The Tanner-Whitehouse 3 (TW3) method recognized globally for assessing skeletal maturity are based primarily on Western and East Asian populations, limiting their accuracy when applied to Indian children. The objective of present study was to develop population-specific reference values for Skeletal Maturity Scores (SMS) in Indian children aged 1-18 years using the TW radius-ulna-short bones (RUS-13) system, and to validate these data against the in vogue TW3 system. This retrospective study analysed 3,549 left-hand radiographs (1,741 boys; 1,808 girls) from healthy Indian children obtained from previously approved bone age studies conducted between 2021 and 2024. Radiographs were scored using the TW3 RUS-13 method by two trained observers. Age- and sex-specific median SMS values were computed and smoothed using Gaussian curve fitting. The Indian SMS was validated prospectively in 50 children (20 healthy, 30 with endocrine disorders) and retrospectively for adult height prediction by substituting Indian bone ages into TW3 adult height prediction equations. SMS values increased progressively with age, showing earlier skeletal maturation in girls than boys. Indian children reached full skeletal maturity (SMS=1,000) at ∼16.5 years in girls and ∼17.5 years in boys. Comparison with TW2 and TW3 references indicated that Indian maturation patterns lie between these datasets. Validation demonstrated strong agreement between Indian and TW3 bone ages (ICC>0.95) and improved accuracy in adult height prediction using Indian SMS (mean absolute error = -0.1 cm for Indian vs. -0.9 cm for TW3). This study provides the first comprehensive Indian reference for skeletal maturity assessment. The Indian SMS enhances clinical accuracy for growth evaluation, endocrine diagnosis, and height prediction, supporting region-specific references for pediatric skeletal maturity.
This study aimed to evaluate the clinical, biochemical, and functional outcomes of sacubitril/valsartan therapy in Indian patients with heart Failure (HF) with reduced ejection fraction (HFrEF) in routine practice. We conducted a retrospective, single-centre, observational study at The Heart Clinic, New Delhi, India. Adult patients (≥18 years) with the New York Heart Association (NYHA) class II-IV HF who were newly initiated on sacubitril/valsartan and had ≥12 months of follow-up were included in the study. Clinical, echocardiographic, and biochemical data were extracted from the electronic medical records. The primary outcomes at 12 months were changes in left ventricular ejection fraction (LVEF), NYHA classification, N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels, estimated glomerular filtration rate (eGFR), and the number of patients receiving the maximum dose of sacubitril/valsartan. The secondary outcomes were cardiovascular and all-cause mortality. A total of 300 patients were analyzed (mean age, 61.3 years; 69.7% male). Hypertension (266 patients, 88.7%), diabetes (163 patients, 54.3%), and chronic kidney disease (153 patients, 51%) were the most frequent comorbidities. At 12 months, the mean LVEF increased significantly from 29.57% to 34.66% (absolute gain of 5.09%, P<0.0001). A significant improvement in functional ability was observed, with 282 patients (94%) classified as NYHA class II at 12 months compared with 22 patients (7.3%) at baseline (P<0.0001), and the NT-proBNP levels decreased from 2344.5 ± 1951.8 pg/mL to 564 ± 410.3 pg/mL (P<0.0001). Renal function remained stable (mean change in eGFR +2.01 mL/min/1.73 m2, P=0.088). Over half of the cohort (52.3%) achieved a target dose of 200 mg twice daily. No cardiovascular or all-cause deaths were observed. In this real-world Indian cohort, sacubitril/valsartan was associated with significant improvements in systolic function, functional class, and NT-proBNP levels, with preserved renal function and good tolerability. These findings support the use of sacubitril/valsartan as a cornerstone therapy for HFrEF management in routine clinical practice.
