Holy Spirit Hospital

Amyand's hernia is a rare anatomic occurrence, and appendicitis in Amyand’s hernia makes it exceptionally rare. We present such a rare case that was unexpectedly found during right inguinal hernia repair, highlighting the rarity and challenges in diagnosing this condition preoperatively, as well as the importance of awareness and proper management of this rare case. A 68-year-old male presented with right inguinal pain, tenderness, and swelling in the right inguinal region, initially admitted for right inguinal hernia repair. Surgery was postponed due to poor glycemic control. The patient was subsequently admitted for said surgery. During the procedure, it was found that the hernial sac contained a part of the bowel and an inflamed appendix, confirming Amyand's. The patient underwent right groin exploration, appendectomy, and hernioplasty. Through this case, we highlight the importance of intraoperative vigilance and adaptability in managing rare surgical findings, emphasizing the need for surgeons to be prepared for unexpected situations during hernia repairs.

Chronic pancreatitis (CP) is a progressive inflammatory disease of the pancreas that leads to irreversible structural damage, abdominal pain, and exocrine and endocrine insufficiency. Its etiology is multifactorial, with alcohol consumption and cigarette smoking representing the most significant modifiable risk factors, while genetic, autoimmune, and metabolic mechanisms are increasingly recognized. The aim of this review was to summarize current knowledge on the pathogenesis, diagnosis, and management of CP, with particular emphasis on the importance of an interdisciplinary approach. A comprehensive literature focused on original studies, clinical guidelines, and meta-analyses published in the last 15 years. Effective management of CP requires a stepwise strategy, beginning with lifestyle modification, pain control, pancreatic enzyme replacement therapy, and management of diabetes. Endoscopic and surgical procedures are reserved for patients with refractory symptoms, with duodenum-preserving techniques demonstrating favorable outcomes in pain relief, pancreatic function preservation, and quality of life. In advanced disease, surgical management provides superior long-term results compared with endoscopy. In addition, psychological care has emerged as an integral part of management, addressing the burden of chronic pain, comorbid depression, and addictive behaviors. Nutritional support, including adequate enzyme supplementation and correction of fat-soluble vitamin deficiencies, remains essential to prevent malnutrition and osteoporosis. In conclusion, CP is a complex disorder requiring multidisciplinary care. Early recognition of risk factors, combined with individualized therapeutic strategies and integration of medical, surgical, and psychosocial interventions, is fundamental to improving patient prognosis and quality of life.

ABSTRACT Background: Due to the complex histological and genomic nature of sarcomas, diagnosing and treating them has proven challenging. Delving into the genomic profiles and molecular markers linked to different sarcoma subtypes will aid in overcoming these obstacles and identifying new potential therapeutic targets. Objectives: The primary objective of this study was to investigate the genomic complexity of sarcoma, while the secondary objective was to identify potential therapeutic targets in the patients with sarcoma from India. Materials and Methods: This retrospective observational study was conducted from January 2020 to February 2024 at 4basecare Precision Health Pvt. Ltd., Bengaluru, India. We carried out comprehensive genomic profiling using gene panels or exome sequencing, including assessment of immunotherapy biomarkers (tumor mutation burden (TMB), microsatellite instability (MSI), programmed death-Ligand 1 (PD-L1)), in a cohort of 263 patients with sarcoma, categorized into 25 sarcoma types, for the present retrospective analysis. Results: We included 263 patients with sarcoma in our study and identified a diverse landscape of pathogenic variants across 138 genes, in 69.5% (183 patients) of the cohort. SNVs were prevalent in TP53 (25.1%; 66 patients), KIT (5.7%; 15 patients), PTEN (4.6%; 12 patients), and RB1 (4.6%; 12 patients), while CDK4 (5.2%; 17 patients) and MDM2 (5.7%; 15 patients) gene amplifications and SS18-SSX2 (1.1%; 3 patients), EWSR1-FLI1 (0.8%; 2 patients), and ASPSCR1-TFE3 (0.8%; 2 patients) gene fusions were recurrent. The majority of the patients harbored mutations affecting cell cycle control (39.2%; 103 patients), PI3K/AKT/MTOR (17.9%; 47 patients), and RAS/RAF/MAPK (14.8%; 39 patients) pathways. The average TMB was 7 mutations/mb, with 13.3% (35 patients) classified as TMB-H. Around 59.3% of the cohort (156 patients) harbored clinically actionable variants of therapeutic significance, including 8.7% of the cohort (23 patients) who were eligible for FDA/NCCN approved therapies. Conclusion: The findings emphasize the clinical usefulness of genomic profiling in guiding precision medicine for sarcoma treatment. Our research offers valuable insights into the genetic makeup of sarcomas, serving as a basis for devising efficient and precise diagnostic approaches and for planning preclinical and clinical studies to develop innovative treatment strategies.

