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Article ; Online: A social networks-driven approach to understand the unique alcohol mixing patterns of tuberculosis patients

Karikalan Nagarajan / Bharathidasan Palani / Javeed Basha / Lavanya Jayabal / Malaisamy Muniyandi

Humanities & Social Sciences Communications, Vol 9, Iss 1, Pp 1-

reporting methods and findings from a high TB-burden setting

2022 Volume 8

Abstract: Abstract Individuals who consume alcohol have a higher chance of contracting tuberculosis (TB) due to their social mixing patterns. We aimed to study the social mixing patterns of TB patients who consume alcohol on a regular basis using a quantitative ... ...

Abstract	Abstract Individuals who consume alcohol have a higher chance of contracting tuberculosis (TB) due to their social mixing patterns. We aimed to study the social mixing patterns of TB patients who consume alcohol on a regular basis using a quantitative social network approach. In a high-TB prevalence context in India, a social network survey of 300 newly diagnosed pulmonary drug-sensitive TB patients was done. The survey found 52 (17%) male TB patients who shared alcohol on a regular basis with 106 (4%) of their first-degree social contacts. Alcohol sharing happened in 16 neighborhood venues. When compared to contacts who did not use alcohol, a higher proportion of contacts with regular alcohol use were diagnosed with TB (12.3%; 95% CI: 6.6–20.00 vs. 3.5%; 95% CI: 2.8–4.3). Social network analysis showed that the network consisting of patients and contacts was less dense and less connected (with density ratio of 0.009, and degree centrality of 1.3, and betweenness centrality of 0.5), indicating weaker transmission potential of the network. Comparatively the network consisting of patients, contacts and their alcohol sharing venues was more dense and more connected (with density ratio of 0.018, higher degree centrality of 3.1 and betweenness centrality of 154.2) indicating stronger transmission potential of the network. Regular alcohol sharing in four venues created a giant network component, that linked a higher proportion of contacts without TB (72.3%) to a higher proportion of TB patients (67.3%) and their contacts with TB (38.4%). When examined from a network perspective, the pooled TB transmission exposure of contacts with regular alcohol use grew by a factor of 10, which helped explain the unfavorable social mixing of patients and contacts with regular alcohol use.
Keywords	History of scholarship and learning. The humanities ; AZ20-999 ; Social Sciences ; H
Subject code	338
Language	English
Publishing date	2022-05-01T00:00:00Z
Publisher	Springer Nature
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: Cost Effectiveness of a Shorter Moxifloxacin Based Regimen for Treating Drug Sensitive Tuberculosis in India.

Muniyandi, Malaisamy / Karikalan, Nagarajan / Velayutham, Banurekha / Rajsekar, Kavitha / Padmapriyadarsini, Chandrasekaran

Tropical medicine and infectious disease

2022 Volume 7, Issue 10

Abstract: Globally efforts are underway to shorten the existing 6-month tuberculosis (TB) treatment regimen for drug-sensitive patients, which would be equally effective and safe. At present, there is a lack of evidence on the cost implications of a shorter 4- ... ...

Abstract	Globally efforts are underway to shorten the existing 6-month tuberculosis (TB) treatment regimen for drug-sensitive patients, which would be equally effective and safe. At present, there is a lack of evidence on the cost implications of a shorter 4-month TB regimen in India. This economic modeling study was conducted in the Indian context with a high TB burden. We used a hybrid economic model comprising of a decision tree and Markov analysis. The study estimated the incremental costs, life years (LYs), and quality-adjusted life years (QALYs) gained by the introduction of a Moxifloxacin-based shorter 4-month treatment regimen for pulmonary TB patients. The outcomes are expressed in incremental cost-effectiveness ratios (ICERs) per QALYs gained. The cost per case to be treated under the 4-month regimen was USD 145.94 whereas for the 6-month regimen it was USD 150.39. A shorter 4-month TB regimen was cost-saving with USD 4.62 per LY and USD 5.29 per QALY. One-way sensitivity analysis revealed that the cost of the drugs for the 4-month regimen, hospitalization cost for adverse drug reactions, and human resources incurred for the 6-month regimen had a higher influence on the ICER. The probability sensitivity analysis highlighted that the joint incremental cost and effectiveness using QALY were less costly and more effective for 67% of the iteration values. The cost-effectiveness acceptability curve highlights that the 4-month regimen was dominant to both patients and the National TB Elimination Programme in India as compared to the 6-month regimen at different cost-effectiveness threshold values.
Language	English
Publishing date	2022-10-08
Publishing country	Switzerland
Document type	Journal Article
ISSN	2414-6366
ISSN (online)	2414-6366
DOI	10.3390/tropicalmed7100288
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Article ; Online: Social network analysis methods for exploring SARS-CoV-2 contact tracing data

