Care Center In South India Research Articles

DECAF score at admission as a tool to predict clinical outcome in acute exacerbation of COPD

Background: The Dyspnea, Eosinopenia, Consolidation, Acidemia, and Atrial Fibrillation (DECAF) score at presentation is designed to predict the risk of death in patients with chronic obstructive pulmonary disease (COPD). Aims and Objectives: To study the DECAF score at admission to predict the clinical outcome of the patients during hospitalization for acute exacerbation of COPD (AE-COPD). Materials and Methods: The study was conducted using a prospective cross-sectional observational study design in a tertiary care center in South India from April 2022 to March 2023. Patients were recruited based on specific inclusion and exclusion criteria. The data corresponding to the five variables of the DECAF score was obtained, and the relation to outcome measures such as survival, ventilation, and duration of stay was measured. Results: Two hundred consecutive patients were assessed. Based on the DECAF score, 102 patients (51%) were classified as low-risk, and this group had no mortalities. In the intermediate-risk group, the mortality rate was 7.4%; in the high-risk group, the observed mortality rate was 38.6%. The differences noted were significant statistically. Higher dyspnea grade as measured by extended Modified Research Council criteria was related to DECAF score was significant and with the outcome. Conclusion: Our study shows that the DECAF score at the initial presentation can be used as a reliable tool to predict the outcome of AE-COPD. Dyspnea grading can be used to predict mortality indirectly.

Comparison of pupil expansion devices in small pupil phacoemulsification.

To study the outcomes of phacoemulsification in small pupils (≤4 mm) using pupil expansion devices at a tertiary eye care center in South India. The study design is prospective, randomized, comparative, and interventional. Mechanical pupil dilatation with iris retractors (group I), B-HEX ring (group II), and Gupta ring (group III) was compared with respect to pupil size achieved (intraoperative), total surgical time, device addition time, complications, endothelial cell loss, and postoperative best corrected visual acuity. Among 36 participants (12 in each group), the mean pupil size, total surgical time, and device addition time were maximum with iris retractors. Intraoperatively, sphincter tear was seen in two eyes in the iris retractors group and one eye in the Gupta ring group. In the B-HEX ring group, only two flanges of the ring could be engaged in two participants, one patient had iris bleeding (during stretching of the iris), and one patient had anterior lens capsular tear. Among all three groups, there was no statistically significant difference in best corrected visual acuity (BCVA), endothelial cell count, and coefficient of variation obtained in the preoperative period, postoperative Day 7 and Day 30, respectively. In our study, in more than 50% of cases, the cause of small pupil was idiopathic/senile. Among nonidiopathic causes, PXF was the most common association. Although iris retractors are cost-effective and give maximum intraoperative dilatation, there is a need of four additional side ports to be made, thus increasing the total surgical time and device addition time. On the other hand, B-HEX and Gupta ring provide comparable intraoperative dilation and device addition time and also have comparable postoperative outcomes in terms of postoperative pupil size and complications.

Vision on wheels: Technician-assisted retinopathy of prematurity screening in rural Tamil Nadu and Andhra Pradesh: 2018-2021 Project Report.

To analyze the incidence of sight-threatening retinopathy of prematurity (ROP) in premature infants in rural Tamil Nadu and Andhra Pradesh from 2018 to 2021, and to analyze its association with birthweight (BW), gestational age (GA), and postconceptional age (PCA). Project Vision on Wheels is a free ROP screening and treatment program initiated by a tertiary eye care center in South India in June 2018 to screen preterm infants in rural areas in 11 centers in Tamil Nadu and Andhra Pradesh by trained technicians. Infants with sight-threatening ROP were immediately shifted for vision-preserving laser. Of the 18,117 infants screened from 2018 to 2021, 1046 infants underwent laser, with the majority being bigger and more mature when compared to Western data. There was a yearly increase in the number of infants with sight-threatening ROP in the lower BW, GA, and PCA categories. The timely detection of the condition by committed screening led to salvage of vision by timely laser in 100% of the treated babies in all the years. The incidence of sight-threatening ROP had a yearly decrease in higher BW, GA, and PCA categories. These trends were statistically significant ( P = 0.001 for ROP and BW, P = 0.037 for ROP and GA, and P = 0.001 for ROP and PCA). The statistically significant trend of decreasing sight-threatening ROP in babies with higher BW, GA, and PCA and increasing treatable ROP in younger and smaller babies (with lower BWs, GAs, and PCAs) in rural India, over time, is a hitherto unreported finding. This is the first such study in rural Tamil Nadu and Andhra Pradesh combined, with the largest data to date (as per MEDLINE search) to document this healthier trend.

