Breach Candy Hospital

Excimer laser coronary atherectomy (ELCA) to modify or debulk atherosclerotic plaque during percutaneous coronary intervention (PCI) has been in clinical use for the past four decades. Primarily, ELCA was introduced to mitigate the challenges posed by routine PCI for complex lesions and in crossing resistant lesions. The aim of the present study was to evaluate the efficacy and safety of ELCA in complex coronary lesions. This study included 71 consecutive patients who underwent treatment with ELCA-assisted PCI for complex coronary lesions. The data were analysed for the incidence of procedural success and related complications with major adverse cardiovascular outcomes at baseline, post-procedure, 1-month and 6-month follow-up. The study included 71 real-world patients with highly complex lesion subsets, comprising uncrossable chronic total occlusions (CTOs; 26 [33.77%]), moderately to heavily calcified lesions (33 [42.86%]), long diffused in-stent restenosis (ISR) lesions (30 [38.96%]), and ST-segment elevation myocardial infarction with a large thrombus burden (27 [35.06%]). The study population was predominantly male (87.32%), including 71 individuals with a mean age of 63.51±13.57 years. The mean left ventricular ejection fraction (LVEF) was 45.1±11.6%; however, 15 patients (21.13%) had an LVEF of <30%. A total of 31 (43.66%) patients had a SYNTAX score of >22. The direct use of maximum energy as a default setting was used in 52 patients (85.3%) and was not associated with any procedural or patient complications. No major adverse cardiac events (MACE) were reported during hospitalisation. The cumulative procedural success rate was 100%, and the device success rate was 96.10%. The 6-month incidence of MACE was significantly low at 2 (2.82%) and was attributed to target vessel revascularisations only. In this study, ELCA was observed to be an effective and safe device, making it a suitable alternative strategy for complex PCI in patients with difficult-to-cross lesions such as CTO, ISR, heavily thrombotic lesions, and calcified lesions. In difficult-to-cross lesions, even when the ELCA device failed to advance across, the delivered ELCA energy modified the lesion sufficiently to render it crossable. There were no safety concerns despite the direct use of maximum energy as a default strategy in this study population.

Introduction:Posterolateral corner (PLC) injuries are often associated with cruciate ligament tears. Historically known as the “dark side” of the knee, advancements have greatly improved our understanding of the PLC, offering various management options today.Case Report:We present the case of a 44-year-old male with a combined PLC and posterior cruciate ligament (PCL) Grade 2 injury. He was managed with an isolated PLC reconstruction using an open anatomical Arciero-based technique with a tibialis anterior allograft. At subsequent follow-ups, the patient was shown to have excellent knee functional outcomes, no instability, and ease of performing regular activities, including low to moderate-demand sporting activities.Conclusion:Effective management of combined PLC and PCL injuries necessitates early identification of the PLC injury and a case-specific management approach, considering factors such as the patient’s condition, surgeon expertise, and graft availability. Allografts are a viable alternative to autografts for PLC reconstruction, offering several advantages over the latter.

Knowledge of local antibiotic susceptibility rates is essential to strengthen antimicrobial stewardship programs. DASH to Protect Antibiotics (https://dashuti.com/), promotes the dissemination of focused local antibiograms in community urinary tract infection (UTI). This study mapped the susceptibility profile of Klebsiella pneumoniae from 18 Indian centers. The centers spanned nine Indian States and three Union Territories. Urinary K. pneumoniae antibiograms from the outpatient clinic were collated and analyzed. Standardization was achieved through online training. For epidemiological purposes, five centers tested fosfomycin. Overall, low susceptibility (<60%) was observed for the standard oral antibiotics prescribed for cystitis: co-trimoxazole, 54% (36-68%); ciprofloxacin, 52% (29-55%); amoxicillin-clavulanic acid, 46%, (35-82%); nitrofurantoin, 39% (19-78%); and cefuroxime, 30% (15-62%). The rates for third- and fourth-generation cephalosporins were 49% (45-52%) and 60% (36-76%), respectively. Extended-spectrum beta-lactamases ranged from 36-61% in India. Piperacillin-tazobactam 74% (65-87%), amikacin 76% (45-91%), and meropenem 81% (61-87%) exhibited higher activity. Fosfomycin was the most active antimicrobial, with 89% (92-97%) susceptibility. K. pneumoniae susceptibility was directly linked to geographic region, log gross domestic product (P <0.001), and humidity, and low and high temperatures (P <0.05). Oral treatment options for K. pneumoniae cystitis are rapidly decreasing. Northern and southern India showed significant differences in antimicrobial susceptibility, highlighting the importance of local antibiograms for promoting antimicrobial stewardship. For uncomplicated cystitis, co-trimoxazole (54%) may be the empirical choice. Good susceptibility to fosfomycin was observed (89%). The empirical use of fluoroquinolones, cephalosporins, and amoxicillin-clavulanic acid has been discouraged. Piperacillin-tazobactam and aminoglycosides are carbapenem-sparing agents.

