Care Hospital In Eastern India Research Articles

Study of correlation between Visual Prostate Symptom Score and International Prostate Symptom Score in men with lower urinary tract symptoms with reference to Uroflowmetry parameters in Indian population.

International prostate symptom score (IPSS) is a complex questionnaire method for objective assessment of Lower urinary tract symptoms. So, there is a need to develop a simple and easy scoring system that could be easily used for illiterates and older aged patients. It was a prospective observational study with 202 participants, conducted at the department of urology of a tertiary care hospital in eastern India. The patients more than 50 years of age, attending urology OPD with Lower urinary tract symptoms were included in the study. Printed IPSS and VPSS questionnaires were given to the patient to answer. Eighty-two percent (82%) of the higher education group and 97% of the lower education group needed assistance to answer IPSS questionnaires while 18% of the higher education group and 44% of the lower education group needed assistance to answer VPSS questionnaires. Sixty-four (64%) of patients in our study belong to the high education level while 36% of patients belong to the low education group. The mean age was 60.1 years. The mean IPSS and VPSS were 19 and 11 respectively. The mean PSA was 1.5 ng/ml. The time taken to fill VPSS questionnaire was much less than IPSS questionnaires. All the patients felt that VPSS was easier. Statistically significant (p-value < 0.05) correlation was found between total IPSS and total VPSS, Q2 IPSS and Q1 VPSS, Q7 IPSS and Q2 VPSS, Q5 IPSS and Q3 VPSS, and IPSS Qol and VPSS Qol. A negative correlation was found between Q3 VPSS and Qmax, and Q5 IPSS and Qmax. VPSS can be used as an alternative tool to IPSS to assess LUTS, which uses pictograms instead of questionnaires, even in patients with limited education.

Factors Affecting Depression and Anxiety in Diabetic Patients: A Prospective Cohort Study from a Tertiary Care Hospital in Eastern India

This abstract was published in a different venue and it is not being published in this Supplement to avoid duplicate publications.Link to the publication: https://www.sciencedirect.com/science/article/pii/S2049080122017058?via%3Dihub

Mycosis Fungoides: A Diagnostic Challenge

Background: Mycosis fungoides (MF) is the most frequent type of cutaneous T-cell lymphomas (CTCL), a heterogeneous group of non-Hodgkin lymphoma of T-cell origin. CTCLs accounts for about 4% of all non-Hodgkin lymphoma. MF mainly involves the skin but in advanced cases it may involve the lymph, blood and other organs. It mimics other skin disorders like erythema necroticans, leprosy, psoriasis etc which leads to delayed diagnosis and subsequent treatment. Case report: A 61 year old male patient visited the OPD of a tertiary care hospital in Eastern India with multiple reddish elevated lesions for last 6 months which later became dome shaped and then ulcerated. He did not have any fever or itching. He informed that he had been taking Homeopathic medicine previously, but the identity of the said medicine could not be confirmed. Physical examination ruled out the presence of pallor, jaundice, oedema and cyanosis. Pulse and BP were within normal range. Systemic examination was unremarkable except mild hepatomegaly. Cutaneous examination revealed multiple erythematous indurated plaques, papules and nodules over chest, abdomen, back, limbs and face. Few of the plaques present on the trunk and left arm had developed ulcers having a necrotic floors. Cervical, axillary and inguinal lymph nodes were palpable, being firm in consistency and mobile in nature. Hair, nail and mucosal examination revealed normal results. Complete blood count (CBC), peripheral blood smear(PBS), serum urea and creatinine level did not deviate from normal findings. Ultrasonography of whole abdomen showed a mildly enlarged liver. A prominent lymph node in the aortocaval groove could be appreciated on the computed tomography(CT) scan of whole abdomen. CT scan of chest revealed bilateral axillary lymphadenopathy. Erythema necroticans, sarcoidosis and CTCL were considered as the differential diagnoses. Lesional biopsy revealed irregular epidermal hyperplasia, parakeratosis and epidermotropism in the absence of spongiosis.There was infiltration of atypical lymphocytes in the epidermis, forming well developed Pautrier’s micro abscesses. The lymphocytes were tagging the dermo-epidermal junction and within the epidermis showing surrounding halo, convoluted nuclei and variable nuclear pleomorphism. Band like papillary dermal lymphoid infiltrate, dermal lymphoid fibroplasia and nodular lymphoid aggregates could be appreciated in the deep dermis. Immunohistochemical tests were performed and the immunophenotypic profile revealed positivity for CD2, CD3, CD5, CD7, CD 8 and TIA1 and negative for CD4, CD20, CD30, CD56 and granzyme B. Based on clinical presentation, histopathology and Immunohistochemical tests, a final diagnosis of MF was made. The patient was then started on systemic antibiotic therapy, due to increased risk of bacterial super infection of lesions due to skin barrier disruption. He was then referred to Oncology department for further treatment. Conclusion: In this case, the male patient was suffering from mycosis fungoides. In the background of its clinical features being similar to other skin disorders like erythema necroticans, clinicians may face a diagnostic dilemma to correctly diagnose it. Timely diagnosis and treatment improves the prognosis in most cases. Histopathological evaluation still remains the investigation of choice.