Blink of innocence: A study of paediatric ocular trauma at a tertiary eye care centre in South India

To assess the prevalence of ocular trauma and extent of visual loss in paediatric patients at a tertiary care eye hospital in South India.A retrospective study was conducted on all children of age group 15 years and younger, of both genders, sustaining ocular injuries and seeking care within the ophthalmology outpatient department of a tertiary eye care hospital. The study spanned for a duration of six months. The demographic profile of the participants was recorded, detailed history was taken, followed by standardised ocular evaluation. Orbital imaging was done where deemed necessary. An eye was considered blind due to trauma if best corrected visual acuity for distance was worse than 3/60 due to trauma. Patients with pre-existing low vision in the affected eye were excluded in the study.50 children were included in the study. The mean age upon initial presentation manifested was 9.8 years. The demographic distribution revealed a predilection for children within the age group of 11 to 15 years, constituting 38% of the sampled populace, with the subsequent demographic tier of 5-10 years encompassing 36%. Noteworthy differentials emerged between rural and urban cohorts, with rural representation at 64% and urban at 36%. The predominant ocular injuries were categorized as 72% closed globe injuries and 18% open globe injuries. Operative interventions were administered to 54% of the cases, while the remaining 46% were subject to conservative therapeutic modalities. Within the subset of closed globe injuries necessitating surgical intervention (36%), specific pathologies included lid tear, canalicular tear, and traumatic cataract.Ocular trauma in paediatric population can lead to permanent blindness and visual handicap. It also affects the social, emotional and psychological development of the child. Most of these injuries can be prevented by supervision of children during play, educating the children, family members and teachers regarding ocular health and hygiene.

Clinicopathological Profile of Primary Extra Nodal Lymphoma from a Tertiary Care Center in South India.

Primary extranodal lymphoma (pENL) is a malignant lymphoid neoplasm that presents with the main bulk of disease at an extranodal site. The incidence of primary pENL has risen sharply in recent years due to the advent of better diagnostic modalities. Diagnosing pENL can be challenging due to its morphological overlap with other tumors native to the site of origin. This study aims to establish the anatomic distribution, clinical presentations, possible etiologic correlations, and histological subtypes of pENL in a tertiary care center located in South India. This is a retrospective study of 109 patients with pENL (69 males, 40 females, M: F = 1.7:1) over 5 years (October 2012 to September 2017). The tumors were reclassified according to WHO classification of Haematolymphoid tumors, 5th edition, 2022. pENL constituted 109/481 cases (22.6%) of all NHL cases, with the highest incidence in 7th decade. The gastrointestinal tract (39%) was the predominant site involved, followed by head and neck (26%). Diffuse large B cell lymphoma (DLBCL) was the most common histomorphological variant followed by Follicular lymphoma (FL). The majority of the patients were immunocompetent (89%) and presented with stage IV disease (31.1%) at diagnosis. This study presents an overview of the diverse distribution patterns of both common and rare pENL within a tertiary care center. The accurate diagnosis of pENL necessitates the elimination of secondary extranodal involvement. It is important to note that the accurate diagnosis of pENL requires careful evaluation and exclusion of other possible causes.

Extra-intestinal salmonellosis in a tertiary care centre in South India.

