Care Center In Northern India Research Articles

Comparison of In-vitro Activity of Cefixime to Doxycycline and Minocycline Against Gram-Negative Bacteria Isolated from Patients Suffering from Respiratory Tract Infections at a Tertiary Care Centre in Northern India

Background: Respiratory tract infections (RTI) form a major part of common ailments encountered by a general physicians hailing from a developing country. Antibiotics are used for treating any infection but inappropriate use of antibiotics lead to development of multidrug resistance (MDR). This study was performed to analyze the comparative in-vitro activity of Cefixime and Tetracyclines by antibiotic susceptibility testing (AST) against the pathogens isolated from respiratory samples.
 Materials and Methods: We performed a prospective study in the Bacteriology section of the Department of Microbiology at a teaching hospital in Northern India from Jan 2022 to June 2022. Cefixime, Doxycycline, and Minocycline were tested for susceptibility against 100 Gram-negative bacteria from respiratory samples. The antibiotic susceptibility testing for each of the isolates was performed by the Kirby Bauer Disc Diffusion method, according to the CLSI, 2019 guidelines.
 Results: Our study cohort included 100 Gram negative isolates with a majority of them obtained from Endotracheal aspirate samples (43, 43%) followed by Sputum (37, 37%) samples. The most common microorganism tested for susceptibility to this drug was Klebsiella pneumoniae (39, 39%) followed by Escherichia coli (33, 33%). Escherichia coli was identified as the most isolated to all the antibiotics and was 12.12% (4/33, 12.12%) susceptible to all three drugs. On overall analysis activity of Doxycycline was better than Cefixime among inducible Enterobacteriaceae and non-fermenter isolate. 
 Conclusion: Doxycycline is a proficient antimicrobial agent for treating an array of Gram-negative bacteria-associated infections showing better in-vitro activity in comparison to Minocycline and other bactericidal agents like Cefixime.

A Case of Hookworm Infection in a Child Causing Severe Anemia Diagnosed by Endoscopy: A Neglected Tropical Disease

Hookworm (Necator americanus, Ancylostoma duodenale) infection are common in tropical and subtropical countries. These are still an neglected tropical disease in rural areas,leading to severe iron deficiency anemia and even mortality. Here we present a case from a tertiary care center in northern India of a 3 year old child with progressive complaint of pallor and generalised body swelling. On upper gastrointestinal gastroscopy hookworms were visualised and recovered. Patients stool sample was sent to lab in which egg of hookworm was also seen on microscopy. The child was treated with albendazole and anemia was also cured

Profile of Childhood Glaucoma Attending a Tertiary Eye Care Center in Northern India.

To ascertain the prevalence and clinical features of the various types of childhood glaucoma at a tertiary eye care hospital in Northern India. Retrospective chart review of all children less than 16 years of age with childhood glaucoma who presented from 1st April 2014 to 31st March 2019, who was diagnosed to have any subtype of childhood glaucoma as per Childhood Glaucoma Research Network (CGRN) classification and advised appropriate management. Out of 405 children with childhood glaucoma, 36% had primary glaucoma, whereas the rest had secondary glaucoma. Primary congenital glaucoma (PCG) was the most common form of primary glaucoma. Glaucoma associated with acquired conditions was the most common cause of secondary glaucoma. Primary glaucoma was mostly bilateral in contrast to secondary glaucoma. The most common age of presentation with primary glaucoma was <1 year of age, and in children with secondary glaucoma was 11-16 years. On presentation, 80% of eyes had intraocular pressure (IOP) of >20 mm Hg and 70% had cupping of >0.7. Eyes with PCG were primarily managed surgically. In our cohort, PCG was the most common primary childhood glaucoma. Traumatic glaucoma was the most common secondary glaucoma. Since childhood glaucoma is an important cause of visual morbidity in children, its timely diagnosis and prompt management are essential to prevent irreversible visual loss. Understanding the disease pattern, their presenting features, and the proportion of different types of childhood glaucoma can help in planning appropriate eye care services, create awareness and better allocate resources to plan appropriate management strategies. Screening programs and counseling of parents should also be strengthened. Dubey S, Jain K, Pegu J, et al. Profile of Childhood Glaucoma Attending a Tertiary Eye Care Center in Northern India. J Curr Glaucoma Pract 2023;17(2):68-74.

