Madras Medical College

Background:Occupational radiation exposure remains a persistent and underestimated hazard in cardiac catheterization laboratories. This study evaluated the impact of post-licensure radiation safety training on adherence to radiation safety practices among interventional cardiologists. Methods:A nationwide cross-sectional survey was conducted between May 2022 and August 2023 among 753 interventional cardiologists. Radiation safety knowledge and practice were assessed across five domains - dose awareness, time, distance, shielding, and collimation - and combined into a composite Radiation Safety Score (RSS; Maximum 100). Demographic and practice-related variables were analysed, and multivariable log-linear regression was used to identify independent predictors of higher RSS. A study-specific, novel Radiation Safety Score (RSS) was developed to assess adherence to radiation safety practices and as such, it was not externally validated or tested for reliability among other cohorts. Results:Of the 753 respondents, 716 met the inclusion criteria. The median age was 44 years [IQR 37-52], and the mean catheterization laboratory experience was 11 ± 8.7 years. Two-thirds (66%) had attended at least one post-licensure radiation safety training program. The mean RSS was 56.5 ± 21.7, and only 16.3% achieved scores ≥ 75. Trained participants demonstrated significantly higher performance across all five radiation safety domains (p < 0.001 for each). In multivariable analysis, post-licensure radiation safety training independently predicted higher RSS (β = 0.216, p = 0.005), corresponding to a 24.1% higher adjusted score. Experience >10 years was also associated with superior RSS (β = 0.267, p < 0.001). Conclusion:Radiation safety practices among interventional cardiologists in India remain suboptimal. Participation in post-licensure radiation safety training is independently associated with better adherence across all major safety domains. Incorporating structured radiation safety training into cardiology conferences may help strengthen radiation safety culture and enhance long-term occupational protection.

Background: Heart failure (HF) is a complex clinical condition requiring resource-intensive management and substantial health expenditure. The adverse economic impact of medical care on patients or financial burden is increasingly recognised as a significant non-clinical entity affecting HF management in low-and middle-income countries (LMIC). We explored the factors associated with Financial Burden (FB) in HF patients in India. Methods: We recruited HF patients from 21 hospitals across India, selected to reflect regional diversity and varying stages of epidemiological transition. Trained personnel collected clinical and economic data using a validated and structured questionnaire. Expenditures were recorded in Indian rupees (INR) and converted to international dollars (INT$). Results: We recruited 1,859 participants. Nearly one-third of participants (30.2%) were women. The mean age was 55.9 (11.3) years, and the mean duration of formal education was 11.3 (3.8) years. Health insurance coverage was reported in one-third (32.2%) of the study population. The average annual out-of-pocket (OOP) expenditure was INR 1,06,566 (INT$ 4,709.10), constituting 92.6% (95% CI: 92.5-92.7) of the total health expenditure. Compared to the previous year, a decline in monthly income was reported by 32.3% of individuals and 36.2% of households. Catastrophic health spending (CHS) and distress financing (DF) were observed in 37.7% (35.5-39.9) and 17.7% (15.9-19.4) of the households, respectively. However, CHS and DF were lower [30.8% (26.2-35.4) and 13.6% (10.2-17.0), respectively] among those with health insurance compared to the uninsured [40.3% (37.6-43.0) and 18.9% (16.7-21.1), respectively]. Conclusion: Seven out of 10 HF patients in India lack financial health protection. OOP expenditures, accounting for over 90% of total health spending, contribute significantly to economic distress in HF patients. Financial burden, affecting more than one-third of HF patients, carries profound implications for individual well-being. Addressing this financial burden, including CHS and DF, is essential for improving clinical outcomes and ensuring health equity.

