Assessment of Awareness Level Regarding Organ Donation among Healthcare Professionals and Students in India.

Introduction: Organ donation can be a life-saving opportunity for patients with severe organ failure. In India, the rate of organ donation of the deceased Indian population is exceptionally low. This necessitates enhancing awareness regarding organ donation among health care professionals and students, which can motivate the general population. Aim: To assess and analyze the awareness level of healthcare professionals and students on organ donation in order to suggest potential strategies regarding improvement of awareness and willingness towards organ donation. Materials and methods: A cross-sectional online and offline survey was conducted at the national level between July 2022 and September 2022. Indian healthcare professionals as well as students of various fraternities were included. The Snowball sampling technique was used for data collection. Statistical analysis was undertaken using the statistical package for the social sciences (SPSS) software, version 25. Results: A total of 1,303 respondents were enrolled in this study. The majority of the participants were students (66.5%) residing in southern India (89.6%) pursuing medical profession (88.9%). The predominant age group was 18-24 years (73.9%). The awareness level regarding organ donation among healthcare professionals and students was 69%. Healthcare professionals and respondents aged 40 years and above had better awareness levels regarding organ donation which was reported as statistically significant (p < 0.001). Conclusion: Healthcare professionals and students awareness about organ donation need to be improved. Strategies including but not limited to prioritizing employment and education to the first relatives of the deceased organ donor should be implemented by the government to legally improve organ donation willingness. How to cite this article: Chandrasekaran S, Chandrasekaran VP, Nandi D, Setty RS, Srinivasan O, Kaur KN. Assessment of Awareness Level Regarding Organ Donation among Healthcare Professionals and Students in India. Indian J Crit Care Med 2023;27(1):57-63.

Theophylline toxicity: Successful management of a patient with distributive shock secondary to drug overdose.

Presenting a case of acute theophylline and salbutamol overdose with distributive shock. Twenty one years old lady presented with history of consumption of 3 gram of theophylline and 40 mg of salbutamol. On admission she had altered sensorium with the systolic blood pressure of 60 mmHg, unrecordable diastolic blood pressure and heart rate of 147/min. Investigations revealed severe metabolic acidosis, hypokalemia, hypocalcemia which was managed by intravenous fluids, vasopressors, infusion of injection calcium gluconate and injection potassium chloride. As her hemodynamic status did not improve, she has been initiated on 1.5 mL/kg of lipid emulsion as bolus and then 0.5 mL/kg/h as infusion. Her hemodynamic status improved gradually and she was discharged in 24 h. Lipid emulsion had been used in local anesthetics and many tablet overdoses. In this patient timely administration of lipid emulsion resulted in early recovery of shock.

Intrapatient variability in plasma rifampicin & isoniazid in tuberculosis patients.

Background & objectives: Large variability in anti-tuberculosis (TB) drug concentrations between patients is known to exist. However, limited information is available on intrapatient drug levels during the course of anti-TB treatment (ATT). This study was conducted to evaluate intrapatient variability in plasma rifampicin (RMP) and isoniazid (INH) concentrations during ATT at start of the treatment, at the end of intensive phase (IP) of ATT and at the end of ATT in adult TB patients being treated in the Revised National TB Control Programme (RNTCP). Methods: Adult TB patients (n=485), receiving thrice-weekly ATT in the RNTCP, were studied. Two-hour post-dosing concentrations of RMP and INH were determined at month 1, end of IP and end of ATT, after directly observed drug administration. Drug concentrations were estimated by high-performance liquid chromatography. Results: The median (inter-quartile range) RMP concentrations during the first month, at end of IP and end of ATT were 2.1 (0.4-5.0), 2.4 (0.6-5.5) and 2.2 (0.5-5.3) µg/ml, respectively. The corresponding INH concentrations were 7.1 (4.2-9.9), 7.2 (3.9-10.9) and 6.7 (3.9-9.5) µg/ml. None of the differences in drug concentrations obtained at different time points during ATT were significant. RMP and INH concentrations at different time points were significantly correlated. Age and body mass index caused significant variability in drug concentrations. Interpretation & conclusions: Plasma RMP and INH estimations in adult TB patients at two hours after drug administration remained unaltered during ATT. Clinicians can consider testing drug concentrations at any time point during ATT. These findings may assume significance in the context of therapeutic drug monitoring of anti-TB drug concentrations.

