Heart-failure decompensation often evolves between visits, driving recurrent admissions and cost. Multi-sensor wearables, adhesive patches, smart watches, and garments capture electrocardiography, thoracic impedance, photoplethysmography, respiration, activity, and speech for near-real-time review. Evidence synthesis indicates two signals. First, integrated telemonitoring, combined with structured clinical intervention during the post-discharge vulnerable phase, reduces cardiovascular events and heart failure hospitalisations in randomised programmes. Second, device-level performance metrics (lead time, alert burden, detection accuracy) demonstrate early warning capability but do not alone establish outcome benefit. Implantable multi-sensor algorithms offer a median lead time of approximately one month, accompanied by manageable alert rates. External systems that estimate lung fluid or fuse wearable signals demonstrate promising feasibility, although large pragmatic trials remain limited. Consumer smartwatches achieve high accuracy for detection of atrial fibrillation in general population; however, evidence is lacking for detection of heart failure decompensation, or for improving the outcome. Key implementation issues include AI-validation, workflow-linked triage, cost-effectiveness, cybersecurity, and equitable access for low- and middle-income settings. Multi-sensor monitoring warrants targeted deployment within intervention pathways and rigorous evaluation focused on patient-important outcomes.

Background & objectives The COVID-19 pandemic came up with distinct challenges for patients with rheumatoid arthritis indicating higher risk of infection and severity due to SARS-CoV-2. In this study, we performed the immunotyping of humoral and cell-mediated responses in patients with rheumatoid arthritis to assess characteristics and durability of Covid vaccine-induced immune memory. Methods We enrolled 50 individuals with rheumatoid arthritis who had received SARS COV-2 vaccine (Covaxin/Covishield). Of these 26 were assessed within six months of the second vaccine dose (T1) and 24 were evaluated 6–9 months after the third dose (T2). Serum IgG titres were measured using chemiluminescent microparticle immunoassay (CLIA), and lymphocyte immunophenotyping. In vitro challenge with the SARS-CoV-2 spike protein was performed using flow cytometry. Results Patients vaccinated with Covishield showed significantly higher IgG titres and elevated levels of cytokines such as TNFα and IFNγ compared to those vaccinated with Covaxin. The Covishield group also exhibited a higher percentage of antigen-specific and inflammatory T cell subsets, contributing to the overall cytokine pool in patients with rheumatoid arthritis. In vitro stimulation with the SARS-CoV-2 spike protein further activated lymphocytes in Covishield-vaccinated individuals. Interpretation & conclusions Our study presents the increased effectiveness of Covishield in initiating responses compared to Covaxin. Covishield vaccinated patients with rheumatoid arthritis show higher antigen specificity and T cell activation indicating a shift of the immune system towards a Th1 phenotype, which makes it imperative to focus on development of safe and durable vaccines with a continuous follow up for the patients with rheumatoid arthritis to control disease severity.

Background & objectives Tribal communities in Pune district of India have relatively high burden of low birth weight and preterm babies. The ‘ Pradhan Mantri Surakshit Matritva Abhiyan ’ (PMSMA), categorises pregnant women according to risk and provides intensive care to high-risk pregnant women until delivery. This study aimed to identify barriers, challenges and supporting mechanisms to implementing the PMSMA programme for the management of high-risk pregnancies and report recommendations in adapting these guidelines. Methods We used the consolidated framework for implementation research (CFIR), to guide the qualitative assessment of the implementation context and identify factors that could influence intervention implementation and effectiveness of PMSMA. Due to COVID-19 pandemic-induced delays in the study implementation, we conducted a rapid qualitative analysis of 20 in-depth interviews and two focussed group discussions. Results The study highlights challenges faced by high-risk mothers in accessing private sonography centres, including untimely ambulance services, connectivity issues, and out-of-pocket expenses. The lack of diagnostics at primary centres adds to these issues. Culturally, pregnancy is kept secret until the first 12 wk, causing delayed intimation and loss of crucial healthcare days. The tribal community perceives large babies as risks during delivery, depriving pregnant women of healthy food and iron supplements. Interpretation & conclusions The study suggests that health systems should utilize a government-funded food supplementation program and ensure proper coordination between departments for better implementation, recommending community awareness, staff training, and collaboration with local governments.

Background & objectives Appropriate infant and young child feeding (IYCF) practices are crucial for growth and development during the first two years of life. Despite national initiatives, suboptimal IYCF practices prevail in tribal regions, contributing to undernutrition among under- five children. This necessitates need of specific targeted interventions through involvement of front line workers considering their role in community engagement. This study aims to assess awareness and knowledge of frontline workers about IYCF practices in Palghar district of Maharashtra. Methods This paper is part of a pre-intervention phase of a quasi-experimental study on IYCF practices in a tribal block of Palghar district, which included qualitative data through 56 in-depth interviews among frontline workers [ anganwadi worker supervisor, anganwadi workers, and accredited social health activists (ASHAs)] to explore their awareness and knowledge on World Health Organization IYCF domains. Data were coded, thematically analysed, and responses were summarised descriptively to identify gaps for the intervention phase. Results While FLWs exhibited basic awareness of breastfeeding, there was limited knowledge among ASHAs on complementary feeding, minimum dietary diversity, minimum meal frequency and amylase rich flour preparation. While FLWs were aware of key IYCF messages, their implementation is uneven, likely due to limited refresher training, and the lack of user-friendly, validated tools. Interpretation & conclusions The study identified specific knowledge gaps in IYCF practices among frontline workers, particularly among ASHAs. There is an adequate scope for targeted health education to address misconceptions and supportive supervision to strengthen frontline workers’ capacity to deliver accurate and consistent IYCF messages in tribal communities.