Background: The unmet need for contraception remains a significant public health concern in rural India, despite high awareness of family planning methods. Aims and Objectives: This study aimed to estimate the prevalence of unmet need for contraception and identify factors associated with non-use among rural women aged 15–45 years. Materials and Methods: A community-based cross-sectional study was conducted from January to December 2020 in the rural field practice area of Chengalpattu Medical College, Tamil Nadu. Using multistage sampling, 268 eligible women aged 15–45 years were interviewed with a pre-tested semi-structured questionnaire. Unmet need for contraception was defined using standard Demographic and Health Surveys (DHS) criteria. Data were analyzed using descriptive statistics and logistic regression. Results: Awareness of contraception was high (91.0%). More than half of the women were current contraceptive users (54.85%), predominantly female sterilization (67.35%). The overall unmet need for contraception was 25.37%, mainly for spacing births (67.65%). Higher unmet need was observed among women aged 21–25 years (41.67%), those married at ≥21 years (32.24%), women with parity ≤2 (34.27%), and women with one living child (51.55%). Unmet need was significantly higher among women not involved in family planning decisions (63.64%), those unaware of contraceptive methods (50.00%), and those reporting lack of perceived availability (44.68%). Multivariable analysis identified age at first childbirth ≥23 years, lack of female participation in decision-making, poor awareness, perceived non-availability of services, and longer duration of marriage as independent predictors of unmet need. Conclusion: Despite high awareness, the unmet need for contraception remains substantial, particularly for spacing methods. Strengthening early counseling, improving access to spacing methods, and promoting shared decision-making are crucial to reducing unmet need in rural settings.

Background:Sacral chordomas are rare malignant tumors arising from notochordal remnants that present unique surgical challenges due to their indolent growth, locally aggressive behavior, and high recurrence rates despite treatment. This review synthesizes current evidence on surgical management, reconstruction techniques, adjuvant therapies, and translational advances for sacral chordomas. Methods:This systematic review synthesizes current evidence on surgical management, reconstruction techniques, adjuvant therapies, and translational advances through analysis of PubMed, Scopus, and Web of Science databases [2023-2025]. Results:En bloc resection with wide negative margins remains the cornerstone of treatment, achieving optimal local control but often at the cost of significant neurological and functional morbidity. Modern reconstruction techniques, including vascularized grafts and three-dimensional (3D)-printed prostheses, have improved spinopelvic stability and postoperative outcomes. Adjuvant particle beam radiotherapy, particularly proton and carbon ion therapy, demonstrates superior 5-year local control rates of 77-89% compared to 10-30% with conventional photon therapy, while stereotactic radiosurgery achieves 81% local control. Systemic therapies remain limited, though targeted inhibitors of platelet-derived growth factor receptor (PDGFR), epidermal growth factor receptor (EGFR), and the PI3K/AKT/mTOR pathway show modest activity with disease stabilization in 60-70% of cases. Novel immunotherapeutic approaches, including Brachyury-targeted vaccines and checkpoint blockade, are under investigation. Molecular insights have identified key drivers, including Brachyury [T-box transcription factor T (TBXT)], receptor tyrosine kinases, and emerging biomarkers that may guide future therapeutic selection. Conclusions:Integrated multimodal care is critical for improving survival and function in patients with sacral chordomas.

Chronic Wounds are one of the most prevalent types of Dermatoses, which are the result of impaired Healing and Complications. In addition, Type 2 Diabetes Mellitus is one of the main causes of impaired Healing (due to the development of Complications and other factors). Therefore, it is of interest to evaluate the way T2DM influences Healing, Recurrence and Clinical Outcomes (in Dermatology Clinics) over a period of five years. A retrospective review of medical records (of chronic wound patients) identified differences between the T2DM and the Non-Diabetic Groups. The T2DM patients demonstrated a significantly longer median Healing Time than the Non- Diabetic Patients, with increased Infection Rates and an increased need for Advanced Wound Care. The rate of Recurrence and Amputation were also higher than in the Non-Diabetic Group. A Multivariate Analysis indicated that T2DM, Baseline Wound Infection and Wound Size >10 cm2 were significant predictors of Delayed Healing for T2DM Patients. Thus, these data demonstrate that T2DM places a significant burden on Wound Outcomes in a Dermatology Practice. Early identification of risk factors, multidisciplinary management and optimised glycaemic control are crucial to improving Healing and reducing complications associated with Chronic Wounds and T2DM.