Baba Raghav Das Medical College

Percutaneous coronary intervention (PCI) is a minimally invasive treatment that reestablishes the flow in occluded coronary arteries with the use of wires, balloons, and stents. Chronic total occlusion (CTO) PCIs are one of the most challenging procedures in interventional cardiology because the morphology of the lesions is complex, the duration is prolonged, and there is a higher risk of complications like vessel perforation. The management of distal perforations can sometimes be very problematic when conventional approaches have failed.A 47-year-old male was admitted with acute chest pain and diagnosed with an inferior wall myocardial infarction. Coronary angiography revealed a CTO of the right coronary artery (RCA). Standard CTO techniques, including guidewire escalation, microcatheter support, sequential balloon angioplasty, and deployment of a drug-eluting stent (DES), were initiated to perform PCI. During the procedure, distal RCA perforation occurred. Initial management with prolonged balloon tamponade was unsuccessful, and a covered stent could not be advanced due to the tortuosity of the vessel. To address this, an alternative approach was employed whereby access was obtained via the marginal branch by dilating the stent struts of the previously deployed DES, allowing the covered stent to be advanced and deployed into the acute marginal branch, effectively isolating the perforated segment.This case illustrates a novel bailout approach for managing distal RCA perforation during complex CTO-PCI. When the delivery of a covered stent is not possible via a standard approach, accessing the main vessel through a side branch and stent strut dilatation may offer a viable route to successful sealing of perforation.To the best of our knowledge, this is the first case in the literature of distal RCA perforation that was successfully managed by functional annulment using a covered stent delivered through a side branch after stent strut dilatation. This technique illustrates a creative and effective solution for a rare but potentially catastrophic complication.The patient remained hemodynamically stable post-procedure. Serial echocardiography demonstrated no pericardial effusion, and cardiac biomarkers appropriately trended down. The patient was asymptomatic at the three-month follow-up with preserved left ventricular function.

Introduction:Rotator cuff tears are a common cause of shoulder pain and disability. Arthroscopic repair is the preferred surgical approach for symptomatic full-thickness tears that fail conservative management. Single-row and double-row techniques are widely used, but clinical outcomes for small-to-medium tears are often comparable. This study aimed to evaluate functional outcomes following arthroscopic single-row rotator cuff repair using the Penn shoulder score (PSS).Materials and Methods:Thirty patients (aged 18–60 years) with small-to-medium full-thickness rotator cuff tears, unresponsive to at least 6 months of non-operative management, underwent arthroscopic single-row repair with bioabsorbable suture anchors. Patients were evaluated using the PSS preoperatively and at follow-up visits at 2, 6, 10, 24 weeks, and final review (~12 months). The PSS evaluates pain, function, and patient satisfaction on a 100-point scale. Data were analyzed using paired t-tests (P < 0.05).Results:The cohort had a mean age of 38.9 years; 70% were male. All tears were either small or medium per Cofield’s classification. The mean PSS improved from 30.4 ± 3.9 preoperatively to 98.4 ± 3.8 at final follow-up (P < 0.001), with significant gains at each interval. At 1 year, 93.3% achieved an “Excellent” outcome, and all patients were satisfied with their results. No re-tears or major complications were reported.Conclusion:Arthroscopic single-row rotator cuff repair provides excellent functional outcomes and high patient satisfaction for small-to-medium tears. The technique is cost-effective and safe, making it especially suitable for resource-constrained settings like India.