Karikalan Nagarajan / Malaisamy Muniyandi / Bharathidasan Palani / Senthil Sellappan

BMC Medical Research Methodology, Vol 20, Iss 1, Pp 1-

2020 Volume 10

Abstract: Abstract Background Contact tracing data of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is used to estimate basic epidemiological parameters. Contact tracing data could also be potentially used for assessing the heterogeneity of ...

Abstract	Abstract Background Contact tracing data of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) pandemic is used to estimate basic epidemiological parameters. Contact tracing data could also be potentially used for assessing the heterogeneity of transmission at the individual patient level. Characterization of individuals based on different levels of infectiousness could better inform the contact tracing interventions at field levels. Methods Standard social network analysis methods used for exploring infectious disease transmission dynamics was employed to analyze contact tracing data of 1959 diagnosed SARS-CoV-2 patients from a large state of India. Relational network data set with diagnosed patients as “nodes” and their epidemiological contact as “edges” was created. Directed network perspective was utilized in which directionality of infection emanated from a “source patient” towards a “target patient”. Network measures of “ degree centrality” and “betweenness centrality” were calculated to identify influential patients in the transmission of infection. Components analysis was conducted to identify patients connected as sub- groups. Descriptive statistics was used to summarise network measures and percentile ranks were used to categorize influencers. Results Out-degree centrality measures identified that of the total 1959 patients, 11.27% (221) patients have acted as a source of infection to 40.19% (787) other patients. Among these source patients, 0.65% (12) patients had a higher out-degree centrality (> = 10) and have collectively infected 37.61% (296 of 787), secondary patients. Betweenness centrality measures highlighted that 7.50% (93) patients had a non-zero betweenness (range 0.5 to 135) and thus have bridged the transmission between other patients. Network component analysis identified nineteen connected components comprising of influential patient’s which have overall accounted for 26.95% of total patients (1959) and 68.74% of epidemiological contacts in the network. Conclusions Social ...
Keywords	SARS-CoV-2 ; Social networks ; Contact tracing ; India ; Infectious diseases ; Degree centrality ; Medicine (General) ; R5-920
Subject code	616
Language	English
Publishing date	2020-09-01T00:00:00Z
Publisher	BMC
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A study on tuberculosis disease disclosure patterns and its associated factors

Karikalan Nagarajan / Malaisamy Muniyandi / Senthil Sellappan / Srimathi Karunanidhi / Keerthana Senthilkumar / Bharathidasan Palani / Lavanya Jeyabal / Rajendran Krishnan

PLoS ONE, Vol 18, Iss

Findings from a prospective observational study in Chennai

2023 Volume 1

Abstract: Background Disclosure of tuberculosis (TB) status by patients is a critical step in their treatment cascade of care. There is a lack of systematic assessment of TB disclosure patterns and its positive outcomes which happens dynamically over the disease ... ...

