The Mar Augustine Kandathil Memorial Lisie Hospital is a hospital near Kaloor, in Kochi, India, noted for its service to the poor. It was founded in memory of Mar Augustine Kandathil, shortly after his demise, according to his original vision and plans, in 1957, as a token of his devotion to St. Thérèse de Lisieux. It is managed by the Archdiocese of Ernakulam.Pennsylvaniat is a tertiary referral hospital and one of the largest in Cochin. The Lisie Heart Institute is a major interventional Cardiology and Cardiothoracic centre. It performed nearly 4000 interventional cardiac procedures and cardiac surgeries in 2006. Their team of doctors was reconstituted in 2008 with the joining of Jose Chacko Periappuram as the Head of Cardiac Surgery and Jacob Abraham as the head of Cardiac Anaesthesia. The present team was instrumental in performing the first total arterial bypass surgery on a beating heart and heart transplantation under Dr. Jose Chacko in the state of Kerala.
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.
Background:Acute pancreatitis (AP) is without specific drug therapy. We conducted a phase 2b trial of the calcium release-activated calcium channel inhibitor zegocractin, previously found to accelerate recovery of food intake in AP, to determine dose-response, target population, endpoints, safety and tolerability in AP with systemic inflammatory response syndrome. Methods:This double-blind, randomised, placebo-controlled, phase 2b trial enrolled adults (aged ≥18 years) with AP and systemic inflammatory response syndrome at 37 centres in the US and India. Patients were randomly assigned (1:1:1:1) to receive placebo or 0.5 (low), 1.0 (medium) or 2.0 (high) mg per kilogramme intravenous zegocractin once daily for 3 days. The primary outcome was time to solid food tolerance, and all outcomes were specified a priori. This trial is registered with ClinicalTrials.gov (NCT04681066) and is complete. Findings:Between 30th March, 2021 and 16th April, 2024, 216 patients were assigned to placebo (N = 53), low (N = 53), medium (N = 56) or high (N = 54) dose zegocractin. The primary outcome of median time to solid food tolerance was 66, 78, 64, and 67 h in these groups respectively (n.s.). Dose-response was observed in patients with a high haematocrit (n = 92), the median times being 113.5, 78, 64 and 67 h, and in those with Balthazar D or E computed tomography at presentation (n = 145), at 112, 68.5, 68.5, and 66 h respectively. Overall, there were dose-dependent responses for the secondary outcomes new-onset severe respiratory failure (4, 4, 0, and 0 patients), new-onset necrotising pancreatitis (17, 17, 20 and 11 patients) and time to medically indicated discharge (104, 109.5, 104.5 and 89 median hours), reflected in an exploratory win ratio for high dose zegocractin compared to placebo of 1.640 (95% CI 1.030-2.612; p = 0.04). Interpretation:This trial was negative for the primary endpoint of time to solid food tolerance in the whole trial population but improvement with zegocractin was seen in patients with a high haematocrit or Balthazar score. Multiple secondary endpoints improved consistently with zegocractin compared to placebo, most notably in preventing new-onset severe respiratory failure. These findings identified a suitable dose, a potential patient population, and endpoints for a phase 3 trial. Funding:CalciMedica.
Plasma exchange (PLEX) improves survival in acute liver failure (ALF); however, there is no study specifically analyzing its utility in hepatitis A virus-related ALF (HAV-ALF). A few reports suggest that ALF patients who are not on inotropes tolerate PLEX better. We aimed at comparing the efficacy of PLEX and of standard medical treatment (SMT) to treat HAV-ALF. We retrospectively compared consecutive HAV-ALF patients treated with PLEX (2018–2024) vs. SMT (2011–2024) at 13 centers across India. We compared in-hospital native liver survival in both groups. In the subset of patients not on inotropes, we compared survival and assessed predictors of poor outcome in PLEX and SMT groups. Eighty-four HAV-ALF patients in PLEX group (61 males; age = 23.5 [21–33] years, median [IQR]; King’s College Criteria [KCC] fulfilled = 22 patients, 26.2
BACKGROUND:Inflammatory bowel disease (IBD), including ulcerative colitis (UC) and Crohn's disease (CD), poses significant diagnostic challenges, particularly in South-East Asia, where its prevalence has risen sharply. Although endoscopic biopsies and histopathological evaluations are central to IBD management, inconsistencies in sampling, processing and reporting hinder accurate and reliable diagnosis. METHODS:To address these gaps, the Indian Association of Pathologists and Microbiologists (IAPM), the Indian Society of Gastroenterology (ISG) and the Colitis and Crohn's Foundation, India, (CCFI) collaborated to formulate comprehensive guidelines. Using a structured Delphi process and expert consensus, recommendations were developed to standardize biopsy protocols, histological evaluation and reporting of mucosal biopsies and tackling critical diagnostic challenges. RESULTS:The recommendations cover biopsy sampling, optimal processing, orientation, interpretation methods, histopathological algorithms, recommendations on histological scoring, follow-up biopsies and differentiation of IBD from its mimickers based on existing literature and expert's experience. Reporting formats were suggested to ensure uniformity in practice. CONCLUSION:These evidence-based, practical recommendations aim to enhance diagnostic precision, unify practices and improve patient outcomes in IBD care, providing pathologists in resource-diverse settings with a standardized approach to gastrointestinal mucosal biopsy evaluation.
The Mediterranean diet is a nutritional approach reported to be beneficial in various diseases. We performed a systematic review about its role in the treatment of inflammatory bowel disease (IBD). Electronic databases (PubMed, Embase and Scopus) were searched on 10th February 2025 to identify reports on the use of the Mediterranean diet in the treatment of IBD. We extracted data with respect to clinical response, remission and endoscopic and histological responses with the use of the Mediterranean diet in the treatment of IBD. Pooled clinical response rates and remission rates were calculated. Eight studies were eventually included. Seven studies involving 223 participants provided information about the induction of remission. The pooled clinical remission rate with Mediterranean diet was 0.62 (95
