Care Centre In Southern India Research Articles

Surgically induced necrotizing scleritis (SINS): Is it a standalone condition or a variant of necrotizing scleritis?

To report the clinical pattern of surgically induced necrotizing scleritis (SINS) in a tertiary eye care center in Southern India. Retrospective analysis of all SINS cases visiting the uveitis clinic of a tertiary eye institute between January 2009 and April 2019. In total, 15 patients with a median age of 65 (IQR:52-70) years were included in the study. Male (53%) predominance was noted, and SINS was unilateral (100%) in all cases. Most (87%) of the patients developed SINS after a single surgical procedure, with a median onset period of 251 (IQR:127-1095) days. None of these patients had any evidence of systemic association. Ocular hypertension (n = 3, 20%), and cataract (n = 5, 33%) were the most common complications. When compared with a cohort of patients with idiopathic necrotizing scleritis, the index study did not find any statistically significant difference between SINS and idiopathic scleritis. SINS is idiopathic necrotizing scleritis rather than an independent entity of scleritis.

Prevalence of cardiac complications in perinatally acquired human immunodeficiency virus infection in children in Southern India: an observational study

Background: Human immunodeficiency virus (HIV) infection is a multisystemic illness that impacts most organ system, to investigate prevalence of cardiovascular abnormalities in children with perinatally acquired HIV infection. Methods: This observational study was conducted in a tertiary care centre in Southern India. HIV-positive children between the ages of 18 months and 15 years were included. Cardiac abnormalities were defined as abnormalities identified on 2D echocardiography and/or electrocardiogram. Results: The 73 children with HIV infection had their cardiac manifestations assessed. Median age of children was 8 years with 52% of female participants, 22 (30.13%) children had cardiac abnormalities, of which 5 (27.27%) were symptomatic. Overall, 21/22 (95.45%) children had abnormalities on their ECG, 16 (72.72%) had abnormalities on 2D echocardiography. Of these, we found that children with delayed diagnosis of HIV infection and with more advanced clinical and immunological staging in HIV are more prone to develop cardiac complications irrespective of antiretroviral therapy (ART). Conclusions: HIV-related heart involvement is not uncommon, rather occur subclinical. A decreasing CD4 count and worsening clinical status are associated with increased risk. Hence its crucial to screen the children, diagnose at the earliest and timely manage the complications appropriately for prevention of early mortality.

Lung Involvement Patterns in COVID-19: CT Scan Insights and Prognostic Implications From a Tertiary Care Center in Southern India.

Background COVID-19, caused by the SARS-CoV-2 virus, has presented an unparalleled challenge and a profound learning curve globally. Among the myriad of investigative tools, CT scans of the chest have become instrumental in assessing the magnitude of lung involvement in the pathogenesis of this disease. Objectives This study aimed to evaluate the distribution and patterns of lung involvement depicted in the CT chest scans of COVID-19 patients admitted to a specialized tertiary care center located in a southern state of India. Methods With clearance secured from the Institutional Ethics Committee, an analytical cross-sectional study was conducted. It encompassed CT chest images from all symptomatic COVID-19 patients within the designated study center during the specified study timeline. Subsequent data analysis ensued. Results Among the 1066 COVID-19 patients evaluated, ground-glass opacities (GGO) were the predominant lung involvement pattern. Distinct patterns, such as GGOs combined with solid consolidation or atelectasis, were noted, with the highest mortality linked to GGOs paired with pneumomediastinum (PM). Data underscored a direct correlation between the extent of lung involvement and patient prognosis, with specific lung regions, namely the right apical, right posterior, right superior basal, left superior lingular, and left inferior lingular segments, showing frequent involvement. Conclusion Amidst the pandemic, our study emphasizes that ground-glass opacities on CT scans are robust indicators of COVID-19 in RT-PCR-positive patients. Early identification can enhance patient management, with findings highlighting a strong link between lung involvement and prognosis. This insight aids in refining patient triage, while further research is warranted to delve deeper into variations in lung involvement and guide treatment advancements.

