Care Centre In North India Research Articles

Scleral buckling in retinal detachment due to retinal dialysis - A vitreoretina fellow's perspective.

To analyze the efficacy of scleral buckling in the hands of vitreo-retina (VR) fellows under training in eyes with retinal detachment associated with retinal dialysis and analyze the patient and retinal characteristics in these eyes. We carried out a retrospective consecutive case review at a tertiary eye care center in North India. Records of all the patients who had undergone scleral buckling (SB) for retinal dialysis-associated rhegmatogenous retinal detachment by VR fellows (with less than 2 years' experience) between January 2017 and January 2020 were reviewed. Fifty-three eyes of 53 patients with a mean age of 20.77 years were analyzed. Of the patients, 73.58% were males. History of eye trauma was present in 71.69% patients. A total of 21 residents operated these 53 eyes. SB was able to achieve retinal attachment in a single surgery in 84.9% (45/53) eyes. Mean preoperative best corrected visual acuity was 1.9 ± 1.05 log of minimum angle of resolution (logMAR), which improved postoperatively to 1.07 ± 0.72 logMAR (P < 0.001). Surgical success rate was 85.71% (24/28) in eyes with no proliferative vitreoretinopathy (PVR), 66.66% (2/3) in eyes with PVR-A, 91.66% (11/12) in eyes with PVR-B, and 80% (8/10) in eyes with PVR-C1. Fifty-two eyes had a single dialysis and one eye had two separate dialysis. Six eyes had giant retinal dialysis (dialysis greater than 3 clock hours) and all were due to trauma. Five patients had retinal dialysis in the fellow eye and were diagnosed with bilateral idiopathic retinal dialysis. Scleral buckling is a safe and effective management for retinal dialysis retinal detachment even in the hands of VR fellows under training.

Is the combination of propranolol and flunarizine better than propranolol, flunarizine and amitriptyline alone in prophylaxis of migraine? An observational study at a tertiary care centre of North India

Background: Migraine is a primary headache disorder marked by recurrent attacks of pain and associated symptoms. Propranolol is traditionally considered highly effective for migraine prophylaxis, but other drugs have recently shown promise. Methods: This study was a prospective, observational, randomized, parallel-arm, unicentric trial conducted in the neurology department of a tertiary care hospital in North India. Patients with migraine without aura were randomly assigned to one of four treatment groups. After obtaining consent, patients were randomized using a random number table. Group 1 received propranolol (80 mg), group 2 received flunarizine (10 mg), group 3 received a combination of propranolol (40 mg) and flunarizine (10 mg), and group 4 received amitriptyline (10 mg) daily. The primary outcome was a change in the frequency of migraine days, while secondary outcomes included changes in moderate-to-severe headache days and disability levels. Results: The combination of propranolol (40 mg) and flunarizine (10 mg) was significantly more effective in reducing the frequency of migraine attacks at the end of 3 months compared to the group receiving amitriptyline (10 mg). However, no significant differences between the groups were observed at baseline, 1 month, and 2 months. For other outcomes, including adverse drug reactions (ADRs), there were no significant differences between the groups. Conclusions: The combination of propranolol (40 mg) and flunarizine (10 mg) demonstrated superior efficacy over amitriptyline (10 mg) after prolonged treatment, while its effectiveness was comparable to other groups at earlier time points. ADRs were similar across all groups.

Assessment of diabetes-specific knowledge and its determinants among children with type 1 diabetes mellitus and their primary caregivers: Experience from a tertiary care center in North India.

Assessment of diabetes-specific knowledge among children with type 1 diabetes (T1D) and their caregivers using a validated diabetes knowledge test (DKT) and to determine the factors associated with DKT score. A cross-sectional study was conducted in a tertiary care hospital, New Delhi (India). Children 5-18 years with T1D and caregivers were evaluated using a validated DKT tool to assess knowledge in basic and advance domains. The factors associated with DKT scores were studied. 110 T1D children with mean (SD) age 12.2 (3.3) years and duration 5.3 (2.7) years were assessed. The mean (SD) composite DKT score (%) was 58.0 (11.1) while in basic and advance domains were 66.4 (9.5) and 50.4(1.5), respectively. Maternal education (≥graduate), socio-economic strata (≥upper middle), annual per capita income (>Rs 50,000/700 USD), urban setting and HbA1c<8.5 % were significantly associated with higher odds of DKT score>50 %. HbA1c<8.5 % and urban setting were significant predictors of the DKT score on multivariate logistic regression analysis (p<0.001). DKT can identify individual challenges in specific (basic or advance) domains related to diabetes self-management skills. Higher maternal education significantly impacted achieving a high DKT score and improved glycemic control.