Extra-intestinal salmonellosis is associated with higher case fatality and is underestimated in the developing countries like India. Here we present a case series of bacteriologically proven extra-intestinal salmonellosis managed at our institute over the past two years. Retrospective analysis of bacteriologically proven extra-intestinal salmonellosis over two years between January 2020 to December 2021 was carried out. Medical records were reviewed for site of infection, evidence of any underlying or predisposing illnesses and antimicrobial susceptibility report. Eight patients were diagnosed with extra-intestinal salmonellosis. Male to female ratio was 3:1. Mean age was 44 years. Four were typhoidal and four were nontyphoidal Salmonellae. The extra-intestinal sites involved were purulent aspirates from scrotum, caecum, perianal region, intraperitoneal collection, synovium, and urine. Predisposing factors include chronic myeloid leukemia, HIV and gastric malignancy. All deep seated abscess required surgical intervention. All typhoidal Salmonella (n=4) were sensitive to cotrimoxazole, ampicillin, ceftriaxone. Among nontyphoidal Salmonella, one was resistant to cotrimoxazole; two were resistant to ampicillin, ceftriaxone and three resistant to ciprofloxacin. The diagnosis of extra-intestinal salmonellosis requires a high degree of clinical suspicion and should be included in the differential diagnosis in patients with deep-seated abscesses.

Cardiac Involvement in Pediatric Mucopolysaccharidoses Patients and their Genetic Profile: A Retrospective Single-center Study

Abstract Background: Mucopolysaccharidoses (MPS) are rare metabolic disorders of monogenic inheritance, with varying degrees of cardiac involvement due to undegraded glycosaminoglycans getting aggregated in the spongiosa of the cardiac valves, the myocardium, and myointima of the coronary arteries. This study is an effort to understand the cardiac involvement and genetic pattern of pediatric MPS patients at a tertiary care center in South India. Methods: This descriptive study was done by examining records in our hospital database for MPS patients in the age group of 0–15 years, diagnosed between January 2014 and January 2023. Of these patients, 37 patients with echocardiographic loops available in the hospital system were reevaluated by a single pediatric cardiologist to avoid observer bias. The underlying genetic spectrum was also reviewed. Results: The cohort comprised 67.5% of males and a median age of 9.8 years (interquartile range: 6.5–14.9 years) with a distribution of 37.8% MPS I, 32.4% MPS II, 13.5% MPS IV, and 10.8% MPS VI. Early cardiac involvement in the form of valvar thickening, predominantly left sided (mitral [92%] >aortic [38%]), was seen across all MPS subtypes. We also noted an increased involvement of the tricuspid valve (38%) in our cohort. Moderate–severe valvar involvement was seen in 16% of the cohort, mostly MPS I, II, and VI patients, and more in the second half of the age group (>6 years), suggesting an age-associated worsening of cardiac lesions. Genetic analysis done in 68% of the cohort detected 61% of pathogenic variants, with a predominance of missense mutation (43%). However, no genotype–cardiac phenotype correlation could be ascertained. Conclusions: We identified a high proportion of cardiac abnormalities in our pediatric MPS cohort, which ranged from isolated valvar thickening to a more severe clinical picture, including moderate-to-severe valvular insufficiency and/or stenosis and left ventricular hypertrophy. Cardiac pathology is an early manifestation and a known cause of mortality in many MPS subtypes. Echocardiography is a key diagnostic technique for early detection, careful monitoring, and guidance in the initiation of a timely intervention that will help curb its progression. Hence, the need arises to raise awareness among the primary caretakers of this subset of patients on the need for early cardiac evaluation with a detailed echocardiography.

Clinical profile and treatment outcomes in pediatric uveitis - A series from South India.