Comparison of post-operative acidemia after intraoperative administration of balanced crystalloid plasma – Lyte A® vis-a-vis 0.9% sodium chloride in gastrointestinal surgery at a tertiary care hospital in Eastern India

Background: Fluid therapy is the most challenging and debatable aspect of perioperative care. Choice of administrating intravenous fluid perioperative period varies considerably among anesthesiologist. Aims and Objectives: The aims of this study were to compare the effects of intraoperative administration of balanced crystalloid solution (Plasma-Lyte A®) and 0.9% sodium chloride (NaCl) on acid–base balance in the post-operative period on patients undergoing gastro intestinal surgery at a tertiary care hospital. Materials and Methods: A prospective, randomized, comparative, and observational study was conducted on 80 patients of either sex aged 18–60 years with ASA-l and ASA-II who underwent gastrointestinal surgery which was at first randomly allocated to two equal groups of 40 each. Group 1 received Plasma-Lyte A® as the sole crystalloid and Group 2 received 0.9% NaCl. Intraoperative crystalloid infusion volumes, urinary output, blood loss, and blood transfusion volumes were recorded on hourly basis. Electrolytes (Na+, K+) and arterial blood gases were measured after induction of anesthesia and then every hour in the intraoperative period and at the 1st, 6th, and 12th hour of post-operative period. Results: The demographic data with respect to age, sex, and type of surgery were comparable among the two groups with no significant difference (P&gt;0.05). Intraoperative and post-operative fluid transfusion and blood transfusion were also comparable with no significant difference. On intergroup comparison, serum Na+ conc. of both the groups was comparable and no difference shown at the time of induction, but after 12 hours following operation, there was a significant increase in Group 2 (P&lt;0.05). There was no significant difference in serum K+ concentration in both the groups except at 6-hour postoperatively, there was an increase in K+ concentration in Group 1 (P&lt;0.05). Serum Cl- concentration at post-operative 1st, 6th, and 12th hour interval very significantly increased in Group 2 (P&lt;0.001). A significant decrease in pH (P&lt;0.05) observed in 0.9% NaCl group in comparison to Plasma-Lyte® group when the duration of surgery increased to more than 120 minutes. Conclusion: Plasma-Lyte A® and 0.9% NaCl can be used safely during gastrointestinal surgery as the sole crystalloid. However, chance of developing hyperchloremic metabolic acidosis is more with 0.9% NaCl than Plasma-Lyte A® in prolonged surgery exceeding 2 hours.

Spectrum of abdominal tuberculosis presenting as acute surgical emergency: Relevance in 21st century, a case series

BackgroundAbdominal tuberculosis presenting as acute surgical emergency continues to be a major issue in developing countries including India. Being an indolent disease with varied presentation, there is a need to describe the epidemiology, clinicopathological nature of the disease. Hence, this series was conducted with the aim of describing our institutional experience in the management of abdominal tuberculosis presenting as acute surgical emergency, outlining the epidemiology, management aspects and the analysis of risk factors for poor outcome in our population. MethodsThis was a descriptive series of patients operated for abdominal tuberculosis presenting as acute surgical emergency at a tertiary care hospital in Eastern India from January 2021 to January 2022. All consecutive patients presenting with intestinal obstruction or peritonitis who underwent laparotomy with intra operative and histopathological finding suggestive of tuberculosis were taken for the study. ResultsA total of 30 patients with acute abdominal tuberculosis were included in the study. 56.7% of patients were males; the mean age of presentation was 43 years with majority of patients in the younger to middle age groups. Most (80%) patients were from rural areas with limited access to healthcare. One patient had co-infection with HIV. Five patients had diabetes and six patients had hypertension as co-morbidities. 73.3% of patients had primary intestinal tuberculosis. Majority (76.7%) presented with acute intestinal obstruction. All patients had colicky abdominal pain as a consistent feature. 40% of patients were anaemic and 70% had low serum albumin levels. The most common site of affection was Ileo-cecal region (73.3%) with stricture as the pathology. Segmental resection with end to end anastomosis was the most common procedure performed (46.7%). 26.7% of patients had an adverse post operative complication, and 23.3% had surgical site infection (SSI). The mortality rate in our series was 6.7%. Although coexisting SSI, co-morbidities were associated with increased mortality, it was not found to be statistically significant (p = 0.08). 16 patients were lost to follow up. ConclusionAbdominal tuberculosis presenting as acute abdomen continues to challenge surgeons even in the 21st century. Majority in the developing countries present late with varied complications. A high index of clinical suspicion is required for timely diagnosis to reduce the mortality and morbidity of the disease.