Efficacy of Corticosteroid Therapy in Severe Community-acquired Pneumonia: A Monocentric Single-blinded Randomized Placebo-controlled Trial from a Tertiary Care Center in North India

Efficacy of Corticosteroid Therapy in Severe Community-acquired Pneumonia: A Monocentric Single-blinded Randomized Placebo-controlled Trial from a Tertiary Care Center in North India

Perceived Mental Health and Quality of Life in Mothers of Children with Autism Spectrum Disorder in Armed Forces in a Tertiary Care Center of North India: A Cross-Sectional Study

Purpose: To explore the impact on mental health and quality of life among mothers following the diagnosis of mild or moderate autism in their child.Methods: The study included 100 consecutive mothers with a defence background, each having a child aged 3 to 10 years diagnosed with mild to moderate autism. Participants were briefed about the study, and informed consent was obtained. A quantitative experimental design was employed, utilising the Depression, Anxiety, and Stress Scale-21 Items (DASS-21) and the World Health Organisation Quality of Life Scale-Brief (WHOQOL-Brief) to assess the mothers.Results: The results indicated that mothers experienced moderate levels of anxiety (mean±standard deviation, 10±6.4) and stress (19±6.7), but lower levels of depression (11±7.7), as measured by the DASS-21 questionnaire. The WHOQOL-Brief revealed a moderate decline in psychological health (transformative [T]-score=38) and social relationships (T-score=31). However, satisfaction with their environment (T-score=75) and physical health (T-score=63) was higher, potentially due to their defence background, which may provide easier access to healthcare and improved living conditions.Conclusion: Mothers of children with autism spectrum disorder experience moderate levels of stress and anxiety, and low levels of depression. Additionally, they face a decline in their quality of life.

Molecular Characterization of MDR and XDR Clinical Strains from a Tertiary Care Center in North India by Whole Genome Sequence Analysis

Molecular Characterization of MDR and XDR Clinical Strains from a Tertiary Care Center in North India by Whole Genome Sequence Analysis

Profile of patients with Juvenile Dermatomyositis and Anti-MDA5 autoantibodies.

Anti-MDA5 autoantibody-positive dermatomyositis (MDA5-DM) is associated with clinically amyopathic forms and rapidly progressive interstitial lung disease (ILD); however, data in children are limited. In this study, we described our cohort of anti-MDA5-positive juvenile DM (MDA5-JDM) from a tertiary care center in North India. We performed a retrospective analysis of children with MDA5-JDM who were diagnosed and followed up at our center and compared them with our anti-MDA5-negative cohort. We also compared the published literature on MDA5-DM with the juvenile cohort. Of 66 children with JDM who underwent testing for MSA, 10(15.5%) had anti-MDA5 positivity. The mean age at onset of clinical manifestations was 8.4 years; male: female ratio was 7:3. Five of nine patients who underwent screening HRCT chest had ILD; one amongst them had a fatal rapidly progressive disease. Children with MDA5-JDM had significantly more arthralgia/arthritis (p = 0.006) and ILD (p = 0.0005) compared to anti-MDA5 negative JDM in our cohort. While MDA5-DM had high rates of Raynaud's phenomenon (p = 0.04) and pulmonary involvement (p = 0.001), juvenile patients had a higher prevalence of constitutional symptoms (p = 0.01), skin manifestations (p = 0.003), arthritis (p = 0.001), and muscle weakness (p = 0.001). Arthritis and ILD are commonly seen with MDA5-JDM; however, the frequency of ILD and clinically amyopathic forms are less common compared to adult counterparts. The frequency of anti-MDA5 antibodies in a North Indian cohort of JDM is much lower (15.5%) compared to adult studies in dermatomyositis from Southeast Asia (~25%). Incidence of interstitial lung disease (ILD) and arthritis is high in anti-MDA5 autoantibody-positive JDM. Rates of a rapidly progressive form of ILD and clinically amyopathic dermatomyositis are much lower in children compared to adults with anti-MDA5-associated dermatomyositis.

