Peerless Group

Sepsis remains a major cause of mortality and long-term morbidity worldwide. Data on long-term outcomes among Indian intensive care unit (ICU) survivors with sepsis remain limited. This study evaluated long-term mortality, readmission, and quality-of-life outcomes among sepsis survivors in Indian ICUs. LOSS study was a multicenter observational cohort/ follow-up study conducted among adult patients enrolled in the SEPSIS INDIA registry who survived hospital discharge. Baseline demographic, clinical, and comorbidity data were obtained from the registry. Comorbidity burden was assessed using the Charlson Comorbidity Index (CCI). Long-term outcomes were collected through structured telephone interviews. Outcome assessment included long-term mortality, hospital readmission, and health-related quality of life assessed using a modified SF-36 questionnaire. Follow-up was conducted for up to 39 months after discharged alive. A total of 608 patients were included. Median age was 65 years (IQR 54–75), and 58.1

Thyroid nodules are a prevalent clinical concern globally, with a rising incidence attributed to enhanced screening and diagnostic capabilities. In India, palpable thyroid nodules are notably common, affecting up to 12.2% of the population. The 2023 Bethesda System for Reporting Thyroid Cytopathology (TBSRTC) provides a standardized classification for fine-needle aspiration (FNA) results, categorizing nodules from nondiagnostic (Category I) to malignant (Category VI). While FNA effectively diagnoses 75%–80% of nodules, 20%–25% remain indeterminate (Bethesda III and IV). In settings like India, where advanced molecular diagnostics (e.g. Afirma Genomic sequencing classifier (GSC), Thyroseq v3) may be financially inaccessible to a significant portion of the population, intraoperative frozen section (FS) has traditionally been employed. FS offers a rapid intraoperative assessment, potentially guiding immediate surgical decisions and avoiding a second surgery if malignancy is confirmed. However, the actual clinical utility and necessity of FS, especially in indeterminate categories, are widely debated. Pathologists in India are often requested to perform FS on cytologically indeterminate nodules (Bethesda III and IV) to obtain a definitive diagnosis. The 2023 Bethesda update and recent Indian studies report malignancy rates of 15%–35% in Bethesda IV nodules, further reducing the expected yield of routine FS. This review article aims to reassess the role of FS in thyroid surgery, particularly focusing on its diagnostic performance in follicular thyroid nodules, considering its limitations, and analyzing its cost-effectiveness within the unique healthcare landscape of India.

Food allergy is an emerging public health concern in India, driven by rapid urbanisation, changing dietary patterns, environmental influences, and increasing recognition of allergic diseases. Despite the growing burden, food allergy care in India is challenged by limited epidemiological data, variable diagnostic practices, and inadequate access to specialised services. These gaps underscore the need for standardised, context-specific guidance tailored to the diverse sociocultural and dietary landscape of the country. This consensus document was developed by a multidisciplinary panel of allergy experts using a structured Delphi methodology to ensure methodological rigour and expert agreement. It provides a comprehensive overview of evidence-based approaches to the diagnosis and management of food allergy, adapted to Indian clinical practice. The consensus recommends adoption of a standardised diagnostic framework incorporating detailed clinical history, skin prick testing, serum-specific IgE estimation, and supervised oral food challenges, where appropriate. Recognition of region-specific allergens-including milk, wheat, egg, peanut, fish, chickpea, lentils, and sesame-is emphasised to improve diagnostic accuracy and culturally relevant patient counselling. The document highlights the importance of comprehensive management strategies that integrate strict allergen avoidance with balanced, culturally appropriate nutritional planning and psychosocial support. Standardisation of clinical practice is advocated to reduce heterogeneity in care, facilitate early diagnosis, and improve patient outcomes. At a broader level, the consensus emphasises strengthening public health policies through clear food labelling, enhanced allergy education, and school-based preparedness programs. Preventive strategies, including early supervised introduction of allergenic foods, are encouraged in appropriate settings. Advanced therapeutic options such as biologic agents and oral immunotherapy are recommended only for selected patients with severe disease and under specialist supervision. Finally, the consensus underscores the urgent need for robust epidemiological studies, improved diagnostic infrastructure, and enhanced professional training to address existing knowledge gaps. Collectively, these recommendations aim to improve quality of care, reduce disease burden, and support the development of effective, evidence-based food allergy management in India.

