Dr. Ram Manohar Lohia Hospital

BackgroundStroke is a major cause of death and disability in India. Many stroke patients seek care at government medical colleges but studies have not comprehensively assessed the quality of acute stroke care. This study aims to evaluate key indicators for optimal stroke care in the pre- implementation phase of implementation of an evaluation and treatment package for uniform stroke care (IMPETUS) study across 23 medical colleges in India.MethodsIMPETUS stroke is a multicentric, prospective, multiphase, mixed-methods, quasi-experimental implementation study, comprising three phases. During its pre-implementation phase, baseline assessment of stroke care was performed using pre-structured case report form, among prospectively enrolled acute stroke patients.ResultsA total of 2,018 patients were enrolled during the pre-implementation phase. The mean (SD) age was 59.08 (14.4) years, with male preponderance (64.2%); 69.06% had an onset <24 h, majority had ischemic stroke (60.1%), followed by intracerebral hemorrhage (38.4%). Key risk factors were hypertension, diabetes, smoking, alcohol and previous stroke. Imaging performed included non-contrast computed tomography (NCCT) (69.6%), computed tomography angiography (CTA) (25.6%) and magnetic resonance angiography (MRA) (24.6%). Intravenous thrombolysis (IVT) was administered in 39.2% eligible patients, predominantly with tissue plasminogen activator (tPA) (72%). In-hospital delay was the most common reason for not receiving thrombolysis (44.8%). The median door-to-CT, CT-to-needle and door-to-needle time were 95, 36.5 and 67 min, respectively. Other important stroke care indices were also evaluated. In-hospital mortality was 19.4 and 33.1% patients achieved modified rankin scale (mRS) score 0–2 at 90-days.ConclusionThis comprehensive data provides a representative baseline status of acute stroke care in select medical colleges across India, which will be useful in comparing advancements during the implementation phase and improve policy making.

Soft-tissue sarcomas constitute rare malignant tumours of the head and neck region. Leiomyosarcoma presents with varied clinical presentations and is usually misdiagnosed as carcinomas. Hence, their definite diagnosis is on histopathology along with immunohistochemical analysis. We have reported a case of a 57-year-old man with a tumour of the lower lip for the past 1 year. He underwent a wide local excision and Estlander flap lip reconstruction. A histological and immunohistochemical study showed the presence of dermal leiomyosarcoma. The origin of primary dermal cutaneous leiomyosarcoma can be the piloerector muscle, the smooth muscle of the sweat glands or the dartos muscle. The hypodermal form derives from the smooth muscle of the wall of cutaneous arterioles and venules. Primary cutaneous leiomyosarcoma is preferentially located on the extensor surfaces of the lower limbs and rarely affects the oral cavity.

Abstract Background: Hormonal relationship especially effect of long-term vitamin D supplementation to sarcopenic patients is understudied. This study investigatedassociated risk factors and correlation of different hormones with sarcopenia. Further, effects of six-month cholecalciferol supplementation and quality of life were also studied. Methodology: CKD5 patients aged 18–60 years were screened for sarcopenia using handgrip strength and bioimpedance-based muscle mass. Sarcopenia was classified as probable, confirmed, and severe categories. Confirmed sarcopenic cases were supplemented with 60,000 IU weekly cholecalciferol for 12 weeks in vitamin D deficit and fortnightly for 6 weeks in sufficient patients. Comprehensive nine hormonal profile and risk factor assessment in all sarcopenic patients were done. All were subjected for QoL by KDQOL-36 SF at baseline and 6 months. Changes in Sarcopenia, physical and mental domains of QoL (PCS and MCS) were studied at baseline and 6th month. Results: Of 401 patients, sarcopenia prevalence as probable, confirmed and severe were 333 (82.29%), 134(33.4%) and 124(25.44%) respectively with higher prevalence in dialysis patients.Vitamin D supplementation showed improvement in confirmed and severe sarcopenia at 3rd month (13.1 %.and 41.1%) and 6th month (23/3% and 66.9%) respectively (p = 0.001). Vitamin D levels deficiency significantly reduced from 80.6% at baseline to 45.5% after supplementation.At six months among non-responder sarcopenic patients exhibited greaterbaseline hormonal abnormalities like high insulin resistance, hyperprolactinemia, lower T3 levels, whereas responder had better baseline muscle strength/mass and higher vitamin D levels. Among non-responder who were still vitamin D deficient showed positive correlation of vitamin D deficiency with IGF-1, testosterone deficiency and negative correlation with insulin resistance was seen. Overall, IGF-1deficiency, insulin resistance,subclinical hypothyroidism, hypogonadism, hyperprolactinemia, were highly prevalent in sarcopenic patients. KDQOL-36 scores improved significantly in mean PCS(p=0.004) and MCS (p = 0.003) after vitamin D supplementation. Diabetes and vitamin D deficiency were determined as risk factor of sarcopenia. Conclusion: Diabetes and vitamin D deficiency are risk factor for sarcopenic CKD5 patients. Six months vitamin D supplementation improved sarcopenia and quality of life in them. Non responsive sarcopenic patients had hormonal imbalances which remain uncorrected or may have blunted therapeutic effects of vitamin D. Trial registration: CTRI/2025/08/092512 –dated 6th august 2025 (retrospectively registered)

