All India Institute Of Medical Sciences Research Articles

Evaluating Ischemia-Modified Albumin as an Early Biomarker for Hypertensive Disorders During Pregnancy: A Case-Control Study.

Background Ischemia-modified albumin (IMA) is looked upon as a newer marker of myocardial ischemia. There is a paucity of literature however with regardto studies correlating levels of IMA in patients with hypertensive disorders of pregnancy. The present study therefore aimed at estimating the levels of IMA in patients with gestational hypertension and assessing its utility in predicting hypertensive disorders of pregnancy. Methods The present study was a hospital-based case-control study conducted in the Department of Biochemistry, All India Institute of Medical Sciences (AIIMS), Nagpur. IMA was estimated in 30 controls (Group I) and 20 cases of gestational hypertension (Group II) using a spectrophotometric assay detecting free unbound Cobalt left behind. The clinical data and lab results were presented as mean ± SD. Student's t-test was applied and Pearson's correlation coefficient was calculated. A value of p < 0.05 was taken as statistically significant. The ROC (Receiver Operator Characteristic) curve was used to establish the cut-off of serum IMA levels in pregnancy-induced hypertension (PIH). Results There was no significant difference in age and period of gestation (POG) at the time of sample collection between the groups. There was a significant difference in the systolic and diastolic blood pressures (BPs) of both groups. The mean level of serum IMA was significantly higher in cases of gestational hypertension (0.88 ± 0.14 absorbance units {ABSU}) as compared to controls (0.69 ± 0.08 ABSU) (p<0.001). On correlation analysis, the systolic and diastolic BPs were found to be highly positively correlated with serum IMA levels (p<0.001). ROC curve analysis suggested that at a cut-off of 0.73 ABSU, IMA has 85% sensitivity and 80% specificity for predicting gestational hypertension. Conclusion Statistically significant results of serum IMA levels obtained in gestational hypertension which falls on the lesser severe spectrum of the diseaseimply that serum IMA can be used for early diagnosis of gestational hypertension and impending Pre-eclampsia (PE) and Eclampsia.

The Demographic Profile of Suicidal Hanging Deaths in North India.

Suicidal hanging is the most prevalent means of suicide worldwide, particularly among young people, and reveals the state of mental health in certain indigenous populations. According to the National Crime Records Bureau, hanging was the most frequent cause of suicide in India in 2019 and 2020, accounting for 53.6% and 57.8% of total suicidal deaths. The current study examines the seasonal distribution of suicide-hanging fatalities in Rishikesh, Uttarakhand, as well as the male and female incidence. A four-year retrospective examination of autopsy data at the All India Institute of Medical Sciences (AIIMS), Rishikesh, from October 2018 to July 2022. A total of 1720 autopsies were performed during this period with 130 (7.56%) suicidal hangings. Males were disproportionately impacted (n=100, 76.92%). The ratio of men to women is 3.33:1. The mean ages of the males and females were 33.09 ±12.59 and 24.9 ±7.84 years, respectively. The majority of deaths occurin the third decade of life. The summer months saw the highest number of deaths (April-June). This data may be used to identify persons with a higher chance of committing suicide by hanging and can be utilized to help people through a nationwide suicidal prevention program that employs a multi-disciplinary team approach. Epidemiological studies should evaluate the psychosocial characteristics of men and women separately to identify the population at risk and develop preventative approaches. This is a single-center, retrospective study.

Epidemiological Characteristics and Role of Connexin-43 in Patients of Syndactyly Attending a Tertiary Care Center in Odisha, India.

Syndactyly is one of the most common hereditary limb malformations. Yet, epidemiological data in our state is not reported. The current study aims to understand the Connexin-43 expression in such patients. A retrospective cohort study was done in the Department of Plastic surgery and Anatomy of All India Institute of Medical Sciences (AIIMS), Bhubaneswar. The study duration was three years, between 2019 and 2022. The total number of cases was 49 and included patients diagnosed with Syndactyly seeking surgical intervention. The demographic details and the personal and disease history were collected, analyzed, and interpreted. Immunohistochemistry study using Connexin-43. Out of the 49 patients, 26 (53.1%) were male, and 23 (46.9%) were female. Thirty nine (79.6%) had syndactyly, and 10 (20.4%) were diagnosed with syndactyly associated with another syndrome. Both complete and incomplete syndactyly was found. Strong membranous positivity of Connexin-43was found in the keratinocytes of the stratum spinosum layer of the epidermis, while the stratum granulosum and stratum basale layer revealed negative staining. Syndactyly is mostly non-familial, sporadic with male preponderance affecting unilaterally and in incomplete form in our geographical location. We found an overt expression of Connexin-43 in these patients' stratum basale.

