Two-year safety and efficacy of Indigenous Abluminus Sirolimus Eluting Stent. Does it differ amongst diabetics? – Data from en-ABLe- REGISTRY

Introduction: To evaluate the efficacy/safety profile of the Abluminus DES+ over 2-years follow-up in the "real-world" scenario in diabetics as compared to non-diabetics. Methods: In prospective, all-comers, open-label registry conducted at 31 sites, patients were analyzed for 1 & 2-year outcomes with the primary endpoint defined as 3P-MACE of CV death, target vessel related myocardial infarction (TV-MI), ischemia-driven target lesion revascularization (TLR)/target vessel revascularization (TVR) apart from Stent thrombosis (ST). Results: Of 2500 patients of PCI with 3286 Abluminus-DES+, 1641 (65.64%) were non-diabetics while859 (34.36%) were diabetics. The 3-P MACE for the cohort at 1 & 2 years were 2.9%, and 3.16%; TLR/TVR - 1.4% at both the intervals for 2493 patients at 2 yrs. follow-up. TV-MI & ST were 0.36% and0.56% at 1st and 2nd year respectively. The 3P-MACE was lower in non-diabetics at 1 & 2 years (2.3%vs 4.2%; 2.4% vs 4.7% respectively). For components of MACE, CV mortality (0.9 vs 1.9% at 1 yr ; 1.0vs 2.1% at 2 years) was significant (P < 0.05) while TLR (1.1 vs 1.9% at 1 yr. & 1.1 vs 2.1% at 2 yrs.) and TV-MI (0.9 vs 1.9% at 1 yr. & 1 vs 2.1% at 2 years) were similar for diabetics and non-diabetics so was ST (P > 0.05). Conclusion: Abluminus-DES+ showed excellent 2-year safety and efficacy with low 3-P MACE which was higher in diabetics driven by higher CV death but similar TLR, TV-MI and ST

A prospective, multi-centric, observational registry to evaluate performance of Excel™ DES in ‘Real World, All Comers’ patient population

AbstractObjectivesThis study aims to assess the safety and efficacy of a biodegradable polymer-coated Rapamycin-Eluting Stent (Excel) used in conjunction with six-month dual antiplatelet therapy in daily practice.BackgroundThe polymeric material of cardiac stents has been reported to adversely affect the safety profile of the drug-eluting stents and is also suspected to cause serious long-term complications. It has been proposed that the biodegradable polymer coatings may reduce such late-stage adverse effects.MethodsThis is a prospective, multi-center registry of 654 patients from across 9 cardiology centers in India, who were enrolled and exclusively treated with Excel stents between February 2008 and May 2010. The recommended antiplatelet regimen included clopidogrel and aspirin for 6 months period, followed by lifelong aspirin therapy.ResultsThe study population included 46.94% diabetics, 24.31% smokers, 48.93% hypertensives and 14.98% hyperlipidemics. The cumulative rates of major adverse cardiac events were 0.153% at discharge and 1.38% at 12 months. The mean percentage of stenosis was 88.24 ± 9.17% No events occurred between 6 and 12 months.ConclusionsThis multi-center registry study on “real world, all comers” has, thus, showed that EXCEL™ stent which is PLA-coated biodegradable Rapamycin-Eluting Stent exhibited high efficacy and safety profile in treatment of patients undergoing PCI as evidenced by significantly lower rates of MACE and no case of stent thrombosis. There was no event even after DAPT was discontinued after 6 months

Baseline Features and Reasons for Nonparticipation in the Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) Study, a Colorectal Cancer Screening Trial.

