Deenanath Mangeshkar Hospital and Research Center

Background and Aims:Emergency laparotomy is associated with substantial morbidity and mortality. This study assessed the impact of the structured intraoperative component of Singapore’s Emergency Laparotomy Audit (EMLA), inspired by the National Emergency Laparotomy Audit (NELA) conducted in the United Kingdom, in patients undergoing emergency laparotomy in an Asian context.Methods:This prospective, single-centre quality improvement study was conducted at a 700-bed tertiary hospital using iterative Plan–Do–Study–Act cycles. Adult patients (aged 18 years or older) who underwent emergency laparotomy between August 2020 and August 2024 were included (n = 586). The intraoperative bundle consisted of three components: consultant-delivered anaesthesia and surgical care, goal-directed haemodynamic therapy (GDHT) for high-risk patients (NELA score greater than 10), and maintenance of normothermia. Primary measures included consultant presence, GDHT adherence, and intraoperative normothermia. Secondary outcomes were complications, intensive care unit (ICU) admission, length of stay (LOS), and 30-day mortality.Results:The presence of a consultant anaesthesiologist increased from 89.6% to 98.8% (P < 0.0001). Adherence to GDHT remained high across all phases (94.6%, 88%, and 86.7%). Hypothermia persisted in 11–16% of cases and was independently associated with longer LOS and higher ICU admission rates. No significant change in 30-day mortality was observed.Conclusion:Implementation of the structured intraoperative EMLA bundle improved consultant coverage and maintained high adherence to GDHT. Consultant presence was associated with a 42% relative reduction in medical complications; however, causality cannot be established in this quality improvement project. Persistent hypothermia highlights the need for enhanced temperature management strategies.

Read about A Prospective Observational Study to Determine The Role of the immature platelet fraction in predicting severity of thrombocytopenia and occurrence of bleeding manifestation in patients of dengue infection.

Cytomegalovirus (CMV) reactivation poses a significant risk post-allogeneic hematopoietic stem cell transplantation (HSCT), particularly in high-risk settings. This report details the clinical course of a relapsed acute myeloid leukemia patient who underwent haploidentical HSCT following graft failure linked to CMV viremia. Letermovir prophylaxis effectively suppressed CMV but was discontinued on day +60, following which the patient experienced transient reactivation. The episode was successfully managed in the outpatient setting with oral valganciclovir. This case highlights the importance of sustained CMV prophylaxis and the role of accessible antiviral strategies in optimizing transplant outcomes.

This review explores how emerging technologies are reshaping musculoskeletal radiology. It examines recent advances where computer-based algorithms assist in interpreting complex imaging data, aiming to improve diagnostic accuracy and streamline clinical workflows. The discussion centres on practical applications, including automated lesion detection, fracture identification and the quantitative evaluation of degenerative conditions. Drawing on a range of clinical studies and technological evaluations, the review highlights the potential benefits of these tools while also addressing the challenges of data integrity, regulatory compliance and the need for comprehensive training among radiology professionals. The analysis emphasises that while many of these systems demonstrate significant promise in reducing human error and increasing efficiency, their integration into everyday practice must be approached with caution. Key hurdles include ensuring reliable data quality and balancing technological capabilities with established radiological methods. The review advocates for a measured adoption strategy that combines technological innovation with the expertise of seasoned radiologists. By assessing both the transformative potential and the inherent limitations of current AI applications, this article provides a balanced perspective on future directions in musculoskeletal imaging. The overall goal is to encourage further collaboration among clinicians, engineers and policymakers to foster innovations that enhance patient care without compromising safety or diagnostic standards.

Introduction:A spinoglenoid cyst is a ganglion cyst that compresses the suprascapular nerve in the spinoglenoid notch. On failure of the conservative treatment, surgical decompression is the treatment of choice. The arthroscopic method helps to decompress the cyst intra-articularly through the labral tear and also allows repair of the labral tear. This study aims to bring out the functional outcome of arthroscopic Spinoglenoid Cyst Decompression with labral repair.Materials and Methods:This study is a case series of eight symptomatic Spinoglenoid cysts with labral tears which were treated with arthroscopic cyst decompression and labral repair over 5 years from January 2018 to December 2023. The American Shoulder and Elbow Surgeon’s score (ASES), Constant Murley (CM) score, and Visual Analog Score (VAS) were used to assess the patients preoperatively and postoperatively at regular intervals.Results:All the patients had good to excellent results. There was a significant improvement in the ASES from a mean pre-operative 61.5 to a mean 1-year follow-up of 90.3, while the CM score improved from a mean pre-operative 66.8% to a mean 1-year follow-up of 93.4%. The VAS decreased from a mean pre-operative 6.3 to a mean 1-year follow-up of one.Conclusion:Spinoglenoid Cyst is usually seen in individuals and athletes who are involved in an overhead activity. Arthroscopic decompression of the cyst and labral repair is a simple and effective treatment and gives excellent functional outcomes.

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.

Typhoid fever, measles, and rubella continue to contribute significantly to childhood morbidity and mortality in India. In line with WHO recommendations for co-administration of Typhoid Conjugate Vaccine (TCV) and measles–rubella (MR) vaccine at 9 months of age, this phase IV, randomized, open-label, multicenter clinical trial was conducted to assess their immunological compatibility and safety when administered concomitantly. A total of 900 healthy Indian infants aged 9–10 months were randomized into three groups: Group A received TCV and MR vaccine concomitantly; Group B received MR on Day 0 and TCV on Day 28; Group C received TCV on Day 0 and MR on Day 28. Subjects were followed for 6 months after concomitant/last vaccination. Seroconversion rates (SC) in Groups A/B/C at Day 28 were 90.2%/75.3%/89.5% for anti-Vi; 80.4%/75.2%/77.7% for anti-measles, and 87.7%/84.0%/85.2% for anti-rubella antibodies. By study end, SC for anti-Vi was 87.1%/71.6%/83.0%, while SC for anti-measles and anti-rubella reached ~90% and ≥98%, respectively, across all groups. Geometric mean titers increased significantly for all antigens, with no evidence of immunological interference. Safety assessments showed adverse events in 23.9%/32.0%/32.7% participants in Group A/B/C. Most adverse events were mild, and only one serious adverse event was reported. These findings support the co-administration of TCV and MR vaccine as a safe and effective strategy.