Care Centre In Southern India Research Articles

Clinical and Histopathological Factors in the Prognosis of Cutaneous Malignant Melanoma- An Ambispective Study

Introduction: Melanomas are the most dangerous among the different skin cancers, they can arise from a pre existing lesion or may arise de novo. Among the common skin cancers, melanoma is the most dangerous. It accounts for approximately 75% of all skin cancer-related deaths, although it comprises only 3% of all skin cancers diagnosed each year. The incidence of Cutaneous Malignant Melanoma (CMM) is increasing worldwide faster than any other cancer. Aim: To study the clinical and histological factors in relation to the outcomes among patients diagnosed with the CMM in a tertiary care centre in Southern India. Materials and Methods: This ambispective study was conducted in Department of General Surgery at Shri BM Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India (tertiary care centre), from June 2001 to June 2016. A total of 87 patients, aged more than 18 years with histopathological evidence of cutaneous malignant melanoma and patients with more than 1 year of follow-up were enrolled in present study. Data obtained included sex, age at diagnosis, site over the body, histological subtype, Clark’s level, Breslow’s thickness, lymph nodal status (clinical and pathological), treatment received and status at the time of review. Descriptive statistics were presented as mean, median and standard deviation, Chi-square test was used for the analysis of qualitative variables and ‘t’ test was used for continuous variables. Results: The mean age in the present study (N=87) was 57±10 years with maximum cases 32 (36.78%) aged between 61-70 years, followed by the 22 (25.29%) case aged between 51-60 years and 18 (20.69%) aged between 41-50 years. Maximum patients, 27 (42.19%) In disease free group and 37 (57.81%) in non disease free group were aged >50 years. A total of 48 (55.17%) males patient and 39 (44.83%) females were included in present study. Out of total, 71 (81.6%) patients had primary lesion on the extremities and 16 (18.40%) patients had primary lesions on the trunk, head and neck. Ulceration was present in total 56 patients. Out of these 56 patients ulceration was present in 34 (60.71%) in non disease free group and in 22 (39.29%) in disease free group. Clark’s level was unknown for 23 patients. out of 64 patients, in disease free group, maximum patients 11 (78.57%) were in Clark’s level II, while in non disease free group maximum patients 13 (76.47%) were in Clark’s level IV followed by the 12 (63.16%) in Clark’s level III. Maximum cases 7 (63.63%) in disease free group were seen in <1 mm and 7 (41.18%) in 1.01-2 mm group. Conclusion: Significant relation between Clark’s levels and prognosis of the CMM was seen. The study also showed statistically significant association of Breslow’s thickness on prognosis. The common histologial type of malignant melanoma in the study was was nodular type.

Clinical and Histopathological Factors in the Prognosis of Cutaneous Malignant Melanoma- An Ambispective Study

Introduction: Melanomas are the most dangerous among the different skin cancers, they can arise from a pre existing lesion or may arise de novo. Among the common skin cancers, melanoma is the most dangerous. It accounts for approximately 75% of all skin cancer-related deaths, although it comprises only 3% of all skin cancers diagnosed each year. The incidence of Cutaneous Malignant Melanoma (CMM) is increasing worldwide faster than any other cancer. Aim: To study the clinical and histological factors in relation to the outcomes among patients diagnosed with the CMM in a tertiary care centre in Southern India. Materials and Methods: This ambispective study was conducted in Department of General Surgery at Shri BM Patil Medical College, Hospital and Research Centre, Vijayapura, Karnataka, India (tertiary care centre), from June 2001 to June 2016. A total of 87 patients, aged more than 18 years with histopathological evidence of cutaneous malignant melanoma and patients with more than 1 year of follow-up were enrolled in present study. Data obtained included sex, age at diagnosis, site over the body, histological subtype, Clark’s level, Breslow’s thickness, lymph nodal status (clinical and pathological), treatment received and status at the time of review. Descriptive statistics were presented as mean, median and standard deviation, Chi-square test was used for the analysis of qualitative variables and ‘t’ test was used for continuous variables. Results: The mean age in the present study (N=87) was 57±10 years with maximum cases 32 (36.78%) aged between 61-70 years, followed by the 22 (25.29%) case aged between 51-60 years and 18 (20.69%) aged between 41-50 years. Maximum patients, 27 (42.19%) In disease free group and 37 (57.81%) in non disease free group were aged >50 years. A total of 48 (55.17%) males patient and 39 (44.83%) females were included in present study. Out of total, 71 (81.6%) patients had primary lesion on the extremities and 16 (18.40%) patients had primary lesions on the trunk, head and neck. Ulceration was present in total 56 patients. Out of these 56 patients ulceration was present in 34 (60.71%) in non disease free group and in 22 (39.29%) in disease free group. Clark’s level was unknown for 23 patients. out of 64 patients, in disease free group, maximum patients 11 (78.57%) were in Clark’s level II, while in non disease free group maximum patients 13 (76.47%) were in Clark’s level IV followed by the 12 (63.16%) in Clark’s level III. Maximum cases 7 (63.63%) in disease free group were seen in <1 mm and 7 (41.18%) in 1.01-2 mm group. Conclusion: Significant relation between Clark’s levels and prognosis of the CMM was seen. The study also showed statistically significant association of Breslow’s thickness on prognosis. The common histologial type of malignant melanoma in the study was nodular type.

