Randomized comparison of precut papillotomy and endosonography guided rendezvous procedure for difficult biliary access in Malignant distal biliary obstruction.

Background And Aims: Difficult biliary cannulation (DBC) is a marker for prolonged procedure time and increased adverse event rate (AER) during endoscopic retrograde cholangiopancreatography (ERCP). We previously showed that EUS-guided rendezvous procedure (EUS-RV) had a higher single session success rate than precut papillotomy (PcP) in DBC patients. The present randomized study aims at comparing the technical success and AER between the two approaches.

Thyroid Hormone Resistance With a Novel Mutation.

Syndrome of thyroid hormone resistance (THR) is a rare inherited condition characterized by a reduced responsiveness of the tissues to the thyroid hormone. The syndrome is caused primarily by mutations in the thyroid hormone receptor beta (THRB) gene, leading to impaired hormone receptor function. It is a diagnosis of exclusion and often leads to delays in establishing the diagnosis.

Association of Physicians of India Expert Recommendations on Oral Fluid, Electrolytes, and Energy Management during Transition Care and Discharge for Hospitalized Patients with Nondiarrheal Illnesses.

Acute nondiarrheal illnesses (NDIs) involve overt or subclinical dehydration, requiring rehydration and electrolyte repletion. Dehydration is frequently under-recognized and under-managed, both in outpatient departments (OPDs) and inpatient departments (IPDs). Postadmission dehydration is associated with longer hospital stays and higher inhospital mortality rates.

Endoscopic ultrasound-guided gastrointestinal anastomosis: Are we there yet?

Endoscopic ultrasound (EUS) is increasingly used as a therapeutic approach for gastrointestinal diseases, especially with the advent of lumen-apposing metal stents (LAMS). This has led to a rise in of EUS-guided gastrointestinal anastomosis procedures. Due to the reliability of intestinal conduits with LAMS, indications for EUS-guided gastrointestinal anastomosis are becoming more common and trend to potentially be standard care for gastric outlet obstruction, afferent loop syndrome, and EUS-directed transgastric interventions such as EUS-directed endoscopic retrograde cholangiopancreatography.

Safety and effectiveness of the novel Myval Octacor transcatheter heart valve in severe, symptomatic aortic valve stenosis - A real-world Indian experience (The OCTACOR India Study).

Purpose: To evaluate the safety and effectiveness of the novel, next-generation Myval Octacor - Transcatheter Heart Valve (THV) in patients with severe, symptomatic, native aortic stenosis (AS).

Methods: This multicenter, real-world observational registry included 123 patients with severe symptomatic AS, across 16 Indian centers who underwent treatment with the novel Myval Octacor THV. Study endpoints included all-cause mortality, all stroke, acute kidney injury (AKI), major vascular complications, moderate or severe paravalvular leakage (PVL) and new permanent pacemaker implantation (PPI) until 30 days follow-up.

Treatment challenges in the management of difficult-to-treat gram-positive infections: A consensus view apropos therapeutic role of novel anti-MRSA antibiotics, levonadifloxacin (IV) and alalevonadifloxacin (oral).

Purpose: Treatment of antibiotic-resistant Gram-positive infections (GPIs), including methicillin-resistant Staphylococcus aureus (MRSA) is becoming increasingly difficult, particularly in patients with multiple co-morbidities who require antibiotics with greater safety and a consistent pharmacokinetic/pharmacodynamic (PK/PD) profile. Such difficult-to-treat GPIs are often associated with poor outcomes, extended hospital stay and increased expenditure. This can be partly attributed to the limited safety and aberrant PK/PD profile of existing anti-MRSA antibiotics.

Relationship of End Expiratory Lung Volume, Compliance, and Plateau Pressure in Acute Respiratory Distress Syndrome.

COVID-19 ARDS (acute respiratory distress syndrome), caused by SARS-CoV-2, involves a decrease in the end expiratory lung volume (EELV), compliance, and hypoxemia. The authors retrospectively analysed the relationship between the EELV, Plateau pressure (Pplat), and compliance of the respiratory system in a group of 21 mechanically ventilated COVID ARDS patients with moderate to severe hypoxia who were subjected to a recruitment manoeuvre. Further, these parameters were studied after dividing them into two groups as Group 1 of clinically non-recruitable and Group 2 of clinically recruitable patients.

Angiographic quantification of aortic regurgitation following myval octacor implantation; independent core lab adjudication.

Background: The balloon expandable Myval transcatheter heart valve (THV) showed encouraging results regarding residual aortic regurgitation (AR) from multiple observational studies. The newly designed Myval Octacor has been introduced recently, aiming for a reduction in AR and improved performance.

Objectives: The focus of this study is to report the incidence of AR using the validated quantitative Videodensitometry angiography technology (qLVOT-AR%) in the first in human use of the Myval Octacor THV system.

Laparoscopic Radical Hysterectomy for Endometrial Carcinoma in a Woman with an Ectopic Pelvic Kidney.

A 59-year-old post-menopausal female presented with complaints of per vaginal spotting for 3 months. Histopathological examination of contents of dilation and curettage revealed endometrial carcinoma (FIGO stage I), along with benign endocervical polyps. MRI also showed presence of left-sided structure indicative of ectopic pelvic kidney.

Endoscopic ultrasound-guided balloon-occluded gastrojejunostomy bypass, duodenal stent or laparoscopic gastrojejunostomy for unresectable malignant gastric outlet obstruction.

Objectives: Malignant gastric outlet obstruction (GOO) can be relieved by either laparoscopic gastrojejunostomy (LGJ), endoscopic stenting (SEMS) or endoscopic ultrasound-guided gastrojejunostomy (endoscopic ultrasound-guided balloon-occluded gastrojejunostomy bypass; EPASS). This study aimed to compare the outcomes of the three treatment methods.

