Army Hospital (Research And Referral), also known as Army Hospital (R&R), AH (R&R) and RR Hospital, is the apex flagship medical care centre for the armed forces of India. Completed in the mid 1990s, the hospital, which includes a teaching hospital and nursing college, is located in Delhi Cantonment, New Delhi. It is the only Armed Forces Medical Services hospital to be commanded by a Lieutenant General rank officer and provides for 27 sub-specialties. The hospital is also meant to cater to the President of India and the chiefs of the military.
Clinical and biochemical screening is recommended to monitor hepatobiliary late-effects in childhood acute lymphoblastic leukemia survivors (cALLs). Transient elastography (TE) noninvasively evaluates liver fibrosis by measuring liver stiffness (LSM) with good sensitivity. We screened cALLs for high-LSM using TE, comparing them to controls and evaluated risk factors for high-LSM. This case–control study included cALLs who were under 18 years at diagnosis, had completed therapy between 2016 and 2023, and were at least 6-months post-completion of therapy. This study also included 50 age- and sex-matched controls. TE (Fibroscan®) was used for LSM, with cutoff ≥ 5.1 kPa for high-LSM indicating fibrosis, and for controlled attenuation parameter (CAP), with cutoff > 248 dB/m for steatosis. Fifty-eight cALLs with mean (SD) age of 136.58 (58) months at enrollment were analyzed after mean (SD) duration of 27 (8) months post-completion of therapy. High-LSM was observed in 22/58 (37.9
Chemotherapeutic protocols developed in high-income countries do not produce comparable results in low- and lower-middle income countries (LMICs). This study analyzed the treatment outcomes of modified Berlin–Frankfurt–Munster (BFM)-2009 protocol in children with acute lymphoblastic leukemia (ALL) in a tertiary care referral center in Northern India. This retrospective study evaluated the treatment outcomes of children with newly diagnosed ALL treated with the modified BFM-2009 protocol using a risk-stratified approach between July 2018 and Dec 2024 and followed-up till June 2025. One hundred sixty six children with a median (q1, q3) age 51 (31, 78) months were followed-up over a median (range) duration of 36.5 (6-84) months. Patients were categorized as standard-risk (SR, 34
Alveolar soft part sarcoma (ASPS) is a rare malignant neoplasm, accounting for <1% of soft tissue sarcomas. It typically presents as a slow-growing, painless mass, most often located in the deep soft tissues of the extremities. It is frequently associated with metastatic disease at the time of diagnosis. Distinguishing ASPS from its histological mimics can be challenging, particularly when it arises in atypical locations. We present a retrospective analysis of five cases of ASPS involving uncommon sites: breast, parapharyngeal region, mandible, elbow, and thigh. Histologically, all tumors exhibited a classic alveolar architecture, characterized by nests of polygonal cells separated by delicate vascular channels. Immunohistochemistry (IHC) confirmed transcription factor E3 nuclear positivity in each case, supporting the diagnosis. Awareness of such unusual presentations is essential to avoid misdiagnosis and inappropriate management. This series underscores the importance of careful histopathological evaluation and ancillary studies in recognizing ASPS at rare anatomical sites.
Abstract Multiple endocrine neoplasia type 2A (MEN 2A) is a rare hereditary endocrine syndrome typically characterized by medullary thyroid carcinoma, pheochromocytoma, and primary hyperparathyroidism. Cutaneous lichen amyloidosis (CLA) is an uncommon dermatologic manifestation associated with REarranged during Transfection (RET) mutations, especially at codon 634. We report the case of a 26-year-old female who initially presented with a pruritic interscapular skin lesion, later diagnosed as CLA. Further evaluation revealed MEN 2A, confirmed by genetic testing showing a RET Cys634Tyr mutation. She underwent successful bilateral adrenal-sparing adrenalectomy, total thyroidectomy, and parathyroidectomy. This case underscores the diagnostic importance of recognizing CLA as a cutaneous marker for early identification of MEN 2A, enabling timely genetic counseling and management.
Abstract Objective: The objective of this study was to compare the effects of continuous infusion and bolus administration of magnesium sulfate on left ventricular strain in patients undergoing coronary artery bypass grafting (CABG) surgery under cardiopulmonary bypass (CPB). Design: This was a prospective, randomized, double-blinded study. Setting: This study was conducted at a university-level tertiary referral cardiac care hospital. Participants: We enrolled 72 adult patients aged between 18 and 70 years undergoing elective CABG under CPB. Interventions: The study participants were randomized into the infusion group (Group I, n = 37) and the bolus group (Group B, n = 35). Group I patients received an infusion of magnesium sulfate at 10 mg/kg/h, initiated during induction of anesthesia, and continued until the end of surgery. Group B patients received a 50 mg/kg bolus of magnesium sulfate before the aortic cross-clamp was released during CPB. Measurements and Main Results: Primary objective parameters of global longitudinal strain (GLS) and global circumferential strain (GCS) were measured using transesophageal echocardiography. The secondary observations of the study were (1) vasoactive inotropic score (VIS), (2) serum lactate levels, (3) serum magnesium levels, (4) systemic vascular resistance index (SVRI) during CPB, (5) incidence of arrhythmias after aortic cross-clamp release, (6) duration of mechanical ventilation, and (7) length of intensive care unit (ICU) and hospital stay. The post-CPB GLS values were significantly less negative in Group B in comparison to Group I (−11.85% ±3.65% vs. −13.32% ±2.09%, P = 0.0383), whereas there was no significant difference in the post-CPB GCS values between the two groups. The serum lactate levels were significantly higher in Group B in comparison to the Group I at 60 min of CPB (2.38 ± 0.52 mmol/L vs. 1.81 ± 0.8 mmol/L, P = 0.0007): 90 min of CPB (2.78 ± 0.68 mmol/L vs. 1.92 ± 0.59 mmol/L, P = 0.0001) and in the post-CPB period (3.01 ± 0.59 mmol/L vs. 2.35 ± 0.89 mmol/L, P = 0.0004). On comparison of SVRI (dynes.sec.cm/m 2 ) between the two groups, it was significantly higher in Group B at 60 min (2285.29 ± 217.1 vs. 2177.43 ± 233.01, P = 0.0462) and in Group I at 90 min (2068.35 ± 125.75 vs. 1940.1 ± 199.48, P = 0.0016). The VIS was significantly less in Group I in comparison to Group B at different time points: after weaning from CPB (4.86 ± 2.28 vs. 7.11 ± 4.22, P = 0.0060), on ICU arrival (5.62 ± 2.02 vs. 7.86 ± 4.07, P = 0.0039), and at 6 h in ICU (5.35 ± 1.65 vs. 7.57 ± 4.29, P = 0.0046). The duration of mechanical ventilation admission was significantly less in Group A compared to Group B (9.86 ± 2.23 h vs. 11.6 ± 2.85 h, P = 0.0051). In contrast, the length of ICU and hospital stay was comparable between the two groups. Conclusion: The results suggest that administering magnesium sulfate as an infusion, rather than as a bolus, demonstrated a cardioprotective effect, as evidenced by the maintenance of higher post-CPB GLS values compared with bolus administration. Magnesium sulfate infusion is safe and effective in attenuating electromechanical effects, improving electrical stability, reducing the need for inotropic and vasopressor support, decreasing serum lactate concentrations during CPB, and shortening the duration of mechanical ventilation in the post-CPB period.