Abstract Disclosure: S. Sahu: None. T. Jain: None. A.J. Augustine: None. G. Palaniswamy: None. T. Mareedu: None. P.R. Patel: None. B. Padamati: None. N. Koduri: None. A. Dixit: None. Background: Polycystic Ovary Syndrome (PCOS) is a prevalent endocrine disorder among reproductive-age women, characterized by hormonal imbalance, insulin resistance, and metabolic dysfunction. Despite growing evidence linking PCOS to cardiovascular risk factors such as hypertension, dyslipidemia, and chronic inflammation, longitudinal studies examining the direct association between PCOS and cardiovascular disease (CVD) remain limited. Women under 40 with PCOS face an elevated risk of cardiovascular disease due to metabolic and hormonal imbalances. Key risk factors include insulin resistance, obesity, and hypertension. Lifestyle interventions and management of weight and diabetes are essential strategies to reduce this risk. While PCOS is associated with increased cardiovascular risk, further research is needed to fully understand the independent effects of PCOS on CVD. This study aims to evaluate the long-term cardiovascular risk in women diagnosed with PCOS through a retrospective cohort analysis and address this research gap.Methods: A retrospective analysis was conducted using a dataset comprising 1,000 women aged 18-40, with 500 diagnosed with PCOS and 500 age-matched controls without PCOS. Key cardiovascular risk markers, including systolic and diastolic blood pressure (BP), lipid profile (LDL, HDL, triglycerides), fasting glucose, insulin resistance (HOMA-IR), and inflammatory marker C-reactive protein (CRP), were compared between groups. T-tests were used for continuous variables, and a chi-square test was performed to assess the association between PCOS and CVD. Additionally, logistic regression was conducted to evaluate PCOS as an independent predictor of CVD after adjusting for confounders such as BMI, smoking status, and physical activity.Results: Women with PCOS exhibited significantly higher systolic BP (p &amp;lt; 0.01), LDL cholesterol (p &amp;lt; 0.001), triglycerides (p &amp;lt; 0.001), fasting glucose (p &amp;lt; 0.01), and CRP (p &amp;lt; 0.001) compared to controls. The prevalence of CVD was markedly elevated in the PCOS group (chi-square test, χ² = 26.24, p &amp;lt; 0.0001), suggesting a strong association between PCOS and cardiovascular risk. Logistic regression confirmed that PCOS remained an independent predictor of CVD (OR: 2.45, 95% CI: 1.78–3.42, p &amp;lt; 0.001) even after adjusting for confounders.Conclusion: This study provides compelling evidence that PCOS is a significant risk factor for cardiovascular disease, independent of BMI and lifestyle factors. The elevated levels of atherogenic lipids, blood pressure, and inflammatory markers in PCOS patients underscore the urgent need for early cardiovascular screening and risk management in this population. Future research should focus on long-term interventions to mitigate CVD risk in women with PCOS and further clarify the independent role of PCOS in cardiovascular outcomes. Presentation: Saturday, July 12, 2025

BackgroundNeurologic complications associated with dengue infection have been increasingly recognized globally, particularly following detection of dengue virus in cerebrospinal fluid via polymerase chain reaction. Despite this, no prior study has assessed neurologic sequelae in patients with dengue-associated acute encephalitis syndrome (DEN-AES). This study aimed to evaluate the extent and domains of neurologic sequelae in pediatric DEN-AES cases.MethodsThe study was conducted in 2023, including diagnosed DEN-AES cases (≤18 years) discharged between January 2018 and December 2019. DEN-AES was defined as acute fever onset with altered mental status (confusion, disorientation, coma, or inability to speak) and/or new seizures (excluding simple febrile seizures), as confirmed by NS1/IgM enzyme-linked immunosorbent assay and reverse transcription polymerase chain reaction tests for dengue. Long-term sequelae were assessed via home visits with a standardized disability assessment tool. Hospital records provided clinical, biochemical, and laboratory data for analysis.ResultsOf 56 children (median age, 7.5 years [IQR, 5–10]; 53.6% male), neurologic sequelae of varying severity were observed in 22 (39.3%) cases. Severe disabilities were noted in 6 children, with 1 postdischarge death. Thirty-four children were fully recovered, scoring 5 on the Liverpool Outcome Score. Cognitive and behavioral impairments were the most common sequelae (37.5%), and 5 children required antiepileptic drugs for ongoing seizure management.ConclusionsNeurologic sequelae were identified in 39% of pediatric DEN-AES cases, underscoring the need for early diagnosis, continuous follow-up, and dedicated rehabilitation policies in dengue-endemic regions to support affected children.