Methods: This was a retrospective study of patients who suffered from malignant GOO between January 2012 to November 2020 that received either EPASS, LGJ or SEMS.

A retrospective review of a 2-year strong antimicrobial stewardship program in a tertiary care institute in Mumbai.

Background Information: Many institutes have implemented a strict antimicrobial stewardship (AMS) program in the postantibiotic era.

Aim: To investigate how the resistance pattern changes after implementation of a stringent AMS programme.

Methodology: It employs a defined daily dose methodology (DDD).

Evaluation of an all-in-one hybrid model (EUS Magic Box) for stepwise teaching and training in multiple interventional EUS procedures.

While multiple interventional endoscopic ultrasound (EUS)-guided procedures have evolved over the past two decades, there is no model that allows for training in all of these procedures. We aimed to develop and validate an all-in-one hybrid model for stepwise learning in multiple EUS interventions. A hybrid model was created utilizing a pig esophagus and stomach, a silicon-based duodenum and pancreato-biliary system, a pseudocyst, and biopsy targets.

Energy expenditure in COVID-19 mechanically ventilated patients: A comparison of three methods of energy estimation.

Background: Indirect calorimetry (IC) is the gold standard for measuring resting energy expenditure. Energy expenditure (EE) estimated by ventilator-derived carbon dioxide consumption (EEVCO ) has also been proposed. In the absence of IC, predictive weight-based equations have been recommended to estimate daily energy requirements.

Changing Paradigm in Treatment of Differentiated Thyroid Cancer.

Differentiated thyroid cancer is an indolent cancer with an excellent prognosis when treated adequately. The treatment algorithm is well established and standardized. Surgery followed by radio-iodine treatment has stood the test of time.

Intensive Care in India in 2018-2019: The Second Indian Intensive Care Case Mix and Practice Patterns Study.

Background: We aimed to study organizational aspects, case mix, and practices in Indian intensive care units (ICUs) from 2018 to 2019, following the Indian Intensive Care Case Mix and Practice Patterns Study (INDICAPS) of 2010-2011.

Methods: An observational, 4-day point prevalence study was performed between 2018 and 2019. ICU, patient characteristics, and interventions were recorded for 24 hours, and ICU outcomes till 30 days after the study day.

Extra digital glomus tumor causing scapulothoracic impingement: A case report.

Glomus tumor is a painful benign neoplasm which arises from the glomus body. The glomus body is neuromyoarterial receptor responsible for regulating the peripheral skin blood flow and local temperature. The classical clinical symptoms of the glomus tumor are acute local pain, pin point tenderness and hypersensitivity to cold.

Hepatobiliary malformations: proposed updation of classification system, clinicopathological profile and a report of largest pediatric giant choledochal cyst.

Background: The present study was aimed to update the classification of hepatobiliary malformations and study the clinicopathological profile of pediatric choledochal cyst (CDC) and pediatric giant choledochal cyst (GCC) patients undergone surgery.

Methods: We have retrospectively analysed the data of 57 consecutive cases of CDCs in paediatric patients from a time period spanning from 2016 to 2020.

Results: Revised classification of hepatobiliary malformations was proposed and these were divided into 2 broad headings, choledochal (congenital and acquired) and extra-choledochal spectrum.

Extra nodal Rosai Dorfman disease masquerading as metastatic soft tissue sarcoma- A case report.

Rosai Dorfman disease is rare benign disease of phagocytic histiocytosis usually present as painless massive lymphadenopathy. Extra nodal presentation of Rosai Dorfman disease is rare but also described. We hereby describe an unusual presentation of the extra nodal Rosai Dorfman disease with rapidly growing soft tissue lesion in the left thigh with associated osseous lesions in the right distal femur, left distal femur, left proximal tibia and presence of solitary pulmonary nodule.

Diabetic Foot Ulcers and Osteomyelitis: Use of Biodegradable Calcium Sulfate Beads Impregnated With Antibiotics for Treatment of Multidrug-Resistant Organisms.

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Smart secretion management to protect nurses from COVID19 and other infectious diseases.

Background: COVID-19 has been linked to over 40 million infections and 1.1 million deaths in 210 countries as of October 19, 2020. This highly contagious communicable disease has put not only infected individuals but other patients and frontline workers like nurses at risk in hospitals, especially in Intensive Care units (ICUs).

In Vitro activity of a Novel Benzoquinolizine Antibiotic, Levonadifloxacin (WCK 771) against Blood Stream Gram-Positive Isolates from a Tertiary Care Hospital.

 Blood stream infections (BSIs) due to Gram-positive pathogens such as methicillin-resistant (MRSA) are associated with high mortality ranging from 10 to 60%. The current anti-MRSA agents have limitations with regards to safety and tolerability profile which limits their prolonged usage. Levonadifloxacin and its oral prodrug alalevonadifloxacin, a novel benzoquinolizine antibiotic, have recently been approved for acute bacterial skin and skin structure infections including diabetic foot infections and concurrent bacteremia in India.

CT Scan Findings of Five Mildly Symptomatic COVID Patients from India.

The outbreak of the SARS-Cov-2 (Severe Acute Respiratory Syndrome - Coronavirus 2) viral pandemic which started at Wuhan China has spread to 200 countries and have resulted in a huge loss to mankind and the global economy. Computerised Tomographic (CT) scan may play an important role in the diagnosis and management of the COVID -19-the disease caused by the SARS-Cov-2. This modality might help in triaging this extremely contagious disease and thus help serve in reducing the outbreak.