India bears the world's largest tuberculosis (TB) burden, and under-reporting from private-sector providers continues to hinder elimination goals. In the Akot Tuberculosis Unit (TU) of Maharashtra, private notifications remained disproportionately low despite extensive private healthcare presence. This study implemented a structured quality-improvement (QI) model using Plan-Do-Study-Act (PDSA) cycles to enhance TB case notifications from private providers.A mixed-method quality-improvement study was conducted from August to December 2023. Four iterative PDSA cycles were implemented targeting private practitioners, pharmacists, and laboratory technicians. Interventions included sensitization workshops, weekly WhatsApp-based digital outreach, and personalized follow-up visits by Public-Private Mix (PPM) coordinators. Quantitative data were extracted from the Ni-kshay platform and validated through Tuberculosis Unit records. Private notification trends (2018-2024) were analysed using segmented regression to assess temporal trends, while qualitative insights from key informant interviews (n = 6) explored barriers and enablers influencing notification practices. A total of 90 stakeholders participated (45 practitioners, 30 pharmacists, and 15 laboratory technicians). Private TB notifications increased from 16 of 90 total cases (17.8%) during January-July 2023-63 of 121 cases (52.1%) during November-December 2023, reflecting increase during the post-intervention period. The interrupted time-series analysis demonstrated a positive post-intervention trend in private TB notifications (β = +50.5, p = 0.032). Qualitative findings revealed that personalized digital mentoring and hands-on technical support helped address barriers such as Ni-kshay login issues, misconceptions about notification responsibility, and perceived workload. The implementation of a structured PDSA-based quality-improvement approach was associated with improvements in private-sector TB notifications in a previously low-performing tuberculosis unit. The findings suggest that integrating digital engagement, capacity building, and supportive supervision within existing NTEP structures may strengthen TB surveillance and private-sector engagement. These insights may inform scalable strategies to improve TB notification systems in similar programmatic settings.

India is the second-largest consumer of tobacco. Tobacco cessation clinics were introduced in India in 2001 and have been decentralised to the district level through the National Tobacco Control Programme. Research evidence on effective cessation interventions is limited in India. This paper aims to explore the implementation of tobacco cessation services in the public sector at the district level from a provider perspective. Two Maharashtra districts with a high prevalence of tobacco use were selected. Healthcare providers responsible for tobacco cessation services at the tertiary, secondary and primary levels were purposively selected. An exploratory qualitative study design was employed. Linnan and Steckler’s process evaluation framework guided the design and analysis of the data. Resources are inadequate to meet the requirements within districts, resulting in a weak ‘reach’ of services to tobacco users. The utilisation of follow-up services is limited except for those with chronic conditions. Among the 5 A’s, ‘Ask’ and ‘Advise’ are common, but the remaining three are used only by select healthcare providers. Data on cessation outcomes are limited, if at all. Healthcare providers reported that cessation outcomes were poor. The reach of tobacco cessation services is limited, and there is a need to increase the capacity of primary-level providers with brief key messages. The ‘fear-inducing’ tone is predominant in the ‘Advice’ messages. This needs to be supplemented by ‘Assist’ and ‘Arrange’ approaches. Cessation outcomes should be systematically recorded in health service systems.

Objectives This paper examines the differential impact of responsive parenting and nutrition interventions on early child development in stunted versus never-stunted children at 24 months of age in rural India.Methods We conducted a secondary analysis of data from Stepping Stones—a cluster randomised controlled trial involving 21 subcentres/clusters allocated to intervention or control group. The intervention comprised home visits, group sessions and community workshops, focusing on responsive parenting and nutrition. Developmental outcomes, cognitive, motor, language and socio-emotional, were assessed at 24 months using validated tools. A mixed-effects regression model with an interaction term was used to estimate effect sizes for stunted and never-stunted children.Results Among 588 children analysed, 35.9% were stunted at 24 months, and 35 (5.95%) of them exhibited ‘early-onset persistent stunting’. The intervention improved cognitive (β=0.22), motor (β=0.23), language (β=0.17) and socio-emotional development (β=0.23) in never-stunted children compared with those who have not received intervention. For stunted children who have not received the intervention, a development score was lower for all development domains compared with never-stunted children, but not statistically significant (p>0.05). Although the effects differed between stunted and never-stunted children, the interaction effects between intervention and stunting were not statistically significant across all domains (p>0.05), indicating that the intervention’s benefits did not significantly differ by stunting status.Conclusion Integrated parenting and nutrition interventions improved developmental outcomes across all domains, regardless of the child’s stunting status. These findings support universal application of such programmes, highlighting the need to integrate them into existing child development and nutrition programmes.

