Acute Venous Thrombosis in the Emergency Department: Clinical Profile and Outcomes from a Tertiary Care Centre in North India

Background and aims: The profile of hypercalcaemia in hospitalized patients in India seems to be changing. However, studies evaluating the profile of hypercalcaemia in hospitalized settings in India are extremely limited. This prospective study aims to evaluate the clinical and biochemical profile of hospitalized patients with hypercalcaemia from a tertiary care centre in north India. Materials and methods: Clinical and biochemical profiles of subjects with hypercalcaemia detected during hospitalization/hospitalized with hypercalcaemia were assessed. A total of 91 subjects with sustained hypercalcaemia, who were eligible, underwent further investigation as per the institutional protocol and the data collected were analyzed. Results: The mean age of participants was 57.88 ± 14.23 years, with 62.64% of participants being females. The most common symptoms were nausea and anorexia, which were observed in all patients. The most common clinical sign was dehydration, which was observed in 32.97% of subjects. Primary hyperparathyroidism was the most common cause (41.76%), followed by suspected or confirmed malignancy/solid tumours in 15.38% of subjects. Other causes were advanced chronic liver disease (10.99%), multiple myeloma (9.89%), vitamin D toxicity (8.79%), granulomatous disorders (2.20%) and drug-i nduced disorders (1.10%). Forty-one subjects (45.05%) developed acute kidney injury and 14 subjects (15.38%) developed acute pancreatitis as a complication. Six subjects (6.59%) died during the course of hospitalization because of either primary disease or other secondary complications. Conclusions: Clinicians should be aware of changing patterns of hypercalcaemia in a hospital setting. Hypercalcaemia in hospitalized patients is associated with significant complications and mortality. Further large-scale prospective studies are needed to understand the changing pattern of hypercalcaemia in hospitalized patients from India.

The aim of the present study was to provide insight into various demographic, clinical, and management profile of Indian patients with oral tongue squamous cell cancer (OTSCC). All the OTSCC patients who had undergone surgical treatment during 1995 to 2010 at a tertiary care center in North India were considered for the present study. The details of the patients were retrieved from a prospectively maintained computerized database. A total of 124 patients were included in the present study. Mean age of the patients was 50.4±12.0years. Lateral border of the tongue was the most common sub-site involved in 110 (88.7%) patients. Neck nodes were clinically palpable in 56.4% patients. Hemiglossectomy and anterior partial glossectomy were common surgical procedure undertaken in 57.2 and 25.8% patients. Negative resection margin was achieved in 97.5% patients. Pathological neck metastasis was seen in 40.3% patients. Occult neck metastasis was present in 25.9% patients among clinical N0 neck. At a mean follow-up of 29.8months (SD 3.1), 20.1% developed disease relapse and 4.0% patients developed second primaries. Kaplan-Meier analysis estimated a 5-year disease-free survival of 81.5% and a 5years overall survival of 78.6%. Cox proportional regression analysis predicted tumor size and number of positive nodes to be independent predictive variables for disease recurrence. Quality controlled surgery, coupled with adjuvant treatment when required, provides a safe and effective treatment of OTSCC with a good disease-free survival and loco-regional control.