Development and Validation of a Smartphone Application for Telenutrition in Patients with Inflammatory Bowel Disease.

The use of smartphone-based applications as a telenutrition tool could redefine the nutritional management of IBD. We developed and validated a digital health platform in the form of a smartphone application for the nutritional assessment of IBD patients. Our team of gastroenterologists and dieticians at the All-India Institute of Medical Sciences, New Delhi developed a smartphone application titled IBD NutriCare, which was made available in both Android and iOS interfaces in English and seven other Indian languages. The application includes >650 Indian recipes and provides subjective global assessment and IBD clinical activity scores in a patient-friendly manner. The utility of the smartphone app was validated in comparison with the traditional 24-h dietary recall method. A total of 49 IBD patients were enrolled in the study. The mean difference in energy intake between the two dietary assessment methods was −4.776 kJ (95% LOA, range −417.916–408.365 kJ). A total of 94% of patients found the smartphone application convenient and acceptable in comparison to the recall method for dietary assessment. Bland–Altman plots showed a good level of agreement for nutrients and food groups between the two methods. Telenutrition in the form of a smartphone application helps in real-time tracking of dietary details of IBD patients, thus making appropriate interventions and large-scale data acquisition feasible.

The Association of Hematological and Biochemical Parameters With Mortality Among COVID-19 Patients: A Retrospective Study From North India.

BackgroundThere have been reports published in the Indian setting that describe demographics, clinical characteristics, hospital course, morbidity, and death in coronavirus disease 2019 (COVID-19) patients; however, they are based on small numbers of cases. The current analysis of patients with known outcomes allowed us to gain a better understanding of the disease process and progression in COVID-19 patients, as well as correlate the factors that influence the outcome.MethodsThis was a record-based, retrospective observational study of patients admitted to a COVID-19 hospital (All India Institute of Medical Sciences (AIIMS), Raipur, India). Between June 1 and August 31, 2021, we gathered medical records of all hospitalized patients having a laboratory-confirmed COVID-19 diagnosis and a known outcome (discharged or died). The extracted data included basic demographics, signs and symptoms, duration of hospitalization, laboratory parameters, and outcomes. Categorical variables were analyzed using either the chi‑square test or Fisher’s exact test. The level of significance was set at p<0.05.ResultsThe mean age of the patients was 53.77±15.85 years. Of the patients, 84.2% have moderate to severe disease, and 15.8% of the patients have mild disease. Furthermore, 26.3% of the subjects were deceased, while 73.7% were discharged. The laboratory parameters that were significantly (p<0.05) raised among the dead compared to discharged patients included serum total bilirubin (mg/dL), serum direct bilirubin (mg/dL), serum indirect bilirubin (mg/dL), serum urea (mg/dL), serum uric acid (mg/dL), hematocrit (%), total leukocyte counts (/mm3), neutrophils (%), serum sodium (Na) (mEq/L), serum chloride (Cl) (mEq/L), and phosphate (mg/L).ConclusionClinical and laboratory features reflect disease pathophysiology and hence assist doctors in determining the severity of medical sickness. They also help in the creation of clinical care management algorithms that may improve patient outcomes.

Early prediction of hypothermia in pediatric intensive care units using machine learning.

