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Objectives: The severity of pulmonary artery hypertension affects the outcomes of patients undergoing mitral valve replacement (MVR). Speckle-tracking derived strain is a new modality for the assessment of the right ventricular (RV) function as well as the longitudinal contractile pattern. Our main objective of this study was to evaluate the right ventricular (RV) function in patients undergoing MVR with pulmonary artery systolic pressure (PASP) of more than 50 mmHg at 1 and 4 weeks postoperatively. Material and Methods: This prospective cohort study included 40 patients with rheumatic heart disease (RHD) (mitral stenosis [MS] and mitral regurgitation [MR]) scheduled to undergo MVR between January 2022 and December 2023 in AIIMS, New Delhi. Serial 2D echocardiography, tissue Doppler imaging, as well as RV speckle-tracking echocardiography were performed, and serum brain natriuretic peptide (BNP) levels were measured during the pre-operative period, 1st week and 4th weeks postoperatively to evaluate RV function. Results: Tricuspid annular plane systolic excursion (TAPSE) and left ventricular ejection fractions (LVEFs) were significantly lower at 1 week after surgery, compared to pre-operative levels, and reached the pre-operative values at 4 weeks after surgery. The RV fractional area change (RVFAC) at 4 weeks postoperatively significantly increased compared to 1st week and baseline values. The tricuspid valve (TV) tissue velocity in systole (S′), TV velocity in diastole (E′), RV global strain (RVGLS), and RV free wall strain (RVFWLS) at post-operative 4 weeks were lower than pre-operative values, and this difference was statistically significant. Conclusion: Four weeks after MVR, in adult patients with RHD (MS and MR) having PASP >50 mmHg, it was observed that deformational indices or speckle-tracking echocardiography such as RVGLS and RVFWLS predict better RV dysfunction than linear indices like TAPSE. The BNP, PASP (delta TR), right atrial volume, left atrial volume, LV internal diameter in systole, and LV internal diameter in diastole decreased significantly in these patients. RVFAC increased significantly to compensate for the loss of longitudinal function. [ABSTRACT FROM AUTHOR]

Introduction: Lung transplant (LTx) is a potential treatment option for all patients with chronic, end‑stage respiratory disease, who are refractory to optimal medical therapy or where no medical therapy exists. In India, LTx is still in its evolving stages and published literature is sparse. The current study was carried out to study the selection criteria for lung transplant and to evaluate the clinical and socio‑economic profile of patients referred for the same at a tertiary health care facility. Methods: The study was a descriptive, prospective, observational study. All adults referred for lung transplant were evaluated for clinical and laboratory profiles. All enrolled patients were assessed for presence of referral criteria, listing criteria, contraindications, and willingness for lung transplant. These patients were followed up for 2 years for transplant‑free survival, and the Cox proportional hazards model was used to determine independent predictors of all‑cause mortality. Results: A total of 103 were included in study. The most common diagnosis was interstitial lung disease (57.2%), followed by bronchiectasis (17.5%) and COPD (13.6%). Most patients were referred for LTx at an advanced stage as 90% met listing criteria. Fifty‑four (52.4%) patients had an absolute or relative contraindication to transplant; however, the majority of those contraindications were modifiable. Patients with a lower socio‑economic status were less likely to be willing for LTx. The median survival was 757 days. A 6‑minute walk distance (6MWD) lesser than 250 m was found to be an independent predictor of mortality. Conclusion: Making patients aware about lung transplant early in their treatment may give them sufficient time to come to terms with their disease and understand the risk and benefits associated. Efforts should be focused on screening and early treatment of reversible contraindications for the eligible patients. Patients with 6MWD < 250 m are at increased risk of mortality. [ABSTRACT FROM AUTHOR]