BackgroundFever of unknown origin (FUO) is difficult to diagnose despite recent improvements, because of its nonspecific clinical characteristics and wide differential diagnosis. Although infections are the most common causes in underdeveloped nations, they are frequently overlooked in their early stages because of atypical presentations and empirical use of antibiotics. The purpose of this study was to describe the clinical characteristics, diagnostic methods, and infectious spectrum of patients with classical FUO.Figure 1Etiological distribution of FUO casesFigure 2Diagnostic yield of investigations in infectious FUOMethodsWe prospectively enrolled 122 adult patients meeting classical FUO criteria at a tertiary care center in North India. Comprehensive data, including clinical, laboratory, imaging, course, and clinical outcome, were collected. Final diagnoses were categorized as infectious, inflammatory, malignant, miscellaneous, or undiagnosed. Subgroup analysis was done focusing on infectious etiologies.Table 1Spectrum of infectious etiologies in FUOResultsInfections accounted for 62 of 122 cases (50.8%), while other causes included malignancy(n=28, 23%), inflammatory(n=17, 13.9%), miscellaneous (n=2, 1.6%), and 13(10.7%) cases remained undiagnosed. The most common infectious cause was tuberculosis(n=43/62, 69.4%), which included pulmonary (12.9%), extrapulmonary (33.9%), and disseminated forms (22.6%). Additional infectious causes included enteric fever (8.1%), visceral leishmaniasis (6.5%), intra-abdominal abscesses (4.8%), infective endocarditis (4.8%), and viral infections (CMV/EBV, 3.2%). Among patients with infection, the median length of fever was two months. In 42% of these instances, a bone marrow sample plus an FDG PET-CT scan helped with the diagnosis. Infectious FUO had a considerably higher prevalence of prior antibiotic usage (p=0.037), which may have decreased microbiological output. The percentage of mortality among infectious cases was low(1.6%).ConclusionInfectious diseases, particularly tuberculosis, are still the leading cause of classical FUO in endemic settings. Early consideration of extrapulmonary and disseminated TB is vital. Advanced diagnostics such as PET-CT and bone marrow examination substantially improve etiological yield. Judicious antibiotic use is crucial to avoid masking microbiological diagnoses and ensuring timely, targeted therapy.DisclosuresAll Authors: No reported disclosures

Swati PabbiIntroduction Multiple myeloma (MM) forms a significant proportion of hematological malignancies. Autologous transplantation continues to be an effective consolidation strategy in resource-restricted settings such as India. Objectives The main objective of the study was to analyze the clinical outcomes of autologous hematopoietic stem cell transplant (HSCT) in MM patients in a single tertiary care center in north India over a period of 5 years. Materials and Methods This retrospective observational study was conducted in a tertiary care center in north India. Data of all MM patients who underwent HSCT between January 2014, and December 2018, were analyzed. The outcome of HSCT was investigated in terms of transplant-related mortality (TRM), progression-free survival (PFS), overall survival (OS), and relapse. PFS and OS were calculated by Kaplan-Meier method and differences between the groups were tested for statistical significance using the two-tailed log-rank test. Life-table method was used for the estimation of survival rate at 1, 3, 5, and 6 years. Results Patient characteristics and survival post-transplant was similar to other published Indian studies. In total, 378 patients were diagnosed with MM in our hospital between 2014 and 2018. One hundred ninety-three patients were found to be eligible for autologous HSCT, out of which 52 ended up having a transplant giving us a high percentage (26.9%) of patients receiving a transplant in our setting. Transplant-related mortality (TRM) was nil in the present study. The mean PFS and OS were 62.8 and 70.1 months, respectively. The mean PFS and OS rates at 5 years were 75.3% and 84.2%, respectively. The average cost estimate of HSCT in our setting was 7.2 lakh Indian national rupees. Conclusion Autologous HSCT is a safe procedure with nil 100-day mortality in present series. Moreover, considering the cost of novel agents, autologous transplant remains a cost-effective way for prolonging remission and time-to-next treatment in India.


 
 