Background cardiovascular risk factors in patients of metastatic prostate cancer on androgen deprivation therapy: A retrospective observational study from a tertiary care hospital of Eastern India

Background: Androgen deprivation therapy (ADT) is indispensable part of treatment for metastatic prostate cancer (MPC) patients. There is documented association between ADT and adverse cardiovascular (CV) events, with variability between the different modes. However, there is dearth of evidence on the background CV risk factors of these group of patients at diagnosis. Aims and Objectives: We envisaged this retrospective observational study in the department of oncology to document the background CV risk factors of MPC patients at diagnosis, to help us better select the available ADTs based on their CV risks. Materials and Methods: Over a period of 2 years, all patients registered for treatment with a diagnosis of MPC, indicated for ADT, and available detailed history and background cardiological evaluation at presentation, were included in the study. As indirect indicators of CV risks, history of smoking, presence and treatment of dyslipidemia, and type 2 diabetes mellitus (T2DM), were documented. As direct indicators of CV risks, presence and treatment of hypertension, ischemic heart disease (IHD), congestive cardiac failure (CCF), ECG, and echocardiography changes suggesting cardiac morbidity were documented and the data were analyzed using descriptive statistical methods. Results: Indirect indicators: dyslipidemia, habit of smoking, and T2DM were found in 74%, 29.3%, and 13.3% patients, respectively. Direct indicators: Presence of hypertension, IHD, CCF, abnormalities in ECG, and echocardiography were found in 38.7%, 10.6%, 4%, 28%, and 34.6% patients, respectively. ST-T changes on ECG, low EF, and IHD on echocardiography were seen in 28.5%, 23%, and 26.9%, respectively. Conclusions: MPC patients have a substantial pre-existing CV risk at diagnosis. Our findings warrant a meticulous screening of all MPC patients for CV risk factors, to help in judicious selection of their ADT.

Prevalence of Anaemia and its Association with Severity of COVID-19 among Hospitalised Patients: A Cross-sectional Study

Introduction: Coronavirus Disease-2019 (COVID-19) emerged as a global pandemic and was associated with various haematologic abnormalities. There are very few studies from India regarding the association between anaemia and disease severity of COVID-19. Aim: To check the prevalence of anaemia and its association with severity of disease among hospitalised COVID-19 patients. Materials and Methods: This was a cross-sectional study involving 203 patients admitted in general ward and Intensive Care Unit (ICU) of a tertiary care hospital in eastern India. Complete blood count at admission along with other relevant clinical and laboratory parameters was noted. Haematological parameters of the patients were described and then correlated with disease severity and death. Spearman’s correlation and Chi-square test were used to determine the associations. Results: Out of 203 patients with COVID-19,145 (71.4%) had anaemia. The study included 107 males (52.7%) and 96 females (47.3%), of which 77 (80%) females had anaemia compared to 68 (63.5%) males. Co-morbidities were present in 73 patients. Haemoglobin levels were significantly negatively correlated with disease severity (p&lt;0.001). This was even true for patients without any other co-morbidities (p&lt;0.05). Haemoglobin was also negatively correlated with deaths in this study (p&lt;0.05). Conclusion: The prevalence of anaemia in admitted patients of COVID-19 was very high and low haemoglobin levels were associated with more severe disease and death. So, low haemoglobin levels in COVID-19 may be considered as a risk factor for more severe disease and death.

Impact of diabetes mellitus on treatment outcome of newly diagnosed smear-positive pulmonary tuberculosis patients: A case–Control study

