Histopathologic Evaluation of Gastrointestinal Endoscopic Biopsies with Risk Factor Analysis in a Tertiary Care Hospital in South India

Introduction: Profiling of medico-legal cases is an important aspect for the prevention of preventable casualties in future and to study the genuine crime in the area which contributes a substantial workload in casualty department. Objectives: The aim of the study is to measure the incidence of medicolegal cases recorded in a tertiary care hospital in South India in one year. Method: A retrospective analytical content based analysis was made on 776 medicolegal cases recorded in a tertiary care hospital in South India in one year from June 1st 2017 to May 31st 2018 and the results were tabulated. Results: Of the 776 cases, 545 were men and 231 were women with RTA constituting 70.74% (549 cases) of the cases and poisoning with 10.69% (83 cases) of the cases forming the majority of the case profile. Conclusion: The study concludes that road traffic accidents are the major causes of medicolegal cases recorded in a tertiary care hospital in South India. Preventive measures of better traffic control and road safety are to be instituted at the earliest. More number of medicolegal profiling should be conducted in every region for further measures.

Background: Diabetes mellitus in India is estimated to be 77 million individuals affected by this disease, which is likely to go up to 134 million by 2045. Globally, it is projected at 9.3% in 2019 (463 million persons). It is projected to increase to 10.2% by 2030 (578 million) and 2045. Aims and Objectives: The study aimed to analyze antidiabetic drug utilization in type 2 diabetes mellitus patients in south India tertiary care hospital. Materials and Methods: This cross-sectional and observational study was conducted at the endocrinology Department of a Tertiary Care Medical College and Hospital in south India over 12 months. After obtaining informed consent, diagnosed adult type 2 diabetes patients receiving any antidiabetic drugs were included in the study. Demographic, and clinical proportions of each class of antidiabetic drug were analyzed. Results: Out of 364 patients, age distribution (years): 30–39 (11%), 40–49 (25%), 50–59 (34%), 60–69 (22%), and >70 (8%); Gender: male (37%) and female (63%); duration of diabetes (years): newly diagnosed (7%), <5 years (21%), 5–10 years (24%), and >10 years (43%); body mass index (kg/m2): range 21–29.6, hemoglobin A1C (%): Range 6.1–9.4. Associated comorbidities: hypertension (38%), dyslipidemia (21%), diabetic nephropathy (7%), diabetic retinopathy (2%), diabetic foot ulcer (4%), and diabetic retinopathy (2%). Metformin is the most common drug used in all regimens, with over 90% of participants using it in monotherapy and over 80% of participants using it in combination with other drugs. Conclusion: In almost all the patients, the treatment initiation was done by metformin; in two-thirds of patients’ treatment, intensification was done with glimepiride, insulin, Dipeptidyl peptidase-4is, or pioglitazone as dual, triple, or quadruple drug combination regimen where metformin was also an integral part of the combination regimen.

Dear Sir, The article titled “Analysis of prenatal and postnatal risk factors of retinopathy of prematurity. In a tertiary care hospital in South India”, made an interesting read.[1] The criteria for selecting pre term infants with birth weight between 1500-2000g and gestational age >32 weeks have not been clearly delineated and needs more clarification. This is pertinent because different inclusion criteria can have different sensitivities in identifying cases of Retinopathy of prematurity (ROP) as demonstrated by Dogra et al.[2] Therefore, any inference regarding the incidence of ROP and by extension the risk factors would be deemed incomplete unless qualified by clear inclusion criteria. The current criteria for screening pre term/low birth weight infants for ROP have been well defined by Jalali et al.[3] The authors have also reported that their criteria for LASER therapy comprised of Threshold ROP, Stage 4 ROP and Stage 5 ROP. The Early Treatment for Retinopathy of Prematurity cooperative group has recommended treatment for Pre threshold type 1 ROP.[4] The findings of that study had found reduction in both unfavorable visual outcomes from 19.5 to 14.5% (P 0.01) and unfavorable structural outcomes from 15.6% to 9.1% (P < 0.001) by resorting to early treatment as opposed to observation till the onset of Threshold ROP.

