Meditrina Hospital is a hospital in the city of Kollam, India. It is the first tertiary care hospital in the city, located at Ayathil, and was inaugurated 13 December 2014. Meditrina Group of Hospitals is headquartered at Kollam, mainly aiming to provide bypass and allied cardiac care.The Meditrina Group has recently raised $6 Million(INR 30 crores) from Matrix Partners India..
Randomized trials in true distal left main (LM) bifurcation PCI have shown broadly comparable outcomes between stepwise provisional and planned two-stent strategies. We evaluated long-term clinical outcomes and procedural patterns in a contemporary real-world cohort. We analyzed a single-center registry of patients with true distal LM bifurcation lesions (Medina 1,1,1; 1,0,1; or 0,1,1) treated with either a stepwise provisional or an upfront two-stent strategy. The primary endpoint was major adverse cardiovascular events (MACE), defined as all-cause death, myocardial infarction, or target lesion revascularization (TLR). Stabilized inverse probability of treatment weighting (IPTW) was used as a sensitivity analysis for the primary strategy comparison. To address the nonrandomized use of intravascular imaging, we also performed a post hoc propensity score–weighted analysis for imaging guidance including age, sex, diabetes, chronic kidney disease, left ventricular ejection fraction, SYNTAX score, ACS presentation, and initial stent strategy. Among 214 patients (provisional n = 106; two-stent n = 108) with a median follow-up of 25 months (IQR 8–50), upfront two-stent cases more frequently used intravascular imaging and kissing balloon inflation (both p < 0.001). MACE occurred in 17.9
Type 2 Diabetes Mellitus (T2DM) confers a significant risk for Mild Cognitive Impairment (MCI), yet robust biomarkers for early detection remain limited. In this study, 150 age-matched participants (50 Healthy Controls, 50 T2DM, 50 T2DM with MCI) were assessed using high-resolution structural MRI, neuropsychological testing, and serological profiling to identify sensitive neuroanatomical and cognitive markers. Cortical thinning was observed, most prominently in the Left Pars Opercularis (LPO), which exhibited stepwise unidirectional atrophy across the diagnostic continuum, highlighting its potential as a structural marker for cognitive deterioration in T2DM. Significant deficits in episodic memory, processing speed, executive function, and verbal memory were also observed, reflecting disruptions in medial-temporal and frontoparietal networks. A Random Forest classifier integrating multimodal features achieved high discriminatory performance (AUC-ROC = 0.95) for distinguishing T2DM with MCI from T2DM patients. SHAP, an Explainable AI method, identified cortical thickness at LPO, and executive function assessed by TMTB as the most influential predictors. These findings establish the LPO as a key neuroanatomical substrate of T2DM-related cognitive impairment and demonstrate that combining targeted neuroimaging with domain-specific cognitive assessments provides a clinically viable framework for early identification of at-risk T2DM patients, offering critical opportunities for preventive intervention.
Background Retention of a microcatheter distal tip during chronic total occlusion (CTO) percutaneous coronary intervention (PCI) is rare and particularly challenging in heavily calcified, balloon-uncrossable lesions. Case Summary A 66-year-old man with symptomatic chronic coronary syndrome underwent PCI for a severely calcified ostial left anterior descending artery CTO. After antegrade wire crossing, the lesion remained balloon-uncrossable. During balloon-assisted wire exchange, the Finecross distal radiopaque tip fractured and remained embedded within the CTO segment. Rotational atherectomy with a 1.5-mm burr resulted in fluoroscopic disappearance of the retained tip while preserving TIMI flow grade 3. Because lesion crossability remained limited, a 1.25-mm burr was used for further plaque modification, possibly because interaction with the retained tip material reduced the initial burr's cutting efficiency. PCI was then completed with stent implantation and an excellent final angiographic result. Discussion This case highlights rotational atherectomy as a bailout option in calcified uncrossable CTOs, while acknowledging the uncertain downstream risk of fragmented microcatheter material. Take-Home Message Controlled plaque modification may permit safe PCI completion when retrieval is impractical.
BACKGROUND AND METHODS:The Trivandrum Heart Failure Registry (THFR) is a prospective cohort study of patients hospitalized with acute decompensated heart failure (HF) in 18 hospitals across Trivandrum, Kerala, from January to December 2013. Trained nurses collected detailed clinical and treatment data, and participants were followed every 3-6 months for ten years. We used Kaplan-Meier survival curves and the Cox proportional hazards model to analyze factors associated with mortality in HF. RESULTS:A total of 1,205 patients were enrolled (mean age 61.2 ± 13.6 years), with a male predominance (n=834, 69%). The majority (n=752, 62.4%) had heart failure with reduced ejection fraction (HFrEF), 21.8% had mildly reduced EF (HFmrEF), and 15.8% had preserved EF (HFpEF). Comorbid conditions were common, with 55% having diabetes and 58% hypertension. Ischemic heart disease was the leading cause of HF (71.9%), followed by dilated cardiomyopathy (12.9%) and rheumatic heart disease (7.9%). At discharge, only 25.4% of HFrEF patients received guideline-directed medical therapy (GDMT), a combination of an ACE inhibitor or ARB, a beta-blocker, and a mineralocorticoid receptor antagonist. Complete follow-up data was available for 88.8% of participants. The overall mortality at 10 years was 875 (82.7%) out of 1,058 patients available for follow-up, with cardiovascular causes accounting for 838 (96%) of deaths; the remainder were attributed to COVID-19 and other non-cardiovascular conditions. Mortality was highest among those with HFrEF (85.3%), followed by HFmrEF (82.1%) and HFpEF (72.7%) (Log-rank p<0.001). Among patients with HFrEF on follow-up, the mortality was 126 (75.9%) for those prescribed GDMT at baseline, compared with 437 (88.6%) for those not prescribed GDMT (HR=0.71; 95% CI 0.57-0.88, p=0.002). CONCLUSIONS:In this Indian HF registry, 83% of patients died over 10 years, reflecting high mortality. GDMT for HFrEF showed lasting survival benefits, while patients with HFpEF had lower mortality than HFrEF and HFmrEF. The findings stress the need for better implementation of GDMT and wider preventive strategies to reduce HF burden.