The purpose of the study was to look at the clinical spectrum, treatment options, and visual outcomes in a large cohort of pediatric uveitis from a tertiary eye care center in South India. This is a retrospective study carried out at a tertiary eye center in South India. Cases of pediatric uveitis between January 2012 and June 2022 were retrieved from the hospital's medical database. Uveitis was classified according to the Standardization of Uveitis Nomenclature criteria. Demographic details, clinical presentation, complications, medical and surgical management, and visual outcome were evaluated. Two hundred and six eyes of 132 cases were included, with a median age of 12 years. The male to female ratio was 1:1. Bilaterality was seen in 63.1% of cases. The mean duration of uveitis was 11.5 ± 18.5 months, and the mean follow-up period was 20.5 ± 25.1 months. Noninfectious uveitis was seen in 70.45% cases. Most common etiology in the noninfectious group was idiopathic (27.3%), while in the infectious group, it was tuberculosis (TB; 14.4%). Immunomodulators were used in 43.9% and biologics in 10.9% of cases. Most common complications were cataract (25.24%) and posterior synechiae (21.35%). Surgical procedures were done in 12.62%. The mean visual acuity was 0.81 ± 1.14 log of minimum angle of resolution (logMAR) at presentation and 0.49 ± 0.87 logMAR at the end of the study ( P = 0.002). Pediatric uveitis poses a challenge in comparison to adult uveitis. Our study highlights the need for early diagnosis and aggressive management to prevent sequelae. Multidisciplinary approach is a key in improving the overall visual prognosis.

Clinicopathological Profile of Pyoderma Gangrenosum: A 10-Year Retrospective Study from a Tertiary Care Center in South India.

Pyoderma gangrenosum (PG) is a reactive neutrophilic inflammatory dermatosis with a varied clinicopathologic presentation. It commonly manifests as rapidly progressive painful ulcers, mimicking varied conditions including infections, vasculitis, and malignancies, and is a diagnosis of exclusion. There are scarce data on PG from the Indian subcontinent. The aim of the study was to study the clinicopathologic profile of patients with PG and their underlying systemic associations. A retrospective observational study was done between 2011 and 2021, and patients diagnosed as PG based on the diagnostic tool proposed by Maverakis et al. were recruited and their demographic, clinical, and histological findings were obtained. Among 54 patients with suspected PG, 17 patients (eight males and nine females) fulfilled the diagnostic criteria, and the mean age of disease onset was 32.1 years (range: 3-60 years). Ulcerative variant was the most common type (9/17, 52.9%), and 29.4% had systemic associations including autoinflammatory syndromes. The onset at atypical sites such as face and hand were noted in one patient each. Histopathology revealed a polymorphous dermal infiltrate with neutrophilic predominance in the majority (94.1%). Systemic steroids (dose ranging from 0.5-1 mg/kg prednisolone equivalent) were used in 11/17 (64.7%) patients. The commonly used alternative drugs included clofazimine (47%), minocycline (29%), thalidomide (23.5%), adalimumab and mycophenolate mofetil in 17.6% each, dapsone and ciclosporine in 11.7% each. Remission was achieved between two weeks and three months in 10 (58.8%) patients after treatment initiation and two mortalities (11.7%) were recorded. PG can affect any age group and may be localized to rarer, atypical sites. The possibility of underlying autoinflammatory conditions should be considered in addition to the evaluation of other disorders like inflammatory bowel disease, hematological disorders, and rheumatological disorders.

A Follow-up Study on Coping Strategies and its Association with Relapse Among Alcohol-dependent Patients.

