BACKGROUND:Postamputation pain in amputees is a major cause of morbidity. Studies have highlighted the impact of preemptive surgical intervention of the amputated nerves for treatment of postamputation pain. The study aimed to analyze the role of targeted muscle reinnervation (TMR) at the time of limb loss in addressing both residual limb pain and phantom limb pain. METHODS:A randomized controlled trial (RCT) in acutely injured patients undergoing above-knee amputation (AKA) (n = 97) were randomized into two groups with equal allocation, i.e., group A with TMR (intervention) and group B with conventional stump formation (control) at the time of amputation using mixed block randomization. The timeframe for the outcome analysis was 48 hours and 12 weeks postamputation. The psychological well-being was assessed using the Hospital Anxiety and Depression Scale (HADS), McGill Pain Questionnaire (MPQ), and functionality using Patient Reported Outcomes Measurement Information System (PROMIS) pain questionnaires. The anatomical evaluation of the severed nerve was done at 12 weeks with high-frequency ultrasonography. RESULTS:The majority of the patients were males (n = 92, 94.8%) with a mean age of 32.5 years. The mean Mangled Extremity Severity Score (MESS) was comparable ( p  = 0.98) between the groups. The difference of the mean NRS of the residual limb pain (1.8 vs. 3.3) and phantom limb pain (1.2 vs. 2.6) was statistically significant between the two groups ( p  = 0.001). The psychological scores HADS, MPQ, and PROMIS were statistically significant. The neuroma size measured using ultrasound at 12 weeks was statistically significant between the groups ( p  < 0.05). CONCLUSION:The preemptive surgical intervention of amputated nerve at the time of amputation by TMR techniques significantly reduces the postoperative residual limb pain and phantom limb pain at 3 months follow up.( J Trauma Acute Care Surg . 2026;100: 871-878. © 2026 American Association for the Surgery of Trauma.). LEVEL OF EVIDENCE:Randomized Controlled Trial with no negative criteria; Level I.

Background: Functional independence (FI) in adults aged ≥80 years is influenced by physical, cognitive, nutritional, and psychosocial factors. However, evidence from low- and middle-income countries, particularly India, remains limited for the oldest old. This study aimed to examine multidimensional characteristics associated with FI among adults aged ≥80 years attending a geriatric outpatient clinic in northern India. Materials and Methods: We conducted a cross-sectional study with an exploratory analytical approach over 3 months (March–May 2024) among 40 adults aged ≥80 years attending a tertiary geriatric outpatient clinic. Functional status was classified using the Lawton Instrumental Activities of Daily Living Scale. Participants underwent multidimensional assessment, including physical performance (grip strength, Short Physical Performance Battery [SPPB]), cognition (Mini-Mental State Examination/Hindi Mental State Examination), nutritional status (MiniNutritional Assessment–Short Form [MNA-SF]), psychosocial factors, and geriatric syndromes. Between-group comparisons were performed using bivariate statistical tests. Results: The mean age was 84.1 years and 67.5% were male. Compared with independent individuals, dependent participants had lower grip strength (median 17.3 vs. 28.6 kg; P < 0.001) and SPPB scores (median 4 vs. 9.5; P < 0.001). Nutritional status (MNA-SF difference ~3.5 points; P < 0.001) and cognitive scores (difference ~ 5 points; P = 0.009) were lower in the dependent group. Depressive symptoms, loneliness, social isolation, and geriatric syndromes – including sarcopenia risk, frailty, and urinary incontinence – were more frequent among dependent participants. Conclusions: In this exploratory cross-sectional study, FI in the oldest old differed across multiple domains. These findings represent unadjusted associations, do not imply independent predictors, and highlight multidimensional vulnerability, generating hypotheses for future longitudinal studies.

