Institute of Post Graduate Medical Education and Research

Nipah virus (NiV) is a highly lethal zoonotic virus that has caused sporadic but severe outbreaks in South and Southeast Asia since its emergence in 1998. Despite the relatively small size of most outbreaks, NiV poses a substantial public health challenge due to its high case fatality rate. To examine the evolving epidemiology, clinical features, virological insights, and preparedness challenges associated with NiV infection in South Asia. We conducted a narrative review synthesising epidemiological, clinical, and public health data from national surveillance systems, WHO Disease Outbreak News reports, and published outbreak investigations. We describe the shift from pig-amplified transmission observed in Malaysia to bat-driven spillover and human-to-human transmission, particularly within household and hospital settings, as characterised by recent outbreaks in Bangladesh and eastern India, and specifically review Kerala's experience since 2018. Particular attention is given to the re-emergence of NiV in West Bengal in early 2026, involving a limited cluster of infections among healthcare workers that was rapidly contained but remains epidemiologically important given the region's prior history of nosocomial spread. We discuss persistent challenges in early diagnosis, access to high-containment laboratory testing, and clinical management, alongside emerging roles for mobile Biosafety Level 3 laboratories and point-of-care diagnostics. Overall, the South Asian experience underscores that NiV represents a persistent zoonotic threat rather than an episodic emergence, necessitating sustained preparedness, pathogen-agnostic clinical vigilance, and proportionate risk communication to mitigate future outbreaks. Sustained preparedness, rather than episodic alarm, must guide future responses.

Objective: In India, despite the presence of Adolescent Friendly Health Clinics (Anwesha Clinics), barriers to accessing these services remain prevalent. This study explores the accessibility, availability, and utilization of services at Anwesha Clinics in Bankura Health District, a rural, backward caste-dominated district in eastern India. Material and Methods: This study employed an analytical design with an explanatory sequential mixed-methods approach, combining quantitative and qualitative data. The research was conducted across three randomly selected Anwesha Clinics in Bankura, covering a total sample size of 212 adolescents. Data collection spanned 18 months (April 2021–September 2022) and included a pre-designed semi-structured questionnaire for quantitative data, focus group discussions (FGDs) with adolescents who never visited the clinic, and in-depth interviews with counselors for qualitative insights. Clinic infrastructure and IEC materials were assessed using a UNFPA (United Nations Population Fund) reportbased checklist. Quantitative data were analyzed using SPSS for descriptive statistics, chi-square tests, and logistic regression to identify predictors of service utilization. Qualitative data were thematically analyzed, with coding to identify themes related to service access and barriers. Results: The study found 66.51% service utilization, predominantly for counseling, menstrual issues, and anemia. Barriers included lack of awareness, distance, privacy concerns, and inadequate clinic infrastructure. Logistic regression identified significant predictors of service utilization, with females, adolescents from lower socio-economic classes, and those within 3 km of a clinic being more likely to utilize services. Conclusion: Enhancing clinic infrastructure, increasing awareness, and ensuring privacy are crucial for improving adolescent engagement with Adolescent Friendly Health Clinics.

Abstract Objective We aimed to prospectively validate and compare published prediction models and clinician-assigned triage categories for early trauma care. Design Prospective multicentre cohort study. Setting Three public hospitals in urban India: one secondary care hospital in Mumbai and one tertiary care teaching hospitals in Delhi and Kolkata each. Participants Adult patients aged over 18 years presenting to the emergency department with a history of trauma between 2016 and 2022. A total of 13,041 patients were included in the final analysis. Methods We externally validated five published trauma prediction models (GAP, Gerdin, KTS, MGAP, and RTS) and clinician-assigned triage categories based on initial assessment. The primary outcome was 30-day all-cause mortality. Models were recalibrated using a separate updating sample prior to evaluation, and model performance was assessed in terms of discrimination (AUC), calibration (calibration slope and plots), and decision curve analysis. Results All models and clinician gestalt-based triage demonstrated excellent discrimination (AUC range: 0.90-0.96) and good calibration after updating. The GAP model achieved the highest AUC (0.96, 95% 0.94-0.97), and RTS demonstrated the highest sensitivity (0.70). Conclusion Simple, physiology-based prediction models and clinician gestalt both demonstrated excellent performance in predicting 30-day mortality among adult trauma patients in Indian emergency departments. These findings provide a practical foundation for further development of trauma triage systems.