Hypothermia is a life-threatening condition where the temperature of the body drops below 35°C and is a key source of concern in Intensive Care Units (ICUs). Early identification can help to nudge clinical management to initiate early interventions. Despite its importance, very few studies have focused on the early prediction of hypothermia. In this study, we aim to monitor and predict Hypothermia (30 min-4 h) ahead of its onset using machine learning (ML) models developed on physiological vitals and to prospectively validate the best performing model in the pediatric ICU. We developed and evaluated ML algorithms for the early prediction of hypothermia in a pediatric ICU. Sepsis advanced forecasting engine ICU Database (SafeICU) data resource is an in-house ICU source of data built in the Pediatric ICU at the All-India Institute of Medical Science (AIIMS), New Delhi. Each time-stamp at 1-min resolution was labeled for the presence of hypothermia to construct a retrospective cohort of pediatric patients in the SafeICU data resource. The training set consisted of windows of the length of 4.2 h with a lead time of 30 min-4 h from the onset of hypothermia. A set of 3,835 hand-engineered time-series features were calculated to capture physiological features from the time series. Features selection using the Boruta algorithm was performed to select the most important predictors of hypothermia. A battery of models such as gradient boosting machine, random forest, AdaBoost, and support vector machine (SVM) was evaluated utilizing five-fold test sets. The best-performing model was prospectively validated. A total of 148 patients with 193 ICU stays were eligible for the model development cohort. Of 3,939 features, 726 were statistically significant in the Boruta analysis for the prediction of Hypothermia. The gradient boosting model performed best with an Area Under the Receiver Operating Characteristic curve (AUROC) of 85% (SD = 1.6) and a precision of 59.2% (SD = 8.8) for a 30-min lead time before the onset of Hypothermia onset. As expected, the model showed a decline in model performance at higher lead times, such as AUROC of 77.2% (SD = 2.3) and precision of 41.34% (SD = 4.8) for 4 h ahead of Hypothermia onset. Our GBM(gradient boosting machine) model produced equal and superior results for the prospective validation, where an AUROC of 79.8% and a precision of 53% for a 30-min lead time before the onset of Hypothermia whereas an AUROC of 69.6% and a precision of 38.52% for a (30 min-4 h) lead time prospective validation of Hypothermia. Therefore, this work establishes a pipeline termed ThermoGnose for predicting hypothermia, a major complication in pediatric ICUs.

BASANT, A Marvellous Polyherbal Formulation that Cures Abnormal Vaginal Discharge Restoring Healthy Vagina, It Prevents Sexually Transmitted Infections such as Gonnorrhoeae, and HIV and eliminates HPV Preventing Carcinoma of Cervix

While working at the All-India Institute of Medical Sciences, I learnt that a fairly large number of women suffer from abnormal vaginal discharge. Can anything be done to restore a healthy vagina? We developed a Polyherbal formulation employing Curcumin (diferuloyl methane), Aloe vera, purified extracts of Amla (Emblica Officinalis) and Neem (Azadirachta Indica) along with pharmacopially approved excipients. This formulation was named BASANT, which in India is the spring season. Curcumin is an important ingredient of the formulation besides others, and it has yellow hue.

Transcriptional modulation of inflammation, and aging in Indian obese adults following a 12-week yoga-based lifestyle intervention: A randomized controlled trial.

IntroductionObesity is one of the major global problems in today's world, both in children, and the adult age group. Current evidence suggests obesity alters the expression of various genes related to oxidative stress, inflammation, and aging. In recent times complementary therapy like yoga-based lifestyle intervention (YBLI) is used as an adjunct therapy to modern medicine. This study examines the efficacy of 12 weeks of yoga-based lifestyle intervention with standard care (SC) on the expression of genes related to oxidative stress, inflammation, and aging in obese adults.MethodsThis was a two-arm parallel randomized control trial implemented at Integral Health Clinic (IHC), an outpatient facility that regularly conducted YBLI programs for the prevention of lifestyle diseases like obesity and diabetes in the Department of Physiology, All India Institute of Medical Sciences (AIIMS), New Delhi. Blood samples at baseline and weeks 2,4, and 12 were collected from 72 adults (male n = 21; female n = 51) of age 20–45 years with a body–mass index (BMI) of 25–35 kg/m2 who were randomized to receive either a 12-week SC (n = 36) or YBLI (n = 36). SC included recommendations for the management of obesity as per Indian guidelines including a low-calorie individualized diet and physical activity. Asana (physical postures), pranayama (breathing exercises), and meditation were all part of the YBLI. Primary outcomes were relative fold change in the expression of genes associated with oxidative stress [Nuclear factor-kappa B (NF-Kappa B)], inflammation [Tumor necrosis factor-α (TNFα), interleukin-6 (IL-6)], and aging [human telomerase reverse transcriptase (TERT)] in peripheral blood mononuclear cells between the two groups at week-12.ResultsThere were no significant changes in fold change of TERT, IL-6, and NF-kappa B between the groups at week 12. The relative fold change of TERT was significantly greater in the YBLI group (p = <0.0001) vs the SC group at 2 weeks. The relative fold change of TNF α was significantly lower at week 12 in YBLI though the change was not continuous and reliable. Within both groups, TERT expression was significantly increased at week 2 though the change was greater in the YBLI group (p < 0.0001). TNF α gene expression was significantly lower at weeks 2 and 4, compared to baseline level, in the SC group but it increased at week 12.ConclusionThe results while did not confirm our hypothesis, are important to share with the scientific society, to be able to improve prospective study designs and find optimal time/intervention/biological marker settings for this highly important scientific field. The results are suggestive of a positive impact of YBLI and SC on the fold change of aging-related TERT gene in obesity, though the benefit was not evident till week 12. However, the results should be evaluated with caution and in light of other published studies. To better understand the positive effects of YBLI on oxidative stress, inflammation, and aging-related gene expression in obesity, larger studies are recommended.