BACKGROUND & AIM:Maladaptive cortical plasticity is central to the pathophysiology of phantom limb pain (PLP), a condition often accompanied by sleep disturbances, anxiety, and depression states affecting quality of life. Repetitive transcranial magnetic stimulation (rTMS) has potential for relieving chronic neuropathic pain. Dorsolateral prefrontal cortex (DLPFC) is a critical component of neural circuitry subserving pain processing and associated affective aspects of pain. rTMS induced neuromodulation of DLPFC could be a potential therapeutic strategy in PLP management. Present study explored the role of rTMS of DLPFC on pain, anxiety, depression, and quality of life in PLP patients. METHODS:Twenty-seven traumatic amputees with PLP were randomized into real or sham rTMS group. Real rTMS therapy included 10 sessions over 2 weeks, with 1Hz stimulation at 90% resting motor threshold applied to DLPFC contralateral to amputation site. For sham rTMS therapy, same protocol was used, except coil was placed perpendicular to the scalp, preventing actual stimulation. The primary outcome was pain intensity assessed using Visual Analogue Scale. Secondary outcomes included pain assessment using Short-Form McGill Pain Questionnaire, anxiety using Hamilton Anxiety Rating Scale, depression using Hamilton Depression Rating Scale, and quality of life using WHO quality of life-BREF questionnaire. Assessments were performed at baseline, after 10th session, and during follow-up on days 15, 30, and 60 post-therapy. RESULTS AND CONCLUSION:rTMS on DLPFC was associated with improvement in PLP, anxiety, depression, and quality of life. The findings suggest the potential of DLPFC-rTMS as an adjunctive modality in the management of PLP.

Background and Aim: Fibromyalgia is an idiopathic chronic widespread pain syndrome affecting 2-4% of the general population globally. Besides widespread fibromyalgia pain, morning stiffness, associated neurologic as well as sleep problems are also reported. Disease is more prevalent in females of middle-age group with low socioeconomic status, thus deteriorating overall productivity and psychosocial health. There is no permanent cure of the disease. This study aimed to explore, validate and assess the effect of four weeks of supervised yogic intervention on pain status, quality of life, sleep, cortical excitability, flexibility and range of motion in fibromyalgia patients, as compared to standard therapy. Method: Case-control study, interventional study and assessor-blind randomized controlled trial, conducted in 120 fibromyalgia patients (60 yoga group: 60 waitlisted controls) and 60 age-matched healthy controls. Pain was assessed subjectively, using questionnaires and objectively, using quantitative sensory testing and ELISA. Sleep and quality of life were assessed using common and disease specific descriptors. Flexibility and range of motion was assessed using sit and reach box, lateral goniometry and modified Schober test. Transcranial magnetic stimulation on M1 was used to assess corticomotor excitability of participants. Study parameters were assessed at baseline and after four weeks of the intervention. Results: A significantly poor sleep, flexibility and quality of life was reported in the fibromyalgia patients due to excruciating pain (VAS = 6.90, 0.12); corticomotor function was also abnormal in the patients, which were restored after four weeks of yogic intervention. On subjective and objective assessment of pain, we found significant relief and improvement in pain status in the yoga group as compared to the waitlisted controls. Fibromyalgia impact, sleep, quality of life and flexibility were also found solely better in fibromyalgia patients undergoing yogic interventions. Cortical parameters, specifically RMT, MEPs and MEP recruitment curves showed a significant improvement in yoga group as compared to waitlisted controls. Conclusion: Four weeks of regular and supervised yogic intervention may ameliorate pain, improve flexibility and range of motion and change cortical plasticity in the Indian cohort of fibromyalgia patients, as compared to standard therapy. Yoga-based interventions can also improve overall quality of life and sleep impairments by reducing catastrophization and fibromyalgia impact. ### Competing Interest Statement The authors have declared no competing interest. ### Clinical Trial CTRI/2023/06/054093 ### Funding Statement Department of Science and Technology, Government of India Indian Council of Medical Research ### Author Declarations I confirm all relevant ethical guidelines have been followed, and any necessary IRB and/or ethics committee approvals have been obtained. Yes The details of the IRB/oversight body that provided approval or exemption for the research described are given below: Institute Ethics Committee, All India Institute of Medical Sciences, New Delhi, India I confirm that all necessary patient/participant consent has been obtained and the appropriate institutional forms have been archived, and that any patient/participant/sample identifiers included were not known to anyone (e.g., hospital staff, patients or participants themselves) outside the research group so cannot be used to identify individuals. Yes I understand that all clinical trials and any other prospective interventional studies must be registered with an ICMJE-approved registry, such as ClinicalTrials.gov. I confirm that any such study reported in the manuscript has been registered and the trial registration ID is provided (note: if posting a prospective study registered retrospectively, please provide a statement in the trial ID field explaining why the study was not registered in advance). Yes I have followed all appropriate research reporting guidelines, such as any relevant EQUATOR Network research reporting checklist(s) and other pertinent material, if applicable. Yes All data produced in the present work are contained in the manuscript

