Armed Forces Medical College

Painful ulcers have shown high economic and epidemiologic impacts. This is a novel study to assess the analgesic effectiveness and safety of topical sevoflurane during the debridement of a painful ulcer. This study is a prospective observational study that includes 100 patients above the age of 20 years, with chronically infected ulcers (more than 4 weeks) associated with pain (baseline visual analog scale (VAS) score > 8) of various etiologies requiring dressing/debridement. Debridement was done with IV analgesic drugs only or both IV analgesia and topical sevoflurane on alternative dressing as a crossover design. Group 1 (odd day) underwent IV analgesic alone—Injection Paracetamol 1 g IV, and Group 2 (even day) underwent IV analgesic + topical sevoflurane—Injection Paracetamol 1 g IV + sevoflurane topically applied. Dose of sevoflurane—1 mL/1 cm2 of ulcer area. The gauze piece was soaked with sevoflurane and kept over the ulcer for 7–10 min before starting the dressing/debridement. The patient was kept blinded, and the VAS score was recorded every time. The mean age was 66 ± 12 years, with female patients on the higher side. The etiology includes 38% arterial ulcers, 35% venous ulcers, and the rest traumatic ulcers. There was a significant reduction in the mean VAS scores during subsequent dressings. This novel study group had a dominant of elderly patients who were suffering from chronic ulcers. Sevoflurane was found to be beneficial in managing pain in these patients. Its use in the elderly population is particularly promising due to its potential to alleviate patients suffering from chronic ulcers. This study opens up new possibilities for utilizing sevoflurane in pain management beyond its traditional use in anesthesia.

PT-CY use in T cell-replete haploidentical HCT has significantly improved outcomes. However, hyperhydration with MESNA in CY administration poses a challenge, in patients with cardiac/ renal problems. PT-CY also increases VOD risk with prior exposure to hepatotoxic drugs. Katsanis et al. in a phase Ia trial in patients undergoing HCT for hematological malignancies showed that partially replacing PT-CY with PT-BEN had comparable outcomes to conventional PT-CY. We conducted an ambispective study in 54 patients [haplo (39), MSD(14), and MUD(1)] with nonmalignant hematological disorders and hematological malignancies in pediatric and adult patients undergoing HCT (MAC/RIC) from February 2019 to May 2024. GvHD prophylaxis comprised of PT-CY/BEN (PT-CY 50 mg/kg Day +3; PT-BEN 90 mg/m² Day +4) in a prospective arm (n = 21) and PT-CY/CY (50 mg/kg on Days +3, +4; comparator arm) in ambispective (prospective 12; retrospective 21) arm. In both groups, immunosuppression with CNI and MMF was also given. PT-CY/BEN was comparable to PT-CY/CY in terms of safety, efficacy, and GVHD prevention. In the PT-CY/BEN group, there was earlier neutrophil (0.008) and platelet (0.0057) engraftment with significantly lower BK viremia. Incidence of bacterial infection, TRM, EFS, and OS were comparable in both groups.

Background The current study’s objective is to evaluate the drug prescribing patterns and analyze such patterns using the 2023 AGS Beers Criteria ® , among senior patients over 65 years old receiving care at the geriatric outpatient department (OPD) at a teaching hospital in Western India. Methodology A total of 100 patients, 50 males and 50 females, who met the inclusion criteria and consented to the study at the geriatric OPD of the hospital had their prescriptions examined. The frequency of prescriptions for potentially inappropriate medicines (PIMs) was examined using the 2023 revision of the AGS Beer Criteria ® . The Chi-square test was used to analyze the data and compare the proportions of polypharmacy between genders as well as the relationship of polypharmacy with the frequency of PIM prescriptions. Results Seventy-five formulations out of 617 formulations were found to be PIMS in 74 patients. PIMs most commonly prescribed were pantoprazole (28 individuals), followed by aspirin and glimepiride ( P = 0.05). A statistically significant correlation ( P > 0.05) was observed between PIM prescription and polypharmacy. Conclusion This study highlights the need for guidelines to prevent PIM and drug-related issues to ensure the safe and effective use of medications in the elderly.