India bears a high burden of thalassemia, underscoring the need for enhanced awareness, systematic screening, and standardized, high-quality care. In the absence of indigenous guidelines, gaps remain in knowledge and care delivery. To address this, the Pediatric Hematology Oncology Chapter of the Indian Academy of Pediatrics (IAP-PHO) is issuing evidence-based regional guidelines tailored to the Indian context. The primary objective of these guidelines is to establish nationally accepted standards for the diagnosis, comprehensive management, and prevention of thalassemia syndromes, incorporating the latest and locally relevant evidence. These evidence-based guidelines were developed through structured deliberations by 67 national experts under the IAP-PHO, incorporating iterative literature review, expert consensus, and context-specific considerations for India. The evidence quality (levels A-D, X) and strength of recommendation (strong, moderate, weak) are graded using the updated American Academy of Pediatrics framework. These guidelines provide a comprehensive, evidence-based framework for thalassemia care in India, encompassing prevention, diagnosis, transfusion and chelation, complication management, curative therapies and systems-based care, including day-care services and transition to adult care. Regular transfusion therapy with leukodepleted packed red cells to maintain pre-transfusion hemoglobin of 9.5-10.5 g/dL is the cornerstone of management in transfusion-dependent thalassemia (TDT), with individualized adjustment in special situations such as cardiac dysfunction. Iron chelation therapy should be initiated after 10-20 transfusions or when serum ferritin (SF) exceeds 1000 ng/mL; oral deferasirox is the preferred first-line agent. Combination therapy using deferasirox, and/or deferiprone and/or desferrioxamine is recommended when monotherapy with either deferasirox or deferiprone fails to reduce SF to < 2500 ng/mL or in the case of poor tolerance to one agent or when there is evidence of significant organ iron overload on T2*MRI (magnetic resonance imaging); de-escalation of chelation is recommended when SF approaches < 500 ng/mL. Comprehensive multidisciplinary care, incorporating systematic screening and timely interventions for cardiac, hepatic, endocrine, and skeletal complications, is strongly recommended. Early counseling for hematopoietic stem cell transplantation (HSCT) should be offered at diagnosis, with transplantation preferably performed at a younger age. Universal antenatal screening, cascade screening, and access to prenatal diagnosis, are critical to reducing disease burden. Emerging disease-modifying therapies may be considered in selected patients, with evolving pediatric data. Delivery of care through dedicated thalassemia day-care centers and structured transition to adult services is recommended to ensure continuity of care and best quality of life.
Digital inclusion may influence how women access health information and health services, but state-level evidence linking women's digital inclusion with women's health indicators in India remains limited. This study examined ecological associations between women's internet use, women's own mobile phone use, and selected women's health indicators across Indian states and union territories. This ecological cross-sectional secondary analysis used an uploaded aggregated National Family Health Survey 2019-2021 (NFHS-5) state-level dataset. The India aggregate was excluded, leaving 36 states and union territories. Primary exposures were women who had ever used the internet and women having a mobile phone that they themselves use. Priority outcomes included menstrual hygiene, anemia, maternal health, contraception, and cancer screening indicators. Descriptive statistics, Pearson and Spearman correlations, simple linear regression, exploratory education-adjusted models, and NFHS-4 to NFHS-5 change analyses were conducted. Among 36 states and union territories, women's internet use ranged from 20.6% in Bihar to 76.7% in Sikkim, while women's own mobile phone use ranged from 38.5% in Madhya Pradesh to 91.2% in Goa. Menstrual hygiene was moderately and positively correlated with internet use (Pearson r = 0.615, p < 0.001) and mobile phone use (r = 0.583, p < 0.001). Anemia among women aged 15-49 years was negatively correlated with internet use (r = -0.432, p = 0.009) and mobile phone use (r = -0.464, p = 0.004). Maternal health, contraception, and cancer screening indicators showed weaker and less consistent associations. In exploratory models adjusted for women's schooling, the associations with menstrual hygiene and anemia were substantially attenuated and were no longer statistically significant. Higher women's digital inclusion was ecologically associated with better menstrual hygiene and lower anemia prevalence across Indian states and union territories, but associations were weaker for several service-use outcomes. These findings are ecological and should not be interpreted as individual-level or causal evidence. Digital inclusion should be considered part of a broader social and health system context for women's health equity.