Impact of BCG vaccination and metabolic risk factors on the severity of SARS-Cov-2 infection: a cross-sectional study from a tertiary care centre in northern India

Background and aims: We present a study on the earliest cohort of patients infected with the SARS-CoV-2 virus who were admitted to the All India Institute of Medical Sciences (AIIMS), New Delhi. The primary objective of the study was to find the difference in the rate of intensive care unit (ICU) admission with coronavirus disease 2019 (COVID-19) in patients based on BCG vaccination status. The secondary objective was to assess risk factors for ICU admission and clinical course of patients with COVID-19. Methods: A cross-sectional observational study was done between 1 May 2020 and 30 July 2020 in AIIMS, New Delhi. Patients aged more than 14 years attending or admitted to the COVID-19 facility with suspected or confirmed SARS-CoV-2 infection were screened and 205 patients with confirmed COVID-19 were included in the study. Patients were managed as per standard protocol. The difference in ICU admission rate with COVID-19 in patients with and without metabolic risk factors was analysed. Results: The study shows higher ICU admission in the age group ≥45-75years (n=16; 68.5%) compared to the age group 15-44 (n=10; 38.5%) which was statistically significant (p=0.01). In multivariate analysis, the age group ≥45-75 years [AOR=3.76, 95% CI (1.10,12.82), p=0.03] and diabetes mellitus [AOR=5.20, 95% CI (1.08,25.16), p=0.04] were significantly associated with higher ICU admission. Of the 26 patients admitted to ICU, 4 (15.3%) were vaccinated in contrast to 22 (84.6%) who were unvaccinated (p&lt;0.001). Conclusion: Diabetes was strongly associated with ICU admission and appears to be a risk factor for severity in patients with COVID-19. BCG vaccination status is positively correlated with fewer ICU admission rates in patients with COVID-19.

An Assessment of the Profile and Predictors of Outcomes in COVID-19 Patients Hospitalized in a Tertiary Care Institute in Central India

BackgroundCoronavirus disease 2019 (COVID-19) is the largest pandemic that has affected people around the globe. Various researches have been conducted worldwide, but there is a scarcity of data from Central India on the relationship between several risk factors for infection and mortality. Our study assessed the predictors and patient profiles of those with COVID-19, which will aid in prioritizing patient treatment and preventive measures.MethodsA retrospective study was done between March and December 2020. The study included 5,552 COVID-19 patients admitted to the All India Institute of Medical Sciences (AIIMS), Raipur. A validated questionnaire form provided by the WHO was used. Data for multiple clinical and nonclinical parameters were collected, and analysis was done using SPSS version 26 (IBM Corp., Armonk, NY, USA) and STATA version 12 (StataCorp LLC, College Station, TX, USA). Mortality and risk assessment of patients was done using multivariate logistic regression.ResultIn our study cohort of 5,552 COVID-19 patients, the median age was found to be 47 years (interquartile range (IQR): 31-60 years; range: 14-100 years), and 3,557 (64%) were male. Predominantly, patients presented with fever (41.30%), cough (40.20%), and dyspnea (29.29%). The major comorbidities were hypertension (29.70%), diabetes (25.40%), and chronic cardiac disease (5.79%). The common complications were liver dysfunction (26.83%), viral pneumonitis (23.66%), acute renal injury (15.25%), and acute respiratory distress syndrome (ARDS) (13.41%). In multivariate analysis, age (more than 40 years) (odds ratio (OR): 2.63; 95% confidence interval (CI): 1.531-4.512; p<0.001), diabetes (OR: 1.61; 95% CI: 1.088-2.399; p=0.017), obesity (OR: 6.88; 95% CI: 2.188-12.153; p=0.004), leukocytosis (OR: 1.74; 95% CI: 1.422-2.422; p<0.001), lymphocytopenia (OR: 2.54, 95% CI: 1.718-3.826; p<0.001), thrombocytopenia (OR: 1.15; 95% CI: 1.777-8.700; p=0.001), and ferritin concentration > 1,000 ng/mL (OR: 4.67; 95% CI: 1.991-10.975; p<0.001) were the independent predictors of mortality among COVID-19 patients.ConclusionThe leading comorbidities in our study were hypertension, followed by diabetes. Patients who were 40 years or older, obese patients, and diabetic patients have a higher mortality risk. The poor prognostic predictors in COVID-19 patients were high ferritin levels (>1,000 ng/mL), leukocytosis, lymphocytopenia, and thrombocytopenia.

