Global Hospitals

Abstract Background High body mass index (BMI) presents a serious and ongoing global health challenge. However, the difficulty of high BMI intervention has not yet been systematically evaluated. Methods We developed a Generative Artificial Intelligence Meta-Evaluation (GAME) framework, which integrated 18 indicators from 4 dimensions, including “Macro-System Level”, “Socio-Cultural Level”, “Community-Family Level”, and “Individual Level” to evaluate the difficulty of high BMI intervention across 226 locations. The GAME framework applies 8 leading AI models to generate intervention difficulty scores (IDS) of each indicator on a scale from 1 to 5, with higher scores indicating greater difficulty. Meta-analysis was conducted to derive combined scores, evaluate the heterogeneity and sensitivity. Final intervention difficulty scores were calculated as the weighted sum of all 18 indicators. Additionally, SHapley Additive exPlanation (SHAP) values were used to evaluate the importance of each indicator in determining the intervention difficulty. Results The global difficulty of high BMI intervention shows significant imbalance. Norway (IDS = 1.48) exhibited the easiest intervention, while Yemen (IDS = 4.56) faced the greatest challenge. Regions such as Western Europe, Australasia, and High-income Asia Pacific showed lower intervention difficulty, reflecting there are mature public health frameworks, supportive social-cultural environments for healthy lifestyles, and high levels of health awareness. On the contrary, countries in North Africa and Middle East, South Asia, Oceania, and Sub-Saharan Africa faced higher intervention challenges, suggesting the need for long-term, collaborative efforts from multiple sectors. Among the 18 indicators, “Cognition and Awareness” has the most significant impact on intervention difficulty, with the SHAP value of 31.03, followed by “Family life and cognitive patterns” (18.08) and “Health Care System” (11.7). Furthermore, the IDS for high BMI was significantly correlated with Socio-Demographic Index (SDI). Higher SDI values were associated with easier interventions. Finally, the independent external empirical verification demonstrated high consistency between intervention difficulty and increase in annual prevalence of obesity, population mean BMI, and national policies. It supported the GAME framework to characterize global heterogeneity in high BMI intervention challenge. Global results were freely available at http://www.deepburden.com/high-bmi . Conclusion The difficulty of high BMI intervention varies widely across countries and regions, highlighting the need for comprehensive strategies and governance to address the growing health issue effectively.

Abstract Background: Medical devices are crucial in health care; however, adverse events (AEs) require safety evaluation. Causality assessment determines the contribution of the device to AEs and guides decisions. India lacks a standardized scoring tool, leading to inconsistent interpretation. Aim: This study aimed to develop and validate a reliable causality assessment tool for AEs associated with medical devices. Materials and Methods: A nine-question structured scale was developed from a literature review to classify causality as certain, probable, possible, or unlikely. Validity was established through expert comparisons using the European Union Causality Assessment Scale. Sensitivity, specificity, and area under the curve (AUC) were calculated. Reliability testing occurred in two phases using 50 random Manufacturer and User Facility Device Experience database cases (2014–2024) assessed by six raters (physicians, biomedical engineers, and pharmacists). After 6 weeks, the same cases were reassessed. Reliability was determined using Cronbach’s alpha and intraclass correlation coefficient (ICC). Results: The ICC values for phases 1 and 2 were 0.324 and 0.399, respectively ( P < 0.001), indicating moderate agreement. Validity testing showed a sensitivity of 90.95%, specificity of 83.25%, and AUC of 0.8605, demonstrating strong accuracy in determining causality. The scale demonstrated high reliability (Cronbach’s alpha = 0.893). Conclusion: The validated causality assessment tool enhances consistency and reduces subjectivity among evaluators. It provides a reliable scoring system to support regulatory decisions, improve safety, and enable postmarket surveillance. This tool enables systematic assessment of device-related AEs across healthcare settings.

