Observation on Clinico-pathological and radiological findings of head and neck swellings in a tertiary care centre

Bone marrow necrosis (BMN) is seen in various malignant and non-malignant disorders. The relative frequency ranges between 0.37 and 6.5 % in western countries. The aim of this study is to analyze various etiology and prevalence at our tertiary care center and to compare our clinico-pathologic profile of this uncommon entity to western data. This is a retrospective observational study done in the Department of Hematology, tertiary care centre in northern India over a period of 21 months. Various clinical features and laboratory parameters of the cases showing BMN were noted from hospital records. Bone marrow trephine biopsies with BMN were graded semi-quantitatively according to the criteria laid down by Maisel et al. grading system into three grades I, II, and III as area of the biopsy showing necrosis like <20, 20–50, and >50 %, respectively. Bone marrow necrosis was observed in 1.8 % of bone marrow biopsies studied for various clinical indications over the study period. Median age was 35 years with male to female ratio of 3.4:1. Underlying non-malignant disease was seen in 64.4 % cases with tuberculosis as the most common etiology (59.32 %). Among malignancies, hemato-lymphoid malignancies were observed in 23.72 % cases. On semi-quantitative grading, bone marrow biopsies revealed grade I, II, and III necrosis in 62.71, 18.64, and 18.64 % of cases, respectively. BMN is rare clinico-pathological entity with a poor prognosis. Although the etiology of BMN is varied, this differential possibility should be kept in mind in any patient presenting with bicytopenia or pancytopenia especially in the setting of infection and malignancy. Tuberculosis should always be an important differential diagnosis in developing countries like India, before considering malignancy.

Clinical Profile and Response to Treatment with Pegylated Interferon α 2b and Ribavirin in Chronic Hepatitis C—A Reappraisal from a Tertiary Care Center in Northern India

Snakebites represent a critical occupational hazard for individuals working in agriculture and outdoor labor, leading to significant global morbidity and mortality. Despite their impact, accurate global data are scarce due to patients often seeking traditional remedies over formal healthcare. This study aims to analyze the clinical, biochemical, and cardiac profiles of snakebite patients at a tertiary care center in Northern India. This prospective observational study was conducted at a tertiary care center. It included patients aged ≥13 years who presented with snakebites. Baseline investigations were done, and treatment outcomes, complications, and survival rates were monitored. Statistical analysis was performed using Statistical Package for Social Science (SPSS) version 24.0. Of 120 snakebite patients, 20% were under 18 years, 58.3% were aged 18-45 years, and 21.7% were over 45 years. The mean age was 32.59 ± 15.53 years, with a male-to-female ratio of 6:5. Most patients were farmers (35%) and from rural areas (93.3%). Snakebites predominantly occurred during the monsoon season, affecting the lower limbs (69.2%). Delayed presentation (>6 hours) was common, linked to increased complications. The most frequent complications were acute renal failure (ARF) (14.2%) and respiratory failure (13.3%). Mean troponin T levels were higher in deceased patients (0.060 ± 0.176) compared to survivors (0.011 ± 0.066), though this difference was not statistically significant (p = 0.077). N-terminal pro B-type natriuretic peptide (proBNP) levels were significantly higher in the deceased group (1,668.8 ± 4,625.2) compared to survivors (374.66 ± 780.53) (p = 0.010). Electrocardiogram (ECG) abnormalities included sinus tachycardia (25%) and T-wave inversion (5%). The mean hospitalization duration was 3.42 ± 2.17 days for survivors and 4.00 ± 2.50 days for deceased patients, without significant correlation to outcome. The study found an association between delayed hospital arrival and increased complications. Elevated potassium and serum glutamic-oxaloacetic transaminase (SGOT) levels were also observed in deceased patients, alongside higher respiratory rates (RRs) and lower blood pressures and Glasgow Coma Scale (GCS) scores. ProBNP level was found to be significantly higher in deceased patients.

Detection of extensive drug resistance by the Xpert MTB/XDR assay in multidrug resistant tuberculosis cases at a tertiary care centre in northern India, and therapeutic decision making for the six-month BPaLM regimen.

