Sassoon General Hospital (Marathi: ससून सर्वोपचार रुग्णालय) is a large state-run hospital in Pune, India with over 1500 beds. The B. J. Medical College, Pune and a Nurses training School is attached to it.The Jewish philanthropist David Sassoon from Mumbai made a generous donation to make the construction of the hospital possible in 1867. The hospital could originally accommodate 144 patients.A well-respected child-care center and orphanage, Society of Friends of Sassoon Hospitals (SOFOSH), is connected to the hospital. SOFOSH was started in August 1964 by a group of Pune citizens for the welfare of poor patients of Sassoon Hospitals. Child care activities were initiated in 1973. SOFOSH’s child care center, "Shreevatsa", has provided a home to orphan children ranging from newborns to six-year-olds. Many of the children are placed with adoptive families in India and overseas. A number of children are physically and mentally challenged and a growing number are afflicted by life-threatening ailments. Many of these children will never find adoptive families, and are cared for by the SOFOSH "Preetanjali" project. This also helps kids from ages 0–6 get a home in their orphanage care system; they have been matching adults up with children for 32 years now..
Background Total knee arthroplasty (TKA) is widely performed for end-stage osteoarthritis; however, 15–20% of patients remain dissatisfied despite technically successful surgery. Mechanical alignment aims for a neutral limb axis but may not restore individual constitutional alignment, potentially affecting outcomes. The Coronal Plane Alignment of the Knee (CPAK) classification offers a phenotype-based approach. This study evaluated whether CPAK-guided alignment improves early postoperative outcomes compared with mechanical alignment in TKA. Materials and Methods This multicentric, prospective, randomised study was conducted across three tertiary orthopaedic centres. Fifty patients undergoing unilateral primary TKA were randomised into CPAK-guided and mechanical alignment groups. Standardised surgical and rehabilitation protocols were followed. Outcomes were assessed using KSS, OKS, and VAS at baseline, 3 and 6 months. Radiographic parameters included HKA deviation and joint line obliquity. Results Both groups improved postoperatively, but the CPAK group showed superior outcomes. At 6 months, KSS and OKS were higher and VAS lower in the CPAK group (all p < 0.05). Medial soft-tissue release was less frequent (12% vs 40%; p = 0.02). Better restoration of alignment correlated with improved outcomes (r = − 0.48, p = 0.004). Conclusion CPAK-guided alignment provides better early functional outcomes, less pain, and fewer soft-tissue releases than mechanical alignment, supporting a more personalised approach to TKA.
BACKGROUND:Transitioning from pediatric to adult HIV care is critical for adolescents and young adults living with HIV (AYLH). This study assessed the timing and factors associated with this transition in Asia. SETTING:Retrospective study of AYLH enrolled in Therapeutics Research, Education, and AIDS Training Asia Pediatric HIV Observational Database clinics between May 1991 and December 2020. METHODS:Eligible AYLH were categorized into <18-year-old transitions, and ≥18-year-old transitions or continued pediatric care. RESULTS:The analysis included 1803 AYLH from 6 countries. Of these, 92.7% (n = 1672) had perinatally acquired HIV, and 69.9% (n = 1260) were ≥18-year-old transitions or continued pediatric care. Excluding AYLH who remained in pediatric care, median age at transition was 16.1 years (interquartile range [IQR]: 14.9-17.0) for <18-year-old transitions and 20.0 years (IQR: 19.1-21.2) for ≥18-year-old transitions. At age 18, among 1368 AYLH with available viral load data, 72.9% (n = 998) had viral loads <50 copies/mL (78.9% in <18-year-old transitions [n = 310/393] vs 70.6% in ≥18-year-old transitions [n = 688/975]; P = 0.002). The median CD4 count was 635 cells/μL (IQR: 450-842). Factors independently associated with transitions at ≥18-year-old or continued pediatric care included residence in an upper-middle-income country (adjusted odds ratio [aOR] 10.68 [95% confidence interval (CI): 7.76 to 14.68], P < 0.001), living with family (aOR 2.81 [95% CI: 1.99 to 3.97], P < 0.001), and previous antiretroviral therapy class switching (aOR 1.91 [95% CI: 1.34 to 2.72], P < 0.001). CONCLUSION:Most AYLH in this cohort transitioned at ≥18 years of age. About one-fourth had unsuppressed viral loads at age 18, irrespective of transition status, underscoring the need for personalized treatment approaches that support antiretroviral therapy adherence from pediatric care, preparing AYLH for transition to adult clinics.
BackgroundDrug-resistant Mycobacterium tuberculosis remains a major obstacle to tuberculosis (TB) control. First-line line probe assay (FL-LPA) enables rapid detection of resistance-conferring mutations and provides valuable epidemiological insights. This study aimed to analyze drug resistance patterns and associated mutation profiles detected by FL-LPA in a tertiary care hospital setting.MethodsA prospective observational study was conducted from September 2022 to February 2024 in the TB Culture and Drug Susceptibility Testing laboratory of a tertiary care center. Samples were processed as per national guidelines. Resistance patterns and mutation profiles detected by FL-LPA were analyzed.ResultsA total of 1,295 FL-LPA results were analyzed. The majority of isolates were pan-susceptible (70.96%), while MDR-TB accounted for 22.62%. Mutation analysis of MDR-TB isolates revealed 20 distinct banding patterns, with rpoB WT8 loss plus MUT3 in combination with katG MUT1 being the most frequent. Distinct mutation patterns were identified among isoniazid- and rifampicin mono-resistant isolates and were analyzed independently.ConclusionFL-LPA demonstrated a substantial burden of MDR-TB with notable molecular diversity. The predominance of well-characterized resistance-conferring mutations highlights the utility of FL-LPA for rapid diagnosis, mutation surveillance, and guiding appropriate TB management in high-burden settings.
