Polycystic ovary syndrome (PCOS) is a common endocrine disorder affecting women of reproductive age and is reported frequently with mental health disorders. This systematic review aims to synthesize the available evidence on mental health screening and its potential role in identifying and addressing mental health conditions among women with PCOS. This systematic review will be conducted according to JBI methodology for systematic reviews of effectiveness. The search strategy will follow the Peer Review of Electronic Search Strategies (PRESS) checklist. Literature searches will be conducted in the Cochrane Library, PubMed/MEDLINE, Scopus, Embase, CINAHL, Web of Science, and PsycINFO databases, as well as relevant grey literature sources. Studies involving women with PCOS that report the use of mental health screening tools or assessment of mental health outcomes will be eligible for inclusion. Experimental, quasi-experimental, and observational studies will be considered. Two independent reviewers will perform study selection and data extraction using predefined eligibility criteria and standardized forms, with disagreements resolved through discussion or consultation with a third reviewer. Methodological quality will be assessed using the JBI critical appraisal tools appropriate to the study design. Where sufficient data are available, a meta-analysis will be conducted; otherwise, findings will be synthesized narratively. The certainty of evidence will be evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. This systematic review will provide a comprehensive synthesis of the available evidence on mental health screening among women with PCOS. The findings may inform clinical practice, support evidence-based guideline development, and identify priorities for future research in the holistic management of PCOS. PROSPERO CRD420251240567

BACKGROUND:Optimizing colistin dosing in patients with renal impairment, particularly those undergoing renal replacement therapy (RRT), remains a major challenge due to complex and variable pharmacokinetics. This systematic review identifies key covariates affecting pharmacokinetics of colistimethate sodium (CMS) and its active form colistin and evaluates dosing variability in patients with renal impairment, including those receiving RRT. METHODS:Systematic searches of PubMed, Embase, Scopus, and Cochrane Library (up to November 2025) identified studies reporting the pharmacokinetics of intravenous CMS, formed colistin or colistin sulfate (nebulized CMS used as adjuvant in some studies) in adults with renal impairment or on RRT. Data on dosing regimens, dialysis characteristics, pharmacokinetic parameters, and covariates were extracted, and methodological quality was appraised using validated pharmacokinetic criteria. RESULTS:Thirteen studies (n = 450) met inclusion. CMS clearance was primarily determined by renal function and dialysis-related parameters were the most consistent determinants of pharmacokinetics, while additional covariates such as cystatin C, ALT, hematocrit, and body weight were identified in individual studies. In patients undergoing SLEDD, extracorporeal clearance was reported to account for up to 67% of total drug clearance in a single study. Standardized CMS dosing regimens often failed to achieve pharmacodynamic targets for formed colistin (fAUC/MIC ≥12). CONCLUSIONS:Colistin pharmacokinetics in patients with renal impairment and those receiving renal replacement therapy are highly variable and influenced by both renal and non-renal factors, including dialysis modality. Standard dosing regimens frequently fail to achieve pharmacodynamic targets, highlighting the need for individualized, physiology-based dosing strategies. Integration of renal function, RRT parameters, and emerging biomarkers such as cystatin C, alongside therapeutic drug monitoring, is essential to optimize efficacy while minimizing toxicity in this high-risk population. PROSPERO:www.crd.york.ac.uk/prospero identifier is CRD42021294141.

OBJECTIVES:To assess antibiotic prescribing patterns and quantify antibiotic use in secondary care hospitals in South India using a point prevalence survey, and to generate baseline data to support antimicrobial stewardship initiatives and national AMR surveillance efforts. METHODS:A point prevalence survey (PPS) was conducted between April-September 2025 across 12 secondary care hospitals in India. All inpatients present at 8:00 am on the survey day were included. Data included patients' characteristics, antimicrobials received, and therapeutic indications. RESULTS:Among the 359 patients surveyed, 196 (54.6%) received at least one antibiotic, with hospital-level prevalence ranging from 24% to 100%. Most antibiotics were administered parenterally (84.8%), and respiratory infections (20.9%) were the leading indication. Empirical therapy accounted for 53.1% of prescriptions. Broad-spectrum antibiotics, predominated. Culture sensitivity testing was documented in 28% of cases, reflecting limited microbiological support. AMS programs were largely absent. According to WHO AWaRe classification, 74.2% of prescriptions were from Watch group, and only 22.1% from Access. CONCLUSION:Antibiotic use in secondary care hospitals shows high variability and suboptimal practices, underscoring the need for strengthened AMS, improved diagnostics, and better guideline adherence.

