renal failure in COPD patients. These findings underscore the importance of early detection and management of sarcopenia and CRF in COPD patients to optimize their clinical outcomes.

Exploring the Prognostic Significance of the C-reactive Protein/Albumin Ratio in Assessing the Severity of Acute Pancreatitis: A Prospective Observational Study in the Indian Population.

Background The present study aimed to evaluate the predictive utility of the C-reactive protein (CRP)/albumin (CRP/Alb) ratio in predicting outcomes of acute pancreatitis in Indian patients. Methods This prospective observational study included 150 patients admitted within 24 hours of symptom onset. Serum CRP and albumin levels were measured to calculate the CRP/Alb ratio. Atlanta criteria classified severity as mild, moderate, or severe. The primary outcome was persistent organ failure. Results The mean age was 45±15 years, and 63% were males. The median C-reactive protein was 120 mg/L, Alb 3.2 g/dL, and CRP/Alb ratio 0.28. Severe acute pancreatitis patients (n = 50) had higher CRP/Alb ratios than mild cases (0.45 vs. 0.20, p<0.001). At a cut-off of 0.25, the CRP/Alb ratio demonstrated 85% sensitivity, 80% specificity, and an AUROC of 0.82 for predicting organ failure. This was significantly higher than the CRP (area under the receiver operating characteristic (AUROC) curve 0.72, p = 0.03) and Ranson score (AUROC 0.76, p = 0.04). On multivariate regression, CRP/Alb ratio >0.25 independently predicted severe acute pancreatitis after adjusting for age, gender, and CT severity index (adjusted OR 5.2, 95% CI 2.8-9.6). Conclusion The CRP/Alb ratio calculated within 24 hours reliably predicts persistent organ dysfunction in Indian acute pancreatitis patients. Incorporating this inexpensive biomarker into clinical prediction tools could significantly improve early risk stratification and streamline healthcare delivery in resource-limited settings.