Infectious scleritis: Clinical profile and treatment outcome in a tertiary eye care center in Southern India

Infectious scleritis: Clinical profile and treatment outcome in a tertiary eye care center in Southern India

COVID-19 Vaccination Status among Patients with Chronic Respiratory Diseases: A Cross-sectional Study from a Tertiary Care Centre in Southern India

Introduction: Pre-existing respiratory diseases were recognized as risk factors for COVID-19 associated morbidity and mortality. One year after the launch of vaccines against COVID-19, vaccination status in specific population was not clear. Vaccination of population at risk is crucial for COVID-19 control. Aim: To estimate the COVID-19 vaccination status and to detect the reasons for vaccine hesitancy among people with chronic respiratory diseases. Materials and Methods: This cross-sectional observational study was conducted in Respiratory Medicine Department at Narayana Medical College, Nellore, Andhra Pradesh, India, from January and February 2022. All the patients above 18 years of age, who presented with chronic respiratory diseases, were included in the study. After taking informed consent, their responses were noted using a validated questionnaire containing data like demographic data and details of vaccination against COVID-19 and reasons for refusal/hesitancy. Results: Out of total 755 subjects, 48.47% were of Chronic Obstructive Pulmonary Disease (COPD), 42.38% were of asthma, 9.40% were of pulmonary tuberculosis sequelae, 5.16% were of bronchiectasis, and 1.72% were of Interstitial Lung Disease (ILD). Mean age of study population was 51.37±15.30 years, 58% were male and 42% were female. Overall, 75% subjects received at least single dose of COVID-19 vaccine. Higher vaccine acceptance was noted among 31-42 years age group, males, residents of rural area, graduates, subjects with income more than one lac per month and smokers. Vaccine hesitancy was 25%. Intake of a native medicine (72.87%) was the most common cause for vaccine refusal among these subjects. Other reasons for vaccine hesitancy were, worries about sideeffects (63.3%), associated multiple co-morbidities (44.15%), lack of confidence in vaccines (15.96%) and fear of injection (14.89%). Conclusion: Vaccine acceptance against COVID-19 is nearly 75% among people with chronic respiratory diseases in India. Nonetheless, some people were still hesitant to receive vaccine. Continuous health education at every level is needed to achieve vaccination targets.

Clinical and Genetic Spectrum of Inborn Errors of Immunity in a Tertiary Care Center in Southern India

