BGS Global Hospital

IntroductionStroke recurrence and vascular events remain major contributors to post-stroke mortality in India, where care is delivered through heterogeneous government and private healthcare systems. This post-hoc analysis of the Secondary Prevention with a Structured Semi-Interactive Stroke Prevention Package in India (SPRINT INDIA) trial compared primary and secondary stroke outcomes between government and private hospitals.MethodsSPRINT INDIA was a multicentre randomized controlled trial conducted across 31 centers (18 private, 13 government) within the Indian Stroke Clinical Trial Network (INSTRuCT). Adults with sub-acute stroke were randomized to a structured mHealth-supported secondary prevention intervention or standard care and followed for 1 year. The primary outcome was a composite of recurrent stroke, high-risk transient ischemic attack, acute coronary syndrome, and all-cause mortality. Secondary outcomes included functional status (modified Rankin Scale), behavioral risk factors, medication adherence, body mass index, physical activity, and laboratory measures of vascular risk. Outcomes were compared between government and private hospitals using adjusted regression models.ResultsAmong 4,298 randomized patients, 3,038 completed 1-year follow-up (59.8% private; 40.2% government). There was no significant difference was observed in the composite primary outcome between private and government institutions (2.8 vs. 3.7%; p = 0.215). Private hospitals demonstrated non-significantly lower adjusted odds of the primary outcome and higher odds of good functional recovery. The intervention was associated with improved functional outcomes and reductions in systolic blood pressure and fasting blood glucose in government hospitals, while private hospitals showed greater improvements in medication adherence, smoking and alcohol cessation, and body mass index.ConclusionsStroke outcomes at 1 year were broadly comparable across healthcare sectors; however, the intervention demonstrated context-specific benefits, improving risk factors and functional recovery in government hospitals and reinforcing behavioral adherence in private hospitals. These findings highlight the importance of tailoring secondary stroke prevention strategies to healthcare system context.Clinical trial registrationhttp://ctri.nic.in, identifier: CTRI/2017/09/009600.

Background: Anterior knee pain (AKP) remains a common cause of dissatisfaction after total knee arthroplasty (TKA). Circumpatellar denervation using electrocautery has been proposed to reduce postoperative pain by ablating nociceptive fibers in peripatellar tissues. Aim: To evaluate the effect of intraoperative patellar denervation by electrocautery on postoperative anterior knee pain and functional outcomes in patients undergoing primary TKA for osteoarthritis. Methods: This prospective randomized comparative study was conducted at BGS Global Hospital, Bangalore, between July 2019 and May 2021. Seventy patients aged 45–80 years with advanced primary knee osteoarthritis undergoing TKA were randomized into two groups: electrocautery (n=35) and control (n=35). All patients underwent standard TKA. The intervention group received circumpatellar electrocautery using monopolar diathermy. Outcomes were assessed preoperatively and at 1, 3, 6, and 12 months using the Visual Analogue Scale (VAS), Insall Knee Score (KSS), Patellar Score (PS), and range of motion (ROM). Statistical analysis was performed using repeated-measures ANOVA. Results: Both groups showed significant postoperative improvement. However, the electrocautery group demonstrated significantly lower VAS scores at all follow-ups (12-month mean: 0.03 vs 0.49; p<0.001). Functional outcomes were superior in the intervention group, with higher KSS (94.63 vs 89.74) and PS (27.23 vs 22.26) at one year (p<0.001). ROM improved in both groups without statistically significant intergroup difference. Conclusion: Circumpatellar patellar denervation during TKA significantly reduces anterior knee pain and improves functional outcomes. The technique is simple and safe, though larger long-term studies are recommended.