Objective: The present study was conducted to evaluate the clinical profile, and risk factors of peripartum cardiomyopathy (PPCM) and its association with maternal and fetal outcomes from a tertiary care center in Northern India. Methods: An observational cohort study was conducted on 19 pregnant females showing features of heart failure in the last month of pregnancy or 5 months postpartum. We analyzed the clinical profiles and outcomes in these women with PPCM. Results: The mean age of presentation was 27.9 years with a mean gestational age of 34.9 weeks. 68.4% were primigravida. The most commonly associated comorbidities were anemia and preeclampsia/eclampsia. Breathlessness was present in all women with maximum presenting with class IV breathlessness. The mean baseline ejection fraction (EF) was 34%. A significant change ( P &lt; 0.05) was observed in various echo parameters (left ventricular [LV] end diastolic volume; LV end systolic volume; LV strain; EF; right ventricular systolic excursion velocity; left atrial diameter) from baseline to 3 months. Maternal and fetal deaths occurred in 5.2% and 31.5% of subjects, respectively. Cardiogenic shock and significantly reduced EF were associated with adverse fetal and maternal outcomes. Conclusion: The majority of the study participants were young primigravidas with preeclampsia and anemia being strongly associated risk factors. PPCM with poor LVEF and shock is associated with adverse fetal and maternal outcomes. Larger studies with a higher number of patients are needed to study PPCM in detail in the Indian subset.

The rising incidence of differentiated thyroid cancer (DTC), particularly papillary thyroid carcinoma (PTC), has sparked interest in de-escalating surgical management to reduce morbidity while maintaining oncological safety. While total thyroidectomy remains the standard of care, hemithyroidectomy has emerged as a potential alternative for low- to moderate-risk PTC. This study evaluates the feasibility and oncological outcomes of hemithyroidectomy compared to total thyroidectomy in a tertiary care center in Northern India. This observational study included 214 patients diagnosed with PTC between 2010 and 2015. Patients were divided into two groups: 107 underwent hemithyroidectomy, and 107 underwent total thyroidectomy. The groups were matched for age, gender, tumor size, and ATA risk stratification. Primary outcomes included disease-free survival (DFS), structural recurrence, and all-cause mortality over 1, 5, and 10 years. Statistical analysis was performed to compare outcomes between the two groups. The mean age at diagnosis was 41.72 ± 5.2 years in the hemithyroidectomy group and 40.6 ± 5.2 years in the total thyroidectomy group (p = 0.47). Tumor size (1.67 ± 0.37cm vs. 1.78 ± 0.30, p = 0.073) and ATA risk stratification (low risk: 65 vs. 61, p = 0.57; intermediate risk: 42 vs. 46, p = 0.57) were comparable. Structural recurrence rates at 1, 5, and 10 years were similar between groups with no statistically significant difference (p = 0.166). The 5-year DFS rates were 95.00% (hemithyroidectomy) and 97.10% (total thyroidectomy), while the 10-year DFS rates were 93.45% and 96.26%, respectively. Hemithyroidectomy demonstrates comparable oncological safety to total thyroidectomy in low- to selected moderate-risk PTC, which include patients with microscopic extra thyroidal extension and microscopic capsular & vascular invasion, supporting its role as a conservative surgical option. Strict adherence to follow-up protocols is essential to detect and manage recurrence promptly. Careful patient selection and individualized treatment planning are critical to achieving optimal outcomes in the era of surgical de-escalation for thyroid cancer.

Hypothalamic and pituitary dysfunction is common in tubercular meningitis: A prospective study from a tertiary care center in Northern India

Vitiligo is a common acquired depigmentation disorder with significant psychosocial implications, especially in pediatric populations. Despite the availability of topical treatments, systemic immunosuppressive agents are increasingly being explored for progressive disease. However, limited data exist regarding their efficacy and safety in pediatric vitiligo. This study aims to analyze clinicodemographic features and treatment responses to systemic immunosuppressants in childhood and adolescent vitiligo. A retrospective chart review was conducted at a tertiary care center in Northern India, evaluating pediatric vitiligo patients (≤ 18 years) from 2017 to 2023. Clinicodemographic data, disease subtypes, associated comorbidities, and treatment outcomes were assessed. Treatment regimens included topical corticosteroids, tacrolimus, oral mini-pulse (OMP) corticosteroids, and systemic immunosuppressants such as azathioprine, methotrexate, and tofacitinib. Disease stabilization, repigmentation rates, and relapse frequencies were analyzed. A total of 304 pediatric vitiligo patients were included, with a median age of 10 years and a slight male predominance (51.3%). Non-segmental vitiligo (NSV) was the most common subtype (93.7%), with 17.7% exhibiting Koebner's phenomenon. OMP therapy led to disease stabilization in 63.6% of cases, though 25.3% experienced relapses post-discontinuation. Azathioprine achieved disease control in 17.7%, methotrexate in 52%, and tofacitinib in 88.9% of cases. Phototherapy showed good response rates with minimal relapses. No severe adverse effects were observed. Systemic immunosuppressants demonstrate efficacy in stabilizing progressive pediatric vitiligo with manageable side effects. Early intervention and individualized treatment approaches are crucial in minimizing relapses and improving long-term outcomes. Future research should focus on larger cohorts and extended follow-up to optimize therapeutic protocols for pediatric vitiligo.