Clinicopathological Parameters of Haemophilia Patients at a Tertiary Care Centre in Northern India.

Haemophilia affects a large number of people all over the world, yet very little is known about the clinical manifestations and diagnostic protocols of the condition in areas with limited access to resources in developing countries. Understanding the clinical spectrum and diagnostic approach will help with the design of measures to address the situation in these places. The primary objective of this study was to examine the clinicopathological parameters of haemophiliacpatients. From the departmental archive, a thorough history of each patient was retrieved, including values of bleeding time, prothrombin time, activated partial prothrombin time, and percentage of specific factor activity. Out of a total of 385 cases over the period of six years, 86.75% were classified as haemophilia Aand 13.25% of cases were diagnosed as haemophilia B. In terms of the severity of the disease, 44.93% were classified as severe, 42.08% as moderate, and 12.99% as mild. Joint bleeding was the first and most typical clinical manifestation of the disease, accounting for 34.80% of cases, followed by ecchymosis (23.12%), post-traumatic bleeding (12.73%), epistaxis (12.20%), and gum bleeding (8.05%). 1.56% of patients had a positive screening test for the hepatitis C virus, followed by 1.30% for HIV and 0.78% for hepatitis B surface antigen. In the presence of joint bleeding, ecchymosis, and post-traumatic bleeding in an otherwise healthy individual, a clinician should be alerted to the possibility that the patient has haemophilia and should request a work-up for the bleeding disorder.

Profile of Amoebic vs Pyogenic Liver Abscess and Comparison of Demographical, Clinical, and Laboratory Profiles of these Patients From a Tertiary Care Center in Northern India

Amoebic liver abscess (ALA) and pyogenic liver abscesses (PLA) are the most common causes of liver abscess in developing and developed countries, respectively. Although incidence of liver abscess is low, but mortality is high amongst the patients due to delayed diagnosis. The study was done to find out the prevalence of amoebic and PLA among patients of liver abscess. The clinical, personal, and demographical details were also evaluated to find out the risk factor(s) associated with ALA and PLA, respectively. A retrospective study was conducted to find the prevalence of amoebic and PLA. Clinical, demographic, personal details were evaluated from hospital records. Laboratory parameters such as total leucocyte count, platelets, bilirubin, ESR (Erythrocyte Sedimentation Rate), hemoglobin, glycosylated hemoglobin (HbA1c), alkaline phosphate (ALP), Aspartate aminotransferase (SGOT/AST), Alanine aminotransferase (SGPT/ALT), serum albumin, bilirubin levels, and procalcitonin were recorded. The Ultrasonography (USG) findings regarding the size, location, volume, and number of abscesses were also analyzed. Total of 107 patients of liver abscess were evaluated, and 61.6% of patients were of amoebic etiology, and 25.3% were of pyogenic etiology. Males of 20-60 years of age were predominantly affected with right upper quadrant pain and fever as the most common presentations. ALA patients were found to have solitary abscess in the right lobe involving 6th and 7th segments, with decreased hemoglobin, hyperbilirubinemia, elevated ALP and SGOT, with normal SGPT, and addiction to alcohol. PLA patients had increased HbA1c, increased PCT values, low serum albumin levels, and low platelet-to-white blood cellvalues. The most common bacteria causing PLA was Escherichia coli (n= 8) followed by Enterobacter cloacae (n= 5). Mortality was seen in 6 patients. Liver abscess is found to have relatively high mortality and morbidity. Therefore, early diagnosis is the only method to prevent mortality and morbidity in these patients. Since the presentation is very nonspecific, evaluation of certain risk factors and laboratory parameters can aid in the diagnosis.

