Himalayan Institute of Medical Sciences

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A pilot randomized controlled trial comparing noradrenaline and adrenaline as a first-line vasopressor for fluid-refractory septic shock in neonates
(PUBMED, 2024-10-13) Reema Garegrat1 ,; Suprabha Patnaik; Sonali Suryawanshi; Chinmay Chetan; Nishant Banait; Pari Singh; Aditya Kallimath; Naharmal B. Soni; Yogen Singh; Pradeep Suryawanshi
Background and study design: Limited data exists on noradrenaline therapy in neonatal septic shock. We compared the efficacy of noradrenaline with adrenaline in neonatal septic shock. This single center, open label, pilot randomized controlled trial included neonates with clinical evidence of sepsis and shock. Study outcomes: Primary outcomes were: 1) resolution of shock one hour after treatment, and 2) mortality during hospital stay. Secondary outcomes included: need for additional vasopressors; hemodynamic stability without further administration of vasopressors for ≥2 h; changes in blood pressure and heart rate after 1 h of vasopressor treatment; and morbidities during the hospital stay. Results: Of 65 eligible neonates, 42 were randomized (21 each in adrenaline and noradrenaline treatment arms) between August 2020 and January 2022, at level III neonatal intensive care unit (NICU) of Bharati Vidyapeeth Deemed University Medical College and Hospital (BVDUMCH). The mean (SD) gestational age and mean (SD) birth weight were 36.1(4.2) weeks and 1.8 (0.2) kilograms birth weight for noradrenaline and 36.9 (4.1) weeks and 1.7 (0.7) kilograms for adrenaline. Shock resolved within 1 h of vasopressor therapy in 76.2% neonates in the noradrenaline arm and 61.9% in adrenaline arm (p value-0.53). Mortality during hospital stay was 28.6% (6/21) in noradrenaline group and 33.3% (7/21) in adrenaline group (p value- 0.58). Additional vasopressors were required in 23.8% neonates of the noradrenaline group compared to 38.1% neonates in adrenaline arm (p value-0.53). Median (SD) duration of intensive care stay was 6 (SD) days in the noradrenaline group and 10 (SD) days in the adrenaline group (p value-0.045). Conclusion: Among neonates with septic shock, the efficacy of noradrenaline was comparable to adrenaline in resolving septic shock after one hour of infusion and on the mortality during hospital stay
A rare case report of T cell Lymphoblastic Lymphoma masquerading as tubercular effusion
(IP Innovative Publication Pvt. Ltd., 2026-05-19) Pundir, Sammi; Jethani, Varuna; Khanduri, Sushant; Kala, Mansi; Gupta, Dhruv
Pleural fluid characterized by exudative, high adenosine deaminase (ADA) and lymphocytic predominant in a country with high prevalance of tuberculosis favours tuberculosis but sometimes it can be challenging. Here we present a case report of young male who presented to us with unilateral pleural effusion and pericardial effusion with mediastinal and cervical lymphadenopathy, as exudative high ADA, being started on anti– tubercular medications (ATT) and steroids who responded well initially but worsening of pleural and pericardial effusion made us re evaluate on our diagnosis and finally patient was diagnosed as T cell Lymphoblastic lymphoma (T-LL).
A Scoping Review to Evaluate Different Treatments Used in Advanced Nonsmall‑cell Lung Cancer in India
(Wolters Kluwer, 2026-04-18) Semwal, Jayanti; Juyal, Ruchi et al.
Nonsmall‑cell lung cancer (NSCLC) accounts for nearly 85% of all lung cancers and represents a major global health burden. In India, treatment strategies must be optimized through a customized approach that considers genetic and environmental differences. Objectives: To provide evidence from Indian RCTs with valuable insights into effective and cost effective treatment options. Materials and Methods: This review, conducted according to the Cochrane Handbook guidelines, identified 179,960 studies across databases—PubMed (26,383), Google Scholar (17,100), ScienceDirect/Embase (136,458), and the Clinical Trials Registry of India (19). Results: After screening, 11 primary studies involving 3,470 patients were included. Treatment regimens studied included platinum‑based chemotherapy (carboplatin and cisplatin), taxanes (paclitaxel and docetaxel), epidermal growth factor receptor tyrosine kinase inhibitors (EGFR TKIs), and combination therapies. Carboplatin and cisplatin were the most frequently used agents; gefitinib plus cisplatin showed better efficacy in EGFR‑mutated patients; pemetrexed plus carboplatin was more tolerable than paclitaxel plus carboplatin; and chemoimmunotherapy demonstrated superior survival outcomes compared to chemotherapy alone. Targeted therapies such as EGFR TKIs were equally effective with fewer toxicities. Conclusion: In conclusion, platinum‑based chemotherapy remains the mainstay of NSCLC treatment, but patient tolerance, mutational status, and toxicity profiles must be carefully considered. Chemoimmunotherapy and EGFR TKIs are promising alternatives with improved results, while personalized treatment approaches and novel drug combinations should be the focus of future research.