Anemia continues to be a significant public health concern in India, affecting various age groups and carrying substantial economic and health burdens. In India, nutritional anemia, predominantly from iron deficiency, is a significant challenge to public health. To assess the prevalence of anemia by causes and severity in different age groups among Indians. We searched different bibliographic databases (such as MEDLINE via PubMed, IMSEAR (WHO Regional Office Library for South-East Asia Region)) and the WHO Micronutrients database. Additionally, we searched the reference lists of the included studies, vital statistics data, government surveillance data and reports, and population censuses and survey data. The search strategy was restricted to studies conducted in India to ensure relevance to the Indian healthcare context, where disease epidemiology, healthcare infrastructure, and treatment protocols differ significantly from global settings. We performed the last search on June 2025. After removing duplicates, we screened all the studies based on titles and abstracts, followed by full-text screening. We extracted the data and analysed it using StataCorp. We used random-effects meta-analysis with 95

Background and Aims:Artificial Intelligence (AI) beginning to integrate in healthcare, is ushering in a transformative era, impacting diagnostics, altering personalized treatment, and significantly improving operational efficiency. The study aims to describe AI in healthcare, including important technologies like robotics, machine learning (ML), deep learning (DL), and natural language processing (NLP), and to investigate how these technologies are used in patient interaction, predictive analytics, and remote monitoring. The goal of this review is to present a thorough analysis of AI's effects on healthcare while providing stakeholders with a road map for navigating this changing environment. Methods:This review analyzes the impact of AI on healthcare using data from the Web of Science (2014-2024), focusing on keywords like AI, ML, and healthcare applications. It examines the uses and effects of AI on healthcare by synthesizing recent literature and real-world case studies, such as Google Health and IBM Watson Health, highlighting AI technologies, their useful applications, and the difficulties in putting them into practice, including problems with data security and resource limitations. The review also discusses new developments in AI, and how they can affect society. Results:The findings demonstrate how AI is enhancing the skills of medical professionals, enhancing diagnosis, and opening the door to more individualized treatment plans, as reflected in the steady rise of AI-related healthcare publications from 158 articles (3.54%) in 2014 to 731 articles (16.33%) by 2024. Core applications like remote monitoring and predictive analytics improve operational effectiveness and patient involvement. However, there are major obstacles to the mainstream implementation of AI in healthcare, including issues with data security and budget constraints. Conclusion:Healthcare may be transformed by AI, but its successful use requires ethical and responsible use. To meet the changing demands of the healthcare sector and guarantee the responsible application of AI technologies, the evaluation highlights the necessity of ongoing research, instruction, and multidisciplinary cooperation. In the future, integrating AI responsibly will be essential to optimizing its advantages and reducing related dangers.

Background:Although Helicobacter pylori (H. pylori) infections are widespread throughout the world, it is yet unknown whether they are linked to systemic illnesses like dyslipidemia. The purpose of this systematic review and meta-analysis was to examine the connection between lipid metabolism and H. pylori infection, with a particular emphasis on how it affects dyslipidemia. Methods:We conducted a thorough search up until October 10, 2024, across databases such as PubMed, Web of Science, and Embase. Studies that reported lipid profiles in both H. pylori-infected and non-infected patients were considered eligible. The primary outcomes were triglyceride, LDL-C, HDL-C, and total cholesterol levels, which were examined using a random-effects model in R software version 4.4. Results:There were 17 studies with more than 150,000 participants from 681 screened publications. Higher levels of LDL (MD: 5.32 mg/dL; 95% CI: 1.315 to 9.319) and total cholesterol (MD: 6.28 mg/dL; 95% CI: 0.718 to 11.842), as well as lower levels of HDL (MD: -2.06 mg/dL; 95% CI: -3.212 to -0.915), were the results of the meta-analysis. Among those infected, triglyceride levels were likewise higher (MD: 7.93 mg/dL; 95% CI: 0.413 to 15.436), but the odds ratio (OR) did not show a significant increase in risk (OR: 1.002; 95% CI: 0.995 to 1.010). Conclusion:H. pylori infection is associated with significant dyslipidemia, suggesting a potential link between chronic bacterial infection and lipid metabolism. The findings emphasize the need for further research to explore the mechanisms and potential therapeutic interventions.