Correlation of endometrial thickness using transvaginal sonography with histopathology in women with abnormal uterine bleeding: A cross-sectional study

Background: Abnormal uterine bleeding (AUB) is one of the most common complaints seen in gynecological practice, and transvaginal sonography (TVS) remains the first-line, non-invasive diagnostic tool in these women. Aims and Objectives: The aim was to study the endometrial thickness (ET) using TVS and correlate it with histopathological findings obtained through endometrial biopsy in patients with AUB. Materials and Methods: This was a prospective observational study conducted in a tertiary care center in Northern India, from January 2018 to June 2019. One hundred and sixty women in the reproductive age group presenting AUB were recruited. TVS was done to note (ET) and its echotexture with additional findings such as uterine, adnexal, or other pelvic pathology. The patient underwent endometrial aspiration using Karman Cannula, and its findings were correlated with TVS. Results: In our study, a majority of patients (40%, n=64) presenting with AUB belonged to the age group of 41–45 years, with fibroid being the most common cause (39.3%, n=63). Thickened ET (&gt;12 mm) was noted in 44 (27.5%) patients and 4 had an endometrial polyp. The mean ET was 11.48±5.11 mm (range: 4–35 mm). The most common normal histopathology noted was secretory endometrium (29.37%, n=47), followed by proliferative endometrium (20.6%, n=33). The abnormal changes included disordered proliferative endometrium (23.1% n=37) and simple endometrial hyperplasia (6.8%, n=11). Four cases were found to have endometrial adenocarcinoma. On correlating TVS with histopathology, it was noted that out of 8 patients with ET of &gt;20 mm, 3 patients had endometrial carcinoma, 2 had disordered proliferative endometrium, and 1 each had pill endometrium, normal secretory, and atypical hyperplasia. Conclusion: TVS provides crucial information on echo-morphological features of the uterine cavity, and increasing ET mandates histopathological confirmation for ruling malignancy.

Are Buffy-coat Pooled Platelet Concentrates an Effective Alternative to Apheresis Platelet Concentrates? An In vitro Analysis at a Tertiary Care Center in Northern India.

There is a need for platelet products to have the best quality. Apheresis platelet concentrates (PCs) obtained from single-donors PCs (SD-PCs) are considered best but have issues such as feasibility and cost. Buffy-coat pooled PCs (BCP-PCs) are considered an alternative to SD-PCs. This study compares BCP-PCs and SD-PCs for in vitro quality parameters and their changes during storage. Fifteen units of BCP-PCs and 15 units of SD-PCs were prepared. In this study, a pool of five buffy coats was prepared. Fifteen units of BCP-PCs were analyzed on day 1 and day 5 of storage, while 15 SD-PCs were analyzed on day 1 while ten units on day 5. The parameters analyzed were volume, hematological parameters, pH, swirling, and sterility. The mean platelets count of SD-PCs was found to be significantly higher as compared to BCP-PCs. White blood cells (WBCs) contamination was significantly lower in BCP-PCs as compared to SD-PCs. The mean pH and mean platelet volume of SD-PCs were significantly lower than BCP-PCs. During storage, the mean platelets count of BCP-PCs was decreased significantly while that of SD-PCs nonsignificantly. The mean WBCs count and pH decreased in both BCP-PCs and SD-PCs significantly. All units in both types of PCs were sterile. Platelet yield was significantly better in SD-PCs, while mean WBCs contamination was significantly lower in BCP-PCs. BCP-PCs may be preferred in place of SD-PCs in case of nonavailability of apheresis, difficulty in finding a willing donor, or when the cost is of consideration.

