Institute of Medical Sciences and Sum Hospital

Provision of invasive mechanical ventilation (IMV) in the neonatal intensive care has seen a steady rise in low-esource settings (LRS). However, outcomes among those exposed to IMV remain under-reported, with the current evidence base being restricted to single-centre observational studies, thus limiting comparative analyses and effective healthcare planning. This study aims to estimate the pooled proportion of mortality and morbidity among neonates exposed to IMV in low-resource settings. Medline, Embase, and CENTRAL were searched until 22 August 2025. Randomised and non-randomised studies were included. Two reviewers, blinded to each other, extracted data independently. Proportion-based meta-analyses using random-effects model were performed. Risk of bias was assessed using ROBINS-E, and evidence-certainty was evaluated using the GRADE approach. One hundred of 117 studies were included, with most conducted in South Asia. In-hospital mortality was reported in 68 studies (7193 neonates), with a pooled estimate of 45

BACKGROUND:Several countries are using fractionated or limited-dose regimens of full dose inactivated polio vaccine (IPV) in infants in addition to oral poliovirus vaccine (OPV), due to procurement cost of IPV and delivery challenges for its campaign use. An adjuvanted dose-sparing IPV (ds-IPV) with around a one-fourth antigen content of the full dose of IPV was developed in India. A non-inferiority trial was conducted to compare the immune response of ds-IPV with IPV in infants. METHODS:A phase 2/3, double-blind, randomised controlled trial was conducted at nine tertiary care hospitals in India. Healthy infants aged 6-8 weeks, who received a birth dose of bivalent OPV were enrolled. Participants with fever or acute infection, and previous receipt or plan to receive any other poliovirus-containing vaccines were excluded. Infants were randomly assigned (1:1; block randomisation managed through an interactive web response system) to receive either ds-IPV or IPV in a three-dose regimen-a single dose of 0·5 mL administered by intramuscular route at age 6 weeks, 10 weeks, and 14 weeks. The vaccine syringes were masked with an opaque peel before administration to maintain masking. All participants were concomitantly administered oral rotavirus vaccine, and injectable DTwP-HB-Hib and pneumococcal conjugate vaccine in the contralateral thigh by the intramuscular route. Blood samples were collected at baseline before the first dose and at 28 days after the third dose for measuring the neutralising antibodies against each poliovirus serotype using microneutralisation assay. The site staff evaluating the study outcomes, participants' parents, and the laboratory personnel were masked to the vaccine allocations. The primary outcome of type-specific percentage seroconversion at 28 days after the third dose of ds-IPV or IPV (non-inferiority margin ≥10%) and secondary outcomes of type-specific geometric mean titres and percentage seroprotection (titre ≥8) were assessed in the per-protocol population as the primary population and the full analysis population as the supportive population. Secondary outcomes on safety evaluation included immediate, solicited, unsolicited, and serious adverse events. This study is registered with the Clinical Trials Registry of India (CTRI/2022/05/042363), and is complete. FINDINGS:Between May 23, 2022, and April 13, 2024, of the 658 participants screened, 648 were eligible and randomly assigned to ds-IPV (n=324) or IPV (n=324). Consent was withdrawn for five participants after randomisation; thus, a total of 643 infants received ds-IPV (n=323) or IPV (n=320). The seroconversion rates for type 1 poliovirus in the ds-IPV and IPV groups were 283 (94·7% [95% CI 91·5 to 96·9]) of 299 participants and 270 (92·8% [89·2 to 95·5]) of 291 participants, respectively, with a difference of 1·9 (95% CI -2·1 to 5·8). The seroconversion rates for type 2 poliovirus in the ds-IPV and IPV groups were 287 (96·3% [93·5 to 98·1]) of 298 participants and 284 (97·9% [95·6 to 99·2]) of 290 participants, respectively, with a difference of -1·6 (-4·7 to 1·5). The seroconversion rates for type 3 poliovirus in the ds-IPV and IPV groups were 291 (97·3% [94·8 to 98·8]) of 299 participants and 288 (99·0% [97·0 to 99·8]) of 291 participants, respectively, with a difference of -1·6 (-3·8 to 0·5). Solicited events, including tenderness, redness, swelling, and fever, were very common (≥10%) in both vaccine groups. No causally related serious adverse events were reported. INTERPRETATION:ds-IPV was immunologically non-inferior to IPV and had a similar safety profile. The new adjuvanted IPV could become an alternative option to IPV. The availability of ds-IPV will support a constant supply of IPV for use in poliovirus-naive and exposed target populations. FUNDING:Serum Institute of India.

