Care Center In Northern India Research Articles

Severity of COVID-19 Disease in Pregnant and Nonpregnant Females of Reproductive Age Group: A Preliminary Comparative Study

Objectives: This study was conducted to compare the disease severity of COVID-19 in pregnant and nonpregnant females of reproductive age group and to evaluate the effect of COVID-19 on neonatal outcome. Materials and Methods: The present prospective observational study was conducted at a tertiary care center in northern India over a period of 6 months. Females of reproductive age group (15–44 years) that were admitted in COVID isolation ward with reverse transcription–polymerase chain reaction-positive COVID-19 disease were included in the study and followed till discharge. Results: Among the 60 females of reproductive age group, 41.67% (25) were pregnant and 58.34% (35) were nonpregnant. The median duration of hospitalization among pregnant and nonpregnant females was 9 and 8.5 days, respectively. The severity of infection among pregnant and nonpregnant females was as follows: asymptomatic + mild disease 96% (24) and 77.14% (27) and moderate + severe disease 4% (1) and 22.86% (8), respectively. There were no maternal mortalities. Forty percent (10) of pregnant females had lower segment cesarean section (LSCS) and 32% (8) had normal vaginal delivery. There were 8 preterm, 6 full-term, 3 early-term, and 1 late-term deliveries. Twelve newborns had normal birth weight, 4 were low birth weight (LBW), 1 was very LBW, and 2 intrauterine deaths IUD were reported. No case of neonatal death or neonatal asphyxia was reported. Conclusion: In comparison to nonpregnant women with COVID-19 pneumonia, the infected pregnant females had mild or no respiratory symptoms, and none developed severe respiratory compromise or required intensive care. Preterm delivery, LSCS, and LBW were common in COVID-19-infected females.

Preoperative Predictors for the Presence of Motile Spermatozoa in the Epididymis and Patency of Anastomosis during Microsurgical Vasoepididymal Anastomosis in Patients with Obstructive Azoospermia.

Following microsurgical vaso-epididymal anastomosis (VEA), anastomotic patency with sperm returning to the ejaculate is not always present and may even be delayed. The presence of motile spermatozoa is highly suggestive of future patency following surgery. We prospectively analyse the factors that could predict motile spermatozoa at the epididymis intraoperatively and predictors of patency in patients with obstructive azoospermia (OA) undergoing microsurgical VEA. Department of Urology of a tertiary care centre in Northern India. It is a prospective observational study. Over a 2-year period (July 2019 to June 2021), 26 patients with idiopathic OA were enrolled in the study. Twenty patients underwent microsurgical VEA. Patients were divided into two groups based on the presence/absence of intraoperative motile spermatozoa. Analysis of preoperative and intraoperative factors was done using the Mann-Whitney U-test, Chi-squared test and Fischer exact test. Out of 20 patients, 5 (group 2) had intraoperative motile spermatozoa in the epididymal fluid and 15 (group 1) had nonmotile spermatozoa. Low luteinising hormone (LH) levels (P = 0.01) and high testosterone levels (P = 0.05) were the predictive of presence of motile spermatozoa in epididymal fluid. Mean follow-up was 9 months (6-18 months). Predictors of higher patency were grade 2 epididymis (firm, turgid and tense) (P = 0.003), low LH levels (P = 0.03), low sertoli cell index (P = 0.006), high sperm-Sertoli index (P = 0.002) and better surgeon satisfaction (P = 0.01). Low LH levels and high testosterone levels may be predictive of the presence of motile spermatozoa in epididymal fluid. Firm, turgid and tense epididymis, low Sertoli cell index, high sperm-Sertoli index and surgeon satisfaction suggest a greater chance of success after VEA for idiopathic azoospermia.

Allogeneic stem cell transplant for myelofibrosis- A retrospective single-center study.