Etiologic Spectrum of Pediatric-Onset Leukodystrophies and Genetic Leukoencephalopathies: The Five-Year Experience of a Tertiary Care Center in Southern India

BackgroundWhite matter (WM) disorders with a genetic etiology are classified as leukodystrophies (LDs) and genetic leukoencephalopathies (GLEs). There are very few studies pertaining to the etiologic spectrum of these disorders in the Asian Indian population. MethodsThis study was conducted over a period of five years from January 2016 to December 2020, in the medical genetics department of a tertiary care hospital in southern India. A total of 107 patients up to age 18 years, with a diagnosis of a genetic WM disorder confirmed by molecular genetic testing and/or metabolic testing, were included in the study and categorized into LD or GLE group as per the classification suggested by the Global Leukodystrophy Initiative consortium in 2015. ResultsForty-one patients were diagnosed to have LDs, and 66 patients had GLEs. The two most common LDs were metachromatic LD (16 patients) and X-linked adrenoleukodystrophy (seven patients). In the GLE group, lysosomal storage disorders were the most common (40 patients) followed by mitochondrial disorders (nine patients), with other metabolic disorders and miscellaneous conditions making up the rest. The clinical presentations, neuroimaging findings, and mutation spectrum of the patients in our cohort are discussed. ConclusionsThis is one of the largest cohorts of genetic WM disorders reported till date from the Asian Indian population. The etiologies and clinical presentations identified in our study cohort are similar to those found in other Indian studies as well as in studies based on other populations from different parts of the world.

Primary Gastrointestinal Lymphoma: Clinicopathological Study: 10 Years Experience in a Tertiary Care Center in Southern India

Background: The gastrointestinal tract (GIT) is a common site for extranodal lymphomas, accounting for 10%–15% of all non-Hodgkin lymphoma cases and 30%–40% of extranodal lymphomas. Regarding the incidence of the various histological subtypes and areas of involvement, there is a lot of heterogeneity in the literature. This study looked into the anatomical distribution, histological subtypes, and locations of primary gastrointestinal tract lymphomas (PGL) that were seen at a tertiary referral hospital in Southern India. Materials and Methods: A retrospective analysis of 96 individuals who had been diagnosed with PGL over the course of 10 years (2012–2022) was done. We carried out an audit of the clinicopathological profile of patients with PGL diagnosed over a period of 10 years. All lymphomas were classified according to the World Health Organization’s 2008 classification. Results: Of the 96 patients with PGL, 74 (77%) were male. The most common site for PGL was the stomach (50%), followed by the terminal ileum (14.58%). The most common histological subtype was diffuse large B cell lymphoma (DLBCL), which was seen in 85.42% of the patients. The most common symptom was abdominal pain (51.04%). Rituximab–cyclophosphamide–doxorubicin–vincristine–prednisolone was the most commonly used treatment regimen (56.3%). Conclusion: In this large single-center retrospective study, we found that the pattern of distribution of PGLs in India is comparable to the Western literature in that the stomach is the most prevalent site of PGL and DLBCL is the most common histological subtype.

A clinical study of childhood penetrating ocular trauma in a tertiary care center in Southern India