AIM:Emerging evidence suggests that alterations in gut microbiota composition may contribute to the onset and progression of sarcopenia through mechanisms involving systemic inflammation, metabolic dysregulation, and reduced production of short-chain fatty acids (SCFAs). However, data from Indian older adults-who exhibit diverse diets and microbiota profiles-are lacking. METHODS:This hospital-based cross-sectional pilot study enrolled 30 older adults aged ≥ 60 years, including 15 with sarcopenic and 15 age- and sex-matched nonsarcopenic. Sarcopenia was classified according to the Asian Working Group for Sarcopenia (AWGS-2019) criteria. Stool samples were analyzed using 16S ribosomal RNA (rRNA) sequencing (V3-V4 region, Illumina MiSeq). Taxonomic classification and diversity indices (Chao1, Shannon, UniFrac) were compared between groups. RESULTS:The mean age (S.D.) of study participants was 73.27 ± 5.96 years. A total of 251 315 high-quality sequences were generated from 30 fresh human fecal samples. The dominant phylum in the nonsarcopenic group was Firmicutes (41.2%), followed by Bacteroidetes (36.0%), whereas in the sarcopenic group, Bacteroidetes (39.2%) was most common, followed by Firmicutes (37.8%). A decrease in Operational Taxonomic Units (OTUs) of genus Bifidobacterium (2.21% vs. 3.71%), Bacteroides (8.50% vs. 11.11%) was observed in the sarcopenic group. An increase in OTUs of genus Faecalibacterium (10.64% vs. 8.23%) in the sarcopenic group was observed. The alpha-diversity index Chao1, Shannon was reduced in sarcopenic population. CONCLUSIONS:Exploratory differences in microbial diversity and relative abundance were observed between sarcopenic and nonsarcopenic older adults. These findings are descriptive and hypothesis-generating and warrant confirmation in larger, adequately powered studies.

Introduction Frailty assessment has proved useful for evaluating the ability to withstand cancer treatments, but it remains understudied in low- and middle-income countries, where the average life expectancy is about two decades lower than in higher-income countries. This study aimed to establish frailty cutoffs to guide treatment decisions by determining optimal G8 (Geriatric 8) and SCOPE-C (SCreening of the Older Person with Cancer) scores to predict postoperative outcomes in older Indian adults with head and neck cancer. Materials and methods In a tertiary care cancer facility in North India, patients ≥60 years with primary head and neck cancers undergoing curative surgery were included. This prospective observational study took place from January 2024 to March 2025. Pre-surgical frailty assessment was done by G8 and SCOPE-C. The main outcomes were major surgical complications and 30-day readmission. Results Of 115 patients included (mean age 66.9 years; 79.1% male), 22.6% developed major complications and 7.8% required readmission. On multivariable analysis, lower G8 (odds ratio [OR] 0.77, p = 0.007) and flap use (OR 3.21, p = 0.048) predicted major complications, while G8 alone predicted readmissions (OR 0.52, p = 0.001). Receiver operating characteristic analysis identified G8 cutoffs of ≤13 score for predicting complications (area under the curve [AUC] 0.636) and ≤ 11 for readmissions (AUC 0.839). Patients with G8 ≤ 11 had higher readmission rates (17% vs 1.5%; p = 0.003), and G8 ≤ 13 had more major complications (28.8% vs 11.9%; p = 0.04). Discussion Compared to the SCOPE-C screening tool, the G8 demonstrated statistically significant predictive value for both major surgical complications and readmissions; however, its low AUC indicates limited sensitivity and guarded clinical usefulness in predicting major postoperative complications.

