Medical Trust Hospital, Cochin, Kerala

We evaluated brentuximab vedotin (BV) as maintenance therapy after autologous stem cell transplantation (ASCT) in 353 patients with relapsed/refractory Hodgkin lymphoma (HL). Of these, 52.6% received BV prior to ASCT. The five-year overall survival (OS) and progression-free survival (PFS) from the start of BV maintenance were 85.1% and 69.9%, respectively. Multivariable analysis revealed that age at ASCT (HR 1.17, P = 0.037), disease status (HR 3.61, P = 0.002), and BV treatment before ASCT (HR 0.40, P = 0.033) significantly impacted OS. Disease status at ASCT was the only factor significantly associated with PFS (HR 3.09, p < 0.001) and relapse risk (HR 3.33, p < 0.001). Although a trend toward improved PFS (HR 0.59, p = 0.053) and lower relapse risk (HR 0.57, p = 0.051) was observed in patients treated with BV before ASCT, the data were not statistically significant. Patients in complete remission (CR) at ASCT showed similar 2-year OS (94.6% vs. 99.2%, P = 0.3) and PFS (84.6% vs. 89%, P = 0.3) regardless of BV pre-transplant. In those not in CR, OS (83.1% vs. 93.6%, P = 0.076) and PFS (51.5% vs. 75.3%, P = 0.039) were higher in those previously treated with BV. This large study emphasizes BV maintenance post-ASCT, even in patients pre-treated with BV, ang highlights disease status as a key prognostic factor.

Background Although shock following cardiac arrest is common and contributes significantly to mortality, the influence of the modalities used to manage the hemodynamic situation, particularly with regard to fluid balance, remains unclear. We evaluated the association between positive fluid balance and outcome after out-of-hospital cardiac arrest (OHCA). Methods We conducted a multicenter study from August 2020 to June 2022, which consecutively enrolled adult OHCA patients in 17 intensive care units. The primary endpoint was 90-day survival. Multivariate Cox analysis, propensity score matching and landmark analysis were performed, along with several sensitivity analyses. Results Of the 816 patients included in our study, 74% had a positive fluid balance, and 291 of 816 patients (36%) were alive at 90-day. A positive fluid balance was associated with mortality after adjusted multivariate analysis (HR = 1.8 [1.3 – 2.3], p < 0.001), after propensity score matching (n = 193 matched patient pairs, HR = 1.6 [1.1 – 2.1], p = 0.005) and after landmark analysis. We reported a dose-dependent association between fluid balance and mortality. Patients with a positive fluid balance were more likely to need renal replacement therapy (10% vs. 2%, p = 0.001) and had a lower minimum PaO2/FiO2 ratio in the first seven days (158 vs. 180, p < 0.001). Conclusions After cardiac arrest, a positive fluid balance is consistently associated with a worse outcome. Pending further data, a restrictive fluid therapy strategy may be beneficial in post-OHCA patients. Trial registration: ClinicalTrial.gov cohort AfterROSC-1 NCT04167891 registered November 13th, 2019, ethics committees 2019-A01378-49 and CPP-SMIV 190901. Graphical abstract Supplementary Information The online version contains supplementary material available at 10.1186/s13054-025-05391-x.

Selective anti-polysaccharide antibody deficiency (SPAD) predisposes to encapsulated bacterial infections. The diagnosis is challenging, and literature reports are scarce in adult patients, we therefore aim to describe the demographics, infectious complications, therapeutic strategies, and outcome of adult patients. We conducted a multicenter observational study involving 55 adult patients with SPAD. The median [interquartile range, IQR] age was 45 [36–60] years at diagnosis of SPAD, and 75% of patients were female. Twenty-one patients (38%) had a history of allergic and/or inflammatory disease, mainly asthma (n = 12), and rheumatic diseases (n = 6). Twelve patients (22%) were diagnosed after a single severe infection and 43 (78%) in a context of recurrent benign and/or severe infections. In the latter, the median time from first infections to diagnosis was 74.5 [33–167] months. Diagnostic delay was significantly higher in patients presenting with bronchiectasis than in those without (122 months [33–219.5] vs 24 months [14.5–74.5], p = 0.0042). In 22 patients (40%) receiving immunoglobulin replacement therapy (IgRT), the mean (min–max) frequency of antibiotic courses decreased from 7.9 (2–18) to 0.7 (0–2) courses per year (p < 0.001) with a median follow-up period of 46 [27–73] months. Patients diagnosed after a single severe infection did not have any relapse during a median follow-up of 85 [80.5–104.5] months after diagnosis. Adult patients with SPAD have allergic or inflammatory disorders which could contribute to the diagnostic delay. IgRT is effective in preventing recurrent infections. Further studies are warranted to confirm if SPAD should be considered after a first unexplained severe bacterial infection.