Anti-tuberculosis drug concentrations in tuberculosis patients with and without diabetes mellitus.

PURPOSE: The aim of the study was to compare plasma concentrations of rifampicin (RMP), isoniazid (INH) and pyrazinamide (PZA) between tuberculosis (TB) patients with and without diabetes mellitus (DM). METHODS: Two-hour post-dosing concentrations of RMP, INH and PZA were determined in adult TB patients that were studied with (n = 452) and without DM (n = 1460), treated with a thrice-weekly regimen in India. Drug concentrations were estimated by HPLC. RESULTS: The median (IQR) INH [6.6 (3.9-10.0) and 7.8 (4.6-11.3)] and PZA [31.0 (22.3-38.0) and 34.1 (24.6-42.7)] microgram per milliliter concentrations were significantly lower in diabetic than non-diabetic TB patients (p < 0.001 for both drugs). Blood glucose was negatively correlated with plasma INH (r = -0.09, p < 0.001) and PZA (r = -0.092, p < 0.001). Multiple linear regression analysis showed RMP, INH and PZA concentrations were influenced by age and drug doses, INH and PZA by DM, RMP by alcohol use and PZA by gender and category of ATT. DM reduced INH and PZA concentrations by 0.8 and 3.0 µg/ml, respectively. CONCLUSIONS: TB patients with DM had lower INH and PZA concentrations. Negative correlation between blood glucose and drug concentrations suggests delayed absorption/faster elimination of INH and PZA in the presence of elevated glucose.

Intense-Field Double Detachment of Electrostatically Bound F(-)(NF3)n Cluster Anions.

The interaction of intense laser pulses with size-selected F(-)(NF3)n clusters is experimentally studied. Intense-field double- and multiple-detachment processes in the isolated atomic F(-) anion and in electrostatically bound F(-)(NF3) dimer and F(-)(NF3)2 trimer systems are directly compared. Both dimer and trimer systems are found to exhibit similar enhancement of the highly nonlinear processes, with respect to the atomic system, as reflected in significantly lower saturation intensities. The dependencies of different product channels as a function of laser peak intensity, polarization ellipticity, and laser pulse shape are presented, indicating an efficient nonrescattering mechanism.

Genetic diversity of Mycobacterium tuberculosis isolates from central India.

BACKGROUND & OBJECTIVES: There is a paucity of data available on genetic biodiversity of Mycobacterium tuberculosis isolates from central India. The present study was carried out on isolates of M. tuberculosis cultured from diagnostic clinical samples of patients from Bhopal, central India, using spoligotyping as a method of molecular typing. METHODS: DNA was extracted from 340 isolates of M. tuberculosis from culture, confirmed as M. tuberculosis by molecular and biochemical methods and subjected to spoligotyping. The results were compared with the international SITVIT2 database. RESULTS: Sixty five different spoligo international type (SIT) patterns were observed. A total of 239 (70.3%) isolates could be clustered into 25 SITs. The Central Asian (CAS) and East African Indian (EAI) families were found to be the two major circulating families in this region. SIT26/CAS1_DEL was identified as the most predominant type, followed by SIT11/EAI3_IND and SIT288/CAS[2]. Forty (11.8%) unique (non-clustered) and 61 (17.9%) orphan isolates were identified in the study. There was no significant association of clustering with clinical and demographic characteristics of patients. INTERPRETATION & CONCLUSIONS: Well established SITs were found to be predominant in our study. SIT26/CAS1_DEL was the most predominant type. However, the occurrence of a substantial number of orphan isolates may indicate the presence of active spatial and temporal evolutionary dynamics within the isolates of M. tuberculosis.

Prevalence of chest symptoms amongst brick kiln migrant workers and care seeking behaviour: a study from South India.