Sudden cardiac arrest is a major public health concern with survival rates of less than 10% for out-of-hospital cardiac arrests in India. Integrating basic life support (BLS) training into school curricula is a promising strategy for widespread resuscitation education. This quasi-experimental study aimed to compare the effectiveness of BLS training among middle school (class 6-8) and high school (class 9-10) students in Northeast India. A total of 106 students were enrolled, equally divided between the two groups. The training included a pretest to assess baseline knowledge, a 1-h theory session, and a practical session with manikin demonstrations. Post-training assessments evaluated both knowledge gain and practical skill performance. Twelve key cardiopulmonary resuscitation (CPR) skills were scored using a structured checklist based on the American Heart Association guidelines. Statistical analysis included paired t-tests for within-group comparisons and unpaired t-tests for between-group comparisons. Middle school students showed significant improvement in knowledge scores (pretest mean: 11.9, posttest mean: 14.28; t = -11.85, p < 0.001). High school students also improved (pretest mean: 13.62, posttest mean: 14.83; t = -6.62, p < 0.001) but with a smaller effect size. In practical skills, high school students outperformed middle school students in key areas such as patient assessment and correct CPR rate. However, no significant differences were found in skills like hand placement and airway management across age groups. BLS training is effective across age groups, but high school students exhibit superior skill retention and application. Early introduction and reinforcement during high school are recommended.
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Vibrio fluvialis is an emerging enteric pathogen increasingly implicated in diarrhoeal disease outbreaks and sporadic infections, particularly in low- and middle-income countries. Reports of multidrug resistance (MDR) in this species are rising; however, comprehensive genomic data from Indian clinical isolates remain limited. A detailed understanding of its antimicrobial resistance (AMR) determinants, virulence repertoire, and population structure is essential for guiding surveillance and public health interventions. We performed whole-genome sequencing of clinical V. fluvialis isolates collected in India between 2019 and 2025. High-quality draft genomes were subjected to in silico analyses to identify acquired AMR genes, chromosomal resistance determinants, virulence-associated genes, and mobile genetic elements including plasmids and integrative elements. To contextualize Indian isolates within the global population structure, we conducted single nucleotide polymorphism (SNP)-based phylogenetic analysis incorporating publicly available V. fluvialis genomes from diverse geographic and ecological sources. Phylogenetic clustering was examined to explore evolutionary relationships and potential links between clinical, environmental, and non-human isolates. Indian clinical isolates demonstrated considerable genomic diversity and harbored a broad array of AMR genes conferring resistance to commonly used antimicrobial classes. Several resistance determinants were associated with mobile genetic elements, underscoring the role of horizontal gene transfer in shaping the resistome. Virulence profiling identified genes linked to adhesion, toxin production, and intestinal colonization. SNP-based phylogeny revealed that Indian isolates were distributed across multiple global lineages, with certain clusters including environmental and non-human isolates, suggesting potential environmental reservoirs and transmission interfaces. This study provides a comprehensive genomic overview of contemporary Indian clinical V. fluvialis isolates within a global framework. The findings highlight the genetic diversity, MDR potential, and possible environmental connectivity of this emerging pathogen, reinforcing the need for sustained genomic surveillance and a One Health approach to its monitoring and control.
