Zachariah Bobby

Aim: To ascertain the effectiveness of a first‐trimester combined screening model for risk stratification of preeclampsia (PE) in a south Indian population. Methods: One hundred and sixty pregnant women were screened at 11–14 gestation weeks with routine antenatal ultrasound, mean uterine artery pulsatility index (UtA PI), mean arterial blood pressure (MAP), and serum placental growth factor (PlGF) assessments. Sensitivity, specificity, area under the receiver operator characteristic (AUC) curves, and diagnostic accuracy were ascertained for 1 in 50, 1 in 100, and 1 in 150 cutoff criteria. Results: PE and gestational hypertension developed in 18 (11.6%, 95% CI: 7.47–19.67) and 10 (6.5%, 95% CI: 3.54–11.74) screened women, respectively. The first‐trimester combined screening model identified 26 (16.77%), 34 (21.94%), and 38 (24.52%) screen‐positive women using a 1 in 50, 1 in 100, and 1 in 150 cut‐offs, respectively and had an AUC of 0.85 (95% CI: 0.76, 0.93). The detection rates, AUC, and odds ratio were higher with the 1 in 150 cut‐off criteria than the 1 in 100 or 1 in 50 cut‐off, but there was a slight decrease in the specificity and diagnostic accuracy. Conclusion: The first‐trimester combined screening model at 11–14 weeks differentiated pregnant women at high risk for preterm PE in this population. A risk stratification cutoff of 1 in 150 had a better AUC than a 1 in 100 or 1 in 50 cutoff.

Objectives: Cancer therapy-related cardiac dysfunction (CTRCD), defined based on changes in left ventricular ejection fraction (LVEF) and cardiac biomarker levels, is a significant complication of chemotherapy, often subclinical in early stages. While conventional markers (high sensitivity cardio troponin I [hscTnI], N-terminal pro-brain natriuretic peptide) are routinely used, the role of novel biomarkers (glycogen phosphorylase BB [GPBB]), myeloperoxidase (MPO), chemokine ligand-23 (CCL23) and macrophage migration inhibitory factor (MIF) remains unknown. Furthermore, the potential influence of shared cancer and cardiovascular disease on tumour marker variability remains unclear, as they share common risk factors and biological pathways. This study aimed to evaluate selected biomarkers alongside hscTnI and LVEF in breast cancer patients undergoing neoadjuvant chemotherapy (NACT). Materials and Methods: Postmenopausal women ( n = 37) newly diagnosed with locally advanced breast cancer were recruited. Biomarkers were measured using a Beckman Coulter chemiluminescence analyser (Dxi600) and enzyme-linked immunosorbent assay before and after 7 cycles of NACT. The Statistical Package for the Social Sciences software version 20.0 was used for analysing the data. Results: GPBB, hscTnI and cancer antigen 19-9 (CA 19-9) showed a significant increase from baseline after NACT, with a significant reduction in LVEF. No significant differences were observed in CCL23 (Myeloid Progenitor Inhibitor Factor-1), MIF, MPO, CA 125, carcinoembryonic antigen, CA 15-3 and cytokeratin fragment antigen 21-1 before and after NACT. A significant inverse correlation emerged between LVEF and hscTnI levels (r = −0.58, p < 0.001). No significant correlations were seen between LVEF and other biomarkers. Thirty per cent of breast cancer patients developed mild, asymptomatic CTRCD after NACT. The levels of LVEF and hscTnI among patients with and without CTRCD after NACT differed significantly. However, levels of other biomarkers did not differ significantly between the two patient groups. Conclusion: The evaluated novel biomarkers did not demonstrate clinically significant additional utility for assessing cancer therapy-related cardiotoxicity in our cohort. However, these findings are exploratory and require validation in larger studies.

Objectives: An association of antiseizure drugs and the frequency of seizures with abnormalities in bone metabolism resulting in low bone mineral density (BMD) and fractures have been hypothesised. The objective of the study was to compare the indices of bone health between people with drug-resistant and well-controlled epilepsy. Materials and Methods: Forty people each were recruited into two groups for the cross-sectional study. Adults with well-controlled epilepsy formed Group I, whereas adults with refractory epilepsy were included in Group II. Gender- and age-matched people of 18–40 years who had been on antiseizure medications for more than 5 years were included. Smokers, known hypertensive and diabetic patients, people with alcohol use disorder, people with infections or head injuries and lactating women were excluded. Biochemical parameters, fasting glucose, 25OH Vitamin D, C-telopeptide of type 1 collagen, procollagen type 1 N-terminal propeptide, malondialdehyde, total antioxidant status, Ca, P and alkaline phosphatase were estimated. A Hologic dual-energy X-ray absorptiometry scan estimated the total hip, neck of femur and L1 to L4 lumbar spine BMD with trabecular bone scores. Results: The bone health biochemical indices and BMD, as well as the proportion of people with low bone mass and degraded bone at the lumbar spine, were not different between the two groups of people with epilepsy. Conclusion: Bone health appears to be unaffected and was comparable in both well-controlled and drug-resistant people with epilepsy.