Gram-negative sepsis (GNS) is associated with high global mortality rates, particularly in intensive care unit (ICU) settings. Despite the availability of various sepsis severity scores, there is a lack of predictive tools tailored for GNS. Our study aimed to develop and temporally validate a novel prediction scoring tool for poor prognosis in GNS patients requiring early ICU or High-dependency unit (HDU) admission. This retrospective observational study included 312 adult patients with GNS admitted to the ICU or HDU of a tertiary care hospital from January 2016 to December 2020. Primary outcome of interest was poor prognosis. Candidate variables were grouped into demographics, comorbidities, clinical presentation at admission, laboratory data, resistance pattern, and early complications. Independent predictors of poor prognosis were identified using multivariate logistic and cox regression analysis. A prediction scoring tool was developed and temporally validated on a prospective cohort (October-December 2024). All the analysis was conducted using SPSS version 29.0. The study was meticulously designed, implemented, and documented in compliance with the TRIPOD checklist. Among 312 patients with GNS in the development cohort, 71.4

Pesticide poisoning and unsafe handling among pesticide users, particularly with farmers, pose a significant threat to both public health and the environment. Despite efforts to improve farmers Knowledge, Attitude and Practices, most interventions lack tailored education and sustained follow-up, limiting their effectiveness. This trial assesses the impact of need-based educational intervention with educational documentary, improving safe pesticide practices among farmers in Karnataka, India. The study is a multicentric randomized controlled trial, which will be conducted across 4 phases in Udupi, Mysuru, and Shivamogga districts of Karnataka. Phase 1 features a cross-sectional study design of 175 farmers to evaluate their baseline knowledge, attitudes, and practices on usage of pesticides. Phase 2 employs semi-structured interviews with 20–30 farmers and 10–20 key stakeholders, including pesticide dealers, scientists from Farm Science Centers [Krishi Vigyan Kendra (KVK)], and joint directors of agriculture to explore pesticide handling approaches, challenges, and community-specific needs while handling pesticides. The findings from Phases 1 and 2 will help in development and validation of an intervention in the form of educational video in Phase 3 which will be piloted. Phase 4 involves implementing the validated intervention and conducting long-term follow-up to assess the impact and sustainability. Phase 4 will be a two-arm, single-blind, parallel-group randomized controlled trial, with villages randomized 1:1 into intervention and control groups. The intervention group will receive a 15–20-minute educational documentary in the local language, while the control group will receive no intervention. The outcomes will be evaluated based on changes in Knowledge, Attitudes, and Practices (KAP) scores, with assessments conducted immediately post intervention, at 6 months, and at 12 months from the date of intervention. These will be correlated with outcomes including quality of life and laboratory parameters. The study aims to provide robust evidence on the role of need-based educational intervention in promoting safe pesticide practices among farmers in rural region. The primary aim of the study is to develop practical strategies to enhance public health and farmer safety by addressing gaps and contextual relevance. It seeks to improve farmers’ knowledge, attitudes, and practices regarding pesticide use, ultimately enhancing their quality of life and promoting better health and safety outcomes. The trial is registered at Clinical trials Registry India with the trial registration number CTRI/2024/06/069678.