Acute pancreatitis is a serious, life-threatening illness. Its early prediction can reduce the risk of organ dysfunction, morbidity, mortality, and hospital burden. Though many validated scores are being used in practice in predicting organ dysfunction and mortality among patients with acute pancreatitis, the triglyceride-glucose (TyG) index can also assess mortality risk in the same condition. However, there is a scarcity of studies assessing the predictive value of the TyG index in the Indian subcontinent. Hence, we planned to evaluate the diagnostic and prognostic value of the TyG index among patients with acute pancreatitis. This observational study was conducted at Kalinga Institute of Medical Sciences (KIMS), Bhubaneswar, India, from December 15, 2025, to May 15, 2026. We obtained ethical approval prior to the commencement of the study. We assessed the TyG index in patients with acute pancreatitis admitted to our hospital during the study period. We compared those values with existing validated scores, such as the modified Marshall score and the Bedside Index for Severity in Acute Pancreatitis (BISAP) score. We computed the sensitivity, specificity, diagnostic accuracy, and threshold values of the TyG index for diagnosing organ dysfunction in patients with acute pancreatitis and predicting in-hospital mortality of the study participants. R software (version 4.3.2) was used for data analysis. We analyzed 185 patients with acute pancreatitis in this study. The study population's mean age was 54.8 ± 9.6 years. In our study, 138 (74.6%) participants were males. The mean serum amylase, lipase, triglyceride, and fasting blood glucose values were 553.3 U/L, 1148.6 U/L, 269.1 mg/dL, and 109.4 mg/dL, respectively. The mean TyG index was 8.98 ± 0.76. 24 (13.0%) patients died during their hospital stay. The sensitivity, specificity, diagnostic accuracy, and threshold values of the TyG index in predicting organ dysfunction in patients with acute pancreatitis were 29.6%, 33.3%, 29.7%, and 7.11, respectively. The sensitivity, specificity, diagnostic accuracy, and threshold values of the TyG index in predicting in-hospital mortality were 70.8%, 51.6%, 54.1%, and 6.70, respectively. We found that the TyG index had lower diagnostic accuracy for predicting organ dysfunction in patients with acute pancreatitis than the modified Marshall score. However, it had better prognostic performance in assessing the mortality risk.
Healthcare systems worldwide face the combined pressures of chronic diseases, aging populations, and fragmented care delivery. Family Medicine offers a pragmatic, cost-effective, and person-cantered solution to these systemic challenges. This article urges medical graduates-particularly in India-to consider postgraduate training in Family Medicine, whether through MD, DNB, or Diploma programs. Drawing international comparisons, especially with the UK's NHS and the U.S. Indian Health Service (IHS), I highlight the transformative potential of Family Medicine in creating equitable, resilient healthcare systems.
Primary Health Centre (PHC) coverage in Himalayan India is constrained by terrain, dispersed settlement and a population-based norm (one PHC per 20,000 in hilly areas) that treats elevation as exogenous. Existing accessibility analyses describe these gaps but rarely evaluate the resource-allocation trade-offs of closing them. Using village-level Census 2011 data and PHC locations from the Department of Medical Health and Family Welfare, Uttarakhand, we mapped catchment areas in Chamoli and Rudraprayag using Voronoi polygons and 5/10/15-km buffers, and recomputed coverage with attention to the limitations of Euclidean distance in mountainous terrain. We then built a resource-allocation model comparing four scenarios: status quo (S0); strict NHM compliance at one PHC per 20,000 population (S1); a coverage-optimised scenario that adds the minimum number of PHCs needed to bring the share of population beyond 15 km below 5% (S2); and an altitude-adjusted dynamic threshold (S3). Costs used Indian Public Health Standards-aligned parameters (capital ₹1.85 crore per new PHC; recurring ₹86 lakh per PHC per year, 2024 prices) discounted at 5% over a 10-year horizon, with one-way sensitivity analysis. At baseline, 23% of Chamoli's population and 2% of Rudraprayag's lay beyond 15 km of any PHC (combined 83.7% coverage; ~94,000 people uncovered). Achieving strict NHM compliance (S1) required 18 additional PHCs at a 10-year present-value (PV) cost of ₹275 crore (incremental cost-effectiveness ratio ICER ₹19,671 per additional person covered). The coverage-optimised scenario S2 required only 6 additional PHCs, reached 96.0% coverage at ₹158 crore PV cost, and dominated all alternatives with an ICER of ₹8,373 per additional person covered. The altitude-adjusted scenario (S3) achieved near-complete coverage but at the highest cost (ICER ₹29,274). Results were most sensitive to the time horizon and recurring cost; capital cost had a small effect (±₹3 crore for ± 25% variation). A small, geographically targeted expansion of the PHC network in upper Chamoli yields the largest cost-effectiveness gains and accounts for most of the avoidable access gap. Population thresholds alone are an unreliable allocation rule in mountainous districts; explicit coverage-cost optimisation should inform Health and Wellness Centre placement under Ayushman Bharat in hill regions.
