Christian Medical College

Aplastic anaemia (AA) is a rare bone marrow failure disorder with a notably higher incidence in Asian populations, including India. Due to limited access to bone marrow transplantation (BMT) in resource-limited settings, immunosuppressive therapy (IST) remains the mainstay of treatment. However, the optimal combination of available IST regimens in low-resource environments remains uncertain. Therefore, we performed a meta-analysis to evaluate the effectiveness and safety of various immunosuppressive strategies—particularly equine antithymocyte globulin (eATG) combined with cyclosporine A (CSA), with or without eltrombopag (EPAG), as well as CSA and anabolic steroids-based monotherapies, for the treatment of AA in Indian patients. Fifty-nine studies (49 single-arm, 10 multi-arm) from PubMed, Google Scholar, and Indian Society of Haematology Blood Transfusion (ISHBT) conference proceedings from December 2024 to December 2024 were included. The primary outcomes comprised overall response rates (ORRs) at 3, 6, and 12 months. Secondary outcomes included 5-year overall survival (OS), event-free survival (EFS), and treatment-related adverse events (TRAEs). Pooled estimates were calculated using a random-effects model, and heterogeneity was assessed with I² statistics. Meta-regression was used to explore sources of variability, and sensitivity analyses assessed the robustness of the pooled outcomes. Response rates (RR) varied significantly across treatment modalities and time points. In single-arm analysis, monotherapy with CSA or anabolic steroids showed limited efficacy, with pooled ORRs at 3 months of 26.9

Background:India is one of the countries with a high typhoid fever burden. In 2022, the National Technical Advisory Group on Immunisation recommended including the typhoid conjugate vaccine (TCV) in the Universal Immunisation Programme. In this study, we aimed to estimate the 2023 burden of typhoid fever and its antimicrobial resistance (AMR) to inform targeted vaccine introduction strategies. Methods:We used a decision tree model to estimate typhoid cases, hospitalisations, complications, and deaths. Incidence and clinical parameters were derived from a multicentre Indian study, with state-wise AMR prevalence from a systematic review. Two co-primary and four alternative scenarios were presented to validate the robustness of the findings. Findings:We estimated 4.9 million (95% UI: 4.4-5.6) typhoid cases and 7850 (4300-14,900) deaths in India in 2023. Of 730,000 (534,000-970,000) hospitalisations, 600,000 (435,000-799,000; 82%) were attributable to fluoroquinolone-resistant. Under primary scenario A, children <5 years accounted for 321,000 (235,000-427,000; 44.0%) hospitalisations and 2600 (1300-4800; 34.0%) deaths. Under primary scenario B, 5-9 years of age accounted for 265,000 (135,000-278,000; 36.0%) hospitalisations and 2900 (1500-5300; 36.0%) deaths. Delhi, Maharashtra, and Karnataka together accounted for 29% of the national burden and had the highest rates of fluoroquinolone-resistant cases and deaths among the ten highest-burden states. Deaths linked to fluoroquinolone-resistance, multidrug resistance, third-generation cephalosporins, and azithromycin resistance were 4700 (1800-10,200), 122 (45-294), 183 (69-431), and 183 (68-432), respectively. Interpretation:Fluoroquinolone-resistance drives a large share of typhoid-related hospitalisations and deaths, especially in children under five and in high-burden states of India. Targeted TCV introduction, with broader age coverage among children, would maximise impact. Funding:WISE programme; Vaccine Impact Modelling Consortium; Japan Agency for Medical Research and Development.

A 38-year-old lady presented with recurrent episodes of palpitations since the last four years. The electrocardiogram (ECG) during tachycardia indicated pre-excited atrial fibrillation, while the baseline ECG revealed preexcitation with QS waves in the inferior leads. Initial attempts at endocardial ablation and ablation via the coronary sinus approach did not yield successful results. Subsequently, we successfully ablated the inferoparaseptal (posteroseptal) pathway by utilizing a percutaneous epicardial approach. This method should be considered in cases where other techniques fail.

BACKGROUND:Asthma has been shown to have a significant association with the diagnoses of mental health disorders, including depression; however, information from India is scarce. OBJECTIVES:The study aims to estimate the prevalence of depression in asthma patients and identify associated risk factors. METHODS:A total of 248 participants aged 18 and above who presented to the pulmonary medicine outpatient clinic of the Christian Medical College, Vellore, Tamil Nadu, India, were recruited. Socio-demographic and clinical details, including treatment compliance were collected, and inhaler technique was assessed. Asthma control was measured by the Asthma Control Test (ACT) and the quality of life by Asthma Quality of Life Questionnaire (AQLQ). The Patient Health Questionnaire-9 (PHQ-9) was used to screen for depression. Logistic regression was used to determine the risk factors for depression. RESULTS:Out of the 248 participants, 24.6% screened positive for depression. Asthma control was worse (ACT 19.07 ± 4.87 vs 21.93 ± 3.66; p < 0.001) and quality of life was poorer (AQLQ 5.53 ± 0.72 vs 6.06 ± 0.63; p < 0.001) in those with depression. There was a low negative correlation (ρ = -0.332, P < 0.001) between ACT score and PHQ-9 score and a moderate negative correlation (ρ = -0.451, P < 0.001) between AQLQ score and PHQ-9 score. Univariate logistic regression analysis showed six independent factors associated with depression: female gender (OR 1.87), presence of one or more comorbidities (OR 2.10), incorrect inhaler technique (OR 3.59), poor compliance with inhaled corticosteroids (ICS) (OR 2.30), poorly controlled asthma (ACT) (OR 2.92) and lower AQLQ score (OR = 0.32). Multivariate logistic regression analysis revealed that the AQLQ was the only independent risk factor for depression (OR 0.27, P = 0.001). CONCLUSION:Adult asthma patients in this Indian cohort showed a high prevalence of depression. The study highlights key risk factors for depression in asthma and reiterates the need to screen asthma patients for depression.

Overweight and obesity are estimated to affect more than 40% of adults in the Asia-Pacific (APAC) region. This study used a cross-sectional online survey to assess the impact of obesity on health-related quality of life (HRQOL) using the Impact of Weight on Quality of Life (IWQOL)-Lite instrument and willingness to pay for obesity management among adults with body mass index (BMI) ≥ 18 kg/m2 in Australia, India and South Korea. A total of 2952 adults completed the survey. Most respondents (82%) were concerned with their weight, increasing with obesity class. Rated on a scale of 0-100 (worst to best quality of life), the mean (SD) overall IWQOL-Lite score was 61 (30) with no differences by gender. The mean lowest score was in the self-esteem domain, with female respondents reporting greater impairment than male respondents (47 vs. 53, p < 0.05). Total IWQOL-Lite and domain scores declined with increasing weight class (mean of 81 for individuals with normal weight to 35 for those with Obesity Class III). Of the 1752 individuals living with obesity, 80% would be willing to pay USD $25 per month for a weight loss method requiring minimal/moderate changes to diet, exercise and lifestyle that would enable them to achieve weight loss in 1 year; nearly half were willing to pay USD $225 per month. Our study highlights the negative impact of weight on the HRQOL of individuals in three APAC countries and the willingness to pay to achieve weight loss.