Sree Chitra Tirunal Institute for Medical Sciences and Technology (SCTIMST), formerly Sree Chitra Tirunal Medical Center, is an autonomous medical school and an Institute of National Importance in India established in 1976 at Thiruvananthapuram, Kerala. The institute is named after Chithira Tirunal Balarama Varma, the last Maharajah of Travancore, who gifted the building. The institute is under the Administrative Control of the Department of Science and Technology, Government of India. SCTIMST is one of the most prominent research Institutes and centers in India..
Insomnia disorder, with its high prevalence and profound impact on physical health, mental well-being, and overall quality of life, presents an ongoing challenge in diagnosis and management, both in India and globally. This expert opinion paper aims to provide an updated and comprehensive overview of current strategies for diagnosing and managing insomnia disorder in the Indian clinical context, with emphasis on integrating emerging evidence into practice. This paper synthesizes expert perspectives and current clinical guidelines relevant to insomnia disorder diagnosis and treatment in India. It discusses key diagnostic approaches, including assessment of sleep patterns, identification of comorbid conditions, and differentiation between short-term and chronic insomnia disorder. Management strategies covered include both non-pharmacological approaches, such as cognitive-behavioural therapy for Insomnia disorder (CBT-I), and pharmacological options. Non-pharmacological interventions, particularly CBT-I and sleep hygiene education, are emphasized as first-line treatments. Pharmacotherapy remains relevant, especially in chronic cases or where behavioural interventions are inaccessible. Newer pharmacologic agents such as Dual orexin receptor antagonists (DORAs) are highlighted for their favorable efficacy and safety profiles compared to traditional sedative-hypnotics, particularly in the Indian treatment landscape. Accurate diagnosis and individualized treatment planning are critical to improving insomnia disorder outcomes. Clinicians are encouraged to tailor interventions based on patient age, comorbidities, and risk of adverse effects. The integration of newer therapeutic options like DORAs can enhance clinical outcomes and improve quality of life for individuals suffering from insomnia disorder in India.
The mTOR pathway is important for neurodevelopment. The GATOR1 complex, composed of DEPDC5, NPRL2, and NPRL3, functions as a negative regulator of mTORC1 activity and pathogenic variants in the genes which comprise this complex cause focal epilepsy and malformation of cortical development, all named as GATORopathies. While focal cortical dysplasia is commonly reported, the full spectrum of associated neuroimaging findings remains incompletely defined. To characterize the neuroimaging features associated with GATOR1 complex mutations and to explore potential associations between imaging phenotypes and specific genotypes. MRI studies were retrospectively reviewed from January 2019 to December 2025 in patients with genetically confirmed GATOR1 mutations. Clinical, radiological, and genetic data were analyzed to identify imaging patterns and genotype–phenotype correlations. Twenty patients (median age : 6 years; range 1–25 years) were included. DEPDC5 mutations were most frequent (n = 12), followed by NPRL3 (n = 5) and NPRL2 (n = 3). MRI abnormalities were identified in 16 patients (80
Middle East respiratory syndrome coronavirus (MERS-CoV) is a zoonotic beta coronavirus identified in 2012 that circulates in dromedary camels and occasionally infects humans. Although community spread is limited, the disease shows a high case fatality rate near 36 percent and has caused hospital outbreaks such as the 2015 South Korea event. The viral spike binds the DPP4 (CD26) receptor, enabling entry into airway epithelial and selected immune cells, while accessory proteins suppress early innate immunity. Genetic studies indicate continuing evolution with clades A, B, and C across the Arabian Peninsula and Africa. Human infection is linked to camel contact, farm exposure, or raw camel products, with secondary spread mainly in healthcare settings. Diagnosis uses rRT-PCR and serology; treatment is supportive, and vaccines and antivirals are under study. A One Health approach is vital for surveillance, early detection, and control.
Healthcare associated infections remain a major global health concern because they increase illness, mortality, hospital stay, and healthcare costs. This review provides an updated synthesis of recent evidence on the epidemiology, microbiology, diagnostics, and prevention of healthcare associated infections. These infections arise from patient susceptibility, invasive procedures, antibiotic overuse, contaminated equipment, and poor infection control practices. Device associated infections such as catheter associated urinary tract infection, central line associated bloodstream infection, ventilator associated pneumonia, and surgical site infection are common and often involve multidrug resistant pathogens. Biofilm formation on devices and hospital surfaces creates persistent reservoirs that promote resistance spread. Advances in automated culture systems, rapid molecular assays, metagenomics, and whole genome sequencing improve detection and surveillance. This article integrates evidence from 2020 to 2025 to provide a multidisciplinary framework for understanding and controlling HAIs.
BACKGROUND:Patients with noncardioembolic ischemic stroke or transient ischemic attack (TIA) are at risk for recurrent stroke. Low factor XI levels are associated with a reduced risk of ischemic stroke. Asundexian inhibits activated factor XI. Whether the addition of asundexian to antiplatelet therapy would be superior to antiplatelet therapy alone for the secondary prevention of ischemic stroke is unclear. METHODS:In this phase 3, double-blind trial, we randomly assigned patients within 72 hours after the onset of a noncardioembolic ischemic stroke or high-risk TIA to receive asundexian (50 mg once daily) or placebo, in addition to planned dual or single antiplatelet therapy. Patients had at least one of the following: a nonlacunar infarct on imaging, a history of atherosclerosis, or evidence of atherosclerotic plaque at any location on cerebrovascular imaging. The primary efficacy outcome was ischemic stroke. The composite of death from cardiovascular causes, myocardial infarction, or stroke was a key secondary outcome. The primary safety outcome was major bleeding. RESULTS:Among 12,327 patients who underwent randomization (6162 to the asundexian group and 6165 to the placebo group), the incidence of ischemic stroke was lower in the asundexian group than in the placebo group (6.2% vs. 8.4%; cause-specific hazard ratio, 0.74; 95% confidence interval [CI], 0.65 to 0.84; P<0.001). The incidence of the composite of death from cardiovascular causes, myocardial infarction, or stroke was lower in the asundexian group than in the placebo group. The incidence of major bleeding was similar in the asundexian group and the placebo group (1.9% and 1.7%, respectively; cause-specific hazard ratio, 1.10; 95% CI, 0.85 to 1.44). The incidence of adverse events was 69.3% in the asundexian group and 70.1% in the placebo group; the incidence of serious adverse events was 19.2% and 19.5%, respectively. CONCLUSIONS:Among patients with noncardioembolic ischemic stroke or high-risk TIA treated with antiplatelet therapy, asundexian at a daily dose of 50 mg resulted in lower risks of ischemic stroke and major cardiovascular events than placebo, without a higher risk of major bleeding. (Funded by Bayer; OCEANIC-STROKE ClinicalTrials.gov number, NCT05686070.).
