Kokilaben Dhirubhai Ambani Hospital

Extraskeletal chondromas are rare slow growing benign neoplasms predominantly formed by the hyaline cartilage. These tumors arise from the tenosynovial sheath or the soft tissue adjacent to the tendon sheath. Hands and feet are the most frequently involved sites. Other less frequent sites such as the knee, trunk, oral cavity, pharynx, and the base of the skull have also been reported in the literature. The histomorphology closely resembles a chondroblastoma of the bone. It is extremely important that these benign tumors be differentiated from its other similar looking benign mimcs. To the best of our knowledge, only 12 cases of chondroblastoma like soft tissue chondroma (CLC) have been reported, 11 of which were located in the hand. In this case report, we present a 54-year-old female with a soft tissue swelling over the right hand index finger diagnosed as CLC on core needle biopsy followed by excision.

Adolescent type 2 diabetes mellitus (T2DM) is on the rise in India and is commonly attributed to co-existence of overweight and obesity in adolescents. In this line, a study by Maheshwari et al titled ‘Prevalence of obesity, determinants, and its association with hyperglycaemia among community dwelling older adolescents in India’ concluded that overweight, obesity, socioeconomic factors and higher education status were responsible for hyperglycemia in adolescents aged 15-19 years in India. We highlight that there is a significant prevalence of T2DM even in normal body mass index (BMI) and below normal BMI subjects, as mentioned in their study. There is a high prevalence of normal weight obesity in Indian adolescents which often gets missed due to a large population with normal BMI in the country. In this letter, we analyze the importance of measurement of central adiposity beyond routine BMI measurements.

Myelin oligodendrocyte glycoprotein antibody-associated disease (MOGAD) is a rare autoimmune neuroinflammatory disorder. While it typically presents as optic neuritis, myelitis, or acute disseminated encephalomyelitis (ADEM), its manifestation as pyrexia of unknown origin (PUO) with subsequent meningitis is extremely rare. We report a 17-year-old male who presented with persistent fever and headache, without focal neurological deficits. Extensive infectious workup was inconclusive. Cerebrospinal fluid (CSF) analysis revealed mild pleocytosis, and empirical antibiotics were initiated without clinical improvement. A repeat CSF analysis demonstrated worsening pleocytosis, prompting an expanded autoimmune and neuroinflammatory panel. MOG-IgG antibodies were detected in both serum and CSF, confirming the diagnosis of MOGAD. The patient responded well to high-dose corticosteroids followed by mycophenolate mofetil for maintenance therapy. This case highlights the importance of considering MOGAD in patients with unexplained fever and headache with inflammatory CSF. Early recognition and prompt immunotherapy initiation are essential for optimal outcomes. A favorable outcome was observed following timely immunotherapy.

Dysarthria is a disease that affects timing, rhythm, and pronunciation, which frequently makes traditional Automatic Speech Recognition (ASR) systems less effective. Most of the corpora for dysarthric research are in English language, which restricts multilingual users. In this paper, we aim to develop an multilingual speech corpora for ASR system (i.e., Assistive Speech Technology (AST)) that can adapt to various dysarthric severitylevels, improving accessibility and inclusivity in speech-based technologies. To that effect, speech samples in Hindi, Marathi, Gujarati, and Indian English are collected from both dysarthric vs. normal subjects in order to accomplish this goal. The initial goal of the research is to use spectral analysis to distinguish between dysarthric and typical speech, with the ultimate goal of creating a sophisticated ASR system for people with dysarthria. After obtaining clearance from ethics committee, data collection is conducted as a synergistic collaboration between DAU and KDAH-MRI. Finally, we present interim results in severity-level classification using spectral features and obtained accuracy of 60.46 %. We also employed transformers based features, in which we got highest accuracy of 58.13 %. For realistic approach of the proposed dataset, we performed analysis of latency period.

Dengue infection is a major public health problem in tropical and subtropical countries. While most cases are self-limiting, a subset progresses to severe dengue with shock, multiorgan dysfunction, and atypical manifestations. We report a case of a 39-year-old female with severe dengue complicated by refractory shock, stress cardiomyopathy, and a paradoxical large inferior vena cava (IVC) thrombus extending into the right atrium. The case highlights the role of cytokine storm in the pathogenesis of severe dengue and underscores the need for high clinical suspicion for atypical manifestations.

Background: There is limited clinical evidence from India comparing robotic-assisted surgery (RAS), laparoscopic surgery (LPS), and open laparotomy (OL) approaches for managing stage 1 endometrial cancer (EC). This multicenter study aimed to evaluate and compare the perioperative and short-term outcomes of these techniques across high-volume Indian institutions.Methodology: This multicenter, retrospective, non-randomized comparative study reviewed medical records of consecutive patients who underwent OL, LPS, or RAS for stage 1 EC between January 2010 and December 2023.Results: A total of 2,090 patient records were analyzed, including 1,223 in the RAS group, 451 in the LPS group, and 416 in the OL group. The average age was 59.66 ± 9.31 years, with no significant differences between groups. The overall mean operative time was 220.51 ± 93.73 minutes, with the RAS group demonstrating a significantly shorter duration than both OL and LPS groups (P < 0.001). The mean estimated blood loss was 128.87 ± 226.75 mL, with the RAS group resulting in the least blood loss, followed by the LPS and OL groups (P < 0.001). The need for intraoperative blood transfusion was also lowest in the RAS group. Intraoperative complications were more frequent in the OL group, while conversion to open surgery was higher in the LPS group (P < 0.001). Hospital stay was shortest in the RAS group (2.71 days), followed by the LPS (3.77 days) and OL (5.95 days) groups (P < 0.001). Postoperative complications were significantly fewer in the RAS and LPS groups than in the OL group. Positive margins were lowest in the RAS group (P < 0.001). Sentinel lymph node sampling was highest in the RAS group (P < 0.001). Patients in the RAS group started adjuvant treatment sooner than the LPS (P < 0.001) and OL (P = 0.004) groups.Conclusions: This study reports the first multicentric evidence for RAS in Indian settings, compared to conventional approaches, and offers encouraging outcomes.

Abstract BACKGROUND: Limiting the use of blood components to occasions when they are strictly required can minimize risks to patients due to transfusion, thereby conserving a limited resource and also contain cost. AIMS AND OBJECTIVES: In this study we aim to determine the effect of prospective monitoring of transfusion requests on the appropriate use of blood components. MATERIAL AND METHODS: This is a prospective interventional study performed at a tertiary care hospital based blood centre. Blood request forms were audited with respect to indications for transfusion and the clinical and laboratory parameters of the patient. Requisitions (N = 6000) were monitored by trained medical officer for compliance with institutional guidelines. The treating clinician was contacted for relevant discussion prior to processing the request. In case of disagreement, the original request was always honoured. Rate of inappropriate transfusion episodes after intervention were compared with those prior to the intervention. RESULTS: Requests for wrong dose/indication for FFP and platelets were the most common inappropriate practices noted. There was a significant reduction in the rates of inappropriate transfusion episodes (red cells 59% to 20% (P=0.002), platelets 40% to 15%(P=0.001), FFP 70% to 38%(P=0.002) and cryoprecipitate 30% to 18%(P=0.031). Acceptance of red cell units up to 7-10 days old increased by 48%. Acceptance of out-of-group platelet transfusions increased from nil to 31% (P=0.001). CONCLUSION: The retrospective audit was useful to identify the current patterns of blood usage and areas of improvement. Prospective monitoring of blood requisition forms was useful in reducing the rate of inappropriate transfusions.