ABSTRACT Background Persistent gas‐predominant dyspeptic symptoms affect many patients despite adequate proton pump inhibitor (PPI) therapy, reflecting mechanisms beyond acid secretion. We evaluated the real‐world effectiveness and safety of simethicone (80 mg) plus activated charcoal (250 mg) in adults with persistent symptoms despite prior PPI therapy. Methods In this prospective, multicenter observational study across nine Indian sites, adults with persistent gas‐related symptoms despite ≥ 2 weeks of standard‐dose PPI therapy received the combination thrice daily for 28 days. Severity across 11 gastrointestinal domains was assessed using a modified Visual Analog Severity scale at baseline, Day‐14, and 28. The primary outcome was change in symptom severity from baseline to Day 28, analyzed using Friedman testing with Bonferroni‐adjusted Wilcoxon post hoc comparisons. A global symptom score (mean of all 11 domains) was used for exploratory subgroup analyses; secondary outcomes included adherence and safety. Results All 183 participants completed follow‐up, with significant reductions across all 11 symptoms (all p < 0.001). Belching decreased from 46.3 ± 26.4 to 10.9 ± 19.5, epigastric burning from 48.1 ± 27.3 to 10.7 ± 17.9, and bloating from 44.2 ± 29.1 to 12.9 ± 18.6. Improvements were evident by Day‐14 and sustained to Day‐28. The median global symptom score reduction was 25.0 units (95% CI: 22.7–27.3), with consistent improvement across demographic and clinical subgroups. Full adherence was 87.1% at Day 14 and 83.6% at Day 28, with no serious clinical events. Conclusion In patients with persistent gas‐predominant dyspepsia despite PPI therapy, simethicone–activated charcoal was associated with significant short‐term symptomatic improvement. Controlled trials are warranted to confirm treatment effect.

ABSTRACT Background: The optimal duration of dual antiplatelet therapy (DAPT) after acute coronary syndrome (ACS) continues to evolve, but current recommendations derived largely from Western data may not reflect the clinical profile of Indian patients, underscoring the need for region-specific guidance. Objective: To develop consensus-based, India-specific recommendations on DAPT duration in ACS by integrating global evidence with real-world clinical considerations. Materials and Methods: A modified Delphi process was conducted among experienced interventional cardiologists across India. Participants reviewed evidence summaries and anonymously rated ten statements on prolonged, shortened, and risk-stratified DAPT strategies. Consensus was defined as ≥75% agreement. Results: All 34 cardiologists completed the survey (100% response). Consensus (≥≥70%) was achieved for all statements. Strong agreement supported prolonged DAPT in high-thrombotic-risk ACS (97.1%) and balancing ischemic and bleeding risks (94.1%). Agreement with the ESC 6-month DAPT recommendation for stable DES percutaneous coronary intervention (PCI) was lower (61.8%), reflecting preference for extended therapy in Indian practice. While short DAPT reduced bleeding (85.3%), most experts acknowledged higher MI risk in ACS, consistent with SMART-DATE and STOPDAPT-2 ACS (79.4%). Prolonged DAPT (≥≥12 months) in complex PCI received strong support (97%), with universal agreement that it reduces MACE and cardiothrombotic events (100%). Key factors favoring extended therapy included smoking and prior MI/stent thrombosis (97% each), as well as procedural complexity. Routine PPI cotherapy was endorsed by 79.4%. Conclusion: The GOLD-DAPT consensus offers practical, risk-adapted recommendations for Indian ACS patients, supporting individualized rather than fixed-duration DAPT and emphasizing the need for India-specific prospective data to guide future national policy.