Allogeneic hematopoietic stem cell transplantation (HSCT) is currently the only curative treatment option for myelofibrosis (MF). Despite the benefits of long-term relapse-free survival, HSCT can be associated with substantial treatment-related morbidity and mortality. This is an observational retrospective study of 15 consecutive patients with MF who underwent allogeneic HSCT at a tertiary care center in Northern India between June 2012 and January 2020. The pre-transplant Dynamic International Prognostic Scoring System (DIPSS) and hematopoietic cell transplantation-specific co-morbidity index (HCT-CI) scores were used. The primary endpoints were overall survival (OS) and disease-free survival (DFS), and the secondary endpoints were post-transplant complications (acute and chronic graft-versus-host-disease [GvHD], graft failure [GF], and cytomegalovirus reactivation [CMV]). The OS and DFS in our study were 60% with no relapse at a median follow-up of 364 days (range 7-2,815 days). Twenty-seven percent of patients developed acute GvHD and 27% of patients developed chronic (limited) GvHD. The non-relapse mortality (NRM) was 40%, with the main cause of death being sepsis, followed by acute GvHD. MF remains a challenging condition to treat, with a poor prognosis. Our study showed that reduced toxicity conditioning provided good DFS and OS. Thus, it should be offered to patients with high DIPSS scores. Sepsis was the predominant cause of mortality in this cohort.

Use of Diffusion Tensor Imaging in Distinguishing Neoplastic and Infective Intra-Axial Brain Lesions: An Intergroup and Etiology Wise Inter Sub-Group Analysis - Experience from a Tertiary Health Care Center in Northern India

Background: Neoplastic and infective brain lesions may present as imaging mimickers. This study aims to help differentiate between etiology of lesions based on diffusion tensor imaging (quantitatively and qualitatively). Method: DTI was performed in 50 patients (12 - metastases,13 - high grade glioma,13 - tuberculoma, 12 - Neurocysticercosis). Lesional and perilesional Fractional anisotropy (FA) and mean diffusivity (MD) values were calculated. Lesional and perilesional mean FA and MD values were compared by using Student’s ‘t’-test. Result: Mean FA values in the perilesional area of neoplastic lesions were found to be significantly higher (0.17±0.12 vs. 0.08±0.02), P < 0.001) in comparison to infective lesions. Mean MD values in the perilesional area of infective lesions were found to be significantly higher (1.51±0.22 vs. 1.20±0.33x10-3mm2/sec, P < 0.001) in comparison to neoplastic lesions. Perilesional FA was found to be significantly higher and perilesional ADC to be significantly lower in High Grade Gliomas (HGG) when compared with Metastasis, Tuberculomas or Neurocysticercosis. Infective group showed significantly higher prevalence of displacement of white matter tracts (60%) and the neoplastic group showed significantly higher prevalence of the disruption (40%). Conclusion: FA and MD values from the lesion and from perilesional region are helpful in differentiating among brain lesions. Fiber tracking along with quantitative parameters is helpful in determining type of involvement of tracts, thus helping in prognostication.

Clinical and Microbiological Profile of Elizabethkingia meningoseptica Bacteraemia: A Cross-sectional Study from a Tertiary Care Centre in Northern India