Comparison of efficacy and safety of sutureless glue-free versus suture technique for autogenous conjunctivolimbal grafting in primary pterygium excision

To compare the efficacy and safety of sutureless glue-free versus suture technique for autogenous conjunctivolimbal grafting in primary pterygium excision. A prospective observational study was conducted in thirty consecutive patients of primary progressive pterygium after taking their informed written consent and ethical clearance in a tertiary eye care centre of Northern India. Patients were randomly divided equally into group “A” and “B” each constituting fifteen patients. Group A patients underwent suture technique and group “B” patients underwent sutureless technique for conjunctivolimbal graft placement. Comparison of both groups was done in terms of intraoperative time, postoperative symptoms and recurrence over a period of one year. Data was compiled and entered into Microsoft Excel software and SPSS version 21.0 was used for data analysis.The mean duration of surgery was 42 min and 30 min in group A and B respectively and this difference was found to be statistically significant (p=0.0001). On 1 postoperative day, pain and foreign‐body sensation was present in 12 patients in group A, while only 1 patient of group B had these symptoms and this difference was statistically significant (p = 0.00014). Postoperative hyperaemia was seen in 8 patients of group A and 6 patients of group B which was statistically insignificant (p = 0.564). Only two patients in group A had conjunctival chemosis while no patients in group B developed chemosis, and the difference was statistically insignificant (p = 0.964). Subconjunctival haemorrhage was seen in 2 patients of Group A and 1 patient of Group B which resolved over a period of 2-3 weeks. Conjunctivolimbal graft was found to be more stable in group A while it was misplaced in 1 patient of group B and the difference was statistically insignificant (p = 1.000). Only 1 patient of group A developed suture related complication i.e suture granuloma. Over a period of 1 year follow up, only 1 patient of group A had recurrence of pterygium.Sutureless glue-free technique is a time saving, cost effective and better surgical modality in comparison to conventional suture technique for autogenous conjunctivolimbal grafting in primary pterygium resection.

A Comparative Study to Assess the Safety and Efficacy between Intravenous Iron Sucrose and Ferric Carboxymaltose in the Treatment of Iron Deficiency Anemia in Pregnancy – A Single Center Prospective Observational Study from a Tertiary Care Center.

Abstract Objective: To Compare the safety and efficacy between intravenous iron sucrose and ferric carboxy maltose in the treatment of iron deficiency anemia in pregnancy. Methodology: A Prospective study was conducted on 100 antenatal women with iron deficiency anemia in department of Obstetrics and Gynecology of a tertiary care center in northern India from June 2021 to May 2022. Results: The mean age in group A (Iron Sucrose group) was 25+ 2.83 years and in group B (FCM group) was 24.08+4.45 years. In group A (IS group) the average increase in Hb level was about 1.24 ± 0.29 gm/dl at 3 weeks and 2.62 ± 0.2 gm/dl at 6 weeks. In group B (FCM group) the average increase was about 1.74 ± 0.42 gm/dl at 3 weeks and 4.15 ± 1.94 gm/dl at 6 weeks. In IS group the average increase in ferritin was about 18.83 ± 18.18 ng/dl at 3 weeks and 43.54 ± 31.71 ng/dl at 6 weeks. In FCM group the average increase was about 34 ± 19.83 ng/dl at 3 weeks and 96.62 ± 50.7 ng/dl at 6 weeks. P value at both time periods was 0.0001, which is highly significant. 43 patients (86%) in Group B as compared to 19 patients (38%) in group A showed improvement in anaemia in PBS findings over 3 week and 6 week period, which was statistically significant with a P value of 0.024. In Group A (IS group ) only two patients complained of diarrhoea, two complained of headache, 1 patient complained of nausea ,vomiting, one complained of nausea only, In Group B (FCM group) total 3 patients (6%) complained of minor reactions like nausea, vomiting and itching. There were mild side effects only in both the groups. Conclusion: Intravenous FCM is more efficient and better alternative than iron sucrose in the treatment of iron deficiency anaemia in pregnancy. Key Words: IDA, FCM, IS, Ferritin, Haemoglobin.