ObjectivesWe aim to define the burden of rifampicin monoresistant tuberculosis (TB) at a tertiary care centre in northern India as well as determine the second-line drug susceptibilities (SL-DST) in a...

Introduction: Dengue Fever (DF) is associated with systemic inflammation, clinically manifesting as involvement of different organ systems, including the pulmonary system. Pulmonary involvement is characterised by pleural effusion, pneumonia, haemoptysis, pulmonary haemorrhage, secondary bacterial infections with Acute Respiratory Distress Syndrome (ARDS), and Dengue Haemorrhagic Shock Syndrome (DHSS), which are the leading causes of mortality and morbidity. Aim: This study aims to analyse the pleuropulmonary manifestations associated with DF. Materials and Methods: This cross-sectional study was conducted at a tertiary care centre in northern India from June 2018 to November 2018. A total of 140 patients diagnosed with DF using Non-Structural protein 1 (NS1), Immunoglobulin (Ig)M, (Ig)G rapid card tests and confirmed by Enzyme-Linked Immunosorbent Assay (ELISA) were included. Patients were examined for pleuropulmonary manifestations and other systemic features. Baseline investigations, including Complete Blood Count (CBC), Haematocrit (Hct), Liver Function Test (LFT), Renal Function Test (RFT), chest X-ray (PA view), and HighResolution Computed Tomography (HRCT) of the chest when required, were performed. Data analysis was carried out by using Statistical Package for Social Sciences (SPSS) version 25.0. Results: A total of 140 patients (108 males and 32 females) aged between 18 and 35 years were included and analysed. Among them, 113 (81%) were diagnosed with uncomplicated febrile illness, 17 (12%) with Dengue Haemorrhagic Fever (DHF), and 10 (7%) as Dengue Shock Syndrome (DSS). Patients with co-morbidities, particularly respiratory system illnesses, and young patients were found to be at increased risk of morbidity. Pleuropulmonary manifestations observed in the study included pleural effusion, pneumonia, pulmonary haemorrhage, ARDS, and pneumothorax. Conclusion: DF is associated with the involvement of the pulmonary system, and its incidence is increased in cases of moderate to severe disease. Therefore, pleuropulmonary manifestations can be useful in evaluating the severity of DF cases.

Antiretroviral therapy (ART) programmes have been successful in several countries. However, whether they would succeed as part of a national programme in a resource-constrained setting such as India is not clear. The outcomes and specific problems encountered in such a setting have not been adequately studied. We assessed the efficacy and functioning of India's national ART programme in a tertiary care centre in northern India. All ART-naive patients started on ART between May 2005 and October 2006 were included in the study and were followed until 31 April 2008. Periodic clinical and laboratory evaluations were carried out in accordance with national guidelines. Changes in CD4+ lymphocyte count, body weight and body mass index were assessed at follow-up, and the operational problems analysed. The setting was a tertiary care centre in northern India with a mixed population of patients, mostly of low socioeconomic status. The centre is reasonably well resourced but faces constraints in health-care delivery, such as lack of adequate human resources and a high patient load. The response to ART in the cohort studied was comparable to that reported from other countries. However, the programme had a high attrition rate, possibly due to patient-related factors and operational constraints. A high rate of attrition can affect the overall efficacy and functioning of an ART programme. Addressing the issues causing attrition might improve patient outcomes in India and in other resource-constrained countries.

Background: Chronic obstructive pulmonary disease (COPD) is a lung disease that is thought to result from chronic inflammation that may affect other organ systems. Similarly, metabolic syndrome includes central obesity, hypertriglyceridemia, low high-density lipoprotein cholesterol (HDL-C), hyperglycemia, and hypertension. The prevalence of metabolic syndrome and its associated factors among female COPD patients in northern India needs to be evaluated.Aim and objectives: To find the prevalence of metabolic syndrome and its correlates among female chronic obstructive pulmonary disease patients at a rural tertiary health care center in northern India.Materials and methods: A cross-sectional study was conducted between January 2019 and June 2020 at a rural tertiary health care center in northern India. The female patients who presented with symptoms of COPD and fulfilled the inclusion criteria were included and classified by Global Initiative for Chronic Obstructive Lung Disease (GOLD 2020) guideline while the clinical diagnosis of metabolic syndrome was made according to National Cholesterol Education Program: Adult Treatment Panel III (NCEP: ATP III) criteria.Results: A total of 210 female COPD patients were included, the mean age of patients who had metabolic syndrome was 63.38±10.54 years. Metabolic syndrome was diagnosed in 60.48% of patients. There was a significant difference between female COPD patients with and without metabolic syndrome regarding body weight, BMI (body mass index), waist circumference, systolic blood pressure (SBP) and diastolic blood pressure (DBP), blood sugar, serum triglyceride, serum HDL-C. Whereas no significant difference was found between patients with and without metabolic syndrome group regarding smoking exposure, biomass fuel exposure, duration of biomass fuel exposure, mMRC (modified Medical Research Council) grading of breathlessness, GOLD grading of airflow limitation, route and duration of corticosteroid used. In our study, we also found a significant association between the severity of airflow limitation of COPD with the duration of biomass fuel exposure and BMI. Also, there was a significant association between biomass fuel exposure and the presence of cough in female COPD patients.Conclusion: Metabolic syndrome is a prevalent entity in female COPD patients among the northern Indian population. Body weight, BMI, waist circumference, SBP, DBP, fasting blood sugar, serum triglyceride, and serum HDL-C have a significant impact on developing metabolic syndrome in female COPD patients. Duration of biomass fuel exposure and BMI also have a significant impact on the severity of airflow limitation in female COPD patients. So early detection and treatment of parameters of metabolic syndrome are important to reduce complications.