Behavioural medicine, at the intersection of behavioural science and medicine, aims to understand how behaviour influences health and to design interventions for better quality of life. Focusing on the interplay between behaviours, psychological processes, and biological factors, the field applies behavioural principles to prevent, diagnose, and treat medical conditions. Its key components include application of psychosocial and behavioural paradigms for the analysis of health promotion, disease prevention, and adherence to medical treatment. In public health, behavioural medicine plays a pivotal role by contributing to initiatives promoting healthy behaviours, identifying risk factors, and addressing social determinants of health. Despite its potential to contribute to this field, behavioural medicine has limitations, including the complexity of human behaviour and challenges in sustaining long-term behaviour change. In modern era medicine, focus is on evidence-based practice. In this context, N-of-1 trials, or single-subject trials, introduce a personalized approach to behavioural medicine research. The logic for the focus on individual patients is that 'each person is unique'. These trials focus on individual patients, systematically implementing and evaluating behavioural interventions over multiple cycles. By randomizing and blinding interventions, collecting repeated measures of outcomes, and prioritizing patient-centred outcomes, N-of-1 trials offer a nuanced understanding of how specific interventions impact individual health. While literature on N-of-1 trials in behavioural medicine is limited, they hold promise in tailoring interventions to individuals, addressing the diverse and dynamic nature of human behaviour in health contexts.
To characterize the genotypic and phenotypic spectrum of children with genetically confirmed hereditary spastic paraplegia (HSP) at a tertiary care center in Northern India. This prospective case series included patients with genetically confirmed (whole exome sequencing or clinical exome sequencing) HSP attending the Medical Genetics Clinic of a tertiary care center in Northern India between 2018 and 2023. Neurological and radiological assessments were also conducted. A total of 21 patients from 16 families were included. The median (q1, q3) age of onset of symptoms was 5 (1.5, 8.5) years, and the median (q1, q3) age of diagnosis was 8 (5, 13.5) years. The most common features at diagnosis were toe walking with progressive spasticity of lower limbs. Genetic testing identified 18 variants across eight different genes, including six pathogenic variants, 10 likely pathogenic variants, and two variants of uncertain significance (VUS). Thirteen families had autosomal recessive (AR) HSP, two had autosomal dominant (AD) HSP, and one had X-linked HSP. The most frequently identified subtype was SPG35 (spastic paraplegia type 35), observed in six families, followed by SPG11 in three families and SPG52 in two families. There was one family each with SPG18B, SPG15, CSPSD (cataracts, spastic paraplegia, and speech delay), SPG4, and SPG2. Hereditary spastic paraplegia exhibits genotypic and phenotypic heterogeneity with a predominance of AR inheritance. Five novel variants and some recurrent variants, suggesting potential founder effects, were noted. HSP should be suspected in cases with slowly progressive spasticity in lower limbs, even without a family history, which may mimic cerebral palsy.
Obesity is increasingly affecting military personnel, yet its accurate assessment remains challenging because body mass index (BMI) does not distinguish between fat and lean mass; percent body fat (PBF) offers a more physiologically meaningful alternative. However, data on PBF-defined obesity prevalence and its predictors among elite Indian military personnel, such as Indian federal contingency force (IFCF) commandos, remain scarce. We conducted a cross-sectional study among 116 IFCF personnel stationed in Gujarat, western India. PBF was measured using direct segmental multi-frequency bioelectrical impedance analysis (InBody 770) and served as the reference standard, with PBF-defined obesity considered as PBF ≥ 25%. BMI-based obesity was classified using both Asian (BMI ≥ 25 kg/m²) and WHO (BMI ≥ 30 kg/m²) criteria, with diagnostic accuracy of BMI evaluated via receiver operating characteristic (ROC) analysis. Data on demographics, service-related factors, physical activity (Global Physical Activity Questionnaire), and eating behavior (Adult Eating Behavior Questionnaire) were additionally collected, and predictors of obesity identified using multivariable Firth-penalized logistic regression. PBF-defined obesity prevalence was 16% (95% confidence interval [CI]: 10-23%). The Asian BMI criterion overestimated obesity at 28% (95% CI: 20-36%), while the WHO criterion identified no obese individuals. BMI demonstrated good discriminative ability (AUC, 0.85; 95% CI: 0.75-0.95). The Asian BMI criterion showed sensitivity of 78% and specificity of 82%. The empirically derived optimal cut-off (25.4 kg/m²), closely approximated the Asian threshold. Each additional year of age increased obesity odds by 15% (95% CI: 1.03-1.31), those recruited from central armed police forces had 75% lower odds compared to army (95% CI: 0.06-0.83), and every additional 1000 MET-minutes/week of physical activity reduced obesity odds by 31% (95% CI: 0.45-0.98). Approximately one in six IFCF commandos were obese by PBF-based criterion. The WHO BMI criterion substantially underestimated obesity, while the Asian BMI criterion closely aligned with the PBF-derived cut-off. These findings support the Asian BMI criterion for obesity screening, while supplementary PBF assessment may be considered where feasible. Obesity prevention efforts should prioritize individuals at greater risk, such as older personnel and those in service roles involving relatively lower physical activity.