Alcohol Dependence Syndrome is a chronic illness that is relapsing in nature. Past research has shown that coping strategies that are specific to alcohol dependence are useful in preventing long-term relapse. This follow-up study is, therefore, an attempt to understand the coping styles and strategies that are associated with relapse among individuals dependent on alcohol. We aimed to cross-sectionally assess the severity of alcohol dependence and coping styles of Alcohol dependent individuals. One hundred and twenty-seven consecutive patients who satisfied the International Classification of Diseases Tenth Edition (ICD 10) criteria for alcohol dependence and who were above the age of 18 years were included. This study was conducted in the de-addiction outpatient services of a Tertiary care center in South India between April 2019 and June 2020. Our Institutional Ethical Committee granted the approval for this study. We used a self-designed proforma for collecting the socio-demographic details. The Severity of Alcohol Dependence Questionnaire (SADQ) and Coping Orientation to Problems Experienced Inventory (Brief - COPE) were administered. Patients were followed up for six months. Motivation Enhancement Therapy was given to all our participants during their monthly follow-up visit. Descriptive analysis was performed using mean and standard deviation. We used the student t-test and chi-squared test to understand the differences in the coping strategies between relapsed and non-relapsed persons. Spearman's correlation was used to assess the correlation between the severity of alcohol dependence and coping strategies. A p value of <.05 was taken as significant. Non-relapsed individuals had significantly higher scores on active coping (p = .008), emotional support (p = .044), informational support (p = .017), planning (p < .001), acceptance (p = .030), and humor (p = .001). Relapsed individuals had statistically significant scores on denial (p = .005), substance use (p = .024), and self-blame (p = .012). We found a positive correlation between the severity of alcohol dependence and maladaptive coping strategies (p < .01). Relapsed individuals were found to have significantly higher maladaptive coping strategies. Non-relapsed individuals exhibited greater adaptive coping styles. Maladaptive coping strategies positively correlated with the severity of alcohol dependence.

A Cohort Study on Comparison of Volumes of Breast-Pump-Expressed Human Milk Donor Among Term and Preterm Gestational Mothers in South India––Time to Redefine “Coming to Volume” in the Milk Bank?

Introduction Human milk banking is an essential perinatal service. The present study evaluates the impact of gestational age on the volumes of milk. Further, it also re-evaluates the definition of “Coming to Volume” in pump-based expression of milk. Methodology This cohort study was conducted at a tertiary care centre in south India over 10 months from September 2022 to June 2023. The primary objective of the study was to compare the volume of donor milk secreted in relation to postnatal day among mothers delivered at term and preterm gestation. The secondary objective of the study was to compare the definition of “Coming to Volume” (secretion of 500 mL per day by postnatal day 14) with the volumes of milk in the present study. A surrogate marker for “Coming to Volume”, that is, an expression of at least 80 mL in one sitting of the donation was considered. Results Of the total 458 mothers, there were 349 (Term) and 109 (preterm) mothers. The average volumes of donor human milk were 142 mL and 122 mL among term and preterm mothers, respectively ( p-value .0068). Further, 80% of the term mothers and 75% of the preterm mothers were able to secrete&gt;80 mL per sitting. This volume was attained by postnatal day 7 in 80% (223/280) of term mothers and 65% (53/82) of preterm mothers.

Quality of life following a maternal near-miss event during the COVID-19 pandemic at a tertiary care center in South India.

To assess the quality of life (QoL) in women following a maternal near-miss event and to assess the women's attitude towards future fertility and their contraceptive choices. A cross-sectional observational study was conducted in Government Medical College, Kozhikode, India among women who had experienced a near-miss event (n = 50) between January 1, 2020 and May 31, 2021 during the peak of the COVID-19 pandemic. The QoL was assessed using the WHO Quality of Life, BREF Version, questionnaire, which was administered to the consenting participants over phone. Information regarding desire for future fertility, contraceptive choices, and urogenital symptoms was also collected. A comparison between the short-term and long-term effects on the QoL was also done. A maternal near-miss event was not found to adversely affect the overall quality of life in the present study. The scores in all the four domains-physical, psychological, social relationships, and environmental-suggested good QoL, although greater variability in values were observed in the physical and psychological domains. The influence in these two domains was more pronounced following a perinatal loss and following prolonged physical morbidities. There was no difference in short- and long-term QoL following a maternal near miss (MNM). The MNM did not influence the contraceptive choices and there was no subsequent pelvic floor dysfunction in most women. MNM was not found to adversely affect the overall subsequent QoL in the present study. There was no difference in short- and long-term QoL following a MNM. Studies carried out over a longer period of time with a control group would yield more information.

