National Academy of Medical Sciences (India), better known by its acronym, NAMS, is a nodal agency under the Government of India, which acts as an advisory body to the Government in matters related to National Health Policy and Planning and as a promoting agency for continuing medical education (CME) for medical and health professionals. It is a part of the Inter Academy Medical Panel (IAMP), a global network of medical academies. The Academy is headquartered at NAMS House, at Ansari Nagar, neighbouring the All India Institute of Medical Sciences and the Indian Council of Medical Research House, along Mahatma Gandhi Marg, in the Indian capital of New Delhi.
Osteoporosis is a major and growing health concern in the Asia-Pacific region, y et it remains widely underdiagnosed and undertreated due to limited access to dual-energy X-ray absorptiometry (DXA) in many areas. Artificial intelligence (AI) offers new opportunities to improve osteoporosis screening and management, but unvalidated tools pose risks of inconsistent care. This consensus was developed to provide regionally harmonized guidance on the safe, effective, and equitable use of AI in osteoporosis care. Purpose The aim of this work was to establish expert consensus recommendations on the role of AI in osteoporosis screening and management in the Asia-Pacific region. Key objectives were to define appropriate applications of AI (e.g., imaging-based bone assessment and fracture risk prediction) and specify minimum standards for validation and reporting, addressing region-specific implementation challenges and ensuring that AI use aligns with clinical guidelines and ethical principles. Methods This consensus was developed through multidisciplinary collaboration among experts across the Asia-Pacific region. Each participant reviewed draft statements, contributed feedback during virtual meetings, and provided insights based on clinical experience and current evidence. Consensus was reached iteratively until full agreement was achieved for all statements. The process integrated global best practices and regional adaptations, drawing from peer-reviewed studies, international AI guidelines, and local fracture registry data. The final recommendations emphasize the validation, transparency, and ethical implementation of AI within regional healthcare systems, ensuring compatibility with local regulations. Ultimately, twelve consensus statements were established to guide the responsible use of AI for osteoporosis screening and management in the Asia-Pacific region. Results The panel produced 12 consensus statements covering the role of AI as an adjunct for opportunistic osteoporosis screening rather than a diagnostic tool, requirements for imaging quality and AI model transparency, standards for validation and performance reporting, integration of AI with clinical risk stratification, demonstration of clinical utility in real-world settings, adherence to data protection laws and ethical AI principles, training of clinicians in AI use, strategies for implementation and monitoring (including post-market surveillance and feedback loops), and recognition of technical, clinical, and equity limitations of AI. All 12 statements give extensive recommendations for using AI to improve osteoporosis management while ensuring patient safety, accuracy, and equity. Conclusion This first Asia-Pacific consensus on AI in osteoporosis concludes that AI, when appropriately validated and implemented, can help bridge the osteoporosis care gap by identifying high-risk patients who would otherwise remain undiagnosed, thus facilitating earlier intervention. It emphasizes that AI should complement-not replace-standard diagnostic methods and clinical judgment. The guidance emphasizes validation, transparency, and ethical oversight to facilitate early intervention while minimizing risks associated with unvalidated or premature AI adoption.
PURPOSE:To update the ASCO guideline on use of hematopoietic colony-stimulating factors (CSFs) in patients with cancer. METHODS:A systematic review identified randomized controlled trials (RCTs), meta-analyses, and systematic reviews that addressed use of CSFs for the prevention or treatment of neutropenic events, or for mobilization of stem cells, in adults with cancer. PubMed and the Cochrane Library were searched for articles published from September 1, 2014, to August 22, 2025. ASCO convened an Expert Panel to review the evidence and formulate recommendations. RESULTS:The updated systematic review included 33 RCTs and 16 systematic reviews. Additions to the body of evidence include approval of new CSFs and additional biosimilars, and approval of an additional CXCR4 inhibitor that may be used with CSFs for the mobilization of hematopoietic stem cells. RECOMMENDATIONS:Prophylactic use of CSFs to reduce the risk of febrile neutropenia is warranted when the risk of febrile neutropenia from chemotherapy is approximately 20% or higher and no other equally effective and safe regimen that does not require CSFs is available. For patients receiving chemotherapy with a <20% risk of febrile neutropenia, primary prophylaxis with a CSF may be warranted if patients are at a high risk of febrile neutropenia based on age, medical history, or disease characteristics. For stem-cell mobilization, CSFs may be used either alone, after chemotherapy, or in combination with plerixafor or motixafortide. The guideline also provides information about the dosing and selection of CSFs.Additional information is available at www.asco.org/supportive-care-guidelines.
