Rajagiri Hospital is a multi-specialty tertiary care hospital in the south Indian city of Kochi, Kerala. Established in 2014, it is owned and managed by Rajagiri (CMI) group of institutions. It is one of the few hospitals in the country with both JCI and NABH accreditation.Rajagiri Healthcare and Education Project is a joint initiative of CMI Sacred Heart Province, together with two of its prominent units, St. Antony's Monastery, Aluva and Sacred Heart Monastery, Thevara.
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.
Extrahepatic portal vein obstruction (EHPVO) is a major cause of noncirrhotic portal hypertension, particularly in children and young adults. Traditionally, definitive management relied on surgical shunts such as proximal splenorenal shunt and meso-Rex bypass; however, extensive porto-mesenteric thrombosis, unfavorable anatomy, perioperative morbidity, and limited surgical expertise may restrict surgical feasibility in many patients. Over the last decade, advances in interventional radiology have substantially expanded therapeutic options beyond surgery. Portal vein recanalization (PVR) is increasingly considered a physiological endovascular treatment strategy in anatomically suitable patients because it restores hepatopetal portal flow while preserving native hepatic perfusion. In patients with diffuse intrahepatic involvement, persistent portal hypertension, or inadequate portal inflow, adjunctive transjugular intrahepatic portosystemic shunt (TIPS) may improve decompression and long-term patency. Transjugular extrahepatic portosystemic shunt (TEPS) serves as an advanced salvage option in complex anatomy unsuitable for conventional TIPS, while partial splenic embolization and variceal embolization complement management of hypersplenism and refractory variceal bleeding. This review provides an overview of endovascular interventions in EHPVO, highlighting the underlying rationale, patient selection, techniques, outcomes, and complications.
PURPOSE:Acute respiratory infections (ARIs) are a major global health concern, causing over 4 million deaths annually, particularly in developing countries. Traditional diagnostic methods, such as microbial culture, are slow, leading to delayed treatment and increased antimicrobial resistance (AMR). This study evaluates the BIOFIRE Pneumonia Plus panel, a multiplex PCR-based assay, for detecting bacterial and viral pathogens and AMR genes in bronchoalveolar lavage (BAL) specimens. METHODS:A method-comparison study was conducted in a tertiary care setting using identified clinical data over one year. BAL specimens were analyzed using the BIOFIRE Pneumonia Plus panel and standard culture, and their results and turnaround times were compared. RESULTS:Among 303 specimens, the BIOFIRE Pneumonia Plus panel detected pathogens in 70.3 % of cases, significantly outperforming standard culture (14.85 %). The most frequently identified bacteria were Pseudomonas aeruginosa (20.08 %), Klebsiella pneumoniae (17.15 %), and Haemophilus influenzae (16.31 %). The most common viruses detected were human rhinovirus/enterovirus (18.81 %) and influenza A (9.24 %). AMR genes were found in 24.09 % of cases, with CTX-M and NDM being the most prevalent. The BIOFIRE panel provided results in 2 h 35 min, compared to 56 h 46 min for standard culture. CONCLUSION:The BIOFIRE Pneumonia Plus panel enables rapid and accurate pathogen detection, improving clinical decision-making and supporting antimicrobial stewardship. Despite limitations such as the detection of colonizers or non-viable microorganisms, it is a valuable tool for enhancing ARI diagnostics and guiding targeted therapy.
