Paras Hospitals

Background:Heart failure (HF) remains a major public health challenge in India, with a need for effective and well-tolerated therapeutic strategies.Objective:The RESTORE-HF study evaluated the real-world effectiveness and safety of torsemide-spironolactone fixed-dose combination (FDC) in Indian patients with HF.Design:Prospective, multicenter, observational study.Methods:This study was conducted across 101 sites in India. Patients aged 18–75 years with HF with reduced ejection fraction and signs of congestion were enrolled and initiated on the torsemide-spironolactone FDC. Participants were followed over 3 weeks from baseline. The primary objective was the change in body weight. Secondary endpoints included changes in New York Heart Association (NYHA) functional class, edema, occurrence of adverse events (AEs), and physician and patient assessments of efficacy and tolerability.Results:Of the 1841 patients screened, 1752 were enrolled, and 1520 completed the study. The mean (SD) age of participants was 58.61 (9.45) years, of whom 61.05% were male. The study showed a significant reduction in mean body weight was observed from 75.54 kg at baseline to 73.13 kg at week 3 (mean difference: 2.41 kg; p < 0.0001). Additionally, an improvement in NYHA functional class and edema was observed over 3 weeks from baseline. Overall, 22.11% patients achieved no-edema stage. Only three mild AEs related to loose stools were reported, and no serious AEs or deaths occurred. Over 98% of physicians and patients rated the therapy favorably.Conclusion:The RESTORE-HF study demonstrated that the torsemide-spironolactone FDC may be associated with a mean body weight reduction of 2.41 kg and may be generally well-tolerated in Indian heart failure patients. Furthermore, the FDC may be linked to significant symptomatic improvement over 3 weeks in real-world clinical practice.

COVID-19 has had a severe impact on the education sector with the closure of schools. The attempts for continuum of education during lockdown, particularly at school level, through digital learning mediums had limited success. The review brought out that very limited literature are available to assess the effect of digital learning on mental health of students. The review developed the operational definition of digital learning and mental health to make it as much inclusive of all mediums and elements for establishing connectedness between digital learning and mental health. The measuring framework, based on the secondary review, have 13 Likert-type five-point rating scale-based statements to capture the negative and positive effects of digital learning on mental health of the students. The measuring framework will be a useful tool for policy makers, counsellors and academicians to assess the interlinkage between digital learning and mental health outcomes, both positive and negative.

Despite robust clinical guidelines and the availability of potent lipid-lowering therapies (LLTs), many very-high-risk dyslipidaemia patients fail to achieve target LDL cholesterol (LDL-C) levels, primarily due to poor adherence and delayed treatment intensification. Two virtual meetings were convened involving a panel of senior cardiologists. Insights were synthesised into an expert framework, developed through polling and collective inputs from expert. The panel strongly recommends LDL-C target of <55 mg/dl (<1.4 mmol/l) for very-high-risk patients. A 2 × 2 matrix was proposed to tailor LLTs based on patient adherence and CV risk, emphasising early initiation of combination therapy and use of inclisiran in non-adherent patients. Patients with very high baseline LDL-C require combination therapy with high-intensity statins, with add-on proprotein convertase subtilisin/kexin type 9 inhibitors, which significantly enhances LDL-C reduction and improves goal attainment. A simplified decisionmaking algorithm that accounts for adherence and promotes timely treatment intensification with combination LLTs needs to be implemented to effectively lower LDL-C in very-high-risk Indian patients in clinical practice.

Introduction:The Girdlestone resection arthroplasty procedure is one of the options for treating an infected hip arthroplasty. It is a surgical procedure that involves resection of the head and neck of the femur, resulting in pseudarthrosis of the hip joint. This is often kept as a last resort for patients with significant co-morbidities or when other treatments have been ineffective. This procedure should be considered a salvage procedure, primarily aimed at pain relief and infection control.Case Report:We report a case of a 73-year-old male who sustained a fracture of the neck of the femur in 2019 and was operated on multiple times for the same. He presented us with an unstable hip.Conclusion:We used a novel technique of Girdlestone resection arthroplasty, which involved stabilization of the proximal femur with Prolene mesh.

