Care Hospital In Eastern India Research Articles

Evaluation of functional results of different treatment modalities in Intra- articular fracture of distal end of radius in adults at a tertiary care hospital in Eastern India

Fractures of the distal radius (DRF) are the most common orthopedic injuries: one out of every six fractures presented at emergency department is a distal radius fracture. Almost two-thirds of these fractures are displaced and need to be reduced. Epidemiological studies point out that the age rate curve is bimodal and that the highest incidences are found in children and the elderly. DRF constitute 14% of all extremity injuries. They occur as a result of high or low energy trauma resulting in significant injury and impairment of function of the upper extremity. Randomized controlled trial has been attempted to scrutinize the best method for treating DRF, ranging from methods of conservative treatment to advanced strategies of plate osteo-synthesis.124 Patients with 126 intra-articular distal radius fractures were studied, who met with predefined inclusion and exclusion criteria at Department of Orthopaedics, Kalinga Institute of Medical Sciences, Bhubaneswar from 1st October 2017 to 30th September 2019. They underwent different treatment interventions. The cases were followed for 12 months at regular intervals for serial clinical & radiological evaluation. Functional grading and pain scoring was done for different treatment modalities. Radiological grading was made based on union/ non-union of fracture.Majority with wrist fracture were of age 20-40 years followed by the age group 61-80 years. Grip strength was reported better in surgical group(79.2%). Mode of treatment is statistically significant with Palmar flexion (p = 0.015), Supination (p=0.025) and Pronation (p<0.001) of wrist post surgical treatment. Plating group experience significantl less pain (p=0.012). Mean function score for surgical group is 19.8.The impetus for the inclination towards treatment of wrist fracture by surgery, mainly plating method, stands multifactorial and might bring better outcomes in terms of range and degree of movement, expedited recovery, lower chances of malunion and in a way, better prognosis and quality of life in case of DRF.

Hair and urine lead, cadmium, nickel, and arsenic levels in children with attention‐deficit hyperactivity disorder: A case–control study in a tertiary care hospital in eastern India

AbstractAttention‐deficit hyperactivity disorder (ADHD) is a neurodevelopmental disorder characterized by inattention and/or hyperactivity–impulsivity. It is one of the most widespread neurodevelopmental conditions and has compound etiopathogenesis involving both environmental and genetic factors. Though the role of heavy metals on ADHD has been implicated but is less studied. Hair and urine are two non‐invasive methods which can substitute blood as a method of monitoring and assessing heavy metal levels. Twenty‐four cases of ADHD and their age matched healthy children (24) were taken as controls. Hair and urine samples were analyzed for lead, cadmium, nickel, and arsenic using inductively coupled plasma optical emission spectrometry (ICP‐OES) after acid digestion and extraction. The levels of heavy metals were significantly higher in cases; lead (p = .004, .003), cadmium (p = .020, <.001), and nickel (p = .016, <.001) of the hair and urine samples, respectively. Arsenic was below the limit of detection for all the samples. Hence, in conclusion, the heavy metal levels in hair and urine were significantly higher in ADHD cases as compared to their healthy counterparts.

Dermatoses in geriatric diabetic patients and its association with socioeconomic condition – A cross-sectional observational study in a tertiary care hospital in Eastern India

Background: Diabetes mellitus can have varied cutaneous manifestations. Aims and Objectives: This study aims to explore the plethora of dermatoses among the geriatric diabetic population and evaluate their association with the socioeconomic conditions of the patients. Materials and Methods: This is a cross-sectional observational study carried out on 300 diabetic patients aged 60 and above in department of dermatology of a tertiary care hospital in Eastern India. Data were collected in a pre-designed proforma, and all findings were recorded. Results: Three hundred diabetic patients aged 60 and above were evaluated; 42% were male, 58% were female. About 61.33% belonged to lower socioeconomic status (SES), 24% to middle, and 14.67% to upper SES. Xerosis (66%) and generalized pruritus (44%) were the most common skin manifestations. Among the infective dermatoses, fungal infections (49.3%) were the most common followed by bacterial (29.3%). There was statistically significant correlation of diabetic dermatoses with SES, female gender, obesity, increased intake of junk food, active smokers for more than 10 years, living singly, sedentary lifestyle, and hypertension. Conclusion: An in-depth knowledge of diabetic dermatoses in the elderly and the role of SES and demographic parameters accounting for their increased prevalence has not been sufficiently studied among the Indian population. This study will shed some light on the same and bring in awareness among the doctors and policymakers alike to enhance the health-care needs of the elderly.

