Care Center In South India Research Articles

Watch your eyes: Workplace ocular hazards presenting at a tertiary eye care centre in south India

: Eye injuries can majorly affect individuals by reducing quality of life. In this study we report the prevalence of ocular trauma and the proportion of vision loss due to trauma presenting in tertiary care center.To evaluate the prevalence of occupational ocular injuries and the degree of visual loss in patients attending a tertiary eye care hospital in South India.The study was a retrospective observational study, which included patient’s aged 16 years and older attending Outpatient department of a tertiary eye care hospital following ocular trauma at workplace. The study took place across a six-month duration. A detailed demographic profile and history of the patient was documented. Patient underwent comprehensive ocular examination and further orbital imaging if necessary. The ocular injuries were classified using the Birmingham Eye Trauma Terminology System.This study included 210 patients, with a mean age group of 21-30 years. Men had a more than five-times higher rate of eye injury at work than women; with the most common mode of injury being metallic foreign body (75%). The predominant ocular injuries were categorized as closed globe injuries with 83 % incidence. 67% of the patients needed surgical intervention.Most work-related eye injuries often result from inadequate eye protection, with the majority of affected patients being young men, which highlights the importance of implementing preventive measures early in their careers. This study underscores the need of awareness and prevention programs for eye protection at workplace.

A 5-years cross-sectional study of risk-factors feto-maternal outcomes in placenta accreta spectrum at single tertiary care centre in South India

: PAS is an abnormal placental trophoblastic invasion into the myometrium, serosa and surrounding structures causing severe maternal morbidity and mortality due to massive obstetric hemorrhage (MOH). The incidence of PAS is on the rise due to increasing rate of Cesarean Section (CS) worldwide. : This study aimed to assess the risk factors associated with Placenta accreta spectrum (PAS) and to compare the feto-maternal outcomes in elective and emergency delivery in PAS.This is a 5 years single centre cross-sectional study from 1st January 2018 to 31st December 2022. All diagnosed cases of PAS beyond 28 weeks of gestation were included. A total of 38 cases of PAS were studied. Chi-square test and T-test were used to compare the categorical variables with p value 0f <0.05 as statistically significant.The incidence of PAS was 1.85/1000 deliveries. Advanced maternal age, previous CS, placenta previa in current pregnancy were major risk factors. MOH was the commonest complication. The blood loss, increased operative time and need for blood transfusions was mainly dependent on the placental location. Prematurity and low birth weight were the most important perinatal outcomes. Adequate blood and blood products prior to surgery is important as even in expert hands blood loss can be massive. Early referral and specialized regional team to manage PAS at tertiary care are needed. Future studies should emphasize on easy and early detection of PAS.

Eye on impact: An analysis of blunt ocular trauma cases at a tertiary eye care centre in South India

This study investigates the epidemiology, injury mechanisms, and clinical features of blunt ocular trauma. It aims to assess the prevalence of these injuries and the extent of vision loss among patients at a tertiary eye care center in South India.A retrospective observational study was conducted at a teaching hospital over four months, from June 2024 to September 2024. The study included 417 patients of all age groups who visited the outpatient department of a tertiary eye care center after experiencing blunt ocular trauma. Data were collected on the cause and circumstances of the injury, injury mechanism, clinical features, management, and visual outcomes.This study included 417 patients, with the majority falling into the 21–30 year age group. Men had a higher rate of eye injuries than women, and the most common cause of injury was road traffic accidents (35.97%). The predominant type of ocular injury was closed globe injuries, with an incidence of 95.92%. Additionally, 17.2% of the patients required surgical intervention.Most blunt ocular trauma is caused by road traffic accidents, followed by physical assaults, with young men being the most affected. This underscores the need for preventive measures, such as wearing helmets and avoiding driving under the influence of alcohol, to reduce the incidence of these injuries. Public awareness campaigns can play a vital role in promoting safety and protecting vulnerable populations.

