Bhagwan Mahaveer Jain Hospital

Abstract Nodoparanodopathies are a group of autoimmune peripheral neuropathies which present with subacute or chronic relapsing “chronic inflammatory demyelinating polyneuropathy like” chronic/relapsing sensorimotor and/or cranial and autonomic neuropathy which respond well to immunotherapy. We herein present two cases of antineurofascin NF186 antibody-related autoimmune neuropathy. One patient presented with subacute sensorimotor neuropathy and gait ataxia while the other patient presented with worsening of preexistent chronic sensorimotor neuropathy with subacute onset of respiratory distress and cranial nerve palsies. Both of them had a delay in diagnosis due to other overlapping causes of peripheral neuropathy. We highlight the red flags in peripheral neuropathy diagnosis where there could be coexistence of multiple etiologies, especially autoimmune neuropathy which is treatable that needs a high degree of suspicion along with proper evaluation protocol and management guidelines that need to be followed which can change the overall clinical course and improve prognosis.

Background: Functional dyspepsia (FD) is a prevalent gastrointestinal condition with a multifactorial origin, in which Helicobacter pylori infection may play a contributory role. Although eradication therapy has been shown to offer symptomatic relief in a subset of patients, predictors of response remain inadequately defined. To evaluate the effect of H. pylori eradication on gastric histological parameters and symptom resolution in patients with functional dyspepsia and to identify histopathological predictors of treatment response. Methods: This prospective observational study included 121 adult patients with functional dyspepsia and confirmed H. pylori infection. All patients underwent upper gastrointestinal endoscopy and gastric biopsies were obtained before initiating eradication therapy. Biopsy specimens were stained with H&E and Giemsa and histological assessment was performed by a blinded pathologist using the Modified Sydney System. Parameters assessed included chronic inflammation, neutrophilic activity, glandular atrophy, intestinal metaplasia and H. pylori density. A composite Sydney score was calculated. Follow-up was conducted at 3 months to assess symptom resolution. Patients were categorized into "Resolved" and "Non-improved" groups based on symptomatic outcomes. Results: Out of 100 patients enrolled, follow-up data were available for 79. Symptom resolution was observed in 52 patients (51.5%), while 27 (26.7%) reported no improvement. Patients with symptom resolution had significantly higher pre-treatment scores for chronic inflammation (p=0.012), neutrophilic activity (p=0.021), H. pylori density (p=0.008) and composite Sydney score (p=0.002). Glandular atrophy (p=0.486) and intestinal metaplasia (p=0.671) showed no significant association with symptomatic improvement. Conclusions: Symptomatic benefit following H. pylori eradication in functional dyspepsia appears to be associated with higher baseline levels of chronic and active gastric inflammation, as well as H. pylori density. Histopathological assessment using the Modified Sydney System may help predict treatment response and guide clinical decision-making.

Objective: To conduct an intercenter outcome assessment of maxillomandibular relationships for patients with repaired complete unilateral cleft lip and palate between the ages of 8 and 14 using the GOSLON Yardstick index. Design: Retrospective cohort study. Setting: Ten Comprehensive Cleft Care Centers across India. Subjects: A total of 397 subjects with repaired unilateral cleft lip and palate. Methods: Using GOSLON Yardstick, 397 study models of patients with complete unilateral cleft lip and palate were assessed. The intra-rater and inter-rater reliabilities were assessed using weighted kappa statistics. One-way analysis of variance test was performed to determine if there were any statistically significant differences in GOSLON ratings among the centers. Significance levels were set at P < .05. Results: The inter-rater and intra-rater reliability values of GOSLON ratings were 0.882 and 0.836. The GOSLON ratings across ten different centers range from 3.1 to 3.9. The center with the best score, that is, Center G, with 37.5% of its patients with a GOSLON 4 and 5 combined, whereas Center A with the worst score, that is, 57.5% of its patients with a GOSLON 5. Conclusions: The outcomes vary from fair to poor GOSLON scores among Indiacran centers. Continued efforts to share best practices and improve standardization across centers may enhance the quality of care and decrease the burden of care for patients with cleft lip and palate and their parents.