Abstract Polymyxin remain essential last-line agents for the treatment of multidrug-resistant gram-negative infections in critically ill patients. However, dosing polymyxin B and colistin in patients with renal impairment is clinically challenging due to complex pharmacokinetics, fluctuating renal function, toxicity concerns and limited implementation of therapeutic drug monitoring. While pharmacokinetic and guideline-based recommendations exist, little is known about how clinicians navigate these complexities in real-world practice. We conducted an inductive qualitative study using semi-structured interviews with physicians involved in the management of critically ill patients with severe gram-negative infections. Participants were purposively sampled from critical care, nephrology, infectious diseases and general medicine. Interviews explored experiences and decision-making related to polymyxin selection, dosing adjustments, renal dysfunction, renal replacement therapy, safety monitoring and institutional influences. Transcripts were analysed using a constructivist grounded theory approach, following iterative coding, constant comparison and theme development. Coding and analysis were performed using ATLAS.ti software. Reporting adhered to the COREQ checklist. Seventeen physicians were interviewed. Analysis yielded six interrelated themes: 1. Clinical determinants of polymyxin selection, 2. Individualized and adaptive dosing practices, 3. Renal dysfunction and renal replacement therapy-related uncertainty, 4. Safety-driven decision-making, 5. Monitoring, diagnostic, and evidence limitations, and vi. Institutional and system-level influences. Clinicians described polymyxin dosing as a dynamic experience-driven process requiring continuous reassessment and risk–benefit negotiation. Renal function variability, lack of therapeutic drug monitoring, and absence of standardized institutional protocols contributed to cautious and heterogenous dosing practices, particularly in patients receiving dialysis. Polymyxin dosing in critically ill patients with renal impairment is shaped by complex clinical judgement, safety concerns and systemic constraints rather than rigid adherence to dosing algorithms. These findings highlight a gap between pharmacokinetic evidence and bedside practice and underscore the need for pragmatic, context-appropriate dosing guidance, multidisciplinary stewardship support and decision-support tools to optimize polymyxin use in high-risk populations.

Tuberculosis (TB) and chronic kidney disease (CKD) are interconnected global health concerns. CKD patients have a higher risk of developing TB. Decreased clearance of drugs in kidney disease enhances toxicity risk. Current guidance on medication doses is not based on therapeutic drug monitoring. We measured and compared the concentrations of first-line anti-TB drugs in CKD and those with normal kidney function. A prospective observational study was conducted from September 2020 to December 2023. Patients with microbiologically confirmed tuberculosis were included, and drug concentrations were determined by using Liquid Chromatography-Tandem Mass Spectrometer (LC-MS/MS) and compared between CKD and those with normal kidney function. Of 151 participants, 51 had CKD. Higher trough concentrations were found in CKD for isoniazid [697.15 ng/mL (IQR 199.07–3321.68) vs. 187.58 ng/mL (IQR 95.56–323.65), P < 0.0001], rifampicin [141.53 ng/mL (IQR 40.86–730.66) vs. 33.24 ng/mL (IQR 22.49–86.20), P < 0.0001], and ethambutol [635.67 ng/mL (IQR 264.38–1594.12) vs. 230.92 ng/mL (IQR 161.95–417.22), P < 0.0001], while pyrazinamide level [1469.79 ng/mL (IQR 0.00–5160.53) vs. 4273.94 ng/mL (IQR 2151.29–8023.81), P = 0.002] was higher in those with normal kidney function. At 2-hours, a greater number of CKD patients had below the reference threshold for rifampicin [33/51 (64.7

Background In the majority of the LMICs, the private sector accounts for a substantial proportion of antibiotic use but remains weakly integrated into antimicrobial stewardship and surveillance systems. Understanding the stewardship practices in this sector requires examination of both provider behaviour and system level enablers. Methods This is a cross-sectional study conducted among private medical practitioners in the Udupi district of South India, using a validated knowledge, attitude, and practice questionnaire, assessing prescribing behaviour for common infectious syndromes, and evaluating the availability of stewardship-enabling infrastructure. Antibiotic prescriptions are assessed using the WHO Access, Watch, Reserve (AWaRe) classification. Descriptive and comparative analysis is conducted. Results A total of 141 practitioners participated in the survey (response rate 65.2%). KAP scores were generally favourable for antimicrobial resistance and stewardship. However, watch category antibiotics were commonly prescribed for self-limiting infections and community-acquired infections, whereas Access category antibiotics remained low. Despite access to a microbiology laboratory, there was limited utilisation of culture and sensitivity tests. Formal sterwadship structures, training and resistance patterns were uncommon. Overall, KAP scores did not differ significantly across individual practitioner level characteristics, suggesting systemic drivers for inappropriate use rather than individual factors. Conclusion In private health care settings, antibiotic prescription practices are shaped less by knowledge deficits and more by the structural gaps, such as the absence of guidelines, limited diagnostic stewardship, and weak stewardship governance. Effective AMS strategies should extend beyond education to address system-level enablers and accountability in the private health care. Trial Registration: The study was registered in the Clinical Trial Registry of India (CTRI/2021/01/030448) on 14th January, 2021 URL:https://ctri.nic.in/Clinicaltrials/regtrial.php?trialid=50974&EncHid=24540.89288&modid=1&compid=19

