Indira Gandhi Co-operative Hospital (IGCH), formerly known as the Cochin Co-operative Hospital, is a hospital operating in the co-operative sector in Kochi, Kerala, India..
BACKGROUND & AIMS:We conducted a target trial emulation study to examine the effect of 2 glucagon-like peptide-1 receptor agonists (semaglutide and tirzepatide) on clinical outcomes in patients with inflammatory bowel diseases with obesity and/or diabetes. METHODS:We emulated a target trial of glucagon-like peptide-1 receptor agonists in eligible, stable patients with inflammatory bowel diseases (no steroid use, no inflammatory bowel disease-related hospitalization or surgery and stable dose of inflammatory bowel disease therapy for >6 months) with comorbid obesity and/or diabetes using observational data from an administrative claims database (OptumLabs Data Warehouse) between 2018 and 2023. We created 2 separate cohorts: (cohort 1) background 5-aminosalicylates or no inflammatory bowel disease-directed medications; and (cohort 2) background advanced therapies and/or immunomodulators. We compared the 1-year risk of relapse (composite of inflammatory bowel disease-related hospitalization, surgery, or prednisone use) and safety with glucagon-like peptide-1 receptor agonist initiation vs noninitiation, after 1:1 propensity score matching. RESULTS:Cohort 1: In 2028 patients initiated on glucagon-like peptide-1 receptor agonists (age, 63 ± 11 years; 63% female; 71% with ulcerative colitis) matched 1:1 to glucagon-like peptide-1 receptor agonist noninitiators, there was no difference in risk of relapse (7.9% vs 7.9%; relative risk, 1.01; 95% confidence interval, 0.82-1.24) or safety outcomes (7.0% vs 7.9%; relative risk, 0.88; 95% confidence interval, 0.71-1.10); 36% patients discontinued glucagon-like peptide-1 receptor agonists within 1 year. Cohort 2: In 346 patients initiated on glucagon-like peptide-1 receptor agonists (age, 59 ± 12 years; 62% female; 43% with ulcerative colitis) matched 1:1 to glucagon-like peptide-1 receptor agonist noninitiators, no significant difference was observed in the risk of relapse (12.4% vs 15.6%; relative risk, 0.80; 95% confidence interval, 0.55-1.15) or safety outcomes (5.5% vs 6.6%; relative risk, 0.88; 95% confidence interval, 0.48-1.58); 33% of patients discontinued glucagon-like peptide-1 receptor agonists within 1 year. CONCLUSIONS:Adjunctive treatment with semaglutide or tirzepatide does not improve outcomes in patients with stable inflammatory bowel diseases on advanced therapies and/or immunomodulators and/or 5-aminosalicylates.
Xanthelasma palpebrum (XP) is the most common cutaneous xanthoma, presenting as bilateral, yellowish periorbital plaques, occurring more commonly in women during the fourth and fifth decades of life. Although benign, XP can be cosmetically distressing to the patient, warranting treatment. There are multiple therapeutic modalities available, such as surgical excision, chemical cauterisation, cryotherapy, laser ablation, and radiofrequency (RF) cautery. Among these, RF cautery is popular for its precision, ease of use, and low cost. However, conventional RF carries a significant risk of post-inflammatory hyperpigmentation (PIH), scarring, and recurrence (especially in darker skin types) due to excessive thermal injury or incomplete removal of the lesion. Here, the authors describe a novel dual-modality technique combining superficial RF cautery with subsequent manual needle extraction of residual lipid deposits. After initial lesion debulking by RF, a 26-gauge needle is used to extract deeper xanthelasma material, similar to milia extraction. This approach minimises collateral thermal damage, reduces PIH and scarring risk, and ensures thorough lesion clearance, thereby lowering recurrence. This method demonstrated faster recovery and superior cosmetic outcomes compared to conventional RF cautery alone. This simple, low-cost modification addresses the major limitations of conventional RF, while providing a safe and cosmetically superior alternative for management of XP and adds a valuable innovation to the dermatologist’s surgical toolkit.
Abstract Medical gas pipeline system (MGPS) and liquid medical oxygen (LMO) storage tanks are indispensable components of modern healthcare infrastructure. They ensure uninterrupted delivery of oxygen, nitrous oxide, medical air, vacuum, and other essential gases required for patient care in intensive care units, operation theaters, emergency departments, and critical care areas. Failure of these systems may result in catastrophic consequences such as fire hazards, explosions, hypoxia, gas contamination, and interruption of life-saving therapies. This article reviews the essential safety guidelines, operational protocols, maintenance practices, and emergency preparedness measures required for the safe functioning of MGPS and LMO installations in hospitals.
INTRODUCTION:Despite regulatory mandates for advanced therapy (AT) washout periods of up to 5 drug half-lives before enrolling patients in inflammatory bowel disease (IBD) trials, the evidence base for these requirements is largely empirical, and whether shorter intervals independently increase the risk of serious infections in real-world practice remains unknown. METHODS:Using the OptumLabs Data Warehouse, we identified adult patients with IBD who initiated a new AT (tumor necrosis factor antagonists, vedolizumab, interleukin (IL)-12/23 or IL-23 antagonists, or Janus kinase inhibitors) between 2018 and 2023 using a class-specific new-user design. We examined whether exposure to AT within the preceding 12 months (vs no exposure to AT within that window) and timing of discontinuation (≤1 month, 1-<3 months, or 3-12 months) were associated with risk of serious infections using multivariable Cox proportional hazards regression. RESULTS:Among 21 564 AT initiators (47 ± 18 years; 52% female; 57% Crohn's disease), 7490 (34.7%) had AT exposure within the preceding 12 months. Over a mean follow-up of 1.6 ± 0.9 y, 1955 (9.1%) experienced a serious infection. Prior AT exposure was associated with higher infection risk (hazard ratio [HR]: 1.19, 95% confidence interval [CI]: 1.07-1.33), consistent in inverse probability of treatment-weighted analyses (HR, 1.20 [1.06-1.37]). Among patients with prior exposure, timing of discontinuation was not associated with infection risk (HR, 1.17 [0.95-1.43] for ≤1 month vs 3-12 months; HR, 1.01 [0.83-1.22] for 1-<3 months), with no dose-response relationship on continuous modeling. DISCUSSION:AT exposure within the preceding 12 months is associated with modestly higher risk of serious infection after initiating a new AT in IBD, but timing of discontinuation does not independently influence this risk.
