Indian J Med Res
· 2026 Feb · PMID 41949133
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India's escalating number of road traffic accidents, demands systemic transformation beyond traditional enforcement measures. This viewpoint proposes the establishment of a public, real-time Trauma Dashboard to transform...India's escalating number of road traffic accidents, demands systemic transformation beyond traditional enforcement measures. This viewpoint proposes the establishment of a public, real-time Trauma Dashboard to transform fragmented, delayed reporting into an open, evidence-based system of accountability. The dashboard would integrate cross-verified datasets from police, hospitals, and insurance companies through interoperable digital platforms such as Open Data Kit (OTK), and Talend Open Studio, or similar platform hosted on the Government of India's MeghRaj Cloud. Automated cross-verified data flows would provide dynamic insights into crash patterns, high-risk zones, and temporal trends. Drawing on successful precedents such as the Central Pollution Control Board (CPCB) Air Quality Index and trauma registries - UK Trauma Audit and Research Network (TARN), US National Trauma Data Bank (NTDB) and India's National Organ and Tissue Transplant Organization (NOTTO), this project proposes to facilitate continuous monitoring, policy responsiveness, and public awareness.
Yadav RM, Suri D, Singh S
… +14 more, Pandiarajan V, Satheesh C, Ranganath P, Gulati R, Puri RD, Temkar L, Khalkho P, Almas, Rajasekhar L, Raj R, Shukla A, Rawat A, Madkaikar M, NRROID Registry PID Contributors group
Indian J Med Res
· 2026 Feb · PMID 41949132
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Background and objectives Global estimates identify about 7,000 rare diseases affecting 6-8% of the population, with 80% being genetic. India lacks comprehensive data on their prevalence, distribution, and natural histor...Background and objectives Global estimates identify about 7,000 rare diseases affecting 6-8% of the population, with 80% being genetic. India lacks comprehensive data on their prevalence, distribution, and natural history. Inborn errors of immunity (IEI) registry was developed by Indian Council of Medical Research (ICMR) as part of a comprehensive multi-centric 'National Registry for Rare and Other Inherited Disorders', from centres which expressed interest in contributing to this national database in 2019. This study aims to establish an Indian rare-disease registry to assess disease burden, collect clinical and demographic data, understand natural history, support research on underlying mechanisms, create cohorts for evaluating therapies and orphan products, and strengthen connections among patients, families, and clinicians to improve comprehensive care across the country effectively. Methods After ethics approval from the participating centres, data were collected in a structured format developed jointly by ICMR- National Institute of Immunohaematology, Mumbai and Postgraduate Institute of Medical Education and Research, Chandigarh, identified as nodal centres for inborn errors of immunity (IEI) by ICMR. Cases with molecular confirmation of diagnosis or those satisfying the European Society for Immunodeficiencies (ESID) registry working definition in absence of molecular confirmation were included. The Data were compiled in excel format and analysed using Epi Info v7.2.5.0. Results Data for 676 patients enrolled between January 2019- October 2024 from six participating centres including ICMR-NIIH Mumbai, PGI Chandigarh, Apollo Chennai, JIPMER Pondicherry, Nizams Institute Hyderabad, and Sir Gangaram Hospital Delhi was analysed. Immunodeficiencies affecting cellular and humoral immunity (CID) and CID with associated or syndromic features (n=187,27.6%), predominantly antibody deficiency (n=146,21.6%), congenital defects of phagocyte number or function (n=117,17.3%) were the most frequent IEIs. The median age of presentation was 16 (IQR 4,63) months and diagnostic delay of 16 (IQR 3,55) months. The presenting clinical manifestations comprised of recurrent infections (n=459,67.9%), autoimmunity or auto-inflammation (n=292,43.2%), adverse effect following immunisation (n=38,5.6%), and malignancy (n=5,0.73%). 103/146 (70%) patients with antibody deficiency received IVIG and 90 (13.3%) IEI patients underwent hematopoietic stem cell transplant. On follow up, 118 (17.4%) patients died due to infections by 2024. Interpretation and conclusions The IEI registry developed by ICMR as an attempt to maintain a patient database gives us insights on the demographic, clinical presentation, diagnostic-delay and treatment outcomes of these disorders.