Microbiological Characterization and Clinical Facets of Elizabethkingia Bloodstream Infections in a Tertiary Care Hospital of Eastern India.

Elizabethkingia is an emerging non-fermenting Gram-negative bacillus (NFGNB) causing bloodstream infections (BSI) associated with high mortality. It demonstrates a unique antimicrobial profile in showing susceptibility to antimicrobials effective against Gram-positive bacteria. This study was undertaken to determine the overall frequency of Elizabethkingia BSI, associated risk factors, microbiological susceptibility, and clonal relationship of Elizabethkingia isolates using Enterobacterial Repetitive Intergenic ConsensusPolymerase Chain Reaction (ERIC-PCR). Elizabethkingia isolates obtained from the blood culture of admitted patients (August 2020-December 2021) were identified by the VITEK 2 system and subjected to an antimicrobial susceptibility test by standard procedures. Demographics, co-morbidities, risk factors for survival, and outcome were summarized and analyzed by Chi-square test, Kaplan-Meier curve, and Cox regression. Clonal relatedness between Elizabethkingia isolates was analyzed using ERIC‑PCR fingerprinting with the "PAST: Paleontological statistics software package". Of 13,747 blood samples received during the study period, 13.59% were culture positive, and 14.60% were NFGNBs. The frequency of Elizabethkingia spp. among all NFGNBs in BSI was 29.30%, and the overall prevalence in BSI was 4.21%. In patients with Elizabethkingia BSI, Foley's catheter was present in 81.25% of the cases. 100% susceptibility was observed to linezolid, followed by vancomycin (98.75%) and chloramphenicol (89.5%). The 30-day mortality rate in the patients of Elizabethkingia BSI was 26.25%. The Presence of COVID-19, pneumonia, diabetes mellitus (DM), mechanical ventilation (MV), and prior antibiotics were significantly different (p<0.05) between the survival and death groups. ERIC-PCR profile dendrogram of Elizabethkingia isolates showed ten major clusters indicating high genetic diversity. Elizabethkingia was responsible for one-third of NFGNB BSI in a single-center study, with approximately 26% of 30-day all-cause mortality. Most isolates were susceptible to linezolid, vancomycin, and chloramphenicol. COVID-19 was the most significant risk factor associated with mortality. ERIC-PCR of Elizabethkingia isolates exhibited high genetic diversity.

An in-depth appraisal of clinico-biochemical and radiological findings of COVID-19 patients during the COVID-19 pandemic in a dedicated COVID Care Hospital in Eastern India and its outcome in relation to the COVAXIN vaccination status: A 2-year study.

COVID-19 pandemic hit Odisha province from April 2020 to December 2020, then from April 2021 to August 2021 and from February 2022 to April 2022 as the first, second, and third waves, respectively, with the most severe form witnessed during the second wave. Kalinga Institute of Medical Sciences hospital in Odisha was declared a Dedicated COVID Hospital (DCH) during those three waves and witnessed 9485 cases of admissions among which there were 1214 deaths. COVAXIN vaccination of the vulnerable population was launched in February 2021 onwards. This study has been done to know the clinic-biochemical profiles, radiologic findings of COVID-19 admitted patients, the predictors of mortality in the second wave, and clinical outcomes in the three waves in relation to COVAXIN vaccination status. This was a serial three-round retrospective study from the electronic medical records using multistage random sampling where we collected and critically analyzed the demographic, and all the relevant possible health data of the cases that consist of 514 cases admitted in three waves. The data from death certificates among the 555 cases in the second wave have been analyzed to conclude predictors of mortality. Mortality increased with age, male gender, comorbidities, and raised C-reactive protein level. High NL ratio, extent of pulmonary involvement. There was a wide variation in incidence and spectrum of illness starting from 79% incidence of mild symptomatic in the initial and third wave, but remained in the range of 35-65% in the second wave, respectively, and the most noticeable symptomatic illness was that of the upper respiratory tract. In fulminant cases, the mode of presentations was severe pneumonia and acute respiratory distress syndrome. Males were more sufferers than females. Children had better outcomes compared to adults. COVID-associated coagulopathy had a normal platelet count. Subsequently, in 2021 year onwards vaccination of the vulnerable population was launched in a phased manner that changed the dynamics of the disease outcome by better survival chances despite intercurrent COVID infection by induction of herd immunity. On the contrary, there was a higher prevalence of serious illness among non-vaccinated individuals. While the cases continued during the second wave of the pandemic, long COVID became a clinical entity of symptomatic that persisted or recurred among the COVID illness recovered cases after reverse transcriptase polymerase chain reaction results for COVID-19 became negative. The symptoms consisted of fatigue, cough, dyspnea as pulmonary manifestations and extra-pulmonary involvement of the cardiac, renal, and central nervous systems and the pulmonary imaging features consisted of interstitial pneumonia, consolidation, cavity pattern, and prone to microbial infection. These events lead to morbidity and admission. Coinciding with the vaccination of all population of Odisha province with the first dose of the vaccine by around the period of the first quarter of 2022, there was a new variant named Omicron responsible in the third wave, in which the majority of the admitted cases had.mild upper respiratory illness. This was not as lethal as its predecessors due to its lower propensity to invade the lungs and blood vessels. Immune dysregulation plays a central role in the pathogenesis of the manifestations. Vaccine-induced protection and the induction of herd immunity played a proactive role in the waning of the severity of clinical presentations.

