Apollo Gleneagles Hospitals

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.

Background: Masturbation is a common and normal sexual behavior, also observed among children. Despite its benign nature, childhood masturbation (CM) often causes parental concern. However, literature on CM from South Asia remains scarce. Objectives: We aimed to see the available clinical evidence on CM in South Asia, considering clinical presentation, diagnosis, and management. Methods: This narrative review was conducted through comprehensive searches of PubMed, Scopus, Google Scholar, and Google without time restrictions, using both Medical Subject Headings and free-text terms. Eligible studies included original articles, case series, and case reports involving CM from South Asian countries. Results: Eighteen studies (2006–2025) comprising 148 children were included, mostly from India ( n = 11). Case reports ( n = 10) and case series ( n = 5) predominated. Ages ranged from 4 months to 7 years, with a female predominance (62.2%). Common presentations were rhythmic body movements, leg crossing, facial flushing, grunting, sweating, and seizure-like episodes. Pediatricians were consulted as the first level carer in most of the cases, and laboratory tests were usually normal. Non-pharmacological interventions, behavior therapy, psychoeducation, and parental counseling were frequently used ( n = 16) and found effective. Conclusions: CM in South Asia is a relatively less-reported clinical entity. Increasing awareness, promoting culturally sensitive interventions, and prioritizing non-pharmacological management can improve the status quo. Future research should move beyond case reports toward population-based studies that explore the prevalence and psychosocial impacts of CM in South Asia.

Background and Aims: Postoperative pulmonary complications (PPC) pose significant problems, especially in patients with chronic obstructive pulmonary disease (COPD). We aimed to assess the risk of developing PPC in COPD patients undergoing non-thoracic surgeries along with its correlation to the type of surgery, anaesthesia technique and patient-related factors. Material and Methods: We prospectively collected data such as the comorbidities, preoperative pulmonary risk scores, recent history of respiratory infection, investigations, surgical (type, duration, surgical urgency and site) and anaesthesia data (general or regional, airway intervention if any), American Society of Anaesthesiologists (ASA) scores, the Assess Respiratory Risk in Surgical Patients in Catalonia (ARISCAT) risk index scores and Global Initiative for Chronic Obstructive Lung Diseases (GOLD) classification of COPD in 196 patients. We tried to find a correlation between these factors to the development of PPC. Results: The risk of PPC in patients with an ASA category 3 was 3.24 times higher than in those with an ASA 2. It was 1.22 times higher in patients with COPD classified as GOLD criteria 3 compared with those classified as GOLD criteria 1 and 2. PPC in high-risk ARISCAT scores was 4.97 times higher than in patients with intermediate to low-risk ARISCAT scores. The risk factors which had a significant association with PPC were patients more than 65 years of age, patients with metabolic equivalent (MET) score less than 4, respiratory infection in the last 1 month, haemoglobin less than 10 gm/dl, pre-operative oxygen saturation (SpO 2 ) less than 95% on room air, administration of general anaesthesia over regional anaesthesia, emergency surgery and surgical time more than 3 hours. Conclusion: ASA classification and GOLD criteria are useful to assess preoperative health status and the severity of COPD and reasonably predict the risk of PPC. The ARISCAT risk index, however, is a stronger modality to predict PPC.

BackgroundIn simultaneous bilateral total knee arthroplasty (bTKA), surgeons often encounter scenarios where femoral or tibial component sizes differ between limbs. While component sizing is routinely individualized, the functional and survivorship implications of such asymmetry remain insufficiently studied. A clearer understanding is clinically relevant, as patient anatomy, bone stock, and soft-tissue balance often necessitate asymmetric sizing, yet evidence guiding its safety and outcomes is limited. This prospective multicenter study evaluated whether inter-limb differences in component sizing influence postoperative function, patient-reported outcomes, or revision risk in bTKA.MethodsPatients undergoing cemented bTKA with standardized implants (metal femoral components, metal-backed tibial baseplates, and ultra-high-molecular-weight polyethylene inserts) were prospectively enrolled across 10 high-volume centers. Patients were stratified into Subset A (identical component sizes in both knees) and Subset B (different component sizes between knees). Clinical and functional outcomes were assessed preoperatively and postoperatively at regular intervals up to three years. Endpoints included range of motion (ROM), Knee Society Score (KSS), Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC), and 36-Item Short-Form Health Survey (SF-36). Radiographic assessment evaluated alignment, fixation, and implant stability. Minimal clinically important difference (MCID) thresholds were used to confirm the clinical relevance of improvements.ResultsA total of 166 patients (332 knees) were analyzed, with 140 in Subset A and 26 in Subset B. Baseline characteristics were comparable between groups. Both subsets demonstrated significant improvements in ROM and functional scores from baseline to three years (p<0.001 for within-group changes). Subset A achieved higher final ROM (123.6° vs. 118.1°; p<0.001) with less variability, and KSS were also significantly greater in this group (p<0.05).Subset B, despite inter-knee size differences, showed improvements similar to Subset A in WOMAC scores and demonstrated higher values in selected SF-36 domains, including physical functioning, role limitations, and emotional well-being (p<0.05). No implant-related complications, revisions, or radiographic failures were reported in either group during the three-year follow-up, and radiographs confirmed stable and well-aligned prostheses.ConclusionA one-size difference in femoral or tibial components between knees does not compromise clinical or functional outcomes in bTKA. While symmetric sizing may provide slightly greater ROM and KSS improvements, minor asymmetry is not detrimental and may even be associated with enhanced patient-reported quality-of-life domains. These findings support the practice of individualized component selection and reassure surgeons that small inter-limb differences in implant sizing do not negatively impact mid-term function or survivorship.