Background & objectives The incidence, risk factors and outcomes of upper body deep vein thrombosis (DVT) is less well studied in critically ill patients. This study aimed to estimate the incidence and identify the risk factors for the development of upper body-DVT. Secondary objectives included evaluating the anatomical sites of DVT, the impact of thromboprophylaxis, and short-term outcomes. Methods In this prospective observational cohort study, patients admitted to the intensive care unit (ICU) between December 2021 and December 2022 were screened for DVT using duplex ultrasonography at 48 h, 7, 14, 21, and 28 days after admission. Results Among 241 participants, 39 (16.2%) developed upper body DVT and 8 (3.3%) had lower limb DVT. The internal jugular vein was the most frequent site of DVT. Multivariable analysis identified platelet transfusion [Odds ratio (OR)=19.4; 95% Confidence interval (CI): 4.4-86.1], platelet count (OR=1.007; 95% CI: 1.002-1.011), duration of central venous catheter use (OR= 1.2; 95% CI: 1.1-1.3), and number of dialysis sessions (OR= 1.15; 95% CI: 1.01-1.3) as independent risk factors for upper body DVT. Participants with upper body DVT had significantly longer ICU stay (41 vs. 8 days) and duration of mechanical ventilation (33 vs. 5 days). However, ICU mortality was similar in those with or without DVT (48.7% vs. 44.3%). Interpretation & conclusions Upper body DVT occurred more frequently than lower limb DVT, with internal jugular vein being the most common site. Platelet transfusion, higher platelet counts, prolonged catheter use, and increased dialysis sessions were associated with increased risk of upper body DVT. Upper body DVT was also linked to prolonged ICU stay and increased ventilation days but not increased mortality.

The Omicron sub-lineages are known to have higher infectivity, immune escape and lower virulence. During December 2022 - January 2023 and March - April 2023, India witnessed increased SARS-CoV-2 infections, mostly due to newer Omicron sub-lineages. With this unprecedented rise in cases, we assessed the neutralization potential of individuals vaccinated with ChAdOx1 nCoV (Covishield) and BBV152 (Covaxin) against emerging Omicron sub-lineages. Neutralizing antibody responses were measured in the sera collected from individuals six months post-two doses (n=88) of Covishield (n=44) or Covaxin (n=44) and post-three doses (n=102) of Covishield (n=46) or Covaxin (n=56) booster dose against prototype B.1 strain, lineages of Omicron; XBB.1, BQ.1, BA.5.2 and BF.7. The sera of individuals collected six months after the two-dose and the three-dose demonstrated neutralizing activity against all variants. The neutralizing antibody (NAbs) level was highest against the prototype B.1 strain, followed by BA5.2 (5-6 fold lower), BF.7 (11-12 fold lower), BQ.1 (12 fold lower) and XBB.1 (18-22 fold lower). Persistence of NAb responses was comparable in individuals with two- and three-dose groups post six months of vaccination. Among the Omicron sub-variants, XBB.1 showed marked neutralization escape, thus pointing towards an eventual immune escape, which may cause more infections. Further, the correlation of study data with complete clinical profile of the participants along with observations for cell-mediated immunity may provide a clear picture for the sustained protection due to three-dose vaccination as well as hybrid immunity against the newer variants.

Tuberculosis (TB) continues to be the second most-leading cause of death due to a single infectious agent as of 2022 after COVID-19. Many affordable new molecular diagnostic tools are being developed for early and more accurate diagnosis, especially for low-resource settings in low- and middle-income countries. In this context, there is a need to develop a standardized protocol for validation of new diagnostic tools. Here, we describe a generic protocol for multi-centric clinical evaluation of molecular diagnostic tests for adult pulmonary TB. This protocol describes a cross-sectional study in TB reference laboratories in India. Adults (>18 yr) visitng the chest clinics or outpatient departments with symptoms of TB need to be enrolled consecutively till the required sample size of 150 culture positives and 470 culture negatives are met. Mycobacterium tuberculosis (Mtb) culture (mycobacteria growth indicator tube liquid culture) to be used under this protocol as the gold standard and Xpert MTB/RIF molecular test will be used as the comparator. The sputum samples will be tested by smear microscopy, Mtb culture, Xpert MTB/RIF and index molecular test as per the proposed algorithm. The specificity sensitivity, and positive/ negative predictive values are to be calculated for the index test with reference to the gold standard. TB diagnosis poses many challenges as it differs with type of disease, age group, clinical settings and type of diagnostic tests/kits used. Globally, different protocols are used by several investigators. This protocol provides standard methods for the validation of molecular tests for diagnosis of adult pulmonary TB, which can be adopted by investigators.