Indian J Med Res
· 2026 Feb · PMID 41949130
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Background and objectives The global epidemic of type 2 diabetes mellitus (T2DM) is disproportionately severe in rural and agricultural populations, driven by the complex interplay of socioeconomic, behavioural, and gene...Background and objectives The global epidemic of type 2 diabetes mellitus (T2DM) is disproportionately severe in rural and agricultural populations, driven by the complex interplay of socioeconomic, behavioural, and genetic risk factors. While these determinants are acknowledged individually, few studies have validated a parsimonious, integrated measurement model to effectively structure and assess their collective influence on glycaemic control within a rural primary care context. We aimed to address this critical gap. Methods We conducted a cross-sectional, observational study utilising a purposive sample of 1,011 patients with uncontrolled T2DM recruited from a rural diabetic healthcare setting. To empirically test the structural relationships among key risk factors, we employed a confirmatory factor analysis (CFA) to validate a four-factor measurement model. This model integrated 14 observed indicators across the latent constructs of alcohol addiction, economic conditions, dietary habits, and family history of T2DM. Results The proposed four-factor model demonstrated an excellent practical fit to the observed data, confirming its structural validity. All factor loadings were statistically significant (P<0.001). The magnitude of practical misfit was medium (Cohen's w=0.37), validating the model's overall explanatory power. Factor intercorrelations revealed a significant positive correlation between alcohol addiction and economic condition (r=0.109, P=0.006), and a significant negative relationship between diet and family history of T2DM (r=-0.154, P=0.014). Interpretation and conclusions Our findings establish alcohol addiction, economic conditions, dietary habits, and family history as robust, interrelated determinants of glycaemic control in rural primary care. The validated structural model provides an evidence-based tool for risk stratification and personalised intervention.
Manna S, Roy SP, Lyngdoh T
… +13 more, Chowdhury R, Khandelwal S, Thiruvengadam R, Gupta Y, Nair M, Sharma KA, Radhika AG, Mukherjee A, Kulkarni B, Chandhiok N, Bhatnagar S, Yajnik CS, Mukherjee R
Indian J Med Res
· 2026 Feb · PMID 41949129
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Background and objectives Gestational weight gain is an important indicator of maternal and neonatal health, yet research on this topic in the Indian context remains limited. We conducted a research-setting exercise to i...Background and objectives Gestational weight gain is an important indicator of maternal and neonatal health, yet research on this topic in the Indian context remains limited. We conducted a research-setting exercise to identify priority research questions related to gestational weight gain in the Indian context, aiming to guide researchers and policymakers. Methods We used a hybrid approach combining Child Health and Nutrition research Initiative (CHNRI) and a modified James Lind Alliance- Priority Setting Partnership (JLA-PSP). The four CHNRI steps produced an interim priority list, which was refined through the modified JLA-PSP to finalise the priorities Result Sixty researchers participated in the online survey, yielding 54 questions (response rate:30%). These were consolidated into 12 questions across three domains- (a) development of standards and guidelines, (b) Epidemiology and determinants and (c) Evaluation of interventions and strategies for gestational weight gain. We calculated research priority scores, and average expert agreement. The expert group determined four priority questions, emphasising gestational weight gain cut-offs related to short- and long-term feto-maternal outcomes, determinants of gestational weight gain, and effective interventions. Interpretation and conclusion These priorities provide a roadmap for researchers and funders for targeted research in the area of gestational weight gain to improve maternal and child health outcomes in India.