Introduction: Elizabethkingia meningoseptica (E. meningoseptica) is an emerging pathogen that causes bloodstream infections, especially among immunocompromised or critically ill patients. Due to its multidrug resistance, limited antibiotic treatments are available. Therefore, correct identification with a proper susceptibility report is compulsory to reduce mortality and morbidity caused by this rare pathogen. Aim: To analyse the clinical features, underlying comorbidity, outcomes, and antibiotic resistance potential of E. meningoseptica causing bacteraemia. Materials and Methods: This cross-sectional study was conducted in Department of Microbiology, Rajshree Medical Research Institute (RMRI), Bareilly, Uttar Pradesh, India. The study spanned three years from August 2020 to July 2023. All patients with E. meningoseptica bacteraemia were identified from blood culture reports and included in the study. As it was a duration-based study, all consecutive patients identified with E. meningoseptica bacteraemia were enrolled. The total sample size was 43. Blood samples growing gram negative, non fermenting, non motile isolates that were positive for the oxidase reaction were further identified using the Vitek 2 compact system (Biomerieux, France). All relevant data regarding demographic and clinical characteristics, underlying diseases, and antibiotic treatments were collected from the hospital information system. Patient demographics were presented as mean ± standard deviation. Clinical characteristics and co-morbid conditions were presented as frequency and percentages. Results: The majority of patients were elderly males admitted to the Intensive Care Unit (ICU). The most common underlying co-morbidity was malignancy in 12 (27.9%), and pneumonia in 12 (48.8%) was the major diagnosis among these bacteraemic patients. A total of 10 (23.25%) infections were polymicrobial, with common concomitant pathogens being Pseudomonas aeruginosa and Methicillin-Resistant Staphylococcus aureus (MRSA). Co-trimoxazole, fluoroquinolones, and Piperacillin/ Tazobactam were the most effective antibiotics. Thirty-nine (90.7%) patients recovered completely, while four patients (9.3%) died of complications. Conclusion: Improper antimicrobial therapy increases resistance and mortality among patients with E. meningoseptica infections. It is imperative that clinicians remain vigilant about this rare pathogen and advise antimicrobial susceptibility testing for appropriate treatment, leading to favourable outcomes.

Study the association between spirometry based functional grading and six minute walk distance in chronic respiratory disease patients at a rural tertiary care centre of India.

Six-min walk test (6MWT) is easy to use, the least expensive, and a quick measure of physical function and it reflects the capacity to perform our day-to-day activities hence quality of life can be assessed with 6MWT. This study was planned to assess the role of 6MWT in chronic respiratory disease patients and its association with spirometry-based functional grading at a rural tertiary care center of northern India. This was a hospital-based cross-sectional study done between December 2019 and July 2021. In this study, 110 patients were included as per inclusion and exclusion criteria. 6MWT and spirometry were conducted as per the American Thoracic Society/European Research Society recommendation using Spiropalm 6MWT and the association between 6MWT and spirometry was assessed. A total of 110 chronic respiratory disease patients were included in the study. There were 69 (63%) males while 41 (37%) were females. Among study participants, chronic obstructive pulmonary disease patients were the most common 48 (43.6%) patients, followed by asthma 28 (25.5%), posttuberculosis sequelae patients 22 (20%), interstitial lung disease 9 (8.2%), and bronchiectasis 3 (2.7%) patients were found. There was a significant positive correlation of 6-min walk distance (6MWD) and % predicted 6MWD with spirometric parameters, forced expiratory volume in 1 s (FEV1), forced vital capacity (FVC) and there was a significant positive correlation of 6MWD with FEV1% (predicted) also. 6MWD and % predicted 6MWD negatively correlated with FEV1/FVC and association between 6MWD and FEV1/FVC was not statistically significant and between % predicted 6MWD and FEV1/FVC, it was found statistically significant. The 6MWD traveled by chronic respiratory disease patients was significantly lower than the predicted 6MWD and 6MWD correlated with spirometric variables well. Therefore, it can conclude that 6MWT is a useful alternative of spirometry in the management of chronic respiratory disease patients in resource-limited settings.

Shock index as a predictor of maternal outcome in postpartum hemorrhage: an experience from a tertiary care centre in Northern India

Introduction: Postpartum hemorrhage (PPH) is one of the commonest causes of maternal morbidity and mortality. Serious adverse outcomes mostly occur due to delays in the recognition and management of massive PPH. Shock index (SI) has been proposed as an early diagnostic indicator to monitor PPH women. Aims and objectives: To study SI as a predictor of maternal outcome in PPH patients. Patients and methods: This retrospective study was conducted over a duration of 1year (January 2021- December 2021) on the cohort of patients having PPH at the department of obstetrics and gynecology at a tertiary care hospital in northern India. The Age, parity, number of pregnancies, booked/unbooked pregnancy, singleton/multiple pregnancies, mode of delivery (vaginal or caesarean section), SI, blood transfusions, type and severity of PPH, type of management- medical/surgical, ICU admissions and maternal outcomes were recorded. Results: This study included a total of 105 women with PPH for analysis. 43.8% of patients had severe PPH and required massive blood transfusion > 4 units while 40% required ICU admission. 68 patients had S.I>0.9 while 46 patients had S.I>1.1. The value of S.I>1.1 correlated significantly with all studied adverse outcomes like ICU admission, massive blood loss, massive blood transfusion, and need for surgical intervention(p value<0.05). SI value of ≥1.1 had maximum sensitivity and specificity. Conclusion: The shock index seems to be an easy, practical, and effective clinical method for predicting adverse outcomes objectively in postpartum hemorrhage patients. Our study suggests a cut-off value of 1.1 for predicting adverse clinical outcomes.