Introduction: RTA is the public health issue and cost a lot to individuals, families, communities and nations as injuries and deaths due to road traffic accidents (RTA) are a major public health problem in developing countries. Objectives: The present study was carried out with the objective to find out the profile of RTA cases in a tertiary care hospital in South India in one year. Methods: A retrospective analytical content based analysis was made on 549 RTA cases recorded in a tertiary care hospital in South India in one year from June 1st 2017 to May 31st 2018 and the results were tabulated. Results: Of the 549 cases, 409 cases were males and 140 were females of which head injury with 182 cases (29.50%) forms the majority of the injury followed by orthopaedic injuries with163 cases (26.04%). Conclusion: This study thus analyses various aspects of RTA with head injury being the most common and and its various confounding factors which shows that there is clearly a need for road safety education particularly targeting student community.

The job profile of security officers in tropical countries involves prolonged standing in hot conditions causing heat stress as well as complications of sedentary lifestyle. The objectives of this study were to estimate the prevalence of noncommunicable diseases and heat stress in security officers and analyze factors affecting heat stress and estimated glomerular filtration rate (eGFR). This was an observational cross-sectional study conducted among security personnel working at a tertiary care hospital in South India during the hottest months of March to May 2020. Screening camps were conducted during which anthropometric measurements were taken and blood was collected for hemoglobin, creatinine, and fasting glucose estimation. Urine dipstick analysis for glucose, protein, pH, and red and white blood cells were done on early morning voided sample. Heat stress was assessed by a validated 18-item questionnaire called heat strain score index (HSSI). A structured questionnaire was prepared for surveillance of risk factors of noncommunicable diseases. A total of 678 security officers were screened. Majority (659/678, 97.2%) were men and mean age of the cohort was 45.4 ± 9.2 years. Fifty-two percent (355/678) of participants were engaged in outdoor work for a median duration of 6 (IQR, 0-8) hours/day. Prevalence of obesity, diabetes, hypertension, and chronic kidney disease (CKD) were 70.9, 25.5, 15.9 and 1.3 percentage, respectively. Half of the cohort (324/678) had definite heat stress and 0.9% (6/678) developed CKD of undetermined etiology. Heat stress was higher in those working outdoors and longer employment duration and lower in those with abdominal obesity. eGFR was lower in older officers, smokers, hypertensives, and those with longer employment duration, but was unaffected by HSSI scores. Kidney function was unaffected by high levels of heat stress experienced by security personnel working at a tertiary hospital in South India. Future studies are needed to understand the pathomechanisms of differential impacts of heat stress on kidney function of agricultural various worker categories.

Background: Complementary and alternative medicine (CAM) refers to medical practices that are not part of conventional medicine. Reports in literature suggest the prevalence of CAM use ranges from 37% to 87%. There are no data on frequency of CAM use in Indian patients with psoriasis. Materials and Methods: A descriptive study was designed to look at frequency of CAM use in psoriasis patients attending the DVL outpatient department of a tertiary care hospital in South India. The clinicoepidemiological details and details of CAM use were entered into a predesigned pro forma. Results: Ninety-six psoriasis patients were included in the study. CAM use was seen in thirty (31.58%) psoriasis patients. Siddha treatment was the most common CAM used. Statistical analysis showed significant association of gender (male &gt; female), time since diagnosis, alcohol use, and Psoriasis Area and Severity Index (PASI) score with use of CAM. Logistic regression analysis found age, education, socioeconomic status, alcohol use, time since diagnosis, presence of concomitant disease, affordability of medication, and PASI score to be independent predictors of CAM use. Limitations: The limitations of our study were the small sample size and lack of emphasis on dietary modifications followed. Conclusion: CAM is used by approximately 30% of psoriasis patients in South India, and the most common therapy used is Siddha. Knowledge of evidence regarding CAM therapies will help the dermatologist offer a balanced view of risks and benefits of indigenous CAM practices to our patients.