Background Dietary measures have been used as an adjunctive therapy in the management of psoriasis. Intermittent fasting (IF) is an eating pattern in which energy is not consumed for a fixed duration, resulting in metabolic switch from liver-derived glucose to adipose-derived ketones. The data regarding effectiveness of IF in psoriasis are limited. Aim and Objectives The aim of this study was to assess efficacy of IF in patients with chronic plaque psoriasis. The primary outcome of the study was change in psoriasis severity as measured by psoriasis area and severity index (PASI) at 28 weeks. The secondary outcome measures were change in metabolic parameters and biomarkers for atherosclerosis in each group. Patients and Methods The study was designed as a randomized parallel group trial. Clinical parameters, psoriasis severity, fasting and postprandial blood sugar, lipid profile, high sensitivity C-reactive protein (hsCRP), vascular endothelial growth factor (VEGF), and interleukin 6 (IL-6), were measured using standard methods at baseline, 16 weeks, and 28 weeks. Patients were randomized to receive methotrexate in the dose of 0.3 mg/Kg/week with or without intermittent fasting. Results A total of 120 patients were randomized in two groups of 60 each: group 1 (methotrexate) and group 2 (methotrexate and intermittent fasting). The mean age, mean duration of disease, PASI, and dermatology life quality index (DLQI) in group 1 were 45.5 (±12.9) years, 5.06 (±5.5) years, 17.1 (±6.7), and 12.33 (±5), respectively. The mean age, mean duration of disease, PASI, and DLQI in group 2 were and 42.9 (±14.6) years, 6.91 (±6.2) years, 16 (±4.3), and 11.9 (±4.3), respectively. There was no statistically significant difference in baseline parameters in two groups. In both the groups, there was a statistically significant difference in PASI, DLQI, VEGF, and hsCRP from baseline to 16 and 28 weeks. At week 16, 44 (73.3%) patients in group 1 and 47 (78.3%) in group 2 achieved PASI50 ( P = 0.8). At week 28, 16 (36%) in group 1 and 27 (54.4%) patients in group 2 maintained PASI50 ( P = 0.054). There was a statistically significant weight and waist circumference reduction at 16 weeks and 28 weeks in group 2. There was a statistically significant reduction in VEGF, IL6, and hsCRP at 28 weeks in group 2 as compared to group 1. Limitations The small sample size and loss to follow-up are major limitations of the study. Conclusion Intermittent fasting using 16: 8 protocol is easy to perform and a safe and effective adjuvant for managing severe chronic plaque psoriasis. It helps in maintaining remission and results in improvement in metabolic parameters and markers of vascular inflammation.

Introduction Surgical site infections (SSIs) after cardiac surgery poses a serious challenge. The foremost reason for contamination in operating rooms (OR) is airborne. Effective surveillance by air sampling or settle techniques is crucial in maintenance of air quality in cardiac OR. Methodology The air quality of two different cardiac OR (adult and pediatric) with laminar air flow system and HEPA filters in place was studied with an aim to compare the plate and air sampling technique. Sampling was done both passive and actively using a Surface Air System air sampler. Muller Hinton Agar plates incubated at 36 °C were used, and total viable count assessment was calculated using Koch’s sedimentation method. Results Colony-forming unit (CFU) counts showed significant differences at various time points in both adult and pediatric OR. The settle plate as compared to the air sampling device correlated but showed lesser CFUs across pre, mid, and postsurgical periods (P < 0.05). The adult cardiac OR had significantly higher bioload than pediatric OR (P < 0.05). The results suggested that both the technique was good for air quality monitoring in OR. Conclusion The study compares the two-sampling technique in adult and pediatric cardiac OR, finding higher levels of bioload in adult ORs possibly due to more personnel and longer surgeries. Although settle plates offer basic contamination assessment, air samplers detect specific events efficiently. Using either air sampler or settle plate technique for microbial surveillance in cardiac ORs is suggested for monitoring and prevention of SSI.

Giant cell arteritis (GCA) is a medium-to-large-vessel vasculitis affecting both intracranial and extracranial vessels. It generally presents with constitutional symptoms, headache, jaw claudication, and vision loss. Presentation as thunderclap headache is unusual. We present an unusual case of thunderclap headache in a middle-aged individual who was eventually diagnosed with GCA. The patient was diagnosed with a case of GCA based on clinical findings and temporal artery biopsy with a good response to treatment. GCA should be considered differential of thunderclap headache with normal imaging and cerebrospinal fluid findings.

Antiphospholipid antibody syndrome (APS) is characterized by vascular thrombosis. Somewhat paradoxically, some patients with this disease develop diffuse alveolar haemorrhage. This bleeding is usually a delayed manifestation, occurring a few years after the onset of other manifestations and diagnosis of APS. We encountered a patient with an unusual presentation, i.e. onset with diffuse alveolar haemorrhage as well as vascular thromboses. He also had autoimmune haemolytic anaemia, which is infrequent in APS. The diagnosis of APS was based on elevated levels of IgM and IgG anti-cardiolipin antibody and IgG and IgM beta-2 GP1 antibodies. Treatment with high-dose glucocorticoids, anticoagulants and rituximab led to a decline in levels of these antibodies and was associated with a good and lasting clinical response.