 
 Introduction: The objective of this study was to determine the etiology of acute undifferentiated fevers (AUF) in hospitalised children with in a tertiary care centre in North India. The various causes of acute undifferentiated fevers included dengue, malaria, scrub typhus, enteric fever, leptospirosis and Chikungunya. The clinical spectrum and therapeutic outcome of these cases was also studied.
 Methods: This retrospective study was conducted over a period of 6 months from June 2019 to December 2019. The clinical information of 126 children who tested positive for any of the causes of AUF namely dengue, malaria, scrub typhus, enteric fever, chikungunya and leptospirosis was obtained from the Paediatrics Department. The information was recorded in a predesigned proforma. Various tests performed for the diagnosis of these illnesses were noted. They included dengue NS1 antigen ELISA and IgM ELISA, peripheral blood smear (PBS) for malarial parasite and rapid malarial antigen detection test (RMAT), scrub typhus IgM ELISA, leptospira IgM ELISA, and Chikungunya IgM ELISA.
 Results: The diagnosis of AUF were dengue (55.5%; 70/126), malaria (19%; 24/126) and scrub typhus (19%; 24/126), enteric fever (4.7%;6/126) and Chikungunya (1.5%; 2/126). The most common presenting symptom was fever or pyrexia followed by myalgia, generalised aches and pains in the body and vomiting. Commonly observed complications included thrombocytopenia, hepatitis and shock.
 Conclusions: Dengue, malaria and scrub typhus are the major causes of AUF in the hospitalised children with dengue being the most prevalent infection. The study further emphasises the need to develop a systematic approach to the diagnosis of AUFs. This should be using a combination of clinical, epidemiological and laboratory parameters, which will be very useful for developing a relevant action plan for treatment and prevention of such fevers in any hospital setup.
 
 
 

Background: Numerous studies have examined the psychological impact of COVID-19 within the Indian context. However, there is limited evidence comparing psychological distress among healthcare workers, both with and without a history of COVID-19 infection, from a tertiary care center in North India. This study seeks to identify psychological distress in healthcare workers from a tertiary care hospital in North India, with comparisons between those who had contracted COVID-19 and those who had not. Materials and Methods: The present study used a cross-sectional comparative design, selecting participants based on their past RTPCR-confirmed COVID-19 infection status. Psychological distress was assessed using three standardized screening instruments: patient health questionnaire-9 (PHQ-9), the generalized anxiety disorder scale (GAD-7), and the impact of event scale–revised (IES-R). Results: The mean age of the participants was 35.59 ± 8.6 years, with the majority being female (74%), married (80%), and working as nurses (62.6%). The overall prevalence of depression, anxiety, and post-traumatic symptoms related to COVID-19 among the participants was 25.7%, 13.5%, and 8.8%, respectively. These psychological symptoms were more frequently reported among those who had been infected with COVID-19 than among those who had not. Logistic regression analysis indicated that individuals with a history of COVID-19 infection were twice as likely to experience depressive symptoms, anxiety symptoms, and post-traumatic stress compared to those without such a history. Conclusion: The study found that 11–27% of healthcare workers experienced psychological morbidities during the COVID-19 pandemic. These findings emphasize the importance of ongoing psychological assessment and support for healthcare workers in similar pandemic situations.

The overuse and misuse of antimicrobials contribute significantly to antimicrobial resistance (AMR), which is a global public health concern. India has particularly high rates of AMR, posing a threat to effective treatment. The World Health Organization (WHO) Access, Watch, Reserve (AWaRe) classification system was introduced to address this issue and guide appropriate antibiotic prescribing. However, there is a lack of studies examining the prescribing patterns of antimicrobials using the AWaRe classification, especially in North India. Therefore, this study aimed to assess the prescribing patterns of antimicrobials using the WHO AWaRe classification in a tertiary care centre in North India. To study the prescribing patterns of antimicrobials using WHO AWaRe classification through a cross-sectional study in All India Institute of Medical Sciences Rishikesh. A descriptive, cross-sectional study was conducted from July 2022 to August 2022 at a tertiary care hospital. Prescriptions containing at least one antimicrobial were included in the study. Data on prescriptions, including patient demographics, departments, types of antimicrobials prescribed, and duration of treatment, were collected. A questionnaire-based survey was also conducted to assess the knowledge and practices of prescribing doctors regarding the utility of AWaRe classification. The study involved a total of 123 patients, each of whom received at least one antimicrobial prescription. Most prescriptions were for inpatients, evenly distributed between Medicine (Internal medicine, Pediatrics, Dermatology) and Surgical departments (General surgery and specialties, Otorhinolaryngology, Ophthalmology, Obstetrics and Gynecology). Metronidazole and ceftriaxone were the most prescribed antibiotics. According to the AWaRe classification, 57.61% of antibiotics fell under the Access category, 38.27% in Watch, and 4.11% in Reserve. Most Access antibiotics were prescribed within the Medicine department, and the same department also exhibited a higher frequency of Watch antibiotics prescriptions. The questionnaire survey showed that only a third of participants were aware of the AWaRe classification, and there was a lack of knowledge regarding AMR and the potential impact of AWaRe usage. This study highlights the need for better antimicrobial prescribing practices and increased awareness of the WHO AWaRe classification and AMR among healthcare professionals. The findings indicate a high proportion of prescriptions falling under the Access category, suggesting appropriate antibiotic selection. However, there is a significant difference between the WHO Defined Daily Dose and the prescribed daily dose in the analysed prescriptions suggesting overuse and underuse of antibiotics. There is room for improvement and educational interventions and antimicrobial stewardship programs should be implemented to enhance knowledge and adherence to guidelines, ultimately contributing to the containment of AMR.

