Aditya Birla Memorial Hospital

Meconium periorchitis (MPO) is an unusual entity that presents as a scrotal mass in the early neonatal period and is seen in 1 in 30,000 live births. MPO is associated with meconium peritonitis, that leads to leakage of sterile meconium through patent processus vaginalis into the developing scrotum. Clinically, this entity presents as a para-testicular mass which shows scattered calcifications on imaging, thus warranting diagnostic work up and histopathological confirmation. Our case is an 8 month-old male baby with a firm to hard scrotal cyst. Intraoperatively, a diagnosis of teratoma was considered due to the complex solid cystic nature of the lesion and it was excised. Histology confirmed the diagnosis of MPO. Although some cases of MPO show spontaneous regression, about 65% warrant a surgical intervention. However, lack of awareness of this entity can lead to unnecessary orchiectomy.

Psychological distress in people with CRDs is often under-recognised and under-treated, especially in low-resource rural settings where access to mental health support is limited and awareness remains low. PR offers a platform to integrate psychosocial care, but implementation guidance is lacking. This study explored healthcare providers’ views on integrating a psychosocial intervention into PR for rural Indian patients to inform the co-design of a culturally tailored intervention. A 90-minute stakeholder engagement workshop was held at KEM Hospital Research Centre, Pune in April 2025 with physiotherapists, chest physicians, psychologists, and nutritionists. Following a presentation of findings from a systematic review, stakeholders participated in group discussions and word clouds guided by prompts on barriers, stigma, delivery models, referral pathways, and sustainability. Ten stakeholders participated and contributed insights. Key recommendations included using culturally appropriate, non-stigmatising language; embedding psychosocial support and intervention within exiting PR routines; and adopting modular staff training to overcome time and workforce limitations. Stakeholders also emphasised involving family members, integrating dietary and nutritional counselling, and improving referral systems to specialist care. Insights from this stakeholder engagement workshop will directly inform the design of a feasible, locally adapted, co-developed psychosocial intervention tailored to rural needs and grounded in patient and provider perspectives. NIHR RESPIRE-funded PhD Project (RESPIRE PhD:16/136/1091)

We report a rare case of vertebral osteomyelitis due to Mycobacterium farcinogenes in a patient who had undergone left-sided percutaneous nephrolithotomy for renal stones. Following the procedure, he developed a wound site infection that progressed to vertebral osteomyelitis and a paravertebral abscess. Initial treatment with empirical anti-tubercular drugs was ineffective. A computed tomography-guided aspiration and biopsy identified acid-fast bacilli as M. farcinogenes using Matrix-assisted laser desorption ionization-time-of-flight. Treatment was then tailored based on the susceptibility results, leading to a positive response.

ObjectiveTo study the factors affecting the Extubation time in patients undergoing Coronary Artery bypass grafting surgery.Material and methodsAfter approval from the ethical committee, a retrospective observational study was conducted, and data on the patients undergoing coronary artery bypass grafting surgery was collected from 1 January to 30 September 2024. Adult patients undergoing CABG surgery patients who require postoperative mechanical ventilation were included while patients who underwent combined procedures CABG + valve replacement or any other Open Heart surgeries, Patients with pre existing mechanical ventilation & Patients who expired within 24 hrs of ICU admission were excluded from the study. Data collection was done using the hospital's EMR system which included pt's demographic characteristics, preoperative status like ejection fraction, lab investigations, etc, Intraoperative data like duration of surgery, blood loss, number of grafts used, MAP, inotropes used, use of pack cells, Postoperative data like no of inotropes used, use of IABP, drain volume, extubation time {early (< 6 hrs) vs late (> 6 hrs), any post-operative complications, length of stay in ICU and mortality data was collected. Patients were grouped based on extubation time: Early extubation < 6 hrs post-surgery Delayed extubation > 6 hrs post-surgery Statistical analysis -continuous variables were summarised as means ± SD, comparison between two groups was for continuous variables performed using Student's t-test or Mann Whitney test, and logistic regression analysis was used to identify predictors of early and late extubation.ResultsAmong the 51 cases which we studied, the mean age was 61.16 ±10.8 years. Early extubation was achieved in 65.31% of patients (n=32) while 34.69% of patients (n=17) had delayed extubation. The median extubation time was 10.03 ± 13.15 hours. The extubation time was significantly affected by this factors Blood loss during surgery, duration of surgery, no of inotropes required & ejection fraction. Multivariate Logistic regression Analysis revealed that Blood loss during surgery was a significant independent risk factor for delayed extubation. With the increase in blood loss, the risk for delayed extubation significantly increases with adjusted Odds Ratio of 1.006. Early extubation was associated with lower mortality and fewer postoperative complications while Patients in the delayed group had a longer ICU stay and also higher rate of reintubation.DiscussionThe study demonstrates that early extubation after CABG is associated with improved outcomes including shorter ICU stays and reduced rate of complication rate, this findings align with prior research work emphasizing the benefits of fast-track protocols in cardiac surgery. Delayed extubation was linked to older age, higher BMI, and intraoperative complications consistent with existing studies.ConclusionIn patients undergoing CABG surgery, some perioperative & post-operative factors had significant effects. Therefore, considering this factors is important for designing a treatment plan & evaluating patients prognosis. This study highlights the importance of early extubation although a future large sample size study is required to validate these findings.