Post-graduate training in Laboratory Medicine: Potential to fill a crucial gap in Indian healthcare system

Quality Laboratory services with a widespread reach is the core of a healthcare system of the country. Diagnostic services at all levels requires technical expertise of different laboratory specialists. However the presence of all specialist together in one setup is always not possible due to limited number of trained manpower. Even today, diagnostic laboratory services remain unsupervised. To void this gap, All India Institute of Medical Sciences (AIIMS) New Delhi, in 1988, opened up the patient-centric department of Laboratory Medicine with a centralised specimen collection centre and a core laboratory performing the majority of the routine laboratory investigations, offering a one-window solution to both patients and clinicians. In 1997, a three-year postgraduate Masters degree (MD) in Laboratory Medicine was started. This medical specialty encompasses the art of test selection, test operation, and test interpretation to manage patients. It aligns with the recent technological advancement of automation and advanced instrumentation that are breaking boundaries of the traditional medical laboratories of pathology, biochemistry, and microbiology. This postgraduate model ensures that the laboratory services are accessible, affordable, and available to both patients and clinicians without compromising quality care. Laboratory Medicine is emerging as an answer to one of the several inadequacies and pitfalls of the Indian health system.

AIRWAY INFLAMMATION IS ASSOCIATED WITH PULMONARY FUNCTION IN OBESE ASTHMATIC INDIAN CHILDREN

Objective: Obesity and asthma are related conditions, however, the underlying mechanism between the two is not understood. This study aims to determine the correlations between fractional exhaled nitric oxide (FeNO) and spirometry parameters in obese asthmatic children. Design and method: In this study, 47 overweight/ obese asthmatic children (physician-diagnosed children with partly/ uncontrolled asthma as per Global Initiative forAsthma guidelines) were recruited from Pediatrics Chest Clinic, Department of Pediatrics, All India Institute of Medical Sciences (AIIMS), New Delhi, India. The measured height and weight were used to calculate BMI. BMI derived was categorized by using Z score tables of WHO-BMI for age standards for boys and girls between 5 and 19 years. Children were assessed using measurement of FeNO(NIOX1; Aerocrine, Solna, Sweden), and spirometry parameters were assessed using Superspiro MK2 Micro Medical Ltd, UK. Correlation between FeNO levels and spirometry parameters were investigated using Spearman’s correlation coefficients. Results: The mean ± SDage was 11.3 ± 2.5 years (males, n = 37), BMI = 24.91 ± 7.05 Kg/m2 and median (interquartile range) FeNO levels were 22.0 (17.0, 65.0) ppb. The mean ± SD predicted forced expiratory flow (FEF25–75) predicted was 83.5 ± 16.3%. The mean age of onset of asthma was 6.3 years. Twenty-four children had partly controlled asthma and 23 children had uncontrolled asthma. FeNO was significantly and inversely correlated with predicted FEF25-75 (r = -0.378, p &lt; 0.001). Conclusions: FeNO an easily measurable indicator of airway inflammation in combination with lung function may prove a useful tool in the asthma assessment and management in obese Indian asthmatic children.

Protocol for process evaluation of SMART Mental Health cluster randomised control trial: an intervention for management of common mental disorders in India

IntroductionIn India about 95% of individuals who need treatment for common mental disorders like depression, stress and anxiety and substance use are unable to access care. Stigma associated with help...

Methanol Poisoning: An Autopsy-Based Study at the Tertiary Care Center of Uttarakhand, India.