BACKGROUND: Early detection and treatment of tuberculosis (TB) have been key principles of TB control. However, this can be a challenge with 'hard to reach' populations such as migrants. Brick kiln workers are one such group of migrants who are exposed to smoke, heat and dust from brick kilns which are one of the major causes of respiratory illnesses. METHODOLOGY: A cross-sectional community based study was carried out in Thiruvallur, Tamil Nadu, South India, from August 2011 to June 2012. A total of 4002 individuals from 55 brick kiln chambers were interviewed to determine the prevalence of chest symptoms and care seeking behaviour patterns. RESULTS: Three hundred and seventy-seven (9.4%) chest symptomatics were identified. The most significant variables associated with chest symptoms were illiteracy, alcohol abuse and heavy smoking. Of the chest symptomatics identified, 50.4% took action to get relief from their symptoms. The duration of over 6-month stay in the chamber was significantly associated with taking action (OR, 5.5, 95% CI: 2.3, 13.3). CONCLUSIONS: The TB control programme needs to further explore how to extend its services to such 'hard to reach' groups. Active case finding to ensure early diagnosis and treatment initiation amongst such groups needs consideration.

Removal of chromium using Rhizobium leguminosarum.

The chromium (Cr(III) and Cr(VI)) removal capability of Rhizobium leguminosarum was checked by estimating the amount of chromium in the medium before and after inoculation. To determine the efficiency of R. leguminosarum in removal of chromium, the influence of physical and chemical parameters such as temperature, pH and different concentrations (0.1-1.0 mM) of trivalent (Cr(III)) and hexavalent (Cr(VI)) chromium were studied. The chromium removal in aqueous solution by different size of active and inactivated biomass and immobilized cells of R. leguminosarum in a packed-bed column was also carried out. Results showed that in a medium containing up to 0.5 mM concentration of both Cr(III) and Cr(VI), R. leguminosarum showed optimal growth. The maximum chromium removal was at pH 7.0 and 35°C. Active biomass removed 84.4 ± 3.6% of Cr(III) and 77.3 ± 4.3% of Cr(VI) in 24 h of incubation time. However, inactivated biomass removed maximum chromium after 36 h of incubation. Immobilized bacterial cells in a packed-bed column removed 86.4 ± 1.7% of Cr(III) and 83.8 ± 2.2% of Cr(VI) in 16 and 20 h of incubation time, respectively.

Hierarchical assembly of Sm2Co7/Co magnetic nanoparticles into highly stable and uniform nanospheres.

Hierarchical assembly of colloidal Sm2Co7/Co clusters in the form of nanospheres has been processed through a polyol process. The SmCo nanospheres are found to be robust, uniform ( 100 nm) and tend to self-assemble in the form of ordered superstructures. Each nanosphere consists of large number of discrete fine particles ( 6.0 nm), having two-phase structure of both Sm2Co7 and Co-phases. Upon annealing, these phases transform into Sm2Co17 phase with very high magnetization (169 emu/g). A possible mechanism on the formation of nanospheres from the individual Sm2Co2o7 and Co nanoparticles is also discussed.

Status of Acute Myocardial Infarction in Southern India During COVID-19 Lockdown: A Multicentric Study.

There has been a reduction in the reported cases of acute myocardial infarction (MI) across the globe during the outbreak of coronavirus disease 2019 (COVID-19) (severe acute respiratory distress syndrome coronavirus 2). An attempt was made to find out the number of acute MI cases treated during the COVID-19 lockdown period (April 2020) and highlight the possible reasons for the changes in the occurrence. A multicentric retrospective observational study was performed to collect the selected data from 12 private hospitals distributed in 4 cities-Madurai, Trichy (Thiruchirapalli), Erode, and Salem-of the Tamil Nadu state in southern India. There was a significant (P<.001) reduction in ST-segment elevation MI (STEMI), non-STEMI (NSTEMI), and total (STEMI and NSTEMI together) cases during the lockdown period (April 1 to 30, 2020) as compared with no-lockdown periods such as January and February 2020 and April 2019 and April 2018 in all cities, whereas the reduction was not significant for NSTEMI in Trichy when data for the lockdown period was compared with those for January and February 2020. Overall, there is a reduction in acute MI cases, which may be due to alterations in modifiable risk factors during the COVID-19 lockdown period. Hence, implementation of public education and polices on controlling modifiable risk factors is likely to pay dividends.

Residue from vacuum ultraviolet irradiation of benzene ices: Insights into the physical structure of astrophysical dust.