Aims: Ocular trauma is one of the major causes of monocular blindness in the pediatric age group, causing significant visual morbidity. The purpose of this study is to identify the causes, types, location of injuries, and clinical features due to ocular trauma in a tertiary care center. Settings and Design: It is a retrospective hospital-based observational study. Materials and Methods: Demographic details of 69 consecutive patients up to 14 years of age who were hospitalized for primary repair of penetrating ocular injuries during March 2017 to March 2019 were documented and evaluated. Results: Fifty-six (81.16%) children were male. The mean age was 8.31 ± 3.96 years. Thirty-one (44.93%) were in the 6–10-yearage group. The most common cause of injury was with wooden stick in 23 cases (33.33%). Full-thickness corneal tear was seen in 52 cases (75.36%). Associated anterior segment involvement included iris prolapse in 34 cases (49.28%), hyphemia in 11 (15.94%), and traumatic cataract in 15 (21.74%), interlamellar corneal foreign body in two cases, and associated full-thickness lid tear involving lid margin in two cases. The posterior segment involvement in the form of vitreous hemorrhage in 19 (27.53%) cases, retinal detachment involving macula in seven cases (10.14%), choroidal detachment in six cases (8.69%), endophthalmitis in five cases (7.25%), and retained intraocular foreign body in three (4.35%). Conclusions: Prevention is always considered superior to the best treatment. Parents should be educated about the devastating complications of ocular trauma, need for supervision, and need for timely referral to the eye care center.

Short-Term Outcomes and Quality of Life Following Minimally Invasive Esophagectomy in a Tertiary Care Center in Southern India.

With the advent of multimodality therapy and minimally invasive surgical approaches, patients suffering from carcinoma esophagus are showing promising outcomes. Hence, the frontier needs to be widened to assess the postoperative quality of life (QoL) of those surviving carcinoma esophagus. The objective of the study was to determine the short-term outcomes of minimally invasive esophagectomy (MIE) /hybrid esophagectomies in carcinoma esophagus and the organ-specific QoL in survivors of MIE for carcinoma esophagus, and to compare health-related QoL in patients following MIE for carcinoma esophagus with the general population. A longitudinal study design was used to evaluate the short-term postoperative outcomes of patients undergoing MIE for carcinoma esophagus between July 1, 2021, to July 15, 2022, and analyze the QoL of those patients who survived at one year without tumor recurrence. QoL was assessed using the European Organization for the Research and Treatment of Cancer (EORTC) QoL Questionnaire (EORTC QLQ-C30) and the EORTC QoL Questionnaire - Oesophageal Cancer Module (EORTC QLQ-OES18). A total of 15 patients who underwent minimal invasive/hybrid esophagectomy for esophageal carcinomawere included. Of these, 13 patients underwent hybrid esophagectomy while two patients underwent thoraco-laparoscopic esophagectomy. Squamous cell carcinoma was observed as the most common histological variant (60%) while 33% were adenocarcinoma and 6.7% lymphoma. The most common site of the tumor was the lower one-third esophagus (60%). Nine out of 15 patients developed postoperative complications needing prolonged ICU stay. One major anastomotic leak as well as one conduit necrosis was observed among 15 cases operated. Median length of hospital stay was 16 (IQR 12-24). QoL was assessed among 12 patients at the one-year follow-up excluding mortality cases and patients with tumor recurrence. The patients following MIE for carcinoma esophagus were observed to have low scores in physical functioning, role functioning, and social functionwhen compared with the general population. Cognitive functioning and emotional function were not found to be significantly different. No statistically significant difference was observed in the global health status among the two groups. There was no significant difference found in the general symptoms score comparison of the MIE patients with the general population. When it comes to organ-specific symptom scales, reflux was observed as a major issue among the patients who survived carcinoma esophagus after undergoing MIE. Dysphagia and dry mouth received low scores suggestive of minor issues. Though analysis of global health QoL scores of those with postoperative complications and those who had uneventful recovery at one year revealed a higher score for the latter, it was not statistically significant. Postoperative complications can prolong hospital stay, delay resuming normal work, and affect the global QoL of patients compared with those who recovered uneventfully. Physical and role functions were observed to be deficient among survived patients when compared with the normal population. Nutritional prehabilitation, cutting-edge surgical practice including minimally invasive techniques, minimizing deviation from normal postoperative recovery by high-quality ICU care, and postoperative rehabilitation are the cornerstones to ensure better QoL.