Introduction: Inhaled alkyl nitrite analogues, commonly known as “poppers,” are short-acting vasodilators that can cause euphoria, dizziness, and related effects. Nitrites rarely result in acute life-threatening complications such as ventricular dysrhythmias. We report a case of electrical storm following accidental inhalation of isobutyl nitrite. Case Presentation: A 40-year-old male had accidental occupational exposure to isobutyl nitrite, after which he became unconscious and was brought to our hospital. On arrival, he was found to be in ventricular fibrillation, and cardiopulmonary resuscitation was initiated as per Advanced Cardiac Life Support protocol. He required three defibrillations, with return of spontaneous circulation achieved after 30 minutes. Post-resuscitation, an SaO2–SpO2 gap of 15% was noted, suggesting a high probability of methemoglobinemia. The patient was immediately treated with methylene blue (2 mg/kg) and transferred to the intensive care unit. Due to hypotension, vasopressors and inotropes were initiated. Two-dimensional echocardiography revealed severe left ventricular systolic dysfunction with an ejection fraction of approximately 30%. Management and Outcome: In the ICU, the patient developed multiple episodes of ventricular tachycardia requiring cardioversion, without sustained return of spontaneous circulation. Extracorporeal cardiopulmonary resuscitation was initiated using a 25 Fr multistage venous cannula in the left femoral vein and a 19 Fr return cannula in the right common femoral artery. Spontaneous circulation was achieved within eight minutes. Over the next 24 hours, the patient experienced eight additional episodes of ventricular tachycardia, all managed with cardioversion, and was started on a lignocaine infusion for 48 hours. The patient gradually regained sensorium, and co-oximetry showed no evidence of methemoglobinemia. Left ventricular function improved to 40%. ECMO was weaned and discontinued on day three. The patient was extubated on day four and discharged on day nine with no recurrence of arrhythmias on telemetry. Conclusion: This case highlights a rare but life-threatening complication of isobutyl nitrite exposure presenting as refractory ventricular arrhythmias. Prompt recognition and timely initiation of extracorporeal support were crucial for survival.

Aims: Strongyloidiasis is an asymptomatic disease caused by the intestinal helminth Strongyloides stercoralis in immunocompetent individuals and are present for decades. The rarity of our case presents in the facts that an elderly gentleman being immunocompetent before, being evaluated for a surgical condition, circumstances lead to sudden deterioration and within one day of the biopsy report succumbs to the condition. While undergoing retrospective evaluation it was diagnosed as hyper infection and disseminated strongyloidiasis. Presentation of the Case: 77 year old elderly male , a case of chronic idiopathic demyelinating neuropathy(recovered) , previously was on oral steroids for a period of 1-2 months; was admitted with persistent vomiting at other hospital, and on evaluation diagnosed with hiatus hernia with severe gastritis and referred to us, patient underwent Naso jejunal tube placement in view of gastric outlet obstruction and for feeding, post which, patient had initially loose stools and thereafter malena, upper Gi scopy with cessation of bleed done, to recur as hematemesis and within one day of diagnosis of duodenal biopsy suggestive of Strongyloides stercoralis, patient succumbed to the disease. Discussion: The case emphasizes on the importance of evaluation of various gastrointestinal infections especially caused by pathogens in our country with tropical climate and need to correlate the immunocompetency of patient especially on steroids with underlying infections. Conclusion: strongyloidiasis infection should be ruled out in all the immunodeficient patients especially on steroids for brief periods and presenting with gastrointestinal symptoms of vomiting and diarrhoea.

Drug-eluting balloons, surface-coated with antiproliferative agents such as sirolimus or paclitaxel, have emerged as an alternative therapeutic option for coronary stenosis. This study evaluated safety and effectiveness of the MOZEC sirolimus-eluting percutaneous transluminal coronary angioplasty (PTCA) balloon dilation catheter (Meril Life Sciences Pvt. Ltd., India) across diverse clinical scenarios in coronary artery stenosis treatment. A prospective, single-arm, multicenter, real-world, post-marketing surveillance study evaluated the safety and performance of the MOZEC sirolimus-eluting balloon (SEB) in treating native coronary artery disease in daily clinical practice. Patients were followed for 24 months, with clinical visits or telephonic calls at 1, 6, 12, and 24 months after the index procedure. Safety endpoints included major adverse cardiac events (MACEs), and performance endpoints include change in late lumen loss, clinical success, and device success. A total of 141 patients were enrolled in the study. The MOZEC SEB was used in 127 (70.17%) de novo lesions, 40 (22.1%) in-stent restenosis lesions, and 14 (7.73%) bifurcations lesions. Over the 24-month follow-up period (n = 134), six cumulative MACEs (4.47%) were observed, comprising two cardiac deaths (1.49%), five myocardial infarctions (3.73%), and four target lesion revascularizations (2.99%). Late lumen loss analysis included 17 patients who underwent additional coronarography at the 6-month follow-up. In-segment and in-device late lumen loss at 6-month follow-up was 0.14 ± 0.37 mm. The application of MOZEC SEB in various clinical scenarios demonstrated safety and efficacy over long-term follow-up. These findings align with the favorable vessel healing observed during the 6-month imaging follow-up.