Introduction: The aim of this study is to study the additional effect of 1000 mg of ferric carboxymaltose (FCM) on hemoglobin (Hb) recovery post total knee arthroplasty (TKA) as compared to 500 mg of FCM. Methods: We prospectively recruited 168 unilateral primary TKA who received 1000 mg of FCM on the first postoperative day in the study group. Our control group consisted of 157 TKA from our previous study receiving 500 mg of FCM. We compared the Hb levels preoperatively (Preop-Hb), on the third postoperative day (day 3-Hb), and at 5(+1) weeks postoperatively (week 5-Hb). We also compared the number of Hb responders (rise in Hb ≥2 g/dl from day 3-Hb to week 5-Hb) in each group. We used Student’s t-test and Fisher’s exact probability test for statistical analysis. Results: The rise in Hb from day 3-Hb to week 5-Hb was higher (P &lt; 0.001) in the study group, whereas the difference in preoperative Hb and week 5-Hb was lower (P &lt; 0.001) in the study group. There was a higher number of Hb responders in the study group (61.31%) as compared to the control group (33.76%). (P &lt; 0.001); no major complications were recorded in either group. Conclusion: 1000 mg of intravenous (IV) FCM administered on the first postoperative day post-TKA further hastens the Hb recovery as compared to 500 mg of FCM. More than twice the number of patients are able to achieve preoperative Hb values by 5 weeks post-TKA, with more than 60% patients showing ≥2 g/dl rise in Hb from the immediate postoperative status. Routine administration of 1000 mg of IV FCM in all patients undergoing primary unilateral TKA can further hasten the Hb recovery.

From a radiological point of view, the statement of irreversibility can only be made with certainty for the signs of irregular reticulation in conjunction with traction bronchiectasis and for honeycomb cysts in the HR-CT morphologically fibrotic phenotype. The HR-CT signs of the inflammatory phenotype can behave differently. Ground-glass nodules always have a reversible potential. In contrast, the underlying pathology of ground-glass opacity can only be assessed over time, as it does not necessarily correlate with inflammation but can also correspond to fine fibrosis. Similarly, air trapping on HR-CT is an important sign of hypersensitivity pneumonitis in both the radiologically inflammatory and fibrotic form. The persistence of air trapping in the inflammatory type over years suggests the possibility of irreversibility of the bronchiolitis in these cases. Whether a higher resolution in HR-CT, such as through photon-counting CT, can lead to clearer differentiation and prediction of reversibility and irreversibility in the future remains to be seen.

Background Augmentation rhinoplasty requires graft with substantial volume. In cases where patient is reluctant to use costal cartilage, this can be done using septum and conchal cartilage graft. Using the technique of "stacked cartilage graft" an assembly is made using septum and conchal cartilage for nasal augmentation and contour defects. Although multilayered grafts have been described before, we propose an elaborate and effective method named after our city, Mumbai, to shape these grafts and highlight economical use of conchal and septal cartilage to overcome its limited volume. It also describes its clinical and aesthetic outcome of this technique in Indian patients. Materials and Methods A retrospective study from 2005 to 2020 was done in our institute. Data was collected from medical and hospital records. Preoperative and postoperative photographs were obtained for preoperative planning and outcome analysis. Rhinoplasty Outcome Evaluation score was used for outcome analysis. Minimum follow-up was 1 year in our study. Results A total of 210 patients were included in our study. In all cases, the stacked cartilage graft technique produced a natural appearing dorsum. Complications of cartilage such as resorption, extrusion, and warping were minimum. All the patients were satisfied with their results. Conclusion Although the limited volume of conchal cartilage is criticized, in reality it can be used effectively for larger requirement with "economy of use" using our technique. The curvatures and convolutions of conchal cartilage can be effectively neutralized by using this technique to obtain a smooth surface. However, this technique requires incorporation of every bit of cartilage and meticulous stacking of the pieces to get the desired shape. Thus, the stacked cartilage grafts have excellent versatility and produce natural and long-lasting results and minimal complications.

Background Aim. To compare the efficacy of omeprazole to other proton-pump inhibitors (PPIs) or placebo for the treatment of acid peptic disorders (APDs) using a comprehensive literature search including hard-to-access journals and non-English articles. Methods. PubMed, Google Scholar, and China National Knowledge Infrastructure were searched (from inception to March 2023) for trials comparing omeprazole to other types of PPIs or placebo for the treatment APD. Efficacy was analyzed separately for erosive diseases and nonerosive diseases. Primary outcomes included improvement of APD symptoms and frequency of ulcer or erosion healing. Secondary outcomes included adverse events, cost effectiveness, nocturnal acid breakthrough, and length of stay if hospitalized. Random and fixed-effects models were used to determine estimates of efficacy. Results. Thirty-one eligible trials (N = 10,539 participants) were analyzed, including 12 articles not typically included in previous reviews due to translation or journal access issues. Omeprazole significantly improved heartburn compared to placebo (RR = 2.47, 95% CI: 2.13 and 2.86, and p&lt;0.001) and was equivalent to the other five types of PPI. Omeprazole had significantly fewer patients reporting adverse events versus placebo (11% versus 31%, respectively) and other PPIs. Omeprazole was the most cost-effective PPI compared to the other types of PPIs in India. Conclusions. Omeprazole continues to be an effective proton-pump inhibitor to treat patients with acid peptic disorders and was well tolerated. Omeprazole was significantly better than placebo and was equivalent with other PPIs for curing heartburn and was equivalent to other PPIs for the healing of ulcers or erosions in addition to being the most cost-effective.