Purpose To prospectively assess the incidence, types, and risk factors for complications following interventional radiology-guided peripherally inserted central catheter (PICC) placement in adult cancer patients at a lower-middle-income-country tertiary center. Materials and Methods In this single-center prospective cohort, all cancer patients >14 years who received a 4 Fr single-lumen PICC under ultrasound guidance with fluoroscopic tip confirmation were followed until line removal. Weekly structured follow-up (in-person or telephonic) was conducted. Complications were recorded using predefined criteria. Associations with demographic, clinical, and procedural factors were analyzed using chi-square/Fisher's exact or t/Mann-Whitney U tests. Results Fifty-six PICCs were placed in 48 patients (50% female; 28 solid and 28 hematologic cancers), contributing 4,386 catheter-days (median dwell time: 54 days). Twenty-five lines (44.6%) developed complications (32 events; 7.3/1,000 catheter-days). The most frequent were occlusion (17.9%; 2.3/1,000 days), catheter-related bloodstream infection, defined clinically rather than culture-confirmed (12.5%; 1.6/1,000 days), dislodgement (10.7%), and break/leak (10.7%). No symptomatic deep vein thrombosis (DVT) occurred. Complications led to premature removal in 21 lines (37.5%), with an 87.5% device-loss rate among affected catheters. Mean dwell time was significantly longer in lines with complications (103.6 vs. 57.9 days; p = 0.021). Higher body mass index showed a trend (p = 0.053), but other factors, including age, cancer type, puncture attempts, and tip position, were not associated with complication rates. Conclusion PICC complications remain common despite imaging guidance and are driven chiefly by prolonged dwell time and patient factors, not insertion technique. Mechanical problems (including occlusion, dislodgement, and breakage) and catheter-related infections were the most common complications, and no symptomatic DVT was observed, although subclinical events could not be excluded.

Respiratory syncytial virus (RSV) is an increasingly recognized cause of severe acute respiratory infection (SARI) among adults. Despite its clinical significance, data on RSV prevalence and outcomes in adults from India remain limited. With recent FDA approval of RSV vaccines for older adults, understanding regional epidemiology is critical for guiding vaccination strategies and clinical management. A prospective observational study was conducted at AIIMS, New Delhi, from November 2023 to January 2025. Adults aged ≥18 years hospitalized with SARI were enrolled consecutively. Clinical, demographic, and laboratory data were collected using a structured proforma. Respiratory specimens (nasal/throat swabs and lower respiratory tract samples) were tested by real-time RT-PCR for RSV, influenza, and other respiratory viruses. RSV-positive patients were followed during hospitalization to assess clinical outcomes, including oxygen requirement, complications, and mortality. Among 300 SARI patients (median age 46 years; 54% male), RSV was identified in 8% (all serotype B). Common comorbidities were chronic lung disease (44.1%), hypertension (22%), and diabetes (17%). Compared to non-RSV cases, RSV-positive patients more frequently had CHF (25% vs 10.1%), COAD (29.2% vs 14.5%), and diabetes (29.2% vs 15.9%). No RSV patients had HIV or CLD. Viral Coinfections were seen in 25% of RSV SARI patients and secondary bacterial infection also in 25% patients, with carbapenem-resistant Acinetobacter baumannii predominant. Overall mortality was 19.3%, slightly higher in RSV-positive cases (20.8%). No significant differences were noted in ICU admission, mechanical ventilation, or mortality between RSV and non-RSV SARI patients. RSV contributes significantly to the burden of SARI in Indian adults. Early identification of RSV infection, preventive strategies such as vaccination for high-risk populations, and targeted clinical management could potentially reduce the morbidity and mortality associated with RSV. All Authors: No reported disclosures

