Pushpagiri Medical College

Previous studies of antidepressant prescribing patterns largely were limited to a single location or time, and very few involved Asia. This Asian Psychotropic Prescription Patterns Consortium study investigated pharmacoepidemiologic trends and factors associated with use and dosing of newer antidepressants across 12 Asian sites in 2003, 2013, and 2023. Data from each site included demographic, treatment setting, clinical features, and type and dosage of antidepressants prescribed. Sociodemographic and clinical variables were examined using univariate methods, followed by multivariable logistic and linear modeling. Of 8357 adult participants (59.8% female), 82.8% received at least one modern antidepressant. Use of these drugs was strongly associated with more recent year, younger age, inpatient status, and affective or anxiety-related disorders. Higher daily antidepressant doses were associated with inpatient status, male gender, more recent year, and younger age. This large, multisite study provides a two-decade overview of evolving antidepressant-prescribing patterns in 12 Asian sites and highlights patient characteristics associated with prescription of newer antidepressants and their dosage. Needed are further studies of psychotropic prescribing practices related to specific illness subtypes and their impact on psychosocial functioning over time among Asian patients.

Background: First rib cartilage undergoes age-dependent calcification, a physiological process influenced by genetic, hormonal, and biomechanical factors, which can stiffen the chest wall and predispose to pseudarthrosis. Pseudarthrosis, a false joint formation, results from mechanical stress on calcified segments and is often mistaken for fractures. This study aimed to analyze calcification patterns and pseudarthrosis prevalence in this population using CT imaging, correlating findings with age and sex. Methodology: This was a retrospective observational, cross-sectional study conducted at a tertiary care center in South Kerala. Eighty patients (160 first rib cartilages) undergoing non-traumatic CT thorax imaging were included; patients with a recent history of trauma were excluded. Images from a 128-slice MDCT scanner were analyzed. Pseudarthrosis was identified by joint-like structures or complete clefts in calcified cartilage, and calcification was graded as absent, minor, or severe. Statistical analysis was performed using IBM SPSS version 21. Results: Pseudarthrosis was found in 51 (31.9%) first rib cartilages, with no significant gender or side predilection. Patients with pseudarthrosis were significantly older (mean 59.82 years) than those without (mean 31.35 years, p<0.001). Calcification was present in 71.9% of cases: minor in 17.5% and severe in 54.4%. Mean age increased with calcification severity. A strong association (p<0.001) was observed between pseudarthrosis and calcification; 94.1% of pseudarthrosis cases occurred in severely calcified cartilages. Conclusion: This study confirms an age-dependent increase in calcification and a strong association with pseudarthrosis, particularly severe calcification.

Gallstone disease during pregnancy poses clinical challenges due to altered physiology and concerns over fetal safety. We present the case of a 28-year-old primigravida who had undergone endoscopic retrograde cholangiopancreatography (ERCP) with biliary stenting for choledocholithiasis prior to conception. She remained asymptomatic during early pregnancy, with normal liver function and no signs of cholecystitis on magnetic resonance cholangiopancreatography (MRCP). After multidisciplinary evaluation, laparoscopic cholecystectomy was performed during the second trimester using fetal-safe anaesthetic techniques and open abdominal access. The procedure was uneventful, and recovery was smooth. She later delivered a healthy term infant via spontaneous vaginal delivery at 37 weeks. This case supports the growing evidence that laparoscopic cholecystectomy, when carefully timed and executed, is a safe and effective treatment for gallstone disease in pregnancy.

Background: There are many approaches while performing a total knee arthroplasty, with the medial parapatellar and the subvastus approaches being the more common among surgeons. While there are many studies comparing both the approaches, there is a lacuna regarding their long term functional outcome in the Indian population. The study aimed to evaluate the functional outcome of TKA through subvastus approach and medial parapatellar approach by using the knee society score, at postoperative day 5, 2 weeks, 6 weeks, 3 months, 6 months, 12 months and 24 months postoperatively. Methods: This randomized controlled prospective study included patients with advanced knee osteoarthritis who underwent elective primary TKA either through the subvastus or medial parapatellar approaches at a tertiary care center in South India from January 2021 to December 2024 .Knee Society Scores were compared in the two groups of patients on postoperative day 5, 2 weeks, 6 weeks, 3 months, 6 months, 12 months and 24 months postoperatively. Results: 300 people were included in the study of which, of which 150 of them underwent a TKA via a medial parapatellar approach and the rest via the subvastus approach. There was an overall significant change over time in KSS scores but the results were comparable between the two groups. The subvastus group showed significantly quicker return of quadriceps function and shorter hospital stays. The medial parapatellar group has the shorter surgical time. Conclusions: Both approaches are comparable in terms of functional outcome, with the subvastus approach showing a longer surgical duration but a quicker return of quadriceps function and shorter hospital stay.