Abstract Background: Worsening heart failure (WHF) is characterized by the progression of symptoms in patients with established HF, necessitating intensified treatment, typically with diuretics. Outpatient (OP) management of WHF offers an alternative to hospitalization, as many patients experience a gradual onset of symptoms, allowing timely intervention. However, OP WHF is often underrecognized and excluded from clinical trials, highlighting the need for structured guidance. This expert consensus aims to address this gap by providing clinical practice recommendations for OP WHF management. Methodology: A panel of Indian cardiologists convened for an expert meeting moderated by a leading cardiologist. Based on clinical evidence, expert insights, and live polling, consensus recommendations were developed. Results: Experts agreed that WHF is defined by symptom worsening despite standard HF therapy, decompensation in chronic HF, and an increase in oral or intravenous diuretic dose. Vericiguat was recognized as suitable for patients with reduced eGFR (<30 mL/min/1.73 m²), unlike angiotensin-converting enzyme inhibitor/angiotensin II receptor blocker/angiotensin receptor-neprilysin inhibitor (ACEi/ARB/ARNi) and digoxin. While ACEi/ARB/ARNi doses may be reduced in WHF with worsening renal function, beta-blockers should be maintained as long as possible. OP management should prioritize early vericiguat initiation alongside rapid HF therapy optimization. About 44% of experts recommended initiating vericiguat at the first follow-up (3–7 days postdischarge), whereas 33.3% preferred it as a last-line option. Management of end-stage heart failure with advanced options like assist devices and transplants is needed with failure of drug therapy, persisting end-organ failure, and repeated hospitalization. Conclusion: This consensus highlights early OP department (OPD)-based recognition of WHF, OPD-based structured HF therapy optimization, and early vericiguat initiation to improve WHF management in outpatient settings.

This study presents a comprehensive review of the existing literature regarding the role of vitamin D3 in chronic plantar fasciitis.The pleiotropic effects of vitamin D3 in modulating inflammation, promoting tissue repair, and maintaining the structural integrity of connective tissues are highlighted.Evidence suggests that vitamin D3 plays a crucial role in inhibiting proinflammatory cytokines and upregulating anti-inflammatory mediators, which may be particularly beneficial in the context of chronic plantar fasciitis.Additionally, vitamin D3 has been found to enhance the expression of genes involved in extracellular matrix remodeling and collagen synthesis, essential for the repair and regeneration of the plantar fascia.Intervention studies have demonstrated that individuals with chronic plantar fasciitis often exhibit lower serum vitamin D levels compared to healthy controls, and supplementation with vitamin D3 can lead to significant improvements in pain, physical function, and quality of life.The findings also suggest a potential association between vitamin D3 status and the development of chronic plantar fasciitis.However, it is important to acknowledge the limitations of the existing literature, as many of the studies to date have been observational in nature, and the causal relationship between vitamin D3 status and the development or progression of plantar fasciitis remains to be fully elucidated.

Introduction: To establish a comprehensive consensus statement on dyslipidemia management, incorporating contemporary evidence and drawing from the valuable real-world experiences of Indian physicians and cardiologists Methods: A virtual collaborative educational initiative was convened in May 2023, through a series of 13 nationwide virtual interactive meetings (n=238) at the forefront of dyslipidemia management (STRATIFY 2 Consensus Group). The cumulative clinical experience was approximately 6,000 man years, who rated their level of agreement for 10 questions with each item on a 5-point Likert scale. This was preceded by a contemporary evidence-based discussion on the updates for dyslipidemia including statins. Weighted mean for the Likert scale was calculated and consensus was pre-defined as a score > 100. GraphPad 9.5.1 and ANOVA were used for statistical analysis. Results: The highest agreement score was for, using LDL-C as a performance measure enhances cholesterol control in high-risk groups, leading to reduced cardiovascular disease morbidity and mortality (119), attainment of LDL-C goals in patients receiving high-intensity statin therapy needs improvement in real-world settings (116), combination of short-term DAPT and intensive rosuvastatin reduces the risk of recurrent stroke (113), validated risk calculators such as QRISK3 are valuable tools for guiding clinical decisions regarding the initiation of statin therapy (112), rosuvastatin 40 mg daily is more effective in reducing LDL-C levels as compared to atorvastatin 80 mg (110), Rosuvastatin is more effective than Atorvastatin in reducing LDL-C levels in diabetes mellitus (104) (Figure). The highest mean response scores (±SD, 95% CI) for consensus were for agree (61±25, 95% CI 44 to 80) followed by strongly agree (32±17, 95% CI 20 to 44) Conclusions: The consensus findings contribute to advancing dyslipidemia management and guiding evidence-based practices for improved patient outcomes.