Epidemiological and endoscopic profile of patients with upper gastrointestinal bleeding at a tertiary care center in Northern India : A retrospective analysis of twenty years

Background: Upper gastrointestinal (UGI) bleed is a common emergency presenting to emergency departments all over the world. Since the spectrum of UGI bleeding varies from region to region, it is important to know the profile of UGI bleed for proper management approach. Here, we present the endoscopic profile of UGI bleed presenting to a tertiary care setting in Northern India. Aims and Objectives: This study aimed to determine the epidemiological and endoscopic profile of patients with UGI over twenty years. Materials and Methods: The retrospective and observational study included adults patients (above 18 years of age) of either gender, who presented with UGI bleed at our center over a twenty year period from January 1999 to December 2018. Results: A total of 13418 patients with UGI bleed had esophagogastroduodenoscopy (EGD) done on them during this period. Six thousand one hundred and thirty-two patients (45.7%) were females while 7285 were males (54.3%). Mean age was 46±16 years. The common endoscopic findings were pepticulcer disease in 7508 (48.25%) patients followed by erosive gastritis in 2305 (14.81%), UGI tract malignancy in 1152 (7.8%). Variceal bleed was seen in 900 (5.77%) patients. Conclusion: Peptic ulcer related bleed is the most common cause of UGI bleed in our center. Portal hypertension is relatively less frequent a cause of UGI bleed in our place.

An Uncommon Presentation of Common Disease at Tertiary Care Centre of Northern India

Snake bite is often met emergency in Indian subcontinent especially in rural settings. We sent a case of a 26-year-old male, residing in North India who sented with complaints of swelling over left leg along with breathlessness. His renal functions deteriorated gradually. In view of various physical and laboratory findings, a diagnosis of vasculotoxic snake bite envenomation with acute kidney injury and pulmonary oedema was made. He was managed conservatively with IV fluids, parenteral antibiotics and haemodialysis. Acute kidney injury is an important complication in vasculotoxic snake bites and should be addressed early.

Study of Demographics, Clinical Profile and Risk Factors of Inguinal Hernia: A Public Health Problem in Elderly Males.

Inguinal hernia repair is the most commonly performed elective surgery in Indiadraining significant healthcare resources. This observational study was conducted at a tertiary-level institute in northern India to look into the demographics, clinical profile and risk factors of inguinal hernia. This study was conducted as an observational study at the tertiary care centre of northern India, including 110 patients who had come to the surgical outpatient department for inguinal hernia repair. After obtaining informed consent from all the participants, demographic details, history and clinical examination were recorded. This was a prospective, single-centre, non-randomized, observational study. In our study, 43 patients (39%) were >50 years of age. One hundred and sevenpatients (97.27%) were males, and three (2.72%) were females. Male: Female ratio was 32:1.The preponderance of males was due to their involvement in more strenuous exercises and lifting weights and the anatomical differences between them. The main risk factor in the present study was lifting heavy weights 55%, followed by altered bowel habits 36.36% and respiratory disease (chronic obstructive airway disease). Smoking and diabetes were also associated as risk factors for the hernia. In this study, the most common side of hernia was on the right side, 63%, on the left, 33% and bilateral in 4% of patients. The indirect hernia was the most common type. Inguinal hernia is a surgical problem found commonly in the male elderly. Right-sided inguinal hernia is common, with the indirect type being more frequent. Heavy weight lifting and strenuous exercises were commonly found risk factors.

Predictors of Mortality Among Post-COVID-19 Discharged Patients in Northern India: A Case-Control Study.

Introduction The post-discharge all-cause mortality of COVID-19 disease is known, but predictors for the same have not been studied as much. The objective of this study was to develop an understanding of predictors of mortality to guide in prioritizing patient care and preventive approaches. Methods This current research is a single-center unmatched case-control study conducted at a tertiary care center in northern India, between April and September 2022. The data were extracted retrospectively from the hospital's electronic medical records of patients with the assistance of trained physicians using a standardized data extraction sheet. Results A total of 184 patients were enrolled and were segregated into two groups, cases and control, with 92 in each. The mean age of patients was 49.3 ± 17.53 years. The mortality group had a higher mean age (53.24 ± 18.53 yrs) as compared to the control group (45.37 ± 15.58 yrs, p=0.002). Bivariate analysis revealed a significant difference in the two groups with respect to O2 saturation at the time of admission (case - 91.12 ± 12.49 %, control - 95.46 ± 5.01 %, p=0.003); maximum O2 flow rate (L/min) (case - 11.01 ± 22.2, control - 6.41 ± 13.31, p=0.04); ICU need (p=0.005), cancer (p=0.001), O2 requirement at discharge (p=0.001) and acute kidney injury (AKI; p=0.007). On multiple regression analysis, cancer (adjusted odds ratio (aOR) - 2.469; 95% CI1.183-5.150, p=0.016), ICU admission (aOR - 2.446; 95% CI1.212-4.938, p=0.013), oxygen at discharge (aOR - 2.340; 95% CI0.971-5.640, p=0.0586) and AKI (aOR - 5.6; 95% CI2.351- 13.370, p=0.00) only found to be significant. Conclusion Among the patients released from the hospital post-COVID-19 treatment, the following aspects oxygen requirement (2.3 times), malignancy (2.4 times), ICU admission (2.4 times), and AKI (5.6 times) are risk factors of mortality. The presence of these variables would warrant a close follow-up for these patients in order to decrease post-COVID mortality.