Background Case reports are one of the important forms of documentation and publication of clinical physiotherapy presenting the first line of evidence in scientific literature. In order to provide a systematic and precise structure for reporting and presenting cases, the CARE guidelines were established in 2013. However, these guidelines present limitations as while reporting require items of specific specialties following the checklist. Authors from different specialities have developed CARE extensions specifying the characteristic features of corresponding fields, however, an extension dealing with physiotherapy assessment and line of management in the CARE guidelines is proposed as PhyCaRe. Method After consulting with the advisors, a draft will be prepared of the specific elements that should be included in the PhyCaRe using web Delphi methodology considering CARE statement as the source and SurveyMonkey will be used to undertake the web Delphi questionnaire. The web Delphi methodology will be assumed for three rounds and will be open to physiotherapists and others with substantial experience in reviewing case reports. Subsequently, an online consensus meeting, pilot testing, and submission of the CARE extension for physiotherapy will be conducted for publication. Dissemination The 2010 “Guidance for Developers of Health Research Reporting” and instructions from the EQUATOR Network will be followed in the preparation of PhyCaRe guidelines. The guidelines will be propagated at different platforms and journals will be requested to adopt the guidelines. Registration The reporting guideline under development is prospectively registered on the EQUATOR Network website on PhyCaRe – Reporting guideline for physiotherapy case reports.

BACKGROUND:The rapid rise of non-communicable diseases, particularly type 2 diabetes mellitus (T2DM), poses a significant global public health challenge, with South Asia experiencing an increasingly severe burden. This study aimed to analyse historical trends of T2DM across South Asia from 1990 to 2021 and forecast incidence through 2031. RESEARCH DESIGN AND METHODS:We carried out analysis based on the data from the 2021 Global burden of disease study. Joinpoint regression was used to identify significant changes in trends over time, and ARIMA models were applied to forecast incidence rates. RESULTS:Between 1990 and 2021, the average annual percentage change (AAPC) of age-standardized prevalence rates and incidence rates increased by 2.15 and 1.72 respectively. The age-standardized mortality rate rose more slowly, at 1.05 AAPC, with females experiencing a slightly higher AAPC than males. ARIMA forecasts suggest that by 2031, T2DM incidence rates will continue to rise significantly across all South Asian countries. CONCLUSIONS:This study highlights the need for public health policies focused on preventing obesity, promoting physical activity, and improving healthcare access. It also calls for addressing regional disparities in T2DM prevalence and mortality to better allocate resources and prioritize policies to combat the diabetes epidemic inSouth Asia.

Background:Good care and conscious, mindful parenting are the essential requirements of the early childhood period. Good care in early childhood consists of mindful handling of children's needs like hunger, care in sickness, socio-emotional needs, safety, love and affection. Good care promotes children's development and provides a favourable environment for learning. It's a well-known fact that hospitalization is a stressful situation for child of any age. Play is an integral part of early childhood period which is virtually restricted in hospital settings. This study will try to explore the effectiveness of play therapy delivered in hospital settings, on early child development (ECD). Methods:This will be a randomized control trial conducted in the Paediatrics department of a tertiary care hospital in Wardha, India. The sample size will be 360 children, 180 each in intervention and control arm. The hospitalized children from intervention arm will receive customized Play Therapy sessions from trained research assistants and will be followed up at scheduled monthly home visits for one year from the date of enrolment. All children will be assessed for changes in cognitive, motor and socio-emotional development scores. The differences in development scores between intervention and control groups will be compared and effect sizes of changes will be calculated. Discussion:Implementation of play stimulation activities have been reported as useful strategies for promoting child development and good recovery during hospitalization. This trial will attempt to explore the effectiveness of play therapy on changes in child development scores of children from intervention group compared to the control group. The customized play therapy program will be adapted to paediatric inpatient settings, and attempts will be made to improve the Play Therapy kit for hospitalized children. Registration:Clinical Trial Registry of India Registration No.: C.T.R.I./2022/03/041355, dated 24/03/2022. Protocol Version: v6 Dated 04/10/2024.