A Secret Worth Telling: The Salivary Secret (Ory) Affair
(Wiley, 2026-04-26) Singh, Monika; Yadav, Monika; Bist, S. S.; Chandra, Smita
Secretory carcinoma (SC) of the salivary gland is a low- grade, slowly growing tumour. However, cytological diagnosis of SC is often challenging due to its morphological mimics. Characteristic cytoplasmic vacuolation seen in SC can be displayed in many tumours. However, careful evaluation of architecture, cytological content and background can assist in a definite diagnosis on FNAC. Application of immunocytochemistry on cell blocks can further aid in diagnosis
A Study of Clinical Profile of Retinal Diseases in Premature Infants
(EuroPub, 2025-06-06) Priyanka Narula; Renu Dhasmana; Saikat Patra; Udit Raj Sharma
Purpose: Retinal diseases in premature infants, particularly retinopathy of prematurity (ROP), are significant causes of childhood blindness worldwide. The prevalence and severity of these conditions are influenced by various factors, including gestational age, birth weight, and neonatal care quality. This study aims to analyze the clinical profile of retinal diseases in premature infants visiting or admitted to the Himalayan Institute of Medical Sciences, Dehradun, Uttarakhand. Methods: The present observational study was conducted in the Department of Ophthalmology, Himalayan Institute of Medical Sciences (HIMS), Swami Rama Himalayan University, Dehradun over a period of 12 months. Preterm neonates attending ophthalmology or pediatric outpatient department or admitted in neonatal intensive care unit of Himalayan hospital were included in the study. Premature infants born before 37 weeks of gestation were screened for retinal diseases using indirect ophthalmoscopy. Data on gestational age, birth weight, oxygen therapy, and other relevant clinical parameters was collected. Results: Of the total 101 patients studied, 62 (61.4%) had retinal disease. Males had significantly higher proportion of retinal disease 42 (67.7%) as compared to females 20 (32.2%). P value 0.012. The incidence of ROP was found to be 62 (61.4%). Significant risk factors for the development of retinal diseases included low gestational age, birth asphyxia, ventilator support, oxygen administration and delivew by cesarean section. Conclusion: The study highlights the need for early screening and intervention for retinal diseases in premature infants, particularly those with identified risk factors.
Alarming medication error with prostaglandin E1 (PGE1) in a term neonate with critical congenital heart disease
(BMJ case report, 2024-04-08) Saikat Patra; Prachi Patwal; Chinmay Chetan; Girish Gupta
An outborn full-term female newborn with birth weight 2.45kg was admitted to our centre at 24 hours of life with respiratory distress and cyanosis. The baby had tachycardia and oxygen saturation (SpO2 ) 40% at admission to neonatal intensive care unit (NICU). She was mechanically ventilated on synchronized intermittent mandatory ventilation (SIMV) mode. Clinical evaluation raised suspicion of critical congenital heart disease; echocardiogram revealed transposition of the great arteries with 6mm ostium secundum atrial septal defect and small patent ductus arteriosus. The baby was started only on intravenous prostaglandin E1 (PGE1) as per unit protocol, where 1 ampoule (500 µg) of PGE1 is mixed in 49mL of 5% dextrose yielding a concentration of 10 µg/mL and is then started using an infusion pump at a rate of 0.6mL/kg/hour to provide a dose of 0.1 µg/kg/min. She developed tachycardia along with confluent erythematous macules over the scalp, face, neck and trunk, 10 hours after starting PGE1 infusion (figure 1). There was no associated fever or hypertension, while lowest blood pressure recorded was 52/30mm Hg. The skin rash, characterised by bright erythematous macular lesions, rapidly spread to the extremities. It was noticed that PGE1 was wrongly administered at 10 times the expected dose for the last 2hours prior to the cutaneous manifestation. The infusion was immediately stopped, and the baby was given
ARIMA based projection of infant mortality rate by the year 2030: a comparative analysis of India and Madhya Pradesh
(SCOPUS, 2025) Abhinav Bahuguna; Akanksha Uniyal; Vidisha Vallabh
