The Government Medical College, Thiruvananthapuram (also known as Thiruvananthapuram Medical College or Trivandrum Medical College) is in Thiruvananthapuram (the capital of Kerala), India. Founded in 1951, it was inaugurated by Prime Minister Jawaharlal Nehru and is Kerala's first ever Medical College. Its campus houses several hospitals and institutions in addition to Medical College Hospital (MCH), including the Colleges of Nursing and Pharmaceutical sciences, the Regional Cancer Centre; an autonomous institution under Central Government, Thiruvananthapuram Dental College, Sree Chitra Tirunal Institute for Medical Sciences and Technology; another autonomous institute under Govt of India, the Priyadarshini Institute of Paramedical Sciences, the Sree Avittom Thirunal Hospital for Women and Children (SAT Hospital), where the highest number of deliveries are reported in Asia, Child development centre (CDC) an autonomous institution under state government and the Multidisciplinary Research Laboratory (MDRL). The Regional Institute of Ophthalmology (RIO), also a part of the college, is being upgraded to a national-level independent institute.
Background:Sacral chordomas are rare malignant tumors arising from notochordal remnants that present unique surgical challenges due to their indolent growth, locally aggressive behavior, and high recurrence rates despite treatment. This review synthesizes current evidence on surgical management, reconstruction techniques, adjuvant therapies, and translational advances for sacral chordomas. Methods:This systematic review synthesizes current evidence on surgical management, reconstruction techniques, adjuvant therapies, and translational advances through analysis of PubMed, Scopus, and Web of Science databases [2023-2025]. Results:En bloc resection with wide negative margins remains the cornerstone of treatment, achieving optimal local control but often at the cost of significant neurological and functional morbidity. Modern reconstruction techniques, including vascularized grafts and three-dimensional (3D)-printed prostheses, have improved spinopelvic stability and postoperative outcomes. Adjuvant particle beam radiotherapy, particularly proton and carbon ion therapy, demonstrates superior 5-year local control rates of 77-89% compared to 10-30% with conventional photon therapy, while stereotactic radiosurgery achieves 81% local control. Systemic therapies remain limited, though targeted inhibitors of platelet-derived growth factor receptor (PDGFR), epidermal growth factor receptor (EGFR), and the PI3K/AKT/mTOR pathway show modest activity with disease stabilization in 60-70% of cases. Novel immunotherapeutic approaches, including Brachyury-targeted vaccines and checkpoint blockade, are under investigation. Molecular insights have identified key drivers, including Brachyury [T-box transcription factor T (TBXT)], receptor tyrosine kinases, and emerging biomarkers that may guide future therapeutic selection. Conclusions:Integrated multimodal care is critical for improving survival and function in patients with sacral chordomas.
Background and objectives: Obesity is a chronic disease with its onset as early as infancy. This study was conducted to determine risk factors of obesity in infants and young children below 2 years of age. Methods: For this case-control study, obese children aged 1 month to 2 years were enrolled as cases. Controls were age, sex and calendar matched non-obese children from the same setting (1:1). Sociodemographic characteristics, clinical features and potential risk factors (parental obesity, maternal weight gain during pregnancy, low birth weight, cessation of exclusive breastfeeding before 6 months of age, introduction of semisolid feeds before 6 months of age, formula feeding at enrolment, bottle feeding at enrolment, junk food consumption, and lifestyle diseases in family) were noted. Obesity was defined as weight-for-length or BMI-for-age more than 3 standard deviations above median as per World Health Organization 2006 growth charts. Results: Univariate analysis on 52 pairs (22 male pairs) showed maternal pre-conceptional BMI>25 kg/m2, maternal BMI>25 kg/m2 paternal BMI>23 kg/m2, bottle feeding and/or formula feeding at enrolment, cessation of exclusive breastfeeding before 6 months, junk food consumption, and lifestyle diseases in family as risk factors. With multivariable logistic regression, maternal BMI>25 kg/m2 at enrolment [Adjusted odds ratio (aOR) 11.25, 95% confidence interval (CI) 3.66-34.49, P<0.001], formula feeding (aOR 6.13, 95% CI 1.33-28.17, P=0.020) and lifestyle diseases in family (aOR 6.88, 95% CI 1.83-25.88, P=0.004) were identified as significant risk factors. Interpretations and conclusions: Risk factors of obesity in children below 2 years of age were included maternal pre-conceptional BMI>25 kg/m2, maternal BMI>25 kg/m2 at enrolment, formula feeding at enrolment, and lifestyle diseases in family.
Survodutide represents an innovative approach to obesity management and metabolic-associated fatty liver disease (MAFLD). These conditions, often closely linked with type 2 diabetes (T2DM) and cardiovascular diseases, demand effective treatment strategies. Survodutide acts by targeting both GLP-1 and glucagon receptors. This new dual agonist offers potential transformative benefits, with early clinical trials showcasing significant weight loss and improvements in metabolic markers. Survodutide's mechanism of action includes appetite regulation, enhanced glucose metabolism, and increased energy expenditure, making it a promising option for those struggling with obesity and related health issues. This review assesses Survodutide's pharmacology, efficacy, and safety in MASH and obesity, while also outlining its broader metabolic and cardiovascular benefits. It compares Survodutide's dual-agonist mechanism and clinical performance with single-target incretin therapies to clarify its potential role in the evolving treatment landscape. While the initial results are promising, the review emphasizes the importance of continued research to fully understand Survodutide's long-term safety and effectiveness. Ongoing trials will provide critical insights into its overall impact, side effects, patient response, and cost considerations. This article highlights Survodutide's potential in the treatment of obesity and metabolic disordersand evaluates its place in therapy for seeking improved outcomes.
Background and Purpose We aimed to evaluate whether early versus late initiation of direct oral anticoagulant (DOAC) after acute ischemic stroke (AIS) yields different safety and efficacy outcomes in Asian versus non-Asian patients. Methods We analyzed Early versus Late initiation of direct oral Anticoagulants in post-ischaemic stroke patients with atrial fibrillatioN (ELAN) trial data from 2,013 AIS patients with atrial fibrillation (AF) randomized to early (≤48 hours for minor/moderate stroke, 6–7 days for major stroke) or late DOAC initiation (3–4 days for minor ischemic stroke, 6–7 days for moderate ischemic stroke, 12–14 days for major ischemic stroke). Patients were categorized by region as Asian (Japan and India) or non-Asian. The primary outcome was a composite of major extracranial bleeding, symptomatic intracranial hemorrhage (SICH), recurrent ischemic stroke, systemic embolism (SE), or vascular death at 30 days (trial registration: ClinicalTrials.gov number, NCT03148457). Results Among 1,975 patients, 245 were Asian (192 from Japan and 53 from India) and 1,730 were non-Asian. The primary outcome occurred in 6.5% of Asian patients (4.8% early vs. 8.3% late) and 3.1% of non-Asian patients (2.7% vs. 3.6%) (P<0.01). Higher rates of recurrent ischemic stroke (4.1% [2.4% vs. 5.8%] vs. 1.7% [1.3% vs. 2.1%], P=0.02) and SE (2.0% [0.8% vs. 3.3%] vs. 0.5% [0.4% vs. 0.6%], P=0.02) accounted for this difference. No significant differences were observed in major extracranial bleeding, SICH, recurrent ischemic stroke, SE, or vascular death. No significant interaction was observed between region and treatment allocation. Conclusions Although Asian patients had worse baseline profiles and outcomes, treatment effects did not differ by region, supporting the generalizability of early DOAC initiation in Asian AIS patients without region-specific timing modifications.
