United Hospital, located in St. Paul, Minnesota, is a 556-bed non-profit hospital that serves St. Paul and the eastern Twin Cities metropolitan area. United Hospital is part of Allina Health and offers specialty services including pregnancy care, birth center, behavioral health, cancer care, heart and vascular services, orthopedics and neuroscience. The hospital provides health care services to more than 200,000 people each year. United Hospital is the main hospital for the United Heart and Vascular Clinic.
Postpartum hemorrhage (PPH) remains a major cause of both maternal mortality and morbidity worldwide. PPH is a nightmare for obstetricians. Uterine artery embolization (UAE) has a high success rate in controlling bleeding from secondary PPH, with a success rate of 85%. UAE is particularly useful for PPH caused by uterine atony, retained placental fragments, or abnormal blood vessel formation (AVM). We report a case of a recurrent secondary PPH which was successfully treated with uterine arterial embolization. A 36-year-old female, Para-3, with a history of two previous cesarean sections, presented with massive per vaginal bleeding 40 days after cesarean section due to twin pregnancy. On the 17th post-operative day of cesarean section, she developed severe secondary PPH and underwent D & C for retained product of conception. After the procedure, bleeding continued on and off but the last episode was catastrophic. After initial resuscitation and hemodynamic stabilization and medical management, her bleeding was reduced but still persisted. She received 11 units of blood transfusion throughout the postpartum period .Her ultrasound was done which suspected C-section site-acquired arteriovenous malformation. Considering her age and desire to preserve fertility, the patient underwent bilateral uterine arteriovenous embolization by coils. Her per vaginal bleeding dramatically reduced after the procedure. UAE is often considered when conservative management fails to control bleeding or surgical interventions are not preferred. UAE is a fertility-sparing option, allowing women to potentially have future pregnancies. Compared to surgical interventions like hysterectomy, UAE is less invasive, resulting in short hospital stay and faster recovery times. In essence, UAE is an available tool in the multidisciplinary approach to managing secondary PPH in a tertiary care center.
PURPOSE:Immunotherapy for frontline mismatch repair-deficient/microsatellite instability-high (dMMR/MSI-H) metastatic colorectal cancer (mCRC) is effective; however, nearly half of the patients treated with single-agent PD-1 therapy will progress within 12 months. Preclinical studies in CRC and clinical data from other cancers suggest that vascular endothelial growth factor inhibition and chemotherapy can synergize with PD-L1 inhibition. METHODS:The NRG-GI004/SWOG-S1610 (COMMIT) three-arm prospective phase III open-label trial randomly assigned first-line dMMR/MSI-H mCRC patients (1:1:1) to either: mFOLFOX6 (oxaliplatin 85 mg/m², leucovorin 400 mg/m², 5-FU bolus 400 mg/m², and 46-hour infusional 5-FU 2,400 mg/m²)/bevacizumab (FFX/bev), or atezolizumab (atezo) monotherapy (840 mg IV once every 2 weeks), or the combination of FFX/bev/atezo. The primary end point was progression-free survival (PFS) in the intent-to-treat population. Because of KEYNOTE 177 results, the FFX/bev arm was closed after 20 patients were enrolled. The study continued with atezo alone versus FFX/bev/atezo, with a revised sample size of 100 patients in the two remaining arms (120 patients across all three arms). RESULTS:From November 2017 to March 2025, a total of 102 patients were enrolled in the three arms: FFX/bev: n = 20, atezo: n = 41, and FFX/bev/atezo: n = 41. At a median follow-up of 46 months for the two arms (median age: 63.3 years; 47.6% female; 23.2% BRAF V600E mutated), PFS of FFX/bev/atezo was superior to that of atezo (hazard ratio [HR], 0.439 [95% CI, 0.23 to 0.84]; P = .0103) and below the critical value of 0.0152. The objective response rate was 86.1% versus 46%, and the disease control rate at 12 months was 64.7% versus 32.4% in the FFX/bev/atezo arm compared with the atezo-only arm, respectively. Grade 3 or higher adverse events of any attribution occurred in 52 patients (atezo: 18; combination arm: 34). CONCLUSION:The combination of FFX/bev plus atezo led to significantly longer PFS compared with atezo monotherapy in the first-line treatment of dMMR/MSI-H mCRC.