A deep dive into penetrating ocular trauma: Insights from a South Indian tertiary eye care center

Penetrating ocular trauma is a significant cause of visual impairment and blindness worldwide. In India, with its vast and diverse population, understanding the epidemiology and patterns of Penetrating ocular trauma is crucial for effective prevention and management. This study aims to investigate the prevalence, characteristics, and outcomes of penetrating ocular trauma in the South Indian population. By analyzing data from a tertiary eye care center in South India, this research seeks to contribute to the existing knowledge base and inform evidence-based interventions to reduce the burden of penetrating ocular trauma in this region.To analyze the clinical profile, management, and outcomes of penetrating ocular trauma cases at a tertiary eye care center in South India.A retrospective review of medical records from January 2024 to June 2024 was conducted. Data collected included demographic details, mode of injury, clinical presentations, management approaches, and visual outcomes.Out of 150 cases, 120 were male (80%) and 30 female (20%). The majority of cases occurred in the 20-40 age group (60%). Common causes included workplace accidents (45%), domestic injuries (30%), and road traffic accidents (15%). Initial visual acuity varied from no light perception to >6/18. Surgical intervention was required in 90% of cases. Post-operative follow-up indicated that 60% achieved a visual acuity of 6/60 or better, while 20% had no light perception.Penetrating ocular trauma predominantly affects young males in South India, with workplace injuries being a major cause. Early surgical intervention improves visual outcomes. Public awareness and safety measures could reduce the incidence of such injuries.

Incidence and Outcomes of Infectious Keratitis After Corneal Collagen Cross-Linking Over 10 years From a Tertiary Care Center in South India.

The purpose of this study was to report the incidence and outcomes of infectious keratitis after corneal collagen cross-linking (CXL) over 10 years in South India. Patients who underwent CXL for progressive keratoconus between January 2011 and December 2020 and those with infectious keratitis were identified from an electronic database system. The clinical and microbiological profiles of those affected were extracted from the case files and included in the analysis, whereas viral keratitis was excluded. Eleven eyes with post-CXL infectious keratitis were identified, with 3842 CXL procedures (0.21%) occurring in-house, while 3 were referred from outside. The mean age of the patients was 21.8 ± 7.8 years, and 7 (64%) were male. Six eyes (54%) had conventional isotonic CXL, whereas 5 had hypotonic CXL when pachymetry was <400 μm. Six eyes (54%) presented with hypopyon at a median of 3 days after CXL. Culture of the corneal scrapings grew methicillin-sensitive Staphylococcus aureus in 4 patients, methicillin-sensitive Staphylococcus epidermidis in 2, Aspergillus fumigatus in 1, Aspergillus flavus in 1, Haemophilus parainfluenzae in 1, and no organisms in 2 patients. Almost all the isolates were resistant to ciprofloxacin and other fluoroquinolones. The majority of eyes responded well to intensive topical antibiotics guided by antibiograms and regained 6/18 vision (median). Therapeutic keratoplasty was needed in 2 eyes while cyanoacrylate glue was needed in another 2 eyes. Post-CXL infections are rare, most frequently caused by antibiotic-resistant commensals, and resemble the clinical spectrum and outcomes of non-CXL-related infectious keratitis in most cases.

Clinical characteristics and functional outcomes of pediatric Guillain-Barré syndrome admitted to the Neuro-intensive care unit: a decade-long retrospective observational study.

Guillain-Barré Syndrome (GBS) remains a significant contributor to acute flaccid paralysis in pediatric patients worldwide. Despite its impact, studies focusing on pediatric GBS requiring intensive care unit (ICU) management are limited. This study aimed to address this gap by exploring the clinical and outcome characteristics of pediatric GBS necessitating ICU care. This retrospective observational study, spanning a decade, analyzed the records of 75 pediatric GBS patients admitted to the Neuro-ICU of a tertiary care center in South India. Data included demographics, prodromal symptoms, clinical features, investigations, treatment modalities, and outcomes. The majority (55/75) of patients were male, with a median age of 12 years. The highest incidence of GBS requiring ICU admission was in the monsoon season. Prodromal symptoms were observed in 56%. Most patients (93.33%) presented with typical GBS symptoms, and 40% had respiratory distress on ICU admission. Acute motor axonal neuropathy (AMAN) was the most common subtype. Approximately 80% required mechanical ventilation, with a median duration of 22.5 days. No in-hospital mortality was recorded. At discharge, most patients had a GBS disability score of 4, improving to 2 at a median follow -up of 228 days. Pediatric GBS patients requiring ICU care exhibit distinctive characteristics, including a higher prevalence of AMAN subtype, seasonal clustering, and favorable outcomes with intensive treatment. The absence of in-hospital mortality underscores the effectiveness of prompt ICU admission and dedicated Neuro-intensive care.

