Intellectual disability (ID), a widely prevalent condition is a neurodevelopmental condition which encompasses diverse causes, both genetic and non-genetic. They most commonly show symptoms of delayed milestones, limited motor skills, unwarranted emotional changes, difficulty in learning new skills and poor memory. Genetic causes usually accounting up to 50%, most frequently includes chromosomal (structural and numerical), monogenic and de novo variants. Advancements in genetic testing options have enabled early diagnosis, minimizing complications and preventing further hereditary transmission. Genetic tests, such as karyotyping, chromosomal microarray (CMA), Next-Generation Sequencing (NGS) and various molecular assays like Multiplex Ligation-dependent Probe Amplification (MLPA), Methylation Specific polymerase chain reaction (MS-PCR) are available in contemporary healthcare settings for timely diagnosis. This study focuses on individuals with Intellectual disability (ID), who require support for diagnosis and rehabilitation and are visiting the National Institute for the Empowerment of Persons with Intellectual Disabilities (NIEPID) for therapy and are referred for genetic testing and genetic counseling. The paper also analyzes the reasons for diagnostic delays and gaps in genetic counseling, affecting the treatment and management. It also advocates for collective efforts to enhance awareness, potentially reduce costs and improve accessibility for testing, paving the way for a future grounded in precise management and preventative medicine.
Background: Robot-assisted surgery (RAS) is expanding rapidly across surgical specialities, yet adoption across the globe remains variable. There is growing recognition to expand RAS across all healthcare settings, to ensure equity of access and improve clinical outcomes for all patients. Facilitating the expansion of RAS requires the development of high-quality, durable and sustainable RAS programmes. The aim of the RoboDev study was to develop a universal, globally applicable guideline to aid development and expansion of RAS programmes. Methods: The RoboDev study was conducted as an international, multistakeholder Delphi process consisting of four phases: (1) scoping review and item generation, (2) questionnaire design and pre-testing, (3) accelerated two-round Delphi survey, and (4) consensus meetings. Participants were stratified by World Bank income classification. Recommendations achieving ≥80% agreement were retained. A subset of participants subsequently evaluated the final recommendations using the APEASE criteria (Acceptability, Practicability, Effectiveness, Affordability, Spill-over effects, and Equity). Results: A total of 1,000 participants completed Round 1 and 812 completed Round 2 of the Delphi, representing HIC (59.5%), UMIC (16.6%), LMIC (18.7%), and LIC (1.6%) stakeholders. From 245 initial statements across eight domains, 194 recommendations achieved global consensus. Tailored adaptations were added for each income group, resulting in 197 recommendations for HICs, 207 for UMICs, 206 for LMICs, and 216 for LICs. Training, infrastructure readiness, and multidisciplinary engagement showed the greatest variation across settings. APEASE evaluation confirmed overall acceptability, practicality, and equity, with LIC participants reporting the highest spill-over and equity benefits. Conclusion: The RoboDev study has developed the first global, evidence-based, and context-sensitive guidelines for building and expanding robot-assisted surgical programmes. By combining universal principles with context-specific adaptations, these recommendations provide a roadmap for equitable and sustainable expansion of robotic surgery worldwide. Adoption of these guidelines has the potential to improve patient outcomes, strengthen surgical systems and ensure that the benefits of robotic innovation are shared equitably across all global contexts.
Background: Diabetes is one of the commonest disease that affects over 100 million people worldwide. CAD is the most prevalent complication of diabetes and is the leading cause of death. HbA1c is a marker of long term glycemic control in patients with DM for micro-vascular and macrovascular disease. SYNTAX score helps clinicians to establish the optimum revascularisation approach in patients with complex CAD and provides individual mortality predictions for CABG and PCI. Aim: To assess CAD in diabetics with ACS by syntax score in association with HbA1c. Patients And Methods: The prospective observational study was conducted in the department of cardiology, Dr.PSIMS & RF from February 2020 To February 2022. 60 Diabetic patients with ACS meeting the eligibility criteria were included. Echocardiography and routine blood investigations were done. HbA1c levels of each patient were estimated and categorized accordingly. All patients were subjected to CAG and the SYNTAX score was used to assess the complexity of coronary artery lesions. Observations And Results: Mean age was 57.17±10.826 years. Out of 60 diabetic patients with ACS,75% were males. Mean duration of typeII DM 8.42±7.587 years. Out of 60, 17(28.3%) had inferior wall STEMI,12(20%) had Anterior wall STEMI, 16(26.7%) had NSTEMI and 15(25%) had unstable angina. On angiography, DVD was found in 27(45%), TVD was found in 24(40%) and SVD was found in 9(15%). LAD was involved in 44(73.3%), LCx-35(58.3%), RCA-42(70%), OM1-10(16.7%), PDA-5(8.3%) and OM2-1(1.6%). Mean SYNTAX score was 22.475±9.8. Mean PCI syntax II score was 34.14±8.10. Mean CABG syntax II score was 19.52±10.234. High syntax scores(≥33) were found in 16.7%. There was signicant positive correlation(p=0.05) between HbA1c and syntax score. Conclusion: HbA1c levels signicantly correlated with severity of CAD assessed by SYNTAX scores in diabetic patients with ACS. HbA1c level can be useful indicator to predict the severity of CAD among diabetics.
Abstract Background: Invasive arterial blood pressure monitoring is the gold standard, but it is costly and expertise is required. Parallel noninvasive methods such as automated arterial blood pressure monitoring and auscultatory methods are available. Objective: To study the accuracy of blood pressure measurement using auscultatory method and noninvasive arterial blood pressure monitoring compared to invasive arterial blood pressure monitoring in hypotensive patients. Materials and Methods: Single-center, hospital-based and prospective study was carried out among 50 cases of hypotension. For each case, systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial blood pressure were measured with the help of noninvasive as well as invasive methods. For arterial line either radial artery or femoral artery was used whichever was accessible. Results: Males were more than females 64% versus 36%. Similarly, patients <60 years were more compared to the elderly i.e., 66% versus 34%. Only SBP measurement was significantly lowest by auscultatory method compared to noninvasive and invasive methods. However, DBP and mean arterial blood pressure (MAP) were similar at admission. Only SBP by auscultatory method and noninvasive method were significantly lower compared to invasive method. However, SBP by auscultatory and noninvasive was similar. DBP was similar across all categories except noninvasive and invasive methods and same thing can be seen for MAP also. Conclusion: Invasive arterial blood pressure monitoring is a better choice of technique for blood pressure monitoring. Map rather than SBP is preferred metric in the emergency department to guide therapy in hypotensive patients.