Pediatric Ocular Morbidity among Admitted Patients in a Tertiary Care Hospital in Eastern India

Pediatric Ocular Morbidity among Admitted Patients in a Tertiary Care Hospital in Eastern India

Clinico-epidemiological study of leprosy in a tertiary care hospital of Eastern India

Background: Accurate diagnosis of leprosy is of paramount importance, because delays and misdiagnosis are more common in non-endemic zones. It has a long incubation period, varied clinical presentations, and reaction states which can present in any point of lifetime, becoming more challenging for proper management of this enigmatous disease. Methods: This was conducted as an institution based cross- sectional study over a period of 12 months. 100 patients were selected. Inclusion and exclusion criteria were maintained. Data collected was checked, tabulated, statistically analysed and compared with existing literature. Results: In our study, majority, 49% belonged in age group of 41-60 yrs, only 6% were less than 20 years old. Male: female ratio was 3.34. 62% were from rural areas. Family history of Hansen was present in 5%. 6% had Histoid while 5% had pure neuritic representing least common subtypes. Most common occupations were Housewives (19%), shopkeepers (16%) and office workers (16%). 59% presented with hypoesthesia, 28% with fever. 59% belonged to borderline, 27% belonged to polar spectrum. Trophic ulcers were found in 20%, clawing of digits in 27%. Conclusions: Leprosy is still a pressing problem in our country. A considerable number of children and adolescents get affected indicating high rate of transmission in community. A comprehensive approach includes proper diagnosis, treatment, and identification of reaction patterns, prevention of disability and deformities, and implementation of rehabilitation measures.

Level of Satisfaction Towards Healthcare Services in Patients Attending Psychiatry Outpatient Department of a Tertiary Care Hospital in Eastern India.

Patients' satisfaction with healthcare services contributes to their compliance with the treatment and thus impacts their health. Therefore, patient satisfaction is increasingly being used as an indicator of health system performance in a country. Though several studies have been reported from different parts of India, most did not include psychiatric patients. This study assessed the level of satisfaction of psychiatric outpatients and its association with socio-demographic, hospital-related, and treatment-related variables. This cross-sectional study assessed 152 patients attending psychiatry outpatient department (OPD) of a tertiary care hospital. Treatment-related satisfaction was measured using the Short Assessment of Patient Satisfaction (SAPS) scale, and variables not related to treatment were assessed using Likert scales. Most participants were satisfied with the overall cleanliness of the hospital (82.9%), the useable condition of toilets (73%), and waiting time in the OPD ticket counter, doctor's room, and pharmacy. More than 80% were pleased with the OPD staff's behavior and working efficiency. In the seven dimensions of the SAPS scale, satisfaction level was variable. Overall satisfaction with the care received in the hospital was 60.5%. The level of patient satisfaction is good in psychiatry OPD services of our hospital, and it depends on treatment-independent variables also. So, liaison between the medical- and non-medical-management teams is crucial to augment patient satisfaction.

