Mahatma Gandhi Mission Medical College and Hospital

IntroductionRevision lumbar spine surgery is an increasing challenge, often necessitated by adjacent segment disease (ASD), recurrent stenosis, or implant-related complications. This study aimed to analyze the etiology and short-term outcomes of revision lumbar surgeries at a tertiary spine center.Materials and methodsA prospective observational study was conducted at our institute, including all revision lumbar surgeries performed during the defined study period. Data collected included patient demographics, details of the index surgery, presenting complaints, indications for revision, characteristics of the revision procedure, and six-month postoperative outcomes (Visual Analogue Score (VAS) and Oswestry Disability Index (ODI)).ResultsA total of 103 revision surgeries (mean age 58.3 years; 54 females, 49 males) were included. Those in Group A were revised within two years (n=50, 49%); Group B were revised between two to five years (n=25, 24%); and Group C were revised more than five years after the index surgery (n=28, 27%). In Group A, revisions were predominantly in patients who had fusion procedures in the first surgery. In contrast, Group C had more patients whose index procedure was non-fusion. Analysis of the preoperative radiographs of previous surgeries revealed overlooked ASD, foraminal stenosis, and inadequately decompressed stenotic segments. Statistically significant improvement in pain and functional outcomes was noted at the six-month follow-up.ConclusionPrevention of early revision lumbar surgery requires adequate decompression during the primary procedure, identification and prophylactic treatment of partially stenotic adjacent levels, and recognition and decompression of the foraminal stenosis.

Background: The application of predictive analytics, particularly through artificial intelligence (AI) and machine learning (ML), has the potential to transform risk assessment in Acute Ischemic Stroke (AIS). This study aims to compare the performance of deep learning (DL) models against traditional machine learning (ML) algorithms in predicting AIS risk, using clinical data from patients with a history of cerebrovascular stroke events. Methods: In this retrospective analysis, we examined data from 5120 patients with documented AIS events, sourced from Rhythm Heart and Critical Care. Key predictive variables included hypertension, history of heart disease, occupation, average glucose levels, body mass index (BMI), and smoking status. To ensure unbiased model development, stroke history was blinded during training. We assessed the performance of various DL architectures. These were benchmarked against established traditional models, such as Logistic Regression (LR), AdaBoost, and Gaussian Naïve Bayes (GaussianNB). Model efficacy was evaluated using key metrics including accuracy, precision, prediction rate, and area under the receiver operating characteristic curve (AUC). Results: The RADAIS model, incorporating deep learning techniques, successfully generated stroke predictions for 5017 patients (97% of the cohort). The model demonstrated superior performance with an accuracy of 0.95, precision of 0.99, prediction rate of 0.97, and AUC of 0.97. In contrast, traditional machine learning models exhibited lower performance, with Logistic Regression (accuracy: 0.71, precision: 0.71, prediction: 0.69, AUC: 0.79), Gaussian Naïve Bayes (accuracy: 0.70, precision: 0.68, prediction: 0.73, AUC: 0.81), and AdaBoost (accuracy: 0.78, precision: 0.75, prediction: 0.82, AUC: 0.76). These results underscore the superior accuracy and precision of deep learning models in AIS prediction. Conclusion: The findings from the RADAIS study highlight the significant advantages of deep learning models over traditional machine learning methods for predicting the risk of Acute Ischemic Stroke. With a remarkable accuracy of 0.95 and an AUC of 0.97, deep learning-based models offer a more precise, reliable, and clinically relevant tool for stroke risk assessment, ultimately facilitating more informed decision-making in stroke management.