Red cell alloimmunization and associated risk factors in multiply transfused thalassemia patients: A prospective cohort study conducted at a tertiary care center in Northern India.

One of the complications of chronic transfusions in thalassemia is the development of red cell alloimmunization. The aim of the study was to determine the frequency, specificity of red cell alloantibodies, and factors influencing alloimmunization in multiply transfused thalassemia patients. The study was carried out prospectively on beta-thalassemia patients over 10 months. Plasma samples were used for antibody screening and identification using the column agglutination technique. Patients' clinical, laboratory, and transfusion details were obtained from hospital information system and patient files. Continuous variables were reported as median and quartile, whereas categorical variables were provided as numbers and proportions. P < 0.05 was considered statistically significant. Out of 255 patients, 17 (6.6%) patients developed alloantibodies. Alloimmunized patients had significantly higher median ages at their first transfusions (1 year vs. 0.5 years; P = 0.042) than nonalloimmunized patients. Alloimmunized patients had significantly higher conjugated bilirubin (P = 0.016) and serum ferritin (P = 0.007). The majority of alloantibodies had specificity toward K antigen, followed by E, C, D, JKa, and JKb antigens. Alloimmunized patients received more units per year than nonalloimmunized patients (median, 30 vs. 24 units; P < 0.001). The average transfusion interval time between two successive transfusions showed a significant difference (P < 0.001). The prevalence of alloimmunization in thalassemia patients in North India is relatively low. Since most of the alloantibodies belong to Rh and Kell blood group system, extended phenotype-matched blood for Rh and Kell will be helpful in further preventing or decreasing the development of alloantibodies in multiply transfused thalassemia patients.

Assessment of Serum cholinesterase and Serum Creatinine Phosphokinase Levels in Organophosphorus Poisoning Patients at a Tertiary Care Centre of Northern India

Introduction: Poisoning with Organophosphorus compounds is an important global health problem, possibly the most common acute poisoning in developing countries. This study was done to correlate the severity of acute organophosphorus poisoning with serum cholinesterase and serum creatine phosphokinase level.Materials and Methods: A Prospective observational clinical study was done on 42 patients suspected of Organophosphorus poisoning of age &gt;15 years admitted to the emergency unit at a tertiary healthcare center in northern India. Serum cholinesterase levels and serum Creatinine phosphokinase levels were estimated at the time of admission in all patients and the severity of Organophosphorus poisoning was assessed according to Peradeniya Organophosphorous Poisoning (POP) Scale.Results: In this study, among 42 patients of acute organophosphorus poisoning 32(76.2%)were males and 10(23.8%) were females. Our study authors observed a significant correlation between the severity of poisoning categorized by the POP scale and the serum cholinesterase and Serum CPK level at the time of the patients’ initial presentation. Also found that there was a significant correlation between serum cholinesterase and serum CPK with the outcome of the patients.Conclusion: In our study severity as well as outcomes of OP poisoning was directly correlated with serum cholinesterase level and serum Creatinine phosphokinase.

Demographics and Prevalence of Risk Factors in Patients With Peripheral Arterial Disease Presenting to a Tertiary Care Center in Northern India.