ObjectivesTo study the incidence, clinical manifestations, and genetic spectrum of primary immunodeficiency diseases (PID)/inborn errors of immunity (IEI) in a tertiary care hospital in Southern India.MethodsA retrospective analysis of all patients with a clinical suspicion of PID/IEI seen at a tertiary care hospital was performed. All patients had at least one or more warning signs of PID. Serum immunoglobulin levels and other targeted investigations were performed as warranted by the clinical presentation. All families with suspected PID were counseled and offered genetic testing.ResultsA total of 225 children were evaluated for PID during the study period of 6 y. Fifty-six of them did not meet the European Society of Immunodeficiencies (ESID) criteria (working definition of clinical diagnosis) and were excluded. An IEI was found in 30/49 (61.2%) patients. The most frequent reason for referral was recurrent/unusual or serious infections (28%), or cytopenia (16%). Group IV diseases of immune dysregulation was the most common category (19%), followed by group III predominant antibody deficiencies in 23/163 (14%), as per the International Union of Immunological Societies (IUIS) classification.ConclusionsThis study highlights the heterogeneity of the present cohort, the underuse of genetic tests, and efforts to provide optimal care for children with possible IEI in this center.

Feasibility and Outcomes of Left Main to Branch Vessel PCI with Novel Tapered Coronary Stent in a Tertiary Care Centre: A Real World Experience.

To assess the safety and efficacy of Novel tapered (BioMime™ Morph) sirolimus- eluting stent (SES) for left main PCI in a real-world scenario. Currently, no data is available on clinical usefulness of tapered ultrathin stents in left main PCI. This was a prospective, non-randomised, single centre study carried out between February 2018 and May 2020 at a tertiary cardiac care centre in southern India. The study included patients treated with BioMime Morph tapered stent for distal de novo LMB lesion or ostial LAD/LCX lesions with significant size disparity between reference segments based on the eligibility criteria. Primary endpoint of the study was the cumulative incidence of major adverse cardiovascular events (MACE) composed of cardiac death, myocardial infarction, and clinically driven target-lesion revascularisation at follow-up. A total of 41 patients (average age of 54.83±9.81 years) were included in the study. Average SS-2 score was 23.17±5.42. Majority of the lesions (n=31; 75.61%) were of medina class (0.1.0). Provisional single stent strategy was adopted for treatment of LMB lesions. TIMI flow-3 was achieved in 40 patients (97.56%). Median clinical follow-up was 20 months (range 6-34 months). There was no periprocedural complication or MACE during follow-up. Tapered stents may be an acceptable alternative for LM intervention in an anatomical subset of patients with tapered vessels.

Guillain-Barre Syndrome and Antibodies to Arboviruses (Dengue, Chikungunya and Japanese Encephalitis): A Prospective Study of 95 Patients Form a Tertiary Care Centre in Southern India.

Objective:The aim of this study was to detect the presence of IgM antibodies against dengue (DEN), chikungunya (CHIK) and Japanese encephalitis (JE) in the serum and CSF of patients with Guillaine-Barre syndrome (GBS).Methods:GBS patients (>12 years of age) were included after informed consent. Data on history, clinical manifestations, treatment details, and outcome were collected. Serum and CSF were tested for IgM antibodies against DEN, CHIK, and JE.Results:From April 2018 to December 2019, 95 patients were included in this study. Anti-arboviral IgM antibodies were detected in 30 patients (31.5%) (CSF 11, serum 13, both CSF and serum 6). Serum IgM antibody was present in 19 patients (JE 8, DEN 5, CHIK 2, more than 1 virus 4). Of the 66 patients who underwent CSF studies, antibodies were present in 17 (CHIK 14, DEN 1, more than 1 virus 2). Antibody positivity did not affect the outcome of GBS.Conclusion:One-third of the GBS patients had evidence of recent infection by arboviruses. This suggests that DEN, CHIK, and JE could be the inciting event for GBS in endemic regions.

Extrapulmonary Tuberculosis: An Otorhinolaryngologist's Perspective.