Introduction Liver steatosis is increasingly recognized as a major comorbidity in people living with HIV (PLWH), with growing evidence suggesting an increased risk of progression to advanced liver disease. We assessed predictors of liver steatosis progression over 36 months in PLWH from low- and middle-income countries. Methods Between 2020 and 2023, we enrolled PLWH aged >= 40 years who had been on antiretroviral therapy (ART) for >= 6 months at nine HIV clinics in the IeDEA Sentinel Research Network (SRN) across the Asia-Pacific, the Americas and African IeDEA regions, and followed them prospectively for 36 months. Participants with available and reliable controlled attenuation parameter (CAP) measurements at both enrolment and the 36-month visits were included in the analysis. Steatosis progression was defined as incident steatosis (CAP >= 248 dB/m) or a transition to a higher steatosis grade (moderate >= 268 dB/m; severe >= 280 dB/m) among those with a lower steatosis grade at enrolment. Logistic regression was used to assess predictors of progression. Results We included 923 participants (63% female; median age 50 years, interquartile range 45-55) in this analysis. At enrolment, 51% were overweight or obese, 10% had type 2 diabetes mellitus (T2DM), 94% had HIV RNA <1000 copies/mL and 72% were on integrase strand inhibitor (INSTI)-based ART. During the 36-month follow-up, 190 (20%) participants showed steatosis progression, including 147 (74%) with incident steatosis and 49 (26%) with worsening of steatosis grades. The progression rate was significantly higher in Asia-Pacific (33% [95% CI, 24-44]) and the Americas (36% [95% CI, 26-46]) compared to the African regions (17% [95% CI, 14-20]). Independent predictors of steatosis progression were overweight/obesity (aOR: 2.97, 95% CI: 2.03-4.40), T2DM (aOR: 2.41, 95% CI: 1.45-3.96) and dyslipidaemia (aOR: 1.46, 95% CI: 1.01-2.12). In females, INSTI use for >= 2 years at enrolment was additionally associated (aOR 3.19, 95% CI: 1.35-8.01). Conclusions Metabolic disorders-including T2DM, overweight/obesity and dyslipidaemia-were associated with steatosis progression in PLWH in our cohort. These findings underscore the need for targeted monitoring and prevention strategies to address this significant public health issue.
Viral load testing is recommended to monitor antiretroviral therapy effectiveness. This study examines changes overtime in the frequency of viral load and CD4 testing, as well as the relationship with AIDS diagnosis and mortality among an Asia-Pacific cohort of people with HIV. We included adults enrolled in the Treat Asia HIV Observational Database between 2003-2018 who were on ART for at least one year. VL and CD4 testing rates were analyzed using Poisson regression models. Association between testing frequency and AIDS diagnosis or survival were evaluated using Fine and Gray competing risk regression. The analysis included 8446 patients. VL testing rates remained steady at 1 per person-year (PYS) between 2013-2018. Increased VL testing was associated with more frequent CD4 testing ( > 2 tests in the previous year; IRR=1.57, 95%CI 1.53-1.60), later follow-up years (2008-2012: IRR=1.15, 95%CI 1.12-1.18; 2013-2015: IRR=1.07, 95%CI 1.04-1.10), older age (31-40 years: IRR=1.06, 95%CI 1.03-1.08; 41-50 years: IRR=1.08, 95%CI 1.05-1.11; > 50 years: IRR=1.07, 95%CI 1.03-1.11), higher current VL (401-1000 copies/mL: IRR=1.16, 95%CI 1.09-1.24; > 1000 copies/mL: IRR=1.07, 95%CI 1.04-1.11), initial ART regimen (NRTI+PI: IRR=1.07, 95%CI 1.04-1.10; other combinations: IRR=1.11, 95%CI 1.05-1.17), and higher country income levels (upper-middle: IRR=2.17, 95%CI 2.11-2.23; high: IRR=3.14, 95%CI 3.03-3.26). CD4 testing rates decreased from 2.04 to 1.06/PYS over the same period. Lower CD4 testing frequency was associated with HIV exposure mode (MSM: IRR=0.94, 95%CI 0.92-0.96; IDU: IRR=0.93, 95%CI 0.90-0.97; unknown: IRR=0.90, 95%CI 0.87-0.93), higher current CD4 (201-350 cells/µL: IRR=0.95, 95%CI 0.93-0.97; 351-500 cells/µL: IRR=0.89, 95%CI 0.87-0.91; > 500 cells/µL: IRR=0.85, 95%CI 0.83-0.87) and receiving an NRTI+PI first-line combination (IRR=0.96, 95% CI 0.94-0.98). VL and CD4 testing frequencies were not significantly associated with AIDS diagnosis. However, having > 2 CD4 tests in the previous year was associated with higher mortality risks. Recognizing demographic, clinical and socio-economic factors affecting the frequency of CD4 and VL testing is critical to optimizing monitoring strategies and improving outcomes for PWH in the region. All Authors: No reported disclosures
