Narayana Health (formerly known as Narayana Hrudyalaya) is an Indian chain of multi-speciality hospitals, heart centres, and primary care facilities with its headquarters in Bengaluru, India. It was founded by Dr. Devi Shetty in the year 2000.Narayana Health has its presence across major Indian cities Bangalore, Delhi, Gurugram, Kolkata, Ahmedabad, Jaipur, Mumbai, Mysore etc. with an international subsidiary in the Cayman Islands. The facilities offer medical care in over 30 medical specialities and three of its hospitals – Narayana Institute of Cardiac Sciences, Bangalore, and Health City Cayman Islands – are JCI (Joint Commission International) accredited.
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
To compare automated and manual quantification of retinal haemorrhages in eyes with diabetic retinopathy (DR) and to analyse the risk of progression to proliferative DR (PDR). Retinal haemorrhages on ultra-widefield (UWF) pseudocolor images in eyes with non-proliferative diabetic retinopathy (NPDR) were manually segmented. DR severity was assessed within the seven ETDRS fields at baseline and 1-year follow-up. Lesions were also automatically segmented using EyeRead UWF software (Eyenuk) and the frequency and area of retinal haemorrhages and the average distance of haemorrhages from the optic nerve centre were computed. Manual and automated results were compared and correlated with progression to PDR at one year. Sixty-three eyes with NPDR at baseline were included, of which 29 progressed to PDR over one year. The automated measurements of total haemorrhage frequency, area and the distance from the optic nerve were significantly lower compared to manual grading, but the parameters were significantly correlated (r = 0.5–0.96; all P < 0.001). The distance of the haemorrhages from the optic nerve was found to be a significant risk factor for progression to proliferative DR from both approaches. Automated detection of retinal haemorrhages may serve as a surrogate to the manual grading in predicting the progression to PDR. Although the automated approach detects a lower number of lesions compared to manual grading, the results are correlated and the automatically determined parameters are still predictive of progression.
e24019 Background: Asian Cardio Oncology Society (ACOS) was started in 2020 to promote awareness regarding cardio-oncology in south-eastern Asia. This study describes our baseline survey on knowledge, attitude and practice (KAP) of cardio-oncology amongst cardiologists & oncologists of India and south-east Asia. Methods: A 38-question survey was administered online via google forms using email and watsapp to contact members of ACOS and other cardiologists/oncologists in south-east Asia from December 2020 to January 2021. Results: Total 215 responses were collected. Maximum respondents were from India (90%) followed by Bangladesh (4%). Majority were medical oncologists (41%) followed by cardiologists (23%) & radiation oncologists (20%). Female participation was 18%. Cardiologists encountered cancer diagnosis in 5% of their patients while oncologists encountered average 30% patients with cardiac disease. Risk of cancer therapy related cardiac dysfunction (CTRCD) was estimated < 10% by 39%, 10-20% by 25% and > 20% by 35%. Regarding knowledge of cardio-oncology and familiarity with guidelines, 29% rated themselves poor, 48% average and 23% good. 85% did not have dedicated cardiologist at their centre. Echocardiography was not performed by trained cardiologists at 33% centres. 68% believed in baseline cardiac evaluation for all oncology patients. Cardiology referral was opined for all patients before starting anticancer therapy by 24%, while 10% believed in referral only for cardiac symptoms/toxicity and 66% believed in referral only before starting cardio-toxic therapy. Only 21% were confident of using potentially cardio-toxic treatment in patients with high risk of cardiotoxicity or suboptimal cardiac function. 67% expressed need for separate guidelines for CTRCD in lower-middle-income countries (LMIC) and 70% strongly agreed for separate cardio-oncology clinic to improve patient outcomes. Conclusions: Despite significant growth in field of cardio-oncology in West, there are significant gaps in KAP among health care providers in south-east Asia. Collaboration between cardiologists and oncologists and separate cardio-oncology guidelines will improve KAP of cardio-oncology and consequentially the patient outcomes, for south-east Asian region and LMIC.
Background: Cervical cancer is among the leading preventable cancers affecting women in India, with Human Papillomavirus (HPV) being its principal etiological agent. Despite the availability of effective HPV vaccines such as Gardasil and Cervavac, uptake remains low. Physicians play a crucial role in influencing vaccine acceptance through their knowledge, attitudes, and prescribing behaviours. Objective: This study aimed to evaluate the knowledge, attitudes, and practices (KAP) of physicians in Kochi, Kerala regarding HPV vaccine prescription and identify key factors influencing their recommendation patterns. Methods: A descriptive cross-sectional study was conducted among 120 physicians (gynaecologists, paediatricians, general practitioners, and physicians) in Kochi during April–May 2025. A structured 24-item questionnaire, validated through expert review and pilot testing, assessed participants' KAP related to HPV vaccination. Descriptive statistics and chi-square tests were applied using SPSS to explore associations between demographic variables and KAP scores. Results: High levels of awareness were observed: 99.2% recognized HPV as a cause of cervical cancer, and 83.3% correctly identified the recommended vaccination age (9–14 years). While 80% reported having recommended the vaccine at least once, only 55% did so routinely. Attitudinally, 96.6% believed in the vaccine's effectiveness, yet practical barriers such as cost (90.8%) and cultural resistance (87.5%) were frequently cited. Significant associations were found between medical specialty and both knowledge and prescription behavior (p < 0.05). Conclusion: Despite strong knowledge and positive attitudes, prescribing practices remain inconsistent, highlighting a need for systemic interventions such as Continuing Medical Education (CME), consultation prompts, and culturally sensitive patient education materials. Strengthening these elements may improve HPV vaccine uptake and contribute to cervical cancer prevention goals.
Background: Brush biopsy is a minimally invasive method for early detection of oral squamous cell carcinoma (OSCC). Enhanced accuracy for clinical utility depends on analysis of the whole cell population and automated cohort classifications. Aim: This study aims to delineate OSCC, high-grade dysplasia (HGD), and low-risk lesions (LRLs) by profiling single-cell level alterations using multiplexed flow cytometry. Methods: Brush-biopsy samples were analyzed from patients with LRL, HGD, and OSCC. Flow cytometry analysis was standardized to ascertain cell distribution, heterogeneity, and epithelial cell content. Markers were used for epithelial cell (Pan-Cytokeratin [Pan-CK]/ propidium iodide [PI]) and atypical cell (Sambucus–Nigra–Agglutinin-1 [SNA-1]/ polyadenosine diphosphate-ribose polymerase inhibitor [PARPi-FL]) delineation. In addition, scatter properties and molecular-equivalence fluorescence (MEF) values of markers were analyzed for cohort classification. Results: Brush-biopsy samples from OSCC/HGD patients showed heterogeneity in the percentage of Pan-CK+ve/PI+ve cells. Significant variation in MEF values of SNA-1/PARPi-FL/PI delineated the OSCC cohort (area under the curve > 0.85). Furthermore, the markers in combination with scatter properties delineated OSCC (multivariate logistic regression; sensitivity: 90%, specificity: 82%). The analysis of the forward-scatter height-to-area ratio delineated HGD from low-risk lesions by capturing the morphology-based cellular differences. Conclusions: These results suggest that a flow cytometry-based analysis of brushbiopsy samples may serve as an adjunct tool for risk stratification of oral lesions. Relevance for patients: This study provides evidence towards the application of flow cytometry as an objective, quantitative adjunct to conventional cytology, and improves early detection and risk stratification of oral lesions using a minimally invasive sampling method, thereby supporting timely clinical decision-making and patient management.