We have irradiated benzene ices deposited at 4 K on a cold, interstellar dust analog with vacuum ultraviolet (9 eV) irradiation for periods lasting from several hours to nearly a day, after which the irradiated ice was warmed to room temperature. Vacuum ultraviolet photoabsorption spectra of the aromatic residue left at room temperature were recorded and showed the synthesis of benzene derivatives. The residue was also imaged using an electron microscope and revealed crystals of various sizes and shapes. The result of our experiments suggests such geometrically shaped dust particles may be a key component of interstellar dust.

Cross-referral between HIV counselling and testing centres and smear microscopy centres in Tamil Nadu.

BACKGROUND: The combined tuberculosis and human immunodeficiency virus (TB-HIV) epidemic demands effective and urgent action. OBJECTIVE: To assess the effectiveness of the system of referral of TB suspects from the integrated HIV counselling and testing centres (ICTCs) to the designated microscopy centres (DMCs) in Tamil Nadu, and to identify reasons for dropping out. DESIGN: ICTC counsellors identified TB suspects among clients (excluding pregnant women and children) in six districts of Tamil Nadu in 2007 and referred them to DMCs, irrespective of their HIV status. From the records at ICTCs and DMCs, we collected information on the number of referrals to the DMCs, TB suspects attending DMCs and smear-positive TB cases with or without HIV. Clients who did not attend the DMCs were interviewed to elicit reasons for dropping out. RESULTS: Of 18329 clients counselled, 1065 (6%) were identified as TB suspects and referred to DMCs. Of these, 888 (83%) attended and 177 (17%) dropped out; 81% of the drop-outs were interviewed. Reasons for dropping out were multiple: 51% were due to the health system, 62% due to the disease and 62% due to personal reasons. Twelve per cent of DMC attendees were smear-positive. CONCLUSION: The ICTC-to-DMC referral system makes a significant contribution to the detection of TB cases. Reasons for dropping out were multiple, but are correctable. This study also probes into current policies on programme coordination and recommends strategies for strengthening the collaboration between the TB and HIV programmes.

Depressive symptoms and human immunodeficiency virus risk behavior among men who have sex with men in Chennai, India.

Men who have sex with men (MSM) in India are a hidden population, facing unique environmental stressors and cultural pressures that place them at risk for depression. Depression may affect HIV risk behavior in MSM, and may affect the degree to which MSM may benefit from HIV prevention interventions. Depression in MSM in India, however, has largely been understudied. Two hundred ten MSM in Chennai completed an interviewer-administered behavioral assessment battery, which included the 20-item Center for Epidemiologic Studies Depression Scale (CES-D), demographics, sexual risk and identity, and other psychosocial variables. Over half (55%) of the sample exceeded the cutoff (CES-D >or= 16) to screen in for clinically significant depressive symptoms; this was associated with having had unprotected anal sex (OR = 1.97; 95% CI: 1.01-3.87) and higher number of male partners (OR = 1.04; 95% CI: 1.01-1.07). Statistically significant bivariate predictors of meeting the screen in for depressive symptoms included sexual identity (Kothi > Panthi; OR = 4.90; 95% CI: 2.30-10.54), not being married (OR = 3.40; 95% CI: 1.72-6.81), not having a child (OR = 4.40; 95% CI: 2.07-9.39), family not knowing about one's MSM identity (OR = 2.30; 95% CI: 1.18-4.90), having been paid for sex (OR = 5.10; p 95% CI: 2.87-9.47), and perceiving that one is at risk for acquiring HIV (OR = 1.10; 95% CI: 1.02-1.17; continuous). In a multivariable logistic-regression model, unique predictors of screening in for depressive symptoms included not being married (AOR = 3.10; 95% CI: 1.23-7.65), having been paid for sex (AOR = 3.80; 95% CI: 1.87-7.99) and the perception of increased risk for HIV (AOR = 1.10; 95% CI: 1.03-1.21; continuous); unprotected anal sex in the 3 months prior to study enrollment approached statistical significance (AOR = 2.00; 95% CI: 0.91-4.48). Depression among MSM in Chennai is of concern and should be considered while developing HIV prevention interventions with this population. MSM who are not married, sex workers, and those who perceive they are at risk for acquiring HIV may be of higher risk for symptoms of depression.