Background Infant mortality is an important predictor of a government’s commitment to its people. Global infant deaths have declined since past decades but at a pace that leaves much to be desired. India’s declining pattern of trends is encouraging but the low performance of individual states like Madhya Pradesh (MP) indicates an urgent need for policy revision and implementation. Methods This paper forecasts the Infant mortality rate (IMR) of India and MP by the year 2030 through autoregressive integrated moving average (ARIMA) model after obtaining stationarity by differencing the series of IMR once. The Akaike’s information criterion and Bayesian information criterion have been used for the selection of best ARIMA model amongst other existing choices. The model diagnostics through Ljung and Box test shows absence of autocorrelation in the residuals (p>0.05). Results The findings through ARIMA(3, 1, 0) foretell a declining IMR from 27 to 20 per thousand live births (from 2021 to 2030) in India. Similarly, MP is expected to experience reduction in infant deaths from 44 to 39 per thousand live births (from 2021 to 2030). The deployed model is well fitted as mean absolute percentage error lies below 5%. During 2010–20, India and MP witnessed a decadal reduction of 40% and 31% in IMR, respectively. From the year 2010 onwards, India experienced the highest annual reduction of 8.1% in IMR during 2015–16. Similarly, MP encountered a decrease of 6.5% in IMR recently (2019–20), which is the highest declining annual IMR in the state during past ten years. Conclusions The projected figures on IMR are satisfactory for policy makers at national level, but MP is still miles away to achieve acceptable IMR as compared to the country’s IMR. The state requires more attention and focus on exploring reasons and identifying underlying factors responsible for higher IMR across its demographic structure including socio-economic characteristics.
Assessment of awareness on basic life support among healthcare workers in a tertiary care teaching hospital in northern region of India
(Springer, 2025-08-30) Himadri Mamgain; Omkarnath Sivarchaka; Sundar Lal Jethani; Vaibhav
Background Basic Life Support (BLS) serves as the basis for preserving lives following cardiac arrest, especially considering that heart disease ranks as the leading cause of death and constitutes a silent epidemic within the Indian population. Ischemic Heart Disease (IHD) stands out as the primary global cause of mortality, concurrently contributing significantly to the loss of disability-adjusted life years (DALYs). Hence it is crucial for healthcare workers (HCW) to have substantial knowledge and awareness of BLS to help patients when they need it the most. This study aimed to assess the awareness on BLS among HCWs in a tertiary care teaching hospital. Methods A cross-sectional study was conducted among HCWs in a tertiary care teaching hospital. A self-administered questionnaire was developed to assess knowledge on key BLS components, including cardiopulmonary resuscitation (CPR) techniques, use of an automated external defibrillator (AED), and the chain of survival. Data were analyzed using descriptive statistics and chi-square tests. Results Out of 206 responders, 60 were doctors, 122 were nursing staff and 24 were technicians. None of the responders have complete knowledge of basic life support, 58.8% mean percentage of knowledge. There was a significant difference in BLS knowledge between different professional groups, with doctors scoring higher than nurses and paramedics (p<0.001). Conclusion Even though healthcare professionals receive BLS training at a high rate, there remains a knowledge and retention gap in BLS abilities. Regular skills practice and updated training is recommended to enhance BLS proficiency.
Assessment of Central Catheter Tip Position in Neonates by Ultrasonography Versus X-ray
(SCOPUS, 2024-06-01) Prachi Patwal; Chinmay Chetan; Brajendra Singh; Vinayak Madhukar Jedhe; Girish Gupta
Central catheters are frequently inserted in neonatal intensive care units. The tip of these catheters should be in the correct position; otherwise, it may lead to life-threatening complications. X-ray has been universally used as a standard imaging modality to localize the position of central lines. Ultrasonography is an upcoming promising modality. We compared the catheter tip localization using ultrasonography versus X-ray.