Tubercular longitudinally extensive transverse myelitis- A case report - SAJCRR- Print ISSN No: - Online ISSN No:- 2319-1090 Article DOI No:- 10.18231/j.sajcrr.2025.001, Southeast Asian Journal of Case Report and Review-South Asian J Case Rep Rev

Endobronchial ultrasound-guided transbronchial needle aspiration (EBUS-TBNA) plays an important diagnostic role in concealed pulmonary diseases. However, diagnosing sarcoidosis and differentiating it from tuberculosis is a diagnostic quandary. We, thus, aimed to evaluate EBUS-TBNA cytology in these cases in a tubercular-endemic zone. A prospective 5-year study was done in a tertiary care center on 118 patients with tuberculosis versus sarcoidosis with mediastinal lymphadenopathy who underwent EBUS-TBNA. All samples obtained were sent for cytomorphological and microbiological evaluation. On cytology analysis, demonstration of acid-fast bacilli was considered diagnostic of tuberculosis. However, in its absence, a multidisciplinary diagnostic (MDD) approach was followed to establish a diagnosis. EBUS-TBNA cytology contributed in reaching the final diagnosis in 88.1% cases. Of the 55 cases of tuberculosis, cytomorphological features were contributory in 90.9% cases. Out of 29 cases of sarcoidosis, 24 showed granulomas. Microbiological tests were contributory in the final diagnosis of tuberculosis in only 21.8% cases as compared to 90.9% by cytology analysis. In 10 cases, a definitive diagnosis could not be made on cytology analysis and were finally diagnosed on the basis of MDD. A definitive distinction between tuberculosis and sarcoidosis could not be made despite MDD in four cases. While a diagnosis of tuberculosis can be made independently on cytological features, MDD with contributory cytological findings is essential for the diagnosis of sarcoidosis. EBUS-TBNA cytology, thus, plays an important role in the multidisciplinary strategy of approaching thoracic lesions.

