P.D. Hinduja National Hospital and Medical Research Centre

Out-of-pocket health expenditure (OOPE) is a significant public health concern in India, with an estimated 55 million individuals pushed into poverty due to healthcare expenses. Evidence on the burden and patterns of OOPE among older adults requiring palliative care, and the financial strain faced by them, is limited. Data from the Longitudinal Ageing Study in India (LASI) identified 2903 older adults aged 60 years and more with palliative care needs using the Supportive and Palliative Care Indicator Tool for Low-Income Settings (SPICT-LIS). Annual healthcare expenditure and OOPE were estimated separately for outpatient care and hospitalisation. At the household level, OOPE and Catastrophic Healthcare Expenditure (CHE) were calculated for the last month. CHE prevalence was mapped across India’s states. The Kruskal-Wallis test and Multivariate logistic regression were used to assess differences in mean expenditure and identify household factors associated with CHE, respectively. The mean annual health expenditure for older adults with palliative care needs was ₹5002 for outpatient care and ₹36,263 for hospitalisation. OOPE accounted for 94

Carbapenem-resistant Escherichia coli (CR-E. coli) pose major therapeutic challenges. We evaluated the activity of plazomicin against 52 CR-E.coli isolates from a Mumbai tertiary hospital. Plazomicin demonstrated potent activity (Minimum Inhibitory Concentration [MIC] 0.19-2 mg/L) against isolates, including those harboring NDM or OXA-48-like carbapenemases, with or without aminoglycoside-modifying enzymes (AMEs). In contrast, isolates carrying 16S rRNA methyltransferases (RMTs) (e.g., rmtB1, rmtC, rmtF1) exhibited high-level resistance (MICs of ≥256 μg/mL). These findings not only highlight the advantage of plazomicin in AME-positive, RMT-negative strains, but also warn about the threat of emerging 16S RMT-mediated resistance that limit its clinical utility.

ABSTRACT Background Acne vulgaris is a common skin condition that typically begins in adolescence but can often persist in adulthood, contributing to significant physical and psychosocial burden. Despite the availability of multiple treatment options, challenges such as poor adherence, treatment‐related side effects, and post‐inflammatory hyperpigmentation remain common in clinical practice. Dermocosmetics are increasingly used in acne management, either alone in mild cases or as adjuncts to medical therapy. Objectives To assess acne prevalence, treatment practices, and key management challenges, along with the role of dermocosmetics, based on expert consensus from India. Methods A panel of 10 dermatologists participated in a modified Delphi process comprising a pre‐meeting survey followed by a structured advisory board discussion, capturing clinical practice patterns, treatment approaches, and perspectives on dermocosmetic use in acne management. Results Experts reported treating a high number of acne patients, primarily adolescents, with a higher proportion of females. Hyperpigmentation and scarring were common sequelae of acne, while treatment adherence and antibiotic resistance, particularly to erythromycin and azithromycin, were noted as key challenges. Procedural interventions, including chemical peels, lasers, and comedone extraction, were increasingly used in early acne management, especially in patients prone to post‐inflammatory hyperpigmentation and relapse. Low‐dose isotretinoin and hormonal therapies were commonly used in acne management, while dermocosmetics were utilized as monotherapy in mild cases and as maintenance therapy following treatment in more severe cases. Lifestyle factors such as high glycaemic diets, whey protein, multivitamins, and steroid‐like drugs were identified as potential contributors to acne exacerbation. Limitations Findings are based on a small expert panel convened with industry support and reflect clinical opinion rather than primary patient data. Conclusion Procedural interventions are becoming more popular, thereby providing an opportunity to incorporate dermocosmetics into acne treatment regimens.

INTRODUCTION:Rapid and precise identification of nontuberculous mycobacteria (NTM) at the species level is essential as treatment and antimicrobial susceptibility vary across species This study evaluated Matrix-Assisted Laser Desorption/Ionization Time-of-Flight mass spectrometry (MALDI-TOF MS) using a modified extraction protocol for identification of NTM isolates in a tertiary care setting in Mumbai, India. MATERIALS AND METHODS:A total of 110 consecutive clinical NTM isolates, including 73 rapid growers and 37 slow growers, were analyzed. Protein extraction was standardized using a bead-based method with 70% alcohol inactivation before MALDI-TOF MS analysis. Identification results were compared with those obtained from the GenoType® Mycobacterium CM assay Line Probe Assay Line Probe Assay (LPA). RESULTS:MALDI-TOF MS correctly identified 108/110 isolates (98.18%), with 92.72% concordance with LPA. Two isolates (1.82%) were discordant, while six isolates (5.45%) reported as Mycobacterium spp. by LPA were further identified to species level by MALDI-TOF MS. The MALDI-TOF workflow provided results within 90-120 min, compared with 24-48 h for LPA. CONCLUSION:MALDI-TOF MS with optimized protein extraction is a rapid, accurate, and reproducible method for NTM identification. Its efficiency supports timely clinical decision-making and offers a practical alternative to molecular assays in diagnostic laboratories.

AIM:To assess the utility of fluorodeoxyglucose (FDG) PET-based myocardial viability in patients with left ventricular (LV) dysfunction, its role in guiding therapeutic decision-making, and its impact on patient outcomes. MATERIALS AND METHODS:This retro-prospective study included 70 patients of coronary artery disease, with myocardial infarction and LV dysfunction [left ventricular ejection fraction (LVEF) ≤ 35%]. All patients underwent rest single-photon emission computerized tomography myocardial perfusion imaging and FDG PET cardiac viability imaging. Viability was assessed qualitatively and quantitatively as the percentage of viable hibernating myocardium. Patients were categorized as having predominantly viable myocardium (≥7% viable hibernating LV myocardium) or predominantly scarred myocardium (<7%). Management decisions included surgical revascularization or medical therapy. Outcomes at 6-month followup included improvement in LVEF (≥5%), cardiac events, and cardiac-related death. RESULTS:During follow up, two patients died of noncardiac causes. Among 68 patients (mean LVEF 25.58%), 88.2% ( n  = 60) had predominantly viable myocardium and 11.8% ( n  = 8) had scarred myocardium on FDG PET cardiac scan. Of viable patients, 89.8% (44/49) undergoing revascularization showed LVEF improvement at least 5% vs. 45.5% (5/11) medically managed ( P  = 0.002784). Cardiac events occurred in 4.1% vs. 27.3%, respectively ( P  = 0.039). No significant association was found between treatment type and outcomes in the scarred group ( P  = 0.464). CONCLUSION:FDG PET-based myocardial viability assessment can potentially play a role in guiding therapeutic decision-making in patients with LV dysfunction by identifying those with predominantly viable hibernating myocardium who are more likely to benefit from revascularization and have better outcomes in terms of improved LV function and fewer cardiac events compared to those managed medically.