Introduction:Total knee arthroplasty is one of the most common orthopedic surgeries performed worldwide. As a major surgery, it has its own spectrum of complications, one of which is a retained surgical drain requiring prompt management. While traditional imaging modalities have limitations in localizing retained drain segments, 3D computed tomography (CT) offers enhanced visualization capabilities.Case Report:We report two cases with retained segments of surgical drains after total knee arthroplasty. In the first case, a 56-year-old female had a retained drain segment that broke after an attempt to remove it. In the second case, a 69-year-old male experienced drain breakage due to impingement between the patella and the femoral component. Both cases were successfully managed using 3D CT for precise localization, enabling minimally invasive retrieval through targeted suture removal rather than extensive wound exploration.Conclusion:Three-dimensional CT can play a valuable role in managing these complications. It can help accurately mark the site and measure dimensions from the proximal suture line, ultimately enabling a minimally invasive re-exploration.

Esophageal stricture refers to a pathological narrowing of the esophageal lumen, causing dysphagia and impairing the patient's quality of life. There are various etiologies including esophageal malignancy, peptic injury, caustic ingestion, post-surgical anastomosis, radiation therapy, and inflammatory disorders such as eosinophilic esophagitis. The primary goal in managing esophageal strictures is to relieve dysphagia by maintaining luminal patency. Endoscopic dilation remains the mainstay of treatment for most benign strictures, with either bougie or balloon dilators. For patients who develop refractory or recurrent strictures that are difficult to manage with dilation alone, adjunctive therapies like intralesional steroid injections, topical or injected mitomycin C, incisional therapy, stent placement, and finally surgery may enhance outcomes and reduce the frequency of repeat procedures. The present review focuses on the basics of dilation and adjunctive strategies for the management of esophageal stricture.

Abstract BACKGROUND ACPs are brain tumors that typically originate in the suprasellar region and are associated with significant morbidity, with patients experiencing visual impairment, pituitary dysfunction and headaches. No systemic therapies are available for ACP, while surgery or radiation can be challenging and result in complications. Almost all ACPs have Wnt pathway-activating mutations (WPAMs), predominantly CTNNB1 activating mutations. FOG-001 is a Helicon™ peptide that competitively inhibits the interaction between β-catenin and TCF transcription factors in the Wnt-signaling pathway. Here we report safety and preliminary efficacy of FOG-001 in ACP patients. METHODS This is a first-in-human, phase 1/2, multicenter study of FOG-001 in patients with WPAM+ solid tumors, treated at doses ranging from 36-480 mg/m2 (NCT05919264). Patients with histologically confirmed, locally-advanced ACP are eligible. Disease assessments, per RECIST v1.1, are performed every 8 weeks for 48 weeks and every 12 weeks thereafter. Primary objective is safety and tolerability of FOG-001. Secondary objective is anti-tumor activity. RESULTS As of May 11, 2025, 3 ACP patients have received FOG-001 monotherapy at doses of 144 mg/m2 (n=1) and 360 mg/m2 (n=2). All patients are male and median age is 42 years (range 19-62). All patients had prior surgery and 1 received radiation. All treatment-related adverse events (TRAEs) were low-grade (no Grade ≥3 TRAEs). The most common TRAEs were hyponatremia (n=2) and thrombocytopenia (n=2), both reversable. No treatment-related serious adverse events or dose reductions have been reported. Tumor size has decreased in all patients, with one patient achieving a partial response (PR), with a 48.0% reduction, and the other two stable disease (24.0% and 19.2% decrease). CONCLUSIONS FOG-001 has been well tolerated in patients with locally-advanced ACP. All patients have had tumor size reductions, including one PR, suggesting that the Wnt-signaling pathway is an actionable target in ACP.

Over the past two decades, technological refinements, the introduction of newer tools, and both physician and patient preference for catheter-based techniques have contributed to a global increase in endovascular interventions. Despite these advancements, operators continue to encounter unforeseen hardware-related complications stemming from various factors. Globally, reports of broken or dislodged fragments of hardware—such as catheters, guidewires, angioplasty balloons, and stents—have become increasingly common. These fragments may result in life-threatening consequences. Accordingly, interventionists must remain vigilant and proficient in various retrieval techniques. We present two cases involving successful percutaneous retrieval of broken, dislodged, and embolized angiographic catheters from the coronary and renal arteries, each performed using a distinct technique.