Child malnutrition remains a critical public health concern in India, particularly among under-five children. This study analyzed trends in nutritional deficiencies from 1990 to 2021 using Global Burden of Disease (GBD) data and predicted prevalence up to 2031. Joinpoint regression revealed significant declines in prevalence (-1.55% APC, 2010-2016) and mortality rates, with the sharpest reduction among females (-19.38% APC, 2019-2021). Bihar reported the highest prevalence in 2021, while Chhattisgarh saw the largest decrease (-85%). Projections indicate a slight increase by 2031. Regional and gender disparities necessitate targeted interventions to ensure equitable progress and meet global nutrition goals.

INTRODUCTION:Dengue fever is a significant health concern globally, especially in tropical regions. Identifying reliable markers for severe dengue, such as hypoalbuminemia, is crucial for early diagnosis and treatment. METHODS:This review systematically explores the association between hypoalbuminemia and severe dengue. We searched databases including PubMed, Embase, Scopus, Cochrane, and Web of Science until 28 December 2023, focusing on studies that reported albumin levels in dengue patients. Our selection criteria aimed at observational studies, from which data extraction and quality assessment were performed using Nested- Knowledge and the Newcastle-Ottawa Scale. RESULTS:A meta-analysis of 17 studies involving 974 severe and 18,496 non-severe dengue patients identified a standardized mean difference (SMD) in albumin levels of -1.625 g/dL (95% CI: -3.618 to -0.369). Subgroup analysis indicated more pronounced hypoalbuminemia in pediatric patients, with a pooled SMD of -1.08 g/dL (95% CI: -1.71 to -0.45). Our analysis demonstrated the link between hypoalbuminemia and severe dengue, indicating a significant pooled relative risk of 2.286, within 95% CI 1.308 to 3.996. CONCLUSIONS:The study confirms hypoalbuminemia as a significant predictor of severe dengue. Recognizing hypoalbuminemia in dengue patients can aid clinicians in forecasting the severity, potentially improving patient outcomes through targeted therapeutic strategies.

BackgroundDelivering Early Childhood Development (ECD) interventions in low-resource settings requires context-sensitive adaptive strategies grounded in community realities. The Stepping Stones Program, implemented in rural central India, sought to improve parenting practices and child development outcomes through structured community engagement. This paper presents the approach, implementation, and program impact, offering insights into building scalable, community-owned models for ECD.MethodsThis mixed-methods study was embedded within a cluster-randomized controlled trial conducted in 106 villages across two rural blocks in Maharashtra, India. A total of 656 pregnant women were enrolled and followed until their child reached 24 months. Intervention clusters received a responsive parenting and nutrition program integrated with existing Anganwadi services, while control clusters received standard government services. Community engagement was operationalized through participatory planning, the Photostory approach for initiating dialogue with the community, and the establishment of Curriculum Development Committees and a Community Engagement Board. A Monitoring, Evaluation, and Learning framework supported real-time adaptations. Process indicators were analyzed descriptively; child development outcomes were assessed at 24 months using mixed-effects regression models.ResultsThe program demonstrated strong community participation, with 85% of households engaging in at least one activity and 70% regularly attending sessions. Fathers’ participation in caregiving sessions increased from 4.3 to 33.65%. Balsakhis (local female volunteers) independently delivered over 80% of sessions. Integration with government systems was achieved through policy alignment and involvement of ICDS functionaries in program delivery. At 24 months, the mean difference of the development score in all domains between the intervention and control arm was statistically significant (p > 0.05). Children in the lowest wealth quintile showed the largest improvements in cognitive (effect size: 0.92, p < 0.001), motor (0.72), and language development (0.79). Children below the poverty line also showed significant gains across developmental domains.ConclusionStructured, participatory community engagement was critical to the successful implementation and impact of the Stepping Stones Program. The program evolved from a top-down intervention to a community-driven platform for nurturing care. Findings support the utility of an adaptive engagement framework in building equitable, sustainable, and scalable ECD interventions in low-resource settings.

