Getwell Hospital and Research Institute

BackgroundChronic obstructive pulmonary disease (COPD) is a significant public health concern, and inhalation therapy is a critical component of its management. However, using an inhaler is challenging, especially for patients with COPD, who are often elderly and experience reduced dexterity, visual and cognitive impairment, and difficulty synchronizing inhalation with dose actuation. Synchrobreathe® is an easy-to-use, breath-actuated inhaler that releases medication during inhalation, addressing these challenges. Although its use in asthma is well documented, evidence in COPD is limited.MethodsThis prospective, multicenter, observational study carried out during August 2021 and August 2022 evaluated the clinical outcomes of the budesonide/formoterol combination (BUD/FORM) delivered through Synchrobreathe® in patients with COPD in India. The primary endpoint was disease control, that is, change from baseline in COPD Assessment Test (CAT) score at 12 weeks. Secondary endpoints included changes in CAT and modified Borg Dyspnea Scale (mBDS) scores and device usability. Adverse events were monitored over 12 weeks.ResultsIn the study population (N = 250), significant reductions from baseline were observed in mean CAT (−6.56 ± 0.33; p < 0.001) and mBDS (−1.60 ± 0.09; p < 0.0001) scores at 12 weeks. Almost all (98%) patients were satisfied with Synchrobreathe® and preferred it over their previous inhalers. No significant adverse events were reported.ConclusionBUD/FORM delivered through Synchrobreathe® significantly improved CAT and mBDS scores, with no reported serious adverse events in patients with COPD. Its simple usage makes it an effective option for this patient population.Supplementary InformationThe online version contains supplementary material available at 10.1007/s40801-025-00522-w.

The anterior cruciate ligament (ACL) plays an important role in stabilising the knee joint. ACL injuries can lead to substantial functional limitations, necessitating surgical intervention for most patients experiencing knee instability and pain. To assess the clinical and functional outcomes of anatomical arthroscopic ACL reconstruction using a hamstring graft with an adjustable loop and graft retensioning technique. The present prospective clinical study was carried out on patients, with ACL tears confirmed clinically or radiologically. Following the anatomical arthroscopic ACL reconstruction using a hamstring graft with an adjustable loop and graft retensioning technique, a radiograph was obtained to confirm graft placement. Patients then underwent physiotherapy of the affected knee to restore range of motion, strength, and proprioception. Regular follow-ups were conducted at 1, 3, and 6 months postoperatively, with specific evaluations focussing on active knee flexion of the operated knee. In our study, a total of 30 patients were included with the mean age of 36.60 ± 7.58 years. Postoperatively, 43.3% of patients achieved excellent functional outcomes, while 56.7% achieved good outcomes. The Lysholm knee score showed significant improvement from preoperative to postoperative levels (P < 0.05). The range of motion measurements at each follow-up (1, 3, and 6 months) demonstrated significant improvement compared to baseline values (P < 0.05). Our study showed that patients who underwent anatomical arthroscopic ACL reconstruction using a hamstring graft achieved good to excellent clinical and functional outcomes. This was accomplished using an adjustable loop fixation technique combined with graft retensioning.

Objective Existing mepolizumab trials have excluded patients with severe asthma with an eosinophilic phenotype (SAEP) from India. This study (NCT04276233) investigated the safety and effectiveness of mepolizumab in Indian adults with SAEP. Methods Multi-center, open-label, single-arm, interventional study; patients received 100 mg mepolizumab subcutaneously every four weeks for 24 weeks. Primary endpoint: incidence of adverse events (AEs), serious AEs (SAEs), and AEs of special interest (AESIs). Secondary endpoints: clinically significant exacerbation (CSEs) frequency (including exacerbations requiring hospitalization); change from baseline to Week 24 in forced expiratory volume/second (FEV1), peak expiratory flow (PEF), and Asthma Control Questionnaire (ACQ-5) scores. Results Overall, 100 patients received ≥1 mepolizumab dose. Baseline characteristics: female, 51.0%; mean (standard deviation [SD]) age, 44.8 (12.0) years; mean (SD) body mass index, 24.4 (4.7) kg/m2. On-treatment AEs and SAEs were reported by 18.0% and 3.0% of patients, respectively; regarding AESIs, 5.0% reported infection and 2.0% reported systemic reaction. One fatal event occurred (unrelated to mepolizumab). CSEs were reported by 8.0% of patients; 2.0% had an exacerbation requiring hospitalization. Least squares (LS) mean change (95% confidence interval) in pre- and post-bronchodilator FEV1 and PEF by Week 24 was 0.081 L (–0.05, 0.21; p = 0.231), 0.055 L (–0.06, 0.17; p = 0.325), and 13.67 L/min (3.08, 24.25; p = 0.012), respectively. By Week 24, ACQ-5 scores had significantly improved (LS mean change [standard error]: −0.69 [0.121]; p < 0.001). Conclusions Mepolizumab was well tolerated in Indian adults with SAEP and improved asthma control and health-related quality of life.

The COVID-19-patient health tracking system is a risk factormajor public health challenge for COVID-19 patients, and it has inherited an ample supply of mindfuless recently from the medical community because of the ageing population and an increase in chronic illnesses. It is challenging for traditional wireless communication technology to fully meet the real-time requirements for wearable medical devices. Current monitoring framework cannot handle the massive amount of synchronous cardiovascular data due to the lack of effective streaming data processing mechanisms. The suggested paper uses Internet of Things (IoT) technology to obtain patient medical data both locally and remotely. The patient's temperature sensor and pulse sensor send data to a cloud server, which analyses it with the unification of Hybrid deep-learning model combining a convolutional neural network (CNN) and long short-term memory (LSTM) is utilized and manages it for later analysis. According to the experimental findings, the accuracy of our proposed system was 99.4, sensitivity 99.3%, specificity 99.2% and F1-score is 98.9% respectively.