: Worldwide incidence of hip fractures is estimated to increase by 4.50-6.26 million by 2050 and half of that being in Asia. With a 30-day death rate between 5% and 10% and a one-year mortality rate as high as 40%. This should be a great health burden to India. Our aim is to look at 1 month and 1 year mortality rate in this high-risk group and factors which might influence them. This 2-year retrospective cohort analysis was carried out at our hospital which is a Level III Trauma Care Hospital in South India. Case notes were analyzed, and telephone interview was done to check one year mortality. : 167 patients in total, with a mean age of 70.8, were evaluated; 90 of these patients (53.9%) were men, and 77 (46.1%) were women. Of the 167 patients, 51 (30.53%) underwent hemiarthroplasty, 84 (50.29%) proximal femur nails, and 24 (14.37%) Total hip replacements (THR). In our study 4 patients (2.4%) died within 30 days of admission, and 25 (14.9%) died within a year following surgery. As the patients' ASA grade increases, the mortality rate also increases. Postoperative complications were another one of the strongest predictors of death. The most significant contributing factor to mortality in hip fractures is found to be timing of surgical intervention. Our mortality rate is comparable to or lower than that of developed nations. ASA grade, Presence of postoperative complication, time delay to surgery were significant contributing factors in our study.

Background:The knowledge and skills about the basic life support (BLS) and the advanced life support are the most important determining factors of the cardiopulmonary resuscitation (CPR) success rates. Objectives: To determine the level of awareness on BLS and skills among undergraduate and postgraduate students of medical and dental profession, as well as nursing students and interns in a tertiary care hospital.Materials and Methods:This descriptive cross-sectional study was conducted in a tertiary care hospital in South India. The awareness level on BLS and factors associated which include age, sex, level of training (undergraduate, internship, and postgraduate groups), course of study (nursing, dental, and medical groups), and previous exposure to BLS were assessed by using a structured questionnaire. The association of these variables with awareness level was assessed by independent t test, analysis of variance, and linear regression analysis.Results:Among 520 study subjects, 229 were students, 171 were interns, and 120 were postgraduate students. The overall mean score of awareness was 4.16 ± 1.40 (score range: 0-10). Age, sex, level of training, course of study, and previous exposure to BLS were significantly associated with awareness level in univariate analysis (P < 0.05). Linear regression model also showed that all the above variables were significantly associated with awareness level (P < 0.05). About 322 (61.9%) subjects attributed lack of awareness about BLS to lack of available professional training. About 479 (92.1%) responded that BLS training should be a part of medical curriculum.Conclusion:Awareness level on BLS is below average indicating the importance of professional training at all levels in a tertiary care health institution.

Introduction: Urolithiasis is a disorder in which urinary solutes precipitate to form aggregates of crystalline material in the urinary space which includes renal pelvis, ureter, bladder and urethra, affecting 5%-15% of the global population and shows high recurrence rates. In India, particularly in southern regions, the prevalence of urinary stones is significant, with nearly half of those affected at risk of severe renal damage. Although urinary metabolic abnormalities play a central role in stone formation, limited data is available on the metabolic profiles and stone compositions specific to the patients in South India. This study aims to identify prevalent metabolic abnormalities and stone compositions to guide tailored prevention strategies. Methods: This cross-sectional study included 126 urolithiasis patients in a single tertiary centre of South India over period of 18 months. Demographic data, imaging findings, and 24-hour urine samples were collected. Urine samples were analysed for metabolic abnormalities (e.g., calcium, oxalate, citrate excretion) and stone composition using Fourier Transform Infrared Spectroscopy. Results: Of the patients studied, 80.95% exhibited at least one metabolic abnormality, with hypocitraturia (40.5%) as the most common, followed by hyperoxaluria (30.2%) and hypercalciuria (26.2%). Calcium oxalate dihydrate was the most prevalent stone type (53.2%), followed by calcium oxalate monohydrate (27.8%). Gender comparisons showed higher median excretion values for urinary calcium, phosphate, oxalate, and uric acid in males, though these differences were not statistically significant. Discussion: The findings highlight the prominence of hypocitraturia and hyperoxaluria in patients of urolithiasis visiting a tertiary care hospital in South India, suggesting that preventive strategies should target these metabolic abnormalities. Calcium oxalate dihydrate’s dominance as a stone composition aligns with global trends, though regional dietary and lifestyle factors may influence metabolic profiles. Further studies with larger samples and lifestyle factors analysis are recommended to refine prevention approaches. Conclusion: Urinary stone formation varies by region and population, requiring prevention strategies tailored to metabolic profiles and individuals. In our study including patients of urolithiasis visiting a tertiary care hospital in South India, most had metabolic abnormalities, with hypocitraturia being the most common, followed by hyperoxaluria. Promptly addressing these issues can reduce recurrence risk. Calcium oxalate dihydrate was the primary stone component in this group.