From times immemorial, women has had the difficult road to travel, may be their values in societal position, their active participation and understanding and realisation of their voice in matters of legislation, not to say the least in day to day contribution still needs to be appreciated despite working full time24/7. When I was a resident in the seventies, I often used to wonder, why the Opd’s were full of womenfolk as compared to men in chronic ailments of musculoskeletal pains carrying a with them , a thick pad of opd papers with only written legible prescription was ctall (continue all). On the other hand, the numbers were higher for male gender in trauma and sports injuries. To attend the OPDs, probably was an outing for them, getting away from daily chores of unrecognised and unappreciated, housebound work of 24/7. The most research subjects were males than females and the surprising feature was absent of consent when it came to consent for surgery, as if their presence does not matter and their place needs to be at home alone. It was accepted that they are not the bread winners but only the homemakers and medical expenditure on them was not very fruitful. It was after the 1993 the National Institute of Health made a declaration to deliver equal high quality of care and effective management to all and not to make gender biased discrimination. As we crossed the twentieth century and went into the 21st century, a forward progressive thinking brought about sea of change, when women started working in offices, took up to education, excelled more than men in education and in financial matters , thereby becoming independent and therefore demanded equality of status. There are now ever increasing number of women not only doing Orthopaedics but also superspecialising in sub specialist and attracting female patients and thus competing with their male counterparts. So you no longer see the world” destined for men only “ operating today, because of the need felt to give equal opportunity to all without any bias and discrimination of social status and circumstances to attain their full potential. Nowadays you see more women readily agree to consent for surgery, since more and more educated young men and women tend to accompany their mother for being operated because they insure their parents for medical treatment and feel satisfied emotionally and morally as they are giving back to them to reciprocate their loved and care. But still in some developing and underdeveloped countries for want of insurance agencies and abilities, there opportunities of facilities of care are lacking and therefore the male counterpart still is preferred for surgery over female patient. The female patient has more ailments of osteoporosis, osteoarthrosis and musculoskeletal problems than the male counterparts and the need to be promptly treated, to keep the pillar and backbone of the family healthy and not disabled. In developed countries, many joint replacement registries show, increasing number of female patients getting operated for joint replacement surgery and even for sports related injuries, implying that the ratio is changing to the prevailing order earlier. This reversing trend is better for society as the female patient becomes multitasked and well respected needs to be equally cared for and given the importance.

: To evaluate effectiveness and safety of intravenous alteplase (tPA) for the treatment of acute ischemic stroke. In this prospective observational study, adult patients with ischemic stroke were treated with intravenous alteplase. We recorded baseline demographics and NIHS score was calculated at baseline, 2 hours, 24 hours and 7 days. Improvement was assessed by evaluating total NIH stroke score at different time points. Based on the neurological assessment, patients were categorised into three categories: unchanged (U), improving (I) and deteriorating (D). Blood pressure was closely monitored until 24 hours after infusion of alteplase. Both neurological assessment and blood pressure was monitored every 15 minutes for the first 2 hours after start of infusion, then every 30 minutes for next 6 hours, and hourly from the post infusion hour until 24 hours after infusion. Twenty-six patients [male 16 (61.50%); female 10 (38.50%)] between 34 to 86 years of age were enrolled in this study. Total NIHS score reduced from 10.77 (+5.01) at pre-treatment to 4.04 (+4.00) at 7 days. The improvement in NIHS score at two hours versus pre-treatment (p<0.001), at 24 hours versus 2 hours (p=0.002) and 7 days versus 24 hours (p<0.001) was statistically significant. Clinically no significant change was observed in the blood pressure of the patients till 24 hours after thrombolysis. At the end of 24 hours, 40% patients showed improved status and in 60% patients, status was unchanged. Intravenous alteplase is effective and safe treatment approach for treatment of acute ischemic stroke. No major complications were observed in this study.