Background: Tuberculosis (TB) and diabetes mellitus (DM) are major public health problems in developing countries such as India. The link of DM and TB is more prominent in these countries where TB is endemic, and the burden of DM is increasing. Studies regarding the effect of DM on smear conversion and treatment outcome of pulmonary TB (PTB) in India are limited. Aims: The study aimed to compare the conversion and treatment success among new smear-positive PTB patients with and without DM. Materials and Methods: A case–control study was conducted in the department of pulmonary medicine of a tertiary care hospital in eastern India between October 2019 and September 2020. All newly diagnosed smear-positive drug-sensitive PTB patients visiting the outdoor or being admitted were identified, and their initial smear status, history of diabetes, and glycemic status were recorded. All the patients were treated with category I regimen of the Revised National TB Control Program. Sputum smear was followed up at the end of intensive phase and at the end of treatment and compared between diabetic and nondiabetic patients. The software SPSS version 16 was used to analyze all the data. Results: Sixty newly diagnosed smear-positive PTB patients with DM and sixty smear-positive PTB without DM were included in this study. Smear conversion was seen in 24 (40%) out of 60 diabetic TB patients and 55 (91.7%) out of 60 nondiabetic TB patients. Treatment success was seen in 40 (66.7%) out of 60 diabetic TB patients and 56 (93.3%) out of the 60 nondiabetic TB patients. Conclusion: Smear conversion and treatment success rate are lower in diabetic TB patients as compared to nondiabetic TB patients.

Perception toward Peripheral Venous Catheter Care Guidelines among Nurses Working in Pediatric Wards of a Tertiary Care Hospital

Abstract Background: The rationale for failed peripheral venous catheter (PVC) care was found to be the nature of complication, lack of time, type and amount of fluid infused, drug administered, nurse: patient ratio, and lack of resources. Revision and reinforcement of policy, protocol, and guidelines on PVC care guidelines are mandatory for quality patient care. Aim: The present study aimed to assess the nurse’s perception of the peripheral venous catheter (PVC) care guidelines among nurses. Methodology: A cross-sectional study was conducted among 44 registered nurses in pediatric wards of a tertiary care hospital in Eastern India. The data collection tool includes nurses’ sociodemographic data, a Likert scale on the perception of nurses toward PVC care guidelines implementation, and a semi-structured interview guide to conduct focus group discussion on nurse’s opinions toward PVC care guidelines. Results: Majority (84.1%) of the nurses had a neutral perception, and less than one-fourth (9.1%) had a positive perception of PVC care guidelines. The focus group discussion found three themes including “Revision to PVC care guidelines,” “Problems in providing PVC care,” and “Merits of PVC care guidelines.” Conclusion: Frequent updating through the in-service session on PVC care guidelines helps nurses to understand the PVC care procedure better for quality patient care. However, other factors to be considered include the availability of resources, staff workload, and work environment for nurse’s better adherence.

Dermatological Manifestations in COVID-Related Illness in Children: A Retrospective Observational Study at a Tertiary Care Hospital of Eastern India

Objectives: To identify the spectrum of cutaneous manifestations and to evaluate temporal relationship between each type of dermatological lesions and the severity of COVID-19-related illness in the pediatric population. Subjects and Methods: Retrospective observational study on 35 children (upto12 years) from Kolkata and different district areas of West Bengal, admitted to our tertiary care hospital with COVID-related illnesses (COVID-19 and/or multisystem inflammatory syndrome in children [MIS-C]). Results: Maculopapular rash was heading the list (n = 18, 51.4%) followed by chilblain-like lesions (n = 12, 34.2%), vasculistic lesion (n = 8, 22.8%), vesicular rash (n = 5, 14.3%), and urticaria (n = 3, 8.5%). In majority of patients (n = 26, 74.2%), dermatologic manifestations proceeded (n = 16, 45.7%) or merged (n = 10, 28.6%) with the onset of systemic symptoms. In rest of the patients (n = 9, 25.7%), skin manifestations occurred after the systemic symptoms, particularly in vascular lesions. 57.1% children required pediatric intensive care unit (PICU) admission. All children with vasculitis (n = 8) required PICU admission and 87.5% (n = 7) of them needed inotrope support. Intravenous immunoglobulin (IVIG) was mostly given in children with chilblains (n = 11, 92%). Methylprednisolone and repeat dose of IVIG was mostly needed in patients with vasculitis (75% and 25% of vasculitis children, respectively). The duration of PICU stay was least in patients with vesicular rash (4.4 ± 2.5 days) and longest in vasculistic lesions (18.75 ± 1 days), highest being 56 days. The overall mortality rate among MIS-C patients with cutaneous manifestations was 25.7% (n = 9) while patients with vasculistic lesions had the highest mortality rate of 50% (n = 4). Conclusion: Our study finding reveals that COVID-related disease severity is highly depends on the type of skin lesions but not just on mere occurrence of skin manifestations. Lesions such as maculopapular, chilblains, and vesicular rash had good prognosis and urticaria and vasculitis had poor prognosis.