Effectiveness of Clinic-Based Vision Therapy for Non-Strabismic Binocular Vision Anomalies (NSBVA) Among Adults

Background: To assess the effectiveness of clinic-based vision therapy in adults with non-strabismic binocular vision anomalies. Methods: This retrospective study was conducted between January 2018 and December 2021 at a tertiary eye care center in Southern India. Elec-tronic medical records of adults aged 30 years and above diagnosed with non-strabismic binocular vision anomalies, and who underwent a mini-mum of five sessions of clinic-based vision therapy (VT), were reviewed. Clinical parameters of vergence and accommodation were analyzed pre and post-therapy. Results: A total of 44 participants meeting the inclusion criteria were included in the study, with a mean (SD) age of 36 (±6) years. The partic-ipants were categorized into two groups based on the completion of either five sessions (Group A) or ten sessions (Group B) of vision therapy (VT). The overall median (IQR) for near phoria was -4 (-8 to 0) PD, the near point of convergence break point was 8 (4 to 12) cm, fusional conver-gence amplitude for near was 25 (14 to 30) PD, and binocular accommo-dative facility and amplitude were 3 (0 to 6) cpm and 9 (7 to 10) D, respectively. Conclusion: Clinic-based vision therapy is efficacious in managing non-strabismic binocular vision anomalies in adult.

Prevalence of HPV/p16+ infection among oropharyngeal squamous cell carcinoma patients in a tertiary care centre in Southern India

Introduction. Oropharyngeal squamous cell carcinomas are often found to be associated with human papilloma virus (HPV) infection. The prevalence of HPV infection among oropharyngeal squamous cell carcinomas patients in India is comparatively lower to that of the same worldwide. Aim. To find out the prevalence of HPV infection among oropharyngeal squamous cell carcinomas patients who presented in our hospital.Settings and design. Retrospective cross-sectional study.Materials and methods. Tissue block of 60 patients with biopsy-proven oropharyngeal squamous cell carcinomas were subjected to immunohistochemistry for evaluating p16 expression. The p16 expression pattern was correlated with the demographic details. Data was entered in Microsoft Excel and Statistical Analysis was done with the help of SPSS version 22 (IBM Corp. Released, 2013. IBM SPSS Statistics for Windows, Version 22.0. Armonk, NY: IBM Corp.).Results. Prevalence of HPV infection in our study was found to be 11.7 %. 85.8 % of all p16-positive patients had moderate-well differentiated disease. 6 out of 7 p16-positive patients had higher T stage (T3–4). All the patients who were p16+ were found to have a higher Nodal stage (N2–3). 100 % of all p16+ patients were found to have stage IV disease.Conclusion. Prevalence of HPV infection was found to be similar to that of previous studies conducted in India. These patients also presented with advanced nodal disease at presentation and thereby, an advanced overall stage.

Paraquat poisoning; an experience from a tertiary care center in India

Introduction: Paraquat poisoning is a commonly used toxin within the Indian sub-continent. Despite several advances in medical care, mortality in cases of paraquat poisoning continues to be high with controversies in the ideal management. Objectives: The aim of this study was to throw light on the clinical course of these patients in the current setting and evaluate some of the novel therapeutic options such as hemoperfusion in the setting of paraquat poisoning. Patients and Methods: This study is a retrospective observational study examining all adult patients with paraquat poisoning over the last five years from a tertiary care centre in Southern India. Demographic characteristics, clinical and laboratory profile, treatment options, and outcome were analysed from online hospital records. Results: Of 13 patients, all patients, except one, had ingested paraquat deliberately. Acute kidney injury (AKI) occurred in all patients (100%). Dialysis was required in 7 patients (54%) with AKI. Lung injury was seen in 63.5% of patients (n=8) and most patients i.e. 92.3% (12 patients) had multi-organ dysfunction syndrome (MODS). Hemoperfusion was provided to 30.8% of patients without much benefit in terms of duration of hospitalisation or time to death. Hemodialysis and continuous renal replacement therapy (CRRT) were offered for conventional indications. Dialysis was found to have significant bearing on time to death. Conclusion: Paraquat is a highly lethal herbicide with few effective therapeutic options. The majority of patients develop multi-organ dysfunction and succumb to death owing to circulatory collapse. Dialysis may be able to delay mortality in paraquat poisoning.