Introduction Globally around 236.62 million people over 25 had the peripheral arterial occlusive disease (PAOD) in 2015, out of which 72.91 were in lower and middle-income countries. It will be a significant health problem in our country as the Indian population is aging. Our study aims to determine the demographics and prevalence risk factors in patients presenting with PAOD. Methods This prospective observational study was conducted from January 2020 to April 2021 at a tertiary care center in Northern India. A total of 275 patients with PAOD were enrolled in the study. The demographics and the prevalence of the risk factors were studied. Results Males (85.8%) were predominantly affected compared to females (14.2%). About 80.4% were smokers, of which 84.16% predominantly smoked Bidi. Around 39.3% had diabetes mellitus, 43.3% were hypertensive, and dyslipidemia was present in 17.1%. History of coronary artery disease and cerebrovascular accident was present in 22.3% and 12%, respectively. Farming was the occupation for 29.1% and 32.4% had not received formal schooling. The mean annual income was Rupees 1,56,025 (rupees 13,000 per month). Overall, the socioeconomic status was low. Conclusion The demographics and the prevalence of risk factors in patients with PAOD in Northern India differ from those in South India and the Western populations. Most of the patients were elderly males belonging to low socioeconomic status. There is a need for a central registry for vascular diseases in India to monitor the trends of the annual incidence of PAOD and to look for the prevalence of risk factors.

Prevalence of theDirect Antiglobulin Test and Its Clinical Impact on Multiply Transfused Thalassemia Patients: AProspective Study Conducted at aTertiary Care Center in Northern India.

This study was conducted to estimate prevalence of direct antiglobulin test (DAT) positivity and its impact on transfusion support in patients with thalassemia. The DAT testing was performed for patients with β-thalassemia who received transfusion from November 2021 to March 2022. Elution was done for DAT-positive samples. Of 180 patients, 21 (11.6%) were DAT positive. Immunoglobulin G (IgG) was present in 4 (19%) and IgG+C3d was present in 8 (38%). Only complement was present in 9 (42.8%) patients. The IgG-reactive DATs were associated with pan-reactive eluate. Patients who were DAT-positive had significantly higher levels of serum bilirubin, ferritin, and IgG than those who were DAT-negative. Autoantibody formation in multiply transfused thalassemia patients is common and merits equal attention as alloimmunization. It is particularly important as DAT-positive red bloodcells may undergo clinically significant hemolysis, which may increase the transfusion requirements with associated sequalae such as increased serum ferritin and splenomegaly.

Psychiatric Manifestations in the Patients of Obstructive Sleep Apnea at Tertiary Care Center of Northern India

Aim: The aim of the study is to understand the role of anxiety and depression in obstructive sleep apnea (OSA) patients. Patients and Methods: This prospective, observational study was conducted at King George's Medical University, Lucknow, Uttar Pradesh, India, from September 2011 to August 2012. Seventy-one patients were enrolled in the study after obtaining informed written consent. Polysomnography (PSG) was performed to confirm OSA, and the psychiatric features were determined using the Hospital Anxiety and Depression Scale score. Results: A total of 71 individuals were enrolled in the study, and after exclusion, 48 individuals had participated in PSG. Of the 48 patients, 44 (91.67%) had shown OSA with PSG. From 44 OSA-diagnosed patients, 10 (22.73%) patients were diagnosed of having psychiatric manifestations (50% with depression, 30% with anxiety, and 20% having features of both depression and anxiety). No significant difference was found in between those with psychiatric features than that those without in body mass index (mean ± standard deviation [SD]: 32.38 ± 7.17 and 31.64 ± 3.93, P = 0.610), Epworth's sleepiness scale score (mean ± SD: 13.20 ± 4.71 and 11.88 ± 5.63, P = 0.505), apnea/hypopnea index (mean ± SD: 48.01 ± 31.71 and 37.81 ± 22.84, P = 0.263), average saturation (mean ± SD: 92.19 ± 4.37 and 91.74 ± 4.38, P = 0.774), and lowest saturation (mean ± SD: 74.50 ± 11.97 and 74.32 ± 11.97, P = 0.968), respectively. Conclusion: Although patients with OSA must be screened for psychiatric manifestations, the severity of OSA is not directly related to the severity of psychiatric features.

Bacterial Meningitis among Intracranial Surgery Patients at a University Hospital in Northern India.