BackgroundThe invasive fungal illness known as rhino-orbito-cerebral mucormycosis (ROCM) is associated with significant morbidity and fatality rates. The increasing burden of the disease and lack of uniformity in guidelines related to its management have led to an increasing case fatality rate. The main objective of the study was to compare and corroborate the cross-sectional imaging findings of CT and MRI scans with those of intra-operative endoscopic findings.MethodsThis retrospective study was conducted at a tertiary care centre of Mahatma Gandhi Memorial Hospital in Aurangabad, India. Each patient was treated with systemic antifungal therapy and surgical debridement following cross-sectional imaging. The findings on radiology and intraoperative endoscopies were compared, and data were analysed.ResultsRadiological assessment demonstrated high sensitivity, specificity, and positive predictive value (generally >90%) across most anatomical sites when compared with intra-operative endoscopic findings. The maxillary sinus was the most commonly involved sinus in almost 97% of cases, followed by the ethmoid sinuses. The middle turbinate was the most commonly involved among the three turbinates. Diagnostic performance was lower for the superior turbinate, with a positive predictive value (PPV) of 79.3%. Chi-square analysis showed no statistically significant difference between radiological and endoscopic detection across the anatomical sites assessed.DiscussionCross-sectional imaging plays a vital role in the preoperative assessment and management of mucormycosis. MRI scan gives better delineation of orbital involvement and soft tissue extension, as mucormycosis is well known for angioinvasion. However, despite overall concordance between imaging and endoscopic findings, reduced sensitivity in specific anatomical subregions, including the superior turbinate, intraconal compartment, and select maxillofacial soft-tissue spaces, indicates that early disease may be under-represented on imaging alone. These findings support the role of targeted endoscopic exploration to detect occult disease during surgical management. Imaging is also a useful tool in the follow-up of the disease after the patient's discharge on step-down therapy.ConclusionCross-sectional imaging with CT and MRI provides a valuable adjunct for preoperative mapping in ROCM and works synergistically to delineate disease extent, including orbital and deep soft-tissue involvement that may not be clinically apparent. As imaging guides surgical planning and identifies anatomically high-risk regions that would otherwise not be explored, CT and MRI should be performed in all cases of ROCM. However, early disease involvement in several anatomically concealed areas may be missed on cross-sectional imaging; therefore, endoscopic correlation of hidden regions remains essential to ensure complete disease clearance.

BackgroundMedical device adverse events (MDAEs) are critical incidents in healthcare systems that can lead to patient harm, necessitating thorough investigation and management. This study aims to comprehensively analyse MDAE reports collected over six months at a Medical Device Management Centre (MDMC). The investigation focuses on various aspects, including gender distribution, age demographics, types of medical devices implicated, department-wise distribution within hospitals, risk classification according to regulatory standards, and subsequent corrective and preventive actions undertaken.MethodsThe study collected and analysed 80 spontaneous MDAE reports from the MDMC database. Data were meticulously extracted, categorised, and quantified to facilitate detailed analysis. Mean and standard deviation were calculated for quantitative variables, and proportions were calculated for categorical variables to elucidate patterns and trends in MDAE occurrences.ResultsAnalysis revealed a gender disparity, with a higher proportion of MDAEs occurring in males (62%) compared to females (38%). Middle-aged individuals (41-50 years) constituted the largest age group affected by MDAEs, comprising 36.25% of reported cases. Patient monitors, IV catheters, and syringes emerged as the most frequently implicated medical devices, with patient monitors alone accounting for 18.75% of reported events. The Medicine ICU and Dialysis Unit reported the highest number of MDAEs, with 12.5% and 10% of total cases, respectively. Risk classification based on regulatory standards categorised the majority of events as Class B (51.25%), indicating low to moderate risk, while a notable proportion were classified as Class C (32.5%), signifying moderate to high risk. Additionally, in our study, most corrective actions after an MDAE involved repairing and returning the device for hospital use (94.59%). Two cases (5.41%) were sent to the manufacturer for replacement. Additionally, 43 out of 80 adverse events involved discarding single-use devices in hospital facilities. Preventive measures, such as staff training programs, were proposed to mitigate future risks.ConclusionThis study highlights important patterns in patient safety risks. Risk classification demonstrated that most events fell within Class B and Class C categories. Overall, this study emphasises the importance of systematic reporting, analysis, and management of MDAEs to reduce patient harm. Strengthening preventive measures, enhancing staff awareness, and ensuring robust regulatory compliance are essential steps toward improving medical device safety in hospital settings.

Isolated skeletal lymphoma is a rare subtype of lymphoma, and isolated mandibular involvement is extremely uncommon. We describe a case of isolated mandibular lymphoma detected on 18F-FDG PET/CT, presenting as an 18F-FDG-avid lytic expansile lesion in the left hemimandible, with no other pathologic findings in the body.

