ctDNA Dynamics Identifies Pseudoprogression in a Metastatic Melanoma Patient Treated With Nivolumab/Relatlimab.

Pseudoprogression is known to occur in patients with metastatic melanoma treated with immune checkpoint inhibitors and complicates clinical decision-making. Better methods of distinguishing pseudoprogression from true progression are necessary. In this case report, we show how circulating tumor DNA (ctDNA) plays a role in identifying pseudoprogression on early interval radiologic response assessment in a patient with metastatic melanoma treated with combination anti-programmed cell death protein 1 (anti-PD-1) and anti-lymphocyte activation gene 3 (anti-LAG-3).

Successful use of nivolumab and relatlimab as salvage therapy for metastatic uveal melanoma.

Identification of effective systemic therapies for the treatment of metastatic uveal melanoma remains an ongoing challenge. While immune checkpoint inhibitors are frequently used to treat this disease, response rates and survival outcomes remain poor. In this case report, we present two heavily pretreated patients with metastatic uveal melanoma who had robust responses to combination nivolumab (PD-1 inhibitor) with relatlimab (LAG-3 inhibitor) as salvage treatment.

Socioeconomic health and impact of sickle cell disease and vaso-occlusive crises in India: results from B-VOCAL study.

Background: Sickle cell disease (SCD) with vaso-occlusive pain crisis (VOC) has a major impact on healthcare resource utilisation and poses a significant financial burden for the patients. This study examines the economic implications of managing VOC in individuals with SCD in India, from the perspectives of patients, healthcare system and society.

Methods: This cross-sectional, observational study included 1000 patients with SCD across 14 centres enrolled from November 2021 to June 2022.

Burden of vaso-occlusive crisis, its management and impact on quality of life of Indian sickle cell disease patients.

Sickle cell disease (SCD) with vaso-occlusive pain crisis (VOC) significantly impacts patient well-being and often results in extensive healthcare resource utilization. This study assessed the VOC burden, its management and its impact on patients' quality of life (QoL). A cross-sectional observational study was conducted between November 2021 and June 2022, including 1000 SCD patients from high-prevalence states in India.

Task-sharing spinal anaesthesia care in three rural Indian hospitals: a non-inferiority randomised controlled clinical trial.

Background: Task-sharing of spinal anaesthesia care by non-specialist graduate physicians, termed medical officers (MOs), is commonly practised in rural Indian healthcare facilities to mitigate workforce constraints. We sought to assess whether spinal anaesthesia failure rates of MOs were non-inferior to those of consultant anaesthesiologists (CA) following a standardised educational curriculum.

Methods: We performed a randomised, non-inferiority trial in three rural hospitals in Tamil Nadu and Chhattisgarh, India.

Exploring the perioperative infection control practices & incidence of surgical site infections in rural India.

Background: Surgical site infections (SSIs) affect around a third of patients undergoing surgeries worldwide, annually. It is heterogeneously distributed with a higher burden in low and middle-income countries. Although rural and semi-urban hospitals cater to 60-70% of the Indian population, scarce data regarding SSI rates are available from such hospitals.

Non-oncologic incidental uptake on FAPI PET/CT imaging.

Fibroblast-activation protein (FAP) is a serine protease classified in the dipeptidyl peptidase 4 (DPP4) family. FAP is predominantly expressed in activated fibroblasts such as the cancer-associated fibroblasts (CAFs). FAP expression in CAFs is associated with tumor progression and poor prognosis in solid cancers.

Obstetric neonatal emergency simulation workshops in remote and regional South India: a qualitative evaluation.

Background: Healthcare facilities in remote locations with poor access to a referral centre have a high likelihood of health workers needing to manage emergencies with limited support. Obstetric and neonatal clinical training opportunities to manage childbirth emergencies are scant in these locations, especially in low- and middle-income countries.

Objectives: This study aimed to explore the factors, which influenced healthcare worker experience of attending birth emergencies in remote and regional areas of South India, and the perceived impact of attending the Obstetric and Neonatal Emergency Simulation (ONE-Sim) workshop on these factors.

The Impact of Nurse Navigator-Led Preoperative Education on Hospital Outcomes Following Posterolateral Lumbar Fusion Surgery.

Beyond the spine-specific pathology, patient factors such as associated medical and psychosocial conditions, understanding of the treatment process, and the degree of patient activation-defined as the ability of the individual to utilize the available information and actively engage in making their healthcare decisions-can influence outcomes after posterolateral lumbar fusion (PLF) surgery. A retrospective observational cohort study of 177 patients undergoing PLF at a single institution was conducted. Patient demographics, medical and psychosocial risk factors, and outcomes were compared between patients who attended a nurse navigator-led group preoperative education course and those who did not.

A Rapid Recovery Protocol Applied to Total Joint Arthroplasty Reduced Readmissions for Surgical but Not Medical Reasons Over a 5-Year Period.

: Total hip arthroplasty (THA) and total knee arthroplasty (TKA) are commonly performed procedures that are expected to continue increasing in demand. Although they are proven to be safe and effective, emergency room (ER) visits or hospital readmissions within 90 days after these procedures account for more than one-third of the total cost of postacute care. : We sought to identify changes in reasons for 90-day ER visits and readmissions after total joint arthroplasty (TJA) during a 5-year period over which rapid recovery protocols evolved.

Polynomial modeling of emergency department arrivals: An analysis of local and national utilization patterns.

Emergency department (ED) overcrowding is a national problem that is associated with ambulance diversion, decreased patient and provider satisfaction and poor patient outcomes. This study presents a novel approach to modeling the relationship between time of day, day of week, and ED arrivals using a hierarchical polynomial regression model. A series of hierarchical regression models were created to determine polynomial effects and capture the covariability (defined as R) of the relationships from the 2009 to 2017 National Hospital Ambulatory Medical Care Survey (NHAMCS) Emergency Department Public Use Data File and institutional data from a regional medical center from 2018 to 2019.