IMPORTANCE: The Colonoscopy Versus Fecal Immunochemical Test in Reducing Mortality From Colorectal Cancer (CONFIRM) randomized clinical trial sought to recruit 50 000 adults into a study comparing colorectal cancer (CRC) mortality outcomes after randomization to either an annual fecal immunochemical test (FIT) or colonoscopy. OBJECTIVE: To (1) describe study participant characteristics and (2) examine who declined participation because of a preference for colonoscopy or stool testing (ie, fecal occult blood test [FOBT]/FIT) and assess that preference\u27s association with geographic and temporal factors. DESIGN, SETTING, AND PARTICIPANTS: This cross-sectional study within CONFIRM, which completed enrollment through 46 Department of Veterans Affairs medical centers between May 22, 2012, and December 1, 2017, with follow-up planned through 2028, comprised veterans aged 50 to 75 years with an average CRC risk and due for screening. Data were analyzed between March 7 and December 5, 2022. EXPOSURE: Case report forms were used to capture enrolled participant data and reasons for declining participation among otherwise eligible individuals. MAIN OUTCOMES AND MEASURES: Descriptive statistics were used to characterize the cohort overall and by intervention. Among individuals declining participation, logistic regression was used to compare preference for FOBT/FIT or colonoscopy by recruitment region and year. RESULTS: A total of 50 126 participants were recruited (mean [SD] age, 59.1 [6.9] years; 46 618 [93.0%] male and 3508 [7.0%] female). The cohort was racially and ethnically diverse, with 748 (1.5%) identifying as Asian, 12 021 (24.0%) as Black, 415 (0.8%) as Native American or Alaska Native, 34 629 (69.1%) as White, and 1877 (3.7%) as other race, including multiracial; and 5734 (11.4%) as having Hispanic ethnicity. Of the 11 109 eligible individuals who declined participation (18.0%), 4824 (43.4%) declined due to a stated preference for a specific screening test, with FOBT/FIT being the most preferred method (2820 [58.5%]) vs colonoscopy (1958 [40.6%]; P \u3c .001) or other screening tests (46 [1.0%] P \u3c .001). Preference for FOBT/FIT was strongest in the West (963 of 1472 [65.4%]) and modest elsewhere, ranging from 199 of 371 (53.6%) in the Northeast to 884 of 1543 (57.3%) in the Midwest (P = .001). Adjusting for region, the preference for FOBT/FIT increased by 19% per recruitment year (odds ratio, 1.19; 95% CI, 1.14-1.25). CONCLUSIONS AND RELEVANCE: In this cross-sectional analysis of veterans choosing nonenrollment in the CONFIRM study, those who declined participation more often preferred FOBT or FIT over colonoscopy. This preference increased over time and was strongest in the western US and may provide insight into trends in CRC screening preferences

Panurethral Strictures: A Review of Management Options

Introduction: Panurethral strictures represent a complex subgroup of urethral strictures. Lichen sclerosis is the commonest cause for these strictures. We outline the management of panurethral strictures in this review. Material and Methods: Our institute is a tertiary referral center. We evaluated panurethral strictures (primary and redo cases) managed at our institute over the last 20 years (June 1995-June 2015) using single stage Kulkarni one- sided urethroplasty with oral mucosal graft. Patients with incomplete medical records were excluded from the study. Data was analysed for primary or redo case, age, cause of stricture, length of stricture, follow up and success rate. Success was defined as no requirement of any further intervention. Follow up was carried out every 3 months in the first year and every year thereafter. Follow up included clinical examination and uroflow. This is a non-analytic study and descriptive analysis was carried out. Results: 318 (283 primary and 35 redo) cases of panurethral strictures were managed at our institute over last 20 years. Lichen sclerosis was seen in 184 (57.84%) cases. 84.9% (primary 89.39% and redo 57.85%) cases were successful. Age range of patients was 20-76 years (median 44.6 years) with stricture length from 10-19 cms. Follow up was at regular intervals using uroflow assessment. Median follow up was 59 months (range 6.4 to 192). Conclusion: Lichen sclerosis is the commonest cause for panurethral strictures. Kulkarni one-sided panurethroplasty offers a single stage surgery with acceptable outcomes and avoids inclusion of genital skin as seen in staged procedures