BACKGROUND: Antimicrobial resistance in Klebsiella pneumoniae represents a major challenge to healthcare systems. While antibiotic consumption is a key driver of resistance, long-term, setting-specific data linking antimicrobial use with resistance trends remain limited. This study aimed to evaluate temporal trends in antibiotic consumption and corresponding resistance patterns in K. pneumoniae over a six-year period. METHODS: This retrospective, longitudinal surveillance study was conducted at a tertiary-care hospital from January 2019 to December 2024. Non-duplicate K. pneumoniae isolates recovered from various specimens were included. Antimicrobial susceptibility testing was performed using standardized laboratory methods and interpreted accordingly. Antibiotic consumptions data were extracted from electronic records, and quantified annually, with stratification by ICU and non-ICU settings. Temporal trends in resistance and consumption were analysed descriptively using various graphical representation. RESULTS: Over the time, antibiotic consumption demonstrated a progressive shift toward broader spectrum and reserve agents, with a sustained increase in carbapenem use and persistently high fluoroquinolone utilization. Fluoroquinolone susceptibility remained uniformly low despite continued high use, whereas carbapenem susceptibility showed temporal fluctuations with an overall declining trend in later years. A transient improvement in susceptibility across multiple classes was observed in 2021, followed by renewed erosion thereafter. In contrast, aminoglycosides and tigecycline retained relatively stable activity, paralleling their restrained use. CONCLUSION: This six-year surveillance study highlights parallel temporal trends between antibiotic consumption patterns and evolving resistance in K. pneumoniae, with pronounced effects in critical care and bloodstream infections. Integrating consumption data with resistance surveillance is essential to inform setting-specific antimicrobial stewardship strategies and preserve the effectiveness of existing antibiotics in high-resistance healthcare environments.

BackgroundPolymyxin B remains a key treatment option for infections caused by multidrug-resistant gram-negative bacilli, particularly in critically ill patients. However, its optimal dosing strategy recommendation remains uncertain, especially in those undergoing renal replacement therapy. This study aimed to compare the clinical and microbiological outcomes of low, usual and high dose polymyxin B in a real-world ICU population.MethodsThis 5-year retrospective cohort study included critically ill adult patients with gram-negative sepsis who received polymyxin B. Patients were categorized into low-, usual- and high-dose groups based on loading and total daily maintenance dose. Pairwise propensity score matching was performed to adjust for baseline differences. Primary outcome was 28-day all-cause mortality. Secondary outcomes included microbiological clearance, ventilator-free days, ICU-free days, and vasopressor-free days. Subgroup and sensitivity analyses were conducted, including within patients requiring dialysis. All the statistical analysis was performed using R software.ResultsA total of 674 patients were included. After matching, usual-dose polymyxin B (61%) was associated with significantly higher 28-day mortality compared to the low-dose group (48.04%) (HR = 1.47;95% CI:[1.11-1.95];p = 0.007). Vasopressor, ventilator and ICU-free days were also significantly higher in the low-dose group were compared to the other groups. No significant survival advantage was observed with high-dose regimens. Among dialysis-dependent patients (n = 254), mortality did not differ significantly across dosing groups, though microbiological clearance was better with low dosing. Sensitivity and subgroup analysis also supported the results to be robust.ConclusionLow dose polymyxin B regimens were associated with lower mortality and comparable clinical outcomes compared to higher doses and may be feasible in critically ill patients with renal impairment. However, these findings should be interpreted cautiously given the observational design and residual confounding, warranting confirmation in future randomized trials.