Indian J Med Res
· 2026 Jan · PMID 41934433
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Background and objectives The risk-treatment paradox (RTP) has not been studied in very high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). We aimed to describe the cohort of very high-risk NSTE-...Background and objectives The risk-treatment paradox (RTP) has not been studied in very high-risk patients with non-ST-elevation acute coronary syndrome (NSTE-ACS). We aimed to describe the cohort of very high-risk NSTE-ACS patients, analyse the impact of RTP on outcomes, and identify subgroups of patients who derive the greatest benefit from immediate invasive coronary angiography (ICA). Methods This retrospective analysis included 340 patients diagnosed with NSTE-ACS who met at least one of the established criteria for very high risk at admission. RTP was defined as any management tactic other than emergency (<2 h) ICA. Ongoing myocardial ischaemia (OMI) was defined as a combination of ongoing or recurrent chest pain and/or dyspnoea, along with at least one additional established very high-risk criterion. Results RTP was identified in 213 cases (62.6%). There was no adverse effect of RTP on in-hospital mortality [14% vs. 10% in the RTP group, P = 0.34, odds ratio (OR) 0.708; 95% confidence interval (CI) 0.36-1.37] or on the incidence of long-term major adverse coronary events (MACE). An independent predictor of adverse outcomes was evidence of OMI at hospital admission. Signs of OMI were observed in 168 patients (49.4%). In this subgroup, failure to perform emergency invasive coronary angiography was associated with a higher incidence of MACE during the three-year follow up (29% vs. 47.5% in the RTP group, P=0.02, OR 2.2; 95% CI 1.0-4.5). Interpretations and conclusions There was no significant effect of risk-treatment paradox on outcomes in very high-risk patients. Patients with signs of ongoing myocardial ischaemia benefit most from undergoing emergency invasive coronary angiography with the intention of performing percutaneous coronary intervention within two hours.
Gomaz SB, Kaur RJ, Mohandas A
… +5 more, Ambwani S, Charan J, Kumar D, Shukla R, Yadav D
Indian J Med Res
· 2026 Jan · PMID 41934432
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Background and objectives Insulin resistance and elevated endothelin-1 (ET-1) levels are key contributors to cardiovascular and renal complications in patients with type 2 diabetes mellitus (T2DM) and hypertension. This...Background and objectives Insulin resistance and elevated endothelin-1 (ET-1) levels are key contributors to cardiovascular and renal complications in patients with type 2 diabetes mellitus (T2DM) and hypertension. This study compared the effects of telmisartan with other commonly used antihypertensive agents on insulin sensitivity in terms of homeostatic model assessment for insulin resistance (HOMA-IR) and vascular endothelial function in terms of ET-1 levels in patients with T2DM and hypertension. Methods In this randomised, open-label study, 182 patients with coexisting T2DM and hypertension were screened between May 2023 and September 2024. The study was registered with the Clinical Trials Registry-India (CTRI; CTRI/2023/04/051878). Seventy eligible patients were enrolled and randomised 1:1 to receive telmisartan (n=34) or other antihypertensive agents (amlodipine, n=22; cilnidipine, n=12; ramipril, n=2; total n=36) for 12 weeks. The primary outcome was the change in insulin sensitivity as measured by the HOMA-IR. ET-1 levels were evaluated as a secondary outcome. Results At baseline, the median HOMA-IR values were 4.1 [interquartile range (IQR): 2.2-5.9] in the telmisartan group and 3.9 (IQR: 3.1-5.9) in the comparator group. After 12 weeks, the median HOMA-IR significantly decreased in the telmisartan group to 1.79 (IQR: 1.30-2.63) compared to 3.45 (IQR: 2.43-5.12) in the other antihypertensive group (P=0.001). Baseline ET-1 levels were 19.23 pg/mL (IQR: 10.8-29.9) and 17.1 pg/mL (IQR: 10.3-26.48) in the telmisartan and comparator groups, respectively. At 12 weeks, median ET-1 levels decreased to 12.49 pg/mL (IQR: 5.70-18.70) and 11.22 pg/mL (IQR:4.84-23.20), respectively (P=0.90). Interpretation and conclusions Telmisartan significantly improved insulin sensitivity at 12 weeks compared to other antihypertensive agents in patients with T2DM and hypertension. However, the reduction in ET-1 levels was similar across groups, suggesting a comparable effect on endothelial function over 12 weeks. These findings suggest that, beyond its antihypertensive action, telmisartan may offer favourable metabolic benefits that could help limit diabetes-related micro- and macrovascular complications compared with other commonly prescribed antihypertensives.