Abstract	Background Disclosure of tuberculosis (TB) status by patients is a critical step in their treatment cascade of care. There is a lack of systematic assessment of TB disclosure patterns and its positive outcomes which happens dynamically over the disease period of individual patients with their family and wider social network relations. Methods This prospective observational study was conducted in Chennai Corporation treatment units during 2019–2021. TB patients were recruited and followed-up from treatment initiation to completion. Information on disease disclosures made to different social members at different time points, and outcomes were collected and compared. Bivariate and multi variate analysis were used to identify the patients and contact characteristics predictive of TB disclosure status. Results A total of 466 TB patients were followed-up, who listed a total of 4039 family, extra familial and social network contacts of them. Maximum disclosures were made with family members (93%) and half of the relatives, occupational contacts and friendship contacts (44–58%) were disclosed within 15 days of treatment initiation. Incremental disclosures made during the 150–180 days of treatment were highest among neighbourhood contacts (12%), and was significantly different between treatment initiation and completion period. Middle aged TB patients (31 years and 46–55 years) were found less likely to disclose (AOR 0.56 and 0.46 respectively; p<0.05) and illiterates were found more likely to disclose their TB status (AOR 3.91; p<0.05). Post the disclosure, family contacts have mostly provided resource support (44.90%) and two third of all disclosed contacts have provided emotional support for TB patients (>71%). Conclusion Findings explain that family level disclosures were predominant and disclosures made to extra familial network contacts significantly increased during the latter part of treatment. Emotional support was predominantly received by TB patients from all their contacts post disclosure. Findings ...
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
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Article ; Online: A study on tuberculosis disease disclosure patterns and its associated factors

Karikalan Nagarajan / Malaisamy Muniyandi / Senthil Sellappan / Srimathi Karunanidhi / Keerthana Senthilkumar / Bharathidasan Palani / Lavanya Jeyabal / Rajendran Krishnan

PLoS ONE, Vol 18, Iss 1, p e

Findings from a prospective observational study in Chennai.

2023 Volume 0280812

Abstract	Background Disclosure of tuberculosis (TB) status by patients is a critical step in their treatment cascade of care. There is a lack of systematic assessment of TB disclosure patterns and its positive outcomes which happens dynamically over the disease period of individual patients with their family and wider social network relations. Methods This prospective observational study was conducted in Chennai Corporation treatment units during 2019-2021. TB patients were recruited and followed-up from treatment initiation to completion. Information on disease disclosures made to different social members at different time points, and outcomes were collected and compared. Bivariate and multi variate analysis were used to identify the patients and contact characteristics predictive of TB disclosure status. Results A total of 466 TB patients were followed-up, who listed a total of 4039 family, extra familial and social network contacts of them. Maximum disclosures were made with family members (93%) and half of the relatives, occupational contacts and friendship contacts (44-58%) were disclosed within 15 days of treatment initiation. Incremental disclosures made during the 150-180 days of treatment were highest among neighbourhood contacts (12%), and was significantly different between treatment initiation and completion period. Middle aged TB patients (31 years and 46-55 years) were found less likely to disclose (AOR 0.56 and 0.46 respectively; p<0.05) and illiterates were found more likely to disclose their TB status (AOR 3.91; p<0.05). Post the disclosure, family contacts have mostly provided resource support (44.90%) and two third of all disclosed contacts have provided emotional support for TB patients (>71%). Conclusion Findings explain that family level disclosures were predominant and disclosures made to extra familial network contacts significantly increased during the latter part of treatment. Emotional support was predominantly received by TB patients from all their contacts post disclosure. Findings ...
Keywords	Medicine ; R ; Science ; Q
Subject code	610
Language	English
Publishing date	2023-01-01T00:00:00Z
Publisher	Public Library of Science (PLoS)
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article ; Online: A national-level analysis of life expectancy associated with the COVID-19 pandemic in India.

Muniyandi, Malaisamy / Singh, Pravin Kumar / Aanandh, Yamini / Karikalan, Nagarajan / Padmapriyadarsini, Chandrasekaran

Frontiers in public health

2022 Volume 10, Page(s) 1000933

Abstract: Background: From a demographic perspective, the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on life expectancy is not clear. Hence, there is a need to study the number of years of life lost concerning the existing average life ...