BACKGROUND:Screening for latent tuberculosis (LTB) before initiating advanced therapy for inflammatory bowel disease (IBD) helps reduce the risk of tuberculosis (TB) development. However, there is limited data on screening practices from TB-endemic regions. AIM:To study the practices of screening for LTB and study the incidence of TB in patients with IBD on biological and small molecule inhibitors. METHODS:This retrospective multicentre study analyzed LTB screening practices in IBD patients starting advanced therapies between 2018 and 2022. We included patients who were initiated on biologics (infliximab, adalimumab, vedolizumab) or small molecule inhibitors (tofacitinib). We assessed compliance with LTB screening methods, including the tuberculin skin test, interferon-gamma release assay (IGRA), chest X-ray, and computed tomography chest, both at initiation and annually. We also evaluated the incidence of active TB and its predictors. RESULTS:Of 378 patients (mean age: 36.9 ± 14.9 years, males: 56.9%), 158 (41.8%) and 216 (57.1%) had ulcerative colitis and Crohn's disease, respectively. Advanced therapy used were anti-tumor necrosis factor in 309 (81.74%), tofacitinib in 41 (10.84%) and vedolizumab in 28 (7.40%). Standard screening and diligent screening strategy was employed in 59% and 33% of patients, respectively. Compliance with tuberculin skin test and IGRA was noted in 261 (69.04%) and 298 (78.83%) patients, respectively. Chest X-Ray and computed tomography chest were performed in 300 (79.36%) and 242 (64.02%), respectively. Annual screening in those on advanced therapy for > 1 year was performed in 27.2% (50/184). Active TB developed in 17 (4.49%); 15 (88.23%) were on anti-tumor necrosis factor. LTB was detected in 40 (10.72%), with most diagnosed on the basis of IGRA (21/40, 52.50%). Among 17 patients who developed active TB, LTB screen was negative in 12 (70.58%). CONCLUSION:Standard screening practices for LTB, prior to starting advanced therapy, remain suboptimal (< 60%) in India despite high TB endemicity.

Beta-adrenergic receptor stimulation has been reported to positively influence the development and growth of many cancers in animal models. Studies have shown conflicting results regarding the benefit of beta-adrenergic receptor blockers in pancreatic cancer. Hence, we conducted a meta-analysis to investigate the relationship between beta-blocker usage and the prevention of pancreatic cancer and the prognosis after the diagnosis of pancreatic cancer. We searched electronic databases of Medline, Embase, and Scopus from January 2000 to August 2025 to identify studies reporting the relationship between beta-blockers and the development of new pancreatic cancer or survival in diagnosed cases of pancreatic cancer. Adjusted hazard ratios (aHR) were extracted for survival and pooled using a random-effects meta-analysis. One case-control and 13 cohort studies were identified, of which four analyzed the association between beta-blocker use and the incidence of pancreatic cancer, while the other 10 analyzed survival outcomes with the use of beta-blockers in patients with diagnosed pancreatic cancer. The pooled data showed that beta-blockers were significantly associated with a reduced incidence of pancreatic cancer (aHR = 0.77, 95% CI = 0.61 - 0.97, 3 studies). Similarly, continued use of beta-blockers after the diagnosis of pancreatic cancer was associated with improved survival (aHR 0.91, 95% CI: 0.87 - 0.94, 4 studies). However, the use of beta-blockers prior to diagnosis of pancreatic cancer did not improve survival (aHR 0.99, 95% CI: 0.94 - 1.05, 5 studies). The results of the current meta-analysis revealed that beta-blockers have a preventive and protective role against pancreatic cancer. Further research is required to validate the findings of this meta-analysis.

BACKGROUND:Progressive supranuclear palsy (PSP) is a rare and devastating tauopathy with limited global data. Given India's large population, genetic diversity, and clinical heterogeneity, large multicenter datasets are crucial to enrich global understanding of PSP. OBJECTIVE:To characterize the demographic, clinical, and phenotypic profiles of a large multicenter Indian PSP cohort. METHODS:Subjects fulfilling MDS-PSP criteria were prospectively recruited across movement disorders centers (2021-2025). Standardized demographic and clinical data were collected. RESULTS:A total of 1035 subjects were enrolled (M:F = 709:326), with a median age of 65 years and a mean onset age of 62.2 ± 7.9 years. Regional distribution reflected pan-Indian recruitment (South 35%, North 26%, West 21%, East 18%). PSP-Richardson's syndrome was most common (41%), followed by PSP-Parkinsonism (18%) and PSP-CBS (11%); rarer phenotypes included PSP-PI (7%), PSP-F (7%), PSP-PGF (5%), PSP-OM (2%), PSP-SL (1%), and PSP-C (1%). Falls occurred earliest in PSP-PGF (13.7 months) and PSP-SL (16.3 months), while PSP-P showed delayed disability (falls at 31 months) indicating progression patterns. Cognitive onset was prominent in PSP-F (21%) and PSP-SL (57%). Levodopa was prescribed to 893 patients; 186 (21%) reported >25% subjective benefit, and 358 (40%) reported ≤25% benefit. Amantadine was used in 351 (34%) patients, with improvement in 177. CONCLUSION:This largest systematically profiled PSP cohort highlights both shared and distinctive features: high frequency of non-RS variants, aggressive course in PSP-RS/SL, better survival in PSP-P, and limited pharmacological benefit. These findings establish a foundation for longitudinal and genetic studies in diverse populations.