Surveillance and control of cardiometabolic risk factors can be a cost-effective strategy for controlling noncommunicable diseases in resource-limited settings. However, long-term studies on them in rural India are limited. The objective of this study was to assess the changes in the burden of cardiometabolic risk factors between the years 2005 and 2022-2023. Two cross-sectional studies were conducted in 2005 and 2022-2023 in a well-defined population in the Vadu Health and Demographic Surveillance System in the rural Pune district. Trained surveyors used the WHO STEPS tool to measure tobacco use, alcohol consumption, fruit and vegetable consumption, anthropometry, and blood pressure in both studies. Fasting blood glucose was measured only in the recent study. Both studies used random stratified sampling with 10-year age-sex strata for the 25-64-year age group. Data were analyzed using a Chi-square test and age-adjusted, sex-stratified prevalence rates (n = 2073 [2005]; n = 1711 [2022-2023]). Over 17 years, the age-adjusted prevalence of generalized overweight or obesity has more than doubled (31.6% to 70.1% in men and 22.8% to 60.1% in women). Central obesity prevalence has also more than doubled (20.2% to 54.3% in men and from 21.6% to 45.4% in women). While there has been a decrease in the prevalence of hypertension in both genders (25.9% to 22.1% in men and 22.7% to 17.5% in women), the prevalence of prehypertension has increased (41.6% to 60.1% in men and 32.8% to 43.9% in women). The study suggests the need for primary prevention strategies to control obesity and prehypertension in the study population and similar rural communities in India.

Torsemide, a loop diuretic, is increasingly recognized for its role in managing essential hypertension. Its mechanism of action involves inhibiting the reabsorption of sodium and chloride ions in the ascending loop of Henle in the kidneys. By doing so, torsemide promotes diuresis, which refers to increased urine production, and subsequently lowers blood pressure. Studies have shown that torsemide is comparably effective to other antihypertensive agents in lowering blood pressure, with the added benefit of potentially improving renal function. However, while torsemide shows promise in hypertensive management, further research is necessary to fully understand its long-term effects and to establish optimal dosing strategies. Future research should focus on clarifying its role in long-term blood pressure control and refining its use in clinical practice to maximize efficacy and minimize adverse effects.

There is no robust evidence-based data for ABO-incompatible kidney transplantation (ABOiKT) from emerging countries. Data from 1759 living donor ABOiKT and 33 157 ABO-compatible kidney transplantations (ABOcKT) performed in India between March 5, 2011, and July 2, 2022, were included in this retrospective, multicenter (n = 25) study. The primary outcomes included management protocols, mortality, graft loss, and biopsy-proven acute rejection (BPAR). Protocol included rituximab 100 (232 [13.18%]), 200 (877 [49.85%]), and 500 mg (569 [32.34%]); immunoadsorption (IA) (145 [8.24%]), IVIG (663 [37.69%]), and no induction 200 (11.37%). Mortality, graft loss, and BPAR were reported in 167 (9.49%), 136 (7.73%), and 228 (12.96%) patients, respectively, over a median follow-up of 36.3 mo. In cox proportional hazard model, mortality was higher with IA (hazard ratio [HR]: 2.53 [1.62-3.97]; P < 0.001), BPAR (HR: 1.83 [1.25-2.69]; P = 0.0020), and graft loss (HR: 1.66 [1.05-2.64]; P = 0.0310); improved graft survival was associated with IVIG (HR: 0.44 [0.26-0.72]; P = 0.0010); higher BPAR was reported with conventional tube method (HR: 3.22 [1.9-5.46]; P < 0.0001) and IA use (HR: 2 [1.37-2.92]; P < 0.0001), whereas lower BPAR was reported in the prepandemic era (HR: 0.61 [0.43-0.88]; P = 0.008). Primary outcomes were not associated with rituximab dosing or high preconditioning/presurgery anti-A/anti-B titers. Incidence of overall infection 306 (17.39%), cytomegalovirus 66 (3.75%), and BK virus polyoma virus 20 (1.13%) was low. In unmatched univariate analysis, the outcomes between ABOiKT and ABOcKT were comparable. Our largest multicenter study on ABOiKT provides insights into various protocols and management strategies with results comparable to those of ABOcKT.

Objective: In spite of being the most vital part of the health-care system, medicines can become the reason for hospitalization or prolonged hospital stay if not used with vigilance. Adverse drug reactions (ADRs) have become a major reason for the rise in morbidity and mortality rate. Hence, monitoring of the ADRs and understanding their route cause is utmost important in a clinical setup. This project aims to monitor the ADRs and improve ADR reporting in the hospital. Methods: The work was carried out at a tertiary care hospital in Pune. Daily visit to different departments was done and patients were screened from admission to discharge during the study period. ADRs occurring due to chemotherapy, overdose, intoxication, drug abuse, accidental/intentional poisoning, and blood/blood products were excluded. The data of ADRs reported in the hospital in the past 3 years were collected and compared with the prospective data to analyze the improvement in ADR reporting in the hospital. Results: ADRs occurring in males were more than those in females. Adults between the age group of 20 and 59 years were more prone to ADRs. Maximum number of ADRs reported were occurring due to antimicrobial agents. The organ that was commonly affected due to ADRs was skin. Conclusion: High incidence of ADRs insists on vigilant monitoring to prevent its further recurrence. More studies need to be conducted to know the exact occurrence and prevalence of ADRs in the Indian population. Creating awareness among the HCPs for reporting suspected ADRs will help to improve patient safety. ADR reporting can be enhanced if the involvement of clinical pharmacists is strengthened in health-care centers.

We report a case of a 66-year-old man with prostate cancer who underwent 18F-prostate-specific membrane antigen positron emission tomography/computed tomography for baseline staging that revealed primary lesion in prostate gland along with a solitary metastatic deposit in the penile shaft. Penile metastasis is rare and usually associated with widespread metastatic disease. Solitary penile metastasis is even rarer and can present as a unifocal, multifocal, or diffuse lesion. Early detection is important in guiding treatment and preventing complications.