Age estimation is an important component of forensic identification, particularly in cases involving unknown, decomposed, mutilated, or skeletonized human remains. Following completion of skeletal maturity, commonly used indicators such as epiphyseal fusion become less reliable, making evaluation of other skeletal structures necessary. The sternum is considered useful in forensic age estimation because of its resistance to decomposition and progressive fusion changes during adult life. The present study was conducted to evaluate the relationship between age and fusion of different sternal elements in the North Indian population. A prospective cross-sectional study was conducted in a tertiary care centre of southern Haryana, India. A total of 115 medico-legal autopsy cases of known age, aged 15 years and above, were included in the study. The sternum was dissected during autopsy, and the fusion status of the body of the sternum, xiphisternal joint, and manubriosternal joint was assessed grossly. Statistical analysis was performed using IBM SPSS Statistics for Windows, version 29.0 (IBM Corp., Armonk, New York, United States), and associations between fusion patterns and age groups were evaluated using Pearson's Chi-square test. Fusion of the body of the sternum was observed in almost all cases and did not show a statistically significant association with age (p = 0.910). In contrast, fusion of the xiphisternal joint and manubriosternal joint increased progressively with advancing age. Chi-square analysis demonstrated a statistically significant association between xiphisternal joint fusion and advancing age (χ² = 10.152, p = 0.038), while manubriosternal joint fusion approached statistical significance (χ² = 7.467, p = 0.058). Xiphisternal fusion was absent below 25 years and became progressively more frequent in older age groups, whereas manubriosternal fusion was predominantly observed after 35 years of age. Female cadavers demonstrated slightly earlier and higher fusion rates in advanced age groups compared to male cadavers. Binary logistic regression demonstrated that xiphisternal and manubriosternal fusion were significant independent predictors of age ≥45 years, with the combined model showing excellent discriminatory ability (area under the curve (AUC) = 0.896). Fusions of the xiphisternal and manubriosternal joints are potential supportive indicators demonstrating significant age-associated trends, particularly beyond the fourth decade of life. Fusion of the body of the sternum has limited forensic significance because of its early completion and lack of progressive age-related variation. Assessment of sternal fusion should be interpreted in conjunction with other skeletal indicators and population-specific standards for improved medico-legal accuracy.
We examined the association of uranium in community water systems (CWS) and in urine with type 2 diabetes (T2D) incidence in the Strong Heart Family Study (SHFS), a prospective study of American Indian communities, and the Multi-Ethnic Study of Atherosclerosis (MESA), a prospective study of racially and ethnically diverse urban U.S. communities. We evaluated participants from SHFS (N=1,609) and MESA (N=3,080) with CWS and urine uranium available, free of T2D at baseline (2001-2003 and 2000-2002, respectively). We used Cox mixed-effects models to account for clustering by residential ZIP Code and family (SHFS), and estimated hazard ratios (HRs) of incident T2D per log2-increase and across categories of CWS and urine uranium adjusted for T2D risk factors and arsenic levels. Urinary models accounted for kidney function. Incident T2D cases were 198 in SHFS (mean follow-up 5.6 years) and 525 in MESA (mean follow-up 13.8 years). In a meta-analysis across SHFS and MESA, the adjusted HR (95% CI) of incident T2D was 0.97 (0.89, 1.04) and 1.01 (0.97, 1.06) per log-doubling of CWS and urine uranium, respectively. We observed a stronger association between uranium exposure and T2D among participants with lower BMI compared to higher BMI in both cohorts, although this finding was limited by small case sizes in the lowest BMI subgroups. CWS and urine uranium were not statistically associated with T2D across U.S. cohorts with low uranium exposure (median <1.2 μg/L). Given the importance of uranium exposure, further evidence is needed at low- to moderate- exposure levels.