Background: In anxiety disorders, culture is important in symptom presentation and help-seeking. Most tools for anxiety disorders are not validated in India and thus might not capture culture-specific aspects of anxiety. This study aims to identify and generate culturally specific terms to describe symptoms of anxiety as part of the development of the Kannada version of the Panic and Anxiety National Indian Questionnaire (PANIQ). The PANIQ is a tool under development to identify anxiety and panic in Indian settings. Methods: This study used qualitative methods like focus group discussions (FGDs) and in-depth interviews (IDIs) to identify and generate items related to anxiety and panic in Kannada from stakeholders like individuals with anxiety disorders, their caregivers, healthcare workers, and mental health professionals who treat individuals with anxiety and panic disorders. Five FGDs (n = 28), one triad (n = 3), and 34 IDIs (n = 34) were conducted. Results: The mean age of the participants was 38.9 (standard deviation: 12.28) years; 57.1% were from rural areas. We generated 615 Kannada items. These were classified into 21 domains and facets. Items in domains like Somatic symptoms, Fear, and Impairment in day-to-day life were higher than those noted in existing tools for anxiety that focus more on cognitive symptoms of anxiety. Conclusions: This study generated culturally specific items of anxiety through a qualitative process of tool development incorporating subjective experiences of persons with anxiety disorders and other stakeholders. This is among the first steps toward the development of PANIQ. [ABSTRACT FROM AUTHOR]

Endoscopic management of bile duct obstruction is a key aspect in gastroenterology practice and has evolved since the first description of biliary cannulation by McCune et al in 1968. Over many decades, the techniques and accessories have been refined, and currently, the first-line management for extrahepatic biliary obstruction is endoscopic retrograde cholangiopancreatography (ERCP). However, even in expert hands, the success rate of ERCP reaches up to 95%. In almost 4 to 16% cases, failure to cannulate the bile duct may necessitate other alternatives such as surgical bypass or, more commonly, percutaneous transhepatic biliary drainage (PTBD). While surgery is associated with high morbidity and mortality, PTBD has a very high reintervention and complication rate (∼80%) and poor quality of life. Almost parallelly, endoscopic ultrasound (EUS) has come a long way from a mere diagnostic tool to a substantial therapeutic option in various pancreaticobiliary diseases. Biliary drainage using EUS-guidance (EUS-BD) has gained momentum since the first report published by Giovannini et al in 2001. The concept of accessing the bile duct through a different route than the papilla, circumventing the shortcomings of PTBD, and sometimes bypassing the actual obstruction have enthused a lot of interest in this novel strategy. The three key methods of EUS-BD entail transluminal, antegrade, and rendezvous approach. Over the past decade, with growing experience, EUS-BD has been found to be equivalent to ERCP or PTBD for malignant obstruction with better success rates. EUS-BD, however, is not devoid of adverse events and can carry fatal adverse events. However, neither the technique of EUS-BD nor the accessories and stents for EUS-BD have been standardized. Additionally, different countries and regions have different availability of the accessories, making generalizability a difficult task. Thus, technical aspects of this evolving therapy need to be outlined. For these reasons, Society of Gastrointestinal Endoscopy of India (SGEI) deemed it appropriate to develop technical consensus statements for performing safe and successful EUS-BD. [ABSTRACT FROM AUTHOR]

Endoscopic management of bile duct obstruction is a key aspect in gastroenterology practice and has evolved since the first description of biliary cannulation by McCune et al in 1968. Over many decades, the techniques and accessories have been refined and currently, the first-line management for extrahepatic biliary obstruction is endoscopic retrograde cholangiopancreaticography (ERCP). However, even in expert hands the success rate of ERCP reaches up to 95%. In almost 4 to 16% cases, failure to cannulate the bile duct may necessitate other alternatives such as surgical bypass or more commonly percutaneous transhepatic biliary drainage (PTBD). While surgery is associated with high morbidity and mortality, PTBD has a very high reintervention and complication rate (∼80%) and poor quality of life. Almost parallelly, endoscopic ultrasound (EUS) has come a long way from a mere diagnostic tool to a substantial therapeutic option in various pancreatico-biliary diseases. Biliary drainage using EUS-guidance (EUS-BD) has gained momentum since the first report published by Giovannini et al in 2001. The concept of accessing the bile duct through a different route than the papilla, circumventing the shortcomings of PTBD and sometimes bypassing the actual obstruction have enthused a lot of interest in this novel strategy. The three key methods of EUS-BD entail transluminal, antegrade, and rendezvous approach. Over the past decade, with growing experience, EUS-BD has been found to be equivalent to ERCP or PTBD for malignant obstruction with better success rates. EUS-BD, albeit, is not devoid of adverse events and can carry fatal adverse events. However, neither the technique of EUS-BD, nor the accessories and stents for EUS-BD have been standardized. Additionally, different countries and regions have different availability of the accessories making generalizability a difficult task. Thus, technical aspects of this evolving therapy need to be outlined. For these reasons, the Society of Gastrointestinal Endoscopy India deemed it appropriate to develop technical consensus statements for performing safe and successful EUS-BD. [ABSTRACT FROM AUTHOR]