Sir, The recent issue of the journal features an interesting original research article by Meena et al. where they conduct a randomized placebo-controlled clinical trial to study the effect of clonidine premedication on the perioperative hemodynamic and analgesic profile of the patients undergoing laparoscopic cholecystectomy (LC).[1] Sincerely acknowledging the authors’ efforts, it becomes imperative to concurrently draw the attention of the readership to certain unaddressed areas in this research, which mandate deliberation for a better understanding of the subject. Amidst the index double-blinded randomized study involving a 100 µg oral clonidine premedication dose in the investigative frame, it is highlighted that the sample size for the research endeavor was premised on the hemodynamic values emanating from an LC setting involving an oral dose of 150 µg clonidine, as outlined by Singh and Arora in the parent study.[1,2] Meanwhile the authors go on to attribute the lower sedation scores in their study to the reduced dose of clonidine, it was intriguing to witness a much higher duration of analgesia in their study (256.60 ± 34.97 min) when compared to the former study (185 ± 34.4 min).[1,2] Herein, it ought to be said that a more lucid definition of the duration of analgesia, would have assisted an improved comprehension, which in our discretion, conveys the time to the first rescue analgesic requirement[1] Even in the context of multimodal analgesia, one misses the account on the use of routine drugs such as paracetamol in the present study, which notably happens to be projected under GRADE A recommendation in the 2018 PROSPECT (Procedure-specific postoperative pain management) review update on the evidence-based pain management following LC.[1,3] Barazanchi et al. additionally recommend port-site local anesthetic infiltration as one of the components of analgesia for LC.[3] Humbly seeking clarification on the analgesic regimen employed in the control group, the ethical concerns that may arise out of not managing postoperative pain effectively across the study participants, purely for investigative purposes, can be extremely difficult to overlook[4] Given the simultaneous authors’ limitation of not having presented the intraoperative anesthetic requirement, especially in the backdrop of the lack of depth of anesthesia monitoring, it remains to be discerned as to how the hemodynamic fluctuations were actually managed by the blinded physician in the study by Meena et al.[1] Even in the general sense of the matter, the reduced anesthetic requirement is by itself a useful attribute of clonidine premedication[5] Lastly, the real-world value of any perioperative analgesia research continues to be limited in the absence of patient-centric outcomes or the outcomes aligned with the larger principles of enhanced recovery after surgery such as the patient satisfaction and quality of recovery or for that matter, the time to the postoperative resumption of feeding, restoration of the bowel function, and the length of hospital stay. Needless to say, perioperative analgesia can be peculiarly multifaceted, not only mandating a holistic research approach but an equally careful interpretation of the study results.[1,4] Financial support and sponsorship Nil. Conflicts of interest There are no conflicts of interest.

Recent clinical trials on slowing dementia progression have led to renewed focus on finding safer, more effective treatments. One approach to identify plausible candidates is to assess whether existing medications for other conditions may affect dementia risk. We conducted a systematic review to identify studies adopting a data-driven approach to investigate the association between a wide range of prescribed medications and dementia risk. We included 14 studies using administrative or medical records data for more than 130 million individuals and 1 million dementia cases. Despite inconsistencies in identifying specific drugs that may modify Alzheimer's or dementia risk, some themes emerged for drug classes with biological plausibility. Antimicrobials, vaccinations, and anti-inflammatories were associated with reduced risk, while diabetes drugs, vitamins and supplements, and antipsychotics were associated with increased risk. We found conflicting evidence for antihypertensives and antidepressants. Drug repurposing for use in dementia is an urgent priority. Our findings offer a basis for prioritizing candidates and exploring underlying mechanisms. ·We present a systematic review of studies reporting association between drugs prescribed for other conditions and risk of dementia including 139 million people and 1 million cases of dementia.·Our work supports some previously reported associations, for example, showing decreased risk of dementia with drugs to treat inflammatory disease and increased risk with antipsychotic treatment.·Antimicrobial treatment was perhaps more surprisingly associated with decreased risk, supportive of recent increased interest in this potential therapeutic avenue.·Our work should help prioritize drugs for entry into adaptive platform trials in Alzheimer's disease and will serve as a useful resource for those investigating drugs or classes of drugs and risk of dementia.

BackgroundBell palsy is a sudden facial nerve paralysis that affects many individuals annually. It significantly impacts patients and their families, leading to a reduced quality of life if left untreated. The International Classification of Functioning, Disability, and Health (ICF) framework focuses on outcome measures, functional limitations, and overall quality of life of the patients. Early diagnosis is crucial for effective management of the condition. In order to standardize clinical practice and contribute to recommendations of certain interventions, this paper focuses on the optimal dosage of physiotherapy intervention for Bell palsy patients, which includes exercise therapy and electrotherapy.Case presentationAn Indian 33-year-old male visited our physiotherapy department 15 days after being diagnosed with right-sided Bell palsy with unknown aetiology. His chief complaints were right-eye dryness, facial pain, drooping of the face, and difficulty performing facial activities. The outcome measures are the strength duration curve (SD curve), House-Brackmann grading, manual muscle testing, and visual analogue scale (VAS) scale. The physiotherapy intervention includes two primary components: electrotherapy and exercise therapy.ConclusionThe Kabat rehabilitation technique, along with nerve stimulation and an active exercise regimen, is significantly effective in treating Bell palsy, and the outcome measures show significant improvement with optimal therapy dosage.