Abstract	Background: From a demographic perspective, the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on life expectancy is not clear. Hence, there is a need to study the number of years of life lost concerning the existing average life expectancy due to COVID-19 in India. Objective: This study aimed to estimate the impact of life expectancy due to the COVID-19 pandemic in India. Methodology: We considered day-wise age-specific mortality due to COVID-19 which was extracted from the COVID-19 data repository from March 11, 2020, to June 30, 2021, in India. All-cause mortality was collected from the United Nations population estimates. An abridged life table technique was utilized for calculating life expectancies based on all-cause mortality and mortality due to COVID-19. MortPak software was used to calculate the life expectancy with and without the COVID-19 pandemic. Life expectancy at birth in different age groups was estimated with respect to with and without COVID-19. Results: A total of 399,459 deaths due to COVID-19 were distributed age wise, and their corresponding life expectancy was calculated. The general mortality was compared with COVID-19 mortality for the various age groups, and it was observed that mortality due to COVID-19 was significantly higher among the elderly age group [i.e., 45 to 60 years (36%) and > 60 years (51%)] when compared with < 25 years (1%) and 26-44 years (11%) (trend Chi-square 7.59; Conclusion: Overall, it was estimated that COVID-19 has an impact on life expectancy by 0.12 years during the study period. Even though mortality due to COVID-19 was high, factors such as lockdown, vaccination, and accidents also had an influence on mortality. Thus, there is a need to assess the impact of COVID-19 on life expectancy in future.
MeSH term(s)	Infant, Newborn ; Humans ; Aged ; Middle Aged ; COVID-19/epidemiology ; Pandemics ; SARS-CoV-2 ; Communicable Disease Control ; Life Expectancy ; India/epidemiology
Language	English
Publishing date	2022-10-18
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2711781-9
ISSN	2296-2565 ; 2296-2565
ISSN (online)	2296-2565
ISSN	2296-2565
DOI	10.3389/fpubh.2022.1000933
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Article: Cost of screening, out-of-pocket expenditure & quality of life for diabetes & hypertension in India.

Brar, Sehr / Kaur, Gunjeet / Muniyandi, Malaisamy / Karikalan, Nagarajan / Bano, Henna / Bhansali, Anil / Jain, Sanjay / Kumari, Savita / Prinja, Shankar

The Indian journal of medical research

2023 Volume 157, Issue 6, Page(s) 498–508

Abstract: Background & objectives: The Government of India has initiated a population based screening (PBS) for noncommunicable diseases (NCDs). A health technology assessment agency in India commissioned a study to assess the cost-effectiveness of screening ... ...

Abstract	Background & objectives: The Government of India has initiated a population based screening (PBS) for noncommunicable diseases (NCDs). A health technology assessment agency in India commissioned a study to assess the cost-effectiveness of screening diabetes and hypertension. The present study was undertaken to estimate the cost of PBS for Type II diabetes and hypertension. Second, out-of-pocket expenditure (OOPE) for outpatient care and health-related quality of life (HRQoL) among diabetes and hypertension patients were estimated. Methods: Economic cost of PBS of diabetes and hypertension was assessed using micro-costing methodology from a health system perspective in two States. A total of 165 outpatients with diabetes, 300 with hypertension and 497 with both were recruited to collect data on OOPE and HRQoL. Results: On coverage of 50 per cent, the PBS of diabetes and hypertension incurred a cost of ₹ 45.2 per person screened. The mean OOPE on outpatient consultation for a patient with diabetes, hypertension and both diabetes and hypertension was ₹ 4381 (95% confidence interval [CI]: 3786-4976), ₹ 1427 (95% CI: 1278-1576) and ₹ 3932 (95% CI: 3614-4250), respectively. Catastrophic health expenditure was incurred by 20, 1.3 and 14.8 per cent of patients with diabetes, hypertension and both diabetes and hypertension, respectively. The mean HRQoL score of patients with diabetes, hypertension and both was 0.76 (95% CI: 0.72-0.8), 0.89 (95% CI: 0.87-0.91) and 0.68 (95% CI: 0.66-0.7), respectively. Interpretations & conclusions: The findings of our study are useful for assessing cost-effectiveness of screening strategies for diabetes and hypertension.
MeSH term(s)	Humans ; Health Expenditures ; Diabetes Mellitus, Type 2/diagnosis ; Diabetes Mellitus, Type 2/epidemiology ; Quality of Life ; Hypertension/diagnosis ; Hypertension/epidemiology ; India/epidemiology
Language	English
Publishing date	2023-08-01
Publishing country	India
Document type	Journal Article
ZDB-ID	390883-5
ISSN	0971-5916 ; 0019-5340
ISSN	0971-5916 ; 0019-5340
DOI	10.4103/ijmr.IJMR_389_20
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Article ; Online: Estimating TB diagnostic costs incurred under the National Tuberculosis Elimination Programme: a costing study from Tamil Nadu, South India.