Biotinidase deficiency-masquerade of primary immunodeficiency disease in neonate
(PUBMED, 2024-12-15) Chinmay Chetan; Brajendra Singh; Saikat Patra; Girish Gupta
Biotinidase deficiency, a rare metabolic disorder characterised by abnormal biotin metabolism, affects the biotin-dependent carboxylase functions. Primarily characterised by neurological and skin disorder, it may present with myriad features. Early recognition is important for preventing long-term morbidities. Here, we describe a case of a neonate presenting with seizures and a clinical picture suggestive of immunodeficiency. Multiple superficial abscesses along with septic arthritis of the left knee and left hip led to suspicion of primary immunodeficiency disorder. On evaluation, there was severe biotinidase deficiency. The neonate was supplemented with biotin, after which there were no further episodes of severe infection requiring hospitalisation, seizures or skin manifestation. This case report highlights the wide spectrum of clinical picture these disorders may present with and the low threshold for their evaluation and treatment.
Building Palliative Care Capacity in North India: A Multicenter Approach
(Elsevier, 2026-02-02) Kashyap, Komal; Ratre, Brajesh Kumar et al.
In low-resource settings like Northern India, palliative care providers often lack adequate training, institutional support, and interdisciplinary collaboration that are indispensable for effective implementation. Objectives This article highlights strategies to build palliative care capacity through education, interdisciplinary collaboration, and system-level interventions in Northern India. The article describes a palliative care capacity-building project executed from 2023 through 2025. It presents scalable approaches to overcome barriers to palliative care, enhance palliative care competencies, and expand palliative care infrastructure. Material and Method The project proceeded in three phases and began with the selection and development of nine centers of excellence (Phase I), followed by associating each center with ten district hospitals to embed palliative care within the region (Phase II). Phase III focused on palliative care training for providers in 90 district hospitals. The project assessed capacity and quality improvements at the centers and evaluated providers' palliative care knowledge post-training in the district hospitals. Results The centers of excellence reported substantial capacity and continued improvements in palliative care delivery throughout the project. Physicians and nurses affiliated with the district hospital showed significant and lasting knowledge gains after palliative care training. Conclusion These results demonstrate significant progress in palliative care capacity with the region, but they, also, underscore the need for ongoing efforts in training, research, and systematic record-keeping. The project’s success in its three phased approach illustrates the potential for education, collaboration, and system-level support to strengthen palliative care capacity.
Circular RNAs as Biomarkers and Therapeutic Targets in Diabetic Cardiovascular Complications
(Wiley, 2026) Beniwal, Shreya Singh; Jeong,Yujin; Rawat, Akash et al
Background: The global prevalence of diabetes mellitus (DM) is rising rapidly and is projected to reach unprecedented levels by 2035 and 2050, with a disproportionate burden among elderly populations and in low- and middle- income countries. Diabetes- related cardiovascular complications remain a leading cause of morbidity and mortality despite advances in glycaemic control and pharmacotherapy. There is an urgent need for novel molecular biomarkers and therapeutic targets to improve early detec tion, risk stratification, and personalised management. Methods: A comprehensive narrative review of the current literature was conducted to summarise emerging evidence on the biological roles of circular RNAs (circRNAs) in diabetes and its cardiovascular complications. Published experimental, trans lational, and clinical studies investigating circRNA expression, mechanisms of action, and therapeutic potential were critically analysed. Results: CircRNAs have emerged as key regulators in the pathophysiology of diabetes- associated cardiovascular disorders, in cluding diabetic cardiomyopathy, endothelial dysfunction, and vascular inflammation, as well as related microvascular compli cations. Mechanistically, circRNAs act through diverse pathways such as microRNA sponging, modulation of gene transcription, interaction with RNA- binding proteins, and regulation of cellular processes including apoptosis, fibrosis, oxidative stress, and inflammation. Their covalently closed structure confers exceptional stability, while their tissue- and disease- specific expression profiles support their utility as sensitive biomarkers for early diagnosis, prognosis, and therapeutic monitoring. Advances in synthetic circRNA design further highlight their promise as novel therapeutic agents, although challenges related to delivery efficiency, specificity, and off- target effects remain.