Cost-of-illness and associated factors among persons with type 2 diabetes: Findings from a tertiary care center in South India

ObjectiveOur aim was to estimate the cost of illness (COI) from the patient's perspective among individuals with type 2 diabetes (PWDs) attending a public tertiary care center in southern India. MethodsThis cross-sectional analytical study included PWDs on treatment for at least one year. Interviews captured direct medical costs (hospitalization, tests, medications), direct non-medical costs (meals, travel), and indirect costs (wage loss). Median regression analyses examined factors associated with total COI. ResultsOf total 1002 PWDs included, the mean (SD) age was 56 (12) years. Majority were males and from rural areas. One-third had diabetes for more than ten years, half were on insulin therapy, and more than half had comorbidities. Median (IQR) reported household income was US$637 (US$318–US$1115)/year. The Median (IQR) annual COI was US$39 (US$20-US$67), of which 73% was direct costs with a median of US$28. Majority of the participants (n=818, 81.6%) spent on laboratory investigations as direct medical costs and travel (n=1000, 99.8%) as direct non-medical costs. Travel costs represented the largest share of total COI (41%), followed by wage loss. Median annual COI was higher for males, salaried PWDs, and PWDs on insulin. ConclusionsOur findings highlight that PWDs attending a public tertiary care center bear significant out-of-pocket expenses for diabetes care, primarily due to direct costs. Particularly, travel costs were identified as the most substantial component of the total COI.

The Prevalence of Congenital Color Vision Abnormality Among Patients Attending a Tertiary Eye Care Center in Southern India.

Background and objective Color vision abnormality is a condition where the faculty to identify one or more primary colors is either defective (anomalous) or absent (anopia). Occupations like armed forces, merchant navy, navigation, and police and fire services require normal color vision. There is a scarcity of data in the literature regarding the prevalence of congenital color vision abnormality in patients in South India. In light of this, the present study aimed to find the prevalence of congenital color vision abnormality in patients attending the Outpatient Department (OPD) at a tertiary eye care center in South India. Materials and methods This was a descriptive cross-sectional study conducted at a tertiary eye care center in South India from December 2014 to December 2016. Patients with a best-corrected visual acuity of 20/20, normal direct and consensual pupillary light reflex, normal anterior segment, and undilated fundus examination were included. Color vision was assessed using Ishihara pseudoisochromatic plates, American Optical Hardy-Rand-Rittler (AO HRR), and then the Farnsworth Munsell D15 arrangement test. All the results were tabulated and statistically analyzed. Statistical significance was calculated using the ANOVA test. Results A total of 371 patients were screened for color vision abnormality; 184 (49.59%) patients were males and 187 (50.40%)were females. Out of 371 patients in the study, 363(98.10%) had normal color vision while eight patients (2.16%) had color vision abnormality. Of the eight patients with color vision abnormalities, six (75%) had abnormal color vision on all three tests and two(25%) had an abnormality on only two tests (Ishihara and AO HRR). Out of 184 males in the study, eight patients (4.34%) had abnormal color vision while none of the 187 females had color vision abnormality; this difference was statistically significant (p=0.03). Conclusions Early diagnosis and providing education and awareness of this condition are necessary as part of guiding young people with regard to their career options and we recommend that all children should undergo color vision screening before entering high school.

A study of sleep problems and effect of COVID pandemic on sleep patterns in children and adolescents attending a tertiary care centre in Southern India

A study of sleep problems and effect of COVID pandemic on sleep patterns in children and adolescents attending a tertiary care centre in Southern India

Microbiological spectrum and antibiotic susceptibility patterns of non-viral conjunctivitis over 16years at a tertiary eye care center in Southern India.