A cross-sectional study on demography, clinical presentation, knowledge, attitude, practice, and treatment seeking behavior among uncomplicated Plasmodium falciparum malaria patients at a tertiary care hospital in Eastern India

Background: Malaria continues to be a public health problem in India including Kolkata, West Bengal. Timely recognition of the symptoms of malaria, attending health-care facilities, prompt diagnosis and appropriate treatment can only prevent fatal outcome. Aims and Objectives: The aim of the study was to explore the knowledge, attitude, practice, and treatment seeking behavior of uncomplicated Plasmodium falciparum malaria patients attending a tertiary care hospital in Kolkata. Materials and Methods: This cross-sectional and observational study was conducted at a tertiary care hospital in Kolkata after receiving ethics committee approval. Each consecutive consented uncomplicated P. falciparum malaria patients of all age group and gender excluding sick patients, pregnant women, and infants were interviewed with a predesigned and pretested semi-structured questionnaire to elicit personal history, clinical complaints, knowledge, and awareness about malaria, preventive measures, and treatment seeking behavior along with history of medication use. Results: Out of total 112 study participants, majority were young (mean age 37.5 ± 13.41 years), 50.89% had no formal education, mostly engaged in small business (33.03%) or in manual labor. Majority (74.10%) used antipyretic and analgesics for fever and 51.78% consulted a local private physician first before attending government hospital which they usually prefer. Many (58.92%) knew mosquito as vector but only 7.14% regularly used mosquito bed nets. Use of antibiotics (barring antimalarials) was 11.60%. Conclusion: The study participants showed a good knowledge about malaria, its transmission, and clinical symptomatology but a mismatch with attitude and practice in disease prevention and treatment seeking behavior was noted. More awareness campaign should be conducted among general public to improve the same.

Antimicrobial Usage during COVID-19 Pandemic in Intensive Care Unit at a Tertiary Care Hospital in Eastern India: A Retrospective Study

Introduction: Antimicrobials, one of the greatest contributions of the 20th century to the field of therapeutics, appear to be crucial defense in severely ill Coronavirus Disease-2019 (COVID-19) patients. However, a major concern is the excessive and, in a few cases, irrational use of antimicrobials, leading to the global crisis of the emergence of multidrug- resistant microbial strains. Thus, prompt action is needed to optimise antimicrobial therapy. In this context, a situation analysis, such as the present study, focusing on medication management in COVID-19 patients, can help identify key gaps so that appropriate measures may be undertaken to ensure rational antimicrobial therapy in the future. Aim: To analyse the antimicrobial use pattern during the COVID-19 pandemic in the Medical Intensive Care Unit (MICU) of a tertiary care hospital and assess the existing hospital antimicrobial policy. Materials and Methods: A hospital-based, retrospective observational study was conducted in the Department of Pharmacology at a Tertiary Care Hospital (Government Medical College Kolkata), West Bengal, India. The study duration was two months, September and October, 2022. Data were extracted from the standard clinical records of all diagnosed COVID-19 adult patients (≥18 years) admitted for atleast 24 hours in the MICU between April 2021 and June 2021 {positive result on a Reverse Transcriptase-Polymerase Chain Reaction (RT-PCR) assay of a specimen collected with a nasopharyngeal swab indicated a positive diagnosis}. Records containing incomplete data were excluded. A total of 128 records were analysed. Group A included data on patients who expired (n=100), and group B contained data on patients who survived (n=28) during these two months. For the hospital antimicrobial policy, a personal interview was conducted with the Intensive Care Unit (ICU) incharge. Categorical variables were expressed as frequencies (n), percentages (%), and continuous variables were expressed as mean±Standard Deviation (SD). Pearson’s Chi-square test and Mann-Whitney U test were used to assess the significance level for categorical and continuous variables, respectively. A p-value of &lt;0.05 was considered significant. Results: The mean age of the study participants in group A was 58.31±15.22 years and in group B was 51.93±18.33 years. Out of the 128 records collected, 100 patients (78.12%) had succumbed in the ICU during the particular period. Each patient had received an average of 18 drugs and 4.27 Antimicrobial Agents (AMAs) during their stay in the ICU. More than 80% of patients had received concurrent AMAs. Meropenem was the most frequently prescribed AMA (93 patients, 72.65%), followed by piperacillin/tazobactam (88 patients, 68.75%) and doxycycline (79 patients, 61.71%). More than 80% of patients received antimicrobials in the MICU, and an average of 4 AMAs were used per patient. The choice of AMA was empirical. There was no significant relationship between the number and type of AMAs received by the patients and the final clinical outcome. There was no antibiogram or Institutional antimicrobial policy. Conclusion: The study indicates extensive, empirical use of antimicrobials in the MICU, often in combination, without an available antibiogram and without any impact on the clinical outcome of the admitted patients. The findings thus warrant the urgent establishment of a hospital antimicrobial policy to encourage rational antimicrobial therapy in the future.

