Aster Medcity

Scrub typhus is a mite-borne rickettsial infection endemic in many parts of India and typically causes small-vessel vasculitis; large-vessel involvement is rare. We report a 52-year-old immunosuppressed man on long-term tofacitinib who presented with prolonged fever, weight loss, and systemic inflammation, and was found to have multiple pseudoaneurysms involving the abdominal aorta, carotid, and popliteal arteries, along with pulmonary nodules and necrotic lymphadenopathy. Extensive evaluation for tuberculosis, fungal infections, and bacterial endocarditis was negative, with no response to broad-spectrum antimicrobials or antitubercular therapy. Serology for scrub typhus was positive following identification of travel to an endemic area, and doxycycline led to rapid clinical and biochemical improvement. Selected pseudoaneurysms were managed surgically and endovascularly with good outcomes. This case highlights scrub typhus as a rare cause of large-vessel pseudoaneurysms in immunosuppressed patients in endemic regions.

INTRODUCTION:Upper airway oedema seen in robotic-assisted laparoscopic surgeries (RAS) in steep Trendelenburg position (STP) can lead to airway complications. In this study, we evaluated airway changes in RAS after a short period of post-operative ventilation and analysed intraoperative factors contributing to these changes. PATIENTS AND METHODS:This prospective observational cohort study was conducted on 70 patients undergoing RAS in STP. Our primary aim was to assess changes in Samsoon and Young modification of Mallampati classification (MMS) and neck circumference (NC) at 30 min and 4 h post extubation after 30-45 min of ventilation in head up position in the intensive care unit. We studied the association between airway changes and intravenous fluids, duration of surgery and STP. The statistical analysis was performed by the Shapiro-Wilk test, Friedman test, Nemenyi test, Stuart-Maxwell test and Spearman correlation test. P < 0.05 was considered statistically significant. RESULTS:There was a significant change in post-operative MMS (Stuart-Maxwell test: χ2 = 29.000, P < 0.001) and NC (P < 0.001) (Friedman test) at 30 min post-extubation. Four hours later, the changes were not significant. There was a statistically significant weak positive correlation between intake (mL) and change in NC (30 min post-operative) (rho = 0.29, P = 0.015) (Spearman correlation test). CONCLUSION:In robotic-assisted laparoscopic surgeries, there was a significant increase in MMS and NC at 30 min despite post-operative ventilation for at least 30 min. Intraoperative fluids had a positive correlation with NC changes.

Background:Outcomes after mechanical thrombectomy vary widely despite high rates of angiographic reperfusion. Pretreatment infarct core volume is a major determinant of recovery, yet the functional impact of a given core burden may differ by collateral physiology. Therefore, this study aimed to determine whether baseline angiographic collateral grade modifies the association between pretreatment infarct core volume and 90-day functional independence, defined as modified Rankin Scale score 0-2, among adults with anterior-circulation large-vessel occlusion undergoing attempted mechanical thrombectomy. Methods:This retrospective observational cohort included consecutive adults who underwent attempted mechanical thrombectomy at a comprehensive stroke centre. Infarct core volume was quantified on diffusion-weighted magnetic resonance imaging with apparent diffusion coefficient confirmation, or on computed tomography perfusion when magnetic resonance imaging was not feasible, using semi-automated volumetry with artifact correction. Collaterals were graded on baseline angiography using the ASITN/SIR scale (0 to 4) by a reader blinded to core volume and outcomes. The primary endpoint was 90-day functional independence (modified Rankin Scale 0 to 2). Multivariable logistic regression in anterior-circulation strokes evaluated core volume (per 10 cc), collateral grade (per 1 grade), and a prespecified interaction term, adjusting for clinical and workflow covariates. Results:Sixty-nine patients were included (mean age 67.4 ± 10.2 years), with successful reperfusion (final mTICI 2b or higher) in 91.3%. Functional independence occurred in 47.8% overall and 53.8% among anterior-circulation strokes (28/52). Any intracranial haemorrhage occurred in 31.9%, symptomatic intracranial haemorrhage in 13.0%, and 90-day mortality in 20.3%. In anterior-circulation modelling, larger core volume reduced the odds of independence (adjusted OR 0.79 per 10 cc, 95% CI 0.66 to 0.93), higher collateral grade increased the odds (adjusted OR 2.24 per grade, 95% CI 1.18 to 4.25), and the interaction term was significant (adjusted OR 1.12, 95% CI 1.01 to 1.28), with good discrimination (AUC 0.81). Conclusions:Collateral physiology modifies the association between established infarct core burden and 90-day recovery after thrombectomy in anterior-circulation large-vessel occlusion, supporting integrated tissue-plus-physiology prognostication.

Injuries account for 8.5% of global deaths, with 83% occurring in low and middle-income countries (LMICs). India faces a significant trauma burden, with 153 972 road traffic fatalities in 2021, alongside a pronounced shortage of trained emergency care providers. Existing trauma training models, such as WHO-ICRC Basic Emergency Care and the Advanced Trauma Life Support course, while valuable, are resource-intensive. The COVID-19 pandemic has accelerated the adoption of virtual education, presenting an opportunity to scale trauma training in LMICs.This paper describes a novel, gamified trauma telesimulation activity designed to address these challenges. Using the each, Effectiveness, Adoption, Implementation and Maintenance framework, we assessed its reach, effectiveness, adoption, implementation and potential for maintenance. The activity involved 20 emergency medicine residents across four hospitals in India who participated in a competitive, single-elimination trauma simulation via Zoom. Scenarios focused on managing paediatric head trauma and adult polytrauma. A further 159 residents from 13 remote sites observed and contributed to scoring and debrief discussions. The initiative reached 179 trainees across 17 hospitals in 12 cities, spanning distances of over 2000 km. Adoption was facilitated by familiarity with online platforms, English as a shared language and stable connectivity. The model demonstrated feasibility for scaling trauma skills training in resource-limited settings. Future work should include mixed-methods evaluation, tracking clinical outcomes and establishing frameworks for local faculty to sustain delivery. Integrating telesimulation into national programmes and trauma registries may support broader health system strengthening. This model offers a promising, low-cost strategy to help address critical gaps in trauma training and workforce capacity in LMICs.