Poisoning remains a major global public health concern, contributing significantly to morbidity and mortality. The management of poisoning cases is challenged by the absence of standardized treatment protocols, limited diagnostic frameworks, inconsistent antidote availability, and variability in clinical practice. Evaluating quality improvement (QI) approaches is essential to assess current standards of care and identify strategies to optimize poisoning management. This systematic review aimed to evaluate quality management in patients with poisoning by assessing the impact of quality improvement strategies on clinical processes and patient outcomes. This review was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines. A comprehensive literature search was performed across PubMed, Scopus and Embase databases. Studies examining quality management or quality improvement interventions in poisoning care were included. A total of 5,006 records were identified through database searching. After removal of duplicates, 3057 unique articles remained. During title and abstract screening, 2464 articles were excluded. Full-text assessment led to the exclusion of an additional 578 studies. Ultimately, 15 studies met the inclusion criteria and were included for data extraction and qualitative synthesis. In the context of increasing clinical and systemic challenges in poisoning management, the implementation of structured quality management strategies is essential. QI interventions may have the potential to enhance patient outcomes, reduce complications, and shorten hospital length of stay, thereby strengthening healthcare system efficiency. The protocol was registered in the International Prospective Register of Systematic Reviews (PROSPERO) under the registration number CRD42024581815. Not applicable.

Introduction Application of artificial intelligence (AI) tools in the healthcare setting gains importance especially in the domain of disease diagnosis. Numerous studies have tried to explore AI in the diagnosis of various diseases, including tropical fevers such as dengue and malaria. However, there is a lack of standard guidelines to develop the AI models, the gap between clinical and engineering expertise and clinical validation of the models, and hence there is a critical need for the development of an integrated diagnostic tool which uses demographical, laboratory variables and epidemiological parameters of patient and provides early prediction.Methods and analysis The present study aimed to develop and evaluate a machine-learning (ML) prediction tool for differential diagnosis of tropical fevers for adult patients (>18 years) using a three-phase approach in a tertiary care centre in South India by January 2026. Phase Ⅰ involves identification of the prevalent tropical fevers and associated clinical parameters to develop the AI model through a retrospective audit and qualitative interview. Phase Ⅱ involves retrospective data collection from hospital medical records for finalised diseases (1000 cases per disease) and clinical parameters, with data being used for model development using the Python language. Support vector machine, logistic regression, K-Nearest Neighbors, Naïve Bayes and ensemble models such as decision tree and Random Forest will be employed along with explainable AI techniques. They are used as they are easy to understand and interpret, well established, most effective for structured data, enhancing the transparency and interpretability of the predictive machine learning models, and their use has been widely supported in previous studies across various contexts. Suitable statistical parameters like specificity, sensitivity and area under receiver operating characteristic (AUROC) will be applied to evaluate model performance. In phase Ⅲ, the developed model will be implemented prospectively to assess the feasibility of model implementation. Model performance such as specificity, sensitivity and AUROC will be calculated, and the finally developed model will be implemented in a single tertiary care hospital to evaluate its overall performance.Ethics and dissemination Ethical approval for the study has been obtained from the institutional ethics committee of the Kasturba Medical College and Kasturba Hospital, Manipal (IEC number: 6/2024). Informed consent will be taken for obtaining the data of the patient for the evaluation of the model in the third phase of the study, and data will be kept confidential. The study results will be disseminated by publishing them in a peer-reviewed journal.Trial registration number The protocol has been registered with the Clinical Trial Registry of India (CTRI) (CTRI/2024/04/065866) and approved on 16 April 2024.