Reinfection of COVID-19 among doctors at a tertiary care centre in Northern India: A report from a resource-limited setting.

There is an increasing recognition of reinfection in coronavirus disease 2019 (COVID-19). We studied the reinfection of COVID-19 disease among doctors at a tertiary care centre in Northern India. All COVID-19 patients readmitted for COVID-19 disease after any duration with at least a positive Real time- polymerase chain reaction (RT-PCR) for severe acute respiratory syndrome coronavirus 2 were included. Their clinical profile, vaccination status, outcome and Centre for disease control (CDC), Atlanta, USA reinfection criteria screening were recorded. A total of 57 (0.53%) doctors were identified and 56 of them satisfied the CDC criteria. It included 13 (20.3%) females and 89.3% of cases were from clinical specialities; 98.2% of individuals had the first infection in 2020 and mean duration between 2 infections was 156.29 ± 76.02 (35-298) days. Duration between two episodes of the disease with more than 90 days apart was in 80.3% cases. One (1.8%) patient developed severe disease and two (3.6%) cases were of moderate severity. Symptoms were similar in both infections except significantly higher number of extra-respiratory complaints (2.2% vs. 9.1%). There were 37.5% cases who had received first dose of vaccination of any duration at the time of second infection. Nine (16.1%) and four (7.1%) patients with more than 4 weeks after the first and second dose of vaccination developed the second infection, respectively. Majority of reinfection were symptomatic and developed after 90 days and so majority followed CDC criteria. Breakthrough infections among vaccinated healthcare worker are real, and with sustained exposure to the virus, they should continue to use precaution including hand hygiene and mask in order to prevent reinfection.

Leukemia-associated aberrant immunophenotype: A flow cytometry-based experience of 110 cases from a tertiary care center in Northern India.

Leukemic cells express a characteristic set of "cluster of differentiation" (CD) markers, which forms the basis of the current WHO classification. Leukemia-associated aberrant immunophenotype (LAIP) refers to expression of unusual CD markers by leukemic cells, which are not normally expressed by their respective lineage. The incidence of LAIP varies considerably, and its clinical implications, prognostic relevance, and sensitivity to therapy are still debatable. This study was conducted to identify the immunophenotypic aberrancies in newly diagnosed leukemias in our Institute. This was an observational study, which included newly diagnosed leukemias on flow cytometry. Aberrant immunophenotypic expressions were recorded whenever present and were correlated with prognostic factors like age, gender, and total leucocyte count (TLC). The study included 110 newly diagnosed cases of leukemias (85 acute and 25 chronic) over 1.5 years. Immunophenotypic aberrancies were detected in 40.4% of the cases. The highest incidence of aberrations was detected in acute myeloid leukemia (60.7%). LAIPs were detected in 50% of T-acute lymphoblastic leukemia and 25% cases of in B-cell acute lymphoblastic leukemia (B-ALL). Aberrant CD33 and CD56 expression in B-ALL correlated with poor prognostic factors like higher age and higher TLC, respectively. Immunophenotypic aberrancies were present in 28% cases of chronic lymphocytic leukemia. The results of this study have generated valuable baseline data on the incidence of LAIPs in this region. This information is vital because establishing LAIPs at the time of diagnosis is crucial for disease monitoring. Some LAIPs are associated with underlying cytogenetic abnormalities and hence impact the management and prognosis.