Cerebrospinal infections are the cause of poor prognosis among post-neurosurgery patients owing to delay in improvement of neurological functions, leading to increased length of hospital stay, proceeding to disability or death. This retrospective observational study was performed at a tertiary care center in Northern India, where all patients with bacterial cerebrospinal infections from July 2019 to July 2022 were evaluated for post-neurosurgery cerebrospinal shunt infections, and all demographic data and risk factors were extracted from the hospital information system (HIS). The study includes 150 (150/1986, 7.55%) culture-confirmed cases of bacterial meningitis out of 1986 cases of suspected bacterial meningitis patients. Ninety-six (96/150, 64.0%) post-neurosurgery patients with cerebrospinal fluid (CSF) leaks were managed using external ventricular drain (EVD) or ventriculoperitoneal (VP) shunt. Seventy-four (74/96, 77.08%) patients were managed only on EVD, whereas 22 (22/96, 22.92%) patients were managed only on VP shunt. Eighty-two (82/96, 85.4%) multidrug-resistant microorganisms (MDROs) were isolated and 70 (70/82, 85.36%) were gram-negative bacteria, of which 56 (56/74, 75.68%) gram-negative bacteria showed extended-spectrum beta-lactamase (ESBL)-producing character in those with an EVD, 14 (14/22, 63.63%) with a VP shunt. Among gram-negative bacteria, Acinetobacter baumannii showed high rates of resistance: 21 (21/23, 91.30%) and 8 (8/8, 100%) were ESBL-producing A. baumannii in patients managed on EVD and VP shunt, respectively. This study determines the risk factors, the spectrum of pathogenic microorganisms, multidrug resistance, and the nature of intracranial lesions isolated among the patients who developed bacterial cerebrospinal infections in post-neurosurgery patients. Kar M, Jamwal A, Dubey A, Sahu C, Patel SS. Bacterial Meningitis among Intracranial Surgery Patients at a University Hospital in Northern India. Indian J Crit Care Med 2022;26(12):1244-1252.

Prevalence of depression in female patients with hypertension attending outdoor clinic in a Secondary care centre in Northern India

Background: Hypertension is one of the most serious medical conditions affecting a huge population worldwide. Similarly, depression is also one of the major conditions affecting people nowadays especially women who are housewives. There is a direct correlation associated between Hypertension and Depression, where each can worsen the others prognosis. Aims and Objective: Prevalence of depression in female patients with hypertension attending outdoor clinic in a Secondary care centre in Northern India. Materials and Methods: In our study we included 270 patients. Consent was taken and a semi structured proforma was used for collection of socio demographic details. HAM-D scale was used to assess Depression in the patients. Statistical analysis was done of the data that was collected. Results: 68.9% of the sample population had depression, with majority of them having mild symptoms. Moreover, there was statistically significant positive correlation between the duration of hypertension and mean HAM-D score. Conclusions: There is a requirement for proper screening of depression in patients especially females with hypertension so that they can be treated properly and at the earliest.

294P Cross-sectional analysis on cancer-related distress, belief in alternative medicine among cancer patients and attendants visiting a tertiary care center in Northern India

294P Cross-sectional analysis on cancer-related distress, belief in alternative medicine among cancer patients and attendants visiting a tertiary care center in Northern India

COVID-19 Infection After Vaccination Among Healthcare Workers at a Tertiary Level Health Care Center in Northern India: A Cross-Sectional Study.