Introduction Obesity in adolescents is associated with increased mental distress and psychiatric disorders, both of which are under-diagnosed in clinical practice. Methods We designed a mixed methods study, to explore the practical challenges of this screening and its consequences. The qualitative part interviewed 20 physicians: non psychiatrist physicians and child and adolescent psychiatrists – practicing in various specialized settings. The quantitative part examined self-assessment questionnaires and psychiatric clinical diagnoses in 242 patients admitted for inpatient appraisal of obesity. Results 7.9% reported severe depressive symptoms and 71.9% severe anxiety symptoms. Among this cohort, 28.5% were diagnosed with anxiety disorder and 16.9% with depression disorder. Both qualitative and quantitative data show that a large share of adolescents with obesity experience mental health distress, often intense. However, in most of these adolescents, this distress is not diagnosed as a mental health condition, thus creating a discrepancy which we named a “gray area” of psychological suffering. Conclusions Screening adolescents with obesity for both mental health distress and disease should be systematic. Frontline professionals need improved training and referral pathways and resources.

Solitary fibrous tumor (SFT) associated with hypoglycemia is termed Doege-Potter syndrome (DPS). It may be found in almost any site of the body, but most predominantly in the intra-thoracic region, and is a rare differential diagnosis of recurrent hypoglycemia. A 73-year-old, hypertensive, non-diabetic man presented with recurrent hypoglycemic episodes, and examination revealed diminished breath sounds in the right lower lung fields. Investigations demonstrated that the patient had a mass lesion in the right thorax. Excision of the mass lesion produced biopsy samples, and the histopathological examination of the tissue was suggestive of SFT. Patients with recurrent hypoglycemia must always be screened and treated for DPS. SFTs with non-insulin-induced hypoglycemia (NICTH) are likely to be malignant. Early diagnosis and a multidisciplinary approach are pivotal in the management of the disease. Complete surgical excision of the mass lesion is the standard of care for SFTs with DPS.

Background: Football is a high-impact game with high-load running, sprinting, agility, sudden direction-changing. Groin pain is a common injury in football players due to high-speed running, changes in direction, jumping and landing, and kicking. Isometric hip adduction strength is decreased in groin-injured players. The modified Holmich exercises help in hip adductors and pelvic muscles strengthening, and core stabilisation. The objectives of this study are to find out the effect of Modified Holmich Exercise in Improving Hip Adductor Strength, Agility, Sprint Time Among Previously Groin Injured Sub Elite Football Players. Methods: On the basis of selection criteria, 30 subjects were selected and divided equally into Group A (Experimental Group) receiving modified Holmich exercises along with conventional treatment and Group B (Control group) receiving conventional treatment. Sprint time, agility and hip adductor strength were measured at the beginning and after 10-weeks of intervention using 30-meter sprint test, Illinois test, modified sphygmomanometer test respectively. Results: Paired t test showed significant improvement in Sprint time, agility and hip adductor strength within the group. In unpaired t test, sprint time, agility and hip adductor strength expressed significant improvement in the experimental group than control group. Conclusion: There was improvement in Sprint time, agility and hip adductor strength within experimental and control group. The experimental group shows more significant improvement than control group in all the three parameters. Key words: Agility, Football, Hip Adductor Strength, Modified Holmich Exercise, Sprint Time