Relationship Between Vitamin D Deficiency and Non-alcoholic Fatty Liver Disease: A Cross-Sectional Study From a Tertiary Care Center in Northern India.

Background Vitamin D levels are strongly associated with myocardial infarction, coronary artery disease, heart dysfunction, and even mortality. Non-alcoholic fatty liver disease (NAFLD) is a prevalent hepatic illness whose incidence has grown dramatically over the past several decades. Methodology This observational, cross-sectional study was conducted over 1.5 years (January 2019 to June 2020) at the Department of General Medicine of a tertiary care hospital in northern India on 100 adult patients with NAFLD admitted to the emergency ward, intensive care unit, and medical ward. Results In our study, of the 100 patients, 45.0%, 16.0%, and 39.0% of patients exhibited vitamin D deficiency, insufficiency, and sufficiency, respectively. Vitamin D deficiency was the highest among those aged 41-50 (54.2%) and lowest among those aged 30-40 (29.0%). We observed that vitamin D deficiency was less prevalent in people with a normal body mass index (39.1%) than in those who were overweight (91.7%). There was a significant (p < 0.05) association between the severity of vitamin D deficiency and the presence of hepatomegaly, splenomegaly, and ascites. Overall, the incidence of fatty liver was 49% among patients. There was a significant (p = 0.0001) correlation between fatty liver and serum vitamin D levels. The association between the proportion of patients with fatty liver and the degree of vitamin D deficiency was found to be significant (p = 0.04). The relationship between the distribution of patients according to insulin resistance and the degree of vitamin D deficiency was also statistically significant (p < 0.001). Conclusions Vitamin D deficiency is associated with an increased risk of NAFLD, as well as with the severity of NAFLD.

Prevalence of intestinal parasitic infections and attributable factors among patients presenting with gastro-intestinal symptoms at a tertiary care center in Northern India: a prospective cohort study

Prevalence of intestinal parasitic infections and attributable factors among patients presenting with gastro-intestinal symptoms at a tertiary care center in Northern India: a prospective cohort study

Anatomical Variation in Quadriceps Angle With Regard to Different Anthropometric Parameters in a Tertiary Care Center in Northern India: A Descriptive Study.

The quadriceps angle, commonly known as the Q-angle, is the angle formed between the vectors of the pull of the quadriceps muscle and the patellar tendon. The literature varies in terms of the values of Q angles measured by various researchers. It is well appreciated that the normal Q-angle should fall between 12° and 20°, with males being at the lower end of this range and females having higher measurements. An increase in Q-angle beyond the normal range has been associated with knee extensor dysfunction leading to patellar instability. Keeping in mind the clinical and biomechanical importance of the Q-angle, the aim of this study was to compare and establish the range of the Q-angle in healthy individuals and evaluate its variations with respect to age, weight, height, gender, dominant side, and femoral bicondylar distance. These observations will be helpful for sports therapists in understanding the evaluation of Q-angle in athletes as a prognostic value for probable knee pathologies that may appear in the future. The current study was conducted at a tertiary care center, and a total of 100 healthy adults between the ages of 18 and 35 were enrolled in the study (50 males and 50 females), following which their Q-angles, bicondylar distances, and femur lengths were measured. Individuals with any lower limb injury that resulted in a ligamentous, muscular, or bony defect; any spinal or neurological injury; any diagnosed knee disorder, such as a fracture, acute or chronic knee pain, patellar dislocation, or prior orthopaedic surgery in the lower extremities, were excluded from the study. Data were analyzed using paired t-tests, independent sample t-tests, ANOVA, and Pearson correlation coefficients. The mean Q-angle in males was found to be 11.14° ± 1.9° on the right side and 10.84° ± 1.86° on the left side. In females, it was found to be 13.68° ± 1.87°on the right side and 13.61° ± 2.04°on the left side. Among males, right and left Q-angles showed significant positive correlations with height, weight, BMI, right femur length, left femur length, right bicondylar distance, and left bicondylar distance (p<0.05). The highest correlation was found between weight and BMI. Among females, the right Q-angle showed significant positive correlations with weight and BMI (p<0.05). The highest correlation was found with weight.