Background: Thyroid disorders are commonest endocrine disorder in India, studies reveal a high prevalence. Normal thyroid function is critical for early neurocognitive development, which emphasizes strict neonatal screening.Aim: To estimate the prevalence, clinical profile and associated co-morbidities of thyroid dysfunction in neonates.Materials and Methods: A cross-sectional observational study was conducted at a tertiary care hospital in south India. Neonates referred to Endocrinology department with diagnosed thyroid dysfunction were included. Demographic data, clinical features, thyroid profile and relevant investigations of the recruited children were noted.Results: A total of 180 neonates (105 female) with thyroid function abnormalities were included with prevalence of 8/1000 over 6 years study. Graves was noted in 6, majority of the hypothyroidism was due to Hashimoto's (111), subclinical (27), congenital central (11), ectopic thyroid and dys-hormonogenesis in 6 each, transient hypothyroidism in 4. A host of co-morbidities, developmental delay and maternal risk factors were identified.Conclusion: There is a high occurrence of autoimmune hypothyroidism in paediatric age group in south India and need for similar studies from different regions of the country covering larger population are in dire need as early diagnosis may abate subsequent residual sequelae.

Introduction Chronic shoulder pain(CSP) is a significant medical and socioeconomic problem that hinders daily living activities, creating a burden on the individual and society. An epidemiological study will help to find out the risk factors and their impact, thereby giving medical practitioners and policymakers the necessary tools to tackle the problem. Materials and methods This is a cross-sectional study conducted in a tertiary care hospital in South India over a period of four years from 2018 to 2021 using a structured questionnaire, clinical and radiological examination, and visual analog score (VAS). The data were analyzed using SPSS software. Results A statistically significant correlation was found between CSP and increasing age, occupational risk factors like vibrations, repetitive movements, lifting heavy objects, repetitive lifting of the arm above the shoulderand sitting in the same posture for a prolonged time, and work stress. Vitamin D deficiency and diabetes mellitus were found to increase the risk of shoulder pain, smoking, and alcoholism. There was a higher incidence of rotator cuff pathology and frozen shoulder among those who had CSP. Conclusion CSP affects the quality of life and the productivity of the patients. Reducing the physical and psychosocial risk factors is the key to decreasing its prevalence. Maintaining a healthy lifestyle and a good working environment is very essential.

The objective of this study was to examine the evolution of carbapenem-resistant Klebsiellapneumoniae (CRKp) infections and their impact at a tertiary care hospital in South India. A comparative analysis of clinical data from two prospective cohorts of patients with CRKp bacteremia (C1, 2014-2015; C2, 2021-2022) was carried out. Antimicrobial susceptibilities and whole genome sequencing (WGS) data of selected isolates were also analyzed. A total of 181 patients were enrolled in the study, 56 from C1 and 125 from C2. CRKp bacteremia shifted from critically ill patientswith neutropenia toothers (ICU stay: C1, 73%; C2, 54%; p = 0.02). The overall mortality rate was 50% and the introduction of ceftazidime-avibactam did not change mortality significantly (54% versus 48%; p = 0.49). Oxacillinases (OXA) 232 and 181 were the most common mechanisms of resistance. WGS showed the introduction of New Delhi metallo-β-lactamase-5 (NDM-5), higher genetic diversity, accessory genome content, and plasmid burden, as well as increased convergence of hypervirulence and carbapenem resistance in C2. CRKp continues to pose a significant clinical threat, despite the introduction of new antibiotics. The study highlights the evolution of resistance and virulence in this pathogen and the impact on patient outcomes in South India, providing valuable information for clinicians and researchers.