BACKGROUND:Carbapenem-resistant Klebsiella pneumoniae (CRKP) bacteraemia poses a major therapeutic challenge due to limited effective therapeutic options and high mortality. Although polymyxins remain widely used, emerging evidence suggests that non-polymyxin regimens may offer improved efficacy and safety. This study compared clinical and microbiological outcomes between polymyxin-based therapy (PBT) and non-polymyxin regimens (NPR) in patients with CRKP bloodstream infections (BSI). METHODS:In this multicentric, retrospective observational study, adult patients (≥18 years) with confirmed CRKP bacteraemia admitted between January 2019 and December 2023 were included. Patients were categorised based on definitive therapy as PBT or NPR. Baseline characteristics, disease severity, and outcomes were compared using appropriate statistical tests. Predictors of in-hospital mortality were identified by multivariable Cox regression, validated by bootstrap resampling, and assessed through landmark sensitivity analysis excluding early deaths (<48 hours). Kaplan-Meier survival analyses were performed for mortality and microbiological clearance. RESULTS:Of 1,009 patients with K. pneumoniae bacteraemia, 244 patients with CRKP met inclusion criteria (PBT, n = 143; NPR, n = 101). Baseline demographics were similar, but PBT recipients had higher SOFA (4[0-12] vs.3[0-12]; p < 0.001) and CCI scores (4[0-8] vs.3[0-10]; p = 0.025). Clinical cure was achieved more often with NPR (58.4%vs.15.4%; p = 0.02), while in-hospital mortality (38.6%vs.68.5%; p < 0.001) and acute kidney injury (28.7%vs.55.9%; p = 0.008) were significantly higher in the PBT group. Microbiological clearance and time to clearance were comparable. Independent predictors of mortality included treatment with polymyxins (aHR:1.595;95%CI:1.392-1.903;p = 0.015), SOFA score>6 (aHR:1.514;95%CI:1.285-1.928;p = 0.027), history of chronic liver disease (aHR:2.31;95%CI:1.884-3.642;p = 0.02), post-therapy dialysis (aHR:3.11;95%CI:1.008-4.59;p = 0.048), and requirement of ICU admission after definitive therapy (aHR:1.474;95%CI:1.252-1.891;p = 0.02). Survival analysis confirmed superior outcomes for NPR (log-rank p < 0.001). CONCLUSION:NPR was associated with significantly higher clinical cure, lower nephrotoxicity, and reduced mortality compared with PBT regimens. These findings suggest that non-polymyxin regimens may be associated with improved clinical outcomes and lower nephrotoxicity compared with polymyxin-based therapy in patients with CRKP bacteraemia. Prospective studies were warranted to confirm these observations.

Acute febrile illnesses (AFIs) such as dengue, malaria, scrub typhus, leptospirosis etc, prevalent in tropical regions, account for 17% of the global disease burden. Overlapping clinical features and limitations of current diagnostic methods—including false positives, sensitivity/specificity issues made the diagnosis complicated. With increasing digital integration in healthcare, artificial intelligence (AI) offers a promising solution for improving diagnostic accuracy and efficiency. Our study aimed to develop an AI-based tool to aid differential diagnosis of AFIs and support clinical decision-making.Fig 1:Features selected through Recursive Elimination and MulticollinearityBased on Recursive_Feature_Elimination (RFE), a set of high-ranking features was initially identified. These features were then subjected to multicollinearity assessment to eliminate redundant variables with strong linear relationships. The final set of 20 non-collinear, clinically relevant features was selected for model development and is presented in Fig_1Fig 2:Accuracy of the developed models A retrospective cross-sectional study analyzed records of 800 patients (200 per disease). Clinical data were extracted and preprocessed (cleaning, scaling, imputation). Feature selection was conducted using Recursive_Feature_Elimination (RFE) and multicollinearity assessment. Models were developed using supervised machine learning algorithms— Random_Forest(RF), Naïve_Bayes(NB), Logistic_Regression(LR), Support_Vector_Machine(SVM), K-Nearest_Neighbors(KNN), and Decision_Tree(DT). A stacking classifier served as a meta-model. Performance was evaluated using accuracy, precision, recall, and F1-score.Fig 3:Confusion matrix for Stacking ClassifierTable 1:Other performance Metrics Based on RFE, set of high-ranking features were identified and were then subjected to multicollinearity assessment. The final set of 20 non-collinear, clinically relevant features was selected for model development (presented in Fig_1). Among the developed predictive models, the RF demonstrated highest classification accuracy (87%), followed by LR (86.5%), SVM (85.5%), KNN (73%), DT (72.5%), and NB (70.5%), (shown in Fig_2). Additional performance metrics, including precision, recall, and F1-score, are summarized in Table 1. A stacking classifier, integrating the predictions of all base models, achieved an overall accuracy of 89% on training dataset. The confusion matrix for the stacking model is presented in Fig_3 By integrating clinical data with advanced feature selection techniques, AI-based tool can be the future diagnostic aiding tool for screening the tropical diseases. All Authors: No reported disclosures