Histopathologic Perspective of Nail Lichen Planus: A 10-year Case Series From a Tertiary Care Center in South India.

Nail involvement is seen in 10% of lichen planus patients, with a subset developing severe destruction of the nail matrix. Nail biopsy is a complex procedure usually done when nails are the only site of involvement. The pathology of nail lichen planus (NLP) has been the subject of very few studies. Most studies refer to the major and minor histopathologic criteria proposed by Hanno et al. This study aims to characterize the histopathologic features of NLP. Twenty five patients of NLP with nail biopsies, diagnosed in the last 10 years were included in the study. Lichen planus was suspected in all patients, and the alternative diagnosis was psoriasis/onychomycosis and melanoma. On histopathology, the common features included acanthosis (88%), lichenoid lymphocytic inflammation (96%), and hypergranulosis (72%). Detachment of epithelium from the subepithelium, a hitherto unreported feature, was noted in 60% of cases. Less common features were lymphocytic exocytosis (48%), melanophages (40%), basal vacuolar alteration (24%), apoptotic keratinocytes (28%), fraying of the nail plate (24%), and spongiosis (20%). Understanding the common and less common histopathologic features and their correlation with clinical findings is essential to diagnose NLP accurately rather than stressing histologic criteria as major/minor, which may lead to the underdiagnosis of cases.

A Retrospective Analysis of Intestinal Helminthic Infestations at a Tertiary Care Center in South India

A Retrospective Analysis of Intestinal Helminthic Infestations at a Tertiary Care Center in South India

Bird beak-related ocular injuries in southern India: Factors and visual implications

PurposeTo evaluate the visual outcomes and identify prognostic factors in patients with ocular bird beak injuries treated at a tertiary eye care center in South India. MethodsWe conducted a comprehensive analysis of patients with bird beak injuries, considering factors such as age, gender, mode of injury, and size of laceration. The affected eyes underwent detailed examinations using slit-lamp biomicroscopy, and B-scan ultrasonography was performed to assess the status of the posterior segment. Postoperatively, the best-corrected visual acuity (BCVA) was measured at the last follow-up visit. ResultsOur findings demonstrated significant improvements in visual outcomes, including BCVA and uncorrected visual acuity (UCVA), over a follow-up period ranging from 1 week to 3 years (p < 0.05). No significant changes were observed in endophthalmitis, intraocular pressure (IOP), lens status, or retinal abnormalities during the study duration. ConclusionThis retrospective study highlight the potential for favorable long-term visual improvement in patients with ocular injuries caused by bird beaks and emphasize the importance of timely intervention. Delayed surgical treatment and the requirement for multiple surgeries within the first week were found to negatively impact visual acuity. Hence, it is crucial to raise public awareness, particularly in rural areas, to prevent these potentially devastating injuries and ensure early intervention for optimal visual recovery.

A Cross Sectional Study of the Prevalence of Retinopathy in Patients with Chronic Kidney Disease on Hemodialysis in a Tertiary Care Centre in Chengalpattu District, South India

Context: Many studies have reported varying proportions of retinopathy among cases with chronic kidney disease (CKD). Cases with severe grades of CKD were more likely to develop ocular complications, especially diseases which occurs due to small vessel pathology. Aim: To estimate the prevalence of various types of retinopathies in patients with CKD undergoing hemodialysis in a tertiary care centre in South India. Settings and Design: The outpatient Department of Ophthalmology and Hemodialysis unit of Nephrology, Karpaga Vinayaga Institute of Medical Sciences from January 2022 to June 2023 A cross-sectional hospital-based observational study in a low resource setting. Methods and Material: The study consists of 28 patients who were known cases of CKD on hemodialysis. Patients underwent complete ocular evaluation and findings were noted. The pre hemodialysis values of blood urea and serum creatine, hemoglobin, liver function tests and vital parameters were also noted. Data analysis was done utilising version 20 of Statistical Packages for the Social Sciences (SPSS). Results: 56 eyes of 28 patients on hemodialysis were studied. The mean age was 53 years + 10.9 with a male preponderance. 31.6% had retinopathy of which 26.3% had hypertensive retinopathy and 5.3% had diabetic retinopathy. This is contrary to the previous studies that have reported a higher incidence of diabetic retinopathy in patients with end stage CKD. Hypertension resulted in CKD earlier than diabetes. Conclusion: The results emphasize the importance of frequent eye examination in patients with CKD to identify retinopathy earlier, thus potentially averting permanent vision impairment.