Problems/Issues in Blood Transfusion Process: A Focus Group Discussion (FGD) with Nursing Personnel in a Tertiary Care Center of North India

Background Blood and blood product transfusion is an essential component of the health care system. Nursing personnel constitute a significant aspect of the transfusion process as they are the last in the chain of the transfusion process to ultimately transfuse the blood and blood products to the recipient. Nurses face many problems/issues in this process. The present study highlights the problems/issues faced by them in the transfusion of blood and blood products. Objective To explore the problems/issues faced by nursing personnel related to blood and blood products transfusion process in a tertiary care hospital in North India. Methods A qualitative design was used. Three focused group discussions were conducted with 8–10 nurses in each group working in the Emergency Neurosurgery Ward of a tertiary care hospital in North India. Tools used were the sociodemographic and job profile of nurses and a focus group discussion (FGD) guide about blood and blood products transfusion. Each FGD session lasted for 15–20 minutes and data saturation was achieved after three FGDs. Colaizzi’s procedural steps were used to analyse the data. Themes and subthemes were generated. Results and Conclusion The problems/issues identified in the FGD were related to a lack of awareness regarding awareness, transportation, storage in the ward, thawing of fresh frozen plasma, problems in a blood bag, wastage of blood in case of children, inadequate nurse patients ratio, taking consent, Judicial request, proper prescription/orders, related to transfusion responsibilities, monitoring and documentation of blood, and blood products transfusion. The above problem/issues should be addressed and overcome to promote safe transfusion. It is recommended that regular In-service education programs should be planned for nursing personnel to update guidelines awareness, and the developed transfusion monitoring sheet should be implemented, to improve documentation and reduce transfusion errors.

A Comparative Study of Pigtail Catheter and Malecots Chest Tube Thoracostomy in the Management of Empyema Thoracis at a Tertiary Care Center in North India

Background: The study aimed to compare the effectiveness of pigtail catheter vs. malecot chest tube thoracostomy in the management of empyema thoracis and pyopneumothorax. Methods : This prospective randomised interventional study was conducted in the Department of Respiratory Medicine at a tertiary care centre in north India between September 2020 and August 2021. One hundred patients, qualified as per inclusion criteria, were included in the study, and randomization was done using the random number table method. After allocation concealment and randomization, the intervention was done in the sense that Group A (51 cases) received a pigtail catheter (14F) and Group B (49 cases) received a malecot chest tube (28F) (a total of 100 cases). After the intervention, both groups were observed for 14 days. On the 14th day, the data for the primary observations (radiological clearance on day 1, day 7, day 14th, and mean duration of hospital stay) and secondary observations (postoperative pain score, post-procedure complications) were noted, and statistical analysis was done. Results: Radiological clearance in the malecot chest tube group (28F) is better on days 1 (0.55±0.13) and 7 (0.75±0.08) than in the pigtail catheter group on day 1 (0.52±0.18) and day 7 (0.72±0.11). But, radiological clearance on day 14 in the malecot chest tube group (0.91±0.06) and the pigtail catheter group (0.91±0.08) is comparatively equal (p&lt;0.05). The mean duration of hospital stay and pain scores were better in the pigtail catheter group than in the malecot chest tube group. Conclusions: Our study suggests pigtail catheters are a safe and effective method and should be considered in the management of empyema thoracis and pyopneumothorax

Profile of Elderly Substance Users-seeking Treatment: A Retrospective Analysis from a Tertiary Care Center in North India