Background: Immunoglobulin M nephropathy (IgMN) is a rare glomerular disease characterized by isolated IgM deposits in the glomeruli. Its clinical presentation and prognosis remain controversial, often overlapping with other glomerular diseases like minimal change disease (MCD). This is a case series describing the clinical and pathological features of patients diagnosed with IgMN at our tertiary care center. Materials and Methods: A retrospective review of renal biopsies performed between January 2023 and December 2023 was conducted. Patients diagnosed as IgMN were included. Clinical data, laboratory parameters, histopathological findings, immunofluorescence results, treatment regimens, and follow-up data were collected. Results: Five patients (four females, one male) were diagnosed with IgMN. The majority presented with nephrotic syndrome with frequent relapses, and steroid dependence. Histopathological examination revealed mesangial hypercellularity and matrix expansion. Immunofluorescence staining showed diffuse 2+/3+ mesangial IgM deposits. Treatment with corticosteroids and rituximab resulted in clinical improvement and stabilization of renal function. Conclusion: IgMN is a distinct clinical entity with a variable clinical course. Early recognition and appropriate treatment, including immunosuppressive therapy, are crucial for achieving remission and preventing disease progression. Further research is needed to better understand the pathogenesis and optimal management of IgMN.

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.

Osteoporosis has been reported among many postmenopausal women (PMW). Studies also evaluated the link between osteoporosis and periodontitis. However, to date, the relationship between these two conditions remains unclear. Therefore, we systematically reviewed the current literature to answer the PECO question "Is there a relationship between low bone mineral density (BMD) and periodontitis in terms of clinical attachment loss among PMW?" Two authors independently searched the major databases using various MesH terms and keywords to identify and screen studies that fulfilled the eligibility criteria. Critical appraisal tools were used to measure the methodological quality of included studies. GRADE evaluation and meta-analysis were also performed. Seventeen studies (3689 participants) were finally included in the review. The majority of the included studies (n = 14) showed an association between low BMD/osteoporosis and periodontitis among PMW. The risk of bias was measured as moderate among the cross-sectional studies and low in case-control studies. Meta-analysis revealed high heterogeneity among the studies (I 2 = 91%). Increased clinical attachment loss in osteoporosis was observed compared to the control group (pooled standard mean difference = 0.75 (0.22-1.28) with P < 0.001). Sensitivity analysis was also done by eliminating the studies with a high risk of bias. The GRADE quality of evidence was low among the studies indicating more clinical research to support the findings. This systematic review and meta-analysis found a relationship between low BMD/osteoporosis and periodontitis. However, more longitudinal studies with larger sample sizes are required to support the findings of this review.

Background: Renal cell carcinoma (RCC) is one of the most prevalent kidney malignancies, with increasing incidence due to the widespread use of imaging techniques. It remains a significant healthcare challenge, particularly in resource-limited settings. Nephron-sparing surgery (NSS) is a preferred surgical approach for small and localized tumors, offering both oncological safety and renal function preservation. Methods: This case series analyzed 15 patients diagnosed with RCC who presented to our tertiary care hospital between 2018 and 2024 with a radiologically confirmed unilateral renal mass. Patients were evaluated through clinical assessment, imaging studies, histopathological examination, and laboratory investigations to confirm the diagnosis and guide treatment decisions. Surgical outcomes, postoperative recovery, renal function preservation, and imaging were assessed. Results: The case series included 15 patients (aged 34–75 years), with a male predominance (10/15), reflecting typical RCC demographics. Clear cell RCC (ccRCC) was the most common subtype. One case of right renal leiomyoma was identified, highlighting the need for differential diagnosis. Histopathological examination confirmed various tumor grades, with imaging (CT and MRI) effectively assessing tumor characteristics. Partial nephrectomy was successful in tumor removal, preserving renal function, especially for tumors between 4 and 7 cm. Postoperative follow-up showed no recurrence in most patients, emphasizing the safety and effectiveness of nephron-sparing surgery in localized RCC. Conclusion: Nephron-sparing surgery (NSS) was safe and effective for localized RCC, especially in tumors 4–7 cm. Most patients had no recurrence and preserved renal function, supporting NSS as the preferred option for achieving both oncological control and renal preservation.