Isolated Xanthogranuloma of Pelvico-Ureteric Junction: is this Beginning of Xanthogranulomatous Pyelonephritis? – A Case Report

Xanthogranulomatous Pyelonephritis (XGP) is a rare condition characterised by chronic granulomatous inflammation of renal tissue [1,2]. This can be due to obstruction, urinary tract infection and renal calculi [1-5]. The exact pathophysiology and progression of this condition is poorly understood, but altered immune response, changes in lipid metabolism, disturbances in leukocyte function, lymphatic obstruction, venous occlusion/haemorrhage, malnutrition, arterial insufficiency and necrosis of pericalyceal fat [2,4]. Its management with surgical intervention in the form of nephrectomy, partial or complete, is the most definitive management option of this condition [1]. We report the case of a woman with isolated xanthogranuloma obstructing the pelviureteric junction. We propose this as the initial pathophysiological process of Xanthogranuloma pyelonephritis

Polyarteritis Nodosa: Vasculitis Causing Testicular Infarction

Testicular vasculitis (TV) is a cause of testicular infarction (TI) which can lead to significant morbidity and rarely mortality. Polyarteritis Nodosa (PAN) is the most common vasculitis that leads to testicular infarction (TI). This case report describes the retrospective tissue diagnosis of autoimmune vasculitis in a middle aged Caucasian male who developed left unilateral orchalgia and a hard, palpable testicular mass

A rare cause of an abdominal mass

A 57-year-old male presented with right upper abdominal lump since 3 months. He was diagnosed to have a hepatic artery aneurysm. He was investigated thoroughly but no cause was found. He was subjected to endovascular embolisation of the aneurysm using endovascular coils. Subsequently the aneurysm was completely occluded. Hepatic artery aneurysms are very rare among all visceral aneurysms. We report this rare case of hepatic artery aneurysm presenting as an abdominal lump. This case highlights the importance of early diagnosis and management of this rare entity as a rupture may be catastrophic

Robotic bladder neck reconstruction using a double-faced buccal mucosal graft - A novel approach to complete bladder neck obliteration

Objective: Bladder neck contractures (BNCs) are a well-documented, but acceptably uncommon late adverse outcome of surgical treatment for benign prostatic hyperplasia. Urologists successfully manage short segment contractures with endoscopic approaches, but recurrence rates are significant. When two endoscopic attempts fail, or in the case of long segment contractures and complete obliteration of the bladder neck, reconstruction and grafting are the mainstay. In this submission we aim to describe a new surgical solution to the completely obliterated bladder neck and prostatic fossa - a robot assisted laparoscopic (RAL) bladder neck reconstruction using an anterior and posterior buccal mucosal graft to create a double-faced repair. Methods and Surgical Procedure: A 70-year-old male with a history of BPH presented with recurrent bladder neck contractures after an initial TURP. Being recalcitrant to four attempts at endoscopic correction, he was dependant on a suprapubic catheter (SPC) for 18 months. Retrograde urethrogram and SPC-gram confirmed a complete obliteration of the bladder neck and prostatic fossa. The patient underwent a RAL bladder neck reconstruction with a double face buccal mucosal graft. There were no perioperative complications. Results: The patient was discharged on day 2 without perioperative complications. His IDC was removed and SPC clamped at 3 weeks, and the patient was voiding spontaneously without incontinence. At his 7-month follow-up the patient remained continent with a Qmax of 23 ml/s where he previously had no flow at all. His residual bladder volume was 125 ml. He has had no change in his erectile function. His postoperative IPSS was 3, and his quality of life “delighted”. Conclusions: We present a new surgical alternative to treat an obliterated bladder neck whereby we completely reconstruct the defect with a double-faced buccal mucosal graft. Significant morbidity is avoided by the robot assisted transvesical approach, especially in regard to continence and erectile function. As technology becomes more readily available, this procedure will be easily replicated by adequately trained Urologists