Hypoxia is a hallmark of solid tumors and is expressed by low oxygen levels. It drives cancer progression, metastasis, and resistance to radiotherapy, chemotherapy, and immunotherapy. It activates the hypoxia-inducible factor (HIF) pathway and adaptive responses, including the unfolded protein response and nuclear factor kappa B signaling. Hypoxia-activated prodrugs (HAPs) initiate their action in low-oxygen microenvironments, liberating cytotoxic agents such as DNA-damaging radicals or kinase inhibitors while remaining inert in normoxic healthy tissue. This review surveys medicinal chemistry strategies underlying oxygen-responsive hypoxia-activated prodrugs (HAPs), including nitroaromatic agents (e.g., evofosfamide/TH-302), N-oxide derivatives (e.g., tirapazamine and AQ4N), quinone methide–based systems, metal-coordinated complexes (e.g., Pt(IV) and Co(III)), and azo-bond–containing compounds, with emphasis on their bioreductive activation pathways and self-immolative drug-release mechanisms. Preclinical studies have validated the ability of HAPs to selectively eradicate hypoxic tumor cells, overcome resistance to radiotherapy, and improve chemotherapy and immunotherapy outcomes. Despite significant results, clinical translation faces obstacles, including tumor heterogeneity, poor drug penetration into necrotic cores, and a lack of patient stratification biomarkers, such as pimonidazole imaging or gene profiling. Future directions focus on personalized medicine via hypoxia biomarkers and nanotechnology for enhanced delivery. Other developments include rational combinations with photodynamic therapy and anti-programmed cell death protein-1 agents to augment therapeutic indices. Thus, HAPs hold substantial promise for precision oncology, improving treatment specificity, reducing resistance, and optimizing patient outcomes in hypoxia-driven cancers.

Background: Topical combination therapies are the cornerstone of acne vulgaris treatment, with clindamycin-benzoyl peroxide combinations widely prescribed for synergistic antimicrobial effects. Limited data exists on dermatology practitioners' real-world experiences and prescribing patterns with these formulations across diverse Indian populations. Objective: To evaluate dermatology practitioners' perspectives on clindamycin-benzoyl peroxide (Clin-B) combination therapy effectiveness, safety satisfaction, prescribing patterns across acne severity levels, and antibiotic stewardship implementation. Methods: A cross-sectional survey using the SCORE (Survey on Clinred-B's Outcome in Reducing Acne by Experts) questionnaire was conducted among dermatology practitioners across six Indian states (Maharashtra, Rajasthan, Uttar Pradesh, Gujarat, Madhya Pradesh, and Telangana). The 20-question survey assessed treatment utilization, safety satisfaction, comparative effectiveness, clinical decision-making factors, and stewardship awareness. Data were analyzed using descriptive statistics. Results: Thirty dermatology practitioners participated, with the largest representation from Maharashtra (46.7%). High combination therapy adoption was observed (66.7% using in &gt;50% of patients). Safety satisfaction was universal (100% satisfied; 80% very satisfied). Treatment preferences demonstrated clear severity stratification: mild acne 40%, moderate 50%, moderately severe 56.7%, and severe acne 70% preferred Clin-B. Perfect antibiotic stewardship awareness was evident (100% agreement on avoiding monotherapy). Practitioners preferred once-daily night-time dosing (66.7%) and rated Clin-B favorably in comparative effectiveness assessments (73.3% versus clindamycin-adapalene; 66.7% versus adapalene-benzoyl peroxide). Conclusion: Dermatology practitioners demonstrate strong confidence in Clin-B therapy with evidence-based, severity-stratified prescribing (40-70% preference increase). Universal safety satisfaction and perfect stewardship compliance indicate successful resistance prevention implementation. Results provide real-world validation supporting current guidelines recommending combination therapy as first-line acne treatment.