Purpose:The modified Bentall procedure utilizing the Carbomedics Carbo-Seal Valsalva™ graft can be employed to address aortic root pathologies. In this study, we examined the performance of this conduit specifically for treating isolated annuloaortic ectasia. Our objective was to evaluate the long-term outcomes of these surgeries. Methods:A total of 48 consecutive patients with annuloaortic ectasia underwent aortic root replacement using the Carbomedics Carbo-seal Valsalva™ graft between 2012 and 2024. In 7 patients, additional cardiac procedures were performed: two underwent mitral valve annuloplasty, and five had coronary artery bypass grafting. The mean cardiopulmonary bypass time and aortic clamp time during the modified button-Bentall operations were 151 ± 37 min and 128 ± 14 min, respectively. Results:The operative mortality rate was 2.1% (n = 1). Late mortality was 6.3% (n = 3), with causes including chronic heart failure (2.1%; n = 1), cerebral hemorrhage (2.1%; n = 1), and pulmonary complications (2.1%; n = 1). Major late complications included cerebral hemorrhage (4.2%; n = 2), pulmonary bleeding (2.1%; n = 1), and gastrointestinal hemorrhage (2.1%; n = 1). The Kaplan-Meier estimated survival rates were 96.22% at 5 years and 95.20% at 10 years. Additionally, the Kaplan-Meier curves showed event-free survival rates of 98% at 5 years and 82% at 12 years (95% CI). Conclusions:Modified button-Bentall operations for annuloaortic ectasia, with Carbomedics Carbo-Seal Valsalva™ graft, can be performed with a low mid- and long-term mortality and morbidity.
Abstract Background and Objectives: Coronary artery disease (CAD) in Indians occurs a decade earlier than in Western populations. Artificial intelligence powered coronary artery calcium (AI-CAC) scan is a useful method for detecting silent atherosclerotic plaque and preventing heart attacks. However, large-scale data in Indians remain limited. This study shows the prevalence and distribution of silent CAD in the asymptomatic urban Indian population. Materials and Methods: This retrospective cross-sectional study included 10,004 adults who underwent voluntary CAC scanning on a Siemens 384-slice cardiac computed tomography scanner over 2 year period. CAC scores were calculated using the Agatston method. Vessel involvement and severity were assessed. Age, gender-stratification, along with the coronary age gap, were analyzed. Results: Of 10,004 subjects, 6955 (69.5%) were men and 3049 (30.5%) women, with a mean age of 47.3 ± 14.1 years. CAC >0 was detected in 3160 individuals (31.6%). CAC prevalence increased markedly with age: from 2.39% (under 40) to 76.48% (60+ age group). Among CAC-positive individuals, LAD was involved in 88.01%, 67% showing multivessel disease. Severe CAC (≥300) was present in 759 subjects (7.6%). Mean coronary age-gap was highest (3.49 years) for 40–60 years age group. Conclusion: This landmark largest CAC study on the Indian population demonstrates silent atherosclerosis in Indians at younger ages. Data analyses support the incorporation of this scan into preventive cardiology programs in India from the age of 40 years (calculated cutoff age: 42 years (male) and 48 years (female)). This helps in early identification of atherosclerosis and thus prevention of heart attacks through aggressive risk factor modification.
INTRODUCTION:HFpEF accounts for 12-25% of heart failure cases in South Asia, primarily driven by hypertension, diabetes, and obesity. Late diagnosis and healthcare disparities worsen outcomes. This expert consensus aims to provide region-specific guidelines for the diagnosis, management, and prevention of HFpEF. METHODS:A modified Delphi process with experts from five South Asian countries was conducted, informed by a literature review (2018-2024) and adapted international guidelines. RESULTS:Recommendations include the use of an adjusted H2FPEF score (BMI > 25 kg/m²), essential echocardiographic criteria (E/e' > 9, LAVi > 34 mL/m²) for diagnosis, and SGLT2 inhibitors as first-line pharmacotherapy, with finerenone for cardio-renal protection. Emphasis on lifestyle modification, patient education, and aggressive management of comorbidities is highlighted to reduce hospitalizations. DISCUSSION:HFpEF presents earlier and is associated with higher comorbidity in South Asia. Adaptations such as lower BMI thresholds and region-specific screening are critical. Cost and accessibility challenges persist in the use of SGLT2 inhibitors and finerenone. Public health measures and infrastructure strengthening are necessary to improve outcomes. CONCLUSION:Early diagnosis, multidisciplinary management, and tailored treatment strategies can enhance outcomes in HFpEF in South Asia. This consensus serves as a call for regionally focused implementation to reduce the burden of HFpEF.
