Bethesda Hospital

About: Bethesda Hospital is a healthcare organization based out in Ambur, Tamil Nadu, India. It is known for research contribution in the topics: Population & Helicobacter pylori. The organization has 386 authors who have published 472 publications receiving 15193 citations.

Assessment of the therapeutic efficacy of artemether-lumefantrine in the treatment of uncomplicated Plasmodium falciparum malaria in northern KwaZulu-Natal: an observational cohort study.

Abstract: Background Recent malaria epidemics in KwaZulu-Natal indicate that effective anti-malarial therapy is essential for malaria control. Although artemether-lumefantrine has been used as first-line treatment for uncomplicated Plasmodium falciparum malaria in northern KwaZulu-Natal since 2001, its efficacy has not been assessed since 2002. The objectives of this study were to quantify the proportion of patients treated for uncomplicated P. falciparum malaria with artemether-lumefantrine who failed treatment after 28 days, and to determine the prevalence of molecular markers associated with artemether-lumefantrine and chloroquine resistance.

Incarcerated Spigelian Hernias: A Rare Cause of a High-grade Small Bowel Obstruction.

Abstract: A Spigelian hernia is a very rare hernia, making up approximately 0.1% of all abdominal wall hernias. This hernia goes through a defect in the Spigelian fascia which is the part of the transversus abdominis aponeurosis lateral to the rectus muscle, often at the level of the arcuate line, where the fascia is widest and weakest. We present the case of a 77-year-old female with no past surgical history who presented to our teaching hospital with high-grade small bowel obstruction secondary to an incarcerated Spigelian hernia. She was taken to the operating room for a laparotomy and a portion of the small bowel mesentery was found to be strangulated. The hernia was reduced, and the defect was repaired primarily. The diagnosis of a Spigelian hernia can often be difficult to diagnose on history and physical examination alone, but computed tomography (CT) imaging can be a valuable adjunct in diagnosis. Prompt surgical treatment should ensue when the diagnosis of high-grade bowel obstruction is made in a patient with imaging findings consistent with a Spigelian hernia.

Clinical symptoms and risk factors comparison of ischemic and hemorrhagic stroke

Abstract: Backround: It is very important to know and detect various stroke symptoms because stroke is an emergency condition. Lack of knowledge about stroke symptoms leads to delay on stroke treatment. Objective: The aim of this study is to compare clinical symptoms and risk factors between ischemic and hemorrhagic stroke. Methods: This study was a case control study. The subjects in this study were ischemic and hemorrhagic stroke patients. Subject data were recorded in electronic stroke registry at Bethesda Hospital, Yogyakarta. Results: The most common clinical symptoms in both groups were limb weakness (76.4% vs 71.4%), whereas the rarest was face drooping (2% vs 3.6%). Hypertension was the most common risk factor in both group (48% vs 71.4%), whereas atrial fibrillation was the rarest. This study did not find the specific correlation between any clinical symptoms to ischemic stroke incidence, however, decrease a level of consciousness was significant to hemorrhagic stroke incidence (OR: 2.738, 95% CI: 1.503-4.990, p: 0.001). Previous stroke (OR: 2.413, 95% CI: 1.314-4.433, p: 0.005) and dyslipidemia (OR: 4.862, 95% CI: 2.613-9.045, p: 0.000) were significant increasing risk of ischemic stroke. Hypertension was only the significant increasing risk of hemorrhagic stroke (OR: 3.680, 95% CI: 2.086-6.492, p: 0.000). Conclusion: Decrease level of consciousness has a significant correlation to hemorrhagic stroke incidence, but there is no specific symptom correlate to ischemic stroke incidence. Previous stroke and dyslipidemia are significant risk factors for ischemic stroke, whereas hypertension is the only significant risk factor for hemorrhagic stroke.

Abstract OT3-2-04: ADAPT - Adjuvant Dynamic marker-Adjusted Personalized Therapy trial optimizing risk assessment and therapy response prediction in early breast cancer