Introduction: The substance use among the elderly is a growing enormity and an accurate understanding of the patterns of substances of the elderly is missing in the literature. Therefore, this study explored the sociodemographic and clinical profile of the elderly population-seeking treatment at a tertiary care center in North India. Methods: The present study reviewed the case notes of the elderly registered in the de-addiction center of North India. The cohort for this study consisted of all outpatients aged more than 60 years registered in the study setting from January 2017 to December 2021. The profile of the study subjects including sociodemographic and clinical data was reviewed based on the existing structured pro forma used in the department. Results: The data for a total of 508 treatment-seeking elderly aged more than 60 years were analyzed in which the mean age at the presentation was 65 ± 3.8 years. We identified that tobacco (57.5%), alcohol (52.6%), and opioids (36.2%) were the leading substances used in this setting. We noted a statistically significant association among the study subjects with alcohol, opioid, and tobacco dependence based on the presence or absence of a co-occurring medical illness. Conclusion: The present retrospective chart review identified that tobacco, alcohol, and opioids were the leading substances used among treatment-seeking elderly in this setting. Estimating the magnitude of substance use among the elderly is crucial to predict the imposed burden of the illness and ascertain the treatment and prevention strategies for controlling the magnitude of the problem.

Acquired Demyelination Syndrome in Children and Adolescents: 10 Years Experience from a Tertiary Care Centre in North India.

The childhood central nervous system (CNS) acquired demyelinating syndromes (ADS) can be monophasic or recurrent, with both having considerable overlap in the first decade of life. The objective of the study was to describe clinical and radiological features, immunological characteristics, response to therapy and difference between monophasic and first episode of recurrent disorders of pediatric-onset CNS ADS. Case records of all patients presenting with CNS ADS to the Department of Pediatrics between January 2009 to December 2018 were retrospectively reviewed. Those with complete records and at least 12 months follow up were included for analysis. Overall 95 case records were reviewed (66 monophasic: 20 ADEM and 46 CIS, 29 recurrent: 18 MS, 9 NMOSD, and 2 multiphasic ADEM). The median age of the cohort was 7 years (range: 1-12) and nearly two-thirds (62/95) were males. All acute cases were treated with intravenous pulse followed by tapering oral steroid therapy. All the recurrent entities received azathioprine with rituximab in few. Certain clinical and radiological features of CIS and immune and inflammatory characteristics in CSF were found to be significantly different in monophasic cases compared to first episode of recurrent cases. The CNS ADS show favourable response to immunotherapy. Azathioprine may be an effective long term immunomodulator, particularly in resource limited settings. Certain clinical, radiological and immunological features may differentiate monophasic illness from first episode of recurrent disorder.

Clinical spectrum of tuberculosis in adolescents (10–19 years) in a tertiary care center of North India

Background\\objectivesThere is limited literature available to characterize tuberculosis (TB) in adolescents despite them sharing a high burden of the disease. Ours is the first prospective study in India and worldwide to study the clinical profile of tuberculosis in adolescents aged 10–19 years.Methods: We enrolled 82 children and adolescents between March 2021 to March 2022. The diagnosis of TB was made on the basis of National Tuberculosis Elimination Program (NTEP) guidelines 2020. Adolescents were divided into 3 age groups: early (10–13 years), middle (14–17 years), and late adolescents (18–19 years)and the results were compared among the three groups. A two-sided p value of <0.05 was considered statistically significant.Results: The middle age adolescents comprised majority of our study population and females were more than males. The common presenting features were fever, chest pain, breathing difficulty with majority belonging to lower socioeconomic status. The pulmonary TB accounted for 56% and extrapulmonary constituted 44% of the cases. The notable extrapulmonary cases were disseminated TB with secondary lymphangiectasia, compressive myelopathy, sacroiliac joint arthropathy among others. Infiltrates/consolidation were the most frequent radiological findings in patients with pulmonary TB. The microbiological confirmation was available in 44% of the cases. The microbiological positivity was higher in histopathological specimens and in late adolescents. Two patients were rifampicin resistant. Conclusion: There was a varied clinical presentation of TB in this population. The extrapulmonary cases as well as the microbiological yield increased with increasing age of the cases.

Dietary behaviour, attitude and food perceptions of patients with ulcerative colitis - An observational study.