Rathod PG, Kakade SV, Deshmukh KP
… +7 more, Deshmukh PR, Aparnavi P, S P, Yadav A, Sharma S, Goyal C, Gandhi AP
Indian J Med Res
· 2026 Jan · PMID 41934431
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Background and objectives Maternal near miss (MNM) is a marker of severe maternal complications and reflects the quality of obstetric care systems. The present systematic review and meta-analysis aimed to estimate the pr...Background and objectives Maternal near miss (MNM) is a marker of severe maternal complications and reflects the quality of obstetric care systems. The present systematic review and meta-analysis aimed to estimate the prevalence of MNM and identify common risk factors among pregnant women in India. Methods In accordance with PRISMA 2020 guidelines, "MEDLINE, Scopus, Embase, and Web of Science" database search was carried out until November 21, 2024. Observational studies from India that detailed the risk factors and prevalence of MNM were included. The Newcastle Ottawa Scale (NOS) and the JBI checklist were used to evaluate quality. Prevalence and heterogeneity were determined through meta-analysis using a random-effects model. Results There were 6,606 MNM cases in 39 studies with 242,015 pregnant women. The pooled prevalence of MNM was 3.9% (95% CI: 1.6%-7.2%) with substantial heterogeneity (I2=99.4%). The prevalence of MNM varied between the states, with Rajasthan reporting as low as <1% to West Bengal reporting 38%. Anemia, sepsis, haemorrhage, and hypertensive disorders were the most frequently mentioned risk factors. Interpretation and conclusions The prevalence of MNM varies greatly throughout India. The study emphasizes the necessity of integrating MNM surveillance into national health systems.
Sharma A, Das A, Bal A
… +4 more, Srinivasan R, Malhotra P, Prakash G, Kumar R
Indian J Med Res
· 2026 Jan · PMID 41934430
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Background and objectives Diffuse large B-cell lymphoma presents a significant challenge due to its high rate of treatment failure in 40% of patients. In this study we screened microRNAs as biomarkers in chemotherapy non...Background and objectives Diffuse large B-cell lymphoma presents a significant challenge due to its high rate of treatment failure in 40% of patients. In this study we screened microRNAs as biomarkers in chemotherapy non-responding patients, to allow their early prognostication. Methods In the exploratory phase, whole transcriptome microRNA profiling was conducted on 10 diffuse large B-cell lymphoma cases. Three patients achieved complete remission, while seven had refractory or relapsed disease. The differentially expressed miRNAs were validated in 41 retrospective, treatment-naive diffuse large B-cell lymphoma biopsies, including the original 10 cases. Additionally, 33 cases with paired biopsy and plasma samples were prospectively evaluated using qRT-PCR to correlate miRNA expression with clinical outcomes. Functional validation to identify downstream pathways was done by knocking down identified miRNAs in JM-1 cells by semi-quantitative proteomics. Results miR-193b-5p, miR-1307-5p, and miR-671-5p expression were downregulated in refractory/relapsed diffuse large B-cell lymphoma biopsies. Plasma miRNA levels did not reflect prognosis. In vitro proteomics showed their impact on key oncogenic pathways, revealing significant enrichment of replication and transcription-related proteins. Interpretation and conclusions The expression of miR-193b-5p, miR-1307-5p, and miR-671-5p miRNAs in diffuse large B-cell lymphoma tissues may serve as predictive biomarkers.