The Ayushman Bharat Digital Mission (ABDM) represents a transformative initiative aimed at revolutionizing healthcare delivery in India through digitizing health records and establishing an integrated digital health infrastructure. This mission addresses critical challenges in the healthcare system by providing a robust information backbone for healthcare providers, which simplifies the processes of tracking, accessing and updating patient data. By eliminating duplication and reducing errors in data collection, ABDM enhances efficiency and improves the quality of care provided to patients. Patients are empowered to create a Health ID, enabling them to share their medical records seamlessly with healthcare providers. This includes comprehensive details such as doctor appointments, diagnoses, treatments, hospitalizations and medications, ensuring that patients have access to high-quality healthcare. The integration of medical records into a single digital system not only simplifies care coordination but also reduces wait times, standardizes treatments and lowers overall healthcare costs. Furthermore, the digitization of health records allows healthcare providers to deliver more personalised and timely care, as instant access to a patient's medical history significantly improves diagnosis accuracy and treatment outcomes. The ABDM holds immense potential for enhancing the effectiveness, efficiency and transparency of health service delivery in India, ultimately promising a future where every citizen can access their health information within a unified digital health ecosystem.

Type 2 diabetes (T2D), along with other co-morbidities (hypertension, hyperlipidemia, etc.), causes vascular complications and atherosclerosis, leading to heart or kidney damage. The timely detection of cardiovascular disease (CVD) and chronic kidney disease (CKD) risk helps in targeted treatment, thereby reducing hospitalization/death in people with T2D. The vascular complications of T2D, including the onset of CVD or CKD, have been widely studied. However, a clear understanding of the concurrent inter-relatability of diabetes-kidney-heart or diabetes-heart-kidney continuum would further assist the clinicians in preventing morbidity and mortality. The narrative review sought to outline the stages (“prevent,” “regress,” and “retard”), pathophysiological mechanism, and management of the continuum with defined patient profiles and associated risk factors. Pharmacotherapies with a focus on managing both cardiac and renal vascular changes (e.g., sodium-glucose transporter-2 inhibitors {SGLT-2is}, glucagon-like peptide-1 receptor agonists {GLP-1RA}, dipeptidyl peptidase-4 inhibitors {DPP-4is}, lipid-lowering therapy, and renin-angiotensin-aldosterone system {RAAS} blockers) have been discussed. In addition, new diagnostic approaches such as levels of B‐type natriuretic peptide (BNP), N‐terminal prohormone, cardiac troponin, cystatin C, and single-cell transcriptome sequencing, with proven accuracy for detecting vascular complications in the heart and kidney, have been summarized. The review underscores the importance of the early detection of the vascular complications in T2D with individual risk stratification for the initiation/continuation/switching of therapies, to enhance treatment adherence and outcomes.

Aims: Strongyloidiasis is an asymptomatic disease caused by the intestinal helminth Strongyloides stercoralis in immunocompetent individuals and are present for decades. The rarity of our case presents in the facts that an elderly gentleman being immunocompetent before, being evaluated for a surgical condition, circumstances lead to sudden deterioration and within one day of the biopsy report succumbs to the condition. While undergoing retrospective evaluation it was diagnosed as hyper infection and disseminated strongyloidiasis. Presentation of the Case: 77 year old elderly male , a case of chronic idiopathic demyelinating neuropathy(recovered) , previously was on oral steroids for a period of 1-2 months; was admitted with persistent vomiting at other hospital, and on evaluation diagnosed with hiatus hernia with severe gastritis and referred to us, patient underwent Naso jejunal tube placement in view of gastric outlet obstruction and for feeding, post which, patient had initially loose stools and thereafter malena, upper Gi scopy with cessation of bleed done, to recur as hematemesis and within one day of diagnosis of duodenal biopsy suggestive of Strongyloides stercoralis, patient succumbed to the disease. Discussion: The case emphasizes on the importance of evaluation of various gastrointestinal infections especially caused by pathogens in our country with tropical climate and need to correlate the immunocompetency of patient especially on steroids with underlying infections. Conclusion: strongyloidiasis infection should be ruled out in all the immunodeficient patients especially on steroids for brief periods and presenting with gastrointestinal symptoms of vomiting and diarrhoea.

Objective: This study aims to evaluate the efficacy and safety of oral semaglutide in managing type 2 diabetes (T2D) through a cardio-renal-metabolic approach tailored for the Indian context. Materials and methods: A literature review was conducted using PubMed and Google Scholar, focusing on systematic reviews, meta-analyses, and randomized controlled trials related to oral semaglutide. Findings were discussed at the 16th National Insulin and Incretin Summit (NIIS) on November 19, 2022, where an expert panel developed guidelines based on collective insights and live opinion polls. Results/Key findings: The expert committee recommends oral semaglutide for adults with T2D due to its effectiveness in lowering blood glucose and promoting weight loss. It can be used alone or with other oral anti-diabetic agents, except dipeptidyl peptidase 4 inhibitors (DPP-4i). The drug is safe for those with cardiovascular disease or chronic kidney disease (CKD). Common gastrointestinal side effects are typically mild. Administration requires fasting for 30 min after dosing. Gradual dose escalation is advised to minimize side effects, and patients should be counseled on potential interactions with other medications and pregnancy considerations.