Acute-on-chronic liver failure (ACLF) is a condition associated with high mortality in the absence of liver transplantation. There have been various definitions proposed worldwide. The first consensus report of the working party of the Asian Pacific Association for the Study of the Liver (APASL) set in 2004 on ACLF was published in 2009, and the "APASL ACLF Research Consortium (AARC)" was formed in 2012. The AARC database has prospectively collected nearly 10,500 cases of ACLF from various countries in the Asia-Pacific region. This database has been instrumental in developing the AARC score and grade of ACLF, the concept of the 'Golden Therapeutic Window', the 'transplant window', and plasmapheresis as a treatment modality. Also, the data has been key to identifying pediatric ACLF. The European Association for the Study of Liver-Chronic Liver Failure (EASL CLIF) and the North American Association for the Study of the End Stage Liver Disease (NACSELD) from the West added the concepts of organ failure and infection as precipitants for the development of ACLF and CLIF-Sequential Organ Failure Assessment (SOFA) and NACSELD scores for prognostication. The Chinese Group on the Study of Severe Hepatitis B (COSSH) added COSSH-ACLF criteria to manage hepatitis b virus-ACLF with and without cirrhosis. The literature supports these definitions to be equally effective in their respective cohorts in identifying patients with high mortality. To overcome the differences and to develop a global consensus, APASL took the initiative and invited the global stakeholders, including opinion leaders from Asia, EASL and AASLD, and other researchers in the field of ACLF to identify the key issues and develop an evidence-based consensus document. The consensus document was presented in a hybrid format at the APASL annual meeting in Kyoto in March 2024. The 'Kyoto APASL Consensus' presented below carries the final recommendations along with the relevant background information and areas requiring future studies.

ABSTRACT Introduction: A study was performed to determine the most common and most bothersome symptoms and clinical associations in young men (18–40 years) presenting with lower urinary tract symptoms (LUTS). Methods: Cross-sectional study was conducted across 16 centers. Urinary symptoms, impact of bladder problems, bowel symptoms, erectile dysfunction, premature ejaculation, bladder pain, non-bladder myofascial pain, and general well-being were assessed by validated questionnaires. Results: A total of 448 men (median age 30 years) were included. Nocturia ≥1 (89.1%) and feeling of incomplete bladder evacuation (76.6%) were the most common symptoms while the most bothersome symptoms were daytime frequency and nocturia (median score 5; interquartile range 2–8, for both) on the International Consultation on Incontinence Questionnaire for Male LUTS questionnaire. Bladder symptoms were associated with severe or many severe problems (response 5 or 6, on the Patient Perception of Bladder Conditions Questionnaire) in 17.8% of the patients. Men between 18 and 20 years reported greater bother with their bladder condition. Normal erections and “very good” control over ejaculation were reported by 49.8% and 15.6%, respectively. Constipation and loose stools were reported by 22.8% and 12.9%, while bladder pain and non-bladder myofascial pain were reported by 72.5%, and 48.2%, respectively. 17.0% of the patients reported low scores on the WHO-5 Well-Being Scale. Two distinct patient clusters were identified. A larger cluster (63.9%) that presented with voiding symptoms and urgency but fewer sexual or pain symptoms, and a smaller cluster that showed pronounced sexual symptoms, pain, daytime frequency, and nocturia. Conclusions: The most common urinary symptoms in young men are nocturia and a sense of incomplete evacuation. Daytime frequency and nocturia are the most bothersome symptoms. It is important to assess associated symptoms in young men presenting with LUTS.

Thyroidectomy is an intricate surgery where nerve injury can cause significant morbidity. The use of magnification has revolutionised the modern-day otolaryngology practice. Its utility is now the standard of care for many ENT surgeries. Surgical loupes in Head and Neck surgery are emerging as a single important tool in reducing complications and improving precision. This retrospective study aimed to analyse the results of complications in thyroidectomy whilst using the loupes. A retrospective study was conducted for 6 years. All the loupe-assisted thyroidectomies done by two surgeons were included in the study. All surgeries were performed with × 2.5 and some with × 3.5 magnification loupes. The incidence of voice change, hypocalcaemia, and secondary haemorrhage after thyroidectomy were noted. Eighty thyroidectomies were included, 39 were total thyroidectomies and the remaining were hemithyroidectomies. The age group was between 25 and 65 years. The mean stay in the hospital was approximately 2 days. Three patients had recurrent laryngeal nerve palsy, and 3 patients had transient hypocalcaemia which required calcium and magnesium supplementation. All the patients were operated with an intent to save the nerves and parathyroid glands. The use of microsurgical techniques during thyroidectomy should be the standard of care as it reduces morbidity and minimises nerve injury.