Background Recent outbreaks of mpox have raised concerns about its complications, including ophthalmic manifestations such as conjunctivitis, keratitis, and potential vision impairment. The lack of comprehensive data on these ocular complications hinders the development of effective clinical guidelines. This review aims to synthesize existing evidence on the prevalence and characteristics of mpox-related ocular complications.Methods A systematic literature search was conducted across PubMed, Embase, Web of Science, and Scopus, covering studies up to 8 September 2024. Studies focusing on conjunctivitis, keratitis, eye lesions, visual impairment, and other ophthalmic outcomes in mpox cases were included. Meta-analyses were performed via a random effects model to estimate pooled prevalence rates, with heterogeneity assessed with the I2 statistic. Sensitivity analyses and publication bias assessments were also conducted.Results A total of 25 studies were included, with 22 contributing to the meta-analysis. The pooled prevalence of conjunctivitis in mpox cases was 8.9% (95% CI, 4.4%-17.1%); keratitis, 3.4% (95% CI, 1.4%-7.7%); eye lesions, 3% (95% CI, 1%-9%); and visual impairment, 4.3% (95% CI, .8%-20.6%). Other ocular manifestations had a pooled prevalence of 12.4% (95% CI, .6%-76.9%). Significant heterogeneity was observed, particularly for conjunctivitis and other ocular manifestations, suggesting variability in presentation.Conclusions Conjunctivitis is the most common ophthalmic complication of mpox, followed by notable rates for keratitis, eye lesions, and visual impairment. These findings emphasize the need for early recognition, routine ocular examinations, and effective management of mpox-related eye complications. Further high-quality research is necessary to better understand and address these ocular complications.Clinical Trials Registration CRD42024584467 (PROSPERO). This systematic review and meta-analysis reveal conjunctivitis as the most common ophthalmic complication of mpox, with substantial prevalence rates for keratitis, eye lesions, and visual impairment, underscoring the need for early detection and effective management of these conditions.

Background The global burden of zoonotic and emerging infectious diseases is substantial, with an estimated 2.5 billion cases and 2.7 million deaths each year. The One Health framework's multisectoral, transdisciplinary approach is necessary to address these issues. In this context, the "One Health System Strengthening in India (OHSSIN)" project aimed to build the capacity of healthcare professionals in Gujarat, Maharashtra, and Rajasthan, three western Indian states that are often at the forefront of zoonotic disease challenges. Methods This study focused on organised training sessions designed to enhance the knowledge and skills of participants from diverse sectors, including environmental, animal, and human health. The training employed a pre-post study design to evaluate participants' knowledge gains, providing insights into the intervention's effectiveness. The training sessions were carefully designed to be engaging and interactive, employing creative methodologies to facilitate learning. The content focused on key One Health concepts, effective risk communication strategies, and critical competencies required to tackle zoonotic and emerging infectious diseases. Results A total of 649 participants were part of the study, out of which around 60% were females. Most participants (77.50%) were from the human health department. The findings of the knowledge assessment indicate an increase in the number of correct responses across all questions/statements. The results demonstrated a statistically significant increase in mean knowledge scores, increasing from 54.77% before training to 62.41% after training (p < 0.0001). While the results demonstrated notable progress in several areas, some domains, such as community-level zoonotic disease prevention, showed only modest improvement. Conclusion These findings underscore the importance of designing specialised, ongoing capacity-building programs tailored to address specific knowledge deficits. Strengthening the One Health workforce through such initiatives is essential for enhancing preparedness, improving response capabilities, and fostering collaborative efforts to effectively manage zoonotic and emerging infectious diseases. This study highlights the transformative potential of the One Health approach to create a more resilient and informed public health workforce equipped to address the challenges posed by zoonotic diseases.