[Quadruple coronary endarterectomy while off-pump coronary artery bypass surgery - a case report]. / Endarterektomia czterech naczyn wiencowych wykonana w czasie zabiegu rewaskularyzacji wiencowej bez zastosowania krazenia pozaustrojowego - opis przypadku.

Coronary endarterectomy is a controversial procedure. It has got many supporters and enemies among cardiac surgeons. It is very rare, particularly while performing off pump coronary artery bypass grafting. We present a case of a 50-year-old man who underwent coronary artery stenting and than has been admitted to surgery because of the restenosis in coronary arteries. During the surgery four arteries have been grafted. At the same time we performed four endarteriectomies in these vessels. No major problem was observed. We describe our technique and briefly present current literature regarding this problem.

DOTS reaches socially marginalized population in the community: a study from a rural area of South India.

We report here that the Directly Observed Treatment, Short course (DOTS) is reaching all tuberculosis patients in the community irrespective of social classification based on the analysis from the tuberculosis prevalence survey and programme performance during 1999-2003 from a rural area in Tamilnadu, South India. New smear- positive cases treated under a DOTS programme were classified in two groups namely; scheduled caste living in colony and other population. The prevalence of smear- positive cases among the scheduled caste population was 1.9 times higher than the other population and this was reflected in the notification also. The successful treatment outcome was also similar in these two groups (75% and 78% respectively; overall 77%). From these findings it is concluded that people living in colony have equal access to DOTS as those in the village.

Protein Domain Level Cancer Drug Targets in the Network of MAPK Pathways.

Proteins in the MAPK pathways considered as potential drug targets for cancer treatment. Pathways along with the cross-talks increase their scope to view them as a network of MAPK pathways. Side effect causing targeted domains act as a proxy for drug targets due to its structural similarity and frequent reuse of their variants. We proposed to identify non-repeatable protein domains as the drug targets to disrupt the signal transduction than targeting the whole protein. Network based approach is used to understand the contribution of 52 domains in non-hub, non-essential, and intra-pathway cancerous nodes and to identify potential drug target domains. 34 distinct domains in the cancerous proteins are playing vital roles in making cancer as a complex disease and pose challenges to identify potential drug targets. Distribution of domain families follows the power law in the network. Single promiscuous domains are contributing to the formation of hubs like Pkinease, Pkinease Tyr, and Ras. Hub nodes are positively correlated with the domain coverage and targeting them would disrupt functional properties of the proteins. EIF 4EBP, alpha Kinase, Sel1, ROKNT, and KH 1 are the domains identified as potential domain targets for the disruption of the signaling mechanism involved in cancer.

Fungal infection in a post-renal transplant patient with Diaporthe.

Post-renal transplant fungal infections continue to be a major cause of mortality and morbidity. Universally reported fungi are Candida, especially Candida albicans, Cryptococcus, Aspergillus, Trichophyton rubrum and Pityriasis versicolor. Here, we report a case of infection caused by a rare fungus Diaporthe. It is an endophyte reported as plant pathogens and infrequently in humans and mammals. The patient was a renal transplant recipient on immunosuppressant. He had hypothyroidism and diagnosed with permanent pacemaker due to a complete heart block. The patient was treated with itraconazole (200 mg) successfully.

Proposed structural models of human factor Va and prothrombinase.

BACKGROUND: The prothrombinase complex consists of factor Xa, FVa, calcium ions, and phospholipid membrane. The prothrombinase complex plays a key role in the blood coagulation process. OBJECTIVE: To derive solvent-equilibrated models of human FVa and the prothrombinase complex. METHODS: Several modeling techniques have been employed, including homology modeling, protein-protein docking, and molecular dynamics simulation methods, to build the structural models. RESULTS AND CONCLUSIONS: We found, upon simulation, a possibly significant shift towards planarity of the five FVa domains. To estimate a prothrombinase structure, we docked an FXa model to the equilibrated FVa model using experimental data as docking filters. We found that simulation of the docked complex led to some changes in the protein-protein contacts, but not buried surface area, as compared to the initial docking model. Possible locations of prothrombin binding to prothrombinase are indicated.