Background: Guillain Barre syndrome (GBS) is a progressive symmetric muscular weakness with absent or depressed deep tendon reflexes. Wide spectrum of disease severity can be seen ranging from a mild disease to quadriparesis, cranial nerve involvement and autonomic instability. Methods: Hospital based observational study is planned for GBS patients admitted to Cheluvamba hospital, a tertiary care hospital in South India, for a period of 2.5 years from Jan 2020 to August 2022.Results: 30 patients (12 males; 18 females; mean age of 7.7 years) were enrolled in this study. Among which 11 were in age group of 0-5 (36%), 10 were in the age group of 6-10 (33%), 7 were in age group of 10-15 (23%), 2 were in age group 16 and above (6.6%). Type of paralysis was paraparesis in 14 (46%) children quadriparesis in 15 (50%) children and one child had no limb involvement. In associated dysfunctions, autonomic dysfunction was seen in 1 (4.5%), bulbar palsy in 3 (13.6%). One child presented with features of Miller Fischer variant of GBS which are ophthalmoplegia and ataxia. Among 30 children 22 were recovered and discharged, 3 children died, and 5 children left against medical advice.Conclusions: The clinical characteristics, subtype of GBS, and outcome vary according to geographic area. This study is directed to find the clinical pattern and outcome of the same in tertiary care hospital in south India.

Background: Nursing binds human society with a bond of care and affection. Nurses are often the first healthcare professional that patients meet. Quality of care for patients is strongly linked to the performance of the nursing staff. If the mental health status of these nurses is troubled, then they will not be able to give their full attention to this demanding task. Nowadays, all efforts to fight health workers’ illnesses are extremely important. This descriptive cross-sectional study will give us knowledge regarding the anxiety and depression status among nurses and give the nursing staff an opportunity to express their difficulty in professional life working in a tertiary care hospital in South India. Objective of this study was conducted to assess the prevalence of anxiety and depression among nurses working in a tertiary care hospital and to assess the correlation between various factors influencing the level of anxiety and depression among nurses.Methods: Nurses were selected by simple random sampling till the sample size was obtained. A standardised questionnaire was handed over to the participants to collect relevant data and was assessed by Hospital Anxiety and Depression Score (HADS) and analysed using SPSS software.Results: The participants consist of 120 nurses. The study gives frequencies of nurses with anxiety as 48(40%) and depression as 43(35.8%). There does not exist any significant correlation of anxiety and depression with various factors influencing them.Conclusions: Anxiety and depression levels are increased in the younger and less experienced nurses. Thereafter, interventions can be planned to improve the quality of work-life of nurses that can improve patient care and in turn benefit the society.

Neonicotinoids are a newer class of pesticides that are believed to cause predominantly mild toxicity in humans. This study aimed to describe the clinical features of neonicotinoid poisoning and identify predictors of severe toxicity. This retrospective study included all patients with neonicotinoid poisoning admitted to a Tertiary Care Center in India over an 18-year period. Clinical and laboratory features were compared against outcomes to identify predictors of the need for intensive care admission. Twenty-eight patients were included in the study of which 28.6% had severe disease requiring ICU admission. A higher respiratory rate, blood lactate level, SOFA, and qSOFA scores as well as a lower Glasgow coma score at presentation predicted ICU admission. First-generation compounds and imidacloprid consumption were associated with longer ICU stays and a longer duration of invasive ventilation. Neonicotinoid compounds can cause significant toxicity with oral ingestion. Imidacloprid and other first-generation compounds were associated with more severe toxicity requiring intensive care. Simple clinical parameters assessed at presentation can be used to predict severe disease and the need for ICU care. Larger, prospective studies are required to confirm these findings. Sanga L, Jacob A, Jayakaran JAJ, Iyadurai R. Clinical Profile and Predictors of Intensive Care Admission in Neonicotinoid Poisoning in a Tertiary Care Hospital in South India. Indian J Crit Care Med 2024;28(1):66-69.