The study aimed to determine the clinical manifestations and epidemiology of extrapulmonary tuberculosis (EPTB) of the head and neck in the otorhinolaryngeal regions. There is an increase in the incidence of EPTB in recent years because of increase in immunocompromised states and development of resistant bacteria. The clinical symptoms and signs of EPTB of the otorhinolaryngeal regions overlap with that of malignancies and other diseases in otorhinolaryngology thereby requiring correct early diagnosis so as to avoid unnecessary surgeries and procedures with initiation of appropriate anti tuberculous treatment under RNTCP. Our prospective study was done on 45 patients who attended the ENT OPD at a tertiary care centre in Southern India over a period of 18months with diagnosed EPTB of the otorhinolaryngeal regions. The study included 29 (64.4%) patients who presented with cervical lymphadenopathy, 11 (24.4%) patients with tuberculous laryngitis, 3 (6.6%) patients with tuberculous otitis media and 1 each with nasal and oral cavity tuberculosis. In our study 6 (13.3%) patients had co-existing pulmonary tuberculosis, 8 (18%) had diabetes, 5 (11%) had past history of tuberculosis and 7 (16%) had contact with patient with tuberculosis. A high index of suspicion of EPTB must be kept among patients where (i) the clinical symptoms are out of proportion to the signs, (ii) common treatment fails or (iii) there is persistence or recurrence of symptoms despite therapy. The challenge is in confirming diagnosis which requires histopathological examination (HPE) of the tissue specimen. The timely diagnosis and initiation of anti tuberculous treatment (ATT) as per RNTCP helps in complete recovery thereby reducing morbidity.

The Role of Laboratory Parameters in Assessment of Disease Severity and Outcome in COVID-19 patients – A Retrospective Study in a Tertiary Care Centre in Southern India

Background: Corona Virus Disease 2019 (COVID19) is a global pandemic, the outbreak of which started in China in December 2019. Apart from the clinical symptoms and pulmonary computed tomography (CT) findings, several laboratory biomarkers also play an important role in management of these patients so that immediate attention can be given to those with severe disease and critical illness. In this study we tried to find the association of various laboratory biomarkers in COVID-19 patients, analyzed around the time of admission, with the severity of the disease and outcome.
 Methods: In this study 1048 COVID19 positive cases admitted in our hospital during the study period from April 2020 to October 2020 were included. The cases were clinically assessed based on the severity of the disease at the time of presentation and during the course in hospital and categorized into 3 categories as Mild, Moderate and Severe according to our hospital protocol for management of COVID 19 patients. The clinical and laboratory data were retrieved from electronic medical records. The levels of various laboratory parameters at/around the time of admission were compared with clinical categories, severity and outcome of the disease.
 Result: We found a statistically significant association of severity and outcome of COVID-19 with various laboratory parameters. There were significantly higher levels of D-dimer, LDH, CK, CRP, Sr Ferritin, cTnI, NT pro BNP, PCT, IL-6 and lower ALC in non survivors compared to survivors and in severe disease compared to mild disease with a p value of <0.05.
 Conclusion: In this study we propose that along with the initial clinical assessment, age and concurrent co-morbidities of COVID-19 patients which determine the need for their admission to ICUs, the initial assessment of several laboratory parameters is helpful in triaging the patients who need intensive care so that proper allocation of resources can be done.

Neurodegeneration with brain iron accumulation: Characterization of clinical, radiological, and genetic features of pediatric patients from Southern India

BackgroundNeurodegeneration with brain iron accumulation (NBIA) is a group of rare inherited neurodegenerative disorders. Ten types of NBIA are known. Studies reporting various NBIA subtypes together are few. This study was aimed at describing clinical features, neuroimaging findings, and genetic mutations of different NBIA group disorders. MethodsClinical, radiological, and genetic data of patients diagnosed with NBIA in a tertiary care centre in Southern India from 2014 to 2020 was retrospectively collected and analysed. ResultsIn our cohort of 27 cases, PLA2G6-associated neurodegeneration (PLAN) was most common (n = 13) followed by Pantothenate kinase-associated neurodegeneration (PKAN) (n = 9). We had 2 cases each of Mitochondrial membrane-associated neurodegeneration (MPAN) and Beta-propeller protein- associated neurodegeneration (BPAN) and 1 case of Kufor-Rakeb Syndrome (KRS). Walking difficulty was the presenting complaint in all PKAN cases, whereas the presentation in PLAN was that of development regression with onset at a mean age of 2 years. Overall, 50% patients of them presented with development regression and one-third had epilepsy. Presence of pyramidal signs was most common examination feature (89%) followed by one or more eye findings (81%) and movement disorders (50%). Neuroimaging was abnormal in 24/27 cases and cerebellar atrophy was the commonest finding (52%) followed by globus pallidus hypointensities (44%). ConclusionsOne should have a high index of clinical suspicion for the diagnosis of NBIA in children presenting with neuroregression and vision abnormalities in presence of pyramidal signs or movement disorders. Neuroimaging and ophthalmological evaluation provide important clues to diagnosis in NBIA syndromes.