Indian J Med Res
· 2026 Jan · PMID 41934428
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Background and objectives Atherosclerosis is a chronic disease marked by the build up of lipids and inflammatory cells in arterial walls, leading to vessel narrowing and increasing the risk of serious complications like...Background and objectives Atherosclerosis is a chronic disease marked by the build up of lipids and inflammatory cells in arterial walls, leading to vessel narrowing and increasing the risk of serious complications like heart attack and stroke. Recent findings suggest that microRNAs (miRNAs) serve as key regulators in the mechanisms driving atherosclerotic disease. However, the expression levels and functional roles of miRNA-133a-3p and miRNA-124-3p in atherosclerosis remain incompletely understood. The aim of this study was to determine the relationship between the expression levels of miR-124-3p and miR-133a-3p, and the phenotypic changes of S100A4-positive vascular smooth muscle cells in atherosclerosis. Methods We collected tissue samples from 25 patients with atherosclerosis who underwent coronary artery bypass graft surgery. IMA tissues were used as controls; atherosclerotic aortic tissues as cases. Expression levels of miRNAs were assessed using reverse transcription polymerase chain reaction (RT-PCR). Tissue samples underwent immunohistochemical staining with S100A4 protein to evaluate cellular and structural characteristics. Results A marked decrease in the expression of miR-133a-3p and miR-124-3p was observed in the atherosclerosis group compared to the control group, and both differences were statistically significant (P=0). Additionally, an increase in S100A4 protein immunoreactivity was detected in the atherosclerosis group. Interpretations and conclusions The downregulation of miRNA-133a-3p and miRNA-124-3p in atherosclerotic tissues, along with the observed increase in S100A4 protein immunoreactivity, suggests that these two miRNAs may play a role in the regulation of inflammatory endothelial phenotypes. Therefore, the interaction between miRNA-133a-3p, miRNA-124-3p, and S100A4 protein may help elucidate a potential mechanism underlying the prevention of atherosclerosis.
Harshitha R, Goyal LD, Kakkar M
… +2 more, Sharma H, Goyal G
Indian J Med Res
· 2026 Jan · PMID 41934426
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Background and objectives Ovarian carcinoma is one of the most lethal carcinomas among females. Its high prevalence and shorter 5-year survival rate is due to the fact that most of the cases are diagnosed at later stages...Background and objectives Ovarian carcinoma is one of the most lethal carcinomas among females. Its high prevalence and shorter 5-year survival rate is due to the fact that most of the cases are diagnosed at later stages. This highlights the importance of early diagnosis through reliable biomarkers. We studied the diagnostic role of SOX9 protein in ovarian carcinoma and its diagnostic ability. The primary objective was to compare the level and clinical relevance of SOX9 protein in the tissues of patients with ovarian carcinoma with non-malignant ovarian tissues. Methods Tissue levels of SOX9 protein were estimated in the study and control groups (60 each group). SOX9 levels were compared between the study vs. control groups and also between high grade and low-grade ovarian cancer. SK-OV3 ovarian adenocarcinoma cell line was used as supportive evidence to prove the presence of SOX9 in malignant ovarian cells. Results Levels of SOX 9 protein (3.9±2.7 ng/mL) were high in tissue of ovarian cancer patients when compared to non-malignant (1.5 ±1.1 ng/mL) ovarian tissues. Higher levels of SOX 9 protein were found in tissues of ovarian cancer patients when compared to non-malignant ovarian tissues. The mean of SOX 9 levels in tissues of high-grade serous carcinoma was 3.5±2.5 ng/mL as compared to 1.0±0.9 ng/mL in low-grade serous carcinoma. Interpretation and conclusions SOX9 appears to be an important player in the molecular tumourigenesis of ovarian cancer, particularly in high grade tumours.