Comparative performance of biofire pneumonia panel and standard culture-based methods for diagnosing pneumonia in critically ill patients: Impact on antibiotic stewardship
(Elsevier, 2024-04-22) Barnali Kakati; Rajender Singh; Garima Mittal; Nupur Koul
Introduction: Lower respiratory tract infections (LRTIs) are a common cause of morbidity and mortality worldwide. Accurate identification of the pathogens causing LRTIs is crucial for ensuring of diagnostic and antibiotic stewardship. The Biofire Pneumonia Panel (BFPP) is a molecular diagnostic test that allows rapid detection of various bacterial and viral pathogens. In this study, we compared the performance of BFPP with standard culture methods for the detection of pathogens. Materials and methods: Respiratory samples from 70 patient with suspected LRTIs were tested using both BFPP and standard culture methods. The distribution of isolated bacterial pathogens was analyzed, and the sensitivity and specificity of BFPP were calculated. Additionally, the performance of BFPP in detecting antimicrobial resistance genes was evaluated. The results were compared with those obtained from VITEK-2 antimicrobial susceptibility testing and culture-based methods. Results: Among the suspected LRTI cases, BFPP identified a single pathogen in 32.8% of cases and multiple pathogens in 40% of cases. The standard culture method detected a single pathogen in 47.1% of cases. BFPP showed a sensitivity of 93.9% and a specificity of 45.9% for the total sample. The performance of BFPP in detecting antimicrobial resistance genes varied for different pathogens with overall sensitivity of 40.1% and specificity of 95.9%. Conclusion: The Biofire Pneumonia Panel (BFPP) demonstrated high sensitivity for several bacterial pathogens, indicating its potential as a rapid diagnostic tool. However, its performance varied for different microorganisms, and it had limitations in detecting certain pathogens and antimicrobial resistance genes for which still required more further studies to explore different resistance gene mechanism that can be incorporated in this panel in future. The BFPP can complement standard culture methods as a rapid tool in the diagnosis of LRTIs
Comprehensive Evaluation of Pooled Red Blood Cell Saline Suspensions Used in Routine Blood Typing: A Resource Optimisation Laboratory-Based Study
(Elsevier, 2026-05) Raturi, Manish; Gaur, Dushyant S. et al.
Preparation of 2–5% pooled A, B, and O red cell suspensions (RCS) in 0.9% normal saline (NS) is a routine and essential practice in most blood centres to ensure accurate reverse/plasma testing while performing ABO and Rh(D) blood typing [1]. These standardized RCS form the backbone of immunohematology (IH) testing because of their consistent antigen expression, reproducibility, and minimal background reactivity [2,3]. Despite their widespread use, the requirement to prepare RCS fresh each day is both labour intensive and resource-consuming, particularly in high-volume transfusion laboratories. Current literature offers limited data on the biological and functional stability of 5% pooled RCS stored under controlled refrigeration [4]. Evidence-based guidance on safe reuse duration is lacking, even though such a protocol could substantially reduce workload, reagent consumption, and operational costs without compromising test accuracy. This study, therefore, primarily aimed to determine the stability and reusability window of 5% pooled RCS prepared in 0.9% NS when stored at 4 ± 2°C. Secondary objectives included assessing agglutination strength, hemolysis, pH changes, red cell morphology, and sterility over the storage period to establish a scientifically validated reuse protocol for routine IH laboratories.
Correlation of Point-of-Care Lung Ultrasound Scoring System with Clinical Score and Chest X-ray Score for Newborns with Respiratory Distress
(PUBMED, 2025-07-07) Brajendra Singh; Chinmay Chetan; Saikat Patra; Girish Gupta; Vinayak Madhukar Jedhe; Shoham Majumder
Objectives To determine correlation between the lung ultrasound score with the chest X-ray score and the Downes score in neonates with respiratory distress. Methods All consecutive neonates admitted in the neonatal intensive care unit (NICU) with respiratory distress were checked for eligibility at admission. Clinical scoring was done using Downes score immediately. 12 area lung ultrasound scoring was done using Brat Score by trained experts. Chest X-ray scoring was done from high quality anteroposterior images. The findings of the three scores were then compared and correlated using Pearson correlation coefficient. Results One hundred neonates were enrolled with mean gestational age of 34.8 ± 3.6 wk and mean birth weight of 2063.7 ± 722 g. A positive correlation was found between Downes score and lung ultrasound score (Pearson correlation coefficient 0.712, p-value < 0.001) but not between lung ultrasound score and chest X-ray score. In the subgroup analysis, a statistically significant correlation was found between lung ultrasound score and Downes score for babies > 32 wk gestation but not for those < 32 wk gestation. Conclusions In neonates admitted to NICU with respiratory distress, lung ultrasound score correlates well with Downes score, especially in babies with gestational age > 32 wk.
