Government Vellore Medical College

INTRODUCTION:Coronary Artery Bypass Grafting (CABG) and Percutaneous Coronary Intervention (PCI) are standard treatments for Multivessel Coronary Artery Disease (MVD). Their long-term comparative effectiveness remains debated. METHOD:A systematic review and meta-analysis of randomized and observational studies was conducted, including patients with MVD followed for ≥5 years. Data were pooled using randomor fixed-effects models, depending on the level of heterogeneity. RESULTS:Thirteen studies met the inclusion criteria. CABG was associated with reduced all-cause mortality (RR 0.82, 95% CI 0.72-0.91) and fewer repeat revascularizations (RR 1.98, 95% CI 1.74-2.26) compared with PCI. Stroke risk was slightly higher after CABG. DISCUSSION:Findings suggest CABG provides superior survival and event reduction in long-term follow-up, particularly in higher-risk subgroups. However, the modestly increased stroke risk highlights the need for individualized decision-making, taking into account patient comorbidities, anatomy, and surgical suitability. CONCLUSION:CABG offers long-term survival and durability advantages over PCI in MVD, while PCI remains suitable for patients with lower-risk anatomy or when surgery is contraindicated.

Background: Emergency laparotomy is associated with substantial physiological stress, postoperative morbidity, delayed functional recovery and prolonged hospitalization. Enhanced Recovery After Surgery (ERAS) is a multimodal perioperative strategy designed to reduce avoidable physiological stress and accelerate recovery. Evidence in emergency laparotomy is increasing, but institutional data from resource-constrained settings remain important. Aim: To compare postoperative hospital stay and selected postoperative complications among patients undergoing emergency laparotomy managed with an ERAS-based pathway versus conventional postoperative care. Methods: This prospective, non-randomized controlled study was conducted in the Department of General Surgery, Government Vellore Medical College and Hospital, Vellore. Patients undergoing emergency laparotomy from April 2023 to August 2024 were evaluated. Seventy eligible patients were included, with 35 managed using the ERAS pathway and 35 receiving conventional care. The ERAS pathway comprised postoperative day-0 removal of the Ryle's tube and urinary catheter when clinically appropriate, early oral feeding, early ambulation, chest physiotherapy and daily dressing. The primary outcome was postoperative hospital stay. Secondary outcomes were wound infection and respiratory complications. Length of stay was compared using the Mann–Whitney U test; categorical outcomes were analyzed using Pearson's chi-square test and Fisher's exact test. Results: The ERAS group had a significantly lower mean rank for postoperative hospital stay than the conventional-care group (24.30 vs 46.70; Mann–Whitney U=220.500; Z=?4.715; p<0.001). Wound infection occurred in 1/35 patients (2.9%) in the ERAS group and 3/35 (8.6%) in the conventional group; the difference was not statistically significant (Pearson ?²=1.014, p=0.314; Fisher's exact p=1.000). Respiratory complications occurred in 3/35 (8.6%) and 5/35 (14.3%), respectively, without statistical significance (Pearson ?²=1.014, p=0.314; Fisher's exact p=1.000). Subgroup analyses by age (<50 vs ?50 years) and sex did not demonstrate statistically significant differences. Conclusion: In this single-centre non-randomized study, an ERAS-based postoperative pathway was associated with significantly shorter hospitalization following emergency laparotomy without an observed increase in wound or respiratory complications. Larger randomized studies with standardized ERAS compliance measurement, validated patient-reported outcomes and post-discharge follow-up are warranted. Keywords: Enhanced Recovery After Surgery, ERAS, emergency laparotomy, postoperative recovery, length of hospital staym, wound infection, respiratory complications, early feeding, early mobilization