Introduction:Acute abdomen refers to sudden, spontaneous, non-traumatic abdominal pain of less than a week. It is one of the common causes of emergency room visits and abdominal surgery. Therefore, it is critical for healthcare professionals to be familiar with the presentations of the common causes of acute abdomen, as well as the strength and validity of the investigative tools. Methodology:In this hospital-based observational study (September 2023 to August 2024), a total of 81 patients with acute abdomen who underwent emergency surgery were enrolled. Data were collected using a proforma, and statistical analysis was performed using IBM SPSS v28 (P value < 0.05 considered significant). Results:Among 81 patients included in this study, acute abdomen was most common in males and the 16-25-year age group. Common symptoms of acute abdomen were abdominal pain, nausea/vomiting, anorexia, constipation/obstipation, and fever, while common signs were tenderness, rebound tenderness, guarding/rigidity, tachycardia, and abdominal distention. The most common postoperative diagnosis was acute appendicitis (33.33%), and including its sequelae, it accounted for 51.85%. The next most common pathologies were perforation peritonitis (22.2%) and bowel obstruction (21%). Ultrasonography (USG) was the most specific tool in the diagnosis of appendicular pathologies (Sn = 73.81%, Sp = 96.87%, and accuracy = 83.78%). In cases of perforation peritonitis, clinical signs of generalized peritonitis were an equally effective method, with sensitivity comparable to an X-ray. The most sensitive tool in bowel obstruction was plain abdominal X-ray (sensitivity [Sn] = 88.24%), while USG had the highest specificity (Sp) of 94.74%. The diagnostic accuracy of acute abdomen was 88.89%, and the negative laparotomy rate was nil. Conclusion:This study highlights the critical nature of accurate preoperative diagnosis in acute abdomen cases and the potential for improved patient outcomes through enhanced investigative strategies. For better outcomes in patients with acute abdomen, early diagnosis based on clinical findings, supported by laboratory and radiological correlation, followed by timely decision-making regarding operative management, is of utmost importance.
Pilot fatigue and sleep deprivation are increasingly recognized as critical determinants of human performance in safety-sensitive occupations, particularly in commercial aviation. Rapid expansion of aviation systems, including in emerging markets such as India, has been accompanied by intensified aircraft utilization, complex duty schedules and increased night operations, all of which heighten vulnerability to fatigue-related performance impairment. Fatigue is a physiologically grounded state arising from the interaction of sleep loss, extended wakefulness and circadian misalignment. This review synthesizes current understanding of the biological mechanisms underlying pilot fatigue, with particular emphasis on sleep architecture, circadian regulation and the operational significance of the Window of Circadian Low, a period of reduced alertness corresponding to the early morning circadian nadir. Experimental and field studies demonstrate that both acute sleep deprivation and chronic sleep restriction impair vigilance, reaction time, executive function and psychomotor coordination. Epidemiological evidence further indicates a substantial prevalence of fatigue, excessive daytime sleepiness and sleep disorders, including obstructive sleep apnoea, among commercial pilots. Contemporary aviation operations, particularly high-frequency short-haul sectors and irregular duty schedules, exacerbate circadian disruption and cumulative sleep debt. While prescriptive regulatory frameworks such as Flight Duty Time Limitations provide essential safeguards, they may not adequately capture inter-individual variability or dynamic operational demands. In contrast, Fatigue Risk Management Systems offer a data-driven, adaptive approach integrating physiological principles with operational context. By bridging advances in sleep and circadian science with aviation practice, this review identifies key gaps in fatigue mitigation and outlines strategies including circadian-informed rostering, systematic screening for sleep disorders and strengthening of fatigue reporting systems. These findings underscore the need to embed biological principles within aviation policy to enhance pilot wellbeing, operational performance and passenger safety.
Introduction:Hydatid cyst of the liver is a zoonotic disease caused by the larvae of Echinococcus granulosus. It is endemic in countries like South America, Africa, Asia, and China. Giant hepatic hydatid cysts are rare in children and carry a higher risk of complications. We report a similar case of a giant hepatic hydatid cyst in an 8-year-old child managed successfully with laparoscopic surgery. Case presentation:An 8-year-old boy from a remote village of Nepal presented with fever, upper abdominal pain, and a sensation of heaviness in the abdomen for 6 months. Imaging revealed a giant hepatic hydatid cyst measuring 12.6 cm × 11.3 cm × 10.7 cm on the right lobe of the liver. The child underwent laparoscopic partial pericystectomy and recovered well. Postoperative albendazole therapy was continued, and there was no evidence of recurrence at 3 months of follow-up. Discussion:Hydatid disease commonly affects the liver in adults and lungs in children, with giant cysts posing a high risk of rupture, infection, and other complications. Imaging with ultrasonography and computed tomography is essential for diagnosis. Surgery remains the mainstay of treatment, with laparoscopic techniques offering faster recovery, smaller incisions, and fewer complications. Postoperative albendazole therapy and regular follow-up are crucial. This case highlights the effectiveness and safety of laparoscopic partial pericystectomy in a child, even in resource-limited settings. Conclusion:Laparoscopic surgery is a safe and effective option for managing giant hepatic hydatid cysts in children, even in resource-limited settings. Early diagnosis and intervention are crucial to reduce morbidity, mortality, and recurrence.