BackgroundCritically ill obstetric patients constitute a small number of intensive care unit (ICU) admissions. Physiological changes in pregnancy along with certain pregnancy-specific diseases may cause a rapid worsening of the health status of the patient necessitating ICU care. The present study aims to study the clinical profile of the obstetric patients requiring ICU care.Materials and methodsIt was a retrospective analysis of pregnant/postpartum (up to 6 weeks) admissions over a period of 18 months.ResultsOver these 18 months, 127 women required ICU admission. The most common reasons for ICU admission were obstetric hemorrhage (37.79%) and (pre)eclampsia (28.35%). Ten patients presented with antepartum hemorrhage (placenta previa, placenta accreta, placenta increta). The rest of the patients (n = 38) had atonic postpartum hemorrhage with five having severe anemia. Among the nonobstetric causes (n = 26/127), ICU admission was the most common among those with preexisting heart diseases (n = 10; 7.87%). Forty-nine patients were ventilated mechanically (38.58%), with eclampsia being the most common primary diagnosis (n = 23). We observed 10 maternal deaths (7.87%) with septicemia being the most important cause of death.ConclusionsMaternal and child health has become an important measure of human and social development. Early diagnosis and prompt treatment of high-risk obstetric patients in a dedicated obstetric ICU in tertiary hospitals can prevent severe maternal morbidity and improve maternal care.How to cite this articleGupta H, Gandotra N, Mahajan R. Profile of Obstetric Patients in Intensive Care Unit: A Retrospective Study from a Tertiary Care Center in North India. Indian J Crit Care Med 2021;25(4):388–391.

Introduction: The substance use among the elderly is a growing enormity and an accurate understanding of the patterns of substances of the elderly is missing in the literature. Therefore, this study explored the sociodemographic and clinical profile of the elderly population-seeking treatment at a tertiary care center in North India. Methods: The present study reviewed the case notes of the elderly registered in the de-addiction center of North India. The cohort for this study consisted of all outpatients aged more than 60 years registered in the study setting from January 2017 to December 2021. The profile of the study subjects including sociodemographic and clinical data was reviewed based on the existing structured pro forma used in the department. Results: The data for a total of 508 treatment-seeking elderly aged more than 60 years were analyzed in which the mean age at the presentation was 65 ± 3.8 years. We identified that tobacco (57.5%), alcohol (52.6%), and opioids (36.2%) were the leading substances used in this setting. We noted a statistically significant association among the study subjects with alcohol, opioid, and tobacco dependence based on the presence or absence of a co-occurring medical illness. Conclusion: The present retrospective chart review identified that tobacco, alcohol, and opioids were the leading substances used among treatment-seeking elderly in this setting. Estimating the magnitude of substance use among the elderly is crucial to predict the imposed burden of the illness and ascertain the treatment and prevention strategies for controlling the magnitude of the problem.