A 69-year-old gentleman without any previous comorbidities presented with complaints of acute-onset low-grade fever, one episode of loss of consciousness, and weakness of both legs with urinary and stool retention for 1 day. He had an episode of generalized tonic-clonic seizure 3 hours after admission. On examination, he had tachycardia and hypotension; Glasgow Coma Scale (GCS) was E3V2M4, and neurological examination was suggestive of bilateral lower limb upper motor neuron lesion in the shock stage. Blood investigation revealed severe hyponatremia, and magnetic resonance imaging (MRI) with contrast of the dorsolumbar spine revealed longitudinally extensive transverse myelitis (LETM). Blood investigation for antineuromyelitis optica (anti-NMO) antibody was negative. Other investigations revealed low serum osmolality, raised urine osmolality, and spot sodium. Cerebrospinal fluid (CSF) viral panel detected human herpesvirus 6 (HHV6). He was treated with a pulse dose of IV methylprednisolone, hypertonic saline, and IV levetiracetam. He had symptomatic improvement and was discharged with a tapering dose of oral prednisolone. He had a complete recovery after 3 months of regular follow-up. Thus, we report a case of HHV6-induced LETM complicated with cerebral salt wasting syndrome and hyponatremic seizures.

Impaired TBS correlated with longer diabetes duration, poorer glycemic control and CCM abnormalities on exploratory analysis. ConclusionBone microarchitecture and turnover are compromised early in T1DM, preceding detectable changes in conventional BMD.Incorporating TBS and BTMs into bone health assessments may improve early identification of skeletal fragility in this population.

Eosinophilic esophagitis (EoE) is a chronic, antigen-mediated inflammatory condition of the esophagus, characterized by signs of esophageal dysfunction and characteristic endoscopic and histological features. Currently, EoE has developed from a rare disease entity to a prevalent condition with a rising incidence and prevalence in children. Over the past few decades, a deeper understanding of the underlying pathophysiologic mechanisms of EoE has led to better diagnostic and therapeutic strategies. Pediatric patients with EoE face a diagnostic dilemma due to a wide spectrum in symptomatology as well as limited pharmacological armamentarium. Emerging literature is showing promise, especially with dupilumab, a newer biologic with disease modifying potential. In this review we discussed new diagnostic and treatment strategies and future directions of monitoring EoE in children.

Abstract Background: Accurate staging is the cornerstone of management in Head and Neck Squamous Cell Carcinoma (HNSCC). The 8th edition of the AJCC/UICC TNM staging system introduced Depth of Invasion (DOI) and Extracapsular Extension (ECE) to refine prognostic stratification. However, significant discrepancies often exist between pre-operative clinical staging (cTNM) and post-operative pathological staging (pTNM). This study evaluates the magnitude and clinical impact of this discordance in a real-world cohort. Methods: We conducted a retrospective analysis of 52 patients with biopsy-proven Squamous Cell Carcinoma (SCC) of the oral cavity and oropharynx treated at a tertiary cancer center. Patients underwent standard clinical staging followed by definitive surgical resection and neck dissection. Clinical (cT) and pathological (pT) stages were compared to calculate concordance rates, sensitivity, and specificity. High-risk pathological features, including DOI, Worst Pattern of Invasion (WPOI), Perineural Invasion (PNI), and Lymphovascular Invasion (LVI), were correlated with staging upgrades. Results: The overall concordance between cT and pT staging was only 23.0%. A profound "upstaging" phenomenon was observed, with 45.0% of patients receiving a higher pathological stage than determined clinically (e.g., cT2 to pT3). The primary driver of upstaging was the underestimation of DOI on clinical examination and imaging, which demonstrated a moderate negative correlation with Disease-Free Interval (DFI) (r = -0.35). Despite the high rate of pathological upstaging, adjuvant Chemoradiation (CRT) effectively neutralized the risk, resulting in comparable DFI between high-risk and low-risk cohorts (Mean DFI: 4.2 vs. 4.0 years; p > 0.05). Conclusion: Clinical staging significantly underestimates the extent of disease in nearly half of oral cancer patients, primarily due to the "invisible" nature of deep invasion (DOI). This "silent upstaging" underscores the critical need for advanced pre-operative imaging protocols (e.g., MRI with specific DOI sequences) and supports the routine use of adjuvant intensification in pathologically upstaged patients.