Background: Tapentadol is a centrally acting opioid analgesic with m-opioid receptor agonism and norepinephrine reuptake inhibition. Although approved for the management of moderate to severe pain, emerging reports suggest increasing misuse of tapentadol in India, particularly through tampering of oral tablets for intravenous use. Limited data are available regarding the clinical profile and complications associated with this pattern of use. Case series: We describe 13 treatment-seeking young adults with intravenous tapentadol abuse who presented to a tertiary care center between January and December 2025. All patients were male, aged 16–29 years, and from rural backgrounds. The duration of intravenous tapentadol use ranged from 6 months to 6 years, with maximum daily doses ranging from 500 mg to 4000 mg. Alcohol (46.2%) and cannabis (38.5%) were the most common primary substances used before tapentadol initiation. Eight patients fulfilled the ICD-10 criteria for opioid dependence syndrome, while five had harmful opioid use. At presentation, Clinical Opiate Withdrawal Scale (COWS) scores ranged from 12 to 30, indicating mild-to-moderately severe withdrawal. Patients also exhibited psychiatric features, including low mood, aggressive behavior, suicidal ideation, and deliberate self-harm behavior. Injection-related complications, including abscess, cellulitis, and thrombophlebitis, were observed in three patients, while four patients tested positive for hepatitis B. Conclusion: Intravenous tapentadol use among young adults from rural backgrounds represents an emerging public health concern in India. Early identification, harm-reduction strategies, and strengthening of regulatory measures are essential to address the growing misuse of prescription opioids.

Background: Serum ferritin, an indicator of body iron stores as well as an acute-phase reactant, has been investigated as a potential prognostic biomarker in acute ischaemic stroke (AIS). This study evaluated the prognostic relevance of serum ferritin, its association with functional outcome using the modified Rankin Scale (MRS), and its relationship with established vascular risk factors in patients with AIS. Methods: This prospective observational study was conducted in the Department of General Medicine, Government Mohan Kumaramangalam Medical College Hospital, Salem, between November 2018 and August 2019. Sixty patients with AIS presenting within 48 hours of symptom onset were enrolled after informed consent. Baseline demographic, clinical, and laboratory characteristics were recorded. Stroke severity was assessed using the National Institutes of Health Stroke Scale (NIHSS) at admission, and functional outcome was evaluated using the mRS at 4 weeks. Serum ferritin was measured at admission. Results: The mean age was 59.68 ± 10.12 years, and 70% were men. At 4 weeks, 33.3% had good (mRS 1–2) and 66.7% had poor (mRS 3–6) functional outcomes. Mean serum ferritin was 229.71 ± 132.02 ng/mL. Ferritin correlated weakly with age (r=0.309, p=0.016) but not with hypertension, diabetes mellitus, dyslipidaemia, smoking, or alcohol use. Ferritin was significantly higher in patients with poor than good outcome (266.2 ± 131.0 vs. 156.8 ± 103.5 ng/mL; p=0.002). Every 50 ng/mL ferritin increase independently increased the odds of poor outcome by 38% (aOR 1.38; 95% CI: 1.05–1.82; p=0.021). ROC analysis showed an AUC of 0.758; a ≥205 ng/mL cut-off provided 75% sensitivity and 70% specificity. Conclusion: Higher admission serum ferritin was independently associated with poor 4-week functional outcome in AIS and demonstrated moderate predictive ability, supporting its potential role as an adjunctive prognostic marker.

Abstract Background Understanding antimicrobial use and factors driving it in communities is essential to devise its stewardship and reduce emergence of antimicrobial resistance. Objectives To study the intersectional influence of socioeconomic status, migration and place of treatment on antimicrobial use in a semi urban area in Tamil Nadu, India. Methods We conducted a cross-sectional survey among systematically sampled 525 adult men and women from three villages in a semi-urban area in Tiruvallur district. We collected data through structured interviews on incidence of infections in the past 3 months, treatment seeking behaviour, and audited the antimicrobial prescription or empty packs of medicines used. We analyzed the data using R statistical software and performed a multilevel analysis of individual heterogeneity and discriminatory accuracy to study intersectional effects. Results We found that the incidence of infection syndrome was 37% with a majority of them being acute respiratory infections. 143 of them sought treatment, with 40% going to a private general practitioner. People belonging to middle class had a 3.7 times greater odds of going to private sector compared to lower class. Twenty eight (19.6%) of those who sought treatment received an antimicrobial prescription. Sixty percent of them belonged to Access group, 35.7% Watch and 3.6% Restrict group. There was a significant intersectional effect showing middle class- non migrant – private care seekers having 22% probability of antimicrobial use versus lower class – migrant – government care seekers having 16% probability. The variance partition coefficient was 2.6% showing a small by significant portion of the variance contributed by intersectional identities. Conclusion Antimicrobial use in the community is significantly shaped by the intersection of socioeconomic status, migrant status and place of seeking care for the infection. Regulation of private sector prescription patterns and improving access to health care for migrants are key policy interventions.