Achilles tendon lesions often necessitate flap surgery for wound closure, particularly when the paratenon is absent, as skin grafts fail without a vascular bed. While fasciocutaneous flaps offer functional benefits, they are complex and aesthetically unappealing. This study explores a simpler method combining Matriderm, Vacuum-Assisted Closure (VAC) therapy, and skin grafting to enhance healing, reduce scarring, and improve outcomes for exposed Achilles tendons.The study aims to optimize wound healing, minimize complications, and facilitate functional recovery of exposed Achilles tendons through a multi-step intervention involving Matriderm, VAC therapy, and skin grafting.An 87-year-old female with a gangrenous, infected wound over her left lower limb, including an exposed Achilles tendon, underwent debridement and antibiotic treatment. Due to her frail condition, a simpler method was chosen over traditional flap surgery.Intervention Steps: 1. Longitudinal Splitting: The Achilles tendon was split longitudinally to promote granulation tissue formation; 2. Matriderm Application: Matriderm, a bovine collagen matrix, provided a scaffold for cell ingrowth and neovascularization; 3. VAC Therapy: Subatmospheric pressure (-125 mmHg) was applied to remove excess fluid, reduce edema, and enhance blood flow, aiding granulation tissue formation; 4. Monitoring: Continuous monitoring ensured optimal granulation tissue development for successful skin grafting; 5. Second-Stage Skin Grafting: A thin skin graft was applied to the vascularized bed and stabilized with skin staplers; 6. Wound Closure and Rehabilitation: Post-grafting, the wound was dressed and monitored until complete healing, with follow-up evaluations.Preliminary results indicated successful wound closure, minimal complications, and optimized healing. At a one-year follow-up, the skin was pliable, elastic, free from scarring or contracture, and aesthetically appealing.We present a comprehensive very simple approach for wound cover healing of exposed bare Achilles tendon lacking paratenon by using MatriDerm with Vacuum-Assisted Closure (VAC) followed by a second-stage skin grafting procedure. The process involves sequential steps focusing on optimal wound healing, reduction of complications, and restoration of Achilles tendon functionality without the need of microsurgical skill or simple flap surgery with its own donor nonaesthetic morbidity.

Metastatic lesions in the proximal femur are well-known in the literature and are important since they can progress to pathological fractures and impair the patient's mobility. We present the case of a middle-aged female with a history of breast carcinoma 20 years ago, who experienced diffuse chronic hip pain for the past two months. Radiographs, MRI, and PET scans revealed a metastatic lesion in her proximal femur. After consulting with an oncologist, it was determined that adjuvant chemoradiotherapy was unnecessary. The treatment strategy was dependent on the preoperative general health condition, the life expectancy, amount of metastasis, bone quality, pathological fractures and factors affecting the union and capacity to ambulate the patient postoperatively. The patient underwent a cemented bipolar hemiarthroplasty to excise all metastatic tissue and provide a painless, functional, and mobile joint. Bipolar hemiarthroplasties articulate at two levels, and this dual-bearing design is believed to reduce acetabular wear. The bipolar hemiarthroplasty also eliminated the risk of complications associated with the acetabular component, which would necessitate early revision surgery. Modular bipolar hemiarthroplasty is a good modality of replacement associated with fewer complications and improves quality of life.

BackgroundDue to the progressive decline in β-cell function, it is often necessary to utilize multiple agents with complementary mechanisms of action to address various facets and achieve glycemic control. Thus, this study aimed to evaluate the efficacy and safety of a fixed-dose combination (FDC) of metformin/sitagliptin/pioglitazone (MSP) therapy vs. metformin/sitagliptin (MS) in type 2 diabetes mellitus (T2DM).MethodsIn this phase 3, multicenter, double-blind study, patients with T2DM who exhibited inadequate glycemic control with HbA1c of 8.0–11.0% while taking ≥1500 mg/day metformin for at least 6 weeks were randomized to receive either FDC of MSP (1000/100/15 mg) or MS (1000/100 mg) per day for 24 weeks. The primary outcome measure was the change in HbA1c, and secondary outcomes included changes in fasting plasma glucose (FPG), postprandial plasma glucose (PPG), and body weight from baseline to 24 weeks along with safety and tolerability.ResultsAmong the 236 patients randomized, 207 (87.71%) successfully completed the study. All baseline characteristics were comparable between the FDC of MSP and MS groups. There was a subsequent significant reduction of HbA1c in FDC of MSP (− 1.64) vs. MS (− 1.32); between groups was [− 0.32% (95% CI, − 0.59, − 0.05)], P = 0.0208. Similar reductions were found in FPG [− 13.2 mg/dL (95% CI, − 22.86, − 3.71)], P = 0.0068, and PPG [− 20.83 mg/dL (95% CI, − 34.11, − 7.55)], P = 0.0023. There were no significant changes in body weight. A total of 27 adverse effects (AEs) and one severe AE were reported, none of which were related to the study drug.ConclusionThe FDC of MSP demonstrated significant efficacy in managing glycemic indices and could serve as a valuable tool for physicians in the management of Indian patients with T2DM.Trial registrationClinical Trials Registry of India, CTRI/2021/10/037461.