Objective: Fibromyalgia (FM) is an idiopathic progressive musculoskeletal pain syndrome affecting 2%–8% of the global population, predominantly females. Symptoms such as morning stiffness, brain fogging, and sleep disturbances are also common in the FM patients. There is no permanent cure of the disease except for temporary symptomatic relief by few FDA-approved medications. The aim of the current study was to investigate the effect of 4 weeks of regular and supervised medical yoga therapy (MYT) on pain status, lumbar flexion, and corticomotor excitability (CME) in FM patients. Methods: It is an assessor-blinded, randomized controlled trial where the pain was assessed both subjectively and objectively; lumbar flexibility and CME of both male and female FM patients of yoga and waitlisted group were also assessed and compared before and after 4 weeks of MYT and same course of standard care therapy. We have used pressure modality of quantitative sensory testing for objective assessment of pain. Corticomotor parameters were assessed using transcranial magnetic stimulation. Block randomization and opaque concealed envelope method was performed for randomizing and allocating patients in the yoga and waitlisted groups. Parametric tests were applied for the inter-and intragroup comparisons. Results: Demographic and clinical parameters of FM patients of both the arms were comparable at baseline (age: waitlisted group = 36.76 ± 9.20; yoga group = 35.71 ± 8.46; P > 0.05). Pain profile of the patient showed significant improvement, and tender point counts were also found to be reduced in the patients administered with MYT. In the waitlisted group, no significant changes were noted. A significant increase in lumbar flexion was reported bilaterally only after MYT. Former stayed unaltered in the waitlisted group. Moreover, improvements in some CME parameters of FM patients of the yoga group were also recorded. Such cortical changes were not marked in the waitlisted group. Conclusions: MYT can alleviate pain, improve flexibility, and alter CME in FM patients more than the standard therapy. MYT can be adopted in day-to-day lifestyle for symptomatic relief by FM patients.

Background: Intrinsic capacity (IC) underpins the World Health Organization healthy aging framework, yet comprehensive IC assessment is often impractical in routine outpatient care. The Integrated Care Tool 10 (ICT-10) was developed as a brief questionnaire for rapid IC screening among older adults. This study evaluated the agreement and discriminative ability of ICT-10 against standard domain-specific assessments among older adults in India. Materials and Methods: A cross-sectional study was conducted among adults aged ≥60 years attending a geriatric outpatient clinic in northern India. Participants completed the ICT-10, followed by blinded assessment using validated tools across sensory, cognitive, psychological, vitality, and locomotion domains. Agreement was assessed using simple agreement proportions and Cohen’s kappa (κ). Discriminative ability was evaluated using receiver operating characteristic curves and area under the curve (AUC). Results: A total of 137 participants (mean age: 69.5 ± 5.6 years; 52.5% male) were included. Agreement varied across domains. Hearing impairment showed substantial agreement (87.6%; κ =0.66) with good discriminative ability (AUC = 0.835). Fall risk (94.2%; κ =0.40; AUC = 0.699) and depressive symptoms (71.5%; κ =0.27; AUC = 0.690) demonstrated fair agreement and fair discriminative ability. Vision, cognition, vitality, locomotion, and psychological restlessness showed poor, slight, or fair agreement (κ ≤0.23) and poor discriminative ability (AUC: 0.41–0.59). ICT-10 overestimated cognitive and mobility concerns and underestimated sensory and nutritional impairments. Conclusions: ICT-10 showed the strongest performance for hearing impairment, with comparatively better performance for falls and depression. Refinement with clearer wording, cultural adaptation, validation of newly developed items, and assisted administration is required before use as a screening tool.