Worsening heart failure (WHF) is a distinct under-diagnosed and under-treated condition, independent of location of care. Heart failure (HF) progression is punctuated by repeated WHF events, each resulting in reduced cardiac function. One-third of the patients with HF with reduced ejection fraction experience a decompensation event. These decompensation events often result in the emergency department visits and HF hospitalization. Despite its inclusion in recent guidelines, there is no precise definition of WHF or its various forms. It is worth noting that WHF signals a need for treatment optimization as per guideline-directed medical therapy and the addition of novel drugs like a stimulator of soluble guanylate cyclase that benefit this high-risk patient population. This practical document is based on the expert opinion of cardiologists, cardiothoracic surgeons, and physicians that discussed the definition, assessment, pharmacological management, and monitoring of WHF patients in a hospitalized setting. In addition, there is also a need for an expert opinion for the management of WHF in an outpatient setting. [ABSTRACT FROM AUTHOR]

Introduction: Gastric cancer (GC) is one of the leading causes of cancer-related decimations worldwide. The gastric infection at both the stomach and duodenum with Helicobacter pylori causes inflammation by the tumor necrosis factor-alpha (TNF-α). The aim of the study was to associate and evaluate the three TNF-α gene polymorphisms at positions -308 G/A, -238 G/A, and -857 C/T with the risk of GC. Methods: A total of 156 individuals (consecutively diagnosed 95 GC patients and 61 controls) above the age of 18 years were enrolled in the study. Healthy individuals with normal upper gastrointestinal endoscopy (UGIE) irrespective of their family history of GC or peptic ulcer were included as controls. The cited three TNF-α gene polymorphisms were evaluated using polymerase chain reaction-restriction fragment length polymorphism (RFLP). Results: There was no significant difference in the distribution of gene polymorphisms as genetic factors, TNF-α-308 GA/AA (22.1% vs. 14.8%, p = 0.2), TNF-α-238 GA/AA (21% vs. 19.6%, p = 0.8), and TNF-α-857 CT/TT (8.4% vs. 11.5%, p = 0.5), between GC cases and healthy controls. A subgroup analysis of H. pylori-positive patients showed that there was no significant difference in the distribution of GA/AA polymorphisms in TNF-α-308 (15(45.5%) vs. 3(23%); p = 0.17) and -238 (12(36.3%) vs. 2(15.4%); p = 0.17), and the distribution of TT/CT -857 CT/TT (13(39.4%) vs. 2(15.4%); p = 0.13), among the GC cases and controls. Conclusion: The statistical comparisons of GA/AA vs. GG genotypes at -308 (with OR = 1.6, 95% CI: 0.6-3.8), -238 (OR = 1.09, 95% CI: 0.4-2.4) and TT/CT vs. CC genotypes at -857 (OR = 0.7, 95% CI: 0.2-2.1) did not suggest any association of TNF-α with GC in the population herein. Hence, the TNF-α (-308 G/A, -238 G/A and -857 C/T) may not be the associating factor for GC incidence determined by the PCR-RFLP method. [ABSTRACT FROM AUTHOR]