Chronic obstructive pulmonary disease (COPD) remains a leading global health burden, with acute exacerbations accelerating functional decline and impairing quality of life. Reduced inhaler adherence is a well-recognized contributor to exacerbations and poorer outcomes in COPD. While self-management interventions are well established in stable COPD, their initiation during acute exacerbations has been inadequately explored. This randomized controlled trial, conducted in a South Indian tertiary hospital between July 2024 and May 2025, evaluated the effectiveness of a structured self-management program initiated during hospitalization for acute exacerbation of COPD. The intervention included individualized counseling, family engagement, structured telephonic follow-ups (weekly for 3 months, then monthly for 3 months), and scheduled outpatient reviews, while controls received standard care. Primary outcomes were inhaler adherence assessed by the Test of Adherence to Inhalers, health-related quality of life (HRQoL) measured with the St. George's Respiratory Questionnaire (SGRQ), and functional capacity assessed by the six-minute walk test. At six months, good inhaler adherence was observed in 66.7% of the intervention group compared to 10% of controls (p<0.001). The mean between-group difference in six-minute walk distance at six months was 92.8 meters [95% confidence interval (CI): 58.1 to 127.6; p<0.001], favoring the intervention group. HRQoL also improved significantly, with a mean between-group difference in SGRQ score of -38.2 (95% CI: -46.7 to -29.8; p<0.001). These findings indicate that initiating structured self-management during hospitalization for acute exacerbation of COPD results in significant improvements in inhaler adherence, functional capacity, and quality of life. Integrating self-management into acute care pathways may therefore optimize patient-centered outcomes in this high-risk population.
Mild cognitive impairment (MCI) represents a transitional state between normal cognitive aging and dementia, with significant implications for public health. The objective of our study was to estimate the pooled prevalence of MCI among Indian elderly individuals (≥60 years). We conducted a systematic review and meta-analysis in accordance with PRISMA-2020 guidelines. Four databases (PubMed, Scopus, Embase, Web of Science) were searched up to January 2025. Twenty-six studies met the eligibility criteria. Random-effects models were used to calculate pooled prevalence with 95% confidence intervals (CIs), stratified by community- and hospital-based settings. Heterogeneity was assessed using I² and τ² statistics. Subgroup and meta-regression analyses examined potential sources of heterogeneity. Publication bias was evaluated using funnel plots, Egger's regression test. The methodological quality of included studies was assessed using the Joanna Briggs Institute Critical Appraisal Checklist for Prevalence Studies. The pooled prevalence of MCI was 21% (95% CI: 13%-29%) in community settings and 44% (95% CI: 31%-57%) in hospital-based populations. Higher prevalence was observed among individuals with type 2 diabetes (53%), hypertension (57%), and those undergoing hemodialysis (38%). Diagnostic tool choice significantly influenced prevalence, with MoCA-based assessments yielding higher estimates than MMSE or Petersen criteria. Substantial heterogeneity was present across studies (I² >96%). Publication bias was minimal. MCI is prevalent among India's elderly population, particularly in individuals with chronic conditions. These findings underscore the need to integrate cognitive screening into national noncommunicable disease programs and to adopt standardized, context-appropriate diagnostic protocols for early identification and intervention.