Abstract Background: Contralateral retrograde femoral (crossover) approach is the preferred modality for revascularization of iliac, femoral, popliteal, and tibial vessel in patients with chronic limb-threatening ischemia (CLTI). This approach, however, can be demanding in patients with tortuous iliac arteries, distal aortic calcification, and scarred contralateral groin. Flip techniques have been successfully deployed as an alternative to crossover approach to deal with concomitant iliac artery and infrainguinal lesions. Nevertheless, flip techniques have also been associated with complications such as loss of access and dissection at access site. We describe a unique “crisscross” technique which involves concurrent use of retrograde and antegrade sheaths through femoral access for the treatment of ipsilateral iliac and infrainguinal lesions with focus on procedural outcomes and complications. Materials and Methods: This is a case series of 22 patients who underwent percutaneous “crisscross” access for recanalization of lower limb lesions between January 2020 and April 2024. Outcomes were measured included technical and hemodynamic success, and access related complications such as hematoma, bleeding, and pseudoaneurysm formation. Results: Of the 22 cases, retrograde common femoral artery access using 7 Fr sheath was obtained in 15 (68.2%) patients for recanalization of iliac lesion (2 patients had conversion from diagnostic 5 Fr to therapeutic 7 Fr sheath). In the remaining 7 (31.8%) patients, 5 Fr retrograde sheath was utilized for diagnostic iliac artery digital subtraction angiogram due to inconclusive preoperative clinical and radiological findings. All 22 (100%) patients underwent successful infrainguinal revascularization using 6 Fr antegrade sheath across the proximal superficial femoral artery. Technical and hemodynamic success was achieved in all 22 patients. Only 2 (9.1%) patients developed mild hematoma at the access site with no major access related complications. Conclusion: “Crisscross” technique can be considered a safe and effective approach for revascularization of ipsilateral concomitant iliac artery and infrainguinal lesions in patients with CLTI.

Preterm neonates are at high risk of hypothermia, which can lead to adverse health outcomes. This study aimed to compare the effects of immersion bath followed by Kangaroo Mother Care (KMC) versus sponge bath followed by KMC on the thermal stability of preterm neonates. A prospective interventional study was conducted on 76 preterm neonates, with 38 neonates in each group (immersion bath and sponge bath). Axillary temperature was measured before the bath and at various time intervals after the bath (immediately, 15, 30, 45, and 60 minutes). The mean axillary temperature was significantly higher in the immersion bath group compared to the sponge bath group immediately after the bath (97.6°F vs. 96.3°F, p<0.001), at 15 minutes (97.6°F vs. 96.8°F, p<0.001), 30 minutes (97.9°F vs. 97.3°F, p=0.001), and 45 minutes (98.1°F vs. 97.7°F, p=0.002) post-bath. However, the difference was not statistically significant at 60 minutes post-bath (98.2°F vs. 98.0°F, p=0.091). Immersion bathing followed by KMC is more effective than sponge bathing followed by KMC in maintaining thermal stability in preterm neonates. Healthcare providers should consider adopting this approach as the preferred bathing method for preterm neonates to promote better health outcomes.