Association of combined second trimester maternal serum Homocysteine and Uterine Artery Doppler to predict adverse pregnancy outcome.

Disturbances in placentation increase the risk of maternal and fetal complications. Several biochemical and imaging modalities have been studied, but the hunt for a single effective screening test never became a reality as the causes of this complex condition are multifactorial and polygenetic, many of which we are only beginning to discover. Not many studies have been conducted in the developing countries like India and other low resource settings to consider whether it would be worthwhile to combine inexpensive and effective markers together for better prediction of adverse pregnancy outcome.This study primarily aims to investigate the predictability of combined screening with maternal serum homocysteine and second trimester uterine artery Doppler in diagnosis of adverse pregnancy outcome. A prospective cohort study which involved 100 women with singleton gestation, meeting the inclusion criteria, attending the inpatient or outpatient of Obstetrics and Gynaecology in Amrita Institute of Medical Sciences, Kerala, a tertiary care centre in Southern India from July 2016 and September 2018 was conducted. Serum Homocysteine estimation (tHcy) was done between 18 and 28weeks of gestation with informed consent, and uterine artery (UA) Doppler PI which is a non-invasive routine study was done along with targeted second trimester anomaly scan (18-24weeks) in Fetal Medicine Department. Cutoff values of tHcy and UA PI were computed at 95th (> / = 9.7mmol/l) and 90th percentile, respectively as reported by Onalan et al. [9] and Nicholaides et al. [4]. Statistical analysis was performed using IBM SPSS version 20.0 software. Chi-square test and diagnostic measures were also used. Of the 100 patients, 15% (n = 15) developed hypertensive disorder. 7% (n = 7) had FGR and 7%(n = 7) had spontaneous preterm birth. 6% (n = 6) neonates had an APGAR score < 7 and 8% neonates (n = 8) required immediate NICU admission. Statistically significant association was found when tHcy and UA PI were used together for the prediction of FGR (p = 0.003), preterm birth (p = 0.002) and low APGAR score at birth (p = 0.009) with a specificity of 83.4%. With regard to PIH, both parameters were found to be statistically significant only when used independently (p = 0.001) but not when used in combination (p = 0.17). Both elevated tHcy and abnormal UA PI used in combination predicted adverse pregnancy outcome like FGR but with a low sensitivity of 14.3% and high specificity of 98.9%. However, when used independently these markers predicted FGR with a better sensitivity (tHcy- 28.6% and UA PI- 44.4%). Findings from this study have been promising with potential clinical implications for the diagnosis and management of high-risk pregnancies. Though the independent role of the two markers in screening various adverse pregnancy outcomes could be proved, their combined use to improve predictivity of more complications warrants further studies on a larger population with appropriate randomisation.

Functional outcomes in children with reduction glossectomy for vascular malformations - "less is more!"

ObjectivesVascular malformation (VM) of the tongue can cause true macroglossia in children. Reduction glossectomy provides primary relief when sclerotherapy has failed or is not possible. In this study, we evaluated the surgical role in functional outcome of reduction glossectomy performed for VM of the tongue.Patients and Methods We evaluated the functional and surgical outcomes of seven children who were treated at a tertiary care centre in Southern India between 2013 and 2018.ResultsSix children underwent median glossectomy, while one child underwent lateral glossectomy. Functional assessment was performed at least 2 years after the date of surgery. At the time of assessment, speech was comprehensible for three children and was occasionally unintelligible in four children. Taste and swallowing were normal in all seven children. Six children exhibited a minimal residual lesion after surgery, of which only one was symptomatic. Residual lesions were managed with sclerotherapy (n=3), observation (n=2), or repeat surgery (n=1).ConclusionReduction glossectomy in children with macroglossia secondary to VMs has acceptable outcomes in terms of cosmesis and speech, with no gastronomic restriction.