Factors Affecting Pulmonary Artery Catheterisation in Patients Undergoing Coronary Artery Bypass Grafting: A Cross-sectional Study

Introduction: The Pulmonary Artery (PA) catheter continues to be used for monitoring haemodynamic parameters in the majority of patients undergoing Coronary Artery Bypass Grafting (CABG) surgeries, despite concerns raised regarding costeffectiveness and safety issues. Sometimes, placement takes longer or is difficult just by looking at the pressure waves. There are several factors that may influence the duration of Pulmonary Artery Catheter (PAC) insertion. Aim: To determine the factors affecting PAC in anaesthetised patients undergoing elective CABG. Materials and Methods: A single-centred, cross-sectional study was conducted in the Cardiothoracic and Vascular Surgery operation theartre at IPGME&amp;R and SSKM Hospital, Kolkata, India including 138 patients aged 35-65 years of either sex undergoing elective CABG surgery in a tertiary care hospital in Eastern India. The attempt to perform successful first-time catheterisation or failure of the PAC done by a resident cardioanaesthesiologist was noted, as well as whether catheterisation was successfully done within a specified time or not. This time was obtained as the 75th percentile of the time taken for catheter placement for the first 30 cases catheterised in the first attempt. For ease of analysis, all first attempt successful cases were considered as Group A (n=125), and all first attempt failure cases as Group B (n=13). The study data on various parameters were recorded on a proforma and summarised as the mean and standard deviation for normally distributed numerical variables, median and interquartile range for skewed numerical variables, and counts and percentages for categorical variables. A p-value &lt;0.05 was considered statistically significant. Results: A total of 138 patients were analysed during the entire study. There was a predominance of male patients (82.6%) with a male-to-female ratio of 114:24. The first attempt failure rate of successful PAC was 13 out of 138, i.e., 9.42% (95% confidence interval 4.55% to 14.29%). The cut-off time for the procedure as the 75th percentile of the first 30 successful cases is 269 seconds. The number of cases in which it was done within this time was 109 cases, i.e., 78.99%. There was a significant difference (p&lt;0.05) in terms of body weight, body surface area, and neck length between the two groups. Conclusion: Increased body weight and increased body surface area are significant factors associated with difficult PAC placement. On the other hand, short neck length is a significant factor for taking more time in the placement of the catheter.

A retrospective observational study of injury patterns associated with powered circular saw in subjects presenting to the emergency department of a tertiary care hospital.

Powered circular saw-related injuries (PCSRIs) are responsible for a sizable proportion of occupational injuries presented to the emergency department (ED). The present study portrays the mechanisms, injury patterns, epidemiological parameters, and outcomes among subjects presenting with PCSRI to the ED. This retrospective observational study was conducted in the ED of a tertiary care hospital in eastern India. Clinical records of subjects with PCSRI from June 2019 to June 2022 were reviewed. Data pertaining to patients' demographic profiles and the patterns and mechanisms of injury were retrieved. The Modified Hand Injury Severity Score (MHISS) and the Injury Severity Score (ISS) were calculated. Statistical analysis was performed using R version 4.1.0. A total of 175 subjects' data were analyzed. The median age was 34.5 years, and all subjects were men. The mean year of experience of the subjects was 6.2. The most common job category was carpentry (n = 63 [36%]), followed by "do it yourself work" (n = 26 [14.8%]). One hundred twenty-two (69.7%) subjects had hand injuries (HIs), and the left hand was involved in 85 (69.6%) subjects. The index finger was involved in 36 (29.5%) subjects, followed by the thumb (n = 31 [25.4%]). Laceration (n = 155 [88.5%]) was the most common injury pattern. The subjects' mean ISS and mean MHISS were 8.52 and 45, respectively. PCSRI is associated with moderate-to-severe HIs that are most common in occupational settings. Young male carpenters involved in wood and plywood work are more prone to injuries.

Efficacy and Safety of Autologous Serum Therapy in Chronic Spontaneous Urticaria in the Pediatric Population: A Prospective Pilot Study.