Introduction: Academic mentoring is essential for graduate students who are slow or medium achievers. Yet, the usefulness of the Formative Structured Oral Examination (FSOE) as a tool for academic mentoring has not been studied. This study aims to assess the utility of FSOE as a tool for fostering academic mentoring among slow and medium achievers. Methods: A convergent mixed-method study was conducted among 52 first-year MBBS students, covering three biochemistry topics with residents serving as resource persons. The study included both a quantitative single-group pre-post quasi-experimental component and an exploratory qualitative component (feedback and focus group discussions). Two cycles of FSOE were performed for each topic, with one student at a time and pre-prepared color cards. Each FSOE session lasted approximately one hour. Multiple-choice pre- and post-tests were conducted before and after the FSOE. Feedback was collected from students using a structured questionnaire employing a seven-point Likert scale. The questionnaire was reviewed by subject experts for content validity prior to administration, and focus group discussions were held among students and resource persons. Pre- and post-test scores were compared using a paired t-test for normally distributed variables and a Wilcoxon signed-rank test for non-normally distributed variables. P < 0.05 was considered significant. Analyses were done using IBM SPSS Statistics software, version 20 (IBM Corp., Armonk, NY, USA). Results: FSOE implementation resulted in a significant improvement in post-test scores. Among low achievers, fat-soluble vitamin scores increased from 11 (8-13) to 17 (14-20) (p = 0.001; r = 0.85), while medium achievers also showed significant gains (p = 0.001; d = 1.21). Low achievers demonstrated significant improvement in amino acid metabolism and DNA replication (p < 0.05), with large effect sizes (d = 1.80 and 1.02). Scores further improved after the second FSOE cycle across all groups (p < 0.001). Compared with a topic taught without the FSOE, normalized pre- to post-test improvement showed large effect sizes across groups. Internal assessment scores improved significantly among low achievers (p < 0.005). Feedback and focus group discussions indicated enhanced conceptual understanding, improved engagement, reduced examination stress, increased motivation, and improvement in resource persons’ teaching skills, though logistical and inclusivity concerns were noted among the students. Conclusions: The FSOE was an effective academic mentoring program that benefited both students and resource persons. The FSOE may be implemented as a regular mentoring program in medical biochemistry to address academic difficulties.

Neoadjuvant chemotherapy (NACT) is expected to cause cardiovascular complications among patients with breast cancer (BC). Cytoadipokines (Leptin, adiponectin) and cell adhesion molecules (CAMs) have been associated with BC pathogenesis. Psychological distress has been reported in patients with BC. Cardiovascular disorders and endothelial dysfunction are expected to be higher among BC patients who receive NACT. To assess the effect of NACT on cardiovascular function, various endovascular factors such as leptin, adiponectin, sICAM, sVCAM, and stress levels in patients with locally-advanced primary BC. Forty newly diagnosed patients with BC who had planned for NACT were recruited, and the following assessments were performed before and after NACT. Endothelial function was assessed by brachial artery flow-mediated dilation (baFMD) using color Doppler. Stress level was assessed by questionnaires, PSS (perceived stress scale), PHQ-9 (Patient Health Questionnaire-9), and GAD-7 (generalized anxiety disorder-7). Blood levels of oncovascular risk factors (leptin, adiponectin) and CAMs (sVCAM, sICAM) were assessed by ELISA. There was increased endothelial dysfunction (baFMD: 10.8 [8.3–14.2] and 6.5 [2.9–11.4]; p < 0.01), decreased serum leptin levels (30.1 [24.3–40.9] and 20.4 [13.1–30.6]; p < 0.01), trends for increased adiponectin/leptin ratio (1.69 [0.95–3.6] and 2.73 [1.72–5.76]; p = 0.067) and sICAM (283.1 [231.9–357.0] and 323.5 [261.4–395.8]; p = 0.063) levels after NACT. Stress levels (PSS: 7 [5–10] and 9 [7–14]; p = 0.007, PHQ-9: 4 [2–5] and 8 [4–11], p < 0.01 and GAD-7: 2 [2–4] and 6 [4–9], p < 0.001) were found to be increased after the NACT. Dyslipidemia was also observed after chemotherapy. NACT was associated with increased endothelial dysfunction, stress levels, dyslipidaemia, and altered onco-vascular risk factors among the BC patients.