Aims and objectiveThis study describes postmortem and histopathological findings to understand the internal progression of methanol poisoning. The study also aims to examine clinical, biochemical, and histological changes seen with methanol poisoning.Materials and methodsThe study describes the methanol poisoning tragedy that occurred in February 2019 in the Haridwar district of Uttarakhand. Ninety-one patients were admitted to the hospital, four were brought dead, four died within a few hours of admission (designated as early deaths), and four died between 10 and 45 days of hospitalization (designated as late deaths). A medicolegal autopsy was performed on all 12 deaths. Gross external and internal findings were noted, and routine viscera and blood were preserved and sent to Uttarakhand's Forensic Science Laboratory (FSL) to estimate methyl alcohol. A section of the optic nerve was taken from the optic chiasma for histopathological examination. Data were collected retrospectively from records. All data were tabulated and analyzed using Microsoft Excel version 2019. The study was approved by the Institutional Ethics Committee of All India Institute of Medical Sciences (AIIMS), Rishikesh (249201), Uttarakhand, India.ResultsMethanol poisoning is a health-associated disaster in many regions of India. Autopsy, including histopathological examination, could elicit the adverse effects of methanol on different organs. Their mean age was 37.7 years (range 21-70), and 67% (n = 8) of all victims were in the age range of 30-50 years. The average methyl alcohol level reported among hospital deaths and brought dead was 116.08 mg/dl and 224.6 mg/dl, respectively. A blurred vision had been their most common complaint, identified in 75% (n = 6), followed by vomiting and abdominal pain, while 50% (n = 4) had features of respiratory insufficiency. Mean pH and bicarbonate levels among hospital deaths were 6.61 mmol/l and 6.18 mmol/l, respectively. An autopsy revealed signs of hypoxia in all cases. Internal organs were congested. Severe metabolic acidosis leading to the respiratory failure was the cause of death in early deaths. Cerebral and pulmonary edema consequent upon septicemic shock was the cause of late deaths. A case with the most extended survival duration showed cerebral edema with intracerebral hemorrhage. Cirrhotic liver, along with features of renal failure, was an additional internal finding in late deaths. Optic nerve histopathology showed no demyelination or axonal necrosis; however, mild edematous changes were evident.ConclusionsMethanol poisoning is one of the manmade disasters in the developing world. There are various adverse effects of different organs and organ systems inside the body. Timely intervention and diagnosis can save several lives. The organ-directed meticulous autopsy can help autopsy surgeons in establishing the diagnosis and thus help the judiciary in delivering justice to the sufferers.

Effectiveness of nurse-led educational intervention package on back pain and activity of daily living in primigravidae women with back pain

Background: The primigravida women often have more complaints of back pain during pregnancy. Pregnant women reported that back pain might affect the activities of daily routine e.g. walking, climbing stairs, sitting, and women may expect help from family members.Methods: A quasi-experimental study was directed on primigravidae women visiting antenatal outpatient department (OPD) of All India Institute of Medical Sciences (AIIMS) Jodhpur. An absolute of 60 primigravidae women (30 in each experimental and control group) were incorporated through the non-probability consecutive sampling method.Results: The pre-test score uncovered that the majority of the women (70%) in the experimental group and (60%) in the control group revealed moderate pain. The post-test score uncovered that (56.6%) in the experimental group detailed mild pain and 53.3% of women in the control group reported severe pain. When compared with the pre-test, the pain score of members in the experimental group was diminished and in the control group, the pain score was increased in post-test (p≤0.000). No critical contrast was found in the activity of daily living in the experimental and control group. For analysis, paired and unpaired t-test, x2, and Fisher exact tests were used.Conclusions: The majority of primigravidae women had back pain during pregnancy and participants recognized prolong sitting as the most well-known aggravating factor. It was discovered that there was a significant distinction in pain scores between pre-test and post-test in the experimental and control group.

Predicting Timelines in Healthcare Infrastructure Projects: Learnings From an Apex Tertiary Care Teaching Hospital in North India.