Type 2 diabetes (T2D) is primarily a lifestyle-related disorder, which can be controlled by early detection of high-risk individuals with diabetes. It will be beneficial to halt the onset of diabetes by adopting lifestyle modification tools such as Yoga. The present research work emphasizes upon detecting the high-risk individual for diabetes through the Indian Diabetes Risk Score (IDRS). This manuscript addresses an important gap in lifestyle intervention research by highlighting the role of non-glycemic pathways in prediabetes management. Beyond conventional glucose regulation, the findings underscore how yoga-based interventions may influence broader metabolic, psychological, and cognitive domains that are critical in delaying or preventing disease progression. The study carries meaningful implications for preventive healthcare policy and practice. The findings also lay a strong scientific foundation for future longitudinal and mechanistic investigations into the durability of yoga's effects on metabolic regulation, stress resilience, and cognitive health, thereby advancing the evidence base for holistic approaches to chronic disease prevention.
Migraine is a prevalent primary headache disorder associated with substantial disability. Restless legs syndrome (RLS), a sensorimotor disorder linked to dopaminergic dysfunction, has been increasingly reported as a comorbidity in migraine, particularly in chronic forms and those with aura. Data on this association in the Indian population remain limited. To determine the prevalence of RLS in patients with migraine and assess clinical correlations including age, gender, aura status, disease duration, and disability. A cross-sectional observational study was conducted over 12 months at a tertiary care hospital in North India. Adults aged 18-65 years diagnosed with migraine (ICHD-3 criteria) were consecutively enrolled. RLS was diagnosed using IRLSSG criteria. Patients were stratified into two groups based on RLS presence. Disability was assessed using the Migraine Disability Assessment (MIDAS) questionnaire. Statistical analysis included independent t-tests and Chi-square tests; P < 0.05 was considered significant. Of 150 migraine patients, 54 (36%) met diagnostic criteria for RLS. The RLS group had a higher mean age than the non-RLS group (45.2 ± 11.9 vs. 38.2 ± 12.2 years; P = 0.001). RLS prevalence was significantly higher in patients with aura (64.8%) than in those without (21.9%; P < 0.001). The mean migraine duration was longer in the RLS group (13.7 ± 7.3 vs. 9.6 ± 7.4 years; P = 0.001). MIDAS scores were also significantly higher in the RLS group (15.3 ± 6.7 vs. 9.8 ± 4.2; P < 0.001). Gender distribution did not differ significantly. RLS is a frequent comorbidity in migraine, particularly among older patients and those with aura. Its presence is associated with longer migraine duration and greater disability. Routine screening for RLS in migraine patients may aid in comprehensive management and potentially reduce disease burden.
Implantable cardioverter-defibrillators (ICDs) are effective in preventing sudden cardiac death; however, contemporary data regarding appropriate and inappropriate device therapy rates from India remains limited. To evaluate rate of appropriate and inappropriate ICD therapies in a cohort of patients who underwent ICD or CRT-D implantation for either primary or secondary prevention at a tertiary care centre METHODS: We conducted a retrospective single-centre study of 190 patients who underwent ICD or CRT-D implantation between 2010 and 2024 for primary or secondary prevention. The primary outcome included appropriate and inappropriate ICD therapy rates assessed using Kaplan-Meier analysis RESULTS: The mean age of cohort was 53.1 ± 12.5 years. Secondary prevention accounted for 79% of implants. Over mean follow-up of 43.4 ± 39.6 months, appropriate ICD therapy occurred in 23.2% of patients, with median time to first therapy of 28.5 months. The cumulative incidence of appropriate therapy was 6% at 1 year and 22% at 3 years. Inappropriate therapy occurred in 8.9% of patients with cumulative incidence of 4% and 8% at 1 and 3 years respectively. The rates of appropriate and inappropriate therapies were not statistically different between primary and secondary prevention groups (p= 0.92 and 0.72 respectively) and between ischemic and non-ischemic subset (p=0.56 and 0.32 respectively). In this contemporary Indian cohort, ICD therapies remain substantial despite advances in GDMT, with a persistent long-term risk of ventricular arrhythmias. These findings support continued guideline-based ICD use and highlight the need to improve ICD utilization, particularly for primary prevention.