Acute kidney injury (AKI) occurs in 15–50% of trauma patients and worsens outcomes. Early identification of high-risk individuals may enable reno-protective strategies. Urinary tissue inhibitor of metalloproteinases-2 (TIMP-2) and insulin-like growth factor-binding protein 7 (IGFBP7) have shown promise in predicting AKI in various settings, but their utility in critically ill trauma patients remains unclear. This study aimed to evaluate the combined urinary biomarker product (TIMP-2) × (IGFBP7) for early AKI prediction in this group. This prospective observational study was conducted at a tertiary care center in India. Critically ill trauma patients aged 18–65 years admitted to the critical care unit were enrolled and followed for AKI development (KDIGO criteria). Injury Severity Score (ISS) and APACHE II scores were recorded at admission. Urine samples collected at admission and 24 hours post-admission were analyzed for TIMP-2 and IGFBP7 using ELISA-based kits. Associations between biomarker levels, AKI occurrence, and need for renal replacement therapy (RRT) were assessed, along with clinical and hemodynamic parameters. Seventy-nine patients were included; 14 (17.7%) developed AKI. Median APACHE II scores were 11 (7–18) vs 9 (7–11), and ISS scores 34 (25–34) vs 25 (25–34) in AKI and non-AKI groups, respectively. The ROC-AUC for (TIMP-2) × (IGFBP7) was 0.49 at admission and 0.57 at 24 hours. A 24-hour cut-off of 0.008 (ng/mL)²/1,000 yielded 85.7% sensitivity, 27.7% specificity, NPV 90%, and PPV 20.3%. Urinary (TIMP-2) × (IGFBP7) measured at admission did not show any significant discriminating power. However Urinary (TIMP-2) × (IGFBP7) measured 24 hours after admission may help identify critically ill trauma patients at risk of AKI. Parthiban M, Cherian A, Kundra P, Priyamvada PS, Bobby Z, Senthilnathan M. Role of Urinary Biomarkers TIMP-2 and IGFBP7 in Predicting Acute Kidney Injury in Critically Ill Trauma Patients: A Prospective Observational Study. Indian J Crit Care Med 2025;29(11):936–941.

Objectives: To explore whether uniform supplementation causes iron overload among a cohort of South Indian non-anemic pregnant women with diabetes-in-pregnancy (DIP). Methods: The study took place between May 2022 and May 2024 and consisted of 120 participants from 2 groups: healthy pregnant women (HP) and pregnant women with DIP. Levels of Hb and the serum indices of iron homeostasis-iron, unsaturated iron-binding capacity, total iron-binding capacity, transferrin saturation, ferritin, hepcidin, soluble transferrin receptor (sTfR), and sTfR index, were estimated. The levels of high-sensitivity C-reactive protein, indices of oxidative stress, malondialdehyde, total antioxidant status (TAS), and oxidative stress index (OSI; ratio of MDA/TAS), and inflammatory markers, interleukin-10 (IL-10) and interleukin-18 (IL-18), were also estimated. The perinatal outcomes between the 2 groups were compared. Results: The serum iron and ferritin levels were lower, and HbA1c levels were higher in the DIP than in HP. The indices of iron homeostasis and Hb were comparable between the 2 groups. While the levels of OSI were higher in the DIP, the pro-inflammatory markers were comparable between the 2 groups. The perinatal outcome of DIP was inferior in comparison to HP. Conclusion: The current uniform daily oral iron supplementation dose in non-anemic South Indian women with DIP did not show evidence of iron overload in our cohort, contrary to expectations.

Concept mapping is an active learning strategy promoting self‐directed learning. The intellectual involvement in the preparation of concept mapping is a learning process. We tested the utility of concept mapping in improving self‐directed learning among medical graduate students in Biochemistry. The study was conducted among first‐year undergraduate medical students at our institute after their regular teaching modules in biochemistry. The students prepared concept maps on three topics by referring to textbooks and class notes as a home task. Pre‐ and posttests were conducted with MCQs to assess the gain from the exercise. Classification of the students into low, average, and high achievers was carried out to analyze the results. After the training, we took feedback from the students using a Likert scale. We conducted focus group discussions among the different groups of students to examine the factors that facilitated or hindered their learning with concept mapping. There was a significant gain in understanding the three chosen topics by the concept mapping. Although the overall gain from concept mapping was higher than the gain from self‐study, it reached statistical significance only among the low achievers in this study. The students generally felt this exercise was more beneficial than self‐study and enhanced their self‐directed learning process. Several factors facilitated their self‐directed learning by concept mapping. Concept mapping is an effective method for fostering self‐directed learning among graduate medical students in Biochemistry.

Purpose Assessment of the effect of cytotoxic chemotherapy on the indices of iron homeostasis to elucidate the aetiology of anaemia in breast cancer. Methods Forty-two newly diagnosed breast cancer patients with Hb > 10 g/dL were recruited. Iron indices were estimated before and after neoadjuvant chemotherapy (NACT). Anaemia of chronic disease (ACD) and anaemia of chronic disease + iron deficiency anaemia (IDA) were identified by sTfR, sTfR index, and algorithm by Skikne et al. Results Anaemia was 52% at the presentation time, which increased to 93% at the end of NACT. Among the anaemic breast cancer patients, 75% belonged to the group of ACD + IDA, and only 25% belonged to the group of ACD at the time of presentation. After NACT, the number of patients in the ACD + IDA group significantly increased to 93%, while the members of the ACD group significantly reduced to 7%. Ferritin, Hepcidin, Transferrin, sTfR, and sTfR index increased after NACT. Conclusion The primary aetiology of anaemia among Indian breast cancer patients is a combination of ACD and IDA. Indian breast cancer patients were more vulnerable to developing iron deficiency anaemia when compared to anaemia of chronic disease during NACT.