AimHealthcare infrastructure projects are a requirement for the progress of the country. The aim of this study was to identify major completed healthcare infrastructure projects in a tertiary teaching hospital in Northern India and to find out the various factors that influenced the success or failures and the cost and time overrun during the project implementation.Materials and methodsPeriodical review meetings were conducted, right from the planning to the execution and commissioning of these projects. All these had been documented as minutes of the meetings, and the records of the same had been maintained. The study comprised of studying all these documents in detail and finding an answer to the research questions.ResultsFour major completed projects of a tertiary medical institute of India, All India Institute of Medical Sciences (AIIMS), New Delhi, India, were studied. These were the new Outpatient Department (OPD) Block, Burns and Plastic Surgery Block (BPS), Maternal and Child Health Block (MCH), and National Cancer Institute (NCI). Our study revealed that there was no dearth of funds, and hence, there was no cost overrun in any of the projects. Whenever the funds had to be reworked, the funds that were asked for were released. However, there was a considerable time overrun in all the projects ranging from about one to four years. The various reasons that could be attributed to this are the delay in obtaining statutory clearances, political interference, communication hurdles, improper planning, introducing a project officer late into the project, safety concerns, and the COVID-19 pandemic.ConclusionsThis study focuses mainly on the very important hurdles that were faced during the implementation of the projects and tries to suggest an average time frame for various activities for project implementation in a healthcare project in the Indian scenario. This can be taken as blueprints while planning newer healthcare projects of this magnitude.

Prospective validation of AIIMS index as a predictor of steroid failure in patients with acute severe ulcerative colitis.

Optimal outcomes in acute severe ulcerative colitis (ASUC) are related to time-bound management based upon early prediction of response to intravenous (IV) steroids. In an earlier study, we described the All India Institute of Medical Sciences (AIIMS) index (baseline Ulcerative Colitis Endoscopic Index of Severity [UCEIS] ≥ 7 and day 3 fecal calprotectin [FCP] > 1000μg/g) for predicting failure of IV steroids. The current study is designed to validate this index in a prospective cohort. IV steroid-naïve patients with ASUC, satisfying Truelove and Witts' criteria, hospitalized from August 2018 to July 2019 were included. Patients' assessment included baseline sigmoidoscopy, day 1 and 3 FCP, hemogram, biochemistry and day 3 C-reactive protein. All patients received IV steroids, and the primary outcome was steroid failure, defined as the need for colectomy or rescue therapy with cyclosporine (CYC)/infliximab (IFX) during admission. Of the 47 patients, eight were excluded (four received steroids outside, two were directly taken for surgery/infliximab therapy, one had toxic megacolon, and one had infectious colitis), and 39 patients were included (mean age: 36.1 ± 12.6years, male: 31%). Fifteen patients (38%) failed IV steroid and required rescue therapy (IFX: 9, CYC: 2, Colectomy: 3, IFX followed by colectomy: 1). On univariate analysis, UCEIS ≥ 7 at baseline (p = 0.006), day 1 FCP (p = 0.03), day 3 FCP > 1000μg/g (p = 0.001), Oxford criteria (p = 0.04) and AIIMS index (p < 0.001) were significantly different between steroid responders and steroid failures. On multivariate analysis, day 3 FCP > 1000μg/g (odds ratio (odds ratio (OR)= 6.4;(95% CI =2.2-196.1) and baseline UCEIS ≥ 7 (OR) = 10.1;(95% CI = 2.1-80.2) were independent predictors. The AIIMS index predicted steroid failure with a better specificity (100% vs. 83%, p = 0.04) and positive predictive value (100% vs. 64%, p = 0.03) than Oxford criteria. AIIMS index has been validated in 39 prospective ASUC patients as an effective early predictor of steroid failure (sensitivity = 53%, specificity = 100%).