P659 Colonoscopic screening of symptomatic patients suggests an emerging inflammatory bowel disease (IBD) in urban and rural south India

Abstract Background Recent studies suggest that IBD is on the rise in the developing world. This is also the region with limited access to healthcare facilities, poor physician and patient awareness of the disease and diagnostic dilemmas with the infectious bacterial diarrheas preventing adequate diagnosis. There is very limited data on the relative prevalence of IBD compared to the infectious diarrhoeas. We screened symptomatic patients to assess the diagnostic profile in the real world settings with free of cost service to people below poverty line and the un-insured. Methods The study is being conducted in a large tertiary care centre in Southern India from March 2020 till date. We present the results of an interim analysis. Symptomatic patients with diarrhea, unintentional weight loss, bleeding per rectum, chronic abdominal pain and unexplained anemia were screened with a blood test (Haemogram, liver function, serum protein), abdominal ultrasound and colonoscopy/ileoscopy to ensure an early diagnosis and initiation of treatment. Data including the demographics of the patients, predominant symptoms, rural/urban residence, investigations, biopsy and final diagnosis were entered into an excel spreadsheet and analysed. Results 6878 patients, 2188 female (32%), median 44 years (1–82 years) were screened between March 2020 to January 2021. Bloody diarrhoea was noted in 1212(18%), chronic non-bloody diarrhoea in 887 (13%), altered bowel habits in 2381 (35%), pain abdomen in 4030 (59%), un-intentional weight loss in 648 (10%) and anemia in188 (3%). IBD was diagnosed in 397 patients (6%) of which 169 (2.5%) were UC and 228 (3.3%) were CD. Infective etiology including intestinal tuberculosis was seen in 577 (8.3%). Colorectal cancer was diagnosed in 251 (3.6%), polyps in 614 (8.9%). Overall, 4921 (71.5%) were urban and 1957 (28.5%) rural. The proportion of UC (2.3% rural vs 2.5% urban, p=0.65) and CD (3.6% rural and 3.2% urban, p=0.43) were not different in rural and urban groups. There was significantly higher proportion of infectious colitis in the rural subgroup (p=0.01)(Table 1). Conclusion This interim analysis indicates a rising IBD in both urban and rural India vis a vis the infectious diarrheas. However, proportion of infectious colitis was significantly higher in the rural subgroup compared to the urban.

A Comparative Study between Conventional and Modified Leishman Stain

Introduction: Leishman stain has been used as the stain of choice for peripheral blood films since many decades .But it has a disadvantage of consuming 15 minutes for the procedure alone thereby increasing the turn around time of peripheral smear reporting. In this study modified Leishman stain was made by adding phenol to conventional Leishman to reduce the staining time to 3 minutes without interfering with the quality of stain. Aim: To study the quality of modified Leishman stain in comparison with conventional preparation on peripheral blood smears. Materials and Methods: The present cross-sectional study was carried out in Central Haematology laboratory of a tertiary health care centre in Southern India. A pilot study was done to determine the ideal ratio of phenol to Leishman powder in preparing modified stain without compromising the staining quality. After obtaining consent, the blood sample was collected in anticoagulated vials. Sample size was calculated to be 85.Two thin wedge smears were prepared from each sample and one was stained with conventional Leishman stain and other with modified Leishman stain. The staining characteristics were assessed and scored by an experienced pathologist in terms of 6 parameters- RBC pattern, nuclear pattern, neutrophil granules, eosinophil granules, platelets and background staining. The grades were 1, 2, 3 &amp; 4 (poor, satisfied, good and excellent). Smears each with grades 2, 3 and 4 were selected for study. The results were analysed by Statistical Package for the Social Sciences (SPSS) software version 16.0. Result: The mean value for the staining quality using conventional method was 4.73 and for modified method was 5.39, and the total score possible is 6. Photomicrograph showed excellent results with modified Leishman stain. Thus from these values we can interpret that modified method gave much more acceptable results than that of conventional method. Conclusion: Unlike the conventional method which requires a total of 15 minutes, to complete the staining process, modified Leishman staining techniques takes only 3 minutes. Blood films can be stained within a short period of time thus aiding in rapid diagnosis and treatment of patients. Keywords: Leishman stain, Modified Leishman stain, Phenol.