Background Diagnostic delay is one of the greatest challenges in spondyloarthritis (SpA). Better disease knowledge and more accessibility to new image technology could have a positive impact on time to diagnosis. Objectives The objectives are (1) to evaluate trends in time to diagnosis in SpA patients during the last decades and (2) to determine the association between clinical presentation and diagnostic delay. Methods Cross-sectional, retrospective international study, including 3984 patients with SpA diagnosis. Statistical analysis Delay in diagnosis was calculated and patients were stratified according to decade of disease onset and initial clinical presentation. Multivariate logistic model, using an early diagnosis (≤2 years) as dependent variable was used. P value<0.05 was considered statistically significant. A possible interaction between decade of disease onset and initial clinical presentation was performed. Results The overall median delay from disease onset to SpA diagnosis was 2.9 (p25−75=0.3–9.8) years. Diagnostic delay showed a progressive decrease during the last decades, patients with disease onset after 2010 showed a shorter delay in diagnosis than those with disease onset during 2000–2010 ( m 2.00 vs 0.41 years, p<0.01). Age at disease onset (OR 1.02), axial symptom (OR 16.25), peripheral arthritis (OR 6.81), decade at disease onset (OR 3.80) and extra-musculoskeletal manifestation (OR 2.89) were associated with an early diagnosis, while female gender (OR 0.66) was inversely associated. Conclusions The proportion of patients with early SpA diagnosis improve from 15% before 1980 to 88% when first symptoms occurred after 2010. Type and number of initial clinical presentation were independent predictors of time to diagnosis.

Objective Upper Respiratory Tract Infections (URTIs) pose a significant public health challenge worldwide. Azithromycin has been approved for its management due to broad-spectrum antibacterial properties and favorable pharmacokinetics. This study aims to evaluate the effectiveness and safety of Azithromycin in treatment of URTIs in a real-world setting. Methods This multicenter, retrospective, observational study was conducted across 184 Ear, Nose, and Throat (ENT) clinics in India. Medical records of adults (≥18 years) who received Azithromycin 500 mg for 5 days to treat URTIs and provided consent were retrieved. Sore throat, fever, and interference with daily activities were assessed alongside clinical signs (pharyngeal erythema, tonsillar erythema, and exudates/plugs on tonsils). Clinical global impression of change was evaluated using a 7-point rating scale. Statistical analyses included paired t-tests for mean score changes and the McNemar–Bowker test to evaluate symptom improvement from baseline to day 5. Results Data from 884 patients were analyzed. With 5 days of Azithromycin therapy, significant reduction in proportion of patients reporting URTI symptoms and signs was noted. Proportion of patients reporting sore throat was reduced from 95.8% to 10.4%; work absenteeism dropped from 47.9% to 1%; and fever subsided in 97.4% of patients. Clinical signs also improved notably, with moderate-to-severe pharyngeal erythema (90.9% of patients at baseline to 13.6% at day 5), tonsillar erythema (84% of patients at baseline to 9.6%), and tonsillar exudates (58.3% patients at baseline to 4.4%). Also, 97.2% of patients showed considerable improvement in their Clinical Global Impression score with Azithromycin. Adverse events were reported by 2.37% of patients. Conclusion Azithromycin demonstrates a significant improvement in clinical manifestations of URTIs, with a low incidence of adverse events.

This study evaluated initial antihypertensive drug prescription patterns in Indian healthcare settings. An observational, cross‐sectional, prospective prescription registry analyzed prescriptions for 4723 newly diagnosed hypertension patients. Additionally, it investigated the extent to which physicians adhered to either European or Indian hypertension guidelines. Angiotensin receptor blockers (ARBs) were the most commonly prescribed drugs, given to 79% of patients, followed by calcium channel blockers (CCBs) at 55%. Diuretics and beta‐blockers (BBs) were prescribed to 27% and 17% of patients, respectively. Monotherapy was administered to 35% of patients, while combination therapies were more prevalent, with dual therapy at 51% and regimens involving three or more drugs prescribed to 14%. Among multi‐drug treatments (n = 3082, 65%), 98% received fixed‐dose combination tablets. The most common combinations were ARB + CCB (26%), ARB + diuretic (12%), and ARB + CCB + diuretic (8%). Key predictors for an increasing number of prescribed drugs included statin use/dyslipidemia, age, blood pressure level, and diabetes. Non‐adherence to hypertension guidelines was evident as 1364 patients classified from moderate to very high risk received monotherapy. Of these, 496 patients had grade 2 or 3 hypertension. Additionally, 88 patients received the undesirable combination of ACEi + ARB, and 267 (15.9%) type 2 diabetes mellitus (T2DM) patients did not receive RAS‐blockers (146 on monotherapy). The findings reveal a trend toward utilizing ARBs, CCBs, and combination tablets, indicating improved adherence to guidelines. However, a significant number of patients did not receive appropriate treatment, highlighting areas for improvement in prescription practices.