To determine the trends in the microbial spectrum and antibacterial susceptibility patterns of non-viral conjunctivitis over 16years. Microbiology data were reviewed from 2006-2021 for all the patients with clinically and culture-proven infectious conjunctivitis. Conjunctival swabs and/or conjunctival scrapings were collected for microbiological workup, and the demographic and antibiotic susceptibility data were extracted from the EMR (Electronic Medical Record). For statistical analysis, χ2-test was performed. Of the 1711 patients, 814 (47.57%) were culture positive and 897 (52.43%) were culture negative. Of the total culture-proven conjunctivitis cases, 775/814 (95.20%) were bacteria, and 39/814 (4.80%) were fungi. Among these bacterial isolates, 75.74% were gram-positive bacteria, while 24.26% were gram negative. The predominant gram-positive pathogens isolated were S. epidermidis (16.7%), S. aureus (17.9%) (p < 0.05), and S. pneumoniae (18.2%), while Haemophilus spp. (36.2%) (p < 0.05) was the most often isolated gram-negative bacteria (36.2%), and Aspergillus spp. was the most commonly isolated fungus (50%). The susceptibility of gram-positive bacteria to cefazoline increased from 90.46 to 98% (p = 0.01), whereas the susceptibility for gatifloxacin decreased in both gram-positive (81-41%; p < 0.0001) and gram-negative bacteria (73-58%; p = 0.02). Increasing resistance of ocular isolates to mainstay antibiotics is a concern, and this data can assist healthcare practitioners in making informed choices regarding the treatment of ocular infections with ophthalmic antibiotics.

Seminal plasma testis expressed sequence (TEX)-101 as a biomarker for the qualitative assessment of male factor infertility: A case-control study

ObjectiveThe study was conducted to assess the role of seminal plasma Testis Expressed Sequence (TEX)-101 as a biomarker of male infertility. Study designThe study was conducted on 180 men (20–50 years) with 90 having abnormal semen reports as cases and 90 with normal reports as controls in a rural tertiary care center in Southern India over two years. After the enrolment of cases and control, semen samples were cryopreserved till the desired sample size was achieved and a biochemical test for TEX-101 was run using Human Testis-expressed Protein 101 ELISA Kit. The results of TEX-101 were compared between cases and controls and correlated with various semen parameters. Statistical analysis was done using SPSS software version 22.0, a p-value < 0.05 was considered statistically significant. ResultsMean ± SD age of all participants was 29.94 ± 4.91 years. Of 90 cases, 48.9% had asthenospermia, 24.4% oligoasthenospermia, 15.6% oligospermia, 11.1% azoospermia. A statistically significant difference was observed in mean values of seminal plasma TEX-101 between cases (1.45 ± 0.08 ng/mL) and controls (2.26 ± 0.18 ng/mL), p = 0.001. A significant correlation (p = 0.001) was found between seminal TEX-101, semen volume, sperm concentration, progressive motility, and morphology. The area under the Receiver Operating Characteristic curve of TEX-101 between cases and controls was 1.00 (p = 0.001), indicating TEX-101 as a potential biomarker for distinguishing men with abnormal semen parameters from those with normal semen parameters. At a cut-off value of 1.84 ng/mL, seminal plasma TEX-101 had a sensitivity, specificity, and negative and positive predictive values of 100% for male infertility prediction. ConclusionSeminal TEX-101 is a potential seminal biomarker and can be used in the qualitative assessment of male factor infertility.

Clinical Profile of Congenital Factor XIII Deficiency in Children.