Dietary knowledge, perception and practices may have a role in determining the nutritional status of patients with inflammatory bowel disease (IBD). However, the assessment of these patterns has infrequently been done in developing countries. We aimed to evaluate patients with ulcerative colitis (UC) about their dietary beliefs, practices and changes after the diagnosis. We conducted a cross-sectional survey among patients with UC at a tertiary care centre in North India. Apart from clinical details, we collected information about dietary beliefs, sources of information, dietary practices and changes after the diagnosis of UC. The information was collected using a designed and pretested survey questionnaire. We included 93 patients with a mean age of 40.6 ± 13.3 years and 49 (52.7%) were men. A majority of patients felt that diet had an important role in the causation of IBD (86%, n = 80) and triggering relapses (86%, n = 80). A total of 94.6% of patients (n = 88) felt that certain foods (especially spicy and fatty food and milk) items increased the symptoms of IBD. Patients felt that some food items (yogurt and buttermilk) improved the symptoms. A total of 96.8% of patients (n = 90) changed their diet in some form (commonly, restriction of milk products and outside food), 64% of patients (n = 60) deprived themselves of their favourite food after diagnosis, 80.6% of patients (n = 75) felt a need for additional dietary advice. Regular milk intake was seen more often by patients in remission than those with active disease in IBD (36/47 (76.6%) vs 7/15(46.6%), p = 0.03). Most patients believe that diet has an important role in the causation, relapses and treatment of UC. Patients also felt the need for more information regarding diet in IBD.

Early organism identification by Matrix Assisted Laser Desorption Ionization Time of Flight Mass Spectrometry (MALDI-TOF-MS) decreases the time to appropriate antibiotic modifications for common bacterial infections.

MALDI-TOF-MS facilitates the identification of microorganisms from positive cultures in a timely and accurate manner. It eliminates the necessity for the application of biochemicals and operates on the principle of proteomics. It decreases the time required to report culture results. Prompt detection and notification of the pathogen, prior to the disclosure of antimicrobial susceptibilities, could potentially shorten the duration until the initial antibiotic adjustment is necessary, thereby influencing patients' clinical prognoses. Fifty patients in the conventional arm and one hundred patients in the interventional arm were compared in a pre and post quasi-experimental study conducted at a tertiary care centre in North India. Patients with positive cultures from medical wards and intensive care units were included. Comparing the time to first antibiotic modification after culture positivity, MALDI-TOF-MS-based identification, and clinical outcomes in both arms was the primary objective. Antibiotic modifications, escalation, and de-escalation were all recorded. The intervention arm exhibited a substantially shorter median time to first antibiotic modification (2010 mins vs 2905 mins, p=0.002) than the conventional arm. In the interventional group, a total of 44 out of 100 antibiotic modifications were implemented. Of these, 19 (43.3%) were determined solely by the MALDI report, without the anticipation of susceptibility assessments. De-escalation of antibiotics constituted the pre-dominant form of modification (47.4%). The difference between the 27% and 32% mortality rates in the intervention arm and the conventional arm was not statistically significant (p=0.52). MALDI-TOF-MS facilitates the modification of antibiotics early on. The primary benefit lies in the reduction of superfluous antibiotic usage. Early organism identification and reporting prior to the availability of susceptibility results did not result in any mortality benefit. This strategy, when combined with a strong antimicrobial stewardship programme, can aid in the reduction of antibiotic use.

Understanding parental hurdles in accessing strabismus treatment

PurposeTo explore the parental factors that impede early intervention for strabismus and thus identify strategies for improving access to specialized care. MethodsThis hospital-based cross-sectional study included 110 parents of children under 19 years with strabismus receiving treatment at the squint clinic of a tertiary health care center in north India. A pre-validated survey questionnaire was administered to the participants, that had a section about the socio-demographics of the participants, another section addressed the parental knowledge about strabismus about diagnosis, and the need for an eye examination. It also sought information about referral source, the felt need for squint examination, and reasons for not seeking treatment. ResultsA total of 110 parents/guardians of strabismus patients (59 exotropes and 51 esotropes) were interviewed using a survey questionnaire. Parents themselves identified 80% of cases, and a substantial link (P ​< ​0.0001) was found between the education status of parents and the age of identification of strabismus. Fear of surgical outcomes (41.79%) was a significant barrier to timely surgery with a higher percentage of parents expressing fear of surgical outcomes (P ​= ​0.025). The cost of surgery (34.33%) and the non-availability of facilities (23.88%) also delayed the intervention. ConclusionsIt is essential to educate parents about the importance of strabismus therapy at an appropriate time, stressing its reconstructive rather than merely cosmetic nature, as there are notable gaps in their knowledge. Also, we need to do away with the fear of surgical outcomes of surgical interventions for strabismus.