Interfacial failure associated with stress shielding is a primary cause of implant rejection. The customized structure, supported with similar mechanical strength and interconnected porosity, would facilitate improved interfacial crosstalk. Herein, a fugitive templating technique is explored for fabricating tailorable open porous Ti6Al4V. Ti6Al4V powder‐loaded slurry compositions are used to infiltrate fugitive templates with characteristics of 40, 30, and 20 pores per inch (PPI). The fabricated Ti6Al4V foam has open porosity ranging 73.8–91.7%, similar to trabecular bone. Further, the mechanical properties of foam are found to be in close proximity to trabecular bone. The sample of 40 PPI characteristics with different slurry combinations shows promising results compared to other fugitive templates. The Weibull modulus of all samples prepared using 40 PPI templates is evaluated to range between 3.14 and 11.31. Moreover, pore size distribution of the samples ranges from 422 ± 32.3 to 1148 ± 208 μm, with a porosity ranging from 73.8 ± 2.2 to 86.1 ± 0.8%. In vitro and in vivo studies confirm suitability of the samples for biological systems. The results indicate that the scaffolds are cytocompatible, bacteriostatic, hemocompatible, and promote osseoincorporation. Based on the optimized PPI–slurry combination, implants are fabricated as proof of concept.

Sex hormone-binding globulin (SHBG) plays a critical role in regulating androgen bioavailability and has been hypothesized to influence prostate cancer risk, though existing evidence is inconsistent. This systematic review and meta-analysis aimed to evaluate the association between SHBG levels and prostate cancer risk. A comprehensive search was conducted across PubMed, Embase, and Web of Science for studies published up to December 1, 2024. Observational studies assessing SHBG levels and prostate cancer risk were included. Effect sizes were pooled using random-effects meta-analysis. Heterogeneity was evaluated using the I2 statistic, and quality assessment was performed using the Newcastle–Ottawa Scale. Statistical analysis was performed using R software version 4.4. Sixteen studies, including 720,298 participants and 90,799 prostate cancer cases, were analyzed. The pooled odds ratio (OR) for prostate cancer risk per unit increase in SHBG was 0.907 (95

Falls represent a significant health concern among the older adults, particularly geriatric cancer patients, due to their increased susceptibility from both age-related and cancer treatment-related factors. This systematic review and meta-analysis aimed to synthesize global data on the prevalence and risk of falls in this population to inform targeted fall prevention strategies. Following PRISMA 2020 guidelines, we conducted a comprehensive search of PubMed, Embase, and Web of Science up to October 2024. Articles were screened using Nested Knowledge software by two independent reviewers. Eligible studies included those involving geriatric cancer patients aged 60 years or older reporting on fall prevalence. Quality assessment was performed using a modified Newcastle–Ottawa Scale, and meta-analysis was conducted using random-effects models with R software. From 1,365 identified studies, 86 met the inclusion criteria, encompassing 180,974 participants. The pooled prevalence of falls was 24

Mpox is a viral zoonotic disease that has seen a resurgence in recent years, with outbreaks reaching beyond its traditional endemic zones in Central and West Africa to parts of Europe and North America. The relationship between human immunodeficiency virus (HIV) infection and mpox outcomes, particularly hospitalization rates, remains underexplored despite the known immunosuppressive effects of HIV. This systematic review and meta-analysis aimed to clarify the association between HIV infection and the likelihood of hospitalization in mpox cases. A literature search was conducted through PubMed, Embase, Web of Science, Scopus, and the Cochrane Library up until August 10, 2024. The eligibility criteria focused on observational studies that evaluated hospitalization rates among mpox cases, distinguishing between HIV-positive and HIV-negative individuals. Newcastle-Ottawa Scale was used for evaluating study quality. The meta-analysis used a random-effects model to accommodate expected study heterogeneity using R software (V. 4.4). The search yielded 686 records, with 14 studies meeting the inclusion and exclusion criteria after screenings and full-text assessments. The pooled analysis revealed a 56.6