Abstract: Background: Early therapy response is currently not regarded for further treatment decisions as standard of care in the treatment of breast cancer (BC). Predictive markers for the success of a certain therapy could support the physician’s choice of adequate and beneficial therapies by simultaneous reduction of unnecessary toxicity. Proliferation makers as Ki-67 seem to be a suitable tool, as dynamic changes of proliferation (as result of induction therapy) have been shown to be most important for outcome of neoadjuvant chemotherapy prediction in patients with pCR in distinct BC subtypes (luminal B, TNBC, HER2+). Methods: Trial design: ADAPT combines early assessment of prognosis by conventional markers (e.g. molecular classification, nodal status) with dynamic measurement of proliferation changes during a 3-week induction therapy, using baseline diagnostic core biopsy and a second biopsy after induction therapy. ADAPT consists of an umbrella trial and five different sub-trials (HR+/HER2-, HR+/HER2+, HR-/HER2+, HR-/HER2-, Elderly) and is set up as prospective, multi-center, controlled, non-blinded, randomized phase II/III trial. Subtype-specific treatment across the sub-trials is highly innovative and involves the following treatment strategies: • HR+/HER2-: endocrine therapy (ET) vs. chemotherapy (4xPac q2w – 4xEC q2w vs. 8xNab-Pac q1w – 4xEC q2w) + ET, depending on risk classification/early response. • HER2+/HR+: T-DM1 vs. T-DM1 + ET vs. trastuzumab + ET. • HER2+/HR-: Trastuzumab + Pertzumab ± Paclitaxel q1w. • TN: Nab-Paclitaxel + Gemcitabine vs. nab-Pac + Carboplatin. • Elderly: 2xMyocet + Cyclophosphamide q3w, depending on cPR/cCR or NC/toxicity the treatment will be continued for two more cycles or changed to 6xPac q1w. Adaptation/change in therapy regimens can be made by interim analysis after n=130 in each sub-trial. Eligibility criteria: Histologically confirmed unilateral primary invasive BC with known HR-/HER2-status (central pathology) for allocation to the respective sub-trial. Pts requiring chemo- or targeted (anti-HER2) therapy must have adequate laboratory values and organ function and must have no contraindications for the planned treatment. Primary endpoints: Evaluation of dynamic test for outcome prediction/prospective comparison of 5yr EFS in responders (intermediate risk (RS 12-25) / good response to short-term ET in HR+/HER2- or pts with pCR in HER2+/TN BC) compared to low risk HR+/HER2- (RS≤11, N0-1) pts (control group). Statistical methods: Assumption across sub-protocols: adjuvant CTx can be spared in HR+/HER2- or pCR be achieved in HER2+/TN in expected 1120 (HR+/HER2-) or 170 (HER2+/TN) pts, respectively. Outcome will be compared to the control group (expected n=640 HR+/HER2- pts: low risk (by RS), i.e. no CTx). Assuming 94% 5yr survival in control group, one-sided test of non-inferiority at 95% CI will have 80% power for survival non-inferiority margin of 3.2% (i.e. 90.8% survival). Present and target accrual: By June 2014, 73 active sites have recruited 1820 pts for ADAPT HR+/HER2-. Target accrual is 4000 pts. 190 of 380 pts were successfully randomized for ADAPT HER2+/HR+. ADAPT HER2+/HR- has included 17 of 220 pts and ADAPT Triple Negative has recruited 150 of 336 pts. Citation Format: Ulrike Nitz, Oleg Gluz, Raquel von Schumann, Daniel Hofmann, Ronald E Kates, Sherko Kuemmel, Michael Braun, Claudia Schumacher, Benno Nuding, Bahriye Aktas, Helmut Forstbauer, Nicolai Maass, Mahdi Rezai, Stefan Kraemer, Mathias Warm, Rachel Wuerstlein, Nadia Harbeck. ADAPT - Adjuvant Dynamic marker-Adjusted Personalized Therapy trial optimizing risk assessment and therapy response prediction in early breast cancer [abstract]. In: Proceedings of the Thirty-Seventh Annual CTRC-AACR San Antonio Breast Cancer Symposium: 2014 Dec 9-13; San Antonio, TX. Philadelphia (PA): AACR; Cancer Res 2015;75(9 Suppl):Abstract nr OT3-2-04.

A flexible metal ventricular catheter for treatment of complicated and protracted infections of the cerebrospinal fluid spaces: Preliminary experiences

Abstract: In the management of shunt infection, the use of ventricular catheters made of silicone rubber for the temporary external drainage of cerebrospinal fluid (CSF) is general practice. However, the eradication of the primary source of infection may be hindered by the affinity of bacteria to silicone-based material. Compared to silicone catheters, a metal drainage device for temporary ventriculostomy appears to offer more favourable conditions for successful eradication of the infection. Since metal needles cannot be implanted permanently and since their screw-type fixation precludes attachment to the skulls of infants or small children, we developed a flexible metal catheter. This catheter was used exclusively for the treatment of particularly serious or chronic infections of the CSF spaces. The catheter is made of implantation steel and consists of a corrugated tube that renders it flexible. Cerebrospinal fluid drains into a receptable bulb at the tip of the tube. Tubing of other materials may be connected to the end of the metal catheter for either external or internal drainage. It was implanted as a temporary and later permanent CSF drainage in 7 male patients aged from 4 to 60 years, who suffered from chronic, recurrent ventriculitis (n = 5) with an average of 7 previous surgical revisions, as well as from complex infections (n = 2; basal tuberculous meningitis, brain abscess). The infections were successfully eliminated in 6 patients. In the remaining patient, the metal catheter for external ventriculostomy had to be removed after 4 days due a leakage of CSF; it was replaced by a silicone catheter and later on by a needle drainage. Other complications, such as secondary infection or intracerebral haemorrhage, did not occur. The average duration of external CSF drainage via the flexible metal catheter was 27 days (range 4–50 days). In 4 patients, the CSF drainage was converted to a permanent ventriculoperitoneal shunt using a new flexible metal catheter. At the time of post-operative follow-up examination (average = 34 weeks), all shunts were functioning and there was no evidence of infection. In cases of especially complicated and protracted CSF infections, the flexible metal ventricular catheter is a promising device for treatment.