Cost-effectiveness of treating childhood acute myeloid leukemia at a tertiary care center in North India.

Childhood cancers are a significant global health concern, particularly in low- and middle-income countries (LMICs), where over 80% of childhood cancer patients reside. In India, acute myeloid leukemia (AML) constitutes a significant portion of childhood cancers; however, the data on the cost-effectiveness of childhood AML treatment in India and other LMICs remain limited. The study focused on children (<15years of age) diagnosed with AML at a tertiary care cancer center in North India. Data, including treatment outcome, treatment-related morbidity, mortality, and costs were retrospectively collected from the electronic medical record and hospital database. Cost-effectiveness was assessed using disability-adjusted life years (DALY) averted in relation to the country-specific cost-effectiveness threshold. Among 59 AML patients, treatment-related high mortality rates, abandonment, and limited access to bone marrow transplantation were notable challenges. Intensive chemotherapy resulted in substantial sepsis-related complications, with treatment-related mortality reaching 30%. The 3-year event-free survival and overall survival of the 43 patients who received intensive therapy were 24.5%±7.6% and 27.9%±8.3%, respectively. Despite these challenges, treating childhood AML was still found to be cost-effective. The total cost per newly diagnosed patient treated with curative intent was $4454. Cost per DALY averted accounted for 24% of the gross domestic product (GDP) per capita, rendering the treatment to be cost-effective with a stringent cost-effectiveness threshold utilized. The study underscores the challenges faced while treating childhood AML in LMICs, including treatment-induced high sepsis-related mortality and abandonment. Despite these challenges, it remains cost-effective to treat childhood AML in India. Future efforts should focus on reducing treatment-related morbidity and mortality to further improve outcomes and cost-effectiveness.

Progressive Familial Intrahepatic Cholestasis “Case Series from a Tertiary Care Centre in North India

Progressive Familial Intrahepatic Cholestasis “Case Series from a Tertiary Care Centre in North India

Prevalence of hepatopulmonary synome in chilen with portal hypertension: experience from a tertiary care centre in North India

Prevalence of hepatopulmonary synome in chilen with portal hypertension: experience from a tertiary care centre in North India

Evaluation of Schneiderian First-rank Symptoms in Patients of Psychosis Attending a Tertiary Care Center from North India

Abstract Background: The Schneiderian first-rank symptoms (SFRS) have played an extremely important role in the diagnostic systems in psychiatry. However, all studies do not seem to support Schneider’s claim that FRS confer a clear indication of schizophrenia when no organic syndrome is present. Objectives: The objectives of this study were as follows: (1) to examine the presence of SFRS in untreated cases of psychosis, (2) to see the degree of improvement in SFRS with treatment over 12 weeks of short-term follow-up, (3) to see correlation of SFRS with sociodemographic and clinical parameters in our patients, and (4) to see the correlation of SFRS among diagnostic subgroups in our patients. Materials and Methods: Setting: Psychiatry department of a multi specialty tertiary care center in North India. Study Design: This was a short-term prospective study. After taking ethical clearance from the institutional ethics committee and written informed consent from all the patients, data sets were prepared for 60 patients of untreated psychosis. Data analysis was done using the SPSS version 20.0. Results: Voices discussing (83.33%) and voices commenting (80%) were the most commonly noted SFRS, and the mean number of SFRS in our sample was 3.34. Somatic passivity (f = 10.80, P = 0.0001) and thought insertion (f = 6.75 and P = 0.004) could significantly differentiate between schizophrenia and other diagnostic subgroups of untreated psychosis in our study. Conclusions: Only somatic passivity, delusional perception, and thought insertion were extremely specific in distinguishing the patients of schizophrenia from nonschizophrenic patients.

Treatment Delay in Cancer Patients Attending a Tertiary Care Centre of North India: A Cross - Sectional Study

Treatment Delay in Cancer Patients Attending a Tertiary Care Centre of North India: A Cross - Sectional Study