PSOAS ABSCESS – THE CHANGING TRENDS

Introduction: Psoas abscess (IPA) is an abscess collection in the retroperitoneal space tracking along the psoas major muscle. The microbial etiology of Psoas abscess is variable and depends on the geographical area. This study attempts to evaluate the microbial etiology, its implication in deciding the management modalities, and outcomes in patients with Psoas abscess from a tertiary care center in South India.&#x0D; Materials and Methods: This was a retrospective study done in a tertiary care center in Southern India. Results: A total of 47 patients were enrolled in the study, with causative organism identified in 40 (85.15%) patients. In 17 patients (36.17%), it was found to be tuberculous origin; and of nontuberculous origin in 23 patients (48.93%). No causative organism could not be isolated in 7 patients (14.89%). While 33 patients were treated with percutaneous drainage (70.12%), open drainage was done in 14 patients (29.78%) and 1 patient died (2.12%).&#x0D; Conclusion: The most common causative organism of psoas abscess is found to be of nontuberculous origin and PCD was found to be better modality of treatment. Empirical administration of anti-tuberculous drugs needs further evaluation.&#x0D; Key words: psoas, retroperitoneal, retrospective, tuberculous, drainage, empirical

Cognitive Retraining in Traumatic Brain Injury: Experience from Tertiary Care Center in Southern India.

Objective Traumatic brain injury (TBI) is a leading cause of mortality and chronic disability across the globe. This study aimed to understand the effects of cognitive retraining (CR) intervention on neuropsychological functions, symptom reporting, and quality of life in patients with moderate to severe TBI. Materials and Methods The present single-group intervention study with a pre–post design included 12 patients diagnosed with moderate to severe TBI within 3–24 months post injury. Outcome measures included National Institute of Mental Health and Neuro Sciences (NIMHANS) Neuropsychology Battery, Perceived Stress Scale, Rivermead Post-Concussion Symptom Questionnaire, World Health Organization Quality of Life Scale—Brief, and Visual Analogue Scale. All patients underwent a total of 20 sessions of hospital-based CR, spanning over a period of 2 months. The CR included tasks targeting to enhance processing speed, attention, executive function, learning, and memory. Outcome assessments were conducted at baseline and immediately at post intervention. Statistical Analysis Mean, standard deviation, frequency, and percentage were used as measures of descriptive statistics. Pre- and post-intervention scores were compared using Wilcoxon signed-rank test. Results The results showed that at post intervention, significant improvements were found in processing speed, working memory, planning, visuo-spatial construction, visual memory, and verbal encoding. Subjective symptom reporting, perceived stress, and quality of life in psychological domain also improved. Conclusion CR can be helpful in improving not only cognition but also symptom reporting and quality of life in moderate to severe TBI.

POS-687 DONOR CYSTATIN C eGFR> 100 ml/min/1.73m2 IS AN INDEPENDENT PREDICTOR OF GRAFT SURVIVAL IN INDIAN KIDNEY TRANSPLANT RECIPIENTS

India is currently facing an explosion of lifestyle related non-communicable disease, a fact that has major implications for its kidney transplant programme, which is predominantly living kidney donor driven. In this scenario, careful donor selection is required in order to maximise benefit to the recipient and minimise harm to the donor. This study aimed to determine the effect of demographic and metabolic donor characteristics on recipient graft outcome. This single centre, retrospective cohort study included all living donor kidney transplants taking place at a tertiary care centre in southern India from July 2009 – June 2018. Data concerning donor demographic characteristics (age at donation, gender, relationship to the recipient, parity), metabolic risk factors (glycemic status, BMI, non-alcoholic fatty liver disease, dyslipidemia, smoking history, abdominal aortic calcification, hypertension), and kidney function and structure (CKD EPI cystatin C eGFR, CKD EPI creatinine eGFR, presence of cysts or scars in the kidney) were collected from transplant records and the hospital information system and analysed to determine their effect on recipient graft survival A total of 706 living kidney donor transplants took place during the study period. Mean donor age was 43.1 ± 10.8years, 69.1% were female and 62.7% were first degree relations of the recipient. On multivariate Cox proportional hazards analysis, only donor pre-donation CKD EPI cystatin C eGFR> 100 ml/min/1.73 m2 (p = 0.037, HR 0.485, 95% CI 0.246 – 0.957 ), was independently associated with better graft survival, even after adjustment for induction agent, native kidney disease, HLA mismatches, prior sensitization, rejections and symptomatic UTIs. A pre-donation CKD EPI cystatin C eGFR> 100 ml/min/1.73m2 is associated with better graft survival, and may be a useful indicator of adequate donor nephron endowment in South Asian kidney donors which needs to be validated in prospective studies.