COVID-19 vaccines are now accessible to all Indian citizens. Infection with COVID-19, on the other hand, continues to spread constantly. Our study aimed to determine the number of persons who had COVID-19 infections despite receiving the recommended number of doses of the COVID-19 vaccination at AIIMS Rishikesh, a tertiary care facility in Uttarakhand, India. We analysed meticulously preserved data regarding COVID-19 vaccination, COVID-19 infection, clinical symptoms, and RT-PCR testing among all HCWs in our healthcare institution from 16 January 2021 to 30th June 2021. During this period, 5273 (90.3%) HCWs received two doses of the COVID-19 vaccine, while 566 (9.7%) received only one dose. 628 HCWs (10.8%) were BBV152 recipients and 5211 (89.2%) were AZD1222 (ChAdOx1-S) recipients. 423 HCWs (7.2%, confidence interval of 95% - 13.8, 22.0) reported COVID-19 infections. 274 (5.19% of total vaccinated HCWs) breakthrough infections and 149 non-breakthrough COVID-19 infections were reported in HCWs who had previously received a single dose of the COVID-19 vaccination. Viral infections, especially breakthrough infections, following adequate vaccination, are a cause for concern, but there is a lack of data on these infections in the actual world. Therefore, the primary focus of research should be on the emergence of illness in India following the completion of a full vaccine course.

Knowledge, Attitude and Practices Towards Oral Health in Psychiatric Patients Attending a Tertiary Care Centre in Northern India

Background: Dentists frequently treat patients who have noticeable abnormal behavior as well as patients who have psychiatric disorders that are not easily identified. The Psychiatrist usually ignore the oral health and hygiene whereas the Dentist usually ignore the psychological health of the patients. Some patients may be so disturbed that personal hygiene is neglected; leading the patients to neglect oral hygiene and the resultant accumulation of plaque is detrimental to the periodontal tissues. Methods: 237 of the 530 patients presenting to Psychiatry OPD who met the inclusion criteria patients between the age group of 18-60 years, drug-naive patients with a diagnosis of mental illness according to the International classification of diseases – 10. The patients, with co-morbid mental retardation, suffering from neurological conditions, and physical handicap, were excluded from the study sample. The patients requiring emergency treatment due to severity of their psychiatric illness were also excluded. Results: Among the wide range of psychiatric disorder, it was observed that there is a total lack oral health awareness; a slightly better awareness was observed amongst the neurotic disorders; the worst were amongst the psychotic and mood disorders. Conclusions: Poor oral health is the gateway to the overall health. The psychoeducation to the patients and the family member must include the need and awareness towards oral hygiene in addition to the other points. A consultation liaison model must be in place to address these needs of the psychiatric patients as they are hesitant and ignorant towards their oral health.

P313 A retrospective analysis of COVID-19 - associated Mucormycosis in a tertiary care center in Northern India

Poster session 2, September 22, 2022, 12:30 PM - 1:30 PM ObjectivesTo study the prevalence of COVID-19-associated mucormycosis in a tertiary center.To analyze the factors responsible for the incidence of mucormycosis and outcome of the patients in relation to COVID 19 positive status.MethodsThis is a retrospective observational study with (n = 433) samples. Nasopharyngeal and oropharyngeal swabs were collected from clinically suspected cases of mucormycosis. These were then subjected to Xpert® Xpress SARS-CoV-2 test. Those samples which tested positive were included in this study. A history sheet form was designed and filled up for 238 patients who were admitted and could be traced properly.ResultsTotal number of SARS CoV-2 positive samples was 296 out of 433 samples. Among the tested 66% (287/433) were male and 34% (146/433) were female. Relative positivity was higher among women 74% (107/144) than men 66% (189/285). Amongst 238 admitted patients, 83.1% patients (198/238) completed treatment and were discharged while 13.9% (33/238) succumbed during management. Diabetes was found to be most common risk factor at 88.65% (211/238) followed by hypertension 36.5% (87/238), and corticosteroid use 26.89% (64/238). Type 2 DM was the most frequent with 96% (203/211) and only 4% (8/211) patients having Type 1 DM. Amongst the diabetics, 74.8% (158/211) were on medication (oral hypoglycemic agent/insulin/both), and 16.6% (35/158) of them were non-compliant to treatment. Most common clinical presentation was facial swelling 66.8% (159/238) followed by facial pain 52.52% (125/238) and headache 34.45% (82/238). Microscopy findings either nasal or palatal scraping was positive in 69.75% (166/238) cases with aseptate hyphae in 95% (157/166) patients while septate hyphae were seen in 3% (5/166). Both aseptate and septate hyphae were present in 2% (4/166 patients).Amongst the deceased patients 91% (30/33) had diabetes mellitus exclusively of Type 2 and among them, 33% (10/30) were not on any anti-diabetic medication. It was also observed that among the deceased people who were on anti-diabetic medication, 45% (9/20) were non-compliant to the treatment. Combinedly 63.33% (19/30) diabetics were on inadequate blood sugar level control which might be strongly contributing to mortality.ConclusionPercentage of clinically suspected mucor patients who were COVID-19 positive was 67%. Although male patients were twice more tested than females but females were proportionately more positive for SARS-CoV2. Type 2 diabetes mellitus was the lead risk factor, with facial swelling being the predominant presentation. Interestingly, fungal smear was positive in 166 out of 238 patients. Despite the best management, the mortality rate was 13.86% in such patients. It was also seen that untreated or non-compliance to anti-diabetic treatment resulted in increased mortality. Hence, it's necessary to review cases of COVID-19-associated mucormycosis for prompt management and to reduce morbidities and mortality.

