Peerless Group

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: 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.

Medication errors remain a leading cause of preventable harm worldwide. Existing safety assessments rely mainly on audits and staff reports, which often overlook patients’ perspectives. Patient-Reported Experience Measures (PREMs) offer a structured way to capture patients’ views on medication administration safety. However, no PREM tool has been developed in India. To develop, validate, and apply a patient-centred PREM tool for assessing medication administration safety in Indian hospitals. This prospective, multicentre study was conducted across 16 hospitals (September 2023–April 2024). Tool development followed standard questionnaire design processes, including expert focus groups, face/content validation, and piloting. The final 15-item checklist used binary (yes/no) responses. Reliability was assessed using Kuder-Richardson Formula 20 (KR-20). A total of 614 adult inpatients (>24 h stay) completed the questionnaire. Content validity indices showed excellent agreement (S-CVI/Ave = 0.96). Internal consistency was acceptable for an early-phase validation study (KR-20 = 0.66). High adherence was reported for safety practices such as identity verification (95.0%) and allergy history documentation (94.8%). Areas for improvement included cost communication (68.6%) and disclosure of side effects (67.4%). Missed or skipped doses were reported by 17.3% (95% CI, 14.5%–20.5%) of patients. This is the first multicenter effort in India to developed and early-phase validated a PREMs tool for medication administration safety. The tool demonstrated feasibility and patient acceptability, while highlighting key safety gaps. Future work will focus on psychometric refinement and wider application, including integration into national quality assurance frameworks.

This study compared the safety and efficacy of double-walled incubators versus radiant warmers in extremely low-birth weight (ELBW: birth weight < 1000 g) preterm infants, hypothesizing that incubator care would reduce the time to regain birth weight compared with radiant warmer care. In this single-center, nonblinded, randomized controlled trial, ELBW infants with gestational age ≥25 to ≤32 weeks were randomized shortly after birth to stay in either an incubator or a radiant warmer for the first week of life, followed by radiant warmer care for all infants. The primary outcome was time to regain birth weight. Secondary outcomes included fluid intake, sodium levels, hypernatremia, and other neonatal outcomes. One hundred ELBW infants were enrolled. The median time to regain birth weight did not significantly differ between the incubator and radiant warmer groups: 12.00 (IQR 7.00, 17.75) days versus 11.50 (IQR 7.25, 15.75) days, respectively, with an effect size of median difference 0.0 (95% CI -4.0 to 4.0, P = .89). There were no significant differences in any other secondary outcomes. The study lacked sufficient power to detect differences in these outcomes. Either a double-walled incubator or a radiant warmer can be considered similarly safe and effective for thermoregulation and for achieving time to regain birth weight in ELBW infants. Radiant warmers may be preferable in low- and middle-income countries because they are less costly than double-walled incubators.