Congenital Factor 13 Deficiency (FXIIID) is a rare bleeding disorder (RBD) of autosomal recessive inheritance, with an incidence of 1 in 3-5million. The clinical symptomatology, diagnosis, and management of FXIIID are described. A retrospective chart review of children with FXIIID was performed from January 2000 through October 2021 at a tertiary care center in Southern India. The diagnosis was performed by the Urea clot solubility test (UCST) and Factor XIII antigen assay. Twenty children (representing 16 families) were included. Male: Female ratio was 1.5:1. The median age of symptom onset was 6 mo, and the median age of diagnosis was 1 y, demonstrating a delay in diagnosis. Consanguinity was present in 15 (75%) with 4 children having affected siblings. Clinical symptomatology ranged from mucosal bleeds to intracranial bleeds and hemarthrosis, with many children having a history of prolonged umbilical bleeding in their neonatal period. Fourteen children were on cryoprecipitate prophylaxis. Four children had breakthrough bleeds due to irregular prophylaxis, including one intracranial bleed due to a delay in cryoprecipitate prophylaxis during the covid pandemic. Congenital FXIIID presents with a wide range of bleeding manifestations. The high prevalence of consanguinity in Southern India can be a cause of FXIIID's high prevalence in this region. There is a propensity for intracranial bleeding with a significant number having this at first presentation. Regular prophylaxis is required and feasible to prevent potentially fatal bleeds.

Complications of Descemet stripping endothelial keratoplasty - A retrospective interventional study at a tertiary eye care center in Southern India.

To analyze the visual outcome and complications of Descemet stripping endothelial keratoplasty (DSEK) with their management in 256 eyes at a tertiary eye care center in southern India. This is a retrospective interventional study of 62 months duration conducted at a tertiary eye care center in southern India. Two hundred and fifty-six eyes of 205 patients were included in the study after obtaining written informed consent from the patients. All cases of DSEK were performed by a single experienced surgeon. In all cases, donor dissection was performed manually. A Sheet's glide was inserted through the temporal corneal incision and donor button was placed on the Sheet's glide with the endothelial side down. The lenticule was separated and inserted into the anterior chamber by pushing the lenticule into the anterior chamber using Sinskey's hook. Any complication, either intraoperative or postoperative, was recorded and managed either medically or by appropriate surgical means. The mean best corrected visual acuity (BCVA) before surgery was CF-1 m, which improved to 6/18 after surgery. Intraoperative donor graft perforation during dissection was seen in 12 cases, thin lenticule in three eyes, and repeated artificial Anterior Chamber (AC) collapse in three eyes. Dislocation of lenticule was the most common complication seen in 21 eyes, which was managed by graft repositioning and rebubbling. Eleven cases had minimal separation of the graft and seven cases had interface haze. Pupillary block glaucoma was seen in two cases that resolved with partial release of bubble. Surface infiltrate was seen in two cases, which was managed with topical antimicrobial agents. Primary graft failure was seen in two cases. DSEK is a promising alternative to penetrating keratoplasty for corneal endothelial decompensation, but it also has its own merits and limitations, and most often, merits overweigh limitations.

Diagnostic Accuracy of Fine Needle Aspiration Cytology (FNAC) in Salivary Gland Lesions with Histopathological Examination (HPE) Correlation in a Tertiary Care Centre in Southern India.

This study aimed to determine the diagnostic yield of fine-needle aspiration cytology (FNAC) in salivary gland lesions compared to histopathological diagnosis. The present study was done on patients above 18years of age, with a palpable swelling, who are clinically diagnosed as salivary gland lesions were evaluated. A total of 31 patients were evaluated in this study. The mean age of the patients was 41years ± 16.08. The male to female ratio of patients evaluated in our study was 1: 1.066, with a marginal preponderance in the female population. There was a higher incidence of carcinoma in females than males. Parotid gland lesions comprised 83.9% of all the salivary gland lesions analyzed, while submandibular gland lesions comprised 16.1%. In our study, the distribution between non-neoplastic, neoplastic benign, and neoplastic malignant lesions was 9.6%, 83.8%, and 6.4%. The overall diagnostic accuracy for non-neoplastic and neoplastic lesions is 90.3%, with a sensitivity of 89% and a specificity of 100%. The segregation of the results into the positive and negative class of diagnostic outcomes shows 80.6% for true positive, 9.7% for true negative, 0% for false-positive, and 9.7% for false-negative reports. Diagnostic accuracy in differentiating non-neoplastic and neoplastic lesions is 90.3%, with a sensitivity and specificity of 89.0% and 100%, respectively. The diagnostic accuracy of FNAC in differentiating benign from malignant lesions in our study is 93.5% (29 out of 31), the sensitivity of FNAC in our study for diagnosing malignancy is poor, and the specificity is 100%. It can be concluded that FNAC is more accurate in diagnosing benign lesions and more specific than sensitive in diagnosing malignant lesions.