The incidence of occult lymph node metastasis is high in cT4aN0 laryngeal and lateral hypopharyngeal cancers, and bilateral selective neck dissection (levels II–IV) is routinely performed for oncologic clearance. However, the risk, distribution, and determinants of occult contralateral nodal involvement remain incompletely characterised. This retrospective cohort study evaluates the incidence of occult lymph node metastasis, the nodal stations commonly involved, and clinicopathological factors associated with contralateral occult nodal metastasis in patients with cT4aN0 laryngeal and lateral hypopharyngeal cancers. The retrospective chart review spanned from January 2018 to December 2023, encompassing all patients who underwent total laryngectomy.150 patients with clinico-radiologically confirmed T4aN0 status and who underwent bilateral selective neck dissection (level II-IV) were included in analysis. A descriptive pathological study was performed to assess occult nodal distribution in resectable lateralised laryngeal and hypopharyngeal malignancies. The incidence of occult lymph node metastasis was 28

OBJECTIVES:To compare the incidence of pharyngocutaneous fistula and pharyngeal closure time between barbed and conventional polyglactin sutures after total laryngectomy. METHODS:A single-blinded, randomized clinical trial was conducted from February 2023 to October 2024 at a tertiary academic center. Participants included adults with advanced laryngeal or hypopharyngeal carcinoma undergoing primary total laryngectomy with primary pharyngeal closure. Salvage laryngectomies and patients requiring patch pharyngoplasty were excluded. Patients were randomized 1:1 to pharyngeal closure with either a continuous 3-0 polyglycolic acid barbed suture or a continuous 3-0 polyglactin (Vicryl) suture. The primary outcome was the incidence of pharyngocutaneous fistula. The secondary outcome was pharyngeal closure time. RESULTS:Sixty patients were randomized (median age, 59.7 years; 95% men). Pharyngocutaneous fistula occurred in 5 of 30 patients (16.7%) in the Vicryl group and in none of the 30 patients in the barbed suture group; this difference did not reach statistical significance. Median pharyngeal closure time was shorter in the barbed suture group (15 min) compared with the Vicryl group (25 min). CONCLUSION:In this randomised pilot clinical trial, the use of barbed sutures was associated with shorter pharyngeal closure time and a numerically lower fistula rate. These findings suggest potential technical advantages of barbed sutures, although larger, adequately powered trials are required to confirm an effect on pharyngocutaneous fistula incidence. TRIAL REGISTRATION:Clinical Trials Registry-India Identifier: CTRI/2023/06/054351. LEVEL OF EVIDENCE:Level 2.

The purpose of this study was to investigate the efficacy and safety of add-on metformin treatment in persons with active epilepsy (a-PWE). This is a single-centric, double-blind, placebo-controlled trial randomised a-PWE (1:1) to receive either metformin (extended-release 500 mg) or matching placebo for 6 months along with background antiseizure medications. Primary outcome was percentage change in seizure frequency/month, and secondary outcomes were 50

Background Household contacts (HHCs) of MDR-TB patients are at increased risk of developing TB infection (TBI) as well as TB disease. Early identification of TBI is crucial for prevention of TB disease, however Indian data on MDR-TB contacts is limited. Methods We conducted a prospective cohort study (February 2022 to September 2024) in a tertiary care centre enrolling patients from urban slum neighborhoods of New Delhi. 147 HHCs of 36 MDR-TB cases were enrolled for the study and underwent a tuberculin skin test (TST). TBI was defined as TST ≥ 10 mm. Contacts were followed for 2 years for incidence of TB disease. Information on potential risk factors and other co-morbidities such as body mass index, smoking, alcohol consumption, diabetes, hypertension and household overcrowding were recorded. Results TST positivity was seen in 24.48% (36/147) HHCs. During follow-up of 2 years, 5 of 36 TST-positive HHCs (16.67%) developed TB as compared to 1 of 91 TST-negative (1.1%) HHCs. The relative risk of developing TB was 12.75 times higher for TST-positive versus TST-negative HHCs. TB incidence was significantly higher in overcrowded households and among younger or underweight HHCs. Conclusions Our study reinforces the high risk of transmission of MDR-TB to household contacts. Potential risk factors for TB infection include younger, malnourished HHCs with low BMI and household overcrowding. These findings underscore an urgent need to strengthen contact screening and implement targeted interventions in order to curb transmission of tuberculosis amongst contacts.