Survival of Gastric Cancer Patients at a Tertiary Care Hospital in Eastern India: A Retrospective Data Analysis.

Background Gastric cancer is one of the most common cancers and a leading cause of death worldwide. Most cases of gastric cancer are diagnosed at an advanced stage when no definitive treatment is available leading to an overall declined survival rate. In this study, we aimed to investigate the survival rate of gastric cancer patients admitted to our tertiary care center and determined the relationship between sociodemographic and clinicopathological characteristics with mortality. Methodology Gastric cancer patients treated between January 2019 and December 2020 were included in this retrospective study. The clinicopathological and demographic data of 275 gastric cancer patients were analyzed. The Kaplan-Meier method was used to calculate the overall survival of gastric cancer patients. The Kaplan-Meier log-rank test was used to calculate the difference. Results The mean survival of gastric cancer patients was 20.10 months (95% confidence interval = 19.20-21.03). Deaths were higher among stage III (42.6%) and stage IV (36.1%) patients compared to stage I (1.6%) and stage II (19.7%) patients. Mortality was significantly higher (70.5%) in patients without surgery. Conclusions The mean survival in our study setting is lower and is associated with the pathological stage of the disease, surgical intervention, and patients presenting with other gastrointestinal symptoms. A lower survival ratecan be attributed to late diagnosis.

Assessment of Anaemia and Other Haematological Profiles of Pregnant Women Attending Antenatal Care in Tertiary Care Hospital of Eastern India

Assessment of Anaemia and Other Haematological Profiles of Pregnant Women Attending Antenatal Care in Tertiary Care Hospital of Eastern India

ACUTE MESENTERIC ISCHEMIA WITH BOWEL GANGRENE:CASE SERIES IN A TERTIARY CARE CENTRE

Introduction: Acute Mesenteric ischemia (AMI) is a worrisome clinical condition leading to end stage irreversible bowel necrosis. Inspite of advances in medical eld, it continues to remain a diagnostic challenge for surgeons leading to delay in diagnosis and high mortality. In this series we present 8 cases of AMI with bowel gangrene treated surgically with an aim to describe its presentation and various management strategies at our institution. This prospective series of patients operated for acute mesenteri Methodology: c ischemia with bowel gangrene was conducted in a tertiary care hospital in Eastern India from January 2021 to August 2022. All patients presenting to the emergency department with abdominal pain, features of obstruction with or without peritonitis operated with a pre operative diagnosis of acute mesenteric ischemia conrmed radiologically were taken for the study. This series comprised of 8 patients, of which 5 (62.5%) were Results: male and 3 (37.5%) were female. The mean age of patients was 58.5 ± 8.9 years with a range from 45 to 75 years. The most consistent presenting feature was abdominal pain (100%) followed by vomiting (50%) and distension (50%). Four (50%) of patients had a pre-existing cardiac illness. The mean length of hospital stay was 7.6 ± 3.87 days. Post operative complication occurred in 4 patients. The mortality rate in our series was 37.5%. AMI is a life threatening vascular Conclusion: emergency with high mortality and morbidity. Most present in a delayed stage where irreversible bowel ischemia has set in requiring emergency laparotomy. High index of clinical suspicion is required for early diagnosis and prompt effective treatment to prevent disastrous consequences.

Occurrence and Genomic Characteristics of Hypervirulent Klebsiella pneumoniae in a Tertiary Care Hospital, Eastern India.