Clinico-Epidemiological Profile and Treatment Outcome of Severe Cutaneous Adverse Drug Reactions in the Paediatric Age Group of 0 to 18 Years: A Retrospective Cohort Study from Southern India

Introduction: The paediatric population is prone to developing cutaneous adverse drug reactions. However, the incidence of Severe Cutaneous Adverse Drug Reactions (SCAR) is rare in this age group, with few studies describing such reactions in detail. Aim: To describe the clinico-epidemiological factors, drug profile, laboratory parameters, and treatment outcomes of SCAR in children admitted to a tertiary care centre in South India. Materials and Methods: A retrospective cohort study was carried out over a 10-year period, including paediatric patients (0-18 years) admitted to Dermatology, Medicine, and Paediatric wards in the tertiary care centre. Demographic details, suspected drugs, comorbidities, personal and family history of drug reactions, physical examination, laboratory parameters, treatment received along with its duration, and the state of morbidity and mortality were recorded. SPSS version 18.0 was used for analysis. Descriptive statistics were used to summarise the demographics and clinical characteristics of the patients. Results: Among all the patients admitted with SCAR, 27 (15%) belonged to the paediatric age group. The median age was 15 years, and the female-to-male ratio was 1.25. Nineteen (70.3%) were diagnosed with Stevens-Johnson Syndrome (SJS)/Toxic Epidermal Necrolysis (TEN), and eight (29.6%) were diagnosed with Drug Reaction with Eosinophilia and Systemic Symptom (DRESS). There were no cases of Acute Generalised Exanthematous Pustulosis (AGEP). The most common class of drugs implicated was antiepileptics (62.8%). Two patients (7%) had a family history of drug reactions. All patients had mucosal involvement. The majority of the children responded to intravenous steroids, and two required additional intravenous immunoglobulin injections for clinical improvement. All cases were cured with no mortality or long-term sequelae. Conclusion: The incidence of SCAR in the paediatric age group is significant. Anticonvulsants, particularly phenytoin, carbamazepine, and lamotrigine, need to be used with caution in this age group. Prompt diagnosis and treatment with systemic steroids can reduce mortality, morbidity, and long-term sequelae.

Prevalence of specific learning disability in children and its association with somatic symptom disorder – data from a tertiary care centre of South India

Prevalence of specific learning disability in children and its association with somatic symptom disorder – data from a tertiary care centre of South India

A prospective observational study on efficacy and tolerability of the drugs used in treating rheumatoid arthritis

Background: Rheumatoid arthritis (RA) is an autoimmune disorder requiring long-term combination therapy with disease-modifying antirheumatic drugs (DMARDs), non-steroidal anti-inflammatory agents (NSAIDS), low-dose steroids, proton pump inhibitors, calcium, and folic acid and these drugs cause multitude of side effects. This study on the efficacy and tolerability of drugs used in RA among South Indian patients can guide in tailoring a treatment regimen more suited for South Indian population. Aims and Objectives: The main objective of this study was to evaluate the efficacy and tolerability of drugs used in the treatment of RA among South Indian patients. Materials and Methods: In this prospective observational study, 120 newly diagnosed RA patients attending rheumatology outpatient department in a tertiary care center in South India were recruited after obtaining Institutional Ethics Committee approval and informed consent. Sociodemographic details and baseline investigations were done. Each patient was followed up for a period of 6 months wherein, response to treatment was evaluated and adverse drug reactions (ADRs) reported were collected, analyzed and appropriate treatment was instituted. Data analysis was done using SPSS software. Results: One hundred patients completed the study. There was female preponderance (85%) and 38% were rheumatoid factor positive. Efficacy of combination therapy was evidenced falling erythrocyte sedimentation rate (P &lt; 0.001), modified health assessment questionnaire,and disease activity score 28 scorings after 1st, 3rd, and 6th month of therapy (P &lt; 0.001) and improvement in hemoglobin count (P &lt; 0.001). The number of swollen joints was also significantly reduced (P &lt; 0.001). Common ADRs reported were gastritis (29%), mucosal ulcers (10%), macrocytic anemia (3%), chloroquine-related ocular toxicity (2%). Conclusion: NSAIDS and steroids helped to achieve early remission and caused most of adverse effects. Methotrexate and chloroquine had good tolerability and were preferred DMARDs in our center. Thus, we conclude that the combination therapy used in our center is efficacious and well tolerated by South Indian population.