Chronic spontaneous urticaria (CSU) in children is mostly spontaneous in onset (57%). Treatment comprises long-term antihistaminic therapy without need for elaborate investigations. A subset of such patients don't respond to conventional treatment and novel therapies to help reduce pill burden is the need of the hour. To determine the efficacy and safety of autologous serum therapy (AST) in pediatric patients with chronic spontaneous urticaria. All pediatric patients, aged between 6-16 years, attended to our OPD from March 2019 to March 2020 were recruited. Clinico-demographic data and baseline investigations of all patients were performed. Two-weekly AST therapy was given for 8 visits with levocetrizine tablet 5mg on an on-demand basis. Urticaria activity score (UAS) sheet was provided to record and return every 2 weeks. Statistical analysis was done using the IBM SPSS 26 software package. Autologous serum skin test (ASST) was positive in 63% patients. Both the ASST positive and ASST negative group showed significant reduction in UAS7 score at week 14 compared to baseline. The reduction in mean UAS7 score was associated with a decreased pill burden and positive response in the patient and physician global assessment scale. No statistically significant difference between the two groups in terms of mean UAS7 reduction was found. This study has explored the efficacy and safety of autologous serum therapy in the pediatric CSU patients. Both ASST positive and ASST negative group respond to AST therapy.

Medication Adherence Among Patients of Type II Diabetes Mellitus and Its Associated Risk Factors: A Cross-Sectional Study in a Tertiary Care Hospital of Eastern India.

Type 2 diabetes mellitus is a major public health problem. Adherence to anti-diabetic medications improves glycaemic control, which in turn prevents complications as well as reduces out-of-pocket expenditure. The World Health Organization highlights that the impact of interventions directed to improve adherence has far greater implications than specific medical interventions. There are several factors that contribute to poor adherence. Not many studies have been conducted to explore adherence to diabetes medications in eastern India. To measure medication adherence among patients suffering from diabetes. To determine the various risk factors influencing adherence to medication. To find out the association of health-related quality of life with adherence to medication. Ahospital-based cross-sectional study was conducted in the outpatient Department of General Medicine and Endocrinology of a tertiary care hospital in eastern India from January to March 2020. Adult subjects, who were diagnosed with type 2 diabetes mellitus for at least six months, were interviewed using a pretested, structured questionnaire containing 8-item Morisky Medication Adherence Scale (MMAS-8) to determine adherence to diabetic medications. Data were analysed in SPSS version 27 (IBM Corp., Armonk, NY, USA). The mean age of the 331 participants interviewed was 53.40 (SD 11.0) years and the majority were males (57.1%). Medication adherence of 34.14% (n=113) was found among the subjects. Having any comorbidity, positive family history of diabetes and the habit of current alcohol intake increased the odds of poor adherence by 3.26 times, 1.88 times, and 2.35 times respectively in binary logistic regression analysis. Those following a diabetic diet had a protective effect, decreasing poor medication adherence by 79.6%. Poor medication adherence increased by 1.077 times with every one-day increase in unhealthy days. The medication adherence was 34.14% and as compared to other similar studies medication adherence in the study population was poor and was associated with unhealthy days.

Clinicopathological Spectrum of Syringoma: A Report of 50 Cases From a Tertiary Care Hospital in Eastern India.

Background Syringoma is a benign adnexal neoplasm and is considered safe with very low malignant potential. However, multiple tiny lesions typically affect the face and exposed area, which may cause a cosmetic concern for the patient.After a clinical diagnosis, there are two methods to diagnose syringoma: fine needle aspiration cytology (FNAC) and histopathology. FNAC is generally used for the initial evaluation of syringoma, while histopathology is used as a confirmatory test to diagnose syringoma. In developing and resource-limited settings, the combination of FNAC and histopathology would cause a financial and logistics burden. Objective This study aimed to observe the cytological and histopathological features of cases clinically diagnosed as syringomas in a tertiary care hospital to suggest the use of either FNAC or histopathology for diagnosing syringoma. Materials and Methods This cross-sectional observational study was conducted in the Department of Dermatology and Department of Pathology of a tertiary care hospital in eastern India from November 2021 to April 2022. Any clinically provisionally diagnosed case of syringoma was recruited for the study after obtaining informed consent for voluntary participation. With aseptic precautions, the tissue aspirates and punch biopsy were obtained in the Department of Dermatology and the samples were sent to the Department of Pathology. Cytological and histological examination was conducted by a single expert pathologist. Result A total of 50 cases (36 female, 14 male) with a median age of 23 years (range 10-40 years) were included in the study. A total of 43 cases were presented with papular lesions and seven with nodules. In the majority of the cases (40%), the lesion was in the eyelid followed by 26% in the arm. In FNAC, 22 cases were found to be benign adnexal lesions, 16 were suggestive of syringoma, eight were diagnosed as xanthoma, two were diagnosed as warts, and two cases were inadequate for opinion. Histologically, 42 cases were confirmed as syringoma, six were diagnosed as xanthoma, and two cases were diagnosed as warts. There was a significant difference between diagnosis by FNAC and histopathology (McNemar χ2 = 24.038, p-value = 0.0001). Conclusion We found that FNAC and histopathological diagnosis of syringoma may not be corroborative. Benign adnexal lesions are difficult to categorize by FNAC. Histopathological examination of clinically diagnosed cases of syringoma is of help for definitive diagnosis. Hence, FNAC may be avoided for saving time and discomfort for the patients and clinically diagnosed cases may be diagnosed by histopathological examination.