This study was conducted to find out the occurrence of hypervirulent Klebsiella pneumoniae (hvKP) isolates from different clinical specimens in a tertiary care hospital of eastern India and investigate the distribution of virulence factors, capsular serotypes and antibiogram profile. The distribution of carbapenemase-encoding genes in convergent (hvKP and carbapenem-resistant) isolates was also studied. A total of 1004 K. pneumoniae isolates were obtained from different clinical specimens from August 2019 to June 2021 and hvKP isolates were identified using the string test. Genes of capsular serotypes K1, K2, K5, K20, K54 and K57, virulence-associated genes, rmpA, rmpA2, mrkD, allS, iroN, iutA, iuc, kfuB and ybtS, and carbapenemase-encoding genes, NDM-1, OXA-48, OXA-181, and KPC, were evaluated by polymerase chain reaction. Antimicrobial susceptibility was determined primarily by the VITEK-2 Compact automated platform (bioMérieux, Marcy-l'Étoile, France) and supplemented by disc-diffusion/EzyMIC (HiMedia, Mumbai, India) wherever needed. Out of 1004 isolates, 33 (3.3%) were hvKP. Most frequent capsular serotype was K2 in 11 (33.3%). Amongst virulence genes, mrkD, iutA and kfuB were detected most frequently in 93.9%, 84.8% and 63.6% isolates respectively. Classical Klebsiella pneumoniae isolates were significantly more resistant than hvKP to cephalosporins, amoxicillin-clavulanic acid, and fluoroquinolones (p < 0.05). Carbapenem resistance was seen in 10 hvKP convergent isolates with the most prevalent carbapenemase-encoding gene being OXA-48 and OXA-181 in 50% isolates. There is a need for continued surveillance of hvKP strains in view of the impending threat of a global spread of convergent strains.

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.

Non-Valvular Atrial Fibrillation in Young Adults in Eastern India: A Clinico-Aetiological Retrospective Analysis in a Tertiary Care Hospital.

The development of atrial fibrillation adds a lot to the morbidity and mortality of individual patients. The spectrum of non-valvular atrial fibrillation among young adults is less known. The present observational study aims to analyze the clinical-aetiological spectrum of non-valvular atrial fibrillation among young adults between 18 and 40 years of age. A retrospective observational study was carried out to analyze the clinical-aetiological spectrum of non-valvular atrial fibrillation among young adults less than 40 years of age attending the cardiac outpatient department in a tertiary care hospital in Eastern India over a period of two years. Patients with any form of organic valvular heart disease and patients more than 40 years of age were excluded from the study. One hundred and seventeen patients under 40 years of age were analysed with respect to demographic, aetiological, and clinical profiles. Most common aetiologies behind non-valvular atrial fibrillation in young adults (<40 years) were hypertension (40%) and the presence of left ventricular systolic dysfunction (31%). Thyrotoxicosis, obesity, obstructive sleep apnoea, the presence of congenital heart disease, coronary artery disease, myopericarditis, chronic kidney disease, dyselectronemia, diabetes mellitus, and the presence of chronic obstructive pulmonary disease contributed towards the development of non-valvular atrial fibrillation in the young population in less proportion of cases. Most of the cases were symptomatic with palpitation, shortness of breath, or diaphoresis. Less number of cases (17%) had left atrial thrombus which may be due to early clinical attention with the proper therapeutic anticoagulation regimen. Hypertension and the presence of left ventricular systolic dysfunction contribute to the majority towards the development of non-valvular atrial fibrillation among young adults. Accurate measurement and monitoring of blood pressure among young adults and careful assessment of left ventricular systolic dysfunction with subsequent appropriate management of hypertension and left ventricular systolic dysfunction in young can decrease the burden of non-valvular atrial fibrillation among the young population.

Quality of life and its determinants among ambulatory diabetic patients attending NCD prevention clinic: A cross sectional study from Eastern India

IntroductionIndia is experiencing an upward spiral in diabetic population. With the impact of diabetes on physical, social, psychological components of individual's life, a holistic view in terms of Quality of Life (QoL) is being increasingly recognized as an essential component of diabetes care and management. The objective of this study was to evaluate the QoL in ambulatory diabetic patients and factors affecting it in a tertiary care medical institution in eastern India. Material and methodsIn this cross-sectional study, 103 adult diabetic ambulatory patients were recruited by systematic random sampling from a Non-Communicable Disease (NCD) Clinic of a tertiary care hospital of Eastern India. The QoL of patients were accessed by the validated Odia version of WHO-QoL BREF questionnaire. Bivariate analysis was performed to compare the effect of sociodemographic and clinical parameters on QoL scores. ResultsThe maximum domain wise score was in social (65.98 ± 13.89) followed by environmental (61.73 ± 16.27) domain. Overall, 64% of the respondents perceived as their QoL as good. Males, urban residents, persons aged less than 60 years and overweight individuals reported a better QoL than their counterparts. Gender and residence were found to be significantly associated with QoL, across domains. ConclusionsQoL assessment is pivotal as an outcome measure in diabetes care and management. Policy makers ought to consider quality adjusted life years while evaluating health outcomes in patients of chronic diseases like diabetes.

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.