Objectives: To study sociodemographic and clinical variables, including psychiatric co-morbidities, in patients with irritable bowel syndrome. Methods: A total of 158 patients attending a medical gastroenterology clinic in a tertiary care center in Northern India were screened, from whom 100 were selected for the study. Rome IV criteria were used to diagnose IBS, and the severity of symptoms was assessed by the Irritable Bowel Syndrome Symptom Severity Scale (IBS-SSS). Psychiatric co-morbidities were screened via clinical evaluation, and if present, a diagnosis was made as per DSM-5. The Depression, Anxiety, and Stress Scale-21 (DASS-21) and Somatic Symptom Scale-8 (SSS-8) were used to assess depression, anxiety, stress, and somatic symptoms. Result: The mean age of cases was 35.6 years’ old, and the majority of cases (i.e., 38.0%) were between 18 and 29 years’ old. Males comprised 62.0% of the sample and females 38.0%. Moderate IBS was present in 61.0% of the cases. Evaluation via DASS-21 revealed that 53.0% were in the moderate category of depression, 43.0% had moderate anxiety, and 36.0% had moderate stress. The somatic symptom scale revealed that 48.0% patients were in the high category. Psychiatric co-morbidities were present in 29.0% of cases. Depressive disorders were the most common psychiatric co-morbidity. Conclusions: Patients with IBS presenting to a tertiary care center in Northern India were primarily young males living in semi-urban areas who belonged to the Hindu religion, were married, and had a nuclear family. Patients with IBS commonly have associated psychiatric disorders; anxiety disorders and depression are most common.

: To study the cytomorphological presentation of post covid mucormycosis. A retrospective observational study was conducted at a tertiary care center in Northern India for a period of six months, in patients with post covid mucormycosis. The study included 50 cases with post covid mucormycosis. Males with 28 cases (56.0%) were more commonly affected than females. Nose comprising of 36 cases (72.0%) was the most commonly affected area, with nasal cavity showing 24 cases (48.0%) being most common site within the nose. 36 cases (72.0%) were positive exclusively for Mucormycosis. 10.0% cases of mucor showed superadded bacterial infection. Candida was seen in 03 cases (6.0%) and aspergillosis in 02 cases (4.0%). There were 6.0% cases of mucormycosis with associated chronic osteomyelitis. All the patients had a history of steroid use throughout their coronavirus treatment. A rare but fatal fungal infection (mucormycosis) has a strong association with covid-19 infection, in active as well as recovered patients, particularly in those with co-morbid medical conditions and treated with high doses of corticosteroids.

Background: Necrotising enterocolitis (NEC) is primarily a disease of premature infants, but may also be present in 10% of term and near term babies. It is the most common gastrointestinal (GI) medical/surgical emergency occurring in neonates. The objective was to study the r ole of oral probiotics in prevention of necrotising enterocolitis in preterm neonates. Methods: Prospective randomized controlled trial was done in tertiary care centre in Northern India for a period of 18 months. 300 preterm neonates, 150 in the test group and 150 in the control group were studied . The neonates in the test group were fed probiotics with breastmilk twice daily till they reached oral feeds. The neonates in the control group were fed breastmilk alone. Incidence and severity of NEC were measured. Results: 300 neonates (study group n = 150, control group n = 150) were randomized. The incidence of NEC was lower in test group (2.7%) than the control group (9.3%). The severity of NEC was reduced in test group (stage 2 and 3- 0.7%) than the control group (stage 2 and 3-6%). The mortality was also significantly lower in the intervention group (0% versus 20%). Conclusions: Probiotic supplementation has reduced the incidence and severity of necrotising enterocolitis in preterm neonates.