John G, Ghanekar S, Dominic D
… +4 more, Gawde JR, Dora T, Chopra SJ, Goda JS
Indian J Med Res
· 2026 Jan · PMID 41934424
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Background and objectives Radiotherapy for advanced cervical cancer (CaCx) often results in unintended genitourinary toxicities, notably bladder damage. Predicting such radiation-induced toxicity remains challenging. γ-H...Background and objectives Radiotherapy for advanced cervical cancer (CaCx) often results in unintended genitourinary toxicities, notably bladder damage. Predicting such radiation-induced toxicity remains challenging. γ-H2AX, a marker of DNA double-strand breaks (DSBs), offers promise as a predictive biomarker for radiosensitivity. This study aimed to evaluate γ-H2AX foci kinetics in peripheral blood lymphocytes (PBLs) as a surrogate for DNA damage response and a predictor of bladder toxicity in CaCx patients undergoing pelvic radiotherapy. Methods In this prospective study, 43 FIGO stage IIIB CaCx patients were enrolled. Stage I (n=31) assessed γ-H2AX induction post-CT simulation (2-6 mGy); Stage II (n=34) evaluated γ-H2AX kinetics across three radiotherapy fractions (FR1, FR13, FR25) during external beam radiotherapy (50 Gy in 25 fractions ± cisplatin). Blood samples were collected at baseline, 1-, 4-, and 24-h post-irradiation. γ-H2AX foci were quantified via flow cytometry. Bladder toxicity was graded usingRadiation Therapy Oncology Group (RTOG) criteria. Results CT and radiotherapy both induced significant γ-H2AX foci, peaking at 1 h. Patients without bladder toxicity showed higher foci induction and faster decay (1→4h: 48.9% vs. 39.4%; 1→24h: 43.6% vs. 12.8%) across all fractions. Persistent foci at 24 h correlated with increased toxicity risk, indicating deficient DNA repair capacity. Interpretation and conclusions γ-H2AX foci kinetics effectively reflect in vivo DNA repair efficiency and predict radiation-induced bladder toxicity. This minimally invasive biomarker may guide personalized radiotherapy, enabling early identification of high-risk patients and potential use of radioprotectors or treatment modifications.
Indian J Med Res
· 2026 Jan · PMID 41934421
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Background and objectives Xerostomia, or dry mouth, was frequently reported during COVID-19 infection, but its persistence after recovery remains underexplored. This study aimed to assess the prevalence and duration of x...Background and objectives Xerostomia, or dry mouth, was frequently reported during COVID-19 infection, but its persistence after recovery remains underexplored. This study aimed to assess the prevalence and duration of xerostomia following recovery from COVID-19 infection. Methods This observational study included 50 participants who had recovered from COVID-19. They were surveyed using a xerostomia assessment questionnaire and underwent the modified Schirmer test (MST) to measure their salivary flow rate. Results Overall, n=31(62%) of participants reported one or more xerostomia-related symptoms after recovery. "Feeling of dry mouth" (n=22, 44%) was the most common, followed by nocturnal water intake (n=18, 36%), difficulty swallowing dry food (n=7, 14%), and reliance on liquids during swallowing (n=6, 12%). Hyposalivation (MST <15 mm at 3 min) was observed in 10% (n=5) of participants, all of whom were infected during the second wave (Delta variant). A significant association was noted between self-reported dry mouth and MST findings (P=0.029). Symptoms persisted up to 15 months post-recovery. Interpretation and conclusions Xerostomia may persist after COVID-19 recovery, with potential implications for oral health. Early recognition and management are warranted.
Indian J Med Res
· 2026 Jan · PMID 41934420
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The evidence pyramid, originally intended to guide clinicians and students in understanding levels of clinical evidence. Over time, systematic reviews and meta-analyses were elevated to the apex of this hierarchy, often...The evidence pyramid, originally intended to guide clinicians and students in understanding levels of clinical evidence. Over time, systematic reviews and meta-analyses were elevated to the apex of this hierarchy, often misconstrued as superior to primary research. Systematic reviews and meta-analyses, while powerful in integrating findings and invaluable for evidence-based practice, remain secondary analyses that depend on the quality of the included studies. Poorly designed or biased trials, coupled with publication bias and redundant syntheses, risk undermining the reliability of aggregated evidence. The current pyramid has inadvertently fostered a culture of desk-based evidence synthesis priority over original, data-generating studies, thereby discouraging innovation. To address these limitations, we propose a dual-framework model that distinguishes original research from evidence syntheses. This model positions randomised controlled trials, large multicentre studies, and qualitative designs within a hierarchy of evidence generation, while treating meta-analysis, realist reviews, and other qualitative syntheses as non-hierarchical but complementary. This effort is to restore balance, encourage methodological pluralism, and promotion of evidence use based on appropriateness and context rather than rigid ranking.