Introduction:Caregiver burden arises as a natural response to the stress associated with caregiving, encompassing a wide range of psychological, physical, social, and financial challenges. The aim of this study is to evaluate the extent of caregiver burden experienced by carers of cognitively impaired patients and the coping strategies employed by the caregivers. Methods:This cross-sectional study was conducted between January 2019 and March 2020 in the memory clinic of the Department of Geriatric Medicine and 116 patients aged ≥60 years with cognitive complaints and their caregivers were recruited. Addenbrooke's cognitive examination III (ACE-III)-Hindi version was used to define subjective cognitive impairment (SCI), mild cognitive impairment (MCI), and major neurocognitive disorder (MNCD). Caregiver stress was assessed using the Kingston caregiver stress scale (KCSS), and the coping behaviour assessment scale was used to identify caregiver coping strategies. Results:Among 116 patients, 46 (39.66%) had SCI, 20 (17.24%) had MCI, and 50 (43.10%) had MNCD. The caregivers' mean age was 47.82 ± 12.95, and 68 (58.62%) were male. Eighty-eight (75.86%) of them reported caregiver stress, and 85 (73.28%), 28 (24.14%), and 51 (43.97%) had caregiving, family, and financial issues. The presence of caregiver stress was significantly higher in MCND (RRR: 6.92, 95%CI, 2.32-20.64, P = 0.001) and MCI (RRR: 4.36, 95%CI, 1.12-16.96, P = 0.034) than caregivers of SCI patients. The coping score increased in MCI (RRR: 1.22, 95%CI 1.03-1.46) and MNCD (RRR: 1.59, 95%CI 1.34-1.89). Conclusion:Caregiver stress is common among patients with MCI and MNCD, comprising challenges in caregiving, family dynamics, and financial aspects.

Liquid biopsies, which analyze circulating tumor cells or cell-free circulating tumor DNA (ctDNA) from blood, have emerged as promising cancer detection and monitoring tools. Specifically, human papillomavirus (HPV) cell-free (cf) DNA is gaining recognition as a prognostic marker in high-risk HPV-related cancers. However, detecting circulating markers for cervical cancer (CC) requires highly sensitive techniques to quantify circulating HPV DNA. This study aimed to evaluate the use of droplet digital PCR (ddPCR), a highly sensitive technique, for detecting and quantifying circulating HPV DNA in cervical cancer patients, both at baseline (before chemo- or radiotherapy) and during follow-up, to assess its utility as a prognostic marker. Blood samples were collected from 60 cervical cancer patients (Stages I-IV) at AIIMS, New Delhi, at baseline and three months post-treatment. Samples from 10 healthy controls were also included. Plasma was separated and stored at - 80 °C, and cfDNA was extracted from 1 ml of plasma. The presence of high-risk HPV types, HPV16 and HPV18, in cfDNA from 35 patients was assessed using ddPCR. The median concentration of cfDNA in cervical cancer patients was 9.35 ng/µL at baseline, which decreased to 7 ng/µL after three months of treatment. In healthy controls, the median cfDNA concentration was 6.95 ng/µL. ddPCR screening showed that detection rates for HPV18 and HPV16 detection were 45.71% and 82.86%, respectively. A significant correlation was observed between cf HPV16 DNA levels and tumor size, suggesting its potential as biomarker for disease burden.