Muniyandi, Malaisamy / Lavanya, Jayabal / Karikalan, Nagarajan / Saravanan, Balakrishnan / Senthil, Sellappan / Selvaraju, Sriram / Mondal, Rajesh

International health

2021 Volume 13, Issue 6, Page(s) 536–544

Abstract: Background: The National Tuberculosis Elimination Programme (NTEP) of India is aiming to eliminate TB by 2025. The programme has increased its services and resources to strengthen the accurate and early detection of TB. It is important to estimate the ... ...

Abstract	Background: The National Tuberculosis Elimination Programme (NTEP) of India is aiming to eliminate TB by 2025. The programme has increased its services and resources to strengthen the accurate and early detection of TB. It is important to estimate the cost of TB diagnosis in India considering the advancement and implementation of new diagnostic tools under the NTEP. The objective of this study was to estimate the unit costs of providing TB diagnostic services at different levels of public health facilities with different algorithms implemented under the NTEP in Chennai, Tamil Nadu, South India. Methods: This costing study was conducted from the perspective of the health system. This study used only secondary data and information that were available in the public domain. Data were collected with the approval of health authorities. The patient's diagnostic path from the point of registration until the final diagnosis was considered in the costing exercise. The unit costs of different diagnostic tools used in the NTEP implemented by Chennai Corporation were calculated. Results: We estimated the unit cost of the eight laboratory tests (Ziehl-Neelsen [ZN], fluorescence microscopy [FM], x-ray, digital x-ray, gene Xpert MTB/RIF (cartridge-based nucleic acid amplification test [NAAT] that identifies rifampicin resistant Mycobacterium Tuberculosis) Mycobacterium Tuberculosis/Rifampicin [MTB/RIF], mycobacteria growth indicator tube [MGIT], line probe assay [LPA] and Lowenstein Jensen [LJ] culture) for diagnosis of drug-sensitive and drug-resistant TB. The unit costs included fixed and variable costs for smear examination by ZN microscopy (₹ [Indian Rupee] 326 [US${\$}$4.72], FM (₹104 [US${\$}$1.5]), x-ray (₹218 [US${\$}$3.15]), digital X-ray (₹281 [US${\$}$4.07]), gene Xpert MTB/RIF (₹1137 [US${\$}$16.47]), MGIT (₹7038 [US${\$}$102]), LPA (₹6448 [US${\$}$93.44]) and LJ culture (₹4850 [US${\$}$70.28]). Out of 10 diagnostic algorithms used for TB diagnosis, algorithms using only smear microscopy had the lowest cost, followed by smear microscopy with x-ray for drug-sensitive TB (₹104 [US${\$}$1.5] to ₹544 [US${\$}$7.88]). Diagnostic algorithms for drug-resistant TB involving LPA and gene Xpert MTB/RIF were the most expensive. Conclusions: Understanding the various costs contributing to TB diagnosis in India provides crucial evidence for policymakers, programme managers and researchers to optimise programme spending and efficiently use resources.
MeSH term(s)	Humans ; India ; Mycobacterium tuberculosis ; Sensitivity and Specificity ; Sputum ; Tuberculosis/diagnosis ; Tuberculosis/prevention & control ; Tuberculosis, Multidrug-Resistant/diagnosis
Language	English
Publishing date	2021-02-10
Publishing country	England
Document type	Journal Article
ZDB-ID	2526175-7
ISSN	1876-3405 ; 1876-3413
ISSN (online)	1876-3405
ISSN	1876-3413
DOI	10.1093/inthealth/ihaa105
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Article ; Online: Diagnostic accuracy of mercurial versus digital blood pressure measurement devices: a systematic review and meta-analysis.

Muniyandi, Malaisamy / Sellappan, Senthil / Chellaswamy, Vidya / Ravi, Karunya / Karthikeyan, Sananthya / Thiruvengadam, Kannan / Selvam, Jerard Maria / Karikalan, Nagarajan

Scientific reports

2022 Volume 12, Issue 1, Page(s) 3363

Abstract: This study aims to systematically review the diagnostic accuracy of a digital blood pressure measurement device compared to the gold standard mercury sphygmomanometer in published studies. Searches were conducted in PubMed, Cochrane, EBSCO, EMBASE and ... ...