Trends of Central Nervous System Tumours and their Histological Subtypes in a Tertiary Care Centre in Southern India

Trends of Central Nervous System Tumours and their Histological Subtypes in a Tertiary Care Centre in Southern India

Etiological profile of diarrhea in solid organ transplant recipients at a tertiary care center in Southern India.

Diarrhea is one of the common gastrointestinal (GI) adverse events after solid organ transplantation. Diarrhea may be caused by infectious or non-infectious etiology. The infectious etiology of diarrhea varies according to the location and duration of diarrhea. Non-infectious etiologies include drugs, inflammatory bowel disease, neoplasia. The objective of this study was to evaluate the etiological profile of diarrhea in solid organ transplant recipients presenting to a tertiary care center in Southern India. This was a retrospective analysis of prospectively collected data of all solid organ transplantation recipients referred to the Department of Medical Gastroenterology for evaluation of diarrhea from April 2012 till May 2014. All patients had stool evaluated by wet mount examination, modified acid fast (AFB) stain, trichrome stain, culture, and Clostridium difficile toxin assay. EDTA plasma was collected for quantitative Cytomegalovirus (CMV) detection by real-time PCR. If the diarrhea was acute (<2wk), and no etiological agent was identified, empirical antibiotic therapy was instituted and followed up. If persistent or chronic diarrhea (>2-4wk), endoscopic evaluation (upper GI endoscopy and/or colonoscopy with biopsies), depending on the clinical type of diarrhea was done. If no specific etiological diagnosis was established after endoscopic evaluation, breath test for SIBO and celiac serology were done. If no specific etiology was identified after the above investigations, dose of immunosuppressive drugs was reduced. If diarrhea responded to dose reduction, it was considered to be drug related. Fifty-eight episodes of diarrhea occurred in 55 solid organ transplant recipients during the study period. Renal transplant recipients constituted the majority (70%). Most (79%) of patients included in the study had their transplant>6mo ago. Infective diarrhea was the etiology in 46%, drug-related diarrhea in 29.3%. No specific etiology was identified in 22.4% of patients. Parasites accounted for 69% of all infective diarrhea. Stool evaluation was the main investigation in establishing diagnosis in acute diarrhea. Endoscopic evaluation was required in two thirds of patients to establish diagnosis in chronic diarrhea. GI infections and drug-related diarrhea were the common causes of diarrhea in solid organ transplant recipients. Parasites were the most common infectious etiology of diarrhea. Step-wise evaluation was able to identify the etiology in~77% of patients. Overall, 98% of diarrheal episodes resolved.

Clinical Profile of Adolescent Onset Anorexia Nervosa at a Tertiary Care Center

To study the clinical profile and outcome of adolescent onset anorexia nervosa at a tertiary care center in Southern India. Review of hospital records of adolescents diagnosed with anorexia nervosa. Outcome was assessed for those with a follow-up of atleast one year, by outpatient visit or by a telephonic interview. Data of 43 patients (28% males) with mean (SD) age at presentation of 13.4 (1.7) years were included. The mean (SD) BMI at presentation was 13.8 (3.2) kg/m2, the lowest being 8.3 kg/m2. 33 (76%) patients were hospitalized for nutritional rehabilitation. Of the 15 patients followed up 1-5 years later, one had died and 11 had achieved normal weight for age. As compared to other studies, this study showed a higher proportion of boys with anorexia nervosa. Further research is necessary to understand factors affecting long-term outcome.