Human epidermal growth factor receptor 2/neu (HER2/neu) is known to serve as a prognostic and predictive biomarker in several cancers such as breast, gastric and ovarian cancers. In head and neck squamous cell carcinoma, HER2/neu expression is seen but in a fluctuated manner. Hence, its role as a prognostic factor in oral squamous cell carcinoma (OSCC) needs evaluation. To determine the HER 2/neu overexpression in OSCC patients and its association with clinical and pathological parameters. 74 patients of OSCC treated between 2016 and 2018 were included in the study. Immunohistochemistry was done on tissue samples from these patients and HER2/neu expression was measured. Both biopsy and resected specimens were considered for the study. Out of 74 patients, 47.3% (35) were operated and 52.7% (39) were not operated due to loss to follow-up. No significant association was found (p = 0.636, OR = 0.68, CI = 0.14–3.34) between lymphovascular invasion (LVI) and HER2/neu expression. Similar results were seen for perineural invasion (PNI) (p = 0.490, OR = 0.53, CI = 0.88–3.24), depth of invasion (p = 0.21), grade of tumor (p = 0.214), clinical-stage (p = 0.511) and pathological stage (p = 0.091). No significant association existed between HER2/neu expression and LVI, PNI, clinical-stage, the grade of tumor and the pathological stage of oral squamous cell carcinoma. [ABSTRACT FROM AUTHOR]

Hepatitis B virus (HBV) infection continues to be a significant public health problem, affecting more than 2 billion people globally. Around 40 million people in India are HBV carriers, constituting a large proportion of the worldwide HBV burden. Unfortunately, millions of people with chronic hepatitis B around the world face compelling discrimination that limits their education, careers, income and personal relationships. Many factors are associated with stigma against HBV. Amongst them, lack of knowledge and awareness levels of HBV infection appears to be a significant factor for HBV stigma.. Many studies have found that fear of HBV infection is the most common cause of HBV stigma. HBV related stigma affected admission to certain schools or parental rejection at schools, denial of treatment at hospitals/clinics and also acts as an impediment to marriage and having children, so affecting both personal and family life. Female gender, older age, individuals with lower education level tended to have more HBV related discrimination. Public officers like civil servants, or teachers were less likely to exhibit HBV-related discrimination as compared to farmers. Receiving HBV vaccination was related to decreased HBV-related discrimination scores, indicating a protective effect of that HBV vaccination not only from HBV infection, also reduces their levels of HBVrelated discrimination. [ABSTRACT FROM AUTHOR]

Background: The guidelines for performing endoscopy in dyspeptic patients based on clinical parameters alone have shown variable performance, and there is a need for better prediction tools.Aim: We aimed to prospectively develop and validate a simple clinical-cum-laboratory test-based scoring model to identify dyspeptic patients with high risk of upper gastrointestinal malignancy (UGIM).Methods: Adult patients with dyspeptic symptoms were prospectively recruited over 5 years. Clinical details including alarm features were recorded, and blood tests for hemoglobin and albumin were done before endoscopy. The presence of UGIM was the primary outcome. Risk factors for UGIM were assessed, and based on the OR of significant factors, a predictive scoring model was constructed. ROC curve was plotted to identify optimal cutoff score. The model was validated using bootstrapping technique.Results: The study included 2324 patients (41.9 ± 12.8 years; 33.4% females). UGIM was noted in 6.8% patients. The final model had following five positive predictors for UGIM-age > 40 years (OR 3.3, score 1); albumin ≤ 3.5 g% (OR 3.4, score 1); Hb ≤ 11 g% (OR 3.3, score 1); alarm features (OR 5.98, score 2); recent onset of symptoms (OR 8.7, score 3). ROC curve had an impressive AUC of 0.9 (0.88-0.93), and a score of 2 had 92.5% sensitivity in predicting UGIM. Validation by bootstrapping showed zero bias, which further strengthened our model.Conclusion: This simple clinical-cum-laboratory test-based model performed very well in identifying dyspeptic patients at risk of UGIM. This can serve as a useful decision-making tool for referral for endoscopy. [ABSTRACT FROM AUTHOR]