Does Tenecteplase Before Mechanical Thrombectomy Result in a Faster Revascularization as Compared to Alteplase? Observations From a Comprehensive Stroke Care Center in Southern India

Background The Indian data concerning the endovascular mechanical thrombectomy (MT) in acute ischemic strokes (AIS) with large vessel occlusion (LVO) is still scarce and evolving. Tenecteplase (TNK) has been recently approved for intravenous stroke thrombolysis prior to the MT. Methods This study is a single-center retrospective study. We performed data analysis of the AIS patients who consecutively presented during the study period with LVO and underwent thrombectomy. Procedural success was defined by the post-thrombectomy angiographic picture of grades 2b and 3 on modified Thrombolysis in Cerebral Infarction (mTICI) scale. Primary efficacy outcome was defined as an improvement of ≥4 points in National Institute of Health Stroke Scale (NIHSS) score at 24 h. Secondary efficacy outcome was based on modified Rankin Scale (mRS) score at 90 days. We also performed a comparative analysis of TNK and alteplase subgroups. Results Successful recanalization (mTICI 2b/3) was achieved in 65 (86.67%) patients. There was a significant mean difference between the NIHSS scores on admission and at 24 h ( P &lt; .001). Likewise, mRS score at 3 months also showed a significant mean difference as compared to baseline ( P &lt; .001). A faster recanalization was observed in those who were thrombolyzed with TNK, needed fewer number of passes, and if the procedure was performed under conscious sedation. Conclusion This study further strengthens the Indian data on efficacy and safety of MT in LVO ischemic strokes. Besides, whether the observation of TNK resulting in a faster revascularization is due to some factors unaccounted in our study, or an actual effect on thrombus due to a high fibrin specificity, needs to be tested further in larger randomized studies with matched sample sizes.

Patterns of bone marrow infiltration in lymphomas- A retrospective descriptive analysis from a tertiary care centre in Southern India

Bone marrow biopsy (BMB) examination is the gold standard for staging of lymphoma which is interpreted along with other clinical, laboratory and radiological investigations. This study aimed to evaluate the various patterns of BMB infiltration by lymphomas which include Hodgkin and Non Hodgkin lymphoma and the usefulness of BMB compared to bone marrow aspiration (BMA). : In a period of three years, there were 212 cases which showed lymphoma infiltration in bone marrow. We assessed the peripheral blood smear (PBS), BMA and BMB slides and concordance between each was evaluated. BMB slides were assessed for the pattern of involvement. The most frequent subtype was chronic lymphocytic leukemia/small lymphocytic lymphoma (CLL/SLL) (21.70%) followed by Hodgkin lymphoma (HL)(12.73%)and follicular lymphoma (FL)(11.32%). Predominant pattern of infiltration showed by CLL/SLL cases was mixed pattern, by FL was paratrabecular pattern, mantle cell lymphoma(MCL) showed either diffuse or nodular, diffuse large B cell lymphoma (DLBCL) and Burkitt lymphoma(BL) showed predominantly diffuse pattern. Hairy cell leukemia (HCL) and peripheral T cell lymphoma (PTCL) showed an interstitial pattern. In HL, the pattern was usually focal nodular however diffuse involvement was seen in a few. Of the 212 cases, 50.94% cases had atypical lymphocytes or lymphocytosis in PBS and 81.14% cases showed infiltration in BMA. Atypical lymphoid cells may not be present at times in peripheral blood or bone marrow aspirate in spite of infiltration in the bone marrow. Different lymphomas show characteristic patterns of marrow involvement.