Osmania Medical College

The Hospital for Special Surgery (New York, NY, USA) partnered with Osmania General Hospital (OGH) in Telangana, India, to pilot a novel point-of-care ultrasound (POCUS) training program called Sustainable Point-of-Care Ultrasound Education in Anesthesia in a Resource-Limited Setting (SPEARS). In this study, we sought to teach essential POCUS skills that could be integrated into daily practice, evaluate the program’s impact, and establish a reproducible framework for anesthesia providers in resource-limited settings. We conducted a mixed-methods local needs assessment at OGH through direct observations, surveys, and interviews. On the basis of these data, we designed the SPEARS intervention, incorporating online didactics, and training modules followed by a 1-week in-person course. SPEARS was implemented at two time points: in February 2023 (time point 1) and December 2023 (time point 2). Participants were anesthesiology attending physicians and postgraduate residents (N = 26). Data collected at each time point included pre- and post-training knowledge tests, clinical skills assessments, and post-training satisfaction surveys. Participants also maintained logbooks to examine changes in POCUS use over time. The impact of the intervention was analyzed using the Kirkpatrick evaluation model. Repeated measures analysis of variance showed a significant positive within-participant effect on knowledge and clinical skills scores across time points. The mean (standard deviation) 5-point Likert scale satisfaction score was 4.4 (0.8). Logbooks indicated a notable increase in the number of POCUS examinations performed after training. The SPEARS intervention was associated with improved POCUS knowledge, clinical skills, and use among anesthesia providers in a resource-limited setting. These findings suggest that similar blended-learning training initiatives could be adapted and implemented in other resource-limited contexts to build sustainable POCUS capacity.

Purpose Metabolic dysfunction and chronic kidney disease (CKD) often coexist, presenting therapeutic challenges. Saroglitazar, a dual proliferator-activated receptor (PPAR)-α/γ agonist, shows promising effects in managing dyslipidemia and glycemic abnormalities; however, real-world evidence (RWE) is limited across varying degrees of renal function. This study evaluated the effectiveness and safety of saroglitazar (4 mg) in patients with metabolic disease in India stratified by estimated glomerular filtration rate (eGFR). Methods This retrospective observational study analyzed the electronic medical records (EMRs) of 614 patients with metabolic disorders prescribed saroglitazar. Changes in lipid and glycemic parameters, liver enzymes, and renal function were assessed from baseline to follow-up (minimum 90 days) across eGFR categories. Results A total of 614 patients were included. Metabolic and cardiac disorders were the most common conditions at baseline. Significant reductions were observed in triglycerides (TG, -62.68 mg/dL), low-density lipoproteins (LDL, -7.03 mg/dL), and glycosylated hemoglobin (HbA1c, -0.76%) in the overall population (p < 0.001), with similar reductions in patients with eGFR ≥90 mL/min/1.73 m² and 60-89.99 mL/min/1.73 m². Patients with hepatic conditions showed a significant decrease in aspartate transaminase (AST) and alanine transaminase (ALT) levels. eGFR levels remained stable across categories. Saroglitazar was associated with a low incidence of adverse events, including asthenia (n = 12, 1.95%) and pyrexia (n = 6, 0.97%). Conclusion Saroglitazar was associated with improved lipid and glycemic profiles across various levels of kidney function, with limited safety concerns. These real-world findings suggest the potential metabolic benefits of saroglitazar in Indian patients with metabolic abnormalities, across diverse renal functions.

Pleomorphic adenoma of the lacrimal gland is a benign epithelial neoplasm and can rarely undergo cystic degeneration, mimicking other conditions with similar radiological findings. It commonly presents as a slow growing, painless mass in the outer upper eyelid, characterised by exophthalmos, ptosis, diplopia and reduced ocular movements. Here, we present one such case of a male in his mid-30s presenting with a painless, progressive fullness in the left upper eyelid with mild proptosis and restricted ocular movements which was initially suspected to be due to an underlying dermoid cyst owing to the cystic nature of the lesion on imaging. Surgical intervention involving complete excision was preferred, rendering no recurrence on follow-up. Histopathological examination however revealed microscopic features suggestive of a pleomorphic adenoma with cystic changes contrary to the initial diagnosis of a dermoid cyst. This case highlights the challenges faced in arriving at the right diagnosis with successful treatment outcomes.

Introduction Intracranial tumourstumors arise from the brain or its surrounding tissues. Tumors of the central nervous system (CNS) are estimated to be approximately 2% of all new cancers. In India, they constitute about 1.9% of all tumors. Extramedullary lesions, most commonly benign meningioma, account for 70 to 80% of spinal cord tumors. The objective of this study is to characterize histological subtypes, age and gender distribution, and WHO grading of intracranial and spinal tumors in a tertiary care hospital in Jaipur, Rajasthan, India. Material and method A retrospective study was conducted at the Department of Surgical Oncology, Sawai Man Singh (SMS) hospital, Jaipur, Rajasthan, a tertiary care hospital, over a period of 5 years. A total of 1315 cases of CNS and spinal neoplasms were diagnosed during this period. Results  In this study, a total of 1315 cases of CNS and spinal tumors were found. The majority (1199 cases, 91.2%) of the tumors were intracranial, whereas the remaining 116 (8.82%) cases were spinal. Among intracranial tumors, astrocytomas accounted for the largest share in our study, comprising 398 cases (30.27%), mostly seen after the 3rd decade of life, with a mean age of occurrence of 28.44 years. Glioblastoma multiforme forms the largest subtype, constituting 41.96% of all astrocytoma, mostly seen in the 5th or 6th decade of life. Meningioma constitutes the second major group of tumors involving the CNS. Overall, males outnumbered females, the ratio being 1.66:1. However, meningioma is an exception, which was found with higher rates in females (ratio 1:1.37). Among the spinal neoplasms, meningioma was the most common type in our study. Conclusion The most common type of intracranial tumor in the present study was astrocytoma, followed by meningioma. The ratio of male: female for CNS tumors was 1.66:1. However, females outnumbered males in the case of meningioma, with a ratio of 1:1.37. Meningioma was the most common type of spinal neoplasm.