Management of Disseminated Rhinosporidiosis: Experience From a Single Tertiary Institution.

This study aims to present a series of patients with disseminated rhinosporidosis with diagnostic and therapeutic features. A retrospective study was conducted in a tertiary health care centre in South India from 2007 to 2020 with disseminated rhinosporidiosis. Twelve patients with multiple sites of involvement like the nose, nasopharynx, oropharynx, larynx, lacrimal sac and skin were included in the study. All patients underwent surgical excision, followed by peroral dapsone for one year. The age group was around 30-55 years, with male predominance (11:1). Pond bathing history was present in 50% (n=6). The most common site of lesion was the nose (100%), oropharynx (83.3%), skin (75%), larynx (50%) and less commonly, nasopharynx (41.6%) and lacrimal sac (25%). One patient underwent surgery four times (8.3%), followed by thrice and twice by five (41.6%) and six (50%) patients, respectively. On two years of follow-up, two patients (16.6%) had a recurrence in the nose and larynx whereas eight patients (66.6%) had no recurrence and two patients (16.6%) were lost to follow-up. This original article highlights the rare occurrence of disseminated rhinosporidiosis, the possibility of which should be kept in mind, mainly when two or more sites are involved. The most significant number of disseminated rhinosporidiosis cases in the literature is reported here. Dissemination with the cutaneous and multisite disease is rarely reported and poses difficulty in management. Early diagnosis and intervention prevent the dissemination of spores into various parts of the body.

Neuromotor and Neurosensory Impairment among High Risk Infants at One Year of Age – Risk Factor Analysis

Background: Improvement in the quality of perinatal care in the last few decades has led on to improve newborn survival. Sick neonates who have survived are exposed to high risk factors in the prenatal period and are termed as high risk infants (HRIn). This study aimed at determining the proportion of neuromotor and neurosensory impairments among HRIn. Methods: This prospective observational study was conducted in a tertiary care centre in South India between January 2020 and December 2021. Study population comprised of intramural high risk infants fulfilling the criteria. At discharge infants were stratified as mild, moderate or severe risk for developing neurodevelopmental disorders and follow up plan was given. The subjects were assessed at 4, 6, 8 and 12 month for impairments. Results: Total 138 infants were enrolled and 88 completed follow up. Lost for follow up was 36.2%. The impairments detected with respect to motor and vision were 12.5% and 1.1% respectively. Sepsis, seizures, birth asphyxia and preterm were robust prognostic factors for neuromotor impairment. Risk of tone abnormality was 13 times higher in infants who had sepsis. At risk for developmental delay was noticed in 11.4% of the study for which significant association was with prematurity, sepsis and birth asphyxia. Discussion: HRIn are susceptible for neurodevelopmental impairments. Hence early identification and enrolment in intervention programs will ensure favorable outcomes.

Prevalence and Risk Factors of Endometriosis Among Infertile Women in a Tertiary Care Center in South India

Prevalence and Risk Factors of Endometriosis Among Infertile Women in a Tertiary Care Center in South India

Epidemiological Study of Pediatric and Adolescent Poisoning Cases in a Rural Tertiary Care Centre in South India

Pediatric poisoning covers the entire spectrum of cases from accidental ingestion in toddlers to intentional abuse in teenagers. Epidemiological surveillance of oral ingestion of poisonous substances in children and adolescents in a particular area is necessary to determine the extent and characteristics of the problem, according to which related preventive measures can be taken. This was a retrospective, observational study including all pediatric poisoning patients (between the age of 0 to 19 years) received at the Trichy SRM Medical college &amp; Research Centre, Irungalur, Trichy during the 2 year period from May 2021 to April 2023. A total of 52 cases were received in the casualty department of our hospital during the study period. Out of this, Male patients were predominant (53.85%). Most of the cases belonged to the age group between 16- 19 Years . Most of the cases were from the Rural areas (82.69%).Accidental Poisoning (61.54%) is more common followed by suicidal poisoning (38.46%). The substances involved in Poisoning are Kerosene(19%),Rat Killer (10%), Paracetamol(10%), Oleander(8%), ant-killer (8%), Organo-phosphorus Poisoning(6%) among many others. Most of the time the poisoning happened inside Home(65%) followed by area surrounding home(17%). Oral route (88%) was the most common way of taking poison. Most cases took less than 4 hours (71%) to reach the hospital. Vomiting was the most common symptom in most of the cases. 23 cases (44%) were requiring intensive care of which only 8 cases (15%) needed more than 3 days of ICU care.

