Abstract Background: Household contacts of pulmonary tuberculosis (TB) patients are at increased risk of TB disease. Although tuberculosis preventive treatment (TPT) reduces this risk, uptake and completion remain suboptimal in many high-burden settings, including India. This study examined the TPT cascade among household contacts of drug-susceptible pulmonary TB patients and factors associated with initiation and completion. Methods: A mixed-methods cross-sectional study was conducted between September and December 2023 among 251 household contacts of drug-susceptible pulmonary TB index cases in an urban field practice area in Ahmedabad, India. Quantitative data were collected using a structured questionnaire and analyzed using logistic regression. In-depth interviews explored experiences with TPT; qualitative data were analyzed thematically. Results: All 251 eligible contacts were offered TPT; 153 (61.0%) initiated treatment. Among initiators, 118 (77.1%) met the adherence definition and 110 (71.9%) completed the regimen. Higher education and motivation by health staff were associated with initiation, whereas current tobacco/alcohol use (addiction) and fear of side effects were associated with lower uptake. Among initiators, completion was more likely among those without side effects and those receiving home delivery of medicines, while addiction was associated with noncompletion. Qualitative findings identified protecting family members and trust in health workers as facilitators, whereas symptoms, logistical barriers, and low perceived need were important barriers. Conclusions: Although TPT initiation exceeded national averages in this urban cohort, substantial attrition occurred. Strengthening counseling, proactively managing adverse effects, and improving access to medicines may be associated with better TPT outcomes within the National TB Elimination Programme.
Abstract Background: Snakebite remains an important cause of morbidity and mortality in rural India, where delayed access to healthcare and limited emergency services contribute to adverse outcomes. Evidence from secondary healthcare centers in North India remains limited. This study aimed to describe the clinicoepidemiological profile and outcomes of snakebite cases presenting to a rural secondary-care mission hospital. Materials and Methods: This retrospective observational study included all patients presenting with snakebite to a rural secondary healthcare center in North India between January 1, and December 31, 2024. Data were extracted from hospital records using a structured questionnaire and included demographic characteristics, clinical features, time to presentation, treatment, and outcomes. Associations between categorical variables were assessed using Chi-square testing, with P < 0.05 considered statistically significant. Results: A total of 910 snakebite cases were recorded. The mean age was 25 years (range 0.5-78 years), with 485 (53.3%) males and 425 (46.7%) females. Most cases occurred during the monsoon season and agricultural work. Among 165 symptomatic patients, neurotoxic envenomation predominated in 161 (97.6%) cases, while 111 (67.3%) cases required ventilatory support. A total of 544 (60.5%) patients presented within 2 h, whereas 355 (39.5%) presented later. Delayed presentation was significantly associated with mortality ( χ 2 = 40.47, P < 0.001). Overall mortality was 8.5% (77/910). Conclusion: Snakebite in this rural North Indian setting was characterized by predominant neurotoxic envenomation, high ventilatory requirements, and substantial prehospital mortality. Improved awareness, rapid transport, early referral, and stronger emergency care are essential to reduce mortality.
Abstract Background: Desmoplastic stromal reaction reflects complex tumor–microenvironment interactions and may correlate with biological aggressiveness in breast carcinoma. Despite rising breast cancer incidence in India, regional data from North India, particularly Jammu and Kashmir, remain scarce. This study investigated associations between desmoplastic stroma grading and established pathological invasion indicators in breast carcinoma patients. Methods: This cross-sectional observational study analyzed 284 consecutive modified radical mastectomy specimens from patients diagnosed with invasive breast carcinoma at a tertiary care hospital between December 2020 and December 2025. Desmoplastic stromal reaction was graded histologically (mature, intermediate, and immature) using standardized criteria and to evaluate association with established pathological prognostic indicators. Histopathological parameters with which tumor desmoplastic stroma was studied included lymphovascular invasion (LVI), perineural invasion (PNI), histological tumor grade, surgical margin status, and nodal metastasis. Associations were examined using Chi-square tests, Spearman correlation, and multivariable logistic regression adjusting for age, tumor size, and molecular subtype. Results: The mean patient age was 51.4 ± 11.2 years. Immature desmoplastic stroma was present in 38.7% of cases, intermediate in 42.6%, and mature in 18.7%. Immature stromal reaction demonstrated significant associations with LVI (odds ratio [OR] = 4.83, 95% confidence interval [CI]: 2.71–8.62, P < 0.001), PNI (OR = 3.94, 95% CI: 2.15–7.22, P < 0.001), high histological grade (OR = 5.12, 95% CI: 2.84–9.23, P < 0.001), positive surgical margins (OR = 2.87, 95% CI: 1.54–5.35, P = 0.001), and nodal metastasis (OR = 3.56, 95% CI: 2.03–6.24, P < 0.001) after adjustment for confounders. A strong positive correlation was observed between stromal immaturity and the cumulative number of adverse pathological features (Spearman’s ρ = 0.624, P < 0.001). Conclusion: Desmoplastic stromal reaction shows a significant association with multiple pathological indicators of tumor invasion in breast carcinoma, as well as with stromal grading, underscoring its value as a prognostic factor. Routine assessment of stromal features may therefore improve prognostic stratification, particularly in resource-limited regional settings.
Abstract Aviation crashes are high-impact mass-casualty incidents that challenge prehospital rescue, triage, hospital surge capacity, forensic victim identification, and psychosocial support. The Air India Flight AI171 crash in Ahmedabad on June 12, 2025, was an urban aviation disaster with major implications for emergency systems because it occurred in close proximity to a tertiary care medical complex and generated simultaneous casualties on board and on the ground. This narrative review synthesizes publicly available official reports, governmental and institutional communications, and relevant peer-reviewed literature to examine the documented health-system response to the AI171 crash and to identify implications for hospital preparedness and health-system resilience. The available evidence suggests that the response involved rapid incident activation, multiagency coordination, expansion of emergency and mortuary capacity, structured victim identification workflows, and centralized communication. However, the event also highlights persistent vulnerabilities common to large disasters: documentation overload, technology gaps, language barriers, staff fatigue, VIP visit disruptions, and the operational difficulty of handling fragmented or burned remains. International experience from other air crashes, including the Tu-154M and A310 disasters, provides additional context for the importance of disaster victim identification systems, rehearsed incident command, and early family liaison. The AI171 crash therefore offers a clinically and operationally useful case for reviewing aviation disaster management in India and comparable settings, with the central focus on health-system resilience and preparedness rather than aviation accident causation.
Abstract Introduction: Biliary stricture is narrowing of the biliary tree. Cytological studies like biliary brushing and bile aspiration (BA) play a promising role as an initial diagnostic modality by detecting cytomorphological distortion at the stricture site. Materials and Methods: Fourteen cytological samples (six males and eight females) received during 6 months (January 2024–June 2024) were included in this study. Results: Cytological diagnoses were (a) smears positive for malignancy (seven cases in brush cytology and five cases in BA study), (b) smears negative for malignancy (three cases in brush cytology and six cases in BA study), and (c) smears suspicious for malignancy (three cases in brush cytology and one case in BA study). Conclusion: While correlating cytomorphological findings with radiological findings, biliary brush cytology was found to be more sensitive (71% vs. 57%) but less specific (66% vs. 80%) than BA cytology. Joint interpretation of these two cytological methods led to sensitivity and specificity of more than 75%.