Activated Partial Thromboplastin Time (aPTT) as a Screening Test for Predicting Bleeding Manifestations in Adult Patients with Dengue Infection – A Diagnostic Accuracy Study

Abstract Background: Thrombocytopenia has been well established in dengue infections; however, coagulopathy is yet to be explored. Objective: The primary outcome was to assess derangement of activated partial thromboplastin time (aPTT) as a predictor of bleeding manifestations and severity of disease in dengue. Methods: This prospective cohort study included adults with dengue fever confirmed by serology, presenting to a single tertiary care center in South India. A structured questionnaire was used to extract clinical features and laboratory parameters at presentation, including aPTT. The patients were clinically observed during their course of illness for the outcomes of major and minor bleeding manifestations along with features of severe dengue. Results: Between May 2020 and September 2021, 140 patients were screened and 122 were recruited. Among these, 72 patients had normal aPTT and 50 had deranged aPTT. There were 41 bleeding events noted and 35 patients had severe dengue. There was a statistically significant correlation for aPTT derangement with major bleeding events (relative risk [RR] =4.03 [95% confidence interval (CI): 1.6–10.5]; P = 0.002), with minor bleeding events (RR = 2.52 [95% CI: 1.1–5.6]; P = 0.017) and with severity of dengue (RR = 3.14 [95% CI: 1.7–5.8); P &lt; 0.001]. aPTT had a good negative predictive value of 93.1% (95% CI: 84.5–97.7) for major bleeding. There was no statistically significant correlation between thrombocytopenia and bleeding manifestations. Conclusion: aPTT can be used as an indicator for predicting bleeding events and severity in dengue fever, with a good negative predictive value.

Her2 positive metastatic breast cancer treated with low dose lapatinib in a resource-constrained setting in South India: a retrospective audit.

Despite the development of newer anti-Her2 agents, access to these medicines is still restricted with lapatinib being widely used as a second-line agent in Her2-positive metastatic breast cancer. However, lapatinib at approved doses of 1,250 to 1,500 mg/day contributes to a high pill burden and financial toxicity. In a population that has an average national per capita income of only USD 2238.1, lapatinib alone contributes to a financial burden of USD 6153.56 per year (approximately USD 500 per month). A concept of 'value meal' has been suggested - the higher bioavailability of lapatinib with the meal being exploited to reduce its administered dose. This concept was utilised in a resource-constrained tertiary care center in South India and we report the outcomes. In our institution, consecutive patients with Her2 positive metastatic breast cancer from 1 January 2014 to 31 December 2020 who could not afford trastuzumab, lapatinib or any other anti-Her2 agent were offered low-dose lapatinib, 500 mg daily with meal. We conducted a retrospective cohort study of the safety and efficacy of this regimen. Among the 47 patients who received low-dose lapatinib, the majority had de novo metastatic disease (57.4%) and multiple visceral metastases (48.9%). The median number of lines of treatment before lapatinib was one. The disease control rate with lapatinib was 61.7%. The median progression-free survival was 7 months (95% CI: 5.6-8.4 months). The median duration of response was 4.5 months, ranging from 1.3 to 45.8 months. Only eleven patients (23.4%) experienced toxicity, mainly dermatological, with grade 3 in only one (2.1%) and no grade 4 toxicities. Low-dose lapatinib is a regimen that offers an acceptable disease control rate. This strategy requires further exploration, particularly for the benefit of resource-limited areas.

