Abstract Achieving equitable health care for all individuals is imperative for the establishment of a healthy society. A nation that mitigates the financial burden associated with health care while emphasizing preventive measures not only enhances public health outcomes but also contributes to the stability of its population. India follows a multi-payer universal healthcare framework. To assess the overall health of a country’s citizens, several key health indicators have been established. They play a critical role in understanding health conditions and guiding policy decisions aimed at improving health outcomes. In India, these indicators are shaped by a variety of geographical, cultural, and socio-economic factors. They are crucial for policy formulation by assisting policymakers in identifying health priorities and allocating resources effectively and monitoring progress by tracking advancements toward health objectives. Despite progress, India’s healthcare sector continues to face several challenges. A segment of the population lives under the poverty line, which restricts access to health care. There are inadequate health infrastructure facilities in rural and remote areas. The Indian healthcare sector has experienced significant growth over the years, driving economic growth, creating employment opportunities, and improving patient outcomes. The government is working toward health care for all. Primary health care enhances the performance of health systems by reducing overall healthcare expenditure while improving population health and access. Reforms in the healthcare system should be monitored with indicators that reflect the core characteristics of primary health care. However, the government will have to increase the budget for health care to achieve healthcare access for all citizens of India.
Abstract Severe thrombocytopenia is common in Plasmodium vivax malaria, but its clinical importance and transfusion needs are unclear. Despite limited evidence, platelet transfusions are often given as a precaution. This study examines clinical outcomes using a restrictive, bleeding-guided transfusion approach in adults with severe P. vivax -related thrombocytopenia. A retrospective case series was conducted in a defence hospital ICU over 9 months (Jan-Sep 2025). Adults with confirmed P. vivax malaria and severe thrombocytopenia (platelet count <50 × 10⁹/L) were included. All received artesunate-based therapy and followed a restrictive transfusion policy, only giving platelets if there was active bleeding or a procedural need. The main outcome was platelet recovery (platelet count ≥100 × 10⁹/L). Other outcomes included bleeding, transfusion use, and survival without major bleeding or platelet transfusion, with platelet recovery. Six adults were studied, with a median age of 60 and 67% female. The median lowest platelet count was 20 × 10⁹/L, ranging from 17 to 23, and increased to 136 × 10⁹/L at discharge, a six- to seven-fold increase. No major bleeding was seen; two patients (33%) had minor mucocutaneous bleeding. One patient (17%) received a platelet transfusion, and two (33%) received red-cell transfusions. Five of six patients (83%) had a favourable outcome. Outcomes were similar for patients with shock or acute kidney injury and those without organ dysfunction. Platelet count thresholds within the severe range didn’t predict bleeding risk. Profound thrombocytopenia in P. vivax malaria was reversible with antimalarial therapy and rarely linked to major bleeding. This small case series supports against prophylactic platelet transfusion and suggests a restrictive, bleeding-guided approach is safe in practice.
Abstract Background: Central nervous system (CNS) involvement in hematolymphoid malignancies poses a diagnostic challenge and is associated with poor prognosis. Flow cytometry (FCM) has emerged as a sensitive diagnostic tool for detecting malignant cells in cerebrospinal fluid (CSF). Objectives: The objective of this study was to evaluate the diagnostic utility of FCM in CSF of patients with suspected hematolymphoid malignancies and to describe their clinicopathological spectrum. Materials and Methods: This prospective study included 42 patients from January 2024 to March 2025. CSF samples were analyzed through cytomorphology and FCM using lineage-specific panels. Statistical analyses included frequency distribution and correlation of FCM results with clinical, radiological, and bone marrow findings. Results: The mean patient age was 22.26 ± 19.03 years. FCM detected CNS involvement in 90.4% of cases. In terms of final hematological diagnosis, B-cell acute lymphoblastic leukemia (B-ALL) was the most frequent, diagnosed in 24 patients (61.9%), followed by acute myeloid leukemia, diffuse large B-cell lymphoma, and T-cell ALL. Chronic myeloid leukemia, multiple myeloma, and Burkitt’s lymphoma were also diagnosed, although in fewer numbers. Morphologically, the presence of B-lymphoblasts was observed in 38.1% of CSF samples, making it the most common cellular abnormality. This was followed by atypical lymphoid cells (21.4%) and blastoid cells (9.5%), whereas a few samples showed plasma cells, large clonal lymphoid cells, or were reported as negative for blasts. Hence, FCM increases the sensitivity and specificity of detection significantly. Conclusion: FCM significantly enhances the detection of malignant cells in CSF, even in paucicellular samples, proving its utility in routine CNS evaluation in hematolymphoid malignancies.
Abstract Intracholecystic papillary neoplasm (ICPN) is an uncommon preinvasive epithelial tumour of the gallbladder with variable malignant potential. This retrospective study evaluated the clinicopathological spectrum of four ICPN cases diagnosed on cholecystectomy specimens. Clinical, gross and histopathological features including epithelial subtype, grade of dysplasia and stromal invasion were analysed. Patients ranged from 32 to 68 years and lesion size varied from 0.8 to 9 cm. Gastric, biliary and mixed phenotypes were identified. Two cases showed low-grade dysplasia and two showed high-grade dysplasia. No stromal invasion was identified. In this limited series, larger lesions and biliary/mixed differentiation appeared to correlate with higher grades of dysplasia. ICPN represents a morphologically diverse preinvasive lesion with a spectrum of dysplasia, and accurate recognition is important because of its malignant potential.