Since the initiation of economic reforms in 1991, India adopted an outward-oriented strategy for development. After the inception of the World Trade Organization (WTO) in 1995, the country initially relied on multilateral trade reforms for export growth, but slow progress of the Doha Round negotiations over the last decade caused it to explore the regional trade agreements (RTAs) route as well from 2003-04 onwards. While in the initial period India focused on deeper trade relationship with Asian partners--namely, the Association of Southeast Asian Nations (ASEAN), Japan, South Korea, etc.--as preferential trade allies, the perceived need to diversify the export markets has led the country to focus on potential trade partners in Africa, Europe, North and Latin America as well in recent times. On the other hand, the economies of East Africa are also embracing the RTA route for their trade promotion, and the growing Indian market offers an opportunity for them as well. The present analysis attempts to understand the trade potential between the five East African Community (EAC) countries and India in the sphere of merchandise and services trade by looking through various trade indices. The empirical results indicate that bilateral trade between the two regions have a strong potential, which can be aided further through policy reforms at both ends. [ABSTRACT FROM AUTHOR]

Background: Road traffic accidents (RTAs) are a preventable cause of death. The government of India enacted the motor vehicle amendment (MVA) act on September 01, 2019, to curtail the alarming trend of RTAs and their associated fatality. The study objective was to compare the epidemiology and pattern of fatal RTAs before and after the MVA Act 2019 of India. Methods: An autopsy-based cross-sectional study was conducted at the Department of Forensic Medicine and Toxicology (FMT) of a tertiary-care hospital from March 2019 to February 2020. The sample comprised 75 fatal RTA victims who underwent postmortem at FMT. Patients were studied in two groups: One pre-MVA group (n = 47) and one Post-MVA group (n = 28). The data were obtained from medical records and inquest reports with autopsy correlation. Data pertaining to sociodemographic profile, mechanism, injury profile including injury-severity-score (ISS) and survival-time was recorded. Results: There was a 40.4% decline in mortality among RTA victims (P = 0.057) in the post-MVA group. The case fatality rate also declined during post-MVA implementation months compared to pre-MVA months (1.61 vs. 1.96). A significant correlation was noted between the ISS and survival-time of victims (P < 0.001, r = −0.522). The mean age of patients was 39.87 ± 17.44 years. Heavy motor vehicles along with motorized two-wheeler were the most common offending-vehicle. The median ISS of all victims was 41 (33–57). Head injury was the most common cause of death (60%). Conclusion: Study results signal-toward early triumph of the new MVA act, probably due to enhanced adherence to safety gears and constructive behavioral change. [ABSTRACT FROM AUTHOR]

Chronic Hepatitis B (CHB) is a global health problem affecting around 400 million of people worldwide. Two available first-line antiviral drugs are tenofovir disoproxil fumarate (TDF) and Entecavir (ETV). Till date,there are few published reports from India comparing efficacy of TDF and ETV in CHB cases. Therefore, this present study was carried out with an aim to compare the efficacy of ETV and TDF in patients with nucleos(t)ide naïve CHB. This retrospective cohort study was carried out in 192 treatment naïve CHB cases, who completed 24 months of treatment with either TDF or ETV between March 2015 and August 2017. The primary end point of the study was undetectable hepatitis B virus DNA after 24 months of therapy. Of total 192 patients with CHB, 38 hepatitis B e-antigen (HBeAg)–positive and 53 HBeAg-negative patients were treated with tenofovir, whereas 40 HBeAg-positive and 61 HBeAg-negative patients were treated with ETV. Pretreatment characteristics at baseline were not statistically different between the TDF and ETV groups. Patients treated with TDF achieved significantly higher complete viral suppression as compared with ETV-treated patients (Log rank: 7.04, P = 0.008) in HBeAg-positive CHB during the 24 months follow-up time; whereas no significant difference in viral suppression rate could be noticed in HBeAg-negative patients (Log rank: 0.98, P = 0.38). Both univariate and multivariate analysis by cox proportional hazard model confirmed that tenofovir had significant rate of complete viral suppression in comparison with ETV in HBeAg-positive patients (P < 0.05); whereas complete viral suppression rates were similar in HBeAg-negative patients. In our study, tenofovir had more effective antiviral suppressive effect compared with ETV in HBeAg-positive, nucleos(t)ide-naïve CHB cases. [ABSTRACT FROM AUTHOR]