Designing and assessing the impact of a competency-based training program in transfusion medicine among MBBS interns
(SCOPUS, 2025) Manish Raturi; Yashaswi Dhiman; Naveen Bansal; Basanta Khatiwada; Dushyant Singh Gaur; Poonam Rawat
Introduction: It has been widely recognized that there is a pressing need to strengthen transfusion medicine education for both undergraduate and postgraduate medical trainees across various clinical specialties to enhance patient safety. In response to this, the National Medical Commission (NMC) of India implemented a competency-based medical education (CBME) framework in 2019 for undergraduate MBBS students across all medical colleges in the country. The present study aimed to assess the impact of a training program designed for medical interns, developed in alignment with the CBME curriculum prescribed by the NMC. Materials and methods: This was a questionnaire-based cross-sectional study conducted among MBBS interns undergoing rotatory training in different departments of a tertiary care teaching hospital. A structured two day educational program was organized, comprising six modules—three focusing on bedside transfusion practices and three addressing blood donation and laboratory-based transfusion medicine. Each module was designed to reflect the competencies outlined in the CBME curriculum and included pre- and post-training assessments to evaluate knowledge improvement. A pre-test was conducted to assess the knowledge of transfusion medicine among the participants and the post-test was conducted to assess the impact of the training program. Results: Overall, the pre-test score in the present study was 14.1 (47%) which increased to 22.3 (77.6%) in the post-test. Analysis of the pre-test scores showed that 80% of the interns had weak knowledge of blood transfusion reactions and its management. 55.6% of the interns had weak knowledge of indications of blood component therapy whereas 32.2% of the interns had weak knowledge of bedside transfusion medicine practices. 73.3% of the interns had weak knowledge of blood donor selection and counselling. 62.3% of the interns and 73.3% of the interns had weak knowledge of transfusion transmitted infections and basic blood banking including compatibility testing and storage conditions for various blood components, respectively. Post-training results showed a significant improvement across all domains. Effect size analysis using Cohen’s d indicated that the training program was highly effective in five out of six domains, with moderate effectiveness observed in the domain of immunohematology. Conclusion: Although transfusion medicine knowledge is essential for routine practice in core medical and surgical specialties, a substantial knowledge gap exists among medical interns. This study demonstrates that a structured, CBME program is an effective strategy to improve transfusion medicine knowledge among MBBS interns
Development and Formative Assessment of an Innovative Blended Educational Course for Care of Small and Sick Neonates in India and SEARO Countries
(Erratum, 2026-03-16) Kumar, Praveen; Deorari, Ashok et al
Objectives To develop and disseminate an innovative blended educational programme comprising of evidence-based neonatal healthcare practices across India and to identify and empower local champions who could sustain and scale quality improvement (QI) efforts regionally. Methods The study was conducted in two phases and engaged healthcare professionals mentored by trained facilitators (1:8 ratio). A structured methodology was adopted comprising of: (i) assessment of learning needs, (ii) identification of the target audience and local facilitators, (iii) development of content and blended learning strategy, (iv) alignment with measurable QI objectives, (v) documentation of outcomes and (vi) implementation through the support of the National Neonatology Forum. Participant and facilitator feedback guided course evaluation. Results The course engaged 1073 healthcare professionals (590 doctors, 483 nurses) with 2–10 years of neonatal experience mentored by 132 facilitators. Phase 1 included 250 participants from five Indian states, and 823 participants from 18 Indian states and four South-East Asia Regional Organization (SEARO) countries—Bangladesh, Bhutan, Maldives and Nepal—were enrolled in Phase 2. Overall, 57% participants completed weekly online quizzes, and the average attendance for live webinars was 50%. 43 hands-on skill workshops were held training 685 professionals. Conclusion This flipped-classroom, blended model promoted exploratory and self-directed learning. Its adaptability and emphasis on faculty development and QI projects offer a replicable framework for future neonatal training initiatives.
Diagnostic Accuracy of a Smartphone-based 12-lead ECG for Detection of Common Bradycardias, Tachycardias, and Ectopic Arrhythmias
(Galenos Publishing House, 2026-02-24) Mohan, Chandra; Gururani, Kunal et al.