Prekallikrein deficiency: Challenges in laboratory testing

International Journal of Laboratory HematologyEarly View REPLY Prekallikrein deficiency: Challenges in laboratory testing Reema Abraham, Reema Abraham Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaSearch for more papers by this authorGanesh Kumar Viswanathan, Corresponding Author Ganesh Kumar Viswanathan ganesh@aiims.edu orcid.org/0000-0003-4793-6829 Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, India Correspondence Ganesh Kumar Viswanathan, Department of Hematology, All India Institute of Medical Sciences (AIIMS), #206, New Private Ward, New Delhi 110029, India. Email: ganesh@aiims.eduSearch for more papers by this authorJasmita Dass, Jasmita Dass orcid.org/0000-0001-8282-7842 Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaSearch for more papers by this authorRishi Dhawan, Rishi Dhawan Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaSearch for more papers by this authorMukul Aggarwal, Mukul Aggarwal Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaSearch for more papers by this authorPradeep Kumar, Pradeep Kumar Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaSearch for more papers by this authorTulika Seth, Tulika Seth orcid.org/0000-0001-9760-7957 Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaSearch for more papers by this authorManoranjan Mahapatra, Manoranjan Mahapatra Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaSearch for more papers by this author Reema Abraham, Reema Abraham Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaSearch for more papers by this authorGanesh Kumar Viswanathan, Corresponding Author Ganesh Kumar Viswanathan ganesh@aiims.edu orcid.org/0000-0003-4793-6829 Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, India Correspondence Ganesh Kumar Viswanathan, Department of Hematology, All India Institute of Medical Sciences (AIIMS), #206, New Private Ward, New Delhi 110029, India. Email: ganesh@aiims.eduSearch for more papers by this authorJasmita Dass, Jasmita Dass orcid.org/0000-0001-8282-7842 Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaSearch for more papers by this authorRishi Dhawan, Rishi Dhawan Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaSearch for more papers by this authorMukul Aggarwal, Mukul Aggarwal Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaSearch for more papers by this authorPradeep Kumar, Pradeep Kumar Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaSearch for more papers by this authorTulika Seth, Tulika Seth orcid.org/0000-0001-9760-7957 Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaSearch for more papers by this authorManoranjan Mahapatra, Manoranjan Mahapatra Department of Hematology, All India Institute of Medical Sciences (AIIMS), New Delhi, IndiaSearch for more papers by this author First published: 04 April 2022 https://doi.org/10.1111/ijlh.13843Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinked InRedditWechat No abstract is available for this article. Early ViewOnline Version of Record before inclusion in an issue RelatedInformation

Audit of In-Hospital Mortality from a Medical Oncology and Hemato-Oncology Center with the Emphasis on Best Supportive Care.

Deepak SundriyalBackground and Objectives The newly established medical oncology and hemato-oncology center at the All India Institute of Medical Sciences (AIIMS), Rishikesh, Uttarakhand, India, provided us an opportunity to audit in-hospital mortalities with a vision that the audit will serve as a standard for ceaseless improvement. Aim of the study was to initiate a vigorous process for the evaluation of all-cause mortality in patients suffering from cancer. Methods An audit of all in-hospital deaths that occurred during the year 2019 was performed, and comprehensive scrutiny of various parameters (demographic, clinico-pathological, therapeutic, causes of death) was done. Reviews from two independent observers sharpened the infallibility of the audit. The lacunae in the existing practices and the scope for further improvement were noted. Results Forty-five in-hospital deaths were registered during the study period (January-December 2019). The majority of the deaths occurred in patients with advanced stage of malignancy ([ n = 31] 68.8%). Most common causes of death were progressive disease, neutropenic, and non-neutropenic sepsis. Chemotherapeutic agents, growth factors, blood components, and antibiotics were found to be used judiciously as per institutional policy. The reviewers emphasized on the use of comorbidity indexes in the treatment planning and avoiding intensive care unit referrals for patients receiving best supportive care (BSC). Emphasis was put on providing only BSC to the patients with a very limited life expectancy. Emphasis was also laid down on record of out of the hospital deaths. Interpretation and Conclusion The audit disclosed areas of care which require further improvement. The mortality audit exercise should become a regular part of evaluation and training for the ongoing and future quality commitment. This should impact the clinical decision making in an oncology center providing quality care to the terminally ill patients.

Telemedicine practice guidelines in India: Global implications in the wake of the COVID‐19 pandemic

Telemedicine is the delivery of healthcare services from a distance, by use of information and communication technology. There have been no statutory regulations or official guidelines in India specific for telemedicine practice and allied matters so far. For the first time, the government of India released telemedicine practice guidelines for Registered Medical Practitioners on March 25, 2020, amid the COVID‐19 outbreak. This review would initiate the discussion on the features of the guidelines, their limitations, and their significance in times of the COVID‐19 pandemic. The guidelines are with a restricted scope for providing medical consultation to patients, excluding other aspects of telemedicine such as research and evaluation and the continuing education of healthcare workers. The guidelines have elaborated on the eligibility for practicing Telemedicine in India, the modes and types of teleconsultations, delved into the doctor‐patient relationship, consent, and management protocols, and touched upon the data security and privacy aspects of Teleconsultation. After releasing the guidelines, the telescreening of the public for COVID‐19 symptoms is being advocated by the government of India. COVID‐19 National Teleconsultation Centre (CoNTeC) has been initiated, which connects the doctors across India to All India Institute of Medical Sciences (AIIMS) in real‐time for accessing expert guidance on the treatment of the COVID‐19 patients.