Apollo KH Hospital is a multi speciality hospital located at Melvisharam in the city of Vellore, Tamil Nadu. This hospital is a product of joint venture between Apollo Hospitals, Chennai and KH Group, Melvisharam, Vellore who perceived the need of a hospital in this region.
Ventral hernia has seen rapid advancements in technique and approach, with minimally invasive surgery becoming the preferred choice. The extended totally extraperitoneal (e-TEP) and intraperitoneal onlay mesh (IPOM) techniques are two commonly used laparoscopic methods. This study compares the early outcomes of these two approaches. A Prospective study was conducted involving 82 patients with midline ventral hernias, equally divided into two groups: e-TEP( Group A) and IPOM(Group B). Perioperative outcomes including operative time, post-operative pain (VAS score), hospital stay, and complications were evaluated. The e-TEP group demonstrated statistically significant lower postoperative pain scores(p < 0.05). Although operative time was longer for e-TEP, there was no statistically significant difference in complication rates or hospital stay between the groups. Both e-TEP and IPOM techniques are safe and effective for ventral hernia repair. The e-TEP approach may offer an early postoperative pain advantage. Further studies with larger sample sizes and longer follow-up are recommended to assess long- term outcomes such as recurrence and mesh related complications.
Interpectoral lymph nodes (IPNs), or Rotter’s lymph nodes, are a critical yet understudied component of breast cancer lymphatic drainage, with potential implications for staging and therapeutic outcomes. Despite their role in “skip metastases,” clinical guidelines remain ambiguous regarding IPN dissection due to conflicting evidence on their metastatic rates and associated surgical risks. This study aims to address gaps in population-specific data, particularly in India, where breast cancer burden is high, and modified radical mastectomy (MRM) is prevalent. This study sought to quantify IPN metastasis rates in Indian breast cancer patients, identify clinicopathological predictors of IPN involvement, and propose evidence-based criteria for selective IPN dissection to balance oncologic efficacy and surgical morbidity. A retrospective analysis of 472 breast cancer patients (2017–2024) undergoing axillary lymph node dissection (ALND) with mastectomy/lumpectomy was conducted. IPNs were dissected separately and examined pathologically. Clinicopathological variables, including tumor size, nodal status, extranodal extension (ENE), and molecular subtypes, were analyzed. Univariate and multivariate logistic regression identified predictors of IPN occurrence and metastasis. IPNs were detected in 9.1
BACKGROUND:Extended spectrum beta-lactamase producing Enterobacterales are classified as critical priority pathogens with limited therapeutic options. Enmetazobactam is a novel penicillanic sulfone beta-lactamase inhibitor with the spectrum of coverage against range of ESBLs. The combination of cefepime/enmetazobactam has been approved for the treatment of cUTI including acute pyelonephritis in United States and Europe, and additionally licensed for the treatment of hospital acquired pneumonia including ventilator associated pneumonia and their associated bacteremia in Europe. In this study, we determined the in-vitro activity of cefepime/enmetazobactam along with comparators against molecularly well characterised third generation cephalosporin resistant Enterobacterales and P. aeruginosa isolates METHODS: Non-duplicate third generation cephalosporin resistant Enterobacterales (E. coli, n = 262; K. pneumoniae, n = 250; Enterobacter sp., n = 32; Proteus spp., n = 22) and P. aeruginosa (n = 100) clinical isolates were included in this study. Presence of ESBLs, ampCs and OXA-1 encoding genes were detected by PCR. MICs of cefepime/enmetazobactam and comparators were determined by reference broth microdilution. Time kill assay was performed to assess the antibacterial activity of cefepime/enmetazobactam against ESBL and/or ampC producers. RESULTS:Cefepime/enmetazobactam potently inhibited all CTX-M and/or OXA-1 producing E. coli isolates at MIC of ≤ 2 mg/L and ampC (CMY and/or DHA) producing isolates at MIC of ≤ 4 mg/L. Among CTX-M producing E. coli, susceptibility to TZP was significantly dropped from 78% to 58% in the presence of OXA-1. Further, cefepime/enmetazobactam continued to show potent activity against CTX-M producing K. pneumoniae and were inhibited at MIC of ≤ 1 mg/L. All the tested P. aeruginosa isolates were highly susceptible to cefepime/enmetazobactam with 100% inhibition. In time-kill assay, cefepime/enmetazobactam showed ≥ 3 log10 kill against CTX-M producingE. coli and CTX-M producingK. pneumoniae isolates, which is comparable to that of meropenem. CONCLUSION:The findings of the present study retraites that the spectrum of coverage of cefepime/enmetazobactam is superior to that of TZP and similar to that of meropenem, emphasising the importance of cefepime/enmetazobactam as a carbapenem-sparing option.
AIMS:To discuss the role of screening and treatment of affective symptoms, like anxiety and depression in patients with LUTD. A review of the literature regarding the bidirectional association and multidisciplinary approaches integrating psychometric assessments with personalized treatment plans to improve diagnostic accuracy and therapeutic outcomes of LUTD. METHODS:This review summarizes discussions and a narrative review of (recent) literature during an International Consultation on Incontinence-Research Society 2024 research proposal with respect to the role of screening for anxiety and depression, effect of mental health symptoms on treatment outcomes and future implications. RESULTS:Consensus recognized the importance to incorporate attention to anxiety and depression in relation to LUTD. The awareness of this association can lead to better outcomes. Future research projects are proposed to evaluate the bidirectional relationship. CONCLUSION:The relationship between affective symptoms and LUTD underscores the need for integrated treatment approaches that address both psychological and urological dimensions. Further research is required to identify specific patient subgroups that would benefit most from these interventions, to develop standardized screening tools, and to refine treatment protocols. Multidisciplinary care, incorporating psychological assessment and personalized treatment strategies, could enhance outcomes for LUTD patients.
PURPOSE:Non-obstructive azoospermia (NOA) is a common, but complex problem, with multiple therapeutic options and a lack of clear guidelines. Hence, there is considerable controversy and marked variation in the management of NOA. This survey evaluates contemporary global practices related to medical and surgical management for patients with NOA. MATERIALS AND METHODS:A 56-question online survey covering various aspects of the evaluation and management of NOA was sent to specialists around the globe. This paper analyzes the results of the second half of the survey dealing with the management of NOA. Results have been compared to current guidelines, and expert recommendations have been provided using a Delphi process. RESULTS:Participants from 49 countries submitted 336 valid responses. Hormonal therapy for 3 to 6 months was suggested before surgical sperm retrieval (SSR) by 29.6% and 23.6% of participants for normogonadotropic hypogonadism and hypergonadotropic hypogonadism respectively. The SSR rate was reported as 50.0% by 26.0% to 50.0% of participants. Interestingly, 46.0% reported successful SSR in <10% of men with Klinefelter syndrome and 41.3% routinely recommended preimplantation genetic testing. Varicocele repair prior to SSR is recommended by 57.7%. Half of the respondents (57.4%) reported using ultrasound to identify the most vascularized areas in the testis for SSR. One-third proceed directly to microdissection testicular sperm extraction (mTESE) in every case of NOA while others use a staged approach. After a failed conventional TESE, 23.8% wait for 3 months, while 33.1% wait for 6 months before proceeding to mTESE. The cut-off of follicle-stimulating hormone for positive SSR was reported to be 12-19 IU/mL by 22.5% of participants and 20-40 IU/mL by 27.8%, while 31.8% reported no upper limit. CONCLUSIONS:This is the largest survey to date on the real-world medical and surgical management of NOA by reproductive experts. It demonstrates a diverse practice pattern and highlights the need for evidence-based international consensus guidelines.