Background and Objective The discrepancy between donor organ availability and demand leads to a significant waiting‐list dropout rate and mortality. Although quantitative tools such as the Donor Risk Index (DRI) help assess organ suitability, many potentially viable organs are still discarded due to the lack of universally accepted markers to predict post‐transplant outcomes. Normothermic machine perfusion (NMP) offers a platform to assess viability before transplantation. Thus, livers considered unsuitable for transplantation based on the DRI can be evaluated and potentially transplanted. During NMP, various viability criteria have been proposed. These criteria are neither homogeneous nor consensual. In this review, we aimed to describe the viability criteria during NMP and evaluate their ability to predict hepatic graft function following transplantation. We conducted a PubMed search using the terms ‘liver transplantation’, ‘normothermic machine perfusion’ and ‘assessment’, including only English publications up to February 2024. Viability assessment during NMP includes multiple hepatocellular and cholangiocellular criteria. Lactate clearance and bile production are commonly used indicators, but their ability to predict post‐transplant outcomes varies significantly. The predictive value of cholangiocellular criteria such as bile pH, bicarbonate and glucose levels remains under investigation. Novel markers, such as microRNAs and proteomic profiles, offer the potential to enhance graft evaluation accuracy and provide insights into the molecular mechanisms underlying liver viability. Combining perfusion parameters with biomarkers may improve the prediction of long‐term graft survival. Future research should focus on standardising viability assessment protocols and exploring real‐time biomarker evaluations, which could enhance transplantation outcomes and expand the donor pool.

Introduction This study aimed to evaluate the safety and efficacy of HoLEP in patients aged > 85 years with indwelling catheter (IDC). Methods We retrospectively analyzed our bicentric HoLEP database to identify consecutive patients with IDC and trial without catheter (TWOC) failure who underwent surgery between June 2012 and April 2020. Our primary focus was on the population over 85 years of age; Patients under 70 years of age were used as controls. We evaluated the rate of postoperative spontaneous micturition, adverse events and mortality, as well as catheterization duration, hospital stay, and rate of urinary incontinence. Results In total, 144 patients were included, with 71 (49.3%) and 73 (50.8%) in the ≥ 85 and control group, respectively. The median [IQR] prostatic volume and Charlson score was 90 [70–130] vs. 90 [65–120] mL and 6 [5–7] vs. 3 [2–4] in the ≥ 85 and control groups, respectively. Postoperatively, the rates of major complications (2% vs. 3%) and transfusion (11% vs. 9%) were not significantly different. The median length of stay (2 [1–3] vs. 1 [1–2]; p = 0.03) and rate of TWOC failure during hospitalization (24% vs. 5%, p < 0.001) were significantly higher in the ≥ 85 group. At 3 months and one year follow-up visits, 0 and 10 patients (14.1%) in the ≥ 85 group and 0 and 2 patients (3%) in the control group died, respectively. One year after surgery, 69 (97%) and 73 (100%) (p = 0.2) patients in the ≥ 85 and control groups, respectively, could void spontaneously. Conclusion HoLEP is a safe and effective procedure for elderly patients with indwelling catheters. At one year, 97% of patients achieved spontaneous voiding, while the urinary incontinence rate was 11%. The 1-year mortality rate was 14%, comparable to that of the general male population of the same age.