Management of post-COVID mucormycosis at a tertiary care center in Northern India

PurposeOur study aims to compile data on the clinical presentation, pathological and radiological findings in cases of post-COVID mucormycosis, and present the management strategy used in our center.MethodsThis is a retrospective cohort observational study based at a tertiary healthcare institution in Northern India. All COVID-positive patients presenting with clinical features of mucormycosis were included in the study. They underwent complete otorhinolaryngeal, medical, and ophthalmological examination after thorough history taking. Biochemical tests, biopsy and imaging studies were done for all the patients. The treatment strategy included a multidisciplinary team approach, that is, intravenous antifungals as well as surgical debridement of necrotic tissue via Modified Denker’s approach or open maxillectomy, and orbital exenteration, if required. Patients were followed up for six months to look for recurrence.ResultsTwenty-three patients were studied, out of which 14 were males and 9 were females. Pathological findings of 13 out of 15 patients, who underwent surgical debridement revealed mucormycosis as a causative agent, received Amphotericin. Aspergillus was found in two cases which received Voriconazole. Eleven out of 20 patients who were treated in our hospital survived. Three patients were lost to follow up. The average hospital stay of discharged patients was 14 days.ConclusionPost-COVID mucormycosis was reported at an alarming rate after the second COVID wave in India especially after steroid therapies in diabetic patients. Thus a timely, aggressive, team approach using Modified Denkers or open maxillectomy along with proper intravenous antifungals is the key to survival in such patients.

Pulmonary Manifestations of Dengue Fever Section at a Tertiary Care Centre in Northern India: A Cross-sectional Study

Introduction: Dengue Fever (DF) is associated with systemic inflammation, clinically manifesting as involvement of different organ systems, including the pulmonary system. Pulmonary involvement is characterised by pleural effusion, pneumonia, haemoptysis, pulmonary haemorrhage, secondary bacterial infections with Acute Respiratory Distress Syndrome (ARDS), and Dengue Haemorrhagic Shock Syndrome (DHSS), which are the leading causes of mortality and morbidity. Aim: This study aims to analyse the pleuropulmonary manifestations associated with DF. Materials and Methods: This cross-sectional study was conducted at a tertiary care centre in northern India from June 2018 to November 2018. A total of 140 patients diagnosed with DF using Non-Structural protein 1 (NS1), Immunoglobulin (Ig)M, (Ig)G rapid card tests and confirmed by Enzyme-Linked Immunosorbent Assay (ELISA) were included. Patients were examined for pleuropulmonary manifestations and other systemic features. Baseline investigations, including Complete Blood Count (CBC), Haematocrit (Hct), Liver Function Test (LFT), Renal Function Test (RFT), chest X-ray (PA view), and HighResolution Computed Tomography (HRCT) of the chest when required, were performed. Data analysis was carried out by using Statistical Package for Social Sciences (SPSS) version 25.0. Results: A total of 140 patients (108 males and 32 females) aged between 18 and 35 years were included and analysed. Among them, 113 (81%) were diagnosed with uncomplicated febrile illness, 17 (12%) with Dengue Haemorrhagic Fever (DHF), and 10 (7%) as Dengue Shock Syndrome (DSS). Patients with co-morbidities, particularly respiratory system illnesses, and young patients were found to be at increased risk of morbidity. Pleuropulmonary manifestations observed in the study included pleural effusion, pneumonia, pulmonary haemorrhage, ARDS, and pneumothorax. Conclusion: DF is associated with the involvement of the pulmonary system, and its incidence is increased in cases of moderate to severe disease. Therefore, pleuropulmonary manifestations can be useful in evaluating the severity of DF cases.