D-dimer as a Predictor of ICU Admission and Mortality in COVID-19 Patients: Insights From a Two-Year Retrospective Study From a Tertiary Care Center in South India.

Introduction Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)-induced pneumonitis results in a prothrombotic and hypercoagulable state. Prognostic indicators are crucial for identifying patients at risk of complications. D-dimer, a degradation product of cross-linked fibrin, is a specific marker for thrombosis. Elevated D-dimer levels have been strongly correlated with poor prognosis and increased severity of illness in COVID-19 patients. Given D-dimer's eight-hour half-life, periodic measurement is necessary to track disease progression. This study aimed to analyze and derive threshold and peak D-dimer values to predict outcomes in COVID-19 patients, comparing those treated in isolation wards to those requiring intensive care. Methods This two-year retrospective observational study included patients above 18 years with confirmed COVID-19. Patients were categorized into those treated in isolation wards and those admitted to the intensive care unit (ICU). Based on the outcome, they were further divided into survivors and non-survivors. Demographic and outcome-related data were collected from the hospital's laboratory information system. Serial D-dimer measurements were taken at eight time points. Statistical analysis was performed using the Mann-Whitney test for laboratory values and the chi-square test for demographic data. Receiver operating characteristic (ROC) curve analysis was utilized to derive critical D-dimer values. The area under the curve (AUC) was calculated for initial and peak D-dimer values. Results Of 2.149 patients with confirmed COVID-19, 811 (38%) presented with elevated D-dimer levels. ICU admission was required for 239 patients, either due to direct admission or worsening conditions. An initial D-dimer value of ≥0.93 mg/L FEU indicated the need for ICU admission, while a peak D-dimer value of 5.65 mg/L FEU predicted mortality. The AUC for the initial D-dimer was 0.60 (95% CI: 0.55-0.64), indicating moderate discriminatory power. The AUC for the peak D-dimer was 0.58 (95% CI: 0.54-0.62), suggesting lower predictive accuracy for peak values. Sensitivity was high for both initial (0.925) and peak (0.960) D-dimer values, although specificity was lower, especially for the peak D-dimer (0.486), resulting in a higher rate of false positives. Among the ICU patients, the age range was 27-97 years, with a mean of 53.5 years. Males were more affected than females (71% vs. 29%), with a male-to-female ratio of 1.4:1. Of the ICU patients, 64.8% recovered, while 35.2% succumbed to the disease. Younger patients (mean age: 50.5 ± 12 years) recovered faster than older patients (mean age: 64 ± 16 years), with a significant difference in recovery time (p < 0.001). Gender did not significantly impact outcomes (p = 0.743). Survivors spent less time in the ICU (3-7 days) compared to non-survivors (4-14 days) (p = 0.041). Conclusion Serial D-dimer monitoring is essential for predicting outcomes and guiding treatment in COVID-19 patients. Initial and peak D-dimer values can help identify patients requiring intensive care and those at risk of mortality, allowing for timely interventions. D-dimer levels should be integrated into routine clinical assessments for managing COVID-19 patients.