Context: Tuberculosis (TB) has infected mankind since time immemorial. India has been a breeding ground for this disease due to high population density and lack of awareness and education in the population. It is thus very important to understand the profile of TB patients and to find out the various limitations in the functioning of the National Tuberculosis Elimination Programme in order to focus on strengthening the goal of TB elimination in India. Aim: To describe the demographic profile and clinical characteristics of TB patients enrolled at DOTS Centre between October 2018 and December 2022 at a tertiary care center in North India. Settings and Design: A retrospective record-based study. Materials and Methods: A retrospective record-based study was carried out involving a review of existing data in Nikshay-2, which was accessed from the DOTS center at a tertiary care center in North India. Statistical Analysis Used: The data entry was done in a Microsoft EXCEL spreadsheet and analyzed using the SPSS version 17. Results: Of the total 2689 patients, 1222 (45.4%) were diagnosed with pulmonary TB (PTB) and 1467 (54.6%) with extrapulmonary TB, with most common type of EPTB was lymph node TB in 750 (51.1%) patients. The most common comorbidity was diabetes mellitus in 154 (30.1%) patients. Diagnosis of PTB was made by sputum microscopy in 410 (33.5%), CBNAAT 712 (58.2%), chest X-ray 21 (1.7%), and CT chest in 79 (6.4%) patients. Diagnosis of extra-PTB was made by CBNAAT 145 (9.8%), CT and MRI 190 (12.9%), and by cytopathology in 1132 (77.1%) patients. Outcome of TB patients was cured in 1082 (40.2%), treatment completed 1300 (48.3%), 32 (1.2%) patients died during treatment, 190 (7.1%) lost to follow-up, 2 patient migrated, treatment failed in 5 patients, regimen changed in 6 patients and data were not updated for 41 (1.5%) patients. Conclusion: This study thrusts on intensification of strategies like to improve lab infrastructure, to provide CBNAAT and LPA facilities at all medical colleges and district level, and IEC training to doctors (Interns, Medical officers, specialists), TB health workers and laboratory staff with the latest guidelines, importance of updating Nikshay portal and sensitization of treating physicians and lab personnel to send relevant samples for CBNAAT and LPA testing so as to detect drug-resistant cases on time in order to achieve elimination of disease.

Introduction: Due to menopause, ovarian follicles lose its function, which results in decreased production of estradiol and other hormones. Decreased levels of estrogen leads to increased osteoclast formation and enhanced bone resorption, which intern leads to loss of bone density and destruction of local architecture resulting in osteoporosis.Objectives: To assess the prevalence of osteoporosis and osteopenia in postmenopausal women and to study the biochemical parameters related to bone mineral density in postmenopausal females.Materials and Methods: This cross-sectional study was conducted on females attending the Gynecology OPD in a tertiary care Centre in North India over a period of 6 months. The study subjects were divided into 2 groups: Group 1-postmenopausal females (N=75) and Group 2-premenopausal females (N=75). Estimation of biochemical parameters was done. Bone mineral density was determined at the lumbar spine (L2-L4) and femur neck by using densitometry in radiology department.Results: 61.33% of the postmenopausal females had osteopenia as compared to 33.33% in the premenopausal group and 25.33% of the postmenopausal females were osteoporotic as compared to only 2.67% in the premenopausal group. All these differences were found to be statistically significant.Conclusion: The present study concludes that osteopenia and osteoporosis is widely prevalent in the postmenopausal population in North India.