BACKGROUND:Cardio-metabolic risks emerge in early life and progress further in adult life. In recent times, COVID-19 pandemic aggravated risks owing to poor food security and diet quality. We aimed to assess the prevalence of cardiometabolic traits including the metabolically obese normal weight phenotype and its socioeconomic differentials in children and adolescents aged 6-19 years in India. METHODS:A baseline assessment was conducted between August and December, 2022, as part of a school-based cohort study that aimed at longitudinally evaluating the anthropometric and metabolic parameters among urban children and adolescents aged 6-19 years from three public (non-fee paying) and two private (fee paying) schools in India. Private and public schools were considered as a proxy for higher and lower socioeconomic status respectively. Blood pressure and blood samples in a fasting state were obtained only from adolescents aged 10-19 years. The prevalence and its 95% confidence interval using the Clopper exact method and adjusted prevalence ratios were calculated using random-effects logistic regression models. FINDINGS:Among 3888 recruited students, 1985 (51.05%) were from public schools, and 1903 (48.95%) were from private schools aged 6-19 years. The overall prevalence of underweight was 4.95% (95% CI 4.29-5.69), with a significantly higher prevalence in public schools (8.09%) than private schools (1.69%). The overall prevalences of general obesity and central obesity were 13.41% (95% CI 12.35-14.52) and 9.15% (95% CI 8.26-10.11), respectively, with significantly higher prevalence in private schools (p < 0.001). The prevalences of general and central obesity were four times (adjusted PR = 4.42, 95% CI 2.90-6.72) and eight times (adjusted PR = 8.31, 95% CI 4.82-14.35) higher, respectively, in private schools than public schools. The overall prevalence of hypertension was 7.37% (95% CI 6.33-8.51), and similar prevalences were found in public and private schools. Private school students had 2.37 times higher prevalence of impaired fasting plasma glucose (adjusted PR = 2.37, 95% CI 1.19-4.72) and 3.51 times higher prevalence of metabolic syndrome (adjusted PR = 3.51, 95% CI 1.54-8.01) than public school students. Among 2160 adolescents, 67.73% (1463) had normal body mass index. The prevalence of metabolically obese normal weight phenotype (MONW) was 42.86% (95% CI 40.30-45.44), which is higher in public [46.39% (95% CI 43.25-49.54)] than private [35.33% (95% CI 30.99-39.86)] schools (p < 0.001) with adjusted PR of 0.91 (95% CI 0.70-1.17). The most prevalent cardio-metabolic abnormality among metabolically obese normal weight phenotype was low high-density lipoprotein-c, significantly higher among adolescents from public schools (62.12% vs 52.73%, p = 0.039) than private schools. The prevalence of metabolically obese underweight (MOUW) (48/115) was 41.74% (95% CI 32.61-51.30), being higher among adolescents in public schools than private schools but not significant (p = 0.264). INTERPRETATION:Effective implementation of food security measures and targeted initiatives will be crucial to mitigate the socioeconomic disparities associated with the growing burden of cardiometabolic traits. Metabolic obesity among phenotypically normal or underweight adolescents should not be overlooked but should be intervened early through novel screening criteria to prevent future cardiovascular burdens. These findings also have implications for low- and -middle income countries like India, which are undergoing a nutritional transition where socioeconomic status strongly influences cardio-metabolic traits.

Almost half of all head and neck cancer patients in an Indian subcontinent are aged 60 years and above. This geriatric cohort faces its own unique challenges during perioperative period. This study aims at identifying the risk factors for surgical complications in geriatric head and neck cancer patients in an Indian subcontinent. A retrospective analysis of all geriatric head and neck cancer patients operated at a National Cancer Institute from January 2020 to December 2023 was done. 168 patients were screened for their demographic profile, clinicopathological and surgical details, and their impact on the surgical outcomes was analyzed. Our results indicate that female sex, an advanced T stage (T4a, T4b), regional flap usage for reconstruction, and having a higher ACE-27 category are all associated with increased odds of Clavien-Dindo3A/3B surgical complications. Conversely, having an ACE-27 category less than 1 suggests a trend towards lower odds, although it did not observe any statistical significance. Our study strongly advocates risk stratification in geriatric cohort with head neck squamous cell carcinoma (HNSCC) to optimise surgical outcomes and reduce perioperative morbidity and mortality. ACE-27 is useful tool to objectively predict patients at risk for perioperative morbidity. Level 4.