Nazareth Hospital

Calodium hepaticum is a neglected zoonotic parasite of rodents, primarily affecting rats. Highly sensitive molecular assays such as nested PCR are not available to screen the parasite in rat, man and dog. In the present study, parasite specific nested PCR primers were designed to amplify 171bp partial 18S rRNA gene of C. hepaticum and compared with an existing semi nested PCR. Both nested PCR and semi nested PCR assays were sensitive enough to detect at least 10 C. hepaticum eggs in rat liver samples. The limit of detection of nested PCR assay was 420 zM, and it was 35-fold more sensitive than that of semi nested PCR assay. The nested and semi nested PCR assays specifically amplified C. hepaticum egg DNA from human and dog DNA samples spiked with parasite DNA. The molecular prevalence of C. hepaticum in household rats in Chennai was 41.81% based on nested PCR assay. This study suggests that the 18S rRNA gene based nested PCR assay could be a more sensitive detection system for molecular screening of C. hepaticum in rat liver samples and highly suitable for epidemiological studies. Further, both the 18S rRNA gene based nested and semi nested PCR assays can potentially used for detection of C. hepaticum infection in man and dog.

Chromoblastomycosis (CBM) is a chronic, granulomatous subcutaneous infection caused by traumatic inoculation of the dematiaceous fungi into the skin.In 2017, CBM was added to the list of WHO-recognized Neglected Tropical Diseases.CBM poses diagnostic challenges in some cases where classical histopathological findings are not diagnostic.We hereby report an interesting case of misdiagnosed CBM in a 45-year-old man.www.cosmoderma.org

688 Background: Pancreatic cancer is one of the leading causes of cancer-related death and is associated with poor overall survival. Glucagon-like peptide-1 receptor agonists (GLP-1RAs), widely prescribed for diabetes and obesity, have been investigated for potential impact in patients with pancreatic cancer, although their safety and clinical effects remain uncertain. This study evaluates the association between GLP-1RA use and clinical outcomes in a real-world cohort of patients with pancreatic cancer. Methods: Using the TriNetX Network database (72 healthcare organizations), we identified patients with pancreatic cancer who were prescribed GLP-1 receptor agonists (GLP-1RAs; n = 1,972) from 2010 to 2022, and matched controls without exposure to GLP-1RAs (n = 57,645). Propensity score matching balanced demographics and comorbidities, yielding 1,821 patients in each group. The primary outcomes were all-cause mortality and overall survival, assessed with Kaplan–Meier survival curves. Secondary outcomes included hospitalization, postoperative infection/sepsis, venous thromboembolism (VTE), acute kidney injury (AKI), and chronic kidney disease (CKD). Risk ratios (RRs) with 95% confidence intervals were estimated over a three-year follow-up period. Results: After propensity matching, the mean age was 72.0 years in the GLP-1RA group and 71.8 years in the non-GLP-1RA group. GLP-1RA users had lower all-cause mortality compared with non-users (40.6% vs 44.3%; risk ratio [RR] 0.92, 95% CI 0.85–0.99; p = 0.025) and longer median survival (1,065 vs 824 days; hazard ratio [HR] 0.90, 95% CI 0.81–0.997; p = 0.043). Hospitalization was less frequent in GLP-1RA users (40.2% vs 46.1%; RR 0.87; p = 0.040). Postoperative infection/sepsis (18.1% vs 21.3%; RR 0.85; p = 0.023) was also significantly lower in the GLP-1RA group. No significant differences were observed for VTE (15.1% vs 16.4%; p = 0.335), AKI (18.7% vs 20.2%; p = 0.317), or CKD (10.4% vs 8.4%; p = 0.073). Conclusions: GLP-1RA use was associated with lower mortality, longer survival, and reduced risks of hospitalization and postoperative infection/sepsis in patients with pancreatic cancer, without increased risk of VTE or renal complications. Prospective studies are warranted to confirm these findings and further clarify the role of GLP-1RAs in pancreatic cancer care.

Introduction and Importance:Rectus sheath hematoma (RSH) is an uncommon and frequently misdiagnosed cause of acute abdominal pain that may mimic more serious intra-abdominal emergencies, including acute pancreatitis.Case Presentation:We present the case of a 62-year-old man who developed a large RSH following a coughing episode, presenting with right-sided abdominal pain and periumbilical ecchymosis (Cullen’s sign). Normal pancreatic enzymes and computed tomography (CT) imaging were key in excluding pancreatitis and confirming the diagnosis of RSH. The patient was managed conservatively with a successful resolution.Clinical Discussion:This case highlights the importance of considering RSH in the differential diagnosis of acute abdomen, even in the absence of anticoagulation, and the critical role of imaging in its timely diagnosis. This case reinforces the value of CT imaging and focused physical examination in differentiating RSH from other causes of acute abdomen.Conclusion:RSH remains a rare but critical diagnostic consideration in patients presenting with acute abdominal pain, particularly when Cullen’s or Grey Turner’s signs are present but pancreatic enzymes are normal. Early diagnosis, facilitated by CT imaging, can prevent unnecessary surgical interventions and guide successful conservative management, thereby improving patient outcomes.