PURPOSEThe outcomes of patients with myeloma from developing countries are often lacking because of poor record maintenance. Publications from such settings are also limited because of the retrospective nature of the data collection. Information technology can bridge these gaps in developing countries with real-time data maintenance. We present the real-time survival data of the patients with myeloma from a tertiary care center in North India using one such indigenously built software.PATIENTS AND METHODSThese are real-time data of all patients with myeloma presenting to a tertiary care center from North India. The patient characteristics (demographics, baseline disease characteristics, risk stratification, and outcomes) were recorded contemporaneously. The survival of the study population was analyzed and grouped based on various disease characteristics at diagnosis.RESULTSThe median age of the study population (N = 696) was 65.9 (34.9-94.9) years with male predominance (65%). The median follow-up was 3.7 years (0-18.6 years) with the median overall survival (OS) not achieved. The OS of the study population at 1, 3, and 5 years was 94% (n = 558), 87.5% (n = 394), and 83.1% (n = 267), respectively. Most of the patients presented in advanced stages based on International Staging System (III:70%). On Kaplan-Meier analysis, the presence of weight loss (P = .01), renal dysfunction (P = .047), and anemia at diagnosis (P = .004) had a significant impact on survival. On Cox proportional model univariate analysis, the presence of renal dysfunction, anemia, and weight loss had the significant hazard ratio of 1.68 (1-2.82, P = .049), 3.18 (1.39-7.29, P = .0063), and 2.81 (1.22-6.42, P = .014), respectively, whereas on multivariate analysis of hypercalcemia, renal disease, anemia, and bone disease (CRAB) features, only anemia was found to have a significant hazard ratio of 2.56 (1.01-6.47, P = .046).CONCLUSIONThe real-world data show OS comparable with the published western literature. Only anemia was found to have significant impact on survival. The use of such software can aid in better data-keeping in resource-constrained settings.

BackgroundCo-infections of hepatitis B and C viruses are frequent with HIV due to shared routes of transmission. In most of the tertiary care health settings, HIV reactive patients are routinely tested for HBsAg and anti-HCV antibodies to rule out these co-infections. However, using the routine serological markers one can only detect active HBV infection while the occult HBV infection may be missed. There is insufficient data from India on HIV-HBV co-infection and even scarce on occult HBV infection in this group.MethodsWe estimated the burden of HBV infection in patients who were tested positive for HIV at a tertiary care centre in north India. We also attempted to determine the prevalence and clinical characteristics of occult HBV infection among these treatment-naïve patients and compare their demographic features with other HIV patients. During a period of 6 years between January 2002 to December 2007, 837 HIV positive patients (631 males and 206 females (M: F :: 3.06:1) were tested for serological markers of HBV (HBsAg) and HCV (anti-HCV antibodies) infections in our laboratory. For comparison 1000 apparently healthy, HIV-negative organ donors were also included in the study. Data on demographics, sexual behaviour, medical history, laboratory tests including the serum ALT and CD4 count of these patients were recorded. A sub-group of 53 HBsAg negative samples from HIV positive patients were assessed for anti-HBs, anti-HBc total (IgG+IgM) and HBV-DNA using a highly sensitive qualitative PCR and analysed retrospectively.ResultsOverall, 7.28% of HIV positive patients showed presence of HBsAg as compared to 1.4% in the HIV negative control group. The prevalence of HBsAg was higher (8.55%) in males than females (3.39%). The study revealed that occult HBV infection with detectable HBV-DNA was prevalent in 24.5% of patients positive for anti-HBc antibodies; being 45.5% in HBsAg negative patients. Most importantly the occult infection was seen in 20.7% patients who were positive for anti-HBs antibodies. However, in none of the seronegative patient HBV-DNA was detected. Five of the nine HBV-DNA positive (55.6%) patients showed raised alanine aminotransferase levels and 66.7% had CD4+ T cell counts below 200 cells/cumm.ConclusionsHigh prevalence of HIV-HBV co-infection was found in our patients. A sizeable number of co-infected patients remain undiagnosed, if only conventional serological markers are used. Presence of anti-HBs antibodies was not a reliable surrogate marker to rule out occult HBV infection. The most reliable method to diagnose occult HBV co-infection in HIV seropositive patients is the detection of HBV-DNA.

An observational study to assess the feasibility, risks and benefits of robotic PCI(percutaneous coronary intervention) and the clinical profile and outcomes of patients undergoing robotic-PCI in a tertiary care centre in North India’.

Association of HLA class II DR/DQ alleles in children and adolescents with rheumatic heart disease from a tertiary care centre in North India