Standardization And Evaluation Of An In-House ELISA For The Detection Of Rabies Antibody In A Tertiary Care Centre In South India

BackgroundRapid fluorescent focus inhibition test (RFFIT), a neutralization-based assay for detecting rabies antibodies, is the gold standard. The National Action Plan for Dog Mediated Rabies Elimination (NAPRE) is a national program that strategizes the establishment of enzyme-linked immunosorbent assays (ELISA) to detect rabies antibodies. ObjectiveWe developed an in-house ELISA to screen for rabies antibodies using rabies vaccine antigen to study vaccine response among health care workers (HCWs) who received pre-exposure prophylaxis and a few animal bite victims who received post-exposure prophylaxis with rabies vaccine. Study designA prospective study was carried out from April to September 2023 at the Department of Clinical Virology of a tertiary care center in South India. A total of 161 serum specimens, which included 155 serum samples from study participants and 6 samples from a reference laboratory (as controls), were obtained during the study period. Rabies antibody was determined by the in-house standardized ELISA developed using the rabies vaccine and compared with the reference assay, RFFIT. The accuracy indices of the in-house ELISA were estimated by MedCalc software (version 22.023). ResultsA panel of 86 positive and 75 negative serum samples was used for evaluating the in-house standardized ELISA. The sensitivity, specificity, positive and negative predictive values of the in-house ELISA were 98.8%, 100%, 100%, and 98.7% respectively. The accuracy of the in-house ELISA is 99.4%. ConclusionELISA can be a practically feasible and less expensive assay compared to RFFIT which is a cumbersome procedure with a long turn-around time of 3-4 days.

Cytogenetic spectrum and clinical presentation of Klinefelter syndrome: A comprehensive study from South India

BackgroundKlinefelter syndrome (KS) is a common sex chromosome abnormality that mostly presents as testicular failure and a myriad of other clinical features. The phenotypic features and their severity vary between individuals, age groups and cytogenetic subtypes. Karyotyping remains the method of choice for the diagnosis of KS despite advanced molecular testing in this modern era. The objective of this study was to determine the cytogenetic subtypes, clinical presentation and hormonal profile of patients with KS. MethodsRetrospective observational study comprised patients with KS determined by cytogenetic analysis at the tertiary care centre in south India from 2001 to 2019. Clinical details including testicular size, hormone levels and semen analysis were obtained from the medical records. ResultsThere were 147 KS (145 post-natal and 2 pre-natal) patients ranging in age from two days to 51 years, 116 (74.8%) patients being ≥18 years. Classic (cKS), mosaic (mKS) and variant KS (vKS) accounted for 126 (85.7%), 9 (6.1%) and 12 (8.2%) cases and their mean ages were 26.6, 29.6 and 12.8 years, respectively. cKS and mKS had diverse clinical presentations including several co-morbidities of which small testes were most common (94.8%). vKS presented with behavioural problems (58.3%) without any comorbidities. Testosterone (p < 0.05), FSH and LH levels were abnormal in >90% of patients. ConclusionAll three cytogenetic subtypes of KS were seen in our patients. cKS was seen in all ages, mKS was common in adults and vKS was seen predominantly in children. Early diagnosis of KS and timely medical intervention may alter the clinical outcomes and improve the quality of life.

Profile of Nonresolving Pneumonia in a Tertiary Care Center in South India: A Prospective Study

Profile of Nonresolving Pneumonia in a Tertiary Care Center in South India: A Prospective Study

Autonomic Dysfunction in Fibromyalgia Patients: Electrophysiological Evidence from a Cross-sectional Study in Kochi, India

Background: Over the decades, studies from various populations have found fibromyalgia and dysautonomia to be linked. However, recent evidence from Indian populations contradicts these findings. Methods: This cross-sectional study, conducted in a quaternary care centre in South India, recruited 30 women with fibromyalgia (2016 ACR criteria) and 30 age and sex-matched controls. We assessed all participants using Composite Autonomic Symptom Score (COMPASS-31) questionnaires, Sympathetic Skin Response (SSR) for sympathetic dysfunction and Heart Rate Variability battery of tests for parasympathetic dysfunction. Results: Median age of the women was 40 years. Fibromyalgia group reported severe levels of pain and disease impact on life. Fourteen participants (46.7%) with fibromyalgia tested positive for either sympathetic or parasympathetic dysfunction or both, while none of the control participants tested positive for either (odds ratio [OR] = 53.6, 95% confidence interval [CI] = 3–957, p = 0.0068). Conclusion: Dysautonomia is strongly associated with fibromyalgia syndrome. Further research is needed to determine causality.

Unveiling the enigma of spontaneous regression in hepatocellular carcinoma: A case report from a tertiary care center in South India

Unveiling the enigma of spontaneous regression in hepatocellular carcinoma: A case report from a tertiary care center in South India