Background: Oral tongue squamous cell carcinoma (SCC) has the most nodal metastasis among all oral cancers and this nodal involvement considerably lowers survival. The presence of occult metastasis in lower neck levels or skip metastasis to level IV or V complicates the effectiveness of supraomohyoid neck dissection (SOHND) for node-negative (N0) T1/T2 oral tongue SCC. Aim & objective: To evaluate the necessity of extended SOHND in managing N0 T1/T2 oral tongue SCC. Materials & methods: This retrospective cross-sectional study utilized institutional records of all histopathologically confirmed T1/T2 oral tongue SCC cases with N0 neck from a mixed Indian population who underwent extended SOHND between 2008 and 2024. The primary outcome was the positivity rate of level IV. Covariates included demographic factors such as age and sex. Positivity rates and their 95% confidence intervals were calculated. Results: The study included 111 cases meeting the inclusion and exclusion criteria. Positivity rates for levels I-III were 35.5% (32/111; 95% CI = 0.16-0.47), while positivity for level IV was 9% (10/111; 95% CI = 0.0083-0.13). Occult metastasis to level IV was found in only 6.3% (7/111) of cases. Conclusion: The likelihood of occult metastasis to level IV in T1/T2 N0 oral tongue SCC is very low (6.3%). The extended SOHND covers this extremely low risk (6.3%). Neglecting to address level IV in cases of occult metastasis could result in missing a crucial positive node, leading to a failure to administer necessary postoperative radiotherapy.

Introduction Obesity among reproductive-aged women increases the risk of gestational diabetes, preeclampsia, menstrual disorders, infertility, and delivery complications. Despite rising global obesity rates, clinical guidelines often lack comprehensive management strategies. This review examines evidence-based approaches to optimize maternal and gynecologic outcomes through multidisciplinary care. Methods A comprehensive literature review was conducted on obesity-related obstetric and gynecologic complications, including national and international guidelines, clinical trials, and observational studies. Key management strategies such as preconception care, lifestyle interventions, pharmacologic therapies, surgical treatments, and digital health solutions were analyzed. Results Obesity is linked to multiple adverse maternal outcomes, including increased rates of gestational diabetes, preeclampsia, prolonged labor, postpartum hemorrhage, and fetal complications. Gynecologic conditions such as polycystic ovary syndrome (PCOS), endometrial hyperplasia, and infertility are also exacerbated by obesity-related metabolic changes. Effective management strategies involve a combination of preconception weight loss interventions, structured gestational monitoring, pharmacologic treatments, and surgical approaches like bariatric surgery for high-risk cases. Telehealth interventions and digital health solutions provide an opportunity to bridge the gap in healthcare access, particularly in rural areas. However, challenges remain due to provider bias, adherence issues, and evolving clinical guidelines. Conclusions Integrating medical, surgical, and digital health strategies is essential for improving outcomes in obese women. Expanding telehealth, enhancing provider training, and developing culturally tailored interventions will promote equitable healthcare. Future research should focus on region-specific solutions to optimize maternal and fetal health.

Background The Equanimity Scale (ES-16) is a psychometric tool developed to measure an individual's level of equanimity, which refers to a state of psychological stability and composure, especially under stress. Given the importance of cross-cultural research in psychology, translating the ES-16 into different languages is essential. This study aimed to translate the Equanimity Scale-16 into Hindi and evaluate its psychometric properties. Methods The translation process involved forward and backward translation, expert review, and pilot testing. The psychometric properties included assessments of reliability and validity using a sample of 83 participants from a population well versed in both Hindi and English. Factor analysis was performed to examine the factor structure of the translated scale. Results The translated version demonstrated Cronbach's Alpha values as 0.725. Good internal consistency, construct validity, and cultural relevance, making it a valuable tool for cross-cultural studies in equanimity. Conclusion The translated version of ES-16 will provide an objective measure of Equanimity and will thus be useful in Mindfulness based intervention for the Hindi speaking population, which covers the majority of population in India

