Effect of antibiotic de-escalation on clinical outcomes in patients with carbapenem-resistant Enterobacteriaceae bacteremia (CRE) in the hematology-oncology setting.

Introduction: Carbapenem-resistant Enterobacteriaceae (CRE) infections are associated with poor outcomes, particularly among hematology-oncology patients. Appropriate use (selection and de-escalation) of antibiotics is a key component of management of febrile neutropenia particularly in high CRE prevalence regions like India.

Methods: This was a retrospective study done (April 2019-December 2021) in a dedicated oncology center in North India, which assessed the case records of the patients undergoing therapy for hematological malignancies who were diagnosed with CRE bacteremia.

FLAG based v/s Standard 3 + 7 induction therapy in treatment naïve Acute Myeloid Leukemia: Time to think "beyond anthracyclines".

Daunorubicin and Cytarabine (DA; 3 + 7) has been the standard frontline Acute Myeloid Leukemia (AML) induction regimen resulting in Complete Remission (CR) rates of 50-70%. It is associated with induction mortality of 15-30%. We report a comparative analysis of DA versus fludarabine, cytarabine, G-CSF (FLAG) + /- Venetoclax in resource constrained settings.

Candida Empyema in Febrile Neutropenia - Augmented value of direct inoculation into BacT/Alert blood culture vials.

Candida empyema is an uncommon complication of febrile neutropenia. We present 4 such cases which highlight the importance of direct inoculation of body fluids in automated blood culture bottle leading to increased yield. Our cases and review of literature also highlight that echinocandins have poor penetration into pleural fluid; azoles (especially voriconazole) should be preferred as drug of choice.

Robotic thoracic surgery in inflammatory and infective diseases.

Tuberculosis and inflammatory conditions are endemic in India and South-East Asia. They cause intense inflammatory reactions and adhesions, thus making surgical resection difficult. In 2009, we installed an intuitive da Vinci HDSi robot to perform our surgery as a part of a robotic thoracic surgery unit.

A tale of surviving three consecutive cardiorespiratory arrests on table during a right sided pneumonectomy.

Background: Intraoperative cardiorespiratory arrest secondary to lower airway obstruction is often difficult to manage. We describe the management of one such technically challenging case of three consecutive cardiorespiratory arrests during a right pneumonectomy in a young boy.

Methods: A 10 years boy with a large fleshy vascular endobronchial tumor (biopsy proven squamous papilloma), completely occluding the right main-stem bronchus with collapse-consolidation of underlying right lung, was posted for a right pneumonectomy.

Robotic assisted thoracoscopic right upper lobectomy for post tuberculosis aspergilloma.

Background: Minimally invasive techniques for non-oncologic lung resections especially fungal infections are not widely employed. Through this video we share our experience of one such case of a robotic resection of pulmonary aspergilloma.

Methods: A 55-year-old male with recurrent hemoptysis underwent surgical resection of post tuberculosis aspergilloma of right upper lobe using a 4-arm DaVinci Robot.

Single-port versus conventional laparoscopic total extra-peritoneal inguinal hernia repair: a prospective, randomized, controlled clinical trial.

Background: The advantage of single-port total extra-peritoneal (TEP) inguinal hernia repair over the conventional technique is still debatable. Our objective was to compare the outcomes of TEP inguinal hernia repair using either a single-port or conventional surgical technique, in two blind randomized groups of patients.

Methods: In this prospective, randomized, double-blind, controlled clinical trial, 100 patients undergoing surgery for unilateral inguinal hernia were randomized into two groups: One group underwent conventional laparoscopic TEP inguinal hernia repair, while the other was selected for single-port TEP repair.

A prospective randomized controlled trial to compare single-port endo-laparoscopic surgery versus conventional TEP inguinal hernia repair.

Introduction: The success of laparoscopic surgery is due to the less surgical trauma, including less operative pain, complications and better cosmetics. Objective of our study was to compare in two blind randomized groups of patients, the surgical outcome of total extra-peritoneal (TEP) inguinal hernia repair using either single-port or conventional surgical technique. We will report our interim results in the first group of 50 patients.

Coexisting pulmonary tuberculosis and mucormycosis in a patient with aplastic anemia post allogenic stem cell transplantation.

Infections are the most common cause of morbidity and mortality in allogenic stem cell transplant recipients. Survival of the patient depends on the accurate diagnosis of the infectious agents and prompt and effective management of the infection alongwith maintenance of adequate immunosuppression post transplantation. We here reported a case of aplastic anemia who developed left upper lobe consolidation post allogenic stem cell transplantation and was found to have combined infection with tuberculosis and mucormycosis.

Rituximab in steroid refractory autoimmune hemolytic anemia.

Autoimmune hemolytic anemia is rare in children and infants and steroids are the corner stone of therapy. Management of the patients with steroid refractory/dependent disease is difficult .Rituximab is being used in the treatment of a variety of autoimmune diseases including Autoimmune hemolytic anemia (AIHA),especially in adults but there is scarce data regarding the use of this agent in pediatric AIHA patients.

Treatment of acute myeloid leukemia in children: experience from a tertiary care hematology centre in India.

Objective: To assess the treatment and outcome of children with acute myeloid leukemia. The Primary objectives were to assess remission rates, treatment related toxicity and disease free survival. Secondary objective was to assess prognostic factors associated with poor outcome.

Laparoscopic splenectomy in a case of blunt abdominal trauma.

Splenic rupture is a frequent consequence of blunt abdominal trauma. Removal of the spleen (splenectomy) or alternative conservative procedures (splenorrhaphy, partial splenectomy and haemostatic collagen application) are surgical treatment options. Splenectomy was first described in 1910 by Sutherland.