Background:Majority of the Sarcoid series are from Pulmonology centers rather than Rheumatology centers. The ACCESS study quoted commonly in review articles and text books has been described from Pulmonology centers. This multicentric study was undertaken to enumerate the clinical, radiological and pathological aspects of patients of Sarcoidosis presenting to the Rheumatology OPDObjectives:To describe the Clinical, Radiological and pathological manifestations of Sarcoidosis presenting to the Rheumatology OPDMethods:It is a Retro-prospective cross sectional descriptive study of Sarcoidosis from 17 centers in Karnataka, South India. The diagnosis of Sarcoidosis was confirmed either by Clinico – serological, Clinico – radiological or Clinico – pathological co-relation. Descriptive data was collected regarding diagnosis, clinical presentation, organ involvement, radiological findings, serological investigations and histopathologyResults:Data of 360 patients from 17 centers across Karnataka, South India were collected over a period of 24 months. The study (Table 1) had 236 female patients, with mean age at presentation being 48.99 (7-92) years and mean duration of symptoms being 33. 89(0.25 - 432) months. 58 patients had single organ involvement and 302 patients had systemic disease. Arthritis/ arthralgia was seen in 162(45%) patients (oligoarticular-41 and polyarticular-38), Respiratory symptoms were seen in 114 (31.7%) patients, Ophthalmic symptoms in 120(33.3%) patients, 121(33.6%) patients had Dermatological manifestations and 39 (10.8%) patients presented with neurological manifestations. Cardiac sarcoid was identified in 17(4.7%) patients (Tachyarrhythmia-10 & bradyarrhythmia-7). Peripheral lymphadenopathy was the presenting feature in 62(17.2%) patients. Renal manifestations included Nephrolithiasis (4), Nephrocalcinosis(5), renal insufficiency (15) and interstitial nephritis (4). Syndromic presentations as Lofgren’s (18) and Heerfordt’s (4) were observed. Chest radiograph was abnormal in 158 patients. 221 patients with Chest CT had lymphadenopathy and 199 parenchymal involvement. Histopathological diagnosis (Graph 1) was available in 170 (47.2%) cases out of which 147 cases (86.5%) had systemic manifestations. Lymph node (84), skin (38), glandular (11), and Liver (8) were commonly biopsied organs. 46 cases (24.2%) of single organ involvement had radiological/ serological findings. S. ACE levels was elevated in 216 (67.9%) patients (n = 318), in which 14.8% (32) had single organ involvement. Mantoux was negative in 143 patients and Quantiferon gold was negative in 88 patients. 42 patients had received Antitubercular therapy before presenting to the Rheumatologist in whom investigations for tuberculosis were negativeConclusion:Our study had numerically higher percentage of patients with single organ involvement as compared to other studies and differs in specific organ manifestations. Rheumatology centered evaluation may have attributed to this variation. Majority of the patients with single organ involvement required Histopathology and/or S. ACE levels for diagnosis.Limitations: Investigation data was not completely retrievable. Clinical data was available in all the cases.Table 1.DemographyMean age at diagnosis (years)48.99 (7-92)Mean duration of symptoms (months)33.89 (0.25 – 432)M: F ratio1:1.9Histopathological confirmed170 (47.2%)Clinic-radiological diagnosis190 (52.8%)Single organ involvement58(16.1 %)Systemic disease302 (83.9%)Arthritis/ Arthralgias162 (45%)Dermatological manifestations121 (33.6%)Ophthalmological symptoms120 (33.3%)Respiratory symptoms114 (31.7%)Peripheral Lymphadenopathy62 (17.2%)Neurological symptoms39 (10.8%)Cardiac sarcoid17(04.7%)Elevated S. ACE levels216 (n=318, 67.9 %)Abnormal chest radiograph158CT chest – Lymph node enlargement Parenchymal involvement221199Organ Biopsied Lymph node Skin Glandular Liver8438118N = 360Graph 1.Sarcoidosis Diagnosis & PresentationREFERENCES:NIL.Acknowledgements:NIL.Disclosure of Interests:None declared.

Abstract Gastroduodenal artery (GDA) aneurysms are rare forms of splanchnic artery aneurysms with varied etiopathogenesis. Mostly found incidentally, early identification with advanced imaging tools and timely intervention of these aneurysms are essential due to the associated high risk of rupture, morbidity, and mortality with GDA aneurysms. We report a case of successfully treated GDA aneurysm using endovascular coil embolization.