BackgroundEhlers-Danlos syndrome (EDS) encompasses a group of connective tissue disorders often extending beyond musculoskeletal involvement. Emerging evidence indicates a high prevalence of cardiovascular autonomic dysfunction in this population, yet systematic physiologic evaluations remain limited.ObjectiveTo characterize cardiovascular autonomic function in EDS using standardized autonomic testing and heart rate variability (HRV) indices, and to explore intrinsic autonomic coupling by correlating resting heart rate with HRV parameters.MethodsThis cross-sectional study included 30 clinically diagnosed patients with EDS and 30 age- and sex-matched healthy controls. Short-term HRV analysis (five-minute supine ECG) and standard autonomic testing, including head-up tilt, were performed under controlled laboratory conditions. HRV indices were derived using Fast Fourier Transform (FFT) algorithms. Group differences were evaluated with independent t-tests, and correlations between resting heart rate and HRV measures were analyzed using Pearson’s correlation.ResultsCompared with controls, patients with EDS exhibited higher resting heart rate (87.3±11.6 vs 75.2±9.8 bpm), lower parasympathetic time-domain indices (standard deviation of normal-to-normal intervals or SDNN 35.4±9.7 vs 49.1±11.4 ms; root mean square of successive differences (RMSSD; 20.7±6.9 vs 31.6±8.8 ms), and altered frequency-domain markers (low frequency (LF) power 671±205 vs 542±176 ms²; high frequency (HF) power 174±81 vs 272±106 ms²; LF/HF ratio 3.7±1.3 vs 1.8±0.7). Orthostatic intolerance was observed in 16 (53.3%) of the patients with EDS versus three (10%) of the controls. Correlation analysis revealed that in EDS, resting HR correlated negatively with SDNN (r=-0.45, p=0.01), RMSSD (r=-0.52, p<0.01), and HF power (r=-0.39, p=0.03), while showing a positive correlation with LF/HF ratio (r=0.58, p<0.001).ConclusionPatients with EDS had autonomic dysregulation, with sympathetic predominance and diminished vagal modulation. The intrinsic coupling between resting heart rate and HRV indices suggests impaired cardiovascular autonomic integration. HRV profiling is a valuable noninvasive biomarker for early identification and longitudinal monitoring of autonomic dysfunction in EDS, potentially enhancing disease characterization and guiding individualized therapeutic strategies.

IntroductionThe current consensus for treating sagittal imbalance in degenerative spine disease supports deformity correction. However, there is a growing trend toward limited fusion, particularly in patients presenting predominantly with leg symptoms. The present study aimed to compare radiological and clinical outcomes following lumbar fusion between patients with postoperative sagittal balance and those with residual imbalance.MethodsThis study included 270 patients who underwent limited lumbar arthrodesis and were followed for two years. Radiological parameters-sagittal vertical axis (SVA), pelvic incidence (PI), pelvic tilt (PT), and sacral slope (SS)-were recorded preoperatively and at the final follow-up. Clinical outcomes were assessed using the Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and Short Form-36 (SF-36). Patients were divided into two groups based on postoperative sagittal alignment: balanced (SVA < 50 mm) and imbalanced (SVA > 50 mm). Both intragroup pre- and postoperative improvements and intergroup differences in outcomes were analyzed.ResultsOut of 270 patients, 194 had good sagittal alignment and 76 had sagittal imbalance (SVA > 50 mm). Both groups showed significant postoperative (two-year follow-up) improvement in quality-of-life scores (VAS, ODI, and SF-36) compared with baseline values (p < 0.001). However, when comparing the degree of improvement between the balanced and imbalanced groups, no statistically significant differences were observed. A significant but weak negative correlation was noted between the change in the VAS score and the socioeconomic status in patients with sagittal imbalance of the spine.ConclusionIn appropriately selected patients, limited lumbar fusion can achieve favorable short-term outcomes irrespective of postoperative sagittal alignment. These findings suggest that extensive deformity correction may not always be necessary in degenerative cases presenting primarily with leg symptoms.