Telesurgery is a rapidly evolving field in robotic assisted surgery that allows surgeons to operate on patients remotely with the help of robotic systems. This has allowed increased access to specialized care reducing geographic barriers and improving overall surgical outcomes in remote locations. An important challenge that hinders its widespread adoption is latency period which is primarily a delay that exists in data transmission between the surgeon and the robotic system. It is essential to determine strategies that can reduce it to ensure greater precision, dexterity, and patient safety. A literature review was conducted using PubMed, Embase, Google Scholar, and Cochrane Library. After screening the articles for relevance, data were synthesized to present a narrative review on the current challenges and emerging solutions in latency reduction. Those articles were included that discussed telesurgery with latency periods, network infrastructure, AI driven latency compensation, and cybersecurity. After removing 8 duplicates, a total of 238 articles were identified in the literature search out of which 175 articles were excluded after title and abstract screening done by two independent reviewers. 63 full text articles were assessed for eligibility. Latency period greatly impacts telesurgical performance with an ideal value being less than 200 ms. This threshold is essential for effective surgical precision, and safety. The adoption of ultra-low latency 6G wireless networks, quantum computing, and artificial intelligence can enhance telesurgical performance. Ethical, legal, and cybersecurity challenges must be addressed for widespread adoption of telesurgery. Latency in telesurgery arise due to a multitude of factors, including network infrastructure, geographic barriers, cybersecurity protocols, hardware, and software limitations. AI-based algorithms, edge computing, advancements in 5G technology, along with optimum haptic feedback mechanisms are promising solutions in reducing latency.

Angiosarcoma is an uncommon malignant tumor that primarily affects older people and affects vascular endothelial cells. This tumor is quite deceptive and could be mistaken for a benign lesion based on its presentation and progression. We describe the case of a 50-year-old male who had post-traumatic left occipital edema that appeared benign on radiography and clinical examination. The index of suspicion increased due to the sudden increase in size. The excised specimen’s histomorphology revealed a cellular tumor that was mitotically active with large areas of necrosis. Vimentin, CD34, CD31, and FLI1 were all positive in the tumor cells. Clinically benign looking scalp swelling turning out a highly aggressive fatal malignancy was surprising in this case. Histopathology and evaluation by immunophenotyping remain the gold standard in timely diagnosis.

A 46-year-old male, a known case of lepromatous leprosy on regular multi-drug therapy for the past 6 months presented with painless swelling of the left foot for 3 weeks duration. e patient provided a history of numb legs with painless recurrent trophic ulcers on both feet for the past 2 years. Clinical examination revealed a mild but diffuse swelling affecting the left forefoot [Figure 1]. e left forefoot was warm to touch, and on measuring temperature with an infra-red thermometer, it was 4.2°F warmer than the contralateral side (99.3°F vs. 95.1°F) [Figure 2]. X-ray of the left foot revealed erosion of the first metatarsophalangeal joint with multiple intra-articular loose bodies with distension of joint space and juxta-articular osteopenia. Similar changes were also noted in the fifth metatarsophalangeal joint Figure 1: Diffuse swelling of the left foot and the first two toes. Erythema is not appreciable in skin of colour.

Background The combinational assessment of susceptibility-weighted imaging and vessel wall imaging on magnetic resonance imaging (MRI) in patients of unruptured intracranial aneurysms presenting with sentinel headache can show microbleeds and inflammatory changes in the wall of the aneurysms and thus predict the future risk of rupture of the aneurysm. In this pilot study, we hypothesized that combination of vessel wall imaging and susceptibility-weighted imaging would be more informative to assess the changes in the wall of aneurysm in patients with sentinel headache. Materials and Methods Fifteen patients of intracranial aneurysms with history of sentinel headache underwent advanced MRI. Susceptibility-weighted imaging images were evaluated for presence of any hypointensity suggestive of microbleeds along the wall of the aneurysm. The postcontrast vessel wall images were evaluated for presence of any wall enhancement. Results Susceptibility foci suggestive of microbleeds on susceptibility-weighted imaging in the wall of the aneurysms were seen in 14 intracranial aneurysms. Vessel wall imaging showed enhancement of wall in 10 cases and nonenhancement in five cases. Enhancement of the wall on MRI was observed more in aneurysms imaged early after the onset of symptoms (<45 days) than in those imaged late (>45 days). Conclusion Our observations might be indicative of temporally evolving pathologic changes in the aneurysmal wall in unruptured aneurysms with sentinel headache. Combining advanced magnetic resonance sequences can help in elucidation of the wall pathology and rupture risk assessment of unruptured aneurysms, and these observations could be incorporated in future studies.