Challenges and barriers to immunization during COVID-19: An experience of parents/caregivers from a well-baby clinic of a tertiary care hospital of Eastern India

BackgroundImmunization in children is one of the best methods of preventing vaccine preventable diseases.With the onset of the COVID-19 pandemic,there have been disruptions in vaccine supply,its uptake and perception towards routine immunization, globally and in India. This study was planned to identify the challenges faced by the parents, the perceived barriers towards childhood immunization and perception regarding vaccination during the ongoing pandemic. MethodsA cross-sectional study was carried out in the well-baby clinic, providing immunization services. The informants were parents/caregivers of under-five children accompanying their children to the well-baby clinic within the study period. Data was collected using a semi-structured interviewer administered questionnaire and analysed using Epi-info software and p value less than 0.05 was considered to be statistically significant. ResultsDelay in immunization was noted in 62% of the children. The challenges stated by respondents for delay in immunization during this pandemic mostly were “fear about getting infected” (30%) and “someone instructed them not to take the child to the hospital if not ill” (13%). The most common perceived barriers were ‘no vaccination sites were open’ or ‘did not know where the baby can be vaccinated’. ‘Child should receive all vaccines’(99%) and ‘safety is more important than vaccination’ (83%)was the perception of respondents about immunization during the pandemic. ConclusionThough the respondents were aware of the need for timely vaccinations of their children, still a substantial delay was seen among majority of them due to fear of getting infected and unavailability of vaccines.

Factors affecting depression and anxiety in diabetic patients: A cross sectional study from a tertiary care hospital in Eastern India.

Diabetes is one of the most common chronic disease in the world and its prevalence in India is rising day by day. Diabetic patients often suffer from depression and anxiety which has a negative impact on patients resulting in non-adherence to medication, rapid disease progression and overall poor prognosis. India is the land of diversity and so are the causes of depression and anxiety in the people from different parts of the country. The study done in the current population has revealed certain indicators of both depression and anxiety that were not significant in previous studies. These new findings point towards the changing scenario and the need for more precise steps for improving the quality of life of diabetics. The study aims to determine the prevalence of depressive symptoms and anxiety among diabetic patients and the factors associated with them. A prospective cohort study was conducted with 305 participants among which 152 were diabetic while 153 were non diabetic patients. Depression and anxiety of the patients was measured through PHQ-9 scale and GAD-7 scale respectively. Factors associated with prevalence of depression and anxiety in the diabetic population was analysed. The prevalence of depressive symptoms (39.5% versus 12.4%) and anxiety (36.2% versus 14.4%) were significantly higher in diabetic patients as compared to non-diabetic participants. Low-income, urban residence, unmarried status, insulin therapy, presence of retinopathy, and ischemic heart disease were significantly associated with depression among diabetic group of patients. Similarly the major predictors of anxiety were marital status, literacy and diabetic complications like neuropathy, retinopathy and ischemic heart disease. Our study shows depression and anxiety are highly prevalent among diabetic patients. All diabetic patients while seeking clinical contact should be screened for depression and anxiety especially those patients with predisposing risk factors.

Dermatological impact of hand hygiene practices during COVID-19: A cross-sectional web-based survey among doctors in a tertiary care hospital in Eastern India.

The COVID-19 pandemic continues to persist throughout the world with intermittent exacerbation. The changing trend of hand hygiene practices during this pandemic has led to new onset or aggravation of pre-existing hand eczema, especially among doctors. There is a paucity of studies regarding skin changes seen with changing hand hygiene practices in the Indian subcontinent. To estimate the frequency of various cutaneous manifestations and associated factors with hand hygiene practices in doctors during COVID-19 via a web-based online questionnaire survey. It was a cross-sectional web-based survey conducted at a tertiary care teaching institute from July 2021 to September 2021. Those doctors (faculty, residents, and interns) of the hospital completing the questionnaire with electronic informed consent were included in the study. A total of 143 doctors completed the survey. The most common symptoms were dryness in 60 (42%) and itching in 25 (17.5%) doctors. The most common skin changes were scaling in 30 (21%) and redness in 16 (11.2%) doctors. There was a significant association between skin changes and frequency of hand washing and hand sanitizer use (p value < 0.05). The prevalence of hand changes and symptoms was 77% in doctors in our study. The most commonly seen hand changes were scaling followed by redness and symptoms observed were dryness and itching.