Background and Aim: Electrocardiography (ECG) remains the cornerstone for diagnosing cardiac arrhythmias. The purpose of this study was to assess the diagnostic performance of a smartphone-based ECG device (Spandan Ultra 12-lead) compared with a standard 12-lead ECG device for detecting common cardiac arrhythmias (bradycardias, tachycardias, and ectopic arrhythmias), with a cardiologist as the reference standard. Materials and Methods: The study was a prospective, cross-sectional, single-blind, observational, comparative diagnostic accuracy study conducted in 321 patients aged ≥20 years who exhibited signs of arrhythmias. For analysis of diagnostic performance, sensitivity, specificity, negative predictive value (NPV), positive predictive value (PPV), accuracy, F-score, positive and negative likelihood ratios [(positive likelihood ratio (PLR) and negative likelihood ratio (NLR)], Matthews correlation coefficient (MCC), and the Farrington-Manning score were used to provide a comprehensive evaluation. Results: The mean age was 51.95±14.51 years; 50.47% were male. The smartphone-based ECG demonstrated higher sensitivity (86.54% vs. 77.80%), specificity (93.68% vs. 91.38%), PPV (72.58% vs. 64.61%), NPV (97.29% vs. 95.31%), accuracy (92.52% vs. 89.09%), F1 score (0.79 vs. 0.70), PLR (13.7 vs. 9.05), MCC (0.75 vs. 0.64), area under the curve (0.851 vs. 0.846), and lower NLR (0.14 vs. 0.24) compared with the standard 12-lead ECG. The Farrington-Manning non-inferiority test demonstrates that the smartphone-based ECG was non-inferior to the standard 12-lead ECG on all validation parameters. Conclusion: The Spandan Ultra 12-lead smartphone-based ECG is a reliable diagnostic tool for detecting common bradycardias, tachycardias, and ectopic arrhythmias. Its simultaneous multichannel recording enables rapid and accurate rhythm assessment, demonstrating comparable diagnostic performance to that of the standard 12-lead ECG and serving as a complementary diagnostic tool for detecting common arrhythmias.
Diagnostic agreement of smartphone-based electrocardiogram with coronary angiography in identifying vessel involvement in patients with myocardial infarction
(Elsevier, 2026-02-11) Mohan, Chandra; Gururani, Kunal
Background: Acute myocardial infarction (MI) remains one of the major causes of morbidity and mortality throughout the world. The objectives of this study were to determine the diagnostic agreement between the findings from Portable (Spandan Pro) and Conventional Electrocardiogram with coronary angiography (CAG) regarding vessel involvement in MI patients, and to assess related risk factors. Methodology: This study was an Observational, Single-arm, Cross-sectional study performed on 109 subjects at a local hospital in Dehradun. The study was approved by the Institutional Ethics Committee, and informed consent was obtained from all the participants. For diagnostic agreement, Statistical analyses such as Cohen's κ, weighted κ, prevalence- and bias-adjusted κ (PABAK), and Jaccard index were used. Results: The mean age of the included patients was 58 ± 11.96 years, with a significant male predominance (88.07%). For overall vessel involvement of ECGs with CAG, portable ECG showed a higher sensitivity (84.76 vs. 78.10%), and for LAD artery, it also showed higher sensitivity (88.46% vs. 82.05%) compared to the conven tional ECG. Diagnostic agreement showed substantial agreement with CAG (PABAK 0.68), and according to the Jaccard Index, there was a moderate agreement (approximately 50%) between the ECG-derived findings with CAG across all types of vessel diseases. The most prevalent confounding factor among the participants was smoking (41.9%), followed by Hypertension (39.0%) and diabetes (34.3%). Conclusion: This study indicates that Portable ECG performed comparably to conventional ECG and had a moderate level of diagnostic agreement with CAG in the detection of vessel involvement in patients with MI.
Diagnostic Utility of Fine Needle Aspiration Cytology in a Case of Pulmonary Hydatid Cyst Masquerading as Tuberculosis
(PUBMED, 2025) Smita Chandra; Akanksha Aggarwal; Varuna Jethani
Hydatid cyst may mimic other diseases including carcinoma and tuberculosis which may raise diagnostic dilemma that may be more enhanced in areas where tuberculosis is endemic. This may result in delayed diagnosis of hydatid cyst leading to its complications. The present case is therefore being reported as it was clinically and radiologically diagnosed as tuberculosis but on fine needle aspiration cytology (FNAC) turned out to be a case of hydatid cyst. In addition, vigilant cytological examination revealed only protoscolices and hooklets instead of laminated cyst membrane which is more commonly and easily observed. FNAC serves as a valuable adjunctive tool in the diagnosis of hydatid cysts providing rapid and accurate diagnosis that can guide clinical management and improve patient outcome.