Bilateral mammary hibernoma mimicking breast carcinoma: a diagnostic challenge.

We describe a 68-year-old postmenopausal woman who presented with a history of rapidly enlarging lumps in both breasts. Though the breast lumps appeared suspicious on ultrasonography, the core biopsy was reported to be benign. In view of the clinical and radiological suspicion of malignancy, she underwent a diagnostic excision of both the lumps, the histopathology was consistent with mammary hibernoma.

Preoperative Predictors of Same-Day Discharge After Total Knee Arthroplasty.

Background: In January 2020, The Centers for Medicare and Medicaid Services approved total knee arthroplasty (TKA) to be performed in ambulatory surgery centers (ASCs). This study aims to develop a predictive model for targeting appropriate patients for ASC-based TKA.

Methods: A retrospective review of 2266 patients (205 same-day discharge [SDD; 9.

Mortality in sickle cell disease: A population-based study in an aboriginal community in the Gudalur Valley, Nilgiris, Tamil Nadu, India.

Background: Sickle cell disease (SCD), the most common monogenic disorder, affects more than 300 000 births annually, with 44  000 in India. Although the clinical phenotype of SCD is considered to be milder in aboriginal populations in India, there is a paucity of data on outcomes. To determine the severity of SCD in this population, we studied mortality rates and causes of mortality in a longitudinal cohort of patients with SCD in a remote aboriginal community in India receiving community-based comprehensive care.

Risk factors for severe illness in hospitalized Covid-19 patients at a regional hospital.

Background: The Covid-19 pandemic threatens to overwhelm scarce clinical resources. Risk factors for severe illness must be identified to make efficient resource allocations.

Objective: To evaluate risk factors for severe illness.

Simulation capacity building in rural Indian hospitals: a 1-year follow-up qualitative analysis.

Introduction: The benefits of simulation-based medical training are well described. The most effective way to plant and scale simulation training in rural locations remains undescribed. We sought to plant simulation training programmes for anaesthesia emergencies in two rural Indian hospitals.

Structural Allograft Versus Synthetic Interbody Cage for Anterior Cervical Discectomy and Fusion: A Comparison of 1-Year Outcomes From a National Database.

Study Design: Observational cohort study.

Objective: To compare 1-year perioperative complications between structural allograft (SA) and synthetic cage (SC) for anterior cervical discectomy and fusion (ACDF) using a national database.

Methods: The TriNetX Research Network was retrospectively queried.

Cortical bone trajectory instrumentation provides favorable perioperative outcomes compared to pedicle screws for single-level lumbar spinal stenosis and degenerative spondylolisthesis.

Objective: To compare perioperative outcomes between cortical bone trajectory (CBT) instrumentation with pedicle screws (PS) in patients undergoing laminectomy and posterolateral fusion for single-level lumbar spinal stenosis, and degenerative grade I spondylolisthesis.

Methods: A consecutive series of 91 patients from a single institution between January 2017 and July 2019 were retrospectively reviewed.

Results: Patients in CBT group had significantly shorter operative time, lower blood loss and shorter length of stay.

Outpatient, Home-Based Physical Therapy Promotes Decreased Length of Stay and Post-Acute Resource Utilization After Total Joint Arthroplasty.

Background: Patients and healthcare systems are increasingly focused on evaluating interventions that increase the value of care delivered. Our objective of this study is to evaluate early post-operative outcomes among those patients who underwent total joint arthroplasty with and without the participation in our piloted Outpatient Physical Therapy Home Visits (OPTHV) program.

Methods: A retrospective analysis of patients undergoing total hip arthroplasty and total knee arthroplasty at a single institution from July 2016 to September 2017 was performed.

Preoperative Predictors of Patients Requiring Inpatient Admission for Total Hip Arthroplasty Following Removal From the Medicare Inpatient-Only List.

Background: The Centers for Medicare and Medicaid Services has removed total hip arthroplasty from the inpatient-only (IO) list in January 2020. Given the confusion created when total knee arthroplasty came off the IO list in 2018, this study aims to develop a predictive model for guiding preoperative inpatient admission decisions based upon readily available patient demographic and comorbidity data.

Methods: This is a retrospective review of 1415 patients undergoing elective unilateral primary THA between January 2018 and October 2019.

Infrainguinal wound infections in vascular surgery: An antiquated challenge without a modern solution.

Surgical site infections (SSIs) have always complicated recovery after surgery, being associated with increased cost of hospitalization, length of stay, and mortality. The most significant measure to reduce the incidence of SSI was the standardization of prophylactic antibiotic administration in patients undergoing surgical procedures. Since then, countless measures have been proposed to improve rates of SSI and patient outcome, but few have been as efficacious as prophylactic antibiotics.

Defining the burden, scope, and future of vascular acute care surgery.

Objective: The paradigm of acute care surgery has revolutionized nonelective general surgery. Similarly, nonelective vascular surgery may benefit from specific management and resource capabilities. To establish the burden and scope of vascular acute care surgery, we analyzed the characteristics and outcomes of patients hospitalized for vascular surgical procedures in Maryland.

Flow Reduction-Aided Thrombin Injection for Complex Femoral Pseudoaneurysms: Case Series and Review of the Literature.

Background: Peripheral pseudoaneurysms are a known complication of vascular access procedures. Complex lesions-those with short, wide necks or other complex arrangements-would conventionally require open repair, but we believe that even these lesions could be managed with an endovascular approach.

Methods: Four patients with complex pseudoaneurysms were offered an open repair or thrombin injection with the use of flow-reducing balloons.