Clinical Profile and Outcomes of Children with Acute Liver Failure in a Tertiary Care Center in South India: A Retrospective Study.

In this study, we investigated the clinical profile, survival at discharge, and proportion of children with acute liver failure (ALF) meeting the criteria for, yet surviving without, liver transplantation (LT). Medical case records of children aged >28 days to ≤15 years over a period of 7 years, identified from pediatric admission and discharge registers, were screened. Children satisfying the criteria for ALF were included in this study. A total of 71 records meeting the pediatric ALF (PALF) criteria were included. The survival rate at discharge was 61% (n=44). A considerable proportion of children satisfied the King's College Criteria (KCC) (56.3%) and the European Association for the Study of the Liver (EASL) criteria (7%) for LT at admission. Nonetheless, the survival rate in the absence of LT was 42.5% in children who satisfied the KCC and 20% in those who met the EASL criteria. Infection (29.5%) and paracetamol overdose (19.7%) were the major identifiable causes of PALF. Hepatitis A was the most common infection identified. No significant predictors of poor outcomes were identified in multivariable analysis. Our study highlights the changing survival rates and the clinical and etiological profiles of patients with PALF. In areas with poor access to LT services, survival in these children could be improved through early referral to centers with adequate intensive care facilities. Preventing ALF and referring patients to LT services are paramount to reducing mortality.

Prognostic factors and survival of women with endometrial carcinoma attending a tertiary care center in South India

Background: Endometrial cancer is the most common malignancy of the female genital tract in developed countries and the 4th most common cancer in women after breast, lung, and colorectum. It has an estimated lifetime risk of 2.6% for women living in developed nations, and a median age at diagnosis of 61 years. The majority of women with endometrial carcinoma are diagnosed at an early stage and may be cured by surgery with or without radiotherapy. When detected early it has an average survival rate of 95%. There are various prognostic factors epidemiological, tumor characteristics, and the treatment undertaken that have a significant influence on the disease-free survival (DFS) and overall survival (OS) of the disease. Here an attempt was made to analyze the prognostic factors and to determine the DFS among women diagnosed to have endometrial cancer. Aims and Objectives: The aim of this study was to evaluate the factors determining the prognosis and survival of women with endometrial cancer. Materials and Methods: A retrospective review was conducted on 82 cases diagnosed as endometrial carcinoma registered in the Department of Obstetrics and gynecology department in a government hospital. They were subsequently followed up over a period of 42 months. Results: The recurrence-free survival rate was found to be 90.2%. The estimated mean survival time using the inverse Kaplan–Meir method was 37.5 months (95% CI 34.6–41.34) for recurrence-free survival and 38.24 months (95% CI 34.77–41.72) for OS. Endometroid adenocarcinoma was the most common histological variant (79.3%). Diagnosis at an early stage (FIGO Stage 1 and 2) was more (74.3%) as compared to advanced stages. The calculated recurrence rate was 9.5% with a tumor-related mortality of 32.9%. The most common site of recurrence was the vault (62.5%). The statistically significant variables affecting the recurrence rates were the histological type of tumor and the grade. Prognostic variables with statistically significant influence on recurrence-free survival and OS were age, stage of the tumor, grade of the tumor, type of surgical procedure underwent by the patient, and the use of adjuvant therapy. Conclusion: The present study was able to demonstrate that endometrial adenocarcinoma diagnosed at an early stage has a very good prognosis and survival rates in Kerala. FIGO stage and grade of the tumor being the most important variables determining DFS and OS.

Epidemiological Characteristics of Arthroscopically Managed Anterior Cruciate Ligament Injuries in A Tertiary Care Center of South India

Epidemiological Characteristics of Arthroscopically Managed Anterior Cruciate Ligament Injuries in A Tertiary Care Center of South India