P327 Prevalence of orofacial Mycoses in COVID-19patients: experience from a tertiary care center in Northern India

Poster session 3, September 23, 2022, 12:30 PM - 1:30 PM ObjectiveDue to coronavirus disease (COVID-19) a new group of patients at risk emerged with COVID-19-associated mycoses (CAM). The studies, evaluating the prevalence of CAM are missing in India.MethodTo assess CAM prevalence in a tertiary care hospital in India, we applied direct microscopy, fungal culture, and histopathology on respiratory specimens of 285 critically ill COVID-19 patients admitted between September 2020 and March 2022.ResultAmong the 285 patients, 187 were male, and 98 were female. A total of 34.03% had mucor (33.01% Rhizopus arrhizus;1.02% R. microsporus), 59.51% had Aspergillus (50% Aspergillus flavus; 41.17% A. fumigatus; 2.94% A. terreus; 2.35% A. niger), 3.04% had both (Rhizopus arrhizus + Aspergillus flavus), and 3.01% (Schizophyllum sps 5; Fusarium 1, Paecilomyces variotii 1) had other types of mycosis on fungal smear and culture.ConclusionConsistent with others, our findings underline the importance of microbiological/pathological assessment in patients with predispositions for COVID-19-associated mycoses but due to the low prevalence, a routine screening seems not to be indicated currently. However, multicenter studies are desirable for substantiation of findings. A high index of clinical suspicion, diagnosis at an early stage, and use of antifungal agents are essential for a successful outcome.

Nifty cup versus katori-spoon feeding in preterm infants – Study protocol of a randomized controlled trial

Preterm neonates need an alternative method of feeding before breastfeeding. : To compare the Nifty cup with Katori-spoon feeding in preterm neonates on full gavage feeds and deemed fit for oral feeding.This open-label, parallel, randomized controlled trial will be done at the step-down unit of a tertiary care center in Northern India. We will include preterm neonates (&amp;#60; 34 weeks gestation) on gavage feeds. Our primary outcome will be the time taken to achieve full oral feeds (defined as 150 mL/kg/day) and the duration of the feeding transition. The secondary outcomes will be time to attain full breastfeeds, time spent during the feeding sessions, spillage of feeds, adverse events (including mortality), anthropometry (weight, length, occipitofrontal circumference) at discharge, and duration of hospitalization.We will also take the opinion of mothers/caregivers and nurses on Nifty cup use by the use of an indigenously designed questionnaire. We will need 94 participants to detect a significant difference of 3 days in transition duration with 5% α error and 80% power. To account for non-compliance/crossover, we will enroll 106 participants (53 in each group).We will do intention to treat analysis. All data will be analyzed using SPSS version 23 statistical software for Windows. We will do a regression analysis to determine if the intervention is an independent predictor of time to full oral feeds after adjusting for pre-specified variables like gestational age, birth weight, and PMA at enrolment.The study will provide evidence on the best feeding method for feeding preterm neonates. This evidence will guide nurses/health care professionals in deciding the feeding method for preterm infants.