ABSTRACTPulmonary Langerhans cell histiocytosis (PLCH) frequently complicated by pulmonary hypertension (PH), which markedly worsens prognosis. We retrospectively reviewed three institutional PLCH‐PH cases treated with off‐label Sotatercept added to background triple therapy and performed a systematic review of published PLCH‐PH reports (PubMed/Embase through May 2025). Our three patients (ages 69, 62, 49; all female) had progressive vascular disease despite optimized vasodilator therapy. Following Sotatercept, all experienced ≥ 3‐fold increases in 6‐min walk distance and improved functional class. Hemodynamics improved substantially: right‐atrial pressure −78.6%, pulmonary vascular resistance −75.5%, pulmonary artery systolic pressure −58.5%, mean PAP − 56.0%, PA diastolic pressure −51.0%, PAWP − 47.1%; cardiac output and index rose +75.9% and +73.8%, respectively. BNP/NT‐proBNP normalized. Systematic review identified 34 published cases (2010–2025): mean age 37.2 ± 13.7 years, 44.1% female, 45.7% current/former smokers. Reported management strategies included targeted vasodilators, cytotoxic PLCH therapies (e.g., cladribine), smoking cessation, and selective surgery/transplant. In this small series, Sotatercept added to background therapy produced marked clinical and hemodynamic gains in refractory PLCH‐PH. These effects of Sotatercept in Group 5 PH—are encouraging but limited by sample size and retrospective design. Prospective, collaborative studies are needed to define safety, efficacy, and optimal patient selection.

Introduction: Left atrial appendage occlusion (WATCHMAN TM ) device has gained popularity in atrial fibrillation(AF) patients not suitable for systemic anticoagulation. Pulmonary hypertension (PH) is common in this population and may increase risks, particularly during transseptal puncture. The impact of PH on in-hospital outcomes following WATCHMAN TM implantation remains undefined. Methods: We conducted a retrospective study using the 2016–2022 National Inpatient Sample. WATCHMAN TM recipients were stratified by PH status via ICD-10-CM codes. Inverse probability of treatment weighting (IPTW) was used on propensity scores (PS). Logistic regression was used to obtain adjusted odds ratios (aORs) for in-hospital primary (all-cause mortality) and secondary outcomes (including stroke, cardiac arrhythmias, acute kidney injury, procedural complications and major adverse cardiovascular events). P<0.05 was considered statistically significant. Results: Of the 198,670 patients undergoing WATCHMAN TM implantation, 6.26% had PH (mean age 77 years). In the unadjusted cohort, PH patients were more often female, Black, and had higher rates of comorbidity(Table 1). After PS and IPTW, all excellent covariate balance was achieved (Figure 1). On multivariate regression analysis, PH was independently associated with higher odds of all-cause mortality (ACM), aOR 2.74 acute kidney injury (AKI), aOR 1.30, pressor use, aOR 1.91, and composite MACCE, aOR 1.51. In IPTW analyses, PH groups had higher odds of pressor use (aOR 1.80; 1.14 - 2.82; P=0.01), ischemic stroke (aOR 1.56; 1.17 - 2.09; P=0.003 and composite MACCE (aOR 1.77; 1.10-2.85; P=0.02). However, mortality (aOR 1.77; 0.76-4.13; P=0.18), pericardial effusion and cardiac tamponade did not reach significance . PH was however protective for new atrial fibrillation(AF) (aOR 0.78; 0.62-0.99; P=0.032) (Table 2). Conclusion: In this largest to-date inpatient analysis, PH was independently associated with significantly higher pressor use, stroke events and composite MACCE following WATCHMAN TM implantation but had a protective effect from new onset AF. These findings warrant the need for close monitoring and hemodynamic optimization in PH patients prior to undergoing WATCHMAN TM implantation.

BackgroundCritically ill patients experience metabolic alterations that promote muscle atrophy and protein catabolism, increasing morbidity and mortality. While adequate protein provision is essential, the optimal timing remains controversial. Guidelines recommend higher protein targets, but evidence from randomized controlled trials is limited and inconsistent.AimTo evaluate the effects of early versus late protein supplementation on mortality, complications, and clinical outcomes in critically ill patients.MethodsA systematic review and meta-analysis were conducted using PubMed, Embase, Cochrane Library, and Google Scholar (January 2010–December 2022). Studies comparing early and late protein administration in adult ICU patients were included. Primary outcomes were mortality, infectious complications, overall complications, pneumonia, ICU/hospital length of stay, and mechanical ventilation duration.ResultsThirteen studies (8 RCTs, 3 retrospective, 2 prospective cohorts) involving 10,672 patients were analyzed. Mortality (RR = 0.87, 95% CI: 0.74–1.04, p = 0.11; I2 = 36%), overall complications (RR = 0.87, 95% CI: 0.74–1.02, p = 0.08; I2 = 26%), infectious complications (RR = 0.86, 95% CI: 0.58–1.27, p = 0.37; I2 = 65%), and pneumonia (RR = 0.78, 95% CI: 0.41–1.48, p = 0.34; I2 = 0%) showed no significant differences between early protein (EP) and late protein (LP) groups. EP significantly reduced ICU length of stay (MD = −0.28 days, 95% CI: −0.33 to −0.23, p < 0.00001; I2 = 99%) and mechanical ventilation duration (MD = −0.66 days, 95% CI: −0.90 to −0.41, p < 0.00001; I2 = 85%), but was associated with a longer hospital stay (MD = 0.47 days, 95% CI: 0.31–0.63, p < 0.00001; I2 = 98%).ConclusionEarly protein supplementation does not significantly affect mortality or major complications but may shorten ICU stay and ventilation duration. High heterogeneity for some outcomes warrants cautious interpretation.