Multidrug-resistant (MDR) Gram-negative infections pose significant therapeutic challenges, with limited evidence guiding optimal polymyxin B dosing in patients with renal impairment. This systematic review aimed to identify key covariates influencing polymyxin B pharmacokinetic and inform dosing strategies in this population. A comprehensive search of PubMed, Scopus, Embase, and Cochrane library was conducted from inception to May 2025. Population–pharmacokinetic (pop-PK) studies evaluating polymyxin B in adult patients in adult patients with renal impairment, with or without renal replacement therapy (RRT) were included. Study quality was assessed using a validated critical appraisal of clinical pharmacokinetic studies tool (CACPK). Eleven pop-PK studies (603 patients) were included. Considerable interindividual variability in clearance and volume of distribution was noted. Creatinine clearance (CrCL), RRT modality, and disease severity were key covariates influencing drug exposure. Convective RRT modalities (CVVH, CVVHDF) were associated with increased clearance and lower exposure, whereas diffusive modalities (CVVHD) showed variable effects. However, the clinical relevance of CrCL-based dose adjustment alone remains uncertain and should be interpreted alongside other clinical factors. Polymyxin B dosing in renal impairment requires an individualized approach integrating renal function, RRT modality, and disease severity. While a loading dose of 150 mg is appropriate, maintenance dosing should be guided by clinical context, with higher doses in convective RRT and cautious dosing in diffusive modalities. Therapeutic drug monitoring (TDM), where available, is recommended to optimize efficacy and minimize toxicity.

Antimicrobial resistance (AMR) poses a critical global health threat in India due to the high burden of infectious diseases and widespread misuse of antibiotics. Secondary care hospitals, being pivotal in the Indian healthcare system, require effective Antimicrobial Stewardship (AMS) programs to optimize antimicrobial use and combat AMR. However, significant barriers, such as limited resources, lack of trained personnel, and inadequate infrastructure, hinder AMS implementation. This narrative review evaluated the current state of AMS programs in secondary care hospitals in India. It examined their implementation, impact, challenges, and enablers. Successful case studies of AMS programs were analysed to highlight multidisciplinary approaches involving clinicians, pharmacists, microbiologists, and infection control teams. Key strategies, such as formulary restriction, prospective audit with feedback, antibiotic time-outs, and development of evidence-based guidelines, were identified and discussed. AMS programs have shown potential in improving antimicrobial usage, reducing AMR, and enhancing patient outcomes. Critical components for successful AMS implementation include leadership commitment, drug expertise, accountability, and continuous education. Identified challenges include inadequate funding, insufficient training, and resource limitations. Despite these barriers, examples of effective AMS programs demonstrate the feasibility of scaling these interventions with strong policy support and infrastructure development. Strengthening AMS programs in Indian secondary care hospitals is crucial for controlling AMR, improving patient outcomes, and preserving antimicrobial effectiveness. Overcoming existing barriers requires policy frameworks, funding, infrastructure development, and continuous training. Scaling up AMS efforts can significantly contribute to combating AMR at national and global levels. This review offers recommendations to rationalize AMS practices and enhance implementation in India.