Background Back pain or neck pain is the most common complaint patients present to our outpatient department. It may be associated with or without radiating pain and neurological deficits. The spinal intradural tumors causing pain with or without radiating symptoms are not uncommon in our spine practice. It may be extramedullary or intramedullary. It is readily diagnosed by clinical examinations and radiological investigations. Most of the time, the treatment option is surgery which is decompression and excision of the tumor with or without instrumentation. Materials and Methods It was a retrospective study done between 2018 and 2023. All the patients were followed for 1 year. It includes the cervical, thoracic, lumbar, and sacral regions. All patients had a posterior approach, surgery done by a single surgeon. The tumor material was sent for histopathological examinations. The follow-up was done neurologically by the Frankel scoring system at 3 months, 6 months, and at the end of 1 year and radiologically by magnetic resonance imaging at the end of 1 year. Results and Discussion Most of the patients had schwannoma on histopathological examination. All patients had excellent postoperative outcomes. One patient had a dural leak complication treated by dural repair. None of the patients had recurrence. The spinal intradural tumor has a good prognosis due to its benign nature. The selection of the patients at the right time during disease and planning of surgery which is complete surgical excision carries a good prognosis.

Staphylococcus warneri is the Gram-positive coagulase-negative Staphylococcus . Spondylodiscitis caused by S. warneri is rare. Only a few cases have been reported in the literature. The presentation of spondylodiscitis by S. warneri is atypical. Usually, the patients present with chronic back pain mechanical in nature. Our case is a middle-aged man with a chronic dull aching back that improves well after surgery and antibiotic therapy.

Background Pancreatic enucleation is indicated for selected patients and tumours with very low oncological risk to preserve a maximum of healthy pancreatic parenchyma. Minimally invasive pancreatic enucleation (MIPE) is increasingly performed. This study aims to assess the impact of tumor location and center experience on textbook outcomes (TBO) in patients undergoing MIPE. Methods Retrospective nationwide multicentric cohort study including MIPE performed between 2010 and 2021. Tumor localization was classified as head/uncus, neck or body/tail (results are presented in this order). Centers were classified according to a mean volume of MI pancreatectomies performed per year: lower (< 5/year), intermediate (5 to 10/year) and higher volume (≥ 10/year). TBO was defined as meeting all 6 criteria: no postoperative pancreatic fistula (POPF), no post-pancreatectomy haemorrhage (PPH), no bile leak, no readmission, no mortality, and no severe morbidity. Results 27 participating centers performed 200 MIPE located in head/uncus (n = 65, 33%), neck (n = 26, 13%) and body/tail (n = 109, 55%), 8% of them performed by robotic approach. Mortality reached 1.5% (n = 3). Head/uncus lesions were larger (p = 0.03), frequently BD-IPMN (p = 0.04), with significant longer operative time (p = 0.002). TBO achievement was high across all tumor locations (52 vs. 73 vs. 67%, p = 0.09) with higher PPH (p = 0.03) or bile leaks (p = 0.03) for head/uncus lesions. In multivariate analysis, overweight (OR 0.49), preoperative biopsy (OR 0.41) and head/uncus lesion (OR 0.34) were independently associated with lower TBO. No independent risk factor was found for POPF or severe morbidity. While expertise level influenced indications, with more cystic lesions (p = 0.002), larger tumors (p = 0.003), 3D use (p = 0.001), and head/uncus lesions (p = 0.04) in high volume centers, TBO was not significantly different (p = 0.45). Conclusions MIPE is feasible with 1.5% mortality whatever its localization with higher morbidity for head/uncus lesions, justified by the will to avoid pancreaticoduodenectomy. High volume centers push the limits of MIPE without increasing morbidity.

Background Fatigue is a common post-illness symptom that significantly impacts the quality of life (QoL), especially among elderly individuals. The long-term effects of COVID-19 on fatigue and QoL in elderly survivors remain under-explored. Aims and Objectives This study aims to examine the prevalence of fatigue and its impact on the quality of life among elderly COVID-19 survivors. Materials and Methods Data were collected from a tertiary care hospital in India, involving 99 participants aged over 50 years. Sociodemographic and clinical data were obtained via structured interviews. Fatigue was assessed using the Multidimensional Fatigue Inventory-20 questionnaire, while QoL was measured with the WHOQOL-BREF Scale. Results Significant positive correlations were found between age and fatigue. Fatigue scores were notably higher in the physical fatigue and reduced activity domains. Overall QoL scores were significantly negatively correlated with fatigue scores. Conclusion This study underscores the importance of addressing fatigue in post-COVID-19 care for elderly survivors, as fatigue significantly impacts their quality of life.