Abstract	This study aims to systematically review the diagnostic accuracy of a digital blood pressure measurement device compared to the gold standard mercury sphygmomanometer in published studies. Searches were conducted in PubMed, Cochrane, EBSCO, EMBASE and Google Scholar host databases using the specific search strategy and filters from 1st January 2000 to 3rd April 2021. We included studies reporting data on the sensitivity or specificity of blood pressure measured by digital devices and mercury sphygmomanometer used as the reference standard. Studies conducted among children, special populations, and specific disease groups were excluded. We considered published manuscripts in the English language only. The risk of bias and applicability concerns were assessed based on the author's judgment using the QUADAS2 manual measurement evaluation tool. Based on the screening, four studies were included in the final analysis. Sensitivity, specificity, diagnostic odds ratio (DOR), and 95% confidence interval were estimated. The digital blood pressure monitoring has a moderate level of accuracy and the device can correctly distinguish hypertension with a pooled estimate sensitivity of 65.7% and specificity of 95.9%. After removing one study, which had very low sensitivity and very high specificity, the pooled sensitivity estimate was 79%, and the specificity was 91%. The meta-analysis of DOR suggests that the digital blood pressure monitor had moderate accuracy with a mercury sphygmomanometer. This will provide the clinician and patients with accurate information on blood pressure with which diagnostic and treatment decisions could be made.
MeSH term(s)	Blood Pressure ; Blood Pressure Determination ; Child ; Humans ; Mercury ; Sensitivity and Specificity ; Sphygmomanometers
Chemical Substances	Mercury (FXS1BY2PGL)
Language	English
Publishing date	2022-03-01
Publishing country	England
Document type	Journal Article ; Meta-Analysis ; Systematic Review
ZDB-ID	2615211-3
ISSN	2045-2322 ; 2045-2322
ISSN (online)	2045-2322
ISSN	2045-2322
DOI	10.1038/s41598-022-07315-z
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Article: Can Students Learn from Their Co-Students About Tuberculosis? Outcomes from Student-Friendly Quasi-Experimental Intervention Study in India.

Rebecca, B Priscilla / Angamuthu, Dhanalakshmi / Watson, Basilea / Beena, E Thomas / Balaguru, S / Premkumar, Jacob / Suresh, Chandra / Karikalan, Nagarajan

Indian journal of community medicine : official publication of Indian Association of Preventive & Social Medicine

2022 Volume 47, Issue 4, Page(s) 527–530

Abstract: Background: The World Health Organization's "End TB Strategy" aims to end global tuberculosis (TB) epidemic through a holistic combination of health and social interventions placing the patients and communities at the heart of the response. This study ... ...

Abstract	Background: The World Health Organization's "End TB Strategy" aims to end global tuberculosis (TB) epidemic through a holistic combination of health and social interventions placing the patients and communities at the heart of the response. This study aimed to assess the effectiveness of utilizing school children as ambassadors in TB advocacy. Materials and methods: We adopted a quasi-experimental intervention design where students' awareness level was assessed before and after the intervention. A total of 185 student ambassadors were trained to conduct interventions in schools, and 920 students were randomly selected to assess the impact of the ambassador's intervention. A structured questionnaire was used to assess the correct and incorrect knowledge on specific aspects of TB. This intervention study was implemented in a phased manner which involved a participatory formative phase. A student-friendly and culturally relevant educational materials and activities for providing TB knowledge for the study student population were developed. Data collected from the baseline and end-line evaluation surveys were analyzed using STAT Ver. 16.0.- Stata Corp., June 2016, USA. Results: A significant increase (>80%; Conclusions: School students lead intervention could significantly improve correct knowledge on TB and could be replicated.
Language	English
Publishing date	2022-12-14
Publishing country	India
Document type	Journal Article
ZDB-ID	2085330-0
ISSN	1998-3581 ; 0970-0218
ISSN (online)	1998-3581
ISSN	0970-0218
DOI	10.4103/ijcm.ijcm_1441_21
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