IntroductionAcute febrile illnesses are significant clinical challenge in tropical regions due to overlapping symptomatology among infections such as dengue, scrub typhus, and leptospirosis. This diagnostic dilemma leads to delays in appropriate treatment and negatively impacted patient outcome due to limited diagnostic tool availability. Recent advancement in artificial intelligence (AI) application in healthcare help in developing diagnostic aiding tool in such clinical dilemma.AimsStudy aimed to explore physicians' perspectives on diagnostic challenges of tropical Acute-febrile-illnesses and assess perceived utility of AI as a supportive tool in clinical decision-making.MethodsA qualitative interview was conducted using validated semi-structured interview guide using literature and expert opinion and validated by IPR method. To understand the physicians perspective on management infectious diseases in critical care, interview guide administered among ten physicians with 10-30 years of experience across different centres of India. Interviews were audio-recorded, transcribed verbatim, and thematically analyzed using ATLAS.ti software.ResultsFour major themes emerged: clinical experience and practice, diagnostic-challenges, diagnostic-parameters and decision-making, and AI integration in clinical-practice. However, no statistical test can be performed since study mainly focused to understand perception of physicians with respect to managing illness and hence prevalence cannot be determined. Diseases such as dengue, scrub typhus, and leptospirosis were reported as most prevalent, particularly during monsoon seasons. Key diagnostic challenges included overlapping symptoms, diagnostic delays, limited sensitivity/specificity of available tests, and cost constraints. Physicians primarily relied on clinical judgment and laboratory findings, despite the limitations. Most of the participants expressed positive attitudes toward the potential of AI as supportive tool, citing its ability to enhance diagnostic accuracy and streamline clinical workflow with proper validation.ConclusionsGrowing in clinical dilemma AI has significant role in diagnosis of tropical fever with integration of the clinical data & physician perspective can successfully able to incorporate in clinical application.

Problem considered: Disparities exist within both clinical practice and literature regarding the use of corticosteroids in management of acute respiratory distress syndrome (ARDS). Given the absence of definitive evidence from a singular research approach, we adopted a mixed method approach design to address this clinical question. Methods: We employed a sequential exploratory mixed methods approach. Initially, we conducted a retrospective analysis, which was complemented by a comprehensive literature review to identify the best treatment approaches in literature and practice. Subsequently, a semi-structured qualitative interview was conducted to gain insights into perception and experience of the physicians involved in ARDS management. Finally, a metainference was applied to synthesize the evidence to propose a corticosteroid regimen for ARDS, considering the patient etiology, dosage, duration, and timing of administration. Results: The retrospective evidence (nearly thousand patient data from five years) indicates that, low dose corticosteroid for a longer duration of treatment observed to have a significantly better recovery rate than other strategies. The literature (overview of meta-analyses, clinical guidelines and RCTs), and qualitative (among 9 physicians) evidence strengthened this by supporting the use of low dose corticosteroid (1-2 mg/kg) at the early phase (24-72 h), for a longer duration (minimum 10 days) to have better clinical outcome without safety concerns. Additionally, this provides more insights on ARDS epidemiology, management, efficacy, cost and safety. Conclusion: Low-dose corticosteroids for a longer duration of treatment administered at an early phase can be considered a potentially optimal corticosteroid regimen for ARDS which needs to be clinically validated in future.

Background More than 700,000 people die due to suicide every year, and ingestion of pesticides has become one of the means to attempt suicide. Nurses are the first health professionals to meet patients who have consumed poisons in the hospital. Therefore, knowledge, skills, and positive self-esteem are fundamental to practice and influence overall patient outcomes.Objective The objective of this scoping review was to assess nurses’ knowledge and practices in the management of patients with organophosphate poisoning.Methods A scoping review of scientific literature published between 2010 and 2023 was conducted using a comprehensive search strategy. A total of 59 articles were retrieved from online databases. The Joanna Briggs Institute guidelines for conducting the scoping review were adopted and reported using the Preferred Reporting Items for Scoping Review-Scoping Reviews guidelines.Results The mean age of nurses was found to be 34.43 ± 5.83 years. Most nurses who provided care were males, and 534 (40.1%) nurses had good knowledge of managing patients with organophosphate poisoning. Apparently, 602 (51.4%) out of 1172 nurses were confident in managing patients skilfully and efficiently.Conclusion The findings of this scoping review highlight the importance of ongoing training sessions for nurses to improve their confidence in handling toxicological emergencies to avoid complications and prolong hospital stays.